Flashcards in 243 Peadiatrics Deck (48):
What ages is classes as pre term?
What about neonates?
Pre term are 38 weeks before birth (gestation)
Neonates are 0-1 month old
What is the ages range of infants?
1- 24 months old (1 month- 2 years)
What's the age range classed as a child?
What about adolescent?
Child: 2- 12 years
Adolescent: 12- 18 years
Medication errors in children have ___ times the potential For harm compared to adults
What drugs have reduced oral absorption in infants?
What drugs have increased oral absorption for children in general?
At what age do stomach pH and gastric emptying times tend to normalise? What does this effect?
3 years old.
Effects absorption of certain drugs (eg phenytoin, phenobarbital, rifampicin, penicillins)
Why should we try to avoid the IM route in children?
They have a low muscle mass
Neonates have reduced and variable blood flow so will have erratic IM absorption.
If have to give IM, see if medication can be mixed with Lidocaine to reduce pain :)
Percutaneous absorption is increased in neonates and infants, why?
Higher surface area to volume ratio
Immature epidermal barrier
But can result in cushionoid effect- too much cortisol (corticosteroid) absorbed causing face to puff
When may the rectal use be useful in children?
When they're vomiting
When they're nil by mouth (eg post op pain relief)
Child refuses to take oral medicine
Which do you think has the highest volume of distribution: neonates or adolescence?
As a percentage of body mass, their total body water and extracellular volume DECREASE with increasing age, as they become bigger and grow more muscle so water doesn't take up as much room
Neonates will have a higher Vol of distribution for water soluble drugs, so they need higher doses than adults on a weight to weight basis
Eg with penicillin and amino glycosides (water soluble)
Who have the highest % of adipose tissue levels (fats):
A premature baby
Term baby (neonates)
One year old
A one year old! Known as baby fat
A premature baby 3%
Term baby (neonates) 12%
One year old 30%!! (As they don't burn off fat as they're not walking yet but eating lots!!)
This means fat soluble drugs in neonates need smaller doses
What do you need to do if you're administering a highly protein bound drug such as phenytoin into a neonate or infant?
Watch out! As the numbers or proteins and serum albumin is lower in children therefore less drug can be protein bound resulting in a lot of drug being free.
This can give more effects, and increased toxicity
Therapeutic drug monitoring therefore needed
What is pradawillis syndrome?
Where a child never feels full
They eat and eat, leads to obesity :(
What drug do fatalities in neonatal care units tend to happen with?
Which drugs have altered metabolic pathways in neonates compared to children and adults?
What is grey baby syndrome?
a rare but serious side effect that occurs in newborn infants (especially premature babies) following the intravenous administration of the antimicrobial chloramphenicol.
Due to a lack of glucuronidation METABOLISM reactions occurring in the baby, leading to an accumulation of toxic chloramphenicol metabolites.
Baby dies :(
At what ages does renal function completely mature?
6-8 months of age
Before this renal function may be lower
It has been shown to be safe and effective if used as licensed and is of a suitable quality
Something that is NOT licensed for ANY age or indication.
Such as manufacturers specials, imports, chemicals
What does "off label "mean?
Used outside the products terms of license
Eg something may be used for an indication that it isn't licensed for, or used for a condition it isn't licensed for
Can manufacturers advertised unlicensed or off label meds?
What is a PUMA?
Paediatrics use marketing authorisation
In 2011 first ever children's medicine was granted one!
- BUCCOLAM (buccal midazolam) was specifically licensed for children aged 3months-18 Years
Propylene glycol is present in phenobarbital injections
If a child's renal function is effected or they're a slow metaboliser causing reduced elimination of this drug, what effect can this have?
Sever adverse effects on the CNS
Reduce the risk of this by diluting propylene glycol before administering it!
What can polyoxyl castor oil cause in IV injections in children?
A severe anaphylytic reaction
What is benzyl alcohol contra indicated in?
(Present in Amiodarone and Lorazepam injections)
In pre term neonates (premature)
Can cause fatal toxic syndrome
(I'd be scared to give a premature tiny baby any drugs!!)
In liquid formulations you need to consider that the child may be allergic to certain flavourings colourings or preservatives etc
Can you name a few?
Arachis (peanut oil)
Can I disguise my drug in my baby's milk bottle?
No this shouldn't be done
The drug will sink to the bottle of the bottle and the baby is unlikely to finish it!!
When should you definately avoid splitting and giving a fraction of an unscored (round) tablet?
When the drug has a narrow therapeutic window.
This is because the drug may not be uniformly distributed throughout the tablet.
Therefore could end up over dosing or under dosing quite easily if the drug isn't uniformly spread and you split it.
Can we crush enteric coated and sustained release preparations?
Yes if we accept that they now won't have their protective coating so will no longer be slow releasing!!
If we have to disguise a tablet in a child's food or drink, how much should we use? A lot? A little?
We should use the minimum amount of food or fluid possible so that they're more likely to drink or eat it all
Why may their be adherence problems for a child taking medication for a chronic condition such as diabetes or cystic fibrosis? Give four reasons.
Difficulty taking the medication due to the form or tase
Purpose of the medicine not clear
Perceived lack of efficacy eg the medication doesn't actually appear to be helping, but they don't realise if they weren't taking it would be a lot worse.
Real and perceived side effects.
Instructions for administration not clear.
PILs may state not recommended for children if the medication is being used off label- therefore important to educate parents.
Taste- one of the most foul tasting is antibiotic Flucloxacillin, CF children have to take it every day
About ____% of children are affected by at least one chronic disease!
PILs can state "not for use in children" which can cause adherence problems if patients read it. What can be done?
Educate the parents- the medication is being used off label but appropriate evidence backs up its fine and is used all the time and is safe and effective in children.
Or could produce "in-house" PILs that state that the med can be used in children
Or use the medicines for children website, got PILs on here specified to children, and lots of extra info on use in children
What reference sources can be used in paediatrics?
Bnf for children
Neonatal formulary- for medicines used in pregnancy and first year of life
Guys st Thomas hospital Peadiatric formulary
Why can diabetes cause problems in children at school?
Child needs to have regular meal times which can be hard at school
Long acting version: b.d= good as child won't have to inject at school. Or once in morn. With this the child must have regular meal times.
Short acting version: t.d.s= child will have to inject in school.
What if a child can't inject?
The school nurse will have to come in, or the child's carer
Note: the needle must be locked away, child can't keep it on them
Can schools keep an emergency inhaler? (Salbutamol)
No this is currently not allowed
Trying to make this allowed currently.
If a child is having an epileptic fit, need to be able to deal with this in school. What's usually given/ done?
Buccal midazolam is best thing to give (locked away)
Or rectal diazepam (not as good)
Need to have a plan when a child fits- who goes and gets med from storage, who stays with child.
Inform classmates so they can help out supply teacher.
What is given for anaphlaxis?
Epipen stored at school (locked away)
What are the two ways you can calculate doses in a child?
1) base doses solely on the weight of the child
2) base doses on body surface area, this is based on weight and height.
Why was the "safer use of IV gentamicin for neonates" document implemented ?
Due to patient safety incidents being reported, involving:
- administering Gentamicin into Neonates at the incorrect times
-prescribing errors: 40mg/mls being given and not taking into account Displacement values.
- issues relating to blood level monitoring!
How many patient safety incidents were there relating to Gentamicin in neonates?
507 patient safety incidents reported
The document was therefore part of the gentamicin alert project
What is a suitable formula/ formulation protocol to follow for the extemporaneous preparation of Captopril liquid, required for a child taking 1mg captopril tablets three times a day?
4 X captopril 25mg tablets
To be ground to a fine uniform powder
Then add OraPlus to 50% volume. (50ml)
Then make up volume to 100% using Orasweet
This will make a 1mg/ml solution
Give 1 ml three times a day
Keep for 7 days in a fridge in an amber bottle
What is the formula involving xanthum gum used to make captopril liquid used for a child requiring 1mg tds?
4 X captopril 25mg tablets
Then add Xanthum Gum suspending agent 0.5% (known as Keltrol) to 100ml
Makes a 1mg/ml solution
Give 1ml three times a day
Where are the formulas for preparing captopril liquid extemporaneously come from?
Handbook of extemporaneous preparation
Making these extemporaneous preps is unlicensed, so make sure they're made up the same way each time.
Licensed captopril liquid available in Australia: if you import this it will be Unlicensed in UK
For a 25mg/5ml solution:
Age: Dose: Max:
6-8 5ml. QDS
8-10. 7.5ml. QDS
10-12. 10ml. QDS