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PHM 790: Topics in Pediatry > Week 1 Peds Therapeutics > Flashcards

Week 1 Peds Therapeutics Flashcards

1
Q

Limitations to off-label drug usage

A
  • potential for denied insurance coverage
  • liability for adverse effects
  • limited experience in specific conditions or age groups
  • limited available dosage formulations
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2
Q

How to ensure efficacy when using med off-label

A

use guidelines snd use primary literature

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3
Q

Strategies to improve adherence

A
  • caregiver edu
  • ease of admin (palatability and dec frequency)
  • dec child resistance
  • empowering older children/adolescents
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4
Q

Water containing formulations BUD

A

14 days when refrigerated

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5
Q

when is it okay to give injectable solutions as oral formulation

A

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

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6
Q

what is the maximum pediatric dose usually

A

the adult dose

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7
Q

what should you always ask for when determining pediatric drug dosage

A

weight

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8
Q

units for GFR in and out

A

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

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9
Q

Urine assessment anuria, oliguria, normal urine outpt, polyuria

A

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

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10
Q

what happens to the pH of infants

A

higher gastric pH (more basic)

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11
Q

what happens to the gastric emptying of newborns vs infants

A
  • 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
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12
Q

what is rectal absorption like in infants

A

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

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13
Q

what is percutaneous (blood vessel) absorption like in infants

A

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

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14
Q

what is IM absorption like in infants

A

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

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15
Q

what is distribution like in infants

A

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

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16
Q

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

A
  • dec protein binding of fetal albumin = more free drug
  • avoid ceftrixone and sulfonamides in infants 2 months and younger
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17
Q

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

A

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

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18
Q

when do infants develop CYP3A4 mature metabolism

A

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

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19
Q

overall trend of metabolism/ enzymes in newborns/children

A

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

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20
Q

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

A

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

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21
Q

when does complete nephrogenesis (kidney) develop

A

36 weeks
8 months

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22
Q

Elimination implications for drug dose

A

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

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23
Q

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

A

every 72 hours

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24
Q

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

A

every 48 hours

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25
Q

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

A

every 48 hours

26
Q

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

A

every 24 hours

27
Q

challenges in drug delivery for ped pts

A
  • tailor to ability to swallow**
  • tailor to smaller doses
  • alterations in stability
  • palatability
28
Q

considerations for tablets as dosage form

A

can it be manipulated- splitting, crushing, ER?

29
Q

considerations for capsules as dosage form

A

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

29
Q

Pros of liquid dosage form

A

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

30
Q

Cons of liquid dosage form

A
  • lack of controlled release (frequent dosing)
  • volume required
  • accuracy of measuring devices
31
Q

challenges for liquid dosage form

A

not commercially available, various concentration= MED ERRORS

32
Q

Cons of Chewable Tablets

A

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

33
Q

Who should you avoid giving chewable tablets to

A

preterm/infants

34
Q

Pros of minitablets

A

ease the need for swallowing

35
Q

Cons of minitablets

A

limited dose flexibility, max mg per tablet

36
Q

pros of oral disintegrating tablets

A

allows for quick dissolving without need for additional liquid

37
Q

cons of oral disintegrating tablets

A

cannot easy spilt, challenge with masking task

38
Q

pros of orodispersible films

A

dose flexibility with strip cutting mechanism

39
Q

cons of orodispersible films

A

hard to mask taste, higher cost to packaging manufacturing

40
Q

pros powder packets

A

eliminate need for crushing tablets
ready to use

41
Q

cons powder packets

A

may require significant volume to mix, not easily titratable

42
Q

pro sprinkle capsules

A

can ease in admin w/ food

43
Q

con sprinkle capsules

A

limited dose flexibility `

44
Q

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

A

Palatability, FlavorRx

45
Q

common challenges associated with Parenteral formulations

A
  • IM: kids have limited muscle mass
  • volume
46
Q

use and risk associated with benzoyl alcohol in peds. example

A
  • use: perservative
  • risk: neurotoxicity and metabolic acidosis
  • Lorazepam
47
Q

use and risk associated with ethanol in peds. example

A
  • use: solvent to help dissolve/disperse particles
  • Risk: neurotoxicity
  • Dexamethasone
48
Q

use and risk associated with Polysorbates in peds. example

A
  • use: surfactant to improve solubility
  • risk: liver and kidney failure; thrombocytopenia, ascites and pulmonary deterioration
  • Amiodarone
49
Q

use and risk associated with Propylene glycol in peds. example

A
  • Use: solvent
  • risk: seizures, hyperosmolarity, metabolic acidosis and neurotoxicity, multiorgan failure
50
Q

use and risk associated with Sorbitol in peds. example

A
  • use: sweetener to mask taste
  • risk: osmotic diarrhea
  • Loperamide
51
Q

What are powder packets made of

A

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

52
Q

guidelines for extemporaneous preparations

A

USP 795

53
Q

what is gestational age

A

days since conception (first day of missed period)

54
Q

what is post-natal age

A

days since birth

55
Q

what is post-menstrual age

A

combination of GA and PNA

56
Q

Neonate age range

A

Birth to 30 DAYS

57
Q

Infants age range

A

30 days to 1 year

58
Q

child age range

A

1 year to 12 years

59
Q

adolescent

A

12-18 years

60
Q

where to get information about ability to crush pills

A

ISMP’s do not crush list and lexicomp admin tab

61
Q

what is the child GFR equation

A

bed side schwartz

PHM 790: Topics in Pediatry (4 decks)

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