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Exam II Flashcards

1
Q

what is colchicine used for?

A

acute gout attack

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2
Q

why is colchicine used prophylactically?

A

to reduce the incidence of acute attacks

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3
Q

colchicine is pregnancy category what?

A

C

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4
Q

what are the major ADRs of colchicine?

A

GI

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5
Q

does colchicine need a renal dose adjustment?

A

yes

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6
Q

when should you resume colchicine prophylactically after an acute attack?

A

12 hours after it’s resolved

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7
Q

what does allopurinol do?

A

decreases acid production

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8
Q

what is allopurinol used for?

A

most preventative for gout

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9
Q

allopurinol prevents what?

A

increase in uric acid production

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10
Q

does allopurinol need a renal dose adjustment?

A

yes

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11
Q

which patients is allopurinol best for?

A

pts that over produce uric acid

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12
Q

allopurinol is pregnancy category what?

A

C

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13
Q

what should be monitored when taking allopurinol?

A

LFTs

renal function

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14
Q

is allopurinol safe to use in patients with renal insufficiency?

A

yes

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15
Q

what can both colchicine and allopurinol cause?

A

hepatotoxicity

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16
Q

what does probenecid do?

A

increases urinary excretion of uric acid

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17
Q

what is the drug of choice for gout prevention?

A

probenecid

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18
Q

why is probenecid the drug of choice for gout prevention?

A

pregnancy category B
long duration
safety

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19
Q

when should probenecid be started?

A

after an acute attack resides

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20
Q

does probenecid require a renal dose adjustment?

A

yes

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21
Q

what may indicate overdose in patients taking probenecid?

A

gastric intolerance

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22
Q

what should be monitored in pts taking probenecid?

A

CBC for blood dyscrasisa and bone marrow suppression

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23
Q

pts taking probenecid should be asked about what medication allergy?

A

sulfa

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24
Q

when is sulfinpyrazone used?

A

as a last resort; when allopurinol and probenecid are not tolerated

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25
Q

what ADRs are associated with sulfinpyrazone?

A

GI

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26
Q

sulfinpyrazone is pregnancy category what?

A

D

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27
Q

what should be monitored in pts taking sulfinpyrazone?

A

CBC

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28
Q

sulfinpyrazone has what kind of “effect” that other antigout medications don’t?

A

antithrombotic; can cause platelet dysfunction

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29
Q

when is febuxostat used?

A

for chronic gout w/hyperuricemia

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30
Q

what labs should be checked when taking febuxostat?

A

LFTs at 2 mth and 4 mths

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31
Q

what can febuxostat cause that is a deterring factor?

A

an acute gout attack

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32
Q

what should be given simultaneously with febuxostat?

A

NSAIDs or colchicine for 1st six mths

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33
Q

does febuxostat require a renal dose adjustment?

A

no

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34
Q

febuxostat works best in which patients?

A

pts who overproduce uric acid

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35
Q

febuxostat is pregnancy category what?

A

C

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36
Q

when taking febuxostat, what lifestyle modifications should be made?

A

alkaline diet
adequate hydration
avoid alcohol

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37
Q

which corticosteroids are used for adrenal insufficiency?

A

hydrocortisone
prednisone
cortisone

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38
Q

which corticosteroids are used for inflammation?

A

methylprednisone
dexmethasone
prednisone
tiacinolone

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39
Q

which corticosteroids are used for immune suppression?

A

ALL

prednisone used for short half-life

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40
Q

which corticosteroids are used for RA?

A

low dose prednisone short-term (< 2 yrs)

NSIADs first line

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41
Q

if taking steroids for RA, what other medications should be taken?

A

bisphosphonate

calcium/vit. D

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42
Q

when should steroid doses be given?

A

before 9am

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43
Q

what should the initial dose of a steroid be?

A

depends on the disease

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44
Q

how do you know when the pt is receiving the correct dose of a steroid?

A

adjust or maintain until acceptable response reached

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45
Q

how do you determine maintenance for steroids?

A

taper to lowest dosage that maintains adequate response

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46
Q

when pts d/c a steroid medication, what must they do?

A

tape to prevent adrenal insufficiency crisis

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47
Q

when is tapering steroids not necessary?

A

after short-term use (1-2 weeks)

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48
Q

when taking steroids for chronic disease, how are most pts managed?

A

with alternate day therapy

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49
Q

when are long-acting steroids preferred?

A

when the effect sof high doses must be sustained (increased ICP, organ transplant rejection)

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50
Q

what are the muscle & skin ADRs for steroids?

A 
muscle atrophy
thinning skin
mood face
buffalo hump
truncal obesity
striae
hirsutism
poor healing
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51
Q

what are the skeletal tissue ADRs for steroids?

A

osteoporosis

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52
Q

what are the eye ADRs for steroids?

A

cataracts
glaucoma
occular infections

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53
Q

what are the GI ADRs for steroids?

A

PUD- taken in combo with ASA/NSAIDs can increase risk

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54
Q

what are the cardiovascular ADRs for steroids?

A

HTN

fluid & electrolyte imbalances

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55
Q

what are the CNS ADRs for steroids?

A 
delirium
agitation
insomnia
mood swings
severe depression
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56
Q

what are the endocrine ADRs for steroids?

A

adrenal suppression
withdrawal syndrome (abrupt stop)
affects glucose metabolism

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57
Q

what are the NSAID ADRs?

A

*GI disturbances
acute renal insufficiency
increase bleeding time
fluid retention/peripheral edema

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58
Q

what can indomethacin cause?

A

aggravate depression or other psych disturbances

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59
Q

which medications have a black box warning?

A

COX2

NSAIDs

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60
Q

why do COX2 and NSAIDs have a black box warning?

A

for pts with cardiovascular risks

can increase the change of heart attack or stroke

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61
Q

NSAIDs are pregnancy category what?

A

B or C

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62
Q

in the event of acetaminophen overdose, what should be used?

A

N-acetylcysteine

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63
Q

what is the daily max dose of acetaminophen?

A

4 gm/day

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64
Q

what should be limited when taking acetaminophen?

A

alcohol

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65
Q

what should be monitored when taking acetaminophen?

A

LFTs (high-dose or long-term therapy)

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66
Q

when is acetaminophen safe to use?

A

children
pregnancy
most elderly

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67
Q

acetaminophen is the drug of choice for mild to moderate pain in which populations?

A 
pregnancy
h/o GI bleed
ASA allergy
blood coag d/o
upper GI disease
68
Q

acetaminophen is the drug of choice for fever in which population?

A

children- esp. flu-like illness

adults

69
Q

acetaminophen should not be alternated with what other medication?

70
Q

what does acute somatic (connective tissue, muscle, bone, skin) respond best to?

A 
acetaminophen
steroids
NSAIDs
opioids
local anesthetics
ice
massage
71
Q

what does acute visceral (internal organs, abdomen) respond best to?

A

MOST responsive: opioids
can use NSAIDS, ASA, Celebrex, morphine
ibuprofen & naproxen will work

72
Q

COX2 inhibitors should be avoided in which population?

A

pregnancy
children
renal dysfunction
pain r/t CABG

73
Q

COX2 inhibitors should be used cautiously in which patients?

A

HF
HTN
fluid retention

74
Q

ASA should be avoided in which patients?

A

pregnancy
children
renal dysfunction

75
Q

what is WHO’s approach to mild pain?

A

non-opioids (NSAIDs)

adjuvant medications

76
Q

what is WHO’s approach to moderate pain?

A

weak opioids (codeine)
non-opioids
adjuvant medications

77
Q

what is WHO’s approach to severe pain?

A

strong opioids (morphine)
non-opioids
adjuvant medications

78
Q

when are IR opioids used?

A

acute pain
“rescue” or “breakthrough” pain
“dose finding” for chronic pain

79
Q

what are the IR combination drugs?

A 
acetaminophen 
ASA
ibuprofen
\+ 
codeine
oxycodone
hydrocodone
80
Q

what are the single entity IR drugs?

A

morphine
oxycodone
hydrocodone
tramadol

81
Q

when are ER opioids used?

A

chronic pain
acute pain that is difficult to manage
if pt is taking a large amount of IR med

82
Q

who should ER medications not be given to?

A

opioid naive patients

83
Q

why are ER opioids the preferred medications?

A

improved treatment adherence

84
Q

when can ER opioid doses be adjusted?

A

Q2-3 days (based on amt of “rescue” meds used

85
Q

what are ADRs of opioids?

A 
sedation
drowsiness
constipation
decreased appetite
mental clouding
sexual dysfunction
nausea
tolerance/dependence
86
Q

what should opioids not be combined with?

A

alcohol

benzodiazipines

87
Q

what are poor choices for chronic pain control?

A

demerol (poor absorption, toxic metabolite)

mixed agonist-antagonists

88
Q

what is critical for successful opioid responsiveness?

89
Q

how do you reach opioid responsiveness?

A

increase dose until pain relief is adequate
OR
intolerable & unmanageable SE occur

90
Q

what is the max/correct dose for opioids?

A

patient specific

91
Q

what are the strategies to decrease opioid requirements?

A

“opioid rotation”
add non-opioid or adjuvant med
spinal route

92
Q

which medications are used to treat neuropathic pain?

A

antieleptics

antidepressants

93
Q

which anti-eleptics are used to treat neuropathy?

A

Neurontin
Lyrica
Tegretol

94
Q

which anti-depressants are used to treat neuropathy?

A

TCAs (amitriptyline)

serotonin & norepinephrine reuptake inhibitor (Cymbalta)

95
Q

what are the causes of abx resistance?

A 
recent use
over use
< 2 yrs old, >65 yrs old
day-care attendance
exposure to young children
multiple comorbidities
immunosuppression
96
Q

which group(s) of abx don’t have resistance?

97
Q

how can local resistance patterns be identified?

A

antibiogram

98
Q

which vaccine has decreased resistance?

A

pneumococcal

99
Q

amoxicillin is the 1st line use for what?

A

sinusitis

AOM

100
Q

PCN is the first line use for what?

A

strep pharyngitis

101
Q

augmentin is the first line tx for what?

102
Q

1st gen. cephalosporins tx what?

A

skin & soft tissue infections

gram + S. aureus, S. epidermidis

103
Q

2nd gen. cephalosporins tx what?

A

same as first gen.
klebisella
proteus
e. coli

104
Q

3rd gen. cephalosporins tx what?

A

gram -

“braoder” indications

105
Q

4th gen. cephalosporins tx what?

A

resistant to beta-lactamase

gram +

106
Q

which cephalosporin is 5th gen,?

A

ceftaroline

107
Q

ceftriaxone and cefixime treat which disease?

A

gonorrhea

chlamydia

108
Q

cefopodoxime, cefuroxime treat which disease?

A

community-acquired PNA

109
Q

what should you monitor for in pts who take cephalosporins?

110
Q

what are fluoroquinolones used to treat?

A

complicated UTI
pyelonephritis infections
chronic bacterial prostatitis
PNA/chronic bronchitis exacerbation

111
Q

fluoroquinilones can treat PCN resistant what?

A

S. pneumonia
skin infections
bone/joint infections
complicated intra-abd infections, diarrhea

112
Q

what should you be on the lookout for when taking fluoroquinolones?

A

tendon tenderness

113
Q

what are macrolides/azalides used to treat?

A

*community-acquired PNA
pertusis
h. pylori
chronic bronchitis

114
Q

macrolides/azalides are often n alternative for which drug?

115
Q

macrolides have which suffix?

A

-mycin

NOT clindamycin

116
Q

which medication is an azalide?

A

azithromycin

117
Q

which drugs are used to treat herpes?

A

acyclovir
famciclovir
valacyclovir

118
Q

which medication is used to treat herpes in pregnancy?

119
Q

what is the drug of choice for gonorrhea treatment?

A

rocephin (IM)

can use suprax

120
Q

gonorrhea is resistant to which class of abx?

A

fluoroquinolones

121
Q

what is the drug of choice for treatment of chlamydia?

A

azithromycin
OR
doxycycline

122
Q

what is the drug of choice for treatment of chlamydia in pregnancy?

A

azithromycin
OR
amoxicillin

123
Q

erythromycin can be used to treat chlamydia in pregnancy, but why isn’t it used?

A

increased ADEs

reduced effectiveness

124
Q

what are the live attenuated vaccines?

A 
Flumist
MMR
OPV
Rotavirus (Rotarix, RotaTeq)
Varicella (Varivax, ProQuad)
Herpes Zoster (Zostavax)
125
Q

what are the inactivated vaccines?

A 
DTaP
haemophilus B
inactivated poliovirus
hep B
hep A
HPV
influenza
pneumococcal
meningococcal
126
Q

what are the contraindications of receiving live vaccines?

A

pregnancy
immunocompromised
febrile illness
interacts with antiviral drugs

127
Q

other than the standard live vaccine contraindications, what contraindications are there for Flumist?

A

egg allergy

asthma

128
Q

other than the standard live vaccine contraindications, what contraindications are there for MMR?

A

neomycin or gelatin allergy

129
Q

other than the standard live vaccine contraindications, what contraindications are there for MMRV?

A

caution in h/o cerebral injury

seizures

130
Q

other than the standard live vaccine contraindications, what contraindications are there for rotavirus?

A

blood products in the past 42 days

131
Q

other than the standard live vaccine contraindications, what contraindications are there for varicella?

A

neomycin or gelatin allergy
avoid ASA for 6 weeks
may effect drugs that effect immune sys. (chemo, high-dose steroids)

132
Q

other than the standard live vaccine contraindications, what contraindications are there for herpes?

A 
neomycin or gelatin allergy
active TB
acute illness
fever
< 60 yrs old
interacts with: high-dose steroids, antivirals
133
Q

what contraindications are there for DTaP?

A

anaphylactic reaction
progressive neuro disease
high temp
seizure after previous DTaP

134
Q

what contraindications are there for haemophilus?

A

allergy to vaccine components
moderate to severe illness
*only children < 6 yrs

135
Q

what contraindications are there for inactivated polio?

A

allergy to: neomycin, streptomycin, polymyxin B

interacts with immunosuppresants

136
Q

what contraindications are there for hep B?

A

yeast allergy
moderate or severe allergy
immunosuppresion

137
Q

what contraindications are there for hep A?

A

severe reaction to HAV
moderate illness
< 12 mths

138
Q

what contraindications are there for HPV?

A

allergic reaction

allergy to yeast

139
Q

what contraindications are there for inactivated influenza?

A

anaphylaxis to eggs, flu vaccine
guillan-barre w/in 6 wks
febrile illness

140
Q

what contraindications are there for PPV?

A

moderate to severe febrile illness
give 10-14 days before splenectomy, organ transplant, or chemo
< 2yrs

141
Q

what contraindications are there for pneumococcal conjugate (PCV)?

A

only used in adults
same as PPV
> 19 w/immunocompromised conditions, functional or anatomic asplenia, CSF leaks or cochlear implants

142
Q

what contraindications are there for meningococcal?

A

febrile illness

143
Q

after HPV vaccine you should observe for what?

A

observe for 15 mins for syncope

144
Q

bismuth subsalicylate shouldn’t be used in which population?

A

children with viral or flu-like illness

145
Q

antidiarrheals are contraindicated in which population?

A

MOST children

146
Q

antidiarrheals are pregnancy category what?

147
Q

can antidiarrheals be used when lactating?

A

safety not est.

use caution

148
Q

what are the classes of antiemetics?

A

antihistamines
phenothiazines
cannabinoids
5HT3 antagonists

149
Q

which drugs are in the antihistamine class?

A

benadryl

vistaril

150
Q

which drugs are in the phenothiazine class?

A

compazine

phenergan

151
Q

which drugs are in the cannabinoid class?

152
Q

which drugs are in the 5 HT3 class?

153
Q

phenothiazines are contraindicated when?

A

Parkinson’s

154
Q

phenegran has been to have what effect on children?

A

fatal respiratory depression in children < 2yrs

155
Q

if taking promethazine long-term, what should be monitored?

156
Q

when are cannabinoids used?

A

cancer chemo

157
Q

cannabinoids should be used cautiously in which patients?

A

h/o seizure d/o

158
Q

5HT3 medications can mask what?

A

progressive ileus

159
Q

which laxatives are used for rapid response/short-term?

A

stimulants
osmotics
surfactants

160
Q

which laxatives are used for slower response/long-term?

A

bulk-forming

161
Q

which laxatives are safest to use in pregnancy?

A

bulk-forming

162
Q

what is the GERD step-up approach?

A 
antacids & lifestyle modification
H2RA x4-8 wks
-if better then cont. for 12 wks, then wean
if not relieved, then PPI x4-8 wks
-if better, step down to H2RA
-if symptoms return, back to PPI
163
Q

what is the GERD step-down approach?

A

lifestyle modification
PPI x8 wks
-if symptom free wk 4, step down to H2RA
if not relieved, increase PPI to BID 4-8 wks
-if symptom free x4 wks, step down to QD, reassess in 6-12 mths

164
Q

what is not used as a primary treatment for GERD?

165
Q

what is triple therapy for h. pylori tx?

A

PPI
clarithromycin
amoxicillin
(14 days)

166
Q

what is the quadruple therapy for h. pylori tx?

A 
PPI
metronidazole
*tetracycline
bismuth subsalicylate
(14 days, 2nd-line)
167
Q

what is the levofloxacin-based triple therapy?

A

levo
PPI
amoxicillin
(2nd-line, or “rescue” tx)

Pharm Exam II (1 decks)

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