Naplex: Pediatric Conditions

What are the unique characteristics of pediatric patients that affect medication dosing?

Pediatric patients have age-related physiologic characteristics, such as metabolism, requiring patient-specific dosing.

What is the classification of pediatric age groups?

Neonate (0-28 days), Infant (1 month - <2 years), Child (2-11 years), Adolescent (12-18 years).

What is the first sign of illness in young children?

An elevated temperature.

What temperature indicates a need for medical care in patients < 3 months old?

A temperature of 100.4°F (rectally).

What temperature indicates a need for medical care in patients > 3 months old?

A temperature of 101°F (rectally).

What are some signs that require immediate medical attention in pediatric patients?

Allergic reactions, blood in urine or stool, dehydration, difficulty breathing, limping, head injury, ingestions, seizures, severe rash with fever.

What does the Apgar score assess in newborns?

Appearance, pulse, grimace, activity, and respiratory effort.

What Apgar score indicates a newborn is adapting well to extrauterine life?

A score of 7 or higher.

What routine medications are administered shortly after birth?

Intramuscular vitamin K, ophthalmic erythromycin, and the first dose of the hepatitis B vaccine.

What is the definition of patent ductus arteriosus (PDA)?

A condition where the ductus arteriosus remains open after birth, requiring medical observation or intervention.

What is the treatment for patent ductus arteriosus?

Medical observation, surgery, or NSAIDs like IV indomethacin or ibuprofen to help close the PDA.

What causes respiratory distress syndrome (RDS) in neonates?

A deficiency of surfactant production in underdeveloped lungs, leading to alveoli collapse.

What is the standard treatment for respiratory distress syndrome?

Administration of surfactant products immediately after birth.

What is persistent pulmonary hypertension of the newborn (PPHN)?

A condition where blood vessels in the lungs fail to relax after birth, leading to elevated vascular resistance.

What is the standard treatment for PPHN?

Supportive care and inhaled nitric oxide to dilate the pulmonary vasculature.

What is neonatal sepsis?

A bacterial infection in a full-term, previously healthy neonate with a temperature > 100.4°F.

What are common pathogens causing neonatal meningitis?

Group B Streptococcus (GBS) and, rarely, Listeria.

What is the empiric antibiotic treatment for neonates with fever?

Ampicillin plus ceftazidime, cefepime, or gentamicin.

Why is ceftriaxone avoided in neonates?

It can displace bilirubin from albumin and cause bilirubin-induced brain damage.

What is bronchiolitis?

A common lower respiratory tract condition that nearly all children experience by age two, often leading to hospitalization.

What is the risk factor for severe bronchiolitis?

Neonates and premature infants have a higher risk for severe disease, complications, and death.

What is the role of maternal prostaglandin in a fetus?

It maintains the ductus arteriosus, allowing blood to bypass the immature lungs.

What are the common screening tests conducted for newborns?

Heel blood sample, hearing test, and pulse oximetry.

What is the significance of a low Apgar score?

A score < 7 indicates that the newborn is experiencing distress and may need prompt medical intervention.

What is the primary cause of respiratory distress syndrome in preterm infants?

Insufficient surfactant production due to underdeveloped lungs.

What are the common signs of neonatal meningitis?

Fever, lethargy, poor feeding, irritability, and seizures.

What is the importance of universal GBS screening during pregnancy?

To decrease the risk of transmission of Group B Streptococcus to the neonate during labor.

What virus is responsible for the majority of bronchiolitis cases?

Respiratory syncytial virus (RSV)

What percentage of bronchiolitis cases may involve co-infection with other viruses?

Up to 30%

How does RSV invade the body?

It invades via the nasopharynx and enters the lower respiratory tract.

What are common symptoms of bronchiolitis?

Rhinitis, cough, wheezing, tachypnea, and nasal flaring.

What can occur due to mucus plugging in bronchiolitis?

Hypoxemia

What is a greater concern in younger infants with bronchiolitis?

Apnea

What is the primary treatment approach for RSV infection?

Supportive care (suction of secretions, hydration, supplemental oxygen, and fever management).

What is the recommended RSV prophylaxis for pregnant patients?

The recombinant RSV vaccine (Abrysvo) between 32-36 weeks gestation.

What are the two monoclonal antibodies available for RSV prophylaxis?

Nirsevimab (Beyfortus) and palivizumab (Syngqis).

What is the dosing for nirsevimab in infants under 5 kg?

50 mg IM as a single dose for RSV season.

What are the hallmark signs of croup?

Inspiratory stridor, barking cough, and hoarseness.

What age group is most commonly affected by croup?

Children under 6 years old.

What is the mainstay treatment for croup?

Systemic steroids (e.g., dexamethasone).

What additional treatment may be given in an acute care setting for croup?

Nebulized racemic epinephrine.

What is the primary cause of nocturnal enuresis?

It is a normal part of child development.

What non-drug treatment approaches are recommended for nocturnal enuresis?

Behavioral approaches and alarm therapy.

What is the preferred drug treatment for enuresis?

Desmopressin oral tablet.

What is a serious side effect of desmopressin?

Severe, life-threatening hyponatremia.

What precautions should be taken when administering pediatric medications?

Verify doses based on weight, use appropriate measuring devices, and avoid household spoons.

What is the FDA's recommendation regarding cough and cold medications for children?

Not recommended for children under 2 years old.

What is Reye's syndrome associated with in children?

Aspirin and salicylate-containing products during recovery from viral infections.

What is the most common cause of liver failure in children?

Accidental overdose of acetaminophen.

What should caregivers be counseled about regarding acetaminophen?

The danger of inadvertent use of multiple acetaminophen-containing combination products.

What is the dosing for palivizumab in infants?

15 mg/kg IM once monthly through RSV season.

What should be done if a breakthrough RSV infection occurs requiring hospitalization?

Discontinue palivizumab treatment.

What is the age limit for using palivizumab in infants?

Infants under 12 months old born during or entering their first RSV season.

What is the significance of communication between caregivers and pharmacists in pediatric medication safety?

It can decrease the incidence of preventable adverse drug events.

What is the pathophysiology of bronchiolitis caused by RSV?

Lower respiratory tract mucus plugging and swelling in bronchioles.

What are the symptoms of severe bronchiolitis?

Nasal flaring, rhinitis, tachypnea, apnea, and hypoxemia.

What is a major risk associated with the use of multiple acetaminophen-containing products?

Accidental overdose

Why should ibuprofen be avoided in infants under 6 months old?

Due to the risk of nephrotoxicity

What is the recommended dosing interval for acetaminophen in children?

Every 4-6 hours

What is the maximum daily dose of acetaminophen for children?

40 mg/kg/day

What is the recommended dose of ibuprofen for children aged over 6 months?

5-10 mg/kg/dose every 6-8 hours

What should caregivers be cautioned about when administering acetaminophen?

Incorrect dosing or overdose due to multiple acetaminophen products

What is the appropriate dose of acetaminophen for a child weighing 18.5 lbs?

84.09-126.14 mg every 4-6 hours

What is the appropriate dose of ibuprofen for a child weighing 18.5 lbs?

42.05-84.09 mg every 6-8 hours

How can acetaminophen and ibuprofen be administered together?

In alternating doses every 3 hours

What is the primary treatment for nasal congestion in infants?

Gentle suction with intranasal saline drops or spray

What is a common OTC treatment for dehydration due to diarrhea in infants?

Oral rehydration solutions like Pedialyte

What medication should not be used in children due to the risk of Reye's syndrome?

Bismuth subsalicylate

What is the preferred treatment for constipation in children over 6 months?

Oral polyethylene glycol 3350 (MiraLax)

What should be avoided in children under 2 years for constipation relief?

OTC rectal enemas

What is a key potentially inappropriate drug in pediatrics for children under 2 years?

Promethazine

What medications are contraindicated in patients under 12 years?

Codeine and Tramadol

What is a notable exception for using doxycycline in pediatric patients?

Treatment of tick-borne Rickettsial diseases

What are the classic symptoms of measles?

Koplik spots, maculopapular rash, fever, malaise, cough

What vaccine is recommended to prevent measles?

MMR vaccine

What are the symptoms of mumps?

Swollen salivary glands, fever, headache, myalgia

What can rubella cause if contracted by a pregnant woman?

Birth defects

What are the symptoms of rubella?

Fine pink rash, fever, swollen glands, cold-like symptoms

What is the maximum daily dose of ibuprofen for children?

75 mg/kg/day

What should be done for children with ongoing constipation issues?

They should be seen by a pediatrician.

What is the dosing concentration of acetaminophen oral liquid formulations for infants?

160 mg/5 mL

What should caregivers be cautious about when administering medications?

Incorrect dosing or overdose

What is the recommended treatment for intestinal gas in infants?

Simethicone drops

What is a common symptom of dehydration due to diarrhea?

Significant fluid loss

What is the risk of using topical teething products containing benzocaine?

Increased risk of methemoglobinemia