Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics > Pediatric Pharmacology > Flashcards

Pediatric Pharmacology Flashcards

1
Q

Define the following:
1. Preterm or premature

  1. Neonate
  2. Infant
  3. Child
  4. Adolescent
A
  1. less than 36 weeks gestational age
  2. First 30 days of life
  3. 1 month to 1 year of age
  4. 1-12 years old
  5. 12-18 years old
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Variables affecting GI absorption

5

A
  1. pH
  2. Gastric emptying time and GI motility
  3. Pancreatic enzyme activity
  4. GI surface area
  5. Intestinal microorganisms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Variables affecting GI absorption: How does pH differ in children?
3

A
  1. More alkaline than adults until child reaches 1 year
  2. Adversely affects the absorption of weakly acid drugs
  3. improves the absorption of weakly basic drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Variables affecting GI absorption: How does Gastric emptying time and GI motility different in children?

A
  1. Slower than adults for the first month of life

2. Neonates and infants have irregular peristalsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Variables affecting GI absorption:

  1. Pancreatic enzyme activity?
    - Example?
  2. GI surface area? 2
A
  1. Pancreatic enzyme activity
    - Decreased for the first year of life compared to adults
    - Affects drugs that are fat soluble (not absorbed)
    - Example: Neonates cannot absorb Vitamin E
  2. GI surface area
    - Intestinal size relative to body size matters
    - In young children the relative size of the duodenum compared with the adults enhances drug absorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Variables affecting GI absorption: GI microorganisms in children?
3

Example?

A
  1. Intestinal flora depends MORE on diet than age
  2. More rapid development of flora in breast fed infants
  3. Flora is active in the breakdown of various drugs

Example: Digoxin is reduced to inactive metabolites by anaerobic intestinal bacteria. Digoxin metabolites are not detected in children until about 16 months of age and adult like reduction of digoxin does not occur until age 9.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q 
Rectal absorption
1. Who should we use this in?
2. Drug is absorbed by what?
(avoids what)
3. What is the issue with this route?

Example?

A
  1. For patients who cannot tolerate oral drugs or lack IV access
  2. Drug is absorbed by the hemorrhoidal veins and avoids first pass hepatic metabolism
  3. Most drugs administered by this route are erratically and incompletely absorbed

Example: Diazepam, valproic acid or secobarbital may be given PR in status epilepticus when lacking IV access

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

IM absorption

  1. Affected by? 4
  2. Neonates? 3
  3. Infants?
A
  1. Affected by
    - Muscle mass,
    - blood flow to the muscle
    - tone
    - activity
  2. Neonates
    - Decreased muscle mass
    - limited muscle activity decreases blood flow to and from the muscle
    - Erratic and poor drug absorption
  3. Infants
    - Greater density of skeletal muscle capillaries than older children therefore more efficient absorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  1. Percutaneous absorption: Affected by? 2

2. Neonates have thin skin and increased BSA relative to body mass = how is this significant?

A
  1. Affected by
    - Thickness of the skin
    - Body surface area relative to body mass
  2. significant percutaneous drug absorption in neonates compared to adults
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Factors affecting distribution in pediatric patients

7

A
  1. Vascular perfusion
  2. Body composition
  3. Tissue binding characteristics
  4. Physiochemical properties of the drug
  5. Plasma protein binding
  6. Route of administration
  7. Neonates – these factors are significantly different from adults
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  1. Vascular perfusion?

Ex?

A
  1. Changes in perfusion are common in neonates

Ex: in response to hypoxia the blood may be diverted (shunted) from the lungs to the tissues and organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The higher the total body water and extracellular water the ________ the volume of distribution?

A

larger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  1. Neonates and infants have _________ total body water and ECF compared to older children and adults
  2. Some drugs will require a ________ dose per Kg in infants and younger compared to adults
A
  1. increased

2. larger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Tissue binding characteristics: Drugs bound to tissues exhibit increased free blood levels when what?

A

when the mass of tissue is reduced such as in pediatrics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  1. Physiochemical properties that are different in children? 2

These properties affect the ability of the drug to move across membranes into target tissues and cells

A
  1. Lipid solubility
  2. Molecular configuration

Regarding percutaneous absorption, may lead to toxicity in the neonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Plasma protein binding: Neonates have decreased what that binds alkaline drugs?

A

Alpha1-acid glycoprotein

17
Q

They also have decreased albumin that binds what three things?

What does this result in?

How is the Vd affected?

A 
Decreased albumin in neonates
Binds:
1. acid drugs,
2. fatty acids and 
3. bilirubin

Results in drug displacement and increased plasma levels due to decreased available protein for binding

= larger Vd in neonates compared to adults

18
Q

Route of administration:

  1. Orally what becomes the primary distribution site?
  2. What process is it affected by?
  3. Oral doses are generally higher or lower than IV doses?
  4. What are the primary methods of distribution in IV dosing? 2
A

Orally
1. Liver becomes the primary distribution site
2. Affected by hepatic first pass metabolism
3. Oral doses are generally higher than IV doses
IV
4. Heart and lungs act as the primary method of distribution

19
Q

Clinical significance of ECF:

  1. Percentae in adults?
  2. Percentage in children?
  3. Drugs that are distributed mainly in ECF, volume of distribution should reflect what?
  4. Examples?
A
  1. 20%
  2. 40%
  3. the ECF compartment of the patient
  4. Example - Gentamicin:
    Adult Vd = 0.25L/kg, typical range 0.20-0.30 L/kg
    Neonate Vd = 0.50L/kg, range 0.45-0.65 L/kg
20
Q

Protein binding in neonates:
Which drugs have Increased volume of distribution in children? 4

Tissue uptake in neonates:
Which drugs have Increased uptake and Vd in peds? 3

A
  1. Theophylline
  2. Ampicillin
  3. Phenobarbital
  4. Phenytoin
  5. Morphine
  6. Fentanyl
  7. Digoxin
21
Q

Drug metabolism is delayed in neonates, infants and young children. Drug clearance is reliant on what?

A

hepatic metabolism

22
Q
  1. What is Phase I in metabolism and its increased or decreased in neonates?
  2. children and infants?
  3. How does this affects dosing of caffeine and theophylline?
  4. Anticonvulsants in age 6 mo - 2 yrs?
A
  1. (oxidation, reduction, hydrolysis), CYP 450 system
    decreased
  2. increased
  3. Examples: caffeine and theophylline (need smaller doses and less frequent dosing)

Increased in infants and children
4. Anticonvulsants (age 6 mo - 2 yrs) often 2-5x adult dose

23
Q

Drug metabolism is delayed in neonates, infants and young children:

  1. What is phase II of metabolism?
  2. Describe how its differences in neonates and infants affect tylenol metabolism?
A
  1. Phase II (conjugation)
  2. Acetaminophen (Tylenol) normally is metabolized via glucuronidation but neonates and infants don’t have this ability so broken down by sulfate conjugation
24
Q
  1. How is plasma clearance of many drugs via the kidneys affected in children?
  2. ______ increases during the first 2 weeks of life but doesn’t reach adult rates until age 2
  3. Immature renal system: Describe two things that lead to decreased clearance?
A
  1. Decreased
  2. GFR
    3.
    -Decreased tubular secretion and reabsorption rates
    -Proximal tubule decreased ability to concentrate urine, etc.
25
Q
  1. Antibiotics with longer half lives in neonates due to what?
  2. Which ones specifically? 3
  3. Which drugs are not effective because of the decreased GFR?
  4. What level do you need for it to be affective?
  5. How do we give this drug to neonates?
A
  1. decreased renal excretion
    • PCN
    • Sulfonamides
    • Aminoglycosides
  3. Thiazides
  4. Need a GFR > 30 to be effective
  5. In neonates requires higher doses or need to switch to a stronger (loop diuretic)
26
Q

Common overdoses in peds? 2

A
  1. Iron supplements:

2. Acetaminophen:

27
Q

Common overdoses:

  1. Iron supplements are contained in what?
  2. What do we need to council pts to do?
  3. Deadly overdoses primarily in children of what age?
A
  1. Contained in some children’s vitamins
  2. Counsel parents to distinguish vitamins from candy

Acetaminophen:

  1. Deadly overdoses primarily in children > 12 yrs
    - Accidental or intended
28
Q
  1. GI and IM Absorption describe how it differs in children and infants?
  2. For topical absorption what should we remember?
  3. elimination considerations?
A
  1. Infants and children generally absorb medications more rapidly and completely than adults
  2. The younger the human, the more permeable the skin (watch out with those creams, especially steroids)
  3. Infants and children rapidly eliminate meds that are cleared renaly; may need shorter interval between doses
29
Q

Drugs to avoid in pediatrics and why?

2

A
  1. Propylene glycol (added to many injectable drugs to increase stability)
    - may cause hyperosmolality in infants
  2. Benzyl alcohol (preservative in IV fluids)
    - can cause metabolic acidosis,
    - neurologic damage in neonates
30
Q

Factors affecting pediatric therapy? 4

A
  1. Liver disease
  2. Renal disease
  3. Cystic fibrosis
  4. GI disorders
31
Q
  1. How does cystic fibrosis affect dosing in peds?
  2. Which ones specifically? 3
  3. Three GI diseases that might warrant dosing adjustments?
A
  1. Increased requirements / increased clearance
    • Aminoglycosides
    • Penicillins
    • Theophylline
3. Gastrointestinal disorders:
Dosage adjustments may be necessary 
-Celiac disease
-Gastroenteritis
-Severe malabsorption
32
Q

More than 50% of caregivers were unable to dose Tylenol and Motrin properly

  1. What are they commonly having issues with in dosing? 2
  2. When the caregiver knew the child’s weight, had an intact package with instructions, and had an accurate measuring device what was the most common problem?
A
    • They were unable to state the proper dose
    • They were unable to measure the dose
  2. under dosing
33
Q
  1. What are the dosage formualtions for infant and childrens tylenol? 2
  2. What is a handy way to dose this product? 3
A
  1. Dosage formulations
    Infant Drops: 80 mg/1 ml
    Children’s Tylenol: 160 mg/5 ml
  2. Here is a handy way to dose this product
    24-36lbs 5ml
    36-48lbs 7.5ml
    48-60lbs 10ml
34
Q
  1. Ibuprofen comes in two liquid strengths and two chewable tablets. What are they? 2
  2. Motrin for infants?
A
    • Dose ibuprofen 5-10mg/kg per dose, every 6 hours.
    • Reserve the 10mg/kg for high fevers

. Motrin is not labeled for infants less than 6months!!

35
Q

Ibuprophen Recommended dosing for peds over 6 months is what?

A

peds > 6mos is 5-10mg/kg q 6-8h

36
Q

How many ccs or mLs is equal to one teaspoon?

How many lbs in a kilogram?

A

5

2.2

37
Q

Once you hit the ___________, you don’t need to go any further!

The two major drug classes to remember not to use in the peds population are the what?

A

adult dose

fluoroquinolone’s and the tetracycline’s

Pediatrics (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions