Wk 2 - Pediatrics

Question 1

Pre-Term:
Neonate:
Infancy: 
Child:
Adolescent:

Answer 1

Pre-Term: <36 weeks gestational age
Neonate: birth to one month old
Infancy: 1 month to 1 year
Child: 12 months to age 12
Adolescent: age 12 to 18

Question 2

__% of critically ill children receive at least one off-label drug

Answer 2

88%

Question 3

2003 Best Pharmaceuticals for Children Act

Answer 3

All New Drug Applications include pediatric assessment unless waiver
6 month extension on patent if manufacturer studies a given drug in children

Question 4

Full Term Newborn: intracellular water ________ of body weight

Answer 4

75-80%

Question 5

5 months old: intracellular water ________ of body weight

Answer 5

68% (adult is 60%)

Question 6

Fat ______ by 4-5 months

Answer 6

doubles

Question 7

Protein increases and fat decreases in year ___

Answer 7

2

Question 8

Neonates have low muscle mass and erratic blood flow, so have ________ with ____ medications

Answer 8

slower absorption

IM meds

Question 9

Neonates have _____ absorption with _______ meds

Answer 9

better

rectal meds

Question 10

Neonates have _______ hepatic metabolizing enzymes

Answer 10

immature

Question 11

Neonates have increased absorption of topical meds due to larger ________

Answer 11

BSA to body mass ratio
thinner stratum corneum
Increased hydration / perfusion to skin

Question 12

Neonates/infants have ______ gastric pH, therefore have higher bioavailability of _____ meds, and weak acids may require _______

Answer 12

higher
acid labile
higher doses

Question 13

Efflux transporters low at birth, increase to adult level at age ___. Low P-gp in neonates/infants means increased exposure to ______.

Answer 13

2

CNS

Question 14

Gastric motility is _____ in first week, with gradual ______, resulting in ______ for medications

Answer 14

Slow
Increase
Longer time to reach peak concentrations

Question 15

Early infants have greater total body water and less body fat, meaning Vd higher for _______ and Vd lower for _______

Answer 15

hydrophilic drugs

lipophilic drugs

Question 16

Neonates / infants have low levels of ______ including _______, resulting in

Answer 16

protein
albumin
alpha1-acid glycoprotein
increased unbound drug (concern for drugs with high protein binding)

Question 17

In neonates, highly protein bound drugs can compete with _______, resulting in __________, so these antibiotics are avoided in <2 months old.

Answer 17

bilirubin
hyperbilirubinemia
Ceftriaxone/sulfonamides

Question 18

CYP450 enzymes develop to ___ months. Midazolam (CYP___) activity increases from 1.2 to ___mL/min/kg.

Answer 18

3
CYP3A4, CYP3A5
9mL/min/kg

Question 19

Half-life changes seen in early life. Phenytoin half-life prolonged in pre-term ___ hrs, first week ___ hrs, second week ___ hrs.

Answer 19

72
20
8

Question 20

Children <10 years have _____ hepatic clearance, and require ______ weight based dosing

Answer 20

higher

higher

Question 21

Tubular secretion matures in ______ months, and may require ________

Answer 21

first 12 months

less frequent dosing intervals if excretion via golmeruli

Question 22

Infant GFR ___mL/min, adult values at _____

Answer 22

2-4mL/min

8-12 months

Question 23

Pharmacodynamics and pharmacogenomics ____

Answer 23

• Poorly understood in children
• May be age dependent differences in
drug/receptor interactions Pharmacogenomics:
• PG may be big influence, but also not recognized or well understood at birth

Question 24

KIDS list is ______, and includes

Answer 24

Key potentially Inappropriate Drugs in pediatrics
Codeine
Topical corticosteroids
Tetracycline

Question 25

Cough and cold medication not recommended for use in children less than ____ years due to an increased risk of serious side effects

Answer 25

18

Question 26

Opioids like codeine and hydrocodone contraindicated in children under

Answer 26

6

Question 27

Tramadol contraindicated for _________ in children under _______, and cautious use in those with sleep apnea between ages _______ for other conditions.

Answer 27

tonsillectomy and adenoidectomy
under 18 years
12-18