Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology II > Exam 4 - Peds, Gers, & Rx Writing > Flashcards

Exam 4 - Peds, Gers, & Rx Writing Flashcards

1
Q

Gestational Age

A
  • Maturity at birth

- Based on dates (LMP) and PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Postnatal Age

A

-Chronologic age of child after its born

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Post conception age:

A

-Gestational age and post natal age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Preterm infant

A

< 37 weeks GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Full-term infant

A

37-42 weeks GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Post-term infant

A

> 43 weeks GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Newborn or neonate

A

0 to 1 month of age

First month of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Infant

A

1-12 month of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Toddler

A

1 -2 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Young child

A

2 - 5 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Older child

A

6 - 12 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Adolescent

A

13 - 17 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Absorption

A
  • Molecular weight
  • Particle size
  • pH and pKa
  • Dosage form (Need to be able to tolerate).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Two major determinants of gastrointestinal absorption of drugs:

A
  • Gastric acidity
  • Gastric emptying time

Differ greatly between infants and adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

pH dependent passive diffusion:

-Nonpolar, lipophillic states are better absorbed

A

↑ pH in pre-term infant compared to term infants; not producing as much acid yet.

↑ Gastric acid production with ↑ GA (lowers pH - acidic).

Gastric pH: 6-8 in full-term infant for 1-3 days (amniotic fluid).

Highest acid: 1-10 days
Lowest acid: 10-30 days
Lower limit of adult values by 3 months!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Effects drug absorption: Acidic/Basic

A 
Acidic drugs 
Increased ionization (more polar), which decreases absorption.

Basic drugs
Decreased ionization, will have increased absorption.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Gastrointestinal emptying time (GIT):

A

-GIT determines rate of absorption; much slower in infants less than 6 mos of age.

Congenital heart disease = ↓ blood flow = ↓ GIT.
Type of feeding
Gestational and postnatal age(more preterm = slower gastric emptying time).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does a shorter gut in a neonate/infant affect absorption?

A

-Shorter transit time decreases duration of drug contact with absorptive surfaces!

  • Extended release formulations are incompletely absorbed!
  • Leads to serum concentration variations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Intramuscular Absorption

A

Often easier than IV access in infants/neonates.

Blood perfusion to the area of injection

Rate of drug penetration through the capillaries

Apparent volume into which the drug has been distributed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Neonates and infants differ from older children and adults:

A
  • ↓ blood flow to muscles
  • ↓ extent of muscular contractions
  • ↓ rate of drug penetration
  • ↑ percent of water in muscles (high apparent volume of distribution due to high body water)
  • Peripheral vasomotor instability - Can’t regulate temperature well (blood flow is erratic).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Rectal absorption in infants/neonates:

A
  • ↑ bioavailability of some medications (thin mucosa).
  • ↑ mucosal translocation.
  • Neonates/children have ↑ amplitude of rectal contractions
  • Can cause suppositories to be pooped back out (re-dose if happens).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Intraosseus absorption in infants/neonates:

A

-Useful in emergent situations

  • Performed by inserting an intraosseous needle into bone marrow
  • Children have soft outer cortex of long bones with rich vascular bed of marrow
  • Full drug absorption
  • Easy administration - can do fluids, pressors, abx.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Percutaneous absorption in infants/neonates:

A
  • Children have underdeveloped stratum corneum; the skin thickness is inversely related to absorption.
  • Ex: Hypothyroidism from betadine (iodine).
  • Skin is well hydrated with ↑ perfusion.
  • Skin hydration directly proportional to absorption.
  • Ratio of body surface area (BSA) to body mass is significantly ↑ compared with adults.
  • May result in toxicity of topically applied drugs.
  • Seizures and anticholinergic toxidromes from antihistamine lotions
  • Hypoglycemia and lethargy from isopropanol baths
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Volume of distribution (Vd)

A
  • Relates amount of drug in body to serum concentration.
  • Adipose tissue, lipophillic drug, has a large volume of distribution.

Vd = X0/C0

X0 = dose administered
C0 = initial serum concentration

Hydrophillic - low volume of distribution, can’t distribute into fat, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

General factors affecting Vd:

A

-The more lipid soluble, the higher the volume of distribution.

  • Plasma protein binding (i.e. Albumin; doesn’t distribute far from blood stream, low VOD).
  • Tissue binding (Increases in VOD).

Disease state conditions affecting Vd:
-Critically ill states (e.g., burn victims/edema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Distribution in newborn infant:

A
  • Water 70 – 75% of the body weight
  • High extracellular water component

40% in infants vs. 20% in adults

  • Less fat tissue
  • Less muscle tissue

-Results in increased Vd for hydrophilic medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

“The Pediatric Bucket”

A

In order to get a similar blood concentration of drug in hydrophilic medications, pediatrics require HIGHER mg/kg dose than adults.

Why? Bc they have a higher water volume.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Gentamicin

A

Used for neonatal sepsis

Neonates have higher body water; goes down as you get older and have more fat tissue.

Dose:

  • Neonate: 4-5 mg/kg (high)
  • Infants/Children: 2.5-3 mg/kg
  • Adults: 1-2 mg/kg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Plasma proteins:

A

Neonates:
↓ plasma proteins
↓ protein binding/lower protein stores

Compounds that compete for protein binding; i.e. Bilirubin and Rocephin.

Examples:
Phenytoin (used for seizures)
-Decreased protein binding results in higher free fraction of drugs.
-Free levels are higher than you expect without protein binding, which leads to TOXICITY.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Why can’t Rocephin be given to neonates?

A

JAUNDICE

Displaces bilirubin from protein binding sites.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Albumin

A

Albumin

  • Reduced in neonate
  • Infants near adults
  • Children near adults

Neonates have higher free drug, less protein binding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Bilirubin

A

Bilirubin

  • Increased in neonate
  • Infants/children normal

Which is why you won’t see reactions with ceftriaxone after neonatal period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What factors alter drug metabolism in neonates/children?

A

↑ GA & postnatal age: more mature, able to metabolize drugs.

Changes in hepatic blood flow
↑ size of the liver
↑ in quantity & quality of hepatic enzymes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Phase 1 Reactions

A

Net effect: Add sulfur, hydroxyl, carboxyl, or amino group to make water soluble compounds

  • To be excreted by bile, lungs, & kidneys
  • Prepare for Phase 2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Cytochrome (CYP) P450 mixed-oxidative system is most important pathway in Phase 1.

What are the other specific pathways?

A

CYP450 activity of full-term infants is approx. HALF of that of adults.

  • Oxidation: example phenytoin. By 1 year of age postnatal activity increases to 2-5 times that of an adult. Metabolize phenytoin more quickly.
  • Reduction: example chloral hydrate
  • Hydrolysis: example procaine/tetracaine. Less metabolism, bc hepatic and plasma esterase activity are reduced in infants.
  • Demethylation: example theophylline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

CYP450

CYP2E1?
CYP2D6?

CYP2C?
CYP3A4?

A

Within hours after birth CYP2E1 activity increases rapidly. CYP2D6 is detectable soon after.

CYP2C and 3A4 are present within first month.

CYP3A4 activity in young infants may exceed adult levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Phase 2 Reactions

A

Net effect: Addition of endogenous chemical groups to drugs
Excreted by bile or kidneys

Sulfation

  • Ex: acetaminophen
  • Well developed/functional pathway at birth

Methylation

  • Ex: epinephrine
  • Well developed/functional pathway at birth
  • Not significantly utilized in hepatic metabolism of drugs in adults

Glucuronide conjugation
-Ex: morphine, chloramphenicol
-Undeveloped conjugation at birth (longer duration of activity -
high risk of toxicity), mature around 3 years of age

Glycine conjugation

  • Ex: benzyl alcohol (preservative)
  • Cannot conjugate it; will get toxic build up.
  • Neonatal Gaffing? Syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Excretion of drugs:

GFR in infants?
Preterm infants?

A

-Most drugs are renally excreted

GFR & infants:

  • ↑ serum creatinine (SrCr) for 1st week of life (Detecting what mom’s was).
  • Renal function ↑ during 1-2 wks of life

Pre-term infants have ↓ GFR:

  • Immature quality & quantity of glomeruli
  • Immature proximal tubules
  • Reduced renal blood flow

Measure urine output to see how kidneys are functioning.
1ml/kg/hr = Normal; less we are concerned.

6 months of age, they’ll have normal kidney function. 100ml/min.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How does GFR affect half life of gentamicin?

A

Gentamicin

  • Eliminated through kidneys
  • Drugs have longer half-life
  • Takes longer to clear through their kidneys

Preterm babies will take longer to clear it; need to adjust dose accordingly.

Neonate < 1 wk, 3-11.5 hrs
1wk to 1mo 3-6 hrs
Infant 4 hrs 
*Declines as kidneys develop.
*Dose based on gestational age

Ex: Neonate 0-28 days
< 36 wks, every 48hrs.
> 36 wks, every 24hrs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Tubular secretion & reabsorption

A

-Both are significantly ↓ in 1st year of life

General concerns with renal tubular development:
↓ renal blood flow
↓ ability to concentrate urine in kidney
Low urinary pH values

Low urine pH will be acidic to reabsorb acidic meds (aspirin, phenobarb) - increases half-life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How do pharmacogenetics affect codeine metabolism?

A

-CYP2D6: converts codeine to morphine (active form)

  • Poor CYP2D6: slow metabolizer, less effective drug
  • Ultra CYP2D6: convert a lot, drug is more effective
  • Mother (exaggerated response)
  • Child (exaggerated or diminished response)
  • Black box warning: Death Related to Ultra-Rapid Metabolism of Codeine to Morphine.
  • Respiratory depression and death have occurred in children who received codeine post-tonsillectomy and/or adenoidectomy and were ultra-rapid CYP2D6 metabolizers.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Aged-Based Dosing Regimens

A
  • Advantage: Easy to use in practice

- Disadvantage: Assumes maturation of ADME principles is “equal” in all patients; can cause under/overdose.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Body weight dosing regimens:

What are the advantages?

Need to know how to dose pediatrics patients on exam

A

Neonates/infants: 20-30 mg/kg/day PO divided q 12 h

Infants > 3 mo/children: 25-50 mg/kg/day PO divided q 8-12 h

Adults: 200-500 mg PO q 8 h

Advantage:

  • MOST COMMON dosing scheme utilized
  • Children have ↑ med clearance based on weight.
44
Q

If you have a large child whose dose is calculated greater than adult dose (500mg), how do you treat them?

A

Cap dose at the adult dose: 500mg.

45
Q

What are disadvantages of dosing via body weight of child?

A

Disadvantages

  • Potential for over-dosing or under-dosing in overweight children
  • ↑ incidence of overweight children (1/3)
46
Q

Body Surface Area Dosing:

A

Ex: corticotropin—150 mg/m2 IM divided bid

Advantage:

  • More precise for meds requiring calculations
  • Limits potential for OD based on weight

Disadvantage:

  • Difficult to estimate length, height in children (contractures)
  • Numerous BSA calculations
47
Q

Intravenous Drug Administration

A
  • Difficult to get access
  • Volume - Give drug as concentrated as possible; prevents fluid shift.

-Multiple drugs & frequency

  • Intraosseous access easiest in emergencies.
  • Therapeutic drug monitoring (e.g. drug sampling) - Blood can affect hemoglobin, so get as many labs as possible from one sample.
48
Q

IV admin: important to use?

A

Syringe pumps, to make sure you’re infusing right amount into patient.

Rapid infusions can cause pulmonary edema, this is controlled in pumps to prevent.

49
Q

Oral Administration

A
  • Need accurate measuring devices
  • Dosage forms: tablets or liquids; suppositories used in infants.
  • Sensory appeal (gross tasting)
  • Drug-food interactions
  • Inactive ingredient (lactose, dyes, etc).
50
Q

How do you prescribe medications to pediatric patients?

A
  • Obtain current weight
  • Check dose with available references

Consider counseling points with children:

  • Provide child specific language if needed
  • Provide counseling to older children/guardians
51
Q

Drug Dosing

A

IMPORTANT
IMPORTANT
IMPORTANT

52
Q

15 kg child requires amoxicillin for acute otitis media

90 mg/kg/day divided BID

Amoxicillin suspension: 400 mg/5 mL (5 mL = tsp).

How much should this child receive per dose?

A

Dose per day = 15 kg x 90 mg/kg/day = 1350 mg/day

1350 mg/day divided BID = 675 mg/dose

Convert to volume:
400 mg/5 mL = 80 mg/mL

675 mg/dose ÷ 80 mg/mL = 8.4 mL/dose

53
Q

18 kg patient needs ranitidine for GERD symptoms

4 mg/kg/day divided BID
Ranitidine syrup= 15 mg/mL

How much should they receive per dose?

A

18kg * 4mg/kg/day = 72mg/day

72mg/day / BID = 36mg/dose

36mg/dose divided by 15mg/mL

2.4mL BID (round to 2.5mL)

54
Q

12 kg patient is receiving trimethoprim/sulfamethoxazole for cellulitis

4 mg TMP/kg/dose BID

Suspension: sulfamethoxazole 200 mg and trimethoprim 40 mg/5 mL

How much should this child receive?

A

12kg * 4mg TMP/kg/dose = 48mg/dose given BID

40/5 = 8mg/mL

48mg TMP / 8 = 6mL

6mL in AM and PM

55
Q

20 kg child is receiving 2 tsp acetaminophen 4 times a day for fever

Usual dose 15 mg/kg/dose

Acetaminophen suspension: 160 mg/5 mL

Is this child being dosed appropriately?

A

160mg/5ml = 32mg/ml

2 * 5 ml = 10mL QID

32mg/mL * 10mL = 320mg per dose

320mg /20kg = 16mg/kg

He’s getting 1mg extra per dose. Should be getting 15mg/kg/dose.

56
Q

What’s the measurement for a fluid bolus?

A

Fluid bolus: 20 mL/kg

57
Q

Maintenance IV Fluid Calculations

A

4:2:1 Rule

4 mL/kg/hr for the first 10 kg
2 mL/kg/hr for the second10 kg
1 mL/kg/hr for every subsequent kg

58
Q 
Bolus and Maintenance fluid rates for:
8 kg infant
1200 g neonate
45 kg adolescent
100 kg teenager
A

Bolus: 160mL, 24mL , 900mL, 2000mL (give 1L and see how he does before giving 2L).

Maintenance: 32mL/hr, 4.8mL/hr, 85mL/hr, 140mL/hr

59
Q

A 24 kg patient is receiving lidocaine 1% solution for intradermally for a laceration to the face.

The max dose the patient can receive is 5 mg/kg at one time.

How many mL can this patient receive?

A

5mg/kg * 24kg = 120mg
MAX DOSE

1% = 10mg/mL
2% = 20mg/mL

120mg / 10mg/mL = 12 mL injected before toxicity

60
Q

GERIATRICS

A

Geriatric: 65 years of age or older

US life expectancy – 79 y/o

61
Q

Comprehensive Geriatric Assessment (CGA)

A

Focuses on elderly individuals with complex problems

It emphasizes functional status and quality of life. Assess psychosocial, medical, and functional capabilities and limitations.

  • Basic ADLs
  • Intermediate ADLs - taking meds by themselves
  • Advanced ADLs - volunteering at hospital
62
Q

Nutritional Assessment

A

Decreased appetite

  • Loneliness, depression, medications, ill-fitting dentures
  • Constipation, CHF, cancer
  • Finance
  • Unable to prep meals

Supplements
-Recall food, drinks, vitamins, or supplements in last 24 hrs and amount.

  • Eat varied foods, vegetables, milk, fruits
  • Balanced diet
  • Drinks of beer, liquor, or wine daily
  • Takes 3 or more Rx or OTC drugs per day
  • Has lost 10 lbs without trying over the last 6 months
63
Q

Ginseng

A

Ginseng has anticoagulants on top of warfarin, patient had massive head bleed and died from it.

64
Q

Lab tests in CGA:

A

CMP – kidney, liver, electrolytes, fasting glucose, protein (albumin), and acid/base balance

Renal function: (Albumin, BUN/Creatinine Ratio [calculated], Calcium, Carbon Dioxide, Creatinine, Estimated Glomerular Filtration Rate [calculated], Glucose, Phosphate [as Phosphorus, Potassium, Sodium, Urea Nitrogen)

Liver function: (Total Protein, Albumin, Total Bilirubin, Direct Bilirubin, Alkaline Phosphatase, AST, ALT)
Serum cholesterol/lipid panel 
A1C
CBC - Hemoglobin/hematocrit/WBC/plt
Vitamin B12 levels
UA
65
Q

Polypharmacy

A

Polypharmacy – the use of five or more regular medications

Reasons

  • Longer life expectancy
  • Increase chronic diseases
  • Evidence-based clinical practice guidelines (EB CPG)
66
Q

Polypharmacy causes:

A

Age and Co-morbidity 8% increase in number of medications with each additional disease

Example: pt w/ osteoporosis, osteoarthritis, T2DM, HTN, & COPD – 12 different medications at 5 different times per day.

  • Evidence-based guidelines
  • Hospitalizations: 57.4% of pts were prescribed more Rx on discharge than they were on prior to admission
67
Q

Consequences of polypharmacy

A
  • ADR
  • Falls - sedation, hypotension, lightheaded, decreased alertness
  • Decreased compliance
68
Q

Why do patients have decreased compliance?

A

Complex dosing schedule
Multiple medications
Economics – cost of Rx
Lack of Support (formal or informal) – someone to ensure they take the Rx
Mental decline – can’t remember right drug/time
Visual impairment – can’t see right drug or dose
Decreased swallowing ability
Decreased venous access – IV dose
Pt willingness to adhere to treatment

69
Q

End of life

A

Pts have less than 6 months to live; when treating those over 65y/o, tailor to patient’s goals.

70
Q

Cardiac age related changes

A
  • Higher systolic arterial pressure
  • Impedance to left ventricular ejection
  • Reduced heart rate
71
Q

Renal age related changes

A
  • Decrease renal mass
  • Reduced blood flow to the afferent artery
  • Decline in glomerular filtration rate (GFR)
  • Decrease ability to maintain acid-base balance
72
Q

GI age related changes

A
  • Decrease hydrochloric acid and pepsin; decreased gastric emptying
  • Small intestine – decreased absorption
  • Colon – decreased motility
  • Pancreas – decrease lipase and trypsin
  • Liver – decreased blood flow, metabolism, elimination, and liver mass(size)
73
Q

PK age-related changes

Absorption
Drug distribution
Protein binding

A

Absorption

  • Dietary changes, increased OTC meds (laxatives, antacids)
  • Impaired gastric emptying (diabetics)

Drug distribution

  • Reduced lean body mass (muscle decrease, fat increase)
  • Reduced body water

Protein binding

  • Decreases in serum albumin, less drug binding so higher free fraction
  • Increase in α-acid glycoprotein
74
Q

Geriatric drug clearance - kidney

A
  • Reduced renal function
  • Increase in serum creatinine not proportional to decrease in creatinine clearance
  • Less muscle mass in old age
  • Prolonged half-life of drugs
  • Increased risk of toxic concentrations
  • Affected by hydration status
75
Q

Creatinine Clearance

A

Cockcroft-Gault equation
CrCl = (140-age) * (weight in kg)
-THEN DIVIDED BY 72*SCr
-Multiply by 0.85 for women

MDRD equation better for older patients.

76
Q

Creatinine = 0.8

A

When estimating renal function > 70yo, if Cr < 1.0, round up to one anyway

Do not want to over estimate their renal function.

77
Q

PK age-related changes

Drug Clerance
First pass metabolism
Phase 1 and 2

A
  • Drug clearance – liver (capacity of the liver to extract drug from the blood based on hepatic blood flow)
  • First-pass metabolism and bioavailability
  • Decreased function of phase I reactions (CYP450)
  • Minimal changes in phase II reactions
  • Decreased metabolism due to impaired liver blood flow
78
Q

Are geriatric patients more “sensitive?”

A

Can’t eliminate as well, etc.

Can’t compensate for changes in BP, poor homeostatic response

May change pattern or intensity of drug response

-CO, postural hypotension, temperature, FBG

79
Q

SPECIFIC DRUG CLASSES

A

…

80
Q

Sedative hypnotic agents

A
  • CNS depression: causes ataxia, falls, altered mental status
  • Half-life increased 50-150%
  • Accumulate metabolites (altazepram)
81
Q

Analgesics - opioids

A
  • Susceptible to respiratory depression, esp with OSA, COPD, obese
  • Accumulation of metabolites
82
Q

What dont you use on geriatrics?

A

DRUGS WITH METABOLITSE

83
Q

Lithium

A
  • Decreased clearance with renal function

- Concomitant diuretics can increase accumulation

84
Q

Antidepressants

A

Older agents put patients at risk for altered mentation and falls

Newer agents (selective serotonin reuptake inhibitors, SSRIs) are much safer

Prevent sedative ones, avoid MAOI and TCA - hypotension, sedation, altered mental status

85
Q

Antihypertensives

A
  • increased risk orthostatic hypotension

- electrolyte imbalance from diuretics, can affect arrythmias

86
Q

antiarrythmics

A
  • poor hemodynamic reserve
  • electrolyte imblance

-Extended half life of quinidine, procrainamide, lidocaine

more likely to see toxicity with them

87
Q

Tecasin

A

Class 3 antiarrythmic

Mg, K levels need to be normal or leads to TORSADES

88
Q

ADR probability

A

single med = 10%

10 meds = 100%

89
Q

Patients may not recognize drug prodts as medicine:

A

BC powders “Goody’s”

90
Q

RX WRITING

A

…

91
Q

Prescription

A

Prescription = written, verbal, or electronic order from a practitioner to be fulfilled by a pharmacist, lab, etc.

Prescribing practitioners
MDs, DO
PA, ARNP
Podiatrist
Veterinarian
Optometrist
92
Q

State vs. Federal laws

A

Go with whichever is stricter
If not addressed in state law, follow federal law

State: OK to marijuana
Feds can shut down at any time

If not addressed in state law, follow federal law

93
Q

Prescription Requirements

Basic requirements (non-controlled substances)

A

If written or typed, must be LEGIBLE

  • Name of practitioner
  • Name and strength of drug prescribed
  • Quantity of drug to dispense
  • Directions for use
  • Must be dated
  • Signed by prescriber on date issued
94
Q

Rules

A

-No pre-signing prescriptions

  • Scripts can be called in or communicated electronically
  • Must be reduced to written Rx if called in

-All prescriptions are only good for one year (at most)

95
Q

Can you write more than one med on a script?

A

-Multiple non-controlled orders may go on the same prescription

  • Keep controlled substances SEPARATED
  • CII must be by themselves
96
Q

According to FL statute for non-controlled prescriptions, ____ is not required on script:

A

Name
Date of birth

Not on FL statute
Indications preferred

97
Q

How long does a script last?

A

365 days

98
Q

FL LAW

A

Automatically dispenses a generic unless script says

“Dispense as written”

99
Q

Additional requirements for controlled substances

A
  • Name AND full address of the patient (or owner of the animal)
  • If for an animal, the SPECIES must be specified
  • Full name and address of the prescribing practitioner along with DEA number
  • Written and numerical quantity to dispense

40 (forty)

100
Q

Schedule II substances

A

Must be written/typed - No electronic or verbal transmittal!!!! C2

No refills – may be written up to 90 days worth or as 3 different prescriptions to be filled on different dates.

Must be HAND-signed by provider. NO EXCEPTIONS.

101
Q

Schedule III-V

A

III-IV: May only have 5 refills (total of 6 months after Rx written).

May be communicated by phone or facsimile
- benzos, seizure meds

102
Q

Counterfeit Proof Paper

A
  • Produced by specific vendors
  • Must be used for controlled substances not electronically transmitted.
  • Must be hand signed by provider
  • Photocopy = VOID
103
Q

How to keep the pharmacist from calling you… :)

Include strength and dosage forms

A

Don’t write in teaspoon or tablespoon. Use mL only.

Avoid trailing zeros - 5.0 mg read as 50.

Always use leading zeros .1 misread as 1.

104
Q

How to keep the pharmacist from calling you… :)

Include quantity of drug

A

Make sure quantity makes sense based on what’s prescribed (tabs, caps, etc. per day x treatment days)

If you want brand name, must write DAW = Dispense as written

Pharmacies will automatically substitute if possible

105
Q

phone calllllls

A

Include indications

Clarifies instructions for pharmacists. Clarifies instructions for patients.

106
Q

Review patient’s med profile to make sure there are no:

A
  • Antagonistic combinations
  • Duplicate therapies
  • Allergies
  • Make sure things are legible
  • Write within your scope of practice
  • Dermatologist writing for ADHD meds

Pharmacology II (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions