EOR pharm exam part 1

Question 1

MOA of statins

Answer 1

Inhibit HMG-CoA reductase

Question 2

Effects on lipid profile of statins

Answer 2

Decrease LDL by 25-62%
Moderate reduction in TG
Minor increase in HDL

Question 3

`Most common SEs of statins

Answer 3

Constipation
Abdominal pain
Diarrhea
Dyspepsia
Nausea

Question 4

Other SEs of statins

Answer 4

Myopathy including rhabdomyolysis
Increased BG/HbA1c
Cognitive impairment
Pregnancy category X

Question 5

Monitoring of statins

Answer 5

LFTs
-Baseline for all pts
-Fu only if clinically indicated
Creatinine Kinase
-Baseline in those at risk for myopathy
-Fu if clinical signs or sx of myopathy
-Assess for sx of myopathy 6-12 after drug initiation and at each visit thereafter

Question 6

Dose ranges of atorvastatin

Answer 6

10-80 mg

Question 7

Dose ranges of fluvastatin

Answer 7

20-80 mg

Question 8

Special considerations of atorvastatin

Answer 8

Preferred in renal impairment

Question 9

Special considerations of fluvastatin

Answer 9

Preferred in renal impairment

Question 10

Dose ranges of lovastatin

Answer 10

20-80 mg

Question 11

Special considerations of lovastatin

Answer 11

Increased absorption with food

Adjust starting doses if severe renal impairment

Question 12

Dose ranges of pitavastatin

Answer 12

1-4 mg

Question 13

Special considerations of pitavastatin

Answer 13

Decreased absorption with food

Adjust starting dose if severe renal impairment

Question 14

Dose ranges of pravastatin

Answer 14

10-40 mg

Question 15

Special considerations of pravastatin

Answer 15

Decreased absorption with food
Adjust starting doses if severe renal impairment
Hydrophilic

Question 16

Dose ranges of rosuvastatin

Answer 16

10-40 mg

Question 17

Special considerations of rosuvastatin

Answer 17

Adjust starting doses if severe renal impairment

Hydrophilic

Question 18

Dose ranges of simvastatin

Answer 18

10-40 mg

Question 19

Special considerations of simvastatin

Answer 19

Adjust starting doses if severe renal impairment

Question 20

What statin should you consider switching your pts to if they experience myopathies?

Answer 20

Pravastatin and rosuvastatin

Question 21

Gemfibrozil and statins

Answer 21

Contraindicated with statins but if use necessary, pravastatin is necessary

Question 22

Grapefruit juice and statins

Answer 22

Moderate amount of grapefruit juice is ok

<8 oz grapefruit juice daily OR 1/2 grapefruit is ok

Question 23

What drugs are contraindicated with simvastatin?

Answer 23

Itraconazole
Ketoconazole
Posaconazole
Erythromycin
Clarithromycin
Tesithromycin
HIV protease inhibitors
Nefazodone
Gemfibrozil
Cyclosporine
Danazol

Question 24

What should be done for statin intolerance?

Answer 24

Change to another statin, preferably pravastatin
Alternate day dosing
-Give 2x the daily dose but administer every other day
-No daily doses >40 mg daily have been tested

Question 25

Equivalent doses to 40 mg fluvastatin

Answer 25

20 mg lovastatin 20 mg pravastatin 10 mg simvastatin 1 mg pitavastatin

Question 26

Equivalent doses to 80 mg fluvastatin

Answer 26

``` 40-80 mg lovastatin 40 mg pravastatin 20 mg simvastatin 2 mg pitavastatin 10 mg atorvastatin ```

Question 27

Equivalent doses to 80 mg lovastatin

Answer 27

``` 80 mg pravastatin 40 mg simvastatin 4 mg pitavastatin 20 mg atorvastatin 5 mg rosuvastatin ```

Question 28

Equivalent doses to 40 mg atorvastatin

Answer 28

10 mg rosuvastatin

Question 29

Equivalent doses to 80 mg atorvastatin

Answer 29

20 mg rosuvastatin

Question 30

What are examples of ACE inhibitors?

Answer 30

Benazepril Linsinopril Enalapril

Question 31

Common SEs of ACE inhibitors

Answer 31

Hyperkalemia Dry cough Decrease in GFR upon initiation

Question 32

What is a rare but serious SE of ACE inhibitors?

Answer 32

Angioedema

Question 33

Pregnancy category of ACE-Is

Answer 33

X

Question 34

MOA of ACE-Is

Answer 34

Prevent conversion of angiotensin I to angiotensin II

Question 35

Monitoring for ACE-Is

Answer 35

Bring pt back in one week to see change in renal function Ser creatinine, BUN, GFR Serum creatinine increasing by 30% is indicative of renal artery stenosis

Question 36

What do H2 receptor antagonists treat?

Answer 36

Mild to moderate GERD | For symptomatic relief of mild GERD, low-dose, non-prescription or standard doses given BID may be beneficial

Question 37

Most common SEs of H2 receptor antagonists

Answer 37

``` HA Somnolence Fatigue Dizziness Constipation Diarrhea Can develop tolerance with prolonged therapy ```

Question 38

Special considerations for cimetidine (Tagamet)

Answer 38

Has the most drug interactions | Avoid with Plavix

Question 39

Non-Rx dose of cimetidine

Answer 39

200 mg BID

Question 40

Rx dose of cimetidine

Answer 40

400 mg BID

Question 41

Non-Rx dose for famotidine (Pepcid)

Answer 41

10 mg BID

Question 42

Rx dose for famotidine

Answer 42

20 mg BID

Question 43

Non-rx dose for nizatidine

Answer 43

75 mg BID

Question 44

Rx dose of nizatidine

Answer 44

150 mg BID

Question 45

Non-Rx dose of ranitidine

Answer 45

75 mg BID

Question 46

Rx dose of ranitidine

Answer 46

150 mg BID

Question 47

Special considerations for ranitidine

Answer 47

Less drug-drug interactions than cimetidine (Tagamet)

Question 48

Use of proton pump inhibitors (PPIs)

Answer 48

Moderate to severe GERD

Question 49

SEs of PPIs

Answer 49

``` HA Dizziness Somnolence Diarrhea Constipation Nause Vit B12 deficiency C. difficile Fx (long-term usage) ```

Question 50

Drug interactions with PPIs

Answer 50

Include: Ketoconazole Itraconazole Reyataz

Question 51

How much of a trial should PPIs be given?

Answer 51

8 wks Then, stop and see if sx have resolved Use an H2 blocker PRN if sx are mild, continue PPI if sx are still severe

Question 52

Which PPI is preferred with clopidogrel?

Answer 52

pantoprazole (Protonix)

Question 53

Special considerations for lansoprazole

Answer 53

Packet for oral suspension should not be placed through a nasogastric tube