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INTRODUCTION

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There is no specific chapter on the topic of pharmacotherapy of special populations (children and elderly) in Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12th Edition. However, this is an important area of clinical pharmacology because the pharmacotherapy of children and the elderly requires consideration of the differences in pharmacokinetics and pharmacodynamics that can significantly affect the safety and efficacy of drugs used in these special populations. Moreover, most randomized controlled clinical trials exclude young children and the aged, which makes it difficult for the clinician to make evidence-based decisions regarding appropriate drugs and dosing regimens to use in these patients.

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The content of this chapter is drawn from a variety of sources, including a number of chapters in Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12th Edition including Chapters 1 to 3 in Section I: General Principles, and later chapters in which the pharmacotherapy of children or the elderly is discussed in the context of specific agents. Content regarding general principles of pharmacotherapy in these special populations is drawn from online Updates published as part of the online version of Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12th Edition related to pediatric pharmacology (specifically, The History of Pediatric Drug Therapy: Learning from Errors Not Trials and Pediatric Pharmacokinetics: Why Kids Are Not Small Adults), and from Hazzard’s Geriatric Medicine and Gerontology, 6th Edition (specifically, Chapter 8 General Principles of Pharmacology and Chapter 24 Appropriate Approach to Prescribing). Neither a Mechanisms of Action Table nor a Clinical Summary Table is included in this chapter because this information is provided for specific agents in subsequent chapters. In addition to the material provided here, Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12th Edition contains:

  • Appendix II with pharmacokinetic data for a number of drugs with differences in pharmacokinetic parameters that occur in children, the aged, and individuals with specific disease states

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Hazzard’s Geriatric Medicine and Gerontology, 6th Edition contains:

  • Table 8-5 Changes in Pharmacokinetics and Pharmacodynamics with Aging and Suggested Dose Adjustments for Older Patients

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LEARNING OBJECTIVES

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  • Describe the important pharmacokinetic and pharmacodynamic differences between adults and children that can affect safety and efficacy of drugs used in infants and children.

  • Know the FDA’s role in providing information to clinicians to improve safe and effective use of drugs in young children, including breast-feeding infants.

  • Describe the important changes in the pharmacokinetics and pharmacodynamics of drugs that occur in older adults.

  • Know the classes of medications that should be avoided in older adults because of central nervous system (CNS) effects.

  • Know the steps that should be taken to optimize drug regimens in older adults.

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PEDIATRIC PHARMACOKINETICS—ABSORPTION

  • Absorption of drugs from the gastrointestinal (GI) tract is reduced in neonates and changes with maturation making prediction of medication bioavailability of orally administered drugs very difficult.

    • Young children have higher gastric ...

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