Pharm

Question 1

drugs that cause drug-drug interactions

Answer 1

macrolides (erythromycin, clarithromycin)
antifungals (ketoconazole, fluconazole)
cimetidine (Tagamet)
citalopram (celexa)

Question 2

what drugs do grapefruit juice affect?

Answer 2

statins
erythromycin
CCB (nifedipine, isolipdine)
antivirals (indinavir, saquinavir)
amiodarone
benzodiazepines (diazepam, traizolam)
cisapride
carbazempine
buspirone

Question 2

narrow therapeutic index drugs

Answer 2

warfarin (Coumadin): monitor INR
Digoxin (Lanoxin): monitor dig level, EKG, e- (Ca, Mg, K)
levothyroxine: monitor TSH
lithium: monitor blood lvls, TSH, (hypothy risk)

Question 3

Proton pump inhibitors safety issues

Answer 3

increase risk of fractures (post menopausal women, pneumonia, C diff, hypOmg, B12, iron malabsorption, atrophic gastritis, kidney disease)

Question 4

Omeprazole (Prilosec) safety issues

Answer 4

interacts with warfarin, diazepam, carbamazepine, phenytoin, ketoconazole

Question 5

Vitamin K antagonist: Warfarin (Coumadin) Safety issues

Answer 5

interacts with “G” herbs: garlic, ginger, ginkgo, ginseng
fish oil, green tea
STOP 1 week before surgery

Question 6

TZDs: Pioglitazone (Actos) safety issues

Answer 6

BBW: cause/worsen congestive heart failure; NO use in HF 3 or 4
stop if causes dyspnea, weight gain, cough (heart failure)

Question 7

atypical antipsychotics:
Risperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
safety

Answer 7

high risk: weight gain, metabolic syndrome, DM 2
monitor weight q 3 months
BBW: higher mortality in elderly pts
monitor: TSH, lipids, weight/BMI

Question 8

bisphosphonates:
Alendronate (Fosamax)
Risedronate (Actonel)

STOP if?
how to take?

Answer 8

erosive esophagitis, abd pain
STOP if sx’s of esophagitis (chest pain, difficulty swallowing, burning mid back) or jaw pain

take with 8 oz WATER before breakfast, 1st thing in morning

do not lie down 30 mins after

Question 9

statins

atorvastatin (Lipitor)
lovastatin (Mevacor)
Rosuvastatin (Crestor)
Simvastatin (Zocor)

Answer 9

NO grapefruit juice
drug induced hepatitis or rhabdomyolysis higher if mixed with azole antifungals

high dose simvastatin 80 mg have highest risk of rhabdomylosis

Cr kinase goes up

Question 10

clindamycin has a higher risk of what?

Answer 10

c diff associated diarrhea

Question 11

cardiac glycosides: Digoxin (Lanoxin)

treats:
s/sx OD:

Answer 11

SVT and HF due to LV systolic

s/sx of OD: GI (anorexia, n/v, abd pain), arrythmias, confusion, yellow/green color vision changes

Question 12

What laboratory tests should be ordered if digoxin toxicity is suspected?

treatment?

Answer 12

Order a digoxin level, electrolytes (potassium, magnesium, calcium), creatinine, and
serial EKGs

tx: Digoxin-specific antibodies are immunoglobulin G (IgG) antidigoxin
antibodies that bind free digoxin in blood (Digibind, DigiFab)

Question 13

warfarin (Coumadin) indications

Answer 13

Prophylaxis and treatment thromboembolic events a/s with atrial
fibrillation or heart valve replacement (pulmonary embolism, DVT, stroke, thromboemboli)

Question 14

warfarin in pregnancy

Answer 14

category X

Question 15

in warfarin for atrial fib, what is the target INR?

Answer 15

2-3 (ideal INR 2.5)

takes 2-5 days for duration of action for single dose

Question 16

warfarin initial dose:

Answer 16

2-5 mg QD
check baseline PT, APTT, creatinine, LFT, INR

Question 17

ACE inhibitors (Enalapril, Captopril) contraindications

Answer 17

no K supplements
careful with K sparing diuretics
new onset dry cough, switch to ARB

Question 18

ARBs (valsartan, losartan) contraindications

Answer 18

No K supplements
don’t combine with ACEi

Question 19

K sparing diuretics (triameterene, HCTZ, amiloride, spironolactone (Aldactone) contraindications

Answer 19

higher risk of hyperkalemia if taken with ACEI or ARBS and with severe renal dz

worsen urinary incontinence

NO with ACE, ARB, high K supps, salt subs, chronic NSAIDs

Question 20

beta blocks (propranolol (Inderal), atenolol, metoprolol, pindolol) contraindications

Answer 20

pt with chronic lung disease (asthma, COPD, emphysema, chronic bronchitis)

don’t stop abruptly = severe rebound = hypertensive crisis

Question 21

phosphodiesterase 5 inhibitors (sildenafil Viagra, tadalafil (Cialis), vardenafil Levitra) contraindications

Answer 21

NO nitrates (nitroglycerine, isosorbide), some alpha blockers

if erection > 4 hours = go ED!

do not give w/in 3-6 months of MI or stroke

Question 22

SSRI (citalopram (Celexa))

Answer 22

avoid doses > 40 mg, can cause QT prolongation

if pt > 60 yrs old, max dose is 20 mg qd

Question 23

do not combine __ with thiazides due to increase risk of __ toxicity

Answer 23

lithium , lithium toxicity

Question 24

thiazide (HCTZ, chlorthalidone, indapamide) contraindications
*& loop diuretics

Answer 24

sulfa allergy

Question 25

Thiazide adverse effects

Answer 25

elevates plasma glucose/hyperglycemia
elevates LDL
elevates uric acid (gout)
hypokalemia