Clinical Pharm Flashcards
(208 cards)
1
Q
2nd gen antihistamine with some sedation
A
Zyrtec
2
Q
drugs to d/c with BPH
A
1st gen antihistamines
decongestants
3
Q
drugs to avoid with glaucoma
A
decongestants
antihistamines
steroids
4
Q
antihistamine for scabies
A
hydtoxyzine
diphenhydramine
5
Q
rx for poison ivy
A
steroid cream (triamcinolone)
non-sedating oral antihistamine (Cetirizine)
+/- oral steroid
6
Q
adjunct treatment for urticaria
A
H2 blockers
7
Q
definition of anaphylaxis
A
affecting >1 body system: skin/mucosa, respiratoy, GI, cardiac
8
Q
cardiac effects of anaphylaxis
A
hTN
syncope
tachycardia
9
Q
what do we need to watch out for after treating anaphylaxis?
A
rebound–give epi again
10
Q
high risk pts for antihistamines
A
BPH
glaucoma
young/old
high risk ocupations
11
Q
partial agonist opioids
A
tramadol
tapendatol
12
Q
SE of opioids
A
N/V/C dry mouth AMS resp depression tolerance dependence
13
Q
pseudo addiction
A
undertreated pain resulting in red flag behaviors
14
Q
withdrawal sxs w/ abrupt d/c in opioid
A
physical dependence
15
Q
need increased dose for pain relief
A
tolerance
16
Q
three types of pain
A
nociceptive
neuropathic
psychogenic
17
Q
pain caused by injury to the tissue
A
nociceptive
18
Q
what kind of pain with cancer?
A
nociceptive
19
Q
mgmt for nociceptive pain
A
NSAIDs Tylenol steroidsopioids PCA PT TENs
20
Q
pain that results from damage to or dysfunction o f nervers, SC or brian
A
neuropahtic pain
21
Q
mgmt for neuorpathic pain
A
gabapentin pregabalin amitrptiline duloxetine tramadol lidoderm patch/cream SC stimulator/peripheral stimulation ESI
22
Q
interventional pain mgmt
A
epidrual steroid injection join injections intrathecal pump SC stimulator peripheral n blocks sympathetic nerve blocks/neurolysis
23
Q
patient with persistent pain w evidence of psychologic distrubance
A
psychogenic
24
Q
tx of psychogenic pain
A
biofeedback
exercise
psych eval/therpay
25
how much do we decrease daily dose of opioid when converting to a new/long-acting pain med?
50-75%
26
how much should breakthrough medication dose be of long-acting dose?
20-25%
27
what adjunct might we use for myofascia lpain?
TENs
28
adjuncts to pain meds
TENS
aqua therapy
topical cream compound
29
whta topical cream compounds can we use?o
lidocaine
ibuprofen
diclofenac
30
first line tx for fibromylagia
exercise (start with aqua)
31
tx for fibromyalgia pain
```
exercise
counseling
pregabalin/gabapentin
cymbalta
NO opioids
```
32
dosing of patient controlled analgesia
demand dose every 15 min
continuous over each hour
contiuous + demand doses
33
benefits of PCA
patient feels they have control
less opioids while sleeping
get severe pain under control quickly
34
risks of PCA
family members pushing
| overdose
35
requirements for PCA
```
continuous pulseox
naloxone prn orders
discuss w/RN
pt seen w/in 12h
titrate
wean as soon as tolerable
should be seen everyday by anesthesia/surgery
```
36
PO to IV morphine typical conversion
3:1
37
who are fentanyl patches not effective in?
cachectic pts
38
patient education w/ fentanyl patch
exposure to heat=increased absorption
39
use of fentanyl patch
not acute-12h until therapeutic
| two step taper when coming from IV
40
what opioids may help with neuropahtic pain?
methadone
tramadol
tapentadol
41
big SE of methadone
QT prolongation
42
baselines for methadone
EKG
| renal/hepatic function
43
issues with methadone
QT prolongation
slow titration because of long half life
drug interaction
44
issue with tramadol/tapentadol?
serotonin syndrome w/ antidepressants
45
issue with buprenorphine patch
QT prolongation
| NOT used with opioids
46
what pain meds must be avoided with ESRD?
```
morhpine
meperidine
hydrocodone
codeine
cuation:hydromorphone, oxycodone
```
47
DOC in ESRD
fentanyl
| methadone
48
what pain meds should be avoided with hepatic dz?
opioids
49
what pain meds must be avoided with increase ICP?
opioids
50
opioids used in pediatrics
```
morphine
hydromorphone
oxycodone
hydrocodone
fentanyl
methadone
```
51
teenager with testicular torsion. what meds?
analgesics-opioid
| anti-emetic
52
teenager with appendicitis. what meds?
opioids
| antiemetic
53
antiemetics for peds
promethamine
| metoclopramide
54
pain mgmt for burns
IV morphine especially before debridement, cleaning, dressing changes
55
what pain meds do we avoid if pt <12 yo?
codeine
| tramadol
56
what herbal supplement is often taken by geriatrics that increases risk of bleeding w/ warfarin?
gingko bilboa extract
57
what supplement w/ SSRI can cause serotonin syndrome?
st john's wort
58
age related changes increasing risk for adverse drug events
body fat>muscle
| decline in renal and hepatic function
59
stepwise approach to prescribing for geriatrics
```
review meds
d/c unnecessary
consider adverse events for new sxs
consider nonpharm options
reduce dosing if possible
simplify dosing schedule
```
60
Beers criteria for geriatric prescribgin
avoid concurrent opioids w/ benzos or gabas
| avoid SNRIs
61
issue with SNRI in elderly
avoid in pts w/ hx of falls/fractures
62
monitoring of loops
```
I&Os
daily weight
orthostasis/BP
eytes
renal function
```
63
loop diuretic w/o sulfa moeity
ethacrynic acid
64
SE of ethacrynic acid
ototoxicity
65
SE of loop diuretic
hypokalemia
| hyponatremia
66
CI for loop diuretic
anuria
| sulfa allergy
67
SE of thiazides
hypokalemia
| hyponatremia
68
CI to thiazides
anuria
| sulfa allergy
69
thiazide with less sulfa issues?
metolazone
70
CI and cautions with K+-sparing diuretics
hyperkalemia
caution w/ ACEI/ARN
anuria
severe/progressive kidney dz
71
SE of K+-sparing diuretics
hyperkalemia
72
K+-sparing diuretics
spironolactone
eplerenone
triamterene
amiloride
73
drugs that reduce mortality and improve sxs in HF
BB
| ACEi
74
CI for ACEI
angioedema
| pregnancy
75
SE of ACEI
cought
orthostatic hypotension
hyperkalemia
76
what pts are ACEI first line for?
DM
CKD
HFrEF
77
CI for BB
heart blocks
| uncompensated HF
78
nonselective BBs
propranolol
nadolol
timolol
79
SE of BB
```
bronchospasm
worsen CHF
fatigue
depression
impotence
```
80
effects of BBs
-chronotropy
-inotropy
decreased CO
81
cardioselective BB
acebutolo
atenolol
metoprolol
nebivolol
82
BB w/ intrinsic sympathomimetic activity
acebutolo
| pindolol
83
what must be avoided with BBs?
abrupt withdrawal
84
SE of ARBs
orthostatic hTN
| hyperkalemia
85
CI for ARBs
angioedema
| pregnancy
86
you have a HF patient with low energy. what could be done?
lower BB dose
OR
add digoxin
87
effecs of digoxin
+ inotropy
- chronotropy
increased CO
88
SE of digoxin
arrhythmias
HA
fatigue
drwosy
89
what can cause dig toxicity?
hypokalemia
90
first lines for HTN
ACEI
ARB
CCB
thiazide
91
antiHTN in black pts
HXTZ
| CCB
92
antiHTN in non-black pts
ACEI
| BB
93
dihydropyridines
-dipines
94
dihydropyridines vs non-dyhydropyridines
dihydropyridines more vasodilatory effect
95
non-dihydropyridines
verapamil
| diltiazem
96
SE of dihydropyridines
peripheral edema
97
CI to CCBs
non-dihydropyridines:
SA/AV node dysfunction
BB
HF (dihydropyridines)
98
SE of alpha blockers
orthostatic hTN
99
pt with HTN and BPH
alpha blocker
100
antiHTN in pregnancy
methyldopa
101
SE of central alpha agonists
orthostatic hypotension
102
what t oavoid with central alpha agonists?
abrupt withdrawal
103
SE of nitro
throbbing HA
| tachycardia
104
DOC for Prinzmetal angina
CCBs
105
tx for long-term mgmt of chronic stable angina
isosorbide dinitrate/mononitrate
106
drug interaction s with digoxin and beta blocker
bradycardia
| AV block
107
digoxin toxicity
cardiac arrhythmias
GI
neuro
visual disturbances
108
how is digoxin cleared?
renally
109
issue with lisinopril and ibuprofen together?
both affect the GFR
110
how do ACEI affect the GFR?
vasodilates efferent arteriole
111
how do NSAIDs affect the GFR?
vasoconstrict the afferent arteriole
112
normal
GFR >90
113
complicated CAP abx
beta lactam+macrolide
OR
resp. FLQ
114
which drug for UTI should be renally dosed?
pyridium
115
issuw with ACEI/ARB and bactrim?
hyperkalemia if decreased kidney function
116
tx of acute asthma exacerbation
albuterol w/ or w/o ipratropium
117
how long does albuterol last?
~4 hours
118
SE of SABA
tachycardia
tremor
nervousness
dizziness
119
SE of oral glucocorticoid
anxiety
agitation
insomnia
increased appetite
120
oral steroid for acute asthma exacerbation
1-2 mg/kg/day x3-5d
121
dosing of albuterol MDI for bronchospasms
1-2 puffs q4-6h prn
122
step 2 of asthma tx
low dose ICS*
cromolyn
montelukast
123
indications for montelukast
asthma
| allergic rhinitis
124
SE of montelukast
URIs
HA
abd pain
mood changes*
125
when can we step down asthma therapy?
3 mos of symptom control
126
how old to start omalizumab?
6 years or older
127
tiotropium
LAMA
128
salmeterol
LABA
129
SE of SABA
```
nervous, shaky
hyperactivity
tachycardia
nauseau
insomnia
```
130
LAMA SE
dry mouth*
cough*
HA, blurred vision
131
SE of ICS
thrush
| hoarseness
132
tx for COPD exacerbaiton
SABA +/-SAMA
oral prednisone
abx
133
first line abx for COPD exacerbation
azithromycin or levaquin
134
requirements for abx for COPD exacerbaiton
2/3:
increase dyspnea
increase sputum volume
increase sputum purulence
135
tx steps for stable COPD
A: SABA or SAMA or ocmbo
B: LABA or LAMA
C: LAMA
D: LABA+LAMA
136
black box warning for antidepressants
increased risk of suicide in children and adolescents
137
fluoxetine uniques
increased energy=increased AM
| longest half life
138
SE of SSRIs
```
insomnia, nervousness
decreased libido
somnolence
dry mouth
anorexia
```
139
fluoxetine also used for
OCD
bulimia
PMDD
140
sertraline also used for
```
OCD
panic d/o, PTSD
SAD
nocturnal eating
PMDD
```
141
parozetine unique
SSRI
| more weight gain
142
parozetine also used for
```
panic d/o
OCD
GAD, SAD
PSTD
PMDD
```
143
citalopram unique
depression only
144
escitalopram unique
also GAD
145
venlafaxine also used for
GAD, SAD
| panic d/o
146
desvenlafaxine unique
depression only
147
duloxetine also used for
GAD
DM neuropathy
fibromyalgia
148
duloxetine unique
CI in liver dz
149
buproprion MOA
DA/NE reuptake inhibitor
150
buproprion unique
less sex SE
| avoid w/ seizure d/o or anorexia
151
buproprion also used for
SAD
| smoking cessation
152
mirtazapine MOA
alpha 2 antagonist
153
SE of mirtazapine
somnolencce
appetite, weight gain
constipation
dry mouth
154
mirtazapine unique
less sex SE
good for elderly
no other indicaitons
155
duration of antidepressant tx
4-9 mos after therapeutic dose
156
how long should we discontinue antidepressants?
1-6 mos
157
metoclopramide
prokinetic
158
dicyclomine
antispasmodic
159
misoprostol
cytoprotective
160
H2 blockers
on-demand relief
| nocturnal
161
PPIs
takes a few days
30 min before bkfst
taper
162
PPI SE
nutrient malabsorption
osteoporosis
c diff
kidney dz
163
magnesium antacids
diarrhea
| caution: renal insufficiency
164
aluminum antacids
constipation
165
sodium antacids
caution: edema, cirrhosis, HF, renal impairment
166
when to stop PPI and bismuth/abx for H pyloir testing?
PPI: 1-2 wks
| bismuth/abx: 4 wks
167
what drugs can complicated PUD?
anticoagulants
ASA
steroids
168
used to prevent NSAID-induced ulcers
misoprostol
169
misoprostol CI
pregnancy
170
SE of metoclopramide
EPS, tardive dyskinesia
171
CI to metoclopramide
obstruction
perf
hemorrhage
172
ondansetron cuations
cardiac arrythmias, QT interval
| serotonin syndrome
173
SE of dicyclomine
anticholinergic
| caution in elderly
174
what is dicyclomine used for?
IBS
175
what is eluxadoline used for?
IBS-D
176
SE of bulk laxatives
flatulence
| bloating
177
caution with osmotic laxatives
hypermagnesemia in renal insuffiency
178
CI to laxatives
```
acute abdomen
obstruction
perforation
toxic megacolon
unexplained abd pain
```
179
what is methylnaltrexone used for?
opioid-indced constipation
180
antidiarrheal cautions
```
bloody/suspicious infectious
high fever/toxicity
pseudomembranous colitis
ulcerative colitis
hx of drug use
```
181
adverse rxns to anti-diarrheal
ileus
| toxic megacolon
182
CI for pepto
ASAallergy
| kids
183
what is mesalamine used for?
IBD-UC
184
abx for perianal crohn dz
cipro
| metronidazole
185
issues with biologics
infection
hepatotoxicity
malignancy
186
abx for CAP PNA
macrolide or doxycycline
187
abx for strep pneumo PNA
high-dose PCN G
188
inpt tx of CAP PNA
macrolide or doxycycline +bet lactam
| or beta lactam +FLQ
189
tx for unocmplicated cystitis
bactrim
| macrobid
190
tx for complicated cystitis
cipro
191
tx for pyelo
PCN+ beta lactam or FLQ
| carbapenem if resistant
192
SE of FLQ
cartilage
| QT prolongation
193
black box for FLQ
risk >benefit for simple infection
194
tx of PID
IM ceph+doxy
195
tx of chlamydia
doxycycline or azithromycin
196
tx of gonorrhea
ceftriaxone + azithromycin
197
abx of choice for pregnancy
PCN
| cephalosporins
198
avoid what in pregnancy
FLQ
tetracyclines
metronidazole
aminoglycosie
199
what should be avoided in first trimester?
bactrim
200
what should be avoided at term?
sulfas
| nitrofurantoin
201
tx for meningitis
third gen cephalosporin
| +vanco if resistant
202
SE of cephalosporins
rare: neutropenia, thrombocytosis, hemolysis, diarrhea, elevated LFTs
203
tx for cellulitis
clindamycin
bactrim
tetracylcine if purulent
204
lincosamide
clindamycin
205
what is clindamycin useful for?
often MRSA
| toxin-mediated staph and strep
206
what abx can cause blue-black hyperpigmentation?
minocycline
207
glycopeptides
vancomycin
208
SE of vancomycin
nephrotoxicity
hearing loss
red man syndrome
