15 Study Guide 2 Flashcards
What is a general summary for DMARDS?
Disease modifying medication for RA. Slow onset, must bridge w/ NSAIDs if needed. Slow disease progression and joint erosions. Improve functional disability and decrease pain. Interfere with inflammatory process (does NOT treat inflammation)
What hormone is avoided in a female with NO uterus?
Progesterone
What combo of hormones is used in females going through menopause who still have a uterus?
Estrogen + Progesterone
Which DM med causes no weight gain?
Metformin. Januvia (Sitagliptan)
What are the common pathogens that cause Diabetic foot ulcer?
S. aureaus, B Hemolytic Strep
If you see a prescription for MTX 7.5mg PO QD what do you do?
Do not fill. Most regimens should be QW or 2xW
Which form of Fe (gluconate, fumarate, sulfate) has the least elemental iron?
Gluconate has the least
What is the rare side effect of Xolair?
Anaphylaxis. BBW: Bronchospasm, Hypotension, Syncope, Urticaria, and/or Angioedema or throat or tongue
Patient has SJS and you need a diuretic, what do you recommend?
Erytharcrynic acid (only non-sulfa). Safe to use: Amiloride, Eplerenone, Ethacrynic acid, Spironolactone, Triamterene
What do the results of the Asthma Control Test show?
Score of 20+ means asthma is controlled. < 20 not well controlled, < 15 very poorly controlled
How it ICS potency ranked for Asthma?
“Follow Busy Bee For Tulips, Mo”: Fluticasone > Budesonide > Beclomethasone > Flunisolide > Triamcinolone > Mometasone
What is a contraindication for an ARB?
Pregnancy, Renal artery stenosis, volume depletion, renal/hepatic impairment
What is the treatment of Thyroiditis?
Propanolol reduce heart rate/tremors, steroids, etc
Which organism causes CAP?
Strep. pneumonia
Which organism can cause Pneumonia in an otherwise healthy person?
Mycoplasma pneumonia
What does SAR stand for?
Structure Activity Relationship
What is the MOA of GP IIb/IIIa inhibitors?
Directly block platelet GP IIb/IIIa receptor on the platelet membrane; inhibit binding of fibrinogen to the GPIIb/IIIa receptor thus inhibiting platelet aggregation
What is the best timing for tPA use with stroke?
Give tPA within 3 hours of stroke symptoms (if given after 3 hours, improvement in outcomes starts to decline). Best if < 90 minutes
Which statins have the least 3A4 inhibition?
Pravastatin < Rosuvastatin (2C9) < Fluvastatin (2C9)
What are the expected ADRs with Sominex (sleep aid) use?
Morning hangover, Constipation, Diarrhea. Sominex is the same as benadryl
How is COX-2 related to heart risk?
It increases heart risk
Which insulin replicates basal insulin the best?
Lantus - stimulates physiologic basal insulin
HPA axis suppression, which would most likely cause it (prednisone, steroid inhaler, etc.)?
Oral corticosteroids - LT prednisone, dexa or methylprednisone use
What are the IVIG infusion related ADRs?
HA, dizziness, N/V, flushing, arthralgia, etc.
Which antibiotics discolor urine?
Nitrofurantoin. Rifampin
Which Abx covers atypicals?
Cipro, Levo, Moxifloxacin. Macrolides (Clarithromycin, Azithromycin, Telithromycin)
What labs are consistent with UTI?
Leukocyte esterase (trace to large). White cell casts WBC > 5-10. Bacterial cell count (moderate to many). Those 3 are diagnostic…. nitrates, blood, protein are not
Which OTC for hot flashes?
Estroven (has black cohosh and soy)
What is some general information about Buspar?
20-30mg/d divided BID-TID. Start 7.5mg BID, not prn. Its a 5HT1A partial agonist so no sedative, anticonvulsant, muscle relaxant activity
Which type of DM oral drug should not be taken on empty stomach?
Metformin
What is Climara used for?
Normal vasomotor menopause symptoms. Climara Pro (w/ progesterone) used for surgical (hysterectomy) vasomotor menopause symptoms
What does Ginseng do to Warfarin?
Decreases its effect
Which insulin can be given IV?
Only Regular Insulin
W patient is on Medrol Dosepak, what are important things to counsel on?
Take with food. May cause insomnia
Patient on Climara, what do you counsel her on?
Apply to a clean dry area. A women with a uterus should also be on progestin
What is the site of action of Furosemide (Lasix)?
Na-K-Cl pump at the ascending loop of henle
When should you tell the patient to take Lispro?
Rapid-acting insulin, Inject 15 minutes before meals or immediately after meals
What are the symptoms of IVIG?
Renal toxicity and HA
Patient on pernicious anemia what are recommendations for meds?
Take 3 months for symptoms to resolve AND must take meds indefinitely
Which demonstrates proper knowledge of Varenicline?
This medicine causes nausea
Which CCBs cause additive bradycardia w/ propranolol?
Verapamil. Diltiazem
What are the symptoms of GERD?
Chronic cough. Symptoms of asthma. Atypical chest pain
What is needed for Time-Dependent Killing?
Constant infusion, Multiple daily doses
How can Buspirone NOT be taken?
PRN like Diazepam
What disease states can increase the risk for osteoporosis?
Hyperthyroidism. DM Type 2. Cushings Syndrome
What is a common and severe ADR of Linezolid requiring discontinuation?
Myelosuppression: Monitor CBC weekly, esp if > 2 week of therapy, pre-existing myelosuppression, other myelosuppressive drugs, or chronic infection treated with other antibiotics. Consider stopping if myelosuppression occurs or worsens
What are the benefits of Activella (estrogen/northindone for menopause)?
Decrease in fracture risk, decrease risk of colorectal cancer
What are some of the encapsulated bacteria?
H. influenzae type B (Hib). S. pneumoniae (pneumococcus). N. meningitides. Group B Strep (GBS). Klebsiella pneumoniae. Salmonella
What clinical characteristics are important in determining antiviral regimen for Hep C?
Weight. HCV genotype
Why would Elavil likely worsen opioid-induced constipation?
Its an anticholinergic
Which opioid is least constipating?
Transdermal Fentanyl patch
What class of drug is Sumatriptan?
Selective Serotonin Agonist
Which COMT Inhibitor has reports of fatal liver toxicity?
Tolcapone
What has the least effect on efficacy of Oral Contraceptives?
Lamotrigine. Gabapentin
What are the effects in relation to weight gain of Valproic acid and Topiramate (anticonvulsants)?
Valproic acid increases weight. Topiramate decreases weight
How are TCAs and Carbamazepine related?
If someone has a hypersensitivity reaction to TCA, carbamazepine is contraindicated
Which anticonvulsants are renally eliminated and require dose adjustment?
Gabapentin. Topiramate
Whats an important note for Topiramate?
Precipitate kidney stone, drink plenty of fluid
What is the BBW with valproic acid?
Pancreatitis
How is Diastat administered?
Rectally
What formulations is Phenytoin available in?
Liquid, Chewable tablet, IV formulation
Why must patient be aware of importance of good oral hygiene with Phenytoin?
May cause gum and mouth sores
What is used to reverse opioid overdose?
Naloxone
What is morphine metabolized by?
Hepatic Glucuronidation. NOT CYP 450
Phenytoin is effective for all types of seizures except what?
Absence
What are the ADRs with Levodopa?
GI, involuntary movement, efficacy decreases in 3-5 years
What is a common ADR with lithium?
Polyuria. Lithium induced intentional tremor
What are the 1st line therapy options for mood stabilization in patients diagnosed with Bipolar?
Lithium and Depakote
What are common ADRs of Fluoxetine?
Insomnia, GI upset, HA
