Clin Pharm Study Guide

I need to add like 2 more cards lol

When would you use “Dispense as Written” (DAW)?

If brand name drug is preferred over generic or when a substitution is not permissible

When do legend drugs (prescription drugs) expire?

1 year

When do schedule III-V prescriptions expire?

6 mos

When do schedule II prescriptions expire?

7 days

How many refills can be written for non-controlled substances?

No limit

How many refills can be written for schedule II drugs?

None

How many refills can be written for schedule III-IV drugs?

Up to 5 in 6 mos

How many refills can be written for schedule V drugs?

Determined by practitioner

What are the requirements for PAs prescribing controlled substances?

Quantity written numerically & in word; delegation from supervising physician, CME, DEA, & check PDMP

Providers must check PDMP before each controlled substance prescription except for what exceptions?

Schedule V non-opioids & pt under 16 y/o

What is the law regarding PAs prescribing medications in registered pain management clinics?

Prohibited from prescribing controlled substances

How much of a schedule II psychiatric controlled substance can a PA prescribe for kids under 18 under the supervision of a physician?

14 days

How much of a schedule II substance can be prescribed for acute pain?

3 days

How much of a schedule II substance can be prescribed for an acute pain exception?

*must label “acute pain exception”

7 days

With what special cases are there no prescribing limitations for schedule II substances?

*must label “non-acute pain”

Cancer, palliative care, terminal conditions, traumatic injuries (ISS ≥9)

What is required to be prescribed with a schedule II prescription for traumatic injuries w/ ISS ≥ 9?

Emergency antagonist

What drugs are PAs not authorized to prescribe in pure form or combo?

General, spinal, or epidural anesthetics & radiographic contrast media

What antidepressant is a non-nicotine pill used for smoking cessation that can also treat co-existing depression?

Bupropion

What antidepressants are 1st or 2nd line for depression & anxiety and can also be used for neuropathic pain?

SNRIs (duloxetine, venlafaxine)

What antidepressants are used for neuropathic pain (e.g. diabetic neuropathy, centralized pain (e.g. fibromyalgia), migraine prophylaxis, and insomnia?

*no longer first line for depression

TCAs (amitriptyline, nortriptyline, imipramine)

What is used for treatment-resistant depression?

MAOIs (phenelzine, tranylcypromine, selegiline)

What key dangers are associated with MAOIs?

Hypertensive crisis w/ tyramine rich foods, fatal serotonin syndrome if combined w/ seratonergic drugs, requires 2 wk washout period

What teratogenic mood stabilizer can cause ebsteins anomaly?

Lithium

What teratogenic mood stabilizer can cause NTDs?

VPA

What SEs are seen with lithium?

*required monitoring: drug levels, BUN/Cr, TSH

Polyuria, polydipsia, fine tremor, hypothyroidism, narrow TI (toxicity risk)

What SEs are seen with VPA?

*required monitoring: drug levels, LFTs, CBC (plts)

GI upset, wt gain, alopecia, tremor, BBWs for liver failure, pancreatitis, & teratogenicity

What life threatening reaction can occur with typical antipsychotics (haloperidol)?

Neuroleptic malignant syndrome (NMS) → muscle rigidity, AMS, hyperthermia, autonomic instability, elevated CBC, CPK, & LFTs

A 27-year-old man presents to the Emergency Department with high fever, dilated pupils, hyperreflexia on DTRs, and bilateral Babinski. However, there is no muscle rigidity. Which of the following medications is most likely the cause?

Sertraline

What antidepressants have the greatest association with serotonin syndrome?

SSRIs (sertraline, fluoxetine, citalopram)

A 28-year-old woman presents to the Emergency Department with hypertensive crisis after the Disney Wine Fest. She was drinking wine, eating several different types of aged cheese, and liverwurst. Which of the following medications was she probably taking?

Phenelzine

A 19-year-old woman is on Lithium for Bipolar disorder. Which of the following is most likely a side effect to the medication?

Polyuria

A 35-year-old man presents to the Emergency Department with severe muscle rigidity, mental status changes, elevated CBC, CPK, & LFTs.  Which of the following medications is most likely the cause of his symptoms?

Haloperidol

A 23-year-old woman presents to the Family Practice Clinic with the complaint that she can not form any new memories. Her long-term memory is still intact. Which of the following medications is she most likely taking?

Benzodiazepine

A 26-year-old woman is taking Adderall for her ADHD. She comes to you to get treated for her GERD. What is the drug interaction between Adderall and Prilosec?

Inc serum levels of Adderall

What medications can be used to treat strep throat in pregnant patients?

1st line: Amoxi

PCN allergy: Erythro, Cephalosporins, Clinda

What is the treatment for AOM in children?

1st line: Amoxi

Alt: Cefdinir (consider in PCN hive allergy), Azithro, Doxy, Bactrim (not rec d/t resistance)

What bacteria is most likely to cause bacterial eye infection in contact lens wearers?

Pseudomonas

*rx FQ or aminoglycosides

What antibiotic eye drops are used for eye infections in contact lens users?

*don’t sleep in contacts & don’t wear during treatment

1st line: 4th gen FQ (moxifloxacin 0.5%, gatifloxacin 0.3%)

Alt: ciprofloxicin 0.3%, ofloxacin (0.3%)

What are the PCN allergic treatment options for a peritonsillar abscess?

IV Clinda & Vanc

What is the first line tx for PUD?

PPIs (omeprazole, pantoprazole)

*SEs: HA, rash, dizzy, N, D flatulence

What are the treatment options for H. Pylori?

Triple therapy: metro or amoxi + clarithro + PPI

Quadruple therapy: bismuth (pepto) + metro + PPI + tetra or doxy

*pepto can cause dark black stools

What patient education point should be given for H. Pylori treatment?

Avoid foods that stimulate gastric acid secretion & irritate lining (processed, alcohol, soft drinks), eat small meals, inc water intake

What is the treatment for CD flares?

Budesonide, prednisone ± azathioprine (azasan, imuran), mercaptopurine (purinethal, purixan)

Which corticosteroid used for CD flares has fewer SEs & less suppression of pituitary adrenal function, but is more expensive?

Budesonide

What is the treatment for UC flares?

Aminosalicylates (mesalamine, sulfasalazine), ± prednisone, hydrocortisone, anti-TNF (golimumab, infliximab, adalimumab, certolizumab)

What are treatment options for an acute gout attack?

1st line: NSAIDs, Colchicine, or low dose corticosteroids

What are treatment options for chronic gout?

1st line: allopurinol + preventative colchicine

± uricosurics (probenecid, lesinurad) or uricases (pegloticase)

What is 1st line for knee OA?

Exercise + wt loss + topical diclofenac (alt: oral diclofenac)

What is the treatment for a spider bite?

Bactrim (MRSA), I&D, ibuprofen for pain

What is the treatment for a dog bite?

Augmentin (covers pasteurella)

What BBW is associated with metoclopramide?

Tardive dyskinesia

What ADRs can be seen with metronidazole?

Disulfiram rxn up to 2-3 days after completion, secondary candidiasis, dark brown urine, CNS effects

When is metronidazole CI?

Within 2 wks of disulfiram use, concomitant use of alcohol or propylene glycol, hypersensitivity

What medications are used to treat UTIs in pregnancy?

Macrobid (1st line in 2nd tri), fosfomycin

What are treatment options for hyperemesis gravidarum?

Pyridoxine + doxylamine, metoclopramide, ondansetron (avoid 1st tri)

What antihypertensives are preferred in pregnancy?

1st line: labetolol

Alt: Nifedipine (previously methyldopa but now inc PPD risk)

What anti fungal options are available for oral candidiasis?

Nystatin liquid (TOC) or oral fluconazole

What are anti fungal options for vaginal candidiasis?

Cream/supp: Clotrimazole, Miconazole, Terconazole, Butoconazole

Oral: Fluconazole

What antifungal agents for vaginal candidiasis are preferred in pregnancy?

Topical / intravaginal

*avoid terconazole, cat C

What ADRs are seen with fluconazole?

QT prolongation, torsades, skin rash, alopecia, inc LFTs, liver damage or failure

What antibiotic is safe to treat bites in pregnancy?

Augmentin

What are 1st line treatments for acute migraine attacks?

NSAIDs, triptans, antiemetics (metoclopramide)

What are CIs to triptans?

Pregnancy, ischemic heart disease, uncontrolled HTN

When is prophylactic medication indicated for migraines?

>4 attacks/month, significant disability, poor response to a abortive meds

What drugs can be used for migraine prophylaxis?

Propranolol, topiramate, valproate, amitriptyline, CGRP inhibitors (erenumab)

What medications have dual indications for migraines and seizures?

Topiramate & valproate

What long term risk is associated with vertigo meds (Meclizine)?

Adaptation / vestibular loss

What medication classes should generally be avoided in Alzheimer’s patients and why?

Anticholinergics (diphenhydramine), BZDs, & sedative hypnotics d/t cognitive impairment

What is the stroke risk score for AFIB?

M: ≥ 2 needs anticoag

F: ≥ 3 needs anticoag

*start w/ NOAC (rivaroxaban)

What is the INR target for warfarin?

2.0-3.0

What patient education should be provided for patients on warfarin?

Avoid sudden inc or dec in dietary vit K, take same time daily, avoid NSAIDs/ASA, report signs of bleeding, use pill box

What ADRs are seen with warfarin?

Major/minor bleeding, N, abd pain, purple toe syndrome

When is warfarin CI?

Pregnancy (cat X), high bleeding risk, recent major surgery (CNS, eye), supervised patients w/ conditions associated w high bleeding risk

How should warfarin be adjusted?

Inc by 1 daily dosage over the course of the week; frequent INR checks until stable

What are CIs for thrombolytics?

INR > 1.7, plts < 100,000, recent major surgery, previous intracranial hemorrhage, glucose < 50 or > 400, BP > 185/110

What safety screenings should be done before starting anticoagulants?

Pregnancy test, CBC (plts, hgb), CrCl, LFTs, check for drug interactions, assess bleeding risk (hx of bleeding, falls, alcoholism)

What anticoagulant is preferred in pregnancy?

LMWH (lovenox)

What is the algorithm for uncontrolled hypertension?

Max dose of initial med, add diuretic & inc dose, add another medication if needed (CCB, BB, aldosterone antagonist)

What ADRs are seen with loop diuretics (furosemide)?

Hyponatremia, hypokalemia, hypotension, hyperuricemia, ototoxicity, dehydration

What are CIs to furosemide?

Anuria, hypersensitivity to sulfonamides, severe elyte depletion

What patient education should be provided for patients taking oral iron (ferrous sulfate)?

Take w/ vit C to enhance absorption; inc fiber & fluids to prevent constipation; may cause dark stools; takes ~6-8 wks to correct anemia

What are CIs to ferrous sulfate?

Hemochromatosis, PUD, UC

What is the 1st line treatment for scabies?

Permethrin 5% cream → apply from neck down (including under fingernails, b/t fingers, etc) & leave on for 8 hrs/ overnight, rinse & repeat in 14 days if needed

What patient education should be provided for scabies treatment?

Might have continued itching after tx; wash linens & clothes every few days in hot water, bag items that can’t be washed and leave in hot garage x 7 days, tx all household members, spray cars & furniture

What is the 1st line topical agent for tinea versicolor?

Ketoconazole 2% shampoo; selenium sulfide

When would stronger classes of TCS be used?

Thicker skin such as palms/soles (5th layer stratum lucidum)

When would weaker classes of TCS be used?

Thin skin & occluded areas (eyelids, face, body folds, axillae, groin, genitals, perineal)

What can occur with long term use of TCS?

Skin atrophy, telangiectasias, skin bruising, fragility, secondary fungal or bacterial infx (tinea incognito)

What are examples of basal (long acting) insulin?

Glargine, detemir, degludec

What are examples of prandial (rapid acting) insulin?

Lispro, aspart, glulisine

What is basal insulin used for?

Steady background coverage to control fasting BG;

Onset 1-2 hr; duration 24+ hrs

What is prandial insulin used for?

Control post-meal BG spikes; inject 15 min before meal

Onset 15 min; peak 60-90 min; duration 3-4 hrs

What are CIs to metformin?

GFR < 30, metabolic acidosis, DKA, CHF, alcoholism

What are imaging precautions for metformin?

Interacts w/ CT contrast, risk of renal damage & lactic acidosis

*hold for 48 hrs after study; check renal function before restarting

When should a patient FU after adjusting levothyroxine?

Every 6-8 wks until TSH is in target range

When should you send an asthmatic patient to the hospital?

Breathless at rest sitting forward, drowsy, confused, agitated, unable to speak in full sentences, RR > 30, HR >120

When do you escalate asthma therapy?

SABA no longer effective, sx not well controlled, albuterol use >2x per week

What is the stepwise therapy for asthma?

Start with SABA albuterol → add on daily ICS budesonide (Pulmicort) OR combination inhaler with steroid and beta agonist fluticasone/salmeterol (Advair)

What SEs are seen with albuterol?

Nervousness, shakiness, HA, tachycardia, palpitations

What patient education should be provided with ICS?

Rinse out mouth after use d/t risk of thrush; use before brushing teeth