Review Flashcards
Why are women given folic acid? What does it help prevent?
prevents neural tube defects
ex: spina bifida (spinal cord doesn’t form properly)
How much folic acid is recommended for pregnant women?
400 mcg daily before pregnancy until week 12
What happens to babies of mothers with diabetes?
exposed to glucose -> increase in weight -> hypoglycemic at first
Why do we test for group B strep?
What do we do about it?
to prevent the infection of the baby during labor risk of neonatal sepsis
treat with IV ampicillin shortly before labor
1st line: ampicillin, penicillin G
others: cefazolin (Ancef), clindamycin, vancomycin
What disease does the Tdap vaccine aim to prevent in pregnant women?
What other groups should get it?
Pertussis
vaccine with every pregnancy
also, give it to people who are in contact with the baby (grandparents)
Review those infections that a woman can get during pregnancy
TORCH
Toxoplasmosis (don’t change the litter box of a cat)
-others: syphilis, varicella zoster, parvovirus 19)
-Rubella
-Cytomegalovirus
-herpes
What is the risk of a Cytalomegavirus in babies?
What should be done to prevent transmission to the baby?
Hearing loss
-wash your hands regularly (it can be transmitted through saliva, and other fluids)
What do we use to slow down labor? How does it affect the baby?
Tocolytics -> Magnesium (large dose 20 mg)
Magnesium makes the baby lethargic (it goes away)
Which other drugs can be used to slow labor?
earlier: Indomethacin, bc it closes the PDA
later: CCB (Nifedipine)
What can be used to stimulate lung development in premature babies during labor?
Corticosteroid: Bethametasone
What is the ABGAR score?
describes the condition of a newborn immediately after birth
the higher the better
At what HR do you need to start chest compressions in a newborn?
59 (below 60)
What role does surfactant play in neonatology?
reduces surface tension in the alveoli -> makes the alveoli more flexible (without surfactant it would be fragile)
What is the ductus arteriosus?
opening between the aorta and the pulmonary artery to allow oxygenated blood to go to the lungs during utero (later it will close)
it can cause respiratory distress if it doesn’t close by itself
What is the treatment for an open ductus arteriosus?
NSAIDs: Indomethacin, Ibuprofen
Tylenol (can be oral)
What is the common dose of Tylenol for children?
15 mg/kg
A neonate presents with a heart defect. The doctor wants to keep the ductus arteriosus open. Which drug is used to keep it open?
Prostaglandin E1
provide dosing (package instruction on the EXAM)
What medications are usually given to babies with chronic lung disease secondary to
prematurity?
Combi:
Chlorothiazide + Spironolactone (helps to reduce loss in potassium caused by the thiazide)
Which bacteria cause infections in babies born within the first 7 days?
pathogens from the mother
-Group B strep
-E. coli
-H. flu
Which bacteria cause infections in babies born after the first 7 days?
nosocomial (from the environment)
-MRSA
-Staph aureus
-Group B Strep
-E. coli
-Klebsiella
-Pseudomonas
-Enterobacter
-Serratia
-Haemophilus influenzae
-Listeria m.
-Candida (needs antifungal)
Which drugs are used for infections during the first 7 days?
Ampicillin + Gentamicin (avoid in kids with renal failure)
Cefepime, Ceftazidime in renal impairment
Ampicillin covers which bacteria that cause infection in babies?
Listeria
Which drugs are used for infections after the first 7 days?
-Vancomycin (for MRSA)
-Cefepime
-Pip/Tazo
-Meropenem
Why do we give IM vitamin K to newborns?
prevents Vitamin K deficiency bleeding (can cause stroke)
What do we put in the eyes of newborns and why?
to prevent gonococcal opthalmia (prophylaxis)
How is syphilis treated in pregnant women?
Penicillin
Why is it important to refer to redness around the umbilicus?
refer to the ER
could be necrotizing fascitits
What is the newborn screen? Why is this done in all infants?
to find genetic diseases that can be treated early and prevent bad outcomes
What are examples of genetic screen tests for babies?
-PKU (phenylketonuria)
-sickle cell anemia
-cystic fibrosis
-maple syrup urine disease
How many calories per ounce does a standard baby formula have?
20 calories per ounce
prepare a formula with __ calories on the EXAM
example:
2 scoops give 20 calories
3 scoops will give 30 calories
What is the benefit of breast milk compared to baby formula?
breast milk contains immunoglobulins (protects from bacteria in the GI)
Decohexanoic acid (DHA) and arachidonic acid (AA) have shown have benefits in brain development in babies. T/F
False.
Name some of the reasons that children are more vulnerable when it comes to medication safety.
-exposed dose
-the low weight of the baby
-Albumin level is low
-kidney is not developed (less perfusion)
-kidney function (don’t eliminate as fast, less frequently dosing, sometimes higher dosing)
-thin skin
-kids tend to put things in their mouth
List some of the pharmacokinetic variables that are more specific to infants and children that influence drug therapy.
-higher Vd (intravascular)
-protein store is small
-thin skin (absorbs topicals faster)
What are the most common causes of dehydration in children?
vomiting, diarrhea
How many times per day should a baby have a wet diaper?
4-6 times
Name some signs of dehydration in infants and babies.
-dry mouth
-no tears
-no wet diapers
-skin turgor
What is the normal type of fluid used in IV for dehydration?
IV bolus of 10-20 ml/kg over 30-60 minutes
What do we NEVER use as an intravenous replacement fluid? Why?
sterile water, D10
because it’s hypotonic
-use normal saline
-D5 or D5 1/2 NS
-lactated ringers
What are the treatment goals for coughs and Colds?
make them feel comfortable
treat cough if it is severe (cant sleep all night)
Name some non-drug therapy.
-Humidifiers
-Lemon and water
-Honey (kids older than 1)
Vick
Vick Vaporub (menthol, camphor, and eucalyptus oil)
no asthmatics (can exacerbate asthma symptoms)
Why did the FDA mandate that these cough medications NOT be given to children under the age of four years?
-because parents often overdose OTC cough and cold meds
-no significant benefit
What medications are acceptable to use for an “irritant cough?”
-antihistamines
-tessalon perles (over 12y)
-Honey
Should codeine be given for a severe cough in a 16-year-old?
No
one of the exception: Rx for sickle cell disease after genetic testing
What is croup caused by?
Parainfluenza type 1, 2, 3
What happens in the child’s airway to cause the barking cough?
narrowing of the upper airways
What can be done outpatient to help a child with croup?
-Go outside (cold air might help)
-humidified air in the bathroom
What medications are given for more severe croup?
-Racemic epinehprine
-single dose of dexamethasone (helps with recurrence)
-oxygen
Do antibiotics help croup? Antivirals?
No.
Antivirals are typically not used
Why do kids (and adults) still get pertussis even though we vaccinate for it?
because the vaccine is not life-long
What are some of the complications of pertussis in adults?
Whooping cough
Name a few medications that can be used to treat pertussis.
Macrolides
Tetracyclines
FQ
Atypical coverage
What are the common drugs used for constipation?
-Miralax
-Golytely
-senna
-sorbitol
-bisacodyl
A temperature measurement from which sources is considered a CORE temperature?
-Rectal
-ear
-mouth
What is the most reliable way to measure temperature?
rectal
What is the magic number for what is considered a fever?
over 100°4 F core temperature
If a baby is 3 months-old, what is the best way to measure a temperature? > 6 months? > 5-6 years?
3 months: rectal
> 6 months: digital ear, oral, Temporal artery (forehead)
> 5-6 years: digital ear, oral, Temporal artery (forehead)
When should children with fever be referred?
less than 3 months with fever !!!
-they have bloody stool -> REFER
-they have rash -> REFER
-febrile seizure
-chronic disease and fever
-over 104°F
When should a fever be treated?
if the kid feels very bad -> Tylenol
-if they have 102°F but the kid is fine, they don’t need to be treated
What is the dose of Tylenol and Ibuprofen?
10-15 mg/kg
What is the difference between GER and GERD?
GER = gastroesophageal reflux
GERD = symptoms from GER
symptoms: they refuse to eat because of throat pain (from throwing up), weight loss
What are practical things that can help with a child that is spitting up?
-hold them up
-frequent burping
-smaller feedings
-more frequent feedings
What medications are used for GERD?
start with H2RA
then PPIs
sometime prokinetic drugs: erythromycin
How should a baby be laid down?
on the back
What is the most common form of primary headache disorder that causes disability in children?
Migraines
Which drugs are used for Migraines in children?
Triptans
Tylenol
Ibuprofen
Name abortive and preventative therapies for headaches in children.
tylenol, ibuprofen
-prevention:
-topiramate
-gabapentin
-CCB
Match the cause of conjunctivitis with the symptoms.
Allergic reaction
Bacterial infection
Viral infection
Allergic reaction….. itchy eyes, antihistamines
Bacterial infection…. purulent eyes (with pus) -> use topical antibiotic
Viral infection……. swollen eyes, red eyes
What is the prednisone (or equivalent) dose that, if taken for more than 2 weeks, increases the patient’s risk of severe disease?
2 mg/kg for more than 2 weeks or 20 mg
Name a concern for an infection with chicken pox.
scratch the skin -> open wound -> staph infections
What should be recommended for a fever/discomfort in a child with chicken pox? What should not?
Tylenol
Ibuprofen
don’t give Benadryl topical
Who should get acyclovir for chicken pox?
kids predisposed to having bad outcomes
example: cancer patients
What are the common signs and symptoms of meningitis in children?
they are pretty sick
-fever
-stiff neck (usually not in infants)
-Kernig and Brudzinski’s sign (hips and knees flex if the neck flexes)
-N/V
-irritability
-sensitivity to light
What are the common bacteria that cause meningitis in children?
Strep pneumo
-H. flu
-Neisseria
What are the usual therapy for meningitis in kids?
Rocephin (Ceftriaxone)
if they are otherwise healthy
Why don’t we see as much meningitis as we used to?
vaccination
What is the most effective therapy for enuresis?
setting alarms + Desmopressin (antidiuretic)
How does Desmopressin work and what is the side effect?
it causes water reabsorption back into the bloodstream -> dilution of sodium in the blood
hyponatremia
Which medication is used primarily for daytime enuresis?
NAPLEX
Oxybutynin (Ditropan)
TCAS
in general think of Desmopressin (DDAVP)
Why does Kawasaki Disease matter?
it affects blood vessels of the heart, it can cause coronary aneurysm
What symptom does a child have to have in order to be considered to have Kawasaki? What are some of the other common ones?
fever for 5 days !!!
other symptoms:
-conjunctivitis
-changes of lips and oral cavity
-dryness, redness, fissuring lips
-strawberry tongue
-redness of pharyngeal mucosa
What medications are used to treat KD?
Aspirin -> for inflammation
IV Immunoglobulin -> to prevent artery lesions
IV corticosteroid if 2 doses of IV Ig don’t work
Infliximab in IV Ig-resistant patients
What are the signs and symptoms of acute otitis media AOM?
-red ear
-pulling on the ear
-irritability
What are the normal pathogens that cause AOM?
Strep pneumo
sometimes resistant strains of Strep pneumonia (need Rocephin and Vanc)
Why do we give amoxicillin as first line? What is the dose? Why not Augmentin? When should it be used?
because regular Strep doesn’t produce ß-lactamase and is covered by a high dose of Amoxicillin
dose: 40-50 mg/kg/day (high dose: 80-90 mg/kg)
Augmentin may be used for ß-lactamase-producing strains like M. cat and H. flu
What are alternative antibiotics for kids who are PCN-allergic?
Erythromycin, Azithromycin
What strength of Augmentin should be used for AOM?
at least 7:1 BID of Augmentin
What is often the only sign of a UTI?
fever
What is the most common pathogen and why?
E. coli
What is the difference between a UTI and Pyelonephritis?
Pyelonephritis is more painful and comes with flank pain
What IV medications should be considered for a UTI?
Rocephin (Ceftriaxone)
What oral medications should be considered for a UTI?
-Augmentin
-Macrobid (Nitrofurantoin) if sensitivity is known
Macrobid can be used for Pyelonephritis. T/F
False.
What is the definition of Hypertension in children?
Hypertension is defined as >95th to 99th percentile PLUS 5 mm Hg, based on the BP of other children of the same age, sex, and height
What are the most common causes of Hypertension in children?
obesity, heart disease and kidney disease
Which drugs are used to treat HTN in children?
- ACEi/ARB
CCB, thiazides
Which antihypertensive drug should be avoided in infants?
Verapamil (Calan)
their heart don’t tolerate it well
Which drugs are used to treat Spasticity in children?
Baclofen, Benzos
Which drugs are used to treat drooling in children?
-Glycopyrrolate (anticholinergic)
-Scopolamine (antimuscarinics)
Which drugs are used to treat insomnia in children?
Melatonin
Which drugs are used to treat aggression and irritability in children?
Aripiprazole (Abilify) and risperidone
Which drugs are used to treat anxiety and depression in children?
SSRI
Which drugs are used to treat ADHD and depression in children?
Atomoxetine, clonidine, guanfacine
cautious with stimulants if they are aggressive
Which drug is commonly used as an anticoagulant in children?
Enoxaparin
the dose is typically higher in kids
In which conditions are anticoagulants used for children?
DVT secondary to central line, sepsis, malignancy (cancer), heart disease
What is the drug of choice to treat nephrotic syndrome?
corticosteroids
Which drug can be used for nephrotic syndrome in steroid-resistant patients?
Mycophenolate mofetil (less nephrotoxic)
calcineurin inhibitor: cyclosporin, tacrolimus
side effects:
-HTN
-electrolyte abnormalities
-nephrotoxic
Which drugs are used to treat an exacerbation of nephrotic syndrome with edema?
Albumin + furosemide
Which drugs are used for IBS-D (diarrhea)?
Loperamide
Which drugs are used for IBS-C (constipation)?
-fiber and bulk-forming agents + water
-laxatives
-Rx: lubiprostone
What are the 3 pathogens that cause cystic fibrosis and which drugs are used to cover them?
-MRSA: Vancomycin, linezolid
-Pseudomonas
-H. flu
if you cover Pseudomonas, you also cover H. flu
-> Pip/Tazo, Cefepime, Meropenem, Aminoglycoside, Cipro/Levo
What is now being used first-line for asthma exacerbations?
LABA (Formoterol) + inhaled steroids
What are the concerns with Montelukast?
psychiatric issues (especially if they had a history of psychiatric problems)
What is often seen along with atopic dermatitis - the “atopic triad”?
Atopic dermatitis
Asthma
Allergic rhinitis
What is the standard therapy for atopic dermatitis?
topicals: moisturizer, emollients, antihistamines
be aware of skin breakdown and infections:
-> cover MRSA and Group A Strep
What is the medication that is given to sickle cell patients?
Hydroxyurea
What do we monitor for Hydroxyurea?
ANC (absolute neutrophil count, WBCs)
How does Hydroxyurea help in sickle cell disease?
it increases the percentage of fetal hemoglobin
Which patient population is less likely to suffer from sickle cell crisis?
infants, because they have high levels of fetal hemoglobin (reduces the sickling process)
-> Hydroxyurea increases the number of fetal hemoglobin
UC and Crohn’s is usually seen in children of age___
10-12
What is the traditional approach to treating UC and Crohn’s disease?
Step-up
-aminosalicylates
-corticosteroids
-immunomodulators
Which approach is more often used to treat UC and Crohn’s disease?
Biologics
-Adalimumab (Humira): can be used at home
-Infliximab (Remicade)
What is the concern about using biologics?
the risk of hepatosplenic T-cell lymphoma (very rare, seen in patients who also used an immunomodulator, methotrexate, azathioprine, 6-MP)
