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Printable Handouts
Navigable Slide Index
- Introduction
- Neonatal and infant physiology
- General concept of clinical pharmacology
- Developmental PD further add to the variability
- Suggestion 1: this matters!
- Suggestion 2: preventive strategies matter!
- Suggestion 3: common sense
- The formulary/toolbox available
- The framework to work with: PK/PD
- Neonatal pharmacokinetics: ADME
- Absorption, skin: BSA > permeability
- Absorption, skin: heel lancing
- Intranasal route of administration
- Absorption, rectal to oral paracetamol (1)
- Absorption, rectal to oral paracetamol (2)
- Acetaminophen dose: oral, rectal & IV administration
- How is the drug distributed over the body?
- Distribution volume
- Distribution volume: relevance
- Distribution volume: relevance (CNS compartment)
- Intensity of P-gp at various developmental ages
- Distribution volume: relevance (continuous)
- Distribution volume: relevance (intermittent)
- Distribution volume: minor pain syndromes
- After procedural pain (heel prick), uniform negative
- Developmental pharmacokinetics: clearance
- Phase I and phase II metabolism, enzymes
- Hepatic metabolism
- Different types of covariates
- Covariates of drug metabolism: age/weight
- Fentanyl clearance as a first illustration
- Fentanyl clearance as a first illustration: continuous
- Propofol clearance as second illustration
- Propofol concentration over time
- Covariates of drug metabolism: disease severity
- The framework (clin pharm) to work with: PD
- The FDA/EMA decision tree
- The framework to work with: PD-target
- The framework to work with: pain management
- The framework to work with: types of receptors
- The framework to work with: PD-assessment
- Developmental aspect of pain expression
- Think positive
- How to keep you informed on dosing? formularies
- List of links
- Acknowledgements and disclosures
Topics Covered
- Neonatal and infant physiology
- Developmental pharmacokinetics and pharmacodynamics
- Distribution volume
- Clearance of Developmental pharmacokinetics
- Phase I and phase II metabolism
- Covariates of drug metabolism
- Pediatric formularies
Links
Categories:
Therapeutic Areas:
External Links
- Australasian Neonatal Medicines Formulary (ANMF)
- British National Formulary for Children (BNF for Children) – UK only
- BNF for Children – outside the UK
- Dutch Pediatric Formularies (DPF)
- German Pediatric Formularies (‘Kinderformularium’)
- Norwegian Pediatric Formularies
- Austrian Pediatric Formularies
- Pediatric and Neonatal Lexi-Drugs (Lexicomp)
- NeoFax
- Neonatal Formulary
Talk Citation
Allegaert, K. (2024, August 29). Clinical pharmacology principles for analgesics in neonates and infants [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved September 8, 2024, from https://doi.org/10.69645/ZUZO6402.Export Citation (RIS)
Publication History
Financial Disclosures
- There are no commercial/financial matters to disclose. However, off label use of medicines is discussed.
A selection of talks on Neurology
Transcript
Please wait while the transcript is being prepared...
0:00
Welcome to this lecture on
the Principles of
Clinical Pharmacology
applied to analgesics' use in
neonates and infants.
I'm Karel Allegaert.
I'm a Consultant
Neonatologist and
Clinical Pharmacologist
working at both
Erasmus University, Rotterdam,
as well as KU Leuven, Belgium.
0:20
As we likely all know,
there are some specific aspects,
if you try to use drugs
in the appropriate way,
in newborns or infants.
This has to do
with the fact that
pediatrics does not
simply deal with
miniature men and women.
The children are not
just small adults.
Likewise, a newborn is
not just a small child,
and a micro-preemie is
not just a small preterm.
0:48
If you look at the
general concept of
clinical pharmacology,
as you can see on this slide,
you can actually appreciate that
this will start anyhow
with giving a compound,
it will go through a
biological system on
a system pharmacological
approach and
will result in a given
exposure and response.
From DNA, mRNA, protein,
function, to outcome.
Obviously, if you apply
this general concept
as commonly used for adults.
You have to realize that if
you assess this in children,
especially if you do it
in newborns or preterms,
that growth,
maturation as well as
disease-related, environmental,
or polymorphisms
(genetic-related issues)
can further modulate
the pattern of developmental
pharmacokinetics
and pharmacodynamics.
1:39
As you can also see over here,
assuming that, let's say,
the most commonly used
aspect of clinical pharmacology
when based on a receptor.
This will have an impact on
receptor binding
characteristics,
have an impact on
synaptic signaling
and subsequently also
have an impact on
the exposure-response
relationship.
It should be obvious that
developmental pharmacodynamics
further add to
the variability
that's already there,
based on developmental
pharmacokinetics.
Besides differences in
dosing and exposure, also,
the same concentration
may result in
another effect because of
receptor-mediated
pharmacodynamics.
However, it should
be clear that,
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