Lecture Flashcards
Are there a lot of studies on medication in children?
No, there are few studies with small evidence bases
Where does a lot of research for children’s medication come from?
Extrapolation of drug effect from adult studies
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
Off-label use
___% of drugs not FDA approved for children (fewer for infants)
60%
___% of drugs lack dosing, efficacy, and safety data for children
75%
There is limited data on efficacy and safety of _____, they are NOT FDA regulated
complimentary and alternative medicine (CAM)
FDA regulated but efficacy not demonstrated, recent labeling “not for use under 2 years old”
OTC drugs
Why do you round up doses for parents/caregivers?
To avoid decimals
Round-up of drug doses should be limited to ___% of the dose
10%
Why should you not use a teaspoon to measure medicine?
Teaspoons can range from 2.5-7.8mL
What should you use to measure medicine for a child?
Syringe or specific calibrated measuring device (avoid measuring cups!)
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
IM
Drug dissolved and evenly distributed in alcohol; caution re-evaporation
Elixirs
Undissolved particles of drug suspended in solution; need distribution by shaking; caution re-variable dosing if not well distributed
Suspensions
You should not give honey to an infant less than ___ year(s) old
1
Why do you not give honey to infants?
Clostridium botulinum
When can you start giving a child capsules or tablets?
Age 6
Variable absorption may result in higher blood levels; difficult to predict
Rectal
Why is the first pass effect variable in the rectum?
Depends on location of medication in rectum
When can you give a pedi patient a nebulizer?
Age 3
When can you give a pedi patient an MDI?
Age 5
___% of dosing errors occur in children
70
It is okay to use ___ 0’s but not ____ 0’s on prescriptions
LEADING 0’s okay (0.5)
TRAILING 0’s bad (5.0)
How do you calculate the dose on SMX/TMP?
Calculate dose on the TMP component
How do you calculate the dose of amoxicillin/clavulanate?
Calculate on amoxicillin component
Are cough and cold meds labeled for less than 4 years old?
No - FYI infant versions of cough and cold meds were taken off the market in 2008
There has been a ___% reduction in ER visits for children less than 2 years old for OTC toxicity
50
Of 2009 reported poisonings, how many were in children less than 3? How many were in children less than 6?
Less than 3 = 40%
Less than 6 = 50%
1 or 2 capsules of ____ can cause coma, convulsions, or cardiac arrest
Benzonatate
Elemental iron 60mg/kg is a problem drug
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)
What is the best source of information for drug dosing in children, but is often not available?
Manufacturer’s package insert information
What is the hierarchy of accurate measurements for drug dosing from most accurate to least
Best = body surface area Middle = Weight dosing Least = Age dosing
Clark’s rule
For weight dosing
Young’s rule
For age dosing
High gastric pH, irregular peristalsis, low levels pancreatic enzymes, bile acids can all alter absorption
GI system in neonates
