Pharmacy in Pediatrics Flashcards
What is gestational age?
Time from conception until birth
What is postnatal age?
Chronological age since birth
What is post-conceptional age/corrected gestational age/postmenstrual age?
Age since conception
review slide 8
Review slide 9 for important age definitions
What is the age of a premature neonate?
< 37 weeks gestational age
What is the age of a full term neonate?
neonate born 37 - 41+6/7 weeks gestational age
What is the age of a neonate?
Full term neonate up to 28 days PNA
Premature neonate whose PCA is < 42-46 weeks
What are some differences in absorption among pediatric patients?
Higher pH (less acidic earlier in life)
- Absorption of acid labile compounds is higher (ex. penicillin)
- Absorption of weak acids is reduced (ex. phenobarbital)
How does gastric motility change with age in pediatrics?
Increases with age, normalizes at 4 months of age
Slower drug absorption and longer Tmax in neonates
How is skin permeability different among pediatric patients?
Increased topical absorption in neonates/infants (due to thinner skin, therefore give lower potency)
How is IM injections absorption different in pediatric patients?
Reduces skeletal muscle blood flow in neonates, but higher density of capillaries
Therefore more variable drug absorption
What is unique about neonates and infants regarding their distribution.
Very large extracellular and total body fluid
Higher Vd of hydrophillic drugs
Decreased circulating albumin and AAG
Higher amounts of endogenous products (displace drugs from binding sites)
What are some unique aspects of neonatal metabolism?
Delayed maturation of CYP enzymes (may result in more conservative drug dosing)
UGT increases with age
What are some unique aspects of elimination among pediatric patients?
Tubular secretion is immature in neonates/infants, but rapidly increases
GFR increases with age (rapid increase in first 2 weeks of age and reaches adult values at 8-12 months)
What is the Schwartz equation?
Estimates CrCl in pediatric patients (under 1 years old)
use k=0.413 as coefficient
Review slide 24 for CrCl targets
Lower normal CrCl in younger children
What are some ways suspension/solution drug formulation palatability can be improved?
Chocolate or strawberry syrup, peanut butter (coats tongue)
Applesauce (masks flavour, provides medium for mixing)
Ice cream (cold minimizes flavour, numbs taste buds)
Flavouring agent (risk of ruining flavour for patient, taste associated with drug)
What are some oral administration tips for pediatric patients?
Do not adminster liquid straight back into the throat (gag-reflex)
Slowly introduce med to the rear cheek
Always use standardized measuring syringes, not household utensils
What is the thirty minute rule with respect to oral drug administration?
If a child throws up in less than 30 min after drug admin, another dose can be given
If the child throws up again, then do not repeat dose
If the child initially throws up after 30 minutes, do not repeat the dose
What are the three main types of parenteral access lines in pediatrics?
Peripheral IV (short-term use)
Central IV (longer-term use, PICC, broviac, umbilical catheter for neonates)
Intraosseous catheters (used in emergency situations)
What are some characteristics of PICC lines?
Used when larger volumes and more concentrated drug solutions
Also placed if the patient will be in hospital for weeks
What are some characteristics of broviac lines?
Port into veins near heart (ex. chemo patients)
What are some characteristics of intraosseous lines?
They are drilled directly into bone marrow, can give lots of fluid this way (used in emergent situation)
Review slide 46 and 47 for formula method for determining fluid requirements
Review slide 48 and 49 for 4/2/1 method for calculating fluid requirements
What fluid is appropriate in most children?
D5W/NS(normal saline)
Excluding the following patients:
- Renal or CV disease (risk of hypo/hypernatremia)
- Diabetic ketoacidosis (limit dextrose sugar)
- Severe burns (loose more fluid)
- Underlying conditions that affect electrolyte regulation
What factors need to be considered before assessing blood pressure readings in pediatric patients?
Age, sex, height
HTN is generally defined as SBP or DBP greater than 95th percentile
review slide 56 for BP chart
Review slide 58 for typical BP readings among children
Review slide 59 for typical HR readings for children
Review slide 60 for typical respiratory rate readings for children
What are some characteristics of rectal temperature readings in children?
Reference standard for core temps
Gold standard of measurement, but invasive
What are some characteristics of axillary temps in children?
Lower than rectal readings, but much less invasive and easier to obtain
Preferred in neutropenic pts due to infection risk and children who can’t coordinate oral temp
What are some characteristics of oral temps in children?
0.6°C lower than rectal\
Generally preferred in children who can coordinate oral temp devices
What is normal body temperature for children?
37.2C +/-0.5C within a day
Colder in the morning, and late-afternoon/evening peak
Neonates and infants have higher body temps (higher SA to weight ratio and metabolic rate)
What is some new clinical advice about tetracyclines in children?
Tetracyclines have shown to chelate to developing bones and teeth, but short-term use (under 21 days) may be considered if clinical benefits outweigh harms
Other reasonable options need to be exhausted before trying tetracyclines in children
Why are fluoroquinoles not reccomended to use in children?
Arthropathy (cartilage and joint degradation)
Can be used if it is a reasonable alternative to parenteral theraph
Limited use when no other safe options are not safe or effective
What is the caution with TMP/SMX in pediatric patients?
CI in infants under 2 months
May cause hyperbilirubinemia or kernicterus (hyperbili in brain) due to competitive binding to proteins like albumin
When can ASA be used in children despite reccomendation against use in this age group?
Cardiac conditions in pediatrics:
- Kawasaki Disease
- Post-operative Congenital Heart Repair Prophylaxis
- Rheumatic Fever
What is Kawasaki Disease?
Acute systemic vasculitis of childhood (inflammed vasculature)
Self-limited in most cases cases, but if untreated with ASA, 1/4 of these cases eesult in coronary artery aneurysms
What are some symptoms of Kawasaki Disease?
Fever that lasts over 5 days and 4+ of the following sx:
- Strawberry tongue
- Polymorphous rash
- Changes in extremities (edema in hands/feet, erythema in soles/palms)
- Cervical lymphadenopathy
Review slide 80 to 99 for pediatric patient cases
