Pharm

Front 1

What cause orange discoloration to bodily fluids; hepatotoxic?

Back 1

RIF = rifampin (TB drug)

Front 2

What are prostacyclin agonists?

Back 2

iloprost, epoprotenol, teprostinil (FYI side effects of PGI2 or prostacyclin: hypotension, diarrhea, uterine cramping
TB drug

Front 3

: iloprost, epoprotenol, teprostinil

Back 3

prostacyclin agonists
TB drug

Front 4

sildenafil

Back 4

PDE5 inhibitor TB drug

Front 5

PDE5 inhibitor

Back 5

sildenafil

Front 6

Peripheral neuropathy, wide anion gap acidosis, hepatotoxic

Back 6

INH = isoniazid TB drug

Front 7

RIF = rifampin

Back 7

Toxicities
Orange discoloration to bodily fluids; hepatotoxic
Comments
Powerful enzyme inducer; will reduce effect of many other drugs ; in HIV consider rifabutin instead of RIF to ↓impact on HAART in HIV/AIDS;

TB drug

Front 8

List the TB drugs

Back 8

RIF = rifampin INH = isoniazid
Pyrazinamide
Ethambutol
Streptomycin
1. prostacyclin agonists: iloprost, epoprotenol, teprostinil (FYI side effects of PGI2 or prostacyclin: hypotension, diarrhea, uterine cramping)
2. PDE5 inhibitor sildenafil
3. endothelin receptor antagonists: bosentan, ambrisentan

Front 9

bosentan, ambrisentan

Back 9

endothelin receptor antagonists:
TB

Front 10

endothelin receptor antagonists:

Back 10

bosentan, ambrisentan
TB

Front 11

Pyrazinamide

Back 11

Hepatotoxic, may ↑ uric acid level
tb

Front 12

Hepatotoxic, may ↑ uric acid level

Back 12

Pyrazinamide
tb

Front 13

Optic neuritis (↓ acuity, color blindness)

Back 13

Ethambutol

tb

Front 14

Ethambutol

Back 14

Ethambutol
Optic neuritis (↓ acuity, color blindness)
↓ dose in renal impairment

tb

Front 15

Streptomycin

Back 15

Aminoglycoside = nephrotoxic and ototoxic
IM - not absorbed orally

tb

Front 16

Aminoglycoside = nephrotoxic and ototoxic
IM - not absorbed orally

Back 16

Streptomycin
tb

Front 17

Vit B6 to ↓risk of neuropathy; polymorphism in metabolism (fast vs slow acetylators = ↑ risk SLE FYI boards procainamide and hydralazine too)

Back 17

INH = isoniazid

tb

Front 18

what drugs causes SLE?
lupus?

Back 18

procainamide and hydralazine INH = isoniazid

Front 19

Acute Otitis Media: most likely bugs

Back 19

= S pneumo, H influenza, M catarrhalis. Occasionally see P aeruginosa, S aureus, S pyogenes.

Front 20

Acute Otitis Media: tx

Back 20

1. Amoxicillin high dose (80-90mg/kg/day divided into 2 doses daily)
2. In mild PCN allergy: Cefdinir, cefuroxime, cefpodoxime or cefprozil.
3. In anaphylactic (type I) PCN allergy: azithromycin or clarithromycin (clarithromycin causes metallic taste and many drug interactions; resistance to azith is emerging)
4. If very severe illness, consider amoxicillin/clavulanate

Front 21

Sinusitis: Most likely bugs

Back 21

virus, S pneumo, H influenza, M catarrhalis. L monocytogenes, fungi, gm negative bacteria occasionally)

Front 22

Sinusitis TX

Back 22

i. Antibiotics if severe symptoms or duration > 7 days
ii. First line
1. Amoxicillin – low or high dose
2. PCN allergic (mild Ax): cephalosporin
3. Type I PCN allergy: Macrolide (azithromycin, clarithromycin), doxycycline, or sulfamethoxazole/trimethoprim (SMX/TMP)
iii. Treatment failure (not respond within 48-72hr) or antibiotic in last 6 weeks: high-dose amoxicillin/clavulanate, cephalosporin, or resp fluoroquinolone(levofloxacin or moxifloxacin)
iv. High suspicion of PCN resistant S pneumo: high dose amoxicillin, clindamycin, or resp fluorquinolone

Front 23

Pharyngitis: bugs

Back 23

virus, S pyogenes, group A Streptococcus)

Front 24

Pharyngitis tx

Back 24

i. Antibiotics if strep positive
1. 1st line: penicillin (amox tastes better for kids)
2. PCN allergy: cephalexin (if mild Ax), macrolide (azith, clarith, erythromycin)
3. Treatment fail: cefuroxime, cefprozil, cefpodoxime, cefdinir
4. Recurrent: clindamycin, amoxicillin/clavulanate

Front 25

Laryngotracheobronchitis (Croup)- bugs

Back 25

virus peaks in fall/winter; parainfluenza, adenovirus, RSV, influenza A

Front 26

Community acquired pneumonia tx inpatinet

Back 26

Β-lactam (end in –cillin if a penicillin derivative) + macrolide (azithromycin, clarithromycin, erythromycin)
OR
resp fluroquinolone (IV)****- levofloxacin, moxifloxacin; nonrespiratory fluoroquinolone = ciprofloxacin

Front 27

Epiglottitis- bugs

Back 27

viruses,type B H influenze, S pneumo, S aureus, β-hemolytic Strep, gm neg bacteria, N meningitides, H parainfluenzae)

Front 28

Epiglottitis

Back 28

i. Ceftriaxone, cefuroxime, cefotaxime (2nd/3rd gen)
ii. Chloramphenicol
iii. clindamycin

Front 29

CAP
Simple out-patient

Back 29

Doxycycline OR Macrolide-azithromycin, clarithromycin, erythromycin

Front 30

CAP
Outpt chronic disease or antibiotic in last 3 months

Back 30

Β-lactam+ macrolide OR
Resp fluoroquinolone (PO)***

Front 31

levofloxacin, moxifloxacin; nonrespiratory - ciprofloxacin

Back 31

fluorquinolones

Front 32

fluorquinolones

Back 32

Respiratory fluorquinolones=
levofloxacin, moxifloxacin;

nonrespiratory fluoroquinolone = ciprofloxacin

Front 33

nonrespiratory fluoroquinolone

Back 33

ciprofloxacin

Front 34

ciprofloxacin

Back 34

nonrespiratory fluoroquinolone

Front 35

CAP ICU admit

Back 35

Β-lactam+ macrolide or + resp fluroquinolone
(PCN allergic aztreonam + resp fluorquinolone)

Front 36

Inpatient beta lactams

Back 36

3rd gen cephalosporins: cefotaxime, ceftriaxone; ertapenem, ampicillin/sulbactam

Front 37

Outpatient beta-lactam

Back 37

cefuroxime (2nd gen), cefpodoxime (3rd gen), amoxicillin, amoxicillin/clavulanate

Front 38

beta-lactamase inhibitors

Back 38

clavulanate and sulbactam

Front 39

Macrolides

Back 39

azithromycin, clarithromycin, erythromycin

Front 40

azithromycin, clarithromycin, erythromycin

Back 40

Macrolides

Front 41

Hospital acquired pneumonia
late

Back 41

Antipseudomonal Β-lactam + aminoglycoside OR + fluroquinolone (2 drugs for pseudomonas)
Consider MRSA: vancomycin or
Linezolid or ceftalorine

Front 42

Hospital acquired pneumonia
early

Back 42

3rd gen cephalosporin OR
Fluoroquinolone OR
Ampicillin/sulbactam OR
ertapenem

Front 43

Antipseudomonal beta-lactams

Back 43

meropenem, imipenem/cilastatin, cefepime, ceftazidime, aztreonam (aztreonam safe in PCN allergy!)

Front 44

meropenem, imipenem/cilastatin, cefepime, ceftazidime, aztreonam (aztreonam safe in PCN allergy!)

Back 44

Antipseudomonal beta-lactams

Front 45

Aminoglycosides =

Back 45

gentamicin, amikacin, tobramycin

Front 46

gentamicin, amikacin, tobramycin

Back 46

Aminoglycosides =

Front 47

Aspiration pneumonia (cover oral flora

Back 47

clindamycin, metronidazole, amoxicillin/clavulanate, possibly moxifloxacin

Front 48

clindamycin, metronidazole, amoxicillin/clavulanate, possibly moxifloxacin

Back 48

Aspiration pneumonia (cover oral flora

Front 49

covers pseudomonas
3rd gen ceph

Back 49

cefTAZidime

Front 50

cefTAZidime

Back 50

covers pseudomonas
3rd gen ceph

Front 51

ceftalorine

Back 51

5th generation cephalosporin
is LAE but not LAME (it covers MRSA but not listeria, atypicals or enterococci)

Front 52

5th generation cephalosporin
is LAE but not LAME (it covers MRSA but not listeria, atypicals or enterococci)

Back 52

ceftalorine

Front 53

ertapenem

Back 53

NO pseudomonas coverage

Front 54

ciprofloxacin

Back 54

NO S pneumo coverage

Front 55

Contraindications: beta-lactams

Back 55

type I (anaphylactic) penicillin allergy

Front 56

may cause seizure, are renally cleared

Back 56

Carbapenems (and other beta lactams

Front 57

Carbapenems (and other beta lactams
SE

Back 57

may cause seizure, are renally cleared

Front 58

photosensitivity, chelates divalent cations

Back 58

Doxycycline

Front 59

Doxycycline SE

Back 59

– photosensitivity, chelates divalent cations

Front 60

Fluroquinolones SE

Back 60

– generally renally cleared, may cause seizures/confusion, photosensitivity, prolong QT interval

Front 61

– generally renally cleared, may cause seizures/confusion, photosensitivity, prolong QT interval

Back 61

Fluroquinolones

Front 62

Vancomycin SE

Back 62

red man syndrome, nephrotoxicity (monitor drug levels)

Front 63

red man syndrome, nephrotoxicity (monitor drug levels)

Back 63

Vancomycin

Front 64

Aminoglycosides SE

Back 64

nephrotoxicity, ototoxicity, neuromuscular blockade (monitor drug levels)

Front 65

nephrotoxicity, ototoxicity, neuromuscular blockade (monitor drug levels)

Back 65

Aminoglycosides

Front 66

photosensitivity

Back 66

Sulfamethoxazole/trimethoprim

Front 67

Sulfamethoxazole/trimethoprim SE

Back 67

photosensitivity

Front 68

avoid ethanol, metallic taste

Back 68

Metronidazole

Front 69

Metronidazole SE

Back 69

avoid ethanol, metallic taste

Front 70

GI problems, C difficile risk with long-term

Back 70

Clindamycin

Front 71

Clindamycin SE

Back 71

– GI problems, C difficile risk with long-term

Front 72

Intermittent ASTHMA TX

Back 72

SABA prn

Front 73

SABA

Back 73

short acting beta2 agonist = albuterol inhalation

Front 74

LABA = long acting beta agonist

Back 74

salmeterol inh, formeterol inh

Front 75

Mild persistent ASTHMA TX

Back 75

step 2:
Low dose ICS
Alternates:
Montelukast
Cromolyn
Theophyliine if > 5 yrs old

Front 76

Mod persist ASTHMA TX

Back 76

step 3:
med dose ICS
Alt:
Low dose ICA + either LABA or montelukast or theophylline if > 5yo

Consider dose systemic steroid

Front 77

Sev persist

Back 77

step 4:
med dose ICS AND either
LABA, Montelukast, theo if > 5yo

Consider steroid systemic
<OR>

step 5:
High dose ICS with either LABA, montelukast, or theo if > 5yo

<OR>
Step 6 = step 5 + systemic steroids

Front 78

asthma cough worse at night before 6am due to what?

Back 78

due to ↓ in cortisol diurnal rhythym

Front 79

When asthma symptoms worsen, treat to symptom level ....

Back 79

as above.

Front 80

Once a patient is stable ----- at a step, back up 1.

Back 80

3 months

Front 81

Asthma action plan for self-management at home

Back 81

based on personal best peak expiratory flow (PEF)

80-100% of personal best = green zone, carry on with current treatment

50-79% = yellow zone, step up, consider short systemic steroid,contact physician soon

<50% = red zone, get help; follow action plan per physician ER!!!!

Front 82

Beta 2 agonist ↑ cAMP

Back 82

Beta agonist
Short: albuterol, levalbuterol
Long: salmeterol, formeterol, oral albuterol

Front 83

↓cGMP

Back 83

Anticholinergic
Ipratropium
Tiotropium (not approved in asthma, but used for some)

Front 84

Beta agonist SE

Back 84

Tachycardia, hypokalemia, shakiness

Front 85

Beta agonist

Back 85

Beta 2 agonist ↑ cAMP Tachycardia, hypokalemia, shakiness MDI, oral, nebulized

Front 86

antiSLUD: dry mouth, dry eyes, urinary retention, constipation

Back 86

Anticholinergic

Front 87

Anticholinergic SE

Back 87

antiSLUD: dry mouth, dry eyes, urinary retention, constipation

Front 88

Anticholinergic

Back 88

Anticholinergic
Ipratropium
Tiotropium (not approved in asthma, but used for some) Anticholinergic ↓cGMP antiSLUD: dry mouth, dry eyes, urinary retention, constipation Ipratropium useful in acute exacerbation when PEF/ or FEV1<40%

Front 89

Blocks LT receptor →↓ inflammation

Back 89

Leukotriene receptor antagonists (LRTA)
Montelukast (Singulair)
Zafirlukast (Accolate

Front 90

Leukotriene receptor antagonists (LRTA)

Back 90

antagonists (LRTA)
Montelukast (Singulair)
Zafirlukast (Accolate)

Front 91

antagonists (LRTA)
Montelukast (Singulair)
Zafirlukast (Accolate)

Back 91

Leukotriene receptor antagonists (LRTA)

Front 92

Leukotriene receptor antagonists (LRTA)

Back 92

Leukotriene receptor antagonists (LRTA)
Montelukast (Singulair)
Zafirlukast (Accolate) Blocks LT receptor →↓ inflammation Well tolerated Good in peds; dose at bedtime to cover nighttime ↓ in cortisol

Front 93

Good in peds; dose at bedtime to cover nighttime ↓ in cortisol

Back 93

Leukotriene receptor antagonists (LRTA)

Front 94

Mast cell stabilizers: DRUGS

Back 94

nedocromil and cromolyn
Asthma only

Front 95

Mast cell stabilizers:

Back 95

Mast cell stabilizers: nedocromil and cromolyn
Asthma only Prevent exocytosis of histamine from mast cells Minimal Not absorbed systemically. Must have on board before histamine is released (therefore controller not rescue)

Front 96

Mast cell stabilizers: SE

Back 96

Minimal

Front 97

Methylxanthine SE

Back 97

Tachycardia, shakiness, vomiting, seizures that can be fatal

Front 98

Methylxanthine DRUGS

Back 98

Theophylline (a cousin of caffeine)

Front 99

Methylxanthine:

Back 99

Methylxanthine:
Theophylline (a cousin of caffeine) Inhibits phosphodiesterase, ↑cAMP Tachycardia, shakiness, vomiting, seizures that can be fatal Dangerous drug! Many interactions. Smoking cessation can cause toxicity (loss of hepatic enzyme induction caused by smoke)

Front 100

Dangerous drug! Many interactions. Smoking cessation can cause toxicity (loss of hepatic enzyme induction caused by smoke)

Back 100

Methylxanthine:
Theophylline (a cousin of caffeine)

Front 101

Lipooxygenase inhibitor
DRUG

Back 101

Zileuton

Front 102

Increased prostaglandins, hepatotoxic

Back 102

Lipooxygenase inhibitor

Front 103

Lipooxygenase inhibitor SE

Back 103

Increased prostaglandins, hepatotoxic

Front 104

Lipooxygenase inhibitor

Back 104

Lipooxygenase inhibitor
Zileuton Inhibits leukotriene synthesis Increased prostaglandins, hepatotoxic Not used much

Front 105

antiIgE antibody

Back 105

omalizumab (Xolair)

Front 106

antiIgE antibody

Back 106

antiIgE antibody
omalizumab (Xolair) Anti IgE Antiantibody antibodies = anaphylaxis Really really expensive

Front 107

metered dose inhalers (MDI)

Back 107

SLOWLY inhaled

Front 108

SLOWLY inhaled

Back 108

metered dose inhalers (MDI

Front 109

FAST inhalation

Back 109

Dry powder inhalers

Front 110

Dry powder inhalers

Back 110

FAST inhalation

Front 111

Mild FEV1≥80% of predicted (FEV1/FVC<70%)
COPD TX

Back 111

Pneumovax +
Flu vaccine+
SABA prn or ipratropium prn

Front 112

Moderate:
FEV1 50-79% of predicted
COPD TX

Back 112

Pneumovax +
Flu vaccine+
SABA prn or ipratropium prn + 1 or more long acting dilators + rehab. ??theophylline

Front 113

Severe: FEV1 30-49% of predicted
COPD TX

Back 113

Pneumovax +
Flu vaccine+
SABA prn or ipratropium prn + 1 or more long acting dilators + rehab+ inhaled corticosteroid if repeat exacerbations
??theophylline

Front 114

Very severe: FEV1< 30% of predicted OR FEV1< 50% of predicted with chronic resp failure
COPD TX

Back 114

Pneumovax +
Flu vaccine+
SABA prn or ipratropium prn + 1 or more long acting dilators + rehab+ inhaled corticosteroid if repeat exac. + long term O2 + consider surgery
??theophylline

Front 115

Exacerbations of COPD at home
TX

Back 115

1. Increase dose/frequency of short beta-2 agonist (SABA). If not on anticholinergic, add anticholinergic .
2. If baseline FEV1< 50% of predicted, short course of oral steroid (30-40mg prednisolone/day x 7-10 days) OR if condition not severe (i.e.; patient is not acidotic) consider nebulized budesonide

Front 116

Hospital management of exacerbation

Back 116

1. SABA
2. Add anticholinergic if not response to SABA inadequate
3. LABA + ICS not shown to help acute exacerbations (but good for chronic management at home)
4. Oral or IV steroids x 7-10 days. Monitor blood glucose, blood pressure, emotions of pt. NB: addition of steroid reduces margination of WBC, leading to ↑WBC count without left shift

Front 117

Antibiotic therapy (at home or in hospital) COPD

Back 117

↑purulence of sputum + either ↑dyspnea or ↑sputum volume; or if pt requires mechanical vent:

Front 118

Patient type
Uncomplicated: < 4 exacerbations/year, no co-morbid, FEV1>50%, age < 65 years
COPD- BUGS

Back 118

S pneumoniae, H influenza, M catarrhalis, H parainfluenzae. Resistant organisms uncommon

Front 119

Complicated: ≥65 yo, >4 exacerb/yr, FEV1 35-50%
COPD-BUGS

Back 119

As above, but resistant S pneumo and beta-lactamase + H influ and M cat likely

Front 120

Risk of Pseudomonas/ enteric gm- bacteria: Chronic bronchial sepsis, nursing home pts with > 4 exac/yr
COPD-BUGS

Back 120

Pseudomonas aeruginosa
Enteric gram negatives

Front 121

Uncomplicated: COPD
DRUGS

Back 121

Macrolide (azithromycin or clarithromycin), 2nd or 3rd gen cephalosporin, doxycycline

Front 122

Complicated: COPD
DRUGS

Back 122

Amoxicilin/clavulanate
Respiratory fluoroquinolone (levofloxacin, moxifloxacin)

Front 123

Risk of Pseudomonas/ enteric gm- bacteria: Chronic bronchial sepsis, nursing home pts with > 4 exac/yr
DRUGS

Back 123

Respiratory fluoroquinolone, anti-pseudomonal beta-lactams (piperacillin/tazobactam, ticarcillin/ clavulanate, ceftazidime, cefepime, imipenem/cilastatin, meropenem, doripenem, aztreonam)

Front 124

Uncomplicated: pts COPD

Back 124

< 4 exacerbations/year, no co-morbid, FEV1>50%, age < 65 years

Front 125

Complicated: pts COPD

Back 125

≥65 yo, >4 exacerb/yr, FEV1 35-50%