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Thera X > 20 Random Final Questions > Flashcards

20 Random Final Questions Flashcards

1
Q

Which diuretics are preferred in the elderly with HTN?

A

Thiazides, unless CrCl < 30 (in which case loops are used)

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2
Q

What are the two Thiazides used?

A

Chlorthalidone. HCTZ

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3
Q

What are the two Loops used?

A

Bumetanide. Furosemide

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4
Q

What are the disadvantages of ACE-I?

A

Exaggerated response with diuretic use (be very careful when adding it on). Hypotension in hypovolemic patients. Risk of hyperkalemia and hyponatremia. Potential for decreased renal function

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5
Q

What are the advantages of B-Blockers?

A

Reduce sympathetic nervous system activation. Reduce risk for MI. Useful in patients with angina or MI history

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6
Q

What are the disadvantages of B-Blockers?

A

Mimic age-associated CV changes. Reduce exercise tolerance

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7
Q

What are the frequently used B-Blockers?

A

Metoprolol and Carvedilol

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8
Q

Which B-Blocker should be used with caution?

A

Atenolol (d/t renal clearance)

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9
Q

When should B-Blockers be avoided?

A

Insulin-dependent DM. Peripheral vascular disease. Asthma or obstructive airway disease

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10
Q

What are the disadvantages of CCBs?

A

Some agents reduce MI contractility. May worsen CHF symptoms. Most agents are CYP3A4 substrates

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11
Q

Which CCBs are the main ones to avoid?

A

Diltiazem and Verapamil

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12
Q

What are the Alpha-Adrenergic blockers that are generally avoided for treating HTN?

A

Doxazosin, Prazosin, Terazosin

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13
Q

What is the altered presentation of CHF in elderly?

A

Symptoms of hypoxia (lethargy, restlessness, confusion) rather than dyspnea on exertion

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14
Q

What are some drugs that can precipitate CHF?

A

Anti-arrhythmics (eg. Quinidine). B-Blockers, CCBs. Anti-hypertensives (eg. Clonidine). Steroids, NSAIDs, Alcohol

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15
Q

What is the normal CHF treatment strategy?

A

ACE-I or ARB is first choice. B-Blockers (Carvedilol or Bisoprolol), Aldosterone can be added in later stages. Consider holding Diuretics for Stage I, but add it for fluid retention in later stages. Digoxin can be added to Stage III and IV

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16
Q

How does Digoxin work?

A

Increases force and velocity contractions. Decreases activation of sympathetic nervous system and RAA system. Decreased HR and conduction velocity through the AV node4

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17
Q

Which statins can be used if patient didn’t have a good response with one of them?

A

Rosuvastatin (Crestor) or Atorvastatin (Lipitor)

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18
Q

What can be used if patient just has elevated TG?

A

FIbrate (Gemfibrozil or Fenofibrate). All fibrates need renal adjustment

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19
Q

What can be used in patients with Low HDL, High LDL and TG?

A

Statin + Fibrate. OR. Niacin (but patients don’t like d/t flushing)

20
Q

What can be used in patients with Elevated LDL or nonresponse?

A

Ezetimibe (Zetia). OR. Ezetimibe + Simvastatin (Vytorin)

21
Q

What can insulin resistance lead to?

A

HTN, Increased TGs and Insulin, Decreased HDL

22
Q

What are some common ADRs with Metformin?

A

N/V, abdominal pain. Taste disturbance. Anorexia

23
Q

When is Metformin contraindicated?

A

Renal impairment, CHF, h/o acute Lactic Acidosis, Hepatic disease, Hypoxemia, Acute MI, Radiographic contrast (look for iodine allergy)

24
Q

Which Sulfonylurea is avoided?

A

Glyburide. It has an active metabolite that is renally cleared. High risk of hypoglycemia

25
Q

What are the common ADRs with Sulfonylureas?

A

Hypoglycemia. Weight gain

26
Q

What is important to remember about Meglitinides (Repaglinide, Nateglinide)?

A

If you skip your meal, skip the dose. High risk of hypoglycemia. Quick onset and short duration

27
Q

What is a concern with Alpha-Glucosidase Inhibitors (Acarbose, Miglitol)?

A

Adherence (dosed TID). GI side effects

28
Q

Which Incretin Medication is preferred?

A

Sitagliptin (Januvia) - DPP-4 Inhibitor. Oral medication instead of SQ

29
Q

What are the top interactions with Warfarin?

A

NSAIDs, Sulfa drugs, Macrolides, Quinolones, Phenytoin

30
Q

What are the top interactions with ACE-I?

A

Potassium supplements, Spironolactone

31
Q

What are the top interactions with Digoxin?

A

Amiodarone, Verapamil

32
Q

What are the top interactions with Theophylline?

A

Quinolones

33
Q

What are some “Drug/Disease” interactions for DM?

A

Diuretics. Steroids. Beta-blockers

34
Q

What are some inappropriate medications for sleep aid?

A

Barbiturates. TCAs. Long-Acting Benzos. OTC Sleep Aids (Diphenhydramine, Doxylamine)

35
Q

Which BZDP Receptor Agonist has the most appropriate duration of action?

A

Eszopiclone (Lunesta)

36
Q

Which miscellaneous agent is often used off-label for sleep aid?

A

Trazodone. Can cause orthostasis. Useful in dementia

37
Q

What metabolic disorders can cause constipation?

A

Hypothyroidism. Hypokalemia. Hypercalcemia

38
Q

Which laxatives are the best to use for elderly?

A

PEG (MiraLax: requires mixing, 48-96hr onset). Senna (Senokot)

39
Q

What type of Laxative is Senna?

A

Stimulant. Bisacodyl (Dulcolax) is also a stimulant laxative that can be used, but does cause cramping

40
Q

What type of Laxative is PEG?

A

Osmotic

41
Q

What is the stepwise management for constipation in elderly?

A

Stop offending drug (if possible) –> Dietary modifications –> Increase exercise –> Add PEG or similar agent –> Add stimulant laxative –> Tap water or saline enema twice weekly

42
Q

Where do 90% of accidental bruises occur?

A

Extremities rather than the trunk, neck, or head

43
Q

What are bruises like in abused adults?

A

Larger, 5cm (~2 inches) in diameter or larger. More bruises on the head, back, and arms. Most could tell you how they got them, even with dementia

44
Q

What type of abuse is seen in the beginning stages of Alzheimer’s?

A

Financial abuse

45
Q

What type of abuse is seen in the middle stages of Alzheimer’s?

A

Physical abuse

46
Q

What type of abuse is seen in the late stages of Alzheimer’s?

A

Neglect

Thera X (25 decks)

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