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KEY DRUGS/FACTS/ETC Flashcards

1
Q

where do thiazide diuretics work at

A

distal convoluted tubule

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2
Q

where do K-sparing diuretics work at

A

distal convoluting tubule & collecting duct

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3
Q

where do SGLT2 inhibitors work at

A

proximal tubule

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4
Q

where do loop diuretics work at

A

ascending loop of Henle

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5
Q

key drugs that cause kidney disease

A

AMGs
AmpB
Cisplatin
Cyclosporine
Loop diuretics
NSAIDs
Polymyxins
Radiographic contrast dye
Tacrolimus
Vancomycin

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6
Q

key drugs that need ↓dose or↑interval in CKD

A

Anti-Infectives
- Aminoglycosides [↑dosing interval primarily]
- Beta-lactam antibiotics [except antistaphylococcal penicillins & ceftriaxone]
- Fluconazole
- Quinolones [except moxifloxacin]
- Vancomycin
Cardiovascular Drugs
- LMWHs [enoxaparin]
- Rivaroxaban [for AF]
- Apixaban [for AF]
- Dabigatran [for AF]
Gastrointestinal Drugs
- H2RAs [famotidine, ranitidine]
- Metoclopramide
Other
- Bisphosphonates
- Lithium

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7
Q

key drugs that are CI in CKD

A

CrCl <60 mL/min
- Nitrofurantoin
CrCl <50 mL/min
- TDF-containing products [Atripla, Complera, Delstrigo, Stribild, Symfi, Symfi Lo]
- Do not start stribild if <70 mL/min
- Voriconazole IV [due to vehicle]
CrCl <30 mL/min
- TAF-containing products [Biktarvy, Descovy, Genvoya, Odefsey, Symtuza]
- NSAIDs
- Dabigatran [DVT/PE]
- Rivaroxaban [DVT/PE]
GFR <30 mL/min/1.73m2
- SGLT2-i
- Metformin [don’t start if ≤45]
Other
- Meperidine

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8
Q

what level Hgb is considered anemia

A

<13 g/dL

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9
Q

key drugs that raise K+ levels

A

ACE-I
Aldosterone receptor antagonists
Aliskiren
ARBs
Canagliflozin
Drospirenone-containing COCs
Potassium-containing IV fluids [including parenteral nutrition]
Potassium supplements
SMX/TMP
Transplant drugs [cyclosporine, everolimus, tacrolimus]

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10
Q

mavyret

A

glecaprevir/pibrentasvir

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11
Q

epclusa

A

sofosbuvir/velpatasvir

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12
Q

key drugs with BBW for liver damage

A

APAP [high doses, acute or chronic]
Amiodarone
Isoniazid
Ketoconazole [oral]
Methotrexate
Nefazodone
NRTIs
Propylthiouracil
Valproic acid

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13
Q

common pathogens for cns/menigitis ifx

A

Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Group B Streptococcus/E. Coli (young)
Listeria (young/old)

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14
Q

common pathogens for mouth ifx

A

Mouth flora (Peptostreptococcus)
Anaerobic GNR (Prevotella, others)
Viridans group Streptococci

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15
Q

common pathogens for upper respiratory ifx

A

Streptococcus pyogenes
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

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16
Q

common pathogens for lower respiratory [community] ifx

A

Streptococcus pneumoniae
Haemophilus influenzae
Atypicals: Legionella, Mycoplasma, Chlamydophilia
Enteric GNR (alcoholics)

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17
Q

common pathogens for lower respiratory [hospital] ifx

A

Staphylococcus aureus, including MRSA
Pseudomonas aeruginosa
Acinetobacter baumannii
Enteric GNR (including ESBL, MDR)
Streptococcus pneumoniae

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18
Q

common pathogens for heart/endocarditis ifx

A

Staphylococcus aureus, including MRSA
Staphylococcus epidermidis
Streptococci
Enterococci

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19
Q

common pathogens for intra-abdominal ifx

A

Enteric GNR
Enterococci/Streptococci
Bacteroides species

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20
Q

common pathogens for skin/soft tissue ifx

A

Staphylococcus aureus
Streptococcus pyogenes
Staphylococcus epidermidis
Pasteurella multocida ± aerobic/anaerobic GNR (in diabetes)

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21
Q

common pathogens for urinary tract ifx

A

E. coli, Proteus, Klebsiella
Staphylococcus saprophyticus
Enterococci

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22
Q

common pathogens for bone/joint ifx

A

Staphylococcus aureus
Staphylococcus epidermidis
Streptococci
Neisseria gonorrhoeae
GNR (only in specific situations)

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23
Q

common resistant pathogens

A

Kill Each And Every Strong Pathogen
Klebsiella pneumoniae [ESBL, CRE]
Escherichia coli [ESBL, CRE]
Acinetobacter baumannii
Enterococcus faecalis, Enterococcus faecium [VRE]
Staphylococcus aureus [MRSA]
Pseudomonas aeruginosa

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24
Q

hydrophilic ABX

A

beta-lactams
AMGs
vancomycin
daptomycin
polymyxins

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25
Q

hydrophilic ABX characteristics

A

small Vd
renal elimination
low intracellular concentrations
increased clearance
poor-moderate bioavailability

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26
Q

lipophilic ABX

A

quinolones
macrolides
rifampin
linezolid
tetracyclines

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27
Q

lipophilic ABX characteristics

A

large Vd
hepatic metabolism
intracellular concentrations
clearance/distribution is charged minimally in sepsis
excellent bioavailability

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28
Q

concentration-dependent ABX

A

AMGs, quinolones, daptomycin

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29
Q

time-dependent ABX

A

beta-lactams

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30
Q

exposure-dependent ABX

A

vancomycin, macrolides, tetracyclines, polymyxins

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31
Q

first line antihypertensive for CKD, HTN & albuminuria

A

ACE-I or ARB

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32
Q

first line trx for CKD, T2DM & eGFR ≥30

A

metformin + SGLLT2-i

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33
Q

trx for hyperphosphatemia

A
  • restrict dietary phos
  • phosphate binders
    • aluminum-based: aluminum hydroxide
    • calcium-based [1st line]: calcium acetate
    • aluminum-free, calcium-free: sucroferric oxyhydroxude, ferric citrate, lanthanum carbonate [Fosrenol], sevelamer carbonate [Renvela], sevelamer hydrochloride [Renagel]
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34
Q

trx for secondary hyperparathyroidism

A
  • vitamin D analogs: calcitriol, califediol, doxercalciferol, paricalcitol
  • calcimimetic: cinacalcet [Sensipar], etecalcetide [Parsabiv]
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35
Q

trx for anemia of CKD

A
  • ESAs: epoetin [Procrit, Epogen, Retacrit], darbepoietin [Aranesp]
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36
Q

trx for hyperkalemia

A
  • sodium polystyrene sulfonate [SPS, Kayexalate]
  • patiromer [Veltassa]
  • sodium zirconium cyclosilicate [Lokelma]
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37
Q

trx for severe hyperkalemia

A
  • stabilize heart: calcium gluconate
  • move it [shift intracellularly]: regular insulin, dextrose, sodium bicarb, albuterol
  • remove it [furosemide, kayexalate, patiromer, HD
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38
Q

trx for metabolis acidosis

A

sodium bicarbonate
sodium citrate

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39
Q

trx for hepA

A

supportive

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40
Q

trx for hepB

A

PEG-INF or NRTI [pref tenofovir or entecavir]

NRTIs:
- tenofovir disoproxil [Viread]
- tenofovir alafenamide [Vemlidy]
- entecavir [Baraclude]
- lamivudine [Epivir HBV]
- adefovir [Hepsera]

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41
Q

trx for hepC

A
  • DAA combination + RBV
  • DAA combination + RBV + PEG-INF

DAAs:
*pref Mavyret or Epclusa
- glecaprevir/pibrentasvir [Mayvet]
- sofosbuvir/velpatasvir [Epclusa]
- sofosbuvir/ledipasvir [Harvoni]
- sofosbuvir/velpatasvir/voxilaprevir [Vosevi]
- sofosbuvir [Sovaldi]
- paritaprevir/ritonavir/ombitasvir + dasabuvir [Viekira Pak]
- elbasavir/grazoprevir [Zepatier]

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42
Q

tenofovir disoproxil fumarate [TDF]

A

Viread

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43
Q

tenofovir alanafenamide [TAF]

A

Vemlidy

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44
Q

entecavir

A

Baraclude

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45
Q

trx for alcohol-associated liver disease

A
  • alcohol cessation
  • inpatient: BZD
  • outpatient: AED
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46
Q

trx for portal hypertension & variceal bleeding

A
  • band ligation or sclerotherapy [first line]
  • octreotide [selective]
  • vasopressin [non-selective]
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47
Q

trx for hepatic encephalopathy

A
  • 1st line: lactulose
  • 2nd line: rifaximin
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48
Q

trx for ascites

A
  • spironolactone monotherapy -> 50-100mg/day, increased to max 400mg/day
  • furosemide 40mg + spironolactone 100mg
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49
Q

trx for spontaneous bacterial peritonitis

A
  • ceftriaxone
  • alt: amp, genta or FQ
  • ppx: bactrim, ofloxacin or cipro
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50
Q

trx for hepatorenal syndrone

A

albumin, octreotide & midodrine

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51
Q

abx for surgery ppx [cardiac, orthopedic, vascular]

A
  • cefazolin
  • alt: clinda or vanco
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52
Q

abx for surgery ppx [GI]

A
  • cefazolin + flagyl, cefoxitin, cefotetan or unasyn
  • alt: clinda, AMG + flagyl, or FQ + flagyl
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53
Q

abx for surgery ppx [genitourinary]

A
  • cipro or bactrim
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54
Q

trx for meningitis

A
  • <1 month: ampicillin + cefotaxime or gentamicin
  • 1 month - 50 years: ceftriaxone [or cefotaxime] + vanco
  • > 50 years or immunocompromised: ampicillin + ceftriaxone [or cefotaxime] + vanco
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55
Q

trx for acute otitis media

A
  • 1st line: high dose amoxicillin or augmentin - 90mg/kg/day of amox in 2 divided doses
  • non-severe PCN allergy: 2nd or 3rd gen cephalosporin [cefdinir, cefuroxime, cefpodoxime]
  • trx failure: augmentin or CTX IM QD x3 days
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56
Q

trx for acute bronchitis

A

abx not recommended

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57
Q

trx for acute bacterial exacerbation of COPD

A
  • 1st line: augmentin
  • others: azithromycin, doxy, respiratory FQ
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58
Q

trx for outpatient CAP

A

healthy pts:
- amoxicillin high dose
- doxy
- macrolide

high-risk pts:
- beta-lactam + macrolide or doxy
- respiratory FQ

*beta-lactam: augmentin, cefpodozime, or cefuroxime
*respiratory FQ: moxi, levo, gemi

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59
Q

trx for inpatient CAP

A

nonsevere
- beta-lactam + macrolide or doxy
- CTX, cefotaxmine, unasyn
- respiratory FQ

severe:
- beta-lactam + macrolide
- beta-lactam + respiratory quinolone

*MRSA: vanco or line
*PSA: zosyn, cefepime, ceftazidime, imipenem/cilastatin or meropenem

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60
Q

trx for HAP/VAP

A

no MRSA or MDRO risk:
- beta-lactam

MRSA risk but no MDRO risk:
- anti-PSA + vanco/line

MRSA & MDRO risk:
- 2 anti-PSA + vanco/line

*PSA: cefepime, zosyn, imipenem/cilastatin, meropenem, aztreonam, cipro, levo, AMGs

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61
Q

trx for latent TB

A
  • INH + rifapentine once weekly x12 weeks via ODT
  • INH + rifampin QD x3 months
  • rifampin QD x4 months
  • INH QD x6-9 months
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62
Q

trx for active TB

A

intensive phase [2 months]:
- rifampin + INH + pyrazinamide + ethambutol

continuous phase [4 months]:
- rifampin + INH

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63
Q

trx for infective endocarditis

A

empiric:
- vanco + CTX

viridans strep:
- PCN or CTX
- PCN allergy: vanco

enterococci:
- PCN or amp + gentamicin
- alt: amp + HD CTX
- beta-lactam allergy: vanco genta
- VRE: dapto or line

staphylococci:
- MSSA: naf, oxa, cefazolin
- MRSA or beta-lactam allergy: vanco or dapto
- prosthetic valve: add rifampin + genta

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64
Q

abx for infective endocarditis dental ppx

A
  • 1st line: amox 2g PO
  • NPO: amp 2g IM/IV or cefazolin 1g IM/IV
  • PCN allergy: azithromycin or clarithromycin 500mg PO, doxy 100mg PO
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65
Q

trx for impetigo

A
  • topical abx like mupirocin
  • cephalexin if numerous lesions
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66
Q

trx for folliculitis/furuncles/carbuncles

A
  • systemic signs: cephalexin
  • non-responsive: bactrim or doxy
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67
Q

trx for cellulitis

A
  • cephalexin
  • clindamycin
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68
Q

trx for mild-mod purulent ssti

A
  • I&D
  • bactrim, doxy, mino or clinda
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69
Q

trx for severe purulent SSTI

A
  • vanco
  • dapto
  • line
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70
Q

trx for necrotizing fasciitis

A
  • vanco + beta-lactam [zosyn, imipenem/cilastatin or meropenem]
  • clinda
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71
Q

trx for diabetic foot ifx

A

monotherapy [MSSA]:
- unasyn, zosyn, carbapenem or moxi

combo therapy [MRSA & PSA]:
- vanco
- ceftazidime, cefepime, zosyn, aztreonam or carbapenem [no erta]

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72
Q

trx for acute uncomplicated cystitis

A
  • nitrofurantoin [Macrobid] 100mg PO BID x5 days
  • bactrim DS 1 tab PO BID x3 days
  • fosfomycin x1 dose

pregnant:
- amoxicillin
- cephalexin

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73
Q

trx for acute pyelonephritis

A

moderately ill outpatient
- cipro or levo
- CTX, erta or AMG x1 then FQ
- bactrim
- beta-lactam [augmentin, cefidinir, cefadroxil, cefpodoxime]

severely ill inpatient:
- CTX, zosyn, quinolone or carbapenem

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74
Q

trx for complicated UTI

A
  • similar for pyelo trx
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75
Q

trx for c.diff

A
  • fidaxomicin
  • PO vanco
  • flagyl
  • bezlotoxumab [only to decrease risk of recurrence, doesn’t treat active c.diff]
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76
Q

trx for traveler’s diarrhea

A

dysentery, fever, pregnancy or pediatric:
- azithromycin

no dysentery:
- quinolones x1-3 days
- rifaximin x3 days

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77
Q

trx of syphilis

A
  • penicillin B, benzathine [Bicillin L-A] 1.4 million units IM
  • primary, secondary or early latent: x1 month
  • late latent or early: x3 weeks
  • alt: doxy
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78
Q

trx for neurosyphilis

A
  • penicillin G aqueous IV
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79
Q

trx for gonorrhea

A
  • CTX 500mg IM x1 [<150kg]
  • add doxy if chlamydia not excluded
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80
Q

trx for chlamydia

A
  • doxy 100mg PO BID x7 days
  • pregnant: azithro 1g PO x1
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81
Q

trx for bacterial vaginosis

A
  • flagyl
  • flagyl 0.75% gel
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82
Q

trx for trichomoniasis

A
  • flagyl
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83
Q

trx for genital warts

A
  • imiquimod cream
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84
Q

trx for rocky mountain spotted fever

A
  • doxy [DOC even in peds]
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85
Q

trx for typhus

A
  • doxy
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86
Q

trx for lyme disease

A
  • doxy
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87
Q

trx for ehrlichiosis

A
  • doxy
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88
Q

trx for tularemia

A
  • genta or tobra
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89
Q

trx for invasive cryptococcal meningitis

A

ampB + flucytosine

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90
Q

which azole needs renal dose adjustment

A

fluconazole

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91
Q

IV to PO for azoles

A

IV:PO = 1:1

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92
Q

does isavuconium cause QT prolongation

A

no, QT shortening

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93
Q

trx for oropharyngeal ifx [candida albicans]

A

mild: topical antifungal
mod-severe: fluconazole

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94
Q

trx for esophageal ifx [candida albicans]

A

fluconazole

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95
Q

trx for candida krusei & glabrata, all bloodstream ifx

A

echinocandin

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96
Q

trx for aspergillus

A

voriconazole

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97
Q

trx for dermatophyles [nail bed ifx]

A

terbinafine or itraconazole

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98
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
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99
Q

topical trx for herpes labialis

A
  • docosanol [Abreva] OTC 5x daily at first sign of outbreak
  • acyclovir [Zovirax] Rx 5x daily x4 days
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100
Q

systemic trx for herpes labialis

A
  • acyclovir
  • valacyclovir
  • famciclovir
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101
Q

trx for genital herpes in non-HIV

A
  • acyclovir
  • valacyclovir
  • famciclovir
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102
Q

trx for herpes zoster

A
  • acyclovir x7 days
  • valacyclovir x7 days
  • famciclovir x7 days
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103
Q

trx for cytomegalovirus

A
  • ganciclovir
  • valganciclovir
  • cidofovir
  • foscarnet [CMV retinitis, resistant HIV]
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104
Q

ppx for pneucystic jirovecii pneumonia [PJP/PCP]

A
  • CD4 <200 cells/mm3
  • pref: bactrim DS QD
  • alt:
    • dapsone
    • dapsone + pyrimethamine + leucovorin
    • atovaquone

*stop when CD4 >200 for >3 months

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105
Q

ppx for toxoplasma gondii encephalitis

A
  • CD4 <100 cells/mm3
  • pref: bactrim DS QD
  • alt:
    • dapsone + pyrimethamine + leucovorin
    • atovaquone
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106
Q

ppx for mycobacterium avium complex [MAC]

A
  • if not on ART & CD4 <50
  • pref: azithromycin 1200mg weekly

stop if pt taking fully suppressive ART

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107
Q

MOA of maraviroc

A
  • CCR5 antagonist
  • stage 1
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108
Q

MOA of fostemsavir

A
  • attachment inhibitor
  • stage 1
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109
Q

MOA of ibalizumab-uiyk

A
  • post-attachment inhibitor
  • stage 1
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110
Q

MOA of enfuvirtide

A
  • fusion inhibitor
  • stage 2
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111
Q

MOA of NRTIs

A
  • nucleoside reverse transcriptase inhibitors
  • stage 3
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112
Q

MOA of NNRTIs

A
  • non-nucleoside reverse transcriptase inhibitors
  • stage 3
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113
Q

MOA of INSTIs

A
  • integrase strand reverse inhibitors
  • stage 4
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114
Q

MOA of PIs

A
  • protease inhibitors
  • stage 7
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115
Q

pgx test for abacavir

A

HLA-B*5701

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116
Q

pgx test for maraviroc

A

tropism assay

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117
Q

NRTIs

A

Abacavir [Ziagen]
Emtricitabine [Emtriva]
Lamivudine [Epivir]
Tenofovir disoproxil fumarate [Viread]
Tenofovir alafenamide [only in combo for HIV drugs, Vemlidy is single drug for HBV]
Zidovudine [Retrovir]

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118
Q

NNRTIs

A

Efavirenz [Sustiva]
Rilpivirine [Edurant]
Doravirine [Pifeltro]
Etravirine [Intelence]
Nevirapine [Viramune XR]
Delavirdine [no longer recommended]

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119
Q

INSTIs

A

Bictegravir [only in combo Biktarvy]
Cabotegravir [Vocabra, Apretude]
Dolutegravir [Tivicay]
Elvitegravir [only in combo Genvoya & Stribild]
Raltegravir [Isentress, Isentress HD]

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120
Q

PIs

A

Atazanavir [Reyataz]
Darunavir [Prezista]
Fosamprenavir [Lexiva]
lopinavir/ritonavir [Kaletra]
Saquinavir [Invirase]
Tipranavir [Aptivus]
Indinavir [no longer recommended]
Nelfinavir [no longer recommended]

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121
Q

PK boosters

A

Ritonavir [Norvir] → difficult to co-formulate
Cobicistat [Tybost] → can be co-formulated

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122
Q

INSTI-based combo pills

A

Biktarvy: bictegravir/emtricitabine/tenofovir alafenamide
Cabenuva: cabotegravir/rilpivirine
Triumeq: dolutegravir/abacavir/lamivudine
Dovato: dolutegravir/lamivudine
Juluca: dolutegravir/rilpivirine
Stribild: elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate
Genvoya: elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide

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123
Q

NNRTI-based combo pills

A

Delstrigo: doravirine/lamivudine/tenofovir disoproxil fumarate
Atripla: efavirenz/emtricitabine/tenofovir disoproxil fumarate
Symfi, Symfi Lo: efavirenz/lamivudine/tenofovir disoproxil fumarate
Complera: rilpivirine/emtricitabine/tenofovir disoproxil fumarate
Odefsey: rilpivirine/emtricitabine/tenofovir alafenamide

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124
Q

PI-based combo pills

A

Symtuza: darunavir/cobicistat/emtricitabine/tenofovir alafenamide

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125
Q

NRTI-based combo pills

A

Epzicom: abacavir/lamivudine
Trizivir: abacavir/lamivudine/zidovudine
Descovy: emtricitabine/tenofovir alafenamide
Truvada: emtricitabine/tenofovir disoproxil fumarate
Combivir: lamivudine/zidovudine
Cimduo: lamivudine/tenofovir disoproxil fumarate

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126
Q

PrEP regimen

A

truvada or descovy

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127
Q

PEP regimen

A

truvada + dolutegravir [Tivicay] or raltegravir [Isentress]

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128
Q

key abx w/ no renal dose adjustments

A

Antistaphylococcal penicillins [dicloxacillin, nafcillin]
Ceftriaxone
Clindamycin
Doxcycline
Macrolides [azithromycin & erythromycin only]
Metronidazole
Moxifloxacin
Linezolid

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129
Q

trx for hypotonic HYPERvolemic hyponatremia

A

diuresis with fluid restriction

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130
Q

trx for hypotonic ISOvolemic hyponatremia

A

diuresis, fluid restriction
- demeclocycline off-label for SIADH
- arginine vasopressin [AVP] receptor antagonists: conivaptan & tolvapan

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131
Q

trx for hypotonic HYPOvolemic hyponatremia

A
  • hypotonic NaCl if severe symptoms and/or Na <120
  • add desmopressin to reduce water diuresis & avoid overcorrection
  • arginine vasopressin [AVP] receptor antagonists: conivaptan & tolvapan
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132
Q

trx for HYPOvolemic hypernatremia

A

fluids

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133
Q

trx for HYPERvolemic hypernatremia

A

diuresis

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134
Q

trx for ISOvolemic hypernatremia

A

desmopressin

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135
Q

what is the max infusion rate & concentration for IV KCl peripherally

A

max rate: ≤10 mEq/hr
max conc: 10mEq/100mL

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136
Q

MOA of phenylephrine

A

alpha-agonist that increases SVR w/o increasing HR

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137
Q

MOA of Epi & NE

A

mixed alpha & beta-agonists -> increase SVR, CO & HR

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138
Q

MOA of DA

A

Low [renal] dose: 1-4 mcg/kg/min → dopamine-1 agonist → renal vasodilation
Medium dose: 5-10 mcg/kg/min → beta-1 agonist → positive inotropic
High dose: 10-20 mcg/kg/min → alpha-1 agonist → vasopressor effects

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139
Q

MOA of vasopressin

A

acts directly on vasopressin receptors

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140
Q

MOA of AngII

A

increases BP by vasoconstriction & aldosterone release

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141
Q

trx of extravasation of vasopressors

A

phentolamine [alpha-1 blocker]

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142
Q

trx of thiocyanate toxicity

A

hydroxycobalamin

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143
Q

trx of cyanide toxicity

A

sodium thiosulfate + sodium nitrate

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144
Q

MOA of nitroprusside

A

mixed arterial & venous vasodilator

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145
Q

MOA of dobutamine

A
  • beta-1 agonist [increase contractility]
  • weak beta-2 agonist [vasodilation]
  • weak alpha-1 agonist
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146
Q

MOA of milrinone

A
  • selective PDE-3 inhibitor
  • inotrope w/ significant vasodilation
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147
Q

trx for hypovolemic shock

A

fluid resuscitation w/ crystalloids

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148
Q

trx or septic shock

A
  • fluid resuscitation w/ IV crystalloids + broad-spectrum ABX
  • alpha-1 agonist to ↑SVR
  • beta-1 agonist to ↑myocardial contractility & CO
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149
Q

MAP formula

A

MAP =[(2 * DBP) + SBP]/3

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150
Q

trx of cardiogenic shock

A

diuretics & IV vasodilators

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151
Q

trx of ADHF

A
  • volume overload: loop diuretics
  • hypoperfusion: inotropes [milrinone, dobutamine]
    • add vasodilator if hypotensive: DA, NE or phenylephrine
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152
Q

trx of hypoperfusion

A
  • dobutamine
  • milrinone
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153
Q

trx for agitation & sedation

A
  • BZDs
  • non-BZDs [propofol or dexmedetomidine]
    • dexmedetomidine [Precedex]: for both intubated & non-intubated pts
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154
Q

when to seek urgent care for a child

A
  • <3 months with a temp of 100.4°F/38°C [rectal]
  • 3-6 months with a temp of 101°F/38.3°C [rectal]
  • > 6 months with a temp of 103°F/39.4°C [rectal]
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155
Q

standard meds given at birth

A
  • IM vit K
  • opthalmic erythromycin
  • first dose of HepB vaccine
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156
Q

trx for PDA

A
  • NSAIDs: IV indomethacin or ibuprofen
  • APAP
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157
Q

trx for persistent pulmonary HTN of newborns

A
  • inhaled nitric oxide
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158
Q

trx for respiratory distress syndrome

A
  • poractant alfa [Curosurf]
    calfactant [Infasurf]
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159
Q

trx for croup

A
  • dexamethasone 0.6mg/kg
  • nebulized racemic Epi [adrenergic agonist for bronchodilation]
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160
Q

trx for nocturnal enuresis

A
  • desmopressin
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161
Q

trx for cystic fibrosis

A
  1. Inhaled bronchodilators [i.e. albuterol] → to open airways
  2. Hypertonic saline [e.g. HyperSol] → to move mucus to improve airway clearance
  3. Dornase alfa [Pulmozyme] → to decrease viscosity of mucus to promote airway clearance
  4. Chest physiotherapy → to move mucus to improve airway clearance
  5. Inhaled ABX → controls airway infection
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161
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
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162
Q

trx for intermittent ifx in CF

A
  • 2 IV anti-PSA ABX x2-4 weeks
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163
Q

trx for chronic ifx in CF

A
  • inhaled ABX [aztreonam Q8H or tobramycin Q12H] 28 days on, 28 days off
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164
Q

which CTFR modulator cannot be used in homozygous F508del mutation

A

ivacaftor

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165
Q

MOA of ivacaftor

A
  • CFTR modulator that increases the time CFTR channels stay open
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166
Q

MOA of lumacaftor, texacaftro & elexacaftor

A
  • CFTR modulators that increase amount of CFTR delivered to cell surface
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167
Q

induction immunosuppression trx

A

IV med [polyclonal or monoclonal antibody] + HD IV steroids

  • monoclonal antibody: alemtuzumab (T-lymphocyte depleting) & basiliximab (T-lymphocyte non-depleting)
  • polyclonal antibody: antithymocyte globulin [Algam (equine) & Thymoglobumin (rabbit)]
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168
Q

maintenance immunosupression trx

A

calcineurin inhibitor + antiproliferative +/- steroids

CNIs:
- tacrolimus [1st line]
- cyclosporine
antiproliferative:
- mycophenolate [1st line]
- azathioprine
- mTOR inhibitors: everolimus, sirolimus
steroids:
- prednisone

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169
Q

trx for acute rejection

A

HD steroids + increased levels of maintenance immunosuppression

antibody-mediated: plasmapheresis, IVIG & steroids, then rituximab

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170
Q

key drugs that cause weight gain

A

Antipsychotics [clozapine, olanzapine, risperidone, quetiapine]
Diabetes drugs [insulin, meglitinides, sulfonylureas, TZDs]
Divalproex/VPA
Gabapentin, pregabalin
Lithium
Mirtazapine
Steroids
TCAs [aitriptyline, nortriptyline]
Conditions: hypothyroidism

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171
Q

key drugs that cause weight loss

A

ADHD drugs [amphetamine, methylphenidate]
Bupropion
GLP-1 agonists [exenatide, liraglutide]
Pramlintide
Roflumilast
SGLT2-Is
Topiramate
Conditions: hyperthyroidism, celiac disease, IBD

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172
Q

breast cancer screening

A

45-54 years: begin yearly mammogram
≥55 years: mammogram Q2 years or continue yearly

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173
Q

cervical cancer screening

A

21-29 years: pap smear Q3 years
30-65 years: pap smear + HPV

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174
Q

colon cancer screening

A

≥45 years: stool-based tests, visual exams [colonoscopy Q10 years, sigmoidoscopy Q5 years]

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175
Q

lung cancer screening

A

55-74 years: CT chest IF
- good health
- 30 pack-year smoking history
- still smoking or quit in past 15 years

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176
Q

prostate cancer screening

A

> 50 years: PSA +/- DRE

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177
Q

max dose of bleomycin

A

lifetime cumulative dose of 400 units

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178
Q

max dose of doxorubicin

A

lifetime cumulative dose 450-550 mg/m2

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179
Q

max dose of cisplatin

A

max 100mg/m2 per cycle

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180
Q

max dose of vincristine

A

2mg max per dose

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181
Q

chemo drugs that cause myelosuppression

A

Almost all chemotherapy drugs except asparaginase, bleomycin, vincristine, most mAbs, many TKIs

trx:
- neutropenia: CSFs
- anemia: ESAs [palliative only], RBC transfusions
- thrombocytopenia: platelet transfusions

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182
Q

chemo drugs that cause N/V

A

Cisplatin, cyclophosphamide, ifosfamide, doxorubicin, epirubicin

trx: NK1-RA, 5HT3-RA, dexamethasone,

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183
Q

chemo drugs that cause mucositis

trx: symptomatic trx

A

Fluorouracil, methotrexate, capecitabine, irinotecan, many TKIs

trx: symptomatic trx

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184
Q

chemo drugs that cause diarrhea

A

Irinotecan, capecitabine, fluorouracil, methotrexate, many TKIs

trx:
- IV/PO fluid hydration, antimotility medications [e.g. loperamide]
- Irinotecan: atropine for early-onset diarrhea

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185
Q

chemo drugs that cause constipation

A

Vincristine, pomalidomide, thalidomide

trx: stimulant laxatives, PEG 3350

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186
Q

chemo drugs that cause xerostomia

A

radiation therapy

trx: artificial saliva substitutes, pilocarpine

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187
Q

chemo drugs that cause cardiotoxicity

A

Cardiomyopathy:
Anthracyclines, HER2 inhibitors [ado-trastuzumab, trastuzumab, pertuzumab, lapatinib, fluorouracil]

trx: dexrazoxane for doxorubicin

QT prolongation:
Arsenic trioxide, many TKIs, leuprolide

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188
Q

chemo drugs that cause pulmonary toxicity

A

Pulmonary fibrosis
Bleomycin, busulfan, carmustine, lomustine

Pneumonitis
Methotrexate [with chronic use] & mAbs targeting CTLA-4 or PD-1

trx: steroids

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189
Q

chemo drugs that cause hepatotoxicity

A

Antiandrogens [bicalutamide, flutamide, nilutamide], folate antimetabolites [e.g. methotrexate], pyrimidine analog antimetabolites [e.g. cytarabine], many TKIs, some mAbs

trx: symptomatic management

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190
Q

chemo drugs that cause nephrotoxicity

A

Cisplatin
Methotrexate [high doses], pemetrexed, pralatrexate, some mAbs

trx:
- amifostine [Ethyol] for cisplatin

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191
Q

chemo drugs that cause hemorrhagic cystitis

A

Ifosfamide [all doses], cyclophosphamide [higher doses >1 g/m2]

  • mesna [Mesnex] for ifosfamide [always] & cyclophosphamide [sometimes]
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192
Q

chemo drugs that cause neuropathy

A

Peripheral Neuropathy
Vinca alkaloids [vincristine, vinblastine, vinorelbine]
Platinums [cisplatin, oxaliplatin]
Taxanes [paclitaxel, docetaxel, cabazitaxel]
Proteosome inhibitors [bortezomib, carfilzomib], thalidomide, ado-trastuzumab, cytarabine [high doses], brentuxmab

trx:
- avoid cold things w/ oxaliplatin

Autonomic Neuropathy
Vinca alkaloids

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193
Q

chemo drugs that cause thromboembolic risk

A

Aromatase inhibitors [e.g. anastrozole, letrozole], SERMs [e.g. tamoxifen, raloxifene], immunomodulators [thalidomide, lenalidomide, pomalidomide]

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194
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
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195
Q

adjunctive therapy for cisplatin

A

amifostine [Ethyol] & hydration

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196
Q

adjunctive therapy for doxorubicin

A

dexrazoxane [Tofect]

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197
Q

adjunctive therapy for fluorouracil

A

leucovorin or levoleucovorin

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198
Q

adjunctive therapy for fluorouracil or capecitabine

A

uridine triacetate [use within 96 hours]

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199
Q

adjunctive therapy for ifosfamide

A

mesna [Mesnex] & hydration

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200
Q

adjunctive therapy for irinotecan

A

atropine & loperamide

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201
Q

adjunctive therapy for methotrexate

A

leucovorin or levoleucovorin
glucarpidase

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202
Q

normal Hgb levels

A

females: 12-16 g/dL
males; 13.5-18 g/dL

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203
Q

what level can you start ESAs

A

Hgb <10 g/dL

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204
Q

trx for acute CINV

A

5HT3-RA + NK1-RA + steroid ± olanzapine

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205
Q

trx for delayed CINV

A

5HT3-RA + NK1-RA + steroid + olanzapine

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206
Q

trx for anticipatory CINV

A

BZD

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207
Q

trx for high emetic risk

A

3-4 drugs:
- NK1-RA + 5HT3-RA + olanzapine + dexamethasone [preferred]
- Palonosetron + olanzapine + dexamethasone
- NK1-RA + 5HT3-RA + dexamethasone

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208
Q

trx for mod emetic risk

A

2-3 drugs:
- NK1-RA + 5HT3-RA + dexamethasone
- 5HT3-RA + dexamethasone
- Palonosetron + olanzapine + dexamethasone

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209
Q

trx for low emetic risk

A

1 drug [any except NK1-RA]

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210
Q

trx for breakthrough CINV

A

5HT3-RAs, dopamine receptor antagonists, cannabinoids, olanzapine, lorazepam, dexamethasone or scopolamine

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211
Q

which chemo drugs cause hand-foot syndrome

A

capecitabine & fluorouracil

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212
Q

trx for tumor lysis syndrome

A
  • allopurinol: xanthine oxidase inhibitor
  • rasburicase: add on to allopurinol
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213
Q

trx for mild hypercalcemia of malignancy

A

hydration with NS & loop diuretics

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214
Q

trx for mod-severe hypercalcemia of malignancy

A

calcitonin [Miacalcin]

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215
Q

trx for mild, mod, severe hypercalcemia of malignancy

A

IV bisphosphonates
zoledronic acid [Zometa]
- not reclast [for osteoporosis

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216
Q

trx for mod-severe hypercalcemia of malignancy

A

denosumab [Xgeva]
- not prolia [for osteoporosis]

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217
Q

trx for breast cancer

A

premenopausal:
- tamoxifen [SERM]
- fulvestrant [SERD]
- toremifene [SERM]

postmenopausal:
- aromatase inhibtors [anastrozole]
- raloxifene [also for ppx]

HER2(+)
- trastuzumab [Herceptin]

HER2(-)
- abemaciclib
- everolimus

metastatic:
- capecitabine, carboplatin, cyclophosphamide, docetaxel, paclitaxel, doxorubicin & methotrexate

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218
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
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219
Q

trx for prostate cancer

A

ADT:

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220
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
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221
Q

trx for prostate cancer

A

ADT: GnRH antagonist alone or GnRH agonist [combo with antiandrogen]
- GnRH antagonist: Degarelix, Relugolix
- GnRH agonist: Leuprolide [Lupron], Goserelin [Zoladex]
- Antiandrogen: bicalutamide, flutamide, nilutamide

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222
Q

trx for prostate cancer

A

ADT: GnRH antagonist alone or GnRH agonist [combo with antiandrogen]
- GnRH antagonist: Degarelix, Relugolix
- GnRH agonist: Leuprolide [Lupron], Goserelin [Zoladex]
- Antiandrogen: bicalutamide, flutamide, nilutamide

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223
Q

chemo drugs that work at S phase

A
  • Antimetabolites → methotrexate, pemetrexed, 5-FU, capecitabine
  • Topoisomerase I Inhibitors → irinotecan, topotecan
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224
Q

chemo drugs that work at G2 phase

A
  • Topoisomerase II Inhibitors [block DNA coiling & uncoiling] → etoposide, bleomycin
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225
Q

chemo drugs that work at M phase

A
  • Taxanes → paclitaxel, docetaxel
  • Vinca Alkaloids → vincristine, vinblastine
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226
Q

chemo drugs that are cell-cycle independent

A
  • Alkylating Agents → cyclophosphamide, ifosfamide, carmustine, busulfan
  • Anthracyclines → doxorubicin, mitoxantrone
  • Platinum Compounds → cisplatin, carboplatin
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227
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
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228
Q

mAbs that target VEGF

A
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229
Q

mAbs that target VEGF

A

bevacizumab
ramucirumab

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230
Q

mAbs that target EGFR

A

cetuximab
panitumumab

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231
Q

mAbs that target HER2

A

trastuzumab
pertuzumab

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232
Q

mAbs that target CD antigens on cell surface

A

rituximab
brentuximab

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233
Q

mAbs that target immune system [PD-1, PDL-1, CTLA-A]

A

ipilimumab
pembrolizumab

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234
Q

types of TKIs

A
  • BCR-ABL inhibitors: imatinib [Gleevec], dasatinib, nilotinib
  • BRAF inhibitors: vemurafenic, dabrafenib
  • Mitogen-activated extracellular kinase 1&2 inhibitors: cobimetinib
  • EGFR inhibitors: afatinib, erlotinib
  • Anaplastic lymphoma kinase inhibitors: alectinib, brigatinib
  • Others: lapatinib, neratinib, sorafenib, sunitinib
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235
Q

key drugs that cause/worsen depression

A

ADHD medications
- Atomoxetine [Strattera]
Analgesics
- Indomethacin
Antiretrovirals [NNRTIs]
- Efavirenz [in Atripla]
- Rilpivirine [in Complera, Odefsey]
Cardiovascular medications
- Beta-blockers [esp propranolol]
- Hormones
- Hormonal contraceptives
- Anabolic steroids
Other
- Antidepressants
- Benzodiazepines
- Systemic steroids
- Interferons
- Varenicline
- Ethanol

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236
Q

trx for postpartum depression

A

SSRI, TCAs [except doxepin]
brexanolone [Zulresso]: C-IV FDA-approved

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237
Q

serotonin syndrome symptoms

A

severe nausea, dizziness, HA, diarrhea, agitation, tachycardia, hallucinations or muscle rigidity

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238
Q

antidepressant withdrawal symptoms

A

anxiety, agitation, insomnia, dizziness & flu-like symptoms

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239
Q

extrapyramidal side effects

A

dystonia, akathsia, parkinsonism, tardive dyskinesia

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240
Q

key drugs that cause psychotic symptoms

A

Anticholinergics [centrally-acting, high doses]
Dextromethorphan
Dopamine or dopamine agonists [Requip, Mirapex, Sinemet]
Interferons
Stimulants, esp if already at risk [includes amphetamines]
Systemic steroids [typically with lack of sleep - ICU psychosis]
Illicit/recreational substances

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241
Q

trx for tardive dyskinesia

A

valbenazine

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242
Q

trx for neuroleptic malignant syndrome

A

BZDs, dantrolene [Ryanodex, Dantrium, Revonto]

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243
Q

trx for bipolar disorder

A

Manic episode: first-line trx is valproate, lithium or antipsychotic
- Combo of antipsychotic + lithium or valproate is preferred for severe episodes
Depressive episode: first-line trx is antipsychotic [quetiapine, lurasidone]
- Lithium, valproate or lamotrigine can be added or used as alternatives

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244
Q

conversion of lithium

A

8 mEq lithium ion = 300mg lithium carbonate tabs/caps

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245
Q

trx for ADHD

A
  • first line: stimulants
  • atomoxetine [non-stimulant]
  • guanfacine ER [intuniv] & clonidine ER [kapvay]: alone or combo with stimulants
  • to help sleep at night: clonidine IR [Catapres], diphenhydramine, melatonin
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246
Q

key drugs that cause anxiety

A

Albuterol [if used too frequently or incorrectly]
Antipsychotics [e.g. aripiprazole, haloperidol]
Bupropion
Caffeine, in high doses
Decongestants [e.g. pseudoephedrine]
Illicit drugs [e.g. cocaine, LSD, methamphetamine]
Levothyroxine [if therapeutic overdose occurs]
Steroids
Stimulants [e.g. amphetamine, methylphenidate]
Theophylline

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247
Q

trx for anxiety

A

First Line: SSRIs & SNRIs → escitalopram [Lexapro], fluoxetine [Prozac], paroxetine [Paxil], sertraline [Zoloft], duloxetine [Cymbalta], venlafaxine XR [Effexor XR]

Second Line: buspirone, TCAs [amitriptyline & nortriptyline (Pamelor)], hydroxyzine, pregabalin, gabapentin

Special situations: propranolol [Inderal]

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248
Q

LOT BZDs

A

lorazepam, oxazepam, temazepam

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249
Q

key drugs that worsen insomnia

A

Acetylcholinesterase inhibitors [e.g. donepezil]
Alcohol
Antiretrovirals [e.g. emtricitabine, INSTIs]
Aripiprazole
Atomoxetine
Bupropion
Caffeine
Decongestants [e.g. pseudoephedrine]
Diuretics [due to nocturia]
Fluoxetine, if taken late in the day
Steroids
Stimulants [methyphenidate, phentermine]
Varenicline

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250
Q

trx for insomnia [falling asleep]

A

Eszopiclone
Zolpidem
Ramelteon
Zaleplon

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251
Q

trx for insomnia [staying asleep]

A

Eszopiclone
Zolpidem
Doxepin
Suvorexant

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252
Q

trx for insomnia [both falling & staying asleep]

A

Eszopiclone
Zolpidem

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253
Q

trx for RLS

A
  • dopamine agonists: ropinirole IR, pramipexole IR, rotigotine patch [Neupro]
  • gabapentin enacarbil [Horizant]
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254
Q

trx for narcolepsy

A
  • stimulants: modafinil
  • GABA derivations: sodium oxybate [Xyren] or calcium, magnesium, potassium and sodium oxybate (Xywav)
  • histamine-3 receptor antagonist/inverse agonist: pitolisant
  • dopamine & NE reuptake inhibitor: solreamfetol
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255
Q

trx for PD

A
  • carbidopa/levodopa
  • COMT inhibitors: entacapone [Comtan], entacapone/carbidopa/levodopa [Staleva], opicapone [Ogentys], tolcapone [Tasmar]
  • DA agonists: pramipexole [Mirapex], ropinirole [Requip], rotigotine [Neupro]
  • amantadine: blocks DA reuptake
  • selective MAO-B inhibitors: selegiline, rasagiline, safinamide
  • centrally acting anticholinergics: benztropine [Cogentin], trihexyphenidyl
  • adenosine receptor antagonist: istradefylline
  • alpha/beta agonist: droxidopa
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256
Q

key drugs that can worsen dementia

A

Antiemetics → promethazine
AHs → diphenhydramine, doxylamine
Antipsychotics → chlorpromazine, aripiprazole
Barbiturates → phenobarbital, butalbital
BZDs → alprazolam, clonazepam
Central anticholinergics → benztropine
Peripheral anticholinergics → incontinence & IBS drugs
Skeletal muscle relaxants → baclofen
Other CNS depressants → opioids, sedative hypnotics

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257
Q

trx for Alzheimers’

A
  • acetylcholinesterase inhibitors: donepezil [Aricept], rivastigmine [Exelon], galantamine
  • memantine [namenda]: w/ or w/o donepezil
  • aducanumab [Aduhelm]
  • antidepressants: sertraline, citalopram, escitalopram
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258
Q

trx for acute seizure

A
  • BZD inj
  • IM midazolam

not urgent
- diazepam rectal gel
- intranasal or buccal midazolam

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259
Q

trx for chronic seizure

A

AEDs
- Broad-spectrum AEDs: lamotrigine [Lamictal], levetiracetam [Keppra], topiramate [Topamax], valproic acid, divalproex [Depakote]
- Narrow-spectrum AEDs: carbamazepine [Tegretol], lacosamide [Vimpat], oxcarbazepine [Trileptal], phenobarbital, phenytoin [Dilantin] & fosphenytoin [Cerebryx]

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260
Q

MOA of AEDs

A
  • Benozodiazepines: ↑GABA
  • Valproic Acid : ↑GABA
  • Phenobarbital: Enhance/potential GABA effect
  • Levetiracetam: Ca channel blocker & ↑GABA
  • Ethosuximide: T-type Ca channel blocker
  • Pregabalin/Gabapentin: Ca channel blocker
  • Oxcarbazepine: Na & Ca channel blocker
  • Carbamazepine : Na channel blocker
  • Lamotrigine: Na channel blocker
  • Phenytoin/Fosphenytoin: Na channel blocker
  • Topiramate : Na channel blocker
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261
Q

therapeutic range of PHT

A

10-20 mcg/mL [total level]
1-2.5 mcg/mL [free level]

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262
Q

live vaccines

A

MMR
Intranasal influenza
Cholera
Rotavirus
Oral typhoid
Varicella
Yellow fever

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263
Q

which vaccines are PO

A

typhoid [Vivotif] & rotavirus [Rotateq, Rotarix]

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264
Q

key drugs that can raise LDL and/or TGs

A

↑LDL & TG:
- Diuretics
- Efavirenz
- Steroids
- Immunosuppressants [e.g. cyclosporine, tacrolimus]
- Atypical antipsychotics
- Protease inhibitors [e.g. darunavir, ritonavir]

↑LDL Only:
- Fish oils [except Vascepa]

↑TG Only:
- IV lipid emulsions
- Propofol
- Bile acid sequestrants [~5%]

Conditions
- Obesity, poor diet, hypothyroidism, alcoholism, smoking, diabetes, renal/liver disease, nephrotic syndrome

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265
Q

cholesterol classifications

A

non-HDL: <130
LDL: <100
- ≥190 very high
HDL
- men: ≥40
- women: ≥50
TG: <150
- ≥500 very high

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266
Q

how to determine statin trx

A

secondary prevention
- clinical ASCVD: high-intensity

primary prevention
- LDL ≥190: high-intensity
- ASCVD risk ÷20%: high
- DM & age 40-75 w/ LDL 70-189 + multiple risk factors: moderate intensity
- age 40-75 w/ LDL 70-189 + risk-enhancing factors: moderate-intensity

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267
Q

statin equivalent doses

A

Pitavastatin 2mg
Rosuvastatin 5mg
Atorvastatin 10mg
Simvastatin 20mg
Lovastatin 40mg
Pravastatin 40mg
Fluvastatin 80mg

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268
Q

max statin doses [DDIs]

A
  • Cyclosporine, Cobicistat:
    Rosuvastatin 5mg/day max with cyclosporine only
    Atorvastatin 20mg/day max with cobicistat only
  • Amiodarone:
    Simvastatin 20mg/day
    Lovastatin 40mg/day
  • Diltiazem & Verapamil
    Simvastatin 10mg/day
    Lovastatin 20mg/day
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269
Q

normal BP

A

SBP <120 AND DBP <80

270
Q

elevated BP

A

SBP 120-129 AND DBP <80

271
Q

stage 1 HTN BP

A

SBP 130-139 OR DBP 80-89

272
Q

stage 2 HTN BP

A

SBP ≥140 OR DBP ≥90

273
Q

key drugs that increase BP

A

Amphetamines & ADHD drugs
Cocaine
Decongestants [e.g. pseudoephedrine, phenylephrine]
Erythropoiesis-stimulating agents
Immunosuppressants [e.g. cyclosporine]
NSAIDs
Systemic steroids

274
Q

initial trx for HTN

A

ACE-I, ARBs, DHP-CCBs or thiazide diuretics

275
Q

when to start trx for HTN

A

Stage 2 HTN [SBP ≥140mmHG or DBP ≥90mmHg]

Stage 1 HTN [SBP 130-139 or DBP 80-89mmHg AND
- Clinical CVD [stroke, HF or coronary heart disease]
- 10-year ASCVD risk ≥10%
- Doesn’t meet BP goal after 6 months of lifestyle modifications

276
Q

beta-1 selective blockers

A

atenolol [Tenormin]
esmolol [Brevibloc]
metoprolol tartrate [Lopressor]
metoprolol succinate [Toprol]
acebutolol
bisoprolol
nebivolol [has nitric oxide-dependent vasodilation]

277
Q

non-selective beta-blockers

A

propranolol [Inderal]
nadolol [Corgard]

278
Q

non-selective beta & alpha-1 blockers

A

carvedilol [Coreg]
labetalol

279
Q

key IV HTN drugs

A

Chlorothiazide
Clevidipine
Diltiazem
Enalaprilat
Esmolol
Hydralazine
Labetalol
Metoprolol tartrate
Nicardipine
Nitroglycerin
Nitroprusside
Propranolol
Verapamil

280
Q

trx for stable ischemic heart disease

A

A - antiplatelet & antianginal drugs
- aspirin
- aspirin + clopidogrel [≥1 month for bare metal stent, ≥6 months for drug-eluting stent, 12 months for post-CABG]
B - blood pressure & beta-blockers
- beta-blockers 1st line
- CCBs [pref for Prinzmetal]
- nitrates
- ranolazine
C - cholesterol [statins] & cigarettes [cessation]
D - diet & diabetes
E - exercise & education

281
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
282
Q

key drugs that can leave the seizure threshold

A

Bupropion
Clozapine
Theophylline
Varenicline
Carbapenems [esp imipenem]*
Lithium*
Meperidine*
Penicillin*
Quinolones*
Tramadol*
*high doses & renal impairment ↑risk

282
Q

trx for ACS

A

MONA-GAP-BA

Morphine
Oxygen
Nitrates
Aspirin
GPIIb/IIIa antagonists
Anticoagulants
P2Y12 inhibitors
Beta-blockers
ACE-Is

NSTE-ACS: MONA

283
Q

trx for ACS

A

MONA-GAP-BA

Morphine
Oxygen
Nitrates
Aspirin
GPIIb/IIIa antagonists
Anticoagulants
P2Y12 inhibitors
Beta-blockers
ACE-Is

NSTE-ACE: MONA-GAP-BA ± PCI
STEMI: MONA-GAP-BA + PCI or fibrinolytic (PCI preferred)

284
Q

secondary prevention for ACS

A

aspirin 81mg indefinitely
P2Y12 inhibitor
- medical therapy: ticagrelor or clopidogrel + aspirin 81mg for ≥12 months
- PCI: any P2Y12-i + aspirin 81mg for ≥12 months
NTG indefinitely
beta-blocker for 3 years or indefinitely for HF/HTN
ACE-I indefinitely if EF<40%, HTN, CKD or DM
- consider for all MI pts with no CI
aldosterone antagonist indefinitely if EF <40% & symptomatic HF or DM on target doses of ACE-I & beta-blocker
statin indefinitely; high-intensity for most

285
Q

ACC/AHA HF Stages

A

A:
At risk for development of HF, but without symptoms of HF & without structural heart disease or elevated biomarkers
- Ex: pts with HTN, ASCVD, or DM
B: Pre-HF; structural heart disease, abnormal cardiac function or elevated biomarkers, but without signs or symptoms of HF
- Ex: pts with LVH, low EF, valvular disease
C: Structural and/or functional cardiac abnormality with prior or current symptoms of HF
- Ex: pt with known structural heart disease [e.g. LVH] + SOB, fatigue & reduced exercise tolerance
D: Advanced HF with severe symptoms, symptoms at rest or recurrent hospitalizations despite maximal treatment [refractory HF requiring specialized interventions]

286
Q

NYHA HF Stages

A

I: No limitations of physical activity. Ordinary physical activity doesn’t cause symptoms of HF [e.g. fatigue, palpitations, dyspnea]
II:
Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity [i.e. walking up stairs] results in symptoms of HF
III: Marked limitation of physical activity. Comfortable at rest but minimal exertion [e.g bathing, dressing] causes symptoms of HF
IV: Unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest [e.g. SOB while sitting in a chair]

I match with ACC/AHA stage B & C
II & III match with ACC/AHA stage C
IV match with ACC/AHA stage D

287
Q

cardiac output equation

A

CO = HR * SV

288
Q

cardiac index equation

A

CI = CO/BSA

289
Q

drugs that worsen HF

A

⭐Drug Information NATION⭐

Dipeptidyl peptidase 4 inhibitors → alogliptin & saxagliptin
Immunosuppressants → TNF-inhibitors [adalimumab & etanercept] & interferons
Non-DHP CCBs → diltiazem & verapamil [in systolic HF]
Antiarrhythmics
- Class I agents [quinidine & flecainide] & dronedarone
- Amiodarone & dofetilide are preferred in pts with HF
Thiazolidinediones → rosiglitazone, pioglitazone → increase risk of edema
Itraconazole
Oncology drugs → anthracyclines [doxorubicin, daunorubicin]
NSAIDs → all of them [even celecoxib]

290
Q

trx for HF

A

primary: ARNI/ACE-I/ARB + beta-blocker + loop diuretic + SGLT2-i

secondary: ARAs, BiDil, ivabradine [Corlanor]

additional: digoxin, vericiguat

291
Q

cardiac conduction pathway

A

SA node
right & left atria
AV node
bundle of HIs
right & left bundle branches
purkinje fibers

292
Q

cardiac action potential

A

phase 0: rapid ventricular depolarization -> influx of Na -> contraction
phase 1: repolarization -> Na closes
phase 2: plateau -> influx of Ca & efflux of K
phase 3: rapid ventricular repolarization -> efflux of K -> relaxation
phase 4: atrial depolarization -> resting potential

293
Q

select drugs that can increase/prolong the QT interval

A

Antiarrhythmics
- Class Ia, Ic & III
Anti-infectives
- Antimalarials → hydroxychloroquine
- Azole antifungals → except isavuconazonium
- Macrolides
- Quinolones
- Lefamulin
Antidepressants
- SSRIs → highest risk with citalopram & escitalopram
- Tricyclic antidepressants
- Mirtazapine, trazodone, venlafaxine
Antiemetics
- 5-HT3 receptor antagonists
- Droperidol, metoclopramide, promethazine
Antipsychotics
- First generation → haloperidol, chlorpromazine, thioridazine
- Second generation → highest risk with ziprasidone
Oncology medications
- Androgen deprivation therapy → leuprolide
- Tyrosine kinase inhibitors → nilotinib
- Oxaliplatin
Other
- Cilostazol, donepezil, fingolimod, hydroxyzine, loperamide, methadone, ranolazine, solifenacin, tacrolimus

294
Q

class I antiarrhythmics

A

Ia: Disopyramide, Quinidine, Procainamide
Ib: Lidocaine, Mexiletine
Ic: Flecainide, Propafene

295
Q

Class II antiarrhythmics

A

Beta-blockers

296
Q

class III antiarrhythmics

A

Dronedarone, Dofetilide, Sotalol, Ibutilide, Amiodarone

297
Q

class IV antiarrhythmics

A

Verapamil, Diltiazem

298
Q

trx for arrhythmias [rate control]

A
  • pt stays in AF & takes meds to control the HR
  • beta-blockers or non-DHP CCBs
299
Q

trx for arrhythmias [rhythm control]

A
  • goal to restore & maintain NSR
  • Class Ia, Ic, or III antiarrhythmic drugs or electrical cardioversion
    • amiodarone [PO & IV], dofetilide, flecainide, ibutilide & propafenone
    • maintenance of NSR: dofetilide, dronedarone, flecainide, propafenone or sotalol
300
Q

amiodarone DDIs with digoxin, warfarin & statins

A

Decrease digoxin by 50%
Decrease warfarin by 30-50%
Do not exceed 20 mg/day of simvastatin or 40mg/day of lovastatin

301
Q

meds for secondary prevention of ischemic stroke

A

antiplatetlet [noncardioemolic stroke or TIA]
- aspirin 50-325mg QD
- clopidogrel 75mg QD
- aspirin/ER dipyradimole 25/200mg BID

anticoagulants [cardioembolic stroke]
- preferredL DOAC
- alternative: warfarin

antihypertensive
- thiazides, ACE-I/ARB, and or DHP CCB
- goal BP <130/80mmHg

statin
- atorvastatin 40-80mg QD
- rosuvastatin 20-40mg QD

302
Q

trx for intracerebral hemorrhage

A
  • anticoagulant reversal
  • mannitol for osmotic diuresis
303
Q

trx for acute subarachnoid hemorrhage

A
  • PO nimodipine for preventing vasoprasm
304
Q

microcyctic anemia

A

MCV <80
iron deficiency

305
Q

macrocytic anemia

A

MCV >100
vitamin B12 or folate deficiency

306
Q

normocytic anemia

A

MCV 80-100
acute blood loss, malignancy, CKD, bone marrow failure [aplastic anemia], hemolysis

307
Q

labs with iron-deficiency anemia

A

↓Hgb, MCV <80 fL, ↓RBC production [low reticulocyte count]
↓serum iron, ferritin & TSAT [transferrin saturation]
↑TIBC [total iron binding capacity]

308
Q

trx for iron-deficiency therapy

A
  • 100-200mg elemental iron/day
309
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
310
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
311
Q

% elemental ferrous

A
312
Q

% elemental iron in ferrous gluconate

A

12%

313
Q

% elemental iron in ferrous sulfate

A

20%

314
Q

% elemental iron in ferrous sulfate, dried

A

30%

315
Q

% elemental iron in ferrous fumarate

A

33%

316
Q

% elemental iron in carbonyl iron, polysaccharide iron complex, ferric maltol

A

100%

317
Q

trx of macrocytic anemia

A

vitB12 injection

318
Q

trx of anemia of CKD

A

epotein or darbepoietin

319
Q

trx of aplastic anemia

A

immunosuppressants, blood transfusions or stem cell transplant

eltrombopag [Promacta]

320
Q

select drugs that can cause hemolytic anemia

A

Cephalosporins
Dapsone → must avoid
Isoniazid
Levodopa
Methyldopa
Methylene blue → must avoid
Nitrofurantoin → must avoid
Pegloticase → must avoid
Penicillins
Primaquine → must avoid
Quinidine
Quinine
Rasburicase → must avoid
Rifampin
Sulfonamides [sulfa ABX] → must avoid

321
Q

what abx is given as pnuemococcal ppx in young children with SCD

A

penicillin BID until age 5

322
Q

trx for SCD

A
  • hydroxyurea: main disease-modifying therapy that stimulates production of HgbF
  • L-glutamine [Endaril]: for ≥5 years
  • voxelotor [Oxybryta]: inhibits HgbS polymerization
  • crizanlizumab: mAb that reduces frequency of VOC
  • iron chelation therapy: deferasirox & deferiprone
323
Q

sx of cold

A

Thick, dark mucus
Sore throat
Body aches
Symptoms take ~3 days to appear & usually last for a week

324
Q

sx of allergy

A

Thin, clear mucus
Wheezing
Red, watery eyes
Symptoms can last for days or months after contact with allergens

325
Q

trx for chronic, mod-severe allergic rhinitis

A

intranasal steroids: decrease inflammation

326
Q

trx for mild/intermittent allergic rhinitis

A

antihistamines

327
Q

trx for allergic rhinitis w/ congestion

A

decongestants: alpha-adrenergic agonists that cause vasoconstriction
- phneylephrine
- pseudoephrine

328
Q

intranasal cromolyn

A

NasalCrom
- OTC mast cell stabilizer
- must use regularly, not PRN

329
Q

indications of montelukast

A

allergic rhinitis & asthma

330
Q

dextromethorphan

A
  • cough suppressant
  • serotonin reuptake inhibitor
  • high doses = NMDA-receptor blocker -> euphoria & hallucinations
331
Q

cough & cold product restrictions in children <18

A

avoid codeine & hydrocodone

332
Q

cough & cold product restrictions in children <4

A

avoid OTC cough/cold products [package labeling]

333
Q

cough & cold product restrictions in children <2

A
  • avoid OTC cough/cold products [FDA]
  • avoid promethazine [FDA]
  • avoid topical menthol & camphor [package labeling]
334
Q

AD

A

right ear

335
Q

AS

A

left ear

336
Q

AU

A

each ear

337
Q

OD

A

right eye

338
Q

OS

A

left eye

339
Q

OU

A

each ear

340
Q

how many mL in 1 drop

A

0.05 mL

341
Q

trx for glaucoma

A
  • decrease IOP!!
  • Reduce aqueous humor production [make less fluid]
    • Beta-blockers [timolol]
    • Carbonic anhydrase inhibitors [dorzolamide]
  • Increase aqueous humor outflow [move fluid out]
    • Prostaglandin analogs [latanoprost]
  • Both
    Alpha-2 agonists [brimonidine]
342
Q

trx of conjunctivitis

A

self-limiting

343
Q

drugs that cause retinopathy

A

Chloroquine
Hydroxychloroquine

344
Q

drugs that cause optic neuropathy

A

Amiodarone [plus corneal deposits]
Ethambutol
Linezolid

345
Q

drugs that cause intraoperative floppy iris syndrome

A

Alpha-blockers [e.g. tamsulosin]

346
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
347
Q

drugs that cause color discrimination

A
  • Digoxin [with toxicity] → yellow/green vision
  • -PDE-5 inhibitors [e.g. sildenafil] → greenish tinge around objects
  • Voriconazole → color vision changes
    Vision loss/abnormal vision
    Digoxin [with toxicity] → blurriness, haloes
    PDE-5 inhibitors → vision loss [one or both eyes; can be permanent]
    Isotretinoin → decreases night vision [can be permanent], dryness, irritation
    Topiramate → visual field defects
    Vigabatrin → permanent vision loss [high risk]
    Voriconazole → abnormal vision, photophobia
348
Q

drugs that cause color discrimination

A
  • Digoxin [with toxicity] → yellow/green vision
  • -PDE-5 inhibitors [e.g. sildenafil] → greenish tinge around objects
  • Voriconazole → color vision changes
349
Q

drugs that cause vision loss/abnormal vision

A
  • Digoxin [with toxicity] → blurriness, haloes
  • PDE-5 inhibitors → vision loss [one or both eyes; can be permanent]
  • Isotretinoin → decreases night vision [can be permanent], dryness, irritation
  • Topiramate → visual field defects
  • Vigabatrin → permanent vision loss [high risk]
  • Voriconazole → abnormal vision, photophobia
350
Q

trx of otitis externa

A

ciprofloxacin & dexamethasone [Ciprodex]

351
Q

trx of ear wax [cerumen]

A

carbamide peroxide [Debrox]

352
Q

drugs that can cause brown discoloration

A

Entacapone
Levodopa
Methyldopa

353
Q

drugs that can cause brown/black/green discoloration

A

Iron [black stool]
Methocarbamol
Nitrofurantoin
Metronidazole
Tinidazole
Riboflavin [B2]
Chlorzoxazone
Sulfasalazine
Propofol
Flutamide
Phenazopyridine
Rifampin
Rifapentine
Anthracyclines
Deferasirox [urine]
Methylene blue
Mitoxantrone
Amiodarone
Chloroquine

353
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
354
Q

drugs that can cause brown/black/green discoloration

A

Iron [black stool]
Methocarbamol

355
Q

drugs that can cause brown/yellow discoloration

A

Nitrofurantoin
Metronidazole
Tinidazole
Riboflavin [B2]

356
Q

drugs that can cause purple/orange/red discoloration

A

Chlorzoxazone

357
Q

drugs that can cause orange/yellow discoloration

A

Sulfasalazine

358
Q

drugs that can cause yellow-green discoloration

A

Propofol
Flutamide

359
Q

drugs that can cause red-orange discoloration

A

Phenazopyridine
Rifampin
Rifapentine

360
Q

drugs that can cause red discoloration

A

Anthracyclines
Deferasirox [urine]

361
Q

drugs that can cause blue discoloration

A

Methylene blue
Mitoxantrone

362
Q

drugs that can cause blue-gray discoloration

A

Amiodarone
Chloroquine

363
Q

trx of acne

A

OTC benzoyl peroxide and salicylic acid, retinoids, topical or systemic ABXs & systemic isotretinoin

364
Q

trx for onychomycosis

A

itraconazole & terbinafine

365
Q

trx for pinworms

A

Anthelmintics: mebendazole, pyrantel pamoate, albendazole

366
Q

trx for scabies

A

5% permethrin cream [Elimite]

367
Q

trx for lice

A

1% permethrin cream [Nix]

368
Q

trx for head lice

A

topical ivermectin [Sklice]

369
Q

highest to lowest potency of topical steroids

A

ointment
cream
lotion
solution
gel
spray

370
Q

which topical steroids are OTC

A

hydrocortisone 0.5% cream
hydrocortisone 1% cream [Cortaid, Cortisone, Cortizone-10]

371
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
371
Q

key drugs that cause PAH

A
372
Q

key drugs that cause PAH

A

Cocaine
SSRI use during pregnancy INCREASES risk of persistent HTN of a new born [PPHN]
Weight-loss drugs [diethylpropion, phendimetrazine, phentermine]
Methamphetamines/Amphetamines

373
Q

vasodilator substances

A

endotheline-1 & thromboxane 2 [TXA2]

374
Q

vasodilator substances

A

prostacyclin

375
Q

which drugs are used for vasoreactivity testing in PAH

A

Short-acting vasodilators [inhaled nitric oxide, IV epoprostenol or IV adenosine]

376
Q

trx for PAH responders

A

PO CCB: long-acting nifedipine, diltiazem & amlodipine

377
Q

trx for PAH non-responders

A

Prostacyclin analogues and receptor agonists, endothelin receptor antagonists [ERAs], phosphodiesterase-5 [PDE-5] inhibitors, and/or soluble guanylate cyclase [sGC] stimulator

378
Q

prostacyclin analogues & receptor agonists

A
  • potent vasodilators & inhibit platelet aggregation
  • selexipag [Uptravi]
  • epoprostenol & treprostinil: continuous IV infusion at home
379
Q

endothelin receptor antagonists

A
  • vasoconstrictor with cellular proliferative effects
  • bosentan
  • ambrisentan
  • macitenten
380
Q

PDE-5 inhibitors for PAH

A
  • tadalafil
381
Q

soluble guanylate cyclase stimulator

A
  • riociguat [Adempas]: sensitizes sGC to endogenous NO & directly stimulates receptor at diff binding sites
382
Q

trx for pulmonary fibrosis

A

pirfenidone [Esbriet] & nintedanib [Ofev]

383
Q

key drugs that cause pulmonary fibrosis

A

Amiodarone/dronedarone
Bleomycin
Busulfan
Carmustine
Lomustine

384
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
385
Q

SABAs for asthma

A
386
Q

rescue drugs for asthma

A
  • low dose ICS + formoterol
  • SABA
  • systemic steroids
  • inhaled epinephrine
  • SAMAs
387
Q

maintenance drugs for asthma

A
  • ICS
  • LABAs
  • LTRAs
  • theophylline
  • LAMAs
  • mAbs
388
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
388
Q

SABAs for asthma

A

Albuterol [ProAir HFA, ProAir RespiClick (DPI), Proventil HFA, Ventolin HFA,
levalbuterol [Xopenex]
epinephrine [Asthmanefrin]

389
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
390
Q

albuterol

A

ProAir, Proventil, Ventolin

391
Q

dose of albuterol

A
  • 90 mcg/inh
  • 1-2 inhalations Q4-6 PRN
392
Q

LABAs for asthma

A

salmeterol [Serevent DIskus]

393
Q

salmeterol

A

Serevent DIskus

394
Q

ICSs for asthma

A

beclomethasone [QVAR RediHaler]
budesonide [Pulmicort]
budesonide + formoterol [Symbicort]
fluticasone [Flovent HFA, Flovent Diskus, Arnuity Ellipta]
fluticasone + salmeterol [Advair]
fluticasone + vilanterol [Breo Ellipta]
mometrasone [Asmanex]
mometasone + formoterol [Dulura]
ciclesonide [Alvesco]

395
Q

Leukotriene modifying agents

A

montelukast [Singulair]

396
Q

montelukast

A

singulair
- BBW: neuropsychiatric events

397
Q

beclomethasone

A

QVAR RediHaler

398
Q

budesonide

A

pulmicort flexhaler [DPI]
pulmicort respules [nebulizer]

399
Q

budesonide + formoterol

A

Symbicort [MDI]

400
Q

fluticasone

A

flovent HFA [MDI]
flovent diskus [DPI]
arnuity ellipta [DPI]

401
Q

fluticasone + salmeterol

A

Advair Diskus, Advair HFA

402
Q

fluticasone + vilanterol

A

Breo Ellipta

403
Q

mometasone + formoterol

A

Dulera

404
Q

therapeutic range for theophylline

A

5-15 mcg/mL

405
Q

omalizumab

A

Xolair
- must give in healthcare setting w/ medical supervision

406
Q

tiotropium

A

Spiriva Respimat [asthma & COPD]
Spiriva HandiHaler [COPD]

407
Q

MDI characteristics

A
  • HFA, Respimat or no suffix
  • liquid
  • propellant
  • can use spacer
  • shake except for QVAR Redihaler, Alvesco & Respimat products
  • prime
408
Q

which MDIs do you NOT shake?

A

QVAR Redihaler, Alvesco & Respimat products

409
Q

DPI characteristics

A
  • Diskus, Ellipta, Pressair, HandiHaler, RespiClick, Flexhaler
  • powder
  • quick, forceful inhalation
  • don’t shake
  • can’t use spacer
  • no priming
410
Q

MOA of leukotriene modifying agents

A
  • reduce airway edema, constriction & inflammation
  • Zileuton inhibits leukotriene formation
  • montelukast inhibits leukotriene D4
411
Q

MOA of theophylline

A

blocks PDE

412
Q

IL-5 receptor antagonists for asthma

A

mepolizumab
reslizumab
benralizumab

413
Q

ILE-4 & IL-3 receptor antagonist for asthma

A

dupilumab

414
Q

COPD assessment

A

A: CAT <10, mMRC 0-1 & 0 or 1 exacerbation not leading to hospitalization
B: CAT ≥10, mMRC ≥2 & 0 or 1 exacerbation not leading to hospitalization
C: CAT <10, mMRC 0-1 & ≥2 or ≥1 exacerbation leading to hospitalization
D: CAT ≥10, mMRC ≥2 & ≥2 or ≥1 exacerbation leading to hospitalization

415
Q

COPD trx

A

A: bronchodilator: SABA prn, SAMA prn, LABA or LAMA
B: LAMA or LABA
C: LAMA
D: LAMA or LAMA + LABA [if highly symptomatic] or LABA + ICS [if eosinophils ≥300 cells/uL]

416
Q

albuterol/ipratropium

A

Combivent Respimat

417
Q

olodaterol

A

Striverdi Respimat

418
Q

olodaterol/tiotropium

A

Stiolto Respimat

419
Q

tioptropium

A

Spiriva Respimat
Spiriva Handihaler

420
Q

acidinium

A

Turdoza Pressair

421
Q

fluticasone/vilanterol

A

Breo Ellipta

422
Q

umeclidinium

A

Incruse Ellipta

423
Q

umeclidinium/vilanterol

A

Anoro Ellipta

424
Q

umeclidinium/vilanterol/fluticasone

A

Trelegy Ellipta

425
Q

trx for smoking cessation

A
  • NRT
  • bupropion: blocks reuptake of DA and/or NE
  • varenicline: partial nicotinic receptor agonist
426
Q

conversion of A1c to eAG

A

A1C of 6% = eAG of 126 mg/dL → each addition 1% increase = ~28 mg/dL

427
Q

metformin

A
  • Glucophage, Fortamet, Glumetza
  • ↓hepatic glucose production, ↑insulin sensitivity & ↓intestinal absorption of glucose
428
Q

SGLT2 inhbitors

A
  • Canagliflozin [Invokana]
  • Dapagliflozin [Farxiga]
  • Empagliflozin [Jardiance]
  • Ertugliflozin [Steglatra]
  • in proximal renal tubules to reduce reabsorption of glucose & increase urinary glucose excretion
429
Q

GLP-1 agonists

A
  • Liraglutide [Victoza, Saxenda (for weight loss)
  • Dulaglutide [Trulicity]
  • Exenatide [Byetta]
  • Exenatide ER [Bydureon, Bydureon BCise]
  • Lixisenatide [Adlyxin]
  • Semaglutide [Ozempic (SC), Rybelsus (PO), Wegovy (for weight loss)]
  • ↑glucose-dependent insulin secretion, ↓glucagon secretion, slows gastric emptying, improves satiety & can result in weight loss
430
Q

liraglutide

A

victoza
saxenda for weight loss

431
Q

dulaglutide

A

trulicity

432
Q

exenatide

A

byetta

433
Q

exenatide ER

A

bydureon, bydureon BCise

434
Q

lixisenatide

A

adlyxin

435
Q

semaglutide

A

ozempic SC
rybelsus PO
wegovy for weight loss

436
Q

sulfonylureas

A
  • Glipizide [Glucotrol], Glimepiride [Amaryl], Glyburide [Glynase]
  • stimulate insulin secretion from pancreatic beta-cells to decrease postprandial BG
437
Q

meglitinides

A
  • Repaglinide, Nateglinide [Starlix]
  • stimulate insulin secretion from pancreatic beta-cells to decrease postprandial BG
438
Q

glipizide

A

glucotrol

439
Q

glimepiride

A

amaryl

440
Q

glyburide

A

glynase

441
Q

DPP4 inhibitors

A
  • Sitagliptin [Januvia], Linagliptin [Tradjenta], Saxagliptin [Onglyza], Alogliptin [Nesina]
  • prevent DPP-4 from breaking down incretin hormones GLP-1 & GIP
442
Q

sitagliptin

A

januvia

443
Q

linagliptin

A

tradjenta

444
Q

saxagliptin

A

onglyza

445
Q

alogliptin

A

nesina

446
Q

thiazolidinediones

A
  • Pioglitazone [Actos], Rosiglitazone [Avandia]
  • PPARγ]agonists that ↑peripheral insulin sensitivity [↑uptake & utilization of glucose by peripheral tissues (insulin sensitizers)
447
Q

pioglitazone

A

Actos

448
Q

rosiglitazone

A

avandia

449
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
450
Q

acarbose

A

prec

451
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
452
Q

alpha glucosidase inhibitors

A

prec

453
Q

alpha glucosidase inhibitors

A

Acarbose [Precose] & Miglitol [Glyset]

454
Q

bile acid binding resins

A

Colesevelam [Welchol]

455
Q

dopamine agonist

A

Bromocriptine [Cycloset]

456
Q

amylin analog

A

Pramlintide [Symlin]
- risk for severe hypoglycemia

457
Q

actoplus met

A

metformin/pioglitazone

458
Q

janumet

A

metformin/sitagliptin

459
Q

invokamet

A

metformin/canagliflozin

460
Q

basal insulin

A

glargine [Lantus, Toujeo], determir [Levemir] & ultra-long acting degludec [Tresiba]

461
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
462
Q

insulin glargine

A

glargine [Lantus, Toujeo], determir [Levemir] & ultra-long acting degludec [Tresiba]

463
Q

insulin glargine

A

Lantus, Toujeo

464
Q

insulin detemir

A

Levemir

465
Q

insulin degludec

A

Tresiba

466
Q

intermediate-acting insulin

A

Insulin NPH [Humulin N, Novolin N]

467
Q

insulin NPH

A

humulin N, novolin N

468
Q

rapid-acting insulin

A

aspart [Novolog], lispro [Humalog] & glulisine [Apidra]

469
Q

insulin aspart

A

Novolog

470
Q

insulin lispro

A

Humalog

471
Q

insulin glulisine

A

Apidra

472
Q

short-acting insulin

A

regular insulin U-100 [Humulin R, Novolin R]

473
Q

regular insulin U-100

A

Humulin R, Novolin R

474
Q

starting TDD for insulin

A

0.5 units/kg/day

475
Q

room temp stability of humalog mix 50/50 & 75/25

A

10 days

476
Q

room temp stability of humulin 70/30

A

10 days

477
Q

room temp stability of humulin N

A

14 days

478
Q

room temp stability of novolog mix 70/30 pens

A

14 days

479
Q

room temp stability of
Apidra, Humalog, Novolog, Admelog, Lyumjev, Fiasp vials & pens

A

28 days

480
Q

room temp stability of Humalog Mix 50/50 & 75/25 vials

A

28 days

481
Q

room temp stability of Novolog Mix 70/30 vial

A

28 days

482
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
483
Q

room temp stability of Novolog Mix 70/30 vial
Novolin R U-100, N & 70/30 pens
Humulin R U-500 pen
Lantus, Basaglar, Semglee vials & pens
Humulin R U-100, N & 70/30 vials

A
484
Q

room temp stability of
Novolin R U-100, N & 70/30 pens

A

28 days

485
Q

room temp stability of Humulin R U-500 pen

A

28 days

486
Q

room temp stability of Lantus, Basaglar, Semglee vials & pens

A

28 days

487
Q

room temp stability of Humulin R U-100, N & 70/30 vials

A

31 days

488
Q

room temp stability of
Humulin R U-500 vial

A

40 days

489
Q

room temp stability of Novolin R U-100, N and 70/30 vials

A

42 days

490
Q

room temp stability of Levemir vial & pen

A

42 days

491
Q

room temp stability of Tresiba pen

A

56 days

492
Q

room temp stability of Toujeo pen

A

56 days

493
Q

key drugs that increase BG

A

Beta-Blockers*
Thiazide & loop diuretics
Tacrolimus, Cyclosporine
Protease Inhibitors
Quinolones*
Antipsychotics [e.g. olanzapine, quetiapine]
Statins
Steroids [systemic]
Cough syrups
Niacin

494
Q

key drugs that decrease BG

A

Beta-Blockers
Quinolones
Tramadol

495
Q

trx for DKA

A

IV fluids [normal saline to start]
IV regular insulin infusion
Monitor potassium & pH, treat if necessary

496
Q

labs in HYPOthyroidism

A

deficiency in T4 & elevation in TSH

497
Q

key drugs that cause HYPOthyroidism

A

I TALC
Interferons [can also cause hyper]
Tyrosine kinase inhibitors [i.e. sunitinib]
Amiodarone [can also cause hyper]
Lithium
Carbamazepine
Conditions: Hashimoto’s

498
Q

levothyroxine tab colors

A

Orangutans Will Vomit On You Right Before They Become Large, Proud Giants
25 mcg - orange
50 mcg - white [no dye]
75 mcg - violet
88 mcg - olive
100 mcg - yellow
112 mcg - rose
125 mcg - brown
137 mcg - turquoise
150 mcg - blue
175 mcg - lilac
200 mcg - pink
300 mcg - green

499
Q

labs in HYPERthyroidism

A

high FT4 & low TSH

500
Q

trx for hyperthyroidism

A
  • propylthiouracil
  • methimazole
  • beta-blockers for symptom control
501
Q

trx for thyroid storm

A
  • antithyroid: PTU pref
  • inorganic iodide therapy: SSKI or Lugol’s solution
  • beta-blockers: propranolol
  • systemic steroids: dexamethasone
  • cooling!!!
502
Q

trx of hyperthyroid is pregnancy

A

T1: PTY
T2-T3: either one, usually methimazole

503
Q

cushing vs addison

A

cushing = too much cortisol
addison = too little cortisol

504
Q

doses of steroid immunosuppression

A

≥2mg/kg/day or ≥20mg/day of prednisone or equivalent for >2 weeks

505
Q

trx of RA

A
  • DMARDs
  • MTX pref for initial therapy
  • mod-high: combo of DMARDs or TNF-inhibitor biologic or non-TNF biologic
506
Q

key drugs that cause DILE

A

My Pretty Malar Marking Probably Has A Transient Quality
Methimazole
Propylthiouracil
Methyldopa
Minocycline
Procainamide
Hydralazine
Anti-TNF agents
Terbinafine
Isoniazid
Quinidine

507
Q

trx for SLE

A

Hydroxychloroquine, cyclophosphamide, azathioprine, mycophenolate mofetil & cyclosporine → may take up to 6 months

508
Q

trx for MS

A
  • relapsing MS: Interferon beta formulations [Betaseron, Avonex, Rebif, Extavia, Plegridy] & glatiramer acetate [Copaxone, Glatopa]
509
Q

how often is Plegridy dosed

A

14 days

510
Q

trx for Raynaud

A

nifedipine for ppx

511
Q

trx for myasthenia gravis

A
  • cholinesterase inhibitors → pyridostigmine [Mestinon]
  • immunosuppressants
  • Efgartigimod alfa [Vyvgart]: if antiacethylcholine receptor antibody positive
512
Q

types of estrogen in PO contraceptives

A

ethinyl estradiol

513
Q

types of progestin in PO contraceptives

A

norethinedrone, levonorgestrel, drospirenone

514
Q

other indications for COCs

A

dysmenorrhea [menstrual cramps], premenstrual syndrome [PMS], acne, anemia, PCOS, endometriosis

515
Q

SEs of estrogen

A

nausea, breast tenderness, bloating, weight gain, increased BP

516
Q

SEs of progestin

A

breast tenderness, HA, fatigue & depression
- drospirenone has higher risk of clotting

517
Q

plan B one-step

A

levonorgestrel

518
Q

ella

A

ulipristal acetate

519
Q

ca & vit D requirements/day

A

1000mg/day of calcium & 15mcg/day [600IU/day] of vit D

520
Q

teratogens

A

Acne
- Isotretinoin, topical retinoids
Antibiotics
- Quinolones, tetracyclines
Anticoagulants
- Warfarin
Dyslipidemia, Heart Failure & HTN
- Statins, RAAS inhibitors [ACE-Is, ARBs, aliskiren, sacubitril/valsartan]
Hormones
- Most, including estradiol, progesterone [including megestrol], raloxifene, Duavee, testosterone, contraceptives
Migraine
- Dihydroergotamine, ergotamine
Other important teratogens
- Hydroxyurea, lithium, methotrexate, misoprostol, NSAIDs, paroxetine, ribavirin, thalidomide, topiramate, weight loss drugs, valproic acid/divalproex

521
Q

key drugs to avoid in lactation

A

amphetamines, amiodarone, ergotamines, lithium, metronidazole, phenobarbital & statins!!!!

522
Q

lab for osteoporosis

A

T-score ≤-2.5

523
Q

trx for osteoporosis

A
  • bisphosphonates: 1st line
  • denosumab [Prolia]
  • teriparatide [Forteo], abaloparatide [Tymlos]
  • raloxifene [Evista], bazedoxifene/estrogens [Duavee]
  • last line: estrogen & calcitonin
524
Q

trx duration for parathyroid hormones

A

2 years or less

525
Q

trx for menopause

A

local hormone therapy:
- 17-Beta-Estradiol → cream [Estrace], ring [Estring], tab [Vagifem]
- Conjugated Equine Estrogen → cream [Premarin]

systemic hormone therapy:
- Estradiol → patch [Alora, Climara, Vivelle-Dot]
- Conjugated Equine Estrogen → tab [Premarin], inj [Premarin]
- Medroxyprogesterone →tab [Premarin], inj [Premarin]
- Micronized progesterone → tabs [Prometrium]

526
Q

brisdelle

A

paroxtine for mod-severe vasomotor symptoms associated with menopause

527
Q

osphena

A

ospemifene
- estrogen agonist/antagonist indicated for dyspareunia

528
Q

key drugs that can cause erectile/sexual dysfunction

A

Alcohol
Antidepressants [esp SSRIs & SNRIs (including ↓libido)]
Antihypertensives [beta-blockers, clonidine, thiazides]
Antipsychotics [first-gen (chlorpromazine) & prolactin-raising second-gen (risperidone, paliperidone)]
BPH meds [finasteride, dutasteride & silodosin (mostly retrograde ejaculation)]

529
Q

trx for ED

A

PDE-5 inhibitors
- sildenafil [viagra]
- vardenafil [levitra]
- tadalafil [cialis]
- avanafil [stendra]

prostaglandin E1
- alprostadil

530
Q

which PDE5-i is also for BPH

A

tadalafil [cialis]

531
Q

which PDE5-i is also for PAH

A

sildenafil [Revatio]
tadalafil [Advirca]

532
Q

rx for hypoactive sexual desire disorder

A
  • flibanserin
  • bremelanotide
533
Q

drugs that can worsen BPH

A

Centrally-acting anticholinergics [e.g. benztropine]
Drugs with anticholinergic effects:
Antihistamines [e.g. diphenhydramine]
Decongestants [e.g. pseudoephedrine]
Phenothiazines [e.g. prochlorperazine]
TCAs [e.g. amitriptyline]
Caffeine
Diuretics
SNRIs
Testosterone products

534
Q

trx for BPH

A

alpha-blockers
- Non-selective: doxazosin [Cardura], terazosin
- Selective: tamsulosin [Flomax], alfuzosin [Uroxatral], silodosin [Rapaflo]

5 alpha-reductase inhibitors:
- Finasteride [Proscar, Propecia for alopecia (lower doses)], dutasteride [Avodart]

peripherally-acting anticholingerics
- tolterodine

beta-3 receptor agonists
- mirabegron

PDE5-i +/- finasteride
- tadalafil

535
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
536
Q

trx for urge incontinence/mixed incontinence

A

first-line:
- anticholinergics [oxybutynin]
- beta-3 receptor agonist [mirabegron]

537
Q

trx for urge incontinence/mixed incontinence

A

first-line:
- anticholinergics [oxybutynin]
- beta-3 receptor agonist [mirabegron]

  • onabotulinumtoxinA [Botox] has higher efficacy but isn’t first-line

last-line:
- nerve stimulation or surgical interventions

538
Q

trx for stress incontinence

A

no FDA-approved meds
- pseudoephedrine for adrenaline effects –> tachycardia, palpitations
- duloxetine for incontinence/depression

539
Q

anticholinergic side effects

A

peripheral:
- Dry mouth
- Dry eyes/blurred vision
- Urinary retention
- Constipation
- Tachycardia

central:
- Sedation
- Dizziness
- Cognitive impairment

540
Q

morphine conversion to fentanyl

A

Morphine 60mg TDD = 25mcg/hr fentanyl patch

541
Q

which opioid shouldnt be taken with food

A

oxymorphoe

542
Q

trx for OIC

A
  • stimulant laxatives
  • PAMORAs: methylnaltrexone [Relistor], naloxegol [Movantik], naldemedine [Symproic]
  • Chloride channel activator: Lubiprostone [Amitiza]
543
Q

MOA of centrally-acting analgesics

A
  • tramadol & tapentadol
  • mu-opioid receptor agonists & inhibitors of norepinephrine reuptake
544
Q

opioid abuse agents

A
  • buprenorphine
  • naloxone
  • naltrexone
  • Naloxone [Narcan], Buprenorphine [Suboxone (with naloxone SL film), Zubsolv (with naloxone SL tabs)], lofexidine [Lucemyra]
545
Q

adjuvants for pain management

A
  • neuropathy: AEDs [pregabalin, gabapentin, CBZ], TCAs [amitriptyline, desipramine] & SNRIs [milnacipran, duloxetine]
  • musculoskeletal pain:
    • Antispasmodics with analgesic effects: baclofen [Lioresal], cyclobenzaprine [Amrix, Fexmid, Flexeril], tizanidine [Zanaflex]
    • Antispasmodics with sedative effects: carisoprodol [Soma], metaxalone [Skelaxin], methocarbamol [Robaxin]
546
Q

maxalt

A

rizatriptan

547
Q

imitrex, onzetra xsall

A

sumatriptan

548
Q

zomig

A

zolmitriptan

549
Q

trx for migraines

A
  • triptans
  • ergotamine
550
Q

fioricet

A

APAP/butalbital/caffeine [Fioricet]

551
Q

fiorinal

A

aspirin/butalbital/caffeine [Fiorinal]
+ codeine = C-III

552
Q

ppx for migraines

A
  • beta-blockers [propranolol (Inderal), metoprolol tartrate (Lopressor), metoprolol succinate (Toprol XL), timolol]
  • antiepileptics [divalproex (Depakote), topiramate (Topamax)]
  • CGRP receptor antagonists
    • rimegepant [Nurtec ODT]
553
Q

key drugs that increase uric acid

A

Aspirin [lower doses]
Calcineurin inhibitors [tacrolimus & cyclosporine]
Diuretics [loops & thiazides]
Niacin
Pyrazinamide
Select chemotherapy [with tumor lysis syndrome]
Select pancreatic enzyme products

554
Q

trx for gout

A

Treat acute pain with anti-inflammatory drugs
- Colchicine
- Steroids [including intra-articular injections]
- NSAIDs [often with high starting dose]
Treat chronically to prevent future attacks
- Xanthine oxidase inhibitor [XOI]: allopurinol [preferred] or febuxostat
- Acute gout flare can occur so give initially with colchicine
If XOI didn’t work well enough & UA still >6mg/dL
- Add on probenecid or lesinurad to daily XOI
- Replace XOI with IV pegloticase [Krystexxa]

555
Q

trx for acute gout attack

A

NSAID [i.e. indomethacin, naproxen, sulindac & celecoxib], steroid [prednisone/prednisolone, methylprednisolone] or colchicine

556
Q

ppx for gout attack

A
  • colchicine, steroids or NSAIDs for ppx to reduce risk of attacks
  • xanthine oxidase inhibitors: allopurinol & febuxostat
  • uricosurics: probenecid & lisinurad
557
Q

key drugs that can worse GERD

A

Aspirin/NSAIDs
Bisphosphonates
Dabigatran
Estrogen products
Fish oil products
Iron supplements
Nicotine replacement therapy
Steroids
Tetracyclines

558
Q

trx for GERD

A

initial:
- PPI x8 weeks

maintenance:
- PPI at lowest effective dose

559
Q

key drugs that need acidic gut

A

Antiretrovirals: rilpirvirine [NNRTI], atazanavir [PI]
Antivirals: ledipasvir, velpatasvir/sofosbuvir
Azole antifunagls: Sporanox [itraconazole capsules], ketoconazole, posaconazole oral suspension
Cephalosporins [oral]: cefpodoxime, cefuroxime
Iron products
Mesalamine
Risedronate DR
Tyrosine kinase inhibitors: dasatinib, erlotinib, pazopanib

560
Q

medical conditions that can cause constipation

A

Irritable bowel syndrome [constipation predominant]
Anal disorders [fissures, fistulae, rectal prolapse]
Multiple sclerosis
Cerebrovascular events
Parkinson disease
Spinal cord tumors
Diabetes
Hypothyroidism

561
Q

key drugs that can cause constipation

A

Antacids [aluminum & calcium containing]
Antidiarrheals
Clonidine
Colesevelam
Drugs w/ anticholinergic effects: AHs [diphenhydramine], antispasmodics [baclofen], phenothiazines [prochlorperazine], TCAs [amitriptyline], urge incontinence [oxybutynin]
Iron
non-DHP CCBs [esp verapamil]
Opioids
Sucralfate [contains aluminum complex]

562
Q

trx for constipation

A
  • bulk-forming: first-line
  • osmotics
  • stimulants:
  • stool softeners
  • lubricants
  • calcium channel activator: lubiprostone [Amitiza]
  • guanylate cyclase C agonists: linaclotide, plecanatide [Trulance]
  • PAMORAs: alvimopan [Entereg], methylnaltrexone [Relistor], naloxegol [Movantik]
563
Q

bulk-forming laxatives

A

Psyllium [Metamucil], calcium polycarbophil [FiberCon], methylcellulose [Citrucel], wheat dextrin [Benefiber]

564
Q

osmotic laxatives

A

Magnesium hydroxide [Milk of Magnesia], polyethylene glycol 3350 [MiraLax], glycerin [Fleet Liquid, Pedia-Lax, Glycerin Supp], lactulose [Constulose, Enulose], sodium phosphates [Fleet Enema], lactitol [Pizensy], sorbitol

565
Q

stimulant laxatives

A

Senna [Ex-Lax, Senokot], senna + docusate [Senna S, Senokot S], bisacodyl [Dulcolax (supp)]

566
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
567
Q

stool softeners

A

docusate

568
Q

stool softeners

A

Docusate sodium [Colace], docusate + senna [Senna S, Senokot S]

569
Q

lubricant laxatives

A

mineral oil

570
Q

lubricant laxatives

A

mineral oil

571
Q

induction trx for CD

A

Steroids [± thiopurine or methotrexate]
Anti-TNF ± thiopurine
Ustekinumab [Stelara]

572
Q

maintenance trx for CD

A

Mild disease of the ileum and/or right colon:
- Oral budesonide for ≤3 months; after this course, d/c trx or change to thiopurine or methotrexate
Moderate-Severe disease:
- anti-TNF agents
- Adalimumab [Humira]
- Infliximab [Remicade]
- Certolizumab [Cimzia]
- Thiopurine [azathioprine, mercaptopurine]
- Methotrexate
- IL-receptor antagonist
- Ustekinumab [Stelara]
Refractory to above treatments and/or steroid-dependent:
- Integrin receptor antagonists
- Vedolizumab [Entyvio]
- Natalizumab [Tysabri]

573
Q

induction trx for UC

A

Aminosalicylates/5-ASA [oral and/or rectal] ± steroids [oral or rectal]
Anti-TNF agents
Ustekinumab [Stelara]
Tofacitinib [Xeljanz]
Vedolizumab [Entyvio]
IV cyclosporine

574
Q

maintenance trx for UC

A

Mild disease:
- Mesalamine [5-ASA] rectal and/or oral preferred
Moderate-Severe disease:
- anti-TNF agents
- Adalimumab [Humira]
- Infliximab [Remicade]
- Golimumab [Simponi]
- Thiopurine [azathioprine, mercaptopurine]
- Cyclosporine
- IL-receptor antagonist
- Ustekinumab [Stelara]
- Janus kinase inhibitor
- Tofacitinib [Xeljanz] → not first-line
Refractory to above treatments and/or steroid-dependent:
- Integrin receptor antagonists
- Vedolizumab [Entyvio]

575
Q

steroids for IBD

A

PO steroids: prednisone [Deltasone tab], budesonide [Entocort EC for CD, Uceris for UC]
Rectal steroids: hydrocortisone, budesonide

576
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
577
Q

aminosalicylates

A

Mesalamine ER [Pentase (cap), Asocol HD (tab), Rowasa (enema), Canasa (supp)],

FOR UC

578
Q

dramamine vs dramamine all day less drowsy

A

dramamine = dimenhydrinate
dramamine all day less drowsy = dramamine all day less drowsy

579
Q

5 Gs

A

garlic, gingko, ginseng, glucosamine, ginger

580
Q

PGX tests

A

Abacavir and any combination products containing abacavir [HLA-B5701]
Azathioprine [TMPT]
Carbamazepine [HLA-B1502]
Cetuximab and other EGFR inhibitors [KRAS]
Trastuzumab and other HER2 inhibitors [HER2]
Allopurinol [HLA-B5801]
Capecitabine & fluorouracil [DPD]
Clopidogrel [CYP2C19]
Codeine [CYP2D6]
Phenytoin & fosphenytoin
Warfarin [CYP2C92, CYP2c9*3, VKORC1]

581
Q

key drugs that cause photosensitivity

A

Amiodarone
Diuretics [thiazide & loops]
Methotrexate
PO & topical retinoids
Quinolones
St. John’s Wort
Sulfa ABXs
Tacrolimus
Tetracyclines
Voriconazole

582
Q

key drugs that cause TTP

A

PO P2Y12 inhibitors
Sulfamethoxazole

583
Q

key drugs that cause severe skin reactions

A

Abacavir
Allopurinol
Carbamazepine
Ethosuximide
Lamotrigine
Modafinil
Nevirapine
Penicillins
Phenytoin
Sulfamethoxazole

584
Q

BUD for non-sterile compounded products

A

nonaqueous = 6 month
water-containing PO = 14 days in fridge
water-containing topical = 30 days

585
Q

low risk CSP

A

1-3 sterile components

586
Q

medium risk CSP

A

> 3 sterile components

587
Q

high risk CSP

A

non-sterile products & then sterilize at the end

588
Q

room temp BUD for low risk CSP

A

48 hours

589
Q

room temp BUD for med risk CSP

A

30 hours

590
Q

room temp BUD for high risk CSP

A

24 hours

591
Q

fridge BUD for low risk CSP

A

14 days

592
Q

fridge BUD for med risk CSP

A

9 days

593
Q

fridge BUD for high risk CSP

A

3 days

594
Q

low HLB = ?

A

more lipid soluble

595
Q

high HLB = ?

A

more water-soluble

596
Q

primary engineering control

A

sterile hood for compounding
has ISO 5 air

597
Q

laminar airflow workbench

A

type of PEC where parallel air streams flow in 1 direction

598
Q

containing primary engineering control

A

ventilated chemo hood [w/ negative pressure] for HDs

599
Q

biological safety cabinet

A

type of C-PEC - chemo hood [class II or III for sterile HD]

600
Q

secondary engineering control

A

ISO 7 buffer room where the sterile hood [PEC] is
room where we go in to compound

601
Q

containment secondary engineering control

A

ventilated buffer room w/ negative pressure for HDs
- that smol room for chemo

602
Q

segregated compounding area

A

designated space with ISO 5 hood but not part of cleanroom suite

603
Q

containing segreated compounding area

A

same as regular one but for HDs & has negative pressure

604
Q

compounding aseptic isolator

A

glovebox for NON-HDs

605
Q

compounding aseptic containment isolator

A

glovebox for HDs

606
Q

restricted access barrier system

A

glovebox/closed-front sterile hood

607
Q

closed system transfer device

A

prevents escape of HD/vapors

608
Q

containment ventilated enclosure

A

ventilated “powder hodo” for non-sterile products

609
Q

fridge temp

A

2-8C

610
Q

freezer temp with CSP

A

-25 to -10 C

611
Q

freezer temp wth vaccines

A

-50 to -15 C

612
Q

muscarinic agonist

A

pilocarpine
bethanechol

613
Q

muscarinic antag

A

atropine
oxybutynin

614
Q

nicotinic agonist

A

nicotine

615
Q

nictonic antag

A

neuromuscular blockers [rocuronium]

616
Q

alpha-1 [peripheral] agonist

A

phenylephrine
dopamine [dose dependent]

617
Q

alpha-1 [peripheral] antag

A

alpha-1 blockers: doxazosin, carvedilol, phentolamine

618
Q

alpha-2 [brain, central] agonist

A

clonidine, brimonidine [opthalmic for glaucoma]

619
Q

alpha-2 [brain, central] antag

A

ergot alkaloids, yohimbine

620
Q

beta-1 [heart] agonist

A

dobutamine
isopreoterenol
dopamine [dose-dependent]

621
Q

beta-1 [heart] antag

A

beta-1 selective blockers [meto] & non-selective beta-blockers [propra, carve]

622
Q

beta-2 [lungs] agonist

A

albuterol
terbutaline
isoproterenol

623
Q

beta-2 [lungs] antag

A

non-selective beta-blockers [propra, carve]

624
Q

dopamine agonist

A

levodopa
pramipexole

625
Q

dopamine antag

A

1st gen APs [haloperidol, metoclopramide]

626
Q

serotonin agonist

A

triptans

627
Q

serotonin antag

A

zofran, 2nd gen APs

628
Q

CYP INHIBITORS

A

G♥PACMAN
Grapefruit
♥
Protease inhibitors, esp ritonavir
Azole antifungals [flu, itra, keto, posa, vori, isavu]
Cyclosporine, cobicistat
Macrolides [not azithro]
Amiodarone [and dronedarone]
Non-DHP CCBs

629
Q

CYP INDUCERS

A

PS PORCS
Phenytoin
Smoking
Phenobarbital
Oxcarbazepine
Rifampin [and rifabutin, rifapentine]
Carbamazepine [also auto-inducer]
St. John’s wort

630
Q

PGP SUBSTRATES

A
  • Anticoagulants [apixaban, edoxaban, dabigatran, rivaroxaban]
  • Cardiovascular drugs [digoxin, diltiazem, carvedilol, ranolazine, verapamil]
  • Immunosuppressants [cyclosporine, sirolimus, tacrolimus]
  • HCV drugs [dasabuvir, ombitasvir, paritaprevir, sofosbuvir]
  • Others [atazanavir, colchicine, dolutegravir, posaconazole, raltegravir, saxagliptin]
631
Q

PGP INDUCERS

A

Carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampin, St. John’s wort, tipranavir

632
Q

PGP INHIBITORS

A

Carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampin, St. John’s wort, tipranavir

633
Q

CBZ therapeutic range

A

4-12 mcg/mL

634
Q

digoxin therapeutic range for AFIB

A

0.8-2 ng/mL

635
Q

digoxin therapeutic range for HF

A

0.5-0.9 ng/mL

636
Q

gentamicin therapeutic range

A

Peak: 5-10 mcg/mL
Trough: <2 mcg/mL

637
Q

lithium therapeutic range

A

0.6-1.2 mEq/L [up to 15 mEq/L for acute symptoms], drawn as a trough

638
Q

phenytoin/fosphenytoin therapeutic levels

A

10-20 mcg/mL; if albumin is low, calculate a corrected level

639
Q

free phenytoin therapeutic level

A

1-2.5 mcg/mL

640
Q

procainamide therapeutic level

A

4-10 mcg/mL

641
Q

NAPA [procainamide active metabolite] therapeutic level

A

15-25 mcg/mL

642
Q

procainamide + NAPA combined therapeutic level

A

10-30 mcg/mL

643
Q

tobramycin [traditional dosing] therapeutic range

A

Peak: 5-10 mcg/mL
Trough: <2 mcg/mL

644
Q

valproic acid therapeutic level

A

50-100 mcg/mL [up to 150 mcg/mL in some patients]

645
Q

vancomycin therapeutic level

A

Trough: 15-20 mcg/mL for most serious ifx [pneumonia, endocarditis, osteomyelitis, meningitis & bacteremia]
Trough: 10-15 mcg/mL for others

646
Q

warfarin therapeutic level

A

Goal INR is 2-3 for most indications, use higher range [2.5-3.5] for high-risk conditions, such as mechanical mitral valves

647
Q

key drugs with leaching issues

A

Leach Absorbs To Take In Nutrients
Lorazepam
Amiodarone
Tacrolimus
Taxanes [most require non-PVC, exception is Paclitaxel-albumin bound]
Insulin
Nitroglycerin

648
Q

key drugs only diluted in saline

A

SALINE [No Dextrose] → A DIAbetic Can’t Eat Pie
Ampicillin
Daptomycin [Cubicin]
Infliximab [Remicade]
Ampicillin/Sulbactam [Unasyn]
Caspofungin [Cancidas]
Ertapenem [Invanz]
Phenytoin [Dilantin]

649
Q

key drugs only diluted in dextrose

A

DEXTROSE [No Saline] → Outrageous Bakes Avoid Salt
Oxaliplatin
Bactrim [SMX/TMP]
Amphotericin B [all]
Synercid [Quinupristin/Dalfopristin]

650
Q

key drugs with filter requirements

A

That’s my GAL PLAT [who’s head is flat]
Golimumab [Simponi]
Amiodarone
Lorazepam* [continuous filtration only]
Phenytoin* [continuous filtration only]
Lipids → 1-2 micron**
Amphotericin B [lipid formulations]
Taxanes, except docetaxel
*phenytoin & lorazepam need filters when given by continuous filtration; not needed for IV push
**larger pore size filter required, ampho: use 5 micron filter

651
Q

key drugs to NOT PUT IN FRIDGE

A

Dear Sweet Pharmacist, Freezing Makes Me Edgy
Dexmedetomidine [Precedex] [diluted form can be cold]
SMX/TMP [Bactrim]
Phenytoin → crystallizes
Furosemide → crystallizes [diluted form can be cold]
Metronidazole
Moxifloxacin [Avelox]
Enoxaparin [Lovenox]

652
Q

key drugs to protect from light during administration

A

Protect Every Necessary Med from Daylight
Phytonadione [vit K; Mephyton]
Epoprostenol [Flolan]
Nitroprusside [Nitropress]
Micafungin [Mycamine]
Doxycycline

653
Q

daily patches

A

Methylphenidate [Daytrana]: QAM, 2 hours prior to school
Nicotine [NicoDerm CQ]
Rivastigmine [Exelon]
Rotigotine [Neupro]
Selegiline [Emsam]
Testosterone [Androderm]: nightly, not on scrotum

654
Q

dialy patches w/ special instructions

A

Lidocaine [Lidoderm]: 1-3 patches [prn], on for 12 hours, off for 12 hours
Nitroglycerin: on for 12-14 hours, then off for 10-12 hours

655
Q

twice daily patch

A

Diclofenac

656
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
657
Q

twice weekly patch

A

Diclofenac

658
Q

twice weekly patch

A

Diclofenac Estradiol [Alora, Vivelle-Dot]
Oxybutynin [Oxytrol]

659
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
660
Q

twice weekly patch

A

Estradiol [Alora, Vivelle-Dot]
Oxybutynin [Oxytrol]

661
Q

weekly patch

A

Buprenorphine [Butrans]
Clonidine [Catapres-TTS]
Estradiol [Climara]
Estradiol/Levonorgestrel
Ethinyl estradiol/Norelgestromin [Xulane]: weekly for 3 weeks, off for 1 week

662
Q

alpha glucosidase inhibitors

A

Acarbose [Precose] & Miglitol [Glyset]

662
Q

twice weekly patch

A

Estradiol [Alora, Vivelle-Dot]
Oxybutynin [Oxytrol]

662
Q

key drugs that can leave the seizure threshold

A

Bupropion
Clozapine
Theophylline
Varenicline
Carbapenems [esp imipenem]*
Lithium*
Meperidine*
Penicillin*
Quinolones*
Tramadol*
*high doses & renal impairment ↑risk

662
Q

trx for prostate cancer

A

ADT: GnRH antagonist alone or GnRH agonist [combo with antiandrogen]
- GnRH antagonist: Degarelix, Relugolix
- GnRH agonist: Leuprolide [Lupron], Goserelin [Zoladex]
- Antiandrogen: bicalutamide, flutamide, nilutamide

662
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]
663
Q

Q72H patches

A

Fentanyl [Duragesic]: Q72H, if it wears off after 48 hours, change to Q48H
Scopolamine [Transderm Scop]: Q72H if needed

663
Q

stool softeners

A

Docusate sodium [Colace], docusate + senna [Senna S, Senokot S]

664
Q

trx for influenza

A
  • neuraminidase inhibitors: oseltamivir, zanamibir, peramivir
  • endonuclease inhibitor: baloxavir [Xofluza]

NAPLEX (9 decks)

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