Chemo, Derm, Pain, Headaches, Stubstance Abuse, Anemia Flashcards
(170 cards)
1
Q
when is the onset of opioid withdrawal symptoms, depending on if they take shorter and longer acting?
A
shorter: 6-24 hours later, lasts 1 weeks
longer: 2-4 hours after last dose, lasts longer
2
Q
because it’s longer-acting opioid, which med will have a delayed (2-4 day) onset of withdrawal symptoms?
A
methadone
3
Q
which medications are used in opioid withdrawal?
A
Buprenorphine
Naloxone/Naltrexone
Methadone
4
Q
suboxone is a combination of which 2 drugs, used in treating opioid withdrawal
A
buprenorphine + naloxone
5
Q
which opioids withdrawal med is short-acting and may need readministration?
A
Naloxone - can induce withdrawal symptoms
6
Q
between naloxone and naltrexone, which is used in alcohol use disorder?
A
Naltrexone
7
Q
T or F: naltrexone and naloxone are safe in pregnancy
A
FALSE - spontaneous abortion
8
Q
what do you tell patients who are taking naloxone and have pain? what can they take?
A
non-opioid pain meds (ASA, NSAIDs, APAP)
9
Q
which adverse effect must you be extra careful for in alcohol withdrawal?
A
seizure disorder - peaks at 24 hours after last drink (can be fatal)
10
Q
what is the treatment of choice for acute alcohol withdrawal?
A
benzos (lorazepam, diazepam)
11
Q
what are Naltrexone, Disulfiram, and Acamprosate used for?
A
long term alcohol withdrawal prevention
12
Q
which medication causes disulfiram-ethanol reaction?
A
disulfiram (alcohol withdrawal med)
13
Q
what does disulfiram-ethanol reaction look like?
A
decreased BP, increased HR, chest pain, palpitations, dizziness, flushing, sweating, syncope
14
Q
what is contraindicated with disulfiram?
A
CV or cerebrovascular disease, or in combo with hypertensives
15
Q
what is the first line choice for treating acute migraine?
A
NSAIDs (or triptans if NSAIDs unsuccessful)`
16
Q
how do you treat an acute cluster headache?
A
Oxygen + Triptans
17
Q
which types of headaches are triptans best for?
A
cluster and migraines (not so much tension)
18
Q
contraindications to triptans
A
migraine w/ neurologic focality stroke poorly controlled htn unstable angina pregnancy
19
Q
when administering ergots by IV, what adverse effect is common? how do you handle this?
A
Nausea - give antiemetic (metoclopramide, chlorpromazine)
20
Q
using headache medications >____ per month can cause medication overuse headache
A
> 10 days/month
21
Q
what classes of meds are used as headache prophylaxis
A
anticonvulsants
beta blockers
antidepressants
lithium
22
Q
when using beta blockers as headache prophylaxis, what do you need to monitor
A
heart rate, BP.
23
Q
contraindications for Beta blockers as headache prophylaxis
A
reactive airway disease
24
Q
which antidepressants are used for headache prophylaxis
A
Amitriptyline (TCA)
Venlafaxine (SSRI)
25
what medication class is a good alternative for headache prophylaxis if beta blockers aren't tolerated
Anticonvulsants (topiramate, valproic acid, divalproex)
26
which class of headache medication is contraindicated in pregnancy?
Ergots - cause hypoxia to fetus and uterine contractions
27
which triptans are safe in pregnancy, while others are contraindicated
sumatriptan
naratriptan
rizatriptan
28
at what BMI is pharmacologic therapy for weight loss ok to begin
>30
| or >27 + other obesity risk factors
29
T or F: meds are the first line choice for treating obesity
FALSE - lifestyle changes
30
```
Orlistat
Lorcaserin
Phentermine-Topiramate
Naltrexone-bupropion
Phentermine
Diethylpropion
Phendimetrazine
```
weight loss meds
31
this weight loss medication works in the GI tract inhibiting lipase and triglycerides; undigested triglycerides are not absorbed
Orlistat
32
you may need to bring extra clothes with you while taking this medication for weight loss - may have oily spotting, Sharts, oily evacuation, fecal incontinence
Orlistat
33
what is the rare AE of orlistat?
liver injury - look for itching, yellow skin and eyes, light colored stools
34
this weight loss medication is controlled, having a potential for abuse; it is contraindicated in pregnancy.
Lorcaserin
| phentermine-topiramate
35
your patient has been taking Lorcaserin for 12 weeks now, and has lost 2% weight. What do you tell her at her follow up?
D/C the med - if <5% weight loss by week 12
36
watch for serotonin syndrome in this weight loss med if combined with triptans, MAOI, SSRI, TCA, bupropion
Lorcaserin
37
T or F: phentermine-topiramate is ok to use long term
True (but D/C if <5% weight loss after 12 weeks at highest dose)
38
you must confirm negative pregnancy test before taking this weight loss med
phentermine topiramate
39
phentermine-topiramate interacts with MAOI, Oral contraceptives, and alcohol. What happens when taken with OCs?
irregular bleeding - but NOT increased risk of pregnancy
40
contraindications of naltrexone-bupriopion?
high BP, seizures, taking anticonvulsants or chronic opioids, MAOI within 14 days, pregnancy
41
what is phentermine's MOA ?
increase NE and DA release in the CNS
42
T or F: weight loss medication containing phentermine has potential for abuse
True
43
Between Phentermine and phentermine topiramate, which is best if used short term?
Phentermine - best if short term for monotherapy
44
which 2 weight loss medications have a high potential for abuse and MANY contraindications?
Diethylpropion
Phendimetrazine
-only use short term!
45
this weight loss med has a risk of pulmonary hypertension if used for longer than 3 months
Diethylpropion
46
what kind of pain occurs when encountering something painful?
nociceptive
47
what kind of pain occurs when damage occurs?
inflammatory
48
what kind of pain occurs in the PNS
neuropathic
49
what pain medication is best for mild-moderate pain relief?
APAP (acetaminophen)
50
what pain medication is best for moderate+ pain?
APAP + NSAIDs
51
What pain medication is best for inflammatory pain
NSAIDs
52
what pain medication is best for muscle-related pain?
muscle relaxers
53
what are the non-opioid analgesics?
ASA
APAP
NSAIDs
54
how does Acetaminophen interact with warfarin?
can increase bleeding risk (at 2000+ mg/day)
55
T or F: acetaminophen causes renal toxicity
F: Hepatotoxicity - risk increases with hepatitis, chronic alcohol, binge-drinking
56
what is the maximum dose of acetaminophen?
4000 mg per day if NORMAL hepatic function
57
what is ASA MOA?
inhibits cox1 and cox2
58
what analgesic to avoid in kids?
Aspirin - risk of Reye syndrome
59
Adverse effects ASA
GI irritation/bleeding, platelet inhibition, hypersensitivity
60
Choline magnesium
sodium salicylate
salsalate
methyl salicylate
Nonacetylated salicylates
61
what is the preferred class of medication for pain if prostaglandins are involved?
NSAIDs
62
COX1 inhibition yields what effects?
increased GI and renal effects
63
COX2 inhibition yields what effects?
Cardiovascular risk and higher analgesic effect
64
T or F: NSAIDs are NOT helpful in neuropathic pain
True
65
your patient is being started on NSAIDs for inflammatory pain. What do you tell him regarding time until effect
will take 2-3 weeks for full effect
66
which NSAID do you NEVER use for more than 5 days due to high risk
Ketorolac
67
what is the agent of choice for moderate-severe pain associated with cancer?
Opioids
68
T or F: opioids are the analgesic of choice for nonmalignant chronic pain
FALSE - harms outweight benefits and risk for abuse/dependence
69
what is the onset of opioids?
30-45 min
70
what are the common AEs of opioids?
sedation, constipation, nausea.
71
T or F: long-acting opioids yield a higher risk for respiratory depression
True - caution when tolerance develops, give naloxone for reversal incase of overdose
72
This opioid is NOT a first line choice due to risk of tremors, myoclonus, delirium, seizures
Meperidine - caution elderly, renal impairment, kids
73
This opioid has a long half life of 30 hours - caution with what AE
respiratory depression, arrhythmia/QT prolongation
74
this opioid is also used for alcohol abuse treatment
Methadone
75
This opioid is not first line due to its increased risk of seizure, serotonin syndrome, and dependence
Tramadol
76
What is the first line analgesic for neuropathic pain?
Gabapentin
77
```
Cyclobenzaprine
Tizanidine
Carisoprodol
Chlorzoxazone
Metaxalone
Methocarbamol
Ophenadrine
```
Muscle relaxants
78
muscle relaxants decrease spasm and stiffness of muscles, but ______ are still first line
NSAIDs, APAP
79
2 kinds of muscle relaxants: antispastic and antispasmodic. What do antispastic ones work best for?
CP and MS
80
antispasmodic muscle relaxants work best for what type of conditions?
musculoskeletal conditions
81
which 2 muscle relaxants are LAST CHOICE due to abuse potential
diazepam
| carisoprodol
82
most common AE of muscle relaxants
sedation
83
T or F: topical analgesics work similarly to transdermal analgesics
FALSE - transdermal is systemic, topical is local pain relief.
84
Menthol
Capsaicin
Camphor
Methylnicotinate
counterirritants (topical analgesic) - acts as distraction from pain
85
which topical NSAID is best to use for pain?
Diclofenac
86
This topical analgesic blocks superficial somatic nerve conduction, NOT DEEP areas
lidocaine
| benzocaine
87
a deficiency in what 3 things can lead to anemia?
iron
B12
Folic acid
88
you start your patient on an iron supplement for their iron deficiency anemia. what is the dose/route
150-200 mg, split into 2-3 doses
89
your patient has been taking her iron supplements for 2 weeks now, and complains of bloating, constipation, and dark stools. what do you tell her?
this is normal adverse effects - keep taking dose, try taking with food
90
do we prefer IV or PO iron supplementation?
PO is best - IV can cause anaphylactic reactions, esp with high molecular weight Dexferrum
91
How do you treat B12 deficiency anemia and when can you expect results?
B12 shots - will see effect in 1 week
92
Folic acid anemia effects are seen in what time frame?
effects start by 2 weeks with folic acid supplement --> normalizes by 2-4 months
93
Epoetin-alpha
| Darbepoetin-alpha
erythropoietin stimulating agents
94
use of erythropoietin stimulating agents
treating anemia related to cancer, chemo, CKD - results in increased RBC production
95
What potency is Clobetasol Propionate for topical steroid?
super high
96
what potency is fluocinonide ointment and mometasone furoate for topical steroids?
high potency
97
What potency is triamcinolone acetonide for topical steroids
medium
98
what potency is desonide cream, fluocinolone acetonide, hydrocortisone cream for topical steroids?
Low
99
What conditions do you use topical steroids for?
psoriasis
atopic dermatitis
symptomatic relief for burning and pruritis
100
patient presents with psoriasis of the soles of the heels. What steroid to use?
super high potency (Clobetasol) - nonfacial and nonintertriginous
101
what potency steroid do you use for nonfacial and nonintertriginous areas and flexural surfaces
medium-high potency
102
Your patient has lesions on his eyelids or genitals, what potency topical steroid do you use?
LOW potency - used on thin skin (eyes, face, genitals, intertriginous areas)
103
which is strongest potency: cream, lotion, ointment
ointment
104
what are the local cutaneous side effects of topical steroids?
skin atrophy, telangiectasis, striae, acne, allergic contact dermatitis, hypopigmentation
105
Your patient is being started on a topical steroid, and is worried because last time she used it, it left her with white spots on her skin. What do you tell her and how do you handle It?
hypopigmentation is a common adverse effect of steroids - we will reduce this risk by using the LEAST POTENT STEROID FOR THE SHORTEST TIME
106
```
Which systemic (rare) side effect is NOT a possibility in using topical steroids?
Glaucoma, Hypothalamic pituitary axis suppression, Cushing's syndrome, SJS, Hypertension, Hyperglycemia
```
SJS
107
T or F: to avoid the serious systemic side effects of topical steroids, you should use plastic wrap and bandages to keep them localized
FALSE - widespread use and occlusive methods cause this
108
how does the treatment duration differ from super high potency, high/medium potency, and low potency topical steroids?
super high: <4 weeks tx
high/medium: <6-8 weeks tx
Low: side effects rare, but treat for 1-2 week intervals to avoid side effects
109
what can patients with chronic atopic dermatitis use to reduce the risk of relapse?
twice weekly application of topical steroids
110
how many BSA does 1 of the patient's palm cover?
1%
111
1 finger tip units (FTU) covers how much BSA?
2% (2 palms)
1 FTU = 0.5 gm
112
how many grams to cover average adult body for one application?
30 g
113
what type of topical steroid to use on infants/kids?
low potency - they have a higher BSA area-to-volume ratio
114
This medication is used for treating P.acnes (acne vulgaris), and is a vitamin A derivative
Topical retinoids
115
This acne medication works using free radicals to oxidize proteins in P.acnes cell wall
Benzoyl peroxide
116
Topical Abx are also used in treating acne. what are the 2 kinds?
erythromycin
| Clindamycin
117
Topical antibiotics are commonly combined with ______ as opposed to monotherapy in treating acne. Why?
Benzoyl peroxide
| -prevent development of antibiotic resistance
118
T or F: acne treatment targets NEW lesions, not old lesions, not present ones
True
119
how long do topical acne treatments take to see effects?
2-3 months (patient adherence is biggest cause of failure)
120
you are seeing your patient for follow up of acne treatment. It has been 6 weeks and he hasn't seen any major improvement. What do you do?
reassurance - wait 8 weeks to see changes before making changes to medications
121
initial treatment for MILD acne
```
Topical BP or
topical Retinoid (1 agent)
```
122
initial treatment for moderate acne
Combo BP + retinoid
| (+/- topical antibiotic)
123
initial treatment severe acne
Combination oral antibiotic + topical retinoid + topical BP (+/- topical antibiotic)
124
how do you manage patient complaining of dry skin, irritation as an effect of acne treatment
add a ceramide-containing lotion to maintain skin barrier
125
which skin conditions are NOT treatable with topical antifungals?
hair and nail infections - need po
126
what type of topical antifungals are fungistatic?
Imidazoles (ketoconazole, econazole, clotrimazole)
127
what does fungistatic antifungals treat?
dermatophytes and candida
128
which topical antifungals are FUNGICIDAL
Naftifine
Terbinafine
Butenafine
treats dermatophytes BUT NOT CANDIDA
129
which fungistatic topical treats candida but NOT DERMATOPHYTES
nystatin
130
what class of antifungals are first line for tinea corporis (ring worm)
miconazole (imidazoles) - apply bid until resolution then continue 2 weeks (4-6 weeks total)
131
what potency topical steroid is best for treating psoriasis?
high potency (maybe with topical vit D analog)
132
which class of chemo medications causes cardiac toxicity?
anthracyclines (doxorubicin)
133
which chemo medication class causes neurotoxicity
microtubule-targeting agents (vincristine)
134
which chemo medication class causes secondary malignancies?
alkylating agents (melphalan)
135
What are dose-dense therapies
chemo that only allows a short time between cycles
136
what do you give with dose-dense chemo therapy
colony stimulating factors
137
while getting infused with chemo, your patient experiences severe tissue damage. what is this disorder and what do you do?
extravasation - stop injection, aspirate fluid out of injection site
138
how do you treat a hypersensitivity reaction to chemo?
give H1 blocker (steroids may help too)
139
T or F: chemo treatment has a low therapeutic index
TRUE
140
what is the optimal regimen for treating nausea during chemo
prophylaxis + breakthrough antiemetic prn
141
what are the classes of antiemetic that are most commonly used in treating n/v during chemo
Corticosteroids
Serotonin receptor antagonists
NK1 receptor antagonists
Olanzapine
142
your patient has been receiving chemo for a couple of rounds, and she follows up complaining of decomposition of gums, and bleeding. what is this?
Mucositis
143
what is the best way to prevent mucositis?
oral hygiene! keep mouth clean
144
what is febrile neutropenia
gram positive infections through bloodstream due to aggressive chemo. Flora on skin is introduced to blood stream
145
what is the best way to prevent febrile neutropenia?
HAND hygiene
avoid infections
prophylactic abx
colony-stimulating factors
146
your chemo patient is complalining of blood in your urine. you think that it might be ____
hemorrhagic cystitis - bleeding from lining of bladdder
147
which 2 medications are at high risk of causing hemorrhagic cystitis
cyclophosphamide
| ifosfamide
148
how is hemorrhagic cystitis prevented?
Mesna
149
an adverse effect of chemo is described as the tumor being destroyed and its contents get into circulation, leading to crystallization in the renal tubules of the kidney. What is this called
tumor lysis syndrome
150
what medication can be used as prophylaxis to tumor lysis syndrome
Allopurinol - PROPHYLAXIS ONLY
151
your patient has uric acid crystalizing the renal tubule of the kidney. You think it may be a result of tumor lysis syndrome. You immediately treat him with Allopurinol, as it decreases the amount of uric acid
FALSE - does not decrease uric acid, only prevents it. PROPHYLAXIS ONLY
152
what medication do you use for chemo-induced diarrhea, if NOT c.diff
Loperamide
153
what medication do you use for chemo-induced diarrhea diarrhea if c.diff present
Metronidazole
154
Filgrastim
Pegfilgrastim
Sargromostim
colony stimulating factors
155
what is the purpose of using colony stimulating factors?
shortens hospitalization
| shortens duration of neutropenia
156
when administering methotrexate as chemo, what other med can you administer to prevent myelosuppression and mucositis
Leucovorin
157
which medication is added to Methotrexate, and what does it prevent?
Leucovorin - prevents myelosuppression and mucositis
158
what adverse effect happens with Capecitabine, and what class is it in?
Antimetabolite; hand-foot syndrome
159
what are the 3 main toxicities that happen with combined chemo?
cardiotoxicity
neurotoxicity
secondary malignancies
160
the Vinca alkaloids are commonly used in treating hematologic malignancies. What adverse effect to be aware of?
neurotoxicity
161
what can happen 48-72 hours after administration of the Nitrogen Mustards?
encephalopathy (reversible)
162
What is contraindicated (medication) while using Aldesleukin as chemo?
Aldesleukin is an immunotherapy
| CORTICOSTEROIDS contraindicated
163
the "umabs" are more humanized than the "imab, omab". Less humanized = more likely to react. What type of "reaction" are they more likely to?
fever, chilss, to life-threatening allergic reactions
164
What class of chemo are Imatinib and Sorafenib involved with? And what CYP do they interact with?
Tyrosine kinase inhibitors; CYP 3A4
165
When choosing a prophylactic treatment for Migraines, your patient can't tolerate beta blockers. what is your next best choice?
Anticonvulsants (topiramate, Valproic acid, Divalproex, Carbamazepine)
166
which anticonvulsant do you choose as migraine prophylaxis if you want to treat both migraine + trigeminal neuralgia?
Carbamazepine
167
You're choosing a migraine prophylaxis medication for your patient, and she mentions she can't gain any more weight, and is trying to lose weight. Which anticonvulsant has the least likelihood of causing weight gain?
Topiramate
168
which is the heart rate controlling medication of choice specifically for prophylaxis against cluster headaches?
Verapamil (CCB)
can also choose Lithium for prophylaxis
169
your diabetic patient is wanting to start Lorcaserin for extra weight loss help. What adverse effect do you need to monitor for that is especially dangerous considering his diabetes
hypoglycemia
170
which topical analgesic induces depletion of substance P
capsaicin - takes 1-2 weeks to work
