Module Test 2 Set 1

Front 1

Pediatric population is undergoing constant physiologic changes (5)

Back 1

1)convert fetal circulation to neonatal circulation
2)recover from birth asphyxia
3)maintain core body temp
4)regulate fluid balance
5)provide adequate energy substrates

Front 2

Gestational Age (GA)? (2)

Back 2

estimated maturity @ birth
# of weeks of gestation

Front 3

Postnatal age?

Back 3

chronological age after birth

Front 4

Postconceptional age?

Back 4

gestational age plus postnatal age

Front 5

a)preterm
b)full-term
c)newborn/neonate
d)infant
e)toddler
f)young child
g)older child
h)adolescent

Back 5

a)less than 37wks GA
b)37-42wks GA
c)0-1 month old
d)1-12 months old
e)12-24 months old
f)2-5yo
g)6-12yo
h)13-17yo

Front 6

4 considerations w/ gastric pH in PRE-TERM vs. FULL-TERM infants

Back 6

1)gastric pH is 6-8 in full term infant for 1-3 days of life
2)gastric pH is elevated in premature infants b/c of immature acid secretion
3)incr gastric acid production correlates w/ increasing postnatal age
4)acid drugs not as well absorbed, basic drugs are

Front 7

Only thing that increases GIT?

Back 7

human breast milk

Front 8

IM absorption in NEONATES (5)

Back 8

Decr rate/extent of absorption due to:
1)decr muscle blood flow
2)higher % of water in muscle
3)decr extent of muscular contractions
4)peripheral vasomotor instability

Front 9

Rectal absorption in kids (5)

Back 9

1)Good route
2)F of some meds can be incr due to immaturity of hepatic metabolism
3)incr mucosal translocation
4)high amplitude contractions of the rectum vs. adults
5)Decr absorption of LARGE solid suppositories

Front 10

Percutaneous absorption in kids (6)

Back 10

1)chance of higher toxicities w/ topicals
2)higher change of absorbing drugs
3)stratum corneum is underdeveloped and thinner
4)epidermis barely present by 34 gestation weeks
5)skin is more hydrated and associated w/ greater perfusion
6)ratio of BSA to body mass far exceeds adult values

Front 11

Protein binding w/ kids (2)

Back 11

1)decr plasma proteins
2)lower []s of albumin and alpha1-glycoprotein

Front 12

Albumin and protein binding in kids...? (3)

Back 12

1)drugs that are highly protein bound w/ albumin can displase bilirubin
2)leads to incr bilirubin []s in CNS
3)Bactrim causes kernicterus (stains brain yellow/seizures/death)

Front 13

Phase 1 rxns ex (3)

Back 13

1)redox
2)demethylation
3)hydrolysis

Front 14

Phase 2 rxns result in... (2)

Back 14

1)add endogenous molecules to drugs or phase 1 metabolites
2)results in more water soluble product that can be more easily secreted

Front 15

Specific pathways of Phase 2 rxns? (3)

Back 15

1)Sulfation
2)Methylation
3)glucuronide conjugation

Front 16

Phase 2 rxns fxns in kids

Back 16

1)sulfation and methylation WELL DEVELOPED
2)glucuronide conjugation NOT

Front 17

Problems inherent to kids w/ renal tubular development (3)

Back 17

1)decr renal blood flow
2)reduced ability to [] urine in kidney (longer half lives)
3)low urinary pH values (decr reabsorption of weak acids/bases)

Front 18

4 different dosing guidelines for kids

Back 18

1)age-based
2)body-weight based
3)BSA based
4)allometric scaling

Front 19

Age-based dosing regimens
a)adv
b)disadv

Back 19

a)easy to use in everyday practices
b)assumes that maturation of ADME principles is the same in all pts

Front 20

Bodyweight-based dosing
a)adv (2)
b)disadv

Back 20

a1)most common****
a2)kids have a higher med CL based on weight than adults
b)limited for over/underweight kids

Front 21

Other recommendations for Bodywt based dosing (1reg and 3 for overwt kids)

Back 21

1)dosing for post-puberty adolescents should NOT exceed the adult dosing recommendations
2)For overwt: should consider physical size and puberty status
3)For overwt: dosing recommendations are NOT clear
4)For overwt: should NOT be based on chronological age or physical size of kid alone

Front 22

BSA based dosing
a)adv (2)
b)disadv (3)

Back 22

a1)more precise dosing scheme for meds w/ exact dosage calcs
a2)limits potential for overdosing based on actual wt
b1)difficult to estimate ht in children
b2)inconsistencies in calculating BSA
b3)technically challenging

Front 23

Allometric scaling
a)adv
b)disadv

Back 23

a)useful in older children and adolescents
b)not useful in young children and infants

Front 24

Allometric scaling def and ex

Back 24

dose scaled based on changing morphology and physiologic fxn in children and adolescents

bodywt^0.75

Front 25

Drug admin concerns in kids w/ oral admin? (5)

Back 25

1)measuring devices (give w/ Rx)
2)dosage forms
3)sensory appeal of oral dosage forms
4)food-drug interaxns
5)inactive ingredients (EtOH, preservatives)

Front 26

Dispensing points for pediatric pts (3)

Back 26

1)obtain most current wt for child
2)check pediatric dose w/ references that have pediatric dosing
3)dispense oral syringe w/ liquid dosage forms

Front 27

When pt counseling you should consider the following w/ kids (3)

Back 27

1)For older children and adolescents consider counseling them as well as their parents
2)pt education sheets for most meds do not usually consider pediatric pts
3)there are some references available that have adapted pt education sheets to include considerations in kids

Front 28

Psychologic aging?

Back 28

Development of person accompanied by age-specific culturally determined roles/expectations

Front 29

4 categories of old

Back 29

1)older population 50-65
2)elderly population 65-75
3)aged population 75-85
4)very old population 85+

Front 30

# and % of population that is geriatric

Back 30

35million
12.5%

Front 31

Greatest % of old are in what old category?

Back 31

elderly (65-75)

Front 32

M:F ratio is greatest in old category?

Back 32

85+ (28:72)

Front 33

Which population is 2X more likely to be @ FPL?

Back 33

pediatric

Front 34

Pattern of health care utilization in elderly?

Back 34

this 12.5% of the population uses 35-40% of health care resources

Front 35

Living arrangements of elderly (3)

Back 35

1)most self-sufficient in community
2)women have increased risk of living alone
3)5% in LTC's (w/ 50% of these ppl being 85+)

Front 36

_____ live alone @ higher rates

Back 36

old black guys

Front 37

3 leading causes of death and % of deaths they cause

Back 37

1)heart disease
2)cancer
3)cerebrovascular disease
75%

Front 38

____ are most likely to have dementia

Back 38

85+

Front 39

____ are most likely to have depression (2)

Back 39

old women

but instances of depression are the SAME across the old age groups

Front 40

Changes in death rates of:
a)CV
b)cancer
c)cerebrovascular

Back 40

a)decreasing
b)steady
c)decreasing

Front 41

Old changes in BODY COMP
a)normally (4)
b)pathologically (2)

Back 41

a1)decr body water/lean mass
a2)incr body fat
a3)decr serum albumin
a4)incr alpha glycoprotein

b1)obesity
b2)failure to thrive

Front 42

Old changes in CNS fxn
a)normal
b)pathologic (3)

Back 42

a1)decr wt/vol of brain

b1)alzeheimer's
b2)parkinson's
b3)dementia/senility

Front 43

Old changes in endocrine fxn
a)normal (2)
b)pathologic (2)

Back 43

a1)menopause
a2)thyroid gland atrophies

b1)DM
b2)thyroid disease

Front 44

Old changes in GI fxn
a)normal (4)
b)pathologic (2)

Back 44

a1)incr gastric pH
a2)decr GI blood flow
a3)delayed gastric emptying
a4)slowed intestinal tract

b1)chronic constipation
b2)colitis

Front 45

Old changes in GU fxn
a)normal (3)
b)pathologic (2)

Back 45

a1)vagina atrophy b/c decr estrogen
a2)BPH
a3)incontinence

b1)UTI
b2)renal disease

Front 46

Old changes in immune fxn
a)normal
b)pathologic (2)

Back 46

a)decr cell mediated immunity

b1)incr infexns
b2)PUSS- pulmonary, urinary, skin, stomach(GI)

Front 47

Old changes in hepatic fxn
a)normal (2)

Back 47

a1)decr liver size
a2)decr liver blood flow

Front 48

Old changes in oral structures and fxn
a)normal (1)
b)pathologic (3)

Back 48

a1)altered denition

b1)decr saliva
b2)incr carries
b3)incr toothloss

Front 49

Old changes in pulmonary/respiratory fxn
a)normal (5)
b)pathologic (1)

Back 49

a1)decr respiratory strength
a2)decr chest wall compliance
a3)decr total alveolar surface
a4)decr vital capacity
a5)decr maximal breathing capacity

b1)COPD

Front 50

Old changes in renal fxn
a)normal (4)
b)pathologic (2)

Back 50

a1)decr renal blood flow
a2)incr filtration fraction
a3)decr renal mass
a4)decr tubular secretion

b1)renal disease
b2)10% GFR loss every 10yrs after 50

Front 51

Old changes in sensory fxn
a)normal (4)

Back 51

a1)presbopia (old loss of sight)
a2)decr conduction
a3)presbycusis (loss of hearing)
a4)decr accomodation = farsight

Front 52

Old changes in skeletal/muscle fxn
a)normal (1)
b)pathologic (1)

Back 52

a)loss of skeletal bone mass (osteopenia)

b)osteoporosis

Front 53

Iatrogenesis?

Back 53

drug induced harm

Front 54

Top chronic conditions in old (3)

Back 54

1)heart disease
2)HTN
3)arthritis