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Quarter 4 finals > Pharm Clinical App > Flashcards

Pharm Clinical App Flashcards

1
Q

Bismuth-subsalicylate

A

“Pepto-bismol”

Cytoprotective
Anti-diarrhea

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2
Q

Ondansetrone

A

Zofran

n/v

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3
Q

Calcium Carbonate

A

Tums

Antacid

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4
Q

Mg Hydroxide

“milk of magnesia”

A

Laxative

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5
Q

Promethazine

A

Phenergan

n/v

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6
Q

Prochlorperazine

A

Compazine

n/v

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7
Q

Diphenoxylate/atropine (Lomotil)

A

Anti-diarrhea

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8
Q

Metoclopramide

A

Reglan

n/v

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9
Q

Treatment for constipation

A

Lubiprostone

Linaclotide

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10
Q

Dicyclomine

A

Bentyl

anti-spasmodic

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11
Q

Misoprostol

CONTRA:preg

A

Cytoprotective

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12
Q

H2 blockers “tidine” are particularly good for

A

Nocturnal sx

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13
Q

H2 blockers

A

on-demand relief

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14
Q

Eisinophilic esophagitis

A

Allergic reaction

“Stacked rings” on EGD

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15
Q

Meds known for leading to “pill- induced” esophagitis

A

Bisphosphonates

NSAIDs

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16
Q

Best tx for Reflux Esophagitis

A

PPI

better than H2 blocker for “reflux” type

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17
Q

PPI

A

takes 2-5 days
Best taken in MORNING, 30 min before breakfast

do NOT stop abruptly, acid hypersecretion with abrupt discontinuation

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18
Q

Risks of chronic PPI

A

Nutrient malabsorption (Ca, Mg, B12, Iron)
Osteoporosis
C-dif
Kidney dz

best to use lowest dose for shortest amt of time possible

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19
Q

Mg containing antacids

can cause diarrhea SE +

A

Hypermagnesia risk in pts with Renal insuff

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20
Q

Sodium Bicarb Antacids

CAUTION d/t

A

Sodium/fluid retention

caution in pts w: Edema, cirrhosis, HF, Renal impairment

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21
Q

35 YO w epigastric discomfort, belching/bloating, fullness

no alarm features

A

H. Pylori

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22
Q

Testing for H. Pylori

A

Urea breath test

Stool antigen

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23
Q

1st line therapy for H. Pylori infection

A

4 things:
(PPI + BMT)

  • PPI
  • Bismuth
  • Metro
  • Tetracycline
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24
Q

Need to test after H. Pylori tx to make sure it’s completely gone bc if not, risk of:

A

PUD
Iron def anemia
Gastric CA

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25
Q

Discontinue ____ before testing for H. Pylori

A

PPI 1-2 wks before

Bismuth and Abx 4 wks before

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26
Q

57 YO taking Ibuprofen for past year

Epigastric pain within 30 minutes of meal

A

Peptic Ulcer Dz

Gastric ulcer

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27
Q

Complications of PUD:

Hemorrhage
Perf/Penetration
Obstruction

A

Perf/penetration: peritoneal signs, free air under diaphragm

Obstruction: succussion splash

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28
Q

What else besides NSAIDs can complicate PUD/make it worse?

A

Anticoags
ASA
Steroids

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29
Q

Misopristol

A

NSAID induced ulcers but CONTRA in pregnancy

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30
Q

76 YO with Diabetes
sx: 6 mo of early satiety, post meal nausea, intermittent vomiting

worsened by large meals and fatty foods
5lbs unintentional weight loss

A

EGD is negative for PUD or Gastric CA

what is it: Diabetic Gastroparesis

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31
Q

Dietary rec for Diabetic Gastroparesis

A

Small, frequent low fat meals

Improve glucose control*

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32
Q

Metoclopramide (Reglan) use

A

tx n/v, heartburn, early satiety, loss of appetite

CAUTION: Risk of EPS!!!/tardive dyskinesia

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33
Q

CONTRA to Metoclopramide (Reglan) use

A

Obstruction
Perforation
GI hemorrhage

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34
Q

Ondansetron (Zofran) considerations/SE

A

Cardiac arrhythmia
QT prolongation
Seretonin syndrome

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35
Q

Promethazine (Phenergan)

Prochlorperazine (Compazine)

A

Sedating

Drug induced Parkinsonism

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36
Q

Dicyclomine (Bentyl)

A

Antispasmodic med in tx of IBS

Anticholinergic SE: sedation, dry mouth, constipation, urinary retention

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37
Q

May consider using Amitriptyline or Eluxadoline to treat IBS if

A

Psychosocial component bc Amitriptyline is a TCA which can also treat depression

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38
Q

Eluxadoline treat IBS-D

A

Opioid agonist

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39
Q

Levothyroxine is used to treat

A

HYPOthyroidism

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40
Q

Tx for Opioid induced constipation

A

Methylnaltrexone

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41
Q

If pt has acute diarrhea and was recently on Clindamycin…

A

consider C-dif!!

Order C.Diff stool test

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42
Q

Most common SE of Pepto-Bismol

A

Black stool, black tongue, mouth

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43
Q

CONTRA to Pepto Bismol

A

ASA allergy (bc Pepto contains Salicylate)

Avoid in children recovering from viral illness–> Reye’s syndrome risk

44
Q

LLQ abd pain
nausea
loose stools

A

Sigmoid diverticulitis

Tx: Flagyl + Cipro

45
Q

Study of choice to confirm Diverticulitis

A

CT A/P w contrast

46
Q

32 YO man w 6 wks of abd cramp, diarrhea, tenesmus, 3 BM daily w blood
5lb unintential weight loss

NO rebound or guarding

A

CBC confirm IDA
CMP normal kidney and liver fx
CRP/ESR elevated

IBD!!

plan: colonoscopy, reveals sigmoid Ulcerative Colitis

47
Q

Most appropriate med to tx newly diagnosed IBD- Ulcerative Colitis

A

Mesalamine (Lialda)

48
Q

Acute flare of IBD, may add

A

Corticosteroids

short burst in tapering doses

49
Q

Complications of IBD like Peri-anal Chrons, can be treated with

A

Cipro + Flagly

50
Q

Cipro (a FluoroQ) SE

A

Tendon rupture!!

51
Q

Metronidazole (Flagyl) SE

A

Disulfuram like reaction with Alcohol

Make sure to tell pts not to DRINK ALCY

52
Q

If a pt with IBD is taking Immunomodulators and Biologics, what do we need to monitor?

A

CBC

CMP

53
Q

Abx that target cell wall

A

Beta-lactams

54
Q

Beta-lactams

A

PCN
Cephalosporin
Carbapenems
Glycopeptides and Lipoglycopeptides (Vanco)

55
Q

Abx that inhibit protein production

A 
Nitro
Tetracycline
Macrolide
Clindamycin
Rifamycin
Aminoglycosides
56
Q

Abx that inhibit replication

A

Trimetho-Sulfa (Bactrim)
Quinolones
Metro

57
Q

Four categories of bacteria

A

Gram +
Gram -
Anaerobic
Atypical

58
Q

CAP most common pathogens

A 
Strep PNA
H. flu
Legionella
Mycoplasma PNA
Chlamydia PNA
59
Q

Tx for CAP

outpatient

A

Macrolide or

Doxy

60
Q

Macrolides

A

Azithromycin “Z pack”
Clarithromycin
Erythromycin

61
Q

Tx for CAP

inpatient

A

Macrolide or Doxy
+
Beta-lactam (Ceftriaxone, High dose ampicillin, Cefotaxime)

62
Q

Abx specifically for Strep PNA

A

High dose Pen G
Or
Cephalosporin

63
Q

Tx for Uncomplicated Acute Cystitis

“Bladder infection”

A

Bactrim
(if not resistance to E.Coli)
or
Nitro

64
Q

“Bladder infection” tx if pt is diabetic

A

Ciprofloxacin (a FluoroQ)

65
Q

Acute pyelonephritis tx

A

FluoroQ
PCN/Beta-lactam combo
Carbapenem if resistant organism

66
Q

FlouroQuinolones

Ciprofloxacin, Levofloxacin, Moxifloxacin

A

Adverse rxn:
Tendon snap
QT prolongation

“BLACK BOX” warning

67
Q

PID most common pathogen

A

Gonn/Chlamydia

68
Q

Tx for PID

A

Single IM injection of Ceftriaxone
+
Oral Doxy

69
Q

Tx for Chlamydia

A

Doxy or

Azithro (ok if pregnant)

70
Q

Tx for Gonorrhea

A

Ceftriaxone

71
Q

Drugs of choice for Pregnancy

A

PCN

Cephalosporins (“cef”)

72
Q

Most common cause of Acute Bacterial Meningitis

A

Strep PNA

Neisseria

73
Q

Empiric therapy for Bacterial Meningitis

A

3rd gen Cephalosporin

Ceftriaxone or Cefotaxime

74
Q

What to add to Empirically cover Bacterial meningitis to cover PCN resistant strains of Strep PNA?

A

Vancomycin

75
Q

If pt is allergic to PCN, good chance they are also allergic to

A

Cephalosporins

avoid use if possible in PCN pts

76
Q

Empiric tx for “simple” Cellulitis

A

Bactrim
Doxy (a tetracycline)
Clinda (last choice)

77
Q

Tetracyclines

A

Doxycycline, Minocycline

78
Q

Tetracyclines - Doxycycline and Minocycline

A

CONTRA in pregnant, children under 8, can cause blue-black hyperpigmentation

79
Q

Tx for more serious, “complex” cellulitis

fever
high incidence of MRSA

A

Admit

Parenteral Vancomycin

80
Q

Does Vancomycin cover for MRSA?

A

Yes

81
Q

Vancomycin “big guns” covers for

A

C-diff
MRSA

SE:
Nephrotoxic
Hearing loss
Red man syndrome (rapid infusion)

82
Q

Dopamine

A

Parkinsonism

83
Q

Depressive disorder tx goals

A
  1. ) >50% improvement

2. ) Remission (within normal range of tests, PHQ<5)

84
Q

Recovery is considered

A

6 mo or longer

85
Q

After rx med for Depression

A

f/u in 1-2 weeks

86
Q

1st choice for depressoin

A

SSRI

then, SNRI

87
Q

When choosing anti-depressant, consider

A 
Personal past use
Family hx
Provider preference
SE
Co-morbid
Cost
88
Q

CAUTION with antidepressants

A

can unmask MANIA

if underlying bipolar

89
Q

CAUTION with antidepressants

A

can also increase SI in children, teens, young adults 18-24 YO

90
Q

Fluoxetine (Prozac)

SSRI

A

Could increase energy, take in AM
LONG HALF LIFE

SE: insomnia, HA, nervous, libido, nausea, diarrhea, anorexia, dry mouth

91
Q

Sertraline (Zoloft)

SSRI

A

SOCIAL ANXIETY nocturnal eating

92
Q

Parozetine (Paxil)

SSRI

A

assoc with more WEIGHT GAIN

Good for: Hyperanxiety, Acute panic!!!

93
Q

Citalopram (Celexa)

SSRI

A

Only used for depression

SE: insomnia, somnolence, nausea, dry mouth, sexual dysfx

94
Q

Escitalopram (Lexapro)

A

also used for Generalized Anxiety

SE: insomnia, somnolence, HA, nausea, ejaculation disorder

95
Q

SNRIs

have X in the main name

A

Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)

96
Q

Citalopram (celexa)

Escitalopram (lexapro)

A

newer ones

much more SPECIFIC

97
Q

celexa and lexapro are too much for

A

migraine ppl

seretonin systems are very sensitive in these ppl

98
Q

Venlafaxine (effexor)

SNRI

A

Take with FOOD

SE: HA, nervous, dizzy, nausea, anorexia, drymouth, sweating, constipation or diarrhea, abnormal ejaculation/organism, HTN

99
Q

Duloxetine (Cymbalta)

A

Depression and Anxiety
DIABETIC NEUROPATHY
Fibromyalgia

CONTRA: liver dz

100
Q

Buproprion (wellbutrion)

A

Dopamine re-uptake inhibitor
LESS SEXUAL SE

CONTRA: seizures, anorexia

101
Q

Mirtazapine (remeron)

A

a2 antagonist
LESS SEXUAL SE

SE: weight gain, inc cholesterol, constipation

often used in ELDERLY to help w depression, sleep, and increasing appetite

102
Q

Most sexual SE

A

Prozac

103
Q

duration of antidep

A

4-9 months

104
Q

Contiuation therap

A

1-3 years for those with risk factors

105
Q

After 1-3 years

A

If hx of multiple episodes or comorbid Psych - encouraged to continue indefinitely

106
Q

STopping antidep meds

A

over 1-6 months

longer if withdrawal sx present

107
Q

“Zoloft”

an SSRI

A

Sertraline

Quarter 4 finals (11 decks)

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