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MPJE + NAPLEX 2023 PREP > mnemonics + GOOD TO KNOW > Flashcards

mnemonics + GOOD TO KNOW Flashcards

1
Q

Beta-selective BBs

A

AMEBBBA

atenolol
metoprolol
esmolol
bisoprolol
betaxolol
bystolic (nebivolol)
acebutolol

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2
Q

BB in IV Form

A

MAPLES

metoprolol
atenolol [D/C’ed in US]
propanolol
labetalol
esmolol
sotalol

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3
Q

Beta Blocker SEs

A

BLOCKERS

brady/broncho
lipid increase/decrease libido
orthostatic HTN (dizziness)
conduction abnormalities (AV block)
K(c)onstriction of peripheral vasculature (Raynaud’s)/potassium increase
exhaustion/emotional depression
reduced recognition of hypoglycemia (decreased ability to recognize tachycardia)

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4
Q

AV blockers

A

cause bradycardia/can treat afib (also capable of causing atrial fib) [CAN HELP W/ VENTRICULAR RATE]

amiodarone (dronedarone - multaq)
BB
CCBs/corlanor - ivabradine
digoxin

[for afib = first line = BB and non-DHP CCB]

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5
Q

displaces digoxin (increase digoxin concentration)

A

VAQC

verapamil
amiodarone
quinidine (SE: think ear ringing)
clarithromycin

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6
Q

ACEi adverse effects

A

CAPTOPRIL

cough (d/t increase in bradykinin)
angioedema
potassium
taste change (metallic, sweet, salty taste; occurs since ACEi chelates Zn)
orthostasis (hypotension)
pregnancy –> NO (1st trim = cat C // 2nd/3rd trim = cat D)
rash (contra w/ renal artery stenosis)
increase in potassium
leukocytosis (captopril)

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7
Q

BB in HF

A

the cardinal met the bishop

carvedilol (with food)
metoprolol succinate
bisoprolol

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8
Q

increase lipids

A

PASS on the BLT

protease inhibitors
antipsychotics
SGLT2i // STEROIDS

BB
loops
thiazides

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9
Q

cyp3a4 inhibitors

A

GPAC [ increases substrate concentrations]

grapefruit juice
protease inhibitors
azoles, amiodarone, androgen (specific) –> Danazol
CCB (verapamil, diltiazem, amlodipine), clarithromycin (also erythromycin)

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10
Q

cyp3a4 inducers

A

SR CuP

S = St. John’s Wort (OTC), Sustiva (efavirenz)
R = Rifampin (remember, turns you red)

C = Carbamazepine (also oxcarbazepine)
P = Phenytoin, Phenobarbital

*also garlic
*also goldenseal (induces 3A4 and 2D6)

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11
Q

warfarin colors

A

party like girls then bring peaches to your wedding

pink
lavender
green
tan
blue
peach
teal or blue green
YELLOW (7.5 mg)
WHITE (10 mg)

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12
Q

OTCs that increase bleed risk

A

NOT a mnemonic

NSAIDs
garlic
ginger
gingko biloba
vitamin E
fish oils –> can prolong bleeding time

additionally (rx) –> alcohol, SSRIs

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13
Q

anticholinergic SEs

A

hot as a hare (increase body temperature)
blind as a bat (mydriasis - dilated pupils)
dry as a bone (“anhidrosis”; dry mouth, dry eyes, decreased sweat)
red as a beat (flushed face)
mad as a hatter (delirium, altered mental status)
full as a flask (urinary retention)

also:
tachycardia
worsening of glaucoma
constipation
short term memory loss

random: urinary incontinence = LEAKING of urine

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14
Q

anticholinergic (adrenergic) impact

A

increased heart rate (+ chronotrope)
increased contractility (+ inotrope)
increased cardiac output
increased BP
bronchodilation
fat lipolysis/glycogenolysis (increase glucose)
uterus relaxation

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15
Q

what are the vitamin Bs

A

the rabbi needs prayer for comfort

thiamin B1
riboflavin B2
niacin B3
pyridoxine B6
folic acid B9
cyanocobalamin B12

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16
Q

increased uric acid

A

ABCDET

asa, alcohol, ALSO abaloparatide - Tymlos (new PTH analog for osteo)
B3 (niacin), bempedoic acid
calcineurin inhibitors (tacrolimus, cyclosporine), chemo agents
diuretics (loops + thiazides)
ethambutol (“E” = effects the eyes), Empirozenimide (TB drug)
ticagrelor (brilinta), Teriparatide - Forteo (for osteo), tacrolimus

also pyrazinamide (the “P” in the TB “RIPES” mnemonic)

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17
Q

statin SEs

A

HMG-CoA reductase inhibitors

hepatotoxicity, HA
myopathy/rhabdo, memory
glucose increase, GI (flatulence, abdominal pain)
CPK (check only if myopathy is being considered)
ophthalmic (blurred vision)
alopecia

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18
Q

DKA treatment

A

DIABETES

dehydrated (hydrate w/ NS (6 - 8L)
insulin (regular): IV preferred 0.1 U/kg/hr
acidosis (this is just indicating the pt is in an acidotic state)
bicarbonate (this used to be given)
electrolytes (monitor): for every 1 U of insulin given –> 1 U of potassium pulled into the cell [if pt has low K+, giving insulin WON’T be effective]; checking electrolytes to not give TOO much
time
electrolyties
sugar (when glucose drops below 200 or 250..maybe give more)

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19
Q

GLP-1 agonist SEs

A

gall bladder disease, GI symptoms
weight Loss
pancreatitis
1 –> “T” –> thyroid tumors [US boxed warning]

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20
Q

DPP-4 SEs

A

pancreatitis
joint Pain

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21
Q

SGLT2i SEs

A

genital yeast infections
L x4: LDL increase, lowers weight, lowers bp, LABs (increases K, Mg, Phosphate)
bone fracTures

*all given once daily in the AM
*canagliflozin should be taken b4 first meal

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22
Q

hypercalcemia signs/symptoms

A

ways it can be increased: increase PTH, thiazide, lithium

stones (kidney)
bones (disease)
groans (abdominal)
PSYCH overtones (anxiety, depression)

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23
Q

metabolic acidosis causes

A

MUDPILES

methanol
uremia
DKA
paraldehyde
iron, INH (isoniazid)
lactic acidosis
ethylene glycol, etoh
salicylate // STARVATION

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24
Q

glucocorticoid equivalent doses

A

CUTE HOT PRETTY PHARMACISTS MAKE TRIPLE DIGITS BOOOOOM

25mg - Cortisone
20mg - Hydrocortisone
5mg - Prednisolone
5mg - Prednisone
4mg - Methylprednisolone
4mg - Triamcinolone
0.75mg - Dexamethasone
0.6 - 0.75mg - Betamethasone

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25
Q

steroid systemic SEs

A

PREDNISONE (w/ long term use) - oral, not inhaled

PUD/Psychiatric: effects (at high PO doses) delirium, mania, depression, euphoria, mood swings
Retention: of Na & H2O
Eye: Cataracts, glaucoma
Diabetes: increased glucose –> decreased wound healing
Neurologic: CNS - HA, insomnia, seizure
Immunosuppression: however, WBC count increases
Swelling: Cushing’s Syndrome
Osteoporosis
Nausea (used to treat - very effective)
Electrolyte changes (decreased K, increased Na)

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26
Q

equivalent statin doses

A

Pharmacists Rock At Saving Lives and Prevent Fatty deposits

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

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27
Q

divalproex sodium

what to remember

[PNN migraine chapter]

A

depakote [when you die (DIvalproex), you put your coat (depaKOTE) on]

a = think alopecia, ammonia increase
l = liver, check LFTs
p = pancreatitis
t (in brand name) = thrombocytopenia

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28
Q

mtx symptoms

A

METHOTREXATE

m = myelosuppression // mucositis
h = hepatotoxicity
o = (make it a sun) photosensitivity
r = rash // renal (keep urine alkaline w/ Na Bicarb)
x = pregnancy cat X // chest x-ray

ANTIDOTE = LEUCOVORIN

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29
Q

leflunomide (Arava) symptoms

A

L = LFT, looong half life of the active metabolite (monitor AST, ALT. Check ALT qmonth for 6 months)

A = alopecia

also a lot of nausea

antidote = cholestyramine 8 g TID x11 days OR activated charcoal (50g in a suspension) x11 days

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30
Q

hydroxychloroquine (plaquenil)

symptoms // monitoring

A

HYDROXYCHLOROQUINE

monitoring: CBC/CNS, liver function, muscle strength

o = ophthalmologic
c = CBC // CNS
o = tinnitus (decreased hearing acuity)
l = liver function
n = neuroMyopathy

“PLAQ PLAQ PLAQ IN THE EYES”

eye exam at baseline, annual screening beginning after 5 years of use

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31
Q

amiodarone (Pacerone) SEs

A

AMIODARONE

BLUE = can turn pt blue

a = alveoli (check CXR); AV blocker (monitor EKG)
iod = IODine = check TSH (can cause hypo+hyperthyroidism)
o = “eye” = check corneal micro deposits = check eyes
d = DDI = inc warfarin/digoxin (would dec dose of war/dig) = INHIBITOR; 100% liver (CHECK LFTS; don’t worry about renal system); long t1/2 [don’t give w/ sofosbuvir or Harvoni (sofosbuvir + ledipasvir)]
o = sun = PHOTOSENSITIVITY (must wear sunscreen)
n = if waiting > 2 hr and need to make, use NON-PVC
e = check EKG (HR) & BP; check electrolytes (inc K, inc Mg)

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32
Q

CHA2DS2-VASc

A

CHF = 1 pt
HTN = 1 pt
A2GE >/= 75 –> 2 pts
DM = 1 pt
S2TROKE // TIA = 2 pts
VASCULAR DZ = 1pt
AGE 65 - 74 = 1pt
SEX = FEMALE = 1pt

CHEST
Men >/= 1; Women >/= 2 –> anticoagulate
[at least 1 non-sex risk factor]

AHA/ACC
Men >/= 2; Women >/= 3 –> anticoagulate
[at least 2 non-sex risk factors]

Men 1; Women 2 –> MAY consider anticoagulate
[at least 1 non-sex risk factor]

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33
Q

class I antiarrhythmics

A

Sodium channel blockers (I = QDP, II = PLM, III = PF)

Ia = QDP [quinidine, disopyramide, procainamide]
(atrial & ventricular arrhythmias)

IIb = PLM [phenytoin, lidocaine, mexiletine]
(ventricular arrhythmias)

IIIc = PF [propafenone, flecainaide]
(atrial & ventricular arrhythmias)

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34
Q

class II antiarrhythmics

A

Beta Blockers –> RATE CONTROL IN AFIB

IV (acute) = metoprolol, esmolol (brevibloc; shortest half-life), propanalol (inderal)

Oral (long-term rate control) = BBs are 1st line for pts w/ systolic HF & AF requiring rate control: carvedilol, metoprolol succinate or bisoprolol

BB antidote = glucagon

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35
Q

class III antiarrhythmics

A

Potassium channel blockers

IASDD

ibutilide (Corvert = IV; chemical cardioversion)
amiodarone (Pacerone = PO; Nexterone = IV)
sotalol (Betapace, Betapace AF = PO/IV; contra <40 CrCl)
dofetilide (Tikosyn = PO; D/C <20 CrCl; 125 - 500 mcg caps)
dronedarone (Multaq = PO; amio deriv: no thyroid, lung, eye SE; SE = liver failure // HF)

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36
Q

class IV antiarrhythmics

A

non-DHP Ca channel blockers

verapamil and diltiazem

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37
Q

major 2D6 inhibitor

A

fluoxetine, paroxetine, quinidine, sertraline - zoloft (weak/moderate inhibitor), duloxetine - cymbalta, bupropion - wellbutrin + Zyban, mirabegron - myrbetriq

these inhibitors will decrease effectiveness of the following:
-tamoxifen: for breast cancer –> needs to be converted to active form using 2D6
-codeine (prodrug of morphine)

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38
Q

major 1A2 inhibitors

A

fluvoxamine, ciprofloxacin, cimetidine (tagamet), isoniazid, viloxazine (Qelbree, non-stimulant that only increases norepi, similar to Strattera)

[drugs can decrease concentration of warfarin and theophylline]

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39
Q

general antipsychotic SEs

[from PNN schizophrenia chapter]

A

EPSE (dystonic reaction, akathisia, pseudoparkinsonism)

tardive dyskinesia (TD) - repetitive, involuntary movements

neuroleptic malignant syndrome (NMS)

sedation: (w/ aripiprazole and cariprazine: sedation)

anticholinergic effects (most with clozapine; rare w/ ziprasidone, aripiprazole, paliperidone, asenapine, lurasidone)

orthostasis: dizziness (most w/ clozapine, iloperidone; rare w/ aripiprazole, brexipiprazole, cariprazine, asenapine, lurasidone)

hyperprolactinemia: elevated prolactin levels (think risperidone AND paliperidone; aripiprazole has NOT been shown to increase this)

weight gain (think clozapine and olanzapine)

*all typical antipsychotics (block dopamine) have these SEs but w/ newer meds, some have less of these SEs

40
Q

antipsychotic SE mnemonic

[from PNN schizophrenia chapter]

A

WASH MEN

weight gain - block histamine H1 receptors
anticholinergic - block cholinergic receptors
sedation - block histamine receptors
hypotension - BLOCK alpha-adrenergic

movement disorders
EPSE - extrapyramidal symptoms i.e., movement dysfunction
neuroleptic malignant syndrome (NMS) i.e., life-threatening mental status change

41
Q

another anticholinergic mnemonic

[from PNN schizophrenia chapter]

A

ANTI - SLUDGE

ANTI-

Salivation
Lacrimation
Urination
Defecation / Diaphoresis (excessive sweating)
GI motility
Excretion / Emesis

42
Q

ATYPICALS // TYPICALS for rapid tranquilization mnemonic

A

HZZ

rapid IM for ACUTE agitation:

Haloperidal (Haldol)

Ziprasidone (Geodon)

Zyprexa (Olanzapine) –> watch for severe orthostatic hypotension

43
Q

LONG ACTING INJECTABLE ANTIPSYCHOTICS for pts who are noncompliant

ADD DETAIL? P432 IN PNN

A

decanoate means can last for long periods of time (e.g., weeks, months, etc)

Haldol decanoate [typical]
-oral monthly

Fluphenazine decanoate [typical]
-every 2 to 4 weeks

Risperidone (Risperdal = Consta)
-IM every 2 weeks

Risperidone (Perseris)
-subQ monthly

Paliperidone palmitate
-invega sustenna = IM every month
-invega TRInza = IM every 3 months

Aripiprazole (Abilify Maintena)
-IM once monthly

Aripiprazole lauroil (Aristada)
-IM every 4 to 6 weeks

Aripiprazole lauroil (Aristada initio)
-IM is only to be used as a single dose to initiate Aristada “booster”

Olanzapine pamoate (Zyprexa Relprevv)(olanzapine ER)
-every 2 weeks or once a month

44
Q

loss of dopamine results in

[mnemonic; from PNN parkinsons]

A

TRAMPP

tremor: “resting tremor”, bilateral (initially unilateral), absent during sleep

rigidity: stiff “cog wheel rigidity”

akinesia: initiation of movement is difficult. Bradykinesia = slowed movement

mask face: can’t smile or make facial expressions d/t the stiffness of facial muscles

pill rolling with fingers

postural instability later in the disease state

45
Q

contra // caution to anticholinergics

[from PNN parkinsons]

A

BPH

narrow-angle glaucoma

bladder neck obstruction

myasthenia gravis

46
Q

meds with anticholinergic effects

A

atropine

scopolamine

TCAs

dicyclomine (bentyl)

hyoscyamine

47
Q

BZDs for elderly mnemonic

A

LOT

lorazepam (ativan)

oxazepam

temazepam (RESToril) = insomnia only (BZDs also insomnia only: estazolam - ProSom, triazolam - Halcion)

48
Q

BZDs that don’t have many DDIs (i.e., not a substrate) mnemonic

A

LOT

lorazepam (ativan)

oxazepam

temazepam (RESToril) = insomnia only (BZDs also insomnia only: estazolam - ProSom, triazolam - Halcion) [CONFIRM ESTAZOLAM AND TRIAZOLAM CAN ALSO BE USED FOR SLEEP]

49
Q

DSM-5 diagnostic criteria mnemonic

A

five or more symptoms present nearly every day, for 2 weeks. at least one of the symptoms is (1) depressed mood or (2) loss of interest/pleasure

SIG E CAPS:

sleep changes
interest (loss)
guilt (worthless)

energy (lack): fatigue

cognition/concentration
appetite (wt loss or wt gain)
psychomotor agitation (anxiety) or retardation (lethargic)
suicidal thoughts or suicide attempt

50
Q

SSRIs SE mnemonic

A

HOWS G

H = hypotension, HA, hyponatremia
O = bOne (increased risk of fractures), ocular effects
W = wt gain
S = suicidal thinking, sexual dysfunction, serotonin syndrome caution

G = GI (can exacerbate loose stools) // GI Bleed

51
Q

lithium SEs mnemonic

[from PNN anxiety, depression, bipolar disorder]

A

LITHIUM

L = Li levels 0.6 - 1 mEq/L (mainten.), leukocytosis (inc WBC)
I = increase urination (polyuria // polydipsia; concern for nephrogenic diabetes insipidus –> check electrolytes)
T = tremor, TSH (concern for hypothyroidism - low T3 & T4)
H = hypercalcemia, hyperparathyroidism
I = increase CNS // dermatologic (acne, alopecia)
bUn and scr = lithium is excreted renally
M = monitor WEB (Weight // EKG // Electrolytes // Beta-hCG)

52
Q

2C19 inhibitors

A

omeprazole and esomeprazole

[can increase phenytoin and R-warfarin; can decrease impact of plavix]

53
Q

TB Drugs mnemonic

A

RIPES [all drugs are bactericidal except for ethambutol]

Rifampin (rifadin) - empty stomach
Isoniazid (INH) - empty stomach
Pyrazinamide
Ethambutol (Myambutol) - bacteriostatic
Streptomycin
bedaquiline (Sirturo)

combinations:
-rifamate (isoniazid + rifampin) - empty stomach
-rifater (isoniazid + rifampin + pyrazinamide) - empty stomach

54
Q

2C9 inhibitors

A

isoniazid, erythromycin

55
Q

rifampin an inducer of

A

3A4, 1A2 and 2C9

decreases efficacy of oral contraceptives, decreases INR w/ warfarin. avoid using with protease inhibitors d/t increased risk of hepatotoxicity

56
Q

NRTIs mnemonic

A

ZALES DT

zidovudine (AZT,ZDV)(retrovir)
abacavir (ABC)(Ziagen)
lamivudine (3TC)(Epivir, Epivir-HBV)
emtricitabine (FTC)(Emtriva)
stavudine (d4T)(Zerit)

didanosine (ddI)(Videx, Videx EC)
tenofovir

57
Q

NNRTIs mnemonic

A

RNEEDD

rilpivirine (RPV)(Edurant)
nevirapine (NVP)(Viramune)
efavirenz (EFV)(Sustiva)
etravirine (ETR)(Intelence)
doravirine (Pifeltro)
delavirdine (DLV)(Rescriptor)

58
Q

Integrase inhibitors mnemonic

A

RBED

raltegravir (RAL)(Isentress - PO)
bictegravir (+ emtricitabine + TAF = Biktarvy)
elvitegravir (+ cobicistat + TDF + emtricitabine = Stribild; + cobicistat + emtricitabine + TAF = Genvoya)(PO)
dolutegravir (DTG)(Tivicay)(PO)
cabotegravir (Apretude - IM; PrEP; Vocabria - PO; + rilpivirine = Cabenuva - IM)

59
Q

protease inhibitors mnemonic

A

LAND FIRST

lopinavir/ritonavir (RTV)(Kaletra)
atazanavir (ATZ)(Reyataz) w/ cobicistat (Evotaz)
nelfinavir (NFV)(Viracept)
darunavir (DRV)(Prezista) w/ cobicistat (Prezcobix)

fosamprenavir (FPV)(Lexiva)
indinavir (IDV)(Crixivan)
ritonavir (RTV)(Norvir)
Saquinavir (SQV)(Invirase)
tipranavir (TPV)(Aptivus)

60
Q

barbiturates SE mnemonic

A

ex: phenobarbital, pentobarbital, primidone

BARB

bone disease, bone marrow suppression
ataxia (loss of full control of body movements)
rash, respiratory depression
behavior changes, bradycardia

61
Q

seizure med levels

A

phenobarbital
-infants + children: 15 - 40 mcg/mL
-adult: 20 - 40 mcg/mL

primidone: 5 - 12 mcg/mL

fosphenytoin // phenytoin: 10 - 20 mg/L or mcg/mL

valproic acid (divalproex sodium): 50 - 100 mcg/mL

carbamazepine: 4 - 12 mcg/mL

oxcarbazepine: 12 - 30 mcg/mL

ethosuximide: 40 - 100 mcg/mL

62
Q

what enhances GABA (4)

A

-benzodiazepines
-propofol (diprivan)
-ethanol
-phenobarbital

Purpose of GABA:
-inhibitory
-agonize = calming effect
-reduce stress // anxiety
-improve sleep

63
Q

how will alcohol impact phenytoin // warfarin (INR)

A

acute alcohol intake = increase phenytoin levels // increase INR

chronic alcohol intake = decrease phenytoin levels // decrease INR

64
Q

valproic acid and lamictal

A

weak inhibitor of 2C9, 2D6, 3A4

increases blood levels of lamotrigine

65
Q

_______ serotonin ________ sodium

A

increase; decrease

66
Q

adverse effects of COCs:

progestational

androgenic

estrogenic

A

progestational:
-breast tenderness, HA, HTN, acne, oily skin, hirsutism, decreased libido
-progestins have chemical structure similar to testosterone thus have some androgenic activity

androgenic:
-acne, oily skin, INCREASED APPETITE, WT GAIN, DEPRESSION, fatigue, lethargy

estrogenic:
-nausea, edema, fluid retention, HA, wt gain, increased breast size, THROMBO-EMBOLIC EVENTS (PE, DVT, CVA), skin pigment changes

[ESTROGEN THICKENS BLOOD]

67
Q

ABSOLUTE CONTRAINDICATIONS FOR COCs

A

thromboembolic disorder or hx (DVT, CVA)

hx of breast / uterus or any estrogen-dependent neoplasia (abnormal growth of cells)

undiagnosed vaginal bleeding

liver issues (jaundice, general hepatic disease)

pregnancy

World Health Organization (WHO) Contraindications:

-lactation < 6 weeks postpartum (had a baby –> female is in a hypercoagulable state)
-age > 35 & smoke > 15 cigs/day
-HTN
-migraines (IF HAVING AURAS)
-DM w/ end organ disease
-chest pain

[IF BREAST CANCER = NO ESTROGEN]

68
Q

If on COC, contact MD if

[mnemonic]

A

ACHES

abdominal pain (severe)
chest pain, cough, SOB –> concern for PE
headache, dizziness, numbness –> concern for stroke
eye problems (vision loss/burning)
severe leg pain (calf or thigh) –> concern for DVT

SEs will decrease w/ consistent use after 3 months

69
Q

concerning DDIs w/ COC

A

antibiotics / antifungal
-griseofulvin

cyp3A4 inducers
-rifampin
-anticonvulsants (phenytoin, phenobarbital, carbamazepine, oxcarbamazepine)

if taking these meds, should not use hormonal contraception (EXCEPT depo-provera / IUD). If must use COC, some clinicians may recommend COC with 50 mcg of estrogen

70
Q

NORETHINEDRONE // PROGESTERONE ONLY
(MINI PILL)

+ counseling points

A

-Micronor
-Nor-QD
-Aygestin
-Camila
-Errin
-Jolivette
-Nora-BE

^norethindrone: 0.35 mg

TAKE SAME TIME EVERY DAY

INITIATE ON FIRST DAY OF MENSES or on first Sunday after menses begins

USE BACK-UP FOR 2 DAYS IF > 3 HOURS LATE ON DOSE

[progesterone has short half-life –> result –> lining can thin and allow sperm penetration]

EVERY PILL IS THE SAME

71
Q

good candidates for progestin only birth control

A

indicated for contraception / endometriosis

contraception of >1 year duration is desired

pts in whom estrogens should be avoided

non-compliant w/ COC (forgetful)

when breastfeeding is desired

pts w/ a hx of seizures

when amenorrhea is desired

when considered w/ DDIs

[progesterone is sedating // relaxing - estrogen is excitatory]

72
Q

AVOID progesterone in pts w/

A

hx of depression or HAs

73
Q

how to choose the right form of birth control:

acne

wt gain

A
74
Q

how to choose the right form of birth control:

dysmenorrhea (menstrual cramps) or PMS (premenstrual syndrome)

bloating

menstrual migraine

A
75
Q

how to choose the right form of birth control:

women w/ coexisting medical condition

women w/ DM

women w/ hx of DVT / PE, CAD, CHF, or CVA

women w/ migraines & depression

A
76
Q

FLibAnSeriN (Addyi) info

A

mixed serotonin agonist / antagonist for premenopausal women w/ hypoactive (decrease in physical or behavioral activity) sexual desire
-dose = SQ 45 min before sexual activity
-is a major 3A4 substrate –> CONTRA w/ 3A4 inhibitors
-SEs: hypotension, syncope

FLibAnSeriN

L = liver

A = alcohol contraindication

S = serotonin, syncope, substrate: CYP3A4 (CONTRA w/ inhibitors)

N = take it at Night (QHS)

77
Q

allergies to be aware of:

cleviprex

diprivan

prometrium

paclitaxel

LMWH

Hyalgan

Calcitonin

Pramlintide

A

clevidipine –> soy & egg

propofol –> soy & egg

progesterone –> peanut

paclitaxel –> Cremophor EL (polyoxyethylated castor oil)

LMWH (enoxaparin, dalteparin) –> pork allergy

Hyaluronate –> eggs, avian protein, feathers

Miacalcin –> salmon

Symlin –> Metacresol

78
Q

cigarette smoking and drug interactions:

CYP enzyme of concern

what drugs concerned about

what do when quit smoking

A

cigarette smoking induces CYP1A2 substrates

theophylline (Theo-Dur), olanzapine (Zyprexa), clozapine (Clozaril), & fluvoxamine (Luvox) [may need higher dose of these drugs in pts who smoke]

when quit smoking, may need to reduce the dose of CYP1A2 substrates and caffeine [caffeine levels increase when a pt quits smoking; counsel them to reduce their caffeine intake after they quit]

79
Q

how reduce nephrotoxicity w/ cisplatin and carboplatin

A

ALL B4 CHEMO AGENTS

hydrate 2-3L NS

mannitol 25-50 g IV

amifostine (ethyl) [cisplatin ONLY; carboplatin less nephrotoxic than cisplatin]

80
Q

how premedicate:

BuSulfan

A

premedicate w/ prophylactic anticonvulsants (phenytoin, levetiracetam, BZDs, or valproate)

81
Q

how premedicate:

cyclophosphamide and ifosfamide

A

hydrating AND MESNA which binds to acrolein (this is responsible for hemorrhagic cystitis)

82
Q

MTX antidote

A

Leucovorin (folinic acid)

83
Q

how improve effect of fluorouracil (5-FU)

A

ADD leucovorin

84
Q

precursors of:

Fluorouracil (5-FU) and Mercaptopurine (6-MP)

A

Capecitabine (Xeloda) is PRO-DRUG of Fluorouracil (5-FU)

Azathioprine turns into Mercaptopurine (6-MP)

85
Q

Azathioprine // Mercaptopurine (6-MP) major DDI

A

allopurinol // febuxostat are xanthine oxidase inhibitors which increase the concentration of Azathioprine and Mercaptopurine (6-MP)

solution = decrease dose of Azathioprine and Mercaptopurine (6-MP) if need to give together

86
Q

life time doses of:

Bleomycin

Doxorubicin

Daunorubicin

A

400 units

550 mg/m2

550 mg/m2

87
Q

how premedicate:

Doxorubicin and Daunorubicin

A

Dexrazoxane IV (Zinecard: iron chelator) protects against cardiotoxicity

88
Q

how premedicate:

docetaxel (Taxotere)

A

corticosteroids:

dexamethasone 8 mg BID x3-5 days, start 1 day prior

89
Q

how premedicate:

paclitaxel (Taxol)

A

d/t hypersensitivity premedicate before starting taxol w/ dexamethasone, IV diphenhydramine, and IV histamine H2 antagonists (cimetidine, ranitidine or famotidine)

90
Q

how treat diarrhea and dehydration:

irinotecan // topotecan

A

early form –> atropine

late form –> loperamide (no MAX dose HERE)

also replenish fluids and electrolytes

91
Q

tacrolimus SEs

A

tacrolimus mnemonic

t - tremor
a - alopecia, acne
c - cardiovascular (HTN, QT increase)
r - renal
o - oncology (skin cancer; avoid sun & UV light exposure)
l - liver (CYP3A4 substrate)
i - infection, immunosuppression, increase in K, IDDM (insulin dependent DM)
m - monitor levels, malignancy
u - uric acid increase
s - seizures (neurotoxicity)

92
Q

elemental iron values

A
93
Q

mnemonic for MAOi

A

MAO Takes Pride In Shanghai

T –> tranylcypromine (Parnate)

P –> phenelzine (Nardil)

I –> isocarboxazid (Marplan)

S –> selegiline (Emsam; Zelapar)(MAO-B > MAO-A at low doses i.e., 10 mg or less)

*MAO-A degrades: serotonin, dopamine, norepi, epi, tyramine, other chemicals
*MAO-B degrades: dopamine, other chemicals

[ only MAOi w/ preferential inhibition (ONLY at low doses) is selegiline; other 3 inhibit MAO-A and MAO-B EQUALLY ]

94
Q

opportunistic infection prophylaxis:

PCP

Toxoplasmosis

MAC

A
95
Q

Abx w/ NMTT side chain

[MNEMONIC]

A

man met operator 4 tea

cefamandole

cefmetazole

cefoperazone

cefotetan

96
Q

PPI Side Effects

A

all PPIs cause a reduction in calcium absorption

MPJE + NAPLEX 2023 PREP (16 decks)

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