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Exam questions > Pharm > Flashcards

Pharm Flashcards

1
Q

phenytoin side effect

A 
P450
Hirutsim
Enlarged gum
Nystagmus
Yellow/brown skin
Teratogenic
Osteomalacia
Intefere with folic acid/anemia
Neuropathy - vitiligo, ataxia and h/a
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2
Q

4 year old boy 4 days post tonsillectomy and adenoidectomy with significant pain despite acetaminophen given regularly. His oropharynx is shown in a picture (granulation tissue shown bilaterally, left side more than right). What is the best strategy to manage his pain:

a. optimize acetaminophen dosing
b. amoxicillin
c. start codeine

A

optimize acetaminophen dosing

First line = oral acetaminophen or ibuprofen RTC
Ibuprofen shown not to increase risk of bleed post op
BUT avoid ketorolac + ASA → does increase risk of post-op bleed

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3
Q

What is the most common side effect of cephalosporins?

a. Rash
b. Fever
c. Arthritis
d. Diarrhea

A

diarrhea

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4
Q

We no longer use codeine for post-operative pain due to several children who died as a result of this medication. What was the reason for these fatalities?

a. Some children are ultra fast metabolizers of codeine
b. Some children are slow metabolizers of codeine
c. Some children are allergic to codeine

A

Some children are ultra fast metabolizers of codeine

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5
Q

A mother wants to use topical nasal decongestants in her 4 year old child. You recommend against it because:

a. Rebound congestion
b. Irritability
c. Dystonic reaction

A

rebound congestion

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6
Q

Asthmatic needs sedation, med to worry about giving causing histamine release:

a) Morphine
b) Fentanyl

A

morphine

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7
Q

Boy on risperidone with gynecomastia. What would we look for before switching?
a) Prolactin

A

proloactin

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8
Q

How do we treat neuropathic pain

a) Gabapentin
b) Morphine

A

gabapentin

: Gabapentin is structurally related to GABA. However, it does not bind to GABAA or GABAB receptors, and it does not appear to influence synthesis or uptake of GABA.

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9
Q

A 16 year old girl is on multiple medications and develops headaches with blurred optic discs bilaterally. Which of the following is most likely to be responsible?

a. Methylphenidate
b. Calcium
c. Fluoxetine
d. Minocycline

A

d. Minocycline

 IIH, some have stronger evidence vs. some anecdotal:
Evidence for
Growth hormone
Tetracyclines - minocycline, doxycycline
Hypervitaminosis A
Nelson’s also lists
Sulfonamides
Fluoroquinolines
Cyclosporine
Phenytoin
Isotretinoin
OCP
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10
Q

A 7 yo boy is on inhaled corticosteroids for poor asthma control. Mom is concerned about the effect of corticosteroids on his height. What do you tell her?

a. he will lose 1 cm in height
b. he will be significantly shorter than his genetic potential
c. his growth velocity will be decreased, but his final adult height will not be affected
d. he will have a significant catch-up period once he comes off the steroids

A

lose 1 cm

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11
Q

A child has CF. Family wants to use alternative medicine. Homeopathy has been proven effective for which condition:

a) Diarrhea
b) ADHD
c) Allergies

A

diarrhea

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12
Q

Teratogenic effects of carbamazepine

a) Neural tube defect
b) Cleft lip and palate

A

carbamazepine

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13
Q

Asthmatic needs sedation, med to worry about giving causing histamine release:

a) Morphine
b) Fentanyl

A

morphine

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14
Q

Which antiepileptic causes bilateral renal calculi?

a. Topiramate
b. Dilantin (phenytoin)
c. Valproic acid
d. Carbamazepine
e. Keppra
f. Lamotrigine

A

all call SJS
topiramate (also causes weight loss) - glaucoma

VPA- weight gain, alopecia, pancreatic and hepatoxicity

carbamzepine- tic, transien lulpenia, hyponatremia, agranolocytosis

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15
Q

8yr old child is status post renal transplant and was diagnosed with an AOM. He was started on clarithromycin. He had normal cyclosporine levels initially however 3 days later his cyclosporine levels are elevated. What is the MOST likely explanation?

a. As he started to feel better, he started to refeed and this caused increased absorption of the cyclosporine.
b. Impaired renal clearance
c. Clarithromycin affects the p450 enzyme and lead to decreased metabolism of the cyclosporine.

A

Clarithromycin affects the p450 enzyme and lead to decreased metabolism of the cyclosporine.

this increases cyclo levels - l

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16
Q

9y boy on phenytoin and valproic acid for epilepsy. Mom notices gum swelling (describing gum hyperplasia). What should you advise?

a. Decrease phenytoin
b. Stop phenytoin
c. Decrease valproic acid
d. Stop valproic acid

A

Decrease phenytoin - don’t stop cold turkey, can have withdrawal seizures

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17
Q

side effect of anabolic steoirds

A

Endocrine
Decreased sperm count and testicular atrophy in men
Menstrual irregularities and virilization in women
Hepatic: elevated ALT/AST/GGT, cholestatic jaundice, hepatitis, HCC
CV: HTN, glucose intolerance, increased LDL, decreased HDL
Psych: anxiety, depression, mania, psychosis
Physical appearance:
Men: gynecomastia, testicular shrinkage, jaundice, male pattern baldness, acne, striae
Women: hirsutism, deep voice, clitoral hypertrophy, male pattern baldness, acne, striae

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18
Q

Kid with otitis media given Amox/Clav in 4:1 dose. Presents with diarrhea and vomiting. Cause?

a. Wrong clavulin dose
b. Viral gastro

A

wrong clavulin

The dosage amount does not exceed the 10mg/kg/day of clavulanate that is linked with diarrhea
suspension is the 7:1 formulation

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19
Q

During RSI, when is succynilcholine contraindicated?

a. raised ICP
b. muscular dystrophy

A 
muscular dystrophy
others-
Neuromuscular disease
History malignant hyperthermia in patient or family
Significant hyperkalemia
Extensive crush injury with rhabdomyolysis
Renal failure
Burns
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20
Q

Adolescent female being teased at school. Obese, acne. Papilledema, head imaging normal. What is the cause?

a. Minocycline
b. OCP
c. Topical retinoids

A

minocycline

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21
Q

Best amnestic drug?

a. Midazolam
b. Ketamine
c. fentanyl
d. chloral hydrate

A

KETAMINE

a. Midazolam - only
anterograde amnesia
b. Ketamine - both anterograde + retrograde amnesia, dissociative

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22
Q

Counsel about side effects of marijuana use

a. Gynecomastia
b. Small testes

A

gynecomastia

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23
Q

Young boy’s mother wishes counseling about the risk of drug dependency with ADHD medications

a. decreases risk of developing drug dependency - I would pick this if “decreases risk of substance abuse”
b. risk actually increases
c. “one of the stimulants” has been shown to decrease the risk more than others

A

risk actually increases

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24
Q

Teenage female presents with headaches that wake her from sleep. On exam, has bilateral papilledema. Currently on OCPs and minocycline for acne. CT normal. What is the most likely diagnosis?

a. Pseudotumour cerebri
b. Migraines
c. Stroke
d. Tumor

A

Pseudotumour cerebri

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25
Q

Why is diazepam rarely used as a sedative/anticonvulsant in infants?

a. Increased distribution of liquid
b. Decreased hepatic clearance
c. Something about renal clearance

A

Decreased hepatic clearance

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26
Q 
---------------
Why do we not give diazepam to preterm infants?
a. Small volume of lipid distribution
b. Large volume of liquid distribution
c. Immature hepatic metabolism
A

immature hepatic metabolism

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27
Q

What are the main differences between a neonate and an adolescent with respect to drug dosing?

a. Increased distribution of liquid
b. Increased distribution of lipid
c. More rapid renal clearance
d. More rapid liver metabolism

A

Increased distribution of liquid

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28
Q

Which is higher in neonates compared to adolescents?

a. Volume of liquid distribution
b. Volume of lipid distribution
c. Hepatic metabolism

A

a. Volume of liquid distribution

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29
Q

Child has received anthracycline as part of chemotherapy. Which long term side effect should he be tested for:

a. Hearing
b. Vision
c. Renal
d. Cardiac

A

cardiac

Anthracycline cardiotoxicity (doxorubicin [Adriamycin]) on rare occasion causes acute inflammatory myocardial injury, but more classically results in DCM and occurs in up to 30% of patients given a cumulative dose of doxorubicin exceeding 550 mg/m2. The risk of toxicity appears to be exacerbated by concomitant radiation therapy.

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30
Q

You are a rural doc seeing a child who had just completed chemotherapy. What are the side effects of anthrocyclins -what do you need to monitor for?

a. hearing test
b. cardiac echo
c. thyroid function
d. renal function

A

cardiac echo

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31
Q

Most amnestic drug?

a. Midazolam
b. Chloral hydrate -
c. Morphine -
d. Fentanyl -

A

MIDAZ

b. Chloral hydrate - no longer recommended
c. Morphine - opioid
d. Fentanyl - opioid

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32
Q

Teen on OCP. What is the side effect of excess estrogen?

a. Mood swings
b. Breast tenderness
c. Weight gain
d. Acne

A

BREAST TENDER

Mood swings (progesterone)

b. Breast tenderness
c. Weight gain (progesterone)
d. Acne (progesterone)

33
Q

Marijuana use is associated with

a. gynecomastia
b. decreased testicular size
c. bradycardia

A

gynecomastia

34
Q

Which of the following effects of ketamine make it not a preferable drug to use in brain injury for RSI:

a. sympathomimetic effect
b. negative inotrope
c. induces respiratory depression

A

sympathomimetic effect

35
Q

Doxyrubicin causes?

a. dilated cardiomyopathy
b. hypertrophic cardiomyopathy
c. restrictive cardiomyopathy
d. pericarditis

A

cardiomyopathy

36
Q

Which is an absolute contraindication to birth control pill:

a. Migraine headaches
b. Smoking
c. Moderate Hypertension
d. Undiagnosed vaginal bleeding

A

Undiagnosed vaginal bleeding

37
Q

An 8 year old girl with a renal transplant is on cyclosporine. She is admitted to the hospital for pneumonia and receives clarithromycin. On admission her cyclosporine level is normal and three days later it is above the normal range. What is the reason for this?

a. Poor compliance with medication prior to arrival
b. Clarithromycin decreases the renal clearance of cyclosporine
c. Clarithromycin decreases the metabolism of cyclosporine

A

Clarithromycin decreases the metabolism of cyclosporine

38
Q

Mother is concerned about her son who has asthma. He has been on daily moderate dose inhaled steroids for the last few years. She has noticed that he seems to be growing slowly. What can you tell her based on the knowledge that we currently have?

a. He will be slightly shorter than his genetic potential
b. There will be no significant difference in his height
c. He will be significantly shorter than his predicted height
d. There will now be a significant catch up period of growth

A

slightly shorter then geneitc potential

39
Q

Management of postoperative pain in children aged 6-10 years:

a. use BP and HR as a guide for when to give pain medications
b. give regular doses of pain meds in the first 24 hours as they cannot reliably report pain
c. use facial expression as an indication of pain
d. patient can use a visual analog pain scale to describe their pain

A

patient can use a visual analog pain scale to describe their pain

40
Q

Succinylcholine is contraindicated in which of the following

a. DMD
b. Hypothyroidism
c. Increased ICP

A

DMD
Chronic skeletal muscle disease (eg, Becker or Duchenne muscular dystrophy)
●Denervating neuromuscular disease (eg, cerebral palsy with paralysis)
●48 to 72 hours after burns, multiple trauma, or an acute denervating event (eg, stroke or spinal cord injury)
●Extensive crush injury with rhabdomyolysis
●History of malignant hyperthermia in patient or family
●Significant hyperkalemia

41
Q

Which of the following is a late-onset side effect of stimulants?

a. Tics
b. Depression
c. Hypertension
d. Weight loss
e. apetite

A

depression

42
Q

Mom concerned about the risk of dependency in her child, whom you have recently prescribed long-acting Ritalin. What do you tell her:

a. treatment with stimulant medications decreased risk of drug dependency
b. treatment will result in no change in the risk of dependency
c. there is an increase in risk of dependency in those who are treated
d. there is only a decreased risk of dependency with methylphenidate

A

. treatment with stimulant medications decreased risk of drug dependency

43
Q

A teenage girl is being teased at school for her acne. She has recently started a new medication for this and now she has headaches and evidence of papilledema. What is the medication most likely to account for her symptoms?

a. tetracycline
b. retinoic acid
c. OCP
d. clindamycin

A

tetracycloine

44
Q

How long after IVIG should you wait before giving live vaccines.

a. 6 months
b. 9 months
c. 3 months
d. 11 months

A

11mo

45
Q

A child on dilantin is given septra for an infection. She returns ataxic with abnormal speech. What is the mechanism of this interaction?

a. Septra increases absorption of Dilantin
b. Septra displaces dilatin from protein binding sites
c. Septa causes decreased metabolism of Dilantin
d. Septra causes decreased excretion of Dilantin

A

Septa causes decreased metabolism of Dilantin

46
Q

Mother concerned about her child on Ritalin developing dependency. What do you tell her:

a. Stimulant medications decrease risk of developing dependency.
b. Treatment does not alter risk of developing dependency
c. Treatment increases risk of developing dependency
- ————–

A

stimulant meds dec dependacy

47
Q

13 yr male in with his mother who is concerned about his growth as he has been on continuous moderate dose inhaled corticosteroid therapy. What can you tell her?

a. his final height will not be affected
b. he will have catch up growth in the next year
c. puberty will be delayed
d. he will be slightly shorter than his peers

A

d. he will be slightly shorter than his peers

48
Q

You are developing a post-op pain management program for kids 7-12 years. How best to assess their pain?

a. it’s not possible to assess their pain, so you have to guess
b. self-reporting using a owie-face scale

A

b. self-reporting using a owie-face scale

49
Q
  1. A mother brings in her child who has had a low-grade fever and upper respiratory symptoms. She has been diligently giving the child Tylenol 6-7 times a day because she is afraid the fever may be dangerous. What would you recommend?
    a. ensure that the appropriate amount of Tylenol is given (dose and frequency)
A

tyl dosing

50
Q

An 8 year old girl is in a motor vehicle accident and has had significant pain in her left upper extremity. Her symptoms are consistent with neuropathic pain. What treatment do you recommend?

a. opioids
b. gabapentin
c. NSAIDs

A

depression

51
Q

What should be used for sedation while doing a CT scan in a patient with head injury?

a. Midazolam
b. Chloral hydrate
c. Propofol

A

midaz

52
Q

Side effects of hepatotoxicity, pancreatitis and low platelets. Which drug?

a. Phenytoin
b. Carbamazepine
c. Phenobarb
d. Valproic Acid

A

d. Valproic Acid

53
Q

A teen in your practice has been on fluoxetine and risperdal. He presents to your office with hyper-reflexia and tremor and ataxia and 5 or 6 more symptoms. What to do you do?

a. Decrease fluoxetine
b. Stop fluoxetine
c. Increase fluoxetine
d. Decrease risperdal

A

Stop fluoxetine (as per consensus)

54
Q

16 y M on prozac and risperidol for depression. Tx started a few months ago. Patient is now having increased agitation and impaired concentration. Also has subtle ataxia. What do you do?

a. Decrease prozac
b. Stop prozac
c. Increase prozac
d. Decrease risperidol

A

stop prozac
Question describes Serotonin syndrome - altered mental status, neuromuscular hyperactivity (hyperreflexia), autonomic hyperactivity - so d/c SSRI

55
Q
  1. Marijuana has been shown to cause which of the following
    a. Gynecomastia
    b. Glaucoma
    c. Decreased heart rate
A

gynecomastia

Reproductive - suppresses testosterone production in men -> decreased libido, impotence, gynecomastia, increases prolactin in women -> galactorrhea
Cardiac - increases sympathetic activity -> increased HR (though high doses can inhibit sympathetic activity and cause bradycardia)
Ophtho - reduces intraocular pressure

56
Q

A teen is on prozac and risperadol for six months and now experiences ataxia, drowsiness, decreased concentration, diarrhea, agitation. What to do.

a. increase prozac
b. decrease prozac
c. eliminate prozac
d. increase risperadol
e. decrease risperadol

A

eliminate prozac

57
Q

Child at hospital with tonic movements. Consciousness is preserved. He also has ataxia, vomiting, and inability to close mouth. He has been vomiting for several days and mom has been giving him a suppository but can’t remember its name. What do you do?

a. Rectal diazepam
b. Nothing
c. Diphenhydramine
d. Phenobarbitol

A

diphenhydramine

58
Q

A 14 y/o has been treated with Accutane for severe cystic acne. There have been a few case reports in the literature as well as some media attention to which of the following severe side effects:

a. Hallucinations
b. Cerebral thrombosis
c. Somnambulism
d. Major depression with suicide risk
e. Long term memory problems

A

major depression

side effects of accutane
highly teratogenic - must use 2 forms of birth control and get monthly pregnancy tests
cheilitis
xerosis
epistaxis
blepharoconjunctivitis 
increased serum TGs and cholesterol
59
Q

Side effects of marijuana include all of the following except:

a. bronchospasm
b. conjunctival injection
c. large testicles
d. tachycardia

A

large testicles

60
Q

What are the late side effects of stimulant therapy for ADHD?

a. decreased appetite
b. tics
c. difficulty sleeping
d. depression
e. stomach pains

A

d. depression

61
Q

The mechanism of morphine for pain relief (rpt from 1995 exam)

a. works at only 1 type of receptor
b. reduces sensation of pain and emotional perception of pain
c. IM route preferred over IV

A

reduces sensation of pain and emotional perception of pain (analgesic effect on subjective perception of pain and decreased emotional response)

62
Q

What medication should be used for sedating a 2-year old child for a CT scan?

a. oral midazolam (not very sedating orally - approx 50% of time)
b. chloral hydrate *UTD states can use <3yo
c. propofol *can cause resp depression and need IV access

A

chloro vs propofol

63
Q

IVIG is used for all EXCEPT:

a. ITP
b. Guillaine-Barre
c. Kawasaki disease
d. bone marrow transplant
e. nephrotic syndrome

A

nephrotic sx

64
Q

What’s the most common side effect of Prozac?

a. increased ICP
b. drowsiness
c. rash

A

drowsiness

65
Q

Boy, post MVA, very agitated. Neuro exam no focal signs. What’s the best for sedation for CT:

a. Pentathol
b. ketamine
c. midazolam
d. chloral hydrate
e. morphine or fentanyl

A

midaz

66
Q

Potential toxic effects of anabolic steroids :

a. Delayed closure of epiphysis
b. Increased high density lipoproteins
c. Increased testicular size
d. Toxic hepatitis

A

toxic hepatitis

causes advanced closure of epiphysis, and inc LDL and dec HDL and hypogonadism + gynecomastia

67
Q

Which of the following medications is not associated with adverse reaction of urticaria in children?

a. Aspirin
b. codeine
c. penicillin
d. ranitidine

A

ranitidine

Cetirizine (Reactine), Loratidine (Claritin), bilastine
H2 Antihistamine
Ranitidine (Zantac)

68
Q

In the first week of treatment, which side effect is commonly seen in a 7y with 0.5mg/kg per dose of methylphenidate?

a. appetite suppression
b. Dizziness
c. Rebound effect
d. tics

A

appetite suppresion

69
Q

A 3 year with 5 days low grade temperature, rhinorrhea, occasional cough. On exam he looks well, has green crusted nasal discharge. Mom has been giving acetaminophen 6 to 7x/day. Next test:

a. Sinus x-rays and treat if fluid level present
b. treat with amoxil
c. consult with ENT
d. counsel on Tylenol dosing and risk of too much acetaminophen

A

d. counsel on Tylenol dosing and risk of too much acetaminophen

REMEMBER! Think acute bacterial rhinosinusitis with:
Persistent symptoms – The cardinal clinical features are nasal symptoms, cough, or both that persist for more than 10 but less than 30 days and are not improving
Severe symptoms – combination of temperature ≥39ºC (102.2ºF), concurrent purulent nasal discharge for at least three to four consecutive days, and ill-appearance. Persistent high fever for at least three to four days distinguishes this presentation from an uncomplicated viral URI

70
Q

A 15-year-old athletic boy comes in for his regular check up, and he tells you that he is using anabolic steroids. Which of the following is a potential long-term sequela of anabolic steroid use:

a. dementia
b. liver cancer
c. myositis ossificans
d. hemorrhagic cystitis
e. interstitial pneumonia

A

liver cancer

also cholesatsis

71
Q

What is true about methylphenidate:

a. stimulates appetite
b. no effect on growth velocity
c. may exacerbate tics
d. can cause dependency
e. effective in 60% of children with ADD

A

can cause dependance
BLACK BOX- high potential for abuse and dependance and monitor for signs of it - frank psychosis - Also when withdrawing med- severe depression can occur
Tics — Stimulant medications have been reported to cause new onset of tics or worsening of tics in children with tic/tourette disorders ( is a CI for certain stimulants)

72
Q

Management of postoperative pain in children aged 6-10 years:

a. use BP and HR as a guide for when to give pain medications
b. give regular doses of pain meds in the first 24 hours as they cannot reliably report pain
c. they can assess pain meds as required using self report
d. use facial expression as an indication of pain
e. use a visual analog pain scale

A

use a visual analog pain scale

73
Q

Mechanism of action for insulin:

a. glycogen synthesis
b. gluconeogenesis
c. lipolysis
d. ketogenesis
e. cAMP

A

glycogen synthesis

Insulin facilitates entry of glucose into muscle, adipose and several other tissues
Insulin stimulates the liver to store glucose in the form of glycogen
gluconeogensis, lipolysis, ketogenesis all work to INCREASE glucose (and is turned off by insulin)
glucagon, adrenaline all work to increase cAMP

74
Q

Which causes sexual dysfunction in adolescents:

a. calcium channel blockers
b. antidepressants
c. beta-2 agonists
d. theophylline

A

antidepressants

75
Q

IVIG can be used in all of the following EXCEPT:

a. immune thrombocytopenic purpura
b. bone marrow transplant
c. nephrotic syndrome
d. Kawasaki disease
e. Guillain-Barré syndrome

A

nephrotic syndrome

76
Q

14 year old being treated for osteomyelitis. Severe pain despite naproxen and tylenol. Best analgesic:

a. narcotic
b. tricyclic
c. higher dose of NSAID

A

narcotic

77
Q

The reason maxeran is not used commonly is:

a. side effects
b. cost
c. interactions with other drugs

A

s/e
Treatment with metoclopramide can cause tardive dyskinesia, a serious movement disorder that is often irreversible. The risk of developing tardive dyskinesia increases with duration of treatment and total cumulative dose. No tx for TD

78
Q

Which affects the efficacy of the birth control pill:

a. Tetracycline
b. Acetaminophen
c. Theophylline
d. Valproic acid

A

c. Theophylline

List of potential major drug interactions: anything processed in liver

Anticoagulants
Tricyclic antidepressants
Barbiturates
Penicillins
Phenytoin
Rifampin
Theophylline (used for asthma and COPD)

Exam questions (21 decks)

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