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Pharmacology > Chapter 23: Pediatric Patients > Flashcards

Chapter 23: Pediatric Patients Flashcards

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1
Q

7 questions prior to prescribing for a pediatric patient

A
  1. How does the age affect drug’s pharmacokinetics and pharmacodynamics?
  2. has drug dosage (mg/kg) been carefully calculated?
  3. Has tast, texture, and ease of administration been considered?
  4. Have you considered contraindications in pediatric population?
  5. Have black box warnings been considered?
  6. Have risks v benefits been carefully considered?
  7. Has the caregiver’s ability to administer medications and compliance been considered?
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2
Q

what factors affect drug absorption in children

A

blood flow at administration site

GI function

thinner statum corneum (outer layer of epidermis)

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3
Q

what factors affect drug distribution in children

A

body composition changes as they grow

(levels of total water and muscle-to-fat ratio shifts)

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4
Q

what accounts for variability in drug metabolism in children

A

ability of small bowel to metabolize drugs

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5
Q

differences in excretion in infants

A

drugs are more slowly excreted causing dosing adjustments in medications that are excreted renally

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6
Q

how are the vast majority of perdiatric medications dosed

A

mg/kg

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7
Q

why is ASA contraindicated in pediatric patients

A

association with Reye’s syndrome and GI side effects

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8
Q

exceptions to pediatric contraindication of ASA

A

kawasaki syndrome, rheumatic fever, or surgical correction of congenital heart disease

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9
Q

contraindication of cough/cold preparations in pediatric patients

A

do not give to children under 2 because they are inefficient and can produce unwanted side effects

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10
Q

why are fluoroquinolones (Cipro, Levaquin) contraindicated in pediatric patients

A

adverse effects n growth of immature cartilage, joints, and surrounding tissues

not generally given to children under 18

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11
Q

contraindication of tetracyclines in pediatric patients

A

not used in children under 8 because they can cause dental discoloration, enamel hypoplasia, and skeletal development deformities

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12
Q

why is metoclopramide (Reglan) contraindicated for pediatric patients

A

potential to cause EPS and tardive dyskinesia

(often irreversible)

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13
Q

anti-migraine serotonin 5-HT receptor agonists in children

A

contraindicated because of side effects of MI, stroke, death, and vision loss

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14
Q

drugs with black box warning for use in children

A

drugs used to treat depression

drugs used to treat eczema

drugs used to treat asthma

drugs used to treat ADHD

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15
Q

black box warning for promethazine (phenergan) in children

A

can cause severe or fatal respiratory depression in children under 2

over 2, use caution and gice lowest effective dose

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16
Q

black box warning for pimecrolimus (Elidel) and

tacrolimus (Protopic, Prograf) for eczema in children

A

can increase susceptibility to infection and development of lymphoma d/t immunosuppression

not for use in children younger than 2

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17
Q

metformin black box warning for use in pediatric patients

A

may cause lactic acidosis

rare but severe

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18
Q

ACE inhibitor black box warning for use in pediatric patients

A

can cause injury and death to developing fetus

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19
Q

salmeterol (Advair, Serevent) black box warning for use in children

A

increased risk of asthma related deaths

only for use as a last resort

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20
Q

methylphenidate (Concerta, Metadate, Methylin, Ritalin) black box warning for use in children

A

drug dependency may develop

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21
Q

amphetamines (Adderall, Vyvanse) black box warning for use in children

A

misuse can cause death and serious cardiovascular event

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22
Q

what are some family issues that can affect drug adherence

A

caregiver doesn’t understand an important aspect of regimen

caregiver has difficulty administering to child who desnt want to take it

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23
Q

examples of drugs that can increase suicidal ideation in children and adolescents

A

escitalopram (Lexapro)

citalopram (Celexa)

paroxetine (Paxil)

fluoxetine (Prozac)

sertraline (Zoloft)

aririprazole (Abilify)

quetiapine (Seroquel)

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24
Q

treatment of infectious conjunctivitis in children

A

ABT drps (polymyxin B + trimethoprim)

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25
treatment of allergic conjunctivitis
seasonal eyedrops like azelastine or naphazoline+pheniramine
26
symptoms of infectious conjunctivitis
mild lid edema yellow, usially copius discharge, especially on waking sometime mild respiratory infection
27
symptoms of allergic conjunctivitis
conjunctiva has cobblestone appearance discharge is somewhat clear and watery history of sneezing, itching seasonal reoccurence
28
treatment of otitis media in children
usually does not require ABTs watchful waiting ad adequate pain control
29
ABT of choice in treating otitis media if it is needed
amoxicillin syrup
30
difference between amoxicillin rash and allergic rash
amoxicillin is nonpuritic, macopaplura and begin on trunk spreading to rest of the body and will clear on its own. Drug does not need to be discontinued allergic rash is intensly puritic and requires discontinuation of drug
31
treatment of otitis externa (swimmers ear) in children
apply topical agent to Q-tip and insert in ear
32
dextromethorphan use to treat common cold
do not give when cough is productive or generates alot of mucus caution between 2-12 antitussive
33
guaifenesin (Mucinex, Robitussin) to treat common cold
expectorant do not use in children under 2 2mg/kg q4-6 hours
34
codeine in treating the common cold
narcotic antitussive use extreme caution
35
symptoms of allergic rhinitis
nosebleed, nasal pruritus, throat clearing, chronic cough that is worse at night
36
3 step approach to treating allergic rhinitis
begin with oral antihistamine (Benadryl) or loratidine (Claritin) add nasal steroids if needed (Flonase) add oral leukotriene inhibitor (Singulair)
37
typical diagnostic criteria for sinusitis as opposed to allergic rhitic
more than 7 days of copious nasal congestion accompanied by chronic cough
38
treatment of sinustis in children
antibiotics
39
classic symptoms of treptococcal pharyngitis (strep throat)
relatively sudden onset of fever, pharyngitis, exudative/erythematous tonsils, cervical adenopathy, headache, stomach ahce
40
treatment of strep throat
10 days of amoxicillin OR 5 days of cephalosporins
41
presentation of infectious mononucleosis (mono)
several days of lethary followed by fever, cervical adenitis, and intensly painful pharyngitis often tonsilar hypertrophy, cervical adenopathy, and splenomegaly
42
treatment of mono
multipronged and includes the use of steroids markedly edematous tonsils with no obvious abcess can be treated with dexamethasone
43
presentation of herpetic gingivostomatitis
extremely painful and extensive oral lesions affecting entire oral cavity (fever and irritability often precede)
44
treatment of herpetic gingivostomatitis
usually narcotic because of refusal to take anything PO and prevention of dehydration is important
45
treatment of thrush
antifungal drugs such as nystatin fluconazole if nystatin is ineffective
46
what is the most important thing to ascertain first in children with respiratory distress
whether it is affecting the upper or lower airways
47
treatment of asthma in pediatric patients
SABA for occasional attacks, if needed more than 2 days/week add inhaled corticosteroids. Therapy can be stepped down after several months with no attacks
48
therapy goals in treating asthma
prevent symptoms minimize morbidity when attacks occur allow child to live as close to a normal life as possible
49
administration methods of asthma medication to children
\<4: MDI w/ mask/spacer 4-6: MDI and a valve holding chamber \>6: pMDI, breath actuated pMDI, or DPI
50
treatment of bronchiolitis
usually supportive with lots of nasal suctioning can trial SABAs steroids are not appropriate
51
treatment for croup
decadron for mild0mod decadron and nebulized racemic epinephrine for severe
52
treatment of influenze
antivirals zanamivir (Relenza) and oseltamivir (Tamiflu)
53
treatment for pneumonia
ABTs
54
treatment of diarrhea in children
OTC medications fluid and electrolyte therapy if severe
55
treatment of GERD in pediatric patient
start with dietary and feeding techniques add histamine-2 receptor agonists if needed (Zantac, Pepcid) if severe use PPI (once started ween patient off H-2 agonist over 2 weeks)
56
presentation of pinworms
pruritic com[laint in peri-anal region that worsens at night can be seen in rectal area or stools eggs can be seen in skin folds
57
treatment of pinworms
one tablet of mebendazole (Vermox) 100mg with another in 2 weeks
58
treatment of gas in pediatric patients
simethicone (Mylicon) drops
59
pain management in children
best to underdose and workup so as to accidently overdose patient usually can treat with acetominophen or ibuprofen NO ASA d/t Reyes syndrome
60
nonpharmicologic interventions for ADHA
behavior modification family education and counseling educational intervention
61
ADHD medications
methylphenidate (Ritalin) dexmethylphenidate (Focalin) dextroamphetamine (Dextrostat) atomoxetine (Stratters) Lisdexamfetamine dimesylate (Vyvanse)
62
treatment of migraines in children
start with medication at a dose that is meant to abort the meadache within 2 hours if unsuccessful, double the dose and repeat hopefully patient will be symptom free within 4 hours
63
when should prophylactic treatment for migraines be initiated
no response to acute management frequent headaches missing alot of school debilitating headaches
64
medications used for prophylactic migraine treatment
anticonvulsants, antidepressants, antihistamnes, beta-blockers, calcium channel blockers, and NSAIDs
65
medications used for acute treatment of migraines
sumatriptan (Imitrex) zolmitriptan (Zomig) rizatriptan (Maxalt) almotriptan (Axert) eletriptan (Relpax) fovatriptan (Frova)
66
types of primary headaches
migraine tension
67
causes of secondary headaches
sinus disease tumors febrile illnesse such as meningitis or viral infections
68
typical treatment period for migraine prophylactic medication
3-18 months with average at 6 months
69
treatment of iron deficiency anemia in children
iron replacement therapy 3-6mg elemental Fe/kg q24h divided in 3-4 doses formulated as drops, elixir, oral liquid, tablets
70
side effects of oral iron therapy
constipation, dark stools nausea and epigastric pain liquids may stain teeth so give with dropper or drink with straw
71

Pharmacology (28 decks)

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