pharmacology

Question 1

How does gentamicin kill bacteria

Answer 1

concentration dependent

Question 2

How does beta lactam kill bacteria

Answer 2

time dependent

Question 3

What is volume distribution

Answer 3

Amount of drug available to the baby

Vd= Total amount of drug/ plasma conc x wt

Question 4

Side Effects of ACE inhibitors on the Fetus

Answer 4

Oligohydramnios
Renal failure
Lung hypoplasia
Skull ossification defects

Question 5

Side Effects of Beta Blockers on the fetus

Answer 5

Fetal bradycardia
Hypoglycemia
Possibly fetal growth restriction

Question 6

Side effects of methimazole on the fetus

Answer 6

Choanal atresia
Esophageal atresia
Hypothyroidism
goiter
Cutis aplasia

Question 7

First order vs Zero order kinetics

Answer 7

First order: certain percentage of the drug per unit time (proportional to the drug concentration)

Zero order: constant amount of drug regardless of concentration

Question 8

First order vs Zero order kinetics, elimination time

Answer 8

First order: half life is independent of drug dosage, fraction constant

Zero order: dependent on dose- larger the more slow to clear, fraction not constant

Question 9

Volume of distribution and half life

Answer 9

the larger the Vd the longer the half life

Question 10

Peak concentration adjust by

Answer 10

1. Infusion rate: longer lower
2. Dose

Question 11

Trough of a medication is dependent on

Answer 11

Interval of the drug administration

Question 12

Ways milrinone improve cardiac output (3)

Answer 12

1. increasing systolic contractility
2. decreasing systemic vascular resistance (afterload)
3. enhancing diastolic myocardial relaxation.

Facilitating diastolic relaxation: lusitropy.

Question 13

MOA of medication to improve CO

Answer 13

1. Increased heart rate (chronotropy)
2. Increased myocardial contraction with greater shortening fraction (inotropy)
3. Faster electrical conduction of cardiac contraction signals during systole (dromotropy)
4. Increased myocardial relaxation during diastole (lusitropy)

Question 14

How to give adenosine

Answer 14

Large IV/Central catheter IV push

• 1/2 life: <1 min
• dose: 0.1 mg/kg/dose
• ECG running- diagnostic for focal atrial tachycardia (FAT) or AF

Question 15

Ideal location of tip of UE or scalp PICC

Answer 15

T3-T5

Question 16

Ideal location of tip of LE PICC

Answer 16

T8-T10

Question 17

Long Term Complication of chronic PGE use

Answer 17

1. hyperostosis or cortical proliferation of the long bones
2. intestinal and gastric mucosal hyperplasia resulting in gastric outlet obstruction and delayed gastric emptying.

Question 18

Common side effect of fentanyl

Answer 18

Chest wall rigidity

To prevent: slow administration (over 1 min)
To treat: Naloxone/ muscle relaxant (ie rocuronium?)

Question 19

Possible electrolyte abnormality secondary to amphotericin

Answer 19

Hypomagnesemia

Question 20

How does hypothermia change metabolism of medications

Answer 20

• slow the kinetics of most enzymatic pathways involved in phase 1 and phase 2 metabolism.
• Drugs that are eliminated largely unchanged through the kidneys (phase 3) are least affected

Phase 1: biotransformation of a drug, usually by the cytochrome P450 enzymes found in the liver.
Phase 2: conjugation with other molecules, which facilitates its removal via the kidneys or intestine.
Phase 3: final common pathway of drug elimination largely via the kidneys

Meds:
phenobarbital no difference
midazolam 21%
lidocaine −24%;
morphine −21% to −47%,
gentamicin and amikacin −40%

Question 21

What is the first line medication to treat systemic candidiasis

Answer 21

Amphotericin B

• MOA: disrupts fungal wall synthesis by binding to sterols
• If CNS: added second agent (flucytosine)
• Fluconazole: wait for sensitivities due to concern for resistance

Question 22

Main side effects of indomethacin

Answer 22

*Decreased renal blood flow
*Decreased mesenteric blood flow
*Alteration of platelet function