Pharmacologic Differences in Children

2018 ◽  
Author(s):  
Raymond Park ◽  
Lauren Kelly Ugarte
Keyword(s):  
Adverse Effects ◽  
Key Words ◽  
Pediatric Anesthesia ◽  
Propofol Infusion Syndrome ◽  
Anesthetic Care ◽  
Off Label ◽  
Anesthesia Providers ◽  
Increased Risk ◽  
Neurotoxic Effects ◽  
Pharmacologic Agents

Children are physiologically different from adults. Their anesthetic care requires ample consideration of the pharmacologic effects of medications on their minds and bodies to provide an overall pleasant and safe experience. There are many available pharmacologic agents that can be used in the course of a child’s anesthetic. It is essential to be aware of the potential uses and risks of each. Pediatric anesthesia providers must consider physiologic differences in children versus adults that affect pharmacodynamics. They should also consider various medication routes that are available to initiate sedation or anesthesia, dosing changes that need to be made due to metabolism immaturity and increased risk of medication toxicity, concern for possible neurotoxic effects of medications on the developing brain, and adverse effects of medication due to congenital issues or undiagnosed pathology. Medications we use in pediatric anesthesia have always been off label due to limited studies in this population of patients and ongoing studies will help enhance our practice.   This review contains 4 figures, 7 tables, and 64 references. Key Words: anesthetic neurotoxicity, anesthesia uptake, apnea risk, benzodiazepine effects, neonates, midazolam bioavailability, opioids, opioid-sparing medications, premedication routes, propofol infusion syndrome, succinylcholine complications, sugammadex, uptake and distribution in infants.

Pharmacologic Differences in Children

2018 ◽  
Author(s):  
Raymond Park ◽  
Lauren Kelly Ugarte
Keyword(s):  
Adverse Effects ◽  
Key Words ◽  
Pediatric Anesthesia ◽  
Propofol Infusion Syndrome ◽  
Anesthetic Care ◽  
Off Label ◽  
Anesthesia Providers ◽  
Increased Risk ◽  
Neurotoxic Effects ◽  
Pharmacologic Agents

Children are physiologically different from adults. Their anesthetic care requires ample consideration of the pharmacologic effects of medications on their minds and bodies to provide an overall pleasant and safe experience. There are many available pharmacologic agents that can be used in the course of a child’s anesthetic. It is essential to be aware of the potential uses and risks of each. Pediatric anesthesia providers must consider physiologic differences in children versus adults that affect pharmacodynamics. They should also consider various medication routes that are available to initiate sedation or anesthesia, dosing changes that need to be made due to metabolism immaturity and increased risk of medication toxicity, concern for possible neurotoxic effects of medications on the developing brain, and adverse effects of medication due to congenital issues or undiagnosed pathology. Medications we use in pediatric anesthesia have always been off label due to limited studies in this population of patients and ongoing studies will help enhance our practice.   This review contains 4 figures, 7 tables, and 64 references. Key Words: anesthetic neurotoxicity, anesthesia uptake, apnea risk, benzodiazepine effects, neonates, midazolam bioavailability, opioids, opioid-sparing medications, premedication routes, propofol infusion syndrome, succinylcholine complications, sugammadex, uptake and distribution in infants.

Intra-anal use of imiquimod: what is the clinical evidence?

2019 ◽  
Vol 30 (10) ◽  
pp. 1018-1024
Author(s):  
Ioannis D Gkegkes ◽  
Christos Iavazzo ◽  
Apostolos P Stamatiadis
Keyword(s):  
Human Papillomavirus ◽  
Adverse Effects ◽  
Clinical Evidence ◽  
Complete Healing ◽  
Burning Sensation ◽  
High Grade ◽  
Imiquimod Cream ◽  
Off Label ◽  
Anal Lesions ◽  
Intraepithelial Lesions

Imiquimod has been demonstrated to be rather effective in patients with anal as well as perianal high-grade squamous intraepithelial lesions (HSILs). Nevertheless, until now the intra-anal use of imiquimod has been considered off-label. The aim of this study is to review the clinical evidence related to the intra-anal use of imiquimod in the treatment of human papillomavirus-related anal lesions. A systematic search in PubMed and Scopus was performed. In total, 422 patients were included. The most common referred comorbidity was HIV infection (281 patients, 66.6%). The principal clinical entities, which were treated with intra-anal imiquimod, were HSILs. The most frequent formulation was self-applied imiquimod cream. In the HSIL group, there was complete healing in 74 patients (35%) and partial in 44 patients (20.9%), while in the wart group, there was complete healing in 128 patients (67%). Recurrence of HSIL was present in 19 patients (15%), while in cases with warts recurrence was present in 38 patients (19.8%). The most common adverse events were pain, itching, and burning sensation. In conclusion, the adverse effects associated with the intra-anal use of imiquimod seem to be minor. The present clinical evidence suggests that imiquimod may be proposed as effective, safe, and relatively well tolerated treatment.

scholarly journals Predictive Biomarkers of Oxaliplatin-Induced Peripheral Neurotoxicity

2021 ◽  
Vol 11 (7) ◽  
pp. 669
Author(s):  
Roser Velasco ◽  
Montserrat Alemany ◽  
Macarena Villagrán ◽  
Andreas A. Argyriou
Keyword(s):  
Predictive Biomarkers ◽  
Lower Limbs ◽  
Platinum Compound ◽  
Effective Strategy ◽  
Peripheral Neurotoxicity ◽  
Early Biomarkers ◽  
Increased Risk ◽  
Neurotoxic Effects ◽  
Risk Patients ◽  
Dose Limiting Toxicity

Oxaliplatin (OXA) is a platinum compound primarily used in the treatment of gastrointestinal cancer. OXA-induced peripheral neurotoxicity (OXAIPN) is the major non-hematological dose-limiting toxicity of OXA-based chemotherapy and includes acute transient neurotoxic effects that appear soon after OXA infusion, and chronic non-length dependent sensory neuronopathy symmetrically affecting both upper and lower limbs in a stocking-and-glove distribution. No effective strategy has been established to reverse or treat OXAIPN. Thus, it is necessary to early predict the occurrence of OXAIPN during treatment and possibly modify the OXA-based regimen in patients at high risk as an early diagnosis and intervention may slow down neuropathy progression. However, identifying which patients are more likely to develop OXAIPN is clinically challenging. Several objective and measurable early biomarkers for OXAIPN prediction have been described in recent years, becoming useful for informing clinical decisions about treatment. The purpose of this review is to critically review data on currently available or promising predictors of OXAIPN. Neurological monitoring, according to predictive factors for increased risk of OXAIPN, would allow clinicians to personalize treatment, by monitoring at-risk patients more closely and guide clinicians towards better counseling of patients about neurotoxicity effects of OXA.

scholarly journals Are Probiotics and Prebiotics Safe for Use during Pregnancy and Lactation? A Systematic Review and Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2382
Author(s):  
Hauna Sheyholislami ◽  
Kristin L. Connor
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
English Language ◽  
Clinical Decision Making ◽  
Lactobacillus Rhamnosus ◽  
Potential Health ◽  
Increased Risk ◽  
Pregnancy And Lactation ◽  
Adverse Pregnancy ◽  
Synbiotic Supplementation

Probiotic and prebiotic products have shown potential health benefits, including for the prevention of adverse pregnancy outcomes. The incidence of adverse effects in pregnant people and their infants associated with probiotic/prebiotic/synbiotic intake, however, remains unclear. The objectives of this study were to evaluate the evidence on adverse effects of maternal probiotic, prebiotic, and/or synbiotic supplementation during pregnancy and lactation and interpret the findings to help inform clinical decision-making and care of this population. A systematic review was conducted following PRISMA guidelines. Scientific databases were searched using pre-determined terms, and risk of bias assessments were conducted to determine study quality. Inclusion criteria were English language studies, human studies, access to full-text, and probiotic/prebiotic/synbiotic supplementation to the mother and not the infant. In total, 11/100 eligible studies reported adverse effects and were eligible for inclusion in quantitative analysis, and data were visualised in a GOfER diagram. Probiotic and prebiotic products are safe for use during pregnancy and lactation. One study reported increased risk of vaginal discharge and changes in stool consistency (relative risk [95% CI]: 3.67 [1.04, 13.0]) when administering Lactobacillus rhamnosus and L. reuteri. Adverse effects associated with probiotic and prebiotic use do not pose any serious health concerns to mother or infant. Our findings and knowledge translation visualisations provide healthcare professionals and consumers with information to make evidence-informed decisions about the use of pre- and probiotics.

scholarly journals Prevention and Treatment of Oral Mucositis in Children with Cancer

2012 ◽  
Vol 17 (4) ◽  
pp. 340-350 ◽  
Author(s):  
Misty M. Miller ◽  
David V. Donald ◽  
Tracy M. Hagemann
Keyword(s):  
Oral Mucositis ◽  
Keratinocyte Growth Factor ◽  
Oral Intake ◽  
Chemotherapeutic Agents ◽  
Increased Risk ◽  
Significant Burden ◽  
Dividing Cells ◽  
Tissue Changes ◽  
New Research ◽  
Pharmacologic Agents

Oral mucositis affects more than three-fourths of patients undergoing chemotherapy and represents a significant burden to patients and caregivers. Lesions develop as a result of chemotherapeutic agents attacking the rapidly dividing cells of the gastrointestinal tract. Severity can range from mild, painless tissue changes to bleeding ulcerations that prevent oral intake and require narcotic pain relievers. Oral mucositis also leads to an increased risk of infection and can often delay further chemotherapy treatment. A number of assessment scales have been developed to better qualify the symptoms associated with this condition. Few pharmacologic agents have been approved to either prevent the development or alleviate the symptoms of oral mucositis. Current options include the use of antimicrobial mouthwashes, amino acid rinses, and topical healing agents. Palifermin, a keratinocyte growth factor, may be a future option after its use in children is explored. With achievements in other areas of supportive care in patients undergoing chemotherapy, oral mucositis should represent the forefront of new research. This review will provide a comprehensive examination of available options for children who have oral mucositis.

scholarly journals Sinus node dysfunction due to psychotropic agents' combination

2012 ◽  
Vol 24 (4) ◽  
pp. 247-250
Author(s):  
József Simkó ◽  
Gabriella Nagy ◽  
Anikó Dózsa ◽  
István Lörincz
Keyword(s):  
Drug Therapy ◽  
Psychotropic Drug ◽  
Sinus Node ◽  
Bipolar Affective Disorder ◽  
Antipsychotic Agents ◽  
The Elderly ◽  
Sinus Node Dysfunction ◽  
Increased Risk ◽  
Psychotropic Agents ◽  
Pharmacologic Agents

Background: Although sinus node dysfunction is primarily related to degenerative fibrosis of nodal tissue in the elderly, it may occur at any age secondary to other cardiac abnormalities or extrinsic causes. Pharmacologic agents including psychotropic drug therapy may also play a role.Method: We present the case of a 53-year-old woman with bipolar affective disorder in whom antipsychotic agents were suspected of inducing sinus node dysfunction.Result: The combination of psychotropic agents including lithium, quetiapine and carbamazepine (first occasion) or escitalopram (second occasion) has been implicated as a cause for sinus node dysfunction.Conclusion: Patients with severe mental illness usually require long-term psychotropic drug therapy, often in combination. This may enhance efficacy but also involves an increased risk of adverse effects including cardiotoxicity.

Cardiovascular events in patients with type 2 diabetes

2002 ◽  
Vol 2 (1_suppl) ◽  
pp. S4-S8
Author(s):  
Erland Erdmann
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Risk Factor ◽  
Adverse Effects ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Increased Risk

Diabetes is a common risk factor for cardiovascular disease. Coronary heart disease and left ventricular dysfunction are more common in diabetic patients than in non-diabetic patients, and diabetic patients benefit less from revascularisation procedures. This increased risk can only partly be explained by the adverse effects of diabetes on established risk factors; hence, a substantial part of the excess risk must be attributable to direct effects of hyperglycaemia and diabetes. In type 2 diabetes, hyperinsulinaemia, insulin resistance and hyperglycaemia have a number of potential adverse effects, including effects on endothelial function and coagulation. Risk factor modification has been shown to reduce the occurrence of cardiovascular events in patients with diabetes; indeed, diabetic patients appear to benefit more in absolute terms than non-diabetic patients. There is thus a strong case for intensive treatment of risk factors, including insulin resistance and hyperglycaemia, in patients with type 2 diabetes.

scholarly journals Opioid Use and the Risk of Respiratory Depression and Death in the Pediatric Population

2013 ◽  
Vol 18 (4) ◽  
pp. 269-276 ◽  
Author(s):  
Marianne R. Whittaker
Keyword(s):  
Clinical Trials ◽  
Adverse Effects ◽  
Respiratory Depression ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Opioid Use ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Pediatric patients may be at an increased risk of adverse effects from various medications. Recently, there have been a number of serious adverse events, including several pediatric patients experiencing severe respiratory depression and death as a result of the use of codeine for pain control following tonsillectomy and adenoidectomy. OBJECTIVE To assess the safety of opioid agonists in pediatric patients undergoing operative procedures or have experienced trauma and to evaluate the risk of respiratory depression and death among this population. METHODS PubMed and Medline were searched to identify randomized controlled studies from 1994 to 2012 addressing postsurgery/trauma opioid use in pediatric patients. Relative risks and confidence intervals (CIs) were calculated using data available in clinical trials. RESULTS A total of 16 clinical trials were evaluated for this review. Randomized controlled trials included studies comparing opioids versus non-opioids for a variety of painful conditions. The relative risk of respiratory depression associated with opioid use in 1 trial was 1.63 (95% CI: 0.64–6.13). The remaining 15 trials reviewed described no significant difference in respiratory depression or adverse effects associated with treatment. No deaths were attributed to opioid use in any of these studies. CONCLUSION Opioid-associated respiratory depression was very rare and no deaths were reported in the reviewed studies. These findings under the well-defined conditions of controlled studies may not be the best means of determining overall opioid-associated side effects in pediatric patients.

A survey of endotracheal suctioning with instillation of normal saline

1998 ◽  
Vol 7 (4) ◽  
pp. 255-260 ◽  
Author(s):  
D Schwenker ◽  
M Ferrin ◽  
AG Gift
Keyword(s):  
Adverse Effects ◽  
Normal Saline ◽  
Nursing Intervention ◽  
Educational Programs ◽  
University Teaching ◽  
Pulmonary Infections ◽  
Endotracheal Suctioning ◽  
Respiratory Therapists ◽  
Increased Risk ◽  
Saline Instillation

BACKGROUND: Instillation of normal saline before suctioning is a common nursing intervention although little research supports the practice. OBJECTIVES: To determine when and how often saline is used during suctioning and to assess the knowledge of nurses and respiratory therapists of the advantages and dangers of using saline during endotracheal suctioning. METHODS: A survey of nurses and respiratory therapists working in adult ICUs was conducted in a large university teaching hospital. RESULTS: Of the 187 respondents, 96 (51%) rarely instill saline before suctioning, whereas 61 (33%) frequently use saline. Fifty-five percent use saline to enhance retrieval of secretions, and 45% use it to stimulate a cough. Nurses and respiratory therapists differ in their use and understanding of saline instillation. Most nurses (64%) rarely use saline before suctioning, whereas most respiratory therapists (71%) frequently use saline. Respiratory therapists (57%) were more aware than were nurses (37%) of the benefit of using normal saline to stimulate a cough. Nurses indicated more adverse effects of instillation of normal saline, specifically oxygen desaturation and increased risk of pulmonary infections, than did respiratory therapists. CONCLUSION: The results of the survey helped determine target areas for educational programs for nurses and respiratory therapists. A protocol is being developed for use by all who do suctioning.

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