Pediatrics Flashcards
1
Q
which 2 vitals are elevated in children compared to adults
A
HR and RR
2
Q
limitations of off-label drug usage in children
A
insurance denial
liability for AEs
limited experience
limited dosage forms
3
Q
which factors impact drug absorption in peds
A
higher gastric ph
slower gastric emptying
reduced frequency and amplitude of contractions
4
Q
how is IM bioavailability in children compared to adults? why
A
increased bioavailability due to capillary density
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
6
Q
cause and effect of protein binding differences in peds
A
dec concentration of circulating protein
inc free fraction of drugs
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
8
Q
what is the primary reason for noncompliance in children
A
palatability
9
Q
how is dosing done for peds?
A
mg/kg/dose or mg/kg/day
10
Q
neonatal age from conception, how far along in pregnancy
A
gestational age
11
Q
neonatal chronological age, time since birthday
A
post-natal age
12
Q
neonatal age combination of GA + PNA
A
post-menstrual age
13
Q
age for birth to 30 days
A
neonate
14
Q
age for 30 days to 1 year old
A
infant
15
Q
age for 1 to 12 years old
A
child
16
Q
age for 12 to 18 years old
A
adolescent
17
Q
1 kg =
A
2.2 lbs
18
Q
1 inch =
A
2.54 cm
19
Q
BSA equation =
A
sqrt [(height cm x weight kg) / 3600]
20
Q
the administration section of lexi has recommendations for
A
food & drink allowable for mixing
21
Q
adverse reactions of lexi may be
A
specific to age, provide % incidence
22
Q
which section of lexi can help in determining parenteral to enteral conversions
A
PK/MOA
23
Q
which section of lexi can help determine what is commercially available
A
dosage forms
24
Q
how to calculate % severity of dehydration =
A
[ (preillness weight - illness weight) / preillness weight ] x 100
weight in kg
25
fluid deficit (L) equation =
(% dehydration x preillness weight) / 100
26
% dehydration if mild
infants- 1-5%
children 1-3%
27
% dehydration if moderate
infants 6-9%
children 4-6%
28
% dehydration if severe
infants >10% (>15 if shock)
children >6% (>9 if shock)
29
S/S of mild dehydration
slight dry mucosa, decreased UOP, inc pulse
30
s/s of moderate dehydration
tachycardia, norm/low BP, little/no UOP, dry mucosa, sunken face, cool pale, decreased tears, thirsty
31
s/s of severe dehydration
rapid & weak pulse, very low BP, oliguria, parched mucosa, very sunken and cool, no tears, lethargic, unable to drink
32
therapy for mild dehydration
ORT 50 ml/kg over 4 hours
add 10ml/kg for each loose stool/vomit episode
33
therapy for moderate dehydration
100 ml/kg over 4 hours
add 10ml/kg for each loose stool/vomit episode
34
therapy for severe dehydration
iv fluids
35
phase 1 iv fluid dose for dehydration
10-20 ml/kg/dose of NS or LR over 30-60 min up to 3 times
36
phase II of IV fluids for severe dehydration? max rate?
maintenance
max 100ml/hr and no more than 1.5-2x MIVF
37
what should be included in an iv fluid bag
NS- isotonic
D5W
K 20 mEq/L
38
when should you use caution with potassium in IV fluids
renal failure, neonates
39
what can be used in those >6 mos for gastroenteritis
ondansetron
40
dosage forms of zinc are expressed in salt, which is what % elemental
23%
41
how many weeks is a premature, term, and post term neonate
premature <37 weeks
term 38-41 weeks
post-term >42 weeks
42
what age is toddler, early, and older school
toddler- 1-4 yr
early- 5-7 yr
older 8-12 yr
43
weight gain for infants
20-30 grams per day
44
inadequate growth or inability to maintain growth in early childhood
failure to thrive
45
breastmilk calorie contents
20 kcal/oz
46
vit d requirements for breastfed infants
400IU/day starting first few days of life
47
fluoride recommendations for breastfed infants
0.5 mg/day when >6 months old
48
1-2 mg/kg/day of what may be supplemented in breastfed or pre term infants
iron
49
caution with what in a toddlers diet?
fruit juice
50
condition in infants that manifests as spitting up or regurgitation and resolves by 12-14 months
GER
51
condition in infants characterized by excessive regurgitation, food refusal, abdominal pain, etc.
GERD
52
risk factors for GERD in children
locus on chromosome 12, neurologic impairment, obesity, esophageal atresia, chronic lung disease, prematurity
53
treatment for GER
nonpharm- volume of feeding, special formula, supine
54
1st line treatment for mild GERD
H2RAs
55
1st line treatment for mod to sev GERD or erosive esophagitis
PPIs
56
treatment duration for GERD
12 weeks
57
most common bacterial causes of AOM
S. pneumoniae
H. influenzae
M. catarrhalis
58
signs and symptoms for AOM
middle ear effusion
acute onset of symptoms
59
what makes AOM severe
mod/sev otalgia or fever >39C
60
what are the trends for antimicrobial resistance for common AOM pathogens
resistance has been increasing to penicillins
61
when are antibiotics recommended for AOM
mod/sev s&s- otalgia>48 hrs and temp>39
age <24 mos & bilateral AOM
62
when are antibiotics OR observation used for AOM
6-23 mos w/ unilateral w/o severe s/s
>24 mos w/ unilateral or bilateral w/o sev s/s
63
first line antibiotics for AOM
amoxicillin 80-90 mg/kg/d BID
amox/clav 90 mg/kg/d BID
64
when is amox used for AOM
no amox last 30 days
no concurrent purulent conjunctivitis
no penicillin allergy
65
alternative options for AOM
cephalosporin, macrolide, ceftriaxone
66
AOM treatment duration if severe or <2yrs old
10 days
67
AOM treatment duration if 2-5 yrs old with mild/mod symptoms
7 days
68
AOM treatment duration if >6 yrs old with mild/mod symptoms
5-7 days
69
diagnosis of uti is made with
urine culture
70
uti located in the bladder
cystitis
71
uti located in the urethra
urethritis
72
uti located in the kidney
pyelonephritis
73
urine infection
bacturia
74
uti of the gu tract with structural and/or functional abnormalities
complicated
75
uti occurring in anatomically normal ut with no prior instrumentation
uncomplicated
76
most common pathogen causing uti
E. Coli
77
most common pathway of uti infection
retrograde adcent
78
what is the more common pathway of uti infection in infants
hematogenous route
79
first line option for uti?
alternatives?
1st- cephalosporins
alt- bactrim, b-lactam +/- b-lactamase inhibitor
80
treatment duration for uncomplicated uti
7 days
81
treatment duration for complicated uti or pyelonephritis
10-14 days
82
retrograde urinary flow from bladder into ureters and possibly renal collecting system and renal pelvis
vesicoureteral reflux
83
who are more likely candidates for uti prophylaxis
females, vur grade 5, bladder/bowel dysfunction
84
abx choice for uti prophylaxis in neonates and infants <2 mos
amoxicillin
85
abx choice for uti prophylaxis in infants >2 mos
bactrim or nitrofurantoin
86
most common pathogen causing cap
s pneumoniae
87
at what age do atypical bacteria tend to cause cap
5 and up
88
most likely pathogen causing cap in 3 weeks to 3 mos (& 3mos to 5 yrs)
S. pneumoniae, RSV
89
most likely pathogen causing cap in 5 to 15 yeaes
S. pneumoniae
M. pneumoniae
C. pneumoniae
90
most common symptoms occurring with cap
fever cough
91
abx choice for inpatient cap when the patient is fully immunized and their is minimal local penicillin resistance
ampicillin
92
abx choice for inpatient cap in a not fully immunized patient and significant penicillin resistance locally
ceftriaxone
93
general treatment duration for cap? exception?
10 days
azithro & oseltamavir are 5 days
94
first line for outpatient cap
alternative?
amoxicillin 90 mg/kg/day
alt is amox/clav 90 mg/kg/day
95
what type of amox/clav is preferred for cap?
ES forms so there isnt 2x the clav with high doses
96
abx for atypical outpatient cap
azithromycin
97
antiviral used for influenza caused cap
oseltamavir
98
most common pathogen causing meningitis in <1 month old
GBS
99
most common pathogens causing meningitis in 1-23 months old
s. pneumoniae
n. meningitidis
100
most common pathogens causing meningitis in age 2-50
n. meningitidis
s. pneumoniae
101
major sign of meningitis in infants
bulging fontanelle, seizures
102
abx for meningitis if <1 month old
ampicillin + aminoglycoside (+ cefotaxime is alternative)
103
abx for meningitis in 1-50 years
vancomycin + ceftriaxone (or cefotaxime_
104
duration of meningitis therapy
7-21 days
105
why is dexamethasone used in meningitis
decreased hearing loss in h. influenzae meningitis in >6 weeks old
106
when should dexamethasone be given?
timing? who recommended for?
10-20 mins before or with 1st dose of abx
recommended if h. influenzae
107
5 live attenuated vaccines
mmr, varicella, influenza, polio, rotavirus
108
2 toxoid vaccines
diphtheria, tetanus
109
4 inactivated vaccines
hep a, flu, pertussis, polio
110
4 inact/recombinant vaccines
hep b, hpv, rsv, zoster
111
3 conjug/polysaccharide vaccines
hib, meningo, pneumo
112
DTap brand
infanrix, daptacel
113
Tdap brand
adacel, boostrix
114
Td brand
tenivac, tdvax
115
DTaP + IPV brand
kinrix, quadracel
116
DTap + IPV + Hib brand
pentacel
117
DTaP + IPV + HepB brand
pediarix
118
DTaP + IPV + Hib + HepB brand
vaxelis
119
MMR + varicella brand
ProQuad
120
Hep A + Hep B brand
twinrix
121
Hib + MenCY brand
Menhibrix
122
Men A, B, C, W-135, Y brand
Penbraya
123
what steroid treatment requires LA vaccines to be held for 1 month
14 days of high dose (2 mg/kg/day) steroids
124
when should 2 doses of flu be given
<9 yrs old for 1st lifetime dose, 4 weeks apart
125
5 brands of flu vax approved in 6 and up
afluria, fluarix, flulaval, fluzone, flucelvax
126
1 brand flu vax approved for 18 and up
flublok
127
2 brands flu vax approved for 65 and up
fluzone HD and fluad
128
LAIV brand name? age used?
flumist, 2-49 years
129
when can pregnant women get abrysvo
32 weeks to 36 weeks 6 days between september and january
130
nirsevimab indication
<8 mos between oct and march based on moms vax status
131
what is given at birth depending on the moms hep b antigen status
HBIG
132
when must rotavirus series be started? completed?
start by 15 weeks, finish by 8 months
