Random 3

Question 1

Carbamazepine

Answer 1

Reference Range: 4-12
SJS Risk: HLA*B 1502, Asians, highest risk within first 8 weeks of therapy
Drug of choice for trigeminal neuralgia
Can worsen absence seizures

Question 2

Drugs of choice for absence seizures

Answer 2

Ethosuxmide

Valproate

Question 3

Phenytoin

Answer 3

Reference range: 10-20, must be corrected in renal (?) due to high albumin binding
ADE = gingival hyperplasia

If pregnant, may continue but must supplement with high-dose folic acid

Max infusion rate 50mg/min, filter with 0.22 micron during administration due to risk of precipitation, only dilute in NS and use continue cardiac monitoring. Do NOT give IM.

Question 4

Propofol

Answer 4

Max infusion rate 50 mcg/kg/minute - risk of infusion syndrome (PRIS - metabolic acidosis)

ADE = triglycerides, risk of hypotension

Question 5

IV Lorazepam for sedation

Answer 5

Risk of propylene glycol toxicity - at high risk if osmol gap is > 10-12, or if infusion > 5 mg/hr for > 48 horus

Question 6

Anion Gap

Answer 6

= Na - (Cl + HCO3)
Normal is 6-12

If hypoalbuminemia, reduction in anion gap for every 1 less than 4.

Question 7

SEM equation

Answer 7

SEM = SD / sq root of N

CI is 1.96*SEM (95% confidence, 2 SD’s)

Question 8

Type I error

Answer 8

alpha, rejecting the null when there is no association. P-value 0.05% – 5% of the time we will state there is significant when there is not.

Question 9

Type II error

Answer 9

beta, accepting the null when there actually is an association. Occurs if the study does not have enough power.

Increasing the power allows you to reduce risk of type 2 error, as it can help to detect smaller differences between groups.

Question 10

Prevalence vs. Incidence

Answer 10

Prevalence - measures current cases at a given time

Incidence - probability of developing a disease (number of new cases) / those at risk for developing the dx

Question 11

NNT

Answer 11

1/ARR –> only calculate if statistically significant

Question 12

Sensitivity vs. Specificity

Answer 12

Sensitivity = true positives
Specificity = true negatives

Positive predictive value = True positives / total identified positives

Question 13

RR vs. OR calculations

Answer 13

RR: (exposure +/total exposure)/(no exposure +/total no exposure) goes from left to right

OR: (dx in exposed/dx non exposed)/(no dx in exposed/no dx non exposed) goes from top to bottom

Relative Risk Reduction/Increase = 1-RR

If OR/RR 0.75 –> 25% reduction in the risk or odds. If 1.5 –> 1.5 times the risk or odds.

Question 14

CAP Tx:

• Outpatient
• Inpatient

Answer 14

Outpatient:
Amoxicillin, doxycyline, or macrolide

Inpt: Resp FQ (moxi, levo, gemi) or beta lactam + macrolide

If risk factors (COPD, DM) give resp FQ

Question 15

HAP / VAP Tx

Answer 15

Occurs > 48 hours post admission

Single agent: cefepime, Zosyn, levoflox x 7 days

If IV abx in 90 days, high risk mortality, give 2 antipseudo (beta lactam/aminoglycosides OR FQ/aztreonam)
Add on MRSA if high risk VAP (vanco)

Question 16

G6PD Deficiency drugs to avoid

Answer 16

Nitrofurantoin
Bactrim
Rasburicase
Primaquine
Dapsone

Question 17

CYP2C9

Answer 17

Warfarin (also VKORC1), factors 2/7/9/10. S isomer&raquo_space; R isomer
Phenytoin

Question 18

CYP2C19

Answer 18

Clopidogrel (omeprazole)

Voriconazole

Question 19

HLAB5701
HLAB5801
HLAB*1502

Answer 19

HLAB5701 Abacavir
HLAB5801 allopurinol
HLAB*1502 phenytoin, carbamazepine

High risk of hypersensitivity reactions!

Question 20

Phase I vs. Phase II

Answer 20

Phase I = CYP3A4 metabolism

Phase II = UGT, NAT - makes drug more hydrophillic

Question 21

Zero-order elimination vs. first-order elimination

Answer 21

Zero-order, independent of drug concentration (ASA, ethanol, phenytoin)

First-order - concentration dependent, exponential (half-lives, 4-5 t/12)

Question 22

Therapeutic Index

Answer 22

Narrow TI - poor safety profile

TI = lethal dose in 50% of patients / therapeutic dose in 50% of patients
TI > 10 –> good safety profile.

Question 23

Empiric Tx for Meningtitis

Answer 23

Neonates = amp + gent
Adults/Kids = ceftriaxone + vanco
Add on ampicillin if age > 50, age < 2 yoa, or immunosuppressed.

Can add corticosteroid before or at first dose to reduce mortality

Chemo prophylaxis for N.meningitidies with rifampin 600 mg BID for 4 days or cipro 500 mg once

Tx 1-2 weeks. Listeria give for 3 weeks.

Question 24

Endocarditis

Answer 24

Native Value:
Strep = PNC G or ceftriaxone +/- gent
Staph = Naph, cefazolin, vanco if PCN allergy

Prosthetic valve - as above + gent or rifampin and extend duration > 6 weeks

Tx = 4-6 weeks.
Can use dapto for MRSA in native valve only

Question 25

Osteomylitis

Answer 25

If c-reactive protein is greater than 2, use IV abx

Naficillin, cefazolin, ceftriaxone, clinda, or vanco
If sickle cell - cover for salmonella with ceftriaxone or cipro/levo

Duration 6-8 weeks, if brucella 3 months

Question 26

Abx with thrombocytopenia risk

Answer 26

Vanco
Linezolid

Low platelets (< 150K)

Question 27

ICU Initiation of corrective insulin

Answer 27

2 BG readings > 180

Question 28

Hypertensive urgency/emergency

Answer 28

> 180/110 in both cases, emergency would include sx of end organ damage (AMS, low urine output, etc.)

Question 29

Preferred NSAIDS for cardiac / GI bleed risk

Answer 29

Celecoxib if GI bleed risk high
Naproxen if CVD risk high (on ASA)
Administer with PPI or misoprostol 800 mcg/day

Give ibuprofen 30 minutes after or 8 hours before ASA

Question 30

Upper GI bleed Tx

Answer 30

PPI 80 mg bolus + 8 mg/hr for 72 hours, endoscopic tx within 12-24 hours

Question 31

Long term abx in COPD

Answer 31

If on LAMA/LABA and eosin < 100 and former smoker
azithro 250 mg daily or 500 mg 3x weekly

Goal O2 sat > 88%

Question 32

Preferred controller inhaler in preg

Answer 32

budesonide

Question 33

CFR what for IRB?

Answer 33

CFR Title 21 Part 56