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My Peds Prep > Pharm/Pain > Flashcards

Pharm/Pain Flashcards

1
Q

What is volume of distribution?

A

Theoretical volume in the body (fluids and tissues) in which the drug may be found after absorption

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2
Q

What is the concentration of the drug equal to?

A

Amount administered (dose)/The volume of distribution (Vd)

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3
Q

What is clearance?

A

Fraction of the drug that is cleared from the body in any given unit of time

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4
Q

Why is clearance important

A

Dictates how much of drug must be given and how often to maintain desired concentration in the body

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5
Q

What is bioavailability?

A

Amount of administered drug that actually reaches the blood

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6
Q

What 2 classes of drug decrease the bioavailability of calcium, magnesium, iron, and aluminum compounds?

A

Cephalosporins and Fluoroquinolones

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7
Q

If a drug is given IV, what is the bioavailability?

A

100%

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8
Q

If a drug is given PO, sublingual, PR, IM, SQ, ect… what 2 things determine its bioavailability?

A
  1. Host factors: Diet, illness, organ function

2. Drug factors: Whole, crushed, solution, injected

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9
Q

What are 2 reasons a drug concentraiton might be low?

A
  1. Bioavailability is low

2. Clearance is high

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10
Q

What is a lipophilic agent?

A

Bioavailability is enhanced by fatty foods

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11
Q

Name 2 drugs that are lopophilic and should be taken with fatty foods

A
  1. Istretinoin

2. Griseofulvin

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12
Q

What is half life?

A

The amount of time required for the concentration of the drug to decrease by half

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13
Q

After 1 half life, how much of the drug remains?

A

50%

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14
Q

After 2 half life, how much of the drug remains?

A

25%

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15
Q

After 3 half life, how much of the drug remains?

A

12.5%

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16
Q

After 4 half life, how much of the drug remains?

A

6.25%

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17
Q

After 5 half life, how much of the drug remains?

A

3.125%

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18
Q

After how many half-lives is approximately 97% of a drug cleared from the body?

A

5

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19
Q

What is steady state?

A

When a drug is administered at a constant interval and accumulates in the body so the amount in equals the amount out

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20
Q

Drug accumulation follows the same pattern as what?

A

Half-life clearance

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21
Q

After 5 half lives a drug reaches what % of steady state?

A

97%

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22
Q

When a dose or dosing interval changes, how many half lives are required to reach a new steady state?

A

5

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23
Q

What is absorption?

A

The progression of the drug from site of administration to the target sites

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24
Q

Name 3 reasons drugs administered PO are different in kids than adults

A
  1. Neonates and young infants have elevated gastric pH
  2. Neonates and young infants have delayed gastric emptying
  3. Proteins that are required for conversion from a pro-drug to a drug, and for drug transport, are expressed differently at different ages
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25
Q

What are some things which can change absorption or concentration of a drug?

A
  1. Crushing tabs into suspension
  2. Flavoring
  3. Mixing into formula or juice
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26
Q

What is distribution?

A

Where the drug disperses after it is absorbed into systemic circulation

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27
Q

What are two things that cause different distribution of drugs in kids (depending on whether they are hydrophilic or lipophilic)?

A
  1. Higher percentage of total body water

2. Lower body fat stores

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28
Q

What are 3 things which can affect the distribution of drugs?

A
  1. Serum levels of albumin
  2. Serum levels of other binding proteins
  3. Transporters
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29
Q

What is the primary organ for drug metabolism?

A

Liver

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30
Q

Name other organs which have drug-metabolizing enzymes besides the liver

A

Skin, kidney, GI tract, lungs

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31
Q

What are 3 drugs you can’t have dairy with because they are chelated by dairy products?

A
  1. Tetracycline
  2. Doxycycline
  3. Ciprofloxacin
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32
Q

What happens if you take an antiacid with an iron supplement?

A

It binds to the iron and prevents absorption increasing its elimination in the GI tract

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33
Q

How is phenytoin distributed?

A

Bound to plasma proteins

34
Q

What happens if you give sulfa drugs with phenytoin?

A

Sulfa causes phenytoin to unbind and increases potential toxicity and elimination

35
Q

What is involved in the first phase of liver metabolism?

A

CYPs (oxidases)

-Different CYP’s become active at different ages and drug metabolism changes depending on level of each CYP

36
Q

What are some concomitant drugs/herbal remedies which can affect metabolism of certain drugs?

A

St. John’s Wort, Ginkgo Biloba, Milk Thistle (Mom may be taking these and transferring via breast milk)

37
Q

Erythromycin, ciprofloxacin, cimetidine, and omepraxole have what effect on hepatic enzymatic systems?

A

Inhibitory

38
Q

Rifampin, phenobarbital, carbamazepine, and phenytoin have what effect on hepatic enzymatic systems?

A

Inducers

39
Q

What is the impact of drugs which have an inhibitory effect on hepatic enzymatic systems?

A

Reduces theophylline, codeine, beta blockers, antidepressants, corticosteroids, warfarin, and metronidazole metabolism-> Increased bioavailability and toxicity

40
Q

What is the effect of drugs that are inducers of hepatic enzymatic systems?

A

Causes other drugs metabolized by the same enzyme to be eliminated quicker requiring higher dosing to maintain a desired concentration

41
Q

What two organs are responsible for most drug excretion?

A
  1. Liver (bile)

2. Kidney (urine)

42
Q

What is excretion dependent on?

A

The ability of transporters to get the drug from the circulation into the bile or urine for excretion

(If one drug inhibits a transporter, then another drug can’t be transported and will accumulate to toxic levels in body)

43
Q

What is the functional expression of transporters dependent on?

A
  1. Age
  2. Liver injury/disease
  3. Kidney injury/disease
44
Q

What should you consider if they mention liver or kidney disease in a child?

A

Potential for drug toxicity

45
Q

Why must levels of drugs be monitored so closely in infants?

A

Elimination is unpredictable

46
Q

True or False: Medications that are eliminated by the liver won’t be impacted in a patient with renal disease

A

True (same vice versa)

47
Q

What two drugs can inhibit renal metabolism of digoxin resulting in elevated levels?

A
  1. Quinidine

2. Amiodarone

48
Q

Name 3 drugs used for SVT and HTN

A
  1. Atenolol
  2. Metoprolol
  3. Propranolol
49
Q

What are 3 systems affected by beta blockers?

A
  1. CNS
  2. Smooth muscle
  3. Cardiac
50
Q

Name 7 side effects of beta blockers

A
  1. Difficulty sleeping
  2. Fatigue
  3. Bronchospasm
  4. Cold extremities
  5. Bradycardia
  6. Heart block
  7. Sexual dysfunction
51
Q

What is the most likely explanation in a teenager on meds who has variable effects or unexpected drug levels?

A

Poor compliance

52
Q

What condition can beta blockers exacerbate?

A

Asthma

53
Q

What type of medication is acetazolamide?

A

Carbonic anhydrase inhibitor (CAI)

54
Q

How do carbonic anhydrase inhibitors work?

A

They prevent the reuptake of bicarbonate in the proximal tubule

55
Q

What do carbonic anhydrase inhibitors do to the urine?

A

Alkalinize it

56
Q

What electrolyte abnormality does carbonic anhydrase inhibitors cause?

A

Metabolic acidosis

57
Q

What electrolytes do loop diuretics block the absorption of?

A

Na and Cl

58
Q

What electrolytes do loop diuretics result in the wasting of?

A

Calcium, K, and H

59
Q

What electrolyte abnormality do loops diuretics result in?

A

Hypochloremic, hypokalemic, metabolic alkalosis

60
Q

Name 2 dose-related side effects of furosemide

A
  1. Ototoxicity

2. Renal toxicity

61
Q

Name 2 thiazide diuretics

A
  1. Hydrochlorothiazide

2. Metolazone

62
Q

Which diuretic causes hyponatremia and hypochloremia (Na and Cl are lost at the distal tubule)?

A

Thiazide

63
Q

Which diuretic causes contraction alkalosis by causing water loss at the distal tubule?

A

Thiazide

64
Q

With thiazide diuretics, the chloride anions that are lost at the distal tubule are replaced by what?

A

Bicarb

65
Q

What electrolyte derangement do thiazide diuretics cause?

A

Metabolic alkalosis

66
Q

What type of diuretic is mannitol?

A

Osmotic

67
Q

How does mannitol work?

A

Keeps water in the tubules through osmotic pressure resulting in an osmotic diuresis

*Pulls fluid from IC to EC space and blocks fluid reabsorption at kidney level, further decreasing IC fluid levels

68
Q

What kind of acid/base effect does Mannitol have?

A

None

69
Q

What effect does spironolactone have on Na and K?

A

Na is excreted, K is retained (K sparing)

70
Q

What acid/base derangement can spironolactone lead to?

A

Metabolic acidosis

71
Q

Name 3 negative effects of ASA

A
  1. Reye syndrome
  2. GI irritation (most likely)
  3. Tinnitus (dose-related)
72
Q

What was minimal sedation formerly known as?

A

Anxiolysis

73
Q

What describes a drug-induced relief of apprehension with minimal effect on perception and sensorium?

A

Minimal sedation (anxiolysis)

74
Q

What was moderate sedation formerly known as?

A

Conscious sedation

75
Q

What type of sedation is it when the patient retains the ability to respond normally to verbal commands and CV functions are not affected?

A

Moderate sedation (conscious sedation)

76
Q

What is patient response in deep sedation?

A

Responds to repeated or painful stimuli

77
Q

What happens to the protective airway reflexes in deep sedation?

A

Partial or complete loss (need assistance with airway protection

78
Q

What sedation level describes a person who is unarousable with any stimulation and has complete loss of consciousness and airway protective reflexes?

A

General anesthesia

79
Q

What must be monitored during general anesthesia?

A

Vitals

80
Q

Name 4 things required for conscious sedation

A
  1. PALS certified staff member to monitor (no other roles)
  2. Pulse ox & BP (Vitals every 5 minutes)
  3. Bag mask & O2
  4. Reversal agents (naloxone/flumazenil)
81
Q

True or False: EKG monitoring is required for conscious sedation

A

False: In absence of underlying cardiac history, EKG monitoring isn’t needed

My Peds Prep (34 decks)

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