Pharmacology Flashcards
Macrolides:
erythromycin, azithromycin, clarithromycin.
Quinolones:
ciprofloxacin (Cipro), ofloxacin (Floxin).
Sulfa:
Trimethoprim-sulfamethoxazole (Bactrim).
Tetracyclines:
tetracycline, doxycycline
It takes ___ days (platelet life span) for platelet function to return to normal after a patient stops taking clopidogrel (Plavix).
10
____ patients may require lower starting and maintenance doses of warfarin.
Asian
INR values —– increase stroke risk sixfold.
<2.0
—is longer acting and more “effective” than HCTZ.
chlorthalidone
reduce calcium excretion by the kidneys and stimulate the osteoblasts. This helps build bone.
Thiazides
Patients with serious sulfa allergies should avoid
Thiazide and loop diuretics
Spironolactone adverse effects:
Gynecomastia (13%) and hyperkalemia
Spironolactone black box warning
risk of benign and malignant tumors
Alpha-blockers are potent vasodilators common side effects are
dizziness and hypotension. Give at bedtime at very low dose and slowly titrate up. Careful with frail elderly (risk of syncope and falls).
Alpha-blockers are not first-line choice except for males with both
HTN and BPH
ACEIs and ARBs are contraindicated in
pregnancy, renal artery stenosis, angioedema, hyperkalemia (>5.5 mmol/L), and hypersensitivity to the drug.
ACEIs and ARBs protect the kidneys and are preferred drugs for treatment of
hypertension in diabetics and patients with mild-to-moderate CKD. But if severe CKD (eGFR <60), avoid these drugs because of higher risk of hyperkalemia.
ACEIs are first-line therapy for
HF with left ventricular dysfunction (or HFrEF).
Captopril is associated with
agranulocytosis, neutropenia, and leukopenia (rare). Monitor complete blood count (CBC).
Both ACEIs and ARBs are excreted in
breastmilk and pregnant mothers should avoid
ACEI-induced cough and angioedema are caused by
inhibition of the metabolism of bradykinin and kallikrein system, which are involved in the inflammatory process.
Some patients are at higher risk of AKI and hyperkalemia (elderly, patients with renal artery stenosis, diabetics). Check kidney function
3 - 5 days after starting drug
Avoid using diltiazem and verapamil (nondihydropyridine CCBs) in patients
HFrEF (can worsen it).
Pedal edema may occur with _________ because of vasodilation. If it bothers patient, reduce dose or take it later in the day. The pedal edema is positional and improves when laying down.
nifedipine and amlodipine
Dihydropyridine CCBs can cause
peripheral edema, HA, flushing and Lightheadedness
Nondihydropyridine CCBs can worsen
cardiac output and cause bradycardia and constipation in elderly
what are the main sx of main symptoms of CCB poisoning.
hypotension and bradycardia
Do not use oral ——– for mild acne (open/close comedones). Start with OTC topicals such as salicylic acid (Noxzema, Stridex) and benzoyl peroxide.
tetracycline
For mild acne not responding to OTC drugs, try prescription topicals
(benzoyl peroxide and erythromycin [Benzamycin]), tretinoin (Retin-A), or azelaic acid cream.
another tetracycline option is
minocycline
Minocycline side effects are
vertigo can resolve in 1 - 2 days after stopping meds
tetracyclines are best to take how
on empty stomach
erythromyocin side effects are
GI -n/v, diarrhea, abdominal pain
what is the most tolerated macrolide and rare GI side effects
azithromycin
May prolong INR and increase risk of bleeding if warfarin is mixed with
erythormyocin or clarithromycin
first-line treatment for gonorrheal infections.
Ceftriaxone (rocephin) 500 mg IM
MRSA skin infections (boils, abscesses): Do not use cephalosporins. First-line therapy is
trimethoprim–sulfamethoxazole (Bactrim DS) or clindamycin. Treat for at least 5 to 10 days.
Patients who have a true allergy to penicillin (history of anaphylaxis, angioedema) are more likely to have an allergic reaction to
cephalosporins
Patients who have a true allergy to penicillin (history of anaphylaxis, angioedema) are more likely to have an allergic reaction to
1 IgE-mediated reactions.
do not use amoxicillin with what disease b/c causes generalized rash
amoxicillin, ampicillin rash
Dicloxacillin is for
PCN staph like Mastitis and impetigo
is a serious complication of quinolone therapy, and patients who are on steroids or >60 years are at higher risk.
achilles tendon rupture
Do not use quinolones in children (<18 years) or women who are pregnant or breastfeeding because of adverse effects on
growing cartilage
If a patient on quinolone reports a new onset of difficulty in walking, order
an ultrasound to rule out Achilles tendon rupture or peripheral neuropathy and discontinue the medicine.
Bioterrorism-related inhalation of anthrax spores (postexposure prophylaxis) is treated with
ciprofloxacin 500 mg every 12 hours × 60 days (treat within 48 hours). In addition, a three-dose series of anthrax vaccine is recommended
Cutaneous anthrax is treated with
ciprofloxacin 500 mg twice a day × 7 to 10 days.
Traveler’s diarrhea is treated wit
Cipro 750 mg (single dose) or 500 mg twice a day × 3 days.
Ciprofloxacin has the best activity against
Pseudomonas aeruginosa (gram negative) and is the first-line drug for treating pseudomonal pneumonia for patients with cystic fibrosis.
For athletes or very physically active patients, if fluoroquinolone is needed, advise to reduce their training volume and intensity to reduce risk of Achilles tendon injury. Wait
2 to 4 weeks to resume activity
Patients with a UTI who are on warfarin (Coumadin) should not be given
Bactrim increases risk of bleeing monitor INR
Pregnant women (or suspected pregnancy) with a UTI can be treated with
beta-lactams, nitrofurantoin, and fosfomycin.
If the patient (≥18 years) is allergic to macrolides, an alternative is
doxycycline PO twice a day or new-generation quinolones (Levaquin, Avelox).
Capsaicin cream can be used to treat pain in
trigeminal neuralgia and PHN
max number of days that ketorolac (toradol 0 can be used is
5 days
Max dose of acetaminophen (tylenol
3 - 4 g daily
A severe case of poison ivy or poison oak rash may require — to — days of an oral steroid to clear.
14 to 21
Maximum number of refills for Schedule III to V drugs is
five refills
schedule 2 drugs have how many refills
none)
echinachea does what
shortens cold duration
feverfew and butterbur use
migraines
Gingko is for
dementia
isoflavones
estrogen
saw palmetto
BPH
Kava kava, valerian root
anxiety and insomnia
St Johns wort
depression
Turmeric
alzheimers, arthritis
what abx is used for lung infections with comorbidities
no comorbidities
fluroqueinolones
marcrolide -azithromyocin or clarithromycin
what med do we give for pertussis
macrolide -
Azithromycin (Z-pack)
* Erythromycin
* Clarithromycin
Strep pharyngitis treatment
PCN
Acute rhinosinusitis:
wait 10 days, then Amoxicillin or
Augmentin.
Metformin
SE: diarrhea, nausea/vomiting
* WARNINGS:
* Do not use with renal disease, hepatic acidosis, alcoholics.
* Monitor renal function.
* Treatments (in order):
1. Lifestyle modification. Weight loss. Try for 3-6 months.
2. Start metformin 500mg-2,000mg/24hr.
3. Sulfonylurea (Glucotrol) or other oral.
4. Insulin.
Insulins
Rapid acting: covers 1 meal at a time. (lispro, asparat or glulisine)
* Short acting: from meal to meal. (regular)
* Intermediate: from breakfast to dinner. NPH
* Long acting: once a day. Glargline
Graves disease treat with
Propylthiouracil (PTU) and
methimazole (Tapazole).
Hashimoto
levothyroxine
Aces and ARBS
ACEIs “…prils” (benazepril, enalapril, lisinopril)
* & ARBs “…sartan” (losartan, valsartan)
* Blocks conversion of angiotensin I to II.
* DM and CKD drugs of choice.
* WARNING: category C.
* SE: dry cough, hyperkalemia, angioedema.
* Contraindicated: kidney disease (mod to severe), hyperkalemia.
* Ramipril, Benazepril, Enalapril.
Beta blockers
Beta Blockers “…olol”
* WARNING: wean slowly with chronic use. May cause
rebound HTN.
* Contraindicated: asthma, COPD, chronic bronchitis, emphysema.
* Other uses: decrease mortality during acute MI, post MI, migraine HA, decrease IOP in glaucoma, angina pectoris.
* Metoprolol, atenolol, propranolol.
* Propranolol is also used for fine tremors.
Calcium Channel Blockers “…pine”
Systemic vasodilator.
* Treatment for Raynaud’s.
* Blocks voltage-gated calcium channels in cardiac smooth muscle and blood vessels.
* SE: HA (due to vasodilation), ankle edema.
* Contraindication: CHF.
* Nifedipine, amlodipine, verapamil, diltiazem.
Hydrochlorothiazide (HTZ)
Diuretic
* It can treat high blood pressure and fluid retention.
* ⬆urine output,⬇blood volume,⬇venous pressure,⬇preload.
* Favorable effects for osteopenia and osteoporosis.
* Favorable for women in menopause (demineralization).
* Monitor lipid profile.
* WARNING: can worsen
* Hyperglycemia
* Hyperuricemia (don’t use in gout)
* High triglycerides
* High cholesterol
Preferred 1st line drug to tx HTN in DM and pts. with mild to moderate renal disease:
Aces and ARBS
Alpha-1 blockers/antagonists “…zosin”
Potent vasodilators.
* SE: dizziness, hypotension.
* Take at bedtime.
* Terazosin, Doxazosin, Tamsulosin (Flomax) for BPH
Common side effects
Cough + angioedema ➡ ACEIs
* Swollen ankle, HA ➡ CCB
* Hyperuricemia, hyperglycemia ➡ TZD
* Fatigue, depression ➡ BB
Dog bites treat with
augmentin for 10 days
Imeptigo give
mupirocin
RMSF treat with
Doxy
Purulent cellulitis tx
BCD
Bactrim, clindammycin, doxy
non purulent cellulitis tx
keflex (cephalexin)
folliculits tx
bactroban
Erysipelas (strep infection):
PCN or macrolide
Otitis media tx
amoxicillon if allergic augmentin
Otitis externa tx
quinolones (cipro)
Pneumonia tx
amoxicillin 90
Meds safe in pregnancy:
PCN, metformin, cephalosporins, Tylenol, prednisone, insulin.
Meds NOT safe in pregnancy:
chemo, phenytoin (antiepileptic), tetracyclines, fluoxetine
(Prozac), paroxetine (Paxil).
Every pregnancy gets a Tdap @
3rd trimester (27-36 wks.).
Bupropion (Wellbutrin)
Antidepressant and smoking cessation aid.
* No potential for abuse
* Energizing, used to ⬆ libido.
* Don’t use in bulimia (risk for seizures). It is excreted through the kidneys. Risk of toxicity due to recurrent dehydration and electrolyte disturbance.
Osteoarthritis
1st line tx: exercise, weight loss, ice packs, acetaminophen.
* 2nd line tx: NSAIDS. Short term. 2-4 weeks trial with max dose.
* If no relief, refer for steroid injections
UTI: >100,000 CFU/ml
Uncomplicated: 3-day, trimethoprim-sulfa (Bactrim), nitrofurantoin.
* Complicated: cipro
* Pyridium used to relieve symptoms changes urine to orange.
INr
Desired range 2-3.
* INR ⬆: blood cots more slowly than desired. Risk for bleeding.
* INR ⬇: blood clots more quickly than desired. Risk for blood clots.
* Warfarin/Coumadin: vitamin K antagonists: works against the clotting process. (anticoagulant)
* Warfarin interacts with “G” herbs: garlic, ginger, gingko, ginseng & fish oil.
* Discontinue anticoagulation therapy 7 days before invasive procedure.
*Initial treatment is usually 3 months, but it may vary depending on patient.
*Initial daily dose is 5mg, for frail elderly start at 2.5mg.
Spironolactone induces
gynecomastia by decreasing testosterone production, increasing peripheral conversion of testosterone to estradiol, and displacing estradiol from sex hormone-binding globulin.
Misc
Never give Doxy <7 years of age.
* With the elderly start low and slow.
* Statins (Lipitor, Crestor) don’t ever mix with grapefruit juice.
* 1ST line tx strep throat: penicillin. If allergic, Macrolide.
* Gout: NSAIDS Indocin, colchicine for flare up. Allopurinol for long term management.
* Only two methods of contraception that do not contain hormones are condoms and copper T.
* Bisphosphonates: warning with erosive esophagitis, abdominal pain.
* Take alone, in the AM, full glass water, stay up right 30min post taking it.
Bacterial vaginosis tx;
Metronidazole.
Candida Vaginitis tx:
Metronidazole, Diflucan.
Trichomonas tx
Metronidazole *tx partner too.
Chlamydia tx:
Doxy or Azithromycin *tx partner too.
Sexual health
Gonorrhea tx: Ceftriaxone 500mg IM x 1.
* Syphilis tx: Penicillin.
* Condyloma Acuminata tx: (genital warts, HPV) Condylox, Imiquimod.
