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CDM 1 > Pedriatric > Flashcards

Pedriatric Flashcards

1
Q

Gestational age

A

Estimated maturity at birth

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2
Q

Pre-term

A

<37 weeks of age

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3
Q

Full-term

A

37-40 weeks of age

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4
Q

Neonate

A

0-1 month of age

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5
Q

Infant

A

1-12 months of age

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6
Q

Young child

A

2-5 years

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7
Q

Older child

A

6-12 years

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8
Q

Adolescent

A

13-17 years

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9
Q

Medication Errors

A

Failure of a planned action to be completed as intended

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10
Q

The 5 rights

A

the right patient, the right drug, the right dose, the right route, and the right time.

Prescribing
Dispensing
Administration
Documentation

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11
Q

Reasons why these errors occur

A

Dosing medications usually require conversions and calculations

Dosage forms and strengths are not always available

Dosage recommendations are not always available

Medication adherence is difficult

Clinical studies in the pediatric population are scarce

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12
Q

___% of meds have pediatric indication

A

25

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13
Q

1997 FDA Modernization Act

A

The purpose of this was to enable the FDA to reduce the average time required for a drug review from 30 months to 15 months.

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14
Q

Growth

A

increase in size, ->weight, height

Development—changes in function or form is Maturity, intellect

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15
Q

Development

A

Changes in function or form

–> maturity, intellect

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16
Q

Drugs that can affect both growth and development

A

Thalidomide

Fluoroquinolones

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17
Q

Thalidomide Case

A

Used for nausea and morning sickness in pregnant women

Caused phocomelia -shortened or absent long bones of the limbs and many internal malformations

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18
Q

Growth charts for birth to 36 months

A

weight-for-stature for boys and girls

Length/weight-for-age for boys and girls

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19
Q

Growth charts for 2 to 20 years

A

Stature/weight-for-age for boys and girls
BMI-for-age for boys and girls

Overweight: 85th to <95th percentile
Obese: ≥95th percentile
Underweight: <5th percentile

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20
Q

Interpreting a BMI chart: 25th percentile meaning

A

BMI the same or more than 25 percent of reference population

BMI less than 75 percent of the reference population

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21
Q

Weight changes of Neonates

A

Weight may decrease to 10% below birth weight in the first week of life (due to amniotic fluid from womb)

Weight gain of 30 grams/day for the first month of life

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22
Q

Growth Changes of Infants

A

Double birth weight by 4 months of life

Weight should triple and length should double by 1 year of life

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23
Q

Growth changes of Children and Adolescents

A

Weight gain of 2-3 kg/year

Height increases of 5-8 cm/year

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24
Q

Site of temperature measurement

A

Rectal (most accurate way to access)
Oral
Axillary
Tympanic

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25
Q

Normal BP also expressed in percentiles

A

SBP and DBP <90% based on age, sex and height

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26
Q

Pre-Hypertension

A

SBP and DBP are between 90%-95% based on age, sex, and height

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27
Q

Hypertension

A

SBP and DBP >95% based on age, sex and height

Stage 1: >95-99% plus 5 mmHg

Stage 2: >99% plus 5 mmHg

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28
Q

Newborns have higher ___than children or adolescents

A

Heart Rate

the normal upper limit is 190 compared to a 10 YOA which is 110

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29
Q

Respiratory rate from neonates and children

A

infants have high RR as their lungs have low capacity whereas they get older their lungs have higher capacity.

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30
Q

Pharmacokinetics

A

what the body does to the medication

  • Absorption
  • Distribution
  • Metabolism
  • Elimination
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31
Q

Pharmacodynamics

A

What the medications do to the body

  • Therapeutic
  • Toxic
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32
Q

In full-term infants, gastric pH remains elevated ___at birth but declines to ____ within 24 hours

A

6-8, 1-3

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33
Q

Acid-labile drugs have

A

increased absorption

ex. penicillins, erythromycin

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34
Q

Weak acids have

A

decreased absorption

ex. Phenobarbital, Ganciclovir

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35
Q

immature bile acid production

A

decreases absorption such as Fat soluble vitamins

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36
Q

Gastric emptying is ___ in pre term infants but ____ during 1st week of life

A

slower in pre-term infants

increased during 1st week of life

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37
Q

Absorption IM

Infants have___

A

decreased muscle mass

poor perfusion

decreased muscle contractions

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38
Q

Percutaneous absorption can be greatly increased in newborns due to:

A

Underdeveloped epidermal barrier

Increased skin hydration

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39
Q

Absorption of topical medications in pediatrics

A

Increased skin irritation from topical medications

Systemic absorption from topical medications

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40
Q

Distribution is determined by physicochemical and physiological factors such as

A

Extracellular fluid, total body water, and protein binding can all influence the distribution

41
Q

Infants and children have a higher __ to ___ ratio

A

body water to lipid

42
Q

Decreased drug binding in newborns due to

A

Decreased plasma protein concentration

Lower binding capacity

Decreased affinity

Competition

43
Q

Decreased drug binding in newborns results in

A

Increased free drug

Increased volume of distribution

44
Q

Body fat is ___ in neonates and infants than in adults

A

much lower

45
Q

highly lipid-soluble drugs are ___widely distributed in neonates and infants

A

less

46
Q

Kernicterus is

A

Irreversible damage to the brain

Development secondary to the displacement of bilirubin by sulfisoxazole in neonates

47
Q

Metabolism produces a water-soluble product that then is either ___ eliminated or excreted in ___

A

renally, bile

48
Q

Metabolism is responsible for

A

Pro-drug conversion (fosphenytoin, chloramphenicol)

Active drug elimination

49
Q

Metabolism is ___ in infants than in older children and adults

A

slower

50
Q

CYP450 System

A

Approximately half of the adult values for full-term infants

Different isoenzymes mature at different times

Exceeds adult values at 1 year until about 9 years of age

The increased metabolization of drugs

That’s why we see double the dose in children or more frequent dosing because they metabolize faster

51
Q

There are __ groups of enzymes that all mature at different times

A

3

52
Q

Group 1 enzymes

A

peak during 2nd and 3rd trimester

53
Q

Group 2 enzymes

A

Relatively constant through life

E.g. 2C19, 3A5

54
Q

Group 3 enzymes

A

Little function in early life

Expression increases over first several years of life

E.g. 2C9, 2D6, 3A4

55
Q

Metabolism—Pediatric Considerations in Neonates and young infants

A

Decreased enzyme capacity in Neonates, young infants result in Increased t1/2; decreased clearance means dose less frequently

Example
Phenobarbital

56
Q

Metabolism—Pediatric Considerations in children are

A

Increased enzyme capacity leads to Decreased t½; increased clearance (dose more or dose frequently)
Example
Theophylline
Voriconazole

57
Q

Infants have a well developed __ pathway but an underdeveloped __ pathway

A

sulfation, glucuronidation

Examples are
Chloramphenicol
Morphine
Acetaminophen

58
Q

Grey Baby Syndrome

A

Cardiovascular instability

Rapid progression to death

Related to chloramphenicol administration for sepsis

Immature glucoronidation –> decreased metabolism of chloramphenicol –> increased concentration

59
Q

Gasping baby syndrome

A

Benzyl Alcohol

Preservative in many multiple dose IV and PO formulations (pentobarbital, heparin flush, etc.)

Related to immaturity of glycine conjugation system resulting in accumulation of benzoic acid metabolite

Anion gap metabolic acidosis, seizures, gasping, intraventricular hemorrhage, death

Try to avoid if possible; if not keep at <= 25mg/kg/day

60
Q

Elimination usually occurs via the

A

kidneys

61
Q

GFR is much __ in infants than older children and adults

A

lower

pre-term: as low as 0.6-0.7ml/min per 1.73 m^2

full-term: 2-4ml/min per 1.73 m^2

62
Q

Elimination in new-nates through kidney

A

Decreased GFR in neonates and infants leads to increased t1/2; reduced clearance (dose lower )
Example
aminoglycosides

63
Q

Elimination—Treatment Considerations

A

Decreased tubular secretion in neonates and infants increased t1/2; reduced clearance (dose lower)
Example
beta-lactam antibiotics

64
Q

Calculating creatinine clearance in pediatrics

A

Schwartz Equation

1-18 years of age

ml/min/1.73m^2

65
Q

Normal serum creatinine levels

A

It is high from birth till first five days then it declines. After that is reach to normal creatinine levels as child age

66
Q

Schwartz Equation

A

CLcr = k x height /Scr

CLcr = mL/min/ 1.73m^2

k= age specific proportionality constant

height = height in cm

Scr = serum creatinine in mg/dl

67
Q

Age specific proportionality constants

A 
age        K
 0.33
full term --> 0.45
2-12 yrs --> 0.55
13-18 yrs --> 0.55 (female)
               --> 0.7 (male)
68
Q

Bedside Schwartz

A

GFR (ml/min/1.73 m2) = (0.41 x height in cm)/ creatinine in mg/dl

69
Q

Weight based dosing

A

Most common dosing method

Maximum dose not established for pediatric patients—make sure to not surpass adult dosing

70
Q

Age based dosing

A

Easy to use

Assumes ADME is the same for all patients

71
Q

Body-surface-area dosing

A

Precise

Used for drugs that require exact dosage calculations (i.e. chemo)

72
Q

Pediatric Resources

A

Lexicomp Pediatric Dosage

Micromedex

Respective Guidelines are AAP Report of the Committee on Infectious Disease

73
Q

Medication administration concerns

A

Adherence is difficult

Not always available in proper dosage forms/strengths

Children have difficulty with administration Tablets, diskus inhalers

Palatability Issues

Compounding is often necessary

Risk-to-benefit ratioDeciding when it is appropriate to treat

74
Q

Steps to take as the Pharmacist

A 
Obtain weight, age, sex
Ask about allergies 
Calculate dose 
Compare dose with reference
Make sure dose is appropriate 
Dispense with required materials Measuring cup/oral syringe
Medication guides
75
Q

Counseling Pediatric Patients

A 
Show how to use 
Explain 
-How it works If patient is an adolescent, include them in your counseling
-Dosage
-Frequency
-Expectations 
-What to do if there is no improvement 
Be available for future questions
76
Q

Common Cold in Pediatric populations

A

6-8 episodes per year

77
Q

AOM

A

Middle ear infection

Concerns about over-treating

78
Q

Pharyngitis

A

Inflammation of the throat

79
Q

Type 1 DM

A

autoimmune disorder affecting insulin secretion

80
Q

Eczema

A

Chronic, itchy skin condition

81
Q

Conditions seen most commonly in pediatric populations

A 
Common Cold 
AOM
Pharyngitis 
Type 1 DM
Eczema
Asthma 
Hand, Foot, and Mouth Disease
82
Q

Why is immunization important

A

Vaccines have reduced or eliminated many devastating infectious diseases

Herd immunity

83
Q

Passive Immunity

A

Person is given antibodies to a disease

Immediate protection

Only lasts few weeks or months

Via mother-to-baby, IVIG

84
Q

Active Immunity

A

Disease organism triggers immune system to produce antibodies to that disease

Takes several weeks to develop

Long-lasting, sometimes life-long immunity

Via infection, vaccines

85
Q

Vaccines are made using the same components (antigens) of bacteria or viruses that cause disease

A
  • Live but weakened (attenuated)
  • Part of the bacteria or virus (conjugated, subunit)
  • Inactivated toxin (toxoid)
86
Q

How do Vaccines Work

A

Vaccines containing antigens are injected into the body
The immune system produces antibodies to fight off these antigens
Memory cells will remember how to produce those antibodies again
When actual bacteria or viruses enter the body, memory cells can produce the same antibodies quicker to fight off disease

87
Q

Comfort measures for vaccine concerns

A 
Display a positive attitude
Use soft and calm tone
Make eye contact
Explain why vaccines are needed
Be honest
Antipyretics (not routinely recommended by ACIP)
Distraction techniques – music, books, “blowing away the pain” 
Sucrose solutions or breastfeeding
Tactile stimulation
Administration technique
88
Q

Common Adverse Reactions

A 
Mild Injection site reactions such as 
Soreness
Redness
Swelling 
Fussiness
Low grade fever
89
Q

Valid contraindications for vaccines

A

Severe allergy to prior vaccine

moderate to severe acute illness (defer until illness resolves)

90
Q

Anaphylactic reaction to vaccine componenets

A 
Egg Products --> influenza, yellow fever
Neomycin --> IPV, MMR, Var
Streptomycin --> IPV
Polymixin B --> IPV
Baker's yeast --> HepB
Gelatin--> Var, MMR
91
Q

Screening Questions for Vaccinations

A

Is the child sick today? How sick?
Allergies? How bad (anaphylaxis)?
Previous adverse reactions to vaccines?
Immune status of child or other medical conditions?
Recent history of asthma or wheezing?
Recent transfusions of blood, blood products, IVIG?
Patient pregnant?

92
Q

Special Populations

A

Immunocompromised patients
–> live vaccines contraindicated

Pregnancy

  • ->inactivated flu shot
  • -> live vaccines contraindicated
93
Q

Vaccine Information Statements (VIS)

A

Sheets produced by CDC
Document in medical record
–> VIS edition and date provided
–> name, address and title of provider, vaccine manufacturer, and lot #, date of administration
–> record combo vaccines as individual vaccines

94
Q

VIS information covered

A 
Why vaccinate
Who should receive the vaccine 
Risks/Adverse Reactions
What to look for/do
NCVIA and VAERS
95
Q

Vaccine Adverse Event Reporting System (VAERS)

A

National reporting system jointly administered by CDC and FDA

96
Q

Children are not usually able to swallow tablets until at least ______ age

A

6 years of

97
Q

 Medication adherence is difficult because of

A

Palatability of medications

Parents are responsible for the administration

98
Q

Growth charts are used to monitor progress

A

Height, weight, and BMI are expressed as percentiles
16 charts available
Sorted by age and gender

99
Q
A

Increased enzyme capacity leads to Decreased t½; increased clearance (dose more or dose frequently)
Example
Theophylline
Voriconazole

CDM 1 (15 decks)

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