Misc. exam 3 studying

Question 1

True or false: Hepatotoxicity from felbamate is an example of an idiosyncratic SE

Answer 1

True

Question 2

True or false: ALL anti-seizure drugs carry a warning for suicidal ideation and behavior

Answer 2

True

Question 3

List 3 examples of idiosyncratic adverse effects

Answer 3

1) Hepatoxicity
2) SJS/ TEN
3) Suicidality/ mood

Question 4

Give examples of inducers of both CYP and UGT

Answer 4

1) Phenobarbital
2) Phenytoin
3) Primidone
4) Valproate/Divalproex

Question 5

Is Lamotrigine an inducer or inhibitor?

Answer 5

Inducer of UGT

Question 6

When to give dexamethosone:

Answer 6

1) H. influenzae meningitis: recommendations by the IDSA call for the use of adjunctive dexamethasone in infants and children (6 weeks old+)
-0.15 mg/kg every 6 hours for 2 to 4 days, initiated 10 to 20 minutes prior to or concomitant with the first dose of antibiotics
2) Pneumococcal meningitis
-Pediatrics: consider risk vs. benefit
-Adults (suspected or proven): 0.15 mg/kg (up to 10 mg) every 6 hours for 2 to 4 days with the first dose administered 10 to 20 minutes prior to first dose of antibiotics
3) Pros/ Cons:
-Associated with lower rates of hearing loss and short-term neurological sequelae in adults and children
-Potential concern is that adj. therapy may reduce the penetration of antibiotics

Question 7

What age group would you expect to see H. influenzae meningitis in?

Answer 7

1-23 months

Question 8

H. influenzae:
1) Prevention?
2) Prophylaxis?

Answer 8

1) Vaccines
2) Rifampin PO QDay for 4 days (20 mg/kg/dose; maximum, 600 mg).

Question 9

N. meningitidis
1) Prevention?
2) Prophylaxis?

Answer 9

1) Vaccines
2) Antimicrobial chemoprophylaxis of close contacts should be started as soon as possible (ideally <24 hours after identification of the index patient). In general, rifampin, ceftriaxone, and ciprofloxacin are recommended for prophylaxis, however

Question 10

Streptococcus agalactiae (Streptococcus Group B)
1) Prevention?
2) Prophylaxis?

Answer 10

1) None
2) Intrapartum options are: penicillin, ampicillin, cefazolin (if penicillin allergy and not at high risk for anaphylaxis), or vancomycin (if penicillin allergy and at high risk for anaphylaxis)
-Penicillin G: 5 million units IV initially (started at time of labor or rupture of membranes), then 3 million units IV every 4 hours until delivery (guideline dosage)

Question 11

What are the 2 reasons you’d opt for dexamethasone?

Answer 11

1) Empiric therapy
2) If you know pt has H. influenzae or pneumococcal meningitis