Pharmacology

Question 0

What is teraparatide?

Answer 0

Very expensive subQ drug for severe osteoporosis, for pts who have failed bisphosphonate tx, or for pts with multiple risk factors for osteoporosis.

Contraindicated in pts with h/o bone malignancy, paget dz, hypercalcemia or h/o skeletal radiation.

Question 1

What drugs may cause drug-induced lupus pleuritis?

Answer 1

Hydralazine, procainamide, quinidine, amiodarone, bleomycin, bromocriptine, cyclophosphamide, methotrexate, minoxidil, and mitomycin

Question 2

What are the drugs of choice for altitude sickness?

Answer 2

Acetazolamide is the first choice, and it should be started at least one day before the ascent and continued until the patient is acclimatized to the highest planned elevation. If the patient is unable to take it for any reason, including sulfa allergy, dexamethasone is a good alternative.

Question 3

What drugs most commonly cause interstitial nephritis?

Answer 3

Antibiotics, especially penicillins, cephalosporins and sulfonamides and allopurinol.

Question 4

What herbal treatment has been shown to be helpful for varicose veins?

Answer 4

Horse chestnut seed extract

Question 5

What class of drugs should be avoided in patients with chronic kidney disease, or in patients who are at risk for chronic kidney disease because of conditions such as hypertension and diabetes?

Answer 5

NSAIDs

Question 6

What side effects are associated with long-term use of omeprazole?

Answer 6

Increased risk of community acquired pneumonia and Clostridium difficile colitis. It acutely decreases the absorption of vitamin B12 and it decreases calcium absorption leading to an increased risk of hip fracture.

Question 7

What drug that is commonly prescribed for tuberculosis may cause blurred vision?

Answer 7

Ethambutol
It may cause optic neuritis, manifesting as decreased visual acuity, central scotomas, or red green color blindness. Discontinuation of the drug can lead to restoration of sight.

Question 8

What medications may cause serotonin syndrome?

Answer 8

Antidepressants including SSRIs, SNRIs, tricyclic antidepressants, and MAOIs. In addition several opioids including meperidine tramadol methadone and fentanyl can cause it, as well as the antibiotic linezolid

Question 9

What are the features of serotonin syndrome, and what drugs are likely to cause it?

Answer 9

The features of serotonin syndrome include mental status changes, agitation, myoclonus, hyperreflexia, diaphoresis, shivering, tremor, diarrhea, incoordination, and fever. It can be precipitated in patients who are taking an SSRI with a drug that increases serotonin concentrations. These drugs include mono amine oxidase inhibitors, tramadol, sibutramine, meperidine, sumatriptan, lithium, St. John’s wort, ginkgo biloba, and atypical antipsychotic agents.

Question 10

Which flouroquinolone is not indicated for treatment of a urinary tract infection?

Answer 10

Moxifloxacin, because it obtains inadequate urinary concentrations.

Question 11

What medications may cause galactorrhea?

Answer 11

Oral contraceptives especially those containing estrogen, metoclopramide, cimetidine, risperidone, methyldopa, codeine, morphine, verapamil, SSRIs, butyrophenone’s, dopamine receptor blockers, tricyclics, phenothiazines and thioxanthenes.

Question 12

What medications can inhibit renal tubular excretion and falsely elevated serum creatinine level?

Answer 12

Trimethoprim, sulfamethoxazole, and cimetidine.

Question 13

What psychiatric medications are considered safe during pregnancy? What psychiatric medications are not considered safe during pregnancy?

Answer 13

Safe: SSRIs are generally considered safe in pregnancy except for paroxitine which is category D. There is concerned about increased risk of congenital cardiac malformations from first trimester exposure to paroxitine.

Not safe: lithium is known to be teratogenic. Benzodiazepines are controversial due to a possible link to cleft lip and palate. Bupropion may be linked to an increased risk of spontaneous abortion. Paroxitine may cause an increased risk of congenital cardiac malformations if used in the first trimester.

Question 14

What is alendronate?

Answer 14

Trade names are Binosto and Fosamax. It is an oral bisphosphonate that is effective for decreasing both vertebral and hip fractures.

Question 15

What is risendronate?

Answer 15

Trade names are Actonel and Actelvia. An oral bisphosphonate that decreases both vertebral and hip fractures.

Question 16

What is ibandronate?

Answer 16

Trade name is Boniva. It is a bisphosphonate that is given orally once monthly or IV every three months. It has been shown to be effective only for the prevention of vertebral fractures

Question 17

What is zoledronic acid?

Answer 17

It’s tradename is Reclast or Zometa. It is a bisphosphonate derivative that is given IV once per year. It is effective in preventing both vertebral and hip fractures.

Question 18

What is denosab?

Answer 18

Trade name is Prolia or Xgeva. It is a monoclonal antibody that decreases genesis of osteoclasts. It is effective in preventing both vertebral and hip fractures. it is given as a subcutaneous injection.

Question 19

What is teriparatide?

Answer 19

It’s brand name is Forteo. It is recombinant human parathyroid hormone. It is administered subcutaneously once daily. It has been shown to reduce vertebral fractures in osteoporosis, but not hip fractures. Its use is not approved for longer than two years.

Question 20

Of the common herbal supplements which interacts with the most drugs?

Answer 20

St. John’s wort interacts with the most drugs, including statins, warfarin and antidepressants. Note that ginkgo biloba and ginseng may also interact with warfarin.

Question 22

What complementary/alternative therapies have been shown to reduce PMS symptoms?

Answer 22

Vitamin B6 or pyroxidine, and chasteberry.

Question 23

Which drug commonly prescribed for smoking cessation is most likely to cause weight gain?

Answer 23

Chantix or verenicline.

Question 24

Cilostazol (Pletal) should not be given to what patients?

Answer 24

There is a black box warning for patients with CHF.

Question 25

What are the non-dihydropyridine calcium channel blockers? What are their contraindications?

Answer 25

Verapamil and diltiazem. They can diminish cardiac contractility and slow cardiac conduction. As a result these drugs are relatively contraindicated in patients who are taking beta blockers, who have severe left ventricular systolic dysfunction, sick sinus syndrome, or second or third degree AV block.

Question 26

Describe the interaction between Alpha blockers and PDE – 5 inhibitors. What does this mean in terms of how they should be used?

Answer 26

Alpha-2 blockers, including Flomax, should be used with caution in combination with PDE-5 inhibitors because they may trigger hypotension. In a patient already on an alpha-2 blocker, the PDE-5 inhibitor should be started at the lowest possible dose.

Question 27

What is the goal of therapy in hypertensive emergency?

Answer 27

To lower MAP by approximately 25%, or to reduce DBP to 100 to 110 mm over several minutes to several hours.

Question 28

African-American patients with hypertension exhibit somewhat reduced blood pressure responses to monotherapy with what drugs?

Answer 28

ACE’s, ARBs, and beta blockers when compared with diuretics or CCBs.

Question 29

What percentage of increasing creatinine levels in a patient just started on ACE represents a hemodynamic change and not a structural change? What should be done in these cases?

Answer 29

Up to 20 to 30% increase in creatinine, as long as it stabilizes. This actually indicates that intraglomerular pressure has been reduced. The ACE or ARB in question should be continued.

Question 30

Thiazide diuretics increase excretion of what substances and decrease excretion of what substances?

Answer 30

Increase excretion of potassium and magnesium. Reduce excretion of calcium, uric acid and lithium.

Question 31

What two antipsychotics are less likely to worsen symptoms of Parkinson’s than the others?

Answer 31

Clozapine and quetiapine