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Pharm > Clinical Pharm > Flashcards

Clinical Pharm Flashcards

1
Q

2nd gen antihistamine with some sedation

A

Zyrtec

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2
Q

drugs to d/c with BPH

A

1st gen antihistamines

decongestants

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3
Q

drugs to avoid with glaucoma

A

decongestants
antihistamines
steroids

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4
Q

antihistamine for scabies

A

hydtoxyzine

diphenhydramine

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5
Q

rx for poison ivy

A

steroid cream (triamcinolone)
non-sedating oral antihistamine (Cetirizine)
+/- oral steroid

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6
Q

adjunct treatment for urticaria

A

H2 blockers

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7
Q

definition of anaphylaxis

A

affecting >1 body system: skin/mucosa, respiratoy, GI, cardiac

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8
Q

cardiac effects of anaphylaxis

A

hTN
syncope
tachycardia

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9
Q

what do we need to watch out for after treating anaphylaxis?

A

rebound–give epi again

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10
Q

high risk pts for antihistamines

A

BPH
glaucoma
young/old
high risk ocupations

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11
Q

partial agonist opioids

A

tramadol

tapendatol

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12
Q

SE of opioids

A 
N/V/C
dry mouth
AMS
resp depression
tolerance
dependence
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13
Q

pseudo addiction

A

undertreated pain resulting in red flag behaviors

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14
Q

withdrawal sxs w/ abrupt d/c in opioid

A

physical dependence

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15
Q

need increased dose for pain relief

A

tolerance

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16
Q

three types of pain

A

nociceptive
neuropathic
psychogenic

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17
Q

pain caused by injury to the tissue

A

nociceptive

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18
Q

what kind of pain with cancer?

A

nociceptive

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19
Q

mgmt for nociceptive pain

A 
NSAIDs
Tylenol
steroidsopioids
PCA
PT
TENs
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20
Q

pain that results from damage to or dysfunction o f nervers, SC or brian

A

neuropahtic pain

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21
Q

mgmt for neuorpathic pain

A 
gabapentin
pregabalin
amitrptiline
duloxetine
tramadol
lidoderm patch/cream
SC stimulator/peripheral stimulation
ESI
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22
Q

interventional pain mgmt

A 
epidrual steroid injection
join injections
intrathecal pump
SC stimulator
peripheral n blocks
sympathetic nerve blocks/neurolysis
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23
Q

patient with persistent pain w evidence of psychologic distrubance

A

psychogenic

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24
Q

tx of psychogenic pain

A

biofeedback
exercise
psych eval/therpay

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25
Q

how much do we decrease daily dose of opioid when converting to a new/long-acting pain med?

A

50-75%

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26
Q

how much should breakthrough medication dose be of long-acting dose?

A

20-25%

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27
Q

what adjunct might we use for myofascia lpain?

A

TENs

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28
Q

adjuncts to pain meds

A

TENS
aqua therapy
topical cream compound

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29
Q

whta topical cream compounds can we use?o

A

lidocaine
ibuprofen
diclofenac

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30
Q

first line tx for fibromylagia

A

exercise (start with aqua)

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31
Q

tx for fibromyalgia pain

A 
exercise
counseling
pregabalin/gabapentin
cymbalta
NO opioids
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32
Q

dosing of patient controlled analgesia

A

demand dose every 15 min
continuous over each hour
contiuous + demand doses

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33
Q

benefits of PCA

A

patient feels they have control
less opioids while sleeping
get severe pain under control quickly

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34
Q

risks of PCA

A

family members pushing

overdose

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35
Q

requirements for PCA

A 
continuous pulseox
naloxone prn orders
discuss w/RN
pt seen w/in 12h
titrate
wean as soon as tolerable
should be seen everyday by anesthesia/surgery
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36
Q

PO to IV morphine typical conversion

A

3:1

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37
Q

who are fentanyl patches not effective in?

A

cachectic pts

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38
Q

patient education w/ fentanyl patch

A

exposure to heat=increased absorption

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39
Q

use of fentanyl patch

A

not acute-12h until therapeutic

two step taper when coming from IV

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40
Q

what opioids may help with neuropahtic pain?

A

methadone
tramadol
tapentadol

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41
Q

big SE of methadone

A

QT prolongation

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42
Q

baselines for methadone

A

EKG

renal/hepatic function

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43
Q

issues with methadone

A

QT prolongation
slow titration because of long half life
drug interaction

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44
Q

issue with tramadol/tapentadol?

A

serotonin syndrome w/ antidepressants

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45
Q

issue with buprenorphine patch

A

QT prolongation

NOT used with opioids

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46
Q

what pain meds must be avoided with ESRD?

A 
morhpine 
meperidine
hydrocodone
codeine
cuation:hydromorphone, oxycodone
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47
Q

DOC in ESRD

A

fentanyl

methadone

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48
Q

what pain meds should be avoided with hepatic dz?

A

opioids

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49
Q

what pain meds must be avoided with increase ICP?

A

opioids

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50
Q

opioids used in pediatrics

A 
morphine
hydromorphone
oxycodone
hydrocodone
fentanyl
methadone
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51
Q

teenager with testicular torsion. what meds?

A

analgesics-opioid

anti-emetic

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52
Q

teenager with appendicitis. what meds?

A

opioids

antiemetic

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53
Q

antiemetics for peds

A

promethamine

metoclopramide

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54
Q

pain mgmt for burns

A

IV morphine especially before debridement, cleaning, dressing changes

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55
Q

what pain meds do we avoid if pt <12 yo?

A

codeine

tramadol

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56
Q

what herbal supplement is often taken by geriatrics that increases risk of bleeding w/ warfarin?

A

gingko bilboa extract

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57
Q

what supplement w/ SSRI can cause serotonin syndrome?

A

st john’s wort

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58
Q

age related changes increasing risk for adverse drug events

A

body fat>muscle

decline in renal and hepatic function

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59
Q

stepwise approach to prescribing for geriatrics

A 
review meds
d/c unnecessary
consider adverse events for new sxs
consider nonpharm options
reduce dosing if possible
simplify dosing schedule
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60
Q

Beers criteria for geriatric prescribgin

A

avoid concurrent opioids w/ benzos or gabas

avoid SNRIs

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61
Q

issue with SNRI in elderly

A

avoid in pts w/ hx of falls/fractures

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62
Q

monitoring of loops

A 
I&amp;Os
daily weight
orthostasis/BP
eytes
renal function
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63
Q

loop diuretic w/o sulfa moeity

A

ethacrynic acid

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64
Q

SE of ethacrynic acid

A

ototoxicity

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65
Q

SE of loop diuretic

A

hypokalemia

hyponatremia

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66
Q

CI for loop diuretic

A

anuria

sulfa allergy

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67
Q

SE of thiazides

A

hypokalemia

hyponatremia

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68
Q

CI to thiazides

A

anuria

sulfa allergy

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69
Q

thiazide with less sulfa issues?

A

metolazone

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70
Q

CI and cautions with K+-sparing diuretics

A

hyperkalemia
caution w/ ACEI/ARN
anuria
severe/progressive kidney dz

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71
Q

SE of K+-sparing diuretics

A

hyperkalemia

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72
Q

K+-sparing diuretics

A

spironolactone
eplerenone
triamterene
amiloride

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73
Q

drugs that reduce mortality and improve sxs in HF

A

BB

ACEi

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74
Q

CI for ACEI

A

angioedema

pregnancy

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75
Q

SE of ACEI

A

cought
orthostatic hypotension
hyperkalemia

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76
Q

what pts are ACEI first line for?

A

DM
CKD
HFrEF

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77
Q

CI for BB

A

heart blocks

uncompensated HF

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78
Q

nonselective BBs

A

propranolol
nadolol
timolol

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79
Q

SE of BB

A 
bronchospasm
worsen CHF
fatigue
depression
impotence
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80
Q

effects of BBs

A

-chronotropy
-inotropy
decreased CO

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81
Q

cardioselective BB

A

acebutolo
atenolol
metoprolol
nebivolol

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82
Q

BB w/ intrinsic sympathomimetic activity

A

acebutolo

pindolol

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83
Q

what must be avoided with BBs?

A

abrupt withdrawal

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84
Q

SE of ARBs

A

orthostatic hTN

hyperkalemia

85
Q

CI for ARBs

A

angioedema

pregnancy

86
Q

you have a HF patient with low energy. what could be done?

A

lower BB dose
OR
add digoxin

87
Q

effecs of digoxin

A

+ inotropy
- chronotropy
increased CO

88
Q

SE of digoxin

A

arrhythmias
HA
fatigue
drwosy

89
Q

what can cause dig toxicity?

A

hypokalemia

90
Q

first lines for HTN

A

ACEI
ARB
CCB
thiazide

91
Q

antiHTN in black pts

A

HXTZ

CCB

92
Q

antiHTN in non-black pts

A

ACEI

BB

93
Q

dihydropyridines

A

-dipines

94
Q

dihydropyridines vs non-dyhydropyridines

A

dihydropyridines more vasodilatory effect

95
Q

non-dihydropyridines

A

verapamil

diltiazem

96
Q

SE of dihydropyridines

A

peripheral edema

97
Q

CI to CCBs

A

non-dihydropyridines:
SA/AV node dysfunction
BB
HF (dihydropyridines)

98
Q

SE of alpha blockers

A

orthostatic hTN

99
Q

pt with HTN and BPH

A

alpha blocker

100
Q

antiHTN in pregnancy

A

methyldopa

101
Q

SE of central alpha agonists

A

orthostatic hypotension

102
Q

what t oavoid with central alpha agonists?

A

abrupt withdrawal

103
Q

SE of nitro

A

throbbing HA

tachycardia

104
Q

DOC for Prinzmetal angina

A

CCBs

105
Q

tx for long-term mgmt of chronic stable angina

A

isosorbide dinitrate/mononitrate

106
Q

drug interaction s with digoxin and beta blocker

A

bradycardia

AV block

107
Q

digoxin toxicity

A

cardiac arrhythmias
GI
neuro
visual disturbances

108
Q

how is digoxin cleared?

A

renally

109
Q

issue with lisinopril and ibuprofen together?

A

both affect the GFR

110
Q

how do ACEI affect the GFR?

A

vasodilates efferent arteriole

111
Q

how do NSAIDs affect the GFR?

A

vasoconstrict the afferent arteriole

112
Q

normal

A

GFR >90

113
Q

complicated CAP abx

A

beta lactam+macrolide
OR
resp. FLQ

114
Q

which drug for UTI should be renally dosed?

A

pyridium

115
Q

issuw with ACEI/ARB and bactrim?

A

hyperkalemia if decreased kidney function

116
Q

tx of acute asthma exacerbation

A

albuterol w/ or w/o ipratropium

117
Q

how long does albuterol last?

A

~4 hours

118
Q

SE of SABA

A

tachycardia
tremor
nervousness
dizziness

119
Q

SE of oral glucocorticoid

A

anxiety
agitation
insomnia
increased appetite

120
Q

oral steroid for acute asthma exacerbation

A

1-2 mg/kg/day x3-5d

121
Q

dosing of albuterol MDI for bronchospasms

A

1-2 puffs q4-6h prn

122
Q

step 2 of asthma tx

A

low dose ICS*
cromolyn
montelukast

123
Q

indications for montelukast

A

asthma

allergic rhinitis

124
Q

SE of montelukast

A

URIs
HA
abd pain
mood changes*

125
Q

when can we step down asthma therapy?

A

3 mos of symptom control

126
Q

how old to start omalizumab?

A

6 years or older

127
Q

tiotropium

A

LAMA

128
Q

salmeterol

A

LABA

129
Q

SE of SABA

A 
nervous, shaky
hyperactivity
tachycardia
nauseau
insomnia
130
Q

LAMA SE

A

dry mouth*
cough*
HA, blurred vision

131
Q

SE of ICS

A

thrush

hoarseness

132
Q

tx for COPD exacerbaiton

A

SABA +/-SAMA
oral prednisone
abx

133
Q

first line abx for COPD exacerbation

A

azithromycin or levaquin

134
Q

requirements for abx for COPD exacerbaiton

A

2/3:
increase dyspnea
increase sputum volume
increase sputum purulence

135
Q

tx steps for stable COPD

A

A: SABA or SAMA or ocmbo
B: LABA or LAMA
C: LAMA
D: LABA+LAMA

136
Q

black box warning for antidepressants

A

increased risk of suicide in children and adolescents

137
Q

fluoxetine uniques

A

increased energy=increased AM

longest half life

138
Q

SE of SSRIs

A 
insomnia, nervousness
decreased libido
somnolence
dry mouth
anorexia
139
Q

fluoxetine also used for

A

OCD
bulimia
PMDD

140
Q

sertraline also used for

A 
OCD
panic d/o, PTSD
SAD
nocturnal eating
PMDD
141
Q

parozetine unique

A

SSRI

more weight gain

142
Q

parozetine also used for

A 
panic d/o
OCD
GAD, SAD
PSTD
PMDD
143
Q

citalopram unique

A

depression only

144
Q

escitalopram unique

A

also GAD

145
Q

venlafaxine also used for

A

GAD, SAD

panic d/o

146
Q

desvenlafaxine unique

A

depression only

147
Q

duloxetine also used for

A

GAD
DM neuropathy
fibromyalgia

148
Q

duloxetine unique

A

CI in liver dz

149
Q

buproprion MOA

A

DA/NE reuptake inhibitor

150
Q

buproprion unique

A

less sex SE

avoid w/ seizure d/o or anorexia

151
Q

buproprion also used for

A

SAD

smoking cessation

152
Q

mirtazapine MOA

A

alpha 2 antagonist

153
Q

SE of mirtazapine

A

somnolencce
appetite, weight gain
constipation
dry mouth

154
Q

mirtazapine unique

A

less sex SE
good for elderly
no other indicaitons

155
Q

duration of antidepressant tx

A

4-9 mos after therapeutic dose

156
Q

how long should we discontinue antidepressants?

A

1-6 mos

157
Q

metoclopramide

A

prokinetic

158
Q

dicyclomine

A

antispasmodic

159
Q

misoprostol

A

cytoprotective

160
Q

H2 blockers

A

on-demand relief

nocturnal

161
Q

PPIs

A

takes a few days
30 min before bkfst
taper

162
Q

PPI SE

A

nutrient malabsorption
osteoporosis
c diff
kidney dz

163
Q

magnesium antacids

A

diarrhea

caution: renal insufficiency

164
Q

aluminum antacids

A

constipation

165
Q

sodium antacids

A

caution: edema, cirrhosis, HF, renal impairment

166
Q

when to stop PPI and bismuth/abx for H pyloir testing?

A

PPI: 1-2 wks

bismuth/abx: 4 wks

167
Q

what drugs can complicated PUD?

A

anticoagulants
ASA
steroids

168
Q

used to prevent NSAID-induced ulcers

A

misoprostol

169
Q

misoprostol CI

A

pregnancy

170
Q

SE of metoclopramide

A

EPS, tardive dyskinesia

171
Q

CI to metoclopramide

A

obstruction
perf
hemorrhage

172
Q

ondansetron cuations

A

cardiac arrythmias, QT interval

serotonin syndrome

173
Q

SE of dicyclomine

A

anticholinergic

caution in elderly

174
Q

what is dicyclomine used for?

A

IBS

175
Q

what is eluxadoline used for?

A

IBS-D

176
Q

SE of bulk laxatives

A

flatulence

bloating

177
Q

caution with osmotic laxatives

A

hypermagnesemia in renal insuffiency

178
Q

CI to laxatives

A 
acute abdomen
obstruction
perforation
toxic megacolon
unexplained abd pain
179
Q

what is methylnaltrexone used for?

A

opioid-indced constipation

180
Q

antidiarrheal cautions

A 
bloody/suspicious infectious
high fever/toxicity
pseudomembranous colitis
ulcerative colitis
hx of drug use
181
Q

adverse rxns to anti-diarrheal

A

ileus

toxic megacolon

182
Q

CI for pepto

A

ASAallergy

kids

183
Q

what is mesalamine used for?

A

IBD-UC

184
Q

abx for perianal crohn dz

A

cipro

metronidazole

185
Q

issues with biologics

A

infection
hepatotoxicity
malignancy

186
Q

abx for CAP PNA

A

macrolide or doxycycline

187
Q

abx for strep pneumo PNA

A

high-dose PCN G

188
Q

inpt tx of CAP PNA

A

macrolide or doxycycline +bet lactam

or beta lactam +FLQ

189
Q

tx for unocmplicated cystitis

A

bactrim

macrobid

190
Q

tx for complicated cystitis

A

cipro

191
Q

tx for pyelo

A

PCN+ beta lactam or FLQ

carbapenem if resistant

192
Q

SE of FLQ

A

cartilage

QT prolongation

193
Q

black box for FLQ

A

risk >benefit for simple infection

194
Q

tx of PID

A

IM ceph+doxy

195
Q

tx of chlamydia

A

doxycycline or azithromycin

196
Q

tx of gonorrhea

A

ceftriaxone + azithromycin

197
Q

abx of choice for pregnancy

A

PCN

cephalosporins

198
Q

avoid what in pregnancy

A

FLQ
tetracyclines
metronidazole
aminoglycosie

199
Q

what should be avoided in first trimester?

A

bactrim

200
Q

what should be avoided at term?

A

sulfas

nitrofurantoin

201
Q

tx for meningitis

A

third gen cephalosporin

+vanco if resistant

202
Q

SE of cephalosporins

A

rare: neutropenia, thrombocytosis, hemolysis, diarrhea, elevated LFTs

203
Q

tx for cellulitis

A

clindamycin
bactrim
tetracylcine if purulent

204
Q

lincosamide

A

clindamycin

205
Q

what is clindamycin useful for?

A

often MRSA

toxin-mediated staph and strep

206
Q

what abx can cause blue-black hyperpigmentation?

A

minocycline

207
Q

glycopeptides

A

vancomycin

208
Q

SE of vancomycin

A

nephrotoxicity
hearing loss
red man syndrome

Pharm (10 decks)

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