Pharmacology Flashcards
(105 cards)
1
Q
Macrolides:
A
erythromycin, azithromycin, clarithromycin.
2
Q
Quinolones:
A
ciprofloxacin (Cipro), ofloxacin (Floxin).
3
Q
Sulfa:
A
Trimethoprim-sulfamethoxazole (Bactrim).
4
Q
Tetracyclines:
A
tetracycline, doxycycline
5
Q
It takes ___ days (platelet life span) for platelet function to return to normal after a patient stops taking clopidogrel (Plavix).
A
10
6
Q
____ patients may require lower starting and maintenance doses of warfarin.
A
Asian
7
Q
INR values —– increase stroke risk sixfold.
A
<2.0
8
Q
—is longer acting and more “effective” than HCTZ.
A
chlorthalidone
9
Q
reduce calcium excretion by the kidneys and stimulate the osteoblasts. This helps build bone.
A
Thiazides
10
Q
Patients with serious sulfa allergies should avoid
A
Thiazide and loop diuretics
11
Q
Spironolactone adverse effects:
A
Gynecomastia (13%) and hyperkalemia
12
Q
Spironolactone black box warning
A
risk of benign and malignant tumors
13
Q
Alpha-blockers are potent vasodilators common side effects are
A
dizziness and hypotension. Give at bedtime at very low dose and slowly titrate up. Careful with frail elderly (risk of syncope and falls).
14
Q
Alpha-blockers are not first-line choice except for males with both
A
HTN and BPH
15
Q
ACEIs and ARBs are contraindicated in
A
pregnancy, renal artery stenosis, angioedema, hyperkalemia (>5.5 mmol/L), and hypersensitivity to the drug.
16
Q
ACEIs and ARBs protect the kidneys and are preferred drugs for treatment of
A
hypertension in diabetics and patients with mild-to-moderate CKD. But if severe CKD (eGFR <60), avoid these drugs because of higher risk of hyperkalemia.
17
Q
ACEIs are first-line therapy for
A
HF with left ventricular dysfunction (or HFrEF).
18
Q
Captopril is associated with
A
agranulocytosis, neutropenia, and leukopenia (rare). Monitor complete blood count (CBC).
19
Q
Both ACEIs and ARBs are excreted in
A
breastmilk and pregnant mothers should avoid
20
Q
ACEI-induced cough and angioedema are caused by
A
inhibition of the metabolism of bradykinin and kallikrein system, which are involved in the inflammatory process.
21
Q
Some patients are at higher risk of AKI and hyperkalemia (elderly, patients with renal artery stenosis, diabetics). Check kidney function
A
3 - 5 days after starting drug
22
Q
Avoid using diltiazem and verapamil (nondihydropyridine CCBs) in patients
A
HFrEF (can worsen it).
23
Q
Pedal edema may occur with _________ because of vasodilation. If it bothers patient, reduce dose or take it later in the day. The pedal edema is positional and improves when laying down.
A
nifedipine and amlodipine
24
Q
Dihydropyridine CCBs can cause
A
peripheral edema, HA, flushing and Lightheadedness
25
Nondihydropyridine CCBs can worsen
cardiac output and cause bradycardia and constipation in elderly
26
what are the main sx of main symptoms of CCB poisoning.
hypotension and bradycardia
27
Do not use oral -------- for mild acne (open/close comedones). Start with OTC topicals such as salicylic acid (Noxzema, Stridex) and benzoyl peroxide.
tetracycline
28
For mild acne not responding to OTC drugs, try prescription topicals
(benzoyl peroxide and erythromycin [Benzamycin]), tretinoin (Retin-A), or azelaic acid cream.
29
another tetracycline option is
minocycline
30
Minocycline side effects are
vertigo can resolve in 1 - 2 days after stopping meds
31
tetracyclines are best to take how
on empty stomach
32
erythromyocin side effects are
GI -n/v, diarrhea, abdominal pain
33
what is the most tolerated macrolide and rare GI side effects
azithromycin
34
May prolong INR and increase risk of bleeding if warfarin is mixed with
erythormyocin or clarithromycin
35
first-line treatment for gonorrheal infections.
Ceftriaxone (rocephin) 500 mg IM
36
MRSA skin infections (boils, abscesses): Do not use cephalosporins. First-line therapy is
trimethoprim–sulfamethoxazole (Bactrim DS) or clindamycin. Treat for at least 5 to 10 days.
37
Patients who have a true allergy to penicillin (history of anaphylaxis, angioedema) are more likely to have an allergic reaction to
cephalosporins
38
Patients who have a true allergy to penicillin (history of anaphylaxis, angioedema) are more likely to have an allergic reaction to
1 IgE-mediated reactions.
39
do not use amoxicillin with what disease b/c causes generalized rash
amoxicillin, ampicillin rash
40
Dicloxacillin is for
PCN staph like Mastitis and impetigo
41
is a serious complication of quinolone therapy, and patients who are on steroids or >60 years are at higher risk.
achilles tendon rupture
42
Do not use quinolones in children (<18 years) or women who are pregnant or breastfeeding because of adverse effects on
growing cartilage
43
If a patient on quinolone reports a new onset of difficulty in walking, order
an ultrasound to rule out Achilles tendon rupture or peripheral neuropathy and discontinue the medicine.
44
Bioterrorism-related inhalation of anthrax spores (postexposure prophylaxis) is treated with
ciprofloxacin 500 mg every 12 hours × 60 days (treat within 48 hours). In addition, a three-dose series of anthrax vaccine is recommended
45
Cutaneous anthrax is treated with
ciprofloxacin 500 mg twice a day × 7 to 10 days.
46
Traveler’s diarrhea is treated wit
Cipro 750 mg (single dose) or 500 mg twice a day × 3 days.
47
Ciprofloxacin has the best activity against
Pseudomonas aeruginosa (gram negative) and is the first-line drug for treating pseudomonal pneumonia for patients with cystic fibrosis.
48
For athletes or very physically active patients, if fluoroquinolone is needed, advise to reduce their training volume and intensity to reduce risk of Achilles tendon injury. Wait
2 to 4 weeks to resume activity
49
Patients with a UTI who are on warfarin (Coumadin) should not be given
Bactrim increases risk of bleeing monitor INR
50
Pregnant women (or suspected pregnancy) with a UTI can be treated with
beta-lactams, nitrofurantoin, and fosfomycin.
51
If the patient (≥18 years) is allergic to macrolides, an alternative is
doxycycline PO twice a day or new-generation quinolones (Levaquin, Avelox).
52
Capsaicin cream can be used to treat pain in
trigeminal neuralgia and PHN
53
max number of days that ketorolac (toradol 0 can be used is
5 days
54
Max dose of acetaminophen (tylenol
3 - 4 g daily
55
A severe case of poison ivy or poison oak rash may require --- to --- days of an oral steroid to clear.
14 to 21
56
Maximum number of refills for Schedule III to V drugs is
five refills
57
schedule 2 drugs have how many refills
none)
58
echinachea does what
shortens cold duration
59
feverfew and butterbur use
migraines
60
Gingko is for
dementia
61
isoflavones
estrogen
62
saw palmetto
BPH
63
Kava kava, valerian root
anxiety and insomnia
64
St Johns wort
depression
65
Turmeric
alzheimers, arthritis
66
what abx is used for lung infections with comorbidities
no comorbidities
fluroqueinolones
marcrolide -azithromyocin or clarithromycin
67
what med do we give for pertussis
macrolide -
Azithromycin (Z-pack)
* Erythromycin
* Clarithromycin
68
Strep pharyngitis treatment
PCN
69
Acute rhinosinusitis:
wait 10 days, then Amoxicillin or
Augmentin.
70
Metformin
SE: diarrhea, nausea/vomiting
* WARNINGS:
* Do not use with renal disease, hepatic acidosis, alcoholics.
* Monitor renal function.
* Treatments (in order):
1. Lifestyle modification. Weight loss. Try for 3-6 months.
2. Start metformin 500mg-2,000mg/24hr.
3. Sulfonylurea (Glucotrol) or other oral.
4. Insulin.
71
Insulins
Rapid acting: covers 1 meal at a time. (lispro, asparat or glulisine)
* Short acting: from meal to meal. (regular)
* Intermediate: from breakfast to dinner. NPH
* Long acting: once a day. Glargline
72
Graves disease treat with
Propylthiouracil (PTU) and
methimazole (Tapazole).
73
Hashimoto
levothyroxine
74
Aces and ARBS
ACEIs “...prils” (benazepril, enalapril, lisinopril)
* & ARBs “...sartan” (losartan, valsartan)
* Blocks conversion of angiotensin I to II.
* DM and CKD drugs of choice.
* WARNING: category C.
* SE: dry cough, hyperkalemia, angioedema.
* Contraindicated: kidney disease (mod to severe), hyperkalemia.
* Ramipril, Benazepril, Enalapril.
75
Beta blockers
Beta Blockers “...olol”
* WARNING: wean slowly with chronic use. May cause
rebound HTN.
* Contraindicated: asthma, COPD, chronic bronchitis, emphysema.
* Other uses: decrease mortality during acute MI, post MI, migraine HA, decrease IOP in glaucoma, angina pectoris.
* Metoprolol, atenolol, propranolol.
* Propranolol is also used for fine tremors.
76
Calcium Channel Blockers “...pine”
Systemic vasodilator.
* Treatment for Raynaud’s.
* Blocks voltage-gated calcium channels in cardiac smooth muscle and blood vessels.
* SE: HA (due to vasodilation), ankle edema.
* Contraindication: CHF.
* Nifedipine, amlodipine, verapamil, diltiazem.
77
Hydrochlorothiazide (HTZ)
Diuretic
* It can treat high blood pressure and fluid retention.
* ⬆urine output,⬇blood volume,⬇venous pressure,⬇preload.
* Favorable effects for osteopenia and osteoporosis.
* Favorable for women in menopause (demineralization).
* Monitor lipid profile.
* WARNING: can worsen
* Hyperglycemia
* Hyperuricemia (don’t use in gout)
* High triglycerides
* High cholesterol
78
Preferred 1st line drug to tx HTN in DM and pts. with mild to moderate renal disease:
Aces and ARBS
79
Alpha-1 blockers/antagonists “...zosin”
Potent vasodilators.
* SE: dizziness, hypotension.
* Take at bedtime.
* Terazosin, Doxazosin, Tamsulosin (Flomax) for BPH
80
Common side effects
Cough + angioedema ➡ ACEIs
* Swollen ankle, HA ➡ CCB
* Hyperuricemia, hyperglycemia ➡ TZD
* Fatigue, depression ➡ BB
81
Dog bites treat with
augmentin for 10 days
82
Imeptigo give
mupirocin
83
RMSF treat with
Doxy
84
Purulent cellulitis tx
BCD
Bactrim, clindammycin, doxy
85
non purulent cellulitis tx
keflex (cephalexin)
86
folliculits tx
bactroban
87
Erysipelas (strep infection):
PCN or macrolide
88
Otitis media tx
amoxicillon if allergic augmentin
89
Otitis externa tx
quinolones (cipro)
90
Pneumonia tx
amoxicillin 90
91
Meds safe in pregnancy:
PCN, metformin, cephalosporins, Tylenol, prednisone, insulin.
92
Meds NOT safe in pregnancy:
chemo, phenytoin (antiepileptic), tetracyclines, fluoxetine
(Prozac), paroxetine (Paxil).
93
Every pregnancy gets a Tdap @
3rd trimester (27-36 wks.).
94
Bupropion (Wellbutrin)
Antidepressant and smoking cessation aid.
* No potential for abuse
* Energizing, used to ⬆ libido.
* Don’t use in bulimia (risk for seizures). It is excreted through the kidneys. Risk of toxicity due to recurrent dehydration and electrolyte disturbance.
95
Osteoarthritis
1st line tx: exercise, weight loss, ice packs, acetaminophen.
* 2nd line tx: NSAIDS. Short term. 2-4 weeks trial with max dose.
* If no relief, refer for steroid injections
96
97
UTI: >100,000 CFU/ml
Uncomplicated: 3-day, trimethoprim-sulfa (Bactrim), nitrofurantoin.
* Complicated: cipro
* Pyridium used to relieve symptoms changes urine to orange.
98
INr
Desired range 2-3.
* INR ⬆: blood cots more slowly than desired. Risk for bleeding.
* INR ⬇: blood clots more quickly than desired. Risk for blood clots.
* Warfarin/Coumadin: vitamin K antagonists: works against the clotting process. (anticoagulant)
* Warfarin interacts with “G” herbs: garlic, ginger, gingko, ginseng & fish oil.
* Discontinue anticoagulation therapy 7 days before invasive procedure.
*Initial treatment is usually 3 months, but it may vary depending on patient.
*Initial daily dose is 5mg, for frail elderly start at 2.5mg.
99
Spironolactone induces
gynecomastia by decreasing testosterone production, increasing peripheral conversion of testosterone to estradiol, and displacing estradiol from sex hormone-binding globulin.
100
Misc
Never give Doxy <7 years of age.
* With the elderly start low and slow.
* Statins (Lipitor, Crestor) don’t ever mix with grapefruit juice.
* 1ST line tx strep throat: penicillin. If allergic, Macrolide.
* Gout: NSAIDS Indocin, colchicine for flare up. Allopurinol for long term management.
* Only two methods of contraception that do not contain hormones are condoms and copper T.
* Bisphosphonates: warning with erosive esophagitis, abdominal pain.
* Take alone, in the AM, full glass water, stay up right 30min post taking it.
101
Bacterial vaginosis tx;
Metronidazole.
102
Candida Vaginitis tx:
Metronidazole, Diflucan.
103
Trichomonas tx
Metronidazole *tx partner too.
104
Chlamydia tx:
Doxy or Azithromycin *tx partner too.
105
Sexual health
Gonorrhea tx: Ceftriaxone 500mg IM x 1.
* Syphilis tx: Penicillin.
* Condyloma Acuminata tx: (genital warts, HPV) Condylox, Imiquimod.
