Pharm Exam 2 Questions Flashcards
1
Q
Does Astelin make you drowsy?
A
Yes ! Somnolence , give at HS
2
Q
What is the first line tx for allergic rhinitis ?
A
Intranasal corticosteroids
3
Q
What is the safest systemic decongestant?
A
Pseudo ephedrine
4
Q
What type of antihistamine should not be given to elderly (ie, on BEERS LIST)?
A
1st generation antihistamines
5
Q
In a child with urticaria weighing 25 kg what med should you give and what dose?
A
Benadryl 25 mg po now (1 mg/kg/dose)
6
Q
What type of management should be used in URI in peds?
A
Symptom control, nonpharm; supportive
7
Q
What drug is chemically similar to tetracaine?
A
Tessalon Perles
8
Q
What type of pain management should be used in newborn getting a painful procedure?
A
Sucrose on paci, non-nutrient sucking
9
Q
What pain reliever is associated with Stevens Johnson syndrome?
A
APAP
10
Q
What medication would you prescribe for new onset chest tightness radiating down left arm while pt waiting to see cardiologist? How to take and how often to take?
A
Nitroglycerin SL or spray Q 5 minutes x3?
11
Q
What is the pharmacological tx for heart failure stage II.?
A
ACE I AND BB (only time no BB is with HF stage IV)
12
Q
In a pt with —– Adenosine is C/I
A
Pt with bronchial asthma adenosine is C/I
13
Q
In a pt with ——- labetolol is contraindicated
A
Bronchial asthma
14
Q
What labs are needed for a pt on Amiodarone?
A
EKG, make sure drug working, LFTS, TSH and pulmonary function test
15
Q
In a pt with a fib what is an important pharm tx?
A
Anticoagulant ion
16
Q
Which types of CCB worsens CHF.
A
Verapamil
17
Q
Can Heparin be used safely in pregnancy?
A
Yes large molecule cannot cross placenta
18
Q
What class of antihypertesive can cause a cough?
A
ACE-I
19
Q
What class of drug is considered to be a cornerstone for pts in HF.
A
Beta blockers (and ACE-I)
20
Q
What to teach pt about taking nitro SL.
A
drink water to help dry mouth
21
Q
How to describe the pain or arthritis?
A
Somatic, inflammatory
22
Q
What is the first priority when a pt complains of pain?
A
Etiology!
23
Q
What is a side effect of Tramadol?
A
Sedation, Dizzy
24
Q
Neuropathic pain can be treated with:
A
gabapentin, tricyclics
25
What does NP need to know when using Methadone?
Long half life, helpful in chronic pain, high doses needed, get EKG
26
What labs should be measured for a pt with high dose Ibuprofen?
Renal and LFT; monitor for GI Bleed
27
Difference between addiction and dependence?
Dependence is when withdrawal symptoms without ; addiction is psychological
28
Signs of Dig Toxicity?
N/V/D & halos
29
Why do post MI pts benefit from ACE-I?
Prevents remodeling
30
Why do older pts take ASA for cardio protective?
Thromboxane A 2 synthesis; prevents clots
31
Describe Nitrate tolerance
Tachyphlaxis; pt needs nitrate-free period. Pro-drug; needs glutamine to work, uses up all glutamine and body needs time to replenish
32
What drug is used after MI to prevent further MI?
BB
33
Name 3 vasodilating drugs
Nitrates, BBs, CCBs
34
What type of med is recommended for chronic, stable angina?
ACE-I's
35
Drug of choice in angina
Nitrates
36
What to monitor carefully with pt on nitro
BP
37
Side effects of nitro
Flushing, HA, orthostatic hypotension, syncope, reflexive tachycardia
38
Use caution in pts taking nitro that have
Hx migraines
| Hx orthostasis
39
Nitro interacts with....
```
ETOH
Viagra
Heparin
ASA
Anticholinergic
```
40
Increased hypotensive effect of nitroglycerin with these meds:
BBs, CCBs, Haldol, Phenothiazines
41
Teach pt to do this when using nitro ointment:
Wash hands! Apply to non hairy areas and not at night.
42
Short acting nitro and long acting preps
Short: spray and SL
Long: ointment, patch, isosorbide dinitrate, isosorbide mono nitrate
43
Ranolazine/ Ranexa
Use caution in pts with QT prolongation;
$$$ but first line (newer) for chronic angina?
No effect on HR, BP but helps exercise
44
ACE-I's
Recommended in chronic stable angina
Prevent MI/ death
Very effective in DM and pts with left ventricular dysfunction
45
ARB's
Recommended in CAD, HTN and DM
Useful in pts with intolerant ACE-I's
Or can be added to ACE-I in uncontrolled HTN Or insufficient vasodilation
46
ACE-Is and ARBs
Affect the renin angiotensin aldosterone system to decrease BP;
Decrease inappropriate remodeling of myocardial tissue after MI or in HF
47
Angiotensin II leads to...
Remodeling of myocardium ; hyper trophy and fibrosis ; ie the primary mechanism of HF "dead hamburger"
48
Examples of ACE-Is
Captopril
Lisinopril
Enalopril
49
ACE-Is are cornerstone for tx in
HF
50
ACE-I interactions
```
ETOH
NITRATES
DIURETICS
PHENOTHIZAINES
OTHER ANTIHYPERTENSIVES
K SPARING DIURETICS/ K supplements
NSAIDS
```
51
ACE-I contraindications
Bilateral renal artery stenosis;
angioedema;
Cat C in 1st trip and Cat X IN 2nd and 3rd tri;
Pts with hyperkalemia, hepatic impairment
52
Adverse reactions of ACE-Is
Usually mild and transient
Cough (dry)
Hypotension (HA, dizzy, fatigue)
Rash
53
What is the drug of choice for exertion all angina?
Beta blockers
54
Beta blockers are useful in pts with
Resting tachycardia, hyperthyroidism
55
What is the MOA of BBs?
Decreased sympathetic nervous stimulation,
Decreased heart rate and contractility,
Decreased heart rate by increasing diastolic filling time,
Decreased myocardial workload by decreased oxygen consumption
56
Examples of Beta Blockers
Atenolol
Metropolol
Nadolol
Propranolol
57
BB's: dose titration is based on...
Based On HR; titrate up until HR 50-60
58
Caution with BBs in these pts:
Asthmatics, and SSS (experience 2nd and 3rd degree blocks)
59
Side effects of beta blockers
Dizzy
Nightmares
Sexual dysfunction
60
VITAL pt teaching for BBS:
Do NOT stop BBs abruptly.
| Report dizziness and orthostasis
61
MOA of CCBs
Calcium is crucial in contraction and excitation of cardiac muscles. 3 types of voltage channels.
Cardiac muscle is dependent o calcium to complete action potential.
CCBs close calcium channels to decrease HR.
62
What do CCBs do?
Reduce contractility,
Decrease CO,
Decrease requirement of myocardium
63
When are CCBs indicated?
They are first choice in pts who do not tolerate nitrates or BBs well.
Indicated for angina, HTN, and select tachyarrythmias
64
Unlabeled indications in CCBs
Migraine HA prophylaxis
Raynauds
Cardiomyopathy
Esophageal spasm
65
CCBs type I and II
```
Type I: nondihydropyridines
Verapamil
Digitized
Type II: Dihydropyridines
Norvasc
Nifedipine
Nicaripine
Felopidine
```
66
Verapamil: avoid in these pts
HF pt
67
Precautions for CCBs
ONLY DILTIAZEM FOR immediately POST MI (no other CCBs immediately post MI)
Pts with SA/ AV NODE Disturbances
Pts with SBP
68
What is Coronary Steal Syndrome?
When the CCBs dilate the arteries but in areas of ischemia, arterioles already at max dilation, so blood is shifted away leading to increased myocardial damage
69
CCBs can be combined with ----- in pts who are poor candidates for BBs
Nitrates
70
Adverse reactions of nifedipine
Reflexive tachycardia>> increased incidence of mortality, MI, angina
71
SE of Verapamil
Constipation
72
CCBs: side effects
Flushing, HA, edema, dizzy, gingival hyperplasia
73
Combo of long acting nitrates and ------- are not used related to additive effect
CCBs
74
Aspirin is recommended
During MI, with stable or unstable angina
75
Aspirin has a lot of crossover with other drugs, including ----- and can cause....
ETOH; GI bleed; make sure pts have neg guise
76
Multi drug therapy
Allows lower doses and can be more effective than single agent.
Decreased side effects and decreased risk hypotension
77
Heart failure- etiology
CAD
| LVD dysfunction, systolic HF (progressive)
78
Critical criteria for diagnosis of heart failure (MAJOR)
```
MAJOR:
paroxysmal nocturnal dyspnea
Orthopnea
3rd heart sound
Increased jugular venous distant ion
On CXR: cardiomegaly, pulmonary edema
Wt loss > 4 kg in 5 d in response to treatment of presumed HF
```
79
Critical criteria for diagnosis of heart failure (MINOR)
```
Bilateral leg edema
Nocturnal cough
Dyspnea on normal exertion
Tachycardia (>120bpm)
Hepatomegaly
Pleural effusion
```
80
Diagnosis of HF requires that 2 major or 1 minor
....and not attributed to another condition
81
Types of HF
Systolic: "thin weak"
Often after actute MI but can be nonishcemic cardiomyopathy, ETOH and drugs
Diastolic: "thick hard"
Inadequate relaxation, loss of muscle fiber, decreased elasticity, decreased CO, increased diastolic pressure.
Caused by uncontrolled HTN, hypothyroidism, hypertrophic and ischemic cardiomyopathy
**prevalent in elderly especially >70 yo
82
4 classes of HF:
| Stage I or A
A: at risk but no symptoms
HTN,CAD,DM
TX underlying lifestyle issue and HTN
AND /or: tx with short-acting ACEi - Captopril 6.25mg ( can switch to ARB if not tolerated)
83
Stage II / B of HF
Structural CAD, NO Symptoms
Previous MI, LV systolic dysfunction, asymptomatic valvular disease
Tx= same as stage A, except that BBs and ACEi superior to monotherapy
Ex= metoprolol and ACEi
Unless C/I, give BBs to all pts with recent MI and LV DYSFUNCTION
84
Stage III/ C
```
SYMPTOMATIC! SOB, FATIGUE, DECREASED EX TOL
Known structural CAD
TX= ACEi
BBs
+ DIG
+diuretics
+sodium reduced diet
```
85
Digoxin
Cardiac glycoside; INHIBITS sodium ATPase
dose 0.125mg to 0.375mg QD
DOSE LOW GO SLOW
86
Caution with ----- and DIG
Antibiotics increase bioavailability >> toxicity
87
Half life of DIG
36-48 hours, longer in elderly
88
DIG: use with caution in
```
Elderly
AV block
Wt loss
Hypokalemia
Renal impairment
```
89
Side effects of DIG:
```
N/V
DIZZY
Halos (green yellow)
Mental disorders
Dysrhythmias
SA block
Vasoconstriction
Ischemia
Thrombocytopenia
```
90
Stage IV/ D HF
```
REFRACTORY SX AT REST
MARKED SOB
frequent hospitalizations
Need specialists
TX=
ACE I, BB, DIG, DIURETIC, LOW SODIUM DIET
+mechanical assist devices
IV ionoptropic infusions for palpitations
hoSpice
```
91
Reasons to anticoagulants
```
A fib/a flutter
Mechanical valve
DVT
PE
clot prophylaxis
```
92
CHAD VASC:
```
Congestive HF
HTN
Age >75
DM
STROKE/TIA
VAscular disease
Age 65-74
Sex (female > risk)
Score of 2+ = 2-3% risk of CVA per year
```
93
What is a common SE of Nasal Atrovent that pts don't like?
Bad taste
94
When dosing pain- start with....
Start with lowest dose
95
When altering a RX for cardiac, change......
One med at a time.
96
To monitor on Amiodarone:
TSH, LFT, PFT, EKG
97
Dosing bendadryl
1mg/ kg/ dose
98
How to treat bradycardia and tachycardia?
Only tx if symptomatic
99
Nitrate tolerance:how to avoid
Nitrate-free period, preferably overnight
100
What to do when starting someone on an ACEI
Get a baseline BMP
101
Unstable angina needs to be evaluated in the.....
ER!
102
Contraindications of BBS
Severe bradycardia or heart block; asthmatics (except Metoprolol)
103
Adverse effects of CCBs
Verapamil>> constipation;
| Nifedipine can increase reflexive tachycardia and mortality
104
BEST recommendation post MI:
BBs!
105
BBs are the drug of choice in:
Exertional angina
106
How to discontinue BBs
Taper dose!
107
Do NOT use ------- in CHF related to.....
verapamil, STRONG NEGATIVE IONOTROPIC EFFECT
108
Cornerstone of HF
ACEI
109
Good for chronic stable angina
ACEI
110
Drug interactions of ACEI's?
Other hypotensive mess
k+ sparing diuretics
APAP
111
ACEI's are contraindicated in....
```
Bilateral renal artery stenosis,
2nd and 3rd tri pregnancy (Cat x)
Hyperkalemia
Liver impairment
Angioedema
```
112
When using Aldactone make sure to monitor
k+!
113
BBs prevent.....after MI
Remodeling
114
When to use Atropine?
Bradycardia
115
ARBs and ACEI's can increase this electrolyte so....
K+, so do not use with K soaring diuretic
116
Do not use nitrates with....
CCBs
117
Mainstay of angina
Nitrates
118
High dose nitrate
Arterial dilation and decreased after load
119
Low dose nitrate
Venous dilation and decreased preload
120
All pts with LVD should be on....
ACEI
121
Cornerstone of HF
ACEI
122
Other mess that decrease cardiac remodeling
ARBs and ACEI
123
If pt cannot tolerate ACEI csn be changed to...
ARB
124
Ranexa considered first line for ......
CHRONIC angina.
125
Ok to use Ranexa with this....but contraindicated in....
Ok to use with Viagra but contraindicated in renal and liver disease; contraindicated in QT prolongation
126
This class of anti arrhythmic has greatest risk of pro arrhythmia, and anticholinergic effects
class I
127
This class of antiarrythmics can prolong QT
class III
128
INR goal ranges
2.0-3.0
129
Who to anticoagulants
Pts with a fib, a flutter
DVT
PE
130
CHADSVASC measures....and the score means...
Age, sex, hx of CHF, HTN, CVA, Thromboembolism,vascular disease and DM....score > 2 = great candidate for anticoagulation
131
Anticoagulants vs antiplatelets
Anticoagulants slow clotting times. Examples- Heparin, Coumadin, Dabigatran (Pradaxa, acts on Thrombin), Xarelto and Eliquis (Rivaroxaban, Apixiban, acts on Factor Xa)
132
Mnemonic for Class I-IV agents
"some block potassium channels"
Class I "Some" = S = Sodium
Class II "Block" = B =BBs
Class III "Potassium" = K+CBs
Class IV "Channels" = C =CCBs
133
Anticoagulant safe in pregnancy
heparin
134
Drug not to use in HF
Verapamil
135
ASA inhibits
Thomboxane A2
136
Digoxin
Has positive ionotropic effect, side effect =
Indicated in HF AND AFIB
caution in elderly, AV block, decreased K Ca or Mg, hyperthyroidism, and wt loss
SEs= dizzy, HA, N/V/D, halos, visual and mental disturbances
137
Normal EF
60-65%
138
Do mix Verapamil and....
diltiazem
139
Adenosine, contraindicated in....
2/3 degree heart block, symptomatic Brady, ASTHMA, RAD, allergy
140
Low Mag can lead to
Tornadoes or long QT
141
Outpatient management of AFIB
Anticoagulation
142
Risk with Pradaxa (Dabigatran):
Bleed!
143
Astelin is a good option in a pt with....
BPH
144
1st generation antihistamines- careful in pt with....
BPH
145
First line for allergic rhinitis
Intranasal corticosteroids
146
Tessalon Perles, how to take....
SWALLOW WHOLE DO NOT CHEW!
| Contraindicated in anaesthesia
147
Best nonpharm TX for neonate undergoing a procedure?
Sucrose
148
Common SE of Nasal Atrovent that pts do not like?
Bad taste!
149
Best way to to URI.
Tx Sx
150
Safest nasal deongestant?
Pseudo ephedrine
151
Which antihistamines are on BEERS list?
1st gen
152
Codeine is black-boxed in....
Peds
153
FDA recommends using measuring device....
Obtained with med at pharmacy
154
Never give ASA topped recovering from...
Varicella or influenza
155
What med is associated with Stevens Johnson Syndrome (and other skin eruptions)?
APAP
156
APAP can be used at this age; Motrin after....
APAP= under 6 months, Motrin after 6 months
157
ASA in peds is best used
For JRA
158
Do not use EMLA > 1hour in neonate....
Risk of methylglobinemia
159
Tolerance is
When body expects dose
160
Dependence....
Can cause withdrawal. It is normal after use of drug over time.
161
Addiction is....
A psychological dependence , misuse
162
Pain Assessment scorecard
```
P LACE
A MOUNT
I NTENSIFIERS
N ULLIFIERS
E FFECTS ON LIFE
D ESCRIPTION ( burning, dull, sharp etc)
```
163
Rationale approach to pain management "TONI"
T REAT TREATABLE CAUSES
O PTIMIZE ANALGESICS
N ONPHARM MODALITIES
I NVASIVE PROCEDURES
164
WHO Pain Ladder:
Ground level: MILD/mod: NONOPIOID
STEP ONE: MOD/ sev: PO opioid + NONOPIOID
STEP TWO: SEVERE/ persistent: RTC OPIOID + adjuvant meds
165
What is KEY WITH chronic pain pts?
FOLLOW FOLLOW FOLLOW!
166
Chronic pain management includes pain contract and...
Urine drug test, pill count etc
167
which analgesic is good for someone with gastritis?
APAP
168
Dose limits on APAP:
325 mg per tablet max; 4G QD max
169
Biggest adverse reaction with APAP
Liver toxicity!!!
170
Tramadol is .... Careful in....
Class by itself. Opioid agonist, serotonin and norepinephrine, careful in pts already on meds with these and HX of SEIZURES!
171
Initiating opioids
Make sure tried everythingn else first....start low go slow
172
Mr Jones 6/10 still with pain meds, not a candidate for corticosteroids...already on Percocet (short acting) what to do?
Consider long-acting pain med and breakthrough dosing
173
When changing one opioid to another remember....
They are slightly different so start new opioid with slightly lower dose as they will be tolerant of previous meds and SEs but not new one.
174
How to prescribe for breakthrough pain
20% of 24 hour dose of background med
175
Transdermal Fentanyl- careful with
Elderly, malnutrition, poor hydration; heat affects patch.
| Do normal po dose to give patch time to kick in.
176
Know about method one
Long/ variable t 1/2, and can prolong QT.
| GET BASELINE EKG!
177
Starting pt on pain meds-
NSAIDS good place to start. Take with food or offer PPI, CAREFUL with renal/ liver....MISOPROSTOL- not ok in preg
178
Weakest NSAID is.... To step up try....
Motrin. Try Naprosyn or Ketorolac.
179
When are co analgesics used?
With bone pain.
180
Careful with Lyrica in...
Pts with CHF. Can cause pulmonary edema.
181
It's line anticonvulsant for neuro pain
gabapentin (then Dilantin), start low go slow
182
When to tell pt to take gabapentin
At night. Is sedating.
183
Corticosteroids are great to help with inflammatory pain except in...
Diabetics.
184
When using antidepressants for pain, careful of....
OD, anticholinergic SEs
185
With opioids, manage constip ahead of time via...
Stool softeners, then lax, but no bulk-forming lax
186
Always consider ------- interventions with ------- interventions in pain
NONPHARM , PHARM
187
When to use Narcan
RR
188
How to use Equianalgesic chart
Cut dose in 1/2 to 1/3 based on incomplete cross tolerance, ie, morphine 90mg>> 60 mg
189
FIRST PRIORITY WHEN PT ARRIVES IN PAIN
Assess!
190
First line co-analgesic
gabapentin
