Medications

Question 1

What antihypertensive medications should not be use for CHF patients

Answer 1

Nondihydropyridine calcium channel blocker - negative ionotropic effects
Doxazosin

Question 2

What diuretic use for renal impaired patients

Answer 2

Furosemide
Butenamide
Ethacrynic acid
Methalazone

Question 3

What are the primary intervention that can lower blood pressure

Answer 3

Weight reduction
Sodium reduction
Adequate potassium and calcium
Limit Etoh

Not limiting caffein or yoga or relaxation technique.

Question 4

What is the diagnostic criteria for Metabolic syndrome

Answer 4

3 or more of the following
Obesity- men waist >40 in women > 35 in
Blood pressure > 130/85
FBS > 110
TG> 150
HDL < 40 in men , 50 in women's

Question 5

How do you treat HTN emergency. What is the goal

Answer 5

Reduce the blood pressure by 25% , mins to 1 hour if stable bp of 160/100-110 in the next 2-6 hours.

Question 6

What kind of mess for HTN emergency is used. How about for ischemic stroke

Answer 6

Rapid onset short duration mess but not foe ischemic stroke

Question 7

What mess are good to use for HTN emergency associated with an MI ,which to avoid

Answer 7

Esmolol,
Labetalol
Clevidipine
Nicardipine

Avoid iv enalapril and short acting nifedipine

Question 8

After an MI what antihypertensive improved cardiovascular outcome

Answer 8

Beta blocker ,ace inhibitors , aldosterone receptor agonist,

Question 9

What meds are used for chronic HTN in pregnancy

Answer 9

Methydopa

Labetalol’ nifedipine and Procardia

Question 10

What meds should not be used in pregnant women

Answer 10

ACE inhibitor- cause intrauterine growth restriction and renal failure
Tenormin/atenolol- IUGR
Thiazides - especially with eclampsia

Question 11

What meds are used with uncontrolled HTN during active delivery

Answer 11

IV labetalol and hydra lazing

Question 12

What antibiotics treat MRSA cellulitis

Answer 12

, Doxycycline, Bactrim, linezolid, vancomycin , oritavancin and dalbavancin. others like daptomycin, ceftaroline if needed.
Clindamycin too much resistance

Question 13

Green medication does not cause rebound headaches

Answer 13

Try cyclic medications, hydroxyzine, prochlorperazine

Question 14

What medication helps with prevention of migraine headache

Answer 14

Try cyclic, propranolol, Topiramate,divalproex sodium

Question 15

List the most rapid effect of pain meds to least

Answer 15

Fentanyl- 3-5 min
Meperidine- 5-7 min( least preferred due to interactions w/.meds
( MAO inhibitors, SSRI, Toxic metabolites that can cause agitation and seizures
Morphine-20 min
Hydromorphone- dilaudid15-30 min

Question 16

What are the symptoms of SSRI discontinuation syndrome

Answer 16

Somatic symptoms: URI, Gastro symptoms
Disequilibrium , sensory ( parenthesis , electric shock sensation and sleep( lethargy, myalgia)
Psychological : anxiety, c activity, the personalization, decreased concentration confusion and memory loss

Question 17

1) Which SSRI is least likely to cost discontinuity syndrome
2) which has the shortest half like there cause SDS
3) which has the most anti-cholinergic activity
4) which SSRI I has the least likely to have a drug drug interaction 450

Answer 17

1) Fluoxetine due to long half-life
2) paroxetine and fluvoxamine shortest half life
3) Paroxetine
4) Citalopram

Question 18

1) Side effect of Mirtazapine

2) which meds has a box warning for hepatic failure.

Answer 18

Alpha adrenergic agonist- orthostatic hypotension, hypotension, sedation, weight gain, dizziness, increase triglyceride.
Good for people w/ decrease appetite and weight loss and insomnia.
2) nefazodone- Serzone

Question 19

1) What are the symptoms of serotonin syndrome
2) which antibiotic causes birth defects the most
3) which medications are toxic and overdose and can cause QT. and QRS prolongation

Answer 19

1) Muscle rigidity, hyperreflexia, hypothermia, confusion, agitation
2) fluoxetine and paroxetine
3) Venlafaxine and duloxetine

Question 20

1) what vitamins interfere with warfarin causing INR to go up
2) vitamins in excess can cause what
a) vitamin A
b) vitamin C
c) vitamin D
d) Zinc

Answer 20

1) Vitamin
a) alopecia ,ataxia, gloss it’s, hepatotoxic
b) n/ v diarrhea
c) hypercalcemia, hypercalciuria, myalgia, bone demineralization
d) nausea, loss of smell and taste depressed immune function

Question 21

1) which supplements can cause pseudohyperalsosteronism
2) what meds does grapefruit does not affect
3) what supplement can affect migraine
4) useful for depression
5) for insomnia
6) pregnancy related nausea

Answer 21

1) Licorice
2) ASA
3) Feverfew
4) St. John’s wort
5) valerian root
6) pyridoxine, doxylamine

Question 22

Which supplements can prolong bleeding time

Answer 22

Ginkgo , garlic, feverfew, vit E, fish oil

Question 23

What are the side effects of testosterone

Answer 23

It can cause increased risk of prostate cancer, worsening symptoms of BPH, liver toxicity and tumor, worsening of sleep apnea and heart feel year, gynecomastia come and fertility and skin disease. It is not good for patients who want to have children

Question 24

Treatment for polymyalgia rheumatica

Answer 24

Standard initial treatment
Oral prednisone: 15 mg per day for three weeks, then 12.5 mg per day for three weeks, then 10 mg per day for four to six weeks, then decrease by 1 mg every four to eight weeks
Expect one to two years of treatment
Alternate treatment
Intramuscular methylprednisolone (Depo-Medrol): depot formulation, 120 mg every three to four weeks; decrease by 20 mg every two to three months
note: For both polymyalgia rheumatica and giant cell arteritis, treatment must be tailored to patient’s symptoms and inflammatory markers followed; in giant cell arteritis, persistence of ESR/CRP elevation
Bone protection
Patients at high risk of fracture (≥ 65 years or prior fracture): bisphosphonate, calcium, and vitamin D
Polymyalgia rheumatica, low-dose corticosteroid without high fracture risk: calcium and vitamin D, DEXA scan at onset of treatment, bisphosphonate if T-score is –1.5 or lower
Follow-up visits

Question 25

Which anti-depressant with less or most sexual dysfunction

Answer 25

Paxil highest rate

Bupropion the least