Term
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Definition
| first month of postnatal life |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| estimation of maturity at birth |
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Term
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Definition
| days/ weeks of life since birth |
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Term
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Definition
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Term
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Definition
| <37 weeks gestational age |
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Term
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Definition
| absorption, distribution, metabolism, elimination (ADME) |
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Term
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Definition
| objective is to have the drug reach the site of action in a concentration which produces the desired pharmacologic effect |
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Term
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Definition
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Term
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Definition
| 6-8, rapidly lowers to 1-3 within 24 hours of birth in term neonates |
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Term
| Acid labile drugs achieve HIGHER serum concentrations in newborns |
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Definition
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Term
| Weakly acidic drugs achieve LOWER serum concentrations |
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Definition
| Acetaminophen and phenobarbital, for example |
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Term
| premature and term neonates |
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Definition
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Term
| decreased intestinal motility in premature and neonates |
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Definition
| GI motility reaches maturity by approximately 6-8 months |
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Term
| delayed and slow absorption that requires more time to achieve plasma concentrations |
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Definition
| premature and term neonates |
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Term
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Definition
| generally avoided in premature and term neonates |
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Term
| IM injections for infants |
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Definition
| Vastus Lateralis (upper thigh) with max volume of 0.5-1 mL |
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Term
| IM injections for Young children |
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Definition
| upper thigh until deltoid has developed adequate mass with Max vol of 0-1 mL |
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Term
| IM injections older children |
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Definition
| thickest portion of deltoid with max dose of 0-2 mL |
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Term
| SQ injections for infants |
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Definition
| fatty area of thigh with max dose of 0.5-1 mL |
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Term
| SQ injections for young children |
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Definition
| fatty area of thigh or outer aspect of upper arm with max dose of 0.5-1 mL |
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Term
| SQ injections for older children |
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Definition
| outer aspect of upper arm with max dose of 0.5-1 mL |
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Term
| topical administration in premature neonates and children |
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Definition
| systemic absorption is greater with enhanced percutaneous absorption due to thin stratum corneum and epidermis and greater skin surface to body ratio |
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Term
| rectal administration in premature and young children |
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Definition
| caution in this age group due to immature hepatic metabolism and enhanced absorption |
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Term
| rectal admin useful in older infants and children |
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Definition
| peri-operative period, vomiting, delayed or accelerated GI motility |
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Term
| intraosseous (injecting direcly into the bone marrow) |
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Definition
| used in emergencies, most useful in children <5 years old, rapid delivery into systemic circulation, access rarely exceeds 1-2 hours |
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Term
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Definition
| major changes in body composition affect drug distribution and serum concentrations: body water, total body fat composition, plasma protein binding, CNS penetration |
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Term
| total body water in neonates |
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Definition
| immature renal processing of sodium and water leading to increased insensible losses compared to adults |
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Term
| percent body fat increases with age |
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Definition
| fat soluble drugs may have higher serum concentrations when administered to neonates |
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Term
| protein plasma binding in newborns |
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Definition
| decreased plasma fetal proteins with decreased receptor affinity, increased bilirubin (able to displace drugs from albumin) |
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Term
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Definition
| deposition of bilirubin in the brain leading to neurologic dysfunction that may be permanent if untreated |
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Term
| result of decreased serum protein binding sites and an increase competion; drug examples: sulfonamides and ceftriaxones (3rd gen cephalosporins) |
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Definition
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Term
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Definition
| temporarily altered in neonates with immature blood brain barrier leading to increased permeability of hydrophilic molecules; |
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Term
| sulfonamides and ceftriaxone |
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Definition
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Term
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Definition
| ototoxicity due to increased CNS penetration in neonates |
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Term
| cephalosporins (4th gen greatest offender, 1st gen least offender) |
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Definition
| CNS toxicity due to increased penetration in neonates |
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Term
| metabolic pathways in neonates |
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Definition
| most are substantially slower in neonates and infants compared to older children and adults |
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Term
| phase 1 metabolism; reduction pathway |
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Definition
| fully functional at birth |
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Term
| phase 1 metabolism: hydrolysis |
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Definition
| reduced functionality until 10-12 months |
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Term
| phase 1 metabolism; demethylation |
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Definition
| reduced functinality until 15 weeks |
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Term
| phase 1 metabolism; oxidation (CYP450) |
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Definition
| content reduced in the fetal liver but matures rapidly |
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Term
| Phase 2 metabolism; methylation |
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Definition
| higher predominance in infants than adults (eg. theophylline converted to caffeine in newborns) |
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Term
| phase 2 metabolism; glucuronidation |
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Definition
| fetal activity 0-25% of adult activity and reaches maturity by 2-3 years |
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Term
| phase 2 metabolism; sulfation |
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Definition
| well developed in infants, exceeds adult capacity from infancy to early childhood (eg. acetaminophen, theophylline, morphine) |
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Term
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Definition
| not fully functional at birth; GFR rapidly increases during the first 2 weeks of life to an adult level at 8-12 months and tubular secretion reaches adult capacity by 12 months |
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Term
| rapid and variable renal maturation requires |
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Definition
| frequent dosage adjustment and titration |
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Term
| average SCr for premature neonates |
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Definition
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Term
| average SCr for term neonates |
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Definition
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Term
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Definition
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Term
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Definition
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Term
| average SCr for adolescents |
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Definition
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Term
| increasing weight in neonates/ infants |
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Definition
| may need to adjust dose especially because there can be a 10% increase within a two week period |
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Term
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Definition
| inhibits the synthesis of prostaglandins in the CNS and peripherally blocks pain impulse generation, produces antipyresis from inhibition of hypothalamic health regulating center |
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Term
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Definition
| 10-15 mg/kg/dose Q 4-6 hours |
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Term
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Definition
| 20 mg/kg/dose Q 4-12 hours |
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Term
| neonatal tylenol max dose |
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Definition
| 40-60 mg/kg/day depending on gestational age |
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Term
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Definition
| 75 mg/kg/day and 4000 mg/day |
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Term
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Definition
| inhibits prostiglandin synthesis by decreasing the activity of cyclooxygenase |
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Term
| infant and child dosing for ibuprofen |
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Definition
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Term
| max daily dose of ibuprofen |
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Definition
| 40 mg/kg/day and 2400 mg/day |
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Term
| vancomycin use in pediatrics |
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Definition
| coverage of most gram positives, beta-lactam resistant staph, MRSA and Strep; requires dosing adjustment for renal impairment |
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Term
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Definition
| longer time with drug concentration over MIC of target organism = higher rate of kill |
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Term
| Gentamycin and tobramycin use in pediatrics |
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Definition
| coverage of gram negatives and pseudonomas; requires dosing adjustment in renal insufficiency |
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Term
| concentration-dependent kill |
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Definition
| higher drug concentration = higher rate and extent of bacterial killing |
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Term
| phenetoin/ fosphenytoin in pediatrics |
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Definition
| one of several first line agents for seizures; levels affected by decreased albumin and increased bilirubin levels |
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Term
| digoxin use in pediatrics |
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Definition
| common inotrope with dose that varies greatly depending on age and indication |
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Term
| digoxin ONLY withdrawn if |
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Definition
| concern for toxicity: renal function changes, complience, interactions (initiation or discontinuation) |
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Term
| when do you want to get peaks and troughs? |
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Definition
| most medications wait 3-5 doses to reach steady state prior to drawing levels |
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Term
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Definition
| in relationship to when dose is given and drawn 30 minutes after the dose finished infusing |
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Term
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Definition
| in relationship to when a dose is given and immediately prior to when a new dose starts infusing |
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