Pharm Clinical App Flashcards
1
Q
Bismuth-subsalicylate
A
“Pepto-bismol”
Cytoprotective
Anti-diarrhea
2
Q
Ondansetrone
A
Zofran
n/v
3
Q
Calcium Carbonate
A
Tums
Antacid
4
Q
Mg Hydroxide
“milk of magnesia”
A
Laxative
5
Q
Promethazine
A
Phenergan
n/v
6
Q
Prochlorperazine
A
Compazine
n/v
7
Q
Diphenoxylate/atropine (Lomotil)
A
Anti-diarrhea
8
Q
Metoclopramide
A
Reglan
n/v
9
Q
Treatment for constipation
A
Lubiprostone
Linaclotide
10
Q
Dicyclomine
A
Bentyl
anti-spasmodic
11
Q
Misoprostol
CONTRA:preg
A
Cytoprotective
12
Q
H2 blockers “tidine” are particularly good for
A
Nocturnal sx
13
Q
H2 blockers
A
on-demand relief
14
Q
Eisinophilic esophagitis
A
Allergic reaction
“Stacked rings” on EGD
15
Q
Meds known for leading to “pill- induced” esophagitis
A
Bisphosphonates
NSAIDs
16
Q
Best tx for Reflux Esophagitis
A
PPI
better than H2 blocker for “reflux” type
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
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
19
Q
Mg containing antacids
can cause diarrhea SE +
A
Hypermagnesia risk in pts with Renal insuff
20
Q
Sodium Bicarb Antacids
CAUTION d/t
A
Sodium/fluid retention
caution in pts w: Edema, cirrhosis, HF, Renal impairment
21
Q
35 YO w epigastric discomfort, belching/bloating, fullness
no alarm features
A
H. Pylori
22
Q
Testing for H. Pylori
A
Urea breath test
Stool antigen
23
Q
1st line therapy for H. Pylori infection
A
4 things:
(PPI + BMT)
- PPI
- Bismuth
- Metro
- Tetracycline
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
25
Discontinue ____ before testing for H. Pylori
PPI 1-2 wks before
| Bismuth and Abx 4 wks before
26
57 YO taking Ibuprofen for past year
Epigastric pain within 30 minutes of meal
Peptic Ulcer Dz
| Gastric ulcer
27
Complications of PUD:
Hemorrhage
Perf/Penetration
Obstruction
Perf/penetration: peritoneal signs, free air under diaphragm
Obstruction: succussion splash
28
What else besides NSAIDs can complicate PUD/make it worse?
Anticoags
ASA
Steroids
29
Misopristol
NSAID induced ulcers but CONTRA in pregnancy
30
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
EGD is negative for PUD or Gastric CA
what is it: Diabetic Gastroparesis
31
Dietary rec for Diabetic Gastroparesis
Small, frequent low fat meals
| Improve glucose control*
32
Metoclopramide (Reglan) use
tx n/v, heartburn, early satiety, loss of appetite
CAUTION: Risk of EPS!!!/tardive dyskinesia
33
CONTRA to Metoclopramide (Reglan) use
Obstruction
Perforation
GI hemorrhage
34
Ondansetron (Zofran) considerations/SE
Cardiac arrhythmia
QT prolongation
Seretonin syndrome
35
Promethazine (Phenergan)
| Prochlorperazine (Compazine)
Sedating
| Drug induced Parkinsonism
36
Dicyclomine (Bentyl)
Antispasmodic med in tx of IBS
Anticholinergic SE: sedation, dry mouth, constipation, urinary retention
37
May consider using Amitriptyline or Eluxadoline to treat IBS if
Psychosocial component bc Amitriptyline is a TCA which can also treat depression
38
Eluxadoline treat IBS-D
Opioid agonist
39
Levothyroxine is used to treat
HYPOthyroidism
40
Tx for Opioid induced constipation
Methylnaltrexone
41
If pt has acute diarrhea and was recently on Clindamycin...
consider C-dif!!
Order C.Diff stool test
42
Most common SE of Pepto-Bismol
Black stool, black tongue, mouth
43
CONTRA to Pepto Bismol
ASA allergy (bc Pepto contains Salicylate)
Avoid in children recovering from viral illness--> Reye's syndrome risk
44
LLQ abd pain
nausea
loose stools
Sigmoid diverticulitis
Tx: Flagyl + Cipro
45
Study of choice to confirm Diverticulitis
CT A/P w contrast
46
32 YO man w 6 wks of abd cramp, diarrhea, tenesmus, 3 BM daily w blood
5lb unintential weight loss
NO rebound or guarding
CBC confirm IDA
CMP normal kidney and liver fx
CRP/ESR elevated
IBD!!
plan: colonoscopy, reveals sigmoid Ulcerative Colitis
47
Most appropriate med to tx newly diagnosed IBD- Ulcerative Colitis
Mesalamine (Lialda)
48
Acute flare of IBD, may add
Corticosteroids
| short burst in tapering doses
49
Complications of IBD like Peri-anal Chrons, can be treated with
Cipro + Flagly
50
Cipro (a FluoroQ) SE
Tendon rupture!!
51
Metronidazole (Flagyl) SE
Disulfuram like reaction with Alcohol
Make sure to tell pts not to DRINK ALCY
52
If a pt with IBD is taking Immunomodulators and Biologics, what do we need to monitor?
CBC
| CMP
53
Abx that target cell wall
Beta-lactams
54
Beta-lactams
PCN
Cephalosporin
Carbapenems
Glycopeptides and Lipoglycopeptides (Vanco)
55
Abx that inhibit protein production
```
Nitro
Tetracycline
Macrolide
Clindamycin
Rifamycin
Aminoglycosides
```
56
Abx that inhibit replication
Trimetho-Sulfa (Bactrim)
Quinolones
Metro
57
Four categories of bacteria
Gram +
Gram -
Anaerobic
Atypical
58
CAP most common pathogens
```
Strep PNA
H. flu
Legionella
Mycoplasma PNA
Chlamydia PNA
```
59
Tx for CAP
| outpatient
Macrolide or
| Doxy
60
Macrolides
Azithromycin "Z pack"
Clarithromycin
Erythromycin
61
Tx for CAP
| inpatient
Macrolide or Doxy
+
Beta-lactam (Ceftriaxone, High dose ampicillin, Cefotaxime)
62
Abx specifically for Strep PNA
High dose Pen G
Or
Cephalosporin
63
Tx for Uncomplicated Acute Cystitis
| "Bladder infection"
Bactrim
(if not resistance to E.Coli)
or
Nitro
64
"Bladder infection" tx if pt is diabetic
Ciprofloxacin (a FluoroQ)
65
Acute pyelonephritis tx
FluoroQ
PCN/Beta-lactam combo
Carbapenem if resistant organism
66
FlouroQuinolones
| Ciprofloxacin, Levofloxacin, Moxifloxacin
Adverse rxn:
Tendon snap
QT prolongation
"BLACK BOX" warning
67
PID most common pathogen
Gonn/Chlamydia
68
Tx for PID
Single IM injection of Ceftriaxone
+
Oral Doxy
69
Tx for Chlamydia
Doxy or
| Azithro (ok if pregnant)
70
Tx for Gonorrhea
Ceftriaxone
71
Drugs of choice for Pregnancy
PCN
| Cephalosporins ("cef")
72
Most common cause of Acute Bacterial Meningitis
Strep PNA
| Neisseria
73
Empiric therapy for Bacterial Meningitis
3rd gen Cephalosporin
| Ceftriaxone or Cefotaxime
74
What to add to Empirically cover Bacterial meningitis to cover PCN resistant strains of Strep PNA?
Vancomycin
75
If pt is allergic to PCN, good chance they are also allergic to
Cephalosporins
avoid use if possible in PCN pts
76
Empiric tx for "simple" Cellulitis
Bactrim
Doxy (a tetracycline)
Clinda (last choice)
77
Tetracyclines
Doxycycline, Minocycline
78
Tetracyclines - Doxycycline and Minocycline
CONTRA in pregnant, children under 8, can cause blue-black hyperpigmentation
79
Tx for more serious, "complex" cellulitis
fever
high incidence of MRSA
Admit
| Parenteral Vancomycin
80
Does Vancomycin cover for MRSA?
Yes
81
Vancomycin "big guns" covers for
C-diff
MRSA
SE:
Nephrotoxic
Hearing loss
Red man syndrome (rapid infusion)
82
Dopamine
Parkinsonism
83
Depressive disorder tx goals
1. ) >50% improvement
| 2. ) Remission (within normal range of tests, PHQ<5)
84
Recovery is considered
6 mo or longer
85
After rx med for Depression
f/u in 1-2 weeks
86
1st choice for depressoin
SSRI
| then, SNRI
87
When choosing anti-depressant, consider
```
Personal past use
Family hx
Provider preference
SE
Co-morbid
Cost
```
88
CAUTION with antidepressants
can unmask MANIA
| if underlying bipolar
89
CAUTION with antidepressants
can also increase SI in children, teens, young adults 18-24 YO
90
Fluoxetine (Prozac)
SSRI
Could increase energy, take in AM
LONG HALF LIFE
SE: insomnia, HA, nervous, libido, nausea, diarrhea, anorexia, dry mouth
91
Sertraline (Zoloft)
SSRI
SOCIAL ANXIETY nocturnal eating
92
Parozetine (Paxil)
SSRI
assoc with more WEIGHT GAIN
Good for: Hyperanxiety, Acute panic!!!
93
Citalopram (Celexa)
SSRI
Only used for depression
SE: insomnia, somnolence, nausea, dry mouth, sexual dysfx
94
Escitalopram (Lexapro)
also used for Generalized Anxiety
SE: insomnia, somnolence, HA, nausea, ejaculation disorder
95
SNRIs
have X in the main name
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
96
Citalopram (celexa)
| Escitalopram (lexapro)
newer ones
| much more SPECIFIC
97
celexa and lexapro are too much for
migraine ppl
seretonin systems are very sensitive in these ppl
98
Venlafaxine (effexor)
SNRI
Take with FOOD
SE: HA, nervous, dizzy, nausea, anorexia, drymouth, sweating, constipation or diarrhea, abnormal ejaculation/organism, HTN
99
Duloxetine (Cymbalta)
Depression and Anxiety
DIABETIC NEUROPATHY
Fibromyalgia
CONTRA: liver dz
100
Buproprion (wellbutrion)
Dopamine re-uptake inhibitor
LESS SEXUAL SE
CONTRA: seizures, anorexia
101
Mirtazapine (remeron)
a2 antagonist
LESS SEXUAL SE
SE: weight gain, inc cholesterol, constipation
often used in ELDERLY to help w depression, sleep, and increasing appetite
102
Most sexual SE
Prozac
103
duration of antidep
4-9 months
104
Contiuation therap
1-3 years for those with risk factors
105
After 1-3 years
If hx of multiple episodes or comorbid Psych - encouraged to continue indefinitely
106
STopping antidep meds
over 1-6 months
| longer if withdrawal sx present
107
"Zoloft"
an SSRI
Sertraline
