Kee: Pharmacology, 8th Edition

Chapter 7: Pediatric Pharmacology

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Most information available about medications is concluded from studies that use adult
samples, small sample sizes, or samples with healthy children. Few studies have been
conducted to determine the effectiveness of medication for target populations of children
diagnosed as having applicable illnesses.

Research related to pediatric patients is limited owing to several factors. Research risks
and informed consent make it difficult to recruit a pediatric sample. Pharmaceutical
companies invest fewer resources in pediatric drug research because of the smaller
market share afforded to pediatric medications. In the United States, approximately 25%
of all medications carry federally approved indications for use in children, but almost
75% of drugs marketed for adults are also prescribed for children.

In 2003, a law known as the Pediatric Research Equity Act joined the Best
Pharmaceuticals Act of 2002 to require drug manufacturers to study pediatric medication
use and offer incentives for pediatric pharmacology research.

There are significant differences in drug pharmacokinetics with pediatric populations.

These distinctions stem from differences in body composition and organ maturity and
appear to be more pronounced in neonates and infants but less significant in school-aged
and adolescent children.

The degree and rate of absorption are based on factors such as the childs age, health
status, and weight and the route of administration. Absorption becomes more effective as
a child grows and develops. However, during adolescence, poor nutrition, changes in
physical maturity, and hormonal changes may cause a slowing of drug absorption.

The distribution of medication throughout the body of a child is affected by factors such
as body fluid composition, body tissue composition, protein-binding capability, and
effectiveness of various barriers to medication transport.

The metabolism of medications depends greatly on the maturation level of the pediatric
patient and varies from child to child.

For most children younger than 2 years, sustained decreases in levels of hepatic enzymes
result in slower metabolism of medications. Hepatic metabolic activity is lower in
neonates; infant hepatic function matures at age 1 to 2 months.

Pediatric patients generally have higher metabolic rates than adults, which causes the
metabolism of medications to occur more rapidly. This often necessitates a higher
medication requirement than with adults.

The excretion of medications occurs in the kidneys, intestines, lungs, sweat glands,
salivary glands, and mammary glands, with the kidneys providing the most elimination.
Copyright 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Downloadable Key Points

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Before about age 9 months, infants experience a reduction in the elimination capacity of
the kidneys because of decreased renal blood flow, decreased glomerular filtration rate,
and reduced renal tubular function.

Pediatric variables such as organ function, developmental factors, and administration

issues affect drug pharmacodynamics and require nurses to knowledgeably evaluate the
action and effectiveness of pediatric medications.

Copyright 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.