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STEP2 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

How do 1st generation antihistamines cause acute angle closure glaucoma?

A

they are anti-cholinergic&raquo_space; mydrasis > acute closure glaucoma

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2
Q

what class do the following drugs belong to?:
-adine
-cetirizine
Ketotifen

A

2nd gen antihistamine

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3
Q

Cilostazol is a phosphodiesterase inhibitor (like dypyridamole) that is marketed in JAPAN to treat what arterial diease?

A

PAD/intermittent claudication

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4
Q

what is the antidote for anti-cholinergic (mad hatter) toxicity?

A

Physostigmine; inhibits ach-esterase

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5
Q

what is the antidote for cholinergic toxicity? (dumbells/organophosphate)

A

atropine

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6
Q

what adverse affect do PPIs have on the kidneys?

A

allergic interstitial nephritis

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7
Q

early vs Late phase of ASA

A

early = resp alkalosis

late = AGMA

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8
Q

What drugs cause gingival hyperplasia?

A

Phenytoin, cyclosporine, CCBs

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9
Q

Symptomatic management of neuropathic pain can be achieved with what:

  • SNRI
  • antiepileptics
  • TCA
A
  • Duloxetine
  • Gabapentin, pregabalin, carbamazepine (helps trigeminal NEURALGIA)
  • amitriptyline
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10
Q

management of septic cavernous sinus thrombosis (very similar to CRBSI)

A

anticoagulants (regardless if the pt is actively bleeding or not)

ABs

  • VANC
  • Ceftriaxone/Cefepine
  • Metronidazole (should be added if anaerobic bacterial infection is suspected; dental or sinus infection)

+/- amphotericin B (if origin is fungal)

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11
Q

Niacin flushing/itching can be controled with what medication & why?

A

Aspirin; it decreases the prostaglandins made from Niacin

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12
Q

pt with a + PPD skin test but a negative CXR have latent TB infection (LTBI). what is the pharm tx & duration for LTBI

A

weekly rifapentine & isoniazid for three months

if latent = R+I
if active = RI+PE

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13
Q

are vaccination doses weight dependent?

A

NOOO. you never have to weigh a person to determine what dose to give!!

*also, Restarting the immunization series (i.e., from the first dose) is NEVER necessary for routine immunizations, regardless of how much time has passed since the last dose.

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14
Q

what is the first line treatment for CMV retinitis?

A

Valganciclovir, ganciclovir, foscarnet, and cidofovir

“Eating fos food with the CMV gan”

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15
Q

what are the 1st & 2nd line meds for essential tremor?

A

1st line = Primidone (barbituate)

2nd line = propanolol

essentially a primadoma pro

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16
Q

what essential tremor drug is Contraindicated in pt with asthma?

A

propanolol

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17
Q

what drugs kill bugs that don’t show on gram stains (“shows no organisms”) bc they have no cell wall?

ie Chlamydia, Ureaplasma, mycoplasma, mycobacterium

A

doxycycline

erythromycin & azithromycin (macrolides)

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18
Q

what classes of medications are used to treat pituitary adenomas?

A 
dopamine AGONISTS (cabergoline)
somatostatin analogs (octreotide)
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19
Q

what drug class is Demeclocycline?

what condition does it therefore tx?

A

Demeclocycline is an ADH antagonist== a super diuretic

tx SIADH where there’s too much ADH & not enough diuresing

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20
Q

what drug treats nephrogenic DI? (when ADH is produced, but isnt being accepted @ the kidneys> diuresis)

A

indomethacin.

it decreases diuresis in patients with nephrogenic DI by inhibiting the synthesis of renal prostaglandins— which physiologically inhibit the action of ADH on the collecting ducts.

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21
Q

what is the alternative tx for AOM when pt has allergy to oral amoxicillin-clavulante

A

oral macrolide (azithromycin)

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22
Q

what anti-CD20 drug is used to treat AIHA and why?

A

Rituximab, tx the cause of AIHA= CLL & non-Hodgkin lymphoma

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23
Q

what is the first line tx for Pagets disease of the bone?

what is the MOA?

A

IV zoledronate (bisphosphonate)

  • inhibits osteoclast activity = nor more bone remodeling *
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24
Q

when are adjuvant steroids indicated in the treatment of PCP?

A

in HIV pts with PCP; you must give them the standard TMP/SMX ++++ steroids

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25
Q

Filgrastim drug class & use?

A

= a form of recombinant G-CSF

= used in the management of neutropenia in patients receiving chemotherapy.

Filgrastim Flintstones

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26
Q

what drug toxicity presents with wheezing, hypoglycemia, & hypotension?

what is the antidote

A

beta blocker overdose/toxicity!!

glucagon

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27
Q

what drug toxicity presents with nause/vomiting, & yellowing tint of vision?

what is the antidote?

A

digoxin toxicity

Digoxin-specific antibody fragments (Fab)

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28
Q

what is the time cut off for administering activated charcoal for drug overdose?

A

<2 hours

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29
Q

what is the 2 step protocol for managing LARGE brain abscess?

A

1) aspirate/drain the abscess (= culture + decompression to decrease papilledema/ICP)
THEN
2) start ABs (decreasing pressure in brain is priority)

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30
Q

which 3 ABs are used to tx brain abscesses?

A

Metronidazole
3rd/4th gen cephalosporin (ceftriaxone, cefotaxime, ceftazidime, 4= cefepime)
Vancomycin (if abscess is from Staph blood stream infection- IE, neurosurgery, penetrating trauma )

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31
Q

do immunoglobulins prevent disease exposure or post-exposure?

A

POST-exposure!

example: Tetanus immunoglobulin (TIG) is given after pt is exposed w/ a dirty wound

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32
Q

what is the vaccine for tetanus composed of?

A

Denatured C. tetani toxoid

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33
Q

when is the only time you administer TIG with the TDaP vaccine?

A

only with a DIRTY wound & insufficient vaccine hx (never vaccinated/status unknown)

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34
Q

what is the GOLD standard test for acute closed angle glaucoma dx?

A

Gonioscopy = direct visualization of the angle

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35
Q

What 1st line drug is used to treat insulinoma?

A

Diazoxide (thiazide diuretic used for its power to stop insulin secretion from pancreas & tumors!)

2nd line = somatostatin analogs

Diaz was like insulinoma bc he had no sugar/glucose in his home

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36
Q

what is the drug of choice to treat Jarisch-Herxheimer reaction (even though its self limiting)

A

NSAIDs

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37
Q

at what blood pressure do you administer vasopressorsssssssss?

A

<90/<60

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38
Q

what is the pathophys of IDA vs ACD?

A

IDA is caused by low iron + high TIBC.

on the other hand,

ACD is caused by a CHRONIC inflammatory state (> low Fe and low TIBC) by inflammatory marker, hepcidin (the guardian of ferritin storage; wont let iron out/destroys ferroportin when it tries to transfer iron)

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39
Q

how do you treat IDA vs ACD

A

IDA = iron supplements

ACD = treat disease + steroids

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40
Q

what drug is known for causing RTA 2?

what is it used for treating?

A

Acetazolamide

used in IIH & glaucoma

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41
Q

what is the classic adverse side affect of Demeclocycline (a tetracycline)?

A

causes a photoTOXIC drug rxn of blistering skin within minutes of sun exposure?

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42
Q

true or false:

aspirin-exacerbated respiratory disease (AERD) causes a T1HS rxn when pt is admin aspirin?

A

FALSE

AERD > Pseudoallergy bc its caused by inhibition of Cox> flushing & wheezing NOT IgE crosslink (thats why theres no urticaria)

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43
Q

which ART drug for HIV causes urolithiasis?

A

Indinavir

= poor solubility and significant renal excretion, which leads to crystallization and stone formation (urolithiasis)

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44
Q

what 3 drugs cause allergic interstitial nephritis?

A

PPIs, Sulfas, Penicillins

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45
Q

Rasburicase MOA?

A

metabolizes high levels of uric acid into byproducts: Allantoin + Hydrogen peroxide

== no more hyperuricemia :)

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46
Q

why is Rasburicase absolutely contraindicated in pts w/ G6PD deficiency?

A

Rasburicase converts uric acid into a byproduct, Hydrogen Peroxide + allantoin

G6PD pts have an absent Reduced Glutathione; usually produces NADPH (fights pathogens w/ oxidative burst) AND protects RBCs from hydrogen peroxide (» oxidative stress & hemolytic anemia)

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47
Q

Pts with hypomagnesium are at increased risk of nephrotoxicity via what 2 drugs?

A

aminoglycosides

cisplatin

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48
Q

before a patient starts Eculizumab, they must be vaccinated for what bug?

why?

A

Eculizumab blocks C5a> incomplete complement cascade

must be vaccinated for meningococcal bc body uses C5a to fight meningococcal diseases

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49
Q

If the first line treatment for severe/symptomatic SIADH fails, what are the second line pharm tx options?

A

Vaptans (work @ brain)
Demeclocycline (work @ kidney)
loop diuretics (e.g., furosemide)

only use this if urine osm if 2xxxxx GREATER than serum osm

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50
Q

what drugs are used in a hypertensive crisis?

what drugs are used in eclampsia HTN?

A

IV Hydralazine, Labetalol, Nitroprusside, Fendolapam

Moms Love Healthy Neonates:
methyldopa, labetalol, hydralazine, nifedipine

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51
Q

how is Metyrapone used to dx PANHYPOPITUITARISM?

A

Metyrapone inhibits inhibits 11-beta hydroxylase> no cortisol produced.

a decrease in cortisol should trigger + FBL for pit to release ACTH.

PANHYPOPITUITARISM= no increase in ACTH

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52
Q

what is the purpose of an arginine infusion test?

A

to dx PANHYPOPITUITARISM

arginine infusion suppresses endogenous somatostatin- the inhibitor of GH- should normally see rise in GH

if no rise in GH = panhypopituitarism

53
Q

which hormones does Dopamine inhibit & how?

A

Dopamine inhibits the pituitary gland from produced Prolactin.

when Prolactin decreases, GH and TSH decrease with it bc that always move in motion <3

54
Q

MOA of Pegvisomant

what does it treat?

A

== GH ANTtagonist; tx Acromegaly

55
Q

what antibiotic causes gynecomastia?

how does it do this?

A

Ketoconazole !

inhibits 17,20-desmolase, the first step of steroid synthesis

56
Q

which calcium imbalance causes prolonged QT?

A

hypocalcemia

HIPPOcalcemia; hippos have prolonged bodies

57
Q

hypomagenesium causes a decrease in which hormone?

A

PTH. magnesium controls PTH levels

58
Q

Adenosine is a Class ___ anti-arrhythmic drug.

IV adenosine is 1st line tx for what arrhythmia that is common in infant/pediatric pts?

A

Class 5

paroxysmal SVT & AVNRT

59
Q

Digoxin is a Class ___ anti-arrhythmic.

It is used for the rate control of which arrhythmia?

A

Class 5

AFib & Flutter

60
Q

what nerve does Digoxin stimulate to inhibit atrial rate?

A

Vagus nerve

61
Q

Magnesium treats what arrhythmia?

what drug toxicity does magnesium treat?

A

Torsades de Pointes

Magnesium treats Digoxin toxicity!!!

62
Q

How does Adenosine work?

If adenosine fails, what are other options for stoping SVT/AVNRT?

A

binds & activates Gi receptors> inhibits adenylate cyclase = decreased in cAMP=== INC potassium efflux & dec Ca influx = hyperpolarization = AV nodal block that eliminates SVT

63
Q

If adenosine fails, what are second line options for stoping SVT/AVNRT in children?

what is the 3rd line?

A

vagal maneuvers to naturally block the AV node (ex. putting ice water on eyes and neck will stop a SVT)

IV propanolol if adenosine & vagal maneuvers fail

64
Q

what are the 3 absolute contraindications to adenosine?

A

Asthma

hx of AV nodal block

pre-excitation tachycardia = WPW (will worsen this arrhythmia by converting it to VFib!)

65
Q

Adenosine can dx what underlying arrhythmia when a pt has SVT/AVNRT?

A

A fib! it hides in SVT/AVNRT

66
Q

Why is adenosine used during cardiac stress tests?

A

Adenosine acts on A1 receptors in heart (blocks AV node), BUTS also on A2 receptors in heart vessels&raquo_space;> vasodilators

Giving a CAD pt Adenosine for a cardiac stress test will allow us to open the arteries to examine blood flow through them (see if theres a clog or not) :)

67
Q

Caffeine and methyxanthines (theophyllines) decrease activity of what drug by blocking A1 receptors?

A

decrease Adenosine efficacy :)

68
Q

what drug causes a visual phenomenon where things appear painfully BRIGHTER than they actually are?

A

Ivabradine (antiaarythmic used when BBlockers cant be tolerated in CHF)

69
Q

what drug is used as a backup for CHF or stable CHD pts who cant tolerate B-blockers?

A

Ivabradine

70
Q

what 2 drugs are used to manage opioid intoxification?

A

Naloxone = high affinity, but short acting (immediately antagonizes opiod effects at the Mu receptor, but falls off fast» relapse in symptoms)

followed by Naltrexone (also a Mu antagonist, but is longer acting so prevents relapse in overdose symptoms)

71
Q

what AB treats C.diff pseudomembranous colitis?

what Ab causes pseudomembranous colitis?

A

metronidazole treats it

clindamycin causes pseudomembranous colitis

72
Q

what drug is used to treat polymicrobial female GU infections located in the endometrium (endometritis, retained material from D&C, IUD infection)

A

Clindamycin

73
Q

best drug for clostridium perfringes “road scrape” skin infection?

A

clindamycin

74
Q

1st ine tx for asplenia?

A

IV ceftriaxone

75
Q

tx for severe (high fever, peritonitis), inpatient PID?

A

target BOTH neisseria and chlamydia

  • Cefoxitin or cefotetan PLUS doxycycline
76
Q

tx for stable/outpatient PID?

A

One single dose of IM ceftriaxone PLUS oral therapy with doxycycline

77
Q

what is the nl inpatient PID regimen ?

what drug(s) is added when there is a suspected complicated tubo-ovarian abscess ?

A

nl regimen can be a combination of:

  • IV Cefoxitin/cefotetan +++ doxycycline
  • IV clindamycin + gentamicin

If abscess suspected:
add oral clindamycin or metronidazole

78
Q

what is the treatment for the following vaginal infections:

candida
BV
trichomonas

A

candida: fluconazole

BV: clindamycin or metronidazole

Trich: PARTNERS w/ metronidazole

79
Q

examples of fibrinolytics/thrombolytics

A

TPA
rTPA
Streptokinase
Urokinase

80
Q

what 2 antifibrinolytics reverse the effects of tPA?

A

Aminocaproic acid and tranexamic acid

they stop plasminogen from becoming plasmin= no fibrin degraded = stops bleeding

81
Q

Rifampin delays the body’s resistance to what drug ?

Rifampin is used in combination with this drug for tx of what disease?

A

Dapsone.

They are used in combination for tx of Leprosy

82
Q

what drug is used as prophylaxis for children/people exposed to H. influenza & meningococcal meningitis ?

A

Rifampin

83
Q

Why is Rifampin contraindicated in treating HIV pts infected with TB?

what drug(s) therapy is used instead?

A 
RifAMPin INDUCES (*AMPS up*) cytochromeP450 = increased metabolism/excretion of protease inhibitors & NNRTs used in HIV ART drugs. 
- so giving HIV pt on ART Rifampin will decrease the ART effectiveness.

9 months of Isoniazid only. ORRRR Use Rifabutin (because the effect of rifabutin to induce cytochrome P-450 is less potent than that of rifampicin)

84
Q

what is the only TB drug that can be used as monotherapy for LTBI?

A

Isoniazid

85
Q

How does TB become resistant to INH?

A

mutations causing decreased KatG == decreased expression of catalase-peroxidase → less/no biologically active INH

86
Q

what are the adverse effects of I-NH?

A

neurotoxicity

  • seizures that are refractory to benzos
  • peripheral neuropathy (decreased B6/pyridoxine)

hepatotoxicity
- drug induced hepatitis in genetically slow N-acetyltransferase (NAT) acetylators (bc INH is metabolized via liver by NAT)

87
Q

what TB therapy drug causes drug induces LUPUS?

A

Isoniazid

88
Q

what serum pH imbalance does isoniazid cause?

A

AGMA

89
Q

which TB drug inhibits cytochromeP450?

A

Isoniazid

90
Q

what drug produces orange/red body fluids?

A

Rifampin

91
Q

MOA for rifampin

A

inhibits DNA-dependent RNA Polymerase = stops transcription of mRNA= no protein synthesis
(bactericidal effect)

92
Q

what is the 1st & second line therapy in treating hepatic encephalopathy?

A

1 = lactulose

93
Q

what drug causes decreased visual acuity and red-green color blindness which may result in irreversible blindness?

A

Ethambutol

94
Q

Ethambutol is contraindicated in pts with ______

A

optic neuritis

visual problems

95
Q

what TB drug is contraindicated in pts with gout?

A

Py-ra-zina-mide

96
Q

Dapsone has the SAME MOA as Sulfonamindes which is…

A

inhibition of dihydropteroate synthetase = no conversion of PABA to Dihydropteroate> Dihydrofolate

== no folate production

97
Q

Dapsone is used in combination with TMP as an alternative to sulfa drugs to treat:

A

P. jiroveci pneumonia

  • Prophylaxis and
  • Treatment: used in combination with TMP as an alternative to TMP/SMX

Toxoplasmosis:
you can use Dapsone (instead of sulfadiazine) + Pyrimethamine + leucorovin

98
Q

what skin condition does Dapsone tx?

A

dermatitis herpetiformis

99
Q

How does long term use of Dapsone cause dose-dependent Methemoglobinemia?

A

Dapsone is metabolized in the liver via cytochromeP450 (breaks down drugs via powerful OXIDANTs)

increase in oxidants/ROS while using Dapsone» the oxidation of ferrous Fe2+ to ferric Fe3+ == meth-hemoglobinemia (Fe3+–Hgb)

100
Q

what local anesthetics cause acquired Methemoglobinemia?

A

lidocaine & benzocaine

101
Q

How does Dapsone> agranulocytosis?

A

Dapsone has the same mechanism as Sulfa> decreased folate production > agranulocytosis & anemia

102
Q

what topical drug is first line for mild rosacea?

what oral drug is used for severe rosacea

A

mild = topical metronidazole

severe= oral (systemic) tetracycline

103
Q

diuretics thiazides, furosemide, acetazolamide are all apart of what drug class?

what NSAID is also a part of this dug class?

A

sulfonamides!!

Celecoxib

104
Q

another term used for Bactrim (SMX/TMP) is :

A

co-trimoxazole

105
Q

what is the prophylaxis vs tx for toxoplasmosis?

A

Prophylaxis when <100 with SMX/TMP

TREAT with sulfadiazine/pyrimethamine + leucovorin

106
Q

what is the prophylaxis vs tx for P. jiroveci?

A

BOTH prophylaxis (<200) & tx = SMX/TMP

107
Q

what kind of anemia do Diaminopyrimidine derivatives (ie Pyrimethamine & Trimethoprim) cause?

if given in high doses, these drugs cause what electrolyte imbalance?

A

Megaloblastic anemia (-penia)

Hyperkalemia!

108
Q

what drug displaces warfarin from albumin&raquo_space; increased free/circulating warfarin == increased bleeding/anticoagulation?

A

SMX

109
Q

first line pharm tx for bulimia nervosa? (Bc first line tx in general = CBT)

A

Fluoxetine. It stops binging AND purging behavior

110
Q

what are the strongest opioids used for severe pain relief ?

A 
fentanyl 
hydro-morphone 
oxycodone 
-morphine 
methadone

MORPH into a STRONG beast

111
Q

Pregnant women <18weeks can NOT be treated with Pyrimethamine for Toxoplasmosis bc its teratogenic.

What drug is replaces Pyrimethamine to prevent congenital Toxoplasmosis in the 1st trimester?

A

Spiramycin
if maternal infection before the 18th week of pregnancy is suspected/confirmed and infection of the fetus is not suspected/documented

112
Q

what 3 medications are avoided in pre-excitation WPW syndrome & why?

A

Avoid CCBs, Digoxin & Adenosine in patients with pre-excitation because of the risk of the arrhythmia converting to ventricular fibrillation

113
Q

what is the tx for:

normal HUS
vs
Atypical HUS (recurring/refractory)

A

normal HUS = supportive bc HUS is in children

Atypical HUS = still in children, but since its recurring, tx w/ Eculizumab

114
Q

what antipsychotic causes primary hyperparathyroidism?

How?

A

Lithium

It blocks the CaSR’s ability to sense calcium. Since it cant sense calcium, it tells the parathyroid to release PTH> hypercalcemia & hypophosphatemia

115
Q

what are the TOP drugs for MRSA?

A

Vancomycin
Daptomycin
Linezolid

116
Q

drug for ATYPICAL PNA (mycoplasma & chlamydia)

A

Tetracyclines (doxy id prefered)

117
Q

what drug, if taken when expired, leads to Fanconi syndrome (RTA 2)?

A

Tetracycline

118
Q

tetracyclines work intracellularly so the are used in what diseases?

A

ALL intracellular bacteria (chlam) & parasites/ticks

119
Q

1st line med for restless leg syndrome that is affecting sleep & daily function?

2nd line?

A

Gapapentin/pregabalin

dopamine agonists (2nd line bc causes rebound symptoms)

120
Q

first line tx for symptomatic bradycardia?

A

Atropine

121
Q

2nd line options if Atropine fails in treating symptomatic bradycardia?

A

epinephrine & dopamine

122
Q

purpose of glucagon?

A

glucagon = tx B-blocker OVERDOSE

123
Q

what tx for cataplexy is used at NIGHT bc it is a dangerous sedative?

A

sodium oxybate (salts)

124
Q

warfarin is used as prophylaxis for DVT/PE after:

A

hip/fracture surgery
Afib
VALVULAR surgery

125
Q

how do you tx Tinea capitis?

A

ORALLLLL terbinafine or griseofulvin

tinea CAPITIS & UNGUINUM (nail) are the only fungal infections treated ORALLY

126
Q

what 2 vitamins MUST be included in a vegetarian diet?

A

B12 = meats only

Vit D= sun & meats

127
Q

what is the firstline drug for bacterial endocarditis PROPHYLAXIS (before dental procedures)?

what do you use when pt is allergic to the first line drug?

A

Amoxicillin

MacrolideeEEE!!!!!

128
Q

acute & maintenance tx for Whipple dx

A

acute = IV ceftriaxone

maintenance = SMX/TMP

STEP2 (12 decks)

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