Paediatric Prescribing

Question 1

preterm newborn infants are classified as being what age?

Answer 1

<37wks gestation

Question 2

a term newborn infant describes what age range of children in pharmaceutical terms?

Answer 2

0-27 days old

Question 3

infants and toddlers count as being in what age range in pharmaceutical terms?

Answer 3

28 days - 23 months

Question 4

in the pharaceutical industry, drugs suitable for children classes between what age?

Answer 4

2-11yrs

Question 5

n the pharaceutical industry, drugs suitable for adolescents classes between what age?

Answer 5

12 -16/18yrs

Question 6

how does gastric pH differ in neonates than in adults?

Answer 6

in neonates the gastric pH ranges from 6-8 due to residual amniotic fluid in the stomach. it becomes more acidic with age and is at an adult pH by about 2-3yrs of age

Question 7

why do you need to use higher doses (per kg of body weight) of water-soluble drugs in younger children compared to older children and adults?

Answer 7

because a higher percentage of their bodyweight is water which means they have a large volume of distribution

Question 8

what cytochrome P450 metabolises codeine to morphine?

Answer 8

CYP2D6

Question 9

in the classification of adverse drug reactions, what is a type A augmented reaction?

Answer 9

exaggerated effects of the medicine’s known pharmacological action. usually dose dependedt

Question 10

give an example of a type A augemented reaction

Answer 10

opiates and respiratory depression

Question 11

when describing ADRs, what is a type B bizarre reaction?

Answer 11

an unexpected symptom that arises on taking the drug that is unrelated to the medicine’s known pharmacology.

Question 12

give an example of a type B bizarre reaction

Answer 12

antibiotics causing N&V, diarrhoea, skin rashes.
anti-epileptics causing dizziness, skin rash, increased fitting, drowsiness.
NSAIDs causing vomiting, abdo pain, haematuria, skin reactions etc.

Question 13

how many mg are there in 1g?

Answer 13

1000mg

Question 14

what does concentration mean in terms of drug strength? e.g. what does a drug concentration of 50% mean

Answer 14

how many grams dissolved in 100ml of solution.

50% = 50g in 100ml

Question 15

What are the pros and cons of using paracetamol as an analgesic in a child with for example, an ear infection?

Answer 15

it has analgesic and antipyretic properties.
it has no anti-inflammatory activity.
usually well-tolerated with minimal side effects.
no risk of respiratory depression or GI disturbance.
Overdose is dangerous

Question 16

pros and cons of using NSAIDs as analgesics to treat, for example, an ear infection?

Answer 16

better for soft-tissue injury, tissue compression, visceral pain caused by pleural/peritoneal inflammation and bone pain. better for inflammatory conditions, post-op pain, headach and primary dysmenorrhoea.
side effects include coagulation defects, GI upset, impaired renal function, salt and water retention, HTN, skin reactions.

Question 17

what conditions are NSAIDs contraindicatedin?

Answer 17

GI disorders - bleeding, ulceration, perforation.
HF
hx of hypersensitivity (can precipitate attacks of asthma, angioedema, urticaria or rhinitis).

Question 18

what analgesic should NEVER be prescribed in children under 16? and why?

Answer 18

aspirin
(except in Kawasaki disease or when it’s used for its antiplatelet action).
Association with Reye’s syndrome

Question 19

what does Reye’s syndrome cause?

Answer 19

acute encephalopathy and fatty degeneration of the liver

Question 20

can you prescribe opiates in children?

Answer 20

yes

Question 21

why is codeine not included in the analgesic ladder in childrne?

Answer 21

due to reports of morphine toxicity.

Question 22

name 5 routes of drug administration in children

Answer 22

oral, IV, IM, percutaneous/topical, rectal

Question 23

in adults, saturation of what molecule leads to build up of toxic NAPQ?

Answer 23

glutathione stores

Question 24

why is paracetamol overdose less risky in neonates compared to adults?

Answer 24

neonates don’t yet have the mature CYP450 that metabolises paracetamol into the toxic metabolite

Question 25

why might a drug dose be more in a child of younger age compared to the dose for an older child?

Answer 25

if it is a water-soluble drug you may need more of it for a younger child because they have a higher percentage of water making up their body weight compared with older children and adults.

Question 26

8yo female has been unwell with a fever, headaches adn has been becoming more aggressive. today she became drowsy and less responsive and her Dad said she had two seizures on the way into hospital. List some differential diagnoses

Answer 26

herpes simplex encephalitis,
space occupying lesion,
electrolyte disturbance,
meningitis,
hypoglycaemia,
infection with febrile convulsions

Question 27

what is the most common cause of viral encephalitis in children 3 months plus and adults?

Answer 27

Herpes simplex virus-1

Question 28

what is the most common cause of viral encephalitis in neonates?

Answer 28

Herpes simplex virus-2 (HSV-2)

Question 29

what is the triad of presenting featuers in viral encephalitis?

Answer 29

headache, fever, altered mental status

Question 30

what do you use to treat viral encephalitis?

Answer 30

aciclovir

Question 31

if you needed to work out a child’s body surface area in order to administer a drug, where could you find this?

Answer 31

BNF –> guidance –> body surface area in children

Question 32

what is the reason for using body surface area and not weight in some medications in paediatrics?

Answer 32

research has found there is a more linear correlation between total circulating plasma protein and body surface area, rather than weight or height.