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Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

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In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
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Drug Toxicity: Dose-Dependent Reactions01:24

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Drug toxicities can be stratified into pharmacological, pathological, or genotoxic based on their mechanisms. The incidence and severity of these toxicities generally increase with the drug's concentration in the body and exposure time.Pharmacological toxicity is evident when the therapeutic effects of drugs overshoot into adverse reactions in a predictable, dose-dependent manner. Central nervous system (CNS) depression from barbiturates is a classic example, with effects escalating from...
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Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

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Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
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Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

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In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
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Drug Toxicity: Overview01:00

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Drug toxicity quantifies the harm a compound causes to an organism, varying by dose and potentially impacting whole systems or specific organs like the liver. Toxic reactions may arise from venomous insect or spider bites, with effects ranging from mild symptoms to severe outcomes such as brain damage or death. Common forms of acute poisoning include ethanol intoxication and overdose of pain or fever medications, with substances like GHB and heroin being particularly lethal at doses close to...
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Drug Toxicity: Risk factors01:24

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Adverse Drug Reactions (ADRs) are potential complications that arise during pharmacotherapy, influenced by multiple risk factors. Age plays a significant role; both neonates and the elderly are at heightened risk due to their respective immature and diminished metabolic and elimination processes. Gender also impacts ADRs, with females experiencing a 1.5 to 1.7-fold greater risk than males, which may be linked to pharmacokinetic, pharmacodynamic, and hormonal differences. Notably, neonates, the...
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Tapentadol toxicity in children.

Douglas Borys1, Matthew Stanton2, David Gummin3

  • 1Concordia University Wisconsin, School of Pharmacy, Mequon, Wisconsin; Wisconsin Poison Center, Milwaukee, Wisconsin; douglas.borys@cuw.edu.

Pediatrics
|January 21, 2015
PubMed
Summary
This summary is machine-generated.

This study on pediatric tapentadol exposure found no deaths, but two life-threatening events occurred. Most children experienced mild or no effects from tapentadol (Nucynta) overdose.

Keywords:
opioidsoverdosepediatricspoisoning

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Area of Science:

  • Pediatric toxicology
  • Pharmacovigilance
  • Opioid receptor agonists

Background:

  • Tapentadol (Nucynta) is a dual-acting analgesic.
  • Its mechanism involves μ-opioid receptor agonism and norepinephrine reuptake inhibition.
  • No prior studies documented tapentadol toxicity in children.

Purpose of the Study:

  • To investigate the incidence and outcomes of tapentadol exposure in pediatric patients.
  • To describe clinical effects and treatments following pediatric tapentadol ingestion.

Main Methods:

  • Retrospective observational study utilizing the National Poison Data System.
  • Inclusion criteria: pediatric patients (0-17 years) with single tapentadol ingestion (Nov 2008 - Dec 2013).
  • Outcomes were followed to a known result.

Main Results:

  • 104 pediatric patients met inclusion criteria; 93 had unintentional exposures.
  • No deaths reported; 2 major, 6 moderate, 34 minor effects observed.
  • Common effects included drowsiness, lethargy, nausea, and vomiting; opioid-like symptoms were prevalent.

Conclusions:

  • This is the first study on pediatric tapentadol toxicity.
  • While most pediatric exposures resulted in no or minor effects, severe outcomes are possible.
  • Opioid-like symptoms are characteristic of tapentadol toxicity in children.