Pharmacy Foundations Part II Flashcards
(166 cards)
1
Q
Errors of omission
A
Something was left out that is needed for safety (e.g. not using double-check systems)
1
Q
“Medication Safety” definition
A
Freedom from preventable harm from medication use
2
Q
Errors of commission
A
Something was done incorrectly (E.g. prescribing bupropion in someone with a hx of seizures)
3
Q
Which committees in the hospitals should be informed of the error?
A
P&T
Medication Safety Committee
4
Q
MERP
A
Medication Errors Reporting Program
Voluntary, confidential reporting program that provides recommendations as well
5
Q
FMEA
A
Failure Mode and Effects Analysis
Proactive method to reduce the frequency & consequences of errors Screen potential effects of a new system
6
Q
Examples of CQI programs
A
Lean
Sig Sigma (DMAIC: define, measure, analyze, improve, control)
7
Q
Common types of hospital-acquired (nosocomial) infections
A
UTIs from indwelling catheters
Bloodstream infections from IV lines (Central lines = highest risk) & catheters
Surgical site infections
Hepatitis
Decubitus ulcers
Hepatitis
C. diff
VAP
8
Q
When are airborne precautions recommended?
A
Varicella, TB, measles
9
Q
ADRs: Type A
A
Predictable
Dose-dependent, based on pharmacologic properties
Most common
10
Q
ADRs: Type B
A
NOT dose-dependent & not related to pharmacology of drug
Can be immediate or delayed
11
Q
Examples of Type B reactions
A
Drug allergies
Drug hypersensitivity rxns (HLA genes, vanc infusion)
Idiosyncratic reactions (G6PD deficiency)
12
Q
Drug allergy: Type 1 reactions
A
Immediate
IgE-mediate ranging from minor local rxns to severe systemic rxns (anaphylaxis)
13
Q
Drug allergy: Type 2 reactions
A
Delayed
Antibody-mediated, usually occurring 5-8 days after exposure
Ex: hemolytic anemia, thrombocytopenia
14
Q
Drug allergy: Type 3 reactions
A
Delayed
Immune complex reactions, occurring ≥1 week after exposure
Ex: serum sickness
15
Q
Drug Allergy: Type 4 reactions
A
Delayed
T Cell-mediated occurring 48 hrs to weeks after exposure
Ex: SJS
16
Q
Drugs most associated with photosensitivity
A
Amiodarone
Diuretics
MTX
Oral & topical retinoids
Quinolones
St Johns Wort
Sulfa drugs
Tacrolimus
Tetracyclines
Voriconazole
17
Q
Abacavir testing
A
HLA-B* 5701
18
Q
Drugs most commonly associated with severe cutaneous adverse reactions
A
Allopurinol
Amoxicillin
Ampicillin
Carbamazepine
Ethosuximide
Lamotrigine
Nevirapine
Phenytoin
Bactrim
Sulfasalazine
Vancomycin
19
Q
In the NAPLEX you must avoid ALL beta-lactams if someone is allergic. What is a notable exception?
A
- AOM: 2-3rd gen cephalosporin in patients with non-severe cephalosporin allergy
- Aztreonam considered safe in patients with Immediate-type PCN allergy
20
Q
Drugs to avoid if someone has a Sulfa Allergy:
A
Sulfasalazine
Sulfadiazine
Thiazides
Loops (except ethacrynic acid)
Sulfonylureas
Acetazolamide
Zonisamide
Darunavir
21
Q
Drugs to avoid in someone with peanuts or soy allergies
A
Propofol
Clevidipine
22
Q
When is skin testing C/I for PCN allergies?
A
If the patient experienced SJS prior
23
Q
Situation: A pregnant woman has an allergy to PCN and presents with syphillis?
A
Desensitization & PCN treatment
24
Naranjo Scale
Can help determine the likelihood that a drug caused the adverse reaction
25
F calculation
(AUCextra/AUCintra) * (DOSEintra/DOSEextra)*100
26
Calcium corrected equation
Ca(reported) + ([4-albumin) * 0.8)
27
Phenytoin corrected equation
(Total phenytoin measure/(0.2*albumin) + 0.1)
28
Vd equation
Amt of drug in body (dose)/ Concentration in plasma
29
Clearance equation
Rate of elimination/Drug concentration
30
AUC & Cl equation
F*Dose/AUC
31
0 order vs 1st order
0-order: Constant amount is removed per unit of time
1st order: Constant percentage is removed per unit of time
| T1/2 is constant is 1st order and NOT in 0-order
32
Common drugs that exhibit Michaelis-Menten kinetics
Phenytoin
Theophylline
Voriconazole
33
Elimination rate constant (Ke)
Cl/VD
34
Predicting drug concentrations
C2 = C1 X E^-kt
35
Half-life equation
0.693/Ke
36
Loading dose equation
(Desired concentration * VD)/F
37
Allopurinol: prior testing
HLA-B*5801
38
Carbamazepine, Oxcarbazepine: prior testing
HLA-B*1502
39
Clopidogrel: genetic testing
CYP2C19
40
Codeine: genetic testing
CYP2D6
41
Warfarin: genetic testing
CYP2C9*2 and VKORC1
41
Trastuzumab: genetic testing
HER2 (if negative, drug will not work)
42
Cetiximab: genetic testing
KRAS mutation (If positive, don't use)
KRAS negative = wild type = should receive
43
Azathioprine: genetic testing
TPMT
Low/absent lvls risk of severe, life threatening myelosuppression
**IF low/absent, use low dose or alternative treatment**
44
Capecitabine/Fluorouracil: genetic testing
DPD deficiency (inc risk of severe toxicity). If DPD deficient, do not use
45
Folic acid requirements for women in child-bearing years
600 mcg DFE = 360 mcg of folic acid
46
St Johns Wort: drug interactions
Induces CYP450, 3A4, 2C19, 2C9, 1A2
Serotonergic
Photosensitivity
May lower seizure threshold
46
Supplements that increase bleeding risk
5 G's: garlic, ginger, ginkgo, ginseng, glucosamine
Fish oil
Vitamin E
Dong quai
Willow bark (a salicylate)
47
Supplements that can be hepatotoxic
Black cohosh (used for menopausal symptoms)
Kava (used for stress/anxiety)
48
Supplements with cardiotoxicity risk
1. Ephedra (replaced by bitter orange or synerphrine): stimulants
2. DMAA
3. Yohimbe is used to inc. libido & for ED
49
Supplements for anxiety
Valerian
Passionflower
Kava
St Johns Wort
50
Supplements for ADHD
Omega-3-fatty acids
51
Supplements for cold sores
L-lysine
52
Supplements for colds & flu
Echinacea
Zinc
Vit C
53
Supplements for memory
Ginkgo
Vitamin E
54
Supplements for depression
St. Johns Wort
SAMe
Valerian
5-HTP
55
Supplements for diabetes
Alpha lipoic acid
Chromium
Cassia cinnamon
56
Supplements for dyslipidemia
Red yeast rice
Fish oils
57
Supplements for dyspepsia
Ca
Mg
58
Supplements for energy/weight loss
Bitter orange
Caffeine
Guarana, green tea powder
59
Supplements for ED
Ginseng
L-arginine
Yohimbe
60
Supplements for hypertension
Fish oils
L-arginine
Co-Q-10
Garlic
61
Supplements for GI health
Fibers
Chamomile
Probiotics
62
Supplements for Heart health
Co-Q-10
Hawthorn
Fish oils
63
Supplements for inflammation
Fish oils
Flax seeds/oil
Turmeric
64
Supplements for insomnia
Valerian
Melatonin
Chamomile
65
Melatonin dosing for jetlag
0.5-2mg preflight
5mg post-flight
66
Supplements for liver disease
milk thistle
67
Supplements for menopause
Black cohosh
Dong quai
Evening primrose oil
Soy, red clover
67
Supplements for migraine ppx
FeverFew
Butterbur
Mg
Riboflavin (vit B2)
CoQ10
68
Supplements for motion sickness
Ginger
Peppermint
69
Supplements for osteoarhritis
Glucosamine
Chondroritin
SAMe
Turmeric
69
Supplements for osteoporosis
Ca
Vit D
Soy
70
Supplements for prostate health
Saw palmetto
Lycopene
71
Supplements for skin conditions
Tea tree oil
72
Supplements for UTis
Cranberry
72
Safety issues with bitter orange
Stimulant
72
Safety issues with 5-HTP
Serotonergic
73
Safety issues with Feverfew
Mouth ulceration, inc. bleeding risk
74
Safety issues with fibers
GI effects (e.g. bloating, cramping, flatulence)
75
Safety issues with Hawthorn
Positive inotrope. Avoid concurrent use with digoxin (additive effect)
76
Safety issues with L-arginine
Converts into nitric oxide
77
Safety issues with passionflower
QT prolongation
78
Safety issues with red yeast rice (natural form of lovastatin)
CYP450 inhibitors (e.g. amiodarone) will inc. red yeast rice level.
79
Safety issues with SAMe
Serotonergic
Inc. bleeding risk
Do not use in bipolar disorder
80
Safety issues with Soy, red clover
Soy might inc. breast cancer risk in postmenopausal women
81
Safety issues with valerian
Sedation, CNS depressant
82
Safety issues with Vit C
Nephrolithiasis with high doses
82
Safety issues with Vit E
Bleeding risk, CVD Risk
**Do not exceed 400 IU daily**
83
Safety issues with Yohimbe
Inc. BP, Inc. HR, seizure risk
84
Safety issues with Zinc
Nasal products can cause loss of smell
85
Vitamin A
Retinol
86
Vitamin B1
Thiamine
86
Vitamin B2
Riboflavin
87
Vitamin B3
Niacin
88
Vitamin B6
Pyridoxine
89
Vitamin B9
Folic acid
90
Vitamin B12
Cobalamin
91
Vitamin C
Ascorbic acid
92
Vitamin D3
Cholecalciferol
93
Vitamin D2
Ergocalciferol
94
Vitamin E
Alpha-tocopherol
95
Folic acid requirements (women)
400mcg/day = All women of child bearing age
600 mcg/day = during pregnancy
96
How much folate is in prescription prenatal vitamins?
1 mg
97
AAP iron recommendations
4-6 months: formulas contain adequate iron. However, breastfed babies need 1mg/kg/day from 4-6 months and until consuming iron-rich foods.
98
Nutritions depleted with acetazolamide
Ca
K
99
Nutritions depleted with antiepileptics
Ca
100
Nutritions depleted with amphotericin B
Mg
K
101
Nutritions depleted with isoniazid
Vitamin B6
102
Nutritions depleted with loops
K+
103
Nutritions depleted with metformin
vitamin B12
104
Nutritions depleted with MTX
Folate
105
Nutritions depleted with Orlistat
Beta-carotene
Fat-soluble vitamins
106
Nutritions depleted with PPIs
Mg
Vitamin B12
107
Nutritions depleted with SXT-TMP
folate
108
Supplements recommended with AUD
Vitamin B1
Folate
108
Supplements recommended with macrocytic anemia
vitamin b12
folate
109
Supplements recommended with microcytic anemia
iron
110
Supplements recommended with pregnancy
Folate
Ca++
Vit D
Pyridoxine
111
Supplements recommended with CKD
Vit D
112
Poison control center phone #
1-800-222-1222
113
Initial management: topical exposure
remove contaminated clothing
wash skin with soap & water for 10 minutes
114
Initial managment: ocular exposure
remove contact lenses
rinse eyes with a gentle stream of water for at least 15 minutes
115
Ipecac syrup
No longer recommended
116
When is activated charcoal most useful?
within 1 hr
117
Activated charcoal: dose
1g/kg
118
what is recommended to do prior to administering activated charcoal?
Airway protected to prevent aspiration
**Hydrocarbons can inc. risk of aspiration**
119
When is activated charcoal contraindicated?
A. When airway is unprotected, including:
1. is unconscious
2. cannot clear their throat
3. cannot hold their head upright
B. With intestinal obstruction
C. When the GI tract is not intact or when there is dec. peristalsis
119
Acetaminophen overdose: phase 1 (1-24 hrs)
Common asymptomatic or nonspecific symptoms (N/V)
120
Acetaminophen overdose: phase 2 (24-48 hrs)
INR elevation, Inc. AST/ALT
121
Acetaminophen overdose: phase 3 (48-96 hrs)
fulminant hepatic failure (e.g. jaundice, coagulopathy, renal failure, and/or death)
122
Acetaminophen overdose: phase 4 (> 96 hrs)
recovers or receives liver transplant
123
How does NAC work?
acts as a glutathione precursor, resulting in non-toxic metabolites
124
Anticholinergic overdose: symptoms + treatment
Symptoms: flushing, dry skin, mydriasis with blurry vision, AMS, fever
Treatment: supportive care, physostigmine (inhibits enzyme that breaks down ACh)
125
Apixaban, Rivaroxaban overdose: treatment
Andexanet alfa (Andexxa)
126
Dabigatran overdose: treatment
Idarucizumab (Praxbind)
127
Warfarin overdose: treatment
Phytonadione (vitamin K)
128
Heparin, LMWH overdose: treatment
Protamine
129
Warfarin, Factor Xa inhibitor overdose: treatment
Prothrombin complex concentrate (Kcentra)
130
Antipsychotics overdose treatment:
Primarily supportive care
Benztropine for dystonias
131
Benzodiazepines overdose treatment:
Flumazenil (can cause seizures) if used in pts taking benzos chronically
132
Beta-blockers overdose treatment:
Glucagon (if unresponsive to symptomatic treatment)
133
CCB overdose treatment:
Same as BB plus Calcium (IV)
134
Cyanide (smoke inhalation, nitroprusside in high doses/duration/renal impairment) overdose treatment:
Hydroxocobalamin (Cyanokit)
Sodium thiosulfate + sodium nitrite (Nithiodote)
135
Digoxin overdose treatment:
Digoxin immune fab (DigiFab)
136
Ethanol overdose treatment:
Thiamine to prevent wernicke's
Can cause inc. anion gap
137
Heavy metals (arsenic, copper, gold, etc) overdose treatment:
Dimercaprol
Succimer (for lead)
Penicillamine (for copper)
138
Hydrocarbons: petroleum products overdose treatment:
Do not induce vomiting. Keep pts NPO d/t aspiration risk.
139
Insulin or other hypoglycemic overdose treatment:
Dextrose: don't administer if unconscious
Glucagon
140
Isoniazid overdose treatment:
Pyridoxine (vitamin B6): IV for acute neurotoxicity
141
Iron and aluminum overdose treatment:
Deferoxamine (Desferal)
142
Organophosphates (including industrial insecticides) overdose treatment & symptoms:
Symptoms: SLUDD symptoms d/t acetylcholinesterase blockade
Treatment: Atropine, Pralidoxime (reactivates cholinesterase) **Combo can be used **
143
MTX overdose treatment:
Leucovorin (Folinic acid)
Levoleucovorin (Fusilev)
Glucarpidase (Voraxaze)
144
Methemoglobinemia overdose treatment:
Methylene blue **C/I in G6PD deficiency**
145
Neostigmine, pyridostigmine overdose treatment:
Pralidoxime +/- atropine
146
Nicotine overdose treatment + symptoms:
Symptoms: abdominal pain, nausea
Treatment: supportive care, atropine (for symptomatic bradycardia), benzos (for seizures)
147
Salicylates overdose treatment:
Sodium bicarbonate
148
Stimulant overdose treatment:
Benzos
149
Toxic alcohols: ethylene glycol (antifreeze), methanol overdose treatment:
Fomepizole
150
TCAs overdose treatment:
Overdose can quickly cause fatal arrhythmia
Treatment: sodium bicarb to dec a widened QRS complex
151
Valproic acid or topiramate induced hyperammonemia overdose treatment:
Levocarnitine (Carnitor)
152
Animal bites antidotes
Rabies vaccine (RabAvert, Imovax Rabies) + Human rabies Immune immunoglobin
153
Black widow spider bites antidotes
Antivenin for Latrodectus mactans
154
Scorpion stings antidotes
Antivenin immune FAB for centruoides (Anascorp)
155
Snake bites antidotes
Crotalidae polyvalent immune FAB (CroFab) for copperhead and rattlesnake bites
