CPS Drug Therapy and Hazardous Substances Committee Flashcards
What are factors associated with fatalities from over-the-counter cough and cold medications in children? (7)
- Age < 2 yo
- Use in daycare setting (lots of kids, easy to misdose)
- Use of the medication for sedation
- Combining 2 or more medications with same ingredient
- Failure to use a measuring device
- Product misidentification
- Use of products intended for adults
What is the recommendation from Health Canada on the use of over the counter cough and cold medications?
Do NOT use any cough or cold formulations in children < 6 yo
- for children > 6 yo, need to use with caution
- **There is no evidence that these medications cause improvement of symptoms
What is the evidence for use of the following in treatment of children with cough and cold symptoms due to a viral illness? (Recommended, meh, or not recommended)
- fluids
- humidified air
- NSAIDs
- antihistamines
- echinacea
- zinc
- honey
- vitamin c
- Fluid intake: RECOMMENDED (softens secretions and maintains hydration)
- Humidified air: Meh. No evidence proving that it works
- NSAIDs (ie. ibuprofen): Meh. (decreases discomfort or pain but does not reduce duration of cold)
- Antihistamines: NOT RECOMMENDED (too sedating with no positive effect)
- Echinacea: NOT RECOMMENDED (no evidence in Cochrane review showing that it actually works in children as treatment or prophylaxis)
- Zinc: NOT RECOMMENDED (no evidence that it works)
- Pasteurized honey: RECOMMENDED (very safe, decreases mucous, antioxidant properties, increases cytokine release which may result in antimicrobial effects, shown to effectively decrease cough frequency/severity and child/parent sleep quality; give 2.5 ml of honey before sleep to improve cough and sleep quality)
- Vitamin C: NOT RECOMMENDED FOR TREATMENT (cochrane review of more than 30 comparisons and 11,000 participants, no significant improvement of symptoms was noticed with the use of Vitamin C) BUT may be useful for PREVENTION OF COLD/COUGH (consistent benefit shown in multiple studies but no clear recommendation can be made with dosing or how to use regularly)
Fill in the blanks: failure of neural tube closure at the cranial end results in ______ whereas failure of closure at the caudal end results in ______.
Cranial end: anencephaly
-Caudal end: spina bifida
What is the most prevalent congenital malformation associated with mortality in the immediate perinatal period?
-2nd most common?
Most common: cardiac malformations
-2nd most common: neural tube defects
What two drugs taken during pregnancy can increase risk of neural tube defects?
- Valproic acid
2. Carbamazepine
What are the 2 most common neural tube defects diagnosed at birth?
- Anencephaly: not compatible with long term survival
2. Spina bifida: can be surgically corrected but may not improve motor function
Which 3 ethnic groups are at higher risk for neural tube defects compared to the general population?
- Welsh
- Irish
- Sikh
What is the recurrence rate for women who have had a pregnancy which resulted in an infant with a neural tube defect?
2%
What are 2 prenatal screening tests to detect neural tube defects?
-detection rate?
- Maternal AFP
- Obstetrical ultrasound
- together detects 85-90% of affected pregnancies if performed between 15-20 weeks of gestation
If a woman has had a previous child with neural tube defect, what can you offer during her current pregnancy to try to determine whether the fetus has a neural tube defect?
- detection rate?
- risk of fetal loss?
Can offer amniocentesis for measurement of amniotic fluid alpha fetoprotein
- detects in >95% of cases
- assocaited with 0.5-1% risk of fetal loss
What is the recommended dose of folic acid for women of child-bearing age in order to reduce the risk of neural tube defects?
- what about dose in women with previous child with neural tube defect?
- what is the reduction in risk?
In women of child-bearing age: 0.4-0.8 mg folic acid per day
- in women with previous affected child: 0.8-4 mg (optimal dose is yet to be found)
- reduction in risk: 60-70%
What are the neurological complications of pernicious anemia?
Pernicious anemia = vitamin B12 deficiency
- Peripheral neuropathy
- Posterolateral spinal cord degeneration
What is the concern with fortifying foods with folic acid so that all women of child-bearing age will receive enough?
-is there merit to this concern?
Concern is that for people with pernicious anemia (ie. vit B12 deficiency), the addition of folate can mask their megaloblastic anemia and thus delay diagnosis of pernicious anemia
-HOWEVER this does not occur at the doses of folate recommended for primary prevention of neural tube defects and there have been no case reports of pernicious anemia masked by folic acid in these doses
Which food could be chosen for fortification with folic acid to provide an average daily intake for women of child bearing age of betwen 0.5-1 mg per day?
Flour!
