Pharmacotherapy Flashcards
Monitoring on methotrexate
Hemoglobin
ALT/AST
Creatinine
Monitoring on hydroxychloroquine
Routine eye exams
SE to steroids
Adrenal insufficiency
Avascular necrosis
Osteoporosis
Edema
GI ulceration
Glaucoma
Cataract
Glucose intolerance
Muscle weakness
Insomnia
Increased BP
Weight Gain
Skin Thinning
Growth Impairment
Cushingoid Appearances
Menstrual Irregularities
Change in Mood
SE of acetylcholinesterase inhibitors
Nausea
Headache
Dizziness
Fatigue/Somnolence
Insomnia
Diarrhea/Vomiting
Weight Loss/Anorexia
Bradycardia/Syncope
Seizures
Urinary Incontinence
SE of anticholinergics
Dry Mouth
Dizziness
Constipation
Somnolence
Confusion
Blurred Vision
Nausea
Urinary Retention
Which meds are stimulating (can cause insomnia)
SSRIs
Levodopa
BB
Decongestants
NRT
What advice to give a pt about to get chemo?
No live vaccines, stop smoking
AP SE
EPSEs, wt gain, hyperprolactinemia, sedation, orthostatic hypotension, sexual dysfunction, anticholinergic SE
Neuropathic pain med classes
SSRIs, anticonvulsants, cannabinoids
SE of pregabalin
dizziness, sedation, wt gain, peripheral edema, ataxia
SE of nitrofurantoin
pulmonary toxicity, peripheral neuropathy, liver toxicity
Tool for determining drug toxicity cause
Naranjo Adverse Drug Reaction Probability Score
Types of EPSEs
acute dystonia, akathisia, pseudo parkinsonism, tardive dyskinesia
Which classes do you use for rhythm control in AFib?
Class 1/ sodium channel blockers (procainamide) + class 3 antiarrhythmics/ potassium channel blocks = amiodarone
Indications for antihistamines
rhinitis, conjunctivitis, urticaria
Which population should you not use antihistamines in?
Elderly
What to assess on hx for suitability of a pt for cannabinoids?
Pain hx, MH history, SU hx
Common mistakes w/ inhaler use
not loading device properly, not exhaling before use, lack of breath hold, breathing in too fast or slow
Which pt group is SGLT2i CI in?
T1DM
What to monitor while on spironolactone?
BP, K+, Cr
SE antihistamines
sedation, cognitive impairment, psychomotor impairment
What drug classes should be avoided w/ spironolactone?
NSAIDs, trimethoprim, K+ sparing diuretics
Meds causing gynaecomastia
ACEi, CCB, aldosterone receptor antagonists, 5 alpha reductase inhibitors
What acne med in pregnancy
azeliac acid
grades of hepatic encephalopathy + what criteria used to grade
West haven criteria
1 = changes in behaviour
2 = gross disorientation, confusion, asterixis
3 = incoherent, sleepy but rousable
4 = coma
Complication of hepatic enceopahlopathy + what is the treatment
cerebral edema - rx = transplant
lactulose, rifaxamin, PEG - PO or PR (can give enema)
complications of liver disease
SBP, hepatic encephalopathy, hepatorenal syndrome, varices
rx for SBP
abx, paracentesis, albumin
hepatorenal syndrome types
Type 1 = acute deterioration in kidney function
Type 2 = chronic
hepatorenal syndrome rx
minodrine, albumin, octreotide
alcoholic hepatitis Rx
abstain from alcohol, steroids for 1 month
Treatment of varices
treat with non selective BB (carvedilol, propranolol, nadalol)
Screen for hepatocellular carcinoma q6mo
acute hep c - whats the risk of it turning to chronic hep c?
30%
acute hep b - whats the risk of it turning to chronic hep b?
5%
hep C rx
direct acting antivirals for 3mo (Epclusa)
Autoimmune hepatitis ix
anti smooth muscle antibody and anti-liver kidney antibody
Rx for OP
denosumab - rank ligand inhibitor - SC q6mo
forteo - recombinant parathyroid hormone
ralixifene - selective estrogen receptor modulator
CI to wellbutrin
sz, ED, electrolyte disturbances
Classes of antidepressants + names of each
noradrenergic specific serotinergic antidepressant (NASSA) - mirtazapine
norepinephrine dopamine rey-take inhibitor = wellbutrin
SARI - trazodone - can cause priapism
What meds are stimulating
BB, statins, ACEi, SSRIs
venous vs arterial ulcers appearance
venous are medial, swollen + discoloured, varicose veins, hx of leg swellings, hemosiderin staining
arterial are full thickness, punch out, smooth edges
tamoxifen SE
vaginal dryness, hot flashes, irritability, endometrial cancer
Aromatase inhibitor SE
OP, raised lipids, lymphedema
after breast cancer management
mammogram q1y
monthly self breast
clinic breast exam q6mo x3yrs
eGFR <30, what meds to adjust?
DOACs, warfarin, ACEi, diuretics, metformin, abx, NSAIDs, statins, BB
physical exam findings for HTN
fundoscopy, assess for bruits, peripheral pulse exam
NAFLD + NASH rx
semaglutide
Score for pancreatitis mortality + components
Bisaps score:
BUN
AMS
>2 SIRS criteria
Age >60
Pleural effusions present
New meds for IBS
Constella (guanaclase inhibitors)
Ibsrela
Vibrerzi - stomach opioid antagonist - good for diarrhoea predominant IBS
SE of levodopa
‘on’ effects (chorea), ‘off’ effects (hypokinetic)
Peripheral neuropathy causes (poly + mono)
Polyneuropathies:
vasculitis (mononeuritis multiplex)
Thiamine deficiency
heavy metal exposure
Guillan barree syndrome
DM
Neoplastic
Chemo induced
Charcot marie tooth
mononeuropathies:
carpal tunnel syndrome
bells palsy
cubital tunnel syndrome
piriformis syndrome
Parkinsonism sx
TRAP - tremor, rigidity, akathisia, postural instability
Causes of parkinsonism
haldol, maxeran, progressive supranuclear palsy, ecstasy OD, vascular, shy drager
When do you use Dopamine agonists in Parkinsonism, and whats the name?
Young pts - ropinirole, pramipexole
Alternative meds + treatment for PD
Anticholinergic - trihexyphenolil - weekly med for PD
Catecholamine o methyltransferase inhibitors -
MAOi - risegiline
Amantadine - used for terminal dyskinesias
Apo-morphine injectors - IM
Deep brain stimulation
MS drugs + classes
anti-CD20 (Ocrivus) biologics
thingolamid (anti-sphingosine agent)
Methylfumarate
clabradine + terryflunoamide (anti metabolite)
glatiramir, beta interferons (avanex)
New med for dyslipidemia
Incliseran - small interfering RNA
Caroc score for OP components
BMD (lowest T-score of hip and lumbar spine), age, gender, fracture history and steroid use
Young healthy person with normal exam with ED?
MS
Post arrest care
ensure they remain afebrile, bloodwork, support BP with pressors, establish definitive airway, discuss goals of care with family, NG for decompression, CXR to r/o pneumothorax, ?splenic laceration or liver lac
What labs to order if you are transfusing lots of blood?
calcium and coags
Entresto class + use
ARNI - naprilosyn inhibitors + valsartan in CHF
Ivabradine class
F type channel inhibitor
Bug causing gas in gangrene?
C diff
Bilateral erythema in legs causes
Stasis dermatitis, venous insufficiency, eczema, DVT, fungal infection
Cephalosporin 1st gen
Cephalosporin 2nd gen
Cephalosporin 3rd gen
Cephalosporin 1st gen
cephalexin
Cephalosporin 2nd gen
Cefuroxime
Cephalosporin 3rd gen
Ceftriaxone
CKD diagnosis based on ACR + what ACR level to refer to nephro?
ACR >2 = CKD
ACR >6 or eGFR <30 = refer to nephro
Optic neuritis in MS sx
painful, loss of colour saturation, loss of vision - episodes lasting days/ weeks
MIBI - what is it + indications
Myocardial perfusion imaging / nuclear stress test
SOBOE or chest pain w/ activity
Non stress test parameters
Considered reassuring if the fetal heart rate increases at least 15 beats per minute over the baseline (between 120 and 160 beats per minute), lasting at least 15 seconds, within a 20-minute timeframe§
Canadas food guide
½ veggies + fruit
¼ protein
¼ whole grain
Acute dissection score
High risk conditions (Marfans, aortic valve dz)
High risk pain features (chest, back, abdo, abrupt, severe, tearing)
High risk exam features (pulse deficit, focal neuro deficit, new aortic murmur, hypotension)
Apgar score
Activity (tone)
Pulse
Grimace (reflexes)
Appearance (color)
Respiration
Epi dose for peds + adults in CPR
Peds = 0.01mg/kg
Adults = 1mg
Naloxone dose for peds + adults
Peds = 0.1mg/kg
Adults = 0.4mg
Lorazepam dose for peds + adults (seizure)
Peds = 0.1mg/kg
Adults = 4mg
IV/IO
Midazolam dose for peds + adults (seizure)
Peds = 0.2mg/kg
Adults = 10mg
Keppra dose for peds + adults (seizure)
Peds = 60mg/kg
Adults = 4500mg
Amiodarone dose for peds + adults (ACLS)
Peds = 5mg/kg
Adults = 300mg then 150mg
Lidocaine dose for peds + adults (ACLS)
Peds = 1mg/kg
Adults = 1mg/kg
Atropine dose for peds + adults (ACLS)
Peds = 0.02mg/kg
Adults = 1mg
TXA dose for peds + adults (ACLS)
Peds = 15mg/kg
Adults = 1g
Dose of Mg for eclampsia
4g IV