Pharmacology and Pain Management Flashcards
What does in utero exposure to vitamin A cause?
Transposition of the great arteries
Supplementation of Vitamin A during pregnancy is associated with Transposition of the Great Vessels (AKA Transposition of the Great Arteries, or TGA, or TOGA).
A patient presents with:
- tachypnea
- muscle rigidity
- increased pCO2
- acidosis
He had just had a procedure under general anesthesia.
What is the diagnosis?
Malignant hyperthermia
Malignant hyperthermia should be suspected in anyone who gets anesthesia and then has tachypnea + muscle rigidity + increased pCO2 + acidosis. Treat with DANTROLENE + Cooling + O2 + Hyperventilation beyond existing tachypnea. DO NOT give bromocriptine because it’s a dopa agonist. Also look for high CK, arrhythmias, and myoglobinuria. Kids with muscular dystrophy and other neuromuscular disorders are at risk for malignant hyperthermia.
What does in utero exposure to cocaine cause?
Premature birth
Premature birth is common with prenatal cocaine exposure. Surprisingly there are minimal withdrawal symptoms.
What prostaglandin synthase inhibitor can be used in patients with long-term NSAID use to prevent ulcers?
Misoprostol
Misoprostol is a synthetic PROSTAGLANDIN. In patients with long-term NSAID use, it can help prevent GI ulcers.
What are the most common side effects caused by Vincristine and Vinblastine?
Neurologic and SIADH
- neurologic side effects (neuropathies, palsies, seizures, etc.)
- SIADH.
What does in utero exposure to methadone cause?
Seizures
Newborn babies with a history of methadone exposure can have seizures. Symptoms may not present for up to 4–6 weeks!
What does in utero exposure to Heroin cause?
Seizures, tremors, irritability
There is often intrauterine fetal demise (IUFD) from heroin exposure. If not, look for seizures, tremors, irritability, etc.
PEARL: Heroin induces lung maturity, so if the baby survives, s/he is less likely to have lung disease.
A newborn has the following features:
- a small mouth,
- a small chin,
- epicanthal folds,
- midface hypoplasia,
- SPINA BIFIDA.
What was the in-utero drug exposure?
Valproic Acid
Carbamazepine exposure causes similar effects.
A newborn has the follwing features:
- small for gestational age (SGA),
- midface hypoplasia,
- thin upper lip,
- a smooth philtrum,
- a small 5th fingernail,
- 5th finger clinodactyly (curved),
- ASD,
- VSD.
What is this syndrome?
Fetal Alcohol Syndrome
Ethanol exposure causes FETAL ALCOHOL SYNDROME (FAS). Problems include small for gestational age (SGA), midface hypoplasia, thin upper lip, a smooth philtrum, a small 5th fingernail, 5th finger clinodactyly (curved), ASD, and VSD.
PEARL: Many of the symptoms overlap with those of anticonvulsant exposure. If you see SGA, ASD or VSD, consider choosing FAS over antiseizure medication exposure.
Which medications cause acute dystonic reactions?
Metoclopramide and promethazine
Metoclopramide and promethazine can cause acute dystonic reactions. If presented with a child who suddenly has a fixed and uncomfortable looking “pose,” or a fixed gaze, treat with Diphenhydramine!
What is the most common side effect seen with cyclophosphamide?
Hemorrhagic cystitis
Hemorrhagic cystitis is the key side effect to remember for cyclophosphamide.
What is the main side effect caused by Asparaginase?
Pancreatitis
Pancreatitis is the key side effect to remember for asparaginase.
If a medication trough is too high, how do you adjust it?
Increase the interval between doses
If the trough of a medication is too high, increase the interval between doses. The wider the interval, the lower the trough. So if a trough is high, simply wait a little while longer before giving the next dose.
What are the effects of Terbutaline in the neonate when exposed in utero?
Hypoglycemia
Terbutaline is a beta-adrenergic drug that can cause maternal hypERglycemia. This causes fetal hyperinsulinism and subsequent hypOglycemia in the neonate.
What drug is contraindicated in breastfeeding?
Diazepam
Diazepam is contraindicated in breastfeeding.
