Pass/fa Pharm Drill Day 8

Front 1

REVIEW:

Front 2

What direction does a competitive antagonist shift the efficacy curve (right, left, up, or down)?

Back 2

It doesn't: efficacy (Vmax) is not affected
However, potency is decreased (Km is increased) and therefore the POTENCY curve is shifted to the right

Front 3

What direction does a noncompetitive antagonist shift the potency curve (right, left, up, or down)?

Back 3

It doesn't: potency (Km) is not affected (the drug is just as potent as before, but some receptors are turned off)
However, efficacy (Vmax) is decreased and therefore the EFFICACY curve is shifted downward

Front 4

What is the c/u of Ampicillin/Amoxicillin?

Back 4

*HELPS Enterococci
H. Influenza
E. Coli
Listeria
Proteus
Salmonella
Enterococci

Front 5

A patient who was in a bar fight and was bit in the hand comes into the ER, what is the proper tx?

Back 5

Amoxicillin/Clavulonic Acid
(there are no dogs in the bar; he got bit by a person)

Front 6

A patient presents to your office with an infection in which labs show G+ aerobic rods in long, branching filaments….what is tx?

Back 6

Bug = Actinomyces
Tx = 6-12 wks IV Penicillin

Front 7

What is the profile for Norcardia?

Back 7

G+ rods in long branching filaments, anaerobic, partially acid fast

Front 8

What is initial tx for infective endocarditis?

Back 8

Emperical tx = Vancomycin + Gentomycin

Front 9

What is the tx for infective endocarditis that is culture positive for S. Viridans?

Back 9

IV Penicillin G
Ceftriaxone

Front 10

A patient comes to you office; has a fever of 102 F; CBC shows WBC of 500; negative U/A; neg CXR; pt is on chemotherapy, denies cough & diarrhea; what is the next step in the management of this pt?

Back 10

"Dx = Febrile Neutropenia
Pt @ risk of Pseudomonas
Tx for G+'s = IV Ceftazidime or IV Cefipime"

Front 11

A patient comes to you office; has a fever of 102 F and is hypertensive; CBC shows WBC of 500; negative U/A; neg CXR; pt is on chemotherapy, denies cough & diarrhea; what is the next step in the management of this pt?

Back 11

Dx = Febrile Neutropenia with HTN
Pt @ risk of Pseudomonas
Tx for G+'s = IV Ceftazidime or IV Cefipime
PLUS
Tx for G-'s = Vancomycin

Front 12

A patient comes to you office; has a fever of 102 F and is hypertensive; CBC shows WBC of 500; negative U/A; neg CXR; pt is on chemotherapy, denies cough & diarrhea; The pt is tx'd with IV Cefipime plus Vancomycin, but the fever persists; what is the next step in the managment of this pt?

Back 12

Dx = Febrile Neutropenia with HTN
Pt @ risk of Pseudomonas
Tx for G+'s = IV Ceftazidime or IV Cefipime
PLUS
Tx for G-'s = Vancomycin
PLUS
Tx for Fungi = Flucytosine

Front 13

After taking a hiking vacation to the upper NEern US, a pt comes to your office with autoimmune polyarthiritis chronica migrans; what is the tx?

Back 13

Dx = Tertiary Lyme Ds
Tx = IV Ceftriaxone

Front 14

With what sx's does a pt with primary Lyme's Disease present?

Back 14

Flu-like sx's
Erythema chronicum migrans (bull's eye rash)

Front 15

What is the tx for primary Lyme's Disease?

Back 15

Doxycycline

Front 16

With what sx's does a pt with secondary Lyme's Disease present?

Back 16

Migrating pain in muscles, joint, and tendons
Changes in heartbeat --> cardiac manifestations:
Heart palpitations
Dizziness
Neurological manifestations
Bell's Palsy
Meningitis
Encephalitis
Chorea

Front 17

What is the tx for secondary Lyme's Disease?

Back 17

Doxycycline

Front 18

What is the initial tx for a pregnant woman with Lyme's Disease?

Back 18

Ampicillin/Amoxicillin b/c Doxycycline is Teratogenic

Front 19

What is the DOC of a 7 y/o male with severe acute exacerbation of Cystic Fibrosis lung disease?

Back 19

1 AMG (DOC for any G- rod)
AND 1 Other Drug:
Anti-Pseudomonal Penicillin (e.g. Piperacillin, Ticarcillin)
3rd Gen Ceph's (e.g. Ceftazidime)

NOTE: MC infection in CF is Pseudomonas (G- rod); you always cover for Pseudomonas with 2 drugs
"

Front 20

What are the causes of community-aquired pneumonia (CAP)? How does this effect medical management?

Back 20

"Causes of CAP include bacteria, viruses, fungi, and parasites, therefore, broad-spectrim antiboitics (covers G+ AND G-) is used to tx CAP

Front 21

What is the in-house tx for community-aquired pneumonia (CAP)? Out-Patient Tx?

Back 21

Fluoroquinolones (aka Quinolones): broad-spectrum (i.e. G+ AND G-)
Levofloxacin
Gatifloxicin

Out-Patient TX:
Azithromycin (Macrolides)
Intracellular organisms
G+ cocci
Doxycycline (Tetracyclines)
Intracellular orgnaisms
Mycoplasm --> ""walking pneumonia""

Front 22

What is the c/u for Quinolones?

Back 22

G- rods in GI/GU track
CAP (community acquired pneumonia)

Front 23

[REVIEW] What is the c/u of Macrolides?

Back 23

*UPS Lost My Brand New Car
URI's (caused by G+ cocci)
Pneumonia (caused by G+ cocci)
STD's (caused by G+ cocci)
Legionella
Mycoplasma
Bordatella
Neisseria
Chlamydia

Front 24

[REVIEW] What is the c/u of Tetracyclines?

Back 24

*VACUuM The BR
Vibrio Cholerea
Acne (Propionibacterium Acnes)
Chlamydia
Ureaplasma Urealyticum
Mycoplasm
Tularemia
H. Pylori
Bordetella
Rickettsia

Front 25

What is the DOC for bacterial vaginosis in a non-pregnant woman?

Back 25

DOC = Tinidazole
2nd = Metronidazole (more SE's than Tinidazole)

Front 26

A diabetic pt comes to your office with a rhinocerebral infection…what is the next step in management?

Back 26

Dx'd bug = Mucor Rhizopus = HIGHLY FATAL DISEASE!!!
Treatment:
1) Debridement of necrotic tissue
2) Amphotericin B (direct injection)

Front 27

An HIV pt comes to your office with dysphagia, what is the next step in management?

Back 27

Fluconazole (b/c in HIV pt's, dysphagia has 90% correlation w/Candida)

Front 28

An HIV pt comes to your office with dysphagia; the initial tx with Fluconazole doesn't work; what is the next step in management?

Back 28

Endoscopy

Front 29

An HIV pt comes to your office with dysphagia; the initial tx with Fluconazole doesn't work so you do an endoscopy; biopsy reveals large, shallow ulcers; what is the next step in management?

Back 29

Dx = CMV (b/c lg shallow ulcers)
Tx = Ganciclovir

Front 30

An HIV pt comes to your office with dysphagia; the initial tx with Fluconazole doesn't work so you do an endoscopy; biopsy reveals multiple small vesiculated ulcers; what is the next step in management?

Back 30

Dx = HSV (b/c multiple small vesiculated ulcers)
Tx = Acyclovir

Front 31

DAY 8:

Front 32

What is the MOA and target of Statins?

Back 32

Inhibition of HMG CoA reductase in liver

Front 33

What is the MOA and target of Niacin?

Back 33

Inhibits the uptake of Ch'ol as VLDL from hepatocytes into circulation

Front 34

What is the MOA and target of Cholestepol?

Back 34

"It is a bile acid resin that inhibits the uptake of everything in the gut into the liver (works in the gut)

Front 35

What is the MOA and target of Izentamide?

Back 35

Ch'ol absorption blocker in the gut

Front 36

What is the MOA and target of Fibrates?

Back 36

Stimulates LPL in the circulation on the endothelial cells

Front 37

What are the Fibrates?

Back 37

Bezafibrate
Ciprofibrate
Clofibrate (largely obsolete due to side-effect profile, e.g. gallstones)
Gemfibrozil
Fenofibrate

Front 38

What effect do Statins have on LDL, HDL, & TG's?

Back 38

LDL: Decreased
HDL: Increased
TG's: Decreased

Front 39

What effect does Niacin have on LDL, HDL, & TG's?

Back 39

LDL: Decreased
HDL: Increased
TG's: Decreased

Front 40

What effect does Cholestepol have on LDL, HDL, & TG's?

Back 40

LDL: Decreased
HDL: No effect (b/c works in gut)
TG's: Slightly incr'd (indirect action)
(b/c decr'd GI absorption = LES --> incr'd lipolysis --> incr'd vLDL --> incr'd TG's)

Front 41

What effect does Izentamide have on LDL, HDL, & TG's?

Back 41

LDL: Decreased
HDL: No effect (b/c works in gut)
TG's: No effect (b/c still absorb proteins, carbohydrates, and fats)

Front 42

What effect do Fibrates have on LDL, HDL, & TG's?

Back 42

LDL: Decreased
HDL: Increased (1st line drug)
TG's: Decreased

Front 43

Probocal?

Back 43

"LDL: Decreased (increases LDL metabolism in last step of ch'ol elimination)

Front 44

In a pt with CAD, what should his/her LDL be less than?

Back 44

<100 (CAD or 3+ RF's)

Front 45

In a pt with 3 RF's for CAD, what should his/her LDL be less than?

Back 45

<100 (CAD or 3+ RF's)

Front 46

In a pt with 2 RF's for CAD, what should his/her LDL be less than?

Back 46

<130 (2 RF's)

Front 47

In a pt with 1 RF's for CAD, what should his/her LDL be less than?

Back 47

<160 (0 - 1 RF's)

Front 48

In a pt with CAD or 3 or more RF's for CAD, when do I begin medical management?

Back 48

When their LDL is >130 (tx starts when LDL reaches 1 level higher than target, 100)

Front 49

In a pt with 2 RF's for CAD, when do I begin medical management?

Back 49

When their LDL is >160 (tx starts when LDL reaches 1 level higher than target, 130)

Front 50

In a pt with 0 - 1 RF's for CAD, when do I begin medical management?

Back 50

When their LDL is >190 (tx starts when LDL reaches 1 level higher than target, 160)

Front 51

What is the drug of choice for high LDL?

Back 51

Lifestyle Management until they reach 1 level higher than their target LDL
Medical Management once they reach 1 level higher than their target LDL

Front 52

What is the MOA of Doxylamine?

Back 52

H1 receptor blocker

Front 53

What is the c/u for Doxylamine?

Back 53

Hyperemesis Gravidarum
Morning sickness

Front 54

What is the difference between Hyperemesis Gravidarum and morning sickness?

Back 54

Morning sickness occurs in the 1st trimester
Hyperemesis Gravidarum can occur in 1st, 2nd, or 3rd trimester

Front 55

What is Hyperemesis Gravidarum?

Back 55

Can be a severe form of morning sickness
Can be due to a gestational mole

Front 56

With what drug is Doxylamine co-administered?

Back 56

B6

Front 57

What is the MOA of Dimenhydrinate?

Back 57

REVERSIBLY inhibits H1 receptors in tissues

Front 58

What type of histamine receptors are present on gastric parietal cells?

Back 58

H2 receptors

Front 59

What do gastric parietal cells secrete?

Back 59

Intrinsic Factor
Hydrochloric Acid (HCl)

Front 60

How are gastric parietal cells involved in allergies?

Back 60

Though they have histaminic receptors, they are NOT involved in allergies

Front 61

What is the MOA of Fexofenadine?

Back 61

2nd Generation H1 Blocker

Front 62

Why do we use 2nd Gen H1 blockers instead of 1st Gen H1 blockers?

Back 62

Because it has fewer SE's

Front 63

A pt comes to your office has mild intermittent asthma; what is the 1st step in management?

Back 63

Albuterol

Front 64

What is the MOA of Albuterol?

Back 64

B2 agonist leading to bronchidilation

Front 65

A pt comes to your office has moderate persistent asthma; pt is currently taking asthma but is having night time flare-ups more than 3 times a week; what is the 1st step in management?

Back 65

Low-dose steroids

Front 66

What are the 6 actions of steroids?

Back 66

*KIIISS
1) Kills T-cells & eosinophils
2) Inhibit macrophage migration
3) Inhibit phospholipase A
4) Inhibit mast cell degranulation
5) Stabalizes endothelium
6) Stiumulates protein synthesis

Also according to FA: activates NF-κB therefore don't make any TNF-a

Front 67

Where does TNF-a come from?

Back 67

Macrophages

Front 68

What are all the things that Macrophages secrete?

Back 68

IL-1, IL-6, IL-12, TNF-a

Front 69

What do Th-1 cells secrete?

Back 69

IL-2 & IF-gamma

Front 70

What do Th-2 cells secrete?

Back 70

IL-4, IL-5, and IL-10

Front 71

What do Cytotoxic T-cells secrete?

Back 71

IL-3 and TNF-B

Front 72

A pt comes to your office with severe persistent asthma; the pt is currently taking Albuterol and low-dose prednisone; he is currently having an acute exacerbation; what is the next step in management?

Back 72

Give a dose of Albuterol

Front 73

A pt comes to your office with severe persistent asthma; the pt is currently taking Albuterol and low-dose prednisone; he is currently having an acute exacerbation & he has already rec'd ONE dose of Abluterol; what is the next step in management?

Back 73

Give a 2nd dose of Albuterol

Front 74

A pt comes to your office with severe persistent asthma; the pt is currently taking Albuterol and low-dose prednisone; he is currently having an acute exacerbation & he has already rec'd TWO doses of Abluterol; what is the next step in management?

Back 74

Give a 3rd dose of Albuterol

Front 75

A pt comes to your office with severe persistent asthma; the pt is currently taking Albuterol and low-dose prednisone; he is currently having an acute exacerbation & he has already rec'd THREE doses of Abluterol; what is the next step in management?

Back 75

Give high-dose inhaled corticosteroids

NOTE: For acute exacerbation of asthma you try 3 consecutive doses of Albuterol & if that doesn't work you turn to high-dose corticosteroids?

Front 76

An asthmatic pt currently on Albuterol, comes to your office complaining that everytime he work out, he become short of breath; what is the next step in management?

Back 76

Tx: Albuterol prior to working out

Front 77

An asthmatic pt with mild intermittient asthma currently on Albuterol who has not had a flare-up in two years comes to your office; what is the 1st step in management?

Back 77

Switch to Salmeterol, a long-acting B-agonist (prophylaxis)

Front 78

What is a summary of the management guidelines for asthma?

Back 78

1st line: Albuterol
2nd line (having flare-ups): add low-dose prednisone
Still having flare-ups: Albuterol x3 plus high-dose inhaled corticosteroids

Exercise-induced: Albuterol prior to activity trigger

Long-term maintenance/no flare-ups in long time: Salmeterol

Front 79

What is the MOA of Theophylline?

Back 79

Inhibition of PDE --> decr'd cAMP hydrolysis --> incr'd cAMP --> incr'd SS outflow (& decr'd PS ouflow) --> BRONCHODILATION

Front 80

What happens to Epinephrine release with Theophylline?

Back 80

Increases (due to incr'd cAMP) --> BRONCHODILATION

Front 81

What is the MOA of Ipratropium?

Back 81

Inhibits bronchoconstriction by blocking muscarinic receptors

Front 82

What is the MOA of cromolyn sodium?

Back 82

Inhibits mast cell degranulation

Front 83

What is the MOA of Zileuton?

Back 83

Inhibits 5-Lipoxygenase pathway thereby inhibiting the Leukotriene pathway

Front 84

What is the MOA of Zafirlukast/Montelukast?

Back 84

Inhibits Leukotriene receptors

Front 85

What is the MOA of Ranitidine?

Back 85

REVERSIBLY blocks H2 receptors in the gastric parietal cells

Front 86

What are the H2 blockers (reversible)?

Back 86

Cimetidine
Ranitidine
Famotidine
Nizatidine

Front 87

What is the c/u for H2 blockers?

Back 87

Peptic ulcers
Gastritis
Mild esophogeal reflux

Front 88

What are the SE's of Cimetidine?

Back 88

Impotence
Gynacomastia

Front 89

What is the MOA of Lansoprazole?

Back 89

PPI: IRREVERSIBLY inhibits the H+/K+ ATPase in gastric parietal cells

Front 90

What is the c/u for Lansoprazole?

Back 90

Peptic ulcers
Gastritis
Esophageal reflux
Zollinger-Ellison syndrome

Front 91

What is the MOA of Bismuth?

Back 91

"Allows HCO3- secretion to reastablish pH by covering the base of the ulcer & inhibiting gastric acid secretion

Front 92

What is the MOA of Mifepristone?

Back 92

Mifepristone = RU-486 aka the morning after pill
Progesterone antagonist used as an abortifacient

Front 93

What is the MOA of Misoprostol?

Back 93

PGE-1 analog:
Decr'd acid production
Incr'd mucous production/secretion

Front 94

What is the toxicity of Misoprostol?

Back 94

Diarrhea
Abortifacient

Front 95

What is the tx for H. Pylori?

Back 95

Triple Therapy:
Bismuth
Metronidazole
Amoxicillin OR Tetracycline

Front 96

What is the tx for H. Pylori refractory to triple therapy?

Back 96

Add a PPI

Front 97

What are the PPI's

Back 97

Omeprazole
Lansoprazole

Front 98

What is the tx for H. Pylori refractory to triple therapy and PPI's?

Back 98

Scope the pt (look for cancer)

Front 99

What is the tx for Gastric MALT with no "mets" (metatasis)?

Back 99

Clarithromycin (Macrolide)
Amoxicillin (G-)
Omeprazole (PPI)

NOTE: Lymphoma in the GI tract is normally due to Chronic H. Pylori infection; successfully tx H. Pylori & the Lymphoma goes away

Front 100

[REVIEW] What is the c/u of Ampicillin/Amoxicillin?

Back 100

*HELPS Enterococci
H. Influenza
E. Coli
Listeria
Proteus
Salmonella
Enterococci

Front 101

What is the 1st Line tx for Rheumatoid Arthritis?

Back 101

Methotrexate
Hydroxychloroquine
TNF-a inhibitors

Front 102

What is the MOA of Abciximab?

Back 102

Monoclonal antibody to glycoprotein IIb/IIIa

Front 103

What is the MOA of Infliximab?

Back 103

Monoclonal antibody to TNF-a

Front 104

What is the c/u of Infliximab?

Back 104

* CARS
Crohn's
Ankylosing Spondylitis
Rheumatoid Arthritis
Scerotic Arthritis

Front 105

What is the MOA of Sulfasalazine?

Back 105

Sulfasalazine = sulfa drug (antibiotic) + mesalazine (anti-inflammatory)

Front 106

What is the c/u of Sulfasalazine?

Back 106

Irritable Bowel Diseases (IBD's):
Ulcerative Colitis (UC)
Crohn's Disease

Front 107

What is the toxicity of Sulfasalazine?

Back 107

Reversible oligospermia
Drug-induced pancreatitis

Front 108

What is the MOA of Ondansetron?

Back 108

5HT-3 Antagonist

Front 109

What is the c/u for Ondansetron?

Back 109

Anti-emetic:
Post-op pts
Chemotherapy pts

Front 110

What are the SE(s) of Aluminum Hydroxide?

Back 110

Constipation
Hypophosphatemia
Hypokalemia

Front 111

What are the SE(s) of Magnesium Hydroxide?

Back 111

Diarrhea
Hypokalemia

Front 112

What are the SE(s) of Calcium Carbonate?

Back 112

Hypercalcemia
Rebound Acidosis
Hypokalemia

Front 113

What is the MOA of Heparin?

Back 113

Activates AT-III:
Decreases III
Decreases Xa

Front 114

What is the MOA of Enoxaparin?

Back 114

Activates AT-III:
Decreases Xa

Front 115

Which needs monitored with Enoxaparin (pT or pTT)?

Back 115

Neither with a LMWH

Front 116

What is the tx for HIT?

Back 116

Argatroban
Lepirudin

Front 117

What is the tx for Heparin toxicity?

Back 117

Stop Heparin administration
Protamine Sulfate

Front 118

What is the MOA of Protamine Sulfate?

Back 118

Positively-charged Protamine Sulfate binds to negatively-charged Heparin

Front 119

What is the MOA of Warfarin?

Back 119

Inhibits gamma-carboxylation of Vitamin K dependent coagulation factors:
II, VII, IX, X, Protein C, & Protein S

Front 120

Which CF is lost first when Warfarin is administered (i.e. which one has the shortest T 1/2)?

Back 120

Protein C

Front 121

Which CF is lost last when Warfarin is administered (i.e. which one has the longest T 1/2)?

Back 121

CF II

Front 122

Pt comes to your office, he's on coumadin (i.e warfarin); he had a GI bleed last night; he is bleeding this morning; what is next step in management?

Back 122

1) STOP the Drug
2) Give FFP
3) Give Vitamin K

Front 123

Pt comes to your office, he's on warfarin; he had a GI bleed last night; he is not bleeding this morning; what is next step in management?

Back 123

1) STOP the drug
2) Give Vitamin K

Front 124

What distinguishes whether or not FFP is given? What is the rationale?

Back 124

If the pt is actively bleeding, FFP must be given;
Once Vitamin K is given, it goes to liver & takes 24-48 hrs to make CF's;
Therefore, in the mean time, Vitamin K must be supplemented with FFP which replenishes CF's II, VII, IX, X, Protein C, & Protein S
"