Pediatrics Flashcards
What is correct gestational age?
age since conception
= GA+PNA
What is a premature neonate?
born <37 weeks gestational age
What is a full term baby?
37-41 weeks +28 days PNA
What is an infant, child, adolescent?
infant= 1m-1y
child 1-12y
Adolescent 12-18y
What is a Childs gastric pH? At what age does it make it about to adult?
higher=more basic
> 5
Due to a child (<5)’s stomach, how would absorption of a basic and acidic drug change?
acidic= less
basic= more
When a kid is <4 months how does their motility change?
gastric motility very slow= slower absorption or Tmax higher
normalizes at 4 months
Do kids have more or less topical absorption?
thing skin= increased
In regards to water do they have more or less than adults?
more body % water in babies
If more water how does this affect Vd?
higher Vd for hydrophilic drugs
Do babies have more or less albumin?
LESS= more unbound
What other factor of babies affects fraction unbound?
MORE endogenous products to displace drugs from albumin= more unbound
In regards to liver enzymes how is this different for kids?
less enzymes and increases as we age
When does kids reach adult GFR? When does rapid renal function increases happen?
8-12 months
first few weeks of life
Formula for estimating renal function in kids?
bedside Schwartz equation
Limitations of Schwartz equation?
if Sir rapidly changing, bad CKD, obese, malnourished, muscle wasting
What should a kid daily dose not exceed?
adult dose
What is the aliquot method?
make a larger volume and take a portion
EX: 5 mg/ml if need 3 mg you need 0.6 ml
What if a child throws up (not just a spit up) dose?
<30 min= dose again DO NOT REPEAT if vomit again
>30 do not repeat
Which form of tube feeding has less absorption?
NJ
What does number of lumens mean for IV access?
how many ‘holes’ in one IV line for drug compatibility
What is the formula method for fluids?
100 ml for first 10 kg +
50 ml for each additional kg between 11-20 +
20 ml for each additional kg over 20 kg
What is the 4/2/1 method for fluids?
4 ml/kg for first 10 kg +
2 ml/kg for kg 11-20 +
1 ml/kg for each additional kg above 20
Which fluid formula is for daily and hourly?
formula= daily
4/2/1= hourly
What is the fluid used?
D5W/NS
When can you not use D5W/NS?
if renal or cardiac disease, severe burns, electrolyte dz, diabetic ketoacidosis
What do you need to interpret BP of a kid?
age, sex, height, BP
When is it considered HTN for a kid?
if around 95 percentile of BP for their age and height
IN general what is kids BP compared to adult?
lower
IN general what is kids HR/RR compared to adult?
much higher
Gold standard for temp?
rectal
How much lower is oral temp to rectal?
0.6 degrees celsius
What is normal temperature for kid?
37.2 +/- 0.5
Issues with tetracyclines?
bad with bones and teeth
At what age is tetracyclines CI?
<8
What is a safe course of tetracyclines?
<21
Issues with FQ?
arthropathy=cartilage and tendon rupture
CI age of SMP/TMX?
<2 months due to hyperbilirubinemia and kernicterus
What is kernicterus?
permanent brain damage due to high bilirubin= Cerebral palsy, hearing loss, vision issues, bad intellectual
What clavulanic dose causes diarrhea?
about 8 mg/kg/day
When is ASA used in kids?
Kawasaki disease, rheumatic fever, congenital heart repair prophylaxis
Is ciprofloxacin okay to put through tube?
NO- suspension will clog, dissolve and dose
Calculate fluid maintenance of a 40.2 kg patient who is now 39.7kg due to water loss at 1.5x?
How long will it take to get them back to their weight?
4 2 1 rule= 120ml/hr
120-80ml=40ml/hr x hr/500ml= 12.5 hours
To find normal blood pressure for a kid hat do we need?
for accurate= age, sex, and height
When is it considered HTN for a kid?
if in 95 percentile
Normal temperature in kid?
37.2
Why are tetracyclines bad for kids?
<8= CI due to chelating with calcium and refining bones and teeth
What duration of tetracyclines are probably okay?
<21 days
Why should we avoid FQ?
tendon rupture and arthropathy
When is Septra CI?
<2 months= causes hyperbilirubinemia and kernicterus
What is kernictereus?
lots of bilirubin in brain= brain damage such as cerebral palsy
At what dose of clavulanic acid is risk of diarrhea?
> 8mg/kg/day
What is high dose amoxicillin?
> 90mg/kg/day
Why do doctors use two forms of amoxicillin?
keep clavulanic acid low to get a 14:1 ratio
Why not use ASA in kids?
Reyes syndrome = <18
What patients (kids) need ASA therapy?
Kawasaki, heart repair, rheumatic fever
