Cram Deck Flashcards
ml in 1 gal
3785ml per gallon
Gram positive in clusters
Staph!
Gram positive in chains/pairs
Strep
What organisms do penicillins work well against?
Gram positive!
When can you use a penicillin against gram negatives and anaerobes?
If it’s combined with a beta lactamase inhibitor (sulbacyam, clavulanate, tazobactam)
Penicillins CIs
Kidney failure (Crcl<30)
What are cephalosporins not active against?
Enterococcus or atypical
Ceftriaxone CI
Neonate!
How to renally adjust ceftriaxone
You don’t!
Pseudomonas coverage
Pip/tazo
Cefepime
Meropenem
Doripenem
Carbapenems can NOT be used for….
atypical
MRSA
C. Diff
VRE
Can you use aztreonam with PCn allergy?
Yes!!!
What antibiotics do you need to avoid with lovastatin/simvastatin
Clarithromycin and erythromycin.
Vanc systemic infection dosing
15-20mg/Kg q 8-12h
Vanco AUC/Trough goals for serious MRSA infections
Auc/mic 400-600
Trough 15-20
Which abx suspensions do you NOT refrigerate?
Cefdinir Azithro Clarithro Cipro Clinda
Meningitis empiric treatment
Neonates: amp And cefotaxime or gent
1 month-50 years old:
Ceftriaxone and Vanc
> 50 or immunocomp:
Amp, ceftriaxone, and Vanc
Abx of acute bacterial exacerbation of chronic bronchitis (ABECB)
5-7 days of augmentin if sputum volume and puryulence and difficulty breathing
CAP treatment if no comorbidities
Amoxicillin or doxycycline or azithromyicn if resistance is low
CAP tx with comirbidities present
Cephalosporin or augmentin + doxy
HAP tx for low risk of MRSA
Cefepime or pip/tazo
HAP tx for MRSA risk high but low MDR risk
Cefepime + vanco
Meropenem + linezolid
If a patient on warfarin starts taking rifampin, what would you expect their INR to do and why?
INR would decrease because rifampin is a potent 3A4 inducer
What to use for bacteriuria in a pregnant patient
Augmentin!
Can use nitrofuratoin and Bactrim if beta lactam allergy
When to use azithromycin in travelers diarrhea
Fever, blood in stool, pregnant or peds
Otherwise use a floxacin!
Tx options for c. Diff
Oral vanco
Or metronidazole
What can amphotericin B cause a risk of with other agents that can cause this?
Nephrotox!
Issues with Azoles
Increase LFTs
QT prolongation
Interactions!!!!
What azole needs renal adjustment?
Fluconazole
What azole can cause heart failure
Itraconazole
Cyp consideration with Azoles
3A4 inhibitors!
One pill once daily HIV treatment for treatment naive
Biktarvy
Triumeq
Dovato
HIV: what’s the difference between TDF and TAF
TDF has a higher risk of fractures and should not be used in renal impairment
What’s special about abacavir?
HLA-B*5701 testing before use: hypersensitivity reactions
What drugs have abacavir?
Triumeq
Epzicom
Ziagen
What drug has TDF? (Fracture warning)
Truvada
What’s special with Maraviroc?
CCR5 receptor must be present and CXXR4 cannot be present
Assay test called Trofile used to test!
HIV PEP regimen!
Truvada + (Tivicay or Isentress)
What two hiv meds can be used for PrEP
Truvada or Descovy
What are HIV drug boosters?
Cobicistat and Ritonavir
Not interchangeable!
Major CYP inhibitors
G-PACMAN Grapefruit Protease Inhibitors (especially ritonavir) Azoles C - cyclosporine, cimetidine, and cobicistat Macrolides (clarithro and erythro) Amiodarone Non/DHPs (diltiazem and verapamil)
CYP inhibitor effect on non-pro drugs
Decreased metabolism > increased effects/ADRs/toxicities
CYP inducers
PS PORCS Phenytoin Smoking Phenobarbital Oxcarbazepine Rifampin Carbamazepine St Johns Wort
Which statins interact with CYP?
SAL
Simva
Atorva
Lovastatin
Ear drop instructions for adults
Pull earlobe up and back
Ear drop directions for children
Pull earlobe down and back (if less than 3yo)
Drugs that leach with PVC
Leach Absorbs To Take In Nutrients Lorazepam Amoidarone Tacrolimus Taxanes Insulin Nitroglycerin
What drugs require Saline as a diluent
A DIAbetic Can’t Eat Pie Ampicillin Daptomycin Infiximab - Remicade Amp/sulbactam Capsofungin Ertapenem Phenytoin
What drugs require dextrose as a diluent?
BOAS will strangle you if you don’t put these in Dextrose
Bactrim
Oxaliplatin
Amphotericin B
Synercid
Other than phosphate what drug cannot be mixed with calcium with IV such and such
Ceftriaxone! Do not mix with LRs!
Particles in an ISO class 5
3520
BUD for CSPs made in an isolator
12 hours
What does an HLB value of 4 mean
Low value for hydrophilic/lipophilic balance.
Product is more lipid soluble - aka typically for topical emulsions
BUD nonaqueous formulations
6 months! Room temp
BUD water containing oral forms
14 days - store in fridge
BUD water containing topicals
30 days - room temp
True or false: live attenuated vaccines can replicate?
True!
Who cannot receive live attenuated vaccines
Pregnant and immunocompromised
Common live vaccines
COZY IV RM Cholera Oral typhoid Zostavax Yellow fever Intranasal flu Varicella Rotavirus MMR
Age for DTaP
<7 years old
Which flu shot is egg free and what are the age requirements for it
Flublock
Must be >18yo
What is type II error?
Null hypothesis is accepted when it should have been rejected *remember the picture in class with the doctor telling the man he’s pregnant
What factors does warfarin inhibit?
II, VII, IX, X
Which anticoagulant should be used: stroke prophylaxis with mitral stenosis
Warfarin!
Which anticoagulant should be used: stroke prophylaxis with mechanical heart valve
Warfarin
Which anticoagulant: VTE treatment in cancer patient
LMWH
Dose adjustment with Eliquis
For a fib, if patient has two of the following: 80yo or older, body weight less than 60kg, or SCr greater than 1.5mg/dL
Reduce dose to 2.5mg bid
At what creatinine clearance value would you not use Xarelto
<30
Which doac can’t be used if crcl is too good (>95)
Edoxaban
Warfarin color order
Please Let Grandma Brown Bring Peaches To Your Wedding
Pink, lavender, green, brown, blue, peach, teal, yellow, white
What type of anemia McV<80
Microlytic - iron deficiency
Rbcs are small
What type of anemia MCV 80-100
Normocytic
Blood loss, malignancy, CKD, hemolysis
Type of anemia MCV >100
Macrolytic
B12 or folate deficiency
Recommended dose of elemental iron
100-200mg/day
% elemental iron in gluconate
12%
% elemental iron in sulfate
20%
% elemental iron in fumarate
33%
Which IV iron needs a test dose?
Dextran!
Where do loop diuretics work?
Ascending loop of henle at Na-K pump
Where do thiazides work?
Na-Cl pump in distal convoluted tubule
Crcl equation
=(140- (age) / 72 x SCr ) x wt (kg) x0.85(female)
Patient has albuminuria, what should they be put on for kidney protection?
Acei or arb
Drugs CI in CKD
<60 Nitrofuratoin <50 TDF Voriconazole <30 TAF NSAIDs Dabigatran Rivaroxban
Gfr- metformin and SGLT2
What’s sevelamer?
Renvela
Phosphate binder thats non-ca, non-Al based
Not systemically absorbed
N/v/d
Can lower Total Cholesterol
Hyperkalemia treatment
Give calcium gluconate to stabilize the heart
Shift it : dextrose, insulin, sodium bicarbonate, albuterol neb
Remove it: diuretics, hemodialysis
Metabolic acidosis lab value
Sodium bicarbonate <22
Replace
Different mechanisms of HCV drugs
Ns3/4a PI: -previr
ns5a replication Inhibitor: -asvir
Ns5b PI: -buvir in
CYP considerations with DAAs (HepC drugs)
All are CI with strong 3A4 inducers
HepB preferred treatment
Interferon Alfa
Non-selective beta blockers for portal HTN
Nadolol
Propranolol
Allergy medication that is safe in children
>2yo Flonase Cetirizine: 2.5-5mg qd Allegra: 30mg bid Claritin 5mg qd
Benadryl if >6yo
Xyzal: if >6 months
What drugs can decrease IOP
Beta blockers (timolol)
Prostaglandins (lantanoprost)
Alpha 2 agonists (brimonidine)
1 drop daily eye drops
Bimatoprost (Lumigan)
Latanoprosy
Travoprost (Travatan Z)
Bimatoprost (Latisse)
Dosing frequency for timolol
Once daily to twice daily
What’s a risk with steroid eye drops?
They can increase IOP long term
Alopecia tx options
Finasteride
Minoxidil (rogaine)
List of topical steroid potency from high to low
Clobetasol Fluocinonide Betamethasone Mometasone Triamcinolone
LDL equations
Tc-HDL - (TG/5)
What is error of commission?
Something was done incorrectly versus being left out
