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127 Cards in this Set
- Front
- Back
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Why can't you give Bactrim to infants less than 2 months of age?
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Sulfonamides displace bilirubin off their receptors allowing an increase in free bilirubin leading to neonatal encephalopathy
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What causes Gray Baby Syndrome?
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Administration of chloramphenicol for management of H.Flu Meningitis. It accumulates because neonates have impaired conjugation, so drug accumulates in free form
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What causes Gasping Baby Syndrome?
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Benzyl alcohol because of immature glycine conjugation leading to accumulation of benzoic acid metabolite. Glycine makes drug water soluble
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What is therapeutic index?
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A ratio between effective dose and lethal dose in 50% of patients population
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What factors affect absorption in the pediatric population?
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An increase in gastric pH, decreased gastric and intestinal motility, increased gastric and intestinal motility, and decreased bile production
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How does an increased pH affect absorption of basic drugs like Ampicillin?
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It increases bioavailability by making it nonionized and thus, active
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How does an increased pH affect absorption of acidic drugs like Phenobarbital?
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It decreases bioavailability by ionization, thus inactivation
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How does decreased bile acid production affect absorption of fat soluble drugs?
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It decreases bioavailability because you are unable to absorb
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What is volume of distribution?
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It is a mathematically derived volume to "explain" observed blood concentrations for a given dose. How much is dissolved in the "bag of water"?
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What is the formula for volume of distribution?
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Vd = Dose/blood level (100mg/5mg/L = 20mg/L Vd
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As you gain muscle mass, do you need more or less drug if they are water soluble?
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Less drug because you have less water
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Why do neonates have a lower Vd for highly lipid soluble drugs than adults?
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They have less body fat than adults
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What two factors increase Vd in neonates in terms of distribution?
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An increase in total body water/extracellular water and a decrease in albumin concentration
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What is metabolism responsible for?
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Pro-drug conversion and active drug elimination
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Theophylline, Phenobarbital, Phenytoin, and Diazepam are affected by what impaired function in the liver of premature neonates?
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Oxidation
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Is glucuronidation developed in premature neonates?
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No
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Besides hepatic, what is another site of drug elimination?
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Lungs
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What is elimination half-life?
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The period of time needed to eliminate 1/2 of the drug or blood concentrations by 1/2
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How many half-lives are required for elimination?
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5
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What clinical effect is a good indicator of GFR?
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Urine output of 1-2ml/kg/hr
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When does glomerular filtration develop in the neonate?
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30 days
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When does tubular secretion develop in the neonate?
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6 months
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What is creatinine clearance used for?
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To guide renal dose adjustments and to measure GFR
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How is creatinine clearance expressed?
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ml/min/1.73m2
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What is the gold standard of measuring GFR?
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Creatinine clearance
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When is a creatinine clearance not useful?
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In patients with changing renal function or those who are emaciated/malnourished
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When calculating drugs in pediatrics, should your calculation ever exceed the typical adult dose?
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No
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What are the two biggest absorption problems in terms of drug interactions?
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Inhibition of first-pass metabolism or binding in the gut
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If you inhibit first-pass metabolism, what happens to drug concentrations?
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They increase. Example: Grapefruit juice inhibits CYP450 3A4 to increase statin concentrations
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What happens if you have drug binding in the gut?
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Delayed absorption. Example: Antacids and oral contraceptives
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What is the function of th p-glycoprotein?
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It pumps drugs out of cells
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What are some common drugs that inhibit p-glycoprotein?
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Cyclosporine, ketonazole, quinidine
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What are some drug interactions of distribution?
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Protein binding alterations and displacement from another binding site
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What are the main functions of metabolism?
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Increase water solubility and facilitate renal excretion
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What does phase 1 metabolism accomplish?
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Oxidative metabolism via CYP450
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What does phase 2 metabolism accomplish?
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Conjugation of a drug to a water soluble form for excretion
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If you are a CYP450 inducer, what do you do to the CYP450 enzyme?
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You increase its activity and thus the elimination of drugs
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What is a famous example of a CYP inducer?
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Rifampin
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If you are a CYP inhibitor, what do you do to the CYP450 enzyme?
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You decrease the activity of the enzyme and decrease the elimination of drugs
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What happens when you give erytromycin with Seldane (terfenadine)?
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Erythromycin inhibits CYP450 and increases blood levels of Seldane causing Torsades de Pointes (QTc prolongation)
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What is the goal of vaccinations?
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To allow children to develop an immune response without the symptoms of infection or disease
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What is the leading cause of liver cancer?
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Hepatitis B
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What population responds poorly to the Hepatitis B vaccine?
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Infants less than 2000g
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Is rotavirus a live or inactive vaccine?
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Live
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What route is the rotavirus vaccine given?
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Orally
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When can rotavirus vaccine first be given?
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Before 12 weeks of age
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When must the third dose of rotavirus vaccine be completed by?
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Before 8 months or 32 weeks of age
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What type of vaccine is Diphtheria?
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Toxoid
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What occurs clinically with Diphtheria?
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Thick membrane formation on the throat making it difficult to breathe or swallow
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How does tetanus invade the body?
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Through cuts in the skin
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What type of vaccine is tetanus?
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Toxoid
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Who are the vectors for pertussis?
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Adolescents
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When is pertussis most severe?
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In infants less than one year of one age
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What was the leading cause of meningitis until vaccines were made available?
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Haemophilus Influenza type B
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What part of the brain does Hib disease affect?
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The lining of the brain
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How many doses are needed for Hib B vaccines?
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3
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What vaccine is given to children less than 2 years of age for pneumococcal disease?
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Prevnar
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What vaccine is given to children older than 2 years of age for pneumococcal disease?
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Pneumovax
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Should you start pneumococcal vaccine early or later?
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Later because of age-related immunity
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What target groups should receive the flu vaccine?
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Elderly greater than 65, healthy people 6mo-5 years, health care workers, immunocompromised, long-term health care facilities, pregnancy greater than first trimester
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Why can't you give Flumist to populations of elderly, children less than 2 years of age, pregnancy, immunocompromised, or those with egg allergies?
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It is a live vaccine
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Why do we vaccinate for measles?
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To protect pregnant women from miscarriage and premature birth
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What does mumps do to postpubertal males?
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It causes orchitis-swelling of the testes
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What is congenital rubella syndrome?
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Blindness, deafness, heart defects, mental retardation, and death if mother has it
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Measles, mumps, rubella, and varicella are live, attenuated viruses. True or false?
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True
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Who needs the meningococcal vaccine?
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Teenagers ages 11-18
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What is DTap vaccine for?
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Pertussis and tetanus
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Why vaccinate human papillovirus?
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To prevent cancer
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What questions should be asked before administering a vaccine?
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Allergies, pregnancy, sick, how sick, immunocompromised, previous adverse reaction to vaccines, previous transfusions to blood or IVIG?
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What are some valid contraindications to vaccines?
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Allergies, encephalopathy after pertussis vaccine, and moderate to severe illness
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What vaccines are contraindicated in the immunosuppressed?
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Live vaccines...MMR and varicella
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What is minimum inhibitory concentration (MIC)?
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The minimum amount of antibiotic required to prevent visible growth of bacteria
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What does bacteriostatic mean?
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It inhibits growth
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What does bacterialcidal mean?
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Causes bacterial death
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What does concentration dependent killing mean?
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The bigger the dose, the bigger the kill
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What drug classes rely on concentration dependent killing?
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Aminoglycosides, fluoroquinolones, daptomycin, and flagyl
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What is time dependent killing?
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How frequently do you have to give the drug to have effective kill
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If you have a type I hypersensitivity to PCN, you will have allergies to all beta-lactams except?
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Aztreonam
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What drugs are effective in the treatment of MRSA?
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Oxacillin, nafcillin, vancomycin, daptomycin, and linezolid
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What pathogen is effectively treated by PCN?
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Streptococcus
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What drug is superior in the treatment of Pseudomonas?
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Pipercillin
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What B-lactamase inhibitor combo kills Pseudomonas?
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Zosyn
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How do you convert Ampicillin IV to PO?
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Amoxicillin
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How do you convert oxacillin IV to PO?
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Dicloxacillin but it tastes awful so cephalexin is used
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How do you convert Unasyn IV to PO?
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Augmentin
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As you increase cephalosporin generations, what do you lose in terms of coverage?
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Gram positive coverage
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What do you gain by increasing cephalosporin generations?
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Gram negative coverage
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What 2 cephalosporins (3rd) have the best activity against gram positive coverage?
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Ceftriaxone and cefotaxime
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How do you convert Cefazolin IV to PO?
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Cephalexin
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How do you convert Cefoxitin IV to PO?
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Cefuroxime axetil and Flagyl
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How do you convert Ceftriaxone IV to PO?
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Cefdiner or Cefixime
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How do you convert Ceftazidime or Cefepime IV to PO in the treatment of Pseudomonas?
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Cipro
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Does Aztreonam cover gram positive bacteria?
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No, you have to add gram positive coverage
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What adverse effects are seen by high dose PCN and carbapenems?
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Seizures
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What other adverse effects are seen by beta-lactams?
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Immunosuppression, GI, interstitial nephritis
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What fluoroquinolone is superior for community-acquired MRSA?
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Moxifloxicin
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What is Moxifloxacin notorious for?
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QT Prolongation
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What macrolide is used for GI motility?
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Erythromycin
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What two macrolides are strong inhibitors of CYP450?
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Erythromycin and Clarithromycin
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Why don't we dose for obesity with Aminoglycosides?
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They are hydrophilic
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What adverse effects are seen with aminoglycosides?
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Ototoxicity and nephrotoxicity
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Do you give Vancomycin IV or PO for C. Difficile?
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PO
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What adverse effect is seen with Linezolid?
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Thrombocytopenia
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What does Linezolid inhibit?
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MAO
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What form of MRSA cannot be treated with Daptomycin?
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MRSA PNA
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Clindamycin is indicated for what type of MRSA?
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Community acquired
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What is an adverse effect of Clindamycin?
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Pseudomembranous colitis
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What MRSA is treated by Bactrim?
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Community acquired
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What is the leading cause of acquired heart disease in US children?
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Kawasaki's Disease
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What are some "classic" signs of Kawasaki's Disease?
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Fever lasting more than 5 days, conjunctival injection, rash, mucous membrane changes, peripheral extremity changes, and cervical lymphadenopathy
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Why do we give Aspirin to children with Kawasaki's Disease?
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Increased platelet count
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What are the goals of therapy for Kawasaki's Disease?
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Reduce cardiovascular complications, decrease platelet aggregation, reduce systemic inflammation
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What are the treatments for Kawasaki's Disease?
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IVIG 2g/kg over 12 hours and Aspirin 80-100mg/kg/day
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How does Abciximab (Reopro) work?
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It binds the GPIIb/IIIa receptors...basically coating the platelets so that they cannot aggregate
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Should your platelet count drop on Abciximab (Reopro)?
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No, because you are simply "coating" the platelet.
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What is an adverse reaction to Abciximab that can occur 2 hours after infusion?
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Acute thrombocytopenia
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What are the new AHA recommendations for endocarditis?
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There should be a "shift away" from dental procedures and a shift towards access to oral health care
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What high-risk patients should receive endocarditis antibiotic therapy?
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History of endocarditis, prosthetic heart valves, heart transplant patients with valvulopathy, and some forms of congenital heart disease
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What bacteria is usually responsible for endocarditis?
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Streptococcal viridans
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What is the antibiotic regimen for endocarditis?
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Amoxicillin 50mg/kg (2G) PO 30-60 minutes before a procedure
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If your patient with endocarditis has an "immediate-type" allergic reaction to PCN or beta-lactams, what should you do?
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Switch to an antibiotic from another class
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What are the "classic" signs of rheumatic fever?
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Polyarthritis, carditis, chorea, erythema marginatum, and subcutaneous nodules
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What is primary prevention of rheumatic fever?
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Benzathine PCN IM 0.6 MU IM less than 27kg or 1.2 MU IM greater than 27 kg. Also, Pen VK
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What is the most common cause of acute pharyngitis?
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Group A beta-hemolytic strep
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What is the "gold standard" for diagnosing strep pharyngitis?
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Throat culture
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What are the first line treatments for strep pharyngitis?
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Pen VK; Amoxicillin, Benzathine Pen G, Erythromycin
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What antibiotic are NOT recommended for strep pharyngitis?
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Sulfonamides, bactrim, fluoroquinolones, and tetracyclines
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