1. Therapeutics IV Tutoring April 22, 2016 Lisa Hayes lhayes3@uthsc.edu

2. Topics Pediatric Nutrition Pediatric PN SBS IBS

3. Pediatric Nutrition

4. How long does the AAP recommend breast feeding? A – exclusive for 1 year B – exclusive for 8 months C – exclusive for 6 months D – supplemental for 2 years

5. Which of the following is an appropriate recommendation for sleeping in infants? A – pacifier in sleep, co-sleeping B – separate but proximate sleeping, no pacifier C – baby on stomach, pacifier for sleep D – no crib bumper, separate but proximate sleeping, pacifier for sleep

6. Which of the following is matched correctly with its beyond use date for breast milk? A – room temperature: 12 hours B – insulated cooler: 48 hours C – freezer with separate door: 6 months D – refrigerator: 7 days

7. HG is a woman who delivered a baby 2 weeks ago and is breastfeeding currently. She presents to your pharmacy and is looking for an OTC item for HA control. What can you recommend? A – acetaminophen B – Excedrin Migraine C – ibuprofen D – naproxen

8. Fat content is higher at the end of the feeding for a breastfeeding session. A – true B – false

9. Colostrum is a higher fat content milk that is expressed at least 1 week post-partum. A – true B – false

10. What is the typical caloric density of infant formula? A – 18kcal/oz B – 20kcal/oz C – 22 kcal/oz D – 24 kcal/oz

11. Which of the following about vitamins and minerals for pediatrics is appropriately accurate? A – Fluoride supplementation should be started at 3 months B – multivitamin supplementation is needed in all infants C – vitamin D supplementation should occur in children if not taking 1000mL/day of VITD fortified milk D – iron supplementation is necessary for formula fed term infants

12. Cysteine is a conditionally essential amino acid in pediatrics. It is converted to taurine. In which population is it most important and for what reason? A – term infants, neural development B – preterm infants, neural development C – term infants, bone development D – preterm infants, bone development

13. The pH of a pediatric PN is important. Lower pH allows for the addition of more calcium and phosphorus which is important for bone building. Which of the following is true? A – Cysteine increases the pH of PN B – pediatric amino acids are high in phosphate C – lipids are administered separately to allow more additions of Ca/P to the PN D – Ca is always given 1:1 with phosphate

14. Calculate a proper dose of calcium and phosphate for a ex-36 week, 2 week old infant who is 2800gm. A – 7meq Ca; 3mmol phos B – 7meq Ca; 7mmol phos C – 5meq Ca; 3mmol phos D – 5meq Ca; 2.5mmol phos

15. Calculate the daily fluid requirement for a child who is 13kg. A – 1500mL B – 1300mL C – 1150mL D – 1350mL

16. Infant RF is a 6 month old 8kg. Calculate the appropriate formula requirement based on kcal requirements. (use standard formula (20kcal/oz)). A – 8 oz every 4 hours (no overnight feed) B – 6 oz every 4 hours (no overnight feed) C – 8 oz every 4 hours D - 6 oz every 4 hours

17. A 6 year old pediatric patient is to be given IVFE over 24 hours. Which would be the most appropriate for administration according to ASPEN? A – Draw down each 12 hour amount from 100mL container and administer each over 12 hours (prepare each bag 1 hour prior to administration time) B – Draw down 24 hour amount from 100mL container and administer over 24 hours C – Draw up each 12 hour amount into 2 separate syringes and administer each over 12 hours (prepare each syringe 1 hour prior to administration time) D – Draw up 24 hour amount in syringe and administer over 24 hours

18. What can be done to prevent excess levels of aluminum in pediatric TPN? A – eliminate multivitamins B – rotate stock of additives C – filter with 1.2 micron filter D – filter with 0.22 micron filter

19. Short Bowel Syndrome

20. Know the bowel lengths for the infants. Generally can tolerate removal of 40-50% of length of small intestine (this is why you need to know bowel lengths)

21. Predict if the following patient will be able to be weaned from long term PN. Surgeon reports 2 month old infant has 18cm of bowel and no IC valve/colon. A – weaning likely B – weaning unlikely

22. 12 day old preterm infant (36 wk GA, 2.5kg) is s/p laparatomy secondary to NEC and removal of 85cm of bowel. How much expected bowel length does this patient have left? A – 51% B – 28% C – 66% D – 34%

23. Where is B12 absorbed? A – ileum B – duodenum C – jejunum D – large intestine

24. In patients with cholestasis, which of the following would not be an appropriate therapy? A – avoid overfeeding B – ursodiol C – cyclic PN D – hold oral feeds

25. Which stage of SBS is referred to as bowel adaptation? A – Stage I B – Stage II C – Stage III

26. Irritable Bowel Syndrome

27. TJ presents to the ER with complaints of bloody diarrhea, abdominal cramping during defecation, and rectal urgency. Which is the more likely diagnosis? A – ulcerative colitis B – crohn’s disease

28. HB has just been diagnosed with UC as a result of bloody diarrhea and rectal urgency. CT scans have been performed and no infectious process is seen. The medical student asks for your opinion on what to start for treatment of UC. A – budesonide B – sulfasalazine C – metronidazole D – methotrexate

29. What is the benefit of adding on an immunomodulator like Azathioprine? A – works fast B – decreases steroid requirements C – low risk drug to add on D – little monitoring required

30. Which drug is affected by TPMT and the genetic phenotype of TPMT activity? A – methotrexate B – enbrel C – azathioprine D - sulfasalazine

31. WA has a fistula secondary to his CD. The attending on the team has heard you can use Infliximab to treat fistula from CD. What dose should be recommended? A – 5mg/kg x 3 doses (0,2,4 wks), no premeds B – 5mg/kg x 3 doses (0,2,6wks), no premeds C – 5mg/kg x 3 doses (0,2,4wks), premed with benadryl + APAP D – 5mg/kg x 3 doses (0,2,6 wks),premed with benadryl + APAP

32. Classify the following patient as mild, moderate, severe or fulminant UC. GC has 8 stools/day, ESR 35, Fever 100.5, and blood present in stool. A – mild B –moderate C – severe

33. Recommend appropriate therapy for TR who has recently been diagnosed with CD and has undergone a resection of part of his bowel and is now s/p this procedure. A – prednisone B – mesalamine C – infliximab D – budesonide

34. Which of the following is matched correctly? A – sulfaslazine – teratogenecity B – metronidazole – decreased sperm count C – azathioprine – fetal abnormalities D – methotrexate – decreases risk of abortion

35. Thanks!!! Please email me with questions. lhayes3@uthsc.edu