pharmacology Flashcards
How does gentamicin kill bacteria
concentration dependent
How does beta lactam kill bacteria
time dependent
What is volume distribution
Amount of drug available to the baby
Vd= Total amount of drug/ plasma conc x wt
Side Effects of ACE inhibitors on the Fetus
Oligohydramnios
Renal failure
Lung hypoplasia
Skull ossification defects
Side Effects of Beta Blockers on the fetus
Fetal bradycardia
Hypoglycemia
Possibly fetal growth restriction
Side effects of methimazole on the fetus
Choanal atresia
Esophageal atresia
Hypothyroidism
goiter
Cutis aplasia
First order vs Zero order kinetics
First order: certain percentage of the drug per unit time (proportional to the drug concentration)
Zero order: constant amount of drug regardless of concentration
First order vs Zero order kinetics, elimination time
First order: half life is independent of drug dosage, fraction constant
Zero order: dependent on dose- larger the more slow to clear, fraction not constant
Volume of distribution and half life
the larger the Vd the longer the half life
Peak concentration adjust by
- Infusion rate: longer lower
- Dose
Trough of a medication is dependent on
Interval of the drug administration
Ways milrinone improve cardiac output (3)
- increasing systolic contractility
- decreasing systemic vascular resistance (afterload)
- enhancing diastolic myocardial relaxation.
Facilitating diastolic relaxation: lusitropy.
MOA of medication to improve CO
- Increased heart rate (chronotropy)
- Increased myocardial contraction with greater shortening fraction (inotropy)
- Faster electrical conduction of cardiac contraction signals during systole (dromotropy)
- Increased myocardial relaxation during diastole (lusitropy)
How to give adenosine
Large IV/Central catheter IV push
- 1/2 life: <1 min
- dose: 0.1 mg/kg/dose
- ECG running- diagnostic for focal atrial tachycardia (FAT) or AF
Ideal location of tip of UE or scalp PICC
T3-T5
Ideal location of tip of LE PICC
T8-T10
Long Term Complication of chronic PGE use
- hyperostosis or cortical proliferation of the long bones
- intestinal and gastric mucosal hyperplasia resulting in gastric outlet obstruction and delayed gastric emptying.
Common side effect of fentanyl
Chest wall rigidity
To prevent: slow administration (over 1 min)
To treat: Naloxone/ muscle relaxant (ie rocuronium?)
Possible electrolyte abnormality secondary to amphotericin
Hypomagnesemia
How does hypothermia change metabolism of medications
- slow the kinetics of most enzymatic pathways involved in phase 1 and phase 2 metabolism.
- Drugs that are eliminated largely unchanged through the kidneys (phase 3) are least affected
Phase 1: biotransformation of a drug, usually by the cytochrome P450 enzymes found in the liver.
Phase 2: conjugation with other molecules, which facilitates its removal via the kidneys or intestine.
Phase 3: final common pathway of drug elimination largely via the kidneys
Meds:
phenobarbital no difference
midazolam 21%
lidocaine −24%;
morphine −21% to −47%,
gentamicin and amikacin −40%
What is the first line medication to treat systemic candidiasis
Amphotericin B
- MOA: disrupts fungal wall synthesis by binding to sterols
- If CNS: added second agent (flucytosine)
- Fluconazole: wait for sensitivities due to concern for resistance
Main side effects of indomethacin
*Decreased renal blood flow
*Decreased mesenteric blood flow
*Alteration of platelet function
