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Pharmacy > G and G chapter ends > Flashcards

G and G chapter ends Flashcards

1
Q

Alosetron indication other than nausea

A

IBS-D

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2
Q

Zofran MOA

A

5HT-3 antagonist

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3
Q

Lorcaserin MOA

A

5HT-2c agonist

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4
Q

Lorcaserin indication

A

Weight loss

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5
Q

Scary side effect of lorcaserin at supraclinical doses

A

Hallucinations

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6
Q

Triptans MOA

A

5HT-1b and d agonist

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7
Q

Triptans contraindicated in what patients?

A

Ischemic heart disease and coronary artery vasospasm

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8
Q

Which Triptans have drug interactions with cyp 3a4 inhibitors?

A

Eletriptan and naratriptan

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9
Q

Can MAOI’s affect Triptans?

A

Yes, avoid

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10
Q

4 Most common side effects with triptans

A

Dizziness, sleepiness, neck and chest pain

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11
Q

Triptans safe in pregnancy?

A

No

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12
Q

Triptans safe in breastfeeding?

A

No

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13
Q

Can triptans be used concomitantly with SSRI’s/SNRI’s?

A

Not recommended due to serotonin syndrome

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14
Q

Methylergonovine MOA

A

Broad 5-HT action

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15
Q

Methylergonovine indication

A

Prevent post-partum hemorrhage

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16
Q

High dose Methylergonovine can cause what unpleasant side effect?

A

Sustained uterine contracture

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17
Q

Buspar MOA

A

Partial agonist 5-HT1a and D2

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18
Q

Flibanserin MOA

A

5-HT1a agonist and 5-HT2 antagonist

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19
Q

Flibanserin indication

A

Hypoactive sexual desire in premenopausal women

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20
Q

Cabergoline MOA and indication

A

Dopamine agonist, Parkinson’s and hyperprolactinemia

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21
Q

Bromocriptine MOA and indication

A

Dopamine agonist, Parkinson’s and hyperprolactinemia

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22
Q

Rotigotine moa

A

Dopamine agonist

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23
Q

Main reason cabergoline and bromocriptine are avoided

A

Cardiac issues (valvulopathies)

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24
Q

Side effect of dopamine agonists (mirapex, requip…) early in parkinson’s

A

Impulse control

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25
Q

What benefit from use of clozapine in terms of side effects?

A

Less EPS

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26
Q

Why vraylar or rexulti for schizophrenia?

A

Improved side effect profile

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27
Q

Can adderall be used in patients that also have bipolar?

A

Not likely, can worsen psychosis

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28
Q

What side effects does vilazodone lack?

A

Sexual and weight gain

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29
Q

Milnacipran moa

A

SNRI

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30
Q

Duloxetine and milnacipran contraindicated in what?

A

Uncontrolled narrow angle glaucoma

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31
Q

Doxepin drug class

A

TCA

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32
Q

Desipramine drug class

A

TCA

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33
Q

How long to wait after taking MAOI to take TCA?

A

14 days

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34
Q

Blood pressure side effect of TCA’s

A

Orthostatic hypotension

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35
Q

3 indications of atypical antipsychotics

A

Depression, schizophrenia, and bipolar

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36
Q

Isocarboxazid drug class

A

MAOI

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37
Q

Tranylcypromine drug class

A

MAOI

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38
Q

MAOI’s can cause what side effect if tyramine containing foods/drinks eaten?

A

Hypertensive crisis

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39
Q

Trazodone and remeron moa

A

5-HT2 antagonist

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40
Q

Trazodone and remeron dose for successful sleep

A

Low dose

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41
Q

Why avoid nefazodone?

A

Risk of liver failure

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42
Q

Chlorpromazine drug class

A

1st gen antipsychotic

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43
Q

Chlorpromazine hits what 4 receptor types? What are side effects from each receptor type?

A

D2, muscarinic, histamine, and A1. EPS, anticholinergic, sedation, and hypotension

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44
Q

How can chlorpromazine effect the skin?

A

Photosensitivity

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45
Q

Haldol has higher rates of which 3 side effects?

A

EPS, akathisia, and hyperprolactinemia

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46
Q

Hyperprolactinemia manifestations

A

Infertility, decrease BMD in women, and erectile dysfunction and gynecomastia in men

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47
Q

Haldol causes less of which 4 side effects?

A

Anticholinergic, sedation, weight gain, hypotension

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48
Q

2 mg Haldol is equivalent to ___ mg chlorpromazine

A

100

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49
Q

Thiothixene drug class

A

1st gen antipsychotic

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50
Q

Perphenazine drug class

A

1st gen antipsychotic

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51
Q

Loxapine drug class

A

1st gen antipsychotic

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52
Q

Which 2 1st gen antipsychotics have the least EPS and akathisia?

A

Perphenazine and loxapine

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53
Q

Asenapine

A

Saphris

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54
Q

Can saphris ODT be swallowed?

A

No, will be dismantled by liver

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55
Q

Saphris counseling point when administering

A

Avoid water for 10 minutes after taking

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56
Q

How much effect does asenapine have on weight gain?

A

Minimal

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57
Q

What 2 GI and oral side effects does clozapine have?

A

Constipation and drooling

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58
Q

Iloperidone drug class

A

Atypical antipsychotic

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59
Q

4 common side effects of atypical antipsychotics

A

Anticholinergic, sedation, weight gain, and hypotension

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60
Q

Counseling point on Latuda administration

A

Take with 350 cal food

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61
Q

Olanzapine has dose dependent ___ effects

A

Anticholinergic

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62
Q

Invega has high rates of which side effect?

A

Hyperprolactinemia

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63
Q

Which 3 side effects are most common with Quetiapine?

A

Weight gain, sedation, and hypotension

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64
Q

Which 2 atypical antipsychotics have high rates of hyperprolactinemia?

A

Risperidone and paliperidone

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65
Q

Ziprasidone administration counseling point

A

Take with 500 cal food

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66
Q

Ziprasidone has improved tolerability if you need to start at high starting dose of ___ mg per day how?

A

With food

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67
Q

Abilify has low risk of which 2 side effects?

A

Weight gain and hyperprolactinemia (actually lowers prolactin)

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68
Q

Nuplazid

A

Pimavanserin

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69
Q

Nuplazid moa and indication

A

Parkinson’s disease psychosis. 5-HT2a inverse agonist without D2 affect

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70
Q

With Cyp3a4 inhibitors, do what to Nuplazid dose?

A

Decrease by 50% to avoid overdose

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71
Q

Clinical effects of Nuplazid take how long to be seen?

A

4-6 weeks

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72
Q

Monitor what 3 labs with lithium?

A

TSH, lithium level, and renal function

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73
Q

Therapeutic serum level for lithium in acute mania

A

1-1.5 meq/ml

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74
Q

Maintenance therapeutic serum level for lithium

A

0.6-1 meq/ml

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75
Q

Lithium may cause what 2 physical side effects?

A

Tremor, hair loss

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76
Q

What 3 labs are monitored with divalproex?

A

Divalproex level, CBC, and liver function

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77
Q

Avoid rapid dose escalation for carbamazepine to avoid ___ and ___

A

Sedation and ataxia

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78
Q

Why slow dose increase for lamotrigine?

A

To avoid SJS

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79
Q

What to do if patient on lamotrigine and divalproex?

A

Reduce lamotrigine dose by 50%

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80
Q

How does phenytoin affect cyp3a4?

A

Induction

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81
Q

2 Common phenytoin side effects

A

Gingival hyperplasia and facial coarsening

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82
Q

5 common side effects of carbamazepine

A

Drowsiness, vertigo, ataxia, blurred vision, increased seizure frequency

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83
Q

Which anti seizure meds reduce half life of lamotrigine?

A

Phenytoin, carbamazepine, and phenobarbital

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84
Q

Why did they make oxcarbazepine?

A

Less side effects and cyp induction

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85
Q

Lacosamide moa and indication

A

Sodium channel modulator, epilepsy

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86
Q

Ethosuximide moa and indication

A

Calcium channel blocker, epilepsy

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87
Q

6 common side effects of ethosuximide

A

GI, sleepiness, lethargy, dizziness, headache, hypersensitivity

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88
Q

Zonisamide 4 common side effects

A

Sleepy, ataxia, anorexia, fatigue

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89
Q

Zonisamide moa

A

Calcium channel blocker

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90
Q

Abrupt withdrawal of benzos can facilitate what symptom?

A

Seizures

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91
Q

Infinite levels can be increased in cyp___ poor metabolizers

A

2c19

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92
Q

Phenobarbital 2 common side effects in children:

A

Irritability and hyperactivity

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93
Q

Phenobarbital 2 common side effects in elderly

A

Agitation and confusion

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94
Q

Primidone moa

A

GABA enhancer

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95
Q

Primidone is a cyp 3a4 ___

A

Inducer

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96
Q

Fycompa

A

Perampanel

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97
Q

Perampanel

A

Fycompa

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98
Q

Fycompa 6 common side effects

A

Anxiety, confusion, imbalance, vision problems, aggression, suicidal thoughts

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99
Q

Fycompa moa

A

Glutamate receptor antagonist

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100
Q

Keppra 5 common side effects

A

Sleepy, weakness, ataxia, dizziness, mood changes

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101
Q

3 common topiramate side effects

A

Sleepy, fatigue, brain fog

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102
Q

Why did they make rytary?

A

Mixed immediate and extended release sinemet to prevent wearing off effect

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103
Q

3 Most common side effects of dopamine agonists (requip, mirapex…)

A

Sleepy, impulse control disorder, psychosis

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104
Q

Apomorphine drug class and indication

A

Dopamine agonist, Parkinson’s rescue for off episodes

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105
Q

Apomorphine must be used concurrently with what?

A

Nausea meds

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106
Q

Apomorphine is contraindicated with which drug class?

A

Zofran (5-ht3 antagonists)

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107
Q

Neupro

A

Rotigotine

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108
Q

Rotigotine

A

Neupro

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109
Q

Why are COMT inhibitors used in Parkinson’s?

A

To reduce peripheral metabolism of levodopa, increasing efficacy and half life

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110
Q

Entacapone drug class

A

COMT inhibitor

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111
Q

Why would rasagiline or selegeline be used in Parkinson’s?

A

As MAOI’s, they increase dopamine levels.

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112
Q

Max efficacious dose of selegiline in Parkinson’s: ___mg

A

40 mg

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113
Q

Amantadine effective at treating levodopa induced:

A

Dyskinesias

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114
Q

Rivastigmine moa and indication

A

Acetylcholinesterase inhibitor, dementia (Parkinson’s and alzheimer’s)

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115
Q

What is main dose limiting side effect of aricept?

A

GI symptoms (NVD)

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116
Q

Exelon patches have less of what side effect?

A

GI (NVD)

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117
Q

Memantine moa

A

NMDA antagonist (reduces glutamate excitation which leads to damage)

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118
Q

Tetrabenazine moa and indication

A

Depletes pre-synaptic catecholamines, treats tics (Huntington’s chorea)

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119
Q

2 main side effects tetrabenazine

A

Hypotension and suicidal depression

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120
Q

Baclofen moa

A

GABA receptor agonist

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121
Q

Which 4 benzos have the indication for alcohol withdrawal?

A

Chlordiazepoxide, valium, Ativan, and oxazepam

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122
Q

Flumenazil indication

A

Benzo ovedose

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123
Q

Belsomra moa

A

Orexin antagonist

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124
Q

Ballpark phenobarbital half life

A

Long

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125
Q

Levorphanol 2 unique Side effects

A

Delirium and hallucinations

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126
Q

As an opioid, why is loperamide sold OTC?

A

Poor BBB penetration, great for diarrhea

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127
Q

Why is diphenoxylate formulated with atropine?

A

Atropine side effects of weakness and nausea discourage abuse of the opioid component

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128
Q

What syndrome does delsym increase risk for?

A

Serotonin syndrome

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129
Q

Naltrexone boxed warning:

A

Contraindicated in liver failure and hepatitis due to dose dependent liver injury

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130
Q

Precedex should be used only up to ___ duration sedation

A

24 hours

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131
Q

Dexmedetomidine moa

A

A2 agonist

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132
Q

How long to apply lidocaine/prilocaine for onset of action?

A

30 minutesd

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133
Q

Do not use Emla cream where topically?

A

Mucous membranes and open wound

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134
Q

Acamprosate indication

A

Alcoholism

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135
Q

Diuretic used for altitude sickness

A

Acetazolamide

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136
Q

Fomepizole indication

A

Methanol poisoning

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137
Q

Ethacrynic acid moa

A

Loop diuretic

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138
Q

Risk of otoxicity highest with which loop diuretic?

A

ETHACRYNIC ACID

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139
Q

Metolazone drug class

A

Thiazide diuretic

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140
Q

Thiazide diuretics have what effect on blood sugar and LDL?

A

Elevate

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141
Q

amiloride drug class

A

Potassium sparing diuretic

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142
Q

Best diuretic in PCOS

A

Aldactone

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143
Q

Drug of choice for central diabetes insipidus

A

Desmopressin

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144
Q

Major ADR with desmopressin

A

Water intoxication

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145
Q

Inhibition of conversion of angiotensin 1 to 2 causes blood pressure to lower how?

A

Lowers arteriolar resistance

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146
Q

Ace inhibitors contraindicated in renal artery ___

A

Stenosis

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147
Q

How does RAAS contribute to hypertension?

A

Volume overload, so body releases renin, which elevates angiotensin and aldosterone, leading to arteriolar contraction and elevated blood pressure.

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148
Q

Aliskiren moa

A

Direct renin inhibitor

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149
Q

With nitrates, need drug free interval of how long?

A

8 hours

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150
Q

2 indications for calcium channel blockers

A

Angina and HTN

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151
Q

Which formulation of calcium channel blocker preferred for angina?

A

Long acting or XR

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152
Q

Odd potential nifedipine side effect

A

Tachycardia

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153
Q

Common gi side effect with diltiazem and verapamil:

A

Constipation

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154
Q

4 unique and common side effects of beta blockers

A

Bronchospasm, peripheral vasoconstriction, depression, and worsening psoriasis

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155
Q

Ranolazine indication

A

Angina

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156
Q

Ivabradine moa

A

Decreases heart rate by inhibiting SA node firing

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157
Q

Ivabradine 2 indications

A

Heart failure and angina

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158
Q

Ivabradine visual side effect

A

Phosphene (perception of light when none entering eye)

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159
Q

Ivabradine contraindicated with what drugs?

A

Diltiazem or verapamil

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160
Q

Heparin moa

A

Thrombin and factor Xa inhibitor

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161
Q

Thiazides lose efficacy at what eGFR? 2 Exceptions:

A

<40, indapamide and metolazone

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162
Q

Which 3 beta blockers indicated for heart failure?

A

Nebivolol, metoprolol, and bisoprolol

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163
Q

2 Beta blockers of choice in peripheral artery disease

A

Coreg and labetalol

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164
Q

Isosorbide dinitrate and Hydralazine combo indication

A

Heart failure in African americans

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165
Q

3 digoxin common side effects

A

Nausea, diarrhea, visual disturbances

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166
Q

When is Ivabradine used in heart failure?

A

Not tolerating beta blockers or HR over 75 on a beta blocker

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167
Q

Quinidine indication

A

Prevent AF, VT, and VF

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168
Q

3 common side effects with quinidine

A

Diarrhea, QT prolongation, cinchonism: (tinnitus, blurred vision, flushing, dizziness, diarrhea)

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169
Q

Useful general info about theophylline dosing

A

Narrow therapeutic index

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170
Q

Disopyramide common side effects

A

Anticholinergic

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171
Q

Lidocaine systemic CNS side effects

A

Seizures, tinnitus, tremor, hallucinations, drowsiness, and coma

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172
Q

Mexiletine 2 indications

A

Chronic VT and VF prevention

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173
Q

Systemic lidocaine indications

A

Acute VT and VF treatment

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174
Q

Mexiletine common 2 side effects

A

Tremor and nausea

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175
Q

Lidocaine and Mexiletine MOA

A

Sodium channel blocker, fast wear off

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176
Q

Procainamide, quinidine, and disopyramide MOA:

A

Sodium channel blockers, intermediate wear off

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177
Q

Flecainide and propafenone MOA:

A

Sodium channel blockers, slow wear off

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178
Q

Which class of antiarrhythmics 1a, 1b, or 1c is best tolerated?

A

1c (flecainide)

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179
Q

Flecainide and propafenone increase risk of severe arrhythmia in what patient type?

A

Structural heart disease.

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180
Q

Flecainide increases mortality in what patient specific heart disease status?

A

MI

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181
Q

2 common side effects of flecainide:

A

Blurry vision and can worsen heart failiure

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182
Q

Additional mechanism for propafenone:

A

Beta blocker

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183
Q

What are class 2 antiarrhythmics?

A

Beta blockers

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184
Q

Nadolol preferred for what 2 specific heart disease states?

A

Long QT syndrome and CPVT (catecholaminergic polymorphic ventricular tachycardia) (genetic heart defect)

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185
Q

Drug of choice for acute VT and VF and to slow ventricular rate and convert A fib.

A

Amiodarone

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186
Q

Why does amiodarone use require periodic lung evaluation

A

Pulmonary fibrosis side effect

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187
Q

5 common amiodarone side effects:

A

Corneal deposits, hepatotoxicity, neuropathy, photosensitivity, thyroid dysfunction

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188
Q

Multaq indication

A

A fib prevention

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189
Q

Why use multaq?

A

Less side effects

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190
Q

2 common dronedarone side effects

A

GI disturbances and fatal hepatotoxicity

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191
Q

Multaq increases mortality in patients with severe:

A

heart failure

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192
Q

Sotalol, tikosyn, amiodarone , and ibutilide MOA:

A

Potassium channel blocker

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193
Q

Sotalol, tikosyn, and ibutilide have high risk for what side effect?

A

TDP

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194
Q

MOA of class 4 antiarrhythmics

A

Calcium channel blockers

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195
Q

4 common side effects of verapamil and diltiazem

A

Constipation, bradycardia, hypotension, and gingival hyperplasia

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196
Q

NDHP calcium channel blockers contraindicated in what?

A

Heart failure with reduced ejection fraction

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197
Q

Treat TDP with what?

A

Mag sulfate

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198
Q

Digoxin MOA

A

Sodium-potassium ATPase inhibitor

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199
Q

Digoxin indication

A

Rate control in a fib

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200
Q

Digoxin 3 common side effects

A

GI effects, arrhythmia, and visual/cognitive dysfunction

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201
Q

Avoid what 2 drug classes with Cialis and such

A

Nitrates and alpha inhibitors (amlodipine and clonidine…)

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202
Q

Riociguat indication

A

Pulmonary arterial hypertension

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203
Q

Drug class first line for severe PAH

A

Prostacyclin analogs

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204
Q

Treprostinil 5 side effects

A

Jaw pain, hypotension, myalgia, flushing, NV

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205
Q

When is dose adjustment required for lovenox?

A

Crcl less than 30

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206
Q

Warfarin moa

A

Vitamin k antagonist

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207
Q

How to adjust warfarin in renal or hepatic impairment:

A

None, watch INR

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208
Q

Dabigatran

A

Pradaxa

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209
Q

Pradaxa dose reduction at what Crcl:

A

30

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210
Q

When can xarelto be given twice daily?

A

VTE treatment and acute coronary syndrome

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211
Q

When to get reduced dose Eliquis?

A

2 of these: Older than 80, weight < 60 kg, or Scr >=1.5

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212
Q

Savaysa

A

Edoxaban

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213
Q

Savaysa moa

A

Factor Xa inhibitor

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214
Q

What drug can be used to reverse eliquis and xarelto?

A

Andexxa (andexanet alfa)

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215
Q

Alteplase indication

A

Thrombolysis

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216
Q

Dipyridamole moa

A

Inhibits platelet aggregation and causes coronary vasodilation

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217
Q

Brillinta indication

A

ACS

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218
Q

Effient indication

A

After intervention for ACS

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219
Q

Do not use prasugrel in what age

A

> 75

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220
Q

Reduce prasugrel dose at what weight?

A

<60 kg

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221
Q

Statin use in pregnancy

A

Contraindicated

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222
Q

Safest lipid lowering drugs

A

Bile acid sequestrants

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223
Q

3 Common side effects of bile acid sequestrants:

A

Bloating, constipation, dyspepsia

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224
Q

Contraindication to bile acid sequestrant use

A

Hypertriglyceridemia, these increase triglycerides

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225
Q

Why is niacin included in prenatal vitamins, but contraindicated in pregnancy?

A

18 mg in prenatals, but 500 mg in rx strength.

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226
Q

Niacin effect on HDL, LDL, and triglycerides

A

Increase, decrease, decrease

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227
Q

Rx niacin 3 common side effects

A

Flushing, dyspepsia, and itching

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228
Q

Niacin should not be used with what class of hyperlipidemia drugs

A

Statins due to myopathy

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229
Q

Niacin is contraindicated with what 2 diseases?

A

Hx of peptic ulcer disease, and gout

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230
Q

When to choose fibrates?

A

Hypertriglyceridemia

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231
Q

Can fibrates be used in pregnancy?

A

No

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232
Q

When can fibrates be used with statins?

A

They should not

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233
Q

2 Most common side effects with fibrates

A

GI and myopathy

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234
Q

When to use zeta and bile acid sequestrants together?

A

Never

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235
Q

Can PCSK-9 inhibitors and statins be used together?

A

Yes. Complementary mechanisms.

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236
Q

How do statins Lower LDL?

A

Inhibit LDL biosynthesis

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237
Q

PCSK-9 moa

A

Increases LDL receptors and therefore LDL cell uptake.

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238
Q

PCSK-9 2 common side effects:

A

Influenza symptoms and URTI’s

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239
Q

Omega-3 indication

A

Hypertriglyceridemia

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240
Q

3 common side effects with omega-3’s

A

Arthralgia, nausea, and dyspepsia

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241
Q

Xifaxan 4 common side effects

A

Nausea, dizziness, fatigue, and swelling

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242
Q

Xifaxan moa

A

Antibiotic DNA synthesis inhibitor

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243
Q

Prednisone effects on cellular immunity:

A

Decreases pro-inflammatory cytokines IL-1 and IL-6, decreases T cell proliferation, but increases neutrophil and monocyte function.

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244
Q

2 Less obvious cyclosporine indications:

A

Rheumatoid arthritis and psoriasis

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245
Q

Cyclosporine severe interactions with what drug class?

A

Antiarrhythmics

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246
Q

9 common side effects with cyclosporine systemic

A

Tremor, hallucinations, drowsiness, coma, nephrotoxicity, HTN, hirsutism, HLD, and gum hyperplasia

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247
Q

Cyclosporine and tacrolimus MOA

A

Calcineurin inhibitor (reduce T cell activity)

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248
Q

What lab with tacrolimus?

A

Blood levels to avoid tacrolimus

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249
Q

Azathioprine moa

A

Purine metabolism inhibitor

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250
Q

5 commons side effects with azathioprine

A

Bone marrow suppression, infection susceptibility, hepatotoxicity, alopecia, and gi toxicity

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251
Q

Mycophenolate moa

A

Purine metabolism inhibitor

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252
Q

Mycophenolate 2 common side effects

A

GI and hematologic.

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253
Q

Sirolimus which cyp interactions?

A

3A, watch interactions

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254
Q

Who not to use probiotics in?

A

Immunocompromised: risk of translocation and septicemia.

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255
Q

Sirolimus moa

A

Mtor inhibitor: inhibits cytokine mediated T cell proliferation.

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256
Q

Belatacept

A

Nulojix

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257
Q

Belatacept moa

A

T cell stimulation blocker

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258
Q

Belatacept only indication

A

Transplant rejection prevention

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259
Q

Belatacept dose dependent risk:

A

Dose dependent PML, CNS lymphoproliferative disorder, and CNS infections

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260
Q

What is ATGAM?

A

Antibodies against numerous T cell surface molecules.

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261
Q

ATGAM indications:

A

Prevention and treatment of transplant rejection and aplastic anemia

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262
Q

Alemtuzumab moa

A

Anti cd 52, lymphocyte depletion

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263
Q

Rituximab 2 indications:

A

RA and MS

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264
Q

Remicade moa

A

TNF inhibitor

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265
Q

Enbrel moa

A

TNF inhibitor

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266
Q

What 4 infusion reactions with humoral, Enbrel, and remicade?

A

Fever, urticaria, hypotension, dyspnea

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267
Q

3 risks with TNF inhibitors

A

Serious infections, lymphoma, and other malignancies

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268
Q

Name a first line option for MS

A

Ocrelizumab

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269
Q

Tecfidera indication

A

MS

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270
Q

Misoprostol alternative indication

A

GI acid protective

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271
Q

Epoprostenol drug class and indication

A

Prostacyclin analogue and pulmonary arterial hypertension

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272
Q

Bimatoprost common side effect vs other “prost” eye drops

A

Upper respiratory tract infection 10% incidence

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273
Q

Bimatoprost 2 indications:

A

Eyelash darkening and growth and ocular hypertension (glaucoma prevention and treatment)

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274
Q

Aspirin prolongs bleed time for how long after a dose?

A

36 hours

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275
Q

Aspirin associated Reye syndrome in kids is associated with what 2 symptoms/diagnoses?

A

Fever and flu or varicella disease

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276
Q

Diflunisal drug class

A

Salicylate

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277
Q

Diflunisal 2 indications

A

Osteo and rheumatoid arthritis

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278
Q

Why is mesalamine only used for IBD?

A

Specific to lower gi tract.

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279
Q

3 risk factors that lower threshold for Tylenol toxicity

A

Liver impairment, more than 2 alcohol drinks per day, and malnutrition

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280
Q

What is hepatotoxic acetaminophen metabolite?

A

NAPQI

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281
Q

What effect does Tylenol have on platelets and inflammation?

A

Little effect

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282
Q

NSAID used in patent ductus arteriosus in neonates

A

Indomethacin

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283
Q

Indomethacin high risk in what patient population?

A

Over 65 years old due to high incidence of side effects

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284
Q

Why is Indomethacin not used as much as other NSAIDS?

A

Lots of side effects 20% discontinue

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285
Q

Ketorolac effect as anti-inflammatory:

A

Little effect

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286
Q

Diclofenac common, severe side effect

A

Liver toxicity 4%

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287
Q

Mefenamic acid drug class

A

NSAID

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288
Q

Mefenamic acid 2 indications

A

Pain and dysmenorrhea

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289
Q

Mefenamic acid used in what age group and what max duration?

A

Over 14 and 7 days

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290
Q

Ibuprofen effect on aspirin cardioprotection

A

Reduces cardioprotection by competing with aspirin for cox binding site.

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291
Q

Oxaprozin drug class

A

NSAIDx

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292
Q

Oxaprozin half life

A

41-55 hours

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293
Q

Oxaprozin not indicated for what pain?

A

Acute, slow onset

294
Q

Piroxicam half life

A

50 hours

295
Q

Piroxicam 2 serious side effects and how common?

A

Serious GI and skin reactions, 5%

296
Q

NSAID to use to avoid gi side effects

A

Celecoxib cox 2 selective

297
Q

Colchicine moa

A

Depolymerizes microtubules, decreasing neutrophil migration into inflamed sites.

298
Q

Which probiotics to use in C diff?

A

None recommended. Conflicting evidence.

299
Q

Allopurinol secondary indication:

A

Calcium oxalate stones

300
Q

In what impairment does allopurinol dose need to be adjusted?

A

Renal

301
Q

Risk of ___ attacks during early allopurinol treatment.

A

Gout (tissue urate mobilization)

302
Q

How long does allopurinol take to get Uris acid levels down to normal?

A

1 to 3 weeks

303
Q

Allopurinol and febuxostat moa

A

Xanthine oxidase inhibitors

304
Q

What is the most effective drug class for acute migraines?

A

Triptans (eletriptan), not CGRP’s

305
Q

Main contraindication for triptans

A

Vascular disease (stroke, Coronary artery disease, heart attack hx, peripheral artery disease, CHF, pulmonary embolism hx…)

306
Q

2 Probenecid indications

A

Hyperuricemia (not acute), elevated beta lactam levels

307
Q

Probenecid moa

A

Uric acid reabsorption inhibitor in kidneys

308
Q

Doxepin moa

A

tricyclic antidepressant

309
Q

Doxepin topical cream indication

A

Itching

310
Q

Pyrilamine moa

A

Combo topical Antihistamine

311
Q

Promethazine boxed warning

A

Fatal respiratory depression under 2 years old

312
Q

Bepotastine drug class

A

Ocular antihistamine

313
Q

Epinastine drug class

A

Ocular antihistamine

314
Q

Albuterol 4 major side effects

A

Tachycardia, palpitations, muscle tremors, hyperkalemia

315
Q

Levalbuterol advantage over albuterol

A

None

316
Q

How is Formoterol used in asthma?

A

Combo with ICS

317
Q

Loose contraindication for patients on SAMA or LABA?

A

Urinary retention and glaucoma

318
Q

ICS 2 local side effects

A

Hoarseness and thrush

319
Q

Which ICS ideal in children?

A

Budesonide

320
Q

Montelukast moa

A

Leukotriene antagonist

321
Q

Zileuton drug class

A

Leukotriene antagonist

322
Q

What elevated lab contraindicates zileuton?

A

ALT / AST

323
Q

Theophylline / aminophylline 5 commons side effects

A

Nausea, headache, diuresis, arrhythmia, seizure

324
Q

Roflumilast moa

A

PDE-4 inhibitor: inhibits WBC infiltration of lung cells to prevent remodeling and elevates cAMP in lung cells

325
Q

Omalizumab 4 indications:

A

Allergic asthma, food allergy (ig-E mediated), rhinosinusitis w/polyps, chronic urticaria

326
Q

Xolair moa

A

Anti- ig-E

327
Q

Dupixent moa

A

IL-4 antagonist

328
Q

Dupixent 7 indications:

A

Moderate to severe eosinophilia asthma or ICS dependent, asthma with mod to severe atopic dermatitis, atopic dermatitis mod-severe, refractory COPD, eosinophilia esophagitis, prurigo nodularis, and sinusitis w/polyps

329
Q

Generic growth hormone drug name

A

Somatropin

330
Q

Leydig cell function

A

Stimulate testosterone production in the testes

331
Q

Octreotide moa and indication

A

Somatostatin analog (inhibits growth hormone secretion) and acromegaly

332
Q

Cabergoline moa and 3 indications

A

D2 agonist, hyperprolactinemia, Parkinson’s, and acromegaly

333
Q

Which thyroid hormone is active? T3 or T4?

A

T3

334
Q

Getting a thyroid dose that is too high can lead to what 2 diseases?

A

Osteoporosis and atrial fibrillation

335
Q

Armour thyroid composition

A

T3 and T4

336
Q

Methimazole and PTU moa

A

Reduce thyroid hormone production by interfering with iodine incorporation into tyrosyl residues

337
Q

Methimazole pregnancy use:

A

Not first trimester due to embyopathy

338
Q

Major concern with propylthiouracil:

A

Liver toxicity

339
Q

What drug can be used for hyperthyroidism in the first trimester?

A

PTU

340
Q

Lugol solution indication

A

Reduce secretion and synthesis of thyroid hormone

341
Q

Lugol solution dose in thyroid storm in pregnancy:

A

Contraindicated

342
Q

SSKI indication

A

Acute thyroid secretion and synthesis inhibition

343
Q

Tamoxifen moa and indication

A

SERM, breast cancer treatment

344
Q

Raloxifene moa and 2 indications

A

SERM, osteoporosis treatment, breast cancer prophylaxis in high risk post-menopausal women

345
Q

SERM 2 major side effects

A

Hot flashes and clots

346
Q

Clomiphene moa

A

Anti estrogen

347
Q

Exemestane moa and indication

A

Irreversible aromatase inhibitor, breast cancer treatment

348
Q

Anastrozole and letrozole moa and indication

A

Reversible aromatase inhibitor. Breast cancer treatment.

349
Q

Risk with long term use of aromatase inhibitors:

A

Osteoporosis

350
Q

Megestrol is a derivative of what naturally occurring hormone?

A

Progesterone

351
Q

What activity differentiates norethindrone from other progestins?

A

Androgenic activity

352
Q

Mifepristone moa

A

Both progesterone receptor antagonist.

353
Q

Leuprolide moa and 2 common indications

A

GnRH agonist, reducing GnRH secretion, and therefore testosterone and estrogen. Endometriosis, precocious puberty

354
Q

Leuprolide long term use side effect

A

Osteoporosis

355
Q

What options exist outside clomiphene for ovulation induction?

A

injectable FSH and LH

356
Q

Bicalutamide moa and indication

A

Androgen receptor antagonist, add on for metastatic prostate cancer

357
Q

Finasteride moa and indications

A

5 alpha reductase inhibitor, reduces production of dihydrotestosterone in prostate, shrinking the prostate. Alopecia and BPH

358
Q

Sildenafil moa and indications

A

PDE-5 inhibitor(allows relaxation of cavernosal smooth muscle), ED and pulmonary arterial hypertension

359
Q

PDE-5 inhibitor DDI contraindication

A

Nitrates

360
Q

3 common side effects with PDE-5 inhibitors:

A

Headache, flushing, and blue-green tinted vision

361
Q

Chronic hydrocortisone dosing tip: AM and PM doses

A

20 mg AM, 10 mg PM for sleep

362
Q

Fludrocortisone dose is titrated up by what? How often dosed?

A

Blood pressure (upright posture tolerance) once daily due to long half life

363
Q

Corticosteroid 3 short term side effects:

A

Insomnia, weight gain, emotions

364
Q

High-dose/long term corticosteroid 6 side effects:

A

Psychosis, infection risk, osteoporosis, osteonecrosis, myopathy, HPA axis suppression

365
Q

2 common side effects of steroid eye drops:

A

Glaucoma and cataract formation

366
Q

Chronic inhaled steroid use in children effect on height:

A

Slow growth velocity, no effect on final height.

367
Q

inhaled steroid with least side effects and why:

A

Ciclesonide, low oral biavailability

368
Q

Reasons for steroid use in leukemia and lymphoma

A

Cytotoxic effects and relief of pain, nausea, and appetite stimulation

369
Q

Cabergoline off label use for reduction of ACTH

A

Cushing disease

370
Q

Regular insulin onset and duration

A

30 minutes, 4-6 hours

371
Q

Rapid acting insulin onset and duration

A

10 minutes, 3-4 hours

372
Q

NPH insulin onset and duration

A

1 hour, 8-12 hours

373
Q

Long acting insulin onset and duration

A

1 hour, 18-42 hours (Degludec 42 hours)

374
Q

Metformin moa

A

Increase glucose uptake peripherally, decrease hepatic gluconeogenesis

375
Q

3 common ADR’s with metformin

A

Nausea, diarrhea, and lactic acidosis

376
Q

Why metformin stopped on hospital admit?

A

Contrast dye elevated levels due to renal insult

377
Q

Is metformin used in renal and hepatic problems?

A

Dose adjust for renal, not in liver problems

378
Q

Acarbose drug class and moa

A

Alpha glucose dose inhibitor, reduces carb breakdown in gi tract.

379
Q

2 common side effects with acarbose

A

GI flatulence and elevated LFT’s

380
Q

Name 2 DPP4’s

A

Sitagliptin, saxagliptin, linagliptin, alogliptin

381
Q

DPP4 moa

A

Inhibit breakdown of GLP-1, increased satiety, lower blood glucose.

382
Q

Name the 3 sulfonylureas

A

Glipizide, glimepiride, glyburide

383
Q

Sulfonylurea moa

A

Stimulate insulin release

384
Q

Sulfonylurea major side effect

A

Hypoglycemia

385
Q

Nateglinide and repaglinide moa

A

Increase insulin secretion

386
Q

Jardiance class and moa

A

SGLT2 inhibitor. Decrease glucose reabsorption in kidneys.

387
Q

Main side effect of SGLT2 inhibitors:

A

Increased risk of UTI

388
Q

What serious diabetes complication can SGLT2 inhibitors mask?

A

DKA

389
Q

What side effect do SGLT2 inhibitors not cause that other diabetes drugs do?

A

Hypoglycemia

390
Q

Actos moa

A

Increase peripheral insulin sensitivity

391
Q

5 common side effects for actos:

A

Edema, CHF, weight gain, fractures, macular edema

392
Q

Actos drug class

A

Thiazolidinedione

393
Q

actos absolutely contraindicated in:

A

CHF reduced ejection fraction

394
Q

GLP-1 agonists 5 common side effects:

A

Nausea, GI, headache, fatigue, sinus infection

395
Q

Avoid using GLP-1’s with agents that do what?

A

Decrease GI motility (oxybutynin…)

396
Q

Pramlintide moa

A

Slows gastric emptying and decreases glucagon (like amylin naturally occurring)

397
Q

Diazoxide moa

A

Inhibits insulin secretion

398
Q

Name 3 Diazoxide common side effects

A

Nausea, edema, hyperuricemia, thrombocytopenia, hypertrichosis (hair growth), leukopenia

399
Q

Diazoxide 2 indications

A

Hypertensive crisis, hyperinsulinemia

400
Q

Octreotide common side effect

A

Gallbladder abnormality

401
Q

Parathyroid hormone effect on calcium

A

Release calcium from bone into bloodstream, increase gastric calcium absorption, decrease renal excretion of calcium, stimulate osteoblasts.

402
Q

Why would vitamin d help with hypoparathyroidism?

A

Low blood calcium from low absorption leads to hypoparathyroidism and osteoporosis, so vitamin d helps with calcium uptake and parathyroid hormone secretion

403
Q

Why would vitamin d help with CKD induced hyperparathyroidism?

A

Parathyroid is released to increase blood levels of calcium, depleting bone stores (osteoporosis). Vitamin d increases absorption of calcium.

404
Q

Calcitriol moa

A

Active form of vitamin d for CKD patients.

405
Q

Calcitriol effect on phosphate

A

Elevate levels of phosphate

406
Q

Hyperphosphatemia effects in body

A

Calcium deposits in heart, liver, kidneys… muscle cramps

407
Q

Hypophosphatemia body effects

A

Fatigue, weakness, bone pain, seizures (acute re-feeding)

408
Q

Phosphate actions in body:

A

Converting ADP to ATP, bone mineralization, glycolysis, component of cell membrane and DNA and RNA, effects oxygen-carrying capacity of hemoglobin, and acts as urinary buffer by binding to free hydrogen ions.

409
Q

First line option for reducing dietary phosphate

A

Tums

410
Q

Rx option for phosphate binding

A

Sevelamer carbonate

411
Q

Bisphosphonate moa

A

Reduce osteoclast activity, allowing bones to stay strong

412
Q

Counseling point on bisphosphonates:

A

Take on empty stomach and sit up 30 minutes after dose (esophageal ulcers).

413
Q

2 severe issues with bisphosphonates

A

Osteonecrosis of the jaw and femoral fractures

414
Q

Bisphosphonates are contraindicated with delayed ___ ___

A

Esophageal emptying

415
Q

When to change dose or switch from ibandronate.

A

Poor kidney function (CrCl under 30)

416
Q

Zoledronate contraindicated in what 2 things?

A

CrCl under 35 and hypocalcemia

417
Q

Forteo

A

Teriparatide

418
Q

Forteo use limited to less than ___

A

2 years

419
Q

Forteo moa

A

Parathyroid hormone analog (stimulates osteoblasts, increases gastric absorption of calcium, inhibits calcium excretion via kidneys)

420
Q

Chronic high parathyroid hormone net effect

A

Osteoporosis

421
Q

Pulse dosing of parathyroid hormone net effect

A

Bone building

422
Q

Hormone that works opposite of parathyroid?

A

Calcitonin

423
Q

Cinacalcet moa

A

Calcium sensing receptor mimetic (tells sensor that calcium level too high)

424
Q

Cinacalcet 2 indications

A

Hypercalcemia and secondary hyperparathyroidism of CKD.

425
Q

Side effect of cinacalcet

A

Hypocalcemia

426
Q

Cinacalcet interactions:

A

Cyp3a4 strong inhibitors and CYP2d6 substrates.

427
Q

Calcitonin effect on osteoclast

A

Inhibitor.

428
Q

Denosumab moa

A

Binds to RANKL, blocks interaction between RANKL and RANK on osteoclast surface, and prevents osteoclast formation. Builds bone mass.

429
Q

Hydrochlorothiazide effect on calcium

A

Reduce calcium excretion

430
Q

Potentially serious DDI with omeprazole

A

Plavix, studies show increased mortality risk, some studies did not show risk. Better to avoid.

431
Q

4 PPI side effects:

A

Fracture risk, diarrhea, nephritis, b-12 deficiency (long term 3 years use)

432
Q

Misoprostol side effect

A

Diarrhea

433
Q

Sucralfate side effect

A

Constipation

434
Q

Prucalopride moa

A

5ht-4 agonist, increase GI motility

435
Q

Prucalopride 3 indications

A

GERD, gastroparesis, severe constipation

436
Q

2 side effects and 1 risk of prucalopride

A

Headache and diarrhea. Serious cardiac risk

437
Q

Mechanism of gastric movement by metoclopramide:

A

5HT4 agonist

438
Q

3 side effects of metoclopramide:

A

hyperprolactinemia (dopamine antagonism induced), CNS depression, and EPS (tar dive dyskinesia)

439
Q

What macrolide increases gastric motility?

A

Erythromycin

440
Q

Lactulose 2 indications:

A

Constipation and hepatic encephalopathy

441
Q

Linzess youngest age for use:

A

6 years old

442
Q

Linzess moa

A

Guanylate cyclase-C agonist (draw water into bowel)

443
Q

Lubiprostone moa

A

Cl channel activator (draw water into bowel)

444
Q

2 lubiprostone side effects

A

Nausea and diarrhea

445
Q

Naloxegol moa

A

Mu opioid receptor antagonist peripherally for constipation

446
Q

Alosetron indication

A

IBS-D (women)

447
Q

Preferred antibiotic for children with traveler’s diarrhea

A

Azithromycin

448
Q

Xifaxan 2 indications

A

Traveler’s diarrhea and IBS-D

449
Q

What type of diarrhea does clonidine help with?

A

Diabetic diarrhea

450
Q

Lomotil and loperamide soft duration limit

A

10 days.

451
Q

Dicyclomine 3 contraindications

A

Colitis, bowel obstruction, and GERD

452
Q

Zofran moa

A

5HT3 antagonist

453
Q

Ondansetron 4 common side effects

A

Headache, constipation, fatigue, malaise

454
Q

How does prochlorperazine inhibit nausea?

A

Dopamine antagonism at chemoreceptor trigger zone.

455
Q

How does scopolamine inhibit nausea?

A

Anti muscarinic that blocks histamine signals from inner ear to vomiting center

456
Q

5 common side effects with scopolamine

A

Dizziness, constipation, drowsiness, dry mouth, blurred vision

457
Q

Ursodiol indication

A

Prevention and dissolution of gall stones

458
Q

Ursodiol 2 side effects

A

Nausea (GI) and headache

459
Q

Mesalamine by mouth has less effects where in GI tract?

A

Ileum and large intestine

460
Q

How does sulfasalazine reach distal regions of GI tract?

A

Prodrug metabolized by colonic bacteria.

461
Q

Why balsalazide?

A

Reaches colon and does not contain sulfa group.

462
Q

Big risk of IBD treatment with 6 mercaptopurine

A

4 fold higher risk of lymphoma

463
Q

Big risk of treatment with azathioprine

A

4 fold risk of lymphoma

464
Q

What 2 antibiotics are commonly used together in pediatric Crohn’s disease? Not effective in what?

A

Cipro and flagyl, Ulcerative colitis

465
Q

Positional counseling point for doxycycline and all tetracyclines:

A

Do not recline for 1 hour after taking orally due to esophagitis risk.

466
Q

Metronidazole 2 common side effects

A

Headache and metallic taste (dysgeusia)

467
Q

First line in giardiasis

A

Metronidazole

468
Q

What is used for resistant giardiasis?

A

Nitazoxanide

469
Q

Drug of choice in trichomoniasis

A

Metronidazole

470
Q

3 drug regimen for toxoplasmosis:

A

Pyrimethamine, sulfadiazine, and leucovorin.

471
Q

Drug of choice for cryptosporidiosis

A

Nitazoxanide

472
Q

What is albendazole used for?

A

Intestinal worms.

473
Q

Sulfa antibiotics: bactericidal or static?

A

Static, folate synthesis inhibitor.

474
Q

How does silver sulfadiazine work?

A

Prevents infection via folate synthesis inhibition

475
Q

Bactrim has excellent efficacy against what 4 bugs?

A

Staph aureus, staph epi, strep pyogenes, and e. Coli

476
Q

3 common side effects of bactrim

A

Rash, GI upset, and hyperkalemia

477
Q

Quinolones: cidal or static?

A

Cidal

478
Q

Quinolone moa

A

DNA storage damage, inhibit dna topoisomerase and gyrase

479
Q

Do not give quinolones with:

A

Divalent cations

480
Q

3 common side effects with quinolones

A

Neuro, tendinitis, and photosensitivity

481
Q

Quinolones are typically avoided in what 2 patient types?

A

Pregnancy and children

482
Q

Cipro has excellent coverage of what 6 bugs?

A

E. Coli, klebsiella, proteus, serratia, salmonella, shigella

483
Q

Levaquin has excellent coverage of bugs of cipro and which 4 additional bugs?

A

Strep, H flu, legionella, and chlamydia

484
Q

Moxifloxacin cannot be used for what infection?

A

UTI, no penetration

485
Q

Methenamine moa

A

Forms formaldehyde in urine, chronic suppression of UTI

486
Q

Methenamine requires ___ urine to work

A

Acidic

487
Q

Nitrofurantoin moa

A

Causes DNA damage to bacteria.

488
Q

3 things to watch out for with nitrofurantoin

A

Pulmonary toxicity, peripheral neuropathy, and turns urine brown

489
Q

Does fosfomycin have effect in blood?

A

No, only urine

490
Q

Fosfomycin moa

A

Inhibits cell wall synthesis

491
Q

What drug for UTI with proteus?

A

Fosfomycin

492
Q

Are penicillins cidal or static?

A

Cidal

493
Q

Dicloxacillin indications

A

Skin and soft tissue MSSA infections

494
Q

Amoxicillin and ampicillin have excellent coverage of what 2 bugs?

A

Beta hemolytic strep and E. Faecalis

495
Q

Augmentin adds excellent coverage of what 3 bugs?

A

B. Frag, H flu, and proteus

496
Q

Cefadroxil what gen cephalosporin?

A

1st gen

497
Q

Cephalexin and cefadroxil cover what 2 bugs excellently?

A

MSSA and streptococci

498
Q

Cefuroxime, cefaclor, and cefprozil what gen?

A

2nd gen

499
Q

2nd gen cephalosporins add coverage of what bugs?

A

H flu, proteus, E. coli, klebsiella

500
Q

Cefpodoxime what gen?

A

3rd gen

501
Q

Cefixime what gen?

A

3rd gen

502
Q

Third gen cephalosporin 5 indications:

A

CAP, meningitis, UTI, strep endocarditis, and gonorrhea

503
Q

Aminoglycosides cidal or static?

A

Cidal

504
Q

Aminoglycoside moa

A

Concentration dependent, Inhibit bacterial protein synthesis

505
Q

Aminoglycoside oral absorption

A

Almost none, only used orally for bowel decontamination

506
Q

Ear administration of aminoglycosides should be avoided in what patients?

A

Those with tubes in (ototoxicity)

507
Q

Tetracycline moa

A

Protein synthesis inhibitor

508
Q

Tetracyclines: cidal or static?

A

Static

509
Q

Why tetracyclines avoided in pregnancy and children under 8?

A

Binds to developing bone and causes malformations

510
Q

Tetracyclines time or concentration dependent?

A

Time

511
Q

Macrolide moa

A

Inhibit bacterial protein synthesis

512
Q

Macrolide: cidal or static? Time or concentration dependent?

A

Static, concentration

513
Q

Which macrolides are major cyp inhibitors?

A

Erythromycin and clarithromycin

514
Q

Claithromycin usually seen in what 2 infections?

A

H pylori and CAP

515
Q

Clarithromycin side effect at high doses

A

Tinnitus

516
Q

Azithromycin half life

A

48 hours

517
Q

When would you see telithromycin?

A

Macrolide resistant strep and staph

518
Q

Why is telithromycin not used often?

A

Severe Hepatotoxicity

519
Q

Clindamycin moa

A

Protein synthesis inhibitor

520
Q

Clindamycin good activity against what bug class?

A

Strep (pyogenes, pneumo, and viridans)

521
Q

Linezolid moa

A

Static protein synthesis inhibitor

522
Q

Linezolid DDI

A

SSRI, serotonin syndrome

523
Q

Why is Linezolid not dosed once daily?

A

Time dependent

524
Q

Vancomycin, cidal or static? Moa

A

Cidal cell wall synthesis inhibitor

525
Q

Oral vancomycin indication:

A

C diff

526
Q

Is oral vancomycin absorbed?

A

No

527
Q

Daptomycin not effective for what site?

A

Lungs (pneumonia), inactivated by lung surfactant

528
Q

Daptomycin moa

A

Cidal cell wall synthesis inhibitor

529
Q

Metronidazole moa

A

Disrupt dna synthesis in anaerobes

530
Q

Metronidazole has good coverage of what 2 species?

A

B frag and clostridium

531
Q

Bacitracin and mupirocin moa

A

Cell wall synthesis inhibitor

532
Q

Rifampin general ddi

A

Potent Cyp inducer

533
Q

Why is rifampin a problem in alcoholics?

A

Hepatitis

534
Q

Tuberculosis treatment acrostic

A

RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)

535
Q

Dapsone topical indication

A

Acne

536
Q

Dapsone moa

A

Folate antagonist

537
Q

Dapsone oral 4 common indications

A

Leprosy, malaria in combo, pneumocystis jiroveci, toxoplasma prophylaxis

538
Q

What test prior to using dapsone

A

G6PD deficiency

539
Q

Dapsone can cause what side effect at 200+ mg per day dose?

A

Hemolysis

540
Q

Azole antifungal moa

A

Ergosterol synthesis inhibition

541
Q

Itraconazole potent ddi

A

Cyp 3A4 inhibitor

542
Q

Fluconazole inhibits what 2 cyps?

A

3a4 and 2c9

543
Q

Posaconazole administration

A

With food

544
Q

What drug for mucormycosis?

A

Isavuconazole

545
Q

Griseofulvin moa and 2 indications

A

Inhibits microtubule function, ringworm and toenail fungus

546
Q

Griseofulvin has what effect on cyp’s?

A

Induction

547
Q

Terbinafine moa and 2 indications

A

Inhibit fungal squalene epoxidase and reduce ergosterol synthesis. Ringworm and toenail fungus

548
Q

Terbinafine ____ in skin, nails, and fat

A

Accumulates

549
Q

Acyclovir and Val limited to use in ____ viruses

A

Herpes

550
Q

Best against cytomegalovirus

A

Valgancyclovir

551
Q

Trifluridine indication

A

Ocular herpes

552
Q

Oseltamivir moa

A

Neuraminidase inhibitor, prevents release of complete virus from cell.

553
Q

Amantadine moa as antiviral

A

Inhibits m2 protein function

554
Q

Entecavir moa

A

Inhibits HBV reverse transcriptase

555
Q

Entecavir counseling point administration

A

Empty stomach

556
Q

Tenofovir disoproxil fumarate moa

A

Reverse transcriptase inhibitor

557
Q

Tenofovir 6 common side effects:

A

Abd. Pain, nausea, insomnia, pruritus, dizzyness, pyrexia

558
Q

Lamivudine 2 common side effects

A

ENT infections and diarrhea

559
Q

Sofosbuvir/velpatasvir indication

A

Hep c treatment (all genotypes)

560
Q

Velpatasvir administration

A

Acidic stomach required

561
Q

Avoid sofosbuvir if Crcl under ___

A

30

562
Q

2 common side effects of sofosbuvir/velpatasvir

A

Fatigue and headache

563
Q

Sofosbuvir moa

A

Inhibits HCV RNA polymerase

564
Q

Difference between NRTI and NNRTI meds

A

NNRTI’s are newer and do not require phosphorylation to be activated, NNRTI’s are not active against HIV-2

565
Q

Zidovudine 3 common side effects:

A

Anemia, neutropenia, and myopathy

566
Q

Lamivudine 2 indications:

A

HBV and HIV

567
Q

Lamivudine clinical pearl about side effects:

A

Essentially non toxic

568
Q

Abacavir side effect to watch for

A

Hypersensitivity syndrome: fever, abd. Pain, and rash associated with HLA B*5701, stop use: potentially fatal

569
Q

Tenofovir 3 indications:

A

HIV treatment, HBV, and HIV prophylaxis

570
Q

Tenofovir 2 unique side effects:

A

Nephrotoxicity (severe is rare) and bone mineral density loss with chronic use

571
Q

Emtricitabine side effect clinical pearl

A

Generally non toxic

572
Q

Difference between HIV-1 and 2:

A

HIV-2 is slower onset, HIV-1 is predominant in America.

573
Q

Nevirapine drug class

A

NNRTI

574
Q

Nevirapine clinical pearl

A

Autoinducer of metabolism

575
Q

Nevirapine most common side effect:

A

Rash (resolves in time)

576
Q

Efavirenz common side effect

A

CNS toxicity (resolves in time, but can be severe enough to stop drug)

577
Q

Rilpivirine counseling point

A

Give with food, avoid PPI

578
Q

Etravirine common side effect

A

Rash that resolves

579
Q

Ritonavir moa

A

Protease inhibitor, potent CYP3A4 inhibitor (boosts concentration of other drugs)

580
Q

Ritonavir common side effect

A

Nausea

581
Q

Fosamprenavir drug class

A

Protease inhibitor

582
Q

Loping if drug class

A

Protease inhibitor

583
Q

Atazanavir drug class and co-administered with

A

Protease inhibitor, ritonavir or cobicistat

584
Q

Darunavir drug class

A

Protease inhibitor

585
Q

Darunavir co administration

A

Must be used with ritonavir or cobicistat

586
Q

Best tolerated protease inhibitor in HIV

A

Darunavir

587
Q

Drug class for maraviroc and enfuvirtide:

A

Cell entry inhibitors HIV

588
Q

Drug class ending in “gravir”

A

Integrase inhibitors

589
Q

Avoid taking integrase inhibitors with what?

A

Divalent cations

590
Q

Integrase inhibitor counseling point on side effects

A

Well tolerated

591
Q

3 drug classes in oncology:

A

Alkylating agents and platinum coordination complexes, antimetabolites, and natural products

592
Q

Alkylating agents and platinum coordination complexes MOA:

A

Covalent modification of DNA (damage)

593
Q

Alkylating agents and platinum coordination complex 5 side effect types:

A

Immunosuppression, dividing mucosal and hair follicle cell toxicity, delayed pulmonary fibrosis, reproductive system toxicity, leukemogenesis (leukemia causing)

594
Q

Mechlorethamine drug class:

A

Alkylating agent

595
Q

Cyclophosphamide drug class

A

Alkylating agent

596
Q

Methotrexate drug class:

A

Antimetabolite

597
Q

Carboplatin drug class

A

Platinum coordination complex

598
Q

Pemetrexed drug class

A

Antimetabolite

599
Q

5-fluorouracil drug class

A

Antimetabolite

600
Q

Oxaliplatin drug class

A

Platinum coordination complex

601
Q

Ifosfamide drug class

A

Alkylating agent

602
Q

Melphalan drug class

A

Alkylating agent

603
Q

Chlorambucil drug class

A

Alkylating agent

604
Q

Capecitabine drug class

A

Antimetabolite

605
Q

Cytarabine drug class

A

Antimetabolite

606
Q

Bendamustine drug class

A

Alkylating agent

607
Q

Busulfan drug class

A

Alkylating agent

608
Q

Gemcitabine drug class

A

Antimetabolite

609
Q

5-azacytidine drug class

A

Antimetabolite

610
Q

Carmustine drug class

A

Alkylating agent

611
Q

Streptozocin drug class

A

Alkylating agent

612
Q

Procarbazine drug class

A

Alkylating agent

613
Q

Dacarbazine drug class

A

Alkylating agent

614
Q

Temozolomide drug class

A

Alkylating agent

615
Q

Cisplatin drug class

A

Platinum coordinating complex

616
Q

Mercaptopurine drug class

A

Antimetabolite

617
Q

Fludarabine drug class

A

Antimetabolite

618
Q

Antimetabolite moa

A

Inhibit DNA and RNA function and formation.

619
Q

Vinblastine drug class

A

Natural products

620
Q

Vinorelbine drug class

A

Natural products

621
Q

Vincristine drug class

A

Natural products

622
Q

Cladribine drug class

A

Antimetabolite

623
Q

Eribulin drug class

A

Natural products

624
Q

Paclitaxel drug class

A

Natural products

625
Q

Docetaxel drug class

A

Natural products

626
Q

Clofarabine drug class

A

Antimetabolites

627
Q

Topotecan drug class

A

Natural products

628
Q

Irinotecan drug class

A

Natural products

629
Q

Nelarabine drug class

A

Antimetabolite

630
Q

Actinomycetes drug class

A

Natural products

631
Q

Daunorubicin drug class

A

Natural products

632
Q

Doxorubicin drug class

A

Natural products

633
Q

Pentostatin drug class

A

Antimetabolites

634
Q

Mitoxantrone drug class

A

Natural products

635
Q

Etoposide drug class

A

Natural products

636
Q

Teniposide drug class

A

Natural products

637
Q

What 2 non cancer indications does mercaptopurine have?

A

Crohn’s and ulcerative colitis

638
Q

Hydroxyurea moa

A

Inhibits conversion of ribo to deoxyribonucleotides (inhibits DNA synthesis)

639
Q

L-asparaginase moa

A

Deprives leukemia cells that lack asparagine synthase.

640
Q

Bleomycin moa

A

Binds to DNA and causes damage.

641
Q

EGFR function

A

Growth and differentiation of epithelial cells

642
Q

EGFR tyrosine kinase inhibitor function

A

Inhibit function of EGFR

643
Q

Monoclonal antibody targeting EGFR function

A

Reduce expression and function of EGFR, draw in immune cells to kill cell.

644
Q

Sunosi moa

A

Dopamine and norepinephrine reuptake inhibitor. Does not cause monoamine release like adderall.

645
Q

Drug ending in Mumab?

A

Humanized monoclonal antibody

646
Q

Drug ending in Zumab?

A

Human protein with antigen biding region from mouse

647
Q

Drug ending in Ximab?

A

Chimera of human constant and mouse variable antibody domains

648
Q

Drug ending in Omab?

A

Fully mousey protein sequence

649
Q

Drug ending in ib?

A

Small molecule drugs, mostly tyrosine kinase inhibitors.

650
Q

What is HER2?

A

Human epidermal growth factor receptor 2, a common receptor that gets over expressed in breast cancers and can lead to more aggressive tumors.

651
Q

Jak inhibitors moa

A

Reduce signaling for growth factors in hematopoeisis and immune cells

652
Q

CDK4/6 inhibitor moa

A

Prevent cell progression through mitosis

653
Q

BTK inhibitor moa

A

Prevents excessive B cell growth and differentiation.

654
Q

BCR-ABL inhibitor drug name and importance

A

Gleevec (imatinib), prevents this BCR-ABL complex from forming and causing uncontrollable cell division.

655
Q

ALK inhibitor moa

A

Prevent ALK (a protein in cell membrane) from forming oncogenic drivers

656
Q

Inhibitor of PI3K/Akt/mTOR pathway moa

A

Excessive signaling through this pathway is common in many cancers, these promote cell death for out of control growth.

657
Q

Why target VEGF in cancer?

A

To prevent tumor cells from hijacking blood flow and nutrients to support tumor growth.

658
Q

Describe immune checkpoint inhibitors

A

Cancer cells down regulate T cells to promote their own survival, but the discovery of checkpoints that cancer cells use enabled inhibitors that allow T cells to stay active and kill cancer cells.

659
Q

Name 3 checkpoint targets for inhibition

A

CTLA-4, PD-1 and PD-L1

660
Q

Which interleukin is mimicked with drugs to fight cancer? MOA

A

IL-2, promotes T cell and NK cell growth, stimulates B cell proliferation and antibody production. Drives development of T regs (mediates tolerance and suppression). Limits dangerous autoimmune reactions.

661
Q

Do cancer vaccines exist?

A

Technically yes, but they work for treatment, not prevention.

662
Q

Explain moa of chimeric antigen receptor T cells: (CAR-T)

A

CAR-T cells have an engineered antigen receptor on the T cell surface that recognizes the specific cancer cell, then activates T cells to kill it.

663
Q

Why target PARP1, a DNA repair enzyme?

A

Prevents cancer cells from repairing DNA, then they die faster than normal cells.

664
Q

BCL2 target rationale

A

Family of proteins on cell membrane surface that control membrane permeability and apoptosis. BCL2 is like a dam that holds back apoptotic protein activation in cancer cells. Inhibition leads to cell death.

665
Q

Thalidomide cancer use:

A

Inhibits growth and differentiation of multiple myeloma cancer cells, angiogenesis inhibitor, T cell activation.

666
Q

Proteasome inhibitor moa in cancer

A

Disrupts intracellular signaling cascades and leads to apoptosis.

667
Q

Moa of CD-20 inhibitors

A

All B cells express this receptor, causes death of B cells, useful in lymphomas with B cell hyper differentiation.

668
Q

CD-52 targeting moa

A

CD-52 is an antigen expressed on neutrophils, and all B and T cells. This causes cancer cell death via antibody flagging mechanisms.

669
Q

CD-33 target MOA

A

Expressed on many hematopoetic cancer cells, once taken into cell, potent toxin bound to drug kills cell.

670
Q

Can Linzess caps be opened?

A

Yes, sprinkle on applesauce or water.

671
Q

How is Clindamycin - benzoyl peroxide gel stored in pharmacy. At home?

A

Fridge, then room temp for up to 10 weeks

672
Q

Why Briviact vs levetiracetam?

A

Significantly less side effects

673
Q

Why is it a breakthrough to have colony stimulating factors available for erythrocytes, granulocytes, and macrophages in cancer?

A

This enables use of higher dose chemo drugs and the CSF’s help prevent febrile neutropenia and other associated immunodeficiencies.

674
Q

Why is histone deacetylase a cancer target?

A

Inhibiting this family of enzymes can lead to prevention of differentiation in cancer cells (turned off at the genetic level).

675
Q

Prednisolone max daily dose for acute disease in kids under 12:

A

60 mg

676
Q

Tamoxifen moa

A

Selective estrogen receptor modulator, reduces estrogen levels and treats breast cancer. Both agonizes and antagonizes estrogen receptor.

677
Q

Steady state tamoxifen levels reached how long? Why?

A

3-4 weeks, long half life

678
Q

4 Possible tamoxifen major toxicities (2 agonist, 2 antagonist):

A

Agonist: endometrial cancer and clots.
Antagonist: vasomotor symptoms and menstrual irregularities

679
Q

Fulvestrant moa difference from tamoxifen:

A

estrogen receptor downregulator, no agonist activity or side effects.

680
Q

Anastrozole moa

A

Aromatase inhibitor, lowers serum estrogen

681
Q

Letrozole moa

A

Aromatase inhibitor

682
Q

Aromatase inhibitors contraindication:

A

Use in premenopausal women with ovarian function

683
Q

Beyond use date for long acting inhalers? Same as expiration date?

A

90 days from opening seal, no.

684
Q

Aromatase inhibitor 4 common side effects

A

Vasomotor (hot flashes, night sweats, palpitations), arthralgia, BMD loss (and osteoporosis and fractures), vaginal dryness (dyspareunia)

685
Q

Megestrol moa

A

Progesterone receptor agonist

686
Q

Megestrol 8 common side effects

A

Weight gain, nausea, vomiting, edema, breakthrough bleeding, SOB, thrombophlebitis (clot associated with vein inflammation), pulmonary embolism

687
Q

Medroxyprogesterone cancer use:

A

Endometrial and breast cancers

688
Q

4 common medroxyprogesterone side effects:

A

Hot flashes, weight gain, depression, amenorrhea

689
Q

Leuprolide moa and indications

A

Gonadotropin releasing hormone agonist: androgen deprivation in advanced prostate cancer and breast cancer (suppress estrogen and progesterone production)

690
Q

Bicalutamide indication and moa

A

Non steroidal anti androgen in castration resistant prostate cancer.

691
Q

Bicalutamide 7 common side effects

A

Sexual dysfunction, gynecomastia, fatigue, diarrhea, headache, muscle pain, vasomotor.

692
Q

Perphenazine class and moa

A

1st gen antipsychotic, D2 antagonist

693
Q

Abiraterone moa and indication

A

Inhibit sex hormone production, treatment of advanced prostate cancer

694
Q

Counseling point with abiraterone

A

Take on empty stomach, food causes increased concentrations and toxicity

695
Q

Stimulation of what ophthalmic adrenergic receptor causes mydriasis?

A

alpha 1

696
Q

Stimulation of what ophthalmic cholinergic receptor causes miosis?

A

M3

697
Q

Name 1 anesthetic eye drop

A

Tetracaine or proparacaine

698
Q

Durezol indication and moa

A

Pain and inflammation. Glucocorticoid

699
Q

Which 2 steroid creams are considered high potency?

A

Clobetasol and betamethasone propionate

700
Q

Limit topical steroids to what duration?

A

2-3 weeks

701
Q

Avoid concurrent application of topical retinoids with what? And why?

A

DEET, due to increased DEET absorption. (Separate by 30 minutes)

702
Q

How to start topical retinoids to avoid skin irritation

A

Every other night administration

703
Q

Retinoids have decreased activity in the presence of what 2 things?

A

Sunlight and BPO

704
Q

Which to retinoids do not have decreased activity if exposed to the above things?

A

Adapalene and tazarotene

705
Q

Pregnancy should be avoided for how long after stopping isotretinoin?

A

1 month

706
Q

Pregnancy should be avoided for how long after stopping acitretin?

A

3 years

707
Q

6 non skin side effects of isotretinoin:

A

Conjunctivitis, myalgia, arthralgia, epistaxis, decreased night vision, and hyperlipidemia

708
Q

Calcipotriene indication

A

Psoriasis

709
Q

TNF inhibitor moa in psoriasis (3)

A

Reduces inflammation, decreases keratinocyte proliferation, and decreases vascular adhesion

710
Q

Calcipotriene moa

A

Vitamin d analog that slows production of skin cells

711
Q

Calcipotriene potential side effect:

A

Kidney stones

712
Q

Azelaic acid 3 moa’s and 2 indications

A

Prevents clogged pores (comedolytic), antibiotic, anti-inflammatory for acne and rosacea

713
Q

Why use Clindamycin with benzoyl peroxide?

A

Prevent resistance and better efficacy

714
Q

Avoid what topical med with dapsone?

A

Benzoyl peroxide (orange-brown staining of skin/hair)

715
Q

Why is erythromycin used with BPO?

A

To avoid bacterial resistance and have greater efficacy

716
Q

Sulfur skin moa

A

Keratolytic

717
Q

Sulfacetamide with BPO counseling point

A

Orange brown staining of clothes, not skin

718
Q

Can neosporin be used in a surgical wound?

A

Not typically

719
Q

Mupirocin used against which 2 bugs?

A

Staph aureus and strep pyogenes

720
Q

Can topical ivermectin be used for scabies?

A

No, oral only

721
Q

Moa for ivermectin against scabies and lice

A

Binds glutamate-gated chloride channels, causing hyperpolarization of nerve or muscle cells

722
Q

Lindane indications:

A

Scabies and lice

723
Q

Malathion indication and moa

A

Head lice, acetylcholinesterase inhibitor (causing paralysis)

724
Q

Permethrin indicated for as young as what age?

A

2 months

725
Q

3 skin indications for dapsone:

A

Dermatitis herpetiformis (recurrent skin rash autoimmune), leprosy, neutrophilic dermatoses

726
Q

Podofilox indication

A

Genital warts

727
Q

Imiquimod moa and 3 indications

A

TLR-7 activator, inducing cytokines and upregulating immune response. Genital warts. Actinic keratoses, superficial basal cell carcinoma

728
Q

Topical urea moa

A

Hydration, enhancing skin peeling

729
Q

Topical sulfur moa in hyperkeratotic disorders

A

Breaks down keratin by binding with cysteine and reducing to hydrogen sulfide

730
Q

Penicillamine indication

A

Copper poisoning

731
Q

Indication for deferoxamine, deferasirox, and deferiprone

A

Acute and chronic iron toxicity

732
Q
A

Pharmacy (22 decks)

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