Pediatric GERD Flashcards
Whether using a compounded or commercially available suspension, ALWAYS confirm doses in __ (not __ alone)
- mg
- mL
GER
Passage of gastric contents into the esophagus
GERD
Gastric reflux causes troublesome symptoms or complications (irritability, feeding difficulties, poor weight gain)
Regurgitation
Effortless passage of stomach content, AKA “spitting up”
GER is caused by relaxation of the ___ esophageal sphincter (LES)
* can be caused by eating large volume and ___ gastic emptying
- lower
- delayed
T or F: it is uncertain if PPIs provide benefit in infants
True
T or F: antacids can be used in infants
FALSE; risk of milk alkali syndrome/increasd aluminum levels
for PPI used in older children, cnsider weaning after ___ weeks
* do not stop suddenly; may have rebound ___
4-8 weeks
* hyperacidity
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
- competitive
- first
- short, tachyphylaxis
- famotidine (Pepcid)
- renal
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
- irreversibly, selectively
- meal
- H2RA
- omeprazole and lansoprazole
- 1
Prokinetic agents
MOA: promotion of GI ___ and increased gastric ___
* 2 available agents: ___ and ___
motility, emptying
* metoclopramine
* erythromycin
Prokinetic side effects
Meoclopramide
* ___ AE
* boxed warning: tardive ___ (may be permanent)
Erythromycin
* ___ prologation (can be additive)
* lots of drug interactions
* ___ stenosis
- neurological
- dyskinesia
- QTc
- pyloric
Antacids
for older kids
* avoid ___ containing products
* watch for drug interactions (separate 2 hours before, or 4 hours after)
- aluminum
4 main triggers for vomiting
- blood borne toxins (medications)
- motion (vestibular)
- mechanical (vagal)
- emotion (fear/anxiety)
Normal Stooling Patterns
infants: ___ stools per day
Toddler: ___ stools per day
4+: similar to ___
- 3-4
- 2-3
- adults
Hirschsprung’s disease
(aganglionosis)
nerves stop telling you gut to move, causes constipation
constipation managment in infants
- First line: getting chipped = ___
- prune juice
- increase fluid intake
AVOID: ___ oil, ___ laxatives, ___ enemas
- glycerin suppository
- mineral oil, stimulant, phosphate
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
- water, evacuation
- irritant, peristalsis
- lubricating
- oil-water, softens
Disimpaction
Oral is preferred
* PEG 3350: ___ g/kg/day for 3-6 consecutive days
* Magnesium citrate ___ mL/kg/day for 2 days
- 1-1.5
- 4
Disimaction
Rectal
* normal saline enema ___ mL/kg for 3 consecutive days
* sodium ___ enema
* ___ oil enema
- 10
- phosphate
- mineral
T or F: preschool age and older need adult size enemas
True
Disimpaction
Nasogastric
* PEG with electrolytes: ___ mL/kg/hr until rectal effluent is clear
* typically takes ___ hours
* can give large volumes without __ or ___ disturbances
* onset: ___
- 25-40
- 24-48
- fluid, eletrolyte
- 1-2 hours
Mainrenance
First line agent: ___ 1g/kg/day
PEG 3350
maintenance - osmotic agents (3)
- PEG
- Lactulose
- magnesium hydroxide
maintenance - stool softener
docusate
5mg/kg/day
MAX: 400mg/day
T or F: stimulants are ok to use for short term rescue in kiddos
True
avoid routine use
Four major categories of diarrhea
- secretory
- osmotic
- excretory
- altered motility
T or F: 60% of children prescribed antibiotics have constipation
False: osmotic diarrhea; gut flora killed off, lactate levels build up
T or F: if diarrhea persists after antibiotics are stopped, consider C. diff infection
True
T or F: you choose the strength of amox-clav based off the indicatio
True
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
- 40-50
- 80-90
- 600 mg-42.9 mg/5mL
- 10
If a kid has an ear infection of pneumonia, use ___ dose of amox-clav
high
80-90 mg/kg/day
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
- 100
- 50
- 20
T or F: you can use drugs to treat diarrhea even when the patient has C. diff
FALSE
