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adv. pharm DNP > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

macrolide antibiotics used for CAP

A

azithromycin (zpack) and clarithromycin (Biaxin)

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2
Q

serious side effects of macrolide antibiotics

A

QTC prolongations, LFT abnormalities, GI upset

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3
Q

other macrolide abx considerations

A

use with caution in patients with arrhythmias and heart disease. avoid in patients with a history of hepatic jaundice. hold statins during treatment = interact on CYP34A pathway

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4
Q

sinusitis treatment options

A

intranasal corticosteroids, augmentin, clindamycin, cephalosporins, doxycycline, fluoroquinolones

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5
Q

sinusitis tx recs for common drug allergies

A

PCN allergy –> use doxycycline or resp. fluoroquinolone (moxi or levofloxacin) or clindamycin
*do not use augmentin in patients with a cephalosporin allergy

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6
Q

1st gen antihistamines

A

diphenhydramine (Benadryl) and chlorpheniramine (chlor-tabs)

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7
Q

Diphenhydramine considerations (Benadryl)

A

CI: breast-feeding
Caution: asthma, cardiovascular disease, increase intraocular pressure, BPH, and thyroid dysfunction

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8
Q

Chlorpheniramine (chlor-tab) considerations

A

CI: narrow-angle glaucoma, bladder neck obstruction, BPH
Avoid use with newborns!!! Possible association with SIDS
AE: drowsiness, sedation

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9
Q

2nd gen antihistamines

A

do not cross BBB to same extent as 1st gen, less sedating
Fexofenadine (allegra), Loratadine (Claritin), Certrizine (Zyrtec)

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10
Q

Loratadine (Claritin) AE

A

somnolence, Dry mouth, pharyngitis, dizziness

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11
Q

certrizine (zytec) AE

A

viral infection, nausea, HA, drowsiness, dyspepsia

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12
Q

overall antihistamine considerations

A

Caution in elderly d/t confusion, constipation, dizziness, dry mouth, urinary retention, sedation (1st gen) **beers list
2nd gen antihistamines are ineffective for COUGH d/t COLDs

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13
Q

intranasal antihistamines

A

azelastine(astepro), olopatadine

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14
Q

intranasal antihistamine AE

A

Bitter taste, dry mouth, headache, cough, epistaxis, burning

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15
Q

Decongestants for sinusitis

A

sympathomimetic agents that stimulate alpha and beta receptors causing vasoconstriction
Overall CI: narrow-angle glaucoma, severe uncontrolled hypertension, CAD, recent use of MAOI
Overall AE: HTN, ^ HR, palpitations, insomnia, tremors, urinary retention, gi upset, dizziness

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16
Q

treatment for bronchitis

A

antitussives, expectorants, and antibiotics(macrocodes) or antivirals if indicated

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17
Q

antitussives

A

benzonatate (tessalon pearls) or dextromethorphan (delsym)

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18
Q

Community-acquired pneumonia treatment (WITH comorb)

A

Amox/clav + macrolide, cephalosporin + macrolide OR doxycycline. Fluoroquinolone monotherapy

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19
Q

CAP treatment (WITHOUT comorb)

A

Without comorbidities: Amoxicillin OR Doxycycline OR azithromycin OR clarithromycin

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20
Q

tamiflu prescribing considerations for flu treatment

A

Recommended within 48 hours of symptom onset
Can be used for prophylaxis for up to 6 weeks during a community outbreak for high risk persons
Special considerations: dosage adjustment with reduced kidney function

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21
Q

Theophylline adverse events

A

Tachyarrhythmias, restlessness, insomnia, N/V, GERD, seizures
POTENTIAL FOR LIFE-THREATENING CARDIAC ARRHYTHMIAS

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22
Q

indication for use for leukotriene modifiers

A

allergies and asthma
(age specific drugs)

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23
Q

Montelukast (singulair) BBW:

A

serious behavior and mood changes
ages 2+

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24
Q

Zafirlukast (accolte) considerations

A

ages 7+
Metabolized by CYP450
SE: pharyngitis, headache, rhinitis, gastritis
Rare liver failure- monitor LFTs q2-3 months

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25
Zileuton (zyflow) considerations
age 12+ Metabolized by CYP450 Monitor LFTs before, monthly for 3 months, then q2-3 months SE: dyspepsia, abd pain, nausea Increases theophylline levels and PT/INR levels
26
Asthma quick relief treatment recommendations
8-10 puffs of SABA, may be repeated every 20 minutes fo 1 hour, and then every 3 to 4 hours for the next 24-48 hours or until the patients symptoms are stable - may need short dose of PO corticosteroid - if not stable, go to ER
27
SAMA MOA
short-acting muscarinic agonist relaxes airway smooth muscle - decreased mucous secretions
28
GOLD group D recommendations
-Option 1: daily LABA/LAMA anora-Ellipta, bevespi, Duaklir, Respimat -Option 2: Daily ICS/LABA Advair, Breo, Dulera, and Symbicort -Option 3: Daily ICS/LABA/LAMA, (can add) theophylline, phosphodiesterase 4 inhibitor(roflumilast), macrolide abx TRELEGY
29
LABAs/LAMAs
anora-Ellipta, bevespi, Duaklir, Respimat
30
ICS/LABA combos
Advair, Breo, Dulera, and Symbicort
31
ICS/LABA/LAMA triple therapy
trelegy
32
LABA name
servant diskus (salmeterol)
33
LABA serious side effects
BLACK BOX WARNING: ASTHMA-RELATED DEATH to salmeterol Serious adverse events for: thrush, immunosuppression, paradoxical bronchospasm, asthma exacerbation, asthma-related death, laryngospasm, hypersensitivity reaction, anaphylaxis, HTN, Hypotension, angina, cardiac arrest, arrhythmia, hypokalemia, and hyperglycemia.
34
in asthma, LABA must be used with:
an inhaled corticosteroid (ICS)
35
Memantine (Namenda) MOA
Blocks activation and overstimulation of NMDA receptor during glutamate abundance → inhibits neuronal degeneration that would otherwise result
36
Goals of drug therapy for AD
maintain and maximize the patient's functional ability, quality of life, and independence for as long as possible while minimizing adverse events and cost
37
main drugs for cognitive symptoms of AD
Cholinesterase inhibitors and memantine
38
Medications used for non-cognitive symptoms in AD
Antipsychotics --> risperdal, zyprexa Benzodiazepines --> for anxiety, agitation (lorazepam & alprazolam) SSRI antidepressants --> depression (Zoloft, lexapro)
39
Mild-moderate AD disease tx
Cholinesterase inhibitors Donepezil (exalon), Rivastigmine (razadine), galantamine (aricept)
40
Moderate-severe AD tx
NMDA receptor antagonist memantine (Namenda)
41
Cogentin contraindications
narrow-angle glaucoma (avoid use with KCl, glucagon, anticholinergics)
42
Common meds prescribed for management of PD symptoms
Motor symptoms -anticholinergics (Trihexyphenidyl(artane) or benztropine(cogentin) -amantadine -MAO-Bs (selegiline, rasafiline, safinamide) -Levodopa/carbidopa -COMTIs (entacopone, tolcapone) -Dopamine agonists
43
parkinsons meds non-motor symptoms
depression - venlafaxine, pramipexole psychosis = clozapine dementia = rivastigmine, donepezil insomnia = rotigotine + hypotension meds, drooling preventions, stool softeners
44
MOA of amantadine
its inhibition (NMDA) receptors potentiates dopaminergic responses to reduce PD symptoms binds/blocks NMDA receptors and increases release of dopamine
45
MOA of Levodopa
Levodopa is a dopamine precursor, crosses the blood brain barrier and is then converted via decarboxylation to dopamine → stored in presynaptic neurons until stimulated for release
46
Carbemazepine(tegretol) serious side effects
Black Box Warning: risk of toxic epidermal necrosis/SJS, aplastic anemia, agranulocytosis Screen for HLA-B*1502 allele ( Asian pts) → increased risk of derm reactions Other special considerations: inducer of several CYP pathways, pregnancy category D, can lead to hyponatremia in older adults “Serious but less common adverse events include blood dyscrasias, syndrome of inappropriate diuretic hormone secretion (SIADH), cardiac conduction abnormalities, SJS, and DRESS”
47
Phenytoin and fosphenytoin adverse effects
AE: lateral nystagmus, ataxia, lethargy, acne, increased body hair, arrhythmia, gingival hyperplasia Bb warning: IV forms for cardiovascular events with rapid infusion Serious but less common adverse events include blood dyscrasias (anemia, neutropenia, leukopenia, thrombocytopenia), hepatitis, Stevens-Johnson syndrome (SJS), drug reaction with eosinophilia and systemic syndromes (DRESS), and systemic lupus erythematosus (SLE).
48
acute treatment of status epilepticus
Benzodiazepines IV lorazepam (Ativan) 4mg IV diazepam (valium) 5-10 mg
49
preventative/prophylactic treatment options for cluster headaches
Verapamil IR - 40-80mg TID Lithium 300mg BID Melatonin 10mg every evening Warfarin (INR 1.5-1.9) Galcanezumab (emgality)
50
Preventative/prophylactic treatment for Tension-type headaches
1st line: amitryptiline 2nd line: venlafaxine XR or Mirtazapine
51
migraine meds for patients with hypertension/essential tremor
Beta-blockers (1st line for migraine prophylaxis) Propranolol (Inderal) Metoprolol (Lopressor) Timolol
52
migraine meds for patients with hypertension (2nd line)
CCBs - verapamil
53
Migraine meds for pt with anxiety/depression or post-menopausal hot flashes
venlafaxine XR (SNRI)
54
migraine med options for patients with regimen adherence issues
Injections! usually monthly - CGRP receptor antagonists - a 2nd line ppx -amovig, ajovy, emgality, vyepti
55
2nd line treatment for migraines
Triptans (suma, zolmi, riza, ele, frova) Ditans (Lasmiditan - reyvow) CGRP receptor antagonist (ubrelvy, nurtec) Ergot derivatives (ergomar, migranal, cafergot) Barbiturates (fioricet, forinal) opioids (tramadol, butorphanol) decadron antiemetics
56
Contraindications to triptan therapy
- not indicated for use in children <12 - not okay in pregnancy - avoid in patients with CAD, cerebrovascular disease, severe PVD; basilar, hemiplegic or retinal migraines - not used more than 9 days per month
57
Medication overuse headache treatment
withhold all OTC analgesics for 2 weeks - should go away
58
diagnosis of medication overuse headache
when using OTC analgesic for either migraine or TTH headache more than 2x per week, and it causes a chronic daily headache
59
important education regarding bisphosphonate therapy
-AM dosing on empty stomach -must be taken whole with 8oz of water - stay upright for 30 min-1hr -omit in patients with GERD -monitor with DEXA scans; consider drug holiday if scans are good
60
acute gout treatment recs
1st line: -Colchicine + NSAID - Oral corticosteroid + Colchicine -intraarticular steroid + NSAID NSAIDS Systemic corticosteroids
61
rheumatoid arthritis bridging treatment
NSAIDS or corticosteroids in an acute episode until DMARDS are therapeutic ex. glucocorticoids (prednisone)
62
DMARD name for RA tx
methotrexate
63
treatment of fibromyalgia
SNRIs (Duloxetine, milnacipran, venlafaxine) SSRIs (prozac, Zoloft, lexapro) tricyclics CBT, exercise
64
Psoriasis treatment considerations with Coal tar
MOA: depresses DNA synthesis with anitinflammatory & antipruritic properties Used for 30-45 days, 3-7x per week Cons: odor, staining, photosensitivity (wear sunscreen), folliculitis
65
Herpes zoster (shingles) treatment options
Acyclovir, famciclovir(highest bioavailability), valacyclovir
66
contraindications to Terbinafine/lamisil for toenail fungus (tinea unguium)
AE: elevation in AST/ALTs, diarrhea, dyspepsia, rash, HA Check LFTs before initiation and 6-8 weeks after initiation CI: in chronic liver disease and those with CrCl<50
67
Role of contraceptives in acne treatment
Oral contraceptives that contain ethinyl estradiol, levonorgestrel, and norgestimate or drospirenone. Effective due to a decrease in testosterone production.
68
Impetigo treatment 1st line
Topical mupirocin ointment TID 7-10 days Plus oral abx 7-10 days Broad spectrum penicillin (augmentin or dicloxacillin) OR 1st gen cephalosporin (keflex) ---If PCN allergy - use clindamycin
69
Considerations for prescribing clotrimazole/lotrim cream for cutaneous candidiasis
Contraindications: pregnancy/lactation (HF risk) Continue 1 week after infection clears Common side effects: pruritis, irritation, stinging
70
Considerations for prescribing systemic corticosteroids for contact dermatitis
contraindicated in patients with systemic mycoses and in patients receiving a vaccination These drugs also should be used cautiously in people with tuberculosis, hypothyroidism, cirrhosis, renal insufficiency, hypertension, osteoporosis, and diabetes mellitus Prescribed as a tapering dose Take in the morning to minimize insomnia - prescribed when dermatitis is widespread or resistant to topical preparations
71
treatment of dermatitis on the face and intertriginous areas
use low potency steroids on the thin skin ex. Hydrocortisone 1%, Alcovate or Synalar cream + pimecrolimus (elidel)
72
Accutane Prescribing considerations
Teratogenic - must register users in SMART system - 2 forms of birth control only 30 days prescribed at a time check labs before initiating, can elevate triglycerides AE: dry mucous membranes, musculoskeletal aches BB warning: increased SI and aggressive behaviors
73
1st line treatment for acne
-retinoic acid (tretinoin, Retin-A) -Adapalene gel (Differin) -Tazarotene gel (tazorac) or benzoyl peroxide, azelex, clindamycin, erythromycin
74
superficial MRSA infection treatment
Mupirocin (Bactroban) in nostrils/superficial wounds Trimethoprim-sulfamethoxazole (Bactrim), minocycline, clindamycin, or linezolid
75
Systemic MRSA tx
Vancomycin, Daptomycin, Telavancin, Dalbavancin, Oritavancin, Linezolid, Tedizolid, and Tigecycline
76
topical preparation absorption rates
Creams: most desirable, least effective ointments/gels: most potent/lubricating lotions/sprays: good for widespread areas and scalp
77
Rosacea first-line treatment recommendations
topical therapy -Metronidazole -Sodium Sulfacetamide -Azelaic Acid BID
78
Rosacea 2nd line treatment
adding an oral antibiotic to the topical therapy, after 2 weeks starting to tape back down to just topical tx (tetracycline, doxycycline, erythromycin, bactrim)
79
Dopamine agonists
pramipexole (mirapex), Ropinirole (requip), Rotigotine (neupro), Apomorphine (apokyn)
80
COMTIs
entacopone (Comtan), tocapone (tasmar)
81
MAOBs
selegiline (Eldepryl), Rasagiline (azilect), Safinamide (xadago)

adv. pharm DNP (1 decks)

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