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MS3 > Peds 4 > Flashcards

Peds 4 Flashcards

1
Q

What is bolus amount for kids

A
  • 20 mL/kg (up to 1 L)

- 10 mL/kg for “half” bolus

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2
Q

Components of maintenance fluids for kids

A

D5 1/2NS + 20 mEq KCl

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3
Q

Describe how to calculate maintenance fluids for kids

A

4-2-1

  • For the 1st 10 kg = 4ml/kg/hr
  • Between 11-20 kg = 2ml/kg/hr
  • > 20 kg = 1 ml/kg/hr
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4
Q

Ddx of acute respiratory distress

A

Viral, bacterial pneumonia, foreign body aspiration, asthma, croup, myocarditis

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5
Q

What nutritional supplements are recommended for exclusively breast fed infants

A 
♣	Vitamin K administration at birth
♣	Vitamin D
♣	Sometimes fluoride
♣	Iron at 4-6 months (iron levels in breastmilk are low but highly bioavailable) 
♣	Vitamin B12 to vegan mothers
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6
Q

What type of deficiency will you see in Cystic Fibrosis

A

Fat malabsorption = ADEK deficiencies

A = fontanelle fullness 
D = rickets
E = hemolytic anemia
K = bleeding
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7
Q

MOA of Penicillin

A

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs); which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis

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8
Q

Describe resistance to Penicillin

A

Bacteria produce beta lactamases, which can break the beta lactam drugs (e.g. Staph species)

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9
Q

How do the following drugs differ from Penicillin: Nafcillin, Methicillin, Oxacillin, Dicloxacillin

A

Bulky R groups prevent beta-lactamase binding

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10
Q

Use of Methicillin/Nafcillin

A

Used to treat staphylococci

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11
Q

MOA of MRSA resistance to Penicillins

A

Altered PBPs - MRSA produces PBPs that have low affinity for binding beta-lactam abx

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12
Q

Describe relationship of Ampicillin and Amoxicillin

A

Ampicillin is IV version of Amoxicillin

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13
Q

How does Ampicillin/Amox differ from Penicillin

A

Maintain bacterial spectrum of Penicillin, but have improved activity against gram negatives

Are both beta-lactamase sensitive

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14
Q

Uses of Amoxicillin

A

Strep pharyngitis, otitis media and sinusitis, pneumonia, Lyme disease, H. flu, H. Pylori

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15
Q

Uses of Ampicillin

A

Anaerobic aspiration pneumonia, enterococcus, Listeria meningitis

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16
Q

What are the names of the beta-lactamase inhibitors

A

Clavulanate, Tazobactam, Sulbactam

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17
Q

What is Augmentin

A

Amoxicillin + Clavulanate

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18
Q

Adverse effects of amino penicillins

A

o Amino penicillins can cause rash which may manifest more seriously as Stevens-Johnson syndrome
o Amoxicillin-Clavulante is one of the most commonly reported causes of drug-induced liver injury
o Can lead to skin rashes when used in the setting of viral illness (e.g. Epstein-Barr virus – mono)

19
Q

How do Piperacillin and Ticaracillin differ from Penicillin

A

Broad spectrum coverage similar to Amino-penicillins + anaerobes + Pseudomonas

20
Q

MOA of Cephalosporins

A

Are also beta lactams - Bind PBPs and stop cell wall synthesis - same as Penicillin

21
Q

What are the names of 1st gen cephalosporins

A

“General Lex” wearing a fex hat

Cephalexin, Cefazolin

22
Q

Uses of 1st gen cephalosporins

A

Most gram positive cocci (staph and strep)

Cellulitis, abscess, strep pharyngitis, surgical prophylaxis, can be used to treat UTIs by some gram neg bugs (PEK = Proteus, E. Coli, Klebsiella)

23
Q

What are the names of 2nd gen cephalosporins

A

THINK: Furious general Fox drinking tea

Cefuroxime
Cetotetan
Cefoxitin

24
Q

Uses of 2nd gen cephalosporins

A

Same as 1st gen (staph and strep) with extended gram neg coverage (HeNS PEcK = H. flu, Neisseria, Serratia, Proteus, E. Coli, Klebsiella)

25
Q

What are the names of 3rd gen cephalosporins

A

THINK: General Taz with 3 axes

Ceftriaxone
Cefotaxime
Ceftazidime

26
Q

Uses of 3rd gen cephalosporins

A

Gram positive +

  • Meningitis (strep pneumo, H. flu, N. meningitidis)
  • Pneumonia (Ceftazidime to tx Pseudomonas)
  • Endocarditis (strep viridans)
  • Gram neg GI bugs (salmonella, shigella)
  • Gonorrhea
  • Lyme disease
  • Does NOT treat MRSA
27
Q

What are the names of 4th gen cephalosporins

A

THINK: General Prime

Cefepime

28
Q

Uses of 4th gen cephalosporins

A

Highly active against gram positive and gram negative

Can treat meningitis and pseudomonas

Does NOT treat MRSA

29
Q

What are the names of 5th gen cephalosporins

A

THINK: General Tara

Ceftaroline

30
Q

Uses of 5th gen cephalosporins

A

Broad spectrum + MRSA

31
Q

Describe Cephalosporin’s susceptibility to beta-lactamase

A

Some are stable to beta-lactamase (especially 3rd and 4th gen)

32
Q

Describe resistance to Cephalosporins

A
  • Altered PBP

- Extended spectrum beta lactamase

33
Q

Describe MOA of Monobactams and spectrum coverage

A

Are beta lactams (bind PBP)

Spectrum is limited to aerobic gram negative rods

No effect on anaerobes or gram positives

34
Q

Name of Monobactam drug and its uses

A

Aztreonam

Gram neg coverage similar to 3rd gen cephalosporins - penetrates CSF (meningitis, pneumonia, sepsis, pseudomonas)

35
Q

Describe monobactam susceptibility to beta lactamases

A

Resistant to most beta lactamases

36
Q

What are the Carbapenems

A

Imipenem, Ertapenem, Meropenem, Doripenem

37
Q

MOA and spectrum of Cabapenems

A

Broad spectrum - treat gram neg, gram positive, and anaerobes (including pseudomonas)

Meningitis, psudeomonas, sepsis

38
Q

When do you use Carbapenems

A

With bugs resistant to other tx

39
Q

Describe special consideration when using Imipenem

A

Is inactivated by dehydropeptidase in the renal tubules so it is administered with inhibitor of dehydropeptidase (Cilastin)

40
Q

Adverse effect of Carbapenems

A

Rash, GI effect (N,V,D), lowers seizure threshold

41
Q

Describe Carbapenem susceptibility to beta lactamase

A

Highly resistant to extended spectrum beta lactamases

42
Q

Diagnose: eczema, thrombocytopenia, recurrent infections

A

Wiskott-Aldrich Syndrome

o X-linked recessive immunodeficiency due to mutation in WASp gene
o Leukocytes and platelets unable to reorganize actin skeleton defective antigen presentation
o WATER - Wiskott Aldrich, microThrombocytopenia, Eczema (especially truncal), Recurrent infections
o Treatment – stem cell transplant

43
Q

Diagnose: recurrent pneumonia, atopy, and anaphylactic reaction during blood transfusion

A

Selective IgA deficiency

44
Q

Best way to prevent congenital rubella

A

Maternal immunization prior to conception

MS3 (88 decks)

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