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Top 200 > P3 Quiz #1 > Flashcards

P3 Quiz #1 Flashcards

1
Q

Acetaminophen with codeine phosphate Brand

A

Tylenol #3, #4

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2
Q

Allopurinol brand

A

Zyloprim

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3
Q

Alprazolam brand

A

Xanax

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4
Q

Buprenorphine/naloxone brand

A

Suboxone

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5
Q

Buspirone brand

A

Buspar

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6
Q

Carisoprodol brand

A

Soma

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7
Q

Clonazepam Brand

A

Klonopin

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8
Q

Colchicine brand

A

Colcrys

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9
Q

Diazepam

A

Valium

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10
Q

Cyclobenzaprine

A

Flexeril, Amrix, Fexmid

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11
Q

Fentanyl

A

Duragesic

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12
Q

Hydrocodone/acetaminpophen

A

Norco, Vicodin, Lortab

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13
Q

Hydroxychloroquine

A

Plaquenil

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14
Q

Lorazepam

A

Ativan

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15
Q

Methadone

A

Methadose, Dolophine

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16
Q

Methotrexate

A

Trexall

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17
Q

Methylprednisolone

A

Medrol

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18
Q

Morphine sulfate (ER)

A

MS Contin

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19
Q

Oxycodone

A

OxyContin, Roxicodone

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20
Q

Rizatriptan

A

Maxalt

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21
Q

Sumatriptan

A

Imitrex

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22
Q

Tinazidine

A

Zanaflex

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23
Q

Tramadol

A

Ultram

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24
Q

Tylenol with Codeine dose

A

15-60 mg po q4h prn; with acetaminophen 300-1000 mg

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25
Q

Codeine with tylenol BBW

A

Hepatotoxicity; Children who are CYP2D6 ultrarapid metabolizers; serious risks of misuse, abuse, addiction, overdose, and death; concurrent use with benzodiazepines; immediate release only, serious risk of misuse, accidental ingestion, neonatal opioid withdrawal syndrome

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26
Q

Codeine with tylenol common AE

A

Nausea, vomiting, constipation, somnolence

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27
Q

Codeine with tylenol rare but serious AE

A

Stevens-Johnson syndrome, GI bleeding, elevated liver functions, thrombocytopenia, physical dependence, tolerance, respiratory depression, serotonin syndrome, adrenal insufficiency, decreased sex hormones

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28
Q

Allopurinol indications and dosing

A

Gout= 100-300mg QD
Severed Gout- 400-600 in divided doses BID-TID
Hyperuricemia- 600-800mg PO in divided doses BID-TID
Nephrolithiasis prophylaxis- 300mg/day QD-TID

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29
Q

Allopurinol MOA

A

Allopurinol decreases the production of uric acid by inhibiting the action of xanthine oxidase, the enzyme that converts hypoxanthine to xanthine and xanthine to uric acid.

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30
Q

DDI allopurinol

A

Didanosine- avoid, increases didanosine bioavailability
Azathioprine- increases effect and toxicity of azathioprine
Cylophasphamide- BMS

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31
Q

Common AE of allopurinol

A

None

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32
Q

Rare, serious AE of allopurinol

A

Stevens-Johnson syndrome, toxic epidermal necrolysis, agranulocytosis, aplastic anemia, thrombocytopenia, granulomatous hepatitis, hepatotoxicity, immune hypersensitivity reaction, renal failure

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33
Q

Alprazolam dosing and indication

A

Anxiety- 0.25-0.5mg PO TID, max dose 4mg divided

Panic disorder- 0.5mg PO TID, ER 3-6 mg PO QD

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34
Q

Alprozolam MOA

A

Enhances the postsynaptic effect of the inhibitory neurotransmitter, 𝛾-aminobutyric acid (GABA).

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35
Q

Alprazolam BBW

A

Concurrent use with opioids

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36
Q

Alprazolam contraindications

A

Hypersensitivity to benzodiazepines, narrow-angle glaucoma, concurrent ketoconazole, or itraconazole

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37
Q

Common AE alprazolam

A

Ataxia, lethargy, retrograde amnesia, somnolence, weight gain, change in appetite, constipation, fatigue, cognitive dysfunction, decreased libido

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38
Q

Rare, serious AE for alprazolam

A

Seizures, mania, depression, liver failure, Stevens-Johnson syndrome

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39
Q

Alprazolam DDI with CYP3A4/5 inducers

A

increased alprazolam metabolism reduces alprazolmm efficacy

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40
Q

Alprazolam and CYP3A4/5 inhibitors DDi

A

Decreased alprazolam metabolism increases risk of alprazolam toxicity

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41
Q

Alprazolam and digoxin DDI

A

Reduced renal clearance of digoxin and increased digoxin toxicity

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42
Q

Alprazolam and ethinyl estradiol and other estrogen based BC DDI

A

Inhibition of alprazolam metabolism and additional toxicity

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43
Q

Baclofen use and dose

A

Spasticity: 5 mg po tid; may increase by 5 mg/dose every 3 d based on response

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44
Q

Baclofen MOA

A

Baclofen inhibits both monosynaptic and polysynaptic reflexes at the spinal level, possibly by hyperpolarization of afferent terminals, although actions at supraspinal sites may also occur and contribute to its clinical effect. Baclofen is an analogue of γ-aminobutyric acid (GABA), but there is no conclusive evidence that actions on GABA systems are involved in the production of its clinical effects.

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45
Q

Baclofen BBW

A

Avoid abrupt discontinuation of oral or intrathecal product

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46
Q

Baclofen DDI

A

None

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47
Q

Baclofen common AE

A

Nausea, asthenia, dizziness, somnolence, confusion

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48
Q

Baclofen rare but serious AE

A

Slowed or difficult breathing when used in combination with opioids, pneumonia, GI hemorrhage, seizure

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49
Q

Buprenorphine/naloxone dose

A

Opioid use disorder: Adults and Children >16 y of age, 12-16 mg (buprenorphine component) once daily sublingually, titrate to response; typical dose range from 4 to 24 mg/d

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50
Q

Buprenorphine/naloxone MOA

A

Buprenorphine is a μ-opioid receptor partial agonist and a κ-opioid receptor antagonist. Naloxone is a μ-opioid receptor antagonist that causes opioid withdrawal when injected parenterally and is included in the formulation to reduce the risk of abuse.

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51
Q

Buprenorphine/naloxone common AE

A

Vasodilation, sweating, headaches, insomnia, constipation, GI distress, opioid withdrawal, dizziness

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52
Q

Rare but serious AE for buprenorphine/naloxone

A

Stevens-Johnson syndrome, physical dependence, tolerance, elevated liver functions tests, seizures

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53
Q

Buspirone dose

A

Anxiety: Adults, 5 mg po bid-tid or 7.5 mg po bid, may titrate to 20-30 mg/d in 2-3 divided doses (max 60 mg/d)

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54
Q

Buspirone MOA

A

Buspirone is the first of a class of selective serotonin-5-HT1A receptor partial agonists. It also has some effect on dopamine-D2 auto-receptors and, like antidepressants, can downregulate β-adrenergic receptors. Unlike benzodiazepines, it lacks amnestic, anticonvulsant, muscle relaxant, and hypnotic effects. Its exact anxiolytic mechanism of action is complex and not clearly defined.

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55
Q

Buspirone with linezolid, SSRIs, St. Johns wort DDI

A

Risk of serotonin syndrome

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56
Q

Buspirone common AE

A

Dizziness

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57
Q

Buspirone rare, but serious AE

A

Mania, psychiatric disorder

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58
Q

Carisoprodol dosing

A

Disorder of musculoskeletal system: 250-350 mg po tid and hs

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59
Q

Carisoprodol MOA

A

Carisoprodol blocks interneuronal activity in descending reticular formation and spinal cord, resulting in muscle relaxation.

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60
Q

Carisoprodol contraindications

A

Hypersensitivity to carisoprodol or meprobamate, acute intermittent porphyria

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61
Q

Carisoprodol contraindications

A

Hypersensitivity to carisoprodol or meprobamate, acute intermittent porphyria

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62
Q

Carisoprodol CYP2C19 inducers

A

Increased carisoprodol metabolism reduces carisoprodol effectiveness

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63
Q

Carisoprodol CYP2C19 inhibitors

A

Decreased carisoprodol metabolism increases risk of carisoprodol toxicity

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64
Q

Carisoprodol common AE

A

Drowsiness, dizziness

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65
Q

Carisoprodol rare but serious AE

A

Slowed or difficult breathing when used in combination with opioids, seizure, drug dependence, withdrawal symptoms upon discontinuation after chronic use

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66
Q

Clonazepam dose

A

Panic disorder: 0.25 mg po bid, may titrate by 0.125-0.25 mg po bid every 3 d to a max total daily dose of 1-4 mg (divided into 2-3 daily doses)
Seizure: Infants, Children <10 y of age or <30 kg, 0.01-0.03 mg/kg/d po divided into 2-3 daily doses, may titrate by 0.25-0.5 mg po every 3 d to max of 0.1-0.2 mg/kg/d (divided into 3 daily doses); Children ≥10 y of age or ≥30 kg, 0.5 mg po tid, may titrate by 0.125-0.25 mg po bid every 3 d to a max of 1-4 mg/d (divided into 2-3 daily doses); Adults, 2-8 mg/d in 1-2 divided doses, may titrate to max 20 mg/d

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67
Q

Clonazepam contraindications

A

Hypersensitivity to benzodiazepines, narrow-angle glaucoma, liver disease

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68
Q

Clonazepam DDI with alfentanil, opioids, and other resp depressive agents

A

Additive resp depression

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69
Q

Clonazepam with theophylline DDI

A

Decreased clonazepam effectiveness via inhibition of adenosine receptors

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70
Q

Clonazepam common AE

A

Ataxia, lethargy, somnolence, weight gain

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71
Q

Clonazepam rare but serious AE

A

Seizures, mania, depression, withdrawal symptoms

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72
Q

Colchicine doses

A

Gout, acute: 1.2 mg po at the first sign of a flare followed by 0.6 mg 1 h later; max 1.8 mg over 1 h
Gout, prophylaxis: 0.6 mg po daily to bid, max of 1.2 mg/d or onset of diarrhea
Familial Mediterranean fever: Children 4-6 y of age, 0.3-1.8 mg po daily; Children 6-12 y, 0.9-1.8 mg po daily; Children ≥12 y of age and Adults, 1.2-2.4 mg po daily, increase or decrease dose in increments of 0.3 mg/d

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73
Q

Colchicine MOA

A

Exact mechanism unknown. In patients with gout, may interrupt the cycle of monosodium urate crystal deposition in joint tissues and the resultant inflammatory response that initiates and sustains an acute attack. Colchicine also inhibits urate crystal deposition, which is enhanced by a low pH in the tissues, probably by inhibiting oxidation of glucose and subsequent lactic acid production in leukocytes.

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74
Q

Colchicine contraindications

A

Hypersensitivity to colchicine; concurrent use with strong CYP3A4/5 inhibitors in patients with renal or hepatic failure

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75
Q

Colchicine DDI with fibrates and statins

A

Coadministration of colchicine and lipid-lowering agents may result in myopathy and rhabdomyolysis; mechanism unknown

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76
Q

Colchicine common AR

A

Diarrhea, nausea

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77
Q

Colchicine rare but serious AE

A

Agranulocytosis, Rhabdomyolysis

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78
Q

Cyclobenzaprine dose

A

Skeletal muscle spasm: 5 mg po tid (immediate release); may titrate to 10 mg po tid, may treat up to 2-3 wk, or 15 mg po daily (extended release), may titrate to 30 mg po daily

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79
Q

Cyclobenzaprine MOA

A

Cyclobenzaprine relieves skeletal muscle spasm of local origin without interfering with muscle function. It is ineffective in muscle spasm due to CNS disease. Evidence suggests that the net effect of cyclobenzaprine is a reduction in tonic motor activity, influencing both gamma (𝛾) and alpha (α) motor systems.

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80
Q

Cyclobenzaprine contraindications

A

Hypersensitivity to cyclobenzaprine, concomitant MAOI use, heart failure, acute coronary phase of AMI, heart block, hyperthyroidism

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81
Q

Cyclobenzaprine common AE

A

Xerostomia, headache, dizziness, drowsiness

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82
Q

Cyclobenzaprine rare but serious AE

A

Cardiac dysrhythmia, cholestasis, hepatitis, jaundice, anaphylaxis, immune hypersensitivity reaction, slowed or difficult breathing when used in combination with opioids

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83
Q

Cyclobenzaprine CYP1A2 inducers

A

Increased cyclobenzaprine metabolism reduces cyclobenzaprine effectiveness

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84
Q

Cyclobenzaprine CYP1A2 inhibitors

A

Decreased cyclobenzaprine metabolism increases risk of cyclobenzaprine toxicity

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85
Q

Cyclobenzaprine CNS depressants

A

Additive sedative effects

86
Q

Cyclobenzaprine anticholinergic agents

A

Enhanced anticholinergic AE

87
Q

Diazepam dose

A

Alcohol withdrawal syndrome: 10 mg po tid-qid in first 24 h, then 5 mg po tid-qid prn
Anxiety: Adults, 2-10 mg po bid-qid; Children, 1-2.5 mg po tid-qid
Seizure, adjunct: Adults, 2-10 mg po bid-qid; Children, 1-2.5 mg po tid-qid

88
Q

Diazepam contraindications

A

Hypersensitivity to benzodiazepines, narrow-angle glaucoma, severe liver disease, myasthenia gravis, sleep apnea, respiratory insufficiency, children <6 mo

89
Q

Diazepam digoxin

A

Reduced renal clearance of digoxin and increased digoxin toxicity

90
Q

Diazepam Common AE

A

Drowsiness, impaired motor coordination

91
Q

Diazepam rare but serious AE

A

Seizures, mania, depression, withdrawal symptoms, elevated liver function tests

92
Q

Diazepam and ethinyl estradiol and other estrogen based bc

A

Inhibition of diazepam metabolism and additional toxicity

93
Q

Diazepam and CYP2C19, 3A4/5 inducers

A

Increased diazepam metabolism reduces efficacy

94
Q

Diazepam and CYP2C19, 3A4/5 inhibitors

A

Decreased metabolism increases toxicity

95
Q

Diazepam and alfentanil, opioids, resp depressants

A

Additive respiratory depression

96
Q

Fentanyl dose

A

Pain, chronic (moderate to severe): Adults and Children >2 y of age, opioid tolerant, with pain that cannot be managed by other means, transdermal fentanyl dosage based on the patient’s current 24-h oral morphine requirement; replace patch q72h; may replace patch q48h in patients not achieving adequate analgesia

97
Q

Fentanyl MOA

A

Fentanyl is a phenylpiperidine opioid agonist with predominant effects on the mu opioid receptor and is about 50-100 times more potent as an analgesic than morphine.

98
Q

Fentanyl BBW

A

CYP3A4/5 inhibitors; respiratory depression; transdermal not for use postoperatively; fatalities in children; formulations not interchangeable; fever; care with disposal; REMS program; concurrent use with benzodiazepines or other CNS depressants

99
Q

Fentanyl contraindications

A

Acute or postoperative pain, bronchial asthma, hypersensitivity to fentanyl, mild or intermittent pain management, opioid nontolerant patients, paralytic ileus

100
Q

Fentanyl and Barbiturates, benzodiazepines, centrally acting muscle relaxants, opioids, phenothiazines

A

additive CNS depression

101
Q

Fentanyl and beta-blockers and CCBs

A

Additive hypotension

102
Q

Fentanyl and Buprenorphine, opioid agonists/antagonists, opioid antagonists

A

Precipitation of withdrawal symptoms

103
Q

Fentanyl and CYP3A4/5 inducers

A

Increased fentanyl metabolism decreases fentanyl efficacy

104
Q

Fentanyl and CYP3A4/5 strong/moderate inhibitors

A

Decreased fentanyl metabolism increases risk of fentanyl toxicity

105
Q

Fentanyl and MAOIs

A

Additive resp depression

106
Q

Fentanyl and SSRIs, SNRIs, TCAs, Triptans

A

Increased risk of serotonin syndrome

107
Q

Fentanyl common AE

A

Application site reactions, sweating, constipation, GI distress, confusion, headache, anxiety, urinary retention, fatigue

108
Q

Fentanyl rare but serious AE

A

Stevens-Johnson syndrome, physical dependence, tolerance

109
Q

Hydrocodone/Acetaminophen dose

A

Pain, severe: Adults, 10 mg q12h initially, may titrate to response

110
Q

Hydrocodone/APAP BBW

A

Addiction, abuse, misuse, REMS, respiratory depression, accidental ingestion, neonatal opioid withdrawal, alcohol, CYP3A4/5 interactions, hepatotoxicity, concurrent use with benzodiazepines

111
Q

Hydrocodone/APAP contraindications

A

Hypersensitivity, paralytic ileus, respiratory depression, severe asthma

112
Q

Hydrocodone/APAP DDI

A

Same as fentanyl

113
Q

Hydrocodone/APAP common AE

A

Constipation, GI distress, somnolence

114
Q

Hydrocodone/APAP Rare but serious AE

A

Stevens-Johnson syndrome, physical dependence, tolerance, respiratory depression, serotonin syndrome, adrenal insufficiency, decreased sex hormones

115
Q

Hydroxychloroquine dose

A

Lupus erythematosus: 200-400 mg po daily (may divide into 2 doses)
Malaria, suppression: Adults, 400 mg po q week on the same day; Children, 5 mg base/kg (200 mg hydroxychloroquine sulfate = 155 mg hydroxychloroquine base); begin 2 wk prior to entering an endemic area and continue for 4 wk after leaving the endemic area
Malaria, uncomplicated: Adults, 800 mg followed by 400 mg at 6, 24, 48 h after initial dose (total of 2 g); Children, 13 mg/kg (not to exceed 800 mg), followed by 6.5 mg/kg (not to exceed 400 mg) at 6, 24, 48 h after initial dose
Rheumatoid arthritis, maintenance: 400-600 mg po daily, after 4-12 wk reduce dose to 200-400 mg po daily

116
Q

Hydroxychloroquine MOA

A

The mechanism of action of hydroxychloroquine is unknown. It is effective in treating P. vivax, P. malariae, and susceptible strains of P. falciparum.

117
Q

Hydroxychloroquine contra

A

Hypersensitivity to hydroxychloroquine, retinal or visual field changes from prior hydroxychloroquine, long-term use in children

118
Q

Hydroxychloroquine and digoxin

A

Increased digoxin levels

119
Q

Hydroxychloroquin and fibrates

A

increased risk of cholelithiasis

120
Q

Hydroxychloroquine and metoprolol

A

Decreased metabolism and increased toxicity of metoprolol

121
Q

Hydroxychloroquine and aurothioglucose

A

Increased risk of blood dyscrasias. Contraindicated

122
Q

Hydroxychloroquine common AE

A

none

123
Q

Hydroxychloroquine rare but serious AE

A

Arrhythmias, cardiomyopathy, Stevens-Johnson syndrome, agranulocytosis, seizures, retinopathy, psychosis

124
Q

Lorazepam dose

A

Anxiety: Adults, 1 mg po bid-tid

Insomnia, due to anxiety or situational stress: Adults and Children >12 y of age, 2-4 mg po hs

125
Q

Lorazepam BBW

A

concurrent use with opioids

126
Q

Lorazepam MOA

A

Enhance the postsynaptic effect of the inhibitory neurotransmitter, GABA.

127
Q

Lorazepam contraindications

A

Hypersensitivity to benzodiazepines, narrow-angle glaucoma

128
Q

Lorazepam and valproic acid

A

Decreased metabolism of lorazepam

129
Q

Lorazepam and amitriptyline

A

Additive psychomotor defects

130
Q

Lorazepam and Ethinyl estradiol and other estrogen-based birth control products

A

Increased lorazepam metabolism and decreased effectiveness

131
Q

Lorazepam and Alfentanil, opioids, and other respiratory depressants

A

Additive respiratory depression

132
Q

Lorazepam common AE

A

Drowsiness, impaired motor coordination, retrograde amnesia

133
Q

Lorazepam rare but serious AE

A

Seizures, mania, depression, withdrawal symptoms

134
Q

Methadone dose

A

Pain, chronic (moderate-severe): Opioid-naive patients, 2.5 mg po q8h-q12h, may titrate to response
Drug detoxification, opioid abuse: 15-30 mg po q8h, titrate to response (usual range 80-120 mg/d); when used for treatment of opioid addiction (detoxification or maintenance), may only be dispensed by certified opioid treatment programs

135
Q

Methadone MOA

A

Binds to opiate receptors in CNS, causing inhibition of ascending pain pathways, altering perception to pain, and produces generalized CNS depression. Methadone is a phenylethylamine opioid agonist qualitatively similar to morphine but with a chemical structure unrelated to the alkaloid-type structures of the opium derivatives. Analgesic activity of (R)-methadone is 8-50 times that of (S)-methadone, and (R)-methadone has a tenfold higher affinity for opioid receptors.

136
Q

Methadone BBW

A

Accidental ingestion; addiction, abuse, and misuse; QTc prolongation; respiratory depression; concurrent use with benzodiazepines; REMS; neonatal opioid withdrawal; conditions for use in opioid addiction; CYP interactions

137
Q

Methadone contraindications

A

Bronchial asthma, hypersensitivity to opioids, paralytic ileus, respiratory depression, hypercarbia

138
Q

Methadone and amiodarone

A

QT prolongation

139
Q

Methadone and Barbiturates, benzodiazepines, centrally acting muscle relaxants, opioids

A

CNS depression

140
Q

Methadone and Buprenorphine, opioid agonists/antagonists, opioid antagonists

A

precipitation of withdrawal

141
Q

Methadone and CYP3A4/5 and CYP2B6 inducers

A

Increased methadone metabolism and decreased methadone efficacy

142
Q

Methadone and CYP3A4/5 and CYP2B6 inhibitors

A

Decreased methadone metabolism increases risk of methadone toxicity

143
Q

Methadone and CYP2D6 substrates

A

Reduced metabolism of substrates and increased toxicity

144
Q

Methadone and didanosine

A

Decreased didanosine absorption

145
Q

Methadone and MAOIs

A

Additive respiratory depression, increased risk of serotonin syndrome

146
Q

Methadone and SSRIs, SNRIs, TCAs, triptans

A

Increased risk of serotonin syndrome

147
Q

Methadone common AE

A

Constipation, GI distress, hypotension, dizziness, sedation

148
Q

Methadone rare but serious AE

A

Respiratory depression, arrhythmias, Stevens-Johnson syndrome, QTc prolongation, serotonin syndrome, adrenal insufficiency, hypogonadism

149
Q

Methotrexate dosing

A

Non-Hodgkin lymphoma, advanced (Burkitt lymphoma, stages I and II): 10-25 mg/d po for 4-8 d for several courses with a 7-10 d rest period
Psoriasis, severe: Initial, 2.5-5 mg q12h × 3 doses/wk, may titrate dose to 10-25 mg/wk po
Rheumatoid arthritis, severe: 7.5-15 mg po once weekly, may titrate by 5 mg/wk every 2-3 wk to max 20-30 mg/wk
Juvenile rheumatoid arthritis, polyarticular course: 10 mg/m2 po once weekly, may titrate to clinical response

150
Q

Methotrexate MOA

A

Reversibly inhibits dihydrofolate reductase (DHFR). Dihydrofolates are reduced to tetrahydrofolates by DHFR before they are used in DNA synthesis. Methotrexate interferes with DNA synthesis, repair, and cellular replication.

151
Q

Methotrexate BBW

A

Bone marrow suppression, renal impairment, hepatotoxicity, pneumonitis, GI toxicity, secondary malignancy, tumor lysis syndrome, dermatologic toxicity, opportunistic infections, radiotherapy, hypersensitivity, pregnancy

152
Q

Methotrexate contraindications

A

Hypersensitivity to methotrexate, pregnancy, nursing, preexisting blood dyscrasias in patients treated for psoriasis and rheumatoid arthritis

153
Q

Methotrexate and Aspirin, dantrolene, loop diuretics, NSAIDs, penicillins, PPIs, salicylates, trimethoprim, sulfisoxazole

A

Competition for renal tubular secretion, increased methotrexate toxicity and nephrotoxicity

154
Q

Methotrexate and BCG vaccine, other live vaccines and immunostimulants

A

Increased infection risk

155
Q

Methotrexate and Eltrombopag

A

Inhibition of OATP1B1 by eltrombopag results in decreased methotrexate clearance and increased toxicity

156
Q

Methotrexate and leucovorin

A

Leucovorin is a reduced folate that counteracts the anticancer effects of methotrexate

157
Q

Methotrexate common AE

A

Myelosuppression, nausea, vomiting, alopecia, stomatitis, photosensitivity, rash

158
Q

Methotrexate rare but serious AE

A

Acute renal failure, liver failure, interstitial lung disease, Stevens-Johnson syndrome, secondary malignancies (lymphomas), opportunistic infections

159
Q

Methylprednisolone dosing

A

Adults, 4-48 mg po daily; Children, specific dosing parameters not specified; for all patients, adjust dose according to patient response.

    Allergic states (eg, asthma, etc)
    Dermatologic diseases (eg, exfoliative erythroderma, etc)
    Endocrine disorders (eg, adrenocortical insufficiency, etc)
    GI diseases (eg, regional enteritis, ulcerative colitis, etc)
    Hematologic disorders (eg, acquired hemolytic anemia, etc)
    Neoplastic diseases (eg, palliative management of leukemias and lymphomas, etc)
    Nervous system (eg, multiple sclerosis, cerebral edema, etc)
    Renal diseases (eg, idiopathic nephrotic syndrome, systemic lupus erythematosus, etc)
    Respiratory diseases (eg, idiopathic eosinophilic pneumonia, etc)
    Rheumatic disorders (eg, rheumatoid arthritis, etc)
160
Q

Methylprednisolone MOA

A

Corticosteroids are naturally occurring and synthetic adrenocortical steroids that cause varied metabolic effects, modify the body’s immune responses to diverse stimuli, and are used primarily for their anti-inflammatory effects in disorders of many organ systems.

161
Q

Methylprednisolone contraindications

A

Hypersensitivity to methylprednisolone or other glucocorticosteroids, administration of live vaccines, fungal infections

162
Q

Methylprednisolone common AE

A

GI upset, hyperglycemia

163
Q

Methylprednisolone rare but serious AE

A

Primary adrenocortical insufficiency, Cushing syndrome, decreased growth in children, increased risk of infection

164
Q

Methylprednisolone and warfarin

A

Steroids can either increase or decrease INR in patients taking warfarin

165
Q

Methylprednisolone and phenytoin

A

Phenytoin increases methylprednisolone metabolism; methyl-prednisolone can increase or decrease phenytoin metabolism

166
Q

Methylprednisoone and FQs

A

Concurrent use of steroids and fluoroquinolones can increase risk of tendon rupture, especially in elderly

167
Q

Methylprednisolone and CYP3A4/5 inducers

A

Increased methylprednisolone metabolism decreases methyl-prednisolone efficacy

168
Q

Methylprednisolone and CYP3A4/5 inhibitors

A

Decreased methylprednisolone metabolism increases risk of methylprednisolone toxicity

169
Q

Morphine dose

A

Chronic pain, moderate to severe: 10-20 mg po q12h, titrate to response; use immediate-release formulation to determine patient’s morphine requirement and titrate to response. Extended-release products are administered every 12-24 h
Acute pain: 10 mg po q4h prn, titrate to response (max 30 mg po q4h) in hospitalized patients at low risk of respiratory depression

170
Q

Morphine MOA

A

Morphine is a pure mu agonist. Mu receptors are responsible for analgesia, respiratory depression, miosis, decreased GI motility, and euphoria. In the CNS, it promotes analgesia and respiratory depression by decreasing brain stem respiratory centers’ response to carbon dioxide tension and electrical stimulation. It also decreases gastric, biliary, and pancreatic secretion, induces peripheral vasodilation, and promotes opioid-induced hypotension due to histamine release

171
Q

Morphine BBW

A

Ethanol; addiction, abuse and misuse, REMS, respiratory depression, neonatal opioid withdrawal, accidental ingestion, concurrent use with benzodiazepines, medication errors

172
Q

Morphine contraindications

A

Hypersensitivity to opioids, acute or severe asthma, paralytic ileus, respiratory depression, GI obstruction; concurrent use or use within 14 days of MAOI

173
Q

Morphine DDI

A

Same as fentanyl

174
Q

Morphine common AE

A

Constipation, nausea, vomiting, hypotension, dizziness, sedation, diaphoresis, headaches, depression, xerostomia

175
Q

Morphine rare but serious AE

A

Cardiac arrest, physical dependence, respiratory depression, serotonin syndrome, adrenal insufficiency, decreased sex hormones

176
Q

Oxycodone dose

A

Pain, chronic, moderate to severe: Initial dose for opioid-naïve patient, immediate release, 5-15 mg po q4-6h prn pain; extended release, 10 mg po q12h prn pain; titrate to response

177
Q

Oxycodone MOA

A

Oxycodone is pure mu agonist. Mu receptors are responsible for analgesia, respiratory depression, miosis, decreased GI motility, and euphoria. In the CNS, it promotes analgesia and respiratory depression by decreasing the brain stem respiratory centers’ response to carbon dioxide tension and electrical stimulation. It also decreases gastric, biliary, and pancreatic secretion, induces peripheral vasodilation, and promotes opioid-induced hypotension due to histamine release.

178
Q

Oxycodone BBW

A

Addiction, abuse potential; REMS, respiratory depression, accidental ingestion, neonatal withdrawal, CYP3A4/5 interaction, concurrent use with benzodiazepines, medication errors with oral solution

179
Q

Oxycodone contraindications

A

Hypersensitivity to oxycodone or other opioids, asthma, paralytic ileus, respiratory depression, hypercarbia

180
Q

Oxycodone DDI

A

Same as morphine

181
Q

Oxycodone common AE

A

Constipation, GI distress, sedation, sweating, pruritus

182
Q

Oxycodone rare but serious AE

A

Cardiac arrest, respiratory depression, physical dependence, tolerance, severe hypersensitivity, serotonin syndrome, adrenal insufficiency, decreased sex hormones

183
Q

Rizatriptan dose

A

Migraine: Adults, 5-10 mg po at onset of migraine, may repeat after 2 h prn; max 30 mg/d; Children ≥6 y and Adolescents, <40 kg, 5 mg po at onset of migraine, multiple doses in a 24-h period not recommended

184
Q

Rizatriptan MOA

A

Rizatriptan binds with high affinity to serotonin (5HT) receptor subtypes 1B and 1D. Serotonin receptor agonists are believed to be effective in migraine either through vasoconstriction (via activation of 5-HT1 receptors located on intracranial blood vessels) or through activation of 5-HT1 receptors on sensory nerve endings in the trigeminal system resulting in the inhibition of proinflammatory neuropeptide release.
Drug Characteristics: Rizatriptan

185
Q

Rizatriptan contraindication

A

Cerebrovascular syndromes, hemiplegic or basilar migraine, ischemic bowel disease, ischemic heart disease, peripheral vascular disease, severe hepatic impairment, uncontrolled HTN, MAOI, ergot alkaloids

186
Q

Rizatriptan and SSRIs

A

Additive pharmacologic effects resulting in excessive serotonergic stimulation

187
Q

Rizatriptan and other 5HT agonists

A

Additive pharmacologic effect leading to dangerous toxicity

188
Q

Rizatriptan and MAOIs

A

Metabolism of sumatriptan inhibited by MAOI, increasing serotonin levels and risk of serotonin syndrome

189
Q

Rizatriptan and ergot alkaloids

A

Enhanced vasoconstricting effects

190
Q

Rizatriptan common AE

A

None

191
Q

Rizatriptan rare but serious AE

A

Angina, cardiac dysrhythmia, coronary arteriosclerosis, heart block, HTN, acute myocardial infarction, aphasia, cerebral ischemia, stroke, dystonia, hemiplegia, neuropathy, transient ischemic attack, oculogyric crisis

192
Q

Sumatriptan dose

A

Migraine: Oral, 25-100 mg po at onset of migraine, may repeat after 2 h prn; max 200 mg/d; Nasal, 5-20 mg in 1 nostril, may repeat after 2 h; max 40 mg/d; sq, 6 mg sq; max 12 mg/d; Transdermal, apply 1 patch, may apply a 2nd after 2 h; max 2 patches/d
Cluster headaches: 6 mg sq once; max 12 mg/d

193
Q

Sumatriptan MOA

A

Sumatriptan binds with high affinity to serotonin (5-HT) subtypes 1B, 1D, and 1F receptors. It has no significant affinity or pharmacologic activity at adrenergic α1, α2, or β; dopaminergic D1 or D2; muscarinic; or opioid receptors. Serotonin receptor agonists are believed to be effective in migraine either through vasoconstriction (via activation of 5-HT1 receptors located on intracranial blood vessels) or through activation of 5-HT1 receptors on sensory nerve endings in the trigeminal system resulting in the inhibition of proinflammatory neuropeptide release.

194
Q

Sumatriptan contraindications

A

Hypersensitivity to sumatriptan, cerebrovascular syndromes, hemiplegic or basilar migraine, ischemic bowel disease, ischemic heart disease, peripheral vascular disease, severe hepatic impairment, uncontrolled HTN, MAOIs, ergot alkaloids

195
Q

Sumatriptan DDI

A

Same as rizatriptan

196
Q

Sumatriptan common AE

A

None

197
Q

Sumatriptan rare but serious AE

A

Angina, cardiac dysrhythmia, coronary arteriosclerosis, heart block, HTN, AMI, aphasia, cerebral ischemia, stroke, dystonia, hemiplegia, neuropathy, transient ischemic attack, oculogyric crisis

198
Q

Tizanidine dose

A

Muscle Spasticity: 2 mg po up to tid, may titrate to 8 mg po q6-8h with max dose of 36 mg/d

199
Q

Tizanidine MOA

A

Tizanidine is a centrally acting muscle relaxant. The drug is an imidazole derivative, structurally unrelated to other muscle relaxants. Tizanidine is an agonist of α2-adrenergic receptors, which decreases spasticity by increasing presynaptic inhibition; however, it does not have antihypertensive properties.

200
Q

Tizanidine contraindications

A

Hypersensitivity to tizanidine; concurrent use with CYP1A2 inhibitors

201
Q

Tizanidine and CNS depressants

A

Additive CNS depression

202
Q

Tizanidine and phenytoin/fosphenytoin

A

Increased phenytoin concentration, phenytoin toxicity

203
Q

Tizanidine ant CYP1A2 inhibitors

A

Inhibition of tizanidine metabolism and increased toxicity

204
Q

Tizanidine common AE

A

Hypotension, xerostomia, asthenia, dizziness, somnolence, muscle weakness

205
Q

Tizanidine rare but serious AE

A

AMI, thrombocytopenia, hepatitis, PE, hypersensitivity, death, slowed or difficult breathing when used in combination with opioids

206
Q

Tramadol dose

A

Pain, chronic, moderate to moderately severe: Immediate release, 50 mg po q4-6h prn, may titrate to 400 mg/d; extended release, initial, 100 mg po daily, may titrate to 300 mg/d; to convert from immediate release, convert 1:1 and round down to nearest 100 mg dose

207
Q

Tramadol MOA

A

Tramadol is a mu agonist and a weak inhibitor of serotonin and norepinephrine reuptake. Mu receptors are responsible for analgesia, respiratory depression, miosis, decreased GI motility, and euphoria. In the CNS, it promotes analgesia and respiratory depression by decreasing brain stem respiratory centers’ response to carbon dioxide tension and electrical stimulation.

208
Q

Tramadol BBW

A

Addiction, abuse, misuse, REMS, respiratory depression, accidental ingestions, CYP2D6, neonatal withdrawal syndrome, drug interactions, concurrent benzodiazepines, errors

209
Q

Tramadol contraindications

A

Hypersensitivity to tramadol or other opioids, paralytic ileus, respiratory depression, bronchial asthma, age <12 y, hypercapnia, MAOI use or use within last 14 d

210
Q

Tramadol common AE

A

Constipation, GI distress, dizziness, sedation, edema, sweating, pruritus, headaches, flushing

211
Q

Tramadol rare but serious AE

A

Cardiac arrest, physical dependence, tolerance, seizures, pancreatitis, suicidal ideation, anemia, serotonin syndrome, adrenal insufficiency, decreased sex hormones

212
Q

Tramadol DDI

A

Same as morphine

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