Introduction to Pediatrics

Question 1

Role of the pediatric pharmacist

Answer 1

Drug selection and use
Monitoring of effectiveness and toxicity
Prevention of medication errors
Patient/caregiver education
Contributions to knowledge through research
Knowledge of pediatric disease states and drug therapy
Skills to apply knowledge to practice

Question 2

Most common chronic medical conditions in pediatrics

Answer 2

Asthma and ADHD

Question 3

Signs of pain

Answer 3

Increased respiratory rate
Increased heart rate
Oxygen desaturations
*Hypothermia - indicates sepsis

Question 4

Scales to measure pain

Answer 4

<4 yo = Neonate Infant Pain Scale (NIPS) or Face, Legs, Activity, Cry, Consolability (FLACC)
>4 yo = Wong-Baker FACES
>10 yo = Visual analog scale, numeric pain scale

Question 5

Normal lab values in children vs. adults

Answer 5

DIFFERENT

Question 6

BMI equation

Answer 6

[weight/(height^2)] x 10000

Question 7

IBW equation

Answer 7

[(height^2) x 1.65]/1000

Question 8

Bedside Schwartz

Answer 8

CrCl (mL/min/1.73m2) = (0.413 x height)/SCr

Question 9

Challenges in Pediatric Pharmacotherapy

Answer 9

PK/PD differences
Psychosocial influences on drug therapy
Caregiver medication administration hesitance
Dosage formulation selections
Off-label medication use

Question 10

How many drugs are indicated to be used in pediatric patients?

Answer 10

1/4

Question 11

Limitations to off-label drug usage

Answer 11

Potential for denied insurance provider coverage
Liability for adverse effects
Limited experience in specific conditions or age groups
Limited available dosage formulations

Question 12

Evidence considerations of off-label drug usage

Answer 12

Extrapolating adult data is not always accurate
Use guidelines when available
Use primary literature

Question 13

Consequences of poor-/non-adherence

Answer 13

Delayed/absent clinical improvement
Worsening illness
unnecessary therapy modifications that can lead to adverse clinical outcomes

Question 14

Reasons for non-adherence

Answer 14

Apprehension regarding medication adverse effects
Caregiver inability or unavailability to administer drugs
Caregivers may be overwhelmed/confused
Inappropriate measurements of medication dose
Missed doses due to resistance from the child

Question 15

Strategies to improve adherence

Answer 15

Caregiver education should be reinforced at several points of healthcare visit
Ease of administration (palatable, lower frequency)
Decrease child resistance (reward systems, positive reinforcement)
Empowering older children/adolescents

Question 16

Dosage form considerations: Parenteral

Answer 16

Volume of IV fluids
Vehicle safety
IV access

Question 17

Dosage form considerations: Oral

Answer 17

Manufactured liquid preparations
Extemporaneously compounded liquid preparations
Volume of PO fluids
Chewable tablets
Tablets
Capsules
Granules

Question 18

Dosage form considerations: Palatability

Answer 18

Children have different preferences
Mixing with food (chocolate syrup, peanut butter, crystal lite, applesauce)
Flavoring (FlavoRx)

Question 19

Extemporaneous Preparation Resources

Answer 19

USP
Lexicomp: Pediatric & Neonatal Dosage Handbook
Micromedex
Pediatric Drug Formulations
Extemporaneous Formulations for Pediatric, Geriatric, and Special Needs Patients

Question 20

When compounding/stability information is not available

Answer 20

USP: water containing formulations prepared from solid ingredients BUD no later than 14 days when stored between 2C-8C
Powder papers
Splitting/crushing tablets - ISMP do not crush list
Opening capsules
Injectable medications administered orally - OK if both oral and IV contain same salt form with similar bioavailability

Question 21

Determining Pediatric Drug Dosages

Answer 21

Commonly based on mg/kg/dose OR mg/kg/day
mg/m2
Max pediatric dose = adult dose
May also be based on gestational age, actual age, patient weight ranges

Question 22

Assessment of renal function

Answer 22

eGFR
Urine output
Ins = mL/kg/DAY
Outs = mL/kg/HOUR
Anuria = Zero output
Oliguria = <0.5-1 mL/kg/hour
Normal urine output = > 1 mL/kg/hour
Polyuria = > 4 mL/kg/hour

Question 23

Dosing reference

Answer 23

Preference Lexicomp or Micromedex