Chapter 54: Pediatric Conditions Flashcards
(132 cards)
1
Q
How old is a neonate?
A
0-28 days
2
Q
At what temperature must an infant <3 months old seek urgent care?
A
Rectal temperature >=100.4 F
3
Q
At what temperature must an infant 3-6 months old seek urgent care?
A
Rectal temperature >=101 F
4
Q
At what temperature must an infant >6 months old seek urgent care?
A
Rectal temperature >=103 F
5
Q
What is Apgar score indicating?
A
A newborn’s ability to adapt to extrauterine life
6
Q
What does a Apgar score of < 7 indicate?
A
It is a sign that the newborn is experiencing distress and prompt medical intervention
7
Q
What medication is routinely administered after birth to prevent bleeding?
A
IM Vitamin K
8
Q
What can be used in newborn children for jaundice?
A
Light therapy (Phototherapy)
9
Q
What is the classification of a neonate as premature?
A
A neonate is classified as premature if delivery occurs before 37 weeks of gestation
10
Q
What conditions do premature neonates have a higher risk of experiencing?
A
Patent ductus arteries (PDA)
Respiratory distress syndrome (RDS)
11
Q
In which group of neonates is Persistent pulmonary hypertension (PPHN) more often observed?
A
Term neonates
12
Q
What is the ductus arteriosus?
A
A normal opening between the aorta and pulmonary artery in an unborn fetus that facilitates fetal circulation by allowing blood to bypass the lungs.
13
Q
What maintains the ductus arteriosus during fetal life?
A
Maternal prostaglandin
Prostaglandins are hormones that play a crucial role in various physiological processes.
14
Q
What is the function of the ductus arteriosus in a fetus?
A
Allows blood to bypass the immature lungs
This bypass is essential because the fetus does not use its lungs for oxygen exchange.
15
Q
What happens to the ductus arteriosus after delivery?
A
It should close naturally
The closure occurs as prostaglandin levels decrease in the neonate.
16
Q
What is a patent ductus arteriosus (PDA)?
A
A condition where the ductus arteriosus remains open after birth
17
Q
What are the potential interventions for a PDA?
A
- Medical observation
- Surgery
- Drugs
Interventions depend on the severity and symptoms of the PDA.
18
Q
Which class of medications can help close a PDA?
A
NSAIDs
* IV indomethacin
* Ibuprofen
These NSAIDs work by blocking cyclooxygenase and inhibiting prostaglandin synthesis.
19
Q
What is the mechanism of NSAIDs that helps close a PDA?
A
Blocking cyclooxygenase and inhibiting prostaglandin synthesis
20
Q
Respiratory distress syndrome (RDS) is caused by:
A
A deficiency of surfactant production in the lungs that are not fully developed causes the alveoli to collapse.
RDS can lead to respiratory failure and death if untreated.
21
Q
What do most neonates born before 35 weeks of gestation receive immediately after birth?
A
Surfactant
Surfactant is administered to help prevent or treat RDS.
22
Q
What are common surfactant products?
A
Poractant alfa (Curosurf)
Calfactant (Infasurf)
23
Q
Fill in the blank: A deficiency of surfactant leads to _______.
A
respiratory distress syndrome (RDS)
24
Q
Most babies born < ____ weeks gestation will receive surfactant immediately after birth for RDS
A
35 weeks
25
What happens to blood vessels in the lungs when an infant is born?
Blood vessels in the lungs relax, allowing blood to begin circulating through the pulmonary vasculature
26
What condition can arise if blood vessels in the lungs fail to relax after birth?
Persistent pulmonary hypertension of the newborn (PPHN)
27
What may PPHN be linked to?
In utero exposure to selective serotonin reuptake inhibitors (SSRIs)
28
What is the standard treatment for PPHN?
Inhaled nitric oxide (NO) to dilate the pulmonary vasculature
29
What type of drugs used to treat pulmonary arterial hypertension can be used for PPHN?
Sildenafil (a PDE-5 inhibitor)
30
Fill in the blank: PPHN can lead to elevated vascular resistance in the _______.
pulmonary vasculature
31
What does a sepsis evaluation in neonates generally involve?
Obtaining blood and urine cultures, a lumbar puncture, a chest X-ray (if respiratory symptoms are present), and laboratory tests (e.g., CBC, C-reactive protein, complete metabolic panel).
32
What are signs of neonatal meningitis?
Signs can include fever (or hypothermia), lethargy, poor feeding, irritability, and seizures. Bulging fontanelles occur rarely.
| Bulging fontanelles is swelling between the bones of the skull
33
How do common neonatal bacterial pathogens differ from other age groups?
They differ due to vertical transmission of organisms from the mother to the neonate via contaminated amniotic fluid or during vaginal delivery.
34
What is a common cause of bacteremia in neonates?
Escherichia coli is a common cause of bacteremia.
35
What pathogens most often cause neonatal meningitis?
Meningitis is most often caused by **Group B Streptococcus** (GBS) and (rarely) Listeria.
36
What is the purpose of universal GBS screening during pregnancy?
To identify pregnant women who may be colonized with GBS and provide antibiotic prophylaxis (e.g., penicillin G aqueous) during labor to decrease the risk of transmission to the neonate.
37
What is the empiric antibiotic treatment for neonates with a fever?
Empiric antibiotic treatment consists of ampicillin plus ceftazidime, cefepime, or gentamicin.
38
Why is ceftriaxone generally avoided in neonates?
Ceftriaxone displaces bilirubin from albumin, which can cause bilirubin-induced brain damage (kernicterus).
39
What is a risk associated with concurrent use of ceftriaxone and calcium-containing solutions in neonates?
It can precipitate, causing an embolus and death; concurrent use of these products in neonates is contraindicated.
40
What is bronchiolitis?
A common **lower respiratory tract** condition that nearly all children experience by two years of age.
41
Which group of infants is at a higher risk for severe bronchiolitis?
Neonates and premature infants.
42
What virus is responsible for the majority of bronchiolitis cases?
Respiratory syncytial virus (RSV).
43
How does RSV invade the respiratory system?
It invades via the nasopharynx and enters the lower respiratory tract and causes increased mucus production and sloughing of cells that line the bronchi.
This can lead to significant swelling within the airway and respiratory distress
44
What are the typical symptoms of bronchiolitis?
Rhinitis, cough, wheezing, tachypnea, and nasal flaring.
45
When do bronchiolitis symptoms typically peak?
On days 3 - 5 of illness.
46
What is the primary treatment approach for bronchiolitis?
Supportive treatment.
47
What supportive treatments are used for bronchiolitis?
* Suction of secretions
* Hydration
* Supplemental oxygen
* Fever management
48
What medication can be considered for immunocompromised patients with severe RSV infection?
Inhaled ribavirin (Virazole).
49
What is the recommended gestational period for administering the recombinant RSV vaccine (Abrysvo) to pregnant patients?
32 - 36 weeks gestation
## Footnote
This vaccine is intended to prevent RSV infection in infants less than 6 months old.
50
What is recommended if the mother was not vaccinated against RSV?
RSV prophylaxis for the infant during RSV season
## Footnote
RSV season typically occurs in late fall, winter, and early spring.
51
Name the two monoclonal antibodies available for RSV prophylaxis.
* nirsevimab (Beyfortus)
* palivizumab (Synagis)
## Footnote
These antibodies are used to provide prophylaxis against RSV infection.
52
Nirsevimab brand name
Beyfortus
53
Palivizumab brand name
Synagis
54
What type of injection is Nirsevimab administered as?
Single IM injection
55
Who is recommended to receive Nirsevimab?
* Neonates and infants ≤ 8 months old born during or entering their first RSV season
* Children ≤ 20 months who are vulnerable to severe RSV disease
56
What type of injection is Palivizumab administered as?
IM injection
57
What is the dosage of Palivizumab?
15 mg/kg IM once monthly through RSV season
58
What is the maximum number of doses of Palivizumab unless the RSV season is extended?
5 doses
59
Who is recommended to receive Palivizumab? List at least one group.
*** Premature infant** born at < 29 weeks of gestation and age ≤ 12 months
* Premature infant born at ≤ 35 weeks of gestation and age ≤ 6 months
* Age ≤ 24 months with select congenital heart conditions or chronic lung disease requiring hospitalization
60
In which muscle are the doses of Nirsevimab and Palivizumab administered?
Anterolateral thigh muscle
61
What is croup also known as?
Croup is defined as laryngotracheobronchitis, indicating inflammation of the larynx, trachea, and bronchi.
62
What are the hallmark signs of croup?
* Inspiratory stridor (high pitched breathing sound)
* Barking cough
* Hoarseness
## Footnote
These signs are indicative of significant upper airway inflammation.
63
In which age group is croup most common?
Children < 6 years old
## Footnote
Croup is particularly prevalent in younger children and often worsens at night.
64
What is the mainstay treatment for moderate to severe croup?
Systemic steroids (e.g., dexamethasone 0.6 mg/kg)
65
What additional treatment may be given to patients with difficulty breathing in an acute care setting?
## Footnote
Croup
Nebulized racemic epinephrine
## Footnote
Epinephrine is an adrenergic agonist that helps alleviate symptoms through **decreased airway edema and obstruction**.
66
What is the onset and duration of action for nebulized racemic epinephrine?
Fast onset, short duration (~2 hours)
## Footnote
Monitoring for symptom recurrence is essential after administration.
67
What is nebulized racemic epinephrine composed of?
A 1:1 mixture of dextro (D) and levo (L) isomers
## Footnote
The L-isomer is the active component that provides therapeutic effects.
68
What should be used if racemic epinephrine is not available?
L-epinephrine
## Footnote
L-epinephrine is half the drug (one isomer) and the dose is also halved compared to racemic epinephrine.
69
When are antibiotics used in the context of croup?
Only if a bacterial infection is also present
## Footnote
Antibiotics are not a standard treatment for croup unless there is a confirmed bacterial etiology.
70
What is nocturnal enuresis?
Nocturnal enuresis, or bed-wetting, is a normal part of a child's development
71
At what age is nocturnal enuresis generally not treated?
Before age 5 years
72
What should be attempted first for treating nocturnal enuresis?
Behavioral approaches
73
List some behavioral approaches for nocturnal enuresis treatment.
* Positive reinforcement
* Establishing a normal daytime voiding pattern
* Establishing a normal bowel pattern
* Establishing a normal hydration pattern
74
What is the preferred drug treatment for nocturnal enuresis?
Desmopressin oral tablet
75
What is Desmopressin a synthetic analog of?
Antidiuretic hormone (ADH)
76
How does Desmopressin help with nocturnal enuresis?
It simulates ADH to reduce nocturnal urine production
77
What is the initial dosage of Desmopressin (DDAVP) for enuresis?
0.2 mg PO QHS
78
What is the maximum dosage of Desmopressin that can be titrated for enuresis?
0.6 mg
79
What are the boxed warnings associated with Desmopressin?
Severe, life-threatening hyponatremia can develop
80
What are the contraindications for using Desmopressin?
* **Hyponatremia**
* History of hyponatremia
* CrCl < 50 mL/min
81
What are common side effects of Desmopressin?
* **Headache**
* Fatigue
* Possible low sodium due to water retention
82
What should be limited in fluid intake in relation to Desmopressin dosing?
Limit fluid intake starting 1 hour before dose and until the next morning
83
What essential role do pharmacists play in the context of pediatric patients?
Pharmacists play an essential role in safe medication use for pediatric patients.
## Footnote
Their expertise is crucial in preventing medication errors and ensuring proper dosing.
84
What is one measure to decrease the risk of errors for liquid pediatric medications?
Verify that the dose is appropriate for the patient's weight.
## Footnote
Weight-based dosing is critical for accurate medication administration in children.
85
What should be transcribed on the label of liquid pediatric medications?
The dose in milliliters only.
## Footnote
This helps to standardize dosing and reduce confusion.
86
What type of measuring device should be dispensed with liquid prescriptions for pediatric medications?
An oral measuring device (dosing syringe or cup) appropriate for the age of the patient and the dose volume.
## Footnote
This ensures accurate dosing and is tailored to the child's needs.
87
Why should household spoons not be used for measuring medication?
They are highly variable in size and cause dosing inaccuracies.
## Footnote
This variability can lead to underdosing or overdosing.
88
What does the FDA recommend regarding OTC cough and cold medications in children under 2 years old?
The FDA does not recommend OTC cough and cold medications in children < 2 years old
## Footnote
Most manufacturers include product labeling to avoid use in children under age 4.
89
What syndrome is associated with aspirin and salicylate-containing products in children recovering from viral infections?
Reyes syndrome
## Footnote
Particularly associated with influenza and chickenpox.
90
What is the recommendation for aspirin and salicylate-containing products in patients ≤ 18 years old?
These products are not recommended in patients ≤ 18 years old
## Footnote
Due to the risk of Reyes syndrome.
91
What is the concentration of acetaminophen infant drops compared to children's suspension?
The same concentration to help reduce dosing errors
## Footnote
This measure is to ensure safety in dosing.
92
Use of acetaminophen in doses above the recommended amount is the most common cause of:
Liver failure
93
Why should ibuprofen be avoided in infants ≤ 6 months old?
Due to the risk of nephrotoxicity
## Footnote
This risk is particularly concerning in very young infants.
94
What should caregivers be aware of regarding ibuprofen for patients ≥ 6 months old?
Ibuprofen drops and suspension are supplied in different dosage strengths for infants and children
## Footnote
This is important to prevent dosing errors.
95
What medications are appropriate for treating pain and fever in children ≥ 6 months old?
Acetaminophen or ibuprofen
## Footnote
Both medications are commonly recommended for this age group.
96
What dosing strategy may some physicians recommend for acetaminophen and ibuprofen?
Giving them together in alternating doses (e.g., acetaminophen first, then ibuprofen three hours later)
## Footnote
This strategy can help manage pain and fever effectively.
97
What is the brand name of Acetaminophen?
Tylenol, FeverAll Children's, others
98
What is the brand name of Ibuprofen for infants?
Infants' Advil Drops, Motrin Infants' Drops, Children's Motrin, Children's Advil, others
## Footnote
Ibuprofen is also used for pain relief and has anti-inflammatory properties.
99
What is the recommended dosage of Acetaminophen for children?
10-15 mg/kg/dose every 4-6 hours (max 75 mg/kg/day)
## Footnote
This dosage is important for safe administration.
100
What is the concentration of Acetaminophen oral liquid formulations for infants and children?
160 mg/5 mL
## Footnote
This concentration is standardized for ease of dosing.
101
What is the recommended dosage of Ibuprofen for children?
5-10 mg/kg/dose every 6-8 hours (max 40 mg/kg/day)
## Footnote
Adhering to the dosage guidelines is crucial to avoid overdose.
102
What age group is Ibuprofen indicated for?
Infants ≥ 6 months old
## Footnote
This age restriction is essential for safe use.
103
What is a potential side effect of Ibuprofen?
Nausea
104
What is the primary treatment for nasal congestion in infants?
Saline nasal drops or sprays to loosen and remove mucus.
Examples include Ocean for Kids and Little Remedies.
105
What is intestinal gas?
A common neonatal and infant condition causing distress after feedings.
## Footnote
Usually resolves when the child is 6-8 months old.
106
What treatment can be used for intestinal gas in infants?
Simethicone drops (20 mg, 1-4 times daily PRN).
## Footnote
Simethicone is not absorbed and is considered safe.
107
What can significant diarrhea lead to in infants?
Dehydration, which can be dangerous.
108
How can fluid and electrolytes be replaced in infants with diarrhea?
Using OTC oral rehydration solutions like Pedialyte and Enfamil Enfalyte.
109
Why should bismuth subsalicylate not be used in infants?
Due to the risk of Reye's syndrome.
110
What age group is loperamide not recommended for OTC use?
Children ≤ 6 years old.
111
What natural remedies can be helpful for children with constipation?
Prunes or pears (as fruit or juice) or kiwi fruit.
## Footnote
These foods can help promote bowel movements.
112
What is the preferred treatment for children under 6 months with constipation?
OTC pediatric glycerin suppositories.
## Footnote
This is an off-label use; approved for children ≥ 2 years.
113
What is the dosage of oral polyethylene glycol 3350 (MiraLax) for children ≥ 6 months?
0.2 - 1.5 g/kg/day.
## Footnote
This dosage is preferred for most cases of intermittent constipation.
114
What additional options are available for children aged ≥ 2 years with constipation?
Magnesium hydroxide, docusate, senna, and rectal enemas.
## Footnote
These options provide alternatives for treating constipation.
115
What should not be used for constipation in children < 2 years old due to severe risks?
OTC rectal enemas like sodium phosphate (Fleet Pedia-Lax Enema).
## Footnote
Risks include severe dehydration and electrolyte abnormalities.
116
What additional options are available for children aged ≥ 6 years with constipation?
Bisacodyl suppositories or oral mineral oil.
## Footnote
These provide more treatment choices for older children.
117
What caution should be taken when using mineral oil in children?
Use with caution in children at risk for aspiration.
## Footnote
Risk factors include neurologic impairment and significant gastrointestinal reflux.
118
Fill in the blank: OTC pediatric glycerin suppositories are commonly used for children under _______.
6 months.
## Footnote
This treatment is used for quick relief.
119
True or False: Oral polyethylene glycol 3350 is the preferred treatment for children under 6 months.
False.
## Footnote
It is used for children ≥ 6 months.
120
What topical teething product increases the risk of methemoglobinemia?
Products containing benzocaine
## Footnote
The FDA recommends against the use of benzocaine in children < 2 years old.
121
What is contraindicated in children < 2 years old due to respiratory depression risks?
Promethazine
## Footnote
Promethazine can cause severe or fatal respiratory depression in young children.
122
How is codeine metabolized in the body?
Codeine is metabolized to morphine by the CYP2D6 enzyme
## Footnote
Children who over-express CYP2D6 can produce excessive morphine, leading to respiratory depression and possible death.
123
What is the risk associated with tramadol in children?
Similar risk of respiratory depression as codeine
## Footnote
Tramadol is also metabolized to an active metabolite by CYP2D6.
124
In which patients are codeine and tramadol contraindicated?
All patients < 12 years old and those < 18 years old after tonsillectomy/adenoidectomy
## Footnote
This is due to the risk of severe respiratory issues.
125
What is the current age recommendation for prescription cough and cold medications with codeine or hydrocodone?
They are no longer indicated in patients < 18 years old
## Footnote
This change is due to safety concerns in younger patients.
126
Why are quinolones generally not recommended in pediatric patients?
Due to the possibility of cartilage, bone, and muscle adverse effects
## Footnote
However, benefits may outweigh risks in select conditions such as anthrax or complicated urinary tract infections.
127
What age group should avoid tetracyclines and why?
Children < 8 years of age due to the risk of dental staining and bone growth issues
128
What is the exception for the use of doxycycline in children?
Treatment of tick-borne Rickettsial diseases
129
What are vaccine-preventable childhood diseases?
Measles, mumps, rubella, polio, pertussis, rotavirus, chickenpox (varicella)
130
What is the vaccine to prevent Measles?
MMR
131
What are classic symptoms of measles?
Koplik spots (small white spots on the inside of the mouth), maculopapular rash
132
Measles transmission
airborne
