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Peds and Geriatrics > Week 1 > Flashcards

Week 1 Flashcards

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1
Q

Pediatric vital signs in comparison to adults

A

Newborn:
HR: ~120-160
RR: 30-50
BP: ~60/37

Infant (1-12 months)
HR: ~100-140
RR: 20-40
BP:~70-100/ 50-70
Temp:

Toddlers (1-3 years)
HR: 100-130
RR:20-30
BP: 80-110/50-70
Temp:

Preschooler (3-5 years)
HR: 80-120
RR:20-30
BP: ~95/70
Temp:

School Age (6-12)
HR: 70-110
RR: 20-25
BP:100-120/75
Temp:

Adolescent
HR: 60-100
RR: 12-20
BP:110-120/80
Temp:

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2
Q

Vital sign differences in peds vs adults

A

HR and RR are higher in peds than adults, lower and normalize when they become adult ages

BP is lower in peds than adults, increase as they get older

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3
Q

How to Assess pain in Peds patients

A

physiologic markers
*RR, HR, O2 sat, behvior (grimacing, highi pitched crying)

Standardized scales
children </4:
*neonate pain scale (NIPS)
*Face, Legs, Activity, Cry , Consolability (FLACC)

Children>4 y.o :
*wong baker FACES

Children >10 y.o:
*visual analog scale
*numeric pain scale

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4
Q

common caculations for peds

A

BSA:
BMI: (weight/height^2)x10000
IBW: (height^2)x1.65)/1000
***eGFR:
use bedside Schwartz equation in <18 y.o
[0.413xheight]/SCr

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5
Q

challenges in ped pharmacotherapy

A

PKPD differences
*drug sleection
*dosage

psychosocial influences on drug therapy
*child vs adolescent

caregiver mediation administraion hesitance
*cultural beliefs
*socioeconomic status

dosage formulation selections

off label medicaion use

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6
Q

what is off-label medication use

A

use of a medicationoutside of FDA approved labeled indication

only 1/4 fda approved drugs indicated for ped patients

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7
Q

limitations to off label drug usage

A

potential for denied insurance proider coverage

liability for adverse effects

limited experience in specific conditions or age gorups

limited available dosage formulations

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8
Q

evidence Considerations for off label med use

A

use guidelines (NAEPP and NHlbi when available

use of primary literatureis critical in providing evidence based care to infants, children and adolescents (most data fro retrospecive cohort studies

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9
Q

medication adherance reasons

A

apprehension regarding med AE

caregiver inability or unavailability to adminster drugs

caregivers may be overwhelmed confused

inappropriate measurements of medication dose

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10
Q

straegies to improve adherance in peds

A

educatin of caregiver at several points

ease of amdinistration (palatable dosage forms, less frequent dosing)

decreased child resistance (reward systems, positive reinforcement

empowering older children adolescents

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11
Q

Dosage form considerations

Parenteral

A

volume of iv fluids
(infants and newborns susceptible to volume overload) pick concentrated versions of doses

vehicle safety (ex: propylene glycol can ccumulate in newborns and infnts causing AE)

iv acces ( difficult to obtain and maintain in newborns and infants)

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12
Q

dosage form considerations

oral

A

manufactured liquid preparations

extemporaneously compounded liquid preparations

volume of po fluids

chewable tablets

tablets

capsules

granules
*make sure these solid dosage forms can be manipulated

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13
Q

dosage form considerations

palatbility

A

children have different preferences

mixing with food
*peanut butter
*crystal lite

flavoring
*flavor rx

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14
Q

Considerations for extemporaneous preparations

A

USP:water containing formulations prepared from solid ingredients should have a bud no later than 14 days when stored at cold temps

*ISMP: List of oral dosage forms that should not be crushed)

injectable solutions administered orally
*ok if both formulations (IV and PO) contain same salt form w. similar bioavailability
*ex: glycopyrrolate broide injection (adminstered PO)

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15
Q

determining pediatric dosages

A

ALWAYS ASK FOR WEIGHT

*max pediatric dose=adult dose

doses may be also based on gestational age, actual age, patient weight ranges

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16
Q

Assessment of kidney function in peds

A

calculate eGFR: bedside schwartz equation

Uurine output: reported ml/kg/day for intake
ml/kg/hr: for output

anuria: zero output
oligouria: <0.5-1mL/kg/hr
normal urine output: 1mL/kg/hr
polyuria= 4mL/kg/hr

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17
Q

Peds PK

Absorption-Oral

A

*most common route for drug delivery
*children will reject meds based on color, taste, texture, and temperature

taste:
birth: ability to detect sweet
by 2y.o: can detect bitter/salty/sour
by1-2 y.o: can detect texture and temp

smell: by 5-7 y.o: affective response to colors

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18
Q

Effects of gastric pH on oral absorption in peds

A

varies with growth.
after birth, ph in stomach is high (basic)

can effect acid labile medications (ex acid labile med such as PCN can have higher concentrations in newborns)

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19
Q

effects of gastric emptying on oral absorption in peds

Study These Flashcards
A

increased gastric emptyingduring first week of life . increased drug delivery to site of absoprtion

frequency and amplitue of intstinal contractions reduced in newborns and young infant
*adult motility occurs by 6-8 mo.)

reduced gastirc eptying and poorly coordinated intestinal contractility = decreased rate of drug absoprtion

20
Q

extra-oral routes of adminisration considerations

Study These Flashcards
A

rectal: higher amplituse contractions in infants which expells drug. maydecrease drug absoprtion time. decreases bioavaiabilty

percutaneous: ;arger surface area per unit mass, greater degree of hydratation of skin, higher perfusion rates, enhanced drug permeability

IM: greater capillary densiy in young children compared to older childrn: greater iM bioavailability.

21
Q

refresher on pka and ph

Study These Flashcards
A

if drug is basic in a basic environment, the drug will notionize

if drug is basic in an acid environment, the drug will ionize

if drug is acid in an acidic environment, will not ionize

if drug is acid in a basic environment, drug will ionize

22
Q

ped consdierationds for distribution

Study These Flashcards
A

increased tbw in neonates (75-85% vs adults (55-60%)

extracellul;ar fluid is greater in neonates (35-45% vs adults (20%)

new borns have much less muscle fat.
overall, increase of vs for hydrophyllic drugs and decrease of vd for lipophyllic drugs

examples: AG’s are hydrophyllic drugs… so will need more drug to achieve same conc as adult.

neonates: 4-5 mg/kg/dose
infants: 2.5 mg/kg/dose
adults: 1-2.5 mg/kg/dose

23
Q

protein binding and distribution

Study These Flashcards
A

in new borns, decreased concentration of albumins and binding affinity of fetal albumin to substances…

increases the free fraction of drug, enhancing pharmacologic effects

also increases risk to adverse effects…

ex: ceftriaxone and sulfonamides in infants <2 months of age can displace bilirubin form fetal albumin,,, puts baby at risk for kernicterus (albumin deposits in the brain) can cause cell atrophy and neurologic damage.

drugs that may be affected: phenytoin which is 90-95% bound to albumin and tp range of 10-20

24
Q

metabolism considerations in peds

Study These Flashcards
A

hanges in phase 1 and phase 2 preesent in new borns in conmparison to adults

CYP3A4: doesnt reach adult acitivty levels until 1 year of age. causes decreased metabolism

CYP2C19: activity increased during first 6 months of life( ex PPIs may need to be given more frequently

CYP2E1: approx 80% of adult levels by year 1 of age

CYP1A2: absent in neonates, 25% pf adult levels by year 1, 55% of adult levels by year 9

UGT: in children <12 years of age, less susceptable to APAP toxicity due to use of sulfation pathway for metabolism into nontoxic metabolite instead of just saturating regular glucuronic pathway

25
elimination considerations in peds
nephrogenesis completes by 26 weeks decreased renal blood flow, leads to decreased substrate delivery to kidneys decreased gfr decreased tubular secretions overall causes lower clearance of drugs and longer half lives. drugs can be given at longer dosing intervals, or less frequently. ex: fluconazole t1/2 in prematur infants: =88 hrs t1/2 in full term is less
26
challenges peds pts face for drug deliuvery and dosage forms
nay require manipulation form tailored to ability to swallow may require dosage forms tailed to smaller dose may require alteration sin stability may not be palatable
27
considerations for enteral formulation use tablets
is manipulation feasble or alters med delivery is it extended relewase? can it be split
28
considerations forenteral formulations capsules
must determine contents ex: powder, beads, enteric coating, gel capsules
29
considerations for eneteral formulations liquid dosage forms: pros and cons
most used dosage form in children pros: dose flexibility easy to swallow cons: lack of controlled release mechanisms volume required accuracy of measuring devices challenges: not all meds have commercially available suspensions, single concentrations vs extemporaneous compounds
30
additional enteral formulation sthat are ideal but not perfect in peda
chewable tabs: pro minimizes need for additional liquids con: relies on ability to chew minitablets: eases swallowing tabs con: limited dosage flexibility ODT:L quick dissolve orodispersible films (ODFs) powder packets sprinkle capsules/granules
31
Special considerations for enteral formulations in peds
palability!!! depends on preferences of the individual pt manipulation can change taste flavor rx: commercially available 2. admin via tube *ex: gtube, jtube, ngtube, ndtube what is the site of absorption of the drug, can medication contact plastic? will med clog the tube (
32
parenteral formulations used in peds IV administration
allows for immediate entry into bloodstream most common parenteral admin used
33
parenteral formulations used in peds IM or SQ
muscle and fat mass are factors affecting utility can be used in ana emergency or for single med asmin such a svaccines limitations exist related to volume allowed per injection based on age
34
additonal considerations for parenteral formulations
volume is a common challenge: is dose measurable ? IV access-central vs peripheral vs number of lines available
35
other formulations that pose challenges in peds
inhalation: devices designed for adults nebulizers preffered but cumbersome and require additonal education nasal: devices designed for adults difficult to admin based on age rectal: lmited dosage forms, neonates/infants size restrictions, increased stool count topical: need to consider BSA ratio, potential for systemic absorption transdermal: lmited dosage forms ability to cut/cover age restrictions behavior
36
risiks associated w. excipiennts benzoyl alcohol role as excipient: effects: example:
risiks associated w. excipiennts role as excipient: preservative, to protect microbial contamination effects:neurotoxicity and metabolic acidosis, especially in concerning neonatal population example: IV lorazepam (2% benzoyl alcohol)
37
risiks associated w. excipiennts ehtNOL role as excipient: effects: example:
risiks associated w. excipiennts role as excipient: solvent effects: neurotoxicity example: dexamethasone intensol solution (30%) alcohol
38
risiks associated w. excipiennts polysorbate role as excipient: effects: example:
risiks associated w. excipiennts role as excipient: surfactant, increases solubility of one agent w. another agent effects: liver and kidney failure, thrombocytopenia, ascites, and pulmonary deterioration example: IV amiodarone (PS80 300mg and PS20 20mg)
39
BUD Dating of extemporaneous compounding in peds
USP 795 non preserved aqueous dosage forms: 14 days in fridge preserved acquous dosage forms: 35
39
risiks associated w. excipiennts propylene glycol role as excipient: effects: example:
risiks associated w. excipiennts role as excipient: solvent effects:seizures, hyperosmorality, metabolic acidosis, and neurotoxicity example:IV phenobarbitol (67.8% propylene glycol)
39
other ocmpounded preparations benficial for peds pts
powder papers (used crushed tablets, may or may not need filter injectable meds used as oral solution (ph dependent) oral suspensio: when not commercially available. can use crushed tablets, bulk powders, or filled capsules. need to avoid using extended release products, hard geletin capsules, or capsules w. time released beads
39
risiks associated w. excipiennts Sorbitol role as excipient: effects: example:
risiks associated w. excipiennts role as excipient: sweetner, to mask taste and palatability effects:seizures, hyperosmorality, metabolic can lead to osmotic diarrhea example:loperamide
40
age ranges
neonate: birth -30 days old infant: 1mo-1yr child: 1-12 y.o adolescent: 12-18 years old
41
neonatal dosing
gestational age: "how for along in pregnancy post -natal age: chronilogical age, time in days, weeks, months from birth post menstrual age: combo of GA and PNA
42
important eq for peds
weight ocnversion: 1kg=2.205 lbs 1 inch=2.54 cm bsa m^2=(weightxheight/3600)^1/2
43
commonly used components of a drug monograph
dosing section: recommendations preparation for administration *info on concentrations and appropriate diluents for reconstitution/dilution of parenteral meds administration: *instructions for mixing w. food, missed doses, parenteral info adverse reactions extemporaneous compiunding: if applicable, provided published reference for compounding recommendations into oral solution/suspension from tabs or capsules PK/moa dosage forms, US and canada : shows available products on market, brand name and generic strengths availability

Peds and Geriatrics (5 decks)

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