peds deck 7

Question 1

pharmacokinetic considerations of midazolam

Answer 1

1. crosses BBB 2. absorbed in the GI 3. metabolized by CYP450

Question 2

midazolam acts on what receptors

Answer 2

its a GABA agonist

Question 3

what pediatric populations would you consider giving midazolam

Answer 3

1. preop for separation anxiety

Question 4

T/F: it is common to give midazolam to neonates

Answer 4

FALSE

Question 5

what receptors do propofol work on

Answer 5

NMDA and GABA (but primarily GABA)

Question 6

dose of propofol in peds for induction

Answer 6

2-5 mg/kg

Question 7

infusion rate of propofol

Answer 7

100-300 mcg/kg/min

Question 8

s/e of propofol

Answer 8

1. decreases CMRO2, CBF, and ICP 2. decrease SBP 3. HR - unchanged or inc or dec 4. dose dep respiratory depression

Question 9

why do we like propofol in peds

Answer 9

1. quick on and off 2. easily accessible 3. low s/e profile 4. antiemetic and anticonvulsant properties

Question 10

what pediatric pts in propofol c/i in?

Answer 10

1. mitochondrial d/o 2. central hyopventilation d/o

Question 11

MAC of isoflurane in children

Answer 11

1.2

Question 12

MAC of sevoflurane in children

Answer 12

2.2

Question 13

MAC of desflurane in children

Answer 13

6.8

Question 14

neurologic s/e of INH anesthetics

Answer 14

1. decreased CMRO2 2. increased CBF 3. increased ICP

Question 15

CV s/e of INH anesthetics

Answer 15

1. dose dep dec in BP 2. HR - desflurane will increase; sevoflurane can decrease

Question 16

respiratory effects of INH anesthetics

Answer 16

1. increases RR 2. Tv decrease 3. DD decrease in airway resistance

Question 17

what is the most commonly used inhalational agent in peds

Answer 17

sevoflurane

Question 18

T/F: there is no advantage to one INH agent over another in regards to inducing neuroapoptosis

Answer 18

TRUE

Question 19

_____________ does not cause neuroapoptosis, but does when it is used in conjunction with other volatiles

Answer 19

N2O

Question 20

the highest degree of neurapoptosis was found when INH agents were used with _____________, ___________, or _____________

Answer 20

ketamine; midazolam; N2O

Question 21

what meds/interventions have been found to be protective from neuroapoptosis

Answer 21

1. lithium 2. hypothermia 3. methazolamide 4. melatonin 5. xenon 6. precedex

Question 22

in peds (/= ______________ anesthetics

Answer 22

3

Question 23

T/F: pediatric pts under the age of 3 are at no greater risk of learning disability 2/2 neuroapoptosis with routine anesthetic

Answer 23

TRUE

Question 24

T/F: elective surgery is not recommended in neonates and infants

Answer 24

true - puts at risk for neuroapoptosis and learning disability later in life.

Question 25

T/F: referred pain is not as common in pediatrics as is it is with adults

Answer 25

TRUE

Question 26

challenges with identifying pain in the pediatric pt

Answer 26

1. unable to clearly identify whats going on with neonates and infants (crying but do not know why) 2. toddlers: cannot always make coherent response/response you can respond to 3. difficult to differentiate btwn pain, anxiety, and fear 4. poor coping skills/inabililty to have rational conversations 5. social background - may not speak to you due to their troubled background

Question 27

T/F: the vast majority of medications used in pediatric anesthesia are FDA approved

Answer 27

false; they are used off label/not FDA approved

Question 28

MOA of acetaminophen, ibuprofen, tordol

Answer 28

nonselective COX inhibitor --> inhibition of prostaglandins

Question 29

optimal cases for using tylenol in peds

Answer 29

1. neonates 2. opioid wary (like with pyloric stenosis) 3. febrile (appendicitis) 4. with or without IV

Question 30

concerns with tylenol in pediatrics

Answer 30

1. IV should be given over 15 min 2. hepatotoxicity (due to inadvertent OD) 3. skin reaction warning

Question 31

FDA 2014 recommendation on tylenol in peds?

Answer 31

1. limitation of combination narcotics (those that have tylenol in them) 2. limit tylenol to < 4 g per day 3. education to parents on tylenol and what it can be found in

Question 32

ibuprofen in NOT recommended in those < ____________ (age)

Answer 32

6 months

Question 33

what cases would ibuprofen be a good adjunct

Answer 33

1. mild to moderate pain 2. use in conjuction with opioids 3. IV or no IV

Question 34

concerns with Ibuprofen in pediatrics

Answer 34

1. can cause ASA induced asthma attack 2. risk for GI bleed/increased bleeing 3. hepatic disease

Question 35

________________ is a pain adjunct that is NOT recommended to be used in infants

Answer 35

ketorolac

Question 36

IV dose of ketorolac in peds

Answer 36

0.5 mg/kg; max = 30 mg

Question 37

concerns with ketorolac in pediatrics

Answer 37

1. NSAID allergies 2. causes bronchoconstriction (avoid with asthma) 3. PUD 4. renal failure

Question 38

what meds have the highest cross sensitivity with asprin; therefore, should be avoided in children with asthma

Answer 38

1. ibuprofen 2. naproxen 3. diclofenac

Question 39

NSAID induced airway hyperreactivity occurs in about ______% of adults and _____% of peds

Answer 39

20; 5

Question 40

what is samter's triad

Answer 40

1. asthma 2. nasal polyps 3. asprin/NSAID sensitivity if pt has 2 out of these 3 --> avoid ASA, ibuprofen, naproxen, and ketorolac d/t risk of NSAID induced airway hyperreactivity

Question 41

neonate/infant/school aged child dose of ketamine - IV and gtt

Answer 41

IV = 1-2 mg/kg gtt = 20-75 mcg/kg/min

Question 42

MOA of ketamine

Answer 42

noncompetitive NMDA receptor antagonist

Question 43

ketamine causes dissocation btwn the ____________ & ___________ systems

Answer 43

thalamoneocortical; limbic

Question 44

what cases would ketamine be a good pain adjunct?

Answer 44

1. cardiac pts (esp unrepaired or where SVR increase is desirable) 2. part of TIVA 3. neuromonitoring 4. Burn pts (2/2 opioid tolerance) 5. cases where you want spontaneous resp 6. chronic pain pts

Question 45

concerns with ketamine in peds

Answer 45

1. increases ICP 2. can increase BP (or decrease if catechol depleted) 3. increases secretions 4. can cause emergence reactions 5. 3+ exposures <3 years of age increase risk of neuroapoptosis

Question 46

function of mu-1 receptor

Answer 46

1. analgesia 2. miosis 3. urinary retention 4. N/V 5. pruritis

Question 47

fx of mu-2 receptor

Answer 47

1. sedation 2. respiratory depression 3. decreased GI motility

Question 48

fx of kappa receptor

Answer 48

1. analgesia 2. sedation 3. dec GI motility

Question 49

fx of delta opioid receptor

Answer 49

1. analgesia 2. emotional behavior

Question 50

stimulation of the sigma opioid receptor causes ________________

Answer 50

dysphoria