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PHARMACY > BCPS 2022 > Flashcards

BCPS 2022 Flashcards

1
Q

What is saw palmetto used for?

A

BPH

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2
Q

What is Black cohosh used for?

A

Hot flashes

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3
Q

What is gingko biloba for?

A

dementia

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4
Q

What to do know topical testosterone?

A

Apply in AM, onset about 30 minutes, complete absorption in 2 hours, transfer of gel is possible, apply to upper arms and shoulders

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5
Q

4 stages of heart failure and what they mean?

A

Stage A: at high risk, no structure heart defect, no symptoms
Stage B:with structural disease; but without signs and symptoms of HF
Stage C: with structural disease: with prior or current signs and symptoms of HF
Stage D: Advanced HF

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6
Q

NYHA Classification of HF
What are the symptoms? fatigue, dyspnea, chest pain, syncope, palpitations

A

Class I: No symptoms with normal physical activity
Class II: Mild symptoms with normal physical activity, comfortable at rest
Class III: Moderate symptoms with less than normal physical activity. Comfortable only at rest
Class IV: Severe symptoms with minimal physical activity and even at rest

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7
Q

Risk factors for endometrial cancer

A

age over 55, nulliparity, diabetes, obesity high fat diet, early menarche, late menopause, tamoxifen use

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8
Q

Treatment -UTI caused by ESBL producing organisms

A

Bactrim (TMP/SMX), carbapenem, cipro, levofloxacin,

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9
Q

What is the standard of treatment for acute cluster headaches?

A

100 percent oxygen at 12 L/minute for 15 minutes

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10
Q

In Covid positive patients, when would dexamethasone 6 mg IV/PO for 10 days would be beneficial?

A

Hospitalized patients using oxygen therapy.

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11
Q

Medications associated with drug-induced angioedema?

A

ACE, ARBS, Direct renin inhibitor (aliskiren), DPP4 inhibitors (alogliptin, lingliptin, saxagliptin, sitagliptin, neprilysin inhibitor (sacubitril), NSAIDS, fibrinolytic (alteplase, TNK-ase),
It is a result of increased bradykinin activity.

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12
Q

How long do you have to wait when switching from ACE/ARBS to sacubitril-valsartan

A

36 hours

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13
Q

What best reflects the Heart Protection Study?

A

5806 patients age over 70 years old on simvastatin 40 mg results in 20% fewer vascular events

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14
Q

What are the most common reactions from sorafenib in the 1st 6 weeks?

A

HFSR and rash (hand foot skin reaction)

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15
Q

What CYP enzyme is inhibited by verapamil?

A

CYP3A4

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16
Q

What beta blockers improves mortality in NY II and III heart failure?

A

toprol XL (metoprolol succinate)

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17
Q

Rivaroxaban is a substrate of what?

A

p-GP and 3A4

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18
Q

What is cost-minimization

A

Medications considered to be equal, so consider cost only, pick the cheapest

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19
Q

What is cost-effectiveness?

A

Natural units (mmHg, blood glucose), meds not considered equal

Interventions not equal

Measures cost in dollars and outcomes in natural health units

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20
Q

What is cost-benefit?

A

Dollars; Outcome expressed as benefit; cost or as net cost or as net benefit

  • Pick the one with greatest benefit
  • Have to be able to convert outcomes into meaningful dollar value
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21
Q

What is cost-utility?

A

Quality of adjusted life year QALY

  • Consider quality of life
  • Takes into account measurements of health consequences
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22
Q

Direct medical Cost

A

Associated with Direct patient care, example: supplies, equipmen

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23
Q

Direct Non-medical Cost

A

Cost related to the medical condition but not actual care, example: cost of transportation, child care, special diets

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24
Q

Indirect Costs

A

Cost associated with loss of productivity (loss of work- morbidity, loss of life- mortality)

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25
Q

Intangible Costs

A

Non Financial outcomes of a condition (pain or grief)

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26
Q

What is considered an attractive program for a company?

A

ROI or CBA greater than zero

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27
Q

Stages of FDA Drug Approval

A

Stages 1 to 10

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28
Q

What’s in Stage 3?

A

Phase 1-healthy volunteers;evaluate safety and dosage;20 to 100 participants

Phase 2-;larger group;several hundred participants;evaluate efficacy and side effects

Phase 3-large scale studies; 300 to 3000 participants;efficacy and monitoring of adverse reactions

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29
Q

What created an abbreviated pathway for approval for biosimilars?

A

ACA (Affordable Care Act) which includes the(BPCI) Biologics Price Competition and Innovation Act

BPCI is analogous to the HatchWatchman Act, which established regular abbreviated drug approve pathways in 1984

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30
Q

What is the HITECH Act of 2009?

A

Focused on the development of secure and interoperable electronic medical records, including incentive payments for meeting meaningful use criteria

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31
Q

What is the FDA Safety and Innovation Act?

A

Created a mechanism to assess fees for submission related to biosimilars

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32
Q

What is the FDA modernization Act?

A

Helped streamline data collection regarding clinical trials and created the Clinicaltrials.gov website

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33
Q

What is published in purple book?

A

FDA approved biosimilars

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34
Q

What MAIO inhibitor in patch form is used for depression?

A

Emsam (selegiline). Tablets used for Parkinsons

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35
Q

What can cause anorexia?

A

Topiramate, metformin

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36
Q

What causes diarrhea?

A

5-FU, augmentin, ampicillin, erythromycin, ironitecan

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37
Q

What is the drug of choice for thyroid storm?

A

PTU (blocks conversion of T4 to T3)

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38
Q

What enzyme metabolizes tramadol?

A

2D6 and 3A4

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39
Q

Clindamycin MOA

A

Inhibits 50S ribosome

40
Q

Beta-lactam MOA

A

Inhibits cell wall synthesis via inhibition of transpeptidase,

41
Q

Fluoroquinilone MOA

A

Inhibits DNA replication

42
Q

Bactrim MOA

A

Inhibits nucleotide synthesis

43
Q

What antifungal should not be administered with sirolimus?

A

Voriconazole; Vori inhibits 3A4 and Pgp

44
Q

Chelating agents for copper?

A

D-penicillamine, succimer

45
Q

What beta lactam/beta lactamase inhibitor used for severe diabetic infections?

A

Zosyn

46
Q

BP goal per AHA/ACC

A

Less than 130/80

47
Q

BP goal per JNC 8 guidelines (not sure about this)

A

Less than 140/80

48
Q

FDA approved indications for HF

A

carvedilol

metoprolol succinate

49
Q

Non-FDA APproved indication in HF

A

bisoprolol (Zebeta)

50
Q

What is the treatment for cocaine induced MI?

A

1st line: diazepam/lorazepam

nitrodrip- takes time to set up

51
Q

Types of aortic dissection

What drug do you give first?

A

Stanford Type B: medical management

Stanford A and Debake 1- surgical intervention

esmolol 0.5 mg/kg over 1 minute, then infusion

52
Q

For patient with seizure (ecclampsia)

if only for preeclampsia if not seizing

A

Magnesium 4 to 6 grams with seizure

labetalol of not seizing

53
Q

Diagnosis of Diabetes

A

Result

A1C

Normal less than 5.7%

Prediabetes5.7% to 6.4%

Diabetes6.5% or higher

54
Q

HSV Treatment

A
55
Q

What is the treatment for CMV

A

ganciclovir

valganciclovir

56
Q

How long is the treatment for HBV?

A

maybe greater than 1 year and the another 6 months after clearance

57
Q

What happens if you take expired acyclovir?

What NRTI can cause the same thing?

A

Faniconi syndrome

(adefovir)

58
Q

Hepatitis C

what are the two NS5B RNA polymerase inhibitors?

A

Dasabuvir

Sofosbuvir (Harvoni)

59
Q

What are the five NS5B inhibitors?

A

Ledispavir

Ombitasvir

Velpatasvir

Elbasvir

Daclatasvir

60
Q

What medication is used for HCV, RSV bronchiolitis and pneumonia

A

Ribavirin

61
Q

What is Hgb goal for CKD patients on epoetin

A

No more than 11 mg/dL

(

62
Q

Accurate use of metformi?

A

if CrCl between 35 to 40 ml/min

if it is pt’s current Crcl do not start. If already on it consider reducing dose by 50 percent

63
Q

What drug fro hyperthyroidism is contraindicated in pregnancy?

A

methimazole

64
Q

Tell me about PTU

A

inhibits peripheral conversion of T4 to T3.

It has a shorter half life that methimazole

65
Q

What drugs can cause reduction in levothyroxine levels due to an increase in ezymes involved in drug metabolism?

A

phenytoin, carbamezepin, phenobarbital

66
Q

What can affect the absorption of levothyroxine (synthetic T4)

A

calcium carbonate

67
Q

What is the appropriate goal TIR in most adults?

A

>70 % (over 16 hours daily) range is 70 to 180 mg/dl

For elderly TIR goal is >50%

TIR of >70% corresponds to an A1c =7%; >50% is 8%

For every 10% TIR increases or decreases estimated A1c inc or dec by approximately 0.5%

68
Q

List the SGLT2 inhibitors

clinical pearls

A

canagliflozin (Invokana®),

dapagliflozin (Farxiga®)

empagliflozin (Jardiance®)

hold 3 days prior to surgery

69
Q

what are the preprandial glycemic target ranges for A1c <7%

How about the post prandial target

A

preprandial 80 to 130 mg/dl

post prandial <180 mg/dl

70
Q

What is the max dose for metformin?

A

2500 mg

71
Q

Criteria for diagnosis of DM can include 2 of the following?

A

FPG greater than or equal to 126

prandial greater than or equal to 200

A1c greater than or equal to 6.5%

random plans glucose of greater than or equal to 200 in a patient with classic symptoms of hyperglycemia

72
Q

Graves’ disease and thyroiditis?

A

hyperthyroidism

73
Q

Hashimoto’s disease

A

hypothyroidism

74
Q

When do you recheck TSH lab, after starting or changing dose of levothyroxine?

What is the half life of levothyroxine

A

6 to 7 weeks

half life is 6 to 8 days

75
Q

Important counseling points for levothyroxine

A

preferably taken:

1/2 to 1 hour before breakfast

taken 4 hours apart from drugs like calcium or iron which are known to interfere with its absoprtion

76
Q

PTU inhibits what?

A

thyroid hormone synthesis in the thyroid gland. It can also inhibit the peripheral conversion of T4 to T3

77
Q

Symptoms /signs of thyrotoxicosis

A

Symptoms: weight loss, heat intolerance, warm/moist skin, anxiety/nervousness, tremor, palpitations

Signs: tachy, afib, goiter, exopthalmos

Labs: low TSH and inc total/free zt3 and T4

78
Q

Hashimoto’s disease symptoms

A

fatigue, cold intolerance, hair loss, brittle hair, weigh gain, dry skin, constipation, muschle aches

79
Q

per ADA- what drugs are benficial for the delaying the progression of CKD?

A

canagflogizin (invokana)

empagloflozin (jardiance)

liraglutide (victoza/saxenda)

80
Q

Treatment for myxedema coma

A

levothyroxine IV 200 to 400 mcg loading dose, followed by a maintenance regimen of 1.2 mcg/kg IV daily

or liothyroine 5 to 10 mch loading dose, then maintenance 2.5 to 10 mcg every 8 hours, plus levothyroxine oral 1.6 mcg/kg/day (rather than IV)

81
Q

what is a rare side effect of methimazole (tapazole) and propylthiouracil (PTU) but can be dangerous?

A

agranulocytosis

82
Q

What hormone is produce in the hypothalamus?

A

TRH (thyrotropin releaseing hormone)

which then stimulates the TSH from pituitary gland

TSH then binds to the TSH receptors located on the thyrocytes (aka follicular cells) which will then stimulate the release of T4 and to a lesser amount T3 (triiodothyronine)

83
Q

Warningsfor SGLT2 inhibitors?

A

necrotizing fasciitis

DKA

hypotension

84
Q
A
85
Q

Monoclonal antibody

full human

human and murine

A

full human- mumab

human and murine- ximab

86
Q

How much percent increase to levothyroxine for pregnant Moms?

A

46 to 48 percent

87
Q

after change in dose of levothyroxine, when do you recheck TSH?

A

6 to 7 weeks later

88
Q

Which has longer half life?

methimazole or PTU?

A

methimazole

89
Q

Bad side effects of methimazole and PTU

A

agranulocytosis and hepatocellular toxicity

90
Q

When is PTU or methimazole used?

A

PTU if pt in hospital for thyrocositosis

if outpatient and not in thyrocositosis- then methimazole (since it is only once daily dosing)

91
Q

What is treatment for Von Willebrand disease?

A

Humate P

Factor VIII compleased with vWF

92
Q

What drugs can cause increase in VTEs?

A

tamoxifen

raloxifen

fenofibrate

estrogen

93
Q

Which antiplatelet with reversible effects?

A

Ticlid (ticlopidine)

Brilinta (ticagrelor)

94
Q

Treatment for HIT

A

Direct Thrombin INhibitor

argatroban

bivalirudin

95
Q

What drugs can induced thromboxytopenia?

A

linezolid

bactrim

vancomycin

valproic acid

anti cancer

96
Q
A

PHARMACY (9 decks)

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