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46 Cards in this Set

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Pediatric patients need calculation of individualized doses based on what 4 areas?
1. age
2. weight
3. body surface area
4. clinical condition
What are four challenges in pediatric prescribing?
1. Pediatric prescribing is complex

2. Off-label medication use is common

3. Lack of standardization of recommended doses

4. Lack of guidelines regarding use of adult dosing regimens
What is the first step in pediatric prescribing?
An accurate weight must be obtained and correctly transcribed (pounds or kilograms)
What drugs are usually the least to be given closest to the recommended daily dose?
Anti-epileptics
This is the study of the concentration of a drug within the body during the process of absorption, distribution, metabolism, excretion.
Pharmacokinetics
This is the process that involves drug movement from the site of entry in the body to the blood stream.
Absorption
This is the transport of the drug in the body fluids from the bloodstream to the tisues of the body. Distribution is effected by body water content, body fat content, and plasma protein levels.
Distribution
This is the process by which drugs are chemically inactivated so that they can be excreted.
Metabolism
This is the process whereby metabolized drugs are removed from their sites of action and eliminated by the body.
Excretion
What does Increased total body water in the infant mean for pharmacokinetics.
Increased distribution of drug, decreased blood levels of water-soluble drugs.
What does it mean in pediatric pharmacokinetics that there is increased membrane permeability, skin and blood brain barrier?
Increased CNS distribution and likelihood of neurotoxicity. Enhanced topical absorption.
What are the implications for pediatric pharmacokinetics since they have decreased body fat?
Increased absorption of fat soluble drugs.
What are the implications for pediatric pharmacokinetics since they have immature kidney and liver function?
Prolonged excretion or metabolism of certain drugs.
What are the implications for pediatric pharmacokinetics since they have immature temperature regulation?
May dehydrate readily, increasing concentration of drugs.
Rates of this are lower in infants than in children and adults.
Absorption
Prolonged gastric time and variable gastric pH lead to diminished?
Absorption
Frequent feeding may impede drug _____?
absorption
Low levels of intestinal flora and reduced enzyme function can lead to decreased ________?
Absorption
Low peripheral perfusion and immature heat regulation can decrease absorption of what 3 types of med ROA?
IV, IM, SC
What allows the distribution of medication in infants to be more available in circulation?
1. Low concentration of plasma proteins

2. Diminished protein-binding capacity
Greater permeability of the blood-brain barrier allows for rapid access of drugs to the what in infants?
CNS
Total body water in infants is __% compared to 50% in the adult.
80%
If a drug is water soluble and you are giving it to an infant what may need to be done?
Higher doses of water soluble drugs may be needed to achieve therapeutic effects.
Since drug metabolizing enzymes in the liver of infants are immature. What does this mean for infants?
More drugs in circulatory system may increase potential for drug toxicity.
Since infant's kidneys have higher resistance to blood flow, lower GFR with a decreased ability to concentrate urine what does this mean physiologically?
Infants may secrete drugs more slowly, increasing risk of drug accumulation.
At what age is a child's gastric pH equal to an adult?
By 2-3 years of age.
What are two differences between infants and children in regards to their gastric, skin and blood brain barrier?
Gastric emptying rates are faster than infants.

Skin and blood-brain barrier become more effective.
At what age do plasma proteins reach adult levels?
1
Children up to age 2 years of age may require higher dosages?
Of water soluble drugs.
What are four specific things about the nature of metabolism in children?
1. Liver enzymes are more effective in metabolizing drugs.

2. Due to elevated BMR some drugs are metabolized more rapidly

3. Drug dosages relative to body weight may need to be higher.

4. Drugs may need to be more closely monitored
Children over __ months of age are able to excrete drugs effectively.
12 months
What is a rule about rounding specific to infants and small children?
Do not round
How do you insure safe medication dosing on your watch?
1. calculate daily dose needed

2. Calculate the low and high parameters of safe range (from drug book)

3. Compare the patient's daily dose to the safe range to see if it falls within the safe zone
What is the formula method?
D/H x Q = X

D-dosage desired or ordered
H-what is on hand
Q-unit of measure that contains the available dose. When using solid products (tablets, capsules) Q is always I and can be eliminated. Q varies when using liquid measures. X-the unknown dosage you need to administer.
This system is usually seen as best for infants in dosing?
Broselow Luten System
The color code for pediatric patients was derived in the early eighties .
The Broselow-Luten System
What is the color for the first three weight categories of the Broselow Luten System 3-5kg, 6-12lbs
Gray
What color represents 6-7kg, 13-16lbs in the Broselow Luten System?
Pink
What color represents 8-9kg, 17-20lbs in the Broselow Luten System?
Red
What color represents 10-11kg, 21-25lbs in the Broselow Luten System?
Purple
What color represents 12-14kg, 26-31lbs in the Broselow-Luten System?
Yellow
What color represents 15-18kg, 32-40lbs in the Broselow-Luten System?
White
What color represents 19-23kg, 41-51lbs in the Broselow-Luten System?
Blue
What color represents 24-29kg, 52-64lbs in the Broselow-Luten System?
Orange
What color represents 30-36kg, 35-80lbs in the Broselow-Luten System?
Green
What is an OTC drug that is overdosed to pediatric patients by their parents 73% of the time?
Acetaminophen