Pediatrics Flashcards
What percentage of children take a medication for a chronic illness
25%
What age is a neonate?
<1 month
What is considered preterm?
<36 weeks
What is considered term?
> /=36 weeks
What is a low birth weight?
1500g- <2500g
What is a very low birth weight?
<1500g
What age is an infant?
1mo- 1y
What age is a child?
1y-11y
What age is an adolescent?
12-18y
What medication causes Reye’s syndrome in children?
aspirin
Anyone less than _________ should not take aspirin unless prescribed by a doctor?
<20 y
What ages should tetracyclines be avoided in children?
last half of pregnancy to 8y
What legislative actions encourage trials for pediatric labeling and formulations?
- 2002 Best Practices for Children Act (BPCA)
- 2003 Pediatric Research Equity Act (PREA)
What did BCPA and PREA find regarding gabapentin?
- higher doses were required to control seizures in children <5
- SEs (agitation, hostility) in children <12
What did BCPA and PREA find regarding Fluvoxamine?
- higher doses in adolescents then previously indicated
- lower doses required for girls 8-11 due to excess drowsiness
- SEs (more limited growth)
What happens to HR as we age?
decreases with age
At what age is the circadian rhythm observed?
<4
What happens to respiratory rate as we age?
decreases with age
At what age should children have their BP measured?
> /= 3
What are BP measurements based on to determine if BP is normal?
- sex
- age
- height
What is a normal BP?
SBP and DBP <90th percentile
What is pre-HTN?
SBP and DBP >/=90th percentile BUT <95th percentile
What is stage 1 HTN?
SBP and DBP >95th percentile to 5mmHg above 99th percentile
What is stage 2 HTN?
SBP and DBP > 5mmHg above 99th percentile
What table is used to determine children’s BP?
The fourth table
What is considered a fever?
rectal temp >100.4 degrees F
How should temp be taken in infants to 4 y?
rectally
How should temperature be taken in older children?
- tympanic
- oral (1 degree lower than core)
- axillary (2 degrees lower than core)
When should children < 3 months be referred to PCP for fever?
> /= 100.4
When should children > 3 months be referred to PCP for fever?
- > /= 100.4 for more than 3 days
- appear ill
- > /=102
When should any child be referred to PCP for fever?
- > /= 100.4
- febrile seizures
- recurrent fevers, even if only a few hours
- chronic medical problems (heart disease, cancer, lupus, sickle cell anemia, Lyme disease
- new skin rash
What are treatments for fever?
- encourage the child to drink fluids
- Acetaminophen
- ibuprofen
What is the recommended dose of acetaminophen for infants and children?
10-15 mg/kg/dose every 4-6 hours;
DO NOT exceed 5 doses in 24h
What is the recommended dose of ibuprofen for infants and children?
7.5 mg/kg/dose Q6-8h;
DO NOT exceed 30 mg/kg/day
How do we get an accurate record of the infant/child’s general pattern of growth?
serial measurements
What is the equation for BMI according to the CDC?
weight (kg)/ [height (m)] ^2
What is considered overweight?
BMI >/= 85th-95th percentile
What is considered obese?
BMI >/= 95th percentile
What is considered undernutrition?
BMI <15th percentile
When do the most dramatic PK changes happen in children?
first 2 years of life
Do children have a higher (basic) or lower (acidic pH compared to adults?
higher; basic
What is true about drug concentrations of acid labile drugs in infants due to basic environment?
- increased absorption due to more intact drug
- 5-6x higher concentrations in neonates vs. infants/children
Why are lipophilic drugs less likely to be absorbed in the first 6mo of life?
lower concentration of bile salts and biliary function within the intestine
How does GI motility change as we age?
decreased in neonates and young infants (increases with age)
How does decreased GI motility affect drug absorption?
delays absorption
Why is rectal absorption helpful with older infants/ children?
- not many IV choices
- IV access problems
- impractical oral route
What are issues with rectal administration in young infants?
high-amplitude pulsatile contractions of the lower GI tract; CR suppositories could be expelled before total dose delivered
What volume of IM injection is appropriate in young children?
0.5 mL
What volume of IM injection is appropriate in school age children?
1 mL
What volume of IM injection is appropriate in adolescents and adults?
3-5 mL
Why is IV route preferred over IM?
IM absorption can be erratic
What is the order of capillary density from young infants to adults?
young infants> older children> adults
What is systemic absorption via topical administration increased in children?
- increased skin surface area: body weight ratio
- increased skin hydration
- thinner statum corneum and epidermis
- poorly anchored skin
- less SQ fat
What medications are associated with severe systemic SEs when administered topically?
- hexachlorophene antiseptic
- insect repellant (>10% diethyltoluamide)
- Lindane
- corticosteroids
What type of corticosteroid regimens are associated with HPA axis suppression, poor weight gain, and growth?
- high potency short-term use
- low potency long term use
What happens to TBW with age?
decreases
What is the dose of Gentamicin for a neonate (Vd=0.45 L/kg)?
4-5 mg/kg/dose
What is the dose of Gentamicin for an infant-child (Vd=0.4-0.35 L/kg)?
2.5 mg/kg/dose
What is the dose of Gentamicin for an adolescent-adult (Vd=0.3-0.25 L/kg)?
1.5 mg/kg/dose
Why is the free fraction of drugs higher in neonates?
drugs have lower binding affinity to fetal albumin
Why do babies have a higher rate of jaundice?
increased concentration of bilirubin in all babies due to immature liver
What antibiotic is CI in hyperbilirubinemia neonates?
Ceftriaxone; 85-95% protein bound and displaces bilirubin from albumin
How long does it take for most CYP enzymes to reach near-adult activity?
about 2y
What happens with most drugs that undergo phase 1 and 2 metabolism in the live if these systems are not developed in children?
compensatory mechanisms ensure overall clearance of some drugs do not change with age
What happens to elimination (GFR with age)?
increases
What is the outcome of decreased elimination in children?
longer half-life and dosing intervals
What is a normal dose of Ranitidine at birth?
0.5 mg/kg/dose Q12h IV
What is a normal dose of Ranitidine for a 2 week old neonate?
1 mg/kg/dose Q8h IV
