Chp 3 Pharmacology Review & some OB Flashcards
1
Q
One of the most common drug interactions in the primary care area is between warfarin and ______.
A
Bactrim
2
Q
When a drug is swallowed, it is absorbed through the _______ _________ where it enters the _______ circulation
A
small intestine
portal
3
Q
Inside the liver, the _______ system is responsible for the biotransformation of drugs, alcohol, herbs, foods, and toxins.
A
CYP450
4
Q
Drugs that have extensive ______-_____ ________ cannot be given by the oral route simply b/c there is not enough of the active drug left.
A
first-pass metabolism
5
Q
Drug metabolism:
The most active organ is the ______.
“Induced” means _______ drug ______.
A
liver
increased metabolism
6
Q
Drug metabolism:
Other organ systems involved in the biotransformation of drugs are the _______, __ ______, and the _____.
A
kidneys, GI tract lungs
7
Q
Most drugs are excreted by both the ________ system and the _________.
A
hepatobiliary
kidneys
8
Q
The average amount of a drug in the blood after a dose is given - It is a measure of the availability (bioavailability) of a drug after it is administered:
A
“Area under the curve”
9
Q
The lowest concentration of an antibiotic that will inhibit the growth of organisms (after overnight incubation):
A
Minimum inhibitory concentration
10
Q
The highest concentration of a drug after a dose:
A
Maximum concentration
11
Q
The lowest concentration of a drug after a dose:
A
trough (minimum concentration)
12
Q
Problematic drugs that are responsible for a large number of drug-drug interactions: M A C C
A
Macrolides
Antifungals
Cimetidine (Tagamet)
Citalopram (Celexa)
13
Q
Problematic drugs (potent inhibitors - slow down drug metabolism - increasing drug concentration) that are responsible for a large number of drug-drug interactions: M A C C
A
Macrolides
Antifungals
Cimetidine (Tagamet)
Citalopram (Celexa)
14
Q
Narrow therapeutic index drugs: (With These Drugs, Look, Listen, Do Count)
W
T
D
L
L
D
C
A
Warfarin
Theophylline
Digoxin
Lithium
Levothyroxine
Dilantin
Carbamazepine
15
Q
Digoxin:
Monitor EKG and ________ levels
A
electrolyte
16
Q
Lithium:
Monitor blood levels and ________
A
TSH
17
Q
Lithium:
Monitor blood levels and ________ (risk of _____)
A
TSH; hypothyroidism
18
Q
For consistently stable INRs, check them every __ to _ weeks up to every ____ weeks
A
2 to 4
12
19
Q
For a single out of range INR equal to or less than 0.5 below or above therapeutic range (2 to 3), experts suggest ______ current warfarin dose and retesting INR within ____ to ____ weeks
A
continuing
1 to 2
20
Q
INR of less than 5 with no signifiant bleeding risk:
Omit ____ dose and/or ______ maintenance dose slightly; recheck INR
A
one; reduce
21
Q
Warfarin
One missed dose:
Take the dose as _______ ______ possible on the _____ day.
Do / do not double the dose the next day
A
soon as
same
Do NOT
22
Q
Vitamin K:
The ACCP advises ________ routine vitamin K1 supplementation
A
against
23
Q
High intake of Vitamin K will ______ anticoagulant effect of warfarin (will ______ INR)
A
reduce
decrease
24
Q
Warfarin
Avoid ________ or limit to no more than one to two servings occasionally; Increases risk of bleeding even if INR is in target range
A
drinking
25
Warfarin - Adverse Reaction
"_______ ____ syndrome"
_______ ______ located in subQ fat, breasts, extremities, trunk (within first few days of receiving large doses or warfarin)
purple toes
| skin necrosis
26
Warfarin:
| After warfarin is DCd, anticoagulant effects persist for _ to ____ days
2 to 5
27
Warfarin:
| _____ patients may require lower starting and maintenance doses of warfarin
Asian
28
Warfarin:
Persons older than _____ years are more likely to have large increases in INR (after dose is increased) compared with younger patients
60
29
Warfarin:
| INR values lower than ______ increase stroke risk sixfold
2.0
30
Warfarin - Adverse reactions
| _________, _____ oil, and _______ oil also have high levels of vitamin K
mayonnaise, canola, soybean
31
Thiazide diuretics:
| Are for HTN, ______, edema, ______ _______
HF; diabetes insipidus
32
Thiazide diuretics:
| are for HTN accompanied by _______
osteopenia (or osteoporosis)
33
```
Thiazide diuretics:
Include:
H_______
I______
C______
```
HCTZ
Indapamide
Chlorthalidone
34
Thiazide diuretics:
| Do not combine with ______
Lithium
35
Thiazide diuretics:
| Contraindication is a _______ allergy
sulfa
36
Thiazide diuretics: Adverse effects:
| Elevates plasma _________
glucose
37
Thiazide diuretics: Adverse effects:
| Elevates ______ and ________
cholesterol and LDL
38
Thiazide diuretics: Adverse effects:
| Elevates ______ ______ and can therefore precipitate a gout attack
uric acid
39
Thiazide diuretics: Adverse effects:
| ________ (severe muscle weakness, arrhythmias
hypokalemia
40
______ is longer acting and more "effective" than HCTZ and is preferred by JNC-8
chlorthalidone
41
Patients with both HTN and _________ have an extra benefit from the thiazides
osteoporosis
42
thiazide diuretics reduce ________ excretion by the kidneys and stimulate _______, helping build bone.
calcium
| osteoblasts
43
Patients with serious ________ allergies should avoid thiazide and _____ diuretics. Potassium sparing diuretics, such as ______ and __________, are the alternative options for these patients.
sulfa
loop
triamterene and amiloride
44
Potassium-sparing diuretics:
Include ________ and _______
Combination: _______ and HCTZ
triamterene; amiloride
| triamterene (dyazide)
45
Potassium-sparing diuretics:
BLACK BOX WARNING:
__________ which can be fatal and risk is higher with renal impairment, diabetes, elderly, severely ill
hyperkalemia
46
Potassium-sparing diuretics:
| Monitor serum _______ (baseline, during, dose changes, illness)
potassium
47
Mineralcorticoid receptor antagonists:
| _________ & _________
spironolactone; eplerenone
48
spironolactone: for HTN, _____, ______
HF, hirsutism
49
Mineralcorticoid receptor antagonists:
Avoid giving ________ supplements.
Avoid giving salt substitutes that contain ______.
potassium; potassium
50
Mineralcorticoid receptor antagonists:
| Be careful with combos of ______, _______, or ______ which increase risk of hyperkalemai
ACEIs; ARBs, NSAIDs
51
Mineralcorticoid receptor antagonists:
| Avoid with severe ________ disease
renal
52
Spironolactone adverse effects:
| ______ and _______
gynecomastia (13%) and hyperkalemia
53
Spironolactone BLACK BOX WARNING:
| Increased risk of both _______ and ______ ______
benign and malignant tumors
54
Loop diuretics:
Are for ______ from _____ failure
_______
______ disease, and HTN
edema; heart
cirrhosis
renal
55
Loop diuretics are excreted via the loop of Henle of the kidneys and are ______ ______ than HCTZ
more potent
56
Loop diuretics:
| Include _____, _______
Lasix; Bumex
57
Loop diuretics are _____ _________ than thiazides but with shorter duration of action
more potent
58
Loop diuretics:
BLACK BOX WARNING:
Excessive amounts of furosemide may lead to profound ________; medical supervision required, individualized dose schedule
diuresis
59
Loop diuretics:
| Contraindication is a _________ allergy
sulfa
60
```
Loop diuretics:
Adverse effects:
H
O
P
E
```
Hypovolemia/hypotension
Ototoxicity
Pancreatitis, jaundice, rash
Electrolytes (hypokalemia, hyponatremia, hypomagnesemia, low levels of chlorine)
61
Beta blockers:
| Can be used as adjunctive treatment for __________/_______ to decrease heart rate and anxiety
hyperthyroidism / thyrotoxicosis
62
__________ & _________ are noncardioselective beta blockers (blocks beta-1 and beta-2
Propranolol & carvedilol
63
Cardioselective beta-blockers are more potent because they block beta-__ receptors, which are found mainly in the _________
1
| heart
64
Cardioselective beta blockers:
| Examples are __________ and _________
atenolol
| metoprolol
65
timolol eye drops are for ________
glaucoma
66
beta blockers - contraindications:
A______ (causes ________)
B______
C______
Asthma bronchoconstriction
Bradycardia or or AV block
COPD (incl. chronic bronchitis and emphysema)
67
Beta blockers: Adverse effects
B
B
B
H
E
D
bronchospasm
bradycardia
blunts hypoglycemic response (warn diabetics)
HF
Erectile dysfunction
Depression, fatigue (be careful with elderly)
68
Beta blockers block beta-_____ receptors in the heart and beta-_____ receptors in the lungs
1
| 2
69
Ace Inhibitors and Angiotensin Receptor Blockers:
| Help improve __________ and survival post-MI
LVEF
70
Ace Inhibitors and Angiotensin Receptor Blockers:
| These are the preferred agents for patients with _________-
HFrEF
71
Ace Inhibitors and Angiotensin Receptor Blockers:
Are Category ______ (first trimester) and
Category ____ 2nd to 3rd trimesters
C
| D
72
Ace Inhibitors and Angiotensin Receptor Blockers:
| ____________ is a potent vasoconstrictor
Angiotensin II
73
ACE inhibition blocks conversion of ________ to ________
Angiotensin I to Angiotensin II
74
ARBs block __________
Angiotensin II
75
Ace Inhibitors and Angiotensin Receptor Blockers:
BLACK BOX WARNING
ACEIs can cause death/injury to the fetus during the _____ and ____ trimesters, so DC ACEIs and ARBs immediately if pregnant
2nd and 3rd
76
Ace Inhibitors and Angiotensin Receptor Blockers:
Contraindications:
_________ _________
hereditary angioedema
77
```
Ace Inhibitors and Angiotensin Receptor Blockers:
Adverse effects:
Angioedema and anaphylactoid reactions
ACEI cough
________
```
hyperkalemia
78
Direct Renin Inhibitor:
| _______ blocks the _________ action of renin
Tekturna; catalytic
79
JNC-8 does not recommend ________ as initial treatment for HTN
Tekturna
80
_______ and _______ are preferred drugs for HTN in diabetics (diabetic nephropathy) and for patients with _______
ACEIs and ARBs
| CKD
81
ACEIs and ARBs:
| Avoid using salt substitutes that contain ________
potassium
82
Ace Inhibitors:
| _________ is associated with agranulocytosis, neutropenia, leukopenia. Monitor ______.
Captopril
| CBC
83
_______ and ______ are excreted in breast milk (breastfeeding mothers should avoid them)
ACEIs and ARBs
84
Calcium channel blockers:
| HTN, angina, __________, ___________ (first-line)
arrhythmias, Raynaud's
85
Calcium channel blockers:
| Verapamil - do not mix with ________ and ________ (drug interaction)
erythromycin and clarithromycin
86
```
Calcium channel blockers:
Contraindications:
A
B
C
```
AV block
Bradycardia
CHF
87
Calcium channel blockers:
Be careful/limit use of short-acting CCBs such as ________, as it increases mortality. Long-acting CCBs show no increased risk.
nifedipine
88
```
Calcium channel blockers:
Adverse effects:
H_______ (He)
P________(Put)
B________(Back)
H________(His)
C_________(Crazy)
H_________(Hair)
```
Headache (vasodilation)
Peripheral edema (not due to fluid overload)
Bradycardia
HF and Heart block
Hypotension
Constipation - the most commonly reported side effect
89
Alpha-blockers:
| For HTN with coexisting _________
BPH
90
Alpha blockers are initial therapy for symptomatic ______
BPH
91
Alpha blockers are initial therapy for symptomatic ______
| Terazosin, doxazosin
BPH
92
Alpha blockers:
| ________ 1 mg PO at bedtime
Terazosin
93
```
Alpha blockers:
Adverse effects:
P
O
D
D
```
Priapism (Flomax)
94
```
Alpha blockers:
Terazosin
Doxazosin
tamsulosin
Do not give during ______ / _______ surgery (floppy iris syndrome_
```
cataract / glaucoma
95
Alpha blockers:
| These are not a first-line choice except for males with both ________ and _________
HTN BPH
96
Alpha blockers:
| Potent vasodilator. Common side effects are _______ and __________.
dizziness
| hypotension
97
alpha blockers:
| Give at _________ at very _____ dose and slowly titrate up. Careful with frail elderly due to risk of syncope and falls.
bedtime
| low
98
Some experts recommend taking some antihypertensives (except diuretics) in the __________.
evening
99
Tetracyclines:
may cause permanent _________ of ________ and ______ defects if taken during the last half of pregnancy, in infancy, or by children younger than 9 years of age.
discoloration; teeth
| skeletal
100
Tetracyclines:
| Treat acne starting at age _____ to ______. By this age, all permanent teeth have erupted.
13 to 14
101
Tetracyclines:
Adverse reactions
_________ reaction
photosensitivity
102
Tetracyclines:
Adverse reactions
____________ _________ are rare, swallow tablet completely using a gull glass of water
esophageal ulcerations
103
Tetracyclines:
| Avoid in ________, infancy, and in children ages ___ or younger
pregnancy
| 8
104
Tetracyclines:
| Do not use oral tetracycline for _____ _______. Start with topicals such as salicylic acid and benzoyl peroxide
mild acne
105
```
For mild acne not responding to OTC drugs, try prescription topicals such as
B
E
A
T
```
benzoyl peroxide
erythromycin
azelaic acid cream
tertinoin
106
Macrolides:
Macrolides cover staph aureus, staph pyogenes, and atypical bacteria like mycoplasma and chlamydia. Compared with other antibiotic classes, macrolides are associated with more ________ __________.
drug interactions
107
Both erythromycin and clarithromycin are potent _________ inhibitors, but not _________ (which has fewer drug interactions.
CYP34A; azithromycin
108
All macrolides are category _____ except clarithromycin and telithromycin, which are cat ______.
B; C
109
```
Macrolides:
Adverse effects:
_________
________
______ prolongation
```
```
GI distress (N/V/D)
Ototoxicity, cholestatic jaundice
QT with prolongation
```
110
Macrolides:
If a condition must be treated with a macrolide (atypical bacteria) and the patient cannot tolerate erythromycin, switch the patient to ___________ or _______
azithromycin
| clarithromycin
111
Macrolides:
| May prolong _________ and increase risk of bleeding if warfarin is mixed erythromycin or clarithromycin
INR
112
Cephalosporins and penicillins belong to the ____________ family of antibiotics
beta-lactam
113
beta-lactams are bacteri_____ and work by interfering with the _____ _____ synthesis of actively growing bacteria
bactericidal
| cell wall
114
cephalosporins are Pregnancy Category ___
B
115
First-gen cephalosporins have activity against gram -positive cocci (group ___ strep, S. Aureus)
A
116
First-gen cephalosporins are not effective against ______-______ producing strains and ______
beta lactamase
| MRSA
117
First-gen cephalosporins:
| Poor _______ coverage
anaerobic
118
First-gen cephalosporins:
| Increased risk of cross-reactivity if allergic to ________
penicillin
119
First-gen cephalosporin - an example is ________ taken _____
Keflex; QID
120
Second-gen cephalosporins: Considered to be "_____ _______" antibiotics
broad-spectrum
121
Second-gen cephalosporins: Used to treat both gram-pos and _______ ______ infections
gram neg
122
Second-gen cephalosporins: Used to treat both gram-pos cocci (Streptococcus pneumonia) and gram negative (Haemophilus influenzae, Moraxella catarrhalis) infections such as ________- and _____ ______
rhinosinusitis and otitis media
123
Third-gen cephalosporins:
Better protection against __________ and gram- ______ bacteria (______ ______-, _-______) compared to 1st or 2nd gen cephalosporins
enterobacteria
negative
H. influenzae; E.coli
124
_________ ____ mg ____ (route) is 1st-line treatment for gonorrheal infections
rocephin 250 IM
125
For MRSA skin infections, do NOT use cephalosporins. 1st line therapy for this is either _________, __________ or ___________, and __________. Treat for at least ___ to ____ days.
Bactrim DS, doxycycline or minocycline, clindamycin
| 5 to 10
126
Patients who have a true allergy to penicillin (hx of _____ or _______) are more likely to have an allergic reaction to cepahalosporins (esp 1st gen)
anaphylaxis, angioedema
127
Anaphylaxis and angioedema are type ___, ____-mediated reactions
1; IgE
128
Penicillins:
PCNs are ______ are directly kill bacteria.
________ and _______ are broad-spectrum PCNs
bactericidal
| amoxicillin and ampicillin
129
```
Penicillins:
Penicillin VK PO ____ to _____
Amoxicillin PO ____ to _____
Amoxicillin plus clavulanic acid (Augmentin) PO ____
Benzathine PCN G _____
Dicloxacillin PO ______
```
```
TID to QID
BID to TID
BID
IM
QID
```
130
```
Penicillins:
Adverse reactions:
D
C
V
S
```
Diarrhea
C-Diff
Vaginitis (candida)
Stevens-Johnson syndrome
131
Avoid using amoxicillin for patients with ___________ (causes a generalized rash not related to allergy).
Use ________ instead if not allergic.
mononucleosis
| penicillin VK
132
________ is for penicillinase-producing staph skin infections (mastitis and impetigo)
dicloxacillin
133
Some women will complain of candida vaginitis with ________. Recommend probiotic capsules or eating yogurt daily.
amoxicillin
134
Fluoroquinolones:
Effective against gram-negative bacteria and some atypical bacteria (Chlamydia, mycoplasma, legionella). Newer generation quinolones (levofloxacin, moxifloxacin, gatifloxacin) are also active against gram-positive bacteria and have excellent activity against _______ _______.
streptococcal pneumonia
135
Fluoroquinolones:
Ciprofloxacin PO ______
Ofloxacin PO _____
BID
| BID
136
Broad-spectrum quinolones:
Levofloxacin _____
Moxifloxacin _____
gemifloxacin _____
daily
daily
daily
137
Fluoroquinolones:
BLACK BOX WARNING:
Increased risk of ____ ______ _____. Avoid ______ _____ while on the drug. Stop it if this develops.
Achilles tendon rupture
| strenuous
138
Reserve __________ for those who do not have alternative treatment options.
fluroquinolones
139
```
Fluoroquinolones:
Contraindications:
C
M
P
```
children
myasthenia gravis
pregnancy
140
Fluoroquinolones:
Avoid concomitant use of quinolones with ____-_______ drugs or with ______ imbalance b/c these will elevate the risk of sudden death from arrhythmias (torsades de pointes)
QT-prolonging
| electrolyte
141
Fluoroquinolones:
Co-administration of ________ and ________ (aluminum/magnesium/calcium) or sucralfate drastically reduces effectiveness of quinolones due to binding (inactivation)
minerals and antacids
142
```
Fluoroquinolones:
Adverse effects:
H__________
______ effects
QT prolongation, torsades de pointes
Peripheral neuropathy
P_______
double vision
Tendon rupture, tendinitis
```
hypoglycemia
CNS
Phototoxicity
143
Achilles tendon rupture is a serious complication of quinolone therapy and patients who are on _______ or older than _____ years are at higher risk
steroids
| 60
144
If a patient on a quinolone reports a new onset of difficulty in walking, order an _________ to rule out ________ _______ _______ or _______ ______ and DC the medicine.
ultrasound
Achilles tendon rupture
peripheral neuropathy
145
Bioterrorism-related inhalation of anthrax spores (postexposure prophylaxis) is treated with ________ ____ mg every _____ hours x _____ days. Treat within 48 hours. In addition, a _____-dose series of anthrax vaccine is recommended.
Cipro 500 12 60 days
| 3-dose
146
Bioterrorism-related INHALATION of anthrax spores (postexposure prophylaxis) is treated with ________ ____ mg every _____ hours x _____ days. Treat within 48 hours. In addition, a _____-dose series of anthrax vaccine is recommended.
Cipro 500 12 60 days
| 3-dose
147
CUTANEOUS anthrax is treated with _______ _____ mg ___ x ___ to ___ days
Cipro 500
| BID 7 to 10
148
Traveler's diarrhea is treated with _____ ____ mg _____ for ____ days.
Cipro 500 BID
| 3
149
___________ has the best activity against Pseudomonas aeruginosa (gram neg) and is the 1st line drug for treating pseudomonal pneumonia for patients with _______ _______.
Ciprofloxacin
| cystic fibrosis
150
Sulfonamides:
| Are ________
bacteriostatic
151
Sulfonamides:
| Active against gram ______ bacteria (E. coli, Klebsiella, H. influenzae)
negative
152
```
Sulfonamides:
Other sulfa-type drugs:
Diuretics (furosemide, HCTZ)
Sulfonylureas (________, ________)
COX-2 Inhibitor (celecoxib)
Dapsone
Sulfasalazine
Nitrofurantoin
```
glyburide, glipizde
153
```
Sulfonamides:
Contraindications:
_______ anemia
_________
__________
```
G6PD
Newborns
Pregnancy in late 3rd trimester
154
Sulfonamides:
Drug Interactions:
W
A
Warfarin
| Astemizole
155
Sulfonamides:
Adverse effects:
Fever and nonblistering _________ ______
________-__________ syndrome
morbilliform rash
| Stevens-Johnson syndrome
156
Patients with a UTI who are on ________ should not be given _________ due to increased risk of bleeding
Bactrim
157
Patients with a UTI who are on ________ should not be given Bactrim due to increased risk of bleeding
warfarin
158
Pregnant women with a UTI can be treated with _________ or ___________
Amoxicillin or cephalosporins
159
______ patients are at high risk (25-50%) for sulfa-related Stevens-Johnson syndrome
HIV
160
In the US, the typical G6PD deficiency anemia patient is a person of _________ _______ descent (10%). Usually asymptomatic, but may present with hemolysis/jaundice secondary to being treated with a sulfa drug or after eating fava beans. Look for low H&H and _______.
African American
| janudice
161
G6PD is also seen with __________ ancestry
Mediterranean
162
Sulfonamide antibiotics are the _________ most frequent cause of allergic drug reactions (____ and _____ are the first).
second
| PCNs and cephalosporins
163
An 18-year-old female pt with pos throat C&S for Streptococcus pyogenes (group A beta strep). The patient reports a hx of an allergic reaction to PCN with "swollen lips" accompanied by itchy hives. Which of the following is the most appropriate treatment?
A Clarithromycin (Biaxin) 250 mg PO BID x 10 days
B Gargle with salt water TID
C Cephalexin (Keflex) 250 mg PO QID x 10 days
D Doxycycline 100 mg PO BID x 10 days
```
A Clarithromycin (Biaxin) 250 mg PO BID x 10 days
(doxycycline is not effective against gram-positive infections)
```
164
Become familiar with alternative antibiotics for PCN-allergic patients. A good alternative antibiotic for these patients with gram-positive infections are _______ such as _________ or __________ PO BID. Clindamycin is also an alternative, but it is associated with slightly higher risk of ________.
macrolides
azithromycin; clarithromycin
C-diff
165
A 16 year-old high school athlete is returning for follow-up for a severe sore throat. During the physical exam, purulent exudate is noted on both tonsils. Tender lymph nodes that are 1 cm in diameter are palpable on the posterior cervical chains. The lungs are clear. The rapid strep antigen test is positive for group A beta hemolytic strep. The Monospot test (heterophile antibody test) is positive. What is the best initial clinical management of this patient?
A Initiate a Rx of amoxicillin 500 mg PO BID x 10 days
B Initiate a Rx of penicillin V 250 mg PO TID x 10 days
C Order an Epstein-Barr virus titer to determine whether the patient has an acute or reactivated mono infection
D Write a Rx for an abdominal ultrasound to determine the size of the patient's liver and spleen
B Initiate a Rx of penicillin V 250 mg PO TID x 10 days
Rationale: Avoid using amoxicillin if pt has a mono infection b/c of the risk of an amoxicillin "drug rash" that is not due to an allergy
166
About 70% to 90% of patients with mono taking __________ may break out with a "nonaallergic" generalized maculopapular rash.
amoxicillin
167
If a patient has both mono and strep throat, avoid using _________ or __________. Instead, use penicillin (if not allergic) or a macrolide to treat the patient.
amoxicillin; ampicillin
168
Of patients with a true penicillin allergy, a small percentage (0.17 0 8.4%) will also react to a ______.
cephalosporin
169
In a patient with pneumonia who has an allergy to macrolides (erythromycin, azithromycin), an alternative is ______ PO BID or the new generation _________ if age 18 or older.
doxycycline
| quinolones
170
Consider ______ -resistant S. pneumoniae if the patient was on a macrolide in the previous 3 months.
macrolide
171
A 65 year-old male presents with a hx of chronic cough that is productive of large amounts of off-white colored sputum. The patient reports a 30-pack-year hx of cigarette smoking. The chest-xray reveals hyperinflation with flattened diaphragms and two small bullae on the left lobe. Which of the following drug classes is the initial treatment of choice for this condition?
A short-acting beta-2 agonists
B Anticholinergics
C Pneumococcal polysaccharide vaccine (Pneumovax)
D Oxygen by nasal cannula
A Short-acting beta-2 agonists
Rationale: Arriving at the correct answer is based on your knowledge of the current COPD treatment guidelines (Global Initiative for COPD/GOLD)
Notice that the stem of the question is asking for the "initial treatment" - rule out options B, C, and D.
172
For COPD patients with mild dyspnea, the initial treatment choice is a ____ -_______ _______ or a _______ -______ ________.
short-acting beta beta-2 agonist (albuterol, levalbuterol) short-acting anticholinergic (ipratropium bromide)
173
In COPD patients, if the initial treatment for dyspnea (short-acting beta-2 agonist (albuterl, levalbuterol) or a short-acting anticholinergic (ipratropium bromide) is not effective, the next step is either a ______-______ _________ or a _______-_______ _________.
long-acting beta-2 agonist (salmeterol)
| long-acting anticholinergic (tiotropium)
174
If the question is asking you for the next step in treating COPD with dyspnea if symptoms are not better with short-acting bronchodilators), then start on a ______-______ _________ alone or combined with a ________-______ __________.
long-acting beta-2 agonist
| long-acting anticholinergic
175
The ______ vaccine and ______ is recommended for all with COPD.
flu
| Pneumovax
176
"Pack year" is calculated by multiplying the number of packs per ________ by the number of ________ a person has smoked.
day
| years
177
Topical nasal decongestants:
________ and ________ are examples.
Short-term use ______ PRN x _____ days is considered safe treatment for nasal congestion (common cold, allergic rhinitis)
Afrin
| Neo-Synephrine
178
__________ ________ is due to chronic use (> 3 days) of nasal decongestants
rhinitis medicamentosa
179
Antihistamines:
| are histamine _______ or _____ blockers
antagonists; H1
180
Antihistamines:
| Avoid using _________ in the elderly, if possible
elderly
181
Antihistamines:
| For elderly patients, use ________ because it has a lower incidence of sedation
Claritin
182
Antihistamines:
| _________ is more potent and long acting. It is very effective for acute and chronic urticaria
Zyrtec
183
Topical antihistamines:
| Nasal sprays are indicated for _______ rhinitis, __________ _______ rhinitis, and ______ rhinitis
allergic rhinitis
seasonal allergic
vasomotor
184
Topical antihistamines:
| Nasal sprays are indicated for _______ rhinitis, __________ _______ rhinitis, and ______ rhinitis
allergic
seasonal allergic
vasomotor
185
Topical antihistamines:
| Nasal sprays are indicated for _______ rhinitis, __________ _______ rhinitis, and ______ rhinitis
allergic
seasonal allergic
vasomotor
186
Topical antihistamines:
| _________ nasal spray is an example
Azelastine
187
Antihistamines:
Ophthalmic drops are indicated for ___________ from allergic conjunctivitis. _______ ________ is an example of an ophthalmic drop.
pruritis
| Azelastine hydrochloride
188
Cough, cold, and/or sinus medicines:
Decongestants:
____________ and _________ are examples
pseudoephedrine; phenylephrine
189
The ______ _________ _______ Act of ______ restricts the amount of pseudoephedrine you can buy; you must log in and present your ID to the pharmacy
Combat Methamphetamine 2005
190
Cough, cold, and/or sinus medicines:
Antitussives:
__________ and ________ are examples
dextromethorphan; benzonatate
191
```
Cough, cold, and/or sinus medicines:
Antitussives:
Dextromethorphan increases risk of serotonin syndrome (major drug interaction) with
M
E
S
S
```
MAOIs
Eldepryl
SSRIs
SNRIs
192
Decongestants (pseudoephedrine and phenylephrine) are contraindicated with _______ and _______
HTN; CAD
193
Advise patients that mixing _________ with other stimulants (caffeine, Ritalin, albuterol inhaler) will cause
P
A
T
decongestants
Palpitations
Anxiety
Tremors
194
Topical NSAIDs:
Diclofenac gel
Pennsaid
_______ patch
Flector
195
Ophthalmic NSAIDs:
| For ________ associated with seasonal allergic conjunctivitis and eye pain after cataract surgery (Acular)
itching
196
NSAID warnings:
Should be avoided in _______, severe _______ disease, severe renal disease, GI bleeding, and in the last _____ months of pregnancy
HF; heart
| 3
197
NSAID warnings:
| People with _________ ________ and _______ can be sensitive to aspirin/NSAIDs
nasal polyps; asthma
198
Ketorolac in all forms are for short-term use only (up to ____ days)
5
199
NSAIDs:
For long-term use, document ________ _______ such as the higher risk of serious MI, stroke, emboli, GI bleeds, acute renal failure
informed consent
200
__________ have lower risk of GI bleeding compared with the other NSAIDs. They are not a 1st-line NSAID except for patients at high risk for GI bleeding.
COX-2 inhibitors (celebrex)
201
Increased risk of bleeding if NSAIDs are combined with warfarin, Pradaxa, __________, aspirin, and _________.
steroids
| alcohol
202
For long-term NSAID use, consider prescribing concurrent
P
H
M
PPI
H2-receptor antagonists
misoprostol (Cytotec)
203
Avoid long-term use of NSAIDs if patient is on ______ prophylaxis (interferes with its cardioprotective effect)
aspirin
204
NSAIDs may worsen __________ in patients who were previously well controlled
HTN
205
Salicylates:
| Aspirin 325 to ______ mg every _____ to _____ hours PRN
650; 4 to 6
206
Enteric-coated ASA:
| 650 to ____ mg every _____ hours (do not exceed ____ grams/day)
1,300; 8; 3.9
207
Salicylates:
Acute coronary syndrome:
______ to _____ mg PO
160 to 325
208
```
Salicylates:
Secondary prevention (MI, stroke): ____ to ____ mg, up to ______ mg/day)
```
75 to 81; 325
209
Salicylates:
| Aspirin with caffeine (BC Powder); one powder ____ every ___ hours PRN
SL
| 6
210
Salicylates:
| Nonacetylated salicylates: ________ and _______
salsalate, namebutone (Relafen)
211
Salicylates:
| Do not take ASA under the age of _______ (Reye's syndrome)
12
212
Capsaicin:
for temp relief of muscle and joint pain;
For neuropathic pain (_________ _____, _______ ______)
postherpetic neuralgia
| trigeminal neuralgia
213
Capsaicin:
| May take up to _____ ______ to work
4 weeks
214
_____________ is considered the 1-st line drug for pain for osteoarthritis and DJD
Tylenol
215
Tylenol:
Duration: Do not take for more than _____ days unless directed by health provider
10
216
Tylenol:
| Risk of severe liver damage if intake of ______ or more alcoholic drinks/day while using medication
3
217
Aspirin irreversibly suppresses platelet function for up to ____ days.
7
218
Immune System Drugs:
Oral steroids:
Prednisone ____ to ____ mg/day (high-dosed) for 3 to 4 days; can be used for short-term treatment (asthma exacerbation).
There is no need to taper if patient is not on chronic steroids
40 to 60
219
Immune System Drugs:
Oral steroids:
Medrol Dose Pack x ____ days - does not need to be tapered/weaned
7
220
Topical steroids:
Classification: Class 1 (superpotent) to class 7 (least potent)
Class 1: (superpotent) _____________
a class in between 1 and 7 - (Potent) __________
a class closer to class 7 (moderate) _________
Class 7 (least potent) - ______________
1: clobetasol (superpotent)
halcinonide (potent)
triamcinolone (moderate)
hydrocortisone
221
Immune System Drugs:
Topical steroids:
Be careful with using topical steroids on _________ and limit duration.
children
222
Immune System Drugs:
Topical steroids:
Use ______-potency steroid for the eyelids, face, intertriginous areas, and the genitals.
ex. Use _______ cream/ointment/lotion 0.5 to 1% (OTC) to prescription strength such as __________ 2.5%
low
hydrocortisone
hydrocortisone
223
Use ________ to ______-potency steroids for thicker skin (scalp, soles of feet, palms of the hands) or for plaques (psoriasis). Taper _______-strength topical steroids, or person will rebound.
moderate; high
| potent
224
Thick resistant psoriatic plaques are sometimes treated by using _________ (increases absorption). The topical steroid is applied to the plaque and is covered with plastic wrap. Ultrapotent steroids (_________) should not be occluded for more than 2 weeks due to risk of HPA axis suppression.
occlusion
| Temovate
225
Acutely inflamed joints can be treated with intraarticular ____________ injections up to _____ times per year. Do not inject ______ joint with steroids.
Kenalog
3
septic
226
```
Immune System Drugs:
Side effects of steroids:
S
O
H
I
C
```
Skin changes (atrophy, striae, telangiectasia, acne, pigmentation changes)
Osteoporosis
HPA suppression
Immunosuppression
Cushing's disease
227
A severe case of poison ivy/oak rash may require ___ to ___ days of an oral steroid to clear.
14 to 21
228
The most common cause of acute liver failure in the US is ____________ overdose
acetaminophen
229
Drugs that require eye examination (careful monitoring due to adverse effects - have baseline exam and regular eye exams while taking:
V
E
T
```
F
A
C
P
D
```
Viagra
Ethambutol and linezolid
Topamax
```
Fluoroquinolones
Accutane
Corticosteroids
Plaquenil
Digoxin
```
230
```
Drugs and safety issues:
Propulsid:
Available only by limited access protocol in the US
BLACK BOX WARNING:
serious _________ ________
```
cardiac arrhythmias
231
```
Drugs and safety issues:
Propulsid:
Available only by limited access protocol in the US
BLACK BOX WARNING:
serious _________ ________
Check baseline 12-lead EKG
Check serum electrolytes and creatinine
```
Has numerous drug contraindications such as macrolides, antifungals, TCAs, etc.
cardiac arrhythmias
232
Drugs and safety issues:
Theophylline level (adults: ____ to ____)
Avoid combining with other ___________- (pseudoephedrine, caffeine, Ritalin)
Disorders worsened by stimulants: HTN, arrhythmias, stroke, seizures
With BPH, theophylline causes urinary retention and worsening of symptoms.
Suspect toxicity of persistent ___________.
5 to 15
stimulants
vomiting
233
```
Drugs that need to be tapered/weaned:
B
A
B
A
```
D
O
P
A
Beta blockers
Antiarrhythmics
Benzos
Antipsychotics
Digoxin
Oral steroids
Paxil
Anticonvulsants
234
```
Illegal drugs:
Cannabis:
Dilated pupils (______)
Lowers ________ ______
Increases HR and BP
psychomotor effects lasts 12 to 24 hours
```
mydriasis
| sperm count
235
Illegal drugs:
Cocaine:
Pupil _______
dilation
236
Illegal drugs:
Methamphetamine:
Chronic use results in severe dental caries with loss of front teeth on the upper jaw
Anorexia results in drastic weight loss
pupils appear __________
constricted
237
FDA DEA Controlled Substances Act:
Schedule I drugs: Illegal to prescribe. No currently accepted medical use. High abuse potential.
Includes ______, _______/___, ______
heroin
ecstasy/MDMA
PCP
238
FDA DEA Controlled Substances Act
| Schedule II drugs: Demerol, Dilaudid, Oxycontin, _____, amphetamines, fentanyl, etc
cocaine
239
```
FDA DEA Controlled Substances Act
Schedule II drugs:
Only the _________ ______ with the _________ ________ is acceptable
the total # of pills must be indicated
Refills are / are not allowed?
```
original prescription
prescriber's signature
are NOT
240
FDA DEA Controlled Substances Act
Schedule III drugs: _______ with _______,
___________, anabolic ________, _________
Tylenol with codeine
Vicodin
steroids
testosterone
241
```
FDA DEA Controlled Substances Act
Schedule IV drugs:
L
A
B
S
```
Lunesta
Ambien
Benzos
Soma
242
Schedule V drugs:
cough medicines with less than _____ mg of ______,
__________
_________
200; codeine
Lomotil
Lyrica
243
FDA DEA Controlled Substances Act
| Which scheduled drugs can be mailed to the patient?
Schedule IV and V
244
Category X drugs:
W
I
F
M
A
L
T
Warfarin
Isotretinoin (Accutane)
Finasteride
Misoprostol
Androgenic hormones
Live virus vaccines
Thalimodide, methimazole
245
The new FDA Pregnancy and Lactation Labeling Rule went into effect on June 20, _______.
It _________ the pregnancy letter categories A, B, C, D, and X.
2015
| replaces
246
The new labeling categories that replaced the old categories of A, B, C, D, and X are:
_________
_________
________ and ______ of _______ ______
pregnancy
lactation
females and males of reproductive potential
247
Writing a Rx:
Tamper-resistant prescription pads/paper are required. They should contain the following info:
Practitioner's name/________ #/__________ #
_________ _________ name/designation
______ address
license/ NPI
Supervising physician's name
clinic
248
Writing a Rx:
| Date, name, ________ of the patient
address
249
___-___________ is the preferred method for drug prescriptions for Medicare and Medicaid.
E-prescribing
250
Herbal supplements:
| ________ for migraine headaches
feverfew
251
Herbal supplements:
| Cinnamon improves _____ ____ and _______
blood sugar; cholesterol
252
Herbal supplements:
| Glucosamine is used for _______
osteoarthritis
253
Herbal supplements:
| Natural progesterone cream from wild yam root extract is used for __________ symptoms (hot flashes)
premenstrual
254
Herbal supplements:
| Isoflavones (from soy beans) are used for _____-like effects
estrogen
255
Herbal supplements:
| kava kava, valerian root used for anxiety and ______
insomnia
256
```
Herbal supplements:
St John's Wort: Used for mild depression
Do not use with:
H
S
S
```
HIV protease inhibitors (indinavir)
SSRIs
Sumatriptan
257
```
Herbal supplements:
Tumeric is used for:
C
A
A
```
cancer
arthritis
Alzheimer's
258
What is a drug in the drug class anticholinergics?
ipratropium bromide (Atrovent)
259
```
St John's Wort:
Do not use with:
______
______, or
_____
```
Benzos
TCAs
SSRIs
260
Alternative meds:
Prophylaxis for migraines: _________
Menopause: black cohosh, ___ _____, ______ cream derived from _________.
Weight loss: High-dosed _________
Feverfew
soy isoflavones; progesterone
yams
caffeine
261
Grapefruit juice should not be mixed with _______ - will cause high blood levels of these drugs
statins
262
Cephalosporins:
1st Gen: _____
2nd Gen: ______, _______, _____
3rd gen: _____, ________, _______
Keflex
Cefzil, Ceftin, Ceclor (all 2nd-gen start with "C")
Rocephin, Omnicef, Suprax
263
Penicillins and cephalosporins are both considered _____ ______.
Beta lactams
264
Macrolides include:
the "_______"s
They have more _____-____ interactions compared with the other classes of abtibiotics.
mycins
| drug-drug
265
Mother or infant?
Direct Coombs test - ____________
Indirect Coombs test - ___________
Direct - infant
| Indirect - mother
266
Coombs test:
Rh negative women receive RhoGAM at ___ - ___ weeks.
2nd dose ___ ______
28 - 32
| after labor
267
Pregnancy:
Asymptomatic bacteruria:
screen at ____ weeks or ____ trimester.
Are ASYMPTOMATIC UTIs or bacteruria in pregnant women treated?
12; 1st
YES
268
Pregnancy:
***Asymptomatic bacteruria:
HIGHER risk of ______, _____ birth, and
____ ____ _____
pyelonephritis; preterm
| low birth weight
269
What is the criteria for diagnosing asymptomatic bacteruria in pregnant women?
100,000 CFU/ml of a single organism in 2 consecutive specimens with isolation of the same bacterial species
270
Pregnancy:
Asymptomatic bacteruria:
Urine dipstick will have positive _____ ______ and positive or negative ________.
A urine C&S is done both ___ and ___ treatment
leukocyte esterase
nitrites
pre; post
271
Treatment for asymptomatic bacteruria and acute cystitis in pregnancy includes:
Amoxicillin
Augmentin
Keflex
272
Avoid these antibiotics when treating acute cystitis in pregnancy:
Quinolones
Sulfa drugs
Tetracyclines
273
Protein in urine during pregnancy is _____ _____ and is an indicator of _____ to ______.
Protein of ___ or more is abnormal.
NEVER NORMAL
preeclampsia; eclampsia
1+
274
Pre-eclampsia to eclampsia TRIAD includes:
Hypertension
Edema
Proteinuria
275
HELLP syndrome of preeclampsia includes:
Hemolysis
Elevated liver enzymes
Low Platelets
276
Treatment for HELLP syndrome of preeclampsia includes;
Magnesium
Methyldopa
labetalol (is preferred drug)
277
Eclampsia is BP of ___/___ or higher plus seizures, LOC changes, liver damage, etc
***The only "cure" is ________.
delivery!
278
Which of the following findings is most likely to be found in a woman with preeclampsia?
1 Abdominal cramping and constipation
2 Edema of the face and the upper and lower extremities
3 Shortness of breath
4 Dysuria and frequency
2 Edema of the face and the upper/lower extremities
279
Maternal serum alpha-fetoprotein:
Low AFP: rule out ____ ____
High AFP: rule out ____ ___ ____
```
Down Syndrome (THINK "low down")
neural tube defect
```
280
***At 16 weeks gestation, what labs do you perform?
AFP (alpha-fetoprotein)
281
```
Which of the following genetic diseases is more common in Ashkenazi Jews?
1 cystic fibrosis
2 Sicke cell disease
3 Tay-Sach disease
4 Down syndrome
```
3 Tay-Sach disease
282
Weight gain in pregnancy:
Normal weight (BMI 18.5 - 24.9): ___ to ___ pounds
Overweight: __ to __ pounds
25 to 35
| 15 to 25
283
AVOID ___ ____ vaccines in pregnancy!
live virus
284
Teratogens:
| _____ causes clear cell cancer and adenosis
DES
285
What are the POSITIVE signs of pregnancy?
Palpation of fetus by health provider
Ultrasound visualization
Fetal heart tones
*** The positive signs are the shortest list
286
What are the PROBABLE signs of pregnancy?
Goodell's sign - cervical softening
Chadwick's sign - blue color cervix and vagina
Hegar's sign - softening uterine isthmus
(REMEMBER - CHAD's eyes were BLUE and HE was
UTterly SOFT)
Enlarged uterus
Ballottement
+ Urine or blood pregnancy test
(The "last names" are all the probable signs)
287
```
What are the presumptive signs of pregnancy?
"Quickening" - mother starts to detect ____ ____ for the 1st time
Amenorrhea
nausea
breast changes
fatigue
urinary frequency
increased body temperature
```
fetal movements
288
Fundal heights:
12 weeks: Uterine fundus first rises above ___ ____
16 weeks: Uterine fundus between ____ _____ and the _____
20 weeks: Uterine fundus at the level of the _____
20-35 weeks - height in cm = number of weeks gestation
If there is a size/date discrepancy (diff of 2 cm or more_ do _________
symphysis pubis
symphysis pubis; umbilicus
umbilicus
ultrasound
289
A multigravida who is at 32 weeks of gestation has a fundal height of 31.5 cm. You would:
1 Advise the mother that her pregnancy is progressing well
2 Order an ultrasound
3 Refer her to an OB for an amniocentesis
4 Recommend bedrest with bathroom privileges
1 Advise the mother that her pregnancy is progressing well
