BCPS 2022 Flashcards
What is saw palmetto used for?
BPH
What is Black cohosh used for?
Hot flashes
What is gingko biloba for?
dementia
What to do know topical testosterone?
Apply in AM, onset about 30 minutes, complete absorption in 2 hours, transfer of gel is possible, apply to upper arms and shoulders
4 stages of heart failure and what they mean?
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
NYHA Classification of HF
What are the symptoms? fatigue, dyspnea, chest pain, syncope, palpitations
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
Risk factors for endometrial cancer
age over 55, nulliparity, diabetes, obesity high fat diet, early menarche, late menopause, tamoxifen use
Treatment -UTI caused by ESBL producing organisms
Bactrim (TMP/SMX), carbapenem, cipro, levofloxacin,
What is the standard of treatment for acute cluster headaches?
100 percent oxygen at 12 L/minute for 15 minutes
In Covid positive patients, when would dexamethasone 6 mg IV/PO for 10 days would be beneficial?
Hospitalized patients using oxygen therapy.
Medications associated with drug-induced angioedema?
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.
How long do you have to wait when switching from ACE/ARBS to sacubitril-valsartan
36 hours
What best reflects the Heart Protection Study?
5806 patients age over 70 years old on simvastatin 40 mg results in 20% fewer vascular events
What are the most common reactions from sorafenib in the 1st 6 weeks?
HFSR and rash (hand foot skin reaction)
What CYP enzyme is inhibited by verapamil?
CYP3A4
What beta blockers improves mortality in NY II and III heart failure?
toprol XL (metoprolol succinate)
Rivaroxaban is a substrate of what?
p-GP and 3A4
What is cost-minimization
Medications considered to be equal, so consider cost only, pick the cheapest
What is cost-effectiveness?
Natural units (mmHg, blood glucose), meds not considered equal
Interventions not equal
Measures cost in dollars and outcomes in natural health units
What is cost-benefit?
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
What is cost-utility?
Quality of adjusted life year QALY
- Consider quality of life
- Takes into account measurements of health consequences
Direct medical Cost
Associated with Direct patient care, example: supplies, equipmen
Direct Non-medical Cost
Cost related to the medical condition but not actual care, example: cost of transportation, child care, special diets
Indirect Costs
Cost associated with loss of productivity (loss of work- morbidity, loss of life- mortality)
Intangible Costs
Non Financial outcomes of a condition (pain or grief)
What is considered an attractive program for a company?
ROI or CBA greater than zero
Stages of FDA Drug Approval
Stages 1 to 10
What’s in Stage 3?
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
What created an abbreviated pathway for approval for biosimilars?
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
What is the HITECH Act of 2009?
Focused on the development of secure and interoperable electronic medical records, including incentive payments for meeting meaningful use criteria
What is the FDA Safety and Innovation Act?
Created a mechanism to assess fees for submission related to biosimilars
What is the FDA modernization Act?
Helped streamline data collection regarding clinical trials and created the Clinicaltrials.gov website
What is published in purple book?
FDA approved biosimilars
What MAIO inhibitor in patch form is used for depression?
Emsam (selegiline). Tablets used for Parkinsons
What can cause anorexia?
Topiramate, metformin
What causes diarrhea?
5-FU, augmentin, ampicillin, erythromycin, ironitecan
What is the drug of choice for thyroid storm?
PTU (blocks conversion of T4 to T3)
What enzyme metabolizes tramadol?
2D6 and 3A4
Clindamycin MOA
Inhibits 50S ribosome
Beta-lactam MOA
Inhibits cell wall synthesis via inhibition of transpeptidase,
Fluoroquinilone MOA
Inhibits DNA replication
Bactrim MOA
Inhibits nucleotide synthesis
What antifungal should not be administered with sirolimus?
Voriconazole; Vori inhibits 3A4 and Pgp
Chelating agents for copper?
D-penicillamine, succimer
What beta lactam/beta lactamase inhibitor used for severe diabetic infections?
Zosyn
BP goal per AHA/ACC
Less than 130/80
BP goal per JNC 8 guidelines (not sure about this)
Less than 140/80
FDA approved indications for HF
carvedilol
metoprolol succinate
Non-FDA APproved indication in HF
bisoprolol (Zebeta)
What is the treatment for cocaine induced MI?
1st line: diazepam/lorazepam
nitrodrip- takes time to set up
Types of aortic dissection
What drug do you give first?
Stanford Type B: medical management
Stanford A and Debake 1- surgical intervention
esmolol 0.5 mg/kg over 1 minute, then infusion
For patient with seizure (ecclampsia)
if only for preeclampsia if not seizing
Magnesium 4 to 6 grams with seizure
labetalol of not seizing
Diagnosis of Diabetes
Result
A1C
Normal less than 5.7%
Prediabetes5.7% to 6.4%
Diabetes6.5% or higher
HSV Treatment
What is the treatment for CMV
ganciclovir
valganciclovir
How long is the treatment for HBV?
maybe greater than 1 year and the another 6 months after clearance
What happens if you take expired acyclovir?
What NRTI can cause the same thing?
Faniconi syndrome
(adefovir)
Hepatitis C
what are the two NS5B RNA polymerase inhibitors?
Dasabuvir
Sofosbuvir (Harvoni)
What are the five NS5B inhibitors?
Ledispavir
Ombitasvir
Velpatasvir
Elbasvir
Daclatasvir
What medication is used for HCV, RSV bronchiolitis and pneumonia
Ribavirin
What is Hgb goal for CKD patients on epoetin
No more than 11 mg/dL
(
Accurate use of metformi?
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
What drug fro hyperthyroidism is contraindicated in pregnancy?
methimazole
Tell me about PTU
inhibits peripheral conversion of T4 to T3.
It has a shorter half life that methimazole
What drugs can cause reduction in levothyroxine levels due to an increase in ezymes involved in drug metabolism?
phenytoin, carbamezepin, phenobarbital
What can affect the absorption of levothyroxine (synthetic T4)
calcium carbonate
What is the appropriate goal TIR in most adults?
>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%
List the SGLT2 inhibitors
clinical pearls
canagliflozin (Invokana®),
dapagliflozin (Farxiga®)
empagliflozin (Jardiance®)
hold 3 days prior to surgery
what are the preprandial glycemic target ranges for A1c <7%
How about the post prandial target
preprandial 80 to 130 mg/dl
post prandial <180 mg/dl
What is the max dose for metformin?
2500 mg
Criteria for diagnosis of DM can include 2 of the following?
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
Graves’ disease and thyroiditis?
hyperthyroidism
Hashimoto’s disease
hypothyroidism
When do you recheck TSH lab, after starting or changing dose of levothyroxine?
What is the half life of levothyroxine
6 to 7 weeks
half life is 6 to 8 days
Important counseling points for levothyroxine
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
PTU inhibits what?
thyroid hormone synthesis in the thyroid gland. It can also inhibit the peripheral conversion of T4 to T3
Symptoms /signs of thyrotoxicosis
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
Hashimoto’s disease symptoms
fatigue, cold intolerance, hair loss, brittle hair, weigh gain, dry skin, constipation, muschle aches
per ADA- what drugs are benficial for the delaying the progression of CKD?
canagflogizin (invokana)
empagloflozin (jardiance)
liraglutide (victoza/saxenda)
Treatment for myxedema coma
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)
what is a rare side effect of methimazole (tapazole) and propylthiouracil (PTU) but can be dangerous?
agranulocytosis
What hormone is produce in the hypothalamus?
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)
Warningsfor SGLT2 inhibitors?
necrotizing fasciitis
DKA
hypotension
Monoclonal antibody
full human
human and murine
full human- mumab
human and murine- ximab
How much percent increase to levothyroxine for pregnant Moms?
46 to 48 percent
after change in dose of levothyroxine, when do you recheck TSH?
6 to 7 weeks later
Which has longer half life?
methimazole or PTU?
methimazole
Bad side effects of methimazole and PTU
agranulocytosis and hepatocellular toxicity
When is PTU or methimazole used?
PTU if pt in hospital for thyrocositosis
if outpatient and not in thyrocositosis- then methimazole (since it is only once daily dosing)
What is treatment for Von Willebrand disease?
Humate P
Factor VIII compleased with vWF
What drugs can cause increase in VTEs?
tamoxifen
raloxifen
fenofibrate
estrogen
Which antiplatelet with reversible effects?
Ticlid (ticlopidine)
Brilinta (ticagrelor)
Treatment for HIT
Direct Thrombin INhibitor
argatroban
bivalirudin
What drugs can induced thromboxytopenia?
linezolid
bactrim
vancomycin
valproic acid
anti cancer
