Mcphs Clinical Therapeutics Pediatric Prescribing

Front 1

Pediatric patients need calculation of individualized doses based on what 4 areas?

Back 1

1. age
2. weight
3. body surface area
4. clinical condition

Front 2

What are four challenges in pediatric prescribing?

Back 2

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

Front 3

What is the first step in pediatric prescribing?

Back 3

An accurate weight must be obtained and correctly transcribed (pounds or kilograms)

Front 4

What drugs are usually the least to be given closest to the recommended daily dose?

Back 4

Anti-epileptics

Front 5

This is the study of the concentration of a drug within the body during the process of absorption, distribution, metabolism, excretion.

Back 5

Pharmacokinetics

Front 6

This is the process that involves drug movement from the site of entry in the body to the blood stream.

Back 6

Absorption

Front 7

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.

Back 7

Distribution

Front 8

This is the process by which drugs are chemically inactivated so that they can be excreted.

Back 8

Metabolism

Front 9

This is the process whereby metabolized drugs are removed from their sites of action and eliminated by the body.

Back 9

Excretion

Front 10

What does Increased total body water in the infant mean for pharmacokinetics.

Back 10

Increased distribution of drug, decreased blood levels of water-soluble drugs.

Front 11

What does it mean in pediatric pharmacokinetics that there is increased membrane permeability, skin and blood brain barrier?

Back 11

Increased CNS distribution and likelihood of neurotoxicity. Enhanced topical absorption.

Front 12

What are the implications for pediatric pharmacokinetics since they have decreased body fat?

Back 12

Increased absorption of fat soluble drugs.

Front 13

What are the implications for pediatric pharmacokinetics since they have immature kidney and liver function?

Back 13

Prolonged excretion or metabolism of certain drugs.

Front 14

What are the implications for pediatric pharmacokinetics since they have immature temperature regulation?

Back 14

May dehydrate readily, increasing concentration of drugs.

Front 15

Rates of this are lower in infants than in children and adults.

Back 15

Absorption

Front 16

Prolonged gastric time and variable gastric pH lead to diminished?

Back 16

Absorption

Front 17

Frequent feeding may impede drug _____?

Back 17

absorption

Front 18

Low levels of intestinal flora and reduced enzyme function can lead to decreased ________?

Back 18

Absorption

Front 19

Low peripheral perfusion and immature heat regulation can decrease absorption of what 3 types of med ROA?

Back 19

IV, IM, SC

Front 20

What allows the distribution of medication in infants to be more available in circulation?

Back 20

1. Low concentration of plasma proteins

2. Diminished protein-binding capacity

Front 21

Greater permeability of the blood-brain barrier allows for rapid access of drugs to the what in infants?

Back 21

CNS

Front 22

Total body water in infants is __% compared to 50% in the adult.

Back 22

80%

Front 23

If a drug is water soluble and you are giving it to an infant what may need to be done?

Back 23

Higher doses of water soluble drugs may be needed to achieve therapeutic effects.

Front 24

Since drug metabolizing enzymes in the liver of infants are immature. What does this mean for infants?

Back 24

More drugs in circulatory system may increase potential for drug toxicity.

Front 25

Since infant's kidneys have higher resistance to blood flow, lower GFR with a decreased ability to concentrate urine what does this mean physiologically?

Back 25

Infants may secrete drugs more slowly, increasing risk of drug accumulation.

Front 26

At what age is a child's gastric pH equal to an adult?

Back 26

By 2-3 years of age.

Front 27

What are two differences between infants and children in regards to their gastric, skin and blood brain barrier?

Back 27

Gastric emptying rates are faster than infants.

Skin and blood-brain barrier become more effective.

Front 28

At what age do plasma proteins reach adult levels?

Back 28

1

Front 29

Children up to age 2 years of age may require higher dosages?

Back 29

Of water soluble drugs.

Front 30

What are four specific things about the nature of metabolism in children?

Back 30

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

Front 31

Children over __ months of age are able to excrete drugs effectively.

Back 31

12 months

Front 32

What is a rule about rounding specific to infants and small children?

Back 32

Do not round

Front 33

How do you insure safe medication dosing on your watch?

Back 33

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

Front 34

What is the formula method?

Back 34

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.

Front 35

This system is usually seen as best for infants in dosing?

Back 35

Broselow Luten System

Front 36

The color code for pediatric patients was derived in the early eighties .

Back 36

The Broselow-Luten System

Front 37

What is the color for the first three weight categories of the Broselow Luten System 3-5kg, 6-12lbs

Back 37

Gray

Front 38

What color represents 6-7kg, 13-16lbs in the Broselow Luten System?

Back 38

Pink

Front 39

What color represents 8-9kg, 17-20lbs in the Broselow Luten System?

Back 39

Red

Front 40

What color represents 10-11kg, 21-25lbs in the Broselow Luten System?

Back 40

Purple

Front 41

What color represents 12-14kg, 26-31lbs in the Broselow-Luten System?

Back 41

Yellow

Front 42

What color represents 15-18kg, 32-40lbs in the Broselow-Luten System?

Back 42

White

Front 43

What color represents 19-23kg, 41-51lbs in the Broselow-Luten System?

Back 43

Blue

Front 44

What color represents 24-29kg, 52-64lbs in the Broselow-Luten System?

Back 44

Orange

Front 45

What color represents 30-36kg, 35-80lbs in the Broselow-Luten System?

Back 45

Green

Front 46

What is an OTC drug that is overdosed to pediatric patients by their parents 73% of the time?

Back 46

Acetaminophen