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)
