Introduction to Pediatrics

Question 1

Challenges to pediatric pharmacotherapy

Answer 1

PK/PD differences
Psychosocial influences
Caregiver medication administration hesitance
Dosage formulation selections
Off-label medication uses

Question 2

PK/PD differences in children affect what?

Answer 2

Dosage and drug selection

Question 3

Psychosocial influences

Answer 3

Child vs. adolescent/older child

Question 4

Caregiver medication administration hesitance

Answer 4

Cultural beliefs, socioeconomic status

Question 5

Dosage formulation selection: parenteral factors to consider

Answer 5

volume of IV fluids, vehicle safety, IV access

Question 6

Dosage formulation selection: PO factors to consider

Answer 6

manufactured liquid preparations, extemporaneously compounded liquid preparations, volume of PO fluids, chewable tablets, tablets, capsules, granules

Question 7

Dosage formulation selection: palatability factors to consider

Answer 7

children have different taste preferences

Question 8

Consequences of poor/nonadherence

Answer 8

delayed/absent clinical improvement, worsening of illness, unnecessary therapy modifications that can lead to adverse clinical outcomes

Question 9

Reasons for nonadherence

Answer 9

apprehension regarding medication ADEs, caregiver inability or unavailability to administer drugs, caregivers may be overwhelmed/confused, inappropriate measurements of medication dose, missed doses due to resistance from the child

Question 10

Strategies to improve adherence

Answer 10

caregiver education should be reinforced at several points of healthcare visit, ease of administration (palatable dosage forms, less frequent dosing), decreased child resistance (reward system, positive reinforcement), empowering older children/adolescents

Question 11

Off-label medication use definition

Answer 11

use of a medication outside its FDA-approved labeled indication(s)

Question 12

Limitations to off-label drug usage

Answer 12

Potential for denied insurance provider coverage
Liability for ADEs
Limited experience in specific conditions or age groups
Limited available dosage formulations

Question 13

Evidence considerations for off-label use: adult data

Answer 13

Using adult data isn’t always accurate when determining safe and effective pediatric dosing; use guidelines when available or primary literature

Question 14

Neonates/infants are more susceptible to…

Answer 14

Volume overload, need more concentrated doses of IV medications

Question 15

Limit the use of what vehicle in neonates/infants?

Answer 15

Propylene glycol

Question 16

Something to consider about tablets and capsules in kids

Answer 16

Can they be chewed/crushed/opened?

Question 17

How to handle palatability in kids

Answer 17

Mix medicine into food, FlavoRx

Question 18

Why are extemporaneous formulations needed in infants and children sometimes?

Answer 18

Some drugs aren’t commerically available in a formulation the patient can take, so you have to compound it

Pediatric meds are dosed based on weight, so taking a capsule/tablet might not give them the dose they need

Question 19

A max peds dose of a drug is what?

Answer 19

Adult dose

Question 20

Peds dosing can be based on what?

Answer 20

mg/kg/dose
mg/kg/day
mg/m^2
gestational age
actual age
patient weight ranges