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Intro to D&D Midterm > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

true or false

antihypertensives are commonly prescribed for pediatrics

A

true

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2
Q

true or false

statins are commonly precribed for pediatrics

A

true

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3
Q

in clinical practice, who is considered a pediatric?

A

0-18 years

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4
Q

when stating or viewing a pediatric patient’s age, what is important to consider?

A

UNITS

ie: just “8” could mean 8 months or 8 years, 8 weeks, etc

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5
Q

define the age of a neonate

A

0-1 month

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6
Q

define the age of an infant

A

1 month-1 year of age

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7
Q

define the age of a child

A

1 year-12 years

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8
Q

define the age of an adolescent

A

13-18 years

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9
Q

rank the following from youngest to oldest and state their years:

child
neonate
adolescent
infant

A

neonate (0-1 month)
infant (1 month-1 year)
child (1-12 years)
adolescent (13-18 years)

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10
Q

as mentioned, there are 4 different “age definitions” for pediatrics

what is this based on?

A

organ maturity and development

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11
Q

what is the term for a baby that is born before 37 weeks gestation

A

premature neonate

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12
Q

a 13 month old is classified as what?

A

a child

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13
Q

true or false

growth is linear

A

FALSE

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14
Q

what is a full term neonate

A

born between 37-42 weeks gestation

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15
Q

why are premature neonates further classifed?
what are they classified into?

A

to account for their developmental lack of maturity and for drug disposition

gestational age
postnatal age
postmentrual age/postconceptual age
corrected age

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16
Q

what is “gestational age”?
how is it expressed?

A

time from conception to the date of birth (in weeks)

could be stated as 24-28 weeks, 29-32 weeks, etc

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17
Q

what is postnatal age?
how is it expressed?

A

the age since birth. expressed in days

ie: 0-7 days, 7-14, etc

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18
Q

what is postmenstrual age or post conceptual age?

A

the gestational age + postnatal age

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19
Q

“corrected age” is used for patients of what age?

A

less than 3 years olf

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20
Q

state the classifications of birth weight (no numbers yet)

A

low birth weight
very low birth weight
extremely low birth weight

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21
Q

give the # for low birth weight**

A

less than 2500grams

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22
Q

give the # for very low birth weight

A

less than 1500 grams

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23
Q

give the number for extremely low birth weight

A

less than 1000 grams

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24
Q

true or false

neonate v infant dosing is pretty similar

A

FALSE - very different based on organ maturity

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25
Q

true or false

some medications are contraindicated according to age

A

TRUE

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26
Q

at what age are sulfonamides contraindicated?

A

before 3 months

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27
Q

at what age are tetracyclines contraindicated?

A

before 8 years

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28
Q

at what age are fluoroquinolones contraindicated

A

before 18 years

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29
Q

true or false

a 2 year old can receive the same dose that has been studied in 3 and older

A

FALSE

need studies on that age group

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30
Q

explain how the frequency of administering medication differs between a neonate vs older infants, using a specific example

A

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

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31
Q

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

A

FALSE

may be different dosage forms
ie: chewable, liquid, etc

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32
Q

true or false

it is possible for a neonate to develop unique adverse reactions compared to an infant

A

true

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33
Q

___% of all drugs marketed in the US do not carry FDA labeld indications for pediatric use

what does this mean?

A

50%

therefore, if they’re used in pediatrics it’s considered off label

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34
Q

if a drug is not FDA approved in pediatrics, can it still be used in pediatrics? based on what?

A

yes - based on literature and individual research done.

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35
Q

true or false

you cannot use results of studies in 1 patient population and apply it to another

A

TRUE

FDA said this

36
Q

children are referred to as therapeutic orphans.
what does this mean?

A

there is limited data on their dosing and safety of drugs in children

37
Q

WHY are there lack of well-designed trials in children?

A

drug companies aren’t financially motivated (wouldn’t make a lot)

ethical issues, logistical, technical

38
Q

true or false

a drug that has only been studied in a 34 week old cannot be applied to a 30 week old

A

TRUE

39
Q

many food and drug administration acts have been developed as a result of….

NEW FDA acts tend to try to do what?

A

therapeutic misadventures in children

close the gap between adult and pediatric approval

40
Q

according to the FDA what is defined as a pediatric patient

A

0-16 years

41
Q

according to the american academy of pediatrics, what ages are pediatric?

A

0-21 years

42
Q

name the 3 major FDA acts and what they forced

A

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

43
Q

reason for the 1938 FDCA act

A

107 kids died from sulfonamide elixir tragedy. dued from the solvent - diethylene glycol (anti freeze)

there were no toxicity tests done before marketing

44
Q

reason for the 1962 amendment

A

thalidomide tragedy - meant to treat morning sickness in pregnant ppl and turned out ot be teratogenic

45
Q

what has the FDA done to try to increase the amount of drugs approved for children

A

tried to incentivize manufactureres with a few acts.
they’re not incentivized otherwise – they dont get a lot of money from peds

46
Q

true or false

peds have very similar normal vital signs as adults

A

FALSE - sometimes it’s very different

47
Q

*** are respiratory rates higher in children or in adults

A

children

48
Q

*** is blood pressure lower or higher in children than adults

A

lower in children

120/80 (perfect adult BP) would be considered hypertension in a pediatric patient

49
Q

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?

A

rectally – more accurate
(for older child, oral is fine)

adults and peds have same fever range

50
Q

neonates during sepsis - how may their temp be affected

A

may be hypothermic

51
Q

is the axiallary site (under armpit) accurate in measuring temp

A

not very accurate - rectal preferred

52
Q

the ______ makes the poison or the remedy

A

dose

53
Q

what is ontogeny?
why is it important in pharmacy?

A

study of an individual’s development from the time of fertilization until maturity

ontogeny affects drug therapy in infants, children and adolescents.

54
Q

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?

A

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

55
Q

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

a BASIC drug will absorb much better in gastric environment of neonate

56
Q

true or false

an acidic drug will better dissolve in an acidic environment

A

FALSE — it will better ABSORB, not dissolve

57
Q

true or false

a basic drug will better absorb in a basic environment

A

true

58
Q

***what is the gastric pH of premature neonates

A

6-8

reach adult at 2 years

59
Q

what are “acid-labile” drugs?

explain their significance in a premature neonate

A

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

60
Q

weak acid drugs will have ________ absorption and ______ serum levels in a premature neonate as compared to an adult

A

slower absorption and lower serum levels

61
Q

weak ______ are preferentially absorbed in premature neonates

A

bases

62
Q

name 3 weak acid drugs

A

phenytoin
acetaminophen
phenobarbital

63
Q

name 3 acid labile drugs

A

ampicillin
penicillin
pancreatic enzymes

64
Q

passive and active transport in tubular reabsorption is mature by what age?

A

4 months

65
Q

GI functions achieve adult values and activity by how old?

A

2 years

66
Q

what is an issue with administering iron to a bb getting breast milk

A

the iron gets destroyed by the milk and we dont know how much of it the patient is actually getting

67
Q

name a pancreatic enzyme

is the activity reduced or higher in premature neonates?

what does this mean?

A

alpha amylase

reduced

reduced absorption of fat-soluble drugs

68
Q

how long does the pancreatic enzyme, alpha amylase, activity take to mature

A

1 year

69
Q

function of alpha amylase with drugs

A

helps to absorb fat soluble drugs

70
Q

explain the concentration of bile acids in peds vs an adult

what does this mean?

A

peds have reduced conc of bile acids (only 50% of adult activity)

peds have reduced absorption of lipid soluble drugs

71
Q

why are babies injected with vitamin K right when theyre born

A

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

72
Q

give 2 scenarios when IM absorption would be used in peds

A

when the child is unable to take orally, or when IV access is lost

73
Q

give 2 concerns with IM administration

A

painful
some drugs absorbed arratically

74
Q

why is IM administration not good to use long term

A

kids dont have a lot of muscle mass

75
Q

rank the following in order of adequacy of blood flow to the muscle group
vastus lateralis (thigh), gluteus (buttock), deltoid(arm)

A

highest flow: deltoid
thigh
buttock (lowest)

HOWEVER, in peds the deltoid doesnt have a lot of muscle yet so the thigh is used

76
Q

differentiate between the percutaneous absorption (through the skin) between peds and adults and WHY this is the case

A

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

77
Q

true or false

the BSA: body weight ratio is smaller in infants than adults

A

false - larger

78
Q

what is the #1 factor that allows infants to have greater absorption through the skin

A

their thinner stratum corneum

79
Q

true or false

infants have higher epidermal water content than adults

A

true

allows for greater absorption

80
Q

what is a concern with infants absorbing topical agents better

A

they have more systemic side effects, as shown throughout history

81
Q

infants can suffer systemic side effects from topical agents

give an example of something that was shown to cause methemoglobinemia in infants

A

aniline (diaper dye)

82
Q

issue with topical CS use in infants

A

possible adrenal suppression

they absorb things better through skin

83
Q

lidocaine-pilocaine in infants

A

lidocaine shown to cause seizures

prilocaine shown to cause methemoglobinemia

84
Q

what is an issue with rectal administration

A

they have frequent bowel movements - hard to keep suppository from coming out

critically ill children have unpredictable absorption, so not rec

85
Q

what kind of suppositories are preferred for young children

A

solutions or fast melts - reduce extrusion issue

86
Q
A

Intro to D&D Midterm (29 decks)

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