Pharm/Critical Appraisal Flashcards
Why does codeine cause death in some children?
Codeine is a prodrug that is metabolized to morphine
Some children are ultra rapid metabolizers so get very high doses of morphine
Main teratogenic effect of carbamazepeine
Neural tube defect
Which antiepileptic causes bilateral renal calculi
Topiramate
Which antiepileptic causes gingival hyperplasia
Phenytoin
What intubation med is contraindicated in muscular dystrophy
Succinylcholine
What is the main side effect of clavulanate
Diarrhea
What differentiates neonates from adolescences in terms of their pharmacokinetics
High liquid/TBW
Lower lipid/body fat
Decreased hepatic function
Decreased renal clearance
Contraindications to OCPs
Migraine with aura/focal neurologic symptoms
Smoker >35 (>15 cigarettes/day)
HTN (SBP >160 or DBP >100)
Current/past VTE
<21 days postpartum with other VTE risk factors
<6 weeks postpartum if breastfeeding
Ischemic heart disease or complicated valvular disease
Current breast Ca
Hx of CVA
Severe cirrhosis
Diabetes with retinopathy/nephropathy/neuropathy
Liver tumour (adenoma or hepatoma)
SLE with positive or unknown APL Abs
Relative risk calculation
Relative risk = risk of disease in exposed/risk of disease in unexposed
Drug induced lupus
Presence of SLE manifestations triggered by exposure to specific medications
Ex: hydralazine, minocycline, many anticonvulsants, sulfonamides, and antiarrhythmic agents
Usually provoke a reversible lupus-like syndrome, but can trigger true SLE
Sensitivity
Refers to how often a positive test result correctly identifies those who actually have the disease
Higher the sensitivity = lower the number of results that are falsely negative
Sensitivity = true positive/(true positive + false negative) = true positive/ (# of diseased)
SPIN: SPecific tests help rule IN disease because the false Positive rate is low
Specificity
Identifies how often a negative test result correctly identifies those who do not have the disease
Higher specificity = lower number of patients without the disease who are testing falsely positive
Specificity = true negative/(true negative + false positive) = true negative/(# of not diseased)
SNOUT: SeNsitive tests help rule OUT disease because the false Negative rate is low
Should you prescribe beta lactams or not if
1. Hx of suspected allergy but have tolerated one course
2. Low risk penicillin allergy
3. Suspected IgE mediated allergy
4. Severe systemic cutaneous delayed adverse reactions
- Yes, not allergic
- Can prescribe
- Do not prescribe
- Do not prescribe
When should children with penicillin allergy be reassessed by an allergist?
After 5 years
Allergy can be outgrown
Negative predictive value
The probability of not having a disease if the test is negative
NPV = true negative/ (true negative + false negative)
Positive predictive value
The probability of the disease in a patient with a positive test
PPV = true positives/ (true positives + false positives)
I.E: of all the people who test positive, how many actually have the disease
Reflects the prevalence of the disease
Helps to determine the usefulness of a screening program
