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Clinical Management exam I > Rx writting and Rashes > Flashcards

Rx writting and Rashes Flashcards

1
Q

steps for PA prescribing

A
  1. National Commission on Certification of Physician Assistants (NCCPA) - pass PANCE
  2. apply for state license
  3. apply for DEA license
  4. apply for mass controlled substance license (MCR)

optional DEA-X / MAT waiver optional 24 hours of training to prescribe addiction management meds

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2
Q

superscription

A

Identifying info of

patient and prescriber

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3
Q

inscription

A

name of the medication,
dose, quantity, ingredient, dosage form
(tabs, capsules, syrups)

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4
Q

subscription

A

Directions for use of

medication

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5
Q

signature

A

Provider name, signature,

number of refills

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6
Q

key elements of written rx

A 
 Prescriber
 Supervising physician
 Prescription
 Controlled Substance
 Brand/Interchange
 Patient
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7
Q

define
BID
TID
QID

A

BID -2x a day
TID- 3x a day
QID- 4x a day

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8
Q 
define 
QHS
QAM
QAC
Q4H
Q4-6 H
A

QHS - every bedtime
QAM - every morning
QAC - w/ meals
Q4H - every 4H

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9
Q

if prescribing PRN what must you also include

A

REASON “nausea” “pain” “insomnia”

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10
Q

when dispensing place a ___ before numeric value

A

#

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11
Q

JCAHO “do not use list”

A 
 U or u – unit
 IU – international unit
 QD/ QOD
 Always lead and never follow - we may write 0.5mg but do not write 5.0
 MS – write out Morphine Sulfate
 MgSO4 – write out Magnesium Sulfate
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12
Q

No prescription for a controlled substance listed Schedule ___ or ____ shall be filled
more than _____ after the date of issue and may not be refilled more than ____
times.

A

III or IV
6 months after date of issue
refilled more then 5 times

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13
Q

T/F

Schedule II prescriptions CAN be refilled.

A

CANNOT

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14
Q

T/F

DEA number must be listed on the narcotic/ scheduled II-IV prescriptions.

A

TRUE

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15
Q

name schedule I drugs

A

heroin
marijuana / THC
ecstasy
peyote

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16
Q

name schedule II drugs

A

HIGH potential for abuse

roducts with less than 15 mg of hydrocodone per dosage
unit (Vicodin, Norco)
• Cocaine , methamphetamine
• methadone
• hydromorphone (Dilaudid) / Oxycodone/ OxyContin
• meperidine (Demerol)

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17
Q

name schedule III drugs

A 
products with less than 90 mg of codeine per dosage unit
(Tylenol with codeine)
• ketamine
• anabolic steroids
• testosterone
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18
Q

name schedule IV drugs

A 
xanax
• soma
• Valium
• ativan
• ambien
• tramadol
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19
Q

name schedule V drugs

A 
cough preparations with less than 200 mg of codeine per 100
ml (Robitussin AD)
• Lomotil
• Lyrica
• parepectolin
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20
Q

name schedule VI drugs

A

abx

topical antifungals

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21
Q

verbal scripts are acceptable for schedule ___-____ but the prescription must be filled out w/ in ___ days

A

III-V

7 days

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22
Q

do pts need to present a hard copy of scripts for schedule III-VI

A

NO - just schedule II.

23
Q

schedule II scripts may only be issued for ____days EXCEPT _____ or ______ can be issued a script of up to ____ days when used to tx adha, narcolepsu

A

30 days
methylphen / dextroamphetamine

60 days

24
Q

Schedule III-IV: prescriptions 30-day supply - refilled up to ____ times within ____ months of the date of the prescription.

A

five times w/in 6 mo

25
Q

schedule II re-evaluate at least once every ___ months.

A

4 mo

26
Q

Schedule III-VI re-evaluate at least once every ___ months

A

6 mo

27
Q

May be prescribed for pain management w/ special licensing requirements.

A

Methadone,
Buprenorphine (Subutex),
Buprenorphine/Naloxone(Suboxone),

28
Q

primary survey of a pt assessment with SKIN findings

A

assess ABCs

29
Q

immediate transfer to hospital if:

A

Signs of airway obstruction – CRITICAL
◦ Anaphylaxis
◦ May initially complain of feeling tightness in throat
◦ Audible airway noises (stridor and wheezing)
◦ May need surgical airway

 Respiratory rate <10 or >29
Oxygen sat <92% on RA in a otherwise healthy person
Pulse <50 or > 120
Systolic BP <90
Glasgow Coma Score <12
30
Q

Normal Primary Survey but…

Admission and Close Monitoring

A

Suspected rash for meningococcal septicemia

Definite exposure to a trigger that previously lead to anaphylaxis

Self administration of epinephrine

A suspected anaphylactic reaction that has not fully developed

Cellulitis in a patient that appears toxic, or affecting periorbital tissues

31
Q

Secondary Survey

A

These patients are in no immediate danger so take a careful hx and exam to determine how to treat patient

Hx - onset of sx
rash - diffuse, localized, color
assoc sx - how does pt feel, N/V, neck pain, eye pain
progression of sx
previous hx
medication and drug hx
family and social hx
32
Q

Si/Sx of anaphylaxis

A

Oral: pruritus of lips, tongue, and palate and edema of lips and tongue; metallic taste in the mouth

Cutaneous: flushing, pruritus, urticaria, angioedema, morbilliform rash, and pilor erecti

GI: nausea, abdominal pain (colic), vomiting (large amounts of “stringy” mucus), and diarrhea

Respiratory (major shock organ): laryngeal: pruritus and “tightness” in the throat, dysphagia, dysphonia and hoarseness, dry “staccato” cough, and sensation of itching in the external auditory canals; lung, shortness of breath, dyspnea, chest tightness, “deep” cough, and wheezing; nose, pruritus, congestion, rhinorrhea, and sneezing

Cardiovascular: feeling of faintness, syncope, chest pain, dysrhythmia, hypotension

Other: periorbital pruritus, erythema and edema, conjunctival erythema, and tearing; lower back
pain and uterine contractions in women; aura of “doom

33
Q

criteria for dx anaphylaxis

A

Highly likely when 1 of these 3 criteria are fulfilled:
(Syx of Shock, Respiratory distress, Skin)

two or more occur rapidly
involvement of skin-mucosal tissues
resp compromise w/ assoc end organ dysfunction
reduced bp (infants / children with 30% decrease in systolic BP)

34
Q

what is considered reduced BP in pts w/ suspected anaplyaxis

A

30% decrease in systolic BP

35
Q

tx of pediatric anaphylaxis

A 
assess ABC
IM adrenaline
O2 / cardiac monitor 
Normal saline "wide open"
nebulized adrenaline 
hydrocortisone
diphenhydramine
vasopressors / IV adrenaline

observe for at least 4-8 hours

36
Q

how many refills in an epi pen jr

A

2 pack

11 refills

37
Q

how toes epi work to tx anaphlyaxis

A

Works to increase peripheral vascular resistance and reverse peripheral vasodilation and decrease angioedema and urticaria

38
Q

tx of contact dermatitis

A

topical steroids
abtihistamines (H1 blockers)
topical immunemodulators
abx

systemic steroids
phototherapy

39
Q

when are super-high potency topical steroids used

A

used for severe dermatoses over non-facial and
non intertriginous areas.

Scalp, palms, soles, thick plaques on extensor
surfaces

<4 wks

40
Q

when are medium-high potency topical steroids used

A

Class II-V mild to moderate non-facial and non
intertriginous areas. OK to use on flexor surfaces for short periods

<6-8 wks

41
Q

when are low potency topical steroids used

A

Larger areas and thinner skin such as face, eyelid and
genitals.

1-2 wks on face

42
Q

work-up of a rash

A
  • CBC – Leukocytosis, Thrombocyopenia
  • Mineral Oil mount – Scabies
  • KOH scrapings – Dermatophytes
  • Skin Biopsy
43
Q

what are the 3 types of skin biopsys

A

shave
punch - dx rashes
excision - cancer

44
Q

how do we tx drug eruption rashes

A

remove offending agent
antihistamines
topical steroids BID (hydrocortisone, desonide)
oral prednisone

45
Q

Presented with well demarcated erythematous plaques with an overlying silvery scale on extensor surfaces

A

chronic plaque psoriasis

46
Q

tx of chronic plaque psoriasis

A

Limited Dz: Topical Steroids (Class I) and Vitamin D Analogs (Calcitriol)

Severe Disease: Systemic Rx such as Methotrexate and Biologics (DMARDs)

47
Q

Erythematous annular plaque with peripheral scale and central clearing

A

dermatophytoses / tinea

48
Q

t/f

hair and nail infections respond well to topical antifungals

A

No usually need ORAL

49
Q

most commonly used topical antifungal

A

Nystatin, most commonly used topical therapy, is a polyene drug that is not absorbed by the GI tract

three formulations: 
oral
suspension
ointment
powder.
50
Q

tx for candida and dermatophytes

A

imidazoles

ketoconazole
exonazole
clotrimazole
micoxonazole

51
Q

Allylamines are (Worse / Better) for treating dermatophytes than Candida

A

BETTER

Naftifine
Terbinafine
Butenafine

52
Q

best antifungal against candida

A

polyenes - nystatin

53
Q

tx for tinea pedis

A

Topical Terbinafine or miconazole cream.

◦ Apply to affected area BID for 4-6 weeks

Clinical Management exam I (4 decks)

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