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NUR 622: Adv. Pharmacology Lectures > Week 1: Section 18, Chapter 97. pp 2265 - 2276 (Pediatric Pharmacotherapy) > Flashcards

Week 1: Section 18, Chapter 97. pp 2265 - 2276 (Pediatric Pharmacotherapy) Flashcards

1
Q

True or False:

Children undergo considerable physiologic changes between birth and adulthood. Although most follow the same general pattern of growth, the TIMING OF MATURATION varies from child to child.

A

True

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2
Q

All aspects of pharmacokinetics are affected by growth and development. Drug absorption is altered by a variety of mechanisms, with the most significant differences noted during the ____.

A

first months of life.

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3
Q

The greatest degree of drug distribution change occurs during the _____.

A

first year of life.

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4
Q

Drug distribution is affected by changes in (7)

A
  1. Organ size
  2. Body water content
  3. Fat stores
  4. Plasma protein concentration
  5. Acid-base balance
  6. Cardiac output
  7. Tissue perfusion
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5
Q

True or False:

Metabolic function is highly dependent on ____.

A

patient’s age.

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6
Q

Drug elimination is reduced during _____, resulting in slower rates of clearance for many commonly used drugs.

A

infancy

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7
Q

The effects of puberty can alter the ____ or _____ of many drugs administered during this period.

A

efficacy or toxicity

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8
Q

(In pediatrics) For most dose calculations, _____ is used to account for growth and development.

A

weight

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9
Q

Children do not grow in a predictable, linear fashion, but rather in PERIODIC BURSTS, with additional variation caused by differences in (3)

A
  1. Genetic predisposition
  2. Nutritional intake
  3. Environment
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10
Q

This refers to the research on the impact of growth and development on pharmacokinetics and pharmacodynamics.

A

Developmental pharmacology.

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11
Q

ASA is no longer used in children because of its association with ______ syndrome.

A

Reye’s syndrome (causing mitochondrial damage and resulting in hepatic failure)

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12
Q

NSAIDs are not recommended for use in infants younger than 6 months f age because of an increased risk for _____.

A

renal impairment.

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13
Q

True or False:

In neonates, gastric acid production is DECREASED, giving a higher, nearly neutral pH in the stomach.

A

True.

Therefore: Great absorption tof acid-labile drugs (PCN, erythromycin). Less absorption for weakly acid drugs (Phenobarbital, phenytoin)

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14
Q

Amylase activity is minimal at birth and remains low until the ______.

A

third month of life.

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15
Q

Pancreatic lipase activity is detectable by _____ weeks AOG, but remains low at birth and throughout the next 2 - 3 months.

A

32 weeks

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16
Q

This is present at birth and accounts for greater percentage of fat absorption during early life.

A

Gastric lipase

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17
Q

Adult values for gastric emptying and intestinal transit time are generally reached by _____-

A

4 - 8 months of age

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18
Q

Reduction of splanchnic blood flow may cause damage to the gut lining from _____ drug formulatios.

A

hyperosmolar.

Therefore, enteral route of drug administration is delayed until patient is receiving 1/4 to 1/2 of nutritional needs through enteral feedings.

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19
Q

Intestinal enzymatic activity does not approach adult values until age ____.

A

2 - 3 years old

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20
Q

Why Vitamin K is administered IM in newborns?

A

Vitamin K per IM has slow absorption (due to immature vasculature, small size muscle, etc). It will protect the neonate from belle ding for 1 month. Until such time he is getting Vitamin K from breastmilk or infant formula.

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21
Q

Transdermal drug absorption is higher in neonates because of (4).

A
  1. Greater skin to body surface area ratio
  2. Thinner stratum corneum
  3. Better epidermis hydration
  4. Greater perfusion
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22
Q

The use of Betadine (Povidone-Iodine) in neonates is associated with _____ dysfunction.

A

thyroid

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23
Q

EMLA cream is a mixture of these two drugs.

A

lidocaine and prilocaine.

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24
Q

EMLA cream should be applied ____ prior to circumcision, while lidocaine should be applied ____.

A

1 hour…. 30 minutes

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25
Q

These patch medications are used to treat ADHD in pediatrics (2).

A

Methylphenidate, clonidine

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26
Q

These patch medications are used to treat severe pain in pediatrics (2).

A

lidocaine, fentanyl

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27
Q

These are preferred formulation for rectal administration. They do not require an extended time for dissolution.

A

Gels and liquids.

28
Q

Emperic antibiotic therapy for sepsis and meningitis consists of __ (2).

A

ampicillin and aminoglycoside.

Combination of these is very effective in the neonatal period when drug distribution into the CNS is much higher.

29
Q

Administration of drugs with a high binding affinity for albumin, such as sulfonamides, during neonatal period can result in competition with bilirubin for binding sites. The resulting increase in unbound bilirubin can lead to ______, neurologic damage caused by deposition of bilirubin in the brain, primarily in the basal ganglia.

A

kernicterus

30
Q

Phase 1 reactions include (4)

A
  1. Oxidation
  2. Reduction
  3. Hydroxylation
  4. Hydrolysis
31
Q

This enzyme plays a major role in drug metabolism, including that of erythromycin.

A

Cytochrome P-450 (CYP) 3A enzymes.

32
Q

This is the primary metabolic enzyme in utero.

A

CYP3A7.

33
Q

CYP3A7 can be found in

A

Endoplasmic reticulum of fetal hepatocytes. Has a role in transformation of DHEA and detoxification of retinoid acid derivatives (from maternal serum across the placenta).

34
Q

The lack of ______ activity has a profound impact on the ability of newborns to metabolize benzyl alcohol, a common preservative in injectable drug products.

A

alcohol dehydrogenase

35
Q

This termed is referred to benzoyl alcohol toxicity.

A

Gasping syndrome

36
Q

Phase II reactions include (3)

A
  1. Glucuronidation
  2. Sulfation
  3. Acetylation
37
Q

This enzyme is responsible for glucuronidation of both drugs and endogenous substances. They are low levels in fetal circulation.

A

UGT (5’-diphosphate glucoronosyltransferase

38
Q

The reduced ability of infants to perform glucuronidation has been known for many years as a result of ____.

A

chloramphenicol “gray baby syndrome”

39
Q

This is the primary enzyme responsible for chloramphenicol metabolism.

A

UGT2B7

40
Q

This is responsible for fetal metabolism of thyroid hormones.

A

SULT1A1

41
Q

This enzyme is responsible for metabolism of steroid hormones.

A

SULT2A1

42
Q

This enzyme is responsible for metabolism of catecholamines.

A

SULT1A3

43
Q

The primary site for SULT enzyme development takes place in the

A

liver.

Except for SULT2A1… occurs primarily in fetal adrenal gland.

44
Q

Adverse effects of morphine (3)

A
  1. Hypotension
  2. Respiratory depression
  3. Constipation
45
Q

The ability of kidney to filter, excrete, and reabsorb substances is not maximized until the age of ___./

A

1 year

46
Q

Glomerular filtration rate at birth, for full term neonates.

A

2 - 4 ml/min

47
Q

Normal GFR for adults.

A

100 - 120 ml/min

48
Q

Name 2 renal eliminated drugs

A

Aminoglycosides and vancomycin

49
Q

In neonates, tubular secretion is also decreased. A decrease in tubular secretion also results in prolonged elimination half-life for drugs such as (4)

A
  1. PCN
  2. Cephalosporins
  3. Furosemide
  4. Digoxin
50
Q

This drug has been used for many years in the management of SVT in neonates.

A

Digoxin

51
Q

These (2) are not always useful indicators of renal function in neonates.

A

BUN and serum creatinine

52
Q

This is often used as an additional measure of renal function in neonates.

A

Urine output.

53
Q

Normal urine output for neonates.

A

1 ml/kg/hr

54
Q

One of the most common method to calculate for creatinine clearance in pediatrics is ____.

A

Traub and Johnson Method

55
Q

These maturational changes can result in clinically significant differences in response to common therapies. (3)

A
  1. Receptor conformation
  2. Receptor Density
  3. Receptor Affinity
  4. Signal Transduction
56
Q

Infants have long been suspected to be relatively resistant to the effects of B-adrenergic AGONISTS, including (3)

A
  1. Dopamine
  2. Dobutamine
  3. Epinephrine
57
Q

This is a serious dermatologic reaction in children associated with the use of lamotrigine.

A

toxic epidermal necrolysis

58
Q

Name 2 theories associated for the greater incidence of serious dermatologic reactions in children.

A
  1. Dose-related toxicity

2. Immune-mediated hypersensitivity response

59
Q

Pediatric drug references provide most doses in units per weight; with the exception of _____ (agents), which are dosed by body surface area.

A

Chemotherapeutic

60
Q

A recent study of clonidine clearance in the early postnatal period suggests that both age and weight should be used to optimize clonidine doses in newborns being treated for _____.

A

neonatal abstinence syndrome

61
Q

True or False:

Older children and adolescents should transition to adult dosing whenever the calculated weight-based dose exceeds the usual adult dose.

A

True

62
Q

This is a part of the FDA Modernization Act of 1997. It was developed to address the lack of pediatric study data, including medication prescribing information.

A

Pediatric Exclusivity Program

63
Q

This rule gave the FDA the ability to require manufacturers to conduct clinical trials of drugs that would be used in a significant number of patients.

A

1998 Pediatric Rule

64
Q

This act extended the previous incentives and created a mechanism for funding studies of older, off-patent medications that are often used in children.

A

Best Pharmaceuticals for Children Act of 2002

65
Q

In 2007, the WHO passed a resolution calling for better medications for children. WHO initiated the _____ program with the goal of increasing medication availability for children.

A

Make Medicines Child-Sized program

NUR 622: Adv. Pharmacology Lectures (7 decks)

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