Pharm Final New material:

Here is the study guide for the new material for the final. I don’t have time to do a concise version of the old material, but here is a combined word doc of all the previous study guides so it is easily searchable.

pharmstudyguidefull

NewMaterial

New Material:

 

estrogen-progesterone combined hormone therapy

 

  • together there is a lower chance of endometrial cancer
  • Monophasic—fixed ratio of estrogen and progestin that is taken for 21 days
  • Biphasic—supplies 2 different amounts of progestin during the first and second phases of the menstrual cycle
  • Triphasic—dose of estrogen is constant while progestin is progressively increased (three times) for 21 days

 

anthelmintics

  • A class of antiparasitic drugs that expels parasites from the body.
  • Niclosamide (Nicolicide)
    • Use against flatworms.
    • stool sample must be negative for the parasite for three months to be “cured”
    • Action: kills the head (scolex)
    • parasite is digested once killed.
  • Piperazine
    • paralyzes the worm, then it detaches and is excreted.
  • Mebendazole (Vermox)
    • vermacicidial
    • increased absorption w/ fatty food.

estrogen hormone replacement therapy

  • increase synthesis of DNA, and proteins.
  • can cause Na retention and lower cholesterol
  • For estrogen deficiency, osteoporosis prevention and health
  • SE: WEIGHT GAIN, changes in menses pattern
  • gain about 5lbs of weight from the medication.
  • cautions: endometrial cancer with use over 2 years, do not give to breast feeding women, effects liver, clotting(MI, Stroke), bladder stones,
  • contraindications: breast cancer, abnormal vaginal bleeding, Thrombophlebitis, PE, hyperCa, endometriosis
  • smoking can increase cardiac issues and chance of stroke.

antifungals

 

  • Amphotericin B
  • Broad spectrum  

 

      • Cell wall/membrane permeability is disrupted
        • humans have cell membranes…
        • binds -sterols which are also found in the human body (cholesterol) which causes the renal damage.
        • it is very toxic
      • used for SYSTEMIC mycoses that are potentially fatal, admin parenteral: infusion reaction fever and chills, nephrotoxic
      • ADME: can be found up to a year later in the pt body

 

  • Griseofulvin
  • still in the -azole class
  • just for SUPERFICIAL  (skin infections), not systemic
  • inhibits fungal mitosis

 

    • s/e: Insomnia, Rash and headache

 

  • Ketoconazole

 

    • used in less severe fungal reactions (fungistatic)
    • MOA is it inhibits the synthesis of ergosterol which is a part of the fungal cell membrane
      • this also affects the body’s sterols (sex hormones)
    • -conazols are all less toxic

 

  • Mycostatin (Nystatin)

 

    • Candidiasis only
    • It is in the form of a mouth wash
    • alters the permeability of the membrane
    • used for infant thrush often due to the low side effects.

 

Premarin (estrogen)

  • conjugated estrogen
  • from HORSES
  • see estrogen for SE and other info

anti-parasitics

 

  • for malaria:

 

    • Mefloquine
      • No photosensitivity
      • once a week dose
      • can be used w/ kiddos
      • There are serious psychological SE: anxiety, hallucinations
  • for amebiasis
    • Metronidazole (flagyl)
        • for invasive amebiasis, giardiasis, trichomoniasis
        • SE: neurotoxic, Disulfiram reaction, be cautious with anticoagulants, thrombophlebitis, furry tongue?

oral contraceptives (OCPs, BCPs)

  • Newer OCP have less of the hormones and less side effects.
  • Heavier people have a lower % of “coverage” because of the increased body weight
  • inhibit FSH and LH release
  • many SE and increased coagulability, weight gain, cramps, acne or less acne,
  • Can help with anemia by lessening blood loss during periods.

IUDs

  • a T shaped piece with a copper coil that is pressed up against the fundis and prevents pregnancy for about 5 years.

topical glucocorticoids

Ring / Patch

  • NuvaRing
    • insert for 3 wk
    • take out after menses
    • higher risk of clot than PO

 

  • Patches
    • change wkly, three in a box
    • do not put on the breast
    • Higher risk of clot than PO

isotretinoin (Accutane)

  • Anti acne
  • Preg X
  • monitor triglycerides
  • Steven johnson syndrome, Suicide, Necrolysis, severe birth defects.

Estrogen only pills

  • these are for estrogen replacement, secondary for bone health, and vaginal atrophy
  • Estradiol and estrone are natural occurring steroidal estrogens
  • Conjugated estrogen (Premarin)
  • Diethylstilbestrol (DES) is synthetic
  • Transdermal estrogen (Estraderm)
  • Vaginal creams
  • Compounded mixtures

doxycycline (Tetracycline)

 

  • Broad spectrum
  • Inhibit protein synthesis
  • Effective through PO route
  • for ACNE, lyme Dx, H. pylori, Cholera, Rickettsia, cholera
  • Can treat MRSA with Clindamycin, and Bactrim

 

  • chelation occurs when calcium, Iron, and magnesium containing supplements and foods inactivate the tetracycline and cause it to be inactive
    • do not take with meals!
    • one hour before or two hours after meals to avoid chelation
  • S/E: photosensitivity, brown teeth, not ok for mothers pregnant and breastfeeding moms, do not give to kiddos.

 

testosterone

  • schedule II drug
  • useful for osteoporosis to increases the building blocks for bone growth
  • indicated for hypogonadism, androgen deficiency, may reverse ED, delayed male puberty.
  • administration
    • PO, IM, patches, skin gel
  • SE: ab pain, insomnia, gynecomastia, frequent erections, prostate growth, frequent urination
  • monitor

PDE-5 inhibitors

 

  • cialis
  • levitra
  • Viagra

 

    • schedule II drug
    • useful for osteoporosis to increases the building blocks for bone growth
    • indicated for hypogonadism, androgen deficiency, may reverse ED, delayed male puberty.
    • administration
      • PO, IM, patches, skin gel
    • SE: ab pain, insomnia, gynecomastia, frequent erections, prostate growth, frequent urination
    • monitor for vision changes.

ED Drugs (PDE-5 inhibitors)

 

  • Cialis
  • levitra
  • viagra

 

 

5-alpha reductase inhibitors

  • finasteride (Proscar)
    • inhibits conversion of testosterone into androgen DTH resulting in shrinkage of the prostate.
    • Indication: BPH
    • SE: decrease in lebedo and impotence.
    • Women who are pregnant or may become pregnant should not handle this drug. Male changes in genitalia may result.

DDAVP desmopressin

  • Antidiuretic hormones, for DI (deficiency of ADH) or a deficiency of Vasopressin
  • Nasal route, blow nose before administration
  • only works Neurogenic DI not Nephro-
  • so could be used after head injury and surgery
  • can be used for enuresis too which is bed wetting
  • Complications: water intoxication (imbalance of electrolytes and causes drowsiness headache convulsions and coma)
  • cardiac patients are at a high risk for s/s from fluid overload

vasopressin

  • Antidiuretic Hormone
  • for DI from too little ADH and severe vasodilated shock
  • only excrete unbound water
  • alters renal permeability to reabsorb more water.
  • Decreases urine output and increases BP.
  • can cause an MI in a person with a cardiac pathology
  • Monitor BP, HR and ECG in cardiac patients

amyl nitrate

  • For Chest pain
  • cyanide antidote

thyroid labs

    • TRH is released in the hippocampus
    • TSH is released in the pituitary
    • T3 and T4 are released in the thyroid

 

  • each of these stimulate the production of the chemical below. T3 and T4 slow production/release of TRH telling the hippocampus that there is enough T3/4.  

 

  • In hyPERthyroidism there is high T3 and T4 and low levels of TRH and TSH.
  • In hyPOthyroidism there is low T3 T4 and high levels of TRH and TSH.
    • this can be different depending on other factors, but the takeaway is that the T3/4 hormones are low in hypo and high in Hyper.

BPH Drugs

 

  • 5-alpha reductase inhibitors

 

    • finasteride (Proscar)
  • alpha blockers have an effect shrinking the prostate too

levothyroxine

  • this is T4 and gets converted by the body into T3
  • The dose is very patient dependent and there are MANY pill quantities. this also means that a Generic drug which can be plus or minus 20% of the drug, may cause the patient to be getting too much or too little of the drug.
  • Long H life of a week
  • daily dosing
  • takes about a month to get to the therapeutic effects

liothyronine (Cytomel)

 

  • T3

 

    • shorter H life
    • more money
    • faster onset

radiocontrast dye

 

  • antidote: N-acetylcysteine, Na Bicarb, and normal saline

 

pilocarpine

  • for glaucoma
  • Direct acting cholinergic agonist
  • causes meiosis and contraction of ciliary muscles.
  • eye drops 6qd

flumazenil

  • antidote for Benzos (valium, Diazepam)

cycloplegic drugs

 

  • paralyze ciliary muscles
  • SE: Blurry vision, angle-closure glaucoma, Anticholinergic effects

 

  • mydriatics – dilate the pupil, for surgery and examinations
    • Phenylephrine – dilated eye

N-acetylcysteine

 

  • Antidote for Contrast induced Nephropathy, w/ sodium bicarb and NS
  • antidote for CONTRAST DYE!!!
  • Antidote for acetaminophen (TYLENOL)
  • also a mucolytic but this may be less important.

 

  • PO 140mg/kg, then 70mg/kg q4hr
  • Action: Decreases viscosity of mucus to expectorate
  • inhaled through nebulizer
  • DX that need this are COPD and cystic fibrosis
  • Onset > 1 min Peak 5-10 min
    • Bad odor
  • side effects are runny nose, throat and lung irritation, rash and stomatitis

Sodium bicarb

    • is basic and used to maintain the pH balance

 

  • CHECK IV med compatibility, will get viscous like concrete if mixed with incompatible fluids.
  • enhances renal secretion  
  • antidote for radiocontrast dye with N-acetylcysteine

 

 

ranibizumab (Lucentis)

  • angiogenesis inhibitor
  • can improve visual acuity and reduce risk of further impairment
  • SE: inflammation of the eye, seek medical attention if: eye pain, blurry vision, discharge

antioxidants

  • can help prevent Age related macular degeneration
  • reduce cold/cough time?

medroxyprogesterone

  • a progestin
  • regulates ovulation
  • build up the endometrium for the implantation of the egg

ocular decongestants

  • decrease redness and swelling by vasoconstriction
  • only work on symptoms

Depo Provera

  • IM injection contraceptive
  • lasts three months

angiogenesis inhibitor

 

  • ranibizumab (Lucentis)

 

  • can improve visual acuity and reduce risk of further impairment
  • SE: inflammation of the eye, seek medical attention if: eye pain, blurry vision, discharge

passive vs. active immunity

  • passive immunity is through antibodies
  • active immunity is acting against an active pathogen

Floxin Otic

  • fluoroquinolone, for ear infections in this case
  • can irritate the skin
  • DD interactions w/ amiodarone, and quinidine.

Hep A and B vaccines

 

  • IM inactivated virus injection
  • A
  • Children 12 months or older, 2 doses
  • Duration: 10 years Schedule; first shot, needs booster in 6-12 months Contraindicated in patients with bleeding disorders or febrile illness
  • B

 

    • three doses
    • provides 90% protection; duration unknown
    • May produce mild SE Continue schedule even if delay
    • Most have some immunity after 2 doses.

radioactive Iodine therapy I133

  • for hyperthyroidism and thyroid cancer.  
  • emits gamma and beta particles
  • 8 day H life
  • blocks hormone synthesis
  • needs synthroid after treatment for life (hypothyroid for life)
  • destroys the thyroid gland
  • Lugol’s solution – surgery prep, thyrotoxic crisis, it is an antiseptic

when not to administer a vaccine

  • MMR: not in preg, immunocompromised; allergies to neomycin, gelatin, eggs
  • Varivax: not in preg, immunocompromised, allergies to neomycin, gelatin
  • DTaP: fever, pain
  • OPV: VAPP so use IPV
  • Hib: OK
  • Hep B: anaphylaxis to baker’s yeast; Hep A: OK
  • Influ, Pneumococcal, rotavirus, meningococcal

 

what tetanus to administer by age / circumstance

 

  • If the person has tetanus: Airway, antibiotics, td vaccine, tetanus immunoglobulin
  • DTaP < 10 y.o.; Tdap > 11-12 y.o. as booster; Td if pt has hx of seizures
  • DTap – Schedule: 5 doses; first 3 are 2 mo apart, 4th at least 6 mo after 3rd dose, then between ages 4-6 Not recommended after age 7
  • Contraindicated if previous reaction Report serious rxn: high fever, convulsions, screaming or inconsolable crying, shock

 

IPV

  • Route: SQ; inactivated whole virus
  • Schedule: requires several to reach immunity
  • Protective immune response cannot be assured in immunocompromised
  • Contains trace amounts of streptomycin, neomycin, bacitracin

 

Advertisements

Pharm session 14:

Last Pharm session!!!

 

Session 14

 

Estrogens

  • Estrogen
    • increase synthesis of DNA, and proteins.
    • can cause Na retention and lower cholesterol
    • For estrogen deficiency, osteoporosis prevention and health
    • SE: WEIGHT GAIN, changes in menses pattern
    • gain about 5lbs of weight from the medication.
    • cautions: endometrial cancer with use over 2 years, do not give to breast feeding women, effects liver, clotting(MI, Stroke), bladder stones,
    • contraindications: breast cancer, abnormal vaginal bleeding, Thrombophlebitis, PE, hyperCa, endometriosis
    • smoking can increase cardiac issues and chance of stroke.

 

  • Progestin (megace)
    • changes the thickness of the endometrial lining for the embryo to attach to
    • suppression of ovulation during pregnancy
    • increase appetite which is helpful in anorexia and HIV
    • For hormone imbalance, to start bleeding or stop vaginal bleeding
      • about the same dose for starting and stopping bleeding

 

Contraceptives

  • older meds had higher amounts of the hormones, which caused higher levels of side effects
  • lower dose now and based on a thin teenager, so less effective in a heavier people
  • tested originally in male beagle dogs
  • Action: inhibit FSH and LH secretion, impairs implantation, increases cervical mucus to hinder sperm.
  • SE: gallstones, acne, increased clotting, changes in menses, weight gain
  • can help with anemia but lessening vaginal bleeding.
  • protection against pregnancy if the person remembers to take it
  • Phasic – the number of times that the progestin increases from one to three (mono, bi, tri)
  • Seasonale meds are 3 months on then three months off developed for Sally Wright so that she could go to space.

 

  • YAZ is similar to aldosterone(diuretic) , higher risks of clotting, there is a link to glaucoma after taking for two years. Get your ocular changes checked.

 

non pill contraceptives

  • NuvaRing
    • insert for 3 wk
    • take out after menses
    • higher risk of clot than PO

 

  • Patches
    • change wkly, three in a box
    • do not put on the breast
    • Higher risk of clot than PO
  • long acting progestin only
    • Implanon – inserted in the arm (3-5 years)
    • Depo – Provera (IM injection every 3 months) can cause BONE LOSS
    • IUD (5 years)
    • side effects: vaginal bleeding MM pain, wt gain

 

Other

  • Low-dose progestogens
    • no estrogen and less effective,
    • for during breast feeding

 

Patient education

  • miss one tab – take one now
  • miss two – take two each of the next two days
  • miss three – stop and use a different contraceptive until period.
  • Indomethacin will close the ductus arteriosus so do not take it during pregnancy

 

Postmenopausal help

 

  • Estrogen
  • SSRI
  • Herbals do not have evidence
  • SERMs help bones but increases hot flashes.
    • Ospemifene (osphena)
  • Addyi
    • antidepressant
    • not an immediate impact take for 3 months
    • viagra for women
    • low % of benefit

 

  • can take hormone replacement for 5 years if the woman starts during menopause.

 

Testosterone

 

  • schedule II drug
  • useful for osteoporosis to increases the building blocks for bone growth
  • indicated for hypogonadism, androgen deficiency, may reverse ED, delayed male puberty.
  • administration
    • PO, IM, patches, skin gel
  • SE: ab pain, insomnia, gynecomastia, frequent erections, prostate growth, frequent urination
  • monitor

 

  • what group of HTN meds can reduce BPH
    • alpha blockers

 

many drugs lower the labido of a man

many herbals for this but none are proven.

 

  • Alprostadil (prostaglandin)
    • injection into the corpus cavernosus

 

ED drugs

  • sildenafil (Viagra)
    • action: increase cGMP levels, relaxes smooth muscle, increases blood flow to the erection
    • PO one hour before activity
    • a pilot cannot take this 6-8 hr before a flight because there are changes in color vision. cannot see runway lights correctly.
    • report blue color changes!
    • drink 2L of water a day
    • can develop dependence if taken when they do not need to.
  • Levitra
    • does not need alpha blocker meds
  • Cialis
    • works for 36 hours
    • 5mg daily, or 20mg prn
      • NOT interchangeable!!
      • can cause a heart attack if taking the 20mg daily.

 

Renal disease

 

epogen – for anemia reversal

 

Alu hydroxide(antacid), Ca acetate – to bind extra phosphate

 

calcitriol (rocaltrol) – vitamin D supplement, activated vit D

 

HyperK – arrhythmia issues, causes spiked T wave,

  • Kayexalate – cation exchange resin, binds K and takes it out of the system.
  • Given in enama form and can cause a vagal response slowing down the heart.
  • Insulin can decrease K levels

 

Diuretics – loop and osmotic to deal with fluid balance

 

Na Bicarbonate – to make the pH more basic

  • watch out for the interactions with other meds in the IV line causing the line to clot up and not be patent.
  • can hold on to water, so cardiac, pulmonary, and

 

Pharm Session 13:

Non diabetic hormones and medications

 

Pituitary

 

What is the medication that mimics Oxytocin

  • Pitocin

 

Patients taking an antidiuretic are at risk for fluid overload. What patient would be at a high risk

Posterior Pituitary

 

  • Oxytocin
    • Pitocin is used to induce labor.
  • ADH – Antidiuretic hormone
    • Diabetes insipidus
      • too little ADH
      • can be genetic or injury to pituitary
      • Low specific gravity, bp high tirst
      • Need ADH meds

 

Anterior Pituitary

 

  • DDAVP (Desmopressin)
    • Antidiuretic hormones, for DI (deficiency of ADH) or a deficiency of Vasopressin
    • Nasal route, blow nose before administration
    • only works Neurogenic DI not Nephro-
    • so could be used after head injury and surgery
    • can be used for enuresis too which is bed wetting
    • Complications: water intoxication (imbalance of electrolytes and causes drowsiness headache convulsions and coma)
    • cardiac patients are at a high risk for s/s from fluid overload
  • Vasopressin
    • Antidiuretic Hormone
    • for DI from too little ADH and severe vasodilated shock
    • only excrete unbound water
    • alters renal permeability to reabsorb more water.
    • Decreases urine output and increases BP.
    • can cause an MI in a person with a cardiac pathology
    • Monitor BP, HR and ECG in cardiac patients
  • GH
    • promotes growth of bone and MM
    • GH turns into IGF 1
    • grow tall if the person is young and still growing
    • GH deficiency – these people are normal proportions just small. (treat with GH while young)
    • Acromegaly – when there is an increase in GH after growth is over, this causes bones to grow thicker ie. hands, face, big boggy heart. Self esteem issues.
  • Octreotide (sandostatin)
    • treats acromegaly by suppressing GH release
    • SE: GI, and gallstones (decrease renal function)
    • Assess for Frequency consistency of stools and bowel sounds
    • analog of hormone somatostatin
    • also suppresses Insulin and glucagon, really slow the person down
  • Pegvisomant (somavert)
    • GH receptor antagonist (binds the GH site so that GH cannot do its job)
    • Newest drug class for GH suppression
    • Well tolerated
    • sq injection monthly after loading dose
  • Prolactin
    • Makes milk
    • suppresses ovulation, but do not use this as contraceptive

 

Thyroid medication

 

hormones made here regulate metabolism, Heart function and growth/development

Dwarfism and cretinism may result if these hormones are absent

 

thyroid hormones – TRH ->  TSH ->  T3 and T4

TSH stimulates thyroid to release T3 and T4

 

T3 – active not bound form, and can cross membranes

T4 – is bound and converts to T3 to be used. There is much more T4 than T3.

 

Goiter can come from a lot of different pathologies. Including hypo 95% or goiters and hyperthyroidism 5%

 

Hypothyroidism – T3+4 Low and TSH HIGH. Myxedema

  • liothyronine – T3 analog
  • levothyroxine – T4 analog
  • there are also natural products that are from the ground up cow thyroid

 

Hyperthyroidism – T3+4 high and TSH low. Thyrotoxicosis

  • Graves disease can cause this
  • exophthalmos
  • Too much T3+4

 

  • levothyroxine (synthroid) T4 analog
    • this is T4 and gets converted by the body into T3
    • The dose is very patient dependent and there are MANY pill quantities. this also means that a Generic drug which can be plus or minus 20% of the drug, may cause the patient to be getting too much or too little of the drug.
    • Long H life of a week
    • daily dosing
    • takes about a month to get to the therapeutic effects
  • liothyronine (Cytomel) T3
    • shorter H life
    • more money
    • faster onset

 

  • Propylthiouracil (PTU)
    • used to treat thyroid storm
    • SE: agranulocytosis (discontinue drug if too low WBC count
  • radioactive Iodine-131
    • for hyperthyroidism and thyroid cancer.  
    • emits gamma and beta particles
    • 8 day H life
    • blocks hormone synthesis
    • needs synthroid after treatment for life (hypothyroid for life)
    • destroys the thyroid gland
    • Lugol’s solution – surgery prep, thyrotoxic crisis, it is an antiseptic

 

Effective hyperthyroidism results in decrease in palpitations

 

Adrenal Gland hormones

  • inner medulla stress
  • outer cortex stress, sex and salt
  • Classes
    • Catecholamines – Epinephrine, and norepinephrine
    • corticosteroids – Glucocorticoids work on glucose (cortisol), and mineralocorticoids work on the minerals and salts such as aldosterone
    • Androgens
  • these will be for Addison’s Dx and to suppress inflammation

 

glucocorticoids aka corticosteroids (hydrocortisone, and prednisone)

  • Always taper these meds if on for more than a week
    • glu, lipid, and protein increase blood levels
    • increase glu production and decrease the cellular uptake of glu
    • DO not take for long periods
    • increases cap permeability

 

  • hydrocortisone
    • synthetic cortisol, corticosteroid
    • for adrenocortical insufficiency
    • Altered glucose metabolism at the normal dose, shown by increased GLU levels.
      • HYPERGLYCEMIA, watch closely in DM patients
    • Can cause cushing’s syndrome or adrenal suppression if too much is given
    • Taper dose once the treatment is done.

 

  • Prednisone
    • steroidal Antiinflammatory, intermediate immune modifier
    • Taper the med
    • MAKE SURE THE PATIENT knows how to taper and understand the instructions
    • will go into an adrenal crisis if they do not taper and will look like a person with cushing’s disease
    • Cushing’s Dx test – Dexamethasone suppression test
      • Dexamethasone 1 mg at 2300, the measure the plasma cortisol at 0800. if the ACTH is suppressed

 

Mineralocorticoids

 

addison’s Dx patient need replacement and it comes from extreme adrenal stress. These patients need mineral and glucocorticoids.

 

  • Fludrocortisone (florinef)
    • for addison’s Dx
    • weight gain from edema so watch I and O’s
    • monitor K, BP and NA
    • geven IM in a Addisonian Crisis

 

OB Session 7:

 

Vernix (the white stuff covering the skin) is less abundant the longer GA

 

Acrocyanosis – blue periphery and is normal

 

1st period of reactivity is before the baby falls back asleep. Lasts about an hour.

  • do a lot of mother to baby contact and feeding at this time.

 

The next period is the period of inactivity when the baby cannot really be woken up

 

L.A.T.C.H. score 0-10 10 being best.

Latch, Audible swallowing, Type of nipple, Hold

 

Normals: 110-160bpm, 30-60RR, 98-99F

 

Reasons that babies are bad at controlling temp:

  • Large body SA to Mass, thin epidermis, posture flexed, and need a higher ambient temp to keep their body temp up.
  • Can’t shiver
  • give the baby a layer more than you are wearing

 

Brown fat:

  • once depleted it does not come back
  • 2-7% of body weight
  • on chest and back

 

Blood glucose at 1 hour is ordinary

  • <40ish mg/dl is too low.
  • needs some sort of calories if this is the case.
  • syringe, cup feeding, gavage feed – g tube feeding directly into the stomach.
  • lavage is the cleaning out of the stomach
    • this will happen if the baby swallows bloody amniotic fluid.

 

before placing ID bads what should you do

  • double check identities
  • explain that there may be an alarm system associated with baby’s band to make sure that no one takes it.
  • dont take it off if the baby is still at the hospital

 

milia – don’t pick them

  • keratin cysts
  • they go away

 

stork bite

  • reddened area, may go away

 

epstein pearls

  • white round dots in the back of the throat
  • normal and goes away

 

natal tooth

  • painfull for breast feeding and could be a choking hazard

 

sucking blister in utero

 

polydactyly – extra finger

  • check the rest of the baby closely

 

Lanugo

  • body hair, that is fuzzy and falls off

 

Hair tuft at low back or sacral dimple point towards spina bifida

 

reflexes

  • rooting sucking
  • Moro
  • Palmar grasp
  • step
  • tonic neck
  • Galant
  • Plantar grasp
  • Babinski
  • Protective reflex – link to stanford website

 

Signs or effective breastfeeding

  • seisity
  • good latch
  • stool color change
  • stooling after feeds
  • eventual weight gain, after an initial weight loss of no more than 10% of initial body weight.

 

erythema toxicum

  • normal baby rash and goes away

 

before discharge

  • PKU test
  • car seat test
  • Hearing test
    • Hearing test can be failed due to fluid in the ear canal, need to see a pediatrician to fix this
  • education
  • total bilirubin (sometimes)

 

circumcision is an elective procedure

  • plasta bell, the plastic part is left on until it falls off naturally.
  • clamp types need petroleum jelly to prevent adherence to the diaper.

 

danger or warning signs for parents

  • lay baby on back to prevent SIDS

 

Cephalohematoma

  • does not cross suture line

Caput

  • can cross suture lines

 

Pseudo menstruation, from hormonal withdrawal

brick dust, uric acid excretion in boys and should only happen once.

 

syndactyly, webbed toes

 

slate grey spots – ok and go away

 

Nevus Flammeus – do not generally go away

 

Physiologic jaundice – happens after 24 hours and is OK

Pathologic Jaundice – happens before 24 hours and is bad

  • can be caused by ABO incompatibility

 

Hypoglycemia – <40 mg/dl

  • risk factors:
  • Neonate of DM mother

 

We treat HTN with Aldomet 250mg if the mother has bad HTN, not proteinuria if HTN before

  • HTN can cause Nephrotoxic issues

 

Preeclampsia – HTN after 20 week GA w/ proteinuria  

  • Volume overload and leaky vessels
  • HELLP – hemolysis, elevated liver enzymes, and low platelets
  • cause is mostly know, but thought to be from the placenta developing incorrectly, increased inflammatory response, with endothelial response and leaky.
  • only cure is delivering baby.
  • risk factor: 1st time, HTN or vascular Dx, big baby from DM
  • risks: DIC, abruptio
  • Mag sulfate is for the neural maturity of the baby
    • 4-6 gm loading dose
    • 2-3g/hr
    • Lab: 4-7 mEq/mL
    • monitor mag and RR
    • Pulmonary edema, resp depression and arrest,
    • Calcium gluconate IV is the antidote for MAG toxicity
    • should be on this for 24 hours postpartum, and still at risk for at least 6 weeks