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Question 1

ANC equation

Answer 1

ANC = WBC * (% seg neuts + % bands)

Neutropenia ANC < 500
Must have ANC > 1500 to be eligible for chemotherapy

Question 2

Dexrazoxane

Answer 2

Prevent cardiomyopathy in doxorubicin > 300 mg/m2
Give 10% of doxo dose as dexrazoxane

Also used for extravasation

Question 3

Amifostine

Answer 3

Use for nephrotoxicity from cisplatin

Question 4

Leucovorin

Answer 4

Use after MTX doses > 1000, rescue tx in MTX > 500

Can add on glucarpidase but do not administer leucovorin 2 hours before or afterwards

Question 5

Tumor lysis syndrome

Answer 5

Rasburicase tx, use allopurinol or fluids as prophylaxis

Increased uric acid

Question 6

Hypercalcemia (cancer related)

Answer 6

Ca > 14

Fluids, loop diuretics, bisphosphonates, calcitonin

Question 7

Corrected Ca equation

Answer 7

= (4-albumin)* 0.8 + Ca
Normal is 12-14

use if albumin < 3.5

Question 8

Leapfrog Hospital Safety Grades

Answer 8

VA hospitals, critical access hospital excluded
Issued 2x per year
Barcode scanning on med admin one of the criteria - goal is to reduce preventable mistakes

Question 9

HEDIS

Answer 9

NCQA - part of CMS

Not required to report to HEDIS, but used for ratings

Question 10

IRB required members

Answer 10

5 members

1 scientific, 1 nonscientic, 1 not affiliated with org, and one that represents perspectives of research participants

Question 11

Cost Benefit
Cost effectiveness
Cost minimize
cost utilization

Answer 11

Cost Benefit: Looks at tx + costs saved with benefit outcomes
Cost effectiveness: Looks at measured clinical uses or outcomes (years of lives saved)
Cost minimize: Compares therapies
Cost utilization: Looks at mortality / QALY

Question 12

ivabradine (Corlanor)

Answer 12

Used in HF EF < 35% and on max tolerated BB with HR > 70 bmp.
ADE: bradycardia, atrial fibrillation, HTN
Lowers hospitalizations

Question 13

Criteria for antibiotics in COPD

Answer 13

Dyspnea OR increase sputum volume
+ increased sputum purulence

OR mechanical ventilation

Augmentin, macrolide, doxycyline if GOLD 1 or 2
Levo/cipro if GOLD 3 or 4 (pseudo coverage)

Question 14

Theoyphilline

Answer 14

MOA - phosphodiesterase inhibitor, methylxanthine. No longer recommended for acute tx of asthma

Can lower seizure threshold

Question 15

FEV cut-off's
GOLD 1
GOLD 2
GOLD 3
GOLD 4

Answer 15

GOLD 1 >= 80%
GOLD 2 50-79%
GOLD 3 30-49%
GOLD 4 < 30%

Question 16

Pneumococcal vaccine recommendations

Answer 16

Age 19-64 w/ chronic medical condition (give if FEV1 < 40%) - 1 dose of PPSV23

Immunocompromised > 19 yoa: 1 dose PPSV13, 8 weeks later PPSV23, then 5 years later booster PPSV23

65 and older - PPSV 13 and PPSV 23 one year later

Question 17

Hyponatremia

Answer 17

If due to dehydration, give NaCl 0.9%, check in q4h
Na < 120, symptomatic - use hypertonic saline NaCl 3%
1 mEq/L/hr (severe), 0.5 mEq/L/hr in moderate. Can give NaCl 0.45% to slow down the rise.

Do not correct more than 10-12mEq per 24 hours, or > 18 mEq in 48 hours.

Treating hypokalemia will help increase Na as well! If Euvolemic or edematous, fluid restriction (<800mL/day) or vasopressin antagonists like tolvaptan

Med induced = thiazides, antiepileptics, SSRI’s, hypothyroid, SIADH

Question 18

Hypernatremia

Answer 18

Na > 145 - caused by dehydration, sodium retention, brain injuries. Requires H2O! Must give by mouth or via D5W, never SW infusion!
If hypotensive, can give NaCl 0.9%

Question 19

Hypokalemia

Answer 19

K < 3.5
Causes: insulin, beta agonists (albuterol), alkalosis, hypothermia, diuretics, GI losses

K 3-3.5 –> PO KCl 40-80 mEq/day
K 2-3 –> IV or PO (IV 10-20 mEq/hr)
K < 2 give 20 - 40 mEq/hr IV (ECG monitor)

Divide doses > 60 mEq to reduce GI SE
Max peripheral IV is 60-80 mEq
Don’t mix K in dextrose

Question 20

Hyperkalemia

Answer 20

K > 5; if > 6.5 it is an emergency !
If symptomatic:
- Calcium gluc 1 g IV push to reduce cardiac risk
- Insulin 10 units IV + 25-50 g glucose via 50% IVpush
- Sodium bicarbonate 50 mEq IV push
- Albuterol 10-20 mg neb (if on BB, pt will not respond - not as effective)

If asx, give sodium polystyrene sulfonate alone 15 g q6h

Causes: succ, K sparing diuretics, acei, arbs, trimethoprim. If CAD, CHF, DM - higher risk of sudden death

Question 21

Hypomagnesium / hypermagnesium

Answer 21

Mg < 1.7
Oral supplementation, mag oxide - SE is diarrhea
1-4 g slow IV infusion, lower dose by 50% in renal
Can give push if emergency

Mg > 2.3
0.9% NaCl, loops, IV calcium if sx

Question 22

Hypocalcemia

Answer 22

Corrected Ca if Ca < 8.5
Sx: muscle twitch/seizure
CaCl 1g via central line
CaGluc 2-3 g via peripheral line
max rate 60 mg/min

Question 23

Hyperpcalcemia

Answer 23

Due to malignancy: NaCl 0.9% plus bisphosphonate (zolendronic acid 4 mg IV - can take up to 7 days for nadir to be reached) + calcitonin (if symptomatic)

Question 24

Medicare Access and CHIP Reauth Act (MACRA)

Answer 24

Fee for service to a value-based or pay for performance model

Question 25

NDA
ANDA
INDA

Answer 25

NDA - Submitted after Phase III studies before market approval

ANDA - generic drugs, submitted 3-5 years after market exclusivity by brand company. Retain a 180 day exclusivity of generic product.

INDA - used for new drug, new indication, off-label use. Must be submitted after pre-clinical trials, before Phase I trials.

Question 26

Orange Book

Answer 26

A - both pharmaceutical equivalents and bioequivalent, may be interchanged
B - pharmaceutical equivalents only, cannot be interchanged

Biosimilars - purple book, availavlee for biological products after 12 years exclusivity

Question 27

Medwatch Form FDA 3500, 3500A, 3500B

Answer 27

Form 3500 - voluntary reporting by HCP, can disclose PHI
Form 3500A - IND reporters, manufacturers, distributors, etc
Form 3500B - Consumers and patients

Question 28

HITECH Act

Answer 28

Promote healthcare information tech, authorizes DHHS to promote

CMS gives financial incentives for “meaninful use” of EMR (under ARRA)

Question 29

Orphan Drug Act

Answer 29

Grants, assistance, for patient populations of < 200,000
Grants market exclusivity for 7 years after FDA approval
Grants 20 year patent life (starts when molecule is invented)

Question 30

New Drug Process

Answer 30

Preclinical trials > INDA > Phase I: PK/PD in ~ 50 human volunteers > Phase 2: Indication for drug in several hundred patients > Phase 3: Efficacy and safety evaluation > NDA > Phase 4: Postmarketing studies

Question 31

Drug causes of SIADH

Answer 31

SSRI’s
Carbamazepine
Barbiturates
Narcotics