1. Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Focus on Pharmacology, First Edition By Jahangir Moini Focus on Pharmacology Essentials for Health Professionals Chapter 30 Pediatrics Jahangir Moini, MD, MPH

2. Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Focus on Pharmacology, First Edition By Jahangir Moini Terms Neonate: birth to 28 days Infant: 29 days to walking age (typically 1 year) Toddler: 1 to 3 years of age

3. Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Focus on Pharmacology, First Edition By Jahangir Moini Factors that Affect Pharmacokinetics in Children Drugs inactivated by low pH gastric contents should not be given orally. Peristalsis is irregular and slower. Rate of gastric emptying is variable.

4. Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Focus on Pharmacology, First Edition By Jahangir Moini Physiologic Impacts on Pharmacokinetics The physiologic processes that influence pharmacokinetics in children include: –GI function –Tissue blood flow –Body fluid levels –Plasma protein concentrations –Liver function –Renal function.

5. Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Focus on Pharmacology, First Edition By Jahangir Moini Drug Distribution in Children Neonates have higher total body water than adults. Body fat is about 15%. Protein binding of drugs is lower in neonates.

6. Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Focus on Pharmacology, First Edition By Jahangir Moini Drug Absorption in Children Physiologic conditions can reduce rate of blood flow to site of administration: heart failure, cardiovascular shock, vasoconstriction If peripheral blood circulation improves, sudden increase of circulating drugs may cause toxic drug concentrations.

7. Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Focus on Pharmacology, First Edition By Jahangir Moini Drug Metabolism in Children Neonates exhibit substantially lower drug-metabolizing activities of oxidases and conjugating enzymes Dose-response relationships of some drugs may change markedly during first few weeks after birth

8. Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Focus on Pharmacology, First Edition By Jahangir Moini Drug Elimination in Children Glomerular filtration rate is lower in neonates. Drugs that require renal function for elimination are removed from the body very slowly during first weeks of life.

9. Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Focus on Pharmacology, First Edition By Jahangir Moini Limited Clinical Studies Very few clinical drug studies are done in children. Little data on effects of drugs in this population. Efficacy and dosage difficult to establish.

10. Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Focus on Pharmacology, First Edition By Jahangir Moini Pediatric Dosage Forms Elixirs: alcoholic solutions that offer consistent dissolution and distribution of drugs Suspensions: contain undissolved drug particles; must be shaken to evenly distribute drug particles

11. Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Focus on Pharmacology, First Edition By Jahangir Moini Drug Safety During Lactation If data are not available about a certain drug and its effects on breastfeeding, the mother should not take it.

12. Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Focus on Pharmacology, First Edition By Jahangir Moini Pediatric Pharmacokinetic Differences The differences in pharmacokinetics can lead to stronger or weaker drug effects in children compared with those of young adults.

13. Copyright ©2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Focus on Pharmacology, First Edition By Jahangir Moini Pediatric Drug Doses Based on proportionally reduced adult doses Based on body surface area, age, or body weight