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Peds 1 Flashcards

1
Q

What affects kid’s drug absorption?

A

affected by blood flow at the site of administration, GI function, and a thinner stratum corneum than adults

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2
Q

Why is a child’s GI functioning variable?

A

Gastric pH does not reach adult levels until a child is 18-36 months old
Gastric emptying time of a child is longer than that of an adult - until 9 months old

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3
Q

Why must topical creams be used with caution in kids?

A

thinner stratum corneum than adults, as well as a larger body surface area meaning that they absorb medication more readily

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4
Q

Hardest time to predict a drug’s pharmacokinetics during a pt’s lifetime?

A

puberty

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5
Q

How does drug metabolism change in kids?

A
  • drug metabolism increases until it reaches normal adult levels between 1-2 years
  • continues to rise beyond adult levels until puberty is reached
  • metabolic clearance of drugs by cytochrome P450 enzymes (CYP450) begins to decline to adult levels after puberty
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6
Q

What can affect CYP450 metabolism? (foods and lifestyle choices)

A

Grapefruit juice, charbroiled foods, vegetables, and cigarette smoking (2nd hand)

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7
Q

When does GFR reach adult volume?

A

1 yr old

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8
Q

What should be kept in mind when adjusting med doses in newborns?

A

dosage adjustments of drugs (strength and intervals) that depend on renal excretion (aminoglycosides, ampicillin) must be carefully made because these drugs are more slowly cleared in infants than they are in an older person

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9
Q

How are ped meds typically dosed?

A

milligram per kilogram basis

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10
Q

When using a liquid medication, what should a parent make sure to do?

A

caretakers should always use the measuring device (dropper, dosing cup, dosing spoon) that is packaged with each formulation

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11
Q

In situations where the calculated dose of a peds medication exceeds the recommended dose, what should be done?

A

the clinician should prescribe the recommended adult dose

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12
Q

15-month-old male, weight of 13.4 kg, using amoxicillin
Amoxicillin is usually dosed at 80-90 mg/kg/day divided into 2 doses to be administered 2x/day for otitis media (OM)
You decide to dose at 90 mg/kg/day divided to dose 2x/day
You select amoxicillin suspension at a dose form of 400 mg/5 mL -> 80 mg/ mL
What should the dosing be?

A

90 x 13.4 = 1206
Total dose required: 1,206 mg
Performing some quick math, you see that 1,206 mg/(400 mg/5 mL) = 15.075 mL
Round this number down to 15 mL for ease of delivery
Finally, divide this amount (15 mL) into a twice-daily schedule, and you arrive at 7.5 mL (1.5 teaspoons) of amoxicillin, 400 mg/5 mL strength, 2x/day

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13
Q

Why is poor adherence an issue?

A
  • Usually due to the caretakers’ failure to understand some important aspect of the drug regimen
  • Caretakers may experience difficulty actually administering a medication to a child due to the amount, taste, or texture
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14
Q

What can be done to assist a parent in administering a medication to their child?

A

Prescribing alternative modes - crushable tablet

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15
Q

What can aid parents in improving adherence?

A

Motivational and reminder aids for caretakers can help improve adherence

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16
Q

What are some common meds that are contraindicated in kids but okay in adults?

A

aspirin, OTC cold medications, fluoroquinolones, tetracyclines, metoclopramide, and antimigraine serotonin 5-HT receptor agonists

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17
Q

Aspirin use in kids causes?

A

Reye’s syndrome and GI side effects

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18
Q

Over-the-counter cough/cold preparations cause what in kids?

A

generally discouraged because they are not efficient and have the potential for adverse reactions

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19
Q

Fluoroquinolones are not used in kids under 18 because of?

A

adverse effects on the growth of immature cartilage, joints, and surrounding tissues

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20
Q

Tetracyclines are not used in kids under 8 because?

A

dental discoloration, enamel hypoplasia, and skeletal development problems

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21
Q

Metoclopramide is not used in kids because?

A

can cause extrapyramidal symptoms (EPS) and tardive dyskinesia, which are often irreversible

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22
Q

Antimigraine serotonin 5-HT receptor agonists (sumatriptan, rizatriptan, and zolmitriptan) can cause what in kids?

A

MI, stroke, death, and vision loss

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23
Q

Who should prescribe Antimigraine serotonin 5-HT receptor agonists (sumatriptan, rizatriptan, and zolmitriptan) to kids?

A

Peds neurologists

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24
Q

Promethazine (Phenergan) black box warning

A

In children < 2 years old: potential for severe or fatal respiratory depression, even with recommended doses
In children > 2 years old: use caution; lowest effective dose should be given.

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25
Tacrolimus black box warning
may increase susceptibility to infection and development of lymphoma owing to immunosuppression - not recommended under 2 yrs old
26
Salmeterol black box warning
increased risk of asthma-related deaths
27
When should salmeterol be used in in kids?
Should only be used when other asthma drugs, such as low- to medium-dose inhaled corticosteroids, do not work
28
Lisinopril and other ACE inhibitors black box warning
can cause injury to and death of a developing fetus
29
Methylphenidate (Concerta, Metadate, Methylin, Ritalin) black box warning
drug dependency may develop with their use
30
Black box warning on antidepressants and antipsychotics
increase the risk of suicidal thinking and behavior in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders
31
Tx options for infectious conjunctivitis
Polymyxin B + trimethoprim - drops Polymyxin B + bacitracin - ointment bacitracin + neomycin + polymyxin B - both moxifloxacin, tobramycin, ofloxacin, ciprofloxacin, garamycin
32
Tx options for allergic conjunctivitis
naphazoline + pheniramine - OTC azelastine - drops olopatadine - drops
33
What are some administration tips for kids and conjunctivitis meds?
- place the drops in the medial corner of the closed eyes so that when the patient opens his or her eyelids, the drops roll into the eye - avoid use of drops in children is to use ointments, but may have same difficulty instilling them
34
What is the typical tx regimen for kids with OM?
- Most children with otitis media do not require antibiotic therapy - Policy of watchful waiting with adequate pain control measures is appropriate
35
What is considered tx failure for OM?
no improvement within 48-72 hours
36
If OM is tx with PCN and fx, what is the next step?
a selection of an antibiotic having a different mechanism of action should be made
37
Describe OM stepwise approach
Fever? No -> Amoxicillin (if PCN allergy use alternative), if tx fx use Augmentin Fever? Yes -> Augmentin (if PCN allergy use alternative), if fx then use ceftriaxone
38
Amoxicillin SE
a rash or diarrhea
39
What is the shelf life for amoxicillin suspension?
When choosing an amoxicillin suspension, the clinician should remind the caretakers that it is only stable for about 2 weeks must be refrigerated
40
How is Augmentin dosed in kids?
Dosed based on its amoxicillin component
41
Augmentin SE in kids
Tends to cause a much higher incidence of GI side effects (nausea/vomiting, abdominal pain/diarrhea), as well as vaginal candidiasis
42
Causes of otitis externa
(Pseudomonas spp., S. aureus)
43
Why is tx of OE difficult?
Topical therapy is often difficult to achieve without the use of a cotton wick
44
How often should an ear wick be replaced?
The wick should be replaced every 24 hours along with any antibiotic
45
Which products should not be given in kids under 2 to tx rhinitis?
Antihistamines, decongestants, cough suppressants, mucolytics, and combination drugs have consistently failed to show improvement in symptoms or overall cure of disease
46
Dextromethorphan (DM)
Antitussive agent found in many OTC cough/ cold preparations
47
When is Dextromethorphan (DM) used?
used for symptomatic relief of cough caused by minor URI
48
When should Dextromethorphan (DM) not be used?
should not be used when the patient has a productive cough or one that is accompanied by significant mucus production
49
Dextromethorphan (DM) SE
drowsiness, dizziness, nausea, rarely rash/edema
50
Dextromethorphan (DM) 2:1 rule of thumb
15-30 mg of DM is equivalent to 8-15 mg of codeine for its cough suppression efficacy
51
Guaifenesin (Mucinex, Robitussin) use
expectorant used to thin mucous in a wide variety of both OTC and prescription cold formulations
52
When should Guaifenesin (Mucinex, Robitussin) not be used?
In pts under 2 yrs
53
Guaifenesin (Mucinex, Robitussin) SE
drowsiness, dizziness, headache, rash, nausea, vomiting, abdominal pain
54
Codeine
narcotic antitussive available by itself or in combination with a wide variety of medicine
55
Codeine should be used on what type of cough?
Nonproductive
56
How quickly does codeine work?
Within 30 min
57
Codeine SE
includes bradycardia and hypotension, pruritis from histamine release, CNS sedation and depression, respiratory depression, nausea, vomiting, constipation, urinary tract spasms, elevated liver enzymes, physical and psychological addiction and extensive interactions with other medications
58
What is the 3 step approach to tx allergic rhinitis?
Begin with an oral antihistamine diphenhydramine (Benadryl) or loratadine (Claritin) Add nasal steroids (Flonase) Add an oral leukotriene inhibitor (Singulair)
59
Benadryl is not recommended in?
Kids under 2 yrs
60
Benadryl SE in kids
paradoxical excitation and rare photosensitivity reactions
61
How do intranasal topical steroids work?
Controlling cellular protein synthesis Decreasing inflammation Decreasing capillary permeability
62
Intranasal steroid SE in kids
CNS side effects (hyperactivity, anxiety, restlessness, behavioral changes) and a type of steroid rage/“roid rage” (sudden, uncontrollable, aggressive and often violent outburst induced by excessive use of anabolic steroids)
63
Montelukast (Singulair) use
AR - treatment of those patients with refractory AR and who have failed other therapies
64
Azelastine (Astelin) use
AR
65
Azelastine (Astelin) SE
typical side effects of antihistamines, it can induce bronchospasm (especially in asthmatics) and can produce local burning of the nasal mucosa, epistaxis, rhinitis, and laryngitis
66
What is the only vasoconstrictor approved for kids?
naphazoline (Naphcon)
67
Naphazoline (Naphcon) use limitations
Not recommended for <6 years old Children >6 years old may receive one spray every 6 hours or as needed, but it should never be used for >3-4 days to avoid rebound congestion
68
Naphazoline (Naphcon) SE
Local mucosa irritation and stinging are usually mild.
69
Olopatadine use is not established in which age group
Kids under 3 yrs
70
Naphazoline + pheniramine is limited to use in?
Kids over the age of 6 yrs because sedation can occur in infants
71
Neonates exhibit blood flow variability, this means that...
Drug absorption from IM or SC injections is affected - if rapid, it may be toxic

Pharm 2 (8 decks)

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