Questions 313 – 624
313. MOA of Plavix: Blocks the ADP receptors, which prevent fibrinogen binding at
that site and thereby reduce the possibility of platelet adhesion and aggregation.
314. Adverse Effects of Theophylline:
- Dose related acute toxicities include: tachycardia, nausea and vomiting,
tachyarrhythmias (SVT), central nervous system stimulation, headache, seizures,
hematemesis, hyperglycemia, and hypokalemia.
- Adverse effects at usual therapeutic doses: insomnia, gastric upset, aggravation
of ulcer or reflux, increase in hyperactivity in some children, and difficulty in urination in
elderly males with prostatism.
315. Respiratory distress in neonates is treated with caffeine. Loading dose of caffeine
citrate: 10-20mg/kg. Maintenance dose: 5mg/kg/day starting 24 hour after loading dose.
316. Drugs that will increase theophylline levels: cimetidine, cipro, biaxin, and
erythromycin.
317: You CAN NOT give carbamazepine for status epilepticus because it does not work
and there is no parenteral form.
318. Methotrexate for a child with Rheumatoid Arthritis is given ONCE WEEKLY.
319. Gestational diabetes: Usually resolves after delivery, although affected women
remain at an increased risk for development of type 2 DM later in life. Gestational
diabetes does NOT cause the birth defects seen in babies born to mothers who were
diabetic BEFORE pregnancy. Uncontrolled or poorly controlled gestational diabetes can
lead to ‘fat’ babies. (that’s not my terminology that’s the books!)
320. Raynaud’s disease: increased sensitivity to cold and numbness in extremeties.
Treatment usually includes DHP-CCB’s (such as nifedipine), alpha-blockers (prazosin)
and vasodilators (nitroglycerin). Daily low-dose aspirin is also usually prescribed for
antiplatelet affects. Drugs that aggravate Raynaud’s includes beta blockers, OTC
products containing pseudoephedrine, and birth control pills.
321. Furosemide has a pka of 3.7 at physiologic pH. Furosemide is an acid; acids are
non-ionized at acidic pH, but are ionized at basic pH. Physiologic pH is 7.4 which is
quite alkaline compared to 3.7. This means furosemide ionized to non-ionized ration
would be > 1:1000, so totally ionized.
322. Isosorbide dinitrate is dosed BID. Remember you need to allow for a nitrate free
period. So, a good regimen for isosorbide dinitrate would be 8AM and 5PM.
323. Know a significant p-value is < 0.05. Look over statistical tests in Herrings notes.
324. You can substitute Desitin ointment w/ zinc oxide.
325. Allopurinol interacts with 6-mercaptopurine (anti-neoplastic agent) by inhibition of
xanthine oxidase. Allopurinol will cause an increase in 6-mercaptopurine levels. The
dose of 6-mercaptopurine should be decreased by 75% when both drugs are used.
326. What do you give someone with a K+ of 7.5 and EKG changes first?
Usually treatment is IV calcium first, then IV bolus of 10-20 units of regular insuin with
25 grams of glucose (prevents hypoglycemia). Kayexalate is the next choice because it is
slow to work. Hemodialysis is the overall best (if choice) if time is available and K+ level
is severe. Peritoneal dialysis is less effective.
327. A question about a bell-shape curve with plots underneath and a k question that said
mean = 120, mode = 120, median = 120. I’m not sure what the deal is w/ this question.
But theoreitically w/ a bell shaped curve, mean=median=mode.
328. Feverfew is used for migraines, muscle soreness and rheumatoid arthritis.
329. Black cohosh is an herb that is used to treat hot flashes and menopausal symptoms.
330. PremPro: conjugated estrogens and medroxyprogesterone; strengths include 0.45
(conjugated estrogen)/1.5 (medroxyprogesterone), 0.625 (conjugated estrogen)/2.5
(medroxyprogesterone), and 0.625 (conjugated estrogen)/5mg medroxyprogesteron).
331. Alkylating agents: leukeran and nitrogen mustard
332. ODT: (I’m assuming that all tablets that dissolve in your mouth are considered
ODT). Know that Rizatriptan (Maxalt MLT), Odansetron (Zomig ODT) and Loratadine
(Claritin Reditabs) all have an orally dissolving tablet form.
333. A BIG contraindication for Wellbutrin is seizures because it lowers the seizure
threshold. Wellbutrin can cause seizures in those who have never had a seizure too!!
334. Home monitoring for asthma: peak flow meter.
335. Know that a counseling point to sulfa eye drops is that they burn when used. This
includes sulfacetamide (Bleph, Carmol) and sulfisoxazole (Gantrisin).
336. The indication for Exelon (rivastigmine) is mild to moderate Alzheimer’s and its
MOA is cholinesterase inhibitor.
337. Atovaquone is an alternative treatment of PCP in a patient with a sulfa allergy.
338. Vaccines with allergies to eggs include influenza and measles.
339. Hepatic encephalopathy is a syndrome observed in patients with cirrhosis. It is
characterized by personality changes, intellectual impairment, and a depressed level of
consciousness. There are 0-4 stages, with 4 being the most severest stage of coma. An
elevated blood ammonia level is the classic laboratory finding. Daily lactulose is
commonly used to decrease ammonia levels in the body. Neomycin and other antibiotics,
such as metronidazole, oral vancomycin, paromomycin, and oral quinolones, are
administered in an effort to decrease the colonic concentration of ammoniagenic bacteria.
Zinc is also used because patients with cirrhosis often have zinc deficiency.
340. CF patients are mostly affected by the organism pseudomonas aeruginosa. A
combo of an IV semisynthetic penicillin, a third or fourth generation cephalosporing, or a
quinolong and an aminoglycoside is typically recommended during acute exacerbations
for at least 10 to 14 days.
341. DHE: dihydroergotamine. Trade names include D.H.E. 45 and Migranal. It is used
for the treatment of migraine headache with or without aura; injection is indicated for
treatment o f cluster headaches. Pregnancy category X!! Do not give to patients with risk
factors for CAD until a cardiovascular evaluation. Dosage forms include IM, IV and
intranasal.
342. Calculation: one infant 0.94kg, drug dosed at 0.05mg/kg, given flow rate of 0.5ml
per hour (in fluid), drug flow of 2mg/ml how much drug will you need for 24 hours.
343.
- Pseudomonas first line treatment: imipenem or meropenem.
- Pseudomonas alternative treatment: Aztreonam, ceftazidime or antipseudomonal Blactamase resistant penicillins
- There is cross sensitivity with penicillins, cephs and carbapenems.
- DOC for staph are anti-staph penicillins (nafcillin, oxacillin, dicloxacillin)
- Treatment of Legionaire’s disease: quinolones or macrolides
- E. coli treatment: E. coli in the GI tract should not be treated with antibiotics.
Rehydrate patient if necessary. Should clear up on its own after 10-14 days.
344. As for the antibiotic questions, many answers included two drugs from one category
and three from another (ie, 3 cephs, and Biaxin and Zithromax) so not all questions could
you use the “which does not belong” theory to choose an answer. But that theory worked
well on others. Look to see if the question tells you they want out patient treatment or in
patient treatment. If it is out patient treatment then you know that they WOULD NOT
give an antibiotic that was IV.
345.
- Treatment for otitis media:
1. Amox 40mg/kg/day (if low risk; > 2, no day care, no antibiotics for past 3 months.)
2. Amox 80-100mg/kg/day (if high risk)
**Second-line includes Augmentin, Ceftin (cefuroxime), Cefzil (cefprozil),
Lorabide (loracarbef). Omnicef (cefdinir), Suprax (cefixime), and Vantin (cefpodoxime).
You would use second line if there is a hypersensitivity issue or if first AB did not work.
Treatment for recurrent otitis media:
Second round of high dosed Amoxicillin, Augmentin or Ceftin
346. Just states there are lots of calculation problems :-P
347. Another calc: need 50mg of morphine and you have a container containing
15mg/ml…how much do you need to use.
348. What do you recommend for a patient with HTN and a stuffy nose? It depends on
options given, but DO NOT recommend a product containing Sudafed.
349.
Adult:
Diarrhea: See peds section for who should see PCP. OTC options are loperamide
(Imodium), attapulgite (Donnagel, Kaopectate, Parapectolin and Rheaban), kaolin-pectin
mixture, polycarbophil (FiberNorm, Fibercon), BSS (Pepto-Bismol, *remember Reye’s
syndrome here) and digestive enzymes (Lactade).
Constipation:
Bulk forming laxatives (methylcellulose): indicated for short-term therapy to relieve
constipation, and they may be indicated for 1. ppl on low-residue diets that cannot be
corrected; 2. postpartum women; 3. patients of advanced age; and 4. patients with
colostomies, IBS, or diverticular disease.
Emollient laxatives (docusate sodium): best suited to prevent constipation and are of little
or no value in treating long-standing constipation, esp. in pts of advanced age or pts. Who
are debilitated. More prophylactic than therapeutic. Good for pts with abdominal hernia,
severe hypertension, or cardiovascular disease that should not strain to defecate, nor
should pts who are immediately postpoartum or who have undergone or are about to
undergo surgery for hemorrhoids or other anorectal disorders.
Lubricant laxatives (liquid petrolatum): Used in cases requiring the maintenance of a soft
stool to avoid strainging ( when there has been hernia, aneurysm, hypertension, MI, or
cerebrovascular accident, or after a hemorrhoidectomy or abdominal surgery). Docusate
is better to use in these pts, however, than liquid petrolatum.
Saline laxatives (magnesium citrate, magnesium hydroxide, magnesium sulfate, etc):
Indicated for use only when acute evacuation of the bowel is required, as when preparing
for endoscopic examinatioin or when eliminating drugs in suspected poisonings. They
have no place in long-term management of constipation.
Hyperosmotic laxatives (glycerin): Used in suppository form to be used for lower bowel
evacuation.
Stimulant laxatives (senna, cascara, castor oil, bisacodyl, etc): often used before
radiologic or endoscopic examination of the GI tract and before GI surgery, when
thorough evacuation of the bowel is crucial.
Vomiting: Take antacids, hitamine2-receptor antagonists (ranitidine, famotidine,
cimetidine, or nizatidine) or BBS for nausea caued by overeating. Take phosphorated
carbohydrate solutions for nausea and vomiting associated with upset stomach caused by
viral gastroenteritis, food indiscretioins, and emotional upset (Emetrol Liquid, Rekematol
Anti-Nausea Liquid). Take antihistamines for self-treatment of nausea and vomiting
caused by motion sickness. Seek medical attention if vomiting does not stop after 5 doses
of phosphorated carbohydrate solution or if any of the following s/sx: blood in vomit,
abdominal pain of distension, prolonged vomiting or nausea (more than 24-48 hours),
dehydration, fever, severe headache, pregnancy, weight loss of more than 5% of total
body weight, recent trauma or suspected poisoning.
Peds:
Diarrhea: Most acute nonspecific diarrhea in the US is self-limiting in nature.
Basically, keep your kid hydrated. If there is a 10% or greater dehydration, signs of shock
or unconsciousness, then they need to be hospitalized. Children need to see a PCP if they
have a fever greater than 101F, severe dehydration, protracted vomiting, chronic diarrhea,
severe abdominal pain, and stools that contain blood or mucus. Most OTC diarrhea
products are not indicated for children under the age of six.
Constipation: Most of these medicines for constipatioin are available in the
paharmacy over the counter and do not require an RX. They include Metamucil, Milk of
magnesia, Citrucel, or mineral oil.
Unlike laxatives in adults, they are generally not considered to be habit forming.
You should use them once or twice a day and work up on the dose until your child is
having a soft BM each day. If your child starts to have diarrhea, then you are giving too
much and you should cut back on the dose.
Senokot is also often commonly used in children, but it is actually a stimulant
lasative and not a stool softener, so you may not want to use it for long periods of time.
A newer medication, Miralax, is available only by prescription to treat
constipation, but is very effective.
If your child has been constipated for a long time or he is having discomfort or significant
pain with bowel movements then you may need to ‘clean out' backed up stool before the
stool softeners will work by using an enema, a glycerine suppository or high doses of
mineral oil. See your pediatrician for information on how to start begin this treatment for
acute constipation.
Vomiting: Rehydrate child. Upon parents request, may give OTC antihistamine.
For children 2-6 years old, may use Diphenhydramine (Benadryl) or Dimenhydrinate
(Dramamine). For children 6-12 years old may give Cyclizine (Marezine),
Diphenhydramine and Dimenhydrinate. **Notice I don’t have Meclizine up here because
it is not recommended for children under 12.
350. Arava MOA: inhibits pyrimidine synthesis, resulting in antiproliferative and
anti-inflammatory effects. Used to treat active rheumatoid arthritis.
351. Precose counseling:
1. Take with first bite of meal.
2. Do not change dosage or discontinue this med without talking to physician.
3. Do not take other meds with or within 2 hours of this medication unless directed by
physician.
4. Avoid alcohol.
5. May cause hypoglycemia.
6. If hypoglycemia occurs, give glucose if conscious or glucagons/IV glucose if
unconscious. (OJ won’t work here nor the usual ways to counteract hypoglycemia!)
7. May cause mild GI side effects for first few weeks.
352. Adefovir (Hepsera) is used for the treatment of chronic hepatitis B with evidence of
active viral replication (based on consistent elevation of ALT/AST or histologic
evidence), including patients with lamivudine-resistant hepatitis B.
353. Side effects of neupogen: Bone pain, splenomegaly
354. Side effects of methotrexate: GI, leucopenia, thrombocytopenia, renal failure,
alopecia, photosensitivity, depigmentation or hyperpigmentation of skin, diabetes,
**myelosuppression is the primary dose-limiting factor (along with mucositis), should
resolve within 2 week.
355. The treatment for PCP is also the prophylaxis for toxoplasmosis (Septra).
356. Prophylaxis:
CD4 < 200 : PCP, strep pneumo
CD4 < 100: Cryptococcal meningitis, herpes simplex virus, toxoplasmosis histoplasmosis
CD4 < 50: Cytomegalo virus, MAC, Cryptococcus
357.
Treatment for V. Fib: Electrical external defibrillation remains the most successful
treatment of VF. Make sure you anticoagulate. Adding on an anti-arrhythmic depends on
patient. This is not my strongest section. You can see more from APhA.
Treatment for supraventricular tachycardia: Vagal maneuvers are the first-line treatment
in hemodynamically stable patients. Vagal maneuvers, such as breath-holding and the
Valsalva maneuver (ie, having the patient bear down as though having a bowel
movement). Use IV adenosine or calcium channel blockers if vagal maneuvers do not
work. Other alternatives for the acute treatment of SVT include calcium channel blockers
like verapamil, dilitiazem or beta-blockers like metoprolol or esmolol. For long-term
medical management use calcium channel blockers, digoxin and/or beta blockers
(esmolol, metoprolol).
358. Treatment for iron overdose: Desferal (deferroxime).
359. Zetia: monitor LFT’s, CBC (thrombocytopenia). This question wanted to know what
to monitor for Zetia toxicity and side effects. Not sure what it is looking for. Definitely
can affect liver.
360. Standard deviation: standard deviation measures how spread out the values in a data
set are. More precisely, it is a measure of the average distance of the data values from
their mean. If the data points are all close to the mean, then the standard deviation is low
(closer to zero). If many data points are very different from the mean, then the standard
deviation is high (further from zero). If all the data values are equal, then the standard
deviation will be zero.
361. How to calculate BMI
Step 1: Multiply your weight in pounds by 703
Example: 703 x 200 lb = 140,600
Step 2: Multiply your height in inches by your height in inches
Example: 63 in x 63 in = 3,969
Step 3: Divide the answer in Step 1 by the answer in Step 2 to get your BMI
Example: 140,600 / 3,969 = 35.4
BMI = 35.4
Test
Measurement Group
BMI calculator 18.5 - 24.9
Normal
BMI calculator 25.0 - 29.9
Overweight
BMI calculator 30.0 - 34.9
Obese
362. See chemo section below #498
363. Know how to calculate with %w/w.
364. Some calculations are very wordy and more difficult than the calculations given by
the GA review.
365. IV diltiazem treats atrial fibrillation or atrial flutter and paroxysmal supraventricular
tachycardia (PSVT).
366. Flomax (tamsulosin) MOA: Alpha 1a adrenoreceptor antagonist in the prostate.
Smooth muscle tone in the prostate is mediated by alpha 1a adrenoreceptors; blocking
them leads to relaxation of smooth muscle in the bladder neck and prostate causing an
improvement of urine flow and decreased symptoms of BPH.
Imitrex (sumatriptan) MOA: selective agonist for serotonin (5HT1d receptor) in cranial
arteries and reduces sterile inflammation associated w/ antidromic neuronal transmission
correlating with relief of migraine. Treats migraine with and without aura as well as
cluster migraines. Pregnancy category C. Use caution in patients with CAD, those who
have used ergotamine derivatives or another 5HT1 agonist within the past 24 hours.
Indicated for patients 18 and older. Use caution also in pts with a h/o seizures.
Formulated in injection, nasal spray and tablet. Nasal spray: administer dose into ONE
nostril. May repeat in 2 hours. Max dose of nasal spray is 40mg/24hr. Max dose of oral is
200mg/24hr. Do not exceed two injections within 24 hours.
**there was no specific question with Imitrex. The person just said that they had a lot of
Imitrex questions.
367. Herbal treatment of cholesterol: Cat’s claw, garlic, evening primrose, policosanol,
and psyllium.
368. In reference to pediculocide: Mechanism of Action: Malathion is an
organophosphate with a broad spectrum of activity when used extensively as an
insecticide. Malathion inhibits the hydrolysis of acetylcholine (ACh) by
acetylcholinesterase (AChE) at the sites of cholinergic transmission in insects.
369. For any type of drug, improving compliance can be done by reducing the number of
doses that must be taken each day and to give a drug with the fewest uncomfortable or
dangerous side effects.
370. Erythromycin MOA: Binds to 50S ribosomal subunit resulting in bloackage of
transpeptidation (inhibits RNA-dependent protein synthesis at the chain elongation step).
371. Treatment of enterococcus faecalis: Usually treated with penicillin or ampicillin plus
AG. Other options are Synercid, Vanc, and Zyvox, and amp/sulbactam.
372. 30cal/20ml Ensure. Pt. receives 900ml total daily dose (formula has 7.3grams
lactose/100ml). What % total daily calories come from carbs?
373. Folic acid deficiency: also known as Macrocytic-normochromic anemia (pernicious
and folate-deficiency).
374. Periogard (chlorhexidine) MOA: Bactericidal as a result of the binding of this
cationic molecule to negatively charged bacterial cell walls and extramicrobial
complexes.
Periostat (doxycycline) MOA: Inhibits protein synthesis by binding with the 30S
ribosomal subunit.
375. The brand name of fluvastatin is Lescol.
376. t1/2 = 0.693/ke Vd = dose (known)/Cp (known) TPN calculations were also on
test.
377. There is no evidence to support that children with ADHD should avoid sugar.
378. Bicitra (Oracrit, Cytra-2, Bictira): Oral alkalinizing agent used for the treatment of
metabolic acidosis. Take 10-30ml with water after meals and at bedtime. Chilling before
use helps palatability. Causes a laxative affect if taken with meals.
379. Use hydroxyurea to increase fetal hemoglobin in sickle cell patients.
380. Filgrastin (neupogen) is used to increase neutrophils (stimulate granulocyte
production in chemotherapy induced neutropenia).
381. Patient is on Xanax. What other antianxiety medications can you suggest to decrease
daytime sedation? They have that diazepam, ativan and buspar are all correct. I can
totally understand buspar and ativan. Diazepam has a shorter duration of action compared
to Xanax…so, I’ll buy that too.
382. Diazepam does not mix well with most drugs in a syringe except for ketamine
(general anesthetic). The question was, do diazepam and Demerol (meperidine)
precipitate in the same syringe. I would say yes, but could not find a source that
specifically said yes.
383. OTC plantar wart treatment: Any product containing salicylic acid: Clear Away
Wart Remover, Compound-W, Dr. Scholl’s Clear Away, DuoFilm Wart Remover, OFFEzy and Trans-Ver-Sal.
384. Dosage form of concerta: osmotic controlled release tablet
385. Strattera (atomoxetine) is a selective NOREPINEPHRINE reuptake inhibitor. It
asked about the advantage of Strattera over Concerta…not sure. The only things I can
come up with is that Strattera isn’t controlled, nor is it a stimulant. Some children have
tics while on stimulants like Concerta. That’s all I can come up with guys.
386. What should you measure before starting Humira (adalimumab)? Perform a TB skin
test prior to initiating therapy. Monitor for signs and symptoms of infection. Assess for
liver dysfunction. (Humira treats active rheumatoid and active psoriatic arthritis).
387. Know that Lasix (furosemide) comes in an injection.
388. Another methotrexate question. Know that methotrexate DOES NOT cause
thrombocytosis. It causes thrombocytopenia (decrease in platelets), NOT thrombocytosis
(increase in platelets).
389. TPN running at 83cc/hr. 25% Dextrose, 4.25%A/A, 20% of 500ml fat. Calc total
calories patient receives in 24 hours.
390. Treatment of atopic dermatitis. Enhancing skin hydration can be achieved through
non-RX measures, as well as through the use of emollients and moisturizers.
Hydrocortisone relieves itching, and cool water compresses relieve weeping vesicles.
Know that hydrocortisone is the only steroid that may be applied to the face because
others are too potent to apply to the thin skin on the face since steroids cause thinning of
the skin.
391. The max daily dose of Prandin (repaglinide) is 16mg/day.
392. Symptoms of sepsis: fever, chills, hypotension, rapid heart beat, fast and swallow
breathing, confusion, disorientation, agitation, decreased urination, and dizziness. NOT
HYPERTENSION.
393. Sepsis treatment:
- Antimicrobial therapy (cover all likely pathogens), use IV antibiotics only, usually
combo used (one is usually AG), bacteriocidal agents are preferred
- Fluid therapy (use normal saline of lactated ringers
- Vasoactive drug support (dopamine, norepinephrine, or phenylephrine)
- Glucose control (maintain serum glucose < 150)
394.
- Passion flower: Used for anxiety and insomnia. Use caution with antianxity meds,
antidepressants, hypnotics or sedatives.
- Kava kava: Used for ADD in children and anxiety, sedation and fibromyalgia for adults.
May cause HEPATOTOXICITY. Contraindicated in parkinson’s disease.
- Valerian: Used for insomnia, nervous unrest, stress, depression, and anxiety. May cause
CV disturbances. Do not take with barbiturates.
- Milk thistle: Used for regeneration of hepatocytes, alcoholic liver damage, fatty liver,
etc.
395. Nitroprusside wrapped in aluminum foil DOES count as light sensitive.
396. Patient wants to check BG without pricking finger. Prior to availability of finger
sticks, products such as Clinitest Tabs and TesTape were used to check urine sugar that
then approximately correlated to BG.
397. 1 pound = 454 grams
398. Lasix (furosemide) has an oral solution formulation. Aricept does not have an oral
solution.
399. If you’re shown a structure with –COOH, this indicates and acidic structure (as in
furosemide).
400. Cystic fibrosis is the most common lethal genetic disease in whites. A diagnosis of
CF is generally made during childhood, but some are diagnosed during adolescence or
adulthood. Median survival is 33 years. This is an autosomal-recessive disorder caused
by mutations of the cystic fibrosis transmembrane conductance regulator (CFTR), a gene
located on chromosome 7. Basically, CF patients have impaired mucociliary clearance.
Secretions become infected, and a vicious cycle of infection, inflammation, and chronic
airways obstruction ensures, resulting in bronchiectasis, chronic infection, and ultimately
premature death.
Diagnosis based on family history, persistently elevated concentrations of sweat
chloride, two known disease-causing CF mutations, or nasal transeptithelial potential
difference measurements that are typical of CF.
Symptoms initially include cough and purulent sputum production. Dyspnea
ensues as the disease progresses. PSEUDOMONAS AERUGINOSA!!!!! Extrapulmonary
manifestations include pancreatic exocrine insufficiency. Pancreatitis occasioinally
develops.
Nonpharm. Treatment: Mucus mobilization, pulmonary rehabilitation, oxygen
therapy, yearly flu vaccine, and pneumovax vaccine.
Pharm. Treatment: bronchodilators (such as beta-adrenergic agonists…think
COPD treatment), Dnase, Pulmozyme, antibiotics, glucocoticoids, azithromycin (daily
kind of like prophylaxis sort of).
401. If you have a patient on nitroglycerin, DO NOT give them a phophodiesterase-5
inhibitor such as…Viagra, Cialis or Levitra. It is okay, however, to give something like
Muse or Caverject.
402. Live vaccines include the following: Influenza, measles, mumps, rubella, typhoid
oral, varicella, vaccinia (smallpos), and yellow fever. DO NOT GIVE A PREGNANT
WOMAN A LIVE VACCINE. Contras during pregnancy: FluMist (LAIV). You may get
tetanus/diphtheria vaccine during pregnancy.
403. Spleenectomy and vaccines: in most cases, live virus vaccines (e.g., chickenpox,
measles, mumps, and rubella--or MMR) should not be given if the spleen was removed
because of a malignancy (such as lymphoma) or because of some other condition that
requires immunosuppressive treatment (e.g., steroids). However, DTaP, inactivated polio,
hepatitis B, pneumococcal, meningococcal, and Haemophilus influenzae type b (Hib)
vaccines are perfectly safe.
404. Know that metformins’ primary MOA is that is works in the liver to inhibit glucose
production by the liver. It also works in the muscle and fat tissue to increase the reuptake
of glucose into these tissues. In the gut, it decreases intestinal absorption of glucose.
Dosing: IR formulation 500 to 850mg daily or 500mg BID. Max dose is 2550mg (think
850mg TID). The XR formulation is 500mg daily at supper with a max dose of 2000mg.
Know that metformin should be held 24 hours before and 48 hours after contrast.
405. Naproxen has a pka of 4.2. What will happen at plasma pH? Same as furosemide,
they’re both acids. See earlier question.
406. Too much DHE (dihydroergotamine/Migranol): peripheral ischemia, paresthesia,
HA, nausea and vomiting.
407. Equianalgesic dosing:
1.5 mg methadone = 1mg IV MSO4 = 1mg Oxycodone = 3mg po MSO4 = 10mg
Fentanyl = 0.2 mg Dilaudid
408. Cubicin (daptomycin): Used to treat complicated skin and skin structure infections
caused by susceptible aerobic gram positive organisms. Treats bacteremia, endocarditis
and other severe infections caused by MRSA and VRE.
Pregnanct category B. May be associated with an increased incidence of myopathy in
conjunction with an increased CPK. May cause peripheral neuropathy. Inhibits
intracellular synthesis of DNA, RNA and protein by causing rapid depolarization. It is
bactericidal in a concentration-dependent manner. Infuse over 30 min.
409. Permethrin is found in all of the following: Nix, Elimite, Acticin, and Rid spray.
410. Know what to do for elevated INRs. I think this question should already be
answered previously.
411. Zantac IV dosing: 50mg every 6 to 8 hours.
412. HRT: If the woman has a uterus, then use estrogen/progestin combos. If a woman
has had a hysterectomy and she has no uterus, then give her HRT of estrogen alone.
They only wrote ‘cyclical progestin and hysterectomy’. Not exactly sure what they were
going for here. I’ve looked in notes from class and also on the web. The only other thing I
know about cyclic progestin is that there is increased risk of break-thru bleeding with this
and that women on cyclic progestins may have a higher risk of developing endometrial
hyperplasia…which may lead to cancer later on.
413. Least effective treatment for prostate cancer: Inhibits the conversion of testosterone
to dihydrotestosterone (DHT). Finasteride, brand named Proscar, is the principle drug in
this class. This class of drugs is probably the least effective. If this isn’t the answer, the
person who wrote this question out chose chemotherapy (alkylating agents), since chemo
is last resort. There are six groups of alkylating agents: nitrogen mustards; ethylenimes;
alkylsulfonates; triazenes; piperazines; and nitrosureas.
414. Cytoxan is similar to ifosfamide.
415. Bicitra (sodium citrate and citric acid). This is an oral alkalinizing agent. Treats
metabolic acidosis.
416. Infectious mononucleosis can be spread from person-to-person, via saliva.
417. Pseudomembranous colitis caused by clindamycin, lincomycin, ampicillin, or
cephalosporin. Antimicrobial agents (including antifungal, antiviral, and metronidazole)
could incite the disease.
418. Dosage forms of sumatriptan (imitrex): tablet, nasal spray, injection
419. Protease inhibitors: THINK -NAVIR
Ritonavir
Nelfinavir
Indenavir
Amprinavir
Adazanavir
Lopinavir
Fosamprinavir
Saquanavir
Tipranavir
420. What should be in an emergency bee sting kit? This was a k type question. The
person chose epinephrine (epi-pen) AND Tylenol. I could NOT find any info about
having Tylenol with a bee sting kit. I wouldn’t choose that answer. But if someone else
knows something I don’t, they can enlighten me 
421.
Lactulose is used as an ammonium detoxicant or osmotic laxative. Use caution in patients
with DM. Monitor for electrolyte imbalances when used for >6 months. If administered
through a gastric or feeing tube, should dilute 60-120ml in water.
Kayexalate (sodium polystyrene sulfonate): used in the treatment of hyperkalemia. Use
caution in pts with CHF, hypertension, edema, or renal failure. Large doses may cause
fecal impaction. Edema will reduce serum potassium faster, but the oral route will result
in a greater reduction over several hours. Causes a bunch of GI disturbances (anorexia,
colonic necrosis, etc).
422. TPN calc questions about calories.
423. Know how to convert mMol/liter to mg/dl.
424. Dosage of indomethacin (Indocin): 25-50mg/dose 2-3 times a day. Max dose is
200mg/day. Extended release capsule should be given on a 1-2 times/day schedule. Max
dose for sustained release is 150mg/day.
425. Treatment for EPS: Discontinue offending agent. Specific agents for the treatment of
EPS are the anti-Parkinson agents such as trihexphenidyl (Artane) or benztropine
(Cogentin), or other anticholinergics such as diphenhydramine (Benadryl). Cogentin and
Benadryl are most commonly prescribed as these agents are well known to be effective
and are preferred due to low toxicity.
426. Imitrex (sumatriptan) works on the serotonin 5-HT1D receptor (agonist).
Contraindications for Imitrex include the following: ischemic heart disease,
cerebrovascular syndromes, peripheral vascular syndromes, uncontrolled HTN, use
within 24 hours of ergotamine derivatives, use with another 5-HT1 agonist within 24
hours, use with MAOI’s within a 2 weeks, and severe hepatic impairment.
427. EES ointment is given to neonates to prevent gonorrhea infection in the eyes.
428. What would you give to someone who had too much albuterol…beta blocker would
work. Especially a cardioselective beta blocker (atenolol, acebutolol, bisoprolol and
metoprolol).
429. Several allegation and mEq questions.
430. Capsacin best if given how? Apply to affected area at least 3-4 times a day;
application frequency less then 3-4 times/day prevents the total depletion, inhibition of
synthesis, and transport of substance P resulting in decreased clinical efficacy and
increased local discomfort. Now, who the hell would’ve known that?
431. Question about why a patient was switched from mellaril to risperal. This person
chose because patient had an increase in AIMS score. This makes sense to me because
typical antipsychotics, such as mellaril, tend to have more problems with EPS adverse
effects. Switching to an atypical antipsychotic, such as risperal, would probably cut back
on that AIMS score since they’re supposed to have less problems with causing EPS.
432. This is what you would tell someone about OTC occult blood tests:
Avoid certain medications and foods:
Non-steroidal anti-inflammatory drugs such as ibuprofen, naproxen, or aspirin (no more
than one adult aspirin per day) for seven days prior to testing
Vitamin C exceeding 250 mg per day from either supplements, citrus fruits, or juices for
three days before testing
Red meats for three days before testing
Raw fruits and vegetables, radishes, turnips, horseradish, and melon for three days before
testing
Wait until your hemorrhoids are not bleeding
Avoid the test during your menstrual period
Avoid cleaning your toilet bowl for several days before the test (chemicals from the
cleanser can affect the test)
433. Prevnar (pneumococcal conjugate vaccine 7-valent) is an immunization for infants
and toddlers against strep pneumonia infection caused by serotypes included in the
vaccine. For all children 2-23 months. Don’t give if child has a hypersensitivity to
diphtheria toxoid. This does not replace the 23-valent pneumo polysaccharide vaccine.
434. Those who should have influenza vaccine:
- persons ≥ 65 years of age
- residents of nursing homes and other chronic care facilities that house persons of any
age with chronic medical conditions.
- adults and children with chronic disorders of the pulmonary or cardiovascular systems,
including children w/ asthma
- adults and children who have required regular medical follow-up or hospitalization
during the preceding year because of chronic metabolic disedases (including DM), renal
dysfunction, hemoglobinopathies, or immunosuppression.
- Adults and children w/ conditions which may compromise respiratory function, the
handling of respiratory secretions, or that can increase the risk of aspiration (ed, cognitive
dysfunction, spinal cord injuries, seizure disorders, other neuromuscular disorders)
- children and adolescents (6 months to 18 years) who are receiving long-term aspirin
therapy and therefore, may be at risk for developing Reye’s syndrome after influenza.
- Women who will be pregnant during the flu season
- Children 6-23 months of age
- Vaccination is also recommended for persons 50-64 years of age, close contacts of
children 0-23 months of age, healthy persons who may transmit influenza to those at risk,
all healthcare workers, and persons who smoke.
435. Doxorubicin and cyclophosphamide need to be refrigerated.
436. Amphotericin B reconstitution: Add 10ml of SWFI (sterile water for injection;
without a bacteriostatic agent) to each vial of ampho B. Further dilute with 250-500ml
D5W. Final concentration should not exceed 0.1mg/ml (peripheral infusion) or
0.25mg/ml (central infustion).
437. Zithromax label should have shake well label.
438. A lady wanting antihistamine eye drop and having dark spot in vision – tell her to
see a physician.
439. Injectable PPI’s: esomeprazole (nexium), lansoprazole (prevacid), pantoprazole
(protonix…this may have been discontinued).
440. Sickle cell patient with anemia: Give hydroxyurea (pts with sickle cell should also
be on folic acid just FYI).
441. Not a helpful statement.
442. Statistics question about significance.
443. A brand name of cefotaxime is Claforan. A question about Claforan 300mg/ml and
how much NaCl 0.9% should be mixed to make 2ml dose. Said it didn’t give a table to
show how much the powder would be equivalent to. Person had to guess.
444. Hyalgan (hyaluronate and derivatives) MOA: A polysaccharide that is distribuated
widely in the extracellular matrix of connective tissue. Forms a derivative form of
viscoelastic solution in water which makes it suitable for aqueous and vitreous humor in
ophthalmic surgery, and functions as a tissue and/or joint lubricant which plays an
important role in modulating the interactions between adjacent tissues.
Use: treatment of pain in osteoarthritis in knee in pts who have failed non-rx treatment
and simple analgesics. Intradermally used to correct moderate-to-severe facial wrinkles
or folds (wonder if I’ll need that one day). Opthalamic: surgical aid in cataract extraction,
intraocular implantation, corneal transplant, glaucoma filtration, and retinal attachment
surgery.
445. Zovirax (acyclovir) counseling: This is not a cure for herpes. Do not take any other
meds with this unless directed by physician. This will not reduce risk of transmitting it to
someone else. Avoid sexual intercourse when you have visable lesions (that’s a pleasant
thought). Use as directed for full course of therapy. Oral doses may be taken with food.
Maintain adequate hydration. May cause nausea/vomiting. Call PCP if you have any
funky adverse effects.
446. Treatment of pseudomembranous colitis in a pt. with PCN allergy: Metronidazole is
usually used to treat the disorder, but vancomycin or rifaximin may also be used
447.
Aminoglycoside MOA: Binds to the 30S ribosome to inhibit protein synthesis.
Synagis (Palivizumab) is used for RSV prevention in children <2 years old (monoclonal
antibody).
448. Forteo (Teriparatide): This is a parathyroid analog used in the treatment of
osteoporosis in postmenopausal women at high risk of fracture; treatment of primary or
hypogonadal osteoporosis in men at high risk of fracture. Stimulate osteoblast function,
increases GI absorption of calcium, and increases renal tubular reabsorption of calcium.
449. Repeat: Bicitra (sodium and citric acid) alkalizing agent. Used for metabolic
acidosis.
450. PhosLo (calcium acetate) MOA: combines with dietary phosphate to form insoluble
calcium phosphate which is excreted in feces. This is used to control hyperphosphatemia
in end-stage renal failure. IT DOES NOT PROMOTE ALUMINUM ABSORPTION.
451. Morphine causes hypotension and bradycardia.
452. Weight gain is a side effect of Actos (pioglitazone)
453.
Mean: the arithmetic average, the average you are probably used
to finding for a set of numbers - add up the numbers and divide by how
many there are
Median: number in the middle. In order to find the median,
you have to put the values in order from lowest to highest, then find
the number that is exactly in the middle:
Mode: the value that occurs most often.
454: Enbrel (etanercept)
MOA: TNF blocker
Administration of dose: SQ
Initial storage of drug: Refrigerate (do not freeze) Stability of vials after reconstitution:
14 days in refrigerator
Indication: RA
455: REPEAT:
Allergic to eggs: can’t get measles vaccine and no influenza vaccine
No spleen: get pneumococcal vaccine
456: Serevent (salmeterol; long acting beta agonist) Dry powder inhaler, that is stable for
6 weeks after removing foil.
457: Sandostatin (Octreotide acetate): This is an antidiarrheal, somatostatin analog.
458: Cyclophosphamide needs to be refrigerated after reconstitution.
459: Lots of TPN questions with calculations, dopamine questions w/ calculations.
460.
Plavix MOA: blocks ADP receptors, which prevent fibrinogen binding at that site and
thereby reduce the possibility of platelet adhesion and aggregation.
Lovenox MOA: Acts as an anticoagulant by enhancing the inhibition rate of clotting
proteases by antithrombin III impairing normal hemostasis and inhibition of factor Xa.
Metformin MOA: Decreases hepatic glucose production, decreasing intestinal
absorption of glucose and improves insulin sensitivity (increases peripheral glucose
uptake and utilization)
Aminoglycoside MOA: binds 30S to inhibit protein synthesis
Vanc MOA: inhibits bacterial cell wall synthesis by blocking glycopeptide
polymerization through binding tightly to d-alanyl-d-alanine portion of cell wall
precursor.
Cipro MOA: binds 50s ribosomal subunit resulting in blockage of transpeptidation.
Septra MOA: Interferes with bacterial folic acid synthesis and growth via inhibition of
dihydrofolic acid formation from para-aminobenzoic acid; trimethoprkim inhibits
dihydrofolic acid reduction to tetrahydrofolate resulting in sequential inhibition of
enzymes of the folic acid pathway (whew).
461. Converting an oral Cipro dose to IV dose?? All I can find is 500mg oral cipro =
400mg IV cipro. Pretty sure that’d get ya there.
462. They give you a bunch of drugs and doses and asked which ones were wrong or not
available in those doses. They had Bumex 40mg (correct 0.5mg, 1mg, 2mg) and
Lopressor 25 (correct 50mg and 100mg).
463. A few diabetes questions…what the therapy could be changed to. Also, a few (2) on
insulin dosing.
464. Vasotec (enalapril) is the only ACEI that comes in IV.
465. Know that vitamin K is given to babies at birth until they can produce their own.
466. Repeat question on Coumadin and INR.
467. Know that Vitamin B6 is given to patients on INH to stop peripheral neuropathy.
468. Peripheral neuropathy: Tylenol, NSAIDS, neurontin, tetretol, dilantin, lidocaine
patch, TCA’s, SSRI’s, and opioid analgesics (codeine and oxycodone).
469. “A patient had hepatic encephalopathy, and some other conditions (I don’t
remember) and asked why hewould be on a protein restricted diet. I picked the
encephalopathy (he wasn’t on any MAOI or Levodopa). I’m pretty sure this is right.
470. Know that garlic is used for cholesterol.
471. Calculate clearance of digoxin, if they give you t1/2 and Vd
t1/2 = 0.693/ke
Cltotal = ke/Vd
472. What lab you would need to get before you get a phenytoin level. This person
picked albumin level. Others didn’t make sense. This drug is highly protein bound so, I’ll
buy that.
473. Question as to which would not put a patient at risk for DVT. The choices were
smokes, obesity, recent surgery, birth control pills, and GI bleed. Answer is GI
bleed…please God let me get easy questions like these…
474. An EZ detector measures fecal blood.
475. You give vitamin K1 (Mephyton, phytonadione) to reverse Coumadin.
476. A couple of questions regarding reference books. Where to look up if a new drug is
available yet? Choices were like Facts & Comparisons, PDR, AHFS (American Hospital
Formulary something) and a few other choices.
477. One question listed a few devices and asked which one was for BG (OnTouch).
Again, please give me simple questions like these!!
478. Question on insulin devices and pumps. I think your rapid acting insulins are the
ones used here (humalog, novalog, apidra; I think that lispro clogs the line more
frequently and novolog is the one used most frequently).
479.
Synercid = Dalfopristin and quinopristin
480. Same question on Phoslo.
481. Again, calculate BMI
482. Know that for the treatment of CMV, ganciclovir is available as an ocular insert.
483.
Varicella vaccine: Given at 12 months
Know that you do not give an immunocompromised patient a live or bacterial vaccine.
Table 9-1: Vaccination of Immunocompromised Adults
Post-Solid
Severely
Organ
Chronic
Symptomatic
ImmunoTransplant /
hepatic
Asymptomatic
Renal
HIV Infection compromised
Chronic
Asplenia
disease,
HIV
Failure
/ AIDS
(non-HIV
Immunocirrhosis,
related)
suppressive
diabetes
Therapy
Live Vaccines
Bacille
Calmette
Guerin
X
X
X
X
U
U
U
Influenza
(LAIV)
X
X
X
X
U
X
X
MMR
(MR/M/R)1
R
W
X
X
U
U
U
Typhoid,
Ty21a
X
X
X
X
U
U
U
Varicella
(Adults)2
U
X
X
X
U
U
U
Yellow Fever3
W
X
X
X
U
U
U
Killed (Inactivated) Vaccines
Haemophilus
influenzae(
Hib)
C4
C4
R
R
R
U
U
Hepatitis A
U5
U5
U
U
U5
U5
U5
Hepatitis B
U5
U5
U
U
U
R6
U
Influenza
(inactivated)
R
R
R
R
R
R
R
Japanese
encephalitis
U
U
U
U
U
U
U
Meningococcal
U
U
U
U
R
U
U
Pneumococcal
polysaccharide
R
R
R
R
R
R
R
Polio (IPV)
U
U
U
U
U
U
U
Rabies
U
U
U
U
U
U
U
Td
R
R
R
R
R
R
R
Typhoid, Vi
U
U
U
U
U
U
U
R = Recommended for all in this patient category
U = Use as indicated for normal hosts
C = Consider
W = Warning
X = Contraindicated
484.
Initial treatment of TB: INH 300mg qd, RIF 600mg qd, pyrazinamide 15-30mg/kg qd,
and EITHER ethambutol 15 mg/kg qd OR streptomycin 15mg/kg.
485. If morphine becomes toxic due to decreased clearance, what happens? (you’re SOL)
Symptoms or toxic effects of morphine usage include constriction of the pupils,
constipation, urinary retention, nausea, vomiting, hypothermia, drowsiness, dizziness,
apathy, confusion, respiratory depression, hypotension, cold clammy skin, coma, and
pulmonary edema.
486. Antiemetic agents that act on serotonin receptors:
- Aloxi (palonesetron)
- Anzemet (dolasetron)
- Kytril (granisetron)
- Zofran (odansetron)
487. EPS
Tardive dyskinesia: involuntary movements affecting mouth, lips and tongue. Reduce
med dose or change type of med.
Parkinsonism: Tremors, rigidity, temporary paralysis and extreme slowness of
movement.
Akathesia: Pacing and the inability to sit still (the need to move).
Acute dystonia: Spastic contraction of muscle groups. Most often effects neck, eyes and
trunk. Occur suddenly and are very painful to patient. Usually occurs within the first
couple of days of treatment.
Neuroleptic malignant syndrome (NMS): Potentially fatal if not treated. Includes
diffuse muscle rigidity, tremor, high fever, labile blood pressure, cognitive dysfunction,
and autonomic disturbances. Usually occurs within first few weeks of treatment.
So, if a patient has slurred speech and a drooping face, the patient is probably
experiencing tardive dyskinesia.
488. A 10 year old kid has allergies, what do you give him prophylactically to prevent
asthma attacks? Choices were albuterol, salmeterol, alupent, and 2 steroid choices.
Answer: you’d prevent with a long acting beta2 agonist, such as Salmeterol (Serevent).
489. Person had quite a few questions on spacers and devices. They gave a list of 5 and
asked which one was not an appropriate device.
490. Fosamax only comes in an oral solution and tablet form. It DOES NOT comes in an
IV formulation.
491. NaCl equivalent problem
492. Citrucel, FiberEase (methylcellulose): This is a laxative used as an adjunct to the
treatment of constipation.
493. Why is polyvinyl chloride put in an eyedrop?
Polyvinyl alcohol works by decreasing the surface tension of the tears so that they spread
more easily over the surface of the eye and don't break into dry spots. It also has
properties similar to the natural mucin produced by the conjunctiva, which soothes and
lubricates the eye and enhances the stability of the tear film.
494. Lost of chemo questions….GREEAAAAT….
495. Mesna is given with cyclophosphamide and ifofosfamide to prevent hemorraghic
cystitis.
496. Which chemo agent must be put in a non-PVC line and be filtered first? (seriously?!
Wtf?)
Docetaxal
This it the only one I could find guys. But I think it’s the only one :-P
497. Repeat of which chemo agents need to be refrigerated. Cyclophosphamide and
doxorubicin
498. Cancer shit
Alkylating Agent
- Cyclophosphamide & Ifosfamide
- Cisplatin & Carboplatin & Oxaliplatin
- Other agents: mechlorethamine, chlorambucil, busulfan, dacarbazine, melphalan,
thiotepa, procarbazine, temozolamide
- Nitrosureas
Cyclophosphamide: Myelosuppression (dose limiting toxicity)
Ifosfamide: Hemorrhagic cystitis (dose limiting toxicity), CNS toxicity (give methylene
blue)
**prevent hemorrhagic cystitis with MESNA (mercaptoethane sodium) and hydration.
Cisplatin: causes the most vomiting, nephrotoxicity (dose limiting)
Carboplatin: myelosuppression (don’t give to pts already on myelosuppressive agents)
Oxaliplatin: Peripheral neuropathy (dose limiting)
**Amifostine prevents damage to normal tissues
Oral alkylating agents: Chlorambucil, Busulfan, melphalan, temazolamide
Antitumore Antibiotics
- Anthracen derivatives (red in pure state, orange in bag)
- doxorubicin (Adriamycin)
- daunorubicin
- idarubicin
- epirubicin
- Mitoxantrone (indigo blue when diluted; sweat, tears, spit are blue)
- Bleomycin
- Mitomycin C
-
-
These meds cause mylosuppression, cardiotoxicity (cumulative doses >
550mg/m2), and extravasation injury (use central catch to prevent chemo burns on
arm)
Dexrazoxane is effective in preventing cardiac damage
Antimetabolites
- Antifolates/methotrexate (myelosuppression and mucositis; if life-threatening
give Leucovorin)
- Purine analogs
o 6-mercaptopurine (6-MP)
o Fludarabine
o Cladribine
- Pyrimidine antagonists
o Cytarabine (myelosuppression; 100mg/m2/day max)
o Fluorouracil (5-FU) {myelosuppression, bloody diarrhea and stomatitis,
mucositis)
o Capecitabine 2500mg/m2 PO divided in two daily doses
o Gemcitabine
o Floxuridine
Plant Alkaloids
- Vinca Alkaloids
o Vincristine (max dose 2mg) Dose limiting neurotoxicity
o Vinblastine (myelosuppression)
o DO NOT give these intrathecally
- Vinorelbine
- Toxoids
o Paclitaxel (hypersensitivity reaction; premed w/ Tylenol, Benadryl, H2 or
5HT blocker)
o Doxetaxel
499. Neulasta (pegfilfrastim): This is a colony stimulating factor used to decrease the
incidence of infection, by sitmulation of granulocyte production, in patients with
nonmyeloid malignancies receiving myelosuppressive therapy associated with a
significant risk of febrile neutropenia. Can’t use this is you’re allergic to something like
e.coli protein? Not sure how you find out how the hell you’re allergic to that. Stored in
fridge and is protected from light. MOA: stimulates production, maturation and activation
of neutrophils, pegfilgrastim activates neutrophils to increase both their migration and
cytotoxicity.
500. You can find off labeled uses for drugs in Facts and Comparisons.
501. Zithromax suspension: may or may not be stored in fridge; shake well; do not take
on full stomach.
502.
Interferon alpha: Don’t know which alpha so, it’s hard to give info on this question.
Adriamycin (Doxorubicin): Anthracycline antineoplastic agent. Used to treat leukemias,
lymphomas, multiple myeloma, among other cancers. Lots of cardiovascular AEs.
Recommended maximum cumulative dose: 550mg/m2. You should not give this drug if
left ventricular EF <30-40%.
Blenoxane (Bleomycin): Antineoplastic agent, antibiotic. Used to treat squamous cell
carcinomas, melanomas, sarcomas, testicular carcinoma, Hodgkin’s lymphoma and nonHodgkin’s lymphoma. May cause Raynaud’s phenomenon, stomatitis and mucositis.
Refrigerate intact vials of powder. Maximum cumulative lifetime dose: 400 units; 1unit =
1mg.
503. Miacalcin: It only goes in 1 nostril daily; only has to be primed once when opening
it the first time; does NOT have to be given in the morning.
504. PTU can cause agranulocytosis.
505. Travuluzimab works on HER-1 receptors.
(I tried looking up info on this drug and can’t find it. I assume it’s spelled wrong)
506. 2 drugs for RSV treatment: paluzimab and ribavarin
507. Know that propofol is an emulsion in soybean oil and egg phosphatide. Apparently,
this is important allergy-wise before giving it to patient.
508. 2 questions on diaper rash. All I know about diaper rash is to slap some zinc oxide
on their butts.
509. Medwatch: A list of reported side effects; completely voluntary reporting.
510. Xenical (orlistat) This is a lipase inhibitor to manage obesity, which includes weight
loss and weight management when used in conjunction with a reduced-calorie diet;
indicated for obese patients with an initial BMI ≥ 30kg/m2 of ≥ 27kg/m2 in the presence
of other risk factors. Dosed 120mg tid with each main meal.
511. 12 hours after an MI…which is not helpful? TNKase, heparin, metoprolol, lipitor
and something else.
TNKase needs to be administered as soon after MI as possible. This is a thrombolytic
agent used to help increase change of survival after an MI.
512. Know that ACEI are used to decrease mortality in CHF.
513. Nicotine formulations: gum, lozenge, inhaler, patch, and intranasal spray.
514. What is not true about nicotine patches? They are applied daily, not every 3 days.
515. What do you monitor when a patient is on a diuretic: weight, I&O daily; BP,
orthostasis, serum electrolytes, and renal function.
516. Nomotop (Nimodopine) is for subarachnoid hemorrhage. This is a calcium channel
blocker.
517. Infasurf (colfosceril) is indicated for the prevention of Respiratory Distress
Syndrome (RDS) in premature infants at high risk for RDS and for
the treatment (“rescue”) of premature infants who develop RDS.
Infasurf® decreases the incidence of RDS, mortality due to RDS,
and air leaks associated with RDS. Intratracheal Suspension.
518. What is true of antihistamines? They picked that they can be given 1 hour prior to
exposure to the allergen.
519. Lost of math questions.
520. You can raise HDL by exercising.
521. Know allegation, drip rates, TPNs
522. Doctor write for G-CSF on RX, what is he asking for? Neupogen (filgrastin).
523. MONA-B for MI (Morphine, Oxygen, Nitroglycerin, Aspirin, Beta-blocker)
524. Again, don’t give live viruses to HIV patients.
525. Valerian is an herb that is used as a sedative.
526. Know conversions (drops to ml’s, ounces to gallons, mls to gallons, etc)
527. Always look at allergies in the patients because the questions often ask for
alternatives for the meds.
528. This person had very little questions on CVD, DM, psychiatric, BC or CF.
529. Lithium is used in the management of bipolar disorders; treatment of mania in
individuals with bipolar disorder (maintenance treatment prevents or diminishes intensity
of subsequent episodes).May cause some cardiac and central nervous system AEs. Initial
dosing for bipolar is 900-2400mg/day in 3-4 divided doses or 900-1800mg/day in two
divided doses of SR formulation. Draw a trough just before next dose (8-12hours after
previous dose). Serum level should be 0.8-1.0mEq/L.
AE’s indicating toxicity include the following: GI complaints, tremor, confusion,
comnolence, seizures, coma, death.
530. Question of blood glucose monitor and pregnancy test monitor.
531. DO NOT use Demerol in a patient with a seizure disorder.
532. Goal percentage for home monitoring for asthma with a peak flow meter is 80-100%
(green zone).
533. Question about Prilosec dosing: 20mg TID is too high.
534. An adverse effect of Metformin is lactic acidosis.
535. Repeat question on Prevnar.
536. Fentanyl IV is Sublimaze (0.05mg.ml)
537. Glucovance (metformin and glyburide)
538. Albumin is important for measuring calcium levels and possibly other highly protein
bound drugs (e.g. phenytoin).
539. What do you not take 4 hours before using an Advance cholesterol test kit? Do not
take Vitamin C is doses of 500mg or more and do not take standard doses (325-1000mg)
of acetaminophen within 4 hours of testing. (this person had the wrong answer here, so
I’m glad I spend 20 minutes looking it up!!)
540. Nolvadex (tamoxifen)
541. Know how to convert cm to inches so that you can calculate BSA to dose
chemo…yay, sounds like fun.
542. Diaper rash: Change diapers frequently at least six times a day; avoid putting rubber
pants over cloth diapers or using highly absorbent disposable diapers. During every
diaper change, flush the infant’s skin with plain water and gently pat it dry or allow to air
dry. Do not wipe the infant with any part of the diaper. Do not use detergent or ordinary
lye-based soaps to launder cloth diapers; avoid starched or very still diapers; avoid
commercial baby wipes that contain alcohol, perfumes and soap, which may burn or sting
the skin. Mostly caused by Candida.
543. Lyposyn III (fat emulsion) can be stored at room tempterature.
545. Stadol (butorphanol): Dosage forms are injection and intranasal spray.
546.
Questran (cholestyramine resin) MOA: forms a nonabsorable complex with bile acids in
the intesting, releasing chloride ions in the process; inhibits enterohepatic reuptake of
intestinal bile salts and thereby increases the fecal loss of bile salt-bound low density
lipoprotein cholesterol.
Colchicine MOA: Decreases leukocyte motility, decreases phagocytosis in joints and
lactic acid production, thereby reducing the deposition of urate crystals that perpetuates
the inflammatory response.
Pt. counseling: Consult prescribing about low-purine diet. Maintain adequate hydration
unless restricted by fluid intake. Do not use alcohol or aspiring-containing medication
without consulting prescriber. You may experience nausea, vomiting, or anorexia; hair
loss. Stop medication and report to prescriber if severe vomiting, watery or bloody
diarrhea, or abdominal pain occurs. Report muscle tremors or weakness; fatigue; easy
bruising or bleeding; yellowing of the eyes or skin; or pale stool or dark urin.
547: Lotrel (amlodipine and benazepril)
548: What herb treats BPH…saw palmetto.
549. Given a patient profile with antibiotic regimen (theirs was clindamycin) what type of
organisms treated: gram (+), gram (– )and anerobe
550. How to treat pt who comes to ER with migraine unresponsive to Imitrex <5 hours.
Not positive, but ergots are the second choice of treatment after triptans. They had listed
(as choices they had I guess?) morphine, Tylenol #3, ibuprofen, and dihydroergotamine.
551. Prophylaxis regimen to give nurse who stuck herself removing IV line from HIV pt:
The most common PEP regimen is Combivir® (AZT & Epivir in one pill) alone or in
combination with Viracept®. PEP is usually prescribed for a period of 4-6 weeks.
Ideally, these drugs are begun immediately after a suspected exposure, however they can
be started as long as 72 hours after exposure. The stats are in and the results are mixed.
Statistics do show that the sooner they are started the better chance they have in reducing
the risk of HIV infection.
552. Again, lots of calculations.
553. Again, review this handout for help.
554. Had a lot of patient profile questions and the calculations were simple math
problems. Calculations included: mEq, dextrose, AA, and fat calories in a TPN, and
elemental calcium.
555. Silicosis affects the pulmonary system.
556. Reviewed lithium earlier.
557. Relative risk questions: 9/1000 have a particular disease, 6/1000 who take the
medication will have this disease what is the relative risk?
RR= Risk in one group (group A)/risk in all other groups
A relative risk that is greater than 1.0
shows that there is an increased risk among
the people in Group A.
558. TDM question regarding theophylline – determine dose and interval if given the
concentration and the desired concentration.
559. Again, cystic fibrosis is a genetic disease. Pulmozyme (dornase alfa) is used in the
management of cystic fibrosis.
560. This person had no HIV questions (lucky them)
561. Doxorubicin adverse effects: big thing is cardiovascular, alopecia, GI, discoloration
of urine (red), myelosuppression, and leucopenia.
562.
Toprol XL (metoprolol succinate)
Hyzaar (losartan and HCTZ)
Synercid (quinupristin and dalfopristin)
563. Reference book questions
564. What herbal has similar effects as Ambien? Answer: Valerian.
565. First line therapy in COPD….bronchodilator
566. Which is the most similar in action to Atrovent? A)albuterol B)cromolyn
C)Budesonide D)Accolate E)must be an anticholinergic to be correct
567. Monitor INR if on Warfarin.
568. Patient wants device to inject insulin where needles are hidden. What would you
recommend? Unless they’re talking about recommended a product available in pen form,
I have no idea what the heck they’re talking about.
569. Know names of blood glucose monitoring kits. (LifeScan, OneTouch, Freestyle,
AccuChek, Ascentia, Precision Xtra)
570. Counsel a patient that they need to use a spacer and peak flow meter every day.
571. Pregnancy test will detect pregnancy how long after conception?
A: Most doctors recommend that you wait until the first day of your missed period before
taking a home pregnancy test. This is usually around two weeks after conception.
However, some tests are more sensitive than others and can be taken earlier.
572. Prempro (conjugated estrogen and medroxyprogesterone)
573. This person had no HIV, cancer, gout or thyroid…can I have their test?
574. A few potassium questions:
Capsule, microencapsulated capsule, infusion, injection (never IV push), powder for oral
solution, tablet, microencapsulated tablet (k-dur), wax matrix (Klor-con), and
microencapsulated (Klor-conM).
575. What is most similar to Actos (pioglitizone)? A) Avandia (rosiglitizone)
576. Sulfonylureas act in the pancreas to stimulate insulin release from the beta cells.
577. What do you use in an acute MI? nitrate, beta-blocker, ACEI, morphine, BUT NOT
CCBs.
578. Lidocaine is a Class 1b antiarrhthmic.
579. 2 CrCl and 1 BSA calc (formula given).
580. All normal lab values are given in patient profile (thank God for that).
581. Several mEq calculations. Watch out for questions with extra lab values given in
problem.
582. Paxil is an SSRI.
583. 1 patient profile on Parkinson.
584. Nicotine repeat question.
585. Looking at a patient profile with an increased Scr of 2.1..what would you do
depending on their profile.
586. Tegretol (Carbamazepine) is an auto-inducer.
587. Eldepryl (Selegeline): MAOI type B inhibitor used as an adjuct in the management
of parkinson’s in which levodopa and carbidopa therapy is deterioriating; also used in the
treatment of major depressive disorders.
588. What is useful for a patient with hemorrhoids?
A) Soap suds enema daily, sitz bath daily, fiber therapy, sitting on a doughnut, cleaning
anal area with soap and water after each defication.
589. Romazicon (flumazenil) is a benzodiazepine antagonist, which reverses effects of
benzos used in conscious sedation and general anesthesia; used also in the treatment of
benzo overdose.
590. What is associated with neural tube defects?
A) Dec in folic acid
591. 1 ANC problem. If ANC decreases to 425 what is happening?
Neutropenia may be seen with viral infections and after radiotherapy and chemotherapy.
Neutropenia lowers the immunologic barrier to bacterial and fungal infection.
Not really sure if that’s the answer they’re looking for? Could also look in pt. profile for a
drug that can cause agranulocytosis.
592. Calc % of carbs in a TPN.
593. LDL goal for a pt. with multiple CHD risk factors is < 100.
594. What do you monitor while a patient is taking Zocor?
A) LFT
595. Lots of mEq questions, 2 or 3 TPN calcs.
596. Relenza (zanamivirf) is a neuraminidase inhibitor used for the treatment of
uncomplicated acute illness due to flu virus A and B; treatment should only be initiated in
patients who have been symptomatic for no more than 2 days.
597. Max dose of Metformin repeat: 2550mg/day; XR 2000mg/day
598. Patient chewing on Protonix (eww gross). What alternatives are available?
A) Nexium (esomeprazole) injection, Prevacid (lansoprazole) oral suspension or
injection, protonix (pantoprazole) injection
Not sure if this is what they were looking for…
599. Signs and symptoms of hypothyroidism:
A)
Weight gain
Loss or thinning of eyebrows
Low sex drive
Abdominal bloating
Dry or thinning hair
Thickening of the skin
Puffy face
Cold intolerance
Depression
Cold hands or feet
Joint or muscle pain
Thin, brittle fingernails
600. Pretreat Niacin with Aspirin.
601. Repeat: receptor for Trastuzamab is HER-2
602.
Relafen (nabmetone): 1000mg/day; an addition 500-1000mg may be needed in some
patients to obtain more symptomatic relief; may be administered once or twice daily; max
dose is 2000mg/day.
Cycotec (misoprotol):
Prevention of NSAID-induced ulcers: 200mcg 4 times/day with food; last does should be
taken at bedtime.
Labor induction or cervical ripening: intravaginal 25mcg; may repeat at intervals no more
frequent than every 3-6 hours. Do not use in patients with previous cesarean delivery or
prior major uterine sugery.
Medical termination of pregnancy: Oral: refer to Mifepristone monograph.
603. What is ARDS worsening?
Acute Respiratory Distress Syndrome (ARDS) is an acute, severe injury to most or all of
both lungs. Patients with ARDS experience severe shortness of breath and often require
mechanical ventilation (life support) because of respiratory failure. ARDS is not a
specific disease; instead, it is a type of severe, acute lung dysfunction that is associated
with a variety of diseases, such as pneumonia, shock, sepsis (a severe infection in the
body) and trauma. ARDS can be confused with congestive heart failure, which is another
common condition that can also cause acute respiratory distress.
They had that some choices were muscular system and renal system??? But this is the
info I found on it.
604. What vaccine can be given both orally and by injection?
A: polio (who knew?0
605. Repeat question on Lyposyn storeage.
606. What should be monitor before giving Humira?
A) TB skin test
607. You can use Rimantidine for influenza prophylaxis.
608. Max dose of Vasotec (enalapril) is 40mg. Max dose of Aricept (Donepezil) is 10mg.
609. Vitamin C will produce a false negative response for blood in stool.
610. Vitamin C will produce false negative responses for blood in the stool.
Patient should not receive vitamin C (ascorbic acid) for 3 days prior to occult blood
testing by guaiac. Vitamin C does not affect the HemoQuant® test. A high bulk, red meat
free diet with restriction of peroxidase-rich vegetables (turnips, horseradish, artichokes,
mushrooms, radishes, broccoli, bean sprouts, cauliflower, oranges, bananas, cantaloupes,
grapes), has been recommended for 72 hours prior to guaiac testing, and during testing, to
decrease the incidence of false-positives. Therapeutic iron causes false-positives with
guaiac tests in over half of healthy subjects.
611. How much elemental calcium is in TUMS?
A) 500mg of Calcium Carb; 200mg of elemental calcium
612. You monitor Xa for Lovenox. Although, I don’t think you have to monitor unless
they’re obese or have bad renal issues. Totally could’ve pulled that out my ass though.
613. Active ingredient for kaopectate: Bismuth
614.
Aggrastat (Tirofiban) storage: Store at 77F (25C); do not freeze; protect from light during
storage.
Nitropress (Nitroprussaide) storage: Stability of parenteral administration at room
temperature (25C) and at refrigeration temperature (4C). use only clear solution; solution
of nitroprusside exhibit a color described as brownish, brown, brownish-pink, light
orange and straw. Solutions are highly sensitive to light. Exposure to light causes
decomposition, resulting in a highly colored soluation of orange, dark brown or blue. A
blue color indicates almost complete degredation and breakdown to cyanide. Solutions
should be wrapped with aluminum foil or other opaque material to protect from light.
615. Again, normal lab values are given.
616. They said they got hit with HTN, CHF, angina, DM, clots and migraines.
Supposedly others have said cystic fibrosis was hit hard, but they had none.
Zollinger-Ellison:
Caused by a non–beta islet cell, gastrin-secreting tumor of the pancreas that stimulates
the acid-secreting cells of the stomach to maximal activity, with consequent
gastrointestinal mucosal ulceration. ZES may occur sporadically or as part of an
autosomal dominant familial syndrome called multiple endocrine neoplasia type 1 (MEN
1). The primary tumor usually is located in the duodenum, the pancreas, and abdominal
lymph nodes, but ectopic locations have also been described (eg, heart, ovary, gall
bladder, liver, kidney).
This is treated with your PPI’s.
617. Cyclosporin is generic for neural and Sandimmune, but they are NOT
therapeutically equivalent.
618. (Meridia) Sibutramine is for weight loss. It asked about an adverse drug reaction that
may occur in DM patients, but I couldn’t find that???
619. TPN questions: Find total kcal pt receives in 24 hours add up lipids + AA + Dex.
TPn find the kcal in carbs given that pt gets 20% Dex and rate is 83ml/hy find for 24
hours TPN find total AA 4, but had to see the tricky part that they gave me 100ml which
was only for 12 hours not 24 hours.
620. Given 15mEq of Na acetate given 2mEq NaCl want 5mEq in 1L how much of each
do you add?
621. Atarax (Hydroxyzine) treats uticaria (hives).
Hydralazine treats hypertension and CHF.
622. Hydralazine and procainamide can cause SLE.
623. Oral liquid dosage forms: nitroglycerine (translingual spray), hydroxyzine, and
digoxin (elixir).
624. Know your dosage forms what comes injection, suppository and tablets.