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Pediatrics > peds deck 7 > Flashcards

peds deck 7 Flashcards

1
Q

pharmacokinetic considerations of midazolam

A
  1. crosses BBB 2. absorbed in the GI 3. metabolized by CYP450
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2
Q

midazolam acts on what receptors

A

its a GABA agonist

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3
Q

what pediatric populations would you consider giving midazolam

A
  1. preop for separation anxiety
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4
Q

T/F: it is common to give midazolam to neonates

A

FALSE

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5
Q

what receptors do propofol work on

A

NMDA and GABA (but primarily GABA)

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6
Q

dose of propofol in peds for induction

A

2-5 mg/kg

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7
Q

infusion rate of propofol

A

100-300 mcg/kg/min

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8
Q

s/e of propofol

A
  1. decreases CMRO2, CBF, and ICP 2. decrease SBP 3. HR - unchanged or inc or dec 4. dose dep respiratory depression
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9
Q

why do we like propofol in peds

A
  1. quick on and off 2. easily accessible 3. low s/e profile 4. antiemetic and anticonvulsant properties
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10
Q

what pediatric pts in propofol c/i in?

A
  1. mitochondrial d/o 2. central hyopventilation d/o
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11
Q

MAC of isoflurane in children

A

1.2

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12
Q

MAC of sevoflurane in children

A

2.2

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13
Q

MAC of desflurane in children

A

6.8

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14
Q

neurologic s/e of INH anesthetics

A
  1. decreased CMRO2 2. increased CBF 3. increased ICP
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15
Q

CV s/e of INH anesthetics

A
  1. dose dep dec in BP 2. HR - desflurane will increase; sevoflurane can decrease
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16
Q

respiratory effects of INH anesthetics

A
  1. increases RR 2. Tv decrease 3. DD decrease in airway resistance
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17
Q

what is the most commonly used inhalational agent in peds

A

sevoflurane

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18
Q

T/F: there is no advantage to one INH agent over another in regards to inducing neuroapoptosis

A

TRUE

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19
Q

_____________ does not cause neuroapoptosis, but does when it is used in conjunction with other volatiles

A

N2O

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20
Q

the highest degree of neurapoptosis was found when INH agents were used with _____________, ___________, or _____________

A

ketamine; midazolam; N2O

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21
Q

what meds/interventions have been found to be protective from neuroapoptosis

A
  1. lithium 2. hypothermia 3. methazolamide 4. melatonin 5. xenon 6. precedex
22
Q

in peds (/= ______________ anesthetics

A

3

23
Q

T/F: pediatric pts under the age of 3 are at no greater risk of learning disability 2/2 neuroapoptosis with routine anesthetic

A

TRUE

24
Q

T/F: elective surgery is not recommended in neonates and infants

A

true - puts at risk for neuroapoptosis and learning disability later in life.

25
Q

T/F: referred pain is not as common in pediatrics as is it is with adults

A

TRUE

26
Q

challenges with identifying pain in the pediatric pt

A
  1. unable to clearly identify whats going on with neonates and infants (crying but do not know why) 2. toddlers: cannot always make coherent response/response you can respond to 3. difficult to differentiate btwn pain, anxiety, and fear 4. poor coping skills/inabililty to have rational conversations 5. social background - may not speak to you due to their troubled background
27
Q

T/F: the vast majority of medications used in pediatric anesthesia are FDA approved

A

false; they are used off label/not FDA approved

28
Q

MOA of acetaminophen, ibuprofen, tordol

A

nonselective COX inhibitor –> inhibition of prostaglandins

29
Q

optimal cases for using tylenol in peds

A
  1. neonates 2. opioid wary (like with pyloric stenosis) 3. febrile (appendicitis) 4. with or without IV
30
Q

concerns with tylenol in pediatrics

A
  1. IV should be given over 15 min 2. hepatotoxicity (due to inadvertent OD) 3. skin reaction warning
31
Q

FDA 2014 recommendation on tylenol in peds?

A
  1. limitation of combination narcotics (those that have tylenol in them) 2. limit tylenol to < 4 g per day 3. education to parents on tylenol and what it can be found in
32
Q

ibuprofen in NOT recommended in those < ____________ (age)

A

6 months

33
Q

what cases would ibuprofen be a good adjunct

A
  1. mild to moderate pain 2. use in conjuction with opioids 3. IV or no IV
34
Q

concerns with Ibuprofen in pediatrics

A
  1. can cause ASA induced asthma attack 2. risk for GI bleed/increased bleeing 3. hepatic disease
35
Q

________________ is a pain adjunct that is NOT recommended to be used in infants

A

ketorolac

36
Q

IV dose of ketorolac in peds

A

0.5 mg/kg; max = 30 mg

37
Q

concerns with ketorolac in pediatrics

A
  1. NSAID allergies 2. causes bronchoconstriction (avoid with asthma) 3. PUD 4. renal failure
38
Q

what meds have the highest cross sensitivity with asprin; therefore, should be avoided in children with asthma

A
  1. ibuprofen 2. naproxen 3. diclofenac
39
Q

NSAID induced airway hyperreactivity occurs in about ______% of adults and _____% of peds

A

20; 5

40
Q

what is samter’s triad

A
  1. asthma 2. nasal polyps 3. asprin/NSAID sensitivity if pt has 2 out of these 3 –> avoid ASA, ibuprofen, naproxen, and ketorolac d/t risk of NSAID induced airway hyperreactivity
41
Q

neonate/infant/school aged child dose of ketamine - IV and gtt

A

IV = 1-2 mg/kg gtt = 20-75 mcg/kg/min

42
Q

MOA of ketamine

A

noncompetitive NMDA receptor antagonist

43
Q

ketamine causes dissocation btwn the ____________ & ___________ systems

A

thalamoneocortical; limbic

44
Q

what cases would ketamine be a good pain adjunct?

A
  1. cardiac pts (esp unrepaired or where SVR increase is desirable) 2. part of TIVA 3. neuromonitoring 4. Burn pts (2/2 opioid tolerance) 5. cases where you want spontaneous resp 6. chronic pain pts
45
Q

concerns with ketamine in peds

A
  1. increases ICP 2. can increase BP (or decrease if catechol depleted) 3. increases secretions 4. can cause emergence reactions 5. 3+ exposures <3 years of age increase risk of neuroapoptosis
46
Q

function of mu-1 receptor

A
  1. analgesia 2. miosis 3. urinary retention 4. N/V 5. pruritis
47
Q

fx of mu-2 receptor

A
  1. sedation 2. respiratory depression 3. decreased GI motility
48
Q

fx of kappa receptor

A
  1. analgesia 2. sedation 3. dec GI motility
49
Q

fx of delta opioid receptor

A
  1. analgesia 2. emotional behavior
50
Q

stimulation of the sigma opioid receptor causes ________________

A

dysphoria

Pediatrics (15 decks)

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