Children Flashcards
(13 cards)
what age is a neonate?
0-28 days
how long is normal pregnancy?
40 weeks, prem is less than 38
what age is a child?
1-17 years
how should prescribing in obesity be approached?
dont use mg/kg- toxicity risk. can use adjusted bw or close tdm
what does off-label prescribing mean?
deviates from spc reccomendations- eg aspirin in under 16s for kawasaki disease
what is unliscensed prescribing?
no spc. specials/extemp
what excipients are cautioned in children and why?
propylene glycol preservative- effects cns
benzoic acid preserve- causes jaundice
sorbitol sweetener- can act as laxative
sucrose etc- tooth decay
ethanol- max for under 6’s is 6mg/kg or 1mg/100ml
what is congenital adrenal hyperplasia?
CAH is an inherited condition that effects adrenal cortex. Effects adrenal glands above kidneys which form hormones such as cortisol, aldosterone and androgens. in CAH there is under production of cortisol and aldosterone and so body overproduces androgens to over comp. cortisol is for stress managment, bp and glucose regulaton. aldosterone is for salt water balance and bp reg. androgens are sex hormones produced in both males and females.
how is CAH treated?
high dose hydrocortisone to replace cortisol deficiency and to supppress androgens
outline the counselling points for hydrocortisone therapy
- if oral liquid, shake well to mix throughouly as has narrow TW
- USse oral syringe/spoon to help with acurate dosing
- look out for the signs of OD- weight gain, swelling, increased BP
- look out for underdosing/adrenal crisis- fatigue, weak, nausea
- Do not stop suddenly- life threatening adrenal insufficency
- may need extra doses in periods of fever, stress or illness but speak to specialist,
- ensure parents have emergency kit and how to use in adrenal crisis
- usually unliscensed meds- so order rx well ina dvance
- make sure patient has adrenal insufficiency card- tells u what to do in sickness, tells others patient is steroid dependent/ adrenal insufficiency risk
what are the pk changes in children?
absorption- decreased intestinal transit time due to being smaller. so decreased cmax (rate) and AUC (extent) of absorption of poorly water sol drugs (theophyline). altering pHs as get older- neonate pH is 7, fluctuates between 0-2 then stabilies after.effects weak acids and bases due to lack of ionisation. decreased bile concentration so decreased solubilisation of lipophilic drugs so decreased cmax and AUC
distribution- high TBW- decreases as get older-increased VD of hydrophilic drugs. High fat content 0-1years- increased VD of liphophilic drugs. decreased serum albumin- decreased protein binding, so increased free fraction of drug, so toxicity risk
metabolism- extended half lives of drugs close to birth, immature liver, so reduced metabolsim of hydroxylated drugs (phase 1)- diazepam. ok after 6 months
excretion- decreased glomerular filtration in less than 3 months (increases with age)- immature kidneys-avoid NSAIDs.
what are PD changes to be aware of in children?
children experience increased extra-pyrimidal effects of drugs (tremors, involuntary movements)
what is the grey-baby syndrome case?
in 1940’s
babies have impaired gluconyl-transferase activity (enzymes of phase 2 glucoronidation) due to immature liver, so accumulated and caused grey baby syndrome (grey discolouration of skin)
