Peds 2 Flashcards
(116 cards)
1
Q
How is sinusitis diagnosed in kids?
A
with >7 days of copious nasal congestion accompanied by chronic cough
2
Q
Tx regimen for kids with sinusitis
A
Amoxicillin or amoxicillin clavulanate
3
Q
Which abx can be used to tx sinusitis in kids with a true PCN allergy?
A
Cephalosporins can be used as an alternative
4
Q
How to definitively dx strep pharyngitis?
A
a rapid strep test and/or a culture is essential
5
Q
Which kids will have repeated rapid strep tests?
A
10-20% of all children are asymptomatic carriers of GABHS
6
Q
Kids who are asymptomatic carriers of GABHS tx regimen?
A
These children should not be treated repeatedly without clinical evidence their illness is a true strep infection
7
Q
Strep pharyngitis in kids tx
A
Amoxicillin or Penicillin V PO for 10 days
Penicillin G (Bicillin) IM once
Alternatives - Cephalosporins, macrolides, clindamycin
8
Q
Which abx are prefered in kids with PCN allergies for tx of strep pharyngitis?
A
Clindamycin or azithromycin may be prescribed for children with a true type 1 allergy to penicillin
Clinda > azithro d/t rising resistance
9
Q
Clindamycin SE
A
Side effects of clindamycin; can include rash, urticaria, Stevens Johnson syndrome, prolonged QT times, thrombocytopenia, neutropenia, GI side effects (nausea, vomiting, diarrhea), pseudomembranous colitis
10
Q
Penicillin G trade name
A
Bicillin - available IM
11
Q
Common PE findings of mono
A
Posterior cervical adenopathy is common
Splenomegaly occurs in up to 50% of patients
12
Q
Mono tx in kids
A
Supportive care (mainstay of therapy) - Acetaminophen or NSIADs
Steroids - Dexamethasone (Used when there are markedly edematous tonsils and/or when there is impending airway obstruction)
Antivirals - No effect on latent infection or ability to cure the infection
13
Q
What should NOT be prescribed to tx mono?
A
Amoxicillin - causes rash
14
Q
Common complication of HSV in kids
A
Dehydration is the most common complication
15
Q
How long do HSV lesions last?
A
10-14 days
16
Q
HSV tx regimen in kids
A
Supportive care
Fluids
Pain control - Acetaminophen or ibuprofen
Prevention of lip adhesions - Barrier cream with petroleum jelly
Acyclovir
17
Q
What is the time limitation to tx HSV with antivirals?
A
Acyclovir can be used within 96 hours of disease onset
18
Q
What causes thrush?
A
Candida albicans
19
Q
Why are infants susceptible to thrush?
A
Usually infects infants, primarily due to the relative immaturity of the infant’s immune system
20
Q
Which meds are used to tx thrush in kids? What modes do they come in?
A
Nystatin - lozenge or suspension (preferred)
Fluconazole - lozenge or suspension
21
Q
Nystatin use directions in an infant?
A
- Feed the baby its normal bottle (if breastfeeding, avoid feeding 5-10 minutes prior to, and after, administration)
- Wipe the plaques out of the baby’s mouth with a moist rag.
- Administer the nystatin
22
Q
When nystatin fails to cure thrush, what is the alternative?
A
Fluconazole
23
Q
Fluconazole MOA
A
Fluconazole works by interfering with the fungal cell membranes by decreasing their ergosterol synthesis
24
Q
Fluconazole SE
A
Headaches, dizziness, skin rash, nausea, abdominal pain, diarrhea, vomiting, hepatitis, increase in liver enzymes
25
What does sodium benzoate cause in infants?
Gasping syndrome - potentially fatal toxicity of sodium benzoate involving metabolic acidosis, respiratory distress, gasping respirations, CNS convulsions, CNS hemorrhage, hypotension, and cardiovascular collapse.
26
Which meds can contain sodium benzoate?
Oral suspensions such as fluconazole
27
What must a clinician determine when faced with a kid with resp. distress?
first determine whether it is a process affecting the upper or lower airways
28
Asthma tx goals
- Prevent symptoms
- Minimize morbidity when an attack occurs
- Allow a child to live as close to a “normal” lifestyle as possible
29
Occasional asthma attacks can be treated with?
SABA
30
When should asthma tx be stepped up?
If it becomes necessary to use SABA agents >2 days/week, therapy should be stepped up to include inhaled corticosteroids
31
When can asthma tx be stepped down?
Several months of no attacks
32
What med is considered the cornerstone of long term management of asthma in kids?
ICS
33
What devices are available to deliver ICS tx?
A nebulizer machine
A dry powder inhaler (DPI)
A pressurized metered dose inhaler (pMDI)
A breath-actuated metered dose inhaler (pMDI)
34
For kids < 6 yrs, what is the most appropriate tx combination for a child with asthma?
a metered dose inhaler with a mask/spacer
35
For kids > 6 yrs, what devices can be used in asthma tx?
Children >6 years old can use a pMDI, a breath-actuated pMDI, or a DPI
36
What is an important counseling point for asthma tx?
children must be reminded to rinse their mouths after use to avoid tooth erosion and thrush (especially ICS)
37
What is the mode of tx for bronchiolitis?
Very few medications to treat bronchiolitis with the exception of administering oxygen
38
In what cases would steroids be used to tx bronchiolitis?
Not usually used, except in those pts with underlying asthma
39
In addition to O2, what other mode of tx can be trialed to tx bronchiolitis?
SABA
40
What supportive tx can be used to tx bronchiolitis?
Frequent nasal suctioning
41
What can be trialed as a mode of tx for bronchiolitis that requires hospitalization?
a trial of racemic epinephrine
42
MCC of croup?
Parainfluenza virus type 1
43
Mild croup tx
Most cases improve within 24 hrs with no tx
44
Mild to moderate croup tx
Decadron 1 dose PO with close f/u
45
Severe croup tx
Decadron and racemic epi with observation
46
How does racemic epi work?
Acts on α- and β-adrenergic receptors - Resulting in both relaxation of smooth muscles in the bronchial tree as well as a decrease in local airway edema with resultant decrease in the work of breathing
47
What does racemic epi contain?
Contains both L-epinephrine and D-epinephrine in a 1:1 ratio
48
Racemic Epi SE
Cardiac effects (arrhythmias, myocardial ischemia, hypertension)
49
Common sxs of influenza in younger kids
higher fevers (which can lead to febrile seizures) and GI symptoms of nausea, vomiting, and anorexia
50
MC complication of influenza in kids
most common complication of influenza is otitis media
51
Meds used for influenza in kids
Oseltamivir
Zanamivir
52
How do antivirals work against influenza?
competitively inhibiting the neuraminidase on the surface of both influenza A and B viruses
53
When given as influenza tx, how much do antivirals shorten the disease by?
1 day
54
Oseltamivir SE in kids
hallucinations, confusion, delirium, and self-injury with fatalities, HA, vomiting, nausea
55
Zanamivir SE in kids
anaphylaxis, allergic reactions, edema, rashes, and neuropsychiatric events (hallucinations, confusion, delirium, and self-injury)
56
Which pts should avoid zanamivir powder use?
Don’t use in those with underlying respiratory disorders (asthma)
57
Uncomplicated CAP in < 5 yrs tx
1st line: Amoxicillin
2nd line: Azithromycin or 3rd gen cephalosporin (Cefdinir or Ceftriaxone IV)
58
School aged kid CAP tx
Macrolides (azithromycin) - to cover for unusual pathogens
59
Hospitalized kids for PNA tx
IV 3rd gen cephalosporin (Ceftriaxone) with IV macrolide (azythromycin)
60
Kids with severe PNA/ resp. distress/ sepsis
Vacno + 2nd or 3rd gen cephalosporin (Ceftriaxone) if MRSA is suspected
61
How are functional disorders of the GI tract diagnosed in kids?
Inflammation of the GI tract is usually diagnosed by its symptoms
62
Tx of vomiting with antiemetics should be reserved for?
the child <2 years old, the child with gastroenteritis, or the child with dehydration
63
Antiemetics used in kids
Promethazine, prochlorperazine and ondansetron
64
How should promethazine be dosed in kids?
Clinicians should start with half the recommended adult dose
65
Promethazine SE
side effects such as sedation, respiratory depression, dystonic reactions, or ataxia
66
Which antiemetics are not recommended in kids less than 2 yrs?
Promethazine and prochlorperazine
67
If a kid has severe diarrhea, what are the interventions?
patients will likely need fluid and electrolyte therapy as well as other non-specific support +/- abx
68
When should diarrhea be worked up in neonates/ young infants?
Accompanied by high fever and or blood in the stools
Causes dehydration and/or weight loss
Altered mental status
Lasts >2 weeks
69
Toddler's diarrhea
form of chronic diarrhea affecting children between 1-3 years old
70
Toddler's diarrhea sxs
Loose, non-bloody stools of 2+/day without fever or pain
71
Toddler's diarrhea possible cause
Consumption of fruit juices
72
Toddler's diarrhea tx
removing any offending agents, decreasing or changing fruit juice consumption, using psyllium bulking agents.
73
MC esophageal disorder in kids
GERD
74
When does infant reflux peak?
Infant reflux peaks ~4 months of age
75
When is reflux considered pathologic in kids?
Have episodes that are more frequent or persistent
Produce esophagitis, esophageal symptoms, or go on to produce respiratory sequelae.
76
GERD kids tx
Stepwise
- mild to moderate reflux, dietary and feeding techniques are usually adequate to help the child
- if they fail, H2 blockers (famotidine) are used
- in severe cases, PPIs are used
77
PPI time limit for use in kids
proton pump inhibitors should not be used >4-12 weeks at a time, depending on which is used
78
When started on a PPI, peds pts should be weaned off of what?
the patient should be weaned off the histamine-2 receptor antagonist over ~2-week period
79
PPIs used in kids
all the "azoles"
80
What causes pin worms?
Enterobius vermicularis
81
Pinworm tx
one mebendazole 100-mg tablet by mouth, then repeated in 2 weeks
82
If a kid cannot take mebendazole pill to tx pinworms, what can be done?
the tablet can be crushed and put it in applesauce or peanut butter
83
Pinworm tx importance?
Important to treat the other children at home
84
Flatulence recommendations for infants
Make sure that the infant is not swallowing too much air when feeding
Burp frequently and position the infant in the prone position while awake
85
Flatulence tx in infants?
Simethicone
86
When tx peds pain, what is the general rule of thumb?
It is best to underdose and work up than to start at too high a dose and cause side effects.
87
Which drugs can be used to tx pain in kids?
The majority of pain can be treated with either acetaminophen or ibuprofen
88
Which pain med should never be given to kids?
Aspirin should never be given to children <19 years old because it may induce Reye’s syndrome
89
How can ASA be listed in combination products?
acetylsalicylate, acetylsalicylic acid, salicylic acid, or salicylate
90
Acetaminophen and ibuprofen come in these forms for kids
oral drops, oral liquids of different flavors, and chewable tablets for infants, toddlers, and children who can’t swallow a tablet or capsule
91
Which pain med is preferred to tx kids pain OVERNIGHT?
Ibuprofen may be the drug of choice for night pain
92
When is ibuprofen contraindicated?
history of GI distress, dehydration, and hepatic or renal insufficiency.
93
Which conditions are opioids reserved for in kids?
ulcers from herpetic gingival stomatitis, post-fracture management, after removal of a toe nail, significant coughs, chronic conditions such as sickle cell disease, etc..
94
ADHD sxs
hyperactivity, impulsivity, and/or inattention, easy distractibility, unable to pay attention and follow directions, and/or has poor self-control
95
ADHD subtypes
Inattentive only
Hyperactive/impulsive ADHD
Combined inattentive/hyperactive/impulsive (most common)
96
What is the tx approach for ADHD?
Psychotropic medication
Behavior modification
Family education and counseling
Educational intervention
97
ADHD meds
Methylphenidate (Ritalin, Methylin, Metadate, Daytrana, Concerta)
Dexmethylphenidate HCL (Focalin)
Amphetamine and/or dextroamphetamine (Dextrostat, Dexedrine, Adderall)
Atomoxetine (Strattera)
Lisdexamfetamine dimesylate (Vyvanse)
98
Methylphenidate MOA
Mild CNS stimulant that blocks the re-uptake of norepinephrine and dopamine
99
Methylphenidate SE
decreased appetite, insomnia, increased anxiety and/or irritability, and mild stomachaches or headaches
100
When methylphenidate is being weaned off, what commonly occurs?
Rebound agitation or exaggeration of premedication symptoms may be seen as the medication is wearing off
101
How can you tx insomnia associated with methylphenidate?
Insomnia can be helped by taking the medication earlier in the day or by adding an antidepressant
102
When starting ADHD tx, what are the first steps?
- Start with methylphenidate (Ritalin, Concerta, Daytrana), an amphetamine, and/or a dextroamphetamine combination; preferably long-acting duration
- Begin by prescribing a low dose and every 1-2 weeks, over a 4-week period, gradually increase the dose if tolerated and if side effects are minimal
103
What happens when a kid has reached the max dose of an ADHD med and is still exhibiting sxs?
an alternate class of stimulant should be chose
104
If a 2nd stimulant does not help ADHD, what is the next step?
Consider guanfacine or tricyclic antidepressants, bupropion, and atomoxetine
105
How often should ADHD pts f/u?
3-6 months
106
Iron deficiency anemia tx in kids
The dose for children is 3-6 mg of elemental Fe/kg/day
Divided into 3 or 4 doses/day
107
Iron SE
Iron may cause constipation, dark stools, nausea, epigastric pain (liquid preparation may stain teeth)
108
When taking iron, what can be done to increase its bioavailability?
replacement iron may be administered with a vitamin C–fortified fruit juice 30 minutes before a meal
109
What is the goal for kids HA/ migraine care?
Goal: eliminate the headache within 1-2 hours of presentation
110
If a child has frequent HAs, what should be done?
- a preventative medication plan may need to be started
- clinician needs to re-evaluate the patient every 6 months to consider weaning or tapering the drug owing to the high rate of remission of migraines in children
111
Which meds are used in peds HAs?
sumatriptan
zolmitriptan
rizatriptan
112
Algorithm for HA tx with triptans in kids
Start with a dose where the intent is to abort the headache within 2 hours.
If the headache has not aborted after 2 hours, then repeat, but use double the same dose as the first in the hope that the patient may be symptom free in 4 hours
113
Which meds can be used as rescue meds alongside of triptans?
acetaminophen, ibuprofen, or an opioid (in rare cases)
114
When to consider prophylactic HA meds in kids?
- When children and adolescents do not respond to acute management of migraine headaches and/or are having frequent headaches
- When missing excessive amounts of school due to headaches
- When presenting with debilitating headaches
115
What are some prophylactic HA meds for kids?
anticonvulsants, antidepressants, antihistamines, beta-blockers, calcium channel blockers, NSAIDs
116
How long should HA prophylaxis be used for in kids?
Once a preventative medication has been started, the typical treatment period is from 3-18 months (average 6 months)
