NAPLEX Flashcards
Aminophylline conversion
Aminophylline x 0.8 = theophylline
Elemental iron in FeSO4
20%
1 ppm
1 mg/L
1 ppb
1 mcg/L
High risk waist size
> 40” (men), >35” (women)
BMI formula
kg/m2
BMI underweight
<18.5
BMI normal
18.5-24.9
BMI overweight
25-29.9
BMI obese
> 29.9
IBW formula (men)
50 kg + 2.3 kg for every inch >5 ft
IBW formula (women)
45.5 kg + 2.3 kg for every inch >5 ft
SCr normal range
0.6-1.2 mg/dL
BUN:SCr ratio
> 20 indicates dehydration
CrCl formula
[(140-age)/(72 x SCr)] x kg, x 0.85 if female
CrCl levels
<15 = renal failure/dialysis, 15-29 = severe deficiency, 30-59 = moderate, 60-90 = mild
Specific gravity
g/mL
BSA formula
sq. root of: (cm x kg)/3600
Dextrose kcal
3.4 kcal/g
Amino acids kcal
4 kcal/g
10% lipid emulsion kcal
1.1 kcal/mL
20% lipid emulsion kcal
2 kcal/mL
K+ normal range
3.5-5 mEq/L
Corrected Ca formula
Ca + [(4-alb) x 0.8]
Max total Ca & phosphate
45 mEq/L
Osmolarity of blood
~300 mOsmol/L
Osmolarity formula
mOsmol/L = (g/L)/(MW) x #species x 1000
mols formula
mols = g/MW
mmols formula
mmols = mg/MW
mEq formula
mEq = (mg x valence)/MW or mEq = mmols/valence
mEq of KCl 10% liquid
20 mEq/15 mL
Celsius to Fahrenheit conversion
C = (F-32)/1.8
Elemental Ca in calcium carbonate
40%; absorption is acid-dependent, so take with food
Elemental Ca in calcium citrate
21%; absorption is not acid-dependent, so can be taken with or without food
RBC life span
120 days
Platelet life span
7-10 days
ANC & clozapine
Do not dispense if <2000; normal range is 2200-8000/uL
Anion gap formula
[Na+] - [Cl + HCO3]; high is >12 mEq/L
pH formula for acid
pH = pKa + log(salt/acid)
pH formula for base
pH = 14 - pKb + log(base/salt) or pH = pKa + log(base/salt)
Hydrocodone/APAP
Vicodin, Lorcet, Lortab, Norco, Zydone (opioid/analgesic)
Simvastatin
Zocor (statin)
Lisinopril
Zestril, Prinivil (ACEI)
Levothyroxine
Synthroid
Azithromycin
Zithromax, Z-Pak, AzaSite (macrolide)
Amoxicillin
Amoxil, Moxatag (amino-PCN)
Amlodipine
Norvasc (CCB)
Omeprazole
Prilosec (PPI)
Alprazolam
Xanax, Niravam (BZ)
Metformin
Glucophage, Glumetza, Riomet, Fortamet (biguanide)
HCTZ
Thiazide diuretic
Zolpidem
Ambien (hypnotic)
Atorvastatin
Lipitor (statin)
Furosemide
Lasix (loop)
Sertraline
Zoloft (SSRI)
Citalopram
Celexa (SSRI)
Ibuprofen
Advil, Motrin (NSAID)
Oxycodone/APAP
Percocet, Endocet, Roxicet (opioid/analgesic)
Prednisone
Deltasone (steroid)
Metoprolol tartrate
Lopressor (BB)
Tramadol
Ultram, Ryzolt (opioid)
Metoprolol succinate
Toprol XL (BB)
Atenolol
Tenormin (BB)
Gabapentin
Neurontin (anticonvulsant)
Fluticasone propionate
Flovent, Flonase (steroid)
Montelukast
Singulair (leukotriene inhibitor)
Clonazepam
Klonopin (BZ)
Cyclobenzaprine
Flexeril (muscle relaxer)
Ciprofloxacin
Cipro (FQ)
Lorazepam
Ativan (BZ)
Clopidogrel
Plavix (ADP inhibitor)
Test for CYP2C19 genotype (converts drug to its active metabolite)
Lisinopril/HCTZ
Zestoretic, Prinzide (ACEI/thiazide)
Fluoxetine
Prozac, Serefem, Selfemra (SSRI)
Amox/Clavulanate
Augmentin
Albuterol
ProAir HFA, Ventolin HFA, Proventil HFA (SABA)
Warfarin
Coumadin, Jantoven (anticoagulant)
Increased bleeding risk (need lower dose) with VKORC1 gene or 2C192/3 alleles
Rosuvastatin
Crestor (statin)
Esomeprazole
Nexium (Mg) / Nexium IV (Na) (PPI)
SMX/TMP
Bactrim, Septra (sulfonamide)
Cephalexin
Keflex (1st Gen Cephalosporin)
Pravastatin
Pravachol (statin)
Escitalopram
Lexapro (SSRI)
Trazodone
Desyrel (triazolopyridine)
Meloxicam
Mobic (NSAID)
Carvedilol
Coreg (alpha-blocker/beta-blocker)
Losartan
Cozaar (ARB)
Duloxetine
Cymbalta (SNRI)
Fluconazole
Diflucan (azole antifungal)
Ranitidine
Zantac (H2RA)
Naproxen
Naprosyn, Aleve/Anaprox (sodium) (NSAID)
Potassium Chloride
potassium supplement
Diazepam
Valium (BZ)
Triamterene/HCTZ
Dyazide, Maxzide (K-sparing/thiazide)
Oxycodone
Oxycontin (opioid)
Pantoprazole
Protonix (PPI)
APAP/Codeine
Tylenol #3 (analgesic/opioid)
Extensive 2D6 metabolizers may have exaggerated response
Tamsulosin
Flomax (alpha-1 blocker)
Doxycycline hyclate
Vibramycin (TCN)
Alendronate
Fosamax (bisphosphonate)
Valsartan
Diovan (ARB)
Paroxetine
Paxil (SSRI)
Allopurinol
Zyloprim (xanthine oxidase inhibitor)
Vit D
Cholecalciferol (D3), Ergocalciferol (D2 - Drisdol)
Amitriptyline
Elavil (TCA)
Promethazine
Phenergan (antihistamine)
Clonidine
Catapres (alpha-2 agonist)
Lovastatin
Mevacor (statin)
Venlafaxine
Effexor (SNRI)
Bupropion
Wellbutrin, Zyban (antidepressant, smoking cessation)
Triamcinolone acetonide
Kenalog, Nasacort, Azmacort (steroid)
Carisoprodol
Soma (muscle relaxer)
Valsartan/HCTZ
Diovan HCT (ARB/thiazide)
Quetiapine
Seroquel
Amphetamine salts
Adderall (stimulant)
Cefdinir
Omnicef
3rd Gen Cephaolosporin
Valacyclovir
Valtrex (antiviral)
Methylprednisolone
Medrol (steroid)
Enalapril
Vasotec (ACEI)
Pioglitazone
Actos (thiazolidinedione)
Lamotrigine
Lamictal (anticonvulsant)
Spironolactone
Aldactone (K-sparing)
Metronidazole
Flagyl, MetroGel
Glimepiride
Amaryl (sulfonylurea)
Folic Acid
Folic acid
Mometasone furoate
Nasonex (steroid)
Topiramate
Topamax (anticonvulsant)
Amlodipine/Benazepril
Lotrel (CCB/ACEI)
Lisdexamfetamine
Vyvanse (stimulant)
Pregabalin
Lyrica (neuropathic pain)
Risperidone
Risperdal (antipsychotic)
Sildenafil
Viagra, Revatio (PDE-5 inhibitor)
Celecoxib
Celebrex (COX-2 inhibitor)
Insulin Glargine
Lantus (long-acting)
Clindamycin
Cleocin (lincosamide)
Temazepam
Restoril (BZ)
Tiotropium
Spiriva
Penicillin VK
Veetids (natural PCN)
Aripiprazole
Abilify
Digoxin
Lanoxin, Digitek (cardiac glycoside)
Norethindrone, ethinyl estradiol, ferrous fumarate
Loestrin 24 Fe
Propranolol
Inderal (non-selective BB)
Morphine sulfate
MS Contin (opioid)
Ramipril
Altace (ACEI)
Glipizide
Glucotrol (sulfonylurea)
Isosorbide mononitrate
Imdur (nitrate)
Benazepril
Lotensin (ACEI)
Tadalafil
Cialis, Adcirca (PDE-5 inhibitor)
Fexofenadine
Allegra (antihistamine)
Polyethylene Glycol
Miralax (hyperosmotic laxative)
Lansoprazole
Prevacid (PPI)
Hydroxyzine
Atarax, Vistaril
Mupirocin
Bactroban (antibiotic)
Buprenorphine/Naloxone
Suboxone (opioid/opioid antagonist)
Ezetimibe
Zetia (cholesterol absorption inhibitor)
Diclofenac
Voltaren (sodium), Flector (epolamine), Cataflam (potassium) (NSAID)
Glyburide
Diabeta, Micronase (sulfonylurea)
Sitagliptin
Januvia (DPP4 inhibitor)
Nitrofurantoin
Furadantin, Macrodantin (macrocrystals)
Sumatriptan
Imitrex (5-HT1 agonist)
Phentermine
Suprenza, Adipex (stimulant)
Fenofibrate
Tricor (fibric acid)
Acyclovir
Zovirax (antiviral)
Mirtazapine
Remeron (tetracyclic antidepressant0
Donepezil
Aricept (cholinesterase inhibitor)
Butalbital/APAP/Caffeine
Fioricet (migraine)
Verapamil
Calan (non-DHP CCB)
Benzonatate
Tessalon (antitussive)
Nystatin
Nystop (antifungal)
Estradiol
Climara, Estrace
Ondansetron
Zofran (5-HT3 antagonist)
Famotidine
Pepcid (H2RA)
Promethazine/Codeine
Phenergan w/Codeine (antitussive)
Extensive 2D6 metabolizers may have exaggerated response to codeine
Conjugated Estrogens
Premarin
Buspirone
Buspar (antianxiety)
Ethinyl estradiol/Etonogestrel
Nuvaring
Niacin
Niaspan (antihyperlipidemic)
Ezetimibe/Simvastatin
Vytorin (cholesterol absorption inhibitor/statin)
Olmesartan
Benicar (ARB)
Methotrexate
Rheumatrex, Trexall (antimetabolite)
Ketoconazole
Nizoral (azole antifungal)
Fentanyl
Duragesic (opioid)
Tizanidine
Zanaflex (muscle relaxer)
Finasteride
Propecia, Proscar (5-alpha reductase inhibtor)
Ethinyl Estradiol/Norgestimate
TriNessa, Tri-Sprintec, Ortho Tri-Cyclen
Gemfibrozil
Lopid (fibric acid)
Nebivolol
Bystolic (BB)
Methocarbamol
Robaxin (muscle relaxer)
Omega-3 Acid Ethyl Esters
Lovaza (omega-3 fatty acid)
Levetiracetam
Keppra (anticonvulsant)
Clobetasol
Clobex (steroid)
Meclizine
Antivert, Bonine, Dramamine II
Doxazosin
Cardura (alpha-1 blocker)
Clotrimazole/Betamethasone
Lotrisone (antifungal/steroid)
Chlorhexidine
Hibiclens, Chlorostat (antibacterial)
Drospirenone/Ethinyl Estradiol
Gianvi, Ocella, Yaz, Zarah
Levofloxacin
Levaquin (FQ)
Latanaprost
Xalatan (glaucoma)
Methylphenidate
Concerta, Ritalin, Metadate (stimulant)
Olmesartan/HCTZ
Benicar HCT (ARB/thiazide)
Budesonide/Formoterol
Symbicort (steroid/LABA)
Diltiazem
Cardizem, Cartia, Dilacor, Tiazac (non-DHP CCB)
Eszopiclone
Lunesta
Methadone
Dolophine (opioid)
Prednisolone sodium phosphate
Orapred (steroid)
Memantine
Namenda
Baclofen
Lioresal (muscle relaxer)
Medroxyprogesterone
Depo-Provera
Ipratropium/Albuterol
Combivent (anticholinergic/SABA)
Ropinirole
Requip (anti-parkinsonian)
Hydrocortisone
Anusol HC (steroid)
Dexlansoprazole
Dexilant (PPI)
Dicyclomine
Bentyl (antimuscarinic)
4th Gen Cephalosporin
Cefepime
5th Gen Cephalosporin
Ceftaroline
Aminoglycosides
Gentamicin, Tobramycin, Amikacin, Neomycin, Streptomycin
Tobramycin/Dexamethasone
Tobradex (AG/Steroid)
Carbapenems
Beta-lactams
Doripenem, ertapenem, meropenem
Fluoroquinolones
cipro, levo, moxi (Avelox), nor, o, gati
Vancomycin
Vancocin (glycopeptide)
Ketolide
Telithromycin
Lincosamide
Clindamycin
Macrolides
Azith, clarity (Biaxin), eryth, fidaxomicin (Dificid)
Linezolid
Zyvox (oxazolidinone)
PCN-ase resistant PCN’s
Diclox, meth, naf, oxa
Neuraminidase Inhibitors
Oseltamivir (Tamiflu)
Zanamivir (Relenza)
Sulfonylureas
Chlorpropamide, tolbutamide, glimeparide, glipizide, glyburide
Metformin/Glyburide
Glucovance (biguanide/sulfonylurea)
DPP4 Inhibitors
Sitagliptin (Januvia), linagliptin (Tradjenta), saxagliptin (Onglyza)
Meglitinides
Nateglinide (Starlix)
Repaglinide (Prandin)
GLP1 Agonists
Exenatide (Byetta, Bydureon)
Liraglutide (Victoza)
Thiazolidinediones
Pioglitazone (Actos)
Rosiglitazone (Avandia)
Ultra-rapid insulins
Aspart (Novolog)
Glulisine (Apidra)
Lispro (Humalog)
Rapid insulins
Human regular (Humulin/Novolin R)
Intermediate insulins
Human isophane (NPH) (Humulin/Novolin N)
Long-lasting insulins
Detemir (Levemir)
Glargine (Lantus)
5-Alpha Reductase Inhibitors
Finasteride, dutasteride (Avodart)
Fluticasone propionate/Salmeterol
Advair Diskus (steroid/LABA)
Type I error
False positive; null is true, but gets rejected
Type II error
False negative; null is false, but gets accepted
Power
Probability of making a type II error
RR
Relative Risk; % treatment / % control
RRR
Relative Risk Reduction; 1 - RR
ARR
Absolute Risk Reduction; % control - % treatment
NNT
1 / ARR
OR
Odds Ratio; odds treatment / odds control (odds is the probability of an event occurring compared to it NOT occurring)
Discrete Data
Nominal & Ordinal; finite set of values, whole numbers only
Continuous Data
Interval & Ratio; infinite set of values
Nominal Data
categories (gender)
Ordinal Data
Ranked categories, but difference between them is not equal (Likert Scale)
Interval Data
Arbitrary zero point (temperature)
Ratio Data
Meaningful zero point (height, weight, time)
CEA
Cost-Effectiveness Analysis; dollars per x
CMA
Cost-Minimization Analysis; cost comparison between two interventions w/same outcome
Abacavir
Ziagen
Must test for HLAB*5701 (hypersensitivity)
Carbamazepine
Tegretol
Test for HLAB*5702 if Asian (skin reaction)
Drugs to avoid w/allergy to soy or peanuts
Combivent, clevedipine (Clevipex), propofol (Diprivan), & progesterone (Prometrium)
Drugs to avoid w/allergy to eggs
Clevedipine (Clevipex), propofol (Diprivan), flu vaccine (no longer MMR vaccine)
Imipenem/cilastin
Primaxin (beta lactam carbapenem)
Opioids that don’t cross-react w/morphine type opioid allergy
Fentanyl, meperidine, methadone
Naproxen/Esomeprazole
Vimovo (PPI protects gut from damage caused by NSAID)
Sumatriptan/Naproxen
Treximet
Granisetron
Sancuso (5-HT3 antagonist)
REMS for EPO in oncology
APPRISE
REMS for isotretinoin
iPLEDGE
MTM: DM w/renal disease and/or HTN
ACEI/ARB
MTM: s/p MI
BB
MTM: chronic high dose steroids
bisphosphonate
MTM: HF
BB
Black cohosh
Remifenin (used for menopause Sx); Estroven = black cohosh + soy
Supplements for breast-fed babies
400 IU Vit-D/day (Poly-Vi-Sol) + 1 mg/kg/day iron from age 4-6 months (Fer-In-Sol)
Natural products that increase bleeding risk
DEFFGGGG; dong quai, Vit-E, feverfew, fish oil (>3 g/day), garlic (high dose), ginger (high dose), ginseng, gingko (most significant)
Arginine
Lowers BP; additive effect w/BP meds
SJW: do not use with…
OCP’s, transplant drugs, warfarin
Vit E risk
CV risk at >150 IU/day
Kava risk
hepatotoxicity (used for anxiety)
Lysine
Used for canker sores (aphthous ulcers)
SAMe
Used for depression & osteoarthritis
Natural products for menopause
Black cohosh, red clover, evening primrose, dong quay (increased INR)
NIH recommended calcium intake for women
1000 mg/day (age 19-50), 1200 mg/day (>50)
NIH recommendation Vit-D intake for women
600 IU/day (up to age 70), 800 IU/day (>70)
Calcium citrate
Citracal (1500 mg tablet has 315 mg elemental calcium - 21%); calcium carbonate has 40% (400 mg elemental calcium in a 1000 mg tablet)
B-vitamin names
B1 = thiamine, B3 = niacin, B6 = pyrodoxine
Wernicke’s encephalopathy
Vit B1 déficience; usually caused by alcoholism
Vit-B supplement w/TB meds
B6 25-50 mg/day
P-gp substrates
dabigatran (Pradaxa), rivaroxiban (Xarelto)
P-gp inhibitors
cyclosporine, ketoconazole, itraconazole, ritonavir, erythromycin, verapamil, SJW
Major CYP inducers
PS-PORCS (phenytoin, smoking, phenobarbital, oxcarbazepine, rifampin, carbamazepine, SJW)
Major CYP inhibitors
G-PACMAN (grapefruit, PI’s (esp. ritonavir), azole antifungals, cimetidine, macrolides, amiodarone, non-DHP CCB’s)
Amiodarone interactions
QT drugs (TCA’s, eryth, other antiarrythmics - decrease dose 30-50% of digoxin, quinidine, procainamide), other negative chronotropes (BB’s, non-DHP CCB’s), electrolyte abnormalities, grapefruit, ephedra/SJW, warfarin (decrease dose 30-50%), statins (need lower doses of simp, lova, ator only)
Azoles w/pH-dependant absorption
Itraconazole (Sporanox) & ketoconazole (Nizoral)
Voriconazole
Vfend; CI w/lots of drugs; PO must be taken 1 hr before/after meals
Warfarin isomers
S more potent than R; S is a 2C9 substrate
Drugs that increase bleeding risk w/warfarin, but don’t affect INR
NSAID’s, clopidogrel/prasugrel, gingko
Drugs that increase K+
ACEI’s, ARB’s, amiloride, triamterene, K-sparing diuretics, salt substitutes, OCP’s w/drospirenone
Live vaccines
MMR, varicella, zoster, yellow fever, FluMist
5 most common Gram(+)
Staph, Strep, Enterococcus, Clostridium, Listeria
Lipophilic ABX
FQ’s, macrolides, rifampin, linezolid, TCN’s, chloramphenicol
Hydrophilic ABX
Beta-lactams, AG’s, vancomycin, daptomycin
PCN that isn’t renally cleared
Nafcillin
Cephalosporin that isn’t renally cleared
Ceftriaxone
FQ’s that do get cleared renally
Levo & cipro
TCN that does get renally cleared
Tetracycline
Macrolides that get cleared renally
none
AG’s
MOA: protein synthesis inhibitors
Concentration-dependant (once daily high dose)
Gram(-) coverage
PCN’s
MOA: cell wall synthesis inhibitors Time-dependant Pip & ticar have Psuedomonas coverage Refrigerate Augmentin susp Nafcillin extrav: cold + hyaluronidase
Ceph’s
MOA: cell wall synthesis inhibitors
Time-dependant
As generations increase, coverage increases vs. Strep & Gram(-), but decreases vs. Staph
1st Gen ceph’s
Better vs. Staph than Strep
Gram (-) coverage PEK (Proteus, E. coli, Klebsiella
2nd Gen ceph’a
Gram (-) HNPEK (Haemophilus, Neisseria)
Anaerobic B. fragilis
Cefotetan can cause disulfiram-like rxn
3rd Gen ceph’s
Gram (-) HNPEKS (Serratia)
Ceftazidime covers Pseudomonas
4th Gen ceph’s
Gram (-) HNPEKS + CAPES (Citrobacter, Acinetobacter, Pseudomonas, Enterobacter, Serratia)
5th Gen ceph
Covers MRSA
Carbapenems
MOA: cell wall synthesis inhibitors Time-dependant Very broad coverage, but no MRSA, VRE, or C. diff Ertapenem does not cover Pseudomonas High cross-sensitivity w/PCN allergy
FQ’s
MOA: Inhibit topo II & IV
Concentration-dependant
Cipro & levo better vs. Gram (-) incl. Pseudomonas
Moxi beter vs. Gram (+) & anaerobes
Avoid Cipro w/seizure disorders & in children <18
Macrolides
MOA: protein synthesis inhibitors
Do NOT refrigerate azith/clarith susp, but MUST refrigerate EES susp
TCN’s
MOA: protein synthesis inhibitors
Sulfonamides
MOA: inhibit folic acid synthesis
Adult UTI: 1 DS tab BID x 3 days
2C9 inhibitors (caution w/warfarin)
Vancomycin
Time-dependant
DOC for MRSA
Dose: 15-20 mg/kg q8-12h
Infuse max 5 mg/mL
Cat D ABX
TCN’s (bones), AG’s, fluconazole, metronidazole (1st trimester), SMX-TMP (3rd trimester), nitrofurantoin (at term)
ABX for surgical ppx
Cefazolin or cefuroxime
ABX for meningitis
PCN or ceftriaxone
ABX for ear infection
High-dose amox/Aug (90 mg/kg/day) q12h
ABX for TB
Latent: INH x 9 mos or rifampin x 4 mos
Active: Rifampin/INH/pyrazinamide/ethambutol x 4 wks, then INH/rifampin x 18 wks
Take INH on empty stomach (it is also a strong CYP inhibitor)
Ethambutol causes vision problems
ABX for intra-abdominal infection
Ceftriaxone x 5-7 days
ABX for Lyme disease
doxycycline
ABX for UTI
SMX-TMP or cipro/levo
ABX for C. diff
metronidazole + vanco
ABX for syphilis
PCN G (Bicillin LA only) 2.4 million units x 1 (if infected for <1 yr; otherwise once a week x 3 wks)
ABX for gonorrhea
Ceftriaxone 250 mg IM x 1
If also chlamydia, add azith 1 gm x 1
ABX for vaginosis
metronidazole 500 BID x 7 days or gel daily x 5 days
Levels for gent/tobra
Peak 5-10, trough <2
Dose 1-2.5 mg/kg IBW
ABX for VRE faecalis
Daptomycin (cannot be used for lung infections); for VRE faecium, use quinupristin-dalfopristin
ABX for CAP
macrolide
Minocycline
Solodyn, Minocin
Rifaximin
Xifaxin (for travelers diarrhea)
3 preferred ART regimens
- NNRTI efavirenz + 2 NRTI’s tenofovir & emtricitabine; emtracitabine & tenofovir = Truvada; all three = Atripla
- PI atazanavir or darunavir (both boosted w/ritonavir) + 2 NRTI’s (Truvada)
- Integrase inhibitor raltegravir + 2 NRTI’s (Truvada)
Tenofovir + Emtracitabine
Truvada (NRTI’s); may cause HBV resistance to develop, or may exacerbate it when D/C this drug; may cause hyperpigmentation of palms/soles, Fanconi’s syndrome, renal insufficiency, osteomalacia, & decreased bone density; used as ppx (1 tab daily) for HIV
Efavirenz
Sustiva (NNRTI); must take at bedtime on an empty stomach; may cause vivid dreams, suicidal thoughts, mania/depression
Protease Inhibitors
All may cause issues w/blood sugar, fat, liver; all are strong 3A4 inhibitors; ritonavir caps must be refrigerated (not tabs)
Prevention & treatment of hepatic portal HTN/variceal bleeding
Prevention: non-selective BB’s (nadolol, propranolol); treatment: octreotide or vasopressin
Treatment for Hep B/C
Interferons (TIW - once a week for pegylated); flu-like side effects; ribavirin & PI’s also used for HepC & NRTI’s also used for HepB (lamivudine = Epivir HBV)
Treatment for hyperthyroid during pregnancy
PTU 1st trimester, then methimazole after (both are Cat D)
Children’s dose for APAP
10-15 mg/kg q4-6h; max 5 doses/day (same dose for ibuprofen)
Ketorolac
Toradol (NSAID); max 5 days, usually post-op (never pre-op)
NSAID’s w/COX-2 selectivity
celecoxib, meloxicam (Mobic), etodolac (Lodine), nabumetone (Relafen)
Morphine + naltrexone
Embeda
Tapapentadol
Nucynta; opioid agonist/NE reuptake inhibitor; less GI S/E than other opioids
Converting between opioids
Calculate total 24-hr dose of current drug, convert as a ratio based on tables, calculate dose of new drug, & reduce by 25%
Drugs that raise blood sugar
Steroids & PI’s for sure; niacin, thiazides (high doses only), olanzapine, statins, cyclosporine, tacrolimus
Drugs that lower blood sugar
FQ’s, BB’s, EtOH
HTN in DM patients
Goal is s are 1st-line
Biguanide
Metformin (Glucophage, Fortamet, Glumetza); decreases production of glucose in liver & absorption in intestines; CI w/SCr 1.5 males/1.4 females or CrCl<60; BID w/meals; not to be used w/hypoxia
Metformin + glyburide
Glucovance
Metformin + sitagliptin
Janumet
Sulfonylureas
Chlorpropamide (Diabinese), Glipizide (Glucotrol), Glimepiride (Amaryl), Glyburide (Diabeta, Micronase); stimulate insulin secretion; once daily w/breakfast; hypoglycemia/weight gain
Meglitinides
Repaglinide (Prandin), Nateglinide (Starlix); stimulate insulin secretion; hypoglycemia/weight gain; 15-30 min before meals (skip)
Thiazolidinediones
Pioglitazone (Actos), Rosiglitazone (Avandia); increase glucose uptake into peripheral tissue; weight gain; daily with/without food; takes a few weeks
Alpha-glucosidase inhibitors
Acarbase (Precose), Miglitol (Glyset); delayed glucose absorption; no weight gain or hypoglycemia; take w/first bite of each meal (skip)
DPP-4 inhibitors
Sitagliptin (Januvia), Saxagliptin (Onglyza), Linagliptin (Tradjenta); prevent breakdown of hormones that regulate BG levels; no weight gain; qam with/without food
GLP-1 agonists
Exenatide (Byetta, Bydureon), Liraglutide (Victoza); cause nausea & pancreatitis; may cause weight LOSS; not for CrCl<30; Byetta 5 mg BID 30 min before meals (NEVER after meal); Bydureon once a week
Pramlintide
Symlin; SC injected before each meal (skip); short-acting (“mealtime” insulin dose must be decreased by 50% at first (can cause severe hypoglycemia)
Rapid insulin
15 min before meal or after meal; aspart (Novolog), glulisine (Apidra), lispro (Humalog)
Short insulin
30 min before meal (NOT after meal); regular (Humulin/Novolin R)
Intermediate insulin
1-2 times/day; NPH (Humulin/Novolin N); looks cloudy
Long insulin
Bedtime (“baseline”); glargine (Lantus), detemir (Levemir)
eAG
Estimated avg glucose
eAG = 28.7 x A1C - 46.7
Bisphosphonates
Alendronate (Fosamax), risedronate (Actonel), ibandronate (Boniva), zoledronic acid (Reclast); use for max 3-5 yrs; take first thing in the morning w/full glass of water & stay upright
TNF-alpha inhibitors
Biologics for RA; etanercept (Enbrel) once a week; adalimumab (Humira) every 2 wks; infliximab (Remicade) every 8 wks
Colchicine
Colcrys for acute gout attack; 1.2 mg, then 0.6 mg 1 hr later; wait 3 days for another round; diarrhea in 80% of pts; for ppx, 0.6 mg daily
Loop equivalents
furosemide 40 = bumetanide 1 = torsemide 20
ARB’s
All are Cat D; valsartan (Diovan), losartan (Cozaar), olmesartan (Benicar), irbesartan (Avapro)
ACEI’s
All are Cat D; benazepril (Lotensin), enalapril (Vasotec), lisinopril (Zestril, Prinivil), ramipril (Altace)
Beta-1 selective BB’s
atenolol (Tenormin), metoprolol tartrate (Lopressor), metoprolol succinate (Toprol XL)
Non-selective BB’s
prpranolol (Inderal), carvedilol (Coreg - take w/food), labetalol (Trandate)
Clonidine
Catapres (alpha-2 agonist); once a week patch
Alpha blockers
doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin); not 1st-line for HTN; mostly for BPH
amlodipine + benazepril
Lotrel
Losartan + HCTZ
Hyzaar
Lisinopril + HCTZ
Zestoretic, Prinzide
Statins
Cat X; daytime = ator (Lipitor), prav (Pravachol), rosuv (Crestor), pitav (Livalo); 3A4 metabolized = simv (Zocor), lova (mevacor), ator (Lipitor)
simvastatin + ezetemibe
Vytorin
Required for HF pts
ACEI + BB; if still symptomatic, add on ARB, aldosterone antagonist (spironolactone, eplerenone/Inspra), or hydrazine/nitrate
Treatment for chronic angina
Antiplatelet (ASA or clopidogrel) + antianginal (BB’s are 1st-line, CCB’s for Prinzmetal’s, ranolazine/Ranexa, nitrates)
Dosing for angina nitrates
NTG patch: on 12-14 hrs, off 10-12 hrs
NTG oint: BID, 6 hrs apart, off for 10-12 hrs
Isosorbide mononitrate: BID, 7 hrs apart, when waking up, then 7 hrs later
Isosorbide dinitrate: TID w/14-hr dose-free interval (7am, 12pm, 5pm)
Enoxaparin dosing
VTE ppx: 30 mg q12 or 40 mg daily (if CrCl<30, 30 mg daily)
Treatment VTE or NSTEMI: 1 mg/kg q12 or 1.5 mg/kg daily (1 mg/kg daily for CrCl)
Fondaparinux
Arixtra (CI if CrCl is <30)
Dabigatran
Pradaxa (direct thrombin inhibitor)
Rivaroxiban
Xarelto (factor Xa inhibitor)
Treatment for NSTEMI/unstable angina
MONA (morphine, oxygen, nitrates, ASA)
GAP-BA (GPIIB/IIIa antagonists, anticoagulants, P2Y12 inhibitors, BB’s, ACEI’s)
Treatment of STEMI
MONA + GAP-BA + thrombolytics (alteplase, etc)
GP IIb/IIIa inhibitors
abciximab (Reopro), eptifibitide (Integrilin), tirofiban (Aggrastat)
P2Y12 inhibitors
clopidogrel (Plavix), prasugrel (Effient), ticagrelor (Brilinta - may cause dyspnea; effectiveness reduced by ASA doses >100 mg)
PDE-5 inhibitors for PAH
sildenafil (Revatio), tadalafil (Adcirca); relax blood vessels in the lungs
Treatment of COPD
Anticholinergic (short-acting ipratropium, long-acting tiotropium) + beta-2 agonists
Ipratropium
Atrovent HFA (short-acting anticholinergic)
Ipratropium + albuterol
Combivent, DuoNeb
Tiotropium
Spiriva (long-acting anticholinergic)
Salmeterol
Servent Diskus (LABA)
Salmeterol + fluticasone
Advair Diskus
Formoterol + budesonide
Symbicort
Arformoterol
Brovana (nebs)
Roflumilast
Daliresp (PDE-4 inhibitor that reduces inflammation in lungs; used for severe COPD
Drugs that cause QT prolongation
Amiodarone, FQ’s, macrolides, azoles, PI’s, TCA’s, SSRI’s (esp citalopram), SNRI’s, TCA’s, ondansetron, antipsychotics
Class Ia antiarrythmics
Intermediate-lasting: quinidine (diarrhea, cramps), procainamide (agranulocytosis, lupus-like syndrome), disopyramide (Norpace)
Class Ib antiarrythmics
Short-lasting; Lidocaine, mexilitine
Class Ic antiarrythmics
Long-lasting: flecainide (Tambocor), propafenone (Rhythmol)
Class II antiarrythmics
BB’s: esmolol (Brevibloc), propranolol (Inderal)
Class III antiarrythmics
Amiodarone (Cordarone), dronedarone (Multaq), sotalol (Betapace), ibutilide (Corvert), dofetilide (Tikosyn)
Class IV antiarrythmics
Non DHP CCB’s
Treatment for asthma in pregnancy
Albuterol & budesonide are DOC’s
Smoking cessation Rx drugs
Zyban (bupropion SR), Chantix (varenicline)
Fluticasone propionate (asthma & allergies)
Flovent & Flonase
Mometasone (asthma & allergies)
Asmanex & Nasonex
Triamcinolone acetonide (asthma & allergies)
Azmacort & Nasacort AQ
Beclomethasone (asthma & allergies)
Beclovent & Beconase
Budesonide (asthma & allergies)
Pulmicort & Rhinocort Aqua
Dornase alfa
Pulmozyme (nebs used in CF to promote clearance of mucus); pancreatic enzymes also given because mucus obstructs natural flow (take BEFORE meals)
Epoetin alfa
Epogen, Procrit; IV/SC TIW
Darbopoetin
Aranesp; IV/SC weekly or q2weeks
Drug therapy for transplants
Calcineurin inhibitor + steroids +/- Cellcept; NEVER skip doses; no NSAID’s or live vaccines; taper prednisone if taking for >7-10 days
Mycophenolate mofetil
CellCept (inhibits T-cell proliferation by altering purine synthesis); may cause infection risk, lymphoma, skin cancer, congenital malformations/spontaneous abortions during pregnancy
Tacrolimus
Prograf (calcineurin inhibitor); take on empty stomach; may cause hyperglycemia & hair loss; no grapefruit
Cyclosporine
Neoral, Gengraf, Sandimmune (calcinuerin inhibitor); may cause HTN, hirsutism, gingival hyperplasia
mTOR kinase inhibitors
(transplants) sirolimus (Rapamune) & everolimus (Afinitor); may cause peripheral edema & HTN
Treatment for Alzheimer’s
ACh inhibitors: donepezil (Aricept - also ODT), rivastigmine (Exelon - also patch), galantamine (Razadyne), tacrine (Cognex - hepatotoxic); all may cause N/V & loose stools; memantine (Namenda) may be added on
Add-on drugs for depression
buspirone (BuSpar), aripiprazole (Abilify), olanzapine/fluoxetine (Symbyax), quetiapine ER (Seroquel XR)
Antidepressants during pregnancy
Preferred are SSRI’s (except paroxetine) & TCA’s
Antidepressants
SSRI’s & SNRI’s require 2-week washout period w/MAOI (5 wks fluoxetine); need to be taoered off (esp. paroxetine)
Fluoxetine
Prozac, Sarafem; causes activation, so take in the morning
Paroxetine
Paxil
Fluvoxamine
Luvox (only for OCD & SAD)
Sertraline
Zoloft
Citalopram
Celexa
Escitalopram
Lexapro
Venlafaxine
Effexor
Duloxetine
Cymbalta
Desvenlafaxine
Pristiq
Amitriptyline
Elavil, Limbitrol (TCA)
Doxepin
Sinequan (TCA)
Phenelzine
Nardil (MAOI)
Selegiline
Emsam patch (TCA for depression); Eldepryl & Zelapar tabs are for Parkinson’s
Bupropion
Wellbutrin, BUdeprion; DO NOT use w/seizure disorder, bipolar, or anorexia; no sexual dysfunction; max 450 mg/day
Mitrazapine
Remeron; take at night (sedating)
Clozapine
Clozaril; best efficacy among antipsychotics, but only for pts who don’t respond to two others first; may cause agranulocytosis; min WBC 3500, ANC 2000
Thioridazine
Mellaril; high risk for QT prolongation
Antipsychotics w/weight gain & elevated BG/lipids
clozapine, olanzapine, quetiapine, risperidone
Long-acting antipsychotics
Haldol decanoate (IM q4wks), Risperdal Consta (risperidone - q2wks), Invega Sustenna (paliperidone - q4wks)
Antipsychotics that come as ODT’s
clozapine, olanzapine, risperidone, asenapine
Antipsychotics w/QT risk
ziprasidone, risperidone, paliperidone, asenapine
Olanzapine
Zyprexa
Risperidone
Risperdal; may increase prolactin
Quetiapine
Seroquel
Ziprasidone
Geodon
Aripiprazole
Abilify
Paliperidone
Invega; may increase prolactin
Asenapine
Saphris
Treatment for bipolar
Valproic acid (Depakene), divalproex (Depakote), lamotrigine (Lamictal - preferred in pregnancy), lithium (Lithobid), 2nd gen antipsychotics
Treatment for PD
Carbo/levo, COMT inhibitor, dopamine agonists, amantadine, anticholinergics, MAO-B’s
Carbidopa/levodopa
Sinamet (ODT = Parcopa); decreased absorption w/iron & protein-rich foods
Entacapone
Comtan (COMT inhibitor); only used with levodopa
Levodopa/carbidopa + entacapone
Stalevo
Pramipexole
Mirapex (DA agonist); decrease dose if CrCl<60
Ropinarole
Requip (DA agonist)
Rotigotine
Neupro (DA agonist); 24-hr patch
Apomorphine
Apokyn (DA agonist); SC injection rescue for off periods in PD; CI w/ondansetron & all 5-HT3 antagonists due to severe hypotension
Selegiline
Eldepryl, Zelapar ODT (MAO-B); only works if taken w/levodopa
Rasagiline
Azilect (MAO-B)
Methylphenidate
Ritalin, Methylin (chewable), Metadate (CD has beads that dissolve at different rates), Daytrana (patch), Concerta (OROS delivery system)
Dexmethylphenidate
Focalin
Dextroaphetamine/Amphetamine salts
Adderall
Lisdexamfetamine
Vyvanse (can’t be injected or snorted, so less abuse potential); can be mixed w/water & drank right away; pro-drug of dextroamphetamine
Atomoxetine
Strattera (2nd-line therapy, or if there is fear of abuse)
Kapvay
ER formulation of clonidine
Modafanil
Provigil
Armodafanil
Nuvigil
Best BZ’s for elderly
Lorazepam, oxazepam, temazepam
Zalepion
Sonata
Eszopiclone
Lunesta
Ramelteon
Rozerem (melatonin receptor agonist)
Doxepin ER
Silenor; TCA used for staying asleep
Drugs for MS
IFN’s (Avenox, Betaseron), glatiramer (Copaxone), natalizumab (Tysabri - q4wks, risk of PML, TOUCH program)
Omeporazole + sodium bicarb
Zegarid
Misoprostol
Cytotec (cytoprotective agent); Cat X
Treatment for BPH
Alpha blockers tamsulosin (Flomax), alfuzosin (Uroxatral - QT prolongation), silodosin (Rapaflo) and 5-alpha reductase inhibitors finasteride (Proscar), dutasteride (Avodart)
Methylnaltrexone
Relistor; SC injection that blocks opioid receptors in the gut
PUD triple therapy
PPI + 2 ABX (amox + clarith); Prevpac
PUD quadruple therapy
PPI + bismuth + metronidazole + TCN
Timolol
Timoptic (BB)
Levobunolol
Betagan (BB)
Travoprost
Travatan Z (PG analog)
Dorzolamide
Trusopt (CAI)
Brimonidine
Alphagan P (adrenergic)
Drugs for itchy eyes
Ketotifen (Zaditor, Alaway), naphazoline (Visine)
Azith eyedrops
Azasite
Moxiflox eyedrops
Vigamox
Cipro eyedrops
Ciloxan
Tobramycin eyedrops
Tobrex
Cyclosporine emulsion
Restasis (for dry eyes)
Minocycline ER
Solodyn (for acne)
Imiquimod
Aldara (genital warts)
Very high potency steroids
Clobetasol propionate (Clobex, Temovate) Betamethasone dipropionate (Diprolene oint)
High potency steroids
Betamethasone dipropionate (Diprolene cream) Mometasone furoate (Elocon oint) Fluocinonide (Lidex)
Medium potency steroids
Mometasone furoate (Elocon cream) Triamcinolone acetonide (Kenalog) Hydrocortisone valerate (Westcort oint)
Low potency steroids
Desonide (DesOwen
Hydrocortisone valerate (Westcort cream)
Fluocinolone acetonide (Derma-Smoothe)
Hydrocortisone
Mupirocin
Bactroban (minor cuts & burns)
Bimatoprost
Latisse (for thinning eyelashes)
Docosanol
Abreva (cold sores)
Neuromuscular blockade
Succinylcholine (intubation only, depolarizing), rocuronium (Zemuron)
Aminocaproic acid
Amicar (for hemostasis)
APAP antidote
N-acetylcysteine
Warfarin antidote
Phytonadione (AquaMephyton)
Antidote for antocholinergics
Physostigmine (Antilirium)
Antidote for BZ’s
Flumazenil (Romazicon)
Antidote for heparin
protamine
Antidote for iron
Deferoxamine (Desferal)
Cyclophosphamide
alkylator; bladder toxicity (use MENSA)
Aromatase inhibitors
anastrazole (Arimidex), exemestane (Aromasin), letrozole (Femara)
SERM’s
tamoxifen (Nolvadex), raloxifene (Evista), fulvestrant (Faslodex)
Anthracyclines
“rubicins” - cardiotoxic; may use dexrazoxane (Zinecard) if doxorubicin will be >300 mg/m2
Bevacizumab
Avastin (angiogenesis inhibitor); causes HTN
Cisplatin
Platinol; must hydrate vigorously due to nephrotoxicity
Mercaptopurine
Purinethol; xanthine oxidase metabolizes it, so allopurinol raises its bioavailability 400-500%
capecitabine
Xeloda (prodrug of 5-FU)