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Advanced Anesthesia II > Peds Pharm > Flashcards

Peds Pharm Flashcards

1
Q

Vd of water soluble drugs

A

High dt high TBW

Ie succinylcholine, antibiotics, bupivacaine

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2
Q

Vd of fat soluble drugs

A

Low ; increased ruation of action b/c less tissue mass

Ie fentanyl, thiopental

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3
Q

Protein binding

A

Altered and lowered

increases free fraction of medications

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4
Q

50th percentile formula

A

Age x 2 … + 9

< 1 year old = mo/2 + 4

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5
Q

Neonatal total water content

A

70-75%

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6
Q

What contributes to a high ECF Vd

A

High TBW
low fat %
Reduced lean muscle mass

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7
Q

Vd water soluble drugs admin

A

Higher initial dose

Delayed excretion

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8
Q

At what age does the BBB improve

A

age 2

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9
Q

protein binding

A

reduced total protein resulting in more of the administered drug to be free in the plasma

lidocaine, alfentanil

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10
Q

dosing for barbiturates and LA

A

reduced dosing

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11
Q

renal function (3)

A

incomplete glomerular development
low perfusion presesure
inadequate osmotic load

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12
Q

aminoglycosides + cephalosporins

A

prolonged elimination 1/2 life in neonates

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13
Q

inhalational agents

A

more rapid induction
more rapid excretion
more rapid overdose occurrence

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14
Q

determinates of wash-in of inhalations

A
  1. inhaled concentration
  2. FRC
  3. CO
  4. alveolar ventilation
  5. solubility
  6. alveolar to venous partial pressure gradient
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15
Q

wash in is inversely related to

A

blood solubility

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16
Q

peds population and respiratory characteristics (3)

A
  1. increased RR
  2. increased blood flow to vessel rich groups
  3. decreased FRC
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17
Q

other explanations for rapid inhalational induction

A
  1. cerebral maturation
  2. age related differences in blood-gas coefficients
  3. state of hydration/dehydration
  4. type of anesthesia circuit
  5. vaporizer design
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18
Q

why is BP sensitive to volatiles?

A

lack of compensation
immature myocardium
reduced calcium stores

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19
Q

Sevoflurane MAC values

A

neonate: 3.2
infant: 3.2
children: 2.5

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20
Q

isoflurane MAC values

A

neonate: 1.6
infant: 1.8
small child: 1.4

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21
Q

desflurane MAC values

A

neonate: 9.2
infants: 10
small children: 8.2

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22
Q

stage I

A

induction of GA to LOC

‘stage of analgesia’

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23
Q

stage II

A

‘stage of excitement
LOC to the onset of automatic breathing

no eyelash reflex

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24
Q

stage III

A

‘state of surgical anesthesia’

onset of automatic respiration to respiratory paralysis

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25
Q

stage III plane I

A

automatic respiration to the cessation of eyeball movements

  • eyelid reflex lost
  • swallowing reflex disappears
  • lots of eyeball movement
  • corneal reflex lost @ end
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26
Q

stage III plane II

A

cessation of eyeball movements to the beginning of IC muscle paralysis

-laryngeal reflex lost

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27
Q

stage III plane III

A

from beginning to complete IC paralysis

  • diaphragmatic respiration persists
  • pupils dilated
  • no light reflex
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28
Q

stage III plane IV

A

complete IC paralysis to diaphragmatic paralysis

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29
Q

stage IV

A

anesthetic overdose causing medullary paralysis and vasomotor collapse

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30
Q

nitrous

A 
analgesia + amnesia
b/g: 0.47
MAC: 104%
ADR: PONV
c/i: pneumo/NEC/bowel obstructions
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31
Q

dalton’s law of partial pressure

A

PT = P1 + P2 + P3

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32
Q

sevoflurane

A

least irritating to the airways

b/g: 0.68

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33
Q

what contributes to compound A

A

high temperature
low FGF
CO2 absorbers w/barium hydroxide or soda lime

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34
Q

isoflurane

A

b/g: 1.43
potentiates NDMR to a greater extent than sevo/des
least costly !!
good for neuro cases/sz risk

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35
Q

desflurane

A

b/g: 0.42
laryngospasm @ 50% if used during induction
c/i with LMA
rapid emergence

36
Q

propofol

A

require larger induction dose r/t increased Vd
elimination 1/2 life is shorter
high rates of plasma clearance

37
Q

IONM prop dose

A

< 120 - 130 mcg/kg/m

38
Q

ketamine used since

A

1964

39
Q

ketamine dosing

A 
oral: 6 - 10 mg/kg
IM sedation: 2 - 5 mg/kg
IM induction: 5 - 10 mg/kg
IV pain: 0.5 mg/kg or 4 mcg/kg/m
IV induction: 1 - 2 mg/kg
40
Q

ketamine ADR:

A

vomit
secretion - consider glyco 0.01 mg/kg
hallucinate

41
Q

ketamine and respiratory considerations

A

preserves spontaneous respirations but apnea and laryngospasm can still occur
rapid IV dose may produce respiratory depression

BRONCHODILATION

42
Q

etomidate

A

not used lots in kids

-pain on injection, myoclonus, anaphylactoid reactions, adrenal suppression

43
Q

etomidate & rr

A

dose dependent reduction

44
Q

opioids

A

MORE POTENT

45
Q

morphine

A

0.025 - 0.05 mg/kg IV

histamine release
hepatic conjugation & renal excretion decreased

46
Q

fentanyl

A 
increased DOA (> 30 - 60 m)
immediate onset, but maximal analgesia will occur in several minutes
47
Q

fentanyl dependence

A

may occur by 7 days

48
Q

fentanyl dosing

A
  1. 25 - 1 mcg/kg IV

0. 5 - 2 mcg/kg/hr gtt

49
Q

hydromorphone

A

semi-synthetic opioid agonist, derivative of morphine. 5x the potency

onset: 5m
DOA: 2 - 3h

50
Q

hydromorphone & renal considerations

A

metabolite accumulation & neuroexcitatory symptoms

tremor - agitation - cognitive dysfunction

51
Q

naloxone

A

reduces resp. depression, n/v, pruritis & urinary retention
0.25 - 0.5 mcg/kg
MAX = 2 MG

52
Q

naloxone onset

A

30s - 1 m

1/2 life - 1.5 - 3 hours

53
Q

naloxone ADR:

A

systemic HTN
arrhythmia
pul. edema

54
Q

midaz history

A

1976 first came into use !!

55
Q

midaz dosing

A

PO 0.5 mg/kg - 20m onset
0.2 - -.3 mg/kg IN
0.05 mg/kg IV 5 m onset
PICU sedation 0.4 - 2 mcg/kg/m

DOA 1 - 6 hours

56
Q

flumazenil

A

onset 5 - 10m
10 mcg/kg IV
1/2 life 1 hour

57
Q

clonidine MOA

A

pre-synaptic alpha agonist. binding decreases calcium levels, thus inhibiting release of NE

58
Q

clonidine dosing

A

PO 4 mcg/kg (60 - 90 m onset)

adjunct to regional: 1 - 2 mcg/kg epidural/caudal (prolongs analgesia by 3h)

59
Q

clonidine adr

A

residual sedation postop

hypotension and bradycardia

60
Q

dexmedetomidine

A

8x more specific for a2adrenergic receptor
anxiolysissedationanalgesia
sedation w/o reespiratory depression

61
Q

precedex dosing

A

PO 1 mcg/kg (45 m onset)
IN 1 mcg/kg
IV 0.25 - 1 mcg/kg over 15m
gtt: 0.2 - 2 mcg/kg/h (great for spine)

62
Q

neonates + nmbds

A

increased sensitivity d/t

  1. reduction in Ach release, reduced muscle mass
  2. fetal receptors have greater opening time, allowing more sodium to enter cell
63
Q

nmbd onset

A

shorter (up to 50%) d/t faster circ times

64
Q

cis dosing

A

0.15 mg/kg IV

65
Q

vec dosing

A

0.1 mg/kg

66
Q

reversals for nmbds

A

glyco 0.01 mg/kg + neostigmine 0.05 mg/kg

sugammadex 2 - 4 mg/kg IV

67
Q

sux

A

larger dose d/t increased ECF volume of distribution
fastest onset
recovery is the same as adult

68
Q

sux + peds risks

A 
arrhythmias
hypeerK
rabdo
myoglobinuria
masseter muscle spasm
MH
69
Q

sux + atropine

A

@ 0.02 mg/kg IV/IM to prevent bradycardia

70
Q

sux dosing

A

IV < 10 kg = 2mg/kg
> 10 kg = 1 - 2 mg/kg
IM = 4 mg/kg
Laryngospasm = 0.5 mg/kg

71
Q

NDMR

A

non-depolarizing has much greater variability with dose and response d/t immature NMJ and increased extrajunctional receptors (all leading to increased sensitivity to drugs)

72
Q

roc RSI dose

A

can be intubated in 45s, but DOA is 60 - 90 m (ugh)

73
Q

low dose roc

A

0.3 mg/kg

can intubate in 3 m

74
Q

roc

A

can cause pain on injection…

75
Q

when did sugammadex get approved

A

2015

76
Q

sugammadex MOA

A

cyclodextrin is rigid, ring-shaped composed of sugar unit. outside is hydrophilic (which makes the molecule water-soluble)

the hole is hydrophobic, which allows lipophilic molecules to enter this cavity creating a water-soluble complex

77
Q

ketorolac

A

0.5 mg/kg
e 1/2: 4 hours
caution: impaired renal, bleeding, impaired bone healing, kids < 1 year

78
Q

glucose homeostasis

A

low glycogen stores –> prone to hypoglycemia during NPO/stress

good news: impaired glucose excretion by kidney beeaanssss

79
Q

hypoglycemia s/s

A

jittery, convulsions, apnea

80
Q

hypoglycemia management

A

D10% 1 - 2 mL/kg

81
Q

how do you dilute D50

A

2 mL into 8 mL

82
Q

what does D50% mean

A

50 grams of dextrose per 100 mL

0.5 grams/mL

83
Q

epinephrine hypotension

A

1mcg/kg

84
Q

epi cardiac arrest

A

10 mcg/kg q 3 - 5 m

85
Q

atropine

A

0.02 mg/kg for bradycardia
max = 1 mg (child)
2 mg for adult

86
Q

adenosine

A

100 mcg/kg
max 6 mg
200 mcg/kg
max 12 mg

Advanced Anesthesia II (9 decks)

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