Pharmacology

Question 1

Rx:
Prevent pneumocystis pneumonia
*Pt with trimethoprim-sulfamethoxazole allergy

Answer 1

Atovaquone

Dapsone (SE: hemolytic anemia, methemoglobinemia)

Question 2

RX:

Med use in combine tx of multiple mycobacterial infections (TB, mycobacterium avium complex)

Answer 2

Rifampin

• CYP 450 inducer
• Lower methadone plasma conc

Question 3

RX:

tx and secondary prophylaxis of CMV retinitis

Answer 3

Valganciclovir

SE: BM suppression and diarrhea

Question 4

Lithium adverse effectss

Answer 4

affect thyroid and renal fx

*monitor creatinine lvs and thyroid fx tests

potential cause of nephrogenic DI: polyuria, polydipsia

Question 5

Ziprasidone imp SE

Answer 5

Prolonged QT interval

SGA antipsychotic

Question 6

which RX:

SE agranulocytosis, seizures, myocarditis, metabolic syndrome

Answer 6

Clozapine

tx resistant schizophrenia (assoc with suicidality)

Question 7

NE-Reuptake Inhibitors used for ADHD

Answer 7

Atomoxetine

Question 8

NE-D reuptake inhibitor

tx depression and tobacco dependence

Answer 8

Bupropion

• Pro: no WG, no sexual Dysfx
• Contraindicate: seizure

Question 9

What type of diet contain tyramine?

Tyramine hypertensive crisis d/t D-D interaction of tyramine and MAOi

Answer 9

Cheese, Draft beer, sausage, cured meats

Question 10

SE of antipsychotic

1st gen (FGAs) - high potency haloperidol

Answer 10

extrapyramidal sx: acute dystonia, akathisia, parkinsonism, tardive dyskinesia

Question 11

SE of antipsychotic

FGAs Low potency chlorpromazine

Answer 11

sedation, cholinergic blockade, orthostatic hypoTN, WG

Question 12

SE of antipsychotic

SGAs (2nd gen antipsychotics)

Answer 12

metabolic syndrome, WG, sedation
extrapyramidal sx (less common than FGAs)

Question 13

D-D interaction: Which medication responsible?

Lithium toxicity
Lethargy, confusion, agitation, ataxia, tremor/fasciculations, seizure

Chronic toxicity: Decrease renal perfusion, dehydration

Answer 13

Thiazide diuretics, NSAIDs, ACE inh
*decr lithium clearance

tx: IV hydration, hemodialysis (severe)

Question 14

D-D interaction: Which medication responsible?

Lithium toxicity
acute tox: n/v/d, late neurologic sequelae

Answer 14

intentional toxicity

tx: IV hydration, hemodialysis (severe)

Question 15

FGAs MOA

Answer 15

D2 R antagonists

*Haloperidol

Question 16

SGAs MOA

Answer 16

Serotonin (5HT2 R antagonism) > D2 R antagonist

Question 17

Antiepileptic drug MOA

Answer 17

inh Na channels&raquo_space; stabilize neuronal membranes

*Carbamazepine (antiepileptic & mood stabilizer)

Question 18

Rx:

Partial opioid R agonist that have significant opioid R antagonist properties in pt with long term opioid therapy

Answer 18

Buprenorphine (partial opioid R agonist that binds mu-R with high affinity but low intrinsic activity)

*high risk of opioid withdrawal if administer in opioid-tolerant pts = n/v, myalgias, dilated pupils, diaphoresis, tahcyC

Question 19

MC SE of SSRI

Answer 19

sexual dysfx (50% of pts)

*freq cause of nonadherence

Question 20

TCA OD SE

Answer 20

cardiac arrhythmias, seizures

*common SE: orthostatic hypoTN, urinary hesitancy (d/t antagonism of a-adreneregic and cholinergic R)

Question 21

SE of psychostimulants (methyphenidate/ amphetamines)

Answer 21

decr appetite, WL, insomnia

SE management: PO after meal, eat nutrient dense foods. monthly monitor weight/height/ HR/ BP

*tics, incr HR/BP

Question 22

Which anticonvulsant/bipolar DO meds?

Cause Steven-Johnson syndrome

Answer 22

Lamotrigine

Question 23

which RX?

drug induced lupus&raquo_space; AKI d/t immune complex-mediated glomerulonephritis.

Answer 23

hydralazine (rare SE)

Lab: urine sediment (red cells, white cells, casts)
*rash, pleuritis

Question 24

which RX?

Drug induced allergic intestinal nephritis (eosinophilic AKI)

Answer 24

beta-lactam ABx
nonsteroidal anti-inflam drug (NSAID)
*after cont exposure after several days

Question 25

which RX? AKI d/t crystalluria, tubular necrosis (grannular cast)

Answer 25

acyclovir, indinavir

Question 26

ABx that cause QT prolongation

Answer 26

macrolides (erythromycin, azi, -mycine) | fluoroquinolones (ciprofloxacin, -floxacin_

Question 27

antiviral rx that cause QT prolongation (rare)

Answer 27

HIV anti viral (saquinavir, atazanavir)

Question 28

antiemetics that cause QT prolongation

Answer 28

ondansetron

Question 29

Anti-fungal that cause QT prolongation

Answer 29

azoles | *except terbinafine (squalene epoxidase inh)

Question 30

Antiarrhythmics that cause QT prolongation

Answer 30

``` class IA (quinidine) class III (dofetilide) ```

Question 31

other conditions/syndrome that cause QT prolongation

Answer 31

electrolytes abn romano-ward syndrome (AD) jervell and lange-nielsen syndrome (AR)

Question 32

``` which Rx (5) drug-induced lupus erythematosus (DILE) ```

Answer 32

``` hydralazine procainamide isoniazid minocycline quinidine ``` * pos ANA * 80% pos anti-dsDNA (SLE, not DILE) * 50/50 pos anti-histone

Question 33

Antidote for NE extravasation (IV site become cold, hard, pale)

Answer 33

Phentolamine (syringe with fine hypodermic needle) | *within 12 hrs of extravasation to be effective

Question 34

Antidote: | antipsychotic drug induced akathisia

Answer 34

reduce med B-blocker Benzo

Question 35

Antidote: antipsychotic drug induced acute dystonia (Haloperadol)

Answer 35

anticholinergic: diphenhydramine, benzotropine | * w/in hours-days of antipsychotic use (d/t rapid dose escalation of high potency FGAs)

Question 36

Antidote: | antipsychotic drug induced parkinsonism

Answer 36

anticholinergic: Benztropine

Question 37

Antidote: | antipsychotic drug induced tardive dyskinesia

Answer 37

irreversible *d/t prolonged exposure (years)

Question 38

Antidote: | seretonin syndrome

Answer 38

cyproheptadine (PO) | 5HT1A/2A antagonist

Question 39

Antidote: | intox benzo

Answer 39

flumazenil