Pediatrics: Pharmacology

Front 1

T/F: Only 25% of drugs marketed in the U.S. are labeled for use in infants & young children.

Back 1

True

Front 2

Some evidence that show the drug could possibly have an adverse reaction, side effect, or be hazardous when used in a pediatric population.

Back 2

NOT Recommended (NR)

Front 3

Unknown risk, insignificant evidence to support pediatric indication; the medication may or may not be safe.

Back 3

NOT Established (NE)

Front 4

What are the 4 major physiological differences seen in pediatrics?

Back 4

1. Absorption
2. Distribution
3. Metabolism
4. Excretion

Front 5

What are some absorption of the drug affected in pediatrics?

Back 5

1) Skin & Conjunctiva
- thinner, more permeable -> increases absorption

2) Cornea
- Larger surface area relative to smaller intraocular volume.

3) GI movements:
- more unpredictable
- possibly decreased motility = drug can be in the system LONGER!

Front 6

How is the distribution of the drug affected in pediatrics?

Back 6

1) Protein binding
- LESS protein binding in infants, especially in premature babies = more free drug is in the body!

2) Increased EXTRAcellular fluid vs TOTAL mass
- potential to dilute drug

3) Blood Brain Barrier
- LESS effective in young children
- MORE CNS effect by drugs

Front 7

How is the metabolism of the drug affected in pediatrics?

Back 7

Metabolism:
- Liver microsomal enzyme system is LESS mature
- LESS effective metabolism -> slower degradation time -> drug will stay in the body LONGER -> LONGER 1/2 life

Front 8

How is the excretion of the drug affected in pediatrics?

Back 8

Excretion:
- If child is dehydrated or has kidney problems, they will have SLOWER rates of excretion & possibly MORE side effects!

Front 9

What are some advantages of topical drops (solutions, suspensions)?

Back 9

ADVANTAGES:

1. Easy to instill in cooperative kids
2. LESS messy
3. LESS effect on vision

Front 10

What are some disadvantages of topical drops (solutions, suspensions)?

Back 10

Disadvantages:

1. Systemic absorption through nasolacrimal system
2. Minimal contact time
3. Difficult administration in uncooperative kids

Front 11

What are some ADVANTAGES of topical ointments?

Back 11

Advantages:

1. MORE comfortable during instillation
2. Reduced potential for systemic toxicity
3. LONGER contact time

Front 12

What are some DISADVANTAGES of topical ointments?

Back 12

Disadvantages:

1. Transient blurry vision
2. Increased potential for contact dermatitis

Front 13

What are 3 commonly used ORAL pharmaceuticals?

Back 13

1. Antihistamines
2. Decongestants
3. Antibiotics

Front 14

What's the BEST way to determine dosage?

Back 14

1. Costeff's Rule
- Body Surface Area (BSA) calculated on weight is also used to determine dosage
- MOST accurate
- MOST commonly used

2. Weight
3. Age

Front 15

What's the BEST OPTION when determining dosage?

Back 15

FDA recommendation is the best option when available.

Front 16

What are some contraindications for Atropine?

Back 16

Children with Down's Syndrome, spastic paralysis, brain damage and very light pigmentation may be hypersensitive to the cholinergic antagonists.

Front 17

What’s the antidote for Atropine toxicity?

Back 17

Physostigmine salicylate

Front 18

What’s the protocol for administering Atropine to kids?

Back 18

Atropine ointment instilled every hour for 3 nights before examination

Front 19

What is a therapeutic use of Atropine?

Back 19

Amblyopia treatment

Front 20

Which antibiotics are safe for infants > 2 months?

Back 20

1) Tobramycin solution & ointment
2) Erythromycin – oral & IV
3) Polytrim

Front 21

Tetracyclines are recommended for pediatrics at what age?

Back 21

Tetracyclines are NOT used in children under 8 years of age

Front 22

Given the patient’s age and condition, give the cycloplegic Rx to use:

Healthy 6 month old

Back 22

2 gtt 0.50% Cyclopentolate

Front 23

Given the patient’s age and condition, give the cycloplegic Rx to use:

3 y/o Hispanic

Back 23

2 gtt, 1% Cyclopentolate

Front 24

Given the patient’s age and condition, give the cycloplegic Rx to use:

3 y/o Hispanic with ET

Back 24

1. NO full cycloplegia with 2 gtt 1% Cyclopentolate

2. 1% Atropine ung qhs for 3 days before appointment

Front 25

NSAIDS can be administered to kids at what age?

Back 25

NSAIDS such as Acular can be administered to kids at least 3 years of age

Front 26

What are two steroids that can be given to kids, and what are the recommended age(s) of administration of these drugs?

Back 26

1) FML = as least 2 years of age

2) Lotoprednol = at least 12 years of age

Front 27

What is the drug of choice for acute anterior uveitis in children?

Back 27

Pred Forte
- Even though NO pediatric guidelines, Pred Forte is still standard of care for acute anterior uveitis in children.

Front 28

Which drug can be given to kids with significant blepharitis with corneal involvement? What is the recommended age for the administration of this drug?

Back 28

Tobradex (Tobramycin 0.3%, Dexamethasone 0.1%) may be used to treat kids with significant blepharitis with corneal involvement for kids at least 2 years of age.

Front 29

Which steroid-antibiotic combination can be used for children of at least 6 years of age?

Back 29

Blephamide (Sulfacetamide 10%, Prednisolone 0.2%)

Front 30

Which drug is the ONLY approved anti-viral for kids?

Back 30

Trifluoridine 1% (Viroptic) for kids at least 6 years of age.

Front 31

What the drug of choice for kids at least age of 6 who suffer from Herpes Simplex?

Back 31

Trifluoridine 1% (Viroptic)

Front 32

Which is the ONLY mast cell-antihistamine combination that can be used for kids at least 4 years of age?

Back 32

Optivar

Front 33

Which anti-allergy steroid can be used for children at least 12 years of age?

Back 33

Alrex

Front 34

Which anti-allergy NSAIDS can be used for children at least 3 years of age?

Back 34

Acular

Front 35

Anti-Allergy (Acute) medications such as Mast cell-antihistamine combinations, NSAIDS, & H1 antihistamines typically are recommended for children of what age?

Back 35

At least 3 years of age

Front 36

A 4 year old with acute allergic conjunctivitis, which drug is LEAST appropriate?

Back 36

Alrex – it’s an anti-allergy steroid approved for kids > 12 y/o.

Front 37

What are some Pediatric Glaucoma protocols for treatment?

Back 37

Pediatric Glaucoma
- Requires surgical intervention
- Poor long-term prognosis
- REFER to pediatric glaucoma specialist (NOT in our scope of practice in CA)

Front 38

What are some medical treatment options for pediatric glaucoma?

Back 38

Little research on age range for glaucoma drugs:

1. Timolol 0.25%, Betaxolol 0.5%
2. Cosopt
3. Diamox
4. Pilocarpine 1%
5. Alphagan

NOTE: Unfortunately, Prostaglandin analogs have shown little effects in most of the children studied.

Front 39

Fluoroquinolones are approved for children of what ages?

Back 39

Fluoroquinolones are approved for children 1 year & older.

Front 40

What are the mechanism of action (MOA) of Fluoroquinolones?

Back 40

Inhibits bacterial DNA gyrase

Front 41

What are the mechanism of action (MOA) of Aminoglycosides?

Back 41

Inhibit protein synthesis

Front 42

Which antibiotics inhibit protein synthesis?

Back 42

1. Aminoglycosides
2. Macrolide

Front 43

Azasite is approved for children of what age group?

Back 43

> 1 year old

Front 44

Erythromycin 0.5% ung, oral, and IV are safe for which pediatric age group?

Back 44

Safe in infants > 2 months

Front 45

Which antibiotic inhibits bacterial cell wall synthesis?

Back 45

1. Bacitracin

2. Penicillin

Front 46

Which antibiotic used in children but NO absolute age range known?

Back 46

Polysporin (Bacitracin, Polymixin B) - ointment

Front 47

Which antibiotic has the following characteristics:

- Steroid antibiotic combo
- Possible severe allergic reactions, including Steven Johnson Syndrome
- Sunburn on affected area can result due to increased photosensitivity with ung.

Back 47

Sulfonamides

Front 48

Anti-viral drugs such as Viroptic have what mechanism of action?

Back 48

Inhibits DNA synthesis