Flashcards in Peds & Geri Deck (151)
Young children are not simply small adults; they have unique physiology that changes remarkably with age; especially in what?
The first year
Neonates and infants have a high percentage of body water. This means what?
Drugs distributed in water have a high volume of distribution
In infants, cardiac output is dependent on:
Due to infants/neonates having a high body water percentage what may be enhanced for this population?
Anesthetic drugs that cause a reduction in heart rate may ________ depress blood pressure and blood flow to tissues.
Name the three common age groups of the pediatric population:
1.) Neonates - less than 4weeks after birth
2.) Infants - between 4 wks and 1 yr
3.) children - greater than 1 yr of age
Neonates often have two subdivisions. What are they?
1. Prematurely (before 37 wks gestation)
2. Term (greater than or equal to 37 weeks)
The understanding, assessment and management of acute pain in pediatrics has lagged behind that of adults. Pediatric pts often receive....
Less analgesia postoperatively than adults
What was the established view of neonates regarding pain?
Neonates were neither capable of perceiving pain NOR able to remember painful stimuli
The primary indication for anesthesia once was the prevention of...
Movement during surgery! :(
(Achieved with little more than Controlled ventilation and NMB’s)
The behavioral response to standard noxious stimulus in the neonate may be:
The stress response associated with noxious stimuli in the neonate is:
Impressive and CONSISTENT
Infants undergoing surgery w/o adequate anesthesia suffer significant ________ and ________ response which adversely affects post op recovery.
Hormonal and metabolic
Important developmental changes in the determinants of pharmacoKINETICS occurs during:
Infantry changes in pharmacokinetics include:
-entry into the brain across BBB
The principal site of absorption for drugs given ORALLY is:
The small intestine
The rate at which a drug leaves the stomach is the determinant of speed of:
Oral Drug absorption is determined by:
The rate at which a drug leaves the stomach
The rate at which most drugs are absorbed when given orally is SLOWER in neonates and infants than in older children because:
Gastric emptying is delayed
Delayed Gastric emptying is more prevalent in what pediatric populations?
Neonates and infants (vs older children)
In neonates, the time (Tmax) at which maximum concentration (Cmax) is achieved is ______.
Gastric emptying and intestinal motor motility rates reach normal adult rates at what age?
In neonates, the gastric pH is:
Greater than 4
The increased gastric pH in neonates increases the bioavailability of ___________. And decreases the bioavailability of _______ ______ when given orally.
Increases: acid-labile compounds (PCN G)
Decreases: weak acids (Phenobarbital)
Compared to the older child, The infant gut is more permeable to:
Large molecules (proteins, high molecular-weight drugs)
Absorption of _______ drugs is increased in neonates due to what 3 reasons?
Topically applied drugs (corticosteroids, LA Creams, antiseptics)
1.) Larger relative skin surface area
2.) increased cutaneous perfusion
3.) thinner stratum corneum
Neonates have a tendency to form methgb b/c they have reduced levels of :
B/c fetal hemoglobin is more readily oxidized than adult hgb, and neonates have a reduced level of methgb reductase what tends to happen?
The reluctance to use EMLA cream in neonates results because of what reasons:
1.) increased epidermis absorption
2.) reduced methemoglobin reductase