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Pharm > Pharm Exam 4 > Flashcards

Pharm Exam 4 Flashcards

1
Q

Patient with PCOS with acne, fluid retention and wants contraceptive to control sx, which drug would have anti-matineral cortinergic properties to control the sx?

A

Drospirenone/EE (Yasmin®, Yaz®)

  • Antiandrogenic, Antimineralocorticoid
  • Less likely to cause cyclic fluid retention
  • Target Population: PMS/PMDD, acne, hirsutism, PCOS
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2
Q

OC with 90-day continuous cycle, that alleviates headaches

A

Seasonique

  • 91 active tablets: 84 combination, 7 low dose estrogen only
  • Levonorgestrel/ethinyl estradiol
  • Continuous cycle with no hormone-free interval
  • Helps with menstrual symptoms, including migraines
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3
Q

Of all contraceptives, which of the following has primary mechanism that has estrogen in combo with menopause medications, what will it do to the body function?

A

Unopposed estrogen can cause endometrial hyperplasia.

  • If has uterus, need to do combination of estrogen and progesterone (EPT)
  • Like Prempro tablets

If had hysterectomy, can use estrogen-only medication
- Premarin tablets or vaginal cream

Avoid oral estrogens and EPT (use different dosage form):

  • Hypertriglyceridemia
  • Known thrombophilias
  • Migraine w/ auras
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4
Q

Of all emergency contraceptives, which has the highest efficacy (doesn’t have to be oral)?

A

Paragard (copper IUD)

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5
Q

Patient calls and forget to take Camilla, what do you tell her to do?

A

Take 2 pills ASAP (today’s + missed does) AND use a backup method for 48 hours.

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6
Q

Which is the advantage of using Mirena (a hormonal IUD)?

A

Local delivery that:

  • Suppresses Endometrial growth
  • Thickens the cervical mucus (not hospitable to sperm)

Also reduces heavy bleeding
Additional indication: treating menorrhagia

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7
Q

What is an adverse effect of Nuva ring? What makes it a disadvantage?

A

increased risk of vaginitis and vaginal discharge

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8
Q

If you had 39 y.o female, looking for contraceptive devices, is a smoker 1 PPD, but has no PMH, what is the best option?

A

IUD: Mirena

Implant: Nexplanon

Injection: Depo-Provera

Medication: Camilla

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9
Q

58 y.o. female with hot flashes, PMH of a PE during pregnancy, has breast cancer history. What med would work to alleviate hot flashes?

A

Paroxetine (Paxil)

  • SSRI antidepressant, 1-2 less hot flashes/day
  • Can’t use Duavee because of her history of breast cancer
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10
Q

53 y.o female, with vasomotor sx, tried transdermal patch, but couldn’t tolerate the side effects (bloating), no vaginal atrophy, and has a uterus still. What drug would be best for her?

A

Conjugated estrogen/baxedoxifene (Duavee®)

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11
Q

Who gets what drugs based on what level of their infection? Know who gets if novel (1 off injection), vs latent (injection every week for 3 weeks), vs neurosyphilis

A 
Incubation, Primary, Secondary, or Early Latent in the non-PCN allergy patient (can use in pregnant patients)  
o	Benzathine penicillin (Pen G): 
	2.4 million units
	IM 
	Single dose
o	PCN Allergy?
	Doxycycline
•	100 mg
•	 BID for 14 days (or tetracycline can be used)  for a much longer period than Pen G!
Latent
o	Benzathine penicillin (Pen G) 
	7.2 million units, as three separate 2.4 mil unit doses
	IM 
	1/week for three weeks
o	PCN Allergy?
	Doxycycline 
•	100 mg 
•	BID for 28 days (or tetracycline can be used)

Congenital in Neonates: cannot give IM dose to neonates.
o Aqueous crystalline Pen G
 100,000–150,000 units/kg/day administered as 50,000 units/kg/dose
 IV
 Q12 during the first 7 days of life and Q8 thereafter for a total of 10 days

Pregnant who haven’t spread it yet
o Benzathine penicillin (Pen G)
 2.4 million units
 IM
 Single dose, but need monitoring by OB for the next 48 hours
o Pregnant with PCN allergy?
 Desensitization treatment with Penicillin (we cannot give Doxycycline; CI’ed in pregnant patients

Tertiary: very aggressive treatment needed
o Consult infectious disease (ID)
o IV

Neurosyphilis
o	Aqueous Crystalline Pen G
	3-4 million units 
•	IV
•	Q4  for 10-14 days
	18-24 million units per day 
•	continuous infusion
o	PCN Allergy?
	Ceftriaxone 
•	2 g 
•	IM 
•	Daily for 10-14 days, but cross-sensitivity is a minor risk

Ocular syphilis
o Neuro management plus ophthalmologist consult

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12
Q

Pregnant patient with chlamydia?

A

Azithromycin 1g PO x 1 dose

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13
Q

Know what Fluoroquinolone is recommended for Gonorrhea?

A

Gentamicin

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14
Q

When treating severe case of PID, what is the treatment (remember you need inpatient IV)? – What you pick is based on local resistance rates.

A

• Cefotetan 2 g IV every Q12 + Doxycycline 100 mg orally or IV Q12
• Cefoxitin 2 g IV Q6 + Doxycycline 100 mg orally or IV Q12
• If cephalosporin allergy:
o Gentamicin loading dose IV or IM (2 mg/kg), followed by a maintenance dose (1.5 mg/kg
• If more polymicrobial and not worried about gonorrhea:
o Ampicillin/Sulbactam 3 g IV Q6 + Doxycycline 100 mg orally or IV Q12

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15
Q

Know what IV antiviral is used for severe herpetic infection?

A 
Acyclovir 5–10 mg/kg IV every 8 hours for 2–7 days or until clinical improvement is observed, followed by oral antiviral therapy to complete at least 10 days of total therapy
o	Foscarnet (Foscavir) if resistance to Acyclovir is suspected
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16
Q

Trichomonas or other BV, how do you avoid systemic SE’s?

A

Local treatment

Metronidazole (Flagyl) gel 0.75%, one full applicator (5 g) intravaginally, once a day for 5 days – 1st line trt

Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days (cheaper than Flagyl)

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17
Q

What is CDC recommended treatment for Trichomonas?

A

Very straightforward testing and simplified management: need to visualize results in 30 minutes

o Metronidazole 2 g orally in a single dose – 1st line
o Tinidazole 2 g orally in a single dose
o Metronidazole 500 mg orally twice a day for 7 days

Partners also need to be treated to avoid re-infection and abstain for 7 days

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18
Q

What should be avoided when take Flagyl?

A

Disulfiram reactions with Alcohol – do not drink! Get Hangover symptoms.

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19
Q

Patient with fever, malaise, myalgias and headaches. They say that they were just treated for syphilis. Know what to do.

A

Patient has Jarisch-Herxheimer Reaction (similar to with allergic reaction to the treatment to syphilis)

  • Symptoms usually resolve within 24 hours
  • Treatment is supportive, using antipyretics(Tylenol and ibuprofen) and analgesics

These sx are a result of the Penicillin G / Long Acting treatment for syphilis.

If pregnant, will be followed by OB or will be admitted for close monitoring.

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20
Q

Consequences of administering IV acyclovir?

A

AKI

insoluble acyclovir crystal forms in the renal tubules

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21
Q

22 yo F, + HIV on first lab test, RNA is extremely high, CD4 is low, how do you treat her?

A

Biktarvy

22
Q

What drugs do you want to avoid with insomnia and depression?

A

NNRTI

  • Efavirenz (Sustiva) (found in Atripia) – just the first few weeks of therapy
  • 1 pill regimen: Atripla® (efavirenz/TDF/emtricitabine)
  • 2 pill regimen: Sustiva® + Descovy®

INSTI’s

  • Dolutegravir (Tivicay) (found in Triumeq)
  • 2 pill regimen: Tivicay® + Descovy® (TAF/emtricitabine)
  • 1 pill regimen: Triumeq® dolutegravir/abacavir/lamivudine
23
Q

Know the mechanism of action, which drug targets transfer step of viral DNA integration?

A

Integrase Strand Transfer Inhibitors (INSTIs)

24
Q

Of all drug class for HIV, which can cause lipodystrophy, hepatic toxicity, and disturbs both hepatic lipid and glucose metabolism?

A

Protease Inhibitors (PIs)

25
Q

37 yo M, naïve treatment, HIV RNA 900, CD4 is 510, PMH for Stage 3 CKD. What drug is recommended for that patient? (HIV patient with elevated but not outrageous RNA and CD4, but does have CKD)

A

Dolutegravir/abacavir/lamivudine (Triumeq)

26
Q

43 yo F, who is on Atripla (efavirenz (Sustiva) / TDF/emtricitabine) when retest after 4 months, viral is still over 500 and CD4 is still under 400. What do you do?

A

Test for resistance

27
Q

24 yo F, 10 wks gestational follow-up, comes back HIV + … what is most appropriate treatment for her?

A

1st trimester:

- Atazanavir/ritonavir (Reyataz®) (PI) + TDF/emtricitabine (Truvada®) (backbone)

28
Q

32 yo PA with needle stick, what is good post-exposure prophylaxis (oPEP) for that patient?

A

Dolutegravir (Tivicay®) (NSTE) + TDF/emtricitabine (Truvada®) (2 NRTI backbone)

Raltegravir (Isentress®) (NSTE) + TDF/emtricitabine (Truvada®) (2 NRTI backbone)

29
Q

What drug is recommended for pre-exposure prophylaxis (PrEP) (like someone with a partner who was exposed)?

A

TDF/emtricitabine (Truvada)!

30
Q

Of all medications, what is the one you take on empty stomach to reduce SE’s?

A

Efavirenz (Sustiva)

  • Administered with 2 NRTI backbone
  • 1 pill regimen: Atripla® (efavirenz/TDF/emtricitabine)
  • 2 pill regimen: Sustiva® + Descovy®
31
Q

HIV+ patient, RNA over 50,000, CD4 is 80, what type of prophylaxis do they need and what is the correct ABX (to treat the most common condition associated with it, (PJP)) (regardless of any confirmatory test)… it is the most common treatment, too?

A

Trimethoprim/sulfamethoxazole (Bactrim®)

32
Q

Which is the MC pharmacokinetic change in a pregnant female?

A

Plasma volume

  • Cardiac output as a result of more volume
  • glomerular filtration as a result of more volume

As a result of these 3, we see a lower concentration of renally cleared drugs

33
Q

If you use a standard recommendation in pregnancy, what is the most standard recommendation?

A

Fetal risk Summary via clinical trials and data collection

Vary by trimester is probably the answer

Naproxen – premature closure of ductus arteriosus

Maternal needs should influence decision (just for minor headache, or is this something that cannot be avoided)

34
Q

A constipation therapy that is best during pregnancy, what is the best drug?

A

Psyllium (Metamucil)

  • 1st line.
  • Completely safe
  • Adding bulk, stretching colon to try and pass stool
  • Once a day

Polyethylene Glycol (MiraLAX)

  • Completely safe
  • Can use a little more often
  • Draws fluid into stool, stays within the gut
35
Q

Pyridoxine (B6), 1st line for N&V… it only works when it does what?

A
  • Needs constant administration to see results (these are preventing the nausea, not treating it)
  • Can be taken in combination with doxylamine (Unisom), which is an antihistamine
36
Q

Pregnant Female with VTE, what do you need to do?

A

No history of HIT (heparin induced thrombocytopenia)
- Unfractionated heparin (UFH) – safe, and also shorter acting, so not as worried about bleeding risk if goes into labor.
- Alternatives:
LMWH –> Lovenox

+ history of HIT:

  • Arixtra
  • DO NOT want to use UFH or Lovenox!

Avoid:
- Warfarin (Category X)

37
Q

Know the novel treatment for that condition

A
  • Apixaban (Eliquis) is the DOAC novel medication

- Xarelto and Pradaxa are Category C

38
Q

What type of drugs are associated with low birth weight?

A

Nicotine

39
Q

Tocolytic drugs: know the MoA’s

A
  • decreases uterine contractions to prolong time to delivery
  • Often used to delay delivery to decrease risks associated with premature delivery (2-7 days)
    24-33 weeks gestation: benefits generally out weight risks of tocolytic therapy
  • Indomethacin (Indocin) (NSAID)
    Inhibits cervical prostaglandin activity

Prostaglandins are blocked and no longer ripen cervix to get it ready for baby to be born.

40
Q

Which antenatal glucocorticoids have the following MoA: giving two that are both tocolytics and are also antenatal glucocorticoids, what do they do?

A

Stimulates fetal lung maturation & surfactant production

41
Q

TN in pregnant patient. What type of drug is most commonly used (need to be able to give PO and IV)?

A

Methyldopa (Aldomet)
- If shortage of 1st line, can use Labetalol, nifedipine and clonidine

Avoid: Category X
- ACEi IV, ARB’s, CCB’s diuretics, clonidine

42
Q

What makes pediatric pharmacokinetic unique?

A

pH fluctuates

43
Q

Considering drugs renally excreted, what do you have to do with dosing (for drugs excreted like gentamicin)

A

Doses:

  • Total Body Water is higher in infants and decreases as you age.
  • They require larger doses b/c gentamicin distributes more throughout the body
  • Adults will stay intravascularly, so don’t need as high of a dose because it isn’t going everywhere and is staying where we need it to.

Intervals change too:

  • Longer dosing interval: Infants (< 1kg) don’t excrete as much, so need less frequent dosing, takes longer to process out the drug.
  • Shorter dosing interval: Children are hyper-excreters and need more frequent dosing (they clear the drug quicker)
44
Q

know in general, what to consider when giving meds to kids?

A

Give PO suspensions or solutions

Tablet size is important, so give chewable tablets, sprinkle formulations, Orally-disintegrating

Rectal for kids who can’t tolerate oral

Avoid:
o	IV (although parenteral route is the most reliable), IM, tablets
45
Q

When you give Augmentin as a suspension, give recommendation on how it needs to be stored?

A
  • Expires 10 days after reconstitution, Refrigerate It

- If the ratio has too much clavulanate, it may cause diarrhea. So, you need to avoid too much GI upset.

46
Q

Of all the resource you can use, which is recommended for pediatric parenteral references?

A

Teddy Bear Book (Pediatric Injectable Drugs)

47
Q

What do you have an error when prescribing the pediatric dose?

A

Mg/kg Day OR Mg/Kg/Dose

  • Consider writing the child’s weight on the prescription so that the pharmacist has easy access to the weight and can easily double check your dosing. Also write the duration of therapy on the Rx for antibiotics, etc.
  • Does it give maximum dose? If have obese kid and calculate weight-based dose to be greater than that of the adult maximum dose, you’d give them the adult dose instead.

Peds are 3x more likely to experience adverse event from a medication error. Requires proper caretaker education:
- Decimal points (always use leading zero, never use a trailing zero), Drops vs. syrup, No Abbreviations, Legibility

48
Q

Vaccines, what type of immunity do they give?

A
  • Artificial Active Immunity (a form of adaptive immunity)

- immunity induced by exposure to an antigen – stimulates response to antigen without causing disease.

49
Q

When consider the MoA, how do inactive vaccines work and how do we give them?

A
  • Given IM
  • Inactive - Killed infectious agent or toxin with enough properties remaining to cause immune response. Better safety profile (esp. for immunocompromised)
  • More likely to provide short-term immunity & require booster doses. As you’ll see most childrens shots req multiple shots and boosters.
  • Inactive vaccines do not have live bacteria or bacteria that can replicate and cause disease. Inactive vaccines contain “inactive” bacteria.
50
Q

Who do we avoid live, attenuated vaccines in?

A

Pregnant and Immunocompromised Patients

- Rely on Inactive Vaccine

51
Q

Which of the following should we consider in the patient population regarding pneumococcal, who gets the PCS 13 and PPSV23 and at what age? What do older adults get? Children under two? Who gets single dose? Who gets it based the recommendations (either going to be very old or very new patients)?

A
  • PCV13- < 5 years of age (6 weeks – 5 years)
  • PPSV23- All > 65 years OR in those > 2 years with chronic health conditions

High risk children get PCV & PPSV (after 24 mo. Of age) (PPSV should be given at least 2 months after PCV)

Pharm (1 decks)

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