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Pharmacology Flashcards

1
Q

What 3 ways we can install dilating drops in patient?

A
  1. Admnister with child’s eyes closed
  2. Spray technique
  3. Ointment
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2
Q

What’s the failure rate of ointments for dilation?

A

10% failure rate

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3
Q

What 3 ways do topical drugs reach systemic circulation?

A
  1. Through ocular tissues
  2. Spillage on lid and cheek (skin absorption)
  3. Nasolacrimal or Oral absorption/ingestion
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4
Q

Which type of systemic absorption is absorbed directly and there’s no first pass metabolism through liver

A

Ocular tissues

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5
Q

Why is skin absorption more when drugs are spilled on lid and cheek of skin?

A
  • kids have thinner & more porous skin

- Kids up to age 6 absorb drugs better

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6
Q

For oral absorption, why is a risk of drug toxicity increased in children?

A
  • gastric secretion & peristalsis are reduced

- GI tract is a poor barrier to drug absorption

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7
Q

Newborns and infants may need higher doses of ______ drugs as expected from weight charts.

A

hydrophillic drugs

- have higher extracellular water compared to adults

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8
Q

Describe the BBB in newborns.

A

Incomplete

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9
Q

Newborns younger than 6mo have less protein available which _____ drug binding.

A

decrease

-decreased drug binding increases the amount of unbound drug in the blood, causing toxicity

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10
Q

What is the primary organ responsible for metabolism?

A

Liver

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11
Q

Children (esp. premature & neonates) have a _____ # of metabolic enzymes.

A

lower

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12
Q

When does metabolism reaches adult levels at what age?

A

3-4years

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13
Q

In neonates, excretion from the kidney is ____ due to what?

A

Decreased

  • renal blood flow is relative to body size
  • decreased drug elimination, more drug in blood
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14
Q

Dosing adjustments must be made for renal function for what 2 groups?

A
  • 1-2 yo

- kids with renal disease

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15
Q

What are the top 3 things needed to determine a pediatric dose?

A
  1. Age
  2. Weight
  3. Surface Area
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16
Q

What are the 4 ways to manage hyperacute bacterial conjunctivitis?

A
  1. gram stain, culture and sensitivies
  2. Refer to pediatrician
  3. systemic antibiotic (amoxicillin or cephalosporin)
  4. Broad spectrum topical antibiotic (besivance, polysporin)
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17
Q

What type of palpebral conj response is found in hyperacute bac. conj vs. acute?

A
  • hyperacute - mixed response (pap & follicles)

- acute = papillary response only

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18
Q

What is the most common cause of post-neonatal conjunctivitis ?

A

Bacterial conjunctivitis (80%)

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19
Q

What are the 3 clinical features of bacterial conj?

A
  1. Sticky eyelids
  2. Mucous/purulent discharge
  3. Self-limiting; 8-10 days
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20
Q

What is the most common pathogen to cause bacterial conj.?

A

H. Influenza (42%, gram negative)

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21
Q

What is the peak incidence of pediatric acute conjunctivitis? What does the child usually also present with?

A
  • 1-3 years old

- otitis media (39%)

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22
Q

What is the most common cause of bacterial keratitis in children under 3? from 3-15yo?

A
  • Pseudomonas aeruginosa (gram -)

- Strep pneumonia

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23
Q

Polytrim, Sulfacetamide is good for what age?

A

2 mo. +

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24
Q

What are the 3 advantages of aminoglycosides?

A
  • Active against H. Influenzae
  • Bactericidal
  • Most effective against gram negative
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25
There's a ___% chance of type 4 hypersensitivity reaction with Neomycin. Allergic reactions usually occur if tx lasts longer than __ week.
10% chance | longer than 1 week.
26
What 2 drugs should not be used in kids?
- Chloramphenicol | - Tetracycline
27
What is the difference between vigamox and moxeza?
- Vigamox is for 1 year +, dosed TID | - Moxeza contains Xanthan gum, 4 mo+, dosed BID
28
What vehicle is found in besifloxacin that enhances ocular surface duration?
Durasite
29
Which generation of FQs have the least amount of resistance?
4th gen.
30
What are the 4 best treatments and dosing for acute bacterial conj. in a 2mo to 1yo?
1. Polytrim - q3h 2. Moxeza - BID 3. Polysporin ung 4. Tobrex ung, q3-4h
31
What are the 2 best treatments and dosing for Acute Bac. Conj. in preschool & school age children?
1. Polysporin ung 2. Besivance TID 3. Azasite BIDx2days then QDx5days 4. Moxeza BID 5. Vigamox TID
32
What are the tx for MRSA?
1. Vancomycin (gold standard) 2. Polytrim 3. Bactrim 4. Bacitracin? 5. Besivance
33
What are the features of blepharokeratoconjunctivitis?
1. Recurrent episodes of chronic red eye 2. watering 3. photophobia 4. blepharitis
34
What are the symptoms of BKC?
1. irritation | 2. constant eye rubbing
35
What are the top 3 associated ocular signs of BKC?
1. Punctate keratitis (55%) 2. Vascularization (53%) 3. Corneal scarring (38%)
36
When is the age of onset greatest in BKC? Median age?
Age of onset = 2-4yo | Average = 5.4 years
37
BKC is more severe in what ethnic groups?
1. Asian | 2. Middle-Eastern
38
What is the tx for BKC?
1. Daily lid hygiene 2. Warm compresses 3. Antibiotic ung, hs 4. Topical steroid (as needed)
39
What is the key in dx neonatal conjunctivitis?
Onset!
40
What is the onset of chemical, bacterial, gonoccal and chlamydial conjunctivitis?
1. Chemical - first 24h 2. Bac - after 24h 3. Gon - 2-4 days 4. Chlam - 2 wks after birth
41
What is the proper workup for neonatal conj?
- Conj. Scrapings for 3 slides | - Conj. Cultures
42
What 3 slides do you need for conj. scrapings?
- Gram stain - Giemsa stain - Chlamydial antibody test
43
What cultures should be used to help dx neonatal conj?
- blood and chocolate agar - thayer martern for gonorrhea - viral culture
44
What is the most common cause of chemical conjunctivitis? How do you tx it?
- Silver nitrate - No tx is necessary - used non-preserved ATs
45
How do we tx gonococcal conj?
1. Hospitalize 2. IV Ceftriaone for 7 days 3. Bacitracin, ung
46
How do we tx chlamydial neonatal infections?
1. Erythromycin syrup 2. Erythro. ung 3. Tx mom and sexual partners
47
Poorly tx chlamydial conj. in a newborn can lead to what 2 things?
1. Chlamydial pneumonia | 2. Otitis media
48
Neonates with suspected herpes simplex infectin should be treated with systemic ____ to reduce risk or systemic infection.
acyclovir, 60mg/kd/day, TID for 14 days
49
What is the best treatment for VKC?
Antihistamine/mast cell stabilizer
50
How many americans have allergies?
50 million
51
What are the top 2 goals in allergic kids?
- to stop the itching | - stop the rubbing
52
What is a good first treatment for allergies?
Decongestant-antihistamine drops (Visine).
53
Naphazoline is contraindicated in who?
- low birth weight and premature infants
54
Naphcon A and Vasocon A are approved for what age?
6 years +
55
Long-termuse of decongestant antihistamine drops should not be used chronically in children bc they'll cause what 2 SE?
1. drowsiness | 2. bradycardia
56
Emadine is an antihistamine drop that targets what receptor?
H1 receptor antagonist
57
What is the age and dosing of Emadine?
3+, QID | - good for mild allergies, not really used for allergic conj.
58
What is the mainstay treatment for chronic allergies?
Mast Cell Stabilizers
59
What is the age and dosing of Alomide, Cromolyn sodium and Alocril?
1. Alomide - 2y+, QIDx3mo 2. Cro. S- 4y+, QID-6x a day Alocril - 3y+, BID
60
What drug acts as a MCS and Eosinophil chemotaxis inhibitor?
Alamast - 3y + - QID
61
What is the age and dosing of BEZPOP>
1. Bepreve: 2+, BID 2. Elestat: 3+, BID 3. Zatidor: OTC, 3+, BID 4. Pazeo: 2+, QD 5. Pataday: 3+, QD 6. Latacaft: 2+, QD
62
What drug is a MCS/AH combo and eosinophil chemotaxis inhibitor?
optivar | 3+, BID
63
What corticosteroid is approved for the ages of 2+?
FML
64
What NSAID is approved for ages 3+?
Acular LS (less stinging than regular Acular)
65
What are the 5 supportive allergy therapy options?
1. Sunglasses 2. Stay inside in am 3. Wash hands after being outside 4. Shower before bed 5. Air conditioner in house, bedroom, car
66
What test is performed to dx viral conj.?
RPS - Rapid pathogen screening Adeno Detector
67
How do we tx. viral conj? Is it contagious?
1. ATs 4-8 times/day | 2. Very contagious
68
How do we decrease the risk of sprading viral conj?
- frequent hand washing - don't share anything - don't touch eyes - don't shake hands
69
Timolol is approved for what age?
Children over 10yo
70
Brinzolamide is contraindicated in what type of kids?
Kids with sulfa allergies
71
PGAs are only allowed to be used in __?
older children
72
There should be no atropine refractions until 3 mo old due to what?
- sensitive period of vision development | - may induce amblyopia
73
Atropine and Cyclogyl are contraindicated in what 3 groups?
1. Down Syndrom children 2. Kids w/ neurological disorders (brain damage, seizure, etc) 3. Albinos - use tropic and phenyl instead of atropine
74
Atropine and Cyclogyl should be used with CAUTION in who?
Lightly pigmented children
75
A 1-5yo with light irides should be dilated using what?
- tropicamide - phenylephrine - tropicamide again (prn) - separate drops by several minutes
76
A 1-5yo with dark irides should be dilated using what?
- tropic + phenyl, use punctal occlusion - hold lids apart for 30secs - wipe excess liquid after lids are closed
77
A normal kid with light iridies should get what drops for a dilated refraction?
- cyclopentolate (1gttp) | - phenyl (1 gttp)
78
A normal kid with dark iridies should get what drops for a dilated refraction?
- cyclopentolate (1gttp) - tropicamide - phenyl (1 gttp)
79
What is the DOC for cycloplgic refraction for accommodative esotropia?
Atropine | - 2 to 3 drops per day for 3 days before exam
80
What is it called when atropine is used in the tx of amblyopia?
Pharmacologic penalization | - alternative to occlusion therapy
81
Pharm. Penalization is used for what type of amblyopia?
Moderate ambly: 20/40 to 20/100
82
What are the main 3 adverse reactions of atropine?
- light sensitivity (18%) - Lid/Conj irritation (4%) - Eye pain/HA (2%)
83
If severe CNS reaction to atropine, what drug should be used?
Physostigmine

Pediatrics (10 decks)

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