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Integrated Exam > P2 YEAR > Flashcards

P2 YEAR Flashcards

1
Q

What allele must be tested before starting Abacavir therapy?

A

HLA-B*57:01

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2
Q

What is Abacavir used for?

A

Reverse transcriptase inhibitor that inhibits HIV-1 viral replication

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3
Q

What are mRNA vaccines?

A
  1. Novel Vaccines
  2. Uses a liposome to deliver an engineered mRNA that expresses the immunodominant region of the SARS-Cov-2 spike protein
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4
Q

Can Cytokine Mediated Alterations have an effect on drug metabolism?

A

Yes, specifically alterations to CYP enzymes

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5
Q

What are the types of Insurance Policies?

A
  1. Health Maintenance Organization HMO
  2. Preferred Provider Organization PPO
  3. Fee-for-Service (Indemnity) Plan
  4. Point of Service (POS) Plan
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6
Q

Health Maintenance Organization HMO

A
  1. General Practitioner Gatekeeper
  2. No deductible is charged
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7
Q

Preferred Provider Organization PPO

A
  1. Any doctor on list of PCPs
  2. Specialist without referral
  3. More out-of-pocket expenses
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8
Q

Fee-for-Service (Indemnity) Plan

A
  1. Obtained by individuals on their own, through groups, employers, or associations
  2. Max out of pocket expenses prescribers will have to pay
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9
Q

Point of Service POS Plans

A
  1. Blend of managed care and indemnity plans
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10
Q

Medicare Part A

A
  1. At least 65 yrs old
  2. Social Security Benefits
  3. Monthly premium
  4. Late enrollment penalty
  5. Payroll tax
    Skill nursing facility only, no nursing home coverage
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11
Q

Medicare Part B

A
  1. Supplemental medical insurance
  2. Monthly premium
  3. Physician services, outpatient, home health, and medical equipment
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12
Q

Medicare Part C

A
  1. Private insurance companies
  2. Advantage
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13
Q

Is long term care such as nursing homes covered by Medicare Part A and B?

A

NO

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14
Q

Medicare Part D

A

Stand Alone Prescription Drug Plan

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15
Q

What is the current issue with Medicare?

A

Part A is at risk of bankrupting

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16
Q

What are the restructuring ideas for Medicare?

A
  1. Increase age requirement
  2. Defined contribution
  3. Individual savings
  4. Managed care
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17
Q

What are the 2 ways a pharmacist can help patient’s overcome health literacy barriers?

A
  1. Verbal Communication (teach back method)
  2. Written Communication: <8th grade
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18
Q

What is the NURS Acronym?

A

N: Name the Emotion
U: Understand the Emotion
R: Respect the Patient
S: Support the Patient

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19
Q

What anticonvulsants are used for neuropathic pain?

A
  1. Gabapentin
  2. Pregablin
  3. Lamotrigine
  4. Topiramate
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20
Q

What antidepressants are used for neuropathic pain?

A
  1. Amitriptyline
  2. SSRI: Duloxetine
  3. SSRI: Venlafaxine
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21
Q

What is the formula for Corrected Sodium?

A

Measured Sodium + [(Glucose-100)/100 ( x 1.7)]

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22
Q

What is the formula for Anion Gap?

A

[Na+] - [Cl-] - [CO2] - Bicarbonate (CO2) from serum blood

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23
Q

What is the formula for Corrected Calcium?

A

Measured Ca2+ +[(4-Albumin) x 0.5]

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24
Q

Symptomatic Hyponatremia <135 mEq/L Treatment

A
  1. 0.9% NaCl or 3% (if symptomatic)
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25
Q

Rapid correction of hyponatremia is associated with the development of osmotic demyelination syndrome. What is the limit?

A

Do NOT go over >12 mEq/L per day

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26
Q

When should you restrict fluid intake when treating hyponatremia?

A

Hypovolemic Hypotonic Hyponatremia

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27
Q

If the patient has fluid restriction hypovolemic hypotonic hyponatremia, what should be given instead of 0.9% NaCl?

A

3% NaCl

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28
Q

Hypernatremia >145 mEq/L Treatment can be associated with development of Cerebral Edema if what?

A

<12 mEq/L per day

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29
Q

Hypokalemia <3.5 mEq/L Treatment

A
  1. Oral K+ Replacement: chloride/phosphate/bicarbonate, max dose 40 mEq
  2. Aldosterone Antagonist (spironolocatone and triamterene)
  3. IV (consider mag replacement if no response occurs)
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30
Q

Hyperkalemia >5.5 mEq/L Treatment Abnormal ECG

A
  1. Ca Gluconate PERIPHERAL IV
  2. Ca Chloride CENTRAL IV
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31
Q

Hyperkalemia Treatment Glucose >250 mg/dL

A
  1. Insulin w/o dextrose

(if glucose <250 give insulin + dextrose)

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32
Q

What are considerations that can be added on in Hyperkalemia Treatment?

A
  1. Albuterol
  2. Sodium Bicarbonate if acidotic pH <7.2
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33
Q

Hypomagnesemia <1.4 mEq/L Treatment

A

Mild: Mag Oxide tabs/caps, antacids, and laxatives
Severe: Mag Sulfate bolus + MD

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34
Q

Hypermagnesemia >2 mEq/L Treatment

A
  1. IV Calcium Gluconate (P) or Calcium Chloride (C)
  2. 0.9% NaCl bolus + IV Loops
  3. Reduce Mg2+ intake
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35
Q

Hypocalcemia <8.5 mEq/L Asymptomatic Treatment

A
  1. Oral Ca2+
  2. Vitamin D
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36
Q

Hypocalcemia <8.5 mEq/L Symptomatic Treatment

A

1.IV Calcium Gluconate (P) or Calcium Chloride (C)
2. MD Dosing

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37
Q

Hypercalcemia >10.5 mEq/L Asymptomatic Treatment (>12, if less than just monitor)

A
  1. 0.9% NaCl
  2. IV Loops
  3. IV Calcitonin
  4. IV Glucocorticoids
  5. IV Bisphosphonate
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38
Q

Hypercalcemia >10.5 mEq/L Symptomatic Treatment (normal kidney, if failed kidney = hemodialysis)

A
  1. 0.9% NaCl
  2. IV Loops
  3. IV Calcitonin
  4. IV Glucocorticoids
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39
Q

Hypercalcemia ACUTE Management

A
  1. 0.9% NaCl (1st line), CI in fluid overload
  2. Loops (2nd line)
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40
Q

Hypophosphatemia <2 mg/dL Asymptomatic Treatment

A
  1. Oral Phos Supplement
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41
Q

Hypophosphatemia <1 mg/dL Symptomatic Treatment

A
  1. Sodium + Potassium IV
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42
Q

What is considered Hyperphoshatemia?

A

> 4.5 mg/dL

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43
Q

What are the SIX Principles of Accounting?

A
  1. Going Concern
  2. Objectivity
  3. Conservatism
  4. Consistency
  5. Matching
  6. Materiality
44
Q

Define Going Concern

A

Any given company plans to remain in existence for the forseeable future

45
Q

Define Objectivity

A

Accounting entries will be recorded on the basis of objective evidence

46
Q

Define Conservatism

A

Accounting estimates, evaluations, and opinions should neither overstate or understate the business activities of the company

47
Q

Define Consistency

A

Similar measurement concepts and procedures for related items within financial statements are applied for entire accounting periods

48
Q

Define Matching

A

Requires that all expenses directly associated with the production of revenues be reported within the same period on the income statement

49
Q

Define Materiality

A

Acknowledges the significance of various decisions and their ultimate effects on the financial statements given the magnitude of a company’s operations

50
Q

What are important considerations for product stocking decisions?

A
  1. Obtain the right products
  2. Obtain the products in the right quantity
  3. Obtain the products at the right time
  4. Obtain the products at the right price
  5. Obtain the products from the right vendor
51
Q

Obtaining products at the right time has considerations in what?

A
  1. Capital costs
  2. Storage costs
  3. Cost of risk
52
Q

What is Just in Time JIT Purchasing?

A

As the last unit of an item sells, the next unit arrives before it is needed

53
Q

Inventory Turnover Rate ITOR Formula

A

Cost of Goods Sold COGS/Average Inventory

54
Q

What is a normal Respiratory Rate?

A

10-20 breaths per minute
Count for 15 seconds and then multiply by 4

55
Q

What is the radial method for reading a pulse?

A

Listen 15 seconds and multiply by 4 on the wrist

56
Q

What is the apical method for reading a pulse?

A

Listen for 60 seconds with stethoscope at the heart

57
Q

What are the Kortkoff sounds?

A

1st = SBP
2nd = DBP

58
Q

What HTN medications are contraindicated in patients with a sulfa allergy?

A
  1. Hydrochlorothiazide
  2. Chlorthalidone
  3. Indapamide
59
Q

What are the warnings for Hydrochlorothiazide, Chlorthalidone, and Indapamide (Thiazides)?

A
  1. Gout flare
  2. Photosensitivity
  3. Hyperlipidemia
  4. Hyperglycemia
  5. SLE Exacerbation
60
Q

What HTN drugs are contraindicated in patients with HFrEF?

A
  1. Verapamil
  2. Diltizaem
61
Q

What are the warnings for Amlodipine, Felodipine, and Nifedipine (DHP CCB)?

A
  1. Hepatic Impairment Caution: amlodipine + nifedipine
  2. High fat meals = increased peak: felodipine
62
Q

What are the warnings for Verapamil and Diltiazem (NON DHP CCB)?

A
  1. Renal Impairment caution: verapamil
  2. Liver Disease caution: diltiazem
63
Q

What HTN drugs are contraindicated with angioedema due to previous ACEi, pregnancy, and concomitant use with Aliskiren?

A
  1. Lisinopril
  2. Enalapril
  3. Ramipril
64
Q

What are the warnings for Lisinopril, Enalapril, and Ramiprill (ACE)?

A
  1. Ascities
  2. Prior to surgery caution
  3. Hyperkalemia
  4. Bilateral Renal Artery Stenosis
65
Q

What HTN drugs are contraindicated with pregnancy and concomitant use with Aliskiren?

A
  1. Losartan
  2. Candesartan
  3. Valsartan
66
Q

What are the warnings for Losartan, Candesartan, and Valsartan (ARB)?

A
  1. Hepatic impairment: losartan
  2. Liver impairment: candesartan
  3. Avoid in ascites
67
Q

What are classes are considered first line treatment for HTN?

A
  1. Thiazides
  2. ACEi/ARN
  3. CCB
68
Q

What are the EB beta blockers for HFrEF?

A
  1. Metoprolol Succinate
  2. Carvedilol
  3. Bisoprolol
69
Q

What is the recommended Action for Treatment in Well Controlled Asthma?

A
  1. Maintain current step
  2. Regular followups every 1-6 months
  3. Consider step down is well controlled for >3 months
70
Q

What is the recommended Action for Treatment in Not Well Controlled Asthma?

A
  1. Step up 1 step
  2. Reevaluate in 2-6 wks
  3. For side effects consider alternative treatment options
71
Q

What is the recommended Action for Treatment in Very poorly Controlled Asthma?

A
  1. Consider short course of oral systemic corticosteroids
  2. Step up 1-2 steps
  3. Evaluate in 2 wks
  4. For side effects consider alternative treatment options
72
Q

Management of Asthma Step One

73
Q

Management of Asthma Step Two

A
  1. QD ICS + PRN SABA or
  2. PRN ICS + SABA
74
Q

Management of Asthma Step Three

A
  1. QD + PRN LOW ICS Formoterol
75
Q

Management of Asthma Step Four

A
  1. QD + PRN MEDIUM ICS Formoterol
76
Q

Management of Asthma Step Five

A
  1. QD MEDIUM-HIGH ICS-LABA + LAMA + PRN SABA
77
Q

Management of Asthma Step Six

A
  1. QD HIGH ICS-LABA + Oral Systemic Corticosteroids + PRN SABA
78
Q

What is the Green Zone Action Plan?

A

PEF >80% personal best >460
1. no symptoms
2. controller medications

79
Q

What is the Yellow Zone Action Plan?

A

PEF 50-80% 290-460
1. some symptoms
2. directions for SABA use

80
Q

What is the Red Zone Action Plan?

A

PEF <50% <290
1. very SOB
2. directions for SABA use
3. call 911

81
Q

What is normal BUN?

A

8-20 mg/dL

82
Q

What is Azotemia?

A

Azote = Nitrogen
Emia = Blood
Elevated BUN

83
Q

What is Uremia?

A

Ures in the blood

84
Q

What is the Normal BUN:Serum Creatinine SCr Ratio?

85
Q

What is the Elevated BUN:SCr Ratio?

A

> 20:1, suggests true volume depletion or effective volume depletion

86
Q

Normal Creatinine Range for Adult Males

A

0.5 - 1.2 mg/dL

87
Q

Normal Creatinine Range for Adult Females

A

0.4 - 1.1 mg/dL

88
Q

Serum Creatinine lags behind GFR by how many days and why?

A

1-2 days
1. Slow Accumulation
2. Increased tubular secretion
3. Increased external clearance

89
Q

What must be at steady state for GFR estimation equations?

90
Q

What drugs interfere with distal tubule secretion of creatinine which increases SCr concentrations?

A
  1. Cimetidine
  2. Trimethoprim
  3. Cefoxitin
91
Q

Cystatin C

A
  1. Not protein bound
  2. Freely filtered
  3. Not secreted
  4. Predicts the presence of AKI 2 days sooner than SCr
92
Q

Oliguria Adults is what

A

<500 ml of urine production within 24 hours

93
Q

Anuria is what

A

Urine <0.3 ml/kg/hr, <100 ml of urine production within 24 hrs

94
Q

Increased pH in Urinalysis means what?

A

UTI, bacteria, or tubular dysfunction

95
Q

What components are seen in Urinalysis that suggest UTI?

A
  1. Nitirite
  2. Leukocyte Esterase
96
Q

Microalbuminuria in Urinalysis is what?

A

30-300 mg/day

97
Q

Macroalbuminura in Urinalysis is what?

A

> 300 mg/day

98
Q

FeNa in urine measures what?

A

The ability of the kidney to concentrate urine

99
Q

What is Urine Osmolality?

A

Measures ability of the kidney to concentrate urine
50-1200 mOsm/kg = normal

100
Q

Red Cell Casts in Urine Microscopy means what

A

Glomerular or Vascular injury

101
Q

White Cell Casts in Urine Microscopy means what

A

Infection or interstitial nephritis

102
Q

Hyaline Casts in Urine Microscopy means what

A

Dehydration or Exercise

103
Q

Granular Casts in Urine Microscopy means what

A

Possible acute tubular necrosis

104
Q

Crystals in Urine Microscopy means what

A

Tumor lysis syndrome or uric acid nephropathy

105
Q

List the NINE risk factors for development of systemic adverse effects with use of topical corticosteroids

A
  1. > 4 weeks of therapy
  2. High potency steroid
  3. Site with thin stratum corneum
  4. Occlusive dressing/intertriginous area
  5. Large surface area
  6. Peds/Geriatric patient
  7. Hepatic impairment
  8. Presence of penetration enhancing substance

Integrated Exam (3 decks)

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