Wk 2 Pharmacology Chapter 10 (12) - Drug Therapy in Pediatric Patients

Distribution factors in pediatrics includes:

Protein binding is immature Blood-brain barrier is immature

Dosage should also be _________ for drugs used for actions outside the CNS if those drugs are capable of producing a CNS toxicity as a result

Reduced

What is the dosage calculation of a pediatric patient?

(Body surface area of the child x Adult dose) / (1.73m2)

When are adult levels of renal function achieved by in neonates and infants?

1 year

Complete liver maturation occurs by

1 year of age

What age do neonates and infants have adult protein binding capacity?

10 to 12 months

When do neonates and infants have adult gastric acidity function?

2 years

When do neonates and infants have adult gastric function?

6 to 8 months

Because there are limited drug/protein binding in infants, infants need higher/reduced dosage

Reduced dosage

A 2-year-old child is prescribed an oral drug that is eliminated by metabolism in the liver. Based on the child's age, the nurse would expect to make which adjustment? A. The drug may need to be administered more frequently. B. The dosage of the drug may need to be decreased. C. The route should be changed from oral to intramuscular. D. The drug should be administered on an empty stomach.

A. The drug may need to be administered more frequently.

What are the stages of pharmacokinetics in neonates and infants?

Absorption Distribution Protein binding of drugs Hepatic metabolism Renal excretion

Increased sensitivity in infants is caused by which immature pharmacokinetic processes:

Absorption Protein binding of drugs Blood-brain barrier Hepatic metabolism Renal drug excretion

Neonates are especially ___________ to drugs that are eliminated primarily by hepatic metabolism.

Sensitive

At what age do children decline in their ability to metabolize drugs?

Age 2

Pediatric patients are what age?

All patients younger than 16 years old

True or False Transdermal Absorption of neonates and infants is more rapid for infants than for older children and adults

True

True or False For drug purposes , infancy is defined as from the end of 4 weeks to 1 year of age .

True

A nurse is preparing to administer medications to a 4 - month old infant . Which of the following pharmacokinetic principles should the nurse consider when administering medications to this client ? ( Select all that apply . ) A. Infants have a more rapid gastric emptying time . B. Infants have immature liver function . C. Infants ' blood - brain barrier is poorly developed . D. Infants have an increased ability to absorb topical medications . E. Infants have an increased number of protein - binding sites .

B. Infants have immature liver function . C. Infants ' blood - brain barrier is poorly developed . D. Infants have an increased ability to absorb topical medications .

True or False The majority of drugs used in pediatrics have never been tested on children .

True

True or False Toddlers often need higher doses per body weight than preschool children .

True

True or false Infants are at an increased risk of toxicity from topical drugs

True

What two laws monitor drugs in children?

Best Pharmaceuticals for Children Act (2002) Pediatric Research Equity Act of 2003 These laws were permanently reauthorized as part of the FDA Safety and Innovation Act (FDASIA) of 2012

A 15-month-old patient develops chemotherapy-induced nausea and vomiting. Which medication, if ordered by the healthcare provider, should the nurse question? A. Ondansetron [Zofran] B. Dexamethasone [Decadron] C. Promethazine [Phenergan] D. Metoclopramide [Reglan]

C. Promethazine [Phenergan]

A toddler has been prescribed a medication that does not have an established pediatric dose. To calculate the appropriate dose for the child, the nurse should consider what information? A. The child's weight is 26 pounds. B. The child's height is 32 inches. C. The child's body surface area is 0.52 kg/m2. D. The child's age is 24 months.

C. The child's body surface area is 0.52 kg/m2.

True or false Infants are especially sensitive to drugs that affect the CNS function

True

True or False Binding of drugs to albumin and other plasma proteins is limited in infants

True Infants have limited amounts of albumin and drug absorption will decrease if all protein have bonded

At what age in children does the livers capacity to metabolize many drugs increase rapidly?

One month the adult level is reached a few months later

Absorption in pediatrics includes:

Oral administration Intramuscular administration Percutaneous absorption

What was found to be true in children in clinical studies?

Twenty percent of drugs were ineffective for children even though they were effective for adults Thirty percent of drugs caused unanticipated side effects, some of which were potentially lethal Twenty percent of drugs required dosages different from those that had been extrapolated from dosages used in adults

What is the major factor in considering medication in pediatrics?

Weight

The nurse provides teaching for the caregiver of a 2-month-old infant and a 3-year-old child. Both children will be taking oral ampicillin (an acid-labile drug) to treat a bacterial infection. The nurse determines that teaching is successful if the caregiver makes which of the following statements? A. "The dose will not be different, but the baby will take the drug for 7 days instead of 10 days." B. "The dose will be higher for the baby, because the infection is more serious." C. "The dose will be the same, because my children have the same infection." D. "The dose will be smaller for the baby, because the drug will be absorbed better in the stomach."

D. "The dose will be smaller for the baby, because the drug will be absorbed better in the stomach."

Pharmacokinetics in Neonates and infants determines what?

Determining the concentration of a drug at its sites of action

What should be included in effective education for a pediatric patient?

Dosage size and timing Route and technique of administration Duration of treatment Drug storage The nature and time course of desired responses The nature and time course of adverse responses

Immaturity of organs puts patient at risk for both of these responses

Elevated drug levels/more intense response and Delayed elimination/Prolonged response

True or False All drugs that are considered safe to admin ister to adults are safe for administration to pediatric patients if the dose is adjusted appropriately for size .

False

True or False Approximating safe doses of drugs for chil dren is most accurate when calculated based on weight .

False

True or False Intramuscular absorption of drugs is slower in the infant than in the adult .

False

True or False Pediatric dosing is an exact science.

False It is an approximation and may need to be adjusted

True or False The drug-metabolizing capacity of newborns is high

False It is low

True or False Most pharmacokinetic parameters of children are not similar to those of adults

False They are similar

True or False Endogenous compounds do not compete with drugs for available binding sites

False They do compete

True or false Blood flow to skin is greater in older patients than infants

False Greater in infants

True or False Two-thirds of drugs used in pediatrics have been tested in pediatric patients

False Have NEVER been tested in pediatric patients

True or False Drugs and other chemicals can not easily access the central nervous system in neonates and infants because of the blood brain barrier

False It can easily access because the blood brain barrier is not fully developed at birth

Oral drug Absorption in neonates and infants depends on:

Gastric emptying time Gastric acidity

What are some age-related effects of adverse drug reactions in children?

Growth suppression (caused by glucocorticoids) Discoloration of developing teeth (tetracyclines) Kernicterus (sulfonamides)

A nurse is preparing to orient new nurses to the pediatric unit. When discussing the differences in the distribution of medication for infants as compared with adults, the nurse will inform the orientees that the amount of water in a young infant's body differs from that found in the body of an adult. How does it differ? What are the clinical implications? What should the nurse teach the orientees about young infants' medication requirements related to the administration of fat-soluble medications and medications that bind to plasma proteins? Is there any information that the nurse should teach the new orientees about the administration of medications to young infants with regard to the blood-brain barrier?

How does it differ?- Amount of water will be higher, so it will require a larger dose What are the clinical implications?- What should the nurse teach the orientees about young infants' medication requirements related to the administration of fat-soluble medications and medications that bind to plasma proteins?- less body fat as a baby, increase dosage because infants have less plasma protein Is there any information that the nurse should teach the new orientees about the administration of medications to young infants with regard to the blood-brain barrier?- more immature, so we need to worry about CNS affects of medication, can develop neurological toxicity faster

Intramuscular drug Absorption in neonates and infants depends on:

Intramuscular administration which can be slow & erratic

Intramuscular absorption in neonates and infants can be delayed as a result of what

Low blood flow to muscles during the first few days of life

During early infancy, absorption of intramuscular drugs are (more rapid/more slow) in neonates than adults

More rapid

What are some factors that affect pediatric patients with drugs?

Show greater individual variation Sensitivity due mainly to organ system immaturity Increased risk for adverse drug reactions Ongoing growth and development Different age groups have different challenges

Why are intramuscular injects not often used during neonates and infants?

Tends to be slow and erratic Delayed absorption as a result of low blood flow to muscles during the first few days of life Absorption of intramuscular drugs more rapid in neonates and adults

Transdermal Absorption of neonates and infants is more rapid for infants than for older children and adults because infants have

Thin skin (stratum corneum)

True or False Children are vulnerable to unique adverse effects related to organ maturity and ongoing growth and development

True

True or False Drug sensitivity in children is more like that of adults than neonates/infants

True

True or False Neonate and infant renal excretion is significantly reduced at birth

True

True or False Pediatric patients respond differently to drugs than the rest of the population

True

The safe dose of a liquid drug for a 6 - month - old is 0.75 mL . Which would be best used to accurately administer the drug ? a . 1 - mL syringe without the needle b . 3 - mL syringe without the needle c . 5 - mL syringe without the needle d . Calibrated plastic medicine cup

a . 1 - mL syringe without the needle

Which drugs are recommended by the American Academy of Pediatrics ( AAP ) as safe and effec tive for relieving cold symptoms in a 4 - year - old child ? ( Select all that apply . ) a . Acetaminophen b . Dextromethorphan c . Ibuprofen d . Ibuprofen and pseudoephedrine e . Phenylephrine

a . Acetaminophen c . Ibuprofen

An infant is diagnosed with scurvy caused by vitamin C deficiency . Based on the principles of pH - dependent ionization and ion trapping and the differences in gastrointestinal physiology in the infant , the nurse would expect that the prescribed dose of vitamin C ( ascorbic acid ) adjusted for weight would be what ? a . Less than an adult dose b . Equal to an adult dose c . More than an adult dose d . None ; vitamin C should not be given to infants .

a . Less than an adult dose

The nurse is preparing to administer 4.5 mL of medication to a shy 6 - year - old child . Which nurs ing intervention is most likely to gain cooperation from the child with taking the drug ? a . Use a syringe to accurately measure the medication and ask the parents if they have any special technique for administering medication that has been effective with this child b . Mix the medication in a 6 - ounce glass of juice to mask the taste . c . Place the medication in a large empty glass so that the child can see that there is only a small amount of medication . d . Use a syringe to accurately measure the medi cation and squirt the medication into the child's mouth .

a . Use a syringe to accurately measure the medication and ask the parents if they have any special technique for administering medication that has been effective with this child

What is the MOST important factor to consider when determining dosage in children?

body surface area

Which is the recommendation by the Centers for Disease Control and Prevention ( CDC ) for over the - counter ( OTC ) cough and cold drug use in children younger than 2 years ? a . Do not give any OTC drugs to a child younger than 2 years . b . Do not give any OTC cough and cold prepara tions to a child younger than 2 years . c . OTC cough and cold drugs are safe and effec tive if the preparation is specifically made for children and is properly measured . d . Use accurate measuring devices specifically designed for pediatric use when administering OTC cough and cold drugs to children younger than 2 years

b . Do not give any OTC cough and cold prepara tions to a child younger than 2 years .

Premature infants are at risk for what kind of response to drugs ? a . Inadequate and short - lived response b . Intense and prolonged response c . Inadequate but prolonged response d . Intense but short - lived response

b . Intense and prolonged response

Immaturity of organs puts patient at risk for ?

both of these responses- more intense response and prolonged response

A pregnant patient received morphine sulfate late in labor . The neonate was born 22 minutes later . Because the drug crosses the placenta , and the characteristics of the blood - brain barrier of the neonate , which neonatal assessment finding would be of most concern to the nurse ? a . Abdominal breathing b . Pulse 160 beats / min c . Respirations 22/min d . Temperature 98.1 F

c . Respirations 22/min

What is one important difference in drug sensitivity between children and adults?

children older than 1 metabolize drugs faster than adults

Drugs eliminated by renal secretion must be ____________

given in reduce dosage and/or at longer dosing intervals

What causes poor renal excretion in neonates and infants?

low renal blood flow, glomerular filtration, and active tubular secretion

What might a healthcare provider need to do to increase therapeutic effect in medication in children over the age of 1?

may need to increase dosage or decrease interval between doses (give dose more often)

Pediatric patients are _______ sensitive to drugs than other patients are

more

Elevated drug levels means what kind of response?

more intense response

Delayed elimination means what kind of response?

prolonged response

At what age is there a sharp decline in a childs ability to metabolize drugs?

puberty