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Pharmacology > Pharm Exam 2 Questions > Flashcards

Pharm Exam 2 Questions Flashcards

1
Q

Does Astelin make you drowsy?

A

Yes ! Somnolence , give at HS

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2
Q

What is the first line tx for allergic rhinitis ?

A

Intranasal corticosteroids

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3
Q

What is the safest systemic decongestant?

A

Pseudo ephedrine

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4
Q

What type of antihistamine should not be given to elderly (ie, on BEERS LIST)?

A

1st generation antihistamines

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5
Q

In a child with urticaria weighing 25 kg what med should you give and what dose?

A

Benadryl 25 mg po now (1 mg/kg/dose)

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6
Q

What type of management should be used in URI in peds?

A

Symptom control, nonpharm; supportive

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7
Q

What drug is chemically similar to tetracaine?

A

Tessalon Perles

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8
Q

What type of pain management should be used in newborn getting a painful procedure?

A

Sucrose on paci, non-nutrient sucking

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9
Q

What pain reliever is associated with Stevens Johnson syndrome?

A

APAP

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10
Q

What medication would you prescribe for new onset chest tightness radiating down left arm while pt waiting to see cardiologist? How to take and how often to take?

A

Nitroglycerin SL or spray Q 5 minutes x3?

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11
Q

What is the pharmacological tx for heart failure stage II.?

A

ACE I AND BB (only time no BB is with HF stage IV)

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12
Q

In a pt with —– Adenosine is C/I

A

Pt with bronchial asthma adenosine is C/I

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13
Q

In a pt with ——- labetolol is contraindicated

A

Bronchial asthma

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14
Q

What labs are needed for a pt on Amiodarone?

A

EKG, make sure drug working, LFTS, TSH and pulmonary function test

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15
Q

In a pt with a fib what is an important pharm tx?

A

Anticoagulant ion

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16
Q

Which types of CCB worsens CHF.

A

Verapamil

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17
Q

Can Heparin be used safely in pregnancy?

A

Yes large molecule cannot cross placenta

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18
Q

What class of antihypertesive can cause a cough?

A

ACE-I

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19
Q

What class of drug is considered to be a cornerstone for pts in HF.

A

Beta blockers (and ACE-I)

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20
Q

What to teach pt about taking nitro SL.

A

drink water to help dry mouth

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21
Q

How to describe the pain or arthritis?

A

Somatic, inflammatory

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22
Q

What is the first priority when a pt complains of pain?

A

Etiology!

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23
Q

What is a side effect of Tramadol?

A

Sedation, Dizzy

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24
Q

Neuropathic pain can be treated with:

A

gabapentin, tricyclics

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25
Q

What does NP need to know when using Methadone?

A

Long half life, helpful in chronic pain, high doses needed, get EKG

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26
Q

What labs should be measured for a pt with high dose Ibuprofen?

A

Renal and LFT; monitor for GI Bleed

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27
Q

Difference between addiction and dependence?

A

Dependence is when withdrawal symptoms without ; addiction is psychological

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28
Q

Signs of Dig Toxicity?

A

N/V/D & halos

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29
Q

Why do post MI pts benefit from ACE-I?

A

Prevents remodeling

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30
Q

Why do older pts take ASA for cardio protective?

A

Thromboxane A 2 synthesis; prevents clots

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31
Q

Describe Nitrate tolerance

A

Tachyphlaxis; pt needs nitrate-free period. Pro-drug; needs glutamine to work, uses up all glutamine and body needs time to replenish

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32
Q

What drug is used after MI to prevent further MI?

A

BB

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33
Q

Name 3 vasodilating drugs

A

Nitrates, BBs, CCBs

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34
Q

What type of med is recommended for chronic, stable angina?

A

ACE-I’s

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35
Q

Drug of choice in angina

A

Nitrates

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36
Q

What to monitor carefully with pt on nitro

A

BP

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37
Q

Side effects of nitro

A

Flushing, HA, orthostatic hypotension, syncope, reflexive tachycardia

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38
Q

Use caution in pts taking nitro that have

A

Hx migraines

Hx orthostasis

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39
Q

Nitro interacts with….

A 
ETOH
Viagra
Heparin
ASA
Anticholinergic
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40
Q

Increased hypotensive effect of nitroglycerin with these meds:

A

BBs, CCBs, Haldol, Phenothiazines

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41
Q

Teach pt to do this when using nitro ointment:

A

Wash hands! Apply to non hairy areas and not at night.

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42
Q

Short acting nitro and long acting preps

A

Short: spray and SL
Long: ointment, patch, isosorbide dinitrate, isosorbide mono nitrate

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43
Q

Ranolazine/ Ranexa

A

Use caution in pts with QT prolongation;
$$$ but first line (newer) for chronic angina?
No effect on HR, BP but helps exercise

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44
Q

ACE-I’s

A

Recommended in chronic stable angina
Prevent MI/ death
Very effective in DM and pts with left ventricular dysfunction

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45
Q

ARB’s

A

Recommended in CAD, HTN and DM
Useful in pts with intolerant ACE-I’s
Or can be added to ACE-I in uncontrolled HTN Or insufficient vasodilation

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46
Q

ACE-Is and ARBs

A

Affect the renin angiotensin aldosterone system to decrease BP;
Decrease inappropriate remodeling of myocardial tissue after MI or in HF

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47
Q

Angiotensin II leads to…

A

Remodeling of myocardium ; hyper trophy and fibrosis ; ie the primary mechanism of HF “dead hamburger”

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48
Q

Examples of ACE-Is

A

Captopril
Lisinopril
Enalopril

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49
Q

ACE-Is are cornerstone for tx in

A

HF

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50
Q

ACE-I interactions

A 
ETOH
NITRATES
DIURETICS
PHENOTHIZAINES
OTHER ANTIHYPERTENSIVES
K SPARING DIURETICS/ K supplements
NSAIDS
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51
Q

ACE-I contraindications

A

Bilateral renal artery stenosis;
angioedema;
Cat C in 1st trip and Cat X IN 2nd and 3rd tri;
Pts with hyperkalemia, hepatic impairment

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52
Q

Adverse reactions of ACE-Is

A

Usually mild and transient
Cough (dry)
Hypotension (HA, dizzy, fatigue)
Rash

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53
Q

What is the drug of choice for exertion all angina?

A

Beta blockers

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54
Q

Beta blockers are useful in pts with

A

Resting tachycardia, hyperthyroidism

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55
Q

What is the MOA of BBs?

A

Decreased sympathetic nervous stimulation,
Decreased heart rate and contractility,
Decreased heart rate by increasing diastolic filling time,
Decreased myocardial workload by decreased oxygen consumption

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56
Q

Examples of Beta Blockers

A

Atenolol
Metropolol
Nadolol
Propranolol

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57
Q

BB’s: dose titration is based on…

A

Based On HR; titrate up until HR 50-60

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58
Q

Caution with BBs in these pts:

A

Asthmatics, and SSS (experience 2nd and 3rd degree blocks)

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59
Q

Side effects of beta blockers

A

Dizzy
Nightmares
Sexual dysfunction

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60
Q

VITAL pt teaching for BBS:

A

Do NOT stop BBs abruptly.

Report dizziness and orthostasis

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61
Q

MOA of CCBs

A

Calcium is crucial in contraction and excitation of cardiac muscles. 3 types of voltage channels.
Cardiac muscle is dependent o calcium to complete action potential.
CCBs close calcium channels to decrease HR.

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62
Q

What do CCBs do?

A

Reduce contractility,
Decrease CO,
Decrease requirement of myocardium

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63
Q

When are CCBs indicated?

A

They are first choice in pts who do not tolerate nitrates or BBs well.
Indicated for angina, HTN, and select tachyarrythmias

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64
Q

Unlabeled indications in CCBs

A

Migraine HA prophylaxis
Raynauds
Cardiomyopathy
Esophageal spasm

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65
Q

CCBs type I and II

A 
Type I: nondihydropyridines
Verapamil
Digitized
Type II: Dihydropyridines
Norvasc
Nifedipine
Nicaripine
Felopidine
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66
Q

Verapamil: avoid in these pts

A

HF pt

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67
Q

Precautions for CCBs

A

ONLY DILTIAZEM FOR immediately POST MI (no other CCBs immediately post MI)
Pts with SA/ AV NODE Disturbances
Pts with SBP

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68
Q

What is Coronary Steal Syndrome?

A

When the CCBs dilate the arteries but in areas of ischemia, arterioles already at max dilation, so blood is shifted away leading to increased myocardial damage

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69
Q

CCBs can be combined with —– in pts who are poor candidates for BBs

A

Nitrates

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70
Q

Adverse reactions of nifedipine

A

Reflexive tachycardia» increased incidence of mortality, MI, angina

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71
Q

SE of Verapamil

A

Constipation

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72
Q

CCBs: side effects

A

Flushing, HA, edema, dizzy, gingival hyperplasia

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73
Q

Combo of long acting nitrates and ——- are not used related to additive effect

A

CCBs

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74
Q

Aspirin is recommended

A

During MI, with stable or unstable angina

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75
Q

Aspirin has a lot of crossover with other drugs, including —– and can cause….

A

ETOH; GI bleed; make sure pts have neg guise

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76
Q

Multi drug therapy

A

Allows lower doses and can be more effective than single agent.
Decreased side effects and decreased risk hypotension

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77
Q

Heart failure- etiology

A

CAD

LVD dysfunction, systolic HF (progressive)

78
Q

Critical criteria for diagnosis of heart failure (MAJOR)

A 
MAJOR:
paroxysmal nocturnal dyspnea
Orthopnea
3rd heart sound
Increased jugular venous distant ion
On CXR: cardiomegaly, pulmonary edema
Wt loss > 4 kg in 5 d in response to treatment of presumed HF
79
Q

Critical criteria for diagnosis of heart failure (MINOR)

A 
Bilateral leg edema
Nocturnal cough
Dyspnea on normal exertion
Tachycardia (>120bpm) 
Hepatomegaly
Pleural effusion
80
Q

Diagnosis of HF requires that 2 major or 1 minor

A

….and not attributed to another condition

81
Q

Types of HF

A

Systolic: “thin weak”
Often after actute MI but can be nonishcemic cardiomyopathy, ETOH and drugs
Diastolic: “thick hard”
Inadequate relaxation, loss of muscle fiber, decreased elasticity, decreased CO, increased diastolic pressure.
Caused by uncontrolled HTN, hypothyroidism, hypertrophic and ischemic cardiomyopathy
**prevalent in elderly especially >70 yo

82
Q

4 classes of HF:

Stage I or A

A

A: at risk but no symptoms
HTN,CAD,DM
TX underlying lifestyle issue and HTN
AND /or: tx with short-acting ACEi - Captopril 6.25mg ( can switch to ARB if not tolerated)

83
Q

Stage II / B of HF

A

Structural CAD, NO Symptoms
Previous MI, LV systolic dysfunction, asymptomatic valvular disease
Tx= same as stage A, except that BBs and ACEi superior to monotherapy
Ex= metoprolol and ACEi
Unless C/I, give BBs to all pts with recent MI and LV DYSFUNCTION

84
Q

Stage III/ C

A 
SYMPTOMATIC! SOB, FATIGUE, DECREASED EX TOL
Known structural CAD
TX= ACEi 
BBs
 \+ DIG
\+diuretics
\+sodium reduced diet
85
Q

Digoxin

A

Cardiac glycoside; INHIBITS sodium ATPase
dose 0.125mg to 0.375mg QD
DOSE LOW GO SLOW

86
Q

Caution with —– and DIG

A

Antibiotics increase bioavailability&raquo_space; toxicity

87
Q

Half life of DIG

A

36-48 hours, longer in elderly

88
Q

DIG: use with caution in

A 
Elderly
AV block
Wt loss
Hypokalemia
Renal impairment
89
Q

Side effects of DIG:

A 
N/V
DIZZY
Halos (green yellow) 
Mental disorders
Dysrhythmias
SA block
Vasoconstriction
Ischemia
Thrombocytopenia
90
Q

Stage IV/ D HF

A 
REFRACTORY SX AT REST
MARKED SOB 
frequent hospitalizations
Need specialists
TX=
ACE I, BB, DIG, DIURETIC, LOW SODIUM DIET
\+mechanical assist devices
IV ionoptropic infusions for palpitations
hoSpice
91
Q

Reasons to anticoagulants

A 
A fib/a flutter
Mechanical valve
DVT
PE
clot prophylaxis
92
Q

CHAD VASC:

A 
Congestive HF
HTN
Age >75
DM
STROKE/TIA
VAscular disease
Age 65-74
Sex (female > risk)
Score of 2+ = 2-3% risk of CVA per year
93
Q

What is a common SE of Nasal Atrovent that pts don’t like?

A

Bad taste

94
Q

When dosing pain- start with….

A

Start with lowest dose

95
Q

When altering a RX for cardiac, change……

A

One med at a time.

96
Q

To monitor on Amiodarone:

A

TSH, LFT, PFT, EKG

97
Q

Dosing bendadryl

A

1mg/ kg/ dose

98
Q

How to treat bradycardia and tachycardia?

A

Only tx if symptomatic

99
Q

Nitrate tolerance:how to avoid

A

Nitrate-free period, preferably overnight

100
Q

What to do when starting someone on an ACEI

A

Get a baseline BMP

101
Q

Unstable angina needs to be evaluated in the…..

A

ER!

102
Q

Contraindications of BBS

A

Severe bradycardia or heart block; asthmatics (except Metoprolol)

103
Q

Adverse effects of CCBs

A

Verapamil» constipation;

Nifedipine can increase reflexive tachycardia and mortality

104
Q

BEST recommendation post MI:

A

BBs!

105
Q

BBs are the drug of choice in:

A

Exertional angina

106
Q

How to discontinue BBs

A

Taper dose!

107
Q

Do NOT use ——- in CHF related to…..

A

verapamil, STRONG NEGATIVE IONOTROPIC EFFECT

108
Q

Cornerstone of HF

A

ACEI

109
Q

Good for chronic stable angina

A

ACEI

110
Q

Drug interactions of ACEI’s?

A

Other hypotensive mess
k+ sparing diuretics
APAP

111
Q

ACEI’s are contraindicated in….

A 
Bilateral renal artery stenosis,
2nd and 3rd tri pregnancy (Cat x)
Hyperkalemia
Liver impairment
Angioedema
112
Q

When using Aldactone make sure to monitor

A

k+!

113
Q

BBs prevent…..after MI

A

Remodeling

114
Q

When to use Atropine?

A

Bradycardia

115
Q

ARBs and ACEI’s can increase this electrolyte so….

A

K+, so do not use with K soaring diuretic

116
Q

Do not use nitrates with….

A

CCBs

117
Q

Mainstay of angina

A

Nitrates

118
Q

High dose nitrate

A

Arterial dilation and decreased after load

119
Q

Low dose nitrate

A

Venous dilation and decreased preload

120
Q

All pts with LVD should be on….

A

ACEI

121
Q

Cornerstone of HF

A

ACEI

122
Q

Other mess that decrease cardiac remodeling

A

ARBs and ACEI

123
Q

If pt cannot tolerate ACEI csn be changed to…

A

ARB

124
Q

Ranexa considered first line for ……

A

CHRONIC angina.

125
Q

Ok to use Ranexa with this….but contraindicated in….

A

Ok to use with Viagra but contraindicated in renal and liver disease; contraindicated in QT prolongation

126
Q

This class of anti arrhythmic has greatest risk of pro arrhythmia, and anticholinergic effects

A

class I

127
Q

This class of antiarrythmics can prolong QT

A

class III

128
Q

INR goal ranges

A

2.0-3.0

129
Q

Who to anticoagulants

A

Pts with a fib, a flutter
DVT
PE

130
Q

CHADSVASC measures….and the score means…

A

Age, sex, hx of CHF, HTN, CVA, Thromboembolism,vascular disease and DM….score > 2 = great candidate for anticoagulation

131
Q

Anticoagulants vs antiplatelets

A

Anticoagulants slow clotting times. Examples- Heparin, Coumadin, Dabigatran (Pradaxa, acts on Thrombin), Xarelto and Eliquis (Rivaroxaban, Apixiban, acts on Factor Xa)

132
Q

Mnemonic for Class I-IV agents

“some block potassium channels”

A

Class I “Some” = S = Sodium

Class II “Block” = B =BBs

Class III “Potassium” = K+CBs

Class IV “Channels” = C =CCBs

133
Q

Anticoagulant safe in pregnancy

A

heparin

134
Q

Drug not to use in HF

A

Verapamil

135
Q

ASA inhibits

A

Thomboxane A2

136
Q

Digoxin

A

Has positive ionotropic effect, side effect =
Indicated in HF AND AFIB
caution in elderly, AV block, decreased K Ca or Mg, hyperthyroidism, and wt loss
SEs= dizzy, HA, N/V/D, halos, visual and mental disturbances

137
Q

Normal EF

A

60-65%

138
Q

Do mix Verapamil and….

A

diltiazem

139
Q

Adenosine, contraindicated in….

A

2/3 degree heart block, symptomatic Brady, ASTHMA, RAD, allergy

140
Q

Low Mag can lead to

A

Tornadoes or long QT

141
Q

Outpatient management of AFIB

A

Anticoagulation

142
Q

Risk with Pradaxa (Dabigatran):

A

Bleed!

143
Q

Astelin is a good option in a pt with….

A

BPH

144
Q

1st generation antihistamines- careful in pt with….

A

BPH

145
Q

First line for allergic rhinitis

A

Intranasal corticosteroids

146
Q

Tessalon Perles, how to take….

A

SWALLOW WHOLE DO NOT CHEW!

Contraindicated in anaesthesia

147
Q

Best nonpharm TX for neonate undergoing a procedure?

A

Sucrose

148
Q

Common SE of Nasal Atrovent that pts do not like?

A

Bad taste!

149
Q

Best way to to URI.

A

Tx Sx

150
Q

Safest nasal deongestant?

A

Pseudo ephedrine

151
Q

Which antihistamines are on BEERS list?

A

1st gen

152
Q

Codeine is black-boxed in….

A

Peds

153
Q

FDA recommends using measuring device….

A

Obtained with med at pharmacy

154
Q

Never give ASA topped recovering from…

A

Varicella or influenza

155
Q

What med is associated with Stevens Johnson Syndrome (and other skin eruptions)?

A

APAP

156
Q

APAP can be used at this age; Motrin after….

A

APAP= under 6 months, Motrin after 6 months

157
Q

ASA in peds is best used

A

For JRA

158
Q

Do not use EMLA > 1hour in neonate….

A

Risk of methylglobinemia

159
Q

Tolerance is

A

When body expects dose

160
Q

Dependence….

A

Can cause withdrawal. It is normal after use of drug over time.

161
Q

Addiction is….

A

A psychological dependence , misuse

162
Q

Pain Assessment scorecard

A 
P LACE
A MOUNT
I NTENSIFIERS
N ULLIFIERS
E FFECTS ON LIFE
D ESCRIPTION ( burning, dull, sharp etc)
163
Q

Rationale approach to pain management “TONI”

A

T REAT TREATABLE CAUSES
O PTIMIZE ANALGESICS
N ONPHARM MODALITIES
I NVASIVE PROCEDURES

164
Q

WHO Pain Ladder:

A

Ground level: MILD/mod: NONOPIOID
STEP ONE: MOD/ sev: PO opioid + NONOPIOID
STEP TWO: SEVERE/ persistent: RTC OPIOID + adjuvant meds

165
Q

What is KEY WITH chronic pain pts?

A

FOLLOW FOLLOW FOLLOW!

166
Q

Chronic pain management includes pain contract and…

A

Urine drug test, pill count etc

167
Q

which analgesic is good for someone with gastritis?

A

APAP

168
Q

Dose limits on APAP:

A

325 mg per tablet max; 4G QD max

169
Q

Biggest adverse reaction with APAP

A

Liver toxicity!!!

170
Q

Tramadol is …. Careful in….

A

Class by itself. Opioid agonist, serotonin and norepinephrine, careful in pts already on meds with these and HX of SEIZURES!

171
Q

Initiating opioids

A

Make sure tried everythingn else first….start low go slow

172
Q

Mr Jones 6/10 still with pain meds, not a candidate for corticosteroids…already on Percocet (short acting) what to do?

A

Consider long-acting pain med and breakthrough dosing

173
Q

When changing one opioid to another remember….

A

They are slightly different so start new opioid with slightly lower dose as they will be tolerant of previous meds and SEs but not new one.

174
Q

How to prescribe for breakthrough pain

A

20% of 24 hour dose of background med

175
Q

Transdermal Fentanyl- careful with

A

Elderly, malnutrition, poor hydration; heat affects patch.

Do normal po dose to give patch time to kick in.

176
Q

Know about method one

A

Long/ variable t 1/2, and can prolong QT.

GET BASELINE EKG!

177
Q

Starting pt on pain meds-

A

NSAIDS good place to start. Take with food or offer PPI, CAREFUL with renal/ liver….MISOPROSTOL- not ok in preg

178
Q

Weakest NSAID is…. To step up try….

A

Motrin. Try Naprosyn or Ketorolac.

179
Q

When are co analgesics used?

A

With bone pain.

180
Q

Careful with Lyrica in…

A

Pts with CHF. Can cause pulmonary edema.

181
Q

It’s line anticonvulsant for neuro pain

A

gabapentin (then Dilantin), start low go slow

182
Q

When to tell pt to take gabapentin

A

At night. Is sedating.

183
Q

Corticosteroids are great to help with inflammatory pain except in…

A

Diabetics.

184
Q

When using antidepressants for pain, careful of….

A

OD, anticholinergic SEs

185
Q

With opioids, manage constip ahead of time via…

A

Stool softeners, then lax, but no bulk-forming lax

186
Q

Always consider ——- interventions with ——- interventions in pain

A

NONPHARM , PHARM

187
Q

When to use Narcan

A

RR

188
Q

How to use Equianalgesic chart

A

Cut dose in 1/2 to 1/3 based on incomplete cross tolerance, ie, morphine 90mg» 60 mg

189
Q

FIRST PRIORITY WHEN PT ARRIVES IN PAIN

A

Assess!

190
Q

First line co-analgesic

A

gabapentin

Pharmacology (17 decks)

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