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Pharm 3 (me) > Peds > Flashcards

Peds Flashcards

1
Q

Premature neonate age?

A

Born at <36 was gestational age

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2
Q

Term neonate age?

A

Born at >36 was gestational age

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3
Q

Neonate age?

A

Birth to 1 month

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4
Q

Infant age?

A

I month to 1 yr

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5
Q

Child age?

A

1 to 11 yrs

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6
Q

Adolescent age?

A

12-16 yrs

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7
Q

Acidity in first 2-3 yrs?

A

Less

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8
Q

Gastric emptying in neonates compared to infants?

A

Slower in neonates

Increase in infants

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9
Q

Stratum corneum in preterm neonates?

A

Underdeveloped

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10
Q

Transdermal absorption compared to adults in peds?

A

Faster

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11
Q

IM absorption compared to adults in peds?

A

Less or erratic

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12
Q

Inhalation onset compared to adults in peds?

A

More rapid

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13
Q

Percent of BW is water in premature infant?

A

85%

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14
Q

When do peds come close to adult body water competition (55-60%)?

A

1 yr but ECF to ICF is nearly equal

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15
Q

Volume of distribution of water soluble drugs in peds?

A

Higher Vd

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16
Q

Dosing requirements for drugs such a NMBs in peds?

A

Higher

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17
Q

Duration of action of lipid soluble drugs like propofol and fent?

A

Longer (less redistribution effect)

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18
Q

What drug types can displace bilirubin in neonates and cause CNS adverse effects?

A

Highly protein drugs

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19
Q

Reduced metabolism of some agents include (3):

A

Benzodiazepines, barbiturates, amide local anesthetics

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20
Q

What kind of clearance of morphine in neonate to 6 months?

A

Reduced

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21
Q

GFR status in neonates?

A

Underdeveloped

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22
Q

Does peds elimination often impact antibiotic dosing?

A

Yes

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23
Q

Nicotine can cholinergic receptors is what kind of channel and when is it that form?

A

Ligand gated ion channel

Felt and adult

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24
Q

Fetal receptors have what kind of response to depolarizing agent and non depolarizing agent?

A

Enhanced to depolarizing

Relative resistance to non depolarizing

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25
Q

Stroke volume is what in neonates and infants?

A

Fixed because immature, non compliant L ventricle

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26
Q

CO is most sensitive to changes in what?

A

HR

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27
Q

Normal HR at neonate?

A

140 bpm

28
Q

Normal HR for 1 yr?

A

120

29
Q

Normal HR for 3 yr

A

100

30
Q

Normal HR for 12 yrs

A

80

31
Q

Sympathetic nervous system in infants?

A

Immature so don’t get baroreceptor reflex response in hypotension (less compensatory vasoconstriction) and blunted response to exogenous catecholamines

32
Q

IV volume depletion in neonates and infants may present as what?

A

Hypotension without tachycardia

33
Q

What do you need to know for Schwartz equation to estimate peds CrCl? (2)

A
  1. Length or height

2. Serum creatinine

34
Q

When is the most danger of overdosing or toxicity in pts age?

A

<1 yrs due to immaturity of organs and enzyme systems

35
Q

6 goals for premedication?

A
  1. Minimal sedation to allay anxiety and facilitate induction
  2. Block autonomic (vagal) reflexes
  3. Reduce airway secretions
  4. Produce amnesia
  5. Provide prophylaxis against aspiration of gastric contents
  6. Provide analgesia
36
Q

Sux dosing for <1 yr and >1 yr?

A

<1 yr: 2-3mg/kg

>1yr: 1-2mg/kg

37
Q

IM dosing of sux for infant and child?

A

Infant: 5mg/kg
Child: 4mg/kg

38
Q

Larygospasm dose of sux for IV and IM?

A

IV: .5-1mg/kg
IM: 3-5mg/kg

39
Q

Sux adverse effect?

A

Bradycardia

40
Q

More susceptible depolarizing agent (4)

A
  1. Severe hyperkalemia
  2. Rhabdomyolysis
  3. Masseter muscle spasm
  4. MH
41
Q

When is Sux mostly used? (3)

A
  1. Emergency intubation
  2. Rapid sequence intubation for full stomach
  3. Laryngospasm unresponsive to positive pressure ventilation
42
Q

3 overall ped differences compared to adults?

A
  1. Neonate differences include immature NMJ
  2. Increase ECF
  3. Less hepatic metabolism may prolong duration of action
43
Q

Nondepolarizing agents need higher dosing in who and why?

A

Neonate > infant > adult

Due to increase ECF

44
Q

MOA of ketamine?

A

NMDA

45
Q

Monitoring and potential adverse effects of dexmedetomidine (2)?

A

Bradycardia

Hypotension

46
Q

Advantage of propofol (2)?

A

Reduces PONV and emergence delirium

47
Q

How much propofol should be used?

A

More the younger pt is

48
Q

Opioids are what in neonates than older children and adults?

A

More potent and can have rigid chest effect

49
Q

Should you use morphine in neonates?

A

NO

50
Q

Why beware of ambient temp IV fluids in peds?

A

Due to increased risk for hypothermia

51
Q

Maintenance glucose requirements for newborns to 8yrs is what?

A

6 mg/kg/min

52
Q

Maintenance glucose requirements for premature neonates is what?

A

6-8 mg/kg/min

53
Q

Water loss is a function of what?

A

Caloric expenditure

54
Q

Approximating IV fluid requirements is based on what?

A

Holliday-segar nomogram

55
Q

Maintenance fluid should include what for peds and neonates?

A

Peds: dext 5%/.45 NS with 20 mEq KCL
Neonates: dext5%/.25% NS (limited ability to manage Na load)

56
Q

Estimate deficit based on what?

A

421 rule x time

57
Q

Dehydrated infants will become hypotensive without what?

A

Tachycardia

58
Q

Replace with what if kidneys unable to handle the Na load? (2)

A
  1. LR

2. .45 NS

59
Q

What to avoid if kidneys are unable to handle the Na load?

A

.9% NS

60
Q

POV rarely occurs in children of what age? (2)

A

< 3yrs

Puberty

61
Q

Risk factors of POV for types of procedure? (4)

A

Strabismus **
Adenotonsillectomy
Inguinal scrotal
Penile procedures

62
Q

Main 4 risk factors for PONV for children?

A

Surgery >30min
Age >3hrs
Strabismus surgery
History of POV or family history of PONV

63
Q

Which antiemetic drug is FDA black box warning?

A

Droperidol

64
Q

Most commonly involved agents for periop anaphylaxis? (3)

A

NMB agents
Latex (30-60min into procedure)
Antibiotics

65
Q

7 things to manage periop anaphylaxis:

A 
O2 
Epi 
Fluid bolus 
Phenylephrine 
Hydrocortisone 
Diphenhydramine 
Ranitidine

Pharm 3 (me) (7 decks)

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