Pharm 2 Exam 2 Master Deck

oral absorption in neonates

Slow gastric emptying Low gastric acid → increased absorption of acid-labile drugs like antibiotics

IM absorption in Neonates

slow and erratic due to low blood flow

transdermal absorption in neonates

Increased absorption, increased toxicity risk

distribution in neonates

Lower albumin levels, increased levels of free drug, increased effects, lower dose needed

BBB in Neonates

Immature → drugs enter CNS easily→ ↑ CNS toxicity risk

Liver metabolism in neonates

lower at birthRapid increase after ~1 month Full maturation ≈ 1 year

Kidney excretion in neonates

decreased function at birthincreased risk of drug accumulationLower dose or dosing intervaladult function at about a year

Infant body composition

total body water about 70%: INCREASE water soluble drug doselower fat: decrease fat soluble drug dose

main pharmacokinetics considerations for children over 1 year old

PK is about the same as an adultBUT: increased metabolism until about 2 years, may need INCREASED dose or decreased interval

Glucocorticoid AEs in kids

growth suppression

Tetreacycline AEs in kids

tooth discoloration

Sulfonamides AEs in kids

Kernicterus

Aspirin AEs in kids

Reyes syndrome brain swelling, liver damagevomitting, confusion, seizures, LOC

Chloramphenicol AEs in kids

Gray baby syndrome Ashen gray skin, cyanosis, CV collapse, abdomen distention in NEWBORNS AND INFANTS

Fluoroquinolones AEs in kids

Tendon rupture

main consideration with redosing

Re-dose if child spits out (estimate loss)

distribution in older adults

↑ fat → ↑ storage of lipid drugs ↓ water → ↑ concentration of water-soluble drugs ↓ albumin → ↑ free drug

Metabolism of older adults

↓ liver function -> ↑ half-life, ↑ drug effects

Renal excretion of older adults

"↓ renal function → #1 cause of toxicityMust assess Creatinine clearance (NOT serum creatinine)"

Older adults have increased sensitivity to

Warfarin and CNS depressants

Older adults have a decreased response to ____

Beta Blockers

antiseptic

used to kill pathogens on LIVING TISSUE

Disinfectant

Used on OBJECTS (too toxic for tissue)

Sterilization

destroys ALL microbes

Sanitization

Reduces microbes to safe level

Germicide

Kills organisms

Germistatic

Inhibits growth, but does not kill

first line treatment for any sort of infection

SYSTEMIC drugs first, not topicals more effective and does not damage tissue

What infections must you wash with SOAP AND WATER?

Clostridium difficileBacillus anthracis when hands are visibly dirty

firstline oral therapy for uncomplicated UTIs

TMP-SMX broad spectrum coverage

MOA of nitrofurantoin

Low dose → bacteriostatic High dose → bactericidal

Indications of Nitrofurantoin

Lower UTIs only Prophylaxis Recurrent UTIs

major AEs of Nitrofurantoin

Pulmonary toxicity Peripheral neuropathy (can be irreversible)

Nitrofurantoin is NOT used for _____

Upper UTIs. it does not reach kidneys well

MOA of Methanamine

converts to Formaldehyde in urine and kills bacteria

Indication for Methanamine

prophylaxis/suppression of recurrent lower UTI

AEs of Methanamine

generally well tolerated

Contraindications of methanamine

Renal and liver failuresevere dehydration

interactions with methanamine

avoid in urinary alkalinizers and sulfonamides

complicated UTIs

often involve kidneysoccur with structural abnormalitiespregnancy, diabetes, immunosuppression, or other conditions

main risks of complicated UTIs

SEPSIS and severe illness

Thyroid gland function

regulates metabolism, energy levels, HR, temp, and digestive function

Hormones released by thyroid

T4 (Thyroxine) = main hormone released by thyroid; converted in tissues to T3 (Triiodothyronine), the more active form.

TSH function

Stimulates thyroid to release T3 and T4

Manifestations of hypothyroidism

Fatigueweight gaincold intolerancebradycardiaconstipationdry skindepressionslowed reflexes overall depression and slowness of all body systems

untreated hypothyroidism in first trimester increases risk of:

decreased fetal brain development, lower IQmiscarriagepreterm birth

treatment for hypothyroidism in pregnancy

Levothyroxinemonitor TSH every 4-6 weeks

Indications of Levothyroxine

Hypothyroidism

Myxedema requires ________

IV levothyroxine

MOA of levothyroxine

replaces deficient thyroid hormoneconverted to T3 in tissues

AEs of Levothyroxine

Hyperthyroid effects if dose too high

Contraindications for Levothyroxine

Untreated adrenal insufficiency: increased metabolic demand and cortisol clearance which can cause adrenal crisisCV disease and older adults: overtreatment can provoke arrhythmias NOT FOR WEIGHT LOSS

Pt education for Levothyroxine

Take on EMPTY STOMACH same time in the morningCalcium, Iron, Antacids, Bile Acid Sequestrants, and sucralfate decrease absorptionIt is usually lifelong Do not stop when symptoms improve Report chest pain, palpitations, severe nervousness

Levothyroxine interaction with warfarin

increases the effect of warfarin monitor INR and adjust warfarin if needed

pregnancy levothyroxine requirements

increased dose needed

Nurse monitoring on Levothyroxine

Monitor TSH and clinical response HR/BP and angina in cardiac patients

Manifestations of Hyperthyroidism

Weight lossHeat intoleranceTachycardiaAnxietyTremorsDiarrheaSweatingInsomniaGoiter, possible exophthalmos Overall HYPERACTIVITY of all body systems

Main antithyroid drugs

Methimazole and Propylthiouracil (PTU)

Indications of Methimazole and PTU

Hyperthyroidism, Graves diseasePre-op prep before thyroidectomy

MOA of Methimazole and PTU

Inhibits thyroid hormone synthesis PTU also decreses T4->T3 conversion

AEs of Methimazole and PTU

Rash, agranulocytosis, hypothyroidism. PTU has added hepatotoxicity

Main use of PTU over methimazole

hyperthyroidism mothers in first trimester

Nurse monitoring on Methimazole and PTU

Monitor CBC and thyroid function Watch for shift into hypothyroidism

Pt education on Methimazole and PTU

Report fever or sore throat immediately because of agranulocytosis risk

Symptoms of Diabetes insipidus

PolyuriaPolydipsiaDilute urineDehydrationHypernatremia if water loss is not replaced

Indications for Desmopressin (DDVAP)

Central diabetes insipidus: decreased ADH release from pituitary

MOA of Desmopressin

acts like Vasopressin (ADH), activates Renal V2 receptors to increase water reabsorption and reduce urine output

AEs of desmopressin

Water intoxication, hyponatremia, headache, confusion

Contraindication for Desmopressin

Hyponatremiapts with significant risk for fluid overload like HF

pt education on desmopressin

Report headache, drowsiness, sudden weight gain, confusionfollow fluid instructions exactly

Nurse monitoring on Desmopressin

I&O, daily weight, serum sodium, urine specific gravity

normal urine specific gravity

1.003 to 1.030

ADH antagonist drugs

Tolvaptan (and the other -vaptans)

Indications of Tolvaptan

Euvolemic or hypervolemic hyponatremia, often SIADH-related, not diabetes insipidus

MOA of Tolvaptan

Block vasopressin receptors, increasing free-water excretion

AEs of Tolvaptan

Thirst, polyuria, dehydration, overly rapid sodium correctionHepatotoxicity with longer-term use

Contraindications for Tolvaptan

Hypovolemic hyponatremia Inability to sense/respond to thirst

Nurse monitoring with Tolvaptan

Strict sodium monitoring

Somatropin is a _______

Recombinant growth hormone

Indications of Somatropin

Pediatric growth hormone deficiency and some growth-failure syndromes

MOA of somatropin

Replaces growth hormone, promoting linear growth and protein synthesis

AEs of Somatropin

EdemaArthralgiaHyperglycemiaintracranial HTN

Contraindications of Somatropin

Active malignancy Closed epiphyses for height-gain purposes Acute critical illness

When to stop Somatropin in children

when epiphyseal growth plates close or adequate final height/growth velocity is reached

pt education on Somatropin

Track height/weight and growth velocity. Rotate injection sites. Monitor glucose and signs of intracranial hypertension or limp/hip pain

Mecasermin is a ______

Recombinant IGF-1 stimulates growth hormone

Indications of Mecasermin

Severe primary IGF-1 deficiency NOT classic GH deficiency

MOA of mecasermin

Replaces IGF-1 downstream of GH action

AEs of Mecasermin

Hypoglycemia is main one Tonsillar/adenoidal hypertrophyintracranial hypertension

Pt education for Mecasermin

Give around meals/snacks to reduce hypoglycemia risk

Nurse monitoring on Mecasermin

Monitor glucose and growth response

Cabergoline is a ______

Dopamine agonist

Indications for Cabergoline

Hyperprolactinemia, prolactinoma

MOA of Cabergoline

Dopamine receptor agonism suppresses prolactin release

AEs of Cabergoline

Nausea, dizziness, orthostatic hypotension, headache

Monitoring on Cabergoline

prolactin level and symptom response

Pt education on Cabergoline

Warn about dizziness and orthostasis

how is acromegaly treated?

Somatostatin analogs

what causes acromegaly?

excess GH after epiphyseal closure

Indication of Hydrocortisone

Adrenal insufficiency replacement