leik book Flashcards
ace I (prils) enalapril-vasotec, catopril-capoten dont combine with
K, sprinolactone (k sparring diuretic) or Arbs (rtans- valsartan-divan, losartan-cozarr
beta blocker contraindication
severe lung disease and second or third degree block
inr less than 5 with no bleed
omit one does and or reduce standing dose rrecheck in 2 weeks
thiazide diuretics - HCTZ contraindicated in
sulfa allergy (lasix and bumex also contraindicated
thiazide diuretecs uniqily good for
pts with HTN and osteoperosis
lood diuretics and aminoglycosides
Gentamicin (generic version is IV only) Amikacin (IV only) Tobramycin. Gentak and Genoptic (eye drops) Kanamycin. Streptomycin. Neo-Fradin (oral) Neomycin (generic version is IV only)
ototoxicity
preferred antihypertensives for DM or Kidney disease
ACEI - prils
dry cough first few months of prils treatment
switch to ARB (artan)
dont use ccb’s
Norvasc (amlodipine) Plendil (felodipine) DynaCirc (isradipine) Cardene (nicardipine) Procardia XL, Adalat (nifedipine) Cardizem, Dilacor, Tiazac, Diltia XL (diltiazem) Sular (Nisoldipine) Isoptin, Calan, Verelan, Covera-HS (verapamil)
in CHF or bradycardia
macrolides
erythromycin, azithromycin, clarithromycin cover
cover Gram plus- think Staph areus, and strep pyrogens, as well as atypicals like mycoplasma CHLAMYDIA
watch out for
gi distress
ototoxicity, cholestatic jaundice, QT PROLONGATION
erythromycin (macrolide) gram + side effects
gi side effects are very common, if you must use a macrolide (atypical bacteria) switch to azithromycin (z-pack), or clithromycin (biaxin)
may prolong INR with coumadin same for clarithromycin
cephalosporins- beta lactams
first generations- Ancef. cefadroxil. cefazolin. cephalexin. Duricef. Keflex. Kefzol
gram positice cocci - group A strep, staph aeurus, not good against beta lactam producers and MRSA though,
not great with PCN allergy, high chance of cross sensitivity
2nd generaton cephalosporins are broad spectrum
Ceclor (DSC) cefaclor. cefotetan. cefoxitin. cefprozil. Ceftin. cefuroxime. Cefzil.
good agains gram Plus- streptococcus pneumoniea and gram negative like haeophilus influenae and moraxella catarrhalis like rinosinusitis and otitis media
rocephin (cephtriaxone) 1st gen cephalosporin use
250mg IM for gonorrhea
MRSA skin boils or abcesses frist line
bactrim ds, doxy or mino BID AND cindamycin, for 5-10 days
if PCN allergy switch to
azithromycin (brand name Zithromax),
clarithromycin (brand names Klacid and Klacid LA),
erythromycin (brand names Erymax, Erythrocin, Erythroped and Erythroped A),
spiramycin (no brand), and.
telithromycin (brand name Ketek).
MACROLIDES
avoid ——— in mono cause it causes a rash not realted to alllergy use——- instead and ——- with allergy
amoxicilin , penicillin VK, macorlides
concern for candida vaginitis with ammoxicilin -
reccomend probiotics and or yogurt
floriquinilones black box warning
ciprofloxacin (Cipro) levofloxacin (Levaquin/Quixin) gatifloxacin (Tequin) moxifloxacin (Avelox) ofloxacin (Ocuflox/Floxin/Floxacin) norfloxacin (Noroxin)
achillies tendon rupture, dc if sore, avoid strenous activiy
also avoid use in HYPO mag or K and with other QT prolonging agents cause of torsades
best drug for pseudomonas aeruginosa (gram neg)
ciprofloxacin
sulfa drug list - good against / contraindications
Gantrisin (sulfisoxazole)
Bactrim or Septra (trimethoprim and sulfamethoxazole)
Sulfadiazine.
Azulfidine (sulfasalazine)
Zonegran (zonisamide)
gram neg (ecoli, klebsiella, H influenzae G^PD anemai, third trimester,
drugs most likely to cause stevens johnson
The medicines that most commonly cause Stevens-Johnson syndrome are:
allopurinol.
carbamazepine.
lamotrigine.
nevirapine.
the “oxicam” class of anti-inflammatory drugs (including meloxicam and piroxicam)
phenobarbital.
phenytoin.
sulfamethocazole and other sulfa antibiotics.
stevens johnson treatment
Stopping the medication that has caused the problem
Replacing electrolytes with intravenous (IV) fluids
Using non-adhesive dressings
Using high-calorie food, possibly by tube-feeding, to promote healing
Using antibiotics when needed to prevent infection
Providing pain relief medications
Treating in an intensive care or burn unit in a hospital
Using specialist teams from dermatology and ophthalmology (if eyes are affected)
In some cases, treating with IV immunoglobulin or amniotic membrane grafts (for eyes)
UTI on comadin
dont give bactrim- increased bleeding
pregnant with UTI
amoxicillin (pcn) or kephlex- cephalosporin
asymptomatic anemia african american background, had a sulfa drug or ate fava beans- is jaundice and hemolysis-
G6PD deficiency
first and second most cause of allergic drug reactions
first is penicillins and cephalosporins,
second are sulfonamide ABX
TMP SMX bactrim (sulfonamide) DS BID is used to profolax
PCP in hiv patients andformrsacellulitis
macrolide alternative with allergy
doxycycline or quinalone levaquin,avelox
COPD order of chow
SABA - albuterol or levabuterol or Short acting anticholonergic- ipratroprium
then combo _combivent
then LABA (salmeterol
or long acting anticholonergic (Ipratropium (Atrovent)
Tiotropium (Spiriva)
pack year calculation
packs per day x years
H1 blocker or antihistimie in elderly
use lortadine (claritn) not benadryl
long standing HIVES (chronic urticaria)
zyrtec is more potent and long acting works well for acute hives too
dont use robitussin dextromethorphan
with 14 days of MAOI inhibitors
rasagiline (Azilect), selegiline (Eldepryl, Zelapar), isocarboxazid (Marplan), phenelzine (Nardil), and. tranylcypromine (Parnate).
decongestants (sudafed, pseudoephedrine) and phenylephrine not to be used when pt has had
CAD, MI, angina
avoid Nsaids in
heart failure, severe heart disease, GI bleed, last three months of preggers, severe renal disease
ketorlac or toradol max days of use
5
ketorlac or toradol contraindications
before surgery, ASA, peds, active or recent GI bleeds, stroke, Labor or delivery
ACS ASA
160-325chew non enteric coated tab
max max tylenol dose
3,250 in 24 hrs
avoid tylenol
etoh, liver disease, chronic hep BCD
asa symptom to dc with
tinnitus could signa asa tox
dig and the eyes
yellow and green vision, halos if blood level too high
theophylinne level
5-15mcg/ml suspect tox with persistant emissi avoid in BPH causes retention, avoid other stims lots of drug reactions
preggers X
finesteride, prosscar, isotretinoin (acutain) coumadin, cytotec Misoprostol, androgenic hormones- birthcontrol or hormone replacemt testosterone, live virus vacccines (measles, mumps, runellla, varicella, rotavirus, flumist) thalidomide, DES methimzaole
prescription pad info
name/designtion/license number/NPI
supervising doc name, designation-not all states
clinic address and phone number
on the script
date, name and address of pt
drug name, dose, for, freq, duration
directions for use, quantities in number and written form of refill
contorlled durgs must have DEA number
schedule II handwritten or typed on tamper proof and MANUALLY signed, cannot be called in
5 rights for prescriptions
patient drug dose time route
sqript method preffered by medicare and medicaid
e-prescribing
leading cause of death all comers
- heart disease
- cancer
- chronic lower respiratory disease
leading cancer killer
lung cancer
leading cause of cancer death in man
lung
prostate
colorectal
leading cause of cancer death in women
lung
breast
colorectal
leading cause of death in adolescents
accidents- 39.% MVA is most common
suicide 16%
homicide 14% non fatal and fata violence is highest in this group
leading cause of death birth to one year 1-44 45-64 65
birth to one year- congenital malformaitons 20%
1-44 unintentional injury
45-64- cancer
65 heart disease
most common or highest prevelance cancer
skin cancer
most common skin cancer
basal cell
melanoma causes the most deaths
men cancer prevelance vs mortality
prostate most
lung deadliest
women cancer prevelance vs mortality
breast most
lung deadliest
most common cancer in KIDS
ALL 34% of cancers
primary prevention oddball
asa for primary preventon of cvd and colon ca in adults age 50-59 with 10%or higher risk
secondary prevention is early detection
screening tests- pap, mamo, CBC for anemia
cage questionaire, testing for hep C in high risk person, asa for second stroke revention, MI, TIA, stroke to prevent future stroke
tertiary prevention, prevents progression, involves rehab and support groups, education on equipment
Support groups
education for pts iwth preexisting disease,
rehab
treatment of hep C
daily asa for preventing another heart atack
baseline Mamogram
start at age 50 and repeat q2 till 74
high risk BRCA start earlier in the 40s
cervical ca screening 21-65 30-65 hysterectomy with cervix removal over 65 with adequate prior screen
21-65 baseline at 21 then q3
30-65 or start at 30 with cytology + HPV every 5 years
hysterectomy with cervix removal stop if not due to ca
over 65 with adequate prior screen no more with not high risk
do not apply for hiv+ or DES diethylstillbestrol exposure or known lesion
colorectal ca screen
start at50 till 75
76-85 usually against but might be special cosiderations
over than 85 not reccomended
colorectal screen how
poop samples x3 annually
flex sig or ct colonography Q5
colonoscopy Q 10
lipid screen and statin starup
lipid profile after 9 hour fast
when all criteria are met start statin
age 40-74
one or more CVD risk factors- dyslipidemia, DM, HTN, smoker
10 year CV risk of 10% or greater
lung ca screening
30 pack year active orhave quit in the last 15 years
ovarian ca screen
routine is not reccoended but
with brca one or two
refer to specialist
trasvag ultrasound, or serum cancer antigen ca-125
starts at 30 years of age or 5-10 years of earliest family diagnosis
AAA screening rec
men 65-75 who have smoked
ultrasound
blood pressure screen
start at 18 get BP outside of clinical setting b4 starting treatment
DM 2 if obese screen
at 40 to 70
obeisity screen age
6-18
osteoperosis screen age
65 or younger if chronic steroids or ris equal to tht of 65 year od white woman
breast ca risk factors
OLDER THAN 50- most commoon previous history of breast ca two or more first degree relatives obeisity early menarche, late menopause
hep b vaccine
3 doses at birth, 1 and 6 months
min of 4 weeks between doses,
do not restart just catch up got one missed two then give two then three.
flu vax
takes 2 weeks to kick in
if eggg allergy only experiences hives they can still get the vax
preggers can get it
flu vax contraindications
under 6 months of age
life threatinging egg allergy
tdap vax
q ten for life
boost with dirty wound if last was more than 5 years
wound with unknown tdap vax status
give tdap and tetanus immunoglobulin injection asap
high risk tetanus wounds
crush injury, soil inwound, puncture, devitalized tissue
ppsv23 who gets
adults 65 or older or younger at high risk
its 50% to 85% efffective
PCV13 or prevnair
kids older than 5 at high risk or also works for 65 plus
at 65 with no previous coverage
give prevnair PCV13 and then PPSV23 one year later
high risk pneumococcal infection group
chronic diseases ETOH, DM CSF leaks, asthma, hepatitis renal disease sickle cell, crappy spleen malignancy or blood cancers history of organ or marrow transplant
if u got pneumovax before 65
give booster dose 5 years after first dose
zostervax is live who gets
at 60
past history of shingles IS NOT a contraindication
can get it if they never had chickenpox
acyclovir 24hrs pre or 14 days post can lower response
may excerbate asthma or polymyalgia rheumatica
shingles risk factors
older than 60
immunocompromised
leukemia lymphoma
contraindications for shingles zostervax
preggers or breastfeeding
leukemia lymphoma, or malignancies of bone or bone marrow
immynocompramised, high dose steroids, over two weeks, anti tumor necorsis factor meds like etanercept
if u never had chicken pox can u get shingles
no
how long is shingles contageous
contact precautions till all skin lesions are dry and crusted
varicella vax
first dose is 12-15 months
acceptable proof of varicella immunity
documentation or 2 doses of vax
written diag of shicken pox or shingles
positive lab varicella titer (IgG elisa
nobody born before 1980 should get it
