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
2
Q
What bacteria causes otitis externa
A
Pseudomonas
Staph aureus
3
Q
What is the treatment for mild otitis external?
A
Acidic acid with propylene glycol and hydrocortisone otic drops
Brand name is VOSOL
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
5
Q
What medication should be avoided if a ruptured TM is suspected?
A
Neomycin containing products
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
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
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
9
Q
What are the complications associated with strep pharyngitis?
A
Scarlet fever
Acute rheumatic fever
Peritonsillar abscess
Poststreptococcal glomerulonephritis
10
Q
What is the pharmacological therapy for actinic keratosis?
A
Topical five – fluorouracil (5-FU)
Imiquimod cream
topical, diclofenac gel
11
Q
What are non-pharmacological treatment options for acinic keratosis
A
Photodynamic therapy w/ topical delta-aminolevulonic acid or
Cryosurgery with liquid nitrogen
12
Q
Treatment for rosacea
A
Topical metronidazole
13
Q
Treatment for psoriasis
A
Medium potency topical corticosteroids
14
Q
Treatment for a verruca vulgaris
A
imiquimod cream
15
Q
Treatment for tinea pedis
A
 Topical ketoconazole
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.
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.
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
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
20
Q
What formulation of topical steroids is preferred for poison ivy treatment
A
Ointments preferred over cream allows medication to contact skin longer
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
22
Q
What are the organisms that cause non-bolus impetigo
A
Staphylococcus aureus
Streptococcus pyogenes
23
Q
What is the treatment for non-bullous impetigo
A
Topical mupirocin
24
Q
What antibiotic is used to cover cellulitis
A
Penicillin VK or cephalexin (Keflex)
25
What antibiotic is used to cover skin abscesses?
TMP/SMX (Bactrim) or
 Doxycycline
To cover MRSA
26
What medication is cause hypothyroidism
Lithium amiodarone, interferon
27
What two types of hyperthyroidism present without exopthalmus or goiter
Thyroiditis that is caused by viral or postpartum or drug induced milder symptoms typically self limiting
28
What is the function of the anterior pituitary gland in relation to the thyroid?
Releases, thyroid, stimulating hormone, to inform the thyroid, how much T4 to release
29
How should Synthroid be dosed?
Does using ideal body weight:
1.6 mcg/kg/day
Elderly: 1mcg/kg/day
30
How long after initiating level thyroxine therapy should you check a TSH
8 weeks
31
What is a normal TSH level?
0.4 to 4.0
32
How much do you titrate levothyroxine by when thyroid levels are out of the norm
Titrate by 12.5 to 25 µg every eight weeks and check TSH.
33
Once patient is stable on levothyroxine therapy how often should you check the TSH level
Measure at six months, once stable than once yearly or when symptomatic
34
What type of medication’s are triptans and what are they used for?
Selective serotonin receptor agonist.
Primarily used as an abortive med for migraines may also be used for tension, headaches and cluster headaches
35
What are the side effects of triptans?
Hypertension, due to potential vascular affect
36
How do triptans work?
By causing cerebral vasoconstriction, to counteract the vasodilation associated with migraines
37
When should controller therapy be initiated for migraine headaches
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
38
What classes of medications are used for migraine prophylaxis
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)
39
What is an important educational piece when prescribing preventive migraine medication?
It may take up to 4 to 6 weeks of use prior to noting clinical effect
40
Which abortive migraine medication is safe to use in patients with heart disease
An oral calcitonin gene-related peptide antagonist (CGRP) -gepant such as ubrogepant (ubrelvy)
41
What test rules out giant cell arteritis?
ESR
42
If a patient with giant cell arteritis has an ESR greater than 100 what diagnostic testing should be performed to confirm diagnosis
Arterial biopsy and or arterial color duplex ultrasound
43
What is the treatment for giant cell arteritis?
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
44
What is the Main serious complication due to giant cell arteritis?
Blindness
45
What type of condition is giant cell arteritis?
Auto immune
46
What condition put a patient at risk for giant cell arteritis
Poly myalgia rheumatica
47
What is the recommended treatment for patient suspected of having Gerd
Eight weeks trial of empiric PPI therapy once daily prior to meals 
48
What vitamin deficiencies is a patient at risk for with protracted PPI use
Iron
Vitamin B-12
Calcium
Magnesium 
49
What G.I. complications are associated with protracted PPI use
Increase risk of cdiff
50
What long-term effect can PPIs have on bone health?
May increase risk of fracture
51
Patience on protracted PPI use are at risk for what pulmonary complication
Pneumonia
52
If Gerd symptoms do not resolved with eight week trial of PPI therapy, what is the next intervention?
Refer to G.I. for an upper endoscopy
53
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
Duodenal ulcer
54
H. pylori is associated with what type of ulcer
Duodenal ulcer
55
What type of hepatitis is most commonly contracted from sexual contact
Hepatitis B
Pneumonic: B equals Boner
56
What lab findings would you expect in a patient with acute hepatitis A?
HAV IgM
Liver enzymes elevated 10 times the norm
57
What lab findings would you expect to see in a patient with acute hepatitis B?
(+) IgM anti-HBc
(+) HBsAg
LFTS > 10x norm
If (+) HBeAG patient is “extra” contagious
58
What laboratory findings would you expect in a patient with chronic hepatitis B infection?
Normal or slightly elevated liver enzymes
(+) HBsAg
59
What lab value indicates immunity to hepatitis B virus?
(+) HBsAb
60
What laboratory findings would you expect to find in a patient with an acute hepatitis C infection
(+) Anti HCV
HCV viral DNA
ELEVATED LFTS
61
What laboratory findings would you expect to see on a patient who has a chronic hepatitis C infection?
(+) Anti-HCV
HCV viral DNA
Normal or slightly elevated LFTs
62
What laboratory findings would you expect to see on a patient with a hepatitis C infection in the past?
(+) Anti-HCV
(-) HCV RNA
Normalized LFTs
63
If somebody has had a resolved hepatitis, C infection, do they form antibodies to protect them from future infection?
No hepatitis C antibody is non-protective
64
Which types of hepatitis offer post exposure prophylaxis?
Hepatitis A and B
65
In addition to hepatitis B, what type of hepatitis does the hepatitis B vaccine protect someone from?
Hepatitis D
66
How do you test for HCVRNA levels
Order a qualitative and quantitative nucleic acid test to detect the quantity in the presence of the virus
67
Which type of inflammatory bowel disease involves the mouth to anus
Crohn’s disease
68
What is the first line antibiotic treatment for diverticulitis?
Amoxicillin clavulanate (Augmentin)
If beta lactam allergy :
Bactrim, Cipro or level Floxin plus Metronidazole
69
What educational instructions are important when ordering a urea breath test
Discontinue antibiotics or PPI’s at least two weeks prior to testing
70
What is the medication regimen for H. pylori infection
Ppi, clarithromycin, and amoxicillin
Pneumonic: “ Pepcid, AC”
71
What is the minimum diagnostic work up when suspecting pneumonia?
CBC with differential
BUN creatinine
Chest x-ray
72
What is the duration of antibiotic therapy for community acquired pneumonia
 Minimum five days with evidence of increasing stability
Patient should be afebrile for 48 to 72 hours prior to anti-microbial discontinuation
73
What is the most common cause of community acquired pneumonia?
Strep pneumoniae
Gram (+)
74
What are the likely causative pathogens for community acquired pneumonia in a patient without comorbidities?
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
75
What antibiotics are used to treat community acquired pneumonia in patients with no comorbidities
Macrolides, amoxicillin, doxycycline
Pneumonic: MAD LUNG
76
What are the likely causative pathogens of community acquired pneumonia in patients with comorbidities
S pneumoniae
H influenzae
M pneumoniae
C pneumoniae
Legionella
Pneumonic: too much SNM in the Cunt leads to legionella and influenzae
77
What is the recommended treatment for community acquired pneumonia in a patient with comorbidities
Fluoroquinolone, such as moxifloxacin or levofloxacin
Or
Doxycycline or macrolide (azithromycin or Clarithromycin) PLUS beta lactam, such as amoxicillin, clavulanate, or a cephalosporin
78
What are the components of curb 65?
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 
79
If a patient has a curb 65 results of greater than two, where should they be treated?
Hospital
80
What medication increases the risk of tendon rupture 60 times the norm if prescribed with fluoroquinolones
Steroids
81
What medication can be prescribed for protracted problematic, cough in acute bronchitis?
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
82
How is asthma diagnosed
Spirometry
83
Asthma is characterized by what type of airway obstruction? Define
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
84
What is considered poor lung function?
FEV less than 60%
85
What test and result is required for a COPD diagnosis
Spirometry with an FEV: FCV< .70 post bronchodilator 
86
Which pathogens that cause community acquired pneumonia are gram-positive
S. pneumonia
Staph aureus
87
Which pathogen that causes pneumonia community acquired are Graham negative
H influenzae
P aeugunoa
88
Which pathogens that cause community choir pneumonia are atypical
S pneumoniae
C pneumoniae
Legionella
89
How long before an ICS takes effect?
2 to 8 days
90
If a patient is experiencing an asthma flare, how long should you step up the ICS’s for?
2 to 4 weeks
91
What is the recommended treatment for a patient with COPD with zero to one moderate exacerbations unless symptoms
Laba or lama is preferred to Saba or Sama
92
What is the recommended treatment for a patient with COPD with zero to one moderate exacerbations and more symptoms
LAMA+LABA
93
What physiological marker would warrant the addition of an inhaled corticosteroid in a patient with COPD
Eosinophils greater than 300
94
What should the insulin regimen look like for a type one diabetic?
50% basal insulin 50% bolus or rapid acting insulin daily
95
When should a type two diabetic be put on insulin therapy
At time of diagnosis, if hemoglobin A1c is greater than 9% or when greater than two oral or injectable agents result in inadequate control
96
What does should you start basal insulin at for a type two diabetic
10 units or 0.2 units per kilogram.
97
How should you titrate basal insulin in a type two diabetic
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. 
98
When starting a type two diabetic on insulin, what type of insulin should you initiate first?
Basal insulin
99
What is the pre-meal glucose target for a type two diabetic
70 to 130 
100
If a patient’s pre-lunch glucose is greater than 130 what rapid acting insulin regimen would you institute
Four unit Bolis before breakfast
101
If your patients pre-dinner glucose is greater than 130 what should your immediate acting insulin regimen be?
Four unit bolus of rapid, acting insulin before lunch or add or increase morning and pH or long acting insulin
102
If bedtime glucose is above target greater than 140 what insulin regimen should you institute?
Four unit bolus, insulin before supper or increase evening basal insulin
103
If our patients post prandial blood glucose is not within limits how do we treat this?
By adding a pre-meal, rapid acting insulin
104
What is the two hour postprandial glucose target?
160 to 180
105
What is the most potent risk factor for angioedema when taking an ace or arb?
Nsaid allergy
106
How much will a moderate intensity statin lower someone’s LDL
30 to 49%
107
How much will a high intensity statin lower someone’s LDL
50%
108
Which statins are considered low intensity, and not recommended
Pravastatin 10 to 20 mg
Lovastatin 20 mg
Pneumonic: pussy, LDL
109
What is the normal pH of the vagina?
3.8 to 4.2.
110
What are the symptoms and treatment for bacterial vaginosis?
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
What type of cells would you see on a saline wet mount from a healthy vagina
Lactobacillus
112
Which herpes virus causes genital herpes
HSV-2
Pneumonic: it takes two to tango or one to talk
113
What is the treatment for genital herpes?
Acyclovir (Zovirax)
Famciclovir (famvir)
Valaciclovir (valrex)
114
What is an important educational piece when educating a patient about transmission of herpes?
The virus can still be transmitted, when not active
115
What are the three causative organism’s of nongonococcal urethritis in cervicitis?
Clamydia trachomatis
Ureaplasma urealyticum
Mycoplasma genitalium
Pneumonic: CUM
116
What is the treatment for nongonococcal urethritis?
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
What are the signs and symptoms and treatment of trichomonas vaginalis
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
What medication’s are safe to treat a UTI and pregnant people
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
What are the most common pathogens associated with urinary tract infection?
E. coli
Klebsiella
S., Saprophyticus
120
What antibiotics are used to treat uncomplicated UTI’s?
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
What types of HPV are associated with 70% of cervical cancer cases
HPV 16 and 18
122
When should PEP be instituted and what is the duration?
As soon as possible, following a higher risk for HIV event, ideally within 72 hours duration is 28 days
123
What condition does red blood cells and red blood cell cast in a urinalysis indicate
Glomerulonephritis
124
What condition does red blood cells and red blood cell cast in a urinalysis indicate
Glomerulonephritis
125
When would you test for an FMR1 gene mutation?
Unsuspected, fragile X syndrome
126
How does cutaneous anthrax present, who is at risk, and what is the treatment?
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
What is the mechanism of action of metFormen
Suppresses the livers production of glucose
Decreases the intestines absorption of glucose
Improves insulin sensitivity
128
Which SSRI has the fastest onset
Escitalopram (Lexapro)
129
Which SSRI is used for OCD and what are the side effects?
Paroxetine (Paxil)
Weight gain, and sedation
130
Which SSRI is least likely to cause weight gain, and it’s good for people with eating disorders
Fluoxetine (Prozac)
“Pro-food”
131
Which class of anti-depressants should be avoided in patients with hypertension? Give two examples of these medication’s.
SNRI’s
Duloxetine (Cymbalta)
Venlafaxine (Effexor) 
132
Which class of antidepressants have a cardiac effects? What are they and how should you proceed before prescribing?
Tricyclics
For patients over 40 update of baseline ECG due to risk of heart block
133
Which antidepressants are the easiest to overdose on and what should you consider when prescribing these to patients?
Tricyclic antidepressants
For patients at risk of suicide, do not prescribe a full course
134
Which class of antidepressants should be avoided in the elderly and why?
Tricyclic antidepressants do the anticholinergic affects
135
What are the two main safety concerns when prescribing MAOIs?
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
What is the typical onset of buspirone? Side effects.
Onset is 2 to 4 weeks
Side effects: nausea and dizziness
137
What should you instruct the patient to do when taking Busseron to avoid dizziness?
Take with a full meal to avoid severe dizziness
138
What medication is used for anxiety and depression should you avoid drinking grapefruit juice with?
BuSpar
MAOIs
139
What is a therapeutic range for lithium?
0.6 to 1.2.
140
What are the side effects of lithium?
Hypothyroidism
Kidney insufficiency
Weight gain
Nausea
Altered sodium levels
141
What are the signs and symptoms of lithium toxicity?
Nausea
Vommiting
Hyper active reflexes
Tremors
Confusion
Vision changes
142
When taking lithium what food or drink should be avoided?
Grapefruit juice
143
Which class of calcium channel blockers do not affect the heart conduction system
Dihydropyridines
“D”= Don’t effect the heart
Dipines
Amlodipine (Norvasc)
Nifedipine (adalat)
144
Which calcium channel blocker is used for cluster headaches
Verapamil
145
What are the two major side effects associated with calcium channel blockers?
Headache
Leg swelling
146
What class of antihypertensive should be avoided in patients with Gerd
Calcium channel blockers
147
What patient should thiazide diuretics be avoided it?
Patience with sofa, allergies
Patients with GFR less than 30
148
Which thiazide is cardioprotective
Chlorthalidone
149
Which laboratory values should you monitor in patients on a thiazide diuretic
Uric acid
Triglycerides
Glucose
150
What protective affects to thiazide diuretics have
Cardioprotective
Bone protective
151
What conditions are beta blockers effective in treating
Heart failure with an EF less than 40%
Previous MI
ANXIETY
Tachycardia related to hyper thyroidism
152
What antihypertensives are safe during pregnancy?
Nifedipine
Labetolol
Methyldopa
Pneumonic: new little mama
153
If large doses of furosemide are administered to quickly, what may happen to the patient
Oto toxicity
154
How long does Lasix last of the patients system?
6-8 hours
Pneumonic: la-six
155
What medication can cause gynecomastia in men
Spironolactone (Aldactone)
156
What is the normal therapeutic range for digoxin?
0.5.-0.8.
157
What are the signs and symptoms of digoxin toxicity?
Visual changes (green, yellow halo)
Fatigue
Weakness
Dysrhythmias
158
What electrolyte in balance me precipitate, digoxin toxicity
Hypo kalemia
159
What is the antidote for digoxin toxicity?
Digibind
160
How should long-acting nitrates be prescribed to prevent tolerance?
With a nitrate free interval, typically overnight
161
What organ systems must you monitor with long-term use of amiodarone
Thyroid: amiodarone contains iodine, and may cause hypo or hyper thyroidism
Eyes: because optic neuropathy or corneal deposits
Lungs : can cause pulmonary toxicity
162
What medication frequently prescribed with amiodarone can result in increased effects of this medication
Anticoagulants
When on amiodarone and anticoagulants, you may need to decrease the dose of the anticoagulant by 25%
163
What are two detrimental side effects of statins
Rhabdo, myelitis and drug induced hepatitis
164
What medications are used to decrease triglycerides
Fibrates
fenofibrate (Tricor)
165
What is niacin used for what is a common side effect? How do we avoid the side effect?
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
What medication is effective at reducing LDL, but is rarely tolerated due to G.I. side effects
Bile acid sequestrant, such as cholestyramine
167
How long should you hold warfarin prior to a surgical procedure?
Five days
168
If a patient who is on warfarin has an INR is 5 to 10 without bleeding how should we treat?
Hold warfarin for 1-2 doses
169
If a patient on warfarin has an INR of 5 to 10 with bleeding how should they be treated?
With vitamin K either PO or IV
170
If a patient on warfarin has an INR greater than 10 without bleeding, how should we treat them?
With PO vitamin K
171
If a patient on warfarin has an INR greater than 10 with bleeding, how should we treat them?
With IV vitamin K and monitoring
172
How long should we treat a DVT with direct oral anticoagulants?
Six months
173
How are DOAC’s typically dosed for DVT treatment
Loading dose for several days, then lower dose for maintenance times six months
174
What lab value is important to monitor for a patient on DOAC’s
Renal function
Does mean need to be adjusted for renal function
175
What type of anesthesia is contra indicated when LMWH is prescribed?
Spinal anesthesia
IfLMWH is used in conjunction with spinal anesthesia. It increases the risk for a spinal hematoma, and can lead to paralysis.
176
How long should you hold aspirin before a surgical procedure?
7 to 10 days, which is the lifespan of a platelet
Pneumonic: platelet is eight letters . Falls between seven and 10.
177
What is something to remember about aspirins mechanism of action when prescribing
Aspirin irreversibly binds to platelets for the lifespan of the platelet, which last 7 to 10 days
178
What is important to prescribe when a patient has had a stent placement
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
What blood test is used to monitor drug Lovenox
Anti-XA
180
What suffix do all long acting beta agonist have?
“Terol”
Exception to the rule, is albuterol in levoalbuterol, which are short acting beta agonist
181
What class of respiratory meds end in the suffix “pium”
Long acting muscarinic antagonist (LAMA)
182
What is the step one treatment for asthma per the Gina guidelines?
A low-dose ICS’s with formoterol (LABA) prn
183
What is step two in the Gina guidelines?
Low-dose ICS’s with formotetol as needed
184
What is step three treatment for asthma in the Gina guidelines
Low does ICS/formoterol daily and rescue
185
What medication class should never be used alone to treat asthma and why?
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
What is the first line treatment for allergic rhinitis?
Intranasal corticosteroids
187
What is the onset peak? In duration of rapid acting insulin
Onset: 15 minutes
Peak: one hour
Duration: 2 to 4 hours
188
What is the onset peak in ration of short acting regular insulin? 
Onset: 30 minutes- 1hour
Peak: 2 to 4 hours
Duration: 6 to 8 hours
189
What is the onset peak? In duration of intermediate acting insulin or NPH?
Onset: 1-2 hours
Peak: 6 to 12 hours
Duration: 24 hours
190
What is the onset peak and duration of long acting insulin Lantus or Levemir?
Answer: two hours
Peak: none
Duration: 24 hours
191
What two factors can increase the risk for the metabolic acidosis associated with metformen?
EtOH
Procedures requiring Iv dye
192
What are alpha glucosidase inhibitors used to treat? How do they work and what are some important educational components?
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
What class of medication’s should be avoided in patients who have a history of multiple endocrine neoplasia or thyroid cancer?
GLP’s-one agonist
194
What classes of diabetes medication should be avoided in patients with a history of pancreatitis
DPP-4 inhibitors
GLP – 1 agonist
195
What are the potential side effects of PTU?
Agranulocytosis
Aplastic, anemia
Hepatitis
196
What lab values should be monitored when a patient is taking PTU for hyperthyroidism
CBC
LFTs
Due to the risk for aplastic, anemia, agranulocytosis and hepatitis 
197
What hyperthyroid ism medication is safe  to use in the first trimester of pregnancy? Second trimester of pregnancy?
First trimester: PTU
Second trimester: Tapazole
Pneumonic: “P” comes before “T”
198
What are the adverse effects associated with ondansetron?
QT prolongation
Increased risk for serotonin syndrome, if used with SSRIs
199
What is the mechanism of action of prochlorperazine (compo)?
Blocks dopamine receptors to alleviate nausea.
200
What are the side effects associated with prochlorperazine?
Anticholinergic affects
Tardive dyskinesia
201
What is an absolute contraindication for the use of promethazine (phenergen)
Age less than two years old
202
How should you does loperamide
Give a loading dose of two times the normal dose, then instruct them to take after any episode of diarrhea
203
What are two contraindications for loperamide treatment
Blood in the stool
Diarrhea that last more than three days
204
Before placing a patient on a PDE- 5 inhibitor what diagnostic testing should you perform? 
First ECG
lipid profile
CBC
CMP
Hgb, A1c
Fasting glucose
Fasting, total testosterone
205
What medication is used as first line treatment for BPH
Alpha blockers “zosins”
Example: terazosin (Hytrin)
206
What adverse effects can alpha blockers used for BPH have
First dose effect may result in profound, hypotension, dizziness, and possible syncope.
Instruct the patient to take the first dose at night
207
What are five alpha reductase inhibitors
Give an example
What are the side effects?
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
Who is not eligible for combined contraceptive?
Age >35 and smokes
Current or history of blood clot
Migraines with aura
Current liver disease
Current cancer
Breast-feeding
209
When starting COC what is meant by Quickstart?
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
Describe the first day start in regards to COC
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
Describe a Sunday start for COC?
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
How should you instructed patient if they miss ONE birth control pill
Take the misspell as soon as possible and continue with taking the rest of the pack on schedule.
No back up method needed
213
How should you instructed patient who missed two active pills in their COC pack?
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
How should you instructed patient if they miss more than two active pills in a COC pack?
Use a back up method and start with new pack
215
What are the advantages to using a COC pill?
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
What type of birth control is the NuvaRing and how is it used?
Combined contraception
Keep in place times three weeks then remove for one week to allow for menses.
217
How should you instruct the patient to proceed if they’re NuvaRing falls out?
Reinserted as soon as possible as long as it’s reinsert it within three hours it will not impact the efficacy
218
Which combined contraceptive option has the highest risk for blood clots ? why?
Ortho Evra (xulane patch)
Has the highest level of estrogen out of all CCs
219
What is an important educational component when prescribing the mini or progesterone only pill?
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
How often is a deck boat Provera administered and what type of contraception is it?
Administered every 12 to 13 weeks
Progestin only option
221
What are some adverse effects associated with Depo-Provera?
Delay in return to fertility
Weight gain
Acne
Depression
Low bone density
222
Depo-Provera contraception is typically limited to what timeframe due to its side effects?
2-5 years
223
What supplement should you prescribed for a patient on Depo-Provera?
Vitamin D and calcium supplements due to the possibility of bone density loss
224
What testing needs to be done prior to IUD insertion?
Pelvic exam
225
What are the contraindications to IUD insertion?
Current pregnancy
History of a topic pregnancy
PID
STI
Abnormal, uterine bleeding
Fibroids, or any disorder that will miss shape in the uterus
226
What are the possible complications associated with an IUD?
Dislodgment
Ectopic pregnancy
227
What educational information is important to relay to your patient with inserting an IUD
Patient should be able to find the string at all times
May cause a Minorea, or may cause breakthrough bleeding in some
228
What type of hormones does the emergency contraceptive pill include?
Progestin only
229
How effective is the morning after pill?
75% effective in reducing the risk of pregnancy, if taken within 72 hours after unprotected sex
230
What are common side effects of the morning after pill
Nausea, spotting, and vomiting
231
What is the time frame for using the copper IUD as emergency contraceptive
Within Seven days after having unprotected intercourse
232
What are some common side effects associated with the copper IUD?
Heavier menses
Spotting
Cramping
233
Which cranial nerve is involved in ocular movement, focus, and pupillary response
Cranial nerve three
234
Which cranial nerve is involved in ocular movement, focus, and pupillary response
Cranial nerve three
235
Which cranial nerve is responsible for outward movement of the eye
Cranial nerve six or the abducens nerve
236
Which cranial nerve is responsible for outward movement of the eye
Cranial nerve six or the abducens nerve
237
Which cranial nerve are we testing when we test the patient’s vision using the Snellen chart?
Optic nerve 2
238
What are the risk factors for Barrett’s esophagus?
Chronic Gerd
Smoking
male sex
Age greater than 50
Obesity
Family history of Barrett’s
239
What are the risk factors for Barrett’s esophagus?
Chronic Gerd
Smoking
male sex
Age greater than 50
Obesity
Family history of Barrett’s
240
Describe where the following would be found on the body:
Tinea faciei
Tinea capitis
Tinea unguium
Tinea Cruris
Tinea faciei: face/beard
Tinea capitis: scalp
Tinea unguium: nail
Tinea Cruris: groin, inner thighs, but
241
Which type of fungal infection should be treated with oral as opposed to topical treatments
Tinea infections of the scalp or follicular areas should be treated with oral antifungal’s
242
What T score is considered osteopenia
-1 to -2.5
243
What is the mechanism of action of a bisphosphonate?
Inhibits osteoclasts reabsorption
244
What is the first line treatment for rheumatoid arthritis?
DMARD
245
What are some important points to remember about allopurinol?
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
What are some important points to remember about allopurinol?
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
What antibiotic can be used for dog bites?
Amox/clav (augmentin)
Pneumonic: dog bitten equals Augmentin
248
What antibiotic can be used for dog bites?
Amox/clav (augmentin)
Pneumonic: dog bitten equals Augmentin
249
What anabiotic is used to treat syphilis
IM pcn G
250
What antibiotic is used to treat per you lent cellulitis that occurs below the waist
Bactrim
251
What antibiotic carries a risk for Steven Johnson syndrome?
Bactrim
252
What are the most common side effects associated with Flagyl?
G.I. distress
Metallic taste in mouth
253
What three antibiotics can be used to treat purulent cellulitis
Bactrim
Clinda myosin
Doxycycline
Pneumonic: BCD
254
What anabiotic should be avoided in severe renal impairment?
Bactrim
Fluoroquinolones
Nitrofurantoin (Macrobid)
Bad F-ing nephron
255
What foods are high in calcium oxalate
Chocolate, spinach, and rhubarb
256
What is the rule of thumb when suturing and timeframe?
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
Neovascularization in micro aneurysms on the fundus exam is associated with what condition
Diabetic retinopathy
258
What inflammatory bowel disease is associated with ankylosing spondylosis
Ulcerative colitis
259
When deciphering between oral candidiasis or leukoplakia, what is a key finding?
An oral candidiasis plaques can be scraped off for a sample. The white plaques of leukoplakia cannot be scraped off.
260
What medication is used to help treat hidradenitis suppurativa?
Topical Clindamycin
261
What is the most specific diagnostic test to diagnose rheumatoid arthritis?
Anti-CCP antibodies
262
What is the most specific diagnostic test to diagnose rheumatoid arthritis?
Anti-CCP antibodies
263
Dose of vitamin D for fall prevention
800-1000 IU/day
