Peds/neo Pharm - Exam 1

Front 1

Community Acquired Pneumonia

Back 1

First Line - Macrolide: azithromycin (kid safe, great GN, some GP coverage)

Second Line - Fluoroquinolones: levofloxacin (broad spectrum GN & GP but NOT for <16yo - affects collagen development)

Front 2

Chlamydia

Back 2

First line - Macrolide: azithromycin

Second line - Tetracycline,

Third - chloramphenicol

Front 3

Hospital Aquired Pneumonia

Back 3

1) draw cultures - treat broad initially, then specify to the bug. - use multiples! aim for syngeristic choices

2) last ditch effort: Telavancin (vanc derivative, only approved for HAP).

Front 4

Pseudomonas (in CF pts)

Back 4

First Line: Aminoglycoside/Beta Lactam combo

if Renal probs: fluoroquinolone and beta lactam combo

Front 5

Rocky Mountain Spotted Fever

Back 5

First Line: tetracyclines (doxy)
Second Line: Chloramphenicol

Front 6

Strep (A or B)

Back 6

1) Penecillin (amoxacillin)
2) if pen allergies, try Macrolide (azithromycin)

Front 7

Meningitis

Back 7

Prophylaxis: fluoroquinolone - ciprofloxacin
First Line CSF: Ceftazidime (3rd gen Cephalosporin)
Second Line CSF: Chloramphenicol (if beta lactam allergies)

Front 8

c-diff

Back 8

First line: metronidazole (flagyl) - anti-anaerobe
(NOT clinda which often leads to c-diff)

Front 9

TB

Back 9

First Line: Rifampin (potent CYP450 inhib)

Second Line: fluoroquinolone (ciprofloxacin)

Front 10

Syphilis

Back 10

First Line: Pen G w/ benzathine (IM ONLY)

Second Line: Tetracycline (doxy)

Third Line: Chloramphenicol

Front 11

VRE

Back 11

First Line: streptogramins - quin/dalfo - NOT approved for <16

Second Line: Oxazolidinones - Linezolid (AE myelo and BM suppression - anemia)

Front 12

Dog/Human bites

Back 12

Augmentin

Front 13

Neutropoenic fever

Back 13

First line: Aminoglycosides

Front 14

Bacterial Vaginosis & Trichomonas

Back 14

anti-anaerobes - metronidazole, or clinda

Front 15

Impetigo

Back 15

Pleuromutilin - retapamulin (topical only)

Front 16

Aminoglycosides

Back 16

gent, tobra
concentration dependent
GRAM NEG DRUG OF CHOICE (broad spectrum, use for CF, first line neut fever)
GRAM POS - some effect - when combo w/ B lactam = synergistic

low cost
AE: oto&nephrotoxic! plus gent prolongs effects of paralytics

Front 17

Anti-Anaerobes

Back 17

Clindamycin - prone to c-diff, GP/GN anaerobes, plus aerobic GPC but very little aerobic GN coverage

metronidazole (Flagyl) - GP&GN anaerobes, H pylori, protozoa *FIRST LINE FOR C-diff*

good for BV & Trichomonas

Front 18

Beta-Lactams: Penicillins

time dependent, broad spectrum

Back 18

*cross sensitive w/ cephalosporins and carbapenems
Pen G = IV, Pen V = PO
Pen G w/ Benzathine or Procaine is IM ONLY!!!

Front 19

Beta-Lactamase

Back 19

enzyme - makes bacteria pen resistant
can give pen w/ beta-lactamase inhibitor

Front 20

Beta-Lactamase Inhibitor

Back 20

Augmentin = amox/clavulanic
Zosyn = pip/tazobactam
Timentin = tic/clabulanic

- no abx effect to inhibitor
- pen w/ inhibitor = drug of choice for dog/human bites
- A/E = hypersensitivity & diarrhea (esp. diarrhea w/ Augmentin)

Front 21

Beta-Lactams: Carbapenems

Back 21

HEAVY HITTERS: Meropenem, imipenem
broadest spectrum abx: GP&GN aerobes, most GN anaerobes
AE: NEUROTOXICITY - seizures (esp. meropenem)

Front 22

Beta-Lactams: Cephalosporins

Back 22

4 gens - 1st and 2nd w/ more GP effect, 3rd and 4th w/ more GN, less GP

3rd & 4th: cross CSF, and good for pseudomonas
Ceftazidime = 3rd gen, for bacterial meningitis, also great for pseudomonas BUT AE= seizures!

Cefepime = 4th gen, also CSF crossing and pseudomonas effective

Front 23

Chloramphenicol

Back 23

concentration dependent
broad spec GP&GN (NOT pseudomonas), anaerobes, spirochetes, chlamydia
*backup: - crosses CSF - for meningitis in PCN allergic pts
- RMSF/typhus in tetrachycline allergic pts
AE: fatal aplastic anemia, BM suppression, Gray Baby syndrome, optic neuritis,

Front 24

Fluoroquinolones

Back 24

Levofloxacin, Ciprofloxacin
Concentration dependent
broad spectrum GP, GN, UTI's, STD's, skin, GI, resp inf.
AE: NOT for <16yo - arthropathy (ruptured achilles) + also seizures, RF & LF
Cipro = prophylaxis for meningitis
HAP, or combo w/ Beta Lactams for CF pseudomonas

Front 25

Macrolides

Back 25

Azithromycin, Erythromycin (Azyth w/ more GN coverage)
potent CYP450 inhib (watch levels of other drugs)
AE: Gi pain, N/V
Low [ ] = static, High [ ] = cidal
GP&GN aerobes
mycoplasma (first line CAP), also chlamydia
*in suspension - shake, do not chew crystals*

Front 26

Monobactams

Back 26

Azactam/aztreonam - cross-reactive w/ pens & cephs b/c of structure
NO GP coverage - no anaerobes
GREAT for GN aerobes (pseudomonas, serratia, citrobacter)
-sub for gent in CF w/ renal dz
-good for UTI's and Resp. infections

Front 27

Oxazolidinones

Back 27

Zyvox/linezolid (IV or PO)
EXPENSIVE!!!
Great for GP, esp MRSA, VRE, pen res. strep
AE: myelosup., anemia w/ mitochondrial effects (chloramphenicol toxicity)
- LAST DITCH EFFORT! use only w/ ID guiding!

Front 28

Pleuromutilins

Back 28

retapamulin - topical only - for impetigo, staph or grp A strep

Front 29

Rifampin

Back 29

VERY active against GPC!
*FIRST LINE FOR TB!!!* + good w/ vanc for MRSA
potent CYP450 inhib

warn families: turns body fluids red!

Front 30

Streptogramins

Back 30

Quinupristin & Dalfopristin
either = static, together in combo = cidal
GP aerobes, anaerobes, some GN
Great for VRE
AE: NOT for <16yo d/t unknown effect on growth, joint S/E

Front 31

Sulfonamides

Back 31

sulfa+trimethoprim = Bactrim or Septra
Folic acid inhibitor - NOT for PREGNANT pts or HIV+ (increased GI effects in HIV pts)
GP & GN orgs except pseudo & grp A strep
also, e. coli, UTI's & autoimmune dz (UC, RA)
AE: inhib metab of many drugs - warfarin & phenytoin!
Rash, fever, GI

Front 32

Tetracyclines

Back 32

suffix: "cycline" (tetracycline, doxycycline)
-static, great drug for RMSF, chlamydia
AE: - NOT FOR <8yo due to perm. dental discoloration
- chelating complexes (not w/ antacids, iron, sucralfate, dairy)

Front 33

Vancomycin

Back 33

narrow spectrum GN aerobes & anerobes, mostly covers GP
-Red man's - watch for - r/t histamine release
- ototoxic in high levels & nephrotoxic w/ renal dz or in combo w/ other nephrotoxic agents

Front 34

Televancin

Back 34

new vanc derivative
limited use - last ditch effort if vanc doesn't work
-for hospital acquired pneumonia when nothing else available

Front 35

Formulary

Back 35

collection of formulae - drugs, scripts etc. - formally arranged

Front 36

Compounding pharmacy

Back 36

specific prep to the pt (for unique route, dose or application)

Front 37

excipient

Back 37

filler/bulking agent, distributed evenly to dilute potent drug & allow precise dosing

Front 38

vehicle

Back 38

ingredient w/ no therapeutic value, convey's the active ingredient

Front 39

Black Box Warning

Back 39

highest level of warning set by FDA

Front 40

Off-label use

Back 40

legal, any application for an age group or purpose the drug was not originally developed for

Front 41

narrow therapeutic index

Back 41

small range btwn therapeutic and toxic

Front 42

Additive vs Synergistic effects

Back 42

additive: 1+1=2
Synergistic: 1+1=4

Front 43

steady state

Back 43

reached after 5 half lives, but generally test levels after 3 half lives in hospital

Front 44

volume of distribution

Back 44

Vd = total amt in body / plasma concentration
development effects Vd (ex: hydrophylic compounds = altered absorption in newborn due to increased proportion of total body and extracellular water compared to adults. Changes in percentage of total body fat or differences in drug binding across age groups also have an effect on volume of distribution

Front 45

loading dose

Back 45

= (desired [ ] - measured [ ] ) x Vd x Wt

Front 46

area under the curve

Back 46

[ ] / time curve

Front 47

enterohepatic recirculation

Back 47

cycles back through - bile to int, to lower tract, reabsorbed and back through before excretion

Front 48

bioavailability

Back 48

proportion absorbed and delivered to site of action

Front 49

free drug

Back 49

is useful drug! (bound is NOT)
-smaller free drugs generally metabolized renaly, larger molecules in the liver

Front 50

First Pass Effect

Back 50

PO route - requires much higher dose due to large amt of med lost/excreted in GI tract

Front 51

Cytrochrome P450

Back 51

family of oxidative enzymes, part of body's detoxification system - individual variations in CYP genes have major effect on increasing or reducing drug metabolism

Front 52

CYP450 Induction

Back 52

happens naturally w/ prolonged exposure - increased CYP450 enzyme causes increased metabolism of the drug

Front 53

CYP450 Inhibition

Back 53

limits/reduces CYP450 enzyme metabolism of the drug (due to presence of another chemical, disease process or injury).

Front 54

zero-order kinetics

Back 54

saturation kinetics - NOT proportional to amt of drug in body (formation of substrate is linear). Recommend a pharmacist to help with these orders!

Front 55

first-order kinetics

Back 55

enzymatic rxn is proportional to the amount in the body - so calculations are more manageable!