THER 202 Flashcards
Off-label use
Refers to the use of drug for a disease not amongst its indications
Pedia Dose for Paracetamol
10-15 mg/kg/dose every 4 hours
Available preparations:
100mg/ml
120/5ml
250/5ml
Elixir
Dissolved molecules are evenly distributed
Suspension
Uneven distribution (you need to shake it)
GFR by age
Neonates: 30-40% of adult values
1st week of life: 50%
3rd week of life: 50-60%
12 months: adult valuues
Physiologic Variable affecting GI drug absorption (neonates vs older children)
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
Pedia dose of Pen VK/Amoxicillin
30-50 mg/kg/day in 2-3 divided doses
Preparation: 125 mg/5ml 250 mg/5 ml 150 mg/cap 500 mg/cap
Pedia dose of Losartan
0.7-1.4 mg/kg PO qd
MOA of Aminopenicillin
interferes with bacterial cell wall synthesis by halting synthesis of peptidoglycan.
Better against gram (-) than natural penicillins
MOA of Extended macrolides
Bind to 50S ribosomal subunit, inhibiting tRMA transolcation from A site to P site
Covers atypical pathogens
MOA of BLIC
Irreversible binding to the catalytic site of beta lactamases, preventing inanctivation of accompanying beta lactam
MOA of cephalosporins (2nd Gen)
interferes with bacterial cell wall synthesis by halting synthesis of peptidoglycan.
more stable than B-lactamases
Less activity against gram (+) cocci
MOA of Chloramphenicol
Bind to the 50S ribosomal subnit, inhibiting transpeptidation
MOA of Fluoroquinolone
Inhibits DNA replication by binding to DNA gyrase and topoisomerase IV
excellent bactericidal activity against hemophilus
Low risk CAP
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
Moderate risk CAP
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
HIGH-RISK CAP
Any of the clinical feature of moderate risk CAP plus any of the following:
Severe sepsis and septic shock
Need for mechanical ventilation
pCAP A or B
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
pCAP C
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
pCAP D
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
Most common etiology of CAP in the Philippines
S. pneumoniae
Physiologic changes in aging
Increase adipose tisssue Decrease total body water Decreases in lean body mass Decrease in hepatic metabolism Decrease in renal excretion Decrease response of baroreceptors
Effect of Aging in Absorption
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
Effect of Aging in Distribution
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
Effect of Aging in Metabolism
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
Effec of AGing in excretion
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
Omission
Deletion of a drug previously used
Commisssion
addition of a drug not previously used
Beers-American
List of drugs not supposed to be taken by old people
START-STOPP
Irish
more itemized in terms if organ systems
PRISCUS
German
NORGEP
Norwegian
Prescribing cascade
prescription of a drug to treat a dug- induced event
Loading Dose
Target concentraion x Vd
Clearance
Dose/AUC
Glomerular filtration
affects all drugs and metabolites
Influence by protein binding
Only the unbound drugs gets filtered
Drug filtration rate = GFR x fu x Cp
Renal tubular secretion
Not influenced by protein binding
Affected by competiton with other drugs
Passive reabsorption
nonionic diffusion
Affects weak acids and weak abses
Only important if excretion of free drug is major elimination path
MOA of Thiazide diuretics
Blcoks Na-Cl symported at DCT
Decrease PVR
MOA of ACE-i
Blocks RAAS
MOA of ARB
Blocks RAAS
MOA of CCB
decrease intracellular calcium -> vasodilation
MOA of B-blocker
B receptor antagonist - > negative ionotropic
Primary Headache Disorders
CATEGORIES
Migraine
tension-Type Headache
Cluster Headache and othe trigeminal autonomic cephalagias
Other primary headaches
MIGRAINE without aura
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
MIGRAINE with aura
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
Tension type Headache
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)
Infrequent Episodic Tension-type Headache
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:
- Pressing/Tightening (non-pulsating) quality
- Mild or Moderate intensity
- Bilateral Location
- No aggravation by walking stairs or similar routine physical activity
D. Both of the following:
- No nausea or vomiting
- Photophobia and phonophonia are absent, or one but not the other is present
E. Not better accounted for by another ICHD-3 diagnosis
Frequent Episodic Tension Type Headache
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:
- Pressing/Tightening (non-pulsating) quality
- Mild or Moderate intensity
- Bilateral Location
- 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
Chronic Tension-Type Headache
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
- Pressing/Tightening (non-pulsating) quality
- Mild or Moderate intensity
- Bilateral Location
- 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
Cluster Headache
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:
- Conjunctival injection
- LAcrimation
- nasal congestion
- Rhinorrhea
- Forehead and facial sweating
- Miosis
- Ptosis
- Eyelid edema
MOA of NSAIDs
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
MOA of Paracetamol
weak inhibitor of prostaglandin synthesis, acting on COX in the central nervous system
MOA of Opiods
presynaptic inhibition of neurotransmitter release in the CNS
MOA of Triptans
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)
MOA of Ergotamine
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
mediation errors that occurred and severity or duration could have been substantially reduced if a different action had been taken
Ameliorable ADE
Administration of a drug not previously approved by the attending phsyician
Unauthorized drug error
Characteristic of a drug that can present higher risk to occurrence of medication errors
Narrow therapeutic index
A mistake in prescribing, dispensing, or planned medication administration that is detected and corrected through intervention is termed
potential error
Important quality indicators to ensure medication safety
Structure indicators
Process indicators
Outcome indicators
Prophylactic drug for migraine in a hypertensive patient
propanolol
prophylactic drug for migraine in a patient with depression
fluoxetine
prophylactic drug for migraine in a patient with lack of appetite
Pizotifen
prophylactic drug for migraine in a patient with epilepsy
Valproate
what drug is not used as a single drug treatment of tension type headache
caffeine
well controlled asthma in adult
NO daytime symptoms >2x/week
NO night time waking due to asthma
NO activity limitation due to asthma
