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DONE CLINICAL > PAEDIATRICS > Flashcards

PAEDIATRICS Flashcards

1
Q

How many weeks gestation is classed as ‘pre term’?

A

Less than 37 weeks

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2
Q

What age range is classed as a ‘child’?

A

2-12yrs

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3
Q

12-18yrs is classed as…

A

Adolescent

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4
Q

Neonates are…

A

0-1 month

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5
Q

Infants are classed as…

A

1-24 months old

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6
Q

Infants have _____ oral abs of Penicillin antibiotics

A

INCREASED - due to increased gastric emptying time and reduce gastric pH

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7
Q

Infants have _____ oral abs of Phenobarbital, Phenytoin and Rifampicin

A

REDUCED

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8
Q

Those under 3 years old have _____ gastric acid secretion and ____ gastric emptying time

A

REDUCED gastric acid secretion

INCREASED gastric emptying time

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9
Q

Neonates have _____ variable blood flow

A

REDUCED

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10
Q

IM drug absorption is ____ in neonates

A

ERRATIC

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11
Q

Why is Vit K IM given at birth?

A

Because it doesn’t pass well through the placenta so some babies are born deficient which increases the risk of bleeding in the brain (VIT K INVOLVED IN CLOTTING)

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12
Q

Neonates and infants have ____ systemic abs of topical preparations.

Give an example of when this can have consequences.

A

INCREASED - due to well hydrated skin, increased SA to body weight ratio and immature epidermal barrier

Corticosteroid use - moon face (cushinoid effects)

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13
Q

Specials are…
Licensed
Unlicensed
Off - Label

A

Unlicensed

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14
Q

Neonates have _____ variable blood flow

A

REDUCED

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15
Q

IM drug absorption is ____ in neonates

A

ERRATIC

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16
Q

Neonates have a ____ volume of distribution for water soluble drugs

A

HIGHER

17
Q

Due to the differing volume of distribution in neonates, they need ____ doses of water soluble drugs such as penicillins compared to adults.

A

HIGHER on weight to weight basis

18
Q

Fat soluble drugs in neonates need ____ doses e.g diazepam

A

SMALLER

19
Q

Plasma protein binding is reduced in neonates and infants as total protein concentrations and serum albumin are _____

A

LOWER

20
Q

In neonates and infants, hight protein bound drugs are more ____/____

What is a consequence of this?

A

effective/toxic

Lower doses may be required

21
Q

Renal function does not completely mature until __ to __ months of age

A

6 to 8 months

22
Q

What does ‘off-label’ mean

A

Used outside the terms of licence

23
Q

What does ‘licensed’ mean

A
  • Shown to be safe and effective if used as licensed

- Is of suitable quality

24
Q

What is ‘Buccolam’ and what age range can it be used in?

A

Buccal Midazolam - used in fits

  • 3 months to 18 years
25
Q

What is preferable in liquid formulations for paediatrics?

A

Sugar and alcohol free

26
Q

Why shouldn’t we mix medication with food/milk?

A
  • Child may develop an aversion to the food
  • Drug may interact with milk
  • If the full amount of food/milk is not consumed then some of the dose may be omitted
27
Q

Why may a child not adhere to medication?

A
  • Difficulty taking medicine (taste, form)
  • Perceived lack of efficacy
  • Side - effects
  • Unclear instructions
28
Q

What may be useful to put in medicine box if using a medicine that is not normally used in children?

A

Amended PIL

- Can get from medicinesforchildren.org

29
Q

Name 3 chronic conditions that may be a concern in schools

A

Asthma, Epilepsy and Allergies

30
Q

Name common ways of calculating doses in children…

A

Age
Weight
Surface Area

31
Q

What may be a useful drug delivery method for asthma medication in children?

Why?

A

PMDI (pressure meter dose inhaler systems) with Spacer devices - Can also use a face mask with this when necessary

  • Don’t have to co-ordinate pressing and inhalation as can inhale the drug from the spacer in several breaths
  • Less risk of oral thrush for corticosteroid

Breath activated devices (DPI)
- Less co-ordination needed just breathe in

32
Q

Name a neural tube defect…

A

Spina Bifida

33
Q

Which of the following excipients would a pharmacist need to be cautious of when preparing a paediatric IV formulation

Benzyl alcohol
Propylene glycol
Glycerine
Sorbitol
Polyoxyl castor oil
Polysorbates
A

Benzyl Alcohol
Propylene Glycol
Polyoxyl caster oil
Polysorbates

Benzyl alcohol  contraindicated in (pre-term?) neonates as can lead to fatal toxic syndrome

Propylene glycol can cause adverse CNS events if elimination if impaired

Polyoxyl castor oil can cause severe anaphylactoid reactions (consider arachis oil – peanuts)

34
Q

Changes in abs rate appear to be of ____ importance when compared to the age related differences of drug distribution and excretion

A

MINOR

35
Q

Why are water soluble drugs e.g aminoglycosides needed in larger doses in neonates compared to older children?

A
  • Because the total body water and extracellular fluid volume decreases with age
  • So larger doses on a mg per kg of body weight basis are needed in younger patients to achieve the same plasma conc
36
Q

In what age group particularly is metabolic clearance significantly increased?
- What effect does this have?

A
  • 1-9 year olds
  • Increased metabolic clearance of drugs such as Theophylline, phenytoin and carbamazepine
  • May need higher dosage than adults on a mg per kg basis to achieve same plasma drug cons
37
Q

When should BSA calculations be used and when should they be avoided?

A
  • Useful in drugs with a narrow therapeutic index e.g cytotoxics
  • DO NOT USE in those under 1 year old as they tend to have a larger surface area than other age groups USE WEIGHT INSTEAD
38
Q

What can happen if a professional fails to ensure that the use of a medicine is reasonable?

A
  • A suit for negligence may be held (court case etc)
39
Q

Give an example of when an ‘off-label’ medicine may be used in children?

A
  • When a licensed adult dose for an indication is available but no child dose is available
  • Often necessary to prepare an extemporaneous liquid preparation for a child from the licensed form e.g by crushing tablets and adding suitable excipients
  • Appropriate formulas must be used with a valid expiry date to approved standards

DONE CLINICAL (10 decks)

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