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Clin Pharm Exam Two > GIGU Case Wrap Up > Flashcards

GIGU Case Wrap Up Flashcards

1
Q

What abx are HIGH risk for C. Diff?

A

Can Catherine Fuck Andre

Clinda, Cephalo, Fluoroquinolones, Augmentin

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2
Q

What abx are LOW risk for C. Diff?

A 
And Make (him feel) Very Bad 
Aminoglycosides, metro, vanco, bactrim
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3
Q

What is the best antimemetic for nausea?

A

Zofran

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4
Q

What is the first line empiric abx to use in suspected bacterial colitis?

A

Cipro

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5
Q

This bacteria causes Bloody diarrhea, severe cramping, fever 0-30% of the time, N/V

A

E.Coli

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6
Q

Cause/risks/exposure that would perdispose someone to ecoli?

A

Undercooked ground beef, unpasteurized juices and milk, working with cattle

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7
Q

Tx for ecoli?

A

Supportive care. Abx use is controversial as it can release shiga toxin and cause HUS

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8
Q

This bacteria causes profuse watery diarrhea with rapid dehydration. “Rice water stools”. Lose 1-3L per day up to 20L

A

Vibrio cholera

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9
Q

Cause/risks/exposure that would perdispose someone to vibrio cholera?

A

Poor sanitation- is a waterborne disease

Shellfish

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10
Q

Tx for vibrio cholera?

A

REHYDRATE REHYDRATE REHYDRATE

Doxycycline or ciprofloxacin can help limit duration of disease, but dehydration is the main issue

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11
Q

This bacteria causes Diarrhea: bloody, watery, pus, and mucus
Fever, stomach cramps, nausea, vomoting, dehydration

A

Shigella

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12
Q

Cause/risks/exposure that would perdispose someone to shigella?

A

Person to person spread; very virulent.

Fecal oral spread, also flies and inanimate objects.

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13
Q

Tx for shigella?

A

-Ciprofloxacin

Bactrim or azithromycin as alternates

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14
Q

This bacteria causes Fever and diarrhea and is caused by Eating contaminated meat or eggs, or infected food handlers. Handling reptiles?

A

Salmonella

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15
Q

Tx for salmonella?

A

Most cases are self-limiting and do not require abx. If high risk: cipro is the treatment of choice. Bactrim as alternate

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16
Q

This bacteria causes Prodrome: fever, HA, myalgia, malaise.

Abd pain, diarrhea, fever (these are usually low grade)

A

Campylobacter

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17
Q

Cause/risks/exposure that would perdispose someone to campylobacter?

A

Consuming infected sausages and hard meats, undercooked chicken

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18
Q

TOC in campylobacter?

A

Ciprofloxacin

Azithromycin alternate

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19
Q

This bacteria causes Sudden onset explosive diarrhea 1-3 weeks after exposure, abdominal cramping, flatulence, low grade fever, N/V and is the Most common cause of epidemic water borne diarrheal disease in US, most frequent in Rocky Mountain region

A

Giardia

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20
Q

TOC for giardia?

A

Metronidazole

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21
Q

This bacteria causes Profuse watery diarrhea, 15-30 BMs per day, abdominal pain or cramps, low grade fever

A

C. diff

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22
Q

What is the TOC for C. Diff?

A

PO vanco

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23
Q

What is the pathophysiology of GERD?

A

The LES is supposed to relax when food goes from esophagus to the stomach. Reflux occurs when the LES decreases in tightness, causing gastric contents to “reflux” back into the esophagus

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24
Q

What medication class can cause the LES to relax too much?

A

CCB because it relaxes all smooth muscle

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25
Q

What is the MOA of antacodis?

A

Increases pH of gastric reflux by neutralizing gastric acid, thereby decreasing its potential to cause damage to the esophageal mucosa. Also increase the LES tone through alkanization of gastric contents

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26
Q

What medication is used as a first line for managing patients with mils-mod sxs of GERD without esophagitis and can also be used for breakthrough sxs in patients receiving H2 blockers or PPIs

A

Antacids

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27
Q

MOA of sulcrafate?

A

A mucosal coating agent that forms a protective barrier between esophageal tissue and gastric refluxate

-not FDA approved in GERD but some people get relief

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28
Q

Antacids and sulcrafate should not be used in patients with ______?

A

CKD

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29
Q

MOA of H2 receptor antagonists (H2RTs)?

A

Acid suppressive agents that inhibit the action of histamine at the H2 receptor of the parietal cell, decreasing basal acid secretion

30
Q

T/F: All H2RTs are equally effective and are all available OTC?

A

true

Cimetidine, ranitidine, famotidine

31
Q

MOA of PPIs?

A

Irreversibly bind to the H+/K+ ATPase pump of the parietal cell, thereby inhibiting the final step of acid secretion

32
Q

This is something good to know… just read the card

A 
PPI = don't make acid 
H2 = make acid but neutralize it
33
Q

This medication is more effective at treating erosive/ esophagitis than H2RTs?

A

PPI (omeprazole, pantoprazole, lasoprazole, dexilant)

34
Q

PPI are not highly regarded by some medical professionals for what reasons?

A

They are linked to increased c. diff risk, increased fracture risk, vit B12 def, CKD and worsening PNA prognosis.

**They are also CYP2C19 inhibitors and have many drug drug interactions with plavix, diazepam and penytoin

35
Q

______ are #1 in pregnancy for GERD?

A

H2 blockers and antacids (PPIs are ok too but omeprazole is cat C)

36
Q

What is something to consider in a patient with esophagitis as a potential cause?

A

Patient could have pilll esophagitis so make sure the pill is enteric coated

37
Q

What medication should be initiated in a patient with CKD?

A

ACEI and also d/c meds that would contribute to renal impairment

38
Q

What four drugs contribute to renal impairment?

A
  • Metformin
  • Cetirizine (Zyrtec)
  • Vit C & D
  • HCTZ
  • Naproxen
39
Q

What is the most common drug-related problem in chronic renal failure?

A

inappropriate selection or dosing of medications with renal elimination pathways. We must know our patients GFR to evaluate all medications

40
Q

What two meds are contraindicated at GFR <30?

A

Naproxen and Metformin

41
Q

MOA biguanides (metformin)?

A

inhbits the production and release of glucose from the liver and enhances insulin sensitivity in muscle and fat

42
Q

This med is by far best at decreasing a patient’s A1c?

A

Metformin

43
Q

What is a common s/e of metformin?

A

GI upset

44
Q

MOA of sulfonureas (glyburide, glimiperide, glipizide)?

A

insulin secretagogues (a substance that causes another substance to be released) that promote pancreatic B-cell secretion of insulin and potentiate insulin action on extra-hepatic tissue.

45
Q

What is the preferred sulfonurea in renal disease but needs renal dosing?

A

Glipizide

46
Q

MOA alpha-glucosidase inhibitors (acarbose, miglitol)

A

Delay GI break-down and absorption of carbohydrates

47
Q

MOA TZDs (rosiglitazone and pioglitazone)?

A

Insulin sensitizers that reduce insulin resistance by decreasing hepatic glucose release and promoting skeletal muscle glucose absorption

48
Q

What are some side effects of the TZDs?

A

cardiovascular RFs, hepatic dysfunction and associated with weight gain

49
Q

MOA DPP-4 inhibitors (sitagliptin)?

A

They inhibit the DPP4 enzyme which breaks down the proteins that trigger the release of insulin. The MOA is via increased incretin, inhibiting glucagon secretion, decreasing blood glucose, increasing insulin secretion and decreasing gastric emptying.

50
Q

MOA Incretin mimetic/glucagon-like peptide GLP-1 agonist (tides)?

A

mimics the action of the hormone incretin, which helps regulate both fasting and postprandial glucose levels. These agents stimulate GLP-1 receptors enhancing glucose-dependent insulin secretion by the pancreatic B-cells, suppressing inappropriately elevated glucagon secretion and slowing gastric emptying

51
Q

What medication calss for DM can not be prescribed with a DPP4?

A

GLP-1 agonist

52
Q

MOA of the SGLT2 inhbiitors (flozins)?

A

Reduce tubular glucose reabsorption (pee out glucose) therefore reducing blood glucose levels and the need for insulin release

53
Q

This has the potential for the greatest A1C reduction and allows the tightest glucose control?

A

Injectable insulin

54
Q

MOA of ACEI inhibitors (catopril, enalapril, lisinopril)?

A

inhibit conversion of angiotensin to angiotensin II, reducing vasoconstriction and aldosterone secretion

55
Q

MOA ARBs (losartan, valsartan)?

A

impair the vasoconstrictive effect of angiotensin II and block the stimulation of aldosterone secretion

56
Q

Thiazides vs loop diuretics?

A

Use thiazides for BP control and in CKD stages 1-3 and loop in CKD 4 and 5

57
Q

These meds reduce mortality in the treatment of HTN but they can mask the signs and sxs of hypoglycemia

A

Beta blockers

58
Q

______ therapy is often sufficent enough to reduce LCL goals

A

statin

59
Q

_____ reduce LDL levels by about 15-20%

A

Bile acid sequestrants

60
Q

_____ are effective in reducing TG levels but have variable efficacy in reducing LDL and raising HDL

A

Fibrates

61
Q

What two meds are CONTRAINDICATED in patients with CKD as the risk of rhabdo is significantly increased?

A

fibrates/statin combos

62
Q

MOA alpha blockers (alpha adrenergic antagonists)?

A

competitively antagonize a-adrenergic receptors, thereby causing relaxation of the bladder neck, prostatic urethra, and prostate smooth muscle

63
Q

What is the best med for controlling sxs of BPH?

A

alpha blockers – recommended for patients with normal size prostate and PSA

64
Q

Can alpha blockers be used to treat patients with essential htn?

A

NO

65
Q

What medications shrink the prostate and decrease PSA?

A

5-alpha reductase inhibitors

66
Q

MOA 5-alpha reductase inhibitors?

A

inhibit 5-alpha reductase, whichn is responsible for intraprostatic conversion of testosterone to dihydrotestosterone, the active androgen that stimulates prostate tissue growth and size. Thus, resulting in the shrinkage of an enlarged prostate by about 20% to 25% after 6 mo.

67
Q

MOA phosphodiesterase inhibitor?

A

selectively inhibit PDE type 5 which is responsible for the degradation of cGMP. with prolonged cGMP activity, smooth muscle relaxation (leading to increased blood flow), leading to an erection

68
Q

What are a few weird side effects of vardanafil and sildenafil?

A

blurred vision, difficulty in discriminating blue from green, bluish tones in vision or difficulty seeing in dim light

69
Q

What is an absolute contraindication so using phosphodiesterase 5 inhibitors?

A

Nitrates

70
Q

MOA Alprostadil?

A

A prostaglandin E1 analog that induces an erection by stimulating adenyl cyclase, leading to increased cAMP, smooth muscle relaxation, rapid arterial inflow and increased penile rigidity (its an injection)

Clin Pharm Exam Two (6 decks)

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