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Special Populations > Pediatrics Dosing Considerations > Flashcards

Pediatrics Dosing Considerations Flashcards

1
Q

When is weight-based dosing recommended?

A

<18y who are <40kg

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2
Q

What equation is used to calculate CrCl in LBW infants- 21y?

A

Schwart’s equation;
(k x L (cm)) / SCr

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3
Q

What equation is used to calculate CrCl in Infants <1y?

A

Bedside Schwart’s equation;
(0.413 x L(cm)) / SCr

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4
Q

What age are most children not able to swallow SODFs?

A

<6y

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5
Q

What are potentially harmful excipients for children?

A
  1. benzyl alcohol
  2. ethanol
  3. propylene glycol
  4. natural/ synthetic coloring
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6
Q

Why should propylene glycol be avoided in children?

A
  1. potential for lactic acidosis
  2. Arrhythmia
  3. CNS/respiratory depression
  4. seizures
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7
Q

What is the max limit of ethanol in children <6y?

A

0.5%

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8
Q

What is the max limit of ethanol in children 6-12?

A

<5%

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9
Q

What is the max limit of ethanol in children >12y?

A

<10%

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10
Q

What are issues with benzyl alcohol in neonates?

A
  1. liver/kidneys have a decreased capacity for metabolism –> neurologic symptoms
  2. toxic gasping syndrome
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11
Q

What coloring agents should be avoided in children?

A

azo dyes:
tartrazine (yellow 5)
Blue 1

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12
Q

Why are SEs with azo dyes?

A

anaphylactoid reactions, HSR

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13
Q

What medications should be avoided in patients with HSR to azo dyes due to cross sensitivity?

A
  1. aspirin
  2. sodium benzoate
  3. indomethican
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14
Q

What is the definition of failure to thrive?

A

weight for age/height is <5th percentile OR fall off of 2 or more major percentiles

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15
Q

When should weight lost after the first few day of birth be regained?

A

1st-2nd week of life

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16
Q

When is enteral nutrition indicated for children?

A
  1. premature neonates <32-34 weeks gestation
  2. infant too sick to breast feed or bottle feed
  3. on mechanical ventilation
  4. needs not met via oral route
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17
Q

When is parenteral nutrition indicated for children?

A
  1. needs not met via EN
  2. GI tract does not function
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18
Q

What is the recommended daily maintenance fluids for a child 3-10kg?

A

100 mL/kg x day

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19
Q

What is the recommended daily maintenance fluids for a child 11-20 kg?

A

1000 mL/kg x day + 50 mL/kg (>10 kg)

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20
Q

What is the recommended daily maintenance fluids for a child >20 kg?

A

1500 mL/kg x day + 20 mL/kg (>20kg)

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21
Q

What is the recommended daily maintenance fluids for neonates <1500g?

A

140-190 mL/kg/day

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22
Q

What is the recommended daily maintenance fluids for neonates 1500g-2000g?

A

140-160 mL/kg/day

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23
Q

What factors increase fluid requirements for pediatrics?

A
  1. premature/ LBW
  2. fever
  3. vomiting
  4. diarrhea
  5. increased ambient temperatures
  6. hyperventilation
  7. phototherapy
  8. radiant warmers
  9. diuretics
  10. nasogastric suction
  11. ostomy/fistula drainage
  12. glucosuria
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24
Q

What factors decrease fluid requirements for pediatrics?

A
  1. bronchopulmonary dysplasia
  2. intraventricular hemorrhage
  3. PDA
  4. congestive HF
  5. liver/renal failure
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25
Q

What are the daily caloric requirements for preterm neonates?

A

90-120 kcal/kg

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26
Q

What are the daily caloric requirements for 1-12 months?

A

80-105 kcal/kg

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27
Q

What are the daily caloric requirements for 1-7y?

A

75-90 kcal/kg

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28
Q

What are the daily caloric requirements for 7-12y?

A

50-75 kcal/kg

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29
Q

What are the daily caloric requirements for 12-18y?

A

30-60 kcal/kg

30
Q

What factors would increase daily caloric needs in children?

A
  1. critical illness
  2. congenital heart disease
  3. bronchopulmonary dysplasia
31
Q

What factors would decrease daily caloric needs in children?

A
  1. developmental delays
  2. immobility
32
Q

Do protein requirements increase or decrease with age?

A

decrease

33
Q

What does breastfeeding decrease the babys risk of?

A
  1. upper respiratory infection
  2. UTI
  3. NEC
  4. Meningitis
  5. diarrhea
  6. sepsis
  7. SIDs
  8. diabetes
  9. cancer
  10. anemia
  11. obesity
34
Q

How many calories do standard infant formulas provide?

A

20 kcal/oz

35
Q

How many calories do standard children’s formulas provide?

A

30 kcal/oz

36
Q

What is the primary cause of dehydration in children?

A

acute diarrhea

37
Q

What are clinical presentations of dehydration?

A
  1. appearance (normal, lethargic, comatose)
  2. pulse (normal/rapid)
  3. decreased urine output
  4. % weight loss
  5. skin (temperature, turgor capillary refill)
  6. sunken eyes
  7. grayish skin
38
Q

How is % weight loss calculated?

A

(pre illness wt - illness wt) / preillness wt x100

39
Q

What % loss of body weight is considered minimal dehydration?

A

<3%

40
Q

What % loss of body weight is considered mild -mod dehydration?

A

3-9%

41
Q

What % loss of body weight is considered severe dehydration?

A

> 9%

42
Q

When should IV therapy for dehydration be given?

A

severe dehydration

43
Q

When should PO therapy for dehydration be given?

A

mild-moderate dehydration and tolerating oral intake

44
Q

What type of tonicity should ORS have?

A

isotonic or hypotonic; replace water, Na, K, HCO3

45
Q

Why should coke or juice not be used when the child is dehydrated?

A

hypertonic

46
Q

How much Na is in ORS?

A

75-90 mEq/L

47
Q

How should ORS be dosed for mild dehydration?

A

rehydration: 50 mL/kg
maintenance: 10 mL/kg for every stool or emesis over a 4h period

48
Q

How should ORS be dosed for moderate dehydration?

A

rehydration: 100 mL/kg
maintenance: 10 mL/kg for every stool or emesis over a 4h period

49
Q

How should ORS be administered?

A

1 tsp (5 mL) every 5 min; if child vomits, wait 10 min and try again

50
Q

What is the treatment of bacterial meningitis in neonates <1mo?

A

Ampicillin + Cefotaxime or Gentamicin

51
Q

What is the treatment of bacterial meningitis in neonates 1-23 mo?

A

Vancomycin + Ceftriaxone or Cefotaxime

52
Q

What is the treatment of bacterial meningitis in neonates 2+y?

A

Vancomycin + 3rd generation cephalosporin

53
Q

What are the issues with Ceftriaxone in pediatrics?

A
  1. displaces bilirubin from albumin
  2. can precipitate with Ca containing solutions
54
Q

By what age have most children been exposed to Respiratory Syncytial Virus (RSV)?

A

2y

55
Q

What is used for RSV prophylaxis?

A

Nirsevimab; long-acting monoclonal antibody

56
Q

When is Nirsevimab recommended for RSV prophylaxis?

A

infants <8 mo born during or entering their first RSV season and parents did not receive RSVpreF vaccine or < 14 days before birth

57
Q

What is the treatment for CROUP?

A

systemic steroids for mild, moderate, and severe cases;
Dexamethasone 0.6 mg/kg x 1 PO/IM/IV max 16mg/dose

58
Q

What patients should systemic steroids be used in caution with?

A
  1. CV disease
  2. cerebrovascular disease
  3. thyroid disease
  4. diabetes
59
Q

What are non pharm treatments for nocturnal enuresis?

A
  1. behavioral approaches (positive reinforcement)
  2. establish normal daytime hydration and voiding patterns
  3. alarm therapy
60
Q

What are pharm treatments for nocturnal enuresis?

A

Desmopressin; synthetic analog of ADH

61
Q

OTC products should not be used in children at less than what age?

A

6y

62
Q

What is the DOC for intestinal gas?

A

Simethicone taken after meals (can be miked with liquids)

63
Q

What is the DOC for nasal congestion?

A

NaCl 0.9% nasal solution 2-6 drops per nostril+ gentile suction

64
Q

What are treatments for constipation?

A
  1. pear/ prune juice
  2. glycerin suppositories (retained for 15min)
65
Q

What age groups is Codine NOT recommended in?

A
  1. <12y
  2. <18y after 2 common childhood surgeries (tonsillectomy and adenoidectomy)
66
Q

What age groups is Tramadol NOT recommended in?

A

<12y

67
Q

What age groups is Promethazine NOT recommended in?

A

<2y

68
Q

What age groups are quinolones NOT recommended in?

A

all pediatrics

69
Q

What age groups is tetracyclines NOT recommended in?

A

<8y

70
Q

What age groups is Ceftriaxone NOT recommended in?

A

neonates (1-28 days)

71
Q

What age groups are OTC cough and cold products NOT recommended in?

A

<6y

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