Pharm 3 Random
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*A newly diagnosed Type 2 diabetic is being started on a medication. Their BMI is >30. What medication can best help control their diabetes and lose weight? *
abliglutide (tanzeum)
3 multiple choice options
**A type 1 diabetic 13 year old male decided to eat 2 slices school lunch pizza, instead of the lunchable his mother packed. What does he need to take after eating?**
Insulin Lispro (Humalog)
3 multiple choice options
**23yr old female diabetic (1) wakes up in the morning and plans on eating a small bowl of honey nut cheerios. What insulin does she need that morning for day time coverage?**
Insulin glargine (lantus)
3 multiple choice options
Which medication is associated with lactic acidosis in renally impaired pts? (GFR <30)
Buformin
3 multiple choice options
Which oral hypoglycemic can cross the placenta and deplete fetal insulin stores?
Glimepiride (amaryl)
3 multiple choice options
Which medication for Hashimoto's supresses TSH?
Levothyroxine (Synthroid)
3 multiple choice options
**Know bolus insulin from basal insulin**
Bolus: meal time: ultra-short acting: Lispro, Aspart, Glulisine
Basal: am/pm :Ultra Long acting Glargine, Detemir, Degludes
A patient is admitted to the ER with signs of severe hypoglycemia, they are identified as having type 1 diabetes. The patient has not lost consciousness. What can quickly raise their glucose levels?
IV Dextrose
3 multiple choice options
Which diabetes medication was derived from the toxins of the US most venomous lizard?
Exenatide (Byetta)
3 multiple choice options
**Know what treatment option next DM2**
1st metformin. If not enough -> add on a 2nd med.
add 2nd: depends on pt sx and weight -> add if not enough
3rd Med: depends on sx.
Last option: Basal insulin + meal time insulin or GLP-1RA Try triple therapy before moving to insulin.
A patient is determined to have an inoperable form of breast cancer. What medication may help reduce the cancer?
Fluoxmesterone
3 multiple choice options
A patient currently taking medication for hypogonadism begins showing signs of jaundice. You determine the hepatic effects are from their medication. Which medication is causing the issue?
PO. 17- alkylated testosterone
3 multiple choice options
Which medication can help treat Benign prostatic hypertrophy?
Finasteride (proscar)
3 multiple choice options
Which medication works as a DHT inhibitor, competitive inhibition 5a reductase?
Dutasteride (Avodart)
3 multiple choice options
Which medication interferes with oxidation of iodide ions, by inhibiting peroxidase enzymes?
Propylthiouracil (PTU)
3 multiple choice options
A 45 year old female begins to experience symptoms of weakness, fatigue, increasing weight loss. On admission to the ER she her blood pressure is found to be 90/65. You notice her medical alter bracelet for Addison's. What medication can help quickly raise her BP?
Fludrocortisone
3 multiple choice options
Which medication can help alleviate a patient experiencing a thyrotoxic crisis? (not monotherapy)
Iopodate
3 multiple choice options
What medication should Addison's pts use during episodes of illness?
Hydrocortisone
3 multiple choice options
A type 2 DM patient needs a medication that decreases glucose absorption, by competively inhibiting enzymes at the intestinal brush border?
Acarbose (precose)
3 multiple choice options
What is the most common cause of intrinsic AKI?
acute tubular necrosis
3 multiple choice options
Which treatment option is best to avoid development of AKI?
Normal Saline 0.9%
3 multiple choice options
Which medication can help prevent contrast induced nephropathy?
N-acetylcysteine (Mucomyst)
3 multiple choice options
Which medication can lower ICP by drawing water off CNS?
Mannitol
3 multiple choice options
What diuretic is good for patients, experiencing loop diuretic resistance, & has a GFR <20 mL/min?
"can make a rock pee"
Metolazone (zaroxoyln)
3 multiple choice options
Which medications can aid in CKD induced anemia?
Epoetin alfa
3 multiple choice options
Which medication is most associated with development of acute tubular necrosis? (class of medication)
Gentamycin
3 multiple choice options
How do you monitor aminoglycosides?
Trough concentrations
3 multiple choice options
Which medication can be given prophylactically for Cisplatin chemotherapy to avoid nephrotoxicity? Chelator.
Amifostine (ethyol)
1 multiple choice option
Which agent can prevent Amphotericin B nephrotoxicity?
Liposomal formulations (AmBisome)
3 multiple choice options
What type of hyponatremia is most caused by SIADH?
Euvolemic Hypotonic
3 multiple choice options
How do you correct hyponatremia?
slowly. No faster than 12mEq/L 1st 24 hrs
3 multiple choice options
What severe complication arises from correcting Hypernatremia too swiftly?
Cerebral Edema
3 multiple choice options
A patient suffering from hyponatremia d/t SIADH can be treated with what to alleviate their hyponatremia? (medication inhibits tubular AVP activity)
Demeclocycline
3 multiple choice options
A 17 year old female presents to the clinic after ingesting too many salt tablets. She is determined to be in salt over load. What medication can help alleviate the hypervolemic/hyponatremic state she is in?
Torsemide (demadex)
3 multiple choice options
Which medication works by supressing PTH secretion and stimulating Ca absorption?
Calicitrol (rocaltrol)
3 multiple choice options
Which form of Iron is an oral medication?
Ferrous gluconate
3 multiple choice options
Which diuretic works as an osmotic diuretic?
Mannitol
3 multiple choice options
Which medication works via vasodilation in prevention of AKI?
Fenoldopam
3 multiple choice options
What should be monitored for with administering large doses of Isotonic Saline?
Hyperchloremic Acidosis
3 multiple choice options
Which medication treats hyperuricemia by increasing renal clearance of uric acid?
Probencid
3 multiple choice options
Active form of vitamin D?
calcitriol
need to give pts with renal failure this form directly
What is the average urine output we are looking for in an adult?
O.5-1 ml/kg/hr
the goal for hydration is MAP > 65 and UO >0.5
Is dehydration a cause of prerenal, postrenal, or intrinsic AKI
prerenal
2 multiple choice options
What falsely elevates the serum creatinine
dehydration
2 multiple choice options
Which drug is used for tylenol overdose and can also be used in preventing kidney damage due to contrast dye
N-acetylcysteine (Mucomyst)
What is the problem if you give too much normal saline
hyperchloremic acidosis
What is the acronym to remember when you need dialysis
A - acid base abnormalities
E- electrolyte imbal.
I- intoxications
O- fluid overload
U- uremia
What is the use of mannitol? and what is the downside to the med?
it brings water wherever it is-- used in cerebral swelling
it crystallizes out at room temp
What is the best way to treat loop diuretic resistance
add on a thiazide
What is the only thiazide diuretic that works when CrCl < 20
metolazone
can make a rock pee!
What is an electrolyte complication of a pt on RRT
hypocalcemia
due to citrate anticoagulant
When should metformin be d/c in a pt with CKD
when gfr <30
What do you have to give with drugs like Epoetin alfa and Darbepoetin
iron supplements
What is the BBW for ESA drugs
increase risk of death, stroke, VTE, and some cancers (breast, NSC lung)
What is the range you want to keep calcium and phosphate within
Ca x P < 55
What is first line for phosphate binders in CKD
You would use Tums or Ca Acetate as first line early in Dz when pt is more hypocalcemic
TQ: What type of vitamin D therapy would you do if a pt's P and Ca are both high?
paricalcitol
When phosphate increases what happens to calcium
it decreases because it is getting bound by phosphate
What is one of the MC causes of acute tubular necrosis
aminoglycosides
How do aminoglycosides damage the kidneys
generate reactive oxygen species that damage the mitochondria
What is the most important measurement to watch with aminoglycosides
trough concentrations
if >2 it is a problem!
What is the use of the drug Amifostine
it chelates to cisplatin, protecting the kidneys
What is the most common type of sodium imbalance in the body
hypotonic hyponatremia
What are symptoms of severe hyponatremia
seizures, coma, brainstem herniation, and death
What is the issue with correcting hyponatremia too quickly
central pontine myelinolysis
the longer they have been hyponatremic, the more likely this is to be caused
If you have a patient who is hypervolemic hypotonic hyponatremic, what is your best treatment? What about hypovolemic?
3 % NaCl and a loop diuretic
0.9% NaCl
TQ: What is the limit on how fast to correct hyponatremia
no faster than 12 meq in the first 24 hrs
What drug causes diabetes insipidus to help treat SIADH
demeclocycline
What two drugs for this test did we learn cause a pt to turn blue
rasburicase and benzocaine (could potentially be other -caines too)
Which -caine is the most cardiotoxic? And how did we learn to treat?
bupivacaine- causes arrythmias
tx with lipid emulsion to get it off the heart
Which sleep agent has a REMS program associated with it and is used more as a second line?
sodium oxybate
A 65 year old male presents to the clinic wanting to discuss medications for ED. He complains of muscle aches from the current ED med he is on. Which medication is causing these aches?
Tadalafil (Cialis)
3 multiple choice options
Which medication for ED works on cAMP?
Alprostadil
3 multiple choice options
Which ED medication has the GREATEST risk of priapism?
Intracavernosal Injection (Alprostadil)
3 multiple choice options
Which medication for BPH can decrease Static factors?
Finasteride (Proscar)
3 multiple choice options
A 17 yr old presents to the ER after acute acetaminophen ingestion, it has been 6 hours and their levels are at 250. How do you proceed?
Administer N-acetylcysteine
3 multiple choice options
What dietary considerations should be taken into consideration when starting Sildenafil?
Fatty foods can decrease rate of absorption
3 multiple choice options
Which prostate tissue is most influenced by static factors? (hormones)
epithelial tissue
3 multiple choice options
Which receptors are found on stromal tissue in prostate?
A1 adrenergic
3 multiple choice options
The prostate has a high concentration of _____________?
Zinc
3 multiple choice options
56 year old male, with a sulfa allergy, is complaining about bladder fullness. He describes his urine stream as weak and discontinuous. He mentions how he has to keep getting up at night because he always has to pee every few hours. Upon ultrasound, it is determined his prostate isn't significantly enlarged.
What medication can help his current alleviate the symptoms?
Doxazosin (cardura)
3 multiple choice options
What type of urinary incontinence is best described by urethral underactivity?
Stress incontinence
3 multiple choice options
60-year-old, menopausal women, G4P4004 currently taking Lisinopril for her HTN, comes to the clinic complaining about leaky urine every time she sneezes, or coughs. It seems to be getting worse. What can help mange these symptoms?
Duloxetine (Cymbalta)
3 multiple choice options
68 year old female, currently taking daily Amitriptyline for Fibromyalgia, a daily fiber gummy for regulation, daily HRT, comes to the clinic complaining of urinary frequency issues. She feels like she always has to go to the bathroom, but never seems to get much out. Which medication is contributing to her overflow incontinence? (bladder under activity/urethral overactivity?)
Amitriptyline
3 multiple choice options
which medication(s) is first line in addressing urge urinary incontinence? (Detrusor over activity)
Oxybutynin (anticholinergic)
3 multiple choice options
Who should be cautioned against live vaccines?
26 year old pregnant female
3 multiple choice options
Which vaccine would require a booster dose?
TdAP
3 multiple choice options
What is the window between 2 live vaccines?
4 weeks if not given on same day
3 multiple choice options
Which of the following is a considered a mild "normal" reaction to vaccines?
injection site pain
3 multiple choice options
Which strains of HPV are most associated with cervical cancer, and protected against with the Gardasil vaccine?
16 & 18
3 multiple choice options
A parent brings their 12-month-old child to the clinic for discussing vaccinations. It's currently October and they're concerned about their child getting the flu. What counseling point should you discuss when giving the influenza vaccination for the first time.
first time is a 2 dose series
3 multiple choice options
What is the most commonly used site for administering vaccines?
Deltoid
3 multiple choice options
A 33-year old female, recently diagnosed with gastric cancer, needing to undergo chemotherapy, is here to discuss vaccines. She has 4 kids at home, and its flu season.
What advice about vaccines should she be given for when it is safe to have a vaccine.
2 weeks prior to starting chemo, or 3 months after chemo.
3 multiple choice options
Which vaccine is associated as a CI in patients with an egg allergy? (see slide 23)
Inactivated Flu vaccine. (Not recombinant)
3 multiple choice options
Which polysaccharide vaccines are T-cell dependant antigens? Safe for children at least 2month old.
Conjugate polysaccharide
3 multiple choice options
a 63-year-old male Vero beach resident presents to the ER after being bit on the arm by a bobcat after trying to fight it off when it was sniffing around his chicken-coop. His wife scared the bobcat away after shooting it with pink-water gun.
Florida department of wildlife is currently trying to locate the animal and it's rabies status is unknown. The patient informs you he had his tetanus booster 3 years ago. What should the patient receive for their bite?
Administer Rabies immune Globulin (HRIG)
directly into the wound, and start rabies vaccine series.
3 multiple choice options
What counseling point should be given to patients when starting Doxazosin for BPH? (or any 2nd gen)
Take at night, patient may experience 1st dose syncope.
3 multiple choice options
K: In elderly patients what would be considered intelligent non-compliance?
Taking a BID medication daily to save money
3 multiple choice options
K: Inactivated vaccines cause which type of immunity?
Active
3 multiple choice options
K: Tadalafil (Cialis) is most likely associated w/ which characteristic?
Most likely to cause muscle aches
3 multiple choice options