DRUGS USED IN PADEATRIC

Pediatrics Infancy & Childhood are period of rapid growth & development Various organs, body systems, enzymes that handle drugs develop at different rates Accordingly drug dosage, formulations, response to drug, adverse reactions vary thought the childhood

ICH pediatric classification Preterm Newborn Infant Term newborn infants (0-27 days) Infants & toddlers (27 days – 24 months) Children (2 – 11 years) Adolescents (12 – 16/18 years)

Normal growth measures Weight & Height: Most widely used indicators of growth Progresses assessed by recording wts on percentile chart Head circumference: Indicator for children < 2 years

Different pk in children Oral Absorption: Affected by several factors (GI pH, transit time etc) Changes in growth affects these parameters Ex. Gastric acid output = adult in 2 year Topical Absorption: Affected by skin depth, hydration etc Newborn have higher hydration Used to advantage to counter needle phobia

Different pk in children Rectal Absorption: Buccal Absorption: Drug Distribution: Growth affects factors affecting drug distribution Children have a higher % of Total body water compared to adults Low conc of plasma protein leads to reduced protein binding

Different pk in children Drug Metabolism: Drug Metabolizing Enzyme either absent or very low for newborn Enzyme Levels increase dramatically (1-9 years) > Adults Compensatory pathways in children Renal Excretion: Anatomically/functionally kidney in children is Immature (Not fully developed) Glomerular function, tubular reabsorption mature by 6-8 months

Drug therapy in children Dosage: Wt, Ht, BSA best correlate with how much dose is needed in children Method of dosage calculation should be appropriate Therapeutic Index of drug Body surface area based on wt based ? No method is perfect, TDM should be used when necessary

Choice of preparation Buccal route Oral Route Convenient, challenging in case of un-cooperative child Liquids preferred < 7 years age Additives in formulation IV formulation can be used Lactose intolerance

Choice of preparation Nasogastric/Gastrostomy Route Nasogastric tube for unconscious child Parenteral feeding id necessary Intranasal Route: Rectal Route: Convenient, But NOT many products available Useful in case of unconscious child (OT)

Choice of preparation Parenteral Route IV route preferred but has challenges Access to veins challenging Fluid Overload, should NOT exceed Daily Fluid Requirement 100 ml/kg for 1st 10 kg, 50 mg/kg for next 10 kg Lack of pediatric formulations Rates of infusion Dead space

Choice of preparation Pulmonary Route Aerosol inhalers use challenging , coordination needed Breath activated devices, spacer device

Counselling, adherence Non-adherence is wide spread Many reasons Patient resistance, complicated dosing Misunderstanding of instructions Fewer medications, Better taste, appearance Children should be involved in counselling

Monitoring parameters Vital Signs, hematological, Biochemical parameters change thought the childhood These differ from Adults Assessment of Renal function Adverse Drug Reactions in Children Medication Errors

THANK YOU -PHARMA STREET