P2 YEAR Flashcards
(105 cards)
1
Q
What allele must be tested before starting Abacavir therapy?
A
HLA-B*57:01
2
Q
What is Abacavir used for?
A
Reverse transcriptase inhibitor that inhibits HIV-1 viral replication
3
Q
What are mRNA vaccines?
A
- Novel Vaccines
- Uses a liposome to deliver an engineered mRNA that expresses the immunodominant region of the SARS-Cov-2 spike protein
4
Q
Can Cytokine Mediated Alterations have an effect on drug metabolism?
A
Yes, specifically alterations to CYP enzymes
5
Q
What are the types of Insurance Policies?
A
- Health Maintenance Organization HMO
- Preferred Provider Organization PPO
- Fee-for-Service (Indemnity) Plan
- Point of Service (POS) Plan
6
Q
Health Maintenance Organization HMO
A
- General Practitioner Gatekeeper
- No deductible is charged
7
Q
Preferred Provider Organization PPO
A
- Any doctor on list of PCPs
- Specialist without referral
- More out-of-pocket expenses
8
Q
Fee-for-Service (Indemnity) Plan
A
- Obtained by individuals on their own, through groups, employers, or associations
- Max out of pocket expenses prescribers will have to pay
9
Q
Point of Service POS Plans
A
- Blend of managed care and indemnity plans
10
Q
Medicare Part A
A
- At least 65 yrs old
- Social Security Benefits
- Monthly premium
- Late enrollment penalty
- Payroll tax
Skill nursing facility only, no nursing home coverage
11
Q
Medicare Part B
A
- Supplemental medical insurance
- Monthly premium
- Physician services, outpatient, home health, and medical equipment
12
Q
Medicare Part C
A
- Private insurance companies
- Advantage
13
Q
Is long term care such as nursing homes covered by Medicare Part A and B?
A
NO
14
Q
Medicare Part D
A
Stand Alone Prescription Drug Plan
15
Q
What is the current issue with Medicare?
A
Part A is at risk of bankrupting
16
Q
What are the restructuring ideas for Medicare?
A
- Increase age requirement
- Defined contribution
- Individual savings
- Managed care
17
Q
What are the 2 ways a pharmacist can help patient’s overcome health literacy barriers?
A
- Verbal Communication (teach back method)
- Written Communication: <8th grade
18
Q
What is the NURS Acronym?
A
N: Name the Emotion
U: Understand the Emotion
R: Respect the Patient
S: Support the Patient
19
Q
What anticonvulsants are used for neuropathic pain?
A
- Gabapentin
- Pregablin
- Lamotrigine
- Topiramate
20
Q
What antidepressants are used for neuropathic pain?
A
- Amitriptyline
- SSRI: Duloxetine
- SSRI: Venlafaxine
21
Q
What is the formula for Corrected Sodium?
A
Measured Sodium + [(Glucose-100)/100 ( x 1.7)]
22
Q
What is the formula for Anion Gap?
A
[Na+] - [Cl-] - [CO2] - Bicarbonate (CO2) from serum blood
23
Q
What is the formula for Corrected Calcium?
A
Measured Ca2+ +[(4-Albumin) x 0.5]
24
Q
Symptomatic Hyponatremia <135 mEq/L Treatment
A
- 0.9% NaCl or 3% (if symptomatic)
25
Rapid correction of hyponatremia is associated with the development of osmotic demyelination syndrome. What is the limit?
Do NOT go over >12 mEq/L per day
26
When should you restrict fluid intake when treating hyponatremia?
Hypovolemic Hypotonic Hyponatremia
27
If the patient has fluid restriction hypovolemic hypotonic hyponatremia, what should be given instead of 0.9% NaCl?
3% NaCl
28
Hypernatremia >145 mEq/L Treatment can be associated with development of Cerebral Edema if what?
<12 mEq/L per day
29
Hypokalemia <3.5 mEq/L Treatment
1. Oral K+ Replacement: chloride/phosphate/bicarbonate, max dose 40 mEq
2. Aldosterone Antagonist (spironolocatone and triamterene)
3. IV (consider mag replacement if no response occurs)
30
Hyperkalemia >5.5 mEq/L Treatment Abnormal ECG
1. Ca Gluconate PERIPHERAL IV
2. Ca Chloride CENTRAL IV
31
Hyperkalemia Treatment Glucose >250 mg/dL
1. Insulin w/o dextrose
(if glucose <250 give insulin + dextrose)
32
What are considerations that can be added on in Hyperkalemia Treatment?
1. Albuterol
2. Sodium Bicarbonate if acidotic pH <7.2
33
Hypomagnesemia <1.4 mEq/L Treatment
Mild: Mag Oxide tabs/caps, antacids, and laxatives
Severe: Mag Sulfate bolus + MD
34
Hypermagnesemia >2 mEq/L Treatment
1. IV Calcium Gluconate (P) or Calcium Chloride (C)
2. 0.9% NaCl bolus + IV Loops
3. Reduce Mg2+ intake
35
Hypocalcemia <8.5 mEq/L Asymptomatic Treatment
1. Oral Ca2+
2. Vitamin D
36
Hypocalcemia <8.5 mEq/L Symptomatic Treatment
1.IV Calcium Gluconate (P) or Calcium Chloride (C)
2. MD Dosing
37
Hypercalcemia >10.5 mEq/L Asymptomatic Treatment (>12, if less than just monitor)
1. 0.9% NaCl
2. IV Loops
3. IV Calcitonin
4. IV Glucocorticoids
5. IV Bisphosphonate
38
Hypercalcemia >10.5 mEq/L Symptomatic Treatment (normal kidney, if failed kidney = hemodialysis)
1. 0.9% NaCl
2. IV Loops
3. IV Calcitonin
4. IV Glucocorticoids
39
Hypercalcemia ACUTE Management
1. 0.9% NaCl (1st line), CI in fluid overload
2. Loops (2nd line)
40
Hypophosphatemia <2 mg/dL Asymptomatic Treatment
1. Oral Phos Supplement
41
Hypophosphatemia <1 mg/dL Symptomatic Treatment
1. Sodium + Potassium IV
42
What is considered Hyperphoshatemia?
>4.5 mg/dL
43
What are the SIX Principles of Accounting?
1. Going Concern
2. Objectivity
3. Conservatism
4. Consistency
5. Matching
6. Materiality
44
Define Going Concern
Any given company plans to remain in existence for the forseeable future
45
Define Objectivity
Accounting entries will be recorded on the basis of objective evidence
46
Define Conservatism
Accounting estimates, evaluations, and opinions should neither overstate or understate the business activities of the company
47
Define Consistency
Similar measurement concepts and procedures for related items within financial statements are applied for entire accounting periods
48
Define Matching
Requires that all expenses directly associated with the production of revenues be reported within the same period on the income statement
49
Define Materiality
Acknowledges the significance of various decisions and their ultimate effects on the financial statements given the magnitude of a company's operations
50
What are important considerations for product stocking decisions?
1. Obtain the right products
2. Obtain the products in the right quantity
3. Obtain the products at the right time
4. Obtain the products at the right price
5. Obtain the products from the right vendor
51
Obtaining products at the right time has considerations in what?
1. Capital costs
2. Storage costs
3. Cost of risk
52
What is Just in Time JIT Purchasing?
As the last unit of an item sells, the next unit arrives before it is needed
53
Inventory Turnover Rate ITOR Formula
Cost of Goods Sold COGS/Average Inventory
54
What is a normal Respiratory Rate?
10-20 breaths per minute
Count for 15 seconds and then multiply by 4
55
What is the radial method for reading a pulse?
Listen 15 seconds and multiply by 4 on the wrist
56
What is the apical method for reading a pulse?
Listen for 60 seconds with stethoscope at the heart
57
What are the Kortkoff sounds?
1st = SBP
2nd = DBP
58
What HTN medications are contraindicated in patients with a sulfa allergy?
1. Hydrochlorothiazide
2. Chlorthalidone
3. Indapamide
59
What are the warnings for Hydrochlorothiazide, Chlorthalidone, and Indapamide (Thiazides)?
1. Gout flare
2. Photosensitivity
3. Hyperlipidemia
4. Hyperglycemia
5. SLE Exacerbation
60
What HTN drugs are contraindicated in patients with HFrEF?
1. Verapamil
2. Diltizaem
61
What are the warnings for Amlodipine, Felodipine, and Nifedipine (DHP CCB)?
1. Hepatic Impairment Caution: amlodipine + nifedipine
2. High fat meals = increased peak: felodipine
62
What are the warnings for Verapamil and Diltiazem (NON DHP CCB)?
1. Renal Impairment caution: verapamil
2. Liver Disease caution: diltiazem
63
What HTN drugs are contraindicated with angioedema due to previous ACEi, pregnancy, and concomitant use with Aliskiren?
1. Lisinopril
2. Enalapril
3. Ramipril
64
What are the warnings for Lisinopril, Enalapril, and Ramiprill (ACE)?
1. Ascities
2. Prior to surgery caution
3. Hyperkalemia
4. Bilateral Renal Artery Stenosis
65
What HTN drugs are contraindicated with pregnancy and concomitant use with Aliskiren?
1. Losartan
2. Candesartan
3. Valsartan
66
What are the warnings for Losartan, Candesartan, and Valsartan (ARB)?
1. Hepatic impairment: losartan
2. Liver impairment: candesartan
3. Avoid in ascites
67
What are classes are considered first line treatment for HTN?
1. Thiazides
2. ACEi/ARN
3. CCB
68
What are the EB beta blockers for HFrEF?
1. Metoprolol Succinate
2. Carvedilol
3. Bisoprolol
69
What is the recommended Action for Treatment in Well Controlled Asthma?
1. Maintain current step
2. Regular followups every 1-6 months
3. Consider step down is well controlled for >3 months
70
What is the recommended Action for Treatment in Not Well Controlled Asthma?
1. Step up 1 step
2. Reevaluate in 2-6 wks
3. For side effects consider alternative treatment options
71
What is the recommended Action for Treatment in Very poorly Controlled Asthma?
1. Consider short course of oral systemic corticosteroids
2. Step up 1-2 steps
3. Evaluate in 2 wks
4. For side effects consider alternative treatment options
72
Management of Asthma Step One
1. PRN SABA
73
Management of Asthma Step Two
1. QD ICS + PRN SABA or
2. PRN ICS + SABA
74
Management of Asthma Step Three
1. QD + PRN LOW ICS Formoterol
75
Management of Asthma Step Four
1. QD + PRN MEDIUM ICS Formoterol
76
Management of Asthma Step Five
1. QD MEDIUM-HIGH ICS-LABA + LAMA + PRN SABA
77
Management of Asthma Step Six
1. QD HIGH ICS-LABA + Oral Systemic Corticosteroids + PRN SABA
78
What is the Green Zone Action Plan?
PEF >80% personal best >460
1. no symptoms
2. controller medications
79
What is the Yellow Zone Action Plan?
PEF 50-80% 290-460
1. some symptoms
2. directions for SABA use
80
What is the Red Zone Action Plan?
PEF <50% <290
1. very SOB
2. directions for SABA use
3. call 911
81
What is normal BUN?
8-20 mg/dL
82
What is Azotemia?
Azote = Nitrogen
Emia = Blood
Elevated BUN
83
What is Uremia?
Ures in the blood
84
What is the Normal BUN:Serum Creatinine SCr Ratio?
10-15:1
85
What is the Elevated BUN:SCr Ratio?
>20:1, suggests true volume depletion or effective volume depletion
86
Normal Creatinine Range for Adult Males
0.5 - 1.2 mg/dL
87
Normal Creatinine Range for Adult Females
0.4 - 1.1 mg/dL
88
Serum Creatinine lags behind GFR by how many days and why?
1-2 days
1. Slow Accumulation
2. Increased tubular secretion
3. Increased external clearance
89
What must be at steady state for GFR estimation equations?
SCr
90
What drugs interfere with distal tubule secretion of creatinine which increases SCr concentrations?
1. Cimetidine
2. Trimethoprim
3. Cefoxitin
91
Cystatin C
1. Not protein bound
2. Freely filtered
3. Not secreted
4. Predicts the presence of AKI 2 days sooner than SCr
92
Oliguria Adults is what
<500 ml of urine production within 24 hours
93
Anuria is what
Urine <0.3 ml/kg/hr, <100 ml of urine production within 24 hrs
94
Increased pH in Urinalysis means what?
UTI, bacteria, or tubular dysfunction
95
What components are seen in Urinalysis that suggest UTI?
1. Nitirite
2. Leukocyte Esterase
96
Microalbuminuria in Urinalysis is what?
30-300 mg/day
97
Macroalbuminura in Urinalysis is what?
>300 mg/day
98
FeNa in urine measures what?
The ability of the kidney to concentrate urine
99
What is Urine Osmolality?
Measures ability of the kidney to concentrate urine
50-1200 mOsm/kg = normal
100
Red Cell Casts in Urine Microscopy means what
Glomerular or Vascular injury
101
White Cell Casts in Urine Microscopy means what
Infection or interstitial nephritis
102
Hyaline Casts in Urine Microscopy means what
Dehydration or Exercise
103
Granular Casts in Urine Microscopy means what
Possible acute tubular necrosis
104
Crystals in Urine Microscopy means what
Tumor lysis syndrome or uric acid nephropathy
105
List the NINE risk factors for development of systemic adverse effects with use of topical corticosteroids
1. >4 weeks of therapy
2. High potency steroid
3. Site with thin stratum corneum
4. Occlusive dressing/intertriginous area
5. Large surface area
6. Peds/Geriatric patient
7. Hepatic impairment
8. Presence of penetration enhancing substance
