Pharmacology Flashcards
Mechanism of morphine for pain relief?
Mu delta receptor
= inhibit ascending pain pathway
+ alter perception
+ generalized CNS depression
T or F: morphine works at 1 type of receptor
False.
- mu-delta= analgesia, CNS
- K-opioid: spinal, miosis, psychotomimetic effect
T or F: morphine can only be given IV and PO.
False.
- IM, SC, IV, PO
Mechanism of Topical Benzyl Peroxide:
a. less p. acne resistance
b. less androgen sensitivity at sebum gland
c. less sebum production
c. less sebum
3X rxn
- less sebum
- lyse comedone
- inhibit P acne
What is the main difference btwn a neonate compared to teen re: drug dosing?
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
Can a mom on isoniazid BF?
Yes.
What cardiac med increase risk of hyPOthyroidism in BB?
a. esmolol
b. digoxin
c. amiodarone
d. procainamide
Amiodarone
- neonatal brady, long QT, PVC, neonatal hyPOthyroidism, neurodevelopment abnormalities
HENCE: PO or IV amiodarone ONLY if refractory to other tx
Mom on amiodarone. What is the risk to BB?
Neo HYPOthyroidism
Neonatal brady
Long QT
PVC
Neurodevelopment abnormalities
In utero exposure to cocaine results in:
a. lacking hearing
b. microcephaly
c. low BP
d. spinal dysraphism
Microcephaly
Preterm \++ Miscarriage \++ Placental abruption Low BW SGA Microcephaly
Usually no withdrawal but can have neurobehav (less arousal, bit jittery)
+/- longterm neurobehavioral abnormalities
List contraindications to succinylcholine:
- Skeletal muscle myopathy (muscular dystrophy, myopathy, MS)
- Acute burn or trauma (risk high K)
- Malignant hyperthermia (PMHX of FHX)
- Hypersensitive to succ
Warning: may increase intraocular pressure (avoid in narrow angle glaucoma, eye trauma)
4 Absolute contraindications to ketamine:
- 1=Hypersensitivity to Ketamine or part of its formulation
2. Severe HTN
3. Known or suspected schizophrenia
4. Infant < 3 mo.
Pt on cyclosporine. Treated with clarithromycin. Levels of cyclo go up. Why?
Clarihro causes decreased metabolism of cyclosporine.
B/Cmacrolide antibiotic inhibit CYP3A4 pathway?
What are side effects of MJ in teens:
- 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.
Most commonly abused illicit drug is:
Marijauna
T or F: 75% of high school students have used MJ.
False.
25-50%
List acute and chronic adverse effect of MJ in teens:
Acute:
- anxiety
- panic
- psychotic symptom
- roda crash if driving
Chronic:
- dependence (1 in 10)
- chronic bronchitis
- psychotic symp
- subtle cognitive impairment
Child on risperidol has frequent Syncope. You worry about?
Prolonged QT
List three side effects of typical and atypical antipsychotics:
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
Outside of wt gain, list 3 serious side effects of Risperidone:
- Prolonged QT
- Agranulocytosis (acute low WBC)
- Neuroleptic malignant syndrome (hyperthermia + altered LOC + muscular rigidity)
- Hepatotoxicity
What is the diff in symptom w/ NMS vs. Serotonin Syn?
NMS:
- hot (> 38)
- lost (alter LOC)
- rigid (muscular rigidity)
Serotonin Syn:
- dilated pupil
- myoclonus
- +++ DTR
What anti epileptic has AE of pancreatitis, hepatitis, thrombocytopenia:
a. carbemezapine
b. VPA
c. topiramate
d. phenytoin
= VPA
Bad Carbama: SJS, agranulo cytosis, liver, anemia
Bad Phenytoin: cerebral, hirsutism, SJS, liver
Bad Topa:
Cognitive, Glaucoma
List two reasons for girl on VPA to have vomit + lethargy:
- Hyper ammonemia/ encephalopathy
- Pancreatitis
- low plt cause hemorrhage
Pt on VPA develop lethargy or vomiting or low temp. MUST CHECK:
Ammonia level
T or F: septra decrease phenytoin clearance.
True.
Describe phenytoin toxicity:
Cerebellar= nystagmus, ataxia
Low Tone
LOC
Lethargy
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%
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)
Which med is associated w/ pyloric stenosis risk if used in infants?
Erythromycin
List 4 AE of indomethacin:
- low plt function = GI bleed, IVH
- NEC
- Spontaneous GI perf
- transient RF
List 4 AE of furosemide:
Lasix= inhibit reabsorption of Na and Cl from distal tubule and loop of Henle
- Hypo-K
- Hypo-Na
- Hypo-Cl
- Azotemia
- NICU prem= severe hyper-Calciuria, nephrolithiasis
6, Potential Prem= ototoxic, cholelithiasis
Child done w/ anthracycline. What do you monitor?
Cardiac echo
Anthracycline= doxorubicin, daunorubicin
- baseline echo recommended
- looking for dilated cardiomyopathy
Long term effect of doxorubicin:
- dilated cardiomyopathy
- hypertrophic cardiomyopathy
- pericarditis
- restrictive cardiomyopathy
Dilated Cardiomyopathy
Doxorubicin= Anthracycline= chemo= need echo.
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
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
E part of OCP related to:
- mood
- acne
- salt + water retention
Salt and water retention
Increased ICP. Obese + Acne. No sexual activity. Likely cause: OCP vs. Minocycline?
Minocycline.
= Po tetracycline
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
T or F: adult ht will be slightly shorter (1-1.5cm below predicted) if on moderate inhaled ICS for asthma.
True.
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
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
What is late AE of ADHD stimulant tx?
- appetite
- sleep
- tics
- depression
Depression
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))
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
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
Paroxetine is…
SSRI
SSRI overdose Features:
- tachycardia
- sedation
- seizure
- long QT
- rarely serotonin syndrome (LOC, autonomic, myoclonus, hyper reflexia/DTR)
Tx for SSRI overdose?
Supportive Care
- ECG
- R/O serotonin syndrome
- Benzo if mild serotonin syn
- Cyproheptadine if severe
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)
Child vomting; mom gave unknown suppositories. Recurrent tonic neck spasm. Normal LOC. Give:
- diazepam
- benadryl
- naloxone
Benadryl (anticholinergic)
to Tx drug induced dystonia
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
What has amnesia effect:
- midday
- chloral
- fentanyl
- morphine
Amnesia
= Midaz
Analgesia + Sedate
= fentanyl + morphine
Only sedate; no analgesic or amnesia
= Chloral
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
What med to use if sedate CT w/ head injury:
- midaz
- chloral
- propofol
Propofol
- fast, reduce ICP
Teen. Fever + hepatomegaly + gram neg. rod =
Salmonella likely.
Tx: CIPRO
Good med for intubating if bronchospasm?
Ketamine
Bronchodilator.
Maintain SVR/PVR.
Great for sepsis.
Contraindication for midazolam:
Hypotension/ drop BP.
QUICK on/off
Which med for intubation help decrease ICP?
Propofol
Drop BP
good to drop ICP
Gram (+) cocci:
Enterococcus Catalase (+) = Staph Catalase (-) = Strep
Gram (-) cocci:
meningitides, gonorrhoea
vs. bacilli (GI shigella, h. pylori, cholera; GU e. coli, proteus, kleb, enterobacter, Resp= bordatella, h. influx, pseudomonas)
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.
Most concerning post-natal after preg SSRI exposure:
- low BG
- apnea
- congenital malformation
- persistent pul HTN
- intellectual disability
Persistent pul HTN of newborn
