Chronic Pediatric Disease Inclass

Question 1

Which drug for HTN

Answer 1

1. ACEi/ARB
   CCB, Thiazides

Question 2

What are the symptoms of Cerebral Palsy?

Answer 2

-Flexed elbow
-Bent wrist
-Flonated forearm
-Clenched fist
-thumb in palm

also movement disorder:
-Spasticity
-dystonia
-choreoathetosis
-ataxia

Question 3

Which drugs are used for spasticity in children?

Answer 3

1. Baclofen
   or Benzos (Diazepam, Clonazepam)

Question 4

Which drugs are used for drooling in children?

Answer 4

Scopolamine (antimuscarinic)
Glycopyrrolate (anticholinergic)

drooling can cause skin breakdown

Question 5

Which drug for Insomnia in children?

Answer 5

Melatonin

Question 6

Which drugs are for Aggression and irritability?

Which drugs for anxiety and depression?

Which drug for ADHD?

Answer 6

Aggression and irritability: Aripiprazole (Abilify) and risperidone (Risperdal)

anxiety and depression: SSRI

ADHD: stimulants like Atomoxetine, clonidine and guanfacine

Question 7

What are the 3 forms of IBS?

Answer 7

-IBS-D (with diarrhea)
-IBS-C (with constipation)
-Visceral hypersensitivity (altered intestinal sensation): increased pain -> anxiety

Question 8

Treatment for IBS-D and IBS-C

Answer 8

IBS-C: Fiber and bulk-forming agents + water, laxatives, Rx: Lubiprostone

IBS-D:
-Loperamide (Imodium)
-Anitspasmatics (Hyoscyamine, Dicyclomine) - not often, peppermint oil

-SSRIs: lots of serotonin receptors in the GI
-TCAs: may use to treat comorbid depression

-oral corticosteroids, mesalamine (anti-inflammatory)
-Probiotics
-fecal transplant

Question 9

Which disease is treated with Aspirin in children?
Why is it usually avoided in children?

Answer 9

Kawasaki disease

it is avoided in children because of Reyes syndrome

Question 10

What is the cause of most DVTs in kids?

Answer 10

often caused by the central line (IV catheter)

Question 11

What is the main thing to remember about
dosing of enoxaparin in kids?

Answer 11

the dose is much higher in kids

Question 12

What is the treatment for a patient with Sickle cell disease who presents in the ER? (acute)

Answer 12

-give O2 due to hypoxia (causes pain)
-give fluids
-pain treatment: opioids
-antibiotics like ceftriaxone (it could be caused by an infection)

Question 13

What happens over time in patients with Sickle cell disease?

Answer 13

Functional Asplenia, may end up with splenectomy

Question 14

Which prophylactic treatment is necessary for patients with sickle cell disease or patients after a splenectomy?

Answer 14

-> Prophylaxis vaccine against encapsulated bugs:
Strep pneumo
Salmonella
Neisseria meningitis
Haemulus influenza

Question 15

Which drug is used to treat Sickle cell disease?

Answer 15

Hydroxyurea

Question 16

What are the three types of crises that are
dangerous in Sickle cell disease patients and why?

Answer 16

-Vasoocclusive pain crisis (sickle RBC blocks blood vessels -> causes pain): hydration, pain meds, transfusion

-Aplastic crisis (no RBC production)

-Sequestration crisis: hypovolemia of the spleen, it has filtered so many sickle cells that it can rupture

Question 17

Hydroxyurea dosing

Question 18

Which protein is the defect in cystic fibrosis?

Answer 18

CFTR protein
a Chloride channel !!!
-> affects water transfer -> higher viscosity (various organs, usually the lungs)

Question 19

What are the 3 common bacteria isolated from the lungs of CF patients?

Answer 19

-Pseudomans
-H. flu
-MRSA

Question 20

Which antibiotics would be a good empiric therapy in children for cystic fibrosis?

Answer 20

Pseudomonas:
-Zosyn (Pip/Tazo)
-Cefepime
-Meropenem
-Aminoglycoside (gentamicin) given with Zosyn
-Levaquin/Cipro

Staph aureus (MRSA):
-Vancomycin
-Linezolid (caution: thrombocytopenia, serotonin syndrome, seizure)

need to cover Staph aureus and Pseudomonas!!

Question 21

Why might Rocephin and Bactrim be dangerous in kids under 2 months?

FYI Naplex

Answer 21

-displaces bilirubin -> Hyperalbuminemia, kernicterus
-bind to Calcium

Question 22

How is antibiotic dosing for cystic fibrosis different in kids than in adults?

Answer 22

doses are higher in kids bc renal elimination is faster and the Vd is greater than in adults

Question 23

Patients with cystic fibrosis have decreased pancreas activity and are treated with pancreatic enzymes.

What gastrointestinal signs may indicate an
inadequate dose of pancreatic enzymes?

Answer 23

floating stool (Steatorrhea)

due to low Lipase (produced in the pancreas)

Question 24

How are exacerbations of Nephrotic syndrome treated?

Which ones are used for suppression?

Answer 24

IV albumin and a big dose of furosemide

for suppression:
Corticosteroids, or Cytoxen, cyclosporin, or mycophenolate mofetil (immunosuppressant)

Question 25

What types of adverse reactions are caused by these medications (mycophenolate mofetil, cyclosporin)?

Answer 25

-HTN -nephrotoxicity they often already have HTN, so it makes it worse

Question 26

Which equation is used to estimate renal function in children?

Answer 26

Bedside Schwartz equation

Question 27

Inhaled corticosteroids can cause growth suppression in children when used long-term. T/F

Answer 27

True

Question 28

Which drug is often prescribed for patients for asthma treatment instead of Albuterol only?

Answer 28

Budesonide + Formeterol Combi Formoterol (LABA) -> quick onset for rescue)

Question 29

What should be considered when using Montelukast in kids for asthma?

Answer 29

contraindicated in kids with psychiatric issues but if they don't have mental problems, its worth to try in kids who have tried other drugs

Question 30

Which diseases are often seen with Atopic Dermatitis?

Answer 30

Atopic Triad: -Atopic dermatitis -Allergic rhinitis -Asthma or food allergies

Question 31

What is often seen secondary to Atopic Dermatitis? !!!

Answer 31

Skin infections due to skin breakdown Treatment: antibiotics for MRSA (Staph aureus) and Group A Strep Candida and herpes are less common

Question 32

Which drugs are used for Atopic Dermatitis?

Answer 32

topical therapy (moisturizer, emollients, antihistamines, topical calcineurin inhibitor) -avoid triggers: season change, dry skin, foods, irritants, stress, infections)

Question 33

Difference between Ulcerative Colitis and Crohn's disease

Answer 33

Ulcerative Colitis: in the colon (curable, cut parts out) Crohn's disease: can be anywhere in the GI tract

Question 34

Which drugs are used for Crohn's disease and Ulcerative Colitis?

Answer 34

-Corticosteroids, aminosalicylates -immunomodulators, biologics and antibiotics if moderate or severe

Question 35

Which biologics are used in UC and Crohn's disease?

Answer 35

Top-down approach: Biologics -Adalimumab (Humira®): can be used at home -Infliximab (Remicade®): need infusion for administration others: Certolizumab pegol (Cimzia), Natalizumab (Tysabri), Vedolizumab (Entyvio) & Ustekinumab (Stelara)

Question 36

What is a rare but bad side effect of combination use of azathioprine, 6-mercaptopurine, or methotrexate with biologics?

Answer 36

Hepatosplenic T-cell Lymphoma often seen when started with azathioprine, 6-MP, and methotrexate but it is very rare