Pediatric Pharmacology

Pediatric medication dosing follows weight-based (mg/kg) and body surface area (BSA-based) calculations, with maximum adult doses serving as safety caps. Developmental changes in hepatic enzyme activity (CYP450 maturation), renal function (GFR increases during first 2 years), and body composition (increased extracellular water in infants) significantly affect drug disposition in children compared to adults.

Neonatal therapeutic drug monitoring requires careful consideration of gestational age, postnatal age, and renal/hepatic maturation. Aminoglycoside dosing in neonates uses extended-interval protocols with gestational age-adjusted nomograms, while vancomycin trough targets (10-20 mcg/mL) guide dosing for late-onset neonatal sepsis.

Emergency pediatric medication dosing, including resuscitation drugs per PALS guidelines, seizure management (benzodiazepines, levetiracetam, phenytoin), and rapid sequence intubation (RSI) medications, must be calculated rapidly using weight-based nomograms such as the Broselow tape or length-based weight estimation formulas.