Pediatrics Info Flashcards
Infant Age range
1-12 months
Young child age range
2-5 years
Older child age range
6-12 years
Adolescent age range
13-17 years
Gestational age divided into 2
Preterm ( <37 weeks age)
Fullterm (37-40 weeks age)
Neonate age range
0-1 month after birth
What are the 5 rights?
Right….
Patient Drug Dose Route Time
Potential areas for med errors?
Prescribing
Dispensing
Administration
Documentation
Why do dose calculation errors occur?
usually require conversion and calculations
dosage forms and strengths not always available
dosage recommendations not always available, a lot off label/case study for use
At what age can children usually swallow tablets?
around 6 years old
Why is medication adherence difficult in children?
Not all medications taste good
Parents are responsible for admin, sometimes forget
Drugs that affect growth and development?
Thalidomide Fluoroquinolone (Tendon ruptures and brown teeth)
Most common Growth Chart from Birth - 36 months
Weight-for-stature for boys and girls (Can stand on own)
Length/weight-for-age for boys and girls (Laying down)
Most common Growth Chart from 2 - 20 years of age
BMI-for-age for boys and girls
What is considered overweight (2-20yr old)
85th to 95th
What is considered Obese (2-20yr old)
> 95th percentile
What is considered Underweight (2-20yr old)
<5th percentile
What would 25th percentile mean on a growth chart?
BMI is the same or more than 25% of the reference population
BMI is less than 75% of the reference population
Neonates growth info
weight decrease ~10% after birth, due to releasing fluids
30g/day target gain for first month
Infant growth info
double birth weight by 4 months of life
weight should triple and length should double by 1 yr of life
Children and Adolescents info
Weight gain of 2-3kg/yr
Height increases 5-8cm/yr
want to make sure not gaining too quickly
Vital signs - Temp info
issue with self-regulation
Might not really have temp, just too bundled
Rectal best way to get temp
How is BP expressed in pediatrics?
Expressed as a % based on age, sex and height
Average and UL of Normal go down as get older
Same with Respiratory Rate
Absorption - GI Pediatrics
Gastric pH varies between infants and older children/adults
Full term infants pH remains elevated (6-8) at birth and declines to 1-3 after 24hrs….due to amniotic fluid and parietal cells not being matured at first
(Pediatrics) Acid-Labile (Weak Base) drugs will have….
increased absorption in peds
Penicillin, erthromycin
(Pediatrics) Weak acid drugs will have….
decreased absorption in peds
Phenobarbital, ganciclovir
(Pediatrics) Immature bile acid production causes….
decreased absorption of fat soluble vitamins
(Pediatrics) Gastric emptying is….
slower in pre-term infants and increased during 1st week of life.
have reduced blood flow
Frequent feedings = drug-food interactions
IM absorption in infants is….
hard to predict due to…
decreased muscle mass
poor perfusion
decreased muscle contractions
Skin absorption in newborns can be….
greatly increased
this is due to underdeveloped epidermal barrier and increased skin hydration
can experience increased skin irritation from topical mediations
Systemic absorption from topical medications can occur
(Pediatrics) The volume of distribution will be….
higher in infants/children due to a higher body water-to-lipid ratio
Decreased drug binding in newborns is due to….
decreased plasma protein conc
lower binding capacity
decreased affinity
competition
Decreased drug binding in newborns results in….
increased free drug
increased volume of distribution
Body fat in infants and neonates is…
much lower than adults
highly lipid-soluble drugs are less-widely distributed
CYP450 System infants
Exceeds adult values at 1yr - 9yr, causing increased metabolization of drugs
Might have to have higher dose or increased frequency compared to adults
When do Group 1 enzymes mature?
Peak during 2nd and 3rd trimester
When do Group 2 enzymes mature?
Relatively constant through life
When do Group 3 enzymes mature?
Little function early life
Expression increases over 1st several years of life
Decreased enzyme capacity (Neonates/young infants) will lead to….
increased 1/2 life and decreased clearance
Increased enzyme capacity (Children) will lead to….
Decreased 1/2 life and increased clearance
Which pathway is well developed in infants? underdeveloped?
Sulfation = well developed
Glucuronidation = underdeveloped
Grey Baby Syndrome
Related to Chloramphenicol, due to Glucuronidation underdeveloped
Rapid progression to death, CV instability
Is GFR lower or higher in infants?
Much lower in infants when compared to older children and adults
Reach approximate adult values within 1 year of life
Decreased GFR (neonates/infants) leads to…..
increased 1/2 life and reduced clearance
Decreased tubular secretion (Neonates/infants) leads to….
increased 1/2 life and reduced clearance
3 Types of dosing for pediatrics
Weight-based dosing (Most common, max dose not established so don’t surpass adult)
Age-based dosing (easy to use, assume same ADME all patients)
Body-surface-area dosing (Precise, used for drugs requiring exact dosage calc and narrow TI)
Pediatric resources…..
Lexicomp Pediatric Dosage Handbook
Micromedex
Respective guidelines
Medication Administration concerns
adherence is difficult, and children have trouble with admin
many meds not available in proper dosage/strength
bad taste
Steps pharmacist should take to reduce error
Obtain weigh/age/sex and diagnosis if possible
Verify allergies
Calculate dosage with known info
compare dose with pediatric dosing refernce
Make sure dose and form appropriate
dispense with proper materials
Counseling Pediatric Patients
show how to measure proper dose
Explain medication
Explain what to do if symptoms do/don’t improve
make yourself available for future questions
Common Pediatric conditions
Common cold AOM Pharyngitis Type 1 DM Eczema Asthma Hand,Foot,Mouth disease
Reasons to immunize?
Vaccines have reduced or eliminated many devastating infectious disease
Herd Immunity
Endorsed by a bunch of health organizations
Passive immunity
Person given antibodies to a disease
Get immediate protection, also few weeks or months
Via mother-to-baby or IVIG
Active immunity
Via infection, or Vaccine
Long acting, sometimes life long immunity
Takes several weeks to develop
Disease organism triggers immune system to produce antibodies
Types of vaccines
Made using same components (antigens) of bacteria or viruses that cause disease
Killed = inactivated Live but weakened = attenuated Part of bacteria/virus = conjugated/subunit Inactivated toxin= toxoid Messager RNA = mRNA
How do vaccines work simplified?
Vaccine with antigens injected into body
immune system produces antibodies to fight antigens off
Memory cells will remember how to produce antibodies again
When actual bacteria/virus enter body the memory cells can produce the same antibodies quicker to fight off disease
Some diseases Vaccines are used for….
Polio Rubella Influenza Pertussis/Diphtheria/Tetanus Pneumococcus Varicella Measles, mumps, rubella HPV
Risk vs Benefit of Vaccines
No vaccine is 100% safe or effective
Vaccines associated with milder form of disease
Risk of risk is far greater than risk of vaccine
Vaccine Misconceptions
Chicken pox not fatal? = no true, can be older age
Disease eliminated? = no, because vaccination rates reduced and disease reemerging
Vaccines have mercury? = have different kind, Ethyl mercury not methyl mercury. also moving away from
Cause autism? = paper discredited and not peer reviewed
More than 1 at a time is dangerous? = not really, maybe sore arm
Common Adverse Reactions to vaccines
At injection site: Soreness, redness, swelling
Fussiness, low grade fever
Vaccine Contraindications
Sever allergies (anaphylaxis) to prior vaccine or component
Having moderate to sever illness, defer until resolved
Contraindicated Vaccines immunocompromised patients?
Live vaccines: MMR, Varicella, Rotavirus
Contraindicated Vaccines in Pregnancy?
Live Vaccines: MMR, Varicella, Flumist
Vaccine components that can cause anaphylactic reaction?
Egg product Neomycin Streptomycin Polymixin B Baker's Yeast Gelatin
Questions to ask prior vaccine admin?
Any allergies
Any reactions to previous immunizations
Any unlisted medical conditions
