Correlate Review Flashcards
Sildenafil (viagra) and antibiotics
Viagra is metabolized by CYP450 so use the smallest dose possible when using with other 3A4 drugs (macrolides except azithro and azoles).
Step 4 Asthma Treatment
Medium Dose ICs and LABA or montelukast
Step 2 Asthma Treatment
Low Dose ICS or cromolyn or montelukast
H. Pylori Treatment
Clarithromycin (caution with statins). PPIs can cause false positives.
Betaxolol
Second Gen Beta-Blocker (Cardioselective)
First Gen Beta-Blocker (Non-Cardioselective) Side Effects
Bronchospasm, worsen CHF, exercise intolerance, depression, fatigue, raise lipids, imparied glucose tolerance, decreased libido. Avoid abrupt withdrawal.
Intermittent Asthma
less than or equal to 2 times a week. No nighttime awakenings.
Parkinson’s and DA
Smooth movement. Substantia nigra to basal ganglia .
Furosemide and metoprolol and lisinopril
All lower BP (hypotension). Decreased renal blood flow with increase digoxin levels.
Stage 1 HTN
140-159/90-99
Fexofenadine (Allegra)
Second Generation H1 blocker. Longer lasting and non sedating. Approved for pilots.
Step 1 Asthma Treatment
SABA PRN
Prochlorperazine (compazine)
Anti-emetic. Has anticholinergic effects, CNS depression EPS.
Ranitidine (Zantac)
H2 blocker. Used as adjunct for uticaria.
Citalopram (celexa) Side Effects
Insomnia, somnolence, nausea, dry mouth, sexual dysfunction.
Velafaxine (Effexor) indications
SNRI. MDD, GAD, SAD, panic.
Aliskren (tekturna) Side Effects
Hyperkalemia, renal impairment, hypersensitivity. Contraindicated in pregnancy.
Diphenhydramine (Benadryl)
(Nytol, Sominex). First Generation H1 blocker.
African Americans and HTN
CCB or thiazide
Salmerterol/fluticasone
LABA + ICS. Control. Thrush and hoarseness.
Labetolol
Combined Alpha and Beta antagonist
Meclizine (Antivert)
First Generation H1 blocker.
Hydrocodone Schedule
Schedule II
IBD Treatment
Newly diagnosed cases should get a tapering dose of prednisone. adalimumab (humira), infliximab (remicade).
Drugs that potentiate Digoxin
Diuretics (except spironolactone), Propranolol, amiodarone, Antibiotics (erythromycin and tetracycline), IV calcium, CCB, quinidine, thyroid hormone.
Hyperthyroidism and HTN
BB
Norepinephrine in the cerebral cortex
Arousal and attention
Nociceptive Pain Treatment
NSAIDs, Tramadol, opiates, muslce relaxants, PT
Step 6 Asthma Treatment
Add oral Glucocorticoid.
Metoprolol
Second Gen Beta-Blocker (Cardioselective)
Spironolactone
potassium sparing diuretic and aldosterone antagonsit (decreases number of sodium channels).
Norepinephrine in the hypothalamus
Appetite. Increased NE suppresses appetite.
Stage C COPD Treatment
ICS + LABA or LAMA
Morphine Schedule
Schedule II
Acebutolol
Second Gen Beta-Blocker (Cardioselective)
Norepinephrine targets
Limbic lobe, Cerebral Cortex and hypothalamus.
Contraindicated in Depression
BB, central alpha blocker
Stage D COPD Treatment
ICS+ LABA + LAMA
Metoclopramide (reglan)
Prokinetic. Risk of EPS and tardive. SE: cramping and diarrhea.
Norepinephrine in the limbic lobe
Mood. Increased/decreased NE release is associated with bipolar disorder.
Prazosin (“-zosins”) Side Effects
First dose phenomenon (postural hypotension). fatigue, weakness, nasal congestion and HA. Beneficiall effect on lipids and BPH.
Bisacodyl (dulcolac)
Stimulant laxative
Essential tremor and HTN
BB (nonselctive)
Timolol
First Gen Beta-Blocker. Non-Cardioselective.
Citalopram (celexa) Indications
SSRI. MDD only
CKD and HTN
ACEI/ARB
Clorpheniramine (Chlor-trimeton)
First Generation H1 blocker.
Risks of PPIs
Malabsorption (ca, mg, iron, b12), osteoporosis, respiratory/enteric infections, CKD.
Serotonin in the cerebral cortex
Sensation and perception
SSRI/SNRI Black Box Warning
Incrased suicidal thinking in children and young adults (monitor closely during first 1-2 months). Trip a manic episode if underlying bipolar disorder. Must taper down gradually.
Dicyclomine
Anti-spasmodic used for IBS. Anticholinergic properties. Caution in elderly.
Combined Alpha and Beta antagonist Side effects
Orthostatic hypotension, bronchospasm. Really only used in HTN emergencies or after an MI.
NSAIDS and Renal Function
NSAIDS cause vasoconstriction of the afferent arterioles
Sertraline (Zoloft) Indications
SSRI. MDD, OCD, Panic, PTSD, SAD, nocturnal eating, PMDD
Norepinephrine production site
Brianstem
Propranolol
First Gen Beta-Blocker. Non-Cardioselective.
Contraindicated in gout
diuretics
Neuropathic Pain Treatment
Neurontin (gabapentin), Lyrica (pregabalin), Elavil (amitriptyline), Cymbalta (duloxetine), lidoderm patch, spinal cord stimulator, ESI.
Magnesium antacids Side effects
Diarrhea
Antihistamines and Breast Feeding
Loratadine (Claritin) and Cetirizine (Zyrtec)
Contraindicated in second or third degree block
BB, verampamil/diltiazem
Sodium-bicard Side effects
Fluid retention (caution in CHF)
Pre-HTN
120-139/80-89
Chronic Stable Angina
BB
Clonidine and Methyldopa MOA
Central acting alpha agonist (alpha2). Reduces SNS vasoconstriction and vascular resistance.
Statins and antibiotics
Risk of elevated transaminase levels, myopathy, rhabdomyolysis and ARF. Contraindicated with Erythromycin, itraconazole, niacin and gemfibrozil.
Desvenlafaxine (pristiq) Indications
SNRI. MDD only.
Stage 2 HTN
greater than 160/100
Fluoxetine (Prozac) Side Effects
Insomnia (take in am), HA, Nervousness, decreased libido, diarrhea, anorexia. Longest half life with the broadest effects, least specific for 5HT.
Oral Gluccocotricoids and asthma
Prednisone. Used for acute exacerbations. SE: anxiety, agitation, insomnia, increased appetite.
ARB (“-sartans”) MOA
Blocks the effect of angiotensin II on the tissue.
Urticaria treatment
Second generation antihistamines with an H2 blocker as adjunct. Consider adding a tapering course of steroids.
Opiates and ESRD
DOC is fentanyl. Avoid morphine, demerol, vicodin, codeine.
Docusate (colace)
Stool Softener. Safe in pregnancy.
Nifedipine (“-pines”) MOA
CCB. Dihydropyridines that cause arteriolar smooth muscle relaxation and decrease peripheral resistance. Potent vasodilators.
Olopatadine (patanol)
Antihistamine eye drops. Mast cell stabilizer.
A-Fib and HTN
BB, verapamil/diltiazem
Escitalopram (lesapro) Side Effects
Insomnia, somnolence, nausea, ejaculation disorders.
Buproprion (wellbutrin) Side Effects
Insomnia, HA, nausea, weight loss, dry mouth, tachycardia, dizziness. Less Sexual side effects compared to SSRIs. Avoid in patients with seizure disorder (lowers the seizure threshold) and anorexia.
ARB (“-sartans”) Side Effects
hypotension and hyperkalemia. Contraindicated in pregnancy.
Aliskren (tekturna) MOA
Direct renin inhibitor. Decreases plasma renin activity.
Antihistamine Side Effects
Anticholinergic side effects (First generation more so than second). Sedation (First gen). Impotence, urinary hesitancy, sedation, confusion, weight gain, hypersensitivity, prolonged QT (arrhythmias).
Montelukast (singulair)
Leukotriene receptor antagonist. SE: URIs, HA, abdominal pain, mood changes.
Thiazide MOA
Block sodium reabsorption in the distal convoluted tubule via Na/Cl transporter.
Contraindicated in Liver Disease
Methyldopa
Levaquin Renal dosing (CAP)
Renal dosing is based on the creatinine clearance. Monitor serum levels of the drug.
Step 3 Asthma Treatment
Medium Dose ICS
Sertraline (Zoloft) Side Effects
Insomnia, HA, Dizziness, fatigue, Decreased libido, somnolence, nausea, diarrhea, anorexia, dry mouth
Antiepileptics and antibiotics
such as phenytoin, carbamazepine and phenobarbital. Effects are ptentiated by inhibitors of CYP450: Macrolides (EXCEPT Azithromycin), and the azoles.
Serotonin in the hypothalamus
Appetite and sleep
Second Gen Beta-Blocker (Cardioselective) Side Effects
Less side effects than first generation. Still raise lipids. Avoid abrupt withdrawal (MI, rebound HTN, bronchoconstriction).
Infective Esophagitis
Fluconazole. Beware of interaction with statins (rhabdo and myopathy).
Codeine Schedule
Schedule II
Buproprion (wellbutrin) Indications
DA reuptake inhibitor. MDD, SAD and smoking cessation. Can be used in combination with SSRIs.
MDD treatment plan
Antidepressants (SSRIs are first line), +/- psychotherapy, follow up in 1-2 weeks (SE profile), instructions on when to contact provider, crisis line number, community resources. Refer if PHQ-9 is greater than 16.
Nadolol
First Gen Beta-Blocker. Non-Cardioselective.
Dopamine Production to Targets
Substantia nigra to basal ganglia Ventral tegmentum to nucleus accumbens/frontal cortex
SSRI/SNRI Patient Education
Takes 2-8 weeks to have effect. Side effects usually occur during the first few days and resolve in a week. Do not stop abruptly (need taper).
Severe asthma
Throughout the day. Night time awakenings weekly.
Ondansetron (zofran)
Anti-emetic. QT prolongation and risk of serotonin syndrome.
Misoprostol (cytotc)
Prevents ulceration induced by NSAIDs. Contraindicated in pregnancy.
Contraindicated in Renovascular Disease
ACEI/ARB, renin inhibitor
OCPs and antibiotics
Insufficient evidence but still encouraged to use an alternative form of birth control.
ACEI (“-prils”) Side Effects
Dry cough, orthostatic hypotension, hyperkalemia, angioedema, elevated creatinine, rash. Contraindicated in Pregnancy.
Angina and HTN
BB or CCB
Desvenlafaxine (pristiq) Side Effects
Same as SSRIs with adrenergic effects. Insomnia, HA, nervousness, diaphoresis, constipation/diarrhea, dizziness, increased BP, ejaculation/orgasm difficulties.
Parozetine (Paxil) Side Effects
Most weight gain of all SSRIs (especially in combo with antipsychotic). Insomnia, HA, Dizziness, fatigue, Decreased libido, somnolence, nausea, diarrhea, anorexia, dry mouth
Mild Asthma
more than twice a week
Migraines and HTN
BB
Contraindicated in hyponatremia
thiazides
Stage A COPD Treatment
SABA or SAMA PRN
Mitrazapine (Remeron) Side Effects
Somnolence, increased appetite, weight gain, increased cholesterol, constipation, dry mouth. Less sexual side effects than SSRIs.
Dilitiazem MOA
Middle ground between the dipines and verapamil.
Tylenol with Codeine Schedule
Schedule III
Oxymorphone Schedule
Schedule II
Contraindicated in Pregnancy
ACEI/ARB, renin inhibitor
Verapamil and Diltiazem Indications
Arrhythmias, variant angina, long term angina and a-fib.
Famotidine (Pepcid)
H2 blocker. Used as adjunct for uticaria.
Promethazine (Phenergan)
First Generation H1 blocker.
ACEI (“-prils”) MOA
Block the enzyme to stop the formation of angiotensin II. Causes venous dilation (decreases resistance and BP)
Anticholinergics and COPD
Relief. Long acting: Tiotripium (spiriva). Short acting: Ipatripium (atrovent). Dry mouth, cough, HA, nausea, blurred vision, dizziness.
Pindolol
First Gen Beta-Blocker. Non-Cardioselective.
ACEI/ARBs and Renal Function
Vasodilate the efferent arterioles. Increase the risk or hyperkalemia with renal failure.
Loops Side Effects
HYPOKALEMIA.
Duloxetine (cymbalta) Side Effects
Insomnia, somnolence HA, Dizziness, fatigue, nausea, anorexia, dry mouth, contstipation/diarrhea, sexual dysfunction. Doesn’t increase BP like other SNRIs. Contraindicated in liver disease.
Scabies Antihistamine Choice
Hydroxyzine (Atarax) stops the itching and helps with sleep. Treatment also includes permethrin cream 5%.
Drugs that Cause Constipation
Anti-psychotics, aluminum hydroxide, dicyclomine (bentyl), antidepressants, CCBs, calcium, opiods.
Second Gen Beta-Blocker (Cardioselective) Indications
Good to treat HTN if previous MI, Stable CHF, angina or A-fib
Nociceptive Pain
Injury to tissues. Somatic or visceral.
Ketotifen (zatidor)
Antihistamine eye drops. Mast cell stabilizer.
Potassium sparing Diuretics Side Effects
Don’t combine with ACEI/ARBs due to risk of hyperkalemia. Not great diuretics, may be combined with loops to balance potassium effects.
Albuterol
Short acting beta agonist. SE: tachycardia, tremor, nervousness, dizziness.
Triamterene
potassium sparing diuretic. Inhibits Na/K exchanger in the collecting tubule independent of aldosterone.
Magnesium Hydroxide
Osmotic Laxative
NSAIDS and ACEI/ARB and Diuretics
BAD NEWS. Increased risk of AKI.
H2 blockers Indications
Quick onset for on-demand relief. Most effective at decreasing night time acid production.
Azelastine (Optivar)
Antihistamine eye drops
Mitrazapine (Remeron) Indications
Presynaptic alpha 2 antagonist (enhances noradrenergic and serotonergic transmission). Often used in elderly patients with depression, sleep, and increased appetite.
Verapamil and Diltiazem Side Effects
Diarrhea (verapamil). Bradycardia, SA node dysfunction, heart block.
BPH and HTN
Alpha blocker (zosins)
Moderate asthma
Daily
Thiazide Side Effects
hypokalemia, hyperuricemia, hyponatremia, hypercalcemia, hypertriglyceridemia, hypercholesteremia.
Post MI and HTN
ACEI/ARB, BB, Adlo agonist
Bisoprolol
Second Gen Beta-Blocker (Cardioselective)
Loratadine (Claritin)
Second Generation H1 blocker. Longer lasting and non sedating. Approved for pilots and breast feeding (category B).
Cetririzine (Zyrtec)
Second Generation H1 blocker. Longer lasting and non sedating (Most sedation of second gen). Ok for breast feeding (category B).
Loop Diuretics
Furosemide, torsemide, bumetanide
Methadone Schedule
Schedule II
Serotonin in the Limbic Lobe
Mood. Decreased serotonin release is correlated to mood disorders and OCD
Acute COPD exacerbation treatment
Albuterol/ipratropium (duoned) SVN, intensify SABA +/- SAMA, Oral steroids, Antibiotics (macrolide or fluoroquinolone) if 2/3 of the cardinal symptoms (dyspnea, sputum volume, purulent sputum).
MDD Treatment length
at least 4-9 months after determining therapeutic dose. Risk of reoccurence should have 1-3 years of treatment. Multiple episodes or comorbid disorders will have indefinite treatment.
Carvediolol
Combined Alpha and Beta antagonist
Fluoxetine (Prozac) Indications
SSRI. MDD, OCD, Bulemia, panic, PMDD, depression with bipolar disorder (combined with olanzapine (zyprexa)).
Diluadid Schedule
Schedule II
Addiction pathaway
Pleasure and reward. DA from Ventral tegmentum to nucleus accumbens/frontal cortex.
Metformin and Renal Function
Contraindicated in ARF due to the high risk of lactic acidosis.
Clonidine and Methyldopa Side Effects
Orthostatic hypotension, sedation, drowsiness, avoid abrupt withdrawal (rebound HTN). Used only for refractory HTN.
Verapamil MOA
CCB. Diphenylalkylamines. Less vasodilation. Has negative ionotripic and chronotropic properties.
Azelastine + fluticasone (Dymista)
Antihistamine nasal spray
Antihistamine Contraindications
BPH and glaucoma (closed angle).
Serotonin Targets
Limbic Lobe, Hypothalamus, cerebral cortex.
Parozetine (Paxil) Indications
SSRI. MDD, Panic, OCD, GAD, PTSD, SAD, PMDD
Step 5 Asthma Treatment
High Dose ICS and LABA or montelukast
Thiazide Diuretics
HCTZ, Chlorothiazide, Metolazone. First line choice for african americans.
Duloxetine (cymbalta) Indications
SNRI. MDD. neuropathic pain (DM) and fibrimyalgia.
Anaphylaxis Treatment
Epinephrine! Diphenhydramine (benadryl). IM glucocorticoid (dexamethasone). Famotidine (pepcid).
Amiloride
potassium sparing diuretic. Inhibits Na/K exchanger in the collecting tubule independent of aldosterone.
Osteoporosis and HTN
Thiazides
Serotonin Production Site
Brainstem
Contraindicated in Angioedema
ACEI
Cimetidine
H2 blocker. CYP450 and antiandrogen effects.
Escitalopram (lesapro) Indications
SSRI. MDD and GAD.
HTN Treatment Goals
140/90 unless older than 60 (without CKD or DM) then 150-90.
Ceftriaxone renal dosing (CAP)
No adjustment needed
Nifedipine (“-pines”) Side Effects
reflex tachycardia, HA, flushing (short term). Edema. Less affect on contractility.
Systolic Failure and HTN
ACEI/ARB, BB, Diuretic, aldosterone agonists.
Stage B COPD Treatment
LAMA or LABA
Atenolol
Second Gen Beta-Blocker (Cardioselective)
PPI indications
Reflex esophagitus. Takes 3-4 days to work. Take every morning before breakfast. Caution of rebound effect.
Ocycodone Schedule
ScheduleII
PUD Treatment
PPI, amoxicillin and clarithromycin. Can add bismuth subsalicylate.
Fentanyl Schedule
Schedule II
Azelastine (Astelin)
Antihistamine nasal spray
Digoxin and metoprolol interaction
Both cause bradycardia which can lead to an AV block
Digoxin and Furosemide Interaction
Loop diuretics can cause hypokalemia which increases digoxin toxicity.
Velafaxine (Effexor) Side Effects
Same as SSRIs with adrenergic effects. Insomnia, HA, nervousness, diaphoresis, constipation/diarrhea, dizziness, increased BP, ejaculation/orgasm difficulties. Take with food. Must be tapered (impending sense of doom).
Contraindicated in hyperkalemia
Aldo antagonists, ACEI/ARB, renin inhibitor
DOC for Reflux esophagitus
PPIs (prazoles).
Vasospastic Angina DOC
CCB
Contraindicated in Bronchospastic Disease
BB
Naphazoling (naphcon A)
Antihistamine eye drops
Fluticasone (flovent)
low dose ICS
Promethazine (phenergan)
Anti-emetic. SE: Sedation, CNS/Respiratory depression. Contraindicated in children less than 2 due to respiratory depression.
Soma Schedule
Schedule IV
MDD Screening
PHQ-9. 5-9 (minor), 10-14 (moderate), 15-19 (mod-severe), 20 or more (severe).
Warfarin and Antibiotics
Ciprofloxacin, macrolides (erythromycin, azithromycin), metronidazole, bactrim are contraindicated. Almost all antibiotics can potentiate warfarin but inhibiting the intestinal flora that produces vitamin K.
Azithromycin Renal dosing (CAP)
No adjustment needed
Dimenhydrinate (Dramamine)
First Generation H1 blocker.
Loop MOA
Blocks Na/K/2Cl transporters in the thick ascending limb.
Fluoroquinolones (floxacins)
Don’t combine with cations (ca, mg, al, iron). Will reduce the absorption of fluoroquinolones. At least take 2-4 hours apart.
MDD DSM-V Criteria
Five or more symptoms (SIGECAPS) for at least 2 weeks. At least one symptom must be depressed mood or lost of interest/pleasure.
MDD Presentation
SIGECAPS. Sleep, Interest (lack), Guilt, Energy (decreased), Concentration (indecisiveness), Appetite, Psychomotor (agitation or retardation), Suicidal ideation.
Poison Ivy Treatment
Steroid cream (triamcinolone) and Second gen antihistamine (zyrtec). Steroid taper if not improving.
Raynaud’s and HTN
CCB (dipines)
Penbutolol
First Gen Beta-Blocker. Non-Cardioselective.
Prazosin (“-zosins”) MOA
Alpha antagonist. Reduces NE constriction leading to vasodialtion.
Hydroxyzine (Atarax)
(vistaril) First Generation H1 blocker. Extremely sedating.