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TOP 300 drugs - NAPLEX > Pharmacy Foundations Part II > Flashcards

Pharmacy Foundations Part II Flashcards

1
Q

Errors of omission

A

Something was left out that is needed for safety (e.g. not using double-check systems)

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1
Q

“Medication Safety” definition

A

Freedom from preventable harm from medication use

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2
Q

Errors of commission

A

Something was done incorrectly (E.g. prescribing bupropion in someone with a hx of seizures)

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3
Q

Which committees in the hospitals should be informed of the error?

A

P&T
Medication Safety Committee

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4
Q

MERP

A

Medication Errors Reporting Program
Voluntary, confidential reporting program that provides recommendations as well

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5
Q

FMEA

A

Failure Mode and Effects Analysis
Proactive method to reduce the frequency & consequences of errors Screen potential effects of a new system

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6
Q

Examples of CQI programs

A

Lean
Sig Sigma (DMAIC: define, measure, analyze, improve, control)

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7
Q

Common types of hospital-acquired (nosocomial) infections

A

UTIs from indwelling catheters
Bloodstream infections from IV lines (Central lines = highest risk) & catheters
Surgical site infections
Hepatitis
Decubitus ulcers
Hepatitis
C. diff
VAP

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8
Q

When are airborne precautions recommended?

A

Varicella, TB, measles

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9
Q

ADRs: Type A

A

Predictable
Dose-dependent, based on pharmacologic properties
Most common

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10
Q

ADRs: Type B

A

NOT dose-dependent & not related to pharmacology of drug
Can be immediate or delayed

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11
Q

Examples of Type B reactions

A

Drug allergies
Drug hypersensitivity rxns (HLA genes, vanc infusion)
Idiosyncratic reactions (G6PD deficiency)

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12
Q

Drug allergy: Type 1 reactions

A

Immediate
IgE-mediate ranging from minor local rxns to severe systemic rxns (anaphylaxis)

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13
Q

Drug allergy: Type 2 reactions

A

Delayed
Antibody-mediated, usually occurring 5-8 days after exposure
Ex: hemolytic anemia, thrombocytopenia

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14
Q

Drug allergy: Type 3 reactions

A

Delayed
Immune complex reactions, occurring ≥1 week after exposure
Ex: serum sickness

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15
Q

Drug Allergy: Type 4 reactions

A

Delayed
T Cell-mediated occurring 48 hrs to weeks after exposure
Ex: SJS

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16
Q

Drugs most associated with photosensitivity

A

Amiodarone
Diuretics
MTX
Oral & topical retinoids
Quinolones
St Johns Wort
Sulfa drugs
Tacrolimus
Tetracyclines
Voriconazole

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17
Q

Abacavir testing

A

HLA-B* 5701

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18
Q

Drugs most commonly associated with severe cutaneous adverse reactions

A

Allopurinol
Amoxicillin
Ampicillin
Carbamazepine
Ethosuximide
Lamotrigine
Nevirapine
Phenytoin
Bactrim
Sulfasalazine
Vancomycin

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19
Q

In the NAPLEX you must avoid ALL beta-lactams if someone is allergic. What is a notable exception?

A
  1. AOM: 2-3rd gen cephalosporin in patients with non-severe cephalosporin allergy
  2. Aztreonam considered safe in patients with Immediate-type PCN allergy
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20
Q

Drugs to avoid if someone has a Sulfa Allergy:

A

Sulfasalazine
Sulfadiazine
Thiazides
Loops (except ethacrynic acid)
Sulfonylureas
Acetazolamide
Zonisamide
Darunavir

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21
Q

Drugs to avoid in someone with peanuts or soy allergies

A

Propofol
Clevidipine

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22
Q

When is skin testing C/I for PCN allergies?

A

If the patient experienced SJS prior

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23
Q

Situation: A pregnant woman has an allergy to PCN and presents with syphillis?

A

Desensitization & PCN treatment

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24
Q

Naranjo Scale

A

Can help determine the likelihood that a drug caused the adverse reaction

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25
Q

F calculation

A

(AUCextra/AUCintra) * (DOSEintra/DOSEextra)*100

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26
Q

Calcium corrected equation

A

Ca(reported) + ([4-albumin) * 0.8)

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27
Q

Phenytoin corrected equation

A

(Total phenytoin measure/(0.2*albumin) + 0.1)

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28
Q

Vd equation

A

Amt of drug in body (dose)/ Concentration in plasma

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29
Q

Clearance equation

A

Rate of elimination/Drug concentration

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30
Q

AUC & Cl equation

A

F*Dose/AUC

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31
Q

0 order vs 1st order

A

0-order: Constant amount is removed per unit of time
1st order: Constant percentage is removed per unit of time

T1/2 is constant is 1st order and NOT in 0-order

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32
Q

Common drugs that exhibit Michaelis-Menten kinetics

A

Phenytoin
Theophylline
Voriconazole

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33
Q

Elimination rate constant (Ke)

A

Cl/VD

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34
Q

Predicting drug concentrations

A

C2 = C1 X E^-kt

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35
Q

Half-life equation

A

0.693/Ke

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36
Q

Loading dose equation

A

(Desired concentration * VD)/F

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37
Q

Allopurinol: prior testing

A

HLA-B*5801

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38
Q

Carbamazepine, Oxcarbazepine: prior testing

A

HLA-B*1502

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39
Q

Clopidogrel: genetic testing

A

CYP2C19

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40
Q

Codeine: genetic testing

A

CYP2D6

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41
Q

Warfarin: genetic testing

A

CYP2C9*2 and VKORC1

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41
Q

Trastuzumab: genetic testing

A

HER2 (if negative, drug will not work)

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42
Q

Cetiximab: genetic testing

A

KRAS mutation (If positive, don’t use)
KRAS negative = wild type = should receive

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43
Q

Azathioprine: genetic testing

A

TPMT
Low/absent lvls risk of severe, life threatening myelosuppression
IF low/absent, use low dose or alternative treatment

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44
Q

Capecitabine/Fluorouracil: genetic testing

A

DPD deficiency (inc risk of severe toxicity). If DPD deficient, do not use

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45
Q

Folic acid requirements for women in child-bearing years

A

600 mcg DFE = 360 mcg of folic acid

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46
Q

St Johns Wort: drug interactions

A

Induces CYP450, 3A4, 2C19, 2C9, 1A2
Serotonergic
Photosensitivity
May lower seizure threshold

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46
Q

Supplements that increase bleeding risk

A

5 G’s: garlic, ginger, ginkgo, ginseng, glucosamine
Fish oil
Vitamin E
Dong quai
Willow bark (a salicylate)

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47
Q

Supplements that can be hepatotoxic

A

Black cohosh (used for menopausal symptoms)
Kava (used for stress/anxiety)

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48
Q

Supplements with cardiotoxicity risk

A
  1. Ephedra (replaced by bitter orange or synerphrine): stimulants
  2. DMAA
  3. Yohimbe is used to inc. libido & for ED
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49
Q

Supplements for anxiety

A

Valerian
Passionflower
Kava
St Johns Wort

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50
Q

Supplements for ADHD

A

Omega-3-fatty acids

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51
Q

Supplements for cold sores

A

L-lysine

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52
Q

Supplements for colds & flu

A

Echinacea
Zinc
Vit C

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53
Q

Supplements for memory

A

Ginkgo
Vitamin E

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54
Q

Supplements for depression

A

St. Johns Wort
SAMe
Valerian
5-HTP

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55
Q

Supplements for diabetes

A

Alpha lipoic acid
Chromium
Cassia cinnamon

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56
Q

Supplements for dyslipidemia

A

Red yeast rice
Fish oils

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57
Q

Supplements for dyspepsia

A

Ca
Mg

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58
Q

Supplements for energy/weight loss

A

Bitter orange
Caffeine
Guarana, green tea powder

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59
Q

Supplements for ED

A

Ginseng
L-arginine
Yohimbe

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60
Q

Supplements for hypertension

A

Fish oils
L-arginine
Co-Q-10
Garlic

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61
Q

Supplements for GI health

A

Fibers
Chamomile
Probiotics

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62
Q

Supplements for Heart health

A

Co-Q-10
Hawthorn
Fish oils

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63
Q

Supplements for inflammation

A

Fish oils
Flax seeds/oil
Turmeric

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64
Q

Supplements for insomnia

A

Valerian
Melatonin
Chamomile

65
Q

Melatonin dosing for jetlag

A

0.5-2mg preflight
5mg post-flight

66
Q

Supplements for liver disease

A

milk thistle

67
Q

Supplements for menopause

A

Black cohosh
Dong quai
Evening primrose oil
Soy, red clover

67
Q

Supplements for migraine ppx

A

FeverFew
Butterbur
Mg
Riboflavin (vit B2)
CoQ10

68
Q

Supplements for motion sickness

A

Ginger
Peppermint

69
Q

Supplements for osteoarhritis

A

Glucosamine
Chondroritin
SAMe
Turmeric

69
Q

Supplements for osteoporosis

A

Ca
Vit D
Soy

70
Q

Supplements for prostate health

A

Saw palmetto
Lycopene

71
Q

Supplements for skin conditions

A

Tea tree oil

72
Q

Supplements for UTis

72
Q

Safety issues with bitter orange

72
Q

Safety issues with 5-HTP

A

Serotonergic

73
Q

Safety issues with Feverfew

A

Mouth ulceration, inc. bleeding risk

74
Q

Safety issues with fibers

A

GI effects (e.g. bloating, cramping, flatulence)

75
Q

Safety issues with Hawthorn

A

Positive inotrope. Avoid concurrent use with digoxin (additive effect)

76
Q

Safety issues with L-arginine

A

Converts into nitric oxide

77
Q

Safety issues with passionflower

A

QT prolongation

78
Q

Safety issues with red yeast rice (natural form of lovastatin)

A

CYP450 inhibitors (e.g. amiodarone) will inc. red yeast rice level.

79
Q

Safety issues with SAMe

A

Serotonergic
Inc. bleeding risk
Do not use in bipolar disorder

80
Q

Safety issues with Soy, red clover

A

Soy might inc. breast cancer risk in postmenopausal women

81
Q

Safety issues with valerian

A

Sedation, CNS depressant

82
Q

Safety issues with Vit C

A

Nephrolithiasis with high doses

82
Q

Safety issues with Vit E

A

Bleeding risk, CVD Risk
Do not exceed 400 IU daily

83
Q

Safety issues with Yohimbe

A

Inc. BP, Inc. HR, seizure risk

84
Q

Safety issues with Zinc

A

Nasal products can cause loss of smell

85
Q

Vitamin A

86
Q

Vitamin B1

86
Q

Vitamin B2

A

Riboflavin

87
Q

Vitamin B3

88
Q

Vitamin B6

A

Pyridoxine

89
Q

Vitamin B9

A

Folic acid

90
Q

Vitamin B12

91
Q

Vitamin C

A

Ascorbic acid

92
Q

Vitamin D3

A

Cholecalciferol

93
Q

Vitamin D2

A

Ergocalciferol

94
Q

Vitamin E

A

Alpha-tocopherol

95
Q

Folic acid requirements (women)

A

400mcg/day = All women of child bearing age
600 mcg/day = during pregnancy

96
Q

How much folate is in prescription prenatal vitamins?

97
Q

AAP iron recommendations

A

4-6 months: formulas contain adequate iron. However, breastfed babies need 1mg/kg/day from 4-6 months and until consuming iron-rich foods.

98
Q

Nutritions depleted with acetazolamide

99
Q

Nutritions depleted with antiepileptics

100
Q

Nutritions depleted with amphotericin B

101
Q

Nutritions depleted with isoniazid

A

Vitamin B6

102
Q

Nutritions depleted with loops

103
Q

Nutritions depleted with metformin

A

vitamin B12

104
Q

Nutritions depleted with MTX

105
Q

Nutritions depleted with Orlistat

A

Beta-carotene
Fat-soluble vitamins

106
Q

Nutritions depleted with PPIs

A

Mg
Vitamin B12

107
Q

Nutritions depleted with SXT-TMP

108
Q

Supplements recommended with AUD

A

Vitamin B1
Folate

108
Q

Supplements recommended with macrocytic anemia

A

vitamin b12
folate

109
Q

Supplements recommended with microcytic anemia

110
Q

Supplements recommended with pregnancy

A

Folate
Ca++
Vit D
Pyridoxine

111
Q

Supplements recommended with CKD

112
Q

Poison control center phone #

A

1-800-222-1222

113
Q

Initial management: topical exposure

A

remove contaminated clothing
wash skin with soap & water for 10 minutes

114
Q

Initial managment: ocular exposure

A

remove contact lenses
rinse eyes with a gentle stream of water for at least 15 minutes

115
Q

Ipecac syrup

A

No longer recommended

116
Q

When is activated charcoal most useful?

A

within 1 hr

117
Q

Activated charcoal: dose

118
Q

what is recommended to do prior to administering activated charcoal?

A

Airway protected to prevent aspiration
Hydrocarbons can inc. risk of aspiration

119
Q

When is activated charcoal contraindicated?

A

A. When airway is unprotected, including:
1. is unconscious
2. cannot clear their throat
3. cannot hold their head upright
B. With intestinal obstruction
C. When the GI tract is not intact or when there is dec. peristalsis

119
Q

Acetaminophen overdose: phase 1 (1-24 hrs)

A

Common asymptomatic or nonspecific symptoms (N/V)

120
Q

Acetaminophen overdose: phase 2 (24-48 hrs)

A

INR elevation, Inc. AST/ALT

121
Q

Acetaminophen overdose: phase 3 (48-96 hrs)

A

fulminant hepatic failure (e.g. jaundice, coagulopathy, renal failure, and/or death)

122
Q

Acetaminophen overdose: phase 4 (> 96 hrs)

A

recovers or receives liver transplant

123
Q

How does NAC work?

A

acts as a glutathione precursor, resulting in non-toxic metabolites

124
Q

Anticholinergic overdose: symptoms + treatment

A

Symptoms: flushing, dry skin, mydriasis with blurry vision, AMS, fever
Treatment: supportive care, physostigmine (inhibits enzyme that breaks down ACh)

125
Q

Apixaban, Rivaroxaban overdose: treatment

A

Andexanet alfa (Andexxa)

126
Q

Dabigatran overdose: treatment

A

Idarucizumab (Praxbind)

127
Q

Warfarin overdose: treatment

A

Phytonadione (vitamin K)

128
Q

Heparin, LMWH overdose: treatment

129
Q

Warfarin, Factor Xa inhibitor overdose: treatment

A

Prothrombin complex concentrate (Kcentra)

130
Q

Antipsychotics overdose treatment:

A

Primarily supportive care
Benztropine for dystonias

131
Q

Benzodiazepines overdose treatment:

A

Flumazenil (can cause seizures) if used in pts taking benzos chronically

132
Q

Beta-blockers overdose treatment:

A

Glucagon (if unresponsive to symptomatic treatment)

133
Q

CCB overdose treatment:

A

Same as BB plus Calcium (IV)

134
Q

Cyanide (smoke inhalation, nitroprusside in high doses/duration/renal impairment) overdose treatment:

A

Hydroxocobalamin (Cyanokit)
Sodium thiosulfate + sodium nitrite (Nithiodote)

135
Q

Digoxin overdose treatment:

A

Digoxin immune fab (DigiFab)

136
Q

Ethanol overdose treatment:

A

Thiamine to prevent wernicke’s
Can cause inc. anion gap

137
Q

Heavy metals (arsenic, copper, gold, etc) overdose treatment:

A

Dimercaprol
Succimer (for lead)
Penicillamine (for copper)

138
Q

Hydrocarbons: petroleum products overdose treatment:

A

Do not induce vomiting. Keep pts NPO d/t aspiration risk.

139
Q

Insulin or other hypoglycemic overdose treatment:

A

Dextrose: don’t administer if unconscious
Glucagon

140
Q

Isoniazid overdose treatment:

A

Pyridoxine (vitamin B6): IV for acute neurotoxicity

141
Q

Iron and aluminum overdose treatment:

A

Deferoxamine (Desferal)

142
Q

Organophosphates (including industrial insecticides) overdose treatment & symptoms:

A

Symptoms: SLUDD symptoms d/t acetylcholinesterase blockade
Treatment: Atropine, Pralidoxime (reactivates cholinesterase) **Combo can be used **

143
Q

MTX overdose treatment:

A

Leucovorin (Folinic acid)
Levoleucovorin (Fusilev)
Glucarpidase (Voraxaze)

144
Q

Methemoglobinemia overdose treatment:

A

Methylene blue C/I in G6PD deficiency

145
Q

Neostigmine, pyridostigmine overdose treatment:

A

Pralidoxime +/- atropine

146
Q

Nicotine overdose treatment + symptoms:

A

Symptoms: abdominal pain, nausea
Treatment: supportive care, atropine (for symptomatic bradycardia), benzos (for seizures)

147
Q

Salicylates overdose treatment:

A

Sodium bicarbonate

148
Q

Stimulant overdose treatment:

149
Q

Toxic alcohols: ethylene glycol (antifreeze), methanol overdose treatment:

A

Fomepizole

150
Q

TCAs overdose treatment:

A

Overdose can quickly cause fatal arrhythmia
Treatment: sodium bicarb to dec a widened QRS complex

151
Q

Valproic acid or topiramate induced hyperammonemia overdose treatment:

A

Levocarnitine (Carnitor)

152
Q

Animal bites antidotes

A

Rabies vaccine (RabAvert, Imovax Rabies) + Human rabies Immune immunoglobin

153
Q

Black widow spider bites antidotes

A

Antivenin for Latrodectus mactans

154
Q

Scorpion stings antidotes

A

Antivenin immune FAB for centruoides (Anascorp)

155
Q

Snake bites antidotes

A

Crotalidae polyvalent immune FAB (CroFab) for copperhead and rattlesnake bites

TOP 300 drugs - NAPLEX (12 decks)

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