Pediatric Pharmacology Quiz Study Guide

Pediatric Pharmacology Quiz Study Guide Pediatric Pharmacology Quiz Study Guide Although the test questions may cover any of the presented material, this guide can help you focus your study in preparation for the quiz. Study the content below and mark your notes appropriately. Good luck!  Categories of pediatric clients and the corresponding ages o Decreased organ function (peds have not matured) o Definition of ped: 16 years or younger o Premature infants: <36weeks o Full term: >36-40week o Neonate: first four weeks of life o Infants: week 5 to 1 year o Children: 1-12 years o Adolescents: 13-16 years o 1/3 ped meds have been tested o 20% meds are ineffective even though they were effective to adults o 20% needed different dose o 30% unanticipated side effects (including death)  Principles of absorption in neonates and infants o Pharmacokinetics (how it moves in body) o Pharmacodynamics (what it does to body) o Absorption  IV: longer (neonate, because liver is not mature to metabolize) or shorter effects  SQ: decline slowly in neonate, levels raise higher than adults  Gastric empting (ped)  Prolonged and irregular in early infancy (6-8 months it reaches adult levels)  Stomach meds (increased absorption)  Intestine (delayed absorption)  pH is high because of low acidity (birth to 2 years)  acid labile medication is destroyed in acid environment. They are absorbed better because of less acid in neonate  IM injection are slow and erratic in neonates. Infants absorb is more rapid than adults    Transdermal: thin skin, absorption is more rapid o Distribution  Protein binding limited in infants (lower albumin levels) cause higher levels of active drugs  Blood brain barrier (immaturity in neonates / infants)  CNS drugs  Given in lower doses  Hepatic and renal considerations in neonates and infants o Hapatic Neonates and infants  Lower hepatic metabolism o Maturity?  1 year o Dosing should be reduced and intervals lengthened o Renal functions neonates and infants  Lower renal function o Maturity  1 year o Dosing should be reduced and intervals be lengthened Matching specific medications/pharmacologic classes with the corresponding complication o Children of 1 year  Pharmacokinetics, the relationships to adult pharmacokinetics are similar  Metabolism fastest between 1-2 years of age  Slowly declines until puberty, then sharp decline  Doses should be increased, interval decreased for drugs metaboized by liver o Adverse reaction  Androgens: permature puberty in males (shorter height)  Salicylates: reyes syndrome  Chloramphenical: gray syndrome  Glucocorticoids: growth support  Fluoroquinolones: tendon ruptures  Hexachlorophene: CNS toxicity in infants  Nalidixic acid: caritlage erosion  Phenothiazines: SIDS  Sulfanamides: kernicterus in neonates  Tetracycline: staining of teeth o Determining dose for peds  Extrapolation from adult doses  BodySurfaceArea x adult dose / 1.73m2  Adjust based on  Serum levels  Clinical status (neonates and etc)  Strategies to promote adherence o Spills/spitting  Estimate drug wasted and readminister o Double dosing  Limit responsibility  MAR at home, chart dose given o Form/schedule  Use the most convenient form/schedule (not the most accurate) o Mix with food or juice o Calibrated spoon or syringe o Time and education with young/inexperienced parents Moderate Sedation and Paralytic Agent Study Guide NURS 250 Moderate Sedation and Paralytic Agent Quiz Study Guide Although the test questions may cover any of the presented material, this guide can help you focus your study in preparation for the quiz. Study the content below and mark your notes appropriately. Good luck! 1) Moderate Sedation    Purpose o “conscious sedation” involves iv sedative to reduce anxiety and control pain. Will induce amnesia. Goal depress LOC to allow surgical, diagnostic or therapeutic procedures while maintaining comfort and allowing patient cooperation. Increase use for short term procedures o Patient must be able to retain airway, reflexes, responsiveness Administration o Provider, anethesiologist, anethetist, trained credential nurse or provider, TJC oversight criteria Monitoring o Patient monitored closely, never left alone, nurse or provider watches for rhythms recognition/treatment, O2, nurse or provider are qualified for ACLS/Resuscitation/intubtion, nurse and patient ratio 1:1., training in moderate sedation,   o One person who is solely dedicated to VS, must be taken every 5 minutes. LOC Q 10 min, Pain Q 10 min, skin color/condition Q 10 min, O2/EKG continuously (watching constantly) o Equipment involved: emergency cart, EKG, BP, O2, Temp, HR/breath sound 100% o2, airway, sunction IV, medication… all these equipment must be in the room Discharge criteria o LOC baseline, demonstrate protective reflex (swallow and gag test), VS stable and baseline for 30 min, O2 95% or baseline, cardiac rhythm baseline, BP/HR within 20 points of baseline or WNL, Temp can’t be more than 101F, pain rating less than or at baseline, no site drainage/swelling, must be able to ambulate, and responsible adult present to monitor at home for 2 halflives of anethesia meds administered. Matching specific medications with their description (including reversing agents) o Anethetics, opioids, benzo o Anethetic:  Propofol (diprovan): popular for moderate sedation. Short acting hypnotic agent. No analgesic properties, but it will induce amnesia. Onset: rapid (40 sec), Peak: unknown, Duration: 3-5 min, ½ life: 3-12 hours. Administer under physician who has competency, for critical care only. Will cause apnea and dependence. Infusion syndrom: high doses or long duration of infusion o Opioids  Morphine: 1-2mg over 30 sec q 5-10 min. onset rapid, peak is 20 min, ½ life 2-3 hours. Concerns are resp depression , apnea, cns depression  Fetanyl: potency 100x than morphine. Administered slowly 2-5 mins Q 10-15 min. if given rapid: rigid chest happens/ to treat: muscle relaxant mechanical ventilation. Onset 1-2 min, peak 3-5 min, ½ life 3-6 hours  Dilaudid: 0.1=0.5 mg over 30 sec Q 5-10 min. onset is rapid, peak 15 -30 min, ½ life 2-4 hours  Meperidine (demerol): dilute and administer in 10mg increments over 30 seconds every 5-10 min. (slowly may be painful). Onset immediate. Peak 5-7 min. ½ life 7 hours. Do no give if patient is taking serotonin raising meds. Can cause neurotoxicity o Benzodiazepines  Diminish skeletal muscle anxiety  Induce amnesia in high doses, but does not always happen (mainly patient with ETOH abuse)  Does not have analgesic properties  Midazolam (versed)  Given IV, reduced by 1/3 if given with opioid  Onset rapid  Duration 2-6 hours  3-4x more potent than valium, drug of choice  Ativan  Reduce by 1/3 with opioid.  Peak unknown  Onset 5-15 min  Duration 48 hr  This is why versed preferred o Reversal Agents  Naloxone (narcan)  For opioids, dilute in 10mL and titrate to effect (0.5mL/2min for max, 0.8mg total)  Flumazenil (romazicon)  For benzodiazepines, 0.2mg doses (over 15 sec). wait 45 sec. may repeat at one minute intervals to a total of 1 mg  Effects in long term benzo users can cause life threatening seizures  Anesthetic agents  Dissipate quickly 2) Neuromuscular Blocking Agents    Criteria for use o Paralytic agents: prevent acetolcholine from stimulating nicotinic receptors on muscles (blocks skeletal muscle contractions). Used for surgery/intubation o Manual ventilation is mandatory! Patient physically prevented from breathing Depolarizing vs. non-depolarizing o Depolarizing  Bind, cause effects, keep depolarizing (cell can’t repolarize)  Bind to acetocholine receptors and cause contractions, but depolarization is sustained (initial contraction is started than blocked). Followed quickly by paralysis o Non-depolarizing  Ach antagonist. Block depolarization  Competitively and reversible bind to acetolcholine receptors and prevent depolarization Therapeutic and adverse effects o Eyelids, to fingers, to jaws, to limbs, to abdomen, to respiratory muscles o Histamine to be released  Bronco spasm    o No effect on LOC Rapid sequence intubation o Succinylcholine (depolarizing) is drug of choice Use in clients with renal disease o Cisatracurium (non-depolarizing) med of choice Reversing agents o Non-depolarizing agents  Cholinergic drugs  Neostigmine  Pyridostigmine  Edrophonium o Succinylcholine (depolarizing)  No reversing agents What is not a neuromuscular agent use? To facilitate moderate sedation Question 1 0 / 1 pts The purpose of moderate sedation is to reduce anxiety and control pain Correct Answer True You Answered False Question 2 1 / 1 pts The client undergoing moderate sedation cannot be left alone for more than 2 minutes once the procedure has begun. True Correct! False Question 3 1 / 1 pts Caregivers monitoring clients undergoing moderate sedation should be skilled in identifying dysrhythmias, resuscitation and intubation, ACLS and training in moderate sedation. Correct! True False Question 4 1 / 1 pts Assessments during moderate sedation include: VS q5", LOC & pain q10", Skin color/condition q15", SaO2 & EKG continuously. True Correct! False Question 5 1 / 1 pts Which of the following is NOT a discharge criterion for the client undergoing moderate sedation. alert and oriented as at baseline Correct! SaO2 97% on 2L O2 30 minutes after last drug dose should be on room air temperature not above 101 F. pain less than or equal to baseline Question 6 1 / 1 pts Match the following medication with the best description Correct! propofol (Diprovan) short-acting hypnotic with amnesic properties Correct! Morphine opioid analgesic with a rapid IV onset and peak response of 20 minutes Correct! fentanyl (Sublimaze) opioid analgesic 100x m ore potent than morphine Correct! benzodiazepine pharmacologic clas s that reduces skeletal muscle spasms, reduces anxiety and produces amnesia Correct! midazolam (Versed) benzodiazepine of choice for moderate sedation Correct! naloxone (Narcan) revers al agent for opioids Correct! flumazenil (Romazicon) revers al agent for benzodiazepines Question 7 1 / 1 pts Neuromuscular blocking agents (paralytic agents) should ONLY be used on a client who is (or will immediately be) mechanically ventilated. Correct! True False Question 8 1 / 1 pts Depolarizing agents cause skeletal muscle paralysis, non-depolarizing agents do not. True Correct! False Question 9 0 / 1 pts Which of the following is an effect of a neuromuscular blocking agent? Correct Answer paralysis You Answered hypertension it can cause hypotension bronchodilation sedation Question 10 1 / 1 pts Which of the following statements about Succinylcholine are correct? (Select all that apply) Correct! it is a depolarizing agent and causes culations before paralysis it has a rapid effect which lasts 15-30 minutes. Correct! it is the drug of choice for rapid sequence intubation