BCPS 2013: Infectious Disease (Pneumonia)

Infectious Disease.  The topic that I like but loathe.  At the same time. Pneumonia

1. Community Acquired Pneumonia (CAP) - not hospitalized 2 days or more within the past 90 days, not in a LTC facility/residence, no IV antibiotic therapy, IV chemo, or wound care in the past 30 days, or attendance at a hospital or dialysis clinic.  Must have at least two of the following symptoms:  fever or hypothermia, rigors, sweats, new cough (with or without sputum), chest discomfort, onset of dyspnea, or fatigue, pain, headache, myalgias, anorexia.CURB-65 - predictor of complicated course and whether to admit to the hospital.  Give a point for each of the following:  age > 65, comorbid illnes (DM, CHF, lung dz, renal dz, liver dz), high temp > 101F, Bacteremia, altered mental status (think elderly), immunosuppression (cancer, steroid use), High-risk etiology (S. aureus, legionella, G- bacilli, anaerobic aspiration), multilobe involvement or pleural effusion.
2. Nosocomial Pneumonia:  Hospital Acquired Pneumonia (HAP) (48 hours or more after admission), Ventilator Assoc Pneumo (more than 48–72 hours after intubation), Health care Assoc Pneumo (2 or more days within 90 days of the infection) - know risk factors of nosocomial pneumonia.  Pretty common sense.
3. CAP Organisms:  Unidentifiable (40-60%), M.pneumo, S. pneumo, H.flu, C.pneumo, viruses, S. aureus, Moraxella cat,
4. Alcoholics - S. pneumoniae, oral anaerobes, gram negative bacilli
5. Nursing Home - S. pneumoniae, H. influenzae, gram negative bacilli, S. aureus
6. COPD - S. pneumoniae, H. influenzae, M. catarrhalis
7. Postinfluenza: H. influenzae, S. aureus, S. pneumoniae
8. Exposure to water: Legionella
9. Poor oral hygiene: oral anaerobes
10. HIV infection: P. jiroveci, S. pneumoniae, M. pneumoniae, Mycobacterium

HAP Organisms:  S. aureus, Pseudomonas aeruginosa, Enterobacter spp., Klebsiella pneumoniae, Candida, Acinetobacter spp., Serratia marcescens, Escherichia coli, S. pneumoniae

P. aeruginosa is transmitted by health care workers’ hands or respiratory equipment S. aureus is transmitted by health care workers’ hands Enterobacteriaceae endogenously colonize hospitalized patients’ airways (healthy people seldom have gram negative upper airway colonization) Stress changes respiratory epithelial cells so that gram-negative organisms can adhere Up to 70% of patients in the intensive care unit have gram-negative upper airway colonization, and 25% of them will become infected through aspiration

TREATMENT

CAP - duration of treatment at least five days:

Empiric nonhospitalized - prev healthy and no abx in past 3 mos - macrolide or doxy (macrolide if H.flu suspected) and if comorbidities present or recent antibiotics in past 3 months - Respiratory fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg])

-- OR -- Macrolide (or doxycycline) with high-dose amoxicillin (1 g 3 times/day) or amoxicillin/clavulanate (2 g 2 times/day) or with a cephalosporin (ceftriaxone, cefuroxime, or with cefpodoxime)

Empiric treatment of hospitalized patients with moderately severe pneumonia - Respiratory fluoroquinolone

--OR-- Ampicillin, ceftriaxone, or cefotaxime (ertapenem in select patients) plus a macrolide (or doxycycline)

Empiric treatment of hospitalized patients with severe pneumonia requiring intensive care unit treatment (may need to add other antibiotics if P. aeruginosa or MRSA is suspected)

• Ampicillin/sulbactam plus either a respiratory fluoroquinolone or azithromycin
• Ceftriaxone plus either a respiratory fluoroquinolone or azithromycin
• Cefotaxime plus either a respiratory fluoroquinolone or azithromycin

Treatment duration—at least 5 days, with 48–72 hours afebrile and no more than one sign of clinical instability (elevated temperature, heart rate, or respiratory rate; decreased systolic blood pressure; or arterial oxygen saturation) before therapy d/c

Hospital Acquired Pneumonia - Treatment duration—Efforts should be made to decrease therapy duration to as short as 7 or 8 days (14 days for pneumonia secondary to P. aeruginosa).

1. Early onset (less than 5 days) and no risk factors for multidrug-resistant organisms -  Common organisms include S. pneumoniae, Haemophilus influenzae, (MSSA), Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., and Proteus spp. -- Treatment -- Third-generation cephalosporin (cefotaxime or ceftriaxone), Fluoroquinolone (levofloxacin, moxifloxacin, ciprofloxacin), Ampicillin/sulbactam, OR Ertapenem
2. Late onset (5 days or longer) or risk factors for MDR organisms - Common organisms include those listed above for early onset plus Pseudomonas aeruginosa, K. pneumoniae (extended spectrum β-lactamase positive), Acinetobacter spp., MRSA, and Legionella pneumophila. -- Treatment -- a.  Ceftazidime or cefepime plus aminoglycoside or fluoroquinolone (cipro-, levo-)  b.  Imipenem, meropenem, or doripenem plus aminoglycoside or fluoroquinolone (ciprofloxacin, levofloxacin), OR c.  Piperacillin/tazobactam plus aminoglycoside or fluoroquinolone (ciprofloxacin, levofloxacin)  ***Vancomycin or linezolid should be used only if MRSA risk factors (e.g., history of MRSA infection/colonization, recent hospitalization or antibiotic use, presence of invasive health care devices) are present or there is a high incidence locally (greater than 10%–15%).

Risk factors for MDR organisms -- Antibiotic therapy within the past 90 days, Hospitalization of 5 days or more, High resistance in community or hospital unit, Risk factors for health care–associated pneumonia, Immunosuppressive disease and/or therapy

A wonderful article published just last November that I love.  (Pharmacy Times)  Only thing is it doesn't go into the detail of the different antibiotics with Late vs Early Onset of Hospital Acquired.  Just CAP.  That's OK

And because guidelines haven't changed, my quizlet from last year.  Hope you enjoy:

BCPS 2013: ADHD Pediatrics (Stimulants: Amphetamines)

Ironically enough I could stand to use an amphetamine this morning as I am struggling to wake up.  Caffeine will have to suffice.  Have you started studying yet?  I really think it's time if you want to make it a more enjoyable experience rather than cramming as I did last year.  It just doesn't work for an old 40 year-old brain like myself.  That's right.  I'm turning 40 today.  I cannot believe it.  Ask anyone around me though, (ok maybe this is just a hope I have) I still am youthful.  Perhaps it's the young toddler almost kindergartner and 2 1/2 year-old I have.  Perhaps it's my mindset.  Whatever it is, I hope it sticks around the next 40 years.  

Amphetamine-containing products in ADHD

1.  Adderall - mixed amphetamine salts immediate release

2.  Adderall XR - mixed amphetamine salts extended release:  indicated for the treatment of ADHD in children 6 years and older.  50/50 immediate release and extended release beads.  Duration 10-12 hours.  Once daily dosing.  Can sprinkle on applesauce.

3.  Vyvanse - Lisdexamfetamine dimesylate (say that one three times fast!):  prodrug, designed for less abuse, duration 10 hours, no clinical superiority over other amphetamine-containing meds.

Adverse Effects of Amphetamine-containing products:  appetite loss, insomnia, abdominal pain, and nervousness, hypertension worsening, tic disorder worsening.  *Recent labeling change warns of association with sudden cardiac death (potential) so IS NOT RECOMMENDED FOR PATIENTS WITH KNOWN STRUCTURAL HEART DEFECTS.  Routine eletrocardiography is not recommended unless history and physical exam suggest cardiac disease.  And, don't withhold if you can't get an electrocardiogram or assessment by a pediatric cardiologist (if otherwise healthy).

Nonstimulant medications in ADHD

1.  Strattera - Atomoxetine Potent inhibitor of NE reuptake, once or twice daily dosing, **considered first line therapy for children with an active substance abuse problem, comorbid anxiety, or tics.

Adverse Effects - dyspepsia, decreased appetite, weight loss, and fatigue, can cause liver injury but don't monitor liver enzymes, *doesn't exacerbate tics (imagine a question like this:  kid has tics what is the best choice for ADHD), and don't forget black box warning that a lot of SSRIs have for suicidal ideation in children and teens.  AND Please don't forget CYP2D6 with atomoxetine.

2.  Antidepressants - Non-FDA label approved treatment - Bupropion and Imipramine/Nortriptyline

Bupropion obviously contraindicated in seizure disorder.  Can use immediate or extended release.

Imipramine and Nortriptyline - electrocardiogram to start and after each dose increase and desipramine used with extreme caution due to reports of sudden death.

3.  Alpha-Adrenergic Receptor Agonists - Clonidine and Guanfacine

Clonidine - KAPVAY - ADHD in 6-17 year olds (clonidine extended release), use in combo with methylphenidate lessons tics

May be more effective for hyperactivity than for inattention

adverse effect:  SEDATION

Guanfacine - Intuniv - extended release for 6-17 year olds.  Shown to improve comorbid tic disorder.  Less sedating with a longer DOA than clonidine.  Can have rebound hypertension with abrupt d/c of extended release product.

BCPS 2013: ADHD Pediatrics (Stimulants: Methylphenidates)

The DSM-5 will not be out until later this year (hopefully).  So, the criteria for ADHD in the DSM-IV-TR:

DSM-IV Criteria for ADHD

I. Either A or B:

Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for developmental level: Inattention

1. • Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
   • Often has trouble keeping attention on tasks or play activities.
   • Often does not seem to listen when spoken to directly.
   • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
   • Often has trouble organizing activities.
   • Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
   • Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
   • Is often easily distracted.
   • Is often forgetful in daily activities.

   Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level: Hyperactivity

• Often fidgets with hands or feet or squirms in seat when sitting still is expected
• Impulsivity
• Often blurts out answers before questions have been finished.
• Often has trouble waiting one's turn.
• Often interrupts or intrudes on others (e.g., butts into conversations or games)
• Often gets up from seat when remaining in seat is expected
• Often excessively runs about or climbs when and where it is not appropriate (adolescents/adults feel restless)
• Often has trouble playing or doing leisure activities quietly
• Is often on the go or often acts as if driven by a motor
• Often talks excessively

II. Some symptoms that cause impairment were present before age 7 years.

III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).

IV. There must be clear evidence of clinically significant impairment in social, school, or work functioning.

V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Based on these criteria, three types of ADHD are identified:

IA. ADHD, Combined Type: if both criteria IA and IB are met for the past 6 months

IB. ADHD, Predominantly Inattentive Type: if criterion IA is met but criterion IB is not met for the past six months

IC. ADHD, Predominantly Hyperactive-Impulsive Type: if Criterion IB is met but Criterion IA is not met for the past six months.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

In late October 2011, the American Academy of Pediatrics (AAP) released new guidelines for the diagnosis and treatment of ADHD, updating guidelines that dated back to 2000 and 2001. The biggest change is that the guidelines were expanded to include recommendations for children and adolescents ages 4 to 18. The previous guidelines included children ages 6 to 12.

There are two recommended forms of treatment for ADHD, medication and behavior therapy. The new guidelines recommend starting with a course of behavior therapy in preschool age children (ages 4-5) and adding medication if necessary. For older children, they recommend a combination of medication and behavior therapy.

Treatment Options: Combination of pharmacotherapy and behavioral therapy is more beneficial compared

with either intervention alone.

Stimulant medications: Some children with ADHD respond better to one stimulant type than another; therefore, both methylphenidate- and amphetamine-containing products should be tried before stimulant treatment is deemed a failure.

a. Methylphenidate-containing products: “Ramp effect” = behavioral effects are proportional to the

rate of methylphenidate absorption into the central nervous system

Treatment

**Combination therapy with behavioral therapy and medication is better than either alone.

Stimulant Medications (amphetamine or methylphenidate try both before deeming stimulants a failure)

Adverse Effects of this category:  (a) Headache, stomachache, loss of appetite, and insomnia  (b) Use with caution in patients with glaucoma, tics, psychosis, and concomitant monoamine oxidase inhibitors (c) Insomnia

Methylphenidate immediate release (Ritalin)

• A 50:50 racemic mixture of l-threo and d-threo isomers of methylphenidate
• The short duration of action requires two or three doses daily.

Dexmethylphenidate (Focalin)

• Only d-threo isomer, thought to be the active enantiomer of methylphenidate
• l-Threo isomer hasn't been shown to hinder the effectiveness or increase the adverse effects of methylphenidate
• Recommended doses are half those of racemic methylphenidate immediate release
• Short duration of effect requires two or three doses daily
• Offers no proven pharmacoeconomic benefit over other methylphenidate immediate release products (i.e., Ritalin and generics)

Methylphenidate sustained/extended release (Metadate ER, Ritalin SR)

• Duration of action may be up to 8 hours, but must use two doses daily for afternoon control
• May be used in place of methylphenidate immediate-release BID dosing regimen after dose titration with IR product

Methylphenidate (OROS) (Concerta)

• Indicated for the treatment of ADHD in children 6 years and older
• Tablet contains osmotic agents and a rate-controlling membrane with a laser-drilled hole for release
• Outer capsule contains 22% of drug (immediate release) and tablet core contains the remainder released over 10 hours
• Do not crush or divide
• Duration of effects is 10-12 hours (behavioral)
• Once daily dose with/without food

Dexmethylphenidate ER (Focalin XR)

• Uses spheroidal oral drug absorption system polymer-coated beads
• Bimodal drug release
• Faster onset than methylphenidate (OROS), but shorter duration of action.  Afternoon symptom control isn't as good as with methylphenidate (OROS) Concerta.

Methylphenidate modified release (Metadate CD)

• Treatment for children 6 and older
• Capsule contains 30% immediate-release beads and 70% extended-release beads (slowly released about 4 hours after ingestion)
• Duration of behavioral effects is 6–8 hours probably need afternoon coverate
• Once-daily dosing; capsule may be opened and sprinkled on applesauce

Methylphenidate extended release (Ritalin LA)

• Indicated for the treatment of ADHD in children 6 years and older
• Uses spheroidal oral drug absorption system polymer-coated beads
• Contains 50/50 immediate/extended release to mimic BID methylphenidate immediate release
• Efficacy can wane later in the day requiring methylphenidate IR coverage for late-day symptoms
• Once daily dosing can sprinkle on applesauce

Methylphenidate transdermal system (Daytrana)

• Apply to hip 2 hours before effect is needed; recommended to remove 9 hours after but can wear up to 16 hrs
• Duration of effect is about 3 hours after removing the patch
• Dose may be titrated weekly to desired effect
• Can swim or exercise while wearing

Amphetamine containing continued tomorrow...

BCPS 2013: Pediatric Seizures

Pediatric Seizures

Partial - VPA, CBZ, PHT PB, gabapentin, lamotrigine, tiagabine, topiramate, oxcarbazepine, zonisamide, levetiracetam

Generalized:

Tonic-clonic - VPA, CBZ, PHT Lamotrigine, topiramate, zonisamide, levetiracetam

Myoclonic - VPA Topiramate, zonisamide, levetiracetam

Absence - Ethosuximide, VPA Lamotrigine, zonisamide, levetiracetam

Lennox-Gastaut - VPA, topiramate, lamotrigine Rufinamide, clobazam, felbamate, zonisamide

Infantile spasms - ACTH Vigabatrin, lamotrigine, tiagabine, topiramate, VPA, zonisamide

Know the adverse effects and pharmacokinetics interactions of the medications listed above. Think about a scenario. Teen girl has acne, overweight, and seizures. Phenytoin should immediately be crossed of the list because of its side effect profile. Which drugs affect birth control pills effectiveness?

What type of seizure does ACTH cover? What type of seizure does ethosuximide cover?

I will start adding my Flashcards to these topics this week.

BCPS 2013: Vaccines

Vaccines:  the memorization of when and what and when not to if the patient has certain conditions.  Imagine questions that are simple but complicated.  For example, perhaps an age is given and you need to know what vaccinations were due by that age or if the child had never had vaccines what could be given as catch-up?  It is really not complicated and again if you are a parent this may be an easier topic if you are of the pro-vax crowd (as I am). Below see the schedule from the CDC that is also approved by the American Pediatric Association along with the recommended schedule for catching up on vaccines if missed.

Special Population Considerations

1. Preterm infants

• Immunize on the basis of chronologic age.
• Do not reduce vaccine doses.
• If birth weight is less than 2 kg, delay HepB vaccine because of reduced immune response until the patient is 30 days old or at hospital discharge if it occurs before 30 days of age (unless the mother is positive for HepB surface antigen).

2. Children who are immunocompromised

• No live vaccines
• Inactivated vaccines and immune globulins are appropriate
• Household contacts should not receive oral polio vaccine
• MMR, influenza, varicella, and rotavirus vaccines are recommended

3. Patients receiving corticosteroids

a. Live vaccines may be administered to patients receiving the following:

• Topical corticosteroids
• Physiologic maintenance doses
• Low or moderate doses (less than 2 mg/kg/day of prednisone equivalent)

b. Live vaccines may be given immediately after discontinuation of high doses (2 mg/kg/day or more      of prednisone equivalent) of systemic steroids given for less than 14 days.

c. Live vaccines should be delayed at least 1 month after discontinuing high doses (2 mg/kg/day or more      of prednisone equivalent) of systemic steroids given for more than 14 days.

4.  HIV Positive Patients

a. MMR should be administered unless patient is severely immunocompromised. b. Varicella should be considered for asymptomatic or mildly symptomatic patients. c. Inactivated vaccines should be administered routinely.

BCPS 2013: Pediatrics Otitis Media

Such a fun topic!  Who loves it when the kid says his/her ear hurts?  I cringe just thinking about this one: Otitis Media:  The Bane of all Daycare and all School-aged Youngsters

Common Pathogens

• Viral
• S. pneumoniae
• Nontypeable H. influenzae
• Moraxella catarrhalis

Treatment

• Watch and wait if > 2 yo and pain/fever less than 48-72 hours
• Bulging tympanic membrane/perforation = antibiotics
• Always antibiotics if < 6 months old 4. Middle ear fluid does not indicate repeated treatment unless persists > 3 months
• Corticosteroids, antihistamines, and decongestants are not recommended

Antibiotic regimens a. Amoxicillin (high dose: 80–90 mg/kg/day): Recommended by AAP as the first-line therapy for acute otitis media b. Amoxicillin/clavulanate c. Cefuroxime d. Other antibiotic options (e.g., cefdinir, cefpodoxime) may be effective. e. Duration i. The most appropriate duration is unclear. ii. In general, 7–10 days, but a shorter course (5 days) has been used in children older than 2 years iii. For confirmed cases of acute otitis media not responding to the initial antimicrobial regimen within 48–72 hours, a change in antibiotic regimen is warranted. Failure of the the above warrants ceftriaxone IM for 3 days or tubes i. Intramuscular ceftriaxone may also be considered if adherence is a concern. ii. Tympanostomy with tube placement may be most beneficial for children with persistent otitis media with effusions and significant hearing loss (e.g., greater than 25-dB hearing loss in both ears for more than 12 weeks).

Prophylaxis 1. Reserved for patients with recurrent acute otitis media 2. Reduces occurrence by about one episode per year 3. The risk of promoting bacterial resistance may outweigh the slight benefit

BCPS 2013: Pediatrics

I feel I have a bit of insight into the test and can attest to what is needed to know in each section.  Keep in mind the guidelines could change between 2012 and 2013 along with the test questions, but for the most part I found the test to be incredibly fair though stressing areas more than others that I would have not expected. I want you to pass!  First attempt!

So what do you need to do to pass?  Start now.  I especially am talking to those with families and/or children and very little time to spare for sitting down and studying the traditional way.  Again, I did fail this past year, so I will disclose that immediately, but I do believe I have insight into the test and very much plan to pass it this fall.  It's a goal at this point for my own personal development.

So, ahead I will have some material presented that does come from the ACCP study material though reworded and simplified in more study form and perhaps some hints as to what was important on the test in each particular section.  I am hoping to not get in any sort of trouble by doing this as far as with the BPS, so if this is not appropriate, would someone from there contact me?  I do not plan on giving test questions per se' and I couldn't if I tried as there were far too many to memorize.

After two children I am convinced parts of my brain were delivered with the children as it is.

First up!  PEDIATRICS!

This was always the topic that would terrify me prior to having children, but at this point besides missing one of the most common concepts of children and the very small amount of data on the test regarding pediatrics (at least in my opinion), pediatrics just doesn't seem so daunting.

Know the common pathogens of children in sepsis and meningitis.

0–1 month  

• Group B streptococcus
• Escherichia coli
• Listeria monocytogenes
• Viral (e.g., herpes simplex virus)
• Coagulase-negative staphylococcus—nosocomial
• Gram (−) bacteria (e.g., Pseudomonas spp., Enterobacter spp.)
• nosocomial

1–3 months

• Neonatal pathogens (see above)
• Haemophilus influenzae type B
• Neisseria meningitidis
• Streptococcus pneumoniae

3 months–12 years

• H. influenzae type Ba
• N. meningitidis
• S. pneumoniae

> 12 years

• N. meningitidis
• S. pneumonia

Not to hard to figure out correct?  Keep in mind that H. flu is less and less due to immunizations.  I suppose if you live in an area where vaccination is the devil, you may find more of this organism.

Potential Antibiotic Regimens

Age                                                                         Regimen

0–1 month                                                            Ampicillin + gentamicin OR ampicillin + cefotaxime

1–3 months                                                          Ampicillin + cefotaxime/ceftriaxone

3 months–12 years                                             Ceftriaxone ± vancomycina

> 12 years                                                             Ceftriaxone ± vancomycina

**Addition of vancomycin should be based on the regional incidence of resistant S. pneumoniae.

Regimens for Chemoprophylaxis  (I will have to reformat this later)

Drug                      Neisseria meningitidis                                                                       Haemophilus influenzae

Rifampin            < 1 month old: 5 mg/kg/dose PO every 12 hours × 2 days                       20 mg/kg/dose (maximum 600 mg)

> 1 month old: 10 mg/kg/dose PO every 12 hours × 2 days                   daily x 4 days

Adults: 600 mg PO every 12 hours × 2 days

Ceftriaxone             < 15 years old: 125 mg IM × 1 dose                                                               Not indicated

> 15 years old: 250 mg IM × 1 dose

**Ciprofloxacin and azithromycin are possible alternatives although not routinely recommended.

RSV - Identify the drugs available for preventing and treating respiratory syncytial virus.

Prophylaxis

1. Nonpharmacologic: Avoid crowds during RSV season and conscientiously use good hand-washing practice.
2. RSV IVIG (RespiGam): No longer marketed in the United States (didn't see on the test ;))
3. Palivizumab (Synagis)

• a. Dosing: 15 mg/kg/dose intramuscularly; given monthly during RSV season
• b. Effects on outcomes

i. A 55% reduction in hospitalizations for RSV

ii. Safe in patients with cyanotic congenital heart disease

iii. No reduction in overall mortality

iv. Does not interfere with the response to vaccines

v. Not recommended for the prevention of nosocomial transmission of RSV

Know this:  Supportive care.  Treatment is supportive care only.

American Academy of Pediatrics Palivizumab approval:  (you WILL see this)

i. Premature infants born before 32 weeks’ gestation (i.e., 31 weeks, 6 days or earlier) who are 6 months old or younger at the beginning of RSV season

(a) Infants born at less than 28 weeks’ gestation may benefit up to 12 months of age.

(b) Eligible for a maximum of five doses of palivizumab during RSV season

ii. Infants with chronic lung disease who are 2 years or younger and who required medical management of their chronic lung disease in the previous 6 months – Eligible for a maximum of five doses of palivizumab during RSV season

iii. 32 and 35 weeks’ gestation (i.e., 32 weeks, 0 days through 34 weeks, 6 days) who are 3 months or younger at the beginning of RSV season

(a) With at least one of the following risk factors may benefit: infant attends childcare or sibling younger than 5 yo in same household

(b) Eligible for a maximum of three doses of palivizumab during RSV season

iv. Infants 24 months and younger with hemodynamically significant congenital heart disease

(a) Eligible for a maximum of five doses of palivizumab during RSV season

(b) There is a 58% decrease in palivizumab serum concentration after cardiopulmonary bypass; therefore, a postoperative dose of palivizumab is recommended as soon as the patient is medically stable.

v. Infants 12 months and younger with congenital abnormalities of the airway or neuromuscular disease that compromises the handling of respiratory tract secretions – Eligible for a maximum of five doses of palivizumab during RSV

Tomorrow will continue with otitis media...

The Power of Quizlet and Studying for the BCPS 2013

Quizlet is an amazing online flashcard storage site where there are many many sets of different types of collections of cards or "sets" to study.  I do not remember exactly how I found Quizlet, but suffice it to say that it is a great resource.  I am "lofgrenb" on there if you are looking for me.  I have tons of sets that are mostly set to private, but would be glad to share.  Just message me. Basically you create a profile either by hand or like everything else out there on the interwebs, just link it to your Facebook, because you KNOW you want everyone to know your business.  (wink wink)

In the "search Quizlet" box, you will type in BCPS.  Right now it's 2012 and 2011 cards that pop up, but as more and more BCPS pharmacists-to-be (including me) start creating new sets, you will be able to see them.  There is a "copy" button where you can copy the entire set that the user spent hours on and make it your own.  I know, slick right?  I have done a bit of both:  making my own and copying others and then editing to my liking.  Since there isn't a lot of ACCP material on regulations and stats, I highly recommend taking a look at some sets I like at the moment.

This is a regulatory one.

See this user:  rx_jenn:  All of her sets are fabulous.

If anyone knows her, tell her Blonde Pharmacist thanks her.  I should have spent a little more time studying to pass rather than barely failing, but I'm ready to tackle the beast again.

Anyone want to join in on flashcard creating?

Anyone up for meeting in Reno, NV at the ACCP 2013 Update in Therapeutics?  I will be there!