Worksheets612 Exam 4
Total questions: 35
Worksheet time: 1hrs 10mins
Which of the following is true about PK changes in pediatric patients?
Bioavailability of acidic drugs is decreased in neonates
Volume of distribution for fat-soluble drugs is increased in neonates
Neonates have higher concentrations of plasma proteins
Neonates have thicker stratum corneum, which increases risk of systemic absorption
Phase I reactions are increased in neonates, requiring more frequent dosing
JO was born at 25 weeks gestation and weighs 950 grams. What is her birth weight category?
Full term
Low birth weight
Very low birth weight
Extremely low birthweight
Micropremie
JO is now 41 cm long and SCr 0.71. What is her creatinine clearance (using the bedside Schwartz equation)?
42 mL/min
50 mL/min
104 mL/min
24 mL/min
78 mL/min
1. What is an APGAR score?
An assessment performed at 1 and 5 minutes after birth
A way of identifying successful deliveries
A test to determine a baby’s health at birth
A way to determine how successful a neonate will be later in life
Chloramphenicol can cause gray baby syndrome, so its use is contraindicated in infants. Why does this occur?
Infants lack glucuronidation enzymes
Infants have underdeveloped alcohol dehydrogenase activity
It is a highly lipophilic drug that crosses the blood brain barrier easily in neonates
It is renally cleared, so infants with poor renal function are more likely to develop toxicity
Infants metabolize it through the sulfation pathway
Which of the following is NOT an appropriate counseling point for a parent picking up an amoxicillin suspension for a 3 yo child?
Peanut butter or chocolate may be used to help mask unpleasant flavors
A normal spoon is a good instrument for measuring doses
Dose on label should be provided in a measurable quantity
Vanilla is not very effective in masking flavors
The child should be watched to make sure they take the dose
Which pediatric drug reference does NOT provide quality drug dosing information?
Neofax
Lexicomp
Red Book
Drug Prescribing in Renal Failure
Nelson’s Textbook of Pediatrics
MA is a 13 yo male who weighs 38 kg. What is his daily maintenance fluid requirement?
1000mL
1600mL
1900mL
2300mL
2500mL
MA is a 13 yo male who weighs 38 kg and was admitted to Mott Children’s Hospital for treatment of pneumonia. The team would like to give him ceftriaxone (dosing for community acquired pneumonia in patients >3 months old: 50 to 100 mg/kg/day IV in 1-2 divided doses daily, MAX 4 g/day). What ceftriaxone dose do you recommend?
1.5g BID
1g QD
4g QD
3g BID
750mg TID
1. What percentile is MA for weight?
<5
10-25
25-50
50-75
75-90
CL is an 83 yo male with worsening dementia (MMSE score 13 at last appointment). He has also become increasingly aggressive. His family had previously only wanted to do non-pharmacologic therapy, but now they would like to explore medication management. What medication would you like to start?
Galantamine 12 mg BID
Memantine 7 mg ER daily
Citalopram 20 mg daily
Donepezil 5 mg in the evening
Rivastigmine patch 9.5 mg/day
Six months after starting the therapy you recommend, CL has been taking donepezil 23 mg daily but seems to be worsening with MMSE score now 7 with increasing aggression. What do you recommend?
e. Recommend more behavioral interventions and counsel family on worsening status
Increased donepezil dose to 30 mg daily
Change to rivastigmine 13.3 mg/day
Add memantine 5 mg daily
Add haloperidol 10 mg daily for aggression
CL’s son tells you he’s been giving CL zolpidem to help him sleep at night. What do you tell him?
Zolpidem may be making his symptoms worse
He should switch to hydroxyzine
Zolpidem likely interacts with his Alzheimer’s disease therapy
Lorazepam would be a safer alternative for insomnia
This should be safe for him to do
Which of the following is NOT a risk factor for Alzheimer’s disease?
Obesity
IV drug use
Head injury
Depression
Hypercholesterolemia
Which cholinesterase inhibitor is contraindicated in renal impairment?
Donepezil
Galantamine
Memantine
Rivastigmine
Which of the following is NOT a common trigger for migraines?
sleeping 8 hours
weather changes
caffeine use
flying
hormone fluctuations
A 43 yo woman is having migraines about 5 days a month for the last month. She has not tried anything yet for her migraines, what should she try?
Ergotamine
Acetaminophen
Caffeine and regular sleep
Naproxen
Zolmitriptan
A patient has severe migraines that causes her to miss work 4 days a week. What therapy do you suggest
Sumatriptan
Dihydroergotamine
Propranolol
Valproic Acid
Nortriptyline
Which is NOT a contraindication for triptans
Not for use in heart failure
Do not use an ergot within 24 hours
Ischemic heart disease
Hemiplegic and basilar migraines
Concomitant MAOIs
An obese patient presents with severe migraines around 10 days a week, causing their grades to plummet in school, which therapy do you recommend?
Propranolol
Venlafaxine
Topiramate
Divalproex
Which of the following is NOT likely to contribute to ED
Diuretics
Warfarin
Hypertension
Alcohol consumption
Age
A patient has been using sildenafil 20 mg without response. He tells you he does not drink and otherwise takes the medication appropriately. What do you recommend?
Sildenafil is not working; try switching to vardenafil
Sildenafil is not working; he should try topical testosterone instead
He is likely using another medication that interacts with sildenafil, such as ritonavir
He probably is not using sildenafil correctly; make sure he takes it on an empty stomach
He should increase the dose to 40 mg and see if there is a response
SP complains of a weak urine stream and feels like his bladder is always full. He has a PSA of 1.9. What medication(s) would you like to start?
Terazosin alone
Tamsulosin + mirabegron
Terazosin + finasteride
Finasteride alone
Solifenacin + tadalafil
Which of the following is NOT a potential side effect of dutasteride?
hypotension
muscle weakness
gynecomastia
ED
teratogenicity
Which PDE5 inhibitor lasts the longest?
Tadalafil
Sildenafil
Avanafil
Vardenafil
Which medication does NOT have strong anticholinergic properties?
Hydroxyzine
Atropine
Oxybutynin
Amitriptyline
Venlafaxine
HT is an 85 yo patient currently taking verapamil and hydrochlorothiazide. He has history of gout, heart failure, and recent complaint of constipation. Which of the following is true?
Verapamil may exacerbate gout
HCTZ hay worsen heart failure
HT should be started on aspirin 81 mg daily for primary prevention
Verapamil may be causing constipation
HCTZ should be continued
Which of the following is NOT a recommendation made by the American Geriatrics Society?
Avoid using appetite stimulants or high-calorie supplements
Don’t prescribe cholinesterase inhibitors for dementia without periodic assessment for perceived cognitive benefits and adverse effects
Diabetic elderly patients should have goal BP of <150/90 and A1c <8%
Avoid benzodiazepines and other sedative hypnotics for insomnia, agitation, or delirium
Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present
1. SW is 89 yo and has frequent hypoglycemia while taking metformin, glyburide, bisoprolol, and sliding scale insulin. What do you recommend?
stop glyburide
Only decrease metformin
Stop bisoprolol
stop sliding scale insulin
Which study showed benefit for secondary prevention with a moderate intensity statin in elderly patients?
4S
AFCAPS
PROVE-IT
PROSPER
SAGE
YR is 82 and has blood pressure of 152/94 today in clinic. He has not been previously diagnosed with hypertension and appears well with no known comorbidities. What do you recommend?
Start lisinopril
Start metoprolol tartrate
Start amlodipine
Start furosemide
Do not start any new medications at this time
RE is having an acute angle closure crisis with an IOP of 68 (weight 71 kg). What treatment is most appropriate?
Pilocarpine 1-2% every 5 minutes for 2-3 doses and then every 4-6 hours
Mannitol IV 70 g
Acetazolamide
Labetalol
Latanoprost
PL has open angle glaucoma and would like to start therapy. She has history of COPD, sulfa allergy, and currently takes selegiline (an MAOI) for Parkinson’s disease. What do you recommend?
Latanoprost
Brimonidine
Methazolamide
Carteolol
Carbachol
1. A patient has glaucomatous visual field loss but a normal IOP of 18. When treating this patient, what is your goal IOP reduction?
IOP <21
IOP <10
IOP <10-12
Since this patient has normal IOP, you do not try to reduce IOP but use other means to improve glaucoma
Which of the following are contraindications for using latanoprost?
Macular edema
COPD
CHF
herpetic keratitis
bradycardia
