Pediatrics Flashcards
which 2 vitals are elevated in children compared to adults
HR and RR
limitations of off-label drug usage in children
insurance denial
liability for AEs
limited experience
limited dosage forms
which factors impact drug absorption in peds
higher gastric ph
slower gastric emptying
reduced frequency and amplitude of contractions
how is IM bioavailability in children compared to adults? why
increased bioavailability due to capillary density
what impacts Vd in peds? how?
higher total body water and ECF
inc Vd of hydrophilic and dec Vd of lipophilic drugs
cause and effect of protein binding differences in peds
dec concentration of circulating protein
inc free fraction of drugs
cause and effect of elimination differences in peds
dec renal BF, GFR, and tubular secretion
slower CL, longer t1/2
less frequent dosing needed
what is the primary reason for noncompliance in children
palatability
how is dosing done for peds?
mg/kg/dose or mg/kg/day
neonatal age from conception, how far along in pregnancy
gestational age
neonatal chronological age, time since birthday
post-natal age
neonatal age combination of GA + PNA
post-menstrual age
age for birth to 30 days
neonate
age for 30 days to 1 year old
infant
age for 1 to 12 years old
child
age for 12 to 18 years old
adolescent
1 kg =
2.2 lbs
1 inch =
2.54 cm
BSA equation =
sqrt [(height cm x weight kg) / 3600]
the administration section of lexi has recommendations for
food & drink allowable for mixing
adverse reactions of lexi may be
specific to age, provide % incidence
which section of lexi can help in determining parenteral to enteral conversions
PK/MOA
which section of lexi can help determine what is commercially available
dosage forms
how to calculate % severity of dehydration =
[ (preillness weight - illness weight) / preillness weight ] x 100
weight in kg
fluid deficit (L) equation =
(% dehydration x preillness weight) / 100
% dehydration if mild
infants- 1-5%
children 1-3%
% dehydration if moderate
infants 6-9%
children 4-6%
% dehydration if severe
infants >10% (>15 if shock)
children >6% (>9 if shock)
S/S of mild dehydration
slight dry mucosa, decreased UOP, inc pulse
s/s of moderate dehydration
tachycardia, norm/low BP, little/no UOP, dry mucosa, sunken face, cool pale, decreased tears, thirsty
s/s of severe dehydration
rapid & weak pulse, very low BP, oliguria, parched mucosa, very sunken and cool, no tears, lethargic, unable to drink
therapy for mild dehydration
ORT 50 ml/kg over 4 hours
add 10ml/kg for each loose stool/vomit episode
therapy for moderate dehydration
100 ml/kg over 4 hours
add 10ml/kg for each loose stool/vomit episode
therapy for severe dehydration
iv fluids
phase 1 iv fluid dose for dehydration
10-20 ml/kg/dose of NS or LR over 30-60 min up to 3 times
phase II of IV fluids for severe dehydration? max rate?
maintenance
max 100ml/hr and no more than 1.5-2x MIVF
what should be included in an iv fluid bag
NS- isotonic
D5W
K 20 mEq/L
when should you use caution with potassium in IV fluids
renal failure, neonates
what can be used in those >6 mos for gastroenteritis
ondansetron
dosage forms of zinc are expressed in salt, which is what % elemental
23%
how many weeks is a premature, term, and post term neonate
premature <37 weeks
term 38-41 weeks
post-term >42 weeks
what age is toddler, early, and older school
toddler- 1-4 yr
early- 5-7 yr
older 8-12 yr
weight gain for infants
20-30 grams per day
inadequate growth or inability to maintain growth in early childhood
failure to thrive
breastmilk calorie contents
20 kcal/oz
vit d requirements for breastfed infants
400IU/day starting first few days of life
fluoride recommendations for breastfed infants
0.5 mg/day when >6 months old
1-2 mg/kg/day of what may be supplemented in breastfed or pre term infants
iron
caution with what in a toddlers diet?
fruit juice
condition in infants that manifests as spitting up or regurgitation and resolves by 12-14 months
GER
condition in infants characterized by excessive regurgitation, food refusal, abdominal pain, etc.
GERD
risk factors for GERD in children
locus on chromosome 12, neurologic impairment, obesity, esophageal atresia, chronic lung disease, prematurity
treatment for GER
nonpharm- volume of feeding, special formula, supine
1st line treatment for mild GERD
H2RAs
1st line treatment for mod to sev GERD or erosive esophagitis
PPIs
treatment duration for GERD
12 weeks
most common bacterial causes of AOM
S. pneumoniae
H. influenzae
M. catarrhalis
signs and symptoms for AOM
middle ear effusion
acute onset of symptoms
what makes AOM severe
mod/sev otalgia or fever >39C
what are the trends for antimicrobial resistance for common AOM pathogens
resistance has been increasing to penicillins
when are antibiotics recommended for AOM
mod/sev s&s- otalgia>48 hrs and temp>39
age <24 mos & bilateral AOM
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
first line antibiotics for AOM
amoxicillin 80-90 mg/kg/d BID
amox/clav 90 mg/kg/d BID
when is amox used for AOM
no amox last 30 days
no concurrent purulent conjunctivitis
no penicillin allergy
alternative options for AOM
cephalosporin, macrolide, ceftriaxone
AOM treatment duration if severe or <2yrs old
10 days
AOM treatment duration if 2-5 yrs old with mild/mod symptoms
7 days
AOM treatment duration if >6 yrs old with mild/mod symptoms
5-7 days
diagnosis of uti is made with
urine culture
uti located in the bladder
cystitis
uti located in the urethra
urethritis
uti located in the kidney
pyelonephritis
urine infection
bacturia
uti of the gu tract with structural and/or functional abnormalities
complicated
uti occurring in anatomically normal ut with no prior instrumentation
uncomplicated
most common pathogen causing uti
E. Coli
most common pathway of uti infection
retrograde adcent
what is the more common pathway of uti infection in infants
hematogenous route
first line option for uti?
alternatives?
1st- cephalosporins
alt- bactrim, b-lactam +/- b-lactamase inhibitor
treatment duration for uncomplicated uti
7 days
treatment duration for complicated uti or pyelonephritis
10-14 days
retrograde urinary flow from bladder into ureters and possibly renal collecting system and renal pelvis
vesicoureteral reflux
who are more likely candidates for uti prophylaxis
females, vur grade 5, bladder/bowel dysfunction
abx choice for uti prophylaxis in neonates and infants <2 mos
amoxicillin
abx choice for uti prophylaxis in infants >2 mos
bactrim or nitrofurantoin
most common pathogen causing cap
s pneumoniae
at what age do atypical bacteria tend to cause cap
5 and up
most likely pathogen causing cap in 3 weeks to 3 mos (& 3mos to 5 yrs)
S. pneumoniae, RSV
most likely pathogen causing cap in 5 to 15 yeaes
S. pneumoniae
M. pneumoniae
C. pneumoniae
most common symptoms occurring with cap
fever cough
abx choice for inpatient cap when the patient is fully immunized and their is minimal local penicillin resistance
ampicillin
abx choice for inpatient cap in a not fully immunized patient and significant penicillin resistance locally
ceftriaxone
general treatment duration for cap? exception?
10 days
azithro & oseltamavir are 5 days
first line for outpatient cap
alternative?
amoxicillin 90 mg/kg/day
alt is amox/clav 90 mg/kg/day
what type of amox/clav is preferred for cap?
ES forms so there isnt 2x the clav with high doses
abx for atypical outpatient cap
azithromycin
antiviral used for influenza caused cap
oseltamavir
most common pathogen causing meningitis in <1 month old
GBS
most common pathogens causing meningitis in 1-23 months old
s. pneumoniae
n. meningitidis
most common pathogens causing meningitis in age 2-50
n. meningitidis
s. pneumoniae
major sign of meningitis in infants
bulging fontanelle, seizures
abx for meningitis if <1 month old
ampicillin + aminoglycoside (+ cefotaxime is alternative)
abx for meningitis in 1-50 years
vancomycin + ceftriaxone (or cefotaxime_
duration of meningitis therapy
7-21 days
why is dexamethasone used in meningitis
decreased hearing loss in h. influenzae meningitis in >6 weeks old
when should dexamethasone be given?
timing? who recommended for?
10-20 mins before or with 1st dose of abx
recommended if h. influenzae
5 live attenuated vaccines
mmr, varicella, influenza, polio, rotavirus
2 toxoid vaccines
diphtheria, tetanus
4 inactivated vaccines
hep a, flu, pertussis, polio
4 inact/recombinant vaccines
hep b, hpv, rsv, zoster
3 conjug/polysaccharide vaccines
hib, meningo, pneumo
DTap brand
infanrix, daptacel
Tdap brand
adacel, boostrix
Td brand
tenivac, tdvax
DTaP + IPV brand
kinrix, quadracel
DTap + IPV + Hib brand
pentacel
DTaP + IPV + HepB brand
pediarix
DTaP + IPV + Hib + HepB brand
vaxelis
MMR + varicella brand
ProQuad
Hep A + Hep B brand
twinrix
Hib + MenCY brand
Menhibrix
Men A, B, C, W-135, Y brand
Penbraya
what steroid treatment requires LA vaccines to be held for 1 month
14 days of high dose (2 mg/kg/day) steroids
when should 2 doses of flu be given
<9 yrs old for 1st lifetime dose, 4 weeks apart
5 brands of flu vax approved in 6 and up
afluria, fluarix, flulaval, fluzone, flucelvax
1 brand flu vax approved for 18 and up
flublok
2 brands flu vax approved for 65 and up
fluzone HD and fluad
LAIV brand name? age used?
flumist, 2-49 years
when can pregnant women get abrysvo
32 weeks to 36 weeks 6 days between september and january
nirsevimab indication
<8 mos between oct and march based on moms vax status
what is given at birth depending on the moms hep b antigen status
HBIG
when must rotavirus series be started? completed?
start by 15 weeks, finish by 8 months
