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25 Cards in this Set

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How much circulating blood volume is in an infant?
80 cc/kg
Max. amount of blood that can be taken?
<5% or circulating blood volume
8 lb newborn- how much blood can you draw?
8 lbs * (1 kg/ 2.2lbs) = 3.6 kg

3.6 kg * (80cc/kg) *0.05 = 14.5 cc
If we needed to gather 8 samples @ 5cc/sample how much should the child weigh?
5cc/sample * 8 samples = 40cc

80cc/kg * X kg *0.05= 40cc

X = 10 kg, child should weigh > 10 kg.
Definition of preterm infant
23-34 weeks gestation
Treament and side effects of NRDS
1) Mechanical ventilation, O2, surfactant

2) Can lead to inflammation, treat with corticosteroids
Did a double-blind study find an increased risk of cerebral palsy in low birth weight infants exposed to dexamethasone?
Yes
Is absorption of wk acids slower or faster in children? Why?
Slower until 3-7 years

Due to higher gastric pH
Name 2 acid-labile compounds that have increased bioavailability in kids?
Penicillin G
Ampicillin
Is intestinal transit time increased or decreased in kids?
Decreased
*Know slophyllin gyrocaps for this (oral med for bronchial asthma)
Dose and Vd
Dose = concentration * Vd
% total body H2O in infants
Increased, consider aminoglycosides
% total body fat in infants and children
decreased
Protein [albumin] in children < 1 year
Decreased
Protein binding affinity in infants? How does this affect sulfonamides?
Decreased

Sulfonamides compete w/bilirubin for albumin
Age related physiologic changes
Absorption
Vd
Clearance (hepatic and renal)
Schwartz equation for baby? For child?
Creatinine Clearance = 0.45 * length (cm)/Crs

Creatinine clearance = 0.55 * length(cm)/Crs
% clearance of these P450 cytochromes: 3A4, 2D6, 2C9
3A4- 50%
2D6- 20%
2C9- 15%
Total = 60%
Gray baby syndrome
Chloramphenicol toxicity
(when a baby is given chloramphenicol for bacterial meningitis -> can't metabolize the drug properly -> toxicity)
Some times infants produce weird metabolites. Give an example.
Theophylline--> caffeine
What is p-glycoprotein
Multidrug efflux pump for lipophilic compounds that is expressed in many tissues including BBB
Examples of drugs affected by p-glycoprotein
Bilirubin
Cyclosporin
Methotrexate
Why do pts. get kernicterus
Slow intestinal transit time

Decreased albumin binding of bilirubin

Immature glucoronidation pathway

BBB lacks sufficient p-glycoprotein
Kernicterus
Bilirubin encephalopathy affecting CNS esp. basal ganglia

Results in neuro damage, deafness, and cerebral palsy.
Dangerous side effects of:
SSRIs
Diphenhydramine
Lamotrigine
S- increased risk of suicide
D- sedation/hyperactivity
L- Steven's Johnson syndrome