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704 Pediatrics > General Pediatrics > Flashcards

General Pediatrics Flashcards

1
Q

Which vitals are generally higher in infancy and decrease with time?

A

Heart rate and respiratory rate

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2
Q

Which vital sign is generally lower in infancy and increases with time?

A

Blood pressure

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3
Q

T/F: Infected/septic newborns may present with HYPOthermia instead of a fever

A

TRUE

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4
Q

Which eGFR formula should be used in pediatrics (do not memorize)?

A

Bedside Schwartz
CrCl (mL/min/1.73m^2) = (0.413*height)/SCr

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5
Q

What are limitations to off-label drug use?

A
  • Denied insurance coverage possible
  • Liability for adverse effects
  • Limited experience in specific conditions or age groups
  • Limited available dosage formulations
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6
Q

Which substance is in many preparations and should be avoided in pediatrics?

A

Propylene glycol

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7
Q

What is the BUD for a water-containing formulation prepared from solid ingredients and refrigerated?

A

14 days

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8
Q

When can injectable solutions be given orally?

A

If both (IV and PO) solutions contain the same salt form with similar bioavailability

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9
Q

What do you need to ask for when dosing something in pediatrics?

A

BODY WEIGHT

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10
Q

If there is no provided dosing resources, what is usually the maximum pediatric dose of a given medication?

A

The usual adult dose

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11
Q

What is normal urine output?

A

1 mL/kg/hour

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12
Q

What are we worried about when urine output falls below 1 mL/kg/hour?

A

AKI - are they on any nephrotoxic agents?

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13
Q

When does the ability to detect bitter/sour/salty tastes develop?

A

2 years

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14
Q

When will a child likely respond to odors in medications?

A

5-7 years

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15
Q

T/F: Gastric pH is lower in early life

A

FALSE, pH is higher

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16
Q

What are acid labile drugs that may be broken down more in older children as opposed to neonates?

A

Beta-lactams and macrolide antibiotics

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17
Q

What leads to a decreased rate of drug absorption in neonates?

A

Low rate of gastric emptying + poor intestinal contractility (until about 6-8 months)

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18
Q

Why should the rectal route be avoided in infants?

A

Higher amplitude pulsatile contractions -> decreased absorption/bioavailability

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19
Q

Pediatrics have (greater/lesser) absorption through the percutaneous route than adults

A

GREATER (SA, hydration, perfusion rate, permeability)

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20
Q

Why do young children have better IM bioavailability than older children?

A

Greater capillary density -> more drug reaching bloodstream

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21
Q

A neonate needs to take phenobarbital, a weak acid drug. Should their dose be higher or lower than an adult dose?

A

HIGHER - more drug is ionized due to the basic environment and will be trapped in the digestive tract -> less absorbed

22
Q

Why might neonates need higher doses of hydrophilic drugs?

A

A greater percentage of total body water leads to higher Vd of these drugs, and less drug available in the blood stream

23
Q

Why might neonates need lower doses of lipophilic drugs?

A

Less muscle/fat than adults means a lower Vd for these drugs, and more drug available in the blood stream

24
Q

Are aminoglycosides hydrophilic or lipophilic?

A

HYDROphilic

25
Q

What causes low protein binding in newborns?

A
  • Decreased circulation protein concentrations (albumin, a1-acid)
  • Decreased binding affinity of fetal albumin
  • Competitive binding (bilirubin, free fatty acids, etc…)
26
Q

What is kernicterus?

A

A condition caused by bilirubin buildup and damage in the brain

27
Q

What drugs can cause kernicterus and should therefore be avoided in infants <2 months of age?

A

Ceftriaxone and sulfonamides

28
Q

Neonates should be given (higher/lower) doses of phenytoin

A

Lower - higher free fraction than adults

29
Q

When does CYP3A4 function reach adult levels?

A

1 year of age

30
Q

In general, neonates and children have (higher/lower) CYP metabolism

A

Lower -> leads to higher drug levels

31
Q

Why are children less than 12 sort of protected from APAP toxicity?

A

More drug is metabolized via the sulfation pathway, decreasing the risk of glucuronidation pathway saturation

32
Q

When does kidney function start reaching adult levels?

A

1-2 years of age

33
Q

What percentage of children ages 6-11 report inability to swallow a tablet?

A

56%

34
Q

What are advantages of liquid dosage forms?

A
  • Flexible dosing
  • Easy to swallow
35
Q

What are disadvantages of liquid dosage forms?

A
  • Lack of controlled release (may need more frequency)
  • Volume required
  • Accuracy of measuring devices
36
Q

What is the primary source of noncompliance in children?

A

Palatability

37
Q

What is a consideration to make when administering drugs via tube?

A

What is the site of absorption? (stomach, pH, intestine, etc…)

38
Q

When do we usually consider IM/SC administration?

A

Emergency or single-dose administration such as vaccines

39
Q

What is a common challenge of parenteral formulation in pediatrics?

A

Volume - is the dose measurable?

40
Q

What excipient can cause neurotoxicity and metabolic acidosis, especially in neonates?

A

Benzoyl alcohol

41
Q

What excipient can cause osmotic diarrhea?

A

Sorbitol

42
Q

Without other available resources, what do we rely on for BUDs of extemporaneous compounds?

A

USP 795

43
Q

What must we determine before considering manipulation of capsules?

A

What are the CONTENTS and makeup (powder, mini beads, EC, gel)

44
Q

What is a challenge that leads to medication errors with liquid dosage forms?

A

Not always commercially available -> extemporaneous compounding -> error risk

45
Q

What dosage form offers dose flexibility with a strip-cutting mechanism?

A

Oro-dispersible tablets (ODFs)

46
Q

What is gestational age?

A

Time from conception to time along in pregnancy (how far along?)

47
Q

What is post-natal age? (PNA)

A

Time from birth

48
Q

What is post-menstrual age? (PMA)

A

GA + PNA (time from conception to now)

49
Q

What is the formula for BSA?

A

BSA (m^2) = sqrt [(height in cm * weight in kg)/3600]

50
Q

Where do you look in lexicomp to find info on diluents and preparation/reconsistution?

A

Preparation for administration

51
Q

What PKPD parameter is useful for determining dosing intervals?

A

Half life

52
Q

What PKPD parameter is useful for IV to PO conversions, if not described explicitly?

A

Bioavailability

704 Pediatrics (6 decks)

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