Pharm Clinical App Flashcards
Bismuth-subsalicylate
“Pepto-bismol”
Cytoprotective
Anti-diarrhea
Ondansetrone
Zofran
n/v
Calcium Carbonate
Tums
Antacid
Mg Hydroxide
“milk of magnesia”
Laxative
Promethazine
Phenergan
n/v
Prochlorperazine
Compazine
n/v
Diphenoxylate/atropine (Lomotil)
Anti-diarrhea
Metoclopramide
Reglan
n/v
Treatment for constipation
Lubiprostone
Linaclotide
Dicyclomine
Bentyl
anti-spasmodic
Misoprostol
CONTRA:preg
Cytoprotective
H2 blockers “tidine” are particularly good for
Nocturnal sx
H2 blockers
on-demand relief
Eisinophilic esophagitis
Allergic reaction
“Stacked rings” on EGD
Meds known for leading to “pill- induced” esophagitis
Bisphosphonates
NSAIDs
Best tx for Reflux Esophagitis
PPI
better than H2 blocker for “reflux” type
PPI
takes 2-5 days
Best taken in MORNING, 30 min before breakfast
do NOT stop abruptly, acid hypersecretion with abrupt discontinuation
Risks of chronic PPI
Nutrient malabsorption (Ca, Mg, B12, Iron)
Osteoporosis
C-dif
Kidney dz
best to use lowest dose for shortest amt of time possible
Mg containing antacids
can cause diarrhea SE +
Hypermagnesia risk in pts with Renal insuff
Sodium Bicarb Antacids
CAUTION d/t
Sodium/fluid retention
caution in pts w: Edema, cirrhosis, HF, Renal impairment
35 YO w epigastric discomfort, belching/bloating, fullness
no alarm features
H. Pylori
Testing for H. Pylori
Urea breath test
Stool antigen
1st line therapy for H. Pylori infection
4 things:
(PPI + BMT)
- PPI
- Bismuth
- Metro
- Tetracycline
Need to test after H. Pylori tx to make sure it’s completely gone bc if not, risk of:
PUD
Iron def anemia
Gastric CA
Discontinue ____ before testing for H. Pylori
PPI 1-2 wks before
Bismuth and Abx 4 wks before
57 YO taking Ibuprofen for past year
Epigastric pain within 30 minutes of meal
Peptic Ulcer Dz
Gastric ulcer
Complications of PUD:
Hemorrhage
Perf/Penetration
Obstruction
Perf/penetration: peritoneal signs, free air under diaphragm
Obstruction: succussion splash
What else besides NSAIDs can complicate PUD/make it worse?
Anticoags
ASA
Steroids
Misopristol
NSAID induced ulcers but CONTRA in pregnancy
76 YO with Diabetes
sx: 6 mo of early satiety, post meal nausea, intermittent vomiting
worsened by large meals and fatty foods
5lbs unintentional weight loss
EGD is negative for PUD or Gastric CA
what is it: Diabetic Gastroparesis
Dietary rec for Diabetic Gastroparesis
Small, frequent low fat meals
Improve glucose control*
Metoclopramide (Reglan) use
tx n/v, heartburn, early satiety, loss of appetite
CAUTION: Risk of EPS!!!/tardive dyskinesia
CONTRA to Metoclopramide (Reglan) use
Obstruction
Perforation
GI hemorrhage
Ondansetron (Zofran) considerations/SE
Cardiac arrhythmia
QT prolongation
Seretonin syndrome
Promethazine (Phenergan)
Prochlorperazine (Compazine)
Sedating
Drug induced Parkinsonism
Dicyclomine (Bentyl)
Antispasmodic med in tx of IBS
Anticholinergic SE: sedation, dry mouth, constipation, urinary retention
May consider using Amitriptyline or Eluxadoline to treat IBS if
Psychosocial component bc Amitriptyline is a TCA which can also treat depression
Eluxadoline treat IBS-D
Opioid agonist
Levothyroxine is used to treat
HYPOthyroidism
Tx for Opioid induced constipation
Methylnaltrexone
If pt has acute diarrhea and was recently on Clindamycin…
consider C-dif!!
Order C.Diff stool test
Most common SE of Pepto-Bismol
Black stool, black tongue, mouth
CONTRA to Pepto Bismol
ASA allergy (bc Pepto contains Salicylate)
Avoid in children recovering from viral illness–> Reye’s syndrome risk
LLQ abd pain
nausea
loose stools
Sigmoid diverticulitis
Tx: Flagyl + Cipro
Study of choice to confirm Diverticulitis
CT A/P w contrast
32 YO man w 6 wks of abd cramp, diarrhea, tenesmus, 3 BM daily w blood
5lb unintential weight loss
NO rebound or guarding
CBC confirm IDA
CMP normal kidney and liver fx
CRP/ESR elevated
IBD!!
plan: colonoscopy, reveals sigmoid Ulcerative Colitis
Most appropriate med to tx newly diagnosed IBD- Ulcerative Colitis
Mesalamine (Lialda)
Acute flare of IBD, may add
Corticosteroids
short burst in tapering doses
Complications of IBD like Peri-anal Chrons, can be treated with
Cipro + Flagly
Cipro (a FluoroQ) SE
Tendon rupture!!
Metronidazole (Flagyl) SE
Disulfuram like reaction with Alcohol
Make sure to tell pts not to DRINK ALCY
If a pt with IBD is taking Immunomodulators and Biologics, what do we need to monitor?
CBC
CMP
Abx that target cell wall
Beta-lactams
Beta-lactams
PCN
Cephalosporin
Carbapenems
Glycopeptides and Lipoglycopeptides (Vanco)
Abx that inhibit protein production
Nitro Tetracycline Macrolide Clindamycin Rifamycin Aminoglycosides
Abx that inhibit replication
Trimetho-Sulfa (Bactrim)
Quinolones
Metro
Four categories of bacteria
Gram +
Gram -
Anaerobic
Atypical
CAP most common pathogens
Strep PNA H. flu Legionella Mycoplasma PNA Chlamydia PNA
Tx for CAP
outpatient
Macrolide or
Doxy
Macrolides
Azithromycin “Z pack”
Clarithromycin
Erythromycin
Tx for CAP
inpatient
Macrolide or Doxy
+
Beta-lactam (Ceftriaxone, High dose ampicillin, Cefotaxime)
Abx specifically for Strep PNA
High dose Pen G
Or
Cephalosporin
Tx for Uncomplicated Acute Cystitis
“Bladder infection”
Bactrim
(if not resistance to E.Coli)
or
Nitro
“Bladder infection” tx if pt is diabetic
Ciprofloxacin (a FluoroQ)
Acute pyelonephritis tx
FluoroQ
PCN/Beta-lactam combo
Carbapenem if resistant organism
FlouroQuinolones
Ciprofloxacin, Levofloxacin, Moxifloxacin
Adverse rxn:
Tendon snap
QT prolongation
“BLACK BOX” warning
PID most common pathogen
Gonn/Chlamydia
Tx for PID
Single IM injection of Ceftriaxone
+
Oral Doxy
Tx for Chlamydia
Doxy or
Azithro (ok if pregnant)
Tx for Gonorrhea
Ceftriaxone
Drugs of choice for Pregnancy
PCN
Cephalosporins (“cef”)
Most common cause of Acute Bacterial Meningitis
Strep PNA
Neisseria
Empiric therapy for Bacterial Meningitis
3rd gen Cephalosporin
Ceftriaxone or Cefotaxime
What to add to Empirically cover Bacterial meningitis to cover PCN resistant strains of Strep PNA?
Vancomycin
If pt is allergic to PCN, good chance they are also allergic to
Cephalosporins
avoid use if possible in PCN pts
Empiric tx for “simple” Cellulitis
Bactrim
Doxy (a tetracycline)
Clinda (last choice)
Tetracyclines
Doxycycline, Minocycline
Tetracyclines - Doxycycline and Minocycline
CONTRA in pregnant, children under 8, can cause blue-black hyperpigmentation
Tx for more serious, “complex” cellulitis
fever
high incidence of MRSA
Admit
Parenteral Vancomycin
Does Vancomycin cover for MRSA?
Yes
Vancomycin “big guns” covers for
C-diff
MRSA
SE:
Nephrotoxic
Hearing loss
Red man syndrome (rapid infusion)
Dopamine
Parkinsonism
Depressive disorder tx goals
- ) >50% improvement
2. ) Remission (within normal range of tests, PHQ<5)
Recovery is considered
6 mo or longer
After rx med for Depression
f/u in 1-2 weeks
1st choice for depressoin
SSRI
then, SNRI
When choosing anti-depressant, consider
Personal past use Family hx Provider preference SE Co-morbid Cost
CAUTION with antidepressants
can unmask MANIA
if underlying bipolar
CAUTION with antidepressants
can also increase SI in children, teens, young adults 18-24 YO
Fluoxetine (Prozac)
SSRI
Could increase energy, take in AM
LONG HALF LIFE
SE: insomnia, HA, nervous, libido, nausea, diarrhea, anorexia, dry mouth
Sertraline (Zoloft)
SSRI
SOCIAL ANXIETY nocturnal eating
Parozetine (Paxil)
SSRI
assoc with more WEIGHT GAIN
Good for: Hyperanxiety, Acute panic!!!
Citalopram (Celexa)
SSRI
Only used for depression
SE: insomnia, somnolence, nausea, dry mouth, sexual dysfx
Escitalopram (Lexapro)
also used for Generalized Anxiety
SE: insomnia, somnolence, HA, nausea, ejaculation disorder
SNRIs
have X in the main name
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Citalopram (celexa)
Escitalopram (lexapro)
newer ones
much more SPECIFIC
celexa and lexapro are too much for
migraine ppl
seretonin systems are very sensitive in these ppl
Venlafaxine (effexor)
SNRI
Take with FOOD
SE: HA, nervous, dizzy, nausea, anorexia, drymouth, sweating, constipation or diarrhea, abnormal ejaculation/organism, HTN
Duloxetine (Cymbalta)
Depression and Anxiety
DIABETIC NEUROPATHY
Fibromyalgia
CONTRA: liver dz
Buproprion (wellbutrion)
Dopamine re-uptake inhibitor
LESS SEXUAL SE
CONTRA: seizures, anorexia
Mirtazapine (remeron)
a2 antagonist
LESS SEXUAL SE
SE: weight gain, inc cholesterol, constipation
often used in ELDERLY to help w depression, sleep, and increasing appetite
Most sexual SE
Prozac
duration of antidep
4-9 months
Contiuation therap
1-3 years for those with risk factors
After 1-3 years
If hx of multiple episodes or comorbid Psych - encouraged to continue indefinitely
STopping antidep meds
over 1-6 months
longer if withdrawal sx present
“Zoloft”
an SSRI
Sertraline
