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Phenytoin has a variable half life. Neonates t1/2=21 hr, children t1/2=2-20 hr, adults t1/2=11-29 hr. Phenytoin may cause cardiac arrhythmias, blood dyscrasias and CNS symptoms. Many drugs of the “seizure class” are used to treat psychiatric symptoms in children. Phenobarbital can cause paradoxical hyperactivity in some children. |
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methylphenidate (long acting forms available) has been associated with cardiac toxicity, appetite suppression and insomnia |
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SSRI for depression have been associated with increased risk of suicide, other adverse effects; insomnia, GI symptoms, withdrawal reaction if abruptly discontinued |
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mild pain use acetaminophen or ibuprofen avoid the use of aspirin due to the possibility of Reyes syndrome, Morphine for severe pain use appropriate age/weight corrected dosages |
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screen for alcohol, marijuana, other drugs of abuse, inhalants, steroids, OTC and herbal products, cigarette smoking, internet-based products |
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prevent CNS complications of diseases, meningococcal vaccine |
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drug prepared in alcohol based solution |
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un-dissolved particles of drug in vehicle, shaking required |
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decreased drug metabolizing enzymes Cytochrome p450 60% of adult levels Phase 1 – oxidative, demethylation, hydrolysis Phase 2 – glucuronidation, conjugation, sulfonation |
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