Gen Med Midterm Pediatrics
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What is a pediatric patient?
- birth to one month
- one month to one year
- one year to 11 years
- counted from day of last menstrual period
- from day of last mensturation to current day
- less than 37 weeks
- 37-42 weeks
Growth vs development?
- Growth: physical
- development: function and capacity
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)
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)
How is protein binding different in neonates?
protein binding is decreased (lower [ ] , lower affinity)
thus be cautious of drugs with >80% of protein binding
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)
Why is chloramphenicol toxic in babies?
- 90% inactivated by UGT (UGT low at birth-> toxicity)
- Also eliminated by renal filtration-> more toxicity
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
Give an example of PD changes in kids compared to adults
For which medications do you not use body weight?
Topical medications+ vitamins
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)
Nutritional development of children
- 0-6 months: milk or formula
- 6-9 months: breastmilk/formula
- 9-12 months: finger foods/bite sized foods
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
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)
Prednisone vs prednisolone
- Taste: Not good; better
- Availability: extemporaneous; commerical
- Strength: 5ug/mL; 1ug/mL
- Volume/dose: smaller;bigger
Suggestions to mask bad taste
- Use gelatin capsule
- dispense higher concentration
- use dropper/oral syringe
- numb tastebuds
- drink cold-water after administration
- hold nose
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?
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
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
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)
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
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