Week 1 Peds Therapeutics Flashcards
Limitations to off-label drug usage
- potential for denied insurance coverage
- liability for adverse effects
- limited experience in specific conditions or age groups
- limited available dosage formulations
How to ensure efficacy when using med off-label
use guidelines snd use primary literature
Strategies to improve adherence
- caregiver edu
- ease of admin (palatability and dec frequency)
- dec child resistance
- empowering older children/adolescents
Water containing formulations BUD
14 days when refrigerated
when is it okay to give injectable solutions as oral formulation
ok if iv and po formulations have same salt form w/ similar bioavailability
what is the maximum pediatric dose usually
the adult dose
what should you always ask for when determining pediatric drug dosage
weight
units for GFR in and out
in= ml/kg/day
out= ml/kg/hr
Urine assessment anuria, oliguria, normal urine outpt, polyuria
anuria= zero output
oliguria <.5-1 ml/kg/hr
normal UO >1 ml/kg/hr
polyuria >4ml/kg/hr
what happens to the pH of infants
higher gastric pH (more basic)
what happens to the gastric emptying of newborns vs infants
- higher rates during first week of life (newborn) leads to more drug delivery to site of absorption
- infants have reduced rates of contractions and gastric emptying leads to dec dru absorption
what is rectal absorption like in infants
more stools, dec time drug is able to be absorbed, decreased bioavailability
what is percutaneous (blood vessel) absorption like in infants
greater degree of hydration and higher perfusion rates= enhanced drug permeability
what is IM absorption like in infants
inc capillary density (more drug in blood stream) = inc IM bioavailability
what is distribution like in infants
inc Vd of hydrophilic drugs (ex. aminoglycosides), dec Vd of lipophilic drugs
what is protein binding like in infants, what drugs to avoid
- dec protein binding of fetal albumin = more free drug
- avoid ceftrixone and sulfonamides in infants 2 months and younger
what should happen to dosing of CYP2C19 drugs if pt is 3 months old and why?
Inc dose
CYPC19 metabolism increased during first 6 months of life then normalizes. ex Omeprazole
when do infants develop CYP3A4 mature metabolism
1 year. starts as 3A7 then turns to 3A4
overall trend of metabolism/ enzymes in newborns/children
Enzyme activity increases w/ time. UGT matures earlier than other enzymes
Pearls about Phase 2 metabolism of Acetaminophen in children less than 12
Infants have protection against APAP toxicity as the primary phase 2 metabolism is sulfation instead of glucoronidation. Therefore they wont of over saturation
when does complete nephrogenesis (kidney) develop
36 weeks
8 months
Elimination implications for drug dose
due to dec renal BF & GFR
- Slower drug clearance
- longer drug half-life
- requires less frequent dosing
How frequent should dosing of antibiotics be for a pt who is <29 weeks gestation and born < 14 days ago
every 72 hours
How frequent should dosing of antibiotics be for a pt who is <29 weeks gestation and born > 14 days ago
every 48 hours
How frequent should dosing of antibiotics be for a pt who is 30-39 weeks gestation and born < 14 days ago
every 48 hours
How frequent should dosing of antibiotics be for a pt who is 30-39 weeks gestation and born >14 days ago
every 24 hours
challenges in drug delivery for ped pts
- tailor to ability to swallow**
- tailor to smaller doses
- alterations in stability
- palatability
considerations for tablets as dosage form
can it be manipulated- splitting, crushing, ER?
considerations for capsules as dosage form
formulation of capsule and content- beads, enteric coated, gel, powder?
Pros of liquid dosage form
Dose flexibility, easy to swallow
Preferred in 2-5 yo
Cons of liquid dosage form
- lack of controlled release (frequent dosing)
- volume required
- accuracy of measuring devices
challenges for liquid dosage form
not commercially available, various concentration= MED ERRORS
Cons of Chewable Tablets
Relies on ability to chew, no ER, may not mask taste, difficult to control dosage
Who should you avoid giving chewable tablets to
preterm/infants
Pros of minitablets
ease the need for swallowing
Cons of minitablets
limited dose flexibility, max mg per tablet
pros of oral disintegrating tablets
allows for quick dissolving without need for additional liquid
cons of oral disintegrating tablets
cannot easy spilt, challenge with masking task
pros of orodispersible films
dose flexibility with strip cutting mechanism
cons of orodispersible films
hard to mask taste, higher cost to packaging manufacturing
pros powder packets
eliminate need for crushing tablets
ready to use
cons powder packets
may require significant volume to mix, not easily titratable
pro sprinkle capsules
can ease in admin w/ food
con sprinkle capsules
limited dose flexibility `
what is the primary source of non-compliance in children and a resource used in pharmacies
Palatability, FlavorRx
common challenges associated with Parenteral formulations
- IM: kids have limited muscle mass
- volume
use and risk associated with benzoyl alcohol in peds. example
- use: perservative
- risk: neurotoxicity and metabolic acidosis
- Lorazepam
use and risk associated with ethanol in peds. example
- use: solvent to help dissolve/disperse particles
- Risk: neurotoxicity
- Dexamethasone
use and risk associated with Polysorbates in peds. example
- use: surfactant to improve solubility
- risk: liver and kidney failure; thrombocytopenia, ascites and pulmonary deterioration
- Amiodarone
use and risk associated with Propylene glycol in peds. example
- Use: solvent
- risk: seizures, hyperosmolarity, metabolic acidosis and neurotoxicity, multiorgan failure
use and risk associated with Sorbitol in peds. example
- use: sweetener to mask taste
- risk: osmotic diarrhea
- Loperamide
What are powder packets made of
crushed tablets combined with filler to create measurable quantity for smallest dosage needed
guidelines for extemporaneous preparations
USP 795
what is gestational age
days since conception (first day of missed period)
what is post-natal age
days since birth
what is post-menstrual age
combination of GA and PNA
Neonate age range
Birth to 30 DAYS
Infants age range
30 days to 1 year
child age range
1 year to 12 years
adolescent
12-18 years
where to get information about ability to crush pills
ISMP’s do not crush list and lexicomp admin tab
what is the child GFR equation
bed side schwartz
