Peds Flashcards
age groups
-Pre-term infants
-Term infants (birth – first month)
-Children (1 month – 2 y.o)
-Children (2 y.o – 12 y.o)
-Children (12 y.o – 18 y.o)
-Gestational age (GA)=post-menstrual age (PMA) -> time from conception to birth
-Postnatal age (PNA) -> age from birth to present
-Postconceptional age (PCA) -> age since conception to present
assessment of neonatal pts
-Age (neonate) -> need to know GA and PNA
-be specific about PNA in days and GA in weeks
-drug dosing based on degree of prematurity and age in days after birth
-Weight (grams or kg)
-current weight (update on qweekly basis)
-birth weight in neonate or young infant
-normal weight gain 20-40 grams/day in first 6 months of life
-Length (cm) - need to determine Clcr
pharmakinetics: absorption
-neonates affected the most
-decrease gastric acidity
-decrease gastric & intestinal motility- variable oral bioavailability of some drugs
-topical absorption
-IM administration not recommended
-rectal administration is common
pharmacokinetics distribution
-increase total body water
-decrease protein binding
-decrease amount of fat in neonates and infants- fat soluble drugs
pharmacokinetics: metabolism
-Phase I reactions - working at 50-75% of full capacity in neonates
-Glucuronidation takes up to 1 year to develop
pharmacokinetics: elimination
-reach 50% of adult GFR by 1 month of age
assessment of renal function- dont need to know
-Creatinine Clearance
CLcr = K * L/Scr
K - age-specific proportionality constant (0.48)
L - length in cm
Scr - serum creatinine in mg/dL
-Normal urine output -> 2-5 cc/kg/hr
-Renal insufficiency -> < 1 cc/kg/hr
elimination: drugs to be adjusted
-Penicillins
-cephalosporins
-aminoglycosides
-probenecid
-aspirin
-furosemide
-thiazides
-need to be adjusted for GA and weight
-full-term neonate -> GFR = 33
-1 month -> GFR = 50
-2 months -> GFR = 70
-6 months -> GFR = 110
-3 years -> GFR = 130
human teratogenic drugs
-Alcohol
-Androgenic hormones
-ACEI*
-Anticonvulsants
-Antineoplastics
-Benzodiazepine*
-Cocaine
-Diethylstilbestrol
-Estrogens*
-Etretinate
-Iodides
-Isotretinoin
-Lithium
-Live vaccines
-Methimazole
-Oral hypoglycemics*
-Penicillamine
-Quinolones*
-Tetracycline
-Thalidomide
-Warfarin
recognized human teratogens
-Maternal conditions:
-Alcohol use
-IDDM
-SLE
-Smoking
-Iodide deficiency
-Intrauterine infections
-CMV
-Rubella
-Varicella
-Syphilis
drugs CI in peds pts: neonates
-sulfonamides (ie, TMP/SMX) -> kernicterus
-ceftriaxone -> biliary sludging/kernicterus
-antihistamines
drugs CI in peds pts: children in general
-aspirin in kids < 15 y.o. -> Reye’s syndrome
-fluoroquinolones -> cartilage erosions in premature animals, however has not been shown in humans (theoretical contraindication)
-tetracyclines ® tooth discoloration (kids < 8 y.o)
peds specific ADRs
ped drug dosing
-Most doses determined on a mg/kg basis
-Some dose recommendations are given on age basis
-You MUST be able to do the following:
-Convert pounds to kilograms: 2.2 lb = 1kg
-Convert ml (cc) to drops: 1 ml = 20 drops
-Convert ml (cc) to teaspoon: 5ml = 1 teaspoon
-Convert ml (cc) to tablespoon: 15ml = 1 tablespoon
-Convert ml (cc) to ounces: 30 ml = 1 ounce
-!!Given the dose/kg and dosage forms available, you will be able to:
-Calculate the particular dose of a drug for pediatric pt
-Calculate the total quantity required for a course of therapy
-Provide drug in a form and volume the child can take
-Provide specific instructions that caregiver can understand
-** be sure to note if the dose is provided in mg/kg/dose or mg/kg/day with specifics on how the daily dose should be divided**
acetaminophen
-Dose = 10-15 mg/kg/dose q4-6h PRN, MDD = 5 dose/day
-Some dosage forms available
-Chewable tablets: 80mg & 160 mg
-Tylenol liquid: 160mg/5ml – 120 ml bottle
-Tylenol drops: 100mg/ml – 15ml & 30ml bottle with droppers marked at 0.4ml for 40mg dose & 0.8ml for 80mg dose
-Example: 3 year old weighing 30 lbs
1. 30/2.2 = 13.6kg x 10-15mg/kg= 136mg-204mg/dose
2. Age based dosing for 3 y.o. = 160mg
