peds deck 7 Flashcards
pharmacokinetic considerations of midazolam
- crosses BBB 2. absorbed in the GI 3. metabolized by CYP450
midazolam acts on what receptors
its a GABA agonist
what pediatric populations would you consider giving midazolam
- preop for separation anxiety
T/F: it is common to give midazolam to neonates
FALSE
what receptors do propofol work on
NMDA and GABA (but primarily GABA)
dose of propofol in peds for induction
2-5 mg/kg
infusion rate of propofol
100-300 mcg/kg/min
s/e of propofol
- decreases CMRO2, CBF, and ICP 2. decrease SBP 3. HR - unchanged or inc or dec 4. dose dep respiratory depression
why do we like propofol in peds
- quick on and off 2. easily accessible 3. low s/e profile 4. antiemetic and anticonvulsant properties
what pediatric pts in propofol c/i in?
- mitochondrial d/o 2. central hyopventilation d/o
MAC of isoflurane in children
1.2
MAC of sevoflurane in children
2.2
MAC of desflurane in children
6.8
neurologic s/e of INH anesthetics
- decreased CMRO2 2. increased CBF 3. increased ICP
CV s/e of INH anesthetics
- dose dep dec in BP 2. HR - desflurane will increase; sevoflurane can decrease
respiratory effects of INH anesthetics
- increases RR 2. Tv decrease 3. DD decrease in airway resistance
what is the most commonly used inhalational agent in peds
sevoflurane
T/F: there is no advantage to one INH agent over another in regards to inducing neuroapoptosis
TRUE
_____________ does not cause neuroapoptosis, but does when it is used in conjunction with other volatiles
N2O
the highest degree of neurapoptosis was found when INH agents were used with _____________, ___________, or _____________
ketamine; midazolam; N2O
what meds/interventions have been found to be protective from neuroapoptosis
- lithium 2. hypothermia 3. methazolamide 4. melatonin 5. xenon 6. precedex
in peds (/= ______________ anesthetics
3
T/F: pediatric pts under the age of 3 are at no greater risk of learning disability 2/2 neuroapoptosis with routine anesthetic
TRUE
T/F: elective surgery is not recommended in neonates and infants
true - puts at risk for neuroapoptosis and learning disability later in life.
T/F: referred pain is not as common in pediatrics as is it is with adults
TRUE
challenges with identifying pain in the pediatric pt
- unable to clearly identify whats going on with neonates and infants (crying but do not know why) 2. toddlers: cannot always make coherent response/response you can respond to 3. difficult to differentiate btwn pain, anxiety, and fear 4. poor coping skills/inabililty to have rational conversations 5. social background - may not speak to you due to their troubled background
T/F: the vast majority of medications used in pediatric anesthesia are FDA approved
false; they are used off label/not FDA approved
MOA of acetaminophen, ibuprofen, tordol
nonselective COX inhibitor –> inhibition of prostaglandins
optimal cases for using tylenol in peds
- neonates 2. opioid wary (like with pyloric stenosis) 3. febrile (appendicitis) 4. with or without IV
concerns with tylenol in pediatrics
- IV should be given over 15 min 2. hepatotoxicity (due to inadvertent OD) 3. skin reaction warning
FDA 2014 recommendation on tylenol in peds?
- limitation of combination narcotics (those that have tylenol in them) 2. limit tylenol to < 4 g per day 3. education to parents on tylenol and what it can be found in
ibuprofen in NOT recommended in those < ____________ (age)
6 months
what cases would ibuprofen be a good adjunct
- mild to moderate pain 2. use in conjuction with opioids 3. IV or no IV
concerns with Ibuprofen in pediatrics
- can cause ASA induced asthma attack 2. risk for GI bleed/increased bleeing 3. hepatic disease
________________ is a pain adjunct that is NOT recommended to be used in infants
ketorolac
IV dose of ketorolac in peds
0.5 mg/kg; max = 30 mg
concerns with ketorolac in pediatrics
- NSAID allergies 2. causes bronchoconstriction (avoid with asthma) 3. PUD 4. renal failure
what meds have the highest cross sensitivity with asprin; therefore, should be avoided in children with asthma
- ibuprofen 2. naproxen 3. diclofenac
NSAID induced airway hyperreactivity occurs in about ______% of adults and _____% of peds
20; 5
what is samter’s triad
- asthma 2. nasal polyps 3. asprin/NSAID sensitivity if pt has 2 out of these 3 –> avoid ASA, ibuprofen, naproxen, and ketorolac d/t risk of NSAID induced airway hyperreactivity
neonate/infant/school aged child dose of ketamine - IV and gtt
IV = 1-2 mg/kg gtt = 20-75 mcg/kg/min
MOA of ketamine
noncompetitive NMDA receptor antagonist
ketamine causes dissocation btwn the ____________ & ___________ systems
thalamoneocortical; limbic
what cases would ketamine be a good pain adjunct?
- cardiac pts (esp unrepaired or where SVR increase is desirable) 2. part of TIVA 3. neuromonitoring 4. Burn pts (2/2 opioid tolerance) 5. cases where you want spontaneous resp 6. chronic pain pts
concerns with ketamine in peds
- increases ICP 2. can increase BP (or decrease if catechol depleted) 3. increases secretions 4. can cause emergence reactions 5. 3+ exposures <3 years of age increase risk of neuroapoptosis
function of mu-1 receptor
- analgesia 2. miosis 3. urinary retention 4. N/V 5. pruritis
fx of mu-2 receptor
- sedation 2. respiratory depression 3. decreased GI motility
fx of kappa receptor
- analgesia 2. sedation 3. dec GI motility
fx of delta opioid receptor
- analgesia 2. emotional behavior
stimulation of the sigma opioid receptor causes ________________
dysphoria
