Pedriatric Flashcards
(99 cards)
1
Q
Gestational age
A
Estimated maturity at birth
2
Q
Pre-term
A
<37 weeks of age
3
Q
Full-term
A
37-40 weeks of age
4
Q
Neonate
A
0-1 month of age
5
Q
Infant
A
1-12 months of age
6
Q
Young child
A
2-5 years
7
Q
Older child
A
6-12 years
8
Q
Adolescent
A
13-17 years
9
Q
Medication Errors
A
Failure of a planned action to be completed as intended
10
Q
The 5 rights
A
the right patient, the right drug, the right dose, the right route, and the right time.
Prescribing
Dispensing
Administration
Documentation
11
Q
Reasons why these errors occur
A
Dosing medications usually require conversions and calculations
Dosage forms and strengths are not always available
Dosage recommendations are not always available
Medication adherence is difficult
Clinical studies in the pediatric population are scarce
12
Q
___% of meds have pediatric indication
A
25
13
Q
1997 FDA Modernization Act
A
The purpose of this was to enable the FDA to reduce the average time required for a drug review from 30 months to 15 months.
14
Q
Growth
A
increase in size, ->weight, height
Development—changes in function or form is Maturity, intellect
15
Q
Development
A
Changes in function or form
–> maturity, intellect
16
Q
Drugs that can affect both growth and development
A
Thalidomide
Fluoroquinolones
17
Q
Thalidomide Case
A
Used for nausea and morning sickness in pregnant women
Caused phocomelia -shortened or absent long bones of the limbs and many internal malformations
18
Q
Growth charts for birth to 36 months
A
weight-for-stature for boys and girls
Length/weight-for-age for boys and girls
19
Q
Growth charts for 2 to 20 years
A
Stature/weight-for-age for boys and girls
BMI-for-age for boys and girls
Overweight: 85th to <95th percentile
Obese: ≥95th percentile
Underweight: <5th percentile
20
Q
Interpreting a BMI chart: 25th percentile meaning
A
BMI the same or more than 25 percent of reference population
BMI less than 75 percent of the reference population
21
Q
Weight changes of Neonates
A
Weight may decrease to 10% below birth weight in the first week of life (due to amniotic fluid from womb)
Weight gain of 30 grams/day for the first month of life
22
Q
Growth Changes of Infants
A
Double birth weight by 4 months of life
Weight should triple and length should double by 1 year of life
23
Q
Growth changes of Children and Adolescents
A
Weight gain of 2-3 kg/year
Height increases of 5-8 cm/year
24
Q
Site of temperature measurement
A
Rectal (most accurate way to access)
Oral
Axillary
Tympanic
25
Normal BP also expressed in percentiles
SBP and DBP <90% based on age, sex and height
26
Pre-Hypertension
SBP and DBP are between 90%-95% based on age, sex, and height
27
Hypertension
SBP and DBP >95% based on age, sex and height
Stage 1: >95-99% plus 5 mmHg
Stage 2: >99% plus 5 mmHg
28
Newborns have higher ___than children or adolescents
Heart Rate
the normal upper limit is 190 compared to a 10 YOA which is 110
29
Respiratory rate from neonates and children
infants have high RR as their lungs have low capacity whereas they get older their lungs have higher capacity.
30
Pharmacokinetics
what the body does to the medication
- Absorption
- Distribution
- Metabolism
- Elimination
31
Pharmacodynamics
What the medications do to the body
- Therapeutic
- Toxic
32
In full-term infants, gastric pH remains elevated ___at birth but declines to ____ within 24 hours
6-8, 1-3
33
Acid-labile drugs have
increased absorption
ex. penicillins, erythromycin
34
Weak acids have
decreased absorption
| ex. Phenobarbital, Ganciclovir
35
immature bile acid production
decreases absorption such as Fat soluble vitamins
36
Gastric emptying is ___ in pre term infants but ____ during 1st week of life
slower in pre-term infants
increased during 1st week of life
37
Absorption IM
Infants have___
decreased muscle mass
poor perfusion
decreased muscle contractions
38
Percutaneous absorption can be greatly increased in newborns due to:
Underdeveloped epidermal barrier
Increased skin hydration
39
Absorption of topical medications in pediatrics
Increased skin irritation from topical medications
Systemic absorption from topical medications
40
Distribution is determined by physicochemical and physiological factors such as
Extracellular fluid, total body water, and protein binding can all influence the distribution
41
Infants and children have a higher __ to ___ ratio
body water to lipid
42
Decreased drug binding in newborns due to
Decreased plasma protein concentration
Lower binding capacity
Decreased affinity
Competition
43
Decreased drug binding in newborns results in
Increased free drug
Increased volume of distribution
44
Body fat is ___ in neonates and infants than in adults
much lower
45
highly lipid-soluble drugs are ___widely distributed in neonates and infants
less
46
Kernicterus is
Irreversible damage to the brain
Development secondary to the displacement of bilirubin by sulfisoxazole in neonates
47
Metabolism produces a water-soluble product that then is either ___ eliminated or excreted in ___
renally, bile
48
Metabolism is responsible for
Pro-drug conversion (fosphenytoin, chloramphenicol)
Active drug elimination
49
Metabolism is ___ in infants than in older children and adults
slower
50
CYP450 System
Approximately half of the adult values for full-term infants
Different isoenzymes mature at different times
Exceeds adult values at 1 year until about 9 years of age
The increased metabolization of drugs
That's why we see double the dose in children or more frequent dosing because they metabolize faster
51
There are __ groups of enzymes that all mature at different times
3
52
Group 1 enzymes
peak during 2nd and 3rd trimester
53
Group 2 enzymes
Relatively constant through life
E.g. 2C19, 3A5
54
Group 3 enzymes
Little function in early life
Expression increases over first several years of life
E.g. 2C9, 2D6, 3A4
55
Metabolism—Pediatric Considerations in Neonates and young infants
Decreased enzyme capacity in Neonates, young infants result in Increased t1/2; decreased clearance means dose less frequently
Example
Phenobarbital
56
Metabolism—Pediatric Considerations in children are
Increased enzyme capacity leads to Decreased t½; increased clearance (dose more or dose frequently)
Example
Theophylline
Voriconazole
57
Infants have a well developed __ pathway but an underdeveloped __ pathway
sulfation, glucuronidation
Examples are
Chloramphenicol
Morphine
Acetaminophen
58
Grey Baby Syndrome
Cardiovascular instability
Rapid progression to death
Related to chloramphenicol administration for sepsis
Immature glucoronidation --> decreased metabolism of chloramphenicol --> increased concentration
59
Gasping baby syndrome
Benzyl Alcohol
Preservative in many multiple dose IV and PO formulations (pentobarbital, heparin flush, etc.)
Related to immaturity of glycine conjugation system resulting in accumulation of benzoic acid metabolite
Anion gap metabolic acidosis, seizures, gasping, intraventricular hemorrhage, death
Try to avoid if possible; if not keep at <= 25mg/kg/day
60
Elimination usually occurs via the
kidneys
61
GFR is much __ in infants than older children and adults
lower
pre-term: as low as 0.6-0.7ml/min per 1.73 m^2
full-term: 2-4ml/min per 1.73 m^2
62
Elimination in new-nates through kidney
Decreased GFR in neonates and infants leads to increased t1/2; reduced clearance (dose lower )
Example
aminoglycosides
63
Elimination—Treatment Considerations
Decreased tubular secretion in neonates and infants increased t1/2; reduced clearance (dose lower)
Example
beta-lactam antibiotics
64
Calculating creatinine clearance in pediatrics
Schwartz Equation
1-18 years of age
ml/min/1.73m^2
65
Normal serum creatinine levels
It is high from birth till first five days then it declines. After that is reach to normal creatinine levels as child age
66
Schwartz Equation
CLcr = k x height /Scr
CLcr = mL/min/ 1.73m^2
k= age specific proportionality constant
height = height in cm
Scr = serum creatinine in mg/dl
67
Age specific proportionality constants
```
age K
0.33
full term --> 0.45
2-12 yrs --> 0.55
13-18 yrs --> 0.55 (female)
--> 0.7 (male)
```
68
Bedside Schwartz
GFR (ml/min/1.73 m2) = (0.41 x height in cm)/ creatinine in mg/dl
69
Weight based dosing
Most common dosing method
Maximum dose not established for pediatric patients—make sure to not surpass adult dosing
70
Age based dosing
Easy to use
Assumes ADME is the same for all patients
71
Body-surface-area dosing
Precise
Used for drugs that require exact dosage calculations (i.e. chemo)
72
Pediatric Resources
Lexicomp Pediatric Dosage
Micromedex
Respective Guidelines are AAP Report of the Committee on Infectious Disease
73
Medication administration concerns
Adherence is difficult
Not always available in proper dosage forms/strengths
Children have difficulty with administration Tablets, diskus inhalers
Palatability Issues
Compounding is often necessary
Risk-to-benefit ratioDeciding when it is appropriate to treat
74
Steps to take as the Pharmacist
```
Obtain weight, age, sex
Ask about allergies
Calculate dose
Compare dose with reference
Make sure dose is appropriate
Dispense with required materials Measuring cup/oral syringe
Medication guides
```
75
Counseling Pediatric Patients
```
Show how to use
Explain
-How it works If patient is an adolescent, include them in your counseling
-Dosage
-Frequency
-Expectations
-What to do if there is no improvement
Be available for future questions
```
76
Common Cold in Pediatric populations
6-8 episodes per year
77
AOM
Middle ear infection
Concerns about over-treating
78
Pharyngitis
Inflammation of the throat
79
Type 1 DM
autoimmune disorder affecting insulin secretion
80
Eczema
Chronic, itchy skin condition
81
Conditions seen most commonly in pediatric populations
```
Common Cold
AOM
Pharyngitis
Type 1 DM
Eczema
Asthma
Hand, Foot, and Mouth Disease
```
82
Why is immunization important
Vaccines have reduced or eliminated many devastating infectious diseases
Herd immunity
83
Passive Immunity
Person is given antibodies to a disease
Immediate protection
Only lasts few weeks or months
Via mother-to-baby, IVIG
84
Active Immunity
Disease organism triggers immune system to produce antibodies to that disease
Takes several weeks to develop
Long-lasting, sometimes life-long immunity
Via infection, *vaccines*
85
Vaccines are made using the same components (antigens) of bacteria or viruses that cause disease
- Live but weakened (attenuated)
- Part of the bacteria or virus (conjugated, subunit)
- Inactivated toxin (toxoid)
86
How do Vaccines Work
Vaccines containing antigens are injected into the body
The immune system produces antibodies to fight off these antigens
Memory cells will remember how to produce those antibodies again
When actual bacteria or viruses enter the body, memory cells can produce the same antibodies quicker to fight off disease
87
Comfort measures for vaccine concerns
```
Display a positive attitude
Use soft and calm tone
Make eye contact
Explain why vaccines are needed
Be honest
Antipyretics (not routinely recommended by ACIP)
Distraction techniques – music, books, “blowing away the pain”
Sucrose solutions or breastfeeding
Tactile stimulation
Administration technique
```
88
Common Adverse Reactions
```
Mild Injection site reactions such as
Soreness
Redness
Swelling
Fussiness
Low grade fever
```
89
Valid contraindications for vaccines
Severe allergy to prior vaccine
moderate to severe acute illness (defer until illness resolves)
90
Anaphylactic reaction to vaccine componenets
```
Egg Products --> influenza, yellow fever
Neomycin --> IPV, MMR, Var
Streptomycin --> IPV
Polymixin B --> IPV
Baker's yeast --> HepB
Gelatin--> Var, MMR
```
91
Screening Questions for Vaccinations
Is the child sick today? How sick?
Allergies? How bad (anaphylaxis)?
Previous adverse reactions to vaccines?
Immune status of child or other medical conditions?
Recent history of asthma or wheezing?
Recent transfusions of blood, blood products, IVIG?
Patient pregnant?
92
Special Populations
Immunocompromised patients
--> live vaccines contraindicated
Pregnancy
- ->inactivated flu shot
- -> live vaccines contraindicated
93
Vaccine Information Statements (VIS)
Sheets produced by CDC
Document in medical record
--> VIS edition and date provided
--> name, address and title of provider, vaccine manufacturer, and lot #, date of administration
--> record combo vaccines as individual vaccines
94
VIS information covered
```
Why vaccinate
Who should receive the vaccine
Risks/Adverse Reactions
What to look for/do
NCVIA and VAERS
```
95
Vaccine Adverse Event Reporting System (VAERS)
National reporting system jointly administered by CDC and FDA
96
Children are not usually able to swallow tablets until at least ______ age
6 years of
97
Medication adherence is difficult because of
Palatability of medications
| Parents are responsible for the administration
98
Growth charts are used to monitor progress
Height, weight, and BMI are expressed as percentiles
16 charts available
Sorted by age and gender
99
Increased enzyme capacity leads to Decreased t½; increased clearance (dose more or dose frequently)
Example
Theophylline
Voriconazole
