UAMS P2 - CPK Exam 2 SG

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148 Terms

1
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T/F: Active Absorption of most drugs are unchanged as patients get older

False - Passive absorption... not active

2
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In terms of Drug Distribution, a Decrease in Muscle Mass can lead to __________________________

Decreased Vd for Water soluble drugs

3
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In terms of Drug Distribution, a Decrease in Total body water can lead to __________________________

Decreased Vd for Water soluble drugs

4
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In terms of Drug Distribution, an Increase in Body fat can lead to __________________________

Increased Vd for Fat soluble drugs

5
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Decreased albumin = ______________________ free fraction = ______________________ drug to act on receptors

Increased; More

6
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T/F: No dosing changes are needed when titrating Albumin to effect

True

7
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In older patients, Bioavailability ___________________

Increases

8
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T/F: Phase 2 Reaction activity are generally preserved with aging

True

9
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Decreased renal mass & blood flow = ____________________ renal excretion of drugs

Decrease

10
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Dose standardization for Pediatrics

Amoung per kg or per BSA

11
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Gastric emptying and intestinal motility matures by ______________

4 months old

12
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Neonates have ______________ pH compared to adults

higher

(acid labile drug would have greater bioavailability)

13
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The ratio of TBSA:BM in infants is _____________ than adults

greater

14
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Premature Infants have _____________ Total Body water % compared to Adults

higher

15
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Premature Infants have _____________ Albumin Level compared to Adults

Lower

16
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Drug distribution in neonates is directly related to ___________________________

gestational age

17
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Pediatrics have ____________ Vd than adults

Higher

18
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Neonates have ______________________ Metabolism until aged 1-5 where it ______________________. After puberty, it then ______________________

Decreased; Increases; Decreases

19
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___________________________ have higher metabolism of theophylline (caffeine) than adults

Younger Children (peaks at 1-9 years)

20
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By _______________, GFR of a child expectedly reaches above 100 mL/min

6 months

21
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For Penicillins, Adults rely on _____________________ for elimination whereas Neonates ________________ is the major pathway for elimination

Tubular Secretion; GFR

22
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Agents with Black Box warnings in kids

Atomoxetine,

Codeine,

Tramadol

(CYP2D6)

23
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Children receiving Atomoxetine should have a dose ______________ to prevent _______________ who are ___________________________ for CYP2D6.

Decrease; Toxicity; Poor metabolizers

24
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Codeine and Tramadol are a concern for Children who are __________________________.

Ultra-rapid metabolizers

25
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Carboplatin is dosed based on

AUC

26
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Agents that increase toxicity and reduce metabolism of Carboplatin

Fluorouracil,

Irinotecan,

Mercaptopurine,

Thioguanine

27
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Calvert Equation

(CrCl/GFR + 25) * Target AUC

28
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High dose = Methotrexate > ______________ gram/m2 IV

0.5

29
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What agent is required for all patients receiving High Dose therapy of Methotexate?

Leucovorin

30
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___________________________ is to be used only when Methotrexate level is > 1 mcmol/L plus evidence of delayed methotrexate clearance and kidney injury

Glucarpidase

31
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Use sodium bicarbonate-based IV fluids and ensure alkalization of urine ______________ infusing methotrexate to prevent precipitation and to promote excretion of drug

before

32
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Leucovorin dose adjustments are made based on ___________________________

methotrexate levels and creatinine trend

33
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Busulfan pharmacokinetic analysis and subsequent dose adjustments help optimize dose to ______________________________________

maximize efficacy and minimize toxicity

34
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In obesity, Delayed gastric emptying results in

Lower Cmax

35
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In obesity, Absorption of oral med is increased with a fatty meal results in

Higher Cmax

36
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T/F: IM injections administered instead of SubQ results in Higher Cmax

False - impact is unknown

37
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A __________________ Vd implies the drug is distributed extensively to tissue

high

38
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A __________________ Vd implies the drug is concentrated in the plasma

low

39
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In obesity, Lipophilic medications are associated with higher Vd, which usually requires ___________________

TBW dosing

40
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In obesity, Hydrophilic medications are associated with lower Vd, which usually requires ___________________

IBW or ABW (if TBW > 120% IBW)

41
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In obesity, Aminoglycosides are primarily distributed through ECF... we should use ____________________

IBW/ABW (Decreased Vd if based on TBW)

42
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In obesity, Vancomycin are primarily distributed through the tissues... we should use ____________________

TBW

43
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Depleting Agents (lyses T cells)

Thymoglobulin, Alemtuzumab

44
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Non-Depleting Agents (inhibits T cells)

Basiliximab

45
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Primary Maintenance Immunosuppressants

Calcineurin Inhibitors,

Antimetabolites,

Corticosteroids

46
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Adjuvant Maintenance Immunosuppressants

mTOR inhibitors,

Costimulation Blockers

47
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Calcineurin Inhibitors

Tacrolimus, Cyclosporine

48
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Tacrolimus Trough Goals Post Transplant

1-90 days:

90-365 days:

> 365 days:

1-90 days: 8-10 ng/mL

90-365 days: 6-8 ng/mL

> 365 days: 5-7 ng/mL

49
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Antimetabolites

Mycophenolate,

Azathioprine

50
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Mycophenolate is inhibited by

Cyclosporine (MRP2 transport protein inhibitor)

51
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Azathioprine is an _______________________ inhibitor

Xanthine Oxidase (leads to myelosuppression and hepatotoxicity)

52
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Azathioprine should test for _____________________ before administration

TPMT Deficiency

53
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T/F: Mycophenolate is teratogenic and interacts with birth control

True

54
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mTOR Inhibitors

Sirolimus, Everolimus

55
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How should Antimetabolites be dosed?

based on side effects

56
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How should Calcineurin Inhibitors be based on?

Based on Levels

57
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mTOR inhibitors should be based on

Trough levels

58
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Enzyme Inducers _________________ drug concentrations

Decrease

59
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Enzyme Inhibitors _________________ drug concentrations

Increase

60
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BBW of mTOR inhibitors?

Increased hepatic artery thrombosis or renal artery thrombosis

61
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Costimulation blockers

Belatacept

62
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When immunosuppressant agent may be used in Epstein Barr Virus positive patients only?

Costimulation Blockers (Belatacept)

63
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SLED, EDD, PD, iHD are all examples of ______________________ therapy

Intermittent Renal Replacement Therapy

64
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CVVH, CVVHD, CVVHDF, SCUF are all examples of ______________________ therapy

Continuous Renal Replacement Therapy

65
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Which types of Dialysis are primarily seen in Inpatient or Outpatient?

iHD,

PD

(Everything else in ICU)

66
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Which type of Dialysis is Simpler?

IRRT

67
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Which type of Dialysis is Adjustable?

CRRT

68
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Which type of Dialysis can lead to Hypotension/Electrolyte changes?

IRRT

69
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Which type of Dialysis requires anticoagulant and can lead to Hypothermia?

CRRT

70
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Drug Characteristics that ImpactDialysis Removal

Molecular Weight (Large molecules less cleared by dialysis),

Vd (Large Vd not easily removed),

Protein Binding (more bound, less cleared by dialysis),

Renal vs Non-Renal Clearance (<25% renal elimination may have little effect by dialysis)

71
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Which Type of Dialysis is most effective?

CVVHDF

(CVVHDF > CVVHD > CVVH > PIRRT >= iHD)

72
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Low flux

Smaller Pores

73
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High Flux

Larger Surface area and pore size

- can lead to removal of larger drug molecules

74
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Diffusion results in the movement of solutes from ____________________________

high to low concentration

75
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Which Renal Replacement Therapies use Diffusion

iHD,

CVVHD,

PIRRT

76
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Which Renal Replacement Therapies use Convection (Hemofiltration)

CVVH

77
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Which type of Renal Replacement Therapy provides better removal of larger solutes?

Convection (CVVH does this)

78
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Vancomycin is dependent on

AUC/MIC (should be 400 when treating MRSA)

79
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Vanc dosing Goals for Non-invasive (blood infections)

Trough 4-5 times MIC

no lower than 10 mcg/mL

80
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Vanc dosing Goals for Invasive (CNS, Lung, Bone infections)

8-10 times MIC

AUC/MIC 400 for MRSA

81
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Nephrotoxicity Levels of Vanc

Troughs > 15 mcg/mL,

AUC > 800

82
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When to Change the dose ONLY (no change in int)

Both Peak and Trough are Low (increase dose) or HIGH (decrease dose)

83
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If Trough Low and Peak Normal

Shorten interval

84
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If Trough High and Peak Normal

Lengthen Interval

85
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If Trough High and Peak Low

Lengthen Interval and Increase dose

86
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If Trough Low and Peak High

Shorten Interval and Decrease dose

87
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Anti-Xa Therapeutic Levels

0.3-0.7 U/mL

88
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Dalteparin Class

Low Molecular Weight Heparin

89
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Enoxaparin Class

Low Molecular Weight Heparin

90
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Dabigatran Class

Direct Thrombin Inhibitor

91
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Argatroban Class

Direct Thrombin Inhibitor

92
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Bivalirudin Class

Direct Thrombin Inhibitor

93
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Apixaban Class

Anti-Xa

94
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Rivaroxaban Class

Anti-Xa

95
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Edoxaban Class

Anti-Xa

96
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Fondaparinux class

Anti-Xa

97
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Warfarin Class

Vitamin K Antagonist

98
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Reversal Agent for Unfractionated Heparin

Protamine Sulfate

99
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Low Molecular Weight Heparin Target Peak

0.5-1.1 IU/mL

100
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Reversal Agent for Low Molecular Weight Heparin

Protamine Sulfate