Exam II Flashcards
(167 cards)
1
Q
what is colchicine used for?
A
acute gout attack
2
Q
why is colchicine used prophylactically?
A
to reduce the incidence of acute attacks
3
Q
colchicine is pregnancy category what?
A
C
4
Q
what are the major ADRs of colchicine?
A
GI
5
Q
does colchicine need a renal dose adjustment?
A
yes
6
Q
when should you resume colchicine prophylactically after an acute attack?
A
12 hours after it’s resolved
7
Q
what does allopurinol do?
A
decreases acid production
8
Q
what is allopurinol used for?
A
most preventative for gout
9
Q
allopurinol prevents what?
A
increase in uric acid production
10
Q
does allopurinol need a renal dose adjustment?
A
yes
11
Q
which patients is allopurinol best for?
A
pts that over produce uric acid
12
Q
allopurinol is pregnancy category what?
A
C
13
Q
what should be monitored when taking allopurinol?
A
LFTs
renal function
14
Q
is allopurinol safe to use in patients with renal insufficiency?
A
yes
15
Q
what can both colchicine and allopurinol cause?
A
hepatotoxicity
16
Q
what does probenecid do?
A
increases urinary excretion of uric acid
17
Q
what is the drug of choice for gout prevention?
A
probenecid
18
Q
why is probenecid the drug of choice for gout prevention?
A
pregnancy category B
long duration
safety
19
Q
when should probenecid be started?
A
after an acute attack resides
20
Q
does probenecid require a renal dose adjustment?
A
yes
21
Q
what may indicate overdose in patients taking probenecid?
A
gastric intolerance
22
Q
what should be monitored in pts taking probenecid?
A
CBC for blood dyscrasisa and bone marrow suppression
23
Q
pts taking probenecid should be asked about what medication allergy?
A
sulfa
24
Q
when is sulfinpyrazone used?
A
as a last resort; when allopurinol and probenecid are not tolerated
25
what ADRs are associated with sulfinpyrazone?
GI
26
sulfinpyrazone is pregnancy category what?
D
27
what should be monitored in pts taking sulfinpyrazone?
CBC
28
sulfinpyrazone has what kind of "effect" that other antigout medications don't?
antithrombotic; can cause platelet dysfunction
29
when is febuxostat used?
for chronic gout w/hyperuricemia
30
what labs should be checked when taking febuxostat?
LFTs at 2 mth and 4 mths
31
what can febuxostat cause that is a deterring factor?
an acute gout attack
32
what should be given simultaneously with febuxostat?
NSAIDs or colchicine for 1st six mths
33
does febuxostat require a renal dose adjustment?
no
34
febuxostat works best in which patients?
pts who overproduce uric acid
35
febuxostat is pregnancy category what?
C
36
when taking febuxostat, what lifestyle modifications should be made?
alkaline diet
adequate hydration
avoid alcohol
37
which corticosteroids are used for adrenal insufficiency?
hydrocortisone
prednisone
cortisone
38
which corticosteroids are used for inflammation?
methylprednisone
dexmethasone
prednisone
tiacinolone
39
which corticosteroids are used for immune suppression?
ALL
| prednisone used for short half-life
40
which corticosteroids are used for RA?
low dose prednisone short-term (< 2 yrs)
| NSIADs first line
41
if taking steroids for RA, what other medications should be taken?
bisphosphonate
| calcium/vit. D
42
when should steroid doses be given?
before 9am
43
what should the initial dose of a steroid be?
depends on the disease
44
how do you know when the pt is receiving the correct dose of a steroid?
adjust or maintain until acceptable response reached
45
how do you determine maintenance for steroids?
taper to lowest dosage that maintains adequate response
46
when pts d/c a steroid medication, what must they do?
tape to prevent adrenal insufficiency crisis
47
when is tapering steroids not necessary?
after short-term use (1-2 weeks)
48
when taking steroids for chronic disease, how are most pts managed?
with alternate day therapy
49
when are long-acting steroids preferred?
when the effect sof high doses must be sustained (increased ICP, organ transplant rejection)
50
what are the muscle & skin ADRs for steroids?
```
muscle atrophy
thinning skin
mood face
buffalo hump
truncal obesity
striae
hirsutism
poor healing
```
51
what are the skeletal tissue ADRs for steroids?
osteoporosis
52
what are the eye ADRs for steroids?
cataracts
glaucoma
occular infections
53
what are the GI ADRs for steroids?
PUD- taken in combo with ASA/NSAIDs can increase risk
54
what are the cardiovascular ADRs for steroids?
HTN
| fluid & electrolyte imbalances
55
what are the CNS ADRs for steroids?
```
delirium
agitation
insomnia
mood swings
severe depression
```
56
what are the endocrine ADRs for steroids?
adrenal suppression
withdrawal syndrome (abrupt stop)
affects glucose metabolism
57
what are the NSAID ADRs?
*GI disturbances
acute renal insufficiency
increase bleeding time
fluid retention/peripheral edema
58
what can indomethacin cause?
aggravate depression or other psych disturbances
59
which medications have a black box warning?
COX2
| NSAIDs
60
why do COX2 and NSAIDs have a black box warning?
for pts with cardiovascular risks
| can increase the change of heart attack or stroke
61
NSAIDs are pregnancy category what?
B or C
62
in the event of acetaminophen overdose, what should be used?
N-acetylcysteine
63
what is the daily max dose of acetaminophen?
4 gm/day
64
what should be limited when taking acetaminophen?
alcohol
65
what should be monitored when taking acetaminophen?
LFTs (high-dose or long-term therapy)
66
when is acetaminophen safe to use?
children
pregnancy
most elderly
67
acetaminophen is the drug of choice for mild to moderate pain in which populations?
```
pregnancy
h/o GI bleed
ASA allergy
blood coag d/o
upper GI disease
```
68
acetaminophen is the drug of choice for fever in which population?
children- esp. flu-like illness
| adults
69
acetaminophen should not be alternated with what other medication?
ibuprofen
70
what does acute somatic (connective tissue, muscle, bone, skin) respond best to?
```
acetaminophen
steroids
NSAIDs
opioids
local anesthetics
ice
massage
```
71
what does acute visceral (internal organs, abdomen) respond best to?
MOST responsive: opioids
can use NSAIDS, ASA, Celebrex, morphine
ibuprofen & naproxen will work
72
COX2 inhibitors should be avoided in which population?
pregnancy
children
renal dysfunction
pain r/t CABG
73
COX2 inhibitors should be used cautiously in which patients?
HF
HTN
fluid retention
74
ASA should be avoided in which patients?
pregnancy
children
renal dysfunction
75
what is WHO's approach to mild pain?
non-opioids (NSAIDs)
| adjuvant medications
76
what is WHO's approach to moderate pain?
weak opioids (codeine)
non-opioids
adjuvant medications
77
what is WHO's approach to severe pain?
strong opioids (morphine)
non-opioids
adjuvant medications
78
when are IR opioids used?
acute pain
"rescue" or "breakthrough" pain
"dose finding" for chronic pain
79
what are the IR combination drugs?
```
acetaminophen
ASA
ibuprofen
+
codeine
oxycodone
hydrocodone
```
80
what are the single entity IR drugs?
morphine
oxycodone
hydrocodone
tramadol
81
when are ER opioids used?
chronic pain
acute pain that is difficult to manage
if pt is taking a large amount of IR med
82
who should ER medications not be given to?
opioid naive patients
83
why are ER opioids the preferred medications?
improved treatment adherence
84
when can ER opioid doses be adjusted?
Q2-3 days (based on amt of "rescue" meds used
85
what are ADRs of opioids?
```
sedation
drowsiness
constipation
decreased appetite
mental clouding
sexual dysfunction
nausea
tolerance/dependence
```
86
what should opioids not be combined with?
alcohol
| benzodiazipines
87
what are poor choices for chronic pain control?
demerol (poor absorption, toxic metabolite)
| mixed agonist-antagonists
88
what is critical for successful opioid responsiveness?
titration
89
how do you reach opioid responsiveness?
increase dose until pain relief is adequate
OR
intolerable & unmanageable SE occur
90
what is the max/correct dose for opioids?
patient specific
91
what are the strategies to decrease opioid requirements?
"opioid rotation"
add non-opioid or adjuvant med
spinal route
92
which medications are used to treat neuropathic pain?
antieleptics
| antidepressants
93
which anti-eleptics are used to treat neuropathy?
Neurontin
Lyrica
Tegretol
94
which anti-depressants are used to treat neuropathy?
TCAs (amitriptyline)
| serotonin & norepinephrine reuptake inhibitor (Cymbalta)
95
what are the causes of abx resistance?
```
recent use
over use
< 2 yrs old, >65 yrs old
day-care attendance
exposure to young children
multiple comorbidities
immunosuppression
```
96
which group(s) of abx don't have resistance?
none
97
how can local resistance patterns be identified?
antibiogram
98
which vaccine has decreased resistance?
pneumococcal
99
amoxicillin is the 1st line use for what?
sinusitis
| AOM
100
PCN is the first line use for what?
strep pharyngitis
101
augmentin is the first line tx for what?
bites
102
1st gen. cephalosporins tx what?
skin & soft tissue infections
| gram + S. aureus, S. epidermidis
103
2nd gen. cephalosporins tx what?
same as first gen.
klebisella
proteus
e. coli
104
3rd gen. cephalosporins tx what?
gram -
| "braoder" indications
105
4th gen. cephalosporins tx what?
resistant to beta-lactamase
| gram +
106
which cephalosporin is 5th gen,?
ceftaroline
107
ceftriaxone and cefixime treat which disease?
gonorrhea
| chlamydia
108
cefopodoxime, cefuroxime treat which disease?
community-acquired PNA
109
what should you monitor for in pts who take cephalosporins?
c. diff
110
what are fluoroquinolones used to treat?
complicated UTI
pyelonephritis infections
chronic bacterial prostatitis
PNA/chronic bronchitis exacerbation
111
fluoroquinilones can treat PCN resistant what?
S. pneumonia
skin infections
bone/joint infections
complicated intra-abd infections, diarrhea
112
what should you be on the lookout for when taking fluoroquinolones?
tendon tenderness
113
what are macrolides/azalides used to treat?
*community-acquired PNA
pertusis
h. pylori
chronic bronchitis
114
macrolides/azalides are often n alternative for which drug?
PCNs
115
macrolides have which suffix?
-mycin
| NOT clindamycin
116
which medication is an azalide?
azithromycin
117
which drugs are used to treat herpes?
acyclovir
famciclovir
valacyclovir
118
which medication is used to treat herpes in pregnancy?
acyclovir
119
what is the drug of choice for gonorrhea treatment?
rocephin (IM)
| can use suprax
120
gonorrhea is resistant to which class of abx?
fluoroquinolones
121
what is the drug of choice for treatment of chlamydia?
azithromycin
OR
doxycycline
122
what is the drug of choice for treatment of chlamydia in pregnancy?
azithromycin
OR
amoxicillin
123
erythromycin can be used to treat chlamydia in pregnancy, but why isn't it used?
increased ADEs
| reduced effectiveness
124
what are the live attenuated vaccines?
```
Flumist
MMR
OPV
Rotavirus (Rotarix, RotaTeq)
Varicella (Varivax, ProQuad)
Herpes Zoster (Zostavax)
```
125
what are the inactivated vaccines?
```
DTaP
haemophilus B
inactivated poliovirus
hep B
hep A
HPV
influenza
pneumococcal
meningococcal
```
126
what are the contraindications of receiving live vaccines?
pregnancy
immunocompromised
febrile illness
interacts with antiviral drugs
127
other than the standard live vaccine contraindications, what contraindications are there for Flumist?
egg allergy
| asthma
128
other than the standard live vaccine contraindications, what contraindications are there for MMR?
neomycin or gelatin allergy
129
other than the standard live vaccine contraindications, what contraindications are there for MMRV?
caution in h/o cerebral injury
| seizures
130
other than the standard live vaccine contraindications, what contraindications are there for rotavirus?
blood products in the past 42 days
131
other than the standard live vaccine contraindications, what contraindications are there for varicella?
neomycin or gelatin allergy
avoid ASA for 6 weeks
may effect drugs that effect immune sys. (chemo, high-dose steroids)
132
other than the standard live vaccine contraindications, what contraindications are there for herpes?
```
neomycin or gelatin allergy
active TB
acute illness
fever
< 60 yrs old
interacts with: high-dose steroids, antivirals
```
133
what contraindications are there for DTaP?
anaphylactic reaction
progressive neuro disease
high temp
seizure after previous DTaP
134
what contraindications are there for haemophilus?
allergy to vaccine components
moderate to severe illness
*only children < 6 yrs
135
what contraindications are there for inactivated polio?
allergy to: neomycin, streptomycin, polymyxin B
| interacts with immunosuppresants
136
what contraindications are there for hep B?
yeast allergy
moderate or severe allergy
immunosuppresion
137
what contraindications are there for hep A?
severe reaction to HAV
moderate illness
< 12 mths
138
what contraindications are there for HPV?
allergic reaction
| allergy to yeast
139
what contraindications are there for inactivated influenza?
anaphylaxis to eggs, flu vaccine
guillan-barre w/in 6 wks
febrile illness
140
what contraindications are there for PPV?
moderate to severe febrile illness
give 10-14 days before splenectomy, organ transplant, or chemo
< 2yrs
141
what contraindications are there for pneumococcal conjugate (PCV)?
only used in adults
same as PPV
> 19 w/immunocompromised conditions, functional or anatomic asplenia, CSF leaks or cochlear implants
142
what contraindications are there for meningococcal?
febrile illness
143
after HPV vaccine you should observe for what?
observe for 15 mins for syncope
144
bismuth subsalicylate shouldn't be used in which population?
children with viral or flu-like illness
145
antidiarrheals are contraindicated in which population?
MOST children
146
antidiarrheals are pregnancy category what?
C
147
can antidiarrheals be used when lactating?
safety not est.
| use caution
148
what are the classes of antiemetics?
antihistamines
phenothiazines
cannabinoids
5HT3 antagonists
149
which drugs are in the antihistamine class?
benadryl
| vistaril
150
which drugs are in the phenothiazine class?
compazine
| phenergan
151
which drugs are in the cannabinoid class?
marinol
152
which drugs are in the 5 HT3 class?
-setron
153
phenothiazines are contraindicated when?
Parkinson's
154
phenegran has been to have what effect on children?
fatal respiratory depression in children < 2yrs
155
if taking promethazine long-term, what should be monitored?
CBS
156
when are cannabinoids used?
cancer chemo
157
cannabinoids should be used cautiously in which patients?
h/o seizure d/o
158
5HT3 medications can mask what?
progressive ileus
159
which laxatives are used for rapid response/short-term?
stimulants
osmotics
surfactants
160
which laxatives are used for slower response/long-term?
bulk-forming
161
which laxatives are safest to use in pregnancy?
bulk-forming
162
what is the GERD step-up approach?
```
antacids & lifestyle modification
H2RA x4-8 wks
-if better then cont. for 12 wks, then wean
if not relieved, then PPI x4-8 wks
-if better, step down to H2RA
-if symptoms return, back to PPI
```
163
what is the GERD step-down approach?
lifestyle modification
PPI x8 wks
-if symptom free wk 4, step down to H2RA
if not relieved, increase PPI to BID 4-8 wks
-if symptom free x4 wks, step down to QD, reassess in 6-12 mths
164
what is not used as a primary treatment for GERD?
H2RA
165
what is triple therapy for h. pylori tx?
PPI
clarithromycin
amoxicillin
(14 days)
166
what is the quadruple therapy for h. pylori tx?
```
PPI
metronidazole
*tetracycline
bismuth subsalicylate
(14 days, 2nd-line)
```
167
what is the levofloxacin-based triple therapy?
levo
PPI
amoxicillin
(2nd-line, or "rescue" tx)
