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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
stage III plane I
automatic respiration to the cessation of eyeball movements - eyelid reflex lost - swallowing reflex disappears - lots of eyeball movement - corneal reflex lost @ end
26
stage III plane II
cessation of eyeball movements to the beginning of IC muscle paralysis -laryngeal reflex lost
27
stage III plane III
from beginning to complete IC paralysis - diaphragmatic respiration persists - pupils dilated - no light reflex
28
stage III plane IV
complete IC paralysis to diaphragmatic paralysis
29
stage IV
anesthetic overdose causing medullary paralysis and vasomotor collapse
30
nitrous
``` analgesia + amnesia b/g: 0.47 MAC: 104% ADR: PONV c/i: pneumo/NEC/bowel obstructions ```
31
dalton's law of partial pressure
PT = P1 + P2 + P3
32
sevoflurane
least irritating to the airways | b/g: 0.68
33
what contributes to compound A
high temperature low FGF CO2 absorbers w/barium hydroxide or soda lime
34
isoflurane
b/g: 1.43 potentiates NDMR to a greater extent than sevo/des least costly !! good for neuro cases/sz risk
35
desflurane
b/g: 0.42 laryngospasm @ 50% if used during induction c/i with LMA rapid emergence
36
propofol
require larger induction dose r/t increased Vd elimination 1/2 life is shorter high rates of plasma clearance
37
IONM prop dose
< 120 - 130 mcg/kg/m
38
ketamine used since
1964
39
ketamine dosing
``` 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
ketamine ADR:
vomit secretion - consider glyco 0.01 mg/kg hallucinate
41
ketamine and respiratory considerations
preserves spontaneous respirations but apnea and laryngospasm can still occur *rapid IV dose may produce respiratory depression* BRONCHODILATION
42
etomidate
not used lots in kids | -pain on injection, myoclonus, anaphylactoid reactions, adrenal suppression
43
etomidate & rr
dose dependent reduction
44
opioids
MORE POTENT
45
morphine
0.025 - 0.05 mg/kg IV *histamine* release hepatic conjugation & renal excretion decreased
46
fentanyl
``` increased DOA (> 30 - 60 m) immediate onset, but maximal analgesia will occur in several minutes ```
47
fentanyl dependence
may occur by 7 days
48
fentanyl dosing
0. 25 - 1 mcg/kg IV | 0. 5 - 2 mcg/kg/hr gtt
49
hydromorphone
semi-synthetic opioid agonist, derivative of morphine. 5x the potency onset: 5m DOA: 2 - 3h
50
hydromorphone & renal considerations
metabolite accumulation & neuroexcitatory symptoms | tremor - agitation - cognitive dysfunction
51
naloxone
reduces resp. depression, n/v, pruritis & urinary retention 0.25 - 0.5 mcg/kg MAX = 2 MG
52
naloxone onset
30s - 1 m | 1/2 life - 1.5 - 3 hours
53
naloxone ADR:
systemic HTN arrhythmia pul. edema
54
midaz history
1976 first came into use !!
55
midaz dosing
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
flumazenil
onset 5 - 10m 10 mcg/kg IV 1/2 life 1 hour
57
clonidine MOA
pre-synaptic alpha agonist. binding decreases calcium levels, thus inhibiting release of NE
58
clonidine dosing
PO 4 mcg/kg (60 - 90 m onset) | adjunct to regional: 1 - 2 mcg/kg epidural/caudal (prolongs analgesia by 3h)
59
clonidine adr
residual sedation postop | hypotension and bradycardia
60
dexmedetomidine
8x more specific for a2adrenergic receptor *anxiolysis*sedation*analgesia* sedation w/o reespiratory depression
61
precedex dosing
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
neonates + nmbds
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
nmbd onset
shorter (up to 50%) d/t faster circ times
64
cis dosing
0.15 mg/kg IV
65
vec dosing
0.1 mg/kg
66
reversals for nmbds
glyco 0.01 mg/kg + neostigmine 0.05 mg/kg | sugammadex 2 - 4 mg/kg IV
67
sux
larger dose d/t increased ECF volume of distribution fastest onset recovery is the same as adult
68
sux + peds risks
``` arrhythmias hypeerK rabdo myoglobinuria masseter muscle spasm MH ```
69
sux + atropine
@ 0.02 mg/kg IV/IM to prevent bradycardia
70
sux dosing
IV < 10 kg = 2mg/kg > 10 kg = 1 - 2 mg/kg IM = 4 mg/kg Laryngospasm = 0.5 mg/kg
71
NDMR
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
roc RSI dose
can be intubated in 45s, but DOA is 60 - 90 m (ugh)
73
low dose roc
0.3 mg/kg | can intubate in 3 m
74
roc
can cause pain on injection...
75
when did sugammadex get approved
2015
76
sugammadex MOA
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
ketorolac
0.5 mg/kg e 1/2: 4 hours caution: impaired renal, bleeding, impaired bone healing, kids < 1 year
78
glucose homeostasis
low glycogen stores --> prone to hypoglycemia during NPO/stress good news: impaired glucose excretion by kidney beeaanssss
79
hypoglycemia s/s
jittery, convulsions, apnea
80
hypoglycemia management
D10% 1 - 2 mL/kg
81
how do you dilute D50
2 mL into 8 mL
82
what does D50% mean
50 grams of dextrose per 100 mL | 0.5 grams/mL
83
epinephrine hypotension
1mcg/kg
84
epi cardiac arrest
10 mcg/kg q 3 - 5 m
85
atropine
0.02 mg/kg for bradycardia max = 1 mg (child) 2 mg for adult
86
adenosine
100 mcg/kg max 6 mg 200 mcg/kg max 12 mg

Advanced Anesthesia II (9 decks)

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