pediatric growth and development - dr gore

1 hour ~ 5 questions

which of the following is this: 0-28 days old or 0-44 weeks postmenstrual age (PMA)?

a. neonate

b. infant

c. child

d. adolescent

a.

which of the following is this: 1-12 months old?

a. neonate

b. infant

c. child

d. adolescent

b.

which of the following is this: 1-12 years old?

a. neonate

b. infant

c. child

d. adolescent

c.

which of the following is this: 12-17 years old?

a. neonate

b. infant

c. child

d. adolescent

d.

which of the following is this: ≤ 26 weeks gestational age or < 800 g

a. micro-preemie

b. extremely preterm

c. very preterm

d. premature

e. full term

a.

which of the following is this: < 28 weeks gestational age

a. micro-preemie

b. extremely preterm

c. very preterm

d. premature

e. full term

b.

which of the following is this: 28-32 weeks gestational age

a. micro-preemie

b. extremely preterm

c. very preterm

d. premature

e. full term

c.

which of the following is this: < 37 weeks gestational age

a. micro-preemie

b. extremely preterm

c. very preterm

d. premature

e. full term

d.

which of the following is this: 37-42 weeks gestational age

a. micro-preemie

b. extremely preterm

c. very preterm

d. premature

e. full term

e.

what is the time elapsed between the first day of the last normal menstrual period and the day of delivery (weeks)?

a. gestational age

b. chronological age or postnatal age

c. postmenstrual age (PMA) or corrected gestational age (CGA)

d. corrected age

a.

what is the time elapsed since birth?

a. gestational age

b. chronological age or postnatal age

c. postmenstrual age (PMA) or corrected gestational age (CGA)

d. corrected age

b.

what is the gestational age + chronological age?

a. gestational age

b. chronological age or postnatal age

c. postmenstrual age (PMA) or corrected gestational age (CGA)

d. corrected age

c.

what is the number of weeks before 40 weeks of gestation - chronological age?

a. gestational age

b. chronological age or postnatal age

c. postmenstrual age (PMA) or corrected gestational age (CGA)

d. corrected age

d.

who does corrected age describe?

children up to 3 years of age who were born preterm

absorption in pediatric pts

______ gastric pH

________ GI motility and ________ gastric emptying

what dosage forms absorption differs compared to adults?

higher gastric pH

less GI motility and prolonged gastric emptying

DF: IM, rectal, and topical

_______ drugs will have a LARGER Vd in neonates/infants

a. hydrophilic

b. lipophilic

a.

_______ drugs will have a SMALLER Vd in neonates/infants

a. hydrophilic

b. lipophilic

b.

what processes are immature at birth, resulting in increased risk for toxicity?

phase I and II metabolite processes

excretion

GFR is very _____ at birth

clearance of renally-eliminated drugs may be _______, so ______ dosing intervals needed

GFR is very low at birth

clearance of renally-eliminated drugs may be reduced, so longer dosing intervals needed

how do we estimate glomerular filtration rate in pediatric patients?

a. Cockcroft Gault equation

b. Bedside Schwartz equation

b.

SCr is ______ at birth

a. elevated

b. reduced

a.

T/F term neonates SCr declines rapidly in the first week of life

TRUE

medication dosing for neonatal, infant, and pediatric patients is based on ___________

weight or BSA

idk if important

what are exceptions to dosing meds based on weight or BSA?

med dose standardized by age: respiratory, topicals, multivitamins, ophthalmic and otic

meds whose weight based dosing would exceed max adult dose

what weight is used for med dosing for neonates?

birth weight or most current weight (whichever is greater)

drug dosing weight

what is the IBW equation for pediatric pts < 5 ft?

([height in cm] x 2 × 1.65)

1000

what is the IBW equation for male pediatric pts > 5 ft?

39 + (2.27 x [height in inches - 60])

what is the IBW equation for female pediatric pts > 5 ft?

42 + (2.27 x [height in inches - 60])

practice — make sure you note if the dosing is per DAY or per DOSE

according to UptoDate Lexidrug: Clindamycin 30-40 mg/kg/day divided every 6-8 hours

patient weighs 10 kg

what dose is correct:

a. 300 mg every 8 hours

b. 100 mg every 8 hours

c. 37.5 mg every 8 hours

b.

what dosage form do we avoid in pediatrics due to alcohol content?

elixirs

what age usually requires liquid formulations?

< 8 years old

depending on the drug properties

since every med does NOT come as an oral liquid, what are some measures we can take? (SATA)

a. IV formulation admin orally

b. crushed tablet or opened capsule may be mixed in a fixed volume of water

c. topical formulation placed sublingually

d. extemporaneous formulation can be prepared

a. b. d.

for IV access, what may be used in the NICU and are considered central access?

umbilical artery catheter (UAC)/umbilical vein catheter (UVC)

T/F all drugs will have the same concentrations that can be administered centrally vs peripherally as adult patients

FALSE - depending on drug it may have different concentrations allowed compared to adult pts

medications may be too concentrated to allow for accurate measurement of a dose thus requiring _______

dilutions

medication concentrations used in adults may be too dilute for neonates, what could this cause?

use up a significant percentage of total daily fluid allowed —> fluid overload

in general, volumes less than _____ should be drawn up into a syringe, and volumes greater than that should be dispensed into a bag

50 mL

which allows for more accuracy in very small hourly rates (< 5 mL/h)?

a. large volume infusion pump

b. syringe pump

b.

SQ injections are administered into _____ for infants aged < 12 months with a max volume of _____

thigh - 0.5 mL

SQ injections are administered into _____ for persons aged > 12 months with a max volume of _____

upper-outer triceps area - 1 mL

what is a reference tool for medication safety in pediatrics and includes a list of medications with a high likelihood of adverse drug events for pediatric patients?

the kids list - key to potentially inappropriate drugs in pediatrics

T/F medications may list that excipients are included within the formulation, but not always the total amount of each

TRUE

what excipients do we need to avoid or use caution with for pediatric patients?

• alcohol/ethanol/ethyl alcohol

• propylene glycol

• phenylalanine

• polysorbate 80

should we use preservative (parabens, benzyl alcohol, sodium benzoate, benzoic acid) or preservative-free formulations in neonates?

why?

preservative-free

toxicities: respiratory spasms, metabolic acidosis, hyperbilirubinemia, CNS depression

KNOW THIS

where are rate of errors and potential ADEs significantly higher?

NICU

T/F rate of potential ADEs 3x higher for pediatric patients

TRUE

why is there an increased risk for med errors for pediatric patients (specifically prescribing)?

1. different and changing PK parameters

2. lack of pediatric formulations, DFs, guidelines

3. calculation errors

4. inconsistent measurement of preparations

5. problems with drug deliver systems

what dosage reference is preferred for neonatal population?

a. NeoFax

b. UpToDate Lexidrug

a.

what dosage reference is preferred for infant/pediatric population?

a. NeoFax

b. UpToDate Lexidrug

b.

what reference provides an overview of age-related PK changes, nutrition, and other disease states?

a. Pediatric Pharmacotherapy

b. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children

c. The Harriet Lane Handbook

d. Brigg’s Pregnancy and Lactation Guide

a.

what reference is used for dose adjustments required for pediatric patients based on their GFR?

a. Pediatric Pharmacotherapy

b. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children

c. The Harriet Lane Handbook

d. Brigg’s Pregnancy and Lactation Guide

b.

what reference is used for pediatric disease states and vital sign ranges?

a. Pediatric Pharmacotherapy

b. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children

c. The Harriet Lane Handbook

d. Brigg’s Pregnancy and Lactation Guide

c.

what reference has information on fetal and neonatal risks?

a. Pediatric Pharmacotherapy

b. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children

c. The Harriet Lane Handbook

d. Brigg’s Pregnancy and Lactation Guide

d.

what references have information regarding medications and breastfeeding women? (SATA)

a. LactMed

b. E-Lactancia

c. Hale’s Medication and Mother’s Milk 2021

d. Red Book

a. b. c.

note: E-Lactancia is available in English and Spanish

what reference has information on pediatric disease states and their development?

a. Nelson’s Textbook of Pediatrics

b. Red Book

c. The Teddy Bear Book: Pediatric Injectable Drugs

d. Hale’s Medication and Mother’s Milk

a.

what reference has information on antimicrobial treatment options and disease states?

a. Nelson’s Textbook of Pediatrics

b. Red Book

c. The Teddy Bear Book: Pediatric Injectable Drugs

d. Hale’s Medication and Mother’s Milk

b.

what reference would you use for IV medication preparation and administration?

a. Nelson’s Textbook of Pediatrics

b. Red Book

c. The Teddy Bear Book: Pediatric Injectable Drugs

d. Hale’s Medication and Mother’s Milk

c.