Pediatric Pharmacology Flashcards
(52 cards)
How does protein binding compare between
pediatric and adult patients?
Protein binding is decreased in preterm and term infants, but is
similar between children and adults.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 84.
How does the volume of distribution for water-soluble
drugs compare between pediatric and adult patients?
Infants (both preterm and term) have a higher proportion of
water compared to their body mass. As a result, the volume of
distribution for water-soluble drugs is greater. Because of this,
they often require a higher loading dose of water-soluble drugs
such as digoxin, succinylcholine, and some antibiotics.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 85.
How does the responsiveness to dopamine compare
between term neonates and adult patients?
Term neonates exhibit decreased cardiovascular
responsiveness to many drugs. The dose required to increase
blood pressure and urine output in neonates may be as high as
50 mcg/kg/min. This dose would produce such severe
vasoconstriction in adults that it could cause injury to the patient.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 85.
How does the proportion of body fat and muscle
mass compare between pediatric patients and
adults?
Children and adolescents have fat and muscle masses
comparable to that of adults, but term and preterm neonates
have a decreased proportion of both.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 85.
How does the metabolism of morphine differ in
neonates compared to children and adults. Why?
Term and preterm infants cannot metabolize morphine as
effectively as children and adults. Neonates have a limited
ability to perform glucuronidation. Because morphine
undergoes glucuronidation, the active form of the drug will be
present in the circulatory system for a longer period of time.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 88-89.
Renal excretion of drugs is less effective in neonates
than in older children and adults. Why is this?
Neonates have incomplete glomerular development, a low
perfusion pressure, and an inadequate osmotic concentration to
exert a normal countercurrent effect.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 90.
What is the appropriate dose for oral ketamine in
pediatric patients?
5-6 mg/kg is the appropriate dose for orally administered
ketamine in patients from 1 to 6 years of age.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1225.
What is the caution regarding the use of intranasal
ketamine?
Ketamine has been shown to enter the central nervous system
directly when given via the intranasal route because it can track
along neurovascular tissues in the nasal mucosa. The
preservative in ketamine is neurotoxic and the possibility of
CNS toxicity exists with the administration of intranasal
ketamine.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 118.
How does premedication of pediatric patients with
ketamine affect the incidence of emergence delirium?
Premedication with ketamine has been shown to reduce the
incidence of emergence delirium in pediatric patients.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 118.
How does the bioavailability of intramuscular
ketamine compare between adults and pediatric
patients?
The bioavailability of ketamine is high in adults (93%), but is
even higher in children.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 117.
What is the IM induction dose of ketamine?
5-10 mg/kg
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 118.
What is the IV induction dose of ketamine?
1-3 mg/kg
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 118.
What drugs and foods can interfere with the
metabolism of midazolam?
Drugs that interfere with the cytochrome pathway that
metabolizes midazolam (CYP 4503A 4) include grapefruit juice,
erythromycin, calcium channel blockers, and protease
inhibitors. The concomitant administration of these agents can
potentially prolong the elimination half-life of midazolam.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 142.
Is midazolam effective as an induction agent for
pediatric patients?
No. Studies have demonstrated that doses as high as 1 mg/kg
IV do not reliably produce unconsciousness in pediatric patients.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 142.
You administer an intramuscular dose of midazolam
to a pediatric patient without an IV who cannot
cooperate to take PO midazolam. How long should
you wait before considering a supplemental dose?
The onset time of IM midazolam is 3-5 minutes and the time to
peak effect is 10-20 minutes. You should wait at least 20
minutes before considering giving a supplemental dose of
midazolam.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 142.
You administer midazolam rapidly via the IV route to
a pediatric patient. The patient begins to exhibit
seizure-like activity. What do you ascertain is the
likely cause of this?
Rapid IV or nasal administration of midazolam can produce
myoclonus that may have the appearance of seizure-like activity.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 141.
What factors can prolong the half-life of midazolam
in pediatric patients?
The elimination half-life of midazolam can be prolonged in
hypovolemia and in those receiving vasopressors. It is also
prolonged by any conditions that reduce hepatic blood flow
(such as cardiac surgery using bypass).
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 141.
By what routes may midazolam be administered in
pediatric patients? Which is least recommended?
Midazolam can be administered oraly, rectally, nasally,
intravenously, or intramuscularly. The IM route is not
recommended because of pain and the risk of a sterile abscess.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1230
How does the use of preoperative ketamine affect
the incidence of postoperative nausea and vomiting
in the pediatric patient?
The use of ketamine increases the incidence of postoperative
nausea and vomiting in pediatric patients.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1225.
What food allergies should be explored further in a
pediatric patient prior to the administration of
Diprivan? Why?
Soybeans and eggs, because Diprivan is formulated with 1%
propofol, 10% soybean oil, and 1.25% egg yolk phosphatide,
glycerol, EDTA, and sodium hydroxide.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 114.
What is the appropriate intravenous dose of
flumazenil in pediatric patients?
10 mcg/kg. The rectal dose is 50 mcg/kg.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 148.
A pediatric patient is exhibiting oversedation from
midazolam. How can you reverse the effects of this
drug in this patient?
Flumazenil can be used to antagonize benzodiazepines in
pediatric patients. It should be noted that the short half-life of
flumazenil has been associated with re-sedation in children
ages one to five. Larger doses of flumazenil have been
associated with seizures in pediatric patients.
Cote CJ, Lerman J, & Anderson BJ. A Practice of Anesthesia
for Infants and Children. 5th Ed. Philadelphia: Elsevier
Saunders; 2013: 148.
You have administered 10 mg of midazolam PO to a
pediatric patient who weighs 44 lbs. Thirty minutes
later, the patient appears completely unaffected by
the drug. Was the first dose appropriate? If not,
how should you proceed?
The normal dose for PO midazolam in pediatric patients is 0.5
mg/kg. 10 mg is an appropriate dose for this patient. About
14% of all pediatric patients will not respond to this dose and a
higher total dose of 0.75 mg/kg may be required.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1240.
What is the dose for intranasal midazolam in
pediatric patients?
0.2-0.3 mg/kg
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1230.
