paedeatrics pharmacy

short term complications of pre-term birth

Breathing difficulties due to immature and under-developed respiratory system

Heart problems such as patent ductus arteriosis and low blood pressure

Bleeding in the brain

Gastrointestinal problems that can result in necrotizing enterocolitis (NEC).

Anaemia and newborn jaundice

Hypoglycemia

Immune system problems – high risk of infection

longt term complications of pre-term birth

Cerebral palsy

Impaired learning

Dental problems

Behavioural and psychological problems

Chronic health issues such as infections, asthma and feeding problems

what complication can occur with the patent ductus arteriosus in pre-term babies

failure of PDA closure so give PGE inhibitors like ibuprofen/paracetamol to close it

basic rules in paediatric prescribing

•Prescribe dose in mg, grams etc. not mLs unless required

     e.g. co-amoxiclav, Sytron, Abidec.

•Use the current BNF for children (Doses do change!)

•NO abbreviations (drug, units, micrograms)

•Generic prescribing, unless brand prescribing required

     e.g. antiepileptic drugs

Why are calculations and dosing important in paediatric pharmacy?

Paediatric dosing often requires precise calculations based on weight (mg/kg), age, or body surface area (BSA) due to the significant variations in size and metabolism in children compared to adults.

What factors must be considered when prescribing medicines to children?

Factors include the child’s weight, age, pharmacokinetics, pharmacodynamics, and the specific formulation and taste of the medication to ensure compliance and effectiveness.

What are some of the challenges in paediatric pharmacy related to formulations?

Challenges include the need to manipulate adult dosage forms (e.g., crushing tablets), dealing with inconvenient dosage forms, and ensuring the excipients used are child-friendly and safe.

Why might ethanol be a concern as an excipient in children's medicines?

can cause concerns of overdose with chronic use or acute accidental overdose. It may impair the ability to concentrate and participate in school activities.

What complication can benzyl alcohol cause in neonates?

Benzyl alcohol can cause gasping syndrome in neonates, leading to respiratory acidosis, neurological insult, renal failure, intraventricular hemorrhages, and cardiovascular collapse due to the immaturity of metabolic enzymes in neonates.

EMA proposed safety thresholds for ethanol in children's medicines?

• for children under 6 years, blood alcohol content (BAC) should not exceed 1mg/100ml (6mg/kg).

• For children aged 6-12 years, BAC should not exceed 12.5mg/100ml (75mg/kg).

How does the gastric pH of neonates compare to that of adults?

Gastric pH is higher at birth in neonates than in adults→ inc absorbtopn of basic drugs and Vice Versa

How does the bioavailability of lipophilic drugs in neonates compare to that in adults

Neonates have reduced bioavailability of lipophilic drugs, such as diazepam

Why is rectal administration of drugs considered poor and erratic in infants?

Rectal absorption can be poor and erratic in infants, and dosage forms may not be suitable for very small patients. Infants also have a higher number of rectal contractions than adults.

Why is intramuscular (IM) administration rarely used in children?

IM administration is unpredictable due to low muscle mass, is painful, and muscles are poorly perfused in children

Why is protein binding in neonates lower than in adults

Neonates have reduced levels of albumin, leading to fewer binding sites and a greater percentage of free drugs

metabolism in neonates

Glucorondiation and oxidation more immature → higher levels of drugs that use this pathway e.g chloramphenicol = toxicity and grey-baby syndrome

medicines to be used in caution or Contraindicated in children

tetracylcine

codeine

aspirin

metacopromide

domperidoe