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Naplex Drug Review

List three PDE-5 inhibitors and the effect they have on blood pressure Viagra (sildenafil) and Levitra (vardenafil) should not be taken with a high fat meal, Cialis (tadalafil) is unaffected by food and has a longer onset/duration of action. Stendra (avanafil) has shortest duration of action. All cause hypotension.
Which of the following drugs do not treat hyperkalemia? a. Sodium polystyrene b. Albuterol c. HCTZ d. Insulin glargine e. Furosemide f. Ibuprofen Answer: D,F; Lantus (insulin glargine) and Motrin (Ibuprofen) as well as other NSAIDs will raise K+ levels
If a phenobarbital elixir contains 28.2 mg of phenobarbital per 5 mL, how many grams of phenobarbital would be used to prepare a pint of the elixir? 28.2 mg/5 mL x 473 mL/1 pint x 1 g/1,000 mg = 2.67 g
Bonine and Dramamine Non-Drowsy are two products indicated for the treatment or prevention of motion sickness. What class of medication are these products, what is their primary ingredient that makes them less sedating, and what is their age limit? They contain meclizine, which is a 1st generation antihistamine and mild anticholinergic. The use of these products is contraindicated in children < 12 yrs of age.
The concomitant use of Flagyl (Metronidazole) and _____ produces a disulfiram-like reaction characterized by N/V, flushing, and abdominal distress. Alcohol
Valium, Ativan, Klonopin, and Xanax are all what class of medications? What is their antidote? Class: Benzodiazpines Antidote: Romazicon (flumazenil)
What is the conversion ratio of Methylprednisolone IV to Prednisone PO? 4 mg IV = 5 mg PO
Hemoglobin A1C% corresponds to what time frame? What is a reasonable A1C goal for a diabetic? 90 - 120 days (3 - 4 months). For a young diabetic with few or no comorbidities, a usual goal is A1c <7. The goal may be <8 for an older patient with a lot of health conditions or a diabetic with a high baseline A1c where a modified goal for them is more
Enbrel (etanercept) and Humira (adalimumab) can both treat rheumatoid arthritis and other conditions dealing with joint inflammation. What test must be performed prior to treatment with Humira which is not a prerequisite for taking Enbrel? Tuberculin skin test - Humira can increase the likelihood of contracting life threatening infections such as tuberculosis.
Carbidopa prevents the peripheral degradation of Levodopa. What class of medication is Carbidopa and for what condition is it indicated? Carbidopa is a dopa decarboxylase inhibitor which is used for Parkinson's Disease. Sinemet is a brand product that contains both carbidopa and levodopa.
How many milliliters of hydrocortisone liquid (40mg/mL) will be needed to prepare 30g of a 0.25% cream (w/w)? 0.25% = 0.25g/100g = 250mg/100g = 75mg/100g x 1mL/40mg = 1.875 mL needed
Which drug reference contains lay terms (patient oriented terms)? USP-DI Volume II
Which drug reference contains drug cost information? Red Book
Which anti-arrhythmic drug is a CYP3A4 inhibitor that can cause pulmonary fibrosis, hepatotoxicity, thyroid abnormalities, and increased bleeding risk when combined with Warfarin? Amiodarone
Cisplatin is a drug used for cancer of the ovaries, testes, bladder, and lung. What is the antidote? Ethyol (amifostine)
What makes the Harriet Lane Handbook useful? It contains pediatric diagnosis and treatment plans.
Antizol (fomepizole) is an antidote used for intoxication of what? Alcohol
Ferrous Sulfate and other iron-containing products can cause what cardinal side effects? I. diarrhea II. constipation III. dark tarry stools and urine discoloration IV. hair loss A) I, III B) II, III C) I, III, IV D) II, III, IV B. II, III
Which statistical error is described below? - Not detecting a difference when one exists - Increases in lower powered studies - Accepting a false null hypothesis Type II error
Does not change viscosity when stirred or agitated: a. Newtonian flow b. Plastic flow c. Thixotropic flow d. Dilatant flow e. Pseudoplastic flow A. Newtonian flow
What are some of the side effects one could expect from Levothyroxine? Weight loss, increased appetite, insomnia, anxiety, diarrhea = hyperthyroid symptoms
How should Fosamax be taken? What is the generic name? Fosamax (alendronate) should be taken once a day or once a week depending on the dose; sit upright or stand for at least 30 minutes after a dose; do not crush pills and take them with a glass of plain water; do not take other oral medications within 30 mi
Calculate the BMI for a female who is 5'5" tall and weighs 155 lbs. Would they be classified as underweight (<18.5), normal weight (18.5 - 24.9), overweight (25 - 29.9), or obese (>30)? BMI = (kg/m^2) or BMI = (pounds/in^2) x 704.5 = (155/60^2) x 704.5 = 30.33 = obese
What is the brand/generic name of a xanthine oxidase inhibitor that treats gout and what are at least 3 common side effects of this medication? Zyloprim (allopurinol) or Uloric (febuxostat). Allopurinol can cause drowsiness, kidney stones or renal insufficiency if not properly hydrated, rash, GI upset, N/V, diarrhea, abdominal pain. Same for Febuxostat except less harm to kidneys.
What is the brand name for Lisdexamphetamine and when should it not be taken? Vyvanse (lisdexamphetamine) should only be taken in the morning. It should not be taken at night because it can cause insomnia, and it should not be taken before performing an activity that requires coordination since the medication can cause dizziness.
Why is the combination of Gemfibrozil with a statin drug contraindicated? Increased risk of myopathy and rhabdomyolysis
Which Statin drugs should be taken in the evening? Zocor (simvastatin), and Mevacor (lovastatin) should be taken at night since more cholesterol is produced at night. Lipitor, Crestor, and Pravachol can be taken anytime. *Lescol (fluvastatin) is taken at night but rarely used.
Lithobid (lithium) is a mood stabilizer used for the treatment of manic episodes in bipolar disorder. What are the main side effects? Select all that apply: a. Drowsiness b. Tinnitus c. Anuria d. Muscle weakness A. Drowsiness B. Tinnitus D. Muscle weakness Choice "C" is incorrect. It can cause polyuria instead.
Which drug can be used during pregnancy (i.e. Category A - C)? a. Losartan b. Amiodarone c. Lovastatin d. Megestrol e. Cholestyramine E. Cholestyramine is pregnancy category C. The rest are D or X.
What class of drug is Elavil and what pregnancy category does it fall under? Elavil (amitriptyline) is a tricyclic antidepressant (TCA) and it does not have an established pregnancy category.
The use of Lubiprostone is contraindicated in patients with known or suspected mechanical GI obstruction. What is the brand name of this drug and what is its primary indication? Amitiza (lubiprostone) is used for chronic idiopathic constipation, so it can be used for the treatment of certain types of Inflammatory Bowel Syndrome.
Which of the following drugs do NOT cause weight gain? Select all that apply: a. Megace b. Remeron c. Synthroid d. Prednisone e. Actos f. Concerta g. Amaryl h. Lyrica Answer: C,F; Concerta (methylphenidate) and Synthroid (levothyroxine) cause weight loss.
What class of drug does Mobic (meloxicam) fall under and what is the primary indication? Mobic (meloxicam) is an NSAID and used for osteoarthritis and rheumatoid arthritis.
Glucophage (metformin) can cause what major side effect that is characterized by myalgia, cold limbs, somnolence, and hyperventilation? Lactic acidosis
Select all of the following drugs that can cause Serotonin Syndrome: a. Imitrex b. Hytrin c. Cymbalta d. Elavil e. Emsam A. Imitrex (sumatriptan) C. Cymbalta (duloxetine) D. Elavil (amitriptyline) E. Emsam (selegiline)
How many refills are permitted for Methadone and why? No refills because it is a C-II drug.
Why is the combination of tyramine foods (beer, wine, caffeine, chocolate, deli meat, aged cheese) with an MAOi (i.e. selegiline) contraindicated? Hint: blood pressure The combination of these medications can cause hypertensive crisis, which is characterized as an instance where an individual's blood pressure increases to >180/120 in most cases and can lead to further complications or even death
Medrol dose packages contain how many tablets and last for how many days of treatment? 21 tablets and 6 days Day 1: 6 tablets Day 2: 5 tablets Day 3: 4 tablets Day 4: 3 tablets Day 5: 2 tablets Day 6: 1 tablet
Cushing's Disease can be caused by hyperactive adrenal glands or chronic steroid use. This condition causes an abnormally high level of what in the body? Cortisol
Hashimoto's Disease is an autoimmune disorder that causes what condition? Hypothyroidism
Express 0.04% as a ratio strength (1:X) 0.04% = 0.04/100 = 1 part/x parts = 1:2500
What is the brand name for the thyroid medication that is natural and comes from pigs? Armour
When taking Zaroxolyn, it is important to monitor electrolyte levels and administer doses early in the day. What is the generic name and what class of medications does it belong to? Zaroxolyn (Metolazone) is a thiazide-like diuretic.
What is Modafinil used for and the presence of what side effect warrants discontinuation of therapy? Provigil (modafinil) is used to increase alertness and reduce daytime drowsiness. Therapy should be stopped at the first signs of rash (Steven Johnson's Syndrome).
Drugs given by the nasal route, such as Nasonex, can cause epistaxis which is known as what? Nosebleeds
Singulair (montelukast) is what class of medication? Is it used for acute bronchospasms or chronic maintenance of asthma? It is a leukotriene receptor antagonist used for chronic maintenance of asthma.
Niaspan (niacin) is used to reduce LDL and increase HDL. What is the most common side effect of this medication and how can it be reduced? Flushing is common, but it can be reduced by taking an NSAID 30 minutes before a dose of Niacin.
Which of the following are non-DHP Calcium Channel Blockers? a. Norvasc b. Verelan c. Cardizem d. Carden SR e. Plendil f. Adalat CC B. Verelan (Verapamil) C. Cardizem (Diltiazem)
Nitrofurantoin is commonly used to treat urinary tract infections. Why can't it be used in the elderly or in patients with a CrCl <60? If the kidneys are compromised, an inadequate/sub-therapeutic concentration of the drug will be in the urine for treatment purposes.
Why is the use of NitroStat with PDE-5 inhibitors a cause for concern? Increased anti-hypertensive effects
What do the drugs on the BEERS list all have in common? They are inappropriate for the use in the elderly.
What are the contraindications for taking Loestrin 24 Fe? a. pregnancy b. antibiotic use c. thromboembolic disorder d. cardiovascular disease e. A and B f. all of the above All of the above
What class of medications is Xanax and what is the generic form? a. Clonazepam b. Alprazolam c. Lorazepam d. Triazolam e. Diazepam Xanax is a Benzodiazepine B. Alprazolam is the generic form
Which of the following is a traditional anti-psychotic? a. Haloperidol b. Aripiprazole c. Clozapine d. Olanzapine e. Paliperidone A. Haloperidol
Risperidone and Spironolactone both have the potential to cause gynecomastia. What is this known as? Man breasts
Which drug decreases triglycerides and increases LDL with side effects including nausea and fishy burps? Lovaza (omega-3-acid) a.k.a. fish oil
What is the generic name for Prilosec and what is the class of medication? Prilosec (omeprazole) is a proton pump inhibitor
Orphenadrine can cause tachycardia, dry mouth, drowsiness, and urinary retention. It should not be used if there are duodenal, bladder, or other obstructions present. What class of medications does it belong to? Norflex (Orphenadrine) is a muscle relaxant
Concerns exist due to a possible connection between flu vaccines and what neurological disorder that causes lower limb weakness that gradually ascends to the upper body? Guillain-Barré
Is Tegretol a CYP3A4 inducer, inhibitor, or substrate? Inducer and substrate
Clozaril (clozapine) was the first atypical antipsychotic produced. It was taken off the market in 1975 due to reports of agranulocytosis. It was later reinstated for treatment-resistant schizophrenia but requires monthly monitoring of what? White blood cells and absolute neutrophil count
In which class of antipsychotics are these side effects more common? 1st gen, 2nd gen, or both? a. Anticholinergic - dry mouth, constipation b. EPS - motor disturbances (ex: akasthesia) c. Metabolic - wht gain, diabetes d. Sedation, sexual dysfunction A. Anticholinergic - 1st gen B. EPS - 1st gen C. Metabolic - 2nd gen D. Sedation and sexual dysfunction - both
Define miosis and select the drug or drugs from below that cause this condition: a. Most opioids b. Most antipsychotics c. Most anticholinergics d. Most amphetamines Miosis is constriction of the pupil and caused by opioids and antipsychotics - selections "A" and "B"
Define mydriasis and select the drug or drugs from below that cause this condition: a. Most opioids b. Most antipsychotics c. Most anticholinergics d. Most amphetamines Mydriasis is dilation of the pupil and caused by anticholinergics and amphetamines - selections "C" and "D"
What is nystagmus and which of the following drugs can cause it? Select all that apply: a. Anticonvulsants b. Benzodiazepines c. Opioids d. Barbiturates A. Anticonvulsants B. Benzodiazepines D. Barbiturates Choice "C" is incorrect. Opioids cause miosis.
Which of following medications used for the treatment of Diabetes does not cause weight gain? a. Sulfonylureas b. Thiazolidinediones c. Insulin d. Biguanides e. DPP4 inhibitors Answer: D,E; Biguanides (i.e. Metformin) and DPP4 inhibitors (Sitagliptin) are weight neutral.
Arrange the Statin drugs in order of potency from highest to lowest: a. Pravachol b. Lipitor c. Crestor d. Zocor e. Mevacor f. Lescol C, B, D, E, A, F; Crestor 5 mg = Lipitor 10 mg = Zocor 20 mg = Mevacor/Pravachol 40 mg = Lescol 80 mg
What class of medications are diphenhydramine and dimenhydrinate? Do they cause somnolence? What are their brand names? They are both 1st generation antihistamines that cause somnolence(sedation). Diphenhydramine is Benadryl and Dimenhydrinate is Dramamine.
What is goal INR ranges for Warfarin and what is the possible antidote that can be used? INR goal of 2-3 normally and 2.5 - 3.5 with mechanical valves. The antidote is Mephyton (phytonadione) also referred to as Vitamin K.
What is the antidote for opioids (ex: overdose on morphine)? Narcan (naloxone)
What is the specific gravity of 170 mL of glycerin weighing 146 grams? Specific gravity = 146g / 170 mL = 0.86; NO UNITS!!
What is the antidote for Digoxin? Digibind (digoxin immune fab)
How many mL of a 1:2500 (w/v) solution of aluminum acetate can be made from 100 mL of a 0.2% solution? 1:2500 = 0.04% = (0.04%)(X) = (100 mL)(0.2%) = 500 mL
What is the antidote for Acetaminophen? Injection: Acetadote (n-acetyl cysteine) Inhaled solution: Mucomyst (n-acetyl cysteine)
Beta blockers are just one of the many drugs that can mask the symptoms of what condition? List 3 drugs in this class. Mask symptoms of hypoglycemia Some examples: Coreg (carvedilol), Trandate (labetalol), Tenormin (atenolol), Inderal (propranolol), Toprol XL (metoprolol succinate), Lopressor (metoprolol tartrate), Zebeta (bisoprolol)
What is Zollinger-Ellison Syndrome and how can it be treated? It is a hypersecretory condition caused by tumors (located in pancreas or small intestines) and leads to increased gastrin production and excess stomach acid. First line treatment is proton pump inhibitors. Can perform surgery as well.
Evista (raloxifene) is a SERM. What does that stand for? What is the primary indication for use and why is its use contraindicated in patients with thromboembolic events? SERM = selective estrogen receptor modulator It is used for prevention and treatment of osteoporosis, and it is contraindicated in the presence of thromboembolic events, because it controls estrogen receptors; increasing estrogen can increase clot risk.
What is the recommended pharmacological therapy for patients with AHA Stage A CHF? American Heart Association stage A heart failure is classified as being asymptomatic but having a high risk. The standard therapy for this stage is an ACE inhibitor.
What is the difference between an H1 and H2 antagonist? They are both antihistamines but differ in their site of action. H2 antagonists (i.e. Ranitidine) act in the stomach and help treat ulcers. H1 antagonists (i.e. Loratadine) have a wider range of activity and are generally used for allergic rhinitis.
What is Paget's Disease? Excessive bone breakdown and disorganized bone remodeling. Similar to osteoporosis.
Polycystic ovary syndrome (PCOS) is characterized as an imbalance in female hormones and is a leading cause of what condition that causes abnormal hair growth in women (ex: lip or chest)? Hirsutism
Label each effect as a product of estrogen or progesterone: a. increase blood clots b. relieve hot flashes c. relieve night sweats d. natural diuretic e. restore normal libido f. prevent endometrial cancer g. improve vascular tone (vasoconstrict) A. Estrogen B. Estrogen C. Estrogen D. Progesterone E. Progesterone F. Progesterone G. Progesterone
What is the generic name for Prempro? Conjugated estrogens and Medroxyprogesterone
What is the brand name of Rizatriptan? What is the primary indication? When it is contraindicated? Maxalt (rizatriptan) is used for migraine headaches and is contraindicated in hepatic/renal impairment, heart conditions, uncontrolled hypertension, angina. Do not give with MAOi, SSRI, SNRI, Ergots.
Which of the following group of side effects occur when using Vesicare (solifenacin)? a. drowsiness, constipation, and UTI b. dry mouth, diarrhea, and dizziness c. insomnia, constipation, and blurry vision d. chest pain, headache, and somnolence Vesicare (solifenacin) is for overactive bladder. Answer: A. Drowsiness, constipation, and UTI -also causes dry mouth, dizziness, and blurry vision, but the only entirely correct choice is "A"
Which of the following can result from hyperglycemia? Select all that apply: a. Polydipsia b. Anuria c. Diabetic ketoacidosis d. Dizziness Answer: A,C,D; Choice "B" is incorrect. Hyperglycemia causes polyuria rather than anuria.
Vancomycin is recommended to be administered in a dilute solution slowly, over at least 60 minutes (maximum rate of 10 mg/minute for doses >500 mg) What occurs if it is infused too quickly? Red Man Syndrome
What is the therapeutic serum level of Tegretol (carbamazepine) for treatment of seizures? a. 10.0 - 15.0 mg/L b. 3.5 - 5.0 mg/L c. 0.5 - 1.3 mg/L d. 2.0 - 10.0 mg/L e. 4.0 - 12.0 mg/L E. 4.0 - 12.0 mg/L
When taking Dilantin, which supplements are NOT recommended? Select all that apply: a. Folic acid due to macrocytic anemia b. Vitamin D and Ca2+ due to osteomalacia c. Pyridoxine due to Vit B6 deficiency d. Zinc due to immunocompromised state Answer: C,D; Choice "C" applies to Isoniazid and other drugs used to treat tuberculosis. Choice "D" was a complete fabrication and does not relate to Dilantin.
Depakote (valproic acid) mechanism involves the increase in which neurotransmitter? a. Ach b. Epinephrine c. GABA d. Dopamine e. Serotonin C. GABA
How many grams of NaCl are in 500 mL of 1/2 NS? 1/2 normal saline = 0.45% = 0.45g/100mL x 5 = 2.25g/500mL
Desyrel has two different treatment indications based on the dose administered. What two indications are they? Desyrel (trazodone) treats depression at high doses (150 - 600 mg qday in 3 divided doses) and insomnia at low doses (≤200 mg qday)
What is the most common pathogen present in a urinary tract infections (UTI)? E. coli
How do thiazides and thiazide-like diuretics affect sodium, potassium, and calcium levels? Reduce sodium, reduce potassium, increase calcium
What is in a Novolog 70/30 FlexPen? Once punctured, how should the pens be stored and how long are they good for? 70% insulin aspart protamine suspension (intermediate acting) and 30% insulin aspart short acting injection. They should be stored at room temperature once punctured, and they are good for 14 days.
Which of the following about intravenous Furosemide is false? a. Can be diluted in D5W b. Can be diluted in NS c. Must be refrigerated d. It is a loop diuretic Answer: C; Furosemide should NOT be refrigerated
Which of the following about intravenous Propofol is false? a. Do not refrigerate b. Shake well before use c. Can cause urine to turn green d. Can cause hypertension Answer: D; Propofol cause hypotension
What is the brand name, medication class, and primary indication for Tramadol? Ultram (tramadol) is an opioid/analgesic used for moderate to severe pain.
How do Sudafed and Sudafed PE differ in terms of ingredients and availability for purchase? What class of medication are they? Sudafed contains pseudoephedrine and is kept behind the counter where strict limitations are placed on its distribution. Sudafed PE contains phenylephrine and is available over the counter (OTC). They are both decongestants.
What class of medication is Nystatin? (Polyene) antifungal
What are the 3 components of a topical antibiotic combination product referred to as Triple Antibiotic and Neosporin? Bacitracin, Neomycin, and Polymyxin B
Which of the following products comes as an extended release formulation? Select all that apply: a. Avinza b. Metoprolol Succinate c. Duragesic d. Metoprolol Tartrate Answer: A,B,C; Avinza is extended release form of Morphine. Metoprolol succinate is extended release and comes as Toprol XL. Duragesic is an extended release fentanyl patch
What are the 2 drugs that can be used for hypertension in pregnant women? Methyldopa and Labetalol
What are the 4 things measured for a complete blood count (CBC) and what are their normal ranges? White blood cells range from 4,000 - 11,000 cells/mm³. Hemoglobin ranges from 14 - 18 gm/dL for men and 12 - 16 gm/dL for women. Hematocrit ranges from 40% - 50% for men and 36% - 46% for women but can vary slightly. Platelets range from 150,000 - 400,000
What is the blood pressure goal for an individual ≥60 yrs of age with no Diabetes and no CKD per JNC 8? <150/90
At what age for males and females does it become a risk factor for dyslipidemia? Men > 45 years of age and Women > 55 years of age
Which of the following are microvascular complications caused by Diabetes? Select all that apply: a. Retinopathy b. Nephropathy c. CVA d. CAD e. Neuropathy f. Myonecrosis Answer: A,B,E; Retinopathy leads to vision changes which is why diabetic patients should have regular eye exams. Nephropathy leads to kidney damage. Neuropathy causes nerve damage in places like the foot.
What is the 15-15-15 rule as it pertains to Diabetes? When blood glucose level < 70 mg/dL, drink 1/2 can of soda that is non-diet or eat 3-4 hard candies/glucose tablets. Then wait 15 min, retest blood sugar, and repeat if blood glucose level is still < 70 mg/dL.
What classifies as diastolic right-sided heart failure? a. normal ejection fraction and pulmonary edema b. normal ejection fraction and peripheral edema c. reduced ejection fraction and pulmonary edema d. reduced ejection fraction and peripheral edema Answer: B; Choice "A" is diastolic left-sided Choice "C" is systolic left-sided Choice "D" is systolic right-sided
Why is the use of NSAIDs in CHF patients contraindicated? What would you give as an alternative? NSAIDS increase fluid retention, which is dangerous since CHF patients already have fluid accumulation (edema) and are usually on a diuretic. Instead of taking an NSAID, Tylenol or Tramadol can be given instead for the same intended purposes.
What is a urinary tract infection that affects the kidneys and generally requires a longer duration of treatment compared to usual cases of acute uncomplicated cystitis? Pyelonephritis
What is a risk factor for contracting a UTI? Select all that apply: a. Female b. Diabetes c. Immobility d. Increased sexual activity e. Pregnancy All of the above
In order to properly diagnose a patient with this condition, infiltrate on lung imaging (usually through chest x-rays) must be found. What is this condition? Community acquired pneumonia (CAP)
What are the components of the CURB-65 score and what does it determine? Confusion, Uremia (BUN > 19), Respiratory Rate ≥ 30, Blood Pressure (Systolic < 90, Diastolic < 60), Age ≥ 65. The presence of at least 2 of these abnormalities warrants inpatient treatment for CAP rather than outpatient.
What are the components of the CHADS-2 score and what does it determine? CHF = 1 point, Hypertension (>140/90) = 1 point, Age ≥ 75 = 1 point, Diabetes = 1 point, Stroke (prior) = 2 points. Score of ≥ 1 warrants use of oral anticoagulants for stroke prevention rather than Aspirin/Plavix. This score accesses stroke risk.
What antithrombotic agent is the appropriate form of anticoagulation for use in pregnancy? Low Molecular Weight Heparin (LMWH)
List 3 antibiotics that can treat MRSA: Linezolid, Vancomycin, Clindamycin, Bactrim, Doxycycline, Minocycline, Daptomycin, Tigecycline, Ceftaroline
Which of the following vaccines are given through the intramuscular (IM) route at a 90 degree angle? a. Varicella b. MMR c. Hep A d. Influenza e. A & C f. C & D Answer: F; Influenza, Hep A, Hep B, Tdap are all given IM. The pneumococcal vaccine can be given IM or SQ.
Which of the following vaccines are given through the SQ route at a 45 degree angle? a. Varicella b. Zoster c. MMR d. Pneumococcal e. A,B,C f. All of the above Answer: F; All of these vaccines can be given SQ.
Calculate the corrected calcium based on the following data and state whether it is within normal limits: -measured calcium: 8.7 mg/dL -measured albumin: 3.5 g/dL Corrected calcium = 8.7 + 0.8(4 - 3.5) = 9.1 mg/dL. This is within normal limits of 8.4 - 10.2 mg/dL.
Calculate the anion gap based on the following data and state whether it is within normal limits: -measured potassium = 4.1 mEq/L -measured sodium = 133 mEq/L -measured chloride = 100 mEq/L -measured bicarbonate = 24 mEq/L Anion gap = (4.1 + 133) - (100 + 24) = 13.1 mEq/L. This is within the normal range of 10 - 14 mEq/L.
Calculate the serum osmolality based on the following data and state whether it is within normal limits: -measured sodium = 136 mEq/L -measured blood urea nitrogen = 14 mEq/L -measured fasting blood glucose = 142 mg/dL Osmolality = 2(136) + (14/2.8) + (142/18) = 284.89 mOsmol/kg. This is within the normal range of 275 - 295 mOsmol/kg.
The live attenuated influenza vaccine (LAIV) is given via nasal spray under the trade name FluMist. What are the contraindications? a. Asthma b. History of Guillain–Barré Syndrome c. Age > 49 d. Egg allergy e. Diabetes f. B,C,D g. All of the above Answer: All of the above
What is the significance of the new influenza vaccine known as Flublok? It is free of eggs, latex, and preservatives, so it makes the flu vaccine accessible to a larger population.
What is the new oral anticoagulant approved in December 2012 that requires no INR monitoring, has less drug interactions than Warfarin, has no dietary restrictions, has no current antidote, and can be used in non-valvular Afib patients? Eliquis (apixaban)
Which of the following is a protease inhibitor? a. Combivir b. Kaletra c. Sustiva d. Isentress Answer: B; Combivir is an NRTI, Sustiva is an NNRTI, and Isentress is an Integrase inhibitor
Calculate the osmolar concentration, in milliosmoles, represented by 1 liter of a 10% (w/v) solution of anhydrous dextrose (M.W. = 180) in water. 10% = 10g/100mL = 100g/L; 100g x 180g/mol = 0.555 Osmols x 1,000 = 555.6 mOsmol
Which HIV medication can lead to a falsely positive test for marijuana in drug screening assays or tests? Atripla and Sustiva are two HIV brand products that contain Efavirenz which can cause these false positives for marijuana.
What do all of these drugs have in common? a. Cyclophosphamide b. Stanozolol c. Methotrexate They are immunosuppressants. They can also cause hair loss.
What do all of these drugs have in common? a. Amoxicillin/Clavulanic Acid b. Bisacodyl c. Fluoxetine d. Lithium e. Digoxin They can cause diarrhea
What are the 5 initiation steps to consider when counseling a patient on smoking cessation? Ask, Advise, Assess, Assist, Arrange
When dispensing Zyban to a patient for the first time, what do you tell them about this medication as it relates to its delayed onset of action? Zyban (bupropion) takes 1 week to start working, so the patient should continue smoking for 1 week to wait for the medication to take effect. After 1 week, the cigarettes will no longer be needed.
What do all of these drugs have in common? a. Heroin b. Lysergic acid diethylamide c. Tetrahydrocannabinols d. Gamma-hydroxybutyric acid They are Schedule-I controlled substances (C-1), so they currently have no accepted medical use in treatment in the United States and a high potential for abuse.
Xeloda (Capecitabine) is one of many antineoplastic agents that can cause redness, swelling, tingling, thick callouses, peeling skin, and pain in the palms of the hand and soles of the feet. What is this condition called? The condition is known as Hand Foot Syndrome and can lead to a disappearance of fingerprints.
What do all of these drugs have in common? a. Finasteride b. Spironolactone c. Risperidone They cause gynecomastia (man breasts)
What do all of these drugs have in common? a. Amphetamine b. Orlistat c. Bupropion d. Levothyroxine e. Topiramate They cause weight loss
What do all of these drugs have in common? a. Nicoderm CQ b. Prozac c. Vyvanse d. Provigil They cause insomnia
What do all of these drugs have in common? a. Phenytoin b. Cyclosporine c. Prednisone d. Testosterone Hint: effect is usually transient, but even if treatment is desired, Spironolactone is a good choice. They cause hirsutism
What do all of these drugs have in common? a. Propranolol b. Timolol c. Amitriptyline d. Valproic acid e. Topiramate They can all be used for migraine prophylaxis
What do all of these drugs have in common? a. Sulfasalazine b. Levofloxacin c. Sulfamethoxazole/Trimethoprim d. Minocycline e. Tretinoin They cause photosensitivity
If 200mg of a drug are added to a 500mL bag, what will be the rate of flow, in mL/hr, to deliver 500mcg of drug per min? 200mg/500mL = 200,000mcg/500mL = 400mcg/mL x 500mL/hr = 1.25mL/hr x 1hr/60min = 0.02mL/min
Atropine is an anticholinergic and antimuscarinic that comes from what plant? Atropa belladonna (deadly nightshade)
Warfarin can cause a rare but distinct syndrome resulting from microemboli to the feet. Pain and color changes can result. What is it called? Purple toe syndrome
Digoxin originates from which plant? Digitalis purpurea (common foxglove)
A prescription calls for 15g of 5% imiquimod, 20g xylocaine, and 25g hydrophilic ointment. What is the percentage strength of imiquimod in the following prescription? 5% imiquimod = 5g/100g = 0.75g imiquimod/15g of cream = 0.75g imiquimod/60g of entire prescription mixture. 0.75g/60g x 100 = 1.25%
Pseudoephredrine is a decongestant and stimulant that originates from which plant? Ephedra sinica (ephedra, ma huang)
Taxol (paclitaxel) is an anti-neoplastic agent that originates from which tree? Taxus brevifolia (Pacific yew tree)
Benadryl (diphenhydramine) has been known to cause restless leg syndrome at high doses. What effect does Benadryl have on the body to produce this adverse effect? (Hint: deals with electrolytes) Benadryl can lower K+ levels which make the muscles more prone to spasms. Drugs used for Parkinson's Disease are also indicated for RLS. Requip (Ropinirole) and Mirapex (pramipexole) are two drugs FDA approved for RLS. There are others as well.
Topamax (topiramate) is sometimes referred to under the nicknames "Stupamax" and "Dopamax" for what reason? It can cause memory loss, aphasia (disruption in speech), and general cognitive impairment.
What neurological condition is characterized by disturbances with all the senses, and most notably, objects can appear much larger or smaller than normal. The individual may also have distortions in body image or in its position in space. The condition is known as Alice in Wonderland Syndrome (Todd's Syndrome) and can be caused by migraines, Epstein Barr Virus, Topamax, unapproved high doses of Dextromethorphan, and a number of other psychoactive drugs or drugs containing codeine.
Which drugs should be avoided or limited in the presence of a sulfa allergy? a. Microzide b. Bactrim c. Celebrex d. Azulfidine e. B and D f. A and B g. All of the Above Answer: All of the above. Microzide (hctz), Bactrim (sulfamethoxazole/trimethoprom), Celebrex (celecoxib), and Azulfidine (sulfasalazine) are all sulfonamide drugs.
Which 3 Beta blockers are approved for the use in CHF? Zebeta (bisoprolol), Coreg (carvedilol), and Toprol XL (metoprolol succinate)
Which drugs require gradual tapering before discontinuing? a. Beta blockers b. Antidepressants c. Anticonvulsants d. All of the above e. None of the above All of the above. Stopping Beta blockers abruptly can cause a hypertensive emergency, MI, and angina. Antidepressants can cause hyper arousal, flu symptoms, and insomnia if stopped suddenly. Discontinuing anticonvulsant therapy suddenly can cause seizures
Calcium channel blockers can cause a side effect associated with the gums. What is it called and what does it look like? Gingival hyperplasia can occur and it involves enlargement and overgrowth of the gums.
What indication are Alpha 1 blockers generally used for and how can they affect blood pressure? Name an alpha-1 selective and an alpha-1 non-selective drug in this class: They treat bph and can cause hypotension. Selective alpha-1 blockers include Flomax(tamsulosin) and Rapaflo(silodosin). Non-selective include Cardura(doxazosin), Hytrin(terazosin), Uroxetral(alfuzosin), and Minipress(prazosin)
Why is it best to take Alpha 1 blockers at bedtime? There is a risk of orthostatic hypotension (drop in blood pressure when standing up that can cause dizziness, blurry vision, and falls). Taking it at bedtime when patient is unlikely to move for several hours is ideal.
What drugs are best known for causing rhabdomyolysis and what are the symptoms, method of diagnosis, and usual standard of treatment? Statins and Fibrates are main perpetrators. Common Fibrates: Lopid (gemfibrozil) and Tricor (fenofibrate). Symptoms include muscle pain, weakness, swelling, dark urine, jaundice. Diagnosed with elevated creatinine kinase blood levels. Treat with fluids
What class of medication do colesevelam and cholestyramine fall under? How are they administered in respect to other drugs and food? Welchol (colesevelam) and Questran (cholestyramine) are bile acid sequestrants. Take them with food and take other medications 1 hour before or 4 hours after a dose of a bile acid drug, because bile acid drugs can reduce the absorption of other drugs.
Oxycodone dispensed as the generic product is distinctly different than the available brand product Oxycontin. Although they both treat moderate to severe pain, their formulations are different. How so? Oxycodone is the generic form that is immediate release and requires q4h dosing. If the drug is dispensed in its brand form (Oxycontin), it is the sustained release formulation that only requires q12h dosing and thus has a greater risk of overdose.
Which of the following drugs are positive inotropes? Select all that apply: a. Verapamil b. Digoxin c. Quinidine d. Atenolol e. Dobutamine Answer: B,E; Verelan (verapamil) is a calcium channel blocker, Quinidex (quinidine) is an antiarrhythmic, and Tenormin (atenolol) is a beta blocker. All of these are negative inotropes and thus the incorrect answers.
Eplerenone is contraindicated in the presence of: a. CrCl < 60 b. Child-Pugh Class B c. Hyperkalemia d. All of the above Answer: C; Child-Pugh Class C and CrCl < 30 are the other contraindications missing.
What is the purpose of calculating the Child-Pugh Score? To determine the severity of liver disease/impairment.
Which electrolyte imbalances can lead to Digoxin toxicity? a. Hypocalcemia, Hyperkalemia, hypermagnesemia b. Hypercalcemia, Hypokalemia, Hypermagnesemia c. Hypercalcemia, Hypokalemia, Hypomagnesemia d. Hypocalcemia, Hypokalemia, Hypomagnesemia Answer: C; Hypercalcemia, hypokalemia, hypomagnesemia
Which of the following can be a symptom of Digoxin toxicity? a. Pleural effusion b. Bradycardia c. Blue nose d. Diminished hearing e. Abdominal distension Answer: B; Digoxin toxicity can cause arrhythmias (brady/tachy), blurry vision, anorexia, and N/V
What is the therapeutic range for Digoxin levels in the blood? 0.8 - 2.0 ng/mL
Compare MOA of Apresoline (hydralazine) and Imdur (isosorbide mononitrate): a. Hydralazine reduces preload while ISMN reduces afterload b. Hydralazine reduces afterload while ISMN reduces preload and arterload c. They have the same mechanism Answer: B; They are both vasodilators, but they differ in MOA. Since ISMN dilates arteries and veins, it reduces both preload and afterload. Hydralazine selectively dilates arteries so it only reduces afterload.
What is the brand and generic name for the "morning after pill" and how long after unprotected sex does it remain effective? Plan B (levonorgestrel) is a form of emergency contraception that's 95% effective if taken within 24 hrs of unprotected sex, 89% effective within 72 hrs, and fairly effective for up to 5 days after sex. Should not serve as main method of contraception.
How do Plan B One-Step and Next Choice differ? a. Next Choice is a cheaper generic product b. Plan B is kept behind the counter while Next Choice is available OTC c. Next Choice is effective for up to 7 days after sex while Plan B only works for 5 days Answer: A Plan B One-Step has market exclusivity as of June 2013 until 2016. It is the only OTC emergency contraceptive and has no age restriction. Next Choice and other generics are behind the counter and require customer ID. Girls <17 require an Rx.
What do all of these drugs have in common? a. Citalopram b. Methadone c. Ondansetron d. Ropinirole e. Eletriptan f. Trazodone g. Amitriptyline h. Dextromethorphan They can cause serotonin syndrome when used together.
What do all of these drugs have in common? a. Ginger b. Meclizine c. Pyridoxine d. Doxylamine They can be used for pregnancy-induced nausea and vomiting
Which of the following drugs can cause Lupus-like symptoms and what are these common symptoms? a. Hydralazine b. Naproxen c. Hydroxychloroquine d. Prednisone e. Cyclosporin Answer: A; symptoms include red scaly rash, fever, fatigue, pericarditis, pleuritis, and joint pain. Phenytoin, Carbamazepine, Chlorpromazine, and Minocycline are a few others that can cause these symptoms. Choice B,C,D,E are all treatments for Lupus.
What is Hypertrichosis (also called Ambras syndrome)? It is also given the name "Werewolf Syndrome" because it is characterized as excessive growth of body hair, especially on the face.
What is a rare form of polymorphic ventricular arrhythmia involving a prolonged QT interval? a. Torsade de Pointes b. Ablation c. Chordae Tendinae d. Hypertrophic Obstructive Cardiomyopathy e. Endocarditis Answer: A; Torsade de Pointes may be congenital or acquired. It can terminate spontaneously, but frequently recurs, and may degenerate into ventricular fibrillation. It can be caused by electrolyte imbalances (hypo K or hypo Mg) or by antiarrhythmic drugs
Which condition is more life threatening, atrial fibrillation or ventricular fibrillation? Which one affects the lower chambers and which one affects the upper chambers of the heart? Atrial fibrillation affects the upper chambers while ventricular fibrillation affects the lower chambers and is more life threatening. A.fib cause arrhythmias while V.fib causes the heart to stop beating all-together.
When are cardiac enzymes (troponin, CK-MB) present? a. Unstable angina b. STEMI c. nSTEMI d. B and C e. All of the above Answer: D (STEMI and nSTEMI)
Which drug is a direct thrombin inhibitor that can treat heparin induced thrombocytopenia (HIT)? a. Warfarin b. Fondaparinux c. Clopidogrel d. Argatroban Answer: D; Argatroban, Lepirudin, and Bivalirubin are 3 possible direct thrombin inhibitors.
Which of the following is the most appropriate regimen for treating H. pylori induced Peptic Ulcer Disease? a. 2 Antibiotics + PPi b. Pro-kinetic agent such as Metoclopramide c. OTC antacid monotherapy d. Non-pharmacological therapy only Answer: A; Prevpac contains lansoprazole, amoxicillin, and clarithromycin
Which of the following strategies is most likely to prevent constipation? a. Consuming a diet low in fiber b. Limiting physical activity c. Drinking of plenty of fluids d. All of the above are legitimate strategies for preventing constipation Answer: C; eating fiber and exercising promotes normal bowel movements, so you would not want to limit them
Which of the following is not a symptom of GERD? a. Pyrosis b. Belching c. Hyper salivation d. Regurgitation e. All are symptoms of GERD Answer: E; pyrosis is another term for heartburn.
Which organism is most commonly the cause of ulcers? a. Helicobacter corrodens b. Campylobacter jejuni c. Haemophilus ducreyi d. Helicobacter pylori Answer: D
Which of the following most accurately describes a lower respiratory tract infection? a. Sinusitis b. Otitis media c. Pyelonephritis d. Acute bronchitis e. Pharyngitis Answer: D; Otitis media is middle ear infection. Sinusitis is inflammation of the nasal passages. Pyelonephritis is a kidney infection. Pharyngitis pertains to the throat.
All of these are reasons to change from IV to PO administration of an antibiotic EXCEPT: a. Afebrile for 24-48 hours b. Decreasing w.b.c. c. Decreasing kidney function d. Functional GI tract Answer: C
The probability that the patient is tested negative (not sick/without disease), when the patient is not sick (True negative): a. Confidence interval b. Sensitivity c. Specificity d. Precision e. Accuracy Answer: C - Specificity
The lowest concentration of a drug that inhibits visible growth of a bacterium is known as: a. Minimum inhibitory concentration (MIC) b. Minimum bactericidal concentration (MBC) c. Microdilution d. Therapeutic window Answer: A - Minimum inhibitory concentration
Which of these agents is the best pharmacological choice for anxiety disorders? a. Benzodiazepines b. SSRIs c. TCAs d. Beta Blockers e. MAOis Answer: A
Which drug should not be given to children and teenagers recovering from chickenpox or flu-like symptoms, because it can cause Reye's Syndrome (brain and liver swelling, confusion, seizures, and loss of consciousness)? Aspirin is a salicylate, which is in several brand products such as Ecotrin, Bayer, and Excedrin. Also, other salicylates should also be avoided such as Pepto Bismol (bismuth subsalicylate) and salsalate
What are the three components in Excedrin? Acetaminophen, Aspirin, Caffeine
What class of drug is Paracetamol? Paracetamol is the same as Acetaminophen and Tylenol, so it is an analgesic (pain reliever) and antipyretic (fever reducer)
What is an OTC product that can treat tinea pedis? Select all that apply: a. Cetaphil cream b. Micocide NS solution c. Tinactin (tolnaftate) spray d. Clotrimazole 1% cream Answer: B,C,D; Micocide and Tinactin both contain tolnaftate to treat athlete's foot. Clotrimazole is another ingredient with the same indication. Cetaphil is incorrect and is a skin moisturizer for acne.
Children's Pain Relief Plus Multi-Symptom Cold is an OTC oral suspension that contains Acetaminophen, Dextromethorphan, Phenylephrine, and Chlorpheniramine. What symptoms are each ingredient intended to treat? Acetaminophen treats pain and fever. Dextromethorphan treats dry cough. Phenylephrine treats congestion. Chlorpheniramine treats sneezing, runny nose, and other symptoms of allergic rhinitis.
Dristan 12 hour and Afrin are both brand nasal sprays containing what primary ingredient? List the name of the ingredient and its class of medication: Oxymetazoline is a decongestant and CNS stimulant with addictive properties
Benzedrex is an OTC decongestant that contains what stimulant? a. Propylhexedrine b. Amphetamine c. Oxymetazoline Answer: A - Propylhexedrine
Phenazopyridine is an OTC analgesic used for pain associated with what indication? It relieves pain related to urinary tract infections. One common side effect from this medication is dark orange or red urine, which is a harmless sign that the drug is in the body.
Pamprin is used to relieve symptoms associated with menstrual cycles. It has many different products containing a variety of ingredients. Some products contain caffeine, while others contain Pamabrom, to treat what particular symptom? Caffeine and Pamabrom are diuretics that can relieve bloating.
Midol is used to relieve symptoms associated with menstrual cycles. Which analgesic does it contain? a. Acetaminophen b. Naproxen c. Ibuprofen d. All of the Above e. None of the Above Answer: D - All of the above; Midol comes in many forms. For example: Midol Complete contains Acetaminophen. Midol Extended Release 12 Hour contains Naproxen. Midol Liquid Gels contain Ibuprofen.
What is the natural ingredient created from Vitamin B5 that is contained in many natural products used to reduce cholesterol? Pantethine
Nephazoline and Tetrahydrozoline are both alpha 1 agonists that can be used in ophthalmic preparations to relieve what symptom? How do they work? Naphazoline can be found in brand products like Clear Eyes while Tetrahydrozoline can be found in Visine. They relieve eye redness through vasoconstriction of blood vessels in the eye.
Which of these antihistamine-containing products is short acting? a. Allegra b. Claritin c. Benadryl d. Zyrtec Answer: C - Benadryl (diphenhydramine) is sedating short acting 1st gen. Allegra (fexofenadine) is a non sedating long acting 2nd gen. Claritin (loratadine) is a non sedating long acting 2nd gen. Zyrtec (cetirizine) is a non sedating long acting 2nd gen
Zaditor, Alaway, Zyrtec Itchy Eye, and Claritin Eye are all brand products that contain what 2nd generation antihistamine? Ketotifen
Pseudoephedrine can cause which of the following side effects? a. Daytime somnolence b. Reduced sweating c. Hypertension Answer: C - Hypertension
Which of the following statements about Dextromethorphan is false? a. Will not treat a cough caused by smoking, asthma, or emphysema b. Causes drowsiness c. Can cause serotonin syndrome d. Treats dry cough e. An active ingredient in Mucinex Answer: E - It is not an ingredient in Mucinex. Guaifenesin is the ingredient in Mucinex.
Patient complains of a wet cough and wants something for daytime relief. Which of the following are appropriate treatments? Select all that apply: a. Dextromethorphan b. Drinking fluids c. Guaifenesin d. Codeine e. Menthol Answer: B,C; Drinking fluids thins out the mucus and Guaifenesin is an appropriate expectorant. Dextromethorphan, Codeine, and Menthol are cough suppressants and you don't want to suppress a wet cough.
Dextromethorphan comes in 2 different forms: Polistirex and HBr. How do these forms differ in terms of duration of action? The polistirex form, used in Delsym, is long acting and only requires q12h dosing. The HBr form, found in many combination products such as Nyquil, is short acting and requires q4h or q6h dosing.
What is the difference between Polysporin and Neosporin? a. Neosporin contains Neomycin sulfate so not used in sulfa allergies b. Polysporin is more broad spectrum c. Neosporin is more broad spectrum d. They are identical with different brand names Answer: Neosporin is more broad spectrum because it contains the two ingredients of Polysporin (polymixin, bacitracin) plus neomycin. This gives it better anti-bacterial coverage.
Which of the following products are lice treatment shampoos? Select all that apply: a. Nix (permethrin) b. Ovide (malathion) c. Desitin (zinc oxide) d. Lice MD (dimethicone) Answer: A,D; Ovide (malathion) treats lice but comes in a lotion rather than a shampoo. Desitin (zinc oxide) treats diaper rash, not lice.
Cepacol and Chloraseptic are both OTC medications used to treat sore throat. What dosage form do they come in and what are their two primary ingredients? They are each taken as lozenges and contain the oral anesthetics/analgesics Benzocaine and Menthol.
Which of the following medications can NOT treat overactive bladder? a. Ditropan (oxybutynin) b. Detrol (tolterodine) c. Vesicare (solifenacin) d. Sanctura (trospium) e. Metamucil (psyllium) f. Enablex (darifenacin) g. Toviaz (fesoterodine) Answer: E; Metamucil is a laxative that would increase bladder activity and thus exacerbate symptoms of overactive bladder.
Drugs used to treat overactive bladder are both muscarinic receptor antagonists and anticholinergics. What is a precaution when taking these meds? a. Avoid prolonged heat exposure b. May cause insomnia c. Can cause hypersalivation d. None of the above Answer: A; In addition to causing dry mouth, anticholinergics cause decreased sweating and make someone more susceptible to heat stroke.
What do all of these drugs have in common? a. Phenergan b. Bonine c. Reglan d. Compazine They can all serve as an antiemetic
Which of the following drugs can increase bleeding? Select all that apply: a. Metronidazole b. Meclomen c. Mephyton d. Yaz Answer: A,B; Metronidazole (antifungal) and Meclomen (NSAID) can both increase bleeding. Mephyton (Vit K) actually promotes clotting. Yaz is an oral contraceptive that contains estrogen and can increase clotting formation.
Which oral rinse product contains Diphenhydramine, Lidocaine, and several Antacids to treat mouth ulcers caused by radiation and/or chemotherapy? Magic Mouthwash
What type of antibiotic is Tigecycline and what is its black box warning? It is a tetracycline antibiotic and its black box warning is increased risk of mortality. It should only be reserved as a last resort alternative.
Label the class of each Cephalosporin: a. Ancef b. Omnicef c. Rocephin d. Keflex e. Maxipime f. Teflaro Answer: Ancef (cefazolin) and Keflex (cephalexin) are 1st gen. Omnicef (cefdinir) and Rocephin (ceftriaxone) are 3rd gen. Maxipime (cefepime) is 4th gen. Teflaro (ceftaroline) is 5th generation.
Which herb and indication pair does not match? a. Saw Palmetto - BPH b. St. John's Wort - Depression c. Kava - Allergic rhinitis d. Gingko Biloba - Memory Enhancement Answer: Choice "C" in incorrect. Kava is used for anxiety but has been known to cause liver impairment.
QVAR is what type of medication? What is the generic name? What is the major side effect to counsel patients about? QVAR is an inhaled corticosteroid. Its generic name is Beclomethasone and its major side effect is oral thrush that can be prevented by rinsing the mouth after administering a dose.
Which of the following antibiotics is not an Aminoglycoside? a. Tobramycin b. Streptomycin c. Daptomycin d. Neomycin e. Gentamicin Answer: Daptomycin does not belong to this class. It's a lipopeptide agent.
What are the generic components in Bactrim, Zosyn, Unasyn, and Augmentin? Bactrim (sulfamethoxazole/trimethoprim), Zosyn (piperacillin/tazobactam), Unasyn (ampicillin/sulbactam), Augmentin (amoxicillin/clavulanic acid)
How do Ritalin and Concerta differ? What is their active ingredient? Ritalin is short acting and usually requires tid dosing. Concerta is sustained release and lasts up to 12 hours. They both contain methylphenidate.
What is the active ingredient in Focalin and Focalin XR? How do their durations of acting differ? They both contain Dexmethylphenidate. Focalin is dosed q4-6h and is immediate acting. Focalin XR is dosed once a day in the morning.
What is pharmacodynamics? a. ADME b. Mechanism of the drug action c. Adverse effects of a drug Answer: B; ADME deals with pharmacokinetics and adverse effects of a drug deal with toxicology.
What do the following drugs have in common? a. Famciclovir b. Benazepril c. Fosaprepitant d. Vyvanse They are all prodrugs
What is the primary indication of Desyrel? Desyrel (trazodone) is an antidepressant.
Levothyroxine comes in what form, T3 or T4? Levothyroxine comes in T4 and is converted to T3 in the body.
What is the active ingredient in Cytomel and what is a main side effect? a. fatigue b. bradycardia c. cold intolerance d. anxiety Cytomel (liothyronine) treats hypothyroidism and it can cause anxiety, which is choice "D." The other symptoms are caused from having hypothyroidism. Liothyronine contains T3 while levothyroxine contains T4.
What do these medications have in common? a. Propylthiouracil b. Tapazole (methimazole) c. Radioactive Iodine They treat hyperthyoidism
4 cups, 3 pints, 1 quart, and 1 gallon is equivalent to how many ounces? 4 cups = 32 oz, 3 pints = 48 oz, 1 quart = 32 oz, 1 gallon = 128 oz = 240 total ounces
What is the most common pathogen in a respiratory infection? S. pneumoniae (pneumococcus)
Which of the following are beta-lactam antibiotics? Select all that apply: a. Pencillin b. Meropenem c. Cefuroxime d. Aztreonam e. Clavulanic Acid Answer: A,B,C,D; Clavulanic Acid is incorrect. It is a beta lactamase inhibitor that is given with a beta lactam antibiotic to reduce pathogen resistance (ex: Augmentin contains amoxicillin and clavulanic acid)
List an atypical organism and an antibiotic that can provide adequate coverage Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila are atypicals. Some good antibiotic treatment options include Macrolides (i.e. azithromycin), Tetracyclines (i.e. doxycycline), Fluoroquinolones (i.e. moxifloxacin), and Tigecycline
List 2 antibiotics that provide anaerobic coverage? Metronidazole, Clindamycin, Tigecycline, Carbapenems, 2nd Generation Cephalosporins [Mefoxin (cefoxitin), Cefotan (cefotetan), Ceftin (cefuroxime)], Moxifloxacin, Augmentin, Unasyn, Zosyn,
Gleevec is a tyrosine kinase inhibitor. What is the generic name for Gleevec and what is its primary indication? Gleevec (imatinib) is used to treat leukemia and other forms of cancer.
Which drug is a CYP3A4 inducer? a. Cimetidine b. Clarithromycin c. Carbamazepine d. Clotrimazole e. Cyclosporine b. Answer: C; Carbamazepine is the only inducer listed. The rest are inhibitors.
Which drug is a CYP3A4 inducer? a. Amiodarone b. Diltiazem c. Grapefruit juice d. St. John's Wort Answer: D; St. John's Wort is the only inducer in the list. The rest are inhibitors.
Which class of antibiotics has been known to cause tendon rupture? Fluoroquinolones
Why should Minocycline not be used during pregancy? Minocycline can cause permanent tooth discoloration in children.
What type of antibiotic is Factive and what kind of organisms are covered? Gram positive, Gram negative, or both? Factive (gemifloxacin) is a fluoroquinolone that treats Gram negative infections.
What do all of these drugs have in common? a. Cardioquin (quinidine) b. Norpace (disopyramide) c. Procanbid (procainamide) d. Xylocaine (lidocaine) e. Cardizem (diltiazem) f. Lanoxin (digoxin) They are all antiarrhythmic drugs
How can colloidal silver affect the skin? It can cause the skin to permanently turn a grey/blue color.
Which is not a contraindication for using Acetaminophen? a. liver disease b. frequent Norco use c. hypersensitivity to NSAIDs d. alcoholism Answer: C; Acetaminophen is not an NSAID
Percocet 5/325 contains what 2 components and of what amounts? Percocet 5/325 contains 5 mg of oxycodone and 325 mg of acetaminophen
List the following opioids in order of potency: a. Fentanyl b. Morphine c. Hydromorphone d. Oxycodone e. Hydrocodone f. Oxymorphone g. Codeine Answer: Fentanyl, 7.5mg Hydromorphone, 10mg Oxymorphone, 20mg Oxycodone, 20mg Hydrocodone, 30mg Morphine, 200mg Codeine. All equivalent oral doses included except Fentanyl since it is only given through injection. It is 10x more potent than Hydromorphone
What is the generic form of Adderall? Amphetamine/Dextroamphetamine
What is the brand name of Rivaroxaban? Name it's class of medication and mechanism of action. Xarelto (rivaroxaban) is a Factor Xa inhibitor and oral anticoagulant.
List an antibiotic that can be used to treat C.diff Vancomycin or Metronidazole. A new treatment that has over a 90% success rate is fecal transplants, but antibiotics are still first line.
Fluzone High Dose (Fluzone HD) is intended for which population? a. Ages 18 - 64 b. Ages 65 and older c. People with egg allergies B. Fluzone HD is for seniors aged 65 and older. There is less redness, swelling, and itching associated with this vaccine compared to Fluzone Intradermal, which is indicated for ages 18 - 64. Flumist is given to those with egg allergies
Which HPV vaccine can be used in both males and females? Gardasil can be given to both males and females. Cervarix is the other HPV vaccine but only intended for use in women.
Which vaccine is approved for the use in children under the age of 7? Dtap or Tdap? Dtap
In Parkinson's Disease, what are the general levels of Ach and Dopamine? Which is high and which is low? Low Dopamine and high Ach
What is the primary ingredient in Aldara and Zyclara, what is its primary route of administration, and what does it treat? Aldara (imiquimod) is applied topically to the skin to treat external warts, actinic keratosis (too much sun exposure), and certain types of skin cancer.
List the generic names for all of the following drugs and list which class they all belong to: a. Aciphex b. Prevacid c. Protonix d. Nexium e. Prilosec f. Zegerid They are all proton pump inhibitors. Aciphex (rabeprazole), Prevacid (lansoprazole), Protonix (pantoprazole), Nexium (esomeprazole), Prilosec (omeprazole) Zegerid (omeprazole),
Asacol and Pentasa are used for the treatment of ulcerative colitis. What is their primary ingredient. Mesalamine
Pick the synthesis pathway that is in the correct order: a. tyrosine, dopamine, L-dopa, E, NE b. dopamine, L-dopa, NE, E, tyrosine c. tyrosine, L-dopa, dopamine, NE, E d. tyrosine, dopamine, L-dopa, NE, E e. tyrosine, L-dopa, dopamine, E, NE Answer: C
Which of the following breathing aids comes in a dry powdered inhaler that is inhaled slowly? a. Singulair b. Spiriva c. Asmanex d. Advair e. Xopenex Answer: B; Spiriva (tiotropium bromide); Singulair comes in tablet form. Asmanex and Advair are inhaled fast. Xopenex comes in the standard canisters rather than dry powder form.
Which of the following drugs does not contain an ACE inhibitor? a. Accuretic b. Altace c. Avalide d. Lotrel Answer: C; Avalide (hctz/irbesartan) contains a diuretic and ARB. Accuretic (hctz/quinipril), Altace (ramipril), and Lotrel (amlodipine/benazepril) all contain an ACE
Which of the following is not an oral anti-diabetic medication? a. Amaryl b. Avandia c. Prandin d. Starlix e. Zetia f. None of the above Answer: E; Zetia (ezetimibe) is used to low cholesterol.
What is the main neurotransmitter associated with Alzheimer's Disease? Acetylcholine (Ach); in Alzheimer's Disease, Ach levels are low.
What is the most effective treatment for Parkinson's Disease and thus considered the gold standard? a. Mirapex b. Requip c. Sinemet d. Eldepryl Answer: C; Sinemet (levodopa/carbidopa) can cross the BBB and convert into more dopamine. Mirapex and Requip are dopamine agonists that mimic dopamine but don't increase its levels. Eldepryl is an MAOi which blocks breakdown of dopamine.
When treating Parkinson's Disease, increasing or preserving the level of Dopamine is the goal. What is the cardinal side effect that comes with an increase in Dopamine? Hallucinations
Exelon can be used to treat Alzheimer's Disease. What is its primary ingredient? Name another drug in the same class Exelon (rivastigmine) is a acetylcholinesterase inhibitor; another drug in the same class is Aricept (donepezil)
What do all of these medications have in common? Cimetidine, Erythromycin, Clarithromycin, Amiodarone, Verapamil, Diltiazem, Itraconazole, Ketoconazole, Atazanavir They are all CYP3A4 inhibitors
Methotrexate, Hydroxychloroquine, Leflunomide, and Sulfasalazine are known as DMARDs, so they can be used to treat which condition? Answer: Rheumatoid arthritis; Methotrexate is first line therapy.
If someone of Asian nationality plans to take Carbamazepine or Phenytoin, they must first be tested to make sure they do not have the human leukocyte antigen HLA-B*1502 which can increase their risk of developing what adverse effect? Steven Johnson's Syndrome and Toxic Epidermal Necrosis
How is Codeine metabolized? a. CYP3A4 b. CYP2C9 c. CYP2D6 d. CYP1A2 Answer: C
What are the names of each vitamin? a. Thiamine b. Ascorbic acid c. Retinol d. Niacin e. Folic acid f. Pyridoxine g. Cholecalciferol h. Cobalamine i. Phytonadione j. Riboflavin Answer: Thiamine (Vit B1), Ascorbic acid (Vit C), Retinol (Vit A), Niacin (Vit B3), Folic acid (Vit B9), Pyridoxine (Vit B6), Cholecalciferol (Vit D3), Cobalamine (Vit B12), Phytonadione (Vit K1), Riboflavin (Vit B2)
Wernicke-Korsakoff Syndrome is a brain disorder caused by deficiency in which vitamin? Thiamine (Vitamin B1)
Which vitamin is required for Calcium absorption? Vitamin D
Name the primary ingredient in Timoptic that can be used to treat glaucoma and name its class of medication. Timolol; beta blocker
Lumigan (bimatoprost), Xalatan (latanoprost), and Travatan (travaprost) are all possible treatment options for glaucoma and belong to which class of medication? Prostaglandin analogs
Alphagan can be used to treat glaucoma. Name its primary ingredient and medication class. Alphagan (brimonidine) is an alpha 2 agonist and sympathomimetic
Trusopt (dorzolamide) is a carbonic anhydrase inhibitor and anti-glaucoma agent. Azopt is another such product in the same class. Name its primary ingredient. Answer: Brinzolamide; Carbonic anhydrase inhibitors should not be given with sulfa allergies.
All of the following drugs belong to which class of medications? List all the generic names of each brand product below: a. Celexa b. Lexapro c. Zoloft d. Prozac e. Paxil They are all SSRIs; a. Citalopram; b. Escitalopram; c. Sertraline; d. Fluoxetine; e. Paroxetine
Many anti-depressants can cause xerostomia which is known as what? Dry mouth syndrome
Elavil and Pamelor are what class of medication? Elavil (amitriptyline) and Pamelor (nortriptyline) are tricyclic antidepressants (TCA)
Which of the following drugs is not an SSRI? a. Paroxetine b. Fluoxetine c. Duloxetine d. Escitalopram Answer: C; Cymbalta (duloxetine) is an SNRI
Which condition involves a tumor of the adrenal glands causing sympathetic nervous system hyperactivity with increased production of epinephrine and norepinephrine? Symptoms include headache, sweating, and heart palpitations. Pheochromocytoma; this can be caused by genetic disorders, spinal injuries, panic attacks, chronic use of decongestants, and even by suddenly stopping anti-hypertensive meds.
Unlike most anti-depressants, this medication does not cause sexual dysfunction and can also be used for smoking cessation. Name this medication: Wellbutrin and Zyban both contain bupropion. Wellbutrin is mainly used for depression while Zyban is for smoking cessation.
Propranolol and Alprazolam are both treatment options for which condition? Inderal (propranolol) and Xanax (alprazolam) can be treat anxiety
If a lipid panel is taken and reveals a triglyceride count of 600, what is the main concern? At what point does controlling triglycerides take priority over monitoring LDL and total cholesterol levels? Triglycerides > 500 make them the priority due to a risk of pancreatitis
What would not be a first line option for an acute gout attack? a. Allopurinol b. Indomethacin c. Colchicine d. Hydrocortisone Answer: A; Allopurinol is not used for acute gout attacks since it does not alleviate pain and inflammation. It is useful only for chronic gout as a prophylactic agent. NSAIDs, corticosteroids, and oral colchicine are 1st line for acute gout attacks.
What is the mechanism of action for Febuxostat? Is it used for chronic or acute gout treatment? How does it differ from Allopurinol? Uloric (febuxostat) is a xanthine oxidase inhibitor used to treat chronic gout. Unlike Allopurinol, it can be used with severe renal dysfunction and without dose adjustments. One drawback to Febuxostat is the cost. Allopurinol must be taken with food.
What are the 2 ingredients in Dulera? What does it treat? Acute or long term treatment? Dulera (mometasone/formoterol) treats long term asthma; does not work for acute exacerbations.
Kenalog contains what corticosteroid? What type of injection can it be administered as? Intradermal, Intravenous, or Intramuscular? Triamcinolone is given via intradermal, intra-articular, or intrabursal injection
What is the target/goal level of serum uric acid to prevent gout flares? >6 mg/dL
What is the generic name for Dilaudid? How does its water solubility and strength compare to Morphine? Dilaudid (hydromorphone) is more water soluble and stronger than Morphine.
Which type of anemia is usually caused by iron deficiency? Microcytic anemia or Macrocytic anemia? Microcytic anemia is caused by iron deficiency. Macrocytic anemia is caused by folate and/or Vitamin B12 deficiency.
INFeD (iron dextran) can be given via injection to correct an iron deficiency. Before initiating therapy, what must be done, and why? A 0.5 mL IV test dose should be given and the patient should be observed for at least 1 hour to watch for any signs of an anaphylactic reaction.
Which is not a side effect of ACE inhibitors? a. dry cough b. angioedema c. renal impairment d. hypokalemia e. dizziness Answer: D; ACE inhibitors cause hyperkalemia rather than hypokalemia.
Aggrenox is used for stroke prevention and contains what two primary ingredients? Aspirin and extended-release Dipyridamole
Accutane (isotretinoin) is a last line alternative for the treatment of severe acne. Why is its distribution regulated under the iPLEDGE program? It is teratogenic, so women of child bearing ages should be counseled to use 2 forms of contraception while taking this medicine
Although proton pump inhibitors are preferred, name an H2 antagonist that can be used for GERD H2 antagonist - Zantac (ranitidine), Tagamet (cimetidine), Pepcid (famotidine), and Axid (nizatidine)
What is the generic form of Zegrid? a. metoclopramide/aluminum hydroxide b. rabeprazole/calcium carbonate c. famotidine/magnesium hydroxide d. omeprazole/sodium bicarbonate Answer: D; choice "C" is Pepcid Plus and choice "A" and "B" do not exist
Infliximab is a monoclonal antibody used to treat autoimmune conditions such as crohn's disease, rheumatoid arthritis, and psoriasis. What is a side effect to this medication in relation to its main indications for use? What is the brand name? Remicade (infliximab) treats autoimmune diseases through its immunosuppressive action. This effect makes patients on this medication more vulnerable to infection so they should not be given live vaccines. It belongs to the class of TNF Antagonists
What class of medication does Invanz belong to? a. ACEi b. Carbapenem c. Beta Blocker d. Anti muscarinic e. Psychostimulant f. Aldosterone antagonist Answer: B; Invanz (ertapenem) is a carbapenem antibiotic
What class of medication is Avandia? Name another medication in the same class Avandia (rosiglitazone) and Actos (pioglitazone) are both thiazolidinediones (TZD)
All of these medications contain metformin except for one. Which one is it? a. Avandamet b. Glucophage c. Metaglip d. Riomet e. Tagamet f. Glucovance Answer: E; Tagamet only contains cimetidine. Avandamet (metformin/rosiglitazone), Glucophage (metformin), Metaglip (glipizide/metformin), Riomet (metformin solution), and Glucovance (glyburide/metformin) all contain metformin.
Why is the use of Metformin contraindicated in individuals with renal insufficiency? Without the proper kidney function, the risk of lactic acidosis while on Metformin is increased
What is the black box warning for Thiazolidinediones? Their use is contraindicated in individuals with heart failure and there is a risk of bladder cancer.
Long term use of Metformin can lead to a deficiency in which vitamins? Vitamin B12 (Cobalamine) and Vitamin B9 (Folate)
How do you take Levothyroxine in regard to meals? Take it without food at the same time every day if possible. Take it at least 1 hour before or 2 hours after eating to ensure optimum drug absorption
What medical emergency can be characterized as a sudden increase in thyroid production leading to severe hyperthyroidism and symptoms of fever, tachycardia, delerium, coma, labored breathing, and even death? Thyroid storm or thyroid crisis
During menopause, what happens to estrogen, progesterone, FSH, and LH levels? Estrogen and Progesterone levels decrease while FSH and LH levels increase
In birth control pills, which mechanism of action for estrogen and/or progesterone is correct? a. Estrogen blocks ovulation b. Progesterone blocks ovulation c. Both block ovulation d. Neither block ovulation Answer: B; only progesterone blocks ovulation
What do all of these medications have in common? a. Errin b. Camila c. Ovrette Errin (norethindrone), Camila (norethindrone), and Ovrette (norgestrel) are progestin only contraceptive pills; progestin only contraception is recommended in women over the age of 35 that are active smokers
What is Forteo (teriparatide) primarily used to treat? It is given as a once daily subcutaneous (SQ) injection to treat osteoporosis and stimulates bone formation. Use for more than 2 years, use with bisphosphonates, or use in Paget's disease not recommended. Refrigerate and discard after 28 days.
What is hemochromatosis? How do you treat it? Hemochromatosis is iron overload or excess iron in the body. You can treat iron overload by removing blood (phlebotomy) or using an iron chelating agent. Desferal (deferoxamine) is given parenterally while Exjade (deferasirox) is given orally.
Prochlorperazine and Chlorpromazine serve several purposes. One such indication is to treat emesis. They belong to the same medication class which is what? Compazine (prochlorperazine) and Thorazine (chlorpromazine) are dopamine antagonists and are typical (1st generation) antipsychotics.
What is the brand name of Mycophenolate and what does it treat? Cellcept (mycophenolate) is an immunosuppressant used to prevent organ rejection after a transplant. Prograf (tacrolimus) and Imuran (azathioprine) are other medications used for the same purpose.
The combination of atropine and diphenoxylate is present in what C-V brand product? What is the indication for use? Lomotil (atropine/diphenoxylate) is a C-V substance and is used for diarrhea
Alendronate, Ibandronate, Risedronate, and Zoledronate are all what class of medication? Fosamax (alendronate), Boniva (ibandronate), Actonel (risedronate), and Zometa (zoledronate) are bisphosphonates
Probencid is used for gout prophylaxis. How does it work to prevent gout attacks? Probenecid is a uricosuric drug that increases uric acid secretion. It requires high urine output, so patient must hydrate well and have adequate kidneys (CrCl >60). In contrast, Zyloprim (allopurinol) prevents attacks by decreasing uric acid production.
Compare the uses of Methadose, Buprenex, Suboxone, and Narcan as it pertains to opioid overdose/addiction: Methadose (methadone), Buprenex (buprenorphine), and Suboxone (buprenorphine/naloxone) are used for opioid addiction. Narcan (naloxone) is used for opioid overdose.
What brand product contains acetaminophen, caffeine, and aspirin? Does it come as OTC or Rx? Excedrin is an OTC product
Zarontin (ethosuximide) is the first drug of choice for the treatment of a type of seizure that involves brief loses of consciousness. What type of seizure is this? Absence seizure; Lamictal (lamotrigine) and Depakote (valproic acid) are also used as alternatives
What is oligohidrosis and which drug can cause this? a. caffeine b. topiramate c. aripiprazole d. citalopram Oligohidrosis is the absence of sweating and is most notably caused by Topamax (topiramate). Zonegran (zonisamide) is another drug culprit.
Which of the following side effects can not be attributed to the use of anticholinergics? a. insomnia b. constipation c. blurry vision d. dry mouth e. urinary retention Answer: A; anticholinergics cause sedation rather than insomnia.
What is pseudoparkinsonism and how is it caused? Diminished gait, stiff posture, tremors, and other symptoms that resemble Parkinson's Disease. It is a reversible condition caused primarily by antipsychotics (mostly 1st gen) and can be treated with anticholinergics like Cogentin (benztropine).
What is the drug class of choice to treat schizophrenia? What parameters should be monitored with these types of medications? Atypical antipsychotics are the optimum treatment. Abilify, Clozaril, Zyprexa, Invega, Seroquel, Risperdal, Saphris, and Ziprasidone are some examples. The patient's weight, lipid panel, and blood glucose should be monitored.
Ebstein's anomaly is a congenital heart defect and infants are thought to be at an increased risk if their mother takes which medication in the first trimester of pregnancy? a. lithium b. phenytoin c. warfarin Answer: A; phenytoin can cause growth deficiencies and hypoplasia of the extremities and face. Warfarin can cause hypoplasia of the nose and low birthweight.
What class of medications does Librium belong to and what is the generic name? Librium (chlordiazepoxide) is a hypnotic and benzodiazepine
What indication do all of these OTC products have in common? a. Calamine lotion b. Burow's solution c. Benadryl d. Hydrocortisone cream Poison ivy or itching in general
RID and NIX both contain insecticides to treat head lice, but they have different primary ingredients. What are they? RID contains pyrethrins and NIX contains permethrin
What is rhinitis medicamentosa and how is it caused? It is a term that means "rebound nasal decongestion" and it can occur if nasal decongestant sprays are used excessively (5 consecutive days or more); examples include oxymetazoline, phenylephrine, and naphazoline.
Tessalon contains benzonatate, which is what kind of medication? Non-narcotic cough suppressant (antitussive)
Name the type of laxative for each product. Choices include stool softener, lubricant, stimulant, bulk forming, and osmotic: a. Metamucil b. Colace c. Lactulose d. Dulcolax e. Milk of Magnesia f. Mineral Oil g. Miralax h. Senokot Metamucil (psyllium) = bulk form. Colace (docusate) = stool soft. Lactulose = osmotic. Dulcolax (bisacodyl) = stimulant. Milk of Magnesia (magnesium hydroxide) = osmotic. Mineral Oil = lubricant. Miralax (PEG3350) = osmotic. Senokot (senna) = stimulant
Zometa and Reclast both can treat osteoporosis and contain what primary ingredient? How do they differ in dose? What is their class of medication? Zometa comes in conc. of 4mg/5mL and must be diluted before infusion. Reclast comes in conc. of 5mg/100mL and ready for infusion. They contain Zoledronic acid and are bisphosphonates. They can cause osteonecrosis of the jaw especially in cancer patients.
Which of the following are counseling points for Zoledronic Acid? Label each as True or False: a. may cause hypercalcemia b. dental exams recommended c. take Vitamin D and Calcium daily False (causes hypocalcemia), True (can cause osteonecrosis of the jaw), True (take Calcium and Vitamin D)
What is the black box warning for Forteo and what is the recommended maximum duration of use for this medication? Forteo increases the risk of osteosarcoma and should not be used for more than 2 years. Individuals excluded from receiving Forteo include those that have had radiation to the bones, children, and those with Paget’s disease
Bumex (bumetanide) is what class of medication? How does its potency compare to Lasix? Bumex is a loop diuretic that is 40x more potent than Lasix.
Zyflo CR (zileuton) is what class of medication, comes in what dosage form, and is used for which indication? Leukotriene production inhibitor and lipooxygenase inhibitor, comes as an oral tablet, and is used for long term management of asthma
What is the brand name for montelukast? Class of medication? Indications for use? Dosage form? Time of day it should be taken? Singulair (montelukast) is a leukotriene receptor antagonist indicated for long term management of asthma or allergic rhinitis. It comes in tablet/granule form. Should be taken at night for asthmatics since only bedtime admin. was used in clinical studies
Why should the use of thiazolidinediones be avoided in CHF patients? They can cause fluid retention
Identify the following sig abbreviations: a. DAW b. as c. pc d. au e. od f. ss g. os h. ou i. ad j. gtt(s) a. dispense as written; b. left ear; c. after meals; d. both ears; e. right eye; f. one half; g. left eye; h. both eyes; i. right ear; j. drop
Which of the following is primarily an intracellular ion? a. potassium b. chloride c. sodium d. calcium Answer: A. Potassium. The rest are extracellular.
A dramatic decrease in systemic bioavailability of a drug following oral administration is most likely due to what? Hepatic "first pass" effect
Which class of antipsychotics can cause EPS symptoms and what are some of these symptoms? 1st generation antipsychotics cause higher incidence of EPS symptoms that include acute dystonia (muscle spasms), akasthisia (restlessness, need to be in constant motion), and tardive dyskinesia (rapid and repetitive facial tics such as blinking).
How can you treat EPS symptoms caused by antipsychotics? Change to a 2nd generation antipsychotic where EPS symptoms are less common or take an anticholinergic (benzotropine or diphenhydramine). Benzodiazepines, low dose Propranolol, or Mirtazapine have shown results and could be considered as alternatives.
Which antibiotic does not cover Pseudomonas? a. Piperacillin/Tazobactam b. Ertapenem c. Cefepime d. Ciprofloxacin e. Aztreonam f. Ceftazidime g. Tobramycin Answer: B; Unlike the other Carbapenems, Ertapenem does not cover pseudomonas.
Which sleep aid is a natural product? Which is OTC? Which is non-controlled Rx? Which is C-IV Rx? Which is a benzodiazepine? a. Rozerem b. Melatonin c. Ambien d. Unisom e. Restoril a. Rozerem (ramelteon) is an Rx only melatonin receptor agonist; b. Melatonin is a natural product sleep aid; c. Ambien (zolpidem) is a C-IV Rx sleep aid; d. Unisom (doxylamine) is an OTC antihistamine sleep aid; e. Restoril (temazepam) is a benzo
What is the generic name for Demerol and what is it used to treat? Demerol (meperidine) is an opioid used to treat moderate to severe pain.
Activase (alteplase) is a tissue plasminogen activator. One of the steps of its synthesis involve fermentation in a nutrient medium containing what antibiotic? What is Alteplase used for? Activase (alteplase) is used for acute MI since it involves the lysis of blood clots. It is fermented in a medium containing Gentamicin
What are the two components in Duexis and what makes it different from other pain meds? Duexis contains ibuprofen to treat pain associated with arthritis. What makes Duexis unique is it also contains famotidine, an H2 blocker, which protects against stomach ulcers that can be caused by pain meds.
Label each of the Warfarin doses with their appropriate color: 1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg, 10 mg In order from lowest to highest doses: Please (pink) Let (lavender) Greg (green) Brown (brown) Bring (blue) Peaches (peach) To (teal) Your (yellow) Wedding (white)
List all 12 of the available Synthroid doses 25 mcg, 50 mcg, 75 mcg, 88mcg, 100mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg, 200 mcg, 300 mcg
What do all of these antibiotic/antifungal medications have in common? (Hint: storage) Azithromycin, Clindamycin, Ciprofloxacin, Linezolid, Cefdinir, Bactrim, Doxycycline, Clarithromycin, Levofloxacin, Voriconazole, Fluconazole They should NOT be refrigerated
How often should a Td booster vaccination be administered? Every 10 years
Engerix-B is the brand name for which vaccination? What is the route of administration? What is the dosing schedule? Engerix-B is the Hepatitis B vaccine. It is given through the IM route. There are 3 x 1 mL shots given. The shot schedule is 0,1, and 6 months for the 3 shots.
Which of the following is a chronic autoimmune disease where the salivary and lacrimal glands are damaged leading to dry mouth/eyes? a. Fanconi syndrome b. Guillain-barre Syndrome c. Sjogren's Syndrome d. Lesch-nyhan Syndrome Answer: C; Fanconi affects the proximal renal tubules causing glucose, bicarb, etc to pass thru the urine instead of being reabsorbed. Guillain-bare causes peripheral nerve dysfunction leading to muscle weakness. Lesch-nyhan is known as juvenile gout.
What is Benzonatate used for and why should it be swallowed whole and not crushed or chewed? Benzonatate is a cough suppressant that provides a numbing effect in the lungs and throat. It should not be crushed or chewed because it can cause the mouth to go numb and the medication's efficacy will be negated.
What are the insertion instructions for NuvaRing? How is NuvaRing stored in the pharmacy and how long is it good for once it is dispensed to a patient? Each NuvaRing is inserted vaginally for 3 weeks and then taken out for 1 week. NuvaRing is refrigerated in the pharmacy, but once dispensed to the patient it can be stored at room temp and is good for 4 months (120 days)
Doxepin can be used to treat depression and certain forms of anxiety. What class of medication does it fall under? List another medication in the same class. Doxepin, also known under such brand names as Adaptin or Sinequan, is a tricyclic antidepressant. Some others in same class: Amitriptyline, Nortriptyline, Imipramine
Saphris (asenapine) is an atypical antipsychotic used to treat schizophrenia and bipolar disorder. What unique dosage form does it come as? Sublingual tablets
What is the brand name of ticagrelor? Class of medication? Name at least 2 contraindications Brilinta (ticagrelor) is an antiplatelet agent. Contraindications: allergy, active bleeding, severe liver disease, scheduled heart surgery within the next 5 days
How long is Advair Diskus good for once it has been opened? How often is Advair generally taken. Advair is taken 1 puff bid and expires after 30 days.
The FDA approved Breo Ellipta in May 2013 for the use of COPD. What inhaled steroid and LABA does it contain? An allergy to what exists as a contraindication for use? What makes it unique in terms of dosing? Breo Ellipta (fluticasone/vilanterol) is contraindicated with allergies to milk proteins. Breo comes as an inhalation powder that is only taken once a day. Breo expires 6 weeks after being opened. Not approved for use in asthma or individuals < 18 yrs old
Arrange the following benzodiazepines from highest to lowest strength in terms of dosing equivalency: a. Valium (diazepam) b. Klonopin (clonazepam) c. Librium (chlordiazepoxide) d. Tranxene (clorazepate) e. Ativan (lorazepam) f. Xanax (alprazolam) Answer: B,F,E,A,D,C; Clonazepam 0.25 mg = Alprazolam 0.5 mg = Lorazepam 1 mg = Diazepam 5 mg = Clorazepate 7.5 mg = Chlordiazepoxide 10 mg
Baclofen is often used to relieve symptoms of multiple sclerosis and various spinal cord injuries. What class of medication does it fall under? Muscle relaxant or antispastic
What is the drug of choice for chronic hiccups (a.k.a. intractable hiccups)? (Hint: it's an antipsychotic) Thorazine (chlorpromazine) is a typical antipsychotic also used for nausea/vomiting, anxiety and chronic hiccups
Marinol (dronabinol) is a C-III drug due to its THC properties. What indication is it primarily used for? It is used as an antiemetic for chemotherapy patients experiencing chronic N/V; another product used for this same indication is Zofran (ondansetron)
Belviq (lorcaserin) and Qsymia (phentermine/topiramate) are both C-4 drugs used for long term treatment of what indication? They are used for weight loss. Recommended for individuals at least 18 yrs old and with a BMI of at least 27. Should not be used in pregnancy due to potential for birth defects. Should be d/c if 5% weight loss not seen in 12 weeks
This medication is a muscle relaxant used for pain associated with musculoskeletal conditions. It is marketed under the brand name Soma. What is the generic form called? Carisoprodol
Tussionex contains chlorpheniramine and hydrocodone. What symptoms does it relieve? A. runny nose B. sneezing C. pain D. cough E. a,b,c F. all of the above Answer: All of the above; Chlorpheniramine relieves the allergy symptoms such as runny nose and sneezing. Hydrocodone relieves pain and cough. Taking too much can cause hallucinations and nausea which is common for other opioids as well.
Intuniv and Tenex are 2 brand products used to treat ADHD. What is their primary ingredient? How do they differ from other ADHD drugs? Which can be crushed? They contain guanfacine. Not a stimulant like most ADHD drugs. Intuniv is extended release. Tenex is the immediate release and can be crushed. Both are once daily dosing though. They are not addictive like stimulants and can be used for hypertension too.
Ciprodex is an otic drop used for ear infections. It contains what fluoroquinolone antibiotic and steroid? Ciprofloxacin and Dexamethasone
Which drug is not a sulfonylurea? a. Glipizide b. Chlorpropamide c. Repaglinide d. Glyburide Answer: C; Repaglinide belongs to an oral antidiabetic class known as meglitinides.
Trental (pentoxifylline) and Pletal (cilostazol) help treat intermittent claudication. What symptoms are associated with this condition? Intermittent claudication is more formerly referred to as peripheral artery disease. Symptoms include pain, fatigue, and discomfort in the legs and arms due to a reduction in blood circulation.
Calculate the ideal body weight for a male that is 5ft 7in tall. 50kg + 2.3kg(7) = 66.1kg or 145.4 lbs
Calculate the creatinine clearance for a 77yr old female that is 5ft 2in tall and whose SCr is 1.06 IBW = 45.5 + 2.3(2) = 50.1kg; CrCl = (140-77) x 50.1 = 3156.3/(72 x 1.06) = 41.36 x 0.85 = 35.2 mL/min
Which of the following antibiotics are known to have bactericidal activity due to its ability to inhibit cell wall synthesis? a. Piperacillin/Tazobactam b. Azithromycin c. Minocycline d. Ciprofloxacin Answer: A; Beta lactams inhibit cell wall synthesis. Azithromycin and Minocycline inhibit protein synthesis. Ciprofloxacin inhibits DNA replicaton.
Pulmicort belongs to which class of medication? a. short acting beta 2 agonist b. long acting beta 2 agonist c. corticosteroid d. methylxanthine e. anti-cholinergic Answer: C; Pulmicort (budesonide) is an inhaled corticosteroid. Albuterol would be an example of a SABA. Formoterol would be an example of a LABA. Theophylline is a methylxanthine. Tiotropium bromide is an anti-cholinergic.
What is the MOA of Depakote? a. decreases GABA concentration b. increases GABA concentration c. increases Na+ influx into brain d. decreases Na+ influx into brain Answer: B
Noxafil (posaconazole) is an antifungal oral suspension. Which of the following auxillary labels is required for dispensing? a. Must refrigerate b. For ear use only c. May cause drowsiness d. Take on empty stomach e. Shake well before use Answer: E
Label each of the following medications with their appropriate expiration date from the time the package is opened (14 days, 30 days, 45 days, 90 days, 1 year plus): a. Asmanex b. Combivent c. Ventolin d. Symbicort e. Advair f. Pulmicort Asmanex - 45 days; Combivent - 90 days; Symbicort - 90 days; Ventolin - 1 yr plus; Advair - 30 days; Pulmicort - 14 days
Invokana (canagliflozin) is an SGLT2 inhibitor that gained approval in March 2013 for the treatment of what condition? Type 2 Diabetes; It is a sodium glucose transport inhibitor (SGLT2) and the only one of its class approved.
Ranexa (ranolazine) is used to treat chronic angina. What is angina? How does this drug differ from other drugs used for angina such as beta blockers or nitrates? Ranexa treats angina (chest pain). It is not a nitrate and is referred to as antianginal and cardiovascular agent. It differs from BB/nitrates by not having a significant effect on blood pressure or heart rate.
Clomiphene is a SERM that is used to treat what condition? What does SERM stand for? SERM = selective estrogen receptor modulator; Clomiphene is used to promote female fertility and can be used off-label for male fertility in cases of hypogonadism
What are the components and differences in strength for Tylenol #3 and Tylenol #4 Tylenol #3 (300 mg APAP/30 mg Codeine), Tylenol #4 (300 mg APAP/60 mg Codeine)
Creon is a medication used for the treatment of digestive disorders associated with various conditions such as chronic pancreatitis. What is the generic name? At what part of the day should it be taken? Creon (pancrelipase) contains amylase, protease, and lipase; normally produced by the pancreas. Do not take if you are allergic to pork. Take Creon with meals. Do not inhale capsule powder or chew the capsule to prevent irritation
At what point would the adjusted body weight be used rather than the ideal body weight when calculating creatinine clearance? What is the equation for adjusted body weight? Use adjusted body weight when individual's weight >30% of ideal body weight. ABW = IBW + 0.4(actual weight - IBW)
TobraDex is the brand product that contains what 2 ingredients? What is the difference between the brand and generic dosage forms? TobraDex contains Tobramycin and Dexamethasone. TobraDex brand comes in ophthalmic ointment while generic form comes in ophthalmic suspension.
Lyrica and Neurontin can both be used for neuropathic pain caused by diabetes, spinal cord injuries, and fibromyalgia. What are their generic names and what other indication can they be used to treat? Lyrica (pregabalin) and Neurontin (gabapentin) can also be used as anti-convulsants. One common side effect to this medication is weight gain/edema
What class of medication is Prozac and what makes it different from other medications in the same class in terms of discontinuing therapy? Prozac is an SSRI. It is long acting and does not need to be tapered prior to stopping like other antidepressants (including other SSRIs) that are short acting.
What enzyme does Warfarin inhibit? What clotting factors does Warfarin reduce the synthesis of? Warfarin inhibits Vitamin K epoxide reductase and inhibits synthesis of clotting factors 2,7,9,10
The Virchow's triad that determines an individual's risk of forming clots and assesses their need for anticoagulation is composed of what 3 components? Virchow's triad consists of trauma, stasis (cases of immobility such as obesity and surgery), and hypercoagulable states (taking birth control, cancer, pregnancy, protein C/S deficiency, taking a SERM)
Which isomer of Warfarin is more potent and how is it metabolized? The "S" isomer is 5x more potent than the "R" isomer and is metabolized by CYP2C9. Any drugs that affect this enzyme will have a profound effect on the action of Warfarin as a result.
What is the advantage to having a prosthetic valve as opposed to a mechanical valve in atrial fibrillation patients? a. Increased durability b. Lower risk of thrombosis c. More comfortable for the patient d. More readily available/obtainable Answer: B; prosthetic valves have a lower risk of thrombosis. The downside to them is they are less durable and will need to be replaced more often than a mechanical valve
If a patient is a chronic alcohol drinker, how might their Warfarin dose need to be adjusted? Warfarin is metabolized by the liver. Chronic drinkers have more liver enzymes that were made to metabolize all the alcohol they consume. As a result, more enzymes available to metabolize Warfarin faster thus dose may need to be increased.
Which drug is not part of the FAB 4 in terms of medications that can significantly increase INR in patients on Warfarin? a. Azole antifungals b. Amiodarone c. Aspirin d. Bactrim e. Metronidazole Answer: C; Aspirin is not part of the FAB 4. It may increase the risk of bleeding when given with Warfarin but it will not affect INR. With the other choices, Warfarin dose should be empirically reduced by 30-50% if the interacting meds are not d/c
What is the generic name for Byetta? What indication does it treat? When is it injected? What do you tell a patient that misses a dose? When does the pen expire? Byetta (exenatide) treats Diabetes and should be given bid within 1 hour before a meal. If patient forgets to inject and they have already eaten, skip that missed dose and take the next dose as scheduled before eating. Pen expires 30 days after first use
When is it recommended to start taking Chantix once an individual plans to quit smoking? They should start taking Chantix 1 week before their decided quit date. They start taking 1 week early to give the drug a chance to take effect. During that week, they can continue to smoke.
One clear sign of Phenytoin toxicity is nystagmus? What is this symptom? What is Phenytoin generally used for? Phenytoin is used mainly as an anticonvulsant and nystagmus is characterized as the involuntary movement of the eyes from side to side without staying fixed and focused on a particular point/object.
An albumin:Cr ratio of what value would indicate possible renal insufficiency in a Diabetic patient warranting the use of an ACE inhibitor as the best option for their hypertension due to its renal protective properties? a. >30 b. >100 c. >200 d. >300 Answer: >300 would indicate macroalbuminemia and renal dysfunction
Renvuela contains what generic ingredient? What is it used for and when should it be taken? Renvuela (sevelamer) is a phosphate binder used in dialysis patients. It only binds to dietary phosphate so take with meals.
Lacosamide belongs to which drug class? a. NSAID b. Laxative c. Diuretic d. Anti-convulsant e. Anti-diarrheal Answer: D; Vimpat (lacosamide) is an anticonvulsant used as adjunctive therapy for partial onset seizures or for diabetic neuropathic pain. It's a C-V drug and usually taken as a tablet bid (morning and night)
Patient comes in complaining of nausea. They are taking Metformin 1,000 mg bid (before breakfast and dinner). What could you recommend to decrease their risk of nausea without changing/adding medications? Tell the patient to take Metformin WITH food, not on an empty stomach. Also, trying Metformin 1,000mg extended release qday may lower the risk of nausea.
What are the directions for use of Gavilyte-C? a. Avoid solid foods 3 hrs before and 2 hrs after b. Once mixed, do not refrigerate c. The preferred choice for the treatment of constipation d. Can take other medications at the same time Answer: A; Gavilyte-C and other similar forms are taken before procedures (i.e. colonscopy). They flush out the intestines and induce watery stools. Avoid other meds within 1 hour of admin. After mixing, store in fridge. Not for general constipation.
Given that Galantamine is an acetylcholinesterase inhibitor, what condition does it treat? Alzheimer's Disease
Edarbyclor is used for the treatment of hypertension and contains azilsartan and what other primary ingredient? What type of supplements should be avoided when taking this medication unless told otherwise by your doctor? When taking Edarbyclor (azilsartan/chlorthalidone), avoid potassium supplements and salt substitutes. The ARB will raise serum K+ and taking salt subs will antagonize the diuretics action of reducing salt absorption.
Samsca (tolvaptan) is a very expensive diuretic indicated for what primary condition? Used to treat hyponatremia in patients with CHF, cirrhosis, or excessive release of anti-diuretic hormone. Should not be used longer than 30 days. May affect liver but has no negative effect on kidneys. Does not cause hypotension like other diuretics.
Calculate the true corrected phenytoin serum conc. in this patient and whether it is a therapeutic level or not. Measured phenytoin = 12, albumin = 3.1, CrCl = 18. How would your answer change if the patient had normal kidney function (higher CrCl) Corrected phenytoin = 12/[(3.1 x 0.1)+ 0.1] = 29.27 = SUPRATHERAPEUTIC since goal serum level = 12-20. If CrCl was >20, adjustment factor would be 0.2 instead of 0.1. Equation would change to 12/[(3.1 x 0.2)+0.1] = 16.67 = THERAPEUTIC
What are the 3 short acting benzodiazepines that are recommended for use in the elderly? Hint: LOT Lorazepam, Oxazepam, and Temazepam are short acting benzos, so they are used in the elderly over other benzos. One reason is due to the increased risk of falls in the elderly due to drowsiness caused by these medications.
Januvia, Onglyza, and Tradjenta all belong to what class of medication? What are their generic names? Which one does not have to be renally dose adjusted? Januvia (sitagliptin), Onglyza (saxagliptin), and Tradjenta (linagliptin) are DPP4 inhibitors. Tradjenta does not have to be renally dose adjusted.
Which of the following is an SNRI that can be used for fibromyalgia? a. Savella b. Effexor c. Pristiq d. Prozac e. Cymbalta Answer: A; Savella (milnacipran) can be used for fibromyalgia. All the others are also SNRIs except for Cymbalta which is an SSRI. None of those are used for fibromyalgia.
List the GFR ranges for each stage of CKD. Stage 1, Stage 2, Stage 3A, Stage 3B, Stage 4, Stage 5 Stage 1: >90; Stage 2: 60-89; Stage 3A: 45-59, Stage 3B: 44-30; Stage 4: 15-29; Stage 5: <15 or on dialysis
What is the max recommended daily dose of Metformin in adults? 2,550 mg
Which of the following is true about Tramadol? a. Partial opioid agonist b. No abuse potential c. Inhibits serotonin reuptake d. Promotes norepinephrine reuptake Answer: A; Tramadol does have abuse potential and does carry the risk of causing serotonin syndrome by increasing serotonin release in the body. It does not affect the reuptake of serotonin. It inhibits the reuptake of NE rather than promoting it.
Which brand name product contains Mometasone and Formoterol? a. Combivent b. Advair c. Symbicort d. Dulera Answer: D; Symbicort (budesonide/formoterol), Combivent (albuterol/ipratropium), and Advair (fluticasone/salmeterol) are all incorrect answers.
Which is an effect of SSRIs? a. Increase risk of thrombosis b. CYP2C9 inhibitor that increases effect of Warfarin c. Reduces platelet aggregation d. CYP2C9 inducer that reduces effect of Warfarin Answer: C; SSRIs reduce platelet aggregation, which in turn increase the risk of bleeding. They do not affect Warfarin metabolism.
Which of the following is a loop diuretic? a. Diamox b. Inspra c. Mannitol d. Microzide e. None of the above Answer: E; Diamox (acetazolamide) is a carbonic anhydrase inhibitor. Inspra (eplerenone) is a K+ sparing/aldosterone antagonist. Mannitol is an osmotic diuretic. Microzide (hctz) is a thiazide diuretic.
A penicillin V 250 mg tablet equals 400,000 units of penicillin activity. A patient is taking penicillin V 500 mg tablets QID for 7 days. How much penicillin activity, in units, will this patient receive? 800,000 units/tablet x 28 tablets = 22,400,000 units
Which one of these medications do not raise blood pressure? a. Advil b. Sudafed PE c. Clear Eyes ophthalmic drops d. Preparation H e. They all raise blood pressure f. None of them affect blood pressure Answer: E; Advil (ibuprofen) is an NSAID which causes water retention. Sudafed PE and some forms of Preparation H contain a decongestant (phenylephrine) that constricts blood vessels. Clear Eyes contains the decongestant Naphazoline.
Pepto-Bismol and Kaopectate are anti-diarrheal brand products that can cause dark stools due to what primary ingredient? Bismuth subsalicylate
Which step in the smoking cessation process would a person be in if they are ready to quit and have set a quit date within the next 2 weeks? Answer: They are in Preparation. Precontemplate and Contemplative both involve not setting a quit date yet. Action and Maintenance involve a person that has already quit smoking.
Calculate the HASBLED score for this patient: 56 years old male, BP: 150/90, SCr: 1.9, no prior major bleeding events, AST = 45, ALT = 42, stroke 3 years ago, INR TTR < 50%, drinks 2 beers/day Hypertension (SBP>160), Abnormal liver/renal function (SCr > 2.6 or AST/ALT 2-3x normal limit), Stroke, Bleeding predisposition, Labile INR (<60% of time therapeutic range), Elderly (>65), Drugs/Alcohol (≥8 drinks per week) = 3
Which of the following is not considered a basal insulin? a. NPH b. Lantus c. Levemir d. Bydureon Answer: D; Bydureon is not insulin. Although NPH is an intermediate insulin while Lantus and Levemir are longer acting, they are all 3 regarded as basal insulins
A patient that is currently taking 40 units of Lantus daily is switching to Levemir. How many units of Levemir should he be taking? a. 40 units b. 52 units c. 28 units d. 60 units Answer: A (40 units); Lantus and Levemir can be switched with a 1:1 dose ratio. This would not be the case if the patient was switching from NPH to Levemir/Lantus. This would require a 20% dose reduction.
This condition can be caused by a combination of hyperglycemia and dehydration. Symptoms include N/V, confusion, fruity breath, and gasping for air. Name the condition. The condition is known as Diabetic ketoacidosis (DKA) and can be treated with insulin and fluid administration. It is more common in DM Type 1
A pattern of high morning sugars preceded by episode of hypoglycemia. Sugars may drop too low in the middle of the night, so your body counters by releasing hormones to raise sugar levels: a. Dawn Phenomenon b. Somogyi Effect c. Hofstader Insufficiency Answer: B; This is also called the Somogyi rebound and can be caused by too much nighttime insulin or too small of a bedtime snack to counteract the insulin. The Dawn Phenomenon leads to high morning sugars but there is no middle of the night hypoglycemia
A 45 milliliter nasal spray delivers 20 sprays per milliliter of solution. Each spray contains 1.5 mg of active drug. How many milligrams of drug are contained in the 45 mL package? 45 mL x 20 sprays/mL = 900 sprays x 1.5 mg/spray = 1,350 mg total
35yr old female has BP of 125/74, fasting BG of 119, HR of 96, albumin:creatinine ratio of 85, and is currently taking Metformin 1000mg bid. What do they need? a. ACE inhibitor b. Beta blocker c. Diuretic d. PPI e. Antiemetic f. None of the above Answer: A; for diabetic patients with a urine albumin:creatinine ratio >30, an ACE inhibitor is recommended for renal protection even if they have normal BP. Lisinopril 2.5 mg would be optimal in this case.
When screening for depression, what are the symptoms to ask the patient about? Hint: SIGECAPS Sleep decreased (insomnia), Interest in activities decreased, Guilt or worthlessness, Energy decreased, Concentration difficulties, Appetite disturbance and/or weight loss, Psychomotor agitation, Suicidal thoughts
Which is not an alpha blocker? What are they primarily used for? a. Hytrin b. Cardura c. Uroxatral d. Proscar Answer: D; Proscar (finasteride) is an 5-alpha reductase inhibitor. Both alpha blockers and 5-alpha reductase inhibitors are indicated for the treatment of bph
Which drug does not inhibit the reuptake of serotonin? a. Escitalopram b. Trazodone c. Paroxetine d. Fluvoxamine e. Vortioxetine f. None of the above Answer: F; none of the above. All of these drugs block serotonin reuptake even if they aren't all selective serotonin reuptake inhibitors
Rapaflo(silodosin) is used for bph and comes as 4mg and 8mg doses. When should the 4mg dose be used? The 4mg dose should be used when the CrCl is 30-50 mL/min. If CrCl <30, this medication is contraindicated
Which medication for bph has less side effects (i.e. hypotension, dizziness, syncope, headache)? a. Tamsulosin b. Terazosin c. Doxazosin d. Alfuzosin Answer: A; Unlike tamsulosin, the other medication choices are all alpha 1 non-selective so they cause more side effects
Finasteride can be used for bph and male pattern hair loss. What are the brand names for each of the 2 indications? Proscar is indicated for bph and Propecia is indicated for male pattern hair loss
Which of the following medications is recommended for the treatment of chronic insomnia (>4 weeks)? a. Ambien b. Temazepam c. Diphenhydramine d. Nyquil Answer: A; Benzos should not be used for more than 2-4 weeks. Diphenhydramine, Nyquil, and other antihistamine-containing products can induce drowsiness but do not improve sleep patterns.
What is the 1st line treatment for primary acute insomnia? Cognitive behavioral therapy which includes having good sleep hygiene - avoiding caffeine, nicotine and exercise before bed, only using the bed for sleep, avoiding daytime naps, avoiding big meals/excessive drinking before bed, and going to bed at normal
What is the age range for recommending a Hep B vaccine? 18-59 years old
At what age is baby aspirin recommended for stroke prophylaxis? ADA guidelines: men>60, women>50 AHRQ guidelines: men>55, women>45
What do all of these medications have in common? Vesicare, Cardura, Avodart, Cialis They can all be used to treat bph.
If a patient forgets to fast before getting their lipid panel drawn, which of the following components would not be affected? a. triglycerides b. LDL c. total cholesterol Answer: C
LDL can be calculated if the values for total cholesterol, triglycerides, and HDL are known. What would the calculated LDL value be if a patient's triglycerides were 425, total cholesterol was 233, and HDL was 47? Answer: LDL can not be calculated when triglycerides > 400. Normally LDL is calculated by an equation. LDL = TC - [(TG/5)+HDL]
Which form of Calcium is best to take when a patient is also taking a PPI or H2 antagonist? Calcium Carbonate or Calcium Citrate? Calcium carbonate contains twice the elemental calcium of Calcium citrate, but if a patient is on an acid reducing medication, they should not be taking Calcium Carbonate since it requires an acidic environment to be readily absorbed
Which statement is true comparing LMWHs with UFH? a. LMWHs have a shorter half life b. LMWHs can be used if CrCL < 30 while UFH cannot c. LMWHs are cheaper d. LMWHs are given IV while UFH are given SQ Answer: C
The usual DVT prophylaxis dose of Lovenox (enoxaparin) is 40 mg per day. How does the dosing change for the treatment of a past or active DVT? 1 mg/kg/bid or 1.5 mg/kg/day
In January 2014, an FDA warning was issued pertaining to the dose of Zolpidem immediate and controlled release. What did the warning say about dosing, and in what population? Since women clear Zolpidem more slowly than men from their bodies, the maximum daily dose for women of Zolpidem immediate release should be reduced from 10 mg to 5 mg and max of Zolpidem controlled release should be reduced from 12.5 to 6.25 mg/day.
How can hyperthyroidism or CHF affect INR values? a. Increase b. Decrease c. No change d. Make INR values difficult to measure Answer: A
Does Nitroprusside cause vasodilation or vasoconstriction? Drug accumulation can occur if the kidneys are dysfunctional. What would the patient be at risk for if nitroprusside clearance was reduced? Nitroprusside causes the release of nitric oxide so it can cause vasodilation. With reduced drug clearance, the patient has a risk of developing cyanide toxicity
How do you calculate cardiac output (CO)? Cardiac output (CO) = heart rate (HR) x stroke volume (SV)
What do these medications all have in common? a. Invega (paliperidone) b. Concerta (methylphenidate) c. Glucophage XR (metformin) These drugs all have an extended release formulation and can thus cause a capsule or tablet to be in the stool.
Due to the increased risk of blood clots/strokes when on testosterone replacement therapy, what is recommended for a patient taking testosterone? Regular blood donations to combat the rise in hematocrit as a result of testosterone injections
What is the Black Box Warning for Clindamycin? a. QT prolongation b. Neurotoxicity c. Severe colitis d. Birth defects Answer: C; Clindamycin can cause severe and sometimes fatal colitis caused by C. diff. Symptoms include abdominal cramps, fever, bloody/loose stools. Doctor should be contacted immediately.
What is the blood pressure goal for an individual 18 - 59 yrs of age with no comorbidities per JNC 8? <140/90
Which one of the following agents is not a 1st line treatment option for hypertension per JNC 8? a. ARBs b. CCBs c. BBs d. Thiazide-like diuretics Answer: C; Beta blockers are considered later line alternatives
What is the blood pressure goal for a Diabetic per JNC 8? <140/90; per ADA guidelines, the goal would be <140/80
What do all of these drugs have in common? a. Rifampin b. Ethambutol c. Pyrazinamide d. Isoniazid They are treatment options for tuberculosis. If there is resistance to Isoniazid or Rifampin, they can be replaced with a fluoroquinolone.
Physician writes order for aminophylline 500 mg IV, dosed at 0.5mg/kg/hr. Patient weighs 165 pounds. How many milligrams of theophylline would the patient receive per hour? Patient weight: 165 lbs/2.2 = 75 kg; 75kg x 0.5mg/kg/hr = 37.5mg/hr of aminophylline x 0.8 = 30mg/hr of theophylline
The prescription calls for a total aspirin quantity of 6,000 mg with a total of 30 capsules dispensed. How many grains of aspirin will be in each capsule? 6,000 mg x 1 grain/65 mg = 92.3 grains/25 caps = 3.7 grains of aspirin per capsule
Name an OTC insulin product Novolin N, Novolin R, Novolin 70/30, Humulin N, Humulin R, Humulin 70/30
Name an NMDA receptor antagonist used to treat Alzheimer's Disease. Namenda (memantine)
What is the purpose of a PHQ-9 questionnaire? It is used to screen, diagnose, monitor, and measure the severity of depression.
A cough syrup contains 4g of brompheniramine maleate per liter. How many milligrams are contained in a tablespoonful dose of elixir? 4g/L = 4,000mg/1,000mL = 4mg/mL x 15mL/tablespoon = 60 mg
What is the antidote for Atropine? Physostigmine
A mouth rinse contains 1/12% (w/v) of chlorhexidine gluconate. How many grams should be used to prepare 18 liters of mouth rinse? 1/12% = 0.083g/100mL = Xg/18,000mL = 15 grams
Which drug reference contains foreign drug information? Martindale
Name a renin inhibitor that should not be co-administered with ARBs or ACEIs due to risk of hyperkalemia. Tekturna (aliskiren)
Morphine originates from what plant? Papaver somniferum (poppy)
Grave's Disease is an autoimmune disorder that causes what condition? Hyperthyroidism
There are 50 mg of a drug in 50 mL of solution. Express the concentration as a ratio strength (1:X) 50mg/50mL = 100mg/100mL = 0.1g/100mL = 1 part/X parts = 1:1000
Match the appropriate brand and generic names: a. Boniva b. Fosamax c. Actonel d. Evista 1. Ibandronate 2. Risedronate 3. Alendronate 4. Raloxifene Boniva (ibandronate), Actonel (risedronate), Fosamax (alendronate), Evista (raloxifene)
What is the antidote for Heparin? Protamine
Nitroglycerin has a specific gravity of 1.59. How much would 1 quart of Nitroglycerin weigh? 1 pint = 473 mL; 1 quart = 946 mL (2 pints); 1.59 x 946 mL = 1,504 grams
What drug schedule is Promethazine with Codeine cough syrup? C-V
If a patient is 6'5" tall and weighs 166 pounds, what is their body surface area? Answer = 2.02m^2; BSA = square root of ([height in cm x weight in kg]/3600); 6'5" tall = 77 inches x 2.54 cm/inch = 195.6 cm; 166 pounds/2.2 = 75.5 kg
What do all of these drugs have in common? a. Remeron b. Paxil c. Amaryl d. Megace e. Avandia They all cause weight gain
A nurse is hanging a 4% lidocaine solution for a patient. If the dose is 6mg/min, how many hours will a 250mL bag last? 4% = 4g/100mL = 4000mg/100mL = 40mg/mL x 250mL bag = 10,000mg x 1min/6mg x 1hr/60min = 27.8 hours
An intravenous infusion contains 2mL of a 1:1000 (w/v) solution of epinephrine and 250mL of D5W. At what flow rate, in mL/min, should the infusion be administered to provide 0.3 mcg/kg/min of epinephrine to an 80kg patient? 1:1000 = 0.1% = 1mg/mL = 2mg/2mL; 250 mL D5W + 2 mL epinephrine = 252mL total; 252mL/2mg x 1mg/1,000mcg x 24mcg/min = 3mL/min
What is the antidote for Methotrexate? Leucovorin
Using 20g of a 9% boric acid ointment base, the pharmacist will manufacture a 5% ointment. How much diluent is required? (20g)(9%) = (X)(5%) = 36 g total; 36g - 20g = 16g of diluent
You are asked to prepare 80g of a 12.5% ichthammol ointment. You have 16% and 12% ichthammol ointments in stock. How much of each do you use to get your desired final product? Use allegation to solve. 0.5 parts x 20g = 10g of 16% ichthammol ointment. 3.5 parts x 20g = 70g of 12% ichthammol ointment
A patient receives 200 mg of a drug. How much of the drug still remains in the patient after 10 hours if the elimination rate constant (k) = 0.1386? t1/2 = ln(2)/k = 0.693/0.1386 = 5 hrs; After 10 hrs (2 half lives), there is 50 mg of the drug left in the patient
TE is a 32 year old male who is receiving 325 grams of dextrose, 85 grams of amino acids, and 300 mL of 10% lipids via his TPN therapy. What percentage of calories is provided by the protein content? Dextrose = 3.4kcal/g = 3.4 x 325 = 1,105kcal; Protein = 4kcal/g = 4 x 85 = 340kcal; 10% lipid emulsion = 1.1kcal/mL = 1.1 x 300 = 330kcal; 340kcal protein/1,775kcal total = 19.2% protein
A chronic autoimmune digestive disease that damages villi of the small intestines and interferes with absorption of food nutrients: a. Crohn's Disease b. Inflammatory Bowel Syndrome c. Celiac Disease d. Ulcerative Colitis e. Peptic Ulcer Disease Answer: C; Celiac disease is caused by an abnormal reaction to gluten found in wheat, rye, and barley oats. Medication not required. Treatment is to eat gluten-free foods.
What are the 3 ingredients that make up the HIV drug Atripla? Efavirenz, Emtricitabine, Tenofovir
Calculate the amount of grams of potassium chloride (M.W. = 74.5) needed to make 200 mL of a solution containing 250 mOsmol/L. Solve for X; 250 mOsmol/L = X grams/74.5 g/mol x 2 (valence) x 1,000; X = 9.31g/L = 1.86g/200mL
What is the Celsius temperature equivalent to 88 degrees Fahrenheit? a. 41.9 b. 190.4 c. 12.2 d. 31.1 Answer: D; [(88-32)]/1.8 = 31.1
Write out the Henderson Hasselbalch equation for calculating the pH of a weak acid. What is the pH of a solution prepared to be 0.5M sodium citrate and 0.05M citric acid (pKa = 3.13)? pH = pKa + log (salt/acid) = 3.13 + log (0.05/0.5) = 3.13 + 1 = 4.13
Which of the following drugs does not have the potential to raise blood glucose levels? a. Olanzapine b. Prednisone c. Ritonavir d. Simvastatin e. None of the above Answer: E; atypical antipsychotics, corticosteroids, protease inhibitors, statins, beta agonists, cyclosporine, tacrolimus, and high doses of HCTZ can raise blood glucose
Name the class of medication for each of the following: Pioglitazone, Glyburide, Glucotrol, Liraglutide, Januvia, Canagliflozin Actos (pioglitazone) is a TZD. Diabeta (glyburide) and Glucotrol (glipizide) are sulfonylureas. Victoza (liraglutide) is a GLP-1 agonist. Januvia (sitagliptin) is a DPP-4 inhibitor. Invokana (canagliflozin) is a SGLT-2 inhibitor
Which oral Diabetes medication should not be used with sulfonylureas due to similar MOA involving the stimulation of insulin secretion from the pancreatic beta cells? a. Meglitinides b. Carbonic anhydrase inhibitors c. DPP4 inhibitors d. Biguanides Answer: A; Prandin (repaglinide) and Starlix (nateglinide) are examples of meglitinides. Their levels are increased by gemfibrozil. Only take meglitinides 15 - 30 minutes prior to meals.
Which of the following is not a possible side effect of Procainamide? a. Agranulocytosis b. Lupus-like syndrome c. QT prolongation d. Thrombocytopenia Answer: D
BD is a 15 yr old male with Type 1 Diabetes. Assuming the typical starting dose for insulin is 0.6 Units/kg/day and the patient weighs 55k, how many grams of carbohydrates would be covered by 1 unit of insulin in this patient? (Hint: Rule of 500) 0.6 x 55 = 33 daily units of insulin. Grams of carbs covered by 1 unit of insulin = 500/total daily dose of insulin = 500/33 = 15
A compounded aqueous preparation that requires refrigeration should have an expiration date of how long? 14 days
What is the process of reducing the size of a particle of a solid by triturating (grinding) it down to smaller particles in a mortar or spatulating it on an ointment slab with a wetting agent in which the solid is not soluble? Levigation
What would you call the mixture of 2 immiscible liquids that stay separate and form a 2 phase system? a. Surfactant b. Suspension c. Solution d. Emulsion Answer: D
Which does not describe a lotion? a. Contains mostly water b. Absorbs quickly c. Spreads easily d. Used for skin wounds due to occlusive benefit Answer: D; ointments are used for this purpose rather than lotions. As opposed to lotions, ointments are 80% oil-based and trap in moisture to help dry, cracked, or injured skin.
What is the primary indication for treatment with Buspar (buspirone)? a. Cough b. Depression c. Bipolar disorder d. Anxiety e. Pain Answer: D; Buspar is part of the Azapirone drug class that stimulates serotonin receptors and treats anxiety. It works slower than Benzodiazepines but has no withdrawal symptoms.
What do all of these drugs have in common? (Hint: condition where they are contraindicated) Naproxen, Metformin, Pioglitazone, Diltiazem, Amiodarone Heart failure - Ibuprofen increases fluid retention/worsens edema. Hypoperfusion in CHF can lead to increase risk of lactic acidosis when taking Metformin. Pioglitazone has BBW that it can worsen CHF. Diltiazem/Amiodarone are negative inotropes.
Hypothyroidism is often diagnosed with which lab values? a. high TSH, high T4 b. low TSH, high T4 c. high TSH, low T4 d. low TSH, low T4 Answer: C
Which drug is not on the FDA flush list? a. Demerol b. Dilaudid c. Methadose d. Ultram e. Oxycontin f. Percocet g. Suboxone Answer: D
Quinidine, Procainamide, and Disopyramide block sodium and potassium channels. They all are which class of antiarrhythmic? a. Class IC b. Class IA c. Class 2 d. Class 3 e. Class IB Answer: B (Class IA); they reduce conduction velocity and automaticity while they decrease refractory period
Which class of medication has a black box warning that says their use is contraindicated if the patient has a family history of thyroid carcinoma or has active multiple endocrine neoplasia syndrome type 2? (Hint: Oral Diabetes medication) GLP-1 agonists such as Bydureon or Victoza
Amiodarone is a class III antiarrhythmic medication that blocks: a. K+ channels b. K+ channels and Ca2+ channels c. K+ channels, Ca2+ channels, and Na+ channels d. Cl- channels and K+ channels e. Slow and fast Ca2+ channels Answer: C; Amiodarone blocks K+ channels, Ca2+ channels and Na+ channels. It also blocks alpha and beta adrenergic receptors
What is the shared mechanism of action of fluoroquinolones, rifampin, and metronidazole? a. protein synthesis inhibitors via 30s subunit binding b. DNA/RNA inhibitors c. protein synthesis inhibitors via 50s subunit binding d. Cell wall inhibitors Answer: B
What would be expected in a patient with Wolff-Parkinson-White Syndrome? a. Abnormal hair growth b. Severe mydriasis c. Tachycardia d. Hypersalivation e. Wheezing and erythema Answer: C; It is a heart condition with an abnormal extra electrical pathway of the heart. Can lead to episodes of rapid heart rate. It is one of the most common causes of fast heart rate disorders in infants and children
What do all of these medications have in common? Phenytoin, Phenobarbital, Oxcarbazine, Rifampin, Carbamazepine, St. John's Wort They are all CYP3A4 inducers
What is the main difference between OTC and Rx Prenatal vitamins? Their amount of folic acid. OTC products generally contain 400 - 800 mcg which is adequate. Rx products contain at least 1,000 mcg and can often cause more nausea than the OTC choices.
Ciprofloxacin should not be administered within 2 hours of taking what? a. Iron supplements b. Multivitamins c. Yogurt and cheese d. None of the above e. All of the above Answer: E
What effect does grapefruit juice have on Amiodarone levels? a. Increase b. Decrease c. No change Answer: A; Amiodarone and grapefruit juice are both CYP3A4 inhibitors; however, Amiodarone is also a CYP3A4 substrate, so its metabolism would be inhibited by grapefruit juice.
When treating a patient with STEMI, what is the correct treatment? a. Fibrinolytics within 30 minutes of presentation b. PCI within 12 hours of presentation c. PCI within 4 hours of presentation d. Both A and B e. Both A and C Answer: A; PCI is preferred treatment that involves inserting a balloon to open up the artery. It must be done within 90 - 120 minutes of presentation. If these times can not be met, fibrinolytics should be utilized as well as other add-on medications
Which of the following is not a possible treatment for unstable angina (UA) and NSTEMI? a. Oxygen b. Morphine c. ACE inhibitors d. Beta blockers e. Thrombolytics f. Aspirin g. Brillinta Answer: E; thrombolytics are reserved for STEMI treatment where there is total occlusion of the artery and it must be broken down. In UA/NSTEMI, the blood flow is sluggish but there is no complete blockage
Which is the best way for acute coronary syndrome (UA, NSTEMI, STEMI) diagnosis? a. 99mTc cardiac imaging b. creatinine kinase levels c. troponin 1 levels d. electrocardiogram e. lactate dehydrogenase levels Answer: D; An electrocardiogram (ECG) measures electrical activity of the heart. Used for initial diagnosis by observing ST elevations and Q waves. Then the cardiac enzymes are used for the final diagnosis
What are the contraindications for using thrombolytics? a. Thrombocytopenia b. History of bleeding c. Recent surgery d. History of hemorrhage while on thrombolytics e. All of the above Answer: E
Caused by an autosomal recessive gene on chromosome 7. The body produces viscous mucus secretions that clog the lungs and lead to lethal lung infections. It is treated with Dornase alfa, bronchodilators, and antibiotics. Which condition is this? Cystic fibrosis
What is the shared mechanism of action of macrolides, clindamycin, and linezolid? a. protein synthesis inhibitors via 50s subunit binding b. cell membrane inhibitors c. cell wall inhibitors d. folic acid synthesis inhibitors Answer: A
Which is not a contraindication for use of Multaq? a. Pregnancy b. Permanent atrial fibrillation c. Diabetes d. HR < 50 e. Liver disease Answer: C; Multaq (dronedarone) is a class III antiarrhythmic similar to amiodarone but less lipophilic
What is the shared mechanism of action for aminoglycosides and tetracyclines? a. Protein synthesis inhibitors via 30s subunit binding b. Folic acid synthesis inhibitors c. DNA/RNA inhibitors d. Cell membrane inhibitors Answer: A
What is the shared mechanism of action for sulfonamides? a. Cell wall inhibitors b. Folic acid synthesis inhibitors c. protein synthesis inhibitors via 30s and 50s subunit binding d. None of the above Answer: B
Which one is not a cell wall inhibitor? a. Penicillin b. Ceftriaxone c. Carbapenem d. Vancomycin e. Daptomycin Answer: E; Daptomycin is a cell membrane inhibitor
Which is the difference between bacteriostatic and bacteriocidal? Bacteriostatic - limits growth of bacteria without harming it. Bacteriocidal - kills bacteria
Which antibiotic is not bacteriocidal? a. Bactrim b. Zithromax c. Maxipime d. Flagyl e. Levaquin Answer: B; All protein synthesis inhibitors are bacteriostatic which include macrolides, clindamycin, linezolid, aminoglycosides, and tetracyclines. Sulfonamides and trimethoprim are bacteriostatic used alone but bacteriocidal when used in combination.
Due to the black box warning of Ziagen (abacavir), what screening must be done prior to starting this drug therapy? Before starting abacavir, patient must be screened for HLA-B*5701 allele. If positive, they are at an increased risk for hypersensitivity which can be fatal. They should not use abacavir.
Efavirenz, Etravirine, Nevirapine, and Rilpivirine belong to which medication class? a. Protease inhibitors b. NNRTIs c. NRTIs d. Fusion inhibitors e. Integrase inhibitors Answer: B
Antibiotics that exhibit concentration-dependent killing are dosed usually only once a day at high doses to maximize their concentration above the minimum inhibitory concentration (MIC). List 2 antibiotics of different classes that exhibit this: Aminoglycosides and Quinolones
Fuzeon (enfuvirtide) belongs to which class of antiretroviral drugs? Fusion inhibitors
Atazanavir, Darunavir, Fosamprenavir, Ritonavir, Lopinavir and Saquinavir fall under which class of medication? a. Protease inhibitors b. NNRTIs c. NRTIs d. Fusion inhibitors e. Integrase inhibitors Answer: A
Prior to starting HIV therapy with Selzentry (maraviroc), what screening must be done? Must screen to determine the tropism of their HIV since this agent only works in patients with the CCR5-tropic disease
Isentress belongs to which class of antiretrovirals? Isentress (raltegravir) is an integrase inhibitor
Which HIV combination product has a mismatched brand with generic? a. Combivir (lamivudine, zidovudine) b. Epzicom (lamivudine, abacavir) c. Stribild (emtricitabine, tenofovir, elvitegravir, cobicistat) d. Truvada (emtricitabine, tenofovir, efavirenz) Answer: D; Truvada does not contain efavirenz. The correct brand name for choice "D" would be Atripla.
Accumulation of which drug can cause gray baby syndrome characterized by cardiovascular collapse, shock, and even death? a. Thalidomide b. Sulfanilamide c. Prednisone d. Chloramphenicol e. Ketoconazole f. Rifampin Answer: D; the greatest risk occurs when chloramphenicol is given IV. This drug is metabolized through glucoronidation, but this process isn't fully developed until babies reach 6-18 months of age.
Pilocarpine and Carbachol are referred to as miotics or cholinergic agonists. They are rarely used due to their required frequent dosing which leads to patient noncompliance. What condition do they primarily treat? Do they dilate or constrict the pupil? They constrict the pupil and are used to treat glaucoma (the leading cause of blindness)
Timolol eye drops can be used to treat glaucoma by suppressing the production of aqueous humor and thus decreases intraocular pressure. It comes as which brand name product? Name its class of medication. Timoptic (timolol) is a beta blocker
Iron is generally given to correct microcytic anemia. Which of the following would NOT reduce iron absorption? a. Milk b. Tea c. Antacids d. Orange juice e. Antibiotics Answer: D; orange juice is acidic and will improve iron absorption. Antacids raise pH therefore decrease iron absorption. Antibiotics decrease iron absorption through chelation. Dairy products and tea should be avoided as well.
Prandin (repaglinide) and Starlix (nateglinide) treat Diabetes thru which mechanism? a. Stimulate release of insulin b. Decrease hepatic glucose production c. Improve insulin sensitivity d. Prevent glucagon postprandial secretion Answer: A; These drugs fall under the class of Meglitinides. They are intended to only be taken before meals and skipped if meal is skipped.
Diabeta (glyburide), Glucotrol (glipizide), and Amaryl (glimepiride) work by which MOA? a. Stimulate insulin secretion b. Improve insulin sensitivity c. Decrease hepatic glucose production d. Decrease intestinal absorption of glucose Answer: A; These drugs are 2nd generation sulfonylureas
Metformin is a biguanide that works through which MOA? a. Stimulate insulin secretion b. Moderates glucagon secretion c. Delays stomach emptying d. All of the above e. None of the above Answer: E; Biguanides such as Metformin work thru 3 mechanisms. They decrease hepatic glucose production, decrease intestinal absorption of glucose, and improve insulin sensitivity
Type 1 Diabetes is characterized as having no insulin production. True of False? Answer: True; Type 1 Diabetes is known as insulin dependent. Type 2 Diabetes involves an impaired insulin production but not a complete lack thereof.
Which of the following medications does NOT suppress hepatic glucose production? a. Actos b. Avandia c. Januvia d. Tradjenta e. Glucophage f. Glyset Answer: F; Glyset (miglitol) is an alpha glucosidase inhibitor which inhibits the breakdown of large saccharides to glucose. The other answer choices consist of TZDs, DPP4 inhibitors, and Biguanides; all of which inhibit hepatic glucose production
The intermediate/long acting insulin vials appear clear while the rapid/short acting insulin vials appear cloudy. Always draw up medication from the clear vial before the cloudy. True or False? False; The rapid/short acting vials are clear and the intermediate/long acting vials are cloudy.
Chocolate inhibits calcium absorption so it should not be given concomitantly with a calcium containing supplement. True or False? True
Which of the following NSAIDs is NOT a non-selective COX-1/2 inhibitor? a. Indomethacin b. Sulindac c. Naproxen d. Meloxicam e. Celecoxib f. Diclofenac Answer: E; Celebrex (celecoxib) is a COX-2 inhibitor
Voltaren is an NSAID-containing gel used for joint pain. Because of its topical application, it doesn't cause GI and other common side effects caused by NSAIDs. What is the primary ingredient in Voltaren? Diclofenac
Which of the following decreases lithium serum concentration? a. ACE inhibitors b. Caffeine c. NSAIDs d. Fluoxetine e. Thiazides Answer: B; the rest increase lithium levels
Capaxone comes as a SQ injection for the treatment of what? a. Osteoarthritis b. Chronic back pain c. Multiple sclerosis d. Cystic fibrosis e. Heart failure Answer: C; Copaxone (glatiramer) treats MS. It comes as a once daily injection and injection sites should be rotated each day so that no site is used more than once per week.
What is the volumetric pressure in the ventricles at the end of a diastole, just prior to contraction, which is affected by venous BP and rate of venous return? a. Afterload b. Preload c. Ejection fraction d. Pulmonary vascular resistance Answer: B; Afterload is the tension in the ventricular wall during contraction. Ejection fraction is % of blood ejected from ventricles after contraction. PVR is the resistance to flow of blood exiting right ventricle to the lungs
Which one is spread primarily through food or water contaminated by stools from an infected person? a. Hep A b. Hep B c. Hep C Answer: A; Unlike Hep A, Hep B and Hep C are not spread through contaminated food or water. They are mostly spread through needles or blood transfusions. All three can be spread through sexual contact though.
What do all of these medications have in common? Zanaflex (tizanidine), Norflex (orphenadrine), Soma (carisoprodol), Flexeril (cyclobenzaprine), Skelaxin (metaxalone), and baclofen They are muscle relaxants. They are used in Parkson's Disease.
Anticonvulsants are known to reduce the levels of what in pregnant women which is believed to be linked to newborns with the neural tube defect known as spina bifida? a. Vitamin D b. Folic acid c. Vitamin B12 d. Iron Answer: B
What is the mechanism of action for statin drugs? HMG-CoA reductase inhibitor that inhibits the conversion from HMG-CoA to Mevalonate (precursor for cholesterol)
Altoprev is the extended release formulation for which statin drug? a. Atorvastatin b. Simvastatin c. Lovastatin d. Rosuvastatin Answer: C
Caduet is a combination product that contains a calcium channel blocker and statin. Name them. Amlodipine and Atorvastatin
Antibiotics that exhibit time-dependent killing are dosed more frequently to maximize the time their concentration is above the minimum inhibitory concentration (MIC). List 3 antibiotics from different classes that exhibit this: Penicillins, Cephalosporins, Carbapenems, Monobactams (i.e. Aztreonam), Clindamycin, Macrolides, Linezolid, Vancomycin
Ribavirin, Didanosine, Abacavir, Emtricitabine, Lamivudine, Zidovudine, Tenofovir, and Stavudine belong to which class of medication? a. Protease inhibitors b. NNRTIs c. NRTIs d. Fusion inhibitors e. Integrase inhibitors Answer: C
Which antibiotic does NOT cover Gram positive infections? a. Vancomycin b. Linezolid c. Daptomycin d. Aztreonam e. Tigecycline Answer: D
Which antibiotic does NOT cover Gram negative infections? a. Ciprofloxacin b. Moxifloxacin c. Zosyn d. Aztreonam e. Tobramycin Answer: B
How do 1st Generation Cephalosporins compare to 3rd Generations in terms of coverage? a. 1st Gen have better Gram negative activity b. 1st Gen covers atypicals c. 3rd Gen has better Gram positive activity d. 3rd Gen has better Gram negative activity Answer: D
All of the following antibiotics are recommended to be taken without food to ensure complete absorption except: a. Tigecycline b. Doxycycline c. Minocycline d. Tetracycline Answer: A; these antibiotics should be taken 2 hours before or 4 hours after a meal. This also applies to the administration of vitamins, supplements, and drinks other than water since absorption can be affected by them as well.
Which antibiotic does not cover Pseudomonas? a. Imipenem b. Levofloxacin c. Ticarcillin/Clavulanic acid d. Doripenem e. Moxifloxacin f. Gentamicin Answer: E; all other fluoroquinolones cover pseudomonas. Moxifloxacin is the exception.
Which of the following drugs does NOT lower the seizure threshold? a. Bupropion b. Fluoxetine c. Amoxicillin d. Tramadol e. None of the above Answer: E; beta lactam antibiotics, opioid analgesics, and antidepressants can lower the seizure threshold. Other medications and conditions can have the same effect such as medication withdrawal.
Symptoms of Rocky Mountain Spotted Fever include fever, abdominal pain, rash, vomiting, etc. It is caused by tick bites. Which bacteria causes this disease? a. Helicobacter pylori b. Salmonella typhi c. Borrelia burgdorferi d. Rickettsia rickettsii Answer: D; This disease would be treated with Doxycycline. Helicobacter pylori causes peptic ulcers and stomach cancer. Salmonella typhi causes typhoid fever. Borrelia burgdorferi causes lyme disease.
1st line treatment for acute uncomplicated cystitis is Bactrim. Assuming drug resistance to Bactrim, patient having sulfa allergies and having a CrCl <60, what could be used? a. Ciprofloxacin b. Linezolid c. Nitrofurantoin d. All of the above Answer: A; Linezolid is not effective against Gram negative bacteria (i.e. E. coli is primary cause of UTI). Nitrofurantoin is contraindicated if CrCl < 60. Another viable alternative to Ciprofloxacin could be Levofloxacin but it wasn't an answer choice.
The treatment for acute uncomplicated pyelonephritis is similar to acute uncomplicated cystitis. They both can be treated with fluoroquinolones. How does the treatment duration compare? Treatment for acute uncomplicated cystitis is generally 3-5 days. Treatment for acute uncomplicated pyelonephritis is generally 7 days but can be as long as 14 days if there is drug resistance. Also fever is more common in pyelonephritis.
Which of the following is not a treatment principle for C. diff? a. Discontinue the offending agent b. Avoid antimotility agents c. Use alcohol hand sanitizers to prevent transmission d. Isolate patient to a single room to prevent transmission Answer: C; alcohol sanitizers do not kill C. diff. Washing hands with soap and water is recommended instead.
Which is not a symptom of Crohn's Disease? a. Recurrent diarrhea b. Abdominal cramps/pain c. Fever d. Fatigue e. Weight loss f. None of the above Answer: F; they are all classic symptoms of Crohn's
Choose correct statement comparing Crohn's Disease and Ulcerative Colitis (UC): a. UC affects the whole digestive tract b. Crohn's affects only the innermost lining of the colon c. More hematochezia with UC d. More uniform inflammation with Crohn's Answer: C; They both are types of inflammatory bowel disease. Crohn's affects the entire digestive tract from mouth to anus while UC is limited to the colon and rectum. UC affects only the innermost layer of the bowel and has more uniform inflammation
The pharmacist is going to add 80 mEq of sodium to the TPN; half given as sodium acetate (2mEq/mL) and half as sodium chloride (4mEq/mL). How many mL of sodium chloride will be needed? 80 mEq/2 = 40 mEq from sodium chloride; 40 mEq x 1 mL/4 mEq = 10 mL needed
The main treatment option for mild to moderate cases of Inflammatory Bowel Disease (Crohn's and Ulcerative Colitis) include all of the following except: a. Pentasa b. Lialda c. Asacol d. Azulfidine e. Colazal f. Medrol Answer: F; Pentasa (mesalamine), Lialda (mesalamine), Asacol (mesalamine), Azulfidine (sulfasalazine) and Colazal (balsalazide) are Aminosalicylates (5-ASA). Medrol (methylprednisolone) is corticosteroid reserved for short term tx of moderate-severe cases
Which of the following is a parasympatholytic? I. Pilocarpine II. Neostigmine III. Scopolamine IV. Atropine a. IV only b. I,II c. I,II,III d. II,III e. III,IV Answer: E; Parasympatholytics are anticholinergics since they block the muscarinic effects of acetylcholine (ACH). They include: Atropine, Scopolamine, drugs used for urinary incontinence (i.e. tolterodine), anti-Parkinsonism drugs (i.e. benztropine), etc
Fiorcet is a combination product used for the treatment of tension headaches. Its primary ingredients include: a. APAP, Ibuprofen, Caffeine b. APAP, Codeine, ASA c. Butalbital, APAP, Caffeine d. APAP, Sumatriptan Answer: C; Fiorcet is sometimes combined with Codeine as a 4th ingredient which makes it a C-III controlled substance.
Aleve contains which NSAID? a. Acetaminophen b. Aspirin c. Ibuprofen d. Naproxen e. Indomethacin f. Capsaicin Answer: D; acetaminophen and capsaicin are not NSAIDs. Ibuprofen and Aspirin are NSAIDs not contained in Aleve.
Which class of medication is Dexilant? Dexilant (dexlansoprazole) is a proton pump inhibitor
NSAIDs can cause Peptic Ulcer Disease (PUD). True or False? True; high dose and/or long term NSAID use can cause stomach ulcers and lead to peptic ulcer disease. The most common cause of PUD though is from H. pylori infection that causes duodenal ulcers
Created by: cg2014