Lecture

Question 1

Are there a lot of studies on medication in children?

Answer 1

No, there are few studies with small evidence bases

Question 2

Where does a lot of research for children’s medication come from?

Answer 2

Extrapolation of drug effect from adult studies

Question 3

Use med for treatment of illness not listed in package insert, use drug outside licensed age range, dosing drug outside approved dose range, use of route of administration not approved

Answer 3

Off-label use

Question 4

___% of drugs not FDA approved for children (fewer for infants)

Answer 4

60%

Question 5

___% of drugs lack dosing, efficacy, and safety data for children

Answer 5

75%

Question 6

There is limited data on efficacy and safety of _____, they are NOT FDA regulated

Answer 6

complimentary and alternative medicine (CAM)

Question 7

FDA regulated but efficacy not demonstrated, recent labeling “not for use under 2 years old”

Answer 7

OTC drugs

Question 8

Why do you round up doses for parents/caregivers?

Answer 8

To avoid decimals

Question 9

Round-up of drug doses should be limited to ___% of the dose

Answer 9

10%

Question 10

Why should you not use a teaspoon to measure medicine?

Answer 10

Teaspoons can range from 2.5-7.8mL

Question 11

What should you use to measure medicine for a child?

Answer 11

Syringe or specific calibrated measuring device (avoid measuring cups!)

Question 12

Route of administration that is not well tolerated because of variable muscle mass in infants and young children as well as variable blood flow to muscle and SQ tissue

Answer 12

IM

Question 13

Drug dissolved and evenly distributed in alcohol; caution re-evaporation

Answer 13

Elixirs

Question 14

Undissolved particles of drug suspended in solution; need distribution by shaking; caution re-variable dosing if not well distributed

Answer 14

Suspensions

Question 15

You should not give honey to an infant less than ___ year(s) old

Answer 15

1

Question 16

Why do you not give honey to infants?

Answer 16

Clostridium botulinum

Question 17

When can you start giving a child capsules or tablets?

Answer 17

Age 6

Question 18

Variable absorption may result in higher blood levels; difficult to predict

Answer 18

Rectal

Question 19

Why is the first pass effect variable in the rectum?

Answer 19

Depends on location of medication in rectum

Question 20

When can you give a pedi patient a nebulizer?

Answer 20

Age 3

Question 21

When can you give a pedi patient an MDI?

Answer 21

Age 5

Question 22

___% of dosing errors occur in children

Answer 22

70

Question 23

It is okay to use ___ 0’s but not ____ 0’s on prescriptions

Answer 23

LEADING 0’s okay (0.5)

TRAILING 0’s bad (5.0)

Question 24

How do you calculate the dose on SMX/TMP?

Answer 24

Calculate dose on the TMP component

Question 25

How do you calculate the dose of amoxicillin/clavulanate?

Answer 25

Calculate on amoxicillin component

Question 26

Are cough and cold meds labeled for less than 4 years old?

Answer 26

No - FYI infant versions of cough and cold meds were taken off the market in 2008

Question 27

There has been a ___% reduction in ER visits for children less than 2 years old for OTC toxicity

Answer 27

50

Question 28

Of 2009 reported poisonings, how many were in children less than 3? How many were in children less than 6?

Answer 28

Less than 3 = 40% | Less than 6 = 50%

Question 29

1 or 2 capsules of ____ can cause coma, convulsions, or cardiac arrest

Answer 29

Benzonatate

Question 30

Elemental iron 60mg/kg is a problem drug

Answer 30

I didn't know how to turn this into a flash card but I have trust issues so I wanted to make sure you all saw it in case T dubs tries to trick us (Which he won't but... Trust no one)

Question 31

What is the best source of information for drug dosing in children, but is often not available?

Answer 31

Manufacturer's package insert information

Question 32

What is the hierarchy of accurate measurements for drug dosing from most accurate to least

Answer 32

``` Best = body surface area Middle = Weight dosing Least = Age dosing ```

Question 33

Clark's rule

Answer 33

For weight dosing

Question 34

Young's rule

Answer 34

For age dosing

Question 35

High gastric pH, irregular peristalsis, low levels pancreatic enzymes, bile acids can all alter absorption

Answer 35

GI system in neonates

Question 36

Diarrheal conditions in children can ___ absorption

Answer 36

DECREASE

Question 37

___ absorption is highly variable

Answer 37

Rectal

Question 38

___ absorption is higher in neonates/infants

Answer 38

Topical

Question 39

Thin stratum corneum, increased cutaneous perfusion, higher surface to weight ratio

Answer 39

Reasons why topical absorption is higher in neonates/infants

Question 40

A full term infant is ___% water

Answer 40

70-75% (Holy shit babies are just like lettuce... mostly water)

Question 41

A small preterm infant is ___% water

Answer 41

85% FYI Babies are NOT hydration foods please don't eat them

Question 42

Is body fat high or low in pre-term infants?

Answer 42

Low

Question 43

How does low body fat affect the distribution of a drug?

Answer 43

Drugs with lipid affinity will have more free drug

Question 44

Serum proteins are ___ bound to albumin in infants (sulfonamides)

Answer 44

LESS

Question 45

When does a child have adult albumin levels?

Answer 45

About 1 year

Question 46

The body water of a child/infant affects ____ soluble drugs

Answer 46

WATER like aminoglycosides (Not lipid)

Question 47

Neonates have ____ P450 activity

Answer 47

LESS (50-70% of adult levels)

Question 48

Phase 1 reactions and enzymes are impaired in??

Answer 48

Preterm infants and neonates

Question 49

Children have 2X the adult rate of hepatic metabolic enzyme activity from ___ months to ___ years

Answer 49

6 months to 9-12 years

Question 50

Variable rates of hepatic metabolic enzyme activity are good to know for which drugs??

Answer 50

Anticonvulsants

Question 51

Infants of mothers on drugs that induce hepatic enzymes, like phenobarbital, may have increased ______ rates early after delivery

Answer 51

Metabolic

Question 52

When do babies GFR rates meet adult rates?

Answer 52

6-12 months

Question 53

___ have more rapid metabolism and renal elimination than adults

Answer 53

Toddlers

Question 54

When can you use cockoft-gault formula?

Answer 54

When a child turns 18

Question 55

What is the creatinine clearance equation for children?

Answer 55

Schwartz equation

Question 56

The blood brain barrier is ____ effective in neonates and young children

Answer 56

Less -- greater opioid impact and bilirubin can pass through

Question 57

Infants have only ___ to ___% of adult number of alveoli

Answer 57

10-15%

Question 58

Children reach the same number of alveoli as adults at age ___

Answer 58

8

Question 59

Do children have more or fewer beta receptors than adults?

Answer 59

Less, fewer, not as much... makes sense cause they tiny

Question 60

What types of drugs can cause children to have paradoxical effects?

Answer 60

Benz's and antihistamines

Question 61

Children will have increased dystonic reactions to _____

Answer 61

Metochlopramide

Question 62

Parents need to take caution with systemic absorption of which drug?

Answer 62

Lidocaine

Question 63

What can be prescribed for teething?

Answer 63

Lidocaine (caution), 7.5% benzocaine gel w/o alcohol (Orajel baby), HS ibuprofen NOT BOOZE turns out its bad for babies oh well more for us

Question 64

What is used to treat a mild, non-candidal diaper rash?

Answer 64

Zinc oxide cream

Question 65

What can you use to treat a candidal diaper rash?

Answer 65

Clotrimazole 1% cream

Question 66

What type of diet do you give to a child with mild diarrhea?

Answer 66

A regular diet, BRAT diet is less effective

Question 67

Acid pH to replicate normal ear canal environment

Answer 67

Otic suspensions

Question 68

Why shouldn't you use otic suspensions with vent tubes or recent perforations?

Answer 68

Painful! You wouldn't want to hurt a child and if you do you're an ass hole

Question 69

Balanced pH, more viscous

Answer 69

Ophthalmic suspensions

Question 70

How do you make an ophthalmic solution an otic solution?

Answer 70

Add 2-3 drops of NSS to a 5mL bottle

Question 71

Can cause increased impulsivity, silliness, daring conduct, and agitation in adolescents

Answer 71

SSRIs/antidepressants

Question 72

What drugs carry an increased suicidal ideation risk in the initial months of therapy and after dose changes?

Answer 72

Antidepressants/SSRIs

Question 73

Antidepressants have a __ __ warning

Answer 73

Purple box.... Just kidding.... Brown box.... Just kidding BLACK BOX (sorry Paige I stole your card funny)

Question 74

This drug makes children and adolescents more susceptible to extrapyramidal symptoms, especially dystopias, and can cause more weight gain which would make high school a real bitch

Answer 74

Antipsychotics

Question 75

Am I going to include anything about dosing in these cards?

Answer 75

No thats what uptodate is for

Question 76

What drug do you NEVER EVER EVER want to use in children especially when they have a fever and why

Answer 76

Aspirin - can cause Reye's syndrome?

Question 77

Fatty liver degeneration, encephalopathy, liver failure

Answer 77

Reyes syndrome

Question 78

Preferable to Lidocaine for topical mucosal administration, especially if administered repeatedly; Poorly soluble in water and very slowly absorbed so don’t get toxic levels as easily as lidocaine

Answer 78

Benzocaine

Question 79

Joint space crystalization possibilities in children | Have been used in children with cystic fibrosis without significant problems

Answer 79

Fluoroquinolone antibiotics

Question 80

Not for repeated topical application in children due to rapid absorption and potential toxicity

Answer 80

Lidocaine

Question 81

Primarily hepatic concentration/metabolism, biliary excretion; P450 interactions, nausea, increased gastric motility

Answer 81

Erythromycin, clarithromycin

Question 82

Tissue & macrophage concentration, minimal hepatic metabolism; Primarily excreted in bile

Answer 82

Azithromycin

Question 83

Generalized motor seizures in infants

Answer 83

Phenobarbitol

Question 84

Avoid in PG and children less than 8 years old because of dental staining

Answer 84

Tetracyclines

Question 85

Teratogenic (increases risk malformed fetus 25x)

Answer 85

Isotretinoin

Question 86

Patients on isotretinoin have to be on how many forms of birth control?

Answer 86

2

Question 87

Barrier protection for diaper irrigation in infants and nursing homes

Answer 87

Zinc oxide cream

Question 88

Do we wanna study the drug tables for this exam?

Answer 88

No fuck the drug tables we have already been tested on everything on there good job PEACE OUT