Chronic Pediatric Disease Inclass Flashcards
Which drug for HTN
- ACEi/ARB
CCB, Thiazides
What are the symptoms of Cerebral Palsy?
-Flexed elbow
-Bent wrist
-Flonated forearm
-Clenched fist
-thumb in palm
also movement disorder:
-Spasticity
-dystonia
-choreoathetosis
-ataxia
Which drugs are used for spasticity in children?
- Baclofen
or Benzos (Diazepam, Clonazepam)
Which drugs are used for drooling in children?
Scopolamine (antimuscarinic)
Glycopyrrolate (anticholinergic)
drooling can cause skin breakdown
Which drug for Insomnia in children?
Melatonin
Which drugs are for Aggression and irritability?
Which drugs for anxiety and depression?
Which drug for ADHD?
Aggression and irritability: Aripiprazole (Abilify) and risperidone (Risperdal)
anxiety and depression: SSRI
ADHD: stimulants like Atomoxetine, clonidine and guanfacine
What are the 3 forms of IBS?
-IBS-D (with diarrhea)
-IBS-C (with constipation)
-Visceral hypersensitivity (altered intestinal sensation): increased pain -> anxiety
Treatment for IBS-D and IBS-C
IBS-C: Fiber and bulk-forming agents + water, laxatives, Rx: Lubiprostone
IBS-D:
-Loperamide (Imodium)
-Anitspasmatics (Hyoscyamine, Dicyclomine) - not often, peppermint oil
-SSRIs: lots of serotonin receptors in the GI
-TCAs: may use to treat comorbid depression
-oral corticosteroids, mesalamine (anti-inflammatory)
-Probiotics
-fecal transplant
Which disease is treated with Aspirin in children?
Why is it usually avoided in children?
Kawasaki disease
it is avoided in children because of Reyes syndrome
What is the cause of most DVTs in kids?
often caused by the central line (IV catheter)
What is the main thing to remember about
dosing of enoxaparin in kids?
the dose is much higher in kids
What is the treatment for a patient with Sickle cell disease who presents in the ER? (acute)
-give O2 due to hypoxia (causes pain)
-give fluids
-pain treatment: opioids
-antibiotics like ceftriaxone (it could be caused by an infection)
What happens over time in patients with Sickle cell disease?
Functional Asplenia, may end up with splenectomy
Which prophylactic treatment is necessary for patients with sickle cell disease or patients after a splenectomy?
-> Prophylaxis vaccine against encapsulated bugs:
Strep pneumo
Salmonella
Neisseria meningitis
Haemulus influenza
Which drug is used to treat Sickle cell disease?
Hydroxyurea
What are the three types of crises that are
dangerous in Sickle cell disease patients and why?
-Vasoocclusive pain crisis (sickle RBC blocks blood vessels -> causes pain): hydration, pain meds, transfusion
-Aplastic crisis (no RBC production)
-Sequestration crisis: hypovolemia of the spleen, it has filtered so many sickle cells that it can rupture
Hydroxyurea dosing
Which protein is the defect in cystic fibrosis?
CFTR protein
a Chloride channel !!!
-> affects water transfer -> higher viscosity (various organs, usually the lungs)
What are the 3 common bacteria isolated from the lungs of CF patients?
-Pseudomans
-H. flu
-MRSA
Which antibiotics would be a good empiric therapy in children for cystic fibrosis?
Pseudomonas:
-Zosyn (Pip/Tazo)
-Cefepime
-Meropenem
-Aminoglycoside (gentamicin) given with Zosyn
-Levaquin/Cipro
Staph aureus (MRSA):
-Vancomycin
-Linezolid (caution: thrombocytopenia, serotonin syndrome, seizure)
need to cover Staph aureus and Pseudomonas!!
Why might Rocephin and Bactrim be dangerous in kids under 2 months?
FYI Naplex
-displaces bilirubin -> Hyperalbuminemia, kernicterus
-bind to Calcium
How is antibiotic dosing for cystic fibrosis different in kids than in adults?
doses are higher in kids bc renal elimination is faster and the Vd is greater than in adults
Patients with cystic fibrosis have decreased pancreas activity and are treated with pancreatic enzymes.
What gastrointestinal signs may indicate an
inadequate dose of pancreatic enzymes?
floating stool (Steatorrhea)
due to low Lipase (produced in the pancreas)
How are exacerbations of Nephrotic syndrome treated?
Which ones are used for suppression?
IV albumin and a big dose of furosemide
for suppression:
Corticosteroids, or Cytoxen, cyclosporin, or mycophenolate mofetil (immunosuppressant)
What types of adverse reactions are caused by these medications (mycophenolate mofetil, cyclosporin)?
-HTN
-nephrotoxicity
they often already have HTN, so it makes it worse
Which equation is used to estimate renal
function in children?
Bedside Schwartz equation
Inhaled corticosteroids can cause growth suppression in children when used long-term. T/F
True
Which drug is often prescribed for patients for asthma treatment instead of Albuterol only?
Budesonide + Formeterol Combi
Formoterol (LABA) -> quick onset for rescue)
What should be considered when using Montelukast in kids for asthma?
contraindicated in kids with psychiatric issues
but if they don’t have mental problems, its worth to try in kids who have tried other drugs
Which diseases are often seen with Atopic Dermatitis?
Atopic Triad:
-Atopic dermatitis
-Allergic rhinitis
-Asthma or food allergies
What is often seen secondary to Atopic Dermatitis?
!!!
Skin infections due to skin breakdown
Treatment: antibiotics for MRSA (Staph aureus) and Group A Strep
Candida and herpes are less common
Which drugs are used for Atopic Dermatitis?
topical therapy (moisturizer, emollients, antihistamines, topical calcineurin inhibitor)
-avoid triggers: season change, dry skin, foods, irritants, stress, infections)
Difference between Ulcerative Colitis and Crohn’s disease
Ulcerative Colitis: in the colon (curable, cut parts out)
Crohn’s disease: can be anywhere in the GI tract
Which drugs are used for Crohn’s disease and Ulcerative Colitis?
-Corticosteroids, aminosalicylates
-immunomodulators, biologics and antibiotics if moderate or severe
Which biologics are used in UC and Crohn’s disease?
Top-down approach:
Biologics
-Adalimumab (Humira®): can be used at home
-Infliximab (Remicade®): need infusion for administration
others: Certolizumab pegol (Cimzia), Natalizumab (Tysabri), Vedolizumab (Entyvio) & Ustekinumab
(Stelara)
What is a rare but bad side effect of combination use of azathioprine, 6-mercaptopurine, or methotrexate with biologics?
Hepatosplenic T-cell Lymphoma
often seen when started with azathioprine, 6-MP, and methotrexate
but it is very rare
