Pediatrics Flashcards
true or false
antihypertensives are commonly prescribed for pediatrics
true
true or false
statins are commonly precribed for pediatrics
true
in clinical practice, who is considered a pediatric?
0-18 years
when stating or viewing a pediatric patient’s age, what is important to consider?
UNITS
ie: just “8” could mean 8 months or 8 years, 8 weeks, etc
define the age of a neonate
0-1 month
define the age of an infant
1 month-1 year of age
define the age of a child
1 year-12 years
define the age of an adolescent
13-18 years
rank the following from youngest to oldest and state their years:
child
neonate
adolescent
infant
neonate (0-1 month)
infant (1 month-1 year)
child (1-12 years)
adolescent (13-18 years)
as mentioned, there are 4 different “age definitions” for pediatrics
what is this based on?
organ maturity and development
what is the term for a baby that is born before 37 weeks gestation
premature neonate
a 13 month old is classified as what?
a child
true or false
growth is linear
FALSE
what is a full term neonate
born between 37-42 weeks gestation
why are premature neonates further classifed?
what are they classified into?
to account for their developmental lack of maturity and for drug disposition
gestational age
postnatal age
postmentrual age/postconceptual age
corrected age
what is “gestational age”?
how is it expressed?
time from conception to the date of birth (in weeks)
could be stated as 24-28 weeks, 29-32 weeks, etc
what is postnatal age?
how is it expressed?
the age since birth. expressed in days
ie: 0-7 days, 7-14, etc
what is postmenstrual age or post conceptual age?
the gestational age + postnatal age
“corrected age” is used for patients of what age?
less than 3 years olf
state the classifications of birth weight (no numbers yet)
low birth weight
very low birth weight
extremely low birth weight
give the # for low birth weight**
less than 2500grams
give the # for very low birth weight
less than 1500 grams
give the number for extremely low birth weight
less than 1000 grams
true or false
neonate v infant dosing is pretty similar
FALSE - very different based on organ maturity
true or false
some medications are contraindicated according to age
TRUE
at what age are sulfonamides contraindicated?
before 3 months
at what age are tetracyclines contraindicated?
before 8 years
at what age are fluoroquinolones contraindicated
before 18 years
true or false
a 2 year old can receive the same dose that has been studied in 3 and older
FALSE
need studies on that age group
explain how the frequency of administering medication differs between a neonate vs older infants, using a specific example
neonate receives fluconazole every 3 days
older infants receive once a day
ampicillin given to neonates every 12 hours
every 6 hours in older infants
true or false
a 1 month old, 2 year old, and 6 year old are prescribed amoxicillin PO.
they are given the same dosage form
FALSE
may be different dosage forms
ie: chewable, liquid, etc
true or false
it is possible for a neonate to develop unique adverse reactions compared to an infant
true
___% of all drugs marketed in the US do not carry FDA labeld indications for pediatric use
what does this mean?
50%
therefore, if they’re used in pediatrics it’s considered off label
if a drug is not FDA approved in pediatrics, can it still be used in pediatrics? based on what?
yes - based on literature and individual research done.
true or false
you cannot use results of studies in 1 patient population and apply it to another
TRUE
FDA said this
children are referred to as therapeutic orphans.
what does this mean?
there is limited data on their dosing and safety of drugs in children
WHY are there lack of well-designed trials in children?
drug companies aren’t financially motivated (wouldn’t make a lot)
ethical issues, logistical, technical
true or false
a drug that has only been studied in a 34 week old cannot be applied to a 30 week old
TRUE
many food and drug administration acts have been developed as a result of….
NEW FDA acts tend to try to do what?
therapeutic misadventures in children
close the gap between adult and pediatric approval
according to the FDA what is defined as a pediatric patient
0-16 years
according to the american academy of pediatrics, what ages are pediatric?
0-21 years
name the 3 major FDA acts and what they forced
1938 - Food drug and cosmetic act. new drugs must be proven SAFE and have adequate directions for use
1962 amendment to the act - drug must be safe and effective in the population INTENDED FOR USE
1979 - Pediatric drug labeling emphasized. PI’s must have a separate section for peds in the indications and usage section based on WELL CONTROLLED trials in kids
reason for the 1938 FDCA act
107 kids died from sulfonamide elixir tragedy. dued from the solvent - diethylene glycol (anti freeze)
there were no toxicity tests done before marketing
reason for the 1962 amendment
thalidomide tragedy - meant to treat morning sickness in pregnant ppl and turned out ot be teratogenic
what has the FDA done to try to increase the amount of drugs approved for children
tried to incentivize manufactureres with a few acts.
they’re not incentivized otherwise – they dont get a lot of money from peds
true or false
peds have very similar normal vital signs as adults
FALSE - sometimes it’s very different
*** are respiratory rates higher in children or in adults
children
*** is blood pressure lower or higher in children than adults
lower in children
120/80 (perfect adult BP) would be considered hypertension in a pediatric patient
how is it preferred to take the temperature of a younger child and why?
is the fever range different from a ped to an adult?
rectally – more accurate
(for older child, oral is fine)
adults and peds have same fever range
neonates during sepsis - how may their temp be affected
may be hypothermic
is the axiallary site (under armpit) accurate in measuring temp
not very accurate - rectal preferred
the ______ makes the poison or the remedy
dose
what is ontogeny?
why is it important in pharmacy?
study of an individual’s development from the time of fertilization until maturity
ontogeny affects drug therapy in infants, children and adolescents.
explain how the gastric pH of an adult differes from that of a neonate.
when does the pH seem to fully mature into that of an adult?
in adult - pH is 1-3
in neonate, it’s much more basic at 6-8
after 2 years it matures (for PREMATURE NEONATE)
for full term, they may reach adult gastric pH within 24 hours
as mentioned, neonates have a much more basic gastric environment than adults.
therefore, will an acidic or basic drug absorb better in the gastric environment of a neonate?
a BASIC drug will absorb much better in gastric environment of neonate
true or false
an acidic drug will better dissolve in an acidic environment
FALSE — it will better ABSORB, not dissolve
true or false
a basic drug will better absorb in a basic environment
true
***what is the gastric pH of premature neonates
6-8
reach adult at 2 years
what are “acid-labile” drugs?
explain their significance in a premature neonate
acid-labile drugs are those easily destroyed in an acidic environment
premature neonates have a much higher gastric pH, therefore, the serum levels of acid labile drugs will be much higher in a premature neonate than in an adult
weak acid drugs will have ________ absorption and ______ serum levels in a premature neonate as compared to an adult
slower absorption and lower serum levels
weak ______ are preferentially absorbed in premature neonates
bases
name 3 weak acid drugs
phenytoin
acetaminophen
phenobarbital
name 3 acid labile drugs
ampicillin
penicillin
pancreatic enzymes
passive and active transport in tubular reabsorption is mature by what age?
4 months
GI functions achieve adult values and activity by how old?
2 years
what is an issue with administering iron to a bb getting breast milk
the iron gets destroyed by the milk and we dont know how much of it the patient is actually getting
name a pancreatic enzyme
is the activity reduced or higher in premature neonates?
what does this mean?
alpha amylase
reduced
reduced absorption of fat-soluble drugs
how long does the pancreatic enzyme, alpha amylase, activity take to mature
1 year
function of alpha amylase with drugs
helps to absorb fat soluble drugs
explain the concentration of bile acids in peds vs an adult
what does this mean?
peds have reduced conc of bile acids (only 50% of adult activity)
peds have reduced absorption of lipid soluble drugs
why are babies injected with vitamin K right when theyre born
it is lipid soluble
bbs have reduced bile acids (50% of adult) and do not absorb lipid soluble drugs now
if they’re injected with vitamin K right when they’re born, it is absorbed much better than if you waited – prevents from bleeding issues – till they can make their own vit k
give 2 scenarios when IM absorption would be used in peds
when the child is unable to take orally, or when IV access is lost
give 2 concerns with IM administration
painful
some drugs absorbed arratically
why is IM administration not good to use long term
kids dont have a lot of muscle mass
rank the following in order of adequacy of blood flow to the muscle group
vastus lateralis (thigh), gluteus (buttock), deltoid(arm)
highest flow: deltoid
thigh
buttock (lowest)
HOWEVER, in peds the deltoid doesnt have a lot of muscle yet so the thigh is used
differentiate between the percutaneous absorption (through the skin) between peds and adults and WHY this is the case
infants have thinner skin
greater cutenous perfusion
greater hydration of the epidermis
higher BSA:body weight ratio
therefore, they have greater systemic exposure to topical agents
increased absorption through the skin
true or false
the BSA: body weight ratio is smaller in infants than adults
false - larger
what is the #1 factor that allows infants to have greater absorption through the skin
their thinner stratum corneum
true or false
infants have higher epidermal water content than adults
true
allows for greater absorption
what is a concern with infants absorbing topical agents better
they have more systemic side effects, as shown throughout history
infants can suffer systemic side effects from topical agents
give an example of something that was shown to cause methemoglobinemia in infants
aniline (diaper dye)
issue with topical CS use in infants
possible adrenal suppression
they absorb things better through skin
lidocaine-pilocaine in infants
lidocaine shown to cause seizures
prilocaine shown to cause methemoglobinemia
what is an issue with rectal administration
they have frequent bowel movements - hard to keep suppository from coming out
critically ill children have unpredictable absorption, so not rec
what kind of suppositories are preferred for young children
solutions or fast melts - reduce extrusion issue
