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NeoBoards > pharm / ethics / stats > Flashcards

pharm / ethics / stats Flashcards

1
Q

what is the bioavailability with IV administration?

A

100%

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2
Q

What is ‘absorption’

A

Movement of a drug from site of administration into systemic circulation

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3
Q

which properties favor absorption?

A

lipid soluble, small molecule, unionized molecules

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4
Q

how can liver damage impact pharmacokinetics?

A

can decrease first-pass metabolism (making it more bioavailable), and decrease metabolism in general making it less ready to be eliminated

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5
Q

What is volume of distribution

A

the theoretical volume that would be necessary to contain the administered dose of drug at the same concentration observed in the plasma
V(d) - D (dose)/C (Concentration)

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6
Q

which drug qualities have a larger V(d)

A

lipophilic drugs, not protein bound drugs

PT babies have larger Vd

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7
Q

which proteins bind what kind of drugs

A

albumin binds acidic drugs, alpha 1 acid glycoprotein binds basic drugs

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8
Q

serum drug concentration includes which type of drugs

A

both bound and free

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9
Q

what is ‘metabolism’

A

biotransformation of a drug to a more water-soluble compound to facilitate elimination. Primarily occurs in liver. Primarily through cyp 450 system

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10
Q

what is ‘elimination’

A

removal of a drug or metabolite from the body, primarily via renal excretion

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11
Q

how should you change management in renail impairment?

A

decrease dose of drugs that are time-dependent (pnc), decrease interval of drugs that are concentration dependent (aminoglycosides)

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12
Q

describe first order elimination

A

drug clearance is based on concentration, fraction of drug cleared is constant.
looks like a curved line, linear when logarithmic

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13
Q

describe zero order elimination

A

constant amount of drug is cleared, fraction of clearance is variable.
looks like a linear line, curved when logarithmic

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14
Q

what is saturation kinetics

A

drugs can display zero order kinetics when they are overdosed or have poor clearance.

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15
Q

What are drugs contraindicated in breastfeeding

A

illicit drugs
radiopharmaceuticals
antineoplastic chemo agents

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16
Q

What is a relative infant dose?

A

dose that baby will receive in BM compared to maternal dose. If <10%, okay to use

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17
Q

how do you calculate loading dose

A

cv/Fs

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18
Q

what is the teratogenic effect of ACEi

A

renal dysfunction, iugr, skull ossification, fetal death

1st tri: CHD, CNS malformation

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19
Q

what is the teratogenic effect of ARBs

A

renal dysfucntion, limb contractions, fetal death, skull ossification defects
1st tri: data shows no risk

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20
Q

what is the teratogenic effect of AEDs

A

over all causes CHD, cleft lip/palate
carbamazepine: NTD, iugr, craniofacial defects, fingernail hypoplasia
lamotrigine: facial cleft
phenytoin: fetal hydantoin syndrome, facial cleft, hypertelorism, short nose, short neck, microcephaly iugr, mental deficiency
topiramate: oral cleft, hypospadias
valproic acid: NTD, cardiac defect, FHS features. most likely to have cognitive impairment*

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21
Q

teratogenic effetc of antiretroviral drugs?

A

zidovudine: chd, neuromitochndrial disease

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22
Q

teratogenic effects of cyclophosphamide

A

cns malformations, facial defects, absent digits, single coronary artery, imperforate anus, eye defects

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23
Q

teratogenic effects of cocaine

A

fetal loss, microcephaly, growth retardation, lmb reduction, urinary tract malformation, cardiac anomalies, placental abruption, poor neurodevelopment

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24
Q

teratogenic effects of ethanol

A

FAS, iugr, microscephaly, growth retardation, developmental delay, behavioral abnormalities

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25
Q

isotretinoin (Retinoids) teratogenic effect?

A

spontaneous aborption, cardiac defects (TGA), craniofacial defects, thypmic hypoplasia

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26
Q

lithium teratogenic effects

A

ebstein anomaly

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27
Q

teratogenic effect of methotrexate

A

NTD, anencephaly, microcephaly, iugr, craniofacial, craniosynostosis, ToF

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28
Q

misoprotstol teratogenic effect

A

NTD, limb defect, mobius syndrome

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29
Q

teratogenic effect of tetracycline

A

malformation of tooth enamel and bone

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30
Q

teratogenic effect of thalidomide

A

limb shortening defect, hearing loss, facial paralysis

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31
Q

teratogenic effect of warfarin

A

nasal hypoplasia, epipyseal stippling, limb/digit hypoplasia, pthalmic anomlaies, LBW, CNS defects

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32
Q

what is the correct concentration of iv epi

A

1:10,000 (0.1 mg/ml)

33
Q

what is the MOA of aminoglycosides

A

inhibit protein synthesis by binding to 30S ribosomal subunit

34
Q

MOA of penicillins and cephalosporins

A

b-lactam, bacteriocidal action by binding to penicillin binding proteins and inhibiting bacterial wall synthesis

35
Q

MOA of vancomycin

A

inhibits bacterial cell wall synthesis by inhibiting peptidoglycan synthesis. bacteriocidal at higher doses.

36
Q

MOA of amphotericin

A

binds ergosterol in fungal cell wall, leading to alteration of cell membrane permeability, leakage of cell components, cell death

37
Q

MOA of fluconazole

A

decreases ergosterol synthesis in fungal cell membrane by interrupting fungal cytochorme p450 activity, inhibiting fungal cell membrane formation

38
Q

moa of acyclovir

A

acyclovir triphosphate acts as inhibitor of HSV dna polymerase, inhibiting dna synthesis and viral replication

39
Q

what is the adverse effect off SSRI

A

pphn, less commonly nas

40
Q

where does furosemide act

A

on ascending loop of henle. binds to chloride receptor of na/k/cl channel

41
Q

where does chlorothiazide act

what are the side effects

A

distal convoluted tubule by blocking na/cl transporter.

side effects of intrahepatic cholestasis, hyperglycemia, and hyperuricemia

42
Q

what is the criteria for a level II nicu

A

> 32 weeks, >1500g, ventilation for <24 hours

43
Q

What does STABLE stand for

A

sugar, temperature, airway, blood pressure, emotional support

44
Q

what are six characteristics when implementing QI?

A

safety, effectiveness, patient centeredness, timeliness, efficiency, equitable

45
Q

define perinatal death

A

fetal death + neonatal death (most commonly death >20 weeks + death <28d)

46
Q

define perinatal mortality

A

still birth + neonatal death

47
Q

define fetal death

A 
death > 8 weeks (prior is an embryo)
8-20 miscarriage
20-27 early
28-term late
>28 still birth
48
Q

define infant death

A

death any time after birth - 365 days

49
Q

define early neonatal death and late neonatal death

A

early <7 d, lat 7-28 days

50
Q

define postneonatal death

A

28d-365d

51
Q

what is parens patriae

A

common law that states gvt intervention on behalf of incompetent individual is allowed protecting safety and well being, may challenge surrogate authority

52
Q

what is the doctrine of double effect

A

that something can have both good and bad effects. permissable if

1) action is not wrong
2) good effect is intended and direct result of action
3) good > bad

53
Q

what are the four principles of ethical analysis?

A

beneficience, non-maleficence, autonomy, justice

54
Q

what is EMTALA

A

law in 1986 that requires provision of emergency care to all, despite ability to pay

55
Q

what is the difference between a systematic review and a meta-analysis?

A

Systematic Review: looks at the literature and identifies all articles meeting criteria to avoid inclusion bias.
Meta-analysis: Combines data from several articles to increase power of comparisons. Results in forest plot

56
Q

What is the Receiver operating characteristic curve (ROC), AUC, and what are one the axis?

A

ROC curve is compares sensitivity and specificity of a test. The closer the ‘shoulder’ of the curve is to top left corner, the more perfect is.
AUC is the area under the curve. 1 is perfect, 0.5 is a flat line which is no better than chance.
X axis is 1-specficity, Y is sensitivity.

57
Q

What is the likelihood ratio?

A

Looks at the chance of a positive or negative result based on sensitivity and specificty, use a nomogram once you know the LR.
LR calculation for positive change: sensitivity/(1-sp) (positive, positive is on top)
LR calculation for negative change: (1-sensitivity)/sp. (negative things is on top)
Tells you how much the odds of an outcome are changed if a test is positive/negative

58
Q

which tests are affected by prevalence?

A

PPV and NPV. If prevalence is low, you are going to have increased FP, PPV will decrease. If prevalence is very high, you are going to have FN, NPV will decrease.

59
Q

what is a hazard ratio

A

a specific type of relative risk comparing outcome rates

60
Q

which studies use odds ratio vs relative risk

A

Odds ratio is used in case control studies. ‘A’ and ‘O’ are different. Odds are 1:1 so in the calculation it’s a/c over b/d
Relative Risk is used in cohort studies. Relatives are similar, just like ‘o’ and ‘o’ in cohort are similar. This is 1/2 in the calculation. a/a+b over c/c+d.

61
Q

What are the three kinds of variables?

A

Continuous: ie weight
Ordinal: apgars
Categorical/nominal: ie. sex

62
Q

when do you use t-test

A

continuous, normal data, two variables

63
Q

when do you use x2 test

A

categorical. Fisher test if small sample size. ‘cat’, Chi, ‘fish’.

64
Q

how does prevalence of an outcome affect odds ratio vs relative risk

A

If prevalence is low, OR and RR are similar.

If prevalence is high, O > R

65
Q

What kinds of paired tests are used?

A

paired t test for continuous variables

McNemar test for pair categorigal variables (nemar like lemur, animals.. cat)

66
Q

when do you use an anova test

A

3+ variables, just tells you if there is a difference in the mean (rejecting the null hypothesis)

67
Q

when do you use non-parametric tests and what are examples

A

ordinal data, non-normal distribution

man whittney U and wilcox RANK sam test

68
Q

what is the method to correct for multiple comparisons

A

Bonferroni method, divide the p value by number of comparisons.

69
Q

what is standard error

A

measure of precision of an estimate of the mean of a population

70
Q

what are the different stages of trials

A

preclinical: animal, looking at pharmacokinetics and adverse events –> results reported in investigational brochure. Apply for IND if want to go to clinical trials.
stage 1: 20-100 healthy individuals, looking for pharmacokinetics and adverse events in humans
stage 2: 20-300 individuals, looking at efficacy
stage 3: 300-3000 individuals, looking at efficacy and adverse events
stage 4: post-marketing looking at long term adverse events

71
Q

what is ‘determination’

A

the ability of a test to correctly risk stratify. determined by ‘c statistic’ which = AUC in ROC.

72
Q

what is ‘calibration’

A

a model’s ability to correctly predict outcome.

73
Q

what is ‘coefficient of correlation’

A

-1 to 1, how well two variables correlate to each other

74
Q

what is ‘coefficient of determination’

A

r squared: fraction of variation explained by variables in a regression model

75
Q

what is absolute risk reduction?

A

a/(a+b) - c/(c+d)

76
Q

when are OR and RR similar, when are they different?

A

when the outcome is rare, they are similar. When it is large, OR > RR

77
Q

what are the axis in an ROC curve

A

sensitivity on y axis, 1-sp on x axis. making x=0 and y=infinity the best test.

78
Q

what electrolyte imbalance can amphotericin cause?

A

hypomagnesemia

79
Q

which side effect of aminoglycosides is reversible vs non-reversible?

A 
renal toxicity (due to ATN) is reversible
ototoxicity is irreversible

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