NAPLEX: Pediatric conditions

neonate is classified as

0-28 days

infant is:

1 month-12 months

toddler is:

1-2 years

a child is:

2-12 years

Adolescent is:

13-18 years

Seek urgent care with a child <3 months when

a temp. of 100.4F/38C (rectal)

seek urgent care w/ age 3-6 months when

temp 101F/38.3C (rectal)

seek urgent care >6 months when

temp. 103F/39.4C (rectal)

Seek urgen care for a child any age when:

cough/cold worsening not improving for several days

unusual persistent pain not going away several hours

blood in urine or stool

inability to sleep or drink

rash that looks severe or any rash with fever

abrasions/cuts dirty or deep (requiring sutures)

limping/unable to move extremity

seizure

T/F: A household spoon can be used to measure medication

False: Never, oral syringes preferred, dosing cups can be used too

A newborn's general condition is assessed with an_____

A lower score indicates

apgar score

lower score requires more medical care.

newborns:

apgar score of <7 means

medical distress, immediate medical intervention needed (eg, resuscitation)

Standard meds given at birth include

vitamin K to reduce bleed

erythromycin opthalmic to prevent conjunctivitis

hepatitis B vaccine

light therapy for jaundice if needed

low apgar scores in pre-term infants are usually due to:

immature lung and heart development

Drugs that can be used to cause the ductus arteriosus to close

NSAIDS like indomethacin or ibuprofen

work by blocking PGs that keep PDA open

preterm baby conditions + treatment

patent ductus arteriosus (PDA) - NSAIDs to close

persistent pulmonary htn of newborn - supp care, inhaled NO

resp distress syndrome - surfactant (curosurf, infasurf)

NSAIDs are avoided in the third trimester of pregnancy because they can

cause the PDA to close prematurely

NSAIDS for closing the PDA must be administered within ____ of birth

14 days

Persistent Pulmonary Hypertension of the Newborn (PPHN) may be linked to

in utero SSRI exposure

Respiratory distress syndrome is caused by

a deficiency of surfactant production in lungs (not fully developed)

Most babies born <35 weeks gestation will receive _____ immediately after birth or within first few days of life due to under-developed lungs

surfactant

Surfactant names can be recognized with

Surf or -actant in the name

Aspirin and salicylate-containing products (bismuth subsalicylate) cannot be used in patients <_____ years old including infants due to

<16

Reye's syndrome

acetaminophen dosing for infants

10-15 mg/kg/dose every 4-6 hours

max 75mg/kg/day

T/F: An infant can safely take pepto bismol since they don't appear to be sick

False. don't recommend salicylates for patients <16, it may not be apparent they are recovering from a viral illness and its use is associated with Reye's syndrome

T/F: Acetaminophen infant drops and children's suspension are the same concetration

true - to help reduce dosing errors

ibuprofen drops and suspension are supplie din different dose strengths for infants and children!!!

Age to avoid ibuprofen: <___

due to risk of _____

<6 months

risk of nephrotoxicity

ibuprofen dosing for infants

5-10 mg/kg/dose every 6-8 hours

Medication for infants experiencing intestinal gas

simethicone drops

non-pharm suggestions for nasal congestion

cool-mist humidifier near bedside can help reduce, esp. in winter

sit in the bathroom while a hot shower creates steam (avoid burning skin)

gently suction with saline drops/spray to loosen mucus

T/F: Most OTC cough and cold medications are available for children <2 years old

False: THE FDA DOES NOT RECOMMEND OTC COUGH AND COLD MEDS TO CHILDREN <2 years old

Treatment of intermittent constipation in children

Miralax (polyethylene glycol 3350) - takes a while

prunes

glycerin suppositories (pediatric size, OTC) for quick relief)

if ongoing, see a pediatrician

miralax should not be used in infants <_____ old

____ can be used instead

<6 months old

glycerin

Oral rehydration solutions for diarrhea

pedialyte and enfamil enfalyte

Antidiarrheal medication _____ is not recommended, risk of reye's syndrome

bismuth subsalicylate

loperamide is not recommended for OTC use in children

Acetaminophen (children's tylenol/infant's fever reducer) dosing (and max/day)

10-15 mg/kg dose every 4-6 hours

(max 75 mg/kg/day

ibuprofen (infants' advil/motrin, children's suspension) dosing, max, and age indication

5-10 mg/kg/dose every 6-8H

(max 40mg/kg/day)

6 months+ indication

concentration of children's tylenol

160mg/5mL

ibuprofen for infants has a caution for

nausea

simethicone for infants should be administered

after meals and at bed time

can be mixed w/ water, formula, liquids and shaken prior

How should parents be instructed to alternate tylenol and ibuprofen

keep at least 3 hours between any doses, and at least 6 hours between doses of same medication

ibuprofen can be given before bed to help with sleep (lasts longer)

constipation:

<6 mos

>/= 6 mos

age >/= 2

>/= 6 yrs

<6mos: glycerin supps

>/=6mos: miralax or glycerin (quick relief only)

>/=2yrs: above + mag hydroxide, docusate, senna, rectal enemas

>/= 6 yrs: above + bisacodyl supps and mineral oil

constipation:

when should rectal enemas (eg. sodium phosphate, fleet, pedia-lax) NOT be used in children? why?

<2 yrs old

severe dehydration, electrolyte abnormalities

A diagnosis of bacterial meninigitis is made based on

lumbar puncture

(nuchal rigidity may be present in some cases but cannot make the final dx)

Empiric treatment in neonates with a fever is:

ampicillin PLUS

either ceftazidime, cefepime, or gentamicin

T/F: Ceftriaxone is a good alternative to patients who cannot tolerate ampicillin in their empiric meningitis regimen

False: it's avoided in neonates since it displaces bilirubin from albumin, causing brain damage (kernicterus), and can precipitate w/ Ca-containing solutions

Antibiotic avoided in neonates due to kernicterus and forming precipitates with solutions containing _____

Ceftriaxone

precipitates with solutions containing Calcium

Once a patient is no longer a neonate, then bacterial menigitis regimen switches from ________ to _____

ampicillin + cefotaxime or aminoglycoside (gent)

to

vancomycin plus either ceftriaxone or cefotaxime

bacterial meningitis treatment by age group

<1 month (neonatal)

1-23 mos

2+ yrs

amp + cefotaxime or aminoglycoside

vanc + 3rd gen ceph (ceftriaxone or cefotaxime)

vanc + 3 gen ceph (ceftriaxone or cefotaxime)

RSV can be deadly in:

premature babies and neonates

RSV is a common cause of

bronchiolitis (swelling and mucus build up in bronchioles

treatment for RSV is

primarily supportive

if severe: inhaled ribavirin

rsv prophylaxis is recommended:

pregnant patients 32 to 36 weeks gestation to protect Infants < 6 mos

If mother was not vaccinated, RSV prophylaxis is recommended during RSV season

what is available For RSV prophylaxis?

Nirsevimab (beyfortus)

pavlizumab (synagis)

whe is nirsevimab (beyfortus indicated)?

pavlizumab( synagis)?

bey:

Virazole is used for

severe RSV (inhaled ribavirin)

Pavlizumab is used for:

1st year of life:

preterm infants, esp if chronic lung dx

2nd year: preterm with cld

Synagis is dosed _____ and given ____ at the _____

monthly and given IM at the anterolateral thigh muscle

Patients should not receive more than ______ doses of palivizumab during the RSV season

5 monthly doses

T/F: If the baby becomes infected with RSV, give double doses of palivizumab

False: If a baby becomes infected, do not give ANY MORE doses of palivizumab

nirsevimab (beyfortus) is used for RSv prophylaxis. how is it given?

SINGLE im dose given in anterolateral thigh muscle

Croup is usually due to a________

viral infection

Croup affects the

upper airway (laryns, trachea, bronchi

Hallmark signs of croup

inspiratory stridor (high pitched breathing sound), barking cough, hoarseness

croup is most common in:

children <6

Mainstay of croup treatment

Systemic steroids (dexamethasone) +/- racemic epinephrine (if severe)

which isomer of epinephrine is the active isomer

L-isomer (levo)

What to use if racemic epinephrine is not available

L-epinephrine is used (use half the dose)

how are steroids (which one) dosed in croup?

SINGLE dose dexamethasone

0.6mg/kg PO/iv/im

nebulized Epinephrine is a (agonist/antagonist)

adrenergic agonist

Epinephrine MOA

relaxes bronchial smooth muscle, causes bronchodilation

racemic epinephrine dose and diluted in what

0.05-0.1 ml/kg max 0.5 ml (usually just give this) in NS

Term for "bed-wetting"

nocturnal enuresis

what age is bed wetting treated?

>5 years old

non-drug treatment for nocturnal enuresis

positive reinforcement

establishing daytime voiding patter/normal hydration pattern

alarm therapy

T/F: Bladder training exercises can improve nocturnal enuresis

false: These are not recommended. Embarassment should also be minimized

Next steps if behavioral methods are unsuccessful after 3 months

alarm therapy

alarm therapy with desmopressin

Only preferred medication for enuresis

desmopressin tablet

desmopressin drug class

synthetic analog of ADH (decreases nocturnal urine production)

T/F: Desmopressin nasal spray and injections can be used for enuresis

false: These are more commonly used for diabetes insipidus and hemophilia A

Contraindications to desmopressin

hyponatremia

boxed warning to desmopressin

severe, life-threatening hyponatremia can develop

side effects of desmopressin

headache

Codeine is metabolized to morphine by:

CYP2D6

Codeine is contraindicated in:

all patients <12

patients <18 after tonsillectomy adenoidectomy

Prescription cough and cold meds with codeine or hydrocodone are no longer indicated in patients

<18

promethazine is contraindicated in

children <2

promethazine is limited in use to young children due to

potentially fatal respiratory depression

in addition to ceftriaxone, these antibiotics are not recommended in pediatric patients, but due to adverse effects on cartilage, bone, and muscle

quinolones

tetracyclines are not recommended in

children <8

tetracyclines have limited use in children because they:

can stain teeth, and deposit into bone and cartilajge

exception to limiting tetracyclines for patients 8+

tick-borne rickettsial diseases- doxycycline is the most effective and benefits may outweight cons

FDA recommends against the use of ________ in patients <______ for help with teething

benzocaine <2 years old

Benzocaine-containing teething products carry a risk of

methemoglobinemia

tramadol is contraindicated

in age <12

ceftriaxone is contraindicated in

neonates (1-28 days)

A patient is 3 years old and has a cough. Are there any safe cough/cold medications they can be recommended?

yes. OTC cough and cold preparations in age <2 are recommended against though, but this patient is three. there are likely some recommendations safe for use.

Common culprits of accidental overdose in children

iron, acetaminophen

(sulfonylureas can also be very fatal)

CI in pediatrics + ages