Lecture6 - Children.pdf

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Department
Pharmacology
Course Code
Pharmacology 4350A/B
Professor
Rommel Tirona

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Change from Adult Values Child Newborn Infant Total protein Albumin or Acid glycoprotein Fetal albumin Present Absent Absent Globulin APPEAR 3-4 APPEAR AFTER PRESENT IN FETUS BIRTH MONTHS OF AGE CYP1A2 CYP3A7 CYP2D6 CYP1A1 CYP3A4 CYP3A5 CYP2C9 CYP2C 18/19 CYP2E1 Change from Adult Values Child Newborn Infant Total protein Albumin or Acid glycoprotein Fetal albumin Present Absent Absent Globulin APPEAR 3-4 APPEAR AFTER PRESENT IN FETUS BIRTH MONTHS OF AGE CYP1A2 CYP3A7 CYP2D6 CYP1A1 CYP3A4 CYP3A5 CYP2C9 CYP2C 18/19 CYP2E1 Lecture6- Children April-22-12 9:51 AM Divisionofchildhood 1. Infancy(birth-1yo) ○ Mostrapidgrowth 2. Todler(1-3) ○ Slowbodygrowthbutrapidpsycho/socialgrowth+finemotor 3. Pre-school(4-5) ○ Developmentslows 4. Schoolage(6-10) ○ Developmentslows 5. Adolescent(early,middle,late)(11-19) ○ Sexualmaturation Physiologicalchanges 1. Extracellularwaterdecrease+intracellularwaterincreaseASYOUAGE 2. Liver+kidneylargest%bodyweightinnewborn 3. Plasmabindingproteins a. LowerTotalbindingprotein b. Newborn:loweralbumin+lowerAAG+fetalalbuminpresent+lowerglobulin c. Infant:lowerAAG+no fetalalbumin+lowerglobulin d. Child:sameasadult Pharmacokineticchanges - AbsorptionfactorschangesCOUNTER-balancesoabsorptioneffectsmay/maynotchange ○ GastricpH(lowerpHinfant=increaseabsorptionfordrugsdegradedbyacid) ○ Biliaryfunction  Decreaseininfant=decreaseabsorptionofsomedrugs ○ Transittime  Decreasegastricemptying=increaseT1/2of somedrugs  DecreaseGImotility=increaseabsorption ○ Surfacearea  Decrease=lowerabsorption ○ Transporters  Reducetransporteractivity=reduceabsorption ○ GItract microbialcolonization  Differentbacteriainstomach=reduceabsorptionofsomedrugs ○ Metabolism  Reducegutactivityofphase1+phase2 enzymes - DistributionchangesmostlyaffectHIGHLYbounddrugsbut overallchangesareminimal Sulfamethoxazole(watersoluble)-increaseVdininfants ○ Water-fatratio  Infantshavemorewater=increaseVdforwater-solubledrugs(Sulfamethoxazole)
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