PANCE - Meds/Vaccines Flashcards
Can multiple vaccines be put in one syringe?
Yes actually preferred and do not diminish immune response or increase rate of adverse events
Contraindications to vaccines
- anaphylactic reactions to previous vaccines
- encephalopathy within 7 days of DTaP
- Pregnancy or immunocomp’d (avoid live vaccines)
What are live vaccines?
MMR, varicella, live attenuated influenza
When should live vaccines be avoided?
pregnancy
immunocompromised
Vaccine preservatives that commonly cause anaphylaxis? In which vaccines?
neomycin and streptomycin in MMR and inactivated polio vaccine
Child with otitis media treatment
1st line: amoxicillin
then Augmentin or Omnicef (Cefdinir)
If Baker’s yeast allergy then avoid _____ vaccine.
Hep B
If egg allergy then avoid _____ vaccine.
influenza
If gelatin allergy then avoid _____ vaccine.
varicella
Precaution with all vaccines and consider rescheduling when…
patient has moderate to severe illness and fever (>102.5 F)
When should MMR and varicella vaccine be postponed?
recent administration of immunoglobins; wait 3 to 6 months
recent thrombocytopenic purpura
Contraindication to DTaP
chronic seizure disorder
Pregnant patients should avoid what vaccines?
HPV, live influenza, MMR, varicella, polio
Patients immunized with varicella should avoid what?
avoid family members with immunodeficiency
Pharmacogenetics
study of genetically determined variations in drug responses for individual patients
genetic polymorphism
All copies of a specific gene present within a population may not have identical nucleotide sequences. These differences contribute to variability observed in a patient population
Average weights of neonate, 1, 4, 9, 14 year old
neonate = 7 lbs 1 yo = 20 lbs 4 yo = 40 lbs 9 yo = 70 lbs 14 yo = 100 lbs
Differences in the neonate gut and digestion
- more basic pH due to milk and less gastric acid secretion
- slower gut motility
- decreased plasma protein binding (albumin has lower affinity for drugs)
- reduced biliary function
- reduced renal and liver function
Albumin binds more to _____ agents and alpha1-acid glycoprotein binds more _______ agents.
acidic
basic
Renal clearance of neonates and what this causes?
drug elimination is prolonged and increases risk of renal toxicity
How is half-life different in neonates compared to adults?
half-life much longer in neonates
Drugs that are cleared by kidney and thus in the neonate’s system much longer than adult
penicillins, morphine, diazepam, phenytoin, acetaminophen
Enzymes necessary for adult level glucuronidation don’t develop until age _____.
3-4 yo
glucuronidation
a phase II detoxification pathway in liver which conjugates glucuronic acid to toxins. Effectively detoxifies most commonly prescribed drugs
OTC med with most mortalities and morbidities in infants
Cough/cold meds (antihistamines, decongestants, cough suppressants)
*controversial studies about whether they even help or may cause more problems
How are kg converted to lbs?
weight (lbs.) / 2.2
1 kg = 2.2 lbs
10 kg = 22 lbs
How is dosing done in pediatric patients?
according to weight in kg or body surface area
Common causes of dehydration in pediatric patient
vomiting, diarrhea, fever and hyperventilation
Low vs high sodium dehydration
Hyponatremia: more electrolyte loss than water
Hypernatremic: more water loss than electrolyte loss; due to oral rehydration solutions (ORS) with excess sodium or due to fever and hyperventilaiton
symptoms of hyponatremia
N/V
Homemade ORS recipe
6 tsps sugar, 1/2 tsp salt, 1 liter of water
Signs of severe dehydration
rapid weak pulse
cyanosis
cold limbs
signs of shock or coma
When is IV hydration necessary?
severe hydration
uncontrolled vomiting
unable to drink d/t extreme fatigue, stupor, or coma
Gastric or intestinal distention
Dehydration management
Mild/mod: rehydration with ORS
Severe: IV fluids (20 mL/kg of 0.9% saline or other isotonic solution)
Define nocturnal enuresis
urinary incontinence during sleep in children 5 yo or older who have never achieved satisfactory nighttime dryness and don’t have bladder dysfunction or infection
DDX of daytime enuresis
UTI, bladder dysfunction, child abuse
Nocturnal enuresis management
- Education and reassurance (usually outgrow)
- Motivational therapy
- Enuresis alarms
- Desmopressin prn
MOA of Desmopressin
synthetic ADH analogue
Indications of Desmopressin
nocturnal enuresis (short term), diabetes insipidus, hemophila A, von Willebrand’s disease
Common ADR of Desmopressin
fatigue and runny nose
- MI, lyte imbalances, seizure serious but very rare
General management of diaper dermatitis
- Topical barrier ointments: zinc oxide (Desitin), petroleum jelly, NO powders
- Add antifungal if candida suspected
- Add low-potency topical steroid if severely inflamed irritant dermatitis
- don’t use steroid and anti fungal together
- Frequent diaper changes and airing out
How to treat common cold symptoms under 6 months old? if older than 6 months?
< 6 mon: acetaminophen
> 6 mon: acetaminophen or ibuprofen
How to treat nasal congestion in kids?
Conservative: saline nose drops, cool mist humidifier
Topical decongestants like oxymetazoline (Afrin) if over 6 yo
Sedating antihistamine (diphenhydramine) if over 2 yo
How to treat pharyngitis in kids?
- Throat lozenges and sprays
- Gargling with diphenhydramine if able to
How to treat cough and chest congestion in kids?
Physiotherapy by parent - with child face down on knee, gently tap back
Honey (not under 1 yo)
No cough suppressant meds given
Alternative therapies and supplements for common cold
Work: Vitamin C prophylaxis, zinc
Don’t work: echinacea, essential oils, chiropractors
Benefits of fluoride
mineralization of bone and teeth, strengthens enamel, prevents cavities
When should fluoride supplements be given?
high risk for dental caries, drinking water deficient in fluoride
When are fluoride supplements started?
6 months old
Uses of Cefdinir (Omnicef)
alternative antibiotic for children - upper and lower airways, middle ear, pharynx, skin
MOA of Omnicef
inhibits cell wall synthesis
ADR of Omnicef
GI upset (esp diarrhea), Candida infections, red-brown stool, CDAD
DI of Omnicef
Warfarin (since omnicef disrupts Vit K synthesis)
Antacids and iron supplements (omnicef likes to bind to cations)
When does gastric emptying time reach normal adult function?
6-8 months
When do kidneys reach normal adult function?
GFR: 6 mon
renal blood flow and tubular secretion: 9 mon
When does microbial flora reach normal adult pattern?
infant
Describe development of normal total body water
neonate: increased (75%)
infant: increased
child: adult pattern (60%)
When does BBB permeablitiy reach normal adult pattern?
infant
When does albumin and drug protein binding reach normal adult pattern?
1 year
What is fat composition of neonate, infant, and children?
neonate: decreased (15-20% of TBW, may be as low as 1% in preterm)
infant: decreased (21-26% of TBW)
child: boys (12%), girls (25%)
What parameters of function are increased in neonates compared to adults?
- Permeability of BBB
- Total body water
Cough/cold products (diphenhydramine) not recommended in age _____ unless good reason. Use contraindicated in age _______.
< 6 yo
< 2 yo
IBUPROFEN not recommended in age _____ unless good reason. Ibuprofen contraindicated in age _______.
< 6 mon
< 2 mon
