FRCPC Pharmacology Review Flashcards
What is the most common side effect of cephalosporins?
- Diarrhea
Why do we no longer use codeine to control post operative pain?
- Some children are ultra fast metabolizers of codeine and in these children there is an increased risk of mortality due to overdose
A mother wants to use nasal decongestants for her 4 year old. Why do you recommend against it?
Increased risk of rebound nasal congestion
List 5 drugs associated with pseudotumor cerebri
- Tetracyclines
- Systemic tretinoin (not topical)
- Vitamin A
- Sulfonamides
- Nalidixic acid
- Corticosteroid therapy and withdrawal
- Nitrofurantoin
- Cytarabine
- Cyclosporin
- Phenytoin
- Mesalamine
Mother is concerned about the effect of inhaled corticosteroids on her child’s height. What do you tell her?
Will lose about 1cm of his genetic height potential
What is the teratogenic effect of carbemazepine?
Neural tube defects
Asthmatic patient needs sedation. Which medication would you try to avoid because of the excess histamine release associated with it?
Morphine
What is the most common side effect of diazepam in the neonate?
Respiratory depression
Which antiepileptic medication causes bilateral renal calculi?
Topiramate
An 8 year old child is status post renal transplant and is started on clarithromycin for AOM. He had normal cyclosporine levels initially but three days later his cyclosporine levels are elevated. What is the most likely explanation?
Clarithromycin (and other macrolides) are inhibitors of the p450 enzyme system in the liver which would cause decreased metabolism of the cyclosporine.
9 year old boy is on phenytoin and valproic acid for epilepsy. Mother noticed gum hypertrophy. What would you recommend?
Discontinue the phenytoin
List 5 consequences of using anabolic steroids
- In men: Testicular atrophy, decreased sperm count, gynecomastia
- In women: acne and menstrual irregularities, hirsutism and male pattern baldness
- Cholestasis without signs of inflammation (toxic hepatitis)
- Liver cancer
- Jaundice
- Acne
- Marked striae
Child with AOM is prescribed amoxiclav in a 4:1 dose and presents with vomiting and diarrhea. What is the reason why?
Dose of clavulin is too high, should be prescribed in a 7:1 dose to maximize treatment benefit while minimizing side effects like vomiting and diarrhea
During RSI when is succinylcholine contraindicated?
Muscular dystrophy
Which sedative drug has the most amnestic effect?
Midazolam
List 5 side effects associated with marijuana use
- Gynecomastia
- Galactorrhea
- Conjunctival injection
- Decreased intraocular pressure
- Cough, sputum production, inflammatory changes
- Increased risk of lung cancer, HEENT cancer, bladder cancer
- Psychosis
- Tachycardia, hypotension
- Cannabinoid hyperemesis syndrome
- Decreased sperm count
Mother is worried about the risk of drug dependency in her child who was just started on a stimulant for ADHD. What do you tell her?
- In general, kids with ADHD are at a higher risk for substance use problems than kids without ADHD
- Of the children with ADHD who are treated, their risk of substance use problems is decreased compared to kids with ADHD who are not treated.
What is a late onset side effect of stimulants?
Depression
Why is diazepam rarely used as an anticonvulsant in neonates?
Decreased hepatic clearance
What are the main differences between a neonate and an adolescent with respect to drug dosing?
Increased distribution of liquid
What is one long term side effect of anthracycline chemotherapy?
Dilated cardiomyopathy, all kids who received it should be screened with an echo
What is one estrogenic side effect of an OCP?
Breast tenderness
Why should ketamine not be used for kids where there is a risk of raised ICP?
Symathomimetic effect can further raise ICP
List 5 absolute contraindications of OCPs
- Undiagnosed vaginal bleeding
- Migraine with aura
- Severe hypertension
- History of CVA, DVT, PE
- Liver disease
- Pill induced HTN
- Pregnancy
- Breast cancer
- SLE
- HUS
- TTP
How long after a child receiving IVIG do you need to wait before giving live vaccines?
11 months
A child on dilantin is given septra for an infection. She returns ataxic with abnormal speech. What is the mechanism of this interaction?
Septra causes decreased metabolism of dilantin
What is one treatment you can recommend for neuropathic pain?
Gabapentin
Which antiepileptic medication has the side effects of hepatitis, pancreatitis, thrombocytopenia?
Valproic acid
Which antiepileptic medication has the following side effects: rash, gingival hypertrophy, ataxia, double vision, slurred speech, confusion?
Phenytoin
Which antiepileptic medication has the following side effect profile: N/V/D, hyponatremia, rash, pruritis, drowsiness, dizziness, blurred vision, lethargy and HA?
Carbemazepine
Which antiepileptic medication has the following side effect profile: Increased salivation, N/V, constipation, somnolence, aggression, irritability, ataxia, insomnia
Clobazam
Which antiepileptic medication has the following side effect profile: increased risk of infection, fatigue, somnolence, dizziness, agitation, anxiety, irritability, depression
Levetiracetam
Which antiepileptic medication has the following side effect profile: Nausea, rash, altered sleep cycles, sedation, lethargy, behavioural changes, hyperactivity, ataxia, tolerance, dependence
Phenobarbitol
Which antiepileptic medication has the following side effect profile: weight loss, paresthesias, fatigue, nervousness, difficulty concentrating, confusion, depression, anorexia, language problems, anxiety, mood problems, tremor
Topiramate
Which antiepileptic medication has the following side effect profile: vision loss, drowsiness, fatigue, dizziness
Vigabatrin
A teen in your practice is on risperidone and fluoxetine. He presents to the office with tremors, ataxia, hyperreflexia, increased agitation and poor concentration. How to manage this?
Stop fluoxetine
List the diagnostic criteria for serotonin syndrome
Patient must have ingested a serotonergic agent and present with one of the following:
- Spontaneous clonus
- Hypertonia PLUS Hyperthermia PLUS ocular clonus or inducible clonus
- Inducible clonus PLUS agitation OR diaphoresis
- Tremor PLUS hyperreflexia
- Ocular clonus PLUS agitation or diaphoresis
Child presents to hospital with tonic movements, ataxia, vomiting and inability to close his mouth. Had been vomiting and mom was giving him a suppository she cannot remember the name of. How would you manage this?
Give diphenhydramine.
Worried about EPS and neuroleptic malignant syndrome due to suppository of promethazine
14 year old is being treated with accutane for severe cystic acne. What is one of the most serious side effects of this medication?
Depression and suicidal ideation
What is the mechanism of pain control in morphine?
Reduces sensation of pain and emotional perception of pain
Which type of overdose is NOT associated with increased ICP?
TCA overdose
What is the most common side effect of prozac?
Drowsiness
What should be used for sedation in a patient with head injury for a CT scan?
Midazolam
A 3 year old has a 5 day history of rhinorrhea and nasal congestion with cough and low grade temps for which mother has been giving tylenol. What is your next step?
Counsel mother about the risks of giving too much tylenol to this child
What is the best way to assess for postoperative pain in a child?
Use a visual analog pain scale
What is the mechanism of action for insulin?
Induces glycogen synthesis
Which medication is known to cause sexual dysfunction in adolescents?
Antidepressants
A 14 year old is being treated for osteomyelitis and has ongoing pain despite being on tylenol and an NSAID. Which would be the nest best choice to manage his pain?
Narcotic
What is the main reason why metaclopromide is not more commonly used in pediatrics?
Side effect profile is too crazy
What is the calculation used to calculate anion gap?
Na - HCO3 - Cl
What is one long term complication of methanol toxicity?
Vision loss
What is one medication that can be used to treat methanol toxicity?
Fomepizole
List two things you can do to manage opioid overdose
- Support the airway
- Consider naloxone
Child is recovering post operatively. Received a dose of codeine and now is fount to be very somnolent with SPO2 of 94%. Why?
Child must be a hyper fast metabolizer of codeine.
Name 5 side effects of indomethacin
- Platelet inactivation
- Oliguria
- GI bleeding
- Nausea, vomiting, epigastric pain
- Headache
- Hypersensitivity reaction
- Acute kidney injury
- Hepatic dysfunction/failure
Child is taking a newly prescribed SSRI. What are the two most important side effects to warn about?
- SSRI (Citalopram) can be associated with QT prolongation
- SSRI can be associated with increased risk suicidal ideation
List 5 serotonergic side effects of SSRIs
- GI upset
- Restlessness
- Appetite changes
- Sleep disturbance: insomnia, somnolence
- Sexual dysfunction
- Headache
Parents ask about giving cough medicine to their child. What do you tell them?
- Use of OTC medications is not beneficial in most cases and is associated with increased risk of morbidity and mortality due to dosing errors, using more than one product with the same active ingredient and using products that were made for adults
- Bottom line: don’t do it
Child receiving vancomycin. 30 minutes into infusion develops a red rash all over his body. What do you do?
- Interrupt the infusion and treat with 50mg diphenhydramine
- For the next infusion, try running it at a lower infusion rate and also premedicating with diphenhydramine prior to the infusion
List 4 absolute contraindications to ketamine
- Patients under three years old
- Patients with psychosis
- Patients with history of severe reactions to ketamine in the past
- Patients with increased intraocular or intracranial pressure
Girl with developmental delay is on valproate for seizure control. Mother is concerned because for the past 1-2 weeks she has been irritable and vomiting every day. List 4 investigations you would do.
- Valproate level
- Ammonia level
- Serum electrolytes (for history of vomiting)
- AST/ALT
- CBC and differential
List 3 side effects of risperidone
- Metabolic: Weight gain, metabolic syndrome, dyslipidemia
- Qt prolongation
- Neuroleptic malignant syndrome
- Leukopenia
- Hyperprolactinemia
List 6 clinical signs of gravol overdose
- Mad as a hatter: delirium
- Hot as a hare: hyperthermia
- Red as a beet: flushing
- Dry as a bone: anhidrosis
- Blind as a bat: pupillary dilation
- Full as a flask: urinary retention
List three long term side effects of cyclophosphamide
- Pulmonary fibrosis
- Gonadal dysfunction
- Hemorrhagic cystitis, bladder cancer
Child is at home receiving palliative care for AML. List four principles of using opiates that will guide your management.
- Prescribe regularly dosed medication
- Have PRNs that can be used for breakthrough
- Increase the dose as needed if the patient develops tolerance
- Manage side effects: constipation, pruritis, nausea
What complication is associated with erythromycin use in neonates?
Pyloric stenosis
14 year old girl found in a field by her friends and is disoriented and confused. Found to have Jimson weed on her. List 4 things you might expect to find on clinical examination.
- Cutaneous vasodilation
- Hyperthermia
- Mydriasis
- Urinary retention
- Delirium
- Anhidrosis
List 5 side effects of furosemide in a neonate
- Hypokalemia
- Hyponatremia
- Ototoxicity
- Transient rise in BUN
- Nephrocalcinosis
