Night CAP
Name 3 major side effects of fluoroquinolones
tendon rupture, CNS effects (seizures, delirium, etc.), peripheral neuropathy - will accept others (qt prolongation, etc.)
Name the strength of Bactrim DS tablets and Bactrim SS tablets
800mg/160 mg and 400/80 mg
Your patient has a prescription for ferrous sulfate 325 mg PO Every other day. What side effects do you counsel your patient on?
May upset your stomach or cause constipation. Can take with food to reduce GI irritation. Avoid taking with milk. Stool softener or laxative may help treat constipation. (Some. may recommend taking with orange juice to improve absorption)
Brand name for propranolol
Inderal
What is increasing water intake (64 oz), increasing physical activity, increasing fiber intake. (Limiting caffeine and alcohol also accepted)
Name two drug classes commonly used to treat CAP which must be avoided in children
tetracyclines and FQs
List all NRTIs
Zidovudine, lamivudine, abacavir, tenofovir disoproxil fumarate, tenofovir alafenamide, emtricitabine (Z <3 latte)
Your patient is taking Kava for anxiety (an herbal supplement) and milk thistle. They have cirrhosis and wonder if they can continue to take these medications. What do you tell them?
Kava is a hepatotoxin and should be discontinued. Milk thistle lacks data to support benefit but does not appear to be harmful.
What drug can be used for patients with variceal bleeding to reduce or stop bleeding by causing splanchnic vasoconstriction?
Octreotide (Sandostatin) or terlipressin (Terlivaz)
Bisacodyl and senna
A 55 yo patient with community acquired pneumonia (low risk, outpatient tx candidate) and no other comorbidities may be treated monotherapy with which oral medications?
Doxycycline or amoxicillin (will accept azithromycin or clarithromycin)
comorbidties or 65+ must be treated with a beta lactam + macrolide OR respiratory FQ
Patients with HIV and CD4 counts <100 cells/mm3 may require primary prophylaxis for which OI?
Pneumocystis jirovecii (PJP), toxicoplasma gondii, (and mycobacterium avium complex (MAC) if CD4 <50 and not on ART)
You're using Clinisol (an amino acid product) 10% to fulfill a TPN order. Your patient wants to know how many calories she is getting from this protein source. 500mL are used in the TPN. How many calories are supplied from 500 mL of this product?
50 kg x 4kcal/gram = 200 calories
What's the purpose of lactulose in a patient with cirrhosis?
To reduce ammonia levels (prevents hepatic encephalopathy)
A pregnant patient is constipated. What is the drug of choice?
What is metamucil (psyllium), calcium polycarbophil (FiberCon), methylcellulose (Citrucel), Wheat dextrin (Benefiber) (A bulk forming drug)
Name 5 oral medications which cover MRSA
Bactrim, clindamycin, linezolid, doxycline, minocycline
Name the black box warning for abacavir
Ziagen - risk for hypersensitivity reactions, must screen patients for HLA-B *5701 allele
Your patient is taking sertraline 100 mg qday and has a new prescription for Zyvox 600 mg BID. What do you counsel your patient on?
Risk of serotonin syndrome (fever, tremors, shaking, altered mental status, sweating, tachycardia, etc.) (headaches, nausea, diarrhea are common side effects)
Which beta blockers are used to reduce portal hypertension in patients with liver disease?
Non selective beta blockers, specifically - carvedilol, nadolol, and propranolol
This drug is used ONLY for opioid induced constipation.
What is methylnaltrexone (Relistor), naloxegol (Movantik), Naldemedine (Symproic)
Name two oral medications which cover psuedomonas aeruginosa.
Ciprofloxacin and levofloxacin
Explain why maraviroc requires a tropism assay before initiating in a patient with HIV
Maraviroc is CCR5 antagonist which blocks HIV form binding and entering the CD4 cell is viral strains which use the CCR5 co receptor. If the viral strain uses CXCR4 receptors or mixed, maraviroc will not work and HIV will be able to enter HIV cell
Your patient wants to know if they can take acetaminophen. They have a history of cirrhosis. What do you tell him or her?
Acetaminophen is generally avoided in patients with liver disease, but can sometimes be used for short periods of time at lower doses (max/day 2000 mg), but you should ask your provider if this is okay for you
What is spontaneous bacterial peritonitis and how do we usually treat it?
Infection of the ascitic fluid, usually treated with ceftriaxone (cipro may be used an alternative)
Pediatric patients with diarrhea require oral rehydration solutions. Why are oral rehydration solutions superior to water for rehydration?
Oral rehydration solutions replace electrolytes lost in diarrhea, additionally they contain glucose and sodium which allow for better absorption of water in the gastrointestinal tract (the glucose and sodium are co transporters which get absorbed and create an osmotic gradient, facilitating water absorption)