Paediatrics

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  • Created by: LBCW0502
  • Created on: 06-04-21 17:49
Describe features of the pediatric population
25% of the UK population are <18 years. 320,000 disabled children. 1 million children with mental health problems. 25% of children are in one-parent families. Children are frequent users of health services: routine health checks and immunizations, acute i
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What makes children different to adults when considering medicines?
More susceptible to S/E. Unable to swallow tablets. Sensitive to bitter-tasting medicine. Adherence. Dose adjustment. Height/weight changes. Organ systems not fully functioning. IV issue with smaller veins. Eating habits.
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Describe features of oral absorption
Delayed gastric emptying and transit time – impact on drug absorption. Reduced gastric acid secretion. Birth pH = 7 (normal pH of 4-4.5
reached by 2 years). Reduced absorption of basic drugs (ketoconazole, phenobarbital). Reduced absorption of drugs need
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Describe features of topical absorption
Greater rate and extent of absorption. Immature epidermal barrier. Increased skin hydration. Higher SA: bodyweight ratio. Topical administration can lead to systemic toxicity (chlorhexidine - burns, corticosteroids - Cushinoid symptoms)
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Describe features of parenteral absorption
IV - smaller veins, greater risk of air emboli, infection, inflammation of phlebitis. IM - less muscle mass (unpredictable absorptive, very painful), muscle is poorly perfused (drug is released very slowly into systemic circulation, sustained drug release
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Describe features of body composition
Changes significantly over time. Normal pregnancy of 40 weeks. Term - above 37 weeks. By 1 year of age, babies fat content increases, gain weight. From 1 year to adult – lose fat, become more active. Pre-term – born before 37 weeks, earlier born, less fat
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Describe features of drug distribution
Affected by absorption rate, penetration of biological membranes (BBB more permeable in neonates), perfusion of organs, drug's disposition to distribute e.g. theophylline distributes in TBW, gentamicin distributes in ECF. Drug's affinity for protein bindi
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Describe features of protein binding
Less protein available for drug binding. More displacement of endogenous substances e.g. bilirubin. CNS toxicity from deposition of unconjugated bilirubin in the brain, particularly in basal ganglia (kernicterus). Lower plasma levels for protein bound dr
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Describe features of metabolism
Hepatic CYP450 enzyme function develops slowly (reduced metabolism of drug, increased levels in the body, hangs around for longer, dose adjustment/intervals). Phase I: (Oxidation; Reduction; N-demethylation). Phase II (acetylation, glucuronidation, sulpha
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Describe features of excretion
Some functional nephrons at 8/40 gestation. >26/40 – all present but ↓ size and function. Full complement at 36/40. Wide inter-patient variation – difficult to predict drug clearance. GFR in term (40 ml/min), pre-term >1kg (2-3 ml/min), pre-term <1kg (0.5
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How is the renal function calculated?
eGFR. Neonate = 30 x height / serum creatinine. Child over 1 year = 40 x height / serum creatinine. Height in cm, serum creatinine in micromol/l. Cannot use Cockcroft & Gault equation for children
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Give examples of pharmacodynamic differences in children
Ceftriaxone in neonates – high levels of bilirubin in neonates. use cefotaxime instead). Tetracycline in <12 years (teeth stained). Metoclopramide in <20 years (EPS). Beta-2-agonists in <6 months (sensitive). Aspirin <16 years (Reye's syndrome)
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Describe features of dosing for children (1)
One size fits all (useful for tablets e.g. paracetamol, ranitidine). When does a child become an adult? When can doses be rounded up/down (paracetamol, cefuroxime), is the licensing logical (aciclovir)
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Describe features of dosing for children (2)
Doses based on age (for drugs with a wide TI, no calculations) e.g. amoxicillin PO, 1m-1yr (125 mg TDS), 1-5 years (250 mg TDS), 5-18 years (500 mg TDS). But what if the child is small/large for their age? Doses can be based on BSA e.g. aciclovir but less
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Describe features of dosing for children (3)
Doses based on weight. E.g. Ceftriaxone IV
All ages 50mg/kg OD (max 4g). Cetirizine PO
1–2 years 250mcg/kg BD. Oseltamivir PO
15–23kg 45mg
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Describe features of dosing for children (4)
Need to check if the dose is measurable and if the dose is sensible
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State features of licensing of medications
Clinical trials not carried out in children – issues with consent, increased costs/compensation for complications/limited funding
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What are the consequences of unlicensed medicines?
Greater prescriber responsibility. Nurse/pharmacist responsibility (e.g. for checking appropriateness of drug
and dosage info). Greater risk of harm? Cause of concern for patients/parents/carers. Problems with supply between care sectors
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What properties would make an ideal medicine for a child to take orally?
Liquid, taste, sugar-free, easy to administer, size (not a choking hazard, rectal administration), smell, colour, once-daily dosing, texture, long shelf life
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Describe features of formulation choices
Consider: preferred ROA, if PO can child swallow solid dosage form, what preparations of licensed?
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What are the options if no suitable licensed preparation exists?
“Specials” or “extemps”
– Imported product
– Dosage form manipulation. Cutting or crushing tablets. Dissolving/dispersing tablets. Opening capsules. Cutting suppositories. Administering injections orally. Administering medicines via feeding tubes.
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Describe features of altering formulations (1)
Changing the way in which a dosage form is presented can: alter its absorption characteristics, result in medicines instability, produce local irritant effects, cause failure to reach the site of action, may produce occupational health and safety issues,
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Describe features of altering formulations (2)
E.g. Rx: 10mg PO diclofenac for a 10kg child. Formulation available: 25mg soluble tablets. Solution: Dissolve one tablet in 5mL water, give 2mL. Studies have shown that this method results in highly variable dosing (10- 80% of desired dose)
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Where would you find information to check how to administer medications to a child?
BNFc
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What colour are the enteral syringes for the administration of liquid medicines?
Purple
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Describe features of excipients used in pediatric medicines
Ethanol - Licensed phenobarbitone liquid contains 38%. Benzyl alcohol - can cause circulatory collapse, present in amiodarone, some heparin solutions, clonazepam, lorazepam, triamcinolone, clindamycin, Synacthen Depot®, diazepam, diclofenac. Propylene gly
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Describe features of communicating with children
Address the child / young person. Evidence shows that children / young people want to be involved in their care. The UN states children should be informed of and involved in
decisions regarding their treatments. HCPs speak to the child (more acceptable)
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Describe features of communicating with adolescents (1)
The brain and peoples routine are still developing. Healthy behaviours can be established and embedded. Interventions in adolescence can shape healthcare beliefs in adulthood. Transition period where the child begins to take responsibility for own health
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Describe features of communicating with adolescents (2)
Two main factors – vocabulary and use of jargon:
One study showed that teenagers had a vocabulary of just over 12,600 words compared with the nearly 21,400 words that the average person aged 25 to 34 uses. Young people use approximately 20 words in convo
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What is an error?
A medication error is a preventable event that may cause or lead to inappropriate medication use or Patient harm while the medication is in the control of the health care professional, patient or consumer. 13% of hospital paediatric prescriptions contain
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What are the common dosing errors?
Incorrect documentation of weight. Calculation errors. Exceeding maximum adult dose
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Other cards in this set

Card 2

Front

What makes children different to adults when considering medicines?

Back

More susceptible to S/E. Unable to swallow tablets. Sensitive to bitter-tasting medicine. Adherence. Dose adjustment. Height/weight changes. Organ systems not fully functioning. IV issue with smaller veins. Eating habits.

Card 3

Front

Describe features of oral absorption

Back

Preview of the front of card 3

Card 4

Front

Describe features of topical absorption

Back

Preview of the front of card 4

Card 5

Front

Describe features of parenteral absorption

Back

Preview of the front of card 5
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