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Pharm 2 > Unit 1 Exam > Flashcards

Unit 1 Exam Flashcards

HEENT and Mental Health

1
Q

Acute Otitis Media

Treatment?

A

**Pain **-> motrin/tylenol
1st Line -> Amoxicillin x 7-10 days

PCN allergy -> Azithromycin (macrolide)
PCN allergy 2 -> Cefdinir (3rd gen cephalosporin)

Amoxicilin 80-90mg/kg divided BID (max 875mg BID)

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2
Q

Acute Otitis Media

Pt Education?

A

AOM is common
Abx compliance important!!!
Most cases self-limited to 1 week
Taking abx when not needed harmful
Sx’s improve in 2-3 days, if not then f/u

Ab overuse -> abx resistance

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3
Q

Acute Otitis Media

Risk Factors?

A

Smoke exposure
Not breast feeding
Daycare
Not UTD on vaccines

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4
Q

Acute Otitis Externa (Bacterial)

Overview of AOE?

goals, overarching idea

A

Goals -> pain management and fight infection
+ ear canal must be debrided prior to tx
+ ear wicks can be used to reach entire infection BUT must be changed q 48 hrs

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5
Q

Acute Otitis Externa (bacterial)

Treatment?

Pain and First Line, no recurrence

A

Pain -> motrin/tylenol or codeine
1st line -> alcohol/acetic acid solution

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6
Q

Acute Otitis Externa

Treatment for persistent infection?

A

TM Intact -> Cipro/dexamethasone, Cipro/fluocinolone, Cipro/hydrocortisone, neomycin or polymyxin (ototoxic)

TM Not inact? NON-OTOTOXIC drops only!!

depends on if TM is intact/visualized
today’s tx of AOE is fluoroquinolone (cipro) + glucocorticoid (dexamethasone)

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7
Q

Acute Otitis Externa

Systemic Therapy?

pt population and meds

A

needed most often in immunocompromised, DM, or when infection spreads past ear canal

Adults -> PO Cipro
Peds -> PO Cephalexin

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8
Q

Acute Otitis Externa

Pt Education?

A

keep ear canal dry!
do not place ANYTHING in the ear!
most improve in 3 days and resolve by 10 days
do NOT use ear plugs

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9
Q

Ear Infections

What medication should be prescribed if a pt has taken Amoxicillin in the last 30 days?

A

Augmentin

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10
Q

Ear Infections

If H. flu or M. catarrhalis are suspected, what med do you give?

A

Augmentin

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11
Q

Ear Infections

Pt presents with non-intact TM. Which ear drops should you avoid? Why?

A

Ototoxic drops such as neomycin or polymyxin

can cause deafness

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12
Q

Bacterial Pharyngitis

MC Etiology?

causative organism

A

Streptococcus pyogenes (GABHS)

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13
Q

Bacterial Pharyngitis

What criteria is used in diagnostics for strep throat?

A

Crentor Criteria
- absence of cough
- fever
- tonsillar exudates
- anterior cervical LAD

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14
Q

Bacterial Pharyngitis

First line treatment

Adult and Peds

A

Adult -> PencillinV 500mg po BID x 7-10 days

Peds -> Amoxicillin 45mg/kg divided BID x 7-10 days (max 500-875 mg BID)

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15
Q

Bacterial Pharyngitis

What med should be given if the patient has a PCN allergy?

A

Azithromycin 500mg po x1, 250mg PO days 2-5

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16
Q

Acute Bacterial Sinusitis

General Information

how common, time frame, sx’s

A

Less common
sx’s >10 days
fever, purulent mucous

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17
Q

Acute Bacterial Sinusitis

Etiology

class of organisms

A

gram + or anaerobes

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18
Q

Dental Infections

First Line treatment?

A

Augmentin 500-875/125mg po BID x 7-10 days

Amoxicilliln/Clavulanate

avoid with PCN allergy

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19
Q

Dental Infections

What med should be given if a patient has PCN allergy?

PCN = penicillin

A

Cefuroxime 500mg po BID + Metronidazole 500mg po TID x 7-10 days for both

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20
Q

Anaphylaxis

Describe the condition.

A

presents as mass inflammation and dilation of the body in a severe, life-threatening form

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21
Q

Anaphylaxis

Immediate treatment

A

Epinephrine (in house or epi-pen) q 5-15 minutes until they improve

max 3 doses

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22
Q

Anaphylaxis

Pt has been given x3 rounds of epi-pen w/o improvement. What treatment should you do next?

A

IV Epinephrine infusion

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23
Q

Anaphylaxis

What non-medicine steps should you do with a pt in anaphylatic shock?

A

manage airway!1
lay supine with legs elevated
give supplemental o2
treat HOTN with rapid infusion NS

albuterol prn for bronchospasm

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24
Q

Anaphylaxis

What adjunct therapy can be considered?

A

antihistamines or steroids

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25
Q

Anaphylaxis

Epi-pen dosing and administration instructions

A

Adult 0.3-0.5 mg
Peds 0.01mg/kg

inject epi-pen IM mid outer-thigh

Peds switch to adult dosing when > 30kg

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26
Q

Seasonal Allergies

Which medication class is MOST effective in treating seasonal allergies?

A

Glucocorticoids!

  • prevent inflammatory response to allergens thus reducing ALL symptoms

nasal use can cause nasal irritation and slowing of growth in pediatrics

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27
Q

Seasonal Allergies

What medication class is the 2nd most effective in treating seasonal allergies?

NOT glucocorticoids

A

Antihistamines!
- reduces itching, sneezing, rhinorrhea

no effect on congestion

1st gen can cause CNS effects (sedation) and anticholinergic effects (drying, urinary hesitancy, palpitations)
can be nasal or oral, bitter taste

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28
Q

Seasonal Allergies

Cromolyn

A
  • moderate decrease in all symptoms
  • nasal use, no ADR’s
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29
Q

Seasonal allergies

Which medication class decreases CONGESTION only?

and also has ADR’s

A

Sympathomimetics!
- nasal or oral

nasal causes rebound congestion if prolonged use occurs
oral can cause systemic sympathetic effects

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30
Q

Seasonal Allergies

Which medication class reduces secretions only?

A

Anticholinergics!
- nasal use BUT can cause nasal drying + irritation

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31
Q

Seasonal Allergies

Which medication class reduces nasal congestion only and is very safe?

no significant ADR’s

A

Leukotriene inhibitors

Montelukast

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32
Q

Cough/Cold

Expectorants

what they do + ADR

A

increase respiratory rate of fluid secretion
- N/V and dizziness

lets you cough up the mucous better

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33
Q

Cough/Cold

Decongestants

what they do + ADR’s

A

Constrict blood vessel’s and reduce nasal congestion
- rebound congestion, HTN, sympathetic effects, abuse potential (pseudoephedrine)

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34
Q

Cough/Cold

Antitussive’s

what they do + ADR’s

A

Suppress cough reflex by acting on Medulla
- drowsiness, dizziness, nausea, abuse potential (codeine, dextromethorphan)

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35
Q

Cough/Cold

Mucolytics

what they do + ADR’s

A

Breakdown mucous chemically
- N/V and rhinorrhea

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36
Q

Cough/Cold

Antihistamines

what they do in this setting + ADR’s

A

Reduce nasal secretions and cough reflex
- drowsiness, dry mouth, blurred vision

ADR’s really depend on which antihistamine type is given

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37
Q

Cough/Cold

Inhaled corticosteroids

what they do + ADR’s

A

Reduce airway inflammation and mucous production
- thrush, hoarseness, cough

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38
Q

Cough/Cold

Anticholinergics

what they do + ADR’s

A

Reduce bronchoconstriction and mucous productions
- dry mouth, throat irritation, HA

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39
Q

Lifespan Antihistamine Use

Infant concerns with antihistamines use?

A

can cause sedation
- used in small doses > 6 months but caution should be maintained

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40
Q

Lifespan Antihistamine Use

Children/Adolscent antihistamine use

A

use in small doses, side effects similar to those in adults

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41
Q

Lifespan Antihistamine Use

Pregnancy and Antihistamine use

A

Category C!
- avoid unless ABSOLUTELY necessary

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42
Q

Lifespan Antihistamine Use

Breastfeeding Women and Antihistamine use

A

small doseas appear not to cause sedation with infants BUT caution is still advised

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43
Q

Lifespan Antihistamine Use

Older Adults/Elderly/Geriatrics and Antihistamine use

A
  • many antihistamines should be avoided or started in small doses and titrated up
  • worsen glaucoma and BPH
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44
Q

Antihistamines

Key Prescribing Considerations

A

ID high risk pt’s and those with conditions that can be worsened by muscarinic blockage!

Minimize adverse effects -> if sedation is an issue, pt can take at night prior to sleep. If GI upset is issue, pt can take with food

asthma, urinary retention, BPH, open-angle glaucoma

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45
Q

Lifespan Glucocorticoid Use

Children and Glucocorticoid use

A

long-term use can inhibit bone growth and decrease stature, as well as increase risk for lifetime osteoporosis

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46
Q

Lifespan Glucocorticoid Use

Pregnancy and Glucocorticoid use

A

increased risk of fetal cleft palate and neonatal hypoadrenalism

If NEEDED, Hydrocortisone is preferred

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47
Q

Lifespan Glucocorticoid Use

Breastfeeding women and Glucocorticoid use

A

low doses are okay but high doses NOT recommended

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48
Q

Lifespan Glucocorticoid Use

Elderly and Glucocorticoid use

A

risks associated with prolonged use are significantly higher (osteoporosis, adrenal insufficiency, GI ulceration)

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49
Q

Lifespan Glucocorticoid Use

Pt Education Points

A
  • take in AM to mimic natural physiologic timing of hormone release
  • do not stop abruptly -> withdrawal sx’s can occur
  • take with milk or snack to reduce GI discomfort
  • Carry ID of being on long-term GCS use for medical providers in ER
  • Education pt on infection sx’s
  • Risk of cataracts, glaucoma, GI bleeds
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50
Q

Glucocorticosteroids

Tapering Schedule

A

tapering recommended after > 10 days or high doses of systemic therapy TO ALLOW FOR recovery of adrenal function

  • taper dose to physiologic range over 7 days
  • taper dose to 50% of physiologic value over 1 month
  • Monitor production of endogenous cortisol!
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51
Q

Glucocorticoids

What is the therapeutic goal in prescribing glucocorticoids?

A

reduce and control harmful inflammatory and allergic reponses

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52
Q

Glucocorticoids

What baseline PT data should be obtained when starting a glucocorticoid?

A

H&P w/ particular attention to neuromuscular exam and opthalmic exam
- sx’s of infection
- BP, BMI
- Labs: CBC w/ diff, serum Glucose, BMP, Lipid panel, Bone mineral denisty (BMD), and latent TB

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53
Q

Glucocorticoids

What monitoring should be done with a pt on long-term glucocorticoid use?

A
  • Labs: CBC, glucose, electrolytes, and lipids in 1 month then q6-12 months
  • Eye exam q 6 months
  • Check for muscle weakness at each visit
  • BMD in 1 year then q2-3 yrs
  • Peds height every 6 months
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54
Q

Glucocorticoids

High Risk Pt’s

A

immune disorder, DM, CV dz, impaired renal function, H/O osteoporosis, open-angle glaucoma, GI dz, recent receival of live-vaccine

digoxin use, NSAID use, insulin use

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55
Q

Glucocorticoids

Minimizing Adverse Effects

A
  • Osteoporosis -> Ca + Vit D
  • Glucose intolerance -> may need to increase dose of hypoglycemia med
  • Myopathy -> reduce steroid use
  • Fluid/Electrolyte -> limit Na intake, increase K intake
  • Growth delay -> minimized w/ alternate day therapy
  • Psych disturbances -> dependent on dosage, sx’s reverse when med is withdrawn
  • Peptic Ulcer -> avoid NSAIDS + give H2 blocker
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56
Q

Primary Open Angle Glaucoma

Pathophysiology/Etiology

how does it happen?

A

Gradual increase in IOP leads to optic nerve damange due to narrow angle in aqueous humor flow
- results in vision loss that starts peripherally and moves centrally

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57
Q

Primary Open Angle Glaucoma

Which options are considered definitive treatment options?

A

Trabeculectomy and Laser trabeculoplasty

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58
Q

Primary Open Angle Glaucoma

First-line Med Therapy Options

A
  • Beta blocker -> Timolol 0.25% 1gtt in affected eye(s) BID
  • Selective BB -> Betaxolol
  • Prostglandin Analog -> Latanoprost
  • Alpha2 Agonist -> Brimonidine

Latanoprost can cause darkening of iris’s

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59
Q

Primary Open Angle Glaucoma

Second-line Med Therapy Options

A
  • Cholinergic Muscarinic Agonist -> Pilocarpine
  • Cholinergic Cholinesterase Inhibitor -> Echothiphate
  • Carbonic Anhydrate Inhibitor -> Acetazolamide
  • Rho Kinase Inhibitor -> Netarsudil
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60
Q

Primary Open Angle Glaucoma

Pt Education

for meds/condition

A
  • take meds according to schedule (if days are skipped, vision loss may occur)
  • Call doc ASAP if having vision loss, eye pain, HA, or N/V (AACG)
  • Photophobia? sunglasses, hat
  • Caution with contacts!! If ggt has benzalkonium, wait 15 minutes before putting in
  • Do NOT touch eyedropper
  • close eyes for 3 minutes and lightly press thumb over medial cnathus to increase absorption
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61
Q

Primary Open Angle Glaucoma

Prescribing Considerations

A
  • periodic evals compare to baseline data to evaluate therapeutic effect
  • minimize adverse effects
  • identify high risk patients

High Risk Pt’s: hx of med noncompliance, HF, bradycardia, HB, asthma, COPD

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62
Q

Acute Angle Glaucoma

Pathophysiology/Etiology

A

Sudden increase in IOP and nerve damage caused by complete obstruction in aqueous humor flow
- if left untreated, will cause permanent vision loss in 1-2 days

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63
Q

Acute Angle Glaucoma

What meds should immediately be given?

A

Acetazolimide -> rapidly decrease IOP
Pilocarpine -> reverse angle closure
Refer to optho for corrective surgery

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64
Q

Allergic Conjunctivitis

Pathophysiology/Etiology

A

Biphasic inflammation of the conjunctiva in response to an allergen
- release of inflammatory mediators w/i 20 minutes causing mucous production and vaso dilation
- abates in 20 minues then -> amplification response 6+ hrs later

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65
Q

Allergic Conjunctivitis

Sx’s

A

itching, burning w/ thin watery discharge and red congested eyes

can be seasonal or perennial

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66
Q

Allergic Conjunctivitis

Most Effect Tx Options

A

Mast Cell Stabilizer w/ symptomatic relief meds until the mast cell med reaches full effectiveness (in 2+ weeks)

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67
Q

Allergic Conjunctivitis

Meds Used for Symptomatic Relief

A
  • H1 Receptor Antagonist (Antihistamine): provide immediate relief by blocking histamine release
  • NSAIDS: reduce inflammatory sx’s by preventing prostaglandin synthesis
  • Glucocorticoids: reduce inflammatory sx’s by preventing prostaglandins, leukotrienes, and thromboxane synthesis
  • Ocular decongestants: cause vasoconstriction immediately thrugh activation of alpha-1-adrenergic receptors
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68
Q

Allergic Conjunctivitis

Pt Education Points

A
  • allergen avoidance can reduce severity of sx’s
  • Oral antihistamines will probably cause eye dryness
  • artificial tears may provide relief
  • Application of cold compresses 5-15 minutes at home may help discomfort
  • Avoid rubbing eyes/contact use
  • Wait at LEAST 5 minutes b/w multiple drug administration
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69
Q

Allergic Conjunctivitis

What are the therapeutic goals with medication prescribtions?

A

relief of sx’s + prevention of associated complications that occur secondary to eye irritation or vigorous eye rubbing

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70
Q

Allergic Conjunctivitis

High Risk Patients

A

Pt’s with h/o AACG -> ocular decongestants are contraindicated

Cataracts -> long-term glucocorticoid use may increase IOP

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71
Q

Allergic Conjunctivitis

What med class should not be used for longer than 2 weeks? Why?

A

Decongestants!
- can cause rebound congestion

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72
Q

Dry Eye

Medication Classes Used in Treatment

only the class names. not what they do

A
  • Opthalmic Demulcent
  • Immunomodulators
  • Ocular Decongestants
  • Glucocorticoids
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73
Q

Dry Eye

Opthalmic Demulcent Tx

A

aka Artificial Tears
- isotonic solutions that can be used as much or as often as needed
- No ADR’s

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74
Q

Dry Eye

Immunomodulator Tx

A

Topical Cyclosporine Opthalmic Emuslsion
- aka Restasis

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75
Q

Dry Eye

Ocular Decongestant Tx

A

vasoconstrict dilated vessels leading to redness
- can cause rebound congestion with overuse
- NO MORE THAN 2 WEEKS
- i.e., Phenylephrine, Naphazoline, Oxymetazoline, Brimonidine, Tetrahydrozoline

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76
Q

Dry Eye

Glucocorticoid Tx

A

used in absence of infection but can have significant ADR’s
- ADR’s: catarct, reduced VA, glaucoma
- may cause permanent vision loss if given with present infection

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77
Q

Bacterial Conjunctivitis

Etiology/Pathophysiology

A

infection/inflammation of the eye, usually only treated when serious
- all optic abx are topical and used for 7-14 days

all the abx are equally effective as the other

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78
Q

Bacterial Conjunctivitis

Tx Options?

A
  • Fluoroquinolones: Cipro or Ofloxacin
  • Aminoglycosides: Tobramycin
  • Macrolides: Erythromycin
  • Tetracycline: Doxycycline
  • Polymyxin B/Trimethoprim

Erythromycin 0.5% ointment 1cm to affected eye(s) q4-6 hrs

79
Q

Bacterial Conjunctivitis

Pt Education/Key Prescribing Considerations

A
  • Bacterial and Viral conjunctivitis are VERY contagious
  • No contact lens PERIOD when eyes are being treated (increased risk of Pseudomonas)

Bacterial infectious until 48 hrs of treatment
Viral infectious until completely gone

80
Q

Major Depressive Disorder

Etiology/Pathophysiology

What is it?

A

Mood disorder characterized by depressed mood and anhedonia
- thought to be caused by the monoamine oxidase theory

81
Q

Major Depressive Disorder

PHQ 9 score qualifer

A

Pts with a score > 15 meet criteria for MDD diagnosis

82
Q

Major Depressive Disorder

What medication treatment options are there?

main overarching classes

A

SSRI’s
SNRI’s
TCA’s (OD easy)
MAOI’s
Atypical’s

83
Q

Major Depressive Disorder

What are some therapeutic treatment options?

non pharm

A

CBT and Somatic therapy + adjunct therapy with meds

84
Q

Major Depressive Disorder

How are drug classes chosen for a patient?

A

Drug/Classes are chosed based on the ADR’s

pt struggles to sleep? choose one with drowsiness as an ADR

85
Q

Major Depressive Disorder

What other work-up must be done when first diagnosing a PT with MDD?

A

TSH -> r/o thyroid disorder
HCG -> r/o pregnancy
CBC -> r/o anemia
EKG -> many tx options cause QT prolongation

86
Q

Major Depressive Disorder

How long does it typically take to see results from pharm therapy?

A

Drug response begins in 1-3 weeks but takes 12 weeks to reach full effect

87
Q

Major Depressive Disorder

What are the pharm timeline recommendations for MDD?

A
  • 1st event -> tx for x6 months
  • 2nd event -> continued for 6-9 months
  • 3rd event -> consider lifetime therapy
88
Q

Major Depressive Disorder

What is a major point of pt education when starting a medication for MDD?

A

Increased risk of suicide at week 3!
- typically decreases by week 4
- thought to be due to pt finally having the energy to actually carry through with their plan

89
Q

Major Depressive Disorder

What do you do if a drug is not effective for a pt after an 8 week trial?

A

Many Options!
- increase dosage (typically first step)
- Switch to diff drug w/i the same class (poor side effects?)
- Switch to a drug in diff class
- Add a second drug (consult psych!!)

90
Q

Major Depressive Disorder

Serotonin Syndrome

What is it?

A

potential lethal cluster of sx’s caused serotonin receptor overstimulation
- starts days after starting a new medication

91
Q

Major Depressive Disorder

How does Serotonin Syndrome present?

A

Pt precents with AMS, agitation, confusion, disorientation, anxiety, hallucinations, poor concentration, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, fever
- potentially fatal

92
Q

Major Depressive Disorder

Serotonin Syndrome Tx

A
  • D/C new med that was started
  • Start Benzodiazepines
  • Give o2
  • IV fluids
  • cardiac montioring and supportive care for hyperthermia
93
Q

Major Depressive Disorder

Describe the Hunter Criteria for Serotonin Syndrome.

A

pt has taken one serotonergic agent and has one of the following:
- spontaneous clonus + inducible clonus + agitation
- diaphoresis + ocular clonus + agitation
- diaphoresis + tremor
- Hyperreflexia + hypertonia + temp > 38c

94
Q

Major Depressive Disorder

What is Neonatal Abstinence Syndrome?

A

Syndrome seen in neonates whose mothers are taking/did take SSRI’s/SNRI’s during pregnancy

95
Q

Major Depressive Disorder

How does Neonatal Abstinence Syndrome present?

A

Neonate with irritability, abnormal crying, tremor, respiratory distress +/- seizures

tx -> supportive care, baby is essentially going through withdrawal

96
Q

Major Depressive Disorder

What is Persistent Pulmonary HTN (PPHN)?

A

severe respiratory distress in a neonate caused when they are born to mothers who did take/are taking SSRI’s/SNRI’s during pregnancy

97
Q

Major Depressive Disorder

Persistent PHTN Tx

A
  • Neonate placed in ICU on vent support
  • Acid base and CV support
98
Q

Major Depressive Disorder

What is SSRI Discontinuation Syndrome?

A

Withdrawal that can occur when pts d/c their serotonin medication

99
Q

Major Depressive Disorder

How does SSRI Discontinuation Syndrome present?

A

dizziness, fatigue, HA, nausea

No tx needed

100
Q

Major Depressive Disorder

Explain HTN Crises in regards to MDD tx.

A

HTN crises that occur with MAOI’s and eating tyramine

Pt presents with HTN, N/V, HA, diaphoresis

101
Q

Major Depressive Disorder

Explain TCA’s and why they are used as last-line treatment for MDD.

A

they are easy to OD on
- TCA OD’s must be treated with intubation, gastric lavage, activated charcoal, and IV Na Bicarb

102
Q

Major Depressive Disorder

1st Line Antidepressant Tx Options?

A

SSRI’s -> block neuronal reuptake of Serotonin
- Escitalopram
- Fluoxetine
- Paroxetine
- Sertraline 50mg po QD

SNRI’s -> block neuronal reuptake of Serotonin AND Norepi
- Venlafaxine

Other -> Bupropion XR 150mg po qAM

Sertralin can be started at 25mg po QD

103
Q

Major Depressive Disorder

Second Line Antidepressant Tx Options?

A

TCA’s -> block neuronal reuptake of Serotonin, Norepi, Histamine, Muscarinic, AND Alpha adrenergic receptors
- Imipramine

MAOI’s -> Phenelzine

104
Q

Peripartum Depression

What is it?

A

Depression that is thought to be caused by a sharp drop in estrogen and progesterone after delivery

105
Q

Peripartum Depression

Tx Options?

A

Education + Pharmacotherapy
- Sertraline
- NO FLUOXETINE (can cause Colic and slow weight gain of baby)
- Reduce isolation, ensure adequate rest, and spent time alone with partner or support system

106
Q

Anxiety Conditions

What disorders are included in Anxiety condition?

A
  • Generalized Anxiety Disorder (GAD)
  • Obsessive Compulsive Disorder (OCD)
  • Post-Traumatic Stress Disorder (PTSD)
  • Panic Disorder (PD)
  • Social Anxiety Disorder (SAD)
107
Q

Anxiety Conditions

What is GAD and how does it present?

Generalized Anxiety Disorder

A

Unrealistic or excessive anxiety about several events lasting > 6 months
- pesents as vigiliance, tension, apprehension, poor concentration, sleep problems, trembling, muscle tension, restlessness, signs of hyperactivity (palpitations, sweating, tachycardia)

108
Q

Anxiety Conditions

Tx options for GAD?

Generalized Anxiety Disorder

A
  • Non-pharm: Supportive therapy, CBT, Biofeedback and Relaxation training
  • SSRI/SNRI and Buspirone for cognitive sx’s
  • Benzo’s used PRN for somatic sx relief (rapid onset)
  • Propanolol for somatic sx relief
109
Q

Anxiety Conditions

SRI Med Options for GAD?

Serotinin Receptor Inhibitor

A
  • Venlafaxine (SNRI)
  • Paroxetine (SSRI)
  • Escitalopram (SSRI)
110
Q

Anxiety Conditions

What is Panic Disorder (PD) and how does it present?

A

Recurrent intense and uncomfortable episodes (panic attacks) with abrupt surges of fear or intense discomfort
- peaks in a few minutes and dissipates within 30 minutes

111
Q

Anxiety Conditions

What treatment options are there for PD?

Panic Disorder

A

CBT + Pharmacotherapy x 6-9 months
- Drug chosen based on ADR’s

112
Q

Anxiety Conditions

What Pt Education should be given with those struggling with an Anxiety disorder?

A

Avoid the following:
- caffeine
- sympathomimetics
- sleep deprivation can worsen sx’s

Encourage regular exercise!

113
Q

Anxiety Conditions

What is Obsessive Compulsive Disorder (OCD) and how does it present?

A

Persistent obsession and compulsion causing marked distress, consuming at least 1 hour a day and interferes with daily living

114
Q

Anxiety Conditions

What TX options are there for PD?

Panic Disorder

A

CBT + Pharmacotherapy (SRI’s) x 1 year
- taper the SRI to prevent recurrence of episodes

115
Q

Anxiety Conditions

What is Social Anxiety Disorder (SAD) and how may it present?

A

Intense irrational fear of situations in which one might be scrutinized or humiliate themselves

116
Q

Anxiety Conditions

What tx options are there for SAD?

Social Anxiety Disorder

A

CBT + Pharmacotherapy
- First line -> SSRI’s
- 2nd line -> benzo’s PRN or BB (Propanolol) to decrease somatic sx’s associated with social events

117
Q

Anxiety Conditions

What is Post-Traumatic Stress Disorder (PTSD) and how may it present?

A

Traumatic event elicited an immediate reaction of fear, helplessness, or horror followed by experiencing the event

118
Q

Anxiety Conditions

What tx options are there for PTSD?

Post-Traumatic Stress Disorder

A

Trauma focused therapy + pharmacotherapy
- 1st line -> Sertraline, Paroxetine, Venlafaxine
- 2nd line -> Mirtazapine, TCA, or MAOI

119
Q

Schizophrenia

What is Schizophrenia?

A

Mood disorder of unknown etiology causing positive (mesolimbic) and negative (mesocortical) sx’s

120
Q

Schizophrenia

List a few positive symptoms.

Recall: Mesolimbic system

A

Hallucinations, Delusions, Disorganized thoughts/speech

due to increased serotonin

121
Q

Schizophrenia

List a few negative symptoms.

Recall: Mesocortical system

A

Anhedonia, Avolition, Blunted affect

due to decreased serotonin

122
Q

Schizophrenia

What is the mainstay treatment of Schizophrenia?

A

Antipsychotics (1st and 2nd gen) based solely on side effects
- usually given orally but can be given depot leading to improved adherence, reduced hospitalization rates, and more stable serum levels

depot administration is costly and has risk of pt agitation due to feeling of decreased autonomy

123
Q

Schizophrenia

Goals of Therapy?

A

suppress acute episodes, exacerbations, and maintain the highest level of functioning possible

Tx takes 1-2 days to start working and several months for full response
**lifelong therapy

124
Q

Schizophrenia

How do you encourage adherence with medication tx?

A
  • Encourage family members to oversee medication management
  • Establish good therapeutic relationship with patient and/or family
  • Use IM depot for long-term therapy
125
Q

Schizophrenia

What are some common ADR’s associated with Antipsychotic medication therapy?

A

Extra-pyramidal Symptoms (EPS)!
- Acute dystonia (early): muscle spams, treated with Benztropine (anticholinergic)
- Parkinsonism (early): slowed movements, rigidity, tremor, tx via anticholinergic (diphen or benztropine), amantadine, or switch to SGA
- Akathisia (early): restless movements, anxiety/agitation, reduce dose to tx or switch to low potency FGA
- Tardive Dyskinesia (late): oral-facial dyskinesia, tx involves prevention b/c it can be irreversible

For Tardive dyskinesia, d/c all anticholinergics and give a benzo

126
Q

Schizophrenia

What is Neuroleptic Malignant Syndrome (NMS) and how does it present?

A

Presents as dysrhythmia’s, fluctuations in BP, falling in and out of consciousness/comatose, rigidity, high fever, sweating

127
Q

Schizophrenia

How do you treat NMS?

Neuroleptic Malignant Syndrome

A
  • Supportive care (cooling blankets and antipyretics)
  • Benzodiazepines
  • Dantrolene
  • Bromocriptine

!! Wait 2 weeks to resume antipsychotic therapy and switch to SGA prn

128
Q

Schizophrenia

Describe anticholinergic ADR effects associated with antipsychotic treatment?

A

Dry mouth, blurred vision, photophobia, urinary hesitancy, constipation, tachycardia

129
Q

Schizophrenia

Describe potential affects that antipsychotics may have on BP?

A

Orthostatic HOTN!
- occurs by blocking alpha/beta receptors leading to compensatory vasoconstriction when standing from supine position
- manage with slow movements + tolerance

130
Q

Schizophrenia

How do you manage the sedative affect of some antipsychotics?

A

Advise pt to take medication at night

131
Q

Schizophrenia

Describe the neuroendocrine effects of antipsychotic med treatment.

tuberoinfundibular effects

A

Increase in Prolactin can promote a variety of things
- breast tissue growth in men
- growth of cancer that is already present (may or may not realize the presence)

132
Q

Schizophrenia

Describe the effect of antipsychotic medication tx on Seizures

A

Antipsychotic meds lower the threshold for seizures
- easier risk for seizure to occur

133
Q

Schizophrenia

Describe the effects antipsychotic tx may have on sexual function?

A

Can result in sexual dysfunction and decreased libido
- consider switching drug or lowering dosage if this is a concern to the patient

134
Q

Schizophrenia

What is agranulocytosis and why does it occur?

in regard to pharmacotherapy

A

Neutrophil count is less than < 100 resulting in the immune system having decreased ability to fight infections

  • tx involves withdrawal of antipsychotic medication to allow for reversal
135
Q

Schizophrenia

What are some other ADR’s of antipsychotic med’s?

Not including EPS, NMS, Anticholinergic, Orthostatic HOTN, Sedation, Neuroendocrine effects, Seizures, Sexual dysfunction, or Agranulocytosis

A
  • Dysrhythmia’s via QT prolongation
  • Weight gain
136
Q

Schizophrenia

Which meds decrease suicidal thoughts?

A

Clozapine and Olanzapine

137
Q

Schizophrenia

Which meds have the lowest risk of weight gain?

A

Aripiprazole and Ziprasidone

138
Q

Schizophrenia

Which meds have the highest risk of weight gain?

A

Clozapine and Olanzapine

these meds also are best at decreasing suicidal ideation

139
Q

Schizophrenia

Which meds have the lowest risk of orthostatic HOTN?

HOTN = Hypotension

A

Haloperidol, Ariprazole, and Risperidone

140
Q

Schizophrenia

Which meds have the highest risk of orthostatic HOTN?

HOTN = Hypotension

A

Chlorpromazine

also highest risk of QT prolongation and sedation

141
Q

Schizophrenia

What meds have the lowest risk of QT prolongation?

A

Aripiprazole, Clozapine, Olanzapine, and Risperidone

Aripiprazole - lowest risk weight gain, sedation, and orthostatic HOTN

Clozapine - best at decreasing suicidal ideation, highest risk of weight gain and sedation

Olanzapine - best at decreasing suicidal ideation, highest risk of weight gain, best for lactating mothers

Risperidone - lowest risk of HOTN, QT prolongation, and sedation, increases prolactin

142
Q

Schizophrenia

Which meds have the highest risk of QT prolongation?

A

Chlorpromazine, Haloperidol, Quietipine, Ziprasidone

143
Q

Schizophrenia

Which meds have the lowest risk of sedation?

A

Haloperidol, Ariprazole, Risperidone

144
Q

Schizophrenia

Which meds have the highest risk of sedation?

A

Chlorpromazine and Clozapine

145
Q

Schizophrenia

Which antipsychotic med increases prolactin the most?

A

Risperidone

BUT lowest risk for ortho HOTN, QT prolongation, and sedation

146
Q

Schizophrenia

Which antipsychotic medication would you prescribe to a lactating mother?

A

Olanzapine

also best at decreasing suicidal thoughts and low risk of QT prolongation, but has highest risk of weight gain

147
Q

Schizophrenia

Which antipsychotic medication has the highest risk of developing EPS ADR’s?

EPS ADR’s: Acute dystonia, Parkinsonism, Akathisia, & Tardive Dyskinesia

A

Haloperidol

also lowest risk for ortho HOTN and sedation BUT highest risk of QT prolongation

148
Q

Bipolar Disorder

What is Bipolar disorder and how may it present?

A

Mood disorder characterized by periods of mania and depression with suspected cause being disruption in neuronal growth and survival

HIGH HIGHS followed by LOW LOWS

149
Q

Bipolar Disorder

How do you promote drug adherence in bipolar pt’s?

A

involving and education parents/support system

150
Q

Bipolar Disorder

What is the first-line tx option for Bipolar disorder?

A

Lithium (mood stabilizer) given to relieve sx’s during manic or depressive episodes without worsening any sx’s

151
Q

Bipolar Disorder

What are some things to keep in mind when prescribing Lithium for bipolar disorder?

A
  • can be VERY toxic!
  • baseline labs and EKG need to be done
  • pt’s must be monitored q 2-3 days during early treatment then q 2-3 months thereafter
  • lithium toxicity!!
152
Q

Bipolar Disorder

How does lithium toxicity present? And how do we treat?

A
  • N/V, tremors, confusion, blurred vision, tinnitus
  • IV aggressive NS fluids to dilute concentration
  • If sx’s persist s/p IV NS, proceed with hemodialysis PRN
  • avoid diuretics
153
Q

Bipolar Disorder

What are other mood stabilizer’s used in the tx of Bipolar disorder?

2nd and 3rd line options

A

Valproate (2nd) and Carbamazepine (3rd)

154
Q

Bipolar Disorder

What antipsychotics (SGA’s) are used in tx of Bipolar disorder?

A

Olanzapine and Risperidone
- usually given in combo with mood stabilizer to help control sx’s during severe manic episodes

155
Q

Bipolar Disorder

What antidepressant’s are used in the treatment of Bipolar disorder?

A

Bupropion, Venlafaxine, SSRI’s (Sertraline or Fluoxetine)
- given during depressive episodes but never as monotherapy for fear of increasing positive symptoms (mania)

156
Q

Dose Memorization Required

Amoxicillin for Strep tx

PCN class

A

Amoxicillin 45mg/kg divided BID (max 500-875 BID)

157
Q

Dose Memorization Required

Amoxicillin dose for O.M.

PCN

A

Amoxicillin 90mg/kg divided BID (max 875mg BID)

158
Q

Dose Memorization Required

Augmentin dosing

Amoxicillin/Clavulanate

A

500-875mg/125mg po BID

159
Q

Dose Memorization Required

Azithromycin

strep treatment

A

500mg PO day 1
250mg PO days 2-5

160
Q

Dose Memorization Required

Diphenhydramine dosing

A

25-50mg PO (IM/IV) q4-6 hrs (max 300mg day)

161
Q

Dose Memorization Required

Epinephrine dosing

A

Adults 0.3-0.5mg autoinjector SC/IM mid lateral thigh x1 then repeat q5-15 minutes until sx’s resolve (max 3 doses)

Kids 0.01mg autoinjector

162
Q

Dose Memorization Required

Prednisone dosing for acute asthma, allergy, etc

A

40-60mg PO QD x 5 days

163
Q

Dose Memorization Required

Codeine dosing for cough

A

15-60mg PO q4hrs PRN

beware of risk for abuse

164
Q

Dose Memorization Required

Timolol dosing for glaucoma

A

0.25% sln 1 gtt in affected eye(s) BID

165
Q

Dose Memorization Required

Erythromycin ointment dosing (conjunctivitis)

A

0.5% ointment 1cm to affected eye(s) BID

166
Q

Dose Memorization Required

Bupropion dosing

A

(XR) 150mg PO qAM

167
Q

Dose Memorization Required

Sertraline dosing

A

50mg po QD

Can be started at 25mg po QD

168
Q

ID Review and ENT Infection Objectives

What is selective toxicity?

A

unintended interactions of certain antimicrobial agents against our own body’s cells and receptors which then cause associated adverse reactions seen in drugs

169
Q

ID Review and ENT Infection Objectives

Common Pathogen causing O.M.

A
  • H. flu
  • M. catarrhalis
  • Strep. pneumoniae
170
Q

ID Review and ENT Infection Objectives

Walk-through the Tx for AOM

A

First -> pain management and Amoxicillin 80-90mg/kg divided BID

recurrent? Augmentin 90mg/kg divided into two doses OR Ceftriaxone 50mg IM x 3 days

171
Q

Immune/Allergy

B Cell

A

antibody production

172
Q

Immune/Allergy

Cytotoxic T cells (CD8)

A

Lyse target cells

173
Q

Immune/Allergy

Helper T Cells (CD4)

A

promote B and CD8 cell proliferation, delayed hypersxn rxn

174
Q

Immune/Allergy

Macrophages

A

phagocytosis of tagged cells

175
Q

Immune/Allergy

Mast cells

A

immediate hypersensitivity reactions (produce histamines)

176
Q

Immune/Allergy

Basophils

A

immediate hypersensitivity reactions (histamines!)

177
Q

Immune/Allergy

IgA

A
  • located in mucous membranes
  • given to infant via breast milk
178
Q

Immune/Allergy

IgD

A

found on surface of mature B cells and serves as receptor for antigen recognition

179
Q

Immune/Allergy

Histamine effects

A
  • vasodilation
  • capillary permeability
  • bronchoconstriction
  • CNS effects
  • Sensory nerves (itching)
180
Q

Immune/Allergy

H2 stimulation effects

A

gastric acid secretion

181
Q

Immune/Allergy

H1 Antihistamines

A

first gen - sedating
second gen - non-sedating

selectively bind to H1 histamine receptors and muscarinic receptors to reduce flushing, reduce capillary permeability/edema, reduce itching and pain

uses: seasonal allergic rhinitis

182
Q

Immune/Allergy

1st gen Antihistamine

A

Diphenhydramine

183
Q

Immune/Allergy

2nd gen Antihistamine

A

Loratidine

184
Q

Immune/Allergy

How to Glucocorticoids interrupt inflammation

A
  • inhibiting synthesis of chemical mediators -> reducing sx’s
185
Q

Immune/Allergy

Glucocorticoid examples

A
  • Short acting: Cortisone and Hydrocortisone
  • Intermediate acting: Prednisolone, Prednisone, Methylprednisolone, Triamcinolone
  • Long acting: betamethasone, dexamethasone
186
Q

Immune/Allergy

Therapeutic uses of Glucocorticoids

A

RA, Lupus, IBS, Allergic conditions, Asthma, Derm, Neonatal resp distress

187
Q

Immune/Allergy

MoA of Epi

A
  • A1 receptors: increase vasoconstriction, decrease mucosal edema
  • A2 receptors: decrease insulin and norepi release
  • B1 receptors and B2 receptors: increase bronchodilation and vasodilation, decreased mediator release
188
Q

Immune/Allergy

Adjunct therapy in acute managment of Anaphylaxis

A

Cetirizine 10mg IV over 2 minutes
OR
Diphenhydramine 25-50mg IV over 5 minutes for urticaria and itching

IV Methylprednisolone 125mg

189
Q

Immune/Allergy

Intranasal Glucocorticoid’s for Allergies

A

Beclomethasone
Budesonide
Flunisolide
Triamcinolone

2nd gen:
Fluticasone

ADR: drying of nasal mucosa, epistaxis, sore throat, HA

190
Q

Immune/Allergy

What is the most effect OTC med for cough and most widely used?

A

Dextromethorphan (antitussive)
-suppressed cough reflex in medulla

191
Q

Optho Disease

PAOG TX B-adrenergic Blockers

A

Timolol
- can cause bradycardia and AVHB
- can cause bronchospasm
- MOA: lower IOP by decreasing production of aqeuous humor
- ADR: ocular stinging, blurred vision, photophobia
- C/I: AVHB, CV dz, asthma, COPD

192
Q

Optho Disease

PAOG Prostaglandin Tx

A

Latanoprost
- fewer side effects
- 1st line med option
- lowers IOP by faciliting humor outlfor and relaxing ciliary muscle
- ADR: brown pigmentation of iris

193
Q

Optho Disease

PAOG A2-Adrenergic agonist tx

A

Brimonidine
- topical agent approved for long-term reduction of elevated IOP
- lowers IOP by reducing production of humor and delay optic nerve degeneration
- ADR: dry mouth, ocular hyperemia

194
Q

Optho Disease

PAOG Direct-Acting Muscarinic Agonist

A

Pilocarpine
- caused miosis aka constriction of pupil which contracts ciliary muscle and decreased IOP
- ADR: near sighted focus and retinal detachment

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