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pharm Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

Tx of lung infections
w/ and w/out comorbidities:
if abx in past 3 months

A

Lung infections
* With comorbidities: FLUROQUINOLONES
* No comorbidities: MACROLIDE (azithromycin or clarithromycin)
* If antibiotics in the past 3 months
* Doxy
* Levofloxacin
* Azithromycin or Clarithromycin + Amoxicillin or Augmentin

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2
Q
  • Hacking cough, may vomit after cough.

how to treat ?

A

PERTUSSIS “whooping cough”
Lasts 2-3 weeks.

Treatment: MARCOLIDE
* Azithromycin (Z-pack)
* Erythromycin
* Clarithromycin

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3
Q

How to tx strep pharyngitis

A

PCN, Amoxicillin, macrolide

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4
Q

How to tx mono?

A

ibuprofen/ tylenol. no abx

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5
Q

how to tx allergic rhinitis

A

intranasal glucocorticoids, antihistamines,
decongestants

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6
Q

how to tx acute rhinosinusitis

A

wait 10 days, then Amoxicillin or
Augmentin.

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7
Q

SE: diarrhea, nausea/vomiting
* WARNINGS:
* Do not use with renal disease, hepatic acidosis, alcoholics.
* Monitor renal function.

A

Metformin

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8
Q

DM tx in order

A
  1. Lifestyle modification. Weight loss. Try for 3-6 months.
  2. Start metformin 500mg-2,000mg/24hr.
  3. Sulfonylurea (Glucotrol) or other oral.
  4. Insulin.
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9
Q

pancreas makes_____

A

Pancreas makes insulin
and glucagon

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10
Q

different kinds of insulins

A
  • Rapid acting (insulin lispro, aspart) : covers 1 meal at a time. (tray in front of pt)
  • Short acting (regular insulin) : from meal to meal. (just had lunch and will have dinner in 3 hours)
  • Intermediate (NPH) : from breakfast to dinner.
  • Long acting (insulin glargine) : once a day.
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11
Q
  • Hyperthyroidism: excess T3, T4.
  • Autoimmune.
  • Exophthalmos, goiter.
    *weight loss, muscle wasting, tremors.
A

Graves

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12
Q

Tx of graves

A

Tx: Propylthiouracil (PTU) and
methimazole (Tapazole).

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13
Q

ACEIs…

A

Prils.

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14
Q

ARBs

A

“…sartan” (losartan, valsartan)

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15
Q

Blocks conversion of angiotensin I to II.
* DM and CKD drugs of choice.
* WARNING: category C. (careful in pregnancy)
* SE: dry cough, hyperkalemia,
angioedema.
* Contraindicated: kidney disease (mod to
severe), hyperkalemia.
* Ramipril, Benazepril, Enalapril.

A

ACEIs

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16
Q

WARNING: wean slowly with chronic use. May cause rebound HTN.
* Contraindicated: asthma, COPD, chronic bronchitis, emphysema.
* Other uses: decrease mortality during acute MI, post MI, migraine HA, decrease IOP in glaucoma, angina pectoris.
* Metoprolol, atenolol, propranolol.
* Propranolol is also used for fine tremors.

A

Beta Blockers

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17
Q

Blocks beta receptors in the heart causing decreased HR, force of contraction, rate of AV conduction

SE: Lethargy, bradycardia, CHF, decreased BP, depression

A

Beta Blockers

  • Metoprolol, atenolol, propranolol.
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18
Q
  • Systemic vasodilator.
  • Treatment for Raynaud’s.
  • Blocks voltage-gated calcium channels
    in cardiac smooth muscle and blood
    vessels.
  • SE: HA (due to vasodilation), ankle
    edema.
  • Contraindication: CHF.
  • Nifedipine, amlodipine, verapamil,
    diltiazem.
A
  • Calcium Channel Blockers “…pine”
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19
Q
  • Calcium Channel Blockers “…pine”
A

Systemic vasodilator.Blocks voltage-gated calcium channels in cardiac smooth muscle and blood vessels.

Nifedipine, amlodipine, verapamil, diltiazem.

dont give to CHF pts

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20
Q

used for fine tremors

A

propranolol

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21
Q

Diuretic
* It can treat high blood pressure and fluid retention.
* ⬆ urine output, ⬇ blood volume, ⬇venous pressure, ⬇ preload.
* Favorable effects for osteopenia and osteoporosis (calcium sparing)
* Favorable for women in menopause (demineralization).
* Monitor lipid profile.

WARNING: can worsen
* Hyperglycemia
* Hyperuricemia (don’t use in gout)
* High triglycerides
* High cholesterol

A

Hydrochlorothiazide (HTZ)

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22
Q

Preferred 1st line drug to tx HTN in DM and pts. with mild to moderate renal disease:

A
  • ACEIs and ARBs (kidney protective)
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23
Q

Common SE of CCB

A

CCB cause swollen ankles, HA

Nifedipine, amlodipine, verapamil,
diltiazem.

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24
Q

Common SE of OF ACEIs

A

ACEIs cause Cough + angioedema

  • Ramipril, Benazepril, Enalapril.
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25
Q

Common SE of TZD

A

hyperuricemia, hyperglycemia, cholesterol

Hydrochlorothiazide

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26
Q

Common SE of beta blockers

A

beta blockers cause fatigue, depression

-“lol”

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27
Q

Potent vasodilators.
* SE: dizziness, orthostatic- hypotension.
* Take at bedtime.
* Terazosin, Doxazosin, Tamsulosin (Flomax) for BPH, Hytrin

A

Alpha-1 blockers/antagonists “…zosin”

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28
Q

Drug to give to pt with HTN and BPH

A

Hytrin

a Alpha-1 blocker/antagonist

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29
Q

How to care for burns?

A
  • Wash with soap and water.
  • Use sterile tongue blade and apply 1% silver silver sulfadiazine (Silvadene).
  • Use Desitin daily 1-2 weeks to relieve discomfort.
  • Sulfa allergy* use mupirocin (Bactroban) ointment.
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30
Q

Tx animal bite wounds?

A

treat prophylactic with Augmentin PO x10 days.
* Tetanus vaccine (Tdap if >7yo).

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31
Q

How to tx impetigo?

A

honey crusted lesions

muprocin

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32
Q

How to tx erythema multiform

A

removal of causative organism. Usually its an NSAID

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33
Q

Bright red diaper rash: candida infection ➡

A

antifungal “azoles”.

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34
Q

Tx for Mountain spotted fever/ Lyme:

A

Doxy

Mtn spotted fever is life threatening give Doxy to kids anyway

Lyme = give beta lactam to kids

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35
Q

Tx for eczema

A

steroids

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36
Q

Tx for purulent cellulitis

A

MRSA
Incision and drainage
Bactrim, Clindamycin, Doxy (B,C,D)

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37
Q

Tx of non-purlent cellulitis

A
  • Gram +
  • cephalexin (Keflex)
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38
Q

EX: Hydrocortisone vs Betamethasone steroids

A

Hydrocortisone (low potency)

Betamethasone (high potency) -generally limit high potency to < 2 week duration

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39
Q

TX for folliculitis

A

Bactroban

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40
Q

Tx for molluscum (belly button like rash)

A

viral- self limited

if seen on privates of kids-> think abuse

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41
Q

tx for contact and atopic dermatitis

A

topicla steroid

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42
Q

Acne found on armpits and groin,
painful lumps= Hidradenitis suppurativa.

How to tx?

A

Diet low in sugar and fat, lose weight, keep clean

Tx: topical clindamycin, tetracycline.
If severe use oral Clindamycin, Rifampin.

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43
Q

tx for cutaneous anthrax

A

Cipro 500mg PO BID for 60 days.

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44
Q

Tx for actinic keratosis

A

… precursor to squamous cell. A rough, scaly patch on the skin caused by years of sun exposure

topical 5FU (topical chemotherapy) , cryotherapy.

45
Q

Tx for basal cell

A

Dome shaped, pearly white, Telangiectasias, may have ulcerated center. grows very slowly. on sun exposed areas like the back

chemo or immunotherapy

46
Q

Tx for erysipelas (strep infection) on the face

A

PCN or macrolide

47
Q

Tx of spider bite

A

abx on wound, cold ice packs.

48
Q

Tympanic membrane bulging, cloudy, stiff.
* With effusion: with fluid behind tm.
* Most common organism strep Pneumo.

A

Otitis media

Tx: Amoxicillin. If allergic →Augmentin.

49
Q

“Swimmer’s ear”
* Inflammation of the ear canal.
* Tenderness of tragus/pinna or ear canal edema/erythema.

A

Otitis Externa

50
Q

Tx for otitis externa

A

Tx: quinolones are treatment of
choice (Cipro drops) + analgesics,
local anesthetics, steroid

51
Q

Tx for Roseola infantum

A

6th disease. Bed rest, fluids, Tylenol.

52
Q

Tx for Kawasaki

A

high dose aspirin, IVIG.

53
Q

Tx for Hand , foot, mouth

A

symptomatic treatment,
ibuprofen or Tylenol, cold fluids.

54
Q

Tx of pertussis in kids

A

Macrolide

55
Q

Tx of croup - barking cough

A

Treatment is single dose dexamethasone.

56
Q

Tx of bronchiolitis

A

lower resp infection, obstructs bronchioles
* Supportive treatment, NO STEROIDS! NO NEB TX!

57
Q

Tx of pneumonia in kids

A

Amoxicillin 90mg/kg/day.

58
Q

Tx Encorporesis in kids

A

Child resists having a bowel movement→ constipation → leakage.
* Involuntary soiling of stool age >4.
* Underlying problem is constipation, treat with laxatives, MiraLAX.

59
Q

Tx febrile seizures

A
  • Tx: ibuprofen, acetaminophen.
  • Ibuprofen not recommended <6mos.
60
Q

11-12 years old, booster 16 years old.

A
  • MCV (meningococcal) vaccines
61
Q

When is flu vax started?
MMR/ VZV?
Hep B?
HVP?

A

Flu- 6 months
MMR/ VZV- 12 months (can cause localized rxn)
Hep B @ birth (0 months)
HVP- 2 doses given to girls and boys

62
Q

Who should get shingrix?
PPSC23?

A

Shingrix (not live) Adult’s age ≥50

PPSC23 > 65 years - make sure they also have the 13 at least 1 year apart

63
Q

vaccines to get while pregnant
when?

A

Flu vaccine OK during any trimester.
* Every pregnancy gets a Tdap @3rd trimester (27-36 wks.).
* Avoid live vaccines in pregnancy (teratogenic).

64
Q

Pre-eclampsia management

A

Diuretics, antihypertensives (Labetalol, methyldopa, hydralazine), CCB.

65
Q

Meds not safe during pregnancy

A

chemo, phenytoin (antiepileptic), tetracyclines, fluoxetine
(Prozac), paroxetine (Paxil).

Misoprostol (Cytotec): used to protect stomach lining in the prevention of ulcers.- during pregnancy causes abortion

Thalidomide: Used in the 50s for nausea in pregnancy. Caused worldwide tragedy of many baby
deaths.

66
Q

meds safe during pregnancy

A

PCN, metformin, cephalosporins, Tylenol, prednisone, insulin

67
Q

Antidepressant and smoking cessation aid.
* No potential for abuse
* Energizing, used to ⬆ libido.
* Don’t use in bulimia (risk for seizures). It is excreted through the kidneys. Risk of
toxicity due to recurrent dehydration and electrolyte disturbance.

A

Bupropion (Wellbutrin)

68
Q

too much serotonin. Can happen after starting a new antidepressant med.
* S&S: N&V, diarrhea, rapid HR, tremors, twitching, sweating.
* WARNING S&S ⚠: high fever, seizures, uneven heartbeat, passing out.

A

Serotonin syndrome

69
Q

1st line antidepressants (including elderly). It is common to get a HA after
initiation of tx. (Citalopram, Lexapro, Prozac, Zoloft)

A

SSRIs

70
Q

not 1st line for depression. Used for prophylactic tx: migraines, chronic pain,
neuropathic pain (Elavil, Pamelor). Do not give to suicidal patients due to high risk of
overdosing.

A

TCAs

71
Q

⚠ Weight gain, metabolic syndrome, DM II. Monitor weight every 3 months

A

Atypical Antipsychotics

clozapine, risperidone, olanzapine (Zyprexa), (Seroquel),

72
Q

What are Benzos used for ?

A

anxiety, panic, insomnia.

73
Q

Common SE of antipsychotics

A

dizziness, weakness, depression,
restlessness.

74
Q

Tx of polymyalgia rheumaticia (lots of areas of pain)

A

steroids, symptom management

75
Q

Tx of plantar fasciitis

A

NSAIDS ➡ orthotics ➡ steroid inj ➡ PT.

76
Q

1st and 2nd line tx of osteoarthritis

A
  • 1st line tx: exercise, weight loss, ice packs, acetaminophen.
  • 2nd line tx: NSAIDS. Short term. 2-4 weeks trial with max dose.
  • If no relief, refer for steroid injections.
77
Q

Tx for osteoporosis

A

Fosamax, calcium, vitamin D. Weight bearing exercises.

take meds first thing in AM while standing (risk of esophageal erosion) with big glass of water

78
Q

Tx for Repetitive strain injury/Overuse syndrome

A

stop doing what is causing pain
NSAIDS.
Steroid injections (refer!)

79
Q

tx of H pylori

A

Triple: PPI or ranitidine bismuth citrate, combined with Clarithromycin and Amoxicillin or Metronidazole.

  • Quadruple: Bismuth+ Flagyl+ tetracycline+ PPI
    • bismuth can turn stool dark*
80
Q

⬆ risk of fractures on postmenopausal women due to low estrogen
and demineralization

A

PPIs

(dont take PPIs forever)

81
Q

PPI or H2blocker first?

A

PPIs are now 1st line

82
Q

Tx UTI
complicated vs uncomplicated

A

UTI: >100,000 CFU/ml
* Uncomplicated: 3-day, trimethoprim-sulfa (Bactrim), nitrofurantoin.
* Complicated: cipro
* Pyridium used to relieve symptoms changes urine to orange

83
Q

Desired INR range

A

2-3

84
Q

INR ⬆

A

blood cots more slowly than desired. Risk for bleeding.

85
Q

INR ⬇

A

blood clots more quickly than desired. Risk for blood clots.

86
Q

vitamin K antagonists: works against the clotting process. (anticoagulant)

A

Warfarin/Coumadin

87
Q

Warfarin interacts with “_____” herbs:

A

Warfarin interacts with “G” herbs: garlic, ginger, gingko, ginseng & fish oil.

88
Q

Discontinue anticoagulation therapy ______before invasive procedure.

A

7 days

89
Q

*Initial treatment of anticoagulant is usually _______, but it may vary depending on patient.
*Initial daily dose is____, for frail elderly start at mg.

A

3 months

5mg
start at 2.5 for frail/ elderly

90
Q

Tx of BV

A

Metronidazole.

91
Q

Tx of candida vaginitis

A

Metronidazole, Diflucan.

92
Q

Trichomonas tx:

A

Metronidazole *tx partner too.

93
Q

Atrophic vaginitis tx:

A

topical estrogen

94
Q

Chlamydia tx:

A

Doxy or Azithromycin *tx partner too.

95
Q

Gonorrhea tx:

A

Ceftriaxone 500mg IM x 1.

96
Q

Syphilis tx:

A

PCN G

97
Q

Condyloma Acuminata tx:(genital warts, HPV)

A

Condylox, Imiquimod.

98
Q

Statins (Lipitor, Crestor) don’t ever mix with

A

grapefruit juice.

99
Q

1ST line tx strep throat:

A

penicillin. If allergic, Macrolide.

100
Q

Tx gout

A

NSAIDS Indocin, colchicine for flare up. Allopurinol for long term management.

101
Q

warning with erosive esophagitis, abdominal
pain.
* Take alone, in the AM, full glass water, stay up right 30min post taking it.

A

Bisphosphonates

102
Q

induces gynecomastia** by decreasing testosterone production, increasing peripheral conversion of testosterone to estradiol, and displacing estradiol from sex hormone-binding globulin.

A

Spironolactone

103
Q

Never give Doxy ______of age.

A

<7 years

104
Q

Tx cluster ha

A

Oxygen and sumatriptan

105
Q

Tx muscle tension HA

A

NSAIDS, stressor ⬇.

106
Q

What foods to avoid with MAOIs

A

MAOIs and tyramine containing foods: aged cheeses, aged meats, red wine, beer

107
Q

What foods to avoid when taking anticoagulant

A

Avoid excess intake of vitamin K rich foods: dark green leafy vegetables, broccoli, kale…

108
Q

A 2 year old kid is brought in by his mother complaining about hacking cough and vomitus elicited by cough for the past two weeks. What is the best treatment?

A

Azithromycin

109
Q

Untreated Actinic Keratosis has the potential to turn into what type of skin cancer?

A

Squamous cell

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