(quizlet) Pharm E1: unit 3 Peds

how do neonates differ from older children and adults?

how do neonates differ from older children and adults?

less blood flow, higher distribution of water, less muscle use

children have an underdeveloped ______________

stratum corneum

why can topical drugs result in toxicity in children?

underdeveloped stratum corneum

what could happen if a child is exposed to antihistamine lotions? isopronanol baths?

lotion → seizures/anticholinergic toxidromes

baths → hypoglycemia and lethargy

what factors affect Vd?

- lipid solubility

- plasma protein binding

- tissue binding

- peripheral tissue distribution

if a pt has a higher Vd, how does this affect their dosage?

require a higher dose → "bigger bucket to fill"

because neonates have less plasma proteins and protein binding, how does this affect drugs?

decreased protein binding results in higher free fractions (phenytoin example)

CYP450 activity of full-term infants is ____ that of adults

half

what are the specific pathways of phase I reactions?

oxidation

reduction

hydrolysis

demethylation

what are the specific pathways of phase II reaction?

sulfation

methylation

glucuronide

glycine conjugation

why do neonates have high creatinine during the first week of life?

measured mother's creatinine

how is renal function monitored for newborns?

urine output

what is a disadvantage of dosing children based on bodyweight?

potential for over-dosing and under-dosing in overweight children

what are the pros and cons of dosing based on BSA?

pro: more precise for meds requiring calculation

disadvantage: difficult to estimate length and height, numerous BSA calculations

what are the 3 types of neonatal sepsis?

intrauterine

perinatal acquisition during delivery

hospital acquisition

what is considered early and late sepsis?

early = birth-6 days of life

late = 7-89 days

what is the treatment for early onset sepsis?

empiric therapy:

ampicillin PLUS gentamicin x10 days

which organisms are associated with early onset sepsis?

GBS

E. coli

Listeria

which organisms are associated with late onset sepsis?

GBS

E. coli

Candida

what is the treatment for late onset sepsis?

empiric therapy:

ampicillin or vanco PLUS gentamicin or cefotaxime

what is the duration of tx for late-onset sepsis?

bacteremia = 10 days

meningitis = 14-21 days

when should intrapartum abx be given?

if GBS is isolated for urine or identified as a carrier

OR

unknown GBS status with any of these risk factors:

- pre term

- ROM >18 hrs

- temp >100.4

what is the tx for prevention of GBS sepsis?

Pen G

or

ampicillin

PCN allergy = cefazolin, clinda, vanco

if an infant is ill-appearing, what tx should be given?

empiric tx with ampicillin and gentamicin

what is the treatment for neonatal herpes?

IV acyclovir

what factors increase surfactant?

1. antenatal steroids (betamethasone, dexamethasone)

2. PROM

3. maternal HTN

what surfactants are used for RDS?

Survanta (beractant)

Curosurf (poractant alfa)

administered via ET tube; divided into 2-4 aliquots

what is the tx for apnea of prematurity?

caffeine (methylxanthines)

what accounts for 95% of morbidity and mortality in pts with CF?

lung disease

what is the tx for CF?

chest PT

inhalation therapy

abx therapy

What is CPT?

chest percussion combined with postural drainage → cough clears mucus from large airways

recommended 1-4x daily

what abx are used for pulm tx for CF?

aerosolized abx → adjunct to IV abx

tobramycin, gentamycin, amikacin

colistimethate

ceftazidime

which drug is a DNA enzyme which selectively cleaves DNA from the nuclei of degenerating neutrophils in the lung and reduces the viscosity of CF sputum?

Pulmozyme

how does hypertonic saline tx CF?

draws water to mucous → breaks up mucous

- rheologic properties

- transport of mucous

- hydration of airway surface

- mucociliary clearance

- lung fxn

how are pulm exacerbations treated?

aggressively

2+ weeks

max dose of abx

which oral abx can be used for lung infection caused by staph?

dicloxacillin

kelfex

clinda

augmentin

macrolide

which oral abx can be used for lung infxn caused by H. influenza?

amox

augmentin

2/3rd gen ceph

which oral abx can be used for lung infxn caused by pseudomonas?

cipro

tobramycin

which IV abx should be used for pulm infection?

minimum of 2 abx:

aminoglycoside + antipseudomonal beta lactam (cefepime, ceftazidime, unasyn)

may need 3rd abx for staph aureus and burkholderia

what anti-inflammatory drugs are used for tx of CF?

corticosteroids

ibuprofen

macrolides

which drugs are used for pancreatic enzyme replacement?

pancrelipase products→

pancrease

creon

zenpep

ultrase

when should you consider addition of PPI or H2 antagonist to increase fat absorption when administering pancreatic enzyme supplements?

doses >3000 units

why are cholinergic agonists contraindicated in CF pts?

increases mucous formation

which new CF treatment is a CFTR potentiator that increases chloride transport by potentiating channel opening probability?

Ivacaftor

which new CF treatment improves conformational stability of F508del-CFTR increased processing and trafficking of mature protein to cell surface?

lumacaftor

what lifestyle mods can be used for tx of GERD in infants?

thickening of infant's formula (rice cereal)

hypoallergenic formula

how do antacids tx GERD?

neutralize gastric acid

calcium carbonate (tums)

mag/aluminum hydroxide (maalox)

how do prokinetics treat GERD?

increase LES pressure, improve esophageal peristalsis and accelerate gastric emptying

metoclopramide

erythromycin

why is reglan sedating?

dopamine receptor antagonist

erythro drug interactions

CYP3A4 and CYP1A2 inhibitor

how do histamine H2 receptor antagonists treat GERD?

competitively inhibit interaction of histamine with H2 receptors on the gastric parietal cells in decreased acid secretion

nizatidine

famotidine

cimetidine

cimetidine is a _________ inhibitor

strong CYP3A4 inhibitor

what is the MOA of PPIs?

covalently and irreversibly binds and deactivates the H+, K+ ATPAse pump in parietal cells, thereby blocking the ion exchange that is the final step in HCl secretion

what is the MC cause of constipation in children?

painful BM with resultant voluntary withholding of feces

what oral meds are used for treatment of constipation?

mineral oil

polyethylene glycol

mag hydroxide

mag citrate

lactulose

sorbitol

senna

bisacodyl

why should we avoid sodium phosphate based enema in children?

cause fatal hyperphosphatemia → use glycerin instead

what rectal meds are used for tx of constipation?

enemas

suppositories