ASHP- test Test

ASHP- test Test

Question Answer
How would nausea/vomiting elevate INR? reduced intake of vitamin K
Antidote fo doxorubicin extravasation? dexrazoxane administered within 5 hours
Because paclitaxel is low emetogenicity, what is recommended for N/V? Zofran 8mg po or dexamethasone 12mg po 30 min prior to paclitaxel
What is the fourth option for hypertensive patients not at goal on 3 BP meds already? add spironolactone, switch hydrochlorothiazide to chlorthalidone, or switch beta-blocker to Coreg
minimum frequency recommended by the American Diabetes Association (ADA) for self-monitoring of blood glucose (SMBG) in patients receiving multiple injections of insulin daily? 3 times/day
Classifications of CKD in terms of CrCl? 1. normal GFR: crcla??902. mild renal impairment Crcl 60-893. moderate renal impairment Crcl 30-594. Severe renal impairment Crcl 15-295. Kidney failure Crcl<15
Which anticoag is recommended for NSTE-ACS pt going to cath lab? Unfractionated heparin + glycoprotein IIb/IIIa inhibitor
What is DAPT? dual antiplatelet therapy following stent. A score of ?2 is associated with a favorable benefit/risk ratio for prolonged DAPT while a score of <2 is associated with an unfavorable benefit/risk ratio
Fluoxetine inhibits which CYP? 3A4, 2D6, 2C19
Plavix is an inactive prodrug that requires what CYP activation? 2C19
When should you use tolvaptan in hyponatremic patients? When fluid restriction fails
When should you use 3% saline in hyponatremic patients? Na<125 + symptoms
What is normal LV ejection fraction? ? 55%
After the TSH levels normalize and a dosage is established, when should the next TSH level be drawn? 6 months, then annually
At what Crcl is Pradaxa contraindicated? crcl<15
At what CHADS2 score is aspirin not sufficient and warfarin may need to be used? CHADS2 score > 1
normal PCWP? 8-12
At what triglyceride level are fibrates indicated? TG ? 500
At CD4 count < 50cells/mm3 in HIV, what is recommended? Azithromycin 1.2g PO qwk because of Mycobacterium avium complex (MAC)
Is MMR vaccine live or killed? live attenuated
What is the recommended treatment for PJP? 1st line: BactrimAlternative: Dapsone, Atovaquone
Which HIV drug is associated with Fanconi syndrome? tenofovir
Can efavirenz exacerbate depression? Yes
What is a sentinel event? unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury. e.g. retention of a foreign object, falls and performing procedures on the wrong patient
What is a medication error? any preventable event that may cause or lead to inappropriate medication use or patient harm
What is the beyond-use-date and time? it is the storage period before administration
What is the appropriate response for Joint Commission sentinel event? Root cause analysis. reporting individuals to professional state boards is not required.
What is the Hawthorne Effect? subjects improve or modify their behavior in response to the fact that they know that they are being studied
What legislation identifies US Pharmacopeia and National Formulary as the official standards of drugs? Pure Food and Drug Act of 1906
What is the time window for alteplase after 1st sign of stroke symptoms? 3-4.5 hours
At what BP is lowering BP required before initiating alteplase? ? 185/110
Why is an ECG recommended periodically for pt on citalopram? QT prolongation
Why is Calcium citrate preferred over calcium carbonate in pt taking PPI? calcium carbonate requires acidic environment for max absorption whereas calcium citrate does not
Why is doxazosin in Beer's criteria? orthostatic hypotension
Which opioids are preferred in ESRD? methadone (no active metabolite, fecal excretion), fentanyl (no active metabolite, liver metabolism)
Healthcare Effectiveness Data and Information Set (HEDIS)? a tool utilized by health insurances to measure performance on quality care and services
When is HPV vaccine indicated? at 9 years old, it is a 2 dose series 6 months apart
Flonase (fluticasone propionate) and Veramyst (fluticasone furoate) age limit? Flonase: ? 4 yoVeramyst: ? 2 yo
Do you observe or treat acute otitis media in children <2 yo? Treatment with antibiotics (not observation) is recommended by the American Academy of Pediatrics for non-toxic appearing children less than 2 years of agewith unilateral AOM with otorrhea
Side effect of inhaled corticosteroids in children with asthma related to bone health? inhaled corticosteroids can suppress linear growth and increase the risk for osteopenia and osteoporosis. Use lowest possible dose.
What is VAP? Pnuemonia occuring more than 48-72 hrs after endotracheal intubation
Treatment duration for HAP, VAP, or HCAP? 7 days
When should vancomycin be added for PNA? when local hospital prevalence of MRSA ? 20% or antibiotic use within 90 days
When is hydrocortisone recommended in sepis or septic shock? it is indicated only after both fluid resuscitation and vasopressor therapy have been unsuccessful in restoring hemodynamic stability
In critically ill patients (e.g. sepsis), what is the blood glucose goal? ? 180 (NICE-SUGAR study)
serious adverse drug event from a suspected counterfeit medication be reported to? MedWatch
What legislation require obtaining informed consent from research subjects? The Kefauver-Harris Amendments of 1962
Emergency use investigational new drug (IND) application? allows the FDA to authorize use of an experimental drug in an emergency situation that does not allow time for submission of an IND application (e.g. Ebola virus treatment)
Conversion of oral oxycodone to oral morphine? oxycodone po 2mg = morphine po 3mg
Conversion of oral morphine to IV morphine? 1 mg IV morphine = 3 mg po morphine
Pradaxa is contraindicated at what Crcl? Crcl<15
Rivaroxaban is contraindicated at what Crcl? Crcl<15
If CHADS2 score > 1, is ASA or warfarin recommended? warfarin
Normal cardiac index? CI>2.5
At what level of TG is fibrates indicated? >500
Which class of HIV drugs has the greatest risk of lactic acidosis and severe hepatomegaly? NRTI
Which genotype testing is useful in abacavir hypersensitivity? HLA-B* 5701
What is the BUD for median risk sterile preparation, e.g. making a batch IV from larger container? 30 hrs at RT; 9 days in fridge
The Kefauver-Harris Amendments? established the requirement for drug firms to demonstrate efficacy as well as safety, obtain informed consent for research subjects, GMP.
The Durham-Humphrey Amendment? Prescription vs OTC
Federal Food Drug and Cosmetic Act? giving authority to the FDA to oversee the safety of food, drugs, and cosmetics
What is the age cutoff for the 4 ? hour window for starting tPA? <80 yo
Which organization came up with root cause analysis after a sentinel event? The Joint Commission

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