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Patho exam 2
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140
Pharmacology
Graduate
10/09/2011

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Term
normal PCO2 range
Definition
35-45 mm Hg
Term
normal HCO3- range
Definition
22-26 mEq/L
Term
Anion Gap equation
Definition
Na+ - (HCO3- + Cl-)
Term
If anion gap is less than 12
Definition
no anion gap metabolic acidosis
Term
if anion gap is greater than 12
Definition
anion-gap metabolic acidosis
loss of bicarbonate due to buffering of endogenous acids
Term
excess gap equation
Definition
calculated anion gap - 12
Term
what is the excess gap?
Definition
indicates the amount of bicarb lost to buffering acids
Term
If measured bicarb + excess gap is less than 22
Definition
non-anion gap metabolic acidosis (the bicarb level would still be low even if they didn't buffer the acids)
Term
if measured bicarb + excess gap is greater than 26
Definition
metabolic alkalosis
Term
when is using NaHCO3 appropriate in metabolic acidosis?
Definition
severe acidemia, renal dysfunction (when kidneys can't regenerate enough bicarb), intoxications
Term
when is using NaHCO3 inappropriate for metabolic acidosis
Definition
lactic acidosis, ketoacidosis
Term
what are the limitations of using NaHCO3 for pts with metabolic acidosis
Definition
can't give more than half of the HCO3 deficit (or can cause volume overload, hypernatremia, hyperosmolarity, overshoot alkalemia, hypokalemia)
Term
What are the limitations in using NaHCO3 in pts with respiratory acidosis
Definition
can generate CO2 and worsen acidemia
Term
neonate
Definition
28 days of life or less
Term
infant
Definition
29 days to less than 12 mos.
Term
child
Definition
1-12 years
Term
adolescent
Definition
13-17 years
Term
GA
Definition
age from date of mother's first day of last menstrual period to date of birth
Term
full term
Definition
describes infants born at 38-wks gestation or after?
Term
premature
Definition
describes infants born before 37-wk gestation
Term
small for GA
Definition
neonates with birth weight below the 10th percentile among neonates of the same GA
Term
large for GA
Definition
neonates with birth weight above the 90th percentile among neonates of the same GA
Term
chronological (post natal) age
Definition
age from birth to present measured in days, wks, mos, or yrs
Term
corrected (adjusted) age
Definition
may be used to describe the age of a premautre child up to 3 yrs of age
Term
corrected age equation
Definition
chronological age (mos.) - [(40 - GA in wks at birth)/4 wks]
Term
LBW infant
Definition
Premature infant with birth weight between 1500 and 2500 g
Term
VLBW infant
Definition
Premature infant with birth weight 1000 g to less than 1500 g
Term
extreme LBW infant
Definition
Premature infant with birth weight less than 1000 g
Term
How do you calculate hourly fluid maintenance requirements in children
Definition
first 10 kg = 4ml/kg/hr
second 10 kg = 2ml/kg/hr
remain kg = 1 ml/kg/hr
Term
how do you calculate daily fluid maintenance requirements in children
Definition
first 10 kg = 100ml/kg/day
second 10 kg = 50 ml/kg/day
remain kg = 20 ml/kg/day
Term
significant clinical signs of mild dehydration in children
Definition
decreased urine output and thirst. no physical changes yet. behavior, HR and BP are normal
Term
significant clinical signs of moderate dehydration in children
Definition
listlessness, physical changes begin, heart rate increases, BP is normal, markedly decreased UO
Term
significant clinical signs of severe dehydration in children
Definition
behavioral changes, intense physical changes, BP and HR changes, no urine output
Term
what are the percentages of degrees of dehydration in older children
Definition
mild = 3%
moderate = 6%
severe = 9%
Term
what are the percentages of dehydration in infnats
Definition
mild = 5%
moderate = 10%
severe = 15%
Term
how do you calculate rehydration fluid?
Definition
phase I (immediate) = 20ml/kg
phase II (8 hours) = 1/2 remaining deficit + 1/3 daily maintenance fluid
phase III (16 hours) = 1/2 remaining deficit + 2/3 daily maintenance fluid
Term
how do you calculate fluid deficit in children?
Definition
%dehydration x wt in kg
Term
which acid-base disorder is hyperkalemia associated with?
Definition
acidosis
Term
Which fluid is sodium found in?
Definition
ECF
Term
Which fluid is Potassium found in?
Definition
ICF
Term
which organs control potassium regulation?
Definition
kidneys
Term
hypokalemia symptoms
Definition
cramps, muscle weakness, polyuria, ECG changes, cardiac arrhythmias
Term
causes of hypokalemia
Definition
renal/GI losses, inadequate intake, medications (insulin, diuretics, corticosteroids)
Term
hypokalemia treatment
Definition
potassium replacement
-check for hypomagnesemia
Term
patient with hypokalemia and low phosphate levels, use:
Definition
potassium phosphate
Term
hypokalemic patient with acidosis
Definition
potassium acetate
Term
hypokalemic patient with alkalosis
Definition
use potassium chloride
Term
symptoms of hyperkalemia
Definition
muscle weakness, hypotension, ECG changes, cardiac arrhythmias, decreased pH
Term
causes of hyperkalemia
Definition
increased intake (salt substitutes, IV, potassium sparing diuretics), decreased excretion (renal failure, Addison's disease), potassium release from ICF (tissue breakdown, blood transfusions, metabolic acidosis)
Term
treatments of hyperkalemia
Definition
D/C potassium-sparing diuretics, salt substitutes, potassium supplements
antagonize proarrhythmic effects (IV calcium)
drive potassium into ICF (dextrose, insulin, beta agonists)
lower total potassium content
(sodium polysterene sulfonate, loop diuretics, hemodialysis)
Term
cause of high anion gap metabolic acidosis
Definition
lactic acidosis, ketoacidosis, renal failure
Term
cause of normal anion gap metabolic acidosis
Definition
diarrhea
Term
causes of metabolic alkalosis
Definition
loss of acid, prevention of excretion (hypovolemia), drugs (bicarb, corticosteroids)
Term
respiratory acidosis causes
Definition
respiratory failure (NM and pulmonary disease), impaired CNS control of respiration
Term
cause of respiratory alkalosis
Definition
hyperventilation
Term
cause of hypertonic hyponatremia
Definition
hyperglycemia (inc in TBW)
Term
causes of hypotonic hypervolemic hyponatremia
Definition
CHF, cirrhosis, nephrotic syndrome
Term
causes of hypotonic euvolemic hyponatremia
Definition
SIADH, hypothyroidism, kidney failure, mineralocorticoid deficiency
Term
causes of hypotonic hypovolemic hyponatremia
Definition
diuretics, sweating, wound drainage, GI losses
Term
cause of hypernatremia
Definition
loss of water, decrease in intake, diuresis, DI
Term
causes of hypokalemia
Definition
losses: GI, renal
Inadequate intake
alkalosis
meds: insulin, loop diuretics
Term
causes of hyperkalemia
Definition
increased intake
decreased excretion:renal failure, addison's
movement into the ECF: tissue breakdown, blood transfusions, metabolic acidosis
Term
causes of hypocalcemia:
Definition

inadequate intake

losses:hypoparathyroidism, renal failure, alkalosis, pancreatitis, blood product infusion, vitamin D deficiency

Term
causes of hypercalcemia
Definition
hyperparathyroidism, hyperthyroidism, malignancy, addison's, bony fractures, immobilization, acidosis
Term
hypophosphatemia causes:
Definition
decreased absorption: starvation, antacids, vitamin D deficiency, diarrhea increased renal loss: diuretics, ketoacidosis inc distribution to ICF:hyperglycemia, insulin, malnourishment
Term
causes of hyperphosphatemia
Definition
increased intake: enemas, laxatives
decreased excretion: renal failure
movement into ECF
Term
causes of hypomagnesemia:
Definition
inadequate intake:
losses: GI, urinary
Term
causes of hypermagnesemia:
Definition
increased intake: meds
decreased loss: renal failure
Term
treatment of hypertonic hyponatremia:
Definition
treat hyperglycemia
Term
hypotonic hypervolemic hyponatremia treatment:
Definition
sodium and fluid restriction
treat underlying cause (CHF, cirrhosis, nephrotic syndrome)
Term
hypotonic euvolemic hyponatremia treatment:
Definition
fluid restriction
Term
treatment of hypotonic hypovolemic hyponatremia
Definition
water and salt replacement (isotonic)
Term
hypernatremia treatment
Definition
hypotonic fluids
Term
hypocalcemia treatment
Definition
replacement
Term
hypercalcemia treatment
Definition
rehydration
diuresis
bisphosphonates in renal insufficient pts
Term
hypophosphatemia treatment
Definition
replacement
Term
hyperphosphatemia treatment
Definition
dietary restriction
phosphate binder
IV calcium
Term
hypomagnesemia treatment
Definition
replacement
Term
hypermagnesemia treatment
Definition
D/C meds with mag
normal saline infusion
furosemide
IV calcium
Term
use for normal saline
Definition
ECF replacement, TBW depletion
Term
use for half normal saline
Definition
treatment for hypertonic patients (they lost ECF)
Term
use for hypertonic saline
Definition
severe hyponatremia
Term
what is use for ringer's lactate
Definition
replace ECF, buffer acids
Term
use for D5W
Definition
severe hypernatremia, KVO
Term
a patient with elevated anion gap tells us
Definition
they have metabolic acidosis due to acids present
Term
a non-elevated anion gap metabolic acidosis tells us
Definition
loss of bicarb
Term
tonicity of D5W
Definition
isotonic, but acts as hypotonic
Term
infant's absorption in stomach
Definition
slower gastric emptying, so increased absorption in stomach
Term
water content in babies
Definition
much higher
Term
volume of distribution in babies
Definition
larger for w/s drugs, lower for lipophilic drugs
Term
protein binding in babies
Definition
smaller albumin stores > less protein binding
Term
describe metabolism as you age
Definition
depressed at birth, then exceeds adult. at 12, starts to level off
Term
phase II metabolism in infants
Definition
glucoronidation is decreased
sulfation is increased
acetylation is decreased
Term
elimination in infants
Definition
depressed, bc of low GFR, renal blood flow, and tubular secretion
Term
what is the normal urine output in infants
Definition
1-2 mL/hour
Term
how to estimate creatinine clearance in babes
Definition
KxL/SCr
Term
effect of reduced metabolism and clearance on dosing in peds
Definition
longer half-lives >>> extended dosing intervals
Term
what is appropriate for fluid boluses?
Definition
isotonic (NS, lactate ringer)
Term
how are GI fluid losses replaced in children?
Definition
1/2 NS
Term
sodium deficit in kids
Definition
(desired Na - measured Na)x.6 x wt
Term
formulation of pancreatic enzymes
Definition
eneteric-coated microspheres
Term
monitoring parameters of pancreatic enzymes in CF
Definition
stool output, steatorrhea, abdominal symptoms, weight gain, nutritional status
Term
antibiotics used in CF outpatients-pseudomonas
Definition
oral fluoroquinalones with tobramycin
Term
inpatient therapy for CF, antibiotics:
Definition
antipseudomonal beta-lactam (cephaloasporins) plus aminoglycoside (tobramycin)
Term
volume of distribution in CF
Definition
increased
Term
half-life in CF
Definition
decreased
Term
body clearance in CF
Definition
increased
Term
dose of aminoglycosdies in pts with CF
Definition
increased (increasd Vd)
Term
Aztreonam
Definition
inhaled med for CF that improves respiratory system, FEV, and reduces productive cough
Term
how is pulmonary system measured/evaluated in CF
Definition
FEV
Term
use of azithromycin in CF
Definition
antiinflammatory, improves lung function
Term
side effect of taking supplemental iron when pregnanct
Definition
constipation
Term
purpose of taking folic acid while pregnancy
Definition
prevents neural tube defects
Term
effect of pregnancy on absorption
Definition
decreased
Term
effect of pregnancy on distribution
Definition
increased Vd, decreased protein binding
Term
effect of pregnancy on metabolism
Definition
variable
Term
effect of pregnancy on renal elimination and dosing
Definition
increases clearance, so drugs need to be dosed more frequently
Term
first line therapy for n/v
Definition
promethazine, prochlorperazine, or pyridoxine/doxylamine
Term
first line treatment constipation
Definition
polycarbophil, psyllium
Term
first line therapy for hemorrhoids
Definition
witch hazel
Term
heartburn therapy
Definition
antacids (avoid aluminum products), all other OTC meds are fine
Term
management of pain in pregnancy
Definition
acetaminophen
Term
cough and congestion treatment during preg
Definition
DM, gauifenacin, pseudofed (in 2 and 3 trimester)
Term
treatment for allergies during preg
Definition
inhaled corticosteroid
Term
what can and can't you give for bacteriuria in pregn?
Definition
give amox, ceph, and nitrofurantoin
don't give bactrim or fluroquinalones
Term
how to treat bacterial vaginosis in pregn
Definition
metronidazole
Term
how to treat bacterial vaginosis during lactation
Definition
clindamycin cream
Term
treatment for vulvovaginal candidiasis
Definition
azole cream for 7 days
Term
treatment for chlamydia during preg?
Definition
amox and zithro
Term
treatment of chlamydia during lactation
Definition
doxycycline, zithro
Term
gonorrhea treatment
Definition
cefixime, ceftriaxone
Term
HSV treatment
Definition
acyclovir
Term
treatment of syphillis during preg
Definition
benzathine penicillin G
Term
treatment of syphillis during lactation
Definition
erythromycin or doxycycline
Term
trichomoniasis treatment
Definition
metronidazole (oral)
Term
treatment for preterm labor
Definition
antenatal corticosteroids
tocolytic agents (CCB)
antibiotics
Term
treatment for group B strep
Definition
penicillin G
Term
acute mastitis treatment
Definition
ceph/dicloxacillin
Term
nipple candidiasis treatment
Definition
topical antifungal and nystatin to baby
Term
lactation enhancement therapy
Definition
metoclopramide
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