Pharmacology

Question 1

Variables Affecting GI Absorption

Answer 1

pH
Gastric emptying time
GI motility
Pancreatic enzyme activity
GI surface area
Intestinal microorganisms

Question 2

pH and GI Absorption

Answer 2

More alkaline than adults
Decrease absorption of weakly acidic drugs
Increase absorption of weakly basic drugs

Question 3

Gastric Emptying Time/GI Motility and GI Absorption

Answer 3

Slower than adults

Irregular peristalsis

Question 4

Pancreatic Enzyme Activity and GI Absorption

Answer 4

Decreased for first year of life

Affects drugs that are fat soluble

Question 5

GI Surface Area and GI Absorption

Answer 5

Intestinal size vs. body size

Enhances drug absorption

Question 6

GI Microorganisms and GI Absorption

Answer 6

Intestinal flora depends on diet
More rapid development of flora in breast fed infants
Flora active in breakdown of drugs

Question 7

Rectal Absorption and GI Absorption

Answer 7

Cannot tolerate oral drugs/lack IV access
Absorbed by hemorrhoidal veins
Erratically & incompletely absorbed

Question 8

IM Absorption Affected by:

Answer 8

Muscle mass
Blood flow to muscle
Tone
Activity

Question 9

IM Absorption in Neonates

Answer 9

Decreased muscle mass
Decreased blood flow
Erractic/poor drug absorption

Question 10

IM Absorption in Infants

Answer 10

Greater density of skeletal muscle capillaries

Efficient absorption

Question 11

Percutaneous Absorption Affected by:

Answer 11

Thickness of skin

Body surface area to body mass

Question 12

Thin Skin + Increased Body Surface Area =

Answer 12

Significant percutaneous drug absorption

Watch for toxicity

Question 13

Factors Affecting Distribution in Pediatric Patients

Answer 13

Vascular perfusion
Body composition
Tissue binding characteristics
Physiochemical properties of the drug
Plasma protein binding
Route of administration

Question 14

Vascular Perfusion in Distribution

Answer 14

Changes in perfusion common

Question 15

Body Composition in Distribution

Answer 15

Higher body water & ECF the larger the volume of distribution
Some drugs need larger doses/kg

Question 16

Tissue Binding Characteristics in Distribution

Answer 16

Drugs bound to tissues exhibit increased free blood levels when the mass of tissues i reduced

Question 17

Physiochemical Properties in Distribution

Answer 17

Lipid solubility

Molecular configuration

Question 18

Plasma Protein Binding in Distribution

Answer 18

Decreased alpha1-acid glycoprotein
Decreased albumin
Increased plasma levels of drugs
Larger volume of distribution in neonates

Question 19

Routes of Administration

Answer 19

Orally
IV
IM

Question 20

Oral Route of Administration

Answer 20

Liver primary distribution site
Hepatic first pass metabolism
Oral doses higher than IV doses

Question 21

IV Route of Administration

Answer 21

Heart and lungs primary method of distribution

Question 22

Increased Volume of Distribution of Protein Binding Drugs

Answer 22

Theophylline
Ampicillin
Phenobarbital
Phenytoin

Question 23

Increased Uptake and Volume of Distribution of Tissue Uptake

Answer 23

Morphine
Fentanyl
Digoxin

Question 24

What is delayed in neonates, infants, and young children?

Answer 24

Drug metabolism

Plasma clearance of drugs

Question 25

GFR of Neonates Compared to Adults

Answer 25

Decreased until age 2

Question 26

Decreased GFR Leads to:

Answer 26

Decreased tubular secretion & reabsorption rates | Proximal tubule decreased ability to concentrate urine

Question 27

What are some common overdoses in children?

Answer 27

Iron supplements | Acetaminophen

Question 28

GI and IM Absorption in Pediatric Patients

Answer 28

Infants & children absorb medications more rapidly & completely Younger the human, more permeable the skin Readily eliminate meds that are cleared renally

Question 29

Drugs to Avoid in Pediatric Patients

Answer 29

Propylene glycol | Benzyl alcohol

Question 30

Factors Affecting Pediatric Therapy

Answer 30

Liver disease Renal disease Cystic Fibrosis GI disorders

Question 31

Liver & Renal Disease Factors

Answer 31

Avoid hepatotoxic drugs | Avoid nephrotoxic drugs

Question 32

Patients with Cystic Fibrosis Require Increased Amounts & Increased Clearance of These Drugs

Answer 32

Aminoglycosides Penicillins Theophylline

Question 33

GI Disorders that may Require Dosage Adjustments

Answer 33

Celiac disease Gastroenteritis Severe malabsorption

Question 34

How is Antibiotic Dosing Done in Pediatrics?

Answer 34

mg/kg format

Question 35

Equation to determine amount of mL

Answer 35

(Desired dose x volume of suspension) / concentration

Question 36

Tylenol Dosing

Answer 36

10-15 mg/kg q 4-6 hours

Question 37

Ibuprofen Dosing

Answer 37

5-10 mg/kg per dose q6 hours

Question 38

Two Major Drug Classes to NOT Use in a Pediatric Population

Answer 38

Fluoroquinolone's | Tetracycline's

Question 39

Why can you not use fluoroquinolone's in a pediatric population?

Answer 39

Not studied in children

Question 40

Why can you not use tetracycline's in a pediatric population?

Answer 40

Black teeth | Osteomyelitis