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Patients who are very young or very old respond differently to drugs than anyone.
Pediatric Groups:
• premature infants = less than 36 weeks gestational age
• full-term infants = 36 to 40 weeks gestational age
• neonates = first 4 postnatal weeks
• infants = weeks 5 to 52 postnatal
• children = 1 to 12 years
• adolescents = 12 to 16 years
- adjustment of dosage for infants on the basis of body size alone is not
sufficient to achieve safe results
1. Absorption
a. oral administration
- gastric emptying time is both prolonged and irregular in early
infancy
- reaches adult values by 6 to 8 months
- from the stomach, delayed gastric absorption is
delayed
- gastric acidity is very low 24 hours after birth
- does not reach adult values for 2 years
- absorption of acid-labile drugs is increased
b. intramuscular administration
- IM injection in the neonate is slow and erratic
- delayed absorption is due in part to low blood flow through
muscle during the first
days of postnatal life
- by early infancy, absorption of IM drugs becomes more rapid
than in neonates and
adults
c. percutaneous absorption
- because the skin of the very young is thin, percutaneous
drug absorption is
significantly greater than in older children and adults
- increases the risk of toxicity from topical drugs
2. Distribution
a. protein binding
- plasma proteins are limited in the infant because the amount
of albumin is relatively
low and endogenous compounds (e.g., fatty acids,
bilirubin) compete with
drugs for available binding sites
- concentration of free levels of such drugs is relatively high in
the infants, intensifying
effects
- reaches adult values within 10 to 12 months
b. blood-brain barrier
- not fully developed at birth
- drugs and other chemicals have relatively easy access to the
CNS, making the infant
especially sensitive to drugs
- ex. glucocorticoids can effect growth through the
hypothalamus
tetratcyclines effect teeth by staining them
aspirin should not be given with chicken pox or flu-like
symptoms
B. HEPATIC METABOLISM
- drug metabolizing capacity of newborns is low
- neonates are especially sensitive to drugs that are eliminated primarily
by hepatic metabolism
- capacity of the liver to metabolize many drugs increases rapidly about 1
month after birth with compete
maturation of the liver by 1 year
C. RENAL EXCRETION
- significantly reduced at birth
- renal blood flow, glomerular filtration, and active tubular secretion are all
low during infancy
- drugs that are eliminated primarily by renal excretion must be given in
reduced dosage
- adult levels are reached by 1 yrear
Issues to Address:
• dosage size and timing
• route and technique of administrations
• duration of treatment
• drug storage
• nature and time course of desired and adverse responses