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Parenterals Final > Pediatric Parenteral Medication > Flashcards

Pediatric Parenteral Medication Flashcards

1
Q

IM Route Considerations

A

Altered blood flow (compromised circulation reduces absorptive potential)
Smaller muscle mass than adults (limit volumes to 0.5 mL for infants and 1 mL for children)

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2
Q

Intraosseous route Considerations

A

Used in emergency situations to gain rapid vascular access

Proximal site = optimal site

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3
Q

What can be given intraosseous route?

A

Crystalloid/colloid solutions
Blood products
Meds

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4
Q

Upper extremities peripheral line placement

A

Forearm, dorsal veins of hands, antecubital fossa

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5
Q

Lower extremities peripheral line placement

A

Saphenous vein at the ankle or dorsal part of foot

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6
Q

Peripheral Line Consideration

A

Remain in place for a few days
Veins are small and fragile (thrombophlebitis, infiltration, extravasation, bleeding, bruising, phlebitis)
Limit drug solution (900-1000 mOsm)

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7
Q

Osmolarity

A

Most drugs will have to be diluted

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8
Q

pH Considerations

A

Drugs outside of 7.35-7.45 can increase thrombophlebitis risk

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9
Q

Central line placement

A

Internal jugular vein
Subclavian vein
Femoral vein

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10
Q

Central line considerations

A

For prolonged IV therapy
Number of lumens, lumen size and length
Less extravasation and infiltration
Heparin to prevent catheter occlusion

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11
Q

Complications of central line usage

A

Line infection
Sepsis
DVT
Embolism

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12
Q

Placement of Peripherally Inserted Central Catheters (PICC)

A

Median cubital vein and tip advanced centrally
Infuses into the superior vena cava
Single, double, triple lumen catheters

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13
Q

PICC Limitations

A

Placement requires specialty trained nurses or a physician and must be confirmed with x-ray
Require heparin flushes

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14
Q

PICC Benefits

A

Longer duration of use compared with peripheral line (2-8 weeks)
Tolerate higher osmolar solutions

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15
Q

Placement of Central Venous Catheters (CVC)

A

Generally require surgical placement
Infuse into the superior vena cava
Can be single, double, or triple lumen

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16
Q

CVC Limitations

A

Surgical placement
Higher cost
Require heparin flushes

17
Q

CVC Benefits

A

Best for long term use

Tolerate higher osmolar solutions

18
Q

Pediatric-friendly formulations

A

Geometric dilution must be utilized to oaccurately deliver small doses

19
Q

Dilutions

A

Often administering less than 1 mL of drugs

Can accurately measure 2 mg of drugs

20
Q

Drug Volume Limitations

A

Drug volume must be minimized to allow for nutrition

High potential for error when dose volumes less than 1 mL

21
Q

Syringe Pump Devices

A 
Pressure controls infusion rate
Microbore tubing (infusion rate is limited due to lumen size)
Pediatric benefits (improved accuracy at rates less than 10 mL/hr & limit delayed drug delivery
22
Q

Dead space

A

Drug can be hidden or lost with small volumes in the IV set
Within the hub of the needle, Y-site injection ports, in-line filters
So need to allow for priming volume and to account for dead space during preparation

23
Q

Dead space volume policies

A

Priming volume equal to anticipated dead space

Dispense medication in exact volume and then flush line after drug infusion completed

24
Q

Intermittent Infusions are:

A

Administered via slow infusion over a set time period using a syringe pump or gravity

25
Q

Continuous infusions:

A

Require close infusions

Infused via syringe pump for accurate control of rates

26
Q

Pediatric Medication Errors Formulation Issues

A

Most are designed/studied for adults
Few correct strengths available
Can require complex calculations and dilutions

27
Q

Dosing can vary according to:

A

Age
Degree of prematurity in neonates
Weight
Clinical conditions

28
Q

Calculation errors:

A

10 fold and 100 fold dosing errors
Misplacement of decimal point
Inappropriate use of zeros
Incorrect units

29
Q

Benzyl Alcohol

A

Additive
Excreted via the urine but newborns have immature conjugation pathways so their is accumulations
5 mg/kg/d

30
Q

Propylene Glycol

A

Additive
Excreted via the urine but neonates have prolonged metabolism
Rapid infusion can cause hypotension, arrhythmias and seizures

31
Q

Methylparaben

A

Preservative/additive
Displaces bilirubin from albumin
Impossible to avoid

32
Q

Aluminum

A

Contaminant
May leach out of glass containers, tubing sets, needles, syringes
Cause osteomalacia, anemia, encephalopathy

33
Q

How do you limit contamination of aluminum?

A

Rotate stock
Limit exposure
Select plastic containers

34
Q

DEHP

A

Additive

Used to make PVC plastic bags and tubing soft/flexible and can leach out of these products

35
Q

Premature infants + DEHP

A

Toxic to reproductive system, lungs, kidney and liver

36
Q

Known meds commonly associated with errors:

A 
IV meds
Analgesics (narcotics)
Abx
Fluids/electrolytes
Digoxin
Heparin
37
Q

What can you do as a pharmacists?

A

Require weights on peds orders
Require orders in mg/kg/dose and calculated doses
Add check system for IV solution for peds
Final concentration verification
Use preservative free products

Parenterals Final (7 decks)

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