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Pharmacology > Chapter 23: Pediatric Patients > Flashcards

Chapter 23: Pediatric Patients Flashcards

1
Q

7 questions prior to prescribing for a pediatric patient

A
  1. How does the age affect drug’s pharmacokinetics and pharmacodynamics?
  2. has drug dosage (mg/kg) been carefully calculated?
  3. Has tast, texture, and ease of administration been considered?
  4. Have you considered contraindications in pediatric population?
  5. Have black box warnings been considered?
  6. Have risks v benefits been carefully considered?
  7. Has the caregiver’s ability to administer medications and compliance been considered?
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2
Q

what factors affect drug absorption in children

A

blood flow at administration site

GI function

thinner statum corneum (outer layer of epidermis)

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3
Q

what factors affect drug distribution in children

A

body composition changes as they grow

(levels of total water and muscle-to-fat ratio shifts)

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4
Q

what accounts for variability in drug metabolism in children

A

ability of small bowel to metabolize drugs

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5
Q

differences in excretion in infants

A

drugs are more slowly excreted causing dosing adjustments in medications that are excreted renally

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6
Q

how are the vast majority of perdiatric medications dosed

A

mg/kg

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7
Q

why is ASA contraindicated in pediatric patients

A

association with Reye’s syndrome and GI side effects

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8
Q

exceptions to pediatric contraindication of ASA

A

kawasaki syndrome, rheumatic fever, or surgical correction of congenital heart disease

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9
Q

contraindication of cough/cold preparations in pediatric patients

A

do not give to children under 2 because they are inefficient and can produce unwanted side effects

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10
Q

why are fluoroquinolones (Cipro, Levaquin) contraindicated in pediatric patients

A

adverse effects n growth of immature cartilage, joints, and surrounding tissues

not generally given to children under 18

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11
Q

contraindication of tetracyclines in pediatric patients

A

not used in children under 8 because they can cause dental discoloration, enamel hypoplasia, and skeletal development deformities

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12
Q

why is metoclopramide (Reglan) contraindicated for pediatric patients

A

potential to cause EPS and tardive dyskinesia

(often irreversible)

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13
Q

anti-migraine serotonin 5-HT receptor agonists in children

A

contraindicated because of side effects of MI, stroke, death, and vision loss

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14
Q

drugs with black box warning for use in children

A

drugs used to treat depression

drugs used to treat eczema

drugs used to treat asthma

drugs used to treat ADHD

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15
Q

black box warning for promethazine (phenergan) in children

A

can cause severe or fatal respiratory depression in children under 2

over 2, use caution and gice lowest effective dose

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16
Q

black box warning for pimecrolimus (Elidel) and

tacrolimus (Protopic, Prograf) for eczema in children

A

can increase susceptibility to infection and development of lymphoma d/t immunosuppression

not for use in children younger than 2

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17
Q

metformin black box warning for use in pediatric patients

A

may cause lactic acidosis

rare but severe

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18
Q

ACE inhibitor black box warning for use in pediatric patients

A

can cause injury and death to developing fetus

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19
Q

salmeterol (Advair, Serevent) black box warning for use in children

A

increased risk of asthma related deaths

only for use as a last resort

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20
Q

methylphenidate (Concerta, Metadate, Methylin, Ritalin) black box warning for use in children

A

drug dependency may develop

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21
Q

amphetamines (Adderall, Vyvanse) black box warning for use in children

A

misuse can cause death and serious cardiovascular event

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22
Q

what are some family issues that can affect drug adherence

A

caregiver doesn’t understand an important aspect of regimen

caregiver has difficulty administering to child who desnt want to take it

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23
Q

examples of drugs that can increase suicidal ideation in children and adolescents

A

escitalopram (Lexapro)

citalopram (Celexa)

paroxetine (Paxil)

fluoxetine (Prozac)

sertraline (Zoloft)

aririprazole (Abilify)

quetiapine (Seroquel)

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24
Q

treatment of infectious conjunctivitis in children

A

ABT drps (polymyxin B + trimethoprim)

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25
Q

treatment of allergic conjunctivitis

A

seasonal

eyedrops like azelastine or naphazoline+pheniramine

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26
Q

symptoms of infectious conjunctivitis

A

mild lid edema

yellow, usially copius discharge, especially on waking

sometime mild respiratory infection

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27
Q

symptoms of allergic conjunctivitis

A

conjunctiva has cobblestone appearance

discharge is somewhat clear and watery

history of sneezing, itching

seasonal reoccurence

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28
Q

treatment of otitis media in children

A

usually does not require ABTs

watchful waiting ad adequate pain control

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29
Q

ABT of choice in treating otitis media if it is needed

A

amoxicillin syrup

30
Q

difference between amoxicillin rash and allergic rash

A

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

31
Q

treatment of otitis externa (swimmers ear) in children

A

apply topical agent to Q-tip and insert in ear

32
Q

dextromethorphan use to treat common cold

A

do not give when cough is productive or generates alot of mucus

caution between 2-12

antitussive

33
Q

guaifenesin (Mucinex, Robitussin) to treat common cold

A

expectorant

do not use in children under 2

2mg/kg q4-6 hours

34
Q

codeine in treating the common cold

A

narcotic antitussive

use extreme caution

35
Q

symptoms of allergic rhinitis

A

nosebleed, nasal pruritus, throat clearing, chronic cough that is worse at night

36
Q

3 step approach to treating allergic rhinitis

A

begin with oral antihistamine (Benadryl) or loratidine (Claritin)

add nasal steroids if needed (Flonase)

add oral leukotriene inhibitor (Singulair)

37
Q

typical diagnostic criteria for sinusitis as opposed to allergic rhitic

A

more than 7 days of copious nasal congestion accompanied by chronic cough

38
Q

treatment of sinustis in children

A

antibiotics

39
Q

classic symptoms of treptococcal pharyngitis (strep throat)

A

relatively sudden onset of fever, pharyngitis, exudative/erythematous tonsils, cervical adenopathy, headache, stomach ahce

40
Q

treatment of strep throat

A

10 days of amoxicillin

OR

5 days of cephalosporins

41
Q

presentation of infectious mononucleosis (mono)

A

several days of lethary followed by fever, cervical adenitis, and intensly painful pharyngitis

often tonsilar hypertrophy, cervical adenopathy, and splenomegaly

42
Q

treatment of mono

A

multipronged and includes the use of steroids

markedly edematous tonsils with no obvious abcess can be treated with dexamethasone

43
Q

presentation of herpetic gingivostomatitis

A

extremely painful and extensive oral lesions affecting entire oral cavity (fever and irritability often precede)

44
Q

treatment of herpetic gingivostomatitis

A

usually narcotic because of refusal to take anything PO and prevention of dehydration is important

45
Q

treatment of thrush

A

antifungal drugs such as nystatin

fluconazole if nystatin is ineffective

46
Q

what is the most important thing to ascertain first in children with respiratory distress

A

whether it is affecting the upper or lower airways

47
Q

treatment of asthma in pediatric patients

A

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

48
Q

therapy goals in treating asthma

A

prevent symptoms

minimize morbidity when attacks occur

allow child to live as close to a normal life as possible

49
Q

administration methods of asthma medication to children

A

<4: MDI w/ mask/spacer

4-6: MDI and a valve holding chamber

>6: pMDI, breath actuated pMDI, or DPI

50
Q

treatment of bronchiolitis

A

usually supportive with lots of nasal suctioning

can trial SABAs

steroids are not appropriate

51
Q

treatment for croup

A

decadron for mild0mod

decadron and nebulized racemic epinephrine for severe

52
Q

treatment of influenze

A

antivirals zanamivir (Relenza) and oseltamivir (Tamiflu)

53
Q

treatment for pneumonia

A

ABTs

54
Q

treatment of diarrhea in children

A

OTC medications

fluid and electrolyte therapy if severe

55
Q

treatment of GERD in pediatric patient

A

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)

56
Q

presentation of pinworms

A

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

57
Q

treatment of pinworms

A

one tablet of mebendazole (Vermox) 100mg

with another in 2 weeks

58
Q

treatment of gas in pediatric patients

A

simethicone (Mylicon) drops

59
Q

pain management in children

A

best to underdose and workup so as to accidently overdose patient

usually can treat with acetominophen or ibuprofen

NO ASA d/t Reyes syndrome

60
Q

nonpharmicologic interventions for ADHA

A

behavior modification

family education and counseling

educational intervention

61
Q

ADHD medications

A

methylphenidate (Ritalin)

dexmethylphenidate (Focalin)

dextroamphetamine (Dextrostat)

atomoxetine (Stratters)

Lisdexamfetamine dimesylate (Vyvanse)

62
Q

treatment of migraines in children

A

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

63
Q

when should prophylactic treatment for migraines be initiated

A

no response to acute management

frequent headaches

missing alot of school

debilitating headaches

64
Q

medications used for prophylactic migraine treatment

A

anticonvulsants, antidepressants, antihistamnes, beta-blockers, calcium channel blockers, and NSAIDs

65
Q

medications used for acute treatment of migraines

A

sumatriptan (Imitrex)

zolmitriptan (Zomig)

rizatriptan (Maxalt)

almotriptan (Axert)

eletriptan (Relpax)

fovatriptan (Frova)

66
Q

types of primary headaches

A

migraine

tension

67
Q

causes of secondary headaches

A

sinus disease

tumors

febrile illnesse such as meningitis or viral infections

68
Q

typical treatment period for migraine prophylactic medication

A

3-18 months with average at 6 months

69
Q

treatment of iron deficiency anemia in children

A

iron replacement therapy

3-6mg elemental Fe/kg q24h divided in 3-4 doses

formulated as drops, elixir, oral liquid, tablets

70
Q

side effects of oral iron therapy

A

constipation, dark stools

nausea and epigastric pain

liquids may stain teeth so give with dropper or drink with straw

71
Q
A

Pharmacology (28 decks)

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