PC707 Final Safety Exam Questions & Answers 100% Accurate

Understand, identify, and rank evidence-based prescribing resources - Answer *Trusted sources* Research: RCT, systematic reviews Expert orgs like ACOG, AAFP, etc Lexicomp Natural Meds LactMeds DailyMed CredibleMeds (QT) Describe safe and ethical prescribing for family and friends - Answer *if* you do it, treat as any patient full history, exam, etc Rx only with *extreme* caution if even allowed in your state Understand pregnancy letter categories and PLLR - Answer Categories A, B, C, D, X --phasing out, too confusing PLLR is more comprehensive and specific about known risks Immune-mediated adverse drug reactions (hypersensitivity rxn) - Answer Type 1: immediate, IgE, anaphylaxis Type 4: delayed, t-cell, dermatitis, SJS Understand agonist/antagonist and receptor site activity - Answer Agonist=activates receptor Antagonist=blocks drug from binding to receptor Know term - absolute contraindication - Answer Risk always outweighs benefit, never give Know term - relative contraindication - Answer Benefit *may* outweigh risk Know term - precaution - Answer =warnings Understand med reconciliation and safety - Answer Review meds at *every* visit for changes -including supplements -medicinal foods -polypharmacy (5+ concurrent meds) -increased risk of adverse reaction Understand how physiologic changes in the elderly impact prescribing - Answer Small liver mass-->less enzymes-->less effective metabolism==>lower dose Same with kidneys - less mass and capability to break down and clear drugs, remain in blood stream longer Understand how physiologic changes in peds impact prescribing - Answer neonates/infants have immature metabolic capacity, cannot break down and clear drugs as well as everyone else Review OTC meds regarding safety in pregnant women and peds - Answer -Not well known r/t lack of research -few "A" drugs: acetaminophen, 1st gen antihistamines -pediatric formulation important, may have same name as for adults but contain different active ingredient What is BEERS list and STOPP tool and use implications - Answer -guidelines of rx'ing to those 65+ -identifies Potentially Inappropriate Medications -not hard rules, but considerations Genomics: Poor metabolizer - Answer No alleles to metab drug Active drug: increased exposure b/c not metabolized out of body Prodrug: decreased exposure b/c not metabolized into active form Genomics: Intermediate metabolizer - Answer Decreased alleles to metab drug Active drug: increased exposure b/c not metabolized out of body as efficiently Prodrug: decreased exposure b/c not metabolized into active form Genomics: Extensive metabolizer - Answer Has typical alleles for drug metabolism Normally metabolizes active drugs and prodrugs Genomics: Ultrarapid metabolizer - Answer Extra alleles to metab drug Active drug: decreased exposure b/c metabolized out of body quickly Prodrug: increased exposure b/c metabolized into active form quickly What is a teratogen? - Answer -must cause a characteristic malformation -occurs only during specific window of vulnerability -incidence of malformation increases with increased dose and duration of exposure What does "all or nothing" mean in pharmacology terms? - Answer time from fertilization to implantation where exposure to a substance will either destroy the conceptus or cause no problems When does organogenesis occur? - Answer 1st trimester Understand food/drug interactions (including grapefruit juice, CYP pathways) - Answer grapefruit juice disables the CYP450 pathway for about 3 days, in that time the body cannot metabolize drugs that use that pathway, causing a build-up Scheduled drugs and prescribing - Answer Need DEA number to rx Sch 1: always nope Sch 2: opioids, high risk of abuse or diversion, no refills Sch 3 through 5: mostly benzos, barbituates, lesser opioids, descending risk of abuse or diversion, up to 5 refills within 6 months Safety of off-label prescribing - Answer -not improper, illegal, contraindicated, nor investigational -means that use is not included in package label -practice careful SDM -obtain informed consent Safety of vitamins, minerals, and nutraceuticals - Answer *Fat soluble* A, D, E, K stored in liver and adipose tissue -can become deficient if lacking for a long time -can OD *Water soluble* B, C not stored in large amounts -easy to become deficient -need frequent ingestion Understand prolonged QT interval - Answer Toursades de Pointe (TdP) risk of ventricular dysrrhythmia, sudden death *risk factors* -female r/t hormones, small kidney/liver -K, Mg, Ca deficiencies -D2D interaction -CYP3A4 inhibition (grapefruit juice) -congenital predisposition Know terms common side effects and serious side effects - Answer *common side effects* happen commonly, unpleasant, shouldn't preclude person from taking a needed drug. Ex nausea, HA, dizziness *serious side effects* reasons not to take a drug ex QT prolongation, GI bleed, anaphylaxis Factors that decrease risk of antibiotic resistance - Answer -use antibiogram to know local susceptibility/resistance -prescribe only when appropriate -use combo-therapy -educate to complete course; prevent infection; take with/without food; pg/lact concerns; watch for SE Understand causes and prevention of super-infections such as C. diff and MRSA - Answer Superinfections occur when an overrowth of resistant bacteria secondary to suppression of drug-sensitive organisms Broad spectrum antibiotics have a higher risk of this occurring compared to narrow spectrum Combine PCN with b-lactamase inhibitor to reduce resistance Which are b-lactam drugs? Understand cross-reactivity and safety with b-lactums - Answer PCNs and cephalosporins (cepha- and cef- drugs) Allergy provoked by a b-lactam is to a component of the b-lactam ring, so may have cross-sensitivity to another b-lactam If PCN allergy is *mild* ok to try a cephalosporin, otherwise avoid PCNs safety, teaching, SE, peds, pg - Answer Safety: caution with allergy to cephalosporins Teaching: ID bracelet is allergic, GI side effects are common, not allergy Peds: commonly rx'd Pg: Cat B Tetracyclines safety, teaching, SE, peds, pg, D2D, BBW - Answer *Safety:* chelation, incr photosensitivity, risk superinfection/C. diff *Teaching:* space from milk, metal supplements; min UV exposure; use secondary birth control *SE:* *Peds:* avoid <8yr r/t tooth stuff *Pg:* avoid r/t tooth stuff *D2D:* many esp digoxin, birth control *BBW:* tooth discoloration/bone malformation Fluoroquinolones safety, SE, peds, pg, BBW - Answer *Safety:* QT prolongation, hepatotoxicity, phototoxicity, chelation, aortic dissection, lowers blood sugar *SE:* GI irritation *Peds:* no r/t tendon rupture risk *Pg:* avoid r/t lack of info *D2D:* many, notably warfarin *BBW:* tendon rupture, myesthenia gravis Sulfonamides (Bactrim) safety, SE, D2D, peds, pg, teaching, cross-reactivity, BBW - Answer *Safety:* caution with blood dyscrasia, kidney stones, within 3 weeks of gout attack, creatinine clearance <50, PUD *Teaching:* use back-up birth control, drink lots of water, UV protection *SE:* CNS, GI, derm, hemato, renal, endocrine, lactic acidosis *Peds:* kernicterus <2 mo old *Pg:* cat C, avoid 1st/3rd trimesters *D2D:* many, warfarin, ACEIs, reduce OCP efficiency *BBW:* n/a *cross-reactivity:* incr risk of hypoglycemia with sulfanylureas, general not with non-abx sulfas Cephalosporins safety, education, SE, peds, pg - Answer *Safety:* cross-sensitivity to PCNs, disulfiram rxn *Teaching:* avoid alcohol! *SE:* well tolerated *Peds:* common rx *Pg:* cat B Macrolides (-mycins) safety, education, SE, peds, pg, BBW - Answer *Safety:* QT prolongation, ototoxicity, CYP metab *Teaching:* push water, empty stomach (unless GI upset), report tinnitus immediately *SE:* GI upset *Peds:* n/a *Pg:* avoid 1st trimester *BBW:* clinda - C. diff potential Antivirals safety, education, SE, peds, pg, BBW - Answer *Safety:* use for flu only if sx <48hr, poss. renal failure, susceptible to resistance *Teaching:* adhere to schedule, not curative - reduce severity and duration of symptoms *SE:* generally well tolerated *Peds:* generally ok *Pg:* cat B, ensure bene > risk, avoid famciclovir r/t lack of data *BBW:* nothing noteworthy Metronidazole teaching, safety, BBW - Answer *Safety:* disulfiram rxn, many D2Ds, poss neurotoxicity *Teaching:* avoid alcohol for 48-72 hrs, for lactation: consider pump-n-dump if PO administration, avoid topical on/near breast *BBW:* carcinogenic risk in mice, avoid use when possible Anti-TB drugs (rifampin, isoniazid) BBW, D2D, supplmentation - Answer *Supplementation:* B6 *D2D:* B6, OCP, isoniazid=strong CYP450 inhibitor; rifampin=strong CYP450 inducer *BBW:* severe hepatitis Immunizations safety and order - Answer Yes, they're safe contraindications: true egg allergy, encephalopathy give *live* vaccines on same day or space by at least 28 days, there is potential to cause some illness and viral shedding, avoid in pg and immunocompromised inactivated vaccines can be given any time Give Tdap at 27-36 weeks gestation Antacids - who should use which, D2Ds? - Answer *Ca (Tums)* Good for: IBS/diarrhea, pg, lactation, postmenopausal Bad for: constipated *Na Bicarb (Alka Seltzer)* Good for: Bad for: HTN and other CVD r/t fluid retention, pg (contains ASA) *Mg* Good for: constipation, pg/lact safe Bad for: diarrhea, renal insufficiency *Al* Good for: ok in pg, not 1st choice Bad for: constipation, renal insufficiency, *warfarin* Space from other meds by 2 hours Review enteric-coated drugs - Answer designed to stay intact in stomach pH and dissolve in small intestine pH