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Pharm Review One
Family Medicine Rotation May 2012
| Question | Answer |
|---|---|
| What are the side effects that are commonly associated with Amiodarone? | Pulmonary Fibrosis*, Increased LFTs, Photodermatitis, SJS, Pro-arrhythmic, QTc Prolongation |
| Drug Interaction: Amiodarone and Warfarin. By what mechanism? | Amiodarone may enhance the anti-coagulant effect of warfarin. Amiodarone causes 2C9 Inhibition. |
| What does BNP stand for? How is it useful? | Brain Natriuretic Peptide - has vasodilatory action in response to stress to the heart in CHF. This helps the patient who has CHF breathe. Levels > 400 may be an indication an exacerbation of CHF. |
| What is a potential complication of correction of serum sodium concentration too quickly? | Central Pontine Myelinolysis, neurological disorder (paralysis, dysphagia) |
| Briefly explain Ejection Fraction, and what it may indicate | Ejection Fraction quantifies the volumetric percentage of blood that is pumped out by the ventricles in a cardiac cycle. Normal EF 55% - 75% <40% is indicative of Systolic HF Normal EF may indicate Diastolic HF |
| What is the number one cause of heart failure? | ischemic heart disease |
| Name the major risk factors that affect LDL goal (5) | Cigarette Smoking HTN or on anti-HTN meds LDL < 40 mg/dL FHx of CHD (Men < 55, Women < 65) Men ≥ 45 Women ≥ 55 ***HDL > 60 is a negative risk factor |
| What are the CHD Risk Equivalents? What is that patient populations goal LDL? | Clinical CHD Symptomatic Carotid Artery Disease Peripheral Artery Disease Abdominal Aortic Aneurysm *Diabetes |
| If a patient presents with no CHD risk equivalents, is not diabetic, what is there LDL goal if they have 0 or 1 risk factors? 2+ Risk factors? | 0-1 <160 2+ <130 |
| With which drugs is Zocor absolutely contraindicated according to the new FDA guidelines in 2012 (11) | Itraconazole, Ketoconazole, Posaconazole, Erythromycin, Clarithromycin, Telithromycin, HIV Protease Inhibitors, Nefazodone, Gemfibrozil, Cyclosprine, Danazol |
| With which drugs must Simvastatin have a ceiling dose of 10mg? (3) | Amiodarone Verapamil Diltizaem |
| With which drugs must Simvastatin have a ceiling dose of 20mg? (2) | Amlodipine Ranolazine |
| Carbamazepine's (Tegretol)claim to fame | 3A4 Autoinduction |
| What does PAE stand for? What is PAE? With which class of drugs is this concept exploited? | Post Antibiotic Effect - The suppression of bacteria by an antibiotic even after its been cleared. It is commonly exploited with aminoglycosides. |
| Which are the most common atypical bacteria? (3) | Clostridia, Mycoplasma, Bacteroides |
| Which drugs cover pseudomonas? | Aminoglycosides (Tobramycin, Amikacin, Gentamicin), Ceftazidime(3rd), Cefepime (4th), Ciprofloxacin, Pipercillin, Ticarcillin, Aztreonam |
| With regards to electrolyte levels, why may we use precation when using Timentin or Zosyn? | Hypternatremia (Ticarcillin > Pipercillin) |
| When is it appropriate to prophylax against Mycobacterium Avian Complex? Which agents and doses are appropriate to use? | CD4 < 50 Azithromycin 1200mg PO QW Azithromycin 600mg PO BIW Clarithromycin 500mg PO BID Rifabutin 300mg PO QD |
| When is it appropriate to prophylax against PCP Pneumonia? Which bacteria is the offender? Which agents are appropraite for use? Provide Doses | CD4 < 200 Pneumocystis Jirovecii Bactrim SS or DS PO QD Bactrim DS TIW Dapsone 100mg PO QD Atovaquone 1500mg PO QD Aerosolized Pentamidine 300mg Q28days |
| When prophylaxing against PCP, when is it appropriate to discontinue treatment? | When CD4 increases above 200 for > 3 months |
| When is it appropriate to prophylax against Toxoplasmic Encephalitis? What is the primary offender? What are the treatment options and doses? | When CD4 < 100 Bactrim DS or SS PO QD Dapsone 50mg QD + Pyrimethamine 75mg + Leucovorin 25mg Weekly Atovaquone 1500mg QD +/- Pyrimethamine 25mg + Leucovorin 10mg daily |
| What is the mechanism by which NSAIDs should not be used in renal failure? | NSAIDs inhibit prostaglandins which typically vasodilate renal tubules. By inhibiting this vasodilation, you caue vasoconstriction and decreased renal blood flow. |
| Which class of drugs does indapamide belong to? | Thizadine Diuretic |
| Which class of drugs does bumetanide belong to? | Loop Diuretic |
| When is metformin contraindicated in regards to serum creatinine? | Men ≥ 1.5 Women ≥ 1.4 |
| Why may SSRIs be harmful in a patient with Bipolar Disorder? | SSRIs may exacerbate a manic episode. |
| Which of the SSRIs is the most activating? | Fluoxetine (Prozac) |
| In which patients, is Wellbutrin (Bupropion) contraindicated? | In patients with history of seizures or bulimia/anorexia. |
| Which narcotic analgesic is known to cause pronounced QTc prolongation? | Methadone |
| Lovenox dosing for DVT Prophylaxis. Provide Renal adjustments | 40mg SQ QD CrCl < 30ml/min - 30mg SQ QD |
| What unique side effects are associated with the use of hydrochlorothiazide? | HYPERcalcemia, HYPERuricemia, HYPERglycemia |
| Why is it uncommon to see doses of HCTZ > 25mg/day | There is a minimal change in blood pressure lowering from 25mg to 50mg, with a marked increase in side effects |
| Which drugs are contraindicated in sytolic heart failure? | Calcium Channel Blockers (negative inotropy) |
| On what lab value may calcium be dependent? Explain the rationale. | Ca2+ level based on the serum albumin level Bound Ca2+ is measured Normal Albumin: 3.4-5.4 g/dL Hypoalbuminemia may provide falsely low levels of Ca2+ |
| Provide the formula for corrected calcium? What is normal albumin? | Corrected Ca = [0.8 x (normal albumin - patient's albumin)] + serum Ca |
| Mechanism of Action: Warfarin Which factors does warfarin inhibit? | Vitamin K Antagonist which is needed for synthesis of clotting factors 2,7,9,10, as well as protein C and S |
| Why does it take 48-72 hours for warfarin to begin to work? | Warfarin antagonizes Vitamin K, which is necessary for the synthesis of factor II (prothrombin) which may take 72 hours to clear. |
| Explain how to bridge warfarin with lovenox | DVT Treatment (Lovenox 1 mg/kg SQ Q12h) Begin in conjunction with warfarin 5mg Check INR Q2-3 days Treat with lovenox at least 5 day. May d/c Lovenox when INR is therapeutic with warfarin dose (2-3) |
| By what % should warfarin be dose adjusted? | Increase or Decrease dose by 10-20% Weekly |
| Which antibiotics are concentrated dependent? | Aminoglycosides, Fluoroquinolones |
| Which antibiotics are time-dependent? | Vancomycin, B-Lactams |
| Which antibiotic is associated with decreasing the seizure-threshold? | Imipenem-Cilastatin |
| Which drugs cover MRSA? | Vancomycin, Linezolid, Daptomycin, Quinupristin/Dalfopristin |
| What are the rare but most well known side effects associated with Vancomycin? | Ototoxicity, Nephrotoxicity |
| A BUN:Cr Ratio over what number is associated with dehydration? | >30 |
| Which combination of anti-hypertensives has been proven effective in treating Heart Failure in African Americans by reducing mortality and inproving functional HF Class? | Isosorbide Dinitrate - Hydralazine (BiDil) |
| Which oral anti-hyperglycemics are contraindicated in patients with heart failure? Why? | Thiazolidinediones (Pioglitazone, Rosiglitazone) Increased risk of peripheral edema |
| What is the mechanism by which ACE Inhibitors are renoprotective? | ACE inhibitors block the degradation of bradykinin leading to vasodilation of renal tubules. |
| Which Diuretic is often given with furosemide to reduce diuretic resistance? | Metolazone |
| Which vaccine should be given annually to all diabetic patients over the age of 6 months? | Influenza |
| What is HgBA1c? Over how long does this measure calculate? What is the goal A1c? | Glycosylated Hemoglobin. 3-4 months (life of RBC) Goal A1c < 7 |
| When is it appropriate to treat elevated triglycerides? What is the goal triglyceride level? | > 500. Goal TG level is <150 |
| Which drug can increase HDL but can also significantly increase blood gluycose levels at high dose? | Niacin |
| After how many days of systemic corticosteroid use would it be necessary to implement a taper? | > 14 days of Prednisone therapy |
| Which antibiotics show the best evidence for treatment of community acquired pneumonia? inpatient? | Macrolide, Respiratory FQ, or B-Lactam + Macrolide |
| Explain the Morphine PO to Parenteral conversion | 10mg (parenteral) = 30mg PO |
| What is the concern with the use of Meperidine (demerol)? With which metabolite is the concern? | Normeperidine: Neurotoxicity - Increases risk of Seizures, tremor, confusion, delirium. Avoid in renal insufficiency |
| What is the dose limiting side effect associated with Gabapentin? What is the maximum daily dose? | Sedation and fatigue are highly associated with gabapentin. Maximum Daily Dose: 2,700mg |
| Which medications are indicated for treatment of peripheral neuropathy? Explain preference for agents? | Pregabalin --> Cymbalta --> Gabapentin |
| Explain the symptoms associated with depression. How many symptoms must be present and for how long? | SIGECAPS Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor Agitation, Suicide (5/9 x 2 wks) |
| Name the contraindications to the use of Bupropion? What is the reason for the contraindication? | Anorexia/Bulimia --> electrolyte imbalance, Hx of Epilepsy Increase risk of seizures |
| What are the common side effects associated with corticosteroids? | Hyperglycemia (especially post-prandially), Stunted growth in children, Osteoporosis, Weight gain, increased risk of cataracts/glaucoma, HTN |
| Pertinent counseling points for Advair? | - not for prn use (maintenance) - breathe in quickly and deeply - wash mouth out after use - good for 30 days once opened |
| What are the most common side effects associated with 1st generation anti-psychotics? At which receptor do these agents work? What is treatment for these side effects? | Extrapyramidal Symptoms: Dystonia, Pseudo-parkinsonism, akathisia, tardive dyskinesia D2 Receptor Treatment is supportive including use of bromocriptine, dantrolene |
| Which 2 atypical anti-psychotics are associated with the least metabolic side effects? (2) with most weight gain? | Least metabolic side effects: Aripiprazole, Ziprasidone. Most weight gain: Clozapine, Olanzapine |
| Which side effect is most commonly associated with clozapine? | Agranulocytosis |
| Name 3 carbonic anhydrase inhibitors. Which IV formulation is useful in management for emergency open angle glaucoma? | Brinzolamide (azopt), Dorzolamide (trusopt), Acetazolamide(diamox) --> open angle glaucoma |
| When is it appropriate to draw a vancomycin trough? | Right before 4th consecutive dose to reach steady state concentration. |
| What is sevelamer indicated for? What is the maximum daily dose? | Indication: Hyperphosphatemia HCl (Renagel) - 13 g/day Carbonate (Renvela) - 14 g/day |
| What class of drugs does Pradaxa belong to? When must the dose be adjusted? | Direct Thrombin Inhibitor for A. Fib; prophylaxis Adjust from 150mg po bid to 75mg po bid w/ CrCl < 30 ml/min |
| Which SSRIs typically require a taper, and why? | Paroxetine and venlafaxine require a taper due to their short half-lives. These short half-lives are associated with more rebound depressive symptoms |
| What is the mechanism of action of Clonidine, and discuss the receptor with which it works on. | A2 agonist. A2 is inhibitory receptor |
| What are the 4 FDA warnings associated with PPIs? | 1.) osteoporosis 2.) Hypomagnesemia 3.) Increase risk of C. Diff infxn 4.)Plavix DDI |
| Which anemia(s) is microcytic and associated with a decrease in MCV? | Iron Deficiency Anemia |
| Which anemia(s) is macrocytic and associated with an increase in MCV? | B12/Folate Deficiency |
Created by:
jason.mallada
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