Flashcards in 243 Peadiatrics Deck (48)
What ages is classes as pre term?
What about neonates?
Pre term are 38 weeks before birth (gestation)
Neonates are 0-1 month old
What is the ages range of infants?
1- 24 months old (1 month- 2 years)
What's the age range classed as a child?
What about adolescent?
Child: 2- 12 years
Adolescent: 12- 18 years
Medication errors in children have ___ times the potential For harm compared to adults
What drugs have reduced oral absorption in infants?
What drugs have increased oral absorption for children in general?
At what age do stomach pH and gastric emptying times tend to normalise? What does this effect?
3 years old.
Effects absorption of certain drugs (eg phenytoin, phenobarbital, rifampicin, penicillins)
Why should we try to avoid the IM route in children?
They have a low muscle mass
Neonates have reduced and variable blood flow so will have erratic IM absorption.
If have to give IM, see if medication can be mixed with Lidocaine to reduce pain :)
Percutaneous absorption is increased in neonates and infants, why?
Higher surface area to volume ratio
Immature epidermal barrier
But can result in cushionoid effect- too much cortisol (corticosteroid) absorbed causing face to puff
When may the rectal use be useful in children?
When they're vomiting
When they're nil by mouth (eg post op pain relief)
Child refuses to take oral medicine
Which do you think has the highest volume of distribution: neonates or adolescence?
As a percentage of body mass, their total body water and extracellular volume DECREASE with increasing age, as they become bigger and grow more muscle so water doesn't take up as much room
Neonates will have a higher Vol of distribution for water soluble drugs, so they need higher doses than adults on a weight to weight basis
Eg with penicillin and amino glycosides (water soluble)
Who have the highest % of adipose tissue levels (fats):
A premature baby
Term baby (neonates)
One year old
A one year old! Known as baby fat
A premature baby 3%
Term baby (neonates) 12%
One year old 30%!! (As they don't burn off fat as they're not walking yet but eating lots!!)
This means fat soluble drugs in neonates need smaller doses
What do you need to do if you're administering a highly protein bound drug such as phenytoin into a neonate or infant?
Watch out! As the numbers or proteins and serum albumin is lower in children therefore less drug can be protein bound resulting in a lot of drug being free.
This can give more effects, and increased toxicity
Therapeutic drug monitoring therefore needed
What is pradawillis syndrome?
Where a child never feels full
They eat and eat, leads to obesity :(
What drug do fatalities in neonatal care units tend to happen with?
Which drugs have altered metabolic pathways in neonates compared to children and adults?
What is grey baby syndrome?
a rare but serious side effect that occurs in newborn infants (especially premature babies) following the intravenous administration of the antimicrobial chloramphenicol.
Due to a lack of glucuronidation METABOLISM reactions occurring in the baby, leading to an accumulation of toxic chloramphenicol metabolites.
Baby dies :(
At what ages does renal function completely mature?
6-8 months of age
Before this renal function may be lower
It has been shown to be safe and effective if used as licensed and is of a suitable quality
Something that is NOT licensed for ANY age or indication.
Such as manufacturers specials, imports, chemicals
What does "off label "mean?
Used outside the products terms of license
Eg something may be used for an indication that it isn't licensed for, or used for a condition it isn't licensed for
Can manufacturers advertised unlicensed or off label meds?
What is a PUMA?
Paediatrics use marketing authorisation
In 2011 first ever children's medicine was granted one!
- BUCCOLAM (buccal midazolam) was specifically licensed for children aged 3months-18 Years
Propylene glycol is present in phenobarbital injections
If a child's renal function is effected or they're a slow metaboliser causing reduced elimination of this drug, what effect can this have?
Sever adverse effects on the CNS
Reduce the risk of this by diluting propylene glycol before administering it!
What can polyoxyl castor oil cause in IV injections in children?
A severe anaphylytic reaction
What is benzyl alcohol contra indicated in?
(Present in Amiodarone and Lorazepam injections)
In pre term neonates (premature)
Can cause fatal toxic syndrome
(I'd be scared to give a premature tiny baby any drugs!!)
In liquid formulations you need to consider that the child may be allergic to certain flavourings colourings or preservatives etc
Can you name a few?
Arachis (peanut oil)
Can I disguise my drug in my baby's milk bottle?
No this shouldn't be done
The drug will sink to the bottle of the bottle and the baby is unlikely to finish it!!
When should you definately avoid splitting and giving a fraction of an unscored (round) tablet?
When the drug has a narrow therapeutic window.
This is because the drug may not be uniformly distributed throughout the tablet.
Therefore could end up over dosing or under dosing quite easily if the drug isn't uniformly spread and you split it.