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AANP certification exam > Chp 3 Pharmacology Review & some OB > Flashcards

Chp 3 Pharmacology Review & some OB Flashcards

1
Q

One of the most common drug interactions in the primary care area is between warfarin and ______.

A

Bactrim

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2
Q

When a drug is swallowed, it is absorbed through the _______ _________ where it enters the _______ circulation

A

small intestine

portal

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3
Q

Inside the liver, the _______ system is responsible for the biotransformation of drugs, alcohol, herbs, foods, and toxins.

A

CYP450

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4
Q

Drugs that have extensive ______-_____ ________ cannot be given by the oral route simply b/c there is not enough of the active drug left.

A

first-pass metabolism

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5
Q

Drug metabolism:
The most active organ is the ______.
“Induced” means _______ drug ______.

A

liver

increased metabolism

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6
Q

Drug metabolism:

Other organ systems involved in the biotransformation of drugs are the _______, __ ______, and the _____.

A

kidneys, GI tract lungs

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7
Q

Most drugs are excreted by both the ________ system and the _________.

A

hepatobiliary

kidneys

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8
Q

The average amount of a drug in the blood after a dose is given - It is a measure of the availability (bioavailability) of a drug after it is administered:

A

“Area under the curve”

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9
Q

The lowest concentration of an antibiotic that will inhibit the growth of organisms (after overnight incubation):

A

Minimum inhibitory concentration

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10
Q

The highest concentration of a drug after a dose:

A

Maximum concentration

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11
Q

The lowest concentration of a drug after a dose:

A

trough (minimum concentration)

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12
Q 
Problematic drugs that are responsible for a large number of drug-drug interactions:
M
A
C
C
A

Macrolides
Antifungals
Cimetidine (Tagamet)
Citalopram (Celexa)

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13
Q 
Problematic drugs (potent inhibitors - slow down drug metabolism - increasing drug concentration) that are responsible for a large number of drug-drug interactions:
M
A
C
C
A

Macrolides
Antifungals
Cimetidine (Tagamet)
Citalopram (Celexa)

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14
Q

Narrow therapeutic index drugs: (With These Drugs, Look, Listen, Do Count)
W
T
D

L
L
D
C

A

Warfarin
Theophylline
Digoxin

Lithium
Levothyroxine
Dilantin
Carbamazepine

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15
Q

Digoxin:

Monitor EKG and ________ levels

A

electrolyte

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16
Q

Lithium:

Monitor blood levels and ________

A

TSH

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17
Q

Lithium:

Monitor blood levels and ________ (risk of _____)

A

TSH; hypothyroidism

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18
Q

For consistently stable INRs, check them every __ to _ weeks up to every ____ weeks

A

2 to 4

12

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19
Q

For a single out of range INR equal to or less than 0.5 below or above therapeutic range (2 to 3), experts suggest ______ current warfarin dose and retesting INR within ____ to ____ weeks

A

continuing

1 to 2

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20
Q

INR of less than 5 with no signifiant bleeding risk:

Omit ____ dose and/or ______ maintenance dose slightly; recheck INR

A

one; reduce

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21
Q

Warfarin
One missed dose:
Take the dose as _______ ______ possible on the _____ day.
Do / do not double the dose the next day

A

soon as
same

Do NOT

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22
Q

Vitamin K:

The ACCP advises ________ routine vitamin K1 supplementation

A

against

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23
Q

High intake of Vitamin K will ______ anticoagulant effect of warfarin (will ______ INR)

A

reduce

decrease

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24
Q

Warfarin
Avoid ________ or limit to no more than one to two servings occasionally; Increases risk of bleeding even if INR is in target range

A

drinking

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25
Q

Warfarin - Adverse Reaction
“_______ ____ syndrome”
_______ ______ located in subQ fat, breasts, extremities, trunk (within first few days of receiving large doses or warfarin)

A

purple toes

skin necrosis

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26
Q

Warfarin:

After warfarin is DCd, anticoagulant effects persist for _ to ____ days

A

2 to 5

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27
Q

Warfarin:

_____ patients may require lower starting and maintenance doses of warfarin

A

Asian

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28
Q

Warfarin:
Persons older than _____ years are more likely to have large increases in INR (after dose is increased) compared with younger patients

A

60

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29
Q

Warfarin:

INR values lower than ______ increase stroke risk sixfold

A

2.0

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30
Q

Warfarin - Adverse reactions

_________, _____ oil, and _______ oil also have high levels of vitamin K

A

mayonnaise, canola, soybean

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31
Q

Thiazide diuretics:

Are for HTN, ______, edema, ______ _______

A

HF; diabetes insipidus

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32
Q

Thiazide diuretics:

are for HTN accompanied by _______

A

osteopenia (or osteoporosis)

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33
Q 
Thiazide diuretics:
Include:
H\_\_\_\_\_\_\_
I\_\_\_\_\_\_
C\_\_\_\_\_\_
A

HCTZ
Indapamide
Chlorthalidone

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34
Q

Thiazide diuretics:

Do not combine with ______

A

Lithium

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35
Q

Thiazide diuretics:

Contraindication is a _______ allergy

A

sulfa

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36
Q

Thiazide diuretics: Adverse effects:

Elevates plasma _________

A

glucose

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37
Q

Thiazide diuretics: Adverse effects:

Elevates ______ and ________

A

cholesterol and LDL

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38
Q

Thiazide diuretics: Adverse effects:

Elevates ______ ______ and can therefore precipitate a gout attack

A

uric acid

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39
Q

Thiazide diuretics: Adverse effects:

________ (severe muscle weakness, arrhythmias

A

hypokalemia

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40
Q

______ is longer acting and more “effective” than HCTZ and is preferred by JNC-8

A

chlorthalidone

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41
Q

Patients with both HTN and _________ have an extra benefit from the thiazides

A

osteoporosis

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42
Q

thiazide diuretics reduce ________ excretion by the kidneys and stimulate _______, helping build bone.

A

calcium

osteoblasts

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43
Q

Patients with serious ________ allergies should avoid thiazide and _____ diuretics. Potassium sparing diuretics, such as ______ and __________, are the alternative options for these patients.

A

sulfa
loop
triamterene and amiloride

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44
Q

Potassium-sparing diuretics:
Include ________ and _______
Combination: _______ and HCTZ

A

triamterene; amiloride

triamterene (dyazide)

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45
Q

Potassium-sparing diuretics:
BLACK BOX WARNING:
__________ which can be fatal and risk is higher with renal impairment, diabetes, elderly, severely ill

A

hyperkalemia

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46
Q

Potassium-sparing diuretics:

Monitor serum _______ (baseline, during, dose changes, illness)

A

potassium

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47
Q

Mineralcorticoid receptor antagonists:

_________ & _________

A

spironolactone; eplerenone

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48
Q

spironolactone: for HTN, _____, ______

A

HF, hirsutism

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49
Q

Mineralcorticoid receptor antagonists:
Avoid giving ________ supplements.
Avoid giving salt substitutes that contain ______.

A

potassium; potassium

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50
Q

Mineralcorticoid receptor antagonists:

Be careful with combos of ______, _______, or ______ which increase risk of hyperkalemai

A

ACEIs; ARBs, NSAIDs

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51
Q

Mineralcorticoid receptor antagonists:

Avoid with severe ________ disease

A

renal

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52
Q

Spironolactone adverse effects:

______ and _______

A

gynecomastia (13%) and hyperkalemia

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53
Q

Spironolactone BLACK BOX WARNING:

Increased risk of both _______ and ______ ______

A

benign and malignant tumors

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54
Q

Loop diuretics:
Are for ______ from _____ failure
_______
______ disease, and HTN

A

edema; heart
cirrhosis
renal

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55
Q

Loop diuretics are excreted via the loop of Henle of the kidneys and are ______ ______ than HCTZ

A

more potent

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56
Q

Loop diuretics:

Include _____, _______

A

Lasix; Bumex

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57
Q

Loop diuretics are _____ _________ than thiazides but with shorter duration of action

A

more potent

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58
Q

Loop diuretics:
BLACK BOX WARNING:
Excessive amounts of furosemide may lead to profound ________; medical supervision required, individualized dose schedule

A

diuresis

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59
Q

Loop diuretics:

Contraindication is a _________ allergy

A

sulfa

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60
Q 
Loop diuretics:
Adverse effects:
H
O
P
E
A

Hypovolemia/hypotension
Ototoxicity
Pancreatitis, jaundice, rash
Electrolytes (hypokalemia, hyponatremia, hypomagnesemia, low levels of chlorine)

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61
Q

Beta blockers:

Can be used as adjunctive treatment for __________/_______ to decrease heart rate and anxiety

A

hyperthyroidism / thyrotoxicosis

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62
Q

__________ & _________ are noncardioselective beta blockers (blocks beta-1 and beta-2

A

Propranolol & carvedilol

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63
Q

Cardioselective beta-blockers are more potent because they block beta-__ receptors, which are found mainly in the _________

A

1

heart

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64
Q

Cardioselective beta blockers:

Examples are __________ and _________

A

atenolol

metoprolol

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65
Q

timolol eye drops are for ________

A

glaucoma

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66
Q

beta blockers - contraindications:
A______ (causes ________)
B______
C______

A

Asthma bronchoconstriction
Bradycardia or or AV block
COPD (incl. chronic bronchitis and emphysema)

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67
Q

Beta blockers: Adverse effects
B
B
B

H
E
D

A

bronchospasm
bradycardia
blunts hypoglycemic response (warn diabetics)

HF
Erectile dysfunction
Depression, fatigue (be careful with elderly)

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68
Q

Beta blockers block beta-_____ receptors in the heart and beta-_____ receptors in the lungs

A

1

2

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69
Q

Ace Inhibitors and Angiotensin Receptor Blockers:

Help improve __________ and survival post-MI

A

LVEF

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70
Q

Ace Inhibitors and Angiotensin Receptor Blockers:

These are the preferred agents for patients with _________-

A

HFrEF

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71
Q

Ace Inhibitors and Angiotensin Receptor Blockers:
Are Category ______ (first trimester) and
Category ____ 2nd to 3rd trimesters

A

C

D

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72
Q

Ace Inhibitors and Angiotensin Receptor Blockers:

____________ is a potent vasoconstrictor

A

Angiotensin II

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73
Q

ACE inhibition blocks conversion of ________ to ________

A

Angiotensin I to Angiotensin II

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74
Q

ARBs block __________

A

Angiotensin II

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75
Q

Ace Inhibitors and Angiotensin Receptor Blockers:
BLACK BOX WARNING
ACEIs can cause death/injury to the fetus during the _____ and ____ trimesters, so DC ACEIs and ARBs immediately if pregnant

A

2nd and 3rd

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76
Q

Ace Inhibitors and Angiotensin Receptor Blockers:
Contraindications:
_________ _________

A

hereditary angioedema

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77
Q 
Ace Inhibitors and Angiotensin Receptor Blockers:
Adverse effects:
Angioedema and anaphylactoid reactions
ACEI cough
\_\_\_\_\_\_\_\_
A

hyperkalemia

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78
Q

Direct Renin Inhibitor:

_______ blocks the _________ action of renin

A

Tekturna; catalytic

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79
Q

JNC-8 does not recommend ________ as initial treatment for HTN

A

Tekturna

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80
Q

_______ and _______ are preferred drugs for HTN in diabetics (diabetic nephropathy) and for patients with _______

A

ACEIs and ARBs

CKD

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81
Q

ACEIs and ARBs:

Avoid using salt substitutes that contain ________

A

potassium

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82
Q

Ace Inhibitors:

_________ is associated with agranulocytosis, neutropenia, leukopenia. Monitor ______.

A

Captopril

CBC

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83
Q

_______ and ______ are excreted in breast milk (breastfeeding mothers should avoid them)

A

ACEIs and ARBs

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84
Q

Calcium channel blockers:

HTN, angina, __________, ___________ (first-line)

A

arrhythmias, Raynaud’s

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85
Q

Calcium channel blockers:

Verapamil - do not mix with ________ and ________ (drug interaction)

A

erythromycin and clarithromycin

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86
Q 
Calcium channel blockers:
Contraindications:
A
B
C
A

AV block
Bradycardia
CHF

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87
Q

Calcium channel blockers:
Be careful/limit use of short-acting CCBs such as ________, as it increases mortality. Long-acting CCBs show no increased risk.

A

nifedipine

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88
Q 
Calcium channel blockers:
Adverse effects:
H\_\_\_\_\_\_\_ (He)
P\_\_\_\_\_\_\_\_(Put)
B\_\_\_\_\_\_\_\_(Back)
H\_\_\_\_\_\_\_\_(His)
C\_\_\_\_\_\_\_\_\_(Crazy)
H\_\_\_\_\_\_\_\_\_(Hair)
A

Headache (vasodilation)
Peripheral edema (not due to fluid overload)
Bradycardia
HF and Heart block
Hypotension
Constipation - the most commonly reported side effect

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89
Q

Alpha-blockers:

For HTN with coexisting _________

A

BPH

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90
Q

Alpha blockers are initial therapy for symptomatic ______

A

BPH

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91
Q

Alpha blockers are initial therapy for symptomatic ______

Terazosin, doxazosin

A

BPH

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92
Q

Alpha blockers:

________ 1 mg PO at bedtime

A

Terazosin

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93
Q 
Alpha blockers:
Adverse effects:
P
O
D
D
A

Priapism (Flomax)

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94
Q 
Alpha blockers:
Terazosin
Doxazosin
tamsulosin
Do not give during \_\_\_\_\_\_ / \_\_\_\_\_\_\_ surgery (floppy iris syndrome_
A

cataract / glaucoma

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95
Q

Alpha blockers:

These are not a first-line choice except for males with both ________ and _________

A

HTN BPH

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96
Q

Alpha blockers:

Potent vasodilator. Common side effects are _______ and __________.

A

dizziness

hypotension

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97
Q

alpha blockers:

Give at _________ at very _____ dose and slowly titrate up. Careful with frail elderly due to risk of syncope and falls.

A

bedtime

low

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98
Q

Some experts recommend taking some antihypertensives (except diuretics) in the __________.

A

evening

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99
Q

Tetracyclines:
may cause permanent _________ of ________ and ______ defects if taken during the last half of pregnancy, in infancy, or by children younger than 9 years of age.

A

discoloration; teeth

skeletal

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100
Q

Tetracyclines:

Treat acne starting at age _____ to ______. By this age, all permanent teeth have erupted.

A

13 to 14

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101
Q

Tetracyclines:
Adverse reactions
_________ reaction

A

photosensitivity

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102
Q

Tetracyclines:
Adverse reactions
____________ _________ are rare, swallow tablet completely using a gull glass of water

A

esophageal ulcerations

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103
Q

Tetracyclines:

Avoid in ________, infancy, and in children ages ___ or younger

A

pregnancy

8

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104
Q

Tetracyclines:

Do not use oral tetracycline for _____ _______. Start with topicals such as salicylic acid and benzoyl peroxide

A

mild acne

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105
Q 
For mild acne not responding to OTC drugs, try prescription topicals such as 
B
E
A
T
A

benzoyl peroxide
erythromycin
azelaic acid cream
tertinoin

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106
Q

Macrolides:
Macrolides cover staph aureus, staph pyogenes, and atypical bacteria like mycoplasma and chlamydia. Compared with other antibiotic classes, macrolides are associated with more ________ __________.

A

drug interactions

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107
Q

Both erythromycin and clarithromycin are potent _________ inhibitors, but not _________ (which has fewer drug interactions.

A

CYP34A; azithromycin

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108
Q

All macrolides are category _____ except clarithromycin and telithromycin, which are cat ______.

A

B; C

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109
Q 
Macrolides:
Adverse effects:
\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_
\_\_\_\_\_\_ prolongation
A 
GI distress (N/V/D)
Ototoxicity, cholestatic jaundice
QT with prolongation
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110
Q

Macrolides:
If a condition must be treated with a macrolide (atypical bacteria) and the patient cannot tolerate erythromycin, switch the patient to ___________ or _______

A

azithromycin

clarithromycin

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111
Q

Macrolides:

May prolong _________ and increase risk of bleeding if warfarin is mixed erythromycin or clarithromycin

A

INR

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112
Q

Cephalosporins and penicillins belong to the ____________ family of antibiotics

A

beta-lactam

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113
Q

beta-lactams are bacteri_____ and work by interfering with the _____ _____ synthesis of actively growing bacteria

A

bactericidal

cell wall

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114
Q

cephalosporins are Pregnancy Category ___

A

B

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115
Q

First-gen cephalosporins have activity against gram -positive cocci (group ___ strep, S. Aureus)

A

A

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116
Q

First-gen cephalosporins are not effective against ______-______ producing strains and ______

A

beta lactamase

MRSA

117
Q

First-gen cephalosporins:

Poor _______ coverage

A

anaerobic

118
Q

First-gen cephalosporins:

Increased risk of cross-reactivity if allergic to ________

A

penicillin

119
Q

First-gen cephalosporin - an example is ________ taken _____

A

Keflex; QID

120
Q

Second-gen cephalosporins: Considered to be “_____ _______” antibiotics

A

broad-spectrum

121
Q

Second-gen cephalosporins: Used to treat both gram-pos and _______ ______ infections

A

gram neg

122
Q

Second-gen cephalosporins: Used to treat both gram-pos cocci (Streptococcus pneumonia) and gram negative (Haemophilus influenzae, Moraxella catarrhalis) infections such as ________- and _____ ______

A

rhinosinusitis and otitis media

123
Q

Third-gen cephalosporins:
Better protection against __________ and gram- ______ bacteria (______ ______-, _-______) compared to 1st or 2nd gen cephalosporins

A

enterobacteria
negative
H. influenzae; E.coli

124
Q

_________ ____ mg ____ (route) is 1st-line treatment for gonorrheal infections

A

rocephin 250 IM

125
Q

For MRSA skin infections, do NOT use cephalosporins. 1st line therapy for this is either _________, __________ or ___________, and __________. Treat for at least ___ to ____ days.

A

Bactrim DS, doxycycline or minocycline, clindamycin

5 to 10

126
Q

Patients who have a true allergy to penicillin (hx of _____ or _______) are more likely to have an allergic reaction to cepahalosporins (esp 1st gen)

A

anaphylaxis, angioedema

127
Q

Anaphylaxis and angioedema are type ___, ____-mediated reactions

A

1; IgE

128
Q

Penicillins:
PCNs are ______ are directly kill bacteria.
________ and _______ are broad-spectrum PCNs

A

bactericidal

amoxicillin and ampicillin

129
Q 
Penicillins: 
Penicillin VK PO \_\_\_\_ to \_\_\_\_\_
Amoxicillin PO \_\_\_\_ to \_\_\_\_\_
Amoxicillin plus clavulanic acid (Augmentin) PO \_\_\_\_
Benzathine PCN G \_\_\_\_\_
Dicloxacillin PO \_\_\_\_\_\_
A 
TID to QID
BID to TID
BID
IM
QID
130
Q 
Penicillins: 
Adverse reactions:
D
C
V
S
A

Diarrhea
C-Diff
Vaginitis (candida)
Stevens-Johnson syndrome

131
Q

Avoid using amoxicillin for patients with ___________ (causes a generalized rash not related to allergy).
Use ________ instead if not allergic.

A

mononucleosis

penicillin VK

132
Q

________ is for penicillinase-producing staph skin infections (mastitis and impetigo)

A

dicloxacillin

133
Q

Some women will complain of candida vaginitis with ________. Recommend probiotic capsules or eating yogurt daily.

A

amoxicillin

134
Q

Fluoroquinolones:
Effective against gram-negative bacteria and some atypical bacteria (Chlamydia, mycoplasma, legionella). Newer generation quinolones (levofloxacin, moxifloxacin, gatifloxacin) are also active against gram-positive bacteria and have excellent activity against _______ _______.

A

streptococcal pneumonia

135
Q

Fluoroquinolones:
Ciprofloxacin PO ______
Ofloxacin PO _____

A

BID

BID

136
Q

Broad-spectrum quinolones:
Levofloxacin _____
Moxifloxacin _____
gemifloxacin _____

A

daily
daily
daily

137
Q

Fluoroquinolones:
BLACK BOX WARNING:
Increased risk of ____ ______ _____. Avoid ______ _____ while on the drug. Stop it if this develops.

A

Achilles tendon rupture

strenuous

138
Q

Reserve __________ for those who do not have alternative treatment options.

A

fluroquinolones

139
Q 
Fluoroquinolones:
Contraindications:
C
M
P
A

children
myasthenia gravis
pregnancy

140
Q

Fluoroquinolones:
Avoid concomitant use of quinolones with ____-_______ drugs or with ______ imbalance b/c these will elevate the risk of sudden death from arrhythmias (torsades de pointes)

A

QT-prolonging

electrolyte

141
Q

Fluoroquinolones:
Co-administration of ________ and ________ (aluminum/magnesium/calcium) or sucralfate drastically reduces effectiveness of quinolones due to binding (inactivation)

A

minerals and antacids

142
Q 
Fluoroquinolones:
Adverse effects:
H\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_ effects
QT prolongation, torsades de pointes
Peripheral neuropathy
P\_\_\_\_\_\_\_
double vision
Tendon rupture, tendinitis
A

hypoglycemia
CNS
Phototoxicity

143
Q

Achilles tendon rupture is a serious complication of quinolone therapy and patients who are on _______ or older than _____ years are at higher risk

A

steroids

60

144
Q

If a patient on a quinolone reports a new onset of difficulty in walking, order an _________ to rule out ________ _______ _______ or _______ ______ and DC the medicine.

A

ultrasound
Achilles tendon rupture
peripheral neuropathy

145
Q

Bioterrorism-related inhalation of anthrax spores (postexposure prophylaxis) is treated with ________ ____ mg every _____ hours x _____ days. Treat within 48 hours. In addition, a _____-dose series of anthrax vaccine is recommended.

A

Cipro 500 12 60 days

3-dose

146
Q

Bioterrorism-related INHALATION of anthrax spores (postexposure prophylaxis) is treated with ________ ____ mg every _____ hours x _____ days. Treat within 48 hours. In addition, a _____-dose series of anthrax vaccine is recommended.

A

Cipro 500 12 60 days

3-dose

147
Q

CUTANEOUS anthrax is treated with _______ _____ mg ___ x ___ to ___ days

A

Cipro 500

BID 7 to 10

148
Q

Traveler’s diarrhea is treated with _____ ____ mg _____ for ____ days.

A

Cipro 500 BID

3

149
Q

___________ has the best activity against Pseudomonas aeruginosa (gram neg) and is the 1st line drug for treating pseudomonal pneumonia for patients with _______ _______.

A

Ciprofloxacin

cystic fibrosis

150
Q

Sulfonamides:

Are ________

A

bacteriostatic

151
Q

Sulfonamides:

Active against gram ______ bacteria (E. coli, Klebsiella, H. influenzae)

A

negative

152
Q 
Sulfonamides:
Other sulfa-type drugs:
Diuretics (furosemide, HCTZ)
Sulfonylureas (\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_)
COX-2 Inhibitor (celecoxib)
Dapsone
Sulfasalazine
Nitrofurantoin
A

glyburide, glipizde

153
Q 
Sulfonamides:
Contraindications:
\_\_\_\_\_\_\_ anemia
\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_
A

G6PD
Newborns
Pregnancy in late 3rd trimester

154
Q

Sulfonamides:
Drug Interactions:
W
A

A

Warfarin

Astemizole

155
Q

Sulfonamides:
Adverse effects:
Fever and nonblistering _________ ______
________-__________ syndrome

A

morbilliform rash

Stevens-Johnson syndrome

156
Q

Patients with a UTI who are on ________ should not be given _________ due to increased risk of bleeding

A

Bactrim

157
Q

Patients with a UTI who are on ________ should not be given Bactrim due to increased risk of bleeding

A

warfarin

158
Q

Pregnant women with a UTI can be treated with _________ or ___________

A

Amoxicillin or cephalosporins

159
Q

______ patients are at high risk (25-50%) for sulfa-related Stevens-Johnson syndrome

A

HIV

160
Q

In the US, the typical G6PD deficiency anemia patient is a person of _________ _______ descent (10%). Usually asymptomatic, but may present with hemolysis/jaundice secondary to being treated with a sulfa drug or after eating fava beans. Look for low H&H and _______.

A

African American

janudice

161
Q

G6PD is also seen with __________ ancestry

A

Mediterranean

162
Q

Sulfonamide antibiotics are the _________ most frequent cause of allergic drug reactions (____ and _____ are the first).

A

second

PCNs and cephalosporins

163
Q

An 18-year-old female pt with pos throat C&S for Streptococcus pyogenes (group A beta strep). The patient reports a hx of an allergic reaction to PCN with “swollen lips” accompanied by itchy hives. Which of the following is the most appropriate treatment?
A Clarithromycin (Biaxin) 250 mg PO BID x 10 days
B Gargle with salt water TID
C Cephalexin (Keflex) 250 mg PO QID x 10 days
D Doxycycline 100 mg PO BID x 10 days

A 
A Clarithromycin (Biaxin) 250 mg PO BID x 10 days
(doxycycline is not effective against gram-positive infections)
164
Q

Become familiar with alternative antibiotics for PCN-allergic patients. A good alternative antibiotic for these patients with gram-positive infections are _______ such as _________ or __________ PO BID. Clindamycin is also an alternative, but it is associated with slightly higher risk of ________.

A

macrolides
azithromycin; clarithromycin
C-diff

165
Q

A 16 year-old high school athlete is returning for follow-up for a severe sore throat. During the physical exam, purulent exudate is noted on both tonsils. Tender lymph nodes that are 1 cm in diameter are palpable on the posterior cervical chains. The lungs are clear. The rapid strep antigen test is positive for group A beta hemolytic strep. The Monospot test (heterophile antibody test) is positive. What is the best initial clinical management of this patient?
A Initiate a Rx of amoxicillin 500 mg PO BID x 10 days
B Initiate a Rx of penicillin V 250 mg PO TID x 10 days
C Order an Epstein-Barr virus titer to determine whether the patient has an acute or reactivated mono infection
D Write a Rx for an abdominal ultrasound to determine the size of the patient’s liver and spleen

A

B Initiate a Rx of penicillin V 250 mg PO TID x 10 days

Rationale: Avoid using amoxicillin if pt has a mono infection b/c of the risk of an amoxicillin “drug rash” that is not due to an allergy

166
Q

About 70% to 90% of patients with mono taking __________ may break out with a “nonaallergic” generalized maculopapular rash.

A

amoxicillin

167
Q

If a patient has both mono and strep throat, avoid using _________ or __________. Instead, use penicillin (if not allergic) or a macrolide to treat the patient.

A

amoxicillin; ampicillin

168
Q

Of patients with a true penicillin allergy, a small percentage (0.17 0 8.4%) will also react to a ______.

A

cephalosporin

169
Q

In a patient with pneumonia who has an allergy to macrolides (erythromycin, azithromycin), an alternative is ______ PO BID or the new generation _________ if age 18 or older.

A

doxycycline

quinolones

170
Q

Consider ______ -resistant S. pneumoniae if the patient was on a macrolide in the previous 3 months.

A

macrolide

171
Q

A 65 year-old male presents with a hx of chronic cough that is productive of large amounts of off-white colored sputum. The patient reports a 30-pack-year hx of cigarette smoking. The chest-xray reveals hyperinflation with flattened diaphragms and two small bullae on the left lobe. Which of the following drug classes is the initial treatment of choice for this condition?
A short-acting beta-2 agonists
B Anticholinergics
C Pneumococcal polysaccharide vaccine (Pneumovax)
D Oxygen by nasal cannula

A

A Short-acting beta-2 agonists

Rationale: Arriving at the correct answer is based on your knowledge of the current COPD treatment guidelines (Global Initiative for COPD/GOLD)

Notice that the stem of the question is asking for the “initial treatment” - rule out options B, C, and D.

172
Q

For COPD patients with mild dyspnea, the initial treatment choice is a ____ -_______ _______ or a _______ -______ ________.

A

short-acting beta beta-2 agonist (albuterol, levalbuterol) short-acting anticholinergic (ipratropium bromide)

173
Q

In COPD patients, if the initial treatment for dyspnea (short-acting beta-2 agonist (albuterl, levalbuterol) or a short-acting anticholinergic (ipratropium bromide) is not effective, the next step is either a ______-______ _________ or a _______-_______ _________.

A

long-acting beta-2 agonist (salmeterol)

long-acting anticholinergic (tiotropium)

174
Q

If the question is asking you for the next step in treating COPD with dyspnea if symptoms are not better with short-acting bronchodilators), then start on a ______-______ _________ alone or combined with a ________-______ __________.

A

long-acting beta-2 agonist

long-acting anticholinergic

175
Q

The ______ vaccine and ______ is recommended for all with COPD.

A

flu

Pneumovax

176
Q

“Pack year” is calculated by multiplying the number of packs per ________ by the number of ________ a person has smoked.

A

day

years

177
Q

Topical nasal decongestants:
________ and ________ are examples.
Short-term use ______ PRN x _____ days is considered safe treatment for nasal congestion (common cold, allergic rhinitis)

A

Afrin

Neo-Synephrine

178
Q

__________ ________ is due to chronic use (> 3 days) of nasal decongestants

A

rhinitis medicamentosa

179
Q

Antihistamines:

are histamine _______ or _____ blockers

A

antagonists; H1

180
Q

Antihistamines:

Avoid using _________ in the elderly, if possible

A

elderly

181
Q

Antihistamines:

For elderly patients, use ________ because it has a lower incidence of sedation

A

Claritin

182
Q

Antihistamines:

_________ is more potent and long acting. It is very effective for acute and chronic urticaria

A

Zyrtec

183
Q

Topical antihistamines:

Nasal sprays are indicated for _______ rhinitis, __________ _______ rhinitis, and ______ rhinitis

A

allergic rhinitis
seasonal allergic
vasomotor

184
Q

Topical antihistamines:

Nasal sprays are indicated for _______ rhinitis, __________ _______ rhinitis, and ______ rhinitis

A

allergic
seasonal allergic
vasomotor

185
Q

Topical antihistamines:

Nasal sprays are indicated for _______ rhinitis, __________ _______ rhinitis, and ______ rhinitis

A

allergic
seasonal allergic
vasomotor

186
Q

Topical antihistamines:

_________ nasal spray is an example

A

Azelastine

187
Q

Antihistamines:
Ophthalmic drops are indicated for ___________ from allergic conjunctivitis. _______ ________ is an example of an ophthalmic drop.

A

pruritis

Azelastine hydrochloride

188
Q

Cough, cold, and/or sinus medicines:
Decongestants:
____________ and _________ are examples

A

pseudoephedrine; phenylephrine

189
Q

The ______ _________ _______ Act of ______ restricts the amount of pseudoephedrine you can buy; you must log in and present your ID to the pharmacy

A

Combat Methamphetamine 2005

190
Q

Cough, cold, and/or sinus medicines:
Antitussives:
__________ and ________ are examples

A

dextromethorphan; benzonatate

191
Q 
Cough, cold, and/or sinus medicines:
Antitussives:
Dextromethorphan increases risk of serotonin syndrome (major drug interaction) with 
M
E
S
S
A

MAOIs
Eldepryl
SSRIs
SNRIs

192
Q

Decongestants (pseudoephedrine and phenylephrine) are contraindicated with _______ and _______

A

HTN; CAD

193
Q

Advise patients that mixing _________ with other stimulants (caffeine, Ritalin, albuterol inhaler) will cause
P
A
T

A

decongestants
Palpitations
Anxiety
Tremors

194
Q

Topical NSAIDs:
Diclofenac gel
Pennsaid
_______ patch

A

Flector

195
Q

Ophthalmic NSAIDs:

For ________ associated with seasonal allergic conjunctivitis and eye pain after cataract surgery (Acular)

A

itching

196
Q

NSAID warnings:
Should be avoided in _______, severe _______ disease, severe renal disease, GI bleeding, and in the last _____ months of pregnancy

A

HF; heart

3

197
Q

NSAID warnings:

People with _________ ________ and _______ can be sensitive to aspirin/NSAIDs

A

nasal polyps; asthma

198
Q

Ketorolac in all forms are for short-term use only (up to ____ days)

A

5

199
Q

NSAIDs:
For long-term use, document ________ _______ such as the higher risk of serious MI, stroke, emboli, GI bleeds, acute renal failure

A

informed consent

200
Q

__________ have lower risk of GI bleeding compared with the other NSAIDs. They are not a 1st-line NSAID except for patients at high risk for GI bleeding.

A

COX-2 inhibitors (celebrex)

201
Q

Increased risk of bleeding if NSAIDs are combined with warfarin, Pradaxa, __________, aspirin, and _________.

A

steroids

alcohol

202
Q

For long-term NSAID use, consider prescribing concurrent
P
H
M

A

PPI
H2-receptor antagonists
misoprostol (Cytotec)

203
Q

Avoid long-term use of NSAIDs if patient is on ______ prophylaxis (interferes with its cardioprotective effect)

A

aspirin

204
Q

NSAIDs may worsen __________ in patients who were previously well controlled

A

HTN

205
Q

Salicylates:

Aspirin 325 to ______ mg every _____ to _____ hours PRN

A

650; 4 to 6

206
Q

Enteric-coated ASA:

650 to ____ mg every _____ hours (do not exceed ____ grams/day)

A

1,300; 8; 3.9

207
Q

Salicylates:
Acute coronary syndrome:
______ to _____ mg PO

A

160 to 325

208
Q 
Salicylates:
Secondary prevention (MI, stroke): \_\_\_\_ to \_\_\_\_ mg, up to \_\_\_\_\_\_ mg/day)
A

75 to 81; 325

209
Q

Salicylates:

Aspirin with caffeine (BC Powder); one powder ____ every ___ hours PRN

A

SL

6

210
Q

Salicylates:

Nonacetylated salicylates: ________ and _______

A

salsalate, namebutone (Relafen)

211
Q

Salicylates:

Do not take ASA under the age of _______ (Reye’s syndrome)

A

12

212
Q

Capsaicin:
for temp relief of muscle and joint pain;
For neuropathic pain (_________ _____, _______ ______)

A

postherpetic neuralgia

trigeminal neuralgia

213
Q

Capsaicin:

May take up to _____ ______ to work

A

4 weeks

214
Q

_____________ is considered the 1-st line drug for pain for osteoarthritis and DJD

A

Tylenol

215
Q

Tylenol:
Duration: Do not take for more than _____ days unless directed by health provider

A

10

216
Q

Tylenol:

Risk of severe liver damage if intake of ______ or more alcoholic drinks/day while using medication

A

3

217
Q

Aspirin irreversibly suppresses platelet function for up to ____ days.

A

7

218
Q

Immune System Drugs:
Oral steroids:
Prednisone ____ to ____ mg/day (high-dosed) for 3 to 4 days; can be used for short-term treatment (asthma exacerbation).
There is no need to taper if patient is not on chronic steroids

A

40 to 60

219
Q

Immune System Drugs:
Oral steroids:
Medrol Dose Pack x ____ days - does not need to be tapered/weaned

A

7

220
Q

Topical steroids:
Classification: Class 1 (superpotent) to class 7 (least potent)
Class 1: (superpotent) _____________
a class in between 1 and 7 - (Potent) __________
a class closer to class 7 (moderate) _________
Class 7 (least potent) - ______________

A

1: clobetasol (superpotent)
halcinonide (potent)
triamcinolone (moderate)
hydrocortisone

221
Q

Immune System Drugs:
Topical steroids:
Be careful with using topical steroids on _________ and limit duration.

A

children

222
Q

Immune System Drugs:
Topical steroids:
Use ______-potency steroid for the eyelids, face, intertriginous areas, and the genitals.
ex. Use _______ cream/ointment/lotion 0.5 to 1% (OTC) to prescription strength such as __________ 2.5%

A

low
hydrocortisone
hydrocortisone

223
Q

Use ________ to ______-potency steroids for thicker skin (scalp, soles of feet, palms of the hands) or for plaques (psoriasis). Taper _______-strength topical steroids, or person will rebound.

A

moderate; high

potent

224
Q

Thick resistant psoriatic plaques are sometimes treated by using _________ (increases absorption). The topical steroid is applied to the plaque and is covered with plastic wrap. Ultrapotent steroids (_________) should not be occluded for more than 2 weeks due to risk of HPA axis suppression.

A

occlusion

Temovate

225
Q

Acutely inflamed joints can be treated with intraarticular ____________ injections up to _____ times per year. Do not inject ______ joint with steroids.

A

Kenalog
3
septic

226
Q 
Immune System Drugs:
Side effects of steroids:
S
O 
H
I
C
A

Skin changes (atrophy, striae, telangiectasia, acne, pigmentation changes)

Osteoporosis
HPA suppression
Immunosuppression
Cushing’s disease

227
Q

A severe case of poison ivy/oak rash may require ___ to ___ days of an oral steroid to clear.

A

14 to 21

228
Q

The most common cause of acute liver failure in the US is ____________ overdose

A

acetaminophen

229
Q

Drugs that require eye examination (careful monitoring due to adverse effects - have baseline exam and regular eye exams while taking:
V
E
T

F
A
C
P
D
A

Viagra
Ethambutol and linezolid
Topamax

Fluoroquinolones
Accutane
Corticosteroids
Plaquenil
Digoxin
230
Q 
Drugs and safety issues:
Propulsid:
Available only by limited access protocol in the US
BLACK BOX WARNING:
serious \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_
A

cardiac arrhythmias

231
Q 
Drugs and safety issues:
Propulsid:
Available only by limited access protocol in the US
BLACK BOX WARNING:
serious \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_
Check baseline 12-lead EKG
Check serum electrolytes and creatinine

Has numerous drug contraindications such as macrolides, antifungals, TCAs, etc.

A

cardiac arrhythmias

232
Q

Drugs and safety issues:
Theophylline level (adults: ____ to ____)
Avoid combining with other ___________- (pseudoephedrine, caffeine, Ritalin)
Disorders worsened by stimulants: HTN, arrhythmias, stroke, seizures
With BPH, theophylline causes urinary retention and worsening of symptoms.
Suspect toxicity of persistent ___________.

A

5 to 15

stimulants

vomiting

233
Q 
Drugs that need to be tapered/weaned:
B 
A
B
A

D
O
P
A

A

Beta blockers
Antiarrhythmics
Benzos
Antipsychotics

Digoxin
Oral steroids
Paxil
Anticonvulsants

234
Q 
Illegal drugs:
Cannabis:
Dilated pupils (\_\_\_\_\_\_)
Lowers \_\_\_\_\_\_\_\_ \_\_\_\_\_\_
Increases HR and BP
psychomotor effects lasts 12 to 24 hours
A

mydriasis

sperm count

235
Q

Illegal drugs:
Cocaine:
Pupil _______

A

dilation

236
Q

Illegal drugs:
Methamphetamine:
Chronic use results in severe dental caries with loss of front teeth on the upper jaw

Anorexia results in drastic weight loss
pupils appear __________

A

constricted

237
Q

FDA DEA Controlled Substances Act:
Schedule I drugs: Illegal to prescribe. No currently accepted medical use. High abuse potential.
Includes ______, _______/___, ______

A

heroin
ecstasy/MDMA
PCP

238
Q

FDA DEA Controlled Substances Act

Schedule II drugs: Demerol, Dilaudid, Oxycontin, _____, amphetamines, fentanyl, etc

A

cocaine

239
Q 
FDA DEA Controlled Substances Act
Schedule II drugs:
Only the \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_ with the \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ is acceptable
the total # of pills must be indicated
Refills are / are not allowed?
A

original prescription
prescriber’s signature

are NOT

240
Q

FDA DEA Controlled Substances Act
Schedule III drugs: _______ with _______,
___________, anabolic ________, _________

A

Tylenol with codeine
Vicodin
steroids
testosterone

241
Q 
FDA DEA Controlled Substances Act
Schedule IV drugs:
L
A
B
S
A

Lunesta
Ambien
Benzos
Soma

242
Q

Schedule V drugs:
cough medicines with less than _____ mg of ______,
__________
_________

A

200; codeine
Lomotil
Lyrica

243
Q

FDA DEA Controlled Substances Act

Which scheduled drugs can be mailed to the patient?

A

Schedule IV and V

244
Q

Category X drugs:
W
I
F

M
A
L
T

A

Warfarin
Isotretinoin (Accutane)
Finasteride

Misoprostol
Androgenic hormones
Live virus vaccines
Thalimodide, methimazole

245
Q

The new FDA Pregnancy and Lactation Labeling Rule went into effect on June 20, _______.
It _________ the pregnancy letter categories A, B, C, D, and X.

A

2015

replaces

246
Q

The new labeling categories that replaced the old categories of A, B, C, D, and X are:
_________
_________
________ and ______ of _______ ______

A

pregnancy
lactation
females and males of reproductive potential

247
Q

Writing a Rx:
Tamper-resistant prescription pads/paper are required. They should contain the following info:
Practitioner’s name/________ #/__________ #
_________ _________ name/designation
______ address

A

license/ NPI
Supervising physician’s name
clinic

248
Q

Writing a Rx:

Date, name, ________ of the patient

A

address

249
Q

___-___________ is the preferred method for drug prescriptions for Medicare and Medicaid.

A

E-prescribing

250
Q

Herbal supplements:

________ for migraine headaches

A

feverfew

251
Q

Herbal supplements:

Cinnamon improves _____ ____ and _______

A

blood sugar; cholesterol

252
Q

Herbal supplements:

Glucosamine is used for _______

A

osteoarthritis

253
Q

Herbal supplements:

Natural progesterone cream from wild yam root extract is used for __________ symptoms (hot flashes)

A

premenstrual

254
Q

Herbal supplements:

Isoflavones (from soy beans) are used for _____-like effects

A

estrogen

255
Q

Herbal supplements:

kava kava, valerian root used for anxiety and ______

A

insomnia

256
Q 
Herbal supplements:
St John's Wort: Used for mild depression
Do not use with:
H
S
S
A

HIV protease inhibitors (indinavir)
SSRIs
Sumatriptan

257
Q 
Herbal supplements:
Tumeric is used for:
C
A
A
A

cancer
arthritis
Alzheimer’s

258
Q

What is a drug in the drug class anticholinergics?

A

ipratropium bromide (Atrovent)

259
Q 
St John's Wort:
Do not use with:
\_\_\_\_\_\_
\_\_\_\_\_\_, or 
\_\_\_\_\_
A

Benzos
TCAs
SSRIs

260
Q

Alternative meds:
Prophylaxis for migraines: _________

Menopause: black cohosh, ___ _____, ______ cream derived from _________.

Weight loss: High-dosed _________

A

Feverfew
soy isoflavones; progesterone
yams
caffeine

261
Q

Grapefruit juice should not be mixed with _______ - will cause high blood levels of these drugs

A

statins

262
Q

Cephalosporins:
1st Gen: _____
2nd Gen: ______, _______, _____
3rd gen: _____, ________, _______

A

Keflex
Cefzil, Ceftin, Ceclor (all 2nd-gen start with “C”)
Rocephin, Omnicef, Suprax

263
Q

Penicillins and cephalosporins are both considered _____ ______.

A

Beta lactams

264
Q

Macrolides include:
the “_______”s
They have more _____-____ interactions compared with the other classes of abtibiotics.

A

mycins

drug-drug

265
Q

Mother or infant?
Direct Coombs test - ____________
Indirect Coombs test - ___________

A

Direct - infant

Indirect - mother

266
Q

Coombs test:
Rh negative women receive RhoGAM at ___ - ___ weeks.
2nd dose ___ ______

A

28 - 32

after labor

267
Q

Pregnancy:
Asymptomatic bacteruria:
screen at ____ weeks or ____ trimester.
Are ASYMPTOMATIC UTIs or bacteruria in pregnant women treated?

A

12; 1st

YES

268
Q

Pregnancy:
***Asymptomatic bacteruria:
HIGHER risk of ______, _____ birth, and
____ ____ _____

A

pyelonephritis; preterm

low birth weight

269
Q

What is the criteria for diagnosing asymptomatic bacteruria in pregnant women?

A

100,000 CFU/ml of a single organism in 2 consecutive specimens with isolation of the same bacterial species

270
Q

Pregnancy:
Asymptomatic bacteruria:
Urine dipstick will have positive _____ ______ and positive or negative ________.
A urine C&S is done both ___ and ___ treatment

A

leukocyte esterase
nitrites
pre; post

271
Q

Treatment for asymptomatic bacteruria and acute cystitis in pregnancy includes:

A

Amoxicillin
Augmentin
Keflex

272
Q

Avoid these antibiotics when treating acute cystitis in pregnancy:

A

Quinolones
Sulfa drugs
Tetracyclines

273
Q

Protein in urine during pregnancy is _____ _____ and is an indicator of _____ to ______.
Protein of ___ or more is abnormal.

A

NEVER NORMAL
preeclampsia; eclampsia
1+

274
Q

Pre-eclampsia to eclampsia TRIAD includes:

A

Hypertension
Edema
Proteinuria

275
Q

HELLP syndrome of preeclampsia includes:

A

Hemolysis
Elevated liver enzymes
Low Platelets

276
Q

Treatment for HELLP syndrome of preeclampsia includes;

A

Magnesium
Methyldopa
labetalol (is preferred drug)

277
Q

Eclampsia is BP of ___/___ or higher plus seizures, LOC changes, liver damage, etc
***The only “cure” is ________.

A

delivery!

278
Q

Which of the following findings is most likely to be found in a woman with preeclampsia?
1 Abdominal cramping and constipation
2 Edema of the face and the upper and lower extremities
3 Shortness of breath
4 Dysuria and frequency

A

2 Edema of the face and the upper/lower extremities

279
Q

Maternal serum alpha-fetoprotein:
Low AFP: rule out ____ ____
High AFP: rule out ____ ___ ____

A 
Down Syndrome (THINK "low down")
neural tube defect
280
Q

***At 16 weeks gestation, what labs do you perform?

A

AFP (alpha-fetoprotein)

281
Q 
Which of the following genetic diseases is more common in Ashkenazi Jews?
1 cystic fibrosis
2 Sicke cell disease
3 Tay-Sach disease
4 Down syndrome
A

3 Tay-Sach disease

282
Q

Weight gain in pregnancy:
Normal weight (BMI 18.5 - 24.9): ___ to ___ pounds
Overweight: __ to __ pounds

A

25 to 35

15 to 25

283
Q

AVOID ___ ____ vaccines in pregnancy!

A

live virus

284
Q

Teratogens:

_____ causes clear cell cancer and adenosis

A

DES

285
Q

What are the POSITIVE signs of pregnancy?

A

Palpation of fetus by health provider
Ultrasound visualization
Fetal heart tones
*** The positive signs are the shortest list

286
Q

What are the PROBABLE signs of pregnancy?

A

Goodell’s sign - cervical softening
Chadwick’s sign - blue color cervix and vagina
Hegar’s sign - softening uterine isthmus
(REMEMBER - CHAD’s eyes were BLUE and HE was
UTterly SOFT)

Enlarged uterus
Ballottement
+ Urine or blood pregnancy test

(The “last names” are all the probable signs)

287
Q 
What are the presumptive signs of pregnancy?
"Quickening" - mother starts to detect \_\_\_\_ \_\_\_\_ for the 1st time
Amenorrhea
nausea
breast changes
fatigue
urinary frequency
increased body temperature
A

fetal movements

288
Q

Fundal heights:
12 weeks: Uterine fundus first rises above ___ ____
16 weeks: Uterine fundus between ____ _____ and the _____
20 weeks: Uterine fundus at the level of the _____
20-35 weeks - height in cm = number of weeks gestation

If there is a size/date discrepancy (diff of 2 cm or more_ do _________

A

symphysis pubis
symphysis pubis; umbilicus
umbilicus

ultrasound

289
Q

A multigravida who is at 32 weeks of gestation has a fundal height of 31.5 cm. You would:
1 Advise the mother that her pregnancy is progressing well
2 Order an ultrasound
3 Refer her to an OB for an amniocentesis
4 Recommend bedrest with bathroom privileges

A

1 Advise the mother that her pregnancy is progressing well

AANP certification exam (10 decks)

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