Pediatric GERD

Question 1

Whether using a compounded or commercially available suspension, ALWAYS confirm doses in __ (not __ alone)

Answer 1

• mg
• mL

Question 2

GER

Answer 2

Passage of gastric contents into the esophagus

Question 3

GERD

Answer 3

Gastric reflux causes troublesome symptoms or complications (irritability, feeding difficulties, poor weight gain)

Question 4

Regurgitation

Answer 4

Effortless passage of stomach content, AKA “spitting up”

Question 5

GER is caused by relaxation of the ___ esophageal sphincter (LES)
* can be caused by eating large volume and ___ gastic emptying

Answer 5

• lower
• delayed

Question 6

T or F: it is uncertain if PPIs provide benefit in infants

Answer 6

True

Question 7

T or F: antacids can be used in infants

Answer 7

FALSE; risk of milk alkali syndrome/increasd aluminum levels

Question 8

for PPI used in older children, cnsider weaning after ___ weeks
* do not stop suddenly; may have rebound ___

Answer 8

4-8 weeks
* hyperacidity

Question 9

H2RA

• ___ inhibition of histamines receptors on parietal cells which decreases acid secretion
• ___ line therapy for mild-moderate GERD
• ___ term use (associated with ___ )
• pediatric H2RA of choice ___
• requires ___ dosing adjustment

Answer 9

• competitive
• first
• short, tachyphylaxis
• famotidine (Pepcid)
• renal

Question 10

PPIs

MOA: ___ block gastric H+/K+ ATPase pump, ___ inhibit H+ secretion
* maintain acid suppresion for longer periods, inhibit ___ induced acid sectretion
* usually trialled after an ___, but not always
* most data is available for ___ and ___
* dosing is approx ___ mg/kg/day

Answer 10

• irreversibly, selectively
• meal
• H2RA
• omeprazole and lansoprazole
• 1

Question 11

Prokinetic agents

MOA: promotion of GI ___ and increased gastric ___
* 2 available agents: ___ and ___

Answer 11

motility, emptying
* metoclopramine
* erythromycin

Question 12

Prokinetic side effects

Meoclopramide
* ___ AE
* boxed warning: tardive ___ (may be permanent)
Erythromycin
* ___ prologation (can be additive)
* lots of drug interactions
* ___ stenosis

Answer 12

• neurological
• dyskinesia
• QTc
• pyloric

Question 13

Antacids

for older kids
* avoid ___ containing products
* watch for drug interactions (separate 2 hours before, or 4 hours after)

Answer 13

• aluminum

Question 14

4 main triggers for vomiting

Answer 14

• blood borne toxins (medications)
• motion (vestibular)
• mechanical (vagal)
• emotion (fear/anxiety)

Question 15

Normal Stooling Patterns

infants: ___ stools per day
Toddler: ___ stools per day
4+: similar to ___

Answer 15

• 3-4
• 2-3
• adults

Question 16

Hirschsprung’s disease
(aganglionosis)

Answer 16

nerves stop telling you gut to move, causes constipation

Question 17

constipation managment in infants

• First line: getting chipped = ___
• prune juice
• increase fluid intake

AVOID: ___ oil, ___ laxatives, ___ enemas

Answer 17

• glycerin suppository
• mineral oil, stimulant, phosphate

Question 18

Categories of Laxaives

Osmotic/Hyperosmotic - draws ___ into lumen, promotes distention, peristalsis, and ___

Stimulant - local ___ on colon, stimulates ___

Lubricant - eases passage of stool by softening stool and ___ intestines

Surfactant - reduces tension of ___ interface of stool . Enhanced incorporation of water and fat ___ stool

Answer 18

• water, evacuation
• irritant, peristalsis
• lubricating
• oil-water, softens

Question 19

Disimpaction

Oral is preferred
* PEG 3350: ___ g/kg/day for 3-6 consecutive days
* Magnesium citrate ___ mL/kg/day for 2 days

Answer 19

• 1-1.5
• 4

Question 20

Disimaction

Rectal
* normal saline enema ___ mL/kg for 3 consecutive days
* sodium ___ enema
* ___ oil enema

Answer 20

• 10
• phosphate
• mineral

Question 21

T or F: preschool age and older need adult size enemas

Answer 21

True

Question 22

Disimpaction

Nasogastric
* PEG with electrolytes: ___ mL/kg/hr until rectal effluent is clear
* typically takes ___ hours
* can give large volumes without __ or ___ disturbances
* onset: ___

Answer 22

• 25-40
• 24-48
• fluid, eletrolyte
• 1-2 hours

Question 23

Mainrenance

First line agent: ___ 1g/kg/day

Answer 23

PEG 3350

Question 24

maintenance - osmotic agents (3)

Answer 24

• PEG
• Lactulose
• magnesium hydroxide

Question 25

maintenance - stool softener

Answer 25

docusate 5mg/kg/day MAX: 400mg/day

Question 26

T or F: stimulants are ok to use for short term rescue in kiddos

Answer 26

True | avoid routine use

Question 27

Four major categories of diarrhea

Answer 27

1. secretory 2. osmotic 3. excretory 4. altered motility

Question 28

T or F: 60% of children prescribed antibiotics have constipation

Answer 28

False: osmotic diarrhea; gut flora killed off, lactate levels build up

Question 29

T or F: if diarrhea persists after antibiotics are stopped, consider C. diff infection

Answer 29

True

Question 30

T or F: you choose the strength of amox-clav based off the indicatio

Answer 30

True

Question 31

standard dose of amox-clav = ___ mg/kg/day high dose amox-clav = ___ mg/kg/day * use ___ strength if possible (minimizes risk of diarrhea) * keep clav < ___ mg/kg/day | amox componen

Answer 31

* 40-50 * 80-90 * 600 mg-42.9 mg/5mL * 10

Question 32

If a kid has an ear infection of pneumonia, use ___ dose of amox-clav

Answer 32

high 80-90 mg/kg/day

Question 33

# Calculating Fluid Requirements Holliday-Segar Method * Up to 10 kg: ___ mL/kg * 10-20 kg: 1000 mL + ___ mL/kg for every kg greater than 10 * >20 kg: 1500 mL + ___ mL/kg for every kg greater than 20

Answer 33

* 100 * 50 * 20

Question 34

T or F: you can use drugs to treat diarrhea even when the patient has C. diff

Answer 34

FALSE