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** A Rowe Final - all > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Macrolides:

A

erythromycin, azithromycin, clarithromycin.

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2
Q

Quinolones:

A

ciprofloxacin (Cipro), ofloxacin (Floxin).

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3
Q

Sulfa:

A

Trimethoprim-sulfamethoxazole (Bactrim).

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4
Q

Tetracyclines:

A

tetracycline, doxycycline

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5
Q

It takes ___ days (platelet life span) for platelet function to return to normal after a patient stops taking clopidogrel (Plavix).

A

10

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6
Q

____ patients may require lower starting and maintenance doses of warfarin.

A

Asian

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7
Q

INR values —– increase stroke risk sixfold.

A

<2.0

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8
Q

—is longer acting and more “effective” than HCTZ.

A

chlorthalidone

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9
Q

reduce calcium excretion by the kidneys and stimulate the osteoblasts. This helps build bone.

A

Thiazides

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10
Q

Patients with serious sulfa allergies should avoid

A

Thiazide and loop diuretics

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11
Q

Spironolactone adverse effects:

A

Gynecomastia (13%) and hyperkalemia

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12
Q

Spironolactone black box warning

A

risk of benign and malignant tumors

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13
Q

Alpha-blockers are potent vasodilators common side effects are

A

dizziness and hypotension. Give at bedtime at very low dose and slowly titrate up. Careful with frail elderly (risk of syncope and falls).

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14
Q

Alpha-blockers are not first-line choice except for males with both

A

HTN and BPH

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15
Q

ACEIs and ARBs are contraindicated in

A

pregnancy, renal artery stenosis, angioedema, hyperkalemia (>5.5 mmol/L), and hypersensitivity to the drug.

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16
Q

ACEIs and ARBs protect the kidneys and are preferred drugs for treatment of

A

hypertension in diabetics and patients with mild-to-moderate CKD. But if severe CKD (eGFR <60), avoid these drugs because of higher risk of hyperkalemia.

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17
Q

ACEIs are first-line therapy for

A

HF with left ventricular dysfunction (or HFrEF).

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18
Q

Captopril is associated with

A

agranulocytosis, neutropenia, and leukopenia (rare). Monitor complete blood count (CBC).

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19
Q

Both ACEIs and ARBs are excreted in

A

breastmilk and pregnant mothers should avoid

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20
Q

ACEI-induced cough and angioedema are caused by

A

inhibition of the metabolism of bradykinin and kallikrein system, which are involved in the inflammatory process.

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21
Q

Some patients are at higher risk of AKI and hyperkalemia (elderly, patients with renal artery stenosis, diabetics). Check kidney function

A

3 - 5 days after starting drug

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22
Q

Avoid using diltiazem and verapamil (nondihydropyridine CCBs) in patients

A

HFrEF (can worsen it).

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23
Q

Pedal edema may occur with _________ because of vasodilation. If it bothers patient, reduce dose or take it later in the day. The pedal edema is positional and improves when laying down.

A

nifedipine and amlodipine

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24
Q

Dihydropyridine CCBs can cause

A

peripheral edema, HA, flushing and Lightheadedness

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25
Q

Nondihydropyridine CCBs can worsen

A

cardiac output and cause bradycardia and constipation in elderly

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26
Q

what are the main sx of main symptoms of CCB poisoning.

A

hypotension and bradycardia

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27
Q

Do not use oral ——– for mild acne (open/close comedones). Start with OTC topicals such as salicylic acid (Noxzema, Stridex) and benzoyl peroxide.

A

tetracycline

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28
Q

For mild acne not responding to OTC drugs, try prescription topicals

A

(benzoyl peroxide and erythromycin [Benzamycin]), tretinoin (Retin-A), or azelaic acid cream.

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29
Q

another tetracycline option is

A

minocycline

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30
Q

Minocycline side effects are

A

vertigo can resolve in 1 - 2 days after stopping meds

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31
Q

tetracyclines are best to take how

A

on empty stomach

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32
Q

erythromyocin side effects are

A

GI -n/v, diarrhea, abdominal pain

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33
Q

what is the most tolerated macrolide and rare GI side effects

A

azithromycin

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34
Q

May prolong INR and increase risk of bleeding if warfarin is mixed with

A

erythormyocin or clarithromycin

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35
Q

first-line treatment for gonorrheal infections.

A

Ceftriaxone (rocephin) 500 mg IM

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36
Q

MRSA skin infections (boils, abscesses): Do not use cephalosporins. First-line therapy is

A

trimethoprim–sulfamethoxazole (Bactrim DS) or clindamycin. Treat for at least 5 to 10 days.

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37
Q

Patients who have a true allergy to penicillin (history of anaphylaxis, angioedema) are more likely to have an allergic reaction to

A

cephalosporins

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38
Q

Patients who have a true allergy to penicillin (history of anaphylaxis, angioedema) are more likely to have an allergic reaction to

A

1 IgE-mediated reactions.

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39
Q

do not use amoxicillin with what disease b/c causes generalized rash

A

amoxicillin, ampicillin rash

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40
Q

Dicloxacillin is for

A

PCN staph like Mastitis and impetigo

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41
Q

is a serious complication of quinolone therapy, and patients who are on steroids or >60 years are at higher risk.

A

achilles tendon rupture

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42
Q

Do not use quinolones in children (<18 years) or women who are pregnant or breastfeeding because of adverse effects on

A

growing cartilage

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43
Q

If a patient on quinolone reports a new onset of difficulty in walking, order

A

an ultrasound to rule out Achilles tendon rupture or peripheral neuropathy and discontinue the medicine.

44
Q

Bioterrorism-related inhalation of anthrax spores (postexposure prophylaxis) is treated with

A

ciprofloxacin 500 mg every 12 hours × 60 days (treat within 48 hours). In addition, a three-dose series of anthrax vaccine is recommended

45
Q

Cutaneous anthrax is treated with

A

ciprofloxacin 500 mg twice a day × 7 to 10 days.

46
Q

Traveler’s diarrhea is treated wit

A

Cipro 750 mg (single dose) or 500 mg twice a day × 3 days.

47
Q

Ciprofloxacin has the best activity against

A

Pseudomonas aeruginosa (gram negative) and is the first-line drug for treating pseudomonal pneumonia for patients with cystic fibrosis.

48
Q

For athletes or very physically active patients, if fluoroquinolone is needed, advise to reduce their training volume and intensity to reduce risk of Achilles tendon injury. Wait

A

2 to 4 weeks to resume activity

49
Q

Patients with a UTI who are on warfarin (Coumadin) should not be given

A

Bactrim increases risk of bleeing monitor INR

50
Q

Pregnant women (or suspected pregnancy) with a UTI can be treated with

A

beta-lactams, nitrofurantoin, and fosfomycin.

51
Q

If the patient (≥18 years) is allergic to macrolides, an alternative is

A

doxycycline PO twice a day or new-generation quinolones (Levaquin, Avelox).

52
Q

Capsaicin cream can be used to treat pain in

A

trigeminal neuralgia and PHN

53
Q

max number of days that ketorolac (toradol 0 can be used is

A

5 days

54
Q

Max dose of acetaminophen (tylenol

A

3 - 4 g daily

55
Q

A severe case of poison ivy or poison oak rash may require — to — days of an oral steroid to clear.

A

14 to 21

56
Q

Maximum number of refills for Schedule III to V drugs is

A

five refills

57
Q

schedule 2 drugs have how many refills

A

none)

58
Q

echinachea does what

A

shortens cold duration

59
Q

feverfew and butterbur use

A

migraines

60
Q

Gingko is for

A

dementia

61
Q

isoflavones

A

estrogen

62
Q

saw palmetto

A

BPH

63
Q

Kava kava, valerian root

A

anxiety and insomnia

64
Q

St Johns wort

A

depression

65
Q

Turmeric

A

alzheimers, arthritis

66
Q

what abx is used for lung infections with comorbidities
no comorbidities

A

fluroqueinolones

marcrolide -azithromyocin or clarithromycin

67
Q

what med do we give for pertussis

A

macrolide -
Azithromycin (Z-pack)
* Erythromycin
* Clarithromycin

68
Q

Strep pharyngitis treatment

A

PCN

69
Q

Acute rhinosinusitis:

A

wait 10 days, then Amoxicillin or
Augmentin.

70
Q

Metformin

A

SE: diarrhea, nausea/vomiting
* WARNINGS:
* Do not use with renal disease, hepatic acidosis, alcoholics.
* Monitor renal function.
* Treatments (in order):
1. Lifestyle modification. Weight loss. Try for 3-6 months.
2. Start metformin 500mg-2,000mg/24hr.
3. Sulfonylurea (Glucotrol) or other oral.
4. Insulin.

71
Q

Insulins

A

Rapid acting: covers 1 meal at a time. (lispro, asparat or glulisine)
* Short acting: from meal to meal. (regular)
* Intermediate: from breakfast to dinner. NPH
* Long acting: once a day. Glargline

72
Q

Graves disease treat with

A

Propylthiouracil (PTU) and
methimazole (Tapazole).

73
Q

Hashimoto

A

levothyroxine

74
Q

Aces and ARBS

A

ACEIs “…prils” (benazepril, enalapril, lisinopril)
* & ARBs “…sartan” (losartan, valsartan)
* Blocks conversion of angiotensin I to II.
* DM and CKD drugs of choice.
* WARNING: category C.
* SE: dry cough, hyperkalemia, angioedema.
* Contraindicated: kidney disease (mod to severe), hyperkalemia.
* Ramipril, Benazepril, Enalapril.

75
Q

Beta blockers

A

Beta Blockers “…olol”
* WARNING: wean slowly with chronic use. May cause
rebound HTN.
* Contraindicated: asthma, COPD, chronic bronchitis, emphysema.
* Other uses: decrease mortality during acute MI, post MI, migraine HA, decrease IOP in glaucoma, angina pectoris.
* Metoprolol, atenolol, propranolol.
* Propranolol is also used for fine tremors.

76
Q

Calcium Channel Blockers “…pine”

A

Systemic vasodilator.
* Treatment for Raynaud’s.
* Blocks voltage-gated calcium channels in cardiac smooth muscle and blood vessels.
* SE: HA (due to vasodilation), ankle edema.
* Contraindication: CHF.
* Nifedipine, amlodipine, verapamil, diltiazem.

77
Q

Hydrochlorothiazide (HTZ)

A

Diuretic
* It can treat high blood pressure and fluid retention.
* ⬆urine output,⬇blood volume,⬇venous pressure,⬇preload.
* Favorable effects for osteopenia and osteoporosis.
* Favorable for women in menopause (demineralization).
* Monitor lipid profile.
* WARNING: can worsen
* Hyperglycemia
* Hyperuricemia (don’t use in gout)
* High triglycerides
* High cholesterol

78
Q

Preferred 1st line drug to tx HTN in DM and pts. with mild to moderate renal disease:

A

Aces and ARBS

79
Q

Alpha-1 blockers/antagonists “…zosin”

A

Potent vasodilators.
* SE: dizziness, hypotension.
* Take at bedtime.
* Terazosin, Doxazosin, Tamsulosin (Flomax) for BPH

80
Q

Common side effects

A

Cough + angioedema ➡ ACEIs
* Swollen ankle, HA ➡ CCB
* Hyperuricemia, hyperglycemia ➡ TZD
* Fatigue, depression ➡ BB

81
Q

Dog bites treat with

A

augmentin for 10 days

82
Q

Imeptigo give

A

mupirocin

83
Q

RMSF treat with

A

Doxy

84
Q

Purulent cellulitis tx

A

BCD
Bactrim, clindammycin, doxy

85
Q

non purulent cellulitis tx

A

keflex (cephalexin)

86
Q

folliculits tx

A

bactroban

87
Q

Erysipelas (strep infection):

A

PCN or macrolide

88
Q

Otitis media tx

A

amoxicillon if allergic augmentin

89
Q

Otitis externa tx

A

quinolones (cipro)

90
Q

Pneumonia tx

A

amoxicillin 90

91
Q

Meds safe in pregnancy:

A

PCN, metformin, cephalosporins, Tylenol, prednisone, insulin.

92
Q

Meds NOT safe in pregnancy:

A

chemo, phenytoin (antiepileptic), tetracyclines, fluoxetine
(Prozac), paroxetine (Paxil).

93
Q

Every pregnancy gets a Tdap @

A

3rd trimester (27-36 wks.).

94
Q

Bupropion (Wellbutrin)

A

Antidepressant and smoking cessation aid.
* No potential for abuse
* Energizing, used to ⬆ libido.
* Don’t use in bulimia (risk for seizures). It is excreted through the kidneys. Risk of toxicity due to recurrent dehydration and electrolyte disturbance.

95
Q

Osteoarthritis

A

1st line tx: exercise, weight loss, ice packs, acetaminophen.
* 2nd line tx: NSAIDS. Short term. 2-4 weeks trial with max dose.
* If no relief, refer for steroid injections

96
Q
A
97
Q

UTI: >100,000 CFU/ml

A

Uncomplicated: 3-day, trimethoprim-sulfa (Bactrim), nitrofurantoin.
* Complicated: cipro
* Pyridium used to relieve symptoms changes urine to orange.

98
Q

INr

A

Desired range 2-3.
* INR ⬆: blood cots more slowly than desired. Risk for bleeding.
* INR ⬇: blood clots more quickly than desired. Risk for blood clots.
* Warfarin/Coumadin: vitamin K antagonists: works against the clotting process. (anticoagulant)
* Warfarin interacts with “G” herbs: garlic, ginger, gingko, ginseng & fish oil.
* Discontinue anticoagulation therapy 7 days before invasive procedure.
*Initial treatment is usually 3 months, but it may vary depending on patient.
*Initial daily dose is 5mg, for frail elderly start at 2.5mg.

99
Q

Spironolactone induces

A

gynecomastia by decreasing testosterone production, increasing peripheral conversion of testosterone to estradiol, and displacing estradiol from sex hormone-binding globulin.

100
Q

Misc

A

Never give Doxy <7 years of age.
* With the elderly start low and slow.
* Statins (Lipitor, Crestor) don’t ever mix with grapefruit juice.
* 1ST line tx strep throat: penicillin. If allergic, Macrolide.
* Gout: NSAIDS Indocin, colchicine for flare up. Allopurinol for long term management.
* Only two methods of contraception that do not contain hormones are condoms and copper T.
* Bisphosphonates: warning with erosive esophagitis, abdominal pain.
* Take alone, in the AM, full glass water, stay up right 30min post taking it.

101
Q

Bacterial vaginosis tx;

A

Metronidazole.

102
Q

Candida Vaginitis tx:

A

Metronidazole, Diflucan.

103
Q

Trichomonas tx

A

Metronidazole *tx partner too.

104
Q

Chlamydia tx:

A

Doxy or Azithromycin *tx partner too.

105
Q

Sexual health

A

Gonorrhea tx: Ceftriaxone 500mg IM x 1.
* Syphilis tx: Penicillin.
* Condyloma Acuminata tx: (genital warts, HPV) Condylox, Imiquimod.

** A Rowe Final - all (5 decks)

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