PAEDIATRICS Flashcards by Gab O

How many weeks gestation is classed as ‘pre term’?

Less than 37 weeks

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What age range is classed as a ‘child’?

2-12yrs

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12-18yrs is classed as…

Adolescent

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Neonates are…

0-1 month

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Infants are classed as…

1-24 months old

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Infants have _____ oral abs of Penicillin antibiotics

INCREASED - due to increased gastric emptying time and reduce gastric pH

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Infants have _____ oral abs of Phenobarbital, Phenytoin and Rifampicin

REDUCED

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Those under 3 years old have _____ gastric acid secretion and ____ gastric emptying time

REDUCED gastric acid secretion

INCREASED gastric emptying time

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Neonates have _____ variable blood flow

REDUCED

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IM drug absorption is ____ in neonates

ERRATIC

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Why is Vit K IM given at birth?

Because it doesn’t pass well through the placenta so some babies are born deficient which increases the risk of bleeding in the brain (VIT K INVOLVED IN CLOTTING)

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Neonates and infants have ____ systemic abs of topical preparations.

Give an example of when this can have consequences.

INCREASED - due to well hydrated skin, increased SA to body weight ratio and immature epidermal barrier

Corticosteroid use - moon face (cushinoid effects)

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Specials are…
Licensed
Unlicensed
Off - Label

Unlicensed

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Neonates have _____ variable blood flow

REDUCED

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IM drug absorption is ____ in neonates

ERRATIC

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Neonates have a ____ volume of distribution for water soluble drugs

HIGHER

Due to the differing volume of distribution in neonates, they need ____ doses of water soluble drugs such as penicillins compared to adults.

HIGHER on weight to weight basis

Fat soluble drugs in neonates need ____ doses e.g diazepam

SMALLER

Plasma protein binding is reduced in neonates and infants as total protein concentrations and serum albumin are _____

LOWER

In neonates and infants, hight protein bound drugs are more ____/____

What is a consequence of this?

effective/toxic

Lower doses may be required

Renal function does not completely mature until __ to __ months of age

6 to 8 months

What does ‘off-label’ mean

Used outside the terms of licence

What does ‘licensed’ mean

Shown to be safe and effective if used as licensed

- Is of suitable quality

What is ‘Buccolam’ and what age range can it be used in?

Buccal Midazolam - used in fits

3 months to 18 years

What is preferable in liquid formulations for paediatrics?

Sugar and alcohol free

Why shouldn't we mix medication with food/milk?

- Child may develop an aversion to the food - Drug may interact with milk - If the full amount of food/milk is not consumed then some of the dose may be omitted

Why may a child not adhere to medication?

- Difficulty taking medicine (taste, form) - Perceived lack of efficacy - Side - effects - Unclear instructions

What may be useful to put in medicine box if using a medicine that is not normally used in children?

Amended PIL | - Can get from medicinesforchildren.org

Name 3 chronic conditions that may be a concern in schools

Asthma, Epilepsy and Allergies

Name common ways of calculating doses in children...

Age Weight Surface Area

What may be a useful drug delivery method for asthma medication in children? Why?

PMDI (pressure meter dose inhaler systems) with Spacer devices - Can also use a face mask with this when necessary - Don't have to co-ordinate pressing and inhalation as can inhale the drug from the spacer in several breaths - Less risk of oral thrush for corticosteroid Breath activated devices (DPI) - Less co-ordination needed just breathe in

Name a neural tube defect...

Spina Bifida

Which of the following excipients would a pharmacist need to be cautious of when preparing a paediatric IV formulation ``` Benzyl alcohol Propylene glycol Glycerine Sorbitol Polyoxyl castor oil Polysorbates ```

Benzyl Alcohol Propylene Glycol Polyoxyl caster oil Polysorbates Benzyl alcohol  contraindicated in (pre-term?) neonates as can lead to fatal toxic syndrome Propylene glycol can cause adverse CNS events if elimination if impaired Polyoxyl castor oil can cause severe anaphylactoid reactions (consider arachis oil – peanuts)

Changes in abs rate appear to be of ____ importance when compared to the age related differences of drug distribution and excretion

MINOR

Why are water soluble drugs e.g aminoglycosides needed in larger doses in neonates compared to older children?

- Because the total body water and extracellular fluid volume decreases with age - So larger doses on a mg per kg of body weight basis are needed in younger patients to achieve the same plasma conc

In what age group particularly is metabolic clearance significantly increased? - What effect does this have?

- 1-9 year olds - Increased metabolic clearance of drugs such as Theophylline, phenytoin and carbamazepine - May need higher dosage than adults on a mg per kg basis to achieve same plasma drug cons

When should BSA calculations be used and when should they be avoided?

- Useful in drugs with a narrow therapeutic index e.g cytotoxics - DO NOT USE in those under 1 year old as they tend to have a larger surface area than other age groups USE WEIGHT INSTEAD

What can happen if a professional fails to ensure that the use of a medicine is reasonable?

- A suit for negligence may be held (court case etc)

Give an example of when an 'off-label' medicine may be used in children?

- When a licensed adult dose for an indication is available but no child dose is available - Often necessary to prepare an extemporaneous liquid preparation for a child from the licensed form e.g by crushing tablets and adding suitable excipients - Appropriate formulas must be used with a valid expiry date to approved standards