pharm 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
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
3
Q
How to tx strep pharyngitis
A
PCN, Amoxicillin, macrolide
4
Q
How to tx mono?
A
ibuprofen/ tylenol. no abx
5
Q
how to tx allergic rhinitis
A
intranasal glucocorticoids, antihistamines,
decongestants
6
Q
how to tx acute rhinosinusitis
A
wait 10 days, then Amoxicillin or
Augmentin.
7
Q
SE: diarrhea, nausea/vomiting
* WARNINGS:
* Do not use with renal disease, hepatic acidosis, alcoholics.
* Monitor renal function.
A
Metformin
8
Q
DM tx in order
A
- Lifestyle modification. Weight loss. Try for 3-6 months.
- Start metformin 500mg-2,000mg/24hr.
- Sulfonylurea (Glucotrol) or other oral.
- Insulin.
9
Q
pancreas makes_____
A
Pancreas makes insulin
and glucagon
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.
11
Q
- Hyperthyroidism: excess T3, T4.
- Autoimmune.
- Exophthalmos, goiter.
*weight loss, muscle wasting, tremors.
A
Graves
12
Q
Tx of graves
A
Tx: Propylthiouracil (PTU) and
methimazole (Tapazole).
13
Q
ACEIs…
A
Prils.
14
Q
ARBs
A
“…sartan” (losartan, valsartan)
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
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
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.
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”
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
20
Q
used for fine tremors
A
propranolol
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)
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)
23
Q
Common SE of CCB
A
CCB cause swollen ankles, HA
Nifedipine, amlodipine, verapamil,
diltiazem.
24
Q
Common SE of OF ACEIs
A
ACEIs cause Cough + angioedema
- Ramipril, Benazepril, Enalapril.
25
Common SE of TZD
hyperuricemia, hyperglycemia, cholesterol
Hydrochlorothiazide
26
Common SE of beta blockers
beta blockers cause fatigue, depression
-"lol"
27
Potent vasodilators.
* SE: dizziness, orthostatic- hypotension.
* Take at bedtime.
* Terazosin, Doxazosin, Tamsulosin (Flomax) for BPH, Hytrin
Alpha-1 blockers/antagonists “…zosin”
28
Drug to give to pt with HTN and BPH
Hytrin
a Alpha-1 blocker/antagonist
29
How to care for burns?
* 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.
30
Tx animal bite wounds?
treat prophylactic with Augmentin PO x10 days.
* Tetanus vaccine (Tdap if >7yo).
31
How to tx impetigo?
honey crusted lesions
muprocin
32
How to tx erythema multiform
removal of causative organism. Usually its an NSAID
33
Bright red diaper rash: candida infection ➡
antifungal “azoles”.
34
Tx for Mountain spotted fever/ Lyme:
Doxy
Mtn spotted fever is life threatening give Doxy to kids anyway
Lyme = give beta lactam to kids
35
Tx for eczema
steroids
36
Tx for purulent cellulitis
MRSA
Incision and drainage
Bactrim, Clindamycin, Doxy (B,C,D)
37
Tx of non-purlent cellulitis
* Gram +
* cephalexin (Keflex)
38
EX: Hydrocortisone vs Betamethasone steroids
Hydrocortisone (low potency)
Betamethasone (high potency) -generally limit high potency to < 2 week duration
39
TX for folliculitis
Bactroban
40
Tx for molluscum (belly button like rash)
viral- self limited
if seen on privates of kids-> think abuse
41
tx for contact and atopic dermatitis
topicla steroid
42
Acne found on armpits and groin,
painful lumps= Hidradenitis suppurativa.
How to tx?
Diet low in sugar and fat, lose weight, keep clean
Tx: topical clindamycin, tetracycline.
If severe use oral Clindamycin, Rifampin.
43
tx for cutaneous anthrax
Cipro 500mg PO BID for 60 days.
44
Tx for actinic keratosis
... precursor to squamous cell. A rough, scaly patch on the skin caused by years of sun exposure
topical 5FU (topical chemotherapy) , cryotherapy.
45
Tx for basal cell
Dome shaped, pearly white, Telangiectasias, may have ulcerated center. grows very slowly. on sun exposed areas like the back
chemo or immunotherapy
46
Tx for erysipelas (strep infection) on the face
PCN or macrolide
47
Tx of spider bite
abx on wound, cold ice packs.
48
Tympanic membrane bulging, cloudy, stiff.
* With effusion: with fluid behind tm.
* Most common organism strep Pneumo.
Otitis media
Tx: Amoxicillin. If allergic →Augmentin.
49
“Swimmer's ear”
* Inflammation of the ear canal.
* Tenderness of tragus/pinna or ear canal edema/erythema.
Otitis Externa
50
Tx for otitis externa
Tx: quinolones are treatment of
choice (Cipro drops) + analgesics,
local anesthetics, steroid
51
Tx for Roseola infantum
6th disease. Bed rest, fluids, Tylenol.
52
Tx for Kawasaki
high dose aspirin, IVIG.
53
Tx for Hand , foot, mouth
symptomatic treatment,
ibuprofen or Tylenol, cold fluids.
54
Tx of pertussis in kids
Macrolide
55
Tx of croup - barking cough
Treatment is single dose dexamethasone.
56
Tx of bronchiolitis
lower resp infection, obstructs bronchioles
* Supportive treatment, NO STEROIDS! NO NEB TX!
57
Tx of pneumonia in kids
Amoxicillin 90mg/kg/day.
58
Tx Encorporesis in kids
Child resists having a bowel movement→ constipation → leakage.
* Involuntary soiling of stool age >4.
* Underlying problem is constipation, treat with laxatives, MiraLAX.
59
Tx febrile seizures
* Tx: ibuprofen, acetaminophen.
* Ibuprofen not recommended <6mos.
60
11-12 years old, booster 16 years old.
* MCV (meningococcal) vaccines
61
When is flu vax started?
MMR/ VZV?
Hep B?
HVP?
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
Who should get shingrix?
PPSC23?
Shingrix (not live) Adult's age ≥50
PPSC23 > 65 years - make sure they also have the 13 at least 1 year apart
63
vaccines to get while pregnant
when?
Flu vaccine OK during any trimester.
* Every pregnancy gets a Tdap @3rd trimester (27-36 wks.).
* Avoid live vaccines in pregnancy (teratogenic).
64
Pre-eclampsia management
Diuretics, antihypertensives (Labetalol, methyldopa, hydralazine), CCB.
65
Meds not safe during pregnancy
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
meds safe during pregnancy
PCN, metformin, cephalosporins, Tylenol, prednisone, insulin
67
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.
Bupropion (Wellbutrin)
68
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.
Serotonin syndrome
69
1st line antidepressants (including elderly). It is common to get a HA after
initiation of tx. (Citalopram, Lexapro, Prozac, Zoloft)
SSRIs
70
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.
TCAs
71
⚠ Weight gain, metabolic syndrome, DM II. Monitor weight every 3 months
Atypical Antipsychotics
clozapine, risperidone, olanzapine (Zyprexa), (Seroquel),
72
What are Benzos used for ?
anxiety, panic, insomnia.
73
Common SE of antipsychotics
dizziness, weakness, depression,
restlessness.
74
Tx of polymyalgia rheumaticia (lots of areas of pain)
steroids, symptom management
75
Tx of plantar fasciitis
NSAIDS ➡ orthotics ➡ steroid inj ➡ PT.
76
1st and 2nd line tx of osteoarthritis
* 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
Tx for osteoporosis
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
Tx for Repetitive strain injury/Overuse syndrome
stop doing what is causing pain
NSAIDS.
Steroid injections (refer!)
79
tx of H pylori
Triple: PPI or ranitidine bismuth citrate, combined with Clarithromycin and Amoxicillin or Metronidazole.
* Quadruple: Bismuth+ Flagyl+ tetracycline+ PPI
* * bismuth can turn stool dark*
80
⬆ risk of fractures on postmenopausal women due to low estrogen
and demineralization
PPIs
(dont take PPIs forever)
81
PPI or H2blocker first?
PPIs are now 1st line
82
Tx UTI
complicated vs uncomplicated
UTI: >100,000 CFU/ml
* Uncomplicated: 3-day, trimethoprim-sulfa (Bactrim), nitrofurantoin.
* Complicated: cipro
* Pyridium used to relieve symptoms changes urine to orange
83
Desired INR range
2-3
84
INR ⬆
blood cots more slowly than desired. Risk for bleeding.
85
INR ⬇
blood clots more quickly than desired. Risk for blood clots.
86
vitamin K antagonists: works against the clotting process. (anticoagulant)
Warfarin/Coumadin
87
Warfarin interacts with “_____” herbs:
Warfarin interacts with “G” herbs: garlic, ginger, gingko, ginseng & fish oil.
88
Discontinue anticoagulation therapy ______before invasive procedure.
7 days
89
*Initial treatment of anticoagulant is usually _______, but it may vary depending on patient.
*Initial daily dose is____, for frail elderly start at mg.
3 months
5mg
start at 2.5 for frail/ elderly
90
Tx of BV
Metronidazole.
91
Tx of candida vaginitis
Metronidazole, Diflucan.
92
Trichomonas tx:
Metronidazole *tx partner too.
93
Atrophic vaginitis tx:
topical estrogen
94
Chlamydia tx:
Doxy or Azithromycin *tx partner too.
95
Gonorrhea tx:
Ceftriaxone 500mg IM x 1.
96
Syphilis tx:
PCN G
97
Condyloma Acuminata tx:(genital warts, HPV)
Condylox, Imiquimod.
98
Statins (Lipitor, Crestor) don’t ever mix with
grapefruit juice.
99
1ST line tx strep throat:
penicillin. If allergic, Macrolide.
100
Tx gout
NSAIDS Indocin, colchicine for flare up. Allopurinol for long term management.
101
warning with erosive esophagitis, abdominal
pain.
* Take alone, in the AM, full glass water, stay up right 30min post taking it.
Bisphosphonates
102
induces gynecomastia** by decreasing testosterone production, increasing peripheral conversion of testosterone to estradiol, and displacing estradiol from sex hormone-binding globulin.
Spironolactone
103
Never give Doxy ______of age.
<7 years
104
Tx cluster ha
Oxygen and sumatriptan
105
Tx muscle tension HA
NSAIDS, stressor ⬇.
106
What foods to avoid with MAOIs
MAOIs and tyramine containing foods: aged cheeses, aged meats, red wine, beer
107
What foods to avoid when taking anticoagulant
Avoid excess intake of vitamin K rich foods: dark green leafy vegetables, broccoli, kale…
108
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?
Azithromycin
109
Untreated Actinic Keratosis has the potential to turn into what type of skin cancer?
Squamous cell
