Pharmacology Flashcards
(80 cards)
1
Q
Highest risk of TdP in antipsychotic
A
IV haldol
2
Q
Antipsychotics with relatively low risk of torsades
A
Quetiapine, ariprazole, olanzapine
3
Q
Antidepressants with lowest risk of torsades
A
Bupropion, duloxetine,
4
Q
Risks of megestrol
A
Increase weight, mostly edema, and risk of VTE
5
Q
Best options for insomnia when non-pharm doesn’t work
A
Quetiapine, olanzapine (good for appetite and mood)
6
Q
Which antidepressants should be used for tolerability
A
Sertraline, escitalopram
7
Q
Antidepressant for melancholic presentation
A
Bupropion, duloxetine, nortriptyline
8
Q
Only FDA drug for hiccups
A
Chlorpromazine
9
Q
SSRI with longest half life
A
prozac
10
Q
pro/con of zoloft
A
few side effects, can take longer than others to see results
11
Q
substitutions for determining depression in pall care
A
- depressed appearance
- social withdrawal, decreased talkativeness
- brooding, self-pity, pessimism
- lack of reactivity, can’t be cheered up
12
Q
SSRIs with lowest risk of drug interactions
A
escitalopram
13
Q
SSRI good for patients primarily with anxiety
A
escitalopram
14
Q
SNRI best for chemo-associated neuropathy
A
duloxetine
15
Q
how much venlafaxine do you need to get pain benefits
A
225mg
16
Q
dose range for cymbalta (duloxetine)
A
20-120mg (minimal benefit >60mg)
17
Q
best SSRI for a patient on multiple meds
A
escitalopram (lexapro)
18
Q
brand name for citalopram
A
celexa
19
Q
brand name for lexapro
A
escitalopram
20
Q
brand name for fluoxetine
A
prozac
21
Q
brand name for venlafaxine
A
effexor
22
Q
brand name for duloxetine
A
cymbalta
23
Q
combination of medications for poor energy
A
SSRI+ wellbutrin OR stimulant
24
Q
combination of medications for poor sleep
A
SSRI + Remeron, SSRI + SGA (sedating), or SSRI + trazodone
25
combination of medications for nausea
Remeron + Zyprexa
26
antidepressant that can worsen anxiety
wellbutrin
27
benefit of cholinesterase inhibitors
small benefit in regards to cognition, behaviors, and function for mild to late Alzheimer's type dementia
28
side effects of cholinesterase inhibitors
gastrointestinal and include nausea, diarrhea, weight loss, and bradycardia
29
most common side effect of memantine
dizziness; followed by confusion, constipation, headache
30
Lowest dose long acting morphine available
Kadian 10mg
31
Rapid dose escalation for acute pain IV morphine
1mg q1m x10mins, 5 minute respite, repeat if needed
32
Goal for pain control in rapid dose escalation
Reduction in 2-4 points of pain control or RR<10
33
Rapid dose escalation using IV dilaudid
0.2mg IV hydromorphone q1min x10, rest for 5, repeat
34
How to convert patient from methadone for SUD to pain control
Divide daily methadone dose for SUD into 3 separate doses
35
What are the fastest acting immediate release medications for pain control
Fentanyl, methadone (more lipid soluble)
36
Rapid dose escalation using po morphine
5mg oral morphine x30min until pain decrease 2-4 points
37
Converting IV methadone to po methadone
1:1.3 conversion (IV:po)
38
How long to wait before changes in methadone dosing
5-7 days
39
Conversion from opiate to methadone <60mg OME
2-7.5mg methadone per day, increase q5-7days
40
Conversion from opiate to methadone daily OME 60-199 and pt <65yo
10:1 ratio (opiate to methadone)
41
Conversion from opiate to methadone daily OME >200 or patient greater than 65
20:1 conversion (opiate to methadone)
42
Adjustments to methadone based on liver disease
Consider decrease in dose and increase time between dose chagnes
43
At what Qtc to avoid methadone
>500msec
44
What to consider if patient smokes and is taking methadone
Smoking increases CYP2B6-> increases clearance of methadone, so stopping smoking causes increase in methadone in system
45
How to counsel patient about taking immediate acting opiate prior to volitional pain activity
30-45mins prior to activity
46
What is duration of effectiveness of methadone for pain
6-12 hour duration
47
What is the duration of effectiveness of methadone for SUD
24-36 hours (hence daily dosing)
48
With what increases do patients not feel change in pain control
Don’t feel pain control with increases <25%
49
How to adjust opiate dosing when a patient has good control but adverse effects
Decrease ATC by 30%, keep immediate the same
50
How to adjust opiate dosing when a patient has continued pain and adverse side effects
Decrease ATC by 30-50% or switch opiate
51
Open ended question to get better idea of how they’re taking opiate
Tell me how you take your opioid medication
52
How to adjust dose when converting to fentanyl patch
Don’t need to decrease for cross tolerance because that has already been accounted for when you multiply by 2
53
What are three types of drugs that interact with methadone
Three As- amiodarone
- anti-invectives
- anti-depressants
54
How to manage someone on methadone enzyme inhibitor
Decrease dose methadone by 25%
55
How rapidly can enzyme inducers/inhibitors work on methadone
Inducers- take 1-2 weeks to notice difference, so make prns readily available
Inhibitors-take a few hours-days to work, so methadone overdose can occur quickly.
56
Starting dose of methadone in opioid naive
2.5mg BID or TID, can be as low as once daily in older/frail
57
What to look for in first five days of methadone initiation
Counsel partner to look for signs of somnolence- patient not able to woken up by voice or firm shake or doze off during a conversation. Look for euphoria, loud snoring, slurred speech, ataxia. Ask them to check twice a day.
58
How to titrate methadone
Increase by no more than 5mg q5-7days, after reaching 30-40mg/day, you can consider increasing by 10mg/5-7 days
59
Oral methadone:oral morphine to convert methadone back to morphine
1:3
60
PCA demand dose
50-150% of continuous infusion
61
When to titrate continuous PCA infusion
Should wait at least 8 hours but ideally 12-24 hours increase
62
PCA to TDF transition
Keep continuous for 6 hours, 50% at 6 hours, and then off at 12 hours
63
PCA to oral meds
Give long acting 2-3 hours before discontinuing PCA
64
How often can the PCA bolus dose be adjusted
Can be increased every two hours
65
Fundoscopic exam of CRVO
Dilated veins, diffuse retinal hemorrhages, retinal and macular edema, possible afferent pupillary defect
66
Painful vision loss differential
Acute glaucoma, optic neuritis, GCA, uveitis, migraine
67
Painless vision loss differential
central retinal artery occlusion (CRAO), central retinal vein occlusion (CRVO), ischemic optic neuropathy, cataract, vitreous hemorrhage, amaurosis fugax, TIA, cortical blindness, retinal detachment, macular degeneration, diabetic retinopathy, CMV retinitis, methanol intoxication, and functional visual loss.
68
deep, boring eye pain and nausea/vomiting
Acute glaucoma
69
Describe ophthalmology exam
Visual fields, visual acuity, pressure, pupils, fundoscopy, EOM, fluorescein, slit lamp, US
70
Ophthalmology follow up for acute central retinal artery occlusion, acute glaucoma, and giant cell arteritis
Immediate
71
Management of open globe
NPO, avoiding FB removal, avoiding eye manipulation, eye shield placement, head of bed elevation to at least 30 degrees, aggressive nausea treatment, analgesia, and IV antibiotics including vancomycin plus fluoroquinolone or ceftazidime, tetanus
72
Labs to assess GCA
ESR/CRP
73
Magnesium dose In children
20 to 25mg/kg bolus if pulseless, infusion over 15 to 30 mins for asthma
74
Treatment of torsades in child
Magnesium, defibrillation, lidocaine
75
Who usually gets retropharyngeal abscess
<6yo
76
Treatment of RPA
Abx-unasyn or zosyn (vancomycin as well in severe cases), ?intubation, ENT consult, ICU
77
Sore throat what to always think of in a child
Foreign body
78
Recurrent croup, think
Bacterial tracheitis
79
Imaging of bacterial tracheitis
Lateral neck, CXR (pneumonia would make tracheitis more likely), endoscopy
80
Child with concerning neck pathology
Call ENT right away
