Exam 2 Flashcards
macrolide antibiotics used for CAP
azithromycin (zpack) and clarithromycin (Biaxin)
serious side effects of macrolide antibiotics
QTC prolongations, LFT abnormalities, GI upset
other macrolide abx considerations
use with caution in patients with arrhythmias and heart disease. avoid in patients with a history of hepatic jaundice. hold statins during treatment = interact on CYP34A pathway
sinusitis treatment options
intranasal corticosteroids, augmentin, clindamycin, cephalosporins, doxycycline, fluoroquinolones
sinusitis tx recs for common drug allergies
PCN allergy –> use doxycycline or resp. fluoroquinolone (moxi or levofloxacin) or clindamycin
*do not use augmentin in patients with a cephalosporin allergy
1st gen antihistamines
diphenhydramine (Benadryl) and chlorpheniramine (chlor-tabs)
Diphenhydramine considerations (Benadryl)
CI: breast-feeding
Caution: asthma, cardiovascular disease, increase intraocular pressure, BPH, and thyroid dysfunction
Chlorpheniramine (chlor-tab) considerations
CI: narrow-angle glaucoma, bladder neck obstruction, BPH
Avoid use with newborns!!! Possible association with SIDS
AE: drowsiness, sedation
2nd gen antihistamines
do not cross BBB to same extent as 1st gen, less sedating
Fexofenadine (allegra), Loratadine (Claritin), Certrizine (Zyrtec)
Loratadine (Claritin) AE
somnolence, Dry mouth, pharyngitis, dizziness
certrizine (zytec) AE
viral infection, nausea, HA, drowsiness, dyspepsia
overall antihistamine considerations
Caution in elderly d/t confusion, constipation, dizziness, dry mouth, urinary retention, sedation (1st gen) **beers list
2nd gen antihistamines are ineffective for COUGH d/t COLDs
intranasal antihistamines
azelastine(astepro), olopatadine
intranasal antihistamine AE
Bitter taste, dry mouth, headache, cough, epistaxis, burning
Decongestants for sinusitis
sympathomimetic agents that stimulate alpha and beta receptors causing vasoconstriction
Overall CI: narrow-angle glaucoma, severe uncontrolled hypertension, CAD, recent use of MAOI
Overall AE: HTN, ^ HR, palpitations, insomnia, tremors, urinary retention, gi upset, dizziness
treatment for bronchitis
antitussives, expectorants, and antibiotics(macrocodes) or antivirals if indicated
antitussives
benzonatate (tessalon pearls) or dextromethorphan (delsym)
Community-acquired pneumonia treatment (WITH comorb)
Amox/clav + macrolide, cephalosporin + macrolide OR doxycycline. Fluoroquinolone monotherapy
CAP treatment (WITHOUT comorb)
Without comorbidities: Amoxicillin OR Doxycycline OR azithromycin OR clarithromycin
tamiflu prescribing considerations for flu treatment
Recommended within 48 hours of symptom onset
Can be used for prophylaxis for up to 6 weeks during a community outbreak for high risk persons
Special considerations: dosage adjustment with reduced kidney function
Theophylline adverse events
Tachyarrhythmias, restlessness, insomnia, N/V, GERD, seizures
POTENTIAL FOR LIFE-THREATENING CARDIAC ARRHYTHMIAS
indication for use for leukotriene modifiers
allergies and asthma
(age specific drugs)
Montelukast (singulair) BBW:
serious behavior and mood changes
ages 2+
Zafirlukast (accolte) considerations
ages 7+
Metabolized by CYP450
SE: pharyngitis, headache, rhinitis, gastritis
Rare liver failure- monitor LFTs q2-3 months
Zileuton (zyflow) considerations
age 12+
Metabolized by CYP450
Monitor LFTs before, monthly for 3 months, then q2-3 months
SE: dyspepsia, abd pain, nausea
Increases theophylline levels and PT/INR levels
Asthma quick relief treatment recommendations
8-10 puffs of SABA, may be repeated every 20 minutes fo 1 hour, and then every 3 to 4 hours for the next 24-48 hours or until the patients symptoms are stable
- may need short dose of PO corticosteroid
- if not stable, go to ER
SAMA MOA
short-acting muscarinic agonist
relaxes airway smooth muscle - decreased mucous secretions
GOLD group D recommendations
-Option 1: daily LABA/LAMA
anora-Ellipta, bevespi, Duaklir, Respimat
-Option 2: Daily ICS/LABA
Advair, Breo, Dulera, and Symbicort
-Option 3: Daily ICS/LABA/LAMA, (can add) theophylline, phosphodiesterase 4 inhibitor(roflumilast), macrolide abx
TRELEGY
LABAs/LAMAs
anora-Ellipta, bevespi, Duaklir, Respimat
ICS/LABA combos
Advair, Breo, Dulera, and Symbicort
ICS/LABA/LAMA triple therapy
trelegy
LABA name
servant diskus (salmeterol)
LABA serious side effects
BLACK BOX WARNING: ASTHMA-RELATED DEATH to salmeterol
Serious adverse events for:
thrush, immunosuppression, paradoxical bronchospasm, asthma exacerbation, asthma-related death, laryngospasm, hypersensitivity reaction, anaphylaxis, HTN, Hypotension, angina, cardiac arrest, arrhythmia, hypokalemia, and hyperglycemia.
in asthma, LABA must be used with:
an inhaled corticosteroid (ICS)
Memantine (Namenda) MOA
Blocks activation and overstimulation of NMDA receptor during glutamate abundance → inhibits neuronal degeneration that would otherwise result
Goals of drug therapy for AD
maintain and maximize the patient’s functional ability, quality of life, and independence for as long as possible while minimizing adverse events and cost
main drugs for cognitive symptoms of AD
Cholinesterase inhibitors and memantine
Medications used for non-cognitive symptoms in AD
Antipsychotics –> risperdal, zyprexa
Benzodiazepines –> for anxiety, agitation (lorazepam & alprazolam)
SSRI antidepressants –> depression (Zoloft, lexapro)
Mild-moderate AD disease tx
Cholinesterase inhibitors
Donepezil (exalon), Rivastigmine (razadine), galantamine (aricept)
Moderate-severe AD tx
NMDA receptor antagonist
memantine (Namenda)
Cogentin contraindications
narrow-angle glaucoma
(avoid use with KCl, glucagon, anticholinergics)
Common meds prescribed for management of PD symptoms
Motor symptoms
-anticholinergics (Trihexyphenidyl(artane) or benztropine(cogentin)
-amantadine
-MAO-Bs (selegiline, rasafiline, safinamide)
-Levodopa/carbidopa
-COMTIs (entacopone, tolcapone)
-Dopamine agonists
parkinsons meds non-motor symptoms
depression - venlafaxine, pramipexole
psychosis = clozapine
dementia = rivastigmine, donepezil
insomnia = rotigotine
+ hypotension meds, drooling preventions, stool softeners
MOA of amantadine
its inhibition (NMDA) receptors potentiates dopaminergic responses to reduce PD symptoms
binds/blocks NMDA receptors and increases release of dopamine
MOA of Levodopa
Levodopa is a dopamine precursor, crosses the blood brain barrier and is then converted via decarboxylation to dopamine → stored in presynaptic neurons until stimulated for release
Carbemazepine(tegretol) serious side effects
Black Box Warning: risk of toxic epidermal necrosis/SJS, aplastic anemia, agranulocytosis
Screen for HLA-B*1502 allele ( Asian pts) → increased risk of derm reactions
Other special considerations: inducer of several CYP pathways, pregnancy category D, can lead to hyponatremia in older adults
“Serious but less common adverse events include blood dyscrasias, syndrome of inappropriate diuretic hormone secretion (SIADH), cardiac conduction abnormalities, SJS, and DRESS”
Phenytoin and fosphenytoin adverse effects
AE: lateral nystagmus, ataxia, lethargy, acne, increased body hair, arrhythmia, gingival hyperplasia
Bb warning: IV forms for cardiovascular events with rapid infusion
Serious but less common adverse events include blood dyscrasias (anemia, neutropenia, leukopenia, thrombocytopenia), hepatitis, Stevens-Johnson syndrome (SJS), drug reaction with eosinophilia and systemic syndromes (DRESS), and systemic lupus erythematosus (SLE).
acute treatment of status epilepticus
Benzodiazepines
IV lorazepam (Ativan) 4mg
IV diazepam (valium) 5-10 mg
preventative/prophylactic treatment options for cluster headaches
Verapamil IR - 40-80mg TID
Lithium 300mg BID
Melatonin 10mg every evening
Warfarin (INR 1.5-1.9)
Galcanezumab (emgality)
Preventative/prophylactic treatment for Tension-type headaches
1st line: amitryptiline
2nd line: venlafaxine XR or Mirtazapine
migraine meds for patients with hypertension/essential tremor
Beta-blockers (1st line for migraine prophylaxis)
Propranolol (Inderal)
Metoprolol (Lopressor)
Timolol
migraine meds for patients with hypertension (2nd line)
CCBs - verapamil
Migraine meds for pt with anxiety/depression or post-menopausal hot flashes
venlafaxine XR (SNRI)
migraine med options for patients with regimen adherence issues
Injections! usually monthly - CGRP receptor antagonists - a 2nd line ppx
-amovig, ajovy, emgality, vyepti
2nd line treatment for migraines
Triptans (suma, zolmi, riza, ele, frova)
Ditans (Lasmiditan - reyvow)
CGRP receptor antagonist (ubrelvy, nurtec)
Ergot derivatives (ergomar, migranal, cafergot)
Barbiturates (fioricet, forinal)
opioids (tramadol, butorphanol)
decadron
antiemetics
Contraindications to triptan therapy
- not indicated for use in children <12
- not okay in pregnancy
- avoid in patients with CAD, cerebrovascular disease, severe PVD; basilar, hemiplegic or retinal migraines
- not used more than 9 days per month
Medication overuse headache treatment
withhold all OTC analgesics for 2 weeks - should go away
diagnosis of medication overuse headache
when using OTC analgesic for either migraine or TTH headache more than 2x per week, and it causes a chronic daily headache
important education regarding bisphosphonate therapy
-AM dosing on empty stomach
-must be taken whole with 8oz of water - stay upright for 30 min-1hr
-omit in patients with GERD
-monitor with DEXA scans; consider drug holiday if scans are good
acute gout treatment recs
1st line:
-Colchicine + NSAID
- Oral corticosteroid + Colchicine
-intraarticular steroid + NSAID
NSAIDS
Systemic corticosteroids
rheumatoid arthritis bridging treatment
NSAIDS or corticosteroids in an acute episode until DMARDS are therapeutic
ex. glucocorticoids (prednisone)
DMARD name for RA tx
methotrexate
treatment of fibromyalgia
SNRIs (Duloxetine, milnacipran, venlafaxine)
SSRIs (prozac, Zoloft, lexapro)
tricyclics
CBT, exercise
Psoriasis treatment considerations with Coal tar
MOA: depresses DNA synthesis with anitinflammatory & antipruritic properties
Used for 30-45 days, 3-7x per week
Cons: odor, staining, photosensitivity (wear sunscreen), folliculitis
Herpes zoster (shingles) treatment options
Acyclovir, famciclovir(highest bioavailability), valacyclovir
contraindications to Terbinafine/lamisil for toenail fungus (tinea unguium)
AE: elevation in AST/ALTs, diarrhea, dyspepsia, rash, HA
Check LFTs before initiation and 6-8 weeks after initiation
CI: in chronic liver disease and those with CrCl<50
Role of contraceptives in acne treatment
Oral contraceptives that contain ethinyl estradiol, levonorgestrel, and norgestimate or drospirenone. Effective due to a decrease in testosterone production.
Impetigo treatment 1st line
Topical mupirocin ointment TID 7-10 days
Plus oral abx 7-10 days
Broad spectrum penicillin (augmentin or dicloxacillin) OR
1st gen cephalosporin (keflex)
—If PCN allergy - use clindamycin
Considerations for prescribing clotrimazole/lotrim cream for cutaneous candidiasis
Contraindications: pregnancy/lactation (HF risk)
Continue 1 week after infection clears
Common side effects: pruritis, irritation, stinging
Considerations for prescribing systemic corticosteroids for contact dermatitis
contraindicated in patients with systemic mycoses and in patients receiving a vaccination
These drugs also should be used cautiously in people with tuberculosis, hypothyroidism, cirrhosis, renal insufficiency, hypertension, osteoporosis, and diabetes mellitus
Prescribed as a tapering dose
Take in the morning to minimize insomnia
- prescribed when dermatitis is widespread or resistant to topical preparations
treatment of dermatitis on the face and intertriginous areas
use low potency steroids on the thin skin
ex. Hydrocortisone 1%, Alcovate or Synalar cream
+ pimecrolimus (elidel)
Accutane Prescribing considerations
Teratogenic - must register users in SMART system - 2 forms of birth control
only 30 days prescribed at a time
check labs before initiating, can elevate triglycerides
AE: dry mucous membranes, musculoskeletal aches
BB warning: increased SI and aggressive behaviors
1st line treatment for acne
-retinoic acid (tretinoin, Retin-A)
-Adapalene gel (Differin)
-Tazarotene gel (tazorac)
or benzoyl peroxide, azelex, clindamycin, erythromycin
superficial MRSA infection treatment
Mupirocin (Bactroban) in nostrils/superficial wounds
Trimethoprim-sulfamethoxazole (Bactrim), minocycline, clindamycin, or linezolid
Systemic MRSA tx
Vancomycin, Daptomycin, Telavancin, Dalbavancin, Oritavancin, Linezolid, Tedizolid, and Tigecycline
topical preparation absorption rates
Creams: most desirable, least effective
ointments/gels: most potent/lubricating
lotions/sprays: good for widespread areas and scalp
Rosacea first-line treatment recommendations
topical therapy
-Metronidazole
-Sodium Sulfacetamide
-Azelaic Acid BID
Rosacea 2nd line treatment
adding an oral antibiotic to the topical therapy, after 2 weeks starting to tape back down to just topical tx
(tetracycline, doxycycline, erythromycin, bactrim)
Dopamine agonists
pramipexole (mirapex), Ropinirole (requip), Rotigotine (neupro), Apomorphine (apokyn)
COMTIs
entacopone (Comtan), tocapone (tasmar)
MAOBs
selegiline (Eldepryl), Rasagiline (azilect), Safinamide (xadago)
