Pharmacy questions

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Pharmacy questions
2014-06-30 23:13:02

pharmacy questions
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  1. Steroid of choice in pregnancy?
  2. Antihistamine of choice in pregnancy?
  3. Which hormone should you increase if there is mid-cycle break through bleeding?
  4. Which hormone should you increase if there is late-cycle break through bleeding?
  5. In Parkinson's patients, what is the antidepressant class of choice?
  6. In Parkinson's, what is the antipsychotic of choice?
  7. Why should you NOT use antipsychotics for demential related psychoses?
    Increased risk of death from infection or cardiovascular complications
  8. What is the benzo of choice in treating status epilepticus?
  9. Which 3 benzos are consider less harmful in the elderly?
    • L - lorazepam
    • O - oxazepam
    • T - temazepam
  10. Which 2 seizure medications are preferred for treating absence seizures?
    Valproic acid and ethosuximide
  11. What are considered 2 first-line seizure medications?
    Keppra and Lamictal
  12. What is chloral hydrate used for?
    Sedation in children
  13. Which is the weaker class of diuretics - thiazides or loops?
  14. Why do thiazides have a protective effect on bone?
    They increase calcium reabsorption
  15. Which NSAIDs are similar to celebrex in terms of low GI risk?
    meloxicam, nabumetone, and etodolac
  16. Systolic dysfunction is characterized by a LV EF less than what %?
  17. Cardiac output
    CO = stroke volume x heart rate
  18. Sodium restriction in heart failure
    <1500 mg/day
  19. Beta-blockers used in heart failure
    • Metoprolol succinate
    • Carvedilol
    • Bisoprolol
  20. Drugs with mortality benefit in heart failure
    • ACE-Is (or ARBs in pt cannot tolerate ACEI)
    • Beta blockers
    • Aldosterone antagonists
    • Bidil (in black people only!!)
  21. Heart failure drugs
    • 1st line:
    • ACE-Is


    • 2nd line:
    • Aldosterone antagonists
    • Loop diuretics  - prn fluid overload
    • Digoxin  - to increase QOL and reduce exacerbations
    • ARBs - when cant tolerate ACEI
    • BiDil -in blacks
    • Statins
  22. Why would beta blockers be stopped in HF?
    In cases of acute decompensated HF if hypotension or hypoperfusion is present
  23. IV ionotropes used in HF to treat hypoperfusion
    Dobutmaine = beta agonist, use when SBP >90

    Milrinone = PDE3 inhibitor

    Dopamine = use when SBP <90
  24. Heparin-induced thrombocytopenia (HIT)
    Reduction in platelets >50% from baseline
  25. Lovenox prophylaxis
    30 mg Q12 or 40 mg daily

    CrCl < 30 = 30 mg daily
  26. Lovenox treatment of VTE/UA/NSTEMI
    1 mg/kg Q12 or 1.5 mg/kg daily

    CrCl <30 = 1 mg/kg daily
  27. Lovenox treatment for STEMI
    <75 = 30 mg IV bolus + 1 mg/kg SC THEN treat like the others

    >75 = No bolus, just 0.75 mg/kg Q12
  28. Prinzmetal's angina
    Due to vasospasm in arteries, NOT plaque buildup

    Preferred treatment is CCBs
  29. First line treatment for chronic stable angina?
    Beta blockers for antianginal therapy + aspirin for antiplatelet therapy

    Can use CCBs or long-acting nitrates as alternative when BBs CI or need more relief

    Use clopidogrel when ASA CI
  30. Secondary prevention for cardioembolic stroke?
  31. Secondary prevention for non-cardioembolic stroke or TIA?
  32. Ulcerative colitis
    Rectum and colon (more distal)

    Superficial ulcerations

    More continuous

    More bleeding in stool, smoking improves symptoms
  33. Crohn's
    Can affect any part of the GI tract - mostly ileum

    Deep ulcerations, transmural

    Lesions skip around - not continuous
  34. What do we use to treat acute exacerbations of IBD?
    Short courses of IV or oral steroids
  35. Opioid hyperalgesia
    Chronic opioid use can worsen pain sensitivity
  36. 3 classes of drugs that can cause physical dependence?
    • Opioids
    • Benzos
    • Barbituates
  37. Why are NSAIDS so bad for the stomach?
    Because they inhibit prostaglandin synthesis, and one of the functions of prostaglandins is to protect the stomach lining
  38. Why is some aspirin enteric coated?
    To reduce nausea
  39. When can you be started on fentanyl patch if inpatient?
    60mg morphine or equivalent for 7 or more days
  40. Which 3 opioids should you absolutely avoid alcohol with?
    Avinza, Opana ER, Nucynta ER
  41. Theophylline
    Therapeutic range: 5-15 mcg/ml

    Caution in patients with CVD and seizures

    AEs: nausea, loose stool

    Aminophylline contains 80% theophylline
  42. What drug can increase beta-lactam concentrations (particularly penicillin)?
  43. MOA for beta lactams?
    Inhibit cell wall synthesis by binding to PBPs 

    Time-dependent killing

  44. Fanconi's syndrome
  45. RIPE for active TB
    • rifampin
    • isoniazid
    • pyrazinamide
    • ethambutol

    • All heptatotoxic except ethambutol
    • Rifampin can change urine red/orange
  46. When can you schedule albuterol inhalers?
    COPD only, NOT asthma

    Give to children <7
  48. Both varicella vaccines and MMR are contraindicated with allergies to what 2 things?
    Neomycin and geltain
  49. Inactivated polio virus vaccine contraindicated with allergies to what 3 things?
    Streptomycin, neomycin, and polymyxin B
  50. Live vaccines are contraindicated in what 2 patient groups?
    Pregnancy and immunocompromised
  51. What dose of steroids is thought to induce immunnosuppression?
    >= 20mg per day or 2 mg/kg/day of prednisone
  52. Havrix
    Hep A vaccine

    Children >1
  53. Engerix-B
    Hep B

    3 dose series: 0, 1, 6

    Can give at birth!
  54. Cervarix
    HPV 2 strain vaccine for cervical caner

    3 series: 0,1-2, 6

    For women ONLY aged 9-26
  55. Gardasil
    HPV 4 strain vaccine for cervical cancer, genitcal warts, and PAP smear abnormalities

    For males and females aged 9-26
  56. Which flu vaccine is completely egg free? (Recombinant)
  57. When is it appropriate to get 2 shots of flu vaccine?
    Unvaccinated children <8 or those with <2 shots since 2010

    Give 4 weeks apart
  58. Fluzone intradermal for what ages?
  59. Afluria ages
    Labeled for children >5, but ACIP recommends giving it at age 9
  60. Vaccines with egg components
    Flu, yellow fever, rabies
  61. Vaccines given SC
    Varicella vaccines, MMR, Menomune
  62. Meningococcal vaccines
    • Menomune = 56+
    • Menactra = 9 months-55
    • Menveo = 2-55

    1 dose at 11-12, booster at 16-18

    OR just 1 dose 13+ 

    2 doses if HIV+
  63. Pneumococcal vaccines
    • PCV13
    • -Start at 6 weeks
    • -4 doses if children 

    • PPSV23
    • -Can give at 2
    • >65 = 1 dose
    • 19-64 if have asthma/COPD, smoke
    • 2-64 if chronic illness
    • Revaccinate if received 1st dose <65 and 5 years ago
  64. Dehydration is indicated by what BUN:Scr ratio?
  65. Which calcium salt is preferred in IV admixtures?
    calcium gluconate
  66. What do you add first, calcium or phosphate?

    NTE 45 meq/L
  67. 2 factors to keep calcium and phosphate from precipitating?
    Low pH and low temp
  68. How many half-lives to reach steady state?
  69. Using only the confidence interval, how do you tell if results are statistically significant?
    If the range DOES NOT cross 0

    If using RR CI, significant if DOES NOT include 1
  70. Which drug is first line in RA?
    Methotrexate, however the biologics can be used if severe
  71. Biggest side effect of cyclophosphamide?
    Hemorrhagic cystitis
  72. Black box warning for Tysarbi?

    Can cause PML - progressive multifocal leukoencephalopathy
  73. Sjogren's syndrome
    Auto-immune disease causing dry eyes and dry mouth
  74. Goal INR for patients with PAH treated with warfarin?
  75. Raynaud's phenomenon
    Reduced bloody supply to fingers/toes that causes discoloration

    Common in PAH
  76. All chemo drugs can cause myleosuppression except which 2?
    Bleomycin and vincristine
  77. What drug is used to treat neutropenia in cancer?
    Neupogen (filgrastim)

    Can cause bone pain!!

    Can also use Neulasta (pegfilgrastim)
  78. Which cancer drug has highest risk of emesis?
  79. Which can drugs are classified as high emetic risk?
    Anthracyclines, cyclophosphamide, cisplatin,  dacarbazine

    • Treat with 3 drug anti-emetic combo:
    • Aprepitant(or fosaprepitant IV) + steroid(dexamethasone) + 5HT3 antagonist

    Aloxi is first line, IV push, lasts a week
  80. ABVD regimen
    • Adriamycin
    • Bleomycin
    • Vinblastine
    • Dacarbazine

    For Hodgkins lymphoma
  81. FOLFOX regimen
    • FOLinic acid (leucovorin)
    • Flurouracil
    • OXaliplatin

    For colorectal cancer
  82. Main side effect with bleomycin?
    Pulmonary reactions
  83. 3 HIV drugs that can co-treat Hep B
    emtricitabine, lamivudine, and tenofovir
  84. DOC for surgical prophylaxis
  85. DOC for CA-MRSA
  86. DOC for MRSA
  87. DOC for VRE facelis
    Pen G or ampicillin
  88. DOC for VRE faceium
  89. DOC for ESBL producing bacteria
  90. DOC for treating acinetobacter
  91. Drugs used in meningitis
    Usually ceftriaxone/cefotaxime + vancomycin

    +ampicillin if >50
  92. DOC for acute otitis media
    High dose amoxicillin 90mg/kg/day

    If fail, can try Augmentin or ceftriaxone for 3 days
  93. DOC for sinusitis
    Amoxicillin, Bactrim, or Doxycycline
  94. DOC for pharyngitis
    Penicillin, amoxicillin, 1/2 gen cephalosporins, macrolides
  95. Drugs used in severe bronchitis (>14 days)
    Bactrim, macrolides
  96. DOC for outpatient CAP
    Healthy: Doxycycline or macrolide

    Not: Respiratory FQ, Beta lactam + macrolide
  97. DOC for inpatient CAP
    Respiratory FQ, Beta lactam + macrolide
  98. DOC for sphyilis
    Penicillin G (Bicillin LA)
  99. DOC for gonorrhea
    Ceftriaxone + azithromycin


    can sub doxy for azith

    Can treat chlamydia too (azith)
  100. DOC for Bacterial vaginosis/trichomoniasis