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Pharm 2 > Unit 1 Exam (HEENT/Mental Health > Flashcards

Unit 1 Exam (HEENT/Mental Health Flashcards

Dr. Bester

1
Q

Infectious Disease Review

What are two major examples of a Gram + bacteria?

A

Streptococci (pyogenes, viridans, enterococci, pneumoniae)
Staphylococci (epidermidis, aureus)

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2
Q

Infectious Disease Review

Pencillin coverage?

A

Gram (+) organisms

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3
Q

Infectious Disease Review

Augmentin coverage?

A

Gram (+) and (-)

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4
Q

Infectious Disease Review

Zosyn coverage?

Piperacillin/Tazobactam

A
  • Gram (+)
  • Gram (-)
  • Anaerobes
  • Pseudomonas
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5
Q

Infectious Disease Review

Metronidazole coverage?

A

Anaerobes

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6
Q

Infectious Disease Review

1st Gen Cephalosporin coverage?

A
  • Gram (+)
  • SOME Gram (-)

Cephalexin (PO) and Cefazolin (IM/IV)

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7
Q

Infectious Disease Review

2nd Gen Cephalosporin coverage?

A
  • Gram (+)
  • Gram (-)

Cefuroxime (IM/IV)

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8
Q

Infectious Disease Review

3rd Gen Cephalosporin coverage?

A
  • SOME Gram (+)
  • Gram (-)
  • Pseudomonas (Ceftazidime only)

Ceftriaxone (IV/IM) and Cefdenir (PO)

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9
Q

Infectious Disease Review

4th Gen Cephalosporin coverage?

A
  • Gram (+)
  • Gram (-)
  • Pseudomonas

Cefepime (IV)

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10
Q

Infectious Disease Review

5th Gen Cephalosporin coverage?

A
  • MRSA
  • Gram (+)
  • Gram (-)
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11
Q

Infectious Disease Review

Fluoroquinolone coverage?

A
  • SOME Gram (+)
  • Gram (-)
  • Pseudomonas
  • Moxifloxacin -> anaerobes + atypicals
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12
Q

Infectious Disease Review

Macrolides coverage?

A
  • Gram (+)
  • SOME Gram (-)
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13
Q

Infectious Disease Review

Tetracyclines coverage?

A
  • Gram (+)
  • SOME Gram (-)
  • Doxycycline -> MRSA
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14
Q

Infectious Disease Review

Clindamycin coverage?

A
  • MRSA
  • Gram (+)
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15
Q

Infectious Disease Review

Vancomycin coverage?

A
  • MRSA
  • Gram (+)
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16
Q

Infectious Disease Review

Carbepenems coverage?

A
  • Gram (+)
  • Gram (-)
  • Pseudo and Anerobes EXCEPT for Ertapenem
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17
Q

Infectious Disease Review

MC etiology of bacterial meningitis?

A

S. pneumoniae & N. meningitides

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18
Q

Infectious Disease Review

MC etiology of Acute Sinusitis?

A

S. pneumoniae & H. flu

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19
Q

Infectious Disease Review

MC etiology of Pharyngitis?

A

Streptococcus pyogenes

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20
Q

Infectious Disease Review

MC etiology of cellulitis?

A

S. aureus and Strep. spp

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21
Q

Infectious Disease Review

1st Gen Cephalosporins?

A
  • Cephalexin (PO)
  • Cefazolin (IM/IV)

Stap and Strep coverage

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22
Q

Infectious Disease Review

2nd Gen Cephalosporins?

A

Cefuroxime (IM/IV)

Staph, Strep, and Gram (-) coverage

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23
Q

Infectious Disease Review

3rd Gen Cephalosporins?

A
  • Ceftriaxone (IV/IM)
  • Cefdenir (PO)

Staph, Strep, Gram (-) coverage
Mainly in Meningitis and CA-PNA tx

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24
Q

Infectious Disease Review

4th Gen Cephalosporin?

A

Cefepime (IV)

Staph, Strep, Gram (-), & Anaerobe coverage

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25
Q

Abx Use

Infantile Use Concern?

A
  • drug toxicity risk due to underdeveloped kidney/liver
  • neonates eliminate slower
  • NO SULFA in newborns
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26
Q

Abx Use

Children/Adolescents Concern?

A
  • No tetracyclines! tooth discoloration
  • No quinolones! tendon rupture
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27
Q

Abx Use

Pregnancy Concerns?

A
  • abx cross placenta presenting fetal risks
  • NO gentamycin -> hearing concerns
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28
Q

Abx Use

Breastfeeding Women Concerns?

A
  • Abx may enter breast milk, avoid if possible
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29
Q

Abx Use

Geriatric/Elderly Concerns?

A

Decreased metabolism and excretion poses risks for toxicity

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30
Q

Acute Otitis Media

MC Causative organism?

A
  • H. flu (56%)
  • M. catarrhalis (22%)
  • S. pneumoniae (12%)
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31
Q

Acute Otitis Media

Treatment options?

A

Amoxicillin 80-90mg/kg divided BID

PCN Allergy -> Azithromycin 500mg day 1 then 250mg QD days 2-5

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32
Q

Acute Otitis Media

Preventive Measures?

A
  • Breast feeding
  • Avoidance of daycare
  • Vaccination (PCV and Flu)
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33
Q

Acute Otitis Media

Home Management/Tx?

A
  • Motrin/Tylenol for pain (avoid ASA)
  • Sx’s should improve in 2-3 days
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34
Q

Otitis Externa

MC causative organism?

A

Pseudomonas aeruginosa

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35
Q

Otitis Externa

Treatment options?

A
  • 2% acetic acid + alcohol solution
  • Fluoroquinolone

Severe OE -> Cipro for adults and Cephalexin for peds

36
Q

Otitis Externa

Treatment for Edematous EAC with closure of canal?

A

Insert a wick, apply drops to the tip, keep the wick moist

replace q 48 hrs

37
Q

OM and OE

Therapeutic goal of tx?

A
  • Reduce inflammation
  • Eliminate infection
  • Prevent complications d/t AOM and AOE
38
Q

OM and OE

High-Risk Tx Patients?

A
  • PCN allergy -> Cefdinir or Azithromycin
  • Amoxicillin in last 30 days? Augmentin
  • > 3 episodes of AOM in past 6 months or 4 episodes in 1 year? refer to HEENT
  • Can’t see TM in OE? avoid ototoxic drops
  • DM or immunocompromised with OE? systemic treatment +/- otic wick
39
Q

Bacterial Pharyngitis (strep)

Mainstay Tx Options?

A
  • Pencillin V
  • Amoxicillin
  • Azithromycin (2nd line)

+ avoid smoke exposure and humidify the environment

40
Q

Bacterial Pharyngitis (strep)

Pt Education Points?

A
  • stay home from work or school until 24 hrs completed on abx tx
  • Abx compliance!!
  • Do not share food/drinks
  • Throw toothbrush away after 24 hrs and consider again at end of course
41
Q

Acute Bacterial Rhino Sinusitis (ABRS)

What sinuses are MC effected?

A

Frontal, Ethmoid, and Maxillary

42
Q

Acute Bacterial Rhino Sinusitis (ABRS)

What is the MC causative origin?

bacterial

A

S. pyogenes

43
Q

Acute Bacterial Rhino Sinusitis (ABRS)

Indication for Abx Tx?

A
  • lack of adequate f/u
  • sx’s unchanged after 7 days
44
Q

Bacterial Pharyngitis

Mainstay Tx Options?

A
  • Adult: PCN V 500mg po BID x 7-10 days
  • Peds: Amoxicillin 45mg/kg divided BID x 7-10 days

PCN Allergy -> Azithromycin 500mg qd day 1 then 250mg QD days 2-5

45
Q

Dental Abscesses

First Line Tx?

A

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

Amoxicillin/Clavulanate

46
Q

Dental Abscesses

Tx option for those with PCN allergy?

PCN = penicillin

A

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

7-10 days for BOTH

47
Q

Immunology

B-Cell action?

lymphocytes

A

Antibody production

48
Q

Immunology

Cytotoxic T Cell (CD8) action?

A

lyse target cells

49
Q

Immunology

Helper T-cell (CD4) action?

A

Promote B and CD8 cell proliferation
- delayed hypersensitivity reactions

50
Q

Immunology

Macrophage action?

A

Promote B and CD8 cells as Ag-presenting cells
- phagocytosis of cells tagged with ab’s
- promote CD8 cell proliferation

51
Q

Immunology

Mast Cell action?

A

Immediate hypersenstivity reactions

produce histamines!

52
Q

Immunology

IgE MOA?

A
  • Binds to surface of mast cells, causing subsequent binding of Ag to IgE stimulating the release of histamiens and other mediators
53
Q

Allergy

H1 Antihistamines MOA/Effects?

A

selectively bind to H1 histamine receptors and muscarinic receptors
- reduce flushing, reduce capillary permeability (edema), reduce itching & pain, suppress mucous secretion

mild seasonal allergies, motion sickness, insomnia

54
Q

Allergy

H1 Antihistamine ADR’s

A
  • sedation
  • CNS: dizziness, incoordination, confusion
  • N/V, loss of appetite, constipation, diarrhea
  • Anticholinergic: dry mucous, urinary retention, constipation, palpitations

Avoid use in BPH d/t urinary retention

55
Q

Allergy

H1 Antihistamine interactions to be aware of?

A

Etoh and CNS depressants (benzo’s/opiods)

56
Q

Allergy

1st Gen Represenative H1 Antihistamine?

A

Diphenhydramine

Ethanolamines

57
Q

Allergy

2nd Gen representative H1 antihistamine?

A

Loratidine

non-sedating

58
Q

Allergy

Key prescribing considerations with H1 antihistamines?

A
  • therapeutic goal is relief of sx’s (mild-moderate disorders)
  • no lab monitoring required
  • identify high risk pt’s
  • minimize ADR’s (drowsiness concern? take QHS)

High-risk pt’s: young children, elderly, h/o asthma, urine retention, BPH, open-angle glaucoma, BPH

59
Q

Allergy

Where are glucocorticoids produced?

A

adrenal cortex

60
Q

Allergy

Examples of natural glucocorticoids and synthetic glucocorticoids?

A
  • Natural: cortisone
  • Synthetic: prednisone, dexamethasone
61
Q

Allergy

Metabolism of glucocorticoids?

A

Promote glucose storage, lipolysis, and decrease protein metabolism

62
Q

Allergy

Glucocorticoid effects on Cardiovasc/Heme?

A
  • vasoconstriction
  • increase RBC/neutrophils
  • decrease lymphocytes and monocytes
63
Q

Allergy

Glucocorticoid effects on CNS?

A
  • low levels cause depression, high levels cause excitation and mania
64
Q

Allergy

Glucocorticoid effects on fluids/electrolytes?

A

Na/H2O retention and K excretion at kidneys

65
Q

Allergy

How do Glucocorticoids interrupt inflammation?

A
  • inhibiting synthesis of chemical mediators -> reduces sx’s
  • Suppressing infiltration of phagocytes, preventing damage from lysosomal enzymes
  • Suppressing lymphocyte proliferation and reducing immune component of inflammation
66
Q

Allergy

Which administration route has the slowest systemic absorption? fastest?

A

Slowest -> intraarticular
Fastest -> IM/IV then PO

67
Q

Anaphylaxis

What initial management should be considered?

A
  • airway!!
  • pt placed on monitor
  • administration of epinephrine!!

+/- Di[henhydramine to help itching/hives

68
Q

Allergy

Glucocorticoid use concerns across lifespan?

peds, pregnancy, breast-feeding, and elderly

A

Peds -> long-term use results in delayed bone growth and decreased stature

Pregnancy -> cleft palate and neonatal hydroadrenalism risk

Breast-feeding -> low dose ok

Elderly -> osteoporisis, adrenal insufficiency, and GHI issue’s

69
Q

Anaphylaxis

What receptors does epinephrine work on? correlating effect at each receptor?

A
  • A1 -> vasoconstriction, decreased mucosal edema
  • A2
  • B1
  • B2 -> bronchodilation, vasodilation, decreased mediator release
70
Q

Anaphylaxis

Epinephrine administration recommendations?

A

Adult -> 0.3-0.5mg IM to mid-outer thigh (if sx’s don’t improve, repeat up to 3 times q5-15 minutes)

Peds -> 0.01 mg/kg IM to mid-outer thigh q5-15 minutes (>30kg, give adult dosing)

71
Q

Anaphylaxis

What medication options should be considered in acute anaphylaxis in the ED?

exception of Epi

A
  • IV 20mL/kg NS bolus
  • IV Diphenhydramine 1mg/kg (max 50mg) over 5 minutes
  • IV Methylprednisolone 1mg/kg (max 125mg)
72
Q

Seasonal Allergies/Allergic Rhinitis

Route and Action of glucocorticoids?

A
  • Nasal
  • prevent inflammatory response to allergens and reducing all sx’s

ADR = nasal irritation

73
Q

Seasonal Allergies/Allergic Rhinitis

Route and action of antihistamines?

A
  • Oral/Nasal
  • blocks H1 receptors & thus decrease itching, sneezing, and rhinorrhea
  • do NOT reduce congestion

ADR = sedation and drying effects, bitter taste (nasal)

74
Q

Seasonal Allergies/Allergic Rhinitis

Route and action of Cromolyn?

A
  • Nasal
  • Prevents release of inflammatory mediators from mast cells and decrease’s all sx’s
  • benefits are modest

ADR = none

75
Q

Seasonal Allergies/Allergic Rhinitis

Route and action of Sympathomimetics?

A
  • Oral/Nasal
  • activate vascular a1 receptors and cause vasoconstriction, which reduces nasal congestion
  • does NOT decrease sneezing, itching, or rhinorrhea

ADR = restlessness, insomnia, increased BP, rebound nasal congestion

76
Q

Seasonal Allergies/Allergic Rhinitis

Route and action of anticholinergics?

A
  • Nasal
  • block nasal cholinergic receptors and reduce secretions
  • do NOT decrease sneezing, nasal congestion, or PND

PND -> post-nasal drip

ADR = nasal drying and irritation

77
Q

Seasonal Allergies/Allergic Rhinitis

Route and action of antileukotrienes?

A
  • Oral
  • block leukotriene receptors and thus reduce nasal congestion

ADR = rare neuropsych effects

78
Q

Seasonal Allergies/Allergic Rhinitis

First-line tx options?

A

Intranasal Glucocorticoids!
- most effective prevention and tx of seasonal and perennial rhinitis

Fluticasone (also Mometasone, Budesonide, Triamcinoline)

79
Q

Cough

MOA for Expectorants?

Guaifenesin

A

increases respiratory tract fluid secretion

ADR = N/V, dizziness

80
Q

Cough

MOA for Decongestants?

Phenylephrine, Pseudoephedrine, and Oxymetazoline

A

constrict blood vessels reducing nasal congestion
- potential for abuse

ADR = rebound congestion, HTN, restlessness, insomnia

81
Q

Cough

MOA for Antitussives?

Dextromethorphan, Codeine, Benzonatate, and Diphenhydramine

A

Suppresses the cough reflex by acting on the cough center in the medulla
- abuse potential

ADR = drowsiness, dizziness, nausea

82
Q

Cough

MOA for Mucolytics?

Acetylcysteine

A

Breaks down mucous by reducing disulfide bonds within mucous proteins

ADR = N/V, rhinorrhea

83
Q

Cough

MOA for antihistamines?

Diphenhydramine

A

Blocks histamine receptors thus reducing nasal secretions and cough reflex

ADR = drowsiness, dry mouth, blurred vision

84
Q

Cough

MOA for inhaled corticosteroids?

Fluticasone

A

Reduces airway inflammation and mucous production

ADR = thrust, hoarseness, coughing

85
Q

Cough

MOA for anticholinergics?

Ipratropium

A

Blocks muscarinic receptors reducing bronchoconstriction and mucous production

ADR = dry mouth, throat irritation, and headache

86
Q
A

Pharm 2 (2 decks)

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