STATE EXAM
SUMMARIES
,PEDIATRICS STATE EXAM
SILA ACAR
INTRODUCTION
, Pediatric drug therapy
Drugs in BF mother:
• Ergotamine for example inhibits prolactin!
• Estrogen → Inhibits lactation
• Thiazides → suppresses lactation
Drug therapy in pregnancy (perinatal):
• The access of drug to fetus further depends on:
◦ Lipid solubility: Thiopental is used as anaesthesia in C-section → can cause sedation and
apnea in newborn!
◦ The placenta cannot be crossed by drugs with a great molecular size or weight
• Antibiotics during pregnancy:
◦ Drugs of choice: Penicillins (Amoxicillin), Cephalosporins, Macrolides
◦ Contraindications:
▪ Tetracyclines → bone damage, malformations, yellow teeth
▪ Chloramphenicol → 'gray baby syndrome' → leads to gray color of skin, CV collapse,
and abdominal distention
▪ Fluoroquinolones → bone and cartilage damage
• Antihypertensives:
◦ Drugs of choice: Methyldopa in arterial hypertension, BBs (Labetolol)
◦ Contraindications:
▪ Diuretics → reduction of placental perfusion
▪ ACEI → CNS malformations, CV disturbances, renal damage
Pediatric drug dosage calculation:
• The metabolism and the elimination in children is slower, because children have less
hepatocytes, less glomeruli, etc. → this is why children get smaller doses!!
• Calculation:
• Administration:
◦ Absorption from the skin → The absorption is increased in neonates because of an
underdeveloped epidermal barrier!
◦ Absorption from rectal route → It is useful in infants or children who are unable to take
oral medications!
• Common medications:
◦ Ibuprofen:
▪ Forms: liquid, tablet
▪ Children: 4-10 mg/kg/dose every 8 hours
▪ Children >12 years: 200mg every 4-6 hours as needed (maximum 1200mg/24h)
, 1. Growth and physical development of the child
Stages of development:
1. PRENATAL PERIOD: *Fastest period of growth*
• Germinal stage:
◦ Sperm + egg cell → Zygote, which moves towards the uterus → process of cell division
and growth takes place → Formation of Blastocyst → Implantation!
• Embryonic period:
◦ From conception to 8th week of gestation
◦ 4th week: head begins to form
◦ End of the 8th week: development has been reached
• Fetal period:
◦ From 9-40. week of intrauterine life
◦ 3rd month: sex organs begin to differentiate
.
2. INFANCY PERIOD:
• Neonatal period:
◦ First 28 days
◦ Period of adaptation
◦ Measurements: length ~48-53cm; weight ~2.9-3.9kg; RR 40-60 bpm; HR 120-160 bpm
◦ There is a normal loss of ~7% of birth weight within the first 5 days of life. The weight
is regained back in ~1 week!
◦ A neonate should gain about 30g/day in the 1 st month of life!
• Infancy period:
◦ Period of fastest brain growth!
.
◦ Doubles weight by 6 month and triples by 1 year
◦ The passive immunity of the mother starts to drop and the acquired immunity starts to
develop
3. CHILDHOOD PERIOD:
Secretion of GH by pituitary gland→ converted to IGF-1 at the liver (main determent of growth)
• Toddler period:
◦ From 1-3 years
◦ Growth becomes slower
◦ Fast development of intelligence
• Preschool period:
◦ From 3-6 years
◦ Character starts to form
• Middle childhood period:
◦ From 6-12 years
◦ Growth becomes more steady → more mature intelligence develops
4. ADOLESCENT / PUBERTY:
• From 12-18 years
• Sex hormones (esp.testosterone & estradiol) boost GH secretion. They also cause a fusion of
growth plates
• This is the second fastest period of growth and development
• Highest growth peak in boys at 13 and stops when 18. In girls it is at 11 and stops when 16!
• In too early onset of puberty the epiphysis of bones fuse too early and growth is restricted
earlier than usually → less growth!
.
SUMMARIES
,PEDIATRICS STATE EXAM
SILA ACAR
INTRODUCTION
, Pediatric drug therapy
Drugs in BF mother:
• Ergotamine for example inhibits prolactin!
• Estrogen → Inhibits lactation
• Thiazides → suppresses lactation
Drug therapy in pregnancy (perinatal):
• The access of drug to fetus further depends on:
◦ Lipid solubility: Thiopental is used as anaesthesia in C-section → can cause sedation and
apnea in newborn!
◦ The placenta cannot be crossed by drugs with a great molecular size or weight
• Antibiotics during pregnancy:
◦ Drugs of choice: Penicillins (Amoxicillin), Cephalosporins, Macrolides
◦ Contraindications:
▪ Tetracyclines → bone damage, malformations, yellow teeth
▪ Chloramphenicol → 'gray baby syndrome' → leads to gray color of skin, CV collapse,
and abdominal distention
▪ Fluoroquinolones → bone and cartilage damage
• Antihypertensives:
◦ Drugs of choice: Methyldopa in arterial hypertension, BBs (Labetolol)
◦ Contraindications:
▪ Diuretics → reduction of placental perfusion
▪ ACEI → CNS malformations, CV disturbances, renal damage
Pediatric drug dosage calculation:
• The metabolism and the elimination in children is slower, because children have less
hepatocytes, less glomeruli, etc. → this is why children get smaller doses!!
• Calculation:
• Administration:
◦ Absorption from the skin → The absorption is increased in neonates because of an
underdeveloped epidermal barrier!
◦ Absorption from rectal route → It is useful in infants or children who are unable to take
oral medications!
• Common medications:
◦ Ibuprofen:
▪ Forms: liquid, tablet
▪ Children: 4-10 mg/kg/dose every 8 hours
▪ Children >12 years: 200mg every 4-6 hours as needed (maximum 1200mg/24h)
, 1. Growth and physical development of the child
Stages of development:
1. PRENATAL PERIOD: *Fastest period of growth*
• Germinal stage:
◦ Sperm + egg cell → Zygote, which moves towards the uterus → process of cell division
and growth takes place → Formation of Blastocyst → Implantation!
• Embryonic period:
◦ From conception to 8th week of gestation
◦ 4th week: head begins to form
◦ End of the 8th week: development has been reached
• Fetal period:
◦ From 9-40. week of intrauterine life
◦ 3rd month: sex organs begin to differentiate
.
2. INFANCY PERIOD:
• Neonatal period:
◦ First 28 days
◦ Period of adaptation
◦ Measurements: length ~48-53cm; weight ~2.9-3.9kg; RR 40-60 bpm; HR 120-160 bpm
◦ There is a normal loss of ~7% of birth weight within the first 5 days of life. The weight
is regained back in ~1 week!
◦ A neonate should gain about 30g/day in the 1 st month of life!
• Infancy period:
◦ Period of fastest brain growth!
.
◦ Doubles weight by 6 month and triples by 1 year
◦ The passive immunity of the mother starts to drop and the acquired immunity starts to
develop
3. CHILDHOOD PERIOD:
Secretion of GH by pituitary gland→ converted to IGF-1 at the liver (main determent of growth)
• Toddler period:
◦ From 1-3 years
◦ Growth becomes slower
◦ Fast development of intelligence
• Preschool period:
◦ From 3-6 years
◦ Character starts to form
• Middle childhood period:
◦ From 6-12 years
◦ Growth becomes more steady → more mature intelligence develops
4. ADOLESCENT / PUBERTY:
• From 12-18 years
• Sex hormones (esp.testosterone & estradiol) boost GH secretion. They also cause a fusion of
growth plates
• This is the second fastest period of growth and development
• Highest growth peak in boys at 13 and stops when 18. In girls it is at 11 and stops when 16!
• In too early onset of puberty the epiphysis of bones fuse too early and growth is restricted
earlier than usually → less growth!
.
