Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

8361 Exam 2 > Mod IV: Peds Opioids, Neuromuscular Blocking Agents - Anticholinergics - Benzodiazepines > Flashcards

Mod IV: Peds Opioids, Neuromuscular Blocking Agents - Anticholinergics - Benzodiazepines Flashcards

1
Q

Opiods - Key Points

Opiods are a/w Increased central respiratory depression, particularly in what age group?

A

Neonates and infants < 6mos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Opiods - Key Points

Opiods are a/w Increased central respiratory depression, particularly in Neonates and infants < 6mos. Which opioid is most responsible for this?

A

MSO4 > fentanyl, sufenta, alfentanil, & remifentanil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Opiods - Key Points

What are other negative effects o opioid use in neonates and infants < 6mos?

A

Increase incidence PONV

Upper airway obstruction in susceptible patients

Chest wall rigidity is not uncommon in this population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Opiods - Key Points

What’s The most frequently used narcotic in children for postop pain control

A

Morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Opiods - Morphine

Use Morphine cautiously in neonates and infants, why?

A

Reduced hepatic conjugation

Decreased renal clearance of morphine metabolite

Infants have immature BBB, crosses over more than adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Opiods - Morphine

IV Dose of Morphine is:

A

0.1 to 0.2 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Opiods - Morphine

T/F: Morphine May be given rectally in peds

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Opiods - Morphine

How does Ventilatory depression as a result of Morphine administration manifest?

A

Decreased VT and Rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Opiods

What’s the most popular anesthesia adjuvant for all age groups?

A

Fentanyl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Opiods - Fentanyl

How can Fentanyl be administered in peds?

A

IV, IM, Oral, or Transmucosal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Opiods - Fentanyl

Which factors results in prolongation of effect of fentanyl?

A

Anything decreasing hepatic blood flow

Hypothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Opiods - Fentanyl

T/F: Respiratory depressant effect of Fentanyl outlasts analgesia

A

True

Pt will become free from analgesic effect of Fentanyl but still have some respiratory depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Opiods - Fentanyl

Bradycardia with large doses of Fentanyl is secondary to:

A

Near complete ablation of sympathetics

(more cardiac than vascular)

Significant negative effect on peds CO since it is so dependent on HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Opiods

Which opioid, although not used frequently, Possess the most favorable profile

A

Remifentanil

Easily titratable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Opiods - Remifentanil

How is Remifentanil metabolized?

A

Tissue and plasma esterases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Opiods - Remifentanil

How quickly do Remifentanil Effects dissipate after discontinuing infusion?

A

Effects dissipate within 5 – 10 mins of discontinuing infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Opioids - Remifentanil

T/F: Remifentanil is associated with decreased incidence of postoperative apnea in premature infant and neonate

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Opioids - Remifentanil

Both bolus and continuous infusion doses of Remifentanil are higher in infants and young children; why?

A

Larger Vd

Increased elimination clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Opioids - Remifentanil

Bolus and continuous infusion doses of Remifentanil:

A

Remifentanil

1-2ug/kg bolus followed by

continuous infusion at 0.5ug/kg/min and TTE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Opioids

Opioid that is less commonly used, but that is less potent, more protein bound, and allows for rapid awakening

A

Alfentanil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Opioids - Alfentanil

Incidence of postoperative nausea and vomiting w/ Alfentanil

A

30% to 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Opioids - Alfentanil

DOA of Alfentanil in hepatic disease (or preterm)

A

Prolonged action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Opioids

Most potent synthetic narcotic:

A

Sufentanil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Opioids - Sufentanil

Bolus doses of Sufentanil can cause

A

Bradycardia/Asystole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Opioids - Sufentanil

Dose and administration of Sufentanil:

A

Sufentanil

0.1ug/kg then TTE

Dilute 50 ug/ml to 5 ug/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Opioids - Sufentanil

T/F: Sufentanil can be used intranasal for preop

A

True

But watch your patient really closely after the dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Neuromuscular Blocking Agents

Muscle relaxant are less commonly used during induction in peds compare to adults. Why is that?

A

Many children have LMA or ET tube placed after receiving inhalation agents and placement of an IV access, and administration of various combinations of Propofol, opioids, and Lidocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Neuromuscular Blocking Agents

Which Neuromuscular Blocking Agent remains the fastest acting with shortest duration of action of any muscle relaxant?

A

Succinylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Neuromuscular Blocking Agents - Succinylcholine

Dose requirements for Succinylcholine higher in infants, neonates, and young children. What’s the infants & neonates dose?

A

3 mg/kg IV

30
Q

Neuromuscular Blocking Agents - Succinylcholine

Dose requirements for Succinylcholine higher in infants, neonates, and young children. What’s the young children dose?

A

2 mg/kg IV

31
Q

Neuromuscular Blocking Agents - Succinylcholine

How could you administer Succinylcholine in emergency when IV access is not available?

A

Can be given IM in emergencies when IV access not available

32
Q

Neuromuscular Blocking Agents - Succinylcholine

What’s the IM dose of Succinylcholine when given in emergency d/t IV access not being available?

A

4-6mg/kg IM

33
Q

Neuromuscular Blocking Agents - Succinylcholine

What’s the Onset time and duration of Succinylcholine when given in emergency d/t IV access not being available?

A

Onset time 3-4mins with

Duration approx. 20mins

34
Q

Neuromuscular Blocking Agents - Succinylcholine

What are Adverse effects/complications a/w administration of Succinylcholine?

A

Profound Bradycardia/junctional arrhythmias/sinus node arrest (after 1st dose without pretreatment with atropine)

Must always administer atropine 0.02 mg/kg (minimum dose 0.1 mg) prior to administering succinylcholine in pediatric patients

Hyperkalemia

Life-threatening arrhythmias (wide complex tachycardia, ventricular fibrillation, asystole

Muscle atrophy (Duchenne Muscular dystrophy)

Up-regulation of extra-junctional acetylcholine receptors (Burns)

Rhabdomyolysis leading to myoglobinuria

Muscle masseter spasm

May represent a normal response, especially if succinylcholine is under dosed

Harbinger of MH

(50% of those who develop severe MMR test positive for MH)

Malignant hyperthermia

Increased IOP, ICP, and intragastric pressure

Fasciculations/postoperative myalgia

Uncommon in children < 8yrs of age

35
Q

Neuromuscular Blocking Agents - Succinylcholine

Must always administer atropine 0.02 mg/kg (minimum dose 0.1 mg) prior to administering succinylcholine in pediatric patients; why?

A

Profound Bradycardia/junctional arrhythmias/sinus node arrest after 1st dose without pretreatment with atropine

36
Q

Neuromuscular Blocking Agents - Succinylcholine

Hyperkalemia a/w administration Succinylcholine can cause/or be the result of:

A

Life-threatening arrhythmias

(wide complex tachycardia, ventricular fibrillation, asystole)

Muscle atrophy

(Duchenne Muscular dystrophy)

Up-regulation of extra-junctional acetylcholine receptors

(Burns)

37
Q

Neuromuscular Blocking Agents - Succinylcholine

What’s the Treatment for Hyperkalemia a/w administration of Succinylcholine?

A

CaCl 5-10 mg/kg IV

38
Q

Neuromuscular Blocking Agents - Succinylcholine

Muscle masseter spasm (Masseter Muscle Rigidity) may represent a normal response, especially if:

A

Succinylcholine is under dosed

39
Q

Neuromuscular Blocking Agents - Succinylcholine

What percentage of pts who develop severe MMR test positive for MH?

A

50%

40
Q

Neuromuscular Blocking Agents - Succinylcholine

T/F: Fasciculations/postoperative myalgia following administration of Succinylcholine is common in children < 8yrs of age

A

False

Fasciculations/postoperative myalgia following administration of Succinylcholine is uncommon in children < 8yrs of age

41
Q

Neuromuscular Blocking Agents - Succinylcholine

According to the FDA “Black Box” warning, “Succinylcholine in children should be reserved for which types of procedures?

A

Emergency intubations, or

Instances where immediate securing of the airway is necessary

42
Q

Neuromuscular Blocking Agents - Succinylcholine

Accepted indications for Succinylcholine use in peds are:

A

RSI with full stomach

Laryngospasm

Difficult airway

43
Q

Neuromuscular Blocking Agents - Succinylcholine

T/F: Despite drawbacks to use in children, succinylcholine retains its place as agent of choice for RSI and life-threatening airway obstruction

A

True

44
Q

Neuromuscular Blocking Agents - Succinylcholine

11 Side Effects of Succinylcholine

A

Inc. ICP

Inc. IOP

Inc. IGP

Trismus

Cardiac dysrhythmias

Hyperkalemia

Myalgia

Rhabdomyolysis

Myoglobinemia

Inc. O2 consumption & Inc. CO2 production

Release of catecholamines

45
Q

Neuromuscular Blocking Agents - NDMRs

Why are dosage and response to NDMRs variable in peds?

A

Larger Vd => increases bolus dose required to achieve desired affect

Increase sensitivity (immature NMJ) => decrease dosage requirement

Immature hepatic function prolongs duration action for drugs that depend primarily on hepatic metabolism

Pancuronium, vecuronium, & rocuronium

46
Q

Neuromuscular Blocking Agents - NDMRs

Recommended doses of NDMRs agents are identical on a weight basis for neonates, infants, children and adults. How does their DOA compare to that of adults

A

Slightly longer

47
Q

Considerations when selecting a NDMR - Possible side effects

Which NDMR has desirable vagolytic properties?

A

Pancuronium

48
Q

Considerations when selecting a NDMR - Possible side effects

Which NDMRs are a/w Histamine release?

A

Mivacurium

Atracurium

49
Q

Considerations when selecting a NDMR - Route of metabolism/excretion

How are Amino steroid (vecuronium, pancuronium, Rocuronium) metabolized?

A

Liver to inactive products

This is the reason why their duration of action is unpredictable

50
Q

Considerations when selecting a NDMR - Route of metabolism/excretion

How are Benzylisoquinoliniums (cisatracurium, atracurium, mivacurium) metabolized?

A

Hoffmann’s elimination

Results in Predictable duration of action

51
Q

Neuromuscular Blocking Agents - NDMRs

Which is considered the drug of choice for routine intubation (Not RSI) in the pediatric patient?

A

Rocuronium

52
Q

Neuromuscular Blocking Agents - NDMRs

Fastest onset of nondepolarizing muscle relaxants

A

Rocuronium

53
Q

Neuromuscular Blocking Agents - NDMRs

What are effects of Higher dosages (0.9-1.2 mg/kg IV) of Rocuronium

A

Produces onset of action within 90secs

Expect prolonged duration of action (90mins)

54
Q

Neuromuscular Blocking Agents - NDMRs

What’s the only NDMR that can be given IM?

A

Rocuronium

1.0- 1.5 mg/kg IM

Requires 3-4mins for onset

Deltoid injection

55
Q

Anticholinergics

T/F: Anticholinergics are very important in the pediatric practice

A

True

56
Q

Anticholinergics - Atropine

Dose and route of administration of Atropine:

A

Atropine

0.02 mg/kg

oral, rectal, IM, IV

57
Q

Anticholinergics - Atropine

Effects of Atropine

A

Decreases LES tone in infants

58
Q

Anticholinergics - Atropine

How is Atropine prepared?

A

Emergency syringe

Succinylcholine + atropine with IM needle available for laryngospasm/bradycardia

59
Q

Anticholinergics

T/F: Glycopyrrolate has slower onset but longer action compared to Atropine

A

True

60
Q

Anticholinergics

What’s the administration dose of Glycopyrrolate?

A

Glycopyrrolate

0.01 mg/kg

61
Q

Anticholinergics

When is Glycopyrrolate often used in peds?

A

For Airway procedures such tonsillectomy or

For Dental procedures

62
Q

Benzodiazepines - Midazolam

What’s a common indication for Midazolam in Peds?

A

Separation anxiety

63
Q

Benzodiazepines - Midazolam

How is Midazolam typically administered in peds and why?

A

Oral

Lack of IV access

64
Q

Benzodiazepines - Midazolam

What’s the typical dose of Midazolam?

A

Midazolam

0.5-1.0 mg/kg PO

up to max 10 mg

65
Q

Benzodiazepines - Midazolam

What are effects of 0.5 mg/kg dose of Midazolam in peds?

A

Anterograde amnesia after 10”

Significant anxiolysis by 15”

66
Q

Benzodiazepines - Midazolam

What’s a potentially undesirable effect of a > 0.75 mg/kg dose of Midazolam?

A

May delay discharge (30”)

67
Q

Benzodiazepines - Midazolam

Which factor is important to consider when timing administration of Midazolam to alleviate separation anxiety?

A

Peak sedation 30”

Do not attempt separation from family just 5 min for example after administration

Allow 10 -15 min for effect

Realize that time for peak sedation is 30 min

Parent administer for better acceptance

For peds under 16 mo old, you may forgo the Midazolam

68
Q

Benzodiazepines - Midazolam

What percentage of pre-op anxiety treated w/ Midazolam result in peaceful separation

A

85%

69
Q

Benzodiazepines - Midazolam

What can you mix w/ Midazolam to increase acceptance?

A

Grape concentrate

Tylenol syrup

Motrin suspension

70
Q

Benzodiazepines - Midazolam

What’s a concern w/ mixing Midazolam with other solutions to increase acceptance?

A

NPO status

Beware: total volume > 0.4-0.5 ml/kg (NPO)

8361 Exam 2 (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions