Exam 1 - Pediatrics Flashcards
Traditional Designation of “Pediatrics”
Less than 18
Newer Designation of “Pediatrics”
Less than 12
Antenatal
Occurring before birth (maternal)
Perinatal
Period from the 12th week of gestation through the 28th day of life after birth
Pediatric pt is defined as…
<18 years of life
Neonate is defined as…
First month of life
Infant is defined as…
Months 1-17 of life
Toddler is defined as…
18 months to 3 years
Preschool child is defined as…
3-5 years
Child is defined as…
6-11 years
Adolescent is defined as…
12-18 years
Young adult is defined as…
18-24 years
Premature is defined as…
<37 weeks gestational age
Full-term is defined as…
39-42 weeks gestational age
Post-term is defined as…
Greater than or equal to 42 weeks gestational age
What is the term for age of a fetus expressed in weeks?
Gestational age
-“Dates” calculated from the first day of the last normal menstrual period
What is the term for age after birth?
Postnatal age
What is the term for GA + Postnatal age?
Postmenstrual age
What does APGAR stand for?
A- Appearance P- Pulse G- Grimace A- Activity R- Respiration
Good APGAR score?
Anything above 7
What do you do if APGAR score is not above 7?
Repeat every 10 minutes if not above 7
Which route of administration is most desirable?
ORAL
Which route of administration is most effective?
IV
Who are we most cautious about topical administration?
Babies
What are the 8 modes of administration in pediatrics?
1) Oral
2) IV
3) IM
4) Rectal
5) Inhalation
6) Ophthalmic
7) Otic
8) Topical
At what age can peds pts be able to swallow tablets?
By 5-8 years of age
Which mode of administration has the most effective absorption and is most reliable?
IV
Which modes of administration has erratic absorption?
IM and RECTAL
Which peds patients have increased drug absorption?
Premies
-Can see increased systemic absorption
Can you use patches in the pediatric population?
YES
-Some can be cut in half, but not all
When should you utilize topical formulation?
N/V, constipation
When is a nebulizer needed?
In younger kids
T/F: You can put ear drops in the eyes also.
FALSE
-Can put eye drops in the ears, but not ear drops in eyes
Do peds pts get larger or smaller doses than adults?
LARGER
Which age range are super excreters and are dosed more frequently?
Age 2-9 years
-Have short half-life, clearance is high
Who has the largest volume of distribution?
Neonates
-Larger Vd and Vd range (depends on when they were born)
Younger patients are able to do mainly Phase I or Phase II metabolism?
PHASE I METABOLISM
What are Phase I metabolism reactions?
Oxidation
Reduction
Hydrolysis
What are Phase II metabolism reactions?
Acetylation
Glucuronidation
Amino Acid Conjugation
What do conjugation Phase II metabolism reactions do?
Increase water solubility
T/F: Sulfation Phase II metabolism reactions are relatively well developed at birth.
TRUE
-Adult values
When do Acetylation Phase II metabolism values reach adult levels?
~10-20 days
When do Amino Acid Conjugation Phase II metabolism values reach adult values?
2-4 months
When do Glucuronidation Phase II metabolism values reach adult levels?
Between 1.5-4 years of life
-Endogenous compounds, steroids, and bilirubin
T/F: Glumerular filtration increases at birth.
FALSE
-Glumerular filtration DECREASES at birth; accelerates with birth
T/F: Tubular filtration and reabsorption mature slowly.
TRUE
What percentage at birth do kidneys receive cardiac output?
5-6%
When is GFR lowest?
In neonates
When is GFR the same as adults?
By 3 years
Which matures first - secretion or reabsorption?
SECRETION
Creatinine Clearance =
K * L/SCr
L = length in cm SCr = serum creatinine concentration in mg/dL K = constant of proportionality that is age and sex specific
What age is pediatric creatinine clearance used?
Less than or equal to 21 years of age
What is the unit for CrCl in peds?
mL/minute/1.73 m^2)
At what age is IBU appropriate?
> 6 months
What is the FDA recommendation for OTC cough and cold preparations?
Not using in infants and children <2 years of age
What would be appropriate for peds pts for OTC cough and cold preparations?
APAP
IBU - >6 mo
Saline sprays
Humidifiers
Name local anesthetics for pain therapy.
EMLA
Numby Stuff
Synera
What is contained in a Vapocoolant spray for pain therapy?
Benzocaine
What pain therapy can be used for peds patients <6 months old?
Pacifier with SUCROSE on it
What modes of delivery are available for pain therapy?
Intermittent - i.e. Fentanyl Continuous infusion PCA - set lockout Epidural Transmucosal Transdermal
T/F: It is safe to use Meperidine and Codeine in peds patients?
FALSE
-Don’t use Meperidine and avoid Codeine - active metabolite that can cause seizures (long-acting drug)
Complications of childhood obesity:
- Impaired glucose tolerance
- T2DM
- Hyperandrogenism
- Metabolic syndrome
- HTN
- Dyslipidemia
- Non-alcoholic fatty liver disease
- Obstructive sleep apnea
- Orthopedic conditions
- Psychosocial
Body Weight Calculation for obese children =
[(actual BW - ideal BW) * 0.4] + ideal BW
Traub Method = IBW in kg
Children <5ft = [(ht in inches]^2 * 1.65)/1000
Boys >5ft = 39 + (2.27 * [ht in inches - 60])
Girls >5ft = 42 + (2.27 * [ht in inches - 60])
BMI =
Wt (kg) / Ht (m)^2
What drug can cause biliary sludge?
Cephalosporins (Ceftriaxone)
When is biliary sludge most common?
In the first 2 months of life
What drug treats congenital syphillis?
Penicillin
Name two classes of drugs that are hepatically eliminated.
- Macrolides (Azithromycin)
- Cephalosporins (Cefoxatin)
What is the drug of choice for ANIMAL BITES?
AUGMENTIN
What drugs cause Stevens Johnsons Syndrome?
Sulfa drugs
Dapsone
What class of drugs causes teeth staining?
Tetracyclines (Doxycycline)
-With REPEATED DOSES
What class of drugs causes Kernicterus?
SULFA DRUGS
Name the key potentially inappropriate drugs in pediatrics (KIDs list)
- ASA/Salicylates
- Codeine
- Cough/cold meds
- Fluoroquinolones
- Meperidine
- Promethazine
- Paragoric/Opium tincture
- SSRIs
- Tetracycline - <8 years old
Why don’t we give ASA or salicylates?
Reye’s Syndrome
Why don’t we want to give Promethazine?
Respiratory distress in <2 years of age
Why don’t we want to give Paragoric/opium tincture?
Difficult to measure
Why don’t we want to give SSRIs?
Suicidal ideations
T/F: Indinavir is contraindicated in pediatric patients.
TRUE
Name two drugs that use is CAUTIONed.
Lamotrigine
Olanzapine
TCA use in pediatrics - Desipramine and Imipramine?
AVOID Desipramine
CAUTION Imipramine
What about Valproic Acid?
AVOID in INFANTS
CAUTION in <6 years old
Name Dopamine Antagonists to AVOID in Neonates.
- Chlorpromazine
- Fluphenazine
- Haloperidol
- Perphenazine
- Pimozidine
- Prochlorperazine
- Promethazine
- Trifluoperazine
Medications to avoid in infants:
- Benzocaine
- Ceftriaxone (biliary sludge)
- Chloramphenicol
- Fleets enema
- Gentamicin ophthalmic
- Hexachlorophene
- Lidocaine 2% viscous
- Loperamide
- Macrolides (Erythromycin)
- Midazolam
- Naloxone
- Sulfa agents
Why would we avoid Erythromycin in infants?
Pyloric stenosis - lots of vomiting
Why would we avoid Gentamicin ophthalmic meds in prolonged use?
B/C it burns the eyes
When is Ceftriaxone contraindicated in peds pts?
< 28 days old
What solutions are avoided in reconstitution with Ceftriaxone?
Calcium containing solutions
- LR
- Hartman’s solution
- TPN
Name drug excipients to avoid.
- Benzyl alcohol
- Methylparaben and propylparaben
- Propylene glycol
- Polysorbate 80
- Ethanol <5%
- Sugar, Sodium, Phenylalanine, Isopropyl alcohol
Why do we avoid benzyl alcohol?
“Gasping syndrome” in neonates
Why do we avoid methylparaben and propylparaben?
Kernicterus in <2 months (CAUTION)
Why do we avoid propylene glycol?
Hyperosmolality in infants
When do we avoid polysorbate 80?
<1 year old
When do we avoid ethanol <5%?
<6 years of age
- CNS depression
- Hypoglycemia
When do you start dosing males like an adult?
13-15 years of age
When do you start dosing females like an adult?
12-14 years of age
