pharm exam 2

what is the supportive tx of AOM (acetaminophen)

10-15mg/kg/dose every 4-6hr max-75mg/kg/day can be used <6mo

neonates: stomach pH decreases (acidifies) to adult pH by __________

18-36 mo

expanded to include food, drugs, medical devices, and cosmetic manufactured and sold in the US. requiring new drugs to be shown safe before filing new drug application prior to approving meds

1938 amendment

required manufacturers to prove their drugs safe and effectiveness inspired by the thalidomide tragedy

1962 kefauver harris amendments

neonates and infants have early decreased intestinal motility. peristalsis is absent in the first ________ days of life-increases absorption of some meds. then increased intestinal motility in infants-altered absorption of drugs with limited water solubility

2-4

1 kg is equal to _______ lbs

2.2

adolescence may go up to age ______

21

LK is a 24 month old male that was born at 28 weeks gestational age. what is his corrected age

24 mo - (40 wks-28 wks) x 1mo/4wks=21 mo

renal blood flow and glomerular filtration rate (eGFR) of newborns is ________ of an adult

30-40%

what is the supportive tx of AOM (ibuprofen)

5-10mg/kg/dose every 6-8hr max single dose-400 max daily-40 only for >6mo

SCr reflects maternal SCr at birth until _______ PNA, adult levels are reached at _________

7-10 days, 9-12 mo

gastric emptying time in neonates and infants reaches adult level at _________

9 mo

what is the dosing of amoxicillin in AOM

90mg/kg/day divided twice daily

what is the abx duration in the tx of AOM

<2 or severe sx-10 days 2-5 with mild-moderate sx-7 days >6 with mild-moderate sx-5-7 days

what are the causes of cytochrome P450 enzymes being inhibited or induced

CF, grapefruit juice, cruciferous veggies, drugs (phenytoin, carbamezepine, fluconazole, rifampine)

what does fluconazole oral suspension inhibit

CYP2C19, 2C9, 3A4

what CYP enzymes are postnatal pattern

CYP2C9, 2C19, 2D6, 3A4

what CYP enzymes are prenatal pattern

CYP3A7

passage of gastric contents of stomach into esophagus due to relaxation of lower esophageal sphincter. regurg is common in infancy, typically resloves by age 1 disease results when episodes are persistent resulting in esophagitis, nutritional compromise, or respiratory complications

GERD

AVOID IN PEDS. no better than placebo in children <12 yrs. potential for adverse effects higher and even fatal overdose in children <2

OTC cold/cough preparations (doesnt include analgesics and antipyretics)

contraindicated in patients <2 months. displaces bilirubin from albumin binding sites causing hyperbilirubinemia and kernicterus.

TMP/SMX

created from federal food, drug, and cosmetic act (FDCA) in 1906 established to protect the public from harmful durgs manufacturers must prove products are not adulterated, not mislabeled, safe to use established 2 drug classes (legend-prescription only, OTC)

US food and drug administration (FDA)

What is the mechanism of action (MOA) of racemic epinephrine? a. Stimulates both alpha- and beta-adrenergic receptors, resulting in both relaxation of smooth muscles in the bronchial tree as well as a decrease in local airway edema with resultant decrease in the work of breathing b. Stimulates both alpha- and beta-adrenergic receptors, resulting in both contraction of smooth muscles in the bronchial tree as well as a increase in local airway edema with resultant decrease in the work of breathing c. Stimulates alpha-adrenergic receptors, resulting in both relaxation of smooth muscles in the bronchial tree as well as a decrease in local airway edema with resultant decrease in the work of breathing d. Stimulates beta-adrenergic receptors, resulting in both relaxation of smooth muscles in the bronchial tree as well as a decrease in local airway edema with resultant decrease in the work of breathing

a

What is the recommended dosage of amoxicillin for an 80-kg adolescent with otitis media? a. 90 mg/kg divided twice daily b. 50 mg/kg divided twice daily c. 60 mg/kg divided twice daily d. 45 mg/kg divided twice daily

a

Which drug is a common over-the-counter (OTC) topical vasoconstrictor that should never be used for more than 3 to 4 days due to rebound congestion? a. naphazoline (Naphcon) b. fluticasone c. azelastine d. mometasone

a

Which medication is contraindicated in the pediatric population? a. doxycycline b. penicillin c. cephalexin d. amoxicillin

a

no risk to fetus in 1st trimester. no evidence of risk in later trimesters

a

which statement is true regarding medication errors a. they are most commonly the result of multiple events b. a faulty system will not contribute to medication errors c. they are usually caused by a single careless person d. they are most commonly the result of a single event

a

what are the side effects of oral iron replacement

abdominal pain, constipation or diarrhea, dark stools

what are examples of schedule III substances

acetaminophen w codeine, ketamine, anabolic steroids (testosterone), buprenorphine

what is the tx of mild to moderate migraines

acetaminophen, ibuprofen, naproxen

weak acids are nonionized in what environment

acidic pH

acute inflammation and infection of the middle ear. middle ear effusion-bulging tympanic membrane, decreased or no mobility of the TM, or purulent fluid in the middle ear inflammation-erythema of TM or otalgia

acute otitis media

sxs: ear pain (tugging or rubbing ear), fever, irritability, otorrhea, poor feeding considered severe if moderate or severe otalgia or otalgia for 48+ hours or temp 39C or higher

acute otitis media

what is the most common dx for which children are prescribed antibiotics

acute otitis media

make dx: >5 sxs be present in more than on setting persist for at least 6 mo be present before age of 12 impair function in academic, social, or occupational activites be excessive for the developmental level of the child

adhd

sxs: inattention, hyperactivity, impulsivity cause: defects in dopamine pathways that regulate reward anticipation and emotional self regulation

adhd

12-18 yr

adolescent

what are the pediatric side effects of allergic rhinitis

adrenal suppression, growth reduction, hyperactivity, anxiety

pc

after meals

the majority of pediatric doses are based on ___________

age or milligram per kilogram of body weight

neonatal stomach is more ________ at birth due to amniotic fluid neutralization

alkaline

weak bases are nonionized in what environment

alkaline pH

common in children with history of other allergic reactions. sxs include swelling, itching, burning, redness, tearing/watery discharge, bilateral presentation, typically seasonal

allergic conjunctivitis

10-20% of pediatric population IgE mediated reactions to allergens in the nasal mucosa. allergen binding to IgE leads to mast cell degranulation and release of inflammatory mediators rhinorrhea, epistaxis, nasal/eye/throat pruritus, throat clearing and chronic cough that generally worsens at night

allergic rhinitis

what meds in bacterial conjunctivitis are toxic to the corneal epithelium and may cause reactive corneal and conjunctivits inflammation

aminoglycosides (tobramycin, gentamicin)

what medications are renally excreted and will require renal dose adjustments

aminoglycosides and B-lactam antibiotics

_________ has >10 formulations

amoxicillin

suspencions can be stored at room temp, but taste better if refrigerated

amoxicillin

what is the 1st line tx of acute otitis media if no recent beta lactam therapy, no concomitant conjunctivitis, no history or recurrent AOM

amoxicillin

what is the empiric tx of community acquired pneumonia

amoxicillin, azithromycin or 3rd generation cephalosporin

suspensions must be stored in the refrigerator

amoxicillin-clavulanate

what is the 1st line tx in AOM if recent beta lactam therapy, concomitant purulent conjunctivitis

amoxicillin-clavulanate

what is the tx of severe sinusitis

amoxicillin/clavulanate ES, cephalosporin. azithromycin or clindamycin if PCN allergy

what is the tx of mild/moderate sinusitis

amoxicillin/clavulanate, amoxicillin

what are the high alert drug classes

antiarrhythmics, anticoagulants, chemotherapeutic agents

what infectious rhinitis-common cold drugs have the MOA of inhibition of serous and seromucous gland secretions

anticholinergic nasal spray (ipratropium nasal spray)

prn

as needed

have i selected the most appropriate drug and drug dosage have i weighed all the risk and benefits have i addressed the need to monitor the effects of this medications am i fully informed about this patients condition, other meds, comorbidities, allergies and adverse events with other meds have i made the prescription as legible to the pharmacist as it is to me have i done all i can to assure the patient will be compliant have i considered what the med will cost the patient have i considered the health literacy of the patient have i involved my patient in a shared decision making process have i done all i can to minimize errors and increase patient safety

ask before prescribing

AVOID IN PEDS. risk of reyes syndrome. contraindicated in febrile illness or headache in patients <19. watch out for alka selzer

aspirin

most common chronic disorder in children and adolescents

asthma

represents a significant source of missed school days, ER visits, hospital admissions, and mortality in the US. 80% of diagnoses made before 5

asthma

hs

at bedtime

stat

at once, immediately

what drug has the MOA of SNRI, selectively inhibits pre-synaptic reuptake of norepinephrine

atomoxetine

what drug has the black box warning of risk of suicidal ideation in children and adolescents, monitor for suicidal thinking or worsened mood

atomoxetine

what are the considerations of nystatin oral suspension

available as lozenge for 4+ with no choking risk, apply 1-2ml inside cheek

what are the considerations of ondansetron

avoid in congenital long qt syndrome, monitor ekg for hypokalemia, magnesemia

what is the non pharm tx of allergic conjunctivitis

avoid rubbing eyes, cold compress to reduce swelling, artificial tears to dilute/remove allergens, reduce use of contacts, allergen avoidance

what are the nonpharm tx of migraines

avoid triggers, keep headache diary, dark quiet room, cool compress on forehead and eyes

what are the antihistamine tx for allergic conjunctivitis

azelastine, olopatadine

what meds are only for children 3 yr or older. safety and efficacy not established for <3

azelastine, olopatadine

what is the empiric tx of school aged 5+ years pneumonia

azithromycin, erythromycin

A patient with mononucleosis with markedly edematous tonsils and no obvious abscess can be treated with which drug? a. hydrocodone/acetaminophen (Lortab) b. dexamethasone (Decadron) c. amoxicillin clavulanic acid (Augmentin) d. amoxicillin (Amoxil)

b

Which drug can be used to treat a child with group B strep throat infection who is not allergic to penicillin? a. clindamycin b. amoxicillin c. bicillin-LA d. azithromycin

b

Which drug is a leukotriene receptor antagonist that helps diminish vascular permeability, and mucosal edema? a. diphenhydramine (Benadryl) b. montelukast (Singulair) c. naphazoline (Visine) d. loratadine (Alvert)

b

Which drug should be used as a first-line treatment in a child with thrush? a. fluconazole (Diflucan) b. nystatin (Mycostatin) c. griseofulvin (Grifulvin V) d. acyclovir (Zovirax)

b

Which drug was once a popular medication in the pediatric population but is now contraindicated because of its association with Reye's syndrome? a. ibuprofen b. aspirin c. acetaminophen d. antihistamines

b

Which medication carries a black box warning because it cause pseudomembranous colitis? a. bicillin-LA b. clindamycin c. clindamycin d. amoxicillin

b

a cornerstone for preventing medical errors when prescribing medication includes the following a. right method, right dose, right route, right timing, right drug b. right patient, right drug, right dose, right route c. right patient, right location, right dose, right drug d. right patient, right drug, right location, right timing

b

a patient is instructed to apply one drop to each eye. which abbreviation for these instructions is accurate a. one gr ad b. one gtt ou c. one gtt au d. one gtt od

b

no risk ot fetus in animal studies, but no well controlled studies in pregnant women

b

which abbreviation indicates that a medication should be taken by mouth twice daily a. po TIW b. po bid c. po qd d. po ac

b

which abbreviation indicates that three drops should be placed in both ears a. three gtt ad b. three gtt au c. three gtt as

b

which statement is true regarding the drug enforcement administration (DEA) categories of scheduled drugs a. schedule I drugs have a low potential for abuse and no accepted medical use in the US b. schedule I drugs have a high potential for abuse and no accepted medical use in the US c. schedule V drugs have a high potential for abuse d. schedule II drugs have a low potential for abuse

b

what are examples of schedule IV substances

benzodiazepines (diazepam, lorazapam, alprazolam, midazolam), sedatives/hypnotics (zolpidem, eszopiclone), carisoprodol, phentermine, tramadol, clobazam

most severe warning FDA may place on a prescription medication. used to communicate, alert, and highlight a risk in prescribing the drug.

black box warning

reasonable evidence of a serious hazard with a drug. adverse reaction may lead to serious harm and/or death. usually added after drug approved and reports of adverse events come in

black box warning

po

by mouth

Fluoroquinolones, such as Cipro and Levaquin, are effective antimicrobials against a wide range of pathogens. However, they may cause...? a. Tardive dyskinesia. b. Extrapyramidal symptoms. c. Adverse effects on the growth of immature cartilage, joints, and surrounding tissue. d. Dental discoloration and enamel hypoplasia.

c

The gastric emptying time of a child is longer than that of an adult and does not reach adult levels until what age? a. At least 6 months old b. At least 1 month old c. At least 9 months old d. At least 3 months old

c

The glomerular filtration rate (GFR) of newborns is about what percent as that of adults? a. 10% to 20% b. 20% to 30% c. 30% to 40% d. 40% to 50%

c

Which drug carries a black box warning advising that its use in children younger than age 2 years has the potential for severe or fatal respiratory depression? a. tacrolimus (Protopic, Prograf) b. metformin (Glucophage) c. promethazine (Phenergan) d. pimecrolimus (Elidel)

c

adverse effects on fetus in animal studies, but no well controlled studies in humans. benefits may outweigh risks

c

the signa or signature component on a written prescription includes a. patient data, such as age, name and gender b. prescriber data, such as name, practice location, phone number and professional degree c. instructions the prescriber has given to the patient which will appear on the medication label d. brand or generic name and strength of medication

c

this phase of clinical drug trial takes place over 1-4 years and includes 300-3,000 volunteers with the disease/condition of interest a. phase I b. phase II c. phase III d. phase IV

c

which abbreviation indicates that a patient should take their medication at bedtime a. BID b. PRN c. HS d. PC

c

which of the following could be the subscription component on a prescription a. patient name and address b. john smith, RPA-C, license number c. dispence #100 d. take 5mL PO twice daily for 10 days

c

which of the following examples could be the inscription component on a prescription a. take one tablet PO twice daily for 10 days b. john smith, RPA-C, license number c. ceuroxime 500mg d. dispense #20

c

what are the considerations of methylphenidate, dexmethylphenidate, amphetamines (dextroamphetamine/amphetamine, lisdexamfetamine)

can increase suicidal thoughts and behaviors, may precipitate manic episodes in bipolar

what are examples of schedule V substances

cannabidiol, robitussin AC, diphenoxylate/atropine, pregabalin, lacosamide

contraindicated in neonates. displaces bilirubin from albumin binding sites causing hyperbilirubinemia and kernicterus. also contraindicated in per-term infants up to 41 weeks gestational age as well as full term neonates up to 28 days after birth

ceftriaxone

what is the empirical tx of inpatient pneumonia

ceftriaxone, ceftazidime + macrolide

what drugs have the MOA of unknown, but proposed that alpha stimulation regulates activity in the prefrontal cortex, area of the brain responsible for emotions, attention, and behaviors and causes reduced hyperactivity

central alpha 2 adrenergic agonist (guanfacine ER, clonidine ER)

what is the AOM tx if mild allergy to penicillin

cephalosporins (cefdinir, cefuroxime)

4-11 yr

child

_______ are at higher risk of over- and under-dosing, toxicities, and harm

children

time since birth, also known as postnatal age

chronological age

black box warning-pseudomembranous colitis or clostridioides difficile associated diarrhea (CDAD) can be caused by other abx too. alteration of the normal colon flora, leading to overgrowth of c diff toxin a and b produced by c diff cause significant diarrhea with blood or mucous, severe abdominal pain if CDAD diagnosed ongoing abx use may need to be stopped. direct abx therapy to c diff, fluid and electrolyte management as clinically indicated

clindamycin

disease associated maternal and/or embryo fetal risk. dose adjustments during pregnancy and postpartum period. maternal adverse reactions. fetal/neonatal adverse reactions. labor and delivery

clinical considerations

AVOID IN PEDS. black box warning-CYP2D6 polymorphisms may cause rapid conversion to active metabolite, morphine, causing respirator depression/death. is excreted in breast milk

codeine, tramadol

AVOID IN PEDS. contraindicated in all children <12. contraindicated in <18 with obesity, OSA, severe lung disease, or post tonsillectomy or adenoidectomy

codeine, tramadol

environment plays a role in shaping brain chemistry and can affect behavior. despite strong support, some pts require meds

cognitive behavioral therapy

what is the first line tx of adhd

cognitive behavioral therapy

what is the tx of severe migraines

combo therapy, promethazine or ondansetron, iv dihydroergatime last line

applying pharm knowledge and considering the following factors: patient (age, weight, culture) disease drug social knowledge 3rd party government and learned societies collaborating colleagues

conscientious prescribing

what are the considerations of simethicone

contains sodium benzoate, may precipitate gasping syndrome

enforcement by the drug enforcement agency (DEA) and the department of justice. labelling requirements, accountability regulations affecting flow and distribution down to the admnistration. placed in 1 of 5 categories based on potential for abuse/addiction

controlled substance act

any drug with potential for abuse, dependence of both

controlled substances

what is the non pharm tx of infectious rhinitis-common cold

cool mist vaporizer, bulb syringe and saline nasal spray, hydration with warm soun and fluids

chronological age - number of weeks born before 40 weeks gestation

corrected age

preferred after the perinatal, neonatal hospital stay up to age 3 years if infant/child was preterm

corrected age

infection causing inflammation, edema in the larynx, trachea, bronchi primary cause: viral (parainfluenza) typically occurs in children 6mo to 3yrs sx: seal like barking cough, hoarseness, stridor, chest retractions, varying degres of respiratory distress, low grade fever

croup (laryngotracheitis)

Which drug is a mild central nervous system (CNS) stimulant that blocks the reuptake of norepinephrine and dopamine into presynaptic neurons and appears to stimulate the cerebral cortex and subcortical structures? a. atomoxetine (Strattera) b. venlafaxine (Effexor) c. bupropion hydrochloride (Buproban) d. methylphenidate (Concentra)

d

Which option is a common side effect of amoxicillin/clavulanic acid (Augmentin)? a. Frequent urination b. Anorexia c. Headache d. GI distress

d

positive human fetal risk has been reported. considering potential benefit vs risk may, in some cases, warrant the use of these drugs in pregnant women

d

which statement regarding herbals, vitamins, minerals, and food supplements is true a. manufacturers must prove that their herbals, vitamins, minerals, and food supplements are free from adulteration b. manufacturers must prove that legitimacy of any claims they make about their herbals, vitamins, minerals and food supplements c. manufacturers must prove the safety of their herbals, vitamins, minerals, and food supplements d. herbals, vitamins, minerals, and food supplements are not regulated by the US food, drug, and cosmetic act (FDCA)

d

describe the data that provide the scientific basis for the information presented int the risk summary and clinical considerations

data

what croup drug has the MOA of decreasing inflammation in bronchial tree through inhibition of inflammatory mediator production and reversal of increased capillary permeability

dexamethasone

what is the tx of moderate to severe croup

dexamethasone and racemic epinephrine, maybe intubation

what is the tx of mild croup

dexamethasone, antipyretics, cool mist, oral fluids

what is the tx of mild to moderate croup

dexamethasone, racemic epinephrine

what are the side effects of ondansetron

diarrhea, constipation, headache, fever, urticaria, qt prolongation

what are examples of weak bases

diazepam, theophylline

what is the nonpharm tx of flatulence

diet changes for breastfeeding mothers, ensure infants isnt swallowing air when feeding, burping frequently and prone position while awake

what are the side effects of fluconazole oral suspension

dizziness, headache, hepatotoxicity, skin rash, qt prolongation

what are the considerations of atomoxetine

doesnt exacerbate tics or worsen anxiety, serious hepatotoxicity (120 days of starting), may cause serious CV events, CYP2D6 substrate

what is the prevention of abx therapy in AOM

dont use prophylactic abx due to side effects

maturation occurs at variable rates, making generalized __________

dosing not recommended

what are the side effects of leukotriene modifiers

dream abnormalities, insomnia, anxiety, depression, suicidal thinking, increased liver enzymes

gtts

drops

which medication is an example of a schedule I (C-I) drug a. oxcodone b. morphine c. buprenorphine d. methadone e. heroin

e

what are the side effects of oral nasal decongestants (oxymetazoline)

epistaxis, drying of nasal membranes. more than 3 days may lead to rebound congestion

what are the side effects of oral chest decongestant (dextromethorphan)

euphoria, fatigue, paradoxical excitation

qd

every day

qod

every other day

what GERD drugs have the MOA of H2RAs, inhibition of histamine at H2 receptors on gastric parietal cells leading to reduced acid secretion

famotidine, ranitidine, cimetidine, nizantidine

provides information about need for pregnancy testing, contraception recommendations, and/or effects on fertility. provides information only if relevant to the medicatoin

female and males of reproductive potential

suspension contains sodium benzonate, causing gasping syndrome in neonates

fluconazole oral suspension

used after nystatin tx failure, severe thrush, or immunocompromised pt

fluconazole oral suspension

what thrush tx has the MOA of inhibiting ergosterol synthesis, the principal sterole in fungal cell membrane

fluconazole oral suspension

what is the 1st line tx in bacterial conjunctivitis for contact lens wearers

fluoroquinolones

AVOID IN PEDS. black box warning-risk of tendinitis and tendon rupture. currently no reports in children. reserve for multidrug resistant infections with no safe and effective alternative, FDA-approved indications, oral FQ-sensitive organisms when other options are IV only

fluroquinolones: levofloxacin, ciprofloxacin, moxifloxacin

AVOID IN PEDS. have risk of joint damage and inflammation due to erosion of cartilage in weight baring joints. a lot harder in children due to still growing

fluroquinolones: levofloxacin, ciprofloxacin, moxifloxacin

what are the rx nasal steroids for allergic rhinitis

fluticasone furoate >2, mometasone >2, beclomethasone >4

what are the otc nasal steroids for allergic rhinitis

fluticasone propionate >4, budesonide >4, triamcinole >2

>36 weeks gestational age (GA)

full term

time between the 1st day of the last menstrual period and birth

gestational age

what are the considerations of oral iron replacement

give between meals with water or juice, give with food if gi upset, avoid with milk, may cause gray staining of teeth or gums

what are the considerations of leukotriene modifiers

good choice with antihistamine if pt cant tolerate nasal glucocorticoid or has refractory rhinitis, may help with asthma and eczema, granule formation sprinkled on food, avoid in pre-existing anxiety, depression, psych conditions

what are the common organisms of bacterial conjunctivitis

haemofilus influenzae, streptococcus pneumoniae, staphylococcus aureus

what are the side effects of omeprazole, esomeprazole, pantoprazole, lansoprazole, rabeprazole

headache, dizziness, rash, diarrhea, increase risk of c diff, pneumonia, URI

what are the side effects of 2nd gen antihistamines

headache, xerostomia, drowsiness

what are examples of schedule I substances

heroin, LSD, MDMA

what are the side effects of augmentin (amoxicillin/clavulanate)

higher incidence of GI side effects. take with food. take extra strength 600mg to reduce GI side effects

what are the side effects of dexamethasone

hypertension, hyperglycemia, increased appetitie, insomnia

what are the side effects of famotidine, ranitidine, cimetidine, nizantidine

increase risk of c diff, acute gastroenteritis, pneumonia

prescribing must be ________

individualized

1-12 mo

infant

toddlers may be split between ________

infant and child groups

highly contagious. easily treated with topical products. viral: watery discharge (scant mucus), burning/sandy/gritty feeling in one eye, second eye can get involved bacterial: redness, purulent discharge, crusting, often unilateral but can be bilateral

infectious conjunctivitis: pink eye

what is the most common eye disorder seen in children

infectious conjunctivitis: pink eye

caused by epstein-barr. by age 4, EBV sero-prevalence is ~100% in developing countries and 25-50% in lower socioecominic groups in the US usually asymptomatic or subclinical several days to weeks of general malaise, fever, cervical adenitis, intensely painful pharyngitis

infectious mononucleosis

viral infection of the upper respiratory tract. responsible for ~40% of all sick visits to clinicians in the US. typically self limiting, 1-2 wk duration

infectious rhinitis-common cold

caused by influenza A/B viruses. abrupt onset of fever (tend to be higher in younger children), headache, malaise, myalgia respiratory sxs: cough, sore throat, conjunctival injection GI sx: nausea, vomiting, anorexia rapid diagnostic tests available: vary in sensitivity, specificity

influenza

what are the cornerstone of maintenace therapy in asthma

inhaled corticosteroids

name of drug and strength of each unit

inscription

FDA oversight for safety issues related to similarly named drugs (hydralazine, hydroxyzine) creation of 2 national reporting systems for med errors voluntary: provide confidential feedback to health professionals mandatory: medication erros made available to the public

institute of medicine (IOM) recommendations

what are the high alert specific medications

insulin, KCl, Mg, Kphos, methotrexate

more water soluble, less able to diffuse across lipid membrane

ionized drugs

what is the most common cause of anemia

iron deficiency

what is the most common nutritional deficiency

iron deficiency

what should not be used as a measuring device for meds

kitchen silverware, use supplied measuring devices

provides information on use during breastfeeding. drug/metabolite amount in breast milk. potential effects onf breastfed infant

lactation

if the drug distributes outside of plasma, its Vd is ________ than if it just stayed in the plasma

larger

increased volume of distribution of water soluble drugs (gentamicin, linezoilid, phenobarbital) may require _________ doses

larger

os

left eye

what allergic rhinitis tx has the MOA of leukotriene receptor antagonist, reduces cellular activity associated with inflammatory processes, decreasing vascular permeability, mucus production, and mucosal edema. approved in 6+

leukotriene modifiers (montelukast)

absorption occurs through a lipid membrane which makes __________

lipophilic molecules go through easier. fat soluble molecules go through easier, water soluble harder

what is the most important organ for drug metabolism

liver

what is the side effects of simethicone

loose stools

decreased volume of distribution of fat soluble drugs (diazepam, lorazepam) may require ________ doses

lower

what is the AOM tx if severe allergy to penicillin

macrolides (azithromycin, clarithromycin), lincosamides (clindamycin)

_________ often seen in patients with mono after administration of ampicillin or amoxicillin

maculopapular rash

what are the considerations of dexamethasone

may use injection dosage from orally as its more concentrated

preventable event that may cause or lead to inappropriate medication use or patient harm. 2 people are injured every minute in the US from a medication error. 3rd leading cause of death in the US in 2018

medicaiton errors

who can prescribe

medical dr, pa, np, dentist, osteopath, optometrist, podiatrist, vets

caused by: (swiss cheese model) failed communication poor drug distribution practices complex/poorly designed technology access to drugs by non pharm personnel lack of info about the patient allowing the pt to leave without verifying understanding of therapy

medication errors

what are the adhd pharm tx stimulants

methylphenidate, dexmethylphenidate, amphetamines (dextroamphetamine/amphetamine, lisdexamfetamine)

what drug has the MOA of blocking norepinephrine and dopamine reuptake into presynaptic neurons and promotes release of catecholamine from storage sites on presynaptic neurons

methylphenidate, dexmethylphenidate, amphetamines (dextroamphetamine/amphetamine, lisdexamfetamine)

what drugs have the black box warning of high potential for dependence and abuse. long term abuse may result in tolerance

methylphenidate, dexmethylphenidate, amphetamines (dextroamphetamine/amphetamine, lisdexamfetamine)

AVOID IN PEDS. increased drug sensitivity, avoid in children <2 or under 10kg. may cause extrapyramidal symptoms (EPS) and permanent tardive dyskinesia, pseudoparkinsonism, acute dystonia, akathiasis

metoclopramide, prochorperazine

sxs: nausea, vomiting, photophobia, phonophobia, abdominal pain, relieved by sleep

migraine

triggers: dehydration, weather, meds, sunlight, odors, hormones, excessive noise, lack of sleep, stress, caffeine

migraine

what is the most common acute and recurrent headache syndrome in children

migraine

a barky cough, mild stridor present when crying or upset, but no stridor at rest

mild croup

inspiratory stridor at rest, little to no respiratory distress or agitation

mild to moderate croup

biphasic stridor at rest, chest retractions, significant distress and agitation

moderate to severe croup

what are the considerations of neuraminidase inhibitors

monitor pt for unusual behavior, 5 day tx duration

what is the pathogens that cause school aged 5+ years

mycobacterium pneumonia, clostridium pneumonia

what are the decongestant + histamine tx for allergic conjunctivitis

naphazoline + pheniramine

what can cause sedation in children <6 and using it more than 5 days may cause rebound congestion and redness

naphazoline + pheniramine

what allergic rhinitis tx have the MOA of increasing anti-inflammatory protein synthesis, decrease inflammatory cytokine and chemokine production

nasal steroids

what are the side effects of amoxicillin

nausea, diarrhea, rash

what are the side effects of neuraminidase inhibitors

nausea, vomiting, hallucinations, confusion, delirium, self injury

through eval of etiology important before treating, if unsure of cause may be best to observe child vs masking with drugs reserve tx for: 2+ years with gastroenteritis with dehdration with post op (not promethazine or prochlorperazine)

nausea/vomiting

what are the ways asthma medications are administered

nebulizer, dry powder inhaler, pressurived metered dose inhaler, breath actuated pressurized metered dose inhalaer

0-28 days year old

neonate

intramuscular or subcutaneous. blood flow at site of absorption. high variability in blood flow to muscle and lower muscle mass. can lead to toxic dose if rapid

neonates

stratum corneum thinner. have higher percentage of total body water. larger ratio of surface area:body weight. increased risk of toxicity based on these factors

neonates

longer gastric emptying time in _________. increases amount of time something will stay in the GI tract

neonates and infants

what influenza drugs have the MOA of inhibiting neuraminisdase on influenza A/B virus, decreases release of new virions from host cells

neuraminidase inhibitors (oseltamivir, zanamivir, peramivir)

what is the infectious rhinitis-common cold tx for 6-12

no otc cold/cough nonpharm tx, ipratropium nasal spray, lozenges

what is the infectious rhinitis-common cold tx for <6

no otc cough/cold acetaminophen and ibuprofen, nonpharm tx

more lipid soluble and able to passively diffuse across lipid membrane

nonionized drugs

what is the tx of allergic rhinitis

nonpharm <2 (saline nasal spray, neti pot, allergen avoidance) OTC and prescription agents 2+ (oral/nasal antihistamine, nasal steroids, oral leukotriene modifier)

what is the 2nd line tx or if abuse risk tx of adhd

nonstimulants (atomoxetine)

what is the side effects of anticholinergic nasal spray (ipratropium nasal spray)

nosebleeds, nasal dryness, mouth dryness

what is the watchful waiting tx of acute otitis media

not all require tx. needed for close follow up in 2-3 days to prevent antimicrobial resistance 6-23mo with unilateral AOM >23 with nonsevere bilateral or unilateral AOM

what is the 1st line tx of thrush

nystatin oral suspension

what thrush tx has the MOA of binding to fungal cell membrane, changes cell wall permeability and causes leakage

nystatin oral suspension

when FDA approved medicationis prescribed for a conditon, age group, or in a manner not approved by the FDA providers may legally prescribe manufacturers may not market

off label

are ointments or drops preferred for bacterial conjunctivitis in peds

ointments, stays on longer, easier administration

what GERD drugs have the MOA of PPIs, inhibit H+K+ proton pump, the final step to gastric acid secretion by parietal cells

omeprazole, esomeprazole, pantoprazole, lansoprazole, rabeprazole

comes in tablets, suspension, ODT tablets, injection

ondansetron

what N/V drug has the MOA of selective serotonin 5-HT3 receptor antagonist

ondansetron

ss

one half

what are examples of controlled substances

opiates, sedatives, stimulants, hallucinogens

what oral antihistamine tx has the MOA of histamine-1 receptor antagonist in blood vessels and respiratory tract. block histamine activity

oral antihistamines (1st gen-diphenhydramine, 2nd gen-loratadine, fexofenadine, cefirizine), intranasal agents (5+ azelastine, 6+olopatadine) oral easier than intranasal but more ADRs

what infectious rhinitis-common cold drugs have the MOA of unknown, thought to increase hydration of respiratory tract, reduce mucus viscosity. granules, suspension, tablets (IR and ER). avoid ER tablets in <12

oral chest deconestant (guaifenesin)

what infectious rhinitis-common cold drug has the MOA of decreases sensitivity of central cough receptors to decrease cough impulse. structurally related to codeine, increased risk of CNS depression and death

oral chest decongestant (dextromethorphan)

what is the tx of choice for iron deficiency

oral iron replacement (3-6mg/kg/day 3-4x daily)

what infectious rhinitis-common cold drugs have the MOA of vasoconstriction of nasal mucosa

oral nasal decongestants (pseudoephedrine, phenylephrine), oxymetazoline

what is the infectious rhinitis-common cold tx for >12

otc cough/cold appropriate in conjunction with nonpharm

what are examples of schedule II substances

oxycodone, hydrocodone, fentanyl, methadone, morphine, dextroamphetamine, methylphenidate

absorption is mainly gastrointestinal absorption via ________

passive diffusion

name and address

patient identifiers

ranges from pre-term neonates to adolescents that metabolize medications like adults

pediatric

congress passed ____________ which allowed pediatric treatment to be based on best evidence

pediatric research equity act of 2003

what is the tx of strep throat

pen VK, amoxicillin, cephalexin. compliance concern-penicillin g PCN allergy-clindamycin, azithromycin

intensely pruritic, raised red rash, throat and tongue swelling, wheezing, raised rash dyspnea (anaphylaxis), onset within minutes

penicilliin hypersensitivity immediate (type 1)

non-pruritic maculopapular rash, begins on the trunk of the body, onset 3-14 days after starting treatment, non systemic sxs

penicillin hypersensitivity delayed

pr

per rectum

constant physiologic changes with age leads to variable ____________

pharmacokinetics and pharmacodynamics

20-100 healthy volunteers or people with disease/condition. occurs over several months purpose: initial safety data and dosage pharmacology phase approx 70% of drugs move to the next phase

phase I

several hundred people with the disease/condition of interest. over several months to 2 years purpose: efficacy and side effects exploratory phase ~33% of drugs move to the phase

phase II

300-3,000 volunteers who have the disease/condition of interest. over 1-4 years purpose: efficacy and monitoring of adverse reactions confirmatory phase ~25-30% of drugs move to the next phase

phase III

several thousand volunteers with the disease/condition of interest purpose: safety and efficacy after approval evaluate rare but serious effects that cant be assessed in smaller trials post marketing phase success rate: 70-90%

phase IV

what are examples of weak acids

phenobarbital, phenytoin

inflammation and/or infection of lower respiratory tract caused by bacteria, viruses, fungi, mycoplasma, or various chemicals air spaces fill with inflammatory cells, fluid, and cellular debris that may obstruct airways leading to hypoxia community acquired most common can follow an otherwise routine upper respiratory tract illness up to 80% of children <2 diagnosed sx: fever, poor feeding, cough, respiratory distress (tachypnea, retractions, dyspnea), cxr findings-infiltrates

pneumonia

what are the antibiotic drops and ointment treatments for bacterial conjunctivitis

polymyxin B+trimethoprin, polysporin ointment, fluroquinolone eye drops (ciprofloxacin, ofloxacin, moxifloxacin)

what are the side effects of nystatin oral suspension

poorly absorbed, rxns uncommon, may cause mild gi upset

gestational age+chronological age, also know post conceptual age

postmenstrual age

preferred during perinatal, neonatal hospital stay for preterm infants

postmentrual age

what are the contraindications of methylphenidate, dexmethylphenidate, amphetamines (dextroamphetamine/amphetamine, lisdexamfetamine)

pre-existing heart conditions and known cardiac abnormalities, use within 14 days of an MAO inhibitor

<36 weeks gestational age (GA)

pre-term

what are the considerations of omeprazole, esomeprazole, pantoprazole, lansoprazole, rabeprazole

preferred over H2RAs for esophagitis, give 30-60min before breakfast, wean to prevent rebound sxs

addresses shortcomings of pregnancy and lactation informaiton in prescription drug labeling. removes pregnancy categories (a, b, c, d, x)

pregnancy and lactation labeling rule (PLLR)

monitor pregnancy outcomes in women exposed to drug in pregnancy, if one does not exist this section is omitted

pregnancy exposure registry

name, credentials, office address, telephone number

prescriber identification

avoid use of abbreviations dont use vague language

preventing medication errors

include age and weight (when appropriate), drug name, exact strength, dosage form use of leading zero for decimal expression of quantities should always be used (0.5) terminal/trailing zero should never be used after a decimal

preventing medication errors

prescribed documents must be legible, verbal order should be minimized orders should include brief notation of purpose orders written in metric system, except for therapies that use standard units (insulin, vitamins)

preventing medication errors

what drug has the black box warning of respiratory depression in children <2

promethazine

what N/V drugs have the MOA of dopamine antagonists, inhibit dopamine at chemoreceptor trigger zone

promethazine, prochloraperazine

formulations: tabs, syrup, suppository, injection

promethazine, prochlorperazine

contact lens wearers are at a higher risk for _______ infections

pseudomonas

qs

quantity sufficient

what croup drug has the MOA of alpha and beta adrenergic agonist, causes bronchial smooth muscle relaxation and decreased airway wall thickness and edema. mixture of d and l enantiomers of epinephrine

racemic epinephrine

defined by the dietary supplement health and education act (DSHEA) of 1994. manufacturer does not have to prove that its product is safe and effective. FDA is not authorized to review dietary supplement products for safety and effectiveness before they are marketed. the manufacturers and distributors are responsible for making sure their products are safe before they go to market. they are prohibited from marketing products that are adulterated or misbranded -vitamins or minerals -herb or botanical -amino acid -dietary substance for use to supplement the diet by increasing the total dietary intake -concentrate, metabolite, constituent, or extract FDA has authority to remove from market if it poses a significant or unreasonable risk to consumers, adulterated, marketed with incorrect labeling

regulation of dietary supplements

rare but serious condition that causes liver and brain swelling that arises when aspirin is given to children and teenagers recovering from a viral infection (most often the flu or chicken pox)

reye syndrome

ad

right ear

what are the 5 rights for preventing medication errors

right patient, right drug, right dose, right route, right timing

risk of adverse developmental outcomes based on relevant human data. includes structural abnormalities (malformations, deformation), embryo-fetal and/or infant mortality (miscarriage, stillbirth, infant death), functional impairment (deafness, neurodevelopmental effects), alteration to growth

risk summary

what are the common viral pathogens of acute otitis media

rsv, rhinovirus, influenza, adenovirus

what are the common bacterial pathogens of acute otitis media

s pneumoniae, h influenza, m catarrhalis

high potential for abuse, no accepted medical use in US

schedule I

high potential for abuse (psych of physical) with severe dependence of liability, no refills

schedule II

some potential for abuse (low-moderate physical or high psychological) up to 5 refills within 6 mo

schedule III

low potential for abuse (physical or psychological) up to 5 refills within 6 mo

schedule IV

low potential for abuse. subject to state and local regulation (may not require prescription)

schedule V

what is the adhd tx used after stimulants (nonstimulants)

selective norepinephrine reuptake inhibitor (atomoxetine), central alpha 2A adrenergic agonists (guanfacine ER, clonidine ER)

instructions by the provider given to the patient

signa

what drug has the MOA of surfactant decreases surface tension of gas bubbles to disperse and prevent pockets of gas in GI system

simethicone

what is the tx of flatulence

simethicone

overlap between allergic rhinitis, and upper respiratory infections make condition difficult to distinguish. more than 7-10 days of copious nasal discharge/congestion accompanied by chronic cough (especially during the day) that fails to improve or worsens often indicates this

sinusitis

what routes of meds should you avoid in neonates (0-28 days)

skin and parenteral

if the drug stays in the plasma the Vd is ________ than if it is distributed widely in tissues

smaller

what are the side effects of central alpha 2 adrenergic agonist (guanfacine ER, clonidine ER)

somnolence, dizziness, skin rash with guanfacine)

what is the first line tx of adhd

stimulants

what are the pathogens that cause community acquired pneumonia

strep (MC), staph aureus, group a strep, haemofilus influenza

most common in ages 5-15. rapid strep test or a culture is essential for definitive diagnosis. sudden onset of fever, pharyngitis, exudative/erythematous tonsils, cervical adenopathy, headache, stomach ache, vomiting, little to no cough/congestion

strep throat

instructions to pharmacist regarding dose form and number of dosage units to dispence

subscription

what meds in bacterial conjunctivits causes burning upon administration and may cause hypersensitivity

sulfonamides

what tx to avoid with bacterial conjunctivitis

sulfonamides, aminoglycosides (tobramycin, gentamicin)

what is the tx of moderate to severe migraines

sumatriptan, almotriptan, rizatriptan, zolmitriptan

what is the tx of infectious mononucleosis

supportive (acetaminophen or NSAIDs), severe-dexamethasone, abx can lead to maculopapular rash

what are the considerations of racemic epinephrine

sx relief in 10-20 min, monitor 2-3hr post dose for rebound effect, continuous ekg monitoring

are cups or syringes/droppers preferred as measuring device for meds

syringes/droppers

what are the side effects of oral nasal decongestants (pseudoephedrine, phenylephrine)

tachy, elevated diastolic bp, palpitations

what are the side effects of racemic epinephrine

tachy, hypertension, dysrhythmias, tremor, agitation, anxiety

what are the considerations of famotidine, ranitidine, cimetidine, nizantidine

tachyphylaxis, for mild intermittent GERD that doesnt respond to lifestyle changes, cimetidine has many drug interactions, ranitidine on recall

AVOID IN PEDS. should not be used in children <8. permanent tooth discoloration, enamel hypoplasia, and skeletal development problems

tetracyclines: doxycycline, tetracycline, minocycline

does not respond to teeth whitening products as the stains are not on the exterior surface but are within the tooth, however certain conditions warrant use: rocky mountain spotted fever, lyme disease, risk v benefit in limited alternative therapy options. deposits there and causes permanent discoloration

tetracyclines: doxycycline, tetracycline, minocycline

fungal infection caused by candida albicans presents as white plaque like lesions in mouth, usually on tongue and inner buccal mucosa risks: immature immune system-most seen in young infants abx use inhaled glucocorticoid use (asthma or allergic rhinitis) chemotherapy or radiation therapy

thrush

1-3 yr

toddler

bid

twice daily

aims to improve accuracy of prescription writing to prevent medication errors

united states pharmacopeia

what is the empiric tx of admision to the ICU, toxic appearance pneumonia (MRSA)

vacomycin + 3rd generation cephalosporin + macrolide

the volume of fluid in which a drug would need to be distributed to achieve a concentration equal to the concentration measured in plasma

volume of distribution (Vd)

neonates: higher doses may be required for ________ to overcome poor absorption

weak acids

most drugs are _______

weak acids or bases

neonates: lower doses may be required for ________ to account for increased absorption

weak bases

fetal abnormalitis reported, positive evidence of fetal risk. risk clearly outweighs benefit. should not be used in pregnant women

x

what are the side effects of 1st gen antihistamines

xerostomia, dizziness, sedation (beneficial for night time sx to help them sleep)