Mueller Old Content - Final

Question 1

What is Digoxin used to treat?

Answer 1

• Heart Failure
• Atrial Fibrillation

Question 2

What is the relationship between Digoxin and Potassium?

Answer 2

Due to Digoxin + Potassium competing, we must have normal potassium levels

Question 3

What can cause Digoxin toxicity?

Answer 3

hypokalemia

Question 4

How to treat Digoxin toxcity?

Answer 4

Digibind ®- Digoxin specific Antibody Fab fragments

Question 5

What does Acetaminophen treat?

Answer 5

• Pain or Fever
• This is NOT an NSAID, does NOT work for inflammation

Question 6

What are adverse effects of Acetaminophen?

Answer 6

Hepatotoxicity: extremely rare at therapeutic dosages

Question 7

What is an antidote to acetaminophen overdose?

Answer 7

Acetylcysteine

Question 8

What are the two groups of NSAIDs?

Answer 8

• Salicylates/Irreversible NSAIDS
  - ASPIRIN ONLY
• Non-Salicylates/ Reversible NSAIDS
  
  • All other NSAIDS are in this category

Question 9

Why use aspirin?

Answer 9

used for its artery benefits (STROKE AND MI PREVENTION)

Question 10

What are symptoms of salicylism toxicity?

Answer 10

• Tinnitus
• Respiratory Alkalosis (rapid breathing)

Question 11

What are adverse effects of aspirin?

Answer 11

• Asthma
• Salicylism poisoning (N/V/D, breathing)
• Premature closure of ductus arteriosus/Platelet disaggregation/ Peptic Ulcer Disease
• Intestinal bleeding
• Reye Syndrome/Renal Impairment/Rapid breathing
• Idiosyncratic Reaction
• Noise (Tinnitus)/Nephropathy(kidneys)

Question 12

What are some reversible NSAIDs?

Answer 12

• ibuprofen
• naproxen
• ketorolac

Question 13

What are some concerns for reversible NSAIDs?

Answer 13

• Take with food or water/milk
• Contra-indicated to use in people with Chronic Kidney Disease (acute or chronic)
• Avoid in history of heart disease/MI (Contra-indication)
• Increased risk for bleeding

Question 14

What are some examples of pure opioid agonists?

Answer 14

Morphine Prototypes

• Morphine, Codeine, Hydromorphone, Oxycodone, Hydrocodone

Non-morphine Prototypes

• Methadone, Fentanyl, Meperidine, Tramadol

Question 15

What are some examples of mixed opioid agonists?

Answer 15

• Buprenorphine
• Butorphanol
• Nalbuphine
• Pentazocine

Question 16

Name an Opioid Antagonist (Antidote).

Answer 16

Naloxone

Question 17

Name Anti-diarrheal Drugs (Opioid).

Answer 17

• Loperamide
• diphenoxylate-atropine

Question 18

What are adverse effects of morphine-like drugs?

Answer 18

• Miosis (constriction of the pupil)
• Out of it (sedated)
• Respiratory depression
• Pruritus (common)
• Hypotension (dizzy) & Head injury(avoid!)
• Infrequency of urination and bowel movements (referring to urinary retention or constipation)
• Nausea/Narcotics
• Emesis

Question 19

Describe muscarinic response during a cholinergic crisis.

Answer 19

SLUDGE (M) and the Killer B’s
- Salivation/Secretions (mouth, GI tract, lungs)
- Lacrimation (tear production)
- Urination (voiding)
- Defecation/Diarrhea
- GI Motility and Gastric Acid production, can lead to abdominal cramping
- ‘Emesis (vomiting)
- Miosis (pinpoint pupils)

• Bradycardia, Bronchospasm, Bronchorrhea, Blood pressure Drops

Question 20

What is an antidote for cholinergic crisis?

Answer 20

Atropine

Question 21

Describe the two types of cholinergic drugs.

Answer 21

• Direct Acting Agents
  ~ Work DIRECTLY at a RECEPTOR
  ~ Produce effects that mimic Acetylcholine (ACh)
  ~ Are typically agonists at Muscarinic receptors
• Indirect Acting Agents (pyridostigmine)
  ~ Do NOT work at RECEPTORs
  ~ Instead, they inhibit acetylcholinesterase, an enzyme that breaks down acetylcholine

acetylcholinesterase inhibitors and pyridostigmine is what you need to know

Question 22

What are some acetylcholinesterase inhibitors?

Answer 22

• Organophosphates/Carbamates
  ~ Insecticides
  ~ Nerve Gas

Question 23

What are adverse effects of pyridostigmine?

Answer 23

• Minor SLUDGE (M)
• drop in BP and/or HR
• Cholinergic Crisis!

Question 24

What are the four adverse effects of ALL antibiotics?

Answer 24

1. Allergic Reactions
2. Super/Supra Infection
3. Always Finish the Therapy
4. Antibiotics can Interfere with lots of Drugs

Question 25

What is vancomycin used to treat?

Answer 25

• Gram + only
• MRSA (IV only)
• Clostridium difficile (C.diff) (PO only)
• pneumonia, meningitis, osteomyelitis, UTIs, sepsis, etc.

Question 26

What are the big three adverse effects of vancomycin?

Answer 26

1. Nephrotoxicity
2. Ototoxicity
3. Histamine release / flushing syndrome

Question 27

What is penicillin used to treat?

Answer 27

• Strep
• Piperacillin- Pseudomonas, Klebsiella

Question 28

When should you not give penicillin?

Answer 28

A History of a BETA-LACTAM allergy (cross-reactivity)

• This means penicillins, cephalosporins, carbapenems, monobactams

Current infection with EBV (Mononucleosis)

• Common to see a rash if a patient has Mono (EBV)
• Specifically seen with amino-penicillins (like amoxicillin)

Question 29

Describe penicillin G benzathine + penicillin G procaine.

Answer 29

• given via IM injection
• thick white paste appearance
• NEVER GIVE IV

Question 30

Takeaway

Answer 30

all antibiotics today are called BETA-LACTAMS

• penicillins - “cillin”
• cephalosporins - “cef”, “ceph”
• carbapenems - “penem”
• monobactams - aztreonam

Question 31

Abx for Acute Otitis Media

Answer 31

Amoxicillin

Question 32

Abx for Pseudomonas

Answer 32

Aminoglycosides, Carbapenems, FQs, Some “cefs”