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NAPLEX 2022 > Drug Ref, IV Drug Compatibility & Degradation, Lab Values & Drug Monitoring, Toxicology & Antidotes, Crit. Care, Pharmacogenomics, Allergic Rhinitis, Cough & Cold, & Emergency Preparedness > Flashcards

Drug Ref, IV Drug Compatibility & Degradation, Lab Values & Drug Monitoring, Toxicology & Antidotes, Crit. Care, Pharmacogenomics, Allergic Rhinitis, Cough & Cold, & Emergency Preparedness Flashcards

1
Q

Drug References

Which book have dosage forms, strengths, package size & availability?

A

Red Book

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2
Q

Drug References

Which book talk about immunizations?

A

Pink Book

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3
Q

Drug References

Which book talk about CDC’s guide for international travelers?

A

Yellow Book

Yellow for Sun (plane flies in sky)

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4
Q

Drug References

Which book talk about biological products?

A

Purple Book

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5
Q

Drug References

Which book talk about therapeutic equivalence?

A

Orange Book

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6
Q

Drug References

What book talk about pediatrics?

A

Harriet Lane Handbook

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7
Q

Drug References

What book talk about pregnancy & lactation guide?

A

Briggs

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8
Q

What resource is good to look up IV compatibility, stability & compounding?

A

Trissel’s

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9
Q

Drug References

Where do you report drug ADRs?

A

FAERS

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10
Q

Drug References

Where do you report vaccines ADRs?

A

VAERS

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11
Q

Drug References

What resource is good to look up drug shortages, recalls & NDC directory?

A

FDA

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12
Q

IV Drug Compatibility & Degradation

Common drugs that leach into PVC bags:

A

Etoposide
Paclitaxel
Docetaxel

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13
Q

IV Drug Compatibility & Degradation

Common drugs that cause sorption

A

Nitroglycerin
Amiodarone
Insulin
Lorazepam

N.A.I.L.

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14
Q

IV Drug Compatibility & Degradation

Drugs that can ONLY be mixed with dextrose

A

Amphotericin B
Quin/Dalfo (Synercid)
Bactrim

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15
Q

IV Drug Compatibility & Degradation

Drugs that can ONLY be mixed with saline

A 
Unasyn
Phenytoin
Ampicillin
Remicade
Daptomycin

U. PARD

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16
Q

IV Drug Compatibility & Degradation

Common causes of IV interaction or degradation risk

A

Extended infusion times
Heat
Light

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17
Q

IV Drug Compatibility & Degradation

Drugs that are incompatible with PVC can be put in what?

A

Glass or polyolefin bags instead

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18
Q

IV Drug Compatibility & Degradation

Most drugs use what size micron filters? Except lipids, what size?

A

Majority 0.22 micron filter

Lipids - 1.2 micron filter

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19
Q

IV Drug Compatibility & Degradation

Discoloration typically indicates what?

A

Oxidation or other form of decomposition of the drug

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20
Q

Emergency Preparedness, Toxicology & Antidotes

OTC drugs that require child-resistant containers are:

A 
Iron
Diphenhydramine
APAP
NSAIDs
Afrin
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21
Q

Emergency Preparedness, Toxicology & Antidotes

Activated Charcoal

A

Dosed: 1g/kg
Indication: remove toxic amounts of a substance & is not effective if used within one hour of ingestion

don’t use the kind with sorbitol, bc it can induce vomiting & cause electrolyte imbalance

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22
Q

Emergency Preparedness, Toxicology & Antidotes

What is APAP’s antidote?

A

N-acetylcysteine (NAC)

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23
Q

Emergency Preparedness, Toxicology & Antidotes

What is BZD’s antidote?

A

Flumazenil

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24
Q

Emergency Preparedness, Toxicology & Antidotes

Digoxin antidote?

A

DigiFab

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25
Q

Emergency Preparedness, Toxicology & Antidotes

Isoniazid antidote?

A

Pyridoxine (vit B6)

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26
Q

Emergency Preparedness, Toxicology & Antidotes

Protamine is the antidote to what?

A

Heparin & LMWH

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27
Q

Emergency Preparedness, Toxicology & Antidotes

Deferoxamine (Desferal) is the antidote to what drug?

A

Iron

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28
Q

Emergency Preparedness, Toxicology & Antidotes

Vitamin K is the antidote to what drug?

A

Warfarin

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29
Q

Emergency Preparedness, Toxicology & Antidotes

Naloxone is the antidote to what class?

A

Opioids

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30
Q

Emergency Preparedness, Toxicology & Antidotes

In acetaminophen toxicity what is used to determine treatment?

A

APAP serum levels

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31
Q

Critical Care & Fluids/Electrolytes

Shock is characterized by

A

Hypotension & Hypoperfusion

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32
Q

Critical Care & Fluids/Electrolytes

What is the general treatment for shock?

A
  1. 30 mL/kg crystalloid fluid (NS or D5)
  2. Peripheral vasoconstrictor
  3. Beta-1 agonist to increase CO (Dobutamine or Epinephrine)
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33
Q

Critical Care & Fluids/Electrolytes

Hypovolemic Shock for Non-hemorrhagic

A

Crystalloid fluids 30 mL/kg

if pt is unresponsive then use vasopressor but ONLY if intravascular volume is adequate

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34
Q

Critical Care & Fluids/Electrolytes

Hypovolemic Shock for Hemorrhagic

A

Blood products (packed RBCs or fresh frozen plasma)

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35
Q

Critical Care & Fluids/Electrolytes

What type of fluids pass freely through membranes & travels into extravascular spaces (tissues)

A

Crystalloids (NS or D5)

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36
Q

Critical Care & Fluids/Electrolytes

What type of fluids are large molecules that remain in the vasculature to increase oncotic pressure?

A

Colloids (Albumin)

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37
Q

Critical Care & Fluids/Electrolytes

Sepsis bundle

A
  1. Broad spectrum antibiotics
  2. Crystalloids 30 mL/kg
  3. Vasopressors to maintain MAP > 65 mmHg (NE is vasopressor of choice)
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38
Q

Critical Care & Fluids/Electrolytes

Name the vasopressors

A

NE
Epi
Phenylephrine
Dopamine

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39
Q

Critical Care & Fluids/Electrolytes

All vasopressors are vesicants and can cause extravasation, which is a medical emergency causing severe tissue damage. What is used to treat the vasopressor extravasation?

A

Phentolamine

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40
Q

Critical Care & Fluids/Electrolytes

What is the strength of epinephrine for IV and IM use?

A

IV use: 0.1 mg/mL

IM use: 1 mg/mL

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41
Q

Critical Care & Fluids/Electrolytes

IV fluid resistant hypotension that requires vasopressors to maintain BP is called?

A

Septic shock

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42
Q

Critical Care & Fluids/Electrolytes

What are other names for vasopressin?

A

Antidiuretic hormone (ADH) & arginine vasopressin (AVP)

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43
Q

Critical Care & Fluids/Electrolytes

What are the 4 types of shock?

A
  1. Hypovolemic (hemorrhagic)
  2. Distributive (septic)
  3. Cardiogenic (Post-MI)
  4. Obstructive (PE)
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44
Q

Critical Care & Fluids/Electrolytes

In ADHF, beta blockers should ONLY be stopped when?

A

if hypotension or hypoperfusion is present (so if pt is in shock)

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45
Q

Critical Care & Fluids/Electrolytes

Congestion from ADHF is initially treated with what?

A

Loop diuretics

IV vasodilators (NTG, Nitroprusside, or nesiritide)

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46
Q

Critical Care & Fluids/Electrolytes

Nitroglycerin - When to use? MOA? CI?

A

When to use: when there is an active MI or uncontrolled HTN but limited use to 24-48 hours

MOA: venous vasodilator at low doses & arterial vasodilator at high doses

CI: when SBP <90 mmHg & concurrent use of PDE-5 inhibitors

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47
Q

Critical Care & Fluids/Electrolytes

Nitroprusside - MOA? Monitoring?

A

MOA: mixed venous & arterial vasodilator at all doses & has greater effect on BP than NTG

Monitoring: requires continuous BP monitoring bc it causes excessive hypotension

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48
Q

Critical Care & Fluids/Electrolytes

Cardiogenic shock treatment

A

Vasopressors and/or positive inotropes

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49
Q

Critical Care & Fluids/Electrolytes

What is the inotrope of choice in ADHF with SBP <90 mmHg (hypoperfusion)?

A

Dobutamine (medium dose)

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50
Q

Critical Care & Fluids/Electrolytes

Dobutamine MOA

A

beta-1 agonist which increases HR & contraction –> CO

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51
Q

Critical Care & Fluids/Electrolytes

Name the positive inotropes

A

Dopamine
Dobutamine
Milirinone

52
Q

Critical Care & Fluids/Electrolytes

What color does dobutamine turn when oxidized?

A

Pink

53
Q

Critical Care & Fluids/Electrolytes

Milrinone MOA

A

PDE-3 inhibitor which produces inotropic effects PLUS significant vasodilation with decreased effect on HR

54
Q

Critical Care & Fluids/Electrolytes

Which positive inotrope requires dose reduction in renal insufficiency?

A

Milrinone

55
Q

Critical Care & Fluids/Electrolytes

What is first-line for pain in ICU but still need to follow principles of pain management?

A

IV opioids

56
Q

Critical Care & Fluids/Electrolytes

Agitation in ICU is managed with what class(es)?

A

Benzodiazepines: Midazolam or lorazepam

and/or hypnotics: propofol or precedex

57
Q

Critical Care & Fluids/Electrolytes

What class(es) are linked to decrease LOS, improve outcomes & shorten duration of required ventilation?

A

Nonbenzodiazepines/hypnotics

58
Q

Critical Care & Fluids/Electrolytes

What is the ONLY approved sedative for non-intubated patients?

A

Precedex

59
Q

Critical Care & Fluids/Electrolytes

Sedation “vacations” are used how often?

A

Daily

to determine if the patient can be weaned off sedatives

60
Q

Critical Care & Fluids/Electrolytes

Lorazepam can cause what even at low doses?

A

Propylene glycol toxicity (ARF & acidosis)

61
Q

Critical Care & Fluids/Electrolytes

What drug is contraindicated in patients with an egg or soy allergy?

A

Propofol

62
Q

Critical Care & Fluids/Electrolytes

Propofol can cause what?

A

Green urine, hair or nail beds

63
Q

Critical Care & Fluids/Electrolytes

What size micron filter must be used to administer propofol?

A

> 5 micron filter

64
Q

Critical Care & Fluids/Electrolytes

What sedative requires pretreatment with a benzo to decrease incidence of emergence reactions (vivid dreams, delirium, hallucinations)?

A

Ketamine

65
Q

Critical Care & Fluids/Electrolytes

What drug is typically used to treat delirium although there is a little evidence to support its use?

A

Haloperidol

66
Q

Critical Care & Fluids/Electrolytes

What atypical antipsychotic can be used for delirium with less SE of EPS?

A

Quetiapine

67
Q

Critical Care & Fluids/Electrolytes

Sedating a patient with what type of class can decreases the incidence of delirium?

A

Non-benzos

68
Q

Critical Care & Fluids/Electrolytes

What are the 2 main risk factors for development of stress ulcers?

A

Mechanical ventilation & coagulopathy

69
Q

Critical Care & Fluids/Electrolytes

What class(es) are recommended for prevention of stress ulcers?

A

H2RAs & PPIs

70
Q

Critical Care & Fluids/Electrolytes

Side effects of PPIs

A

C. diff, fractures, and nosocomial PNA

71
Q

Critical Care & Fluids/Electrolytes

Prophylaxis should NOT be used when?

A

Patients without risk factors for stress ulcers

72
Q

Critical Care & Fluids/Electrolytes

Common types of anesthetics used

A
  1. Local - lidocaine
  2. Inhaled - desflurane (Suprane) or sevoflurane (Ultane)
  3. Injectable - bupivacaine (Marcaine or Sensorcaine), ropivacaine (Naropin)
73
Q

Critical Care & Fluids/Electrolytes

Uses & effects of anesthetics

A
  1. Local - numbing of area
  2. Regional - block pain
  3. General - loss of consciousness during surgery
74
Q

Critical Care & Fluids/Electrolytes

What class is commonly used with anesthetics to reduce opioid requirements post-surgery?

A

Opioids

75
Q

Critical Care & Fluids/Electrolytes

Inhaled anesthetics can cause what rare condition?

A

Malignant hyperthermia (MH)

76
Q

Critical Care & Fluids/Electrolytes

This drug given IV can be fatal

A

Bupivacaine epidurals

77
Q

Critical Care & Fluids/Electrolytes

This drug can NOT be given by dual routes (IV & topical)

A

Lidocaine

78
Q

Critical Care & Fluids/Electrolytes

Sedatives & Analgesics must be given prior to these agents

A

Neuromuscular Blocking Agents (NMBA)

79
Q

Critical Care & Fluids/Electrolytes

NMBAs require a red sticker that states:

A

“Warning, paralyzing agent”

80
Q

Critical Care & Fluids/Electrolytes

Glycopyrrolate MOA/Brand

A

Brand: Robinul

MOA: anticholinergic agent used to reduce secretions while patients receive an NMBA

81
Q

Critical Care & Fluids/Electrolytes

Types of NMBAs

A
  1. Depolarizing: succinylcholine (Quelicin)

2. Non-depolarizing: rocuronium (Zemuron) & cisatracurium (Nimbex)

82
Q

Critical Care & Fluids/Electrolytes

Succinylcholine MOA

A

Works by binding to ACh receptors causing desensitization

83
Q

Critical Care & Fluids/Electrolytes

IVIG indication, contraindication, SE, dose based on which weight?

A
  1. Indication: given for plasma protein replacement therapy in immune deficient patients who have decreased antibody production
  2. SE: thrombosis, rarely cause acute renal failure (use caution in elderly, renal disease, DM, sepsis)
  3. IBW used to calculate dose
  4. CI: patients with IgA deficiency
84
Q

Critical Care & Fluids/Electrolytes

HYPOvolemic hyponatremia treatment

A
  1. Correct the underlying cause (V/D, blood loss, diuretic use)
  2. Administer saline solutions
85
Q

Critical Care & Fluids/Electrolytes

HYPERvolemic hyponatremia treatment

A

Diuretics & fluid restriction

86
Q

Critical Care & Fluids/Electrolytes

EUvolemic hyponatremia caused by what? treatment?

A
  1. Caused by SIADH

2. Tx: fluid restriction or diuresis

87
Q

Critical Care & Fluids/Electrolytes

Name vasopressin antagonists

A

Conivaptan (Vaprisol)

Tolvaptan (Samsca)

88
Q

Critical Care & Fluids/Electrolytes

Sodium correction CAN NOT EXCEED what?

A

12 mEq/L over 24 hours

cause paralysis, seizures, & death

89
Q

Critical Care & Fluids/Electrolytes

Conivaptan is contraindicated in patients with what allergy?

A

Corn

90
Q

Critical Care & Fluids/Electrolytes

Tolvaptan is contraindicated in patient who are unable to respond to or sense what?

A

Thirst

91
Q

Critical Care & Fluids/Electrolytes

What vasopressin antagonist can NOT be used for > 30 days causes hepatotoxicity?

A

Tolvaptan

92
Q

Critical Care & Fluids/Electrolytes

If serum Mg < 1 mEq/L with seizures/arrhythmia what is recommended?

A

IV magnesium sulfate

replacement should continue for 5 days to fully replace stores

93
Q

Critical Care & Fluids/Electrolytes

What electrolyte is necessary for potassium reuptake?

A

Magnesium

94
Q

Critical Care & Fluids/Electrolytes

IV phosphate is recommended when?

A

PO4 < 1 mg/dL (this is considered severe)

for less severe hypophosphatemia, oral replacement is recommended but can take > week to fully replace

95
Q

Lab Values & Drug Monitoring

Common Therapeutic Range for Digoxin (AF)

A

0.8-2

96
Q

Lab Values & Drug Monitoring

Common Therapeutic Range for Digoxin (HF)

A

0.5-0.9

97
Q

Lab Values & Drug Monitoring

Common Therapeutic Range for Lithium

A

0.6-1.2

98
Q

Lab Values & Drug Monitoring

Common Therapeutic Range for Phenytoin/Fosphenytoin

A

10-20

99
Q

Lab Values & Drug Monitoring

Common Therapeutic Range for Free Phenytoin

A

1-2.5

100
Q

Lab Values & Drug Monitoring

Common Therapeutic Range for Valproic Acid

A

50-100

101
Q

Lab Values & Drug Monitoring

Common Therapeutic Range for Vancomycin

A

10-20

102
Q

Lab Values & Drug Monitoring

Name the cardiac enzymes used to diagnosis MI

A

TnT
TnI
BNP
NT-proBNP

103
Q

Lab Values & Drug Monitoring

Name the cardiac enzymes used to diagnosis heart failure

A

BNP & pro-BNP

**higher BNP = higher likelihood of HF

104
Q

Lab Values & Drug Monitoring

Anti-XA levels should be drawn when?

A

4 hours after LMWH is given

105
Q

Lab Values & Drug Monitoring

Patients with G6PD deficiency can experience what? with what drugs?

A

Hemolytic anemia

Drugs: Probenecid, Quinidine, Nitrofurantoin

106
Q

Pharmacogenomics

Prior to starting Abacavir, what genetic testing is done?

A

HLA-B*5701

**if positive, do NOT use Abacavir*

107
Q

Pharmacogenomics

In order to use Maraviroc (Selzentry) for HIV treatment, what must a patient test positive for?

A

CCR5

108
Q

Pharmacogenomics

A patient must be BCR-ABL positive to be able to use what for treatment of CML?

A

a “nib”

109
Q

Pharmacogenomics

Conversion of codeine to morphine is based on the presence/absence of what polymorphism?

A

CYP2D6

110
Q

Pharmacogenomics

Define Pharmacogenomics

A

Personalized medicine tailored to a patient’s genotype

111
Q

A patient that have a severe skin reaction to carbamazepine is has what gene present?

A

HLA-B*1502

112
Q

Pharmacogenomics

A patient that have a severe skin reaction to carbamazepine is has what gene present?

A

HLA-B*1502

113
Q

Allergic Rhinitis, Cough & Cold

Name the types of intranasal corticosteroids.

A

Budesonide (Rhinocort)
Fluticasone (Flonase)
Triamcinolone (Nasacort)
Mometasone (Nasonex)

114
Q

Allergic Rhinitis, Cough & Cold

What are the 1st line treatment for mild symptoms?

A

Oral antihistamines

  • have little effect on nasal congestion but good for other symptoms
  • 2nd gens are preferred bc less sedation
115
Q

Allergic Rhinitis, Cough & Cold

Name the 1st generation antihistamines

A

Diphenhydramine (Benadryl)

Chlorpheniramine (Chlor-Trimeton)

116
Q

Allergic Rhinitis, Cough & Cold

Name the 2nd generation antihistamines

A 
Cetirizine (Zyrtec)
Levocetirizine (Xyzal)
Loratadine (Claritin)
Desloratadine (Clarinex)
Fexofenadine (Allegra)
117
Q

Allergic Rhinitis, Cough & Cold

Decongestants MOA

A

Alpha adrenergic agonist

*used to decrease nasal congestion by causing vasoconstriction in the nasal cavity

118
Q

Allergic Rhinitis, Cough & Cold

Name decongestants & how they work

A

Phenylephrine (systemic)
Pseudoephedrine (systemic)
Oxymetazoline (local/topical) - limit use to 3 days due to rebound congestion

119
Q

Allergic Rhinitis, Cough & Cold

What is the maximum dose of pseudoephedrine (PSE) allowed?

A

3.6 g per purchase

9 g per month

120
Q

Allergic Rhinitis, Cough & Cold

Name natural products for colds

A

Zinc
Vitamin C (ascorbic acid)
Echinacea

121
Q

Allergic Rhinitis, Cough & Cold

Name a Cough expectorant

A

Guaifenesin (Mucinex or Robotussin)

122
Q

Allergic Rhinitis, Cough & Cold

Name the Cough suppressants

A

Dextromethorphan (Delsym or Dayquil)
Codeine
Benzonatate (Tessalon perles)
Diphenhydramine (Benadryl)

123
Q

Allergic Rhinitis, Cough & Cold

FDA prohibits OTC products for children under what age?

A

2 years of age

124
Q

Allergic Rhinitis, Cough & Cold

AAPE prohibits OTC products for children under what age?

A

6 years of age

125
Q

Allergic Rhinitis, Cough & Cold

Acetaminophen dosing

A

10-15 mg/kg Q4-6H

126
Q

Allergic Rhinitis, Cough & Cold

Ibuprofen dosing

A

5-10 mg/kg Q6-8H

NAPLEX 2022 (25 decks)

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