Exam 2 - Pharm

Front 1

Will medications in the Biguanide drug class cause:

1) Neutral Effect on or Loss of Weight

2) Weight Gain

Back 1

Weight Loss / Neutral

Front 2

Will medications in the High-dose Meglitnide drug class cause:

1) Neutral Effect on or Loss of Weight

2) Weight Gain

Back 2

Weight Gain

Front 3

Will medications in the DPP-4 Inhibitor drug class cause:

1) Neutral Effect on or Loss of Weight

2) Weight Gain

Back 3

Weight Loss / Neutral

Front 4

Will medications in the Thiazolidinediones (TZDs or Glitazones) drug class cause:

1) Neutral Effect on or Loss of Weight

2) Weight Gain

Back 4

Weight Gain

Front 5

Will medications in the Alpha glucosidase inhibitor drug class cause:

1) Neutral Effect on or Loss of Weight

2) Weight Gain

Back 5

Weight Loss / Neutral

Front 6

Will medications in the GLP-1 agonist drug class cause:

1) Neutral Effect on or Loss of Weight

2) Weight Gain

Back 6

Weight Loss / Neutral

Front 7

Will medications in the SGLT2-inhibitor drug class cause:

1) Neutral Effect on or Loss of Weight

2) Weight Gain

Back 7

Weight Loss / Neutral

Front 8

Will medications in the Basal insulin drug class cause:

1) Neutral Effect on or Loss of Weight

2) Weight Gain

Back 8

Weight Gain

Front 9

Will medications in the Sulfonylurea drug class cause:

1) Neutral Effect on or Loss of Weight

2) Weight Gain

Back 9

Weight Gain

Front 10

The most common adverse effect with amlodipine (Norvasc) -- a calcium channel blocker -- is?

Back 10

Peripheral edema

Front 11

The most common adverse effect with lisinopril (Prinivil) -- an ACE inhibitor -- is?

Back 11

Cough

Front 12

The most common adverse effects with metroprolol (Lopressor) -- a Beta Blocker -- are?

Back 12

Bradycardia or mask symptoms of hypoglycemia

Front 13

The most common adverse effect with atorvastatin (Lipitor) -- a statin -- is?

Back 13

Myalgia

Front 14

Patients taking atenolol (Tenormin) -- a beta-blocker -- and verapamil (Calan) -- a calcium channel blocker -- have a risk for the following drug interaction...

Back 14

Bradycardia

Front 15

Patients taking lisinopril (Prinivil) -- an ACE inhibitor -- and losartan (Cozaar) -- an ARB -- have a risk for the following drug interactions...

Back 15

Hyperkalemia, renal dysfunction

Front 16

Patients taking lovastatin (Altoprev) -- a statin -- and gemfibrozil (Lopid) -- a Fibrate -- have a risk for the following drug interaction...

Back 16

Risk of myopathy, rhabdomyolosis

Front 17

Patients taking ramipril (Altace) -- an ACE inhibitor -- and spironalactone (Aldactone) -- a potassium sparing diuretic -- have a risk for the following drug interaction...

Back 17

Hyperkalemia

Front 18

What drug class is simvastatin (Zocor) in?

Back 18

HMG CoA reductase inhibitors, or "statin"

Front 19

What drug class is amlodipine (Norvasc) in?

Back 19

Dihydropyndine calcium channel blocker

Front 20

What drug class is metroprolol (Toprol XL) in?

Back 20

Beta Blocker

Front 21

What drug class is diltiazem (Cardizem) in?

Back 21

Non-dihydropyridine calcium channel blocker

Front 22

What drug class is aliskiren (Tekturna) in?

Back 22

Renin inhibitor

Front 23

What drug class is lisinopril (Zestril) in?

Back 23

ACE inhibitor

Front 24

What drug class is Losartan (Cozaar) in?

Back 24

Angiotensin receptor blocker (ARB)

Front 25

What drug class is clonidine (Catapres) in?

Back 25

Central alpha-2 receptor agonist

Front 26

What drug class is spironolactone (Aldactone) in?

Back 26

Aldosterone antagonist

Front 27

What drug class is Doxazosin (Cardura) in?

Back 27

Peripheral alpha-1 receptor blocker

Front 28

What drug class is Hydrochlorothiazide (HCTZ) in?

Back 28

Thiazide diuretic

Front 29

What drug class is furosemide (Lasix) in?

Back 29

Loop diuretic

Front 30

What drug class is metalozone (Zaroxolyn) in?

Back 30

Thiazide-like Diuretic

Front 31

What drug class is Ezetimibe (Zetia) in?

Back 31

Cholesterol absorption inhibitor

Front 32

What drug class is gemfibrozil (Lopid) in?

Back 32

Fibrate

Front 33

What drug class is cholestyramine (Questran) in?

Back 33

Bile acid sequestrant

Front 34

What drug class is Torsemide (Demadex) in?

Back 34

Loop diuretic

Front 35

Will spironolactone increase or decrease potassium?

Back 35

Increase

Front 36

Will furosemide increase or decrease potassium?

Back 36

Decrease

Front 37

Will hydrochlorothiazide increase or decrease potassium?

Back 37

Decrease

Front 38

Will lisinopril increase or decrease potassium?

Back 38

Increase

Front 39

Will Losartan increase or decrease potassium?

Back 39

Increase

Front 40

Will Bumetanide (loop diuretic) increase or decrease potassium?

Back 40

Decrease

Front 41

Will eplerenone (potassium sparing diuretic) increase or decrease potassium?

Back 41

Increase

Front 42

Will Klor-Con increase or decrease potassium?

Back 42

Increase

Front 43

A representative drug for the GLP-1 Agonist drug class is?

Back 43

liraglutide (Victoza)

Front 44

A representative drug for the Basal insulin drug class is?

Back 44

insulin glargine (Lantus)

Front 45

A representative drug for the Sulfonylurea drug class is?

Back 45

glimepiride (Amaryl)

Front 46

A representative drug for the Biguanide drug class is?

Back 46

metformin (Glucophage)

Front 47

A representative drug for the SGLT2-inhibitor drug class is?

Back 47

Canagliflozin (Invokana)

Front 48

A representative drug for the Alpha glucosidase inhibitor drug class is?

Back 48

acarbose (Precose)

Front 49

A representative drug for the Thiazolidinediones (TZDs or Glitazones) drug class is?

Back 49

pioglitzaone (Actos)

Front 50

A representative drug for the DPP-4 Inhibitor drug class is?

Back 50

sitagliptin (Januvia)

Front 51

A representative drug for the Metglitinide drug class is?

Back 51

Prandin (Repaglinide)

Front 52

What diabetes medication may cause a B12 deficiency, is listed as a Preg. Category "B", and is contraindicated in patients with elevated serum creatinine due to potential for lactic acidosis?

Back 52

metformin (Glucophage)

Front 53

What diabetes medication may cause edema and is contraindicated in patient's with CHF?

Back 53

Pioglitazone (Actos)

Front 54

What diabetes medication is injectable with possible GI adverse effect?

Back 54

exanatide (Byetta)

Front 55

What diabetes medication should not be given to a patient with a sulfa allergy?

Back 55

glimepiride (Amaryl)

Front 56

What diabetes medication is basal insulin, has a Pregnancy Category "B", and is an injectable drug primarily bound to albumin?

Back 56

Insulin detemir (Levemir)

Front 57

What diabetes medication is an insulin that is usually administered multiple times daily before meals?

Back 57

Insulin aspart

Front 58

What diabetes medication is a PO incretin-based drug?

Back 58

sitagliptin (Januvia)

Front 59

In the population aged ≥18 years with CKD, initial (or add-on) antihypertensive treatment should include an _____ or _____ to improve kidney outcomes.

Back 59

ACE inhibitor or ARB

Front 60

In the general nonblack population, including those with diabetes, initial antihypertensive treatment should include ... (choose from 4 types of medications)

Back 60

a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB).

Front 61

In the general black population, including those with diabetes, initial antihypertensive treatment should include _______ or _______.

Back 61

a thiazide-type diuretic or CCB.

Front 62

In the general population aged ≥60 years, initiate pharmacologic treatment to lower SBP <____ mm Hg and goal DBP <____ mm Hg.

Back 62

SBP <150 mm Hg and goal DBP <90 mm Hg.

Front 63

NSAIDs can reduce _______ efficacy

Back 63

thiazide

Front 64

Hypercalcemia, hyponatremia, hypokalemia, hypomagnesemia, hyperlipidemia, hyperglycemia, hyperuricemia; increased toxicity risk of lithium, digoxin, andantiarrhythmic agents, and a decrease in efficacy of anticoagulants and drugs to treat gout r/t what drug class?

Back 64

Thiazide diuretics

Front 65

What diuretic class is the most potent?

Back 65

loop diuretic

Front 66

Adverse drug effects: Hyponatremia, hypokalemia, hypomagnesemia, hypocalcemia,hypotension, hyperglycemia, hyperuricemia

Cardiac arrhythmia potential...

What drug class causes these adverse effects?

Back 66

Loop diuretic

Front 67

What is an adverse effect of potassium-sparing diuretics?

Back 67

hyperkalemia, especially in combination with ACE inhibitor or renal insufficiency

Front 68

What drug class affects BP complex in the following ways?

-Modulation of renin

-Reduction in CO and/or PR

-Negative inotropic/chronotropic effects

-Antagonise the effects of sympathetic nerve stimulation or circulating catecholamines

-Vasodilatory properties

-Reduce peripheral resistance

Back 68

Beta-blockers

Front 69

Initiation of ___________ may cause bradycardia, heart block, or s/s of heart failure. May also WORSEN depression. Other adverse effects of this medication are:

-Hypotension, syncope

-Bronchospasm, dyspnea

-Fatigue

-Electrolyte imbalances

Back 69

Beta-blockers

Front 70

Abrupt discontinuation of __________ may cause ischemic syndromes. Therefore, it is important to taper the dose over several days-weeks. Strong caution with heart rate < 60 bpm and respiratorydisease(s)

Back 70

Beta-blockers

Front 71

There is a strong caution with heart rate < 60 bpm and respiratorydisease(s) for which class of HTN med?

Back 71

Beta-blocker

Front 72

Do nondihydropyridine CCB cause reflex tach?

Back 72

No. Dihydropyridine CCBs do.

Front 73

Dihydropyridine CCBs are commonly associated with ________ and _________. Can also cause reflex tach.

Back 73

edema and constipation

Front 74

Are Dihydropyridine CCBs useful for managing atrial dysrhythmias?

Back 74

No. There is no utility in managing atrial dysrhythmias with Dihydropyridine CCBs.

Front 75

Are Nondihydropyridine CCBs effective in atrial fibrillation?

Back 75

Yes.

Front 76

Are Nondihydropyridine CCBs useful for african americans with HTN?

Back 76

No. Dihydropyridine CCBs are.

Front 77

Amlodipine (Norvasc), Felodipine Plendil), Isradipine (Dyna CircSR), Nicardipine (Cardene), Nifedipine Adalat, (Procardia),Nisoldipine (Sular) are examples of what drug class?

Back 77

Dihydropyridine CCBs

Front 78

Diltiazem, (Cardizem, Dilacor, others), Verapamil (Calan) are examples of what drug class?

Back 78

Nondihydropyridine CCBs

Front 79

Atenolol (Tenormin), Bisoprolol Zebeta), Metoprolol (Lopressor,Toprol XL) Esmolol (Brevibloc) are examples of what drug class?

Back 79

cardioselective beta blocker

Front 80

Nadolol (Corgard), Nebivolol (Bystolic), Propranolol (Inderal),Timolol (Blocadren) are examples of what drug class?

Back 80

non-cardioselective beta blocker

Front 81

Consider a _________ beta-blocker in a patient with mild asthma, COPD, peripheral vascular disease, or diabetes (can mask hypoglycemia)

Back 81

cardioselective beta blocker

Front 82

ACE inhibitors and ARB are drugs of choice for what condition?

Back 82

Chronic kidney disease... NOT RENAL FAILURE

Front 83

Indications for this drug class include...

•Heart failure

• Post-myocardial infarction

• Chronic kidney disease (This or ARB drug of choice [JNC8]). Not renalfailure.

• Recurrent stroke prevention

• Diabetes (but no longer recommended above other three initial drugs[JNC8]).

Back 83

ACE inhibitors

Front 84

True or False, ACE inhibitors are contraindicated in pregnancy?

Back 84

True.

Front 85

Common adverse effects of this drug class include:

• Persistent dry cough

• Angioedema

• Hyperkalemia (anticipate elevations)

• Decreased renal function

• Blood dyscrasias

• Hypotension

*Contraindicated in Preg.

Back 85

ACE inhibitors

Front 86

These medications are in what drug class? Benazepril (Lotensin)• Captopril (Capoten)• Enalapril (Vasotec)• Fosinopril (Monopril)• Lisinopril (Zestril)• Moexipril (Univasc)• Perindopril (Aceon)• Quinapril (Accupril)• Ramipril (Altace)• Trandolopril (Mavik)

Back 86

ACE Inhibitors

Front 87

ARB effectiveness is enhanced when combined with _________.

Back 87

Diuretics

Front 88

ARB are well tolerated alternatives to ______ in patientswith: Chronic kidney disease, Diabetes (type 2), Post-acutemyocardial infarction, Heart failure, Left Ventricular Hypertrophy

Back 88

ACE Inhibitors

Front 89

Adverse effects of this drug class include:

hyperkalemia, decrease renal function, angioedema, hypotension

*Contraindicated in pregnancy

Back 89

ARB

Front 90

These medications are in what drug class?

Candesartan (Atacand)• Eprosartan (Tevetan)• Irbesartan (Avapro)• Losartan (Cozaar)• Olmesartan (Benicar)• Telmisartan (Micardis)• Valsartan (Diovan)

Back 90

ARB

Front 91

Aliskiren (Tekturna) is an example of a ________ blocker. It is very similar to ACEI and ARB. Can cause angioedema,hypotension, hyperkalemia. May be effective alone or with HCTZ.

Back 91

Renin

Front 92

_________ are used in patients with benign prostate hyperplasia (BPH). Side effects include: syncope, dizziness, palpitations.

Back 92

Alpha Blockers

Front 93

The following medications: Clonidine, methyldopa, guanfacine, guanabenz

are ____________ that reduce sympathetic outflow and enhance parasympathetic activity. Side effects include: orthostasis, sedation, dry eyes/ mouth, visual disturbances

Back 93

centrally acting agents

Front 94

Hypertensive urgency is severe elevation in BP _________ evidence of acute or lifethreateningtarget organ damage

Back 94

without

Front 95

The following is a treatment plan for ________:

• Oral short acting medication

• Captopril, clonidine, labetalol

• Observation in emergency department

• Discharge on oral medication

• Follow-up within 24 hours as outpatient

Back 95

Hypertensive urgency

Front 96

A short-acting CCB, such as Procardia, should be avoided in ___________ r/t increased risk for MI and Stroke.

Back 96

hypertensive urgency

Front 97

________ and ________ are two BP medications that are not very effective and are riskier in African American populations.

Back 97

ACE inhibitors and ARBs

Front 98

Give a ______ or ______ for BP if patient has CKD.

Back 98

ACE inhibitor or ARB

Front 99

The risk of atherosclerosis is directly related to increasinglevels of serum _________

Back 99

cholesterol

Front 100

If a patient has Triglycerides from 150 to 500 mg/dL and serum HDLcholesterol < 40 mg/dL... evaluate for ________ syndrome.

Back 100

Metabolic

Front 101

The following drug class is recommended in these patient populations:

• ASCVD

• Elevations of LDL to 190mg/dl

• 40-75yo with diabetes, LDL 70-189, no ASCVD

• No ASCVD or diabetes 40-75 yo, with estimated 10 yrASCVD risk of 7.5 or above

Back 101

Statins

Front 102

________ are the medications of choice to treat highLDL cholesterol. ________ inhibit conversion of HMG-CoA to L-mevalonic acidand subsequently cholesterol.

Back 102

statins; statins

Front 103

In addition to improving cholesterol levels, ________ may:

• Reduce inflammation

• Decrease C-reactive protein (CRP)

• Reduce lipoprotein oxidation

• Chemically reduce oxidized LDL

• Enhance endothelial synthesis of nitric oxide

• Inhibit thrombosis

Back 103

statins

Front 104

Rosuvastatin (Crestor) and Atorvastatin (Lipitor) are statins that are used for __________ intensity treatment.

Back 104

moderate-high

Front 105

Two main side effects/adverse effects for statins are:

Back 105

1. increased LFT

2. myopathy/rhabdomyolosis

Front 106

_________ is a Cholesterol absorption inhibitor that typically is used in adjunctive therapy with statins.

Back 106

Ezetimibe (Zetia)

Front 107

Bile Acid sequestrants ______ LDL cholesterol.

Back 107

Lower

Front 108

The following medications are in which drug class?

• Cholestyramine (Questran, Prevalite)

• Colestipol (Colestid)

• Colesevelam (Welchol)

Back 108

Bile Acid Sequestrants (BAS)

Front 109

Side effects of what drug class include:

• GI problems, bloating, flatulence,constipation. Increase fluid intake

• BAS’s may interfere with the absorption of someother drugs, and therefore should be separatedfrom them regarding times of administration.

• Welchol not well-tested with other drugs, separateby at least 4 hours

• Some evidence to show that this may reduce HgbA1Cin diabetics with dyslipidemias.

Back 109

Bile Acid Sequestrants

Front 110

Which drug class has these effects?

• Reduce CHD events, and the progression of atherosclerosis when combined with a statin

• Reduce LDL 5-25%

• Reduce triglycerides 20-50%

• Increase HDL 15-35%

Back 110

Niacin

Front 111

With _________ (medication), start low dose to avoid flushing; can raise BSand uric acid level.

Back 111

Niacin

Front 112

The following medications are in what drug class?

• Fenofibrate (Tricor, Triglide)• Gemfibrozil (Lopid)• Fenofibric Acid (Trilipix)

Back 112

Fibrates

Front 113

What drug class...?

• Most effective triglyceride-lowering drugs

• Used primarily in patients with elevated triglycerides andlow HDL

• Stimulate the function of lipoprotein lipase

• Decrease triglyceride levels by 20-50%

• Increase HDL levels by 9-30%

Back 113

Fibrates

Front 114

What drug class causes the following adverse reactions / effects?

• Generally well-tolerated

• AR – GI upset, flatulence, abdominal pain,dypepsia, fatigue

• May cause myopathies like statins, and esp. whencombined! Monitor closely

• Do not tend to raise BS or uric acid levels

Back 114

Fibrates

Front 115

Omega 3 Fatty Acids are useful for patients with high....?

Back 115

triglycerides

Front 116

The following medications are indicated in treating ________:

•Diuretics for edema – reduce fluid burden

• ACE inhibitors (or ARB) – reduces afterload, definitely useful. Monitorkidney function. Interesting, ACC mentions combination.

• Beta blockers (esp. if recent MI), but helpful in all HF stage B orgreater

• In selected patients:

• Aldosterone antagonists – broader use, now maybe earlier, BUTneed sufficient Cr (2.5 men, 2.0 women) monitor K+

• Hydralazine/nitrates – very effective in AA patients

• Digoxin – may be beneficial, later stage, very carefully, will takeless. Careful with K+, especially if on ald. agent, ACE/ARB

Back 116

Heart Failure

Front 117

The following medications are CONTRAINDICATED in _________:

• TZDs – contraindicated, fluid retention

• Metformin – may be necessary, but extra caution d/tincreased risk of lactic acidosis

• CCB – very risky with reduced CO, d/t reduced inotropiceffect. Especially concerning after MI with low EF.

• NSIADs – cause fluid retention (also note for HTNtreatment)

• Warfarin needs will be reduced in acute HF

Back 117

Heart Failure

Front 118

______ are indicated in heart failure r/t edema and reducing fluid burden.

Back 118

diuretics

Front 119

_______ or ______ are indicated in heart failure r/t reducing afterload.

Back 119

ACE inhibitors and ARB

Front 120

___________ (especially if recent MI) are indicated in heart failure and are helpful in all heart failure stage B or greater.

Back 120

Beta Blockers

Front 121

__________ antagonists can be used to treat heart failure but must need sufficient creatinine (2.5 men, 2.0 women); monitor potassium

Back 121

Aldosterone antagonists

Front 122

___________ or __________ are effective medication options in African Americans with heart failure.

Back 122

Hydralazine or Nitrates

Front 123

_______ may be a beneficial medication in later-stage heart failure. Be careful with K levels if patient is also on Aldosterone agent, ACE/ARB.

Back 123

Digoxin

Front 124

Monitor ________ levels if the patient is on an aldosterone agent, ACE, ARB.

Back 124

potassium

Front 125

_______ and ______ are contraindicated in heart failure r/t fluid retention.

Back 125

Thiazolidinediones (TZDs or Glitazones) and NSAIDs

Front 126

________ is contraindicated/must be used with extra caution r/t heart failure because of increased risk of lactic acidosis.

Back 126

Metformin (Glucophage)

Front 127

________ are risky in heart failure r/t reduced cardiac output because it can cause a reduced inotropic effect. Especially concerning after MI with low ejection fraction.

Back 127

calcium channel blockers

Front 128

What is a normal ejection fraction?

Back 128

A normal LVEF ranges from 55-70%.

Front 129

Warfarin doses need to be _________ in acute HF.

Back 129

reduced

Front 130

Tretinoin, Isotretinoin, Adapalene, Acitretin are medications in the ________ class.

Back 130

Retinoids

Front 131

True or False: Retinoids can be used with pregnant women?

Back 131

FALSE

Front 132

Adverse effects for _________ (a Retinoid) include:

Teratogenicity, extreme xerosis, increased liver function tests & triglycerides, etc.

** DO NOT PRESCRIBE RETINOIDS TO PREGNANT WOMEN

Back 132

Isotretinoin

Front 133

Class 1 and Class 2 topical steroids are extremely strong. They should never be applied to the _________ or _________.

Back 133

Face / skin folds

Front 134

True or False: Class VII topical steroids are safe for use on face / skin folds?

Back 134

True

Front 135

An example of a Class VII topical steroid is...?

Back 135

Hydrocortisone 0.5%, 1%, 2.5% oint and cream

Front 136

Two examples of Class I topical steroids are?

Back 136

-Betamethasone diproprionate 0.05 % oint (Diprolene)

-Clobetasol propionate 0.05% oint & cream (Temovate)

Front 137

Class ___ and ___ steroids should be used for short-term (14-day) control.

Back 137

Class I and II

Front 138

True or False: Topical tazoretene (Tazorac) should be used in pregnant women?

Back 138

FALSE

Front 139

The therapy for __________ includes:

- Identification of allergen and avoidance: drugs, pollen, chemicals, food, bacteria, preservatives, malignanttumor, etc.

- Antihistamines (Avoid systemic steroids):

* loratadine (Claritin) 10mg daily, cetirizine 10mg daily, fexofenadine 180mg daily (OTC now)

* hydroxyzine (Atarax) 10mg-20mg q 6-8 hrs

- If chronic (> 6 weeks) consider adding:

* cimetidine (Tagamet) 400mg bid-tid

Back 139

urticaria

Front 140

For widespread skin involvement for a dermatophyte infection, consider ____ antifungal agents.

Back 140

oral

Front 141

True or False: Topical Agents are usually effective in T. captis ad T. unguium (nail) infections?

Back 141

False

Front 142

It may take 3-4 weeks for itching to completely resolve with ___________?

Back 142

Scabies

Front 143

In Tinea pedis, manuum, corporis, and cruris... what is the first-line treatment?

Back 143

Topical azone / allamine

Front 144

Griseofulvin is the first-line treatment in children with Tinea ________.

Back 144

Capitis

Front 145

___________ is the first-line treatment in patients with Onychomycosis (tinea unguium).

Back 145

Terbinafine(oral)

Front 146

Topical corticosteroids induce cutaneous _________.

Back 146

vasoconstriction

Front 147

For optimal absorption of most topical drugs, apply them to _______ skin either immediately after bathing / wet soak.

Back 147

moist

Front 148

______________ are indicated to treat contact dermatitis, atopic dermatitis/eczema, and psoriasis.

Back 148

topical corticosteroids

Front 149

For the _______ medication, cream formulations are usually stronger than lotions, but less potent than ointments.

Back 149

SAME

lotions < cream < ointment

Front 150

True or False: Solutions (dermatology) tend to be drying.

Back 150

True

Front 151

Avoid fire, flame, and/or smoking during and immediately after application of _______ (dermatology vehicle).

Back 151

Foams

Front 152

____________ can enhance topical corticosteroid potency by as much as 100-fold.

Back 152

Occlusion

Front 153

USA classification system divides into __ potency groups (dermatology)

Back 153

seven, 7

Front 154

Class ____ is the highest potency of topical corticosteroids. Class ____ has the lowest potency of topical corticosteroids.

Back 154

Class 1 = most potent

Class 7 = least potent

*Class 1 is 1000x more potent than Class 7

Front 155

Consider ______ absorption with application to large area (r/t topical corticosteroids)

Back 155

systemic absorption

Front 156

True or False: The Genitalia and structures of the head absorb the highest % of the total dose for dermatological application.

Back 156

True

Front 157

______ risk areas for dermatology medication absorption include: face, groin, intertriginous, axillae. Risk increases with thinning of skin or atrophy of skin. Consider systemic effects.

Back 157

High Risk

Front 158

The maximum length for dermatological treatment utilizing topical steroids in pediatric clients is __________ weeks.

Back 158

1 to 2

Front 159

The maximum length for dermatological treatment utilizing high-potency topical steroids is a max of ______ weeks.

Back 159

3 weeks MAX

Front 160

________ is a progressive decrease in clinical response due to repetitive use of a drug. Occurs when body becomes tolerate to effects of particular medication.

Back 160

Tachyphylaxis

Front 161

There is an increased risk for adverse effects r/t topical corticosteroid use when prescribed more than _____ weeks.

Back 161

3 weeks

Front 162

The following adverse effects apply to which dermatological drug class?

-Local effects: Burning, pruritis, erythema

-Skin changes

***Skin atrophy

-Depressed, shiny, wrinkled skin with prominent telangiectasias

-May recover within weeks to months if therapy is DC’d as soon as skinchange occurs

-Ecchymosis, purpura

-Striae

-Aceneiform eruption

-Hypo/Hyperpigmentation

-Hirsutism

-Hypersensitivity reaction to vehicle or drug

-Photosensitization

-Promotion of fungal growth

Back 162

Topical corticosteroids

Front 163

Skin atrophy is a potential side effect of _______.

Back 163

topical corticosteroids

Front 164

Hypothalamic-pituitary-adrenal (HPA) axis suppression is a potential systemic effect of ____________ that can occur with use for as little as a few weeks.

Back 164

topical corticosteroids

Front 165

Hypothalamic-pituitary-adrenal (HPA) axis suppression r/t topical corticosteroid use can lead to _______ atrophy and loss of cortisol secretory capability.

Back 165

adrenal

Front 166

The following are risks for HPA suppression r/t which drug class?

Risks for HPA suppression

-High-potency

-Chronic/long duration of use

-Children

-Application to highly permeable areas

-Treatment of large areas

-Occlusion

-Poor skin integrity

-Liver failure

Back 166

topical corticosteroids

Front 167

Tapering of steroids if used >2 weeks permits recovery of ________ axis function. Can prevent rebound, systemic effects.

Back 167

Hypothalamic-pituitary-adrenal (HPA) axis

Front 168

The following systemic effects are possible with what drug class?

Immunosuppression, impaired wound healing

Hyperglycemia, unmask DM

*Other possible systemic effects

Glaucoma, cataracts, HTN, Necrosis of femoral head

Back 168

Topical corticosteroids

Front 169

Avoid potent topical steroid medications in children under age ____.

Back 169

12

Front 170

For age-related dose considerations of ________ (dermatologic drug class), consider:

1/5 adult dose - infants

2/5 adult dose - children

2/3 adult dose - adolescents

Back 170

topical corticosteroids

Front 171

alcohol causes a __________ in blood glucose because of its effects on hepatic glucose production.

Back 171

decrease

Front 172

thiazide diuretics (usually higher dose) may __________ blood glucose r/t effect on insulin resistance.

Back 172

may increase BG

Front 173

steroids (oral, injectable) may ___________ blood glucose levels r/t effect on insulin.

Back 173

increase

Front 174

nicotinic acid may _________ blood glucose r/t effect on insulin action and resistance.

Back 174

increase

Front 175

antipsychotics (ex: clozaril, zyprexa) may _________ blood glucose levels r/t effect on insulin. Can cause weight gain.

Back 175

increase

Front 176

Beta blockers may _______ blood glucose levels r/t effects on insulin secretion. May also mask hypoglycemia.

Back 176

increase

Front 177

Unless contraindicated, _________ remains the optimal, first-line medication for Type II diabetes.

Back 177

metformin

Front 178

The following is the MoA of _____________.

MOA–

- *Decreases hepatic glucose production

– Improves insulin sensitivity

• increases peripheral glucose uptake and utilization

– Decreases intestinal absorption of glucose

Back 178

Metformin (Glucophage)

Front 179

The following are benefits of _____________. (diabetes medication)

Benefits

– Works well

– Favorable effect on serum lipids

– Does not increase appetite or promote fat storage

• Wt neutral or wt loss!!!

– Does not cause hypoglycemia as monotherapy

Back 179

metformin

Front 180

True or False: metformin causes hypoglycemia as monotherapy.

Back 180

False

Front 181

The following are adverse effects for ________:

Main: GI

• Nausea, diarrhea, abd pain

• Strategies to decrease GI side effects

• ER version

• Take with evening meal

• Gradual titration

Lesser

• Vitamin B12 deficiency

• Metallic taste

• *Risk for Lactic acidosis

Back 181

metformin

Front 182

_______ (diabetes medication) is contraindicated in patients with Renal Impairment.

-Avoid in patients with elevated serum creatinine (>1.4 Females or >1.5 Males)

-Avoid in patients with GFR <30mL/min

-In patients with GFR between 30-60 mL/min reduce dose by 1/2

Back 182

metformin

Front 183

Aside from Renal Impairment, the following are contraindications to using ___________ for managing type II diabetes:

– >80 years of age

– Alcohol abuse

– Hepatic dz

– Surgery

– Dehydration

– Severe CHF, low EF

– Severe hypoxia (ex: COPD, on O2)

Back 183

metformin

Front 184

For metformin dosing, start with _______mg QD with food. The max dose for metformin is ________mg per day.

Back 184

500mg start

Max dose = 2000mg/day (high dose = more benefit)

Front 185

True or False: Hold metformin for IV iodinated contrast material r/t risk for contrast-induced renal failure

Back 185

True (hold until stable renal function established)

Front 186

Hold metformin until stable ________ function can be established. Patient must have normal urine output, serum creatinine, and no physical exam evidence of fluid overload or circulatory compromise.

*Serum creatinine typically assessed 2-3 days after contrast administration.

Back 186

renal function

Front 187

Symptoms of _________ r/t metformin use may be vague. These vague symptoms include: anorexia, N/V, abdominal pain, lethargy,hyperventilation, hypotension

Back 187

lactic acidosis

Front 188

_________ are the oldest class of oral hypoglycemic agents and are used as a second line option if metformin is contraindicated.

MoA = enhances insulin secretion

Back 188

Sulfonylureas

Front 189

The ______ generation of sulfonylureas is preferred. Medications in this generation include:

• Glimepiride

• Glyburide (CV risk?)

• Glipizide (shorter acting)

Back 189

second generation

Front 190

____________ (diabetes medication class) are more effective earlier in the type II DM treatment process. Requires adequate beta cell function and are not as effective long-term.

Back 190

Sulfonylureas

Front 191

The following are adverse effects for ____________ (diabetes medication class):

Common AE: hypoglycemia, weight gain, increased risk of hypoglycemia in combination with other DM meds

Caution: sulfonamide allergy

Back 191

Sulfonylureas

Front 192

Meglitinides/Glinides are ______-acting secretagogues that increase insulin secretion. This class is an option for patients with sulfa allergy. Causes less hypoglycemia r/t ______-acting.

Back 192

short;short

Front 193

A con of Meglitinides/Glinides is the dosing schedule. This class of medication is dosed ______ with meals.

*Adverse effects of Meglitinides/Glinides include: hypoglycemia/weight gain (but less than sulfonylurea)

Back 193

TID

Front 194

________-acting options for type II DM management are preferred for the elderly.

Back 194

short-acting

Front 195

______________ (diabetes medication class) work by increasing insulin receptor sensitivity, decreasing hepatic glucose production, and enhance glucose uptake in muscle cells.

Back 195

Thiazolidinediones (TZDs)

Front 196

Thiazolidinediones (TZDs) are a pregnancy category ______ medication.

Back 196

Pregnancy Category C

Front 197

Adverse effects of ____________ (diabetes drug class) include:

• *Weight gain

• *Edema

• *Increased risk of fractures

• Anemia

• Hepatotoxicity (rare)

– Monitor LFTs

• Bladder cancer risk (pioglitazone)

– Related to dose and long‐term use

– Report adverse events to FDA MedWatch

Back 197

Thiazolidinediones (TZDs)

Front 198

Thiazolidinediones (TZDs) are CONTRAINDICATED in patients with ___________.

Also avoid in patients with:

– Increased fx risk

– Active or hx of bladder cancer (Pioglitazone)

– CVD (Rosiglitazone)

– Active liver disease

Back 198

Heart failure

Front 199

Avoid prescribing Pioglitazone (Actos) -- a Thiazolidinediones (TZD) -- in a patient with active or hx of __________ cancer.

Back 199

bladder

Front 200

Rosiglitazone (Avandia) -- a Thiazolidinediones (TZD) -- may be contraindicated in patients with _______ or may cause related issues.

Back 200

Cardiovascular Disease

Front 201

The following is the MoA of ________________ (diabetes medication class):

Inhibit upper GI enzymes (alpha‐glucosidases)that convert complex polysaccharide carbohydratesinto monosaccharides, thereby delaying glucoseabsorption and reduce PP BG.

Back 201

Alpha-Glucosidase Inhibitors

Front 202

_______________ (diabetes medication class) are not commonly used r/t poor tolerance, lower efficacy, and increased cost compared with alternatives.

*Can cause severe GI adverse effects, including cramping, flatus, and diarrhea.

Back 202

Alpha-Glucosidase Inhibitors

Front 203

Acarbose (Precose); Miglitol (Glyset) are examples of medications in which diabetes drug class?

Back 203

Alpha-Glucosidase Inhibitors

Front 204

Canaglifozin (Invokana®), Dapaglifozin (Farxiga) are examples of medications in which diabetes drug class?

Back 204

Sodium-glucose co-transporter 2 inhibitors

(or SGLT2 inhibitors)

Front 205

The following is the MoA for _________ (a diabetes drug class):

promotes urinary excretion of glucose by preventing tubularreabsorption. Mild effect on HbA1c level– Decrease 0.5‐0.7%

*additional benefits: low hypoglycemia risk, reduction in wt. 4-7 lbs, reduced systolic BP ~5mmHg

Back 205

Sodium-glucose co-transporter 2 inhibitors

(or SGLT2 inhibitors)

Front 206

What is a contraindication of prescribing a Sodium-glucose co-transporter 2 inhibitor (SGLT2 inhibitor)?

Back 206

GFR <60 mL/min

Front 207

The following are adverse effects for __________:

Primary: GU tract infections

– Reports of DKA

• Near normal BG, N/V, fatigue, abdominal pain

Back 207

Sodium-glucose co-transporter 2 inhibitor (SGLT2 inhibitor)

Front 208

__________ are hormones normally released in the gut throughout the day and are increasingly released after meals. Incretins promote glucose homeostasis and their release is often decreased in clients with Type II diabetes.

Back 208

Incretins

Front 209

The following is the MoA for ________ (a diabetes drug class):

Inhibits the intestinal enzyme, DPP‐4 ... increasesendogenous incretins ... Glucose‐dependent release ofinsulin; suppression of glucagon

Back 209

DPP-4 Inhibitors

Front 210

Sitagliptin (Januvia), Saxagliptin(Onglyza), Linagliptin (Tradjenta) are examples of medications in which diabetes drug class?

Back 210

DPP-4 Inhibitors

Front 211

__________ (diabetes drug class) are more effective earlier in Type II DM treatment process.

*Are generally well-tolerated; low chance of hypoglycemia or weight gain; weak effects on A1C and are expensive

***Possible link w/ severe joint pain, pancreatic-duct changes, and acute pancreatitis

Back 211

DPP-4 Inhibitors

Front 212

Exenatide (Byetta, BID), Liraglutide (Victoza, QD), Exenatide ER (Bydureon, weekly), Dulaglutide (Trulicity, weekly) are examples of medication in what drug class?

Back 212

GLP-1 Agonists

Front 213

The following is the MoA of ____________ (a diabetes drug class):

MOA: Incretin‐based therapy, mimics GLP‐1 action, Glucose‐dependent release of insulin; suppression of glucagon

– Additional MOA: Delays gastric emptying

Back 213

GLP-1 Agonists

Front 214

GLP-1 Agonists are administered in a _________ form.

Back 214

injection (subcutaneous); pen delivery system

Front 215

____________ are administered via a "Pen Delivery System."

*Side effects of this diabetic drug class include N/V, increased satiety, and weight loss.

Back 215

GLP-1 Agonists

Front 216

Avoid ___________ (diabetic drug class) in patients w/ history of pancreatitis (or high risk), gastroparesis, Multiple endocrine neoplasia type 2, medullary thyroid carcinoma

*This medication also can cause transient GI side effects, is expensive, and is available only in an injectable form.

Back 216

GLP-1 Agonists

Front 217

Benefits of ___________ (diabetic drug class) include:

-decrease in postprandial glucose

-no hypoglycemia

-decrease in weight

Back 217

GLP-1 Agonist

Front 218

liraglutide (Victoza, Saxenda) is a diabetic medication in the _________ class that is used for weight loss.

*treatment for obesity is usually at a higher dose (3mg/day)

Back 218

GLP-1 Agonist

Front 219

_________ GLP-1 Agonists to reduce GI side effects. Start at the lowest dose; increase SLOWLY.

Back 219

titrate

Front 220

The following is the MoA for ____________ (a diabetes medication class).

MOA

– Suppresses glucagon secretion

– Slows gastric emptying

– Promotes satiety

– Decreases postprandial glucose rise

Back 220

Amylin Mimetic

Front 221

________ is peptide hormone that is co-secretedwith insulin by the pancreas. It is found to be decreased in T1DM and longstandingT2DM.

Back 221

Amylin

Front 222

Pramlintide/Symlin are medications in the following diabetic drug class: _____________.

Back 222

Amylin Mimetic

Front 223

The benefits of _____________ (diabetes drug class) include: Satiety, possible weight loss, targets PP BG,can reduce total insulin need

The cons of ____________ include: Cost, Frequent injections, Frequent Self Monitoring BG (2 hr pp)

Close follow-up required r/t hypoglycemia risk

Back 223

Amylin Mimetics (Pramlintide/Symlin )

Front 224

Cut mealtime insulin in _____ when starting Pramlintide/Symlin (Amylin Mimetics)

Back 224

half

Front 225

Avoid prescribing ____________ (diabetes drug class) in pediatric patients and patients with:

– Compliance issues

– Gastroparesis

– H/O recurrent severe hypoglycemia

*Different dosing for T1 DM vs. T2 (Higher in T2)

Back 225

Pramlintide/Symlin (Amylin Mimetics)

Front 226

True or False: Amylin Mimetic dosing requirements are higher in patients with Type II DM?

Back 226

True

Front 227

___________ (oral DM drug class) MoA is: decreased Hepatic glucoseproduction and Increases insulin sensitivity

Advantages: Extensive experience, No hypoglycemia, Weight neutral, may reduce risk of CVD, low cost

Disadvantages: Gastrointestinal SE, Lactic acidosis (rare butserious), B‐12 deficiency, Contraindication in renal impairment.

Back 227

Biguanides

Front 228

___________ (oral DM drug class) MoA is: closes potassium ATP channels, increases insulin secretion

Advantages: extensive experience, decreased microvascular risk, low cost

Disadvantages: risk for hypoglycemia, increased wt., low durability, may blunt ischemic preconditioning, allergic sensitivity

Back 228

Sulfonylureas

Front 229

___________ (oral DM drug class) MoA is: closes potassium ATP channels, increases insulin secretion

Advantages: decreased postprandial glucose, dosing flexibility, moderate cost

Disadvantage: hypoglycemia, increased wt, blund ischemic preconditioning, dosing freq.

Back 229

Meglitinides

Front 230

___________ (oral DM drug class) MoA is: PPAR-y activator, increased insulin sensitivity

Advantages: no hypoglycemia, durability, increases HDL, decreases risk for cardiovascular events (pioglitazone), low cost

Disadvantages: increased wt, edema/HF, bone fractures, LDL increase (rosiglitazone), increased MI risk (rosiglitazone)

Back 230

Thiazolidinediones (TZDs or Glitazones)

Front 231

___________ (oral DM drug class) MoA is: Inhibits DPP-4, increases incretin (GLP-1, GIP) levels

Advantages: no hypoglycemia, well tolerated

Disadvantages: may increase risk for HF or pancreatitis , high cost

Back 231

DPP-4 inhibitors

Front 232

___________ (oral DM drug class) MoA is: inhibits SGLT2 in proximal nephron, increases gluosuria

Advantages: decreased wt, no hypoglycemia, lower BP, effective in all stages of DM

Disadvantages: frequent GU infections, polyuria, volume depletion, increase LDL, increase creatinine, high cost

Back 232

SGLT2 inhibitors

Front 233

___________ (injectable DM drug class) MoA is: activates GLP-1 receptor, increases insulin production, decreases glucagon, decreases gastric emptying, increases satiety

Advantages: decreases weight, no hypoglycemia, lower postprandial glucose, lowers risk for cardiovascular events

Disadvantages: gastrointestinal SE, pancreatitis, increases HR, medullary cancer risk, injectable, high costs, training req.

Back 233

GLP-1 Receptor Agonists

Front 234

___________ (injectable DM drug class) MoA is: activates insulin receptor

Advantages: universally effective, efficacious; low microvascular risk

Disadvantages: hypoglycemia, wt. gain, injectable, patient reluctance, training req, variable cost

Back 234

Insulin

Front 235

___________ (injectable DM drug class) MoA is: activates amylin receptor, decreases glucagon, decreases gastric emptying, increases satiety

Advantages: decreased wt, decreased postprandial glucose

Disadvantages: GI side effects, modest reduction in A1C, high cost, injectable, hypoglycemia if insulin dose not reduced, dosing freq, training req.

Back 235

Amylin mimetics

Front 236

Prescribing ___________ and ____________ together is a common 2nd line option if A1C <9% due to strong efficacy, low cost, long term data

*Two oral medications

Back 236

Metformin + Sulfonylurea

Front 237

Prescribing ________ and _________ together is a frequently recommended 2nd line if failure with Metformin monotherapy and A1C >9%

Back 237

Metformin + Basal Insulin

Front 238

Prescribing TZD and Basal Insulin together for management of DM contributes to high risk for weight ________.

Back 238

gain

Front 239

Discontinuing __________ is often recommended with concurrent insulin use r/t high risk for _____________.

Back 239

sulfonylurea; hypoglycemia

Front 240

True or False: It is possible to combine two incretin-based therapies, such as DPP-4 inhibitor and GLP-1 agonist for DM management.

Back 240

FALSE

Front 241

_________ (age group) considerations for DM:

-start low, go slow with med. dosing

-avoid combinations that increase hypoglycemia risk

-check kidney function (creatinine clearance)

-Metformin contraindicated, esp. in >80 y.o.

Back 241

Elderly

Front 242

_____________ is not an attractive DM management medication option in the elderly population. Especially avoid in patients >80 y/o.

Back 242

Metformin

Front 243

___________ is approved for pediatric DM treatment >10 y/o. Insulin is approved for use in pediatric patients with Type I and Type II DM.

Back 243

Metformin

Front 244

A pediatric A1C goal is usually less stringent and is around _________%.

Back 244

usually <7.5%

Front 245

A normal A1C level for a patient w/out diabetes is: ______________

Back 245

4.5-6%, usually under 5.7%

Front 246

Consider unstable Type II DM tx if patient A1c is over _______, fasting plasma glucose >250 mg/dL, or random glucose >300mg/dL

Back 246

Over 8.5% consider T2DM instability... definitely over 10%

Front 247

_________ is indicated for all patients with Type I and Type II diabetes.

Back 247

Insulin

Front 248

___________ insulin is short-acting.

Onset = 30 min

Peak = 2-4 Hrs

Duration = 5-8 Hrs

Back 248

Regular

Front 249

Novolog®, Humalog®, Apidra®... Newly FDA approved: Inhaled insulin, Afrezza® are all examples of what type of insulin?

*Generic names: Lispro, Aspart,Glulisine

Back 249

Rapid Acting

Front 250

_____________ insulin has:

Onset = 5-15 min

Peak = 1-2 hrs

Duration = 3-5 hrs

Back 250

Rapid Acting

Front 251

Lispro, Aspart,Glulisine are __________ insulins. What is the onset, peak, and duration?

Back 251

Rapid-Acting

Onset = 5-15 min

Peak = 1-2 hrs

Duration = 3-5 hrs

Front 252

What is the onset, peak, and duration of "regular" or short-acting insulin?

Back 252

Onset = 30 min

Peak = 2-4 Hrs

Duration = 5-8 Hrs

Front 253

NPH is an example of an __________-acting insulin.

Back 253

intermediate-acting = NPH

Front 254

What is the onset, peak, and duration of NPH, an intermediate acting insulin?

Back 254

Onset = 2 hrs

Peak = 4-12 hrs

Duration = 18-28 hrs

Front 255

Insulin glargine (Lantus) and Insulin detemir (Levemir) are two examples of ______-acting or "Basal" insulins.

Back 255

Long-acting

Front 256

What is the onset/peak/duration of Insulin glargine (Lantus) -- a long-acting "Basal" insulin?

Back 256

Onset = 2 hrs

Peak = No peak; flat

Duration = 22-24 hrs

Front 257

What is the onset/peak/duration of Insulin detemir (Levemir) -- a long-acting "Basal" insulin?

Back 257

Onset = 2 hrs

Peak = 3-9 hrs

Duration 6-24 hrs (but can be dosed q12hr)

Front 258

_________ insulin cannot be mixed in syringe with other insulin.

Back 258

Basal or Long-Acting

Front 259

Insulin glargine (Lantus) is a "Basal" insulin that is in Pregnancy Category _____.

Back 259

Preg. Category C

Front 260

Insulin is absorbed fastest if injected in the _______.

*Exercise increases absorption.

*Smoking decreases absorption.

Back 260

abdomen

Front 261

Afrezza, an inhaled insulin is rapid-acting. It is indicated for _________ (age group).

*contraindicated in children, women who are pregnant or breastfeeding, asthma, COPD, lung cancer hx, smokers

Back 261

Adults greater than or equal to 18 years old

Front 262

Most common side effect for ________ insulin is?

*concerns about pulmonary toxicity

*avoid in pt. that smoke, have hx of lung cancer, or have chronic lung disease like asthma or COPD

*must monitor pulmonary function

Back 262

Non-Productive Cough

Front 263

DC __________ insulin if patients have aconfirmed decline of ≥20% in FEV1 frombaseline.

Back 263

inhaled insulin

Front 264

Adjust "Basal" insulin doses about __ days apart if suboptimal BG. Consider 10-20% adjustment increments.

Initial Dose: 0.1-0.2 units/kg/day

Back 264

4 days apart

Front 265

When mixing two insulins in a syringe, draw up the __________ acting insulin first.

*Clear before cloudy

Back 265

When mixing insulin in a syringe, draw up the quickest acting insulin first (e.g. draw up Humalog or Novolog before drawing up Regular Insulin, or draw up Regular insulin before Novolin N (NPH) or Lente insulin.

Front 266

There is a decreased support for ___________ r/t insulin therapy due to questionable benefit, safety concerns with lack of individualization, and complicated regimen.

According to Beers List: This increases risk of hypoglycemia without improvement in hyperglycemia.

Back 266

Sliding Scales

Front 267

Glycemic targets & BG‐lowering therapies must be ____________, basedon a variety of patient and disease characteristics.

Back 267

individualized

Front 268

Unless contraindicated, _________ remains the optimalfirst‐line drug.

Back 268

metformin

Front 269

__________ is associated with decliningkidney function. It is usually progressive. To manage this, maintain optimal glycemic control, blood pressure control.

*Use ACE/ARB

Back 269

Albuminuria

Front 270

Are oral contraceptives safe to use with isotretinoin (Accutane) for treatment of acne?

Back 270

Yes

Front 271

Do not use topical ___________ (tretinoin, benzoyl peroxide) to treat acne rosacea.

Back 271

comedolytics

(No comedones)

Front 272

____________ presents as a well-defined plaque with thick silvery scale. Distribution and Pitting of nails are keys to Dx.

Back 272

Psoriasis

Front 273

The following are therapeutic modalities to treat _____________:

- Topical steroid creams and ointments

- Topical calcipotriene cream and ointment

- Topical tazarotene (retinoid) gel

- Topical tar containing ointments

- Phototherapy (UVB & PUVA)

- Oral methotrexate, acitretin (retinoid), or cyclosporine

- Injectable biologic response modifiers: etanercept, infliximab, adalimumab, ustekinumab

Back 273

ezcema

Front 274

In treatment of mild to moderate eczema, use __________ only for flares. Class I or II for severe short-term (under 14 days) control in adults, class III or IV for children. Class IV-VII in adults/children for mild flares.

Back 274

Topical corticosteroids

Front 275

Consider ________ in treatment of Eczema if lesions are crusted, widespread, or grossly infected.

Back 275

antibiotics

Front 276

Therapy of severe and widespread ________ includes:

*Dermatology referral

*Oral or intramuscular steroids

*Phototherapy

*Oral methotrexate

Back 276

eczema

Front 277

__________ arepruritic transient plaques caused by local release of histamine in the skin.Key to dx is transient lesions (<12-24 hrs). R/t Type 1 Hypersensitivity Rxn.

Back 277

urticaria

Front 278

Treatment for _________ includes:

- Identification of allergen and avoidance: drugs, pollen, chemicals, food, bacteria, preservatives, malignanttumor, etc.

- Antihistamines (Avoid systemic steroids):

* loratadine (Claritin) 10mg daily, cetirizine 10mg daily, fexofenadine 180mg daily (OTC now)

* hydroxyzine (Atarax) 10mg-20mg q 6-8 hrs

- If chronic (> 6 weeks) consider adding:* cimetidine (Tagamet) 400mg bid-tid

Back 278

Urticaria

Front 279

___________ infections are usually treated with a topical antifungal cream. If widespread, oral.

*topical nystatin has no effect on this

*avoid combination products r/t skin atrophy due to strong topical steroids

*topical steroids in combo therapy cause localized immunosuppression which promote fungal growth

Back 279

dermatophyte skin infections

Front 280

Permethrin 5% cream is applied to all skin sparing face ror 8-12 hrs as a single application as primary tx for ____________. Topical steroids class III-IV and oral antihistamines are also possible for tx/reduction of s/s.

Back 280

scabies

Front 281

Is treatment necessary for Herpes Simplex Orificialis?

Back 281

No; same as cold sore.

Front 282

Topical bacitracin/polymyxin oint to prevent bacterial superinfection is the recommended tx for __________. (r/t dermatology)

Back 282

Herpes Genitalis

Front 283

_________ is a bacterial infection of the skin usually due to staphylococci / streptococci.

To treat, obtain culture for bacterial identification but begin Clindamycin or Erythromycin before culture results return. Topical mupirocin (Bactroban) ointment has excellent staph/strep action.

Back 283

Pyroderma

Front 284

__________ is used primarily for pregnancy prevention but can also be used for: cycle regulation, decrease ovarian cysts, PMS and pre-menstrual dysphoric disorder, endometriosis, ovarian and endometrial cancer

Back 284

Contraception

Front 285

The following methods of contraception are ______ failure rates:

• Combination pills 0.3‐8%

• Depot medroxyprogesteroneacetate (Depo) 0.3‐3%

• Intrauterine device 0.6‐2%

• Ortho‐evra patch 0.3%

• Progesterone mini‐pills 0.5‐3%

• Sterilization 0.1‐0.4%

Back 285

Low

Front 286

The following methods are ______ failure rates:

• Cervical cap 9‐32%

• Diaphragm 6‐18%

• Periodic abstinence 1‐25%

• Condoms & spermicides 2‐21%

Back 286

High

Front 287

________ contraceptives mean that the method contains both estrogen and progesterone. Works mainly by preventing ovulation.

Examples:

-_________ oral contraceptives

-ortho evra (patch)

-nuva ring

Back 287

Combined

Front 288

The MoA for ________ contraception methods:

• Suppression of pituitary gonadotropins (FSH & LH) by the continuouslevels of estrogen and progesterone

• Progesterone suppresses LH to prevent the mid‐cycle surge, whichstops ovulation

• Progesterone also thickens cervical mucus to impair sperm travel

• Estrogen suppresses FSH to prevent the selection and emergence of adominant follicle

Back 288

Combined

Front 289

All forms of _____________ can exhibit some estrogenic, androgenic, or anabolic activity.

*Desogestrel and norgestimate are less androgenic than others

Back 289

Progesterone

Front 290

"________" combined oral contraceptives provide same amount of hormones every day for 21 days -- days 22-28 are placebo.

*Modified ____‐phasic providesvery low dose estrogen on days24‐28

Back 290

Mono

Front 291

"_____" and "_____" phasic combined oral contraceptives have varying levels of estrogen / progesterone every week.

*Less progesterone in general than monophasics

Back 291

"Bi" and "Tri" phasic COC

Front 292

If an oral contraceptive pill is missed it is important to use __________ method of contraception as precaution.

*Backup protection not required if 1 missed pill. Take both together as soon as remembered.

Back 292

Back-Up

Front 293

Combined oral contraceptives are _____________ in:

-Smokers over age 35

-Strong fam. hx of heart disease

-Clotting disorders

Back 293

Contraindicated

Front 294

The "ACHES" acronym applies to side effects with which medication class?

A= Severe abdominal pain

C= Chest Pain

H= Headache

E= Eye problems

S= Severe leg pain

Back 294

Contraceptives

Front 295

"Mini-Pills" such as (Micronor, Errin, Nor‐QD, Orvette, Camila) and Depo-Provera injection are ____________ methods of contraception.

Back 295

Progestin-Only

Front 296

__________________ contraceptions provide 24 hrs of protection per pill and must be taken at the exact same time daily (within 30 min) -- if more than 3 hrs late, need backup.

*Spotting common w/ first few backs

Mini-Pill MOA: don’t consistently suppress the pituitary gonadotropins LHand FSH‐ they really work by changing the endometrial and cervicalmucus environments

Back 296

Progestin-Only

Front 297

The Depo-Provera injection is given every ______ weeks via IM route. Document weight and BP at visits as both can increase on this medication.

Depa-Provera MOA: suppresses ovulation and changes cervical mucus. Suppressesestradiol levels, which can eventually lead to decreased bone mass(reversible).

Back 297

12 weeks

Front 298

Depa-Provera can suppress __________ levels, which eventually can lead to decreased bone mass (reversible).

Back 298

estradiol

Front 299

Short-Acting Reversible Contraceptives (Mini-Pill / Depo-Provera) are ____________ in the following patients:

• Women who can’t take combined methods because of co‐morbiditiesor chronic disease

• Undiagnosed vaginal bleeding

• Active viral hepatitis or cirrhosis

• Breastfeeding women

• Hypertensives

• Women over 35 that smoke

Back 299

Indicated

Front 300

Mirena and Skyla are examples of ___________ Long-Acting Reversible Contraception (LARCs).

*Last 3-5 yrs

*Check strings monthly after menses

*Inserted in clinic

MOA of LARCs:

• Thickens cervical mucus

• Suppresses ovarian function

• Inhibits sperm movements

• Thins the uterine lining

Back 300

Hormonal

Front 301

Nexplanon (Implanon) is a Hormonal LARC that is _________ into the patient's arm for 3 yrs.

*SE: menstrual irregularities, weight gain, headache, vaginitis

*Increased risk for blood clots

MOA of nexplanon (Implanon):

• Contains etonorgestrel (same progestin as in nuva ring)

• Blocks the LH surge to prevent ovulation

• Thickens the cervical mucus

• Thins the endometrial lining

*Few contraindications

Back 301

inserted/implanted

Front 302

nexplanon (Implanon) is a Hormonal LARC that is __________ in patients with:

active liver disease or active venousthromboembolism

women treated with CYP3A‐inducing orinhibiting meds

Back 302

Contraindicated

Front 303

Paragard (Copper IUD) is a __________ LARC.

-Can be used for up to 10 years

-SE: heavier mentrual bleeding/cramping

Back 303

Non-Hormonal

Front 304

Plan B is a high dose ________ that is used to prevent pregnancy for up to 3 days after unprotected intercourse... better chance of working the sooner it is taken.

-2 pills ... take first as soon as possible, take second 12 hrs later

-MOA: prevents ovulation... won't disturb an established pregnancy

Back 304

Progestin (levonorgestrel)

Front 305

_____________ women are at increased risk for:

• Stroke

• Heart disease

• Fractures‐ especially hip

• Colorectal cancer

• Endometrial cancer

Back 305

Menopausal

Front 306

___________ is defined as the permanent cessation of menses and begins when the patient has an entire year without menses.

Back 306

Menopause

Front 307

The median age in the US for Menopause is ________ to _______.

Back 307

49 to 51

Front 308

_____________ in menopause is due to the remaining follicles becoming resistant to the effects of FSH. Follicles decrease and atrophy with age. Less estrogen produced.

Back 308

Amenorrhea

Front 309

____________ is used to treat symptoms, not to prevent diseases that increase with menopause.

*Not meant to be permanent and are usually taken 1-3 yrs after menopause.

*Consider if pt. has uterus

Back 309

Oral hormone replacement therapy (HRT)

Front 310

True or False: Vaginal estrogen is systemically absorbed.

*Used to help with vaginal symptoms of dryness, burning, or pain with intercourse.

Back 310

False

Front 311

Oral estrogen should be started at a _______ dose and ______ PRN if symptoms are not well controlled

Back 311

Low dose; increase PRN

Front 312

Do not apply ___________ estrogen to breast or waistline.

*most common side effect is skin irritation

Back 312

Transdermal

Front 313

_________ estrogen has a greater effect on the liver due to the first‐passeffect. ____ estrogen administration increases hepatic production oftriglycerides, HDL, and clotting factors

Back 313

Oral; Oral

Front 314

______________ estrogen is as effective in preserving bone density and intreating menopausal symptoms.

Also associated w/ a lower risk ofvenous thrombosis and stroke, and has less effect serum lipids

Back 314

Transdermal

Front 315

Vaginal creams have low ________absorption and are good for vaginalcomplaints.

Back 315

systemic

Front 316

Medroxyprogesterone acetate is the most commonly prescribed_________‐ typically given in a cyclic (5‐10mg/day) or continuousregimen (2.5mg/day)

Back 316

progestin

Front 317

Natural micronized progesterone (prometrium) has ____ impact onlipids and is associated with ____ bleeding. Usual dose 200mg/daycyclically or 100‐200mg/day continuously

Back 317

less; less

Front 318

Estrogen + progesterone combination is used <5 years because of increased risk for ______ cancer.

Back 318

breast

Front 319

___________ can protect against endometrial cancer and hyperplasia in menopausal women.

Back 319

Progesterone

Front 320

Long term use of __________ is associated with hepatocellular neoplasm, increasededema, and elevation of cholesterol level.

Decrease in ____________ accompanies menopause; this can lead toloss of libido

Back 320

testosterone

Front 321

The ONLY indication for _________ is severe vasomotor symptoms and loss of libido

Back 321

testosterone

Front 322

The following medications are _____________ treatments for menopause symptoms:

• Effexor (venlafaxine)

• Paxil (paroxetine)

• Zoloft (sertraline)

• Neurontin (gabapentin)

• Clonidine

Back 322

Non-Hormonal

Front 323

True or False: There is evidence that Bioidentical hormonesare safe / effective for menopause symptom resolution.

Back 323

False... limited evidence even though some are FDA approved.

Front 324

The following are examples of ____________ ... meaning that these foods contain levels of estrogen naturally.

• Soybeans and soy products

• Cashews

• Peanuts

• Oats

• Corn

• Wheat

• Apples

• almonds

Back 324

phytoestrogen

Front 325

_______________ is ABSOLUTELY NOT recommended for the following patients:

• Personal history of breast cancer(esp. estrogen)

• Personal history of endometrialcancer (esp. estrogen)

• Undiagnosed genital bleeding

• Acute liver disease

• Active thromboembolic disease orhistory of

• Known or suspected pregnancy

There are relative CONTRAINDICATIONS for ____________ in the following patients:

• Chronic liver dysfunction

• Uncontrolled/poorly controlledHTN

• Acute intermittent porphyria

Back 325

Hormone Replacement Therapy

Front 326

Are Pregnancy A Category medications safe to use while pregnant?

Back 326

Yes

Front 327

True or False: As a FNP, we should NOT treat HTN in pregnant woman. Refer this patient.

Back 327

True. Do not treat HTN pregnancy... refer.

Front 328

What medication is recommended for heartburn if the client is pregnant?

Back 328

Nexium

Front 329

Diclegis, Zofran, phenergen are recommended for _______ if the patient is pregnant.

Back 329

Nausea and Vomiting

Front 330

Azithromycin is used to treat __________ in a pregnant client.

Back 330

Chlamydia

Front 331

If a patient is pregnant and has a URI, Strep, etc. what antibiotics would you consider?

Back 331

Amoxicillin/Ampicillin

Front 332

True or False: Tessalon perles and Codeine are safe to use in a pregnant client with cough?

Back 332

True

Front 333

True or False: Macrobid, Keflex, and Bactrim are contraindicated in patient with UTI that is pregnant.

Back 333

False. Recommended... except for Bactrim which is contraindicated near-term.

Front 334

_______ is the drug of choice for post-partum depression.

Back 334

Zoloft

Front 335

True or False: Progesterone only or hormone-free (copper IUD) are safe contraceptives to use during lactation?

Back 335

True

Front 336

The first line treatment for a UTI is ________________ (alternative to Macrobid)

*Less likely to cause vaginal yeast infection.

*Caution: N/V, anorexia, INR prolongation, allergy to sulfa

*Contraindicated: <2 y/o, pregnant, breast feeding, megaloblastic anemia

Back 336

Trimethoprim/Sulfamethoxazole

(Bactrim/Septra)

Front 337

The first-line treatment for a UTI (alternative to TMP/SMP) is __________.

*Need 7 days for effect

*SE: Nausea, Dizzyness, Pulmonary complications

*Contraindications: Poor urinary output

Back 337

Nitrofurantoin (Macrobid, Macrodantin)

Front 338

Second-Line treatment for UTI includes medications in the ____________ class.

*may be 1st line for men, post-menopausal women, complicated, or pyelonephritis

*SE: insomnia, drug interactions, Steven Johnson Syndrome, dizziness, Headache

*Contraindication: NOT in children, AVOID in pregnant

*Tendon rupture risk

Back 338

Flouroquinolones

Ciprofloxacin (Cipro) OR Levofloxacin (Levoquin)

Front 339

Avoid _____+_____ for UTI in geriatric populations...

Back 339

fluoroquinolones + nitrofurantoin

Front 340

Consider abuse if _______ (age group) present with recurrent UTI. Consider genitourinary abnormality. Tx takes 7-14 days.

Back 340

children

Front 341

The primary tx of bacterial prostatitis is __________. First line is __________ (medication class). Second line drug is Doxycycline (long-acting tetracycline).

Back 341

antibiotics; fluoroquinolones

Front 342

_______ is the most common prostatic problem in men over age 50.

*Causes difficulty with urination

Back 342

BPH

Front 343

Alpha Blockers and 5a Reductase inhibitors are medications that can improve symptoms of ________.

Alpha Blockers are contraindicated in preg., hepatic and renal insufficiency

*Pregnant women should not handle 5a reductase inhibitors

Back 343

BPH

Front 344

Examples of ____________ are finasteride (Proscar)+ Dutasteride (Avodart).

*Block conversion of testosterone to DHT. This reduces size of prostate.

*SE: impotence, decreased libido, lower ejaculatory volume

Back 344

5a reductase inhibitors

Front 345

Examples of __________ are Terazosin (Hytrin), doxazocin (Cardura), tamulosin(Flomax).

*Relax vasculature, prostate, and bladder neck

*SE: tachyarrhythmia, ortho hypotension, syncope, dizzyness, fatigue

*Best to take at BEDTIME

Back 345

alpha blocker

Front 346

______________ is the most common sexual dysfunction in men.

Back 346

Erectile dysfunction

Front 347

Risk factors for _____________ (sexual disorder) include: age, CV disease, chronic illness,certain medications, sedentary lifestyle, obesity andothers

Back 347

Erectile dysfunction

Front 348

______________ are medications that improve development and function of erection. Examples of medications include:

Sildinafil (Viagra)

Vardenafil Levitra

Tadalafil (Cialis) -- different chemically, longer acting

Back 348

PDE5 inhibitors

Front 349

Contraindications for _____________ (sexual med) include:

-high fat meal prior to dosing

-concurrent use with nitrates/alpha blockers (Flomax can be taken with Cialis)

SE include: headache, flushing, GI upset, nasal congestion, priapism

Back 349

PDE5 inhibitors

Front 350

_______ bladder is defined as urinary frequency / urgency >8x/d and nocturia >2x/night

*Not normal part of aging

*Women report more

Back 350

Overactive

Front 351

Medications to treat _________ are in the anticholinergic/antimuscarinic class. Examples include: oxybutinin (Ditropan) and tolterodine (Detrol) -- first line

*Work by antagonizing muscarinic receptors,thus reducing frequency and strength detrusorcontraction

*SE: blurry vision, dry mouth, constipation, urinary retention, cognitive dysfunction

*Contraindicated in: glaucoma, urinary retention

Back 351

Overactive Bladder

Front 352

______________ (r/t treating overactive bladder) are contraindicated in glaucoma and urinary retention.

Back 352

Anticholinergic/antimuscarinic

Front 353

___________ may help symptoms of overactive bladder in males related toreduction of obstruction, but in females mayincrease stress incontinence.

Back 353

Alpha Blockers

Front 354

True or False: Corticosteroids can cause secondary osteoporosis.

Back 354

True

Front 355

A DXA scan is the gold standard for diagnosis of ___________ and assessment of bone health.

*Should always be accompanied by health promotion

-Calcium / Vitamin D intake

-Smoking cessation

-Moderation in EtOH consumption

-Regular weight bearing exercise

Back 355

Osteoporosis

Front 356

A ________ compares bone mineral density (BMD) to optimal peak BMD (age 30) for patient's gender. This is part of DXA interpretation.

Normal BMD: 0 to -1.0

Osteopenia: -1.0 to -2.5

Osteoporosis: <2.5

Back 356

T-Score

Front 357

True or False: dietary supplemental calcium / vitamin D decrease risk for fractures and can impact bone mineral density.

Back 357

False

Front 358

_________ supplement interferes with absorption of many medications and should ideally be taken 2 hours before/after other agents.

*Avoid taking with PPI/caffeine

*Common SE = dyspepsia and constipation

Back 358

Calcium

Front 359

Vitamin ____ can impact levels of depression and heart disease. This vitamin assists in mineral absorption in the gut and assists in maintaining normal serum calcium and phosphorous levels.

*25-hydroxy-vitamin ___ lab test is the one you want in order to assess deficiency

Back 359

D

Front 360

Vitamin _______ deficiency is recognized as problematic for ALL ages. Causes of deficiency include:

– Decreased sun exposure due to working indoors

– Skin cancer prevention with increased sun block use

– Malabsorption syndromes

– Kidney and liver disease

– Older adults with decreased fat stores

– Poor nutrition

Back 360

Vitamin D

Front 361

Does cholecalciferol (Vitamin D3) or ergocalciferol (Vitamin D2) have better absorption?

Back 361

Vitamin D3 or cholecalciferol

Front 362

The primary goal of pharmacology r/t osteoporosis is ______ reduction.

Back 362

FRACTURE REDUCTION

Front 363

Bisphosphonates _________ bone resorption.

Back 363

inhibit

Front 364

____________ (osteoporosis med class) are indicated in patients:

-That have had a fragility fracture

-T score <-2.5 (osteoporosis)

-T score -1.0 to -2.5 with clinically significant risk factors for fracture

*FRAX scaling tool assesses fracture risk factor

Back 364

Bisphosphonates

Front 365

Alendronate (Fosamax) and Risdronate (Actonel) are examples of medications in the ___________ class. These are considered first-line.

*Avoid in patients with advanced renal failure (CrCl < 30)

*Tablets must be taken on an EMPTY stomach, first thing in morning with 8oz plain water. Must remain 30 min upright and cannot eat/drink anything else.

Back 365

Bisphosphonates

Front 366

Potentially dangerous side effects of ____________ (osteoporosis med class) include:

• Atypical subtrochanteric and diaphyseal femur fractures? (askabout thigh/groin pain before and during therapy)

• Esophogeal cancer? (consider alternate class for patients withsignificant GERD or med‐related exacerbation of symptoms)

• Reclast and ARF? (check renal function just prior toadministration, hold for CrCl<35)

• Osteonecrosis of the jaw? (maintain good oral hygiene andnotify oral surgeon about therapy pre‐procedure)

Back 366

Bisphosphonates

Front 367

_______________ (osteoporosis med) is indicated for patients that:

-Do not tolerate bisphosphonates and have osteoporosis (T‐score < ‐2.5) OR

– Have osteoporosis and additional fragility fracture while on bisphosphonate

*use this med for 18-24 months and then resume bisphosphonate

Back 367

Teriparatid (Forteo)

Front 368

_________ is most effective after bisphosphonates. Used for prevention and treatment. Same risks/contraindications as in menopause.

Back 368

Estrogen

Front 369

Raloxifene (Evista) is a Estrogen Agonist/Antagonist that increases bone mineral ________ and reduce the risk of vertebral fractures.

*Used for prevention/treatment in post-menopausal women; less effective than bisphosphonate/estrogen but has favorable SE

*Concerns: hot flashes, leg cramps, clots

Back 369

density

Front 370

Denosumab (Prolia) MOA is: Human monoclonal antibody to the receptor activator of nuclearfactor kappaB ligand (RANKL), an osteoclast differentiating factor. Itinhibits osteoclast formation, decreases bone resorption, andincreases bone mineral density (BMD).

It is indicated for those who cannot tolerate _____________ and is administered with a SQ injection q6month

*Precautions: hypocalcemia (correct calcium prior to administration); rash/cellulitis at injection site; ONJ and atypical femur fx

Back 370

bisphosphonates

Front 371

_________ is approved for treatment of osteoporosis in women who are atleast 5 years post‐menopausal when alternative treatments arenot suitable. 30% reduction in vertebral fx.

Back 371

Calcitonin

Front 372

To follow-up treatment of ________________, re-scan patient after 1-2 yrs of therapy (if improvement, then q2-5 yrs); medicare covers 2 yrs

Back 372

Osteoporosis

Front 373

If _____________ (Osteoporosis medication) is not tolerated, choose:

– IV bisphosphonate if T‐score < ‐2.5

– Estrogen (for immediately post‐menopausal)

– Raloxifene (Evista) (if no contraindications)

– Calcitonin (for older/no other options)

Back 373

bisphosphonate

Front 374

If patient has a ___________ while on bisphosphonate, start teriparatide (Forteo).

Back 374

fracture