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(PA School Q3) Pharmacology II > Exam II review > Flashcards

Exam II review Flashcards

(120 cards)

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1
Q

Describe how to dose heparin for acute VTE

A

80 units/kg (Max: 10k units) BOLUS DOSE
18 units/kg/hr (Max 2300 units/hr) INITIAL INFUSION RATE
Based on aPTT, you will adjust the maintenance infusion rate

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2
Q

Recommend a lovenox (anticoag) dose for someone either going under a total knee or hip replacement and base the dose off the creatinine clearance and know how many days you need to do it for prevention

A

1) Hip Replacement: 30mg SC q 12 hrs OR 40mg SC q 24hr
Extended prophylaxis may be given for up to 3 weeks
2) Knee Replacement: 30mg SC q 12 hrs
CrCl <30mL/min: 30 mg sub QD

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3
Q

What is Pregnancy category C for one 150mg dose, category D for stronger or more frequent doses?

A

Fluconazole

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4
Q

Verify product name and dose prior to administration, lipid formulations have higher doses compared to convention formulation. This describes what drug?

A

Amphotericin B

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5
Q

Tell me how to premedicate for Amphotericin B Deoxycholate

A

1) APAP or NSAID
2) Diphenhydramine or hydrocortisone
3) Meperidine (demerol/opioid) to decrease duration of rigors
4) Fluid boluses to decrease risk of nephrotoxicity

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6
Q

What is Used for Oral Candidiasis (Thrush)?

A

Nystatin Suspension (100,000 units/mL)

(second line = clometrazole)

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7
Q

Griseofulvin (Gris-PEG) has a cross reaction with what?

A

PCN allergy

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8
Q

What is the dose for Terbinafine (Lamisil) for dermatomycosis/ Onychomycosis?

A

250 mg once a day for 12 weeks.

(exacerbation of SLE)

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9
Q

With sepsis, what drugs would you consider adding to prevent stress ulcer prophylaxis?

A

Stress ulcer prophylaxis with either a PPI or H2RA reduces the risk of GI bleeding
Risk factors may include patients who require mechanical ventilation >48 hours, or experiencing coagulopathy (INR>1.5)
C. Diff infection and PNA have been reported with both PPI and H2RA use

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10
Q

Long-term LMWH monotherapy is preferred for patients with _________-associated VTE

A

cancer

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11
Q

True or false: LMWH is used prophylactically prior to many surgeries to prevent PE (think the hip, knee, and abdomen)

A

True

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12
Q

Amiodarone for AFIB: What is the oral dose?

A

400 mg 2-3 x daily until 10g total, then 200-400 mg daily

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13
Q

Amiodarone doses for AFIB:
1) What if pulseless Vtach/Vfib?
2) What if Stable VT (Pulse)?
3) What if AF (termination)

A

1) 300 mg IV/IO push (can give additional 150mg if persistent VT/VF); follow w/ infusion of 1 mg/min x 6 hours, and then 0.5 mg/min x 18 hours
2) 150 mg IV over 10 minutes, then infusion of 1 mg/min x 6 hours, then 0.5 mg/min x 18 hours
3) 150 mg IV over 10 minutes, infusion of 1 mg/min x 6 hours then 0.5 mg/min x 18 hours

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14
Q

Already taking Warfarin and starting Amiodarone, what do you do?

A

Reduce dose of Warfarin by 30%

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15
Q

Reduce digoxin by ____% when starting amiodarone

A

50%

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16
Q

A pt has LV Hypertrophy and NO HF, what do you give?

A

Amiodarone or dronedarone

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17
Q

List the cardiotoxic drugs

A

ACCE
1) Amphetamines
2) Chemo
3) Carbamazepine
4) Ethanol

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18
Q

We talked about how 50% of ppl die within 5 years with heart failure. What drugs can you use for comorbid AFIB and HF?

A

Amiodarone and Dofetilide are 1st line
Avoid Dronedarone (increased mortality) and Sotalol ( worsening HF)

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19
Q

Can you use your non-dihydros to Tx AFIB for those with an ejection fraction of 33%?

A

No, use a different drug like amiodarone or dofetilide.

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20
Q

Patients with decreased renal function or low body weight, the elderly, or those receiving interacting drugs (AMIODARONE) should receive 0.125 mg daily or QOD of ________

A

digoxin

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21
Q

Give counseling points for warfari

A

Ex: have a consistent diet. I just got Rxd bactrim DS, what do you want me to do? Check INR in 3 days. There are some abx and antifungals that can jack up INR. Lots of drug interactions. Bleeding is the biggest adverse effect of warfarin.

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22
Q

I’m on warfarin, can I take naproxen?

A

Probably shouldn’t, bad idea, use APAP instead of an NSAID.

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23
Q

List the pill in the pocket drugs

A

Propafenone PO
> 70 kg→ 600 mg
< 70 kg→ 450 mg
Flecainide PO
> 70 kg→ 300 mg
< 70 kg→ 200 mg

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24
Q

Describe the Streptococcal Endocarditis 2 week therapy

A

PCN G + gentamicin OR ceftriaxone + gentamicin
a) PCN G→ 12-18 million U/24 hr IV continuously, or divided into 6 doses
b) Ceftriaxone→ 2 g/24h IV/IM 1 dose
c) Gentamicin→ 3 mg/kg/24hr IV/IM in one dose

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25
Describe the Streptococcal Endocarditis 4 week therapy
PCN G OR ceftriaxone ($$; easier @ home use for ceftriaxone) PCN G→ 12-18 million U/24 h IV continuous or divided into 4-6 equal doses Ceftriaxone→ 2 g/24h IV/IM 1 dose
26
What do you do for Streptococcal Endocarditis (susceptible) if type 1 penicillin allergy?
Vancomycin→ 30 mg/kg/24h IV in 2 equal doses Trough of 15 mcg/mL Same dosing for all infection variations
27
List 3 ACEis for HF and their doses (starting and goal)
Lisinopril (Zestril) 2.5-40 mg PO once daily Ramipril (Altace) 1.25-2.5 mg PO once daily Enalapril (Vasotec) 2.5-20 mg PO BID Left Right Enter
28
List the 3 ARBs for HF and their doses (start and goal)
Valsartan (Diovan) 20-160 mg PO BID Losartan (Cozaar) 25-150 mg PO once daily Candesartan (Atacand) 4-32 mg PO once daily valarie lost candle
29
List the dose for an ANRI
Valsartan/Sacubitril (Entresto) 49/51 mg BID titrated to 97/103 mg BID after 2-4 weeks
30
Transition someone on an ACEi or ARB to an ANRI. Look at the current dose of ACEi or ARB. Are they going to start it the next day or wait 36 hours?
1) ACEi should be discontinued 36 hours prior to initiating ARNI; no waiting period is needed in patients receiving an ARB. 2) A reduced dose of Entresto (24/26 mg) is available for patients taking a low dose of either an ACEi or an ARB prior to initiation 3) ANRI is contraindicated in patients with a history of angioedema associated with ACEi or ARB therapy or pregnancy
31
List PSPORCS (strongest induces)
Phenytoin Smoking Phenobarbital Oxcarbazepine Rifampin (and rifabutin/rifapentine) Carbamazepine St. John’s Wort
32
List GPACMAN
Grapefruit PIs (protease inhibitors) Azoles Cyclosporine and cimetidine Macrolides (not Azithromycin) Amiodarone (and dronedarone) Non-DHP CCBs (diltiazem and verapamil)
33
What should you do if a pt has DVT in PG month 2?
Use Lovenox until delivery, then keep taking it for a minimum of 6 weeks.
34
IV Protamine Sulfate can reverse what?
Heparin
35
Phentolamine (alpha-1-blocker) is a reversal agent for _____________ or ___________
dopamine or norepinephrine
36
Name a drug that can cause blindness
Amiodarone
37
Which 2 antiarrhythmics are more effective in ventricular arrhythmias than supraventricular arrhythmias?
Class Ib→ lidocaine and mexiletine
38
List the 3rd class of antiarrhythmics
K+ Channel blockers: 1) Amiodarone 2) Dronedarone 3) Sotalol 4) Ibutilide 5) Dofetilide
39
List 2 drugs you can use for acute conversion of supraventricular arrhythmias to sinus rhythm
1) Ibutilide (IV): 1 mg IV over 10 minutes (may repeat if needed) 2) Dofetilide
40
How do you dose ND-CCBs to slow conduction, prolong refractoriness, and decrease automaticity? (in arrythmias)
1) Verapamil→ 2.5-5 mg IV over 2 minutes, infusion dose is 2.5-10 mg/hr (PSVT, AF rate control) 2) Diltiazem→ 0.25 mg/kg IV over 2 min, infusion of 5-15 mg/hr (PSVT; AF rate control)
41
What is the antidote for Digoxin (Digox) toxicity?
DigiFab
42
Which HF meds decrease mortality?
1) SGLT2i: Empagliflozin, Dapagliflozin 2) ACEi / ARBs in HFrEF 3) Omega-3 polyunsaturated fatty acid 4) ARNi: Entresto
43
I am a beautiful, talented, young woman and I have a yeast infection. What are you gonna do?”
Fluconazole 150mg one now and one 72 hours later.
44
1) The recommended dose for using IV hydrocortisone is _______mg/day. 2) This is recommended for who?
1) 200mg 2) Adult patients with septic shock who are hemodynamically unstable after initial resuscitation with IV fluids and vasopressors.
45
List the 1st, 2nd, and 3rd line vasopressors
1st line Vasopressor = Norepinephrine 2nd line = Dopamine or Vasopressin 3rd line = phenylephrine or dobutamine
46
How do you remember the meds for strep endocarditis? (susceptible)
PCG: 1) Pen G (12-18 million U/24 hr IV continuously, or divided into 6 doses) and/ or 2) Ceftriaxone (2 g/24h IV/IM 1 dose) 3) Gentamicin (3 mg/kg/24hr IV/IM in one dose)
47
Tafamidis Meglumide: What is the MOA?
Stabilizes the TTR tetramer and halts the amyloid deposition process
48
Loop diuretics have a unique adverse effect of _____________, but only with rapid IV administration. They also don't work as well with _____________
ototoxicity; NSAIDs
49
For a gram negative IE infection, your first line should be what?
Ceftriaxone 2g/24 hours IV or IM for 4(native) to 6(prosthetic) weeks. (cephalosporin second line)
50
Heparin, LMWH, apixiban, and riveroxiban all inhibit what?
Factor Xa (and Va)
51
Thrombomodulin modulates thrombin activity by converting ___________ to its active form (aPC)
protein C
52
How do you remember the 2 wk treatment for Staph Endo (resistant)?
PCG 1) PCN G→ 12-18 million U/24 hr IV continuously, or divided into 6 doses 2) Ceftriaxone→ 2 g/24h IV/IM 1 dose 3) Gentamicin→ 3 mg/kg/24hr IV/IM in one dose P + G or C + G
53
What if there's a staph endo infection in a prosthetic valve?
For 6 weeks 1) PCN G→ 24 million U/24h IV continuously or in 4-6 divided doses OR 2) Ceftriaxone→ 2g/24h IV/IM in 1 dose
54
How do you remember the Tx for Staphylococcal Endocarditis?
"Staph = Naf" 6 wks of Nafcillin/Oxacillin→ 12g/24h IV in 4-6 doses
55
How do you Tx subset 2 (warm and wet) of acute decomp heart failure?
1) IV loop (like furosemide (Lasix)) & IV vasodilator (like nitroprusside or hydralazine) 2) If that doesn't work, use adj. strategies
56
How do you Tx subset 3 of acute decomp HF?
1) Assess volume status and PAC (pulmonary artery catheter) 2) If orthostatic or PWCP =/<15, do IV fluids 3) If no orthostasis or PCWP 15-18, assess SBP 4) If SBP <90: IV inotrope (and/or vasopressor) 5) If SBP >/= 90: IV vasodilator
57
How do you Tx subset 4 of acute decomp HF?
1) If SBP <90: IV inotrope (and/or vasopressor) 2) If SBP >/= 90: IV vasodilator
58
What are the only 2 azoles that penetrate CNS?
Fluconazole and voriconazole
59
What is the DOC for aspergillus?
Voriconazole
60
Fluconazole and voriconazole can cause what?
Increased INR w warfarin, QT prolongation
61
You must give IV _________ for sepsis within an hour, and IV __________ within 3 hours
abx; crystalloids
62
What medication do you need to premedicate for?
Amphotericin B
63
After you resuscitate sepsis with dextrose or saline, and they're still unstable, what do you do next?
Hydrocortisone (200mg IV) + vasopressors (norepi, epi, etc) + fluids
64
1) C. diff infection and ___________ have been reported with both PPIs and H2RAs  2) With sepsis, blood glucose level of less than ______mg/dL (10.0 mmol/L) is recommended
1) pneumonia 2) 180mg/dL
65
What extra antifungal is NOT for monotherapy?
Flucytosine F-5C (Ancoban)
66
What are the first, second, and third line vasopressors for sepsis?
1) Epinephrine 2) Norepi 3) Phenylephrine + dobutamine
67
What do all azoles, amphotericin B, and fungins have in common?
All are processed through the liver
68
List the most common anatomical sources of sepsis
Lung (most prominent location) intra -abdominal space Genitourinary tract
69
What are you going to look out for when using a fungin?
Anaphylaxis, LFTs, and hypotension
70
Sepsis: Target MAP of at least ____mm Hg when using vasopressors; MAP >= 70 mm Hg may be harmful
65
71
Sepsis: What is synergistic with Ampho B for Cryptococcus?
Flucytosine F-5C (Ancoban)
72
A negative D-Dimer, for most assays defined as <______/mL, can be useful in ruling out the diagnosis of VTE.
500ng
73
Purple toe is a weird effect of what?
Warfarin
74
When do you use vit k to reverse warfarin?
INR > 10 (just stop Tx if <10)
75
After using TPA, if If aPTT is <___seconds, UFH infusion should be started and adjusted to maintain aPTT in therapeutic range
<80 seconds
76
Stopping DOACs ____days prior to invasive procedures is usually sufficient to restore near-normal hemostasis for pts with normal renal function (except warfarin, which requires 5 days)
2
77
You should avoid the use of DOACs in patients weighing more than _____kg or with a body mass index of greater than 40 kg/m2
120kg
78
Describe the use of anticoags based on Cl/Cr
-Enoxaparin has specific labeling for pts with CrCL <30mL/min (under 30, don’t have ED) -Dabigatran for under 30 CrCl: should be avoided for treatment -Rivaroxaban under 15 CrCl: should be avoided for treatment (15-year-olds can't swim in river) -Apixaban can be used safely regardless of CrCl
79
Warfarin: 1) When do you not need to change dose on days 3-4? 2) What abt for days 7-14?
1) INR 1.5-1.9 2) INR 2.0 - 3.0
80
What 2 drugs are more effective for ventricular arrythmias?
lidocaine and mexiletine
81
How do you remember all of class 1 antiarrythmics?
Quarter pounder double with lettuce, mayo, fries, and a pop are all 1 dollar) (sodium class 1)(all this fast food worsens HF)
82
List the classes of antiarrythmics
1) Class 1: Na+ blockers 2) Class 2: Beta blockers 3) Class 3: Potassium blockers 4) Class 4: Non-dihydro CCBs
83
What drug can cause blue-gray skin, can cause thyroid issues, and can cause photosensitivity?
Amiodarone (Ami has gray walls)
84
How do you remember the potassium channel blocker antiarrythmics?
**A Dude Shits In Dumpsters:** Amiodarone Dronedarone Sotalol Ibutilide Dofetilide
85
How do you remember that Dofetilide can maintain sinus rhythm in patients with supraventricular arrhythmias of longer than 1 week's duration who have been converted to sinus rhythm?
Dolfie was longer than 1 week
86
List and describe the 2 amiodarone drug interactions
1) Warfarin: dose reduce 30% or start at 2.5mg 2) Digoxin: dose reduce 50%
87
What will you give with those an arrythmia with normal left LV function for rate control?
IV beta-blocker: propranolol, metoprolol or esmolol IV non-DHP CCB: diltiazem or verapamil
88
What are you going to give for pts with HFrEF or HFpEF for acute decompensation?
amiodarone or digoxin (am digging for compensation)
89
How do you Tx AF >48 hrs if outpatient?
Administer warfarin at time of TEE Cardioversion should then be performed in 5 days (if inpatient should be within 24 hours)
90
Describe chronic anticoag + antiarrythmic therapy for arrythmias
1) Do CHA2DS2-VASc; prefer DOACs (warfarin good option 2) If structural heart disease, no pill in pocket drugs
91
1) What has a BBB for advanced heart failure? 2) What are the 2 first line options for arrythmias with HFrEF?
1) Dronedarone 2) Amiodarone and dofetilide
92
Describe the dosing for for digoxin in arrythmias
Target serum concentration: 0.8 – 2.0 ng/mL (doses lower for heart failure) Decrease dose @ CrCL < 50 mL / min Decrease dose by 20 – 25% when going from oral to IV
93
1) What is the most common cause of HFrEF? 2) What drug will you use for Amyloid cardiomyopathy?
1) CAD 2) Tafamidis meglumine (Vyndamax)
94
HF: 1) What does norepi do? 2) What lowers BP?
1) Downregulation of beta 1 receptors 2) Natriuretic peptides
95
List the doses for 2 flozin drugs (used in stage A of HF)
1) Empagliflozin (Jardiance): 10mg PO qday (HF w/o DM II) . if with DM: 10-25. 2) Dapagliflozin (Farxiga): 10mg PO qday (HF w/o DM II) if with DM: 5-10mg
96
What do you give all pts in stage 2 with reduced LVEF?
ACE inhibitor or ARB AND BB
97
Know the Cl/Cr dose reductions and counseling for: 1) Furosemide (Lasix) 2) Bumetanide (Bumex)
1) **Furosemide (Lasix):** empty stomach -Double dose if PO -CrCl <20mL/min: 400mg total daily dose 2) **Bumetanide (Bumex)** -DOSE IS SAME IV AND PO -CrCl <20mL/min: 8-10mg total daily dose 3) **Torsemide (Demadex)** -Administer with or without food (PO only) -CrCl <20mL/min: 200mg totally daily dose
98
**This is a test Q:** Know the dose equivalent of 20-40mg of furosemide in Bumetanide, and Torsemide (loops)
Furosemide 20-40mg = Bumetanide 1mg = Torsemide 20m
99
Differentiate between acute and subacute endocarditis etiologies
1) Acute: Staph, aortic 2) Subacute: Strep, mitral (tricuspid = IV drug use)
100
What is the goal trough concentration for vancomycin for streptococcal or staphylococcal endocarditis?
15mcg/ml (4 wk therapy)
101
How do you Tx staph endo if prosthetic valves?
1) MSSA Oxacillin or nafcillin + rifampin +/- gentamicin Cefazolin is cephalosporin substitute; not ceftriaxone 2) MRSA 6-week therapy Vancomycin + rifampin +/- gentamicin
102
How do you Tx enterococcus endocarditis?
4-6 wks of Ampicillin or high-dose penicillin + aminoglycoside (gentamicin) (traditional dosing)
103
How do you Tx enterococcus endocarditis if resistant to beta lactams?
Vancomycin
104
How do you Tx HACEK group endocarditis? (a group of G negatives) Haemophilus spp. Aggregatibacter spp. Cardiobacterium spp. Eikenella spp. Kingella spp.
1) **4-week therapy: Ceftriaxone** -2g/ 24hr IV or IM in one dose or ampicillin 2g IV every 4hr 2) **Type I PCN allergy: Ciprofloxacin** -1000mg/24hr PO or 800mg/24hr IV in 2 doses 3) **6-week therapy: Consider if patient has prosthetic valve**
105
Endocarditis: True or false: Duration of therapy should begin on the first day blood cultures were negative in patients with previously positive blood cultures
True
106
1) What abx is hepatoxic and can turn urine red? 2) Which can cause thrombocytopenia? 3) Which can cause rhabdo?
1) Rifampin 2) Linezolid 3) Daptomycin -d/c if >/= 5 ULN + Sx or >/= 10 ULN
107
Test question: What 5 groups get dental prophylaxis?
1) Prosthetic valves 2) Congenital HDz 3) Prosthetic material used for valve repair 4) Prior dx of infective endocarditis 5) Cardiac transplant with valvopathy
108
**Important** What are gentamicin trough and peak concentrations
Peak 3-4ug/ml, trough <1ug/ml
109
Which 2 abx can cause both ototoxicity and nephrotoxicity?
Vancomycin + gentamicin (this is relevant to Tx of penicillin resistant enterococci) (6 wks)
110
Which one of the five drugs suggested for community-acquired respiratory tract infections does not cause QT-prolongation? a) Levofloxacin b) Ceftriaxone c) Clarithromycin d) Azithromycin e) Moxifloxacin
b) Ceftriaxone
111
Which drug is administered with cilastin and why? a) Ertapenem; to protect the kidneys b) Ertapenem; to protect the liver c) Imipenem; to protect the kidneys d) Imipenem; to protect the liver
c) Imipenem; to protect the kidneys
112
Why is ertapenem not used for hospital-acquired empiric therapy for intra-abdominal infections? a) Doesn’t work for P. aeruginosa b) Doesn’t work for E. coli c) Doesn’t work for S. aureus d) Doesn’t work for any of the above
a) Doesn’t work for P. aeruginosa
113
Which of the following was NOT mentioned as a counseling point for metronidazole? a) May cause a metallic taste b) Don’t drink alcohol c) May cause dermatitis d) Finish the entire course of the drug
c) May cause dermatitis
114
What is the route of administration for piperacillin / tazobactam (Zosyn)? a) PO b) SC c) IV over 4 to 8 hours d) IV over 30 minutes or 4 hours
d) IV over 30 minutes or 4 hours
115
What is the first line treatment for yeast in pregnancy? a) Azoles b) Echinocandins c) Amphotericin B d) None of the above
a) Azoles
116
If pt gets DVT at 2 months preg how long will you treat it? (will be on exam)
3 months. Lovenox will be safe, might be on lovenox for almost whole pregnancy and then take it for a minimum of 6 weeks.
117
How long is the main Tx for DVT?
90 days. There are ppl who will dose reduce but that’s not the mainstay; the mainstay is 90 day Tx.
118
1) How do you dose Apixaban? **will be on exam** (a DOAC) 2) Eliquis shouldn’t be high if Cl/Cr is ______.
1) 10mg PO BID with or without food for 7 days, then 5mg starting on day 8 2) low
119
What is the prophylaxis for dental procedures?
1) No allergy: Oral Amoxicillin (2g) 2) Type 1 allergy: Oral Clindamycin (2g) 2) Type 2 allergy: Oral Cephalexin (600mg)
120

(PA School Q3) Pharmacology II (37 decks)

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