PEBC Sample Questions and Answers

What OTC antifungals for 1st trimester and 2nd/3rd trimesters? 1st: clotrimazole 7 day cream
2nd/3rd: miconazole 7 day cream
Citro-mag, Milk of Magnesia, Epsom Salts and Fleet Enema. What type of medication are they and what
precaution needs to be taken? Osmotic/saline agents for constipation.
Avoid in renal failure, risk of hypermagnesia (first 3) or hyperphosphatemia (Fleet enema)
Decongestant CIs and cautions CIs: Severe HTN, CAD, MOAI within past 14 days.
Cautioned in: CVD, diabetes, hyperthyroidism, prostatic hypertrophy and angle-closure glaucoma
Medications to be cautious of in asthma ASA/NSAIDs/COX-2 inhibitors
Beta-blockers
Beano CI when? Anaphylactic penicillin allergy or taking acarbose.
Factors affecting passage into breast milk? molecular weight, weak bases are trapped, weak acids can
reabsorb, degree of ionization [only ionized can pass], lipid solubility
Drugs that enter breast milk? 1) alcholol 2) narcotics 3) barbituates 4) bdz 5) antidepressants 6)
metoclopramide 7) anticholinergics 8) antipsychotics
FGA or SGA, which cause prolactin levels to increase? FGA (eg. haloperidol)
*** risperidone increases levels slightly***
Medications that decrease prolactin levels bromocriptine, ergot alkaloids, levodopa
Medications that increase prolactin levels metoclopramide, methyldopa, haloperidol, phenothiazines (eg.
chlorpromazine), theophylline, amphetamines
Which antibiotic would you use to treat otitis media? Amoxicillin
In renal disease what are the pain killer and diuretic one should consider? Pain killer: acetaminophen
(APAP > NSAIDs/ASA)
Diuretic: furosemide (loop diuretic > thiazides)
Target serum levels for digoxin 0.8-2.0 ng/ml
Target serum levels for lithium 0.6-1.2 mmol/L
Which UTI Abx do we avoid in pregnancy? 1st trimester: TMP
Last 6 weeks: SMX/TMP
At term (36+ weeks): Nitrofurantoin
*Cipro ALWAYS!
Two anti-epileptic medications that cause folate deficiency CBZ, PHT
Why is cloxacillin good for staph aureus? Long R-chain that beta-lactamase can not bind.
What do you monitor in hepatic encephalopathy and what is used to treat it? Monitor ammonia. treat
with lactulose (or a non-absorbed Abx)
If patient has gonorrhoea, what do you assume they are coinfected with? What do you empirically treat
with? Chlamydia
3rd gen ceph + azithromycin
How do you treat Lithium induced tremor? beta-blocker (propranolol)
*Note: monitor thyroid and renal function every 6 months at least
LTG effects on BCP and patient weight? rarely decreases effect of BCP
Weight neutral
Topiramate's effects on weight? Loss possible
Antiepileptics/bipolar medications that cause hepatotoxicity? Divalproex, VPA, LTG
Which NSAID has the greatest risk fo GI bleeds with chronic use? Ketorolac
What medication class causes SIADH? SSRIs
What is responsible for phototoxic reactions? UVA light
What is the filter size for cold filtration? 0.22 microns
advantage of darbopoetin vs. EPO Longer half-life (once weekly dosing vs. 3x weekly)
What DI would we see with anti-cholinergics and metoclopramide? ACs blunt the pro-motility effects
Time to maximal effect in BPH for finasteride? 6 months
What does SSZ cause a deficiency in? Folate
OC with highest failure rate due to non-compliance? micronor (progesterone only) - 3 hour window.
At what APAP ingestion do you consider acetylcysteine? Children: 200mg/kg
Adults: 6.5g
What are the 4 classifications of hypersensitivity reactions [Grooms]
"ACID" ACID
Type I Anaphylaxis
Type II Cytotoxic-mediated
Type III Immune-complex
Type IV Delayed hypersensitivity
Teratogenic drugs (Major non-Abx)
"TAP CAP" TAP CAP:
Thalidomide, Androgens, Progestins
Corticosteroids, Aspirin & indomethacin, Phenytoin
Epilepsy DOCs for (1) Absence Sz (2) Myoclonus (3) Primary Generalized TC (4) Partial & Secondary
Generalized TC (1) Absence Sz: Ethosuximide, VPA
(2) Myoclonus: VPA
(3) Primary Generalized TC: VPA [CBZ]
(4) Partial & Secondary Generalized TC: CBZ [LTG, OxCBZ]
Young women should make what adjustment when on epilepsy medications? Use BCP with 50ug
EE/alternative contraception.
Also should take folic acid 5mg or less per day.
Therapeutic dosage:
toxicity values for most commonly monitored medications
"The magic 2s" "The magic 2s":
Digoxin (.8-2.0) Toxicity = 2.
Lithium (.6-1.2) Toxicity = 2.
Theophylline (10-20) Toxicity = 20.
Phenytoin (10-20) Toxicity = 20.
APAP (1-30mg/kg) Toxicity = 200mg/kg (kids) [6.5g adults]
Phenytoin adverse effects:
"PHENYTOIN" PHENYTOIN:
P-450 interactions
Hirsutism
Enlarged gums
NYSTAGMUS
Yellow-browning of skin
TERATOGENICITY
Osteomalacia
Interference with B12 metabolism (hence anemia)
Neuropathies: vertigo, ataxia, and headache
SSRIs side effects:
"SSRI" SSRI:
Serotonin syndrome
Stimulate CNS
Reproductive dysfunctions in male
Insomnia
Cholinergics (eg organophosphates) effects:
"LESS DUMB" LESS DUMB:
Lacrimation
Excitation of nicotinic synapses
Salivation
Sweating
Diarrhea
Urination
Micturition
Bronchoconstriction
BDZ safe in liver failure
"LOT" LOT:
Lorazepam
Oxazepam
Temazepam
Teratogenic drugs
"W/ TERATOgenic" "W/ TERATOgenic":
Warfarin
Thalidomide
Epileptic drugs: phenytoin, valproate, carbamazepine
Retinoid
ACE inhibitor
Third element: lithium
OCP and other hormones (eg danazol)
Benzodiazepenes:
drugs which decrease their metabolism
"I'm Overly Calm" "I'm Overly Calm":
Isoniazid
Oral contraceptive pills
Cimetidine
• These drugs increase calming effect of BZDs by retarding metabolism.
Which are the Osmotic diuretics?
"GUM" "GUM":
Glycerol
Urea
Mannitol
Sodium valproate side effects
"VALPROATE" "VALPROATE":
Vomiting
Alopecia
Liver toxicity [LTG also hepatotoxic]
Pancreatitis/ Pancytopenia
Retention of fats (weight gain)
Oedema (peripheral oedema)
Appetite increase
Tremor
Enzyme inducer (liver)
Nitrofurantoin major side effects
"NitroFurAntoin" "NitroFurAntoin":
Neuropathy (peripheral neuropathy)
Fibrosis (pulmonary fibrosis)
Anemia (hemolytic anemia)
Zero order kinetics drugs (most common ones) "PEAZ (sounds like pees) out a constant amount": PEAZ
out a constant amount:
Phenytoin
Ethanol
Aspirin
Zero order
• Someone that pees out a constant amount describes zero order kinetics (always the same amount out)
Steroids side effects
"BECLOMETHASONE" "BECLOMETHASONE":
Buffalo hump
Easy bruising
Cataracts
Larger appetite
Obesity
Moonface
Euphoria
Thin arms & legs
Hypertension/ Hyperglycaemia
Avascular necrosis of femoral head
Skin thinning
Osteoporosis
Negative nitrogen balance
Emotional liability
Hepatic necrosis: drugs causing focal to massive necrosis
"Very Angry Hepatocytes" "Very Angry Hepatocytes":
Valproic acid
Acetaminophen
Halothane
Antibiotics contraindicated during pregnancy
"MCAT""MCAT":
Metronidazole
Chloramphenicol
Aminoglycoside
Tetracycline
Lithium: side effects
"LITH" "LITH":
Leukocytosis
Insipidus [diabetes insipidus, tied to polyuria]
Tremor/ Teratogenesis
Hypothyroidism
What are the 5 components of the Canada Health Act? Public Administration
Comprehensiveness
Universality
Portability
Accessibility
Consequentialism or Utilitarianism Result is all that matter, not how you got there.
Deontology Rightness and wrongness must consider the nature of one's actions as well as the result.
Beneficence In one's actions, one should strive for good consequences
Non-malificence In one's actions, one should strive for the prevention of harmful consequences
Veracity (truth-telling): one should deal honestly and truthfully with others
Extensive list of teratogenic drugs • ACEIs
• Isotretinoin
• Alcohol ingested chronically or in binges.
• Androgens (male hormones).
• Antibiotics: tetracycline, doxycycline and streptomycin.
• Warfarin
• Anticonvulsants: PHT, VPA, trimethadione, paramethadione and CBZ
• Lithium
• Antimetabolite/anticancer drugs: MTX and aminopterin
• Antirheumatic agent and metal-binder penicillamine
• Antithyroid drugs: thiouracil/PTU and carbimazole/MMI.
• Cocaine.
• DES (diethylstilbestrol), a hormone.
• Thalidomide
GERD in renal dysfunction, which medication should you avoid? Cimetidine
Medications that cause dysglycemia • Atypical antipsychotics
• β-blockers
• Glucocorticoids
• Niacin
• Protease Inhibitors
• Phenytoin
• Thiazide Diuretics
How long is the minimum nitrate free interval for those wearing a nitro patch for angina? 10 hours
Common CAP bugs 1) Strep pneumo
2) Mycoplasma pneumo
3) H. influenza
If comorbidities w/o oral CS or ABx in past 3 months:
4) Chlamydophila pneumo
5) M. catarrhalis
If comorbidities AND recent ABx or oral CS use in past 3 months ADD:
6) Legionella
Common HAP bugs General ward admission:
1) Strep pneumo
2) Mycoplasma pneumo
3) H. influenza
4) Chlamydophila pneumo
5) Legionella
ICU ADD:
1) Gram neg rods (Kleb, Entero, Serratia, Acinetobacter)
2) Staph aureus
***Pseudomonas possible in severe cases
Aspiration:
1) Anaerobes
Medications to treat HAP with pseudomonasTwo of the following:
1 - Cipro
2 - Ceftaz
3 - Imipenem
4 - Gent
5 - Tobra
Drugs to treat CAP Amoxicillin, Macrolide, Doxycycline.
More severe: Resp. FQ
Drugs to treat HAP General Ward: 2nd, 3rd, 4th generation ceph, Amoxicillin, Amoxi/Clav,
Macrolide
ICU: 3rd gen ceph + macrolide, 3rd gen ceph + resp. FQ
Define academic detailing Help physicians adopt better prescribing practices
Which liver enzyme elevates first in APAP overdose? AST
Define type 1 and type 2 errors Type 1: False positive
Type 2: False Negative
Most likely to be administered via piggyback IV method? Antibiotics
Common Traveller's Diarrhea bugs? E. coli, Shigella spp, Salmonella spp, Campyrobacter
Traveller's Diarrhea treatment options? Prophylactic:
1) Bismuth subsalicylate QID with food
2) Cholera vaccine (B subunit) 2 doses 7-42 days apart
Acute:
1) FQs (norflox, oflox, ciproflox) 3 days schedule or a single dose.
2) Azithromycin [if FQ resistant - eg. campylobacter] 500mg OD x 3 days or 1000mg as one dose.
3) SMX/TMP
* loperamide
* oral rehydration salts
Which medications have additive ionotropic effects if used together? 1) Amiodarone
2) b-blockers
3) digoxin
4) non-DHP CCBs
Which dyslipidemia medications can you use in pregnancy and children? Resins (eg.
cholestyramine)
Best medications for HDL & TGs niacin, fibrates (eg. fenofibrate, gemfibrozil)
Doubling a statin dose increases LDL lowering effect by how much? 6%
What are the glaucoma medication classes and how does each lower IOP? b-blockers eg. timolol):
decrease aqueous humour formation
CAIs (eg. dorzolamide): decrease aqueous humour formation
Prostaglandin analogues (eg. latan, travo): increase uveoscleral outflow
Bimatoprost: increase uveoscleral and trabecular outflow
Cholinergic agonists (eg. pilocarpine): increase trabecular outflow
List types of EPS Dystonia, akathisia, parkinsonium, rabbit syndrome.
*Can progress to tardive dyskinesia.
Clozapine and smoking. Decreased clozapine levels.
*Note: Clozapine causes constipation 60% of the time, can cause agranulocystosis, has LARGE weight
gain and is HUGELY anticholinergic.
Medications that cause agranulocytosis? Clozapine, CBZ, PTU, MMI, penicillin, chloramphenicol,
SMX/TMP, cytotoxic drugs, gold, NSAIDs and mirtazapine.
Malaria treatments? DOC: Chloroquine [qWeekly: start 1-2 weeks prior, 4 weeks after]
CHQ-resistance: Mefloquine [qWeekly: start 1 week prior, 4 weeks after]
Mefloquine-resistance: Doxycycline [qDaily start 1 day prior, 4 weeks after], Atovaquone/Proguanil
[qDaily start 1 day prior, 1 week after]
Early delusions or hallucinations in dementia can be indicative of? Lewy body Dementia
Time to affect for atomoxetine in ADHD? 6-12 weeks (only 2-3 weeks for stimulants)
What does cost utility analysis mean? A measure of years in full health relative to cost of a
healthcare intervention. Often expressed as QALY [quality-adjusted life years]
Maximum dose amoxicillin in children? 90mg/kg/day divided BID or TID
What is the Somogyi effect? Rebound hyperglycemia in response to low blood sugar. Often occurs
with too high insulin dose at bedtime.
Why give calcium carbonate in end-stage renal disease? To reduce serum phosphate levels.
High phosphate leads to high PTH which in turn lowers serum calcium levels.
Which antiarrhythmic increases HR when treating a. fib? procainamide
What anticoagulant do you substitute in for a patient with (or past) heparin induced thrombocytopenia?
lepirudin
How to treat DM in pregnancy? Diet and if necessary insulin
Which antiepileptics DON'T decrease BCP levels? Divalproex, VPA, Ethosuximide, Gabapentin, LTG
[CBZ, PHT, Topiramate do]
Which antibiotics are hepatically eliminated? erythromycin, azithromycin, moxifloxacin,
norfloxacin, clindamycin, SMX, minocycline
What is the duration of treatment for cellulitis? 10 days
What is used to treat heparin overdose? protamine sulfate (1mg per 100 units heparin)
infliximab MUST be used with what medication? MTX (official indication)
What blood serum level can be increased by iostretinoin? TGs
Carbamazepine side effects all go away if you slowly titrate except? Visual Disturbances
How do you treat methanol toxicity? ethanol (and vice versa)
60) What is the advantage of PTU over MMI in thyroid storm?PTU prevents the conversion of t4 to t3
Which osteoporosis medication is indicated for MEN with osteoporosis? risedronate
Prinzmetal angina - what is the DOC? Amlodipine (CCB) [nitrates also used]
Patient with hypercalcemia, what do you give? Furosemide [not thiazide]
A patient has suicidal ideation. Which of the following should not be given? Bupropion
Where to find the unapproved indications of drugs? Martindale
What should be done if narcotics are stolen from the pharmacy? Report to the office of controlled
substances within 30 days
How long can insulin be kept out of the fridge? 30 days