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218 Cards in this Set
- Front
- Back
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What is 1st line Therapy in DM? |
Metformin |
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How much can you expect Metformin to lower FPG & A1c? |
FPG will lower 60-70 mg/dl |
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Take Metformin with food or without food? |
With food |
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What contraindications for renal insuff do you have with Metformin? |
Contraindicated in males Scr >1.5 or 1.4 in femAles or over 80. |
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How is eczema different from contact dermatitis? |
It is a chronic skin disorder
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Do topical steroids enter the blood stream? |
No |
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Are topical steroids good for long term use? |
No not for long term use |
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What is SE of topical steroids? |
Photosensitivity
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When would oral steroids be used for eczema and contact dermatitis |
When it is severe |
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What would you need to watch with a pt on warfarin whom you will start methylprednisone in? |
INR
Yes
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What is the incretin effect? |
Endogenous protein that helps |
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What does it mean that diabetics are dying from macro vascular problems? |
CVA, cardiac problems |
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Does HRT and ERT help or hurt the following? |
Hurt |
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What is MOA of sulfonylureas? |
Increase insulin response from pancreas |
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How much can you expect sulfonylureas to lower FPG And A1c? |
60-70 |
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What is #1 side effect of sulfonylureas?
Do patients usually gain weight or lose weight on sulfonylureas? Why? |
Hypoglycemia
Gain |
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Can sulfonylureas be used as mono therapy?
How are glinides different than sulfonylureas ? |
Yes
They are pulsatile instead of continuous |
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Do patients experience more hypoglycemia events with glybyride or glipizide? |
Glyburide because long acting
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What is the MOA of Intrauterine System?
Does IUS contain estrogen or no? |
Thickens cervical mucus, suppresses ovarian fnc, inhibits sperm movement, thins uterine lining
Mirena does not contain estrogen |
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What symptoms does Mirena help with?
How often is IM Depo-Provera given? |
Dysmenorrhea (painful Periods), Menorrhagia (heavy period), and anemia
Every 13 weeks |
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Which contraceptives are appropriate for post-partum/ breast-feeding women?
For women who have compliance issues, what contraceptives would you recommend? |
Depo-Provera, Progesterone 'mini-pill'
Depo-Provera q 13 wks, intrauterine system (IUD's) q 5 yrs, subdermal implant q 3 yrs |
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What is the risk of women who smoke and take oral contraceptives?
What contraceptives are best for those who smoke |
MI, bld clot
Low estrogen pills better for smokers under 35 or progesterone only pills in smokers over 35 |
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What is the contraindication in liver disease and contraceptives?
Why would a practitioner ask a patient if they have had a cva, blood clot, or cardiovascular or peripheral dz when talking about contraceptives? |
Oral contraceptives and implanon contraindicated in active liver dz
There is increased risk of blood clots with estrogen, Depo-Provera is safer for these medical issues Implanon contraind in active venous thrombo
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Because of how glinides work, when should it be taken?
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15 min before meal |
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When are glinides a good option for patients?
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In patients who skip meals b/c they just wouldn't take a dose for meal skipped |
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What is MOA of Thiazolidinediones (glitazones) |
Improve insulin sensitivity peripherally, hepatically, in adipose tissue
About 50 mg/dl decrease 1.2-1.5% decrease |
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Do patients see wt gain or wt loss with glitazones? |
Wt gain b/c increase of adipocytes |
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Do glitazones have good or bad glycemic durability? |
Good
Rosiglitazone b/c of possible cardiac SE, inconclusive studies |
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How long does it take for Proton Pump Inhibitors to reach maximal proton pump inhibition?
Why is this the case |
several days
because not all parietal cells are active at the same time |
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When should PPI's be taken?
Why? |
1 hr b/f a meal
b/c they are more effective after a prolonged fast |
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Can PPIs and H2RA be given together? |
No, but can be given at opposite ends of the day |
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Do PPI's or H2RA's provide better GERD symptom resolution and esophageal healing? |
PPI's |
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What is the relationship of PPI's to infection and Pneumonia?
Why is this? |
Slight increased risk of pneumonia on PPI's and infection
Due to gastric acid suppression which permits pathogens to colonize in upper gastro tract |
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Which type of patients should you be cautious about giving PPI's to?
Which is the more acceptable type of therapy? Step-up or Step-down approach with GERD? |
Those at risk for fracture, on Plavix, Fe deficient, pernicious anemia, on diuretics
Both acceptable |
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What are the alarm symptoms for GERD?
What dietary limitations should patients try first before medicine? |
bleeding, anemia, odynophagia (painful swallowing), dysphagia, weight loss
avoid citrus, tomatoes, coffee, peppermint, fatty foods, carbonation, chocolate |
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Which type of patients do you need to watch H2RA's with? |
Patients over 65 and CrCl < 50 ml/min |
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Benefits of the Pill |
Improves anemia, dysmenorrhea, uterine bleeding, acne, Decreased ovarian cycsts, PID, osteoporosis, endometrial cancer, benign breast dz |
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Contraindications for the pill (combo therapy): |
smoking, CA, DVT/clotting disorders, impaired liver, pregnancy, CVA, abnormal bleeding |
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What would you tell a patient some SE they may experience with estrogen are? |
N/V |
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What would you tell your patient about SE of progesterone? |
Mood changes |
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What are some adverse effects of estrogen therapy?
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Thromboembolism |
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What are a few things that are contraindications for both birth control pills and hormone replacement therapy?
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Hx of or active DVT
Acute liver dz |
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In menopause, can you give estrogen therapy alone? Why or why not? |
Yes, if patient does not have a uterus. NO if they do have a uterus...progesterone alone or estrogen and progesterone |
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Can you give a women progesterone therapy alone for menopause? |
Yes if they have a uterus, if they don't have a uterus then progesterone not needed because only purpose is to decrease uterine symptoms |
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Can you give progesterone only therapy for birth control? |
Yes
Yes, but not estrogen alone |
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What would be an option for a patient who likes taking the pill but says she has some acne, wt gain, hair on her face. |
Give her a biphasic or triphasic pill that has less progesterone instead of monophasic that has typically more progesterone |
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What is recommended amount of Calcium for pre-menopausal women? Post-menopausal women?
What vitamin should be taken with it? What are some suggestions with |
1000 mg 1200 mg
Vitamin D sunlight?
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If a patient is taking Alendronate (Fosamax) for osteoporosis, what else should patient take as supplement?
What foods should pt avoid when taking Alendronate? |
Calcium and Vit. D
OJ, dairy, antacids, coffee, ASA, calcium salts, amnioglycosides, NSAIDS |
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What patient education do patients need when taking Fosamax, Boniva, and Actonel for osteoporosis? |
Take with 6-8 oz of water 30 min or more before breakfast Sit upright for for 30-60 minutes after to reduce risk of upper GI irritation, GI bleed with GERD patients |
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What should you tell patients about caffeine and Fe and supplements when taking Calcium? |
Take 1-3 hrs apart |
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Estrogen, in the Women's Health Initiative, confirmed that with or without progesterone, it reduced risk of what type of fractures?
Did they find that this did or did not outweight increased risk of stroke, venous thromboembolism, coronary dz, and breast cancer? |
It reduced risk of hip and verterbral fractures
Did not outweigh added risk of these medical conditions |
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The FDA recommends hormone therapy for osteoporosis only in women with what type of vasomotor symptoms? Mild-moderate moderate moderate-severe |
Moderate to severe |
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In women who have a uterus, why can you not give estrogen alone for hormone therapy?
Can transdermal estrogen be given for osteoporosis? |
Progesterone must given with it to prevent endometrial cancer?
No, only for prevention no for treatment |
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What foods would you tell a patient to eat when taking Depo-provera? |
Calcium - milk, cheese, ice cream Vit. D |
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What are some alternative therapies for menopause? |
SSRI, CLONIDINE |
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What is the problem with unopposed estrogen?
Does this include topical estrogens? |
Unopposed estrogen without progesterone increase risk of endometrial cancer
Yes |
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What is purpose of hormone therapy for menopause? |
SYMPTOM MANAGEMENT only, not for osteoporosis |
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What are quality of life symptoms for menopause? |
insomnia, hot flashes/vasomotor, mood changes |
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What is important teaching for calcium supplements? |
Need to take in divided doses and need vit. D
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What are anti-cholinergic SE of overactive bladder drugs? |
constipation, dry eyes, urinary retention, |
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Patient states he has been nauseous. You start to prescribe reglan when he mentions he has had diarrhea recently. What is your thought?
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Do not prescribe reglan as it can cause diarrhea
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What are some SE of Zofran? |
HA, diarrhea, abdominal/epigastric pain
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What can you give with Reglan and Phenothiazines to reduce the extrapyrimidial effects? |
Benadryl
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What scenarios are corticosteroids given for N/V?
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With chemotherapy
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What is concern for drug-drug interactions with antacids? |
They coat the stomach and can cause decrease absorption of oral meds (I.e. Digoxin, antibiotics, steroids, allopurinol)
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What is 1st line treatment for N/V?
What is 2nd? 3rd? |
Phenothiazines
Antihistamine/anticholinergic Look for physiological cause |
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Which of the bulk forming agents are good for diabetics? |
Psyllium (Metamucil) & methyl cellulose (Citrucel)
They are sugar free |
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What is first line treatment for Rosacea?
What is 2nd line? 3rd line? |
Topical medications: flagyl, sodium-sulfa, azelaic acid
Oral antibiotic of tetra or doxycycline, erythro, bactrim Accutane or refer to dermatology |
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What is first-line treatment of acne vulgaris? |
Topical comedolytics (and add bacteriocidals/antibiotics if closed comedones/pustules)
Oral antibiotics or contraceptives Accutane |
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What is a side effect of Loperamide?
In which type of patients with certain symptoms should you be cautious to prescribe loperamide to? |
Drowsiness
In patients who have a fever or bloody stools |
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In a patient who has diarrhea and a fever, what type of antimicrobial would you prescribe?
In patient with traveler's diarrhea |
Quinolone
Quinolone |
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Patient presents with burning sensation, cough, regurgitation in mouth. Diagonsed w/ GERD. You prescribe an H2 Receptor Antagonist. What will this drug do for the patient?
In what age patients should you not prescribe this drug? And what CrCl should you not use it in? |
It will block histamine (hormone in gastric acid production) and reduce pepsin output and gastric acid volume
Age 65 adn those with CrCl less than 50 ml/min |
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If patient has above symptoms but says he wants the strongest thing you have, what would you prescribe and for how long?
How does this medication act on the stomach? |
PPI - Proton Pump Inhibitor: Omeprazole, Pantoprazole for up to 3 months?
suppresses gastric acid by inhibiting H+ K+ ATPase in gatric parietal cells |
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Which drugs have better GERD symptom resolution and esophageal healing?
What risks do you have to watch out for in patients taking PPI's?
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PPI's
infection (pneumonia, CDiff), hip & vertebral fracture decreased vit B12, Fe, & Mag, Plavix interaction, Biphosphonate So watch with Fe def. anemics, diuretics, |
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Would you give allupurinol for acute treatment of gout?
what is 1st line for acute treatment of gout? Other options? |
NO
Colchicine corticosteroids, NSAIDS |
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What does a low purine diet include? |
skim/lo fat milk juices |
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What would you counsel your patient on with lifestyle changes to help with gout? |
wt loss, review medications (ACE I), stop alcohol, low purine diet and can reduce or eliminate medications |
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How does Colchicine work?
What are the old and new guidelines for colchicine? |
Reduce urate crystal deposits
0.6-1.2 mg, then 0.6 mg q 2h until pain relief 1.2 mg, then .06 new guidelines AE decreased |
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What are some AE of colchicine?
If patient is a diabetic with gout, what medicines will you need to watch and why? |
GI significant - diarrhea, N/V, ab pain
metformin and colchicine watch B12 malabsorption (pernicious anemia) |
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In patients with gout and patients who have high cholesterol, what medicines do you need to watch for drug interactions?
What happens with these drugs?
And what foods do you need to watch? |
Watch statins and Fibrates (fenofibrate, gemfibrozil)
Increase toxicity
grape juice
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What is first-line treatment of acne vulgaris? |
Topical comedolytics (and add bacteriocidals/antibiotics if closed comedones/pustules)
Oral antibiotics or contraceptives Accutane |
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What is concern of prescribing NSAIDS with ACEI or ARBs? |
Decreasing renal function
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Can NSAIDS and ASA be given together?
Why not? |
No give NSAIDS 30 min - 2hrs after or 8 hrs b/f ASA
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What are some SE of triptans? |
DROWSINESS, N/V, lightheaded, dizziness, dry mouth
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What are 1st line drugs for migraine?
2nd line?
3rd line? |
ASA OR NSAIDS
Triptans
Ergot Derivatives
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What will you tell your patients about how long it will take for the triptans to start taking effect?
You prescribed Sumatriptan (Imitrex) for a patient who said it worked well but had some chest tightness. What drug would you recommend she change to? |
2 hours
Naratriptan (Amerge) - still a triptan but shouldn't cause the chest tightness |
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Why do you have to watch for serotonin syndrome with Triptans and other serotonin agonists? And which other drugs would this be?
What are some symptoms of serotonin syndrome? |
Because both can increase serotonin levels by combining serotonin agonists. For example, triptan and SSRI, opioids, detromethrophan, MAOIs
cognitive impairment, agitation, muscle spasms, hallucinations, fever, N/V, diarrhea, hyper-reflexivity |
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When should you be considering a prophylactic med for migraines?
What's the 1st line of drug for prophylaxis? |
When a pt needs a medication 2 or more days a week.
Beta-blockers |
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If a patient as a migraine with aura, does she need estrogen or stay away from estrogen supplements?
What anticonvulsant drug given off-label for migraines can also help with weight loss? |
NO estrogen with aura
Topamax |
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For a new muscle injury, what is 1st line of treatment?
If not enough, then what? |
NSAIDS and tylenol
muscle relaxer |
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What is the risk of use of NSAIDS for a long time? |
cardiovascular events |
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In a patient taking a blood pressure medicine who adds an NSAID, what is the risk?
Which group of HTN meds do NSAIDS have reported interactions?
What are some other risks btw these 2 classes of drugs besides HTN? |
increased blood pressure
ACEI, BB, diuretics
GI (perfs, ulcers, bleeds), platelet (inhibition of aggregation) renal fx |
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How long does it take for SSRI's to b/m effective?
What are 2 SE of SSRI's and reasons patients might want to take the medication at night? What is a major SE that patients stop taking the medication? |
4 - 6 wks
induce anxiety and insomnia
sexual dysfunction |
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What other anti-depressant drug class can you not give with SSRI's or SNRI's? |
MAOIs |
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True or False Singulair can help prevent headaches? |
True |
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Pre-existing epilepsy and cardiac conduction abnormalities are often contraindications to use of what Antidepressant? |
TCA's |
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Many Anti-depressant meds have what SE that mean you should be cautious in using them in elderly patients?
Do SSRI's have this SE? SNRI's? TCA? Atypical Depressants? MAOI's |
ortho-static Hypotension
NO No Yes Yes Very little
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Patient who is on Imitrex for migraines and either Celexa, Prozac, Zoloft, Paxil, or Lexapro starts having lightheadedness, uneasiness, HA, sedation, and flu like symptoms. What is possible cause? |
Serotonin syndrom |
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Why is Buprorion (Wellbutrin) a good 2nd line drug for depression to SSRI's and SNRI's? |
Because it doesn't have the SE of somnolence, wt gain, fatigue or sexual dysfunction |
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Why is pinworm therapy given as one dose now and 1 dose in 2wks? |
To kill adults now and other adults in 2 wks |
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Why is compliance so hard with the HPV vaccine?
Is it meant for both girls and boys?
Is it good for treating active disease?
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Because it takes 3 doses
Yes
No, only for prevention |
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What are some contraindications for the flu vaccine? |
< 6 mo of age, egg allergy, hx of Guianne Barre syndrome |
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Can pregnant woman receive following vaccines: flu vaccine?
HPV
Live vaccines
Tdap |
Yes
No
No
Yes
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If it is unknown if an elderly person has received the pneumonia vaccine, should they receive it?
What vaccine related to chicken pox should elderly receive? besides pneumonia and flu |
Yes, 1 dose
shingles/ herpers zoster |
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What are the live vaccines? |
Varicella Zoster MMR nasal Flu Rotavirus |
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If patient has the following, what would you know about their antibody response to vaccine antigens: elderly smokers alcoholic cirrhosis COPD DM I asthma dialysis patient HIV |
antigen response will be lower to vaccines, less immunity to virus |
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What happens if a person receives an extra dose of a live vaccine? |
It is ok, possibly boost immunity |
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What 4 drugs would you expect a patient to be if they had TB? |
INH - Isoniazid RIF - Rifampin/Rifabutin PZA - Pyrazinamide EMB - Ethambutol
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positive TST means what? |
That person either has active dz or has had it in the past |
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How long is the treatment regime for TB?
What supplement can be given to try to prevent peripheral neuropathy from drugs? |
6 months: Initial phase 8 wks of daily 4 drugs Continuous 18 wks of daily INH & RIF
B6 - pyridoxine |
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How often should liver function tests be done with TB treatment?
What range of LFT #'s is acceptable w/ TB tx? |
Before treatment, 1 month, then q 12 wks and a/f tx
3 x normal (ALT & AST, bilirubin, alkaline phosphatase) |
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Which sort of drugs has contraindications with Rifamycins?
What are SE of Rifamycins? |
CNS, oral contraceptives, warfarin, HIV drugs
discoloration of body fluids, neutropenia, hepatotoxicity |
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What other lab tests would you monitor in TB? |
serum creatinine and platelet count |
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How often should sputum cultures be done for TB after initiating treatment?
What determines if resolution of TB? |
Weekly for 3 weeks, then monthly
3 negative sputum cultures |
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Can TB drugs be given with pregnancy? |
Yes for INH and RIF? PZA can not |
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What are major SE of INH?
EMB? |
peripheral neuropathy
blurred vision, poor color discrimination |
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Should you use DOT - directly observed therapy - with TB?
Is it a reportable dz? |
YES!
YES! |
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In a person who has HIV but viral load is undetectable, is HIV eradicated?
Why is viral load important? |
No
To monitor virologic status, dz progression, ART regimen |
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Should pts with CD4 count 328 be on ART?
Patients w/ 570? |
Yes definintly
yes, most likely |
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How likely is it that patients will experience N/V and diarrhea w/ HIV treatment? |
very likely |
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What are some SE of HIV drugs? Which blood work will probably be elevate? |
Elevated liver ez, cholesterol, triglycerides, blood sugar, peripheral neuropathy, lipodystrophy and lipoatrophy |
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What are some known drug-drug interactions w/ HIV drugs? |
TB meds, lipid-lowering meds, antidepressants, birth control, PPIs, St. John's wort, erectile dysfunction |
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When HIV drugs have interactions with each other, what can sometimes be done to help with this? |
adjust doses of 1 or more meds |
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What are some opportunistic Infections to watch out for with HIV patients?
What is a common OI prophylaxis drug for CD4 60-159?
CD4<50 |
Pneumonia, TB, Meningitis, candidiasis, herpes, cytomegalovirus
TMP-SMX
Zithro |
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Are herbs considered a drug or food? |
Food |
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How do herbs influence drugs and drug metabolism? |
Influence rate of transportation and metabolism |
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What is correlation of herbs and allergies? |
pts with hay fever or seasonal allergies may be allergic to herbs similar to allergens |
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A patient says he is taking St. John's Wort, what is he probably taking it for?
Should you be concerned if patient is on a few different medications as well? |
Depression, nervous disorders, diarrhea, or UTI symptoms
Yes, b/c it has multiple drug interactions |
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A patient says she is taking Kava, what is she probably taking it for?
Should you be concerned? |
Pain or muscle relaxant, sleep if taking in regular doses, stimulant if taken in smaller doses |
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A patient says she is taking Saw Palmetto, what is she likely taking it for?
Should you be concerned? |
BPH - proven trials? Anti-inflammatory
interacts with hormonal drugs, NSAIDS monitor for allergies, kidney, and liver |
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A patient says he has been taking Garlic for several years. Why is he probably taking it?
Should you be concerned? |
Cardio dz, serum lipids, BP, BG
Can interfere with smell
Can cause GI irritation, diaphoresis, bleeding, allergic reactions |
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Why would an aging patient take Ginkgo Biloba?
What are possible interactions with GB? |
Helps w/ memory loss, delay dementias, improve vascular dz
tylenol, HCTZ, tramadol, Zocor, elavil, ASA, losartan, lasoprazole |
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What vitamin is triggered to synthesis by sun
What vitamin prevents cell membrane & damage, bld clot formation, growth & development of muscles, vit A utilization |
Vitamin D |
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Vitamin that body makes most if what it needs with bacteria from GI tract? |
Vitamin K |
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What vitamin helps with bone growth and development, teeth, immunity, vision, mucosal integrity? |
Vitamin A |
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What vitamin helps regulate calcium Levels? |
Vit D |
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What foods should your patient eat if deficient in vitamin E?
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Veg oil, green leafy vegetables, nuts, dairy, eggs, cereal, meat, wheat germ
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What major drug does vit K interact with?
What foods should patient consume to get vit K? |
Anti-coagulants |
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Vitamin that alcoholics and liver dz PTs at risk of being deficient. Deficiency causes paralysis of eye muscle, neuropathy, muscle wasting, ht failure, CHF, anorexia, depression, gastric dZ?
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Vitamin B1 thiamine |
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What are good sources of vitamin B1?
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Wheat, whole grains, beef, pork, fresh veg, breakfast cereals with nutrients added
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What foods should a patient eat to consume vitamin C?
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Citrus fruits, cantaloupe, strawberries, tomatoes, broccoli, cauliflower, cabbage |
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This vitamin is essential for synthesis of nucleoproteins and maintenance of RBCs, neurons, and proteins
If a patient needed vitamin B9, what foods would you tell them to eat? |
Vitamin B9 Folic Acid |
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This vitamin is not stored in the body, it must be consumed each day.
It is essential for collagen & intercellular body tissues, blood vessels, cartilage, bones, teeth, skin & tendons. Helps with wound healing and resistance to infection |
Vitamin C Ascorbic Acid
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What foods should a patient eat to consume vitamin C?
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Citrus fruits, cantaloupe, strawberries, tomatoes, broccoli, cauliflower, cabbage
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Large doses of what drug can attenuate uptake of Ascorbic acid?
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Aspirin
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What are the macrominerals? |
Calcium, chloride, magnesium, phosphorus, potassium, sodium |
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What vitamins, herbs, & minerals are good for preventing headache? |
Riboflavin Magnesium Feverfew (Migrelief Ribo, Mg, fever) co-enzyme Q10 Butterbur extract |
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Does Bupropion impact serotonergic system? |
No |
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when someone states they take acetaminophen quite often, what should you be concerned about?
Does it have anti-inflammatory properties? |
OD b/c taking combo products and don't know it's in other products and take too much
No |
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Does ASA have anti-inflammatory properties?
Would you prescribe it for someone with a history of bleeding, asthma, sensitivity to salicylates or NSAIDS? |
Yes
NO |
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If patient came into clinic with HA that also had stiff neck or started after age 50 or was sudden onset or accelerating pattern, would you prescribe tylenol and send them on their way? |
No, alarm signals |
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Can you use ASA w/ NSAIDS? |
No, reduces effectiveness of NSAIDS |
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If a patient says he keeps taking medicine for HA and it goes away then comes back, what is possibly going on? |
MOH - medicaton overuse headache, HA recurs as dose is wearing off, causing cycle of pain |
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What kind of HA is it appropriate to prescribe anti-depressants for? |
Tension HA |
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Why would you give antiemetic agents with an analgesic? |
It can augment the pain-relieving properties |
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What is the criteria for using a Triptan?
When presicribing a Triptan to a patient, what would you tell them the goal is of therapy? |
Missing more than 11 days of work in last 3 months
To be pain free w/in 2 hrs of taking medication and assoc. symptoms |
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What is criteria for prescribing a prophylactic for migraines?
What is 1st drug therapy a person with migraines should try? |
2-4 HA/wk
ASA or NSAIDS |
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What is 2nd line therapy for a migraine?
What is 3rd line therapy for migraines? |
Triptans
Ergot Derivatives |
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Is Imitrex the only Triptan that relieves all assoc. symptoms? |
? |
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What is a SE of Sumatriptan (Imitrex) related to the chest?
When are Triptans contraindicated? |
Chest tightness
Because they cause vasoconstriction, contraindicated in ht dz, ischemic dz (PVD) and uncontrolled HBP |
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What are the Triptan sensations? |
tightening of the jaw, neck, or chest, tingling, flushing, dizziness, nausea |
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What is a cheap migraine drug for those that don't have insurance?
Could you presribe for woman of child-bearing years? |
Ergot-deriviatives
no pregnancy X or do pregnancy test first |
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What are some prophylactic drugs for migraines? |
Beta Blockers, TCA, Calcium channel blockers (verapamil) |
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Why should a patient not take estrogen if have migraines with auras?
What contraception should be used? |
Can lead to cardiovascular issues
Mirena, progesterone only pill |
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Does estrogen help or hurt migraines? |
Can do either |
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What is 1st line therapy for acute anxiety?
Which of these is better in the elderly and why? |
Benzodiazipines
Alprazolam, lorazepam, buspar, oxazepam, hydroxyzine b/ impaired liver and kidney function may precipitate prolonged SE |
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What is major SE of benzodiazepines?
If a woman on the pill said she thinks she needs something for anxiety, would you prescribe a benzodiazepine? |
Drowsiness, ataxia
No may have increased effect of Benzodiazepine, or start at lowest dose |
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What is a concern of prescribing benzodiazepines?
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Dependence, watch in those who abuse alcohol and other substances
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What are concerns/warnings of ADHD drugs?
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Black box warning for cardiovascular
Growth stunting in kids |
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T/F ADHD stimulant drugs increase chance for sz, esp in those who have had a sz?
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True
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In a pt who starts a cholinesterase inhibitor for Alzheimer's, when would you expect to see improvement?
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3-6 wks
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Why would a patient be on aricept no matter the stage of Alzheimer's?
If a person is on aricept and not able to go to sleep/insomnia, what could be done? |
It is good for all stages
Change to morning dose |
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In patient who has sick sinus syndrome , what is caution in using Donazepil/Aricept?
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Bradycardia
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Does Memantine (namenda) have better or worse outcomes with Aricept?
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Better
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What vitamin is a good cheap alternative for Alzheimer's treatment? How much of a delay in Alzheimer's should it provide?
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Vitamin E
7 month delay |
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What is first line therapy for arthritis?
What conditions is acetaminophen 1st line treatment for? |
Acetaminophen
HA and arthritis |
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Why do NSAIDS remain a 2nd line approach to Tylenol for arthritis? |
GI side effects
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What are SE of acetaminophen?
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Dizziness, rash
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What are GI SE of Tylenol?
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Ulcers
Bleeding Perforation Gastric outlet obstruction |
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If taking Tylenol for arthritis and pain gets better, should patient stop?
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No take around the clock
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How is Celebrex different from other NSAIDS?
How do NSAIDS result in impaired kidney? |
It only inhibits COX-2 enzyme and doesn't have GI SE
It blocks COX-2 which produces protective prostaglandin in kidney responsible for maintaining adequate bld perfusion via vasodilation of afferent arteriole. So have afferent vasoconstriction |
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How does allopurinol help prevent gout?
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Dec synthesis of Uric acid
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From the NSAID article what does it say harm of NSAIDS are with HTN & HF?
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NSAIDS inc BP can tip it over to HTN, increase incidence of HF
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What is a SE of Glitazones to be concerned about with HF patients? |
Fluid Retention, should not be used in NYHA class III or IV, SOB walking upstairs or sitting still |
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Regarding metformin, which of the following is TRUE? |
c. |
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Regarding Actos (pioglitazone), which of the following is FALSE? |
b. All are TRUE except B since it does not cause hypoglycemia when used alone. |
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ACE-Inhibitors such as ramipril (Altace®) may provide several benefits to patients |
e. |
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Regarding glipizide XL, which of the following is FALSE? |
d. |
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In a patient predisposed to fractures, why would you not want to prescribe Glitazones? |
Increases fracture risk |
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What is the concern of a diabetic taking oral contraceptives? |
Some DM meds like glitazone can decrease effectiveness of contraceptives |
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Do Metformin and Sulfonylreas decrease pre or post prandial glucose?
Why do GLP-1 receptor agonists cause nausea |
Both
B/c slows gastric emptying |
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Medications that can cause hyperglycemia include all of the following EXCEPT: |
c. |
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Which of the following are monitoring parameters for ACE inhibitors? a. Potassium |
d. A and B ACE inhibitors do not alter heart rate, but they can increase potassium and creatinine, both of which need to be monitored. |
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List 6 drugs said to be direct irritants to the esophageal mucosa. |
Bisphosphonates (alendronate), Aspirin, Iron, NSAIDs, Quinidine, & KCl. |
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What is the mechanism of action for the treatment of GERD with antacids? |
Antacids increase intragastric pH. |
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List six common side effects of H2RAs. In what patient population are they most likely to occur? |
Headache, somnolence, fatigue, dizziness, constipation, and diarrhea. Side effects are most common in the elderly. |
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Which class of medication for the treatment of GERD carries an increased risk of fractures with longterm use? |
PPIs |
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What vitamin and mineral deficiencies are of concern with longterm use of PPIs? |
Vitamin B12 deficiency, hypomagnesemia, and malabsorption of iron. |
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What is a potentially serious cause of diarrhea in patients on longterm PPI treatment (how must it be treated)? |
Clostridium difficile bacteria (requires antibiotic treatment) |
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At what time, relative to a meal, should a PPI be administered for the treatment of GERD? |
30-60 min prior to meal |
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What are two promotility agents used in select patients as an adjunct to acid suppression therapy in the treatment of GERD? |
Metoclopramide & Bethanecol |
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Indications for topical corticosteroids |
contact dermatitis |
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Choose the best first treatment option for Acne Rosacea:
a. topical corticosteroids - hyrdorcortisone b. oral antibiotics - erthryo c. topical antibacterials- flagyl d. topical antibiotics - bactroban |
c. 1st line treatment is anti-bacterials -flaygyl |
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Name treatment options for acne vulgaris: |
1. Topical therapy benzoyl peroxide retinoids topical antibiotics combo benzoyl/antibiotics
2. oral meds antibiotics (tetra, erythro) contraceptives |
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Name treatment options for impetigo |
1. Topical antibiotics mupirocin 2. Oral antibiotics cephalexin doxycycline
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Ketoconazole and Itraconazole have black box warnings for what? |
Ketoconazole for hepatotoxicity Itraconazole for CV effects |
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What is the important thing to know about taking calcium supplements? |
Take in divided doses Take 1 - 3 hrs apart from supplements, antacids, caffeine, other Ca supplements Can be constipating |
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SE of Oxybutynin? |
Angioedema of face lips, tongue, pharynx
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With hormone contraception, what are looking for with each when thinking about the following? A C H E S |
A abdominal pain, gallbladder C chest pain, PE, MI H HA, CVA, HTN, migraine E eye problems, CVA, HTN S severe leg pain, DVT |
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Can a woman take hormone replacement therapy with a history of breast cancer? endometrial cancer genital bleeding liver dz DVT pregnancy |
NO NO NO |
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What is MOA of bulk forming agents?
Is there diabetic option?
What do you need to watch when giving these agents? |
pull water into stool, promote peristalsis
yes, sugar free
Make sure mobile and not immobile, not for post surgery, drinking plenty of water |
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Milk of Magnesium is a saline agents that holds water in intestine producing results in a few hrs, what do you need to watch with these?
Are these 1st or 2nd line of treatment?
What kind of patients should you use caution wiht these? |
Watch excessive magnesium, renal dysfunction
2nd line
Na restricted patients (HTN, HF, edema) |
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Do lubricant (mineral oil) and surfactants (docusate sodium) treat constipation? |
NO, prevent it. Take 1-3 days and soften stool |
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What is more potent class of laxatives? |
Stimulants - senna, dulcolax, castor oil |
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Which laxative should you watch with diabetics? Why |
Hyperosmotics (miralax) Because increase sugar levels |
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What is the caution in using Cimetidine? |
Has multiple drug interactions |
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Why is it not advisable for a patient to take a PPI for long term use? |
incease risk of fracture |
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Can you take sucralfate with PPIs, H2R, antacids? |
NO! |
