Pediatric pharmacology lecture

Question 1

Premie definition (weeks)

Answer 1

<37 weeks

Question 2

When does pharmacologic maturation take place

Answer 2

3-6 months

Question 3

Drug absorption children vs adults

Answer 3

Same- GI absorption
Different- children are less acidic, and gastric emptying is slower

Question 4

Protein binding in the ped

Answer 4

Less albumin- so more free acidic drugs
Less alpha 1 acid glycoprotein-so more basic drugs

Question 5

Neonate distribution of volume for water soluble drugs is

Answer 5

Larger

Question 6

Neonate distribution for lipohilic drugs is

Answer 6

smaller

Question 7

Pediatrics uptake of inhaled anesthetics is ___ when compared to adults

Answer 7

more rapid bc they have higher alveolar vent: frc ratio

Question 8

Most important age in drug emtabolism

Answer 8

post natal age
Not gestational age

Question 9

when does drug clearance mature

Answer 9

drug clearance reaches adult levels by 3 months

Question 10

Shunting is more pronounces with which volatile agents?

Answer 10

Insoluble- n2o, sevo
they are already max speed, the only thing that can happen is they slow down

Question 11

R-L shunt examples

Answer 11

TOF, TGA, TA, TAPVR

Question 12

R-L shunt effects

Answer 12

Slows uptake- SKIPS THE LUNGS

Question 13

L-R shunt examples

Answer 13

ASD, VSD, PDA, BT shunt

Question 14

L-R shunt effects

Answer 14

increases the speed of uptake, sends more blood to lungs
Large shunt more rapid increase (.8)
Small shunt negligible (.5)

Question 15

MAC values of agents

Answer 15

H .87
I 1.6
S 3.3
Des 9.2

Question 16

stage 2 in infants and children

Answer 16

limited bc fast uptake
so less chance of laryngospasm

Question 17

inhalation induction method

Answer 17

o2/ n2o 2l/4l
Sevo 8%
must be followed with iv agent of inhalation anesthetic

Question 18

risk of inhalation method

Answer 18

bradycardia

Question 19

iv versed dose

Answer 19

.1mg/kg

Question 20

induction dose of propofol- why?

Answer 20

2-5mg/kg
higher clearance (2x) and larger big head

Question 21

dose of ketamine IV and IM

Answer 21

IV 2mg/kg
IM 3-6mg/kg

Question 22

ketamine has analgesic properties for what

Answer 22

not visceral
skin, muscle, bone

Question 23

ketamine should be coadministered with

Answer 23

benzos
also with antisialogogue for secretions

Question 24

narcotics

Answer 24

increased sensitivity
respiratory depression is a function of lipophillicity of opioids

Question 25

morphine dose

Answer 25

0.05-0.1mg/kg
elimination 1/2 T can be up to 14 hours

Question 26

fent dose

Answer 26

1-5mcg/kg

Question 27

remifent dose

Answer 27

0.02-2mcg/kg/min

Question 28

sns matures when

Answer 28

6 months
pns is mature at birth

Question 29

atropine dose

Answer 29

10-20mcg/kg
crosses bbb

Question 30

glyco dose

Answer 30

10-20mcg/kg
better antisialogoigue than atropine

Question 31

succ administration is usually followed by

Answer 31

atropine bc brady

Question 32

succ indications and doses

Answer 32

laryngospasm .4mg/kg
IM SL 4mg/kg
2mg/kg iv

Question 33

first sign of la toxicity

Answer 33

dysrhthmias
cv collapse

Question 34

max dose of LAepi, lido, bup

Answer 34

epi- 2-3mcg/kg but used to be lower bc chance of dysrhthmias with halothane
lido-5mg/kg or 7 if w epi
bup 2.5mg/kg

Question 35

water soluble drugs that require higher dosing

Answer 35

digoxin
succ
aminoglycosides

Question 35

dex dose

Answer 35

.25-1mcg/kg
.2-1 mcg/kg/hr

Question 36

propofil

Answer 36

hydrophillic

Question 37

what does bupivicaine bind to

Answer 37

alpha 1 glycoprotein

Question 38

why use atropinge alongside succ instead of glyco

Answer 38

glyco cause HTN

Question 39

shortest half life LA

Answer 39

chloroprocaine

Question 40

ketamine and emergence deleirum

Answer 40

less in children

Question 41

ketamine and nv

Answer 41

higher in children

Question 42

when is liver function equal to adults

Answer 42

1 yr old

Question 43

remifent context sensitive half life

Answer 43

2-4 minutes