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PHA 397 - Make-Up Therapeutics > Exam 1 - Pediatrics > Flashcards

Exam 1 - Pediatrics Flashcards

1
Q

Traditional Designation of “Pediatrics”

A

Less than 18

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2
Q

Newer Designation of “Pediatrics”

A

Less than 12

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3
Q

Antenatal

A

Occurring before birth (maternal)

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4
Q

Perinatal

A

Period from the 12th week of gestation through the 28th day of life after birth

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5
Q

Pediatric pt is defined as…

A

<18 years of life

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6
Q

Neonate is defined as…

A

First month of life

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7
Q

Infant is defined as…

A

Months 1-17 of life

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8
Q

Toddler is defined as…

A

18 months to 3 years

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9
Q

Preschool child is defined as…

A

3-5 years

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10
Q

Child is defined as…

A

6-11 years

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11
Q

Adolescent is defined as…

A

12-18 years

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12
Q

Young adult is defined as…

A

18-24 years

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13
Q

Premature is defined as…

A

<37 weeks gestational age

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14
Q

Full-term is defined as…

A

39-42 weeks gestational age

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15
Q

Post-term is defined as…

A

Greater than or equal to 42 weeks gestational age

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16
Q

What is the term for age of a fetus expressed in weeks?

A

Gestational age

-“Dates” calculated from the first day of the last normal menstrual period

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17
Q

What is the term for age after birth?

A

Postnatal age

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18
Q

What is the term for GA + Postnatal age?

A

Postmenstrual age

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19
Q

What does APGAR stand for?

A 
A- Appearance
P- Pulse
G- Grimace
A- Activity
R- Respiration
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20
Q

Good APGAR score?

A

Anything above 7

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21
Q

What do you do if APGAR score is not above 7?

A

Repeat every 10 minutes if not above 7

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22
Q

Which route of administration is most desirable?

A

ORAL

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23
Q

Which route of administration is most effective?

A

IV

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24
Q

Who are we most cautious about topical administration?

A

Babies

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25
Q

What are the 8 modes of administration in pediatrics?

A

1) Oral
2) IV
3) IM
4) Rectal
5) Inhalation
6) Ophthalmic
7) Otic
8) Topical

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26
Q

At what age can peds pts be able to swallow tablets?

A

By 5-8 years of age

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27
Q

Which mode of administration has the most effective absorption and is most reliable?

A

IV

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28
Q

Which modes of administration has erratic absorption?

A

IM and RECTAL

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29
Q

Which peds patients have increased drug absorption?

A

Premies

-Can see increased systemic absorption

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30
Q

Can you use patches in the pediatric population?

A

YES

-Some can be cut in half, but not all

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31
Q

When should you utilize topical formulation?

A

N/V, constipation

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32
Q

When is a nebulizer needed?

A

In younger kids

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33
Q

T/F: You can put ear drops in the eyes also.

A

FALSE

-Can put eye drops in the ears, but not ear drops in eyes

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34
Q

Do peds pts get larger or smaller doses than adults?

A

LARGER

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35
Q

Which age range are super excreters and are dosed more frequently?

A

Age 2-9 years

-Have short half-life, clearance is high

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36
Q

Who has the largest volume of distribution?

A

Neonates

-Larger Vd and Vd range (depends on when they were born)

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37
Q

Younger patients are able to do mainly Phase I or Phase II metabolism?

A

PHASE I METABOLISM

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38
Q

What are Phase I metabolism reactions?

A

Oxidation
Reduction
Hydrolysis

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39
Q

What are Phase II metabolism reactions?

A

Acetylation
Glucuronidation
Amino Acid Conjugation

40
Q

What do conjugation Phase II metabolism reactions do?

A

Increase water solubility

41
Q

T/F: Sulfation Phase II metabolism reactions are relatively well developed at birth.

A

TRUE

-Adult values

42
Q

When do Acetylation Phase II metabolism values reach adult levels?

A

~10-20 days

43
Q

When do Amino Acid Conjugation Phase II metabolism values reach adult values?

A

2-4 months

44
Q

When do Glucuronidation Phase II metabolism values reach adult levels?

A

Between 1.5-4 years of life

-Endogenous compounds, steroids, and bilirubin

45
Q

T/F: Glumerular filtration increases at birth.

A

FALSE

-Glumerular filtration DECREASES at birth; accelerates with birth

46
Q

T/F: Tubular filtration and reabsorption mature slowly.

A

TRUE

47
Q

What percentage at birth do kidneys receive cardiac output?

A

5-6%

48
Q

When is GFR lowest?

A

In neonates

49
Q

When is GFR the same as adults?

A

By 3 years

50
Q

Which matures first - secretion or reabsorption?

A

SECRETION

51
Q

Creatinine Clearance =

A

K * L/SCr

L = length in cm
SCr = serum creatinine concentration in mg/dL
K = constant of proportionality that is age and sex specific
52
Q

What age is pediatric creatinine clearance used?

A

Less than or equal to 21 years of age

53
Q

What is the unit for CrCl in peds?

A

mL/minute/1.73 m^2)

54
Q

At what age is IBU appropriate?

A

> 6 months

55
Q

What is the FDA recommendation for OTC cough and cold preparations?

A

Not using in infants and children <2 years of age

56
Q

What would be appropriate for peds pts for OTC cough and cold preparations?

A

APAP
IBU - >6 mo
Saline sprays
Humidifiers

57
Q

Name local anesthetics for pain therapy.

A

EMLA
Numby Stuff
Synera

58
Q

What is contained in a Vapocoolant spray for pain therapy?

A

Benzocaine

59
Q

What pain therapy can be used for peds patients <6 months old?

A

Pacifier with SUCROSE on it

60
Q

What modes of delivery are available for pain therapy?

A 
Intermittent - i.e. Fentanyl
Continuous infusion
PCA - set lockout 
Epidural 
Transmucosal 
Transdermal
61
Q

T/F: It is safe to use Meperidine and Codeine in peds patients?

A

FALSE

-Don’t use Meperidine and avoid Codeine - active metabolite that can cause seizures (long-acting drug)

62
Q

Complications of childhood obesity:

A
  • Impaired glucose tolerance
  • T2DM
  • Hyperandrogenism
  • Metabolic syndrome
  • HTN
  • Dyslipidemia
  • Non-alcoholic fatty liver disease
  • Obstructive sleep apnea
  • Orthopedic conditions
  • Psychosocial
63
Q

Body Weight Calculation for obese children =

A

[(actual BW - ideal BW) * 0.4] + ideal BW

64
Q

Traub Method = IBW in kg

A

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])

65
Q

BMI =

A

Wt (kg) / Ht (m)^2

66
Q

What drug can cause biliary sludge?

A

Cephalosporins (Ceftriaxone)

67
Q

When is biliary sludge most common?

A

In the first 2 months of life

68
Q

What drug treats congenital syphillis?

A

Penicillin

69
Q

Name two classes of drugs that are hepatically eliminated.

A
  • Macrolides (Azithromycin)

- Cephalosporins (Cefoxatin)

70
Q

What is the drug of choice for ANIMAL BITES?

A

AUGMENTIN

71
Q

What drugs cause Stevens Johnsons Syndrome?

A

Sulfa drugs

Dapsone

72
Q

What class of drugs causes teeth staining?

A

Tetracyclines (Doxycycline)

-With REPEATED DOSES

73
Q

What class of drugs causes Kernicterus?

A

SULFA DRUGS

74
Q

Name the key potentially inappropriate drugs in pediatrics (KIDs list)

A
  • ASA/Salicylates
  • Codeine
  • Cough/cold meds
  • Fluoroquinolones
  • Meperidine
  • Promethazine
  • Paragoric/Opium tincture
  • SSRIs
  • Tetracycline - <8 years old
75
Q

Why don’t we give ASA or salicylates?

A

Reye’s Syndrome

76
Q

Why don’t we want to give Promethazine?

A

Respiratory distress in <2 years of age

77
Q

Why don’t we want to give Paragoric/opium tincture?

A

Difficult to measure

78
Q

Why don’t we want to give SSRIs?

A

Suicidal ideations

79
Q

T/F: Indinavir is contraindicated in pediatric patients.

A

TRUE

80
Q

Name two drugs that use is CAUTIONed.

A

Lamotrigine

Olanzapine

81
Q

TCA use in pediatrics - Desipramine and Imipramine?

A

AVOID Desipramine

CAUTION Imipramine

82
Q

What about Valproic Acid?

A

AVOID in INFANTS

CAUTION in <6 years old

83
Q

Name Dopamine Antagonists to AVOID in Neonates.

A
  • Chlorpromazine
  • Fluphenazine
  • Haloperidol
  • Perphenazine
  • Pimozidine
  • Prochlorperazine
  • Promethazine
  • Trifluoperazine
84
Q

Medications to avoid in infants:

A
  • Benzocaine
  • Ceftriaxone (biliary sludge)
  • Chloramphenicol
  • Fleets enema
  • Gentamicin ophthalmic
  • Hexachlorophene
  • Lidocaine 2% viscous
  • Loperamide
  • Macrolides (Erythromycin)
  • Midazolam
  • Naloxone
  • Sulfa agents
85
Q

Why would we avoid Erythromycin in infants?

A

Pyloric stenosis - lots of vomiting

86
Q

Why would we avoid Gentamicin ophthalmic meds in prolonged use?

A

B/C it burns the eyes

87
Q

When is Ceftriaxone contraindicated in peds pts?

A

< 28 days old

88
Q

What solutions are avoided in reconstitution with Ceftriaxone?

A

Calcium containing solutions

  • LR
  • Hartman’s solution
  • TPN
89
Q

Name drug excipients to avoid.

A
  • Benzyl alcohol
  • Methylparaben and propylparaben
  • Propylene glycol
  • Polysorbate 80
  • Ethanol <5%
  • Sugar, Sodium, Phenylalanine, Isopropyl alcohol
90
Q

Why do we avoid benzyl alcohol?

A

“Gasping syndrome” in neonates

91
Q

Why do we avoid methylparaben and propylparaben?

A

Kernicterus in <2 months (CAUTION)

92
Q

Why do we avoid propylene glycol?

A

Hyperosmolality in infants

93
Q

When do we avoid polysorbate 80?

A

<1 year old

94
Q

When do we avoid ethanol <5%?

A

<6 years of age

  • CNS depression
  • Hypoglycemia
95
Q

When do you start dosing males like an adult?

A

13-15 years of age

96
Q

When do you start dosing females like an adult?

A

12-14 years of age

PHA 397 - Make-Up Therapeutics (15 decks)

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