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RC: Specialties Woo Hoo > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Mechanism of morphine for pain relief?

A

Mu delta receptor
= inhibit ascending pain pathway
+ alter perception
+ generalized CNS depression

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2
Q

T or F: morphine works at 1 type of receptor

A

False.

  • mu-delta= analgesia, CNS
  • K-opioid: spinal, miosis, psychotomimetic effect
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3
Q

T or F: morphine can only be given IV and PO.

A

False.

- IM, SC, IV, PO

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4
Q

Mechanism of Topical Benzyl Peroxide:

a. less p. acne resistance
b. less androgen sensitivity at sebum gland
c. less sebum production

A

c. less sebum

3X rxn

  • less sebum
  • lyse comedone
  • inhibit P acne
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5
Q

What is the main difference btwn a neonate compared to teen re: drug dosing?

A

BB has more LIQUID distribution

  • infant have more total body H2O
  • teen have slightly higher body fat
  • renal clearance increases w/ age
  • liver metabolism increase w/ age
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6
Q

Can a mom on isoniazid BF?

A

Yes.

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7
Q

What cardiac med increase risk of hyPOthyroidism in BB?

a. esmolol
b. digoxin
c. amiodarone
d. procainamide

A

Amiodarone

  • neonatal brady, long QT, PVC, neonatal hyPOthyroidism, neurodevelopment abnormalities

HENCE: PO or IV amiodarone ONLY if refractory to other tx

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8
Q

Mom on amiodarone. What is the risk to BB?

A

Neo HYPOthyroidism

Neonatal brady

Long QT

PVC

Neurodevelopment abnormalities

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9
Q

In utero exposure to cocaine results in:

a. lacking hearing
b. microcephaly
c. low BP
d. spinal dysraphism

A

Microcephaly

Preterm
\++ Miscarriage
\++ Placental abruption
Low BW
SGA
Microcephaly

Usually no withdrawal but can have neurobehav (less arousal, bit jittery)

+/- longterm neurobehavioral abnormalities

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10
Q

List contraindications to succinylcholine:

A
  1. Skeletal muscle myopathy (muscular dystrophy, myopathy, MS)
  2. Acute burn or trauma (risk high K)
  3. Malignant hyperthermia (PMHX of FHX)
  4. Hypersensitive to succ

Warning: may increase intraocular pressure (avoid in narrow angle glaucoma, eye trauma)

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11
Q

4 Absolute contraindications to ketamine:

A
  • 1=Hypersensitivity to Ketamine or part of its formulation
    2. Severe HTN
    3. Known or suspected schizophrenia
    4. Infant < 3 mo.
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12
Q

Pt on cyclosporine. Treated with clarithromycin. Levels of cyclo go up. Why?

A

Clarihro causes decreased metabolism of cyclosporine.

B/Cmacrolide antibiotic inhibit CYP3A4 pathway?

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13
Q

What are side effects of MJ in teens:

A
  • elation, euphoria
  • **transient tachy
  • abN ortho BP
  • conjunctival injection
  • dry mouth
  • anti-emetic
  • appetite ++
  • impaired short term memory
  • poor performance of attain task
  • less coordination

NOTE: gynecomastia not as strong link as thought; some studies of low testicular volume.

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14
Q

Most commonly abused illicit drug is:

A

Marijauna

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15
Q

T or F: 75% of high school students have used MJ.

A

False.

25-50%

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16
Q

List acute and chronic adverse effect of MJ in teens:

A

Acute:

  • anxiety
  • panic
  • psychotic symptom
  • roda crash if driving

Chronic:

  • dependence (1 in 10)
  • chronic bronchitis
  • psychotic symp
  • subtle cognitive impairment
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17
Q

Child on risperidol has frequent Syncope. You worry about?

A

Prolonged QT

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18
Q

List three side effects of typical and atypical antipsychotics:

A

Typical:

  • EPS (dystonia, rigidity, tremor)
  • Anticholinergic
  • Drowsy/LOC

Atypical:

  • wt gain
  • metab syn
  • DM
  • hyperlipid
  • hyperprolactin
  • leukopenia, neutropenia
  • seizure
  • hepatotoxicity
  • Neuroleptic malignant syn
  • long QT
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19
Q

Outside of wt gain, list 3 serious side effects of Risperidone:

A
  1. Prolonged QT
  2. Agranulocytosis (acute low WBC)
  3. Neuroleptic malignant syndrome (hyperthermia + altered LOC + muscular rigidity)
  4. Hepatotoxicity
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20
Q

What is the diff in symptom w/ NMS vs. Serotonin Syn?

A

NMS:

  • hot (> 38)
  • lost (alter LOC)
  • rigid (muscular rigidity)

Serotonin Syn:

  • dilated pupil
  • myoclonus
  • +++ DTR
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21
Q

What anti epileptic has AE of pancreatitis, hepatitis, thrombocytopenia:

a. carbemezapine
b. VPA
c. topiramate
d. phenytoin

A

= VPA

Bad Carbama: SJS, agranulo cytosis, liver, anemia

Bad Phenytoin: cerebral, hirsutism, SJS, liver

Bad Topa:
Cognitive, Glaucoma

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22
Q

List two reasons for girl on VPA to have vomit + lethargy:

A
  • Hyper ammonemia/ encephalopathy
  • Pancreatitis
  • low plt cause hemorrhage
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23
Q

Pt on VPA develop lethargy or vomiting or low temp. MUST CHECK:

A

Ammonia level

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24
Q

T or F: septra decrease phenytoin clearance.

A

True.

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25
Describe phenytoin toxicity:
Cerebellar= nystagmus, ataxia Low Tone LOC Lethargy
26
Most common AE of cephalosporin: - Rash - diarrhea - anaphylaxis?
Diarrhea Most common: = GI= biliary sludge (25%), diarrhea (15%), transient LFT up, N/V = rash 1-3% = anaphylaxis 0.1%
27
Hypo pigmented flat scar after trauma + vesicular lesion w/ sun. Most likely med involved?
Naproxen. = Pseudoporphyria = small hypo pigmented scar after minor trauma = photo distributed blistering = Tx: d/c NSAID (because scar can persist for years or be permanent)
28
Which med is associated w/ pyloric stenosis risk if used in infants?
Erythromycin
29
List 4 AE of indomethacin:
1. low plt function = GI bleed, IVH 2. NEC 3. Spontaneous GI perf 4. transient RF
30
List 4 AE of furosemide:
Lasix= inhibit reabsorption of Na and Cl from distal tubule and loop of Henle 1. Hypo-K 2. Hypo-Na 3. Hypo-Cl 4. Azotemia 5. NICU prem= severe hyper-Calciuria, nephrolithiasis 6, Potential Prem= ototoxic, cholelithiasis
31
Child done w/ anthracycline. What do you monitor?
Cardiac echo Anthracycline= doxorubicin, daunorubicin - baseline echo recommended - looking for dilated cardiomyopathy
32
Long term effect of doxorubicin: - dilated cardiomyopathy - hypertrophic cardiomyopathy - pericarditis - restrictive cardiomyopathy
Dilated Cardiomyopathy Doxorubicin= Anthracycline= chemo= need echo.
33
V and D while on 4:1 dosing amox-clav. Most likely cause?
Wrong clavulin dose. - min 7 amox: 1 clan preferred - if use 4:1 dosing= 25% get diarrhea
34
Started vanco. Breaks out in red rash. BP normal. Dx? Immediate management? Two things to prevent next time?
Redman Syn - non IgE rxn to vanco - histamine release - flush, red, itch Stop med Benadryl +/- Ranitidine Restart at half the rate Next time: pre-medicate and run at slow rate
35
E part of OCP related to: - mood - acne - salt + water retention
Salt and water retention
36
Increased ICP. Obese + Acne. No sexual activity. Likely cause: OCP vs. Minocycline?
Minocycline. = Po tetracycline
37
Child w/ head injury. Which is reason ketamine SHOULD NOT be used in this child: a. sympathomimetic b. (-) inotropy c. resp suppression
may increase ICP (increase HR and BP from sympath) Other AE: - disturbing dream, hallucination (premedicate w/ benzo) - increase intraocular presure - ++ secretion - less sz threshold
38
T or F: adult ht will be slightly shorter (1-1.5cm below predicted) if on moderate inhaled ICS for asthma.
True.
39
T or F: hypokalemia cause long QT
True Other: low Ca, low Mg Other: macrolide, fluoroquinolone (levofloxacin), anti fungal, TCA, haldol, risperidone, ondansetron Other: HIV, low temp
40
Do putting a child with ADHD on stimulants: - no effect on risk of drug addiction - decrease future risk of addiction - increased risk of addiction except dextroamphetamine
Reduce risk of future addiction
41
What is late AE of ADHD stimulant tx? - appetite - sleep - tics - depression
Depression
42
2 year old w/ torticollis and neck pain. List three things on dx:
Infection: retropharyngeal abscess, cervical lymph, meningitis Trauma: muscular injury Tumour: cervical cord or posterior fossa tumour Drugs: acute drug rxn (1st d of exposure to antipsychotic; torticollis, retrocollis, oculogyric crisis, tongue protrusion))
43
What is the best way to assess pain in 6-10 y.o.?
Visual analog pain scale or numerical - instrument: FLACC scoring sys - toddler or young may use category (little, middle, lot) or FACES scale (cartoon face of pain), older may rate via number - #= considered gold standard
44
Four things to consider when starting opioids:
- Type of pain (visceral, neuropathic) - Route (IV, PO, PCA) - Frequency (basal) - Breakthrough (PRN) - Titration to effect (no "right"dose for everyone) - Adjunct (use non opioid first; + in addition SSRI, steroid for bone pain, local pain) - Watch for AE (constipation, itch, nausea) - Be aware of impaired clearance (other med, organ dysfunction) - Taper gradually to avoid abstinence sys
45
Paroxetine is...
SSRI
46
SSRI overdose Features:
- tachycardia - sedation - seizure - long QT - rarely serotonin syndrome (LOC, autonomic, myoclonus, hyper reflexia/DTR)
47
Tx for SSRI overdose?
Supportive Care - ECG - R/O serotonin syndrome - Benzo if mild serotonin syn - Cyproheptadine if severe
48
Describe drug induced dystonia:
Transient complication of dopa-receptor blocking med (typical antipsychotic, atypical, antiemetic like metroclopramide or prochlorperazine) - 1st day of med - torticollis - oculogyric crisis - tongue out Tx: benadryl (diphenhydramine)
49
Child vomting; mom gave unknown suppositories. Recurrent tonic neck spasm. Normal LOC. Give: - diazepam - benadryl - naloxone
Benadryl (anticholinergic) to Tx drug induced dystonia
50
Excess Vitamin D Effects. List 4.
Excess= high Ca - GI= vomit, anorexia, pancreatitis constipated - CVS= HTN, arrhythmia, short QT - CNS: lethargy, hypotonia - Renal: hypercalciuria, nephrolithiasis, acute RF
51
What has amnesia effect: - midday - chloral - fentanyl - morphine
Amnesia = Midaz Analgesia + Sedate = fentanyl + morphine Only sedate; no analgesic or amnesia = Chloral
52
What med to use for sedating 2 y.o. in CT: - PO midaz - chloral - propofol - ketamine
PO midaz - chloral long 1/2 life; good sedate - propofol- resp distress - ketamine- good if pain; bad head
53
What med to use if sedate CT w/ head injury: - midaz - chloral - propofol
Propofol | - fast, reduce ICP
54
Teen. Fever + hepatomegaly + gram neg. rod =
Salmonella likely. Tx: CIPRO
55
Good med for intubating if bronchospasm?
Ketamine Bronchodilator. Maintain SVR/PVR. Great for sepsis.
56
Contraindication for midazolam:
Hypotension/ drop BP. QUICK on/off
57
Which med for intubation help decrease ICP?
Propofol Drop BP good to drop ICP
58
Gram (+) cocci:
``` Enterococcus Catalase (+) = Staph Catalase (-) = Strep ```
59
Gram (-) cocci:
meningitides, gonorrhoea vs. bacilli (GI shigella, h. pylori, cholera; GU e. coli, proteus, kleb, enterobacter, Resp= bordatella, h. influx, pseudomonas)
60
The reason maxeran is not commonly used: - AE - cost - interaction w/ other drugs
AE (dystonic rxn, EPS) Black box that if use more > 3 mo associated with usually permanent tardive dyskinesia.
61
Most concerning post-natal after preg SSRI exposure: - low BG - apnea - congenital malformation - persistent pul HTN - intellectual disability
Persistent pul HTN of newborn

RC: Specialties Woo Hoo (31 decks)

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