Exam 1 Flashcards by Caroline Miller

List examples of nucleotide reverse transcriptase inhibitors

Tenofovir is the only one

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List examples of non-nucleoside reverse transcriptase inhibitors

Nevirapine

Efavirenz

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List examples of protease inhibitors

Lopinavir, Ritonavir (Kaletra combo) 
Tipranavir
Darunavir (with COBI)
Atazanavir (with COBI)
(Looks really do alter tips)

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Which of the HIV drugs are the newest and cleanest?

Integrase inhibitors (raltegavir, dolutegravir)

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Which HIV drug is injectable, and which class does it belong to?

Enfuveritide- receptor antagonist inhibitor (CD4 receptor blocker)

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Which receptor antagonist inhibitor is rarely used, and why?

Maraviroc (an R5 receptor blocker) is used as a last ditch effort due to potential for X4 selection)

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What is boosting? list examples of boosters

Boosting is adding a drug with CP450 inhibition to allow fewer doses per day
Examples include Cobicistat and Ritonavir

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Which booster is safer and why?

Cobicistat is safer because Ritonavir (a protease inhibitor) may contribute to resistance

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What is TAF?

Son of Tenofivir (the only nucleotide reverse transcriptase inhibitor) that accumulates intracellularly, is more potent, and has fewer adverse affects (no nephrotoxicity)

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List examples of nucleoside reverse transcriptase inhibitors

Zidovudine (AZT)
Lamivudine 
Emtricitabine
Abacavir
Truvada (2 in combo)

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Which three HIV drugs also cover Hep B?

Lamivudine
Emtricitabine
Tenofovir (and TAF)

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Which HIV drug cross interacts with antacids?

Atazanavir (with COBI)-a protease inhibitor- loves acid (avoid tums, PPIs, H2RAs)

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Which class of HIV drugs often make good CP450s? Name a common side effect

Protease inhibitors, but they often cause metabolic disorders (increased lipid levels)

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What is the drug of choice for PREP?

Truvada (an NRTI)

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Which HIV drug should be avoided in patients with mental health issues?

Efavirenz (an NNRTI) causes nightmares

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Which HIV drug is often associated with rash?

Nevirapine (an NNRTI)

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Name the two nucleoside reverse transcriptase inhibitors that are essentially the same drug with different dosing

Lamivudine

Emtricitabine

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Which HIV drug often causes anaphylaxis and may require blood testing to determine sensitivity?

Abacavir

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List examples of receptor antagonist inhibitors

Enfuveritide

Maraviroc

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List examples of Integrase inhibitors

Raltegavir

Dolutegravir

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List examples of STRs

Atripla 
Genvoya
Complera 
Stribild 
Triumeq 
(All good couples stay together)

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Which HIV drug turns patients yellow due to increased bilirubin?

Atazanavir

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Which HIV medication causes nephrotoxicity?

Tenofovir

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Which substances are not bound by charcoal?

Cyanide, organic solvents, alcohols, lithium, minerals, iron (COAL MI..)

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To whom should ipecac never be given?

Children under six months, patients who are seizing or comatose, patients who ingested corrosive substances (Draino) (Relatively contraindicated in severe bradycardia, pregnancy, and hydrocarbon ingestion)

When is use of gastric lavage appropriate?

If carried out within one hour of toxin ingestion | use saline in children to avoid hyponatremia risk

When are cathartics contraindicated?

In ingestion of corrosives

List two cathartics

Magnesium with saline, sorbitol

Name an indication for use of polyethylene glycol

Whole bowel irrigation to purge entire gut of patients presenting late (more than four hours post exposure) or with ingestion per rectum of foreign bodies

When is peritoneal dialysis used?

Used to remove small, unbound, hydrophilic substances (alcohol) Especially in patients with renal failure

List an advantage and a disadvantage of hemofiltration over hemodialysis

Can filter toxins with larger molecular weight, but also removes platelets causing thrombocytopenia

Name the antidote for narcotic overdose

Narcan

Name the antidote for antipsychotic dyskinesia

Diphenhydramine

Name the antidote for iron overdose

Desferroxamine

Name the antidote for heavy-metal overdose

Dimercaprol (BAL)

Name the antidote for acetaminophen overdose

NAC

Name the antidote for insulin and beta blocker overdose

Glucagon

Name antidote for nitrate overdose

Methylene blue

Name the antidote for nerve gas and insecticide overdose

Pralidoxime

Name the antidote for cyanide overdose

Sodium thiosulfate

Name the antidote for ethylene glycol overdose

Ethanol

Name the antidote for benzo overdose

Flumazenil

What is the treatment for carbon monoxide poisoning?

Supplemental high flow 100% oxygen, in hyperbaric chamber if severe

What is the antidote for rhabdomyolysis?

Bicarb

Which neurotransmitter is cocaine most similar to?

Epinephrine

What medication should be used in cocaine induced hypertensive emergency?

Labetalol

Which medication accounts for 36% of drug ingestion deaths?

TCAs

List two drugs that are structurally and chemically related to TCAs

Cyclobenzaprine and carbamazepine

What does the mnemonic TCA stand for?

Tonic clonic seizures, cardiac (tachycardia and conduction disturbances), anti-cholinergic

How can bicarb reduce acute toxicity in TCA poisoning?

Increased plasma protein binding of TCA, and stabilize fast sodium channels

What EKG changes are seen in TCA overdose?

Wide QRS complex

List the classic triad of opioid intoxication

Miosis, respiratory depression, depressed level of consciousness

Describe the dosing of naloxone continuous infusion

Initial hourly dose of two thirds amount needed to reverse respiratory depression

What is the goal of treating beta blocker overdose, and what is the drug of choice?

Goal is to reverse bradycardia and increase inotropy | Glucagon increases inotropy, atropine may be needed to reverse bradycardia

What drug can be given to calm patients who are violent, anxious, psychotic?

Halidol

What is the greatest danger of ingesting hydrocarbons, and what is the treatment?

Greatest danger is toxicity from aspiration and possible pneumonia (give clindamycin) No treatment required

Describe symptoms of a PCP intoxication

Blank stare, facial grimacing, abnormal posturing, regular respiratory pattern, visual hallucinations, self-induced injury

Describe the toxicity of organophosphate (insecticides)

Highly cholinergic (irreversible acetylcholinesterase inhibitor)

List the parasympathetic, nicotinic, and CNS effects of organophosphates

Parasympathetic – SLUDGE Nicotinic – muscle weakness CNS – confusion, slurred speech, respiratory depression

What is 2-PAM?

Pralidoxime – cholinesterase reactivating agent with great effect at nicotinic sites used in organophosphate poisoning

Name the drugs used in lethal injection

Thiopental (barbiturate), paralytic, potassium chloride

When can benzodiazepines become dangerously toxic?

When combined with alcohol or other CNS depressant

What should be used in suspected but not confirmed benzodiazepine overdose?

Activated charcoal (avoid emesis and only use flumazenil in pure benzo overdose)

What is Fomiepizole and when is it used?

4-MP blocks affects of alcohol dehydrogenase without causing inebriation (given in alcohol overdose as ethanol alternative)

Explain the metabolism of ethanol, methanol, and ethylene glycol

Ethanol metabolized into acetaldehyde then to carbon dioxide and water Methanol metabolized into formaldehyde then to formic acid Ethylene glycol metabolized into glycoaldehyde then to glycolic acid and calcium ox crystals First by alcohol dehydrogenase, then by aldehyde dehydrogenase

What intoxication is suggested by presence of calcium oxalate crystals?

Ethylene glycol

What intoxication is suggested by sweet fruity order on the breath?

Isopropyl alcohol, which metabolizes to acetone

What should be administered in ethanol overdose?

Thiamine, glucose, and naloxone

How does NAC work in acetaminophen toxicity?

Replenishes glutathione which converts toxic intermediate into safe metabolite

When do LFTs peak in APAP toxicity?

Hour 72- when health begins to deteriorated

How long after acetaminophen ingestion is NAC effective?

Ideally 12, maybe up to 24 hours

How long after ingestion can acetaminophen levels be checked?

Four hours – then apply Rumack Matthew nomogram

What is Acetadote?

IV NAC administered with D5W

What does constitutes chronic use of steroids?

20 mg of prednisone for 14 days

What is the typical steroid stress dose?

50-100 mg IV of hydrocortisone, (20 mg PO if minor procedure)

What is the steroid of choice in thyroid storm?

Dexamethasone

Which steroid hormone is highly bound to cortisol binding globulin?

Hydrocortisone

List adverse affects of prednisone

Osteopenia, hypokalemia, weight gain, depression and psychosis, hyperglycemia, peptic ulcers (decreased gastric mucus production)

Which vaccines are live?

MMR, intranasal flu, varicella and zoster

How do you tell Demargination versus left shift in steroid use?

Left shift (due to infection) will produce bands

What is the drug of choice for Addison's disease?

Fludrocortisone

Why doesn't Medrol dose pack cause HPA suppression?

Six total days of therapy is too short duration for HPA suppression

Are steroid safe in pregnancy?

Maintain lowest possible doses and avoid fluoridated agents (TFDB)

Name the fluoridated steroids

Triamcinolone, fludrocortisone, dexamethasone, betamethasone