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117 Cards in this Set
- Front
- Back
Hematologically, what is meant by a "Shift to the left"?
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Increased bands, or immature neutrophils
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Describe serum bicarb levels in a patient with metabolic acidosis
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LOW!
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Describe the respiratory compensation mechanism for metabolic acidosis.
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Tachypnea, breath off the CO2 (Acid!)
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What hematologic labs could be altered in disseminated intravascular coagulopathy?
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Increased PT/PTT and decreased fibrinogen
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Describe the effects of glucocorticoids on WBC levels and how this could be distinguished from a true infection.
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Increased WBC level, but no shift to the left
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What drugs are commonly associated with "Drug Fever"?
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Amp B, Phenytoin, various antibiotics
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Urinary tract infection, predominant pathogen?
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e. coli
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Respiratory tract, predominant pathogen?
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S. pneumoniae (pneumococcus)
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Skin/Soft tissue or IV catheter, predominant pathogen?
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Staph
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Which type of PCN allergy is the use of beta-lactams CONTRAINDICATED?
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IgE mediated (Immediate, Type I)
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Sx of IgE mediated Immediate allergic reaction
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Anaphylaxis, angioedema, bronchospasm, hypotension...
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Patient with IgE mediated PCN allergy, which of the following can be used?
A) PCN B) Aztreonam C) Cephalosporins D) Carbapenems |
B
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With which type of PCN allergy can beta-lactam use be attempted?
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Late, Type 4
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Patient with type IV PCN allergy, which agents are the best to recommend?
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OC3!!!!
Omnicef (Cefdinir) Ceftin (Cefuroxime) Cefpodoxime Ceftriaxone |
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#1 Pathogen for community acquired pneumonia?
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Pneumococcus
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Sx of IgE mediated Immediate allergic reaction
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Anaphylaxis, angioedema, bronchospasm, hypotension...
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Patient with IgE mediated PCN allergy, which of the following can be used?
A) PCN B) Aztreonam C) Cephalosporins D) Carbapenems |
B
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With which type of PCN allergy can beta-lactam use be attempted?
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Late, Type 4
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Patient with type IV PCN allergy, which agents are the best to recommend?
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OC3!!!!
Omnicef (Cefdinir) Ceftin (Cefuroxime) Cefpodoxime Ceftriaxone |
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#1 Pathogen for community acquired pneumonia?
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Pneumococcus
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Sx of IgE mediated Immediate allergic reaction
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Anaphylaxis, angioedema, bronchospasm, hypotension...
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Patient with IgE mediated PCN allergy, which of the following can be used?
A) PCN B) Aztreonam C) Cephalosporins D) Carbapenems |
B
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With which type of PCN allergy can beta-lactam use be attempted?
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Late, Type 4
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Patient with type IV PCN allergy, which agents are the best to recommend?
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OC3!!!!
Omnicef (Cefdinir) Ceftin (Cefuroxime) Cefpodoxime Ceftriaxone |
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#1 Pathogen for community acquired pneumonia?
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Pneumococcus
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4 pathogens that normally colonize the URT?
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Pneumococcus, Strep, Haemophilus and Neisseria
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Most common pathogens that colonize the URT in smokers?
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H. flu and M. catarrahlis
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Which key pathogen does not typically colonize the URT due to normal host defenses?
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GNR... pseudomonas!
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Common mechanism of resistance to macrolides?
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Efflux
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Ciprofloxacin, G+ or G- or BOTH?
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G-
Using in G+ will kill the patient... |
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In the management of pneumococcal CAP, what are considered clnically useful extended spectrum fluoroquinolones?
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Levaquin (Levofloxacin), Avelox (Moxifloxacin)... NOT CIPRO!
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Guideline treatment of pneumococcal CAP (PCN susceptible)
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PCN or....
1) Doxy 2) Macrolide 3) Cephalosporin 4) Ext spectrum FQ |
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Guideline treatment of pneumococcal CAP (Intermediate PCN Resistance)
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PCN or Ceftriaxone OR...
Extended spectrum FQ |
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Guideline treatment of pneumococcal CAP (High Level PCN Resistance)
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Vancomycin
or Extended Spectrum FQ |
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Cefditoren, brand name?
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Spectracef
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Cefditoren, category?
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Antibiotic, 3rd generation cephalosporin
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Cefditoren, indication?
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PCN resistant pneumococcus, beta-lactamase producing H. flu and MSSA
Summary: G+, G- |
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Cefditoren, dietary considerations
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Should take with high fat meal, use with caution in patients with milk protein hypersensitivity
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Linezolid, brand?
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Zyvox
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Linezolid, category?
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Antibiotic, Protein synthesis inhibitor
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Linezolid, indications?
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G+ (inc. res. staph/strep)
Gram positive big guns |
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Linezolid, hallmark ADRs
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*Thrombocytopenia
*Leucopenia Diarrhea, abd pain... |
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Telithromycin, brand?
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Ketek
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Telithromycin, cateogry?
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Antibiotic, similar to macrolides
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Macrolides, predominant coverage?
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G+
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Telithromycin, coverage
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S. pneumoniae (G+)
Minimal GNR/Anaerobes Specific spectrum: 1) S. pneumoniae 2) H. flu 3) M. cat 4) Strep pyogenes 5) C. pneumoniae 6) L. pneumophila 7) M. pneumoniae |
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Telithromycin, indications
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Mild to moderate community acquired pneumoniae (ONLY)
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Major ADR of telithromycin?
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Hepatotoxicity - limited indications
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Telithromycin, common dose
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800mg (2 x 400mg tablets) BID w/ or w/o food
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Telithromycin, INx
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STRONG 3A4 inhibitor:
Affects dig, theophylline, sotalol, rifampin |
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Telithromycin, contraindications
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*Hepatitis or jaundice history associated with Ketek or any macrolide.
*MG |
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Telithromycin, warnings
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*Acute hepatic failure / severe livery injury reported
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Telithromycin, hallmark ADRs
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1) QTC prolongation
2) MG exacerbation (thus C/I) 3) Hepatotoxicity 4) Visual disturbances 5) Loss of consciousness |
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Major off-label use of FQ in peds?
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CF due to pseudomonas
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Extended spectrum respiratory FQ, Hallmark ADRs
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*QTc prolongation
*Avoid with Class 1A or III *Photosensitivities |
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What is Factive?
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Gemifloxacin
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Gemifloxacin, Brand?
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Factive
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Gemifloxacin, Category
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Extended spectrum FQ
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Gemifloxacin, spectrum
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Staph, strep, ATYPICALS
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Gemifloxacin, elimination
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Renal/Hep
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Major ADR of gemifloxacin (Factive)?
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Photosensitivity
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Empiric outpatient Tx of CAP, drug of choice?
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Doxycycline 100mg BID x 7 - 14 days
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Guideline treatment of pneumococcal CAP OUTPATIENT w/ suspected aspiration, preferred agent?
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Augmentin
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Guideline treatment of pneumococcal CAP OUTPATIENT, possible agents?
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1) Doxycycline (DOC)
2) Macrolide (Ery/Azi/Cla) 3) FQ (Not Cipro) 4) Levaquin 5) Augmentin if suspected aspiration |
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CAP Empiric Inpatient Therapy (NON-ICU)
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Ceft or Cefotax + Macrolide
OR B-lactam/Clav + Macrolide OR ESFQ |
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Empiric Inpatient CAP treatment (ICU)
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Ceft or Cefotax or B-lact/clav (Zosyn)
AND Macrolide or ESFQ [Summary: Zosyn + Mac/FQ] B-lact allergy? FQ + Clind |
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CAP Duration of therapy?
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7 - 10 days unless chlamydia or legionella
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Quinidine, Antiarrhythmic Classification
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1A
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Procainamide, Antiarrhythmic Classification
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1A
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Disopyramide, Antiarrhythmic Classification
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1A
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Lidocaine, Antiarrhythmic Classification
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1B
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Mexiletine, Antiarrhythmic Classification
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1B
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Flecainide, Antiarrhythmic Classification
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1C
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Propafenone, Antiarrhythmic Classification
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1C
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Beta-blockers, Antiarrhythmic Classification
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2
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Amiodarone, Antiarrhythmic Classification
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3
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Sotalol, Antiarrhythmic Classification
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3
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Dofetilide, Antiarrhythmic Classification
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3
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Ibutilide, Antiarrhythmic Classification
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3
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Calcium channel blockers, Antiarrhythmic Classification
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4
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Class 1A arrythmias, indications?
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Ventricular and Atrial
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Class 1B arrythmias, indications?
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Ventricular
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Class 1C antiarrythmic indications
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Vent, Atrial.... Flecainide particularly high risk in ventricular
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Quinidine ADRs
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GI upset!!!
Cinchonism Thrombocytopenia Hepatitis Drug fever |
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Quinidine Interactions
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Digoxin, warfarin increased
Amiodarone increases quinidine levels |
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Quinidine elimination
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Liver
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Quinidine Therapeutic Level
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2-6
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Which agent has an active metabolite known as NAPA?
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Procainamide
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What class agent does NAPA act like?
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3
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Procainamide ADRs
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1) Positive ANA
2) SLE 3) GI 4) CNS 5) Fever 6) Rash 7) Neutropenia |
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Symptoms of procainamide induced SLE?
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Pleural or pericardial pain
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Procainamide Elimination
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50% hepatic, 50% renal
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Normal NAPA levels
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<20mg/L
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Major complaint reported by patients for disopyramide?
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Anticholinergic ADRs
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Inotropic classification of disopyramide
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Negative
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Disopyramide drug interactions
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Phenytoin increases disopyramide metabolism
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Disopyramide elimination
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50%/50%
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Lidocaine is useful in the treatment of ______________.
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Ventricular arrythmias
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Lidocaine ADRs
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CNS related
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Lidocaine drug interactions
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Metabolism decreased by beta blockers and cimetidine
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Lidocaine elimination
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90% liver
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Mexiletine major ADRs
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GI IRRITATION
CNS **Take with food |
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Mexiletine drug interactions
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Phenytoin increases metabolism
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Mexiletine elimination
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90% liver
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Flecainide ADRs
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** GI and CNS***
Proarrythmic |
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Flecainide Drug Interactions
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Flecainide levels may be increased by amiodarone
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Flecainide elimination
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70% liver, 30% renal
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Propafenone ADRs
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GI/CNS
Metallic taste Caution: Agent is similar to betablocker |
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What is the most effective antiarrythmic agent for ventricular arrythmias?
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Amiodarone
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SEVERE ADRs of Amiodarone
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Pulmonary fibrosis
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ADRs of Amiodarone
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SEVERE: Pulmonary fibrosis
CNS, thyroid, GI, blue-gray skin, photosensitivity, corneal deposits, optic neuritis, hepatotoxicity, bradycardia Brain explosions, spontaneous combustion, i hate the naplex, i hate studying |
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V. Tach, Tx?
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Lidocaine, then procainamide or amiodarone
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V. fib, Tx?
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Defibrillate
EPI or Vasopressin Amiodarone then Lidocaine Consider magnesium and procainamide if above fails |
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PSVT, Tx?
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Vagal maneuvers
Rx: Adenosine preferred Secondary: Vera, dilt, BB, digoxin |
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A. Fib, Tx?
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Anticoagulate
Block AV node w/ BB, CCB or Dig |
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Torsade De Pointes, Tx?
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Stop cause and correct Electrolyte abnormality
Give Mg 2g bolus Increase HR until cause is removed |
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Digoxin elimination?
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Renal
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