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adv. pharm DNP > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

macrolide antibiotics used for CAP

A

azithromycin (zpack) and clarithromycin (Biaxin)

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2
Q

serious side effects of macrolide antibiotics

A

QTC prolongations, LFT abnormalities, GI upset

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3
Q

other macrolide abx considerations

A

use with caution in patients with arrhythmias and heart disease. avoid in patients with a history of hepatic jaundice. hold statins during treatment = interact on CYP34A pathway

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4
Q

sinusitis treatment options

A

intranasal corticosteroids, augmentin, clindamycin, cephalosporins, doxycycline, fluoroquinolones

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5
Q

sinusitis tx recs for common drug allergies

A

PCN allergy –> use doxycycline or resp. fluoroquinolone (moxi or levofloxacin) or clindamycin
*do not use augmentin in patients with a cephalosporin allergy

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6
Q

1st gen antihistamines

A

diphenhydramine (Benadryl) and chlorpheniramine (chlor-tabs)

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7
Q

Diphenhydramine considerations (Benadryl)

A

CI: breast-feeding
Caution: asthma, cardiovascular disease, increase intraocular pressure, BPH, and thyroid dysfunction

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8
Q

Chlorpheniramine (chlor-tab) considerations

A

CI: narrow-angle glaucoma, bladder neck obstruction, BPH
Avoid use with newborns!!! Possible association with SIDS
AE: drowsiness, sedation

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9
Q

2nd gen antihistamines

A

do not cross BBB to same extent as 1st gen, less sedating
Fexofenadine (allegra), Loratadine (Claritin), Certrizine (Zyrtec)

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10
Q

Loratadine (Claritin) AE

A

somnolence, Dry mouth, pharyngitis, dizziness

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11
Q

certrizine (zytec) AE

A

viral infection, nausea, HA, drowsiness, dyspepsia

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12
Q

overall antihistamine considerations

A

Caution in elderly d/t confusion, constipation, dizziness, dry mouth, urinary retention, sedation (1st gen) **beers list
2nd gen antihistamines are ineffective for COUGH d/t COLDs

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13
Q

intranasal antihistamines

A

azelastine(astepro), olopatadine

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14
Q

intranasal antihistamine AE

A

Bitter taste, dry mouth, headache, cough, epistaxis, burning

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15
Q

Decongestants for sinusitis

A

sympathomimetic agents that stimulate alpha and beta receptors causing vasoconstriction
Overall CI: narrow-angle glaucoma, severe uncontrolled hypertension, CAD, recent use of MAOI
Overall AE: HTN, ^ HR, palpitations, insomnia, tremors, urinary retention, gi upset, dizziness

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16
Q

treatment for bronchitis

A

antitussives, expectorants, and antibiotics(macrocodes) or antivirals if indicated

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17
Q

antitussives

A

benzonatate (tessalon pearls) or dextromethorphan (delsym)

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18
Q

Community-acquired pneumonia treatment (WITH comorb)

A

Amox/clav + macrolide, cephalosporin + macrolide OR doxycycline. Fluoroquinolone monotherapy

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19
Q

CAP treatment (WITHOUT comorb)

A

Without comorbidities: Amoxicillin OR Doxycycline OR azithromycin OR clarithromycin

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20
Q

tamiflu prescribing considerations for flu treatment

A

Recommended within 48 hours of symptom onset
Can be used for prophylaxis for up to 6 weeks during a community outbreak for high risk persons
Special considerations: dosage adjustment with reduced kidney function

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21
Q

Theophylline adverse events

A

Tachyarrhythmias, restlessness, insomnia, N/V, GERD, seizures
POTENTIAL FOR LIFE-THREATENING CARDIAC ARRHYTHMIAS

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22
Q

indication for use for leukotriene modifiers

A

allergies and asthma
(age specific drugs)

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23
Q

Montelukast (singulair) BBW:

A

serious behavior and mood changes
ages 2+

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24
Q

Zafirlukast (accolte) considerations

A

ages 7+
Metabolized by CYP450
SE: pharyngitis, headache, rhinitis, gastritis
Rare liver failure- monitor LFTs q2-3 months

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25
Q

Zileuton (zyflow) considerations

A

age 12+
Metabolized by CYP450
Monitor LFTs before, monthly for 3 months, then q2-3 months
SE: dyspepsia, abd pain, nausea
Increases theophylline levels and PT/INR levels

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26
Q

Asthma quick relief treatment recommendations

A

8-10 puffs of SABA, may be repeated every 20 minutes fo 1 hour, and then every 3 to 4 hours for the next 24-48 hours or until the patients symptoms are stable
- may need short dose of PO corticosteroid
- if not stable, go to ER

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27
Q

SAMA MOA

A

short-acting muscarinic agonist
relaxes airway smooth muscle - decreased mucous secretions

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28
Q

GOLD group D recommendations

A

-Option 1: daily LABA/LAMA
anora-Ellipta, bevespi, Duaklir, Respimat
-Option 2: Daily ICS/LABA
Advair, Breo, Dulera, and Symbicort
-Option 3: Daily ICS/LABA/LAMA, (can add) theophylline, phosphodiesterase 4 inhibitor(roflumilast), macrolide abx
TRELEGY

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29
Q

LABAs/LAMAs

A

anora-Ellipta, bevespi, Duaklir, Respimat

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30
Q

ICS/LABA combos

A

Advair, Breo, Dulera, and Symbicort

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31
Q

ICS/LABA/LAMA triple therapy

A

trelegy

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32
Q

LABA name

A

servant diskus (salmeterol)

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33
Q

LABA serious side effects

A

BLACK BOX WARNING: ASTHMA-RELATED DEATH to salmeterol
Serious adverse events for:
thrush, immunosuppression, paradoxical bronchospasm, asthma exacerbation, asthma-related death, laryngospasm, hypersensitivity reaction, anaphylaxis, HTN, Hypotension, angina, cardiac arrest, arrhythmia, hypokalemia, and hyperglycemia.

34
Q

in asthma, LABA must be used with:

A

an inhaled corticosteroid (ICS)

35
Q

Memantine (Namenda) MOA

A

Blocks activation and overstimulation of NMDA receptor during glutamate abundance → inhibits neuronal degeneration that would otherwise result

36
Q

Goals of drug therapy for AD

A

maintain and maximize the patient’s functional ability, quality of life, and independence for as long as possible while minimizing adverse events and cost

37
Q

main drugs for cognitive symptoms of AD

A

Cholinesterase inhibitors and memantine

38
Q

Medications used for non-cognitive symptoms in AD

A

Antipsychotics –> risperdal, zyprexa
Benzodiazepines –> for anxiety, agitation (lorazepam & alprazolam)
SSRI antidepressants –> depression (Zoloft, lexapro)

39
Q

Mild-moderate AD disease tx

A

Cholinesterase inhibitors
Donepezil (exalon), Rivastigmine (razadine), galantamine (aricept)

40
Q

Moderate-severe AD tx

A

NMDA receptor antagonist
memantine (Namenda)

41
Q

Cogentin contraindications

A

narrow-angle glaucoma
(avoid use with KCl, glucagon, anticholinergics)

42
Q

Common meds prescribed for management of PD symptoms

A

Motor symptoms
-anticholinergics (Trihexyphenidyl(artane) or benztropine(cogentin)
-amantadine
-MAO-Bs (selegiline, rasafiline, safinamide)
-Levodopa/carbidopa
-COMTIs (entacopone, tolcapone)
-Dopamine agonists

43
Q

parkinsons meds non-motor symptoms

A

depression - venlafaxine, pramipexole
psychosis = clozapine
dementia = rivastigmine, donepezil
insomnia = rotigotine
+ hypotension meds, drooling preventions, stool softeners

44
Q

MOA of amantadine

A

its inhibition (NMDA) receptors potentiates dopaminergic responses to reduce PD symptoms
binds/blocks NMDA receptors and increases release of dopamine

45
Q

MOA of Levodopa

A

Levodopa is a dopamine precursor, crosses the blood brain barrier and is then converted via decarboxylation to dopamine → stored in presynaptic neurons until stimulated for release

46
Q

Carbemazepine(tegretol) serious side effects

A

Black Box Warning: risk of toxic epidermal necrosis/SJS, aplastic anemia, agranulocytosis
Screen for HLA-B*1502 allele ( Asian pts) → increased risk of derm reactions
Other special considerations: inducer of several CYP pathways, pregnancy category D, can lead to hyponatremia in older adults
“Serious but less common adverse events include blood dyscrasias, syndrome of inappropriate diuretic hormone secretion (SIADH), cardiac conduction abnormalities, SJS, and DRESS”

47
Q

Phenytoin and fosphenytoin adverse effects

A

AE: lateral nystagmus, ataxia, lethargy, acne, increased body hair, arrhythmia, gingival hyperplasia
Bb warning: IV forms for cardiovascular events with rapid infusion
Serious but less common adverse events include blood dyscrasias (anemia, neutropenia, leukopenia, thrombocytopenia), hepatitis, Stevens-Johnson syndrome (SJS), drug reaction with eosinophilia and systemic syndromes (DRESS), and systemic lupus erythematosus (SLE).

48
Q

acute treatment of status epilepticus

A

Benzodiazepines
IV lorazepam (Ativan) 4mg
IV diazepam (valium) 5-10 mg

49
Q

preventative/prophylactic treatment options for cluster headaches

A

Verapamil IR - 40-80mg TID
Lithium 300mg BID
Melatonin 10mg every evening
Warfarin (INR 1.5-1.9)
Galcanezumab (emgality)

50
Q

Preventative/prophylactic treatment for Tension-type headaches

A

1st line: amitryptiline
2nd line: venlafaxine XR or Mirtazapine

51
Q

migraine meds for patients with hypertension/essential tremor

A

Beta-blockers (1st line for migraine prophylaxis)
Propranolol (Inderal)
Metoprolol (Lopressor)
Timolol

52
Q

migraine meds for patients with hypertension (2nd line)

A

CCBs - verapamil

53
Q

Migraine meds for pt with anxiety/depression or post-menopausal hot flashes

A

venlafaxine XR (SNRI)

54
Q

migraine med options for patients with regimen adherence issues

A

Injections! usually monthly - CGRP receptor antagonists - a 2nd line ppx
-amovig, ajovy, emgality, vyepti

55
Q

2nd line treatment for migraines

A

Triptans (suma, zolmi, riza, ele, frova)
Ditans (Lasmiditan - reyvow)
CGRP receptor antagonist (ubrelvy, nurtec)
Ergot derivatives (ergomar, migranal, cafergot)
Barbiturates (fioricet, forinal)
opioids (tramadol, butorphanol)
decadron
antiemetics

56
Q

Contraindications to triptan therapy

A
  • not indicated for use in children <12
  • not okay in pregnancy
  • avoid in patients with CAD, cerebrovascular disease, severe PVD; basilar, hemiplegic or retinal migraines
  • not used more than 9 days per month
57
Q

Medication overuse headache treatment

A

withhold all OTC analgesics for 2 weeks - should go away

58
Q

diagnosis of medication overuse headache

A

when using OTC analgesic for either migraine or TTH headache more than 2x per week, and it causes a chronic daily headache

59
Q

important education regarding bisphosphonate therapy

A

-AM dosing on empty stomach
-must be taken whole with 8oz of water - stay upright for 30 min-1hr
-omit in patients with GERD
-monitor with DEXA scans; consider drug holiday if scans are good

60
Q

acute gout treatment recs

A

1st line:
-Colchicine + NSAID
- Oral corticosteroid + Colchicine
-intraarticular steroid + NSAID
NSAIDS
Systemic corticosteroids

61
Q

rheumatoid arthritis bridging treatment

A

NSAIDS or corticosteroids in an acute episode until DMARDS are therapeutic
ex. glucocorticoids (prednisone)

62
Q

DMARD name for RA tx

A

methotrexate

63
Q

treatment of fibromyalgia

A

SNRIs (Duloxetine, milnacipran, venlafaxine)
SSRIs (prozac, Zoloft, lexapro)
tricyclics
CBT, exercise

64
Q

Psoriasis treatment considerations with Coal tar

A

MOA: depresses DNA synthesis with anitinflammatory & antipruritic properties
Used for 30-45 days, 3-7x per week
Cons: odor, staining, photosensitivity (wear sunscreen), folliculitis

65
Q

Herpes zoster (shingles) treatment options

A

Acyclovir, famciclovir(highest bioavailability), valacyclovir

66
Q

contraindications to Terbinafine/lamisil for toenail fungus (tinea unguium)

A

AE: elevation in AST/ALTs, diarrhea, dyspepsia, rash, HA
Check LFTs before initiation and 6-8 weeks after initiation
CI: in chronic liver disease and those with CrCl<50

67
Q

Role of contraceptives in acne treatment

A

Oral contraceptives that contain ethinyl estradiol, levonorgestrel, and norgestimate or drospirenone. Effective due to a decrease in testosterone production.

68
Q

Impetigo treatment 1st line

A

Topical mupirocin ointment TID 7-10 days
Plus oral abx 7-10 days
Broad spectrum penicillin (augmentin or dicloxacillin) OR
1st gen cephalosporin (keflex)
—If PCN allergy - use clindamycin

69
Q

Considerations for prescribing clotrimazole/lotrim cream for cutaneous candidiasis

A

Contraindications: pregnancy/lactation (HF risk)
Continue 1 week after infection clears
Common side effects: pruritis, irritation, stinging

70
Q

Considerations for prescribing systemic corticosteroids for contact dermatitis

A

contraindicated in patients with systemic mycoses and in patients receiving a vaccination
These drugs also should be used cautiously in people with tuberculosis, hypothyroidism, cirrhosis, renal insufficiency, hypertension, osteoporosis, and diabetes mellitus

Prescribed as a tapering dose
Take in the morning to minimize insomnia
- prescribed when dermatitis is widespread or resistant to topical preparations

71
Q

treatment of dermatitis on the face and intertriginous areas

A

use low potency steroids on the thin skin
ex. Hydrocortisone 1%, Alcovate or Synalar cream
+ pimecrolimus (elidel)

72
Q

Accutane Prescribing considerations

A

Teratogenic - must register users in SMART system - 2 forms of birth control
only 30 days prescribed at a time
check labs before initiating, can elevate triglycerides
AE: dry mucous membranes, musculoskeletal aches
BB warning: increased SI and aggressive behaviors

73
Q

1st line treatment for acne

A

-retinoic acid (tretinoin, Retin-A)
-Adapalene gel (Differin)
-Tazarotene gel (tazorac)
or benzoyl peroxide, azelex, clindamycin, erythromycin

74
Q

superficial MRSA infection treatment

A

Mupirocin (Bactroban) in nostrils/superficial wounds
Trimethoprim-sulfamethoxazole (Bactrim), minocycline, clindamycin, or linezolid

75
Q

Systemic MRSA tx

A

Vancomycin, Daptomycin, Telavancin, Dalbavancin, Oritavancin, Linezolid, Tedizolid, and Tigecycline

76
Q

topical preparation absorption rates

A

Creams: most desirable, least effective
ointments/gels: most potent/lubricating
lotions/sprays: good for widespread areas and scalp

77
Q

Rosacea first-line treatment recommendations

A

topical therapy
-Metronidazole
-Sodium Sulfacetamide
-Azelaic Acid BID

78
Q

Rosacea 2nd line treatment

A

adding an oral antibiotic to the topical therapy, after 2 weeks starting to tape back down to just topical tx
(tetracycline, doxycycline, erythromycin, bactrim)

79
Q

Dopamine agonists

A

pramipexole (mirapex), Ropinirole (requip), Rotigotine (neupro), Apomorphine (apokyn)

80
Q

COMTIs

A

entacopone (Comtan), tocapone (tasmar)

81
Q

MAOBs

A

selegiline (Eldepryl), Rasagiline (azilect), Safinamide (xadago)

adv. pharm DNP (1 decks)

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