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Nur 943 OB > Exam 3 Pediatrics part 2 > Flashcards

Exam 3 Pediatrics part 2 Flashcards

1
Q

Herbal Remedies are associated with:

A

CV instability
Coagulation Disturbance
Prolonged Anesthesia
Immunosuppression

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2
Q

Which herbal supplements can prolong bleeding?

A 
Garlic, Ginsing, Ginko Biloba (3Gs)
and Feverfew (FG3?)
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3
Q

St. Johns Wort can do what?

A

Decrease Effectiveness of Drugs Metabolized by CYP3A4

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4
Q

Which Herbal supplement messes with immunosuppression?

A

Echinacea

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5
Q

Which herbal supplements POTENTIATES Sedative Effects of Anesthetic Agents?

A

Valerian Root and Kava

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6
Q

Pt has fever >38.4C, malaise, productive cough, wheezing, rhonchi and is scheduled for a non-emergent elective surgery. How would you proceed?

A

Postpone case 4-6 weeks

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7
Q

Pt has mild symptoms, nonproductive cough, sneezing and nasal congestion. Plans for nonemergent surg. How do you proceed.

A

Reginal or GA with mask can proceed.

Need ETT? - Wait 2-4 weeks

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8
Q

What drugs can help reduce airway secretions and hyperreactivity?

A

Anticholinergics and Beta Agonist

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9
Q

Check Hgb with these:

A

Risk of Potential for blood loss
Risk of Hemoglobinopathy
Former preterm infants and those <6mos old

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10
Q 
Pediatric Considerations that effect PK/PD
\_\_\_\_\_\_\_\_\_\_\_ composition
\_\_\_\_\_\_\_\_ of metabolic degradation pathways
\_\_\_\_\_\_\_\_\_ protein binding, 
Immaturity of \_\_\_\_\_\_\_\_barrier
Greater blood flow to \_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ in GFR
\_\_\_\_\_\_\_ FRC
\_\_\_\_\_ MV
Immature receptor responses
A 
Pediatric Considerations that effect PK/PD
Total body water (TBW) composition
Immaturity of metabolic degradation pathways
Reduced protein binding, 
Immaturity of blood-brain barrier
Greater blood flow to vessel-rich organs
Reductions in GFR
Smaller FRC
↑ MV
Immature receptor responses
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11
Q

Total Body Water % for Preterm, Full-term, and Adult

A

90%, 80%, 60%

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12
Q

Extracellular Fluid % for Preterm, Full-term, and Adult

A

50%, 40%, 20%

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13
Q

Intracellular Fluid % for Preterm, Full-term, and Adult

A

40%, 40%, 40%

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14
Q

Fat % by Weight for Preterm, Full-term, and Adult

A

3%, 12%, 18%

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15
Q

Muscle Mass % by Weight

A

15%, 20%, 50%

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16
Q

How to calculate Volume of Distribution

A

Divide dose of administered drug by plasma concentration.

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17
Q

Infants have a _____ Extracellular fluid and _____ TBW. This leads to _____ plasma concentration of water soluble drugs and _____ plasma concentration of lipid soluble drugs.

A

Larger, greater

lower plasma concentration (diluted) H2O-soluble drugs – higher dose; lipid-soluble has higher plasma concentration due to decreased fat & muscle

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18
Q

Infants will need a _____ dose of water soluble drug

A

Higher

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19
Q

Infants will need a ____ dose of lipid soluble drug

A

Lower

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20
Q

Infants have ______plasma proteins, which means

A

Reduced plasma proteins, so more free drug available

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21
Q

Proteins reach adult equivalence by ______

A

5-6 months

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22
Q

Protein binding is fully functional by _______

A

1 year old

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23
Q

What are Phase 1 reactions

A

3 enzyme reactions catalyzed by P450 System
Hydrolysis
Oxidative
Reduction

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24
Q

What are Phase 2 Reactions

A

Conjugation- couples drug with substrate for excretion

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25
Q

Which Phase reaction is immature at birth?

A

Phase 2- Conjugation

26
Q

Enzyme systems are present but reduced at birth, this ______ drug elimination half-lives

A

Increases

27
Q

Major objectives to giving premeds to pediatrics

A 
Allay Anxiety
Block Autonomic (Vagal) Reflexes
Reduce AW secretions
Produce Amnesia
Provide Prophylaxis against Pulmonary Aspiration of Gastric Contents
Facilitate Induction of Anesthesia
Provide Analgesia, if needed
28
Q

What is the Rectal dose for Methohexital?

A

20-40mg/kg (10% solution)

29
Q

Rectal dose for Midazolam

A

1mg/kg

30
Q

Oral dose for Midazolam

A

0.25-0.75mg/kg

31
Q

Nasal dose for Midazolam

A

0.2mg/kg

32
Q

IM dose for Midazolam

A

0.1-0.15

33
Q

Ketamine Oral Dose

A

3-6mg/kg

34
Q

Nasal dose of Ketamine

A

3mg/kg

35
Q

Rectal Dose of Ketamine

A

6-10mg/kg

36
Q

IM dose of Ketamine

A

2-10mg/kg

37
Q

IM dose of Morphine

A

0.1-0.2mg/kg

38
Q

IM dose of Meperidine

A

1-2mg/kg

39
Q

Oral Dose of Fentanyl

A

10-15mcg/kg

40
Q

Nasal Dose of Sufenanil

A

1-2 or 1-3mcg/kg

41
Q

Midazolam is ______-soluble

A

Water-soluble

42
Q

Peak plasma concentrations are
____ after intranasal
____ after rectal
_____ after oral

A

10min
16 min
53 min- Fucking 53 MINUTES!!!!

43
Q

1mg/kg

A

What is the rectal dose for Midazolam?

44
Q

What is the IV dose for Midazolam?

A

0.025-0.1mg/kg IV

or 25-100mcg/kg IV

45
Q

0.25-0.75mg/kg

A

PO dose of Midazolam

46
Q

0.2mg/kg

A

Intranasal dose of midazolam

47
Q

0.025-0.1mg/kg

A

IV dose of midazolam

48
Q

How long does midazolam last?

A

1/2-2hours

49
Q

What are the advantages of midazolam

A

rapid uptake and elimination

50
Q

IV dose for Morphine

A

0.05-0.1mg/kg for preop pain

51
Q

Fentanyl IV dose

A

10-15mcg/kg, onset in 10 mins

52
Q

Intranasal dose of Fentanyl

A

1-2mcg/kg, usually after induction

53
Q

Sufentanil intranasal dose

A

1.5-3mcg/kg (premed)

54
Q

Ketamine causes a dissociation of ____ from the ____system

A

cortex from the limbic

55
Q

Disadvantages of Ketamine

A

Sialorrhea, Nystagmus, Psychological Reactions

56
Q

Anticholinergics can

A

prevent bradycardia
Minimize autonomic vagal effects
Reduce secretions

57
Q

S/E of Anticholinergics

A

Dry Mouth
Skin Erythema
Tachycardia
Hyperthermia

58
Q

Anticholinergics
______ and _____ crosses the BBB
_______ does not

A

Atropine and Scopolamine crosses BBB

Glycopyrrolate does not cross the BBB

59
Q

Acetaminophen dose for myringotomies

A

10-15mg/kg

60
Q

Acetaminophen dos for T and A

A

Preop 40mg/kg + 20 mg rectally in 2 hours

61
Q

Ofirmev 13 years + (>50kg)

A

1000mg/6 hours or 650mg/4 hours

62
Q

Ofirmev 2y/o <50kg

A

15mg/kg/6h or 12.5 mg/4h

Nur 943 OB (11 decks)

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