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THER 202 Flashcards

1
Q

Off-label use

A

Refers to the use of drug for a disease not amongst its indications

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2
Q

Pedia Dose for Paracetamol

A

10-15 mg/kg/dose every 4 hours

Available preparations:
100mg/ml
120/5ml
250/5ml

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3
Q

Elixir

A

Dissolved molecules are evenly distributed

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4
Q

Suspension

A

Uneven distribution (you need to shake it)

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5
Q

GFR by age

A

Neonates: 30-40% of adult values
1st week of life: 50%
3rd week of life: 50-60%
12 months: adult valuues

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6
Q

Physiologic Variable affecting GI drug absorption (neonates vs older children)

A 
Increased Absorption (acid Labile compounds)
AMpicillin
Amoxicillin
Benzyl Penicillin
Fluocloxacillin
Nafcillin
Riboflavin
Decreased Absorption:
Erythromycin
Paracetamol
Phenobarbital
Phenytoin
Tetracyclines
No Change
Cotrimoxazole
Diazepam
Digoxin
Sulfonamides
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7
Q

Pedia dose of Pen VK/Amoxicillin

A

30-50 mg/kg/day in 2-3 divided doses

Preparation:
125 mg/5ml
250 mg/5 ml
150 mg/cap
500 mg/cap
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8
Q

Pedia dose of Losartan

A

0.7-1.4 mg/kg PO qd

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9
Q

MOA of Aminopenicillin

A

interferes with bacterial cell wall synthesis by halting synthesis of peptidoglycan.

Better against gram (-) than natural penicillins

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10
Q

MOA of Extended macrolides

A

Bind to 50S ribosomal subunit, inhibiting tRMA transolcation from A site to P site

Covers atypical pathogens

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11
Q

MOA of BLIC

A

Irreversible binding to the catalytic site of beta lactamases, preventing inanctivation of accompanying beta lactam

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12
Q

MOA of cephalosporins (2nd Gen)

A

interferes with bacterial cell wall synthesis by halting synthesis of peptidoglycan.

more stable than B-lactamases

Less activity against gram (+) cocci

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13
Q

MOA of Chloramphenicol

A

Bind to the 50S ribosomal subnit, inhibiting transpeptidation

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14
Q

MOA of Fluoroquinolone

A

Inhibits DNA replication by binding to DNA gyrase and topoisomerase IV

excellent bactericidal activity against hemophilus

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15
Q

Low risk CAP

A 
Stable Vital Signs:
RR : <30
PR: <125
SBP: >90
DBP>60
Temp >36 or <40
No altered mental state
No suspected aspiration
No or stable co-morbids
Chest xray: localized infiltrates and no evidence of pleural effucsion

OUTPATIENT

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16
Q

Moderate risk CAP

A 
Unstable vital signs:
RR >30
PR>125
SBP<90
DBP<60
Temp <36 or >40
altered mental state
suspected aspiration
Unstable or decompensated co-morbids

WARD ADMISSION

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17
Q

HIGH-RISK CAP

A

Any of the clinical feature of moderate risk CAP plus any of the following:

Severe sepsis and septic shock
Need for mechanical ventilation

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18
Q

pCAP A or B

A

RESPIRATORY RATE
3 -12 months: 50-60
1-5 years : 40-50
>5 years: 30-35

No signs of Respiratory failure
clear CXR
O2 sat : 95%

Outpatient

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19
Q

pCAP C

A

Moderate dehydration
Moderate malnutrition
(+) pallor

RESPIRATORY RATE
3 -12 months: 60-70
1-5 years : >50
>5 years: >35

(+) Retraction (IC/subscostal), headbobbing, cyanosis,with irritable sensorium
(+)CXR findings
O2 sat<95%

Admit to ward

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20
Q

pCAP D

A

Severe dehydration
Severe malnutrition
(+) Pallor

RESPIRATORY RATE
3 -12 months: >70
1-5 years : >50
>5 years: >35

(+) Retractions (Supraclavicular/IC/SC), head bobbing, cyanosis, grunting, apnea with leathargic/stuporous/comatose sensorium
(+)CXR findings
O2 sat <95%

Admit to a critical care facility

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21
Q

Most common etiology of CAP in the Philippines

A

S. pneumoniae

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22
Q

Physiologic changes in aging

A 
Increase adipose tisssue
Decrease total body water
Decreases in lean body mass
Decrease in hepatic metabolism
Decrease in renal excretion
Decrease response of baroreceptors
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23
Q

Effect of Aging in Absorption

A 
DECREASE:
saliva secretion
gastric secretion
gastric surface area
gastric motility
active transport

INCREASE:
gastric pH
gastric emptying time

NOT affected except:
Drugs with low permeability and solubility
Decrease absorption: iron, calcium and glucose
Decrease active transport: Vit B12

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24
Q

Effect of Aging in Distribution

A

DECREASE
cardiac output
body water
serum albumin

INCREASE
peripheral vascular resistance
adipose tissue

VOLUME OF DISTRIBUTION:
Increase Adipose tissue : INCREASE Vd for lipophilic drug
Decrease in total body water: LOW Vd for hydrophilic drugs

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25
Q

Effect of Aging in Metabolism

A 
DECREASE
hepatic blood flow
liver size
phase 1 reactions
clearance
first pass metabolism

INCREASE
steady state levels
Half ives
active metabolites

UNCHANGED
phase 2 reactions

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26
Q

Effec of AGing in excretion

A 
DECREASE
renal perfusion
renal size
GFR (1 ml/min/yr/1.73 m2)
Tubular secretion
Ability to concetrate urine
Thirst during water deprivation
drug elimination

INCREASE
serum level
half life

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27
Q

Omission

A

Deletion of a drug previously used

28
Q

Commisssion

A

addition of a drug not previously used

29
Q

Beers-American

A

List of drugs not supposed to be taken by old people

30
Q

START-STOPP

A

Irish

more itemized in terms if organ systems

31
Q

PRISCUS

A

German

32
Q

NORGEP

A

Norwegian

33
Q

Prescribing cascade

A

prescription of a drug to treat a dug- induced event

34
Q

Loading Dose

A

Target concentraion x Vd

35
Q

Clearance

A

Dose/AUC

36
Q

Glomerular filtration

A

affects all drugs and metabolites
Influence by protein binding
Only the unbound drugs gets filtered

Drug filtration rate = GFR x fu x Cp

37
Q

Renal tubular secretion

A

Not influenced by protein binding

Affected by competiton with other drugs

38
Q

Passive reabsorption

A

nonionic diffusion

Affects weak acids and weak abses

Only important if excretion of free drug is major elimination path

39
Q

MOA of Thiazide diuretics

A

Blcoks Na-Cl symported at DCT

Decrease PVR

40
Q

MOA of ACE-i

A

Blocks RAAS

41
Q

MOA of ARB

A

Blocks RAAS

42
Q

MOA of CCB

A

decrease intracellular calcium -> vasodilation

43
Q

MOA of B-blocker

A

B receptor antagonist - > negative ionotropic

44
Q

Primary Headache Disorders

A

CATEGORIES

Migraine
tension-Type Headache
Cluster Headache and othe trigeminal autonomic cephalagias
Other primary headaches

45
Q

MIGRAINE without aura

A

DX CRITERIA:
A. at least 5 attacks fulfilling B-D

B. Headache attacks lastig 1-48 hours

C. Headache has at least 2 of the ff:
     Unilateral location
     Pulsating quality
     Moderate to severe intensity
     Aggravation by routine or physical activity

D. During Headache, at least 1 of the ff:
Nausea and/or vomiting
Photophobia and/or phonophobia

E. Not better accounted by other ICHD-3 diagnosis

46
Q

MIGRAINE with aura

A

DX. Criteria:
A. At least 2 attacks fulfilling B and C

B. 1 or more of the ff fully reversible aura symptoms:
    Visual
    Sensory
    Speech and/or language
    Motor
    Brainstem
    Retinal

C. At least 2 of the following 4 characteristics
At least 1 aura symptom, spreads gradually over >=5 minutes, and/or 2 or more symptoms occur in succession
Each indvidual aura symptom lasts 5-60 minutes
At least 1 aura symptom is unilateral
The Aura is accompanied, or followed within 60 mins by headache

D. Not better accounted for by another OCHD-3 diagnosis, and Transient ischemic attack has been excluded

47
Q

Tension type Headache

A

Chronic head pain syndrome characterized by bilateral tight, bandlike discomfort (frontal, temporal, occipital)

Pain builds slowly, fluctuates in severity, and may perists more or less continuously for many days

Episodic or chronic (> 15 days/month)

48
Q

Infrequent Episodic Tension-type Headache

A

DX criteria:
A. At least 10 episodes of headache occurring on <1 per month on average (<12 days per year) and fulfilling criteria B-D

B. Headache lasting from 30 minutes to 7 days

C. AT least 2 of the following:

  1. Pressing/Tightening (non-pulsating) quality
  2. Mild or Moderate intensity
  3. Bilateral Location
  4. No aggravation by walking stairs or similar routine physical activity

D. Both of the following:

  1. No nausea or vomiting
  2. Photophobia and phonophonia are absent, or one but not the other is present

E. Not better accounted for by another ICHD-3 diagnosis

49
Q

Frequent Episodic Tension Type Headache

A

DX. Criteria:
A. At least 10 episodes of headache on 1-14 days per month on average > 3 months (>=12 and <180 days per year) and fulfilling B-D

B. Headache lasting from 30 minutes to 7 days

C. At least 2 of the following:

  1. Pressing/Tightening (non-pulsating) quality
  2. Mild or Moderate intensity
  3. Bilateral Location
  4. No aggravation by walking stairs or similar routine physical activity

D. Both of the followin

1. No nausea or vomiting    2. Photophobia and phonophonia are absent, or one but not the other is present

E. Not better accounted for by another ICHD-3 diagnosis

50
Q

Chronic Tension-Type Headache

A

DX. Criteria:
A. Headache occuring on >=15 days per month on average >3 months (.-180 days per year), fullfiling criteria B-D

B. Lasting hours to days or unremitting

C. AT least 2 of the following

  1. Pressing/Tightening (non-pulsating) quality
  2. Mild or Moderate intensity
  3. Bilateral Location
  4. No aggravation by walking stairs or similar routine physical activity

D. Both of the followin

1. No nausea or vomiting    2. Photophobia and phonophonia are absent, or one but not the other is present

E. Not better accounted for by another ICHD-3 diagnosis

51
Q

Cluster Headache

A

Headache attack occurs in clusters
Few days of headache followed by asymptomatic weeks or months, then headache comes back again

DX. Criteria
A. At least 5 attacks fulfilling B and C

B. Severe unilateral orbital, supraorbital, and/or temporal pain lasting 15-180 minutes

C. Headache associated with at least 1 of the following signs that have to be present on the pain side:

  1. Conjunctival injection
  2. LAcrimation
  3. nasal congestion
  4. Rhinorrhea
  5. Forehead and facial sweating
  6. Miosis
  7. Ptosis
  8. Eyelid edema
52
Q

MOA of NSAIDs

A

inhibiting the cyclooxygenase enzyme (COX-1 and COX-2). Inhibition of these enymes terminates the production of prostaglandins

Onset: 30-60 mins
Half-life: 4-6 hours

53
Q

MOA of Paracetamol

A

weak inhibitor of prostaglandin synthesis, acting on COX in the central nervous system

54
Q

MOA of Opiods

A

presynaptic inhibition of neurotransmitter release in the CNS

55
Q

MOA of Triptans

A

Serotonin 5-HT1b and 5-HT1d receptor agonists in bloodvessels, nerve ending in the brain, and inhibition of pro inflammatory neuropeptide release (CGRP and substance P)

56
Q

MOA of Ergotamine

A

Shares structural similarities with NT such as serotonin, dopamine, and epinephrine and act as agonists of several receptors. Pain relief is brought about by 5-HT1b receptor agonism and inhibits trigeminal NT by 5-HT1d.

Side effects are bouaght about by its action on the D2 Dopamine and 5-HT1A receptors

57
Q

mediation errors that occurred and severity or duration could have been substantially reduced if a different action had been taken

A

Ameliorable ADE

58
Q

Administration of a drug not previously approved by the attending phsyician

A

Unauthorized drug error

59
Q

Characteristic of a drug that can present higher risk to occurrence of medication errors

A

Narrow therapeutic index

60
Q

A mistake in prescribing, dispensing, or planned medication administration that is detected and corrected through intervention is termed

A

potential error

61
Q

Important quality indicators to ensure medication safety

A

Structure indicators
Process indicators
Outcome indicators

62
Q

Prophylactic drug for migraine in a hypertensive patient

A

propanolol

63
Q

prophylactic drug for migraine in a patient with depression

A

fluoxetine

64
Q

prophylactic drug for migraine in a patient with lack of appetite

A

Pizotifen

65
Q

prophylactic drug for migraine in a patient with epilepsy

A

Valproate

66
Q

what drug is not used as a single drug treatment of tension type headache

A

caffeine

67
Q

well controlled asthma in adult

A

NO daytime symptoms >2x/week
NO night time waking due to asthma
NO activity limitation due to asthma

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