70-71: Ped GI

Question 1

GER patho

Answer 1

-relaxation of lower esophageal sphinchter
-LES relaxation is transient in healthy kids
-infants eat a relatively large volume
-delayed gastric emptying

Question 2

GER clinical presentation

Answer 2

-infants could be happy spitters or fussy
-many signs and symptoms are nonspecific
-most children older than 4 years have “classic” heartburn symptoms similar to adults

Question 3

GERD symptoms in infants

Answer 3

0regurg
-ffeding difficulties
-hematemesis
-irritability
-failure to thrive
-bacl arching
-persistent cough
-apnea/BRUE

Question 4

GERD symptoms children

Answer 4

-

Question 5

Feeding changes

Answer 5

-thickening of feeds
-inc caloric density while dec volume

Question 6

positioning therapy

Answer 6

-keep upright after feeds
-elevate head of bed
-infants must sleep on back tho

Question 7

Lifestyle changes

Answer 7

-smaller more freq feedings
-freq burping
-dietary mods
-weight reduction
-eliminate smoke exposure

Question 8

Infant pearls

Answer 8

-H2RAs and PPIs
-uncertain if PPIs work
-AVOID antacids in infants

Question 9

Children pearls

Answer 9

-diet/lifestyle mod
-antacids for short-term relief
-consider PPI in older children

Question 10

Tx indications

Answer 10

-GERD
-no improvement after lifestyle mod
-failure to thrive

Question 11

available agents for ped GERD

Answer 11

-H2RAs
-PPIs
-prokinetics
-antacids

Question 12

H2RA moa

Answer 12

-competitive inhbition of histamine = dec acid secretion
-first line

Question 13

H2RA drugs

Answer 13

-famotidine
-cimetidine (not used)
-require renal dosing adjustment
-tachyphylaxis in chronic use

Question 14

PPI moa

Answer 14

-IRREVERSIBLY block H/K ATPase pump
-inhibit H secretion
-maintain acid supression
-inhibit meal-induced acid secretion

Question 15

PPI drugs

Answer 15

-Omeprazole
-Esomeprazole
-Lansoprazole
-Pantoprazole
-Rabeprazole

-1mg/kg/day qd

Question 16

H2RA/PPI adverse effects

Answer 16

-HA, diarrhea, ab pain nausea
-risk of chronic acid suppression include inc incidence of fractures, gas tumors, pneumonia, infants, gas flora

Question 17

Cyprohepatadine

Answer 17

-antihistamine
-appetite stimulation, vommitting ab pain, GERD tx

Question 18

Prokinetic agents moa

Answer 18

-pro motility and gas emptying
-improve esophageal motility and improve LES tone

Question 19

prokinetic drugd

Answer 19

-Metoclopramide
-erythromycin

Question 20

Metoclopromide side effects

Answer 20

-prokinetic
-neurologic adverse effect
-box warning fortardive dyskinesia
-lactation and gynecomastia

Question 21

Erythromycin side effects

Answer 21

-prokinetic
-pyloric stenosis
-qtc prolongation
-drug interactions

Question 22

Antacid moa

Answer 22

-acid neutralization
-reduce heartburn allow healing
-rapid relief
-short term

Question 23

Antacids

Answer 23

-milk of magnesia
-Tums
-avoid aluminum
-watch for drug interactions (quinolones, tetra, myco, heypercalcemia)