Pharmacology Flashcards
Drugs to monitor
Warfarin (INR)
Digoxin (digoxin level, EKG, electrolytes)
Theophylline (blood levels)
Carbamazepine and phenytoin (blood levels)
Levothyroxine (TSH)
Lithium (blood levels, TSH => risk of hypothyroidism)
Safety–PPI’s
Specifically, omeprazole
Increased risk of fractures (postmenopausal women), pneumonia, Cdiff, hypomagnesemia, B12 and iron malabsorption, atrophic gastritis, kidney disease
Interacts with warfarin, diazepam, carbamazepine, phenytoin, ketoconazole
Safety–warfarin
Interacts with “G” herbs–garlic, ginger, gingko, and ginseng, as well as feverfew, green tea, and fish oil
DC 7 days before surgery
Safety–TZD’s
Specifically, pioglitazone (Actos)
Cause or exacerbate CHF; do NOT use in NYHA Class III or IV HF
DC if causes dyspnea, weight gain, cough (HF)
Safety–atypical antipsychotics
Specifically, risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel)
High risk of weight gain, metabolic syndrome, and type 2 DM; monitor weight Q3 months
Monitor TSH, lipids, weight/BMI
Safety–bisphosphonates
Specifically, alendronate (Fosamax), risedronate (Actonel)
Erosive esophagitis, abdominal pain, stop immediately if symptoms of esophagitis or jaw pain (osteonecrosis); take FIRST thing in the morning alone before breakfast
Contraindications: Active GI disease, CKD, esophageal stricture/varices
Safety–statins
Specifically, atorvastatin (Lipitor), lovastatin (Mevacor), rosuvastatin (Crestor), simvastatin (Zocor)
Do NOT mix with grapefruit juice
If mixed with azole antifungals, drug-induced hepatitis or rhabdomyolysis
High-dose Zocor (80mg) has highest risk of rhabdomyolysis
Chinese descent: higher risk myopathy when taking Zocor 40mg or higher with niacin
Creatine kinase level goes up
Safety–Lincosamides
Specifically, clindamycin
Increased risk of Cdiff
S/sx digoxin overdose
Anorexia, N/V/abd pain, arrhythmias, confusion, visual changes (yellowish green tinged-color vision, scotomas
Labs to order if digoxin overdose suspected
Digoxin level, electrolytes, creatinine, serial EKGs
Avoid ____ with ACEI/ARBs
Potassium supplements; careful with potassium-sparing diuretics
Avoid ____ with potassium-sparing diuretics
ACEI, ARBs (hyperkalemia), high potassium diet, salt substitutes, chronic NSAIDs
Gynecomastia may occur
Beta blockers contraindicated if
Patient has chronic lung disease
Do not mix PDE5 inhibitors (Viagra) with
Nitrates and some alpha-blockers
Do not give within 3-6 months of MI, stroke
Celexa max dose adult, and elderly
Adult: 40 mg/d (can prolong QT interval)
>60 years: 20 mg/day
Sources of vitamin K besides dark greens
Mayonnaise, canola oil, soybean oil
Thiazide adverse effects
Hyperglycemia, increases cholesterol/LDL, increases uric acid, hypokalemia
Loop diuretic adverse effects
Low potassium, sodium, magnesium, chlorine; hypovolemia and hypotension; pancreatitis, jaundice, and rash; ototoxicity
Beta blocker adverse effects
Bronchospasm, bradycardia, depression, fatigue, erectile dysfunction, blunts hypoglycemic response, HF
CCB adverse effects
Headache, peripheral edema, bradycardia, HF and heart block, hypotension, QT prolongation, constipation
Alpha-blockers adverse effects
Orthostatic hypotension (why it’s taken at night), dizziness, syncope, priapism
DO NOT GIVE DURING CATARACT/GLAUCOMA SURGERY
Expired tetracycline pills need to be thrown away bc
They degenerate and can cause nephropathy or Fanconi syndrome (disorder of kidney tubule)
Macrolide contraindications/drug interactions
Myasthenia gravis (respiratory depression)
Warfarin, antacid, CCBs, amiodarone, benzos, salmeterol, theophylline, anticonvulsants, ergotamine, statins
1st generation cephalosporin
Keflex PO QID
Pregnancy: UTI
Skin: cellulitis, impetigo
