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Peds Pharmacology > Midterm Exam > Flashcards

Midterm Exam Flashcards

1
Q

What does it mean if a drug is highly bound to protein?

A
  • Less drug is available for distribution
  • May require a higher dose to have desired effect
  • More potential drug interactions
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2
Q

How is body composition different in infants and what does it mean for drug dosing

A
  • higher % water in infants (80%)
    =>may require higher doses of hydrophilic drugs
  • decreased plasma proteins available
    => risk toxicity
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3
Q

What is achlorhydria?

A
  • decreased gastric acid

- relative state for infants in first month

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4
Q

GI drug absorption in infants

A
  • relative achlorhydria in first month
  • slower gastric motility and peristalsis until 6-8 months
  • larger intestinal surface area
  • decreased pancreatic enzymes and bile salt concentration => decreased absorption of fats
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5
Q

Where to find current evidence regarding vaccines

A

CDC

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6
Q

When is varicella vaccine given generally?

A

12-15 month and 4-6 yr

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7
Q

When should a child receive the Hep A vaccine?

A

2 doses between 12 and 23 months

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8
Q

When is the HiB vaccine given generally?

A
  • 3-4 doses from 2- 18 months

- no need after age 5

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9
Q

Important teaching points for inhaled corticosteroids

A
  • use spacer- decrease oral thrush
  • administer 1 puff at a time- increases effectiveness
  • rinse mouth after- decrease oral thrush, hoarseness
  • monitor growth
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10
Q

Treatment for Hep B exposure

A

Hep B vaccine and Hep B immunoglobulin (HBIG)

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11
Q

Who can receive the HPV vaccine?

A
  • males and females, age 11-26
  • ideally before sexually active
  • only 2 doses for 11-12 yr olds
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12
Q

Contraindications for live vaccines

A
  • immunodeficiency

- pregnancy

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13
Q

Ipratropium bromide (Atrovent)

A

inhaled anticholinergic

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14
Q

Oxymetazoline (Afrin) side effect

A

rebound congestion

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15
Q

Intranasal corticosteroids

A
  • Fluticasone (Flonase), Mometasone (Nasonex)

- decrease inflammation assoc. with allergic rhinitis

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16
Q

Inhaled glucocorticoids for asthma

A
  • ## take twice daily regardless of symptoms for persistent asthma
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17
Q

Administration of iron

A

take on empty stomach or with orange juice

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18
Q

Screening for cholesterol

A
  • > 2 yrs with family history

- universal screening 9-11 yrs and

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19
Q

Management of hypertension

A

recheck over multiple visits

  • pharm only after lifestyle changes fail
  • refer to cardiology and echocardiogram
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20
Q

How does blood flow in infants affect absorption of medications?

A
  • underdeveloped periph. circulation- slow absorption
  • can have sudden changes in blood flow- erratic
  • vasoconstriction in cold environments- slow
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21
Q

Bioavailability

A

fraction of the dose absorbed into systemic circulation and is free to engage in a biological response
-IV is 100% bioavailable, oral has the most road blocks

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22
Q

How is absorption of topical medications affected in infants?

A
  • thin stratum corneum and larger surface area- medications absorbed more readily
  • occlusive dressings (diapers) increase absorption
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23
Q

How does protein binding impact pharmacokinetics in infants?

A

-infants < 6 mnths have decreased plasma protein
-drugs have to compete with bilirubin for protein binding
=> elevated levels of unbound medication and exaggerated drug response

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24
Q

Drug metabolism in neonates

A

-decreased metabolic enzyme capacity and biliary function
-decreased CYP450 enzymes
=>limited metabolic clearance of drugs

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25
Q

Drug excretion in infants

A
  • Lower GFR until 6-12 mnths => renally excreted drugs cleared more slowly (water soluble), prolonged half-life
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26
Q

Naturally Acquired Active Immunity

A

exposure to disease causes body to make antibodies

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27
Q

Naturally Acquired Passive Immunity

A

given antibodies created in another human/host- mom to baby

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28
Q

Artificially acquired active immunity

A

antibody production stimulated without clinical disease- vaccines

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29
Q

Artificially acquired passive immunity

A

immunoglobulin (synagis, HBIG)

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30
Q

Which are live vaccines?

A 
MMR
Varicella
Intranasal Influenza
Rotavirus
Oral Polio (OPV)
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31
Q

When is Hep B vaccine given generally?

A

3 doses IM- birth (>2 kg) to 18 months

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32
Q

Side effects of Hep B vaccine

A

low grade fever

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33
Q

Pediarix and Pentacel

A
  • Pediarix (Dtap, IPV, Hep B)
  • Pentacel (Dtap, IPV, HiB)
  • series given to infants
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34
Q

When is DTaP vaccine given generally?

A

5 doses IM @ 2, 4, 6, 15-18 mnth, and 4-6 yrs

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35
Q

Side effects of DTaP

A
  • swelling, soreness at site
  • fever
  • restlessness
  • listlessness
  • seizures
  • inconsolable crying
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36
Q

Contraindications to DTaP

A
  • life-threatening allergic reaction
  • neurologic rxn (seizures, etc) within 7 days of dose
  • non-stop crying > 3 hrs or fever >105 F
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37
Q

When is Tdap given generally?

A

IM, 11-12 yr olds, pregnant women in 3rd trimester

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38
Q

When is IPV given generally?

A
  • 4 doses SQ- 2, 4, 6-18 mnth, 4-6 yr

- not given after 18 yrs

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39
Q

Contraindications to IPV

A
  • severe allergic rxn

- reaction to abx neomycin, streptomycin, or polymyxin B

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40
Q

When is Prevnar given generally?

A
  • 4 doses IM- 2, 4, 6, 12-18 mnths

- not needed after age 5

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41
Q

When is Pneumovax given?

A

2 doses for chronically ill children > 2 yrs

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42
Q

Who receives 2 doses of the flu vaccine?

A

first time recipients under age 9

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43
Q

Contraindications for Flumist

A
  • < age 2
  • age 2-4 with asthma/ recurrent wheezing
  • immunocompromised (live vaccine)
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44
Q

When is the rotavirus vaccine given generally

A
  • 2-3 doses PO- 2,4,6 months
  • not given over 8 months old
  • not initiated over 15 weeks old
45
Q

Contraindications to rotavirus vaccine

A

severe immunodeficiency
uncorrected GI malformation
severe allergic rxn to previous dose

46
Q

Side effects of rotavirus vaccine

A
  • intussesception
  • kawasaki disease
  • fever, runny nose, fussy, vomiting, decrease appetite
47
Q

When is MMR vaccine given generally?

A

2 doses SQ, 12-15 month and 4-6 yr

- not given under 12 months d/t maternal antibodies (less effective)

48
Q

Side effects of MMR vaccine

A

noninfectious generallized rash 7-14 days after

49
Q

Contraindications to MMR vaccine

A

immunodeficiency (caution)
pregnancy (wait 4 weeks before getting pregnant
+ PPD or active TB

50
Q

When is Varicella vaccine given generally?

A

2 doses SQ, 12-15 month and 4-6 yr

51
Q

Side effects of varicella vaccine

A

varicellaform rash

52
Q

Contraindications to varicella vaccine

A
  • allergy to gelatin
  • allergy to neomycin or streptomycin
  • immunodeficiency
  • pregnancy
53
Q

Side effects of HPV vaccine

A

-fainting- sit/lie down for 15 min

54
Q

Who receives the Meningococcal conjugate vaccine (Menactra)

A
  • 11-18 yr olds routinely
  • 19-55 yr olds @ high risk (college, military, travel)
  • 2-55 yr in high risk groups (outbreaks, damaged spleen, immune system disorders)
55
Q

Who receives the Mening B vaccine?

A

age 16-23 if high risk

56
Q

Who receives Synagis?

A
  • monoclonal antibody given to high risk infants (< age 2)

- <32 weeks gestation or 32-35 wks with medical issues

57
Q

General vaccine contraindications

A
  • Live- severely immunocompromised
  • hx anaphylaxis to any vaccine
  • moderate- severe illness
58
Q

How do vaccines impact delivery of IVIG or blood products?

A
  • wait 2 weeks before given IVIG or blood products

- no MMR or Varicella vaccines for 6-9 months after receiving IVIG/blood products

59
Q

What interval should be between all vaccines (min)

A

4 weeks

60
Q

When can a PPD be performed in relation to live vaccines

A

may do at same time or wait 4-6 wks

61
Q

Oseltamivir (Tamiflu)

A
  • treat flu > 2 weeks old

- must start within 48 hrs of symptoms

62
Q

Zanamivir (Relenza)

A
  • treat flu > 7 yrs old
  • inhalation powder BID x 5 days
  • not recommended with underlying resp conditions
63
Q

What is allergic rhinitis?

A
  • inflammation/irritation of mucous membranes from allergens

- antibodies attach to mast cells, which release histamine => swollen/red membranes, sneezing, congestion

64
Q

Symptoms of allergic rhinitis

A
  • ‘allergic salute’
  • ‘allergic shiners’
  • HA
  • poor hearing/smell
  • poor appetite
  • fatique/poor sleep
  • boggy, pale nasal mucosa
65
Q

Management of allergic rhinitis

A
  1. allergen avoidance, antihistamines
  2. intranasal corticosteroid
  3. leukotriene receptor antagonist
  4. immunotherapy
66
Q

First line therapy for intermittent allergic rhinitis

A

2nd gen oral antihistamines

  • Cetirizine (Zyrtec)
  • Desloratidine (Clarinex)
  • Loratidine (Claritin)
  • Fexofenadine (Allegra)
67
Q

First line therapy for persistent mod-severe allergic rhinitis

A

Intranasal corticosteroids - Fluticasone (Flonase), Mometasone (Nasonex), etc

68
Q

Patient education for Intranasal corticosteroids

A
  • takes 5-7 days before improvement of symptoms
  • must take consistently
  • blow nose before administering
69
Q

Name first generation antihistamines

A
  • diphenhydramine (Benedryl)
  • chlorpheniramine (Aller-Chlor)
  • brompheniramine (Ala-hist)
  • clemastine (Tavist)
  • carbinoxamin maleate (Karbinal ER)
70
Q

When are leukotreine receptor antagonists prescribed for allergic rhinitis

A
  • > 6month old, not responsive to antihistimine or INCS
  • asthma diagnosis
  • Montelukast, Zafirlukast
71
Q

Patient education for Topical Nasal decongestants (Afrin or Neo-synephrine)

A
  • use only for short peroid (3-5 days)
  • can be addicting
  • may cause rebound congestion
72
Q

When are intranasal anticholinergics prescribed for allergic rhinitis

A
  • Ipratropium bromide

- > 5 yrs olds with refractory rhinorrhea

73
Q

Rescue drug for asthma

A

Albuterol (short acting beta agonist)

74
Q

When should a patient be started on maintenance therapy for asthma

A

if using SABA >2 days per week

75
Q

Side effects of albuterol

A
  • tachycardia
  • tremors
  • headache
  • hyperglycemia
76
Q

Ipratropium Bromide (Atrovent)

A

Short-acting anticholinergic to relieve acute bronchospasm

77
Q

First line drugs for long term control of asthma

A

Inhaled corticosteroids (ICS)

  • Budesonide (Pulmicort)
  • Fluticasone (Flovent)
  • Beclomethasone dipropriate (Beclovent)
  • Flunisolide (Aerobid)
78
Q

Systemic adverse effects of ICS

A
  • bone mineral density (supplement Ca and Vit D)
  • disseminated varicella
  • dermal thinning and increased bruising
  • ocular effects- cataracts
  • altered gluose metabolism
79
Q

When are LABAs prescribed for asthma

A
  • in combo with ICS for mod-severe asthma in patients >5 yrs

- Salmeterol (Serevent) and Formoterol (Foradil)

80
Q

When are LTRAs prescribed for asthma

A
  • in combo with ICS for moderate persistent asthma
  • may help with exercise-induced bronchospasm
  • Montelukast (Singulair)
81
Q

5-Lipoxygenase Inhibitor (Zileuton)

A
  • for mild persistent asthma >12 yrs old in combo with ICS
82
Q

When are mast cell stabilzers prescribed for asthma

A
  • for mild persistent asthma as it inhibits acute responses to exercise and cold dry air
  • alternative to ICS
  • Cromolyn sodium (intal) and Nedrocromil (Tilade)
83
Q

When are systemic oral corticosteroids used for asthma

A
  • for short term (3-10 d) to gain control
  • for long term in severe asthma- low dose
  • Methylprednisolone, Prednisolone, Prednisone
84
Q

Immunomodulators for asthma

A

Omalizumab

  • SQ injection Q 2-4 weeks
  • monoclonal antibodies
  • for mod-severe persistent asthma not controlled by ICS
  • > age 12 yrs
85
Q

Methylxanthines for asthma

A
  • Theophylline
  • alternative for mild persistent asthma
  • assoc. with cardiac arrhythmias
86
Q

Mild persistent Asthma

A
  • Sx >2 days/week with nighttime sx 1-2x/mnth
  • SABA use >2 d/wk
  • minor interference with activities
  • at least 2 exacerbations in 6 months
87
Q

Moderate persistent Asthma

A
  • Sx daily with nighttime sx 3-4x/mnth
  • SABA use daily
  • moderate interference with activities
  • at least 2 exacerbations in 6 months
88
Q

Severe persistent Asthma

A
  • Sx daily with nighttime sx >1/wk
  • SABA use multiple times a day
  • major interference with activities
  • at least 2 exacerbations in 6 months
89
Q

CHF treatment “4 D’s”

A

Diet- low sodium, high calorie
Diuretics- reduce preload
Dilators- reduce afterload
Digoxin- improve cardiac contractility

90
Q

Thiazide diuretics

A
  • Chlorothiazide and Hydrochlorathiazide
  • inhibit reabsorption of Na & Cl
  • longer onset (2 hr) but longer lasting (12 hr)
  • monitor electrolytes
91
Q

Loop diuretics

A
  • Furosemide & Bumetanide
  • inhibit Na-K-Cl pump => Na and H2O loss
  • short acting, short lasting (6 hrs)
92
Q

Potassium sparing diuretics

A
  • Spironolactone

- may have hyperkalemia with renal impairment

93
Q

ACE inhibitors

A
  • Captopril, Enalapril, Lisinopril
  • prevents vasoconstriction and decreases BP
  • side effects: cough, hyperkalemia, hypotension, drowsiness, increased BUN/Cr.
  • first line for HTN
  • caution in renal failure
94
Q

Beta Blockers

A
  • Metroprolol, Atenolol (cardioselective), Propranolol (noncard selective)
  • Block epi and norepi from acting => decrease HR and BP, vasodilation, possible bronchoconstriction
95
Q

Beta blocker side effects

A
  • diarrhea, n/v
  • rash
  • blurred vision
  • disorientation, insomnia
  • hair loss
  • weakness, fatigue
  • muscle cramps
96
Q

Vasodilators in HF

A
  • Nitroglycerin, Nitroprusside, Hydralazine, Nifedipine

- for hypertensive acute HF unresponsive to Rx or severe valve regurgitations in pts intolerant of ACEIs

97
Q

Digoxin

A
  • cardiac glycoside that improves contractility and decreases HR
  • narrow safety margin (0.8-2 ng/ml)
  • potential for dig toxicity with hypokalemia
98
Q

Digoxin Toxicity symptoms

A
  • vomiting
  • vision changes (halo)
  • confusion
  • decreased appetite
99
Q

Sympathomimetic Amines

A
  • Dopamine and Dobutamine
  • increase CO and decrease systemic and pulmonary vascular resistance
  • for patients with persistent low CO
  • can induce tachycardia/tachyarrhythmia
100
Q

Phosphodiesterase Type III Inhibitors

A
  • Milrinone, amrinone, enoximone, olprinone
  • decrease systemic and pulmonary vascular resistance and increase cardiac contractility
  • for mod/severe ventricular dysfunction with hypoperfusion
101
Q

Symptoms of Infective endocarditis

A
  • weakness, fatigue
  • wt loss
  • fever, chills
  • night sweats
  • anorexia
  • arthralgia
102
Q

What is the drug of choice for antibiotic prophylaxis for endocarditis

A

Amoxicillin

103
Q

Which patients should receive abx prophylaxis for endocarditis

A 
high risk:
- prosthetic valve
- previous endocarditis
- unrepaired cyanotic CHD
- prosthetic material device for first 6 mnths after procedure
-cardiac transplant with valvulopathy
Mod risk:
- CHD
- valvular dysfunction
- hypertrophic cardiomyopathy
- rheumatic heard disease, SLE, Marfan's
104
Q

Which dental procedures require abx prophylaxis for endocarditis

A
  • deep manipulation or teeth/oral cavity
105
Q

First line drugs for hypertension

A
  • ACEIs
  • ARBs
  • CCBs
106
Q

Alpha blocker

A
  • keeps norepi from causing vasoconstriction
  • improves blood flow and lowers BP
  • not first line for HTN, significant side effects
  • Prazosin (Minipress)
107
Q

Angiotensin II Receptor Blockers (ARBs)

A
  • Irbesartan (Avapro), Losaran (Cozaar)
  • blocks vasoconstriction and aldosterone effects
  • similar effects as ACEI
  • among first line for HTN
108
Q

Calcium Channel Blockers

A
  • Amlodipine (norvasc), Nifedipine (Procardia)
  • decrease periph vasc resistance- arterial dilation
  • among first line for HTN

Peds Pharmacology (2 decks)

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