paediatric prescribing Flashcards
1
Q
neonate def
A
0-27 days
2
Q
ear infection drug
A
a 5–7 day course of amoxicillin
3
Q
ear infection drug for people who cant have 1st line
A
5–7 day course of clarithromycin or erythromycin
4
Q
is paracetamol and anti inflammatory
A
no
5
Q
name some pains which respond well to NSAIDs x4
A
soft-tissue injury, tissue compression, visceral pain caused by pleural/peritoneal inflammation and bone pain
6
Q
indications for NSAIDs x4
A
inflammatory conditions, post-operative pain, headache and primary dysmenorrhoea
7
Q
NSAIDs side effects x6
A
coagulation defects, GI upset, impaired renal function, salt/water retention, HTN, skin reactions
8
Q
when are NSAIDs contraindicated
A
in GI disorders (bleeding, ulceration, perforation), heart failure and history of hypersensitivity (can precipitate attacks of asthma, angioedema, urticaria or rhinitis).
9
Q
when to be cautious using NSAIDs x4
A
cardiac impairment, coagulation defects, connective-tissue disorders and IBD
10
Q
can you give kids aspirin
A
no reyes - never under 16
11
Q
when can you give aspirin to kids
A
exceptions: Kawasaki disease or when used for its antiplatelet action
12
Q
age for reyes syndrome
A
5-14
13
Q
what happens in reyes syndrome
A
Acute encephalopathy and fatty degeneration of the liver
14
Q
clinical course of reyes syndrome
A
Usually follows viral illness, with rapid deterioration
15
Q
do you use codein in children
A
restricted for use in children due to reports of morphine toxicity
16
Q
when is codein a serious risk to children
A
children with obstructive sleep apnoea who received codeine after tonsillectomy or adenoidectomy
17
Q
where is codein converted and into what
A
morphine in the liver
18
Q
what converts morphine
A
cytochrome enzymes
19
Q
what is the max daily dose of codein in age 12-18
A
240mg QDS with intervals of 6 hours for maximum of 3 days
20
Q
when is codein contraindicated in children
A
removal of tonsils/adenoids for the treatment of OSA or known ultra-rapid metabolisers
21
Q
what is a down side of rectal medication in children in terms of efficiency
A
Increased risk of expulsion due to larger contraction
22
Q
gastric ph at birth
A
neutral
23
Q
how long till gastric ph is normal after birth
A
2-3 years
24
Q
neonates and infants gastric emptying time
A
long
25
affect of neonate gastric emptying on drug absorption
reduces the rate of drug absorption
26
why is ph neutral at birth
residual amniotic fluid
27
neonate gastric ph affect on drugs
increased absorption of weak base drugs
| decreased absorption of acidic
28
ask about
acid
29
how do neonates absorb fat soluble drugs
poorly as they have immature biliary system
30
example of a fat soluble drug
diazapam
31
when is absorption through bowel wall fully developed
4 months
32
phase 1 of drug alteration is done by
cytochrome p450
33
what happens in the first phase of drug alteration
oxidation, reduction, deemethylisation and hydroxylation
34
what is phase 2 of drug alteration
conjugation
35
which particular drug cant you give to neonates because the enzyme is available yet
choramphenicol
36
what happens if there is a build up of choramphenicol
grey baby syndrome
37
what is grey baby syndrome
circulatory collapse, cyanosis and abdominal distension
38
in adults what is paracetamol metabolised by
cytochrome p459
39
what is the toxic metabolite produced by paracetamol
napqi
40
what is napqi metabolised by
glutathione
41
what is the pathway in neonates for paracetamol
sulphation
42
what is an effervescent tablet
dissolve in water before drinking
43
how do you take orodispersible tablet
dissolve in mouth (no water)
44
what is distribution
volume required for the drug to be the same in all tissues
45
water soluble drugs in children dose
need more because more of the body is water
46
lipid soluble drugs in children dose
need less as there is less adipose tissue
47
proetin binding in children affect on drugs
less protein binding ability so more free drug
48
what does protein binding in a child mean for brain and liver
more cross the blood brain barrier and into the liver
49
which drugs should you avoid in neonatal jaundice
those which bind to albumin as may exaggerate problem as bilirubin cant bind
50
complication of albumin binding drugs in neonatal jaundice
kernicterus
51
how to calculate water soluble drug doses in children
use body surface area as extracellular fluid correlates to this
52
neonates water soluble drug requirement comparaed to adults
require more mg/kg
53
gentamycin class
aminoglycoside
54
gentamycin is soluble in what
water
55
primary organs responsible for the removal of a drug
kidney
56
children gfr compared to adults
lower
57
low gfr in children affect on half life
much longer
58
most likely cause of viral encephalitis above 3
HSV-1
59
most likely cause of viral encephalitis in neonates
HSV-2
60
presenting features of viral encephalitis
headache, fever, altered mental state
61
treatment of viral encephalitis
aciclovir
62
body surface area dose calculation name
Boyd equation
63
when to give abx for OM x4
systemic unwell, risk of complications, otorrhoea, <2 years with bilateral infection
64
abx for OM back up prescirption instructions
if symptoms do not start to improve within 3 days or worsen significantly or rapidly at any time
65
OM abx of choice and regime
5–7 day course of amoxicillin
66
OM antibiotic if allergic to penicillin
5–7 day course of clarithromycin or erythromycin
67
OM acute pain management
paracetamol
68
OM chronic pain management
NSAIDs
69
reye mortality rate
20%
70
what age would you use codein in kids
above 12
71
types of codein metabolisers
poor, intermediate, extensive or ultra-rapid metabolisers
72
when is codein avoided in kids
compromised breathing (neuromuscular, cardiorespiratory
73
why is rectal good for drugs
good vascular supply
74
risk of rectal administer of drug in kids
risk of expulsion - strong contraction
75
what age do kids get adult values for rate of absorption
6-8 months
76
gastric ph at birth and why
neutral - amniotic fluid
77
gastric ph in neonatal period and why
neutral - dont produce much acid
78
when do you get adult gastric ph
2-3 years
79
high gastric ph affect on drugs
weak absorption of base drugs
80
example of a base drug
penicillin
81
premature neonates gastric PH
high - immature gastric mucosa
82
neonates and amount of bile acid secreted
reduced
83
neonates and fat absorption
reduced due to less bile acid
84
neonates and fat soluble drugs
reduces their absorption
85
name a fat soluble drug
diazepam
86
Absorption through the intestinal wall is considered fully developed by what age
4 months
87
2 differences in metabolic pathways
Reduced cytochrome P450 activity
| Reduced hydroxylation
88
main organ for drug metabolism
liver
89
how many phases of drug metabolism is there
2
90
phase 1 metabolism of drugs is done by
cytochrome P450
91
4 aspects of phase 1 drug metabolism
oxidation, reduction, demethylation and hydrolysis
92
what is phase 1 drug metabolism for
alter the structure of the drug
93
what is phase 2 drug metabolism for
conjugation with another molecule, usually to make it water soluble
94
4 aspects of phse 2 of drug metabolism
acetylation, sulphanation, glucuronidation and glycine conjugation
95
which drug is there no enzyme for in neonates
chloramphenicol
96
complication of giving a neonate chloramphenicol
grey baby syndrome
97
whats grey baby syndrome x3
circulatory collapse, cyanosis and abdominal distension
98
in adults paracetamol is metabolism by
cytochrome P450
99
paracetamol toxic metabolite is neutralised by what
glutathione and glucuronidation
100
what happens in paracetamol overdose
stores of glutathione are depleted = toxic metabolites
101
in neonates is paracetmaol metabolised by CYP450
no - immature
102
how is paracetamol metabolised in neonates
sulphation pathway
103
paracetamol and overdose in neonates
less toxic
104
Effervescent tablet
dissolved in water before drinking
105
Orodispersible tablet
disintegrate in the mouth without the aid of water
106
Syrup/solution
medication remains dissolved and does not precipitate out, as it is <2 nanometers small
107
Suspension
medication is dispersed in the liquid, can precipitate on the bottom and so needs shaking before use
108
bacterial endocarditis signs x3
tachycardic
significant pansystolic murmur
necrotic leg skin lesions
109
bacterial endocarditis management
abx
110
in simple terms whats distribution
Movement of a drug to/from the blood and bodily tissues
111
body composition differences in kids
Higher percentage of body weight is water
| Less adipose tissue
112
binding proteins in children compared to in adults
Reduced protein binding
| Competing endogenous compounds
113
Competing endogenous compounds in kids
such as bilirubin in jaundiced babies
114
more complex terms what is distribution
volume required for the drug to be uniform through all tissues
115
potential spaces for distribution x3
intra/extra-vascular space and protein binding
116
children have higher percentage of body weight as water what impact will this have on drugs
need higher doses of water soluble drugs
117
children have reduced adipose tissue what does this mean for drugs
reduced volume of distribution and lower levels of lipid-soluble drugs needed
118
low protein binding affect on children and drugs
greater free drug in the circulation
119
why is there greater free drug in circulation in children x3
low proteins for bnding
competition from endogenous compounds
lower affinity
120
if drug are less protein bound how does this affect the liver and brain
more diffuse into liver for metabolism
| more cross BBB
121
when not to give drugs that are strongly bound to albumin in kids and why
neonatal jaundice - may displace bilirubin from protein binding sites and increase the risk of kernicterus
122
why do children have a reduced GFR x3
Incomplete glomerular development
Low renal perfusion pressure
Inadequate osmotic load for counter-current effect
123
GFR at birth
2-4ml/min
124
GFR 2-3 days
8-20ml/min
125
when does GFR get to adult levels
5 months
126
3 ways of elimination
biliary, intestinal or renal systems
127
main organ for elimination
kidney
128
when is kidney function mature
early childhood
129
reduced GFR and half life
increased half life
130
which drugs are particularly important when thinking about reduced half life in kids x2
aminoglycosides (gentamicin) and digoxin
131
most common cause of viral encephalitis above 3 months
HSV1
132
most common cause of viral encephalitis below 3 months
HSV2
133
viral encephalitis triad
headache, fever, altered mental status
134
viral encephalitis management
aciclovir
135
what do you need to know before you prescribe aciclovir x5
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Indication
Age
Body weight
How to find body surface area estimates
Body surface area
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