paeds OTC Flashcards
1
Q
what are common examples of off-label medicines in children?
A
- salbutamol in children <2 yrs
- paracetamol < 2months
2
Q
what standards relate to childrens medicines?
A
childrens national service framework
standard 10- relates to medicines for children
3
Q
what does standard 10 in the childrens national service framework say?
A
Children, Young people, their parents or carers and health care professionals in all settings should make decisions about medicines based on sound information about risk and benefit….. They have access to safe and effective medicines that are prescribed on the basis of best available evidence.”
4
Q
what are the best routes for children for different formulations?
A
- Oral liquids - suspensions, solutions, syrups, elixirs
- Oral solid - tablets, capsules, granules, lozenges
- Inhaled –MDI (spacer!!!), powder devices, nebules
- Ear/Eye/Nose - drops (solutions, suspensions), ointments
- Skin - creams, ointments, sprays, lotions
- Injection - sub-cut, im, iv, it
- Rectal –suppositories, solutions, enemas, ointments
5
Q
what considerations would you take into account when giving a medicine to a child?
A
- Age of the child –Syringe/spoon?
- Care not to give the dose too fast!
- Accuracy of dose?
- Formulation? –taste, sugar content,
stability, length of treatment? - Food? –Never mix in a babies bottle!
6
Q
what should you consider with a ng/nj tube?
A
- liquids preferable* Newt Guidelines (Secondary care)
- some tablets may mix with water (See BNF/SmPC for
guidance) - Continuous feeding - some may mix with medicines
- may need to stop feed 15 mins before medicine
7
Q
what must you consider when giving a child medicine to the eye?
A
- Eye - preparation must be sterile
- Preserved products, discard 4 weeks after first
opening - Unpreserved - usually 7 days
- Some may require refrigeration
- tilt the head back, drop into corner of the eye,
- mop up excess
- apply ointment to inner lower lid
may require two adults
8
Q
what should you consider when giving a rectal medicine to a child?
A
- Rectal
- suitable for very young children, but less
acceptable in older children - suppositories may be lubricated before use
- splitting suppositories is not recommended
9
Q
how are doses calculated for a child?
A
Children’s doses are usually standardised by weight or body surface area
(in m2).
* Young children may require a higher dose per kilogram than adults because of their higher metabolic rates
10
Q
what are problems associated with dose calculations in children?
A
body-weight in the overweight child
may result in much higher doses being administered than necessary….in
such cases, use ideal weight, related to height and age (see inside back
cover of the BNF).
11
Q
what patient information should be given ?
A
- Primarily how to give -information should be on the label AND explained/shown to the parent
- What is it used for?
- Certain drugs… caution may be needed, e.g. imipramine -nocturnal enuresis - caution with PIL
- What happens if a dose is missed?
- Consider frequency of dosing around child’s waking hours/school
- How long should the medicine be taken for?
- Further supplies?
12
Q
what storage information should be given?
A
- Keep out of reach of children
- Child-resistant containers
- Refrigeration?
- Do not mix medications in the
same bottle - Keep in original container
13
Q
can a child be given a medicine at school?
A
- May vary depending on short or long-term medication
- Will vary depending on age of child
- Staff may require education
- Medicines must be labelled with full details
- Some teaching unions indicate that school staff should not be required to administer medicines - not a legal requirement!!
- Most local education authorities issue guidance and schools should have a medication policy
- May be able to change dosing schedule to avoid administration at school
14
Q
who are recommondations for immunisation based on?
A
advice from the Joint Committee on Vaccination and Immunisation (green book)
* Updates sent to professionals by CMO
15
Q
what immunisations should a child have in their first year?
A
@ 8 weeks- 6 in 1 vaccine- diptheria, tetanus, shooping cough, polio, haemophilus influenza type b, and hepatitis
rotavirus-oral
men b
@12 weeks- 6 in 1 second dose
rotavirus 2nd dose
pneuomococcal vaccine- 1st
@ 16 weeks - 6 in 1 3rd dose
men b 2nd dose
16
Q
what immunisations does a child recieved from 1-15 years?
A
1- Hib/men C, NMR, PVC, Men B
2-10- flu vaccine- nasal every year
3yrs and 4 months= MMR, 4 in1
12-13 years HPV- boys and girls
14 years- 3 in 1 teenage booster
17
Q
what is rotavirus?
A
- Rotavirus is the commonest cause of gastroenteritis among infants and children
- The diarrhoea and vomiting associated with the virus can cause severe dehydration and results in a significant number of young children being admitted to hospital each year
18
Q
when is rota virus most common?
A
- Infection is predominant January- March each year in the UK
19
Q
how long do symptoms go on for?
A
3-8 days
20
Q
when do you give rota virus vaccine?
A
A live vaccine given via the oral route at 8 weeks
* No restrictions on food or drink consumption before or after
administration
21
Q
when would you postpone rotavirus admin?
A
no need due to minor illness but effectiveness can be reduced if it passes through intestine
too quickly!!!
* Therefore postpone if diarrhoea is present but first dose must be given between 6-15 weeks of age
22
Q
when is the second dose of rota virus administered?
A
2nd dose - 3 months of age or at least 4 weeks after the 1st dose –must be received before 24 weeks of age!
* Ideally both doses prior to 16 weeks in order to deliver full protection before main risk of infection.
23
Q
can the virus be transmitted via the vaccine?
A
The vaccine is excreted in the stools so may be transmitted to close contacts….carers of the baby should be advised re hand washing etc
24
Q
what is fluenz and who is it offered to?
A
- Offered to children 2-16 years
A nasal vaccine of LAIV strains that are genetically altered via 3
mechanisms: - Cold adapted to stimulate immune system in the nose where cooler temperatures are found
- Temp sensitive so cannot infect the lungs or warmer nasal passages
- Attenuated….replicates to provoke a full immune response without clinical
symptoms
25
what are the contraindications for the flu vaccine?
▪ Immunocompromised...eg. Leukaemia’s, lymphoma, untreated HIV, high dose steroids
▪ Under 2 years of age
▪ Receiving aspirin or salicylates (increased risk of Reyes)
▪ Egg or gelatin allergy
▪ Pregnancy (note some exceptions –flu/whooping cough)
▪ Children actively wheezing or those with severe asthma
26
where and why is the MEN B vaccine given?
Single injection into the left thigh...SPC states babies are at an increased risk of fever when Bexsero is administered at the same time as other vaccines
27
what should be given after the men B vaccine?
* Give 3 doses of infant paracetamol as a prophylactic measure against
fever...
* 1 dose at the time of vaccination or shortly afterwards and then 2 further doses in four to six hour intervals.
* Note this exceeds and overides the current licensing terms of infant paracetamol (120mg/5ml) which is restricted to a maximum of 2 doses post-immunisation in babies aged 2-4 months.
28
what are the general immunisation issues?
adverse reactions- most are not serious
loclised pain and swelling
fever- prophylactic paractemol is not recommended unless men B is given at same time
29
what is rectal body temp?
Rectal temperature is 0.5 degrees higher than oral temperature, underarm is 0.5 lower. (in general).
30
what is pyrexia?
Fever is caused as a result of pyrogens resulting from viral or bacterial infections causing the body to increase the set body temperature.
31
what is a typical presentation of pyrexia?
* Irritability
* Not eating
* “clingy” or seeking greater parental attention
* Symptoms of a cough or cold
* Increased respiratory rate
32
what questions would you ask with suspected pyrexia?
Age- any child under 3 months should be automatically referred –unless post immunisation!
* How is the child? Don’t just presume the higher the temperature the more ill the child.
* What is the general perception of the parent?
* What other symptoms are present?
* Remember UTIs are damaging and can be asymptomatic apart from a mild pyrexia.
33
what are the differential diagnosis of pyrexia?
URTI- usually viral and self limiting. Look for symptoms of earache which may suggest a bacterial infection.
* UTI- asymptomatic pyrexia, is common and can lead to the development of scarring in the urinary tract.-Refer.
* Meningitis- clearly a dangerous disease which invariably is fatal if untreated-Refer. Typically presents with
* Photophobia
* Stiff neck
* Lethargy/drowsiness
* Petechial rash
34
what treatment do you give for pyrexia?
* Paracetamol- established, evidence based
* Licensed from 2 months for injection pyrexia.
* Licensed from 3 months for general pyrexia and pain.
* Ibuprofen- again established and evidence based.
* Only licensed from 3 months of age and >5kg.
35
what are the standard doses of paracetamol for children?
– Age 3 - 5 months: 60 mg every 4–6 hours (maximum of four doses in 24 hours).[2.5ml]
– Age 6 - 23 months: 120 mg every 4–6 hours (maximum of four doses in 24 hours).[5ml]
– Age 2 - 3 years: 180 mg every 4–6 hours (maximum of four doses in 24 hours).[7.5ml]
– Age 4 - 5 years: 240 mg every 4–6 hours (maximum of four doses in 24 hours).[10ml]
– Age 6 - 7 years: 250 mg every 4–6 hours (maximum of four doses in 24 hours).[5ml]
– Age 8 - 9 years: 375 mg every 4–6 hours (maximum of four doses in 24 hours).[7.5ml]
– Age 10 -11 years: 500 mg every 4–6 hours (maximum of four doses in 24 hours) [10ml]
36
what is the standard doses for ibuprofen?
– Age 3 - 5 months: 50 mg three times a day (maximum of three doses in 24 hours, do not use for more than 24 hours).[2.5ml]
– Age 6 months to 1 year: 50 mg three to four times a day. [2.5ml]
– Age 1 - 3 years: 100 mg three times a day.[5ml]
– Age 4 - 6 years: 150 mg three times a day.[7.5ml]
– Age 7 -10 years: 200 mg three times a day.[10ml]
37
when does atopic eczema occur?
Typical onset between 2-6 months of age.
38
what are other implication factors for atopic eczema?
* More exposure to pets
* Higher maternal age
* Choice of food
* House dust mite- particularly significant especially in the child with severe disease.
39
how do you diagnose atopic eczema?
diagnosis: an itchy skin condition in the last 12 months, plus 3 or more of the following:
A history of involvement of the skin creases
* A personal history of atopic illness (or history of atopic disease in a first degree relative if a child is less than 4 years of age).
* A history of generally dry skin in the last year.
* Onset under the age of 2 years
* Visible flexural eczema
40
how does atopic eczema present?
Lesions may be moist or weeping
* Skin may be thickened lichenified.
* In darker skin this may appear papular.
* Scratch marks are often evident.
* Staphylococcal secondary infections are common with staphylococcal foliculitis occurring as a result of emollients or occlusive dressings.
* Atopic children can also be prone to infection with Herpes simplex
41
what would the differerntial diagnosis be for atopic eczema?
* Seborrhoeic dermatitis- “cradle cap”
* Psoriasis
* Hives/urticaria/allergy
* Contact dermatitis
42
when would you refer atopic eczema?
* Severe cases
* Suspicion of psoriasis or herpetic
complications....eg eye
involvement/systemically unwell
* Treatment failure....be sensible!
* Secondary infection
43
what are the available OTC treatments for atopic eczema?
* Emollients/soap substitutes
* Antihistamines
* Corticosteroids- not OTC for under 10 yrs
44
what counselling points for atopic eczema?
* Firstly avoidance of irritants is one of the steps taken, these
include:
* House dust mite- almost impossible
* Perfumed bath oils/foams
* Possibly some materials such as wool
* Pet dander
45
what are the commonly used sedating antihistamines?
* Brompheniramine
* Chlorphenamine
* Hydroxyzine- POM licensed for pruritus
* Promethazine
* All will cause sedation and have different licensed particulars as regards age for use.
46
what cough and cold preparations can be used for children under 12?
* Brompheniramine, chlorphenamine and
diphenhydramine
* Dextromethorphan and pholcodine
* Guaifenesin and ipecacuanha
* Phenylephrine, pseudoephedrine, ephedrine,
oxymetazoline and xylometazoline
47
when does teething usually occur?
3 months to 3 years
48
what are the symptoms of teething?
* Pain
* Swollen gums
* Red, hot cheeks
* Excessive dribbling
* Nappy rash
49
how does teething present?
* Changes to sleep pattern and/or appetite increased tendency to chew objects/hands
* General irritability
* Much sleep loss can occur for baby and parents.
50
what is the first line treatment for teething?
1st Line Treatment -paracetamol or ibuprofen suspensions
* Also topical teething gels can be used which contain local anaesthetics
* eg. Lidocaine (Anbesol)
51
how does colic present?
Some suggest that colic is present if a baby cries for more than 3 hours per day for more than 3 days of the week for more than three weeks.
52
what may be a possible cause of colic?
▪ An immature G/I tract
▪ Milk/lactose intolerance
▪ Excessive gas swallowing on feed (breast and bottle)
▪ Possibly the extreme end of normal crying
▪ Possibly a set of different conditions resulting in crying but difficult to distinguish between.
53
how does colic present?
* Characterised by a baby pulling their arms and legs up almost in a ball.
* Persistent or spasmodic bouts of crying or screaming.
* Very difficult to console.
* Clearly a child in distress could as easily be suffering from something else.
54
what is the treatment on colic?
Dimethicone - a surface active agent.
* ? MOA - to reduce surface tension which then allows gas bubbles to join.
* These larger bubbles are theoretically easier to pass.
55
how and when can infacol be used?
can be used safely from birth either with or immediately after feeds
56
how and when can infacol be used?
can be used safely from birth either with or immediately after feeds
57
why does constipation occur in children?
* Fairly common in children and often related to changes in diet/hydration.
* Not usually the result of organic disease.
58
what treatments for constipation can be used OTC?
formulations of senna (12 yrs +) or glycerin
suppositiories are available though.
* Appropriate dietary advice should be given –
fruit/veg/water.
59
how does threadworms spread?
* Faecal –oral route
* Retro infection
* Inhalation
60
what is the differential diagnosis of threatworms?
Roundworms & tapeworms can infect patients
and can be evident in the stools - Unlikely in
children.
* Secondary bacterial perianal infection - Can
result from dermatitis
61
what is the threadworm treatment?
Mebendazole is the drug of choice available OTC.
* Avoid in pregnancy –due to teratogenicity
* Mebendazole is licensed from 2 yrs
62
what is recommended for the treatment of threadworms?
Repeat dosages in 14 days are recommended to avoid reinfection
* Hygiene measures should be observed following diagnosis including:
* Nails kept short and clean
* Scrub nails and hands after each toilet visit and before meals
* Wash bed linen daily if possible
* Wear underwear under night clothes to prevent scratching
63
how do you diagnose headlice?
* Diagnosis via seeing live louse
* Transmission via head to head contact
* Treatment
* No louse= No treatment
64
what is the treatment for head lice?
First line - Dimethicone type products (e.g. Hedrin) or Vamousse (isopropyl alcohol + isopropyl myristate)
* Insecticides Pyrethroids & anticholinesterases (Malathion)
* Wet combing essential throughout treatment period and afterwards to prevent re-infestation
* Avoid alcoholic preparations in Asthmatic patients
* Repeat treatment after 7 days
65
what are the main infectious diseases affecting children?
* Measles/Rubella (German Measles)
* Chicken pox
* Mumps
* Whooping cough
* Meningitis
* Impetigo
* Other viral infections
66
what is the treatment for impetigo?
Treatment OTC is with hydrogen peroxide 1% cream (apply two or three times daily for 5 days)
* Or refer for antibiotics, flucloxacillin and topical fusidic acid.
67
what is slapped cheek syndrome?
AKA fifth disease or parvovirus B19 - viral infection usually causes a bright red rash on the cheeks.
68
when do symptoms develop for slapped cheek syndrome?
Usually mild - symptoms develop
4-14 days after becoming
infected.
69
what are the symptoms of slapped cheek syndrome?
Symptoms include a slight fever
around 38C
* runny nose
* sore throat
* headache
* upset stomach
* feeling generally unwell
* Adults may get joint aches
70
is slapped cheek syndrome contageous?
* The virus is not contagious once
this rash appears.
71
what is hand, foot and mouth?
* Common viral infection that causes mouth ulcers and spots on the hands and feet.
72
how long does hand foot and mouth syndrome take to clear?
Hand, foot and mouth disease can be unpleasant, but it will usually clear up within 7-10 days.
* Symptoms usually develop 3-5
days after exposure.
73
what are the symptoms of hand, foot and mouth?
* Initial symptoms:
* Fever 38-39C, a general sense of feeling
unwell
* loss of appetite, abdominal pain
* Coughing, sore throat and mouth
mouth ulcers
spotty rash and blisters
74
what is scarlet fever?
* Bacterial infection caused
by
* first signs - flu-like symptoms, high temp, sore throat and swollen neck glands
* A rash appears 12 to 48 hours later - small, raised bumps starts on the chest then spreads. Sandpaper like feel.
75
how long do symptoms last/ develop with scarlet fever?
* Symptoms lasts around 1 week.
* Infectious up to 6 days before onset of symptoms until 24 hours after 1st dose
of antibiotics.
* No antibiotics, can spread for 2 to 3 weeks after symptoms onset
76
what self care should be done with scarlet fever?
* Self care
* drinking cool fluids
* eating soft foods if sore throat
* paracetamol for fever
* using calamine lotion
or antihistamine tablets to ease itching
77
what is scarlet fever treated with?
Treated with Pen V (QDS for
10 days)
78
what happens to the tongue in scarlet fever?
A white coating also appears on the tongue. This peels, leaving the tongue red, swollen and covered in little bumps (called "strawberry tongue").
79
how is measles spread?
Spread by droplet inhalation or direct person to person contact.
80
what is a prodromal period in measles?
A prodromal period follows for a further 3-4 days, the child will demonstrate a typical severe flu like condition and possible conjunctivitis during this time
81
when is the main infectious period in measles?
is during the prodromal period and for the first two days of the rash.
82
what happens in measles?
The development of white spots on the inner cheeks and gums indicate Koplik’s spotswhich are diagnostic of measles.
* A rash then develops behind the ears and hairline moving down the trunk
83
what is the incubation period for german measles/ rubella?
Incubation 14-21 days with a prodromal phase of 5 days
* Not as contagious, often asymptomatic besides a cold-like syndrome with lymphadenopathy
84
what virus is chicken pox caused by?
Varicella zoster
85
what are the complications of chicken pox?
Secondary infection
* Staphylococcus aureus
* Streptococcus pyogenes
86
what are v rare complications of chickenpox?
* Possible scarlet fever or toxic shock syndrome can
develop in children
* Severe chicken pox carries high morbidity
* Post chickenpox encephalitis
* Thrombocytopenia
87
what is meningitis caused by?
Caused by bacteria, typically Neisseria meningitidis and viruses.
* Infection via Haemophilis influenzae is common in children.
* Viral meningitis is less severe and more common
88
how long does whooping cough last for?
* 14-20 day incubation.
* A cough then develops which eventually becomes grouped into paroxysms of 20-30 coughs.
89
how does a whooping cough sound?
* A cough then develops which eventually becomes grouped into paroxysms of 20-30 coughs.
* The paroxysm ends with an inspiratory “whoop” more correctly termed a ‘stridulous inspiratory cry’.
* Accompanied by thick mucous which is difficult to expectorate.
90
what is the incubation for mumps?
* Incubation is 2-3 weeks with an average of 18 days
91
what is mumps?
* Inflammation of the parotid salivary glands is the main clinical symptom.
* Orchitis occurs in adult males but unusual before puberty.
* Main complication is mumps meningitis.
