drugs in extremes of age - children and neonates 0.0 / 5 ? Pharmacydrugs in extremes of ageUniversityNone Created by: RscottqubCreated on: 07-01-20 14:44 neonate <37 weeks but also 0-27 days 1 of 36 infant/toddle 28days-23 months 2 of 36 children 2-11years 3 of 36 adolescent 12-18years 4 of 36 AMDE most dramatic changes within 1st month of life 5 of 36 types of absorption oral absorption. IM absorption. percutaneous ab. rectal absorption 6 of 36 2 factors contributing to oral absorption 1. gastric acid secretion 2. gastric emptying 7 of 36 gastric acid secretion is decreased at birth --> pH 6-8 . 2-3 years --> 1.5-3.5 . 8 of 36 what does this mean acidic drugs will now be ionised and less absorption . higher dose required 9 of 36 2. gastric emptying slow and delayed - decreased rate of absorption. 10 of 36 pancreatic function is decreased, so less enzymes 11 of 36 IM absorption unpredictable due to - decreased blood flow, decreased muscle mass 12 of 36 if give IM injection can be painful if high volumes are used - risk muscle damage 13 of 36 arterial pressure is high during 1st 4 weeks of life 14 of 36 so this means increased IM absorption and muscle perfusion (why babies get injections after 4 weeks? risk damge to muscle) 15 of 36 Bilirubin toxic yellow metabolite of RBCs 16 of 36 what happens to bilirubin once formed binds to albumin and taken to liver , at liver converted in to conjugated bilirubin and then is eventaully excreted in the urine 17 of 36 changes in body composition will affect distribution of drugs - most dramatic changes in body comp - 1st year of life 18 of 36 the distribution of a drug will affect its efficacy 19 of 36 levels of plasma protein in 1st 6 months low levels of both albumin and a1 glycoproteins 20 of 36 level of bilirubin in 1st 6 months high 21 of 36 decreased plasma proteins means more free drug - lower dose required 22 of 36 BBB in neonates may be functionally incomplete 23 of 36 kernicterus bilirubin brain dysfunction 24 of 36 jaundice xs bilirubin in the blood 25 of 36 classed as kernicterus when bilirubin is found in the brain 26 of 36 high levels of bilirubin can lead to deafness, cerebral palsy , mental retardation 27 of 36 hepatic blood flow is reduced , as get older a greater proportion of cardiac output is distributed to the liver 28 of 36 is the liver fully developed at birth NO 29 of 36 Phase 1 met at birth reduction - fully functional.. demethylation - partial oxidation, hydrolysis - develop over 6 months 30 of 36 CYP enzymes present at birth yes but in low conc - diff cyp enzymes arise at diff ages 31 of 36 phase II met at birth acetylation and glucoronidation - increase over 2 months - adult levels by 3 years 32 of 36 Glucoronidation Hb--> bilirubin . then at liver conjugated with glucoronic acid . but in neonates glucoronic acid levels are lower --> jandice 33 of 36 chloramphenicol and gray baby syndrome lack of enzyme glucoryl transferase to metabolise - toxcity 34 of 36 renal clearance is reduced . reduced GFR at birth , adult levels by 3-5 months 35 of 36 can we use NSAIDS in neonates no due to GFR 36 of 36
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