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CPJE 1 > CPJE Pertinent > Flashcards

CPJE Pertinent Flashcards

1
Q

Frovatriptan

A

Frova

  • Class: Triptans
  • Indication/dose: (Migraines) = 2.5mg can repeat in 2hr (max: 7.5mg/day)
  • Side Effects: Somnolence, tinlging/numbness, chest pressure
  • CI: CV disease or uncontrolled HTN
  • Notes: longest t1/2 (26 hours), slow onset
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2
Q

Oxaprozin

A

Daypro Alta

  • Class: NSAID’s
  • Indication/dose: (osteoarthritis/RA pain) = 1200mg (2tabs) daily (max: 1200mg)
  • Side Effects: GI effects (n/v, bleeding, diarrhea), edema, dysuria
  • Notes: DDI = other NSAID’s
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3
Q

Ciclesonide

A

Alvesco

  • Class: Inhaled corticosteroid
    Indication/dose: (Asthma) = 80-320mcg BID
  • Side Effects: Dysphonia, thrush, hoarseness, hyperglycemia, fracture, pneumonia
  • Notes: rinse mouth and throat with warm water to prevent thrush
    [can be used intranasally, age 6+, for allergic rhinits, Omnaris = 2 sprays in each nostril daily, Zetonna = 1 spray in each nostril daily
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4
Q

Galantamine

A

Razadyne/Razadyne ER

  • Class: Acetylcholinesterase inhibitor –> enzyme that breaksdown acetylcholine
  • Indication/dose: (Alzheimer’s) = 4-12mg BID, ER: start 8mg, up to 16-24mg daily
  • Side effects: bradycardia, fainting, GI (n/v/loose stools)
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5
Q

Rabeprazole

A

Aciphex

  • Class: (PPI)
  • Indication/dose: (acid reflux/GERD) = 20mg daily
  • Side effects: HA, dizziness, constipation, B12 deficiency, low mg, osteoporosis
  • Notes: risk of pneumonia, can raise INR with warfarin (2C19 blocker). Do not crush, cut or chew tabs/caps
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6
Q

Tamsulosin + dutasteride

A

Jalyn

  • Class: selective alpha1a-blocker –> smooth muscle relaxation
  • Indication: (BPH) = 0.4mg, max: 0.8mg
  • SE: orthostatic hypotension, dizziness, HA, floppy iris syndrome during cataract syndrome
  • Notes: may be used in women (bladder outlet obstruction.
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7
Q

Hydromorphone ER

A

Exalgo

  • Class: opioid
  • Indication/dose: (opioid analgesic) = 2, 4, 8mg ER tablets once daily
  • CI: opioid naive, 2 week washout if MAOi’s used
  • Side effects: hypotension, respiratory depression
  • Notes: less itching, nausea.
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8
Q

Hydroxychloroquine

A

Plaquenil

  • Class: DMARDs
  • Indication/dose: (RA) = 400-600mg/day, then 200-400mg/day. (Lupus) = 200-400mg/day
  • Side effects: photophobia, blurred vision, corneal deposits, macular damage, n/v, SJS, skin pigmentation
  • Notes: 6 months for max effect. Take with food!
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9
Q

Sulindac

A

Clinoril

  • Class: NSAID
  • Indication/dose: (Gout)=300-400mg daily
  • Side effects: GI, risk of bleeding
  • Notes: avoid in renal disease (UA is eliminated by kidneys). Take with food!
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10
Q

Diclofenac topical

A

Voltaren gel, Flector patch

  • Class: topical NSAID for localized pain
  • Indication/dose: (localized pain, neuropathic)= AAA 3-4x daily
  • Side effects:
  • Notes: apply to most painful area twice daily. remove for MRI/bathing/showering
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11
Q

Propafenone

A

Rythmol

  • Class: 1c antiarrythmic (sodium channel blocker, beta-adrenergic receptor blocking effect) lower conduction velocity, little effect on ref. period and automaticity
  • Indication/dose: Arrythmia’s/150-300mg q8h (IR) or 225-425mg q12h (SR)
  • Side effects: taste disturbances, n/v, worsening HF
  • Notes: monitor HR, BP, ECG
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12
Q

Acamprosate

A

Campral

  • Class: alcohol abstinence via balancing of glutamate and GABA neurotransmitters
  • Indication/dose: alcohol abstinence (ii 333mg tabs tid)
  • CI: CrCl<30
  • Side effects: anxiety, depression, WG, tachy
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13
Q

Perindopril

A

Aceon

  • Class: ACEi’s
  • Indication/dose: HTN/4-16mg daily
  • Side Effects: Cough, hyperK, angioedema
  • CI: angioedema
  • BBW: d/c if pregnant
  • Notes: avoid concomitant use with ARB when CrCl<60.
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14
Q

Morphine IR liquid

A

Roxanol (20mg/ml)

  • Class: opioid analgesic
  • Indication/dosage: acute/severe chronic pain/ 10 to 30mg q4hours as directed
  • Side effects: GI/CNS/Skin, constipation
  • Notes: for constipation - stimulant laxative (senna/bisacodyl) or osmotic (MOM) or docusate
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15
Q

Interferon beta-1a (weekly)

A

Avonex

  • Class: injectable immune modulators
  • Indication/dose: MS= IM 30mcg weekly
  • Side Effects: flu like Sx’s, depression, suicide, leukopenia
  • Notes: do not shake, comes in powder, need to refrigerate (pens/prefilled syringes)
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16
Q

Azelastine

A

Astelin nasal spray

  • Class: intranasal antihistamine
  • Indication/dose: allergic rhinitis = 1-2 sprays in each nostril BID
  • Side Effects: bitter taste, HA, somnolence, nasal irritation
  • Notes: for kids 5+ years of age
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17
Q

Ropinirole

A

Requip/Requip XL

  • Class: DA-agonist, similar action to DA receptors as DA
  • Indication/dose: PD = Start: 0.25mg TID, titrate weekly to 1-4mg TID. XL = start 2mg daily, max: 24mg/day
  • Side Effects: drowsiness, daytime sleep attacks, nausea, orthostasis, hallucinations, dyskinesias
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18
Q

Tiotropium

A

Spiriva Handihaler

  • Class: LA anticholinergic
  • Indication/dose: (COPD) = 1 cap (18mcg) inhaled daily via handihaler device (requires 2 puffs)
  • Side Effects: dry mouth, upper resp tract infections, bitter taste
  • Precaution: pts with mysthenia gravis, narrow-angle glaucoma, urinary retention, BPH
  • Notes: do not swallow capsules
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19
Q

Ipratropium bromide

A

Atrovent HFA
+albuterol (Combivent, DuoNeb)

  • Class: SA anticholinergic
  • Indication/dose: (COPD) = 1-2 inha 3-4x daily; NEB = 0.5mg 3-4x daily
    Comb = 2 inh QID, Com Res = 1 inh QID
  • SE: dry mouth, upper resp tract infections, bitter taste
  • Notes: Combivent avoid in soy allergy, Comb-respimat no CFCs! :)
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20
Q

Phenytoin

A

Dilantin

  • Class: fast sodium channel blocker stabilizes neuronal membranes and reduces seizures
  • Indication: (seizures) = Initial 100mg TID, max: 600mg/day
  • SE: nystagmus, blurred vision, slurred speech, dizzy, drowsy, gum tenderness (gingival hyper), skin rxns, osteoporosis
  • Notes: Therapeutic levels (10-20). IV to oral ratio (1:1)
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21
Q

Budesonide

A

Pulmicort

  • Class: ICS
  • Indication: Asthma/COPD: low = 180-600mcd/d; medium = 600-1200mcg; High = 1200mcg.
    Symbicort (+formoterol) = 2 inh BID
  • SE: dysphonia, candidiasis, cough, hoarseness, hyperglycemia, fractures, pneumonia
  • Notes: indicated for 1-8 years (respules)
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22
Q

Salmeterol diskus

A

Serevent

  • Class: LABA
  • Indication/dose: (Asthma) = 1 (50mcg) inh BID
  • BBW: do not use LABA monotherapy with persistent asthma
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23
Q

Tigecycline

A

Tygacil

  • Class: Derivative of minocycline/Broad spectrum
  • Indication/DOSE: (G+, G-, anarobes, MRSA, VRE, atypical) = 100mg IV x1, then 50mg IV q12h
  • Side Effects: N/V, diarrhea, LFT’s, photosensitivty (avoid in s (pseudo/proteus/providencia)
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24
Q

Cotrimoxazole

A

Bactrim IV

  • Class: Sulfonamides
  • Indication/dose: PCP tx = 15-20 m/k in 3-4 doses
    PCP Px = 1 DS daily
  • Side Effects: GI, skin rxns, crystalluria, photosensitivity, hyperK
  • Notes: 5:1 ratio (SMX/TMP), dilute in D5W. protect from light, no refrigerate. 4 hr stability
    Strong 2C9 inh –> caution with warfarin
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25
Q

Amphotericin B deoxylate

A

Amphotec>AmphoB>Abelcet>Ambisome

  • Class: ergosterol, fungicidal
    Indication/dose: yeasts, molds, dimorphic
  • Side Effects: hypoK, hypoMG, nephrotoxic
  • Notes: premedication to avoid fever, chills, hypo, nausea: APAP, NSAID, Diph, Meperidine, fluid boluses. D5W compatible only
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26
Q

Echinacea

A
  • reduces risk of cold
  • GI/rash
  • avoid if allergic to ragweed, chrysanthemum, daisies
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27
Q

Carisprodol

A

Soma

  • Muscle relaxant
  • 250-350mg QID prn
  • CIV
  • sedation, dizziness, confusion
  • avoid in elderly
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28
Q

Aliskiren

A

Tekturna

  • Direct renin inhibitor
  • 150-300mg/day
  • CI: avoid with ACEi or ARBs in patients with diabetes; angioedema; bilateral renal artery stenosis
  • BBW: avoid in pregnancy
  • avoid in CrCl<60
  • SE: hyperK, angioedema, hypotension
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29
Q

Buprenorphine

A

Butrans (patch)

  • opioid agonist
  • mod-sev pain pts who need ATC opioid
  • Apply to upper outer arm, chest, side of chest, upper back
  • Change weekly (do not apply to same site for at least 3 weeks), NTE: 20mcg/hour due to QT risk
  • Fold and throw away
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30
Q

Imiquimod

A

Aldara cream

  • Warts (avoid sex during application, can weaken condoms)
  • Caused by HPV, can use also cryotherapy, electrocautery, excision
  • Apply to area at bedtime, rub till no longer visible (1 packet per application). 3x/week until clearance or for 16 weeks.
  • Wash off after 8 hours. Can cause edema, burning, erythema, itching
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31
Q

Calcitonin

A

Miacalcin/Fortical

  • Osteoporosis and hormone therapy
  • Inhale 1 spray (200 IU) daily [alternate nostril daily]
  • MOA: inhibit osteoclastic bone resorption
  • CI: allergy to calcitonin-salmon
  • SE: rhinitis, dizzy, flu-like symptoms, dyspepsia
  • Unused bottle: refrigerate, room temp for opened bottle – need to prime. if remain upright, dont need to re-prime.
  • After 30 sprays, should discard
  • Need to supplement Ca/Vit D
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32
Q

Varenicline

A

Chantix

  • partial a4/b2 nicotinic receptor agonist. DA stimulation as well.
  • reduce cravings for smoking cessation
  • Days 1-3: 0.5mg daily
  • Days 4-7: 0.5mg BID
  • Days 8: 1mg BID
  • Start 1 week before quit date
  • Take with food and water to reduce n/v
  • SE: angioedema, skin rxns, abnormal dreams, n/v
  • BBW: neuropsychiatric events (depression, suicide)
  • medguide required
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33
Q

Post Exposure Prophylaxis (Non-occupational)

A

<72 hr since exposure (known HIV+ status)
Duration: 28 days

NNRTi Based:

  • Efavirenz (NNRTi) +
  • Lamivudine (NRTi) or emtricitabine (NRTi) +
  • Zidovudine (NRTi) or tenofovir (NRTi)

PI-Based:

  • Lopinavir/r (PI) +
  • Lamvudine (NRTi) or emtricitabine (NRTi) +
  • Zidovudine (NRTi)
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34
Q

Post Exposure Prophylaxis (Occupational)

A

Recommended if the source of contaminated blood or body fluid is known to be HIV positive

2 drug regimen:

  • Zidovudine (NRTi) or tenofovir (NRTi) +
  • Lamivudine (NRTi) or emtricitabine (NRTi)

Truvada (emtricitabine/tenofovir)
Combivir (zidovudine/lamivudine)

3 drug regimen

  • Zidovudine (NRTi) or tenofovir (NRTi) +
  • Lamivudine or emtricitabine +
  • Lopinavir/r (PI)
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35
Q

Methotrexate

A

Rheumatrex/Trexall/Folex

  • Folate antimetabolite that inhibits DNA synthesis
  • Indications: MS, RA, cancers, psoriasis
  • RA: 7.5-22.5mg/week
  • SE: n/v, diarrhea, anorexia, skin reddening, mucositis, pulmonary toxicity
  • BBW: hepatotoxic, pneumonitis, bone marrow suppression, acute renal failure, malignant lymphomas, fetal death in pregnancy
  • High dose MTX –> leucovorin (active FA) as rescue
  • Notes: drink plenty of water, avoid use with NSAID’s, penicillins.
  • Monitor: LA, TSH, CBC w/diff, BUN/Scr
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36
Q

Topiramate

A

Topamax (capsule, tablet)

  • Fast sodium channel blocker, blocks T-type calcium currents. Enhances GABA, antagonizes AMPA/kainate glutamate receptors
  • Adjunct therapy for partial seizures or conversion to primary therapy
  • Week 1: 25mg BID, up 25mg weekly. Max: 400mg/day
  • SE: Somnolence, dizziness, difficulty with memory, cognitive impairment, taste perversions, oligohydrosis, hyperthermia
  • Notes: infants with oral clefts to mothers on topiramate (Cat. D)
  • Qsymia (phentermine+topiramate ER): FDA-approved for weight loss
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37
Q

Carbamazepine

A

Tegretol/Carbatrol/Epitol (capsule, tablet, suspension)

  • seizures/trigeminal neuralgia
  • Initial: 200 mg BID (daily if XR)
  • Max: 1600 mg
  • Therapeutic range: 4-12 mcg/mL
  • BBW: Skin rxns, test asians for HLA-B1502 (+? cannot use). Fatal blood cell abnormalities (aplastic anemia and agranulocytosis)
  • SE: n/v, dizziness, drowsiness, HA, ataxia, speech disturbances
  • Monitor: LFT’s, CBC, platelets, chem panel (3,6 months, annually)
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38
Q

Cefoxitin

A

Mefoxin (IV)

  • 1-2g q6-8h
  • 2nd Gen. Ceph: Some G+, HNPEK, B. fragilis
  • CrCL>50: no changes
  • HD: 500mg to 1g q24-48h, give supplemental dose after each dialysis (1 to 2 gram), then give MD
  • Notes: cross sens to PCN (<10%), reduce in renal impairment
  • SE: anaphylaxis, GI upset, seizures with accumulation, raise in LFTs, bone marrow suppression
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39
Q

Strep Pneumonia Px

A
  • Contact precautions
  • Pneumovax (prevnar: 6 weeks, pneumovax: 2 years). Routine: younger than 2years (2, 4, 6 and 12-15 months). 1 dose for all children (14-59 months). 1 single supplemental dose for children (60-71 months)
  • Masks
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40
Q

Estradiol topical

A

Evamist transdermal spray

  • moderate to severe vasomotor symptoms (hot flashes) due to menopause
  • each spray (90 mcL = 1.53 mg of estradiol)
  • apply to forearm just below the elbow (do not apply to breast), let dry for at least 2 minutes, do not wash for at least 30 minutes
  • prime, avoid grapefruit, do not use sunscreen at the same time. Store at room temp
  • SE: chest pain, numbness, vaginal bleeding, jaundice, swollen breasts, weight gain
  • DDi: StW, blood thinner, ritonavir
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41
Q

Cyclosporine eye emulsion

A

Restasis

  • Dry eyes (RX)
  • 1 drop to each eye twice daily
  • SE: burning, stinging, redness, blurred vision
  • requires medguide: use immediately after opening. don’t touch tip to eye, remove contact lenses (separate by 15 min)
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42
Q

Pentazocine and Naloxone

A

Talwin (50mg/0.5mg)

  • CIV (mod to severe pain)
  • Pentazocine (opiate), Naloxone (prevents misuse)
  • 1 tab q3-4h (NTE: 12/day)
  • SE: HTN, hypotension, tachy, syncope
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43
Q

Telmisartan

A

Micardis

  • ARB (block AT2 from binding AT1 receptors on SM)
  • 40-80mg/daily
  • SE: hyperK, angioedema (d/c if occurs), hypotension
  • Avoid use with aliskaren when (CrCl<60)
44
Q

Cetriaxone

A

Rocephin

  • 3rd gen ceph: HNPEKS (Serratia)
  • 1-2g q12-24h (IV/IM)
  • only ceph dosed once daily
  • hepatically cleared
  • y-site biliary sludging with ca-solutions, separate!
45
Q

Dabigatran

A

Pradaxa (75 or 150 mg capsules)

  • Direct thrombin inhibitor
  • reduce risk of stroke and embolism is patient with non-valvular Afib
  • 150 mg BID
  • 75 mg BID (CrCl: 15-30)
  • 4 months expiration after bottle is opened
  • CI: active bleed
  • SE: gastritis, bleeding
  • if switching from warfarin: d/c warfarin, start pradaxa when INR<50)
  • avoid use with rifampin or other p-gp inducers
46
Q

Montelukast

A

Singulair

  • Asthma
  • leukotriene-receptor antagonists (LTRA) - D4. reduce airway edema, constriction and inflammation
  • 10 mg in the evening
  • 12mo-5 years: 4 mg daily
  • 5-14 years: 5 mg daily
  • SE: HA, dizzy, abd pain, LFTs, upper resp tract
  • Cat. B
47
Q

Epoetin alfa

A

Epogen/Procrit

  • IV/SC
  • Anemia
  • Erythrocyte stimulating agent (ESA)
  • 150 U/kg SC TID per week
  • or 40,000 U SC weekly
  • BBW: patient needs medguide, prescribers need to comply with APPRISE program
  • SE: myalgia, arthralgia, cough, bone pain, hypoK
  • CI: *UNCONTROLLED HTN
48
Q

Raltegrivir

A

Isentress

  • Integrase Inhibitor: block enzyme needed for viral DNA to enter host nucleus
  • 400 mg BID
  • SE: rise in CPK, muscle weakness, rhabdo
  • metabolized by UGT1A1-mediated glucoronidation, rifampin is an inducer (concomitant use will reduce levels of raltegravir)
49
Q

Trazodone

A

Oleptro (ER)

  • Depression/insomnia
  • 5-HT reuptake inhibitor and a1-blocker and histamine blocker
  • 100-150 mg BID
  • SE: sedation, orthostasis, priaprism
50
Q

Ropinirole

A

Requip

  • DA agonist (similar to DA at DA receptor)
  • Parkinson’s disease
  • Start: 0.25 mg TID, titrate weekly to 1-4 mg TID
  • XL: start 2 mg daily, max 24 mg/daily
  • SE: drowsiness, daytime sleep attacks, hallucinations, dyskinesias, orthostasis
51
Q

MS Contin

A

Kadian/Avinza

  • opioid
  • ER: dosed q8-12h
52
Q

Bisoprolol and HCTZ

A

Ziac

  • 2.5/6.25
  • 5/6.25
  • 10/6.25
53
Q

Methylprednisolone

A

Solu-Medrol

  • Gout
  • Intra-articular injection
54
Q

Dutasteride

A

Avodart

  • BPH
  • 5-a reductase inhibitor
  • 0.5 mg soft gel daily
  • SE: dec. libido, impotence, breast tenderness
  • Notes: 6 mo’s for max effect, PSA levels will dec.
55
Q

Enoxaparin

A

Lovenox

  • Px of VTE: 30 mg SC q12h or 40 mg SC daily, 30 daily (CrCl<75 years: 30 mg IV bolus plus 1 m/k SC dose followed by 1 m/k q12h (max: 100 for the first 2 doses). 1 m/k SC daily
  • PCI: if 8 hrs past since last dose and before inflation, give 0.3 m/k IV bolus.
    Monitor: Anti-Xa
  • SE: bleeding, thrombocytopenia, anemia
  • LMWH interchange: Dalteparin (Fragmin) - VTE proph/TX of UA+NSTEMI, Tinzaparin
  • HIT: hep antibody bind to platelets, plt drop of 50%+ from baseline (normal: 150-450k/ul)
    tx: Bivali (Angiomax), Argatroban, Lepi (Refludan)
56
Q

Pramlintide

A

Symlin

  • SymlinPen 120 or 60
  • Vial: 0.6 mg/ml (5ml)
  • Diabetes 1 and 2
  • synthetic analog of amylin (assist postprandial glucose control, slow gastric emptying, prevents increase in serum glucagon following a meal, and increases satiety)
  • 1: start at 15 mcg prior to meals (up to 60 mcg)
  • 2: start at 60 mcg (up to 120)
  • SC injection (abdomen, thigh) prior to each meal (>250 kcal or >30 g of carbs)
  • SE: hypoglycemia (reduce mealtime insulin by 50%), nausea, anorexia, weight loss
57
Q

Cyclosporine

A

Neoral/Sandimmune

  • cannot interchange: modified (Gengraf/neoral) has more bioavailability than non-modified (Sandimmune)
  • SE: HTN, hirsuitism, g. hyperplasia, hyperTRIG, nephropathy
58
Q

Protease Inhibitors

A
  • inhibit HIV-1 protease and rendering the enzyme incapable of cleaving gag-pol = immature virions (#7)
  • SE: hyperglycemia, insulin resistance, lipodystrophy, loss of SC fat in face/butt/arms/legs, lipohypertrophy (fat accumulation in various areas of the bod, dyslipidemia, hepatitis, Immune reconstitution syndrome
59
Q

Fenofibrate

A

Trilipix 45 or 135 mg
Antara 43 or 130 mg
TriCor 48 or 145 mg

  • peroxisome receptor alpha (PPARa) activators = enhanced elimination and dec synthesis of VLDL causing TG to decrease and HDL to increase = increase in apolipoprotein lipase = dec LDL
  • when TG’s are high –> TG reduce and LDL may increase
  • monitor: LDL, LFT, renal function
  • SE: LFT inc, CPK inc, myopathy, abd pain, rhabdo with statins
  • Notes: Trilipix has indication with statin, may have similar SE profile. Gemfibrozil may inc risk of myopathy
60
Q

Omeprazole-Na Bicarb

A

Zegerid/OTC (20, 40mg caps with 1.1g of NaBicarb)
Powder: 20, 40 with 1.68g of NaBicarb
Tabs: 20, 40 with 750 NaBicarb/343 MgOH

  • PPI
  • Notes: onset of relief is 2-3 hours and lasts 12-24 hours
  • SE: HA, dizzy, constipation, hypoMg, risk of Cdiff, osteoporosis, inc INR
61
Q

Pantoprazole

A

Protonix

  • PPI
  • 20, 40mg tabs
  • Granules for susp 40mg/pk
  • inj (40mg IV)
62
Q

Salmeterol + Fluticasone (HFA equivalency)

A

Advair (diskus or HFA)

  • LABA+ICS
  • Disk: 1 inh BID
  • HFA: 2 inh BID
    Strengths: HFA – Diskus
  • (230/21) – (500/50)
  • (115/21) – (250/50)
  • (45/21) – (100/50)
63
Q

Hydralazine

A
  • Direct vasodilator - vasodilation of arterioles, no effect on veins
  • SE: LUPUS-LIKE REACTION (fever, joint/muscle aches, fatigue), reflex tachycardia
64
Q

Caspofungin

A

Cancidas

  • Echinocandins
  • DOC: Candida
  • LD: 70 mg IV day 1
  • then 50 mg daily
  • COMPATIBLE WITH NS ONLY
  • SE: LFT’s, hypotension
  • Note: once daily and no requirement for dose adjustment in renal impairment
65
Q

Atazanavir

A

Reyetaz

  • Protease inhibitor (#7)
  • TAKE WITH FOOD (better absorption)
  • hyperbilirubinemia, rash, nephrolithiasis
  • do not take with antacids (2/1 hours)
  • 12 hours before PPI’s
66
Q

Imipenem/Cilastatin

A

Primaxin

  • Carbapenems
  • 250-1000 mg IV q6-8h
  • G+, G-, anaerobes, Pseudomonas
  • SE: diarrhea, rash, seizures with higher doses/renal impairment
  • LOWER DOSE IN RENAL PATIENT
  • avoid in pcn allergy (10-50% cross reactivity)
67
Q

Nicotine patch

A

NicoDerm CQ/Habitrol (OTC or Rx)

> 10 = 21mg/day patch
<10 = 14mg/day patch
- SE: skin reactions, insomnia, VIVID DREAMS
- start on morning of quit date
- wear 16hrs to avoid insomnia, try to wear for 24hr
- neck and waist application (hairless location)
- DO NOT SMOKE CIGS CONCURRENTLY

68
Q

Pneumococcal

A

Prevnar (conjugate) = 2 months
Pneumovax = 2+ years

  • VACCINATE: infants (n<2), 65+, 19-64 if smoke or asthma, 2-64 chronic illness (sickle cell, immune compromised, asplenia)
  • revaccinate: all adults every 5 yrs if at risk
69
Q

Shingles vaccine

A 
Varicella (SC)
- VAR: Varivax (chicken pox) 
- ZOS: Zostavax (herpes zoster/shingles)
SHINGLES:
- FDA (50 years of age or older), ACIP (60+)
  • live vaccines! avoid in immunecompromised and pregnancy
  • use within 30 min of reconstitution
  • avoid if allergic to geletin or neomycin
70
Q

Terbinafine

A

Lamisil

  • tinea unguium (onychomycosis)
  • Fingernail: 250 mg daily (6 weeks)
  • Toenail: 250 mg daily (12 weeks)
  • SE: diarrhea, loss of taste, vision changes
  • may cause liver disease, w/wo food
71
Q

Dehydration

A
  • monitor: BUN, Scr, renal function (dig/amik), pancreatitis (amylase/lipase)
72
Q

Pip/Tazo

A

Zosyn

  • 40+ = 3.375q6h
  • 20-40 = 2.25q6h
  • <20 = 2.25q8h
73
Q

Immunizations for DM

A
  • pneumococcal and influenza
74
Q

Sitagliptin

A

Januvia

  • DPP4-inhibitors (incretin enhancers): prevent DPP-4 enzyme – prevent breakdown of incretin, glucagon-like peptide, and GIP. regulate blood glucose levels by inc insulin release and dec. glucagon secretion
  • 100 mg daily (can start at 50 mg)
  • 25 mg with CrCl < 30, including dialysis
    Goals:
    A1C < 7
    pre 70-130
    post (1-2hrs) < 180
75
Q

Clonidine

A

Catapres-TTS Patch

  • centrally acting alpha-2 agonist (Guanabenz, Guanfacine, Methyldopa)
  • APPLIED WEEKLY
  • Dose: 0.1, 0.2, 0.3 mg/24hr
  • apply to upper, outer arm, upper chest - use white round cover
  • SE: rebound HTN if stopped abruptly, bradycardia, dry mouth, ortho hypotension, psych reactions
76
Q

Seasonale

A
  • 84 active, 7 placebo
  • 3 month birth control
  • Seasonale = placebo 7 days
  • Seasonique = Low estrogen (7 days)
  • Start: sunday after period starts even if still bleeding (b/u 7days)
77
Q

Nuvaring

A
  • APPLY MONTHLY
  • in for 3 weeks, out for 1 week
  • start: day 1-5 from menses
  • week 1: out 3+ hrs –> rinse cool water, reinsert, B/U! for 7 days – EC if sex within 5 days
  • week 2/3: out 3- hrs, rinse + insert
  • week 2/3: out 3+ hrs, rinse + insert (B/U!)
  • 1st cycle = B/U
  • RT for 4 months
78
Q

Ketorolac

A

Toradol

  • nsaid (non-selective)
  • short-term mod-severe acute pain
  • 10-20 mg oral
  • comes in IV, IM, nasal spray
  • 5 DAY MAX TREATMENT
  • avoid in bleeding risk, start with inj switch to oral
79
Q

Lipid goals

A

LDL < 100 = CHD RE with 20%+, DM < 100
LDL < 130 = 2+ RF with 10-20%
LDL < 130 = 2+ RF with < 160 = 0-1 RF

80
Q

Atorvastatin

A

Lipitor

10-80 mg daily
+amlo (Caduet)
DDI: CYP3A4 metabolism (less than lova/simva). 3A4 inh will inc concentration.
- avoid greater than 20 mg: itraconazole, clarithromycin

81
Q

Clopidogrel

A

Plavix

  • MOA: P2Y12 inhibitor. Bind P2Y12 on platelets, prodrug and bind IRR to receptor –> block platelet activation/aggregation
  • needs 2C19 activation to active metabolite. 2C19*2/3 = poor metabolizers
  • SE: bleeding, bruising, rash, TTP (purpura - fever, weakness, paleness)
  • CI: active bleeding
  • d/c 5 days prior to major surgery
82
Q

Prasugrel

A

EFFIENT

LD: 60 mg daily
MD: 10 mg daily
n block platelet activation/aggregation
- reduction of thrombolytic events in pts w/ACS managed with PCI
- Not rec in pts > 75
- d/c 7 days prior to surgery
83
Q

Duloxetine

A

Cymbalta

  • SNRI’s - depression, nerve pain, fibromyalgia
  • 20, 30, 60 mg
  • SE: sexual dysfunction, N/V, BP inc, constipation
  • DDI: maoi’s, 2D6 inhibitors (TRAMADOL - 5ht-x)
84
Q

Sertraline

A

Zoloft

  • SSRI - 50-200 mg/day
  • use for depression, PMDD (2 weeks prior to menses), OCD
  • comes in liquid (20mg/ml)
  • 2 weeks for energy
  • 4-6 WEEKS FOR MOOD
    SE: sexual, GI, anorgasm, ejaculation diff, akathisia, insomnia, poor concentration, fatigue
85
Q

Valproic Acid

A

Depakene, Divalproex, Depakote

  • epilepsy, seizures
  • TR: 50-100, low albumin increase VPA levels
  • BBW: hepatic failure, teratogenicity, pancreatitis
  • SE: GI, abd pain, dizzy, ALOPECIA (supplement with selenium and zinc), thrombocytopenia,
86
Q

Tolterodine

A

Detrol, Detrol LA

  • Overactive bladder
  • 1-2 mg bid or 2-4 mg daily
  • muscarinic receptor antagonist compete with ACH, blocking the contraction of detrusor muscle
  • SE: dry mouth, constipation, dry/eyes (need to verify if have GLAUCOMA), urinary retention
  • other drugs in class: Oxybutynin (Ditropan), Trospium (Sanctura), Enablex, Toviaz, Vesicare
87
Q

Steroid strength

A

Very high: Clobetasol 0.05% (Clobex), Halobetasol 0.05% (Ultravate)
High: Betamethasone 0.05% (Diprolene), oint = very high
High-medium: Fluocinonide 0.05% (Lidex), gel/oin/cream = high
Medium: Mometasone 0.1% (Elocon), oint = high
Lower: Fluocinolene 0.01%, Desonide 0.05% (DesOwen)
Mild: Aclomethasone 0.05%
Lowest: Hydrocortisone 1/2.5%

Clob/Halo > Betam/Fluoc/Mom > Desonide > Hydrocortisone

88
Q

Glycopyrrolate

A

Treatment of ulcers

  • 1 tab 2-3x daily
  • Class: anticholinergic

MG: is an autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigability. It is an autoimmune disorder, in which weakness is caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular junction,[1] inhibiting the excitatory effects of the neurotransmitter acetylcholine on nicotinic receptors throughout neuromuscular junctions.

Myasthenia is treated medically with acetylcholinesterase inhibitors or immunosuppressants

89
Q

Theft of medications from tech

A

Report to DEA/BOP within 14 days

90
Q

Pharmacist Concerta

A

Need:

physician protocol, DEA#

91
Q

Controlled substances check

A
  • testosterone

- soma

92
Q

Error found on Rx?

A

The prescriber’s signature and the date written are required to be written by the prescriber. Everything else can be written by the prescriber or his or her agent. Therefore, the pharmacist can make changes to any other information on the prescription as long as the pharmacist verifies the change with the prescriber first.

93
Q

Out of state

A

Business Code 4005(b) - allows written and oral prescriptions from out-of-state prescribers. Pharmacies must verify the prescription. The pharmacist should use his or her best professional judgment when filling out-of-state prescriptions.

94
Q

Prescriber out of security forms?

A

Can still fill, need to write: 11167 exemption on Rx.

  • 11167 exemption allows:
    1. emergency cases (failure to fill = loss of life or intense suffering
    2. Written orders = signed and dated by prescriber
    3. Reduce oral/faxed Rx’s to hard copy form
    4. Prescriber needs to provide appropriate Rx by 7 days –> if not, we have 144 hours to report to Bureau of Narcotic Enforcement (date/method of notification)
95
Q

Multiple CII drugs be on same form

A

Yes. As long as the new prescription form has the statement at the bottom that reads, “Void if the number of drugs is not noted” and a line provided for the physician to write in the number of drugs prescribed

96
Q

Required to keep separate record for CII prescriptions

A

Pharmacies are required to keep a separate record in the pharmacy of Schedule II prescriptions filled regardless of whether or not the prescription includes other non-Schedule II medications. Additionally, the pharmacy is required to submit the Schedule II prescription information to CURES electronically or on disk, and effective January 1, 2005, must submit both Schedule II and III prescription information to CURES.

97
Q

Prescriber transmit CIII-V from computer or PDA to pharmacy’s comp. or fax?

A

Yes. Have to reduce to oral prescription, retain for at least 3 years

  • be sure to verify the validity of the Rx prior to dispensing
  • electronic? need e-sig
98
Q

How long is a controlled substance prescription valid?

A

Since January 1, 2004, prescriptions for all controlled substances (Schedules II–V) are valid for 6 months from the date written.

99
Q

Do I still have the option of faxing or phoning in a prescription for a Schedule III – V controlled substance?

A

Yes, prescribers can fax or phone in a prescription for a Schedule III – V controlled substance. However, a security feature on the new tamper-resistant security prescription form prints VOID across the face of the prescription when faxed, please use a regular prescription form for faxed prescriptions. Pharmacies will have to validate the faxed prescriptions.

100
Q

Can a California pharmacy fill a prescription for a Schedule II controlled substance that was written by an out-of-state prescriber for an out-of-state patient? What about Schedule III thru V controlled substances?

A

Yes, so long as the prescription conforms to the requirements for controlled substance prescriptions in the state in which the controlled substance was prescribed. The prescription must be delivered to the patient in the other state. Prescriptions for Schedule II controlled substances must be reported to CURES and effective January 1, 2005, prescriptions for both Schedule II and III must be reported to CURES.

101
Q

How does a pharmacist know that a prescriber has the authority to write controlled substance prescriptions using the new tamper-resistant security prescription form?

A

Pursuant to Health and Safety Code section 11161.5 et seq., the approved security printer is required to verify that the prescriber ordering the new tamper-resistant security prescription forms, holds a valid unexpired license and has the authority to write controlled substance prescriptions (any or all Schedules II - V).

If a pharmacist is concerned that a prescriber is not authorized to specifically write a Schedule II controlled substance prescription, the board recommends that the pharmacist ask the prescriber to provide a copy of his or her DEA registration, which lists the schedules of controlled substances that he or she is authorized to prescribe.

102
Q

Can prescriber use exemption for terminally ill meds to be written for controls?

A
  • only for CII’s

- 1/1/05 - CIII-CIV for terminally ill must be on security prescription form, telephoned, faxed in to pharmacy

103
Q

Errors on CII meds?

A
  • can correct
  • need hardcopy mailed/faxed within 7 days with corrections
  • cannot touch sig and date
104
Q

Who can authenticate a controlled substance Rx?

A
  • employees can with direction

- telephoned Rx must be received by intern or pharmacist

105
Q

Can prescriber call in or fax to a pharmacy for CII substances?

A
  • No. Two exceptions:
    1. licensed skilled nursing facility, licensed inter. care facility, licensed home health agency, or licensed hospice - can call in an order or send a fax Rx for II-V substances –> need to reduce to hard copy form (sign/date - Health and safety code 11167.5).
    2. Loss of life or intense suffering without meds - prescriber can phone in Rx/or fax – reduce to hard copy. Prescriber must provide written Rx on new security forms within 7 days – pharmacist will notify Bureau of Narcotic Enforcement within 144 hours if prescriber does not do it
106
Q

How does a prescriber or pharmacist request a patient history of controlled substances prescriptions from the CURES system?

A

A prescriber or pharmacist can download a Patient Activity Report (PAR) request form by clicking on one of the following links:
prescriber - http://caag.state.ca.us/bne/pdfs/BNE1176.pdf
pharmacist - http://caag.state.ca.us/bne/pdfs/BNE1177.pdf
Complete the appropriate PAR form and fax it to the Department of Justice, Bureau of Narcotic Enforcement at (916) 227-5079.

107
Q

Can a physician have more than one DEA number?

A

Yes. A physician who administers or dispenses controlled substances directly to their patients in the office, pursuant to Business and Professions Code section 4170, are required to have a separate DEA registration number for every address from which he or she practices. If the physician only writes prescriptions for their patients to take to a pharmacy to dispense, then he or she is only required to have one DEA number for all practice addresses.

CPJE 1 (1 decks)

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