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CDM1 > Exam 1: Pediatrics > Flashcards

Exam 1: Pediatrics Flashcards

1
Q

Age Definitions: Gestational age

A

Estimated maturity at birth

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2
Q

Age Definitions: Pre-term

A

<37 weeks

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3
Q

Age Definitions: Full Term

A

37-40 weeks

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4
Q

Age Definitions: Neonate

A

0-1 month

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5
Q

Age Definitions: Infant

A

1-12 months

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6
Q

Age Definitions: Young Child

A

2-5 years

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7
Q

Age Definitions: Older child

A

6-12 years

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8
Q

Age Definitions: Adolescent

A

13-17 years

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9
Q

Medication Error definition

A

Failure of a planned action to be completed as intended

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10
Q

T/F: Pediatric patients are at the greatest risk of medication errors

A

True

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11
Q

4 Reasons medication errors occur for pediatrics

A
  1. dosing medication usually require calculations
  2. dosage forms and strengths are not always available
  3. dosage recommendations are not always available
  4. medication adherence is difficult
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12
Q

2 Drugs that can affect growth and development

A
  1. thalidomide

2. fluoroquinolones

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13
Q

Growth and development: Thalidomide effect

A

Used for nausea and morning sickness in pregnant women and cause phocomelia (birth defect, baby has no ilmbs)

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14
Q

Growth and development: Fluoroquinolones effect

A

Affects development of tendons (tendon rupture) and teeth

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15
Q

When do you use weight-for-stature for boys and girls growth chart

A

If they are standing up (birth - 36 months)

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16
Q

When do you use length/weight-for-age for boys and girls growth chart?

A

If they’re laying down (birth - 36 months)

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17
Q

When do you use BMI for age for boys and girls growth chart?

A

2 to 20 years of age

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18
Q

Describe growth in neonates

A

Weight may decrease 10% below brith weight within first week (losing bloating and water retention) and then gain about 30g/day for the first month

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19
Q

Describe growth in infants

A

Double birth weight by 4 months of life, weight should triple and length should double by 1 year of life

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20
Q

Describe growth in children and adolescents

A

Weight gain of 2-3kg/year and height increase of 5-8cm/year

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21
Q

Vital Signs: Temperature - Why is temperature not a complete indication of infection?

A

Self-regulation is not fully developed, sweat glands aren’t regulated properly and cannot cool down well

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22
Q

Vital Signs: Temperature - what is the most accurate site of temperature measurement?

A

Rectal

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23
Q

Vital Signs: BP - What is considered normal BP?

A

SBP and DBP <90% based on age, sex, and height

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24
Q

Vital Signs: BP - What is considered pre-HTN?

A

SBP and DBP between 90-95% based on age, sex, and height

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25
Q

Vital Signs: BP - What is considered HTN?

A

SBP and DBP >95% based on age, sex, and height.
Stage 1: >95-99% plus 5mmHg
Stage 2: >99% plus 5mmHg

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26
Q

T/F: Heart rate decreases as you get older for pediatrics

A

True

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27
Q

T/F: Respiratory rate increases as you get older

A

False – decreases as you get older because lungs are smaller when you are younger, requires more effort

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28
Q

PK: Absorption - Describe GI pH changes in full-term infants

A

Gastric pH remains elevated (6-8) at birth but declines to 1-3 within 24 hours (more amniotic fluid and don’t produce as much gastric acid hence increased pH)

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29
Q

PK: Absorption: ____ drugs have INCREASED absorption

A

Acid-labile drugs (penicillin, erythromycin)

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30
Q

PK: Absorption - Weak ___ have DECREASED absorption

A

Acids (phenobarbital, ganciclovir – become ionized and polar, unable to be absorbed)

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31
Q

PK: Absorption - immature bile acid production _____ absorption

A

Decreases (fat soluble vitamins)

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32
Q

PK: Absorption - describe gastric emptying changes in pediatrics

A

Gastric emptying is slower in pre-term infants and increased during 1st week of life

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33
Q

PK: Absorption - What is the effect of slower gastric emptying?

A

More time for medication to be absorbed, heightened therapeutic effect

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34
Q

PK: Absorption: What is the effect of increased gastric emptying?

A

Less time for med to be absorbed, less therapeutic effect

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35
Q

PK: Absorption - Frequent feedings

A

Drug-food interactions

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36
Q

PK: Absorption: Infants have ____ muscle mass

A

Decreased

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37
Q

PK: Absorption: ____ blood flow

A

Decreased

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38
Q

PK: Absorption: ___ muscle contractions

A

Decreased

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39
Q

PK: Absorption: Skin - percutaneous absorption can be greatly ____ in newborns

A

Increased

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40
Q

PK: Absorption: Skin - Why is absorption through the skin increased in newborns?

A

Underdeveloped epidermal barrier, increased skin hydration

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41
Q

PK: Absorption: Skin - T/F: Pediatric patients are more likely to have skin irritation from topical medications

A

True

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42
Q

PK: Distribution - Infants and children have a ___ body water to lipid ratio

A

Higher

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43
Q

PK: Distribution - Describe changes in body composition

A

As you get older, body water decreases and body fat increases

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44
Q

PK: Distribution: Protein binding - Increased/decreased drug binding in newborns

A

Decreased

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45
Q

PK: Distribution: Protein Binding - Why do newborns have decreased drug binding?

A

Decreased plasma protein conc.
Lower binding capacity
Decreased affinity
Competition

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46
Q

PK: Distribution: Protein Binding - decreased drug binding in newborns results in…

A

increased free drug (easy to become toxic)

increased Vd

47
Q

PK: Distribution: Body Fat - Compare effect of body fat in neonates/infants vs adults

A

Much lower in neonates and infants than adults, highly lipid-soluble drugs are less-widely distributed for babies

48
Q

What is the effect of using sulfisoxazole in neonates?

A

Sulfisoxazole replaces bilirubin in the blood and causes kernicterus (irreversible damage to the brain)

49
Q

PK: Metabolism - Metabolism is typically ___ in infants than in older children and adults

A

Slower

50
Q

PK: Metabolism: CYP450 system - compare CYP450 system between full-term infants and adults

A

Approximately half of adult values for full-term infants

51
Q

PK: Metabolism: CYP450 - T/F all isoenzymes mature at the same time

A

False - different isoenzymes mature at different times

52
Q

PK: Metabolism: CYP450 - At what age range do children values exceed adult values?

A

1-9 years – this causes increased metabolism of drugs, may require higher dose or more frequent use

53
Q

PK: Metabolism - Describe maturation of Group 1 Enzymes

A

Peak during 2nd and 3rd trimester

54
Q

PK: Metabolism - Describe maturation of Group 2 Enzymes

A

Relatively constant through life (2C19, 3A5)

55
Q

PK: Metabolism - Describe maturation of Group 3 Enzymes

A

Little function in early life, expression increases over first several years of life (2C9, 2D6, 3A4)

56
Q

PK: Metabolism: Enzyme Capacity - describe pediatric considerations for neonates and young infants

A

Decreased enzyme capacity, increased t1/2, decreased clearance (phenobarbital)

57
Q

PK: Metabolism: Enzyme Capacity - describe pediatric considerations for children

A

Increased enzyme capacity, decreased t1/2, increased clearance (theophylline, voriconazole)

58
Q

PK: Metabolism: Pathways: What is an example of metabolism pathways maturing at different times?

A

For infants, well-developed sulfation pathway but underdeveloped glucuronidation pathway (chloramphenicol, morphine, acetaminophen)

59
Q

PK: Metabolism: Pathways: What is Grey Baby Syndrome?

A

Related to chloramphenicol administration for sepsis, causes cardiovascular instability and rapid progression to death

60
Q

PK: Metabolism: Pathways: Describe correlation of chloramphenicol and immature glucuronidation pathway

A

Immature glucuronidation > decreased metabolism of chloramphenicol > increased concentration > grey baby syndrome

61
Q

PK: Metabolism: Pathways: What is Gasping Baby Syndrome?

A

Related to benzyl alcohol (preservative in many multiple dose IV and PO formulations - pentobarbital, heparin flush), causes acidosis, seizures, gasping, intraventricular hemorrhage, death

62
Q

PK: Metabolism: Pathways: What is the correlation between benzyl alcohol and immature glycine conjugation system?

A

Immature glycine conjugation system > accumulation of benzoic acid metabolite > gasping baby syndrome

63
Q

PK: Metabolism: Pathways: To avoid gasping baby syndrome ___ should be avoided if possible but if not what dose should prescribers not exceed?

A

Benzyl alcohol, < or equal to 25mg/kg/day

64
Q

PK: Elimination: T/F - Usually occurs via the liver

A

False - usually occurs via the kidney

65
Q

PK: Elimination - T/F: GFR is much higher in infants than older children and adults

A

False - GFR is much LOWER

66
Q

PK: Elimination: What is GFR for pre-term infants

A

As low as 0.6-0.8 ml/min per 1.73 m2

67
Q

PK: Elimination: What is GFR for full-term infant?

A

2-4ml/min per 1.73m2

68
Q

PK: Elimination - Describe pediatric considerations for neonates and infants

A

Decreased GFR, increased t1/2, reduced clearance (aminoglycosides)
Decreased tubular secretion, increased t1/2, reduced clearance (beta-lactam antibiotics)

69
Q

PK: Elimination: CrCl - Describe difference in units for Adult and Pediatric CrCl

A

Adult - ml/min vs Pediatric - ml/min/1.73m2

70
Q

PK: Elimination: CrCl - T/F: Both adults and pediatrics use the Cockcroft-Gault Equation to calculate CrCl

A

False - pediatrics uses Schwartz Equation (1-18 years of age)

71
Q

PK: Elimination: CrCl - What is the Schwartz Equation?

A

CrCl = K x height / Scr

72
Q

PK: Elimination: CrCl - What is K in the Schwartz Equation?

A

K = age-specific proportionality constant

73
Q

PK: Elimination: CrCl - What is Scr in the Schwartz Equation?

A

Serum creatinine in mg/dL

74
Q

PK: Elimination: CrCl - What is the Bedside Schwartz Equation

A

High correlation to measured GFR, replaces older formula

GFR = (0.41 x height in cm) / creatinine

75
Q

What are the 3 types of dosing for pediatrics?

A
  1. weight-based
  2. age-based
  3. body-surface-area dosing
76
Q

Treatment Principles: Describe weight-based dosing

A

Most common dosing method, max pediatric dose not established (don’t surpass adult max dosage unless proven safe)

77
Q

Treatment principles: describe age-based dosing

A

easy to use, assumes ADME is same for all patients

78
Q

Treatment principles: describe body-surface-area dosing

A

Precise, used for exact dosage calculation drugs (chemo)

79
Q

Child M has to get chemo therapy. What type of dosing method would you expect to see?

A

Body-surface-area dosing because it is most precise

80
Q

Common Conditions in Peds Population: Common Cold: What is the frequency per year?

A

6-8 episodes per year

81
Q

Common Conditions in Peds Population: AOM: What is it and any concerns?

A

Middle ear infection, concerns about over-treating it

82
Q

Common Conditions in Peds Population: Pharyngitis: What is it?

A

Inflammation of the throat

83
Q

Common Conditions in Peds Population: Type 1 DM: What is it

A

Autoimmune disorder affecting insulin secretion

84
Q

Common Conditions in Peds Population: Eczema: What is it?

A

Chronic, itchy skin condition

85
Q

Immunizations: Why is it dangerous to assume herd immunity?

A

Disease can still exist and effect non-immunized individuals (ex. Japanese pertussis epidemic - numbers were low, assumed herd immunity, stopped immunizing, blew up later again)

86
Q

Immunizations: What 4 organizations endorse immunizations?

A

ACIP - Advisory Committee on Immunization Practices
COID - Committee of Infection Diseases
AAFP - American Academy of Family Physicians
ACOG - American Congress of Obstetricians and Gynecologists

87
Q

Immunizations: What are the 2 types of immunity?

A

Passive and active immunity

88
Q

Immunizations: What is passive immunity?

A

Person is given antibodies to a disease, immediate protection, short lived (mother-to-baby, IVIG)

89
Q

Immunizations: What is active immunity?

A

Disease organism triggers immune system to produce antibodies to that disease, takes weeks to develop, long-lasting (sometimes life-long), via infection (Vaccines)

90
Q

Immunizations: How do vaccines work?

A

Vaccines containing antigens are injected into body > immune system produces antibodies > memory cells remember how to produce antibodies again if you get sick with that disease

91
Q

Immunizations: How do vaccines work?: What is inactivated vaccine?

A

Killed antigen

92
Q

Immunizations: How do vaccines work?: What is attenuated vaccine?

A

Live but weakened

93
Q

Immunizations: How do vaccines work?: What is conjugated/subunit vaccine?

A

Part of bacteria or virus

94
Q

Immunizations: How do vaccines work?: What is toxoid vaccine?

A

Inactivated toxin

95
Q

Immunizations: Describe risk vs benefit

A

No vaccine is 100% safe or effective but risk of disease is greater than risk of vaccine

96
Q

Immunizations: Misconceptions: Why is the following misconception false but true? “Vaccines have mercury in them, which is bad for my baby”

A

Ethyl-mercury can be found in vaccines but not the same as methyl-mercury that is potentially harmful

97
Q

Immunizations: What is thimerosal?

A

An ethyl mercury-containing preservative used in some vaccines (multi-dose vials of flu vaccine)

98
Q

Immunizations: Describe correlation of thimerosal and Autism

A

Exposure to thimerosal-containing vaccinations is not associated with autism

99
Q

Immunizations: What are some common adverse reactions?

A

Soreness, redness, swelling, fussiness, low grade fever

100
Q

Immunizations: What are some valid contraindications?

A

Severe allergy (anaphylaxis) to prior vaccine, having moderate to severe acute illness (temporarily defer until illness resolved)

101
Q

Immunizations: Anaphylactic Reactions: T/F: Itchiness to eggs means they cannot get the influenza vaccine

A

False - itchiness to eggs usually not a big deal, only concerned if they have anaphylaxis

102
Q

Immunizations: Special Populations: T/F immunocompromised patients should only get live vaccines

A

False – live vaccines are contraindicated (can cause significant illness)

103
Q

Immunizations: Special Populations: What are live vaccines contraindicated for immunocompromised patients?

A

MMR, Var, Rotavirus

104
Q

Immunizations: Special Populations: T/F Pregnant patients should only get the inactivated flu shot

A

True - Live vaccines are contraindicated so not allowed to get FluMist (life attenuated vaccine), MMR, Var

105
Q

Immunizations: What is VAERS and potential issues?

A

Vaccine Adverse Event Reporting System, anyone can put stuff on there (can be manipulated but also can be helpful)

106
Q

Immunization: Anaphylactic Reactions: Vaccines with egg products

A

Influenza, yellow fever

107
Q

Immunization: Anaphylactic Reactions: Vaccines with neomycine

A

IPV, MMR, Var

108
Q

Immunization: Anaphylactic Reactions: Vaccines with Streptomycin

A

IPV

109
Q

Immunization: Anaphylactic Reactions: Vaccines with Polymixin B

A

IPV

110
Q

Immunization: Anaphylactic Reactions: Vaccines with Baker’s yeast

A

HepB

111
Q

Immunization: Anaphylactic Reactions: Vaccines with gelatin

A

Var, MMR

112
Q

Pediatric BMI: What percentile is overweight?

A

85-95 percentile

113
Q

Pediatric BMI: What percentile is obese?

A

> or equal to 95th percentile

114
Q

Pediatric BMI: What percentile is underweight?

A

<5th percentile

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