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NAPLEX > PAH, Anemia, SCD > Flashcards

PAH, Anemia, SCD Flashcards

1
Q

What are the two oral chelators

A

Deferasirox

Deferiprone

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2
Q

What is first line for Hemodiaylisis pts?

A

IV iron

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3
Q

What is group 1 PAH?

A

No identifiable causes

called primary or idiopathic

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4
Q

Macrocytic anemia is characterized by what lab findings?

A

Decreased Hgb increase MCV >100

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5
Q

Treatment for dry eyes?

A

Cyclosporine

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6
Q

What 4 specific drugs need to be separated from iron products?

A

Quinolones, tetracyclines, levothyroxine, Bisphosphanates

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7
Q

What can decrease the serum concentrations of folic acid?

A

Green tea and sulfasalazine

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8
Q

Boxed warning for bosentan

A

Hepatotoxicity

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9
Q

Dosing for timolol

A

1 drop daily or BID

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10
Q

Non drug treatment for SCD? 2

A

Blood transfusion no higher than 10 g/dL

Bone marrow transplant

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11
Q

More severe bacteria that can cause conjuctivitis?

2

A

N. Gonorrhoeae

or Chlamydia

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12
Q

What are the most effective drugs for lowering IOP?

What do they end in?

A

Prostaglandin analogs

Prost

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13
Q

Conjuctivitis or pink eye commonly occurs in what population and can it spread?

A

Young children and is highly contagious

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14
Q

Acular

A

Ketorolac

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15
Q

What is consider the most potent of all PAH meds?

A

IV agents

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16
Q

How is PH defined?

A

mean PAP (mPAP) >=25 mmHg

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17
Q

Additional Vaccines Due to Functional Asplenia

4 speciifc timing

A
  1. Meningococcal series + routine boosters
  2. Meno Serogroup B (Bexsero, Trumenda) >= 10
  3. Pneumo poly (Pneumovax)>= 2 booster 5 years later and at age 65
  4. Pneumo conjugated prevnar x 1 in any pt >= 6 years of age if not given in childhood
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18
Q

What is the dosing for cosopt?

A

1 drop BID

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19
Q

Parenteral iron is reserved due to cost and side effects for what 5 populations?

A
  1. CKD pts on hemodiaylsis
  2. CKD receiving erythropoeisis stimulating agents
  3. Unable to tolerate oral iron celiac disease,
  4. Losing iron really quickly
  5. As an alternative when blood transfusions are not accepted by patients
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20
Q

SCD causes what issue?

A

Fibrosis of the spleen causing functional asplenia

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21
Q

Restasis?

A

Cyclosporine emulsion eye drop

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22
Q

Drugs that cause retinal changes/ retinopathy?

2

A
  1. Chloroquine
  2. Hydroxychloroquine
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23
Q

High risk drugs for hemolytic anemia when G6DP def? 8

A
  1. Chloroquine
  2. Dapsone
  3. Methylene blue
  4. Nitrofurantoin
  5. Primaquine
  6. Probenecid
  7. Rasburcase
  8. Sulfonamides
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24
Q

Bosentan can decrease the effects of?

A

Decrease effects of hormonal contraceptives

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25
Q

What do carbonic anhydrase inhibitors do and what do they end in?

A

zolamide

Reduce humour production

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26
Q
A
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27
Q

Ferrous sulfate 325 mg tablet

How much elemental iron?

A

65

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28
Q

If pts are not responders to vasoactivity test or fail CCB tx what are the next 4 drug classes

A
  1. Prostaglandin analogs and receptor agonists
  2. Endothelin receptor antagoinists ERAs
  3. PDE-5 inhibitors
  4. soluble guanylcyclase
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29
Q

Droxia, Hydrea, Siklos

A

Hydroxyurea

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30
Q

What drugs should be avoided in PAH and why?

A

Drugs that decrease prostaglandin like NSAIDs

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31
Q

What 3 CCBs are recommended to PAH vaso responders?

A
  1. Long acting nifedipine
  2. Diltiazem
  3. Amlodipine
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32
Q

OD and OS?

A

Right eye

Left eye

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33
Q

What is a warning of Carbonic anhydrase inhibitors?

A

Sulfa allergy

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34
Q

Most common cause of B12 def?

A

Perncious anemia

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35
Q

Ferumoxytol`

A

Feraheme

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36
Q

Side effects of Iron products? 3

A
  1. Constipation
  2. Black tarry stools
  3. Nausea
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37
Q

Dried Ferrous sulfate

A

30%

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38
Q

Who is hydroxyurea also indicated for?

A

Pts with acute chest syndrome, chronic symptomatic anemia or disability

consider in all children > 9 months

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39
Q

Which drugs can cause vision trouble at night and why?

A

Cholinergics like carbachol and pilocarpine

Cause pupil constriction

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40
Q

2 PDE 5 inhibitors

Brand and Generic?

A
  1. Revatio: Sildenafil
  2. Adcirca: Tadalafil
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41
Q

What is Nascobal and what is the dosing?

A

Nasal Vit B12 500 mcg in 1 nostril once weekly

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42
Q

Epogen, Procrit

A

Epoetin Alfa

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43
Q

Examples of cough cold and motion sickness meds that can increase IOP? 2

A
  1. Antihistamines
  2. Scopalamine
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44
Q

What are the goals of Iron Def Anemia Tx?

A

Increase in serum Hgb by 1g/dL every 2-3 wks

Continue Tx for 3-6 mo after anemia has resolved and iron stored return to normal

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45
Q

NSAIDs for ocular inflammation?

A

Ketorolac Acular

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46
Q

What type of formulation is L-glutamine?

A

Oral powder mixed with room temp beverage

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47
Q

Long term use of what 3 drugs can cause B12 def?

A

Metformin, H2RA and PPIs

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48
Q

What is the dosing for Lumigan?

A

1 drop QHS

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49
Q

Smoking increases the clearance of what drug?

A

Riociguat

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50
Q

What does Riociguat do?

A

Sensitizes sGC to endogenous nitric oxide and directly stimulates the receptor which incrreases cGMP

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51
Q

Important insturctions for Gels

A

Shake once before use

wait 10 minutes after inserting other eye drops before using gel

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52
Q

PDE5 SEs

A

HA

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53
Q

How should iron dextran be given?

A

First give a test dose to see if they have an allergic response

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54
Q

Flolan

A

Epoprostenol

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55
Q

Which BBs are non-selective?

A

All but betaxolol

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56
Q

Bosentan is a substrate and inducer of?

A

Sb 3A4

Induc 2C9

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57
Q

Black box warning for Iron containing products?

A

Accidental overdose leading cause of poisoning in children call 911 or poison control immediately

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58
Q

What conditions should you be cautious with when counseling someone on timolol? 5

A

COPD, Chronic Bronchitis, emphysema, asthma, advanced cardiac disease

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59
Q

How are ESAs stored?

A

Refridgerator

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60
Q

What does L-glutamine do for SCD pts?

A

Reduces the number of acute complications

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61
Q

What should be monitored for hydroxyurea?

A

CBC q2-4 wks until stable then 2-3 months

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62
Q

Polytrim

A

TMP/Polymyxin B

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63
Q

Maxitrol

A

Neo/poly/dexamethasone

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64
Q

Ferrous Sulfate

A

20%

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65
Q

Macrocytic anemia is caused by?

A

b12 or folate def

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66
Q

Color discrimination? 3 drugs what are the changes for each?

A
  1. Digoxin yellow green with toxicity
  2. PDE-5 Inhibitors (Sildenafil) green tinge around objects
  3. Voriconazole color vision changes
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67
Q

Xalantan

A

Latanoprost

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68
Q

Timoptic, Timoptic XE, Istalol

A

Timolol

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69
Q

All IV irons have risk of?

A

Hypersensitivity Rxn

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70
Q

What do loop diuretics do in PAH?

A

Treat volume overload

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71
Q

Polysaccarharide iron complex

A

100%

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72
Q

Contraindications for Riociguat? 3

A
  1. Pregnancy
  2. Use with PDE-5s
  3. Use with nitrates
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73
Q

What should be used in children when born if they are diagnosed with SCD?

How long should it be continued?

What is the dosing?

A
  • PCNs Twice daily
  • Until 5 yo
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74
Q

What 5 things should you monitor when treating pts with ESA?

A
  1. Hgb
  2. Hct
  3. TSAT
  4. Serum Feritin
  5. BP
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75
Q

Warniings for Flolan?

A

Rebound PH Dont DC or decrease dose abruptly

CHronic IV infusions can cause sepsis or blood stream infections

Epoprostenol has an extrememly short half life 6 minutes

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76
Q

Triferic

What is the indication?

A

Indicated only for patients with hemodialyisis dependent CKD and should be added to the bicarbonate concentrate of the dialysate

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77
Q

6 select drugs that can cause PAH?

A
  1. Cocaine
  2. SSRIs during pregnancy this increases the risk in the newborn
  3. Wt loss drugs (diethylpropion, lorcaserin, phendimetrazone)
  4. Methamphetamines
  5. Dasatinib (Sprycel)
  6. Diazoxide (Proglycem)
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78
Q

B12 def anemia can cause of side effects?

A

Serious neurologic disfunction including peripheral neuropathy

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79
Q

What vaccines are advised in PAH?

A

FLu and pneumococcal

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80
Q

Remodulin

A

Treprostinil

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81
Q

How long does it take for symptoms of SCD to develop and why?

A

2-3 months after birth and fetal Hgb ehich blocks sickling of RBCs

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82
Q

Age indication for Endari

A

>=5 with SCD

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83
Q

What are the 5 examples of anticholinergic that increase IOP?

A
  1. TCAs
  2. Oxybutnin
  3. Tolterodine
  4. Benztropine
  5. trihexphenidyl
84
Q

Contraindications of PDE-5

A

Use with nitrates or riociguat

85
Q

Recommended dose for oral iron therapy

A

100-200 mg elemental per day

86
Q

Common cause of bacterial conjuctivitis?

A

Staph Aureus

87
Q

Aranesp

A

Darbepoetin

88
Q

What do prostaglandin analogs do?

A

Increase aqueous outflow

89
Q

Ferrous sulfate dried

ER

160 mg tablet

A

50 mg elemental iron

90
Q

What is recommended as first line for patients with severe B12 def or neurologic symptoms?

A

B12 injections Cyanocobalamin

91
Q

What 4 things should a parent do to reduce the risk of conjuctivitis?

A
  1. Not touch their eyes
  2. Hand hygiene
  3. Change towels and wash clothes daily
  4. Discard eye cosmetics
92
Q

Since PAH can put you in a prothrombic state wha can pts treated with and what is the goal?

A

Warfarin can be considered

1.5-2.5 gail INR

93
Q

Iron Chelation Tx

What isnt used and why?

A

Defuroxime was used but not any more cause of toxicities and its IV

94
Q

What 4 sets of drugs increase IOP?

A
  1. Anticholinergics
  2. Cough/cold and motion sickness med
  3. Chronic steroids especially in the eye
  4. Topiramate
95
Q

What steroids effect IOP most significantly?

A

Ophthalmic roid prednisolone (Predforte)

96
Q

Antihistamines for allergic conjuctivitis? 2

A
  1. Azelastine
  2. Olaptadine (Patanol, Pataday)
97
Q

Most common virus for conjuctivitis?

A

Adenovirus

98
Q

Warnings for ERAs?

A

Hepatotoxicity, decreased Hgb and Hct, fluid retention

99
Q

Key Vaccines in SCD

Routine Childhood series 2

A
  1. H Flu Type B (Hib)
  2. Pneumo conjugated (PCV13 Prevnar)
100
Q

What do alpha 2 agonists do for glaucoma and what do they end in?

A

Nidine

Increase both outflow and decrease production

101
Q

How should Iron be Taken?

What can it cause?

A

Taken on an empty stomach

Can cause black stools which is common, if constipated ask doctor for stool softeners.

102
Q

What diet should PAH patients follow and what is the /day restriction?

A

Sodium restriction

<2.4 g/day

103
Q

Pts with group five PAH class should be given?

A

IV epoprostenol

104
Q

Cosopt, Cosopt PF

A

Timolol + dorzolamide

105
Q

Folic acid can decrease the serum concentration of what 4 drugs?

A

Fosphenytoin, phenytoin, primidone, phenobarbital

106
Q

2 main side effects of BBs? for glaucoma

A

Stinging

Burning

107
Q

If patients are considered responders to vasoreactivity testing what class of drugs is recommended?

108
Q

Endari

A

L-Glutamine

109
Q

Ferrous Fumurate

110
Q

What are the 3 goals for glaucoma treatmetn?

A
  1. Make less fluid with BB liks timolol
  2. Move fluid out with prostaglandin analogs
  3. Or do both
111
Q

2 warnings for hydroxyurea?

A
  1. Fetal embryo toxicity
  2. Avoid live vaccines
112
Q

Ocuflox

113
Q

Warnings and side effects of cGC

A

Riociguat

Hypotension

HA

114
Q

What does ESA do?

A

Decreases the need for blood transfusions but are ineffective if iron stores are low

115
Q

Do BB eye drops contain BAK?

A

Yes some do

116
Q

What CCB is not recommended in PAH?

A

Verapamil

due to the more significant negative inotropic effects compared to diltaizem

117
Q

AD and AS?

A

Right ear: AD

Left ear: AS

118
Q

How can eye inflammation be reduced? 3 things

A
  1. Cold compress
  2. NSAID if mild
  3. Steroids if severe
119
Q

Roid eye drops for Inflammation?

A

Prednisolone

Omnipre, Preforte, Pred Mild

Limit use due to increase ocular pressure

120
Q

What is the test to see if someone has hemolytic anemia?

A

Positive coombs test

121
Q

Common chronic complication of SCD?

A

Pulmonary HTN

Others but this is underlines

122
Q

How is Pulomonary HTN characterized?

A

continous high BP in the pulmonary arteries

123
Q

Drug tx for SCD? 6

A
  1. Immunizations
  2. Abx
  3. Analgesics for pain
  4. Hydroxyurea
  5. L-Glutamine
  6. Chelation therapy to reduce iron overload from tranfusion
124
Q

Floppy iris syndrome what issues can it cause and what drugs can cause ti?

A
  1. Problems in cataract surgery
  2. Alpha blockers (Doxazosin)
125
Q

What are the treatments for Anemia in CKD?

A

Iron and ESA

126
Q

Otitis Externa Drug Treatment?

A

Ciprodex

Ciprofloaxacin and dexamethasone

127
Q

Prostaglandins end in?

128
Q

What is the component that can be abosrbed in contact lenses?

A

Benzalkonium Chloride (BAK)

Can discolor contact lenses wait 15 minutes to put contacts back in

129
Q

How should unopened bottles of latanaprost be stored?

130
Q

What drug is preferred if pressure is only in one eye?

131
Q

Side effects of Flolan

4

A

Vasodilator rxns, FLushing

Jaw pain

infusion site pain

132
Q

2 generic names for endothelin receptor antagonists?

A
  1. Bosentan
  2. Ambresentan
133
Q

What other drugs should you consider for PAH pts?

A

Loop diuretics and Possibly digoxin

134
Q

Vigamox

A

Moxifloxacin

135
Q

PAH can lead to wht?

A

Puts you in a prothrombic state

136
Q

How do you know if hydroxyurea is at toxic levels? 2 labs

A

ANC<2,000/mm3

Platelet <80,000/mm3

137
Q

Boxed warning for Riociguat?

A

Embryo-fetal tox neg preg before starting and checked monthly

138
Q

What drug can decrease the absorption of B12?

139
Q

Cyanocobalamin, B12 dosing?

A

IM or Deep SC

140
Q

How is hydroxyurea taken?

141
Q

Boxed warning for ERAs?

A

Emryo fetal tox, must have negative preg before use and monthly

142
Q

How long is contraception needed for hydroxyurea?

A

during and after stopping 1 year males 6 months females

143
Q

What drug interactions for hydroxyurea?

A

Drugs that cause myelosuppression

Limuss

Wear sun protection

144
Q

Vision loss/Abnormal Changes

5

A
  1. Digoxin with toxicity blurriness or halos
  2. PDE-5 vision loss in one or both eyes can be permanent
  3. Isotretinoin decrease nice vision which can be permanent
  4. Vigabitrin permanent vision loss, high risk
  5. Voriconazole: abnormal vision, photophobia
145
Q

What supplementation is used for hydroxyurea?

A

FOlic acid

146
Q

ERA side effects?

147
Q

What is hydroxyurea and what does it do?

A

Disease modifying agent that stimulates the production of HgbF

148
Q

Anemia of CKD is primarily due to?

A

Def in Erythropoeitin

149
Q

Latisse

A

Bimatoprost for eyelash growth

150
Q

COntraintications of ERAs?

151
Q

Ferrous gluconate

152
Q

4 warnings of PDE-5s

A
  1. Hearing loss
  2. Vision loss
  3. Nonarteritic anterior ischemic optic neuropathy
  4. Priapism
  5. Hypotension
153
Q

4 main topical antibiotics used for the treatment of bacterial conjuctivitis

A
  1. Moxifloxacin
  2. Neo/pol/dexamethasone
  3. Ofloxacin
  4. TMP/Polymyxins
154
Q

Timoptic XE, Timolol GFS dosing?

A

Gels

Daily

155
Q

What do ERAs do?

A

Endothelin is a potent vasoconstrictor

ERAs block these on the pulmonary smooth muscle

156
Q

Boxed warning for Epogen or Procrit? 6

A
  1. Increased risk of death
  2. MI
  3. Stroke
  4. VTE
  5. Thrombosis
  6. Tumor progression

Use lowest effective dose

157
Q

What do BBs do for glaucoma?

A

Reduce aqeuous humor production

158
Q

What is the treatment for viral conjuctivitis?

A

No topical treatment

159
Q

What is the dosing for Aranesp?

A

Darbapeotin

Its once weekly

the half life is much longer than Epoetin alfa so it can be given weekly instead of 3x/wk

160
Q

What is the major warnings for prosts?

A
  • Darkening of the Iris, eyelid skin and eyelashes, can increase length and number of eyelashes
161
Q

What type of agent is hydroxyurea?

A

Hazardous

Wear disposable gloves to limit exposure dont open the capsule

162
Q

3 drugs that cause optic neuropathy?

A
  1. Amiodarone + corneal deposits
  2. Ethambutol
  3. Linezolid
163
Q

What do PDE-5 inhibitors do?

A

Prevent degradation of cGMP

this increases cGMP and causes pulmonary vasculature relaxation and vasodilation

164
Q

Travatan Z

A

Travoprost

165
Q

Lumigan

A

Bimatoprost

166
Q

What do prostacyclin analgues do for PAH patients?

A

Prostacyclin synthase is reduced in pts with PAH which decreae prostacyclin I2 which is a potent vasodilator

Analogues are potent vaso dilators and also inhibitors of platelet aggregation

167
Q

What do cholinergic (miotics) do for glaucoma?

A

Increase outflow

168
Q

What benefit could digoxin have in PAH?

A

Improve cardiac output and control HR

169
Q

What 6 drugs can cause pulmonary fibrosis?

A
  1. Amiodarone
  2. Bleomycin
  3. Dronedarone
  4. Methotrexate
  5. Nitro
  6. Sulfasalazine
170
Q

What other vitamin can increase the absorption of Iron?

171
Q

What drug requires ice packs for stability?

A

Flolan Epoperstenol

172
Q

What is Blepharitis and what is the treatment?

A

Eyelid inflammation and treat with warm moist compress

173
Q

For cancer pts ESA is not recommended when?

A

Pts outcome is cure

174
Q

What drug can decrease the efficacy of B12?

A

Chloramphenicol

175
Q

When is Hydroxyurea indicated? In SCD

A

Adults who have >=3 acute pain crisis in 1 year

176
Q

SCD most commonly effects what population?

A

African Americans

177
Q

Venofer

A

Iron sucrose

179
Q

PRostcyclin analog Drug interactions? 2 sets

A
  1. Increase effects of antiplatelets, antihypertensives and anticoagulants
  2. Troprostinil (remodulin): levels are increased by 2C8 inhibitors (gemfibrozil) also should be avoided in selexipag
180
Q

Oral iron absorption is decreased with? 3 things

A
  1. Food take iron on an empty stomach
  2. High gastric pH, avoid H2RA, PPIs separate from antacids
  3. Sustained release or enteric coated tablets cause less GI irritation
181
Q

Dx and Tx of Iron def anemia

Lab Findings

3 bullets 7 findings

A
  1. Decrease Hgb, Microcystosis <80, Decrease RBC
  2. Decreased serum iron, ferritin, and TSAT
  3. Availlable iron binding sites increase TIBC
182
Q

PDE-5s are substrates of?

183
Q

What is the goal for the treatment of glaucoma?

A

Decrease IOP

184
Q

What are the two types of Acute Sickle cell crisis and what is the cause?

A

Caused by vascular occlusion

Most common types VOC: Vasooclussive crisis

or Acute pain crisis

If pain in chest it is acute chest syndrome

185
Q

Bosentan levels can be increased with? 3 bullets

A

2C9 inhibitors: Amiodarone, fluconazole

3A4 inhibitors: ritonavir

Cyclophosphamide and Glyburide on contraindicated

186
Q

4 key Side Effects of Prosts?

A
  1. Blurred vision
  2. Stinging
  3. Increased pigmentation of the iris or eyelashes
  4. Eyelash growth
187
Q

Carbonyl Iron

188
Q

Dosing for Epogen or Procrit?

189
Q

When should epogen or procrit therapy be initiated and when should it be stopped?

A

When Hgb is <10

Decrease or interrupt dosing when Hgb approaches or exceeds 11

CKD patients on HD specifically

190
Q

Treatment of cerumen block

A

Carbamide peroxide (Debrox) triethanolamine

191
Q

What are the 3 prostaglandin analogs

A

Bimatoprost

Latanaprost

Travoprost

192
Q

What product does not contain BAK?

A

Travatan Z

193
Q

Pts with severe pain or VOC should be given what?

A

IV opioids or PCA

194
Q

11 drugs that cause hemolytic anemia?

A
  1. Beta lactamase inhibitors
  2. Cephalosporins
  3. Isoniazid
  4. Levodopa
  5. Methyldopa
  6. PCN especially piperacillin
  7. Platinum based chemo
  8. Quinidine
  9. QUinine
  10. Ribavirin
  11. Rifampin
195
Q

Azasite generic, storage and stability

A

Store in fridge

stable for 14 days at room temp

196
Q

Folic acid can decrease the efficacy of what drug?

A

Raltetrexed Avoid combination

197
Q

What prostaglandin also has an indication for eyelash hypertrichosis as well as glaucoma?

What are the two brand names

A
  • Bimatoprost
  • Lumigan for glaucoma
  • Latisse for hypotrichosis
198
Q

What is required for hydroxyurea?

A

Contraception

199
Q

Caution should be used in patients on PDE5 with what other class?

A

Alpha Blockers or other HTN meds

200
Q

Boxed warning for hydroxyurea?

A

Myelosuppression

201
Q

How should Flolan be stored?

A

Protected from light before and during infusion

202
Q

Sepsis and mengingitis can occur in SCD due to what 3 main pathogens?

A
  1. S. Pneumo
  2. H. Influe
  3. N. Mengingitiis
203
Q

Black box warning for iron dextran and ferumoxytol

A

Serious anaphylactic rxn

204
Q

Epogen or Procrit risk in CKD pts

A

Increased risk of death and CV events when Hgb>11

205
Q

What two classes of drugs have boxed warnings for fetal embryo toxicity?

A

ERAs: Bosentan

cG stimulators riociguat

206
Q

What do Rho Kinase inhibitors do and what do they end in?

A

Sudil

Increase aqeuous outflow

NAPLEX (64 decks)

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