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Therapeutics > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

which 2 vitals are elevated in children compared to adults

A

HR and RR

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2
Q

limitations of off-label drug usage in children

A

insurance denial
liability for AEs
limited experience
limited dosage forms

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3
Q

which factors impact drug absorption in peds

A

higher gastric ph
slower gastric emptying
reduced frequency and amplitude of contractions

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4
Q

how is IM bioavailability in children compared to adults? why

A

increased bioavailability due to capillary density

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5
Q

what impacts Vd in peds? how?

A

higher total body water and ECF
inc Vd of hydrophilic and dec Vd of lipophilic drugs

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6
Q

cause and effect of protein binding differences in peds

A

dec concentration of circulating protein
inc free fraction of drugs

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7
Q

cause and effect of elimination differences in peds

A

dec renal BF, GFR, and tubular secretion

slower CL, longer t1/2
less frequent dosing needed

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8
Q

what is the primary reason for noncompliance in children

A

palatability

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9
Q

how is dosing done for peds?

A

mg/kg/dose or mg/kg/day

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10
Q

neonatal age from conception, how far along in pregnancy

A

gestational age

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11
Q

neonatal chronological age, time since birthday

A

post-natal age

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12
Q

neonatal age combination of GA + PNA

A

post-menstrual age

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13
Q

age for birth to 30 days

A

neonate

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14
Q

age for 30 days to 1 year old

A

infant

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15
Q

age for 1 to 12 years old

A

child

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16
Q

age for 12 to 18 years old

A

adolescent

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17
Q

1 kg =

A

2.2 lbs

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18
Q

1 inch =

A

2.54 cm

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19
Q

BSA equation =

A

sqrt [(height cm x weight kg) / 3600]

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20
Q

the administration section of lexi has recommendations for

A

food & drink allowable for mixing

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21
Q

adverse reactions of lexi may be

A

specific to age, provide % incidence

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22
Q

which section of lexi can help in determining parenteral to enteral conversions

A

PK/MOA

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23
Q

which section of lexi can help determine what is commercially available

A

dosage forms

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24
Q

how to calculate % severity of dehydration =

A

[ (preillness weight - illness weight) / preillness weight ] x 100

weight in kg

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25
Q

fluid deficit (L) equation =

A

(% dehydration x preillness weight) / 100

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26
Q

% dehydration if mild

A

infants- 1-5%
children 1-3%

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27
Q

% dehydration if moderate

A

infants 6-9%
children 4-6%

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28
Q

% dehydration if severe

A

infants >10% (>15 if shock)
children >6% (>9 if shock)

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29
Q

S/S of mild dehydration

A

slight dry mucosa, decreased UOP, inc pulse

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30
Q

s/s of moderate dehydration

A

tachycardia, norm/low BP, little/no UOP, dry mucosa, sunken face, cool pale, decreased tears, thirsty

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31
Q

s/s of severe dehydration

A

rapid & weak pulse, very low BP, oliguria, parched mucosa, very sunken and cool, no tears, lethargic, unable to drink

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32
Q

therapy for mild dehydration

A

ORT 50 ml/kg over 4 hours
add 10ml/kg for each loose stool/vomit episode

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33
Q

therapy for moderate dehydration

A

100 ml/kg over 4 hours
add 10ml/kg for each loose stool/vomit episode

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34
Q

therapy for severe dehydration

A

iv fluids

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35
Q

phase 1 iv fluid dose for dehydration

A

10-20 ml/kg/dose of NS or LR over 30-60 min up to 3 times

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36
Q

phase II of IV fluids for severe dehydration? max rate?

A

maintenance
max 100ml/hr and no more than 1.5-2x MIVF

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37
Q

what should be included in an iv fluid bag

A

NS- isotonic
D5W
K 20 mEq/L

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38
Q

when should you use caution with potassium in IV fluids

A

renal failure, neonates

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39
Q

what can be used in those >6 mos for gastroenteritis

A

ondansetron

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40
Q

dosage forms of zinc are expressed in salt, which is what % elemental

A

23%

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41
Q

how many weeks is a premature, term, and post term neonate

A

premature <37 weeks
term 38-41 weeks
post-term >42 weeks

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42
Q

what age is toddler, early, and older school

A

toddler- 1-4 yr
early- 5-7 yr
older 8-12 yr

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43
Q

weight gain for infants

A

20-30 grams per day

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44
Q

inadequate growth or inability to maintain growth in early childhood

A

failure to thrive

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45
Q

breastmilk calorie contents

A

20 kcal/oz

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46
Q

vit d requirements for breastfed infants

A

400IU/day starting first few days of life

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47
Q

fluoride recommendations for breastfed infants

A

0.5 mg/day when >6 months old

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48
Q

1-2 mg/kg/day of what may be supplemented in breastfed or pre term infants

A

iron

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49
Q

caution with what in a toddlers diet?

A

fruit juice

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50
Q

condition in infants that manifests as spitting up or regurgitation and resolves by 12-14 months

A

GER

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51
Q

condition in infants characterized by excessive regurgitation, food refusal, abdominal pain, etc.

A

GERD

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52
Q

risk factors for GERD in children

A

locus on chromosome 12, neurologic impairment, obesity, esophageal atresia, chronic lung disease, prematurity

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53
Q

treatment for GER

A

nonpharm- volume of feeding, special formula, supine

54
Q

1st line treatment for mild GERD

A

H2RAs

55
Q

1st line treatment for mod to sev GERD or erosive esophagitis

A

PPIs

56
Q

treatment duration for GERD

A

12 weeks

57
Q

most common bacterial causes of AOM

A

S. pneumoniae
H. influenzae
M. catarrhalis

58
Q

signs and symptoms for AOM

A

middle ear effusion
acute onset of symptoms

59
Q

what makes AOM severe

A

mod/sev otalgia or fever >39C

60
Q

what are the trends for antimicrobial resistance for common AOM pathogens

A

resistance has been increasing to penicillins

61
Q

when are antibiotics recommended for AOM

A

mod/sev s&s- otalgia>48 hrs and temp>39
age <24 mos & bilateral AOM

62
Q

when are antibiotics OR observation used for AOM

A

6-23 mos w/ unilateral w/o severe s/s
>24 mos w/ unilateral or bilateral w/o sev s/s

63
Q

first line antibiotics for AOM

A

amoxicillin 80-80 mg/kg/d BID
amox/clav 90 mg/kg/d BID

64
Q

when is amox used for AOM

A

no amox last 30 days
no concurrent purulent conjunctivitis
no penicillin allergy

65
Q

alternative options for AOM

A

cephalosporin, macrolide, ceftriaxone

66
Q

AOM treatment duration if severe or <2yrs old

A

10 days

67
Q

AOM treatment duration if 2-5 yrs old with mild/mod symptoms

A

7 days

68
Q

AOM treatment duration if >6 yrs old with mild/mod symptoms

A

5-7 days

69
Q

diagnosis of uti is made with

A

urine culture

70
Q

uti located in the bladder

A

cystitis

71
Q

uti located in the urethra

A

urethritis

72
Q

uti located in the kidney

A

pyelonephritis

73
Q

urine infection

A

bacturia

74
Q

uti of the gu tract with structural and/or functional abnormalities

A

complicated

75
Q

uti occurring in anatomically normal ut with no prior instrumentation

A

uncomplicated

76
Q

most common pathogen causing e. coli

A
77
Q

most common pathway of uti infection

A

retrograde adcent

78
Q

what is the more common pathway of uti infection in infants

A

hematogenous route

79
Q

first line option for uti?
alternatives?

A

1st- cephalosporins
alt- bactrim, b-lactam +/- b-lactamase inhibitor

80
Q

treatment duration for uncomplicated uti

A

7 days

81
Q

treatment duration for complicated uti or pyelonephritis

A

10-14 days

82
Q

retrograde urinary flow from bladder into ureters and possibly renal collecting system and renal pelvis

A

vesicoureteral reflux

83
Q

who are more likely candidates for uti prophylaxis

A

females, vur grade 5, bladder/bowel dysfunction

84
Q

abx choice for uti prophylaxis in neonates and infants <2 mos

A

amoxicillin

85
Q

abx choice for uti prophylaxis in infants >2 mos

A

bactrim or nitrofurantoin

86
Q

most common pathogen causing cap

A

s pneumoniae

87
Q

at what age do atypical bacteria tend to cause cap

A

5 and up

88
Q

most likely pathogen causing cap in 3 weeks to 3 mos (& 3mos to 5 yrs)

A

S. pneumoniae, RSV

89
Q

most likely pathogen causing cap in 5 to 15 yeaes

A

S. pneumoniae
M. pneumoniae
C. pneumoniae

90
Q

most common symptoms occurring with cap

A

fever cough

91
Q

abx choice for inpatient cap when the patient is fully immunized and their is minimal local penicillin resistance

A

ampicillin

92
Q

abx choice for inpatient cap in a not fully immunized patient and significant penicillin resistance locally

A

ceftriaxone

93
Q

general treatment duration for cap? exception?

A

10 days
azithro & oseltamavir are 5 days

94
Q

first line for outpatient cap
alternative?

A

amoxicillin 90 mg/kg/day
alt is amox/clav 90 mg/kg/day

95
Q

what type of amox/clav is preferred for cap?

A

ES forms so there isnt 2x the clav with high doses

96
Q

abx for atypical outpatient cap

A

azithromycin

97
Q

antiviral used for influenza caused cap

A

oseltamavir

98
Q

most common pathogen causing meningitis in <1 month old

A

GBS

99
Q

most common pathogens causing meningitis in 1-23 months old

A

s. pneumoniae
n. meningitidis

100
Q

most common pathogens causing meningitis in age 2-50

A

n. meningitidis
s. pneumoniae

101
Q

major sign of meningitis in infants

A

bulging fontanelle, seizures

102
Q

abx for meningitis if <1 month old

A

ampicillin + aminoglycoside (+ cefotaxime is alternative)

103
Q

abx for meningitis in 1-50 years

A

vancomycin + ceftriaxone (or cefotaxime_

104
Q

duration of meningitis therapy

A

7-21 days

105
Q

why is dexamethasone used in meningitis

A

decreased hearing loss in h. influenzae meningitis in >6 weeks old

106
Q

when should dexamethasone be given?
timing? who recommended for?

A

10-20 mins before or with 1st dose of abx
recommended if h. influenzae

107
Q

5 live attenuated vaccines

A

mmr, varicella, influenza, polio, rotavirus

108
Q

2 toxoid vaccines

A

diphtheria, tetanus

109
Q

4 inactivated vaccines

A

hep a, flu, pertussis, polio

110
Q

4 inact/recombinant vaccines

A

hep b, hpv, rsv, zoster

111
Q

3 conjug/polysaccharide vaccines

A

hib, meningo, pneumo

112
Q

DTap brand

A

infanrix, daptacel

113
Q

Tdap brand

A

adacel, boostrix

114
Q

Td brand

A

tenivac, tdvax

115
Q

DTaP + IPV brand

A

kinrix, quadracel

116
Q

DTap + IPV + Hib brand

A

pentacel

117
Q

DTaP + IPV + HepB brand

A

pediarix

118
Q

DTaP + IPV + Hib + HepB brand

A

vaxelis

119
Q

MMR + varicella brand

A

ProQuad

120
Q

Hep A + Hep B brand

A

twinrix

121
Q

Hib + MenCY brand

A

Menhibrix

122
Q

Men A, B, C, W-135, Y brand

A

Penbraya

123
Q

what steroid treatment requires LA vaccines to be held for 1 month

A

14 days of high dose (2 mg/kg/day) steroids

124
Q

when should 2 doses of flu be given

A

<9 yrs old for 1st lifetime dose, 4 weeks apart

125
Q

5 brands of flu vax approved in 6 and up

A

afluria, fluarix, flulaval, fluzone, flucelvax

126
Q

1 brand flu vax approved for 18 and up

A

flublok

127
Q

2 brands flu vax approved for 65 and up

A

fluzone HD and fluad

128
Q

LAIV brand name? age used?

A

flumist, 2-49 years

129
Q

when can pregnant women get abrysvo

A

32 weeks to 36 weeks 6 days between september and january

130
Q

nirsevimab indication

A

<8 mos between oct and march based on moms vax status

131
Q

what is given at birth depending on the moms hep b antigen status

A

HBIG

132
Q

when must rotavirus series be started? completed?

A

start by 15 weeks, finish by 8 months

Therapeutics (30 decks)

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