Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AS - N934 Advanced Principles II > Pediatric Pharm & Fluids > Flashcards

Pediatric Pharm & Fluids Flashcards

1
Q

Water-Soluble Medications

A

Children ↑H2O body composition
↑Vd
Examples: Succinylcholine, Bupivacaine, & antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Fat-Soluble Medications

A

Children ↓fat & muscle mass
↓Vd
↑DOA (less tissue mass to distribute)
Examples: Fentanyl & Thiopental

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hepatic/Renal Function

A

IMMATURE

Longer drug half-lives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Blood-Brain Barrier

A

IMMATURE

Improved by 2yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pediatric 50th Percentile Weight

A

Age (yrs) x 2 + 9 = kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Weight Formula < 1yo

A

Mos/2 +4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Neonates Physiological Differences

A

↑H2O content 70-75% (adults 50-60%)
↓fat % → reduced lean muscle mass
↑ECF Vd as compared to adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Protein Binding

A

↓total serum protein ↑free drug available

↓barbiturates & LA dosages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hepatic Metabolism

A

Normal adult hepatic enzymes convert medications from lipid-soluble (non-polar) to more polar water-soluble compound

Impaired metabolism improves w/ age
↑enzyme activity ↑drug delivery to the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Renal Excretion

A

Less efficient
- Incomplete glomerular development
- Low perfusion pressure
- Inadequate osmotic load
GFR & tubular function develop rapidly in 1st few months of life
Careful fluid administration to prevent fluid overload
Neonatal kidneys unable to excrete ↑amounts excess H2O or electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What medications have a prolonged elimination half-life in neonates due to impaired renal excretion?

A

Aminoglycosides & cephalosporins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Inhalational Agents

A

More rapid inhalation anesthetics concentration increase in the alveoli
Infants > children > adults
჻ more rapid inhalation induction
Excretion & recovery also more rapid
Potentiates NDMR actions
*Overdose occurs quickly & potentially leads to serious complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Respiratory Physiological Differences

A

↑RR (higher minute ventilation)

↓FRC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cardiovascular Physiological Differences

A 
↑CO to vessel-rich groups
Immature cardiac development
Lack compensatory mechanisms
Immature myocardium
↓Ca2+ stores
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What age does MAC peak?

A

3 months old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Stage 1

A

Analgesia or disorientation

From beginning general anesthesia induction to loss of consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Stage 2

A

Excitement or delirium
From loss of consciousness to onset automatic breathing
Eyelash reflex disappears, but other reflexes remain intact
Coughing, vomiting, & struggle may occur
Respirations irregular w/ breath-holding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Stage 3

A

Surgical anesthesia
From onset automatic respiration to respiratory paralysis
Divided into 4 planes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Plane 1

A

Stage 3
From onset automatic respiration to cessation eyeball movements
Eyelid reflex lost
Swallowing reflex disappears
Marked eyeball movement may occur, but conjunctival reflex lost at the bottom of the plane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Plane 2

A

Stage 3
From cessation of eyeball movements to beginning of intercostal muscles paralysis
Laryngeal reflex lost although upper airway tract inflammation ↑reflex irritability
Corneal reflex disappears

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Plane 3

A

Stage 3
From beginning to completion intercostal muscle paralysis
Diaphragmatic respiration persists, but there’s progressive intercostal paralysis
Pupils dilated & light reflex abolished
Laryngeal reflex lost in plane 2 still able to be initiated w/ painful stimuli

Desired plane for surgery when muscle relaxants were not used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Plane 4

A

Stage 3

From complete intercostal paralysis to diaphragmatic paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Stage 4

A

Anesthetic overdose causing medullary paralysis & vasomotor collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

N2O

A 
Nitrous oxide
2nd gas effect
Analgesia & amnesia
Odorless
PIV placement on older children
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

N2O Contraindications

A

Pneumothorax - N2O 70% doubles pneumo w/in 12min
NEC
Bowel obstructions
contributes to PONV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What gas law explains the 2nd gas effect?

A

Dalton’s law

Total pressure = P1 + P2 + P3 + … + P#

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What’s the choice inhalational anesthesia for pediatrics? Why?

A

Sevoflurane (previously Halothane)

Least irritating to the airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Sevoflurane Considerations

A

Dose-related depression in RR and Vt

CO2 absorbents w/ barium hydroxide or soda lime ↑compound A production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Isoflurane

A

Slowest & pungent
Potentiates NDMR > Sevo or Des
Least costly inhalational agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Desflurane

A 
MOST pungent 
Causes airway irritation
50% laryngospasm incidence w/ induction
Better utilized as maintenance
Use w/ LMA controversial
RAPID emergence 
α emergence delirium
31
Q

Propofol

A 
↑induction dose d/t ↑Vd
Profound hypotension in critically-ill infants (consider Ketamine)
Shorter elimination 1/2 life
↑plasma clearance rates
Discard after 6 hours
↓SVR/BP → profound hypotension
Dose-dependent ventilation depression
Infection risk especially infants or children w/ immature/impaired immune systems
32
Q

Ketamine

A 
Cerebral cortex dissociation
Analgesia & amnesia
Side effects include ↑secretions, vomiting, & hallucinations
Admin w/ Glycopyrrolate 0.01 mg/kg
Nystagmus gaze
Preserves spontaneous respirations
↑SNS response ↑HR/CO/BP ↑pulmonary pressures
Bronchodilation (ideal in asthmatics)
PO 6-10mg/kg
Sedation IM 2-5mg/kg
Induction IV 1-2mg/kg (5-10mg/kg)
Pain IV 0.5mg/kg bolus
Infusion 4mcg/kg/min
33
Q

Etomidate

A

Pain on injection, myoclonus, anaphylactic reactions, adrenal suppression
+ CV stability in hypovolemic patients
- adrenocortical suppression not well-tolerated in critically ill
Dose-dependent ventilation depression
0.2-0.3mg/kg

34
Q

Opioids

A

More potent effects d/t immature blood-brain barrier

↑respiratory centers sensitivity (especially infants)

35
Q

Morphine

A

0.025-0.05 mg/kg IV
Histamine release → erythema & pruritis
Reduced hepatic conjugation
↓renal clearance

36
Q

Fentanyl

A

Synthetic opioid agonist - analgesia & blunts circulatory response to direct laryngoscopy
0.25-1 mcg/kg IV
Infusion 0.5-2 mcg/kg/hr
IV onset almost immediate
Max analgesic & respiratory depression effect w/in several minutes
↑DOA 30-60min w/ high doses d/t ↓fat & muscle
Neonates & preterm infants slower metabolism
Dependence w/in 7 days
Off-label FDA use

37
Q

Hydromorphone

A 
Semi-synthetic opioid agonist
Morphine derivative 5x more potent
IV or epidural
Onset 5min
DOA 2-3hrs
Patients w/ renal toxicity ↑risk metabolite accumulation & neuroexcitatory S/S → tremors, agitation, & cognitive dysfunction
38
Q

Naloxone

A

Antagonizes opioids - reduces respiratory depression, N/V, pruritis, & urinary retention
0.25-0.5 mcg/kg repeat dose until effect
Max 2 mg
Onset 30sec-1min
Elimination 1/2 life 1.5-3hrs
Overdose → systemic HTN, cardiac arrhythmias, & pulmonary edema

39
Q

Midazolam

A

Premedication:
*PO 0.5 mg/kg (onset 20min)
Intranasal 0.2-0.3mg/kg
IV 0.05 mg/kg (onset 5min)

PICU sedation infusion 0.4-2mcg/kg/min
DOA 1-6hrs variable

40
Q

Flumazenil

A 
Benzodiazepine reversal agent
GABA receptor competitive antagonist
Onset 5-10min
IV 10mcg/kg
Elimination 1/2 life ≈ 1hr
41
Q

Clonidine

A 
Pre-synaptic α agonist
↓Ca2+ levels → inhibits NE release
Oral premed 4 mcg/kg (onset 60-90min)
Difficult to time premed
Regional anesthesia adjunct
Epidural/caudal 1-2 mcg/kg prolongs analgesia approximately 3hrs
Residual sedation postop
42
Q

Dexmedetomidine

A 
α2 adrenergic receptor agonist
Anxiolysis, sedation, & analgesic properties
Sedation w/o respiratory depression
Elimination 1/2 life ≈ 2hrs
Oral or intranasal 1 mcg/kg
IV 0.25-1 mcg/kg over 10-15min
Infusion 0.2-2 mcg/kg/hr
43
Q

NDMRs

A

↑variability w/ dose & response
↑sensitivity ↓ACh release (immature neuromuscular junction) & reduced muscle mass
Fetal receptors have longer opening time → Na+ enters the cell
Shorter onset up to 50% d/t ↑circulation times
Prolonged DOA w/ immature hepatic system (Roc, Vec, & Panc)
Difficult to monitor effect w/ peripheral nerve stimulator

44
Q

Muscle Relaxants Doses

A

Rocuronium 0.6 OR 1.2 mg/kg IV (low dose 0.3 mg/kg intubating conditions in 3min)
Cisatracurium 0.15 mg/kg IV (liver transplants)
Vecuronium 0.1 mg/kg IV

45
Q

Muscle Relaxant Reversal

A

Glycopyrrolate 0.01 mg/kg IV
Neostigmine 0.05 mg/kg IV
*Adolescent females avoid Sugammadex to prevent birth control inactivation

46
Q

Succinylcholine

A

Infants require ↑dose d/t ↑ECF Vd
Pediatric patients ↑risk to experience cardiac dysrhythmias, hyperkalemia, rhabdomyolysis, myoglobinuria, masseter muscle spasm, or malignant hyperthermia
Cardiac arrest → treat hyperkalemia
Often avoided in routine elective pediatric surgery

47
Q

Succinylcholine Dose/Routes

A

IV (intubation) <10kg 2 mg/kg >10kg 1-2 mg/kg
IM 4mg/kg
IV (laryngospasm) 0.25-0.5mg/kg
Atropine 0.02 mg/kg IV or IM to prevent bradycardia

48
Q

Sugammadex

A

Water-soluble sugar molecule encapsulates NDMRs
IV 2-4 mg/kg
16 mg/kg after RSI dose Rocuronium 1.2 mg/kg

49
Q

Ketorolac

A

NSAID
0.5 mg/kg IV
Elimination 1/2 life ≈ 4hrs
Caution in impaired renal, ↑bleeding risk, & impaired bone healing
Reserve for children > 1yo (UNC 6mos) when renal function more mature

50
Q

Glucose

A

Neonates - minimal glycogen stores & prone to hypoglycemia when NPO or stressed
Impaired renal glucose excretion

51
Q

Hypoglycemia Treatment

A

10% dextrose 1-2 mL/kg
NEVER admin D50% bolus d/t vessel necrosis & high osmolarity (2mL D50 + 8mL NS = D10%)
Maintenance IV dextrose infusions
Minimize preop fasting

52
Q

Dextrose 10% vs. 50%

Per cent = grams per 100mL

A 
D50% = 50g dextrose per 100mL = 0.5g/mL
D10% = 10g per 100mL = 0.1g/mL
D5% = 5g per 100mL = 0.05g/mL

Dilution 1mL D50% in total 5mL → 0.1g/mL or D10%
1mL D50% dilute in 10mL → 0.05g/mL or D5%

53
Q

MIVF

A

0-10kg → 4mL/kg/hr per kg
10-20kg → 40mL + 2mL/kg/hr per kg >10kg
>20kg → 60mL + 1mL/kg/hr per kg >20kg

54
Q

What fluid type should be utilized for NPO fluid deficits & evaporative loses?

A

Balanced salt solutions such as NS or LR

55
Q

What blood products always require a filter & warmer?

A

PRBCs
FFP
*Platelets only require blood filter tubing

56
Q

EBV

A 
Premature 100mL/kg
Term infant 90mL/kg
6mos 80mL/kg
Children < 1yo 75mL/kg
Children > 1yo 70mL/kg
Adults 55-65mL/kg
57
Q

Volume PRBCs to be transfused FORMULA

A

[(desired Hct - current Hct) x EBV] / PRBCs Hct (≈ 60%)
OR
(desired Hct - current Hct) x EBV x 1.5

58
Q

When to administer FFPs?

A

Replenish clotting factors lost during massive transfusion - often when EBL exceeds 1-1.5x the EBV
Observed coagulopathy
Prolonged PT, PTT, or ROTEM/TEG

59
Q

Tolerated platelet counts in children w/ ITP or chemotherapy _____ mm^3

A

15,000mm^3

Tolerate lower platelet counts to limit donor exposures

60
Q

Platelet transfusion required when _____

A

↓platelet count d/t dilution (massive blood transfusions)
< 50,000mm^3
Filter only
Warming → activated & sticky w/in warming device DO NOT WARM

61
Q

Cell Saver

A 
Salvages erythrocytes (RBCs) from suctioned blood
↑volumes washed cells → coagulopathy d/t coagulation factor dilution
62
Q

What complications does citrate preservative cause?

A

PRBCs & FFP contain calcium citrate
Rapid/multiple transfusions → hypocalcemia
Neonates have impaired ability to mobilize Ca2+ & to metabolize citrate

63
Q

What does serve ionized hypocalcemia lead to?

A

Cardiac depression w/ hypotension

64
Q

Irradiated Blood Products

A

Indicated to prevent transfusion related graft vs. host disease
Cancer & immunocompromised patients

65
Q

Filtered Blood Products

A

Effective way to eliminate CMV infection risk

Cancer & sickle cell patients

66
Q

Washed Blood Products

A

Reserved for patients w/ life-threatening allergic reactions
Wash out WBCs
Significantly ↓RBC lifespan & effectiveness in circulation

67
Q

Recommendations to prevent hyperkalemia cardiac arrest associated w/ blood transfusions:

A
  • Transfuse before significant hemodynamic compromise
  • Use large bore PIV catheters over central lines
  • Fresh (w/in 5 days old) & washed RBCs

Hct goal ↑30%
Earlier transfusions

68
Q

Hyperkalemia Treatment

A 
Hyperventilation
Ca2+ chloride 20mg/kg IV or Ca2+ gluconate 60mg/kg
Dextrose 0.25-1g/kg + insulin 0.1units/kg IV
Sodium bicarbonate 1-2mEq/kg IV
Albuterol
Furosemide 0.1mg/kg IV
Cardiac arrest → CPR
Activate ECMO (arrest > 6min)
69
Q

PRBCs

A

Infants 30-40%
Child 25%
10-15mL/kg
↑Hgb 2-3g/dL

70
Q

FFP

A

Massive blood transfusion
10-15mL/kg
↑factor levels 15-20%

71
Q

Platelets

A

Count < 100,000mm^3
5-10mL/kg
↑platelets 50-100,000

72
Q

Cryoprecipitate

A

Persistent bleeding
10-20mL/kg
↑fibrinogen 60-100mg/dL

73
Q

Calcium Chloride

A

Hypocalcemia
10mg/kg
IV slow admin via central line

74
Q

Calcium Gluconate

A

Hypocalcemia
30mg/kg
IV slow admin via peripheral line

AS - N934 Advanced Principles II (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions