What What OTC OTC ant antif ifun unga gals ls for for 1st 1st tri trime mest ster er and and 2nd/ 2nd/3r 3rd d trim trimes este ters rs?? 2nd/3rd: miconazole 7 day cream
1st: 1st: clot clotri rima mazo zole le 7 day day cre cream am
Citro-mag, Milk of Magnesia, Epsom Salts and Fleet Enema. What type of medication are they and what precaution needs to to be taken? Osmotic/saline Osmotic/saline agents for constipation. constipation. Avoid in renal failure, risk of h ypermagnesia (first 3) or h yperphosphatemia (Fleet (Fleet enema) Decong Decongest estant ant CIs CIs and and cauti cautions ons CIs: CIs: Seve Severe re HTN HTN,, CAD, CAD, MOAI MOAI within within past past 14 days. days. Cautioned in: CVD, diabetes, hyperthyroidism, prostatic hypertrophy and angle-closure glaucoma Medica Medicatio tions ns to be cautio cautious us of in asthma asthma Beta-blockers
ASA/N ASA/NSAI SAIDs/ Ds/COX COX-2 -2 inhibi inhibitor torss
Beano CI when? Anaphylactic penicillin allergy or taking acarbose. Factors affecting affecting passage passage into breast milk? milk? molecular weight, weak bases are trapped, trapped, weak acids can reabsorb, degree of ionization [only ionized can pass], lipid solubility Drugs Drugs that that enter enter breast breast milk? milk? 1) alchol alcholol ol 2) 2) narc narcoti otics cs 3) 3) barb barbitu ituate atess 4) bdz 5) anti antidep depres ressan sants ts 6) metoclopramide 7) anticholinergics 8) antipsychotics FGA FGA or SGA, SGA, whic which h cau cause se prol prolac acti tin n lev level elss to to inc incre reas ase? e? *** risperidone increases levels slightly*** Medication Medicationss that decreas decreasee prolactin prolactin levels levels
FGA FGA (eg. (eg. halo halope peri rido dol) l)
bromocrip bromocriptine tine,, ergot ergot alkaloids alkaloids,, levodopa levodopa
Medication Medicationss that increase increase prolacti prolactin n levels metoclopr metoclopramide amide,, methyldopa, methyldopa, haloperi haloperidol, dol, phenothia phenothiazines zines (eg. (eg. chlorpromazine), theophylline, amphetamines Which antibiotic would you use to treat otitis media? Amoxicillin In renal renal diseas diseasee what what are the pain pain kill killer er and diuret diuretic ic one one should should consid consider er?? (APAP (APAP > NSAIDs/ASA) NSAIDs/ASA ) Diuretic: furosemide (loop diuretic > thiazides) Targe argett ser serum um leve levels ls for for dig digox oxin in
0.80.8-2. 2.0 0 ng/ ng/ml ml
Targe argett ser serum um leve levels ls for for lith lithiu ium m
0.60.6-1. 1.2 2 mmo mmol/ l/L L
Pain Pain kill killer er:: aceta acetamin minoph ophen en
Which UTI Abx do we avoid avoid in pregnancy? 1st trimester: trimester: TMP Last 6 weeks: SMX/TMP At term (36+ weeks): Nitrofurantoin *Cipro *Cip ro ALWAYS! ALWAYS! Two antianti-epi epilep leptic tic medic medicati ations ons that that caus causee folate folate defic deficien iency cy Why is cloxac cloxacillin illin good for for staph staph aureus? aureus?
CBZ, CBZ, PHT PHT
Long R-cha R-chain in that that beta-lac beta-lactamas tamasee can not not bind. bind.
What do you you monitor monitor in hepatic hepatic encephalopa encephalopathy thy and and what what is is used used to treat treat it? it? with lactulose (or a non-absorbed Abx) Abx)
Monitor Monitor ammon ammonia. ia. treat treat
If patient has gonorrhoea, what do you assume they are coinfected with? What do you empirically treat with? Chlamydia 3rd gen ceph + azithromycin How do you treat treat Lithium Lithium induced induced tremor? tremor? beta-bloc beta-blocker ker (propranol (propranolol) ol)
*Note: monitor thyroid and renal function every 6 months at least LTG effects on BCP and patient weight? Weight neutral Topiramate's effects on weight?
rarely decreases effect of BCP
Loss possible
Antiepileptics/bipolar medications that cause hepatotoxicity? Divalproex, VPA, LTG Which NSAID has the greatest risk fo GI bleeds with chronic use? What medication class causes SIADH?
SSRIs
What is responsible for phototoxic reactions? What is the filter size for cold filtration?
Ketorolac
UVA light
0.22 microns
advantage of darbopoetin vs. EPO Longer half-life (once weekly dosing vs. 3x weekly) What DI would we see with anti-cholinergics and metoclopramide? Time to maximal effect in BPH for finasteride? What does SSZ cause a deficiency in?
ACs blunt the pro-motility effects
6 months
Folate
OC with highest failure rate due to non-compliance? micronor (progesterone only) - 3 hour window. At what APAP ingestion do you consider acetylcysteine? Adults: 6.5g
Children: 200mg/kg
What are the 4 classifications of hypersensitivity reactions [Grooms] "ACID" ACID Type I Anaphylaxis Type II Cytotoxic-mediated Type III Immune-complex Type IV Delayed hypersensitivity Teratogenic drugs (Major non-Abx) "TAP CAP" TAP CAP: Thalidomide, Androgens, Progestins Corticosteroids, Aspirin & indomethacin, Phenytoin Epilepsy DOCs for (1) Absence Sz (2) Myoclonus (3) Primary Generalized TC (4) Partial & Secondary Generalized TC (1) Absence Sz: Ethosuximide, VPA (2) Myoclonus: VPA (3) Primary Generalized TC: VPA [CBZ] (4) Partial & Secondary Generalized TC: CBZ [LTG, OxCBZ] Young women should make what adjustment when on epilepsy medications? EE/alternative contraception. Also should take folic acid 5mg or less per day. Therapeutic dosage: toxicity values for most commonly monitored medications "The magic 2s" "The magic 2s": Digoxin (.8-2.0) Toxicity = 2.
Use BCP with 50ug
Lithium (.6-1.2) Toxicity = 2. Theophylline (10-20) Toxicity = 20. Phenytoin (10-20) Toxicity = 20. APAP (1-30mg/kg) Toxicity = 200mg/kg (kids) [6.5g adults] Phenytoin adverse effects: "PHENYTOIN" PHENYTOIN: P-450 interactions Hirsutism Enlarged gums NYSTAGMUS Yellow-browning of skin TERATOGENICITY Osteomalacia Interference with B12 metabolism (hence anemia) Neuropathies: vertigo, ataxia, and headache SSRIs side effects: "SSRI" SSRI: Serotonin syndrome Stimulate CNS Reproductive dysfunctions in male Insomnia Cholinergics (eg organophosphates) effects: "LESS DUMB" LESS DUMB: Lacrimation Excitation of nicotinic synapses Salivation Sweating Diarrhea Urination Micturition Bronchoconstriction BDZ safe in liver failure "LOT" LOT: Lorazepam Oxazepam Temazepam Teratogenic drugs "W/ TERATOgenic" "W/ TERATOgenic": Warfarin Thalidomide Epileptic drugs: phenytoin, valproate, carbamazepine Retinoid ACE inhibitor Third element: lithium OCP and other hormones (eg danazol) Benzodiazepenes: drugs which decrease their metabolism "I'm Overly Calm" "I'm Overly Calm": Isoniazid Oral contraceptive pills
Cimetidine • These drugs increase calming effect of BZDs by retarding metabolism. Which are the Osmotic diuretics? "GUM" "GUM": Glycerol Urea Mannitol Sodium valproate side effects "VALPROATE" "VALPROATE": Vomiting Alopecia Liver toxicity [LTG also hepatotoxic] Pancreatitis/ Pancytopenia Retention of fats (weight gain) Oedema (peripheral oedema) Appetite increase Tremor Enzyme inducer (liver) Nitrofurantoin major side effects "NitroFurAntoin""NitroFurAntoin": Neuropathy (peripheral neuropathy) Fibrosis (pulmonary fibrosis) Anemia (hemolytic anemia) Zero order kinetics drugs (most common ones) "PEAZ (sounds like pees) out a constant amount": PEAZ out a constant amount: Phenytoin Ethanol Aspirin Zero order • Someone that pees out a constant amount describes zero order kinetics (always the same amount out) Steroids side effects "BECLOMETHASONE" "BECLOMETHASONE": Buffalo hump Easy bruising Cataracts Larger appetite Obesity Moonface Euphoria Thin arms & legs Hypertension/ Hyperglycaemia Avascular necrosis of femoral head Skin thinning Osteoporosis Negative nitrogen balance Emotional liability Hepatic necrosis: drugs causing focal to massive necrosis "Very Angry Hepatocytes" "Very Angry Hepatocytes": Valproic acid Acetaminophen
Halothane Antibiotics contraindicated during pregnancy "MCAT""MCAT": Metronidazole Chloramphenicol Aminoglycoside Tetracycline Lithium: side effects "LITH" "LITH": Leukocytosis Insipidus [diabetes insipidus, tied to polyuria] Tremor/ Teratogenesis Hypothyroidism What are the 5 components of the Canada Health Act? Comprehensiveness Universality Portability Accessibility
Public Administration
Consequentialism or Utilitarianism Result is all that matter, not how you got there. Deontology
Rightness and wrongness must consider the nature of one's actions as well as the result.
Beneficence
In one's actions, one should strive for good consequences
Non-malificence In one's actions, one should strive for the prevention of harmful consequences Veracity (truth-telling): one should deal honestly and truthfully with others Extensive list of teratogenic drugs • ACEIs • Isotretinoin • Alcohol ingested chronically or in binges. • Androgens (male hormones). • Antibiotics: tetracycline, doxycycline and streptomycin. • Warfarin • Anticonvulsants: PHT, VPA, trimethadione, paramethadione and CBZ • Lithium • Antimetabolite/anticancer drugs: MTX and aminopterin • Antirheumatic agent and metal-binder penicillamine • Antithyroid drugs: thiouracil/PTU and carbimazole/MMI. • Cocaine. • DES (diethylstilbestrol), a hormone. • Thalidomide GERD in renal dysfunction, which medication should you avoid? Medications that cause dysglycemia • β-blockers • Glucocorticoids • Niacin • Protease Inhibitors • Phenytoin • Thiazide Diuretics
• Atypical antipsychotics
Cimetidine
How long is the minimum nitrate free interval for those wearing a nitro patch for angina? 10 hours Common CAP bugs 1) Strep pneumo 2) Mycoplasma pneumo 3) H. influenza If comorbidities w/o oral CS or ABx in past 3 months: 4) Chlamydophila pneumo 5) M. catarrhalis If comorbidities AND recent ABx or oral CS use in past 3 months ADD: 6) Legionella Common HAP bugs General ward admission: 1) Strep pneumo 2) Mycoplasma pneumo 3) H. influenza 4) Chlamydophila pneumo 5) Legionella ICU ADD: 1) Gram neg rods (Kleb, Entero, Serratia, Acinetobacter) 2) Staph aureus ***Pseudomonas possible in severe cases Aspiration: 1) Anaerobes Medications to treat HAP with pseudomonas Two of the following: 1 - Cipro 2 - Ceftaz 3 - Imipenem 4 - Gent 5 - Tobra Drugs to treat CAP More severe: Resp. FQ
Amoxicillin, Macrolide, Doxycycline.
Drugs to treat HAP General Ward: 2nd, 3rd, 4th generation ceph, Amoxicillin, Amoxi/Clav, Macrolide ICU: 3rd gen ceph + macrolide, 3rd gen ceph + resp. FQ Define academic detailing Help physicians adopt better prescribing practices Which liver enzyme elevates first in APAP overdose? AST Define type 1 and type 2 errors Type 2: False Negative
Type 1: False positive
Most likely to be administered via piggyback IV method? Common Traveller's Diarrhea bugs?
Antibiotics
E. coli, Shigella spp, Salmonella spp, Campyrobacter
Traveller's Diarrhea treatment options? Prophylactic: 1) Bismuth subsalicylate QID with food 2) Cholera vaccine (B subunit) 2 doses 7-42 days apart Acute: 1) FQs (norflox, oflox, ciproflox) 3 days schedule or a single dose. 2) Azithromycin [if FQ resistant - eg. campylobacter] 500mg OD x 3 days or 1000mg as one dose.
3) SMX/TMP * loperamide * oral rehydration salts Which medications have additive ionotropic effects if used together? 2) b-blockers 3) digoxin 4) non-DHP CCBs
1) Amiodarone
Which dyslipidemia medications can you use in pregnancy and children? cholestyramine)
Resins (eg.
Best medications for HDL & TGs niacin, fibrates (eg. fenofibrate, gemfibrozil) Doubling a statin dose increases LDL lowering effect by how much?
6%
What are the glaucoma medication classes and how does each lower IOP? decrease aqueous humour formation CAIs (eg. dorzolamide): decrease aqueous humour formation Prostaglandin analogues (eg. latan, travo): increase uveoscleral outflow Bimatoprost: increase uveoscleral and trabecular outflow Cholinergic agonists (eg. pilocarpine): increase trabecular outflow
b-blockers eg. timolol):
List types of EPS Dystonia, akathisia, parkinsonium, rabbit syndrome. *Can progress to tardive dyskinesia. Clozapine and smoking.
Decreased clozapine levels.
*Note: Clozapine causes constipation 60% of the time, can cause agranulocystosis, has LARGE weight gain and is HUGELY anticholinergic. Medications that cause agranulocytosis? Clozapine, CBZ, PTU, MMI, penicillin, chloramphenicol, SMX/TMP, cytotoxic drugs, gold, NSAIDs and mirtazapine. Malaria treatments? DOC: Chloroquine [qWeekly: start 1-2 weeks prior, 4 weeks after] CHQ-resistance: Mefloquine [qWeekly: start 1 week prior, 4 weeks after] Mefloquine-resistance: Doxycycline [qDaily start 1 day prior, 4 weeks after], Atovaquone/Proguanil [qDaily start 1 day prior, 1 week after] Early delusions or hallucinations in dementia can be indicative of? Time to affect for atomoxetine in ADHD?
Lewy body Dementia
6-12 weeks (only 2-3 weeks for stimulants)
What does cost utility analysis mean? A measure of years in full health relative to cost of a healthcare intervention. Often expressed as QALY [quality-adjusted life years] Maximum dose amoxicillin in children?
90mg/kg/day divided BID or TID
What is the Somogyi effect? Rebound hyperglycemia in response to low blood sugar. Often occurs with too high insulin dose at bedtime. Why give calcium carbonate in end-stage renal disease? To reduce serum phosphate levels. High phosphate leads to high PTH which in turn lowers serum calcium levels. Which antiarrhythmic increases HR when treating a. fib?
procainamide
What anticoagulant do you substitute in for a patient with (or past) heparin induced thrombocytopenia? lepirudin How to treat DM in pregnancy?
Diet and if necessary insulin
Which antiepileptics DON'T decrease BCP levels?
Divalproex, VPA, Ethosuximide, Gabapentin, LTG
[CBZ, PHT, Topiramate do] Which antibiotics are hepatically eliminated? norfloxacin, clindamycin, SMX, minocycline
erythromycin, azithromycin, moxifloxacin,
What is the duration of treatment for cellulitis?
10 days
What is used to treat heparin overdose?
protamine sulfate (1mg per 100 units heparin)
infliximab MUST be used with what medication?
MTX (official indication)
What blood serum level can be increased by iostretinoin?
TGs
Carbamazepine side effects all go away if you slowly titrate except? How do you treat methanol toxicity?
Visual Disturbances
ethanol (and vice versa)
60) What is the advantage of PTU over MMI in thyroid storm?PTU prevents the conversion of t4 to t3 Which osteoporosis medication is indicated for MEN with osteoporosis? Prinzmetal angina - what is the DOC?
risedronate
Amlodipine (CCB) [nitrates also used]
Patient with hypercalcemia, what do you give?
Furosemide [not thiazide]
A patient has suicidal ideation. Which of the following should not be given? Where to find the unapproved indications of drugs?
Martindale
What should be done if narcotics are stolen from the pharmacy? substances within 30 days How long can insulin be kept out of the fridge?
Bupropion
30 days
Report to the office of controlled
