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FNPstuff > LEIK > Flashcards

LEIK Flashcards

1
Q

what can you use if allergic to macrolides

A

doxycycline

newer gen fluoroquinolones IE levaquin

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2
Q

CXR - hyperinflation with flattened diaphgrams

small bullae

A

COPD

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3
Q

initial treatment for chronic bronchitis/copd

A

ipratropium bromide atrovent

Anthicholinergic

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4
Q

COPD step 2

A

add SABA to atrovent

both drugs combined - Combivent

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5
Q

primary prevention for all with COPD

A

pneumovax

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6
Q

which class of abx can cause permanent discoloration of teeth

A

tetracyclines

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7
Q

adverse reactions of tetracyclines

A

photosensitivity reactions - use sunblock, hats, sunglasses

esophageal ulcerations - swallow tab using full glass of water

CONTRAIND - pregnancy, infancy, less than 8

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8
Q

problems with tetracyclines

A

binds some minerals (calcium, dairy, iron magnesium, zinc) - take on empty stomach, 1 hr or 2 hrs before meals

decrease effectiveness of contraceptive

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9
Q

abx that will cause QT prolongation

A

macrolides and quinolones

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10
Q

can prolong INR when mixed with warfarin

A

erythromycin

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11
Q

1st gen cephalosporins

A

treats gram pos - cellulitis, mastitis

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12
Q

2nd gen cephalosporins

A

broad spectrum abx

treats pos and neg bugs

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13
Q

3rd gen cephalosporins

A

better coverage for gram neg

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14
Q

1st line for gonorrhea

A

ROCEPHIN IM (ceftriaxone

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15
Q

MRSA skin infections tx

A

do not use cephalosporins

1st line bactrim, or clindamycin

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16
Q

Dicloxacillin

A

good for penicillnase-producing staph skin infections (mastitis, impetigo)

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17
Q

first line for strep throat

A

Penicillin V

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18
Q

otitis media first line

A

amoxicillin

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19
Q

syphilis first line

A

Benzathine Penicillin G IM

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20
Q

Fluroquinolones efficacy

A

good for gram neg, and some atypicals (chlamydia, mycoplasma, legionella)

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21
Q

quinolone Drug interactions

A

avoid use of other QT prolonging drugs

amio
macrolides
TCAs

ORR electrolyte imbalance (hypomagnesemia, hypokalemia)

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22
Q

First line pseudomonas pneumonia

A

cipro

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23
Q

Cipro good for

A

anthrax inhaled
cutaneous anthrax
travelers diarrhea
pseudomonas

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24
Q

contradin for sulfanomides

A

g6pd anemia

newborns and infants less than 2 months
pregnancy in late 3rd trimester - increased risk of hyperbilirubinemia
hyerpsensitivity

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25
Q

sulfanomides effective against

A

gram neg - bacteriostatic

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26
Q

which other patient population shouldnt be given sulfanomides

A

uti pts on coumadin - increased risk of bleeding

can be treated with amox or cephalosporins

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27
Q

abx with high risk of hypoglyecmia

A

levaquin

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28
Q

which patients are high risk for stevens johnson syndrome

A

HIV patients on sulfa

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29
Q

rhinitis medicamentosa

A

chronic use of nasal decongestants (greater than 3)

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30
Q

who to avoid benadryl with

A

elderly

use loratadine instead

31
Q

avoid mixing decongestants with these:

A

stimulants (caffeine, ritalin)

can cause palpitations, arrythmias, tremors, anxiety

32
Q

Dextromethorphan contraind

A

within 14 days of MAOI and seligiline

33
Q

NSAIDs should be avoided in which conditions

A

heart failure
severe heart disease
gi bleeding,
severe renal disease

34
Q

one reason to discontinue ASA

A

tinnitus

35
Q

ASA post MI or after is stroke is what kind of prevention?

A

tertiary

36
Q

which population to avoid ASA?

A

children with viral infections less than 16 years of age

Reye’s syndrome

37
Q

Long term risk for NSAIDS

A 
MI
stroke
emboli
GI bleeds
acute renal failure
38
Q

NSAID increased risk of bleeding with?

A

warfarin, steroids, aspirin, alcohol

with long term use, consider prescribing concurrent PPI, H2 blockers, misoprostol(cytotec) - which is a synthetic prostaglandin

39
Q

avoid long term use of NSAIDS with ho?

A

pt on ASA prophy - interferes with ASA cardioprotective effect.

40
Q

Reye’s syndrome

A

Swelling of Liver and brain

watch out for those with hx of febrile illness, chickenpox,, flu and salicylate intake (ASA and peptobismol)

3 stages

  1. severe vomitting, diarrhea, lethargy, stupor, high ast, alt
  2. personality changes, hyperactive reflexes
  3. confusion, delerium, cerebal edema, coma death
41
Q

antidote for acetaminophen OD

A

acetylcysteine

42
Q

kenalog injections

A

can be used for inflamed joints up to 3x/year

43
Q

Side effects of glucocorticoids

A

HPA suppression
cushing’s dz (dorsal hump, rounded face)
osteoporosis (advise weight bearing exercises, vit d, calcium, biphosphonates
immunosupporession
skin changes (atrophy, striae, telangiectasia, acne)

44
Q

digoxin (vision se)

A

yellow to green vision, blurred vision, halos

45
Q

ethambutal & linezolid (vision se)

A

optic neuropathy

46
Q

corticosteroids (vision se)

A

cataracts, glaucoma, optic neuritis

47
Q

fluoroquinolones (vision se)

A

retinal detachment

48
Q

viagra, cialis, levitra (vision se)

A

cataracts, blurred vision, ischemic optic neuropathy

49
Q

accutane (vision se)

A

cataracts, decreased night vision,

50
Q

topamax (vision se)

A

acute angle closure glaucoma, increased ICP, mydriasis

51
Q

plaquenil (vision se)

A

neuropathy, loss of vision (permanent)

52
Q

Cisapride (propulsid) safety

A

BLACK box - serious cardiac arrhythmias (vfib, tachy, torsades de pointes, qt prolong)

Check 12 lead ekg baseline.
check electrolytes, creatinine

numerous drug contraind

53
Q

Theophylline safety

A

theophylline level - 5-15 mcg
interact with drugs ( cimetidine, alprazolam, macrolides, fluvoxamine

avoid combining with other stimulants
worsens htn, arrythmias, stroke, sz - with stimulants
BPH - causes urinary retention, worsening of symptoms
Suspect toxicity - persistent vomiting

54
Q

Taper these drugs

A 
beta blocker - rebound htn
benzos - severe anxiety, insomnia, sz, tremors
oral steroids
anticonvulsants
paxil, paroxetine
antiarrythmics - refer to cardio
55
Q

Schedule I

A

illegal to prescribe
no med use
high abuse potential

heroin, ecstasy, mdma, pcp,

56
Q

schedule II

A

only original prescription with signature
total number of pills must be indicated
no refills

demerol, dilaudid, oxycontin, amphetamines

57
Q

Schedule III

A

tylenol w coidiene
vicodin
anabolic steroids
testosterone

58
Q

schedule IV

A

benzos
ambien
lunesta
soma

59
Q

schedule V

A

can be mailed to pt.

60
Q

CATEGORY X

A

finasteride (proscar, propecia)

reproductive aged or pregnant women shouldn’t handle crushed or broken pills

Isotretinoin (accutane)
warfarin
misoprostol
androgenic hormones - birth ctrl pills, HRT, testosterone
live virus vaccines
thilaidomide, DES methimazole
61
Q

live virus vaccines

A 
measles
mumps
rubella
varicella
rotavirus
flumust
62
Q

Finasteride

A

CAT X

proscar 5mg po qday

63
Q

accutane considerations

A

reproductive aged females must use 2 reliable forms of BC and a negative preg test 1 month before, during and 1 month after accutane

64
Q

Vit A

A

high dose is teratogenic in animal studies. Avoid megadoses in pregnancy

65
Q

Warfarin and sulfa

A

avoid - increase INR and bleeding risk

66
Q

glucosamine

A

herbal

OA

67
Q

natural progesterone cream (wild yam root extract)

A

pms symptoms

68
Q

isoflavones (soy beans)

A

estrogen-like effects

69
Q

saw palmetto

A

urinary symptoms of bph

70
Q

kava kava

A

anxiety and insomnia

71
Q

st johns wort

A

mild depression

DON”T use with SSRI, MAOI, sumatriptan, HIV protease inhibitors

72
Q

Absolute contraindications for oral contraceptives

MYCUPLETS

A

My - migraine with focal neuralgic aura

C - CAD or CVA

U - undiagnosed genital bleeding

P - pregnancy

L - liver tumor or liver dz

E - estrogen - dependent tumor

T - thrombus - emboli

S - smoker aged 35 and up

73
Q

Relative contraindications for oral contraceptives

A
  • migraine with or without aura…. (WITH neural aura is absolute contraindication d/t stroke risk)
  • smoker below 35

fracture or cast on lower extremities

  • severe depression
  • hyperlipid

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