Pediatric Pharm

Question 1

Intranasal Dexmedetomidine

1. Dose
2. Onset and Duration
3. Use
4. What should I monitor for?

Answer 1

1. 1-2mcg/kg
2. 15-30 minutes; 55-100 minutes
3. More than mild sedation desired
4. Hypotension and bradycardia

Question 2

Intranasal Fentanyl

1. Dose
2. Onset and Duration
3. What should I monitor for?

Answer 2

1. 1.5-2mcg/kg
2. 10-20 minutes; 30 minutes
3. Hypoxia

Question 3

Intranasal Ketamine

1. Dose
2. Onset and Duration
3. What should I monitor for?

Answer 3

1. 5-8mg/kg
2. 5-10 minutes; 60 minutes
3. Hypoxia

Question 4

Intranasal Midazolam

1. Dose
2. Onset and Duration
3. What should I monitor for?

Answer 4

1. .4-.5mg/kg
2. 10-20 minutes; 20-40 minutes
3. Nasal burning (30-45 seconds)

Question 5

Is the initial dose higher or lower in neonates and infants for NMBDs? Why?

Answer 5

Initial dose of NMBDs is HIGHER -> due to increased Vd for water soluble drugs (distribute rapidly to the ECF but slowly into cells)

Question 6

What are the four reasons why inhalation induction is faster in pediatrics?

Answer 6

1. Increased alveolar ventilation
2. Decreased FRC
3. Increased oxygen consumption
4. Large VRG

Question 7

1. Is the blood gas partition coefficient in pediatrics the same as adults?
2. Is MAC higher or lower in neonates? 1-6 month olds? >6 months?

Answer 7

1. No, lower!

2. LOWER in neonates, HIGHER in 1-6 mo old, decreases with age after 6 months

Question 8

1. What is the MAC of Sevo in <6 mos?

2. 6 months - 1 year?

Answer 8

1. 3%
2. 2.5-2.8%
   * *best agent for infants, not an airway irritant

Question 9

IV Fentanyl

1. Bolus Dose
2. Infusion Dose

Answer 9

Bolus: 1-5 mcg/kg.
Infusion: .1-.2 mcg/kg/min.

Question 10

IV Alfentanil

1. Induction Dose
2. Infusion Dose

Answer 10

Induction: 50-100 mcg
Infusion: 1-5 mcg.kg.min

Question 11

IV Morphine

1. Dose
2. Is conjugation and renal clearance of metabolites increased or decreased in pediatrics?

Answer 11

.05-.3 mg.kg

**Decreased conjugation and decreased renal clearance of metabolites

Question 12

Anticholinergic and Anticholinesterases doses:

1. Atropine
2. Glycopyrrolate
3. Neostigmine
4. Edrophonium

Answer 12

1. Atropine: 015 mg/kg
2. Glyco: .01 mg/kg
3. Neostigmine: .05-.07 mg/kg
4. Edrophonium: .5-1.0 mg/kg

Question 13

Do the ED95s of NMBDs change over the lifespan? Are there any exceptions?

Answer 13

Yes, except Rocuronium (always 600 mcg)

Question 14

Should Succinylcholine be used in Peds?

Answer 14

No, MH like reaction -> black box warning due to undiagnosed duchennes

Question 15

1. What is the induction dose of propofol?

2. What are characteristics of propofol infusion syndrome?

Answer 15

1. 2-3 mg/kg

2. Mitochondrial defects -> rhabdo, metabolic acidosis, hemodynamic instability, hepatomegaly, multiorgan system failure

Question 16

What are the peds doses of:

1. Etomidate
2. Ketamine
3. Benzodiazepines

Answer 16

1. .3-.4mg/kg
2. IV: 2mg/kg, IM: 5-6mg/kg
3. IV: .01-.02mg/kg; IN: .2-.3mg/kg; PO: .3-.5mg/kg