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Boards Abx Flashcards

1
Q

What bacteria’s cause conjunctivitis and what is used to treat it?

A

Staph aureus
Strep, pneumonia
H influenzae
Pneumonic: stupid, shy guys get crusty eyes.

Treatment
Cipro ocular drops
Polymyxin B with trimethropi 
Pneumonic: crusty eyes piss me off

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2
Q

What bacteria causes otitis externa

A

Pseudomonas
Staph aureus

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3
Q

What is the treatment for mild otitis external?

A

Acidic acid with propylene glycol and hydrocortisone otic drops
Brand name is VOSOL

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4
Q

What is the treatment for moderate to severe otitis externa?

A

Polymyxin B – neomycin – hydrocortisone drops
Or
Ciprofloxin otic drops
Pneumonic: crusty ears piss me off

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5
Q

What medication should be avoided if a ruptured TM is suspected?

A

Neomycin containing products

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6
Q

What is the treatment for otitis externa in a patient with HIV or immuno compromised?

A

Cipro Floxin orally due to risk for osteomyelitis of the skull or jaw

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7
Q

What is the treatment for strep pharyngitis?

A

Penicillin VK 500 mg TID times 10 days or
Amoxicillin 500 mg b.i.d. times 10 days
Or
Cephalosporin times 4 to 6 days
If severe penicillin allergy
Macrolide such as azithromycin times five days

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8
Q

What are the primary symptoms of scarlet fever in what is associated with?

A

Strawberry tongue
Sandpaper rash that starts at the head and moves downward
Skin desquamates

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9
Q

What are the complications associated with strep pharyngitis?

A

Scarlet fever
Acute rheumatic fever
Peritonsillar abscess
Poststreptococcal glomerulonephritis

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10
Q

What is the pharmacological therapy for actinic keratosis?

A

Topical five – fluorouracil (5-FU)
Imiquimod cream
topical, diclofenac gel

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11
Q

What are non-pharmacological treatment options for acinic keratosis

A

Photodynamic therapy w/ topical delta-aminolevulonic acid or
Cryosurgery with liquid nitrogen

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12
Q

Treatment for rosacea

A

Topical metronidazole

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13
Q

Treatment for psoriasis

A

Medium potency topical corticosteroids

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14
Q

Treatment for a verruca vulgaris

A

imiquimod cream

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15
Q

Treatment for tinea pedis

A

 Topical ketoconazole

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16
Q

What is a herald patch and what condition is associated with

A

The first Legion to appear in pityriasis rosacea. It appears about two weeks before a full break out. It is a single round to oval shape about 2 to 5 cm in diameter.

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17
Q

How does pityriasis rosacea present

A

Begins with a herald patch, which is an oval round shape lesion about 2 to 5 cm in diameter. two weeks later the patient breaks out in a rash containing oval lesions with find scales that follow skin lines of the trunk in a Christmas tree pattern. The color is typically salmon, pink may or may not be itchy.

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18
Q

What is the cause and duration of pityriasis rosacea

A

May be caused by a viral infection
Self-limiting rash should resolve in about four weeks

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19
Q

What is the topical treatment for poison ivy on non-sensitive body areas

A

Mid or high potency topical corticosteroids:
Triamcinolone 0.1% or clobestasol 0.5%

Pneumonic: I may try to clobber you with one or five clubs, if I have poison ivy

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20
Q

What formulation of topical steroids is preferred for poison ivy treatment

A

Ointments preferred over cream allows medication to contact skin longer

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21
Q

When should you use systemic steroids for poison ivy? And what is the dosing?

A

If the poison ivy covers greater than 20% of the total body, or there a large amount of blisters, or if the rash impacts the face genitals, hands, or if the rash impacts occupational function

Prednisone, 0.5-1mg/kg/day for 5 to 7 days follow up with an additional 5 to 7 days to minimize risk of recurrence of skin lesion

Taper not needed with short term systemic cortical steroid use less than 14 days in duration

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22
Q

What are the organisms that cause non-bolus impetigo

A

Staphylococcus aureus
Streptococcus pyogenes

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23
Q

What is the treatment for non-bullous impetigo

A

Topical mupirocin

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24
Q

What antibiotic is used to cover cellulitis

A

Penicillin VK or cephalexin (Keflex)

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25
Q

What antibiotic is used to cover skin abscesses?

A

TMP/SMX (Bactrim) or
 Doxycycline

To cover MRSA

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26
Q

What medication is cause hypothyroidism

A

Lithium amiodarone, interferon

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27
Q

What two types of hyperthyroidism present without exopthalmus or goiter

A

Thyroiditis that is caused by viral or postpartum or drug induced milder symptoms typically self limiting

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28
Q

What is the function of the anterior pituitary gland in relation to the thyroid?

A

Releases, thyroid, stimulating hormone, to inform the thyroid, how much T4 to release

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29
Q

How should Synthroid be dosed?

A

Does using ideal body weight:
1.6 mcg/kg/day

Elderly: 1mcg/kg/day

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30
Q

How long after initiating level thyroxine therapy should you check a TSH

A

8 weeks

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31
Q

What is a normal TSH level?

A

0.4 to 4.0

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32
Q

How much do you titrate levothyroxine by when thyroid levels are out of the norm

A

Titrate by 12.5 to 25 µg every eight weeks and check TSH.

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33
Q

Once patient is stable on levothyroxine therapy how often should you check the TSH level

A

Measure at six months, once stable than once yearly or when symptomatic

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34
Q

What type of medication’s are triptans and what are they used for?

A

Selective serotonin receptor agonist.
Primarily used as an abortive med for migraines may also be used for tension, headaches and cluster headaches

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35
Q

What are the side effects of triptans?

A

Hypertension, due to potential vascular affect

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36
Q

How do triptans work?

A

By causing cerebral vasoconstriction, to counteract the vasodilation associated with migraines

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37
Q

When should controller therapy be initiated for migraine headaches

A

Frequent migraines greater than three headache days a month

Severe attacks that interfere with the patients daily routine, even with a board of treatments

Overuse of a board of treatments

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38
Q

What classes of medications are used for migraine prophylaxis

A

Beta blockers: metoprolol and propranolol

Tricyclic antidepressants: amitriptyline and nortriptyline

Antiepileptic drugs: divalproex sodium, valproate, topiramate, or Topamax

Butter burr, feverfew coenzyme Q 10 magnesium and riboflavin

Calcitonin, Jean related peptide antagonist (CGRP)
Erenumab, fermanezumab (ubrelvy)

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39
Q

What is an important educational piece when prescribing preventive migraine medication?

A

It may take up to 4 to 6 weeks of use prior to noting clinical effect

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40
Q

Which abortive migraine medication is safe to use in patients with heart disease

A

An oral calcitonin gene-related peptide antagonist (CGRP) -gepant such as ubrogepant (ubrelvy)

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41
Q

What test rules out giant cell arteritis?

A

ESR

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42
Q

If a patient with giant cell arteritis has an ESR greater than 100 what diagnostic testing should be performed to confirm diagnosis

A

Arterial biopsy and or arterial color duplex ultrasound

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43
Q

What is the treatment for giant cell arteritis?

A

2 to 3 months of high-dose systemic corticosteroid therapy then careful reduction in dose continued for two months to six years

Aspirin to reduce risk of stroke

Ppi to protect stomach

May consider bisphosphonate due to osteoporosis risk associated with long-term corticosteroid use

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44
Q

What is the Main serious complication due to giant cell arteritis?

A

Blindness

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45
Q

What type of condition is giant cell arteritis?

A

Auto immune

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46
Q

What condition put a patient at risk for giant cell arteritis

A

Poly myalgia rheumatica

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47
Q

What is the recommended treatment for patient suspected of having Gerd

A

Eight weeks trial of empiric PPI therapy once daily prior to meals 

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48
Q

What vitamin deficiencies is a patient at risk for with protracted PPI use

A

Iron
Vitamin B-12
Calcium
Magnesium 

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49
Q

What G.I. complications are associated with protracted PPI use

A

Increase risk of cdiff

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50
Q

What long-term effect can PPIs have on bone health?

A

May increase risk of fracture

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51
Q

Patience on protracted PPI use are at risk for what pulmonary complication

A

Pneumonia

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52
Q

If Gerd symptoms do not resolved with eight week trial of PPI therapy, what is the next intervention?

A

Refer to G.I. for an upper endoscopy

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53
Q

What type of G.I. condition is associated with gnawing epigastric pain about 2 to 3 hours after eating, is relieved with food and causes nighttime awakenings

A

Duodenal ulcer

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54
Q

H. pylori is associated with what type of ulcer

A

Duodenal ulcer

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55
Q

What type of hepatitis is most commonly contracted from sexual contact

A

Hepatitis B

Pneumonic: B equals Boner

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56
Q

What lab findings would you expect in a patient with acute hepatitis A?

A

HAV IgM
Liver enzymes elevated 10 times the norm

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57
Q

What lab findings would you expect to see in a patient with acute hepatitis B?

A

(+) IgM anti-HBc
(+) HBsAg
LFTS > 10x norm

If (+) HBeAG patient is “extra” contagious

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58
Q

What laboratory findings would you expect in a patient with chronic hepatitis B infection?

A

Normal or slightly elevated liver enzymes
(+) HBsAg

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59
Q

What lab value indicates immunity to hepatitis B virus?

A

(+) HBsAb

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60
Q

What laboratory findings would you expect to find in a patient with an acute hepatitis C infection

A

(+) Anti HCV
HCV viral DNA
ELEVATED LFTS

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61
Q

What laboratory findings would you expect to see on a patient who has a chronic hepatitis C infection?

A

(+) Anti-HCV
HCV viral DNA
Normal or slightly elevated LFTs

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62
Q

What laboratory findings would you expect to see on a patient with a hepatitis C infection in the past?

A

(+) Anti-HCV
(-) HCV RNA
Normalized LFTs

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63
Q

If somebody has had a resolved hepatitis, C infection, do they form antibodies to protect them from future infection?

A

No hepatitis C antibody is non-protective

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64
Q

Which types of hepatitis offer post exposure prophylaxis?

A

Hepatitis A and B

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65
Q

In addition to hepatitis B, what type of hepatitis does the hepatitis B vaccine protect someone from?

A

Hepatitis D

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66
Q

How do you test for HCVRNA levels

A

Order a qualitative and quantitative nucleic acid test to detect the quantity in the presence of the virus

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67
Q

Which type of inflammatory bowel disease involves the mouth to anus

A

Crohn’s disease

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68
Q

What is the first line antibiotic treatment for diverticulitis?

A

Amoxicillin clavulanate (Augmentin)

If beta lactam allergy :
Bactrim, Cipro or level Floxin plus Metronidazole

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69
Q

What educational instructions are important when ordering a urea breath test

A

Discontinue antibiotics or PPI’s at least two weeks prior to testing

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70
Q

What is the medication regimen for H. pylori infection

A

Ppi, clarithromycin, and amoxicillin

Pneumonic: “ Pepcid, AC”

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71
Q

What is the minimum diagnostic work up when suspecting pneumonia?

A

CBC with differential
BUN creatinine
Chest x-ray

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72
Q

What is the duration of antibiotic therapy for community acquired pneumonia

A

 Minimum five days with evidence of increasing stability
Patient should be afebrile for 48 to 72 hours prior to anti-microbial discontinuation

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73
Q

What is the most common cause of community acquired pneumonia?

A

Strep pneumoniae
Gram (+)

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74
Q

What are the likely causative pathogens for community acquired pneumonia in a patient without comorbidities?

A

Strep, pneumoniae (gram +)
M. Pneumoniae(Atypical)
C. Pneumoniae (Atypical)

Pneumonic: you’re getting some S&M in the cunt when you’re young and healthy

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75
Q

What antibiotics are used to treat community acquired pneumonia in patients with no comorbidities

A

Macrolides, amoxicillin, doxycycline

Pneumonic: MAD LUNG

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76
Q

What are the likely causative pathogens of community acquired pneumonia in patients with comorbidities

A

S pneumoniae
H influenzae
M pneumoniae
C pneumoniae
Legionella

Pneumonic: too much SNM in the Cunt leads to legionella and influenzae

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77
Q

What is the recommended treatment for community acquired pneumonia in a patient with comorbidities

A

Fluoroquinolone, such as moxifloxacin or levofloxacin
Or
Doxycycline or macrolide (azithromycin or Clarithromycin) PLUS beta lactam, such as amoxicillin, clavulanate, or a cephalosporin

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78
Q

What are the components of curb 65?

A

Confusion of new onset
Urea nitrogen (BUN) >19
Respiratory rate >/= 30
Blood pressure less than 90 systolic or diastolic blood pressure less than 60
Age 65 or older 

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79
Q

If a patient has a curb 65 results of greater than two, where should they be treated?

A

Hospital

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80
Q

What medication increases the risk of tendon rupture 60 times the norm if prescribed with fluoroquinolones

A

Steroids

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81
Q

What medication can be prescribed for protracted problematic, cough in acute bronchitis?

A

MDI with an inhaled bronchodilator such as
SAMA ipratropium bromide (Atrovent) or SABA Albuterol (Ventolin or Proventil) or
Short course of oral corticosteroids such as prednisone 40 mg PO for 3 to 5 days

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82
Q

How is asthma diagnosed

A

Spirometry

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83
Q

Asthma is characterized by what type of airway obstruction? Define

A

At least partially Reversible airway obstruction
Increase in FEV1, greater than 12% and greater than 200 mL from baseline post short, acting beta agonist use

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84
Q

What is considered poor lung function?

A

FEV less than 60%

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85
Q

What test and result is required for a COPD diagnosis

A

Spirometry with an FEV: FCV< .70 post bronchodilator 

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86
Q

Which pathogens that cause community acquired pneumonia are gram-positive

A

S. pneumonia
Staph aureus

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87
Q

Which pathogen that causes pneumonia community acquired are Graham negative

A

H influenzae
P aeugunoa

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88
Q

Which pathogens that cause community choir pneumonia are atypical

A

S pneumoniae
C pneumoniae
Legionella

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89
Q

How long before an ICS takes effect?

A

2 to 8 days

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90
Q

If a patient is experiencing an asthma flare, how long should you step up the ICS’s for?

A

2 to 4 weeks

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91
Q

What is the recommended treatment for a patient with COPD with zero to one moderate exacerbations unless symptoms

A

Laba or lama is preferred to Saba or Sama

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92
Q

What is the recommended treatment for a patient with COPD with zero to one moderate exacerbations and more symptoms

A

LAMA+LABA

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93
Q

What physiological marker would warrant the addition of an inhaled corticosteroid in a patient with COPD

A

Eosinophils greater than 300

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94
Q

What should the insulin regimen look like for a type one diabetic?

A

50% basal insulin 50% bolus or rapid acting insulin daily

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95
Q

When should a type two diabetic be put on insulin therapy

A

At time of diagnosis, if hemoglobin A1c is greater than 9% or when greater than two oral or injectable agents result in inadequate control

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96
Q

What does should you start basal insulin at for a type two diabetic

A

10 units or 0.2 units per kilogram.

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97
Q

How should you titrate basal insulin in a type two diabetic

A

Increase dose two units every three days until fasting glucose is 70 to 130. May increase by four units every three days if fasting blood glucose is greater than 180. 

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98
Q

When starting a type two diabetic on insulin, what type of insulin should you initiate first?

A

Basal insulin

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99
Q

What is the pre-meal glucose target for a type two diabetic

A

70 to 130 

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100
Q

If a patient’s pre-lunch glucose is greater than 130 what rapid acting insulin regimen would you institute

A

Four unit Bolis before breakfast

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101
Q

If your patients pre-dinner glucose is greater than 130 what should your immediate acting insulin regimen be?

A

Four unit bolus of rapid, acting insulin before lunch or add or increase morning and pH or long acting insulin

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102
Q

If bedtime glucose is above target greater than 140 what insulin regimen should you institute?

A

Four unit bolus, insulin before supper or increase evening basal insulin

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103
Q

If our patients post prandial blood glucose is not within limits how do we treat this?

A

By adding a pre-meal, rapid acting insulin

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104
Q

What is the two hour postprandial glucose target?

A

160 to 180

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105
Q

What is the most potent risk factor for angioedema when taking an ace or arb?

A

Nsaid allergy

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106
Q

How much will a moderate intensity statin lower someone’s LDL

A

30 to 49%

107
Q

How much will a high intensity statin lower someone’s LDL

A

50%

108
Q

Which statins are considered low intensity, and not recommended

A

Pravastatin 10 to 20 mg
Lovastatin 20 mg

Pneumonic: pussy, LDL

109
Q

What is the normal pH of the vagina?

A

3.8 to 4.2.

110
Q

What are the symptoms and treatment for bacterial vaginosis?

A

Thin, gray discharge
Fishy odor
PH greater than 4.2 typically 5 to 7.
Greater than 20 clue sells
Treat with Flagyl

Pneumonic: a clue you have BV is a gray fishy snaggle, so you better fix that with some Flagyl

111
Q

What type of cells would you see on a saline wet mount from a healthy vagina

A

Lactobacillus

112
Q

Which herpes virus causes genital herpes

A

HSV-2

Pneumonic: it takes two to tango or one to talk

113
Q

What is the treatment for genital herpes?

A

Acyclovir (Zovirax)
Famciclovir (famvir)
Valaciclovir (valrex)

114
Q

What is an important educational piece when educating a patient about transmission of herpes?

A

The virus can still be transmitted, when not active

115
Q

What are the three causative organism’s of nongonococcal urethritis in cervicitis?

A

Clamydia trachomatis
Ureaplasma urealyticum
Mycoplasma genitalium

Pneumonic: CUM

116
Q

What is the treatment for nongonococcal urethritis?

A

Doxycycline 100 mg PO b.i.d. times seven days may also use azithromycin 1 g PO as a single dose or levofloxacin 500 mg PO for seven days

117
Q

What are the signs and symptoms and treatment of trichomonas vaginalis

A

Dysuria
Vaginal itching
Vaginal discharge occasionally green in frothy
Strawberry cervix with petechial hemorrhage

Modell organisms in large number of wbc’s an alkaline pH on microscopic exam

Flagyl 500 mg PO be ID times seven days

Pneumonic: Trick or strawberry treat smell my feet (Flagyl) I am a green protozoa for Halloween

118
Q

What medication’s are safe to treat a UTI and pregnant people

A

Cephalexin 500 mg PO be ID for 5 to 7 days or cefdinir or 300 mg PO b.i.d. times 3 to 7 days

119
Q

What are the most common pathogens associated with urinary tract infection?

A

E. coli
Klebsiella
S., Saprophyticus

120
Q

What antibiotics are used to treat uncomplicated UTI’s?

A

Bactrim times three days
Nitrofurantoin (macrobid)
X 5 days
Fosfomycin 3 g one dose
Cipro Floxin three days
Level Floxin three days
Augmentin
Cephalexin or Cefdinir

121
Q

What types of HPV are associated with 70% of cervical cancer cases

A

HPV 16 and 18

122
Q

When should PEP be instituted and what is the duration?

A

As soon as possible, following a higher risk for HIV event, ideally within 72 hours duration is 28 days

123
Q

What condition does red blood cells and red blood cell cast in a urinalysis indicate

A

Glomerulonephritis

124
Q

What condition does red blood cells and red blood cell cast in a urinalysis indicate

A

Glomerulonephritis

125
Q

When would you test for an FMR1 gene mutation?

A

Unsuspected, fragile X syndrome

126
Q

How does cutaneous anthrax present, who is at risk, and what is the treatment?

A

Starts a small itchy, bumps in progresses to a painless ulcer that is black in the center in scabbed over.

Most common in people who work with animals, such as farmers in veterinarian to work with cattle

Treatment equals doxycycline or Cipro

127
Q

What is the mechanism of action of metFormen

A

Suppresses the livers production of glucose

Decreases the intestines absorption of glucose

Improves insulin sensitivity

128
Q

Which SSRI has the fastest onset

A

Escitalopram (Lexapro)

129
Q

Which SSRI is used for OCD and what are the side effects?

A

Paroxetine (Paxil)
Weight gain, and sedation

130
Q

Which SSRI is least likely to cause weight gain, and it’s good for people with eating disorders

A

Fluoxetine (Prozac)

“Pro-food”

131
Q

Which class of anti-depressants should be avoided in patients with hypertension? Give two examples of these medication’s.

A

SNRI’s
Duloxetine (Cymbalta)
Venlafaxine (Effexor) 

132
Q

Which class of antidepressants have a cardiac effects? What are they and how should you proceed before prescribing?

A

Tricyclics
For patients over 40 update of baseline ECG due to risk of heart block

133
Q

Which antidepressants are the easiest to overdose on and what should you consider when prescribing these to patients?

A

Tricyclic antidepressants
For patients at risk of suicide, do not prescribe a full course

134
Q

Which class of antidepressants should be avoided in the elderly and why?

A

Tricyclic antidepressants do the anticholinergic affects

135
Q

What are the two main safety concerns when prescribing MAOIs?

A

Do not prescribe with other antidepressants due to risk for serotonin syndrome

If switching to another class of antidepressants, give the patient a two week washout

Foods high in tyramine
Aged cheese
Fermented sausage
Cured meats
Yogurt
Should be avoided due to risk for hypertensive crisis

136
Q

What is the typical onset of buspirone? Side effects.

A

Onset is 2 to 4 weeks
Side effects: nausea and dizziness

137
Q

What should you instruct the patient to do when taking Busseron to avoid dizziness?

A

Take with a full meal to avoid severe dizziness

138
Q

What medication is used for anxiety and depression should you avoid drinking grapefruit juice with?

A

BuSpar
MAOIs

139
Q

What is a therapeutic range for lithium?

A

0.6 to 1.2.

140
Q

What are the side effects of lithium?

A

Hypothyroidism
Kidney insufficiency
Weight gain
Nausea
Altered sodium levels

141
Q

What are the signs and symptoms of lithium toxicity?

A

Nausea
Vommiting
Hyper active reflexes
Tremors
Confusion
Vision changes

142
Q

When taking lithium what food or drink should be avoided?

A

Grapefruit juice

143
Q

Which class of calcium channel blockers do not affect the heart conduction system

A

Dihydropyridines
“D”= Don’t effect the heart
Dipines

Amlodipine (Norvasc)
Nifedipine (adalat)

144
Q

Which calcium channel blocker is used for cluster headaches

A

Verapamil

145
Q

What are the two major side effects associated with calcium channel blockers?

A

Headache
Leg swelling

146
Q

What class of antihypertensive should be avoided in patients with Gerd

A

Calcium channel blockers

147
Q

What patient should thiazide diuretics be avoided it?

A

Patience with sofa, allergies
Patients with GFR less than 30

148
Q

Which thiazide is cardioprotective

A

Chlorthalidone

149
Q

Which laboratory values should you monitor in patients on a thiazide diuretic

A

Uric acid
Triglycerides
Glucose

150
Q

What protective affects to thiazide diuretics have

A

Cardioprotective
Bone protective

151
Q

What conditions are beta blockers effective in treating

A

Heart failure with an EF less than 40%
Previous MI
ANXIETY
Tachycardia related to hyper thyroidism

152
Q

What antihypertensives are safe during pregnancy?

A

Nifedipine
Labetolol
Methyldopa

Pneumonic: new little mama

153
Q

If large doses of furosemide are administered to quickly, what may happen to the patient

A

Oto toxicity

154
Q

How long does Lasix last of the patients system?

A

6-8 hours
Pneumonic: la-six

155
Q

What medication can cause gynecomastia in men

A

Spironolactone (Aldactone)

156
Q

What is the normal therapeutic range for digoxin?

A

0.5.-0.8.

157
Q

What are the signs and symptoms of digoxin toxicity?

A

Visual changes (green, yellow halo)
Fatigue
Weakness
Dysrhythmias

158
Q

What electrolyte in balance me precipitate, digoxin toxicity

A

Hypo kalemia

159
Q

What is the antidote for digoxin toxicity?

A

Digibind

160
Q

How should long-acting nitrates be prescribed to prevent tolerance?

A

With a nitrate free interval, typically overnight

161
Q

What organ systems must you monitor with long-term use of amiodarone

A

Thyroid: amiodarone contains iodine, and may cause hypo or hyper thyroidism

Eyes: because optic neuropathy or corneal deposits

Lungs : can cause pulmonary toxicity

162
Q

What medication frequently prescribed with amiodarone can result in increased effects of this medication

A

Anticoagulants
When on amiodarone and anticoagulants, you may need to decrease the dose of the anticoagulant by 25%

163
Q

What are two detrimental side effects of statins

A

Rhabdo, myelitis and drug induced hepatitis

164
Q

What medications are used to decrease triglycerides

A

Fibrates
fenofibrate (Tricor)

165
Q

What is niacin used for what is a common side effect? How do we avoid the side effect?

A

Decreases triglycerides
Increases HDL

Causes facial flushing

May be avoided by having patient take aspirin with niacin dose and avoid warm fluids, when taking dose

166
Q

What medication is effective at reducing LDL, but is rarely tolerated due to G.I. side effects

A

Bile acid sequestrant, such as cholestyramine

167
Q

How long should you hold warfarin prior to a surgical procedure?

A

Five days

168
Q

If a patient who is on warfarin has an INR is 5 to 10 without bleeding how should we treat?

A

Hold warfarin for 1-2 doses

169
Q

If a patient on warfarin has an INR of 5 to 10 with bleeding how should they be treated?

A

With vitamin K either PO or IV

170
Q

If a patient on warfarin has an INR greater than 10 without bleeding, how should we treat them?

A

With PO vitamin K

171
Q

If a patient on warfarin has an INR greater than 10 with bleeding, how should we treat them?

A

With IV vitamin K and monitoring

172
Q

How long should we treat a DVT with direct oral anticoagulants?

A

Six months

173
Q

How are DOAC’s typically dosed for DVT treatment

A

Loading dose for several days, then lower dose for maintenance times six months

174
Q

What lab value is important to monitor for a patient on DOAC’s

A

Renal function
Does mean need to be adjusted for renal function

175
Q

What type of anesthesia is contra indicated when LMWH is prescribed?

A

Spinal anesthesia
IfLMWH is used in conjunction with spinal anesthesia. It increases the risk for a spinal hematoma, and can lead to paralysis.

176
Q

How long should you hold aspirin before a surgical procedure?

A

7 to 10 days, which is the lifespan of a platelet

Pneumonic: platelet is eight letters . Falls between seven and 10.

177
Q

What is something to remember about aspirins mechanism of action when prescribing

A

Aspirin irreversibly binds to platelets for the lifespan of the platelet, which last 7 to 10 days

178
Q

What is important to prescribe when a patient has had a stent placement

A

Dual antiplatelet therapy for one year.
This includes aspirin indefinitely with the addition of a P2Y12 inhibitor therapy for 12 months minimum .
P2Y12 inhibitors include clopidogrel (Plavix)

179
Q

What blood test is used to monitor drug Lovenox

A

Anti-XA

180
Q

What suffix do all long acting beta agonist have?

A

“Terol”
Exception to the rule, is albuterol in levoalbuterol, which are short acting beta agonist

181
Q

What class of respiratory meds end in the suffix “pium”

A

Long acting muscarinic antagonist (LAMA)

182
Q

What is the step one treatment for asthma per the Gina guidelines?

A

A low-dose ICS’s with formoterol (LABA) prn

183
Q

What is step two in the Gina guidelines?

A

Low-dose ICS’s with formotetol as needed

184
Q

What is step three treatment for asthma in the Gina guidelines

A

Low does ICS/formoterol daily and rescue

185
Q

What medication class should never be used alone to treat asthma and why?

A

LABA’s due to an increased risk of death

Labas may mask underlying inflammation. This is negated by using this medication in combination with an ICS

186
Q

What is the first line treatment for allergic rhinitis?

A

Intranasal corticosteroids

187
Q

What is the onset peak? In duration of rapid acting insulin

A

Onset: 15 minutes
Peak: one hour
Duration: 2 to 4 hours

188
Q

What is the onset peak in ration of short acting regular insulin? 

A

Onset: 30 minutes- 1hour
Peak: 2 to 4 hours
Duration: 6 to 8 hours

189
Q

What is the onset peak? In duration of intermediate acting insulin or NPH?

A

Onset: 1-2 hours
Peak: 6 to 12 hours
Duration: 24 hours

190
Q

What is the onset peak and duration of long acting insulin Lantus or Levemir?

A

Answer: two hours
Peak: none
Duration: 24 hours

191
Q

What two factors can increase the risk for the metabolic acidosis associated with metformen?

A

EtOH
Procedures requiring Iv dye

192
Q

What are alpha glucosidase inhibitors used to treat? How do they work and what are some important educational components?

A

Used to treat type two diabetes

Works by inhibiting glucose societies in the small intestines, which prevents the breakdown of carbohydrates immediately after ingestion

Education, patients must take with first bite a meal or they won’t work

If hypoglycemia occurs, they must use glucose tablets due to the bodies in the village bring down carbohydrates

193
Q

What class of medication’s should be avoided in patients who have a history of multiple endocrine neoplasia or thyroid cancer?

A

GLP’s-one agonist

194
Q

What classes of diabetes medication should be avoided in patients with a history of pancreatitis

A

DPP-4 inhibitors
GLP – 1 agonist

195
Q

What are the potential side effects of PTU?

A

Agranulocytosis
Aplastic, anemia
Hepatitis

196
Q

What lab values should be monitored when a patient is taking PTU for hyperthyroidism

A

CBC
LFTs
Due to the risk for aplastic, anemia, agranulocytosis and hepatitis 

197
Q

What hyperthyroid ism medication is safe  to use in the first trimester of pregnancy? Second trimester of pregnancy?

A

First trimester: PTU
Second trimester: Tapazole

Pneumonic: “P” comes before “T”

198
Q

What are the adverse effects associated with ondansetron?

A

QT prolongation
Increased risk for serotonin syndrome, if used with SSRIs

199
Q

What is the mechanism of action of prochlorperazine (compo)?

A

Blocks dopamine receptors to alleviate nausea.

200
Q

What are the side effects associated with prochlorperazine?

A

Anticholinergic affects
Tardive dyskinesia

201
Q

What is an absolute contraindication for the use of promethazine (phenergen)

A

Age less than two years old

202
Q

How should you does loperamide

A

Give a loading dose of two times the normal dose, then instruct them to take after any episode of diarrhea

203
Q

What are two contraindications for loperamide treatment

A

Blood in the stool
Diarrhea that last more than three days

204
Q

Before placing a patient on a PDE- 5 inhibitor what diagnostic testing should you perform? 

A

First ECG
lipid profile
CBC
CMP
Hgb, A1c
Fasting glucose
Fasting, total testosterone

205
Q

What medication is used as first line treatment for BPH

A

Alpha blockers “zosins”
Example: terazosin (Hytrin)

206
Q

What adverse effects can alpha blockers used for BPH have

A

First dose effect may result in profound, hypotension, dizziness, and possible syncope.

Instruct the patient to take the first dose at night

207
Q

What are five alpha reductase inhibitors

Give an example

What are the side effects?

A

Medication’s to help BPH by shrinking the prostate

May take up to six months to work

Side effects include erectile dysfunction, and the medication is Teratogenic

208
Q

Who is not eligible for combined contraceptive?

A

Age >35 and smokes
Current or history of blood clot
Migraines with aura
Current liver disease
Current cancer
Breast-feeding

209
Q

When starting COC what is meant by Quickstart?

A

Quick start: take the first pill the day you receive them, regardless of your time in menstrual cycle. Will need back up contraception for seven days.

210
Q

Describe the first day start in regards to COC

A

Start with pills within the first five days of your menstrual cycle start.

Starting COC and this way does not require back up birth control method

211
Q

Describe a Sunday start for COC?

A

Start the pill on the Sunday following your menses this will help avoid the patient having periods on the weekend

Must use back up method for at least seven days 

212
Q

How should you instructed patient if they miss ONE birth control pill

A

Take the misspell as soon as possible and continue with taking the rest of the pack on schedule.
No back up method needed

213
Q

How should you instructed patient who missed two active pills in their COC pack?

A

Take the most recent missed pill as soon as possible, discard the other, missed pill. Continue taking the rest of the pack on schedule while using a back up method.

214
Q

How should you instructed patient if they miss more than two active pills in a COC pack?

A

Use a back up method and start with new pack

215
Q

What are the advantages to using a COC pill?

A

Improved regularity of cycle
Les ovarian cysts
Helps with dysmenorrhea
Helps acne and endometriosis
Decreases risk of endometrial, an ovarian cancer
No wait for fertility to return upon cessation

216
Q

What type of birth control is the NuvaRing and how is it used?

A

Combined contraception
Keep in place times three weeks then remove for one week to allow for menses.

217
Q

How should you instruct the patient to proceed if they’re NuvaRing falls out?

A

Reinserted as soon as possible as long as it’s reinsert it within three hours it will not impact the efficacy

218
Q

Which combined contraceptive option has the highest risk for blood clots ? why?

A

Ortho Evra (xulane patch)
Has the highest level of estrogen out of all CCs

219
Q

What is an important educational component when prescribing the mini or progesterone only pill?

A

There is not a lot of room for error. The dose must be taken every day at the same time. Greater than a three hour window may induce ovulation. 

220
Q

How often is a deck boat Provera administered and what type of contraception is it?

A

Administered every 12 to 13 weeks
Progestin only option

221
Q

What are some adverse effects associated with Depo-Provera?

A

Delay in return to fertility
Weight gain
Acne
Depression
Low bone density

222
Q

Depo-Provera contraception is typically limited to what timeframe due to its side effects?

A

2-5 years

223
Q

What supplement should you prescribed for a patient on Depo-Provera?

A

Vitamin D and calcium supplements due to the possibility of bone density loss

224
Q

What testing needs to be done prior to IUD insertion?

A

Pelvic exam

225
Q

What are the contraindications to IUD insertion?

A

Current pregnancy
History of a topic pregnancy
PID
STI
Abnormal, uterine bleeding
Fibroids, or any disorder that will miss shape in the uterus

226
Q

What are the possible complications associated with an IUD?

A

Dislodgment
Ectopic pregnancy

227
Q

What educational information is important to relay to your patient with inserting an IUD

A

Patient should be able to find the string at all times

May cause a Minorea, or may cause breakthrough bleeding in some

228
Q

What type of hormones does the emergency contraceptive pill include?

A

Progestin only

229
Q

How effective is the morning after pill?

A

75% effective in reducing the risk of pregnancy, if taken within 72 hours after unprotected sex

230
Q

What are common side effects of the morning after pill

A

Nausea, spotting, and vomiting

231
Q

What is the time frame for using the copper IUD as emergency contraceptive

A

Within Seven days after having unprotected intercourse

232
Q

What are some common side effects associated with the copper IUD?

A

Heavier menses
Spotting
Cramping

233
Q

Which cranial nerve is involved in ocular movement, focus, and pupillary response

A

Cranial nerve three

234
Q

Which cranial nerve is involved in ocular movement, focus, and pupillary response

A

Cranial nerve three

235
Q

Which cranial nerve is responsible for outward movement of the eye

A

Cranial nerve six or the abducens nerve

236
Q

Which cranial nerve is responsible for outward movement of the eye

A

Cranial nerve six or the abducens nerve

237
Q

Which cranial nerve are we testing when we test the patient’s vision using the Snellen chart?

A

Optic nerve 2

238
Q

What are the risk factors for Barrett’s esophagus?

A

Chronic Gerd
Smoking
male sex
Age greater than 50
Obesity
Family history of Barrett’s

239
Q

What are the risk factors for Barrett’s esophagus?

A

Chronic Gerd
Smoking
male sex
Age greater than 50
Obesity
Family history of Barrett’s

240
Q

Describe where the following would be found on the body:
Tinea faciei
Tinea capitis
Tinea unguium
Tinea Cruris

A

Tinea faciei: face/beard
Tinea capitis: scalp
Tinea unguium: nail
Tinea Cruris: groin, inner thighs, but

241
Q

Which type of fungal infection should be treated with oral as opposed to topical treatments

A

Tinea infections of the scalp or follicular areas should be treated with oral antifungal’s

242
Q

What T score is considered osteopenia

A

-1 to -2.5

243
Q

What is the mechanism of action of a bisphosphonate?

A

Inhibits osteoclasts reabsorption

244
Q

What is the first line treatment for rheumatoid arthritis?

A

DMARD

245
Q

What are some important points to remember about allopurinol?

A

Is used as a preventative Med for gout

Do not initiate during an acute attack, but also do not stop it if they’re already on it

Because bone marrow suppression monitor the CBC

Also monitor LFTs in renal function

246
Q

What are some important points to remember about allopurinol?

A

Is used as a preventative Med for gout

Do not initiate during an acute attack, but also do not stop it if they’re already on it

Because bone marrow suppression monitor the CBC

Also monitor LFTs in renal function

247
Q

What antibiotic can be used for dog bites?

A

Amox/clav (augmentin)

Pneumonic: dog bitten equals Augmentin

248
Q

What antibiotic can be used for dog bites?

A

Amox/clav (augmentin)

Pneumonic: dog bitten equals Augmentin

249
Q

What anabiotic is used to treat syphilis

A

IM pcn G

250
Q

What antibiotic is used to treat per you lent cellulitis that occurs below the waist

A

Bactrim

251
Q

What antibiotic carries a risk for Steven Johnson syndrome?

A

Bactrim

252
Q

What are the most common side effects associated with Flagyl?

A

G.I. distress
Metallic taste in mouth

253
Q

What three antibiotics can be used to treat purulent cellulitis

A

Bactrim
Clinda myosin
Doxycycline

Pneumonic: BCD

254
Q

What anabiotic should be avoided in severe renal impairment?

A

Bactrim
Fluoroquinolones
Nitrofurantoin (Macrobid)

Bad F-ing nephron

255
Q

What foods are high in calcium oxalate

A

Chocolate, spinach, and rhubarb

256
Q

What is the rule of thumb when suturing and timeframe?

A

Most moons are safe to close within a six hour window from injury
Facial wounds can be closed up to 24 hours from injury

257
Q

Neovascularization in micro aneurysms on the fundus exam is associated with what condition

A

Diabetic retinopathy

258
Q

What inflammatory bowel disease is associated with ankylosing spondylosis

A

Ulcerative colitis

259
Q

When deciphering between oral candidiasis or leukoplakia, what is a key finding?

A

An oral candidiasis plaques can be scraped off for a sample. The white plaques of leukoplakia cannot be scraped off.

260
Q

What medication is used to help treat hidradenitis suppurativa?

A

Topical Clindamycin

261
Q

What is the most specific diagnostic test to diagnose rheumatoid arthritis?

A

Anti-CCP antibodies

262
Q

What is the most specific diagnostic test to diagnose rheumatoid arthritis?

A

Anti-CCP antibodies

263
Q

Dose of vitamin D for fall prevention

A

800-1000 IU/day

BOARDS ABX (6 decks)

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