Quiz Questions Flashcards
Which of the following is a skeletal adverse reaction that can occur when taking cromoglycates
Joint pain
oral corticosteroids are secreted via
urine
when using beta-2 receptor agonists, patient should undergo periodic measurement of
IOP
When prescribing an antibacterial agent for otitis externa, the healthcare practitioner must consider that certain agents have the potential for ototoxicity. Which agent has the greatest potential for it
neomycin/polymyxin B
A patient presents with a red, painful right eye and purulent drainage. Culture shows neisseria gonorrhea. NKDA. what opthalmic agent would be most effective
sulfacetamide opthalmic preparation
after 1 week of treatment for otitis externa with topical antibacterial there is no improvement, whats next
suspect overgrowth of nonsuceptible organism and obtain culture
Montelukast can be used to treat chronic asthma in which age group
1 and older
SABAs are metabolized via
liver
12 yo presents w/ mod left ear pain and serosanguineos drainage. tympanic membrane is perforated. Why should you NOT prescribe benzocaine
contraindicated with perforated eardrum
what decreases absorption of antihistamines
antacids
proper method for ear drop instillation in a child
down and back
when choosing a topical anti-infective, ointments are usually considered more potent, why?
they are more occlusive
patients should NOT take albuterol/ipratropium (Combivent) if they are allergic to
soy (peanuts)
What is the appropriate dose of spiriva when treating COPD
18mcg once daily
when using oral corticosteroids to treat asthma, which electrolyte should be monitores
potassium
what healthcare education should be given to a geriatric patient who is using sulfacetamide solution for his left eye that was prescribed 2 months ago
discard when it turns dark
LABA mechanism of action
stimulation of beta-2 adrenergic receptors in the lungs, resulting in the relaxation of bronchial smooth muscle
mechanism of action of an opthalmic topical anesthetic
acting locally, they block initiation and conduction of nerve impulses by decreasing the neuronal membrane’s sensitivity to sodium ions, thereby decreasing the sensation of pain
half-life of prednisone
2.5-3.5 hours
when salmeterol (Serevent) is used to treat exercise-induced asthma, how should it be dosed
1 inhalation 30 min prior to exercise
mechanism of action for demulcents
form a protective film on the ocular surface, allowing for epithelial repair
mechanism of action for polymers
bind to natural tears and the mucosal surface of the eye to form a protective, lubricant film
mechanism of action for hygroscopic agents
draw water into corneal cells to protect against hyperosmotic stress
mechanism of action for hypertonicity agents
placed in ocular lubricants to draw excess fluid from cornea into tears
LABAs interact with
beta blockers
anti-infective otic agent with a steroid preparation
ciprofloxacin with hydrocortisone
duration of action for all LABAs
12 hours
possible adverse effect of an anticholinergic
worsening glaucoma
A patient with dry eye was prescribed refresh lacri-lube ointment 3 weeks ago with no improvement. If there is no underlying cause, what is likely the problem
she puts it on in the morning before work
contact lense wearers are at greater risk for what type of infection
fungal
contraindicated for use of anticholinergics
prostate enlargement
what other med may need to be adjusted when a patient is taking oral corticosteroids
insulin
a patient has used Debrox for 7 days and now complains of hearing loss. Why
damage to tympanic membrane for use longer than 4 days
what interacts with opthalmic vasoconstrictors causing increased IOP
MAOIs
mechanism of action for bacitacin
inhibits the incorporation of amino acids and nucleotides into the bacterial cell wall
mechanism of action for sulfacetamide
inhibits bacterial dihydrofolate
mechanism of action for fluoroquinolones
inhibits DNA synthesis in invading bacteria
mechanism of action for sulfa drugs
blocks synthesis of folic acid in susceptible bacteria
mechanism of action for erythromycin
prevents protein synthesis in bacteria
common dermatological side effect of long term use of oral prednisone
acne
why are CCBs effective for treating HTN
generally produce no significant CNS side effects and can treat co=existing conditions like angina
one advantage of treating a patient with irbesartan (avapro) instead of enalapril (vasotec)
does not produce dry cough
HTN patients with migraines, ischemic heart disease, or CHF would benefit most form which medication
beta blockers
what drug causes hypotension, dizziness, and death when mixed with nitrates
sildenafil (Viagra)
mechanism of action of which drug reduces preload (through vasodilation) and afterload (through arterial dilation) thus helping to treat both HTN and CHF
captopril
(ACE inhibitor)
patient c/o syncope, postural hypotension, tachycardia, throbbing headaches, and hot flushes. These are common side effects of which medication
nitro patch
a lupus like syndrome occurs with high dosages of which drug
hydralazine
a patient with digoxin toxicity will most likely report what symptom
blurry vision
what is the drug type of choice for prinzmental angina as well as for patients with stable angina, HTN, and supraventricular arrythmias
CCBs
what should NOT be used in a HTN patient who has gout
diuretic
ACE inhibitors increase circulating levels of what
bradykinin
most common side effect of thiazide diuretics
potassium depletion
in addition to nausea, dizziness, and fatigue, what is another possible side effect of CCBs
apoplexy
which drug is best for a black woman with HTN who becomes pregnant
HCTZ
quinidine is an example of which type of antiarrhythmic
sodium channel blocker
black oatient with HTN tend to respond better to
CCBs
80 yo patient with hx of glaucoma presents with hypertensive emergency. Which drug is contraindicated
losartan/HCTS (Hyzaar)
what is a class 1C medication that stabilizes membranes and depresses the action potential phase
flecainide (Tambocor)
what drug is a potassium sparing diuretic
spironolactone
potassium channel blockers are in which class of antiarrhythmic drugs
3
what should NOT be used to treat HTN in pregnant female
losartan
rebound HTN can occur with abrupt withdrawal of
clonidine
because CCBs undergo extensive first pas metabolism what would you expect to see in a patient with cirrhosis
the drug’s half-life is altered
patient is on a BP med but can’t remember the name. c/o skin rash and cough. What is she likely taking
captopril
(ACE inhibitor)
what drug should be avoided when treating a patient with HTN and asthma
metoprolol
what food increases depletion of potassium, thereby increasing risk for digoxin toxicity
licorice
thiazide diuretics act on the distal convoluted tubule where they block transport of what
sodium and chloride
what is the mechanism of action of thiazide diuretics that causes reduced BP
decrease in sodium and water retention which decreases blood volume which decreases cardiac output
what is both an alpha and beta adrenergic blocker
carvedilol
what is the most common side effect of thiazide diuretics
potsddium depletion
a patient experiencing supraventricular arrhythmia has no success with valsalvas maneuver. she has 90% bilat carotid stenosis. What do you do
administer adenosine
what is the drug of choice for pregnancy induced HTN
methyldopa (Aldomet)
why should high doses of short acting CCBs be avoided
increased risk of MI
beta blockers are used in the treatment of CHF because theyr educe heart muscle oxygen demand by
reducing the force of heart muscle contractions
which medication has a side effect profile of dry cough, hyperkalemia, dizziness
captopril
(ACE inhibitor)
absorption of fibric acid deriviatives is reduced by the presence of
levothyroxine is contraindicated in which scenario
patient with recent MI
what is the half-life of PTU
1.5-5 hours
which patient newly diagnosed with T2DM would respond best to sulfonylureas
mild to moderate fasting hyperglycemia
which sulfonylurea causes the most side effects
chlorpropamide (Diabinese)
what is the mechanism of action for sulfonylureas
increasing insulin secretion from pancreatic B cells
contraindication for the use of PTU
pregnancy
levothyroxine is secreted in what
feces
patients taking methimazole (Tapazole) should avoid what
shellfish (iodine)
reversible side effect in children started on T3/T4 combo (liothyronine/levothyroxine)
hair loss
55 y.o man who is 5’9 and 225lbs with T2DM
no comorbidities or medication
recent A1C 6.7%
begin oral hypoglycemic metformin
hold levothyroxine for HR>?
100
vasopressin is used to treat what
diabetes insipidus
prolonged infusion of oxytocin can cause what
seizures (water intoxication)
50-80% of synthroid is absorbed by the
GI tract
what can impair the absorption of liothyronine
cholestryramine (bile acid sequestrant)
what is the main reason that metformin does NOT usually cause hypoglycemia
decreases glucose production in the liver
hematologic side effect of PTU
agranulocytosis
teaching for:
35y/o female with T2DM on oral contraceptives and taking pioglitazone (Actos) and does not want to become pregnant
increase oral contraceptive dose
what can increase absorption of liothyronine
fasting
what drug interferes with parathyroid hormone secretion
cinacalcet
typical starting dose of levothyroxine
50mcg
common side effect of sulfonylureas
weight gain
primary mechanism of action for alpha-glucosidase inhibitors
decreased absorption of carbs in GI tract
most common adverse effect of thiazolidinediones (TZDs) are weight gain and
fluid retention
what is considered glycemic control for a 55y/o male diagnosed with DM 9 months ago
6%
ADA algorhythm for insulin in T2DM
A1C is not around 7% at the end of 3 months of therapy
continue insulin dose and recheck in 3 months
why is it important to titrate up dosage of acarbose (Precose)
to minimize GI side effects
59y/0 female previously controlled on repaglinide (Prandin) with recent A1C of 9%
what do you do
increase dose to 3mg daily in divided doses
primary difference between sulfonylureas and meglitinides
meglitinides are shorter acting than sulfonylureas
advice for patient regarding her repaglinide (Prandin) who will have to skip lunch
do not take lunch dose and continue therapy at dinner
when is Novolog, Apidra, or Humalog recommended for a diabetic patient
when patient eats at the same time insulin is given
advice to a newly diagnosed diabetic started on insulin
BG BID and report back weekly
short acting steroid
cortisone
what does growth hormone do
affects cartilaginous areas of long bones
most important therapeutic intervention for a patient with diabetes
lifestyle modification
which medication class produces GI discomfort to the point that patient’s may discontinue therapy
alpha-glucosidase inhibitors
45y/o female with T2DM who has achieved glycemic control with diet/exercise after 2 months
patients with a lack of serotonin can suffer from what
depression
Of these drugs, which is not pregnancy category D:
Ergot w/ caffeine (Cafergor)
phenytoin (Dilantin)
fosphenytoin (Cerebyx)
oxcarbazepine (Trileptil)
Ergot w/ caffeine
Schedule of benzos
IV
Triptans should NOT be administered with which:
SSRIs
PPIs
PCN
NSAIDs
SSRIs
which is a tricyclic antidepressant used for treatment in severely depressed patients specifically for sedating effect
Effexor
Nardil
Sertraline
silenor
silenor
prescription slep aides should be used no longer than
10 days
what canacer has been associated with levodopa/carbidopa
malignant melanoma
peak effect of diazepam
0.5-2 hours
which should be adminisgtered immediately when treating status epilepticus:
Trileptal
Tegretol
Ativan
Dilatin
Ativan because it is a benzo
which anti-parkinson medication class relaxes smooth muscle both directly and indirectly
anticholinergics
Max amount of immetrex in one day
300mg
which Parkinson medication requires monitoring of IOP
benztropine (Cogentin)
common side effect of MAOIs, TCAs, and SSRIs
weight gain
which is a selective MAO-B inhibitor:
pramipexole (Mirapex)
benztropine (Cogentin)
entacapone (Comtan)
selegiline (Eldypryl, Carbex)
selegiline
which triptan can be given PO, SQ, and nasally
imitrex (sumatriptan)
how how prescription sleeo aides excreted
kidney
atypical antipsychotics are associated with
weight gain
patients taking nortriptyline and amitriptyline should be monitored for all of the following except:
mental status change
cardiac disturbances
confusion
weight loss
weight loss
alprazolam is contraindicated with which medication
ketoconazole
how long does it take to see the effects of TCAs
up to 8 weeks
which benzo is metabolized in the liver and contraindicated in liver disease:
temazepam
oxazepam
midazolam
lorazepam
Midazolam
which disease is charachterized by a dopamine deficiency
Parkinsons
which Parkinson medication is used to treat restless leg stndrome
ropinirole
drugs that affect acetylcholine are useful in treating what
Alzheimers
pregnancy category of ergotamines
X
black box warning on all antipsychotics
may cause increased mortality in elderly with Alzheimers induced psychosis
which antidepressant helps with smoking cessation
wellbutrin
which drug can cause EPS:
amitriptyline
fluphenazine
bupropion
fluoxetine
fluphenazine
what is lithium
light alkaline metal
prescription sleep aides act on which receptors
GABA
when taking MAOIs, patients should avoid foods high in
tyramine
5% of patients taking lithium for over a year develop symptoms of what
hypothyroidism
which is an act of endorphins:
slowed HR
elevated BP
increased respiration
increased pain
slowed HR
what is the most abundant major inhibitory neuron in the CNS
GABA
what are adverse effect of acetylcholinesterase inhibitors
bradycardia
abnormal dreams
HTN
which medication requires CBC monitoring to check for aplastic anemia
35 y/o female taking diflucan for yeast infection should be told to
dont drink alcohol
wear sunscreen
report rashes
adverse reaction associated with septra that can be fatal
stevens-johnson syndrome
which drug shortens flu duration by several days
tamiflu
when giving chloroquine you should know if the patient has
G6PD deficiency
which does not need to be avoided when taking doxycycline:
ASA, milk, antacids, sun exposure
ASA
which antiviral can be used to treat herpes simplex 1 & 2
famciclovir
first generation cephalosporins are best used against which organism
gram- cocci
S. pneumoniae is difficult to treat because of growing resistance to what
PCNs and cephalosporins
Which should patient taking doxyxyline be advised of:
stay out of direct sunlight,
watch for signs of blood dyscrasias,
check INR frequently if on digoxin,
drink 8-10 glasses of fluid daily
stay out of direct sunlight
Zanamivir (Relenza) is not indicated for children younger than
5
what antiparasitic drug is related to macrolide ABTs
ivermectin
what drug is typically use to treat cryptococcal meningitis
amphotericin B
Organisms that produce beta-lactamase have increased resistance to
PCN
which macrolide has the longest half-life
azithromycin
drug of choice for post=exposure prophylaxis against anthrax
cipro
clinicians must remember that aminoglycosides have the potential to cause
ototoxicity
Which is a side effect of clindamycin:
pseudomembranous colitis, hyperglycemia, ototoxicity, crystalluria
pseudomembranous colitis
patients taking flagyl should be advised not to consume what
alcohol
which is associated with fluroquinolones:
prolonged QT interval
serum sickness
increase in potassium
transient decrease in liver enzymes
prolonged QT interval
which medication has serious interactions with digoxin that can cause death in the elderly
clarithromycin (Biaxin)
Levofloxacin is likely to cause what adverse reaction in patients over 60
spontaneous tendon rupture
which interferes with a viruses ability to synthesize its own DNA and finds great use in the treatment of recurrent genital herpes
acyclovir
which drug is used for prophylaxis of malaria in areas resistant to chloroquine
primaquine
antimalarials are contraindicated with which medication
beta-blockers
most commonly used malarial drug
chloroquine
what should be avoided when taking fluroquinolones because it can interfere with absorption
antacids
ketoconazole is metabolized by
the liver
which anti-depressant should be avoided with fluroquinolones
doxepine
which is NOT associated with antivirals:
toxic epidermal necrosis, anemia, anaphylaxis, stevens-johnson syndrome
anemia
antimalarials are excreted via
urine
what is typically given to treat rocky mountain spotted fever and lyme disease
tetracycline
who is NOT considered high risk for adverse reactions to bactrim:
6 month postpartum lactating mother, anyone over 65, anyone abusing alcohol, malnourished individuals
postpartum lactating mother
what has been a life saving treatment for MRSA
vancomycin
which should be used for a 21 y/o pregnant patient with pneumonia:
clindamycin, gentamycin, levofloxacin, doxycyxline
clindamycin
what organism are aminoglycosides INEFFECTIVE against
anaerobic bacteria
typical dosage of flagyl for bacterial vaginosis
500mg BID x 5 days
what are sulfonamides used for in HIV patients
prevention of pneumocystitis
which hepres medication is used topically ONLY
penciclovir
half-life of fluconazole
30 hours
which patient population is safest to prescribe oral contraceptives:
liver disease, undiagnosed vaginal bleeding, clotting disorders, possible pregnancy, hypothyroidism
hypothyroidism
ED drug prescriptions should be limited to
4-10 tablets per month
which can be used to treat a 13y/o with the flue:
tamiflu, cleocin, famvir, zovirax
tamiflu
what is the duration of effect for cialis
36 hours
which medication for BPH is slow to show effect, taking up to 6 months
dutasteride (Avodart)
what can be used to treat a patient with mono who has markedly edematous tonsils and no obvious abscess
dexamethasone
which is an alpha-5 reductase inhibitor to treat BPH:
avodart, flomax, uroxatral, cardura
avodart
which is NOT a major side effect of cholinesterase inhibitors:
diarrhea, bradycardia, nausea, bullous rash, anorexia
bullous rash
possible adverse reaction of fluoroquinolones
adverse effects on the growth of immature cartilage, joints, and surrounding tissue
mechanism of action for 5-alpha reductase inhibitors
inhibit the conversion of testosterone to dihydrotestosterone (DHT)
when should asthma therapy be stepped up in an adolscent patient
when SABA is used more than 2 days a week
which drug carries a black box warning advising that its use in children under 2 can cause severe fatal respiratory depression
promethazine (Phenergan)
which drug is approved for all 3 stages of Alzheimers
Aricept
which is contraindicated in children under 8:
cephalexin, amoxicillin, tetracycline, penicillin
tetracyclines
what is conjugated estrogen (Premarin) approved to treat
hot flashes, all vaginal symptoms of menopause, and to treat and prevent osteoporosis
black box warning associated with the use of atypical antipsychotics in the elderly
increase the rate of MI, stroke, and vascular mortality
what drug is used to treat infectious conjunctivitis in the pediatric population
polymyxin B + trimethoprim (Polytrim)
what may occur if a patient is taking a CCB and is given a PDE5
small additive drop in BP
how should levonorgestrel (Plan B) be prescribed
one 0.75mg tablet within 72 hours of sex and again in 12 hours
what is the role of cGMP in erectile dysfunction
activates a specific protein kinase, leading to smooth muscle relaxation
mechanism of action for biphosphonates
adhere tightly to bone surfaces and inhibit osteoclactic activity, thereby inhibiting both normal and abnormal bone reabsorption
mechanism of action of racemic epinepherine
stimulates both alpha- and beta-adrenergic receptors, resulting in both relaxation of smooth muscles in the bronchial tree as well as a decrease in local airway edema with resultant decrease in the work of breathing
which statement is false:
- absorption of orally adminitered meds is dramtically reduced in elderly patients
- water-soluble drugs have reduced distribution in elderly patients
- total body water and ECF decreases with age
- percentage of total body fat rises steadily with age, affecting lipid-soluble drugs
- Absorption of orally administered meds is dramatically reduced in elderly patients
what is the least appropriate form of testosterone replacement therapy
oral tablets
when is VitaminD contraindicated
parathyroidism, cushings syndrome, hyperthyroidism, skeletal cancer
parathyroidism
administration routes of
- Boniva
- Zometa
- Aredia
- Actonel
- Oral and IV
- IV
- IV
- oral once a week
how long should acute bacterial prostatitis be treated
30 days
what medication has a black box warning that it can cause pseudomembranous colitis
clindamycin
Which ED is the most selective PDE5:
Cialis, Muse, Viagra, Levitra
Cialis
