Child Health PPT

Question 1

altered physiology in kids

Answer 1

■ Low production of gastric acid and erratic gastric emptying in first year of life
.■ Smaller ratio of gut surface area to body mass, but greater gut permeability to larger molecules.
■ Greater proportion of body fat and larger extracellular volume may alter the volumes of distribution of some drugs.
■ Maturation of drug-metabolising enzyme pathways in the liver occurs at different rates over the first year

Question 2

Pharmacokinetics

Answer 2

• Inefficient metabolism and renal clearance
• Absorption – slower rates of gastric emptying and intestinal transit. In neonates gastric pH is neutral which can reduce absorption of weak acids but inc the abs of weak bases
• Distribution – neonates and young kids have a lower body fat content and higher total body water than adults which -> impacts dist of water and lipid soluble drugs
• Neonates have lower plasma albumin conc and higher FFA conc which may compete with drugs for plasma protein binding sites
• The overall effect is reduced plasma protein binding, which may increase the proportion of drug able to cross the blood–brain barrier

Question 3

What should not be used in neonatal jaundice

Answer 3

• Drugs that are strongly bound to albumin should not be used during neonatal jaundice, because the drugs may displace bilirubin (which is mostly in the unconjugated form) from protein-binding sites and increase the risk of kernicterus.

Question 4

drug dose in child

Answer 4

Drug dose for a child = adult dose x SA of child (in m2) /
1.8

Question 5

common meds kids respond diff to

Answer 5

• paracetamol
• aminoglycosides
• opiods
• benzos
• steroids - g&d

Question 6

paradoxial reactions with…

Answer 6

Paradoxical Reactions: Some children may experience paradoxical excitation rather than sedation when given first-generation antihistamines like diphenhydramine.

Question 7

preterm =

Answer 7

before 37 weeks gestation

Question 8

neonate

Answer 8

birth to 27 daysi

Question 9

infant -

Answer 9

28 Dys to 2 yrs

Question 10

child

Answer 10

2-12 yrs

Question 11

adolescent =

Answer 11

12 - 16/18

Question 12

aspirin

Answer 12

Should not be prescribed in children under 16
o Except in Kawasaki disease or rheumatic fever (rare)

Question 13

Reyes syndrome

Answer 13

• Usually between 5 -14 yrs
• Acute encephalopathy and fatty degeneration of the liver
• Usually occurs during recovery of viral illness, with rapid deterioration
• Associated with aspirin use

Question 14

choice of analgesia in kids

Answer 14

1) Paracetamol
2) Add NSAID
3) P + NSAID + Opiod

Question 15

drugs with low Fe (fraction excreted unchanged in urine)

Answer 15

– Paracetamol
– Chloramphenicol (gray baby syndrome)

Question 16

coedine important info

Answer 16

• CYP2D6 variants
• Codeine ultra rapid metabolisers
• ONLY USED IN ABOVE 12S

Question 17

Coedine cant be used …

Answer 17

when BF - goes into milk

Question 18

whats CI in CP

Answer 18

ibuprofen and NSAIDs CI -> nec fascitis

Question 19

Advantages to using the rectal route

Answer 19

• Vomiting
• Bypasses FPM (nasal spray also does this)

Question 20

neonates - ph

Answer 20

• Prolonged gastric emptying
• Unpredictable peristalsis
• pH higher – neutral at birth
• Reduced bile acid secretion

Question 21

young infants pH

Answer 21

• prolonged gastric emptying – more abs time
• Less acidic ph – basic drugs absorbed better than in adults

Question 22

older infants

Answer 22

• Intestinal hurry – rapid bowel transit, reduced abs
• Adult ph

Question 23

children and paracetamol OD

Answer 23

• In children, P450 system immature
• Less NAPQI (toxic) produced in overdose -> more resistant to overdose of paracetamol than adults

Question 24

oral solution vs oral suspension

Answer 24

• Oral solution: particles dissolved in the liquid are much smaller
• Oral suspension: particles larger so precipitate to bottom when its left, need to shake a suspension first before using

Question 25

Dosing of gentamicin in kids

Answer 25

* Higher in kids than in adults – greater ECF bc hydrophilic drug so greater VOD

Question 26

most common cause of viral encephalitis

Answer 26

HSV1

Question 27

aciclovir prescribing

Answer 27

* Confirm CSF – for herpes simplex virus before stopping Tx * Indication, age , weight, body SA * Body SA can be found on BNF under body surface area in children under medicines guidance – need weight to find body SA

Question 28

converting units

Answer 28

Question 29

tablet calcs

Answer 29

Number of tablets required = what u want/ what you’ve got