paeds meds

Question 1

classification of paediatric age group

Answer 1

premature neonate: <37w
term neonate: 37-41w
neonate: 0-28d post natal
infant: 1m -1y
child : 1-12y
adolescent: 13-18yo
adult: 18yo >

Question 2

absorption in paeds

Answer 2

children has a slower absorption by oral route and longer gastric emptying time

Question 3

distribution in paeds

Answer 3

total body water increased in children

decrease in protein binding

larger volume of distribution in neonates and infants

Question 4

metabolism and elimination in paeds

Answer 4

slow metabolism in newborns

reduced clearance rate and prolonged t1/2

renal excretion is reduced

Question 5

to measure renal function

Answer 5

schwartz eqn: (k x cm)/ SCr in mg/dl

bedside schwartz: (0.413 x cm)/ SCr in mg/dl

mmol-> mg/dl: divide by 88.4

Question 6

paracetamol

Answer 6

inhibits cox, no anti-inflammatory property

PO/PR: 10-15mg/kg/dose q4-6h max 75mg/kg or 4g whichever is lower

Question 7

ibuprofen

Answer 7

inhibits central and peripheral cox

> 6m: PO 5-10mg/kg/dose q6-8h
max 40mg/kg/d or 400mg/single dose

> 12yo/>40kg: PO 200-400mg q6-8h

Question 8

diclofenac

Answer 8

> 1yo: PO/PR 0.5-2mh/d in 2-3 divided doses max 150mg/d

Question 9

chlorpheniramine

Answer 9

> 6m: 0.35mg/kg/d TDS dosing

Question 10

diphenhydramine

Answer 10

used as anti-tussive

2-6yo: 6.25mg q6h (max 37.5mg/d)

6-12yo: 12.5mg q8h (max 75mg/d))

*max 6 doses for both

Question 11

promethazine

Answer 11

> 2yo: 0.2-0.5mg/kg/dose BD-TDS

Question 12

ceterizine

Answer 12

2-5yo: 2.5mg OD-BD

> 6yo: 5mg BD -10mg OD

Question 13

desloratadine

Answer 13

1-2yo (only for urticaria): 1.25mg/d

2-11yo: 1.25mg/d

> 12yo: 5mg/d

Question 14

fexofenadine

Answer 14

6m-2yo (only for chronic idiopathic urticaria): 15mg BD

2-11yo: 30mg BD
>12yo: 60mg BD

Question 15

oxymetazoline

Answer 15

alpha adrenergic agonist that vasoconstrict the dilated blood vessels in nasal mucosa

<1yo: 0.01%
2-6yo: 0.025%
>6yo: 0.05%

SE: burning, stinging, dryness, headache, avoid for >5yo

Question 16

acetylcysteine

Answer 16

2-5yo: 1 sachet TDS
>6yo: 2 sachet TDS

Question 17

bromhexine

Answer 17

2-5yo: 2mg TDS
6-12yo: 4mg TDS
>12yo: 8mg TDS

Question 18

ORS

Answer 18

1-2 sachets BD-TDS

Question 19

adsorbents

Answer 19

absorb toxins and other substances produce by diarrhoea

not recommended for acute diarrhoea

Question 20

smecta

Answer 20

natural adsorbents: adsorbs viruses, bacteria, bacterial toxins , protects intestinal mucosa

> 2yo 2-3 sachets a day

Question 21

loperamide

Answer 21

acts on receptors along small inestines to reduce peristalsis

for >6yo: 0.05-0.1mg/kg q8-12h

max 4mg

Question 22

diphenoxylate

Answer 22

cnt use in <2yo

0.3-0.4mg/kg/d in 4 divided doses max 10mg

SE: tachycardia, resp depression, urinary retention

Question 23

red flags for diarrhoea

Answer 23

<6m
premature birth, hx of pmh
fever >38 in infant or >39 in children
blood in stools
high output and frequent
persistent vomiting
signs of dehydration
change in mental status
suboptimal response to ORT or unable to tolerate oral

Question 24

lactulose

Answer 24

semisynthetic disaccharide so not absorbed by gut, metabolised by colonic bacteria to low molecular weights acids increase osmotic pressure

0.5ml/kg/dose q12-24h

Question 25

forlax (PEG/Macrogol)

Answer 25

osmotic laxatives causing intestinal water secretion and increase stool frequency

> 8yo: 1-2 sachet OM
space 2h from other meds

Question 26

glycerin

Answer 26

rectal stimulant due to mildly irritant nature of glycerol, increase osmotic pressure

neonate 1/4 supp
infant: 1/2 supp
children: 1 supp
>12yo: 2 supp

Question 27

bisacodyl

Answer 27

increase intestinal motility by acting on large intestine to produce strong peristaltic movement, stimulate nerve endings to produce parasympathetic reflexes

PR <12m: 2.5mg, 1-5yo: 5mg, >5yo: 10mg
PO: 1-5yo: 5-10mg OD, >5yo: 10-20mg OD

Question 28

co-trimoxazole

Answer 28

TMP: 6-12mg/kg/d dosed BD

Question 29

fluoroquinolone

Answer 29

20-30mg/kg/d dosed BD

not recommended <12yo due to erosion of cartilarge, msk

SE: GI, ECG, Photosensitivity

space with iron and calcium