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KEY CONCEPTS

KEY CONCEPTS

  • image Children are not just “little adults,” and lack of data on important pharmacokinetic and pharmacodynamic differences has led to several disastrous situations in pediatric care.

  • image Variations in absorption of medications from the gastrointestinal tract, intramuscular injection sites, and skin are important in pediatric patients, especially in premature and other newborn infants.

  • image The rate and extent of organ function development and the distribution, metabolism, and elimination of drugs differ not only between pediatric versus adult patients but also among pediatric age groups.

  • image The effectiveness and safety of drugs may vary among age groups and from one drug to another in pediatric versus adult patients.

  • image Concomitant diseases may influence dosage requirements to achieve a targeted effect for a specific disease in children.

  • image Use of weight-based dosing of medications for obese children may result in suboptimal drug therapy.

  • image The myth that neonates and young infants do not experience pain has led to inadequate pain management in this pediatric population.

  • image Special methods of drug administration are needed for infants and young children.

  • image Many medicines needed for pediatric patients are not available in appropriate dosage forms; thus, the dosage forms of drugs marketed for adults may require modification for use in infants and children, necessitating assurance of potency and safety of drug use.

  • image The pediatric medication-use process is complex and error prone because of the multiple steps required in calculating, verifying, preparing, and administering doses.

Remarkable progress has been made in the clinical management of diseases in pediatric patients. This chapter highlights important principles of pediatric pharmacotherapy that must be considered when the diseases discussed in other chapters of this book occur in pediatric patients, defined as those younger than 18 years. Newborn infants born before 37 weeks of gestational age are termed premature; those between 1 day and 1 month of age are neonates; 1 month to 1 year are infants; 1 to 11 years are children; and 12 to 16 years are adolescents. This chapter covers notable examples of problems in pediatrics, pharmacokinetic differences in pediatric patients, drug efficacy and toxicity in this patient group, and various factors affecting pediatric pharmacotherapy. Specific examples of problems and special considerations in pediatric patients are cited to enhance understanding.

image Infant mortality up to 1 year of age has declined from 200 per 1,000 births in the 19th century to 75 per 1,000 births in 1925 and to 5.96 per 1,000 births in 2013.1 This success has resulted largely from improvements in identification, prevention, and treatment of diseases once common during delivery and the infancy period. Although most marketed drugs are used in pediatric patients, only approximately one-fourth of the drugs approved by the US Food and Drug Administration (FDA) have indications specific for use in the pediatric population. Data on the pharmacokinetics, pharmacodynamics, efficacy, and safety of drugs in infants and children are scarce. Lack of this type of information led to disasters such as gray ...

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