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NU 560 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Names of Macrolide abx used for community acquired pneumonia

A

Azithromycin, Clarithromycin

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2
Q

Serious Side Effects of Macrolides for CAP

A

QTC prolongation, LFT abnormalities, GI upset. Use with caution in pts with arrhythmias or heart disease. Avoid with hx of cholestatic jaundice, hepatic dysfunction w/ prior use

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3
Q

First Line Sinusitis treatment

A

Abx after 7 days of watchful waiting.
Amoxicillin or Augmentin if pt is high risk for amoxicillin resistance

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4
Q

Sinusitis treatment if pt has penicillin or cephalosporin allergy

A

Doxycycline or Fluoroquiniolone: Moxifloxacin or Levofloxacin

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5
Q

Names of antihistamines

A

First gen: Benadryl, Chlorpherniramine
Second gen: Fexofenadine (Allegra), Loratadine (Claritin), Catirizine (Zyrtec)
Intranasal: Azelastine, Olopatadine

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6
Q

Consideration for antihistamines for acute respiratory illness

A

Caution in elderly due to confusion, constipation, dizziness, dry mouth, urinary retention, and sedation. On beers list

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7
Q

Considerations for Benadryl

A

Cause drowsiness/sedation. Contraindicated in breastfeeding. Caution in Asthma, CV disease, increased IOP, BPH, thyroid dysfunction

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8
Q

Considerations for Chlorpheniramine

A

Cause drowsiness/sedation. Contraindicated in breastfeeding. Caution in narrow angle glaucoma, bladder neck obstruction, BPH. AVOID IS NEWBORNS&raquo_space;> SIDS

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9
Q

Consideration for 2nd generation antihistamines

A

Less sedating. Caution in renal and hepatic impairment. Ineffective for cough due to colds. May induce dryness and worsen congestion.

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10
Q

SE of intranasal antihistamines

A

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

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11
Q

Names of decongestants for acute respiratory illness

A

Topical: Oxymetazoline (Afrin), Phenylephrine
Oral: Pseudoephedrine

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12
Q

Contraindications and Adverse event of decongestants

A

CI: Narrow angle glaucoma, severe HTN, CAD, recent MAOI use
AE: HTN, tachycardia, palpitations, insomnia, tremors, urinary retention, gi upset, dizziness

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13
Q

Considerations of Afrin and topical Phenylephrine

A

Use for no more than 2-3 days due to rhinitis medicamentosa - rebound congestion. Nasal sprays can become addictive

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14
Q

Considerations for Pseudoephedrine

A

Dont crush or chew, give at least 2 hours before bedtime

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15
Q

Treatment for acute bronchitis WITH comorbid conditions

A

Antibiotics for hx of COPD, high fever, cough longer than 4-6 days, or 65+ with comorbidities (CAD, DM)

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16
Q

Treatment for acute bronchitis WITHOUT comorbidities

A

Antitussives: Bonzonatate or dextromethorphan for mild cough. Cough meds plus codeine or hydrocodone for severe cough.
Expectorants: Guaifenesin to decrease thick secretions

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17
Q

Treatment for community-acquired pneumonia WITHOUT comorbidities

A

Amoxicillin
Doxycycline
Azithromycin
Clarithromycin

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18
Q

Treatment for community-acquired pneumonia WITH comorbidities

A

Augmentin + macrolide (azithromycin)
Cephalosporin (cefazolin, ceftriaxone) + macrolide OR doxycycline
Fluoroquinolone monotherapy

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19
Q

When to prescribe tamiflu

A

Within 48 hours of symptom onset.
Can be taken for up to 6 weeks during a community outbreak.
Groups at highest risk of flu are Adults older than 65, children <2, and pregnant women.
Dose adjustments with reduced kidney function.
Do not use in ESRD

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20
Q

Theophylline adverse events

A

Tachyarrhythmias, restlessness, insomnia, N/V, GERD, seizures. POTENTIONAL FOR LIFE THREATENING CARDIAC ARRHYTHMIAS.
Theophylline toxicity: sinus tach, vtach, afib, SVT, hypotension, cardiac arrest, tremors, hallucinations, seizures

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21
Q

Names of Leukotriene modifiers

A

Montelukast (Singulair)
Zafirlukast (Accolate)
Zileuton (Zyflo)

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22
Q

Indications for leukotriene modifiers

A

Asthma and allergies

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23
Q

Special consideration for Montelukast

A

Black box warning for serious behavior and mood changes

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24
Q

Special consideration of Zafirlukast

A

Metabolized by CYP 450. Rare liver failure > Monitor LFTs q2-3 months

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25
Q

Special considerations for Zileuton

A

Metabolized by CYP 450. Monitor LFTs before, monthly for 3 months, then q2-3 months.
Increases theophylline levels and warfarin activity. ^INR

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26
Q

Asthma quick relief treatment recommendations

A

SABA (albuterol/levalbuterol) - 8-10 puffs, may be repeated q20min for 1 hour, then q3-4 hours for next 24-48 hours or until symptoms are stable

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27
Q

SABA

A

albuterol/levalbuterol

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28
Q

name of a SAMA

A

Atrovent

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29
Q

SAMA Mechanism of action

A

short acting muscarinic antagonist. Relaxes airway smooth muscle and increases bronchial ciliary activity. Decreases mucous secretions.

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30
Q

GOLD group D treatment recommendations

A

Option 1: Daily LABA/LAMA - Ellipta, Genuair, Respimat
Option 2: Daily ICS/LABA - Advair, Airduo, Breo, Dulera, and Symbicort
Option 3: Daily ICS/LABA/LAMA - Trelegy. Can add theophylline, phosphodiasterase 4 inhibitor, macrolide abx, or ICS/LAMA/LABA?roflumilast

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31
Q

Name of single ingredient LABA

A

Serevent Diskus (salmeterol)

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32
Q

Name of combo LABA/corticosteroid

A

Advair, Dulera, Symbicort

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33
Q

LABA black box warning

A

Asthma related death to salmeterol

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34
Q

Serious side effects of LABA

A

Thrush, immunosuppression, paradoxical bronchospasm, astham exacerbation, asthma-related death, laryngospasm, hypersensitivity reaction, anaphylaxis, HTN, hypotension, angina, cardiac arrest, arrhythmia, hypokalemia, hyperglycemia

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35
Q

Menantine (Namenda) mechanism of action

A

For Alzheimer’s disease. NMDA receptor antagonist. Blocks activation and overstimulation of NMDA receptor during glutamate abundance > inhibits neuronal degeneration that would otherwise result

36
Q

Goals of drug therapy for Alzheimers disease

A

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

37
Q

Meds for Non-cognitive symptoms of Alzheimer’s disease

A

Typical Antipsychotics: Haldol
Atypical Antipsychotics: Risperdal, Zyprexa
Benzodiazepines: Lorazepam, Alprazolam
Antidepressants: SSRIs: Zoloft, Lexapro

38
Q

Treatment for Mild Alzheimers disease

A

Cholinesterase inhibitors: Donepezil (aricept), Rivastigmine (exelon), Galantamine (razadyne)

39
Q

Treatment for Moderate to Severe Alzheimer’s disease

A

NMDA receptor antagonist: Namenda. May be used in conjunction with a cholinesterase inhibitor

40
Q

Cogentin Contraindications

A

Narrow angle glaucoma
Avoid with potassium chloride, use of glucagon, and use of other anticholinergics (ipratropium, tiotropium)

41
Q

Common meds for management of Parkinson’s Disease motor symptoms

A

Anticholinergics: Trihexyphenidyl (Artane), Benztropine (Cogentin)
Amantadine (Symmetrel)
Monoamine Oxidase B inhibitors: Selegiline, Rasagiline
Dopamine Agonists: Mirapex, Requip, Neupro, Apokyn
Carbidopa/levadopa: Sinemet, Parcopa, Rytary
Catechol-O-Methyltransferase Inhibitors: Comtan, Tasmar

42
Q

Common meds for management of Non-motor symptoms of Parkinson’s Disease

A

Depression: Mirapex, Effexor, Elavil, Wellbutrin
Psychosis: Clozaril, Seroquel, Donepezil (Aricept), Rivastigmine (Exelon), Ziprasidone (Geodon)
DO NOT USE zyprexa, risperdal, or abilify
Dementia: Rivastigmine (Exelon), Donepezil (Aricept)
Insomnia: Neupro
Autonomic: Hypotension - Florinef, midodrine, indomethacin, droxidopa
Drooling - Sublingual atropine, glycopyrrolate, botox
Constipation - laxatives and stool softeners

43
Q

Levodopa Mechanism of Action

A

Dopamine precursor. Crosses blood brain barrier and is converted via decarboxylation to dopamine. Stored in presynaptic neurons until stimulated for release. Giving with carbidopa limit the peripheral breakdown of levodopa

44
Q

Amantadine Mechanism of Action

A

Inhibits NMDA receptors- potentiates dopaminergic responses to PD symptoms. Binds to and blocks NMDA receptors and increases the release of dopamine.

45
Q

Carbamazepine (Tegretol) side effects

A

Black Box warning for risk of toxic epidermal necrosis/SJS, aplastic anemia, agranulocytosis.
Black Box warning for risk of serious dermatological reactions in patients with HLA B1502. Asian patients should be screened.

46
Q

Names of Hydantoins

A

Phenytoin and fosphenytoin

47
Q

Hydantoins adverse effects

A

Lateral nystagmus, ataxia, lethargy, acne, increased body hair arrhythmia, gingival hyperplasia. Serious but less common include blood dyscrasias, SJS, hepatitis, DRESS, lupus

48
Q

Acute treatment of status epilepticus

A

Benzos: Depress all levels of CNS. GABA receptor agonists.
Lorazepam and Diazepam. Must be given IV (or rectal gel if out of hospital). Goal is to control seizures within 60 minutes of onset.

49
Q

Initiation of Preventive/Prophylactic treatment for Cluster Headaches

A

Verapamil
Lithium
Melatonin
Warfarin
Galcanezumab (Emgality)

50
Q

Initiation of Preventive/Prophylactic treatment for Tension Type Headaches

A

for more than 2 TTH/week requiring meds, start prophylactic treatment.

51
Q

1st Line prevention for TTH = Gold Standard

A

Amitriptyline (Elavil) - Tricyclic antidepressant
Start low and go slow. Can take 4-8 weeks for full effect

52
Q

Considerations for Amitriptyline

A

Use with caution in patients with hx of CV disease, BPH, glaucoma, urinary retention, DM, drug/alcohol use, elderly.
Black box warning: increased risk of suicidal ideation in patients <24 years old w/ depression/psych disorders

53
Q

2nd Line for TTH prevention

A

Venlafaxine (Effexor XR)
SNRI
Nausea, somnolence, sexual dysfunction, sweating, nervousness.
Use with caution in older adults, multiple drug interactions.

Mirtazapine (Remeron)
Atypical Antidepressant
Somnolence, increased cholesterol, dry mouth, weight gain, constipation.
Use with caution in seizure disorder, hepatic/renal impairment, older adults

54
Q

Initiation of preventive treatment for Migraines w/ consideration of underlying disease First Line

A

Beta Blockers: Propanolol, metoprolol, timolol.
Treats migraine + hypertension and essential tremor

55
Q

preventive treatment for Migraines w/ consideration of underlying disease 2nd Line

A

Calcium Channel Blockers: Verapamil
Treats migraine + hypertension
SNRI: Venlafaxine (Effexor XR)
Treats migraines + anxiety/depression and or postmenopausal hot flashes
CGRP receptor agonists: Umabs (emgality)
Good for daily regimen adherence issues

56
Q

Second Line treatment for acute migraines

A

Triptans: Sumatriptan, Zolmitriptan, Rizatriptan, Eletriptan, Frovatriptan.
Ditans: Lasmiditan
CGRP Receptor Antagonist: Ubrelvy, nurtec
Ergot Derivatives: Ergotamine, Dihydroergotamine, Cafergot
Barbiturates: Fioricet (butalbital/caffeine/acetaminophen), Forinal (btualbital/caffeine/aspirin)
Opioids: Butorphanol, Tramadol, Tylenol + Codeine
Steroids: Dexamethasone
Antiemetics: Prochlorperazine, MEtoclopramide, Droperidol

57
Q

Contraindications to Triptan therapy

A

Not for use in children, esp under 12. STRONGLY contraindicated in pregnancy. Avoid use with CAD, cerebrovascular disease, severe PVD. Avoid in basilar, hemiplegic, retinal migraines. Don’t use within 24 hours of other vasoconstriction drugs (ergotamine, DHE). Not for more than 9 days/per month.
Zomig contra in pts with WPW

58
Q

Diagnosis and treatment of medication overuse headache

A

Treating more than two headaches with and OTC analgesic for either migraine or TTH per week can lead to development of chronic daily headaches.
Treatment is withholding all OTC analgesics for 1-2 weeks.

59
Q

Medications that are Biphosphonates

A

Fosamax PO, Actonel PO daily/weekly, Boniva PO monthy, Reclast IV yearly, Miacalcin (nasal)

60
Q

Education regarding Biphosphonate therapy

A

AM dosing on empty stomach.
Must be taken whole with no other medications and with 8oz water.
Must sit upright for 30min-1hr
Not given to patients with GERD, gastritis, peptic ulcer disease.
DEXA scans, can go on drug holiday for several months up to 2 years if bone density looks good

61
Q

1st Line Acute Gout treatment

A

Colchicine + NSAID
Colchicine + Oral Corticosteroid
Intra-articular Steroid + NSAID or colchicine or oral corticosteroid
-Steroids not preferred for pts with diabetes, heart failure, hypertension
NSAIDS: naproxen, indomethacin, sulindac
Systemic corticosteroids
Colchicine MUST be given within 24-48 hours

62
Q

2nd Line Acute Gout Treatment

A

Switch to an alternative 1st line medication.
Do NOT mix NSAIDs with steroids.

63
Q

Rheumatoid Arthritis bridging treatment

A

NSAIDs or corticosteroids in an acute episode until DMARDs (methotrexate) are therapeutic.
Glucocorticoids used to rapidly suppress inflammation and relieve symptoms.
Can take 3-8 weeks until therapeutic improvement

64
Q

Treatment of Fibromyalgia

A

SNRIs: Duloxetine (cymbalta) , Milnacipran (savella), Venlafaxine (Effexor)
SSRIs: Prozac, Zoloft, Lexapro
TCAs: Amitriptyline, Cyclobenzaprine

65
Q

Psoriasis treatment considerations with coal tar (creosote)

A

Can cause odor staining, photosensitivity, folliculitis.
Use sunscreen.
Comes in ointment, gel, bath preparation, shampoo
Side effects result in poor compliance.

66
Q

When to treat Herpes Zoster (shingles)

A

If rash present <72 hours.
If new lesions still developing.
Patient is older than 50.
Immunocompromised.

67
Q

Medications for Herpes Zoster (shingles)

A

Acyclovir
Famciclovir
Valacyclovir

68
Q

Contraindications to Lamisil for toenail fungus

A

Acute or chronic hepatic disease.
AE: elevation in AST/ALT.
Check LFTs before initiation and 6-8 weeks after

69
Q

1st Line Impetigo treatment

A

7-10 days abx
Augmentin or dicloxacillin.
Or cephalosporin (Cephalexin)

70
Q

Impetigo treatment if penicillin allergy

A

If PCN allergy, use Clindamycin.
If pt suspected of being chronic carrier S. aureus give topical mupirocin ointment to nares

71
Q

Clotrimazole/Lotrimin considerations

A

First line for Cutaneous Candidiasis.
Contraindicated in pregnancy/lactation.
Keep away from the eyes.
Occlusive dressing should NOT be applied over the medicine d/t risk of skin irritation.
Recurrent candidiasis should be tested for HIV and DM

72
Q

When to prescribe systemic corticosteroids for contact dermatitis

A

When dermatitis is widespread or resistant to topical preparations.

73
Q

Considerations for systemic corticosteroids for contact dermatitis

A

Taking for less than 2 weeks could cause rebound dermatitis.
CI: pts with systemic fungal infections and receiving vaccines.
Caution in pts with TB, hypothyroidism, cirrhosis, renal insuff, HTN, osteoporosis, diabetes.
Decreased efficacy if given with barbiturates (barbitals) or rifampin.
Prescribed as a taper. Take in morning.

74
Q

Treatment of dermatitis on face and intertriginous areas

A

use Low potency steroids because skin there is thin layer, will be absorbed faster and have stronger effect.
1% hydrocortisone OTC
Pimecrolimus (elidel)- immunosuppressant

75
Q

Accutane indications

A

Severe nodulocystic acne when other treatments fail

76
Q

Accutane considerations

A

Only can prescribe 30 days at a time.
Female pts of childbearing age should use 2 forms of birth control.
Baseline CBC, chem, fasting lipids. Recheck after 1 month.
Pregnancy should be avoided for 1 month after therapy discontinued.
Should not be given in adolescents not done growing, can cause closure of epiphysis.
Prescribers must register in SMART program.
Black Box: aggressive/violent behavior and or suicidal ideation.

77
Q

1st Line treatment for Acne

A

Topical: Retinoic Acid, Adapalene gel (Differin), tazarotene gel (tazorac)

Topical comedolytics: Tretinoin, benzoyl peroxide, Azelex, Clindamycin, Erythromycin, Tazorac

78
Q

Role of PO contraceptives for acne treatment

A

Decrease testosterone production. Contain ethinyl estradiol, levonorgestral, norgestimate, drospirenone

79
Q

Superficial MRSA treatment

A

Mupirocin (Bactroban) in nostrils and on superficial wounds.
If more serious can use use Vanc, daptomycin, telavancin

80
Q

Systemic MRSA treatment

A

Trimethoprim-sulfamethoxazole (Bactrim)
Minocycline
Clindamycin
Linezolid

81
Q

Most effective topical preparation

A

Ointments - are occlusive, prevent water absorption or evaporation, produce greater local effects than creams

82
Q

Least effective topical preparation

A

Creams - are water soluble, washed off more easily. Preferred for hairy areas

83
Q

Gel topical preparations

A

Most water soluble topical dosage form. Spread easily over large areas

84
Q

Rosacea 1st Line treatment recommendations

A

Topical therapy:
Metronidazole
Sodium Sulfacetamide
Azelaic Acid
Begin 2nd line if no improvement after 6 weeks

85
Q

Rosacea 2nd Line treatment

A

Add oral antibiotic. After 2 weeks, reduce by 50%, then after 6 weeks discontinue and continue topical treatment.
Tetracycine
Doxycycline
Erythromycin
Trimethoprim/Sulfamethoxazole

86
Q

Rosacea 3rd line

A

Oral isotretinoin or refer to dermatologist

NU 560 (2 decks)

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