Pharm Flashcards
phenytoin side effect
P450 Hirutsim Enlarged gum Nystagmus Yellow/brown skin Teratogenic Osteomalacia Intefere with folic acid/anemia Neuropathy - vitiligo, ataxia and h/a
4 year old boy 4 days post tonsillectomy and adenoidectomy with significant pain despite acetaminophen given regularly. His oropharynx is shown in a picture (granulation tissue shown bilaterally, left side more than right). What is the best strategy to manage his pain:
a. optimize acetaminophen dosing
b. amoxicillin
c. start codeine
optimize acetaminophen dosing
First line = oral acetaminophen or ibuprofen RTC
Ibuprofen shown not to increase risk of bleed post op
BUT avoid ketorolac + ASA → does increase risk of post-op bleed
What is the most common side effect of cephalosporins?
a. Rash
b. Fever
c. Arthritis
d. Diarrhea
diarrhea
We no longer use codeine for post-operative pain due to several children who died as a result of this medication. What was the reason for these fatalities?
a. Some children are ultra fast metabolizers of codeine
b. Some children are slow metabolizers of codeine
c. Some children are allergic to codeine
Some children are ultra fast metabolizers of codeine
A mother wants to use topical nasal decongestants in her 4 year old child. You recommend against it because:
a. Rebound congestion
b. Irritability
c. Dystonic reaction
rebound congestion
Asthmatic needs sedation, med to worry about giving causing histamine release:
a) Morphine
b) Fentanyl
morphine
Boy on risperidone with gynecomastia. What would we look for before switching?
a) Prolactin
proloactin
How do we treat neuropathic pain
a) Gabapentin
b) Morphine
gabapentin
: Gabapentin is structurally related to GABA. However, it does not bind to GABAA or GABAB receptors, and it does not appear to influence synthesis or uptake of GABA.
A 16 year old girl is on multiple medications and develops headaches with blurred optic discs bilaterally. Which of the following is most likely to be responsible?
a. Methylphenidate
b. Calcium
c. Fluoxetine
d. Minocycline
d. Minocycline
IIH, some have stronger evidence vs. some anecdotal: Evidence for Growth hormone Tetracyclines - minocycline, doxycycline Hypervitaminosis A
Nelson’s also lists Sulfonamides Fluoroquinolines Cyclosporine Phenytoin Isotretinoin OCP
A 7 yo boy is on inhaled corticosteroids for poor asthma control. Mom is concerned about the effect of corticosteroids on his height. What do you tell her?
a. he will lose 1 cm in height
b. he will be significantly shorter than his genetic potential
c. his growth velocity will be decreased, but his final adult height will not be affected
d. he will have a significant catch-up period once he comes off the steroids
lose 1 cm
A child has CF. Family wants to use alternative medicine. Homeopathy has been proven effective for which condition:
a) Diarrhea
b) ADHD
c) Allergies
diarrhea
Teratogenic effects of carbamazepine
a) Neural tube defect
b) Cleft lip and palate
carbamazepine
Asthmatic needs sedation, med to worry about giving causing histamine release:
a) Morphine
b) Fentanyl
morphine
Which antiepileptic causes bilateral renal calculi?
a. Topiramate
b. Dilantin (phenytoin)
c. Valproic acid
d. Carbamazepine
e. Keppra
f. Lamotrigine
all call SJS
topiramate (also causes weight loss) - glaucoma
VPA- weight gain, alopecia, pancreatic and hepatoxicity
carbamzepine- tic, transien lulpenia, hyponatremia, agranolocytosis
8yr old child is status post renal transplant and was diagnosed with an AOM. He was started on clarithromycin. He had normal cyclosporine levels initially however 3 days later his cyclosporine levels are elevated. What is the MOST likely explanation?
a. As he started to feel better, he started to refeed and this caused increased absorption of the cyclosporine.
b. Impaired renal clearance
c. Clarithromycin affects the p450 enzyme and lead to decreased metabolism of the cyclosporine.
Clarithromycin affects the p450 enzyme and lead to decreased metabolism of the cyclosporine.
this increases cyclo levels - l
9y boy on phenytoin and valproic acid for epilepsy. Mom notices gum swelling (describing gum hyperplasia). What should you advise?
a. Decrease phenytoin
b. Stop phenytoin
c. Decrease valproic acid
d. Stop valproic acid
Decrease phenytoin - don’t stop cold turkey, can have withdrawal seizures
side effect of anabolic steoirds
Endocrine
Decreased sperm count and testicular atrophy in men
Menstrual irregularities and virilization in women
Hepatic: elevated ALT/AST/GGT, cholestatic jaundice, hepatitis, HCC
CV: HTN, glucose intolerance, increased LDL, decreased HDL
Psych: anxiety, depression, mania, psychosis
Physical appearance:
Men: gynecomastia, testicular shrinkage, jaundice, male pattern baldness, acne, striae
Women: hirsutism, deep voice, clitoral hypertrophy, male pattern baldness, acne, striae
Kid with otitis media given Amox/Clav in 4:1 dose. Presents with diarrhea and vomiting. Cause?
a. Wrong clavulin dose
b. Viral gastro
wrong clavulin
The dosage amount does not exceed the 10mg/kg/day of clavulanate that is linked with diarrhea
suspension is the 7:1 formulation
During RSI, when is succynilcholine contraindicated?
a. raised ICP
b. muscular dystrophy
muscular dystrophy others- Neuromuscular disease History malignant hyperthermia in patient or family Significant hyperkalemia Extensive crush injury with rhabdomyolysis Renal failure Burns
Adolescent female being teased at school. Obese, acne. Papilledema, head imaging normal. What is the cause?
a. Minocycline
b. OCP
c. Topical retinoids
minocycline
Best amnestic drug?
a. Midazolam
b. Ketamine
c. fentanyl
d. chloral hydrate
KETAMINE
a. Midazolam - only
anterograde amnesia
b. Ketamine - both anterograde + retrograde amnesia, dissociative
Counsel about side effects of marijuana use
a. Gynecomastia
b. Small testes
gynecomastia
Young boy’s mother wishes counseling about the risk of drug dependency with ADHD medications
a. decreases risk of developing drug dependency - I would pick this if “decreases risk of substance abuse”
b. risk actually increases
c. “one of the stimulants” has been shown to decrease the risk more than others
risk actually increases
Teenage female presents with headaches that wake her from sleep. On exam, has bilateral papilledema. Currently on OCPs and minocycline for acne. CT normal. What is the most likely diagnosis?
a. Pseudotumour cerebri
b. Migraines
c. Stroke
d. Tumor
Pseudotumour cerebri
Why is diazepam rarely used as a sedative/anticonvulsant in infants?
a. Increased distribution of liquid
b. Decreased hepatic clearance
c. Something about renal clearance
Decreased hepatic clearance
--------------- Why do we not give diazepam to preterm infants? a. Small volume of lipid distribution b. Large volume of liquid distribution c. Immature hepatic metabolism
immature hepatic metabolism
What are the main differences between a neonate and an adolescent with respect to drug dosing?
a. Increased distribution of liquid
b. Increased distribution of lipid
c. More rapid renal clearance
d. More rapid liver metabolism
Increased distribution of liquid
Which is higher in neonates compared to adolescents?
a. Volume of liquid distribution
b. Volume of lipid distribution
c. Hepatic metabolism
a. Volume of liquid distribution
Child has received anthracycline as part of chemotherapy. Which long term side effect should he be tested for:
a. Hearing
b. Vision
c. Renal
d. Cardiac
cardiac
Anthracycline cardiotoxicity (doxorubicin [Adriamycin]) on rare occasion causes acute inflammatory myocardial injury, but more classically results in DCM and occurs in up to 30% of patients given a cumulative dose of doxorubicin exceeding 550 mg/m2. The risk of toxicity appears to be exacerbated by concomitant radiation therapy.
You are a rural doc seeing a child who had just completed chemotherapy. What are the side effects of anthrocyclins -what do you need to monitor for?
a. hearing test
b. cardiac echo
c. thyroid function
d. renal function
cardiac echo
Most amnestic drug?
a. Midazolam
b. Chloral hydrate -
c. Morphine -
d. Fentanyl -
MIDAZ
b. Chloral hydrate - no longer recommended
c. Morphine - opioid
d. Fentanyl - opioid
Teen on OCP. What is the side effect of excess estrogen?
a. Mood swings
b. Breast tenderness
c. Weight gain
d. Acne
BREAST TENDER
Mood swings (progesterone)
b. Breast tenderness
c. Weight gain (progesterone)
d. Acne (progesterone)
Marijuana use is associated with
a. gynecomastia
b. decreased testicular size
c. bradycardia
gynecomastia
Which of the following effects of ketamine make it not a preferable drug to use in brain injury for RSI:
a. sympathomimetic effect
b. negative inotrope
c. induces respiratory depression
sympathomimetic effect
Doxyrubicin causes?
a. dilated cardiomyopathy
b. hypertrophic cardiomyopathy
c. restrictive cardiomyopathy
d. pericarditis
cardiomyopathy
Which is an absolute contraindication to birth control pill:
a. Migraine headaches
b. Smoking
c. Moderate Hypertension
d. Undiagnosed vaginal bleeding
Undiagnosed vaginal bleeding
An 8 year old girl with a renal transplant is on cyclosporine. She is admitted to the hospital for pneumonia and receives clarithromycin. On admission her cyclosporine level is normal and three days later it is above the normal range. What is the reason for this?
a. Poor compliance with medication prior to arrival
b. Clarithromycin decreases the renal clearance of cyclosporine
c. Clarithromycin decreases the metabolism of cyclosporine
Clarithromycin decreases the metabolism of cyclosporine
Mother is concerned about her son who has asthma. He has been on daily moderate dose inhaled steroids for the last few years. She has noticed that he seems to be growing slowly. What can you tell her based on the knowledge that we currently have?
a. He will be slightly shorter than his genetic potential
b. There will be no significant difference in his height
c. He will be significantly shorter than his predicted height
d. There will now be a significant catch up period of growth
slightly shorter then geneitc potential
Management of postoperative pain in children aged 6-10 years:
a. use BP and HR as a guide for when to give pain medications
b. give regular doses of pain meds in the first 24 hours as they cannot reliably report pain
c. use facial expression as an indication of pain
d. patient can use a visual analog pain scale to describe their pain
patient can use a visual analog pain scale to describe their pain
Succinylcholine is contraindicated in which of the following
a. DMD
b. Hypothyroidism
c. Increased ICP
DMD
Chronic skeletal muscle disease (eg, Becker or Duchenne muscular dystrophy)
●Denervating neuromuscular disease (eg, cerebral palsy with paralysis)
●48 to 72 hours after burns, multiple trauma, or an acute denervating event (eg, stroke or spinal cord injury)
●Extensive crush injury with rhabdomyolysis
●History of malignant hyperthermia in patient or family
●Significant hyperkalemia
Which of the following is a late-onset side effect of stimulants?
a. Tics
b. Depression
c. Hypertension
d. Weight loss
e. apetite
depression
Mom concerned about the risk of dependency in her child, whom you have recently prescribed long-acting Ritalin. What do you tell her:
a. treatment with stimulant medications decreased risk of drug dependency
b. treatment will result in no change in the risk of dependency
c. there is an increase in risk of dependency in those who are treated
d. there is only a decreased risk of dependency with methylphenidate
. treatment with stimulant medications decreased risk of drug dependency
A teenage girl is being teased at school for her acne. She has recently started a new medication for this and now she has headaches and evidence of papilledema. What is the medication most likely to account for her symptoms?
a. tetracycline
b. retinoic acid
c. OCP
d. clindamycin
tetracycloine
How long after IVIG should you wait before giving live vaccines.
a. 6 months
b. 9 months
c. 3 months
d. 11 months
11mo
A child on dilantin is given septra for an infection. She returns ataxic with abnormal speech. What is the mechanism of this interaction?
a. Septra increases absorption of Dilantin
b. Septra displaces dilatin from protein binding sites
c. Septa causes decreased metabolism of Dilantin
d. Septra causes decreased excretion of Dilantin
Septa causes decreased metabolism of Dilantin
Mother concerned about her child on Ritalin developing dependency. What do you tell her:
a. Stimulant medications decrease risk of developing dependency.
b. Treatment does not alter risk of developing dependency
c. Treatment increases risk of developing dependency
- ————–
stimulant meds dec dependacy
13 yr male in with his mother who is concerned about his growth as he has been on continuous moderate dose inhaled corticosteroid therapy. What can you tell her?
a. his final height will not be affected
b. he will have catch up growth in the next year
c. puberty will be delayed
d. he will be slightly shorter than his peers
d. he will be slightly shorter than his peers
You are developing a post-op pain management program for kids 7-12 years. How best to assess their pain?
a. it’s not possible to assess their pain, so you have to guess
b. self-reporting using a owie-face scale
b. self-reporting using a owie-face scale
- A mother brings in her child who has had a low-grade fever and upper respiratory symptoms. She has been diligently giving the child Tylenol 6-7 times a day because she is afraid the fever may be dangerous. What would you recommend?
a. ensure that the appropriate amount of Tylenol is given (dose and frequency)
tyl dosing
An 8 year old girl is in a motor vehicle accident and has had significant pain in her left upper extremity. Her symptoms are consistent with neuropathic pain. What treatment do you recommend?
a. opioids
b. gabapentin
c. NSAIDs
depression
What should be used for sedation while doing a CT scan in a patient with head injury?
a. Midazolam
b. Chloral hydrate
c. Propofol
midaz
Side effects of hepatotoxicity, pancreatitis and low platelets. Which drug?
a. Phenytoin
b. Carbamazepine
c. Phenobarb
d. Valproic Acid
d. Valproic Acid
A teen in your practice has been on fluoxetine and risperdal. He presents to your office with hyper-reflexia and tremor and ataxia and 5 or 6 more symptoms. What to do you do?
a. Decrease fluoxetine
b. Stop fluoxetine
c. Increase fluoxetine
d. Decrease risperdal
Stop fluoxetine (as per consensus)
16 y M on prozac and risperidol for depression. Tx started a few months ago. Patient is now having increased agitation and impaired concentration. Also has subtle ataxia. What do you do?
a. Decrease prozac
b. Stop prozac
c. Increase prozac
d. Decrease risperidol
stop prozac
Question describes Serotonin syndrome - altered mental status, neuromuscular hyperactivity (hyperreflexia), autonomic hyperactivity - so d/c SSRI
- Marijuana has been shown to cause which of the following
a. Gynecomastia
b. Glaucoma
c. Decreased heart rate
gynecomastia
Reproductive - suppresses testosterone production in men -> decreased libido, impotence, gynecomastia, increases prolactin in women -> galactorrhea
Cardiac - increases sympathetic activity -> increased HR (though high doses can inhibit sympathetic activity and cause bradycardia)
Ophtho - reduces intraocular pressure
A teen is on prozac and risperadol for six months and now experiences ataxia, drowsiness, decreased concentration, diarrhea, agitation. What to do.
a. increase prozac
b. decrease prozac
c. eliminate prozac
d. increase risperadol
e. decrease risperadol
eliminate prozac
Child at hospital with tonic movements. Consciousness is preserved. He also has ataxia, vomiting, and inability to close mouth. He has been vomiting for several days and mom has been giving him a suppository but can’t remember its name. What do you do?
a. Rectal diazepam
b. Nothing
c. Diphenhydramine
d. Phenobarbitol
diphenhydramine
A 14 y/o has been treated with Accutane for severe cystic acne. There have been a few case reports in the literature as well as some media attention to which of the following severe side effects:
a. Hallucinations
b. Cerebral thrombosis
c. Somnambulism
d. Major depression with suicide risk
e. Long term memory problems
major depression
side effects of accutane highly teratogenic - must use 2 forms of birth control and get monthly pregnancy tests cheilitis xerosis epistaxis blepharoconjunctivitis increased serum TGs and cholesterol
Side effects of marijuana include all of the following except:
a. bronchospasm
b. conjunctival injection
c. large testicles
d. tachycardia
large testicles
What are the late side effects of stimulant therapy for ADHD?
a. decreased appetite
b. tics
c. difficulty sleeping
d. depression
e. stomach pains
d. depression
The mechanism of morphine for pain relief (rpt from 1995 exam)
a. works at only 1 type of receptor
b. reduces sensation of pain and emotional perception of pain
c. IM route preferred over IV
reduces sensation of pain and emotional perception of pain (analgesic effect on subjective perception of pain and decreased emotional response)
What medication should be used for sedating a 2-year old child for a CT scan?
a. oral midazolam (not very sedating orally - approx 50% of time)
b. chloral hydrate *UTD states can use <3yo
c. propofol *can cause resp depression and need IV access
chloro vs propofol
IVIG is used for all EXCEPT:
a. ITP
b. Guillaine-Barre
c. Kawasaki disease
d. bone marrow transplant
e. nephrotic syndrome
nephrotic sx
What’s the most common side effect of Prozac?
a. increased ICP
b. drowsiness
c. rash
drowsiness
Boy, post MVA, very agitated. Neuro exam no focal signs. What’s the best for sedation for CT:
a. Pentathol
b. ketamine
c. midazolam
d. chloral hydrate
e. morphine or fentanyl
midaz
Potential toxic effects of anabolic steroids :
a. Delayed closure of epiphysis
b. Increased high density lipoproteins
c. Increased testicular size
d. Toxic hepatitis
toxic hepatitis
causes advanced closure of epiphysis, and inc LDL and dec HDL and hypogonadism + gynecomastia
Which of the following medications is not associated with adverse reaction of urticaria in children?
a. Aspirin
b. codeine
c. penicillin
d. ranitidine
ranitidine
Cetirizine (Reactine), Loratidine (Claritin), bilastine
H2 Antihistamine
Ranitidine (Zantac)
In the first week of treatment, which side effect is commonly seen in a 7y with 0.5mg/kg per dose of methylphenidate?
a. appetite suppression
b. Dizziness
c. Rebound effect
d. tics
appetite suppresion
A 3 year with 5 days low grade temperature, rhinorrhea, occasional cough. On exam he looks well, has green crusted nasal discharge. Mom has been giving acetaminophen 6 to 7x/day. Next test:
a. Sinus x-rays and treat if fluid level present
b. treat with amoxil
c. consult with ENT
d. counsel on Tylenol dosing and risk of too much acetaminophen
d. counsel on Tylenol dosing and risk of too much acetaminophen
REMEMBER! Think acute bacterial rhinosinusitis with:
Persistent symptoms – The cardinal clinical features are nasal symptoms, cough, or both that persist for more than 10 but less than 30 days and are not improving
Severe symptoms – combination of temperature ≥39ºC (102.2ºF), concurrent purulent nasal discharge for at least three to four consecutive days, and ill-appearance. Persistent high fever for at least three to four days distinguishes this presentation from an uncomplicated viral URI
A 15-year-old athletic boy comes in for his regular check up, and he tells you that he is using anabolic steroids. Which of the following is a potential long-term sequela of anabolic steroid use:
a. dementia
b. liver cancer
c. myositis ossificans
d. hemorrhagic cystitis
e. interstitial pneumonia
liver cancer
also cholesatsis
What is true about methylphenidate:
a. stimulates appetite
b. no effect on growth velocity
c. may exacerbate tics
d. can cause dependency
e. effective in 60% of children with ADD
can cause dependance
BLACK BOX- high potential for abuse and dependance and monitor for signs of it - frank psychosis - Also when withdrawing med- severe depression can occur
Tics — Stimulant medications have been reported to cause new onset of tics or worsening of tics in children with tic/tourette disorders ( is a CI for certain stimulants)
Management of postoperative pain in children aged 6-10 years:
a. use BP and HR as a guide for when to give pain medications
b. give regular doses of pain meds in the first 24 hours as they cannot reliably report pain
c. they can assess pain meds as required using self report
d. use facial expression as an indication of pain
e. use a visual analog pain scale
use a visual analog pain scale
Mechanism of action for insulin:
a. glycogen synthesis
b. gluconeogenesis
c. lipolysis
d. ketogenesis
e. cAMP
glycogen synthesis
Insulin facilitates entry of glucose into muscle, adipose and several other tissues
Insulin stimulates the liver to store glucose in the form of glycogen
gluconeogensis, lipolysis, ketogenesis all work to INCREASE glucose (and is turned off by insulin)
glucagon, adrenaline all work to increase cAMP
Which causes sexual dysfunction in adolescents:
a. calcium channel blockers
b. antidepressants
c. beta-2 agonists
d. theophylline
antidepressants
IVIG can be used in all of the following EXCEPT:
a. immune thrombocytopenic purpura
b. bone marrow transplant
c. nephrotic syndrome
d. Kawasaki disease
e. Guillain-Barré syndrome
nephrotic syndrome
14 year old being treated for osteomyelitis. Severe pain despite naproxen and tylenol. Best analgesic:
a. narcotic
b. tricyclic
c. higher dose of NSAID
narcotic
The reason maxeran is not used commonly is:
a. side effects
b. cost
c. interactions with other drugs
s/e
Treatment with metoclopramide can cause tardive dyskinesia, a serious movement disorder that is often irreversible. The risk of developing tardive dyskinesia increases with duration of treatment and total cumulative dose. No tx for TD
Which affects the efficacy of the birth control pill:
a. Tetracycline
b. Acetaminophen
c. Theophylline
d. Valproic acid
c. Theophylline
List of potential major drug interactions: anything processed in liver
Anticoagulants Tricyclic antidepressants Barbiturates Penicillins Phenytoin Rifampin Theophylline (used for asthma and COPD)
