Exam 1: Pediatrics Flashcards
(114 cards)
1
Q
Age Definitions: Gestational age
A
Estimated maturity at birth
2
Q
Age Definitions: Pre-term
A
<37 weeks
3
Q
Age Definitions: Full Term
A
37-40 weeks
4
Q
Age Definitions: Neonate
A
0-1 month
5
Q
Age Definitions: Infant
A
1-12 months
6
Q
Age Definitions: Young Child
A
2-5 years
7
Q
Age Definitions: Older child
A
6-12 years
8
Q
Age Definitions: Adolescent
A
13-17 years
9
Q
Medication Error definition
A
Failure of a planned action to be completed as intended
10
Q
T/F: Pediatric patients are at the greatest risk of medication errors
A
True
11
Q
4 Reasons medication errors occur for pediatrics
A
- dosing medication usually require calculations
- dosage forms and strengths are not always available
- dosage recommendations are not always available
- medication adherence is difficult
12
Q
2 Drugs that can affect growth and development
A
- thalidomide
2. fluoroquinolones
13
Q
Growth and development: Thalidomide effect
A
Used for nausea and morning sickness in pregnant women and cause phocomelia (birth defect, baby has no ilmbs)
14
Q
Growth and development: Fluoroquinolones effect
A
Affects development of tendons (tendon rupture) and teeth
15
Q
When do you use weight-for-stature for boys and girls growth chart
A
If they are standing up (birth - 36 months)
16
Q
When do you use length/weight-for-age for boys and girls growth chart?
A
If they’re laying down (birth - 36 months)
17
Q
When do you use BMI for age for boys and girls growth chart?
A
2 to 20 years of age
18
Q
Describe growth in neonates
A
Weight may decrease 10% below brith weight within first week (losing bloating and water retention) and then gain about 30g/day for the first month
19
Q
Describe growth in infants
A
Double birth weight by 4 months of life, weight should triple and length should double by 1 year of life
20
Q
Describe growth in children and adolescents
A
Weight gain of 2-3kg/year and height increase of 5-8cm/year
21
Q
Vital Signs: Temperature - Why is temperature not a complete indication of infection?
A
Self-regulation is not fully developed, sweat glands aren’t regulated properly and cannot cool down well
22
Q
Vital Signs: Temperature - what is the most accurate site of temperature measurement?
A
Rectal
23
Q
Vital Signs: BP - What is considered normal BP?
A
SBP and DBP <90% based on age, sex, and height
24
Q
Vital Signs: BP - What is considered pre-HTN?
A
SBP and DBP between 90-95% based on age, sex, and height
25
Vital Signs: BP - What is considered HTN?
SBP and DBP >95% based on age, sex, and height.
Stage 1: >95-99% plus 5mmHg
Stage 2: >99% plus 5mmHg
26
T/F: Heart rate decreases as you get older for pediatrics
True
27
T/F: Respiratory rate increases as you get older
False -- decreases as you get older because lungs are smaller when you are younger, requires more effort
28
PK: Absorption - Describe GI pH changes in full-term infants
Gastric pH remains elevated (6-8) at birth but declines to 1-3 within 24 hours (more amniotic fluid and don't produce as much gastric acid hence increased pH)
29
PK: Absorption: ____ drugs have INCREASED absorption
Acid-labile drugs (penicillin, erythromycin)
30
PK: Absorption - Weak ___ have DECREASED absorption
Acids (phenobarbital, ganciclovir -- become ionized and polar, unable to be absorbed)
31
PK: Absorption - immature bile acid production _____ absorption
Decreases (fat soluble vitamins)
32
PK: Absorption - describe gastric emptying changes in pediatrics
Gastric emptying is slower in pre-term infants and increased during 1st week of life
33
PK: Absorption - What is the effect of slower gastric emptying?
More time for medication to be absorbed, heightened therapeutic effect
34
PK: Absorption: What is the effect of increased gastric emptying?
Less time for med to be absorbed, less therapeutic effect
35
PK: Absorption - Frequent feedings
Drug-food interactions
36
PK: Absorption: Infants have ____ muscle mass
Decreased
37
PK: Absorption: ____ blood flow
Decreased
38
PK: Absorption: ___ muscle contractions
Decreased
39
PK: Absorption: Skin - percutaneous absorption can be greatly ____ in newborns
Increased
40
PK: Absorption: Skin - Why is absorption through the skin increased in newborns?
Underdeveloped epidermal barrier, increased skin hydration
41
PK: Absorption: Skin - T/F: Pediatric patients are more likely to have skin irritation from topical medications
True
42
PK: Distribution - Infants and children have a ___ body water to lipid ratio
Higher
43
PK: Distribution - Describe changes in body composition
As you get older, body water decreases and body fat increases
44
PK: Distribution: Protein binding - Increased/decreased drug binding in newborns
Decreased
45
PK: Distribution: Protein Binding - Why do newborns have decreased drug binding?
Decreased plasma protein conc.
Lower binding capacity
Decreased affinity
Competition
46
PK: Distribution: Protein Binding - decreased drug binding in newborns results in...
increased free drug (easy to become toxic)
| increased Vd
47
PK: Distribution: Body Fat - Compare effect of body fat in neonates/infants vs adults
Much lower in neonates and infants than adults, highly lipid-soluble drugs are less-widely distributed for babies
48
What is the effect of using sulfisoxazole in neonates?
Sulfisoxazole replaces bilirubin in the blood and causes kernicterus (irreversible damage to the brain)
49
PK: Metabolism - Metabolism is typically ___ in infants than in older children and adults
Slower
50
PK: Metabolism: CYP450 system - compare CYP450 system between full-term infants and adults
Approximately half of adult values for full-term infants
51
PK: Metabolism: CYP450 - T/F all isoenzymes mature at the same time
False - different isoenzymes mature at different times
52
PK: Metabolism: CYP450 - At what age range do children values exceed adult values?
1-9 years -- this causes increased metabolism of drugs, may require higher dose or more frequent use
53
PK: Metabolism - Describe maturation of Group 1 Enzymes
Peak during 2nd and 3rd trimester
54
PK: Metabolism - Describe maturation of Group 2 Enzymes
Relatively constant through life (2C19, 3A5)
55
PK: Metabolism - Describe maturation of Group 3 Enzymes
Little function in early life, expression increases over first several years of life (2C9, 2D6, 3A4)
56
PK: Metabolism: Enzyme Capacity - describe pediatric considerations for neonates and young infants
Decreased enzyme capacity, increased t1/2, decreased clearance (phenobarbital)
57
PK: Metabolism: Enzyme Capacity - describe pediatric considerations for children
Increased enzyme capacity, decreased t1/2, increased clearance (theophylline, voriconazole)
58
PK: Metabolism: Pathways: What is an example of metabolism pathways maturing at different times?
For infants, well-developed sulfation pathway but underdeveloped glucuronidation pathway (chloramphenicol, morphine, acetaminophen)
59
PK: Metabolism: Pathways: What is Grey Baby Syndrome?
Related to chloramphenicol administration for sepsis, causes cardiovascular instability and rapid progression to death
60
PK: Metabolism: Pathways: Describe correlation of chloramphenicol and immature glucuronidation pathway
Immature glucuronidation > decreased metabolism of chloramphenicol > increased concentration > grey baby syndrome
61
PK: Metabolism: Pathways: What is Gasping Baby Syndrome?
Related to benzyl alcohol (preservative in many multiple dose IV and PO formulations - pentobarbital, heparin flush), causes acidosis, seizures, gasping, intraventricular hemorrhage, death
62
PK: Metabolism: Pathways: What is the correlation between benzyl alcohol and immature glycine conjugation system?
Immature glycine conjugation system > accumulation of benzoic acid metabolite > gasping baby syndrome
63
PK: Metabolism: Pathways: To avoid gasping baby syndrome ___ should be avoided if possible but if not what dose should prescribers not exceed?
Benzyl alcohol, < or equal to 25mg/kg/day
64
PK: Elimination: T/F - Usually occurs via the liver
False - usually occurs via the kidney
65
PK: Elimination - T/F: GFR is much higher in infants than older children and adults
False - GFR is much LOWER
66
PK: Elimination: What is GFR for pre-term infants
As low as 0.6-0.8 ml/min per 1.73 m2
67
PK: Elimination: What is GFR for full-term infant?
2-4ml/min per 1.73m2
68
PK: Elimination - Describe pediatric considerations for neonates and infants
Decreased GFR, increased t1/2, reduced clearance (aminoglycosides)
Decreased tubular secretion, increased t1/2, reduced clearance (beta-lactam antibiotics)
69
PK: Elimination: CrCl - Describe difference in units for Adult and Pediatric CrCl
Adult - ml/min vs Pediatric - ml/min/1.73m2
70
PK: Elimination: CrCl - T/F: Both adults and pediatrics use the Cockcroft-Gault Equation to calculate CrCl
False - pediatrics uses Schwartz Equation (1-18 years of age)
71
PK: Elimination: CrCl - What is the Schwartz Equation?
CrCl = K x height / Scr
72
PK: Elimination: CrCl - What is K in the Schwartz Equation?
K = age-specific proportionality constant
73
PK: Elimination: CrCl - What is Scr in the Schwartz Equation?
Serum creatinine in mg/dL
74
PK: Elimination: CrCl - What is the Bedside Schwartz Equation
High correlation to measured GFR, replaces older formula
| GFR = (0.41 x height in cm) / creatinine
75
What are the 3 types of dosing for pediatrics?
1. weight-based
2. age-based
3. body-surface-area dosing
76
Treatment Principles: Describe weight-based dosing
Most common dosing method, max pediatric dose not established (don't surpass adult max dosage unless proven safe)
77
Treatment principles: describe age-based dosing
easy to use, assumes ADME is same for all patients
78
Treatment principles: describe body-surface-area dosing
Precise, used for exact dosage calculation drugs (chemo)
79
Child M has to get chemo therapy. What type of dosing method would you expect to see?
Body-surface-area dosing because it is most precise
80
Common Conditions in Peds Population: Common Cold: What is the frequency per year?
6-8 episodes per year
81
Common Conditions in Peds Population: AOM: What is it and any concerns?
Middle ear infection, concerns about over-treating it
82
Common Conditions in Peds Population: Pharyngitis: What is it?
Inflammation of the throat
83
Common Conditions in Peds Population: Type 1 DM: What is it
Autoimmune disorder affecting insulin secretion
84
Common Conditions in Peds Population: Eczema: What is it?
Chronic, itchy skin condition
85
Immunizations: Why is it dangerous to assume herd immunity?
Disease can still exist and effect non-immunized individuals (ex. Japanese pertussis epidemic - numbers were low, assumed herd immunity, stopped immunizing, blew up later again)
86
Immunizations: What 4 organizations endorse immunizations?
ACIP - Advisory Committee on Immunization Practices
COID - Committee of Infection Diseases
AAFP - American Academy of Family Physicians
ACOG - American Congress of Obstetricians and Gynecologists
87
Immunizations: What are the 2 types of immunity?
Passive and active immunity
88
Immunizations: What is passive immunity?
Person is given antibodies to a disease, immediate protection, short lived (mother-to-baby, IVIG)
89
Immunizations: What is active immunity?
Disease organism triggers immune system to produce antibodies to that disease, takes weeks to develop, long-lasting (sometimes life-long), via infection (Vaccines)
90
Immunizations: How do vaccines work?
Vaccines containing antigens are injected into body > immune system produces antibodies > memory cells remember how to produce antibodies again if you get sick with that disease
91
Immunizations: How do vaccines work?: What is inactivated vaccine?
Killed antigen
92
Immunizations: How do vaccines work?: What is attenuated vaccine?
Live but weakened
93
Immunizations: How do vaccines work?: What is conjugated/subunit vaccine?
Part of bacteria or virus
94
Immunizations: How do vaccines work?: What is toxoid vaccine?
Inactivated toxin
95
Immunizations: Describe risk vs benefit
No vaccine is 100% safe or effective but risk of disease is greater than risk of vaccine
96
Immunizations: Misconceptions: Why is the following misconception false but true? "Vaccines have mercury in them, which is bad for my baby"
Ethyl-mercury can be found in vaccines but not the same as methyl-mercury that is potentially harmful
97
Immunizations: What is thimerosal?
An ethyl mercury-containing preservative used in some vaccines (multi-dose vials of flu vaccine)
98
Immunizations: Describe correlation of thimerosal and Autism
Exposure to thimerosal-containing vaccinations is not associated with autism
99
Immunizations: What are some common adverse reactions?
Soreness, redness, swelling, fussiness, low grade fever
100
Immunizations: What are some valid contraindications?
Severe allergy (anaphylaxis) to prior vaccine, having moderate to severe acute illness (temporarily defer until illness resolved)
101
Immunizations: Anaphylactic Reactions: T/F: Itchiness to eggs means they cannot get the influenza vaccine
False - itchiness to eggs usually not a big deal, only concerned if they have anaphylaxis
102
Immunizations: Special Populations: T/F immunocompromised patients should only get live vaccines
False -- live vaccines are contraindicated (can cause significant illness)
103
Immunizations: Special Populations: What are live vaccines contraindicated for immunocompromised patients?
MMR, Var, Rotavirus
104
Immunizations: Special Populations: T/F Pregnant patients should only get the inactivated flu shot
True - Live vaccines are contraindicated so not allowed to get FluMist (life attenuated vaccine), MMR, Var
105
Immunizations: What is VAERS and potential issues?
Vaccine Adverse Event Reporting System, anyone can put stuff on there (can be manipulated but also can be helpful)
106
Immunization: Anaphylactic Reactions: Vaccines with egg products
Influenza, yellow fever
107
Immunization: Anaphylactic Reactions: Vaccines with neomycine
IPV, MMR, Var
108
Immunization: Anaphylactic Reactions: Vaccines with Streptomycin
IPV
109
Immunization: Anaphylactic Reactions: Vaccines with Polymixin B
IPV
110
Immunization: Anaphylactic Reactions: Vaccines with Baker's yeast
HepB
111
Immunization: Anaphylactic Reactions: Vaccines with gelatin
Var, MMR
112
Pediatric BMI: What percentile is overweight?
85-95 percentile
113
Pediatric BMI: What percentile is obese?
> or equal to 95th percentile
114
Pediatric BMI: What percentile is underweight?
<5th percentile
