Final Flashcards
1
Q
A consistent care process is important for the pharmacist’s process of care and practice because it promotes
A
Consistent outcomes for the care delivered
2
Q
A question to assess the effectiveness of someone who wants to establish care would be:
A
How well do you feel this medication is working for your disease? Need to address outcome or therapy goals.
3
Q
If a patient comes in with two medications with the same indication. (e.g. aspirin and naproxen and ibuprofen, lisinopril, benazapril) What is this indication called?
A
Duplicate therapy
4
Q
IESA (Indication, Effectiveness, Safety, Adherence) is part of what?
A
The pharmacists patient care process (PPCP) and specifically part of ASSESS
5
Q
What is the correct order of indication, effectiveness, safety, and adherence?
A
Indication effectiveness, safety, and adherence
6
Q
If a patient walks into your pharmacy and says that she had Td 10 or more years ago, this is likely an
A
Indication issue and needs additional therapy
7
Q
If you were to assess for safety of the medication a patient is using, you would probably ask if you have ever
A
Had dark tarry stools since you are taking ibuprofen and naproxen
8
Q
When a patient tells you what kind of medications they are taking, is this subjective or objective.
A
Subjective Information
9
Q
Ideal Pharmacist-Patient Relationship Fundamental DOES NOT include what?
A
Knowledge of a pharmacist
10
Q
Where would allergies go in a medical chart
A
Past medical history
11
Q
If a patient has a family history of an allergy (e.g. asthma, excema, fever) , then the patien’t family members would be expected
A
to have the same (e.g. asthma, fever, etc.)
12
Q
Family history should include
A
parents, three generations, deceased siblings, etc. in the patient chart
13
Q
What is a common error in lab setting
A
Faulty reagents
14
Q
Results reported in conventional units or SI units are ____ not/are factors that affect normal values
A
They are NOT factors that affect normal values
15
Q
For complete blood count, hematocrit is
A
the percentage of red blood cells to blood volume
16
Q
INR is a test used to monitor
A
Warfarin
17
Q
A small volume of distribution makes a drug
A
amenable to enhanced elimination
18
Q
NPI (Narrow Therapeutic Index) is
A
Adverse effects are expected at close to the therapeutic dose
19
Q
______ are involved in a majority of poison control exposure
A
Pharmaceuticals
20
Q
Idiosyncratic adverse reactions occur regardless of ____
A
The Drug Dose
21
Q
At a therapeutic dose this drug can cause tiredness, but at doses above the therapeutic dose it can cause life threatening arrhythmias. This is called?
A
Off-target effect
22
Q
Activated charcoal does not bind to
A
Iron, Polar molecules, alcohols, electrolytes, metals
23
Q
______ is the leading cause of preventable injury according to the poinson control center
A
Poisoning
24
Q
There is a small/large amount of substances that have antidotes compared to the number of drugs available
A
There is a small amount of substances that have antitodes
25
Enternal syringes measure what?
Liquid enternal meds
26
Patient is 11kg, 82 cm. Mycophenolate oral dosing is 600/mg/m2/dose every 12 hours. Whats the dose
300mg every 12 hours
27
Patient is 20kg. Prednisone dose = 1-2mg/kg/day in doses. Solution is 15mg/5ml. Whats the proper dose
21mg bid
28
A patient is 12 years old. What should the care provider consider without ANY additional context
Pediatric -to-adult care transition readiness should occur
29
Why should we write dose as 2.5 mL TID for liquid preperations for a new kid patient
For clarity
30
A baby born 3 hours ago has a BP of 75/40, resp of 50, HR 190, weight 3kg. Is this baby "healthy"
Yes, babies are bad at everything
31
What is the most appropriate source to search to see if meds are good for kids
KIDS LIST
32
INCREASED GASTRIC PH, DECREASED BILE ACID SECRETION, AND INTESTINAL TRANSIT TIME ALL AFFECT WHAT?
The absorption of a drug
33
A hydrophilic drug has bigger _____ in neonates
vD
34
What is the formular for glomerular filtration rate?
(0.413*height)/Scr
35
What is the formula to calculate maintenance flud rate in mL/hr if the patient is 40kg.
Segar formula (4/2/1 rule - 4x10,2x10,1x20, 40+20+20 =
36
A patient weights 25kg, what is the correct maintenance fluid rate
65mL/hr
37
For diaper rash, the patient should
Apply the cream first, then cover with a barrier
38
If MRSA isn't common, the _____ is the proper treatment
Cephalexin
39
If a patient only has a couple flares of asthma per year and doesn't show symptoms any other time then the likelihood of having asthma is
Low
40
T/F - Doses of asthma meds are not well known
False and meds and doses are not exploratory
41
Alpha 1 _____ the internal sphincter muscle of the bladder while _____ relaxes it.
Contracts, Muscarinic
42
What would be the acetylcholeine and beta 1 receptor response during rapid and pounding heartbeat
Increased acetylcholine release, increased beta 1 receptor stimulation
43
Dopamine can be use for management of
Hypertensive crisis
44
Primary MOA of doxazosin
Alpha -1 Antagonist
45
2 examples of prn treatments of acute bronchospasm
albuterolor levalbuterol
46
Orthostatic hypotension treated with _____
midodrine
47
In sepsis, a patient should receive ______ for hypotension
Norepinephrine
48
Atenolol is a
Beta-1 Selective ANTAGONIST
49
Local anesthetic with alpha-1 antagonists ______ time in recovery of sensation after a mouth procedure
Decrease
50
AE of terazosin can be
hypotension
51
With urinary retention, you should used a ___________ like ________
non-selective muscarinic agnost, bethanechol
52
______ is an NTM at nicotinic receptors in the skeletal muscle
Acetylcholine
53
With alzheimers, you would use a treatment geared to inhibit _________
Acetylcholinesterase
54
Cholinomimetic drugs should not be used if the patient has _________
asthma
55
Oxybutinin is used in the treatment of
overactive bladder
56
For excessive drooling the patient should recieve
Glycopyrrolate
57
Sympathomimetic toxidrome will present with symptoms like
Agitation, delirium, hallucination, and paranoia, along with HTN, fever, dilated pupils, sweaty skin, normal bowles (adderall OD)
58
Treatment of antimuscarinic toxidrome is usually
physostigmine
59
AE of scopolamine is
dry outh
60
When the intraocular pressure of the eye is increased, the muscarinic receptors _______ the outflow of ________
increased, aqueous humor
61
When timilol is administered after epi, the BP is ______ but the HR is _______. (Increased/Decreased)
BP increased.
HR Decreased
62
Allergic reaction? Give
Epinepherine
63
phentolamine can be used preoperatively to prevent
severe hypertension during surgery
64
cevimeline is more tolerated for those with
dry mouth
65
succinylchole has a therapeutic agonist effect through the ______ receptors
nicotinic
66
When exposed to insecticides, muscle weakness can/cannot be reversed with amlodipine
Cannot be reveresed
67
Benztropine is used when antipsychotic medications cause _______ _____
Dystonic Reactions
68
Diphenhydroamine is an antimuscarinic, so it can also cause what
Antimuscarnic toxidrome
69
When a patient is exposed to insecticide, the endpoint of therapy with atropine is to
Dry respiratory secretions
70
Sympatholytic toxidrome are known to cause
Unresponsiveness, Bradycardia, and Hypotension
71
Metoprolol is known to _____ mortality and ______ in patients with HF
mortality
hospitalizations
72
Mirabegron is used in the management of
Urinary Incontinence (overactive bladder)
73
Sympathetic postganglionic neurons synthesize and release ________, making them andregenic
Norepinepherine
74
Dobutamine has chronotropic effects on the ______
Heart
75
T/F - Airway constriction is not an AE of dopamine
FALSE. DOPAMINE AE ARE HYPERTENSION, LOCAL ISCHEMIC NECROSIS, AND TACHYARRHYTHMIAS
76
Formoterol should be used as maintenance therapy for patients with _______
COPD
77
If someone injects an epi-pen wrong (dumbass) what do you do to reverse effects
Phentolamine reversal
78
Clonidine decreases bp due to its decreased release of NE from
Sympathetic nerve terminals
79
NE/Alpha 1 is the main determinant of
vascular tone
80
varenicline is a partial agonsist of neuronal ______ receptors
nicotinic
81
With patients with COPD, inhaled tiotropium should be given to reduce
brasoconstriction
82
When someone is diagnosed with myasthenia gravis, you should do an IV admin of ______
edrophonium
83
Rocuronium is used to induce _______ during tracheal intubation
paralysis
84
AE of oxybutynin could include
dry mouth
constipation
drowsiness
85
When a patient is presenting with sympathomimetic toxidrome, it is best to use ________ to control agitation
benzodiazepines
86
Patient presents with agitation, delirium, hallucinations, paranoia, HTN, dialated pupils, sweaty skin, DIMINISHED BOWELS(IMPORTANT) they OD'd on
Diphenydramine (antimuscarinic toxidrome
87
Patient presenting with sympatholytic toxidrome, they should be given
catecholamines
88
The MOST Na+ reabsorption occurs in the ___________
Proximal Convoluted tubule
89
Loop diuretics inhibit the ___, ____, _____, cotransporter in the thick ascending limb
Na+, K+, 2Cl-
90
The primary MOA for ACE inhibitors is blocking conversion of
Ang I to Ang II
91
Common side effect of loop diuretics is
hypokalemia
92
Hyperkalemia is a risk with amiloride because it inhibits sodium channels in the distal nephron, reducing _______ excretinon
potassium
93
A common side effect of thiazide diuretics is ______
hypokalemia
94
The primary site of action of spironolactone is the _________
collecting duct
95
the actinos of SGLT2s in the kidney block glucose and sodium reabsorption in the _____________
proximal convoluted tubule
96
The most common argument for using the cockcroft-gault over GFR for drug dosing is that most drug dosing recommendations are based on
creatine clearance cut offs
97
_______ is the recommended initial approach for diagnosing kidney disease in adults
CKD-EPI eGFRer
98
What are teh variables in CKD-EPI eGFRcr
SCr, Age, Sex
99
When using CKD-EPI eGFRcr equation for drug dosing the units should be converted to __/___ in large and small patients
mL/min
100
The most accurate method to determine a patien's kidney function for a 67 year old woman with longstanding malnutrition bilateral below the knee amputatinos, and stable SCr of 2.1 mg/dL is the
CKD-EPI eGFRcr-cys
101
The most appropriate method to determine drug dosing for a 69 year old male, stable SCr of 1.21mg/dL, 77kg, 175cm, BMI 25 with no known medical problems, exercises regularly, eats a healthy omnivorous diet is the
estimated creatinine clearance using the cockcroft-gault equation
102
In resolving AKI WITH A DOWNWARD TRENT IN scR FROM 4.31 YESTERDAY TO 2.71 TODAY. IF THE TREND CONTINUES THE COCKCROFT-GAULT AND CKD-EPI EQUATIONS WOULD
UNDERESTIMATE THIS PATIENTS CURRENT KIDNEY FUNCTION
103
ACEi's and ARB's can cause a drop in
glomular filtration rate through vasodilation of efferent arterioles
104
A patient that is deydrated is most likely to experience AKI when an _____ is initiated
ACEi
105
if a patient has an smz induced acute interstitial nephritis the most important treatment step is to
stop the smz
106
maintaining a serum trough of <2mg/L are associated with lower risk of ATN and may reduce the nephrotoxicity of
aminoglycosides (ex gentamicin)
107
iodinated contrast can cause
acute tubular necrosis
108
continuous renal replacement therapy is primarly used in teh ICU in acute dialysis patients who wouldn't tolerate removal of large amounts of flud over
short periods of time
109
acute indications for dialysis included
electroyte disorders, overload of fluid, and uremic symptoms
110
______ is the internation organizatino that publishes guidelines for managing kidney disease
KDIGO
111
Screening for CKD is recommended annually for all patients with T2DM. So the most important patient is a
71 yera old with T2DM
112
GFR 45-60 IS WHICH G STAGE
G3A
113
ALBUMINURIA IS WHICH A CLASS
A2
114
within the first 4 weeks of starting ACEI OR ARB in CKD, the most important to monitor is
potassium and serum createnine
115
Pt has CKD, due to HTN, G3A, A3, PGM, HTN, CKD, ALLERGIES. The most important medicaiton to slow CKD Progression is
dapagliflozin (SGLT2 best for non diabetic CKD + on ACEi or ARB
116
34 YEAR OLD MALE
T1DM
CKD
GFR = 48
ALB 550
A1C = 6.9
BP 130/80
The most important med to use for CKD progression is
Lisinopril (don't use SGLT2 because of ketoacidosis risk with T1DM
117
48 YEAR OLD
CKD DUE TO T2DM
G3B
A2
BP = 140/80
Most important plan to reduce CV events is to
target systolic BP <120
118
CKD due to T2DM
lisinopril
empagliflozin
metformin
eGFR = 32
ALB = 650
What drug and why
Finerenone is recommended for CKD with T2DM, A2-3 proteinuria, eGFR>25, on ACE-I or ARB.
119
________ is the primary cause of anemia in CKD
decreased erythropoietin production
120
derangements of concentrations of calcium, phosphorus, parathyroid hormone and vitamin D cause the onset of
CKD - MBD
121
Anemia is a complication of CKD in males if
HGB <13
122
CKD-MBD is a complication in a patient with recent hip fracture and iPTH >
2-9x upper limit of normal
123
If a patient is taking calcium carbonate 1000mg TID and has CKD what should you do, explain
check corrected calcium
corrected calcium = calcium value + 0.8*(4-albumin level)
124
Ca normal limits
8.5 - 10.2
125
If pt is on calcium carbonate and corrected ca is above 10.2, what should you do
d/c calcium carbonate and start sevelamer carbonate
126
HGB RANGE 9-11
DARBEPOETIN ALPHA WITH HGB 11.7
FERRITIN = 750
TSAT = 45
BEST TREATMENT?
DECREASE DARBEPOETIN ALPHA
127
Taking darbepoetin alpha
hgb - 9.7
ferritin - 75
tsat - 10%
What is indicated here and why
When ferritin <100 and tsat <10% INDICATION OF IRON DEFICIENCY WHICH IS BEST TREATED WITH IV IRON
128
sodium bicarbonate is most important to initiate if patient has co2 levels
below 22
129
It is important to counsel a patient starting oral iron on adverse effects including
consitpation and it may turn stool dark
130
_______ and anaphylaxis are rare adverse effects of IV iron
hypotension
131
In-center hemodialysis is done _____ days per week for __ - ___ hour sessions via fistula, graft, or catherter
3 days per week
3-5 hour session
132
An advantage of peritoneal dialysis is
better blood pressure control compared to in-center hemodialysis
133
the treatment for hemodialysis complication of hypotension is
midodrine
134
_______ is the most common complication of peritoneal dialysis
Peritonitis
135
Patients with CKD NOT on dialysis should avoid what class of medication
NSAIDS (I.E NAPROXEN)
136
Patients with CKD on dialysis should avoid _______ enemas
phosphate
137
for mild - moderate dehydration in an 8 year old, recommend
2-4 L of ORT over 3 hours and replace fluid losses
138
A 5 month old with 10 diarrhea (ah man) in 24 hours, unresponsive (not ideal), dry, and sunekn fontanelle is considered _______ dehydration
severe
139
ph > 7.4 = _______
PaCO2 >40 and HCO3 >38 = _______
urine chloride <10 = ________
1. alkalosis
2. primary metabolic cause
3. chloride responsive METABOLIC ALKALOSIS
140
Uremia is most likely to result in
anion gap metabolic acidosis
141
COPD is the most likely to result in _______ acidosis
respiratory acidosis
142
PH <7.35 = ______
______ = same direction with decrease in pH
pCO2, HCO3, anion gap = ______
1. acidosis,
2. metabolic
3. na- cl +HCO3 if over 12 considered anion gap
143
After trauma and head injury if labs are drawn with pH <7.35 and PaCO2 and HCO3 risking = ____ _______ acidosis
acute respiratory acidosis
144
5% albumin is an example of a
colloid
145
An example of a crystalloid is lactated ringers. To calculate maintenance rate (4 - 2 -1 rule) 4 * 10 kg = 40, 2 * 10 kg = 20, 1 * additional kg = x, so 40 + 20 + x = mL/hr
So for a 104 kg patient what is the maintenance rate
For a 104 kg pt, 40 + 20 + 84 = 144 mL/hr
146
For severe hyponatremia and altered mental status with intermittent seizures, treat with
150 mL bolus of 3% NaCl
147
Sodium > 145 = hypernatremia, edema and fluid overload =
hypervolemia
148
to calculate tonicity (Na * 2) + (Glucose / 18) + (BUN / 2.8)
So if Na = 152, glucose = 110, BUN = 18, tonicity =
316
149
Hyperkalemia >5, treat with IV _____ and dextrose.
Insulin 5-10 units
150
to stabalize cardiac myocardium treat with
calcium gluconate
151
hypomagnesemia <1.6 treat with
magnesium sulfate
152
You cannot treat hyponatremia with more than 12mEq/L in 24 hours otherwise it can lead to what
osmotic demylination syndrome (ODS) (vegtebelized patient dangit)
153
hyperphosphatemia < 1.5 treat with
potassium phosphate
154
Correct order of the cardiovascular continum: Risk factors, CAD, MI, heart failure, death
Risk factors, CAD, MI, heart failure, death
155
What stage did cigarette smoking, reduced physical activity, and increased meat consumption play a major role in deaths from CV disease
stage 3
156
beat to beat electrical signal in the heart originates from
sinoatrial node (sa node)
157
leakage of mitral valve cause blood to flow back from
Left ventricle to left atrium
158
isovolumetric ventricular contraction phase includes all valves being closed LV volume ______ and pressure in the LV being ______
LV volume unchanged
LV pressure increased
159
Frank starling relationship
effect of the ventricular end diastolic volume on the force generated during systol
160
small arteries and arteiole of the vasculature contain more layers of smooth muscle compared to
veins
161
contraction in the vascular smooth muscle is regulated by ______, not troponin
enzymes
162
arterial blood pressure equation
BP = CO X PVR
163
SBP increases with ______
age (after 40)
164
patient vitals
46 years
154/102
what stage HTN
STAGE 2
165
PATIENT HAS 3 RISK FACTORS
10 year ASCVD risk is 24.3%
framingham risk score of 24.1%
considered ______ risk
HIGH RISK
166
Average of 154/102 mmHg through three readings. Tests to order
BMP
12-LEAD ECG
CBC
LIPID PANEL
URINALYSIS
167
clinical CAD with angina on exertion (bp 150/102) BP GOAL = ?
<130 MMHG SBP
168
active guy
drinks
doesn't diet
used to smoke (aka nick)
needs to continue with outdoor activities
incorporate ______ diet with eating less ______
DASH DIET
less SALT
169
WHITE DUDE
61 yo
framingham score 17.5%
BP 146/100
HR 50
STARTED HCTZ
we recommend
- continue lifestyle changes
- HCTZ
- Add _______
lisinopril
170
72 AA female with lot of shit wrong
>55 yo
family members not alived due to bp
high bp
low hdl-c
this case is probably not on the test
but answer is
4 risk factors
3 affected organs
171
72 AA female with lot of shit wrong
>55 yo
family members not alived due to bp
high bp
low hdl-c
4 risk factors
3 affected organs
added diltiazem 120mg/day
still high bp
needs second drug? which one?
HCTZ 12.5MG QD
172
doxazosin monitoring paramater does not match
seated BP
173
58 latino dude treated with ______ bc he is chunky, DMT2, depression (real), and HTN
LISINOPRIL
174
lisniopril causes _______ due to inhibiting bradykinin breakdown
cough
175
ACEi lowers BP by inhibiting formation of ______
angiontenisin II
176
beta blockers decrease _____ concentrations
________ generated by cardiac myocytes and decrease HR
bb's decrease
cAMP concentrations
peak forces generated by cardiac myocytes
decrease HR of course
177
pedal edema from dihydropyridines from incrased outward capillary hydrostatic pressure gradient, moving fluid ______ (in relation to the capillary)
out of the capillary
178
Verapamil should be used with caution in patients with:
HF
reduced cardiac contractility
and on a B-Receptor antagonist
179
Amlodipine binds to the outer surface of the _ - Type calcium channel toward the Lipid molecules
L-type calcium channel
180
CKD = ACE/ARB
DM = ACE/ARB
ELDERLY + ONE =
MINERALOCORTICOID
181
felodipine (amlodipine cousin) has what affect on
HR
preload
afterload
contractility
^HR
no effect on preload,
decreases afterload
no effect on contractility.
182
37 yo
white male
HTN
asthma
impotence
what are we putting bro on
amlodipine
183
Uncontrolled BP dx can be given under what circumstances
on at least 3 drugs of DIFFERENT CLASSES at max tolerated doses
including a diuretic
184
Amlodipine is monitored by these paramaters (3)
Orthostatic BP
PERIPHERAL EDEMA
FATIGUE
185
Chylomicrons have the highest _______ content
triglyceride
186
ApoA-1 serves a critical role in ___
HDL
187
______ does all of the following
transfer cholesterol to chylomicrons in the exogenous pathway
acts primarily on ApoB containing lipoproteins in the exogenous pathway
raree loss of function mutations in MTP can cause abetalipoprotenemia
MTP
188
A principal part of the exogenous lipid pathway is that triglycerides arising from dietary lipids are metabolized by lipoprotein lipase to deliver
FATTY ACIDS to peripheral tissues
189
________ (drug) activates PPAR-alpha which promotes HDL synthesis and reverse cholesterol transport
fenofibrate
190
Which of the following are associated with fatty streak formation:
deposition of LDL particles in the intima
oxidation of LDL particles in the intima
inflammation and immune cell recruitment to the intima.
all of them
deposition of LDL particles in the intima
oxidation of LDL particles in the intima
inflammation and immune cell recruitment to the intima.
191
T/F - Catalyzing the conversion of cholesterol to cholesterol esters not a major role for apoproteins.
True
192
Bile acid resins should be used in caution in combinatino with other therapeutic agents because they affect the
absorption of other compounds
193
NPC1L1 is a key protein that facilitates uptake of _________ into enterocytes of lipid metabolism
cholesterol
194
The primary MOA of PCSK9 inhibitors is to prevent ____-____ receptor degredation in endosomes
LDL-LDL receptor degredation
195
T/F - Contractility is not a factor contributing to myocardial oxygen supply
TRUE
196
A key factor underlying the transition of atherosclerotic plaques from fatty to fibrous is
smooth muscle cells migrating from the turnica media to the tunica intima
197
Is HTN considered ASCVD
NO
198
A key difference between PREVENT and ASCVD risk score is that ASCVD calculator OVERESTIMATES a patient's CV risk compared to the PREVENT score where risk estimates showed to be overall _______
Lower
199
Patients should come in how long after statin initiation for a repeat lipid panel draw
4-12 weeks after statin initiation
200
48 yo old obese male
no PMH
No meds
excercises regularly
watches diet
ASCVD 3.4%
no risk factors
(LDL 113, TG 158, TC 198, HDL 45)
Today you should emphasize ________. Should you start a statin?
Emphasize lifestyle changes
no itiation of statin therapy
doesn't fall into four statin benefit groups
201
61 year old female, PMH: HTN, depression, T2DM, and ASCVD risk score is 15.4%. (LDL 217, HDL 32, TG 328). She is at high risk and needs
high intensity statin
atorvastatin 40mg
primary prevention first and second statin benefit group
age 40-75 yo
t2dm
requires high intensity statin
202
67 year old AA male, PMH: T2DM, hyperlipidemia, CAD s/p CABG in 2004 with stable angina and HTN. ASCVD: 30%, dad died from MI at 43. Started gemfibrozil six months ago and lipid panels worsened. He is at high risk: start _______.
Should this pt stop med(s)
follow up?
Start high intensity statin
Stop gemfibrozil
Clinical ASCVD (secondary prevention)
hasn't tried statin
203
60 year old female starting atorvastatin 80mg due to CAD with multiple stents. LDL 165. She experienced mild muscle pain and discontinued atorvastatin. Now you recommend ________
TRIAL rosuvastatin 40mg
secondary prevention statin has benefit due to:
intolerance
switch to moderate intensity statin
204
53 year old male, PMH: CAD, 2 ACS events, diabetes, HTN, active smoker. LDL 100, was 150 6 months ago. Taking rosuvastatin 40mg and ezetimibe 10mg. He is working on changing his diet, lifestyle and decreasing cigarettes. You recommend
Evolucumab (Repatha) 140mg SQ every 2 weeks.
High Risk ASCVD
Statin + Ezetemibe
not at target LDL
start PSCK9. (repatha)
205
The four potential secondary causes of hypertriglyceridemia are
underlying disease
diet/lifestyle
drugs
metabolic disorders
206
The REDUCE IT (NEJM 2019) showed cardiovascular benefit with which drug/medication
Icosapent ethyl (vascepa)
207
A false misconception about rx fish oils is that
OTC fish oil is a good replacement because they have the same potency and contents
208
54 year old female, PMH: uncontrolled T2DM, HTN, and current smoker. Mostly eats carbs, one beer/night, meds: HCTZ 25mg and NPH insulin 10 units BID. TG 300. Which of the following can be modified to reduce Sally’s TG level:
change HCTZ to alternative BP med
eliminate alcohol
reduce carbohydrate consumption
improve control of diabetes.
All of the above
change HCTZ to alternative BP med,
eliminate alcohol
reduce carbohydrate consumption
and improve control of diabetes.
209
Ther therapeutic effects of verapamil are that
A. slows heart rate
b. reduces afterload
c. relaxes vasospastic coronary vessels
d. all of the above
D is correct, all of the above
A. slows heart rate
b. reduces afterload
c. relaxes vasospastic coronary vessels
d. all of the above
210
T/F - Metoprolol is NOT the first line in treatment of vasospastic angina
True
211
The MOA of ranolazine is it inhibits late ______ currents in cardiomyocytes
inhibits late SODIUM currents in cardiomyocytes
212
ranolazine is used as an anti-anginal agent because it decreases _______ consumptions during _______
decreases oxygen consumption during diastole
213
Why can drugs that slow heart rate be used to treat stable angina.
- The heart is more efficient, oxygen consumption is reduced
- myocardial blood flow is improved due to the increased time the heart spends in diastole during slower heart rates.
214
Glyceryl trinitrate (nitroglycerin prevents angina by decreasing ______
preload
215
combining a beta blocker and non-dhp for angina is not advised due to what?
Both cause bradycardia
216
PDE5 inhibitors can potentiate the action of which class of drug and cause profound HYPOtension
nitrovasodilators (ex. nitroglycerin)
217
Typical SIHD: chest pressure with exercise/housework, substernal, doesn’t radiate, lasts 5 minutes. PMH: T2DM, weight 245lbs, height 5’6”.
What should this patient be on.
When should they follow up
Start SL NTG
clopidogrel 75mg
empagliflozin (jardiance) 10mg,
semaglutide (ozempic) 0.25mg,
return in 2 weeks.
218
If blood pressure and heart rate are low, which of the following can you use for SIHD.
a Beta blocker
b Long acting nitrate
c non-dhp ccb
d. all of the above
e. a and b
f. none of the above
f. none of the above.
219
If a patient has SIHD, and is already on metoprolol, with low BP and low HR, which drug would you add if pt is still symptomatic
ranolazine (ranexa) 500mg
220
When a patient is diagnosed with sihd what should be discussed immediately?
prognosis
Treatment
Physical Activity
221
what is contraindicated to starting a nonselective beta blocker for SIHD
asthma with daily beta adrenergic agonist inhaler use, active peripheral artery disease, and HR < 60 bpm.
ALL OF THEM ARE CONTRAINDICATED
222
82 year old hispanic female, PMH: HTN, active PVD, hyperlipidemia, presents with SIHD daily and must stop daily chores. ASCVD = 10.5%.
WHAT MEDS ARE WE PUTTING THIS PATIENT ON
Start SL NTG 0.4mg, Aspirin 81mg, Colchicine 0.5mg, Lisinopril 5mg, Rosuvastatin 10mg, Carvedilol 25mg.
Clinical HTN = lisinopril, hyperlipidemia = rosuvastatin, and SIHD = NTG, Aspirin, inflammatory PVD = Colchicine, carvedilol, ASCVD = mod statin
223
BETA ADRENERGIC BLOCKERS ARE PRESCRIBED IN SIHD TO BALANCE WHAT?
myocardial oxygen supply and demand
224
________ BP measurements is a monitoring paramater for SIHD
ORTHOSTATIC BP
225
Which of these can cause harm to a patient with SIHD
sympathomimetic weight loss drugs chronic use of opioids
PDE5 inhibitors
all of them
sympathomimetic weight loss drugs, chronic use of opioids, and PDE5 inhibitors.
226
A patient experiencing MI from small clots at the ruptured plaque site without concomitant necrosis.
What is this patient likely experiencing
Chest Pain
227
A rupture of a thin fibrous cap on a stenotic lipid-rich plaque can lead to....
a thrombus forming on an atheromatous plaque
228
The accumulation of ADP, thromboxane, and thrombin in areas of disturbed blood flow lead to.....
activation and accumulation of platelets
229
the interaction of platelets with damaged endothelial surfaces is most affected in which disease
von willebrands disease
230
ADP activating P2Y12 on platelets results in a conformational change in GPIIb/IIIa receptors that triggers ________
aggregation
231
Platelet aggregation blocking drugs least to worst.
Options, aspirin, clopidogrel, abciximab
aspirin
232
Prasugrel is better than clopidogrel in the sense that the _______ and _______ of prasugrel is higher
1. absorption
2. bioactivation
233
MOA of vorapaxar
block PAR-1 receptors on platelets
234
decreased antithrombin activity can lead to _______ formation
thrombus
235
intrinsic x-ase complex (FIXa/FVIIIa/FX) is on the surface of what
phosphatidylserine-positive activated platelets
236
the initiation of clot formation is most affected by
inactivated tissue factor
237
the function of activated protein C is to _____________ at the site of injury
limit coagulation
238
homeostasis example
cutting yourself shaving then bleeding stops 10 minutes later
239
patients at high risk of bleeding should avoid anticoagulation therapy and should do what instead
sequential compression devices instead of anticoag tx
240
for hemodynamically stable patient, oral _______ is the best therapy and does NOT require injection
DOAC
241
T/F- DOACs should NOT be taken when breastfeeding
TRUE- no DOAC when breastfeeding
242
If switching from injection tx to warfarin for anticoag, typically in pregnant patients, what do you need to do
overlap for 5 days
243
______-_____ or ______ is contraindicated in alteplase
recent surgery or trauma
244
Alteplase binds fibrin clots with high affinity which helps localize what to the clot
plasmin formation
245
What is the best anticoag treatment for factor V Leiden while pregnant
enoxaparin
246
Fondaparinux MOA for inhibiting coagulation is by
increasing the binding of antithrombin to factor Xa
247
Idarucizumab can rapidly reverse the effects of ________
dabigatran
248
Warfarin should be monitored by prothrombin time (PT) displayed as _____
INR
249
Warfarin affects which important clotting factor(s)
factor X and factor II
250
Warfarin should be overlapped during with treatment with another UHF or LMWH. Stops activation of __________ dependent clotting factor and crosses the __________
1. vitamin k
2. placenta
251
Anticoag therapy should be initiated until the VTE has been objectively confirmed so patient should obtain a __________ ultrasound
compression ultrasound
252
__________ helps form coagulation complexes on phospholipid surfaces during fibrin formation
calcium
253
A fractured ankle with plaster cast would cause _______ formation as part of Virchow's triad
thrombus
254
255
Fibrin is most likely to be formed during the ________ phase
propagation
255
Which of the following are contraindications to receiving a fibrinolytic:
all of the above
severe uncontrolled HTN, significant closed head trauma within the last 3 months, and active bleeding
255
SECONDARY prevention of atherosclerotic ischemic stroke is _______
aspirin
255
PREIMARY prevention of CARDIOEMBOLIC ischemic stroke is
apixaban
255
best plan to reverse warfarin with an active bleed is
vitamin k 5mg IV
256
patients with suspected acute ischemic stroke can be eligible for fibrinolysis if they present
within 4.5 hours asn does not have an acute bleed
256
Suspected NSTE-ACS at PCI capable, getting cath lab in 24 hours, pt takes atorvastatin 20, metformin 500 BID, and amlodipine 5. Treatment plan:
Treatment plan: ASA 325 CHEW, hold P2Y12 until table, hold BB, heparin, increase atorvastatin to 40mg, SL NTG prn, continue lisinopril, hold metformin
256
t/f- NSAIDs should not be given in CVD patients
true
256
It is appropriate to give a fibrinolytic in a STEMI with symptoms within _____ hours and unable to get PCI capable within ______ minutes of presenting
1. 12 hours
2. 120 minutes
256
Ticagrelor should not be given with more than 100mg of ______
aspirin
256
CVD patient + headache, what OTC do we recommend
acetaminophen
256
Avoid prasugrel in patients
>75 years
hx of stroke
weight <60 kg
256
Ticagrelor is an _________ medication should be avoided in an _________ patient post STEMI-ACS with DES
1. expensive
2. uninsured
257
Post STEMI-ACS regimen for patient on with DES placed and taking lisinopril 10:
aspirin 81, prasugrel 10, atorvastatin 80, metoprolol 25, continue lisinopril
257
Dual antiplatelet therapy should be continued for ____ months post-ACS with a DES
12 months
257
Which of the following are reasons to avoid IV beta-blockers for acute ACS:
signs of cardiogenic shock, active wheezing, and 2nd degree heart block without a pacemaker
All of the above
signs of cardiogenic shock, active wheezing, and 2nd degree heart block without a pacemaker
257
which study showed lower rates of death & no difference in bleeding risk between prasugrel and ticagrelor
ISAR-REACT 5 (2019) showed lower rates of death & no difference in bleeding risk between prasugrel and ticagrelor
257
which study compared clopidogrel + ASA 81 is better than ASA alone
CURE (2001) compared clopidogrel + ASA 81 is better than ASA alone
258
which study showed that long-term beta blockers may not have strong benefit for ACS with normal EF
REDUCE-AMI (2024) showed that long-term beta blockers may not have strong benefit for ACS with normal EF
258
which study showed low-dose colchicine may reduce risk of ischemic events in patients post-ACS
COLCOT (NEJM 2019) showed low-dose colchicine may reduce risk of ischemic events in patients post-ACS
259
which of the following contribute to the progression of HFrEF: neuroendocrine stimulation, increased myocyte energy expenditure, and enhanced myocyte apoptosis
All of the following contribute to the progression of HFrEF: neuroendocrine stimulation, increased myocyte energy expenditure, and enhanced myocyte apoptosis
260
Accumulation and inflammation of adipose tissue contributes to the progression of _______. (HF)
Accumulation and inflammation of adipose tissue contributes to the progression of HFpEF
261
WHICH of the following neurohormones are matched with their pathophysiological effects progressing HFrEF: increased norepi + B1 adrenergic down regulation, ang II + enhanced cardiac myocyte hypertrophy, vasopressin + retention of free water
All of the following neurohormones are matched with their pathophysiological effects progressing HFrEF:
increased norepi + B1 adrenergic down regulation, ang II + enhanced cardiac myocyte hypertrophy, vasopressin + retention of free water
262
The range for HFmrEF is __-__%
The range for HFmrEF is 40-49%
263
264
_______ P-V loop is shifted to the right (larger EDV and ESV) compared to the normal and HFpEF P-V loops
HFrEF’s P-V loop is shifted to the right (larger EDV and ESV) compared to the normal and HFpEF P-V loops
265
In heart failure, Endothelin I causes potent ____________ in paracrine signaling
In heart failure, Endothelin I causes potent vasoconstriction in paracrine signaling
266
To slow progression of HFrEF, treatments rely on roles of _______ and ________
To slow progression of HFrEF, treatments rely on roles of ang II and norepi
267
WHICH DRUG inhibits PDE3 which increases cardiac contractility and relaxes vascular smooth muscle
Milrinone inhibits PDE3 which increases cardiac contractility and relaxes vascular smooth muscle
268
Which drug is beneficial because it increases plasma concentrations of natriuretic peptides and block ang II receptors
Entresto is beneficial because it increases plasma concentrations of natriuretic peptides and block ang II receptors
269
IV _____ should be administered for severe hypotension and in states of cardiogenic shock
IV dopamine should be administered for severe hypotension and in states of cardiogenic shock
270
Adding carvedilol after an MI is to do what
Adding carvedilol after an MI is to slow the progression of heart failure
271
The Frank Starling curve shows what two metrics
The Frank Starling curve shows EDV (preload) vs systole (cardiac output)
272
273
An example of an SGLT2 inhibitor is
Dapagliflozin (Farxiga)
274
In the EMPEROR trial showed what
In the EMPEROR trial, Empagliflozin (Jardiance) showed to reduce CV death or hospitalization for heart failure in HFpEF
275
276
Give adenosine for what
paroxysmal supraventricular tachycardia
277
If there is a delay at the AV node, you will have an elongated ____ _______ (look at ECG)
If there is a delay at the AV node, you will have an elongated PR segment (look at ECG)
278
If you have HFrEF, you will have what 3 primary symptoms
If you have HFrEF, you will have fatigue, dyspnea, and edema
279
T/F - Aflutter does not have multiple or unstable ectopic pacemakers
TRUE
Aflutter does not have multiple or unstable ectopic pacemakers
280
WHICH TYPE OF arrhythmias require fast current, slow current, and island of UNexcitable tissue
Re-entrant arrhythmias require fast current, slow current, and island of UNexcitable tissue
281
TZDs are pretty chill to use in HF
no TZD will kill your patient.
SAY NO TO TZD IN HF
282
WPW involves an accessory pathway between the a______ and the _________
WPW involves an accessory pathway between the atrium and the ventricle
283
If pt has severe symptoms of irregularly irregular ventricular rhythm arrhythmia and faints, they need rhythm control → give them _________
If pt has severe symptoms of irregularly irregular ventricular rhythm arrhythmia and faints, they need rhythm control → give them dofetilide (Dronedarone NOT for permanent AFIB or HF)
284
Magnesium sulfate treats _____
Magnesium sulfate treats TdP
285
T/F - A patient with mild symptoms of afib for last few days does need rhythm control
FALSE
A patient with mild symptoms of afib for last few days does NOT need rhythm control
286
Decreasing PCWP = (INCREASING OR DECREASING) mortality rate
Decreasing PCWP = decreased mortality rate
287
If a patient has a mechanical heart valve but has Vfib, send them home on long term ________
If a patient has a mechanical heart valve but has Vfib, send them home on long term warfarin
288
If a patient has a mechanical heart valve and Vfib but needs to be DCC, use _______ first
If a patient has a mechanical heart valve and Vfib but needs to be DCC, use UFH first
289
Use amiodarone for WHAT TYPE OF arrhythmias
Use amiodarone for refractory ventricular arrhythmias
290
When using nesiritide, monitor for what?
When using nesiritide, monitor for low blood pressure
291
Amiodarone can lead to which of the following:
pulmonary fibrosis
corneal microdeposits
hepatotoxicity
all of the above
Amiodarone can lead to pulmonary fibrosis, corneal microdeposits, and hepatotoxicity
292
293
Early ___________ can contribute to various forms of arrhythmias. EAD: a sufficient number of ion channels are in the closed state and can be activated by a sufficient depolarizing stimulus thus triggering an AP
Early Afterdepolarizations can contribute to various forms of arrhythmias. EAD: a sufficient number of ion channels are in the closed state and can be activated by a sufficient depolarizing stimulus thus triggering an AP
294
Proarrhythmic means what
Proarrhythmic= when drugs cause arrhythmias
295
If you are NYHA stage 3, your number one priority is what
If you are NYHA stage 3, your number one priority is exercise tolerance
296
Before starting spironolactone (aldosterone antagonist) check which labs
Before starting spironolactone (aldosterone antagonist) check labs: SCr and K
297
If a HF patient wants non-pharm measures, make sure they get which of the following:
vaccines needed
exercise
diet
All of the above
If a HF patient wants non-pharm measures, make sure they get vaccines needed, exercise, and diet (all)
298
299
If you're going to DCC someone, give them _________ first
If you're going to DCC someone, give them Midazolam first
300
If a patient has renal diuretic resistance, first try what before adding anything else on
If a patient has renal diuretic resistance, first try increasing their diuretic dose before adding anything else on
301
if a patient is WARM and WET
deal with that
302
If a patient is on ⅘ of the pillars and doesn't want to start a new med.....
If a patient is on ⅘ of the pillars and doesn't want to start a new med, that's too damn bad cause they're getting empagliflozin (also if they're ok with it cause this was a dual ?)
303
Propranolol can cause ______ in OD
Propranolol can cause seizures in OD
304
Superwarfarins have what kind of half life compared to warfarin
Superwarfarins have a longer half-life than warfarin
305
If a patient has HF, ibuprofen and diltiazem CCBs can do what
If a patient has HF, ibuprofen and diltiazem CCBs can worsen it
306
High BUN (>43)
High SCr(>2.75)
low SBP (<115)
What does this mean for a hospitalized patient
High BUN (>43), High SCr(>2.75), and low SBP (<115)= BAD for in hospital mortality
307
If you eat rat poison and your INR is ok 2 days later, what should you do
If you eat rat poison and your INR is ok 2 days later, check it again in a day
308
Most common AE when giving IV glucagon for BB OD is _______
Most common AE when giving IV glucagon for BB OD is vomiting
309
MOA of high dose insulin on cardiac myocytes in ccb or bb od=
MOA of high dose insulin on cardiac myocytes in ccb or bb od= increased glucose utilization
310
___________ is an indicator of NDHP CCB overdose
Hyperglycemia is an indicator of NDHP CCB overdose
311
Give digoxin immune fab (Digifab) in acute digoxin toxicity if potassium of what level
Give digoxin immune fab (Digifab) in acute digoxin toxicity if potassium of 6.5mEq/L (hyperkalemia >5)
312
If patient has tachycardia and irregular pulse and presents to ED in 4h, give them _______ IV bolus then q6hx2, if O2 sat is low (<90), give them _________, __________ bolus (if fluid overloaded), and TEE now
If patient has tachycardia and irregular pulse and presents to ED in 4h, give them digoxin IV bolus then q6hx2, if O2 sat is low (<90), give them O, furosemide bolus (if fluid overloaded), and TEE now
313
If person has new palpitations over last couple of days and is newly diagnosed with Afib and no thrombus found, give them ____________ for rate control immediately
If person has new palpitations over last couple of days and is newly diagnosed with Afib and no thrombus found, give them METOPROLOL for rate control immediately
314
If a patient passes out from Vfib, they should get IV _________ to terminate it
If a patient passes out from Vfib, they should get IV amiodarone to terminate it
315
Digoxin increases _____ _____ in Afib
Digoxin increases vagal tone in Afib
316
________ is responsible for the rapid depolarization of the SA node
Calcium is responsible for the rapid depolarization of the SA node
317
t/f- VFib is the most immediately life threatening arrhythmia
TRUE
VFib is the most immediately life threatening arrhythmia
318
If a patient with HFrEF is on an ace or an arb, monitor for which of the following:
A. orthostatic bp
B. angioedema
C. BMP
D. ALL OF THE ABOVE
ALL OF THE ABOVE (DUH)
If a patient with HFrEF is on an ace or an arb, monitor for orthostatic bp, angioedema, and BMP
319
T/F- Ivabridine is not shown to decrease morbidity and mortality
TRUE
Ivabridine is not shown to decrease morbidity and mortality
319
If patient has HFrEF & is not on spironolactone.......
If patient has HFrEF & is not on spironolactone, start them on it
320
The age of degenerative and civilization associated disease is related to________ and reduced _________ ________
The age of degenerative and civilization associated disease is related to smoking and reduced physical activity
321
PUT THESE IN ORDER
CV continuum order: HF, Death, risk factor, CAD, MI,
CV continuum order: risk factor, CAD, MI, HF, Death
322
If patient not on all pillars, put them on ___________ if they're not on it
If patient not on all pillars, put them on empagliflozin if they're not on it
323
Lidocaine preferentially inhibits what
Lidocaine preferentially inhibits RAPIDLY depolarizing ventricular myocytes
324
Use dependence of Na channel blocker will (speed up or slow down) conduction of depolarization in Cardiac myocyte
Use dependence of Na channel blocker will SLOW conduction of depolarization in Cardiac myocyte
325
is DOAC tx for MG with palpitations over last 3 days recommended
Yes DOAC tx for MG with palpitations over last 3 days
326
TdP is from what
TdP from prolonged QT
327
___________ is the preferred treatment for hypothyroidism because its tolerated and has a long ½ life
Levothyroxine is the preferred treatment for hypothyroidism because its tolerated and has a long ½ life
328
Overproduction of Thyroxine (T4) is associated with exophthalmos in which disease
Overproduction of Thyroxine (T4) is associated with exophthalmos in graves disease
329
_________ is preferred in hyperthyroidism because it has a longer ½ life and fewer adverse effects compared to PTU
Methimazole is preferred in hyperthyroidism because it has a longer ½ life and fewer adverse effects compared to PTU
330
Type __ diabetes is associated with Diabetic Ketoacidosis
Type 1 diabetes is associated with Diabetic Ketoacidosis
331
Central diabetes insipidus is treated with _________
Central diabetes insipidus is treated with desmopressin
332
Phenytoin could potentially decrease or increase? the efficacy of levothyroxine by enhancing its metabolism (P450 enzymes)
Phenytoin could potentially DECREASE the efficacy of levothyroxine by enhancing its metabolism (P450 enzymes)
333
HbA1c of ___ or higher is diagnostic criteria indicative of diabetes mellitus
HbA1c of 6.5% or higher is diagnostic criteria indicative of diabetes mellitus
334
A complete lack of insulin characterizes Type __ diabetes
A complete lack of insulin characterizes Type 1 diabetes
335
______ facilitates glucose uptake into muscle and adipose tissues in response to insulin during glucose metabolism
GLUT4 facilitates glucose uptake into muscle and adipose tissues in response to insulin during glucose metabolism
336
Activation of GLUT4 translocation to the cell membrane is the mechanism by which insulin promotes the uptake of _____ into skeletal and cardiac muscle post-prandial
Activation of GLUT4 translocation to the cell membrane is the mechanism by which insulin promotes the uptake of glucose into skeletal and cardiac muscle post-prandial
337
Glucagon is released from alpha cells and primarily acts as a catabolic counterpart to _______
Glucagon is released from alpha cells and primarily acts as a catabolic counterpart to insulin
338
Microvascular complications is a consequence of prolonged _________ in diabetes
Microvascular complications is a consequence of prolonged hyperglycemia in diabetes
339
Enhanced insulin secretion and reduced postprandial hyperglycemia would be seen if a drug increased the release of incretin hormones in a patient with WHAT TYPE OF DIABETES
Enhanced insulin secretion and reduced postprandial hyperglycemia would be seen if a drug increased the release of incretin hormones in a patient with T2DM
340
I GUESS THIS IS A STATEMENT SOMEONE WROTE DOWN, I don't know WHAT THIS IS ABOUT
Injection site, dose, and physical activity can affect the onset and duration of its action
Injection site, dose, and physical activity can affect the onset and duration of its action
341
Enhanced ketogenic and elevated blood ketone levels is the effect if _________ secretion is absent
Enhanced ketogenic and elevated blood ketone levels is the effect if insulin secretion is absent
342
Higher fasting glucose levels due to impaired insulin release is the most direct effect of ______ cell loss in T2DM
Higher fasting glucose levels due to impaired insulin release is the most direct effect of Beta cell loss in T2DM
343
If a patient was just diagnosed with T1DM, insulin glargine __ units at bed and insulin aspart _ units TID with meals is appropriate.
→ Patient’s weight is 62 kg– 0.5 units/kg/day, divided between basal and bolus with bolus at every meal
If a patient was just diagnosed with T1DM, insulin glargine 15 units at bed and insulin aspart 5 units TID with meals is appropriate. → Patient’s weight is 62 kg– 0.5 units/kg/day, divided between basal and bolus with bolus at every meal
344
Increase dinner dose of novolog mix 70/30 if his glucose level is at 191 mg/dL 2 hrs after dinner→ postprandial insulin should be <______
Increase dinner dose of novolog mix 70/30 if his glucose level is at 191 mg/dL 2 hrs after dinner→ postprandial insulin should be <180
345
346
_________ breakfast dose of insulin lispro if pre lunch glucose level is 156 mg/dL
→ preprandial should be 80-130
Increase breakfast dose of insulin lispro if pre lunch glucose level is 156 mg/dL→ preprandial should be 80-130
347
_________ evening insulin dose if fasting glucose levels are 64 mg/dL → 80-130 is normal range
Decrease evening insulin dose if fasting glucose levels are 64 mg/dL → 80-130 is normal range
348
or a flexpen, admin it ____ mins before a meal but it can be given up to ___ mins after meal
or a flexpen, admin it 15 mins before a meal but it can be given up to 20 mins after meal
349
weight is 83 kg if A1C increased WHAT SHOULD WE DO
this question did not have very much context for whoever took notes on it
Add glargine 16 units at bedtime if A1C increased→ 10 units per day increase or 0.1-0.2 units/kg/day…weight is 83 kg
350
low context notes
Add aspart 4 units if A1C decreased but post prandial is 190-200 mg/dL
→ 4 units or 0.1 units/kg or 10% of daily dose
Add aspart 4 units if A1C decreased but post prandial is 190-200 mg/dL → 4 units or 0.1 units/kg or 10% of daily dose
351
low context notes on this
Lispro before meal if pre lunch 210 mg/dL, Insulin to Carb Ratio 1:15 and correction factor 30→ mealtime dose=grams of carbs in meal/ICR→ 60g/15=4 units. Correction dose= BG before-BG after/CF (210-120)/30=3, 4+3=7
Lispro before meal if pre lunch 210 mg/dL, Insulin to Carb Ratio 1:15 and correction factor 30→ mealtime dose=grams of carbs in meal/ICR→ 60g/15=4 units. Correction dose= BG before-BG after/CF (210-120)/30=3, 4+3=7
352
MOA of metformin =
MOA of metformin = activate AMPK, reduce gluconeogenesis in the liver
353
GLP1 cardiovasc effect=
GLP1 cardiovasc effect= increased NO production and decreased ROS
354
Metformin should be used in caution with ________ impaired patients
Metformin should be used in quation with renally impaired patients
355
GLP1 agonists promote ______ and _______ gastric emptying
GLP1 agonists promote satiety and slows gastric emptying
356
Metformin __________ TGs, VLDL, and LDL, increases HDL
Metformin decreases TGs, VLDL, and LDL, increases HDL
357
Tirxepatide is a (what class)
Tirxepatide is a GLP1+GIP
358
DPP4 inhibitor inhibits DPP4 to prolong action if _________ (Question of the Year!)
DPP4 inhibitor inhibits DPP4 to prolong action if incretins (Question of the Year!)
359
T/F- Glyburide cannot be combod with bolus insulin
TRUE
Glyburide cannot be combod with bolus insulin
360
If a patient has recurrent UTI, T2DM, CKD obesity, on metformin, glimepiride and has high A1C, give her __________
If a patient has recurrent UTI, T2DM, CKD obesity, on metformin, glimepiride and has high A1C, give her semaglutide
361
Pt has gained 5 lbs in 6mo. ____________ (drug) IS contributing to his weight gain
Pt has gained 5 lbs in 6mo. Pioglitazone contributing to his weight gain
362
Pt with t2dm and ckd and on metformin 1000 BID -> eGFR decreased so now what
Pt with t2dm and ckd and on metformin 1000 BID -> eGFR decreased so reduce metformin to 500mg BID
363
if picking up liraglutide for first time, teach him what
if picking up liraglutide for first time, teach him proper self-injection technique, including site rotation and needle disposal
364
· The glucose lowering effects of SGLT2i are less pronounced at lower _______ levels
· The glucose lowering effects of SGLT2i are less pronounced at lower eGFR levels
365
Metformin should be started at _______mg QD then slowly titrated up to a max dose of ________mg QD
1. 500mg qd
2. 2000mg qd
366
Pt wants to lose weight and does not want to inject any meds -> give him
Pt wants to lose weight and does not want to inject any meds -> give him sitagliptin (januvia)
367
hx of t2dm and MI 3 years ago and Is currently on ASA 81, metformin 2000, Olmesartan, and rosuvastatin 40. Add ____________ to his treatment to reduce risk of CV events MACE
hx of t2dm and MI 3 years ago and Is currently on ASA 81, metformin 2000, Olmesartan, and rosuvastatin 40. Add empagliflozin to his treatment to reduce risk of CV events MACE
368
· Patient develops ulcer on foot and already on a bunch of meds so he needs ________
· Patient develops ulcer on foot and already on a bunch of meds so he needs insulin
369
· Patient with hx of pancreatitis (no glp1 and no dpp4) wants to avoid meds that cause weight gain= what med
· Patient with hx of pancreatitis (no glp1 and no dpp4) wants to avoid meds that cause weight gain= canagliflozin
370
· If diabetes patient loses their insurance and is on metformin, you can give them _______ , they don’t need insulin unless >10
· If diabetes patient loses their insurance and is on metformin, you can give them glipizide (sur are cost effective ), they don’t need insulin unless >10
371
· Don’t use _____ in hf, if on glp1 don’t use _______, and if pt has HF get them on _________ if they have good insurance coverage
· Don’t use tzd in hf, if on glp1 don’t use dpp4, and if pt has HF get them on empagliflozin if they have good insurance coverage
372
· A patient centered approach should be utilized to select diabetes pharmacotherapy according to ______
· A patient centered approach should be utilized to select diabetes pharmacotherapy according to_____
373
· If patient has t2dm, HTN, PVD and an A1c of 7.6, already on metformin 2000, lisinopril 20, amlodipine 10, add ____________ bc ascvd benefit
· If patient has t2dm, HTN, PVD and an A1c of 7.6, already on metformin 2000, lisinopril 20, amlodipine 10, add dalaglutide (Trulicity) bc ascvd benefit
374
· DCCT and UKPDS 33 trials looked at what
· DCCT and UKPDS 33 trials looked at preventing microvascular complications with early intensive glycemic control
375
· Comprehensive foot exams should be performed at least annually starting when with T2DM
· Comprehensive foot exams should be performed at least annually starting at the time of diagnosis with T2DM
376
· To prevent macrovascular complications in a tobacco dependent diabetic patient, initiate a ______ and repeat lipid panel in 4-12 weeks
· To prevent macrovascular complications in a tobacco dependent diabetic patient, initiate a statin and repeat lipid panel in 4-12 weeks
377
· Gastroparesis is a neuropathic complication of ________
· Gastroparesis is a neuropathic complication of _______
378
· According to ADA, patients should incorporate more _____________________ into meals and snacks
· According to ADA, patients should incorporate more non starchy vegetables into meals and snacks
379
T/F- · Core component of comprehensive care plan for patients with diabetes does not include counting carbs
· TRUE
Core component of comprehensive care plan for patients with diabetes does not include counting carbs
380
______ _________ occurs in patients when they are frustrated with their treatment
· Diabetes distress occurs in patients when they are frustrated with their treatment
381
T/F- Depending on intensity of exercise, diabetic patients can experience hypo or hyperglycemia
TRUE
Depending on intensity of exercise, diabetic patients can experience hypo or hyperglycemia
382
T/F- IV dextrose for DKA used when hyperglycemia is NOT resoled and ketoacidosis is not yet resolved
FALSE
IV dextrose for DKA used when hyperglycemia is resolving but ketoacidosis is not yet resolved
383
· If patient is admitted with DKA, initial treatment should be
· If patient is admitted with DKA, initial treatment should be IV fluid, K, IV regular insulin
384
T/F- Infection can cause DKA
TRUE
Infection can cause DKA
385
· If patient is going NPO at midnight
-and bg ok (range 140-180 in hosp ok)-> d/c insulin aspart 8U TID after dinner, change insulin aspart sliding scale to
· If patient is going NPO at midnight
-and bg ok (range 140-180 in hosp ok)-> d/c insulin aspart 8U TID after dinner, change insulin aspart sliding scale to q4h after dinner tonight
386
· Corticosteroids can ________ blood glucose
· Corticosteroids can increase blood glucose
387
_______ insulin glargine by 20-25% for NPO
decrease insulin glargine by 20-25% for NPO
388
______ metformin in hospital (AKI), reduce glargine dose to 5 u and start aspart sliding scale
Hold metformin in hospital (AKI), reduce glargine dose to 5 u and start aspart sliding scale
389
· Dose of levothyroxine calculation = ____ - _____ mcg/kg IBW/day
· Dose of levothyroxine calculation = 1.6-1.8 mcg/kg IBW/day
390
Bg goal in hospital is
Bg goal in hospital is 140-180
391
· Following dose adj of levothyroxine, recheck TSH in
· Following dose adj of levothyroxine, recheck TSH in 4-8 weeks
392
· If TSH is too low and showing signs of hyperthyroidism, decrease levothyroxine by
· If TSH is too low and showing signs of hyperthyroidism, decrease levothyroxine by 12.5-25mcg
393
· Methimazole for _______ disease hyperT
· Methimazole for graves disease hyperT
394
· If patient develops recurrent hypoglycemia despite glucose tx following SUR OD , administer _________
· If patient develops recurrent hypoglycemia despite glucose tx following SUR OD , administer octreotide
395
· Levothyroxine OD most like ____________ toxidrome
· Levothyroxine OD most like sympathomimetic toxidrome
396
· Check ______ ______ for metformin OD
· Check serum lactate for metformin OD
397
· SUR have highest risk of ______glycemia
· SUR have highest risk of hypoglycemia
398
· Oral contraceptive might be less effective after _______ surger
· Oral contraceptive might be less effective after bariatric surger
399
· Obesity classes: BMI=
· Obesity classes: BMI=weight (kg)/ height in m^2
400
· First line tx for obesity management is _________ modifications
· First line tx for obesity management is behavioral modifications
401
· Best recommendation for weight management when patient has been trying to lose weight with diet exercise fro 6mo= ________ (medication)
· Best recommendation for weight management when patient has been trying to lose weight with diet exercise fro 6mo=tirzepatide
402
· Stop phentermine/ topiramate due to lack of full response to treatment if don’t lose _% of weight in _ mo
· Stop phentermine/ topiramate due to lack of full response to treatment if don’t lose 5% of weight in 3 mo
403
which weight loss med is Inappropriate med if HTN/ hx of ascvd
· Inappropriate med if HTN/ hx of ascvd = phentermine
404
· Tirzepetide should be started at low dose and titrated to max dose to avoid ____
· Tirzepetide should be started at low dose and titrated to max dose to avoid AE
405
We expect pts to regain portion of weight back after stopping ___________ (weight loss med)
We expect pts to regain portion of weight back after stopping semaglutide
406
________have the smallest energetic contribution to drug binding
Van der Waals have the smallest energetic contribution to drug binding
407
____________ doesn’t violate lipinski’s rule of 5
Acetaminophen doesn’t violate lipinski’s rule of 5
408
Which statement(s) are true
Drugs bind to multiple biological targets
GPCRs are targets
binding is mediated by molecular interactions
all of the above!
Drugs bind to multiple biological targets, GPCRs are targets, and binding is mediated by molecular interactions
409
which statement(s) are true
Stereochemistry determines pharmacokinetics
Stereochemistry determines pharmacodynamics
Biomolecules are chiral
all of the above are true
Stereochemistry determines pharmacokinetics and pharmacodynamics. Biomolecules are chiral
410
Added _____ groups on structures can cause phenolic oxygens to bind tighter and be more basic and less stable
Added methyl groups on structures can cause phenolic oxygens to bind tighter and be more basic and less stable
411
Halogens can make structures more acidic and more stable
Halogens can make structures ____ acidic and _____ stable
412
Lipinski’s rule of 5
are ?
Lipinski’s rule of 5
5 hydrogen donors
10 hydrogen acceptors
MW of 500 or less
LogP that does not exceed 5 (prime spot 1.4-1.8)
413
_-thalidomide causes birth defects because it’s active but _-thalidomide is not active
D-thalidomide causes birth defects because it’s active but L-thalidomide is not active
414
Carboxyl groups have ______ like tetrazoles, sulfonamide
Carboxyl groups have isosteres like tetrazoles, sulfonamide
415
Phase __ metabolism contains hydroxylation, demethylation, hydrolysis, and epoxidation
Phase 1 metabolism contains hydroxylation, demethylation, hydrolysis, and epoxidation
416
Phase _ metabolism contains sulfation, acetylation, and glucuronidation
Phase 2 metabolism contains sulfation, acetylation, and glucuronidation
417
Phase _ metabolism occur in the gut microbiome
Phase 3 metabolism occur in the gut microbiome
418
___________ can be triggered by ANG 2 which is 2HN-Asp-Arg-Val-Tyr-Ile-His-Pro-Phe-COOH
Vasoconstriction can be triggered by ANG 2 which is 2HN-Asp-Arg-Val-Tyr-Ile-His-Pro-Phe-COOH
419
ACEi accumulate bradykinin which causes ______
ACEi accumulate bradykinin which causes cough
420
LMWH is obtained from ______________. They do not have the same half-lives
LMWH is obtained from unfractionated heparin (UFH). They do not have the same half-lives
421
T/F- heparin activates inactivate vit k reductase
FALSE
heparin DOES NOT inactivate vit k reductase
422
Warfarin mimic_____ and affects recycling
Warfarin mimic vitAMIN k and affects recycling
423
Heparin functions as an ______________ (class)
Heparin functions as an anticoagulant
424
P2Y12 inhibitor that requires CYP activation (clopidogrel) - know this structure
P2Y12 inhibitor that requires CYP activation (clopidogrel) - know this structure
425
know what captopril looks like
know captopril structure
426
identify a pro-drug
identify pro-drug structure
427
Aspirin inhibits COX enzymes in the ________
Aspirin inhibits COX enzymes in the platelet
428
Ticagrelor inhibits platelet activation, it mimics adenosine and a ribose ring
Ticagrelor inhibits platelet activation, it mimics _________ and a ribose ring
429
know structure The Antiplatelet agent (Tirofiban)
know structure The Antiplatelet agent (Tirofiban)
430
know structure - Angiotensin Receptor Blocker (biphenyl ring, carboxylic acid, and an isostere)
know structure - Angiotensin Receptor Blocker (biphenyl ring, carboxylic acid, and an isostere)
431
SGLT2 inhibitors have a ______ like functional group
SGLT2 inhibitors have a glucose like functional group
432
know ccb structure
know ccb structure
433
know antianginal agent structure
know antianginal agent structure
434
Cholesterol lowering agents mimic HMG-CoA or can have a cyclic lactone that acts as a prodrug aspect that gets activated to mimic _____-___
Cholesterol lowering agents mimic HMG-CoA or can have a cyclic lactone that acts as a prodrug aspect that gets activated to mimic HMG-CoA
435
know structure lipid lowering agent that targets PPAR receptor
know structure lipid lowering agent that targets PPAR receptor
436
KNOW COXi structure
COXi structure
437
know mixed beta blocker (carvedilol) structure
know mixed beta blocker (carvedilol) structure
438
_______ channel blockers include procainamide, procaine, verapamil, and lidocaine
Sodium channel blockers include procainamide, procaine, verapamil, and lidocaine
439
know structure arrhythmia drug
.
440
know structure for anticoag that mimics vit k
..
441
Bioisosteres can replace functional groups to improve bioavailability and reduce side effects and off-target effects. Some commercial drugs can be racemic. Amidoxime is used instead of amidine because it’s _______ ______
Bioisosteres can replace functional groups to improve bioavailability and reduce side effects and off-target effects. Some commercial drugs can be racemic. Amidoxime is used instead of amidine because it’s less basic
442
cGMP mediated vasodilation is regulated by nitric oxide which is released from organic ______
cGMP mediated vasodilation is regulated by nitric oxide which is released from organic nitrates
443
