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Pharm 2 > Peds 2 > Flashcards

Peds 2 Flashcards

1
Q

How is sinusitis diagnosed in kids?

A

with >7 days of copious nasal congestion accompanied by chronic cough

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2
Q

Tx regimen for kids with sinusitis

A

Amoxicillin or amoxicillin clavulanate

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3
Q

Which abx can be used to tx sinusitis in kids with a true PCN allergy?

A

Cephalosporins can be used as an alternative

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4
Q

How to definitively dx strep pharyngitis?

A

a rapid strep test and/or a culture is essential

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5
Q

Which kids will have repeated rapid strep tests?

A

10-20% of all children are asymptomatic carriers of GABHS

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6
Q

Kids who are asymptomatic carriers of GABHS tx regimen?

A

These children should not be treated repeatedly without clinical evidence their illness is a true strep infection

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7
Q

Strep pharyngitis in kids tx

A

Amoxicillin or Penicillin V PO for 10 days
Penicillin G (Bicillin) IM once
Alternatives - Cephalosporins, macrolides, clindamycin

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8
Q

Which abx are prefered in kids with PCN allergies for tx of strep pharyngitis?

A

Clindamycin or azithromycin may be prescribed for children with a true type 1 allergy to penicillin
Clinda > azithro d/t rising resistance

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9
Q

Clindamycin SE

A

Side effects of clindamycin; can include rash, urticaria, Stevens Johnson syndrome, prolonged QT times, thrombocytopenia, neutropenia, GI side effects (nausea, vomiting, diarrhea), pseudomembranous colitis

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10
Q

Penicillin G trade name

A

Bicillin - available IM

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11
Q

Common PE findings of mono

A

Posterior cervical adenopathy is common
Splenomegaly occurs in up to 50% of patients

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12
Q

Mono tx in kids

A

Supportive care (mainstay of therapy) - Acetaminophen or NSIADs
Steroids - Dexamethasone (Used when there are markedly edematous tonsils and/or when there is impending airway obstruction)
Antivirals - No effect on latent infection or ability to cure the infection

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13
Q

What should NOT be prescribed to tx mono?

A

Amoxicillin - causes rash

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14
Q

Common complication of HSV in kids

A

Dehydration is the most common complication

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15
Q

How long do HSV lesions last?

A

10-14 days

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16
Q

HSV tx regimen in kids

A

Supportive care
Fluids
Pain control - Acetaminophen or ibuprofen
Prevention of lip adhesions - Barrier cream with petroleum jelly
Acyclovir

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17
Q

What is the time limitation to tx HSV with antivirals?

A

Acyclovir can be used within 96 hours of disease onset

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18
Q

What causes thrush?

A

Candida albicans

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19
Q

Why are infants susceptible to thrush?

A

Usually infects infants, primarily due to the relative immaturity of the infant’s immune system

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20
Q

Which meds are used to tx thrush in kids? What modes do they come in?

A

Nystatin - lozenge or suspension (preferred)
Fluconazole - lozenge or suspension

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21
Q

Nystatin use directions in an infant?

A
  • Feed the baby its normal bottle (if breastfeeding, avoid feeding 5-10 minutes prior to, and after, administration)
  • Wipe the plaques out of the baby’s mouth with a moist rag.
  • Administer the nystatin
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22
Q

When nystatin fails to cure thrush, what is the alternative?

A

Fluconazole

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23
Q

Fluconazole MOA

A

Fluconazole works by interfering with the fungal cell membranes by decreasing their ergosterol synthesis

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24
Q

Fluconazole SE

A

Headaches, dizziness, skin rash, nausea, abdominal pain, diarrhea, vomiting, hepatitis, increase in liver enzymes

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25
Q

What does sodium benzoate cause in infants?

A

Gasping syndrome - potentially fatal toxicity of sodium benzoate involving metabolic acidosis, respiratory distress, gasping respirations, CNS convulsions, CNS hemorrhage, hypotension, and cardiovascular collapse.

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26
Q

Which meds can contain sodium benzoate?

A

Oral suspensions such as fluconazole

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27
Q

What must a clinician determine when faced with a kid with resp. distress?

A

first determine whether it is a process affecting the upper or lower airways

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28
Q

Asthma tx goals

A
  • Prevent symptoms
  • Minimize morbidity when an attack occurs
  • Allow a child to live as close to a “normal” lifestyle as possible
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29
Q

Occasional asthma attacks can be treated with?

A

SABA

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30
Q

When should asthma tx be stepped up?

A

If it becomes necessary to use SABA agents >2 days/week, therapy should be stepped up to include inhaled corticosteroids

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31
Q

When can asthma tx be stepped down?

A

Several months of no attacks

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32
Q

What med is considered the cornerstone of long term management of asthma in kids?

A

ICS

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33
Q

What devices are available to deliver ICS tx?

A

A nebulizer machine
A dry powder inhaler (DPI)
A pressurized metered dose inhaler (pMDI)
A breath-actuated metered dose inhaler (pMDI)

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34
Q

For kids < 6 yrs, what is the most appropriate tx combination for a child with asthma?

A

a metered dose inhaler with a mask/spacer

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35
Q

For kids > 6 yrs, what devices can be used in asthma tx?

A

Children >6 years old can use a pMDI, a breath-actuated pMDI, or a DPI

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36
Q

What is an important counseling point for asthma tx?

A

children must be reminded to rinse their mouths after use to avoid tooth erosion and thrush (especially ICS)

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37
Q

What is the mode of tx for bronchiolitis?

A

Very few medications to treat bronchiolitis with the exception of administering oxygen

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38
Q

In what cases would steroids be used to tx bronchiolitis?

A

Not usually used, except in those pts with underlying asthma

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39
Q

In addition to O2, what other mode of tx can be trialed to tx bronchiolitis?

A

SABA

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40
Q

What supportive tx can be used to tx bronchiolitis?

A

Frequent nasal suctioning

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41
Q

What can be trialed as a mode of tx for bronchiolitis that requires hospitalization?

A

a trial of racemic epinephrine

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42
Q

MCC of croup?

A

Parainfluenza virus type 1

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43
Q

Mild croup tx

A

Most cases improve within 24 hrs with no tx

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44
Q

Mild to moderate croup tx

A

Decadron 1 dose PO with close f/u

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45
Q

Severe croup tx

A

Decadron and racemic epi with observation

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46
Q

How does racemic epi work?

A

Acts on α- and β-adrenergic receptors - Resulting in both relaxation of smooth muscles in the bronchial tree as well as a decrease in local airway edema with resultant decrease in the work of breathing

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47
Q

What does racemic epi contain?

A

Contains both L-epinephrine and D-epinephrine in a 1:1 ratio

48
Q

Racemic Epi SE

A

Cardiac effects (arrhythmias, myocardial ischemia, hypertension)

49
Q

Common sxs of influenza in younger kids

A

higher fevers (which can lead to febrile seizures) and GI symptoms of nausea, vomiting, and anorexia

50
Q

MC complication of influenza in kids

A

most common complication of influenza is otitis media

51
Q

Meds used for influenza in kids

A

Oseltamivir
Zanamivir

52
Q

How do antivirals work against influenza?

A

competitively inhibiting the neuraminidase on the surface of both influenza A and B viruses

53
Q

When given as influenza tx, how much do antivirals shorten the disease by?

A

1 day

54
Q

Oseltamivir SE in kids

A

hallucinations, confusion, delirium, and self-injury with fatalities, HA, vomiting, nausea

55
Q

Zanamivir SE in kids

A

anaphylaxis, allergic reactions, edema, rashes, and neuropsychiatric events (hallucinations, confusion, delirium, and self-injury)

56
Q

Which pts should avoid zanamivir powder use?

A

Don’t use in those with underlying respiratory disorders (asthma)

57
Q

Uncomplicated CAP in < 5 yrs tx

A

1st line: Amoxicillin
2nd line: Azithromycin or 3rd gen cephalosporin (Cefdinir or Ceftriaxone IV)

58
Q

School aged kid CAP tx

A

Macrolides (azithromycin) - to cover for unusual pathogens

59
Q

Hospitalized kids for PNA tx

A

IV 3rd gen cephalosporin (Ceftriaxone) with IV macrolide (azythromycin)

60
Q

Kids with severe PNA/ resp. distress/ sepsis

A

Vacno + 2nd or 3rd gen cephalosporin (Ceftriaxone) if MRSA is suspected

61
Q

How are functional disorders of the GI tract diagnosed in kids?

A

Inflammation of the GI tract is usually diagnosed by its symptoms

62
Q

Tx of vomiting with antiemetics should be reserved for?

A

the child <2 years old, the child with gastroenteritis, or the child with dehydration

63
Q

Antiemetics used in kids

A

Promethazine, prochlorperazine and ondansetron

64
Q

How should promethazine be dosed in kids?

A

Clinicians should start with half the recommended adult dose

65
Q

Promethazine SE

A

side effects such as sedation, respiratory depression, dystonic reactions, or ataxia

66
Q

Which antiemetics are not recommended in kids less than 2 yrs?

A

Promethazine and prochlorperazine

67
Q

If a kid has severe diarrhea, what are the interventions?

A

patients will likely need fluid and electrolyte therapy as well as other non-specific support +/- abx

68
Q

When should diarrhea be worked up in neonates/ young infants?

A

Accompanied by high fever and or blood in the stools
Causes dehydration and/or weight loss
Altered mental status
Lasts >2 weeks

69
Q

Toddler’s diarrhea

A

form of chronic diarrhea affecting children between 1-3 years old

70
Q

Toddler’s diarrhea sxs

A

Loose, non-bloody stools of 2+/day without fever or pain

71
Q

Toddler’s diarrhea possible cause

A

Consumption of fruit juices

72
Q

Toddler’s diarrhea tx

A

removing any offending agents, decreasing or changing fruit juice consumption, using psyllium bulking agents.

73
Q

MC esophageal disorder in kids

A

GERD

74
Q

When does infant reflux peak?

A

Infant reflux peaks ~4 months of age

75
Q

When is reflux considered pathologic in kids?

A

Have episodes that are more frequent or persistent
Produce esophagitis, esophageal symptoms, or go on to produce respiratory sequelae.

76
Q

GERD kids tx

A

Stepwise
- mild to moderate reflux, dietary and feeding techniques are usually adequate to help the child
- if they fail, H2 blockers (famotidine) are used
- in severe cases, PPIs are used

77
Q

PPI time limit for use in kids

A

proton pump inhibitors should not be used >4-12 weeks at a time, depending on which is used

78
Q

When started on a PPI, peds pts should be weaned off of what?

A

the patient should be weaned off the histamine-2 receptor antagonist over ~2-week period

79
Q

PPIs used in kids

A

all the “azoles”

80
Q

What causes pin worms?

A

Enterobius vermicularis

81
Q

Pinworm tx

A

one mebendazole 100-mg tablet by mouth, then repeated in 2 weeks

82
Q

If a kid cannot take mebendazole pill to tx pinworms, what can be done?

A

the tablet can be crushed and put it in applesauce or peanut butter

83
Q

Pinworm tx importance?

A

Important to treat the other children at home

84
Q

Flatulence recommendations for infants

A

Make sure that the infant is not swallowing too much air when feeding
Burp frequently and position the infant in the prone position while awake

85
Q

Flatulence tx in infants?

A

Simethicone

86
Q

When tx peds pain, what is the general rule of thumb?

A

It is best to underdose and work up than to start at too high a dose and cause side effects.

87
Q

Which drugs can be used to tx pain in kids?

A

The majority of pain can be treated with either acetaminophen or ibuprofen

88
Q

Which pain med should never be given to kids?

A

Aspirin should never be given to children <19 years old because it may induce Reye’s syndrome

89
Q

How can ASA be listed in combination products?

A

acetylsalicylate, acetylsalicylic acid, salicylic acid, or salicylate

90
Q

Acetaminophen and ibuprofen come in these forms for kids

A

oral drops, oral liquids of different flavors, and chewable tablets for infants, toddlers, and children who can’t swallow a tablet or capsule

91
Q

Which pain med is preferred to tx kids pain OVERNIGHT?

A

Ibuprofen may be the drug of choice for night pain

92
Q

When is ibuprofen contraindicated?

A

history of GI distress, dehydration, and hepatic or renal insufficiency.

93
Q

Which conditions are opioids reserved for in kids?

A

ulcers from herpetic gingival stomatitis, post-fracture management, after removal of a toe nail, significant coughs, chronic conditions such as sickle cell disease, etc..

94
Q

ADHD sxs

A

hyperactivity, impulsivity, and/or inattention, easy distractibility, unable to pay attention and follow directions, and/or has poor self-control

95
Q

ADHD subtypes

A

Inattentive only
Hyperactive/impulsive ADHD
Combined inattentive/hyperactive/impulsive (most common)

96
Q

What is the tx approach for ADHD?

A

Psychotropic medication
Behavior modification
Family education and counseling
Educational intervention

97
Q

ADHD meds

A

Methylphenidate (Ritalin, Methylin, Metadate, Daytrana, Concerta)
Dexmethylphenidate HCL (Focalin)
Amphetamine and/or dextroamphetamine (Dextrostat, Dexedrine, Adderall)
Atomoxetine (Strattera)
Lisdexamfetamine dimesylate (Vyvanse)

98
Q

Methylphenidate MOA

A

Mild CNS stimulant that blocks the re-uptake of norepinephrine and dopamine

99
Q

Methylphenidate SE

A

decreased appetite, insomnia, increased anxiety and/or irritability, and mild stomachaches or headaches

100
Q

When methylphenidate is being weaned off, what commonly occurs?

A

Rebound agitation or exaggeration of premedication symptoms may be seen as the medication is wearing off

101
Q

How can you tx insomnia associated with methylphenidate?

A

Insomnia can be helped by taking the medication earlier in the day or by adding an antidepressant

102
Q

When starting ADHD tx, what are the first steps?

A
  • Start with methylphenidate (Ritalin, Concerta, Daytrana), an amphetamine, and/or a dextroamphetamine combination; preferably long-acting duration
  • Begin by prescribing a low dose and every 1-2 weeks, over a 4-week period, gradually increase the dose if tolerated and if side effects are minimal
103
Q

What happens when a kid has reached the max dose of an ADHD med and is still exhibiting sxs?

A

an alternate class of stimulant should be chose

104
Q

If a 2nd stimulant does not help ADHD, what is the next step?

A

Consider guanfacine or tricyclic antidepressants, bupropion, and atomoxetine

105
Q

How often should ADHD pts f/u?

A

3-6 months

106
Q

Iron deficiency anemia tx in kids

A

The dose for children is 3-6 mg of elemental Fe/kg/day
Divided into 3 or 4 doses/day

107
Q

Iron SE

A

Iron may cause constipation, dark stools, nausea, epigastric pain (liquid preparation may stain teeth)

108
Q

When taking iron, what can be done to increase its bioavailability?

A

replacement iron may be administered with a vitamin C–fortified fruit juice 30 minutes before a meal

109
Q

What is the goal for kids HA/ migraine care?

A

Goal: eliminate the headache within 1-2 hours of presentation

110
Q

If a child has frequent HAs, what should be done?

A
  • a preventative medication plan may need to be started
  • clinician needs to re-evaluate the patient every 6 months to consider weaning or tapering the drug owing to the high rate of remission of migraines in children
111
Q

Which meds are used in peds HAs?

A

sumatriptan
zolmitriptan
rizatriptan

112
Q

Algorithm for HA tx with triptans in kids

A

Start with a dose where the intent is to abort the headache within 2 hours.
If the headache has not aborted after 2 hours, then repeat, but use double the same dose as the first in the hope that the patient may be symptom free in 4 hours

113
Q

Which meds can be used as rescue meds alongside of triptans?

A

acetaminophen, ibuprofen, or an opioid (in rare cases)

114
Q

When to consider prophylactic HA meds in kids?

A
  • When children and adolescents do not respond to acute management of migraine headaches and/or are having frequent headaches
  • When missing excessive amounts of school due to headaches
  • When presenting with debilitating headaches
115
Q

What are some prophylactic HA meds for kids?

A

anticonvulsants, antidepressants, antihistamines, beta-blockers, calcium channel blockers, NSAIDs

116
Q

How long should HA prophylaxis be used for in kids?

A

Once a preventative medication has been started, the typical treatment period is from 3-18 months (average 6 months)

Pharm 2 (8 decks)

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