Disease Specific Therapy
In pediatric sepsis, the Surviving Sepsis Campaign recommends initial fluid resuscitation with this volume of isotonic crystalloid per kilogram, titrated to clinical response.
What is 10-20 mL/kg?
Unlike adults who are dosed by fixed amounts, most pediatric drug doses are calculated using which method?
What is weight-based dosing?
Other methods include mg/BSA
*It is important to note that sometimes IBW/ABW/BW play a roll as well as "Dry" and "Wet" body weight which can change your dosing weight.
This oral dosage form is preferred in young children who cannot swallow tablets, and pharmacists often need to compound it when no commercial product exists.
What is a liquid suspension (or oral solution)?
Neonates have a higher percentage of total body water compared to adults, which increases this pharmacokinetic parameter for hydrophilic drugs like aminoglycosides.
What is volume of distribution?
Slide 13
Reye's syndrome, a potentially fatal condition involving liver failure and encephalopathy, is the reason aspirin is avoided in pediatric patients with this type of illness.
What are viral infections (e.g. influenza or varicella)?
Slide 43
Unlike adults with community-acquired pneumonia who often receive a macrolide or respiratory fluoroquinolone, the first-line antibiotic for pediatric CAP in a fully vaccinated child is this drug targeting Streptococcus pneumoniae.
What is amoxicillin?
*Bonus Question* What is Strep. pneumo's main mode of antibiotic resistance?
*Bonus Question 2* How do you typically overcome this?
This body surface area formula is commonly used for chemotherapy dosing in both pediatric and adult oncology patients to normalize for body size.
What is the Mosteller (or BSA) formula?
* Note IT dosing is often age based as age banding often presents more accurate dosing.
Propylene glycol, benzyl alcohol, and sorbitol are examples of inactive ingredients found in many liquid medications that can cause serious toxicity in this patient population.
What are neonates (or premature infants)?
Glomerular filtration rate in a full-term newborn is markedly reduced compared to adults at birth, but will reach adult values by approximately this age.
What is 1-2 years of age?
Slide 32
Unlike adults, children receiving fluoroquinolones warrant caution due to preclinical evidence of toxicity to this tissue, though use is acceptable in certain life-threatning or short duration infections.
What is cartilage (or musculoskeletal/articular cartilage or bone)?
Slide 44
Kawasaki disease, a pediatric vasculitis that can cause coronary artery aneurysms, is treated acutely with high-dose aspirin AND a single infusion of this medication.
What is IVIG (intravenous immunoglobulin)?
In neonates, dosing intervals for gentamicin are often extended compared to older children or adults because of this pharmacokinetic difference.
What is a larger volume of distribution and decreased renal clearance (prolonged half life)?
Slide 13,32,33
Because of limited peripheral access and smaller veins, pediatric patients often receive continuous IV infusions via this specialized catheter placed in a large central vein.
What is a PICC line (or central venous catheter)?
CYP3A7 is the predominate fetal cytochrome P450 enzyme; it is gradually replaced by this adult isoform which metabolizes many common drugs including midazolam and tacrolimus.
What is CYP3A4?
Pediatric patients are more vulnerable to this side effect of systemic steroids compared to adults when steroids are given chronically.
What is growth suppression?
Slide 45
For pediatric acute lymphoblastic leukemia, this enzyme derived from bacteria deletes circulating asparagine and exploits the fact that leukemic blasts cannot synthesize their own (asparagine), unlike normal cells.
What is asparaginase (L-asparaginase or pegaspargase)?
ASPARLAS is an asparagine specific enzyme indicated as a component of a multi-agent chemotherapeutic regimen for the treatment of acute lymphoblastic leukemia in pediatric and young adult patients age 1 month to 21 years.
A 10kg child needs amoxicillin 90 mg/kg/day divided every 8 hours. What is this dose and what is this regimen called?
What is 300mg, at high dose regimen?
First-pass effects of many drugs differs in infants compared to adults due to higher gastric pH, slower gastric emptying, and differences in GI enzyme activity affecting this drug property.
What is oral bioavailability?
Slide 8,23
DAILY DOUBLE
Plasma protein binding is reduced in neonates partly because of higher levels of this fetal protein and lower albumin, increasing free drug concentrations.
What is fetal albumin (or alpha-fetoprotein, or bilirubin competition)?
Slide 16
Gray baby syndrome, caused by chloramphenicol toxicity in neonates, results from immature development of this hepatic enzyme responsible for glucuronidation.
What is UDP-glucuronosyltransferase (UGT)?
This medication is used in patients 2 years and older whom have at least one copy of the F508del mutation in the CFTR (cystic fibrosis transmembrane conductance regulator) gene.
What is Trikafta (elexacaftor/tezacaftor/ivacaftor)?
While overall U.S. lung transplants rose (averaging 2,085/year in 2009–2019 vs. 2,747/year after), CF-related transplants fell more than fourfold (243 to 56.7 annually). Similarly, CF patients added to transplant waitlists dropped over fivefold (295 to 55.6), with more patients even being removed due to clinical improvement. These trends highlight Trikafta’s significant impact.
When a calculated pediatric dose exceeds this, pharmacists apply it as a ceiling to avoid overdose, even if the mg/kg math yields a higher number.
What is the maximum adult dose?
This drug formulation/route should not be used in small children or infants due to higher absorption than typical clinical models?
What are transdermal medications (or patches)?
This pharmacodynamic concept explains why children aged 2-6 years paradoxically require higher mg/kg doses of propofol for induction than adults, related to faster redistribution and clearance.
What is age-related pharmacokinetic/pharmacodynamic variability (increased clearance and Vd in young children)?
This unexpected effect is most prevalant in children than adults and is associated with antihistamines, benzodiazepines, codeine and dextromethorphan.
What is a paradoxical reaction?