Pediatric Pharmacologic Flashcards
T/f theres a sig difference in absorption
false.
Absorption: no significant difference between children and adults
how do children differ from adults in terms of distribution of durgs
Distribution: school-aged children have higher proportion of total body water & lower total body fat
o Lipophilic drugs have smaller volume of distribution
o Hydrophilic drugs have larger volume of distribution
• Metabolism
o Phase I: ____ effective in children than adults
o Phase II: ___ (difference)
• Metabolism
o Phase I: more effective in children than adults
o Phase II: about the same in children and adults
in children and adults
o Children require ___ weight adjusted doses to achieve similar plasma levels to adults due to ___ metabolism
o But, you should ALWAYS individualized dosing based on empirical evidence
o Children require higher weight adjusted doses to achieve similar plasma levels to adults due to higher metabolism
o But, you should ALWAYS individualized dosing based on empirical evidence
peds ADHD:
first line non stimulating agent? long acting stimulant?
first line: long acting –> methylphenidate, dextroamphetamines
non stimulating –> atomoxetine
MOA of ADHD stimulants
Stimulants work by blocking ___ of ___ + ___, competitively (____) or non-competitively (____) and stimulate release
Stimulants work by blocking reuptake of dopamine + noradrenaline competitively (dextroamphetamine) or non-competitively (methylphenidate) and stimulate release
key side effects of ADHD stimulant for peds
side effects: insomnia, headache, appetite suppression, unmasking tics, growth delays
§ Serious but rare: seizures, cardiac conduction problems, activation of mania
Atomoxetine works by blocking the reuptake of ____→ also blocks ____ reuptake in ____ cortex
o Outcome: same as stimulants (but takes a while)
side effects?
Atomoxetine works by blocking the reuptake of norepinephrine→ also blocks dopamine reuptake in prefrontal cortex
o Side effects: sedation, fatigue, decreased appetite
§ Serious but rare: increased HR, hypotension, activation of suicidal ideation
o No potential of abuse
phase 1 metabolism:
pyschoactive meds are almost all metabolized through liver and gut via enzymes known as cytochrome P450.
inhibitng metabolism 1= decreases the action of CYP. increases the seffect and duration of meds that use this metabolic pathway. To compensate: decrease dose and/or frequency of affected medication
induced of CYP451: increases the aciton of the enzym,e decreasing effect and duration of meds that use this metabolic pathway
first, 2nd, 3rd line depressive disorders
- 1st line: CBT
- 2nd line: fluoxetine, escitalopram, citalopram, sertraline + CBT
- 3rd line: all other SSRIs + CBT
side effects of SSRIs
Side effects: GI upset, headaches, transient increase anxiety, sexual dysfunction
o Serious but rare: seizures, induction of mania or suicidality (especially in paroxetine and venlafaxine)
EXTRA SEROTONIN CAN CAUSE BLEEDING– An increased risk of abnormal bleeding was strongly associated with the degree of serotonin reuptake inhibition. Case reports and observational studies have both shown an association between use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), and abnormal bleeding.
key TCA for pediatric OCD management
clomipramine
first line therapy for OCD. Second line
first line: sertraline, fluoxetine, fluvocamine (SSRIs)
second line: clomipramine (TCA)
side effects of TCA
Side effects of TCA: dry mouth, nausea, constipation, wt gain, sedation, blurred vision
o Serious: seizures, QTc prolongation, induction of mania, increase intraocular pressure, hepatic failure, EPS
first and second line treatment for anxiety
1st line: SSRIs (sertraline, fluoxetine, fluvoxamine) + CBT
• 2nd line: venlafaxine
Mechanism: see SSRI and SNRI sections above
key electrolyte imbalance that can be caused by SNRIs
hyponatremia
Side effects of SNRI: headache, GI upset, dose-dependent increase in BP, sexual dysfunction
o Serious but rare: hyponatremia, seizures, induction of mania
which antipsychotic can be used to treat non-psychotic OCD?
haloperidol
Peds Bipolar Disorder
• 1st line:
- o Mania without psychotic features: __, ___
- o Mania with psychotic feature: lithium or divalproex + __ __
Mechanism
• Lithium: unknown
- o Outcome: reduced manic symptoms, reduced future episodes
- o Side effects: wt gain, GI upset, memory problems, __, __, ___
§ Serious: __ toxicity, ___ __, cardiac conduction problems, ___ ___
• Divalproex: block voltage gated ___ channels→ increased ___
- o Side effects: sedation, tremor, GI upset, dizziness
- § Serious but rare: __, ___
Peds Bipolar Disorder
• 1st line:
- o Mania without psychotic features: lithium, divalproex
- o Mania with psychotic feature: lithium or divalproex + atypical antipsychotics
Mechanism
• Lithium: unknown
- o Outcome: reduced manic symptoms, reduced future episodes
- o Side effects: wt gain, GI upset, memory problems, leukocytosis, polyuria, polydipsia
§ Serious: lithium toxicity, renal impairment, cardiac conduction problems, nephrogenic DI
• Divalproex: block voltage gated sodium channels→ increased GABA
- o Side effects: sedation, tremor, GI upset, dizziness
- § Serious but rare: hepatotoxicity, pancreatitis
lithium will affect ___s (organ)
divalproex (anticonvulsant) can affect ___, ___
lithium –> kidney
divalproex –> hepatoxicity, pancreatitis
when should you consider a non-stimulant for peds ADHD (first line is amphetamine, methylphenidate
- STIMULANTS ARE NOT TOLERATED OR INEFFECTIVE
- 24H SYMPTOM COVERAGE IS NEEDED
- AN ACTIVE EATING DISORDER
- RISK OF DIVERSION
- CONTRAINDICATIONS TO STIMULANT (SYMPTOMATIC CV DISEASE, HYPERTHYROIDISM)
adolescent depresion: OUTCOMES: THE COMBINATION OF ___ WITH ___ SHOWED THE HIGHEST RESPONSE
RATES, GREATEST IMPROVEMENTS IN DEPRESSION SCORES, AND GREATEST REDUCTION IN SI
adolescent depresion: OUTCOMES: THE COMBINATION OF FLUOXETINE WITH CBT SHOWED THE HIGHEST RESPONSE
RATES, GREATEST IMPROVEMENTS IN DEPRESSION SCORES, AND GREATEST REDUCTION IN S
peds OCT treatment
___ ALONE AND ___ DID NOT DIFFER BUT BOTH RESULTED IN
IMPROVEMENT. PATIENTS TREATED WITH COMBINATION SHOWED A SUBSTANTIALLY HIGHER
PROBABILITY OF IMPROVEMENT INCLUDING REMISSION
CBT ALONE AND SERTRALINE DID NOT DIFFER BUT BOTH RESULTED IN
IMPROVEMENT. PATIENTS TREATED WITH COMBINATION SHOWED A SUBSTANTIALLY HIGHER
PROBABILITY OF IMPROVEMENT INCLUDING REMISSION
atomoxetine is an___
SNRI
SSRIs:
___ AND __ CARRY THE HIGHEST RISK OF SUICIDAL IDEATION IN YOUTH
PAROXETINE AND VENLAFAXINE CARRY THE HIGHEST RISK OF SUICIDAL IDEATION IN YOUTH
___ ARE A REASONABLE MEDICATION CHOICE FOR YOUTH WITH
PSYCHOSIS BUT CAREFUL MONITORING OF SIDE EFFECTS IS REQUIRED.
SGAS (second gen) ARE A REASONABLE MEDICATION CHOICE FOR YOUTH WITH
PSYCHOSIS BUT CAREFUL MONITORING OF SIDE EFFECTS IS REQUIRED.
treatment of early age mania:
RISPERIDONE IS AN EFFECTIVE TREATMENT FOR YOUTH EXPERIENCING
MANIC OR MIXED EPISODES IN BIPOLAR DISORDER BUT CAREFUL MONITORING OF SIDE
EFFECTS IS REQUIRED
RISPERIDONE WAS MORE EFFECTIVE THAN LITHIUM AND DIVALPROEX
FALTER symtoms for neuroleptic malignant syndrome
Fever
Autonomic instability
Leukocytosis
T tremor
E: elevated enzymes (cretaining kinase due tto rhabdomyolysis)
R: rigidity of muscles (lead pipe)
___ OR ____ CAN TREAT PARKINSONISM, DYSTONIA AND AKATHISIA
• ___ CAN BE USED FOR MORE CHRONIC AKATHISIA
BENZTROPINE OR DIPHENHYDRAMINE CAN TREAT PARKINSONISM, DYSTONIA AND AKATHISIA
• PROPRANOLOL CAN BE USED FOR MORE CHRONIC AKATHISIA
____ S CAN ALSO BE USED FOR TIC DISORDERS AND AS ADJUNCTIVE TREATMENT FOR SEVERE
IRRITABILITY AND AGGRESSION IN ASD, ODD AND CD
second generation antipsychotics CAN ALSO BE USED FOR TIC DISORDERS AND AS ADJUNCTIVE TREATMENT FOR SEVERE
IRRITABILITY AND AGGRESSION IN ASD, ODD AND CD
CLONIDINE is an ___ ____ ____ that can be used as a third line ADHD med
alpha 2 adrenergic agonist. less selective and more potent which results in more sie effects, including sedatrion and hypoteninos
T/F neurovegetative symptoms tend to improve before emotional and cognitive symptoms for SSRIs
true. Sleeping, appetite will improve before true depression improces.
- takes 4-8 weeks.
