PAEDIATRICS Flashcards
How many weeks gestation is classed as ‘pre term’?
Less than 37 weeks
What age range is classed as a ‘child’?
2-12yrs
12-18yrs is classed as…
Adolescent
Neonates are…
0-1 month
Infants are classed as…
1-24 months old
Infants have _____ oral abs of Penicillin antibiotics
INCREASED - due to increased gastric emptying time and reduce gastric pH
Infants have _____ oral abs of Phenobarbital, Phenytoin and Rifampicin
REDUCED
Those under 3 years old have _____ gastric acid secretion and ____ gastric emptying time
REDUCED gastric acid secretion
INCREASED gastric emptying time
Neonates have _____ variable blood flow
REDUCED
IM drug absorption is ____ in neonates
ERRATIC
Why is Vit K IM given at birth?
Because it doesn’t pass well through the placenta so some babies are born deficient which increases the risk of bleeding in the brain (VIT K INVOLVED IN CLOTTING)
Neonates and infants have ____ systemic abs of topical preparations.
Give an example of when this can have consequences.
INCREASED - due to well hydrated skin, increased SA to body weight ratio and immature epidermal barrier
Corticosteroid use - moon face (cushinoid effects)
Specials are…
Licensed
Unlicensed
Off - Label
Unlicensed
Neonates have _____ variable blood flow
REDUCED
IM drug absorption is ____ in neonates
ERRATIC
Neonates have a ____ volume of distribution for water soluble drugs
HIGHER
Due to the differing volume of distribution in neonates, they need ____ doses of water soluble drugs such as penicillins compared to adults.
HIGHER on weight to weight basis
Fat soluble drugs in neonates need ____ doses e.g diazepam
SMALLER
Plasma protein binding is reduced in neonates and infants as total protein concentrations and serum albumin are _____
LOWER
In neonates and infants, hight protein bound drugs are more ____/____
What is a consequence of this?
effective/toxic
Lower doses may be required
Renal function does not completely mature until __ to __ months of age
6 to 8 months
What does ‘off-label’ mean
Used outside the terms of licence
What does ‘licensed’ mean
- Shown to be safe and effective if used as licensed
- Is of suitable quality
What is ‘Buccolam’ and what age range can it be used in?
Buccal Midazolam - used in fits
- 3 months to 18 years
What is preferable in liquid formulations for paediatrics?
Sugar and alcohol free
Why shouldn’t we mix medication with food/milk?
- Child may develop an aversion to the food
- Drug may interact with milk
- If the full amount of food/milk is not consumed then some of the dose may be omitted
Why may a child not adhere to medication?
- Difficulty taking medicine (taste, form)
- Perceived lack of efficacy
- Side - effects
- Unclear instructions
What may be useful to put in medicine box if using a medicine that is not normally used in children?
Amended PIL
- Can get from medicinesforchildren.org
Name 3 chronic conditions that may be a concern in schools
Asthma, Epilepsy and Allergies
Name common ways of calculating doses in children…
Age
Weight
Surface Area
What may be a useful drug delivery method for asthma medication in children?
Why?
PMDI (pressure meter dose inhaler systems) with Spacer devices - Can also use a face mask with this when necessary
- Don’t have to co-ordinate pressing and inhalation as can inhale the drug from the spacer in several breaths
- Less risk of oral thrush for corticosteroid
Breath activated devices (DPI)
- Less co-ordination needed just breathe in
Name a neural tube defect…
Spina Bifida
Which of the following excipients would a pharmacist need to be cautious of when preparing a paediatric IV formulation
Benzyl alcohol Propylene glycol Glycerine Sorbitol Polyoxyl castor oil Polysorbates
Benzyl Alcohol
Propylene Glycol
Polyoxyl caster oil
Polysorbates
Benzyl alcohol contraindicated in (pre-term?) neonates as can lead to fatal toxic syndrome
Propylene glycol can cause adverse CNS events if elimination if impaired
Polyoxyl castor oil can cause severe anaphylactoid reactions (consider arachis oil – peanuts)
Changes in abs rate appear to be of ____ importance when compared to the age related differences of drug distribution and excretion
MINOR
Why are water soluble drugs e.g aminoglycosides needed in larger doses in neonates compared to older children?
- Because the total body water and extracellular fluid volume decreases with age
- So larger doses on a mg per kg of body weight basis are needed in younger patients to achieve the same plasma conc
In what age group particularly is metabolic clearance significantly increased?
- What effect does this have?
- 1-9 year olds
- Increased metabolic clearance of drugs such as Theophylline, phenytoin and carbamazepine
- May need higher dosage than adults on a mg per kg basis to achieve same plasma drug cons
When should BSA calculations be used and when should they be avoided?
- Useful in drugs with a narrow therapeutic index e.g cytotoxics
- DO NOT USE in those under 1 year old as they tend to have a larger surface area than other age groups USE WEIGHT INSTEAD
What can happen if a professional fails to ensure that the use of a medicine is reasonable?
- A suit for negligence may be held (court case etc)
Give an example of when an ‘off-label’ medicine may be used in children?
- When a licensed adult dose for an indication is available but no child dose is available
- Often necessary to prepare an extemporaneous liquid preparation for a child from the licensed form e.g by crushing tablets and adding suitable excipients
- Appropriate formulas must be used with a valid expiry date to approved standards
