Misc. Flashcards
drugs contraindicated in renal dysfunction
CrCl <60: nitrofurantoin
CrCl <50: Stribild, voriconazole
CrCl <30: bisphosphonats, dabigatran, duloxetine, genvoya, fondaparinux, NSAIDs, K-sparing diuretics, rivaroxaban, tadalafil, tramadol ER
GFR <30: genvoya, SGLT2 inhibitors (canagliflozin, etc), metformin
Hepatitis A
acute, self-limiting
fecal-oral transmission via contaminated food/water
Hepatitis B
acute/chronic causes infection, cirrhosis, liver failure, death
spread via blood, body fluids
Hepatitis C
spread via blood, body fluids
tx: direct acting antiretrovirals
Direct Acting Antiretrovirals
Harvoni (sofosbuvir + ledipasvir) - avoid PPIs, H2RAs
Epclusa (sofosbuvir + velpatasvir) - avoid PPIs, H2RAs
Vosevi (sofos + velpat + voxilaprevir) - take w/ food, avoid PPIs, H2RAs
Mavyret (glecaprevir + pibrentasvir) - 8 week course, all others x12 weeks
all DAAs c/i w/ 3A4 inducers, most inc conc. of statins, myopathy
GERD initial and maintenance therapy
initial: PPI once daily x8 weeks
maintenance: PPI, H2RA
lifestyle mods: weight loss, raise head of bed, avoid eating before bed, avoid triggers
Antacids for GERD
neutralize gastric acid, raise pH not absorbed relief in minutes, lasts 30-60 minutes calcium carbonate (Tums) magnesium (Phillips, milk of magnesia) Mg + (Al or Ca) combo (Mylanta) Mg + Al + simethicone (Maalox)
H2RAs for GERD
reversibly inhibit H2 receptors, decrease gastric acid secretion
famotidine (Pepcid)
ranitidine (Zantac)
s/e: confusion, cognitive impairment in elderly
PPIs for GERD
bind gastric H/K-ATPase pump, blocks gastric acid secretion
use lowest effective dose for maintenance
esomeprazole (Nexium), omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), dexlansoprazole (Dexilant)
s/e: osteoporosis, fractures, C. diff, diarrhea, hypomagnesemia
decrease efficacy of clopiogrel, absorption of other drugs
GERD other treatments
metoclopramide (Reglan)
s/e: tardive dyskinesia, EPS, restlessness, fatigue, drowsiness
avoid in Parkinson’s
Peptic Ulcer Disease
causes: H. pylori, NSAID-induced, stress-induced
s/sx: dyspepsia, gastric pain in mid/upper stomach
eating lessens pain if H. pylori ulcer
eating worsens pain if NSIAD ulcer
treatment of H. pylori ulcers
first line - quadruple therapy x10-14d (PPI BID or esomeprazole daily + Pepto + metronidazole + tetracycline
triple therapy if no prior exposure to macrolides: PPI/esomeprazole + amoxicillin + clarithromycin
treatment of NSAID ulcers
celecoxib or other COX2 selectives - meloxicam, nabumetone, diclofenac, etodolac
cytoprotective drugs protect ulcer from further damage - misoprostol (Cytotec), sucralafate (Carafate)
constipation treatment special cases
use fiber in pregnancy
stimulant laxative for opioid-induced constipation (senna, bisacodyl)
bulk forming laxatives
psyllium (metamucil)
calcium polycarbophil (FiberCon)
methylcelluose (Citrucel)
take 2 hrs before/after other drugs
osmotic laxatives
magnesium hydroxide (Milk of Magnesia) PEG (Miralax) glycerin (pedia-lax, suppositories) sorbitol, lactulose s/e: electrolyte imbalance
stimulant laxatives
senna (Ex-lax, Senokot)
bisacodyl (Dulcolax)
other laxatives
emollient - docusate (Colace) lubiprostone (Amitiza) linaclotide (Linzess) plecanatide (Trulance) alvimopan (Entereg)
diarrhea
mainly viral, E. coli bacteria
replace fluids, electrolytes
non-infectious = Pepto or loperamide
IBS-D = loperamide, rifaximin (Xifaxin), alosetron (Lotronex - women only)
antidiarrheals
bismuth subsalicylate (Pepto)
loperamide (Imodium)
diphenoxylate-atropine (Lomotil)
antispasmodics for diarrhea
dicyclomine (Bentyl)
anticholinergic - dry mouth, nausea, blurred vision
Mu-opioid receptor agonists for diarrhea
eluxadoline (Viberzi)
antidiarrheal counseling
do not give Pepto to kids/teens w/ viral infection - risk of Reye’s syndrome
do not self treat w/ imodium for >48 hrs
treatment of IBD
short courses of oral/IV steroids for acute exacerbations, aminosalicylates for maintenance, budesonide if confined to ileum or proximal colon
induction of remission for Chron’s, Colitis
Chron’s: steroids +/- thiopurine or methotrexate; anti-TNF +/- thiopurine; interleukin receptor antagonist
Colitis: steroids +/- 5-ASA or thiopurine; anti-TNF +/- thiopurine; cyclosporine
maintenance of remission of Chron’s
mild: budesonide
mod/severe: Anti-TNF (Humira, Remicade, Cimzia), thiopurine (azathioprine, mercaptopurine), methotrexate, IL antagonist (uztekinumab - Stelara)
maintenance of remission of Colitis
mild: mesalamine (5-ASA)
mod/severe: anti-TNF (Humira, Remicade), golimumab (Symponi), thiopurine (azathioprine, mercaptopurine), cyclosporine
steroids for IBD
prednisone (Deltasone)
budesonide (Entocort, Uceris)
aminosalicylates for IBS
indicated for treatment of Colitis mesalamine sulfasalazine basalazide osalazine
thiopurines for IBS
azathioprine
mercaptopurine
immunosuppressants for IBD
methotrexate, cyclosporine
integrin receptor antagonists for IBD
natalizumab (Tysabri)
veolizumab (Entyvio)
sexual dysfunction
common w/ HTN, CAD, DM, depression, stress, stroke
drug-induced: SSRIs, HTN meds, antipsychotics, BPH meds
flibanserin (Addyi) - female viagra
PDE5 inhibitors for ED
smooth muscle relaxation, increased blood flow
sildenafil (Viagra), tadalafil (Cialis), avanafil (Stendra)
s/e: hearing loss, vision loss, hypotension, priapism
do not use w/ nitrates
Prostaglandin E1 for ED
alprostadil (Caverject, Muse)
s/e: penile pain, priapism
5HT1a/2a antagonists for sexual dysfunction
do not enhance sexual performance
for premenopausal women only
flibanserin (Addyi)
c/i with alcohol, hepatic impairment, 3A4 inhibitors
BPH
alpha blockers alone or w/ 5-alpha reductase inhibitor
5-alpha reductase inhibitors decrease prostate size - only use if enlarged prostate
alpha blockers for BPH
relax smooth muscle, reduce bladder obstruction
terazosin, doxazosin (Cardura), tamsulosin (Flomax)
s/e: floppy iris syndrome in cataract pts, abnormal ejaculation
give at bedtime
5-alpha reductase inhibitors for BPH
use only if enlarged prostate
finasateride (Proscar)
dutasteride (Avodart)
c/i in pregnancy, fertile women, children
s/e: impotence, decreased libido, abnormal ejaculation, breast enlargement
decrease prostate size and PSA levels
PDE-5 inhibitors for BPH
tadalafil (Cialis)
c/i with nitrate use
s/e: impaired color vision, hearing loss, vision loss, hypotension, priapism
Overactive Bladder
urge incontinence: can’t hold it long enough to reach toilet
stress incontinence: leaks during exertion
mixed: combo of stress and urge
functional incontinence: physical impairment (ex. wheelchair)
anticholinergics for OAB
oxybutinin (Ditropan, Oxytrol patch) - patch OTC tolterodine (Detrol) trospium solifenacin (Vesicare) fesoterodine (Toviaz) s/e: dizzy, drosy, dry mouth
Beta-3 agonist for OAB
mirabegron (Myrbetriq) s/e HTN
Botox for OAB
s/e: UTI, urinary retention, dysuria
nocturia treatment
desmopressin (Noctiva)
s/e: severe hyponatremia - test sodium levels before starting
Glaucoma
open angle - treated w/ drops or surgery, common
closed angle - sharp sudden increased IOP d/t blockage, medical emergency surgery
prostaglandins most effective in reducing IOP
beta blockers if IOP elevated in one eye
prostaglandin analogs for glaucoma
move fluid out of eye latanaprost (Xalatan) +timolol (Xalacom) travoprost (Travatan Z) bimatoprost (Lumigan) s/e: darkening of iris/eyelashes, eyelash growth/thickening
beta blockers for glaucoma
reduce aqueous humor production
timolol (Timoptic) +brimonidine (Combigan), +dorzolamide (Cosopt), +latanoprost (Xalacom)
s/e: burning, stinging, vision change
avoid timolol in pts w/ asthma, COPD, bronchitis, CVD
cholinergics for glaucoma
increase aqueous humor outflow
cabachol (Isopto, Miostat)
pilocarpine (Isopto, Pilopine)
carbonic anhydrase inhibitors for glaucoma
reduce aqueous humor production dozolamide (Trusopt), timolol (Cosopt) acetazolamide (Diamox) caution w/ sulfa allergy s/e: blurred vision, dry eye
alpha-2 inhibitors for glaucoma
brimonidine (Alphagon) +timolol (Combigan)
avoid timolol in pts w/ asthma, COPD, bronchitis, CVD
otitis externa treatment (outer ear infection)
ciprofloxacin + hydrocortisone (Cipro HC)
cipro + dexamethasone (Ciprodex)
cortisporin TC
ear wax removal
cerumen = ear wax carbamide peroxide (Debrox) triethanolamine (Cerumenex)
ear drop counseling
pull earlobe up & back in adults, down & back in kids
administer drops
keep head sideways for 5 minutes
motion sickness
scopolamine (Transderm Scop) - behind ear, lasts 3 days, use 4 hrs before, c/i with glaucoma
meclizine (Bramamine less drowsy) - take 30-60 min before. s/e: blurred vision
avoid alcohol
alopecia, hair loss treatment
finasteride (Propecia) - c/i in pregnancy, women shouldn’t handle
minoxidil (Rogaine)
diaper rash treatment
change frequently, let skin dry, use protectant
Desitin (petrolatum + zinc oxide)
Vusion (miconazole + zinc oxide + petrolatum)
fungal skin infection treatment
terbinafine (Lamisil) butenafine (Lotrimin) clotrimazole, miconazole tolnftate (Tinactin) betamethasone/clotrimazole (Lotrisone) Rx
fungal nail infection treatment
itraconazole (Sporanox)
terbinafine (Lamisil)
efinaconazole (Jublia)
yeast infection treatment
monistat, diflucan
genital wart treatment
imiquimod (Aldara, Zyclara)
lice, scabies treatment
permethrin, pyrethrin (Nix, Rid) OTC of choice
poison ivy/oak treatment
aluminum acetate (Burrow's) colloidal oatmeal (Aveeno)
weight loss
reduce calories, increase exercise
avoid weight loss drugs in pregnancy
phentermine/topiramate (Qsymia) - s/e anxiety, depression
naltrexone/bupropion (Contrave) - c/i w/ seizures, opioid use, HTN
locaserin (Belviq)
liraglutide (Saxenda)
phentermine (Adipex) - s/e HTN, tachycardia; c/i w/ glaucoma or HTN
orlistat (Alli, Xenical)
Thyroid issues
hypothyroidism: low T3/T4, high TSH
hyperthyroidism: high T3/T4, low TSH
hypothyroid: cause Hashimoto’s
hypothyroid: levothyroxine - empty stomach, separate from vitamins and antacids
hyperthyroid: cause Grave’s disease
hyperthyroid: beta-blockers for s/sx, PTU, methimaazole, potassium iodine
arthritis
bilateral, symmetrical joint pain/swelling, stiffness
goal: remission
tx: MTX, then DMARDs, TNFs, biologics
never use combo of 2 biologics
DMARDs for arthritis
methotrexate (Otrexup, Rasuvo, Xatmep, Trexall) - c/i in pregnancy, do not use with alcohol
hydroxychloroquin (Plaquenil) s/e retinopathy, vision loss
sulfasalazine (Azulfidine)
leflunomide (Arava)
tofacitinib (Xeljanz)
anti-TNF biologics for arthritis
etanercept (Enbrel)
adalimumab (Humira)
infliximab (Remicade)
non-TNF biologics for arthritis
rituximab (Rituxan)
sarilumab (Kavzara)
transplant induction therapy
given before, prevent acute rejection
basilixumab, antithymocyte globulin
transplant maintenance therapy
calcineurin inhibitors (tacrolimus) antiproliferatives (mycophenolate, azathioprine, belatacept) mTOR inhibitors (everolimus, sirolimus)
drugs that decrease oral contraceptive efficacy
anticonvulsants (barbituates, carbamazepine, phenytoin, topiramate, lamotrigine)
antibiotics (rifampin, rifapentine, rifabutin)
St. John’s wort
ritonavir
smoking tobacco
osteoporosis
prevent w/ Ca + Vit D
Vit D deficiency = ricketts, osteomalacia
Vit D deficient: ergocalciferol, cholcalciferol x8-12wks
tx: bisphosphonates, raloxifene, ibandronate, teriperatide
bisphosphonates: alendronate (Fosamax), Risedronate (Actonel), ibandronate (Boniva) - must sit/stand 30 min after taking
raloxifene (Evista) - SERM, s/e hot flashes
pain management
APAP max dose: 4,000 mg/day
ibuprofen (Advil, Motrin) - max 3,200 mg/day
antiepileptics for pain: gabapentin, pregabalin
antispasmodics/muscle relaxants for pain: baclofen, cyclobenzaprine, tizanidine, carisoprodol, methocarbamol
SNRI/TCAs for pain: amitriptyline, duloxetine
topicals for pain: lidocaine patch, capsaicin, methyl salicylate (IcyHot)
Gout treatment
acute tx: NSAIDs - indomethacin (Indocin), naproxen, celecoxib (celebrex); cholchicine (Colcrys)
chronic tx: allopurinol (Zyloprim), lesinurad (Zurampic), probenacid
