drugs 2

Question 1

medication for dizziness

Answer 1

meclizine

Question 2

caveat about lasix dosing

Answer 2

Don’t dose BID, because you will activate RAAS system

Question 3

bumex generic name

Answer 3

bumetanide

Question 4

unasyn

Answer 4

ampicillin/sulbactam

Question 5

cresemba

Answer 5

prodrug for isavuconazole which is a triazole antifungal agent

Question 6

kytril

Answer 6

granisetron (antiemetic)

Question 7

how to taper steroids

Answer 7

• no real evidence-based way, some people alternate every other day

Question 8

potency ratio of lassix from oral to IV

Answer 8

IV 2:1 more potent

Question 9

mscontin

Answer 9

long acting morphine

Question 10

suboxone vs. methadone for opioid detox

Answer 10

• methadone = full agonist, so 100% activity (can start even if narcotics in system, long acting, potential for OD (takes a while to clear))
• suboxone = partial agonist (40% activity), (will displace oxy on mu receptors, so can precipitate withdrawal). So need to have all opioids out of system. Has enough activity at receptor to not get high, but gives you enough activity. So need to be very clear on it, off of it, in withdrawal, and need to be stable and come to all apts.

Question 11

suboxone components

Answer 11

buprenorphrine + naloxone

Question 12

norco

Answer 12

hydrocodone + acetaminophen

Question 13

percocet

Answer 13

oxycodone + acetaminophen

Question 14

MAT

Answer 14

medication-assisted treatment (suboxone/methadone, etc)

Question 15

essential components of opioid prescribing

Answer 15

always use PDMP
always use stepwise approach:
non-pharmacologic therapies → non-opioids → short course of opioids
dosing: go low and slow
CDC: for acute pain prescribe 3-7 day course
Use immediate-acting rather than long-acting formulations.
Avoid prescribing greater than 90 morphine milligram equivalents (threshold that’s thought to significantly increase OD’ing risk)

Question 16

Bisphosphonates

Answer 16

drugs that prevent the loss of bone density, used to treat osteoporosis and similar diseases.

Question 17

how to manage nitroglycerin and cialis interaction

Answer 17

Don’t take one or the other for 4 hours feedback/oversight system.

Question 18

carbamazepine trade name

Answer 18

tegretol/carbatrol

Question 19

lacosamide trade name

Answer 19

vimpat

Question 20

long acting morphine is…

Answer 20

mscontin

Question 21

management of patient who’s been exposed to rabies and is re-exposed

Answer 21

booster course of rabies vaccine (2 doses)

Question 22

management of unvaccinated patient who’s been exposed to rabies

Answer 22

immune globulin and a full vaccination series (4 doses).

Question 23

dysentery workup

Answer 23

stool culture, immunoassay for Shiga toxin, and fecal leukocyte count.

Question 24

dysentery management

Answer 24

empiric ABX

fluids

Question 25

NSTEMI/ACIS management

Answer 25

dual antiplatelet therapy, anticoagulation, a beta blocker, and a high-intensity statin.

Question 26

latent TB options

Answer 26

Isoniazid & rifapentine weekly for 3 months under direct observation (not recommended in patients with HIV) Isoniazid monotherapy for 6-9 months Rifampin for 4 months

Question 27

HIT management

Answer 27

Stop heparin → switch to NOAC (argatroban) | Wait until platelet count recovery to > 150,000/µL, then start warfarin

Question 28

sequelae of acromegaly

Answer 28

cardiovascular disease | colon cancer

Question 29

Catheter-related Bloodstream infection management

Answer 29

vancomycin plus cefepime (or gentamicin). IF severe sepsis, hemodynamic instability, pus from the catheter site, evidence of metastatic infection, or symptoms that do not improve within 72 hours of antibiotic administration → remove catheter

Question 30

ecthyma gangrenosum presentation + clinical features

Answer 30

rapid evolution of >1 skin lesion from an erythematous macule to a pustule or bullae and then into a nonpainful gangrenous ulcer. Fever and systemic signs of illness are common - immunocompromised patients with psuedomonas

Question 31

clostridial myonecrosis presentation

Answer 31

fever, severe muscle pain, and purple-colored bullae

Question 32

pulmonary edema management in heart failure

Answer 32

IV diuresis | If still dyspnic 2/2 pulmonary edema and no response to IV diuretics, consider IV nitroglycerin (assuming pressure good)

Question 33

abx for CF exacerbation

Answer 33

methicillin-resistant S aureus coverage (eg, vancomycin) and 2 drugs active against P aeruginosa (eg, cefepime, amikacin).

Question 34

first step in management of splenic rupture leading to hypovolemic shock

Answer 34

fluids

Question 35

malaria presentation

Answer 35

fevers, headaches, and laboratory findings with thrombocytopenia

Question 36

PCV-13 indication

Answer 36

1) age over 65, then you get PCV-13 + PPSV-23

Question 37

pneumovax indications

Answer 37

PREVNAR ALONE IF 1) chronic heart, lung, liver disease 2) diabetes, smokers, alcoholics

Question 38

sequential prevnar + pnuemovax patients

Answer 38

VERY HIGH RISK | SCD, asplenia, immunocompromised, CKD

Question 39

ACS rule-out section

Answer 39

``` FIRST, assuming suspected and ongoing anginal pain --> ASA 325 NPO at midnight Trop q6h x 3 ECG q6h x 3 Telemetry Check for history of A1C + TSH + HLD Hold BB if hypotensive ```

Question 40

problem with mismanaged scaphoid fractures

Answer 40

can result in avascular necrosis and increase the risk of nonunion.

Question 41

c diff management

Answer 41

start vanc first 125 mg PO q4h first recurrence repeat vanc in prolonged pulse/taper course second recurrence vanc PO followed by rifaximin IF ileus → give vanc rectally IF Fulminant disease (eg, hypotension, ileus, toxic megacolon) → IV metronidazole and high-dose oral vancomycin.

Question 42

STEMI diagnosis

Answer 42

New ST elevation at the J point in >2 anatomically contiguous leads with the following threshold: >1 mm (0.1 mV) in all leads except V2 and V3 >1.5 mm in women, >2 mm in men age >40, and >2.5 mm in men age <40 in leads V2 and V3 New left bundle branch block with clinical presentation consistent with acute coronary syndrome

Question 43

lung cancer screening guidelines

Answer 43

annual low-dose helical CT scan is recommended for patients age 55-80 who have a >30-pack-year smoking history and are current smokers or quit within the last 15 years.

Question 44

sydenham chorea

Answer 44

manifestations of acute rheumatic fever and is the most commonly acquired chorea in children. It is characterized by emotional lability and irregular, rapid jerking movements of the face, hands, and feet.

Question 45

TTP clinical features

Answer 45

Hemolytic anemia (↑ LDH, ↓ haptoglobin) with schistocytes + Thrombocytopenia (↑ bleeding time, normal PT/PTT)

Question 46

vicodin

Answer 46

Hydrocodone/paracetamol

Question 47

Norco

Answer 47

Hydrocodone/paracetamol

Question 48

percocet

Answer 48

oxycodone acetaminophen

Question 49

dilaudid

Answer 49

hydromorphone

Question 50

potency ranking of opioids

Answer 50

dilaudid, oxycodone/hydrocodone, morphine, codeine/tramadol

Question 51

metop tartrate vs succinate

Answer 51

succinate is toprol, long acting

Question 52

extrapulmonary manifestations of sarcoid

Answer 52

skin (eg, erythema nodosum), eyes (eg, uveitis), joints (eg, acute polyarthritis), nervous system (eg, facial nerve palsy), and reticuloendothelial system (eg, hepatomegaly, lymphadenopathy) commonly occur.

Question 53

ruptured ectopic presentation

Answer 53

amenorrhea (missed period), irregular vaginal spotting (embryo can rupture and bleed), acute pelvic pain (can be diffuse since hemoperitoneum occurs), and a positive pregnancy test.

Question 54

stress dose steroid

Answer 54

hydrocortisone

Question 55

what fioricet contains

Answer 55

barbiturate butalbital, the analgesic and antipyretic acetaminophen