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7118 - Clinical Therapeutics for Core Conditions > paediatrics > Flashcards

paediatrics Flashcards

1
Q

What is an unlicensed medicines?

A

They do not have a marketing authorisation or product license in the UK (issued by either the MHRA or EMA)

Examples include imported medicines, extemporaneous preparations, manufactured specials or products manipulated in a ways that is not stipulated in the SPC e.g. opening capsules.

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2
Q

What is an off-label medicine?

A

They do have a marketing authorisation or product licence but are used outside of their recommendations listed in the SPC e.g. differ doses age group, indiction or route.

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3
Q

Do we need consent from parents to use unlicensed or off label medicines ?

A

Yes

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4
Q

Topical preparations in neonates

A

Thin skin - can cause toxicity

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5
Q

IV administration

A

Small veins - can cause irritation

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6
Q

new purchase contracts

A
  • displacement values may need to be recalculated

- new stability work - QC

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7
Q

What are the problems with some preservatives we have in children’s medicines?

A

Parabens (preservative) - Hypersensitivity reported from oral formulations (pruritus, respiratory depression and rash) avoid neonates with liver problems due to risk of jaundice (as it can effect bilirubin binding)

  • benzyl alcohol, benzoates, benzoic acid - fatal reactions have accord in pre-term babies and neonates due to accumulation of benzoic acid.limit to 5mg/kg/day and avoid in pre-term very low weight newborn babies.
  • propylene glycol (solvent, preservative) ADR’s include seizures, CNS toxicity, ototoxicity, hyperosmolity and lactic acidosis. Children < 4 years old have a limited metablock pathway resulting in accumulation of propylene glycol. There are large amounts in some injections

Ethanol - some oral preparations contain up to 30% ethanol. adverse reactions CNS, cardiovascular system, respiration, drug absorption, metabolism and interactions.Long term effects in chronic dosing are unknown. Ethanol blood conc max 25mg/100ml.

Colouring (to aid compliance) - FD and C yellow no5 cause hives and hyperactivity.

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8
Q

Excipients that paediatrics cannot tolerate

A

Parabens (preservatives)

benzoic acid, benzyl alcohol, benzoate’s (preservatives)|

Propylene glycol (solvent/preservative)

Ethanol (solvent/preservative)

Colourings

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9
Q

Do specials require a license to be produced?

A

yes

  • can provide a certificate of conformity (dissolution tests particle size control, homogeneity tests to ensure dose reproducibility)
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10
Q

Children should be referred for investigations if any of the following are present

A 
unexplained feeding difficulties
distressed behaviour
faltering growth
chronic cough/hoarsness
single episode of pneumonia
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11
Q

GORD symptoms

A

0-23 months - regurgitation, crying, feeding difficulties
2-11 years - regurgitation, heartburn, chronic cough
12-17 : regurgitation heart burn

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12
Q

options to combat GORD

A
  • smaller more frequent feeds (maintaining the same daily amount 150ml/kg/day)
  • thickener added (which is weaned on improvement)
  • alginate therapy (gaviscon). If trial of this is successful continue untill weaning on solid foods.

if symptoms still persist: (<12)

1) ranitidine - 4 week trial
2) PPI - 4 week trial

> 12 - 4 week trial of PPI

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13
Q

alginates should not be used in children….

A
  • at risk of dehydration
  • at risk of obstruction
  • pre-term infants
  • renal impairment
  • congestive heart failure (sodium content)
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14
Q

risks of long term PPI’s

A 
C.diff
increased bone fractures
acute interstitial fracture
CAP
low magnesium
B12 deficiency
rebound acid hyper-secretion
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15
Q

Why may breast fed infants not like ‘gaviscon infant’

A

it has a salty taste when mixed with water

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16
Q

ranitidine concerns

A

doses <15mg can only be given with a 1 ml syringe which most community pharmacies probably don’t stock. IT should not be diluted.

It also contains sorbitol, salt and 8% ethanol

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17
Q

ethanol safety levels

A

1-5.9mg/kg/day of ethanol is safe in children up to 6 years old.

6-75mg/kg/day ethanol is safe in 6-12 years old

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18
Q

PPI concerns

A

There are minimum weights on the products

  • 1.7kg om omeprazole 10mg MUPS
  • 3.3kg for omeprazole 10mg capsules
  • 7.5kg for lansoprazole 15mf orodispersible tableys
  • 10kg for esomeprazole 10mg granules
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19
Q

Domperidone

Metoclopramise side effects

A

Cardiac

Neurological

20
Q

Alienate therapy in infants

A
  • should not be used with thick and easy formula together
  • should not be used in pre-term infants
  • initial trial should be 1-2 weeks
21
Q

constipation diagnosis

A

1) less than 3 complete stools per week
2) hard large stool
3) rabbit droppings

Patient gets two or more points in the chart in regards to pattern, symptoms associated with defection and the history.

22
Q

idiopathic constipation is diagnosed when….

A
  • timing of onset of constipation with potential precipitating factors (change in diet, potty training, arrival of new siblings, starting nursery)
  • normal passage of meconium as birth
  • generally well with weight and heigh within normal limits
  • no symptoms in legs normal locomotor development
  • changes in infant formila, weaning, insufficiency fluid intake

If recurrent children may be tested for coeliac disease and hypothyroidism

23
Q

Should we advised unprocessed bran in children?

A

no it can cause bloating, flatulance and reduced absorption of micronutrients.

dietary recommendations - fruit, veg, high fibre bread, baked beans, wholegrain breakfast cereals.

24
Q

Constipation treatment - maintenance therapy

A
  • macrogol
  • stimulant laxative
  • macrogol not tolerated substitute with stimulant in addition or with another osmotic laxative.

Inform families that disimpaction treatment can cause soiling and abode pain.

Enemas should only be trials after all oral meds have been exhausted. Micro lax are not licensed in <3 years however they are used.

impaction should always try to be removed prior to maintenance

Always discontinue gradually depending ons school frequency and consistency

25
Q

macrogol dosing regime.

A
  • child <1 year - 0.5-1 sachet daily of movicol paediatric.
  • child 1-5 years - 2 sachets of mov paed on 1st day, then 4 sachets daily for 2 days and then 6 sachets daily for 2 days then 8 sachets daily
  • child 5-12 - 4 sachets of mov paed on 1st day then increased of 2 sachets daily t a max of 12 sachets daily.

child 12-18 years - 8 sachets daily of movicol adult formulation

26
Q

Maintenance macrogol therapyy

A
  • <1 year - 0.5-1 sachet mov paed
  • child 1-6 years - 1 sachet daily mov paed, max 4 sachets
  • child 6-12 years - 2 sachets daily mov paed, max 4
  • child 12-18 - 103 sachets daily of movicol adult then reduce down in 2 weeks to 1-2 sachets daily
27
Q

lactulose maintenance therapy

A

child < 1 year 2.5ml BD
child 1-5 years - 2.5-10ml BD
child 5-18 years - 5-20ml BD

All adjusted according to patient response

28
Q

Bisacodyl maintenance therapy

A

child 4-18 years - 5-20mg orally once daily at night

child 2-18 years - 5-10 mg rectally once daily at night

29
Q

Docusate maintenance therapy

A

child 6 months to 2 years - 12.5mg TDS
child 2-12 years - 12.5 - 25mg TDS
child 12-18 years - up to 500mg daily in divided doses

30
Q

senna maintenance therapy

A

child 1 month to 4 years - 2.5-10ml OD
child 4-6 years - 2.5-20ml daily or 0.5 to 4 tablets daily
child 6-18 years - 2.5-20ml daily or 1-4 tablets daily

31
Q

sodium picosulphate (non-BNF)

A

child 1 month - 4 years - 2.5-10mg OD

child 4-18years 2.5-20mg OD

32
Q

bulk forming laxatives eg ispaghula husk

A

can increase feacal mass an thus stimulate peristalsis however adequate fund intake is needed to avoid intestinal obstructions and they are difficult to use in children due to poor palatability.

33
Q

Diabetes

A

hyperglycaemia. Glucose >11.1mmol/L
- fatigue
- tiredness
- polyuria
- polydipsia

fasting glucose >7mmol/L
oral glucose tolerance test >11.1mmol/L (2hour post glucose load)

34
Q

DKA is characterised by

A

hyperglycaemia >11.1
acidosis (venous bicarbonate <15mmol/l or arterial pH 7.3)
ketonaemia (ketonuria ++)

medical emergency because it leads to dehydration and electrolyte imbalance

35
Q

sings and symptoms of DKA

A 
polyuria
polydipsia
N and V
SOB
abdo pain
dehydration, hypotension, tachycardia
ketotic smells breath
confusion, drowsiness rarely coma.
36
Q

treatment of DKA

A
  • fluids (NaCL)
  • IV insulin
  • potassium (low K+ with insulin)
  • glucose once BM’s lowers
37
Q

how to we treat viral asthma in children?

A

salbutamol 200-500micrograms 4 hourly ORN

38
Q

possible symptoms of asthma?

A
  • nocturnal cough
  • exercise induced
  • symptoms on a ‘good day’
  • steroids improve
39
Q

difference between asthma in adults and children

A

leukotrein antagonists are favour’s over LABAS’s at the initial add on preventer stages

steroid doses are lower in children.

40
Q

course length of red in kids with acute asthma

A

3 days

41
Q

acute severe asthma attack with SpO2 91%. Mg can be added to each salbutamol and ipatopium for the first hour?

A

True

42
Q

The following statements relating to prescribing inhalers are true…

A
  • products should be prescribed by brand name
  • young children may need spaced with PMDI
  • the choice of device may be influenced by the choice of drug
43
Q

Are dry powder inhalers suitable for children of any age?

A

Yes

44
Q

If a drug is a weak acid would we expect the dose to be higher or lower in a neonate than an older infant ?

A

Higher

45
Q

Renal maturity

A

6 months year old is likely to have renal function >89

Renal maturity is likely to happen around 8-12 months of age therefore if you want to be cautious in a 6 month old you could give 75% of the dose

46
Q

Are solutions and dispersions the same thing ?

A

No

7118 - Clinical Therapeutics for Core Conditions (31 decks)

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