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Pediatrics Module > PANCE - Meds/Vaccines > Flashcards

PANCE - Meds/Vaccines Flashcards

1
Q

Can multiple vaccines be put in one syringe?

A

Yes actually preferred and do not diminish immune response or increase rate of adverse events

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2
Q

Contraindications to vaccines

A
  • anaphylactic reactions to previous vaccines
  • encephalopathy within 7 days of DTaP
  • Pregnancy or immunocomp’d (avoid live vaccines)
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3
Q

What are live vaccines?

A

MMR, varicella, live attenuated influenza

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4
Q

When should live vaccines be avoided?

A

pregnancy

immunocompromised

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5
Q

Vaccine preservatives that commonly cause anaphylaxis? In which vaccines?

A

neomycin and streptomycin in MMR and inactivated polio vaccine

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6
Q

Child with otitis media treatment

A

1st line: amoxicillin

then Augmentin or Omnicef (Cefdinir)

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7
Q

If Baker’s yeast allergy then avoid _____ vaccine.

A

Hep B

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8
Q

If egg allergy then avoid _____ vaccine.

A

influenza

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9
Q

If gelatin allergy then avoid _____ vaccine.

A

varicella

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10
Q

Precaution with all vaccines and consider rescheduling when…

A

patient has moderate to severe illness and fever (>102.5 F)

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11
Q

When should MMR and varicella vaccine be postponed?

A

recent administration of immunoglobins; wait 3 to 6 months

recent thrombocytopenic purpura

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12
Q

Contraindication to DTaP

A

chronic seizure disorder

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13
Q

Pregnant patients should avoid what vaccines?

A

HPV, live influenza, MMR, varicella, polio

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14
Q

Patients immunized with varicella should avoid what?

A

avoid family members with immunodeficiency

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15
Q

Pharmacogenetics

A

study of genetically determined variations in drug responses for individual patients

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16
Q

genetic polymorphism

A

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

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17
Q

Average weights of neonate, 1, 4, 9, 14 year old

A 
neonate = 7 lbs
1 yo = 20 lbs
4 yo = 40 lbs
9 yo = 70 lbs
14 yo = 100 lbs
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18
Q

Differences in the neonate gut and digestion

A
  • 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
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19
Q

Albumin binds more to _____ agents and alpha1-acid glycoprotein binds more _______ agents.

A

acidic

basic

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20
Q

Renal clearance of neonates and what this causes?

A

drug elimination is prolonged and increases risk of renal toxicity

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21
Q

How is half-life different in neonates compared to adults?

A

half-life much longer in neonates

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22
Q

Drugs that are cleared by kidney and thus in the neonate’s system much longer than adult

A

penicillins, morphine, diazepam, phenytoin, acetaminophen

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23
Q

Enzymes necessary for adult level glucuronidation don’t develop until age _____.

A

3-4 yo

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24
Q

glucuronidation

A

a phase II detoxification pathway in liver which conjugates glucuronic acid to toxins. Effectively detoxifies most commonly prescribed drugs

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25
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
26
How are kg converted to lbs?
weight (lbs.) / 2.2 1 kg = 2.2 lbs 10 kg = 22 lbs
27
How is dosing done in pediatric patients?
according to weight in kg or body surface area
28
Common causes of dehydration in pediatric patient
vomiting, diarrhea, fever and hyperventilation
29
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
30
symptoms of hyponatremia
N/V
31
Homemade ORS recipe
6 tsps sugar, 1/2 tsp salt, 1 liter of water
32
Signs of severe dehydration
rapid weak pulse cyanosis cold limbs signs of shock or coma
33
When is IV hydration necessary?
severe hydration uncontrolled vomiting unable to drink d/t extreme fatigue, stupor, or coma Gastric or intestinal distention
34
Dehydration management
Mild/mod: rehydration with ORS | Severe: IV fluids (20 mL/kg of 0.9% saline or other isotonic solution)
35
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
36
DDX of daytime enuresis
UTI, bladder dysfunction, child abuse
37
Nocturnal enuresis management
- Education and reassurance (usually outgrow) - Motivational therapy - Enuresis alarms - Desmopressin prn
38
MOA of Desmopressin
synthetic ADH analogue
39
Indications of Desmopressin
nocturnal enuresis (short term), diabetes insipidus, hemophila A, von Willebrand's disease
40
Common ADR of Desmopressin
fatigue and runny nose * MI, lyte imbalances, seizure serious but very rare
41
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
42
How to treat common cold symptoms under 6 months old? if older than 6 months?
< 6 mon: acetaminophen | > 6 mon: acetaminophen or ibuprofen
43
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
44
How to treat pharyngitis in kids?
- Throat lozenges and sprays | - Gargling with diphenhydramine if able to
45
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
46
Alternative therapies and supplements for common cold
Work: Vitamin C prophylaxis, zinc Don't work: echinacea, essential oils, chiropractors
47
Benefits of fluoride
mineralization of bone and teeth, strengthens enamel, prevents cavities
48
When should fluoride supplements be given?
high risk for dental caries, drinking water deficient in fluoride
49
When are fluoride supplements started?
6 months old
50
Uses of Cefdinir (Omnicef)
alternative antibiotic for children - upper and lower airways, middle ear, pharynx, skin
51
MOA of Omnicef
inhibits cell wall synthesis
52
ADR of Omnicef
GI upset (esp diarrhea), Candida infections, red-brown stool, CDAD
53
DI of Omnicef
Warfarin (since omnicef disrupts Vit K synthesis) Antacids and iron supplements (omnicef likes to bind to cations)
54
When does gastric emptying time reach normal adult function?
6-8 months
55
When do kidneys reach normal adult function?
GFR: 6 mon | renal blood flow and tubular secretion: 9 mon
56
When does microbial flora reach normal adult pattern?
infant
57
Describe development of normal total body water
neonate: increased (75%) infant: increased child: adult pattern (60%)
58
When does BBB permeablitiy reach normal adult pattern?
infant
59
When does albumin and drug protein binding reach normal adult pattern?
1 year
60
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%)
61
What parameters of function are increased in neonates compared to adults?
- Permeability of BBB | - Total body water
62
Cough/cold products (diphenhydramine) not recommended in age _____ unless good reason. Use contraindicated in age _______.
< 6 yo | < 2 yo
63
IBUPROFEN not recommended in age _____ unless good reason. Ibuprofen contraindicated in age _______.
< 6 mon | < 2 mon

Pediatrics Module (15 decks)

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