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Will neonates have reduced or enhanced clearance of Aminoglycosides, why?
Reduced, due to decreased renal blood flow, GFR and Tubular filtration
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Which increases more in the first week of life, tubular secretion or GFR?
GFR
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When does Tubular secretion increase in a neonate and how much over that time period?
Over the first week of life increased 2 fold AND Over the first year of life increased 10 fold
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When does Tubular secretion reach adult levels in babies?
6-7 months Postnatal
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When does tubular reabsorption reach adult levels?
9 months old
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At what point can glucose, PO4 and bicarbonate be concentrated into the urine well, why?
9 months, that is when tubular reabsorption matures
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In a baby that is under 9 months, how will Penicillin be eliminated?
By GFR
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In a baby that is over 9 months, how will Penicillin be eliminated?
By tubular secretion
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What is the major pathway of elimination for neonates?
GFR
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Does a 8 YO, 1MO or Adult on a highly protein bound drug have the most frequent dosing?
8 YO
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Does a 8 YO, 1MO or Adult on a highly protein bound drug have the least frequent dose?
1 MO
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Does a 8 YO, 1MO or Adult on a highly protein bound drug have the highest dose per kg?
1 MO
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Does a 8 YO, 1MO or Adult on a highly protein bound drug have the lowest dose per kilogram?
Adult
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Adults get larger or smaller doses/kilo compared to peds?
Smaller
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Adults have larger or smaller BW/fat raios compared to peds?
Smaller
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Are peds dosed more or less frequently?
More frequently as they age due to increasing metabolism, excretion and clearance
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Half-life/Clearance in a neonate is _________ compared to a child and a child’s half-life is _____________ compared to an adult.
Longer Very short
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Do pregnant women recive higher or lower doses compared to non-pregnant?
Higher
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How do Vd and TBW/fat change in pregnant women?
Increase
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Lactating women receive higher or lower doses than pregnant women?
A little bit bigger but more like prior to pregnancy doses
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What are the major physiological changes in women during pregnancy?
Increased CO, Renal perfusion, BV and weight, decreased GI motility
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What are the pharmacokinetic changes in pregnant women?
Shorter t 1/2, Larger Vd for lipophilic drugs, Potential decreased rate or extent of oral absorption
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Newborns can clear medications quickly (T/F).
False
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Should you promote or avoid medications with long half lives in Newborns, why?
Avoid, clearance is low at first
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Do Fetuses metabolize things in the womb?
No, dependent on mother
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What is the first thing you should look for when evaluating if a lactating mother can have a certain drug?
Is it even absorbed
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Gentamycin oral is unsafe or safe in a lactating mother?
Safe, because it is not absorbed
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Ducosate is unsafe or safe in a lactating mother?
Safe, because it is not absorbed
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How should most drug levels be adjusted in a lactating mom from the doses given during pregnancy?
Should be made smaller
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What are the infant/maternal factors that should be evaluated when deciding on a dose for a lactating mom?
Disease states, ADME and Age of mom and baby
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Lactating doses are different or the same for normal non-pregnant doses?
About the same
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What type of drugs are preferred in women who are lactating and why?
Shorter t1/2, for baby
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Does the fetus/infant receive the same dose of drug that the mom is getting?
No much lower usually
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A drug with what milk:plasma ratio is probably not safe for breast feeding women?
>1
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(True/False) pediatric patient have dynamic pharmacokinetics.
True
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(True/False) Drug absorption in pediatrics can be altered by age, feedings and disease states
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Children between __________ are super excretes/metabolizers
2-9 years
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