Contraindications

Question 1

Abrupt withdrawal can precipitate hypertensive crisis

Answer 1

Centrally Acting Sympatholytics /“Central Alpha Agonists”

Clonidine (Catapres)
Methyldopa

Question 2

Aldosterone Antagonists and K+ sparing diuretics contraindications

Answer 2

Hyperkalemi
Anuria
severe, progressive kidney disease/dysfunction

Question 3

Can’t be given during pregnancy or if the patient has angioedema

Answer 3

ACEs and ARBs

Question 4

TMP-SMX is contraindicated if (renal)

Answer 4

CrCl <15 ml/min

Question 5

Drugs that contain sulfa

Answer 5

Furosemide (Lasix)
Torsemide (Demadex)
Bumetanide (Bumex)
HCTZ (Microzide)
Chlorothiazide (Diuril)
TMP+SMX

Caution:
Metolazone (thiazide related)

Question 6

Antibiotics + Pregnancy

Answer 6

Quinolones, tetracyclines, metronidazole and aminoglycosides unless severe or life threatening infection
Trimethoprim in first trimester (folate)
Sulfas at term (interferes with bile conjugation)
Nitrofurantoin at term (risk of neonatal hemolysis)

Generally, avoid any antibiotics in first trimester if possible and use shortest effective duration

Question 7

Don’t use ____ with digoxin due to risk of bradycardia or AV block

Answer 7

Carvedilol

Question 8

Contraindications to laxative use

Answer 8

Acute abdomen
Intestinal obstruction
Perforation
Toxic megacolon
Unexplained abdominal pain

Question 9

Absolute contraindications for opioid use

Answer 9

Hepatic disease

Increased intracranial pressure

Question 10

Avoid this central alpha agonist during pregnancy

Answer 10

Clonidine

methyldopa okay

Question 11

Avoid _____ in fibromyalgia

Answer 11

Opioids

too often prescribed but not recommended

Question 12

Pyridium is contraindicated if..

Answer 12

CrCl < 50

Question 13

Beers Criteria

Answer 13

use Bactrim with caution→ can elevate risk of hyperkalemia in patients with decreased kidney function who are receiving ACE-I or ARBs

Question 14

Caution
Rebound effect: acid hypersecretion with
abrupt discontinuation→ Consider taper therapy

Answer 14

PPIs

Question 15

Avoid codeine and tramadol if….

Answer 15

<12 years old

Question 16

High potency steroids

Answer 16

Can’t be used on face

Question 17

Avoid ____ for pain control if a patient has a history of falls or fractures

Answer 17

SNRIs

Question 18

Lactic acidosis concerns mean you shouldn’t give _____ if kidney impairment

Answer 18

metformin

Stop in cases of N/V, dehydration

Question 19

Avoid these medications in ESRD

Answer 19

morphine
demerol
hydrocodone
codeine

Question 20

If social history includes _______ opioids might not be the best choice

Answer 20

History of addictive behavior
Caring for small children at home
Teenagers in home

Question 21

Digoxin

Answer 21

Don’t give if reduced renal clearance or hypokalemia

Question 22

Firefighters don’t get

Answer 22

Muscle relaxants

Question 23

Contains Salicylate → contraindicated with ASA allergy

Avoid use in children/teenagers who have or are recovering from viral illness→ Risk of Reye Syndrome (from ASA)

Answer 23

Pepto Bismol

Question 24

BPH: avoid

Answer 24

Meds that trigger urinary retention:

Antihistamines

Question 25

Avoided in patients with seizure disorder or anorexia

Answer 25

Bupropion (Wellbutrin)

Question 26

Beta blockers

Answer 26

``` Asthma Severe bradycardia 2nd/3rd-degree AV block Uncompensated HF SBP <100, Cardiogenic shock ``` * *Avoid abrupt withdrawal!!** * Can precipitate acute coronary events and severe increases in BP

Question 27

Glaucoma: avoid

Answer 27

Meds that trigger increased IOP: Antihistamines

Question 28

Anti-diarrheal Cautions/Contraindications

Answer 28

``` Bloody or suspected infectious diarrhea High fever/toxicity Pseudomembranous colitis Acute ulcerative colitis Use caution in patients with a history of drug abuse ```

Question 29

Caution in elderly patients with IBS

Answer 29

Dicyclomine (Bentyl)

Question 30

CCBs contraindications

Answer 30

SA or AV node Abnormalities, B-blockers, HF HF→ not given due to edema side effects

Question 31

NOT indicated for acute “rescue” treatment of bronchospasm

Answer 31

Inhaled anticholinergics (SAMAs/LAMAs)

Question 32

Don't give _____ to RA

Answer 32

long term short acting opioids! Switch to long acting with short acting PRN for breakthrough pain. (this applies to any chronic pain situation)

Question 33

Is NOT for use with opioids

Answer 33

Buprenorphine patch

Question 34

Extreme caution with these medications in ESRD

Answer 34

hydromorphone | oxycodone

Question 35

Don't use loops (furosemide) with _____ because hypokalemia will increase its toxicity

Answer 35

Digoxin

Question 36

Don't use opioids in combination with

Answer 36

Benzos or gabapentinoids Due to Overdose, respiratory depression and death (dunno if this only applies to elderly?)

Question 37

Metoclopramide CI

Answer 37

obstruction perforation GI hemorrhage

Question 38

Don't give ___ if the patient has anuria

Answer 38

Diuretics (loops, but I think it applies to all)

Question 39

3 drugs not to combine bc all lower BP, together could cause hypotension

Answer 39

Furosemide carvedilol lisinopril

Question 40

SNRI contraindicated if liver disease

Answer 40

Duloxetine (Cymbalta)

Question 41

Too sedating for transportation drivers

Answer 41

Cetirizine (Zyrtec) Levocetirizine (Xyzal) Azelastine (Asteline) Nasal Spray Diphenhydramine (Benadryl)

Question 42

Nitrates CI

Answer 42

Within 24 hours of Sildenafil (Viagra HCM RV infarction

Question 43

Abortifacient→ Contraindicated in pregnancy or those who may become pregnant while taking the drug

Answer 43

Misoprostol