example of a lipophillic drug
diazepam
a drug that dissolves in lipids
this would have a lower distribution in infants
as water soluble drugs are better due to infants having a higher TBW.
Dizepam
indication and drug class: benzodizepene anti-convusulant, sedative and muscle relaxant.
moa: binds to GABA A enhances effect of GABA, increases influx of cl- ions, which causes hyperpolarisation, reduced firing of electrical signals, causing CNS depression and sedative effects.
side effects:
Drowsiness
Fatigue
muscle weakness
diziness
headache
examples of hepatic phase 1 reactions
oxidation
reduction
hydroxylation
develop rapidly
and reach adult capacity in 6 months
what drugs are affected by hepatic phase 1 reactions
phenobarbital
phenytoin
diazepam
how to combat against drugs that undergo hepatic metabolism
increase dosage
reduce dosage interval (give more often)
GFR rate at birth and at premature levels
birth: 2-4ml.min
premature: 0.6-0.8ml/min
but increases greatly within the first 72hours of life
BBB
not fully developed at birth
infants are sesitive to drugs that affect CNS function
why is digoxin maintenace dose higher in infants than in adults
this is because there is a lower binding affinity of recepors in the myocardium for digoxin
- and more digoxin-binding sites on erthrocytes in neonates than adults.
DIgoxin
Indication: Heart failure and arrthymia like AF or atrial flutter
drug class: cardiac glyucoside, antiarrthymic
MOA: Inhibits sodium potassium pump in heart muscle cells, increasing levels of intreacellular sodium, causing more calcium to enter cells via soidum calcium exchanger, causing heart contractions and increasing the force of contraction (positive inotropy)
side effects: Headache, nausea, light headedness, weakness fatigue.
list of how some drug classes cause ADRs in neonates and infants
Glucocorticoids cause growth supression
tetracyline cuases: discolouration of teeth, and impaired bone development
Sulfonamides, cause Kernicterus (nerological condition associated with hyperbilirubinaemia).
what is heamolytic anemia
blood disorder where red blood cells are destroyed faster than the bone marrow can replace them
leading to a reduced number of healthy RBC to carry oxygen
causing fatigue, palness, jaundice, and SOB
it can be caused by autoimmmune related issues like sickle cell or thalassemia
thalassemia: caused by inherited generic mutation, that causes a reduction in haemoglobin production.
what is G6PD deficiency
glucose 6 phosphate dehydrogenase (G6PD)
inherited condition caused by haemolytic anaemia
What drugs to use with caution in G6PD deficiency
Quinolones
* Antimalarials – quinine based
* Nitrofurantoin (avoid in 3rd trimester)
* Sulfamethoxazole
* Sulfadiazine
* Sulfonylureas
* Dapsone
what type of drugs treat the common cold in infants and children
Antihistamines
decongestants
antitussives
expectorants
examples of drugs that are commonly given during intransal route
Midazolam: benzodiazepine, binds to GABA A causing chloride channel to open, increasing influx of choride ions, enhancing inhibitory effects of GABA, causing hyperpolarisation, causing sedative effects.
fentanyl
Morphine
