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Statistics and Pharmacology Flashcards

1
Q

Different data type. Give example of each:
- Categorical
- Nominal
- Ordinal
- Integer
- Discrete
- Continuous
- Ranked

A
  • Categorical: Gender, Race, late preterm, early term etc.
    Nominal = Categorical
  • Ordinal: ROP stages, APGAR scoring,
  • Integer: count. number of accidents, number of hospital re-admissions
    Discrete = Integer = Count
  • Continuous: weight, gestational age.
  • Ranked: assigned a number rank. ranked list of leading causes of death. or leading causes of pediatric hospital admission.
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2
Q

Mean, Median and Mode

In right skewed distribution, where is the peak of the curve? where is each of the above from L to R

A

Mean
Median: values at which 50% of values are greater and 50% are
smaller.
Mode: most common value

Peak of the curve to Left
Mode (peak of the bell curve)
Median
Mean

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3
Q

Normal bell curve
Give percentage of the following:
within 1 SD
within 2 SD
within 3 SD

A

68 % (68.2%)
95 % (95.4%)
99.8%

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4
Q

Box Plot
Outlier:
Far Outlier:
Median
Qu
QL
Inner Fence
Outer Fence

A

outlier: between inner and outer fence
far outlier: outside outer fence
median: 50% ile
Qu: 75% ile
QL: 25% ile
Inner Fence: QL + 1.5x IQR = 95%
Outer Fence: QL + 3x IQR = 99%

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5
Q

What is Null Hypothesis (Ho)?

A

There’s no difference between the two groups.

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6
Q

What is Type 1 Error?
What is Type 1 Error also called?

A

Reject null hypothesis when it is true
False positive

Alpha Error

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7
Q

What is Type 2 error?
What is Type 2 error also called?

A

Accept the null hypothesis when it is false
False negative

Beta error

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8
Q

what is power ？
how to calculate power?

A

Probability of rejecting the null hypothesis when null hypothesis is false
(probability of detecting a difference if it exists)

1- Beta error

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9
Q

Calculate sensitivity/specificity/PPV/NPV and draw the 2x 2

Populations of 1000 babies. 100 babies have a disease
180 babies tested positive, among them 100 do not have the disease

What is the sensitivity, specificity, PPV, NPV.

A

Top: Disease : +, -
Left: Test: +, -

Sensitivity:
80 / 100
(portion of ppl who has the disease and tests positive)
–> needed for screening test.

Specificity:
800 / 900
(portion of ppl who does NOT have the disease and test negative)

PPV:
80 / 180
probability of having the disease when test is positive.

NPV:
800 / 820
probability of not having the disease when test is negative.

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10
Q

what are parametric tests for continuous data? (how to compare continuous data?)

A

2 groups:
- unpaired t-test
- paired t-test (compare two groups before and after)

3 or more groups:
- analysis of variance (ANOVA)
- multiple regression

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11
Q

What are parametric Tests for categorical data?
(how to compare categorical data?)

A

2 groups:
- chi-square
- McNemar’s (two paired groups)

3 or more groups:
- chi-square
- logistic regression

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12
Q

how is p-value related to type I error

A

p-value IS type I (alpha) error.
false positive rate

The probability of observing a difference by chance alone

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13
Q

Confidence interval:

Give some examples of how to explain confidence interval.

A

Based on the sample’s standard deviation and its size (i.e. given its standard error), we are 95% confident that the limits cover the true value for the population mean

OR, if we draw samples of the same size 100 times, 95 of those will include the true population mean

OR, ‘the results are accurate to within +/-2SD 950 times out of 1000’

(if cannot figure out, it’s fine)

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14
Q

case reports, case series and cross-sectional study

A

you just look at cases, exposure and outcome

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15
Q

case-control study

A

cases + controls (chosen by analyst)
you know the outcome,
you look at exposures

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16
Q

cohort study

A

cases + controls (chosen by analyst)
some has exposures and some no exposures.
You look at the outcome.

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17
Q

Relative Risk Reduction

what is it? how to calculate it?

what about Relative Risk?

A

“Risk of adverse outcome in the experimental group is reduced by this proportion relative to controls”

2 x 2
Top: Disease (+, -)
Left: exposure/intervention (+, -)
A, B
C, D

Control event rate: C/ (C+D)
Experimental event rate: A / (A+B)

Relative Risk or releative risk ratio. = experimental event rate / control event rate.

RRR= 1- Relative Risk

(measures of effect)

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18
Q

Odds Ratio

what is it? how to calculate it?

A

“Odds of adverse outcome in the experimental group is reduced by this proportion relative to controls”

Intervention Odds = A/B
Control Odds = C/D

Odds Ratio = Intervention Odds / Control Odds = (A/B) / (C/D)

OR will always overestimate the effect size compared to RR.
(measures of effect)

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19
Q

Absolute Risk Reduction

what is it? how to calculate it?

A

“Risk of adverse outcome in the experimental group is reduced by this absolute percentage.”

Absolute Risk Reduction = control event rate - experimental event rate
(ARR = CER - EER)

[ a / (a+b)] - [ c/ (c+d)]

ARR is aka attributable risk (AR) or risk difference (RD).

(measures of effect)

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20
Q

Numbers Needed to Treat

what is it? how to calculate it?

A

“Need to treat this many patients to avoid one adverse outcome”

NNT = 1/ Absolute Risk Reduction

(measures of effect)

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21
Q

Run Chart
what’s x-axis and what’s y-axis
what are 4 rules
what is the “run”

A

Y-axis: measure of interest
X-axis: unit of time
median line.

“run” = one or more consecutive data points on one side of the median

4 rules:
1. trend (5 or more)
2. shift (6 or more)
3. too many or too few runs (median data line crosses only once)
4. an astronomical data point.

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22
Q

Control chart elements:

x and y axis

A

x-axis: period
y-axis: precent

central line, upper control limit, lower control limit

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23
Q

SMART Aim
what does each letter represent

A

Specific
Measurable
Achievable
Relevant
Time Limited

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24
Q

Three component in QI

A

process
outcome
balancing measures

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25
4 moral principles: (Belmont Report)
Respect for persons > consent Beneficence > risk & benefit Justice > population nonmaleficience > do no harm
26
Fetal death at what week is considered miscarriage? Fetal death at what week is considered: "NCHS Still Birth" "WHO still Birth" Early Fetal Death Late Fetal Death
**THIS WAS ON BOARD** < 20 weeks --> miscarriage "NCHS Still Birth" > 20 weeks "WHO still Birth" > 28 week Early Fetal Death: 20-27 weeks Late Fetal Death > 28 weeks
27
Definition of Infant's Death: What are 2 subcategories of infant death? Among them, one has 2 sub-sub categories.
A live birth that results in death within the first year (<365 days) is defined as an infant death. 0 to < 28 days = Neonatal death * 0 to <7 days = Early neonatal death * 7 to <28 days = Late neonatal death 28 to 364 days = Post-neonatal death
28
3 definition of perinatal death
Definition I **fetal death ≥ 28 weeks through infant death < 7 days** Definition II fetal death ≥ 20 weeks through infant death < 28 days Definition III fetal death ≥ 20 weeks through infant death < 7 days
29
Fetal Mortality Rate
Fetal mortality rate = fetal death in 1 year / (live births + fetal death) x 1000 Fetal death: fetal death >/= 20 weeks (NCHS guideline)
30
Neonatal Mortality Rate
(Death from birth to <28 days / Live births) x 1000
31
Perinatal Mortality Rate
(Fetal death >/= 28 weeks + neonatal death < 7 days) / (Live birth + fetal death > =28 weeks) X 1000
32
Infant Mortality Rate
(Death from Birth to < 365 days / Live births) x 1000
33
postnatal mortality rate
Post-neonatal death (28 day to 364 days) / live births x 1000
34
For gentamicin, trough is used to assess/ monitor what?
Toxicity risk.
35
For vancomycin, trough is used to assess what?
Therapeutic effectiveness. (Vancomycin has time-dependent killing )
36
Most common mechanism of trans-placental drug transfer
Simple diffusion
37
How does prevalence change PPV and NPV? What about sensitivity and specificity?
Increase Prevalence **increase** PPV and **decrease** NPV. No change in sensitivity and specificity.
38
P450 inducer (p450) cytochrome system inhibitor)
1 D, 2P, 1 R Dexamethasone Phenobarbital Phenytoin Rifampin
39
P450 inhibitor
Ranitidine Omeprazole Methadone Indomethacin Fluconazole Erythromycin Cimetidine Chloramphenicol
40
0 order kinetics. What does the half life depend on? what does time vs. log of drug concentration curve looks like? vs. 1st order kinetics.
- half life depends on the dose - curved (vs. 1 order kinetic is straight) 1st order kinetics: certain percentage, proportional to serum drug concentration. not depend on dose
41
Phase I Phase II Phase III Phase IV of clinical trial
I: small, safety and dose, side effect. II: slightly larger, safety, effectiveness III: large cohort, RCT, treatment vs. no treatment. IV: post marketing,
42
one-compartment model of drug distribution and equilibration two- compartment model of drug distribution
One compartment: time and log drug concentration straight line. **Gentamicin** Two compartment: two straight lines: distribution phase and elimination phase **Vancomycin**
43
if you calculate NNT as decimal (like 2.1), what is NNT?
round up, NNT = 3
44
How to increase study power?
1. increase significance criteria aka **p-value** (statistical significance value) increase power: reduce risk of Type II error. increase risk of Type I error (p-value). 2. increase magnitude of effect magnitude of effect: the size of expected observed change increase magnitude of effect would reduce the risk of type II error (false-negative) 3. increase the sample size 4. decrease standard deviation (decrease heterogeneity) Power: probability of rejecting the **null hypothesis** when it is indeed **false**.
45
if Type I error decreases, what happens to the required power
power needs to increase. greater amount of power is needed to detect smaller effect size.
46
peak concentration of drug are dependent on what? trough concentration of drug are dependent on what?
peak concentration of drug are dependent on **infusion rate** and **dosage** trough concentration of drug is dependent on **interval of drug administration**
47
who has higher volume of distribution? Premie or full term baby? what does this mean in term of clearance for preterm infant
Premie has HIGHER volume of distribution Therefore, SLOWER Clearance
48
Volume of distribution calculation? Vd (L/kg)
Vd = total amount of drug in body (mg) / plasma concentration of drug (mg/L) x weight (kg)
49
Phase I reaction in drug metabolism
Cytochrome P450 metabolism oxidation, reduction, hydrolsysis, demthylation
50
Most common Phase II reaction in drug metabolism
Glucuronidation (slow in neonate, important for morphine and acetaminophen metabolism)
51
Dose and Steady state calculation
Dose 1 / [SS] 1 = Dose 2 / [SS] 2 5 half life = steady state
52
what drugs have 0 order kinetics
diazepam, ethanol, aspirin, chloramphenicol
53
Loading dose calculation
Loading Dose = Vd x Cp (mg/L) / (S x F) Cp: plasma concentration S: fraction of drug which is active F: fraction of drug which is bioavailable S and F can be 1.
54
Three formulas for: Clearance of drug (2 formulas) Elimination rate constant (Kel)
Clearance of Drug (L/hr-kg) = Elimination rate constant (Kel) x Volume of distribution Clearance of Drug = (Dose/Interval) / Average steady state concentration Kel = Clearance of Drug / Volume of distribution
55
steady state formula
Steady State = Infusion Rate / Clearance of Drug = Infusion Rate / (Elimination rate constant x Vd) 5 half lives to reach steady state
56
Elimination half-life aka Half-life calculation
Half life = 0.693 / Kel = 0.693 / (Clearance of drug / Vd) = (0.693 x Vd) / Clearance of Drug
57
ACE Inhibitor - adverse effect on fetus?
Oligohydramnios Renal failure Lung hypoplasia Skull ossification defects
58
Beta blockers - adverse effect on fetus?
Fetal bradycardia Hypoglycemia Possibly fetal growth restriction (not macrosomia)
59
Carbamazepine - adverse effect on fetus?
Neural tube defects Craniofacial defects (cleft palate) Growth restriction Hemorrhagic disease of the newborn Developmental delay
60
Methimazole - adverse effect on fetus?
Choanal atresia Esophageal atresia Hypothyroidism, goiter Cutis aplasia
61
Tetracyclines (Doxycycline, Minocycline, and Tetracycline)
Slowed bone growth Enamel hypoplasia Permanent yellowing of the teeth
62
Drug administration modes from greatest to least effect on maternal blood levels
IV > Paracervical > IM > Epidural > Spinal
63
Drugs that displace bilirubin from albumin
Sulfonamides Ceftriaxone Chloral hydrate Ibuprofen
64
Which medications interfere with vitamin K oxidation?
Phenytoin Phenobarbital Isoniazid Rifampin Warfarin Cephalosporins

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