Peds

Question 1

What percentage of drugs are not FDA approved for children (and even fewer for infants)?

Answer 1

60%

Question 2

What percentage of drugs lack dosing, efficacy, and safety data for children?

Answer 2

75%

Question 3

How much can we round up dosese to avoid decimals?

Answer 3

limit round up to 10% of dose

Question 4

What are some issues with IM administration of drugs in children?

Answer 4

not well tolerated

variable muscle mass in infants & young children

variable blood flow to muscle, SQ tissue

Question 5

What are elixirs?

Answer 5

drug dissolved & evenly distributed in alcohol

caution with evaporation

Question 6

What are some suspending agents for crushed tablets?

Answer 6

apple sauce

pudding

chocolate syrup

Question 7

What age can we start giving capsules/tablets?

Answer 7

~ age 6

Question 8

What age can we use a nebulizer?

Answer 8

age 3

Question 9

What age can we start using MDIs?

Answer 9

age 5

Question 10

What percentage of dosing errors occur in children?

Answer 10

~ 70%

Question 11

What is the best source for drug dosing in children but frequently not available?

Answer 11

manufacturer’s package insert information

Question 12

What is the GI system like in neonates?

Answer 12

high gastric pH

irregular peristalsis

low levels pancreatic enzymes

bile acids can alter absorption

Question 13

Why is topical absorption higher in neonates/infants?

Answer 13

thin stratum corneum

increase cutaneous perfusion

higher surface to weight ratio

Question 14

Do neonates have less P450 activity?

Answer 14

yes; 50-70% adult levels

Question 15

What is metabolism & renal elimination like in toddlers?

Answer 15

more rapid metabolism & renal elimination than adults

Question 16

At what age can we start using the Cockroft-Gault Formula?

Answer 16

age 18

Question 17

What is the BBB like in neonates and young children?

What does this impact?

Answer 17

BBB is less effective

greater opioid impact

bilirubin passes through also

Question 18

In children who are teething, what drug to we need to be cautious with because of systemic absorption?

Answer 18

Lidocaine

Question 19

What should we use to treat teething pain in children?

Answer 19

7.5% benzocaine gel without alcohol

Question 20

What should we use to treat mild, non-candidal diaper rash?

Answer 20

zinc oxide cream, drying

Question 21

What should we use to treat candial diaper rashes?

Answer 21

Clotrimazole 1% cream

nystatin ointment resistance issues

Question 22

How should we treat mild diarrhea in children?

Answer 22

regular diet

absorb significant protein, fat, CHO

BRAT diet is less effective

Question 23

What are otic suspensions?

Answer 23

acid pH to replicate normal ear canal environment

Question 24

What happens when you give otic suspensions to children with vent tubes or recent perforation?

Answer 24

painful!

Question 25

What should we give instead of otic suspensions for kids with otitis externa with vent tubes?

Answer 25

ophthalmic suspensions

Question 26

What is the issue with antipsychotics and children/adolescents?

Answer 26

more susceptible to extrapyramidal symptoms, espiecally dystonias more weight gain

Question 27

What is the usual dosing for Acetaminopen? What is the max dosing?

Answer 27

10-15 mg/kg/dose max: 65 mg/kg/day

Question 28

What is the regular dose of Amoxicillin? High dose of Amoxicillin? Maximum child dose?

Answer 28

regular: 40-45 mg/kg/day high: 80-90 mg/kg/day **max child dose is adult dose**

Question 29

Should we use Aspirin in children?

Answer 29

no, especially febrile children

Question 30

What can happen if we give Aspirin to children?

Answer 30

**Reye's Syndrome** fatty liver degeneration, encephalopathy, liver failure

Question 31

Why is benzocaine preferred over lidocaine in children?

Answer 31

benzocaine is poorly soluble in water & very slowly absorbed so don't get toxic levels as easily as lidocaine

Question 32

What are some cautions with antidepressants in children?

Answer 32

suicide ideation impulsivity agitation

Question 33

What are some cautions with antipsychotics in children?

Answer 33

more susceptible to extrapyramidal symptoms tardive dyskinesia

Question 34

What is Phenobarbitol used for?

Answer 34

generalized motor seizures in infants

Question 35

Who should we avoid using Tetracyclines in?

Answer 35

avoid in PG & children \< 8yrs (dental staining)

Question 36

What is a Vitamin A analogue that is teratogenic?

Answer 36

Isotretinoin increases risk of malformed fetus 25x I-PLEDGE program 2 forms contraception (one either surgical or hormonal)

Question 37

What can we use as a barrier protection for diaper irriation? (either in infants or nursing homes)

Answer 37

zinc oxide cream

Question 38

What is Ethosuximide used to treat?

Answer 38

petit mal or absence seizures in children

Question 39

When is the highest risk for suicide after starting a new anti-depressant?

Answer 39

within 2 weeks so want to follow up within that time period

Question 40

Can the location of medicine in the rectal vault influence rates of absorption?

Answer 40

yes