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Peds

P3 Pediatric- Therapeutics

QuestionAnswer
Vital signs: Heart rate age dependent, decreases with age
Vital signs: respiratory rate age dependent, decreases with age
Vital signs: blood pressure age, sex and height dependent, increases with age
pediatric temperatures Normal = 37°C (98.6°F) Low-grade fever = 37.8°C – 39°C (100°F – 102°F) High fever = ≥ 40°C (≥ 104°F)
Erythromycin in neonates <2 weeks pyloric stenosis
fluoroquinolones in children risk of cartilage toxicity
chloramphenicol in neonates grey baby syndrome (cyanosis)
ceftriaxone in neonates bliary sludging/kernicerterus
sulfonamides in infants <2 months kernicterus/BMS
tetracyclines in children <8 years dental staining
ASA in children <18 years reye's syndrome
CF signs in neonate meconium ileus, prolonged obstructive juandice
CF signs in infants/children RTI, GI complaints, failure to thrive
diagnosis for CF sweat test >60 mEq/L
Most common CF pathogens S aureus, H influenza, P aeruginosa
Less common CF pathogens Stenotrophomonas maltophilia, Burkholderia cepacia
mechanism of Ivacaftor (Kalydeco) CFTR potentiator
what form of CF is Ivacaftor used for G551D
dosage of Ivacaftor 150 mg BID with fatty food, decrease dose for hepatic dysfunction and co-treatment with CYP3A inhibitors
what MVI supplement is used in CF ADEK
how is ADEK dosed <12 months: 1 ml po QD 1-3 yr: 2 ml po QD 4-10: 1 tab po QD >10 2 tab po QD
When is zinc supplement given in CF for poor weight gain
dosage of pancreatic enzymes in CF infants: 2000-4000 u/120 ml formula <4: 1000 u/kg with meals and 1/2 with snacks >4: 400-500 u/kg with meals and 1/2 with snacks
mechanism of dornase alfa topical mucolytic agent
dosage of dornase alfa 2.5 mg NMT qd to BID
Ibuprofen dosage in CF 20-30 mg/kg BID, adjusted to levels of 50-100 ug/ml
Azithromycin maintenance dose in CF <40 kg: 250 mg po M-W-F >40 kg: 500 mg po M-W-F
prophylatic inhaled abx in CF TOBI (300 mg NMT BID, 28 on/28 off) Aztreonam (75 mg inh tid, 28 on/28 off) Colistin (75 mg NMT BID, save for multi drug resistant)
management of CFRD insulin, po hypoglycemics
management of osteopenia/osteoporosis in CF exercise, vit D, ca, bispohosphonates
management of depression in CF SSRIs, psychotherapy
empiric po tx for MSSA cefuroxime, amox/clav, sulfmethoxazole/trimethoprim
empiric po tx for PSA ciprofloxacin
empiric iv tx for MSSA cefuroxime or oxacillin or cefepime
empiric iv tx for MRSA vanco +/- rifampin
empiric iv tx for PSA double coverage: aminoglycoside (gent, tob, amikacin) + ceftazidime or cefepime, pip/taz or tic/clav, imipenem/cliastatin or meropenem (2nd line), cipro (last line)
tx for CF exacerbation with B cepacia and/or S maltophilia combination of 2-3 drugs: aminoglycosides, B-lactams (pip/tazo, ceftazidime, carpapenem), cloramhenicol, colistatin, fluoroquinolones, sulfamethoxazole/trimethoprim
CF exacerbation w/ history of MSSA/no PSA colonization cefuroxime or nafcillin or oxacillin
CF exacerbation w/ history of MSSA and PSA colonization double PSA coverage: cefepime + aminoglycoside
CF exacerbation w/ history of MRSA/no PSA colonization vanco +/- rifampin
CF exacerbation w/ history of MRSA and PSA colonization vanco +/- rifampin plus double PSA coverage aminoglycoside + B-lactam (ceftazidime)
duration of tx for CF exacerbations 14-21 days
monitoring in abx therapy in CF FEV1, FVC, SCr, UOP, peak and trough
goal peak and trough in CF aminoglycoside dosing peak: 10-12 mcg/ml trough: <1.5 mcg/ml
exclusions for ped self tx of fever <6 months w/ rectal temp >38.3 C >6 months w/ rectal temp >40C hx of febrile seizures or seizures
ped dosing of APAP 10-15 mg/kg/dose q4-6h
ped dosing of ibu 5-10 mg/kg/dose q6-8h
exclusions for ped self tx of cough/cold high fever, SOB, hx of asthma, immunosuppression therapy
ped dosing for PSE Children < 2 years = 1 mg/kg/dose q6h (not recommended) Children 2 – 5 years = 15 mg q6h (max = 60 mg/day) Children 6 – 12 years = 30 mg q6h (max = 120 mg/day) Children > 12 years = 60 mg q6h (max = 240 mg/day)
ped dosing for phenylephrine Children 4 – 6 years = 2.5 mg PO q4-h (max = 15 mg/day) Children 7 – 12 years = 5 mg PO q4-6h (max = 30 mg/day) Children > 12 years = 10 mg PO q4h (max = 60 mg/day)
exclusions for ped self tx of allerigic rhinitis symptoms of AOM, sinusitis, pneumonia, bronchitis hx of asthma
ped dosing of loratidine Children 2 – 5 years = 5 mg PO daily Children ≥ 6 years = 10 mg PO daily
ped dosing of fexofenadine Children 6 – 23 months = 15 mg PO q12h Children 2-11 years = 30 mg PO q12 Children ≥ 12 years = 60 mg PO q12
ped dosing of cetirizine Children 6-12 months = 2.5 mg PO daily Children 1-5 years 2.5-5 mg per day PO divided q12-24 hours Children ≥ 6 years = 5-10 mg per day PO divided q12-24 hours
pathogens of ped D/V most common: rotavirus others: norwalk like viruses and adenovirus
exclusions for self tx of acute gastroenteritis <6 months, severe dehydration, fever (>38.3 in <3 mon, >40 in infants >3 months), blood or mucus in stool, severe abdominal pain/distress
ORT of diarrhea w/out dehydration ORT 10 mL/kg to replace ongoing stool losses ORT may not be necessary if fluid intake + age appropriate feeding continues
ORT for mild dehydration Correct dehydration: ORT 50 mL/kg over a 4 hour period and reassess q2h Replace ongoing losses: ORT 10 mL/kg/stool; estimate emesis loss and replace
ORT for moderate dehydration Correct dehydration: ORT 100 mL/kg over a 4 hour period and reassess q1h Replace ongoing losses: ORT 10 mL/kg/stool; estimate emesis loss and replace
self tx of diaper dermatitis Products containing ≥ 1 of the following: Allantoin, Cod liver oil, Kaolin, Mineral oil, Zinc oxide, Calamine, Dimethicone, Lanolin, Petrolatum
Created by: Kachmiel