31 - Prescribing for Children Flashcards

1
Q

How do you calculate the body surface area of a child?

A

Normogram or Boyd Method

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2
Q

What is the daily fluid requirements in children and what fluid is used?

A
  • 1st 10kg of bodyweight at 100ml/kg/day
  • 2nd 10kg of bodyweight at 50ml/kg/day
  • Remaining bodyweight at 20ml/kg/day

The fluid type routinely used is 0.9% NaCl + 5% dextrose with 10mmol KCl

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3
Q

What are the paediatric electrolyte requirements?

A
  • Sodium: 2-4mmol/kg/day
  • Potassium: 1-2mmol/kg/day
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4
Q

How do you work out fluid deficit replacement in children?

A

% Dehydration x Weight (kg) x 10

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5
Q

How do you calculate percentage dehydration?

A

Mild dehydration (0–5%): 5% weight loss in infants; 3% in children

Moderate dehydration (5–10%): Weight loss of 10% in infants; 6% in children

Severe dehydration (>10%): Weight loss of 15% in infants; 9% in children

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6
Q

If Mary is 5% dehydrated what would you give her?

A

Maintenance + Correction for dehydration

Use 0.9% sodium chloride with dextrose. If sodium is high then use 0.45%

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7
Q

In an emergency where you cannot weigh the child how do you get an estimated weight?

A

(Age + 4) * 2 OR Broselow Tape

(ALPS criteria)

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8
Q

What is the WETFLAG pneumonic?

A

Used when weight unknown for emergencies

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9
Q

Why do we need to write a child’s age on the prescription?

A

It is legal requirement for all children up to age 12

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10
Q

How does prescription by weight vary for obese children?

A

Should never exceed adult dose

For example if the dose is stated as 8 mg/kg (max. 300 mg), a child weighing 10 kg should receive 80 mg but a child weighing 40 kg should receive 300 mg (rather than 320 mg).

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11
Q

Why do children need a higher dose per kg of certain drugs compared to adults?

A

They have a higher metabolic rate

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12
Q

What is the most important parameter to know for paediatric prescriptions?

A

Weight

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13
Q

How is paracetamol prescribed in children?

A

Always prescribe in mg not ml

Two suspensions of 120mg/5ml or 250mg/5ml

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14
Q

What are two factors in children that differ to adults that affect oral absorption of drugs?

A
  • GI motility: slower in neonates so slower to absorb
  • Gastric pH: until 3 years old higher pH so acidic drugs broken down more quickly
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15
Q

How is absorption in neonates different to infants?

A
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16
Q

How does drug distribution, metabolism and excretion vary in infants?

A
  • Higher total body water: higher volume of distribution
  • Less plasma protein binding
  • Low eGFR
  • Different phase 1 and 2 enzymes in liver
17
Q

What drugs are prescribed by BSA rather than weight in children?

A
  • Aciclovir
  • Chemotherapy
18
Q

As a rule of thumb how much does an average baby and 1 year old weigh?

A

Baby: 3.5kg

Infant: 10kg

19
Q

How should oral rehydration take place?

A

Over 4 hours of 50ml/kg plus maintenance

20
Q

Why are there common prescription errors in paediatrics?

A
  • Individualised doses on age and weight
  • Lots of drugs used off label
  • Abbreviations
21
Q

How can we minimise prescription errors in paediatrics?

(image really important)

A
  • Clinical pharmacists
  • BNFc
22
Q

What happens to fluid prescriptions in children with pneumonia?

A

Givent at 50-80% maintenance due to risk of SIADH

23
Q

How do you prescribe salbutamol and steroids in an asthma exacerbation?

A

Always round to 5mg with prednisolone

24
Q

If there is no IV access in status epilepticus what is first line treatment?

A

Buccal midazolam

25
Q

Which children are offered flu vaccine?

A
  • At risk 6months to 2 years
  • All 2 years to 15 years
26
Q

What are the two different types of Epipen and why are they different?

A
27
Q

What pain relief is available for children?

A

Non-pharmacological: cuddling, comforting, distraction, playing

28
Q

What data base is used for poisoning in children?

A

ToxBase

29
Q

How do you calculate what amount of medication to give a child e.g you want to give 60mgs but oney have 120mgs in 5ml

A

What you want/What you’ve got x What it’s in

60/120 x 5 = 2.5mls