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NU 560 > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

Names of Macrolide abx used for community acquired pneumonia

A

Azithromycin, Clarithromycin

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2
Q

Serious Side Effects of Macrolides for CAP

A

QTC prolongation, LFT abnormalities, GI upset. Use with caution in pts with arrhythmias or heart disease. Avoid with hx of cholestatic jaundice, hepatic dysfunction w/ prior use

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3
Q

First Line Sinusitis treatment

A

Abx after 7 days of watchful waiting.
Amoxicillin or Augmentin if pt is high risk for amoxicillin resistance

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4
Q

Sinusitis treatment if pt has penicillin or cephalosporin allergy

A

Doxycycline or Fluoroquiniolone: Moxifloxacin or Levofloxacin

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5
Q

Names of antihistamines

A

First gen: Benadryl, Chlorpherniramine
Second gen: Fexofenadine (Allegra), Loratadine (Claritin), Catirizine (Zyrtec)
Intranasal: Azelastine, Olopatadine

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6
Q

Consideration for antihistamines for acute respiratory illness

A

Caution in elderly due to confusion, constipation, dizziness, dry mouth, urinary retention, and sedation. On beers list

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7
Q

Considerations for Benadryl

A

Cause drowsiness/sedation. Contraindicated in breastfeeding. Caution in Asthma, CV disease, increased IOP, BPH, thyroid dysfunction

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8
Q

Considerations for Chlorpheniramine

A

Cause drowsiness/sedation. Contraindicated in breastfeeding. Caution in narrow angle glaucoma, bladder neck obstruction, BPH. AVOID IS NEWBORNS&raquo_space;> SIDS

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9
Q

Consideration for 2nd generation antihistamines

A

Less sedating. Caution in renal and hepatic impairment. Ineffective for cough due to colds. May induce dryness and worsen congestion.

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10
Q

SE of intranasal antihistamines

A

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

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11
Q

Names of decongestants for acute respiratory illness

A

Topical: Oxymetazoline (Afrin), Phenylephrine
Oral: Pseudoephedrine

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12
Q

Contraindications and Adverse event of decongestants

A

CI: Narrow angle glaucoma, severe HTN, CAD, recent MAOI use
AE: HTN, tachycardia, palpitations, insomnia, tremors, urinary retention, gi upset, dizziness

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13
Q

Considerations of Afrin and topical Phenylephrine

A

Use for no more than 2-3 days due to rhinitis medicamentosa - rebound congestion. Nasal sprays can become addictive

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14
Q

Considerations for Pseudoephedrine

A

Dont crush or chew, give at least 2 hours before bedtime

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15
Q

Treatment for acute bronchitis WITH comorbid conditions

A

Antibiotics for hx of COPD, high fever, cough longer than 4-6 days, or 65+ with comorbidities (CAD, DM)

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16
Q

Treatment for acute bronchitis WITHOUT comorbidities

A

Antitussives: Bonzonatate or dextromethorphan for mild cough. Cough meds plus codeine or hydrocodone for severe cough.
Expectorants: Guaifenesin to decrease thick secretions

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17
Q

Treatment for community-acquired pneumonia WITHOUT comorbidities

A

Amoxicillin
Doxycycline
Azithromycin
Clarithromycin

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18
Q

Treatment for community-acquired pneumonia WITH comorbidities

A

Augmentin + macrolide (azithromycin)
Cephalosporin (cefazolin, ceftriaxone) + macrolide OR doxycycline
Fluoroquinolone monotherapy

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19
Q

When to prescribe tamiflu

A

Within 48 hours of symptom onset.
Can be taken for up to 6 weeks during a community outbreak.
Groups at highest risk of flu are Adults older than 65, children <2, and pregnant women.
Dose adjustments with reduced kidney function.
Do not use in ESRD

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20
Q

Theophylline adverse events

A

Tachyarrhythmias, restlessness, insomnia, N/V, GERD, seizures. POTENTIONAL FOR LIFE THREATENING CARDIAC ARRHYTHMIAS.
Theophylline toxicity: sinus tach, vtach, afib, SVT, hypotension, cardiac arrest, tremors, hallucinations, seizures

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21
Q

Names of Leukotriene modifiers

A

Montelukast (Singulair)
Zafirlukast (Accolate)
Zileuton (Zyflo)

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22
Q

Indications for leukotriene modifiers

A

Asthma and allergies

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23
Q

Special consideration for Montelukast

A

Black box warning for serious behavior and mood changes

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24
Q

Special consideration of Zafirlukast

A

Metabolized by CYP 450. Rare liver failure > Monitor LFTs q2-3 months

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25
Special considerations for Zileuton
Metabolized by CYP 450. Monitor LFTs before, monthly for 3 months, then q2-3 months. Increases theophylline levels and warfarin activity. ^INR
26
Asthma quick relief treatment recommendations
SABA (albuterol/levalbuterol) - 8-10 puffs, may be repeated q20min for 1 hour, then q3-4 hours for next 24-48 hours or until symptoms are stable
27
SABA
albuterol/levalbuterol
28
name of a SAMA
Atrovent
29
SAMA Mechanism of action
short acting muscarinic antagonist. Relaxes airway smooth muscle and increases bronchial ciliary activity. Decreases mucous secretions.
30
GOLD group D treatment recommendations
Option 1: Daily LABA/LAMA - Ellipta, Genuair, Respimat Option 2: Daily ICS/LABA - Advair, Airduo, Breo, Dulera, and Symbicort Option 3: Daily ICS/LABA/LAMA - Trelegy. Can add theophylline, phosphodiasterase 4 inhibitor, macrolide abx, or ICS/LAMA/LABA?roflumilast
31
Name of single ingredient LABA
Serevent Diskus (salmeterol)
32
Name of combo LABA/corticosteroid
Advair, Dulera, Symbicort
33
LABA black box warning
Asthma related death to salmeterol
34
Serious side effects of LABA
Thrush, immunosuppression, paradoxical bronchospasm, astham exacerbation, asthma-related death, laryngospasm, hypersensitivity reaction, anaphylaxis, HTN, hypotension, angina, cardiac arrest, arrhythmia, hypokalemia, hyperglycemia
35
Menantine (Namenda) mechanism of action
For Alzheimer's disease. NMDA receptor antagonist. Blocks activation and overstimulation of NMDA receptor during glutamate abundance > inhibits neuronal degeneration that would otherwise result
36
Goals of drug therapy for Alzheimers disease
Maintain and maximize patient's functional ability, quality of life, and independence for as long as possible while minimizing adverse events and cost
37
Meds for Non-cognitive symptoms of Alzheimer's disease
Typical Antipsychotics: Haldol Atypical Antipsychotics: Risperdal, Zyprexa Benzodiazepines: Lorazepam, Alprazolam Antidepressants: SSRIs: Zoloft, Lexapro
38
Treatment for Mild Alzheimers disease
Cholinesterase inhibitors: Donepezil (aricept), Rivastigmine (exelon), Galantamine (razadyne)
39
Treatment for Moderate to Severe Alzheimer's disease
NMDA receptor antagonist: Namenda. May be used in conjunction with a cholinesterase inhibitor
40
Cogentin Contraindications
Narrow angle glaucoma Avoid with potassium chloride, use of glucagon, and use of other anticholinergics (ipratropium, tiotropium)
41
Common meds for management of Parkinson's Disease motor symptoms
Anticholinergics: Trihexyphenidyl (Artane), Benztropine (Cogentin) Amantadine (Symmetrel) Monoamine Oxidase B inhibitors: Selegiline, Rasagiline Dopamine Agonists: Mirapex, Requip, Neupro, Apokyn Carbidopa/levadopa: Sinemet, Parcopa, Rytary Catechol-O-Methyltransferase Inhibitors: Comtan, Tasmar
42
Common meds for management of Non-motor symptoms of Parkinson's Disease
Depression: Mirapex, Effexor, Elavil, Wellbutrin Psychosis: Clozaril, Seroquel, Donepezil (Aricept), Rivastigmine (Exelon), Ziprasidone (Geodon) DO NOT USE zyprexa, risperdal, or abilify Dementia: Rivastigmine (Exelon), Donepezil (Aricept) Insomnia: Neupro Autonomic: Hypotension - Florinef, midodrine, indomethacin, droxidopa Drooling - Sublingual atropine, glycopyrrolate, botox Constipation - laxatives and stool softeners
43
Levodopa Mechanism of Action
Dopamine precursor. Crosses blood brain barrier and is converted via decarboxylation to dopamine. Stored in presynaptic neurons until stimulated for release. Giving with carbidopa limit the peripheral breakdown of levodopa
44
Amantadine Mechanism of Action
Inhibits NMDA receptors- potentiates dopaminergic responses to PD symptoms. Binds to and blocks NMDA receptors and increases the release of dopamine.
45
Carbamazepine (Tegretol) side effects
Black Box warning for risk of toxic epidermal necrosis/SJS, aplastic anemia, agranulocytosis. Black Box warning for risk of serious dermatological reactions in patients with HLA B1502. Asian patients should be screened.
46
Names of Hydantoins
Phenytoin and fosphenytoin
47
Hydantoins adverse effects
Lateral nystagmus, ataxia, lethargy, acne, increased body hair arrhythmia, gingival hyperplasia. Serious but less common include blood dyscrasias, SJS, hepatitis, DRESS, lupus
48
Acute treatment of status epilepticus
Benzos: Depress all levels of CNS. GABA receptor agonists. Lorazepam and Diazepam. Must be given IV (or rectal gel if out of hospital). Goal is to control seizures within 60 minutes of onset.
49
Initiation of Preventive/Prophylactic treatment for Cluster Headaches
Verapamil Lithium Melatonin Warfarin Galcanezumab (Emgality)
50
Initiation of Preventive/Prophylactic treatment for Tension Type Headaches
for more than 2 TTH/week requiring meds, start prophylactic treatment.
51
1st Line prevention for TTH = Gold Standard
Amitriptyline (Elavil) - Tricyclic antidepressant Start low and go slow. Can take 4-8 weeks for full effect
52
Considerations for Amitriptyline
Use with caution in patients with hx of CV disease, BPH, glaucoma, urinary retention, DM, drug/alcohol use, elderly. Black box warning: increased risk of suicidal ideation in patients <24 years old w/ depression/psych disorders
53
2nd Line for TTH prevention
Venlafaxine (Effexor XR) SNRI Nausea, somnolence, sexual dysfunction, sweating, nervousness. Use with caution in older adults, multiple drug interactions. Mirtazapine (Remeron) Atypical Antidepressant Somnolence, increased cholesterol, dry mouth, weight gain, constipation. Use with caution in seizure disorder, hepatic/renal impairment, older adults
54
Initiation of preventive treatment for Migraines w/ consideration of underlying disease First Line
Beta Blockers: Propanolol, metoprolol, timolol. Treats migraine + hypertension and essential tremor
55
preventive treatment for Migraines w/ consideration of underlying disease 2nd Line
Calcium Channel Blockers: Verapamil Treats migraine + hypertension SNRI: Venlafaxine (Effexor XR) Treats migraines + anxiety/depression and or postmenopausal hot flashes CGRP receptor agonists: Umabs (emgality) Good for daily regimen adherence issues
56
Second Line treatment for acute migraines
Triptans: Sumatriptan, Zolmitriptan, Rizatriptan, Eletriptan, Frovatriptan. Ditans: Lasmiditan CGRP Receptor Antagonist: Ubrelvy, nurtec Ergot Derivatives: Ergotamine, Dihydroergotamine, Cafergot Barbiturates: Fioricet (butalbital/caffeine/acetaminophen), Forinal (btualbital/caffeine/aspirin) Opioids: Butorphanol, Tramadol, Tylenol + Codeine Steroids: Dexamethasone Antiemetics: Prochlorperazine, MEtoclopramide, Droperidol
57
Contraindications to Triptan therapy
Not for use in children, esp under 12. STRONGLY contraindicated in pregnancy. Avoid use with CAD, cerebrovascular disease, severe PVD. Avoid in basilar, hemiplegic, retinal migraines. Don't use within 24 hours of other vasoconstriction drugs (ergotamine, DHE). Not for more than 9 days/per month. Zomig contra in pts with WPW
58
Diagnosis and treatment of medication overuse headache
Treating more than two headaches with and OTC analgesic for either migraine or TTH per week can lead to development of chronic daily headaches. Treatment is withholding all OTC analgesics for 1-2 weeks.
59
Medications that are Biphosphonates
Fosamax PO, Actonel PO daily/weekly, Boniva PO monthy, Reclast IV yearly, Miacalcin (nasal)
60
Education regarding Biphosphonate therapy
AM dosing on empty stomach. Must be taken whole with no other medications and with 8oz water. Must sit upright for 30min-1hr Not given to patients with GERD, gastritis, peptic ulcer disease. DEXA scans, can go on drug holiday for several months up to 2 years if bone density looks good
61
1st Line Acute Gout treatment
Colchicine + NSAID Colchicine + Oral Corticosteroid Intra-articular Steroid + NSAID or colchicine or oral corticosteroid -Steroids not preferred for pts with diabetes, heart failure, hypertension NSAIDS: naproxen, indomethacin, sulindac Systemic corticosteroids Colchicine MUST be given within 24-48 hours
62
2nd Line Acute Gout Treatment
Switch to an alternative 1st line medication. Do NOT mix NSAIDs with steroids.
63
Rheumatoid Arthritis bridging treatment
NSAIDs or corticosteroids in an acute episode until DMARDs (methotrexate) are therapeutic. Glucocorticoids used to rapidly suppress inflammation and relieve symptoms. Can take 3-8 weeks until therapeutic improvement
64
Treatment of Fibromyalgia
SNRIs: Duloxetine (cymbalta) , Milnacipran (savella), Venlafaxine (Effexor) SSRIs: Prozac, Zoloft, Lexapro TCAs: Amitriptyline, Cyclobenzaprine
65
Psoriasis treatment considerations with coal tar (creosote)
Can cause odor staining, photosensitivity, folliculitis. Use sunscreen. Comes in ointment, gel, bath preparation, shampoo Side effects result in poor compliance.
66
When to treat Herpes Zoster (shingles)
If rash present <72 hours. If new lesions still developing. Patient is older than 50. Immunocompromised.
67
Medications for Herpes Zoster (shingles)
Acyclovir Famciclovir Valacyclovir
68
Contraindications to Lamisil for toenail fungus
Acute or chronic hepatic disease. AE: elevation in AST/ALT. Check LFTs before initiation and 6-8 weeks after
69
1st Line Impetigo treatment
7-10 days abx Augmentin or dicloxacillin. Or cephalosporin (Cephalexin)
70
Impetigo treatment if penicillin allergy
If PCN allergy, use Clindamycin. If pt suspected of being chronic carrier S. aureus give topical mupirocin ointment to nares
71
Clotrimazole/Lotrimin considerations
First line for Cutaneous Candidiasis. Contraindicated in pregnancy/lactation. Keep away from the eyes. Occlusive dressing should NOT be applied over the medicine d/t risk of skin irritation. Recurrent candidiasis should be tested for HIV and DM
72
When to prescribe systemic corticosteroids for contact dermatitis
When dermatitis is widespread or resistant to topical preparations.
73
Considerations for systemic corticosteroids for contact dermatitis
Taking for less than 2 weeks could cause rebound dermatitis. CI: pts with systemic fungal infections and receiving vaccines. Caution in pts with TB, hypothyroidism, cirrhosis, renal insuff, HTN, osteoporosis, diabetes. Decreased efficacy if given with barbiturates (barbitals) or rifampin. Prescribed as a taper. Take in morning.
74
Treatment of dermatitis on face and intertriginous areas
use Low potency steroids because skin there is thin layer, will be absorbed faster and have stronger effect. 1% hydrocortisone OTC Pimecrolimus (elidel)- immunosuppressant
75
Accutane indications
Severe nodulocystic acne when other treatments fail
76
Accutane considerations
Only can prescribe 30 days at a time. Female pts of childbearing age should use 2 forms of birth control. Baseline CBC, chem, fasting lipids. Recheck after 1 month. Pregnancy should be avoided for 1 month after therapy discontinued. Should not be given in adolescents not done growing, can cause closure of epiphysis. Prescribers must register in SMART program. Black Box: aggressive/violent behavior and or suicidal ideation.
77
1st Line treatment for Acne
Topical: Retinoic Acid, Adapalene gel (Differin), tazarotene gel (tazorac) Topical comedolytics: Tretinoin, benzoyl peroxide, Azelex, Clindamycin, Erythromycin, Tazorac
78
Role of PO contraceptives for acne treatment
Decrease testosterone production. Contain ethinyl estradiol, levonorgestral, norgestimate, drospirenone
79
Superficial MRSA treatment
Mupirocin (Bactroban) in nostrils and on superficial wounds. If more serious can use use Vanc, daptomycin, telavancin
80
Systemic MRSA treatment
Trimethoprim-sulfamethoxazole (Bactrim) Minocycline Clindamycin Linezolid
81
Most effective topical preparation
Ointments - are occlusive, prevent water absorption or evaporation, produce greater local effects than creams
82
Least effective topical preparation
Creams - are water soluble, washed off more easily. Preferred for hairy areas
83
Gel topical preparations
Most water soluble topical dosage form. Spread easily over large areas
84
Rosacea 1st Line treatment recommendations
Topical therapy: Metronidazole Sodium Sulfacetamide Azelaic Acid Begin 2nd line if no improvement after 6 weeks
85
Rosacea 2nd Line treatment
Add oral antibiotic. After 2 weeks, reduce by 50%, then after 6 weeks discontinue and continue topical treatment. Tetracycine Doxycycline Erythromycin Trimethoprim/Sulfamethoxazole
86
Rosacea 3rd line
Oral isotretinoin or refer to dermatologist

NU 560 (2 decks)

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