Pediatric Stuff

Question 1

Pediatric PK: Alteration in Absorption

Answer 1

• Gastric pH more neutral
• Less effective GI motility
• Reduced intestinal integrity

Question 2

Pediatric PK: Alteration in Distribution

Answer 2

Inc water, reduced adipose

Hydrophilic rx will require larger dose; lipophilic require smaller dose

Question 3

Pediatric PK: Alteration in Metabolism

Answer 3

Reduced hepatic metabolism; up to 1 year of age to develop CYP fully

Question 4

Pediatric PK: Alteration in Elimination

Answer 4

Reduce kidney fxn until 3-5 mo of age

Question 5

How to calculate GFR in pediatrics

Answer 5

Modified Scwartz

GFR=(0.413*ht)/SCr

Question 6

Usual tacro dose in peds

Answer 6

0.05-0.15 mg/kg BID

Question 7

Usual cyclo dose in peds

Answer 7

2-5 mg/kg BID

Question 8

Usual MMF dose in peds

Answer 8

300-600 mg/m2 BID
OR
15-25 mg/kg BID (~equiv to 1000 mg PO BID in adults)

Question 9

Usual AZA dose in peds

Answer 9

1-2 mg/kg daily

Question 10

Usual everolimus dose in peds

Answer 10

0.8 mg/m2 BID

Question 11

Usual sirolimus dose in peds

Answer 11

0.5-1 mg/m2 per day, divided into 1 - 2 doses

Consider load of 2-3 mg/m2

Question 12

What (& quantity) can tacrolimus granules be mixed with to make the suspension?

Answer 12

Only water at room temp

15-30 mL x2 (to get all medication)

Question 13

What (& quantity) can sirolimus solution be mixed with to make the suspension?

Answer 13

Water or orange juice only

At least 2 oz x2(to get all medication)

Question 14

Valganciclovir dose for pediatrics

Answer 14

Dose=7BSACrCl

BSA=sqrt(htwt/3600)
CrCl via Schwartz = kht/SCr (max 150)

Alt: 15-18 mg/kg/day

Question 15

Max isohemagglutinin titers for pediatric liver txp

Answer 15

None

- However, high titer (1:32) consider PP, IVIG, ritux, triple IS

Question 16

Max isohemagglutinin titers for ABOi pediatric thoracic txp

Answer 16

<1 year old: no max
>1 year old: max 1:16
- Consider intraop plasma exchange, induction, triple IS

Question 17

Palivizumab for RSV prophy: dosing & who it is indicated for

Answer 17

Immunocompromised peds <24 months
Give at beginning of RSV season
15 mg/kg IM Qmonth x5 months

Question 18

Peds diphtheria, tetanus, and pertussis (DTaP) vaccination: How early & schedule

Answer 18

Minimum age: 6 weeks

Schedule: 5-dose series over 4-6 years (can be accelerated to go over ~1 year)

Question 19

Peds Hep A vaccination: How early & schedule

Answer 19

Minimum age: 6 months (accelerated; normal = 12 mo)

Schedule: 2 doses over 6 months

Question 20

Peds Hep B vaccination: How early & schedule

Answer 20

Minimum age: Birth

Schedule: 3 doses over 6-18 months

Question 21

Peds Hib vaccination: How early & schedule

Answer 21

Minimum age: 6 weeks

Schedule: 4-dose series over 12-15 months (also combo with DTaP)

Question 22

Peds influenza vaccination: How early & schedule

Answer 22

Minimum age: 6 months
Schedule: 2 doses separated by at least 4 weeks if < 8 years old and less than 2 influenza vaccine doses before July 1, 2020,

Question 23

Peds MenACWY vaccination: How early & schedule

Answer 23

Minimum age: 2 to 9 months (accelerated for high risk; normal=11-12 years)
Schedule: Varies widely depending on age

Question 24

Peds MenB vaccination: How early & schedule

Answer 24

Minimum age: 10 years (accelerated; normal=16-18 years)

Schedule: 2 or 3 dose series over 1-6 months

Question 25

Peds PCV13 vaccination: How early & schedule

Answer 25

Minimum age: 6 weeks
Schedule: 4-dose series that may be accelerated to 4-5 months (normal: 12 - 15 months)

UNLESS >5 years old –> just need 1 dose

Question 26

Peds PPSV23 vaccination: How early & schedule

Answer 26

Minimum age: 2 years (accelerated; normal age 19)

Schedule: Repeat in 5 years

Question 27

Peds Rotavirus vaccination: How early & schedule

Answer 27

Minimum age: 6 weeks (NOT TO BE GIVEN IF 14w6d)

Schedule: 2-3 doses over 2-4 months

Question 28

Peds Varicella vaccination: How early & schedule

Answer 28

Minimum age: 6 months (accelerated; normal age 12 months)

Schedule: 2 doses as close as 3 months together

Question 29

Peds MMR dose

Answer 29

Minimum age: 12 months

Schedule: 2 doses as soon as 4 weeks apart (usually repeat after 5 years)