Clinical Crap Part 2 Flashcards
How long until HIV becomes detectable?
Up to 3-6 months
How long after exposure should take-home antiboy screening test be used?
3 months
What requirements to confirm HIV?
Antigen test + Antibody test
Initial treatment regimen for HIV
Integrase inhibtor + 2 NRTIs (backbone)
Biktarvy
bictegravir + emtricitabine + TAF
Triumeq
dolutegravir + abacavir + lamivudine
Tivicay
Dolutegravir
Truvada
Emtricitabine + TDF
Descovy
Emtricitabine + TAF
Stribild
Elvitegravir + TDF + Emtricitabine + cobicistat
Genvoya
Elvitegravir + cobicistat + TAF + Emtricitabine
Isentress
Raltegravir
Preferred initial treatment for pregnancy
2 NRTIs + PI
What are the NRTIs
Lamivudine Emtricitabine Abacavir TDF/TAF Zidovudine Stavudine Didanosine
BBW of NRTIs
Hepatomegaly w/ steatosis; lactic acidosis
Abacavir ADE
HSR with HLA-B*5701
Lamivudine ADE
HA
N/V/D
Emtricitabine ADEs
N/V/D Rash Dizziness HA Insomnia Hyperpigmentation
TDF/TAF
Osteoporosis, renal syndrome/Fanconi syndrome
TAF has less
Zidovudine
Macrocytic anemia
Stavudine
Peripheral neuropathy, lipoatrophy, hyperbilirubinemia
Didanosine
Pancreatitis, peripheral neuropathy, increased amylase, pruritus/rash
Which HIV drug classes have CYP interactions?
NOT integrase inhibitors
NNRTIs = CYP inducers
PIs = CYP inhibitors
Viread
TDF
Epivir
Lamivudine
NNRTI class ADEs
Rash, hepatotoxicity
CYP450 inducers
Efavirenz ADEs
QT prolongation, psychiatric/CNS symptoms, rash
Rilpivirine ADEs
depression/mood changes, insomnia
CI with strong CYP3A4 inducers
Nevirapine ADEs
hepatotoxicity, SJS/TEN
Nevirapine requires 14-day lead-in period (worst rash)
Which NNRTI needs to be with in acidic environment?
Rilpivirine (with food and NO H2RAs/PPIs)
Protease inhibitors ending
-navir
Protease inhibitors need boosted with what?
Ritonavir or cobicistat
ADEs of PI class
hepatotoxicity metabolic abnormalities increased CVD risk (EKG changes) GI upset (with food) bleeding rash
Darunavir counseling
Swallow whole
Sulfa allergy
Atazanavir ADEs
Nephrolithiasis, increased bilirubin, myalgia, depression
Caution with acid suppressants
Fosamprenavir ADEs
Caution with sulfa
NO FOOD
Lopinovir/Ritonovir counseling
42% alcohol
Nelfinavir special thing?
No boosting
Ritonavir/cobicistat need to be with or without food?
WITH
Class effects of integrase inhibitors?
increased CPK, HA, insomnia
Interaction with integrase?
Cations (separate by 2 hours)
Dolutegravir ADE
increased SCr
Raltegravir ADE
myopthay/rhabodymyolysis
Miraviroc MOA and ADE
CCR5 antagonist
Hepatotoxicity
Enfuviritide MOA and ADE
Fusion inhibitor
Local injection site reactions
Ibalizumab MOA and ADE
CD4directed post-attachment HIV-1 inhibitor
IV only
Selzentry
Miraviroc
Which class causes diarrhea?
PI
PrEP?
Truvada and testing every 3 months
PEP?
Truvada + raltegravir/dolutegravir - within 72 hours for 28 days
When to refer to doctor for GERD?
2 weeks of OTC
Painful swallowing
Frequent N/V
Dysphagia
How long is PPI treatment course (from doc)?
8 weeks
What antacid type is preferred in pregnancy?
Calcium
Who is at risk of confusion from H2RAs?
Elderly, ill, renally impaired (CrCl <50)
Which H2RAs are availablea s injection?
Ranitidine and famotidine
ADEs of cimetidine?
Gynecomastia, impotence, drug interactions
do not use
ADEs of PPIs
C dif, osteoporosis, hypomagnesemia, pneumonia
PPI drug interaction
CYP2C19 inhibitors
Which PPIs available IV?
Pantoprazole and esomeprazole
Which PPIs can be taken without regard to meals?
Dexlansoprazole
Pantoprazole
Pepcid
Famotidine
Zantac
ranitidine
Prilosec
omeprazole
Protonix
pantoprazole
Dexilant
dexlansoprazole
Prevacid
lansoprazole
Regland
metoclopramide
What is metoclopramide used for?
Gastroparesis (QID before meals)
Metoclopramide ADEs
Tardive dyskinesia, EPS, drowsiness; avoid in PD and decrease dose with renal impairment
What drugs are bound by antacids (5)?
INSTIs Steroids Mycophenolate Sotalol isoniazid
How to diagnose H Pylori
Urea breath test
First-line therapy for H Pylori?
Quadruple therapy -
Bismuth + metronidazole + TC + PPI BID
Length of h pylori treatment?
10-14 days
Alternative H pylori treatment?
Amoxicillin + clarithromycn + PPI BID x 14 days
or replace amoxicillin with metronidazole
Prevpac
Amoxicillin + clarithromycin + lansoprazole
Pylera
Bismuth + metronidazole + tetracycline
Which NSAIDs are COX-2 selective?
Meloxicam Etodolac Nabumetone Diclofenac Celecoxib
Vimovo
Naproxen/esomeprazole
Yosprala
Asa/omeprazole
Arthrotec
Diclofenac/misoprostol
Misoprostol MOA & ADEs
PGE analog
Diarrhea, abd pain, abortificant
Sucralfate ADE
constipation
ISO air quality requirements in PEC BUffer room ante room SCA
PEC: 5
Buffer room: 7
Ante room: 8 (7 if connected to negative pressure buffer)
SCA: none (unclassified air)
How long BUD in SCA?
12 hours
How often to clean PEC?
every 30 minutes
how often to perform gloved fingertip test? And how many samples?
3 samples on TSA plates
annually
How often to perform media fill test?
Annually
What do you use to clean?
Isopropyl alcohol 70%
How often to clean walls, ceilings, shelves?
Monthly
Bubble-point test?
Test filter integrity
How to sterilize glassware and utensils?
Dry-heat oven sterilization
What to use to clean hood?
- germicidal detergent
2. 70% IPA
Risk category of batch
Moderate
Risk category with 3+ ingredients
Moderate
Risk category with non-sterile ingredients
high
Risk categoy of TPN
moderate
BUD of low/medium/high risk components
Low: 14 days in fridge or 48h
Moderate: 30 hours not in fridge
High: 3 dyas in fridge
What is density factor used for?
Suppository molds
How is COPD diagnosed?
Fev1/FVC <0.70
What are used for symptom assessment?
MMRC and CAT
what is preferred treatment for copd?
Bronchodilators (laba/lama)
NOT ICS
Roflumilast MOA
PDE4 inhibitor (increases cAMP)
ADEs of roflumilast
Diarrhea, weight loss, CI with severe liver impairment
Treatment of exacerbation
azithromycn x 5-10 days
Combivent
Ipratropium/albuterol
Atrovent
Ipratropium
Spiriva
Tiotropium
Which Spiriva is DPI and which is MDI?
HandiHaler = DPI Respimat = MDI
Arcapta
Indacaterol
Arformoterol
Formoterol Ar isomer
LAMA ADEs
dry mouth
Inhaler counseling: Respimat
TOP Turn bottom Open top Push dose button Breathe in
Inhaler counseling: Handihaler
Inhale two times to get full dose
Inhaler counseling: Tudorza Pressair
Press button and dose window should turn green, then red after dose inhaled
Pharmacogenomic testing: abacavir
HLAB*5701
HSR
Pharmacogenomic testing:
Azathiorpine
TPMT
Myelosppression
Pharmacogenomic testing:
Carbamazepine
HLAB*1502
SJS/TEN
Pharmacogenomic testing:
Cetuximab
KRAS negative only
Pharmacogenomic testing:
Panitumumab
TPMP
myelosuppression
Pharmacogenomic testing:
trastuzumab/pertuzumab
HER2
Pharmacogenomic testing:
Capecitabine/5-FU
DPD deficiency
Diarrhea/toxicity
Pharmacogenomic testing:
Allopurinol
HLAB*5801
SJS
Pharmacogenomic testing:
Oxcarbazepine, phenytoin
HLAB*1502
Pharmacogenomic testing:
Clopidogrel
CYP2C19 2/3 have faster metabolism
Pharmacogenomic testing:
Codeine
CYP2D6 (UR have increased toxicity)
Pharmacogenomic testing:
Warfarin
CYP2C9 2/3, VKORC1
Increased bleeding risk
Micro:
Bacteroides fragilis
Anaerobic Gram negative
H flu
gram negative rod
enteric rods
Serratia enterobacter e coli klebsiella (SEEK) citrobacter proteus
Atypical bacteria
legionella
chlamydia
mycoplasma
mycobacterium TB
Which drug classes have synergy?
beta-lactams and aminoglycosides for G+
Which drugs are lipophilic (5)
FQ macrolids tetracyclines rifampin linezolid (good for atypicals, great bioavailability - 1:1)
ROA of PCN G benzathine
IM only
Which beta lactam is a vesicant?
nafcillin
Which bugs do cephalosporins NOT cover
enterococcus
Atypicals
Which cephalosporins cover anaerobes?
Cefotetan
Cefoxitin
Ceftriaxone CI
in neonates- biliary sludging
Cefotetan ADE
Disulfiram-like reaction
Which carbapenem does not cover pseudomonas?
Ertapenem
Which beta lactam okay in PCN alergy?
Aztreonam
Aztreonam spectrum?
Only gram-negatives
Which cephalosporin covers pseudomonas?
Ceftazidime
What beta-lactams cover enterococci?
PCN, amoxicillin, carbapenems
Aminoglycoside TDM goals
Trough <2
Peak 5-10
(for gram-negative)
What weight to dose aminoglcyoside?
IBW/AdjBW
ADE of aminoglycoside?
Neuromuscular blockade
FQ moa
Topoisomerase/gyrase inhibitor
Which FQ are respiratory?
levo, moxi, gemi
which FQ cover pseudomonas?
cipro, levo
Which FQ is NOT renally adjusted?
Moxifloxacin (not used for UTIs)
Which FQ covers MRSA?
Delafloxacin
ADEs of FQs?
Peripheral neuropathy
Seizures
BG (high or low)
Psychiatric disturbance
Macrolide MOA
50s ribosomal subunit inhibitor
ADEs of all macrolides
QT prolongation, hepatotoxicity
Which macrolide has most drug interactions
Clarithromycin
Which macrolide causes most GI upset
Erythromycin
Biaxin
Clarithromycin
Solodyn
Minocycline
Vibramycin
Doxycycline
Tetracycline MOA
30s ribosomal subunit
Dosing of Bactrim based on which component?
TMP
ADEs of Bactrim
hyperkalemia anemia (G6PD) SJS/TEN photosensitivity crystalluria increased INR with warfarin
Vancomycin MOA
blocks d-ala d-ala in cell wall synthesis
Goal vanc trough for serious infection
15-20
Daptomycin ADEs
Mytopathy/rhabdomyolysis
Falsely elevates INR
Linezolid ADEs
Thrombocytopenia
Optic neuropathy
Serotonin syndrome (no MOAIs)
Metronidazole CI
Pregnancy
Clindamycin - when to use?
use D-test for S aureus to see if R to erythromycin
Chloramphenicol ADEs
Gray Syndrome (circulatory collapse)
Polymyxin ADE
Nephrotoxicity
neurotoxicity
neuromuscular blockade
Tigecycline - why is it last line?
Increased risk of death
Quinupristin/dalfopristin ades
arthralgia, infusion reaction, hyperbili
Fidaxomicin use
c dif
Rifaximin use
E coli
Fosfomycin use
single dose for UTI
Nitrofurantoin ADEs
Not if CrCl <60
G6PD deficiency (hemolytc anemia)
brown urine
Which oral solution should NOT be refrigerated
Cefdinir (and non-beta lactams)
Which antibiotics need protection from light?
Doxycycline
Micafungin
What are the resistant candida strains?
Glubrata
Krusei
Which fungal infections are mold?
aspergillus and zygomycetes
Amphotericin B ADEs
Infusion reaction (fever, chills, HA, malaise, rigors) - premedicate!
Low K
Low Mg
Nephrotoxicity
What is the lipid formulation of amphotericin?
Ambisome
Amphotericin MOA
holes in cell membranes by binding to ergosterol
Ancobon
Flucytosin
Flucytosine MOA
Converted to FU inside cells
Flucytosine ADEs
Myelosuppression
Azole mechanism
Decrease ergosterol synthesis (no cell membrane)
Class effects of azoles
QT prolongation and increased LFTs
Which azole penetrates CNS?
fluconazole
Which azole is contraindicated in HF?
Itraconazole
Which azole covers aspergillus and resistant candidas?
Voriconazole
ADEs of voriconazole
Visual, increased SCr, hallucination
Photosensitivity
Avoid IV in CrCl <50
Which azoles need acidic environment for absorption?
itraconazole and ketoconazole
Which azole does not have qt prolongation?
isavuconazonium
Echinocandins spectrum
resistnat candidas, aspergillosis
ADEs of echinocandins
Histamin-mediated symptoms (rash, swelling, decreased BP)
Cancidas
caspofungin
Mycamine
micafungin
Griseofulvin MOA
Binds to keratin precurosrs (good for hair/skin/nails)
Griseofulvan ADEs
photosensitivity, increased LFTs, CI with pregnancy
Terbinafine mechanism
Inhibits squalene epoxidase
Mycelex
Clotrimazole
Nystatin use
thrush
DOC for aspergillus
voriconazole
DOC for candida albicans
Nystatin/fluconazole
DOC for candida glabrata/krusei
echincocandins
DOC for cyptococcus
ampho B/flucytosine
DOC for dermatophytes
itraconazole/terbinafine/fluconazole
nail infections
Nizoral
Ketoconazole
Sporanox
Itraconazole
Vfend
Voriconazoe
Noxafil
Posaconazole
Neuraminidase inhibitors should be taken with __ days of symptom onset
2 days
oseltamivir ade
neuropsychiatric events
zanamavir ade
bronchospasm (inhaled)
Rapivab
Peramavir
Relenza
Zanamavir
Which herpes virus causes oropharyngeal v genital disease?
HSV-1 - oropharyngeal
HSV-2 - genital
What drugs to treat HSV?
valacyclovir
acyclovir
famiciclovir
Herpes simplex treatment
docosanol (abreva)
acyclovir
or systemic treatment
When to use antiviral for genital herpes?
within 1 day of legion
Treatment for genital herpes?
valacyclovir
Invasive HSV treatment
IV acyclovir
Herpes zoster treatment within __ days of treatment and treated for __ days
3 days
7 days
Drugs to treat BPH
- a1 blockers
- 5a reductase inhibitors
- phosphodiesterase-5 inhibitors
Natural product to prevent prostate cancr
Lycopene
a-1 blocker ADEs
Floppy iris syndrome Orthostatic hypotension HA Fatigue Ejaculation
How long do a1 blockers take to work?
4-6 weeks
Which a1 blockers are non-selective?
terazosin and doxazosin
ADE of alfuzosin
QT prolongation
ADE of silodosin
Retrograde ejaculation
5-alpha reductase inhibitors ADEs
Impotence
decreased libido
Ejaculation disfunction
gynecomastia
Avodant
Dutasteride
ProScar
Finasteride
Which PDE5 can be used for BPH
Tadalafil
5-alpha reductase CI
pregnancy
women of child-bearing age
Ketorolac CI
liver failure
more than 5 days of use
Relafen
Nabumetone
Voltaren
Diclofenac
Doans
Magnesium salicylate
ASA ades
dyspepsia, heartburn tinnitus (from salicylates)
Indomethacin ADE
CNS side effects
Which opioids need to be avoided with alcohol (4)
Kadian
Embeda
Zohydro
Nucynta ER
What schedule is codeine in combo with pan meds
CIII
How often is fentanyl patch applied
3 days
Fentanyl brand naems
Sublimaze
Duragesic
Which opioids interact with CYP3A4 inhibitors
oxycodone
hydrocodone
Zohydro
oxycodone ER
Dilaudid
Hydromorphone
Dolophine
Methadone
Demerol
Meperidine
Startng dose of dilaudid (PO and IV)
PO: 2-4mg q4-6h
IV: 0.2-1mg q2-3h
Methadone ADEs
QT prolongation, variable half life
Meperidine ADEs
Not in renal impairment (seizures)
serotonergic
Kadian
Morphine
Which opioid has to be taken on an empty stomach
oxymorphone
Opioid conversions
Morphine: 10(IV) 30(PO)
Hydromorphone 1.5(IV) 7.5(PO)
Which opioids cross-react?
Those with -morph and -cod
What are the PAMORAs?
Methylnaltrexone (Relistor)
Naloxegel (Movantik)
Naldemedine (Symproic)
Lupiprostone (Amitzia)
ADEs of PAMORAs
abdominal pain, N/D
Lupiprostone MOA
Cl channel activator
Centrally acting analgesics MOA
Tramadol and tapentadol
Central mu + NE uptake inhibitor
ADEs of tramadol/tapentadol
serotonin syndrome, seizure risk
tramadol drug interaction
CYP2D6
Tx of opioid abuse
Naloxone, buprenorphine(+naloxone)
How often is Butrans applied
weekly (buprenorphine patch)
What is requirement to prescribe buprenorphine?
DATA 2000 (will have DEA that starts with x)
ADEs of gabapentin
ataxia, edema, weight gain
Pregabalin indications
fibromyalgia
PHN
neuropathic pain
what is treatment for trigeminal neuralgia
carbamazepine
Lioresal
Baclofen
Fexmid
cyclobenzaprine
Zanaflex
tizanidine
Robaxin
Methocarbamol
Soma
carisoprolol
What are the analgesic antispasmodics
Baclofen
Tizanidine
cyclobenzaprine
Cycobenzpaprine ade
dry mouth
serotonergic
tizanidine ade
a-2 agonist
decreaed bp, dry mouth
weakness
carisoprodol ade and schedule
CYP2C19 - would increase if poor metabolizer
CIV
How many patches of lidocaine can be applied at once?
3
Zostrix
Capsaicin
OTC intranasal steroids?
Budesonide (Rhinocort)
Fluticasone (Flonase)
Dose of benadryl
25-50mg q6h
Which symptom do antihistamines not fix?
congestion
Which 2nd gen AHs are preferred in pregnancy?
Cetirizine and loratadine
Cetirizine notes on onset
fast onset and works well but higher sedation
Patanase
Olaptadine (nasal spray)
Afrin
Oxymetazoline (intranasal decongestant)
Max treatment length of Afrin?
3 days
Which allergy/cold meds are contraindicated with MAOIs
Sudafed and phenylephrine
Dextromethorphan
T/F: Intranasal cromolyn is used as needed for mild allergy symptoms
FALSE - not PRN
ADE of ipratropium
Drying
Administration requirements of SL immunotherapy
monitored 30 minutes following the first dose
How much Sudafed dispensed in one day and one month?
3.6g/day
9g/month
Natural products for cold
Zinc, Vit C, echinacea
Robafen
Guaifenasin
Dayquil Cough
Dexromethorphine
Tessalon
Benzonatate
Bromfed DM
brompheniramine, pseudoephedrine, dextromethorphan
How old should kids be with allergy meds?
2 years per FDA
6 years per AAP
Codeine not <12 years
What mechanism calls dextromethorphan abuse potential?
NMDA blocker
How long to rinse after topical/ocular exposure
Topical: 10 minutes
Ocular: 15 minutes
What med is used for bradycardia
Atropine
Dose of activated charcoal
1g/kg within 1 hr
APAP antidoate and mechanism
NAT - increases glutathione in cells
Dosing for NAC
Rumack-Matthew Nomogram
Antiodate: anticholinergics
phyostigmine
Antiodate: Benzos
Flumazenil
Antiodate: Cyanide
Hydroxocobalamin
Drug that can cause cyanide poisoning
nitroprusside (will turn blue)
Antidote: ethanol
Vit b1 (to rpevent Wernicke’s)
antidote: hydrocarbons/petroleum
Induce vomiting
Iron antidote
deferoxamine
Antidote: organophosphates
Atropine
Pralidoxime
(cause cholinergic effects)
Antidote: Neostigmine
Pralidoxime
Antidote: Rocuronium, vecuronium, panacuronium
Neostigmine
Antiodte: salicylates
Sodium bicarbonate
Antidote: Stimulants
benzos
Antidote: Methanole
Fomepizole
CroFab for what snake bites?
Rattle snake and copperhead
Per-op Abx
cefazolin 60 minutes before surgery
Pre-op for colorectal surgery
Amp/sul, cefotetan, cefoxitin
Meningitis treatment (adults and neonates)
ceftriaxone/cefotaxime + vancomycin (amp if >50)
Neonates: ampicillin + cefotaxime
AOM antibiotics
High-dose amoxicillin (80-90mg/kg/day)
*can use cephalosporins if PCN allergic
Pharyngitis bug and treatment
S pyogenes
Amoxicillin or PCN
Sinusitis tx
augmentin
COPD exacerbation
augmentin, azithromycin, doxycycline
Bordetella treatment
azithromycin
clarithromycin
bactrim
CAP outpatient
macrolide/doxycycline
Beta-lactam + macrolide OR FQ (if comorbidities or recent abx0
CAP inpatient
Beta-lactam + (ML or DC)
Respiratory FQ
VAP/HAP
2 antipseudomonals + anti-MRSA
Latent TB test
Rifampin x 4 months
ISN + Rifapentine x 12 weeks
RIPE drugs
rifampin
Isoniazide
Pyrazanamide
Ethambutol
Rifampin ADEs
Increased LFTs, positive Coombs test
Isoniazid ADEs
DILE, positive Coombs test, inhibitor
Pyrazanamide
Hyperuricemia, increased LFTs
Ethambutol
Increased LFTs, optic neuritis, hallucinations, confusion
Endocarditis tx
add gentamicin for prosthetic valve synergy
Dental ppx
Amoxicillin
Spontaneous bacterial peritonitis tx
Ceftriaxone
What drugs cover anaerboes
cefoxitin
metronidazole
ertapenem
Impetigo treatment
Mupirocin
Follliculitis treatment
Cephalexin (probably MSSA)
Non-purulent cellulitis
Cephalexin
Severe purulent SSTI
Cover MRSA
Necrotizing fasciitis
Vanc + beta lactam + another
Diabetic foot infections
BROAD coverage (polymicrobial)
UTI - in urinalysis
WBC and bacteria
Treatment for UTI
Macrobid
Bactrim
Fosfamycin
How long to use azo?
2 days
Treatment for pyelonephritis/complicated UTI
Quinolones
Ceftriaxone
Bactrim
Beta-lactam
Pregnancy UTI tx
Augmentin/cephalosporin
Bactrim/Macrobid
Fosfomycin
Cdif
- Vanc or fidaxomicin
- Switch or pulse vanc
- Pulse vanc or rifaximin, fidaxomicin, transplant
Traveler’s diarrha
Azithromycin
Syphilis (early stage)
PCN G benzathine (2.4 mil IM)
Syphilis (late stage)
PCN G benzathine (2.4 mil IM) x 3 doses
Late >1 year or unknown
Second-line for syphilis
Doxycycline
Neurosyphilis
PCN G aqueous
Bicillin LA
PCN G benzathine
Gonorrhea
ceftriaxone IM + azithromycin x1
Chlamydia
Azithromycin 1gm
Bacterial vaginosis
Metronidazole
Trichomoniasis
Metronidazole
Ricketts/lyme/rocky mountain spotted fever
Doxycycline
ADHD diagnosis
Must have 5 symptoms in 2 settings appearing before 12 years old
Natural product for ADHD
fish oil
What neurotransmitters does stimulant increase?
dopamine and norepinephrine
Which ACE is available IV?
enalaprilat
Which beta blockers are available IV?
Esmolol
labetaolol
propranolol
metoprolol
Which thiazide available IV?
Chlorathiazide
Which CCB available IV?
Nicardipine
Clevidipine
Diltiazem
Verpamil
Phenytoin administration requirements?
- NS only
- Separate 2 hours in NS tube
- Use within 4 hours
- Max 50ml/hr due to arrhythmias
Kcal in lipid?
10%: 1.1kcal/mL
20%: 2kcal/mL
30%: 3kcal/mL
kcal in carb?
3.4kcal/g
kcal in protein?
4kcal/g
Nitrogen in protein?
Divide protein by 6.25g
Nucynta
Tapentadol
What bug do carbapenems not cover?
acinetobacter
they DO cover anaerobes!
Which HIV meds need to be with food? -3
protease inhibitors (except fosamprenavir suspension)
Rilpivirine
Etravirine
Which HIV meds need to be on empty stomach? - 4
Efavirenz (Atripla, Symfi)
Fosamprenavir oral suspension
Didanosine
Indinavir
Which HIV med causes nephrolithiasis?
Ataznavir
Indinavir
What is the equation for mOsm?
mOsm/L = g/L/(MW) * valence * 1000
What is the equation for mEq?
mEq = mg * valence / MW
T/F: Stimulants must be dispensed with MedGuide
True
ADEs of stimulants
CV events Mania episodes in BPD decreased seizure threshold serotnin syndrome Erection >4 hours Loss of appetite Dry Mouth Blurry vision
Methylphenidate starting dose
5mg BID
Ritalin
Methylphenidate IR
Concerta
Methylphenidate ER - OROS tablet (ghost)
Quillichew
Methylphenidate chewable tablet
Quillivant
Methylphenidate oral suspension
Contempla
Methylphenidate ODT
Focalin
Dexmethylprednisolone
Adderall
Dextroamphetamine/amphetamine IR
Mydayis
Dextroamphetamine/amphetamine ER
Daytrana
Methylphenidate patch
Vyvanse
lisdexamfetamine - chewable tablet or opennable capsule
Desoxyn
Methamphetamine
Which stimulant has lowest abuse potential
Lisdexamfetamine (prodrug)
Instructions for Daytrana
Apply 2 hours before needed to HIP; remove after 9 hours
Atomoxetine MOA
Selective NE reuptake inhibitor
ADEs of atomoxetine
hepatotoxicity, hypertension/increase HD
Can atomoxetine be opened?
Nope
Kapvay
Clonidine ER
Can alpha 2 agonists be used with stimulants?
Yes
Endings of drug classes:
NS3/4A protease inhibitor
NS5A replication complex inhibitor
NS5B Polymerase inhibitor
NS3/RA: Previr
NS5A: Asvir
NS5B: Buvir
What drug class used for hepatitis C?
Direct acting antivirals
ADEs of all DAAs
Reactivation of hep B
Bradycardia with amiodarone (especially sofosbuvir)
Harvoni
Sofosbuvir/ledipasvir
Epclusa
Sofosbuvir/velpatasvir
Mavyret
Glecaprevir/pebrentasvir
Which Hep C drug can be used for only 8 weeks?
Mavyret
Which Hep C drugs can be used in all genotypes?
Epclusa and Mavyret
Which Hep C drugs can be used with HIV?
Myravaret, Epclusa, Harvoni
Which Hep C drug cannot be used with estradiol?
Viekira Pak
Which Hep C drug cannot be used with antacids
Epclusa
What drug interaction for all Hep C drugs?
Not with strong Cyp inducers
Is ribavirin monotherapy or combination?
Combination
ADEs of ribavirin
hemolytic anemia
CI with pregnancy
Interferon alfa ADEs
Infusion reaction (pre-treat) myelosuppression, depression, increased LFTs, GI upset
How to treat Hep B
IFN alfa
NRTIs
Vemlidy
Tenofovir AF
Entecavir administration requirement
Empty stomach
What hepatitis drugs need original container?
TAF and Harvoni
Natural product for liver
Misk thistle
What vitamin deficiency for alcoholism
Vitamin B1 - thiamine
How to treat portal HTN/variceal bleeding
- bands
- Octreotide/sandostatin
- Nadolol/propranolol (secondary prevention)
What is hepatic encephalopathy caused by and major symptom?
Caused by build up of ammonia
Symptom is atsterexis
Treatment of hepatic encephalopathy
Lactulose
Rifaxim
Neomycin
Metronidazole
ADE of long-term metronidazole
Neuropathy
ADE of neomycin
Neurotoxicity, GI upset
How to treat ascites
Spironolactone monotherapy
Spironolactone/furosemide in 40:100 ratio
How to reat SBP?
Ceftriaxone
Uric acid goal in gout
<6
Acute gout attack treatment
Steroids (injection in joints)
NSAIDs
Colchicine
Which NSAIDs for gout?
Indomethacin
Celecoxib
Solindac
Colchicine ADEs
neuropathy
myopathy
GI upset
myelosuppression
Colchicine dose
2x 0.6mg dose, then 1x0.6mg
Treatment of chronic gout
- allopurinol/febuxostat
- Probenecid/lesinurad
- Pegloticase
Pegloticase MOA
uricase enzyme converts UA to allantoin
How long should xanthine oxidase inhibitors be used with NSAIDs/colchicine?
first 3-6 months
ADEs of allopurinol/febuxostat
Hepatotoxicity
Rash
Nausea
Thrombus (febuxostat)
ADEs of lesinurad
Increased SCr
Probenecid ADE
G6PD deficiency
Probenecid drug interaction
increases beta-lactam levels
Does probenecid or lesinurad have to be used with XOIs/colchicine?
Probenecid - colchicine
Lesinurad - XOIs
Pegloticase administration requirements
IV - pre-medicate
Should pegloticase be with or without XOIs?
WITHOUT
What drugs can increase UA
ASA Niacin Pyrazinamide Calcineurin inhibitors Chemos
Drug classes used for glaucoma
Beta-blockers Prostaglandin analogs cholinergics Rho Kinase inhibitors Carbonic anhydrase inhibitors alpha-2 agonists
Which beta-blocker is selective for glaucoma?
Betaxolol
Which glaucoma med is preferred if for 1 eye only?
Beta-blocker
What preservative can afffect contact lenses?
BAK
What is zolamide?
Carbonic anhydrase inhibitor
Which glaucoma meds decrease humor production?
Beta-blockers
a2 agonists
carbonic anhydrase inhibitors
(BP)
Which glaucoma med increase humor outflow
Cholinergics
a2 agonists
Rho Kinase inhibitors
Ophthalmic antibiotics
Maxitrol
Polytrim
Ofloxacin
Moxifloxacin
What drugs can cause visual changes?
Amiodarone Linezolid Isotretinoin Vigabatrin Hydroxychloroquine Ablockers digoxin PDE-5 inhibitors voriconazole
What med is used for ear infection?
Ciprodex
What med is used for ear wax blockage?
Debrox - carbamid eperoxide
Ear drop counseling - direction to pull ear
Adults: up and back
Kids: Down and back
Then stay upright for 5 minutes
Cosopt
Timolol/dorzolamide (carbonic anhydrase inhibitor)
Drugs that cause constipation (4)
Sucralfate
Colesevelam
Anticholinergics
Aluminum
Metamucil
Psyllium
Citrucel
Methylcellulose
Stool softener
Docusate
Osmotics - 4
Milk of magnesium (Mg hydroxide) - caution with renal
PEG
Glycerin
Lactulose
Stimulants
Senna
Bisacodyl (Colace)
Lubricants
Mineral oil
Which osmotic has risk of neuropathy
OsmoPrep
What color food colorings to avoid before colonsocopy?
red/blue/purple
Lupiprostone mechanism, use
Chloride channel activator for chonic constipation (IBS, OIC)
Linaclotide mechanism, use
(linzessa)
Guanylate cyclase C agnost - IBS, CIC
Alvimopan MOA, max dose, use
PAMORA
For post-surgery constipation (but not for more than 7 days of opioids)
MAX: 15 doses/day
What drugs can cause diarrhea
Magnesium Colchicine Antineoplastics Metoclopramide Misoprostol Quinidine
Pepto-Bismol ADEs
black tongue/stool
Tinnitus
Reye syndrome
CI: ulcer, coagulopathy
Loperamide age limit and max dose
>2 years old Max 16 (Rx), 8 (OTC) for 2 days
Diphenoxylate/atropine - max dose and age limit
> 13 yo
20mg/day
Dicyclomine MOA and ADE
Anticholinergic/antispasmodic
Toxic mega-colon and paralytic ileus
Bentyl
Eluxadoline MOA and CI
Peripherally-acting Mu agonist
C-IV
