Intro to Pediatrics Flashcards
Preterm Newborn
- Gestational age =
<37 weeks
Preterm Newborn
- Extremely preterm =
<28 weeks
Low Birth Weight (LBW) =
<2500 g
Very Low Birth Weight (VLBW) =
<1500 g
Extremely Low Birth Weight (ELBW) =
<1000 g
Gestational age =
age in weeks calculated from conception
Postnatal age =
age calculated since birth
Corrected age =
actual PNA in weeks minus the # of weeks preterm
=> developmental age
Why are children NOT little adults?
- body water & fat content vary with age
- volume of distribution changes throughout early childhood
- protein binding of drugs decreased in neonates/infants
What are the physiologic differences b/t children & adults that affect pharmacokinetics?
- Increased permeability of skin & conjunctivae
- Differences in protein binding
- Delayed gastric emptying, relatively decreased gastric acidity
- Immature renal function
- High total-body-water volume, low body fat
- Immature hepatic metabolism
- Lower muscle mass
What is included in the metabolic pathway development?
- Oxidation
- Hydrolysis
- Acetylation
- Glucuronidation
- Sulfonation
- Methylation
Oxidation =
adult function by childhood (2-5x adult at 1 year)
Hydrolysis =
adult function by 12 months
Acetylation =
adult function by 6 months
Glucuronidation =
adult function by 12-18 months
Sulfonation =
greater than adult function until early childhood
Methylation =
greater than adult function until early childhood
What are the 2 most common metabolic pathway developments in ADULTS?
- Acetylation
- Glucuronidation
What are the 2 most common metabolic pathway developments in CHILDREN?
- Sulfonation
- Methylation
When do kidneys reach adult levels?
~ 2 yoa (~up to 5 yoa)
What is the renal function of neonates?
- minimal or no urine for the 1st few days of life
- ↓ concentrating capacity
What is the most imp. in dose calculations?
weight
What is BSA?
- total SA of the human body
-*NOT IDEAL in pt’s weighing less than 10-15 kg
What are the pediatric considerations?
- Inability to communicate
- No available commercial dosage forms
- Bad taste
What are the pediatric considerations in terms of what they can use but have to know what they’re doing?
Excipient toxicity
- Sodium benzoate/benzyl alcohol preservative
- Propylene glycol (intoxicants like alcohol - sleepy etc.)
- Sorbitol (common in suspensions - can cause diarrhea)
- Parabens preservative
- Ethanol
Normally innocuous things could be toxic
- Normal Saline - Na content
- D5W - hyposmolar
What are the factors contributing to risk of medication errors in children?
- Multiple prescribers at multiple sites of care delivery may use multiple pharmacies
- Frequent changes in medications & doses in response to fluctuating clinical status
- Different formulations & routes of delivery
- No standardized concentrations of liquid preparations of medications
- Uncommon medications, or medications used for an off-label indication
How can you prevent medication errors in children?
- Always use an accurate & recent patient weight
- Use reliable drug information references
- Ensure accuracy of equipment (ie calibration of scale for weighing ingredients)
- Ensure comprehension of caregiver on dose & administration
- Ensure accuracy of dosage form & concentration
- DOUBLE CHECK EACH CALCULATION!
