Pharm Test 2

Pediatric accidental ingestions commonly occur between what ages:

__% of pediatric pts who have accidental ingestions will have a 2nd episode in 1 yr.

Constriction of pupils from clonidine, phenothiazines, cholinesterase inhibitors is called:

Can get deep coma from this drug OD:

This is dilation of pupils from OD of amphetamines, cocaine, LSD & anticholinergics.

This drug classically shows vertical and horizontal nystagmus in OD.

Horizontal nystagmus can be see w/ either of these 2 drugs:

If smell "bitter almonds" on person's breath in OD situation, the most likely poisoned with:

An OD pt has dry skin. They most likely OD'd on:

An OD pt has sweaty skin. They most likely OD'd on:

An OD pt presents w/ cyanosis. These are 2 things that might be happening:

If thinking toxic ingestion and have nystagmus, dysarthria & ataxia, think these drugs:

If low PO2 and high PCO2 on ABG in OD situation, this suggests __ __ & the pt may need __.

Anion gap acidosis can be seen w/ these ingestions:

Looking for what electrolyte if check electrolytes in OD:

Ethylene glycol is in:

If make urine w/ high pH, then the weak acid becomes ionized and can't:

Look for __ as a sign of smoke inhalation.

If nothing else works, try:

Acetaminophen: toxic ingestion: initially asymptomatic, 24-36 hrs later __ injury appears.

__ of phone calls for poisonings don't need a referral.

When a poisoned pt comes into the ED, you first:

GI decontaminate w/:

Gastric lavage is when:

In order to evaluate a pediatric accidental ingestion over the phone, need to know:

Toxic encephalopathy suggests drugs or poisoning because:

If a pt calls & they have a high risk ingestion, you should:

Aspirin toxic ingestion tx:

POISINDEX is a CD that has a list of:

Urinary alkalinization is used for:

Beta blocker ingestion tx:

Xray poisoned pt to:

Dialysis works with:

If drug is enterohepatically circulated, give charcoal doses every 6 hours until:

On EKG, may see a widened:

Disc-shaped battery ingestion tx:

Activated charcoal doesn't help with:

Burning wool, plastics, & other things can cause:

Activated charcoal doesn't inactivate:

Anticholinergic toxic ingestions causes sinus __ & dilated __.

Be careful giving flumazenil if pt has taken:

Look at __ interval for AV block.

Only do gastric lavage if pt is alert or they are:

Most effective decontamination tool is:

High risk ingestions are:

Methanol can cause:

On EKG you see a prolonged QT. Pt may have OD'd on:

Aspiration of hydrocarbons turns into:

Always give glucose w/:

Be careful giving flumazenil if addicted to __.

Antidote to cyanide toxic ingestion:

Iron ingestion is very toxic. What's the antidote?

Urinary alkalinization only works if the drug is a __ acid.

Serum osmolarity measures:

If there is an antagonist for a __, give it.

Treatment of hydrocarbon ingestion:

Less than 10 cc's of __ is fatal!

CCB's toxic ingestion treatment:

If aspirin toxic ingestion, pt will:

Most common pediatric poisoning is:

For TCAD toxic ingestion, give:

Give activated charcoal w/ the following to help pass through to rectum:

If pt took a benzo, give:

Cannot do gastric lavage if:

CCB's antidote:

Serum osmolarity is measuring:

Antidote to anticholinergic poisoning:

Antidote for ethylene glycol:

These decrease inflammation, but do nothing to the immune system, so there's no benefit in autoimmunity.

These suppress inflammation at low doses & suppress the immune system at high doses. They are most often used as an anti-inflammatory b/c there are too many SEs when using as immunosuppressant.

These medications take weeks to months to work and slow down the destruction from underlying rheumatic disease, but don't stop it altogether.

These DMARDs modify the immune system, but don't increase the risk of infections. They're not immunosuppressive, not as powerful & generally not as effective in treating disease.

This is an anti-malarial drug used as a DMARD. It makes the skin rash of psoriasis worse, and can cause retinopathy, so a pt can go blind if this is neglected.

This is the mildest DMARD, so it's used for RA (slows erosive changes in joints) and SLE (helps fatigue, malaise & skin).

This is a DMARD that is best known for treating IBD. It's a sulfa drug which can cause hemolytic anemia in G6PD, photosensitivity, hepatitis, anemia, leucopenia, oligospermia, and it's the MOST COMMON cause of SJS. It's used in mild to moderate RA, IBD, arthritis, & psoriatic arthritis.

These type of DMARDs suppress inflammation and autoimmunity, take longer to work, work better, increase risk of infection, and have more severe SEs than immunomodulating drugs.

This DMARD is the gold standard for RA treatment.

This DMARD can cause stomatitis, myelosuppression, cirrhosis (so don't give to a pt w/ liver problems), pulmonary infiltrates, and might cause lymphoma. Only give it weekly, not daily, IM or PO, and don't take w/ ETOH. Folic acid should be given daily to decrease SEs.

This DMARD must be given w/ a loading dose since it has a very long 1/2-life and then it takes months to see any effect. It's eliminated in the bile and can be around for years, so if need to increase elimination, use cholestyramine & it'll be eliminated in 10 days-2 wks. Common ADRs are HA, GI, hair loss, and rash while serious ADRs are liver disease.

This DMARD is the most powerful immunosuppressent and is used when disease is severe (choice is this drug or death). Most who use have a major complication, including bladder CA, myelosuppression and infection.

This DMARD is used mostly after organ transplant to prevent rejection by suppressing the immune system. It irreversibly decreases kidney function, so only use if absolutely have to.

This DMARD is used for immunosuppression, as chemo, & to prevent organ transplant rejection. SEs include bone marrow suppression, GI, & hepatotoxicity.

This is a substance from a living organism & its products & is used in the prevention, diagnosis, & treatment of CA & other disease. They are very expensive & cost >$10,000 a year).

These are used when nothing else works in rheumatic disease.

These work on cytokines primarily and are focused on products of the immune system. Right now, they are only approved for use in RA, psoriatic arthritis, & AS.

Older DMARDs can be combined w/ biologics, but 2 different __ cannot be combined.

These are the most used biologics, and are successful in RA, psoriatic arthritis, IBD & AS. The onset is days to 3 mo. Common ADRs include injection site or infusion rxns. Serious ADRs include opportunistic infxns such as reactivation of TB (big problem!) & aplastic anemia. Pts need a PPD before beginning treatment.

These Biologics cause T cells to not be activated. They are approved for use in RA, but supposed to use other DMARDs first. There's a possible increase in incidence of lymphoma w/ this drug.

This Biologic binds to CD20 on normal & malignant B lymphocytes and is used for lymphoma & RA.

If mild rheumatic disease, use these.

If systemic complaints w/ rheumatic disease or skin disease, use this drug.

If moderate or severe joint disease, use this drug which is the gold standard, & then after that, usually use a combination of these 2 drugs.

Use these as a bridge since they work fastest in rheumatic disease treatment, but don't use them longterm b/c of SEs.

This is a drug used in gout and is primarily for gouty inflammation and little else. Serious ADRs are myopathy & myelosuppression. It should always be giving PO b/c IV increases the risk of myelosuppression. Can give every hour until relief or diarrhea during acute attack, but don't do this.

These are effective at relieving inflammation gouty crystals cause, and that's it.

This gout drug is uricosuric, has no inflammatory effect, but is not favored b/c there's so many interactions and pts need to drink lots of water & it won't work unless normal kidney function.

This drug for gout takes 2-3 mo for a full effect, there are increased attacks when initiated, and serious hypersensitivity rxns can occur (rash, fever, hepatitis, eosinophilia & RF w/ 25% mortality).

Usually want serum uric acid <__.

This gout drug causes no uric acid to be made. It's used for chronic gout, but is very expensive, and is used in those that can't tolerate Allopurinol.

These work best for acute inflammation in gout.

If NSAIDs can't be used, give this if 1 joint is affected in gout. If more than 1 joint, give this.

To prevent acute inflammation in gout, use this qd-bid.

Acute inflammation in gout is treated with __ or __. Gout can flare when these are started, so should be on prevention medication when start (either __ or __).

To avoid dyspepsia, give NSAIDs w/ __.

Gastric and duodenal ulcers occur in __% of people who take NSAIDs.

This medication increases BP (on average 8-10 mmHg) and also causes retention of salt & fluid.

There's a BLACK BOX WARNING for increased risk of cardiovascular events w/ this medication.

Angioedema occurs in as high as __% of those taking NSAIDs, and although this is not an allergy, the medication should be avoided in the future.

Those w/ nasal polyps and asthma can get __ when taking ASA or NSAIDs.

This drug irreversibly inhibits COX enzymes in platelets, so it has a longer lasting effect on inhibiting platelet function.

This subgroup of NSAIDs have no effect on platelets.

Don't give these drugs if abnormal kidney function b/c can cause increased serum Cr causing decreased blood flow to the kidney and causing RF.

Aseptic meningitis can be seen in those taking NSAIDs, especially __.

NSAIDs may block the __ effect of ASA, decrease effectiveness of __ drugs, __ Lithium levels, and don't use w/ corticosteroids or __ b/c risk of PUD & bleeding.

This drug should be used in combination with narcotics for cancer pain.

Use high doses of this drug for rheumatic fever and arthritis.

This drug causes routine dose-related fecal blood loss, as well as the following ADRs: salicylism (vomiting, tinnitus, decreased hearing, vertigo) and hyperpnea (breathe fast, respiratory alkalosis).

Use these when need an NSAID, but don't want to increase risk of bleeding.

This drug is a sulfa COX-2 selective NSAID that causes fewer ulcers (but unclear if clinically relevant), and there is a risk of thrombotic events only at higher levels than what's used therapeutically.

This is an NSAID that inhibits COX 2 more than COX 1, but not enough to be classified as COX 2 by the FDA. There's less GI upset & no platelet inhibition, so less bleeding.

This is an IM nonselective NSAID used for analgesia, not inflammation. It can only be used during a limited time (usually 5 days) b/c of risk of ulcers. This drug is used for moderate to severe pain and is useful when don't want to use narcotics.

These are the 2 nonselective NSAIDs that have a long 1/2-life, so they are taken qd.

Should avoid these drugs if have CHF, RF, active PUD, uncontrolled HTN b/c risks outweigh benefits.

Don't combine 2 of these drugs b/c it increases risk of adverse events w/o increasing efficacy.

If risk of PUD, and need NSAIDs can do 3 things:

If hx of HTN or HTN is controlled on meds, and need NSAIDs, do this:

If on diuretics or ACEI, and need to take an NSAID, do this:

If a patient drinks greater than or equal too 3 glasses of ETOH/day, they can only take __gm of APAP a day.

APAP is analgesic, __, but not __.

Can get mildly increased LFTs with this drug.

Large doses of this drug cause dizziness, excitement, and disorientation.

This pain reliever is favored for any pain if the pt also has GI upset or an ulcer, a child w/ a virus or chickenpox, or a bleeding d/o.

This is an antihistamine frequently added to injectable narcotics.

This is a neuropathic pain reliever used in diabetic neuropathic pain and post-herpetic neuralgia.

This is a red pepper derivative that works best for neuropathic pain by working on substance P.

These are drug of choice for severe, chronic malignant pain.

These narcotics are metabolized by M3G, which can cause seizures (but only see this effect if on high doses of these drugs or if taking for a long time or RF).

This narcotic becomes normerperidine which can cause seizures if RF or on a high dose for a long time.

These drugs make patients sleepy, but does not cause amnesia. They go into an easily arousable sleep, not normal sleep.

This is the effect that most limits the dose of narcotics in treating severe pain.

These drugs cause miosis, euphoria and N/V.

If a pt has CVS disease or is dehydrated, these drugs can cause blood vessel dilatation and hypotension.

This narcotic has antimuscarinic effects so it can cause tachycardia.

These drugs always cause constipation, can also cause increased pain if a pt has gallbladder disease, and can cause urinary retention.

These drugs can decrease uterine tone and this potentially can prolong labor.

These drugs can cause flushing and warmth of skin, occasionally urticaria too which happens more often when given parenterally and is not an allergic rxn.

Tolerance to narcotics occurs to analgesic effects and all other effects EXCEPT the following 3:

Don't use these drugs if a pt has a head injury, pregnancy, or impaired respiratory function.

If narcotics are used in these 2 diseases, can get prolonged or exaggerated effects from the narcotics.

If narcotics are used with these drugs, a hypertensive crisis can occur.

May get more pain if using narcotics for these 2 types of pain.

These meds work well if having an MI w/ CP and pulmonary edema. Also, they can decrease SOB by decreasing anxiety, preload & afterload.

This full opioid agonist has an equal potency in comparison to morphine, less euphoria and a longer duration of action. It's used for withdrawal in licensed rehab settings. If used for pain, it's given q8 hrs. If for drug abuse, it's given qd.

This full opioid agonist can cause seizures if RF or given for a long time at high doses. It can cause significant antimuscarinic effects (pupils dilate and tachycardia). It's used in OB b/c it's not long-acting (2-4 hrs) & doesn't distribute as fast as others, so less exposure to the fetus.

This full opioid agonist is 100x more powerful than morphine.

This partial narcotic agonist is less powerful than morphine, but absorbed better. It's a good antitussive and has a lower abuse potential, less euphoria, and less dependence.

This partial narcotic agonist is a semi-synthetic derivative of morphine. It's active PO, and abuse of sustained relief preparations are a problem.

This is a partial narcotic agonist that is weaker than Codeine and is for mild to moderate pain. At high doses, seizures and cardiotoxicity may occur.

These narcotics are commonly seen w/ ASA, APAP or an NSAID to boost pain relief.

This opioid antagonist is injectable, but the 1/2-life is shorter than most narcotics, so it wears off before narcotic wears off.

This opioid antagonist is oral, has a long 1/2-life, and 1 dose blocks the effects for 48 hours.

This opioid agonist is newer and has a long 1/2-life, and it is also injectable.

If there is an opioid in a patient's system, a narcotic agonist completely reverses the narcotic's effects in __ minutes.

If depressed CNS, giving an opioid antagonist normalizes respiration, LOC, pupil size, bowel activity, & __ of pain.

This opioid antagonist is given to addicts every other day to prevent effects of narcotic use.

This is a centrally acting analgesic which helps moderately severe pain. There are no effects on respirations or CVS, but it causes seizures, nausea & dizziness. If hx of seizure or on another med that can cause seizures, SSRIs or TCAD, don't take this drug.

Get longer duration of action, decreases systemic absorption and decreased toxicity when adding this to local anesthetics.

This is the greatest risk of local anesthesia in involved procedures.

Duration in hours:
(a) Lido
(b) Lido w/ epi
(c) Bupivacaine
(d) Bupivacaine w/ epi

When a local anesthetic is injected into the vicinity of nerve endings to numb the areas fed by that nerve, it's called this.

When a local is injected into a major nerve trunk, it's called this.

This is a form of IV regional anesthesia used when surgery is performed on a limb. If the surgery is >60 min, this procedure involves placing a tourniquet on the limb & giving IV local anesthesia to make the limb numb.

These cause decreased BP, ventricular irritability, decreased mucociliary function, increased risk of atelectasis & post-op pneumonia, decreased renal blood flow, GFR & urinary output.

This is an autosomal dominant genetic d/o of skeletal muscle trigged by use of inhaled general anesthesia and muscle relaxants. Symptoms include tachycardia, HTN, severe muscle rigidity, hyperkalemia, acidosis, hyperthermia, and death. Also, how would you treat this?

This group of general anesthetics doesn't increase cerebral blood flow, so tend to be favored if head trauma or brain tumor.

These general anesthetics put a pt to sleep quickly, but unless they're added to another agent, they wake up quickly. They don't last long enough to be used alone for anesthesia.

These are used for premedication prior to anesthesia b/c they're sedative and amnetic. If used alone, it's not deep enough, so there's inadequate anesthesia.

These are used in low doses as premedication and as an adjunct to other anesthetics. They're not used alone, but if they are, get awareness during time under anesthesia & get post-op recall.

This is a sedative used as a continuous IV when used for anesthesia. The onset is rapid, recovery more rapid than barbiturates, effects soon gone after stopping, so good for quick ambulatory procedures. Pts feel better & ambulate sooner w/ less N/V. SEs include decreased BP and cardiac contractility.

This general anesthetic has minimal cardiac and respiratory depression, but has no analgesic effect, so usually need to add to narcotics. It's often used if BP is already low before surgery.

This is an induction anesthetic agent w/ sympathetic stimulatory activity. It is profoundly analgesic, but causes increased HR, BP & CO. It's good at low doses in combo w/ others, especially if in shock or going through a short painful procedure on a kid. It's related to PCP, so adults hallucinate and children get excited.

These are adjuncts to anesthesia and make procedures and intubation easier. These mask inadequate anesthesia, so often look at autonomic reflexes as a sign of level of anesthesia (if deep enough, BP & pulse increase). Monitor to make sure muscles are paralyzed using a peripheral nerve stimulator.

These are adjuncts to anesthesia. They decrease secretions (antisialagogues), prevent reflex bradycardia, sedate and cause amnesia. SEs include CNS sedation, tachycardia and increase in temp.

Spinal anesthesia involves injecting a local anesthetic or narcotics into the subarachnoid space usually below __, to block spinal nerve roots. The height of affect is determined by gravity and position of pt.

For epidural anesthesia, use long-acting __ or narcotics or both. Need larger volume than spinal & if needle goes into a vascular space, get systemic toxic rxn.

Alcohol can be found in OTC cough syrups, cold meds, and __.

Antihistamines as well as caffeine can be found in OTC analgesics and __.

Aspirin can be found in OTC cold meds & __.

Sodium can be found in OTC cold meds, antacids, analgesics, and __.

Sympathomimetics can be found in OTC analgesics, asthma products, cough, cold & allergy products, as well as __.

Nighttime or PM OTC products tend to contain a __ to make a pt sleepy.

If an OTC product has the word "sinus" on it, it tends to contain this ingredient.

If an OTC product has the word "cough" on the label, it tends to contain this.

If an OTC product says "non-drowsy", "AM" or "daytime-congestant" it tends not to contain this.

An OTC product w/ the words "cold & flu" will contain __.