Chapter 23: Pediatric Patients Flashcards Preview

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Flashcards in Chapter 23: Pediatric Patients Deck (71):
1

 

 

7 questions prior to prescribing for a pediatric patient

 

  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?

2

 

 

what factors affect drug absorption in children

 

 

blood flow at administration site

GI function

thinner statum corneum (outer layer of epidermis)

3

 

 

what factors affect drug distribution in children

 

 

body composition changes as they grow 

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

4

 

 

what accounts for variability in drug metabolism in children

 

 

ability of small bowel to metabolize drugs

5

 

 

differences in excretion in infants

 

 

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

6

 

 

how are the vast majority of perdiatric medications dosed

 

 

mg/kg

7

 

 

why is ASA contraindicated in pediatric patients

 

 

association with Reye's syndrome and GI side effects

 

8

 

 

exceptions to pediatric contraindication of ASA

 

 

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

9

 

 

contraindication of cough/cold preparations in pediatric patients

 

 

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

10

 

 

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

 

 

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

not generally given to children under 18

11

 

 

contraindication of tetracyclines in pediatric patients

 

 

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

12

 

 

why is metoclopramide (Reglan) contraindicated for pediatric patients

 

 

potential to cause EPS and tardive dyskinesia

(often irreversible)

13

 

 

anti-migraine serotonin 5-HT receptor agonists in children

 

 

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

14

 

 

drugs with black box warning for use in children

 

drugs used to treat depression

drugs used to treat eczema

drugs used to treat asthma

drugs used to treat ADHD

15

 

 

black box warning for promethazine (phenergan) in children

 

 

can cause severe or fatal respiratory depression in children under 2

over 2, use caution and gice lowest effective dose

16

 

 

black box warning for pimecrolimus (Elidel) and

tacrolimus (Protopic, Prograf) for eczema in children

 

 

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

not for use in children younger than 2

17

 

 

metformin black box warning for use in pediatric patients

 

 

may cause lactic acidosis

rare but severe

18

 

 

ACE inhibitor black box warning for use in pediatric patients

 

 

can cause injury and death to developing fetus

19

 

 

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

 

 

increased risk of asthma related deaths

only for use as a last resort

20

 

 

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

 

 

drug dependency may develop

21

 

 

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

 

 

misuse can cause death and serious cardiovascular event

22

 

 

what are some family issues that can affect drug adherence

 

caregiver doesn't understand an important aspect of regimen

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

 

23

 

 

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

escitalopram (Lexapro)

citalopram (Celexa)

paroxetine (Paxil)

fluoxetine (Prozac)

sertraline (Zoloft)

aririprazole (Abilify)

quetiapine (Seroquel)

24

 

 

treatment of infectious conjunctivitis in children

 

 

ABT drps (polymyxin B + trimethoprim)

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