Column 1
A 27-year-old patient is 24 weeks pregnant. Her IMZ history shows she needs influenza, Tdap, MMR, and varicella vaccines. These two vaccines should not be given.
What are MMR and varicella?
A 76-year-old woman with HTN, DM, and prior ischemic stroke is newly diagnosed with atrial fibrillation. Her physician asks whether aspirin alone is enough to prevent another stroke.
No, she likely requires oral anticoagulation unless contraindicated. TE risk is high
A patient taking lamotrigine (Lamictal) develops fever, painful skin lesions, oral ulcers, and blistering shortly after a rapid dose titration.
Suspect:
Immediate action:
Drug that makes this worse
Suspect SJS/TEN
Immediately stop lamotrigine and go to ER
Valproate/divalproex (Depakote) because it increases lamotrigine exposure.
A patient has undergone splenectomy. Name the four major vaccine categories you should make sure are addressed.
What are pneumococcal, MenACWY, MenB, Hib
A patient receives an antibiotic and minutes later develops diffuse hives, wheezing, throat tightness, and BP 78/46. Diphenhydramine is available, but you should administer this first.
What is IM epinephrine?
A 61-year-old man presents with STEMI and severe chest pain. His medication list includes tadalafil (Cialis), which he took approximately 12 hours ago. The team orders sublingual nitroglycerin.
Hold nitroglycerin, can cause profound hypotension.
A 24-year-old with sickle cell disease has functional asplenia. Which meningococcal vaccines should you think?
A 35-year-old patient has been actively seizing for 7 minutes without regaining consciousness. This medication class should be administered first.
What are benzodiazepines?
A patient receiving chemotherapy develops:
Temp 102.1, ANC 300, chills, BP 94/58
No obvious infection source.
Febrile neutropenia requiring prompt empiric broad-spectrum antipseudomonal abx.
Cefepime, piperacillin/tazobactam
This vaccine should be given during every pregnancy, preferably during gestational weeks 27-36.
What is Tdap?
A healthy patient received the first HPV vaccine at age 16. How many total doses are generally needed?
Before age 15:
At age >/= 15:
before age 15 2-dose series
at age >/= 15 3-dose series
A 29-year-old woman has migraine with aura and requests an estrogen-containing oral contraceptive. She does not smoke.
Combined estrogen-containing contraception should be avoided in migraine with aura because of increased ischemic stroke risk
A 72-year-old man with COPD and symptomatic BPH is experiencing urinary retention. His inhalers include tiotropium, this brand inhaler could be contributing to his urinary symptoms.
Spiriva - LAMA = anticholinergic effects
A pregnant patient needs influenza vaccination. This formulation should be avoided.
What is the live attenuated intranasal influenza vaccine (FluMist)?
Which RSV vaccine is specifically used during pregnancy at 32-36 weeks gestation during the recommended seasonal window?
Abrysvo
A 68-year-old woman with osteoporosis is prescribed alendronate (Fosamax). She says: "I'll take it with breakfast and then lie back down for another hour." This is the correct counseling.
Take alendronate first thing in the morning on an empty stomach, with plain water, remain upright for at least 30 minutes. Wait at least 30 mins before food, beverages, or other meds.
A 70-year-old woman has: Afib, previous ischemic stroke, COPD, hyperlipidemia, depression, chronic apixaban (Eliquis) therapy. She develops severe headache, vomiting, confusion, and unilateral weakness.
Ct reveals intracranial hemorrhage. Her meds include: apixaban, atorvastatin, sertraline, tiotropium, albuterol.
Name:
most concerning med
specific reversal agent
indication for apixaban
rescue inhaler
maintenance inhaler
apixaban (Eliquis)
Andexanet alfa (Andexxa)
prevention of cardioembolic stroke associated with afib
albuterol SABA reduce bronchodilator
tiotropium (Spiriva) LAMA maintenance bronchodilator
A 55-year-old adult has never received a pneumococcal conjugate vaccine. Name one regimen that can complete pneumococcal vaccination without a subsequent PPSV23 dose.
What is PCV20 or PCV21 alone?