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Pediatrics Rx (Medication Compliance (Always consider compliance if drug…

- - - - Decr peristalsis = delayed drug absorption
      - Higher pH in stomach: avoid tablets
      - Thin skin & large surface area relative to drug. Greater effect of topical drugs.
    - - More total body water =
        incr volume of distr of hydrophilic drugs
      - Less plasma proteins =
        higher free fraction of protein bounds drugs =
        more effect and higher risk of toxicity
        
        Compete with bilirubin to bind to plasm proteins & may displace bilirubin from albumin, poss leading to kernicterus
      - Blood flow varies right after birth =
        IM injections are unpredictable
    - - Younger child =
        decreased drug metabolism.
        Less CYP450 enzymes
    - - Less renal function,
        esp in 1st year
        
        newborns have 30% eGFR
        
        longer elimination of half-life of a drug that is cleared by kidneys
        
        ie: Gentamicin can be very toxic, narrow therapeutic index, also has BBW for ototoxicity, neurotoxicity & nephrotoxicity
  - - - Never exceed adult doses
      - Not well studied
      - If no ped dosing, can calculate based on age, weight or surface area