Gen Med Midterm Pediatrics

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Gen Med Midterm Pediatrics
2014-02-09 22:51:49
Gen Med Midterm Pediatrics
Gen Med Midterm Pediatrics
Gen Med Midterm Pediatrics
Show Answers:

  1. What is a pediatric patient?
    • <18
    • birth to one month
    • one month to one year
    • one year to 11 years
    • 12-18
  2. Gestational age
    Post-menstrual age
    • counted from day of last menstrual period
    • from day of last mensturation to current day
    • less than 37 weeks
    • 37-42 weeks
  3. Growth vs development?
    • Growth: physical
    • development: function and capacity
  4. Gastric acidity in babies
    • none at birth, starts within hours
    • may see a rise in pH after week/month
    • back to adult pH levels from 3 months to 2 years

    gastric pH of neonates: hinders absorption of weak acids (phenobarbital), increases absorption of weak bases (penicillins)
  5. Distribution changes in neonates (from preterm to 1 year)
    • TBW decreases (85->60)
    • ECF decreases (60-> 20)
    • ICF increases (25-> 40)

    may need higher/lower doses based on hydrophillic/phobicity of drugs

    ex. gentamycin (hydrophillic)
  6. How is protein binding different in neonates?
    protein binding is decreased (lower [ ] , lower affinity)

    thus be cautious of drugs with >80% of protein binding
  7. How is metabolism different in children?
    • Birth-almost none
    • Children-could be higher

    thus drugs metabolized by liver may stay in body longer (decrease dose or increase tau)
  8. Why is chloramphenicol toxic in babies?
    • 90% inactivated by UGT (UGT low at birth-> toxicity)
    • Also eliminated by renal filtration-> more toxicity
  9. How are kidneys different in neonates?
    Nephrogenesis starts at week 9, completed at week 36 (but not functional) -> preterm babies are very compromised

    At birth, all renal functions are reduced

    Adult capacity at 1 y.o.

    ex. Tobramycin (elimated renally)-> reduced dose until they become children
  10. Give an example of PD changes in kids compared to adults
    thalidomide-> Phocomelia
  11. For which medications do you not use body weight?
    Topical medications+ vitamins
  12. In pediatrics, what part of the medication use process requires special attention?
    • Drug product
    • Dosage regimen
    • (safety and efficacy as well, but not as much)
  13. Nutritional development of children
    • 0-6 months: milk or formula
    • 6-9 months: breastmilk/formula
    • 9-12 months: finger foods/bite sized foods
  14. Dosage forms that can be used for diff ages
    • up to 2 years-> only liquids (suspensions, solutions)
    • 2-5 years: liquids, dispersable tablets/powders etc.
    • 6-11 years: everything but capsules (or controlled release stuff)
    • 12: anything
  15. When to use dissolve and dose?
    • If drug is not commercially available as a liquid
    • no extemporaneous liquid formulation exists
    • dose cannot be obtained in tablet form
    • pharmaceutical considerations are satisfied (solubility + stability)
  16. Prednisone vs prednisolone
    • Taste: Not good; better
    • Availability: extemporaneous; commerical
    • Strength: 5ug/mL; 1ug/mL
    • Volume/dose: smaller;bigger
  17. Suggestions to mask bad taste
    • Use gelatin capsule
    • dispense higher concentration
    • use dropper/oral syringe
    • numb tastebuds
    • drink cold-water after administration
    • hold nose
  18. If patient can't tolerate liquid, what can you do?
    • Can tablet be split, crushed or mixed?
    • Is a dose change acceptable?
    • Is family comfortable with this strategy?
  19. Vaccines:
    biological preparations that promote the body's immune system to make antibodies, T-cells and memory cells against bacteria/virus

    • Whole microbes or isolated microbial components
    • Contain altered microorganisms

    Both types provide active immunity
  20. Best site of administration?

    Max volume for each site?
    • Anyone under 2: can do vastus lateralis
    • Anyone over 1: ventrogluteal area or deltoid
    • Anyone over 3: Deltoid, vastus lateralis, ventrogluteal area

    • vastus lateralis: 3mL (1mL for infants)
    • deltoid: 0.5 mL
    • ventrogluteal area: 3mL
  21. What are some ways you can mask pain?
    • EMLA (2.5%lidocaine+2.5%prilocaine-> takes 60 minutes, is a cream
    • Can give sucrose 24% immediately after injection (oral solution)
  22. What info should you give on discharge counselling?
    • difference in administration (give vs. take)
    • correct measuring devices
    • Tips for child aministration (tablets to babies/masking taste)
    • write down info
    • give them a schedule
    • demonstrate medication admin