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leik book Flashcards

1
Q

ace I (prils) enalapril-vasotec, catopril-capoten dont combine with

A

K, sprinolactone (k sparring diuretic) or Arbs (rtans- valsartan-divan, losartan-cozarr

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2
Q

beta blocker contraindication

A

severe lung disease and second or third degree block

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3
Q

inr less than 5 with no bleed

A

omit one does and or reduce standing dose rrecheck in 2 weeks

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4
Q

thiazide diuretics - HCTZ contraindicated in

A

sulfa allergy (lasix and bumex also contraindicated

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5
Q

thiazide diuretecs uniqily good for

A

pts with HTN and osteoperosis

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6
Q

lood diuretics and aminoglycosides

Gentamicin (generic version is IV only)
Amikacin (IV only)
Tobramycin.
Gentak and Genoptic (eye drops)
Kanamycin.
Streptomycin.
Neo-Fradin (oral)
Neomycin (generic version is IV only)
A

ototoxicity

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7
Q

preferred antihypertensives for DM or Kidney disease

A

ACEI - prils

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8
Q

dry cough first few months of prils treatment

A

switch to ARB (artan)

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9
Q

dont use ccb’s

Norvasc (amlodipine)
Plendil (felodipine)
DynaCirc (isradipine)
Cardene (nicardipine)
Procardia XL, Adalat (nifedipine)
Cardizem, Dilacor, Tiazac, Diltia XL (diltiazem)
Sular (Nisoldipine)
Isoptin, Calan, Verelan, Covera-HS (verapamil)
A

in CHF or bradycardia

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10
Q

macrolides

erythromycin, azithromycin, clarithromycin cover

A

cover Gram plus- think Staph areus, and strep pyrogens, as well as atypicals like mycoplasma CHLAMYDIA

watch out for
gi distress
ototoxicity, cholestatic jaundice, QT PROLONGATION

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11
Q

erythromycin (macrolide) gram + side effects

A

gi side effects are very common, if you must use a macrolide (atypical bacteria) switch to azithromycin (z-pack), or clithromycin (biaxin)

may prolong INR with coumadin same for clarithromycin

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12
Q

cephalosporins- beta lactams

first generations- Ancef.
cefadroxil.
cefazolin.
cephalexin.
Duricef.
Keflex.
Kefzol
A

gram positice cocci - group A strep, staph aeurus, not good against beta lactam producers and MRSA though,

not great with PCN allergy, high chance of cross sensitivity

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13
Q

2nd generaton cephalosporins are broad spectrum

Ceclor (DSC)
cefaclor.
cefotetan.
cefoxitin.
cefprozil.
Ceftin.
cefuroxime.
Cefzil.
A

good agains gram Plus- streptococcus pneumoniea and gram negative like haeophilus influenae and moraxella catarrhalis like rinosinusitis and otitis media

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14
Q

rocephin (cephtriaxone) 1st gen cephalosporin use

A

250mg IM for gonorrhea

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15
Q

MRSA skin boils or abcesses frist line

A

bactrim ds, doxy or mino BID AND cindamycin, for 5-10 days

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16
Q

if PCN allergy switch to

A

azithromycin (brand name Zithromax),
clarithromycin (brand names Klacid and Klacid LA),
erythromycin (brand names Erymax, Erythrocin, Erythroped and Erythroped A),
spiramycin (no brand), and.
telithromycin (brand name Ketek).

MACROLIDES

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17
Q

avoid ——— in mono cause it causes a rash not realted to alllergy use——- instead and ——- with allergy

A

amoxicilin , penicillin VK, macorlides

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18
Q

concern for candida vaginitis with ammoxicilin -

A

reccomend probiotics and or yogurt

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19
Q

floriquinilones black box warning

ciprofloxacin (Cipro)
levofloxacin (Levaquin/Quixin)
gatifloxacin (Tequin)
moxifloxacin (Avelox)
ofloxacin (Ocuflox/Floxin/Floxacin)
norfloxacin (Noroxin)
A

achillies tendon rupture, dc if sore, avoid strenous activiy

also avoid use in HYPO mag or K and with other QT prolonging agents cause of torsades

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20
Q

best drug for pseudomonas aeruginosa (gram neg)

A

ciprofloxacin

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21
Q

sulfa drug list - good against / contraindications
Gantrisin (sulfisoxazole)
Bactrim or Septra (trimethoprim and sulfamethoxazole)
Sulfadiazine.
Azulfidine (sulfasalazine)
Zonegran (zonisamide)

A

gram neg (ecoli, klebsiella, H influenzae G^PD anemai, third trimester,

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22
Q

drugs most likely to cause stevens johnson

A

The medicines that most commonly cause Stevens-Johnson syndrome are:
allopurinol.
carbamazepine.
lamotrigine.
nevirapine.
the “oxicam” class of anti-inflammatory drugs (including meloxicam and piroxicam)
phenobarbital.
phenytoin.
sulfamethocazole and other sulfa antibiotics.

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23
Q

stevens johnson treatment

A

Stopping the medication that has caused the problem
Replacing electrolytes with intravenous (IV) fluids
Using non-adhesive dressings
Using high-calorie food, possibly by tube-feeding, to promote healing
Using antibiotics when needed to prevent infection
Providing pain relief medications
Treating in an intensive care or burn unit in a hospital
Using specialist teams from dermatology and ophthalmology (if eyes are affected)
In some cases, treating with IV immunoglobulin or amniotic membrane grafts (for eyes)

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24
Q

UTI on comadin

A

dont give bactrim- increased bleeding

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25
pregnant with UTI
amoxicillin (pcn) or kephlex- cephalosporin
26
asymptomatic anemia african american background, had a sulfa drug or ate fava beans- is jaundice and hemolysis-
G6PD deficiency
27
first and second most cause of allergic drug reactions
first is penicillins and cephalosporins, | second are sulfonamide ABX
28
TMP SMX bactrim (sulfonamide) DS BID is used to profolax
PCP in hiv patients andformrsacellulitis
29
macrolide alternative with allergy
doxycycline or quinalone levaquin,avelox
30
COPD order of chow
SABA - albuterol or levabuterol or Short acting anticholonergic- ipratroprium then combo _combivent then LABA (salmeterol or long acting anticholonergic (Ipratropium (Atrovent) Tiotropium (Spiriva)
31
pack year calculation
packs per day x years
32
H1 blocker or antihistimie in elderly
use lortadine (claritn) not benadryl
33
long standing HIVES (chronic urticaria)
zyrtec is more potent and long acting works well for acute hives too
34
dont use robitussin dextromethorphan
with 14 days of MAOI inhibitors ``` rasagiline (Azilect), selegiline (Eldepryl, Zelapar), isocarboxazid (Marplan), phenelzine (Nardil), and. tranylcypromine (Parnate). ```
35
decongestants (sudafed, pseudoephedrine) and phenylephrine not to be used when pt has had
CAD, MI, angina
36
avoid Nsaids in
heart failure, severe heart disease, GI bleed, last three months of preggers, severe renal disease
37
ketorlac or toradol max days of use
5
38
ketorlac or toradol contraindications
before surgery, ASA, peds, active or recent GI bleeds, stroke, Labor or delivery
39
ACS ASA
160-325chew non enteric coated tab
40
max max tylenol dose
3,250 in 24 hrs
41
avoid tylenol
etoh, liver disease, chronic hep BCD
42
asa symptom to dc with
tinnitus could signa asa tox
43
dig and the eyes
yellow and green vision, halos if blood level too high
44
theophylinne level
5-15mcg/ml suspect tox with persistant emissi avoid in BPH causes retention, avoid other stims lots of drug reactions
45
preggers X
finesteride, prosscar, isotretinoin (acutain) coumadin, cytotec Misoprostol, androgenic hormones- birthcontrol or hormone replacemt testosterone, live virus vacccines (measles, mumps, runellla, varicella, rotavirus, flumist) thalidomide, DES methimzaole
46
prescription pad info
name/designtion/license number/NPI supervising doc name, designation-not all states clinic address and phone number
47
on the script
date, name and address of pt drug name, dose, for, freq, duration directions for use, quantities in number and written form of refill contorlled durgs must have DEA number schedule II handwritten or typed on tamper proof and MANUALLY signed, cannot be called in
48
5 rights for prescriptions
``` patient drug dose time route ```
49
sqript method preffered by medicare and medicaid
e-prescribing
50
leading cause of death all comers
1. heart disease 2. cancer 3. chronic lower respiratory disease
51
leading cancer killer
lung cancer
52
leading cause of cancer death in man
lung prostate colorectal
53
leading cause of cancer death in women
lung breast colorectal
54
leading cause of death in adolescents
accidents- 39.% MVA is most common suicide 16% homicide 14% non fatal and fata violence is highest in this group
55
``` leading cause of death birth to one year 1-44 45-64 65 ```
birth to one year- congenital malformaitons 20% 1-44 unintentional injury 45-64- cancer 65 heart disease
56
most common or highest prevelance cancer
skin cancer
57
most common skin cancer
basal cell | melanoma causes the most deaths
58
men cancer prevelance vs mortality
prostate most | lung deadliest
59
women cancer prevelance vs mortality
breast most | lung deadliest
60
most common cancer in KIDS
ALL 34% of cancers
61
primary prevention oddball
asa for primary preventon of cvd and colon ca in adults age 50-59 with 10%or higher risk
62
secondary prevention is early detection
screening tests- pap, mamo, CBC for anemia cage questionaire, testing for hep C in high risk person, asa for second stroke revention, MI, TIA, stroke to prevent future stroke
63
tertiary prevention, prevents progression, involves rehab and support groups, education on equipment
Support groups education for pts iwth preexisting disease, rehab treatment of hep C daily asa for preventing another heart atack
64
baseline Mamogram
start at age 50 and repeat q2 till 74 | high risk BRCA start earlier in the 40s
65
``` cervical ca screening 21-65 30-65 hysterectomy with cervix removal over 65 with adequate prior screen ```
21-65 baseline at 21 then q3 30-65 or start at 30 with cytology + HPV every 5 years hysterectomy with cervix removal stop if not due to ca over 65 with adequate prior screen no more with not high risk do not apply for hiv+ or DES diethylstillbestrol exposure or known lesion
66
colorectal ca screen
start at50 till 75 76-85 usually against but might be special cosiderations over than 85 not reccomended
67
colorectal screen how
poop samples x3 annually flex sig or ct colonography Q5 colonoscopy Q 10
68
lipid screen and statin starup
lipid profile after 9 hour fast when all criteria are met start statin age 40-74 one or more CVD risk factors- dyslipidemia, DM, HTN, smoker 10 year CV risk of 10% or greater
69
lung ca screening
30 pack year active orhave quit in the last 15 years
70
ovarian ca screen
routine is not reccoended but with brca one or two refer to specialist trasvag ultrasound, or serum cancer antigen ca-125 starts at 30 years of age or 5-10 years of earliest family diagnosis
71
AAA screening rec
men 65-75 who have smoked | ultrasound
72
blood pressure screen
start at 18 get BP outside of clinical setting b4 starting treatment
73
DM 2 if obese screen
at 40 to 70
74
obeisity screen age
6-18
75
osteoperosis screen age
65 or younger if chronic steroids or ris equal to tht of 65 year od white woman
76
breast ca risk factors
``` OLDER THAN 50- most commoon previous history of breast ca two or more first degree relatives obeisity early menarche, late menopause ```
77
hep b vaccine
3 doses at birth, 1 and 6 months min of 4 weeks between doses, do not restart just catch up got one missed two then give two then three.
78
flu vax
takes 2 weeks to kick in if eggg allergy only experiences hives they can still get the vax preggers can get it
79
flu vax contraindications
under 6 months of age | life threatinging egg allergy
80
tdap vax
q ten for life | boost with dirty wound if last was more than 5 years
81
wound with unknown tdap vax status
give tdap and tetanus immunoglobulin injection asap
82
high risk tetanus wounds
crush injury, soil inwound, puncture, devitalized tissue
83
ppsv23 who gets
adults 65 or older or younger at high risk | its 50% to 85% efffective
84
PCV13 or prevnair
kids older than 5 at high risk or also works for 65 plus
85
at 65 with no previous coverage
give prevnair PCV13 and then PPSV23 one year later
86
high risk pneumococcal infection group
``` chronic diseases ETOH, DM CSF leaks, asthma, hepatitis renal disease sickle cell, crappy spleen malignancy or blood cancers history of organ or marrow transplant ```
87
if u got pneumovax before 65
give booster dose 5 years after first dose
88
zostervax is live who gets
at 60 past history of shingles IS NOT a contraindication can get it if they never had chickenpox acyclovir 24hrs pre or 14 days post can lower response may excerbate asthma or polymyalgia rheumatica
89
shingles risk factors
older than 60 immunocompromised leukemia lymphoma
90
contraindications for shingles zostervax
preggers or breastfeeding leukemia lymphoma, or malignancies of bone or bone marrow immynocompramised, high dose steroids, over two weeks, anti tumor necorsis factor meds like etanercept
91
if u never had chicken pox can u get shingles
no
92
how long is shingles contageous
contact precautions till all skin lesions are dry and crusted
93
varicella vax
first dose is 12-15 months
94
acceptable proof of varicella immunity
documentation or 2 doses of vax written diag of shicken pox or shingles positive lab varicella titer (IgG elisa nobody born before 1980 should get it

issues and policy (22 decks)

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