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NAPLEX BABY > Pharmacy Foundations 2 > Flashcards

Pharmacy Foundations 2 Flashcards

1
Q

Root Cause Analysis (RCA)

A

-a retrospective investigation of an event that has already occurred. The information obtained in the analysis is used to design changes that will hopefully prevent future errors

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2
Q

At risk behaviors that can compromise patient safety: Drug and Patient - Related

A

-failure to check/reconcile home medications and doses
-dispensing medications without complete knowledge of the medication
-not questioning unusual doses
-not checking/verifying allergies

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3
Q

At risk behaviors that can compromise patient safety: Communication

A

-not addressing questions/concerns
-rushed communication

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4
Q

At risk behaviors that can compromise patient safety: Technology

A

-overriding computer alerts without proper consideration
-not using available technology

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5
Q

At risk behaviors that can compromise patient safety: Work environment

A

-trying to do multiple things vs focusing on a single complex task
-inadequate supervision of orientation/training

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6
Q

The Joint Commission

A

Independent, not for profit organization that accredits and certifies hospitals –> main focus = safety

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7
Q

TJC: National Patient Safety Goals

A

-label all medication on and off the sterile field
-reduce hard associated with anticoagulant therapy (bleeding risk)
-maintain and communicate accurate patient medical information
-report critical results (labs and diagnostic) on a timely basis
-comply with CDC hand hygiene guidelines
-reduce health-care associated infections

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8
Q

avoid “do not use” abbreviations

A

-U, u –> write units
-IU –> write international units.
-QD,qd, QOD,qod –> write daily or every other day
-trailing zero: X mg or 0.X mg
-MS,MO4 –> write morphine sulfate, magnesium sulfate

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9
Q

High alert medications

A

-anesthetics (propofol)
-antiarrhythmics (amiodarone)
-Anticoagulants/antithrombotics (heparin, warfarin)
-Chemo (methotrexate)
-Epidural/intrathecal
-hypertonic saline
-Immunosuppressants (cyclosporin)
-Ionotropics (digoxin)
-Insulins
-Magnesium sulfate
-Neuromuscular blocking agents (vecuronium)
-opioids
-oral hypoglycemics
-parenteral nutrition
-potassium chloride
-sterile water

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10
Q

what kind of pts have contact precautions?

A

–> intended to prevent transmission of infectious agents which are spread by direct and indirect contact with the patient and the patients environment
-MRSA
-VRE
-C. diff

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11
Q

Universal precautions to prevent droplet transmission

A

-B pertussis
-influenza
-RSV
-adenovirus
-rhinovirus
-N. meningitides
-group A strep

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12
Q

Airborne precautions

A

-isolation room
-KN95 mask

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13
Q

Safe injection practices for healthcare facilities

A

-never administer an oral solution/suspension IV, use oral syringes
-never reinsert used needles into a multiple dose vial or solution container, single dose vials are preferred over multiple dose vials
-use engineered sharp protection needles, drawing the needle into the syringe barrel after use
-never touch the tip or plunger os syringe
-throw the entire needle/syringe assembly (needle attached to the syringe) into the red plastic sharps container

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14
Q

Type A reactions

A

-most ADRs
-dose-dependent and are predictable based on the drugs pharmacology

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15
Q

Type B reactions

A

idiosyntric- not predictable from drugs pharmacology (hard to predict and bad)
-can be influenced by patient specific factors

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16
Q

Type 1 hypersensitivity reaction

A

Immediate (within 15-30 mins of drug exposure).
-severity ranges from minor inconvenience to death :)

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17
Q

Type 2 hypersensitivity reaction

A

-minutes to hours after drug exposure
-hemolytic anemia and thrombocytopenia

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18
Q

Type 3 hypersensitivity reactions

A

-immune complex reactions
-they occur 3-10 hours after drug exposure
ex) drug induced lupus and serum sickness

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19
Q

Type 4 hypersensitivity reactions

A

-delayed reactions, they can occur anywhere from 48hrs to several weeks after drug exposure.
ex: PPD skin test

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20
Q

iPLEDGE program

A

progran for isotretinoin, requires a monthly pregnancy test
-get 30 ds at a time

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21
Q

Where are drugs and vaccine adverse events reported to?

A

-FAERS (FDA adverse event reporting system)
-VAERS (Vaccine adverse event reporting system)

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22
Q

Allergies

A

due to immune system response and can affect multiple areas (bronchoconstruction and severe drop in BP from taking codeine)

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23
Q

Intolerence

A

less severe complaints, such as nausea or constipation. Since the drug bothers the patient, it should be avoided if possible

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24
Q

Histamine release & tx

A

Urticaria: erythematous swelling of the skin, with prutitis (itching)
Angioedema: swellings caused by edema in the deeper dermal, cutaneous and sub-mucosal tissue

–> Prutitus & hives only?
OTC: diphenhydramine
RX: hydroxyzine

–> more than that?
-get airway open with epinephrine
-reduce swelling with steroids
-give antihistamine

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25
Q

Photosensitivity & Type -IV Hypersensitivity (delayed)

A

P: sunlight + drug = severe sunburn on sun-exposed areas
T IV: sunlight + drug = red, itchy rash that can spread to areas that were not exposed to sun; occurs within days of the sun exposure

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26
Q

Drugs most associated with photosensitivity

A

-Aminodarone
-Diuretics (thiazide and loop)
-Methotrexate
-Oral and topical retinoids
-Quinolones
-St. John’s wort
-Sulfa drugs
-Tacrolimus
-Tetracyclines
-Voriconazole

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27
Q

Photosensitivity protection/counseling points

A

-stay out of the sun 10am-4pm, including on cloudy days
-wear sun-protective clothing
-recommend ~SPF 30, broad spectrum (UVA-aging and UVB-burning)
-apply liberally and at least Q2 hrs and reapply after swimming or sweating
-keep infants out of the sun

SPF calculation =
take the usual time the person would burn and multiply by SPF –> 20 SPF x 15 min = 300 min –> BUT reapply q 2 hrs

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28
Q

Different types of spots & rashes

A

-Papules: raised spots
-Macules: flat spots
-Purpura: red/purple skin spots (lesions) due to bleeding underneath the skin
–> Petechiae: smaller lesions, < 3 mm
–> Ecchymoses: larger lesions, > 5 mm
-Hematoma: due to trauma; a collection of blood under the skin, visible or not

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29
Q

Thrombotic Thrombocytopenia Purpura (TTP)

A

-a blood clotting disorder in which clots form throughout the body, the clotting process consumes platelets and leads to bleeding under the skin with purpura
–> TTP can be fatal and should be treated immediately with plasma exchange

*KEY drugs associated: clopidogrel, ticlopidine, acyclovir, famiciclovir, quinine, sulfamethoxozole, valcyclovir

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30
Q

Key drugs associated with severe skin reactions

A

-allopurinol
-lamotrigine
-penicillins
-phenytoin
-piroxicam
-sulfamethoxazole

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31
Q

Key drugs associated with SJS/TEN

A

-Abacavir
-Carbamazepine
-Caspofungin
-Clindamycin
-Clopidogrel
-Deferasinox
-Ethosuximide
-Fosphenytoin
-Hydroxychloroquine
-Isavucinazonium
-Letrozole
-Minocycline
-Nevirapine
-Oseltamivir
-Oxacarbazepine
-Peramivir
-Phenobarbital
-quinine
-Terbinafine
-Tiagabine

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32
Q

Drugs associated with DRESS

A

-Carbamazepine
-Celecoxib
-Doxycycline
-Ethosuximide
-Fosphenytoin
-Gabapentin
-Ibuprofen
-Lacosamide
-Minocycline
-Olanzapine
-Oxacarbozempine
-Sulfasalazine
-Terbinafine
-Valpraote
-Vancomycin

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33
Q

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TENS)

A

S&S: 1-3 weeks after start of the offending drug, symptoms develop: malaise, fever, headache, cough and keratoconjunctivitis
-macules then appear suddenly, usually on the face,neck and upper trunk and then spread elsewhere on the body, coalescing inot large flaccid bullae and slough over a period of 1-3 days

TX: supportive care, cyclosporine, plasma exchange or IVIG and steroids

SJS rash: < 10%
TENS rash: > 30%

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34
Q

Erythema Multiforme (ME)

A

–> causes: herpes simplex virus, hep C, SLE, drugs
-morbilliform rash (looks like measles), with 1-20 mm lesions - in between the lesions is healthy skin

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35
Q

Drug classes that are likely to cause drug allergies

A

–>beta lactam: penicillin’s
–> sulfa allergies: sulfamethoxazole
–> opioids, heparin, biologics
–> ASA/NSAIDs = breathing difficulty

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36
Q

Drugs likely to cause allergic reaction with peanut/soy allergy

A

-Clevidipine (Cleviprex)
-Propofol (Diprivan)
-Progesterone in Prometrium capsules

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37
Q

Drugs likely to cause allergy with egg allergy

A

-Clevidine (Cleviprex)
-Propofol (Diprivan)
-Influenza vaccine, ok if only hives but with severe allergies: use FLBLOK
-yellow fever

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38
Q

Penicillin skin testing

A

-skin test to identify pts who are at greatest risk of a type 1 hypersentitivity reaction if exposed to a systemic penicillin
-can also be used to desensitize pts who need to have tx for sephalysis

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39
Q

Calculating Bioavailability

A

F = 100 * (AUC ex/ AUC IV) * (Dose IV/ Dose EX)

AUC- represents total drug exposure

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40
Q

Properties of drug molecules and their effects on drug distribution

A

-lipophilicity (affinity for lipids) - increased
-molecular weight - small weight is better
-ionization status - uncharged
-protein binding - low = more free drug in blood

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41
Q

formula for corrected calcium

A

calcium (reported/serum) + [ (4.o - albumin) * 0.8]

*use when pt has low albumin

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42
Q

formula for corrected phenytoin

A

total phenytoin measured / (0.2 * albumin) + 0.1

*use when pt has low albumin

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43
Q

Volume of distribution (Vd)

A

-relates amount of drug un the body to the concentration measured in serum or plasma

Vd = amount of drug in body / concentration of drug in plasma

–> small Vd = confined to plasma or extracellular space
–> large Vd = wide distribution to all body tissues

44
Q

Clearance equations

A

cl = rate of elimination / concentration

cl = f* x dose - AUC

*for IV, use F = 1

45
Q

first order elimination

A

(most drugs)
-constant PERCENT of drug is removed per unit of time-

46
Q

zero order elimination

A

-constant amount of drug is removed per unit of time - MG STAYS THE SAME

47
Q

Michaelis- Menten Kinetics

A

-also called saturable or non-linear kinetics
-there is a maximal rate of metabolism (Vmax)
-MM constatnt (Km) is the concentration at 1/2 Vmax
-inc dose leads to a disproportionate inc in concentration

–> can lead to toxicity
–> phenytoin, theophylline and voriconazole

48
Q

Michaelis-Menten Kinetics study tip girl*

A

-most drugs follow first order (linear) kinetics:
–> at steady state, doubling the dose ~ doubles the serum concentration

-some drugs (phenytoin (dose adjustments should be made within the 30-50 mg range), theophyline and voriconazole) follow MM kinetics:
–> using a proportion to calculate a new dose is not appropriate
–> dosing adjustments must be made cautiously to avoid toxicity

49
Q

Elimination rate constant (Ke)

A

-the fraction of the drug eliminated (cleared) per unit of time

ke = CL/Vd

50
Q

Half life and steady state

A

-half life can be used to estimate % of. drug remaining or % of steady-state achieved
–> > 95% of drug is eliminated after 5 half lives
–> 95% of steady state will be achieved after 5 half lives

t1/2 = 0.693/Ke

51
Q

Loading dose

A

-necessary for some drugs to rapidly achieve therapeutic concentrations
-helpful when 1/2 life is long relative to the frequency of admin

LD = desired concentration * Vd / F

52
Q

Required/strongly recommended genomic testing

A

-abacavir (Ziagen) and combination products (Triumeq) - HLAB5701
-Azathioprine - TPMT
-Carbamazepine (Tegretol) - HLAB*1502
-Cetuximab (Erbitux) and panitumumab (Vectibix) - KRAS (want -)
-Trastuzumab (Herceptin), ado-trastuzumab emtansine (Kadcyla), lapatinib (Tykerb) and pertuzumab (Perjeta) - HER2 (want +)

53
Q

Genetic test drugs results and what to do

A

avoid the drug when these pharmacogenomic tests are POSITIVE:
–> HLA-B: a positive test indicates inc risk of hypersensitivity
–> KRAS mutation: a positive test (often called KRAS mutant) predicts a poor response

avoid the drug when this pharmacogeenomic test is NEGATIVE:
–> HER2 expression: a negative result indicates a poor response

54
Q

Interactions with prescription drugs: The 5 Gs

A

-Ginkgo
-Garlic
-Ginger
-Glucosamine
-Ginseng
(others = fish oil, vitmain E, willow bark)

dec platelet aggregation and inc bleeding risk

55
Q

Interactions with prescription drugs: St. John’s wort

A

1) Borad spectrum enzyme inducer (CYP 3A4, 2C19, 2C9, 1A2) –> dec drug levels
-oral contraceptives: increases risk of ovulation and breakthrough bleeding
-transplant drugs: drug failure, organ rejection
-warfarin

2) serotonin syndrome: MAOI, SSRI/SRI, triptans (neuromuscular excitation, AMS, autonomic dysfunction)
3) photosensitivity
4) lowers seizure threshold

56
Q

Dietary supp that induce liver toxicity

A

-kava
-chaparral
-comfrey

57
Q

Dietary supps that induce cardiac toxicity

A

-Ephedra- removed from market
replaced by: bitter orange (synephrine) - reports of cardiac toxicity
-weight loss supplements
-pre-workout
-attention or focus supps

58
Q

Commonly used natural medicine: anxiety

A

-valerian
-passoinflower
-kava
-st johns wort

59
Q

Commonly used natural medicine: ADHD

A

omega -3 fatty acids

60
Q

Commonly used natural medicine: cold sores

A

l lysine

61
Q

Commonly used natural medicine: cold & flu

A

-echinacea
-zinc
-vitamin C

62
Q

Commonly used natural medicine: dementia/memory

A

-ginko
-vitamin E

63
Q

Commonly used natural medicine: depression

A

-st johns wort
-SAMe
-valerian
-5-HTP
-l tryptophan

64
Q

Commonly used natural medicine: diabetes

A

-alpha lipoic acid
-chromium
-cinnamon
-bitter melon
-genseng

65
Q

Commonly used natural medicine: hyperlipidemia

A

-fish oil
-garlic
-niacin
-fibers

66
Q

Commonly used natural medicine: dyspepsia

A

-calcium
-magnesium

67
Q

Commonly used natural medicine: energy/weight loss

A
  • bitter oranges
    -caffeine
    -guaranta
68
Q

Commonly used natural medicine:: erectile dysfunction

A
  • ginseng
    -l-arginine
    -yohimbe
69
Q

Commonly used natural medicine: HF

A

-co enzyme Q10
-hawthorn
-omega 3 fatty acids

70
Q

Commonly used natural medicine: HTN

A

-omega 3 fatty acid
-l arginine
-coenzyme Q
-garlic

71
Q

Commonly used natural medicine: GI health

A

-fibers
-chamomile
-probiotics
-peppermint

72
Q

Commonly used natural medicine: inflammation

A

-omega 3 fatty acid
-flax seeds
-tumeric

73
Q

Commonly used natural medicine: insomnia

A

-melatonin
-valerian
-chamomile

74
Q

Commonly used natural medicine: liver disease

A

milk thisle

75
Q

Commonly used natural medicine: menopause

A

-black cohosh
-dong qui
-primrose oil
-soy, red clover

76
Q

Commonly used natural medicine: migraine

A

-feverfew
-butterbur
-magnesium
-riboflavin

77
Q

Commonly used natural medicine: osteoarthritis

A

-glucosamine
-chondrotin
-SAMe
-tumeric

78
Q

Commonly used natural medicine: osteroprosis

A

-calcium
-vitamin D
-soy

79
Q

Iron need for children 4-6 months (breastfed)

A

need 1 mg/kg/day from 4-6 months old and until consuming iron rich foods

80
Q

drugs that cause nutrient depletion

A

-loop diuretics: potassium
-Orlistat: beta-carotene, fat soluble vitamins
-PPIs: magnesium, vitamin B12
-Valproic acid: calcium

81
Q

Conditions with recommended supplements

A

-alcoholism: vitamin B1/thiamine (wenickes), folate
-pregnancy: prenatal vitamin (calcium, folate)

82
Q

common symptomatic treatments of overdose

A

-agitation: sedatives (benzos)
-bradycardia: atroptine, inotropes
-seizure: benzos
-hypertension: IV vasodilator
-hypoglycemia: dextrose
-hypotension: IV fluids, vasopressors
-QRS widening: sodium bicarbonate
-sedation: protection of airway with intubation

83
Q

decontamination with activated charcoal

A

-non-absorbable adsorbent when indicated (within 1 hr of ingestion***)
-effective adsorbent of drugs/chemicals with a molecular weight of 100-1000 daltons

Dose = 1 g/kg

CI: hydrocarbon injection (gas) inc risk of aspiration,

84
Q

phases of acetaminophen overdose

A

phase 1: 1-24 hrs, asymptomatic or non-specific (N/V)
phase 2: 24-48 hrs, inc INR, and AST/ALT
phase 3: 48-96 hrs, fulinanat hepatic failure (irreversible injury/ death)
phase 4: > 96 hrs, recovery or liver transplant

85
Q

N-acetylcysteine tx

A

-Cetylev PO or IV Acetadote
-restores hepatic glutsthoine (acts as a glutathoine substrate)

Oral: 140 mg/kg x1, followed by 70 mg/kg every 4 hrs x 17 additional doses. repeat the dose if emesis occurs within 1 hr of admin

IV: 150 mg/kg IV over 60 mins, followed by 50 mg/kg IV over 4 hrs, followed by 100mg/kg IV over 16 hrs

86
Q

Initial management of suspected opioid overdose

A

-call 911 if pt is unconscious, having difficulty breathing, agitated, or is having a seizure
-ensure pts airway, breathing and circulation is meintained
-attempt to identify substance/s of OD:
–> opioid overdose can present as slowed breathing, pinpoint pupils, AMS, and/or unconsciousness
–> adminster naloxone if any potential for opioid overdose
–> Naloxone is not harmful if opioids are not present
–> when in dount, just give it

87
Q

Anticholinergic antidotes

A

ex: diphenhydramine, scopolamine, atropa belladonna (deadly nightshade)
–> antidote = physostigmine (only in severe cases)

Symptoms:
-hot as a hare (fever)
-dry as a bone (mucous mems)
-blind as a bat (large pupils)
-red as a beet (flushing)
-mad as a hatter (delirium)

88
Q

Organophosphate antidote

A

ex: industrial insecticides, nerse gases,
–> antidote: atropine and pralidoxime (DuoDote, ATNAA)

Symptoms: SLUDD
Salivation
Lacrimation
Urination
Diarrhea
Defecation

89
Q

Cardio med antidotes (digoxin, BBs, CCBs)

A

-Digoxin, plants contianing digitalis –> DigiFab

-BBs –> glucagon

-CCBs –> IV calcium

90
Q

Anticoagulants antidotes

A
  • Warfarin –> phytonadione (vit K), prothrombin complex concentrates (Kcentra)

-Heparin, LMWH –> protamine

-factor Xa inhibitors: Kcentra,
–> for apixaban and rivaroxaban: coagulant factor Xa recombinant (Adexxa)

-direct thrombin inhibitors: idarucizumab (Praxbind)

91
Q

Additional antidotes to know

A
  • bezos: flumazenil
    -cyanide: hydroxocobalamin
    -hydrocarbons: keep NPO
    -sulfonylureas: octreotide
    -Isoniazid: pyridoxine (B6)
    -Iron: deferoxamine
    -methotrexate: (leucovorin)
    -paralytics: neostigmine, suggamadexx (roc or vec)
    -salicylates: sodium bicarb
    -stimulants: supportive care
    -antifreeze: fomepizole
92
Q

rabies antidote

A

-virus transmitted through contanct with salivia or fluid from an infected animal

Antidote: human rabies immune globulin (HyperRAB S/A)
–> provides immediate antibodies - given at the same time as the rabies vaccine

93
Q

Snake bites

A

rattlesnakes and copperheads

antidote: crotalidae polyvalent immune Fab (CroFab)

94
Q

genetic testing for abavacir

A

-HLA-B*5701

+ ptd are at inc risk for a hypersensitivity reaction; test all pts prior to starting

95
Q

genetic testing for allopurinol (Zyloprim, Aloprim)

A

-HLA-B*5801

+ pts are at inc risk of SJS

96
Q

genetic testing for carbamezepine, oxacarbazepine, phenytoin, fosphenytoin

A

-HLA-B 1502
*ocarbazepine: required for all asian pts

+ pts at risk for SJS and TEN

97
Q

select drugs with CYP450 polymorphisms: Clopidogrel (Plavix)

A

CYP2C19

-pro drug, poor metabolizers are at inc risk of cardiovascular events

98
Q

select drugs with CYP450 polymorphisms: codeine

A

CYP2D6

-prodrug, ultra metabolizers are at inc risk of opioid overdose due to extensive conversion to morphine
–> infant deaths have occurred when nursing mothers who were ultra-rapid metabolizers took codeine for pain

99
Q

select drugs with CYP450 polymorphisms: Warfarin (Jantoven)

A

CYP2C9*2 and *3, VKORCL

-increased bleeding risk (start at a lower dose)

100
Q

Pharmacogenomic testing for: Trastuzumab (herceptin)

A

HER2 gene
-requires over expression of HER2 for efficacy

101
Q

Pharmacogenomic testing for: Cetumimab (Erbitux)

A

KRAS mutation

-do NOT use w/ KRAS mutation

102
Q

Pharmacogenomic testing for: Azathioprine (Azason, Imuran)

A

Thiopurine methyltransfrase (TPMT)

-low/absent TPMT activity can inc the risk of severe, life threatening myelosuppression

103
Q

Pharmacogenomic testing for: Capecitabine (Xeloda)

A

DPD deficiency

-deficiency can inc risk of severe toxicity

104
Q

genetic testing: what does a + or - test require action? *

A

AVOID these drugs when tests are POSITIVE:
–> HLA-B (inc risk of hypersensitivity)
–> KRAS mutation (predicts poor outcome)

AVOID these drugs when tests are NEGATIVE:
–> HER2: indicates a poor outcome

105
Q

Key drugs that genetic testing is required or strongly recommended*

A

-Abacavir & combo products
-Axathioprine
-Carbamazepine
-Cetuximab & other EGFR inhibitors
-Trastuzumab and other HER2 inhibitors

106
Q
A

NAPLEX BABY (23 decks)

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