Prod...Pharmacology Flashcards
How does protein binding compare between pediatric and adult patients?
- preterm and infants is decreased
- children is similar to adults
What is the oral does for midazolam in pediatric patients?
0.25 - 0.5 mg/kg
How does the onset time of midazolam differ between the oral, rectal, and nasal routes of administration in pediatric patients?
- Oral and rectal is 10 minutes
- intranasal is the fastest route
How does the metabolism of morphine differ in neonates compared to children and adults. Why?
-Neonate and infants cannot metabolize morphine like children and adults can. Neonates have limited ability to perform glucuronidation (Metabolism process)
Renal excretion of drugs is less effective in neonates than in older children and adults. Why is this?
- Incomplete glomerular develompent
- low perfusion pressure
- inadequate osmotic concentration
How does the proportion of body fat and muscle mass compare between peiatric patient and adults?
- Term and neonates have decreased proportion of both
- children and adolescents have fat and muscle masses similar to adults
How does the responsiveness to dopamine compare between term neonates and adult patients?
Neonate require more dopamine for a adequate response to increase blood pressure and urine output as high as 50 mcg/kg/min
How does the volume of distribution for water soluble drugs compare between pediatric and adult patients.
Volume of distribution in preterm and term are higher requiring a higher loading dose such as digoxin, succinylcholine, and some antibiotics
How does ketamine affect the PONV in a pediatric patient?
Increases the incidence of PONV
What drugs and foods can interfere with the metabolism of midazolam.
- Midazolam requires CYP4503A
- Substances that interfere with this are grapefruit juice, calcium channel blockers, erythromycin, protease inhibitors.
What is the caution regarding the use of intranasal ketamine?
Ketamine can enter the CNS directly via the intranasal route. The preservative in ketamine cause a neurotoxic event in the CNS
How does premedication of pediatric patient with ketamine affect the incidence of emergence delirium?
Reduce the incidence of emergence delirium in the PEDS patient
How does the bioavailability of intramuscular ketamine compare between adults and pediatric patients?
Bioavailability ins even higher in PEDS
What is the IM induction dose of ketamine?
5-10 mg/kg
What is the IV induction dose of ketamine?
1 - 3 mg/kg
What is the intravenous induction dose of thiopental in healthy pediatric patients?
5 -6 mg/kg
Is midazolam effective as an induction agent for pediatric patients?
NO
You administer an intramuscular dose of midazolam to a pediatric patient without an IV who cannot cooperate to take PO midazolam. How long should you wait before considering a supplemental dose?
-Onset is 3-5 minutes
-Peak effect is 10 - 20 minutes
SHOULD WAIT AT LEAST 20 MINUTES
you administer midazolam rapidly via the IV route to a pediatric patient. The patient begins to exhibit seizure like activity. What do you ascertain is the likely cause of this?
-Rapidly given midazolam can induce myoclonus which can appear is seizure like activity
By what age would the clearance of morphine in pediatic patients be equal to that of adults?
3 month of age
What food allergies should be explored further in a pediatric patient prior to the administration of Diprivan? Why
- Soy beans
- Eggs
- Glycerol
- EDTA
- Sodium Hydroxide
What is the qppropriate dose for oral ketamine in pediatric patients?
- 5 to 6 mg/kg for children between 1 to 6 year of age
What is the appropriate does of flumazenil in pediatric patients?
0.05 mg/kg to a total does of 1 mg/kg
A pediatric patient is exhibiting oversedation from midazolam. How can you reverse the effects of this drug in this patient.
Flumazenil
What factors can prolong the half life of midazolam in pediatric patients?
- hypovolemia
- patients receiving vasopressors
What are the advantages of premedication with ketamine over midazolam in children?
Ketamine is capable of producing both hypnosis and pain relief and may reduce opioid requirements
Is the volume of distributio of propofol larger in children of adults.
Larger in children
How does the clearance of propofol compare between neonates, children, and adults?
The clearance of propofol in children is similar to that of adults but is 66% less in neonates
How does the does of propofol sufficient to abolish the eyelash reflex differ between pediatric patients and adult patients? In what age group is the required dose of propofol the highest?
- As the age decreases the dose increases
- The highest dose of propofol needed is between ages 1 and 6 months
How does propofol affect the systolic blood pressure in pediatric patients?
Decreases arterial blood pressure by 15%
What is the induction dose of propofol in children younger than 2 years of age? Over 2 years of age?
- Younger than 2 year is 3-4 mg/kg
- Older the 2 years is 2.5-3 mg/kg
What age children metabolize thiopental the fastest? How does this affect the duration of action?
- 5 to 13 months of age metabolize thiopental twice as fast as anadult
- The duration of action is not changed however
Under what circumstances would thiopental be used as a high dose infusion in pediatric patients?
-Intracranial hypertension with a dose of 2 mg/kg/hour
What is propofol infusion syndrome?
- pediatric patients that have had prolonged propofol use.
- Onset is lipemia, hyperkalemia, and rhabdomyolysis
Your must administer a dose of succinylcholine intramuscular because no intravenous access is available. What is the time to onset of an intramuscular dose of succinylcholine?
3-4 minute
Can etomidate be used safely in children?
Yes.
In what pediatric patients is succinylcholine contraindicated?
- Malignant hyperthermia
- Muscular dystrophy
- burn injury (Acute)
- spinal cord transection
- prolonged immobilization
What is the IM dose of succinylchoine required to produce intubating conditions?
4 mg/kg
What is the IV dose of succinylchoine to produce intubating conditions in pediatric patient?
1.5 - 2 mg/kg
What infusion does of propofol is required to produce general anesthesia in pediatric patients?
200 - 300 mcg/kg/min
What are the only recommended indication for the use of succinylcholine in pediatric patients?
-When ultra short duration and fast onset are of importance such as laryngospasm.
In what condition is ketamine contraindicated in pediatric patients?
-Intracranial hypertension
How does the sensitivity to vecuronium in pediatric patients compare to that of adult patients?
-Pediatric patient are more sensitive than adults. -Adolescents begin to have the same sensitivity as adults.
What are the potential side effects of succinylcholine administration in pediatric patients?
- Bradycardia
- myalgia
- myoglobinemia
A pediatric patient received an intubating does of rocuronium 45 minutes ago. The nerve stimulator indicates sustained tetany and the patient is breathing on his own. Is it recommended to reverse the muscle relaxant or should you avoid this in pediatric patients?
Yes you should reverse the muscle relaxant.
What are the advantages to the use of pancuronium in pediatric patients?
Pancuronium exerts a vagolytic effect which conveniently counteracts the vagotonic properties of opioids.
What is the normal intubating does of pancuronium in pediatric patients?
- 0.1 mg/kg can intubate in 2.5 minutes 970-90%)
- 0.15 mg/kg can intubate in 80 seconds
Is the duration of action of rocuronium prolonged in pediatric patients with renal failure?
NO…(with the patient being over the age of 1 year.)
What is the intravenous dose of cisatracurium for intubation in pediatric patients and what is the onset of the typical dose?
- Dose is 0.08 mg/kg
- Onset is 2.5 minutes
What are the cardiac changes seen with the administration of intubating doses of rocuronium in pediatric patients?
-Heart rate increases with a dose of 0.6 mg/kg
Is MAC higher in pediatric patients or adult patients?
MAC is higher in PEDS
