NAPLEX Flashcards
specific gravity units
g/ml
SCE or E value units
g NaCl/g drug
mEq to mg or mg to mEq
mg = (mEq)(molecular weight/valence) mEq = (mg)(valence/molecular weight)
BSA equation
square root of: (cm)(kg)/3600
BMI equation
kg/(m^2)
magnesium stearate in compounding
glidant/lubricant
sodium lauryl sulfate in compounding
surfactant to neutralize static charge
adsorbant powders
used to keep powders dry (eutectic mixtures - lower melting point when mixed than either component alone)
magenium oxide, magnesium carbonate, kaolin
emulsifiers
acacia, agar, carbomers, glyceryl monostearate, pectin, PEG, sodium lauryl sulfate, sorbitan lipophilic esters, sorbitan hydrophilic esters
levigating agents
glycerin, mineral oil, PEG, propylene glycol
drugs that cause photosensitivity
carbamazepine, diuretics (thiazide and loop), methotrexate, oral and topical retinoids, quinolones, st. john’s wort, sulfa abx, tacrolimus, tetracyclines, voriconazole
drugs that cause TTP
clopidogrel, ticlopidine
drugs that cause severe skin reactions
allopurinol, lamotrigine, penicillins, phenytoin, piroxicam, sulfamethoxazole
Cl calculations
Cl = Rate of elimination / concentration
Cl = F*dose / AUC
for IV, F = 1
F (bioavailability) calc
F = 100 * (AUC(extravascular)/AUC(IV)) * (Dose(IV)/Dose(extravascular))
k (elimination rate constant) calc
k = Cl/Vd
t1/2 calc
t1/2 = 0.693/k
loading dose calculation
LD = (desired conc)(Vd)/F
CYP inducers
PS-PORCS (big inducers) phenytoin smoking phenobarbital oxcarbazepine rifampin carbamazepine st. john's wort
CYP inhibitors
g pacman (big inhibitors) grapefruit PIs (protease inhibitiors) Azole antifungals C - cyclosporine, cimetidine, cobicistat Macrolides (NOT azithromycin) Amiodarone non-DHP CCBs (dilt and verapamil)
genetic testing strongly recommended prior to starting therapy
abacavir (including Epzicom and Triumeq): HLA-B5701 due to risk of fatal hypersensitivity - must test all patients prior to starting and withhold if positive
Carbamazepine: HLA-B1502 due to SJS or TEN risk - must test all asian patients and withhold if positive
Trastuzumab, adotrastuzumab emtansine: HER2 overexpression is required for use - do not use if negative
Cetuximab: KRAS - drug is not effective in patients with colorectal cancer who have a KRAS mutation - only use if KRAS negative
azathioprine: TPMT - no TPMT activity can lead to increased risk of severe myelosuppression; if TPMT low or absent, start at very low dose or use alt therapy
genetic testing should be considered prior to starting therapy
allopurinol: HLA-B*5801 due to risk of SJS - if positive, avoid
clopidogrel: CYP2C19 allele - *1 allele is fully functional, *2 and *3 alleles have decreased conversion to active metabolite and may experience increase CV events
codeine: CYP2D6 - ultra metabolizers may experience toxicity due to morphine overdose
Warfarin: CYP2C9 *2 and 3, VKORC1 (G to A) - increased bleeding risk with decreased function of alleles
Capecitabine - DPD deficiency cause increase toxicity; if DPD deficient, avoid use
Phenytoin: HLA-B1502 in asian patients - if positive, do not use due to risk of SJS or TEN
Confidence interval: result is statistically significant if the CI does not include
zero
ratio data (risk ratio, odds ratio, hazard ratio): result is statistically significant if the CI does not include
one
alpha
probability of a type-1 error (false positive; i.e. concluded that drug was better than placebo when it was not).
beta
probability of a type II error (false negative, i.e. drug is concluded not to have benefit when it actually does).
statistical power
probability that the test will reject the bull hypothesis when the null hypothesis is false (avoiding a type II error). power = 1-beta. higher statistical power means that we can be more certain that the null hypothesis was correctly rejected.
discrete data
limited or finite set of values. only whole numbers. Nominal and ordinal.
nominal data
type of discrete data. consists of categories where the order is arbitrary (i.e. 0=male, 1=female).
ordinal data
type of discrete data. consists of ranked categories where the difference cannot be considered equal (i.e. NYHA functional class). ranked by severity but cannot be measured/quantified.
continuous data
infinite number of possible values within a defined range. interval or ratio.
interval data
type of continuous data. used to measure data that have legitimate mathematical values. 0 point is arbitrary and does not mean “none” (i.e. celsius).
ratio data
type of continuous data. equal intervals between values and a meaningful zero point (i.e. height, weight)
nominal data statistical tests
2 independent samples: chi squared or fishers exact
3+ independent samples: chi squared
2 paired samples: mcnemar test
3+ paired samples: cochran Q
ordinal data statistical tests
2 independent samples: wilcoxon rank sum or mann whitney U test
3+ independent samples: kruskal-wallis test
2 paired samples: wilcoxon signed rank sum
3+ paired samples: friedman
Continuous data statistical tests
2 independent samples: students T test
3+ independent samples: ANOVA or kruskal-wallis
2 paired samples: paired student T test or wilcoxon signed rank test
3+ paired samples: ANOVA
risk ratio overview
probability of an unfavorable event occurring in the treatment group vs the control group
1= no different in risk
less than 1=fewer events in the treatment group
more than 1=more events in the treatment group
RR = (risk in treatment group)/(risk on control group)
relative risk reduction overview
how much risk is reduced in the treatment group compared to control group
RRR=1-RR
absolute risk reduction
difference between control groups event rate and treatment groups event rate
ARR=(risk in control)-(risk in treatment)
expressed in % meaning that for every 100 patients, X fewer would experience the outcome
number needed to treat
number of people who would need to be treated with the intervention for a certain period of time in order to achieve the desired outcome in one patient
NNT=1/ARR
odds
the probability of the event occurring compared with the probability that it will not occur
100 smokers, 40 develop cancer. 40:60. 67% are the odds of developing cancer
odds ratio
ratio of odds of an event occurring in the treatment group to the odds of an event occurring in the control group. measure of association between an exposure and an outcome.
OR = (drug group gets disease x placebo group does not get disease)/(drug group does not get disease x placebo group gets disease)
if OR is 6, it means that drug group is 6 times as likely to experience the outcome
if OR is 1, there is no difference between groups
hazard ratio
chance of an unfavorable event occurring by a given point in time
used as a time-to-event analysis
HR = (hazard rate in the treatment group)/(hazard rate in the control group)
HR less than one: at any given time, relatively fewer patients in the treatment group have had an event compared to the control
sensitivity
proportion of time a test is positive in patients who have a disease
(true+)/(true+ + false -)
specificity
proportion of time a test is negative in patients who do not have the disease
(true-)/(true- + false+)
low specificity and high sensitivity
false positive
high specificity and low sensitivity
false negative
drugs that require non PVC containers *
amiodarone, insulin, lorazepam, nitroglycerin, tacrolimus
drugs that must be put in saline (no dextrose) *
ampicillin, amp/sul, caspofungin, dapto, phenytoin, ertapenem, infliximab
drugs that must be put in dextrose (no saline) *
amp B, quinupristin/dalfopristin, sulfa/TMP, cell cept
drugs with filter requirements *
continuous amiodarone, ampB (5 micron during compounding only), golimumab, lipids (1.2 micron), lorazepam, phenytoin, parenteral nutrition
drugs that should not be refrigerated *
dexmedetomidine, enoxaparin, furosemide, metronidazole, moxifloxacin, phenytoin, SMX/TMP
drugs to protect from light *
doxycycline, epoprostenol, micafungin, sodium nitroprusside
