Exam 1 - high yield endo, HTN, lipid questions

Question 1

Initial Tx of S Aureus?

Answer 1

Oxacillin or Naficillin

Question 2

Tx of S Aureus if PCN intolerant?

Answer 2

Cefazolin

Question 3

Tx of S Aureus if MRSA or PCN anaphylaxis?

Answer 3

Vando

Question 4

Tx of S Aureus if VRSA?

Answer 4

Dapto

Question 5

Initial tx of Entero Fec?

Answer 5

Amp/PenG + Gent

Question 6

Tx of Entero Fec if bad kidney?

Answer 6

Amp + Ceftriaxone

Question 7

Tx’s of Entero Fec if Gent resist?

Answer 7

1. Amp/PenG + Streptomycin

2. Amp +Ceftriaxone

Question 8

Tx of Entero Fec if resist to PCN or Beta-lactams?

Answer 8

Vanco + Gent

Question 9

Tx’s of Entero Fec if resistant to all and Vanco?

Answer 9

Dapto or Linezolid

Question 10

Initial Tx’s of VGS?

Answer 10

1. PenG x4 weeks

2. PenG + Gent x2 weeks if kidneys good

Question 11

Tx of VGS if PCN rash?

Answer 11

Ceftriaxone + Gent

Question 12

Tx of VGS if PCN anaphylaxis?

Answer 12

Vanco

Question 13

Tx of VGS if PCN bad kidney?

Answer 13

Ceftriaxone longer, hold the Gent.

Question 14

Initial dental prophylaxis?

Answer 14

PO Amox 1h before procedure

Question 15

Two dental prophylaxis if PCN allergy?

Answer 15

Azithromycin or Clarithromycin

Question 16

Final dental prophylaxis?

Answer 16

High dose cephalexin (aka keflex)

Question 17

Three tx for HACEK?

Answer 17

1. Ceftriaxone or
2. Amp or
3. Cipro

Question 18

Definition of HTN in general, age 50+, age 60+, CK, DM?

Answer 18

General: Above 140 or 90
50+: Below 140/90
60+: Below 150/90
CK and DM: Below 140/90

Question 19

Four first lines HTN? Who not to use two in if African American and when to use those two even if AA?

Answer 19

Four: ACE-I, ARB, CCB, Thiazide Diuretics
African Amer: No ACE-I or ARB
Afr Amer w/DM or CKD: Use ACE-I or ARB ok

Question 20

Three Thiazides, MOAs, direction of electrolytes, names, precautions, and best for?

Answer 20

1. Thiadize: Distal tubule prevent Na+ in; K and Na down; Ca, GLU, Uric Acid up; CrCl above 30; Metolazone, HCZT, Chlorthiadone; sun burn, not in severe kidney dz; HTN
2. Loop Diuretic: Loop of Henle; K, Na, Mg, Cl down; Uric Acid up; “-ide”; Cr 10+, Sulfa, nephrotoxic; CHF, Edema, HTN
3. K Sparing Drugs: distal tubule w or w/o block aldosterone; Na down, K up, Spironolactone, Eplerenone; gynecomastia, irreg menstural; balance K

Question 21

ACE-I name, MOA, indication, side-effects, ADE?

Answer 21

“-pril”; block AG I to AGII; HTN, CKD; angioedema, SrCr up, cough, not to Arf Amers w/o CKD or DM, no prego, no renal art stenosis; hyperkalemia w/K supplements and K Sparing diur, NSAIDs

Question 22

ARB name, MOA, indication, side-effects, ADE?

Answer 22

“-sartan”; block AG II at receptor site; HTN, CKD; hypotension, hyperkalemia, dizziness, caution in renal art stenosis; K supplements, K Sparing, NSAIDS

Question 23

CCB name, MOA, indication, side-effects, ADE?

Answer 23

DI: “-ipine”; block Ca influx to vascular smooth musc; HTN, CHF; peripheral edema, reflex tach, flushing, HA, Clevedipine soy+egg allergy
Non-DI: “none”; block Ca influx to cardiac smooth musc; HTN, AFib, SVT, Verapamil (migraine); not for HF, bradycardia, heart block

Question 24

ß-blocker names,classes, MOA, indication, side-effects, ADE?

Answer 24

Cardioselective: Block ß1 reduce epi and norepi chrono- and inotropy; AMEBBA; HF, post-MI, high CAD, CKD; ß-blocker blues, sex dysfunct, rebound HTN if sudden d/c, mask hypogly
Non-specific ß: Block ß1 + ß2; N.P.T.; not for COPD/Asthma!
Mixed alpha + ß: Carv + Lab
ISA: CAPP; rarely used
Propanolol for migraine and hyperthyroid. Severe PAD, Severe Acute HF=NO!

Question 25

Alpha receptor classes, name, MOA, indications, ADE

Answer 25

Alpha-1 blocker: Inhibitor alpha-1 receptor in periphery causing vasodilation; “-zosin”; only add-on for HTN, BPH in men; first-dose-effect, dizzy, vertigo, reflex tachy (not if on ß-blocker), fatigue, vivid dreams, depression, drymouth. Titrate up slowly.
Alpha-2 agonist: Stimulates alpha-2 receptors in brain reducing sympathetic outflow to lower BP and peripheral vasc resist; methyldope, clonidine; M.D. (good for prego), C.D. (resistant HTN, sub abuse, pain mgt, ADHD); ortho hypo, dizzy, fatigue, depressed, sedated, Na/H2O retention, rebount HTN and tachy if sudden d/c, M.D. (liver toxic, hemolytic anemia), C.D. (rash w/patch, anticholinergic-like effects/drymouth)

Question 26

Vasodilator names, MOA, indications, ADE

Answer 26

Hydralizine, Minoxidil. Direct vasodilation in arteries and arterioles causing reduced systemic vascular resistance, Peripheral vasodilation. No indications. Reflex tachy (use ß-bocker) increased Renin causing fluid retention (use diuretic), HA, Hydralizine (Lupus-like syndrome, dermatitis, drug-fever, peripheral neuropathy, hepatitis), Minoxidil (Hirsutism)

Question 27

What are two preferred HTN combos and three acceptable HTN combos?

Answer 27

Preferred: Acceptable:

1. ACE-I/ARB + Thiazide 1. Thiazide + CCB
2. ACE-I/ARB + Dihydro CCB. 2. Thiazide + K Sparing Diuretic
   3. ß-blocker + Diuretic or Dihydro CCB

Question 28

Omega 3 FA and Chol Absorb Inhib MOA, indication, pathway, excretion, name, ADE

Answer 28

Omega 3: Unk MOA, TG 500+ 2nd line, unk path, unk excretion, Lovaza/Fish Oil/Fatty Fish; fishy burbs, indigestion, altered taste
Chol Abs Inhib: Block biliary and dietary chol from GI; glucoronidation active metabolite, Ezetimibe, combo w/moderate statin (Vytorin), diarrhea, MSK, sinusitis

Question 29

Fibrates and Nicotinic Acid MOA, indication, pathway, excretion, name, ADE

Answer 29

Fibrates: Activated PPAR-alpha increasing metabolism and catabolism of lipids, TG 500+ 2nd line, hepatic metabolism, renal excretion, Gemfibrozil/Fenofibrte; ABD pain, nausea, up SrCr, up Transaminases, myopathy
Nicotinic Acid: Lower TG synthesis (unk in adipose), TG 500+, hepatic conjugation, renal excretion, Niacin/Niacinamide/Nicotinic Acid; flushing (ASA 325mg 15min prior), N/V, inc Transaminases, myopathy

Question 30

Bile Acid Sequestrants MOA, indication, pathway, excretion, name, ADE

Answer 30

Anion exchange resins bind to bile acid, inc TG, not absorbed or metabolized, Cholestyramin/Colestipol/Colesevelam; FLATULANCE (biggest), abd pain, constipation, N/V, inhibit vit absorption (take 1-2h before or 4-6h after other meds)

Question 31

Statin MOA, indication, pathway, excretion, name, ADE

Answer 31

Inhbit HMG-CoA Reductase rate-limiting step to Mevalonate, “-statin”, first line; dizzy, HA, Abd Pain, N/V, inc Transaminase, myopathy