Pharmacology

Question 1

Warfarin reversal

When?

How?

Answer 1

PO vitamin K (phytonidione) if > 10

Hemorrhage : IV vitamin K plus PCC

Question 2

Warfarin adverse effects

Answer 2

Bleeding

Purple toe syndrome

Warfarin induced skin necrosis

Teratogenic

Question 3

HIT type I

HIT type II

Answer 3

No clinical significance, transient decrease in platelets

Serious. Low plts while clotting

Question 4

Why lovenox DVT prophylaxis over heparin??

Answer 4

Safer

Less likely to bleed

Less thrombocytopenia

Question 5

When start statin for 10 yr calculated risk?

Answer 5

Greater than 7.5%

Question 6

What other than statins can cause myalgias??

Answer 6

Vitamin D deficiency

Thyroid disease

Question 7

What do you use if high high triglycerides?

Answer 7

Gemfibrozil –Careful use with statins!!!

Fenofibrates

Question 8

Low K, low mag, and bradycardia is perfect set up for what?

Answer 8

Torsades

Question 9

Amio problems

Answer 9

CYP concerns
QT prolongation
Cardiac toxicity 
Pulmonary toxicity - hypersensitivity or subacute cough w patchy interstitial infiltrates 
Recurrent sun exposure --> blue skin

Question 10

Digoxin toxicity

Answer 10

Nausea

PVCs

Yellow green blurred vision

Question 11

Loop diuretic works how?

Answer 11

Blocks Na/K exchange in ascending segment of loop of henle by inhibiting Na/k ATP-ase

Question 12

Thiazides work how?

Answer 12

Interferes with Na/K exchange in early distal convoluted tubule by inhibiting Na/k ATP-ase

Question 13

Side effects of diuretics?

Answer 13

Low K

Orthostatic hypotension

Question 14

How does spironolactone work?

Answer 14

Anti-aldosterone drug, not so much a diuretic actually

Question 15

Side effects of spironolactone ?

Answer 15

Hyperkalemia

Painful gynocomastia

Question 16

adverse effect of ACE-I

Answer 16

Cough
Hyperkalemia
Angioedema - bad

Question 17

Drugs for BPH

Answer 17

Alpha adrenergic blockers

Prazosin, terazosin, doxazosin

Cause postural hypotension

Question 18

Non beta1 selective beta blocker

Answer 18

Propranolol

Metoprolol

Atenolol

Question 19

Beta blocker that also has alpha1 blocking activity

Answer 19

Carvedilol

Question 20

What drugs cause gingival hyperplasia??

Answer 20

Calcium channel blockers

Phenytoin

Question 21

Amlodipine is what class?

Answer 21

Dihydropuridines

Question 22

Dihydropuridines have what MOA?

Answer 22

Vasodilation

Question 23

Inhaled corticosteroids like fluticasone can cause what adverse effect?

Answer 23

Increased risk of osteoporosis

Question 24

What is an adverse effect of anticholinergics??

Answer 24

Urinary retention and increase Intra-ocular pressure.

Use with caution in pts with glaucoma and BPH

Question 25

Short acting beta2 agonist

Answer 25

Albuterol

Question 26

Rescue inhaler in asthma

Answer 26

Albuterol

Question 27

Maintenance inhaler

Answer 27

Long acting beta2 agonist

Question 28

Long acting beta 2 agonist

Answer 28

Salmeterol Formoterol

Question 29

Rescue inhaler in COPD

Answer 29

Albuterol plus ipratropium

Question 30

Short acting inhaled anticholinergic

Answer 30

Ipratropium (used with albuterol)

Question 31

Long acting inhaled corticosteroid

Answer 31

Tiotropium

Question 32

NSAIDs not in pregnancy why?

Answer 32

Can close PDA early

Question 33

What h2 receptor blocker interacts with everything on the Cytochrome P450 list?

Answer 33

Cimetidine !

Question 34

DOC for Rheumatoid arthritis

Answer 34

Methotrexate Second : hydroxychloroquin Severe: TNF inhibitors

Question 35

Warfarin is metabolized by?

Answer 35

CY2C9

Question 36

Aspirin adverse effects

Answer 36

Dyspepsia Reye's syndrome Associated with: Sensorineural hearing loss (ringing) Bronchospasm in asthma pts Asthma, aspirin, and nasal polyps

Question 37

Long term use of PPIs can cause what? Now trying to reign in use

Answer 37

Anemia Fractures Associated with C. diff and infections

Question 38

Drug commonly used for migraine in the ER?

Answer 38

Phenergan

Question 39

What group avoid Phenergan with ?

Answer 39

Kids less than 2 Can cause respiratory suppression and death

Question 40

Post-op constipation only if really need it?

Answer 40

Reglan

Question 41

2x increased risk in congenital heart defects and cleft palat when use this in pregnancy

Answer 41

Ondansetron ! Category B but only use when really need it.

Question 42

First line for allergic rhinitis

Answer 42

Intranasal steroid

Question 43

Treatment of hyperthyroid

Answer 43

First: methimazole to calm down Then, radioactive iodide therapy Unless pregnant: than PTU (propylthiouracil)

Question 44

MOA of bisphosphinates

Answer 44

Drug binds bone -> osteoclasts begin to resorb bone impregnated with bisphosphinate which promotes apoptosis and this leads to reduced bone resorption

Question 45

ADRs of bisphosphinates Quit use after 5 yrs to avoid

Answer 45

Esophagitis or esophageal cancer - take on empty stomach and try to maximize absorption Osteonecrosis of the jaw Atypical femur fractures

Question 46

Priapism -- what do you think of?

Answer 46

Drugs | Sickle cell

Question 47

Migraine treatment

Answer 47

-Triptan Avoid in vasculopaths

Question 48

Alzheimer's treatment

Answer 48

Donepezil If benefit after 3 months continue, if not, discontinue

Question 49

Parkinson's first line

Answer 49

Levodopa + carbidopa

Question 50

When use phenytoin?

Answer 50

Rare now Maybe to prevent seizures in or with head trauma Nystagmus--> toxic and risk of death

Question 51

Carbamazepine adverse effect need to remember

Answer 51

Rash--SJS

Question 52

Valproate use

Answer 52

Mania Migraine prophylaxis

Question 53

Valproic acid adverse effect

Answer 53

Hepatotoxicity Teratogen - don't use in women of hold bearing age at all per FDA

Question 54

When use gabapentin

Answer 54

Restless legs Post-herpetic neuralgia

Question 55

When use lamotrigine?

Answer 55

Bipolar

Question 56

When use topiramate

Answer 56

Migraine prophylaxis

Question 57

SSRI

Answer 57

Fluoxetine and paroxetine Sertraline and citalopram