儿科学:药代动力学和剂量计算

Gudisa Bereda 
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引用次数: 1

摘要

与成人相比,儿科具有不同的药效学、生理学和药代动力学特性以及生长速度。胃pH值在出生时为中性,但在出生后24至48小时内降至pH 1-3。出生时,血脑屏障尚未完全成熟,药物可能进入中枢神经系统,具有序列毒性。血浆蛋白对化合物的附着取决于目前附着蛋白的数量、可用结合位点的数量、药物对蛋白质的亲和力常数,以及可能改变药物-蛋白质附着相互作用的病理生理条件或内源性化合物的可用性。身体总水分(以体重百分比来解释)随着年龄的增长而减少,从新生儿的80%下降到1岁时的60%。可逆性地,体脂随着年龄的增长而加速,早产儿的体脂从1%增加到2%,足月新生儿的体脂从10%增加到15%,1岁婴儿的体脂从20%增加到25%。齐多夫定的首过代谢在出生后14天降低。出生时,肾血流量仅为心输出量的5 - 6%,一岁时为15 - 25%,两岁后达到成人水平。儿童的剂量取决于诸如他们的年龄和体重、他们的健康状况、他们的呼吸系统以及他们的身体系统的药物代谢(如肝酶)和消除(如肾脏)的发展阶段等因素。杨氏规则可以快速应用于患者体重未知的情况;这一规则不能用于新生儿,必须考虑到任何年龄的生长变化。一种计算儿童用药剂量的公式,方法是将儿童的年龄加上12,除以儿童的年龄,然后将成人剂量除以所得到的数字,如下所示:(年龄单位:岁/年龄(岁)+ 12)×成人剂量
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Pediatrics: pharmacokinetics and dose calculation
The pediatrics has various pharmacodynamic, physiological and pharmacokinetic properties as well as growth rate in comparison with adults. Gastric pH is neutral at birth but falls to pH 1-3 within twenty four to forty eight hours after birth. At birth, the blood-brain barrier is still not fully mature and medicinal products perhaps obtain access to the central nervous system with sequence toxicity. Plasma protein attaching of compounds is dependent on the amount of present attaching proteins, the number of available binding sites, the affinity constant of the medicine for the protein(s), and the availability of pathophysiological conditions or endogenous compounds that perhaps change the medicine-protein attaching interaction. Total body water, explained as percentage of body weight, reduces with age, from comparatively 80% in newborns to 60% by 1 year of age. Reversibly, body fat accelerates with age, from one percent to two percent in a preterm neonate to ten percent to fifteen percent in a term neonate and 20 to 25% in a 1-year-old. First-pass metabolism of zidovudine was decrease in the first 14 days of life. At birth, renal blood flow is only 5 to 6% of cardiac output, 15 to 25% by one year of age and reaches adult values after two years of age. Children's dosage depends on factors such as their age and weight, their health status, their respiratory system, and the stage of development of their body systems for drugs metabolism (e.g., liver enzymes) and elimination (e.g., kidneys). Young’s rule can be applied quickly approach a situation in which the patients weight is unknown; this rule cannot be used for newborns and consideration must be made for growth variability in growth at any given age. A young’s rule for calculating the dose of medicine correct for a child by adding twelve to the child’s age, dividing the sum by the child’s age, then dividing the adult dose by the figure obtained, as it expressed beneath: (age in years / age (years) + 12)) × adult dose.
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