Pediatrics

Question 1

References:

Answer 1

• NeoFax (IBM Micromedex)

- LexiComp (Peds LexiComp)

Question 2

Age Terminology:

Answer 2

• Neonates: < 28 days/1 month
• Infant: 1 month to 12 months (< 1 year)
• Child: 1 year to 11 years
• Adolescent: 12-18 years

Question 3

Pregnancy duration:

Answer 3

• Premature: 36 weeks or earlier
• Full term: > 37 weeks
• Term pregnancy: 37-42 weeks (~ 40 weeks)

Question 4

Gestational age:

Answer 4

• Time “immediately before” conception until birth

- # weeks from onset of last menstrual period to date of birth

Question 5

Postnatal age (PNA):

Answer 5

Age from brith to present

Question 6

Postmenstrual age (PMA):

Answer 6

Gestational age plus Postnatal age

Question 7

Acetaminophen Weight Based Dosing:

OTC only ok for 2 y/o +

Answer 7

• PO 10-15 mg/kg Q 4-6 hours
• Rectal 10-20 mg/kg Q 4-6 hours
• Premature infant: Q 6-8 hours
• Max daily dose: 75 mg/kg/day; max 5 doses/day

Question 8

Standard dosing for ≥ 12 years:

Answer 8

325-650 mg Q 4-6 hours

OTC max: 3,250 mg/day
Rx max: 4,000 mg/day

Question 9

Acetaminophen Dosing Considerations:

Answer 9

• Meltaway/Chewable Tablets (80; 160 mg)
• Suppositories (80; 120; 325; 650 mg)
• Infants OR Children’s Oral Suspension (160 mg/5mL)
• Tylenol Regular Strength Tablets (325 mg)
• Tylenol Extra Stength Tablets (500 mg)

Question 10

Ibuprofen Dosing:

not recommended for infants < 6 months

Answer 10

• Weight Based Dosing: 5-10 mg/kg Q 6-8 hrs

- Max Daily Dose: 40 mg/kg/day; max 4 doses./day

Question 11

Standard Dosing for ≥ 12 years:

Answer 11

• 200-400 mg Q4-6 hours
• OTC Max: 1,200 mg/day
• Rx Max: 2,400 mg/day

Question 12

Ibuprofen Formulations:

Answer 12

• Infant’s Concentrated Drops: 50 mg/1.25 mL
• Children’s Suspension: 100 mg/5 mL
• Chewable tablets/ Junior Strength Tablets: 100 mg

Question 13

Oral administration concerns:

Answer 13

• Topiramate sprinkle capsules: sprinkle contents on small amount of soft food, swallow mixture immediately; (1 tsp of applesauce, oatmeal, ice cream, pudding, yogurt)
• Ciprofloxacin oral suspension: should not be administered through feeding tubes (suspension is oil-based, adheres to feeding tube)
• Phenytoin (absorption impaired when given concurrently with continuous feedings (withhold nutritional supplements for 1-2 hours before/after each dose)

Question 14

Pediatric dosing considerations:

Answer 14

• Children < 7 years of age:
• DPI not recommended
• MDI require AeroChambers

Question 15

Schwartz Equation or Bedside Schwartz Equation:

• ideal for pediatric patients
• considers serum creatinine, height, gender, age
• will not provide accurate estimate in patients with: rapidly changing serum creatinine (unstable) and neonates younger than 1 week

Answer 15

Bedside Schwartz Equation (preferred by National Kidney Disease Education Program):

CrCl= (0.413 x height)/ SCr

Question 16

• Maintenance Fluids (neonates/infants have highest risk of dehydration):
• “Body weight method” formula by Holliday & Segar
• Final answer should be mL/hour (divided by 24 hours)

Answer 16

Weight: < 10 kg (100 mL/kg/day)
10-20 kg (1000 mL + 50 mL/kg for each kg > 10 kg)
> 20 kg (1500 mL plus 20 mL/kg for each kg > 20 kg)

Question 17

Pharmacokinetics (Protein Binding)

Answer 17

• Albumin: (Neonates & infants have less serum albumin)
• Decreased affinity for binding medications = displacement
• Albumin levels reach adult level ~ 1 year

Question 18

Bilirubin (binds to albumin)

Answer 18

• Neonates have increased production & decreased clearance
• Medications may displace bilirubin from albumin
• Increased unbound bilribuin, increases risk of kernicterus