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NAPLEX 2022 > Diabetes, HIV, Asthma, Pediatrics, Drugs in Pregnancy & Lactation > Flashcards

Diabetes, HIV, Asthma, Pediatrics, Drugs in Pregnancy & Lactation Flashcards

1
Q

HIV

What is the main indicator of immune function in HIV that determines the need for prophylaxis therapy against opportunistic infections?

A

CD4 count

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2
Q

HIV

What is the most important indicator of response to antiretroviral therapy & should be measured at baseline and regularly throughout therapy?

A

HIV-1 RNA

“Viral load”

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3
Q

HIV

Transmission

A

Semen
Blood
Body secretions

“Some Big Bullshit”

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4
Q

HIV

Define Horizontal transmission

A

Sex or needle sharing

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5
Q

HIV

Define Vertical transmission

A

Mother to baby (pregnancy), birth or breastfeeding

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6
Q

HIV

What is the gold standard HIV test called?

A

HIV ELISA

test for HIV antibody in the blood

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7
Q

HIV

What must a patient have to be diagnosed as HIV positive?

A

Positive HIV ELISA test + positive supplemental tests

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8
Q

HIV

What are the stages of HIV replication cycle & where does each drug work?

A

Stage 1: Attachment (CCR5 antagonists)
Stage 2: Fusion (Fusion inhibitors)
Stage 3: Reverse transcription (NRTIs & NNRTIs)
Stage 4: Integration (INSTIs)
Stage 5: Transcription & Translation (none)
Stage 6: Assembly (none)
Stage 7: Maturation/Budding (PIs)

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9
Q

HIV drug classes

CCR5 Antagonist

A

Maraviroc (Selzentry)

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10
Q

HIV drug classes

Fusion Inhibitor

A

Enfuvirtide (Fuzeon)

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11
Q

HIV drug classes

NRTIs

A

Lamivudine (Epivir)
Abacavir (Ziagen)
Tenofovir (Viread)
Emtricitabine (Emtriva)

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12
Q

HIV drug classes

NNRTIs

A

Efavirenz (Sustiva)
Rilpivirine (Edurant)

“virenz”

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13
Q

HIV drug classes

INSTIs

A

Raltegravir (Isentress)
Elvitegravir (Vitekta)
Dolutegravir (Tivicay)

“gravir”

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14
Q

HIV drug classes

PIs

A

Ritonavir (Norvir)
Atazanavir (Reyataz)
Darunavir (Prezista)

“navir”

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15
Q

HIV

What are antiretrovirals (ARTs) goals?

A
  1. Preserve immune function
  2. Suppress viral load to undetectable levels
  3. Prevent transmission
  4. Reduce morbidity
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16
Q

HIV

What is the adherence rate for ART to be effective long-term?

A

95%

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17
Q

HIV

What is the recommended regimen for pregnant women?

A

2 NRTIs + PI (w/ ritonavir boost)

or

NNRTI + INSTI

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18
Q

HIV

All NRTIs have a boxed warning for what?

A

Lactic acidosis & hepatomegaly with steatosis

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19
Q

HIV

What is Emtricitabine (Emtriva) boxed warning?

A

severe exacerbation of HBV

if drug is stopped –> may also cause hyperpigmentation

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20
Q

HIV

Truvada generic

A

Tenofovir + Emtricitabine

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21
Q

HIV

Atripla generic

A

Tenofovir + Emtricitabine + Efavirenz

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22
Q

HIV

What is the boxed warning for Tenofovir (Viread)?

A

Severe Exacerbation of HBV

if drug is stopped may also cause ARF & osteomalacia

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23
Q

HIV

All NNRTIs can cause:

A

Hepatotoxicity & severe rash (SJS/TEN)

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24
Q

HIV

What ART has a warning for suicidal ideations, fetal toxicity (category D), & convulsions?

A

Efavirenz (Sustiva)

NNRTI

CNS symptoms usually resolve in 2-4 wks

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25
Q

HIV

What ART may decrease levels of oral contraception & methadone?

A

Efavirenz (Sustiva)

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26
Q

HIV

Complications of ARTs

A
  1. Lactic acidosis w/ hepatomegaly
  2. Immune reconstitution inflammatory syndrome (IRIS)
  3. Lipodystrophy: fat redistribution
  4. Lipoatrophy: loss of fate in face, arm, legs (occurs mostly w/ NRTIs)
  5. Lipohypertrophy: fat accumulation in back & neck (mostly PIs)
  6. Diarrhea (mainly PIs)
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27
Q

HIV

What ART is recommended for PrEP?

A

Truvada

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28
Q

HIV

For PEP, treatment should be initiated when?

A

Within 72 hours & includes a 3-drug regimen of Truvada + raltegravir (Isentress) for 4 weeks

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29
Q

Asthma

What is 1st line for maintenance therapy?

A

ICS

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30
Q

Asthma

What is the 1st line for rescue therapy

A

SABA

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31
Q

Asthma

Stepwise approach for asthma

A 
Step 1: SABA PRN
Step 2: Low-dose ICS
Step 3: Low-dose ICS + LABA or Medium-dose ICS
Step 4: Medium-dose ICS + LABA
Step 5: High-dose ICS + LABA
Step 6: High-dose ICS + LABA + Oral CCS
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32
Q

Asthma

Patient should only step down if symptoms have been controlled for how long?

A

3 months

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33
Q

Asthma

If patient is using their SABA for > 2 days/wk then:

A

Step up maintenance therapy

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34
Q

Asthma

What is the injectable that can be considered for patients with allergies & positive skin test called?

A

Omalizumab (Xolair)

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35
Q

Asthma

Omalizumab (Xolair) MOA & boxed warning

A

MOA: IgG monoclonal antibody that inhibits IgE binding

Boxed warning: anaphylaxis (given in office)

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36
Q

Asthma - Drug Class

Name the SABAs

A

Albuterol (ProAir, Ventolin, Proventil)

Levalbuterol (Xopenex)

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37
Q

Asthma - Drug Class

LABAs

A

Salmeterol (Serevent)
Formoterol (Foradil)

never used alone due to boxed warning for asthma related deaths

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38
Q

Asthma - Drug Class

ICSs

A

Beclomethasone (QVAR)
Fluticasone (Flovent, Arnuity)
Budesonide (Pulmicort)

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39
Q

Asthma - Drug Class Combos

Advair generic

A

Fluticasone + Salmeterol

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40
Q

Asthma - Drug Class Combos

Breo generic

A

Fluticasone + Vilanterol

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41
Q

Asthma - Drug Class Combos

Symbicort

A

Budesonide + Formoterol

42
Q

Asthma - Drug Class Combos

Dulera

A

Mometasone + Formoterol

43
Q

Asthma

Counseling for ICS

A

Rinse and spit after use to prevent oral candidiasis (thrush)

44
Q

Asthma

What may be used as add-on therapy to improve bronchodilation?

A

Theophylline

45
Q

Asthma

About Theophylline

A
  1. Active metabolites include caffeine & methylxanthine
  2. Therapeutic peak 5-15 mcg/mL
  3. IBW dosing
  4. Theophylline dose = aminophylline x 0.8
  5. Theophylline levels can be decreased by carbamazepine & high protein diet
46
Q

Asthma

What drug is approved as add-on therapy for patients with severe asthma & an eosinophilic phenotype?

A

Mepolizumab (Nucala)

47
Q

Asthma

What drug is approved for asthma treatment ages 12 years and older?

A

Spiriva Respimat

48
Q

Asthma

Mepolizumab (Nucala) MOA

A

IL-5 antagonist that inhibits IgE binding

49
Q

Asthma

Recommended treatment for asthma in pregnancy

A

Albuterol + Budesonide

50
Q

Asthma

What drug class can worsen asthma symptoms?

A

NSAIDs

51
Q

Asthma

Which type of inhaler should be shaken, requires slow, deep breaths and can be used with spacers?

A

MDIs (HFA or Respimat)

52
Q

Asthma

Which type of inhaler should NOT be shaken, require quick, forceful breaths, and no spacers?

A

DPIs (Ellipta, Diskus, -Haler)

53
Q

Asthma - Zones based on personal best (PB)

Green

A

80-100% of PB = good control

54
Q

Asthma - Zones based on personal best (PB)

Yellow

A

50-80% of PB = worsening lung function, alter regimen

55
Q

Asthma - Zones based on personal best (PB)

Red

A

<50% of PB = use SABA & go to ER

56
Q

Asthma

A patient’s peak expiratory flow rate (PEFR) is known as the patient’s what & is determined by what test?

A

Patient’s personal best (PB)

Determined by a spirometry test

57
Q

Diabetes - Primary mechanism

increase/replace insulin secretions

A

Insulin
Sulfonylureas
Meglitinides

58
Q

Diabetes - Primary mechanism

decrease hepatic glucose output

A

Metformin

59
Q

Diabetes - Primary mechanism

decrease glucagon which decrease glucose production (liver)

A

GLP-1 agonists
DDP-4 inhibitors
Pramlintide

60
Q

Diabetes - Primary mechanism

decrease glucose absorption

A

Alpha-glucosidase inhibitors

61
Q

Diabetes - Primary mechanism

increase glucose excretion

A

SGLT2 inhibitors

62
Q

Diabetes - Primary mechanism

increase insulin sensitivity

A

Thiazolidinediones (TZDs)

63
Q

Diabetes - SE

Metformin

A
  1. Lactic acidosis
  2. Renal adjustments: CrCl < 45 mL/min - reduce dose; CrCl < 30 mL/min - CI
  3. Weight neutral/loss
  4. Hold prior to contract use & wait 48 hours after before restarting
64
Q

Diabetes - Drugs & SE

Sulfonylureas

A

Glipizide (Glucotrol)
Glyburide (Diabeta)
Glimepiride (Amaryl)

SE: Hypoglycemia & weight gain

65
Q

Diabetes - Drugs & SE

Thiazolidinediones

A

Pioglitazone (Actos)
Rosiglitazone (Avandia)

SE: Weight gain; may cause HF & bladder cancer

MOA: PPARy agonists that cause peripheral insulin sensitivity

66
Q

Diabetes - Drugs, MOA SE, CP

Alpha-glucosidase inhibitors

A

Acarbose (Precose)

MOA: inhibit metabolism of sucrose (must use sucrose if hypoglycemic)

SE: flatulence & other GI effects

CP: take with 1st bite of each main meal

67
Q

Diabetes - Drugs, SE, & Warning

SGLT2 inhibitors

A

Canagliflozin (Invokana)
Empagliflozin (Jardiance)
Dapagliflozin (Farxiga)

SE: Mycotic infections, UTIs, hypoglycemia, & weight loss

Warning: Ketoacidosis

68
Q

Diabetes - Drugs & SE

DDP-4 inhibitors

A

Sitagliptin (Januvia)
Sitagliptin + Metformin (Janumet)
Linagliptin (Trajenta)

SE: URT infections, UTIs, & nasopharyngitis

69
Q

Diabetes - Drugs, SE & Warning

GLP-1 agonists

A

Exenatide (Byetta) - not recommended in CrCl <30
Exenatide ER (Bydureon)
Liraglutide (Victoza)
Dulaglutide (Trulicity)

SE: Weight loss

Warning: Pancreatitis

70
Q

Diabetes - Brand, Indication, Administration, & SE

Pramlintide

A

Brand: Symlin

Indicated for both Type 1 & 2 DM

Admin: SQ in abdomen prior to EACH MEAL

SE: hypoglycemia, weight loss & anorexia

71
Q

Diabetes - Insulins, Onset, Peak & Duration

Rapid-acting insulin

A

Aspart (Novolog)
Glulisine (Apidra)
Lispro (Humalog)
Inhaled insulin (Afrezza)

Onset: 10-30 minutes

Peak: 0.5-2.5 hours

Duration: 3-5 hours

72
Q

Diabetes - Insulins, Onset, Peak & Duration

Short-acting insulin

A

Regular (Humulin R, Novolin R)

Onset: 30-60 minutes

Peak: 1-3.5 hours

Duration: 6-10 hours

73
Q

Diabetes - Insulins, Onset, Peak & Duration

Intermediate-acting insulin

A

NPH (Humulin N, Novolin N) - Onset: 1-2 hours; Peak: 4-8 hours

NPH/Regular (Humulin 70/30, Novolin 70/30) - Onset: 30 minutes; Peak: 2-12 hours

Duration: 14-24 hours

74
Q

Diabetes - Insulins, Onset, Peak & Duration

Long-acting insulin

A

Detemir (Levemir) - Duration: 14-24 hours
Glargine (Lantus, Basaglar) - Duration: 24 hours
Degludec (Tresiba) - Duration - 42 hours

Onset: 1-2 hours

75
Q

Pediatric Conditions

IM injection recommended for prevention of RSV in infants born before 29 weeks gestation and for infants with chronic illnesses

A

Palivizumab (Synagis)

76
Q

Pediatric Conditions

Synagis generic, dosage, injection site

A
  1. Generic: Palivizumab
  2. Dose: Monthly injection during RSV season and should NOT EXCEED 5 months/doses
  3. Site: Thigh
77
Q

Pediatric Conditions

Nebulized racemic epinephrine is used for treatment of

A

Difficulty breathing in children along with steroids

78
Q

Pediatric Conditions

ONLY drug treatment recommended for enuresis (bedwetting)

A

Desmopressin (DDAVP)

MOA: synthetic analogue of ADH

79
Q

Pediatric Conditions

OTC cough & cold medicine should NOT be given to children under what age?

A
  1. FDA: <2yo

2. AAP: <6yo

80
Q

Pediatric Conditions

Treatment recommended for intestinal gas

A

Simethicone gas

81
Q

Pediatric Conditions

Treatment recommended for prevention of constipation

A

PEG (Miralax)***

-Glycerin suppositories can be used for stat removal in constipation

82
Q

Pediatric Conditions

Ibuprofen dosing for pain/fever

A

5-10 mg/kg/dose Q 6-8H

83
Q

Pediatric Conditions

Acetaminophen dosing for pain/fever

A

10-15 mg/kg/dose Q 4-6H

84
Q

Drug Use in Pregnancy & Lactation

What is the first line for smoking cessation in pregnant patients?

A

Behavioral intervention

85
Q

Drug Use in Pregnancy & Lactation

Women of childbearing age should consume adequate:

A
  1. Folic acid: 400-800 mcg/day
  2. Calcium: 1000 mg/day
  3. Vitamin D: 600 IU/day
86
Q

Drug Use in Pregnancy & Lactation

When should folic acid (folate) be started in pregnancy to prevent neural tube defects?

A

1 month prior to pregnancy & continued for at least 2-3 months

87
Q

Drug Use in Pregnancy & Lactation

Vaccine Recommended

A
  1. Inactivated flu vaccine
  2. Tdap between 27-36 weeks of EACH pregnancy

NO live vaccines (MMR, Varicella, Nasal flu)

88
Q

Drug Use in Pregnancy & Lactation

Important pregnancy classes

A
  1. C: studies in humans and animals are not available
  2. D: positive evidence of fetal risk, but benefit may outweigh risks
  3. X: contraindicated in pregnancy
89
Q

Drug Use in Pregnancy & Lactation

Common teratogens

A

Alcohol, ACEIs/ARBs, BZDs, Lithium, Ergots, MTX, NSAIDs, etc

90
Q

Drug Use in Pregnancy & Lactation

Treatment recommendations for morning sickness

A

Pyridoxine (vitamin B6) or ginger

91
Q

Drug Use in Pregnancy & Lactation

Treatment recommendations for GERD

A

Tums (calcium carbonate)

92
Q

Drug Use in Pregnancy & Lactation

Treatment recommendations for Flatulence

A

Simethicone

93
Q

Drug Use in Pregnancy & Lactation

Treatment recommendations for Constipation

A

Fiber (psyllium)

94
Q

Drug Use in Pregnancy & Lactation

Treatment recommendations for Cough, Cough, or Allergies

A

1st generation antihistamines (chlorpheniramine), Cromolyn

Zyrtec & Claritin can be used in 2nd or 3rd trimesters

95
Q

Drug Use in Pregnancy & Lactation

Treatment recommendations for Pain

A

APAP

96
Q

Drug Use in Pregnancy & Lactation

Treatment recommendations for Infections

A

PCNs, cephs, erythromycin & azithromycin

97
Q

Drug Use in Pregnancy & Lactation

Treatment recommendations for asthma

A

budesonide (maintenance) PLUS albuterol (rescue)

98
Q

Drug Use in Pregnancy & Lactation

Treatment recommendations for VTE

A

LMWH

99
Q

Drug Use in Pregnancy & Lactation

Treatment recommendations for Hypothyroidism

A

Levothyroxine

100
Q

Drug Use in Pregnancy & Lactation

Treatment recommendations for Hyperthyroidism

A

1st trimester: Propylthiouracil

2nd & 3rd trimesters: Methimazole

101
Q

Drug Use in Pregnancy & Lactation

Treatment recommendations for Diabetes

A

Insulin & metformin

102
Q

Drug Use in Pregnancy & Lactation

Pregnant patients with bacteriuria, even when asymptomatic with negative urinalysis

A

should be TREATED anyways

NAPLEX 2022 (25 decks)

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