Controlled substances
What are the 5 A's of opioid therapy monitoring
Activity, analgesia, adverse effects, aberrant behaviors, affect
Starting dose of metformin while being mindful of SE
125-250-500 mg PO daily, increase every 2-4 weeks to minimize SE
Vaccine schedule to use for someone starting Vaccines between 7-17 years old
Catch up schedule 2
6 Stages of change (name 5)
Precontemplation, contemplation, preparation, action, maintenance, relapse
What is included on the opioid risk tool (main headings), name 3/5
Family history of substance use
Personal history of substance use
Age between 16-45
History of preadolescent sexual abuse
Psychological disease
If a patient has missed 4 days of their methadone how should you adjust their dose
Decrease the dose by 50%, or change it to 30-40 mg (whichever is higher).
Tolerance is lost quickly with methadone!
Name a diatbetic medication that increases wt and one that decreases wt
Increases: INSULIN, Thiazolidinediones
Decreases: GLP -1 , SGLT2, Metformin
What are the publicly funded pneumococcal vaccines in ontario
Vaxneuvance (Pneu-C-15)
Prevnar 20 (Pneu-C-20)
First line medication options for AUD
Naltrexone or Acamprosate
What is the HANDS mnemonic (hint: mental health) and what does it stand for
Antidepressant side effects
Headache or dizziness
Anxiety/ agitation/anticholinergic
Nausea
Diarrhea (and other GI upset)
Sleep disturbance
Is it easier to switch from methadone to buprenorphine or buprenorphine to methadone?
Easier to switch from Buprenorphine to methadone
How to titrate Levothyroxine
Generally, by 12.5 - 25mcg q 8 weeks until TSH normal
Examples of what does NOT need to be reported as a vaccine reaction (Name 3)
Fever with no other symptoms, injection site reaction that lasts less than 4 days, injection site reactions that last less than 4 days, injection site reactions that do not extend past the nearest joint, vasovagal syncope (without injury), events that are clearly attributed to other causes
When to avoid prescribing benzos (Name 3)
Current or past OUD
Comorbid OCD or PTSD
Comorbid personality disorder
Use with caution in depression, older adults, concurrent alcohol, opioid, or gabapentinoid use
Name one of each...
SGLT2 inhibitor
Sulfonylurea
Biguanide
DPP4
SGLT2 inhibitor: empagliflozin, dapagliflozin
Sulfonylurea: Gliclazide, Glimepiride
Biguanide: Metformin
DPP4: Sitagliptin, Linagliptin
CAUTION! What is the black box warning when taking Kadian (slow-release oral morphine)?
Co-ingestion with alcohol can result in the rapid release and absorption of a potentially fatal dose of morphine
Pharm management of Hirstuism, name 3 medicaiton options
CHC, Eflornithine (topical growth inhibitor), Spironolactone, Cyproterone, Finasteride, Flutamide
Name one IM vaccine, one SC vaccine and one oral vaccine
IM: DTAP IPV-Hib, Pnuemococcal, Men-C-C, TDap IPV, TFap, TD booster, influenza
SC: MMR, Varicella, MMRV
Oral: Rotavirus
Baseline monitoring for antipsychotic therapy initiation (name 4)
Efficacy, vital signs, ECG, Wt/BMI, A1C/FBG, Lipids, liver profile, prolactin, Movement AE, constipation
First-line drugs for acute mania (name 2)
Lithium, quetiapine, divalproex, ariprizole, risperidone, paliperidone, cariprazine,
QUICK! You need to give a dose of Narcan.... what is the IM AND Intranasal dose????
Extra 50 points: What happens if you give Narcan to someone that doesnt need it?
IM: 0.4mg IM
IN: 3-4 mg spray, alternate nostrils for repeat doses
Extra 50 points: What happens if you give Narcan to someone that doesnt need it? NOTHING JUST GIVE IT WE ARE IN AN EMERGENCY GOSH DARNIT
Serious side effects of Methimazole (name 2/3)
Agranulocytosis, neutropenia, cholestatic jaundice
Prescribe Shingrex
Shingrix vaccine 0.5 mL suspension for intramuscular injection
Administer 0.5 mL intramuscular once, then repeat another 0.5mL intramuscular dose in 2-6 months, for a total of two doses.
Mitte: one 0.5 mL vial
Refills: one
Name 2 psychotherapy options for PTSD.
CBT, Prolonged exposure, EMDR, cognitive processing therapy
A: What is the starting dose of ozempic
B: When Ozempic is initiated, what do you need to do to the patient's Metformin dose
A: 0.25mg SC weekly, increase to 0.5mg in 4 weeks
B: Nothing, you can just leave the dose the same