Intro to Pediatrics

Question 1

Preterm Newborn
- Gestational age =

Answer 1

<37 weeks

Question 2

Preterm Newborn
- Extremely preterm =

Answer 2

<28 weeks

Question 3

Low Birth Weight (LBW) =

Answer 3

<2500 g

Question 4

Very Low Birth Weight (VLBW) =

Answer 4

<1500 g

Question 5

Extremely Low Birth Weight (ELBW) =

Answer 5

<1000 g

Question 6

Gestational age =

Answer 6

age in weeks calculated from conception

Question 7

Postnatal age =

Answer 7

age calculated since birth

Question 8

Corrected age =

Answer 8

actual PNA in weeks minus the # of weeks preterm

=> developmental age

Question 9

Why are children NOT little adults?

Answer 9

• body water & fat content vary with age
• volume of distribution changes throughout early childhood
• protein binding of drugs decreased in neonates/infants

Question 10

What are the physiologic differences b/t children & adults that affect pharmacokinetics?

Answer 10

• 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

Question 11

What is included in the metabolic pathway development?

Answer 11

• Oxidation
• Hydrolysis
• Acetylation
• Glucuronidation
• Sulfonation
• Methylation

Question 12

Oxidation =

Answer 12

adult function by childhood (2-5x adult at 1 year)

Question 13

Hydrolysis =

Answer 13

adult function by 12 months

Question 14

Acetylation =

Answer 14

adult function by 6 months

Question 15

Glucuronidation =

Answer 15

adult function by 12-18 months

Question 16

Sulfonation =

Answer 16

greater than adult function until early childhood

Question 17

Methylation =

Answer 17

greater than adult function until early childhood

Question 18

What are the 2 most common metabolic pathway developments in ADULTS?

Answer 18

• Acetylation
• Glucuronidation

Question 19

What are the 2 most common metabolic pathway developments in CHILDREN?

Answer 19

• Sulfonation
• Methylation

Question 20

When do kidneys reach adult levels?

Answer 20

~ 2 yoa (~up to 5 yoa)

Question 21

What is the renal function of neonates?

Answer 21

• minimal or no urine for the 1st few days of life
• ↓ concentrating capacity

Question 22

What is the most imp. in dose calculations?

Answer 22

weight

Question 23

What is BSA?

Answer 23

• total SA of the human body

-*NOT IDEAL in pt’s weighing less than 10-15 kg

Question 24

What are the pediatric considerations?

Answer 24

• Inability to communicate
• No available commercial dosage forms
• Bad taste

Question 25

What are the pediatric considerations in terms of what they can use but have to know what they're doing?

Answer 25

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

Question 26

What are the factors contributing to risk of medication errors in children?

Answer 26

- 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

Question 27

How can you prevent medication errors in children?

Answer 27

- 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!