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26 Cards in this Set
- Front
- Back
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Nausea and Vomiting - Major Neurotransmitters
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Serotonin
Acetylcholine Histamine Dopamine |
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Nausea and Vomiting - Management of Hydration
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Oral rehydration as tolerated
-Dextrose and electrolyte solutions -Pedialyte -G2 (Give frequent small amount until urine turns clear) Do not give: -Milk -Sodas -Caffeine drinks -Fruit juices -gelatins |
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Nausea and Vomiting - Management of Increase Oral Intake as Tolerated
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Bland soft diet recommended until nausea resolves.
BRAT Diet - bananas, rice, applesauce, toast (Return to normal diet as soon as possible - around 24 hours) |
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Nausea and Vomiting - Management of Drug Therapy
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Centrally-acting = CNS side effects
1. Prochlorperazine and Promethazine are not used in children less than 2 years old 2. Metoclopramide and Trimethobenzamide are given for chemo induced N/V and with benadryl to avoid EPS 3. Diphenhydramine, hydroxyzine and meclizine are centrally acting and sedating. |
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GERD - Goals of Therapy
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-Relief of symptoms
-Promote normal weight gain and growth -Heal esophageal inflammation reflux -Prevent complications of chronic reflux |
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GERD - LIfestyle Modifications in infants
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Smaller, less frequent feedings.
Thickening feeds. Sleep positioning - wedge or prop up with pillows and blankets |
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GERD - LIfestyle Modifications in Children and Adolescents
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Dietary modification
Weight loss |
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GERD - Drug Therapy (H2 Antagonists)
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Do not use Cimetidine (Tagamet).
Ranitidine (Zantac) Famotidine (Pepcid) |
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GERD - Drug Therapy (PPIs)
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For those who failed max H2RA therpay
Lansoprazole (Prevacid) Omeprazole (Prilosec) Pantoprazole (Protonix) |
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GERD - Drug Therapy (Pro-kinetic Agents)
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Metoclopromide (Reglan) - stimulates gastric emptying and intestinal motility without increased GI secretions
Erythromycin - improves gastric emptying and motility, alters GI flora |
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GERD - Drug Therapy (Antacids)
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Works the quickest
For short term relief of acute, intermittent GER symptom Children's Mylanta Maalox Pepto-bismol - avoid salicylates in kids with fever (Reyes syndrome) Calcium carbonate oral suspension Tums chewable Overuse can cause electrolyte toxicity DDI: aluminum containing antacids - overdose can lead to CNS toxicities. |
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DIarrhea - Causes of Acute Diarrhea
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Infections
Surgery Systemic illness Diet (feeding intolerance/allergy) Malabsorptive disorders Inflammatory disorders Antibiotics or other drugs |
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Infectious Diarrhea - Common Bacterial Pathogens (5)
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Salmonella
Shigella Campylobacter E.Coli Clostridium Difficile |
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Infectious Diarrhea - Common Viral Pathogen (1)
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Rotavirus
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Infectious Diarrhea - Common Parasitic Pathogen (1)
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Giardia
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Clinical Presentation of Infectious Diarrhea with Rotavirus
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Acute onset of fever +/- vomiting
Voluminous watery diarrhea x 5-8 days |
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Infecious Diarrhea with Rotavirus - Vaccinations
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Rotarix - 2 dose series
RotaTeq - 3 dose series |
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Management of Acute Diarrhea - Pharmacotherapy
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Not recommended
-If it bloody, then go to the emergency department STAT |
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Management of Chronic, Non-Infectious or Uncomplicated Diarrhea
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Loperamide (Imodium) or Diphenoxylate + Atropine (Lomotil)
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Management of Antibiotic-Induced Diarrhea (or Prevention)
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Probiotics - lactobacillus
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Constipation - Definition
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Failure to pass 3 stools per week
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Constipation - Symptoms
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Abdominal distention
Diffuse and constant abdominal pain, cramping Irritability Decreased oral intake Nausea |
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Constipation - Complications
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Impaction
Overflow diarrhea Anal fissure Rectal bleedinging UTI Enuresis Fecal incontinence |
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Management of Functional Constipation - Agents to Remove Impaction
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May take 2-5 days
Oral: -High dose mineral oil -PEG solutions Rectal: -Phosphate soda enema -Mineral oil enema -Saline enema -Glycerin suppository in infants (no max dose) -Bisacodyl suppository in older children -Milk of Molasses enema |
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Management of Functional Constipation - Maintenance Medications
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Miralax
Magnesium hydroxide Lactulose Mineral oil Docusate |
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Stimulants used intermittently for "rescue" (to treat constipation) - 2 drugs
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Senna
Bisacodyl (Prolonged use no recommended - but can be used intermittently) |
