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UMB Pediatric Pharmacology - Exam 2
Derm|Neuro|NICU|Mental
120
Pharmacology
Professional
11/28/2016

Additional Pharmacology Flashcards

 


 

Cards

Term
When to see MD for rash?
Definition
>1wk
Spreads beyond diaper area
Signs of infection
Term
Prevention of diaper rash; how to protect skin?
Definition
Zinc oxide
Petrolatum
No powders b/c of aspiration
Term
4 ways to prevent diaper rash
Definition
1. Freq. changes
2. Cleanse and dry
3. Avoid irritants
4. Protect skin
Term
Prevention of diaper rash; what are irritants
Definition
wet
chemicals
fecal enzymes
Term
Pharm products from prevention of diaper rash
Definition
1. Zinc oxide
2. A&D oint.
3. White petrolatum
4. Aquaphor
5. Various compounds/combos
Term
Pharm compounds for the prevention of diaper rash
Definition
1. Kayra in petrolatum or oint
2. Maalox +/- aquaphor
3. Cholestyrmine in aquaphor
4. Carafate paste in aquaphor
5. Nystatin/HC/Zinc ox.
Term
Coating the bum in Maalox or Mylanta does...
Definition
neutralizes acidic poop
Term
Which agent is best for a non-fungal rash
Definition
Carafate
Term
What is a side effect of HC
Definition
HPA (hypothalamus pituitary suppression)
Term
Rash > 2days =
Definition
potential fungal
Term
How to treat fungal rash
Definition
Nystatin
Imidazole (ketoconazole Lotrimin)
Term
How to prevent open wounds in babies with eczema?
Definition
socks on hands
short fingernails
Term
In addition to eczema; pts with eczema commonly have
Definition
allergies, and asthma
Term
Treat eczema with
Definition
Occlusive moisturizers such as
Crisco
Vaseline
Cetaphil
Lubriderm
Aquaphor
Eucerin
Term
Can you grease up eczema kids with olive oil?
Definition
NO
Term
When to apply hydrocortisone?
Definition
Post bath
Before moisturizer
Term
Should you use HC for longer than 1-2mo
Definition
No - looses effectiveness
Term
Are tacrolimus and pimecrolimus used any more to treat eczema?
Definition
No - skin cancer in animals
Term
Use topical antihistamine to treat eczema
Definition
no - oral
Term
Ways to treat eczema
Definition
AH
Tar
Oral Corticosteroid
Oral AB
Term
Treat STAPH bacterial skin infection orally
Definition
KEFLEX (1rst gen ceph)
Dicloxacillin (PCN)
Term
In the NICU IRT ADME talk about Metabolism and Elimination
Definition
Both are constantly increasing...Liver reaches adult level functioning by 1yr, and kidney at 6mo. Hard to dose
Term
In the NICU IRT ADME talk about Absorption
Definition
Skin is thin = increased
pH of GI changes = unpredictable
Less muscle mass= IM admin unreliable
Term
In the NICU IRT ADME talk about Distribution
Definition
More % body water = increased Vd for hydrophilic meds

Reduced plasma = increased free protein-bound drug
Term
Gestational age
Definition
conception to birth
Term
Postnatal age
Definition
birth to current day
Term
Premenstrual age
Corrected gestational age
post-conceptual age
Definition
conception to current day
Term
Risk of RDS (Resp Distress Syndrome)
Definition
<29wk Gestational age ...lungs do not finish developing until 36wks
Term
Treat RDS in the womb with
Definition
steroids giving to mom if expected to deliver early

betamethasone 12mg IM Q24hr
Term
Treat post-natal with
Definition
surfactant replacement therapy via endotracheal tube
Term
Define BDP (Broncho pulmonary dysplasia)
Definition
>21% oxygen for >28days
Term
Treat BPD
Definition
Thiazide diuretic
Albuterol
Fluticasone
Systemic crticosteroids
Term
Prevent BPD
Definition
systemic corticosteroids - DART protocol
Term
Which four antidepressants are approved for kids?
Definition
Fluoxetine - Prozac
Sertraline - zoloft
Fluvoxamine - Luvox
Escitalopram - lexapro
Term
Fluoxetine is approved to treat ______ from what age
Definition
OCD >/= 7yo
MDD >/= 8yo
Initial 5-10mg
Max 60g/day
Term
Are any psychopharmacologi agents approved for anxiety?
Definition
No
Term
Sertraline is approved to treat ______, and from what age?
Definition
OCD >/= 6yo
Intial 6-12yo 25mg
Initial 13-17yo 50mg
Max 200mg/day
Term
Fluvoxamine is approved to treat ______, and from what age?
Definition
OCD >/= 8yo
25mg start
8-11yo incr. to 200
12-17yo increase to 300
BID if >50mg day
Term
Escitalopram is approved to treat ______, and from what age?
Definition
MDD >/= 12 yo
Initial 5-10mg
Max 20mg/day
Term
Which two psychopharmacologics can treat MDD?
Definition
Fluoxetine - proac
Escitalopram - Lexapro
Term
Which of the 4 approved psychopharmacologics is not approved to treat OCD
Definition
Esctialopram - Lexapro
Term
Modality of psychopharmacologic tx?
Definition
start low; go slow; new behaviors is a problem
Term
Disruptive Mood Dysregulation Disorder
Definition
Temper update >3/wk
For >1yr
Present in 2 settings
Onset 6-10yo
Term
Dysthymia
Definition
Depressed/irritable for >1y
Term
Depression
Definition
Depressed mood or irritable + 4or more of the following symptoms
-weight loss
-decrs. appetite
-insomnia
-hypersomnia
-psychomotor agitation/retardation
-fatigue
-lack of energy
-worthlessness
-guilt
-decreased concentration
-indecisiveness
-suicidal thoughts
Term
Due these 3 things to clarify a depression Dx
Definition
1. screen for abuse/neglect
2. Asses learning difficulties
3. Assess risk for mania
Term
TADS - Treatment for adolescents w/ depression study compared
Definition
Placebo
CBT
Fluoxetine (Prozac)
Fluoxetine + CBT
Term
Results of the TADS study
Definition
Prozac + CBT = best outcome
Prozac only = 2nd best
CBT = third
Placebo = fourth but a 34.8% resp. rate
Term
Treatment of SSRI-Resistant Depression in Adolescent (TORDIA)compared:
Definition
switching to another SSRI or Venlafaxine (Trintellix) w/ or wo/ CBT
Term
Results of the TORDIA Study
Definition
-Med switch + CBT = best outcome
-Switching to venlafaxine over other SSRI had similar outcomes
-
Term
Child anxiety Multimodal study (CAMS) compared
Definition
CBT v. Sertaline (Zoloft) v. Zoloft+CBT v. Placebo
Term
Results of the CAMS Study
Definition
Sertaline (Zoloft) + CBT = best outcome
CBT only and Zoloft only had similar outcomes
Placebo much lower resp. rate
Term
Key point: SSRI resonse rate is _________, and RCTs show a ____________ placebo effect
Definition
60%; strong
Term
Kids + Paroxetine (Paxil) =
Definition
suicide
Term
Venlafaxine (Effexor) is a
Definition
SNRI
Term
Typical antidepressant onset of action
Definition
3-4wks
Term
hen selectinf AD consider these four things
Definition
1. FDA
2. Half-life
3. Once daily dosing
4. DDIs
Term
Best AD for sporadic adherence
Definition
Fluoxetine (Prozac) longest half-life
Term
Fluvoxamine id dosed
Definition
BID
Term
Floxetine did not work try...
Definition
Sertaline (Zoloft)
Term
Oh know there is a DDI! Which AD is the best choice?
Definition
Escitalopram (Lexapro) CYP450
Term
Dose increase interval for ADs is
Definition
every 4-7days until desired effect
Term
How is dosing determined
Definition
To the family's behavior goal.
Term
Which surveys are used to monitor therapeutic effect of ADs
Definition
SCARED
PHQ-9
Term
T/F dose changes as kids grow
Definition
T
Term
T/F When switching ADs do so abruptly
Definition
F - taper/increase over a few weeks with the EXCEPTION of Fluoxetine b/c of long half-life.
Term
AD Dose adjustments are made how often?
Definition
Annually
Term
Monitoring AD use
Definition
Quarterly
Term
T/F Fluoxetine (Prozac) can be discontinued abruptly
Definition
T
Term
Bupropion (Wellbutrin) is choice 5 of 4 ADs for kids
Definition
True; 5 of 4 b/c not FDA approved
Term
T/F One problematic side effect of bupropion (Wellbutrin) is seizures?
Definition
True
Term
Wellbutrin is a powerhouse combo b/c it treats what two thngs
Definition
Depression + ADHD
Not FDA approved in peds
Term
T/F Escitalopram (Lexapro) is more effective than Citalopram (Celexa)
Definition
F equal...both SSRI... Celexa not FDA approved in peds
Term
Venalfaxine offers similar efficacy to the approved four ADs, but has_______
Definition
Increased side effect profile
not fda approved in peds
Term
Mirtazapine (Remeron) most bothersome side effect is
Definition
Weight gain
Not FDA approved for peds
Term
T/F CBT has a specified 16wk path?
Definition
T
Term
4 prescribing principles of ADs
Definition
1. prescribe only if Dx
2. Evidence based (FDA approved); avoid outlier Rx-ing (no resp. coul be adherence)
3. Plan to track benefit/side effects
4. Monitor for adherence
5. Always screen for trauma
Term
FDA recommended monitoring plan for ADs
Definition
Week 1-4: weekly
Week 5-8: biweekly
Week9-forever: every 12wks
Term
6 approved antipsychotics:
Definition
risperidone, aripipazole, paliperidone, olanzapine, asenapine, quetiapine
Term
Side effect of Antipsychotics
Definition
Weight gain
Type 2 DM
Term
Treat absence seizures
Definition
Valproic acid
Term
Describe absence seizures
Definition
spells of staring into space; pts commonly have tonic-clonic seizures as well
Term
Describe febrile seizure
Definition
Siezure when temp exceeds 100.4F
FH common
No epilepsy
Term
Treat Febrile seizures
Definition
Alternate Tylenol/Ibuprofren
Aggessive dosing (15mg/kg Tylenol | 10mg/kg Ibuprofren)
Term
Define tonic-clonic seizures
Definition
onset 1-2hrs after wakening
Term
Treat tonic-clonic non-pharm
Definition
Lifetime pharm treatment req. and also
Maintain low stress
consistent sleep
avoid alcohol
be wary of hormonal changes
Term
Treat tonic-cloinc seizures
Definition
Carbamezapine (Carbatrol; Tegretol) (self-inducer)

Phenobarbital (neonate choice; b/c drowsy)

Phenytoin (Dilantin) (satruable; jiggling eye balls; lots of gums)

Topiramide (Topamax) (renal stones; no monitoring)
Term
Treat Epilepsy
Definition
Levetiracetam (Keppra)(dose aggressively; no monitoring)

Clobazam (Onfi)(benzo; sedation; 1rst 2nd line tx)
Gabapentin(Neurontin)(sedation)

Zoniamide (Zonegran)(Sulfonamide)
Term
Treat epilepsy; INFINTILE SPASMS
Definition
Vigabatrin (sabril)(vision probs)
Term
Worried about DDIs with which seizure agents
Definition
Crbamazepine
Oxycarb...
Phenobarbital
Phenytoin
Vigabatrin
Valproic Acid
Term
Seizure meds renally eliminated
Definition
Gaba
Levetiraceetam
Topiramate
Term
What is unique about phenytoin metabolism?
Definition
Non-linear kinetics
Term
Which Bacterial skin infection impetigo is most common
Definition
Impetigo most common, but
Bullous most common in neonate (
Term
Treat bacterial skin infection; strep
Definition
Qunilone (Floxacin)
Term
Treat Strep and Staph bacterial skin infections with
Definition
Vanco (MRSA)
Clindamycin (MRSA sometimes)
Term
When to treat bacterial skin infection systemically?
Definition
Family/daycare outbreak
Deep tissue penetration
Term
Treat Seborrheic Dermatitis
Definition
Dandruff shampoo
Scrub scalp with tooth brush
Be careful of EYEs
Term
Topical v. Systemic treatment of ring worm
Definition
If on head systemic otherwise topical
Term
Which agent to treat ringworm systemically
Definition
Griseofulvin - with a FATTY meal
2nd line = Fluconazole
Term
Lice treatment Nix or rid
Definition
Nix
Term
Rid is used in ______ hair; while Nix is used in _ wet hair
Definition
dry; wet
Term
IRT age; Rid can be used on _______ while Nix is used on __________
Definition
Rid >2yo
Nix >2mo old
Term
T/F Nix/Rid requires to tx to be effective?
Definition
YES
Term
New Lice treatments (Sklice, Ovide, Natroba) can kill lice and nits; AKA one tx
Definition
T
Term
IRT scabies; treat all family members or individuals?
Definition
All
Term
T/F scabies is the gift that keeps giving for 7 additional days after tx
Definition
T; until skin sluffs
Term
Scabies tx agents
Definition
Pernetherin
Lindane (No infants)
Crotalmiton
Sulfur (pregnant/< 2mo old)
Term
t/F If there is a scabies outbreak wash sheets bag stuffed animals...
Definition
T
Term
Preemie/Neonate skin lesions that are not treated
Definition
Neonatal acne (gift from mom)
Milia (white spots)
Mongollian spots (blue)
Term
Back to the NICU; Define AOP Apnea of Prematurity
Definition
Common if birth weight <1kg
Stop breathing for 20secs
Resolves at 36wk PMA
Term
T/F AOP is a Dx of exclusion
Definition
T - Rule out brain stem prob and obstructions
Term
Treat AOP
Definition
By touching baby (no joke)
Caffeine (goal 8-20; 50 is tox)
Term
Define PDA (patent Ductus Arteriosus
Definition
Passage connectin pulmonary artery to descending aorta does not close
Term
5 ways to Tx PDA
Definition
1. Fluid restriction (reduce pressure)
2. Prophylactic expose all to NSAID
3. Presymptomatic ECHO
4. Symptomatic/resue (MOST COMMON)
5. Surgically
Term
Pharm treatment of PDA
Definition
IV indomethacin
IV Ibuprofren
IV Acetaminophen (maybe)
Term
Define NAS Neonatal Abstinence Syndrome)
Definition
Intrauterine exposure to opioids
Term
Screen for NAS
Definition
Urine/meconium/hair/umbilical cord
Term
Symptoms of NAS
Definition
Sneezing/congestion
Excessive sucking, poor feeding, _VD
Tremor; high pitched cry poor sleep
Term
You can score NAS using what survey
Definition
Finnegan
Term
Treat NAS
Definition
Kanagroo care (baby on chest)
Pharm varies by institution
-Morphine taper
-clonidine if weening is not woking
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