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Pediatrics 2 > pediatric pharmacotherapy > Flashcards

pediatric pharmacotherapy Flashcards

1
Q

list 5 factors that place pediatric patients at higher risk of medication errors

A
  1. changing PK parameters at various ages and stages of maturational development
  2. need for calculation of individualized doses based on age, weight or BSA
  3. lack of available dosage forms and concentrations
  4. need for precise dosage measurement
  5. lack of published info or approved labelling for dosing, safety, efficacy and clinical use in paeds
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2
Q

what are the top 5 drugs that cause harm through med errors in pediatrics

A
  1. morphine
  2. potassium
  3. insuling
  4. fentanyl
  5. salbutamol
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3
Q

what do you need to tell families about asthma? what is a mnemonic for this?

A

ASTHMA

Asthma--what is it?
Signs and symptoms
Triggers
Help--> who, when and where
Medications--> reliever, controller/preventer, devices, adherence
Action plan
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4
Q

what is the most common reliever used in asthma

A

salbutamol

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5
Q

name the inhaled corticosteroids commonly used as controllers in asthma

A
  1. beclomethasone/QVAR (MDI)
  2. budesonide/Pulmicort (turbuhaler)
  3. ciclesonide/Alvesco (MDI)
  4. fluticasone/Flovent (MDI, diskus)
  5. mometasone/Asmanex (Twisthaler)
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6
Q

list the common ICS/LABAs used for asthma

A
  1. mometasone and formoterol/Zenhale (MDI)
  2. fluticasone and salmeterol/Advair (MDI, diskus)
  3. budesonide and formoterol/Symbicort (turbuhaler)
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7
Q

what are LRTAs

A

leukotriene receptor antagonists

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8
Q

name the LTRAs used to treat asthma

A
  1. montelukast/Singulair (tabs, chewable tabs, granules)

2. zafirlukast/Accolate (tabs)

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9
Q

what are the two ICS licensed for once daily dosing for asthma

A

budesonide/pulmicort

ciclesonide/alvesco

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10
Q

how does ICS dosing differ from other pediatric med dosing?

A

not weight based… just low medium and high doses

similar effectiveness and safety across age and weight

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11
Q

how do ICS affect growth

A

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

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12
Q

how do you choose an asthma controller medication

A
  1. asthma severity and control–> usually start with an ICS, aim to avoid intermittent use
  2. patient age–> limited data for ICS/LABA in preschoolers
  3. adherence and device–> most patients prefer MDI and spacer, teens may prefer DPI
  4. costs–> costs per days prescribed versus per device
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13
Q

which ICS come in an MDI

A

beclomethasone/QVAR

ciclesonide/alvesco

fluticasone/Flovent

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14
Q

which ICS/LABA combos come in MDI

A

mometasone and formoterol/zenhale

fluticasone and salmeterol/advair

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15
Q

what is the spectrum for cefazolin and cephalexin

A

staph
strep
ecoli

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16
Q

what are the indications for cefazolin/cephalexin use

A

cellulitis

osetomyelitis

surgical prophylaxis

UTI

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17
Q

what is the spectrum for cefuroxime, cefprozil, cefacor

A

staph
strep
ecoli
h. influenzae

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18
Q

what is the indication for cefuroxime/cefprozil/cefaclor

A

second line for otitis media, pneumonia

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19
Q

what is the spectrum for cefotaxime and ceftriaxone

A 
some staph
strep
ecoli
h.influenzae
some gran -

*ceftazidime IV covers pseudomonas

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20
Q

what are the indications for cefotaxime/ceftriaxone

A

sepsis
meningitis
severe pneumonia

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21
Q

in what population do you avoid ceftriaxone

A

neonates

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22
Q

what does ceftriaxone interact with

A

IV calcium

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23
Q

what is the spectrum of cefixime

A 
some staph
strep (but NOT s. pneumo)
ecoli
h.influenzae
some gram -
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24
Q

what are the indications for cefixime

A

resistant UTI
gonococcal infectioms

*once daily dosing

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25
Q

what do the cephalosporins NOT cover

A

enterococcus

listeria

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26
Q

what is the spectrum of oral penicillin

A

strep

mouth anaerobes

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27
Q

what are the indications for oral penicillins

A

GAS prophylaxis and treatment

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28
Q

what is the spectrum for oral cloxacillin

A

staph

strep

29
Q

what is the indication for cloxacillin

A

cellulitis

*bad taste and low bioavailability make cephalexin a better choice

30
Q

spectrum of amoxicillin

A 
strep
some enterococcus
ecoli
h. influenzae
mouth anaerobes
31
Q

indications for amoxicillin

A

otitis media
pneumonia
URTI

32
Q

spectrum of amox clav

A 
staph 
strep
some enterococcus
ecoli
h. influenzae
anaerobes
33
Q

indications for amox clav

A

second line for otitis media
aspiration pneumonia
UTI
bites

34
Q

spectrum of erythromycin

A

some staph
some strep
atypicals

35
Q

indications for erythromycin

A

GAS prophylaxis and treatment in penicillin allergy

pertussis (azithro first line)

36
Q

spectrum of clarithromycin

A

some staph
strep
sometime h.influenzae
atypicals

37
Q

indications for clarithromycin

A

second line OM

pneumonia

pertussis (azithro first line)

**do not put down G tube

38
Q

spectrum of azithromycin

A

some staph
strep
sometimes h. influenzae
atypicals

39
Q

indications for azithro

A

first line pertussis

pneumonia

second line OM

  • daily dosing
  • *less drug interactions and QT prolongation than erythro or clarithro
40
Q

spectrum of clindamycin

A

staph
CA-MRSA
anaerobes

41
Q

indications for clindamycin

A

cellulitis
anaerobic infections

  • *poor taste
  • *Poor CNS penetration
42
Q

spectrum of metronidazole

A

anaerobes

43
Q

indications for metronidazole

A

c diff
anaerobic infections

  • *poor taste
  • *good CNS penetration
44
Q

spectrum of co-trimoxazole

A 
staph
CA-MRSA
some strep (not GAS)
ecoli
h. influnzae
some gram -
45
Q

indications for co trimoxazole

A

UTI

PCP treatment or prophylaxis

46
Q

why should you avoid co-trimoxazole in neonates

A

kernicterus

47
Q

spectrum for nitrofurantoin

A

staph
strep
h. influenzae
some gram -

48
Q

indications for nitrofurantoin

A

cystitis

49
Q

why should you avoid nitrofurantoin in neonates

A

hemolytic anemia

50
Q

spectrum of cipro

A 
staph
ecoli
h. influenzae
some gram -
pseudomonas
51
Q

indications for cipro

A

resistant UTI

CF exacerbation

52
Q

what is a serious side effect of cipro

A

arthropathies

53
Q

what are some ways to make medication taking easier

A

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

54
Q

pharyngitis first line

A

penicillin (amoxicillin)

55
Q

otitis media first line

A

amoxicillin

56
Q

non purulent cellulitis first line

A

cephalexin

57
Q

purulent cellulitis first line

A

*drainage first

then cephalexin and cotrimxazole or clinda

58
Q

dog bite first line

A

amox clav

59
Q

mild CAP older than 3 mo first line

A

amoxicillin

60
Q

severe CAP older than 3 mo first line

A

cefotaxime

with or without clarithro/azithro with or without vanco

61
Q

UTI first line older than 2 mo

A

cephalexin

62
Q

what drugs (generally) require therapeutic dose monitoring (TDM)

A

narrow therapeutic window

correlation between efficacy or toxicity and drug level

large variation in drug levels in different patients from a given dose

63
Q

what drugs are commonly monitored

A
  1. antibiotics–> vanco and aminoglycosides
  2. anticonvulsants –> phenytoin, phenobarbital, carbamazepine
  3. immunosuppressants–> tacrolimus, sirolimus, cyclosporine
64
Q

are drug levels always necessary

A

no–> i.e if less than 48 hours of PO abx

65
Q

what should you ask when interpreting a drug level

A

PITAS

Patient clinical status
IV line where the drug admin? level drawn?
Time level drawn 
Administered over appropriate time?
Steady state?
66
Q

how would you adjust the drug administration of the peak/post levels are too high?

A

decrease DOSE

67
Q

how would you adjust the drug administration of the peak/post levels were too low

A

increase DOSE

68
Q

how would you adjust the drug administration of the trough/pre levels were too low

A

increase FREQUENCY

69
Q

how would you adjust the drug administration of the trough/pre levels were too high

A

decrease FREQUENCY

Pediatrics 2 (19 decks)

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