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leik book Flashcards

1
Q

ace I (prils) enalapril-vasotec, catopril-capoten dont combine with

A

K, sprinolactone (k sparring diuretic) or Arbs (rtans- valsartan-divan, losartan-cozarr

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2
Q

beta blocker contraindication

A

severe lung disease and second or third degree block

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3
Q

inr less than 5 with no bleed

A

omit one does and or reduce standing dose rrecheck in 2 weeks

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4
Q

thiazide diuretics - HCTZ contraindicated in

A

sulfa allergy (lasix and bumex also contraindicated

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5
Q

thiazide diuretecs uniqily good for

A

pts with HTN and osteoperosis

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6
Q

lood diuretics and aminoglycosides

Gentamicin (generic version is IV only)
Amikacin (IV only)
Tobramycin.
Gentak and Genoptic (eye drops)
Kanamycin.
Streptomycin.
Neo-Fradin (oral)
Neomycin (generic version is IV only)
A

ototoxicity

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7
Q

preferred antihypertensives for DM or Kidney disease

A

ACEI - prils

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8
Q

dry cough first few months of prils treatment

A

switch to ARB (artan)

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9
Q

dont use ccb’s

Norvasc (amlodipine)
Plendil (felodipine)
DynaCirc (isradipine)
Cardene (nicardipine)
Procardia XL, Adalat (nifedipine)
Cardizem, Dilacor, Tiazac, Diltia XL (diltiazem)
Sular (Nisoldipine)
Isoptin, Calan, Verelan, Covera-HS (verapamil)
A

in CHF or bradycardia

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10
Q

macrolides

erythromycin, azithromycin, clarithromycin cover

A

cover Gram plus- think Staph areus, and strep pyrogens, as well as atypicals like mycoplasma CHLAMYDIA

watch out for
gi distress
ototoxicity, cholestatic jaundice, QT PROLONGATION

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11
Q

erythromycin (macrolide) gram + side effects

A

gi side effects are very common, if you must use a macrolide (atypical bacteria) switch to azithromycin (z-pack), or clithromycin (biaxin)

may prolong INR with coumadin same for clarithromycin

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12
Q

cephalosporins- beta lactams

first generations- Ancef.
cefadroxil.
cefazolin.
cephalexin.
Duricef.
Keflex.
Kefzol
A

gram positice cocci - group A strep, staph aeurus, not good against beta lactam producers and MRSA though,

not great with PCN allergy, high chance of cross sensitivity

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13
Q

2nd generaton cephalosporins are broad spectrum

Ceclor (DSC)
cefaclor.
cefotetan.
cefoxitin.
cefprozil.
Ceftin.
cefuroxime.
Cefzil.
A

good agains gram Plus- streptococcus pneumoniea and gram negative like haeophilus influenae and moraxella catarrhalis like rinosinusitis and otitis media

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14
Q

rocephin (cephtriaxone) 1st gen cephalosporin use

A

250mg IM for gonorrhea

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15
Q

MRSA skin boils or abcesses frist line

A

bactrim ds, doxy or mino BID AND cindamycin, for 5-10 days

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16
Q

if PCN allergy switch to

A

azithromycin (brand name Zithromax),
clarithromycin (brand names Klacid and Klacid LA),
erythromycin (brand names Erymax, Erythrocin, Erythroped and Erythroped A),
spiramycin (no brand), and.
telithromycin (brand name Ketek).

MACROLIDES

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17
Q

avoid ——— in mono cause it causes a rash not realted to alllergy use——- instead and ——- with allergy

A

amoxicilin , penicillin VK, macorlides

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18
Q

concern for candida vaginitis with ammoxicilin -

A

reccomend probiotics and or yogurt

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19
Q

floriquinilones black box warning

ciprofloxacin (Cipro)
levofloxacin (Levaquin/Quixin)
gatifloxacin (Tequin)
moxifloxacin (Avelox)
ofloxacin (Ocuflox/Floxin/Floxacin)
norfloxacin (Noroxin)
A

achillies tendon rupture, dc if sore, avoid strenous activiy

also avoid use in HYPO mag or K and with other QT prolonging agents cause of torsades

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20
Q

best drug for pseudomonas aeruginosa (gram neg)

A

ciprofloxacin

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21
Q

sulfa drug list - good against / contraindications
Gantrisin (sulfisoxazole)
Bactrim or Septra (trimethoprim and sulfamethoxazole)
Sulfadiazine.
Azulfidine (sulfasalazine)
Zonegran (zonisamide)

A

gram neg (ecoli, klebsiella, H influenzae G^PD anemai, third trimester,

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22
Q

drugs most likely to cause stevens johnson

A

The medicines that most commonly cause Stevens-Johnson syndrome are:
allopurinol.
carbamazepine.
lamotrigine.
nevirapine.
the “oxicam” class of anti-inflammatory drugs (including meloxicam and piroxicam)
phenobarbital.
phenytoin.
sulfamethocazole and other sulfa antibiotics.

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23
Q

stevens johnson treatment

A

Stopping the medication that has caused the problem
Replacing electrolytes with intravenous (IV) fluids
Using non-adhesive dressings
Using high-calorie food, possibly by tube-feeding, to promote healing
Using antibiotics when needed to prevent infection
Providing pain relief medications
Treating in an intensive care or burn unit in a hospital
Using specialist teams from dermatology and ophthalmology (if eyes are affected)
In some cases, treating with IV immunoglobulin or amniotic membrane grafts (for eyes)

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24
Q

UTI on comadin

A

dont give bactrim- increased bleeding

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25
Q

pregnant with UTI

A

amoxicillin (pcn) or kephlex- cephalosporin

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26
Q

asymptomatic anemia african american background, had a sulfa drug or ate fava beans- is jaundice and hemolysis-

A

G6PD deficiency

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27
Q

first and second most cause of allergic drug reactions

A

first is penicillins and cephalosporins,

second are sulfonamide ABX

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28
Q

TMP SMX bactrim (sulfonamide) DS BID is used to profolax

A

PCP in hiv patients andformrsacellulitis

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29
Q

macrolide alternative with allergy

A

doxycycline or quinalone levaquin,avelox

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30
Q

COPD order of chow

A

SABA - albuterol or levabuterol or Short acting anticholonergic- ipratroprium

then combo _combivent
then LABA (salmeterol
or long acting anticholonergic (Ipratropium (Atrovent)
Tiotropium (Spiriva)

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31
Q

pack year calculation

A

packs per day x years

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32
Q

H1 blocker or antihistimie in elderly

A

use lortadine (claritn) not benadryl

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33
Q

long standing HIVES (chronic urticaria)

A

zyrtec is more potent and long acting works well for acute hives too

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34
Q

dont use robitussin dextromethorphan

A

with 14 days of MAOI inhibitors

rasagiline (Azilect),
selegiline (Eldepryl, Zelapar),
isocarboxazid (Marplan),
phenelzine (Nardil), and.
tranylcypromine (Parnate).
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35
Q

decongestants (sudafed, pseudoephedrine) and phenylephrine not to be used when pt has had

A

CAD, MI, angina

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36
Q

avoid Nsaids in

A

heart failure, severe heart disease, GI bleed, last three months of preggers, severe renal disease

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37
Q

ketorlac or toradol max days of use

A

5

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38
Q

ketorlac or toradol contraindications

A

before surgery, ASA, peds, active or recent GI bleeds, stroke, Labor or delivery

39
Q

ACS ASA

A

160-325chew non enteric coated tab

40
Q

max max tylenol dose

A

3,250 in 24 hrs

41
Q

avoid tylenol

A

etoh, liver disease, chronic hep BCD

42
Q

asa symptom to dc with

A

tinnitus could signa asa tox

43
Q

dig and the eyes

A

yellow and green vision, halos if blood level too high

44
Q

theophylinne level

A

5-15mcg/ml suspect tox with persistant emissi avoid in BPH causes retention, avoid other stims lots of drug reactions

45
Q

preggers X

A

finesteride, prosscar, isotretinoin (acutain) coumadin, cytotec Misoprostol, androgenic hormones- birthcontrol or hormone replacemt testosterone, live virus vacccines (measles, mumps, runellla, varicella, rotavirus, flumist) thalidomide, DES methimzaole

46
Q

prescription pad info

A

name/designtion/license number/NPI
supervising doc name, designation-not all states
clinic address and phone number

47
Q

on the script

A

date, name and address of pt
drug name, dose, for, freq, duration
directions for use, quantities in number and written form of refill

contorlled durgs must have DEA number
schedule II handwritten or typed on tamper proof and MANUALLY signed, cannot be called in

48
Q

5 rights for prescriptions

A 
patient
drug
dose
time
route
49
Q

sqript method preffered by medicare and medicaid

A

e-prescribing

50
Q

leading cause of death all comers

A
  1. heart disease
  2. cancer
  3. chronic lower respiratory disease
51
Q

leading cancer killer

A

lung cancer

52
Q

leading cause of cancer death in man

A

lung
prostate
colorectal

53
Q

leading cause of cancer death in women

A

lung
breast
colorectal

54
Q

leading cause of death in adolescents

A

accidents- 39.% MVA is most common
suicide 16%
homicide 14% non fatal and fata violence is highest in this group

55
Q 
leading cause of death 
birth to one year 
1-44 
45-64
65
A

birth to one year- congenital malformaitons 20%
1-44 unintentional injury
45-64- cancer
65 heart disease

56
Q

most common or highest prevelance cancer

A

skin cancer

57
Q

most common skin cancer

A

basal cell

melanoma causes the most deaths

58
Q

men cancer prevelance vs mortality

A

prostate most

lung deadliest

59
Q

women cancer prevelance vs mortality

A

breast most

lung deadliest

60
Q

most common cancer in KIDS

A

ALL 34% of cancers

61
Q

primary prevention oddball

A

asa for primary preventon of cvd and colon ca in adults age 50-59 with 10%or higher risk

62
Q

secondary prevention is early detection

A

screening tests- pap, mamo, CBC for anemia
cage questionaire, testing for hep C in high risk person, asa for second stroke revention, MI, TIA, stroke to prevent future stroke

63
Q

tertiary prevention, prevents progression, involves rehab and support groups, education on equipment

A

Support groups
education for pts iwth preexisting disease,
rehab
treatment of hep C
daily asa for preventing another heart atack

64
Q

baseline Mamogram

A

start at age 50 and repeat q2 till 74

high risk BRCA start earlier in the 40s

65
Q 
cervical ca screening 
21-65
30-65
hysterectomy with cervix removal
over 65 with adequate prior screen
A

21-65 baseline at 21 then q3
30-65 or start at 30 with cytology + HPV every 5 years
hysterectomy with cervix removal stop if not due to ca
over 65 with adequate prior screen no more with not high risk

do not apply for hiv+ or DES diethylstillbestrol exposure or known lesion

66
Q

colorectal ca screen

A

start at50 till 75
76-85 usually against but might be special cosiderations
over than 85 not reccomended

67
Q

colorectal screen how

A

poop samples x3 annually
flex sig or ct colonography Q5
colonoscopy Q 10

68
Q

lipid screen and statin starup

A

lipid profile after 9 hour fast

when all criteria are met start statin
age 40-74
one or more CVD risk factors- dyslipidemia, DM, HTN, smoker
10 year CV risk of 10% or greater

69
Q

lung ca screening

A

30 pack year active orhave quit in the last 15 years

70
Q

ovarian ca screen

A

routine is not reccoended but

with brca one or two
refer to specialist
trasvag ultrasound, or serum cancer antigen ca-125
starts at 30 years of age or 5-10 years of earliest family diagnosis

71
Q

AAA screening rec

A

men 65-75 who have smoked

ultrasound

72
Q

blood pressure screen

A

start at 18 get BP outside of clinical setting b4 starting treatment

73
Q

DM 2 if obese screen

A

at 40 to 70

74
Q

obeisity screen age

A

6-18

75
Q

osteoperosis screen age

A

65 or younger if chronic steroids or ris equal to tht of 65 year od white woman

76
Q

breast ca risk factors

A 
OLDER THAN 50- most commoon
previous history of breast ca
two or more first degree relatives
obeisity
early menarche, late menopause
77
Q

hep b vaccine

A

3 doses at birth, 1 and 6 months
min of 4 weeks between doses,
do not restart just catch up got one missed two then give two then three.

78
Q

flu vax

A

takes 2 weeks to kick in
if eggg allergy only experiences hives they can still get the vax
preggers can get it

79
Q

flu vax contraindications

A

under 6 months of age

life threatinging egg allergy

80
Q

tdap vax

A

q ten for life

boost with dirty wound if last was more than 5 years

81
Q

wound with unknown tdap vax status

A

give tdap and tetanus immunoglobulin injection asap

82
Q

high risk tetanus wounds

A

crush injury, soil inwound, puncture, devitalized tissue

83
Q

ppsv23 who gets

A

adults 65 or older or younger at high risk

its 50% to 85% efffective

84
Q

PCV13 or prevnair

A

kids older than 5 at high risk or also works for 65 plus

85
Q

at 65 with no previous coverage

A

give prevnair PCV13 and then PPSV23 one year later

86
Q

high risk pneumococcal infection group

A 
chronic diseases  ETOH, DM
CSF leaks, asthma, hepatitis
renal disease 
sickle cell, crappy spleen
malignancy or blood cancers
history of organ or marrow transplant
87
Q

if u got pneumovax before 65

A

give booster dose 5 years after first dose

88
Q

zostervax is live who gets

A

at 60
past history of shingles IS NOT a contraindication
can get it if they never had chickenpox
acyclovir 24hrs pre or 14 days post can lower response
may excerbate asthma or polymyalgia rheumatica

89
Q

shingles risk factors

A

older than 60
immunocompromised
leukemia lymphoma

90
Q

contraindications for shingles zostervax

A

preggers or breastfeeding
leukemia lymphoma, or malignancies of bone or bone marrow
immynocompramised, high dose steroids, over two weeks, anti tumor necorsis factor meds like etanercept

91
Q

if u never had chicken pox can u get shingles

A

no

92
Q

how long is shingles contageous

A

contact precautions till all skin lesions are dry and crusted

93
Q

varicella vax

A

first dose is 12-15 months

94
Q

acceptable proof of varicella immunity

A

documentation or 2 doses of vax
written diag of shicken pox or shingles
positive lab varicella titer (IgG elisa

nobody born before 1980 should get it

issues and policy (22 decks)

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