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EM > Pharm > Flashcards

Pharm Flashcards

0
Q

octreotide for upper GI bleed

A

consider for pts w/ uncontrolled bleeding awaiting endoscopy or when endoscopy is unsuccessful, contraindicated, or unavailable.

The dose is 25- to 50-mg IV bolus then IV infusion of 25 to 50 mcg/h.

Use lower dose for elderly or those w/ severe liver disease

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1
Q

Keflex
generic name?

class?
routes available?

used for?

A

Cephalexin

1st gen cephalosporin
available PO only

used to tx: UTIs, otitis media, streptococcal pharyngitis, bone and joint infections, pneumonia & cellulitis

allery in 1-10% of pts w/ true pen allergy
P

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2
Q

Drug tx for bleeding PUD

A

PPIs to reduce rebleeding & need for surgery

best used as an adjunct to endoscopic therapy

IV regimens:

  • Lansoprazole (Prevacid): 60mg bolus, then continuous infusion of 6 mg/hr for
  • Esomeprazole (Nexium) or Pantoprazole (Protonix) 80mg bolus, then a continuous infusion of 8 mg/hr
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4
Q

Inpatient tx of CAP
is hypoTN present?

if pen allergy?
with hypoTN present?

A

IV ceftriaxone & IV azithromycin
add Vanco if hypoTN present

If pen allergy:
IV moxifloxicin (Avalox)
add vanco if hypoTN present

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5
Q

Inpt tx of community acquired aspiration PNA

A

IV unasyn

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6
Q

Tx of HCA PNA?

If Pen allergy?

A

vanc + zosyn +/- cipro

if pen allergy:
vanc + azactam + cipro

PCN All with aspiration: vanc + azactam + cipro + metronidazole

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7
Q

used to tx human and animal bites

A

Augmentin

Amoxicillin-clavulanate

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8
Q

Outpt tx of CAP

A

azithromycin or
doxycycline or

if pulmonary or cardiac comorbidities consider respiratory fluoroquinolone eg moxifloxacin or levofloxacin

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9
Q

moxifloxacin
brand name?
class?
routes available?

A

aka Avalox
4th gen fluoroquinolone

oral, iv and opthalmic soln available

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10
Q

respiratory fluoroquinolone

A

levofloxacin - oral or IV; 3rd gen

moxifloxacin - oral, IV, opthalmic soln; 4th gen

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11
Q

tx of bronchitis

A

bronchitis presents like PNA w/o signs of pneumonia on radiograph

mostly viral - no antibiotics!!

In chronic bronchitis:
Bactrim, doxycycline or azithromycin

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12
Q

Antibiotics with good ANAEROBIC coverage include:

A

1 metronidazole - preferred ageant for anaerobes; covers bacterioides, the most common colonic microbe
2 clindamycin - high rates of c. diff
3 and any BL/BLI (amoxicillin/clavulanate; ampicillin/sulbactam, piperacillin/tazobactam)

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13
Q

Antibiotics with activity against P aeruginosa include:

A

If serious pseudomonal infection is suspected, double coverage is recommended.

Ceftazidime (3rd gen cephalosporin), 
Ticarcillin, 
Aminoglycosides, 
imipenem, meropenem, 
levofloxacin & ciprofloxacin
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14
Q

Tx of MRSA

A

vanco
linezoid (zyvoxx)
daptomycin

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15
Q

tx of gram neg sepsis

A

third-generation cephalosporin or BL/BLI, plus a fluoroquinolone or an aminoglycoside

ex:
ceftriaxone and gentamicin

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16
Q

tx of bacterial meningitis

A

in immunocompetent adult:
3rd generation cephalosporin
eg CEFTRIAXONE

For infants, elderly, or immunocompromised patients (eg, alcoholics, patients with renal failure), add AMPICILLIN to cover Listeria monocytogenes.

If suspect herpes simplex encephalitis add
Acyclovir

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17
Q

otitis media

A

81% spontaneous resolution

ceftriaxone IM single dose

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18
Q

outpt PID

A

ceftriaxone IM x1

doxycycine x14 d

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19
Q

5 indications for prophylactic antibiotics in wounds.

A

These include
1 intraoral lacerations -
2 Complicated human - Augmentin x5 d and f/u in 24 hours; clenched fist injuries have high infxn rates - Staph/Strep, Eikinella corrodens 30%, or anaerobes
3. Complicated dog bites - Augmentin; Pasturella multocida; in pts w/ splenectomy tx w/ prophylactic penicillin due to increased risk of sepsis/death due to the rare bacterial species Capnocytophaga canimorsus;
3 Cat bites - Augmentin, Pasturella multocida
5 Foot puncture wounds - Cipro vs Bactrim

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20
Q

Rabies

A

Human rabies immune globulin (HRIG) 20 IU/kg, half of the dose infiltrated around the wound and half IM, and human diploid cell vaccine (HDCV) 1 mL IM at a site distant from the immunoglobulin on days 0, 3, 7, 14, & 28

Treat bites from bats, skunks, raccoons, foxes, and wild carnivores w/ rabies ppx

Zero-risk animals include cows, pigs, rabbits, rats, squirrels, mice, hamsters, gerbils, & nutria

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21
Q

Cephalosporins: 1st generation coverage

A

Beta-lactam

  1. Gram +: better than 2g/3g
    Staph: covers all except MRSA
    Strep: covers all except enterococci (S. Fecalis; Gp. D)
  2. Gram - rods:
    Covers E. Coli, Proteus Mirabilis (indole -), Neisseria sp., Salmonella, Shigella
    NOT very good for Klebsiella or H. FLU
    Not effective for Pseudomonas, Enterobacter, Serratia, or indole + Proteus
  3. Anaerobes:
    Good for gm + (supradiaphragmatic) anaerobes
    Not effective for Bacteroides fragilis
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22
Q

Ceftriaxone
class

coverage

dosing

A

Rocephin
3rd generation cephalosporin

Coverage:
Gram (+): less for Staph than 1g/2g’s; poor against Enterococci & MRSA
Gram (-) Aerobes: excellent for most except Pseudomonas, Listeria; excellent for Neisseria sp., H. Flu (inc. ?-lactamase producers)
Anaerobes: poor activity

    QD dosing (1-2g) except in meningitis (2g Q12?)
    Drug of choice for gonorrhea (250 IM x 1)
    Cleared through kidneys & liver, so don't need to adjust dose in renal failure
    Theoretical risk of cholecystitis
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23
Q

Tx of intraabdominal infxn’s

A

Gram neg’s and anaerobe coverage:
Cipro + flagyl

or
Aminoglycoside & Flagyl or
Aminoglycoside & Clinda
or 2nd generation cephalosporin (cefotetan or cefoxitin)

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24
Q

PID: outpt tx

A

Ceftriaxone 250 mgs IM and Doxycycline 100 mgs PO BID x14d and Flagyl 500 mgs PO BID x14d

Same tx as for Hugh-Fitz-Curtis

As effective as parenteral tx in mild/moderate dz

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25
Q

PID: Inpt tx

A

Cefotetan or cefoxitin IV
And and doxycycline

Or
IV Clinda and gent

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26
Q

Risk of head bleed after TPA for MI?

A

0.5%

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27
Q

Risk of head bleed after TPA for ischemic stroke?

A

6%

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28
Q

Percentage of chest pain after cocaine having an MI?

A

5%

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29
Q

Aztreonam

A

Azactam
Beta-lactam; IM or IV route

Strong activ against gram-neg bacteria
Including Pseudomonas

No activ against gram-(+) or anaerobes

30
Q

Intra-Abdominal sepsis: tx
If pen all?
If hospital acquired?
If hospital acquired with pen allergy?

A
  • Piperacillin/tazobactam
  • If PCN All: vanco/cipro/metronidazole
  • If hospital acquired:
  • Vanco + piperacillin/tazobactam
  • PCN All: vanco/aztreonam/metronidazole
31
Q

Urosepsis: tx

If pen all?

A
  • Piperacillin/tazobactam

- PCN All: vanco +aztreonam

32
Q

Tx of sepsis for soft tissue infxns

A
  • Vanco + piperacillin/tazobactam

- PCN All: vanco/aztreonam/metronidazole

33
Q

Tx of Neutropenic Sepsis

A
  • Cefepime (+ vanco)

- PCN All: vanco + aztreonam (+/- metronidazole)

34
Q

Doxycycline

A

Community acquired respiratory infxns

Lyme dz
Anthrax in no pregnant or lactating adults

35
Q

Ciprofloxacin

A

second-generation fluoroquinolone

Urinary tract, GI, & abdominal infections

  • Including Gram-(-) (Escherichia coli, Haemophilus influenzae, Klebsiella pneumoniae, Legionella pneumophila, Moraxella catarrhalis, Proteus mirabilis, and Pseudomonas aeruginosa), and
  • Gram-(+) (methicillin-sensitive but not methicillin-resistant Staphylococcus aureus, Streptococcus pneumoniae, Staphylococcus epidermidis, Enterococcus faecalis, and Streptococcus pyogenes) bacterial pathogens
36
Q

Short acting benzo

A

Midazolam (Versed)

IV, IM
PO (tab and liquid form)

37
Q

Treat withdrawn from depressants

A

Beta blocker - anti-adrenergic effects

38
Q

Alcohol withdrawal ie delirium tremens

Treatment?

A
  • IV benzos - diazepam (long acting) or lorazepam (Ativan, intermediate acting)
  • Replete Mg
  • IV Thiamine - Wernicke’s encephalopathy (acute onset confusion, wide-stansed gait, ophthalmo plegia ) - acute thiamine deficiency after giving IV glucose, if glucose given before thiamine
  • IV Folic Acid - megaloblastic anemia

Can progress to seizures –> IV benzo

39
Q

Mannitol

A

IV Diuretic and

PO Cathartic

40
Q

Hyperventilation

A

Vasoconstricts reducing cerebral edema

41
Q

A-a gradient

A

PAO2 - PaO2 = ~10

PAO2 = 150 - 1.2(PaCO2)

42
Q

Delirium Tremens

Clinical presentation ?

A

X

43
Q

Atropine

A

Anticholinergic

44
Q

Pralidoxime

A

Organophosphate intox

Regenerates? acetylcholinesterase

45
Q

PE: tx

A

Bolus 1000 units heparin
Then infuse 1000 units/hr

Check PTT in 6 hours

Bridge to Coumadin
Coumadin x3-6 months

Indication for TPA in PE:

  1. Intractable hypoxemia
  2. Acute pulmonary hypertension
46
Q

Acetaminophen ingestion

A

Need to order APAP level &

Know time since ingestion

47
Q

Meclizine

A

Antivert

48
Q

NAC

A

Optimal outcome if admin. within 8 hrs of ingestion

49
Q

Tylenol ingestion

Tx

A

-if arrive GI Decon with activated charcoal

  • Need 4 hr Tylenol level
  • if >300, 90% chance of hepatotoxicity
  • if 150, initiate NAC tx
  • If APAP level will not be back within 8 hrs post ingestion, empiric NAC tx until level comes back, then plot and decide whether to continue tx
  • 72hr NAC regimen, repeat Tylenol level at end of 72 hr tx course
50
Q

Stages of Tylenol tox

A

Stage 1: 24hrs post exposure, anorexia, nausea, vomiting, malaise, hypoK correlates with high 4-hr level

Stage 2:
48-72 hours: Stage 1 symptoms may resolve, signs of hepatotoxicity - RUQ pain/tenderness, elevated liver enzymes

Stage 3
Day 3-4: fulminant liver failure, metabolic acidosis, coagulopathy, renal failure, encephalopathy, recurrent GI symptoms

Stage 4: after Day 5, resolution of hepatic dysfx in survivors over 1-3 months

51
Q

Angioedema

A

X

52
Q

Allergic rxn

A

1 O2
2 Benadryl - can drop the bp
3 Epi (1:1000 SC) q15 for life threatening emergency, risk of tachyarrhythmia, use for upper airway obstruction
4 IV Steroids

  • Delayed rxn up to 6 hours later
  • Counsel to carry epi pen, avoid allergen
53
Q

Organophosphates

A

Cholinesterase inhibitor

Miosis and muscle fasiculations are considered reliable signs of toxicity

Succ contraindicated

54
Q

Digoxin

A

Na/K ATPase inhibitor

55
Q

Correct Na

A

Add 1.6 mEq per 100 mg glucose > 100 mg/dl

56
Q

Order of priorities in treating DKA

A

Volume –> K –> insulin

57
Q

Organophosphate antidote

A

2-PAM = pralidoxime

1x dose

Organophosphate = acetylcholinedterase inhibitor

58
Q

INH intox

A

B6 IV needed to stop seizures

59
Q

Exceptions to Phenytoin in status

A

Doesn’t help in Li or INH seizures

60
Q

Ea 325 tab FeSO4 tab contains ___ mg of elemental F

A

65

61
Q

5 stages Fe toxicity

A
  1. GI
  2. Latent
  3. Systemic
  4. Hepatic
  5. Delayed sequelae
62
Q

Lead poisoning

A

Basophilic stippling

Hemolytic anemia

63
Q

Physostigmine

A

Reversible cholinesterase inhibitor

64
Q

Carbamazepine

A

Tegretol

65
Q

Properties of toxic overdose amenable to hemodialysis

A

Small volume of distribution - largely in circulation (<500 Da)

66
Q

Octreotide

A

Synthetic somatostatin analogue that antagonizes the release of insulin

If used in sulfonylurea overdose, particularly peds, decreases incidence of hypoglycemic episodes, favored drug of choice after dextrose administration

Somatostatin itself is v short acting

In peds single pill sulfonylurea can kill

67
Q

Clonidine

A

Centrally acting anti hypertensive

Mimics opiates in overdose

68
Q

Antidote for cyanide poisoning

A

Hydroxycobalamin

It binds cyanide to form cyanocobalamin, vitamin B12

69
Q

Antidote for anticholinergic poisoning

A

Physostigmine

Jimson weed is a potential source

70
Q

Venlafaxine overdose

A

Can present similar to TCAS overdose with QT prolongation and seizures

71
Q

Arsinec poisoning

A

Smells like garlic

Tx with dimercaperol

EM (15 decks)

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