Pediatric GERD

Question 1

Whether using a compounded or commercially available suspension, ALWAYS confirm doses in __ (not __ alone)

Answer 1

• mg
• mL

Question 2

GER

Answer 2

Passage of gastric contents into the esophagus

Question 3

GERD

Answer 3

Gastric reflux causes troublesome symptoms or complications (irritability, feeding difficulties, poor weight gain)

Question 4

Regurgitation

Answer 4

Effortless passage of stomach content, AKA “spitting up”

Question 5

GER is caused by relaxation of the ___ esophageal sphincter (LES)
* can be caused by eating large volume and ___ gastic emptying

Answer 5

• lower
• delayed

Question 6

T or F: it is uncertain if PPIs provide benefit in infants

Answer 6

True

Question 7

T or F: antacids can be used in infants

Answer 7

FALSE; risk of milk alkali syndrome/increasd aluminum levels

Question 8

for PPI used in older children, cnsider weaning after ___ weeks
* do not stop suddenly; may have rebound ___

Answer 8

4-8 weeks
* hyperacidity

Question 9

H2RA

• ___ inhibition of histamines receptors on parietal cells which decreases acid secretion
• ___ line therapy for mild-moderate GERD
• ___ term use (associated with ___ )
• pediatric H2RA of choice ___
• requires ___ dosing adjustment

Answer 9

• competitive
• first
• short, tachyphylaxis
• famotidine (Pepcid)
• renal

Question 10

PPIs

MOA: ___ block gastric H+/K+ ATPase pump, ___ inhibit H+ secretion
* maintain acid suppresion for longer periods, inhibit ___ induced acid sectretion
* usually trialled after an ___, but not always
* most data is available for ___ and ___
* dosing is approx ___ mg/kg/day

Answer 10

• irreversibly, selectively
• meal
• H2RA
• omeprazole and lansoprazole
• 1

Question 11

Prokinetic agents

MOA: promotion of GI ___ and increased gastric ___
* 2 available agents: ___ and ___

Answer 11

motility, emptying
* metoclopramine
* erythromycin

Question 12

Prokinetic side effects

Meoclopramide
* ___ AE
* boxed warning: tardive ___ (may be permanent)
Erythromycin
* ___ prologation (can be additive)
* lots of drug interactions
* ___ stenosis

Answer 12

• neurological
• dyskinesia
• QTc
• pyloric

Question 13

Antacids

for older kids
* avoid ___ containing products
* watch for drug interactions (separate 2 hours before, or 4 hours after)

Answer 13

• aluminum

Question 14

4 main triggers for vomiting

Answer 14

• blood borne toxins (medications)
• motion (vestibular)
• mechanical (vagal)
• emotion (fear/anxiety)

Question 15

Normal Stooling Patterns

infants: ___ stools per day
Toddler: ___ stools per day
4+: similar to ___

Answer 15

• 3-4
• 2-3
• adults

Question 16

Hirschsprung’s disease
(aganglionosis)

Answer 16

nerves stop telling you gut to move, causes constipation

Question 17

constipation managment in infants

• First line: getting chipped = ___
• prune juice
• increase fluid intake

AVOID: ___ oil, ___ laxatives, ___ enemas

Answer 17

• glycerin suppository
• mineral oil, stimulant, phosphate

Question 18

Categories of Laxaives

Osmotic/Hyperosmotic - draws ___ into lumen, promotes distention, peristalsis, and ___

Stimulant - local ___ on colon, stimulates ___

Lubricant - eases passage of stool by softening stool and ___ intestines

Surfactant - reduces tension of ___ interface of stool . Enhanced incorporation of water and fat ___ stool

Answer 18

• water, evacuation
• irritant, peristalsis
• lubricating
• oil-water, softens

Question 19

Disimpaction

Oral is preferred
* PEG 3350: ___ g/kg/day for 3-6 consecutive days
* Magnesium citrate ___ mL/kg/day for 2 days

Answer 19

• 1-1.5
• 4

Question 20

Disimaction

Rectal
* normal saline enema ___ mL/kg for 3 consecutive days
* sodium ___ enema
* ___ oil enema

Answer 20

• 10
• phosphate
• mineral

Question 21

T or F: preschool age and older need adult size enemas

Answer 21

True

Question 22

Disimpaction

Nasogastric
* PEG with electrolytes: ___ mL/kg/hr until rectal effluent is clear
* typically takes ___ hours
* can give large volumes without __ or ___ disturbances
* onset: ___

Answer 22

• 25-40
• 24-48
• fluid, eletrolyte
• 1-2 hours

Question 23

Mainrenance

First line agent: ___ 1g/kg/day

Answer 23

PEG 3350

Question 24

maintenance - osmotic agents (3)

Answer 24

• PEG
• Lactulose
• magnesium hydroxide

Question 25

maintenance - stool softener

Answer 25

docusate
5mg/kg/day
MAX: 400mg/day

Question 26

T or F: stimulants are ok to use for short term rescue in kiddos

Answer 26

True

avoid routine use

Question 27

Four major categories of diarrhea

Answer 27

1. secretory
2. osmotic
3. excretory
4. altered motility

Question 28

T or F: 60% of children prescribed antibiotics have constipation

Answer 28

False: osmotic diarrhea; gut flora killed off, lactate levels build up

Question 29

T or F: if diarrhea persists after antibiotics are stopped, consider C. diff infection

Answer 29

True

Question 30

T or F: you choose the strength of amox-clav based off the indicatio

Answer 30

True

Question 31

standard dose of amox-clav = ___ mg/kg/day
high dose amox-clav = ___ mg/kg/day
* use ___ strength if possible (minimizes risk of diarrhea)
* keep clav < ___ mg/kg/day

amox componen

Answer 31

• 40-50
• 80-90
• 600 mg-42.9 mg/5mL
• 10

Question 32

If a kid has an ear infection of pneumonia, use ___ dose of amox-clav

Answer 32

high
80-90 mg/kg/day

Question 33

Calculating Fluid Requirements

Holliday-Segar Method
* Up to 10 kg: ___ mL/kg
* 10-20 kg: 1000 mL + ___ mL/kg for every kg greater than 10
* >20 kg: 1500 mL + ___ mL/kg for every kg greater than 20

Answer 33

• 100
• 50
• 20

Question 34

T or F: you can use drugs to treat diarrhea even when the patient has C. diff

Answer 34

FALSE