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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
Q

Describe phenytoin toxicity:

A

Cerebellar= nystagmus, ataxia

Low Tone
LOC
Lethargy

26
Q

Most common AE of cephalosporin:

  • Rash
  • diarrhea
  • anaphylaxis?
A

Diarrhea

Most common:
= GI= biliary sludge (25%), diarrhea (15%), transient LFT up, N/V
= rash 1-3%
= anaphylaxis 0.1%

27
Q

Hypo pigmented flat scar after trauma + vesicular lesion w/ sun. Most likely med involved?

A

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
Q

Which med is associated w/ pyloric stenosis risk if used in infants?

A

Erythromycin

29
Q

List 4 AE of indomethacin:

A
  1. low plt function = GI bleed, IVH
  2. NEC
  3. Spontaneous GI perf
  4. transient RF
30
Q

List 4 AE of furosemide:

A

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
Q

Child done w/ anthracycline. What do you monitor?

A

Cardiac echo

Anthracycline= doxorubicin, daunorubicin

  • baseline echo recommended
  • looking for dilated cardiomyopathy
32
Q

Long term effect of doxorubicin:

  • dilated cardiomyopathy
  • hypertrophic cardiomyopathy
  • pericarditis
  • restrictive cardiomyopathy
A

Dilated Cardiomyopathy

Doxorubicin= Anthracycline= chemo= need echo.

33
Q

V and D while on 4:1 dosing amox-clav. Most likely cause?

A

Wrong clavulin dose.

  • min 7 amox: 1 clan preferred
  • if use 4:1 dosing= 25% get diarrhea
34
Q

Started vanco. Breaks out in red rash. BP normal. Dx? Immediate management? Two things to prevent next time?

A

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
Q

E part of OCP related to:

  • mood
  • acne
  • salt + water retention
A

Salt and water retention

36
Q

Increased ICP. Obese + Acne. No sexual activity. Likely cause: OCP vs. Minocycline?

A

Minocycline.

= Po tetracycline

37
Q

Child w/ head injury. Which is reason ketamine SHOULD NOT be used in this child:

a. sympathomimetic
b. (-) inotropy
c. resp suppression

A

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
Q

T or F: adult ht will be slightly shorter (1-1.5cm below predicted) if on moderate inhaled ICS for asthma.

A

True.

39
Q

T or F: hypokalemia cause long QT

A

True

Other: low Ca, low Mg
Other: macrolide, fluoroquinolone (levofloxacin), anti fungal, TCA, haldol, risperidone, ondansetron
Other: HIV, low temp

40
Q

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
A

Reduce risk of future addiction

41
Q

What is late AE of ADHD stimulant tx?

  • appetite
  • sleep
  • tics
  • depression
A

Depression

42
Q

2 year old w/ torticollis and neck pain. List three things on dx:

A

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
Q

What is the best way to assess pain in 6-10 y.o.?

A

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
Q

Four things to consider when starting opioids:

A
  • 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
Q

Paroxetine is…

A

SSRI

46
Q

SSRI overdose Features:

A
  • tachycardia
  • sedation
  • seizure
  • long QT
  • rarely serotonin syndrome (LOC, autonomic, myoclonus, hyper reflexia/DTR)
47
Q

Tx for SSRI overdose?

A

Supportive Care

  • ECG
  • R/O serotonin syndrome
  • Benzo if mild serotonin syn
  • Cyproheptadine if severe
48
Q

Describe drug induced dystonia:

A

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
Q

Child vomting; mom gave unknown suppositories. Recurrent tonic neck spasm. Normal LOC. Give:

  • diazepam
  • benadryl
  • naloxone
A

Benadryl (anticholinergic)

to Tx drug induced dystonia

50
Q

Excess Vitamin D Effects. List 4.

A

Excess= high Ca

  • GI= vomit, anorexia, pancreatitis constipated
  • CVS= HTN, arrhythmia, short QT
  • CNS: lethargy, hypotonia
  • Renal: hypercalciuria, nephrolithiasis, acute RF
51
Q

What has amnesia effect:

  • midday
  • chloral
  • fentanyl
  • morphine
A

Amnesia
= Midaz

Analgesia + Sedate
= fentanyl + morphine

Only sedate; no analgesic or amnesia
= Chloral

52
Q

What med to use for sedating 2 y.o. in CT:

  • PO midaz
  • chloral
  • propofol
  • ketamine
A

PO midaz

  • chloral long 1/2 life; good sedate
  • propofol- resp distress
  • ketamine- good if pain; bad head
53
Q

What med to use if sedate CT w/ head injury:

  • midaz
  • chloral
  • propofol
A

Propofol

- fast, reduce ICP

54
Q

Teen. Fever + hepatomegaly + gram neg. rod =

A

Salmonella likely.

Tx: CIPRO

55
Q

Good med for intubating if bronchospasm?

A

Ketamine

Bronchodilator.
Maintain SVR/PVR.
Great for sepsis.

56
Q

Contraindication for midazolam:

A

Hypotension/ drop BP.

QUICK on/off

57
Q

Which med for intubation help decrease ICP?

A

Propofol

Drop BP
good to drop ICP

58
Q

Gram (+) cocci:

A 
Enterococcus
Catalase (+)
= Staph
Catalase (-)
= Strep
59
Q

Gram (-) cocci:

A

meningitides, gonorrhoea

vs. bacilli (GI shigella, h. pylori, cholera; GU e. coli, proteus, kleb, enterobacter, Resp= bordatella, h. influx, pseudomonas)

60
Q

The reason maxeran is not commonly used:

  • AE
  • cost
  • interaction w/ other drugs
A

AE (dystonic rxn, EPS)

Black box that if use more > 3 mo associated with usually permanent tardive dyskinesia.

61
Q

Most concerning post-natal after preg SSRI exposure:

  • low BG
  • apnea
  • congenital malformation
  • persistent pul HTN
  • intellectual disability
A

Persistent pul HTN of newborn

RC: Specialties Woo Hoo (31 decks)

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