Pebc Mcq Sample Questions 1957y

What OTC antifungals for 1st trimester and 2nd/3rd trimesters? 2nd/3rd: miconazole 7 day cream

1st: clotrimazole 7 day cream

Citro-mag, Milk of Magnesia, Epsom Salts and Fleet Enema. What type of medication are they and what precaution needs to be taken? Osmotic/saline agents for constipation. Avoid in renal failure, risk of hypermagnesia (first 3) or hyperphosphatemia (Fleet enema) Decongestant CIs and cautions CIs: Severe HTN, CAD, MOAI within past 14 days. Cautioned in: CVD, diabetes, hyperthyroidism, prostatic hypertrophy and angle-closure glaucoma Medications to be cautious of in asthma Beta-blockers

ASA/NSAIDs/COX-2 inhibitors

Beano CI when? Anaphylactic penicillin allergy or taking acarbose. Factors affecting age into breast milk? molecular weight, weak bases are trapped, weak acids can reabsorb, degree of ionization [only ionized can ], lipid solubility Drugs that enter breast milk? 1) alcholol 2) narcotics 3) barbituates 4) bdz 5) antidepressants 6) metoclopramide 7) anticholinergics 8) antipsychotics FGA or SGA, which cause prolactin levels to increase? *** risperidone increases levels slightly*** Medications that decrease prolactin levels

FGA (eg. haloperidol)

bromocriptine, ergot alkaloids, levodopa

Medications that increase prolactin levels metoclopramide, methyldopa, haloperidol, phenothiazines (eg. chlorpromazine), theophylline, amphetamines Which antibiotic would you use to treat otitis media? Amoxicillin In renal disease what are the pain killer and diuretic one should consider? (APAP > NSAIDs/ASA) Diuretic: furosemide (loop diuretic > thiazides) Target serum levels for digoxin

0.8-2.0 ng/ml

Target serum levels for lithium

0.6-1.2 mmol/L

Pain killer: acetaminophen

Which UTI Abx do we avoid in pregnancy? 1st trimester: TMP Last 6 weeks: SMX/TMP At term (36+ weeks): Nitrofurantoin *Cipro ALWAYS! Two anti-epileptic medications that cause folate deficiency Why is cloxacillin good for staph aureus?

CBZ, PHT

Long R-chain that beta-lactamase can not bind.

What do you monitor in hepatic encephalopathy and what is used to treat it? with lactulose (or a non-absorbed Abx)

Monitor ammonia. 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 Lithium induced tremor? beta-blocker (propranolol)

*Note: monitor thyroid and renal function every 6 months at least LTG effects on B and patient weight? Weight neutral Topiramate's effects on weight?

rarely decreases effect of B

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 B 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 O 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 istration

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 ission: 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 pseudomonasTwo 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 istered 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 B 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?

Bupropion

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?

30 days

Report to the office of controlled