1.2.5: Develop and implement individualized treatment plans, taking into consideration actions and mechanisms of actions of drugs
The emergency physician is unable to obtain CSF fluid after multiple attempts. Based on clinical findings, the team believes that the 15-day-old, former 36-week gestational age baby may have meningitis. What is the best therapy to begin in this baby before sending her to a pediatric hospital?
(A) Ampicillin and gentamicin
(B) Ceftriaxone and tobramicin
(C) Vancomycin and cefotaxime
(D) Ampicillin and ceftriaxone
Ampicillin and gentamicin (A) is a recommended therapy in neonates that will cover the likely pathogens, and is safe to use in this age group.
Ceftriaxone and tobramicin (B) are not correct for multiple reasons. First, the coverage does not include activity against Listeria monocytogenes. Second, ceftriaxone should not be used in neonates because of the possibility of kernicterus. Finally, IV ceftriaxone should not be used within 48 hours of IV calcium in the neonatal population. Although vancomycin (C) does have extensive gram-positive coverage, it is not a first-line therapy against L. monocytogenes. Therefore, this regimen should include ampicillin. Additionally, the addition of vancomycin is not routinely recommended for neonates. Although ceftriaxone (D) provides adequate antimicrobial coverage, it should not be used in neonates because of the possibility of kernicterus. Additionally, when ceftriaxone is used one needs to remember that it should not be used within 48 hours of IV calcium.
Topic: Central Nervous System Infections
Which bronchodilator utilized in the pharmacologic management of COPD is a phosphodiesterase inhibitor?
Theophylline (E) causes bronchodilation, diuresis, central nervous system, cardiac stimulation, and gastric acid secretion by blocking phosphodiesterase, which increases tissue concentrations of cAMP, which in turn promotes catecholamine stimulation of lipolysis, glycogenolysis, and gluconeogenesis, and induces release of epinephrine from adrenal medualla cells.
Levalbuterol (A) increases cAMP, thereby relaxing bronchial smooth muscle. Formoterol (B) increases cAMP, thereby relaxing bronchial smooth muscle. Ipratropium (C) blocks the action of acetylcholine at the parasympathetic sites in bronchial smooth muscle, causing bronchodilation. Fluticasone (D) is not a bronchodilator.
Which mechanism of action of trazodone leads to the side effect of weight gain and reflex tachycardia?
(A) 5-HT receptor antagonist
(B) 5-HT reuptake inhibitor