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Related Concept Videos

Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

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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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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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Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

704
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...
704
Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

744
Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
744
Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists01:28

Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists

748
Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy.  SP binds and activates...
748
Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists01:27

Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists

818
5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
818

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The ability of mannitol to decrease cisplatin-induced nephrotoxicity in children: real or not?

Antonio Ruggiero1, Daniela Rizzo2, Giovanna Trombatore2

  • 1Division of Pediatric Oncology, A. Gemelli Hospital, Catholic University of Rome, Largo A. Gemelli 8, 00168, Rome, Italy. ruggiero@rm.unicatt.it.

Cancer Chemotherapy and Pharmacology
|November 22, 2015
PubMed
Summary

Appropriate hydration is key to preventing cisplatin-induced nephrotoxicity in children. For higher cisplatin doses, hydration plus mannitol may be considered to ensure adequate urine output and protect kidney function.

Keywords:
ChildrenCisplatinHydrationMannitolNephrotoxicity

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Area of Science:

  • Pediatric Oncology
  • Nephrology
  • Pharmacology

Background:

  • Platinum compounds, like cisplatin, are vital in treating childhood cancers, improving survival rates.
  • Cisplatin chemotherapy poses a significant risk of nephrotoxicity (kidney damage) in pediatric patients.
  • Understanding cisplatin nephrotoxicity mechanisms is crucial for effective prevention strategies.

Purpose of the Study:

  • To evaluate the efficacy of mannitol in preventing cisplatin-induced nephrotoxicity in children.
  • To review the pharmacodynamics and clinical characteristics of cisplatin nephrotoxicity.

Main Methods:

  • Literature review on cisplatin nephrotoxicity.
  • Analysis of pharmacodynamic and clinical data related to cisplatin and mannitol.

Main Results:

  • Current strategies for preventing cisplatin nephrotoxicity (hydration alone vs. hydration plus mannitol) lack clear guidelines.
  • There is ongoing controversy regarding the optimal preventive approach for cisplatin-induced nephrotoxicity in both pediatric and adult populations.

Conclusions:

  • Adequate hydration is the cornerstone of preventing cisplatin-induced nephrotoxicity.
  • For cisplatin doses <100 mg/m(2) in patients with normal renal function, routine pre- and post-hydration is recommended.
  • Higher cisplatin doses may warrant the addition of mannitol to hydration protocols to ensure sufficient diuresis and renal protection.