Unit 2 Flashcards
1
Q
goals of AED therapy (4)
A
reduce # of seizures
limit ADRs
return to normal ADL(ex driving)
improve quality of life
2
Q
First-line monotherapy treatment for seizures (gen tonic-clonic, focal, or TBI)
A
Hydantoins: Phenytoin and Fosphenytoin
3
Q
Class of seizures not to use hydantoins
A
gen myoclonic or absence
they can exacerbate symptoms
4
Q
Phenytoin/Fosphenytoin therapeutic serum concentration
A
10-20mcg/ml
5
Q
Phenytoin/Fosphenytoin contraindications
A
heart block, sinus bradycardia
6
Q
Carbamazepine (tegretol) class
A
anticonvulsant
7
Q
Carbamazepine (tegretol) is used for what seizure types?
A
focal onset (1st line) and generalized tonic-clonic
8
Q
Carbamazepine (tegretol) therapeutic range
A
4-12mg/L
9
Q
goals of care for status epilepticus (3)
A
- control SE within 60min (ASAP)
- use of benzo + AED
- supportive measures (airway mgmt, IV access, hemodynamic monitoring, ID underlying cause)
10
Q
considerations for febrile seizures in peds (2)
A
-educated parents on the importance of fever control
-do not need AEDs
11
Q
geriatric considerations related to seizures/meds
A
-risk of drug toxicity due to
decreased drug clearance and metabolism
12
Q
considerations for women with a seizure disorder
A
-most AEDs are preg category C or D
-discuss pregnancy status and desires in women of childbearing age
13
Q
patient education for seizures (6)
A
- avoid sleep deprivation (can lower seizure threshold)
- excess alcohol (can lower threshold)
- avoid heavy machinery or working from heights (risk of self harm if seizure occurs)
- never swim alone
- most sports are ok
- driving
14
Q
T/F: PA providers are mandated reporters of seizures
A
true–> must report to DOT who will further assess the situation and see if the patient can continue to drive
15
Q
3 serious side effects of macrolide antibiotics used for CAP
A
- QTC prolongation
- LFT abnormalities
- GI upset
16
Q
sinusitis treatment (6)
A
intranasal steroids
augmentin
clindamycin
cephalosporins
doxycycline
fluoroquinolones
17
Q
first line treatment for sinusitis
A
amoxicillin/augmentin after 7 days unless severe
18
Q
when to use augmentin for sinusitis
A
if pt at high risk for infection from amoxicillin resistant pathogen
19
Q
antibiotic to prescribe for sinusitis in a patient with PCN allergy
A
doxycycline
moxi/levofloxacin
clindamycin
20
Q
considerations when using antihistamines
A
caution in elderly- confusion, constipation, dizziness, dry mouth, urinary retention, sedation
on beers list
21
Q
considerations when using 2nd gen antihistamines (2)
A
ineffective for cough and may induce dryness causing worsening congestion
caution in renal and hepatic impairment
22
Q
2 first gen antihistamines
A
benadryl
chlorpheniramine
23
Q
considerations when using 1st gen antihistamines
A
drowsiness/sedation
contraindicated in breastfeeding
24
Q
considerations for benadryl (5)
A
caution in:
asthma
CV disease
Increased IOP
BPH
thyroid dysfunction
25
considerations for chlorpheriniamine (4)
caution in:
narrow-angle glaucoma
bladder neck obstruction
BPH
avoid in newborns (SIDS)
26
3 2nd gen antihistamines
fexofenadine (allegra)
loratadine (claritin)
cetirizine (zyrtec)
27
2 intranasal antihistamines
azelastine
olopatadine
28
MOA of nasal decongestants
sympathomimetic agents that stimulate alpha and beta receptors causing vasoconstriction
29
4 contraindications of nasal decongestants
narrow-angle glaucoma
uncontrolled HTN
CAD
recent use of MAOIs
30
8 SE of nasal decongestants
HTN
Tachycardia
palpitations
insomnia
tremors
urinary retention (caution with BPH)
GI upset
dizziness
31
2 topical nasal decongestants
oxymetazoline
phenylephrine
32
education with topical nasal decongestants
no more than 2-3 days d/t rhinititis medicamentosa (rebound congestion)
33
education with oral decongestant x2
don't crush or chew
give at least 2 hrs before bed
34
patho of acute bronchitis
infection of the bronchial tree
35
cause of acute bronchitis
90% viruses
10% bacterial
36
hallmark sign on acute bronchitis
moist productive cough
37
treatment of acute bronchitis
antitussives
expectorants
antibiotics
antivirals
38
antitussive drugs
benzonatate
dextromethorphan
cough meds with codeine or hydrocodone for severe cough
39
expectorant drug
guaifenesin
40
when to use antibiotics for acute bronchitis (4)
hx of COPD
high fever
cough over 4-6 days
65 y/o + with comorbidity (CAD, DM)
41
when to use antivirals for acute bronchitis
flu A or B+
42
which antibiotic for acute bronchitis from H influenzae
amox. or augmentin
43
which antibiotic for acute bronchitis from m catarrhalis
augmentin
44
which antibiotic for acute bronchitis from m pneumoniae
macrolide
45
which antibiotic for acute bronchitis from b pertussis
macrolide
46
treatment of CAP in patients without comorbidities
Amoxicillin 1 g TID OR
Doxycycline 100mg BID OR
azithromycin OR
clarithromycin 500mg BID
47
treatment of CAP in patients WITH comorbidities
amox + macrolide
cephalosporin + marcolide OR doxy
fluroquinolone monotherapy
48
3 considerations when prescribing tamiflu
within 48 hours onset
can be used for prophylaxis for up to 6 weeks during community outbreak
dosage adjustment with reduced kidney function (not recommended in ESRD)
49
theophylline adverse events (6)
Tachyarrhythmias
restlessness
insomnia
N/V
GERD
seizures
50
indication for leukotriene modifiers
allergies and asthma
51
3 drugs that are leukotriene modifiers
montelukast
zafirlukast
zileuton
52
age for montelukast
2+
53
age for zafirlukast
7+
54
age for zileuton
12+
55
montelukast SE
BLACK BOX serious behavior and mood changes
56
zafirlukast SE
pharyngitis, headache, rhinitis, gastritis
57
zafirlukast considerations
metabolized by CYP450
rare liver failure
monitor LFTs q2-3 months
58
zileuton considerations
metabolized by CYP450
monitor LFTs before, monthly for 3 months, then q2-3 months
59
zileuton SE
dyspepsia
abd pain
nausea
60
SAMA mechanism of action
short acting muscarinic antagonist
blocks acetylcholine at muscarinic receptors, decreasing cAMP which relaxes airway smooth muscle and increases bronchial ciliary activity, therefore decreasing mucous secretions
61
GOLD group D
1. daily LABA/LAMA
2. daily ICS/LABA
3. daily ICS/LABA/LAMA, (can add) theophylline, phosphodiesterase 4 inhibitor, macrolide abx, OR ICS/LAMA/LABA/roflumilast
62
13 LABA serious SE
paradoxical bronchospasm
asthma exac
laryngospasm
hypersensitivity
anaphylaxis
HTN
HoTN
angina
cardiac arrest
arrhythmia
hypokalemia
hyperglycemia
BLACK BOX : asthma related death
63
namenda MOA
NaMenDA
blocks activation and overstimulation of NMDA receptor during glutamate abundance which inhibits neuronal degeneration that would otherwise result
64
Goal of drug therapy for AD
maintain and maximize the patient's functional ability, quality of life, and independence for as long as possible while minimizing adverse events and cost
65
Med classes to control noncognitive symptoms in AD
Antipsychotics
benzos
antidepressants
66
antipsychotics used for AD
haldol
risperidone
olanzapine
67
Black box warning for antipsychotics
increased risk of death associated with increased risk of stroke
68
how to use benzos for AD
start low and use sparingly
short acting (ativan and xanax) preferred
use as needed for anxiety/episodic agitation
69
how/why antidepressants for AD
high incidence of depression
improved QoL
SSRIs preferred (zoloft/lexapro)
70
treatment recommendations for mild AD disease
cholinesterase inhibitors
71
3 cholinesterase inhibitors
donepezil
rivastigmine
galantamine
72
treatment recommendations for moderate to severe AD disease
NMDA receptor antagonist
trial second CI may be warrated
73
NMDA receptor antagonist drug
Namenda
74
cogentin contraindication
narrow angle glaucoma
75
cogentin special consideration
avoid with potassium (increase ulcer)
glucagon (increase GI adverse effects)
anticholinergics (increase effects)
76
common treatments for the treatment of motor symptoms in PD mild potency
anticholinergics
amantadine
MAOIs
77
2 examples of anticholinergics for PD
cogentin
artane
78
common treatments for the treatment of motor symptoms in PD high potency
Dopamine agonists (levodopa)
COMTIs
79
COMTI 2 drugs
Comtan
Tasmar
80
3 MAOIs for PD
selegiline
rasagiline
safinamide
81
4 dopamine agonists
Mirapex
Requip
Neupro
Apokyn
82
MOA levodopa
dopamine precursor
crosses BBB
converted via decarboxylation (L-DOPA decarboxylase) to dopamine
stored in presynaptic neurons until stimulated for release
83
carbidopa MOA
limits peripheral breakdown of levodopa and allows for 4x more levodopa to cross BBB
reduces N/V caused by circulating dopamine
84
amantadine MOA
inhibition on NMDA receptors
potentiates dopaminergic responses to reduce PD symptoms
binds/blocks NMDA receptors and increases release of dopamine
85
treatment of PD depression
mirapex
effexor
86
treatment of PD psychosis
clozaril
seroquel
87
medications to NOT prescribe for PD psychosis
zyprexa, risperdal, abilify
can worsen motor deterioration
88
treatment of PD dementia
exelon
aricept
89
treatment of PD insomnia
neupro
90
treatment of PD HoTN (4)
Florinef
midodrine
indomethacin
droxidopa
91
treatment of PD drooling
SL atropine
robinul
botox
92
carbamazepine black box warning
SJS, TEN, aplastic anemia, agranulocytosis
93
carbmazepine consideration (6)
screen for HLA-B*1502 allele
increased risk of derm reactions
Pregnancy category D
can lead to hyponatremia in elderly
inducer of several CYP pathways
B/l CBC and follow up labs
94
Serious carbamazepine SE
blood dyscrasias
SIADH
cardiac conduction abnormalitis
DRESS (drug reaction with eosinophillia and systemic symptoms)
95
Hydantoin drugs (2)
phenytoin
fosphenytoin
96
Serious SE for hydantoins (6)
dose dependent:
lateral nystagmus
lateral gaze
ataxia
lethargy
decreased mentation
arrhythmia
97
Acute treatment of status epilepticus and dose
ativan 4mg IV
valium 5-10mg IV (max dose 30mg)
q3-5 mins if seizure continues
98
5 prophylactic treatments for cluster headaches
verapamil
lithium
melatonin
warfarin
galcanezumab
99
when to treat tension-type headaches
more than 2/week requiring analgesic meds, initiate prophylactic treatment
100
first line ppx treatment for tension-type headaches
amitriptyline
101
amitriptyline drug class
tricyclic antidepressant
102
second line ppx treatment for tension-type headaches
Effexor
Remeron
103
effexor drug class
SNRI
104
remeron drug class
atypical antidepressant
105
treatment for HTN and/or essential tremor PLUS migraine first line
beta-blockers
propranolol
lopressor
timolol
106
treatment for HTN PLUS migraine second line
CCB
verapamil
107
treatment of anxiety/depression and/or postmenopausal hot flashes PLUS migraine
SNRI
effexor
108
treatment of migraine ppx with daily medication regimen adherence issues
CGRP receptor antagonists
-mab
109
second line treatment for migraine ppx
CGRP receptor antagonists
-mab
110
8 second line treatment for migraines
triptans
ditans
CGRP receptor antagonists
Ergot derivatives
barbiturates
opioids
steroids
antiemetics
111
CGRP receptor antagonists for migraine treatment
-pant
112
ergot derivatives (2)
ergotamine
dihydroergotamine
113
triptans education (2)
should not be used for more than 9days/month
should not be used w/in 24 hours of vasoconstricting drugs
114
who to avoid triptans in (4)
patients with basilar, hemiplegic, and retinal migraines
CAD
CeVD
severe PVD
115
triptans contraindications (2)
cocomitant use with ergotamines and dihydroergotamine
pregnancy
116
when are ergot derivatives used
long standing migraines in patient who have had multiple relapses with triptans
117
medication overuse headache diagnosis
treating more than 2 headaches with OTC analgesic per week can lead to development of chronic daily headache
118
risk factors for medication overuse headaches (10)
obesity
caffeine overuse
alcohol consumption
TMJ
Female
genetics
socioexonomic status
head/neck injury
age
life events
119
treatment of medication overuse headache (4)
withhold all OTC analgesics for 1-2 weeks
identify triggers
lifestyle modifications
poss. prophylactic agent
120
important education on bisphosphonate therapy
AM dose on empty stomach
must be taken with 8oz of water and must be upright for 30-60 min
121
why do you have to upright for 30-60 mins after taking bisphosphonate
increase absorption and decrease esophagitis
122
first line treatment for acute gout
colchicine and NSAID
oral corticosteroid and colchicine
IA steroid +NSAID or colchicine or PO steroid
123
3 nsaids for acute gout
naproxen
indomethacin
sulindac
124
consideration for colchicine for acute gout
must be given within 24-48 hours
125
second line treatment of acute gout
switching to alternative 1st line
do not mix steroids and NSAIDs
126
RA bridging treatment
NSAIDs or steroids in an acute episode until DMARDs (methotrexate/plaquenil) is therapeutic
127
4 common SE of steroids
cataracts
glaucoma
glucose intolerance
cutaneous atrophy
128
what to check when prescribing steroids for RA
LFT and CBC before treatment
patient at risk for fibrosis, leukopenia, thrombocytopenia
129
treatment for fibromyalgia (5)
SNRIs
SSRIs
TCAs
CBT
Exercise
130
TCA suffix
-ine
-mine
-line
131
3 examples of SNRIs
cymbalta
savella
effexor
132
3 examples of SSRIs
prozac
zoloft
lexapro
133
4 cons of using coal tar for psoriasis
odor
staining
photosensitivity
folliculitis
134
education for patients using coal tar for psoriasis
use sunscreen
135
when to treat herpes zoster (4)
of rash has been present for fewer than 72 hours
new lesions are still developing
patient older than 50
immunocompromised
136
3 treatments for herpes zoster
acyclovir 800mg 5x/day
famiciclovir 500mg TID
valacyclovir 1g TID
137
terbinafine (lamisil) PO for toenail fungus contraindications
chronic or acute hepatic disease
138
first line treatment of impetigo
oral abx
broad spectrum PCN (augmentin) or first gen cephalosporin (cephalexin)
139
first line treatment of impetigo with PCN allergy
clindamycin
topical bactroban
140
lotrimin cream considerations (2)
keep away from eyes
no occlusive dressing (may cause irritation)
141
lotrimin contraindication
pregnancy/lactation
142
contraindications for prescribing systemic corticosteroids for contact dermatitis (2)
systemic mycoses (systemic fungal infection)
patients receiving a vaccine
143
cautions for prescribing systemic corticosteroids for contact dermatitis (7)
TB
hypothyroid
cirrhosis
renal insufficiency
HTN
osteoporosis
DM
144
SE of systemic steroids for contact dermatitis
avoid prolonged use
skin irritation
pruritus
burning
skin atrophy
145
max treatment duration systemic steroids
children 1 week
adults 2 weeks
146
treatment of dermatitis on the face and intertriginous areas (4)
low potency steroids d/t thin skin
alcometasone
fllucinolone
hydrocortisone
triamcinolone
147
what to order before prescribing accutane
CBC
Chem panel
fasting lipids
and obtained 1 month after initiation
148
Considerations when ordering accutane (5)
2 forms of BC
pregnancy should be avoided for 1 month after d/c'd
only 30 days can be ordered at a time
patient must have finished growing before taking
patients must be registered in SMART program
149
black box warning accutane
aggressive/violent behavior
SI
150
first line treatment for acne (7)
topicals:
tretnoin
differin
tazorac
comedolytics:
benzoyl peroxide
azelex
clindamycin
erythromycin
151
role of oral contraceptives in acne treatment
decreases testosterone production
152
Treatment of MRSA superficial bacterial infection (6)
vanc
dapto
-vancins
-zolids
tigecycline
bactroban in nostrils
153
treatment of community acquired MRSA (4)
Bactrim
minocycline
clinda
linezolid
154
7 factors that influence absorption rates
amount of agent
surface area of application
length of application time
frequency
broken skin/erosions
choice of vehicle (liquids/powders)
stratum corneum thickness
155
topical vehicle preferred for hairy areas
creams
hydrophilic
easy to apply and wash off
156
vehicle that produces the greatest local effects
ointments
157
vehicle that allows medication spread easily over large area
gel
158
first line treatment of rosacea
flagyl
sodium fulfacetamide
azelaic acid
159
second line treatment of rosacea
add oral abx
tetracycline
dozy
erythromycin (when tetra contraindicated)
bactrim
160
third line treatment of rosacea
oral isotretinoin
dermatologist referral
