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Advance Principles I, Exam 4 > Pharm Peds > Flashcards

Pharm Peds Flashcards

0
Q

Protein binding in neonates

A

Albumin and alpha 1 acid glycoprotein are found in lower concentration than in adults, same level at 5 months

Inc free active drug in neonatal

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1
Q

What substances found in neonate can reduce protein binding

A

Bilirubin
Free fatty acid
Maternal steroids

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2
Q

Volume distribution

A

Larger in infants and children due to inc tbw

Decrease FAT: need lower doses of fat soluble meds: Propofol

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3
Q

What med doses need to be increased in neonates

A

Sux, abx

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4
Q

Neonatal kidney receives only ?% of CO

A

5-6% of CO

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5
Q

Term infant GFR is

A

40% of adult

Preterm 20-30% of adult
Increases over 1st year of life

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6
Q

Who has the highest cardiovascular complication durning induction

A

<1 year old

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7
Q

Uptake of inhalation in infants & small children

A

Faster, greater ratio of alveolar ventilation to FRC

Faster RR in infant

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8
Q

Fe: Fi of 1.0
Infant
Child
Adult

A

Infants 25 min
Child 30 min
Adult 60 min

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9
Q

Shunt

Right to left

A

Slower rise in blood concentration

Slower inhalation induction

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10
Q

Shunt left to right

A

Effect on FE: FI depends on size
Large shunts speed induction
Small little effect

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11
Q

Isoflurane

A

Infants MAC 1.6
Less myocardial depression than halothane, but dec SVR more
Pungent

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12
Q

Desflurane MAC

A 
Neonate 9.16
Infant 1-6 months 9.4
Infant >6 mon 9.9
Toddler 8.72
Child = 8.0-8.3
Adult = 6.6
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13
Q

What is des associated with

A

Pungent
Cough, laryngospasm
Good for maintainence not induction

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14
Q

Sevoflurane

MAC

A 
Neonate = 3
Infant 1-6 months = 3.2
Infant >6mon= 2.6
Child 1-12= 2.5
Adult 1.7
Elderly 1.5
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15
Q

Second facts about Sevo

A

Ideal for inhalation
Low incidence of myocardial depression even with overpressure
Avoid low flows due to toxic renal metabolites, esp in neonates
Emergence delirium

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16
Q

Why children require larger dose of induction IV meds

A

Inc met rate
Inc cerebral O2 consumption
Inc cerebral blood flow
Inc vd

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17
Q

Propofol

A

Induction 2-3 mg/kg IV, not common to use

Sedation 60-300 mcq/kg/min

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18
Q

Etomidate

A

Induction .2-.3 mg/kg IV

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19
Q

Ketamine

A

Induction
IV 1-3 mg/kg
IM 5-10 mg/kg

Sedation
IV .5-1 mg/kg intermittent boluses or
Load 1-2 mcq/kg, then gtts 15-75 mcq/kg/hr

20
Q

Robinul + Versed dose

A

Robinul 10 mcq/kg + versed 0.1 mg/kg

21
Q

Midazolam

A

IV 0.1 mg/kg
PO= 0.3-05 mg/kg, up to 20 mg
O: 10 min pre op sedation

Intranasal: 0.2-03 mg/kg
May prolong emergence in short cases

No need before 8-10 months, no separation anxiety

22
Q

Dexmedetomidine

A

Selective alpha agonist w/sed/ analgesic properties

Resp stability w/no ventilatory depression

23
Q

Dexmedetomidine contraindicated

A

In pts with heart block or bradycardia

24
Q

Dexmedetomidine used for

A 
Procedural sed
Supplement to GA
Premedication
Emergence .1-.2 mcq/kg
Post op shivering .1-.25 mcq/kg
25
Q

Dexmedetomidine
Sed or supplement to GA
Premedication

A 
Sed/supplement 
Load: 1 mcq/kg IV
Gtts: .5-1 mcq/kg/hr
Premedication
1-2mcq/kg intranasal, give 30-45 min prior to procedure
26
Q

Dexmedetomidine
Emergence
Post op shivering

A

.1-.5 mcq/kg IV give 30 min prior to end of procedure
Post op shivers
.1-.5 mcq/kg IV

27
Q

Fentanyl

Doses for various procedures

A 
1-2 mcq/kg for small procedures 
5-10 mod to highly
50 mcq/kg cardiac surgery
Intranasal 1-2 mcq/kg
Gtts 1-2mcq/kg/hr, turn off 1 hr
28
Q

Morphine

A

0.025-0.1 mg/kg

Prolong clear end win neonates(liver not 100%)…..best to avoid if planning to extubation

29
Q

Demerol

A

Uncommon
0.25-0.5mg/kg IV
Post op shivers
Contra: seizure, renal disorder

30
Q

Sufentanil

A

Load slowly .2-1mcq/kg

Infusion .01-1 mcq/kg/hr

31
Q

Remifentanil

A

Load 0.5-1mcq/kg: May omit load & use fentanyl on induction
Gtts: 0.1-0.2 mcq/kg/min, titrate to BP/HR
Supplement to GA

32
Q

Sux

A 
Dose higher in neonates d/t inc VD
Induction: 2mg/kg onset within 1 min
Laryngospasm 
IM: 4 mg/kg onset 1-2 min duration: up to 20 min
IV 0.2 mg/kg
33
Q

What med would u give with sux to decrease fasiculation & dose

A

Atropine 10-20 mcq/kg

34
Q

Glycopyrrolate dose

A

10 mcq/kg

35
Q

Why NDMR dose in peds is the same as in adults

A

Inc VD but immature neuromuscular junction: sensitive to NDMR
Duration might be slightly longer in peds

36
Q

NDMR

Which meds have a dose of 0.1 mg/kg

A

Vecuronium
Pancuronium
Cisatracurium

37
Q

Rocuronium dose

A

0.6-1.2 mg/kg

38
Q

Endrophonium dose

A

0.5-1 mg/kg

39
Q

Neostigmine dose

A

50-70 mcq/kg
Give with atropine or robinual or atropine

Anti cholinesterase

40
Q

Ketorolac

A

0.5 mg /kg up to 30 mg/kg

Avoid: renal, bleeding esp ENT, platelet inhibition, dec narcotics

41
Q

Decadron

A

PONV prophylaxis
0.1 mg/kg

Airway edema prophylaxis
0.5-1 mg/kg up to 20 mg
ENT
Post-op stridor

42
Q

What steroid would u use for adrenal insufficiency and what dose

A

Hydrocortisone

2 mg/kg IV pre op, then q 6 hrs the day do surgery

43
Q

Zofran dose

A

0.1mg/kg up to 4 mg

44
Q

Reglan

A

0.15 mg/kg up to 10 mg

45
Q

Dramamine

A

0.5 mg/kg up to 25 mg/IV

46
Q

Bupivicane foe tissue infiltration dose

A

2.5 mg/kg plain

3 mg/kg with epi

47
Q

Lidocaine

A

4 mg/kg plain

7 mg/kg with epi

48
Q

What meds can u use to prevent emergence delirium

A

Precedex

Narcotics

Advance Principles I, Exam 4 (5 decks)

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