Pharm Exam 1 Review

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bp543
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200574
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Pharm Exam 1 Review
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2013-02-14 13:56:01
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Cell Wall Inhibitors
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Pharm Exam 1 Review
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  1. Which 1st generation Cephalosporin is used as single dose prophylaxis for surgical coverage?
    Cefazolin (Ancef)
  2. Which Cephalosporins are resistant to PCNase and are a good PCN G substitute?
    1st generation: Cefazolin (Ancef) and Cephalexin Keflex
  3. Which Cephalosporin is used as tx for N. gonorrhea and CAN be used with renal impairment?
    Ceftriaxone (Rocephin)
  4. What is the BROADEST sprectrum Beta-Lactam, which is used when there is resistance to 3rd/4th generation Cephs?
    Carbapenems (Imipenem, Meropenem)
  5. What combination of drugs allows for better function of a Beta-Lactam by inhibiting Beta-lactamase?
    Amoxicillin/Clavulanic Acid (Augmentin)
  6. What is the MoA of Vancomycin?
    Cell wall inhibitor
  7. What is the coverage of Vancomycin?
    Gram+, MRSA! (C. Difficile, Enterococcal endocarditis)
  8. If giving an antibx via IV infusion and the pt. develops Red Man Syndrome, what drug is being infused?
    Vancomycin (MUST go slow! Give antihistamine!)
  9. What cell wall inhibiting antibx is used mostly topically due to systemic nephrotoxicity?
    Bacitracin
  10. What antibx is used with resistant Gram+ infections (MSSA, MRSA, VRE)?
    Daptomycin (Cubicin*)
  11. What is the MoA of FQ’s?
    Nucleic Acid Inhibitor – interfere with gyrase and topoisomerase
  12. What is a major adverse effect of FQ’s?
    Tendon Rupture (conn. tissue problems, AVOID with pregrancy)
  13. Which FQ is active against BOTH pseudomonas and Anthrax (as well as aerobic Gram-)?
    Ciprofloxacin (Cipro)
  14. Which FQ is considered a “respiratory FQ” that is active against S. pneumniae?
    Levofloxacin (Levaquin)
  15. What is the MoA of Sulfamethoxazole?
    Folate Antagonist
  16. Tetracyclines, Aminoglycosides, and Macrolides all have what in common?
    Protein Synthesis Inhibitors: action on the ribosomes
  17. Bind to the 30s subunit of the ribosome?
    Tetracyclines, Aminoglycosides
  18. Bind to the 50s subunit of the ribosome?
    Macrolides (Erythromycin), Chloramphenicol
  19. Why is the use of Tetracycline contraindicated in pediatric pts.?
    Binds to tissues undergoing calcification: bone deposition, dental discoloration, hypoplasia
  20. A pt. comes in with a tick borne illness (RMSF, Lyme) what antibx is used as 1st line tx?
    Tetracyclines (Doxycycline – can be used w/ RENAL IMPAIRMENT)
  21. Which antibx has the same coverage as PCN and is used as a substitute w/ PCN allergy?
    Erythromycin
  22. Due to the adverse effects of anemia, Gray Baby syndrome, GI upset, and superinfections which drug is LIMITED to life threatening infections?
    Chloramphenicol
  23. Which antibiotic MUST be monitored due to ototoxicity/nephrotoxicity?
    Aminoglycosides
  24. Used to tx Upper Resp Inf?
    Amoxicillin/Augmentin
  25. Used to tx Strep. pharyngitis?
    PCN
  26. Used to tx bacterial UTIs?
    FQ’s or Folate Antagonists (Trimethoprim)
  27. Neisseria, E. coli, Klebsiella, Pseudomonas, Salmonella, Shigella, H. flu, M. Cat all = ?
    Gram -
  28. Staph, Strep, Clostridium all = ?
    Gram +
  29. PCN, Cephalosporins, Monobactams, Carbapenems all =?
    Cell wall inhibiting Beta Lactams
  30. What is the antibx of choice for Group A Strep/Syphilis?
    PCNs
  31. Which PCN is active against P. aeruginosa, Kelbsiella, and Bacteroides?
    Piperacillin
  32. What type of HA is classified by severe, sharp, stabbing, unilateral pain of short duration?
    Cluster HA
  33. What is the acute abortive tx for Cluster HA’s?
    Oxygen
  34. What is the prophylactic tx for Cluster HA’s?
    CCB’s, Lithium, Ergotamine(QHS)
  35. Dosing for Acetaminophen (Tylenol)?
    1000mg Q4-6hrs (max 4000mg in 24 hours)
  36. Dosing for Ibuprofen (Advil, Motrin)?
    200-800mg Q6hrs
  37. Dosing for Sumatriptan (Imitrex)?
    6mg SQ, repeat in 1hr if needed
  38. Dosing for Butorphanol Nasal Spray (Stadol)?
    1 spray (1mg) in 1 nostril! Repeat in 1hr if needed, LIMIT 4sprays/day!
  39. Which HA is characterized by pain shooting form mouth to ipsilateral eye/ear/nose?
    Trigeminal Neuralgia
  40. 1st line tx for Trigeminal Neuralgia?
    Carbamazepine (Tegretol*), Gabapentin (Neurontin*)
  41. Tx for TMJ disorders?
    NSAID, Relaxation Tech, Muscle Relaxant (Flexeril*, Skelaxin*), Dental appliances
  42. Used for a severe HA with N/V?
    Ketorolac (Toradol*)
  43. Contains acetaminophen/aspirin/caffeine?
    Excedrin, Goody’s powder
  44. Provides sedation and muscle relaxation for tension HA?
    Butalbital (Barbiturate)
  45. Non-selective 5HT1 receptor agonist that constricts intracranial blood vessels and is tx for moderatesevere MHA and Cluster HA?
    Ergot Derivatives: Ergomar*, DHE*, Migranal*, Cafergot*
  46. #1 side effect of ergot derivatives?
    N/V (give antiemetic)
  47. NEVER give ergots within 24 hours of what?
    Triptans
  48. 5HT2 antagonist used for refractory HA?
    Methsergide
  49. 1st line tx for moderate to severe migraines/rescue therapy?
    Triptans: Imitrex*, Treximet*
  50. How frequently can Triptans be taken?
    2 doses in 24 hours, no more than 2x per week
  51. When are opiods indicated as tx for HA?
    Intractable migraines (severe) w/ pt. contraindicated for other tx
  52. Na+ channel/Ca+ channel blockade, GABA actions (increase Cl- channel opening), and inhibition of glutamate areall tx for what?
    Seizures
  53. Works by blocking Na+ channels and is used for partial or tonic-clonic seizures?
    Carbamazepine (Tegretol*)
  54. Work by augmenting GABA which increases Cl- channel openings and decreasing neuronal firing?
    Benzodiazepines: Lorazepam (Ativan), Diazepam (Valium)
  55. Used to tx status epilepticus and as adjunctive tx?
    Benzodiazepines
  56. This GABA augmenting drug has a Black Box warning of Hepatic Failure, Pancreatitis, and Teratogenicity?
    Valproic Acid
  57. This drug inhibits Ca+ channels and is used with Absence Seizures?
    Ethosuximide (Zarontin*)
  58. Used for neuropathic pain?
    Pregabalin (Lyrica*)
  59. Has multiple mechanisms and is given as a loading dose for Status Epilepticus?
    Phenytoin (Dilantin*)
  60. Used for tonic-clonic partial seizures?
    Carbamazepine, Phenytoin, Valproic acid
  61. Used for absence seizures?
    Ethosuximide, Valproic acid, Clonazepam
  62. Used for Myoclonic seizures?
    Valproic acid, Clonazepam
  63. Combination of lidocaine and prilocaine used prior to minor procedures (Derm, genital lesions)?
    EMLA cream
  64. Inhibits Substance P, from peppers, and requires regular use for benefit?
    Capsaicin
  65. Muscle relaxant used for tx of spasticity associated with MS or spinal cord lesions?
    Baclofen
  66. Medications to improve cognition?
    Vit. E, Selegiline, Estrogen, NSAIDs
  67. A NMDA receptor antagonist used for moderate to severe Alzheimer’s by blocking toxic effect of excess glutamate?
    Memantine (Namenda)
  68. A cholinesterase inhibitor used in mild to moderate Alzheimer’s?
    Donepezil (Aricept) – specific, less SE’s
  69. Initial treatment for Parkinson’s, delays the need to start Levodopa and decreases motor fluctuations for first 5 years?
    Dopamine agonists (ex. Pramipexole – no liver metabolism, antidepressant effects)
  70. A COMT inhibitor that prevents the degradation of levodopa and decreases the “off time” significantly?
    Entacapone (Comtan)
  71. Used for the tx of Parkinson’s when the symptoms begin interfering with life?
    Levodopa
  72. Added to Levodopa to block the conversion to dopamine in the periphery?
    Carbidopa (levodopa/carbidopa = Sinemet*)
  73. Why must the Sinemet dose/frequency be increased over time?
    End-of-Dose deterioration “wearing off” and drug resistant “off” periods
  74. Why would you use MAO-B inhibitors as a tx of Parkinson’s?
    • Symptomatic benefit for pt wanting to delay tx with Dopamine agonists
    • Anticholinergics (Cogentin*, Symmetrel*) work by blocking Ach in the substantia nigra, which increases dopamine effects. What Parkinson’s symptoms are improved by these actions?
    • Resting tremor, drooling (avoid if pt. >70yoa)
  75. Anticoagulant that interferes with Vit. K synthesis (coagulation factors II, VII, IX, X)?
    Warfarin (Coumadin*)
  76. Injectable anticoagulant which increases the action of antithrombin III (coag. factors IX, I, XI, XII)?
    Heparin
  77. Antiplatelet vasodilator that inhibits activity of adenosine deaminase and phosphodiesterase (decreases platelet aggregation)?
    Dipyridamole (+Warfarin  decreases thrombosis post heart valve replacement, +Aspirin (Aggrenox)  decreased risk of stroke)
  78. Used for stroke prevention when patient is intolerant to Aspirin?
    Ticlopidine (Ticlid)
  79. Antiplatelet that blocks ADP receptors and prevents fibrinogen binding and is used in pts. with established PAD for prevention of MI/Stroke?
    Clopidogrel (Plavix)
  80. Antiplatelet that blocks PG synthetase which prevents formation of thromboxane A2 (actions on hypothalamus decrease fever!)?
    Aspirin
  81. Three important things used for STROKE prevention?
    Aspirin, Statins, BP management
  82. IV thrombolytic that is the tx of CHOICE for acute stroke or AMI?
    Alteplase (Activase, tPA)
  83. Used for ADD/ADHD and narcolepsy by increasing catecholamines in the CNS?
    Amphetamines (Ritalin, Concerta, Adderall)
  84. Withdrawal effects of Nicotine?
    Irritability, anxiety, restlessness, difficulty concentrating, HA
  85. Caffeine is what kind of drug?
    Methylxanthine
  86. What is the tx for mycobacteria meningitis?
    Isoniazide, Pyridoxine (B6), Rifampin, Pyrazinamide, and Ethambutol ~9mo!!!
  87. Most common cause of aseptic meningitis?
    VIRAL – Enterovirus, Cocksackie, Echovirus
  88. Tx for aseptic meningitis?
    1. symptomatic (rest, fluids, analgesics) 2. AVOID STEROIDS 3. Antivirals
  89. What is the appropriate age for Hib vaccine?
    2-18mo.
  90. Peds. 11-12, high school age (if not at 12oya), college freshmen in dorms, microbiologists, military, people living in Africa, pt. with splenectomy/immune disorder, and exposed pts. are all eligible for what vaccine?
    Menactra
  91. What class of antibiotics has a black box warning for neurotoxicity, nephrotoxicity, and ototoxicity?
    aminoglycosides
  92. What antibx is used in the case of a CSF leak, and basilar skull fracture (S. pneumo, H. flu)?
    Vancomycin with a 3rd generation Cephalosprin
  93. What steriod is used with adults with pneumococcal meningitis 10-20 minutes to 1st antibx dose?
    dexamethasone
  94. For the treatment of osteomyelitis what are the 3 steps of treatment?
    • Surgery/Debridement
    • Antibx
    • ( Gram - = Ciprofloxacin, cefipime)(MSSA = Naficillin)(MRSA = Vancomycin)
    • Hyperbaric O2, Vacuum closure (NPWT)
  95. What drug is used as a nasal spray for the treatment of osteoporosis, hypercalcemia, and Padget’s disease? What is it’s MoA?
    Calcitonin (Miacalcin*), inhibits osteoclasts, inhibits tubular resorption of Ca+
  96. What is a treatment option for post-menopausal women with osteoporosis who cannot take estrogen?
    Raloxifene (Evista*)
  97. In the case of a woman with osteoporosis, what is HRT tx option if she has had a hysterectomy? if she has an intact uterus?
    • Hysterectomy=ERT alone
    • Intact=ERT with progestin
    • ERT is a good combo with bisphosphonates*
  98. What is the dosage of Fosamax in the tx of osteoporosis?
    10mg/day or 70mg/week
  99. What is the dosage of Boniva in the tx of osteoporosis?
    2.5 mg/day or 150mg/MONTH (must remain upright for 60mins)
  100. What is the proper administration of bisphosphonates (Boniva, Fosamax) in the treatment of osteoporosis?
    • Take in the AM, 30-120 mins B4 food/other meds
    • Take with a full glass of water
    • Pt must remain upright for at least 30 minutes
  101. What is the FIRST LINE tx for osteoporosis?
    Bisphosphonates (Fosamax, Boniva, Zometa)
  102. What is the proper doasage for daily supplementation of Vit. D?
    400-800 IU (<2000 IU/day)
  103. What is the best supplement for osteoporosis prevention? Dose?
    Calcium Salts (Tums, Oscal+D), 1200-1500mg per day divided (NO more than 2500mg per daytoxic!)
  104. What is the most common cause of drug induced osteoporosis?
    Glucocorticoids (Prednisone), >5mg/day for >3mo.
  105. What is an opiate antagonist that is effective QUICKLY (~30seconds) and is useful for emergent OD tx?
    Naloxone (Narcan*)
  106. What drugs are used for controlled detox from opiates?
    Buprenorphine, Methadone
  107. What synthetic opiod is used for analgesic purposes as injection in post-op and labor/delivery?
    Fentanyl (Duragesic*)
  108. What synthetic opiod is best for women in labor as it is less likely to prolong labor?
    Meperidine (Demerol*)
  109. What drug works by hyperpolarizing cells, decreasing neuronal firing, presynaptic inhibition, and decreasing the release of substance P?
    Morphine
  110. Which opiate receptor involves PAIN relief and respiratory depression?
    Mu
  111. Which opiate receptor has sedative actions?
    Kappa
  112. What is the initial therapy of choice for RA? Dosage?
    Methotrexate (MTX), 7.5mg once weekly
  113. What drugs are used in the treatment of RA for pts who have not responded adequately to MTX?
    Biologics (TNF alpha inhibitors= Enbrel*, Remicade*)
  114. What is the drug of choice for the tx of RA in the case of potential pregnancy?
    Sulfusalazine
  115. What are the most common causes of drug-induced Lupus?
    Hydralazine, procainamide, chlorpromazine
  116. What is an immunosuppressant drug use for the treatment of both SLE and RA?
    Cyclophosphamide (Cytoxan*)
  117. What are the major side effects of Sulfasalazine (Azulfidine*)?
    • GI: anorexia, N/V/D
    • Hematologic: leukopenia
  118. What is the NSAID drug of choice for acute Gout? Dose?
    • Indomethacin (Indocin*)
    • 25-50mg PO every 8hrs
  119. What is the MoA of uricosuric medications?
    Renal clearance of uric acid by inhibiting renal tubular reabsorption
  120. What is an adverse effect common to uricosurics (Probenecid, Benemid*)?
    Precipitation of acute gouty arthritis and stone formation (even though that is what it is used to tx!)
  121. What is the drug of choice in patients with a hx of urinary stones or impaired renal function as prevention for acute gout?
    Allopurinol (Zyloprim*)

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