Pharmacodynamic Differences On Drug Therapy

Drug selection strategy may be similar or different depending on age and disease state, as a result of differences in pathophysiology of certain diseases, and pharmacokinetic and pharmacodynamic parameters among pediatric and adult patients. It is noteworthy that pediatric patients may require the use of different medications from those used in adults affected by certain diseases. For example, phenobarbital is commonly used for treatment of neonatal seizures, but not often used for treatment of seizures in adults, due to differences in seizure etiology and availability of extensive data regarding its use in neonates compared to newer antiepileptic medications. There also exist commonalties between pediatric and adult patients, such as therapeutic serum drug concentrations required to treat certain diseases. For example, gentamicin peak and trough serum concentrations needed to treat Gram-negative pneumonia are the same in children as in adults. The appropriate selection and dosing of drug therapy for a pediatric patient depends on specific factors such as age, weight, height, disease being treated, comorbidities, organ function, and available drug dosage forms. Often, pediatric drug doses are calculated as mg/kg/day or mg/kg/dose based on body weight compared to mg/day or mg/dose for adult patients. Thus, accurate weight should be available while writing or dispensing medications for this patient population. Pediatric doses may exceed adult doses for certain medications due to differences in pharma-cokinetics and pharmacodynamics; hence, the use of pediatric drug dosing guides is recommended.

'©' Equations proposed to calculate pediatric doses based on adjusted age or weight such as Clark's, Fried's, or Young's Rule should not be routinely used to calculate pediatric doses, as they account for only one factor of difference, age or weight, and lack integration of the effect of growth and development on drug pharmacokinetics and pharmacodynamics in this population.

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