1. DRUGS USED IN PADEATRIC

2. 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

3. 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)

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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)

11. 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

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

13. 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

14. 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

15. THANK YOU -PHARMA STREET