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Pharmacology Test 1 > Peds > Flashcards

Peds Flashcards

1
Q

What drug properties affect placental transfer? (i.e. make a drug more likely to cross the placenta)

A

Small molecules, lipophilic, unbound drugs

lipophilic drugs are less likely to be bound to a protein

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2
Q

What are ways the placenta protects to fetus from drug transfer?

A
  1. Placental transporters (pump drug back into maternal circulation)
  2. Placenta acts as a semipermeable barrier and a site of metabolism. (this however, can cause toxic metabolites to get through)
  3. Umbilical vein - 40-60% of blood is directed to fetal liver for additional metabolism
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3
Q

Define teratogenic

A
  1. Results in a characteristic set of malformations
  2. Exerts its effects at a particular stage of development
  3. Show a dose-dependent incidence
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4
Q

During pregnancy when are most drugs CI?

A

the first trimester d/t early development

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5
Q

Name a few known teratogenic drugs

A

Thalidomide - seal limbs, babies born w/o limbs, nerve damage
Carbamzepine - 1st trimester, neural tube defects
Pheytoin - All - fetal hydrantoin syndrome
Valporic acid - All - neural tube defects, cardiac and limb manifestations

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6
Q

FDA Label A

A

No s/e to pregnancy

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7
Q

FDA Label B

A

EITHER Animal studies showed no risk & no well controlled women studies
OR
animal studies show some adverse effect, but there are well controlled women studies that show no risk (fail to so risk)

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8
Q

FDA Label C

A

Benefits outweight risks
OR
no animal studies

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9
Q

FDA Label D

A

Fetal risk but potential benefit outweight risk

ex: epilepsy, bipolar.

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10
Q

FDA Label X

A

Risks outweigh benefits -> known abnormalitis

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11
Q

FDA labels 8.1-8.3

A
  1. 1 - Pregnancy, L & D
  2. 2 - Nursing mother’s, lactation
  3. 3 - Females and males of reproductive potential
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12
Q

Laws for accutane? IPLEDGE, IREMS

A

If used by females who are of reproductive potential they must be on 2 forms of BC and have monthly pregnancy tests.

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13
Q

What’s a NO NO during lactation?

A

tetrocyclines (doxy) - permanent tooth staining
barbiturates - lethargy, sedation, poor suck reflex
lithium - could cause baby to go into renal failure

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14
Q

What classifies a neonate?

A

<28 days

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15
Q

What classifies a preme?

A

36 weeks and under

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16
Q

What classifies a full term?

A

37 weeks or later

17
Q

What classifies a Term pregnancy?

A

37-42 weeks of gestation

18
Q

What pharmacokinetic/pharmacodynamic effects are different in babies and children?

A
  1. GI Absorption - increased for weak bases
  2. Skin absorption - absorbs readily always limit topical meds/ use smallest corticosteroid conc
  3. Distribution - babies are all water - water soluble drugs require higher conc
  4. Protein Binding - decreased protein binding = increased unbound drug
  5. Metabolism - slower at birth and matures rapidly and peaks around 1-9 yrs (exceeding adult values), slowly decreased to adult levels about 9-12 yrs. Requires higher dose of hepatic metabolized drugs.
  6. Glucoronidation Metabolism - immature, adult values at 3-4 yrs, Chloramphenicol toxicity in neonate - grey baby syndrome
  7. Renal Elim - Reduced in neonate and slowest in preme, inc to adult values by 7-12 moth. Peaks at 3-12 yrs and gradually declines. -> longer frequencies in children, shorter freq in babies
19
Q

What is the significant of the BBB in neonates?

A

It has not been formed yet, therefore all drugs can reach the CNS, and increase CNS effects and increase permeability of drugs (aminoglycosides)

20
Q

What is the significance of Bilirubin in neonates?

A

Drugs can displace bilirubin from albumin, increased unbound bilirubin, increased risk of kernicterus.
Neonate have increased production and decreased clearance of bilirubin.

21
Q

When is the Schwart’z equation most ideal?

A

ideal for peds patients, considers serum creatinine, height, gender and age

22
Q

When is the Schwart’s equation not ideal?

A

PICU
infants younger than 1 week
Pts w obesity, malnutrition or muscle wasting

23
Q

What drugs are not CI, but benefits may outweigh risks in infants, children?

A

Quinolones (floxacins)

Tetracyclines (esp < 4 yrs)

24
Q

Dose of APAP in children?

A

10-15 mg/kg/dose Q4-6 hours
Max of 5 doses/day
COMES IN 80mg, 160mg, 325mg (suppositories)
Oral soln 160mg/5ml

25
Q

Dose of Ibu in children?

A

5-10 mg/kg/dose Q6-8 hr

6 months or older

26
Q

Counseling point - Topical decongestants

A

DONT take longer than 3 days

27
Q

Treatment for common cold in peds?

A

Symptom control
Adequate fluid intake
Rest
Use fluid of saline nasal spray

28
Q

Psyllium

A

Avoid in pts who must restrict fluid intake

29
Q

Polyethelene Glycol (Miralax)

A

Mix with 4-8 oz of H2O, avoid in pt who must restrict fluid intake
CAUTION in renal impairment

Pharmacology Test 1 (3 decks)

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