Pharmacology SAQ Flashcards
- 14 yo girl who has received treatment for Hogkins. She was treated with Adriamycin, bleomycin, etoposide, vincristine, steroids and cyclophosphamide. She also received total-field radiation. She wants to talk to you about late effects.
a) What is the most significant complication associated with bleomycin?
b) Name 3 late effects caused by her chemotherapy
c) Name 1 disease she is at risk for from her radiation therapy.
a) Pulmonary fibrosis
b)
1. Adriamycin = doxorubicin: cardiomyopathy
2. Vincrinstine: peripheral neuropathy
3. Steroids: osteoporosis, cataracts
4. Etoposide: secondary leukemia (AML)
5. Cyclophosphamide: gonadal dysfunction, infertility
c)
- Secondary neoplasms
- Hypothyroidism
- GH deficiency
- Hyperprolactinemia
2 a) List 4 clinical entities that the HPV vaccine prevents. b) Some children can get 2 injections instead of 3. What group of children does this apply to?
a) HPV 6&11, 16&18
1. Genital warts
2. Cervical cancer
3. Penile cancer
4. Cancer of vulva
b) 9-14yo, given at least 6mo apart
- Kid with Methanol toxicity. Na 140, K 4, Cl 96, Bicarb 11, BUN 11, Glucose 4, Serum osmolarity– 396
a. Calculate anion gap. Show calculations.
b. If anything, What would you expect of the osmolar gap?
c. What is the long term complication of methanol toxicity?
d. What is one med to treat methanol toxicity?
A. AG = 140 - (96+11) = 140 - 107 = 33
B. OG >10
C. Blindness
D. Fomeprazole. Inhibits alcohol dehydrogenase to prevent breakdown of alcohol into its toxic acid metabolites
- 5 absolute contraindications to oral contraceptive pills in adolescents?
- HTN (160/100)
- Current or past hx of VTE
- Ischemic heart disease
- Cerebrovascular accident
- Complicated valvular heart disease
- Migraine H/A with focal neuro Sx
- Current breast cancer
- Diabetes with retinopathy, neuropathy, nephropathy
- severe cirrhosis
- Liver tumour
- Boy was given codeine after his pharyngitis surgery, and was found to be 94% RA, other vitals stable, ++ somnolent.
a) What is the likely pathology?
b) What causes this pathology?
c) What TWO things do you do?
a) Narcotic overdose
b) ultra rapid metabolizer - rapidly metabolizes codeine to morphine causing sedation
c) 1. Give oxygen, put on cardioresp + sat monitors, monitor for respiratory depression
2. Consider narcan
- What are FIVE side effects of indomethacin?
- AKI
- east bleeding - platelet adhesion + aggregation decreased
- PUD
- GI perforation
- Dermatitis
- Child with SSRI newly prescribed. What are the TWO most important side effects he needs to know about?
Provide a plan of how you initiate, monitor and titrate the drug.
A. 1. Risk of physical symptom improvements occurring before mood symptoms, therefore leading to blackbox warning of increased risk of suicidal ideation.
2. Please seek physicain if behavioural activation (increased agitation or impulsivity), which could suggest bipolar disorder
B.
1. Initiate
- Goal fo starting dose: achieve minimum effective dose in next 1-2 wks. Don’t let youth remain on starting doses of meds for prolonged period of time in face of ongoing symptomatic distress
2. Monitor
- weekly for first 4wks following initiation of SSRi med
- Q2wks for next 4wks
- At 12wks
- As clinically indicated beyond 12 wk point
- Additional contact by phone in between face-to-face visits + suicide risk
- Evaluate suicidal thoughts + behaviours, effectives + potential adverse medication effects at current dose, medication adherence
- Refer to psych prior to D/C meds if Hx of multiple depressive episodes, comorbid psychiatric illnesses (including substance use disorder), complicated depressive episodes
3 Tritrate
- goal of Tx: achieve full remission of depressive Sx
- Once effective dose of medication reached, continue for min 6-12mo to decrease risk of relapse
- Slow taper of meds at relatively stress- free time
- Name 4 serotonergic side effects of SSRIs
- Fever
- Hyperreflexia
- Clonus
- Altered mental status
Parent asking about giving cough medicine to child. What do you tell her?
- Advise not to use in <6yo
- Caution for use in >6yo.
- Do not combine 2 or more meds with the same ingredient. 4. Use a measuring device
Factors assoc’d with fatalities from OTC cough + cold medications in children
- <2yo
- Use of medication for sedation
- Use in a daycare setting
- Combining 2+ medications with the same ingredient
- Failure to use a measuring device
- Product misidentification
- Use of products intended for adults
- Young kid receiving treatment with vancomycin. Thirty minutes into the infusion, he develops an erythematous, diffuse, macular rash over most of his body. No respiratory distress. What’s the NEXT step in management? If you decide to give vancomycin again, what 2 things would you do?
A. Stop the vanco
B. 1. Run at a slower rate
2. Pre-treat with H1 blocker (e.g. Cetirizine)
Red Man Syndrome
- Pseudoallergic rxn: release of histamine + other mediators from cutaneous mast cells from rapid admin of vanco
- Sx: itching, flushing, hives, (hypotension less common) start at face + neck and progress to chest
- List 4 absolute contraindications to ketamine
- <3mo
- Schizophrenia
- Hypersensitivity reaction to drug or any of its componets
- Conditions where increase of BP would be hazardous
- increased intraocular pressure
- increased intracranial pressure
- HTN
- thyrotoxicosis
- heart failure or angina
- aneurysm
- List 3 side effects of Risperidone
- Weight gain
- Extrapyramidal symptoms
- Hyperprolactinemia
- Gynecomastia
- Sedation
Atypical antipsychotic
- clozapine, risperidone, olanzepine, quetiapine, ziprasidone, aripiprazole, paliperidone
SE
- wt gain (highest olanzepine, lowest aripiprazole)
- Hypercholesterolemia
- Orthostatic hypotension
- Sedation
- Anticholinergic Sx (highest clozapine!!)
- Hyperprolactinemia (highest ripseridone)
- Prolonged QT (highest ziprasidone)
- Cardiomyopahies
- Cataracts
- Sexual dysfunction
- EPS/TD (highest risperidone, lowest clozapine, quetiapine)
- Teenager took overdose of Gravol and Tylenol. List six clinical signs of Gravol overdose.
Anticholinergic
- Hyperthermia (hot as a hare)
- Dilated pupils (blind as a bat)
- Agitation (mad as a hatter)
- Flushed skin (red as a beet)
- Dry skin (dry as a bone)
- Tachycardia
- Decreased bowel sounds
- Urinary retention
- Neonate with PDA treated with indomethacin. List four side effects of indomethacin
- Increased risk of bleeding
- Transient renal insufficiency
- NEC
- Spontaneous intestinal perforation
Contraindications
- thrombocytopenia <50
- Bleeding disorders
- Oliguria
- NEC
- isolated intestinal perforation
- Elevated Cr
- List 3 serious side effects of Risperdol in addition to weight gain
- Extrapyramidal Sx
- Hyperprolactinemia
- Metabolic syndrome
