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LEIK Flashcards

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1
Q

what can you use if allergic to macrolides

A

doxycycline

newer gen fluoroquinolones IE levaquin

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2
Q

CXR - hyperinflation with flattened diaphgrams

small bullae

A

COPD

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3
Q

initial treatment for chronic bronchitis/copd

A

ipratropium bromide atrovent

Anthicholinergic

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4
Q

COPD step 2

A

add SABA to atrovent

both drugs combined - Combivent

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5
Q

primary prevention for all with COPD

A

pneumovax

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6
Q

which class of abx can cause permanent discoloration of teeth

A

tetracyclines

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7
Q

adverse reactions of tetracyclines

A

photosensitivity reactions - use sunblock, hats, sunglasses

esophageal ulcerations - swallow tab using full glass of water

CONTRAIND - pregnancy, infancy, less than 8

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8
Q

problems with tetracyclines

A

binds some minerals (calcium, dairy, iron magnesium, zinc) - take on empty stomach, 1 hr or 2 hrs before meals

decrease effectiveness of contraceptive

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9
Q

abx that will cause QT prolongation

A

macrolides and quinolones

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10
Q

can prolong INR when mixed with warfarin

A

erythromycin

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11
Q

1st gen cephalosporins

A

treats gram pos - cellulitis, mastitis

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12
Q

2nd gen cephalosporins

A

broad spectrum abx

treats pos and neg bugs

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13
Q

3rd gen cephalosporins

A

better coverage for gram neg

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14
Q

1st line for gonorrhea

A

ROCEPHIN IM (ceftriaxone

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15
Q

MRSA skin infections tx

A

do not use cephalosporins

1st line bactrim, or clindamycin

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16
Q

Dicloxacillin

A

good for penicillnase-producing staph skin infections (mastitis, impetigo)

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17
Q

first line for strep throat

A

Penicillin V

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18
Q

otitis media first line

A

amoxicillin

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19
Q

syphilis first line

A

Benzathine Penicillin G IM

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20
Q

Fluroquinolones efficacy

A

good for gram neg, and some atypicals (chlamydia, mycoplasma, legionella)

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21
Q

quinolone Drug interactions

A

avoid use of other QT prolonging drugs

amio
macrolides
TCAs

ORR electrolyte imbalance (hypomagnesemia, hypokalemia)

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22
Q

First line pseudomonas pneumonia

A

cipro

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23
Q

Cipro good for

A

anthrax inhaled
cutaneous anthrax
travelers diarrhea
pseudomonas

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24
Q

contradin for sulfanomides

A

g6pd anemia

newborns and infants less than 2 months
pregnancy in late 3rd trimester - increased risk of hyperbilirubinemia
hyerpsensitivity

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25
sulfanomides effective against
gram neg - bacteriostatic
26
which other patient population shouldnt be given sulfanomides
uti pts on coumadin - increased risk of bleeding can be treated with amox or cephalosporins
27
abx with high risk of hypoglyecmia
levaquin
28
which patients are high risk for stevens johnson syndrome
HIV patients on sulfa
29
rhinitis medicamentosa
chronic use of nasal decongestants (greater than 3)
30
who to avoid benadryl with
elderly use loratadine instead
31
avoid mixing decongestants with these:
stimulants (caffeine, ritalin) can cause palpitations, arrythmias, tremors, anxiety
32
Dextromethorphan contraind
within 14 days of MAOI and seligiline
33
NSAIDs should be avoided in which conditions
heart failure severe heart disease gi bleeding, severe renal disease
34
one reason to discontinue ASA
tinnitus
35
ASA post MI or after is stroke is what kind of prevention?
tertiary
36
which population to avoid ASA?
children with viral infections less than 16 years of age | Reye's syndrome
37
Long term risk for NSAIDS
``` MI stroke emboli GI bleeds acute renal failure ```
38
NSAID increased risk of bleeding with?
warfarin, steroids, aspirin, alcohol with long term use, consider prescribing concurrent PPI, H2 blockers, misoprostol(cytotec) - which is a synthetic prostaglandin
39
avoid long term use of NSAIDS with ho?
pt on ASA prophy - interferes with ASA cardioprotective effect.
40
Reye's syndrome
Swelling of Liver and brain watch out for those with hx of febrile illness, chickenpox,, flu and salicylate intake (ASA and peptobismol) 3 stages 1. severe vomitting, diarrhea, lethargy, stupor, high ast, alt 2. personality changes, hyperactive reflexes 3. confusion, delerium, cerebal edema, coma death
41
antidote for acetaminophen OD
acetylcysteine
42
kenalog injections
can be used for inflamed joints up to 3x/year
43
Side effects of glucocorticoids
HPA suppression cushing's dz (dorsal hump, rounded face) osteoporosis (advise weight bearing exercises, vit d, calcium, biphosphonates immunosupporession skin changes (atrophy, striae, telangiectasia, acne)
44
digoxin (vision se)
yellow to green vision, blurred vision, halos
45
ethambutal & linezolid (vision se)
optic neuropathy
46
corticosteroids (vision se)
cataracts, glaucoma, optic neuritis
47
fluoroquinolones (vision se)
retinal detachment
48
viagra, cialis, levitra (vision se)
cataracts, blurred vision, ischemic optic neuropathy
49
accutane (vision se)
cataracts, decreased night vision,
50
topamax (vision se)
acute angle closure glaucoma, increased ICP, mydriasis
51
plaquenil (vision se)
neuropathy, loss of vision (permanent)
52
Cisapride (propulsid) safety
BLACK box - serious cardiac arrhythmias (vfib, tachy, torsades de pointes, qt prolong) Check 12 lead ekg baseline. check electrolytes, creatinine numerous drug contraind
53
Theophylline safety
theophylline level - 5-15 mcg interact with drugs ( cimetidine, alprazolam, macrolides, fluvoxamine avoid combining with other stimulants worsens htn, arrythmias, stroke, sz - with stimulants BPH - causes urinary retention, worsening of symptoms Suspect toxicity - persistent vomiting
54
Taper these drugs
``` beta blocker - rebound htn benzos - severe anxiety, insomnia, sz, tremors oral steroids anticonvulsants paxil, paroxetine antiarrythmics - refer to cardio ```
55
Schedule I
illegal to prescribe no med use high abuse potential heroin, ecstasy, mdma, pcp,
56
schedule II
only original prescription with signature total number of pills must be indicated no refills demerol, dilaudid, oxycontin, amphetamines
57
Schedule III
tylenol w coidiene vicodin anabolic steroids testosterone
58
schedule IV
benzos ambien lunesta soma
59
schedule V
can be mailed to pt.
60
CATEGORY X
finasteride (proscar, propecia) reproductive aged or pregnant women shouldn't handle crushed or broken pills ``` Isotretinoin (accutane) warfarin misoprostol androgenic hormones - birth ctrl pills, HRT, testosterone live virus vaccines thilaidomide, DES methimazole ```
61
live virus vaccines
``` measles mumps rubella varicella rotavirus flumust ```
62
Finasteride
CAT X | proscar 5mg po qday
63
accutane considerations
reproductive aged females must use 2 reliable forms of BC and a negative preg test 1 month before, during and 1 month after accutane
64
Vit A
high dose is teratogenic in animal studies. Avoid megadoses in pregnancy
65
Warfarin and sulfa
avoid - increase INR and bleeding risk
66
glucosamine
herbal | OA
67
natural progesterone cream (wild yam root extract)
pms symptoms
68
isoflavones (soy beans)
estrogen-like effects
69
saw palmetto
urinary symptoms of bph
70
kava kava
anxiety and insomnia
71
st johns wort
mild depression DON"T use with SSRI, MAOI, sumatriptan, HIV protease inhibitors
72
Absolute contraindications for oral contraceptives MYCUPLETS
My - migraine with focal neuralgic aura C - CAD or CVA U - undiagnosed genital bleeding P - pregnancy L - liver tumor or liver dz E - estrogen - dependent tumor T - thrombus - emboli S - smoker aged 35 and up
73
Relative contraindications for oral contraceptives
- migraine with or without aura.... (WITH neural aura is absolute contraindication d/t stroke risk) - smoker below 35 fracture or cast on lower extremities - severe depression - hyperlipid

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