Random Questions that could be on Pharm exam 3 - from c/o 2025 quizlet

Why would we not want to give antihistamines and sympathomimetics to a patient suffering from acute bronchitis?

They dehydrate secretions which may prolong symptoms

If our patient has had persistent symptoms of bronchitis, which antibiotics could we give them?

Doxy for mycoplasma atypical coverage
OR
Macrolides
OR
Fluroquinolones (last resort)

When should we draw blood and sputum cultures when suspected for community acquired pneumonia?

Before giving Antibiotics!!

Which antibiotic treatments would we give to a patient experiencing community acquired pneumonia with no risk of resistant Strep Pneumonia?

Macrolide (1st line)
OR
Doxycycline (2nd line)

Which antibiotic treatments would we give to a patient experiencing community acquired pneumonia with RISK of resistant strep pneumonia?
How about if they have an allergy?

Beta lactam + macrolide (NKDA)
OR
Fluroquinolone (with beta lactam allergy)

What is the best way to treat Community acquired pneumonia inpatient non-ICU? NKDA

IV ceftriaxone (beta lactam) + macrolide (IV/oral)

If our patient is suspect for MRSA community acquired pneumonia, what do we use?

Vancomycin

What antibiotic coverage must we always cover for in Nosocomial Pneumonia ?

Pseudomonas and MRSA

Which antibiotic trio would we give for broad spectrum empiric coverage against nosocomial pneumonia?
HINT --> We need two antipseudomonal and gram-positive MRSA coverage

Antipseudomonal Beta lactam (cefepine, meropenum, zosyn)
PLUS
Antipseudomonal fluroquinolone (Levo) or Aminoglycoside
PLUS
Vancomycin or linezolid

NOTE--> Do not use vanco and aminoglycosides together if the patient has renal issues!! (ototoxicity & nephrotoxicity)

What is our combo therapy we use for treating Tuberculosis for the first 2 months?
Then what for 4 months after?

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

Rifampin and Isoniazid (4 months after)

What is the purpose of isoniazid in our combo therapy for TB?

Inhibits the waxy cell coat of TB in order for the other drugs to go in.

NOTE --> Secreted as acetylated metabolite (which patients could have shorter or longer half-lives for it)

What MUST we give to patients taking isoniazid in order to prevent seizures and CNS affects due to pyridoxine deficiency?

Vitamin B6 (Pyridoxine)

Which allergic reaction can be caused from isoniazid?

Lupus like syndrome (butterfly rash)

Rifampin is considered a CYP450 INDUCER, what could that mean for patients taking long term HIV meds or women taking oral contraceptives?

Those meds will be excreted and metabolized much much quicker leading to low levels of them in the body

What is a side affect of rifampin that we must warn our patients about?

HINT: has to do with secretions

Warn them that their tears, sweat, and urine could turn orange

What is a major adverse effect of taking ethambutol?

Decreased red/green discrimination (partial color blindness)
and decreased visual acuity

What is the function of pyrazinamide used in TB infections?

Lowers the pH so bacteria cant grow

What is an adverse affect to taking pyrazinamide in TB infections?

Gout or kidney stones

If our patient is having an anaphylactic reaction, what solution are we gonna give in order to increase blood pressure due to our histamine lowering it during the anaphylaxis?

HINT: know the dosing for this one too :(

IV crystalloids 0.9% (normal saline)
20mL/kg bolus (1-2 L at a time)
for severe cases use 4-8 L

Which drug are we gonna give in order to vasoconstrict and relax bronchial smooth muscles when our patient is experiencing anaphylaxis?

Epinephrine (IM/SC or IV )

What can we give to block histamine during an anaphylactic reaction?
HINT: There's two types, tell me which one has cutaneous and which has systemic effects?

H1 blocker (diphenhydramine or hydroxyzine) --> cutaneous
H2 blocker (famotidine) --> blocks systemic vasodilation

How does albuterol have an effect on smooth muscle?

Beta 2 agonist so it relaxes the smooth muscle

Which drugs act on all aspects on anaphylaxis but take time to work?
HINT: don't use these for acute reactions

Corticosteroids (methylprednisolone IV, or prednisone)

Which drug would we give a patient to provoke a bronchial reactivity (smooth muscle contraction) to assess if the patient indeed has asthma?

methacholine

Fun fact: 20% drop in FVE1 means they have asthma

What are considered quick relief medications for asthma?
HINT: 3 classes

SABAs
Anticholinergics
Systemic corticosteroids

What are considered long term controllers for asthma?
HINT: be broad, just give some classes, there's alot of them

LABAs
Inhaled corticosteroids
Leukotriene modifiers
Mast cell stabilizers
Anti-IgE antibodies
Methylxanthines (theophylline)

Which drug increases cAMP, relaxes smooth muscle and tends to increase heart rate while treating asthma?

beta 2 agonist

Which drugs can we never never never use alone for asthma?

LABAs such as formoterol or salmeterol

How many weeks do inhaled corticosteroids take to work at full effect?

8 weeks

How do we use our LABAs if we cant use them alone?

we use a LABA plus a corticosteroid

What kinds of drugs are effective in aspirin-induced asthma?

Leukotriene modifiers

What are some major weird side effects of omalizumab (xolair) used to prevents degranulation of mast cells?

Neutralizing antibodies may develop and gets rid the drug making it ineffective (could cause anaphylaxis)

Why would we ever use methylxanthines such as theophylline in real life?
-Theophylline is a phosphodiesterase inhibitor btw

To treat bad status asthmaticus
NOTE: can cause arrhythmias and convulsions (not a good drug tbh)

Which two systemic corticosteroids can be given parenterally?

Methylprednisolone and Dexamethasone

What is one downfall to using a nebulizer for inhaled meds?

You get such high does of the drug which could amplify side effects

How long should we wait in between puffs when using an
inhaled beta 2 agonist?

15-30 seconds

Which 4 drugs do we normally give to patients experiencing status asthmaticus?

Continuous albuterol nebulized
Steroids
Magnesium
Ketamine

What is the mechanism of action of bupropion SR for those needing to cut down on smoking/nicotine consumption?
What kind of patients do we avoid giving this too?

bupropion indirectly activates epinephrine and dopamine by binding to the receptors

avoid giving to those with seizure disorder, MAOI's (antidepressants), and nonadrenergic antidepressants

What could nicotine poisoning cause?

Tachyarrhythmias and hypertension

What is a major major side effect of varenicline (Chantix)?

Could cause neuropsychiatric events (depression, suicidal ideations)

Why should we educate our patients to not drink grapefruit juice with Apixaban (eliquis)?

Eliquis is metabolized via CYP3A4
Could lead to adverse bleeding

What is unique about the Oral factor inhibitor Edoxaban (savaysa)?

If the patient's creatinine clearance is >95mL/min (great) then the drug will clear too quickly and could lead to strokes from underlying afib

What is the only apoprotein of LDL in which it binds to LDL and its receptor?

ApoB-100

What is the mechanism of action for HMG-CoA reductase inhibitors (STATINS)

Inhibits HMG-CoA reductase which reduces intracellular cholesterol and upregulates LDL receptors to uptake more non-HDL particles from circulation

What are three statins that are metabolized by CYP3A4?

Atorvastatin, Lovastatin, and Simvastatin

Which organ should we monitor the most when having patients taking statins?

Liver

What adverse reactions can be caused from using statins?

Myalgia (muscle pain) or rhabdomyolysis (breakdown leading to kidney dysfunction)

NOTE: measure CPK in labs

Can we give statins to pregnant patients?

NOOOO

Which drug is an example of a cholesterol absorption inhibitor?
What area of the body is this working on?
Can this be added with a statin?

Ezetimibe (zetia)
Intestines to inhibit cholesterol absorption
Yes, can be an add on with a statin

What kind of drug interactions can we see with ezetimibe (zetia)

Fibric acid derivatives --> liver/bile duct problems
Bile acid sequestrants --> decrease concentration
Antacids --> decrease concentration
Cyclosporin --> increases concentration

What is the main function of Fibric acid derivatives (fibrates)?

Good reduction in triglycerides
Good at raising HDL

NOTE: Fibrates activate PPAR-alpha --> lowers TG
and
Increase expression of ApoA-1--> raises HDL

If we have a patient with a familial history of just high triglycerides or low HDL, which drug class would be of choice?

Fibrates

Should we pair statins and fibrates?

No, myopathy would be more likely to occur

Note: Fibrates have interactions with most cholesterol drugs and also warfarin

Can we given Fibrates the pregnant women?
How about those with gallbladder disease?

No and No

What's the purpose of bile action sequestrants (resins)?
How does it reduce LDLs?

They bind to bile acids in the GI system and prevent the recirculation of cholesterol, excreting it in the feces

--> This causes the liver to secrete more bile acids and make more LDL receptors --> lowering LDLs

Can we use bile action sequestrants for pregnancy?

Yes!! Does not get absorbed

Note: GI upset is bad, really depends on the patient's choice

Does increasing the dose of bile acids sequestrants help make it more effective?

Nope, just increases the side effects

When should we tell our patients to take bile acid sequestrants?

Hint: with food/without food/ in the morning? which one is it?

Within 1 hr of a meal

What can bile acid sequestrants increase?

Triglycerides
Not good for those who already have high triglycerides

How would we avoid bile acid sequestrants from interacting with alot of cardio drugs?

We either have the patient take the cardio meds 1 hour before taking the Bile acid sequestrant
OR
Have them take the cardio meds 4 hours after taking the bile acid sequestrant

How does Niacin work?

Decreases hepatic production of VLDL and apo B
--> decreases Triglycerides
--> Increases HDL

What is the extended release Niacin supplement called?

Niaspan

How can we prevent patients from obtaining a cutaneous flushing rash that Niacin can create?

Give aspirin prophylactically

Can Niacin mess with glucose and uric acid levels?

Yes, monitor them

Note: Don't advise patients to take niacin if they have a Hx of diabetes, hyperuricemia, PUD, or liver disease

Can you drink alcohol when using niacin?

Nope, advise not too due to the flushing

How do PCSK9 inhibitors work?
Why aren't they used often?

Monoclonal antibodies that block enzymes which keep LDL receptors active longer

Not used because it's only an injectable and expensive

What are two high intensity statins?

Atorvastatin (CYP450/ GRAPEFRUIT JUICE)
Rosuvastatin

How do loop diuretics work?
Which specific carrier does it inhibit?

Stops the reabsorption of sodium in the ascending loop of henle which keeps water in the lumen
Inhibits the Na-2Cl-K carrier

Where would aldosterone have the most affect in the kidney?

Distal tubule

Where would potassium sparing diuretics have the most affect in the kidney?

Collecting duct

What electrolytes are typically excreted when we give a patient loop diuretics

Hint: There's 3 main ones

Calcium, magnesium, and potassium

What is the main loop diuretic used in clinical practice?

Furosemide (Lasix) (MAIN GO TO)

Just have an idea about the ones below
Note: Bumetanide (bumex)
Torsemide (demedex)
Ethacrynic acid (edecrin)

Would we want to give loop diuretics to a patient with diabetes?

No, hyperglycemia can occur with this drug

Which type of patients could benefit from loop diuretics?
HINT: Think about the kidney specifically

Those in renal failure and have a creatinine clearance of below 30ml/min

Name some adverse affects for Loop diuretics?

Hypokalemia
Hyperglycemia
Hyperuricemia
Ototoxicity
Azotemia (BUN increases)

Why would we not want to give NSAIDS with patients on diuretics?

NSAIDS block prostaglandin which constricts the afferent arteriole to the glomerulus, thus reducing GRF and urine output. --> counteracts diuretics

Where do thiazide diuretics work in the kidney?
What transporter do they affect?

Work in the distal tubule
Blocks sodium/chloride channel

What is a BIG difference we see in electrolytes when we compare thiazide diuretics vs Loop diuretics?

Thiazide diuretics hold onto CALCIUM!! (less calcium excretion)

NOTE: GOOD for those experiencing calcium kidney stones because the body will reabsorb it from the lumen (the body can handle high calcium levels)

What diuretic should we give to those experiencing chronic kidney stones?

Thiazide Diuretics

What is the chronic use of thiazide diuretics?

To decrease sodium retention leading to less vasoconstriction in the arteriole walls

We know that loop diuretics are better for those with a low creatinine clearance, but which thiazide diuretic is the exception?

Metolazone

Can make a rock pee

Which class of diuretics can cause:
Hypercalcemia
Constipation
Sexual Dysfunction

Thiazide diuretics

Can we combine potassium sparing diuretics with loop or thiazide diuretics?

Yes!

What are the two potassium sparing diuretics?

Amiloride (midamor)
Triamterene (dyrenium)

If our patient has a high potassium lab value (>5) , which diuretics are contraindicated?

Potassium sparing ones (amiloride, triamterene)
AND
Aldosterone Antagonists (spironolactone, eperenone)

What are our two Aldosterone antagonists?

Spironolactone
Eplerenone

Which aldosterone antagonist has significant causes for menstrual irregularities, hirsutism, and gynecomastia?

Spironolactone

NOTE: Use eplerenone instead!

What are our three carbonic anhydrase inhibitors?

Acetazolamide (diamox)
Dichlorphenamide (daramide)
Methazolamide (Glauctabs)

What would we expect our URINE pH to be when taking carbonic anhydrase inhibitors?
How about our serum (blood) pH to be?

Increases in urine (more alkaline)
Decreases in blood (metabolic acidosis)

What CNS condition can carbonic anhydrase treat?

Epilepsy, because carbonic anhydrase inhibitors make the blood more acidic which reduces seizure risk

What do all ACE inhibitors have at the end of their name?

HINT: this is how you distinguish them

PRIL

What types of comorbidities can be benefitted from ACE inhibitors?

Diabetes
HTN
CHF (specifically LV dysfunction)

What is a very common side effect of ACE inhibitors?

Dry cough (due to bradykinin accumulation in lungs)

NOTE: bradykinin accumulation could rarely cause angioedema

Which electrolyte imbalance can occur from using ACE inhibitors?

Hyperkalemia

NOTE: be careful putting patients on ACE inhibitors and spironolactone--> high levels of K+

Can we give ACE inhibitors or ARBS to pregnant patients?

NO! could cause birth defects

Which specific angiotensin pathway do ARBS block?

Angiotensin 1

All ARBS end in ..........

Sartan

What are the affects of calcium channel blockers on arterial and venous tone?

Ineffective at decreasing venous tone but work on arterial smooth muscle best
--> This can decrease afterload and have no effect on preload

Which types of calcium channel blockers work on the myocytes of the heart and which do not?

Non-DPH works on the heart and slows AV conduction --> (diltiazem and verapamil)
DPH (dihydropyridine) does not affect the heart/AV node

Can we give patient's with Heart block or Heart Failure calcium channel blockers?

No