Pharm Test 2

  1. Pediatric accidental ingestions commonly occur between what ages:
    2-5 yrs
  2. __% of pediatric pts who have accidental ingestions will have a 2nd episode in 1 yr.
  3. Constriction of pupils from clonidine, phenothiazines, cholinesterase inhibitors is called:
  4. Can get deep coma from this drug OD:
  5. This is dilation of pupils from OD of amphetamines, cocaine, LSD & anticholinergics.
  6. This drug classically shows vertical and horizontal nystagmus in OD.
  7. Horizontal nystagmus can be see w/ either of these 2 drugs:
    S-H's and phenobarbital
  8. If smell "bitter almonds" on person's breath in OD situation, the most likely poisoned with:
  9. An OD pt has dry skin. They most likely OD'd on:
    Anticholinergic drug
  10. An OD pt has sweaty skin. They most likely OD'd on:
    • Nicotine
    • Sympathomimetic
  11. An OD pt presents w/ cyanosis. These are 2 things that might be happening:
    • Methemoglobinemia
    • Hypoxemia
  12. If thinking toxic ingestion and have nystagmus, dysarthria & ataxia, think these drugs:
    • S-H
    • ETOH
    • Phenytoin
  13. If low PO2 and high PCO2 on ABG in OD situation, this suggests __ __ & the pt may need __.
    • Respiratory failure
    • Ventilator
  14. Anion gap acidosis can be seen w/ these ingestions:
    • Aspirin
    • Methanol
    • Ethylene glycol
  15. Looking for what electrolyte if check electrolytes in OD:
  16. Ethylene glycol is in:
  17. If make urine w/ high pH, then the weak acid becomes ionized and can't:
    Get back inside the body
  18. Look for __ as a sign of smoke inhalation.
    Smoke in nares or throat
  19. If nothing else works, try:
  20. Acetaminophen: toxic ingestion: initially asymptomatic, 24-36 hrs later __ injury appears.
  21. __ of phone calls for poisonings don't need a referral.
  22. When a poisoned pt comes into the ED, you first:
    Evaluate then decontaminate
  23. GI decontaminate w/:
    • Emesis
    • Lavage
    • Activated Charcoal or
    • Whole Bowel Irrigation
  24. Gastric lavage is when:
    Shove tube down the stomach, fill w/ warm saline & suck liquid back up.
  25. In order to evaluate a pediatric accidental ingestion over the phone, need to know:
    • Name
    • Age
    • Weight
    • Address
    • Phone
    • Agent Ingested
    • Amount Ingested
    • How are they right now
    • How long ago did it happen
  26. Toxic encephalopathy suggests drugs or poisoning because:
    Their whole level of consciousness is down
  27. If a pt calls & they have a high risk ingestion, you should:
    Refer them to a medical facility ASAP
  28. Aspirin toxic ingestion tx:
    • Gastric lavage
    • Activated charcoal (repeated)
    • IVF
    • Sodium bicarb
    • Consider hemodialysis
  29. POISINDEX is a CD that has a list of:
    All the ingredients of all products & antidotes
  30. Urinary alkalinization is used for:
    • Phenobarbital
    • Aspirin
  31. Beta blocker ingestion tx:
    Glucagon b/c increases intracellular cAMP so it increases pulse & BP
  32. Xray poisoned pt to:
    See if they have aspirated or if they ingested a radio-opaque substane (certain potassium or iron substances)
  33. Dialysis works with:
    • Ethylene glycol
    • Methanol
    • ETOH
    • Lithium
    • Aspirin
    • Theophylline
  34. If drug is enterohepatically circulated, give charcoal doses every 6 hours until:
    See charcoal per rectum
  35. On EKG, may see a widened:
    QRS w/ cardiotoxic poisoned pt. See this w/ TCAD.
  36. Disc-shaped battery ingestion tx:
    X-ray GI tract to see where it is. If not in esophagus, hopefully pass (85% in 72 hrs). If stuck in esophagus, remove b4 24 hrs.
  37. Activated charcoal doesn't help with:
  38. Burning wool, plastics, & other things can cause:
    Cyanide toxic ingestion
  39. Activated charcoal doesn't inactivate:
    • ETOH
    • Lithium
    • Iron
    • Potassium
  40. Anticholinergic toxic ingestions causes sinus __ & dilated __.
    • Tachycardia
    • Pupils
  41. Be careful giving flumazenil if pt has taken:
  42. Look at __ interval for AV block.
  43. Only do gastric lavage if pt is alert or they are:
  44. Most effective decontamination tool is:
    Activated charcoal
  45. High risk ingestions are:
    • Caustic solution - corrosive
    • Hydrogen fluoride
    • Drugs of abuse
    • CCB's
    • Narcotics
    • Antidepressants
    • Hypoglycemic agents
    • Intentional ingestion
  46. Methanol can cause:
  47. On EKG you see a prolonged QT. Pt may have OD'd on:
    • Quinidine
    • Lithium
    • New antipsychotic
  48. Aspiration of hydrocarbons turns into:
    Necrotizing pneumonia
  49. Always give glucose w/:
  50. Be careful giving flumazenil if addicted to __.
  51. Antidote to cyanide toxic ingestion:
    Amyl nitrate
  52. Iron ingestion is very toxic. What's the antidote?
  53. Urinary alkalinization only works if the drug is a __ acid.
  54. Serum osmolarity measures:
    • BUN
    • Na2+
    • Glucose
  55. If there is an antagonist for a __, give it.
  56. Treatment of hydrocarbon ingestion:
    DO NOT bring back up
  57. Less than 10 cc's of __ is fatal!
  58. CCB's toxic ingestion treatment:
    Aggressive GI decontamination (charcoal & whole bowel)
  59. If aspirin toxic ingestion, pt will:
    Hyperventilate until stop & get lactic acidosis
  60. Most common pediatric poisoning is:
  61. For TCAD toxic ingestion, give:
    • Sodium bicarb
    • NOT physostigmine
  62. Give activated charcoal w/ the following to help pass through to rectum:
    • Water or
    • Sorbitol
  63. If pt took a benzo, give:
  64. Cannot do gastric lavage if:
    • Pt ingested acid, alkali, or hydrocarbon
    • Pt combative
  65. CCB's antidote:
    Calcium (helps contractility)
  66. Serum osmolarity is measuring:
  67. Antidote to anticholinergic poisoning:
  68. Antidote for ethylene glycol:
  69. These decrease inflammation, but do nothing to the immune system, so there's no benefit in autoimmunity.
  70. These suppress inflammation at low doses & suppress the immune system at high doses. They are most often used as an anti-inflammatory b/c there are too many SEs when using as immunosuppressant.
  71. These medications take weeks to months to work and slow down the destruction from underlying rheumatic disease, but don't stop it altogether.
    Disease Modifying Antirheumatic Drugs (DMARDs)
  72. These DMARDs modify the immune system, but don't increase the risk of infections. They're not immunosuppressive, not as powerful & generally not as effective in treating disease.
    Immunomodulating DMARDs (Hydroxychloroquine, Sulfasalazine)
  73. This is an anti-malarial drug used as a DMARD. It makes the skin rash of psoriasis worse, and can cause retinopathy, so a pt can go blind if this is neglected.
  74. This is the mildest DMARD, so it's used for RA (slows erosive changes in joints) and SLE (helps fatigue, malaise & skin).
  75. This is a DMARD that is best known for treating IBD. It's a sulfa drug which can cause hemolytic anemia in G6PD, photosensitivity, hepatitis, anemia, leucopenia, oligospermia, and it's the MOST COMMON cause of SJS. It's used in mild to moderate RA, IBD, arthritis, & psoriatic arthritis.
  76. These type of DMARDs suppress inflammation and autoimmunity, take longer to work, work better, increase risk of infection, and have more severe SEs than immunomodulating drugs.
    Immunosuppressing DMARDs (Methotrexate, Leflunomide, Cyclophosphamide, Cyclosporine, Azathioprine, Mycophenolate)
  77. This DMARD is the gold standard for RA treatment.
  78. This DMARD can cause stomatitis, myelosuppression, cirrhosis (so don't give to a pt w/ liver problems), pulmonary infiltrates, and might cause lymphoma. Only give it weekly, not daily, IM or PO, and don't take w/ ETOH. Folic acid should be given daily to decrease SEs.
  79. This DMARD must be given w/ a loading dose since it has a very long 1/2-life and then it takes months to see any effect. It's eliminated in the bile and can be around for years, so if need to increase elimination, use cholestyramine & it'll be eliminated in 10 days-2 wks. Common ADRs are HA, GI, hair loss, and rash while serious ADRs are liver disease.
  80. This DMARD is the most powerful immunosuppressent and is used when disease is severe (choice is this drug or death). Most who use have a major complication, including bladder CA, myelosuppression and infection.
  81. This DMARD is used mostly after organ transplant to prevent rejection by suppressing the immune system. It irreversibly decreases kidney function, so only use if absolutely have to.
  82. This DMARD is used for immunosuppression, as chemo, & to prevent organ transplant rejection. SEs include bone marrow suppression, GI, & hepatotoxicity.
  83. This is a substance from a living organism & its products & is used in the prevention, diagnosis, & treatment of CA & other disease. They are very expensive & cost >$10,000 a year).
    Biologic Agents AKA Biological Agents AKA Biological Drug
  84. These are used when nothing else works in rheumatic disease.
    Immunosuppressive Antibodies (Biologic Agents) such as IVIG
  85. These work on cytokines primarily and are focused on products of the immune system. Right now, they are only approved for use in RA, psoriatic arthritis, & AS.
    Monoclonal Antibodies (Biologicals)
  86. Older DMARDs can be combined w/ biologics, but 2 different __ cannot be combined.
  87. These are the most used biologics, and are successful in RA, psoriatic arthritis, IBD & AS. The onset is days to 3 mo. Common ADRs include injection site or infusion rxns. Serious ADRs include opportunistic infxns such as reactivation of TB (big problem!) & aplastic anemia. Pts need a PPD before beginning treatment.
    TNF Alpha Inhibitors (Etanercept, Infliximab, Adalimumab)
  88. These Biologics cause T cells to not be activated. They are approved for use in RA, but supposed to use other DMARDs first. There's a possible increase in incidence of lymphoma w/ this drug.
  89. This Biologic binds to CD20 on normal & malignant B lymphocytes and is used for lymphoma & RA.
  90. If mild rheumatic disease, use these.
  91. If systemic complaints w/ rheumatic disease or skin disease, use this drug.
  92. If moderate or severe joint disease, use this drug which is the gold standard, & then after that, usually use a combination of these 2 drugs.
    • Methotrexate
    • Methotrexate & TNF Agent
  93. Use these as a bridge since they work fastest in rheumatic disease treatment, but don't use them longterm b/c of SEs.
  94. This is a drug used in gout and is primarily for gouty inflammation and little else. Serious ADRs are myopathy & myelosuppression. It should always be giving PO b/c IV increases the risk of myelosuppression. Can give every hour until relief or diarrhea during acute attack, but don't do this.
  95. These are effective at relieving inflammation gouty crystals cause, and that's it.
  96. This gout drug is uricosuric, has no inflammatory effect, but is not favored b/c there's so many interactions and pts need to drink lots of water & it won't work unless normal kidney function.
  97. This drug for gout takes 2-3 mo for a full effect, there are increased attacks when initiated, and serious hypersensitivity rxns can occur (rash, fever, hepatitis, eosinophilia & RF w/ 25% mortality).
  98. Usually want serum uric acid <__.
  99. This gout drug causes no uric acid to be made. It's used for chronic gout, but is very expensive, and is used in those that can't tolerate Allopurinol.
  100. These work best for acute inflammation in gout.
  101. If NSAIDs can't be used, give this if 1 joint is affected in gout. If more than 1 joint, give this.
    • Corticosteroid Injection
    • PO Steroids
  102. To prevent acute inflammation in gout, use this qd-bid.
  103. Acute inflammation in gout is treated with __ or __. Gout can flare when these are started, so should be on prevention medication when start (either __ or __).
    • Allopurinol or Febuxostat
    • NSAIDs or Colchicine
  104. To avoid dyspepsia, give NSAIDs w/ __.
    Food or milk
  105. Gastric and duodenal ulcers occur in __% of people who take NSAIDs.
  106. This medication increases BP (on average 8-10 mmHg) and also causes retention of salt & fluid.
  107. There's a BLACK BOX WARNING for increased risk of cardiovascular events w/ this medication.
    COX 2 selective NSAIDs
  108. Angioedema occurs in as high as __% of those taking NSAIDs, and although this is not an allergy, the medication should be avoided in the future.
  109. Those w/ nasal polyps and asthma can get __ when taking ASA or NSAIDs.
    Increased asthma symptoms
  110. This drug irreversibly inhibits COX enzymes in platelets, so it has a longer lasting effect on inhibiting platelet function.
  111. This subgroup of NSAIDs have no effect on platelets.
    Nonacetylated salicylates
  112. Don't give these drugs if abnormal kidney function b/c can cause increased serum Cr causing decreased blood flow to the kidney and causing RF.
  113. Aseptic meningitis can be seen in those taking NSAIDs, especially __.
  114. NSAIDs may block the __ effect of ASA, decrease effectiveness of __ drugs, __ Lithium levels, and don't use w/ corticosteroids or __ b/c risk of PUD & bleeding.
    • Cardioprotective
    • Anti-HTN
    • Increases
    • Warfarin
  115. This drug should be used in combination with narcotics for cancer pain.
  116. Use high doses of this drug for rheumatic fever and arthritis.
  117. This drug causes routine dose-related fecal blood loss, as well as the following ADRs: salicylism (vomiting, tinnitus, decreased hearing, vertigo) and hyperpnea (breathe fast, respiratory alkalosis).
  118. Use these when need an NSAID, but don't want to increase risk of bleeding.
    Nonacetylated Salicylates
  119. This drug is a sulfa COX-2 selective NSAID that causes fewer ulcers (but unclear if clinically relevant), and there is a risk of thrombotic events only at higher levels than what's used therapeutically.
  120. This is an NSAID that inhibits COX 2 more than COX 1, but not enough to be classified as COX 2 by the FDA. There's less GI upset & no platelet inhibition, so less bleeding.
  121. This is an IM nonselective NSAID used for analgesia, not inflammation. It can only be used during a limited time (usually 5 days) b/c of risk of ulcers. This drug is used for moderate to severe pain and is useful when don't want to use narcotics.
  122. These are the 2 nonselective NSAIDs that have a long 1/2-life, so they are taken qd.
    • Oxaprozin
    • Piroxicam
  123. Should avoid these drugs if have CHF, RF, active PUD, uncontrolled HTN b/c risks outweigh benefits.
  124. Don't combine 2 of these drugs b/c it increases risk of adverse events w/o increasing efficacy.
  125. If risk of PUD, and need NSAIDs can do 3 things:
    • 1. Don't use NSAIDs.
    • 2. Use COX 2 selective NSAIDs.
    • Give NSAIDs w/ protection (PPIs or Misoprostol)
  126. If hx of HTN or HTN is controlled on meds, and need NSAIDs, do this:
    Give NSAID & check BP b4 starting & make sure it's not high & recheck 7-10 days after starting. If above normal, can either stop NSAIDs or give more BP meds.
  127. If on diuretics or ACEI, and need to take an NSAID, do this:
    Recheck Cr 3-7 days after starting b/c of increased risk of worsening RF
  128. If a patient drinks greater than or equal too 3 glasses of ETOH/day, they can only take __gm of APAP a day.
  129. APAP is analgesic, __, but not __.
    • Antipyretic
    • Anti-inflammatory
  130. Can get mildly increased LFTs with this drug.
  131. Large doses of this drug cause dizziness, excitement, and disorientation.
  132. This pain reliever is favored for any pain if the pt also has GI upset or an ulcer, a child w/ a virus or chickenpox, or a bleeding d/o.
  133. This is an antihistamine frequently added to injectable narcotics.
  134. This is a neuropathic pain reliever used in diabetic neuropathic pain and post-herpetic neuralgia.
  135. This is a red pepper derivative that works best for neuropathic pain by working on substance P.
  136. These are drug of choice for severe, chronic malignant pain.
  137. These narcotics are metabolized by M3G, which can cause seizures (but only see this effect if on high doses of these drugs or if taking for a long time or RF).
    • Morphine
    • Hydromorphone
  138. This narcotic becomes normerperidine which can cause seizures if RF or on a high dose for a long time.
  139. These drugs make patients sleepy, but does not cause amnesia. They go into an easily arousable sleep, not normal sleep.
  140. This is the effect that most limits the dose of narcotics in treating severe pain.
    Respiratory depression (increased pCO2)
  141. These drugs cause miosis, euphoria and N/V.
  142. If a pt has CVS disease or is dehydrated, these drugs can cause blood vessel dilatation and hypotension.
  143. This narcotic has antimuscarinic effects so it can cause tachycardia.
  144. These drugs always cause constipation, can also cause increased pain if a pt has gallbladder disease, and can cause urinary retention.
  145. These drugs can decrease uterine tone and this potentially can prolong labor.
  146. These drugs can cause flushing and warmth of skin, occasionally urticaria too which happens more often when given parenterally and is not an allergic rxn.
  147. Tolerance to narcotics occurs to analgesic effects and all other effects EXCEPT the following 3:
    • Miosis
    • Seizures
    • Constipation
  148. Don't use these drugs if a pt has a head injury, pregnancy, or impaired respiratory function.
  149. If narcotics are used in these 2 diseases, can get prolonged or exaggerated effects from the narcotics.
    • Adrenal insufficiency
    • Hypothyroidism
  150. If narcotics are used with these drugs, a hypertensive crisis can occur.
  151. May get more pain if using narcotics for these 2 types of pain.
    Renal and biliary colic
  152. These meds work well if having an MI w/ CP and pulmonary edema. Also, they can decrease SOB by decreasing anxiety, preload & afterload.
    • Narcotics
    • (decreased SOB seen w/ IV morphine)
  153. This full opioid agonist has an equal potency in comparison to morphine, less euphoria and a longer duration of action. It's used for withdrawal in licensed rehab settings. If used for pain, it's given q8 hrs. If for drug abuse, it's given qd.
  154. This full opioid agonist can cause seizures if RF or given for a long time at high doses. It can cause significant antimuscarinic effects (pupils dilate and tachycardia). It's used in OB b/c it's not long-acting (2-4 hrs) & doesn't distribute as fast as others, so less exposure to the fetus.
  155. This full opioid agonist is 100x more powerful than morphine.
  156. This partial narcotic agonist is less powerful than morphine, but absorbed better. It's a good antitussive and has a lower abuse potential, less euphoria, and less dependence.
  157. This partial narcotic agonist is a semi-synthetic derivative of morphine. It's active PO, and abuse of sustained relief preparations are a problem.
    • Oxycodone
    • Hydrocodone
    • (Oxycontin is a sustained relief preparation)
  158. This is a partial narcotic agonist that is weaker than Codeine and is for mild to moderate pain. At high doses, seizures and cardiotoxicity may occur.
  159. These narcotics are commonly seen w/ ASA, APAP or an NSAID to boost pain relief.
    Partial Narcotic Agonists
  160. This opioid antagonist is injectable, but the 1/2-life is shorter than most narcotics, so it wears off before narcotic wears off.
  161. This opioid antagonist is oral, has a long 1/2-life, and 1 dose blocks the effects for 48 hours.
  162. This opioid agonist is newer and has a long 1/2-life, and it is also injectable.
  163. If there is an opioid in a patient's system, a narcotic agonist completely reverses the narcotic's effects in __ minutes.
  164. If depressed CNS, giving an opioid antagonist normalizes respiration, LOC, pupil size, bowel activity, & __ of pain.
  165. This opioid antagonist is given to addicts every other day to prevent effects of narcotic use.
  166. This is a centrally acting analgesic which helps moderately severe pain. There are no effects on respirations or CVS, but it causes seizures, nausea & dizziness. If hx of seizure or on another med that can cause seizures, SSRIs or TCAD, don't take this drug.
  167. Get longer duration of action, decreases systemic absorption and decreased toxicity when adding this to local anesthetics.
  168. This is the greatest risk of local anesthesia in involved procedures.
    Systemic Toxicity
  169. Duration in hours:
    (a) Lido
    (b) Lido w/ epi
    (c) Bupivacaine
    (d) Bupivacaine w/ epi
    • (a) 0.5-1
    • (b) 2-6
    • (c) 2-4
    • (d) 3-7
  170. When a local anesthetic is injected into the vicinity of nerve endings to numb the areas fed by that nerve, it's called this.
  171. When a local is injected into a major nerve trunk, it's called this.
    Nerve block
  172. This is a form of IV regional anesthesia used when surgery is performed on a limb. If the surgery is >60 min, this procedure involves placing a tourniquet on the limb & giving IV local anesthesia to make the limb numb.
    Bier block
  173. These cause decreased BP, ventricular irritability, decreased mucociliary function, increased risk of atelectasis & post-op pneumonia, decreased renal blood flow, GFR & urinary output.
    Inhaled general anesthetics
  174. This is an autosomal dominant genetic d/o of skeletal muscle trigged by use of inhaled general anesthesia and muscle relaxants. Symptoms include tachycardia, HTN, severe muscle rigidity, hyperkalemia, acidosis, hyperthermia, and death. Also, how would you treat this?
    • Malignant hyperthermia
    • Dantrolene
  175. This group of general anesthetics doesn't increase cerebral blood flow, so tend to be favored if head trauma or brain tumor.
    Short-acting barbiturates (Methohexital, Thiopental)
  176. These general anesthetics put a pt to sleep quickly, but unless they're added to another agent, they wake up quickly. They don't last long enough to be used alone for anesthesia.
    Short-acting barbiturates (Methohexital, Thiopental)
  177. These are used for premedication prior to anesthesia b/c they're sedative and amnetic. If used alone, it's not deep enough, so there's inadequate anesthesia.
    Benzos (Midazolam, Lorazepam, Diazepam)
  178. These are used in low doses as premedication and as an adjunct to other anesthetics. They're not used alone, but if they are, get awareness during time under anesthesia & get post-op recall.
    Opioid Analgesics (Morphine, Fentanyl, Sufentanil)
  179. This is a sedative used as a continuous IV when used for anesthesia. The onset is rapid, recovery more rapid than barbiturates, effects soon gone after stopping, so good for quick ambulatory procedures. Pts feel better & ambulate sooner w/ less N/V. SEs include decreased BP and cardiac contractility.
  180. This general anesthetic has minimal cardiac and respiratory depression, but has no analgesic effect, so usually need to add to narcotics. It's often used if BP is already low before surgery.
  181. This is an induction anesthetic agent w/ sympathetic stimulatory activity. It is profoundly analgesic, but causes increased HR, BP & CO. It's good at low doses in combo w/ others, especially if in shock or going through a short painful procedure on a kid. It's related to PCP, so adults hallucinate and children get excited.
  182. These are adjuncts to anesthesia and make procedures and intubation easier. These mask inadequate anesthesia, so often look at autonomic reflexes as a sign of level of anesthesia (if deep enough, BP & pulse increase). Monitor to make sure muscles are paralyzed using a peripheral nerve stimulator.
    Skeletal Muscle Relaxants
  183. These are adjuncts to anesthesia. They decrease secretions (antisialagogues), prevent reflex bradycardia, sedate and cause amnesia. SEs include CNS sedation, tachycardia and increase in temp.
    Anticholinergics (Atropine, Scopolamine, Glycopyrolate)
  184. Spinal anesthesia involves injecting a local anesthetic or narcotics into the subarachnoid space usually below __, to block spinal nerve roots. The height of affect is determined by gravity and position of pt.
  185. For epidural anesthesia, use long-acting __ or narcotics or both. Need larger volume than spinal & if needle goes into a vascular space, get systemic toxic rxn.
  186. Alcohol can be found in OTC cough syrups, cold meds, and __.
  187. Antihistamines as well as caffeine can be found in OTC analgesics and __.
    Menstrual products
  188. Aspirin can be found in OTC cold meds & __.
  189. Sodium can be found in OTC cold meds, antacids, analgesics, and __.
  190. Sympathomimetics can be found in OTC analgesics, asthma products, cough, cold & allergy products, as well as __.
    Hemorrhoid products
  191. Nighttime or PM OTC products tend to contain a __ to make a pt sleepy.
    1st generation antihistamine
  192. If an OTC product has the word "sinus" on it, it tends to contain this ingredient.
    Decongestant and/or analgesic
  193. If an OTC product has the word "cough" on the label, it tends to contain this.
    Detromethorphan and/or guaifenesin
  194. If an OTC product says "non-drowsy", "AM" or "daytime-congestant" it tends not to contain this.
    An antihistamine
  195. An OTC product w/ the words "cold & flu" will contain __.
Card Set
Pharm Test 2
Test 2 Summer 2010