Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Summer pharm 4 > peds > Flashcards

peds Flashcards

1
Q

What are key concepts in peds PK and PD

A

there is little info on PK&PD 2/2
variations in absorption of meds from GI, IM injection sites and skin, and premature and other newborn infants
they are NOT just little adults!
ADME varies between kids and adults, and kids and kids
Concomitant diseases can influence dosage and requirements to achieve a targeted effect
Weight based dosing for obese kids can lead to subtherapeutic doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the peds age ranges

A 
Premature: infant born <37 weeks 
Neonate: birth-1 month
Infant: 1 month- 1 year 
Children: 1-11 years 
Adolescents: 12--16 
Peds: <18 
*Can start dosing kids as adults at 16
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Are a lot of drugs used in peds

A

yes, most marketed drugs can be used for peds pts
but 1/4 have indications for specific use in peds
ADME is different between neonates, premature, children, and adolescents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What affects absorption from GI tract

A

pH dependent passive diffusion

gastric emptying time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is gastric pH at birth

A

ranges from 6-8!
within 24 hours it decreases to 1-3
-in premature kids, pH stays high because of immature acid secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What happens in GI of premature infants

A

higher gastric pH= higher concentration of acid labile drugs (penicillins) and lower of weak acids (phenobarbital)
Passive and active transport may be fully developed by 4 months old
*Gastric emptying is slow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What factors affect IM absorption in premature infants

A 
relative muscle mass
poor perfusion to various muscles
peripheral vasomotor instability
insufficient muscular contractions 
-can't predict the net effect of these factors on drug absorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What happens to skin absorption in peds

A

percutaneous absorption increased (underdeveloped epidermal barrier, increased skin hydration)
increased absorption of steroids
total body surface area:total body weight is highest in younger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is drug distribution determined by in peds

A

Physicochemical properties of the drug (molecular weight, PKa)
Physiologic factors specific to the pt (total body water, protein binding, pathologic conditions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What happens to total body water with age

A

fetus: 94%
premie: 85%
full term: 78%
adults: 60%
-gentamicin distribution volumes of 0.48 l/kg in neonates, and 0.2 l/kg in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

EC fluid volume accounts for

A

50% body weight in premies
35% body weight in 4-6 mo. old
25% in kids 1 yr
19% in adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What happens to distribution in newborns

A

decreased! 2/2
decreased plasma protein concentration, lower binding capacity of protein, decreased affinity of proteins for drug binding, competition for certain binding sites by endogenous compounds (like bili)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What about premies and distribution

A

May require larger loading dose than older kids to get to therapeutic concentration (ex. phenobarbital, phenytoin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What happens to free drug in peds bodies

A

increased concentration of free drug (unbound)
Drugs bound to plasma proteins can not be eliminated by kidney
increase in free drug may also increase clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What happens to distribution based on body fat

A

body fat is lower, so highly lipid soluble drugs are distributed less widely in infants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What happens to metabolism in peds

A

It is much lower in infants than older kids bc while sulfation path is well developed, Glucuronidation pathway is underdeveloped!
ex: APAP is metabolized through the glucuronidation path, so they compensate by trying to metablize thru sulfation pathway

17
Q

What is grey baby syndrome

A

decreased metabolism of chloramphenicol by Glucu pathway causes build up of chlormaphenicol

18
Q

Morphine and infants

A

May need higher serum concentration of morphine to achieve efficacy
infants can NOT metabolize morphine to it’s active 6-Glucuronide metabolite

19
Q

What other drug oxidation is impaired in peds

A

theophylline, phenobarbital, phenytoin

20
Q

What happens to GFR in peds

A

may be as low as 0.6-0.8 in premies, and is appx 2-4 in term infants
Processes may not fully dvelopuntil weeks-1 yr after birth

21
Q

What are concerns about common cold remedies in beds

A

serious toxicities associated with antihistamines, decongestants, antitussives, and expectorants
FDA says do NOT use in <2 y/o, companies label not for use <4!

22
Q

What is the concern with benzyl alcohol use in peds

A

Causes syndrome of:
metabolic acidosis, seizures, neurologic deterioration, gasping respirations, hepatic and renal abn, CV collapse, death
-it is a preservative used in IV flush solutions, IV DXM, methylprednisone, enoxaparin, midazolam, and multivitamins

23
Q

What is the concern with tetracyclines

A

contraindicated in pregnant women, nursing mothers, and kids <8 because:
cause dental staining and defects in enamelization of deciduous and permanent teeth
Decrease in bone growth

24
Q

What are concerns with fluoroquinolones

A

Not recommended for peds or pregnant women, may cause cartilage leisons and arthropathy; *tendonitis and rupture in all ages
EXCEPT if:
<18 w/ inhalation anthrax
Tx complicated UTI and pyelo caused by E Coli
peds w/ CF

25
Q

What are concerns with antidepressants

A

May increase risk of suicide in younger pts
Approved: Sluoxetine, Sertraline, Fluvoxamine
Always assess risk vs benefit; they have a BLACK BOX WARNING!

26
Q

How do you determine dose in peds

A

MC and reliable method: Body weight!
Least reliable: Age!
most accurate: body surface area
(formulas rely on weight, age, body surface area, and mg per weight per day)

27
Q

What is Clark’s rule (weight)

A

(kids weight in lb / 150) x adult dose = child’s dose

28
Q

What is Fried’s rule (age; for very young)

A

(age in mo./150) x adult dose = child’s dose

29
Q

What is Young’s rule (age)

A

(age in yr/age +12 yrs) x adult dose = child’s dose

*ONLY for kids 1-12

30
Q

What is a nomogram

A

a chart that takes into account height and weight to calculate BSA
Dosage for BSA is un units per M2*

31
Q

What is the MC way in which doses are expressed

A

units per Kg
But this means you have to know patient’ weight! include on every Rx you write so the pharmacist can verify the dose
MUST specify per DAY or per DOSE
*always include indication on the label! (ex: for ear infection)

32
Q

Know these conversions

A

1 teaspoon: 5 ML
1 tablespoon: 15 ML
1ounce: 30 ML
1 cup (8oz): 240 ML

33
Q

What are ways to prevent calculation errors

A

Bracketing: write out “pt weights 20kg. 20kg x 8mg/kg/day = 160mg”
Ask colleague or staff
phone a pharmacist
*NEVER memorize peds doses… look them up!

34
Q

Are organ systems normal in kids

A

no, they are not fully developed!
absorption may take longer, fat soluble drugs may take longer to distribute, may have slower or more rapid metabolism
Kids have slower excretion rates= more likely toxicities

35
Q

How do you admin dropper meds to kids

A

on the cheek, not the back of the tongue

Summer pharm 4 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions