Principles of pain pharmacology in paediatrics

2013 ◽  
pp. 429-435 ◽  
Author(s):  
Kim Chau ◽  
Gideon Koren
Keyword(s):  
Clinical Response ◽  
Growth And Development ◽  
Genetic Factors ◽  
Developmental State ◽  
Infants And Children ◽  
Therapeutic Window ◽  
Pharmacological Management ◽  
Interindividual Differences ◽  
Paediatric Patients ◽  
Dosing Regimens

Changes during growth and development may profoundly alter the pharmacokinetic and pharmacodynamics profile of medications in children of different ages, and in comparison to adults. Genetic factors can also influence the disposition and action of a drug, and contribute to interindividual differences in clinical response. Safe and effective pharmacological management of pain in neonates, infants, and children requires a thorough understanding of the principles of analgesic pharmacology in paediatric patients. Analgesic dosing regimens should take into account the severity of pain, the age or developmental state of the infant, and the therapeutic window of the drug.

Principles of clinical pharmacology applied to analgesics in children

2021 ◽  
pp. 441-448
Author(s):  
Karel Allegaert ◽  
Sinno H.P. Simons ◽  
Dick Tibboel
Keyword(s):  
Clinical Pharmacology ◽  
Critical Illness ◽  
Objective Assessment ◽  
Developmental State ◽  
Time Profile ◽  
Therapeutic Window ◽  
Preterm Neonates ◽  
Individual Child ◽  
Pharmacological Management ◽  
Dosing Regimens

Analgesic dosing regimens should take into account the severity and type of pain, the therapeutic window of the drug, and also the age or developmental state of the child. Translation of these concepts to safe and effective pharmacological management of pain in neonates, infants, and children necessitates a thorough understanding of the principles of clinical pharmacology of analgesics in children. Growth, weight or size, and maturation or age evolve in children and profoundly affect the pharmacokinetics (concentration–time profile, absorption, distribution, metabolism, and excretion) and pharmacodynamics (concentration–effect profile, objective assessment) of drugs, and this is also the case for analgesics. This will result in extensive variability in dosing and effects throughout childhood, and this variability is most prominent in infancy. In addition to maturational changes, there are also nonmaturational aspects (preterm neonates and critical illness, obesity, pharmacogenetics) that should be considered to further improve dosing in every individual child.

scholarly journals Ethnic Pharmacogenomic Differences in the Management of Asian Patients with Metastatic Prostate Cancer

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 407
Author(s):  
Darren M. C. Poon ◽  
Kuen Chan ◽  
Tim Chan ◽  
Foo-Yiu Cheung ◽  
Daisy Lam ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Ethnic Differences ◽  
Genetic Factors ◽  
Serious Adverse Events ◽  
Pharmacological Management ◽  
Asian Ethnicity ◽  
Asian Patients ◽  
Develop Prostate Cancer ◽  
Drug Tolerability ◽  
Systemic Therapies

Progression to metastatic disease occurs in about half of all men who develop prostate cancer (PC), one of the most common cancers in men worldwide. Androgen deprivation therapy has been the mainstay therapy for patients with metastatic PC (mPC) since the 1940s. In the last decade, there has been unprecedented advancement in systemic therapies, e.g., taxane, androgen-signalling pathway inhibitors, and biomarker-driven targeted therapies for various stages of disease, resulting in overall survival improvement. Adding to ongoing controversies over how best to treat these patients is the recognition that ethnicity may influence prognosis and outcomes. This review discusses recent evidence for the impacts of Asian ethnicity specifically, which includes environmental, sociocultural, and genetic factors, on the approach to pharmacological management of mPC. Clear inter-ethnic differences in drug tolerability, serious adverse events (AEs), and genetic heterogeneity must all be considered when dosing and scheduling for treatment, as well as designing future precision studies in PC.

scholarly journals A Proof of Concept of the Role of TDM-Based Clinical Pharmacological Advices in Optimizing Antimicrobial Therapy on Real-Time in Different Paediatric Settings

2021 ◽  
Vol 12 ◽  
Author(s):  
Milo Gatti ◽  
Pier Giorgio Cojutti ◽  
Caterina Campoli ◽  
Fabio Caramelli ◽  
Luigi Tommaso Corvaglia ◽  
...  
Keyword(s):  
Drug Interactions ◽  
Real Time ◽  
Antimicrobial Therapy ◽  
Turnaround Time ◽  
Antimicrobial Treatment ◽  
Therapeutic Drug ◽  
Proof Of Concept ◽  
Paediatric Patients ◽  
Dosing Regimens

Introduction: Antimicrobial treatment is quite common among hospitalized children. The dynamic age-associated physiological variations coupled with the pathophysiological alterations caused by underlying illness and potential drug-drug interactions makes the implementation of appropriate antimicrobial dosing extremely challenging among paediatrics. Therapeutic drug monitoring (TDM) may represent a valuable tool for assisting clinicians in optimizing antimicrobial exposure. Clinical pharmacological advice (CPA) is an approach based on the correct interpretation of the TDM result by the MD Clinical Pharmacologist in relation to specific underlying conditions, namely the antimicrobial susceptibility of the clinical isolate, the site of infection, the pathophysiological characteristics of the patient and/or the drug-drug interactions of cotreatments. The aim of this study was to assess the role of TDM-based CPAs in providing useful recommendations for the real-time personalization of antimicrobial dosing regimens in various paediatric settings.Materials and methods: Paediatric patients who were admitted to different settings of the IRCCS Azienda Ospedaliero-Universitaria of Bologna, Italy (paediatric intensive care unit [ICU], paediatric onco-haematology, neonatology, and emergency paediatric ward), between January 2021 and June 2021 and who received TDM-based CPAs on real-time for personalization of antimicrobial therapy were retrospectively assessed. Demographic and clinical features, CPAs delivered in relation to different settings and antimicrobials, and type of dosing adjustments were extracted. Two indicators of performance were identified. The number of dosing adjustments provided over the total number of delivered CPAs. The turnaround time (TAT) of CPAs according to a predefined scale (optimal, <12 h; quasi-optimal, between 12–24 h; acceptable, between 24–48 h; suboptimal, >48 h).Results: Overall, 247 CPAs were delivered to 53 paediatric patients (mean 4.7 ± 3.7 CPAs/patient). Most were delivered to onco-haematological patients (39.6%) and to ICU patients (35.8%), and concerned mainly isavuconazole (19.0%) and voriconazole (17.8%). Overall, CPAs suggested dosing adjustments in 37.7% of cases (24.3% increases and 13.4% decreases). Median TAT was 7.5 h (IQR 6.1–8.8 h). Overall, CPAs TAT was optimal in 91.5% of cases, and suboptimal in only 0.8% of cases.Discussion: Our study provides a proof of concept of the helpful role that TDM-based real-time CPAs may have in optimizing antimicrobial exposure in different challenging paediatric scenarios.

scholarly journals Impact of Sex on Clinical Response in Rheumatoid Arthritis Patients Treated With Biologics at Approved Dosing Regimens

2020 ◽  
Vol 60 (S2) ◽  
Author(s):  
Lanyan Fang ◽  
Xuyang Sonvg ◽  
Ping Ji ◽  
Yaning Wang ◽  
Janet Maynard ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Response ◽  
Dosing Regimens

Intravenous and Oral Propafenone for Treatment of Tachycardia in Infants and Children: Pharmacokinetics and Clinical Response

1998 ◽  
Vol 38 (6) ◽  
pp. 496-501 ◽  
Author(s):  
Shinya Ito ◽  
Robert Gow ◽  
Zul Verjee ◽  
Ester Giesbrecht ◽  
Hidemi Dodo ◽  
...  
Keyword(s):  
Clinical Response ◽  
Infants And Children ◽  
In Infants And Children

scholarly journals P29 The preventative management of migraine headaches in paediatrics

2020 ◽  
Vol 105 (9) ◽  
pp. e21-e21
Author(s):  
Judith Martin
Keyword(s):  
Side Effects ◽  
Controlled Trial ◽  
Treatment Options ◽  
Migraine Prophylaxis ◽  
List Type ◽  
Preventative Treatment ◽  
Clinical Factor ◽  
Childhood Migraine ◽  
Paediatric Patients ◽  
Dosing Regimens

AimTo determine the optimal preventative treatment option for paediatric migraineDesignA retrospective method. A review of 100 paediatric patients who attended outpatient clinics and their clinical outcomes evaluated at day 0, and at their next outpatient appointment (which is approximately 3 months after their first review). Their treatment was analysed to determine if they have remained on their migraine prophylaxis or changed to a different option.SettingChildren outpatient setting in a District General Hospital.Participants100 paediatric patients aged below 18 years of age.InterventionPatients aged below 18 years of age who have a documented diagnosis of migraine. This excluded abdominal migraine.Main Outcome MeasuresTo identify: which classes of drugs are being used for migraine prophylaxis, if there is a drug being used in preference to other drugs, how many preventative treatment options are tried before a preventative treatment is successful, if appropriate dosing regimens are being used for preventative treatment options, the common side effects (if any) of the drugs used in the management of migraine prophylaxis and if a different class of drug is being used for children under 12 years of age and over 12 years of age.Main ResultsPropranolol, topiramate, pizotifen, amitriptyline and gabapentin were medication used as initial treatment for paediatric migraine prophylaxis. Pizotifen was the most commonly used medication (n=71) and had the overall highest positive response rate of 76%. Topiramate, pizotifen and amitriptyline were noted to have caused side effects and prevent the subjects from continuing that course of prophylactic treatment. Age is a clinical factor which can influence the decision to start therapy. With a child’s advancing age, the features of childhood migraine change and therefore different medication may respond to the changing condition. It is evident from this research, pizotifen is used for children under the age of 12 years. However the true reason behind this is unknown. This could be due to the medication licensing or the side effect profile. Further trials are needed to review the demanding consideration on migraine in children of different ages. The BNF-C gives dosing advice on three preventative treatments; pizotifen, topiramate and propranolol. There was overall good compliance with dosing as per the BNFC; 91% in the pizotifen group, 100% in the topiramate group and 82% compliance in the propranolol group. In the BNF-C, for amitriptyline and gabapentin there is no dosing advice for migraine prophylaxis. Therefore, there was no dosing regimens to compare to and achieved 0% compliance with the BNF-C.ConclusionThis research has found pizotifen to be first line treatment for the prevention of migraines. Numerous medication have been identified as potentially preventing migraine but these have either not progressed to fruition or failed to achieve the expected outcomes. Further medication studies are needed to examine their effectiveness for preventing paediatric migraine.ReferencesBarnes N. ( 2019) ‘Migraine Headache in Children’, British Medical Journal. Available at: https://bestpractice.bmj.com/topics/en-gb/678/evidence (Accessed February 2019)Bille BO. ( 1997) ‘A 40-year follow-up of children with migraine’. Cephalalgia 1997;17:488–91. Available at: https://www.ncbi.nlm.nih.gov/pubmed/9209767 (Accessed January 2019)Brandes JL Saper JR, Diamond M, et al. (2004) ‘Topiramate for migraine prevention: A randomized controlled trial’. JAMA. 2004;291:965–973. Available at: https://www.ncbi.nlm.nih.gov/pubmed/14982912 (Accessed January 2019)Forsythe WI, Gillies D, Sills MA. ( 1984) ‘Propranolol in the treatment of childhood migraine’, Developmental Medicine and Child Neurology Journal, 26: 737–41.

P17 An audit of enoxaparin prescribing and monitoring in child health

2018 ◽  
Vol 103 (2) ◽  
pp. e2.19-e2 ◽  
Author(s):  
Chloe Main ◽  
Suzannah Hibberd ◽  
Caroline Cole
Keyword(s):  
British Journal ◽  
Venous Thromboembolism ◽  
Adult Population ◽  
Anticoagulation Therapy ◽  
List Type ◽  
Therapeutic Treatment ◽  
Post Dose ◽  
Paediatric Patients ◽  
Dosing Regimens ◽  
Dose Change

BackgroundVenous thromboembolism (VTE) is becoming increasingly recognised in children’s healthcare despite being relatively uncommon in comparison to the adult population.1,2 The incomplete haemostatic system that is present at birth responds with different pharmacokinetics and pharmacodynamics to anticoagulation therapy using low molecular weight heparins (LMWHs) in comparison to adults.3 It is not clear from what age adult dosing can be applied however this is thought to be around 16–18 years. Currently no comprehensive local guidelines are available for the prescribing and monitoring of enoxaparin in paediatric patients. Due to the increasing use of enoxaparin, there is a need to develop local guidelines for both prophylaxis and therapeutic treatment.AimTo audit prescribing and monitoring of enoxaparin within the Children’s Hospital prior to the development of comprehensive local guidelines.MethodRetrospective and concurrent methods were used to collect data from all paediatric patients prescribed enoxaparin between the 1 st January 2015 and the 31 st January 2016. A range of computer systems, including ePrescribing records, an electronic results server and electronic and paper based notes were used to investigate each patient identified. Data was collected regarding enoxaparin indication, dosing and anti-Xa levels with data being entered into the audit tool.Results71% (n=17) of therapeutic treatment enoxaparin prescriptions were dosed according to the BNFc with no documentation found to justify alternative dosing regimens. 35% of patients had an anti-Xa level taken within 36 hours of therapeutic treatment initiation. 71% of levels (n=17) were taken 4–6 hours post dose. Where levels were found not to be in range, 82% of patients (n=11) had their dose adjusted. 56% (n=9) of patients then went on to have their anti-Xa level re-checked within 24 hours of dose change. 76% (n=25) of prophylactic enoxaparin prescriptions were dosed according to the BNFc. 93% (n=42) of all enoxaparin prescriptions were dosed as whole numbers.ConclusionThe results indicate that prescribers may benefit from having access to clear dosing and monitoring guidelines, to help improve the prescribing and monitoring in paediatric patients prescribed enoxaparin for both prophylaxis and therapeutic treatment of venous thromboembolism. The guidelines should contain details of dosing, monitoring, and how to adjust levels when necessary. Practice should be re-audited 12 months after the guidelines are published.One limitation was the difficulty ascertaining the indication for treatment due to inadequate documentation.ReferencesChalmers E, Ganesen V, Liesner R, Maroo S, Nokes T, Saunders D, et al. Guideline on the investigation, management and prevention of venous thrombosis in children. British Journal of Haematology2011;154(2):196–207.Payne J. Aspects of anticoagulation in children. British Journal of Haematology2010;150(3):259–277.Guzzetta N, Miller B. Principles of hemostasis in children: Models and maturation. Paediatric Anaesthesia2010;21(1):3–9.

Clinical efficacy and safety following dose tapering of ciclosporin in cats with hypersensitivity dermatitis

2016 ◽  
Vol 18 (11) ◽  
pp. 898-905 ◽  
Author(s):  
Elizabeth S Roberts ◽  
Tiffany Tapp ◽  
Ann Trimmer ◽  
Linda Roycroft ◽  
Stephen King
Keyword(s):  
Adverse Events ◽  
Clinical Response ◽  
Clinical Efficacy ◽  
Safety Profile ◽  
Therapeutic Response ◽  
Clinical Pathology ◽  
Efficacy And Safety ◽  
Dosing Frequency ◽  
Dosing Regimens ◽  
Physical Examinations

Objectives This study was designed to evaluate the efficacy and safety of reducing ciclosporin (CsA) dosing frequency from daily to every other day (EOD) or twice a week (TW) according to clinical response in cats with hypersensitivity dermatitis (HD) and treated with CsA. Methods One hundred and ninety-one cats with HD were given 7 mg/kg CsA daily for at least 4 weeks. Depending on clinical response, the dosing frequency was tapered from daily to EOD over the next 4 weeks and further to TW for an additional 4 weeks. Safety was evaluated through physical examinations, clinical pathology and the monitoring of adverse events (AEs). Results The majority of cats were able to have their dose of CsA tapered to either EOD (15.5%) or TW (62.9%) according to the clinical response. Observed AEs were most frequently mild and self-limiting vomiting and diarrhea. A higher percentage of AEs occurred with daily administration (73%) compared with other dosing regimens (27%). Conclusions and relevance Following 4 weeks of daily dosing at 7 mg/kg, CsA may be tapered to EOD or TW while maintaining the desired therapeutic response in cats with HD. Additionally, CsA appears to be well tolerated with fewer AEs at EOD or TW dosing. Establishing the lowest effective dosing frequency of CsA improves the drug’s safety profile.

scholarly journals Molecular Mechanisms of Recurrent Pregnancy Loss

2020 ◽  
Author(s):  
Bahareh Mazrouei ◽  
Mohammad Mehdi Heidari ◽  
Mehri Khatami ◽  
Maryam Tahmasebi
Keyword(s):  
Growth And Development ◽  
Pregnancy Loss ◽  
Molecular Mechanisms ◽  
Genetic Factors ◽  
Recurrent Pregnancy Loss ◽  
Chromosomal Abnormalities ◽  
Molecular Abnormalities ◽  
Appropriate Treatment ◽  
Structural Abnormalities ◽  
Recurrent Pregnancy Losses

Introduction: Pregnancy and health is the process in which the egg is fertilized and being able to survive. When pregnancy occurs under some conditions and the fetus is being at risk, it will lead to abortion that occurs involuntarily and spontaneously. Abortions that occur more than two or three times are called recurrent pregnancy loss (RPL). Various etiological factors involved in RPL, including environmental, pathological and genetic factors. The environmental factors that often related to an inappropriate lifestyle, and endanger the pregnancy. The pathological factors are including autoimmune, infectious, endocrine and anatomical factors. The genetic factors are including several structural and chromosomal abnormalities. The majority of chromosomal abnormalities are including trisomy, polyploidy, and monosomy X. The structural abnormalities due to chromosomal cleavage, which may be balanced or unbalanced. However, a large number of these abortions do not have any clear reason, so molecular studies have shown that these types of recurrent pregnancy losses are related to the gene disorders of the mother. The function of these genes shows that they are associated with the process of formation, implantation and maintenance, fetal growth and development, and so on. This review focuses on the genetic and molecular abnormalities that may involve in the occurrence of recurrent pregnancy loss to choose the appropriate treatment for couples who suffer from RPL, based on the type of disorder.

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