What percentage of drugs are not FDA approved for children (and even fewer for infants)?
What percentage of drugs lack dosing, efficacy, and safety data for children?
How much can we round up dosese to avoid decimals?
limit round up to 10% of dose
What are some issues with IM administration of drugs in children?
not well tolerated
variable muscle mass in infants & young children
variable blood flow to muscle, SQ tissue
What are elixirs?
drug dissolved & evenly distributed in alcohol
caution with evaporation
What are some suspending agents for crushed tablets?
What age can we start giving capsules/tablets?
~ age 6
What age can we use a nebulizer?
What age can we start using MDIs?
What percentage of dosing errors occur in children?
What is the best source for drug dosing in children but frequently not available?
manufacturer's package insert information
What is the GI system like in neonates?
high gastric pH
low levels pancreatic enzymes
bile acids can alter absorption
Why is topical absorption higher in neonates/infants?
thin stratum corneum
increase cutaneous perfusion
higher surface to weight ratio
Do neonates have less P450 activity?
yes; 50-70% adult levels
What is metabolism & renal elimination like in toddlers?
more rapid metabolism & renal elimination than adults
At what age can we start using the Cockroft-Gault Formula?
What is the BBB like in neonates and young children?
What does this impact?
BBB is less effective
greater opioid impact
bilirubin passes through also
In children who are teething, what drug to we need to be cautious with because of systemic absorption?
What should we use to treat teething pain in children?
7.5% benzocaine gel without alcohol
What should we use to treat mild, non-candidal diaper rash?
zinc oxide cream, drying
What should we use to treat candial diaper rashes?
Clotrimazole 1% cream
nystatin ointment resistance issues
How should we treat mild diarrhea in children?
absorb significant protein, fat, CHO
BRAT diet is less effective
What are otic suspensions?
acid pH to replicate normal ear canal environment
What happens when you give otic suspensions to children with vent tubes or recent perforation?
What should we give instead of otic suspensions for kids with otitis externa with vent tubes?
What is the issue with antipsychotics and children/adolescents?
more susceptible to extrapyramidal symptoms, espiecally dystonias
more weight gain
What is the usual dosing for Acetaminopen?
What is the max dosing?
max: 65 mg/kg/day
What is the regular dose of Amoxicillin?
High dose of Amoxicillin?
Maximum child dose?
regular: 40-45 mg/kg/day
high: 80-90 mg/kg/day
max child dose is adult dose
Should we use Aspirin in children?
no, especially febrile children
What can happen if we give Aspirin to children?
fatty liver degeneration, encephalopathy, liver failure
Why is benzocaine preferred over lidocaine in children?
benzocaine is poorly soluble in water & very slowly absorbed so don't get toxic levels as easily as lidocaine
What are some cautions with antidepressants in children?
What are some cautions with antipsychotics in children?
more susceptible to extrapyramidal symptoms
What is Phenobarbitol used for?
generalized motor seizures in infants
Who should we avoid using Tetracyclines in?
avoid in PG
children < 8yrs (dental staining)
What is a Vitamin A analogue that is teratogenic?
increases risk of malformed fetus 25x
2 forms contraception (one either surgical or hormonal)
What can we use as a barrier protection for diaper irriation?
(either in infants or nursing homes)
zinc oxide cream
What is Ethosuximide used to treat?
petit mal or absence seizures in children
When is the highest risk for suicide after starting a new anti-depressant?
within 2 weeks
so want to follow up within that time period
Can the location of medicine in the rectal vault influence rates of absorption?