P2 OSCE Oral Exam Study Guide Flashcards

Vocabulary flashcards covering pharmacology, OTC product selection, drug dosing, mechanisms of action, vaccine classification, electrolyte disorders, diabetes diagnostic criteria, and clinical calculations.

Maximum Daily Dose of Nonprescription Ibuprofen

$$1.2\,\text{g/day}$$

Maximum Daily Dose of Nonprescription Naproxen

$$660\,\text{mg/day}$$

Maximum Daily Dose of Acetaminophen

FDA maximum is $4\,\text{g/day}$ ($2\,\text{g/day}$ in patients on warfarin, with liver dysfunction, poor nutritional intake, or consuming 3+ drinks/day).

Pediatric Dosing of Ibuprofen

$5\text{--}10\,\text{mg/kg/dose}$ Q6-8H (available as $100\,\text{mg}/5\,\text{mL}$ suspension; maximum $40\,\text{mg/kg/day}$).

Pediatric Dosing of Acetaminophen

$10\text{--}15\,\text{mg/kg/dose}$ Q4-6H (available as $160\,\text{mg}/5\,\text{mL}$ suspension; maximum $75\,\text{mg/kg/day}$).

Dextromethorphan (Delsym, Robitussin DM)

Cough suppressant/antitussive indicated for non-productive cough.

Guaifenesin (Mucinex, Robitussin)

Expectorant indicated for productive cough to help clear mucus.

Pseudoephedrine (Sudafed)

Oral decongestant indicated for sinus pressure and congestion.

Bulk-Forming Laxatives

Agents (e.g., Metamucil, Citrucel, Fiber Choice, Benefiber) that absorb water to form bulky stool, stretching the bowel and triggering intestinal contractions.

Lubricant Laxative (Mineral Oil)

Laxative that softens feces by coating contents through emulsification.

Saline Laxatives

Agents (e.g., Milk of Magnesia, Phillip's Milk of Magnesia) that pull water into the intestine via an osmotic gradient, increasing intraluminal pressure to promote GI motility.

Stimulant Laxatives

Agents (e.g., Senokot, Dulcolax) that act on the intramural nerve plexus of intestinal smooth muscle to increase motility and secretion of water and electrolytes.

Emollient Laxatives (Stool Softeners)

Anionic surfactants (e.g., Colace/docusate sodium) that increase wetting efficiency of intestinal fluid to facilitate mixing of aqueous and fatty substances, softening fecal mass.

Osmotic Laxative (Miralax)

Large, poorly absorbable ethylene glycol molecules (polyethylene glycol 3350) that draw water into the colon or rectum through osmosis to stimulate bowel movement.

Nicotine Gum / Lozenge Initial Dosing Rule

Use $4\,\text{mg}$ if the first cigarette is smoked $\le 30\,\text{minutes}$ after waking; use $2\,\text{mg}$ if the first cigarette is smoked $> 30\,\text{minutes}$ after waking.

Nicotine Patch Dosing for Heavy Smokers

For smoking $> 10\,\text{cigarettes/day}$: $21\,\text{mg}$ daily for 4-6 weeks, then $14\,\text{mg}$ daily for 2 weeks, then $7\,\text{mg}$ daily for 2 weeks (total duration 8-10 weeks).

Live-Attenuated Vaccines

Vaccines containing live weakened pathogens, including MMR (Priorix), Rotavirus (Rotarix), Smallpox (JYNNEOS), Varicella (Varivax), Yellow fever (YF-Vax), Intranasal Flu (FluMist), Typhoid Fever (Vivotif), Cholera (Vaxchora), and Dengue (Dengvaxia).

Severe Hyponatremia Acute Treatment

Administer a $100\,\text{mL}$ bolus of 3% \text{NaCl} over $\sim 10\,\text{minutes}$ (may repeat twice if symptoms persist).

Hypernatremia Correction Rate Limit

Serum \text{Na}^+ should be corrected by no more than $10\text{--}12\,\text{mmol/L/day}$ to avoid the risk of brain swelling.

Severe Hyperkalemia Myocardial Stabilization

Administer IV calcium gluconate $1\text{--}2\,\text{g}$ over 2-5 minutes to protect the heart.

Microcytic Anemia

Anemia classified by Low Mean Corpuscular Volume (\text{MCV} < $80\,\text{fL}$); requires checking ferritin levels to evaluate iron deficiency.

Lactulose

First-line agent for hepatic encephalopathy ($20\,\text{g}/30\,\text{mL}$ PO TID) that lowers ammonia levels via colon acidification, titrated to 3-4 bowel movements per day.

Rifaximin (Xifaxan)

Second-line antibiotic for hepatic encephalopathy ($400\,\text{mg}$ PO TID for treatment; $550\,\text{mg}$ PO BID for prophylaxis) that decreases gut ammonia production and absorption.

First-Generation Antipsychotics (FGAs)

Post-synaptic \text{D}_2 receptor antagonists (e.g., Haloperidol, Fluphenazine, Chlorpromazine) effective against positive symptoms, with a high risk of extrapyramidal symptoms (EPS) and hyperprolactinemia.

Second-Generation Antipsychotics (SGAs)

Post-synaptic \text{D}2 and \text{5-HT}{2\text{A}} antagonists (e.g., Olanzapine, Clozapine, Quetiapine, Risperidone) effective against positive and negative symptoms, with lower EPS risk but higher metabolic side effects.

Phase II Benzodiazepines ("LOT")

Benzodiazepines (Lorazepam, Oxazepam, Temazepam) metabolized via conjugation to inactive metabolites; safer for elderly patients and those with hepatic impairment.

Disulfiram (Antabuse) Boxed Warning

Should never be administered to a patient in a state of alcohol intoxication or without their full knowledge.

Type 2 Diabetes Diagnostic Criteria

\text{A1c} \ge $6.5\%$ OR Fasting plasma glucose \ge $126\,\text{mg/dL}$ OR 2-hour plasma glucose during 75g OGTT \ge $200\,\text{mg/dL}$ OR Random Plasma Glucose \ge $200\,\text{mg/dL}$ with classic symptoms of hyperglycemia.

Levothyroxine Dosing and Administration

Dosed at $1.6\text{--}1.8\,\text{mcg/kg/day}$ PO; take first thing in the morning with plain water on an empty stomach, waiting 30 minutes before eating or taking other medications.

First-Line Antihypertensive Drug Classes

Primary classes recommended for patients without comorbidities: ACE inhibitors (e.g., Lisinopril), ARBs (e.g., Losartan), CCBs (e.g., Amlodipine), and Thiazide diuretics (e.g., Hydrochlorothiazide).

Vancomycin Target Monitoring Parameters

Target \text{AUC/MIC} = $400\text{--}600$, Trough = $10\text{--}15\,\text{mg/L}$, Peak = $25\text{--}35\,\text{mg/L}$.

Caloric Values in Parenteral Nutrition

Amino acids (protein) = $4\,\text{kcal/g}$, Carbohydrates (Dextrose) = $3.4\,\text{kcal/g}$ (or Carbs $4\,\text{kcal/g}$), Fats = $10\,\text{kcal/g}$.

Alendronate (Fosamax) Administration Instructions

Administer $10\,\text{mg}$ daily or $70\,\text{mg}$ weekly first thing in the morning $\ge 30\,\text{minutes}$ before food, drink, or other meds with plain water; patient must remain upright for $\ge 30\,\text{minutes}$.

Cockcroft-Gault Creatinine Clearance Equation

$$\text{CrCl (mL/min)} = \frac{(140 - \text{age}) \times \text{Weight (kg)}}{72 \times \text{SCr}} \times (0.85\text{ if female})$$