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132 Cards in this Set
- Front
- Back
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what is different about pediatric pharmacology and the way kids respond to meds?
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-pharmacokinetics is different
-pharmacodynamics are different -adverse drug reactions are different |
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what counts when prescribing a medication to a child? especially one that cannot swallow a pill?
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flavor counts-drug administration can be problematic
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__ & __ changes with the age of the child.
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PD & PK
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what is different about drug absorption when it comes to kids?
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-pH of stomach is higher (until puberty)
-slower motility than an adult |
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protein binding in kids is usually __ in kids.
-more -less |
less-which is less efficient, adjust dosage of protein bound drugs
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infants are __% water.
-50-60 -60-70 -70-80 |
70-80%
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if a child has less body fat that means there is less fat for the drug to __ into.
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distribute
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the younger the kid the __ the metabolism.
-faster -slower |
faster
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if an infant has sepsis, would they get more or less drug (mg/kg) than a 6 month old?
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more at longer intervals-like daily antibiotic instead of lower dose at decreased intervals like bid or tid
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what part of the newborn anatomy is immature at birth, which is why they have higher metabolism?
-gi tract -liver -kidneys |
kidneys
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when do newborn kidney's slow down or mature?
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about 2 weeks
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what type of drugs should be avoided if at all possible in newborns? and why?
-hepatically excreted -renally excreted -gi excreted |
renally excreted due to the immature kidneys
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after about 2 weeks of age how does dosing of drugs typically go?
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decreased dose with increased frequency of dosing schedule
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t/f
benzyl alcohol is safe to use in kids |
false-use stuff that is preservative free
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what could happen if you use benzyl alcohol in kids?
-metabolic acidosis -seizures -hepatic/renal dysfunction -all of the above |
all of the above
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when dosing any med for a kid what must you know?
-age -favorite color -weight -race |
weight
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all drugs except which two require weight (sorry about the previous question)?
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vaccines-doesn't matter
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most pediatric drugs are based on ?
-mg/lb -mg/kg |
mg/kg
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what type of drug is usually based on BSA?
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chemo drugs
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most drugs come in liquid or suspension form except what class of med?
-CCB -diuretics -BB |
beta blockers don't!
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when prescribing a med for a pediatric pt, what must you know about the drug you want to prescribe?
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concentration differences
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Tylenol drops = 100mg/?
Tylenol susp = 80mg/? |
100mg/1cc
80mg/5cc |
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what is better to tell the parent?
-how many cc's to give -how many mg's to give |
mg's to give
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for older kids who may not want a liquid med, what other options are available?
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-tablets
-chewables -sprinkles *remember taste still matters-refrigeration might help* |
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what are 3 pediatric references you should consider for your office?
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-harriet lane
-neofax -nelson's text of pediatrics |
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of the above 3 what is the best reference book for babies up to 6 months of age?
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neofax
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of the 3 reference books which is a good pediatric reference?
-harriet lane -neofax -nelson's peds textbook |
harriet lane
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what is the epidemiology of ADHD?
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3-6% of school aged kids have are on ADHD meds
boys>girls 1/3 to 1/2 kids w/ ADD will have sx's as adults cause unknown |
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what are some non-drug therapy for ADHD?
-structure -family counseling -drug holiday's -all of the above |
all of the above
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what are some major classes of drugs used to tx ADHD?
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stimulants
tricyclic antidepressants MAOI others |
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all of the following are stimulants except what?
-dexedrine -adderall -tofranil -ritalin |
tofranil is a TCA
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what is MOA of stimulants?
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displaces norepinephrine from CNS, with ADHD this calms then down
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what is the dosing of stimulants?
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titration to desired effect
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stimulants "reset the _ level of activity within the brain"
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normal
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what are some problems with stimulants?
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-others might abuse
-pt. might abuse -appetite suppressant -insomnia -growth suppression |
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how do you treat insomnia r/t stimulant therapy?
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adjust the dose, give early in the day
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if stimulants cause growth suppression, what can be done to help with this?
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drug holidays-kids will grow up
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how can you adjust for the appetite suppression caused by stimulants?
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eat well before the dose, then as it is wearing off, eat again...prolly right before bed
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dexedrin, adderall, and ritalin are all examples of what type of drug?
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stimulants
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norpramin, trofanil, and pamelor are all examples of ?
-stimulants -TCA -MAOI |
TCA
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when should you prescribe TCA's for your pt?
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don't-leave this to psychiatrists
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if you give a kid a TCA, what adversely may happen?
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may cause agitation or worsening agitation
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norpramine, tofranil, and pamelor, can have __ effects.
-anticholinergic -cholinergic |
anti-cholinergic effects
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which of the following is the most anti-cholinergic and the least well tolerated?
-norpramin -tofranil -pamelor |
tofranil
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which of the following is very rarely used to treat ADHD?
-stimulants -MAOI -TCA |
MAOI
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what is a major problem with MAOI's?
-side effects -dietary restrictions -tetany |
dietary restrictions
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Parnate is what class of drug?
-TCA -MAOI -stimulants |
MAOI
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in addition to medication what else must a child with ADHD get?
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therapy
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which med has norepinephrine and serotonin effects, meaning it is an inhibitor of norepi/serotonin?
-ritalin -mellaril -strattera |
strattera
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which med is not controlled, not abusable, and can be used in kids and adults?
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strattera
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which of the following is an alpha 2 agonist used in the tx of ADHD?
-catapress -strattera -fluoxetine |
catapress
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all of the following are dopamine antagonists except which?
-haldol -prozac -mellaril -thorazine |
prozac is an ssri
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what does catapress do with the ADHD kid?
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may help to calm
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wellbutrin is appropriate for kids with ADHD in all coexisting condition except what?
-depression -urinary incontinence -seizure disorder |
seizure disorder!!
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prozac can also be helpful in __ disorders
-eating -insomnia -nocturia |
eating disorder
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what is enuresis?
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bedwetting
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what is the rationale for tx of eneresis?
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to relax the bladder
dilate bladder (inc. capacity) dec. production of urine |
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what is first line drug in the treatment of enuresis?
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ddavp
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what are 2 other meds that can be used for enuresis, but that are not used often due to possible behavioral changes?
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tofranil
norpramine |
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which is the most anticholinergic?
-tofranil -norpramine |
tofranil is 4+ therefore is last line therapy
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what routes can ddavp be given?
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ns or po
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when should you give ddavp?
as in what time of day? |
give at hs
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what does ddavp do?
-reduces urine production -reduces bladder spasm -increases bladder tone |
reduces urine production
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what is ddavp?
-adh -adh analgue |
adh analogue
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is ddavp well tolerated?
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yes very much so
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is a pt has "tics, either verbal or physical" is called what?
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tourettes syndrome
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what 3 meds are used in the treatment of tourette's syndrome?
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catapress
haldol verapamil |
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verapamil is what class of drug?
-bb -ccb -acei |
ccb
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what class of drug is catapress?
-bb -alpha 2 agonist -alpha 2 antagonist |
alpha 2 agonist-as long as BP tolerates it
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what type of drug is haldol and what is it typically used as?
-dopamine agonist -dopamine antagonist -serotonin reuptake inhibitor |
dopamine antagoist usually used as an antipsychotic
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you can only use verapamil in the tx of tourette's if what 2 things are maintained?
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hr and bp
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what is the one and only link between all 3 meds used in the tx of tourettes?
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they all get into the cns--that's it.
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otitis media in kids is usually all of the following except?
-s. pneumoniae -h. influenza -m. catarrhalis -s. pyogenes |
not s. pyogenes
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what are the top 3 drugs used in the tx of otitis media?
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amoxil
augmentin 2nd/3rd gen. cephalosporin (cefzil) |
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if a child has otitis media and is under 2 or in daycare how should you tx their OM?
-don't it will resolve on its own -give small course of abx -give big dose of abx |
give big dose, otherwise it will prolly come back and then will develop resistance.
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all of the following are bugs of meningitis except?
-group b strep -e coli -s aureus -l monocytogenes |
not s aureas
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in neonates with meningitis what is the typical bug?
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group b strep from the mom
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what is the treatment of meningitis from group b strep in a neonate?
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ampicillin with either gent or claforan (cefotaxime)
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what is the treatment of meningitis in a child?
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one drug therapy is usually good enough like rocephin
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what are the bugs that typically cause meningitis in children?
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s. pneumonia
n. meningiditus h. influenza |
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if the child is allergic to rocephin, what is an alternative?
-penicillin -imipenem -miripenem |
miripenem
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what is another drug you could give in the case of meningitis?
-lasix -dexamethasone -prednisolone |
dexamethasone-give a little in the 1st 48 hours to decrease morbidity and mortality
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sepsis in a neonate is typically caused by what bugs in a neonate?
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group b strep
l monocytogenes gram neg enteric bacteria (e coli) |
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what abx should you use in a neonate with l monocytogenes?
ampicillin gentamycin claforan |
ampicillin
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what abx should you use in a neonate with gram negative enteric bacteria sepsis?
ampicillin gent claforan |
gent or claforan
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what are the bugs that cause sepsis in children?
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s pneumonia
h influenza n meningitidis |
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what is the tx with a child with sepsis?
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3rd generation cephalosporin such as rocephin or cefotaxime (claforan)
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what are the bugs that commonly cause pneumonia in a neonate....aw hell...all but what?
-group b strip -s aureus -gram neg. bacteria -h influenza |
h influenza is a common bug in the pneumonia of a child
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what do you tx a neonate with pneumonia with?
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amp and gent
or amp and claforan (cefotaxime) |
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all of the following except one are organisms that cause pneumonia in a child...
-s pneumonia -h influenza -s aureus -s pyogenes -m pneumonia -all of the above |
all of the above
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what are the drugs of choice in a child with pneumonia
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rocephin or claforan
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what are common bugs that cause epiglottitis?
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h influenza
s pyogenes s pneumoniae |
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what else will a child need in the tx of epiglottitis?
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iv hydration
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phayngitis is usually caused by what bug and tx's with what antibiotics?
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s pyogenes
tx with a pcn like amoxil |
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t/f
zovirax does not cure but shortens the course of the chicken pox |
true
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what else can you use in the symptomatic tx of chicken pox?
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benadryl
topical corticosteroids |
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if a pt develops the mumps or measles what is the tx?
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give the vaccine and tx symptomatically
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what is the name of the vaccine used in the prevention of rsv?
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synagis that is monoclonal antibody that the baby gets monthly during rsv season (oct-april)
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what disease process overproduces thick secretions?
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cystic fibrosis
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what nebulized med can you give to loosen up secretions within the lungs?
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mucomyst
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if a child has asthma symptoms less than 2 times per week what is the appropriate medication line up?
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short acting B-2 agonist as needed
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if a child has daily symptoms of asthma what is the appropriate treatment?
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daily steroid (po or inhaled)
leukotriene antagonist oral b-2 agonis or inhaled salmeterol prn short acting b-2 agonist can consider theophylline but no one does anymore |
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if a child has asthma symptoms more than 2x a week but not daily what is the med line up?
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qd antiinflammatory po or inhaled (steroid)
leukotriene antagonist prn short acting b2 |
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if a child has severe persistent symptoms of asthma what should their meds be?
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qd inhaled steroid
leukotriene antagonist po b2 or inhaled salmeterol short acting b2 consider po steroid |
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a seal bark cough is indicative of what condition?
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croup
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what is the tx of croup and why?
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racemic epi, because it causes bronchodialation and vasoconstriction
it is the adrenergic of choice |
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what other non-antibiotic meds can help with croup?
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cool mist
antipyretics for fever steroids maybe |
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what is the tx of bronchiolitis?
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fluids
antipyretics steroids bronchodialators antibiotics if a bacterial cause can be found |
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what is the dosage of tylenol for kids?
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10-15mg/kg/dose for fever or pain
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what else can be given to kids for pain?
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motrin, is a good antiinflammatory also comes in suspension and tablets
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can narcotics be used in kids?
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yep sure can otis
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what is the dosage of narcotics in kids based on?
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weight of course
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what is the tx of a child with diarrrhea?
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remove offending agent
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what is the tx of c diff in a child?
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metronidazole
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iv replacement should be provided to a child when they have __% body weight loss.
3% 5% 7% |
5%
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oral fluid replacement can be given if mild body wt. loss, which is?
2-4% 3-5% 5-7% |
3-5%
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t/f
you should give a child with diarrhea antidiarrheal medications. |
false, avoid meds that alter GI motility, let them poop the toxins out. especially if infectious diarrhea
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all of the following meds can be given to kids with reflux except?
-zantac -propulsid -ppi's |
propulsid-nonono, can't even get it anymore
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name a common parasitic infection of children, and the med used to treat it?
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pinworms, treat with vermox or pyrantel pamoate (otc)
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what is the drup of choice in the tx of kids with absence seizures?
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depakote is doc
zarontin is next |
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if a child presents in status epilpticus, what quick lab value should you check at the BS, and what meds should you be quick about giving?
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check a BS
give IV ativan or valium or serzone dilantin or cerebyx phenobarbital if seizure cont's then more of the above if seizure cont's |
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if a child is having partial seizures, what drugs could you prescribe?/
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tegretol-preferred
dilantin depakote (valproic acid) phenobarbital |
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which drug is preferred in the tx of partial seizures?
-phenobarbital -valproic acid -dilantin -tegretol |
tegretol
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what is a problem with dilantin?
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cosmetic problems-can cause course facial features or hirstuism
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what is the tx of generalized tonic-clonic seizures?
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same as partial seizures...
tegretol preferred dilantin depakote (valproic acid) phenobarbital |
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when a child has been poisoned what you consider?
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was it drugs? what kind
plants household chemicals garage stuff |
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what is the tx of choice in child poisonings?
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activated charcoal-1st
chelating agents |
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what is MOA of activated charcoal?
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binds up toxins, r/t increased surface area of the charcoal binds up toxins,
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when giving activated charcoal, what special do you put in the first one?
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charcoal with sorbitol in the 1st bottle, then plain charcoal after that
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why is ipecac no longer recommended in the tx of kids with poisoning?
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risk of aspiration
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what do chelating agents act on?
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iron
lead copper bind them up |
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hwo is chelating agents given?
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iv or po
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