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CPS Statements > Drug Therapy and Hazardous Substances > Flashcards

Drug Therapy and Hazardous Substances Flashcards

1
Q

What are the benefits of Azithromycin?

A
  • easily given to kids in liquid prep
  • once daily dosing for short duration (3-5) days
  • good side effect profile
  • stable in acidic pH
  • bioavailability >30%
  • long halflife up to 96h
  • reaches high drug concentrations intracellularly particularly in phagocytes
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2
Q

What is the mechanism of action of Azithromycin?

A

-inhbits bacterial protein synthesis by binding to the 50S ribosomal subunit

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3
Q

What does Azithromycin cover?

A
  • less gram+ coverage against Strep pneuma compared to other macrocodes but more gran neg coverage against H. flu and Moraxella
  • does not cover strep pneuma resistant strains
  • does not cover H flu well
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4
Q

What is the resistance problem with Azithromycin?

A
  • increased resistance
  • pneumococcal resistance is higher to macrocodes than to penicillin
  • irony is that Azithro is most often used for URTI (e.g. AOM) and LRTI but many of those are caused by Strep pneumo
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5
Q

What is the CPS recommendation regarding the use of Azithromycin in kids?

A
  • should not be used to treat acute pharyngitis, AOM or community acquired pneumonia in others healthy kids except:
  • second-line treatment in the cases of life-threatening beta-lactam allergy
  • considered for treating atypical pneumonia
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6
Q

What are nosodes?

A
  • biological preparations used in homeopathic medicine to prevent disease.
  • derived from an element of a disease or from diseased tissue (either directly from the bacteria or virus or from a tissue that contains it) and is serially diluted by factors of 100 usually and given to prevent or treat a health disorder
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7
Q

Are nosodes approved in Canada?

A

-yes they are approved for human use under the Health Canada’s Natural Health Products Regulations. There is NO scientific evidence that noses are effective in preventing infectious disease

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8
Q

What is the concern with nosodes?

A

-that parents will see this as an effective alternative to immunization and vaccination

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9
Q

What is CAM (complimentary and alternative medicine)?

A

-healing resources that encompass all health systems, modalities and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture

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10
Q

What are examples of natural health products?

A
  • homeopathic preparations
  • traditional medicine (e.g. chinese, aboriginal)
  • mineral, trace element, vitamin, amino acid, etc
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11
Q

What is the principle of homeopathy?

A
  • preparation is made by diluting the agent and rapidly agitating
  • the greater the dilution, the greater the potency of the product
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12
Q

What is the principle of Traditional Chinese medicine?

A
  • goal is promotion, maintenance and restoration of health
  • disturbances in Qi manifest as disease
  • modalities include acupuncture, herbal remedies, dietary therapy, natural health products, exercise therapy, tuina massage
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13
Q

What is chiropractic treatment?

A
  • articular changes that compromise neural integrity, influence organ function and general health
  • many also recommend natural health products and dietary supplements
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14
Q

Which subgroups in peds have the highest use of CAMs?

A
  • arthritis
  • cancer
  • RA
  • CF
  • autism
  • homeless
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15
Q

Are there any RCTs that demonstrate support for the use of CAMs?

A

some do but the results are clouded by poor methodological rigour

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16
Q

What are the problems with CAMs in kids?

A
  • heterogeneity of plant species, the part of the plant, extraction technique
  • concern about contamination
  • dietary supplements do not require premarket testing of efficacy and safety
  • only 20-30% are labeled for paediatric use
  • dosing for kids is uncertain
  • kids have an immature blood-brain barrier allow active substances to gain access to the brain
  • oral absorption is less predictable
  • hepatic and renal clearance mechanisms are immature and changing
  • more likely to be used in kids with serious chronic illness so want to know about drug interactions
17
Q

What is our role as paediatrics with regards to CAM?

A
  • need to be proactive and ask about it
  • need to do more research to collect data about effectiveness and safety
  • we need formal training on CAM
  • CAM providers need formal training in paediatric education including vaccines
  • government needs to monitor safety
  • try to maintain an open, non-judgemental approach
18
Q

What are the potential harms of OTC cough and cold meds?

A
  • have resulted in ED visits
  • contributed to ALTEs
  • have been associated with paediatric deaths
  • effectiveness of most has not been proven in kids or has been shown to be harmful
19
Q

What are factors that were associated with fatalities from OTC cough and cold meds in kids?

A

-age

20
Q

What are the health canada and FDA statements regarding OTC cough and cold meds in kids?

A
  • should not use in kids 6 yrs

- FDA recommended that they should not be used in kids

21
Q

What are alternatives to cough and cold meds that you can advise families?

A
  • fluid consumption softens secretions
  • humidified air (cold or warm), evidence not strong in favour but no evidence of harm
  • NSAIDs for pain
  • antihistamines with decongestives had small effects on older kids
  • echinacea not effective
  • studies not conclusive about zinc
  • honey may be effective in kids >1 yr (reduces cough frequency and severity)
  • vitamin C good for prophylaxis of respiratory episodes but no clear guidance as to dosing
22
Q

What are the recommendations of the CPS regarding drug research in peds in Canada?

A
  • CIHR and industry should develop a national research network focused on the unique needs of kids
  • work to enhance human capacity in drug investigation
  • support drug studies in kids
  • define and address the evolving ethical challenges associated with trials in kids
  • suport innovation in drug research
  • government support for this at a federal level
23
Q

What are neural tube defects?

A
  • congenital malformations produced during intrauterine life by failure of closure of the neural tube (which eventually forms the CNS)
  • results in anencephaly (if at cranial end) or spina bifida (if at caudal end)
24
Q

Which drugs in particular have been implicated in contributing to neural tube defects?

A
  • valproic acid

- carbamazepine

25
Q

What is the recurrence risk for women who have had a previous pregnancy with a neural tube defect?

A

2% (although some high risk populations it can be 4-5%)

-baseline population risk is 0.004%

26
Q

How do we screen for neural tube defects prenatally?

A

-maternal serum alpha fetoprotein and US (if done at 15-20 weeks)

27
Q

Can you have additional testing for neural tube defects besides the screen?

A

-can have amniocentesis to measure alpha fetoprotein which will detect the presence of neural tube defects in >95% of cases
(risk of fetal loss is 0.5-1%)

28
Q

What can be done to prevent neural tube defects?

A

periconceptional folic acid supplementation

29
Q

What is the recommended dose of folic acid to prevent neural tube defects?

A
  • 0.4-0.8mg of folic acid per day
  • if have had a previous child with NTD then the dose should be 0.8-4mg per day. (optimal dose not yet known)

-reduces the risk by 60-70%

30
Q

What does the Canadian government do with regards to folic acid for the general population?

A

-fortify flour with folic acid

31
Q

What are the concerns with too much folic acid?

A

-high dose folic acid therapy can mask the haematological signs of pernicious anemia while the neurological complications can progress (pernicious anemia is Vit B12 deficiency)

  • no evidence at the recommended doses for preconception that this is a real risk
  • need to study adding additional folic acid to flour and what effect this would have

CPS Statements (14 decks)

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