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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
Q

OTC med with most mortalities and morbidities in infants

A

Cough/cold meds (antihistamines, decongestants, cough suppressants)

*controversial studies about whether they even help or may cause more problems

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26
Q

How are kg converted to lbs?

A

weight (lbs.) / 2.2

1 kg = 2.2 lbs
10 kg = 22 lbs

27
Q

How is dosing done in pediatric patients?

A

according to weight in kg or body surface area

28
Q

Common causes of dehydration in pediatric patient

A

vomiting, diarrhea, fever and hyperventilation

29
Q

Low vs high sodium dehydration

A

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
Q

symptoms of hyponatremia

A

N/V

31
Q

Homemade ORS recipe

A

6 tsps sugar, 1/2 tsp salt, 1 liter of water

32
Q

Signs of severe dehydration

A

rapid weak pulse
cyanosis
cold limbs
signs of shock or coma

33
Q

When is IV hydration necessary?

A

severe hydration
uncontrolled vomiting
unable to drink d/t extreme fatigue, stupor, or coma
Gastric or intestinal distention

34
Q

Dehydration management

A

Mild/mod: rehydration with ORS

Severe: IV fluids (20 mL/kg of 0.9% saline or other isotonic solution)

35
Q

Define nocturnal enuresis

A

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
Q

DDX of daytime enuresis

A

UTI, bladder dysfunction, child abuse

37
Q

Nocturnal enuresis management

A
  • Education and reassurance (usually outgrow)
  • Motivational therapy
  • Enuresis alarms
  • Desmopressin prn
38
Q

MOA of Desmopressin

A

synthetic ADH analogue

39
Q

Indications of Desmopressin

A

nocturnal enuresis (short term), diabetes insipidus, hemophila A, von Willebrand’s disease

40
Q

Common ADR of Desmopressin

A

fatigue and runny nose

  • MI, lyte imbalances, seizure serious but very rare
41
Q

General management of diaper dermatitis

A
  • 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
Q

How to treat common cold symptoms under 6 months old? if older than 6 months?

A

< 6 mon: acetaminophen

> 6 mon: acetaminophen or ibuprofen

43
Q

How to treat nasal congestion in kids?

A

Conservative: saline nose drops, cool mist humidifier

Topical decongestants like oxymetazoline (Afrin) if over 6 yo

Sedating antihistamine (diphenhydramine) if over 2 yo

44
Q

How to treat pharyngitis in kids?

A
  • Throat lozenges and sprays

- Gargling with diphenhydramine if able to

45
Q

How to treat cough and chest congestion in kids?

A

Physiotherapy by parent - with child face down on knee, gently tap back
Honey (not under 1 yo)
No cough suppressant meds given

46
Q

Alternative therapies and supplements for common cold

A

Work: Vitamin C prophylaxis, zinc

Don’t work: echinacea, essential oils, chiropractors

47
Q

Benefits of fluoride

A

mineralization of bone and teeth, strengthens enamel, prevents cavities

48
Q

When should fluoride supplements be given?

A

high risk for dental caries, drinking water deficient in fluoride

49
Q

When are fluoride supplements started?

A

6 months old

50
Q

Uses of Cefdinir (Omnicef)

A

alternative antibiotic for children - upper and lower airways, middle ear, pharynx, skin

51
Q

MOA of Omnicef

A

inhibits cell wall synthesis

52
Q

ADR of Omnicef

A

GI upset (esp diarrhea), Candida infections, red-brown stool, CDAD

53
Q

DI of Omnicef

A

Warfarin (since omnicef disrupts Vit K synthesis)

Antacids and iron supplements (omnicef likes to bind to cations)

54
Q

When does gastric emptying time reach normal adult function?

A

6-8 months

55
Q

When do kidneys reach normal adult function?

A

GFR: 6 mon

renal blood flow and tubular secretion: 9 mon

56
Q

When does microbial flora reach normal adult pattern?

A

infant

57
Q

Describe development of normal total body water

A

neonate: increased (75%)
infant: increased
child: adult pattern (60%)

58
Q

When does BBB permeablitiy reach normal adult pattern?

A

infant

59
Q

When does albumin and drug protein binding reach normal adult pattern?

A

1 year

60
Q

What is fat composition of neonate, infant, and children?

A

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
Q

What parameters of function are increased in neonates compared to adults?

A
  • Permeability of BBB

- Total body water

62
Q

Cough/cold products (diphenhydramine) not recommended in age _____ unless good reason. Use contraindicated in age _______.

A

< 6 yo

< 2 yo

63
Q

IBUPROFEN not recommended in age _____ unless good reason. Ibuprofen contraindicated in age _______.

A

< 6 mon

< 2 mon

Pediatrics Module (15 decks)

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