Clinical Fun Facts Flashcards
1
Q
Drugs that INCREASE calcium
A
Thiazides, Ca, Vit D
2
Q
Drugs that DECREASE calcium
A
heparin, bisphosphonate, loop diuretics
3
Q
Drugs that DECREASE Mg
A
PPIs, loop diuretics
4
Q
Drugs that INCREASE potassium
A
AE/ARB, K-sparing diuretics, aliskiren
Canagliflozin
Cyclosporine/tacrolimus
Enzalutamide
5
Q
Drugs that DECREASE sodium
A
SSRIs, loops, carbamazepine, oxcarbazepine
6
Q
Drugs that DECREASE bicarbonate
A
topiramate
7
Q
Drugs that INCREASE bicarbonate
A
loops
8
Q
The major CYP3A4 Inducers
A
St John's wort Phenytoin Oxcarbazepine Rifampin Carbamazepine Smoking Phenobarbital
9
Q
The major CYP3A4 inhibitor
A
Protease inhibitors Azoles Cimetidine, cyclosporine, clarithromycin Macrolides (not azithro) Amiodarone Non-DHP CCBs Grapefruit
10
Q
Agranulocytosis means???
A
Decrease in multiple cell lines
11
Q
Gaussian distribution
A
NORMAL distribution
12
Q
__ % of data within 1 SD
A
68%
13
Q
Type I error is false negative or false positive?
A
False positive (a)
14
Q
Type II error is false negative or false positive?
A
False negative (B)
15
Q
Relative risk v relative risk reduction
A
RR = rate in treatment v rate in control RRR = 1 - RR (% less likely in treatment group)
16
Q
Odds ratio
A
Odds of outcome WITH prior exposure v WITHOUT prior exposure
Expected/unexpected (so exposure+ x no exposure neg/exposure- x no exposure+)
17
Q
Sensitivity
A
# true positive/#w/condition Good sensitivity = no false negatives
18
Q
Specificity
A
# true negative/# without condition Good specifity = no falsae positives
19
Q
Case control study??
A
Patients with a disease compared to those without the disease (retrospective)
20
Q
Cohort study??
A
Patients with exposure compared to those without exposure (prospective!)
21
Q
Which is better - cohort study or case control?
A
Cohort b/c it is prospective
22
Q
Cost minimization?
A
Equal outcomes so which one is cheapest
23
Q
Cost-benefit analysis?
A
Benefits - costs –> but the benefits have to be measured in dollars
24
Q
Cost-effectiveness analysis?
A
Which gets the best outcome per dollar - but both have to have the same outcome measurement
25
Cost-utility analysis?
Assesses outcomes including quality of life/morbidity assessment
26
Which pharmacoeconomic analysis is most commonly used?
Cost-effectiveness analysis
27
Antipsychotics do better at treating positive or negative symptoms??
Positive symptoms
28
Some drugs that cause psychosis?
```
Anticholinergics
Cannabis
Dextromethorphan
Dopamine agonists (Sinemet, Requip, Mirapex)
Interferons
Stimulants
Steroids
```
29
Invega Sustenna (drug and timeframe)
Paliperidone - q4weeks
30
Abilify Maintenna (drug and timeframe)
Aripiprazole - q4weeks
31
Risperdal Consta (drug and timeframe)
Risperidone - q2weeks
32
Haldol Decanoate (drug and timeframe)
Haloperidol - q4weeks
33
Invega Trinza (drug and timeframe)
Paliperidone - q12weeks
| Only after 4 months on Sustenna
34
Black-box warnings for all of the antipsychotics?
Worsening symptoms in patients with dementia
| Stroke
35
Chlorpromazine - what potency?
Low potency
36
Thioridazine - what potency?
Low potency
37
Side effect of thioridazine
QTc prolongation
38
Side effect of loxapine
bronchospasm
39
Loxapine potency?
Moderate potency
40
What is the difference between ADEs for high and low potency antipsychotics?
High potency - moderate sedation and EPS
| Low potency - more CNS effects and anticholinergic effects
41
Haloperidol - what potency?
High potency
42
Fluphenazine - what potency?
High
43
Thiothixene - what potency?
High
44
Trifluoperazine - what potency?
High
45
Perphenazine - what potency?
Moderate
46
Which of the T-drug antipsychotics causes QT prolongation?
Thioridazine
47
What are the EPS effects?
```
Dystonia
Akathisia
Parkinsonism
Tardive Dyskinesia
Dyskinesia
```
48
Which of the EPS are irreversible?
tardive dyskinesia (lip smacking)
49
What population is most likely to experience dystonias?
Young males
50
How to treat Dystonia?
Diphenhydramine and benztropine
51
How to treat Parkinsonism?
Anticholinergics or propranolol (for tremors)
52
How to treat TD?
Stop drug and switch to low risk
53
How to treat akathisia?
Anticholinergics, propranolol, benzos (b/c akathisia has anxiety)
54
Non-EPS side effects of antipsychotics?
```
Leukopenia, neutropenia, agranulocytosis
Seizures
CV - increased HR, orthostatic hypotension
Sexual dysfunction
bronchospasms (Loxapine)
```
55
Which of the antipsychotics has the most cardiovascular effects?
IV haloperidol
56
What 2nd gen APs cause the most metabolic effects?
Clozapine, olonzapine, quetiapine
57
Which 2nd gen antipsychotic has lowest EPS?
Quetiapine
58
Which 2n gen antipsych causes QT prolongation?
Ziprasidone
59
Which 2nd gen antipsych increase procalcitonin?
Risperidone and paliperidone
60
What are the requirements to use clozapine?
Two treatment failures, at least 1 a 2nd generation
61
How long is an adequate trial of antipsychotics?
4-6 weeks
62
Tell me about asenapine
Sublingual 2nd gen antipsychotic
| Metallic aftertaste
63
Tell me about aripiprazole
AKA Abilify
Comes in IM long-acting Maintenna
Causes INSOMNIA, anxiety, akathisia
(Only one that's insomnia)
64
Tell me about lurasidone
2nd Gen antipsychtoic
Latuda
Neutral metabolic effects
W/food
65
Tell me about olanzapine
Metabolic effects
CYP3A4 - smoking decreases conc
Sedation
Relprevv q2-4week injection, ODT
66
What's special about Relprevv
Olanzapine IM injection - requires monitoring for 3 hours after injection
67
Tell me about Paliperidone
Invega
Ghost tablets in stools
Increases procalcitonin, EPS
68
Tell me about quetiapine
Seroquel
Lowest EPS
Metabolic effects, somnolence
Without food or <=300kcal for XR
69
Tell me about risperidone
Risperdal
| EPS, increased procalcitonin levels
70
Tell me about ziprasidone
Geodon
Increased QTc
Take WITH food
71
What drug is used for psychosis with PD?
Pimavanserin
72
What drugs are used for TD?
Valbenazine (VMAT inhibitor)
| Deutrabenazine
73
What are symptoms of neuroleptic malignant syndrome?
Hypertension, muscle rigidity, increase HR/BP/RR
74
Treatment of neuroleptic malignant syndrome?
Stop drug
Cool off with ice
Dantrolene/benzos for muscle relaxation
75
Progestin-only pills have what administration requirements?
Within 3 hours of the same time - or else need 48 hours of alternative contraception
76
What populations are good for POPs?
After childbirth - can be used with breastfeeding
| Patients with migraine w/aura (estrogen contraindicated due to stroke risk)
77
What is the active ingredient in Depo-Provera
Medroxyprogesterone
78
what is unique about Xulane?
Has higher AUC --> increased thrombotic risk
79
Contraindications of estrogen?
h/o DVT/stroke, migraine w/aura, breast/ovary/liver cancer
| uncontrolled htn
80
What's special about drospirenone?
Progestin component - with highest VTE risk, lowest water retention/bloating, increases K+
81
ADE of medroxyprogesterone
Decreased BMD (supplement with Ca/Vit D)
82
How long medroxyprogesterone be used?
3 years
83
How long should back-up contraception be used after starting COC?
7 days
| or 0 days if started w/in5 days of menses
84
What is the weight limit for the patch?
198 pounds
85
Which contraceptive needs back up x 1 week unless started on day 1 of menses?
Nuvaring
86
Water or oil-based lubricants?
water
87
What are 3 emergency contraceptives?
Paragard (within 5 days)
Plan B (levonogestrel x1 or x2 within 3 days or 5 off-label)
Ella (Ulipristal acetate within 5 days)
88
ADEs of Plan B
NAUSEA
89
ADEs of Ella
HA, nausea, abdominal pain
| Delays ovulation - so period can be weird
90
1st-line treatment for female infertility
Clomiphene - SERM
91
2nd-line treatment for female infertifility
Gonadotropins (ie FSH/LH)
92
What people need a reduction in PDE-5 starting dose?
>65 years old
Taking CYP3A4 inhibitor
Have renal/liver dysfunction
---50% reduction
93
Time before sex of the PDE-5 inhibitors?
Sildenafil: 60 minutes
Tadalafil: 30 minutes
Aranafil: 15-30 minutes
Vardenafil: 60 minutes
94
Starting doses of PDE-5 inhibitors
Aranafil: 50-100 mg
Tadalafil: 10mg
Sildenafil: 50mg
Vardenafil: 10mg
95
What are the ADEs of PDE-5 inhibitors?
```
Headache, flushing, dizziness
Priapism
Hearing loss
Vision loss
Hypotension
Impaired color discrimination
Back pain
```
96
What class is aloprostadil?
PGE1
97
Storage requirement for aloprostadil?
Fridge
98
Treatment of hypoactive sexual desire disorder?
Flibanserin (Addyi)
99
Contraindication to Flibanserin
Alcohol
Cyp3a4 inhibitors
hepatic impairment
100
ADEs of filbanserin
Hypotension, fainting
101
What BUN:SCr ratio is dehydration
>20:1
102
Which diuretic class increases calcium?
Thiazides
103
What drugs cause kidney disease?
```
Polymyxin
Loop diuretics
Vancomycin
Aminoglycosides
NSAIDs
Amphotericin
Radiographic dye
Tacrolimus/cyclosporine
Cisplatin
```
104
Who gets ACE-i's and ARBs?
DM + Proteinuria (albuminuria >30)
HTN + Proteinuria
CKD
105
What %SCr increase after starting ACE/ARB needs to stop the drug?
30% increase
106
Which drugs needed renal adjustments?
```
Beta-lactams
Fluconazole
FQ
Xarelto
H2RAs
metoclopramide
Bisphosphonates
```
107
When is nitrofurantoin contraindicated?
CrCl <60mL/min
108
What drugs are contraindicated at CrCl <50mL/min?
IV voriconazole
| TNF-DF
109
What drugs are contraindicated at CrCl <30mL/min
TNF-A
Rivaroxaban, dabigatran
NSAIDs
110
What drugs are contraindicated at eGFR <30?
Metformin
| SGLT2-i's
111
Which of the phosphate binders isn't systemically absorbed?
Sevelamer (Renvela)
112
ADEs of calcium-based phosphate binders?
Increased calcium
113
ADEs of aluminum-based phosphate binders?
Al accumulation; dialysis dementia
114
ADEs of aluminum/ca free phosphate binders?
Contain iron - Ferric citrate and lanthanaum carbonate
Ferric citrate has iron absorption
N/V/D, constipation
115
Which Vitamin D is made in skin?
Cholecalciferol (D3)
116
Which vitamin D is made in plants?
Ergocalciferol (D2)
117
What is calcitriol?
Vitamin D3
118
What is cinacalcet?
calcimimetic that decreases PTH
119
Does cinacalcet increase/decrease Ca?
Decrease
120
Do Vit D analogs increase/decrease Ca?
Increase
121
What are requirements for using ESAs?
HgB <10 and must stop before >11 b/c of increased VTE risk
122
Drugs that increase K+
```
Drospirenone
ACEs/ARBs/aliskiren
Aldosterone antagonists
Transplant drugs
Bactrim
Canagliflozin
```
123
Treatment for hyperkalemia
1. Calcium gluconate (stabilize mycoardium)
2. Push K intracellular
Insulin + Dextrose
Nebulized albuterol
Bicarbonate
3. Remove K+
Loops
Dialysis
Keyexalate/Na polystyrene sulfonate
(separate these from other drugs)
124
What bicarb level is metabolic acidosis
<22mEq/L
125
How to treat metabolic acidosis
Sodium bicarbonate
Sodium citrate
(Monitor Na)
126
What BMI indicates that a patient can use weight-loss therapy?
BMI >30
| BMI >27 w/weight-related comorbidity
127
Tell me about Qsymia
Phentermine/Topiramate
Increase HR, hyperthyroidism, glaucoma
Taper due to seizure risk
128
Tell me about Contrave
Naltrexone/bupropion
BBW: Suicidal thinking in adolescents
CI: Opioid use, uncontrolled HTN, seizure disorder, anorexia, pregnancy
Caution w/psych disorders
129
Tell me about Belviq
Lorcaserin
Serotonin agonist
Warning for NMS, serotonin syndrome, hypoglycemia
130
Tell me about Saxenda
Liraglutide
| Pancreatitis and medullary thyroid cancer and hypoglycemia and nausea
131
Tell me about Orlistat
Alli/Xenical
Alli available OTC
Requires 30% fat reduction from regular diet
ADEs: GI (flatus and fatty stools)
Requires ADEK supplement (but separate by 4 hours)
132
Tell me aout other sympathomimetics for weight loss
CI with CV disease, hyperthyroidism, glaucoma, pregnancy, drug abose
ADEs: HR/BP, agitation
133
How long can stimulant weight loss drugs be used?
12 weeks maximum
134
What sreening tool is used for Alzheimer's and what score indicates cognitive impairment?
MMSE
| Score <24
135
What natural products are used in alzheimer's?
Ginkgo
Vitamin E
Vitamin D
136
ACHe Inhibitors ADEs
Decreased HR
Nausea (take in evening or use rivastigmine patch/ODT donepezil)
Insomnia (take in morning)
137
T/F: Memantine capsules can be sprinkled on food
TRUE -- even though XR
138
What is the treatment order for Alzheimer's?
1. ACHe Inhibitors (ie donepezil)
| 2. Can add memantadine for mod-severe alzheimer's OR can use memantadine as monotherapy
139
What are the acetylcholine esterase inhibitors?
Rivastigmine (Donepezil)
Donepezil (Aricept)
Galntamine (razadyne)
140
Name of donepezil + memantadine?
Namzaric
141
Which systemic steroid is used to treat Addison's Disease?
Fludrocortisone
142
What are symptoms of Cushing's syndrome? (the ones you don't normally remember)
```
Glaucoma
Acne
Cataracts
Hypothyroidism
Stretch marks
Poor bone health
Hirsuitism
Irregular periods
```
143
Equivalency of Steroids
```
Cortisone: 25 (short-acting)
Hydrocortisone: 20
Prednisone: 5 (Intermediate-acting)
Prednisolone: 5
Triamcinolone: 4
Methylprednisolone: 4
Dexamethasone: 0.75 (long-acting)
Betamethasone: 0.6
```
144
What dose of systemic steroid causes immunosuppression?
20mg prednisone/day for 2 weeks
| or >2mg/kg/day for 2 weeks
145
First-line treatment for RA
Methotrexate
146
ADEs/warnings of methotrexate
Trexall
Hepatotoxicity, teratogenic, mucositis/stomatitis, immunosuppression
N/V/D, alopecia, arthralgia/myalgia
Avoid alcohol
147
What does folate do with MTX?
Reduces hematologic toxicities
148
How is MTX dosed for RA?
weekly!
149
Hydroxychloroquine ADEs/BBW?
Irreversible retinopathy
150
Sulfasalazine ADEs?
Yellow/orange discoloration of skin/urine
| SULFA allergy
151
Leflunomide ADEs?
Teratogenic - requires REMS and 2 birth controls
| Hepatotoxicity
152
How long do you have to wait before conceiving after on leflunomide?
2 years - unless you use cholestyramine/activated charcoal to increase clearance
153
What are the anti-TNF DMARDs?
```
Etanercept (Enbrel)
Certolizumab Pegol (Cimzia)
Adalimumab (Humira)
Infliximab (Remicade)
Golimumab (Symponi)
```
154
Which anti-TNFs are IV?
Golimumab and Remicade
Both require filter
Remicade requires NS
155
Which anti-TNFs can only be given with MTX?
Remicade and Symponi
156
Which Anti-TNF SC is given weekly?
Enbrel
157
Which Anti-TNF SC is given monthly?
Golimumab
158
What are the warnings for all anti-TNFs?
```
Demyelinating disease, reactivation of Hep B, worsening HF, hepatotoxicity, DILE
Latent TB infections
Malignancies
Serious infections
Avoid live vaccines
```
159
Where can the anti-TNFs be injected?
Humira: Abdomen/thigh
| Etanercept/golimumab: abdomen, thigh, upper arm
160
What class are tofacitinib and baricitinib?
JAK inhibitors
161
ADEs of infliximb?
Other Anti-TNFs + infusion reaction (premedicate with APAP, antihistamine, and steroid) and delayed HSR
162
Other Biologic DMARDs for RA (besides TNFs)
```
Rituximab (anti-CD20, use with MTX, pre-medicate)
Anakinra (IL-1 antagonist)
Abatacept (CD80/CD86)
Tocilizumab (IL-6)
Sarilumab (IL-6)
```
163
Which RA meds require screening for Hep B reactivation before use?
Rituximab
| Anti-TNF
164
Malar butterfly rash is a sign of what?
Systemic lupus erythematous (SLE)
165
Drugs that induce lupuse
```
Methimazole
Methyldopa
Minocycline
Isoniazid
TNF inhibitors
Terbinafine
Hydralazine
Procainamide
Propylthiouracil
Quinidines
```
166
Belimimumab is used for???
Lupus
167
What vaccines in asthmatic kiddos?
Flu and Pneumovax-23
| Prevnar-13 only if on high-dose steroids
168
Using albuterol more than _____ means step up in therapy needed
2 times/week
169
How many inhalations per albuterol inhaler?
200
| except Ventolin can have 60
170
What is Xopenox?
Levalbuterol (r-isomer of albuterol)
171
ADEs of ICS?
Dysphonia, thrush
172
Which ICS can be nebulized?
Pulmicort (budesonide)
173
Serevent?
Salmterol
174
Spiriva?
Tiotropium
175
Symbicort?
Budesonide/formoterol
176
Advair?
Fluticasone/salmeterol
177
Dulera?
Mometasone/formoterol
178
Breo?
Fluticasone/vilanterol
179
Which MDIs should NOT be shook?
QVAR, Respimat
180
Dose of montelukast (by age)
Adult: 10mg
Child 1-4: 4mg
Child 5-14: 5mg
181
ADE of LTRAs?
neuropsychiatric events
182
How can montelukast granules be given?
1. straight into the mouth
2. into 5mL of breast milk/formula
3. Into spoonful of carrots, rice, apple sauce, or ice cream
183
what are the LTRAs(drugs)?
montelukast
zafirlukast
zileuton
184
Theophylline MOA?
Blocks phosphodiesterase to increase cAMP
185
Thophylline TDM?
Peak of 5-15mcg/mL
186
Thophylline toxicity
Arrhythmias, vomiting, seizures
187
What drugs can increase theophylline?
Cipro
Zafirlukast
Zileuton
188
What drugs can decrease theophylline?
CYP3A4 inducers, ritonavir, high-protein diet and charbroiled meat
189
Omalizumab MOA? and place in therapy?
IgE binding inhibition - allergic asthma
190
What is omalizumab counseling note??
Has to be given in HEALTH CARE SETTING every single time
191
What are IL5 antagonists for?
Eosinophilic asthma
192
T/F: LABAs can be used for exercise-induced asthma
True - use salmeterol 30 minutes before exercise
193
T/F: Spacers help prevent thrush
True
194
PFM directions for use (when to use)
In the morning BEFORE taking medications
195
How to use PEFR?
Compare personal best to daily - need treatment if less than 80% of PB
196
How long can an open package of Pulmicort Respules last?
2 weeks
197
Washing MDIs?
Warm water - but NO water for symbicort/dulera
198
Washing DPIs?
No water!
199
When should you refer kiddos to urgent care (what temperature)?
<3 months: 100.4
3-6 months: 101
>6 months: 103
200
What is a healthy APGAR store and when is it measured?
1 minutes and 5 minutes after birth
| Healthy: 7-10
201
What medication is given at birth to prevent bleeding?
IM Vitamin K
202
What can help PDA close?
NSAIDs given within 14 days of birth
203
Respiratory distress syndrome is caused by deficiency of _____ which should be replaced in most babies born
Surfactant
| <35weeks
204
What is nuchal rigidity?
Inability to bend the neck
205
How can you diagnose meningitis n young children?
Don't have typical symptoms
| Require lumbar puncture
206
Empiric meningitis treatment in neonates?
Ampicillin + cefotaxime or gentamicin
207
Which medication is not use in neonates due to bilirubin-induced brain damage?
Ceftriaxone
208
Ceftriaxone use is contraindicated with concurrent use of what med?? Why?
IV calcium - precipiates and causes embolisms
209
How to treat RSV?
Usually supportive care
| Severe w/underlying condition = inhaled ribavirin (Viraozole)
210
what medication is for prevention of RSV disease?
Palivizumab (Synagis
211
Who gets RSV prophylaxis?
Premature infants (<29 weeks or <32 weeks with chronic lung disease), children with select medical conditions (heart conditions) during RSV season (same as flu)
212
Palivizumab administration?
IM (into thigh) monthly
213
Max # of RSV doses?
5
214
What is croup?
Viral infection that causes stridor, cough, hoarseness
215
How is croup treated?
Systemic steroids
| Nebulized racemic epinephrine if needed
216
What medication is used for nocturnal enuresis?
Desmopressin
217
What med for intestinal gas in infants?
Simethicone drops
218
OTC cough and cold meds should not be used in children
2 years old
219
What age can APAP be used?
0+
220
What age can NSAIDs be used?
<6 months
221
First-line constipation in kids?
PEG for intermittent constipation
| Glycerin suppositories for babies
222
Pediatric dose of APAP?
10-15mg/kg/dose every 4-6 h
223
Pediatric dose of ibuprofen?
5-10mg/kg/dose every 6-8h
224
What is first-line treatment for tick-borne Rickettsial disease?
Doxycycline (even in kids)
225
Topical teething agents with ___ are not recommended in <2 year old
Benzocaine
226
Measles symptoms
Koplik spots in mouth; maculopapular rash
227
How is measles spread?
airborne
228
Difference by Type A and Type B interactions?
Type A: Predictable and dose-dependent
| Type B: Unpredictable and not dose-dependent
229
4 types of drug allergies
Type I: Immediate, IgE-mediated (hives, anaphylaxis, angioedema)
Type II: minutes-hours after exposure
Type III: Immune-complex reactions (hours to weeks)
Type IV: Delayed hypersensitiity reactions (48h-weeks)
230
What type of drug allergy is PPD?
Type IV
231
What type of drug allergy is anaphylaxis?
Type I
232
What type of allergy is hemolytic anemia?
Type II
233
Who develops REMS?
Manufacturer (approved by FDA)
234
What are MedGuides and when should they be dispensed?
Patient-friendly handouts
At each fill - original and refill
Not required inpatient
235
What scale is used to determine the likelihood an event was caused by a drug?
Naranjo Scale
236
What is TTP?
Blood clots forming throughout body -- causes bleeding/purpura on the skin
237
What drugs cause TTP?
Clopidogel and Ticlopidine
238
What drugs to avoid with peanut and soy allergies?(3)
Propofol
Clevidipine
Progesterone
239
What drugs/vaccines to avoid with egg allergy (4)
Propofol
Clevidipene
Yellow fever vaccine
Flu vaccines (FluBlok has no egg, others can still be used)
240
What drugs contain sulfa (that I didn't already know) - 3?
Acetazolamide
Zonisamide
Darunavir
(NOT sulfate)
241
Does desenstivation cure an allergy?
Nah
242
What is the name of the EpiPen with voice instructions?
Auvi-Q
243
BBW of rituximab?
Infusion reactions
244
Main treatment for MS?
```
Glatiramer acetate (Capoxone)
INterferon Beta products
```
245
Which MS treatment for pregnancy?
Glatiramer acetate
246
ADEs of glatiramer acetate?
Injection site reactions, dyspnea, diaphoresis
247
ADEs of interferon beta products?
psychiatric disorders, injection site necrosis, increased LFTs, thyroid dsyfunction, flu-like symptoms (pre-medication)
248
Which interferon can be injected q2weeks?
Peginterferon B-1A (Plegridy)
249
ADEs of flingolomid (Gilenya)
Decreased HR
| Macular edema, hepatotoxicity, myelosuppression
250
How often are TNF inhibitors administered?
Either weekly (etanercept) or every other week (adalimumab and certolizumab)
251
First-line treatment for Raynaud's?
CCBs (nifedipine)
252
Sjogren's syndrome treatment - dry eyes?
Artificial tears, Restasis, Lifitegrast
253
Sjogren's syndrome treatment - dry mouth?
Xylitol gum, lozenges, antimicrobial mouthwash, oral muscarinics (pilocarpine)
254
Treatment for psoriasis
1. Phototherapy
2. Topical: steroids, tazarotene (Retinoid), coal tar, calcipotriene (Vit D analog), anthralin, topical calcineurin inhibitors
2. Systemic: Retinoid, PDE4 inhibitors, IL antagonists, MTX, hydroxyurea
255
Which topical psoriasis options to go on face?
Steroids and calcineurin inhibitors
256
Natural products used in anxiety (4)
Kava
St John's Wort
Valerian
Passion flower
257
1st line treatment for anxiety?
SSRIs/SNRIs (takes 4 weeks)
258
2nd line treatment for anxiety? (3)
Buspirone (takes 2-4 weeks)
TCAs
Hydroxyzine
259
Can buspirone be used with MAO inhibitors?
Nah
260
Which benzodiazepines are preferred in elderly patients? Why?
Lorazepam
Omazepam(?)
Temazepam
(LOT)
Inactive metabolites
261
Which benzos preferred for anxiety?
```
Clonazepam
Lorazepam
Alprazolam
Diazepam
(CLAD)
```
262
Antidote for benzos?
Flumazenil
263
Toxicity of benzos?
Ataxia
264
Which benzo comes IM?
Midazolam
265
What drugs decrease seizure threshold?
Abx: PCNs, FQs, carbapenems
Pain: Meperidine, tramadol
Psych: Buspirone, clozapine, lithium
Misc: chantix, theophylline
266
What are ADEs of all antiepileptic drugs?
BBW for suicidal thoughts
Osteoporosis/decreased BMD (take Ca/VitD)
Teratogenicity (take folate)
CNS depression
267
Equation for phenytoin corrected?
Phenytoin = phenytoin/(0.2*alb+0.1)
268
Which AEDs have worst side effects in kids?
Lamotrigine
| Topiramate/zonisamide
269
Which drugs increase GABA?
benzos, valproic acid
270
Which drugs block Na channels?
carbamazepine, phenytoin, lamotrigine, topiramate
271
Which drugs block Ca channels?
Keppra, gabapentin, ethosuximide
272
What are the broad spectrum AEDs?
Lamotrigine
Valproate
Keppra
Topiramate
273
Lamotrigine ADE
SJS (titrate dose)
274
Levetiracetam ADEs
psychiatric events, somnolence, fatigue
275
Topiramate ADEs
```
Hyperammonemia
Oligohydrosis
Metabolic acidosis
Weight loss/anorexia
Fetal toxicity
nephrolithiasis
Closed-angle glaucoma
```
276
Volpric acid ADEs
```
Fetal harm (decreased IQ)
Hyperammonemia
Weight gain
Thrombocytopenia
Alopecia
Hepatotoxicity
```
277
TDM for valproic acid
50-100
278
TDM for carbamazepine
4-12
279
TDM for phenobarbital
20-40
280
TDM for phenytoin
10-20
281
Carbamazepine ADEs
skin reactions, aplastic anemia, agranulocytosis, SIADH, fetal harm
282
What HLA test for carbamazepine/oxcarbazepine?
HLA-B*1502
283
Lacosamide ADE
QT prolongation
284
Oxcarbazepine ADEs
hyponatremia, SJS?TEN
285
Phenobarbital ADE
Tolerance, dependence, hangover effect, resp depression
286
Prodrug of phenobarbital
Primidone
287
Max Phenytoin/Fosphenytooin infusion rate
50mg/min and 150PE/min
288
ADEs of phenytoin
SJS, fetal harm, extravasation(Purple Glove)
289
Phenytoin toxicity
Nystagmus, diplopia, ataxia
290
Chronic phenytoin ADEs
hepatotoxicity, gingival hyperplasia, hair growth
291
what med used for absence seizures?
ethosuximide (Zarontin)
292
ADEs of felbamate?
Hepatic failure, anemia
293
ADEs of zonisamide
sweating, weight loss, nephrolithiasis
294
ADEs of vigabatrin (sabril)
Vision loss
295
Natural products for hypertension
Fish oil, coenzyme Q10, L-arginine, garlic
296
What BP cut-off for treatment in pregnancy?
160/105
297
Drugs to use in HTN in pregnancy
Labetalol
Nifedipine XR
Methyldopa
298
CrCl needed for thiazide
>30mL/min
299
ADEs of thiazides
increased LDL/TG/BG
300
which antihypertensives decrease lithium clearance?
Thiazides
| ACEs/ARBs
301
ADEs of DHPs
gingival hyperplasia
302
When should nifedipine IR be used?
NOT after heart attack
| Really only in pregnancy
303
What's up with clevidipine?
DHP CCB
Has soybean/eggs
Lipid emulsion
12h BUD
304
What is the caloric content of clevidipine?
2kcal/ml
305
Contraindication to ACEs?
Bilateral renal artery stenosis
306
How long washout for ACEs/ARBs and neprilysn?
ACEs: 36 hours
ARBs: none
307
Which beta-blockers need to be with food?
Carvedilol
| Metoprolol tartrate
308
what is the conversion of metoprolol tartrate PO to IV?
1:2.5
309
What is the conversion of carvedilol to carvedilol xr?
3.25:10
310
MOA of nebivolol?
B1 and NO
311
Which Beta blockers are intrinsic sympathomimetic activity?
Acebutalol, pindolol, peributolol (do not use post-MI)
312
ADEs of alpha-2 agonists?
Rebound HTN, dry mouth, dizziness, constipation, bradycardia, hypotension
313
Methyldopa contraindicated with what med?
MAO inhibitors
314
Methyldopa ADEs
Hemolytic anemia, DILE
315
How often is clonidine applied?
weekly
316
What are the vasodilators?
Hydralazine and minoxidil
317
minoxidil ades
fluid retention, increased HR, hair growth
318
What is aliskirenin
Direct reinin inhibitor (like ACEs/ARBs)
319
How much to decrease BP in first in hour in hypertensive emergency?
25%
320
Age of RFs for ACS?
```
M>45
F>55
FH:
M<55
F<65
```
321
When should cardiac enzymes be checked?
Onset and 6 hours later
322
PCI should be performed within __ hours
2hours
323
What meds are used post-MI?
MONA
GAP
(GLP antagonists, P2Y12 inhibitors, anticoagulants)
324
What are the glycoprotein IIb/IIIa antagonists?
Abciximab
Eptifibatide
Tirofiban
325
What meds to avoid after ACS?
NSAIDs and IR nifedipine
326
Which P2Y12 causes dyspnea?
Ticagrelor
327
Which P2y12 needs to stay in original container?
Prasugrel
328
Which P2y12 is contraindicated in stroke?
prasugrel
329
How to transition from cangrelor to oral P2y12?
Give loading dose of oral after discontinuing
330
Dose of alteplase in ACS?
100mg
331
Drug interaction with clopidogrel?
CYP2C9 inhibitors - omeprazole and esomeprazole
332
How long to continue beta-blocker after ACS?
3 years
333
What is simple compounding?
adding ingredient per manufacturer (reconstituting)
334
What is the sensitivity requirement for torsion balance?
within 5mg;
| Min Wt Quan = SR/acceptable error rate
335
When do use each type of mortar/pestle?
Glass: liquids
Porcelain: Blending powders
Wedgewood: Crushing dry crystals
336
What 2 types of documentation for nonsterile compounding?
```
Master formulation record (recipe)
Compounding record (products including lot #'s, Rx#, etc)
```
337
What to do if no expiration date?
pharmacist assigns one within the next 3 years
338
Comminution
Decreasing particle size by grinding/crushing/vibrating
339
Trituration
Mix thoroughly (grinding or shaking liquid)
340
Levigation
Grinding by adding small amount of liquid
341
Pulveration by intervention
Dissolving crystal in water
342
Solute v suspension v emulsion
Solute: dissolved in solvent for homogenous mixture
Suspension: Solid dispersed in liquid
Emulsion: liquid dispersed in liquid
343
BUD of non-sterile compounding
Oral liquid: 14 days
Topical liquid: 30 days
Nonaqueous: 6 months
344
What causes migiraine?
Vasodilation
345
What medication is contraindicated in patient with aura?
Estrogens (increased stroke risk)
346
Natural products used for migraine - 7
```
Caffeine
Magnesium
Butterbur
Coenzyme Q10
Feverfew
peppermint
Riboflavin
```
347
Drug classes used for migraines
APAP, NSAIDs, caffeine
Triptans
Ergotamines
Opioids/butalbitol/tramadol
348
Triptan mechanism
5HT-1 agonist (vasoconstriction)
349
Contraindications to triptans
Cerebrovascular disease, uncontrolled HTN, ISHD, PVD
350
How many doses of triptans allowed?
2, then must wait 24 hours
351
Triptan with long half-life?
Frovatriptan (Frova) and naratriptan (Amerge)
352
Which triptans can be used in kids
Almotriptan, zolmitriptan, treximet, rizatriptan
353
Which triptans are CI with MAOIs?
Sumatriptan, rizatriptan, zolmitriptan
354
ADEs of triptans
high BP, parasthesia, triptan sensations (heaviness in chest)
355
Rizatriptan DF
Tablet and ODT
356
Sumatriptan DF
SC, nasal spray, nasal powder
357
Zolmitriptan
ODT, nasal spray
358
Treximet
Sumatriptan + naproxen (dispense in original container)
359
Ergotamine mechanism
Non-selective serotonin agonists
360
Ergotamine contraindications
CYP3A4 inhibitors, ISHD, uncontrolled HTN, pregnancy
361
Ergotamine ADEs
Peripheral ischemia, cardiovascular effects
362
DF of dihydroergotamine
injection and nasal spray
363
Schedule of butalbitol products
III (abuse/dependence)
364
Which of the nasal sprays do NOT need primed?
Triptans
365
Who gets migraine ppx?
just has to decrease QoL
366
What meds are used for migraine PPX
```
Beta-blockers
Topiramate
Valproate
TCAs (amitriptyline)
Venlafaxine
Erenumab (aimovig)
Botox (>15 migraine days/month)
```
367
Erenumb mechanism
Calcitonin gene-related peptide antagonist
368
Aimovig
Erenumab
369
How many types per week can acute drugs be used?
2-3 weeks
370
Natural product for acne
Tree oil
371
Natural product for cold sore
Lysine
372
OTC acne treatment
Benzoyl peroxide (the best)
Salicylic acid
Azelaic acid
Adapalene
373
Differin
Adapalene
374
How long do retinoids take to work?
4-12 weeks
375
ADEs of retinoids
teratogenic and photosensitivity
376
How to apply retinoids
Pea size all over face for ~20 minutes
377
Topical antibiotics used for acne
Erythromycin, clindamycin, dapsone gel
378
Isotretinoin ADEs
Teratogen (requires 2 forms of BC for 1 month)
| Dryness
379
What oral antibiotics for acne?
Minocyclin (Solodyn)
| Doxycycline
380
Alopecia treatment
Finasteride (takes 3 months to work)
| Minoxidil
381
Propecia
Finasteride
382
Rogane
Minoxidil
383
Treatment for thinning eyelashes
Bimatoprost (Latisse)
384
Topical cold sore treatment
Docasanol (Abreva) - OTC
| Acyclovir (Zovirax) - Rx
385
Danduff treatment
SElenium sulfide, pyrithione zind, coal tar
| 2nd line: Ketoconazole shampoo
386
Nizoral
Ketoconazole shampoo (A-D is OTC)
387
Diapar rash treatment
topical azoles, hydrocortisone
388
Eczema treatment
1. moisture
2. topical steroids/antihistamines
3. topical calcineurin inhibitors or topical PDE-4
4. IL-4 (Dupilumab)/oral immunosuppressants
389
Protopic
Topical tacrolimus
390
Elidel
Pimecrolimus (topical CNI)
391
ADEs of topical CNI
Photosensitivity, lymphoma, skin cancer
392
Fungal skin infection tx
Terbinafine, clotrimazole, ketoconazole
393
Lamisal AT
terbinafine
394
Extina
Ketoconazole
395
Lotrisone
Betamethasone/clotrimazole
396
Fungal nail infection tx
Terbinafine or itraconazole for a year
397
How to diagnose fungal nail infection
KOH
398
Terbinafine ADE
hepatotoxocity
399
Itraconazole CI
HF
400
Fungal vaginal infection treatment
```
Monistat (miconazole)
Teraconazole
Clotrimazole
Butaconazole
1, 3, or 7 days
Fluconazole - 1 day
```
401
OTC test for vaginal fungal infection
Vagisil Screening Kit
402
Genital warts tx
Imoquimod
403
Hemorrhoid treatment
Fiber
Phenylephrine
Hydrocortisone
Witch hazel (for itching)
404
Preparation H
Phenylephrine
405
First-line Lice treatment
Pyrethrin (Rid)
| Permethrin (Nix)
406
Lindane ADE
Neurotoxicity (only for refractory lice)
407
Scabies treatment
Premethrin
| Ivermectin
408
What's in triple antibiotic ointment
Polymyxin, bacitracin, neomycin
409
MRSA topical treatment
Mupirocin
410
Cortisporin
Bacitracin, neomycin, polymyxin B, hydrocortisone
411
Pinworms tx
```
Pyrantel pamoate (reese's) - 3 tx over 3 weeks
Mebendazole, albendazole
```
412
What steroids available OTC?
Hydrocortisone 0.5% and 1%
413
ADEs of topical steroids
Telangectasia
Rosacea
Skin thinning
Pigment changes
414
Sunburn SPF requirement
15-30 q2h, reapply after swimming
415
Topical steroid potency
```
Clobetasone
Betamethasone
Mometasone ointment
Fluocinonide ointment
Fluocinonide cream
Mometasone cream
Triamcinolone cream
hydrocortisone
```
416
Clobex
Clobetasone
417
Diprolene
Betamethasone
418
Elocon
Mometasone
419
Lidex
Fluocinonide
420
Kenalog
Triamcinolone
421
Cortaid
Hydrocortisone
422
Concerning weight change for CHF
2-4lbs/day or 3-5lb/week
423
When to fluid restrict
<1.5L in Stage D
424
OTC for CHF
Hawthorn
CoQ10
Fish oil
425
Drugs that worsen HF
IFNs
Class I antiarrhythmics
Itraconazole
TNF inhibitors
426
Who gets BiDil
AAs or people who can't use ACE/ARB
427
When to use ivabradine
HR >70bpm
428
Which loop has highest ototoxicity?
Ethacrynic acid
429
Lab changes from loops
Increased BS, TG, cholesterol, bicarbonate
430
Equivalency of loops
Bumetanide 1 mg
Torsemide 20mg
Furosemide 40mg PO = 20mg IV
Ethacrynic acid 50mg
431
ADEs of BiDIl
Syncope, tachyphylaxis (requires 10-12 hournitrate free interval)
432
Digoxin is a ___inotropic and __ chronotropic
Positive inotrope
| Negative chronotrope
433
Digoxin therapeutic range for HF
0.5-0.9
434
Dig toxicity
N/V, loss of appetite, bradycardia
435
Dig electrolyte abnormalities
Decrease K, Mg, increased Ca
436
Corlanor
Ivabradine
437
Ivabradine ADEs
AF, phosphenes, QT prolongation, HTN
438
What potassium DF is open capsules?
Micro-K
439
What Potassium DF is dissolvable tablets?
Klor-Con M
440
what drugs can cause PAH?
SSRIs in pregnancy and cocaine
441
Treatment of PAH
```
Wwarfarin
Loops
Digoxin
CCBs (if vasoreactive responders - NOT verapamil)
Vasodilators (if non-responders)
```
442
What are the vasodilators for PAH?
Prostacyclin analogs
PDE-5 inhibitors
Endothelin Receptor Antagonists
SGC
443
Prostacyclin analogues ADEs
Rebound PH when d/c
Jaw pain
Infusion site reaction
444
What's important about PG infusion?
Cannot have interruptions in infusion
445
Flolan (& administration requirements)
Epoprostenol - PG
Protect from light
Ice for stability
446
ERA ADEs
```
Embryo-fetal toxicity
Hepatotoxicity
Decreased HgB/Hct
Fluid retention
HA
```
447
ERA drugs
-sentan
Bosentan
Ambrisentan
Macitentan
448
Which ERA decreases OC?
Bosentan
449
What is sGC?
guanylate cyclase stimulator - riociguat (Adempas)
450
Riociguat ADEs
embryo-fetal toxicity
| decreased BP, HA
451
Riociguat Drug interactions
NITRATES and PDE-5s
452
What drugs cause pulmonary fibrosis
```
Amiodarone
Bleomycin
Dronedarone
MTX
nitrofurantoin
sulfasalazine
```
453
Harriet Lane book
Pediatric dosing
454
Who does NDA approval
Center for Drug Evaluation and Research
455
Red Book
Drug pricing
456
Orange book
therapeutic equivalencies
457
Purple book
biological products/biosimilarities
458
Pink book
vaccines
459
Yellow book
International travel
460
Green book
Animal products
461
Pink Sheet
Pharma/industry
462
Red book Pediatrics
Peds ID/vaccinations
463
Compounding resources (3)
Allen's
Merck Index
Remington
464
Sanford Guide
ID
465
International drug info
Index Nominum
Martindale
USP Dictionary
466
King Guide
IV drug comptability
467
Goodman and Gilman's
Pharmacology
468
Brigg's
Pregnancy
469
Hale's
Pregnancy
470
How long to take antihistamines before motion sickness?
30-60 minutes
471
How long to use scopolamine patch before motion sickness?
4 hours
472
Does Scop patch needed removed before MRI?
Yes
473
Scop patch ADE
Pupil dilation, anticholinergic
474
CI for antihistamines
Glaucoma
475
What are the antihistamines for motion sickness?
Cyclizine
Diphenhydramine
Dimenhydrinate
Meclizine
476
Dramamine
Dimenhydrinate
477
Meclizine
Dramaminen Less Drowsy
478
Ae limit for promethazine
>2 years old (and Rx only)
479
Drugs contraindicated with G6PD deficiency
```
Chloroquine
Dapsone
Methylene Blu
Nitrofurantoin
Primarquine
Probenecid
Quinidine
Quinine
Rasburicase
Sulfonamide
```
480
Drugs affected by albumin
warfarin
phenytoin
valproate
calcium
481
What is the insulin breakdown product used to tell T1 from T2DM?
C-peptide
482
Digoxin therapeutic goal for AF
0.8-2
483
PT is falsely increased by what drug?
Daptomycin
484
Folate decreased by what drugs?
Phenytoin, phenobarb, MTX, bactrim
485
Eosinophis indicate what infection
Parasite
486
What CBC indicates viral infection?
Lymphocytes
487
FAST means
Face
Arms
Speech
Time
488
Treatment for ischemic stroke
alteplase
489
Max dose of alteplase in stroke
90mg
490
Criteria for giving alteplase
Within 3 hours of symptoms, BP <185/110
491
Secondary prevention after stroke?
Antiplatelets - aspirin or clopidogrel o rdipyridamole/ASA
492
What is the most important RF for stroke?
hypertension
493
Yosprala
Omeprazole + ASA
494
Aggrenox
Dipyridamole + ASA
495
Dipyridamole ade
Inhibits adenosine in platelets and increases cAMP
496
What medication for intracerebral hemorrhage?
Mannitol (to decrease ICP)
497
What medication for acute subarachnoid hemorrhage?
Nimodipine - prevents ischemia
498
ROA for nimodipine
Oral - canNOT give IV
| Can open capsules to get liquid
499
What are the different incontinence types?
Urge - from PD/DM/neuropathy
Stress - from laughing/physical exertion
Overflow - from BPH
or MIXED
500
What muscle causes the symptoms of OAB? What receptors?
Detrusor
| M3 receptors
501
Treatment for OAB?
Kegel exercises
Anticholinergics
B3 agonists
Botox (LAST LINE)
502
Treatment of nocturia
Desmopressin
503
What anticholinergic for OAB is not selective?
Oxybutynin
504
oxybutynin DFs
Patch (Oxytrol), tablet (Ditropan), gel (Gelnique)
505
What anticholinergic for OAB is non-selective and why does this matter?
Solifenacin, tolterodine, darefnacin, fesoterodine
| Fewer CNS effects
506
Vesicare
Solifenacin
507
B3 agonist MOA
relaxes detrusor muscle
508
B3 agonist
Mirabegron (Myrbetriq)
509
ADEs of Mirabegron
HTN, less dry mouth
510
Desmopressin CIs
Patients with risk from fluid retention - HF, uncontrolled HTN
