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
2
Q
Drug References
Which book talk about immunizations?
A
Pink Book
3
Q
Drug References
Which book talk about CDC’s guide for international travelers?
A
Yellow Book
Yellow for Sun (plane flies in sky)
4
Q
Drug References
Which book talk about biological products?
A
Purple Book
5
Q
Drug References
Which book talk about therapeutic equivalence?
A
Orange Book
6
Q
Drug References
What book talk about pediatrics?
A
Harriet Lane Handbook
7
Q
Drug References
What book talk about pregnancy & lactation guide?
A
Briggs
8
Q
What resource is good to look up IV compatibility, stability & compounding?
A
Trissel’s
9
Q
Drug References
Where do you report drug ADRs?
A
FAERS
10
Q
Drug References
Where do you report vaccines ADRs?
A
VAERS
11
Q
Drug References
What resource is good to look up drug shortages, recalls & NDC directory?
A
FDA
12
Q
IV Drug Compatibility & Degradation
Common drugs that leach into PVC bags:
A
Etoposide
Paclitaxel
Docetaxel
13
Q
IV Drug Compatibility & Degradation
Common drugs that cause sorption
A
Nitroglycerin
Amiodarone
Insulin
Lorazepam
N.A.I.L.
14
Q
IV Drug Compatibility & Degradation
Drugs that can ONLY be mixed with dextrose
A
Amphotericin B
Quin/Dalfo (Synercid)
Bactrim
15
Q
IV Drug Compatibility & Degradation
Drugs that can ONLY be mixed with saline
A
Unasyn Phenytoin Ampicillin Remicade Daptomycin
U. PARD
16
Q
IV Drug Compatibility & Degradation
Common causes of IV interaction or degradation risk
A
Extended infusion times
Heat
Light
17
Q
IV Drug Compatibility & Degradation
Drugs that are incompatible with PVC can be put in what?
A
Glass or polyolefin bags instead
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
19
Q
IV Drug Compatibility & Degradation
Discoloration typically indicates what?
A
Oxidation or other form of decomposition of the drug
20
Q
Emergency Preparedness, Toxicology & Antidotes
OTC drugs that require child-resistant containers are:
A
Iron Diphenhydramine APAP NSAIDs Afrin
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
22
Q
Emergency Preparedness, Toxicology & Antidotes
What is APAP’s antidote?
A
N-acetylcysteine (NAC)
23
Q
Emergency Preparedness, Toxicology & Antidotes
What is BZD’s antidote?
A
Flumazenil
24
Q
Emergency Preparedness, Toxicology & Antidotes
Digoxin antidote?
A
DigiFab
25
Emergency Preparedness, Toxicology & Antidotes
Isoniazid antidote?
Pyridoxine (vit B6)
26
Emergency Preparedness, Toxicology & Antidotes
Protamine is the antidote to what?
Heparin & LMWH
27
Emergency Preparedness, Toxicology & Antidotes
Deferoxamine (Desferal) is the antidote to what drug?
Iron
28
Emergency Preparedness, Toxicology & Antidotes
Vitamin K is the antidote to what drug?
Warfarin
29
Emergency Preparedness, Toxicology & Antidotes
Naloxone is the antidote to what class?
Opioids
30
Emergency Preparedness, Toxicology & Antidotes
In acetaminophen toxicity what is used to determine treatment?
APAP serum levels
31
Critical Care & Fluids/Electrolytes
Shock is characterized by
Hypotension & Hypoperfusion
32
Critical Care & Fluids/Electrolytes
What is the general treatment for shock?
1. 30 mL/kg crystalloid fluid (NS or D5)
2. Peripheral vasoconstrictor
3. Beta-1 agonist to increase CO (Dobutamine or Epinephrine)
33
Critical Care & Fluids/Electrolytes
Hypovolemic Shock for Non-hemorrhagic
Crystalloid fluids 30 mL/kg
**if pt is unresponsive then use vasopressor but ONLY if intravascular volume is adequate**
34
Critical Care & Fluids/Electrolytes
Hypovolemic Shock for Hemorrhagic
Blood products (packed RBCs or fresh frozen plasma)
35
Critical Care & Fluids/Electrolytes
What type of fluids pass freely through membranes & travels into extravascular spaces (tissues)
Crystalloids (NS or D5)
36
Critical Care & Fluids/Electrolytes
What type of fluids are large molecules that remain in the vasculature to increase oncotic pressure?
Colloids (Albumin)
37
Critical Care & Fluids/Electrolytes
Sepsis bundle
1. Broad spectrum antibiotics
2. Crystalloids 30 mL/kg
3. Vasopressors to maintain MAP > 65 mmHg (NE is vasopressor of choice)
38
Critical Care & Fluids/Electrolytes
Name the vasopressors
NE
Epi
Phenylephrine
Dopamine
39
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?
Phentolamine
40
Critical Care & Fluids/Electrolytes
What is the strength of epinephrine for IV and IM use?
IV use: 0.1 mg/mL
IM use: 1 mg/mL
41
Critical Care & Fluids/Electrolytes
IV fluid resistant hypotension that requires vasopressors to maintain BP is called?
Septic shock
42
Critical Care & Fluids/Electrolytes
What are other names for vasopressin?
Antidiuretic hormone (ADH) & arginine vasopressin (AVP)
43
Critical Care & Fluids/Electrolytes
What are the 4 types of shock?
1. Hypovolemic (hemorrhagic)
2. Distributive (septic)
3. Cardiogenic (Post-MI)
4. Obstructive (PE)
44
Critical Care & Fluids/Electrolytes
In ADHF, beta blockers should ONLY be stopped when?
if hypotension or hypoperfusion is present (so if pt is in shock)
45
Critical Care & Fluids/Electrolytes
Congestion from ADHF is initially treated with what?
Loop diuretics
IV vasodilators (NTG, Nitroprusside, or nesiritide)
46
Critical Care & Fluids/Electrolytes
Nitroglycerin - When to use? MOA? CI?
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
47
Critical Care & Fluids/Electrolytes
Nitroprusside - MOA? Monitoring?
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
48
Critical Care & Fluids/Electrolytes
Cardiogenic shock treatment
Vasopressors and/or positive inotropes
49
Critical Care & Fluids/Electrolytes
What is the inotrope of choice in ADHF with SBP <90 mmHg (hypoperfusion)?
Dobutamine (medium dose)
50
Critical Care & Fluids/Electrolytes
Dobutamine MOA
beta-1 agonist which increases HR & contraction --> CO
51
Critical Care & Fluids/Electrolytes
Name the positive inotropes
Dopamine
Dobutamine
Milirinone
52
Critical Care & Fluids/Electrolytes
What color does dobutamine turn when oxidized?
Pink
53
Critical Care & Fluids/Electrolytes
Milrinone MOA
PDE-3 inhibitor which produces inotropic effects PLUS significant vasodilation with decreased effect on HR
54
Critical Care & Fluids/Electrolytes
Which positive inotrope requires dose reduction in renal insufficiency?
Milrinone
55
Critical Care & Fluids/Electrolytes
What is first-line for pain in ICU but still need to follow principles of pain management?
IV opioids
56
Critical Care & Fluids/Electrolytes
Agitation in ICU is managed with what class(es)?
Benzodiazepines: Midazolam or lorazepam
and/or hypnotics: propofol or precedex
57
Critical Care & Fluids/Electrolytes
What class(es) are linked to decrease LOS, improve outcomes & shorten duration of required ventilation?
Nonbenzodiazepines/hypnotics
58
Critical Care & Fluids/Electrolytes
What is the ONLY approved sedative for non-intubated patients?
Precedex
59
Critical Care & Fluids/Electrolytes
Sedation "vacations" are used how often?
Daily
to determine if the patient can be weaned off sedatives
60
Critical Care & Fluids/Electrolytes
Lorazepam can cause what even at low doses?
Propylene glycol toxicity (ARF & acidosis)
61
Critical Care & Fluids/Electrolytes
What drug is contraindicated in patients with an egg or soy allergy?
Propofol
62
Critical Care & Fluids/Electrolytes
Propofol can cause what?
Green urine, hair or nail beds
63
Critical Care & Fluids/Electrolytes
What size micron filter must be used to administer propofol?
> 5 micron filter
64
Critical Care & Fluids/Electrolytes
What sedative requires pretreatment with a benzo to decrease incidence of emergence reactions (vivid dreams, delirium, hallucinations)?
Ketamine
65
Critical Care & Fluids/Electrolytes
What drug is typically used to treat delirium although there is a little evidence to support its use?
Haloperidol
66
Critical Care & Fluids/Electrolytes
What atypical antipsychotic can be used for delirium with less SE of EPS?
Quetiapine
67
Critical Care & Fluids/Electrolytes
Sedating a patient with what type of class can decreases the incidence of delirium?
Non-benzos
68
Critical Care & Fluids/Electrolytes
What are the 2 main risk factors for development of stress ulcers?
Mechanical ventilation & coagulopathy
69
Critical Care & Fluids/Electrolytes
What class(es) are recommended for prevention of stress ulcers?
H2RAs & PPIs
70
Critical Care & Fluids/Electrolytes
Side effects of PPIs
C. diff, fractures, and nosocomial PNA
71
Critical Care & Fluids/Electrolytes
Prophylaxis should NOT be used when?
Patients without risk factors for stress ulcers
72
Critical Care & Fluids/Electrolytes
Common types of anesthetics used
1. Local - lidocaine
2. Inhaled - desflurane (Suprane) or sevoflurane (Ultane)
3. Injectable - bupivacaine (Marcaine or Sensorcaine), ropivacaine (Naropin)
73
Critical Care & Fluids/Electrolytes
Uses & effects of anesthetics
1. Local - numbing of area
2. Regional - block pain
3. General - loss of consciousness during surgery
74
Critical Care & Fluids/Electrolytes
What class is commonly used with anesthetics to reduce opioid requirements post-surgery?
Opioids
75
Critical Care & Fluids/Electrolytes
Inhaled anesthetics can cause what rare condition?
Malignant hyperthermia (MH)
76
Critical Care & Fluids/Electrolytes
This drug given IV can be fatal
Bupivacaine epidurals
77
Critical Care & Fluids/Electrolytes
This drug can NOT be given by dual routes (IV & topical)
Lidocaine
78
Critical Care & Fluids/Electrolytes
Sedatives & Analgesics must be given prior to these agents
Neuromuscular Blocking Agents (NMBA)
79
Critical Care & Fluids/Electrolytes
NMBAs require a red sticker that states:
"Warning, paralyzing agent"
80
Critical Care & Fluids/Electrolytes
Glycopyrrolate MOA/Brand
Brand: Robinul
MOA: anticholinergic agent used to reduce secretions while patients receive an NMBA
81
Critical Care & Fluids/Electrolytes
Types of NMBAs
1. Depolarizing: succinylcholine (Quelicin)
| 2. Non-depolarizing: rocuronium (Zemuron) & cisatracurium (Nimbex)
82
Critical Care & Fluids/Electrolytes
Succinylcholine MOA
Works by binding to ACh receptors causing desensitization
83
Critical Care & Fluids/Electrolytes
IVIG indication, contraindication, SE, dose based on which weight?
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
Critical Care & Fluids/Electrolytes
HYPOvolemic hyponatremia treatment
1. Correct the underlying cause (V/D, blood loss, diuretic use)
2. Administer saline solutions
85
Critical Care & Fluids/Electrolytes
HYPERvolemic hyponatremia treatment
Diuretics & fluid restriction
86
Critical Care & Fluids/Electrolytes
EUvolemic hyponatremia caused by what? treatment?
1. Caused by SIADH
| 2. Tx: fluid restriction or diuresis
87
Critical Care & Fluids/Electrolytes
Name vasopressin antagonists
Conivaptan (Vaprisol)
| Tolvaptan (Samsca)
88
Critical Care & Fluids/Electrolytes
Sodium correction CAN NOT EXCEED what?
12 mEq/L over 24 hours
**cause paralysis, seizures, & death**
89
Critical Care & Fluids/Electrolytes
Conivaptan is contraindicated in patients with what allergy?
Corn
90
Critical Care & Fluids/Electrolytes
Tolvaptan is contraindicated in patient who are unable to respond to or sense what?
Thirst
91
Critical Care & Fluids/Electrolytes
What vasopressin antagonist can NOT be used for > 30 days causes hepatotoxicity?
Tolvaptan
92
Critical Care & Fluids/Electrolytes
If serum Mg < 1 mEq/L with seizures/arrhythmia what is recommended?
IV magnesium sulfate
**replacement should continue for 5 days to fully replace stores**
93
Critical Care & Fluids/Electrolytes
What electrolyte is necessary for potassium reuptake?
Magnesium
94
Critical Care & Fluids/Electrolytes
IV phosphate is recommended when?
PO4 < 1 mg/dL (this is considered severe)
**for less severe hypophosphatemia, oral replacement is recommended but can take > week to fully replace**
95
Lab Values & Drug Monitoring
Common Therapeutic Range for Digoxin (AF)
0.8-2
96
Lab Values & Drug Monitoring
Common Therapeutic Range for Digoxin (HF)
0.5-0.9
97
Lab Values & Drug Monitoring
Common Therapeutic Range for Lithium
0.6-1.2
98
Lab Values & Drug Monitoring
Common Therapeutic Range for Phenytoin/Fosphenytoin
10-20
99
Lab Values & Drug Monitoring
Common Therapeutic Range for Free Phenytoin
1-2.5
100
Lab Values & Drug Monitoring
Common Therapeutic Range for Valproic Acid
50-100
101
Lab Values & Drug Monitoring
Common Therapeutic Range for Vancomycin
10-20
102
Lab Values & Drug Monitoring
Name the cardiac enzymes used to diagnosis MI
TnT
TnI
BNP
NT-proBNP
103
Lab Values & Drug Monitoring
Name the cardiac enzymes used to diagnosis heart failure
BNP & pro-BNP
**higher BNP = higher likelihood of HF
104
Lab Values & Drug Monitoring
Anti-XA levels should be drawn when?
4 hours after LMWH is given
105
Lab Values & Drug Monitoring
Patients with G6PD deficiency can experience what? with what drugs?
Hemolytic anemia
Drugs: Probenecid, Quinidine, Nitrofurantoin
106
Pharmacogenomics
Prior to starting Abacavir, what genetic testing is done?
HLA-B*5701
**if positive, do NOT use Abacavir*
107
Pharmacogenomics
In order to use Maraviroc (Selzentry) for HIV treatment, what must a patient test positive for?
CCR5
108
Pharmacogenomics
A patient must be BCR-ABL positive to be able to use what for treatment of CML?
a "nib"
109
Pharmacogenomics
Conversion of codeine to morphine is based on the presence/absence of what polymorphism?
CYP2D6
110
Pharmacogenomics
Define Pharmacogenomics
Personalized medicine tailored to a patient's genotype
111
A patient that have a severe skin reaction to carbamazepine is has what gene present?
HLA-B*1502
112
Pharmacogenomics
A patient that have a severe skin reaction to carbamazepine is has what gene present?
HLA-B*1502
113
Allergic Rhinitis, Cough & Cold
Name the types of intranasal corticosteroids.
Budesonide (Rhinocort)
Fluticasone (Flonase)
Triamcinolone (Nasacort)
Mometasone (Nasonex)
114
Allergic Rhinitis, Cough & Cold
What are the 1st line treatment for mild symptoms?
Oral antihistamines
* have little effect on nasal congestion but good for other symptoms
* 2nd gens are preferred bc less sedation
115
Allergic Rhinitis, Cough & Cold
Name the 1st generation antihistamines
Diphenhydramine (Benadryl)
| Chlorpheniramine (Chlor-Trimeton)
116
Allergic Rhinitis, Cough & Cold
Name the 2nd generation antihistamines
```
Cetirizine (Zyrtec)
Levocetirizine (Xyzal)
Loratadine (Claritin)
Desloratadine (Clarinex)
Fexofenadine (Allegra)
```
117
Allergic Rhinitis, Cough & Cold
Decongestants MOA
Alpha adrenergic agonist
*used to decrease nasal congestion by causing vasoconstriction in the nasal cavity
118
Allergic Rhinitis, Cough & Cold
Name decongestants & how they work
Phenylephrine (systemic)
Pseudoephedrine (systemic)
Oxymetazoline (local/topical) - limit use to 3 days due to rebound congestion
119
Allergic Rhinitis, Cough & Cold
What is the maximum dose of pseudoephedrine (PSE) allowed?
3.6 g per purchase
| 9 g per month
120
Allergic Rhinitis, Cough & Cold
Name natural products for colds
Zinc
Vitamin C (ascorbic acid)
Echinacea
121
Allergic Rhinitis, Cough & Cold
Name a Cough expectorant
Guaifenesin (Mucinex or Robotussin)
122
Allergic Rhinitis, Cough & Cold
Name the Cough suppressants
Dextromethorphan (Delsym or Dayquil)
Codeine
Benzonatate (Tessalon perles)
Diphenhydramine (Benadryl)
123
Allergic Rhinitis, Cough & Cold
FDA prohibits OTC products for children under what age?
2 years of age
124
Allergic Rhinitis, Cough & Cold
AAPE prohibits OTC products for children under what age?
6 years of age
125
Allergic Rhinitis, Cough & Cold
Acetaminophen dosing
10-15 mg/kg Q4-6H
126
Allergic Rhinitis, Cough & Cold
Ibuprofen dosing
5-10 mg/kg Q6-8H
