pharm exam 2

Question 1

Quinolones/Fluroquinolone examples

Answer 1

ciprofloxacin
besifloxacin
gatifloxacin
levoflaxacin
moxifloxacin

Question 2

Quinolones/Fluroquinolone black box warning

Answer 2

increased risk of tendon rupture; tendonitis

may exacerbate MG

Question 3

Lincosamide BB warning

Answer 3

(clindamycin)

BB warn for severe colitis

Question 4

Long acting beta 2 agonists BB warnings

Answer 4

do not use salmeterol or formeterol singly in asthma for all ages; two-fold increase in catastrophic events

Question 5

step 1 asthma therapy

Answer 5

• SABA prn
• s/s when exposed to triggers
• exercise can be mild intermittent

Question 6

step 2 asthma therapy

Answer 6

• one long term control med daily
• low dose ICS (mainstay for all ages)
• cromolyn or leukotriene modifier are alternatives

Question 7

step 3 asthma therapy

Answer 7

-medium dose ICS or low dose ICS plus LABA
OR
-medium dose ICS plus leukotriene receptor modifier

• exacerbations may require oral steroids
• consider allergy therapy/allergist referral

Question 8

step 4 asthma therapy

Answer 8

-medium dose ICS plus:
LABA
or
medium dose corticosteroid
or
leukotriene modifier
or
theophylline

Question 9

step 5 asthma therapy

Answer 9

• consult pulmonology or immunology

- high dose ICS plus LABA

Question 10

step 6 asthma therapy

Answer 10

-high dose ICS plus LABA and oral corticosteroids

Question 11

asthma exacerbation

Answer 11

• treat with oral steroids to regain control, if not effective step up therapy
• increase inhaled beta agonist (2-6 puffs q20min)

Question 12

ICS reduction recommendation

Answer 12

dose of ICS should be reduced 25-50% every 2-3 months to lowest possible dose to maintain control

Question 13

pregnant patients with asthma

Answer 13

• inhaled beta agonists are drug of choice during pregnancy

- ICS are long term drug of choice

Question 14

transient wheezing

Answer 14

caused by prematurity or smoking during pregnancy, children usually outgrow by age 3

Question 15

persistent early onset wheezing

Answer 15

carries on with kids through school age and early adolescence

Question 16

late onset wheezing

Answer 16

often associated with eczema

Question 17

LABA should not be prescribed without what?

Answer 17

ICS

Question 18

Theophylline

Answer 18

a methalyxanthine derivative that causes;

• bronchial smooth muscle relaxation
• SNS stimulants
• CV effects
• increased gastric acid production
• stimulates skeletal muscle
• increase renal blood flow and GFR

Question 19

theophylline dosage

Answer 19

• 2nd or 3rd line drug for asthma or COPD
• adult start at 6mg/kg/day
• dose is increased by 25% q3days until serum levels are 10-20mcg/ml

Question 20

theophylline ADRs

Answer 20

irritability, restlessness, seizures, insomnia, dyspepsia, palpitations, tachycardia, hypotension, arrhythmias

Question 21

theophylline toxicity greater than 20mcg/ml

Answer 21

NVD, HA, vomiting, diarrhea, insomnia, irritability

Question 22

theophylline toxicity greater than 35mcg/ml

Answer 22

hyperglycemia, hypotension, cardiac arrythmias, tachycardia, seizures, brain damage, death

Question 23

what increases clearance of theophylline

Answer 23

• smoking tobacco
• low carb/high protein diet
• charcoal broiled foods accelerate hepatic metabolism of theo

Question 24

when to draw theophylline levels

Answer 24

• Q 6-12 months when steady state reached

- when a new drug is added or deleted from regimen

Question 25

1st line for AOM and sinusitis

Answer 25

amoxicillin

Question 26

1st line for infection following bites, including human

Answer 26

amoxicillin/clavulanate

Question 27

1st line for MRSA, and in special populations (children, pregnancy)

Answer 27

Lincosamides (clindamycin)

Question 28

1st line for C. trachomatis and ureaplasma urealyticum

Answer 28

doxycycline

Question 29

COPD exacerbation

Answer 29

- Augmentin - double strength sulfamethoxazole/trimethoprim - macrolide abx

Question 30

macrolide antibiotics

Answer 30

erythromycin azithromycin clarithromycin

Question 31

healthy adult with CAP

Answer 31

macrolide (or doxy if allergic) and treat for 5 days

Question 32

adult CAP with comorbidities, or risk of DRSP

Answer 32

fluroquinolone beta lactam macrolide

Question 33

CAP in pregnancy

Answer 33

macrolide; azithromycin 1st choice pregnancy category B

Question 34

abx for AOM is PCN allergy

Answer 34

Lincosamide (clindamycin) plus 3rd generation cephalosporin

Question 35

what bugs cause otitis media?

Answer 35

S. pneumoniae, nontypeable H. influenza (HIB), M. catarrhalis

Question 36

ADR's of sulfonamides, nitrofurantoin, and trimethoprim

Answer 36

anorexia, NVD, stomatitis, rashes, increased hypersensitivity reactions, photosensitivity, HA, dizziness, drug interactions

Question 37

long term nitrofurantoin complication

Answer 37

fibrosis- check CXR

Question 38

sulfonamides, nitrofurantoin, and trimethoprim used to treat what?

Answer 38

Most commonly used with UTI infections | MRSA is susceptible in some areas

Question 39

pharmacodynamics of tetracyclines

Answer 39

tetracycline and doxycycline | Bind reversibly to the 30S subunit of the bacterial ribosome

Question 40

pharmacokinetics of tetracyclines

Answer 40

food, milk, and calcium decrease absorption

Question 41

beta lactam contraindications

Answer 41

pregnancy category B | not for hypersensitive reactions to pcn

Question 42

macrolide contraindications

Answer 42

most are safe in pregnancy and children

Question 43

tetracycline contraindications

Answer 43

do not give in pregnancy, lactating women, or children less than 8

Question 44

1st and 2nd line for group A strep

Answer 44

- 1st line PCN/amoxicillin/augmentin - macrolides if pcn allergy - cephalosporins if PCN doesn't work

Question 45

meds to avoid in COPD patients

Answer 45

``` beta blockers (produce bronchial spasms) antitussives ```

Question 46

first line for asthma

Answer 46

SABA - albuterol - metaproterenol - terbutaline - bitolterol - pirbuterol - levalbuterol

Question 47

LABA

Answer 47

- salmeterol - formeterol - indacaterol - arformoterol

Question 48

safe SABA for kids less than 4?

Answer 48

albuterol and metaproterenol

Question 49

Buproprion contraindicated in patients with?

Answer 49

- sz disorder - bulimia - anorexia - use of MAOI within 14 days - hx of stroke, brain tumor, brain surgery, or closed head injury - use cautiously in hepatic cirrhosis

Question 50

PCN increases what drugs?

Answer 50

methotrexate (dont give) | warfarin (monitor INR)

Question 51

what beta blocker is contraindicated with ampicillin

Answer 51

atenalol

Question 52

1st generation cephalosporin used for?

Answer 52

- Used for skin and soft tissue infections | - Primarily active against gram-positive bacteria, S. aureus and S. epidermidis

Question 53

2nd generation cephalosporin used for?

Answer 53

- Active against same as first generation(gram positive, S. aureua, and S. epidermidis) - plus Klebsiella, Proteus, E. coli

Question 54

3rd generation cephalosporin used for?

Answer 54

* Used for broader indications | * More active against gram-negative bacteria

Question 55

4th generation cephalosporin used for?

Answer 55

* Resistant to beta-lactamase | * Primarily active against gram-positive bacteria

Question 56

valcyclovir ADRs

Answer 56

thrombocytopenia purpura | hemolytic uremic syndrome

Question 57

FDA warning about Levaquin

Answer 57

psych reactions hypoglycemia --> coma tendon rupture

Question 58

vancomycin SE

Answer 58

ototoxicity nephrotoxicity red man syndrome neutropenia

Question 59

abx for perforated TM? | contraindicated for perforated TM?

Answer 59

ciprofloxacin is contraindicated | Ofloxacin can be given