Module 6: Chapters 47 to 60 Flashcards

Question

how do you prevent preeclampsia?

Answer 1

adding low dose ASA at the end of the firs trimester for women at risk (risk factors = DM 1 or 2, renal disease, hx of preeclampsia, chronic HTN)

Answer 2

-lifestyle: smaller frequent meals, water, avoid spicy foods -pyridoxine (vit B6) +/- doxylamine -RX: doxylamine/pyridoxine (Bonjesta, Diclegis)

Answer 3

-eat smaller, more frequent meals, not eating 3 hrs prior to sleep -tums (if not working, can add on PPI or H2)

Answer 4

simethicone (gasX, Mylicon)

Answer 5

-inc fluid intake, inc fiber and physical activity -fiber (psyllium, calcium polycarbophil, methylcellulose) -docusate and polyphethylene glycol are used to prevent and treat constipation

Answer 6

-1st line: cromolyn -2nd line: 1st gen antihistamines: chlopheriramine and diphenhydramine -allergy: budesonide and beclomethasone are preferred

Answer 7

-1st line: acetaminophen -AVOID NSAIDs

Answer 8

-budesonide -rescue (inhaled albuterol)

Answer 9

-labetalol -methyldopa -nifedipine

Answer 10

insulin is preferred -metformine and glyburide

Answer 11

-penicillins, cephalosporins, erythromycin and azithromycin are safe --> vag funcgal: topical antifungals x 7 days (avoid fluconazole) --> UTI: cephalexin 500 mg x7, ampicillin 500 mg x 7, -last line = nitrofurantoin, bactrim during 1st trimester, NOT BE USED during the last 2 days of pregnancy

Answer 12

VTE: --> tx: LMWH --> proh: pneumatic conpression +/- LMWH -warfarin is teratogenic (can be switched back after 13th week if has mechanical valve)

Answer 13

-levothyroxine (will require 30-50% dose increase)

Answer 14

-graves disease: propylthiouracil -methimazole also used

Answer 15

-amphetamines -amiodarone -ergotamines -lithium -metronidazole -phenobarbital -statins

Answer 16

-advanced age -ethnicity (caus and asians at higher risk) -family hx -sex (females) -low body weight

Answer 17

-DM -eating disorders -GI disease (IBD, celiac disease, gastric bypass, malabsorption syndrome) -hyperthyroidism -hypogonadism in men -menopause -rheumatoid arthritis, autoimmune disease -others: epilepsy, HIV/AIDS, parkinson disease

Answer 18

-smoking -excessive alcohol intake (3 drinks/day) -low calcium intake -low vit D intake -physical inactivity

Answer 19

-anticonvulsants (carbamazepine, phenytoin, phenobarbital) -aromatase inhibitors -depo-medroxyprogesterone -GnRH -lithium -PPIs -Steroids -thyroid hormone (in excess) -loops, SSRIs, TZDs

Answer 20

the cells involved in bone formation

Answer 21

cells involved in resorption; they break down tissue in the bone

Answer 22

-it compares the pts measured BMD to the average peak BMD of a healthy, young, white adult of the same sex -a DEXA measures BMD so a T-score can be determined -T scores are negative: a score at or above -1 correkated with stronger (denser) bones, which are less likely to fracture

Answer 23

Normal: > -1 Osteopenia: -1 to -24 Osterporosis: < -2.5

Answer 24

-women > 65 y/o -men > 70 y/o -younger patients at high risk for fracture

Answer 25

-rec to take 1,000-1,200 mg elemental ca (do not exceed 500-600 mg/dose) --> calcium carbonate: (tums) -40% elemental calcium -absoprtion: acid dependent -must take with meals --> calcium citrate (citracal) -21% elemental calcium -absorption: not acid-dependent -can take with or without food

Answer 26

-required for caclium absorption -deficiency = serum vitmain D < 25 ng/mL --> treat deficiency with cholecalciferol (vit D3) OR Ergocalciferol (vit D 2) - cholecalciferol: 125-175 mcg daily -ergocalciferol: 1,250 mcg weekly

Answer 27

-T-score < -2.5 in the spine, femoral neck, total hip or 1/3 radius, OR -presence of a fragility fracture, regardless of BMD

Answer 28

-low bone density (T score between -1 and -2.5) AND -FRAX score indicated a 10-yr probability of a major osteoporosis-related fracture > 20% or a 10-yr hip fracture prob > 3%

Answer 29

-1st line -Alendronate (Fosamax) (preven: 5 mg qd, tx: 10 mg qd) CI: hypocalcemia, inability to stand/sit upright for at least 30 mins SEs: esophagitis, hypocal, GI effects (rare ones: atypical femur fracture, osteonecrosis of the jaw -separate from calcium, antacids, iron and mag by at least 2 hrs TX duration: 3-5 yrs in pts with a low risk of fracture

Answer 30

-Ibandronate (Bonvia) 3 mg IV q 3 months -Zoledronic acid 5 mg IV once yearly CI: hypocalcemia -monitor for renal impairment *preferred if esophagitis is present

Answer 31

-an estrogen agonist/antagonist (SERM that dec bone resorption) horse estrogen BBW: inc risk of VTE and death due to stroke CI: VTE, pregnancy -SEs: hot flashes, edema, arthralgia, leg cramps

Answer 32

-inhibits bone resorption by osteoclasts -nasal spray ( 1 qd) or SC/IM: 100 u qd Warnings: hypocalcemia, inc risk of malignancy, hypersensitivity to salmon-derived products

Answer 33

-prevents osteoclast formation= leads to dec bone absorption and inc bone mass- used in pts with high risk of fracture -60 mg sc q 6 months -CI: hypocalcemia, pregnancy warnings: atypical femur fracture, osteonecrosis of the jaw -SEs: HTN, fatigue, edema, dysnpea, headache, N/V, dec PO4

Answer 34

-indicated for postmenopausal females w/ hx of an osteoporotic fracture or multiple risk factors - inhibits sclerostin, a protein that blocks bone formation- tx limited to 12 months -BBW: inc risk of stroke, MI and cardio death -CI: hypocalcemia

Answer 35

-alt to bisphosphonates if high risk of vertebral fractures -increased risk for VTE and stroke -can be used if low VTE risk or high breast cancer risk SEs; vasomotor symptoms

Answer 36

-can be used in women with an intact uterus for prevention of osteoporosis -alsi used as tc for vasomotor symptoms SE: increased risk of cancer

Answer 37

-most effective tx for vasomotor symptoms -women with a uterus: use in combo with a form of progesterone- unopposed estrogens increases the risk of endometrial cancer -associated w/ sig risk of VTE, stroke, breast cancer

Answer 38

-progestins can be given as part of a combination pill or as seperate tab (medroxyprogesterone) -can cause mood disturbances, which may be intolerable; if taken intermittently, spotting can occur -micronized progestins are considered to be dafer than synthetic progestins

Answer 39

-healthy, symptomatic women who are within 10 yrs of menopause, < 60 y/o and have no CI to use -extending tx beyond 60 yrs may be acceptable if the lowest dose is used. -consider QOL priorities and personal risk factors - pts with risk factors should use nonhormonal therapy: SSRIs, SNRIs, gaba or pregablin

Answer 40

-17-beta estradiol: estrace, estring, vagifem, premarin

Answer 41

-estradiol (Alora, climera) -MPA -Prometrium BBW: endometrial cancer, dementia, inc risk of VTE, stroke, breast cancer -CI: breast cancer, uterine bleeding, active VTE, pregnancy

Answer 42

-used for moderate - severe vasomotor symptoms

Answer 43

-oral estrogen antagonist/agonist indicated for dyspareunia (painful intercourse) and moderate vaginal dryness -should be used short term

Answer 44

BBW: secondary exposure in kids warnings: inc risk of breast cancer, prostate cancer, cardio events, VTE SEs: inc appretite, acne, edema, hepatotoxicity, reduced sperm count

Answer 45

- alcohol -antidepressants (SSRIs, SNRIs) -antihypertensives (1st gen, cholrpromazine, prolactin-raising 2nd gen (risperidone, paliperidone)) -BPH meds (finesteride, dutaseride, silodosin) -anticancer drugs (leuprolide, flutamide) -anticholerlinergics -H2RAs (climetidine, ranitidine) -nicotine -opioids

Answer 46

-yohimbe -L-arginine -panax ginseng

Answer 47

-on demand dosing: 25-100 mg qd PRN (start at 50 mg, take 1 1/2 hr before sex) -also used for pulmonary HTN CI: do not use with nitrates or riociguat Warnings: hearing loss, color discrimination, vision loss, hypotension, priapism SEs: headache, fluching, dizziness, -cna have decreased efficiacy if taken with a high fat or large meal

Answer 48

-2.5-5 mg daily (on demand dosing: 5-20 mg daily PRN) -lasts the longest "weekend pill" CI: do not use with nitrates or riociguat Warnings: hearing loss, color discrimination, vision loss, hypotension, priapism SEs: headache, fluching, dizziness, -crcl 30-50 : 5 mg prn, crcl < 30: 5 mg q 72 hrs

Answer 49

> 65 y/o using an alpha blocker using a CYP3A4 inhibitor severe renal or liver failure *decrease dose by 50% (V: 25 mg, C: 5 mg)

Answer 50

-absolute contraindication: using nitrates = extreme hypotension -enhance the hypotensive effects of alpha 1 blockers -alcohol can enhance hypotension -moderate and strong CYP450 inhibitors (grapefruit juice, protease inhibitors, azole antifungals)

Answer 51

- a vasodilator that allows blood to flow into the cavernosal arteries, which then enlarges the penis -either injected into the penis of a pellet is inserted through the urethera

Answer 52

-100 mg QHS (d/c if no benefits after 8 weeks) -BBW: CI with alcohol, CYP3A4 inhibitors Warnings: hypotension, suncope, CNS depression SEs: dizziness, nausea, fatigue, insomnia, dry mouth -avoid in pregnancy or if breast feeding

Answer 53

-1.75 mg SC PRN, injected 45 min before sextual activity CI: do not use with uncontrolled hypertension or known cardiovascular disease Warnings: inc BP, dec HR after each dose -avoid in pregnancy, effective contraception should ne used

Answer 54

-centrally-acting anticholergics (bentropine) -antihistamines -decongestants -phenothiazine -TCAs -caffeine -diuretics -SNRIs -testosterone products

Answer 55

-hesitancy, interm. urine flow, straining or a weak stream of urine -urinary urgency and leaking or dribbling -incomplete emptying of the bladder

Answer 56

Doxazosin (Cardura), (XL version mau leave ghost pill in poop) Terazosin -should be given at bedtime to help minimize the initial "first dose" effect of orthostasis/dizziness

Answer 57

-Tamsulosin (Flomax) -Alfuzosin -Silodosin (can cause retrograde ejaculation

Answer 58

Warnings: orthostatic hypotension/syncope, intraoperative floppy iris syndrome SE: dizziness, fatigue, headache, abnormal ejaculation -alpha blocker can be used for off label for bladder outley obstruction in women

Answer 59

-use caution when giving with PDE-5 inhibitors due to added hypotensive events -silodosin cannot be used with strong P-gp inhibitors, such as cyclosporine -alfuzosin can cause QT prolongation

Answer 60

-F: 5 mg daily (Propecia used for alopecia) CI: women of child-bearing potential pregnancy, children Warnings: may increase risk of high grade prostate cancer SEs: impotence, dec libido, ejaculation disturbances, breast enlargement and tenderness --> prego women should not handle these meds --> tx for 6 months may be required for mx efficacy

Answer 61

-5 mg at the same time each day CI: do not use with nitrates or riociguat Warnings: hearing loss, vision loss, hypotension, priapism SE: headache, flushing, dizziness, dyspepsia, back pain

Answer 62

a sudden and unstoppable urge to urinate. associated with neuropathy and often present in those with DM, strokes, dementia, parkinsons disease or multiple sclerosis

Answer 63

urine leaks out during any form of exertion as a result of pressure on the bladder

Answer 64

combination of urge and stress incontinence

Answer 65

there is no abnormality in the bladder, but the pt may be cognitively, socially or physically impaired thus hindering access to a toilet

Answer 66

leakage that occurs when the quantity of urine stored in the bladder exceeds its capacity. Often occurs without the urge to urinate

Answer 67

-age > 40 -DM -prior vaginal delivery -obesity -neurologic conditions -drugs that increase incontinence (alcohol, cholinersterase inhibitors, diuretics, sedatives)

Answer 68

-1st line is behavioral therapy: bladder training, delayed or scheduled voiding, pelvic floor muscle exercises, fluid management

Answer 69

-1st line drugs include anticholinergics (oxybutynin) or beta -3 receptor agonist (mirabegron), -onabotulinumtoxinA (Botox) has higher efficacy, but is not 1st line

Answer 70

-oxybutynin (Ditropan) 5 mg PO BID -Tolterodine (Detrol) 1-2 mg -Solifenacin (Vesicare) 5-10 mg CI: narrow angle glaucoma Warnings: agitation, confusion, drowsiness, blurred vision SE: dizziness and drowsiness, xerostomia, constipation

Answer 71

-dry mouth -dry eyes/blurred vision -urinary retention -constipation -tachycardia

Answer 72

- sedation -dizziness -cognitive impairment

Answer 73

-dry mouth is a major reason that pts fail to comply with anticholinergic tx -choosing a tx that minimizes dry mouth can improve adherence: --> try extended-release formulations (lower risk than IR formulation) --> try oxybutynin gel or patch (lower risk than oral formulation) --> beta-3 agonists have a lower incidence of dry mouth and can be helpful in pts who cannot tolerate anticholinergics --> try non-drug options to help with symptoms: avoid mouthwashes with alcohol, use ice chips, water, sugar-free candy or gum

Answer 74

-relax the detrusor muscle and increase bladder by activating beta-3 receptor (less dry mouth) Mirabegron (Mybetriq): 25-50 mg daily Vibegron (Gemtesa) 75 mg PO Warnings: urinary retention in pts BPH, mirabegron can inc BP -SEs: headache, constipation, diarrhea, dizziness Monitoring: urinary symptoms, BP

Answer 75

-Desmopressin (DDAVP) 0.2-0.6 mg at bedtime -SL tablet (Nocdurna) females: 27.7 mcg, males: 55.3 mcg BBW: hyponatremia CI: fluid retention warnings: do not use with nasal conditions Monitoring: serum Na

Answer 76

-less costly and generally have fewer have fewer adverse reactions than colloids. -balanced solutions may be preferred in certain disease states, such as sepsis, since the chloride load from a sodium chloride solution can be high enough to contribute to cellular injury, including renal damage --> 5% dextrose (D5W) --> 0.9% NaCl --> Lactated Ringer's

Answer 77

-large molecules (typically protein or starch) dispersed in a solution; they primarily remain in the intravascular space and inc oncotic pressure. -provide greater intravascular volume expansion than equal volumes of crystalloids, but are more expensive and have not shown a clear clinical benefit --> albumin 5%, 2.5%

Answer 78

-Na < 135 mEq/L normal -not usually symptomatic until the sodium is <120 mEq/L -symptoms most often result from cerebral edema and increased intracranial pressure, and can range from mild-moderate to sevre seizures, coma and resp arrest

Answer 79

caused by fluid overlaod (cirrhosis, HF, renal failure) -diuresis with fluid restriction is the preferred tx

Answer 80

-can be caused by the syndrome of inappropriate antidiuretic hormone (SIADH) -tx includes diuresis, restricting fluids and stopping drugs that can induce SIADH

Answer 81

-can be caused by diuretics, salt-wasting syndromes, adrenal insufficiency, blood loss, vom/diarrhea -tx is to correct the underlying causes and stop the intake of hypotonic solutions

Answer 82

-correcting more rapidly than 12 mEq/L/24 hr can cause osmotic demilniation syndrome (ODS) or centeral pontine myelinolsis- which causes paralysis, seizures and death -admin of desmopressin reduced water diuresis and can help avoid overcorrection

Answer 83

-increase excretion of free water while maintaining sodium -Tolvaptan (Samsca) 15 mg po daily (limited to < 30 d due to hepatotoxicity) BBW: should be initiated and re-initiated in a hospital, overly rapid correction is associated with ODS Warnings: hepatoxicity SE: thirst, nausea, dry mouth, polyuria Monitoring: rate to Na increase

Answer 84

Na > 145 mEq/L is associated with a water deficit and hypertonicity -hypovolemic hypernatremia is caused bt dehydration, vomiting or diarrhea and is treated with fluids -hypercolemic hypernatremia is caused by intake of hypertonic fluids and is treated with diuresis -Isovolemic (euvolemic) hypernatremia is frequently caused by dm insipidus, which can dec antidiuretic hormone (ADH), treated with desmopressin

Answer 85

-can be fatal id administered undiluted or via IV push -when hypokalemia is resistant to tx, serum magnesium should be checked -mag is needed for K uptake- replace first when both hypokalemia and hypomagnesemia are present

Answer 86

-given as a plasma protein replacement therapy for immune-deficient pts who have decreased or abolished antibody production abilities BBW: acute renal dysfunction can occur, thrombosis SEs: infusion reaction, renal failure or blood dyscrasias --> pts should be asked about past IVIG infusion, a slower titration and premedication my be needed

Answer 87

Low (renal): 1-4 mcg/kg/min (dopamine-1 agonist) Medium: 5-10 mcg/kg/min (beta-1 agonsit) High: 10-20 mcg/kg/min (alpha-1 agonist)

Answer 88

-alpha-1 -beta-1 -beta-2 agonist should be used IV push: 0.1 mg/mL IM: 1 mg/mL

Answer 89

-alpha-1 agonist activity > beta-1 agonist activity

Answer 90

vasopressin receptor agonist

Answer 91

BBW: dopamine and NE - vesicants when administered IV; treat extravasation with phentolamine SEs: arrhythmias, tachycardia, nescrosis, bradycardia (phenyl), hyperglycemia (epin) Monitoring: MAP --> all vasopressors should be administered via central line

Answer 92

-used when there is active MI or uncontrolled hypertension, limited to 24-48 hrs due to tachyphylaxis -low dose = venous vasodilator, high dose = arterial CI: SBP < 90, use with PDE-5 inhibitor SE: headache, tachycardia, tachyphylaxis -requires a non-PVC container (glass, polyolefin)

Answer 93

-has equal arterial and venous effects) [NOT used in active MI (steals the blood) has better BP effect than nitro, metabolism results in thiocyanate and cyanide formation = toxicity] (hydroxyocobalamin can be admin to reduce the risk of thiocyanate toxicity, sodium thiosulfate + sodium nitrite is used for cyanide toxicity) BBW: cynaide, hypotension - should be diluted w/ D5W SE: heachadem tachycardia, thiocyanate/cyanide toxicity --> requires light protection, use only clear solutions to admin, a BLUE color indicated cyanide (DO NOT USE)

Answer 94

-increase the contractility of the heart D: beta-1 agonsit that inc HR and the force of myocardial contraction = inc CO M: selective phosphodiestrase-3 inhibitor in cardiac and vascular tissue, produces inotropic effects with sig vasodilation --> should only be used when BP is adequate b/c they produce vasodilation

Answer 95

-target a mean arterial pressure (MAP) of > 65 (MAP = [(2 x DBP) + SBP]/3 -fill the tank: optimized preload with IV crystalloids (LR) -squeeze the pipe and kick the pump: alpha-1 agonist activity (peripheral vasoconstriction) to inc SVR, beta-1 agonist activity to inc myocardial contractility and CO (broad spectrum abx and IV crystalloids, can use NE if needed)

Answer 96

-called respirators, air flows into the trachea through an endotrachial tube (ET) places through the mouth or nose. --> inc time on ventialator = inc risk of infection (including lung) -pseudomonas thrive in moist air in ventalators

Answer 97

inc time on foley = inc risk of infection

Answer 98

- pts with edema, JVD and/or ascites = volume overload --> loop diuretics, vasodilators can be added (NTG, nitro) - pts with dec renal function, AMS and/or cool extremities = hypoperfusion --> inotropes (dobutamine, milrinone), can add vasopressor if pt becomes hypotensive (dopa, NE, phenyl) -pt experiences BOTH volume overload and hypoperfuson --> combo og agents

Answer 99

-alpha 2 adrenergic agonist SE: hypo/hypertension, bradycardia, dry mouth, nausea, constipation -monitor: BP,HR, sedation scale --> does not require refrigeration --> duration of infusion should NOT exceed 24 hrs --> use for sedation in intubated and non-intubated pts

Answer 100

-short acting general anesthetic CI: hypersensitivity to egg, soy SE: hypotension, apnea, hypertriglyceridemia, green urine/hair/nails, propofol-related infusion syndrome Monitor: triglycerides --> shake well --> potential for bacterial growth; discard vial and tubing within 12 hrs of use --> oil in water emulation provides 1.1kcal/ml

Answer 101

-injection is formulated in propylene glycol; total daily dose as low as 1 mg/kg/day can cause propylene glycol toxicity (ARF)

Answer 102

benzo -BBW: resp depression -CI: do not use with potent CYP3A4 inhibitors SE: hypotension Monitoring: BP, HR, RR, sedation scale --> can accumulate in obese pts and renal impairrment

Answer 103

-mechanical ventilation > 48 h -Coagulopathy -sepsis -traumatic brain injury -major burns -acute renal failure -high dose systemic steroids

Answer 104

Local: lidocaine (xylocaine) Inhaled: Desflurane (Suprane), sevoflurane Injectable: Bupivacaine (Marcaine), Ropivacaine (Naropin)

Answer 105

-short acting, fast onset (30-60sec) -binds to and activated the ACh receptors and desensitizes them -reserved for intubation and is not used for continuious neuromuscular blockade. -has been associated with causing malignant hyperthermia

Answer 106

-bind aCh receptor, blocking the actions of endogenous ACh- pts cannot breath, move or blink --> Atracurium: short t1/2, intermediate-acting, hofmann elim --> Cisatracurium: short t1/2. interm-acting, hofmann --> Pancuronium: long acting, can accumulate in renal/hepatic dysfunction, inc HR --> Rocuronium: interm --> Vecuronium: interm, can accumulate

Answer 107

-inhibits fibrinolysis or enhancing coagulation SE; vascular occulusion, thrombosis, retinal clotting --> oral is approved for heavy menttrual bleeding, injection approved for hemophilia

Answer 108

-inhibits fibrinolysis or enhancing coagulation BBW: risk of thrombotic events --> FDA approved for hemophilia and factor VII deficiency

Answer 109

-age <3 m: temp of 100.4/38 (rectal) -age 3-6 m: temp 101/38.3 (rectal) -age > 6 m: temp 103/39.4 (rectal) -ant cough/cold that worsens or does not improve in several days -unusual, severe pain -blood in stool or urine -inability to sleep or drink -rash that looks severe or rash w/ fever -abrasions/cuts that are dirty or deep -limping of unable to move extremity -seizures

Answer 110

NSAID- IV indomethacin or ibuprofen) by blocking the prostaglandins that keep the PDA open --> NSAIDs should not be used in 3rd trimester b/c they can cause the PDA to close prematurely

Answer 111

-10-15 mg/kg/dose every 4-6 hr (max 75 mg/kg/day) --> most oral formulations are 160mg/5ml

Answer 112

-5-10 mg/kg/dose every 6-8 hrs (max 40 mg/kg/day) --> infant drops = 50 mg/1.25 ml --> childrens suspension = 100 mg/5 ml **indicated for infants 6 months and UP

Answer 113

-20 mg 1-4 times/day PRN --> adminster after meals and at bedtime for mild gas --> shake drops, can mix with water, formula or other liquids

Answer 114

2-6 drops per nostril PRN

Answer 115

-PEG (miralax) : age > 6 mon: 0.4 mg/kg, max 17 gram, dissolve in 4 oz of water -Glycerin supp: 1 ped supp per dose

Answer 116

-streptococcis agalactiae (group B strep), E. coli, listeria monocytogens, Klebsiella Empiric tx: ampicillin + cefotaxime or ampicillin + aminog (gentamicin)

Answer 117

-streptooccus pneumoniae, Neisseria meningitidis, S, agallactiae, Haemophilus influenzae, E. coli Empiric TX: vanco + 3rd gen ceph (ceftriaxone or cefotaxime)

Answer 118

-N. meningitidis, S. pneumoniae Empiric TX: vanco + 3rd gen ceph (ceftriaxone or cefotaxime)

Answer 119

-dosed monthly at 15 mg/kg per dose given via IM *in the first yr of life: --> premature infants born at < 29 weeks gestation --> premature infants born < 32 weeks gestation eith chronic lung disease who are < 12 months og age --> infants < 12 months of age with certain heart conditions

Answer 120

-viral infection caused by inflammation of upper airway --> signs: inspiratory stridor, barking cough, and hoarseness (most common in children < 6 y/o) -systemic steroids (dexamethasone 0.6 mg/kg dose x 1)

Answer 121

-synthetic analog of antidiuretic hormone - will decrease nocturnal urine production -start at 0.2 mg PO QHS, can titrate to 0.6 mg QHS CI: hyponatremia SE: headache --> limit fluids starting 1 hr before dose and until the next am

Answer 122

CI:*** -codeine in age < 12 -Tramadol in age < 12 -Promethazine in age < 2 -Ceftriaxone in neonates (0-28 days) NOT REC: - aspirin in children and teenagers -quinolones ( AE on bones and cartilage) -tetracylcines in age < 8 (stain teeth) -OTC teeth medications contianing benzocaine in age < 2 -OTC cough and cold preps in age <2 yrs

Answer 123

-Iron and acetaminophen

Answer 124

-Koplick spots in mouth, maculopapular rash -transmission is airborne -Prevention: MMR vaccine

Answer 125

-swollen salivary glands -Prevention: MMR vaccine

Answer 126

-fever, rash, swollen glands -Prevention: MMR vaccine

Answer 127

-nerve damage, cannot walk Prevention: IPV vaccine

Answer 128

-"whoop" sounding cough Prevention: DTaP vaccine

Answer 129

-diarrhea, fever, vomiting Prevention: RV vaccine

Answer 130

itchy, rash, fever Prevention: varicella vaccine

Answer 131

-incurable, hereditary disease cause by a mutation in the gene for the protein CFTR. --> causes thick, viscous secretions in lungs, pancreas, liver and intestine -average lifespan is 35-40 yrs, diagnosed by age 2 (new born screenig at 2-3 days, sweat chloride test, high = CF) -symptoms: salty skin, poor growth/weight gain, coughing, SOB

Answer 132

1) inhaled bronchodilators (albuterol) = opens the airway 2) hypertonic caline (Hypersal) = mobilizes mucus to improve airway clearance 3) Dornase alfa (Pulmozyme) = decreases viscosity of (thins) mucus to promote airway clearance 4) chest physiotherapy = mobilizes mucus to improve airway clearance 5) Inhaled abx = controls airway infection

Answer 133

options: albuterol, hypertonic saline, Dornase alfa* -->DA: works by degrading extracellular DNA in the lungs to decrease viscosity of mucus CI: hypersensitivity to chinese hamster ovary products SE: chest pain, fever, rash -store ampules in the fridge, protect from light, do not mix with any other drug in the nebulizer

Answer 134

-age > 6y/o SE: ototoxicity, tinnitus, voice alteration, mouth and throat pain --> give for 28 days on and 28 days off cycle -do not mix with other drugs in neb

Answer 135

-Enzyme! -breaks down DNA strands into smaller pieces, thinning the mucus to make it easier to cough up

Answer 136

-age > 7 yrs, 75 mg via neb SE: allergic reactions, bronchospasm, fever, wheezing, cough, chest discomfort --> give for 28 days on, 28 days off - do not mix with other drugs in neb

Answer 137

-age > 6 yrs SE: tinnitus, nausea, risk of QT prolongation

Answer 138

-lipase, protease and amylase--> needed to break down fats, proteins and starches

Answer 139

age < 1 yr: varies age 1-3 y: lipase 1000u/kg/meal age > 4 y: lipase 500 u/kg/meal MAX: < 2500 u/kg/meal SE: abdominal pain, flatulance, nausea

Answer 140

-pancreatic enzyme replacement helps pts with CF digest food, maintain weight and improve nutrient absorption -PEP formulations are not interchangable -Viokace is the only PEP that is a tab, must be given with a PPI -all others are capsules: do not cruch, or chew -take PEPs before or with all meals and snacks, high-fat meals may require higher doses (use 50% of mealtime dose with snacks) -protect from moisture, dispense in original containers (exceptions: zenpep and some creon strengths), do not refigerate

Answer 141

-binds to antigens on T-lymphocytes and interferes with their function -BBW: anaphylaxis -SE: infusion reaction --> premedicate to lessen infusion-related reactions

Answer 142

-20 mg iV on the day of transplant (day 0), then repeat dose on post operative day 4 SE: inc BP, fever, stomach upset/n/v

Answer 143

-a calcinerurin inhibitor- cyclosporine or tacrolumus (this is 1st line) -an anti proliferative agent such as mycophenolate (1st line) or azathioprine -w/ or w/o steroids

Answer 144

-suppresses cellular immunity by inhibiting T-lymphocyte activation BBW: nephrotoxicity, inc risk of lymphoma, malignancies, skin cancer SE: inc BP, nephropathy, hyperkalemia, hypomag, QT prolongation Monitor: trough, serum electrolytes, renal function, BP,

Answer 145

-1st line!! suppresses cellular immunity by inhibiting T-lymphocyte activation BBW: inc risk of infections SE: inc BP, nephrotoxicity, inc BG, hyperkalemia, QT prolongation Monitor: serum electrolyyes, renal function, LFTs, BP, blood glucose

Answer 146

-inhibit T- and B-lymphocyte proliferation by altering purine nucleotide synthesis BBW: inc risk of infection, lymphoma, skim malignancies SE: diarrhea, GI upset --> not interchangeable (CellCept 500 mg = Myfotic 360 mg) --> CellCept IV is stable in D5W only --> decreases efficacy of oral contraceptives

Answer 147

-Everolimus (Zortress) --> do not use within 30 days of transplant -Sirolimus (rapamune) --> impaired wound healing

Answer 148

-Basiliximab, an interleukin (IL-2) receptor antagonist -Antithymocyte globulin in pts at higher risk of rejection -high dose IV steroids

Answer 149

-the CNIs (tacrolimus then cyclosporine) --> belatacept as alt to a CNI -adjuvant medications given with a CNI (to achieve adequate immunosuppression while decreasing the dose and toxicity of the individual agents --> antiprolifertave agents (mycophenolate or azathioprine) --> mTOR inhibitors (everolimus or azathioprine) -steroids at lower or tapering doses

Answer 150

-infection risk: suppress the immune system -cancer risk

Answer 151

-influenza (inactivated, not live) annually -pneumococcal vaccines in adults > 19 yrs: PCV20 x1, PCV15 x1 followed by PPSV23 x1 8 weeks later -varicella vaccine

Answer 152

-antipsychotics (clozapine, olanzapine, risperidone, quetiapine) -DM drugs (insulin, sulfonylureas, meglitinides, thiazids) -divalproex/valproic acid -gabapentin/pregablin -lithium -mirtazapine -steroids -TCAs -hypothyroids

Answer 153

-ADHD drugs -bupropion -GLP-1 (-tide) -pramlintide -Roflumilast -SGLT2 (-flozin) -Topiramate -Tirzepatide -Conditions: hyperthyroidism, celiac disease, inflammatory bowel disease

Answer 154

-contrave: contraindicated in ppl with uncontrolled BP (contains bupropion) -caution with Qsymia: monitor HR (contains phentemine)

Answer 155

-Contrave: suicide risk (contains bupropion)

Answer 156

-Contrave: lowers seizure threshold (contains bupropion) caution with Qsymia: must taper off slowly if used (contains topiramate)

Answer 157

-Contrave: blocks opioid receptors (contains naltrexone)

Answer 158

P: sympathomometic (stimulant): release of NE stimulates the satiety center which dec appetite T: inc satiety and dec appetite, possibly by inc GABA, blocking glutamate receptors and/or inhibition of carbonic anhydrase CI: glaucoma, pregnancy (REMS due to teratogenic risk) SE: tachycardia, insomnia, vision problems --> taper off due to seizure risk

Answer 159

N: dec food craving B: dec appetite CI: pregnancy, chronic opioid use, uncontrolled HTN, seizures, use of MAOi within 14 days --> fatty food increases drug levels: do not take with high-fat meal

Answer 160

BBW: risk of thyroid c-cell carcinoma CI: personal or fam hx of medullary thyroid carcinoma warnings: pancrestitis, hypoglycemia SE: nausea --> may need to decrease insulin or sulfonylurea/meglitinide doses to dec risk of hypoglycemia

Answer 161

-dec absorption of dietray fat by ~30% CI: pregnancy Warnings: liver damage, inc urinary oxalate/kidney stones SE: GI, farts w/ dischage, fatty stools --> take vit A,D,E,K and beta carotene at bedtime --> must be used with a low-fat diet

Answer 162

-appetite supp: release NE stimulates the satiety center which dec appetite CI: cardiovascular disease, hyperthyroidism, glaucoma, pregnancy SE: tachycardia, agitation, inc BP --> use short term, up to 12 hrs

Answer 163

-guidelines rec for adults with BMI > 40 kg/m^2 or with a BMI > 35 with an obesity- related condition

Answer 164

-antidote = N-acetylcysteine (NAC) --> glutathione precurser --> administered IV or orally

Answer 165

-GI risk: inc the risk of GI bleed and ulceration -CV risk: can inc the risk of MI and stroke (all non-selevtice NSAID except aspirin) -CABG Surgery: NSAIDs use is CI after this, antiplatelet therapy (Apirin) is rec

Answer 166

-can decrease renal clearance -inc blood pressure -cause premature closure of the ducta arteriousus, do NOT use in 3rd trimester -nausea -photosensitivity

Answer 167

-before birth the DA connects the pulmonary arter to the aorta, allowing oxygenated blood to flow to the baby, by bypassing the immature lungs --> do NOT use NSAID in the 3rd trimester of pregnancy- can prematurely close the DA -after birth, the DA should close on its own, --> IV NSAIDs (Indomethacin, ibuprofen) can be used within 14 days after birth to close a DA

Answer 168

--> all have GI risk, CV risk, and risk in post-operative CABG -Ibuprofen (Advil, caldolor, Motrin): limit self-tx to 10 days, can cause SJS/TENS -Indomethacin (Indocin): high risk for CNS effects -Naproxen (Aleve): can be dosed BID -Ketorolac (Toradol): MAX conbined duration IV/IM and PO = 5 days

Answer 169

-lower risk for GI complications, inc risk of MI/stroke, same risk for renal complications -Celecoxib (Celebrex) : CI with sulfonamide allergy, highest COX-2 selectivity -Diclofenac (voltaren) BBW: avoid in femals of childbearing potential (misoprostol is used to replace the gut-protective prostaglanidins to dec GI risk -Meloxicam (Mobic)

Answer 170

-Aspirin/Acetylsalicylic Acid (Ascriptin, Bufferin, Ecotrin) --> avoid in children and teens with any viral infection due to potential risk of Reye's syndrome SE: PPIs may be used to protect the gut -salicylare overdose can cause tinnitus

Answer 171

-additive bleeding risk -NSAIDs can inc levels of lithium and methotrexate

Answer 172

-addiction, abuse and misuse can lead to overdose and death -respiratory depression -use of opioids and benzo with other CNS depressants, including alcohol can cause death -Morphine ER caps, Nucybnta ER, oxymorphone ER and hydrocodone ER caps: do not consume alcohol -crushing, dissolving or chewing the long-acting products can cause delivery of potentially fatal dose -life-threatening neonatal opioid withdrawal can occur with porlonged use during pregnancy

Answer 173

-opioids are not first line for chronic pain tx --if using opioid, start with immediate release: start low and go slow -- evlauate risk factors --use adjunctive meds to enable a lower opioid dose --avoid bezos

Answer 174

-codeine: hydrocodone, oxycodone -Morphine: hydromorphone, oxymorphone -Buprenorphine: herion

Answer 175

OIRD risk factors: -hx of previous overdose -substance use disorder -using large doses (> 50 mg morpine) -use w/ benzos, gabapentin, or pregablin -comorbid illness, sich as resp or psychiatric disease --> naltrexone should be readily available to pts with elevated risk for ORID

Answer 176

-opioids reduce GI tract peristalsis, making it difficult to have a bowel movement -OIC does not improve over time without tx: it must be anticipated and treated --> stimulant (senna, bisacodyl) or osmotic (polyethylene glycol) laxatives are the typical first line -if laxitives are not sufficient, PAMORAs can be used --> lubiprostone can be used following a trial of laxatives

Answer 177

-block opioid receptors in the gut to reduce constipation w/o affecting analgesia (only affective when constipation is secondary to use of an opioid) --Methylnaltrexone (Relistor) : only for pts who have failed OTC laxatives --Naloxegol (Movantik)- d/c all laxatives prior to use

Answer 178

Lubiprostone (Amitiza)

Answer 179

S&S: extreme sleepiness, slow or shallow breathing, fingernails or lips turning blue or purple, extremely small pupils, slow heartbeat and/or blood pressure --> give naloxone and call 911 -narcan: nasal spray, slower onset of action than injection (naltrexone)

Answer 180

-bupernorphine (C-3) -methadone

Answer 181

-gabapentin (Neurontin) -pregablin (lyrica) -Carbamazepine (tegretol) -amitriptyline -duloxetine (cymbalta)

Answer 182

-baclofen (Lioresal) -cyclobenzaprine (Amrix, Fexmid) -tizanidine (zanaflex) -carisoprodol (soma) -methocarbamol (Robaxin)

Answer 183

-lidocaine -lidocaine 5% (Lidoderm) -capsaicin (zostrix,) - dec substance P -methyl salicylate (bengay, icyhot) -trolamine (aspercreme)

Answer 184

-hormonal changes in women: flunctuations in estrogen, progestrin only pills are rec for migraine with aura due to stroke risk with estrogen-containg pills -foods: alcohol, cheeses, chocolate, aspartame, overdose of caffeine, MSG, salty foods and processed foods -stress -sensory stimuli: bright lights, sun glare, loud sounds and certain scents -changes in wake-sleep patterns -changes in environment

Answer 185

When an adult has at least 5 attacks fulfilling: - headaches last 4-72 hrs and recur sporadically -headaches have > 2 of the following characteristics: unilateral location, pulsating, mod-severe pain and aggravated by routine physical activity -one of the following occurs: nausea/vomiting, photophobia, and phonophobia (sensitivity to sound)

Answer 186

OTC: acetaminopen, aspirin, advil, naproxen, excedrin migraine RX: NSAIDs, triptans, CGRP receptor antagosnits

Answer 187

-vasodilator cranial blood vessels, inhibit neuropeptide release and decrease pain transmission, 1st line for acute tx--> take at the first sign of headache (all have tablet formualtion) -- Rizatreptan (Maxalt-MLT) ODT -- Sumatriptan Nasal, injection -- Imitrex -- Onzetra Xsail -- Zolmitriptran (Zomig) ODT, nasal

Answer 188

CI: cerebrovascular disease, uncontrolled HTN, ischemic heart disease Warning: inc blood pressure, serotonin syndrome SE: paresthesia, tripatan sensations (pressure or heaviness in the chest or pressure in the neck region) --> all SC injections are preferred in lateral thigh or upper arm, protect from light

Answer 189

-risk of serotonin syndrome -Suma, riza and zolmi are CI with MAOi (or within 2 weeks of stopping)

Answer 190

-nonselective agonist of serotonin receptors causes cerebral vasoconstriction, in pts who do not find benefit with a triptan, ergotamine is generally used next --> Dihydrogotamine (DHEA, Mogranal): injection/nasal spray BBW: use with CYP3A4 inhibitors CI: uncontrolled HTN, ischemic heart disease, pregnancy

Answer 191

-contribute to vasodilation and neurogenic inflammation in the pathogenesis of migraines; blocking the CGRP receptor helps reduce or eliminate migraine pain --> Ubrogeapant (ubrelvy): approved to treat acute migraine attacks --> rimegepant (Nurtec): approved to prevent and treat acute migraine attacks

Answer 192

-BBs (propranolol, meto tat, meto succ, timolol) -Antieliptics (topiramate, valporic acid) -CGRP receptor antagonsits (atogepant, epitinezumba, erenumab, nurtec) -antidepressants (amitriptyline) -monophasic OCs, NSAIDs or a triptan (frova, nara) can be started prior to menses and continued for 5-7 days

Answer 193

-botox injections are used from prophylaxis chronic migraines only (> 15 headache days per month)

Answer 194

-aspirin, lower doses -clacineurin inhibitors (tacrolimus and cyclosporine) -diuretics (loops or thiazides) -niacin -pyrazinamide -select chemotherapy -select pancreatic products

Answer 195

Treat acute pain with anti-inflammatory drugs: - colchicine -steroids -NSAIDs Treat chronically to prevent future attacks: -XOI: allopurinol (preferred) or febuxostat If XOI didnt work well enough and UA remins > 6: -add on probenecid or lesinurad to daily XOI -replace the XOI with IV pegloticase (Krystexxa)

Answer 196

CI: P-gp or strong CYP3A4 inhibitors with renal and/or hepatic imparment Warnings: myelosuppression, inc myopathy risk SE: diarrhea, nauseam myopathy, neuropathy --> start within 36 hrs of symptom onset --> wait 12 hrs after a tx dose before resuming proph dose

Answer 197

-Indomethacin (Indocin) -Naproxen (Aleve) -Celecoxib (Celebrex)

Answer 198

-prednisone/Prednisolone -methylprednisolone

Answer 199

-Allopurinol (Zylooprim, Aloprim): SJS.TENs reaction, SE: acute gout attack -Febuxostat (Uloric) BBW: cardiovascular disease