pediatric pharmacotherapy Flashcards
list 5 factors that place pediatric patients at higher risk of medication errors
- changing PK parameters at various ages and stages of maturational development
- need for calculation of individualized doses based on age, weight or BSA
- lack of available dosage forms and concentrations
- need for precise dosage measurement
- lack of published info or approved labelling for dosing, safety, efficacy and clinical use in paeds
what are the top 5 drugs that cause harm through med errors in pediatrics
- morphine
- potassium
- insuling
- fentanyl
- salbutamol
what do you need to tell families about asthma? what is a mnemonic for this?
ASTHMA
Asthma--what is it? Signs and symptoms Triggers Help--> who, when and where Medications--> reliever, controller/preventer, devices, adherence Action plan
what is the most common reliever used in asthma
salbutamol
name the inhaled corticosteroids commonly used as controllers in asthma
- beclomethasone/QVAR (MDI)
- budesonide/Pulmicort (turbuhaler)
- ciclesonide/Alvesco (MDI)
- fluticasone/Flovent (MDI, diskus)
- mometasone/Asmanex (Twisthaler)
list the common ICS/LABAs used for asthma
- mometasone and formoterol/Zenhale (MDI)
- fluticasone and salmeterol/Advair (MDI, diskus)
- budesonide and formoterol/Symbicort (turbuhaler)
what are LRTAs
leukotriene receptor antagonists
name the LTRAs used to treat asthma
- montelukast/Singulair (tabs, chewable tabs, granules)
2. zafirlukast/Accolate (tabs)
what are the two ICS licensed for once daily dosing for asthma
budesonide/pulmicort
ciclesonide/alvesco
how does ICS dosing differ from other pediatric med dosing?
not weight based… just low medium and high doses
similar effectiveness and safety across age and weight
how do ICS affect growth
regular use at low or medium doses for mild to moderate asthma at 1 year treatment period versus placebo showed and decrease in 0.48 cm per year in linear growth velocity
0.61 cm difference in change from baseline height
growth reduction is max during first year
ICA can thus cause small decrease in growth but benefits outweigh risk
how do you choose an asthma controller medication
- asthma severity and control–> usually start with an ICS, aim to avoid intermittent use
- patient age–> limited data for ICS/LABA in preschoolers
- adherence and device–> most patients prefer MDI and spacer, teens may prefer DPI
- costs–> costs per days prescribed versus per device
which ICS come in an MDI
beclomethasone/QVAR
ciclesonide/alvesco
fluticasone/Flovent
which ICS/LABA combos come in MDI
mometasone and formoterol/zenhale
fluticasone and salmeterol/advair
what is the spectrum for cefazolin and cephalexin
staph
strep
ecoli
what are the indications for cefazolin/cephalexin use
cellulitis
osetomyelitis
surgical prophylaxis
UTI
what is the spectrum for cefuroxime, cefprozil, cefacor
staph
strep
ecoli
h. influenzae
what is the indication for cefuroxime/cefprozil/cefaclor
second line for otitis media, pneumonia
what is the spectrum for cefotaxime and ceftriaxone
some staph strep ecoli h.influenzae some gran -
*ceftazidime IV covers pseudomonas
what are the indications for cefotaxime/ceftriaxone
sepsis
meningitis
severe pneumonia
in what population do you avoid ceftriaxone
neonates
what does ceftriaxone interact with
IV calcium
what is the spectrum of cefixime
some staph strep (but NOT s. pneumo) ecoli h.influenzae some gram -
what are the indications for cefixime
resistant UTI
gonococcal infectioms
*once daily dosing
what do the cephalosporins NOT cover
enterococcus
listeria
what is the spectrum of oral penicillin
strep
mouth anaerobes
what are the indications for oral penicillins
GAS prophylaxis and treatment
what is the spectrum for oral cloxacillin
staph
strep
what is the indication for cloxacillin
cellulitis
*bad taste and low bioavailability make cephalexin a better choice
spectrum of amoxicillin
strep some enterococcus ecoli h. influenzae mouth anaerobes
indications for amoxicillin
otitis media
pneumonia
URTI
spectrum of amox clav
staph strep some enterococcus ecoli h. influenzae anaerobes
indications for amox clav
second line for otitis media
aspiration pneumonia
UTI
bites
spectrum of erythromycin
some staph
some strep
atypicals
indications for erythromycin
GAS prophylaxis and treatment in penicillin allergy
pertussis (azithro first line)
spectrum of clarithromycin
some staph
strep
sometime h.influenzae
atypicals
indications for clarithromycin
second line OM
pneumonia
pertussis (azithro first line)
**do not put down G tube
spectrum of azithromycin
some staph
strep
sometimes h. influenzae
atypicals
indications for azithro
first line pertussis
pneumonia
second line OM
- daily dosing
- *less drug interactions and QT prolongation than erythro or clarithro
spectrum of clindamycin
staph
CA-MRSA
anaerobes
indications for clindamycin
cellulitis
anaerobic infections
- *poor taste
- *Poor CNS penetration
spectrum of metronidazole
anaerobes
indications for metronidazole
c diff
anaerobic infections
- *poor taste
- *good CNS penetration
spectrum of co-trimoxazole
staph CA-MRSA some strep (not GAS) ecoli h. influnzae some gram -
indications for co trimoxazole
UTI
PCP treatment or prophylaxis
why should you avoid co-trimoxazole in neonates
kernicterus
spectrum for nitrofurantoin
staph
strep
h. influenzae
some gram -
indications for nitrofurantoin
cystitis
why should you avoid nitrofurantoin in neonates
hemolytic anemia
spectrum of cipro
staph ecoli h. influenzae some gram - pseudomonas
indications for cipro
resistant UTI
CF exacerbation
what is a serious side effect of cipro
arthropathies
what are some ways to make medication taking easier
give frozen treat prior to dose
squirt liquid into side of mouth/cheek
give something sweet after the dose
mix tabs/capsules with chocolate sauce, pudding etc if no interaction
speciality pharmacies can sometimes add flavors or compound better tasting liquids
pharyngitis first line
penicillin (amoxicillin)
otitis media first line
amoxicillin
non purulent cellulitis first line
cephalexin
purulent cellulitis first line
*drainage first
then cephalexin and cotrimxazole or clinda
dog bite first line
amox clav
mild CAP older than 3 mo first line
amoxicillin
severe CAP older than 3 mo first line
cefotaxime
with or without clarithro/azithro with or without vanco
UTI first line older than 2 mo
cephalexin
what drugs (generally) require therapeutic dose monitoring (TDM)
narrow therapeutic window
correlation between efficacy or toxicity and drug level
large variation in drug levels in different patients from a given dose
what drugs are commonly monitored
- antibiotics–> vanco and aminoglycosides
- anticonvulsants –> phenytoin, phenobarbital, carbamazepine
- immunosuppressants–> tacrolimus, sirolimus, cyclosporine
are drug levels always necessary
no–> i.e if less than 48 hours of PO abx
what should you ask when interpreting a drug level
PITAS
Patient clinical status IV line where the drug admin? level drawn? Time level drawn Administered over appropriate time? Steady state?
how would you adjust the drug administration of the peak/post levels are too high?
decrease DOSE
how would you adjust the drug administration of the peak/post levels were too low
increase DOSE
how would you adjust the drug administration of the trough/pre levels were too low
increase FREQUENCY
how would you adjust the drug administration of the trough/pre levels were too high
decrease FREQUENCY
