安徽医科大学：《临床药理学 Clinical Pharmacology》课程教学资源（课件讲稿，英文版）新生儿及儿童合理用药 Drug Therapy in Neonates and children

Drug Therapy in Neonates and children 新生儿及儿童合理用药

Drug Therapy in Neonates and children 新生儿及儿童合理用药 1

How to use drugs in the neonate and children? Medication in neonates and children ▣Same with adults ▣Based on adults Irrational medication result in serious ADR in neonates and children. 2

How to use drugs in the neonate and children ? Medication in neonates and children
Same with adults
Based on adults Irrational medication result in serious ADR in neonates and children. 2

Famous ADR in newborns Gray baby syndrom induced by chloramphenicol in newborns In the 1950's,found in newborns treated with chloramphenicol. Syndrom: Pale or Pale or blue skin,Lethargic eyes, blue skin Vomiting,Refusal to feed, Lethargic eyes Respiration and circulation failure, Death. The effects of drug on the neonate and infant was studied from then on. 3

Gray baby syndrom induced by chloramphenicol in newborns In the 1950’s, found in newborns treated with chloramphenicol. Syndrom: Pale or blue skin,Lethargic eyes, Famous ADR in newborns Vomiting, Refusal to feed, Respiration and circulation failure, Death. 3 The effects of drug on the neonate and infant was studied from then on

Medication in newborns Medication in newborns,infants and children is different from adults due to rapid changes. Body size, Body composition, Organ functions. 4

Medication in newborns Medication in newborns, infants and children is different from adults due to rapid changes. Body size, Body composition, Organ functions. 4

Outline Rational medication in newborns o Rational medication in infants Rational medication in children 5

Rational medication in newborns Rational medication in infants Rational medication in children Outline 5

Peculiar Medication in newborns Pharmacokinetics in newborn Physiological status of newborns Pharmacokinetics in newborn Imperfect liver and kidney function Poor metabolism and excretion Great individual difference Dosage can not calculated based on the dosage for adults Imperfect blood-brain barrier Drug easy transfer into brain High Body surface area External drugs easy to be absorbed 6

Imperfect liver and kidney function Great individual difference Pharmacokinetics in newborn Peculiar Peculiar Medication in newborns Medication in newborns Poor metabolism and excretion Dosage can not calculated based Physiological status of newborns Physiological status of newborns Pharmacokinetics in Pharmacokinetics in newborn newborn 6 Great individual difference Imperfect Imperfect blood-brain barrier High Body surface area Dosage can not calculated based on the dosage for adults Drug easy transfer into brain External drugs easy to be absorbed

Peculiar Medication in newborns Drug absorption in newborns is affected by administration route Intravenous administration(frequently used ) stable absorption,at slow speed. Local drug administration fast absorption,skin,mouth,rectal,avoid toxicity on broken and inflammatory skin. Intramusclar administration irregular absorption (less muscle and poor circulation)

Intravenous administration (frequently used )： stable absorption, at slow speed. Local drug administration : Drug absorption in newborns is affected by administration route Peculiar Peculiar Medication in newborns Medication in newborns Local drug administration : fast absorption, skin, mouth, rectal, avoid toxicity on broken and inflammatory skin. Intramusclar administration ： irregular absorption (less muscle and poor circulation) 7

Pharmacodynamics in newborn Peculiar drug reaction in newborn 1.Hypersensitive reaction 2.Hemolysis,jaundice caused by drugs 3.Hemiglobin 4.Hemorrhage 5.Toxic reaction of nervous system 6.Gray baby syndrom 8

Pharmacodynamics Pharmacodynamics in newborn in newborn 1. Hypersensitive reaction 2. Hemolysis, jaundice caused by drugs Peculiar drug reaction in newborn 8 3. Hemiglobin 6. Gray baby syndrom 5. Toxic reaction of nervous system 4. Hemorrhage

Peculiar drug reaction in newborn 1.Hypersensitive reaction e.g. Morphine respiratory depression Underdeveloped central nervous system, e Digitalis and Salicylate are Toxic Underdeveloped renal excretion and high plasma concentration 9

1. Hypersensitive reaction Morphine respiratory depression Underdeveloped central nervous system, Peculiar drug reaction in newborn e.g. 9 Digitalis and Salicylate are Toxic Underdeveloped renal excretion and high plasma concentration

Peculiar drug reaction in newborn 2.Hemolysis,jaundice caused by drugs Metabolism in liver rifampicin Globin 珠蛋白 novobiocin Free Porphyrin Bilirubin ive Hemoglobin 卟啉 胆红素 iron铁 conjunction type Erythrocyte of Bilirubin 结合型胆红素 Eliminate from Stability of erythrocyte membrane Intestinal tract ·Synthtic vitamin K Suppress Bowl movemrnt ·Sulfonamides磺胺类 Kill normal flora in intestinal 10 tract

Free Porphyrin Globin 珠蛋白 Bilirubin Metabolism in liver • rifampicin • novobiocin 2. Hemolysis, jaundice caused by drugs Peculiar drug reaction in newborn liver 10 Free Hemoglobin iron铁 Porphyrin 卟啉 Bilirubin 胆红素 conjunction type of Bilirubin 结合型胆红素 Eliminate from Intestinal tract • Synthtic vitamin K Synthtic vitamin K • Sulfonamides 磺胺类 Sulfonamides 磺胺类 • Suppress Bowl movemrnt Suppress Bowl movemrnt • Kill normal flora in intestinal tract Stability of erythrocyte membrane liver Erythrocyte