NAPLEX Questions: Medication Safety and Quality
Improvement with correct answers
How is nitroglycerin stored? - ANSWER - Non-PVC containers.
- glass
How often are clonidine patches replaced? - ANSWER Once a week
Dose of clonidine patches? - ANSWER 0.1 mg/24h. Notice that the dose is in
respect to 24 hours while patches are replaced once a week. Finding weekly dose
would require you to multiply daily dose by 7
Sodium nitroprusside should be used? - ANSWER immediately, but you have 24
hours in which you can use it. Short time frame due to risk of buildup of cyanide
Sodium nitroprusside is added to D5W or NS? - ANSWER D5W only
How to transfer sodium nitroprusside? - ANSWER Wrap in foil to reduce break down
of material from light into toxic cyanide material
Cyanide toxicity is associated with which agent? How do you treat it? - ANSWER
Sodium nitroprusside. Treat with sodium nitrate 3% and then sodium thiosulfate
Digoxin levels for A.Fib - ANSWER 0.8 - 2.0
Digoxin levels for CHF - ANSWER 0.5 - 0.8
Prior to initiating digoxin, check - ANSWER - Electrolytes (risk of hypokalemia and
hypomag and hypercalcimia contributing to dig toxicity)
- renal status (80% excreted renally)
When do you check digoxin levels after initiation? - ANSWER Check in 5-7 days
after maintenance dose due to long half-life. Can take 1-3 weeks in patients with
poor kidney fxns
Digoxin drug interactions - ANSWER VAQ
- Verapamil (increase dig by 30-50%)
- Amiodarone (increase dig by 50%) + dronaderone
- Quinidine (increase dig by 50-70%)
Corticosteroids and digoxin - ANSWER Corticosteroids can decrease potassium
levels
Amphotericin B and digoxin - ANSWER Amph B can decrease potassium levels
,licorice and digoxin - ANSWER Licorice is an aldosterone agonist (decreases
potassium levels)
Alpha-2 receptor agonists side effects - ANSWER Anti-cholinergic and sedation
What are the direct cholinergic agonists? - ANSWER Pilocarpine and bethanechol
What are the cholinesterase inhibitors medications? - ANSWER Physostigmine,
neostigmine, and endorphonium
Which beta blockers have alpha and beta inhibition activity? - ANSWER carvedilol
and labetalol
How often do we replace a scopolamine patch? - ANSWER 3 days
Norepinephrine works on which receptors? - ANSWER Primarily alpha-1 receptors
Dopamine works on which receptors? - ANSWER Dopaminergic (renal dilation) 1-2
mcg/min
beta-1 (2-10 mcg/min)
alpha-1 (10-20 mcg/min)
Dobutamine works on which receptors? - ANSWER Beta-1 and beta-2
For patients with AFib, when can we consider cardioversion? - ANSWER If Afib has
been around for < 48 hours
OR
If Afib > 48 hours and echo shows no clot formed.
Initiate IV anticoags and cardiovert. Then give PO anticoag for 4 weeks.
For patients with AFib, when do we not consider cardioversion? - ANSWER If Afib
has been around for > 48 hours and echo shows a clot. Give anticoag to patient for
4-12 weeks first -> cardiovert -> continue anticoag for 4 weeks afterwards
How does CHADSVASc score differ between Chest guideline and AHA/ACC
guideline? - ANSWER Chest guidelines says > 1 non-sex criteria should get
anticoag
AHA/ACC guidelines says definite anticoag in patients w/
- > 2 non-sex criteria
- may consider in patients with > 1 non-sex criteria
Quinidine class? Side effects? - ANSWER - Class 1a
- Cinchonism, blurred vision, diarrhea, thrombocytopenia and hemolytic anemia
PO -> anti-arrhythmia
IV -> life-threatening malaria
Disopyramide class? side effects? - ANSWER - Class 1 a
,- Anti-cholinergic
- negative inotropic (don't give to patient w/ CHF)
PO
Procainamide class? side effects? - ANSWER Class 1a
- ANA+ (drug-induced lupus)
- Agranulocytosis
- Diarrhea
IV/IM
Lidocaine class? Side effect? - ANSWER Class 1b, only ventricular arrhythmias and
not Afib
CNS effects -> light headedness, seizures
IV
Lidocaine is made in NS or D5W? - ANSWER D5W
Can you send someone home with Lidocaine? - ANSWER No. Use Mexiletine (PO).
Take with food or ant-acid (need alkaline environment)
Propafenone class? Side effect? - ANSWER Class 1C. Has beta blocking activity
(used for Afib and PSVT). Negative inotropic effect. Can increase digoxin and
warfarin
Flecainide class? When can we use it? - ANSWER Class 1c. Ventricular and
supraventricular arrhythmias. Do NOT use if Structural Heart Disease
PO
Ibutilide class? Use? - ANSWER Class 3. Used as a chemical conversion for
Afib/flutter
IV
Amiodarone dosing PO - ANSWER LD: 800 - 1600 mg (QD/BID) x 1-3 weeks
MD: 200 - 600 mg QD
Amiodarone dosing IV - ANSWER 150 mg over 10 mins; then infuse 1 mg/min x 6
hours (360 mg); then 0.5mg/min x 18 hours (540 mg)
Amiodarone side effects - ANSWER - Photosensitivity
- Pulmonary fibrosis (need CXR)
- Corneal micro deposits (need ophthalmic exam)
- hypo/hyperthyroidism
- smurf color -> blue color
- QT prolongation
- Monitor LFTs (100% cleared by liver)
- CNS
- Bradycardia/hypotension
How long is amiodarone's half-life? - ANSWER 30-60 days. Even if we stopped
amiodarone a few days, we still need to keep that in mind about possible DDIs
, Amiodarone DDIs - ANSWER - Digoxin
- Warfarin (reduce warfarin dose by 33-50%)
- Sofosbuvir (increase bradycardiac effect of amio)
- Harvoni (combo w/ sofosbuvir)
- fluoroquinolones, macrolides, azoles (qt prolongation)
If making Amiodarone store in...? - ANSWER Using it in less than 2 hours -> store in
PVC
Using it in greater than 2 hours -> store in glass (stable for 24 hours)
How dose dronedarone compare with amiodarone? Side effects? - ANSWER -
Dronedarone only PO
- Only for AFib/Aflutter
- no pulmonary fibrosis, corneal deposits, hypo/hyperthyroidism
- SE: Liver damage, heart failure (do not give in patients with symptomatic HF)
Dronedarone dose - ANSWER 400 mg PO BID w/ food. Avoid Grape fruit juice
When starting sotalol... Monitoring parameters? - ANSWER Start in hospital with
EKG monitoring for 3 days.
Monitor renal function.
Dose adjust Crcl <60
CI: Crcl <40
PO/IV
Dofetilide class. Used for? When starting...? - ANSWER Class 3.
Used for Afib/Aflutter
Start in hospital with EKG monitoring for 3 days
Monitor renal fxn
Dose adjust CrCl <60
CI: CrCl <20
PO
DOC for PSVT? How to administer? - ANSWER Adenosine
IV
Give 6 mg IV push (have to be push). Can repeat with 12 mg IV push
(reboots the heart)
DOC for torsades de pointes - ANSWER Magnesium IV
Ventricular fibrillation/pulseless VT Alogrithm - ANSWER Shock -> medication ->
shock -> medication
Meds used:
- Epinephrine 1 mg IV q3-5 min (first)
- Amiodarone
LD: 300 mg IV bolus; may repeat
MD: 150 mg q3-5 min
Improvement with correct answers
How is nitroglycerin stored? - ANSWER - Non-PVC containers.
- glass
How often are clonidine patches replaced? - ANSWER Once a week
Dose of clonidine patches? - ANSWER 0.1 mg/24h. Notice that the dose is in
respect to 24 hours while patches are replaced once a week. Finding weekly dose
would require you to multiply daily dose by 7
Sodium nitroprusside should be used? - ANSWER immediately, but you have 24
hours in which you can use it. Short time frame due to risk of buildup of cyanide
Sodium nitroprusside is added to D5W or NS? - ANSWER D5W only
How to transfer sodium nitroprusside? - ANSWER Wrap in foil to reduce break down
of material from light into toxic cyanide material
Cyanide toxicity is associated with which agent? How do you treat it? - ANSWER
Sodium nitroprusside. Treat with sodium nitrate 3% and then sodium thiosulfate
Digoxin levels for A.Fib - ANSWER 0.8 - 2.0
Digoxin levels for CHF - ANSWER 0.5 - 0.8
Prior to initiating digoxin, check - ANSWER - Electrolytes (risk of hypokalemia and
hypomag and hypercalcimia contributing to dig toxicity)
- renal status (80% excreted renally)
When do you check digoxin levels after initiation? - ANSWER Check in 5-7 days
after maintenance dose due to long half-life. Can take 1-3 weeks in patients with
poor kidney fxns
Digoxin drug interactions - ANSWER VAQ
- Verapamil (increase dig by 30-50%)
- Amiodarone (increase dig by 50%) + dronaderone
- Quinidine (increase dig by 50-70%)
Corticosteroids and digoxin - ANSWER Corticosteroids can decrease potassium
levels
Amphotericin B and digoxin - ANSWER Amph B can decrease potassium levels
,licorice and digoxin - ANSWER Licorice is an aldosterone agonist (decreases
potassium levels)
Alpha-2 receptor agonists side effects - ANSWER Anti-cholinergic and sedation
What are the direct cholinergic agonists? - ANSWER Pilocarpine and bethanechol
What are the cholinesterase inhibitors medications? - ANSWER Physostigmine,
neostigmine, and endorphonium
Which beta blockers have alpha and beta inhibition activity? - ANSWER carvedilol
and labetalol
How often do we replace a scopolamine patch? - ANSWER 3 days
Norepinephrine works on which receptors? - ANSWER Primarily alpha-1 receptors
Dopamine works on which receptors? - ANSWER Dopaminergic (renal dilation) 1-2
mcg/min
beta-1 (2-10 mcg/min)
alpha-1 (10-20 mcg/min)
Dobutamine works on which receptors? - ANSWER Beta-1 and beta-2
For patients with AFib, when can we consider cardioversion? - ANSWER If Afib has
been around for < 48 hours
OR
If Afib > 48 hours and echo shows no clot formed.
Initiate IV anticoags and cardiovert. Then give PO anticoag for 4 weeks.
For patients with AFib, when do we not consider cardioversion? - ANSWER If Afib
has been around for > 48 hours and echo shows a clot. Give anticoag to patient for
4-12 weeks first -> cardiovert -> continue anticoag for 4 weeks afterwards
How does CHADSVASc score differ between Chest guideline and AHA/ACC
guideline? - ANSWER Chest guidelines says > 1 non-sex criteria should get
anticoag
AHA/ACC guidelines says definite anticoag in patients w/
- > 2 non-sex criteria
- may consider in patients with > 1 non-sex criteria
Quinidine class? Side effects? - ANSWER - Class 1a
- Cinchonism, blurred vision, diarrhea, thrombocytopenia and hemolytic anemia
PO -> anti-arrhythmia
IV -> life-threatening malaria
Disopyramide class? side effects? - ANSWER - Class 1 a
,- Anti-cholinergic
- negative inotropic (don't give to patient w/ CHF)
PO
Procainamide class? side effects? - ANSWER Class 1a
- ANA+ (drug-induced lupus)
- Agranulocytosis
- Diarrhea
IV/IM
Lidocaine class? Side effect? - ANSWER Class 1b, only ventricular arrhythmias and
not Afib
CNS effects -> light headedness, seizures
IV
Lidocaine is made in NS or D5W? - ANSWER D5W
Can you send someone home with Lidocaine? - ANSWER No. Use Mexiletine (PO).
Take with food or ant-acid (need alkaline environment)
Propafenone class? Side effect? - ANSWER Class 1C. Has beta blocking activity
(used for Afib and PSVT). Negative inotropic effect. Can increase digoxin and
warfarin
Flecainide class? When can we use it? - ANSWER Class 1c. Ventricular and
supraventricular arrhythmias. Do NOT use if Structural Heart Disease
PO
Ibutilide class? Use? - ANSWER Class 3. Used as a chemical conversion for
Afib/flutter
IV
Amiodarone dosing PO - ANSWER LD: 800 - 1600 mg (QD/BID) x 1-3 weeks
MD: 200 - 600 mg QD
Amiodarone dosing IV - ANSWER 150 mg over 10 mins; then infuse 1 mg/min x 6
hours (360 mg); then 0.5mg/min x 18 hours (540 mg)
Amiodarone side effects - ANSWER - Photosensitivity
- Pulmonary fibrosis (need CXR)
- Corneal micro deposits (need ophthalmic exam)
- hypo/hyperthyroidism
- smurf color -> blue color
- QT prolongation
- Monitor LFTs (100% cleared by liver)
- CNS
- Bradycardia/hypotension
How long is amiodarone's half-life? - ANSWER 30-60 days. Even if we stopped
amiodarone a few days, we still need to keep that in mind about possible DDIs
, Amiodarone DDIs - ANSWER - Digoxin
- Warfarin (reduce warfarin dose by 33-50%)
- Sofosbuvir (increase bradycardiac effect of amio)
- Harvoni (combo w/ sofosbuvir)
- fluoroquinolones, macrolides, azoles (qt prolongation)
If making Amiodarone store in...? - ANSWER Using it in less than 2 hours -> store in
PVC
Using it in greater than 2 hours -> store in glass (stable for 24 hours)
How dose dronedarone compare with amiodarone? Side effects? - ANSWER -
Dronedarone only PO
- Only for AFib/Aflutter
- no pulmonary fibrosis, corneal deposits, hypo/hyperthyroidism
- SE: Liver damage, heart failure (do not give in patients with symptomatic HF)
Dronedarone dose - ANSWER 400 mg PO BID w/ food. Avoid Grape fruit juice
When starting sotalol... Monitoring parameters? - ANSWER Start in hospital with
EKG monitoring for 3 days.
Monitor renal function.
Dose adjust Crcl <60
CI: Crcl <40
PO/IV
Dofetilide class. Used for? When starting...? - ANSWER Class 3.
Used for Afib/Aflutter
Start in hospital with EKG monitoring for 3 days
Monitor renal fxn
Dose adjust CrCl <60
CI: CrCl <20
PO
DOC for PSVT? How to administer? - ANSWER Adenosine
IV
Give 6 mg IV push (have to be push). Can repeat with 12 mg IV push
(reboots the heart)
DOC for torsades de pointes - ANSWER Magnesium IV
Ventricular fibrillation/pulseless VT Alogrithm - ANSWER Shock -> medication ->
shock -> medication
Meds used:
- Epinephrine 1 mg IV q3-5 min (first)
- Amiodarone
LD: 300 mg IV bolus; may repeat
MD: 150 mg q3-5 min
