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Integrated Exam > P3 YEAR > Flashcards

P3 YEAR Flashcards

1
Q

Legitimate Medical Purpose and Usual Course of Professional Practice

A

Acting in accordance with standard of medical practice generally recognized and accepted in the United States

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2
Q

Corresponding Responsibility

A

Pharmacists are legally responsible for the proper dispensing of controlled substances

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3
Q

Record Keeping Federal vs OK

A

Fed: 5 yrs for Prescription 2 yrs Nightly report
OK: 2 yrs patient records, invoices, inventory

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4
Q

Inventories, records, invoices, and purchase records of Schedules I and II must be kept separate from what?

A

Schedule III-V

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5
Q

In Oklahoma, CDS Inventory must be taken when?

A

Between May 1st and July 1st and a copy included with pharmacy license reneweal

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6
Q

When should a Controlled Substance Inventory must be performed according to OBNDD Federal standards?

A

2 years

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7
Q

What type of diabetes tends to have lower doses of insulin and why?

A

T1DM, because they do not have insulin resistance

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8
Q

What is the insulin requirement for total daily dosing?

A

0.2-0.1 unit/kg/day

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9
Q

When should Fixed Dosing be used in Diabetes?

A

If CHO is consistent with each meal or patient cannot count carbs

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10
Q

If NPH is used in Fixed Dosing, what should be done?

A

Split Dose 2/3 AM and 1/3 PM

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11
Q

Calculate I:CHO

A

500 divided by total daily dose

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12
Q

Calculate CF

A

Rapid = 1800/tdd
Regular = 1500/tdd

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13
Q

List indications to start insulin in T2DM?

A
  1. Hyperglycemia despite maximal doses of 2-3 oral agents
  2. GLP-1 agonist are not an option/patient is already on one
  3. Glucose Toxicity >300
  4. Pregnancy
  5. CI to oral agents
  6. Acute Hyperglycemia
  7. Hospital admission
  8. Cost
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14
Q

What happens to oral agents in T2DM when insulin is added on?

A
  1. Metformin is always maintained unless CI
  2. Oral agents often maintained when basal is added
  3. Once bolus is added, other orals are titrated off
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15
Q

Basal Insulin for T2DM

A

0.1-0.2 units/kg/day or 10-25 units

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16
Q

Bolus Insulin for T1DM

A

10% of basal or 4 units

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17
Q

Tighter vs Looser Ratio of CHO

A

Tight = decrease CHO
Loose = increase CHO

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18
Q

List the rapid acting insulins

A
  1. Humalog
  2. Admelog
  3. Novolog
  4. Fiasp
  5. Afrezza
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19
Q

What is the peak/duration of rapid acting insulin?

A

Peak = 2hrs
Duration = 3-5hrs

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20
Q

List the short acting insulins

A
  1. Humulin R
  2. Novolin R
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21
Q

What is the peak/duration of short acting insulin?

A

Peak = 2-3 hrs
Duration = 6-8 hrs

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22
Q

List the intermediate acting insulins

A
  1. Humulin NPH
  2. Novolin NPH
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23
Q

What is the peak/duration of intermediate acting insulin?

A

Peak = 4-6 hrs
Duration = 8-12 hrs

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24
Q

List the long acting insulins

A
  1. Lantus
  2. Levemir
  3. Toujeo
  4. Tresiba
  5. Basaglar
  6. Semglee
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25
Q

Which long acting insulin is peak-less?

A

Lantus

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26
Q

Which long acting insulins have a duration of 24 hrs?

A
  1. Lantus
  2. Levemir
  3. Semglee
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27
Q

Which long acting insulins have a duration of 30 hrs?

A

Basaglar

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28
Q

Which long acting insulins have a duration of 36 hrs?

A

Toujeo

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29
Q

Which long acting insulins have a duration of 42 hrs?

A

Tresiba

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30
Q

Which long acting insulins are biosimilar?

A

Basaglar and Semglee (glargine)

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31
Q

List the Biguanides

A
  1. Glucophage
  2. Glumetza
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32
Q

Metformin is CI with what?

A

eGFR <30

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33
Q

List the Sulfonylureas

A
  1. Amaryl
  2. Diabeta/Micronase
  3. Glucotrol XL
  4. Glucotrol
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34
Q

What are SU’s CI’d with?

A

Sulfa Allergy and T1DM

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35
Q

List the Meglitinides

A
  1. Prandin
  2. Starlix
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36
Q

List the thiazolidinediones

A
  1. Actos
  2. Avandia
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37
Q

What is the contraindication for thiazolidinediones?

A

Class III or IV Heart Failure

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38
Q

List the DPP-4 Inhibitors

A
  1. Januvia
  2. Onglyza
  3. Tradjenta
  4. Nesina
39
Q

List the SGLT-2 Inhibitiors

A
  1. Invokana
  2. Farxiga
  3. Jardiance
  4. Steglatro
40
Q

What is the contraindication for SGLT-2 Inhibitors?

A

Dialysis

41
Q

List the GLP-1 Agonists

A
  1. Byetta
  2. Victoza
  3. Adlyxin
  4. Trulicity
  5. Ozempic
  6. Rybelsus
  7. Mounjaro
42
Q

What are the MISC Oral diabetic agents?

A
  1. Precose
  2. Symlin
43
Q

What drug has a contraindication of GI disorders and IBD?

A

Precose

44
Q

What drug has a contraindication of Gastroparesis?

A

Symlin

45
Q

Between Sulfonylureas and Meglitinides, which one is glucose independent?

A

Sulfonylureas

meglitinides are dependent

46
Q

Are DPP-4 Inhibitors and GLP-1 Agonists glucose independent or dependent?

A

Dependent

47
Q

What are the AEs of Levothyroxine?

A

HF
Angina
MI
Arrhythmias
Anxiety
Dyspnea

48
Q

What is the dosing of an Uncomplicated Adult <60 for Levothyroxine?

A

1.6 mcg/kg day

49
Q

What is the dosing of an Adult >60 without CHD for Levothyroxine?

A

25-50 mcg/day

50
Q

What is the dosing for any age with CHD for Levothyroxine?

A

12.5-50 mcg/day

51
Q

What is the dosing for Subclinical Hypothyroidism in adults <50 without CHD for Levothyroxine?

A

1.5 mcg/kg/day

52
Q

What is the dosing for Subclinical Hypothyroidism in adults >50 or with CHD for Levothyroxine?

A

25-50 mcg/day

53
Q

What is the dose titration for Levothyroxine?

A

12-25 mcg/day
Every 3-6 wks

54
Q

What are the 2 baseline labs you must get before starting hyperthyroidism thioamide therapy?

A
  1. CBC
  2. LFTs
55
Q

MMI has less hepatotoxcity and is the preferred treatment in hyperthyroidism unless what?

A

PTU is preferred for
1. Pregnancy 1st trimester
2. Lactation
3. Thyroid Storm

56
Q

Plavix MOA

A

Irreversible binding/ platelet ADP receptors

57
Q

Effient MOA

A

Irreversible binding/ platelet ADP receptors

58
Q

Brilinta MOA

A

Reversible binding/platelet ADP receptors

59
Q

Coumadin MOA

A

Inhibits synthesis of vitamin K dependent clotting factors

60
Q

Pradaxa MOA

A

Reversible direct thrombin inhibitor

61
Q

Xarelto MOA

A

Reversible factor Xa inhibitor

62
Q

Eliquis MOA

A

Reversible factor Xa inhibitor

63
Q

Savaysa MOA

A

Reversible factor Xa inhibitor

64
Q

List the 3 anti platelet drugs

A
  1. Plavix
  2. Effient
  3. Brilinta
65
Q

List the 5 anticoagulant drugs

A
  1. Coumadin
  2. Pradaxa
  3. Xarelto
  4. Eliquis
  5. Savaysa
66
Q

What are the 4 MAJOR Statin benefit groups?

A
  1. Severe Hypercholesterolemia LDL >190
  2. 40-75yrs with DM and LDL >70
  3. 40-75yrs w/o DM and ASCVD risk >7.5%
  4. Clinical ASCVD
67
Q

What are the drug interactions for Coumadin?

A
  1. NSAID
  2. Antiplatelet
  3. BAMIF
  4. Fab5
68
Q

What are the drug interactions for Pradaxa?

A
  1. NSAID
  2. Antiplatelet
  3. Pgp Inhibitor
  4. 3A4 Inhibitor
69
Q

What are the drug interactions for Xarelto and Eliquis?

A
  1. NSAID
  2. Antiplatelet
  3. 3A4 Inhibitor/Inducer
70
Q

Limit the dose of Savaysa to 30 mg/day when using what?

A
  1. Verapamil
  2. Azithromycin
  3. Clarithromycin
  4. Erythromycin
71
Q

What are the drug interactions for Plavix?

A
  1. NSAID
  2. ASA
  3. Anticoagulant
  4. Omeprazole/Esomeprazole
  5. Fluoxetine
  6. Grapefruit
72
Q

What should be avoided when using Brilinta?

A

Lovastatin or Simvastatin >40 mg/day

73
Q

What interacts with NSAIDs?

A
  1. Warfarin
  2. Anticoagulants
  3. Probenecid
  4. Lithium
  5. Anti-HTN
  6. Loops
  7. ACEi
  8. Methotrexate
  9. Steroids (systemic)
  10. ASA
74
Q

What WIDENS the CI Width?

A
  1. Increase % confidence
  2. Increase standard error
  3. Decrease sample size
  4. Decrease alpha
75
Q

What NARROWS the CI Width?

A
  1. Decrease % confidence
  2. Decrease standard error
  3. Increase sample size
  4. Increase alpha
76
Q

Unstandardized (b)

A
  1. Predictor variables
  2. Cannot be compared
77
Q

Standardized (B)

A
  1. SD units
  2. Direct comparison
78
Q

Definition of Odds Ratio

A

The odds that an outcome will occur given a particular exposure (X), compared to the odds of the outcome occurring in the absence of that exposure

79
Q

Define OR =1, <1, >1

A

=1: X dose not affect odds of Y
>1: X is associated with higher odds of Y
<1: X is associated with lower odds of Y

80
Q

What is IBS-C?

A

Constipation with hard or lumpy stools >25% of the time

81
Q

OTC Treatment of IBS-C

A

Bulk Forming Laxative
1. Psyllium/Metamucil
2. Polycarbophil/Fiber
3. Methylcellulose

82
Q

Osmotic Laxatives Treatment of IBS-C

A

Draw water from GI
1. PEG/Miralax
2. Lactulose/Emulose
Lactitol/Pizenxy

83
Q

Stimulant Laxatives Treatment of IBS-C

A
  1. Bisacodyl
  2. Senna
84
Q

5HT4 Receptor Agonist Treatment of IBS-C

A
  1. Prucalopride/Motegrity
  2. Tegaserod/Zelnorm WOMEN ONLY
85
Q

Chloride-Channel Activator Treatment of IBS-C

A
  1. Lubiprostone/Amitiza WOMEN ONLY
86
Q

Guanylate Cyclase Agonist Treatment of IBS-C

A
  1. Linaclotide/Linzess
  2. Plecanatide/Trulance
87
Q

What is IBS-D?

A

Diarrhea with loose or watery stools >25% of the time

88
Q

OTC Treatment of IBS-D

A
  1. Loperamide/Imodium
  2. Peppermint Oil
  3. Probiotics
89
Q

Anti-Spasmodics Treatment of IBS-D

A
  1. Dicyclomine/Bentyl
  2. Hyoscyamine/Levsin
90
Q

5HT3 Receptor Selective Antagonist Treatment of IBS-D

A
  1. Alosetron/Lotronex WOMEN ONLY
91
Q

Mu-Opioid Receptor Agonist Treatment of IBS-D

A
  1. Eluxadoline/Viberzi
92
Q

Peripherally Acting Opioid Antagonists Treatment of IBS-D

A
  1. Naldemedine/Symproic
93
Q

Non-Systemic Antibiotic Treatment of IBS-D

A
  1. Rifaximin/Xifaxan
94
Q

Administer vaccines before starting biologics, what vaccine in particular for JAK Inhibitors?

A

Shringrix

Integrated Exam (3 decks)

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