Pharm Test 1

When GH is used to increase height, it must be used before what?

Pts using GH can rarely get this SE involving their brain.

Some pts using GH can get this SE from rapid growth as well as sx's of this other disease.

Never use GH in these pts because it may increase mortality.

This is a growth hormone antagonist used clinically for acromegaly, GH producing adenomas, and rare CA's like gastrinomas and insulinomas.

This medication can cause SEs such as gallstones and cardiac conduction disturbances.

This is used in infertility to stimulate spermatogenesis in men and ovulation in women and are cornerstones for assisted reproductive technology such as IVF.

This type of GnRH Agonist is used to stimulate FSH/LH, but is not used much clinically. If used, it is more often for male infertility than female infertility.

This type of GnRH Agonist is used to produce hypogonadism so no sex steroids are being produced. It is also used in prostate CA or palliation in advanced breast & ovarian CA, controlled ovarian hyperstimulation to prevent FSH from working (so given to prevent ovulation from occurring too early), endometriosis & uterine fibroids, and central precocious puberty.

When this medication is given to women, they get menopause sx's. When given to men, they can experience similar sx's of androgen deprivation.

This medication can cause flushing (related to causing menopausal symptoms).

This medication isn't used much in primary care, but has a more immediate effect when compared to sustained release GnRH and don't have to be used as long. There's also a decreased risk of ovarian hyperstimulation with this med.

This medication is used to induce labor, augment protracted labor or postpartum control of uterine hemorrhage.

This med can cause orthostatic hypotension in pts taking it for acromegaly, hyperprolactinemia or physiologic lactation.

This med can cause fetal distress, placental abruption or uterine rupture as well as excess fluid retention, water intoxication and hypotension (from inadvertent activation of vasopressin receptors).

Contraindications for use of this medication include fetal distress, prematurity, abnormal fetal presentation, and cephalopelvic disproportion.

These meds are used for diabetes insipidus, esophageal or diverticular bleeding, hemophilia A or von Willebrand's disease. It's also part of ACLS protocol.

These meds can cause agitation, hyponatremia and seizures. Watch out if CAD.

Give this thyroid med on an empty stomach b/c food decreases its absorption.

If there's not enough thyroid available, TSH is high/low and need to increase/decrease medication (T4).

If there's too much thyroid, TSH is high/low and need to increase/decrease medication (T4).

Chronic overtreatment w/ too much thyroid supplementation can cause the following SEs:

The most common ADRs to these medications are a rash w/ (sometimes) an accompanying fever.

Rarely can get lupus-like reaction, hepatitis, and cholestatic jaundice while on these meds. Also can get agranulocytosis (no WBCs)!

Estrogens increase/decrease cogaulability so a pt will clot more/less.

Primary hypogonadism is when a pt doesn't ever produce this hormone.

If a pt has a uterus, don't give this medication alone b/c of the risk of endometrial hyperplasia.

If giving estrogen to prevent osteoporosis at onset of menopause, need to also be on __mg qd calcium and __-__iu qd of vitamin D.

This type of therapy involves giving estrogen some days and progesterone others, but often involves bleeding at the end of the cycle which menopausal pts don't like.

This type of therapy involves giving both estrogen and progesterone everyday and menopausal pts like this better because after a few months of bleeding, this tapers off.

This med may decrease risk of colon CA.

Large doses of this can cause prolonged anovulation and amenorrhea, so don't give if pt planning pregnancy in near future.

Give progesterone for 5-7 days and then stop it. If bleeding occurs, estrogen was/was not present, so estrogen is/is not the cause of amenorrhea.

Give progesterone for 5-7 days and then stop it. If bleeding does NOT occur, try again but give estrogen and progesterone. If bleeding occurs the 2nd time, amenorrhea is/is not from estrogen deficiency.

This medication causes hot flushes and N/V in 25% of pts.

This med is used for palliation of breast CA in postmenopausal women and prevention of breast CA in high risk women. It can potentially be used for osteoporosis and potentially can cause endometrial CA.

This med is approved for tx of metastatic breast CA in postmenopausal women w/ estrogen receptor positive CA.

This med is used for prevention of postmenopausal osteoporosis and prophylaxis of breast CA in women w/ risk factors.

This med can be used for ovulatory dysfunction (PCOS), but can cause reversible skin loss, hot flushes, and multiple pregnancies in 10%.

This med can be used as emergency postcoital contraception, but it effects the next cycle so it can't be used constantly.

This med can be used to terminate early pregnancy and is more effective if given with misoprostol.

5% of pts that take this medication have bleeding so severe that it needs medical intervention, so it should only be given by experienced medical providers at a family planning clinic.

This med can be used for endometriosis, fibrocystic breast disease, and hematologic or allergic disorders.

This med can cause weight gain, edema, acne and decreased breast size and is contraindicated in pregnancy, breast feeding and hepatic dysfunction.

This drug can be given orally (but this increases the risk of liver tumors) or transdermally for hypogonadism.

This can be given w/ estrogen as replacement therapy in postmenopausal women. It decreases endometrial bleeding and increases libido.

This drug can be given to reverse protein loss after trauma or surgery.

This can be used for male osteoporosis if their blood levels are low.

ADRs of this med include masculinization of women and pre-pubertal children.

ADRs of this drug in men include sleep apnea, erythrocytosis (increased RBCs), gynecomastia, azoospermia, decreased testicular size, hepatic adenoma, and behavioral effects.

Synthetic versions of this med can cause cholestatic liver toxicity.

Older men may experience prostatic hyperplasia with this med.

Pregnant women shouldn't touch this med b/c it can be absorbed through the skin.

Contraindications to this med include breast CA, prostate CA, children (effects CNS development) and renal or heart disease (b/c of risk of edema).

This med can be used to treat hirsutism in women.

This med can be used to decrease prostate size in BPH and maybe prostate CA.

This med is used in prostate CA.

This type of drug action involves giving a mom a drug to get the effect on the fetus.

This is a drug reaction on a fetus that involves interference w/ nL development of the embryo and causes fetal malformation.

This is a type of toxic drug action that doesn't necessarily cause a fetal malformation, but has significant effects on the newborn/fetus.

If mom needs a drug and it is relatively safe, should take __-__ min after nursing and __-__ hrs before next feeding so concentration in milk is as low as possible.

Try to avoid this type of administration of drugs in preterm infants.

Weak bases are absorbed more/less in peds <3 mo old and weak acids are absorbed more/less because of decreased gastric acid secretion, and pH slowly decreasing as acid secretion increases.

Drugs absorbed in stomach of child <6-8 mo old get more/less absorption and those absorbed in small intestine get more/less absorption, so be careful w/ sustained release products in very young.

Up to about 4 mo of age, __ soluble drugs have decreased absorption because of a decrease in bile salts and lipase.

Dose need of water soluble drugs may be more/less in infants because they are made up of more water and the drugs are distributed through more tissues.

Can get greater/less drug effect in peds b/c amount of drug unbound to proteins is higher.

Need to be careful if giving drugs that are hepatically/renally mediated b/c it may have a longer 1/2 life.

In peds, if mom took a med while pregnant that induced hepatic enzymes, neonate may metabolize drugs faster/slower than expect b/c mom's drug made child's enzymes work earlier.

Drugs that are renally excreted are cleared faster/slower b/c infant's GFR is <50% of adult until 6 mo.

This med can cause closure of patent ductus arteriosus (PDA).

This med will keep patent ductus arteriosus (PDA) open if heart anomaly.

(a) 20 drops = __ mL
(b) 1 tsp = __ mL
(c) 1 tbsp = __ mL or __ tsp
(d) 1 oz = __ mL
(e) 1 kg = __ lbs
(f) 1 mL = __ cc

This is the most accurate way to determine dose in peds and should be used with narrow/wide therapeutic index drugs.

This is the least accurate way to dose drugs in peds.

Decimal point placement rules:

(a) 1.0
(b) 0.1
(c) .1

Natural family planning involves abstaining from sex for __ days before and __-__ days after ovulation.

A pt can have intercourse __ days after maximal cervical mucus until menses occurs.

To use the calendar method, record menses for __ cycles. Take shortest cycle and subtract __ to give earliest fertile day. Take longest cycle and subtract __ to give latest fertile day.

Temp increases 0.2-0.5C __-__ days after ovulation and stays up for __ days after ovulation. End of fertile period is __ days after temp rise.

This type of contraception has a failure rate of 15% in 6 mo, whereas all others are in 1 yr time.

This type of contraception can be put in 6 hrs before sex and MUST stay in for 6 hrs after.

This type of contraception has a risk of toxic shock if it is left in for >24 hrs or if used during menses.

This type of contraception can be inserted up to 8 hrs before sex and can be left in for 48 hrs w/o a risk of toxic shock.

This type of contraception is good to use if a pt has a relaxed anterior vaginal wall.

This type of contraception has a higher risk of pregnancy in parous women in comparison to nulliparous women.

This type of contraception cannot be used if obese or abnormal PAP tests.

This type of contraception provides some protection against certain STDs, but not as effective as condoms.

This type of bleeding occurs when it's not supposed to and can be fixed by increasing estrogen in hormonal contraception.

This type of bleeding is when menses doesn't occur at the end of the pill cycle. Provider often can increase the dose and may get bleeding again, but this is controversial.

The progestin-related component in hormonal contraceptives can cause __ __ and symptomatic gallbladder disease.

__ can be severe enough to stop hormones in 6% that start.

If hx of __ tumor, don't start hormonal contraceptives.

There's an increased risk of venous/arterial thrombosis when taking hormonal contraceptives.

Wait __ weeks after delivery to start hormonal contraceptives to ensure lactation has been established b/c hormones can decrease quality and quantity of milk.

This type of hormonal contraceptive can delay return to fertility by 1-2 years.

This type of dosing of hormonal contraceptives includes a constant dose qd of estrogen and progestin.

This type of dosing of hormonal contraceptive involves altering either or both estrogen and progestin on different days.

This is the cell of the humoral arm of adaptive immunity.

This is the cell of the cellular arm of the adaptive community.

This is the most common immunoglobulin (antibody) and it crosses the placenta.

This is the biggest immunoglobulin (antibody) and is the 1st responder, but fades away eventually.

This is the most common immunodeficiency.

This type of immunoglobulin works best (disease specific vs pooled).

Use this type of immunoglobulin for prevention if exposed to a certain disease.

Use this type of immunoglobulin for prevention w/o specific exposure.

10% of pts who get this type of immunoglobulin will get chills, nausea, and abdominal pain. To prevent this, premedicate w/ __ and infuse slowly/fast.

This type of animal is used as a source of antibodies and causes the least # of reactions.

These 3 types of antibodies are made from equine sources.

Once immunized, if ever see the antigen again, get this type of immune system response.

Will likely only need 1 dose of this type of vaccine for lifelong immunity.

What type of vaccines are these?
Intranasal Influenza
Varicella
Smallpox
Measles, mumps, rubella

Often need multiple doses of these vaccines for lifelong immunity.

Hepatitis B is an example of this type of vaccine.

Try to conjugate to a protein/carbohydrate b/c of its increased immunogenicity.

Pneumococcal vaccine is a type of this vaccine.

Give this type of pneumococcal vaccine to children <2 yo.

Give this type of pneumococcal vaccine to those >2 yo.

This refers to the development of antibodies in the blood that are measured after vaccination to see if immune.

If miss dose of vaccine & have a longer interval than recommended:

If shorter interval between vaccine administration:

If <12 mo old or >50 yo, should not be given these vaccines.

Generally defer vaccine in pregnancy unless:

If severely immunocompromised or CA, don't give these vaccines.

If organ compromise & not on immunosuppressive can or cannot get live vaccines?

Vaccines are/are not contraindicated in:
Mild to moderate local reactions
Mild acute illness
Concurrent antibiotic use
Prematurity
Fm hx of adverse events
Diarrhea
Breastfeeding

Pts may be compensated if they have an adverse reaction to a vaccine w/in __ days of administration.

Use passive immunization (immunoglobulins) for these 3 diseases:

If tetanus prone wound & had full vaccine series <5 years ago:

If tetanus prone wound & had full vaccine series >5 years ago:

If tetanus prone wound & never received or completed series or don't know:

If clean minor wound & never completed series or don't know:

If clean minor wound & had series, but >10 years ago:

This is an immediate type hypersensitivity reaction mediated by IgE where the drug binds to haptens & causes release of histamine from the mast cells. Pts will get anaphylaxis, urticaria, or angioedema. Treat w/ antihistamines, & if severe then give epinephrine, corticosteroids.

This type of hypersensitivity reaction involves the drug modifying host cells, IgG binds to the drug modifed tissue & complement gets activated destroying tissues. Treat by taking away the drug & the autoimmunity resolves. If severe, immunosuppress. Examples include procainamide & hydralazine causing SLE or methyldopa causing hemolytic anemia.

This type of hypersensitivity reaction is also known as serum sickness. Immune complexes containing IgG and drug deposit on basement membrane & activate complement. Pt gets vasculitis or urticaria. Treatment includes corticosteroids & plasmapheresis (if needed). Examples of causes include abx, anticonvulsants, & non-human Ig (snake venom).

This type of hypersensitivity reaction is a delayed type mediated through T cells. 1st exposure doesn't cause reaction, but the 2nd time 2-3 days after they see the antigen they get a reaction, such as contact derm from topical abx or topical drugs.

Do this when giving PCN for syphilis or giving insulin to someone that is allergic to the drug.