Peds 4 Flashcards
What is bolus amount for kids
- 20 mL/kg (up to 1 L)
- 10 mL/kg for “half” bolus
Components of maintenance fluids for kids
D5 1/2NS + 20 mEq KCl
Describe how to calculate maintenance fluids for kids
4-2-1
- For the 1st 10 kg = 4ml/kg/hr
- Between 11-20 kg = 2ml/kg/hr
- > 20 kg = 1 ml/kg/hr
Ddx of acute respiratory distress
Viral, bacterial pneumonia, foreign body aspiration, asthma, croup, myocarditis
What nutritional supplements are recommended for exclusively breast fed infants
♣ Vitamin K administration at birth ♣ Vitamin D ♣ Sometimes fluoride ♣ Iron at 4-6 months (iron levels in breastmilk are low but highly bioavailable) ♣ Vitamin B12 to vegan mothers
What type of deficiency will you see in Cystic Fibrosis
Fat malabsorption = ADEK deficiencies
A = fontanelle fullness D = rickets E = hemolytic anemia K = bleeding
MOA of Penicillin
Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs); which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis
Describe resistance to Penicillin
Bacteria produce beta lactamases, which can break the beta lactam drugs (e.g. Staph species)
How do the following drugs differ from Penicillin: Nafcillin, Methicillin, Oxacillin, Dicloxacillin
Bulky R groups prevent beta-lactamase binding
Use of Methicillin/Nafcillin
Used to treat staphylococci
MOA of MRSA resistance to Penicillins
Altered PBPs - MRSA produces PBPs that have low affinity for binding beta-lactam abx
Describe relationship of Ampicillin and Amoxicillin
Ampicillin is IV version of Amoxicillin
How does Ampicillin/Amox differ from Penicillin
Maintain bacterial spectrum of Penicillin, but have improved activity against gram negatives
Are both beta-lactamase sensitive
Uses of Amoxicillin
Strep pharyngitis, otitis media and sinusitis, pneumonia, Lyme disease, H. flu, H. Pylori
Uses of Ampicillin
Anaerobic aspiration pneumonia, enterococcus, Listeria meningitis
What are the names of the beta-lactamase inhibitors
Clavulanate, Tazobactam, Sulbactam
What is Augmentin
Amoxicillin + Clavulanate
Adverse effects of amino penicillins
o Amino penicillins can cause rash which may manifest more seriously as Stevens-Johnson syndrome
o Amoxicillin-Clavulante is one of the most commonly reported causes of drug-induced liver injury
o Can lead to skin rashes when used in the setting of viral illness (e.g. Epstein-Barr virus – mono)
How do Piperacillin and Ticaracillin differ from Penicillin
Broad spectrum coverage similar to Amino-penicillins + anaerobes + Pseudomonas
MOA of Cephalosporins
Are also beta lactams - Bind PBPs and stop cell wall synthesis - same as Penicillin
What are the names of 1st gen cephalosporins
“General Lex” wearing a fex hat
Cephalexin, Cefazolin
Uses of 1st gen cephalosporins
Most gram positive cocci (staph and strep)
Cellulitis, abscess, strep pharyngitis, surgical prophylaxis, can be used to treat UTIs by some gram neg bugs (PEK = Proteus, E. Coli, Klebsiella)
What are the names of 2nd gen cephalosporins
THINK: Furious general Fox drinking tea
Cefuroxime
Cetotetan
Cefoxitin
Uses of 2nd gen cephalosporins
Same as 1st gen (staph and strep) with extended gram neg coverage (HeNS PEcK = H. flu, Neisseria, Serratia, Proteus, E. Coli, Klebsiella)
What are the names of 3rd gen cephalosporins
THINK: General Taz with 3 axes
Ceftriaxone
Cefotaxime
Ceftazidime
Uses of 3rd gen cephalosporins
Gram positive +
- Meningitis (strep pneumo, H. flu, N. meningitidis)
- Pneumonia (Ceftazidime to tx Pseudomonas)
- Endocarditis (strep viridans)
- Gram neg GI bugs (salmonella, shigella)
- Gonorrhea
- Lyme disease
- Does NOT treat MRSA
What are the names of 4th gen cephalosporins
THINK: General Prime
Cefepime
Uses of 4th gen cephalosporins
Highly active against gram positive and gram negative
Can treat meningitis and pseudomonas
Does NOT treat MRSA
What are the names of 5th gen cephalosporins
THINK: General Tara
Ceftaroline
Uses of 5th gen cephalosporins
Broad spectrum + MRSA
Describe Cephalosporin’s susceptibility to beta-lactamase
Some are stable to beta-lactamase (especially 3rd and 4th gen)
Describe resistance to Cephalosporins
- Altered PBP
- Extended spectrum beta lactamase
Describe MOA of Monobactams and spectrum coverage
Are beta lactams (bind PBP)
Spectrum is limited to aerobic gram negative rods
No effect on anaerobes or gram positives
Name of Monobactam drug and its uses
Aztreonam
Gram neg coverage similar to 3rd gen cephalosporins - penetrates CSF (meningitis, pneumonia, sepsis, pseudomonas)
Describe monobactam susceptibility to beta lactamases
Resistant to most beta lactamases
What are the Carbapenems
Imipenem, Ertapenem, Meropenem, Doripenem
MOA and spectrum of Cabapenems
Broad spectrum - treat gram neg, gram positive, and anaerobes (including pseudomonas)
Meningitis, psudeomonas, sepsis
When do you use Carbapenems
With bugs resistant to other tx
Describe special consideration when using Imipenem
Is inactivated by dehydropeptidase in the renal tubules so it is administered with inhibitor of dehydropeptidase (Cilastin)
Adverse effect of Carbapenems
Rash, GI effect (N,V,D), lowers seizure threshold
Describe Carbapenem susceptibility to beta lactamase
Highly resistant to extended spectrum beta lactamases
Diagnose: eczema, thrombocytopenia, recurrent infections
Wiskott-Aldrich Syndrome
o X-linked recessive immunodeficiency due to mutation in WASp gene
o Leukocytes and platelets unable to reorganize actin skeleton defective antigen presentation
o WATER - Wiskott Aldrich, microThrombocytopenia, Eczema (especially truncal), Recurrent infections
o Treatment – stem cell transplant
Diagnose: recurrent pneumonia, atopy, and anaphylactic reaction during blood transfusion
Selective IgA deficiency
Best way to prevent congenital rubella
Maternal immunization prior to conception
