Pharm Flashcards
What acne cream do you not want to give PG women?
Isotretinoin (accutane!)
What don’t you want to give a febrile child?
ASA
Why don’t you want to give kids ASA?
Reyes syndrome! (fatty liver, encephalopathy)
What should you give to help a child who has a fever?
acetaminophen
What can you give for teething pain?
benzocaine gel or ibuprofen
What do you not want to give?
lidocaine, alcohol
What do you rx for bacterial pharyngitis?
ampicillin
What do you give a child with AOM with 5% local resistance to S. pneumoniae?
amoxicillin
What do you give 17 yo for depression?
SSRI (fluoextine)
What is the black box warning of SSRIs?
increased suicidality (esp. under 24yo)
What do antipsychotics do more in adolesctents?
More extrapyrimadal effects, esp. tardive dyskinesia
What do you give a 2yo with bilateral AOM who has not responded to amoxicillin?
Augmentin
What anti-htn med is safe for PG women?
HCTZ
What class of anti-htn meds do you want to avoid?
ACEI, ARBs
What do you prescribe for absence seizures?
ethosuximide
What do you not want to use for measureing medications in children?
teaspoon/tablespoon
What is a more accurate way to measure medications for children?
syringe
How is the metabolism of anti-seizure meds different in children than adults?
Children metabolize anti-seizure drugs faster
What age can you start giving nebulizer?
3yo
What age can you start giving MDI?
5yo
What do you have to be careful of when giving a medication rectally?
variable absorption (the further in, the more absorption)
What route of admin do you want to avoid in children?
IM (not well tolerated, variable muscle mass, variable flow to muscle)
What do you give for a fungal diaper rash?
clotrimazole
What do you not give for a fungal diaper rash due to resistance?
nystatin
What do you give for protection/barrier from diaper rash?
zinc oxide
What medication is super poisonous to children?
Benzonatate (coma, convulsions, cardiac arrest)
Why do you have to be careful with opioids and children?
They cross BBB more quickly in kids, can cause respiratory distress more easily
What diet is outdated for children with diarrhea?
BRAT diet (just eat regular diet instead)
How much of an increased risk is a child at for having another seizure after having their first febrile seizure?
30 percent increase
What else do adolescents experience more with antispychotics?
increased weight gain
What do you prescribe for sinusitis?
amoxicillin
What is Clark’s rule?
use body weight to calculate dosage
What is the problem with Clarks rule
slightly under doses, outdated
What is the most accurate way to calculate dosing in children?
BSA (usually only used for chemo drugs?)
What do you rx for cellulitis?
cephalexin
10yo with complex focal seizures not controlled by valproic acid. What do you do?
add lamictal (lamotrigine)
What do you give a child with asthma exacerbation for rapid control of sxs?
dexamathasone
What is an elixir?
liquid medication that has alcohol
What do you have to be careful about with elixirs?
If not stored correctly, may evaporate
What is unique about research studies in terms of ped pharm?
Not a lot of research studies
What percent of drugs are not FDA approved for children? What percent of drugs are missing dosing efficacy and safety in children?
- 60 percent not approved by FDA
2. 75 percent missing efficacy
What is not regulated by FDA?
CAM (complementary alternative medications)
What changes were made recently to OTC drugs?
Changed from “not for use for under 4yo” to “not for use for under 2yo”
How do you avoid decimals in children dosing?
round UP (no more than 10 percent of total dose)
What is a suspension?
undissolved particles of drug suspended in solution
What do you need to do with a suspension before distribution?
SHAKE IT!
What suspending agent for chweable tablets do you not want to use in children under 1yo?
honey! (clostriudium botulinum)
When can kids start using capsules/tablets?
6yo
What percent of dosing errors are made in kids?
70
What part of SMP/TMP do you want to calculate the dose for?
TMP component
What part of amox/clavunate so you want to calculate the dose for?
amoxicillin
What are crucial measurements that need to be accurate for dosing in children?
height, weight
What OTC drugs cause poisoning in children frequently?
cough and cold medicines
Other than benzonotate, what else can be poisonous in children?
elemental iron
What is youngs rule?
using age to calculate dose
How is absorption different in neonates?
higher gastric ph, irregular peristalsis, decreased pancreatic enzymes, bile acids alter absorption
How does diarrhea in children alter absorption?
decreases absorption
How is topical absorption different in neonate/children?
topical absorption is higher in neonate/infants
How is body water different in infants?
adults are 50-60 percent water
full term infants are 70-75
pre term infants are 85
How does having more body water affect distribution?
Impacts water soluble drugs (does not impact lipid-soluble drugs)
How does having low body fat in infants affect drug distribution?
drugs w/lipid affinity will have more free drug
What is different about serum proteins in infants?
less bound to albumin in infants (adult albumin level at 1yo)
What is different in neonates in regards to their metabolism?
Less P450 activity (phase 1 reactions impaired)
What is different about hepatic metabolism in neonates?
2x the adult rate @6 months, lasting until 9-12yo (anticonvulsants)
If a mother is taking phenobarbitol, how would that affect the baby?
phenobarbital induces hepatic enzymes, the child may have increased rates early after delivery
How do golumerular filtration rates compare in adults vs infants?
Infants reach adults rates by 6-12 months old
At what age can you start using the Cockroft-Gault equation?
18yo
What equation do you use to calculate childrens CrCl?
schwartz equation
What effect does having a less effective BBB have in young children?
- greater opioid impact
2. bilirubin passes through
What affect does having variable rates of development of receptors in various tissues have on children?
They have less B-Receptors until 8yo, so B-agonists affected
-also increased dystonic reactions to metoclopramide
How do you treat otitis externa?
- otic suspensions (are acidic to replicate ear canal– will be PAINFUL if vent tubes or perforation present)
- If vent tubes/perf use ophthalamic suspensions because they have a balanced pH and are more viscous
Why is benzocaine preferable to lidocaine?
- preferable for topical mucosal admin
- it is poorly soluble in water and very slowly absorbed so doesn’t reach toxic levels as early as lidocaine
What do you have to be careful with when it comes to fluoroquinolones?
joint space crystallization
What are examples of fluoroquinolones?
ciprofloxacin, levofloxacin, moxifloxacin
What should not be used for repeated application in children due to rapid absorption and potential toxicity?
lidocaine
What are macrolide abx?
erythromycin, clarithrymycin, azithromyin
What are erythromycin and clrithromycin metabolized/excreted?
primarily hepatic concentration/metabolism
biliary excretion
What effects do clarithro and erythro have?
P450 interactions, nausea, increased gastric motility
What is azithromycin metabolized/excreted?
tissue and macrophage concentration, minimal hepatic metabolism
excreted via bile
What do you give for generalized motor seizure in children?
phenobarbitol
What class of abx do you want to avoid in PG ladies and kids under 8yo?
tetracyclines
What is a SE of tetracyclines
dental staining
What is a Vit A analogue?
itsotretinoin (accutane)
How many forms of BC do you need when on accutaine?
2
