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PHARM STEP 2CK IM UWORLD

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eesohbel's version from 2016-08-15 18:05

Section

Question Answer
drugs that confer survival benefit in CHFACE-i, ARBS, beta blockers and spironolactone
treatment for organophosphate poisoning (aka cholinergic tox) atropine
rate control for afibbeta blockers or CCB
A/E beta blockers (metropolol)bradycardia, AV block, bronchoconstriction, impotence
A/E nitratesheadaches hypotension
A/E statinshepatotox and myopathy
A/E ACEimcc acquired angioedema, cough, hyperkalemia
disseminated gonoccal infection IV ceftriaxone for 7-14 days and empiric azirhromyicin
drugs that cause folic acid deficiencyphenytoin, methotrexate, trimethoprim
primary syphillis treatment penicillin G X 1 dose
secondary syphillispenicillin G X 1 dose
latent syphillispenicillin G (IV) X 14 days
SBPthird gen cephalosporins (cefotaxime); fluros for prophylaxus
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Section

Question Answer
A/E cisplatin and carboplatincochlear dysfunction
A/E ethambutol and hydroxychloroquineoptic neuritis
toxic causes of peripheral neuropathyphenytoin, isoniazid, vincristine, heavy metals, alcohol
A/E long term cyclophosphamide usebladder cancer, acute hemorrhagic cystitis, sterility and myelosuppression
meningitis ages 2-50 (n.mening, s.pneumo)vancomycin plus third gen cephalosporin
meningitis greater than 50 (s. pneumo, n.meningin, listeria)vanco plus amp plus third gen cephalosporin
meningiits in immunocompromisedvanco plus cefempine (cover gram-negative rods)
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section

Question Answer
tx for scabiestopical permethrin cream or iral ivermectin
electrolyte abnormalities w/loop diureticshypokalemia and hypomagenesemia
tx for hairy cell leukemiacladribine
use of amiodaroneclass antiarrhthymic
a/e amiodaronepulmonary toxicity, bradycardia, thryoid dysfunction, blue gray skin discoloration, hepatic damage
amlodipine and nifedipine dihydroperidine CCBperipheral neuropathy
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asthma/COPD

Question Answer
intermittent asthmaday time symptoms less than 2 X a week and night time less than @X a motn
treatment intermittent asthmabeta agonists
mild persistent asthmaday time symptoms greater than 2X a week and night $X month
treatment mild persistent asthmashort acing beta agonist plus low dose corticosteroid inhaled
moderate persistent asthmadaily symptoms, weekly night time
treatment moderate persistent asthmabeta agonist, low dose corticosteroid, and long acting beta agonist
severe persistent asthmadaily symptoms, frequenty night time wakenings
treatment severe persistent asthmashort acting beta, high dose inhaled steroid, long acting beta can add oral steroid
mainstay of treatment for COPDbeta agonist plus anti-cholinergic (muscarinic) (like ipratropium(
if mainstay not enough addlong acting anticholinergic (tiotropium)
if not enough long acting antichol not enoughadd inhaled steroids
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section

Question Answer
feared complication of PTU/methimazoleagranulocytosis presents as fever and sore throat
medications that cause hyperkalemiabeta blockers; ACE-I; ARBS; K sparing diuretics, digoxin, NSAIDS
name a potassium sparing diureticamiloride
a/e excessive cortisolhypokalemia and hypernatremia. bc cortisol has some mineralocorticoid activity
tx of choice for opioid withdrawalmethadone
major a/e cyclosporinegym hypertrophy and hirsutism
major a/e tacrolimusnephrotox no gum hypertrophy or hirsutism
tox azathioprinediarrhea, leukopenia and hepatotox
tox mycophenolatebone marrow suppression
preferred therapy for Hep Bentecavir and tenofovir
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section

Question Answer
tx for West syndrome (aka infantile spasms)ACTH
tx for absence seizuresethosuximide
tx for Kawasak diseaseaspirin (even tho risk of reye's syndrome) and IVIG
empiric tx for osteomyelitis in SCDthird gen cephalosporin (cover gram negative) and and anti- staph oxacillin or vanco (cover gram positive)
tx bacterial rhinosinusitisoral amoxicillin-clavulanic acid
RSV prophylaxispalivizumab
ribavarinantiviral drug can be used in high-risk infants w/bronchiolitis
neonatal meningitis giveampicillin and cefotaximine (GBS, E. Coli and Listeria)
children meningitisceftriaxone and vancomycin (N. Meningitidis, S. pneumo)
tx for gonoccal conjunctivitisIV or IM ceftriaxone or cefotaxime
tx for chlamydial conjunctivitisoral erythromycin
EHEC is suspected txdo not give antibiotics may increase HUS
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section

Question Answer
tx w/PSVTIV adenosine. can interrupt AV nodal reentry circuit
tx for pheogive alpha blocker (ex. phenoxybenzamine) first then beta blocker
common pharm triggers for SJS/TENallopurinol, antibiotics (sulfa), anitconvulsants (carbamazepine, lamotrigine, phenytoin)
ischemic strokepresentation within 3.5-4 hrs of symptoms onset IV altepase
ischemic stroke w/no prior antiplatelet therapyaspirin
ischemic stroke on aspirin therapyaspirin + dipyridamole or clopidogrel
stroke on aspirin therapy and patient with intracranial large artery atherosclerosisaspirin + clopidogrel
stroke w/evidence of atrial fibrillationlong term anticoagulation
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cards

Question Answer
indicated in patients w/MIoxygen, nitroglycerin, B-blocker, aspirin, morphine, ACE-i, IV heparin
medications that have been shown to lower mortality in systolic HFACEi, ARBs, B-blockers, aldosterone antagonists, hyrdalazine plus nitrate
medications that do not decrease mortality in systolic HFloop diuretics, digoxin
tx for hypertensive emergenciesIV hydralazine, esmolol, or nitroprusside
moa of nitrates in anginacauses systemic vasiodilation. leads to decrease in preload and decrease in myocardial oxygen demand
patient on a statin who presents w/myalgias checkCPK levels
stable patients with wide complex tachycardiaantiarrhythymic drugs (amiodarone, procainamide, sotalol, lidocaine)
treatment for patients w/symptomatic bradycardiaIV atropine. further options IV epi, dopamine or pacing
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cards 2

Question Answer
acute digoxin toxicity symptomsGI (anorexia, nausea, abdominal pain)
chronic digoxin toxicityneuro (lethargy fatigue, confusion) and visual (changes in color vision)
fatal complication of digoxin toxlife threatening arrhythmias
drugs that increase the serum levels of digoxinverapamil, quinidine and propafenone)
tx variant (prinzmetal's) anginaCCB or nitrates
meds to avoid in prinzmetal anginanonselective beta blocks and aspirin because promote vasoconstriction
tx for PH due to LV dysfunctionloops and ACEI
tx for symptomatic idiopathic PHendothelian receptor antag, PDE-5 inhibitors, or prostanoids
beta blockers can use with asthmacardioselective beta blockers (ex. metoprolol, atenolol, bisoprolol, neivolol)
medications to withhold prior to cardiac stress testingbeta blockers, CCB, nitrates
what drug limits ventricular remodelingACE-i
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cards 3

Question Answer
major side effects of amiodaronesinus brady, pneumonitis, thyroid, elevated transaminases, blue-gray skin color discoloration, optic, peripheral neuropathy
dofetilidie a/etorsades
hydralazine a/edrug induced lupus like syndrome
metropololbradyarrythmias, bronchoconstriction
a/e verapamilconstipation and CHF
drug of choice for WPWprocainamide
contraindicated in WPWanything slows conduction through AV node like beta blockers or CCB
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cards 4

Question Answer
tx torsadesmagnesium IV
medications cause long QTantipsychotics (haloperidol, quetiapine, risperidone), TCAS, SSRIS, amiodarone, sotalol, flecinade, macrolides, fluroquinolones
acute termination of AF in WPW ptshemodynically unstable cardiovert; or procainamide
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section

Question Answer
tx for central DIintranasal form of desmopression
tx for nephrogenic DIsodium restriction and thiazide diuretics
tx for cyanide toxicityantidote such as hydroxocobalamin or sodium thiosulfate. or induction methemoglobinemia with nitritres
contraindication to succinylcholinehyperkalemia use non-depolarizing agent such as vecuronium or rocuronium
rifampin a/ebody fluids turn orange/red, induces CYP450
INH a/eperipheral neuropathy and sideroblastic anemia (prevent by giving B6)
pyrazinamide a/ebenign hyperuricemia
ethambutol a/eoptic neuritis, other color vison abnormalities
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section

Question Answer
a/e beta agonistshypokalemia (muscle weakness, arrhythmias, EKG changes), tremor, headache and palpitations
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ID

Question Answer
tx for outpatient CAP in younger than 60azithromycin or clarithromycin
tx in older older adults CAPfluroqunolone first line. or second or third generation cephalosporin
tx HCAPinclude gram negative rods cefepime, imipinen, pip/tazo
menignitis pts between 3mo and 50 yrsceftriaxone or cefotaxime plus vanco
infants, older than 50, immunocompcefotaxime plus amp plus vanco
tx for Hep Bentecavir and tenofovir
tx for chronic hep CIFN and ribavirin
tx acute uncomplicated cystitisoral TMP/SMX for 3 days or nitrofuantoin (5 to 7 days) or fosomycin single dose
tx UTI in pregosampicillin, amoxicillin or oral cephalosporins for 7 to 10 days
tc PCPTMP-SMX proph when CD4 under 200
MAC prophgive when CD4 less than 100 give azithromycin
HCAPvanco plus pip/tazo
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ID continued

Question Answer
best antibiotics for anaerobespenicillin G, clindamycin and metro (for abdominal/GI)
macrolides good forintracellular pathogens mycoplasma, chlamydia, legionella
best antibiotics for gram negative rodsfluroquinolones
if staph resistant to vancolinezolid
pseudomonas coveragespip/tazo; carbapenems, cefepime
cefepime4th generation cephalosprin kills pseudomonas
outpatient pneumoniadoxycycline, azithromycin, moxifloxacin
inpatient pneumonia3rd gen cephalosporin + azithromycin (CAP); vancomycin plus pip/tazo (HAP)
neutropenic fevercefepime
cellulitiscefazolin, bactrim, clindamycin, IV vancomycin
PEP HIVtenofovir-emtrictabine with raltegravir
amoxicillin-clavulinate coversgram positives, gram negatives and anaerobes
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ID continued

Question Answer
alternate regiments for TMP-SMXpentamidine, atovaquone, TMP plus dapsone, clindamycin plus primaquine
avoid what UTI meds in pregnancyfluroquinolones and TMP-SMX
tx febrile neutropeniabest pip-tazo (pseudomonal plus GP/GN/anaerobes)
tx cryptococcal meningitisamphotericin B
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Obgyn

Question Answer
tx of hyperthyroid disease in pregnancyPTU
seizures in pregoslamotrigine
UTI in pregos txnitrofuranton or ceftriaxone
hypertension in pregosalpha-methyl dopa 1st line or hydralazine or labetalol
tx of choice for endometritisIV clindamycin and gentamicin (polymicrobial infection)
tx for ectopic pregnancyif stable methotrexate and unstable surgery
tx for preeclampsiahydralazine IV, labetalol IV or nifedipine PO
tx for ecclamptic seizuresmagnesium sulfate
tx for chorioamnionitisprompt administration of broad spectrum antibiotics
tx premature labortocolytic therapy, steroids, penicillin or ampicillin for GBS prophylaxis, magnesium (less than 32 weeks for neuroprotection)
indications for oxytocininduction or augmentation of labor, prevention and management of postpartum hemorrhage
a/e oxytocinhyponatremia, hypotension, tachysystole
lithium in preggosebstein anomaly first trimester. 2nd and 3rd trimesters goiter and transient neonatal neuromscular dysfunction
tx of eclampsiamagnesium sulfate for seizure recurrence prevention, BP control and expedient delivery
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Obgyn 2

Question Answer
magnesium toxmild nausea, moderate areflexia, severe respiratory paralysis
tx for magnesium toxstop magnesium therapy and give IV calcium gluconate
tx if a at risk of preterm deliveryprogesterone supplementation and serial cervical length measurements
1st line tx for PMS/PMDDSSRIS
HCGpreserves the corpus lutuem
PCOS not attempting to concieveOCPS +/- metformin
PCOS attemption to conceiveclompiphene (SERM) +/- metformin
tx for TSSclinda plus vanco
ER/PR + breast cancertamoxifen
Her2/Neu +trastuzumab
UTI antibiotics in pregnancy oknitrofuarantoin, amoxicillin, amoxicillin-clavulanate, cephalexin
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Obgyn 3

Question Answer
A/E SERMS (tamoxifen, raloxifene)hot flashes, DVT, endometrial hyperplasia (tamoxifen only)
indication for tamoxifenprevention of breast cancer + treatment of breast cancer
indication for raloxifeneprevention of breast cancer in high risk patients plus postmenopausal osteoporosis
tx for atrophic vaginitislow dose vaginal estrogen
tx for lichen sclerosushigh potency vaginal steroids
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medicine

Question Answer
a/e thiazide diureticshyperGLUC hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia
a/e loop diureticsOH DANG Ototoxicity, Hypokalemia, Dehydration, Allergy, Nephritis, Gout
digitalis tox arrythymiaatrial tach w/ AV block
tx for CMLtyrosoine kinase inhibitors such as imatinib
1st line for Paget's disease of the bonebisphosphonates
tx for migraine if happeningIV antiemetics plus NSAIDS or triptans
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medicine

Question Answer
NRTISlactic acidosis
protease inhibitorscrystal induced nephropathy idinavir
didanosine(NRTI)pancreatitis
NNRTISSJS
nevirapine(NNRTI)liver failure
abavacavir (NRTI)hypersensitivity
medications that cause hyperkalemiabeta blockers, ACEi, ARBS, digitalis, cyclosporin, heparin, NSAIDS, succyinlcholine
flecinade a/eQRS prolongation
name thiazideschlorthalidone, hydrochlorothiazide
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medicine

Question Answer
appropriate indicator of severity of intoxication of TCASduration of QRS complex
antidote TCA overdosesodium bicarb
theophylline toxicityCNS smiluation, GI disturbances, cardiac toxicity (arrhythmia)
drugs that increase warfarin effect (CYP inhibitors)acetaminophen, NSAIDS, antibioitcs, amiodarone, cranberry juice, omeprazole, thyroid hormone, SSRIS
drugs that decrease warfarin effect (CYP inducers)carbamazepine, phenytoin, ginseng, green vegetables, OCPS, phenobarbital, rifampin, St. Johns
signs of beta blocker toxbradycardia, AV block, hypotension, and diffuse wheezing
tx for beta blocker toxIV fluids, atropine, and IV glucagon
tx for PNHeculizumab
what electrolyte deficiency can predispose to dig toxhypokalemia
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malaria meds

Question Answer
a/e atovaquone-proguanilexpensive, GI disturbance, increased liver function tests
a/e doxycyclineinexpensive, GI disturbance, sun sensitivity, teratogenic
a/e mefloquineneuropsych effects, agent of choice in preggos, weekly dosing
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psych

Question Answer
antipsychotic EPS effectsacute dystonia, akathisia, parkinsonism, tardive dyskinesia
acute dystoniasuddent, sustained contraction of the neck, mouth, tongue, eye muscles
akathisiasubjective restlessness
parksinsonismgradual onset tremor, rigidity, bradykinesia
tardive dyskinesiagradual onset after prolonged therapy (greater than 6 months). dyskinesia of the mouth, face, trunk, extremities
tx for acute dystoniabenzotropine or diphenhydramine
tx for akathisiabeta blocker or benzo
tx for parkinsonismbenzotropine or amantadine
tx for tardive dyskinesiano definitive tx, clozapine may help
tx for OCDCBT and SSRI
tx for specific phobiabehavorial therapy or short acting benzo
tx for social phobiaSSRI/SNRI or CBT
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