Chapter 23: Pediatric Patients Flashcards
7 questions prior to prescribing for a pediatric patient
- How does the age affect drug’s pharmacokinetics and pharmacodynamics?
- has drug dosage (mg/kg) been carefully calculated?
- Has tast, texture, and ease of administration been considered?
- Have you considered contraindications in pediatric population?
- Have black box warnings been considered?
- Have risks v benefits been carefully considered?
- Has the caregiver’s ability to administer medications and compliance been considered?
what factors affect drug absorption in children
blood flow at administration site
GI function
thinner statum corneum (outer layer of epidermis)
what factors affect drug distribution in children
body composition changes as they grow
(levels of total water and muscle-to-fat ratio shifts)
what accounts for variability in drug metabolism in children
ability of small bowel to metabolize drugs
differences in excretion in infants
drugs are more slowly excreted causing dosing adjustments in medications that are excreted renally
how are the vast majority of perdiatric medications dosed
mg/kg
why is ASA contraindicated in pediatric patients
association with Reye’s syndrome and GI side effects
exceptions to pediatric contraindication of ASA
kawasaki syndrome, rheumatic fever, or surgical correction of congenital heart disease
contraindication of cough/cold preparations in pediatric patients
do not give to children under 2 because they are inefficient and can produce unwanted side effects
why are fluoroquinolones (Cipro, Levaquin) contraindicated in pediatric patients
adverse effects n growth of immature cartilage, joints, and surrounding tissues
not generally given to children under 18
contraindication of tetracyclines in pediatric patients
not used in children under 8 because they can cause dental discoloration, enamel hypoplasia, and skeletal development deformities
why is metoclopramide (Reglan) contraindicated for pediatric patients
potential to cause EPS and tardive dyskinesia
(often irreversible)
anti-migraine serotonin 5-HT receptor agonists in children
contraindicated because of side effects of MI, stroke, death, and vision loss
drugs with black box warning for use in children
drugs used to treat depression
drugs used to treat eczema
drugs used to treat asthma
drugs used to treat ADHD
black box warning for promethazine (phenergan) in children
can cause severe or fatal respiratory depression in children under 2
over 2, use caution and gice lowest effective dose
black box warning for pimecrolimus (Elidel) and
tacrolimus (Protopic, Prograf) for eczema in children
can increase susceptibility to infection and development of lymphoma d/t immunosuppression
not for use in children younger than 2
metformin black box warning for use in pediatric patients
may cause lactic acidosis
rare but severe
ACE inhibitor black box warning for use in pediatric patients
can cause injury and death to developing fetus
salmeterol (Advair, Serevent) black box warning for use in children
increased risk of asthma related deaths
only for use as a last resort
methylphenidate (Concerta, Metadate, Methylin, Ritalin) black box warning for use in children
drug dependency may develop
amphetamines (Adderall, Vyvanse) black box warning for use in children
misuse can cause death and serious cardiovascular event
what are some family issues that can affect drug adherence
caregiver doesn’t understand an important aspect of regimen
caregiver has difficulty administering to child who desnt want to take it
examples of drugs that can increase suicidal ideation in children and adolescents
escitalopram (Lexapro)
citalopram (Celexa)
paroxetine (Paxil)
fluoxetine (Prozac)
sertraline (Zoloft)
aririprazole (Abilify)
quetiapine (Seroquel)
treatment of infectious conjunctivitis in children
ABT drps (polymyxin B + trimethoprim)
treatment of allergic conjunctivitis
seasonal
eyedrops like azelastine or naphazoline+pheniramine
symptoms of infectious conjunctivitis
mild lid edema
yellow, usially copius discharge, especially on waking
sometime mild respiratory infection
symptoms of allergic conjunctivitis
conjunctiva has cobblestone appearance
discharge is somewhat clear and watery
history of sneezing, itching
seasonal reoccurence
treatment of otitis media in children
usually does not require ABTs
watchful waiting ad adequate pain control
ABT of choice in treating otitis media if it is needed
amoxicillin syrup
difference between amoxicillin rash and allergic rash
amoxicillin is nonpuritic, macopaplura and begin on trunk spreading to rest of the body and will clear on its own. Drug does not need to be discontinued
allergic rash is intensly puritic and requires discontinuation of drug
treatment of otitis externa (swimmers ear) in children
apply topical agent to Q-tip and insert in ear
dextromethorphan use to treat common cold
do not give when cough is productive or generates alot of mucus
caution between 2-12
antitussive
guaifenesin (Mucinex, Robitussin) to treat common cold
expectorant
do not use in children under 2
2mg/kg q4-6 hours
codeine in treating the common cold
narcotic antitussive
use extreme caution
symptoms of allergic rhinitis
nosebleed, nasal pruritus, throat clearing, chronic cough that is worse at night
3 step approach to treating allergic rhinitis
begin with oral antihistamine (Benadryl) or loratidine (Claritin)
add nasal steroids if needed (Flonase)
add oral leukotriene inhibitor (Singulair)
typical diagnostic criteria for sinusitis as opposed to allergic rhitic
more than 7 days of copious nasal congestion accompanied by chronic cough
treatment of sinustis in children
antibiotics
classic symptoms of treptococcal pharyngitis (strep throat)
relatively sudden onset of fever, pharyngitis, exudative/erythematous tonsils, cervical adenopathy, headache, stomach ahce
treatment of strep throat
10 days of amoxicillin
OR
5 days of cephalosporins
presentation of infectious mononucleosis (mono)
several days of lethary followed by fever, cervical adenitis, and intensly painful pharyngitis
often tonsilar hypertrophy, cervical adenopathy, and splenomegaly
treatment of mono
multipronged and includes the use of steroids
markedly edematous tonsils with no obvious abcess can be treated with dexamethasone
presentation of herpetic gingivostomatitis
extremely painful and extensive oral lesions affecting entire oral cavity (fever and irritability often precede)
treatment of herpetic gingivostomatitis
usually narcotic because of refusal to take anything PO and prevention of dehydration is important
treatment of thrush
antifungal drugs such as nystatin
fluconazole if nystatin is ineffective
what is the most important thing to ascertain first in children with respiratory distress
whether it is affecting the upper or lower airways
treatment of asthma in pediatric patients
SABA for occasional attacks, if needed more than 2 days/week add inhaled corticosteroids. Therapy can be stepped down after several months with no attacks
therapy goals in treating asthma
prevent symptoms
minimize morbidity when attacks occur
allow child to live as close to a normal life as possible
administration methods of asthma medication to children
<4: MDI w/ mask/spacer
4-6: MDI and a valve holding chamber
>6: pMDI, breath actuated pMDI, or DPI
treatment of bronchiolitis
usually supportive with lots of nasal suctioning
can trial SABAs
steroids are not appropriate
treatment for croup
decadron for mild0mod
decadron and nebulized racemic epinephrine for severe
treatment of influenze
antivirals zanamivir (Relenza) and oseltamivir (Tamiflu)
treatment for pneumonia
ABTs
treatment of diarrhea in children
OTC medications
fluid and electrolyte therapy if severe
treatment of GERD in pediatric patient
start with dietary and feeding techniques
add histamine-2 receptor agonists if needed (Zantac, Pepcid)
if severe use PPI (once started ween patient off H-2 agonist over 2 weeks)
presentation of pinworms
pruritic com[laint in peri-anal region that worsens at night
can be seen in rectal area or stools
eggs can be seen in skin folds
treatment of pinworms
one tablet of mebendazole (Vermox) 100mg
with another in 2 weeks
treatment of gas in pediatric patients
simethicone (Mylicon) drops
pain management in children
best to underdose and workup so as to accidently overdose patient
usually can treat with acetominophen or ibuprofen
NO ASA d/t Reyes syndrome
nonpharmicologic interventions for ADHA
behavior modification
family education and counseling
educational intervention
ADHD medications
methylphenidate (Ritalin)
dexmethylphenidate (Focalin)
dextroamphetamine (Dextrostat)
atomoxetine (Stratters)
Lisdexamfetamine dimesylate (Vyvanse)
treatment of migraines in children
start with medication at a dose that is meant to abort the meadache within 2 hours
if unsuccessful, double the dose and repeat hopefully patient will be symptom free within 4 hours
when should prophylactic treatment for migraines be initiated
no response to acute management
frequent headaches
missing alot of school
debilitating headaches
medications used for prophylactic migraine treatment
anticonvulsants, antidepressants, antihistamnes, beta-blockers, calcium channel blockers, and NSAIDs
medications used for acute treatment of migraines
sumatriptan (Imitrex)
zolmitriptan (Zomig)
rizatriptan (Maxalt)
almotriptan (Axert)
eletriptan (Relpax)
fovatriptan (Frova)
types of primary headaches
migraine
tension
causes of secondary headaches
sinus disease
tumors
febrile illnesse such as meningitis or viral infections
typical treatment period for migraine prophylactic medication
3-18 months with average at 6 months
treatment of iron deficiency anemia in children
iron replacement therapy
3-6mg elemental Fe/kg q24h divided in 3-4 doses
formulated as drops, elixir, oral liquid, tablets
side effects of oral iron therapy
constipation, dark stools
nausea and epigastric pain
liquids may stain teeth so give with dropper or drink with straw
