Pediatrics Intro to D&D PDF

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Intro to Pediatrics Introduction  Pediatric pharmacy focuses on the provision of drug therapy to infants, children and adolescents o Pharmacists who care for pediatric patients should possess knowledge regarding disease states along with drug therapy o Pediatric patients are not simply “small adults” Pediatric Pharmacists  How do you become a pediatric pharmacist? o Pediatric focused PGY-1 o Adult focused PGY-1 with peds focused PGY-2 o PGY-1 with joint peds and adult focus, plus pediatric experience The Basics  Few clinical trials o 1/3 of FDA approved medication have pediatric labeling o 2 SDS  Below average  Zika Pediatric Vital Signs  Respiratory rate and heart rate are higher than in the adults  Blood pressure are lower than in the adults  During early adolescents the vitals change more to adults Pharmacokinetics  Pharmacokinetics (PK) is the study of the time course of drug disposition within the body  PK is described by ADME principles o Pediatric PK doesn’t not equal Adult PK o Absorption  PO absorption is dependent on many factors  Theses factors undergo significant changes as a neonate grows into an adult  Decreased gastric motility  Decreased bile salt production  Decreased pancreatic enzyme activity  Decreased gastric pH

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Decreased/ increased GI bacterial flora

Pediatric patients: o Decreased thickness of stratum corneum o Increased skin hydration o Increased body surface are to body weight ratio  Clinically: o Increased skin absorption o Increased systemic absorption  More water content in the body  80% water content in children  50-60% of adults  Intramuscular  Decreased skeletal muscle blood flow o Decreased rate of absorption  Vaccinations are used but prefer to a IV  Can cause pain o Mix with lidocaine to decrease the long term soreness  Inhalation  Altered structure and capacity of lungs o Increased systemic absorption of drugs  Rectal  Decreased hepatic metabolism o Increased bioavailability of hepatically metabolized drugs  Increased contractions in the rectum o Decreased absorption due to expulsion of dosage form  When cant handle PO or vomiting  Acetaminophen is given to children less than 1 yr old  IV  Most effective and reliable method of drug absorption Distribution  Volume of distribution (VD)  Body composition changes with age  Total body water o Increased in younger patients: increase volume of distribution for water soluble drugs  Adipose tissue o Neonates and children have less adipose tissue (percentage of body weight) as compared to adults  Full term neonate: 12-16% of body weight is adipose tissue o Decrease volume of distribution for fate soluble drugs  Plasma proteins o Decreased amount and altered structure in neonates and children  Increased amount of unbound drug (active drug) o Certain drugs compete for binding sites  Some medication (i.e. antibiotics such as Bactrim) displace bilirubin on albumin  Membrane permeability o Increased permeability into the CNS o Increased distribution of drugs across the blood brain barrier  Bilirubin = jaundice  Can use a UV light to break up the bilirubin  Yellow breakdown product of hemoglobin  Eliminated in the bile and urine  Lipophilic  Heavily albumin-bound  Highly neurotoxic  Kernicterus  Hyperbilirubinemia-induced neurologic damage o Can be irreversible  Incidence increases when serum bilirubin >25 mg/dL ( normal 99 mg/kg  Symptoms: multi-organ failure, severe metabolic acidosis, gasping respirations  Should not use medications with benzyl alcohol as a preservative o Use preservative-free if available

Elimination  Starting in fetal development, renal function is continuously changing as we age  Glomerular filtration rate (GFR) is significantly reduced at birth  Preterm neonate GFR: 0.6-0.8 mL/min/1.73 m2  Term neonate GFR: 2-4 mL/min/1.73 m2  GFR reaches normal adult values between 9-12 months old  Must consider renal maturation when dosing renally eliminated medications  Decreased GFR can result in decreased renal clearance, increased drug accumulation and potential drug toxicities  Estimating renal function  Cockroft- gault = adults  Schwartz= pediatrics  Creatinine values are higher .8-1.2 adult and babies can show higher because they show a reflection of the mothers  Normal = .2-.3  Renal function = urine output  Measuring diapers  GFR will reach adult value at 1 yr  Creatinine alone doesn’t show the renal function the best ...