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202 Cards in this Set
- Front
- Back
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Preterm is what age?
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born prior to 37 week gestation
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neonate is what age?
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first 28 days of life
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infant is what age?
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1 month to 12 months
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Preoperational thinking, magical thinking, egocentric, perception dominates is associated with what age?
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ages 3-4y
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concrete thinking is associated with what age?
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6-12y
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Abstract thinking is associated with what age?
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14-16y
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Common presenting sx of language delay are usually at what age?
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2y
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no words by what age would require language delay evaluation?
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18 months
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<10 words by what age would require language delay evaluation?
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24 months
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no phrases by what age would require language delay evaluation?
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30 months
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at what age are first words usually?
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1 year
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what language milestone is at 2 yrs usually?
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50 words, two sentences, parents understand 50%
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what language milestone is at 3yrs usually?
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800 words vocab, parents should understand 75%, child follows 2 step demands
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what language milestone is at 5yrs usually?
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1500-2000 word vocab, follows 3-4 step commands
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Define mental retardation
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IQ more than 2 SD below mean for age on standard IQ test
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where do the majority of mental retardation people fall on the IQ scale? what are they capable of?
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mid range of 55-69; live independently, read on 4-6th grade level, semi skilled job, physically and psych capable of parenthood
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Diag criteria for mental retardation requires IQ tests and limited fxn in 2 areas including?
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communication, selfcare, social skills, self direction, academic skills, work or leisure activities, health and safety
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What is borderline normal intelligence on IQ scale?
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68-85
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What is mild mental retardation on IQ scale?
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50-70
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What is moderate mental retardation on IQ scale?
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45-55
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What is severe mental retardation on IQ scale?
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20-40
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What is profound retardation on IQ scale?
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<25
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What is normal intelligence on IQ scale?
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~100-110
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What age can start using patches and chew tablets?
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as young as 2
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What age can start using MDI?
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as young as 3
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What age can start using PCA?
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as young as 4
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What age can start swallowing tablets?
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age 8
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what age can inject insulin with supervision?
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age 9
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What age will refuse suppositories?
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age >10
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at what weight should you worry about children's weight based dosing exceeding adult dosing?
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child wt >=40kg
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What are the deadly drugs in peds?
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insulin, morphine, potassium(K), digoxin (think "(not) MI KD" = not my kid)
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What information is in nelson textbook of pediatrics?
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developmental stages through complex genetic disorders; rsv, cf, chd, crying infants, failure to thrive, psych d/o
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how often is nelson textbook of pediatrics updated?
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q 4 to 5 y
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What info is in pediatric dosage handbook?
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monographs with admin, dosage forms, compounding, recipes; dosage recommendations for "neonate-adolescents, adults"; special topic charts including fluid calculations, formulas, blood pressure, growth charts, narcotic comparison charts
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how often is pediatric dosage handbook updated?
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annually
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what info is in the redbook?
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infectious disease topics, tx recommendations, addresses risk association with specific setting (child with hep b in day care, immunization shortages, immunoglobin in IgA deficient pts, dose recommendations)
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how often is redbook updated?
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q 3 yr
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what age group is most susceptible to overdoses?
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children under 2y
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What ages can receive loratadine?
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>2y
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what ages can receive cetirizine?
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down to 6 months
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what is the dose of loratadine for a 2-5y?
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5mg qd
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what id the dose of loratadine for a 6-adult?
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10mg qd
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what is the dose of cetirizine for a 6-12m?
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2.5mg qd
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what is the dose of cetirizine for a 12-23m?
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2.5mg daily or bid
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what is the dose of cetirizine for a 2-5y?
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2.5mg bid or 5mg qd
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What is the dose of cetirizine for >=6y?
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5-10mg qd
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What is the dose of pseudoephedrine for <4y?
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1mg/kg/dose q6h
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What is the max dose of pseudoephedrine for <4y?
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15mg/dose
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What is the max dose of pseudoephedrine for 4-5y?
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max 60mg/day
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What is the dose of pseudoephedrine for 4-5y?
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15mg q 4 to 6 h
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What is the dose of pseudoephedrine for 6-12y?
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30mg q 4 to 6 h
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What is the max dose of pseudoephedrine for 6-12y?
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max 120mg/day
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What is the max dose of pseudoephedrine for >12y?
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max 240mg/day
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What is the dose of pseudoephedrine for >12?
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60mg q 4 to 6 h
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what is the analgesic dose of APAP?
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10-15mg/kg po q 4-6h
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what is the max dose of APAP per day in peds?
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75mg/kg/day (3000mg)
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What is the antipyretic dose of APAP in peds?
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12-15mg/kg po q 6 h; onset of fever reduction is usually ~ 2h
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What is the PR dose of APAP for peds?
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10-20mg/kg pr q 4 to 6h
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What is the max PR dose of APAP for peds?
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75mg/kg/day
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What is the age limitation for ibuprofen?
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>6months
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what is the ped dosing for analgesic ibuprofen dosing?
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5-10mg/kg po q 6 h
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what is the max ped dosing for analgesic ibuprofen dosing?
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30mg/kg/day
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what is the ped dosing for antipyretic ibuprofen dosing?
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10mg/kg po load then 5mg/kg po q 6h
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what is the ped dosing for analgesic ibuprofen dosing?
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5-10mg/kg po q 6 h
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Disimpaction tx for <1y?
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fruit juices ~4oz containing sorbitol (apple, prune, pear), corn syrup (5ml in 60ml of H2O), glycerine suppository-cut lengthwise in half.
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what is the max ped dosing for analgesic ibuprofen dosing?
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30mg/kg/day
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disimpaction tx for 1-2y
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mineral oil, PEG 3350 (Miralax), mag citrate, sorbitol, lactulose
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what is the ped dosing for antipyretic ibuprofen dosing?
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10mg/kg po load then 5mg/kg po q 6h
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disimpaction tx for >2y?
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enemas (glycerin, mineral oil, normal saline-- avoid electrolyte enemas!), suppositories, oral stimulant agents (Senna, bisacodyl).
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Disimpaction tx for <1y?
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fruit juices ~4oz containing sorbitol (apple, prune, pear), corn syrup (5ml in 60ml of H2O), glycerine suppository-cut lengthwise in half.
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hypoallergenic formulas?
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pregestamil, nutramigen, alimentum
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disimpaction tx for 1-2y
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mineral oil, PEG 3350 (Miralax), mag citrate, sorbitol, lactulose
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how to administer omeprazole capsule in g-tube?
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Capsule- mix beads in acidic liquid – then flush
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disimpaction tx for >2y?
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enemas (glycerin, mineral oil, normal saline-- avoid electrolyte enemas!), suppositories, oral stimulant agents (Senna, bisacodyl).
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how to administer omeprazole compounded liquid in g-tube?
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Compounded liquid- then flush
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hypoallergenic formulas?
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pregestamil, nutramigen, alimentum
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how to administer omeprazole powder for oral suspension in g-tube?
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Powder for oral suspension- then flush
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how to administer omeprazole capsule in g-tube?
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Capsule- mix beads in acidic liquid – then flush
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how to administer omeprazole compounded liquid in g-tube?
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Compounded liquid- then flush
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how to administer omeprazole powder for oral suspension in g-tube?
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Powder for oral suspension- then flush
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how to administer pantoprazole delayed release oral suspension in g-tube?
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Delayed release oral suspension- 10ml apple juice
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how to administer esomeprazole capsule in g-tube?
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Capsule- mix beads with water then flush
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how to administer esomeprazole oral packet in g-tube?
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Oral packet- mix as directed then flush
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drug cause of ped discoloration of teeth?
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tetracyclines
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drug cause of ped kernicterus?
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Sulfonamides & Lipid Emulsions
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drug cause of ped gasping syndrome?
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Benzyl Alcohol (preservative) in bacteriostatic flushes and Phenobarbital Na injection solution
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drug cause of ped grey baby?
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chloramphenicol
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drug cause of ped amelia/phocomelia?
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thalidomide
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When is ped gastric ph neutral?
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1st two weeks of life
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when does ped gastric ph become acidic?
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age 2
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when does slower gastric emptying time and reduced peristalsis resolve in peds?
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Adult values are reached within 6-8 months
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When to avoid percutaneous administration in peds?
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first two weeks of life to avoid systemic effects
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infants have a High ratio of body surface area to total body weight. when does it become less pronounced?
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12 months
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when is increased vd relevant?
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if protein binding is >90%
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when is child's head adult sized?
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age 7
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when does bsa reach adult size?
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18y
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intrathecal dosing before age 7 should be dosed off?
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age
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intrathecal dosing at or after age 7 should be dosed off?
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adult recommendations
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when does phase 1 metabolism mature?
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age1
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when does phase 2 metabolism mature?
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age 3-4
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At what age does hepatic metabolism elimination half-life approach adult levels?
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2-6 months
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When is the maturation of hepatic enzymes?
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by age 1 yr
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when does nephrogenesis begin?
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wk9 gestation
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when does nephrogenesis complete?
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wk 34 gestation
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when is gfr > adult gfr?
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3-6y
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what is the old schwartz eq? and gfr units?
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GFR=k(ht)/Scr; GFR ml/min/1.73m^2
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what is the new schwartz eq?
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crcl=(0.41*ht)/Cr
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s/sx of OME?
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mild hearing loss
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s/sx of AOM?
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erthema of tympanic membrane, otalgia, fever, irritable, discharge from ears
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AOM dosing with ibuprofen?
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6-10mg/kg/dose q8h
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AOM APAP dosing?
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10-15mg/kd/dose q6h
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DOC for AOM?
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amox
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AOM AMOX dosing?
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45mg/kg/dose bid x 10 days (max 3g/day)
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When can you do a short duration (5-7days) AMOX in AOM?
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if >=6y, intact TM, no previous AOM in last 30 days
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What are high risk pts in AOM?
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abx in last 30 days, AOM+purulent conjunctivitis, chronic prophylaxis with amox
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What is the drug and dose for high risk pts with AOM?
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Augmentin 45mg/kg/dose bid x 10 days (max 2g/d)
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what is a tx failure in AOM?
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Lack of improvement of signs and symptoms within 48 to 72 hours after initiation of antibiotic therapy
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If a pt fails amox in AOM, what is the tx?
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augmentin 45mg/kg/dose bid x 10 days (max 2g/day)
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If a pt fails augmentin in AOM, what is the tx?
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Ceftriaxone 50mg/kg IM/IV q 24h x 3 days
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If a pt fails tx in AOM and PCN all (non-anaphylactic+severe illness), what is the tx?
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Ceftriaxone 50mg/kg IV/IM q 24h x 3days
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If a pt fails tx in AOM and PCN all (anaphylactic), what is the tx?
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Clindamycin 30-40mg/kg/day divided q8h x 10 days AND Sulfasoxzole 75mg/kg x 1, 120-150mg/kg/day divided qid x 10 days
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When is tympanocentesis indicated in AOM?
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severe illness + failing second line abx
PCN all + failed first line abx seriously ill immunocompromised <2 wks of age AOM refractory to tx |
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What constitutes AOM relapse?
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3 or more episodes occurring within previous 6 months
4 or more episodes occurring within previous 12 months AAP defines recurrent as episode within 30 days of previous episode |
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what is the tx for AOM relapse?
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Augmentin or ceftriaxone
cefuroxime, cefpodoxime, cefdinir |
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what is the schedule for Prevnar13?
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Scheduled sequence at 2m, 4m, 6m, and 12-15m
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what age is menactra indicated for?
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9 months-55yoa
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what age is menveo indicated for?
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>=56 yoa
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Causes of bacterial meningitis in neonates?
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Group B Strep - #1 pathogen in neonates
E. Coli Listeria |
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Causes of bacterial meningitis in children?
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S. pneumoniae - < 1 yr old = more susceptible
N. meningiditis - Higher fatatlity rates |
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neonatal tx for bacterial meningitis?
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Ampicilin 75 mg/kg/dose IV q6h + Cefotaxime 75 mg/kg/dose IV q6h
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neonatal tx for hsv meningitis?
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Acyclovir 20 mg/kg/dose IV q8h
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neonatal tx for gram + meningitis?
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Vancomycin 10 mg/kg/dose IV q6h
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>2 month / ped tx for meningitis?
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Vancomycin loading dose 20 mg/kg
Vaconmycin 10 mg/kg/dose IV q6h + Ceftriaxone 75 mg/kg IV q12h |
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>2 month / ped tx for meningitis w/ documented PCN ALL?
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Meropenem 40 mg/kg/dose IV q8h + Vancomycin 10 mg/kg/dose IV q6h
OR Levofloxacin 10 mg/kg/dose IV q24h + Vancomycin 10 mg/kg/dose IV q6h |
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meningitis prophylaxis tx drugs? bug?
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Rifampin, Ceftriaxone, Ciprofloxacin; n. meningiditis
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CAP in 3m-5y causes?
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Viral (Rsv, influenza A&B, parainfluenza, adenovirus, rhinovirus), S. pneumoniae,
M. pneumoniae, C. pneumoniae |
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CAP in >5y causes?
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S. pneumoniae,
M. pneumoniae, C. pneumoniae |
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CAP outpatient tx for bacterial pneumonia?
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Amox 45mg/kg/dose po q 12h
alternative: augmentin |
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CAP outpatient tx for atypical bacterial pneumonia?
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Azithromycin 10 mg/kg x 1 day then 5 mg/kg x 4 days
Alt: Clarithromycin, erythromycin, doxycycline (>8 yrs) |
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CAP oseltamivir dose for influenza in 0-8m?
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3mg/kg/dose po bid (0-8 months) x 5 days
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CAP oseltamivir dose for influenza in 9-23m?
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3.5mg/kg/dose po bid (9-23months) x 5 days
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CAP oseltamivir dose for influenza in >=24m?
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2mg/kg/dose po bid (>=24months) x 5 days
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CAP tx with zanamivir dosing and age group?
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2 inhalations BID (>=7yoa)
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CAP PEDS requirements for hospitalization?
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Respiratory distress (Sp02 <90%) on room air (tachypnea, dyspnea, retractions, grunting, nasal flaring), Home environment unable to comply with therapy, Suspected or documented virulent pathogen (ca-mrsa), Infants 3-6months of age
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CAP children >=3months + fully immunized tx?
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Amp or Pen G
alt: ceftriaxone or cefotaxime |
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CAP children >=3months + fully immunized tx for ca-mrsa?
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vanc or clinda x at least 10 days
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CAP children >=3months + fully immunized tx for "if suspected"?
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Azithro 10mg/kg x 2 d, 5mg/k/d x 8 d
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CAP children >=3months + NOT fully immunized (OR communities with high s. pneumo resistance to pcn???) tx?
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Ceftriaxone or cefotaxime
alt: levo |
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CAP children >=3months + NOT fully immunized (OR communities with high s. pneumo resistance to pcn???) tx for "if suspected"?
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azithro 10mg/kg x 2d, 5mg/kg/d x 8d
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CAP children >=3months + NOT fully immunized (OR communities with high s. pneumo resistance to pcn???) tx for ca-mrsa?
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vanco or clinda x at least 10 days
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how long to treat m. pneumonia CAP?
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tx 5 days outpatient
tx 10 days inpatient |
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how long to treat s. pneumonia CAP?
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10 days
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how long to treat mrsa CAP?
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at least 10 days
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most common CF mutation? what type of mutation is this? what chromosome?
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deltaf508; autosomal recessive; chromosome 7
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dose of lipase in cf for snack?
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1250 lipase units/kg/snack
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dose of lipase in cf for meal?
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2500 lipase units/kg/meal
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benefits of tobi in CF?
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↑ FEV1
↓ Hospitalizations ↓ IV antipseudomal abx Better QOL ↓ Exacerabations in pts w/ asymptomatic or mild disease |
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benefits of aztreonam in CF?
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↑ FEV1 - with lasting effects (several weeks after tx)!
5 min neb tx - QOL |
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benefits of Pulmozyme in CF?
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Once daily neb
↑ FEV1 Higher overall well being scores ↓ Exacerbations in mild lung disease |
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benefits of hypertonic saline in CF?
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↑ FEV1
Significant ↓ in exacerbations (> 50%) |
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benefits of azithro in CF?
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↑ Lung function
↑ Weight gain (good for these pts!) ↓ Exacerbations = ↓ Hospitalizations Oral medication = pt preferred |
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Benefits of ibuprofen in CF?
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Slows lung function loss
Better linear growth ↓ Hospitalizations |
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risk factors for obesity?
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Ethnicity (African-American, Mexican-American, Native American)
Parental obesity(STRONGEST predictor) <10y + obese parents = double risk Children from families below FPL (federal povertylevel) Publicly insured |
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behaviors associated with weight loss?
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EAT BREAKFAST (important)
Reduce sweetened beverage intake Fruit juice at moderate level Fruit & vegetable inverse relationship with adiposity Fiber intake |
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weight loss goals Children 2-5 years of age + BMI > 21-22kg/m2?
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1lb/month
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weight loss goal for Children > 6 years of age?
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Weight loss of 2lbs per week. More than 2 lbs per week should be investigated: rule out extreme caloric restriction, purging, use of laxatives
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Risk factors for DM2?
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Ethnicity - native american, inuit, african american, mexican, polynesian
overweight family history PCOS |
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when should screeding be performed for dm?
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Begin at 10 yoa or onset of puberty (whichever is first)
Repeat q 2 years |
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What is DOC for treating DM in kids?
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DOC = Metformin 500mg po BID (max 2g/d)
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Who and when do you screen for hypercholesterolemia?
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All children 9-11 years screended at least one time regardless of FH or risk factors
Universal screening repeated 17-21 years of age Children considered high risk screened 2-8 years of age (High risk = diabetes, HTN, obesity, OR FH of CVD or hyperlipidemia) |
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ped ldl goal?
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<130
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ped diabetic ldl goal?
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<100
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ped hdl goal?
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>=40
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ped non-hdl goal?
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<145
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ped triglyceride goal?
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<100 (if >10 y then <130)
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when to tx hyperlipids in peds?
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Children with severe primary hyperlipidemia or homozygous hypercholesterolemia (LDL < 400mg/dL) regardless of age OR
≥ 10 years of age AND A) No risk factors + LDL > 190mg/dL B) (1 High level or 2 moderate RF )+ LDL 160-189mg/dL C) (2 High level or 1 high level + 2 moderate RF) + LDL 130-159 mg/dL |
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what are the high level risk factors in assessing drug tx for ped hyperlipids?
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Hypertension requiring drug therapy
Cigarette smoking BMI ≥ 97th Diabetes Chronic kidney disease Heart transplant Kawasaki disease with an aneurysms |
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What are the moderate level risk factors in assessing drug tx for ped hyperlipidemia?
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Hypertension not requiring medication
BMI 95th % but less than 97th % HDL < 40mg/dL Kawasaki disease with regressed coronary aneurysm chronic inflammatory disease HIV nephrotic syndrome |
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What are the transmitters involved in adhd?
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Dopamine
norepinephrine |
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3 types of ADHD?
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Predominantly inattentive
Predominantly hyperactive-impulsive Combined (most common) |
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What are the short acting adhd meds?
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Methylphenidate (Ritalin)
Dex-methylphenidate (Focalin) Amphetamin (Dexedrine) Mixed amphetamine salts (Adderall) |
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What are the intermediate acting adhd meds?
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Methylphenidate CD (Metadate CD)
Methylphenidate (Ritalin LA) Methylphenidate SR (Ritalin SR) |
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What are the long acting adhd meds?
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Mixed amphetamine salts (MAS) XR (Adderall XR)
Lisdexamfetamine (Vyvanse) |
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what is the black box warning on adhd meds?
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abuse potential
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with adhd meds if Worsening/unchanged ADHD or Intolerable SE, then what?
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change dose, time of dose, preparation
consider adjunctive treatment Consider CBT |
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with adhd meds if Symptoms of rebound, then what?
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Change timing of dose, preparation, and increase frequency of dose
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with adhd meds if Tics, Tourette’s syndrome, then what?
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D/C if worsens
Anti-tic (Haldol) Alternative |
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with adhd meds if Dysphoria, acceleration, agitation, then what?
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Assess toxicity
Developmental/exacerbation of co-mobid Substance abuse (caffeine, nicotine) Reduce dose Alternative |
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with adhd meds if Emergence of depression, mood liability, then what?
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Toxicity or rebound
Reduce/discontinue Add antidepressant/antimanic CBT r/o substance abuse |
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with adhd meds if Emergency of psychosis/mania, then what?
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D/C
Assess/treat psychosis/mania |
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Benefits of using stimulants in adhd?
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Decreases risk for
depressive disorder anxiety disorder disruptive behaviors likelihood of academic failure |
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when to use atmx in adhd?
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second line
combination with stimulants for refractory cases |
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when to use bupropion in adhd?
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substance abuse, nicotine dependence, mood disorders, conduct disorder, depression, bipolar disorder
coexisting cardiac abnormalities |
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What to use for attention deficit and anxiety?
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atmx OR stimulant+ssri
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what is normal (negative result) range in CF quantitative sweat test?
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Normal < 30 mEq/L
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What is the dose for metoclopramide in peds for reflux?
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Metoclopramide 0.1-0.2mg/kg/dose q6h
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What is the dose for sucralfate in peds for reflux?
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40-80mg/kg/d divided doses q6h
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What is the dose for omeprazole in peds for reflux?
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0.5- 3.5mg/kg PO bid
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What is the dose for Lansoprazole in peds for reflux?
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0.5 -1.6mg/kg PO daily
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What is the dose for Pantoprazole in peds for reflux?
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0.5-1mg/kg IV daily
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What is the dose for Esomeprazole in 1-11y for reflux?
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1-11 y or < 20 kg 10mg daily x 8 weeks
>= 20kg 10-20mg daily x 8 weeks |
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What is the dose for Esomeprazole in >12y for reflux?
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> 12y 20-40mg daily x 8 weeks
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