PC707 Final Safety Exam Questions & Answers Solved 100%

Tetracycline - Answer PRE: Photosensitivity, do not take with milk CONTRX: Not in pregnancy, not in children under 8yo (unless indication such as Rocky Mountain Spotted fever) ***Teeth discoloration, deposition on bones, bone growth restrictions Vitamin A - Answer Caution: Pregnancy, childbearing age ***Can be teratogenic in excess Grapefruit Juice - Answer CYP-3A4 inhibitor! Leads to increased pharmacologic effect of drugs (i.e. statins, some BP meds, Viagra) Phenobarbitol - Answer CYP-2A's CYP-2C's inducer Leads to decreased pharmacologic effects of several drugs Tegretol - Answer Caution taking concurrently with estrogen OCPs Caution in pregnancy Increases CYP-450 system and increases metabolism and excretion of estrogen, increasing risk of pregnancy Warfarin - Answer Caution stopping prior to surgery when also on Dilantin Caution with fluconazole (Diflucan), TMP-SMZ (Bactrim), Increases open protein binding sites, reducing free-drug levels of Dilantin, increasing risk for seizure 98% of warfarin is protein bound any other protein binding drugs can essentially double concentration of free warfarin - May increase bleeding time Rifampin / Griseofulvin - Answer Caution with combined OCPs CYP-450 inducer, leading to increased clearance of COC Combined Oral Contraceptive (COC) - Answer Caution with anticonvulsants (lamotrigine), theophylline, Valium, TCAs, lithium CYP-450 inducer - may increase anticonvulsant (etc.) dose while active COC, but if COC has 7 days placebo, then lamotrigine will return to normal dose Antiretrovirals - Answer Caution with COCs May increase or decrease COC - may increase side effects of estrogen or decrease overall effectiveness Drospirenone (Yasmin) - COC - Answer Caution with K+ sparing diuretics, ACE inhibitors, ARBs, heparin, NSAIDs May cause hyperkalemia with concurrent use - check K+ levels during first cycle of therapy St. John's Wort - Answer Caution with COC Decreases blood levels of COC hormones Warfarin - Answer Caution with TMP-SMX (Bactrim), acetaminophen, prednisone Anticholenergic drugs - Answer Try to avoid in elderly - may cause dry mouth, urinary retention, constipation, hallucination, confusion, memory impairment, blurred vision, acute angle glaucoma, tachycardia i.e. Diphenhydramine, paroxetine, oxybutynin (Detrol) and other urinary incontinence drugs, meclizine, promethazine, furosemide, digoxin, nifedipine, ranitidine, muscle relaxants, antidiarrheal, Parkinson's drugs, TCAs NSAIDs - Answer Caution in elderly, decreased renal function, hx of GI bleeds, and in pregnancy CONTRX: in MI *Ketorolac/indomethacin have greatest damage to GI, must give with GI protectant *May cause maternal hypertension, premature closure of ductus arteriosus in fetus *May increase risk for recurrent MI, and increase hypertension Pregnancy MAJOR Contraindications - Answer Isotretinoin (Accutane), ARBs, ACE inhibitors, statins, paroxetine (Paxil) ACEs especially teratogenic in first trimester Fluconazole (Diflucan) - Answer Caution with seroquel - prolonged QT Penicillin - Answer Caution with cephalosporin (also beta-lactam) when PCN allergy Diuretics may cause hyper/hypo-kalemia with PCN Increase levels of methotrexate IgE (Type 1) mediated reaction CONTRAINDICATES cephalosporin Must accurately determine type of reaction, if not type 1, but documented as such, pt is at risk for receiving broad spectrum abx and high rates of drug-resistant bacterial infections (VRE, MRSA, C. Diff) May decrease effect of OCP TMP-SMX (Bactrim) - Answer ACE/ARB (hyperkalemia and may lead to cardiac arrest) Caution in elderly/renal disease: causes hyperkalemia Warfarin and abx - Answer Not with PCN, erythromycin, Bactrim or antifungals (-azole) Can cause significant increase in INR and bleeding Clarithromycin (Biaxin) - Answer Not with lovastatin or simvastaton Not with Ca+ channel blockers - r/t CYP-450 inhibition increased SE (rhabdomyolysis) - May cause serious kidney injury Fluoroquinolones - Answer Caution in elderly, those taking corticosteroids, and organ transplant Caution in CNS pathologies Not in pregnancy or children under 18yo May increase risk for seizure Fluoroquinolones (levofloxacin) BBW - Answer Tendon rupture Live vaccines - Answer NOT in pregnancy or immunocompromised or children <12mo May cause the illness Tetracycline - Answer NOT in pregnancy or children <8yo - unless disease warrants it Impaired long bone development, staining/poor enamel development Macrolides - Answer Caution with other long QT drugs, ototoxic drugs, CYP-450 pathways Sulfonamides - Answer Caution with reactions in HIV+ pts, gout, peptic ulcer disease, decreased renal function Not in 1st/3rd trimesters or lactation r/t folate inhibition Also competes with bilirubin binding sites and may cause neonatal jaundice Echinacea contraindications - Answer Diabetes, HIV+, multiple sclerosis Metronidazole - Answer ALCOHOL USE - will cause severe Antabuse reaction Do NOT drink alcohol for 48hrs after med is dc'd Oxazolidinones - Lenezolid (Zyvox) - Answer Do NOT use within 2 weeks of MAOI's May cause peripheral/optic neuropathy if used longer than 28days Most likely to cause C. Diff superinfection - Answer Imipenem, ceftazidime, clindamycin, moxifloxacin Fluconazole (Diflucan) - Answer Antifungals have many CYP interactions May cause Long QT syndrome Immunization concerns - Answer CONTRX: Encephalopathy; true allergy to egg (flue), gelatin (MMR, varicella), or latex GIVE: Trivalent Flu vaccine in people with egg allergy Antacids - Answer Cause early dissolve of enteric coating Aluminum based decreases Warfarin absorption NOT at same time as tetracycline, iron, or PNV (r/t chelation) Should not take 2hrs before or after enteric meds, tetracycline, PNV, iron, synthroid Cimetidine (Tagamet) - Answer Affects action of beta-blockers, lidocaine, warfarin, phenytoin, nifedipine, diazepam, TCA's, benzos, Ca+ channel blockers metronidazole