EM pharmac and preventive Flashcards
(37 cards)
Typical absence seizures begin between 3 and 10 years of age in otherwise normal children and are characterized by brief, 5 to 20 second lapses in consciousness, speech, or motor activity, sometimes associated with flickering of the eyelids.
Absence seizures are never accompanied by an aura or postictal drowsiness, but lip smacking or eye blinking automatisms may be observed during the seizure. Numerous seizures can occur every day.
The EEG shows classic ictal generalized 3-Hz spike and wave discharges. Typical childhood absence seizures can be triggered by hyperventilation in 80% of children as well as photic stimulation in those with absence epilepsy.
Good response is seen with use of valproic acid, ethosuximide, or lamotrigine. Seizures usually remit by adolescence or early adulthood.
Valproic acid has shown good response for absence epilepsy, second-line therapy for infantile spasms, and variable affect for Lennox-Gestaut syndrome. Of other antiepileptic drugs (AED) for absence seizures, it is least likely to affect behavior adversely. The risk of is of ____ most concern causing it to be contraindicated in ____ disease.
hepatotoxicity, The risk of fatal hepatotoxicity is highest in children younger than 2 years of age who are developmentally delayed or neurologically impaired and receiving other antiepileptic drugs. It can increase levels of other antiepileptic drugs, especially phenytoin and phenobarbital, however, it does not affect oral contraceptives.
The primary adverse effects seen with lamotrigine, one of the newer AED, for the treatment of absence and Lennox-Gestaut syndrome are
severe skin rash, ataxia, and insomnia.
Ethosuximide, the AED of choice for absence seizures, may rarely cause
drowsiness, nausea, and blood dyscrasias.
Carbamazepine has been used to treat partial seizures. Potential side effect are…
Hepatic or blood dyscrasias, associated with aplastic anemia and neutropenia. Other possible side effects include ataxia, diplopia, and rash. Carbamazepine also induces hepatic metabolism thus lowering concentrations of other antiepileptic drugs such as phenytoin, valproic acid, lamotrigine, and topiramate in addition to oral contraceptives, steroids, and warfarin.
Tiagabine is used to treat complex partial seizures. It is another newer AED, and is most likely to cause fatigue in addition to
dizziness, nausea, nervousness, tremor, abdominal pain, confusion, and difficulty in concentrating.
____ is an anesthetic that blocks association pathways and also produces sedation at moderate doses. It may induce dreamlike states of mind and hallucinations before producing a sensory blockade. Hallucinations are common as the medication starts to wear off, and can cause emergent hallucinations; hallucinations are more common in adolescents and adults.
Ketamine. It is especially useful for short painful procedures in younger children. High doses may induce general anesthesia. Midazolam given in conjunction with ketamine helps to minimize the severity of these hallucinations.
____ is a commonly used as an opioid analgesic in hospitalized patients and has a long period of duration. Patients must be carefully monitored for respiratory depression.
Morphine
____ is a potent sedative, anxiolytic, and amnestic with no analgesic effect and a short half-life. It can be given orally, IV, intranasally, or rectally. High doses may cause respiratory depression.
Midazolam
commonly used sedative, ____ , has a longer half-life but less predictable duration; therefore, it requires longer monitoring of patients for respiratory depression. It is useful for lengthy, non-painful, and distressing procedures.
chloral hydrate
___ is used for painful procedures. It is a potent opioid analgesic that may be combined with midazolam to reduce anxiety. High doses are associated with chest wall stiffness and rigidity, especially with rapid titration.
Fentanyl
____ is a synthetic corticosteroid. It has 15 times greater anti-inflammatory activity than hydrocortisone but it is more than 125 times more active as a mineralocorticoid, hence it is used to treat aldosterone deficiency in patients with salt wasting disease. It is not indicated for use in prenatal management of congenital adrenal hyperplasia.
Fludrocortisone. The dose is 0.1-0.3mg daily in 2 divided doses, occasionally up to 0.4mg. In infants the mineralocorticoid requirement is very high in the first few months of life. Older infants and children are usually maintained on 0.05-0.1mg daily.
_____ is the drug of choice and is recommended for pregnancies at risk, as it readily crosses the placenta and helps in prevention of virilization of the female fetus.
Dexamethasone. It is administered in the dose of 20µg/kg of pre pregnancy weight of the mother daily in 2-3 divided doses. This suppresses the secretion of steroids and adrenal androgens by the fetal adrenal gland. If started by 6 weeks of gestation it prevents virilization of the female fetus. No adverse effects have been noted in children exposed to this therapy. Maternal side effects of prenatal treatment include excessive weight gain, edema, hypertension, glucose intolerance, and cushingoid facies.
_____ are not used in prenatal management of congenital adrenal hyperplasia.
Betamethasone and prednisolone
_____ is generally used for long term replacement therapy for congenital adrenal hyperplasia. Dose is 10mg/M2/24 hr in 3 divided doses. It is not used in prenatal management of congenital adrenal hyperplasia.
Hydrocortisone
Though there is a strong link between violent behavior and a history of personal victimization, most children are resilient and do not grow up to be victims, abusers, or violent criminals. Protective factors responsible for this resilience are poorly understood, but may include
innate personality characteristics, encompassing an easy temperament, positive disposition, active coping skills, positive self-esteem, good social skills, internal locus of control, and a balance between help-seeking and autonomy. Protective factors also include the availability of affectionate, stable, alternate adult caretakers; school success; and the presence of a supportive network of family, friends, and community members.
There is a wide range of physical and emotional sequelae impacting children of spouse battering,
including PTSD, depression, anxiety disorders, nightmares, somatic complaints, and hypervigilance.
children who witness violence are at risk for psychosocial and developmental sequelae just like children who are the direct victims of abuse, although the risk is not as severe.
Experiencing both forms of violence represents the most potent predictor of future aggression.
Child neglect also predicts future criminality; however, there is a stronger link between violent behavior and a history of
personal victimization
the child received a clean wound, has had 3 vaccinations, the last within 10 years; therefore, he needs
no further tetanus protection.
DTaP (diphtheria and tetanus toxoids and acellular pertussis) is not indicated for children over the age of 7 years. Both DTap and DT, without the pertussis component, are products that can be used in children younger than age 7 years and usually have 3-5 times as much of the diphtheria component than the adult formulation.
Older children and adults should receive the formulation Tdap and/or Td. 2 relatively new pertussis containing vaccines, named Tdap products, were introduced in 2005 due to continued endemic outbreaks of pertussis seen in adolescents 11 through 18 years of age whose vaccine induced immunity seemed to be waning. The preferred age, however, for Tdap immunization is 11 to 12 years. Before this age, Td should still be used in those older than 7 years but younger than 11 years.
Beyond the age of 5 years, _____ is not necessary unless the child has specific underlying conditions predisposing. Routine recommended schedule is 4 doses at age 2 months, 4 months, 6 months and between 12-15 months.
HIB (Haemophilus influenzae type B vaccine)
The recommended routine schedule for IPV is at ages
2 months, 4 months, 6-18 months, and 4-6 years. Unvaccinated or undervaccinated older children should receive 2 doses of IPV separated by 4-8 weeks with a third dose 6-12 months after the second.
