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Peds Pharmacology > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Adverse effects of Acetaminophen

A

Overdose- Hepatotoxicity: N/V, diarrhea, sweating, abd pain

chronic use- renal damage

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2
Q

Treatment for Acetaminophen overdose

A

acetylcysteine (Mucomyst)

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3
Q

Reye’s syndrome

A
  • Associated with aspirin and salicylate use in children

- liver failure and encephalopathy

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4
Q

First line for fever

A

Acetaminophen

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5
Q

Recommendations for alternating ibuprofen and tylenol

A

not recommended d/t insufficient evidence to outweigh risks

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6
Q

Acetaminophen use for pain

A
  • for mild-mod
  • safe overall
  • 15 mg/kg/dose
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7
Q

COX inhibitors

A
  • NSAIDs- Ibuprofen, Naproxen, Ketorolac
  • Aspirin
  • Celecoxib (Celebrex)- COX2 inhibitor
  • Action- inhibit prostaglandin formation for fever, pain, inflammation, antiplatelet
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8
Q

NSAIDs

A

Ibuprofen, Naproxen, Ketorolac

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9
Q

Side effects of NSAIDs

A
  • GI upset, dyspepsia, GI bleed
  • fluid retention, edema
  • HTN, renal damage
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10
Q

Patient education for NSAIDs

A
  • not for patients <6 mnths (or 12 mnths AAP)
  • do not give if not taking fluids well (renal impact)
  • GI upset/ulcers with chronic use
  • avoid using 2 NSAIDs at same time
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11
Q

Aspirin used in children for 2 conditions

A

Juvenile idiopathic arthritis

Kawasaki Disease

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12
Q

Uses of Celecoxib (Celebrex)

A

acute pain

inflammation (dysmenorrhea)

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13
Q

When to avoid Celecoxib use

A
  • pregnancy
  • children
  • renal dysfunction, heart failure, HTN, fluid retention
  • increased clotting risk (stroke, MI)
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14
Q

Adverse effects of opioids

A
  • constipation
  • N/V
  • pruritis
  • serotonin syndrome- confusion, tachycardia
  • respiratory depression
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15
Q

Commonly used opioids in peds

A 
Morphine
Codeine
Oxycodone
Methadone
Fentanyl
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16
Q

First line for severe pain

A

oxycodone

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17
Q

First line treatment for migraines

A

children- NSAIDs- Ibuprofen or Naproxen

adolescents- Triptans

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18
Q

Abortive medications for migraines

A

*NSAIDs- Ibuprofen, Naproxen
Fioricet or Fiorinal (tylenol/butalbital/caffeine)
*Triptans- Sumatriptan- only for >age 12
Ergots- nasal DHE
*Antiemetics- Metoclopramide, Prochlorperazine, Promethazine

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19
Q

Side effects of triptans for Migraines

A
  • vasospasm, MI, arrhythmias, HTN, stroke
  • seizure, rebound HA
  • chest/jaw/neck pain
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20
Q

Acute management of migraines

A
  • avoid triggers
  • minimize stress
  • treat promptly at onset
  • avoid med overuse (limit to 2-3x/week)
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21
Q

Indications for preventative medical management of migraines

A
  • HA 1-2x/week

- prolonged/debilitating migraines

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22
Q

Medications for migraine management (preventative)

A
  • -propranolol (Inderal)
  • CCBs- Verapamil
  • -TCAs-Amitriptyline (Elavil)- take 6-8 weeks to work
  • -AEDs- topiramate, valproic acid, carbamazepine, neurontin
  • Serotonin agonists- cyproheptadine, methysergide
  • Botulism toxin
  • Calcitonin Gene-related Peptides (CGRPs)
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23
Q

Treatment of febrile seizures

A
  • treat fever and underlying illness
  • no AEDs needed
  • may use rectal Diastat if prolonged
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24
Q

epilepsy defined

A

2 or more unprovoked seizures in childhood

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25
Q

When is treatment started for seizures

A

after 2nd or more seizures, start low and slow

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26
Q

When are AEDs discontinued

A

seizure free for 2 yrs, wean slowly

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27
Q

Which AEDs are CYP450 inducers

A 
Carbamazepine
Phenobarbital
Phenytoin
Primidone
(they decrease the effectiveness of other drugs)
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28
Q

When do AEDs reach a stable level

A

after 5 half-lives (doses)

-infants require more frequent dosing d/t faster metabolism

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29
Q

Adverse reactions for AEDs

A

Subtle- dizziness, fatigue
Severe- toxicity, skin rash, behavioral problems, cognitive decline
Black box warning- increased suicidality

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30
Q

Phenobarbital

A
  • one of the safest AEDs, but has sedative effects
  • often treatement of choice in infants
  • enhances GABA and inhibits glutamate
  • side effects- drowsiness, depression, ataxia
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31
Q

Phenytoin (Dilantin)

A
  • Narrow spectrum AED
  • blocks voltage-dependent Na and Ca channels
  • side effects- GI upset, gingival hyperplasia, hirsutism, hepatotoxicity, thrombocytopenia
  • terotogenic & interacts with contraceptives
  • abruptly stopping can lead to status epilepticus
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32
Q

Valproic acid (Depakote)

A
  • Broad spectrum AED
  • side effects- liver necrosis & pancreatitis (<2 yo), PCOS, hormonal changes, wt gain, abnl coagulation, encephalopathy
  • increase plasma concentration of other AEDs
  • terotogenic
  • many drug interactions (but not contraceptives
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33
Q

Ethosuximide (Zarontin)

A
  • AED
  • first line for absence seizures
  • side effects- GI symptoms, HA, drowsiness, lethargy
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34
Q

Lamotrigine (Lamictal)

A

Broad spectrum AED

  • alternative to Depakote
  • also used as mood stabilizer
  • blocks release of glutamate
  • less cognitive effect/sedation than other AEDs
  • side effects- bad skin rash, elevated LFTs
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35
Q

Topiramate (Topamax)

A
  • Broad spectrum AED
  • also used for migraines
  • side effects- foggy, wt loss, paresthesias, abd pain, kidney stones, glaucoma
  • interacts with contraception, no breastfeeding
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36
Q

Levetiracetam (Keppra)

A

Broad spectrum AED

  • fewer side effects- somnolence, behavior changes, dizziness, anorexia
  • no interaction with contraception
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37
Q

Carbamazepine (Tegretol)

A
  • Narrow spectrum AED
  • side effects- vertigo, nausea, aplastic anemia
  • interacts with contraception
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38
Q

Gabapentin (Neurontin)

A
  • safe but not very powerful AED

- used as analgesia for neuropathic pain

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39
Q

Management of ADHD

A

-Behavioral therapy first line for age 6

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40
Q

First line meds for ADHD

A

-Stimulants- Methylphenidate (Ritalin, Concerta), Amphetamines (Adderall, Dexedrine)

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41
Q

Important labs for AEDs

A

LFTs
CBC
EKG
drug levels

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42
Q

Side effects for stimulants

A

Appetite suppression, tachycardia, dizziness, HA, insomnia, growth suppression
-rare sudden cardiac death

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43
Q

Non stimulants for ADHD

A
  • Atomoxetine (Strattera)- SNRI
  • Buproprion (Wellbutrin)
  • Venlafaxine (Effexor)
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44
Q

Side effects for non-stimulants (ADHD)

A

increased BP, tachycardia, HA, insomnia, anorexia, growth suppression, prolonged QT interval

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45
Q

What should be monitored in ADHD patients

A
  • symptoms
  • ADRs- wt and growth, BP and HR
  • refill pattern- adherence/abuse
46
Q

Mechanisms of antibiotics

A
  • weaken bacterial cell wall
  • disrupt cell division/DNA replication
  • disrupt protein synthesis by RNA
  • disrupt other metabolic processes (folic acid)
47
Q

Beta Lactam antibiotics

A
  • PCNs & Cephalosporins
  • kill bacteria by disrupting cell walls
  • vulnerable to beta-lactamase-producing bacteria
48
Q

Macrolides

A
  • Erythromycin, Clarithromycin, Azithromycin
  • affect bacterial ribosomes- protein synthesis
  • commonly used for resp tract and skin infections
49
Q

Quinolones

A
  • Ciprofloxacin & Levofloxacin
  • disrupt DNA replication in bacteria
  • heavy hitters for pneumonia and bronchitis
50
Q

What should be done if patient claims PCN allergy?

A

do not prescribe until skin testing is done

51
Q

What is the concern with sulfa drugs in neonates

A

sulfa drugs compete with bilirubin- risk kernicterus

-do not prescribe

52
Q

Most common reason for antibiotic prescription in children

A

acute otitis media

53
Q

Most common AOM causative organisms

A

*H. flu
*Strep pneumo
*Moraxella catarrhalis
strep pyogenes
staph aureus

54
Q

AOM signs and symptoms

A
  • acute onset- fever & pain
  • middle ear effusion
  • middle ear inflammation- erythema and otalgia
55
Q

When to treat AOM

A
  • many resolve spontaneously- observe for 24-48 hours
  • treat immediately if <6 mnths old
  • if 6-24 mnths- treat if high fever or severe pain
  • if <24 mnths- observe and treat if not resolved in 24-72 hrs
  • if predisposed to AOM/high risk
56
Q

Treatment for AOM

A
  • High dose Amoxicillin
  • Augmentin if on amox in last 30 days
  • Cephalosporins as alternative- Cefdinir, cefuroxime, ceftriaxone
  • Severe PCN allergy- Bactrim, macrolides, clinda
  • If fail initial abx- Augmentin or ceftriaxone
57
Q

Treatment for Otitis Media Effusion

A
  • observation
  • refer to ENT if persistent (<3 mnths)
  • myringotomy tubes
58
Q

Treatment for conjunctivitis

A
  • Abx opthalmic solution/ointment x 10 days
  • Erythromycin
  • Gentamycin
  • Ciprofloxin
  • Bacitracin and Polymyxin B
  • Sulfacetamide
  • Trimethprim-polymyxin B
59
Q

Treatment for conjunctivitis-Otitis syndrome

A

Augmentin

60
Q

When to treat sinusitis

A

Rhinorrhea or persistent daytime cough lasting >10-14 days without improvement OR severe symptoms (fever, purulent nasal discharge, facial pain, periorbital swelling)

61
Q

Treatment for Sinusitis

A

Amoxicillin or Augmentin- continue for 7 days after symptoms improve/resolve (10-14 days)

62
Q

Treatment of Strep throat

A

PCN or Amoxicillin- not high dose and only after positive throat swab

63
Q

Treatment of recurrent strep pharyngitis

A

Clindamycin
Augmentin
Rifampin (rare)
-refer to ENT

64
Q

Viral vs Bacterial pneumonia

A

Viral- abrupt high fever, cough, tachypnea, wheezing; patchy bronchopneumonia on xray; most common cause in children < 5 yo
Bacterial- productive cough, chest pain, decreased breath sounds; consolidation on xray; most common cause in >5 yo; mycoplasma pneumonia

65
Q

Treatment of community-acquired pneumonia

A
  • if preschool age- likely viral and will self-resolve
  • if school age- high dose amoxicillin
  • if atypical pathogen suspected- add macrolide
  • importance of Prevnar, HiB, and pertussis vaccines, synagis for premies
66
Q

Urinalysis suggestive of UTI

A
  • Leukocyte ersterase- have to accumulate in urine, may not be present in small infants
  • Nitrites- highly suggestive of UTI
67
Q

Treament of UTI

A
  • Bactrim- drug of choice if >2 mths old
  • Cephalosporins
  • Augmentin
  • Ceftriaxone if toxic-looking
68
Q

Safety issue with Fluoroquinolones

A

-risk of nephrotoxicity and arthralgias

69
Q

UTI prophylaxis

A
  • Used if recurrent UTIs or vesicortico reflux
  • Amoxil is drug of choice
  • Bactrim (> 2 mnths old)
  • Nitrofurantoin
70
Q

Definition of functional constipation

A

<= 2 stools/week
large stool, difficult defecation
painful, hard BMs
-often d/t withholding

71
Q

Management of constipation

A
  1. Disimpaction
  2. Adjust diet, behavior, medications
  3. r/o organic disorders
72
Q

Meds for constipation

A
  • 1st line- Osmotic- Miralax, MOM, Lactulose
  • bulk-forming- Citrucel, Metamucil
  • Lubricating- mineral oil
  • Stimulant- Dulcolax, Senna
  • Stool softener- Colace
73
Q

Management of GER

A
  • small frequent feedings
  • thicken formula
  • trial hypoallergenic formula
  • keep @ 30 degrees after eating
74
Q

Proton Pump Inhibitors

A
  • Omeprazole (Prilosec)
  • Lansoprazole (Prevacid)
  • Esomeprazole (Nexium)
  • blocks production of stomach acid
  • first line for reflux
75
Q

Histamine-2 Receptor Antagonists

A
  • Famotidine (Pepcid)
  • Cemetidine (Tagamet)
  • Ranitidine (Zantac)
  • decreased acid production
  • 2nd line for reflux
76
Q

First line treatment for reflux

A

PPIs- Omeprazole, Lansoprazole, Esomeprazole

77
Q

Safety alert for Ranitidine (Zantac)

A

probably human carcinogen NDMA

78
Q

Aluminum-containing Antacids

A

Not recommended for children

-Sucralfate

79
Q

Metoclopramide (Reglan)

A
  • Prokinetic agent
  • stimulates more rapid emptying of stomach
  • not recommended under 12 yrs d/t extrapyramidal rxns
80
Q

Management of gas pains

A

Simethicone (Mylicon)

  • use <12 doses per day
  • good burping, slower feeding, football holds
81
Q

Anti-diarrheals

A
  • not recommended- focus more on fluid replacement

- Imodium, Lomotil, Children’s Kaopectate

82
Q

Anti-emetics

A
  • Ondansetron (Zofran)- first line
  • Promethazine (Phenergan)- for severe, inpatient
  • Trimethobenzamide (Tigan)- contains salicylates
  • Metoclopramide (Reglan)- last resort
  • Antihistamines - Meclizine, dimenhydrinate, diphenhydramine; off label use
83
Q

Oral Rehydration Solutions

A
  • main treatment for diarrhea in children
  • Pedialyte, breast milk
  • frequent small amounts
  • not water, sports drinks, high carb drinks
84
Q

Peppermint oil

A

works well for abd pain, IBD, nausea

85
Q

Probiotics

A
  • mixed results on effectiveness for diarrhea
  • not FDA regulated
  • not routinely recommended
86
Q

Management of acute gastroenteritis

A
  • > = 3 episodes diarrhea/vomiting
  • Oral rehydration therapy- 15 ml/kg/hr + 10 ml/kg for every episode; pedialyte, salted rice water or soup
  • Ondansetron (Zofran)
  • diet- simple starches, fruits & veggies, yogurt
  • probiotics
  • zinc
87
Q

Rapid-actiing insulin

A
  • Lispro (Humalog)
  • Aspart (Novalog)
  • Glulisine (Apidra
  • take with meal/eat immediately
  • onset <15 min, peak 1-2 hrs
88
Q

Short-acting insulin

A
  • Regular
  • take 20 min prior to eating
  • rarely used d/t rapid insulin availability
  • onset 30-60 min, peak 2-4 hours
89
Q

Intermediate-acting insulin

A
  • NPH
  • can mix with rapid or regular
  • onset 2-4 hrs, peak 4-8 hours
90
Q

Very long-acting insulin

A
  • Insulin glargine (Lantus)
  • Insulin detemir
  • Degludec
  • Peakless, 24-72 hour insulin
91
Q

Rapid/Intermediate Insulin regimen

A
  • Humalog/NPH
  • 3 shots/day
  • timing and carb content must be consistent
92
Q

Basal/Bolus Insulin regimen

A
  • more commonly used

- daily very-long-acting insulin plus carb coverage and correction boluses

93
Q

Medication approved for use in pediatric T2DM

A

Metformin

94
Q

Metformin (Glucophage)

A
  • Biguanide- decreases sugar production in liver (gluconeogenesis), increases insulin sensitivity, suppresses appetite
  • only approved diabetic med for children >age 10
  • does not cause hypoglycemia
  • side effects- diarrhea, nausea; lactic acidosis (contraindicated if urine ketones present)
  • take with meals to decrease SE
  • monitor liver/kidney function
95
Q

Management of T2DM

A
  • diet and exercise first
  • metformin
  • add insulin if metformin not successful
96
Q

Incretin Mimetics

A
  • T2DM
  • increase insulin secretion & decrease glucagon production, delay gastric emptying
  • being studied in Peds
  • GLP-1 agonists- Exanatide (Byetta)
  • GIP (Liraglutide)- more effective, assoc. with thyroid tumors
97
Q

DPP4 inhibitors

A
  • T2DM
  • slows inactivation of incretin hormones
  • needs more study in Peds
98
Q

Hypothyroidism in newborns

A
  • requires prompt treatment

- crucial for brain development, can have permanent neuro impairment

99
Q

Primary hypothyrodism

A
  • most common
  • gland itself is effected
  • Hashimoto
  • check for other autoimmune disorders
100
Q

Central hypothyroidism

A
  • issue with pituitary gland

- assess adrenal function- replace glucocorticoid first before thyroid replacement

101
Q

Symptoms of hypothyroidism

A 
Goiter
Growth retardation
Difficulty concentrating
Fatigue, lethargy
Bradycardia
constipation
Fluid retention/wt gain
dry skin
cold intolerance
102
Q

Labs for hypothyroidsim

A

increased TSH

decreased T4

103
Q

Treatment of hypothyroidism

A

T4- Levoxyl, Synthroid, Levothyroid

  • must take on empty stomach, same time each day
  • absorption effected by calcium, iron, and soy- may need higher dose
  • only exists in pill form
104
Q

Symptoms of hyperthyroidism

A 
-Grave's disease
nervousness/anxiety
heat intolerance
palpitations, tachycardia
warm/moist/smooth skin
exophthalmus
wt loss/increased appetite
105
Q

Treating Grave’s disease

A
  • Thionomides- Methimazole (MMI) and Propylthiouracil (PTU)
  • Propranolol- symptomatic relief
  • Radioactive Iodine
  • Surgery
106
Q

Thionomides for Grave’s disease

A
  • anti-thyroid
  • Methimazole (MMI) and Propylthiouracil (PTU)
  • check CBC for underlying leuko/thrombocytopenia
  • MMI drug of choice
  • PTU - risk liver failure
  • Monitor LFTs
107
Q

Side effects of Thionomides

A
  • antithyroid- MMI/PTU
  • agranulocytosis- prompt CBC if fever, mouth ulcers, sore throat (retropharyngeal abcess)
  • increased LFTs
  • GI upset
  • bitter taste
  • headache
108
Q

Growth hormone

A
  • Somatropin- SQ daily
  • increases bone mass and osteoclast activity
  • promotes epiphyseal growth
  • decreases lipogenesis
  • increases lean muscle mass
109
Q

Manifestations of PCOS

A
  • Irregular/lack of menses
  • Hirsutism
  • Alopecia/female pattern baldness
  • Wt problems- fluctuating, apple-shape
  • Acne
  • Acanthosis Nigricans
  • Migraines
110
Q

PCOS diagnosis

A
  • pelvic u/s- ovarian cysts
  • labs- hormone levels
  • H & P
111
Q

PCOS medications

A
  • oral contraceptives
  • antiandrogens- spironolactone
  • antidiabetics- metformin
  • estrogen agonist-antagonist- Clomiphene
  • gonadotropins

Peds Pharmacology (2 decks)

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