Week 1 Peds Therapeutics

Question 1

Limitations to off-label drug usage

Answer 1

• potential for denied insurance coverage
• liability for adverse effects
• limited experience in specific conditions or age groups
• limited available dosage formulations

Question 2

How to ensure efficacy when using med off-label

Answer 2

use guidelines snd use primary literature

Question 3

Strategies to improve adherence

Answer 3

• caregiver edu
• ease of admin (palatability and dec frequency)
• dec child resistance
• empowering older children/adolescents

Question 4

Water containing formulations BUD

Answer 4

14 days when refrigerated

Question 5

when is it okay to give injectable solutions as oral formulation

Answer 5

ok if iv and po formulations have same salt form w/ similar bioavailability

Question 6

what is the maximum pediatric dose usually

Answer 6

the adult dose

Question 7

what should you always ask for when determining pediatric drug dosage

Answer 7

weight

Question 8

units for GFR in and out

Answer 8

in= ml/kg/day
out= ml/kg/hr

Question 9

Urine assessment anuria, oliguria, normal urine outpt, polyuria

Answer 9

anuria= zero output
oliguria <.5-1 ml/kg/hr
normal UO >1 ml/kg/hr
polyuria >4ml/kg/hr

Question 10

what happens to the pH of infants

Answer 10

higher gastric pH (more basic)

Question 11

what happens to the gastric emptying of newborns vs infants

Answer 11

• higher rates during first week of life (newborn) leads to more drug delivery to site of absorption
• infants have reduced rates of contractions and gastric emptying leads to dec dru absorption

Question 12

what is rectal absorption like in infants

Answer 12

more stools, dec time drug is able to be absorbed, decreased bioavailability

Question 13

what is percutaneous (blood vessel) absorption like in infants

Answer 13

greater degree of hydration and higher perfusion rates= enhanced drug permeability

Question 14

what is IM absorption like in infants

Answer 14

inc capillary density (more drug in blood stream) = inc IM bioavailability

Question 15

what is distribution like in infants

Answer 15

inc Vd of hydrophilic drugs (ex. aminoglycosides), dec Vd of lipophilic drugs

Question 16

what is protein binding like in infants, what drugs to avoid

Answer 16

• dec protein binding of fetal albumin = more free drug
• avoid ceftrixone and sulfonamides in infants 2 months and younger

Question 17

what should happen to dosing of CYP2C19 drugs if pt is 3 months old and why?

Answer 17

Inc dose
CYPC19 metabolism increased during first 6 months of life then normalizes. ex Omeprazole

Question 18

when do infants develop CYP3A4 mature metabolism

Answer 18

1 year. starts as 3A7 then turns to 3A4

Question 19

overall trend of metabolism/ enzymes in newborns/children

Answer 19

Enzyme activity increases w/ time. UGT matures earlier than other enzymes

Question 20

Pearls about Phase 2 metabolism of Acetaminophen in children less than 12

Answer 20

Infants have protection against APAP toxicity as the primary phase 2 metabolism is sulfation instead of glucoronidation. Therefore they wont of over saturation

Question 21

when does complete nephrogenesis (kidney) develop

Answer 21

36 weeks
8 months

Question 22

Elimination implications for drug dose

Answer 22

due to dec renal BF & GFR
- Slower drug clearance
- longer drug half-life
- requires less frequent dosing

Question 23

How frequent should dosing of antibiotics be for a pt who is <29 weeks gestation and born < 14 days ago

Answer 23

every 72 hours

Question 24

How frequent should dosing of antibiotics be for a pt who is <29 weeks gestation and born > 14 days ago

Answer 24

every 48 hours

Question 25

How frequent should dosing of antibiotics be for a pt who is 30-39 weeks gestation and born < 14 days ago

Answer 25

every 48 hours

Question 26

How frequent should dosing of antibiotics be for a pt who is 30-39 weeks gestation and born >14 days ago

Answer 26

every 24 hours

Question 27

challenges in drug delivery for ped pts

Answer 27

- tailor to ability to swallow** - tailor to smaller doses - alterations in stability - palatability

Question 28

considerations for tablets as dosage form

Answer 28

can it be manipulated- splitting, crushing, ER?

Question 29

considerations for capsules as dosage form

Answer 29

formulation of capsule and content- beads, enteric coated, gel, powder?

Question 29

Pros of liquid dosage form

Answer 29

Dose flexibility, easy to swallow *Preferred in 2-5 yo*

Question 30

Cons of liquid dosage form

Answer 30

- lack of controlled release (frequent dosing) - volume required - accuracy of measuring devices

Question 31

challenges for liquid dosage form

Answer 31

not commercially available, various concentration= MED ERRORS

Question 32

Cons of Chewable Tablets

Answer 32

Relies on ability to chew, no ER, may not mask taste, difficult to control dosage

Question 33

Who should you avoid giving chewable tablets to

Answer 33

preterm/infants

Question 34

Pros of minitablets

Answer 34

ease the need for swallowing

Question 35

Cons of minitablets

Answer 35

limited dose flexibility, max mg per tablet

Question 36

pros of oral disintegrating tablets

Answer 36

allows for quick dissolving without need for additional liquid

Question 37

cons of oral disintegrating tablets

Answer 37

cannot easy spilt, challenge with masking task

Question 38

pros of orodispersible films

Answer 38

dose flexibility with strip cutting mechanism

Question 39

cons of orodispersible films

Answer 39

hard to mask taste, higher cost to packaging manufacturing

Question 40

pros powder packets

Answer 40

eliminate need for crushing tablets ready to use

Question 41

cons powder packets

Answer 41

may require significant volume to mix, not easily titratable

Question 42

pro sprinkle capsules

Answer 42

can ease in admin w/ food

Question 43

con sprinkle capsules

Answer 43

limited dose flexibility `

Question 44

what is the primary source of non-compliance in children and a resource used in pharmacies

Answer 44

Palatability, FlavorRx

Question 45

common challenges associated with Parenteral formulations

Answer 45

- IM: kids have limited muscle mass - volume

Question 46

use and risk associated with benzoyl alcohol in peds. example

Answer 46

- use: perservative - risk: neurotoxicity and metabolic acidosis - Lorazepam

Question 47

use and risk associated with ethanol in peds. example

Answer 47

- use: solvent to help dissolve/disperse particles - Risk: neurotoxicity - Dexamethasone

Question 48

use and risk associated with Polysorbates in peds. example

Answer 48

- use: surfactant to improve solubility - risk: liver and kidney failure; thrombocytopenia, ascites and pulmonary deterioration - Amiodarone

Question 49

use and risk associated with Propylene glycol in peds. example

Answer 49

- Use: solvent - risk: seizures, hyperosmolarity, metabolic acidosis and neurotoxicity, multiorgan failure

Question 50

use and risk associated with Sorbitol in peds. example

Answer 50

- use: sweetener to mask taste - risk: osmotic diarrhea - Loperamide

Question 51

What are powder packets made of

Answer 51

crushed tablets combined with filler to create measurable quantity for smallest dosage needed

Question 52

guidelines for extemporaneous preparations

Answer 52

USP 795

Question 53

what is gestational age

Answer 53

days since conception (first day of missed period)

Question 54

what is post-natal age

Answer 54

days since birth

Question 55

what is post-menstrual age

Answer 55

combination of GA and PNA

Question 56

Neonate age range

Answer 56

Birth to 30 DAYS

Question 57

Infants age range

Answer 57

30 days to 1 year

Question 58

child age range

Answer 58

1 year to 12 years

Question 59

adolescent

Answer 59

12-18 years

Question 60

where to get information about ability to crush pills

Answer 60

ISMP's do not crush list and lexicomp admin tab

Question 61

what is the child GFR equation

Answer 61

bed side schwartz