Pharm

Question 1

SSRI
AE (early and late)

Answer 1

Ex: Fluoxetine, paroxetine, sertraline, escitalopram, citalopram

Early AE: Nausea, anxiety, insomnia - will go away
Late AE: decreased libido - wont go away
Use with alcohol can cause depression

Safe for breastfeeding moms

Question 2

Bupropion
MOA, Use

Answer 2

MOA: Norepinephrine dopamine reuptake inhibitor

Use: Used for depression, smoking cessation.
AE: increase sz threshold for anorexic/bulimic patients. Favorable sexual side effect

Question 3

Indomethacin

Answer 3

1. Tocolytic used at <32 weeks, poses greater risk of used >32 weeks
2. 1st line for gout

AE: Chronic renal disease, GI bleed

Question 4

Alternative medicine

Answer 4

Saw Palmetto: Benign prostatic hyperplasia
Garlic: Hypercholesterolemia
St. John’s wort: Depression
Glucosamine & Chondroitin: Osteoarthritis

Question 5

ADAPT
what is is, tx

Answer 5

Cause: most commonly 1st gen antipsychotic

Acute dystonia: sustained muscular contraction –> Benztropine, Diphenhydramine

Akathesia: restlessness, pacing, tapping –> Benztropine, Benzo, Beta blocker

Parkinsonism: rigidity, mask facies, shuffling gait, tremor –> Benzotropine, Amantadine

Tardive dyskinesia: lip-tongue smacking, repetitive/uncontrolled –> stop med, switch to 2nd gen antipsychotic (Clozapine), Valbenazine

Question 6

Steroids
AE for skin, Endocrine, Eyes, Neuro, Immune, GI

Answer 6

• Skin: Atrophy, easy bruising
• Endocrine: adrenal insufficiency, hyperglycemia, linear growth impairment, osteoporosis
• Eyes: cataracts
• Neuro: behavior and sleep disturbances
• Immune: Neutrophilia, immuosuppresssion
• GI: Gastrisitis, ulcers, GI bled
• Cardio:HTN

Question 7

Inhaled steroids
AE and its Tx

Answer 7

AE: oral candidiasis (thrush) which can be removed, showing areas of inflammation.
Comp: esophagitis
Tx: Topical antifungal (nystatin suspension or clotrimazole). Resistant form can be treated with oral fluconazole.

Question 8

HTN Meds
AE of Loops, Thiazide, ACE, ARB
How to stop if possible

Answer 8

Loops
AE: OHHH DANG - Ototoxicity, HypoK, HypoH+ HypoMg, Dedhyration, Sulfa allergies, Nephritis, Gout

Thiazides
AE: HyperGLUC and Hypo Na, K, H+, Pancreatitis

ACEs:
AE: CATCHH - cough, angioedema, teratogen, increase creatinine, HyperK and Hypotension, Pancreatitis

ARB’s:
AE: HyperK, decrease GFR, Hypotension, teratogen, Pancreatitis

Can stop if stable BP below target BP for at least a year with good adherence to nonpharmacologic measures. Discontinue 1 medication at a time. Can decrease dose daily or take every other day over 1-2 months. Abrupt discontinuation of a short-acting drug can cause rebound hypertension.

Question 9

Doxycycline

Answer 9

Lymes, acne vulgaris

AE: photosensitivity, Effect bone and teeth in kids

Question 10

Isotretinoin
4 AE

Answer 10

Nodulocystic acne may initially flare up and subsequently improve within the first few weeks of isotretinoin therapy.

Teratogenicity: 2 negative pregnancy test beforehand, 2 concurrent methods of contraception (1 month before, during and month after)
Other AE: dry skin & mucous membranes, myalgias, pseudotumor cerebri (with other tetracycline used)

Question 11

OCP
MOA

Answer 11

Combined hormone contraception –> constant elevated systemic levels of estrogen and progesterone –> negative feedback of hypothalamus (decrease pulsatile release) and anterior pituitary (decrease LH, FSH)

Question 12

Doxrubicin
AE

Answer 12

AE: Cardiotoxicity
Monitor with Radionuclide ventriculography: quantitating LVEF.
Performed at baseline before chemotherapy and before each subsequent dose of chemotherapy.
Regimen is dependent on baseline cardiac function…CI if EF <30%.
Decrease in EF by >10% warrants discontinuation of therapy.

Question 13

Methotrexate
AE

Answer 13

AE: inhibits DHFR which is needed to convert folic acid into folinic acid –> folate deficiency –> macrocytic anemia
Tx: Folinic acid (Leucovorin)

Question 14

TCA
Toxicity Sx , Tx

Answer 14

CNS: AMS, Seizures, Respiratory depression

Cardio: Sinus Tachy, hypotension, Prolonged PR/QRS/QT interval, Arrhythmia

Anti-cholinergic: Dry mouth, blurry vision, dilated pupils, urinary retention, flushing, hyperthermia

Tx: Oxygen, Intubation, IVF, Activated charcoal (if within 2 hrs), IVF sodium bicarbonate for QRS interval widening or ventricular arrhythmia (blocks fast Na channels and neutralized TCA

Question 15

Fentanyl
MOA, AE

Answer 15

MOA: Short-acting opioid analgesic
AE: Respiratory depression, Exacerbated hypotension

Question 16

Ketamine
MOA, AE

Answer 16

MOA: NMDA receptor antagonist/phencyclidine derivative
Preferred med for awake intubation of difficult airways. Provided dissociation, amnesia, and analgesia
AE: hypertension

Question 17

Propofol

Answer 17

MOA: GABA receptor agonist
Rapid onset sedation and amnesia
AE: Respiratory depression, hypotension, loss of airway reflex

Question 18

Rocuronium
Succinylcholine
MOA, AE

Answer 18

Neuromuscular blocking agents used for sedation.
Both cause paralysis, loss of upper airway tone, cessation of all respiratory efforts

Question 19

Levodopa

Answer 19

MOA:
- dopamine immediate precursor
- Can cross BBB and be converted to dopamine.
- Rapidly metabolizes peripherally to dopamine and 3-O-metyldopa.
- Excess peripheral dopamine –> N/V, tachyarrhythmia, postural hypotension

• Carbidopa blocks peripheral conversion and increases amount of dopamine going to the brain. This decreases peripheral AE but not central AE.