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M3 Drugs > Family Medicine > Flashcards

Family Medicine Flashcards

1
Q

1st line dyslipidemia plus concerning side wffects

A

Statins hmg coa reductase
Myopathy ( fatigue elevated creatinine kinase)
Hepatoxicity

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2
Q

Intermittent claudication from peripheral arterial disease

A

Cilostazol + antiplatelet agent (aspirin or clopidegrel) + statin

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3
Q

What lipid lowering agent can cause itching

A

Niacin B3 ( increases prostaglandin synthesis). Give ibprofen half hour before taking

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4
Q

Doxazosin

A

Alpha one blocker, reduces systemic vascular resistance, decreases blood pressure

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5
Q

Prazosin

A

Alpha 1 blocker for htn

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6
Q

Name 2 nonselective beta blockers

A

Labetalol
Carvedilol

Beta 1 on heart
Alpha 1 smooth vascular mm
Beta in kidney

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7
Q

Prevention for thromboembolism in a fib

A

Warfarin to inhibit synthesis of vitamin k dependent factors

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8
Q

Dihydropyridine calcium channel blockers like amlodipine cause systemic vascular vasodilation, which increases hydrostatic pressure in precapillary blood vessels and can lead to peripheral edema. What can be added to reduce edema?

A 
Ace inhibitor (pril)
Arbs (angiotensin ii receptor blockers ) (sartan)
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9
Q

Important contraindications for metformin

A 
Renal failure
Iodinated contrast medium
Heart failure
Sepsis
Alcoholism

Elderly and ppl with renal and cardiac insufficiency are high risk for metformin associated lactic acidosis

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10
Q

Amiodarone

A

Vtach and refractory AFib
Amiodarone has low negative inotropic effect so it can be used for ppl with low ejection fraction

Side effects thyroid probs, neuropathy, rare but serious: pulmonary fibrosis, chronic interstitial pneumonitis

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11
Q

First line medical tx for hypertrophic cardiomyopathy

A

Metoprolol, other beta blockers (rate control, longer diastole, less contractility and therefore o2 demand) plus avoid strenuous exercise

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12
Q

Prophylaxis for dental procedures for high risk patients

A

Oral amoxicillin 1 hour before

High risk pts for endocarditis include pts with prosthetic heart valves, hx of infectious endocarditis, unrepaired cyanotic heart defect

Viridins streptococci s. Sanguinis s. Mutans s. Mitis

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13
Q

what do you give for beta blocker overdose (bradycardia, wheezing, hypoglycemia, hypotension, prolonged PR intervals)

A

try IV fluid resuscitation and atropine; if that doesn’t work, IV glucagon

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14
Q

antidote for cholinergic syndrome (SLUDGE-M)
Sweating/Salivation; Lacrimation, Urination, Diarrhea, Gastrointestinal distress, neuromuscular Excitation/Emesis - Miosis/Muscle spasms)

A

pralidoxime

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15
Q

histoplasmosis treatment

A

supportive for mild disease; oral itraconazole for chronic cavitation >1 year

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16
Q

antibody against RSV (preventative for kids at high risk of severe complications)

A

palivizumab

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17
Q

Pertussis treatment

A

macrolides (azithromyocin, erythromycin, clarithromycin)

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18
Q

moa for macrolides; side effects

A

block bacterial protein synthesis at ribosomal subunit 50s

QT prolongation, GI distress, acute cholestatic hepatitis, exanthem, eosinophila

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19
Q

treatment for moderate to severe croup ( dyspnea and tachycardia at rest but airway compromise isn’t imminient, i.e. not hypoxic or bradycardic)

A

nebulized epinephrine + oral/parenteral glucosteroids

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20
Q

treatment for confirmed GAS tonsilitis

A

penicillin V

alt: macrolides, erythromycin

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21
Q

treatment for acute exacerbations of asthma

A

low dose inhaled corticosteroid (eg budesonide) + formeterol (b2 agonist)

ICS (budesonide, flutacisone, beclomethasone, mometasone, triamcinolone) reduce inflammation and the beta 2 agonist formeterol dilates bronchial smooth mm

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22
Q

upper airway cough syndrome (post nasal drip syndrome)

A

first generation anti histamine e.g. oral diphenhydramine for 2 weeks to confirm diagnosis

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23
Q

moa of amlodipine

A

inhibits Ltype calcium channels in vascular smooth muscle, reduces vascular resistance and thus blood pressure

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24
Q

treatment for most common cause of septic arthritis

A

most common cause of septic arthritis is staph aureus. treat with penicillinase-resistant penicillines:
oxacillin
nafcillin
cefazolin

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25
Q

treatment for gonococcal arthritis

A

IV ceftriaxone

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26
Q

treatment of septic arthritis in kiddos >3moths

A

cefazolin +nafcillin

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27
Q

a patient treated for salmonella gastritis has a positive Thompson test (lying in prone position; squeeze calf, plantar flexion is absent). What medicine should be immediately discontinued.

A

fluoroquinolone

positive Thompson test suggest achilles tendon rupture, a rare side effect of fluoroquinolones. discontinue immediately.

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28
Q

etanercept

A

TNF alpha inhibitor, a disease modifying antirheumatic drug that can be used for rheumatoid arthritis

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29
Q

first line long term therapy for moderate to severe rheumatoid arthritis

A

methotrexate (slow onset >6 weeks, use nsaids or glucocorticoids as bridge)
methotrexate is a folic acid antagonist decreases dna synthesis and thus anti proliferative

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30
Q

what prophylaxis should be given when starting a high dose methotrexate

A

leucovorin (folinic acid); because methotrexate inhibits folic acid in dna synthesis, a side effect can be myelosuppression (macrocytic anemia, thrombocytopenia, leukocytopenia)

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31
Q

treatment for neonate with HSV (vesicular skin lesions, meningioencephalitis)

A

IV acyclovir

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32
Q

combination therapy for chronic hep C infection

A

ledipasvir/sofosbuvir AND ribavirin

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33
Q

syphilis treatment

A

penicillin G

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34
Q

treatment to prevent progression to deafness in congenital CMV

A

prolonged ganciclovir

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35
Q

tx for cholestasis of pregnancy?

A

ursodial (ursodeoxycholic acid)

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36
Q

what kind of birth defects are caused by valproic acid

A

neural tube defects like spina bifida

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37
Q

what kind of birth defect is caused by lithium exposure?

A

heart defect especially epstein’s anomaly (posterior displacement of tricuspid valve, atrialization of right ventrical and enlargement of right atrium)

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38
Q

what is the anticoagulant of choice in pregnancy

A

heparin, low dose aspirin can also be used espeically for high risk preeclampsia but high doses must be avoided especially in third trimester. warfarin can cause abortion and intracranial hemorrhage so do not ever use in pregnancy

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39
Q

adrenal steroid inhibitors

A

ketoconazole, metyrapone

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40
Q

diuretic of choice for hyperaldosteronism

A

spironolactone (potassium sparing diuretic; hyperaldosteronism causes hypokalemia (weakness, constiation, arrhythmia) and hypernatremia and metabolic alkalosis)

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41
Q

drug to increase fertility in pcos pts

A

clomiphene

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42
Q

name three first line drugs for tx of painful diabetic neuropathy

A

Pregabalin (usually first choice)
Amitriptyline (tricyclic antidepressant)
Duloxetine or Venlafaxine (SNRIs)

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43
Q

moa of tramadol

A

opioid analgesic that also inhibits serotonin and norepinephrine reuptake

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44
Q

tx for graves disease

A
  • thioamide (anti thyroid peroxidase, reduces t3 and t4)
  • beta blockers
  • radioiodine therapy
  • thyroidectomy
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45
Q

medical blockade for pheochromocytoma given prior to surgical resection

A

phenoxybenzamine (alpha blocker)

46
Q

antithyroid drug for graves disease during the FIRST trimester

A

propylthiouracil (use methimazole during 2nd and 3rd trimester)

47
Q

antithyroid drug for graves disease during second and third trimesters

A

methimazole

48
Q

nefedipine

A

calcium channel blocker, antihypertensive

49
Q

acarbose

A

alpha glucosidase inhibitor/blocks glucose uptake in small intestine used in DM2. can cause GI probs like flatulence. no risk of hypoglycemia. Do not use if patient has malabsorption, renal failure, or inflammatory bowel disease

50
Q

sitagliptin

A

inhibits breakdown of GLP-1 by blocking DDP4; results in increased insulin release from B cells. Used in DM2. Can cause diarrhea, constipation, arthralgia, pancreatitis, renal failure.

51
Q

saxagliptin

A

inhibits breakdown of GLP-1 by blocking DDP4; results in increased insulin release from B cells. Used in DM2. Can cause diarrhea, constipation, arthralgia, pancreatitis, renal failure.

52
Q

miglitol

A

alpha glucosidase inhibitor/blocks glucose uptake in small intestine used in DM2. can cause GI probs like flatulence. no risk of hypoglycemia. Do not use if patient has malabsorption, renal failure, or inflammatory bowel disease

53
Q

voglibose

A

alpha glucosidase inhibitor/blocks glucose uptake in small intestine used in DM2. can cause GI probs like flatulence. no risk of hypoglycemia. Do not use if patient has malabsorption, renal failure, or inflammatory bowel disease

54
Q

repaglinide

A

DM2 med, can cause weight gain and hypoglycemia

55
Q

nateglinide

A

DM2 med, can cause weight gain and hypoglycemia

56
Q

glyburide

A

sulfonylurea used for DM2; increases insulin release. Causes weight gain and alcohol intolerance. can lead to dangerous hypoglycemia

57
Q

glipizide

A

sulfonylurea used for DM2; increases insulin release. Causes weight gain and alcohol intolerance. can lead to dangerous hypoglycemia

58
Q

dapagliflozin

A

DM2 drug, makes you pee out the glucose. Can lead to weight loss. often used in younger pts. decreases BP. Risk of UTIs and genital infections, dehydration and severe DKA

59
Q

empagliflozin

A

DM2 drug, makes you pee out the glucose. Can lead to weight loss. often used in younger pts. decreases BP. Risk of UTIs and genital infections, dehydration and severe DKA

60
Q

canagliflozin

A

DM2 drug, makes you pee out the glucose. Can lead to weight loss. often used in younger pts. decreases BP. Risk of UTIs and genital infections, dehydration and severe DKA

61
Q

exenatide

A

GLP-1 receptor agonist that increases insulin release. Used in DM2.
Weight loss and no risk of hypoglycemia.
Risk of GI upset, pancreatitis, pancreatic cancer

62
Q

_______________ can mask the warning signs of hypoglycemia and decrease blood glucose further

A

beta blockers

63
Q

treatment for primary hyperaldosteronism

A

eplerenone, an aldosterone antagonist

64
Q

treatment for uncomplicated pyleonephritis

A

fluoroquinolone like ciprofloxicin, outpatient, 7days; if need be you can initiate with single IV dose of ciprofloxicin, gentamycin, or ceftriaxone. Encourage fluids. Check on pt at 24-48 hrs, if no improvement get CT abdomen and tailor antibiotics to culture

65
Q

treatment for urge incontinence

A

oxybutynin, avoid bladder irritants

66
Q

first line treatment for BPH

A

alpha blockers:
doxasozin
terazosin
tamsulosin

67
Q

second line treatment for BPH if alpha blockers dont relieve symptoms

A

finesteride, dutasteride, or other 5 alpha reductase inhibitor

68
Q

a first line treatment for functional constipation

A

polyethylene glycol, lactulose

69
Q

contraindications of pegylated IFN alpha for chronic hep B

A 
autoimmune disorders (IFN alpha upregulates the immune system), also severe cardiac problems, uncontrolled seizures, uncontrolled psych issues
instead: tenofovir, entecavir
70
Q

first line for mild ulcerative colitis

A

mesalamine

71
Q

tx for tropical sprue

A

tetracycline + folic acid

72
Q

triple therapy for H pylori eradication

A

PPIs (-prazole) at 2x dose plus clarithromycin + amoxicillin or metronidazole

73
Q

first line for lyme disease in children <8

A

amoxicillin

74
Q

Active TB regimin

A

isoniazid, ethambutol, pyranizamide, and rifampin for 2 months followed by 4 months of isoniazid and rifampin

remember to give pyridoxine with isoniazid to prevent perpheral neuropathy from sideroblastic anemia (B6 deficiency because the isoniazid competes with pyridoxine, B6).

75
Q

prophylaxis against P. falciparum in pregnant women

A

mefloquin (chloroquin is also safe but chloroquin resistance is widespread)

76
Q

what do you add to acute leukemia treatment if the patient has the philadelphia translocation (9;22)?

A

BCR-ABL tyrosine kinase inhibitor like imatinib

77
Q

management of antiphospholipid syndrome

A

acute: low molecular weight heparin; chronic prophylaxis: mild cases - aspirin, severe cases– warfarin unless they want to be pregnant then low molecular weight heparin plus aspirin

78
Q

tx for CD 20+ B cell non hodgkin lymphoma

A

rituximab

79
Q

major risk of antineoplastic agent bleomyocin

A

pulmonary fibrosis

80
Q

trimethoprim-sulfamethoxazole can cause _______, predisposing pts to bacterial infection

A

agranulocytosis

81
Q

ABVD therapy

A

adriamycin (myelosupp/cardiotox) (or doxorubicin)
bleomycin (pulmonary fibrosis)
vinblastin (myelosuppression)
dacarbazin

82
Q

adverse effects of methimazole (antithyroid drug)

A

agranulocytosis (stop right away!)
pruritic rash
teratogen

83
Q

what drug would cause hyperthermia, muscle rigidity, decreased reflexes, autonomic instability like HTN and tachycardia, altered mental status, elevated transaminases, creatinine kinase, and leukocytosis?

A

high potency typical antipsychotics like haloperidol but also low potency atypical antipsychotics and antiemetics like metoclopromide ; over 1-3 days

84
Q

glimepiride

A

sulfonylurea; stimulates insulin secretion

weight gain, hypoglycemia risk esp if kidney disease; may increase cv risk; may stop working after a couple years

85
Q

glyburide

A

sulfonylurea; stimulates insulin secretion

weight gain, hypoglycemia risk esp if kidney disease; may increase cv risk; may stop working after a couple years

86
Q

glipizide

A

sulfonylurea; stimulates insulin secretion

weight gain, hypoglycemia risk esp if kidney disease; may increase cv risk; may stop working after a couple years

87
Q

empagliflozin

A

sodium glucose cotransporter 2 inhibiot–> increased urinary excretion of glucose **reduces overal CV morality.
weight loss but also risk of dehydration, UTI/mycotic genital infection, bone loss & fracture

88
Q

canagliflozin

A

sodium glucose cotransporter 2 inhibiot–> increased urinary excretion of glucose
weight loss but also risk of dehydration, UTI/mycotic genital infection, bone loss & fracture
DKA can occur with stress

89
Q

dapagliflozin

A

sodium glucose cotransporter 2 inhibiot–> increased urinary excretion of glucose
weight loss but also risk of dehydration, UTI/mycotic genital infection, bone loss & fracture
DKA can occur with stress

90
Q

nateglinide, repaglinide

A

increases insulin secretion **weight gain, risk of hypoglycemia

91
Q

linagliptin

A

DPP-4 inhibitorneutral re weight

92
Q

sitagliptin

A

dipeptidyl-peptidase 4 inhibitor neutral re weight

93
Q

saxagliptin

A

DPP4 inhibitor neutral re: weight; may increase hospitalization for HF

94
Q

alogliptin

A

DPP4 inhibitor neutral re:weight; may increase hospitalization for HF

95
Q

pioglitazone

A 
a thiazolidedione; increases glucose uptake by fat and mm; decreases hepatic glucose production
**weight gain
may reduce stroke risk
good for nonalcoholic steatohepatitis
**do not use in CHF
risk of fractures
96
Q

rosiglitazone

A 
thiazolidedione; incrases glucose uptake by fat and mm and decrease hepatic gluc production
**weight gain
**do not use in CHF
may reduce stroke risk
risk of fractures
97
Q

colosevelam hydrocholoride

A

bile acid sequesterant; decreases LDL! may cause constipation

98
Q

acarbalose

A

alpha glucosidase inhibitor for DM2; gi symptoms!

99
Q

miglitol

A

alpha glucosidase inhibitor for DM2, gi symptoms!

100
Q

pramlintide

A

DM2 med, **weight loss, increased satiety, GI effects

101
Q

bromocriptine mesylate

A

D2 agonist used in DM2. may have CV benefits . can cause nausea, rhinitis, fatigue, orthostatic hypotension. **do not use for pts taking antipsychotics

102
Q

exenatide

A

glucagon-like peptide 1 receptor agonist, injectable. increases insulin secretion/decreases glucagon secretion; slows gastric emptying and increases satiety
*weight loss; GI symptoms
do not use if CrCl<30

103
Q

liraglutide

A

glucagon-like peptide 1 receptor agonist, injectable. increases insulin secretion/decreases glucagon secretion; slows gastric emptying and increases satiety

  • weight loss; GI symptoms
  • decreased CV mortality
104
Q

albiglutide

A

glucagon-like peptide 1 receptor agonist, injectable. increases insulin secretion/decreases glucagon secretion; slows gastric emptying and increases satiety
*weight loss; GI symptoms

105
Q

dulaglutide

A

glucagon-like peptide 1 receptor agonist, injectable. increases insulin secretion/decreases glucagon secretion; slows gastric emptying and increases satiety
*weight loss; GI symptoms

106
Q

semaglutide

A

glucagon-like peptide 1 receptor agonist, injectable. increases insulin secretion/decreases glucagon secretion; slows gastric emptying and increases satiety
*weight loss; GI symptoms

107
Q

symptomatic management of diabetic neuropathy pain

A

venlafaxine (SNRI)

108
Q

immunmodulator for severe, poor controlled asthma (step 5-6)

A

omalizumab (xolair); anti IgE

109
Q

name 3 leukotriene receptor antagonist (alternatives for steps 2-4 of asthma control)

A

montekulast, zafirlukast, zileuton

110
Q

name three short acting beta 2 agonists

A

albuterol, levalbuterol, pirbuterol. Given prn for step 1; quick relief

111
Q

name three long acting beta 2 agonists + inhaled corticoid steroids

A

formeterol +budesonide (symbicort)
fluticasone + salmetoral (advair)
mometasone _ formeterol (dulera)

112
Q

omeprazole

A

proton pump inhibitor

M3 Drugs (1 decks)

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