Pediatrics - Introduction/PKPD Flashcards
What scales are for children 4 or less? (2)
neonate infant pain scale (NIPS), face legs activity cry consolability (FLACC)
What scale is for children 4 or more?
Wong-Baker FACES
What scales are for children 10 or more? (2)
visual analog scale, numeric pain scale
What is the Bedside Schwartz equation?
CrCl = (0.413 x height in cm)/SCr in mg/dL; must be less than 18
What percent of outpatient prescriptions are off-label in pediatrics?
67-96%
What percent of inpatient prescriptions are off-label in pediatrics?
79%
What are reasons for non-adherence in pediatrics?
apprehension regarding AEs, caregiver inability/unavailability to administer, confusion, inappropriate measurements of medication dose, resistance
What are strategies to improve adherence in pediatrics?
caregiver education/reinforcement, ease of administration, decrease child resistance (rewards and positive reinforcement), empowering older children
What is the BUD for water containing formulations when refrigerated?
14 days
What is the “Ins” units?
mL/kg/day
What is the “Outs” units?
mL/kg/hr
What is anuria considered? Oliguria? Normal? Polyuria?
zero; < 0.5 - 1 mL/kg/hr ; > 1 mL/kg/hr ; > 4 mL/kg/hr
What is first-line for dosing references in pediatrics? (2)
Lexicomp, NeoFax
What are the age ranges for taste and smell characteristics? (4)
birth = sweet, by 2 = bitter/salty/sour, by 1-2 texture/temperature, 5-7 odors
Is gastric pH higher or lower in early life?
higher (more BASIC)
How does gastric emptying affect drug absorption in pediatrics?
increases absorption since emptying rates are increased during first week of life
How do rectal contractions affect drug bioavailability in pediatrics?
decrease
How do percutaneous differences affect drugs in pediatrics?
enhance drug permeability
How does capillary density affect drug bioavailability in pediatrics?
enhance drug permeability
How is Vd of drugs affected in pediatric populations?
infants have less muscle/fat (more water): hydrophilic drugs increased Vd, lipophilic drugs decreased Vd
How is protein binding affected in pediatric populations?
decreased concentrations of circulating binding proteins and decreased binding affinity
What drugs should be avoided in infants 2 months or less? (2) Why?
ceftriaxone and sulfonamides; risk of displacement of bilirubin from albumin binding sites (kernicterus)
Which Phase I CYP enzymes are usually present by 1 year of age? (3)
3A4, 2C19, 2E1
What Phase II enzymes do children have more of?
sulfates
Why are children less than 12 less susceptible to APAP toxicity?
NAPQI, the toxic component from APAP degradation, is the result of glucuronidation which children perform less of
What is the major organ of elimination in children?
kidneys
In general, dosing is required ______ in pediatrics?
less frequently
