General Pediatrics Flashcards
Which vitals are generally higher in infancy and decrease with time?
Heart rate and respiratory rate
Which vital sign is generally lower in infancy and increases with time?
Blood pressure
T/F: Infected/septic newborns may present with HYPOthermia instead of a fever
TRUE
Which eGFR formula should be used in pediatrics (do not memorize)?
Bedside Schwartz
CrCl (mL/min/1.73m^2) = (0.413*height)/SCr
What are limitations to off-label drug use?
- Denied insurance coverage possible
- Liability for adverse effects
- Limited experience in specific conditions or age groups
- Limited available dosage formulations
Which substance is in many preparations and should be avoided in pediatrics?
Propylene glycol
What is the BUD for a water-containing formulation prepared from solid ingredients and refrigerated?
14 days
When can injectable solutions be given orally?
If both (IV and PO) solutions contain the same salt form with similar bioavailability
What do you need to ask for when dosing something in pediatrics?
BODY WEIGHT
If there is no provided dosing resources, what is usually the maximum pediatric dose of a given medication?
The usual adult dose
What is normal urine output?
1 mL/kg/hour
What are we worried about when urine output falls below 1 mL/kg/hour?
AKI - are they on any nephrotoxic agents?
When does the ability to detect bitter/sour/salty tastes develop?
2 years
When will a child likely respond to odors in medications?
5-7 years
T/F: Gastric pH is lower in early life
FALSE, pH is higher
What are acid labile drugs that may be broken down more in older children as opposed to neonates?
Beta-lactams and macrolide antibiotics
What leads to a decreased rate of drug absorption in neonates?
Low rate of gastric emptying + poor intestinal contractility (until about 6-8 months)
Why should the rectal route be avoided in infants?
Higher amplitude pulsatile contractions -> decreased absorption/bioavailability
Pediatrics have (greater/lesser) absorption through the percutaneous route than adults
GREATER (SA, hydration, perfusion rate, permeability)
Why do young children have better IM bioavailability than older children?
Greater capillary density -> more drug reaching bloodstream
A neonate needs to take phenobarbital, a weak acid drug. Should their dose be higher or lower than an adult dose?
HIGHER - more drug is ionized due to the basic environment and will be trapped in the digestive tract -> less absorbed
Why might neonates need higher doses of hydrophilic drugs?
A greater percentage of total body water leads to higher Vd of these drugs, and less drug available in the blood stream
Why might neonates need lower doses of lipophilic drugs?
Less muscle/fat than adults means a lower Vd for these drugs, and more drug available in the blood stream
Are aminoglycosides hydrophilic or lipophilic?
HYDROphilic
What causes low protein binding in newborns?
- Decreased circulation protein concentrations (albumin, a1-acid)
- Decreased binding affinity of fetal albumin
- Competitive binding (bilirubin, free fatty acids, etc…)
What is kernicterus?
A condition caused by bilirubin buildup and damage in the brain
What drugs can cause kernicterus and should therefore be avoided in infants <2 months of age?
Ceftriaxone and sulfonamides
Neonates should be given (higher/lower) doses of phenytoin
Lower - higher free fraction than adults
When does CYP3A4 function reach adult levels?
1 year of age
In general, neonates and children have (higher/lower) CYP metabolism
Lower -> leads to higher drug levels
Why are children less than 12 sort of protected from APAP toxicity?
More drug is metabolized via the sulfation pathway, decreasing the risk of glucuronidation pathway saturation
When does kidney function start reaching adult levels?
1-2 years of age
What percentage of children ages 6-11 report inability to swallow a tablet?
56%
What are advantages of liquid dosage forms?
- Flexible dosing
- Easy to swallow
What are disadvantages of liquid dosage forms?
- Lack of controlled release (may need more frequency)
- Volume required
- Accuracy of measuring devices
What is the primary source of noncompliance in children?
Palatability
What is a consideration to make when administering drugs via tube?
What is the site of absorption? (stomach, pH, intestine, etc…)
When do we usually consider IM/SC administration?
Emergency or single-dose administration such as vaccines
What is a common challenge of parenteral formulation in pediatrics?
Volume - is the dose measurable?
What excipient can cause neurotoxicity and metabolic acidosis, especially in neonates?
Benzoyl alcohol
What excipient can cause osmotic diarrhea?
Sorbitol
Without other available resources, what do we rely on for BUDs of extemporaneous compounds?
USP 795
What must we determine before considering manipulation of capsules?
What are the CONTENTS and makeup (powder, mini beads, EC, gel)
What is a challenge that leads to medication errors with liquid dosage forms?
Not always commercially available -> extemporaneous compounding -> error risk
What dosage form offers dose flexibility with a strip-cutting mechanism?
Oro-dispersible tablets (ODFs)
What is gestational age?
Time from conception to time along in pregnancy (how far along?)
What is post-natal age? (PNA)
Time from birth
What is post-menstrual age? (PMA)
GA + PNA (time from conception to now)
What is the formula for BSA?
BSA (m^2) = sqrt [(height in cm * weight in kg)/3600]
Where do you look in lexicomp to find info on diluents and preparation/reconsistution?
Preparation for administration
What PKPD parameter is useful for determining dosing intervals?
Half life
What PKPD parameter is useful for IV to PO conversions, if not described explicitly?
Bioavailability
