Transcript najważniejsze izoenzymy cytochromu p450 biorace udział w

Jarosław Woroń PharmD, PhD
MISTAKE IN PEDIATRIC
PHARMACOTHERAPY
Chair Of Pharmacology, Dept. Of Clinical
Pharmacology Jagiellonian University College of
Medicine Krakow
ADVERSE DRUG REACTIONS
 Are one of the first ten causes of death
 20% of funds spent on health protection is
used for ADR
 10-15% of hospitalization is connected with
ADR
 5-9% of hospitalization costs are costs of
ADR
 30-60% of cases of ADR can be prevented
TYPES OF ADR
A
Connected with
mode of action of
drugs and the used
dose.
F
Unexpected failure
of treatment
E
B
Connected with
They don’t
stopping
correlate with the
D
administration of
dose
Delayed
the drug
- atopic
- idiosyncratic
C
Connected with the
dose and the time
of administration
FACTORS INCREASING THE RISK OF
MAKING A MISTAKE IN
PHARMACOTHERAPY
1. polypharmacy
2. Patients treatment by a few doctors who don’t
consult the given pharmacotherapy
w
3. Lack of accepted standards in pharmacotherapy
4. Lack of pharmacotherapy control- the posibility
of repeating mistakes
5. Self- medication
SOURCES OF MEDICAL
MISTAKES IN
PHARMACOTHERAPY
• - attractive pharmacotherapy- for the patients is
the one which brings fast results and can put the
patients in danger of side effects
• - the rule of three- wrong drug in the wrong dose
for the wrong patient
• - the pharmacotherapy without considering the
limits and contraindications, before starting the
treatment carelessly intervied patient
• - treating the child as a miniature of an adult- a lot
of ADR depend on the age of the patient
DIFFERENCES IN
PHARMACOKINETIC
PARAMETERS IN PEDIATRICS
• - small area of gastrointestinal tract
• - lower production of acid, pepsynogen
and slower emptying of the stomach,
irregular peristalsis, lower production on
pancreas enzymes and bile
• - immaturity of intestinal enzymesCYP3A4 and P-glycoprotein
• - it’ s best to give to children drugs in the
form of syrupes and solutions
DISTRIBUTION
• - in distribution we observe increased
volume of distribution in the water phaseit’s better to calculate the doses
depending on the area of the body, weaker
connection of drugs with albumins,
increased permeability of blood/brain
barrier- increased risk of ADR
METABOLISM
Unsatisfactory ability of cytochrome P450
isoenzymes, which take partin drug
metabolism, weaker connection with
glucuronic acid
ELIMINATION
• - kidney activity in newborn babies
constitutes 30-40% of activity in
comparison with adult
OFF-LABEL DRUG USE
• - every disease has its own characteristics
• - lack of possibility of observationof drug
safety profile
• - lack of information about ADR
• - lack of possibility of determiningthe ratio
between the benefit and the risk
CONTRAINDICATION OF DRUG
USE DEPENDENT ON AGE
•
•
•
•
•
•
•
Can be used above
-Thiocodin -12 years of age
- Sulfarinol -12 years of age
- Dextrometorphan- 6 years of age
- Detreomycin maść- 11 years of age
- Acetylosalicylic acid- 12 years of age
- Actifed , Actitrin- 6 years of age
USE OF PROMETAZINE IN CHILDRENDOUBTED BENEFIT AND HIGH RISK
 Absolutly contraindicated undre 2 years of age- can cause
breath depresion and it can result in sudden newborn death
syndrome
 drowsiness
 dizziness
 Weakening of the muscles
 Poor slightniewyraźne widzenie
 Combined with metamizole increases the risk of hypothermia
DRUG INTERACTIONS
• - pharmacokinetic
• - pharmacodynamic
• - common profile of side effects
HOW TO PREVENT ADR IN
CHILDREN
• - use of the drugs according to
registration
• - avoidance of unwanted drug interactions
• - monitoring of ADR
• - it must be remembered a child is not a
miniature of an adult