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PHM 790: Topics in Pediatry > Week 2 Peds Therapeutics > Flashcards

Week 2 Peds Therapeutics Flashcards

1
Q

most common organism in <1 month with bacterial meningitis

A

Group B Strep

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2
Q

most common organism in 1-23 months with bacterial meningitis

A

S. pneumoniae and neisseria meningitidis

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3
Q

most common organism in 2-50 yovwith bacterial meningitis

A

N. meningitidis

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4
Q

risk factors for bacterial meningitis in children

A

HIV
Immunodeficiency
Sickle cell anemia
Recent upper resp tract inf
Head Trauma

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5
Q

Presentation of bacterial meningitis

A

Infants
-Seizures, Irritability, Lethargy, Bulging fontanelle
Children
-Fever, Vomiting, Seizure, Confusion, Photophobia

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6
Q

Gold Standard for Bacterial Meningitis Diagnosis

A

CSF lumbar puncture
- elevated WBC, Protein, Glu (low in infants <0.6), pos bacterial culture

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7
Q

Empiric Treatment for neonates with BM

A

Ampilicillin + (AG or Cefotaxime)
Cefotaxime preferred if pt has poor kidney function

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8
Q

Empiric Treatment for 1 mon-50 yo with BM

A

Vancomycin + (Cefotaxime or CTX)

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9
Q

Targeted Treatment for infants with BM

A

Penicillin or Ampicillin
3rd gen cephalo

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10
Q

Duration of therapy for N. meningitidis & H. influenza

A

7 days

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11
Q

Days of treatment for S. Pneumoniae

A

10-14 days

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12
Q

Use and admin of dexamethasone as adj therapy in BM

A
  • dec hearing loos in pts w/ H. influenza
  • Only use before or at the same time as 1st dose of AB. after 1 hr post AB no benefit
  • use with S. Pneumonia if risk of mortality
  • use with H. influenza if initiated b/f admin of AB
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13
Q

Prevention of BM

A

Vaccines
- Hib, PCV15/PCV20, Meningococcal

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14
Q

Risk factors for CAP (5)

A
  • Recent hx of URTI
  • lower socioeconomic status
  • Crowded living environment
  • Exposure to cigarette smoke
  • Comorbidities
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15
Q

What comorbidities are associated with CAP

A

Asthma
Bronchospasm
Cystic fibrosis
Congenital heart disease
Sickle cell disease

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16
Q

ways pathogen enters the lung and most common

A

**inhaled aerosolized particles
- through bloodstream
- aspiration

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17
Q

signs and symptoms of CAP and the ones required for diagnosis

A

**fever and cough
- chest pain
- purulent expectorant
- tachypnea (inf >70, child >50)
- respiratory distress

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18
Q

gold standard for diagnosis of CAP

A

chest x-ray
- viral will be wide spread
- bacteria will have dense consolidation

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19
Q

(6) who should be hospitalized for CAP

A
  • mod to severe cap
  • resp distress <90% sat
  • all infants <3 months of age
  • infants <6 months of age w/ suspected bacterial CAP
  • suspicion of MRSA
  • underlying medical conditions
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20
Q

most common bacterial pathogen of CAP in all age groups

A

S. pneumoniae
*Atypical common in older children

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21
Q

most common viral pathogen of CAP

A

Influenza

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22
Q

2nd most common bacterial pathogen of CAP in 5yo- 15yo group

A

Atypicals M & C. Pneumoniae

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23
Q

outpt first line treatment for CAP

A

Amox 90mg/kg/day in 2-3 doses
alt Augmentin 90mg/kg/day in 2-3 doses AE: diarrhea

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24
Q

inpt first line treatment for CAP who is fully immunized and low community resistance

A

Ampicillin or peni

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25
Q

Ampicillin empiric dose CAP

A

150-200 mg/kg/day IV divided every 6 hours

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26
Q

Ampicillin empiric dose for group A strep CAP

A

200 mg/kg/day IV divided every 6 hours

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27
Q

Ampicillin empiric dose for S. Pneumoniae

A

300-400 mg/kg/day IV divided every 6 hours CAP

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28
Q

inpt first line treatment for CAP who is not fully immunized or high community resistance

A

Ceftriaxone 50 mg/kg/dose IV every 24 hrs
or Cefotaxime

29
Q

first line treatment for CAP w/ atypical bacteria

A

Azithromycin 10 mg/kg day 1 , then 5mg/kg days 2-5

30
Q

antiviral therapy for CAP

A

oseltamivir
- must be initiated w/in 48 hrs of symptoms
- for 5 days

31
Q

vaccine prevention for CAP

A

PCV13 (S. pneumoniae) & Hib (H. influenza)

32
Q

what complications are associated with UTIs

A
  • Recurrent UTIs
  • Acute Kidney Injury
  • End-stage Renal Disease
33
Q

risk factors for UTI

A
  • <12 month yo (fever is a symptom)
  • female
  • uncircumcised infants
  • bladder or bowel dysfunction
  • immunocompromised (DM, genetic)
34
Q

Most common and rarest infection pathway UTI

A

Most common- retrograde ascent (uretha up to bladder)
Rarest- fistula (between UT and GI/vagina)

35
Q

what classifies complicated UTI

A
  • GU tract w/ structural/function abnormalities
  • catheters
36
Q

what are some neonate UTI symptoms

A

Jaundice, failure to thrive, fever, difficulty feeding, irritability, vomiting and diarrhea

37
Q

what are some infants and children <2yrs UTI symptoms

A

cloudy or malodorous urine, hematuria, frequency and dysuria

38
Q

what are some children>2 UTI symptoms

A

enuresis (wetting themselves), abdominal pain, frequency, fever

39
Q

gold standard for uti diagnosis

A

Urine culture

40
Q

AAP guideline definition of UTI and bacteria for the different types of collection

A
  • significant bacturia + pyuria
  • clean catch >100,000 bacteria
  • Catheter >50,000 bacteria
  • SPA= any growth
41
Q

first line treatment for UTI

A

cephalosporins - cephalexin
bactrim
beta lactams

42
Q

who. gets parenteral UTI treatment

A
  • Acutely ill (septic) children
  • infants <2 mon
  • immunocompromised
  • unable to tolerate PO
    **continue until patient is afebrile and clinically stable
43
Q

duration for UTI uncomplicated vs complicated

A

uncomplicated= 7 days
complicated= 10- 14 days

44
Q

what is VUR

A

retrograde urinary flow from bladder into ureters and then up to kidney causing kidney to be inflamed

45
Q

risk factor and complications of VUR

A

Risk factor: febrile UTI
Complications: recurrent UTI, renal scarring, hypertension

46
Q

treatment of VUR

A

observation, antibiotic prophylaxis and surgery

47
Q

Goal with UTI prophylaxis

A

Prevent irrversible damage/ scarring

48
Q

RIVUR trial conclusions

A

pts who use antimicrobal prophylaxis have decreased recurrent UTI
- they also have inc resistance
- no difference in rate of renal scarring

49
Q

target populations for UTI prophylaxis and for how long

A
  • females, VUR grade IV or V
  • bladder/bowel dysfunction
  • for 1-2 years
50
Q

Antibiotics for UTI prophylaxis

A

Amoxicillin (<2 mon yo)
Nitrofurantoin or Bactrim (>2 mon)
generally avoid ceph

51
Q

what is otorrhea

A

discharge/drainage from ear

52
Q

what is otalgia and presentation

A

ear ache or ear pain
tugging/pulling at ear

53
Q

what is an uncomplicated AOM

A

AOM without otorrhea (drainage)

54
Q

what is a non-severe AOM

A

AOM w/ mild otalgia (pain) ANDDD temp <39

55
Q

what is a severe AOM

A

AOM w/ mod-severe otalgia ORR fever>39

56
Q

what is a recurrent AOM

A

3 or more documented and separate occasions of AOM in the last 6 months ORRR 4 or more episodes in the last 12 months w/ 1 beginning in the last 6 months

57
Q

difference between viral and bacterial AOM

A

viral is only supportive care, bacterial is treatable

58
Q

risk factors for AOM

A
  • genetics/ fam hx
  • allergies
  • lack of breast feeding
  • Low socioeconomic status
  • passive smoke exposure
  • daycare attendance
  • pacifier use
  • winter season
  • <24mons old
59
Q

signs/ symptoms AOM

A
  • Otalgia
  • irritability
  • HA
  • disturbed or restless sleep
  • poor feeding
  • vomiting/diarrhea
  • fever
60
Q

Diagnostic Criteria AOM

A
  • Bulging of tympanic membrane w/ or w/o recent onset of ear pain/erythema.
  • new onset of otorrhea not caused by otitis externa
61
Q

who gets AOM therapy

A
  • pts >2 w/ mod or worse symptoms
  • consider in pts 6 mon-2 year if unilateral AOM w/o otorrhea
  • start ABx after 49-72 hrs if symptoms persist or worsen
62
Q

first line options for AOM and aes

A

amox or augmentin 90mg/kg/day
ae: diarrhea, hypersensitivity, c. diff

63
Q

2nd line options for AOM (pen allergy)

A

Cefdinir 14mg/kg/day
Cefuroxime 30 mg/kg/day
Ceftriaxone 50 mg IM or IV

64
Q

treatment durations AOM

A

<2yos: 10 days
>2yo: 5-7 dayvs

65
Q

pain management w/ doses AOM, which is preferred** in 6 mon and up for anageslic effect

A

**Ibuprofen 5-10 mg/kg/dose Q6H PRN
APAP 10-15 mg/kg/dose Q4-6H PRN
- can try alternating regimen if symptom persist

66
Q

who is tympanostomy tubes an option for and its pros/cons

A
  • pts w/ recurrent AOM
  • Pros: dec episodes, restore hearing, relieve pain
  • Cons: requires anesthesia for surgery, can cause scarring
67
Q

why should ceftriaxone be avoiding in neonate with BM

A

cause inc bilirubin

68
Q

how to treat neonates with BM if they have herpes

A

add on a acyclovir to amp + (ag or cefotixime)

PHM 790: Topics in Pediatry (4 decks)

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