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Question 1

What does Clarithromycin interact with? Why?

Answer 1

Any statin that is a 34 A substrate. (i.e. Simvastatin, lovastatin, atorvastatin). A 34 A inhibitor will prevent the offloading of the statin, thereby increasing the statin level. This can lead to Rhabdomyolysis.

Question 2

What is doxycycline good for treating? What is the drug interaction percent?

Answer 2

Strep-pneumonia, H flu (haempophilus influenzae), and acute bacterial rhinosinusitis (ABRS). 0.0 drug interaction. Would use in case of a penicillin allergy.

Question 3

What are statin good at?

Answer 3

They are highly anti-inflammatory, and good at stabilizing plagues.

Question 4

What is a beta-lactam allergy? What antibiotics should be avoided with this allergy?

Answer 4

An allergy to the beta lactam ring in antimicrobials. Penicillins, cephalosporins, carbapenems, monobactams.

Question 5

What is MedWatch? Purpose?

Answer 5

FDA reporting program, warnings, advisory. Purpose is for providers to have a guilt free system to report adverse effects.

Question 6

FDA Boxed Warning? Formerly “Black Box Warning. Examples?

Answer 6

Assigned by the FDA to advise about specific injury attributed to use of medication.

Moneluakast - serious behavior and mood-related changes
Zolpidem - Complex sleep behaviors (i.e. sleepwalking, sleep driving, etc). This drug has complications that are “benzo-like”

Question 7

How do you write a prescription? Steps

Answer 7

1. Assess allergy and reaction status. Confirm reactions: are they bothersome or life threatening. (I.e. Urticaria in response to penicillin - potentially life-threatening. Cough in response to ACE inhibitors - bothersome, GI upset in response to NSAID use - bothersome.
2. Perform a med reconciliation
3. Assess patient’s height and weight
4. Define the clinical problem, and consider if drug therapy warranted. (Define the therapeutic goal: Symptom relief? Alter the course of disease? Prevent disease progression? Prevent additional disease?
5. Select the best medication (Consider: safety and efficacy, evidence-based, cost and insurance coverage)
6. Ensure correct patient. 2 + identifiers (Name, DOB, driver’s license)
7. Include route of administration, Form, Reason, Frequency and duration of therapy. Add instructions as needed (i.e thiazide diuretic: take in AM as soon as possible after getting up; or if the medication requires food to facilitate dissolving the drugs macrocrystal.
8. Determine the number of doses to be dispensed. (Chronic med in stable patient you may prescribe a 90 day supply. New medication 30 day or 5-6 weeks amount to leave a little wiggle room).
9. Number of refills. Insurers will require a new prescription every year.
10. Provide verbal and written information about the patient’s condition.

Always re-evaluate medication periodically and discontinue unnecessary meds

Question 8

What can you prescribe instead of an ACE inhibitor if patient is coughing?

Answer 8

Switch over to an ARB, cough will take a week to go away.

Question 9

What can you use is Motrin is causing stomach upset?

Answer 9

Recommend switching to liquid Motrin. It is gentler on the stomach.

Question 10

What is a Med reconciliation? When is it mot important to do one?

Answer 10

A formal process of creating the most complete and accurate list of patient’s most current medication. (Did the patient see another doc, like a cardiologist, prior to seeing you?)

Pre and post hospitalization, re-habilitation stay, sub specialty, and urgent care visit.

Question 11

Examples of rationale for changing medications.

Answer 11

*Reducing dose of HTN med with intentional weight loss
*Discontinuing metformin in person with eGFR < 30 mL/min/1.73 m^2
* increasing insulin does in persistent hyperglycemia.

Question 12

Patient counseling with med use points?

Answer 12

• Adverse effects
• When to discontinue
• Get informed consent if med has potentially serious adverse effects
• Allergic reaction possibilities