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NAPLEX BABY > Pharmacy Foundations 1 > Flashcards

Pharmacy Foundations 1 Flashcards

1
Q

what happens with chelation and what drugs do you want to separate from them?

A

-occurs when a drug binds to polyvalent cations (Mg++, Ca, Fe++) in another compound (antacids or iron supplements) –> passes thru the stool
-quinolones, trtracyclines, levothyroxine, and oral bisphosphonates

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2
Q

pharmacodynamics

A

the effect that a drug has on the body. the effect can be therapeutic or toxic

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3
Q

pharmacokinetics

A

the effect the body has on the drug as it goes through the ADMW processes

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4
Q

if gastrointestinal pH is Increased, aborportion will be _______

A

decreased
ex: H2RAs, PPIs (acidic) taken with itraconazole decrease the funtion of the antifungal and can lead to resistant infections

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5
Q

what are the prodrug and active metabolite pairings:

1) Capecitabine:
2) Clopidogrel:
3) Codeine:
4) Colistimethate:
5) Cortisone:

A

1) Fluorouracil
2) active metabolite
3) morphine
4) colistin
5) cortisol

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6
Q

what are the prodrug and active metabolite pairings:

6) Famciclovir:
7) Fosphenytoin:
8) Isavuconazonium sulfate:
9) Levadopa:
10) Lisdexametamine:

A

6) Penciclovir
7) Phenytoin
8) Isavuconazole
9) Dopamine
10) Dextroamphetamine

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7
Q

what are the prodrug and active metabolite pairings:

11) Prednisone:
12) Primidone:
13) Tramadol:
14) Valacyclovir:
15) Valganciclovir:

A

11) Prednisolone
12) Phenobarbital
13) active metabolite
14) Acyclovir
15) Ganciclovir

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8
Q

what effect do CYP enzyme inhibitors have?

A

DECREASE enzyme function and the ability to metabolize compounds
substrates: decrease the rate of metabolism = INCREASED serum drug levels

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9
Q

what are common CYP inhibitors involved in drug interactions? (G <3 PACMAN)

A

G: grapefruit
P: protease inhibitors (ritonavir)
A: Azole antifungals (fluconazole, itraconazole, ketoconazole, posaconazole, voriconazole, and isvuconazonium)
C: cyclosporine, cobicistat
A: amiodarone and drondarone
N: non-DHP CCBs: diltiazam, verapamil

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10
Q

What effect to CYP enzyme inducers have?

A

increase enzyme production or activity
-substrates for the enzyme will have an INCREASED rate of drug metabolism = DECREASED serum drug level
-actions: increase dose of substratecomm

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11
Q

Common CPY inducers involved in drug interactions: (PS PORCS)

A

P: phenytoin
S: smoking

P: phenobarbital
O: oxacarbazepine
R: rafampin, rifabutin, rifapentine
C: carbamazepine (also an auto-inducer)
S: st. johns wort

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12
Q

what are P-gp efflux pumps?

A

loacted in many tissue membranes where they protect against foreign substances by moving them out of critical aread
-pump out of the bod by pumping them into the gut, where they can be excreted in the stool

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13
Q

Common P-gp substrates:

A

-anticoagulants (apixaban, rivaroxaban)
-cardio drugs (digioxin, diltiazam, verapamil)
-immunosuppressants (cyclosporine, tacrolimus)
-HCV drugs: sofosbuvir
-others: (colchicine)

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14
Q

Common P-gp inducers:

A

-carbamazepine
-phenobarbital
-phenytoin
-rifampin
-St. John’s wort

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15
Q

Common P-gp inhibitors:

A

-anti-infection: clarithromycin, itraconazole, posaconazole
-cardio drugs: amiodarone, diltiazam, verapamil
-HIV drugs: cobicistat, ritonavir
-HCV drugs: ledipasvir
-others: cyclosporine

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16
Q

what is enterohepatic recycling?

A

-the recycling of a already metabolized drug- increases the duration of action of amny drugs, including some abx, NSAIDs and ezetimibe

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17
Q

DDI: amiodarone and warfarin

A

-can be used together for afib
-amiodarone inhibits multiple enzymes, including CYP2C9, which metabolizes the more potent warfarin isomer
–> dec warfarin metabolism = inc INR and bleed risk
-want to dec warfarin dose and monitor INR

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18
Q

DDI: amiodarine and digoxin

A

-can be used together for afib
-amiodarone inhibits P-gp: digoxin is a P-gp substrate –> dec digixon excretion = inc ADRs/toxicity
-both drugs: inc risk of bradycardia, arrhythmia, fatality
–> dec digixon dose by 50% if used together and monitor HR

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19
Q

DDI: Digoxin and loop diuretics

A

-can be used for HF tx
-loop diuretics dec K, Mg, Ca, Na = can worsen arrhythmias
–> digoxin toxicity risk is increased with less K, Mg and inc Ca level
(renal impairment: dec digoxin dose, freq or d/c drug)

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20
Q

DDI: statins and strong CYP3A4 inhibitors

A

-inhibitors = ritonavir, cobicistat, clarithromycin, erythromycin, azole antifungals, cyclosporine, grapefruit
-inc levels of lovastatin, simvastatin, atorvastatin = inc myopathy risk, can cause rhabdomyolysis with ARF
–> simvastatin and lovastatin are CI with strong CYP3A4 inhibitors: can use pitavastain, pravastatin, rosuvastatin

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21
Q

DDI: warfarin and CYP2C9 inhibitors and inducers

A

-inhibitors: azoles, sulfamethoxazole/trimethoprim, amiodarone, metronidazole –> INC level of warfarin
-inducers: rifampin, St. John’s wort –> DEC levels of warfarin

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22
Q

DDI: CYP3A4 inhibitors and CYP3A4 substrates (opioids, fentanyl, hydrocodone, oxycodone, methadone)

A

-dec CYP3A4 substrate metabolism will cause INC drug levels, and INC ADRs/toxicity

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23
Q

DDI: Valproate and lamotrigine

A

-valproate DEC lamotrigine metabolism and INC lamotrigine levels causing inc risk of skin reactions: SJS/TEN

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24
Q

DDI: MAOIs and drugs/foods that inc sertonin, epi, NE and DA

A

do NOT use together
-use a 2 week washout period when switching between drugs with MAOI inhibition or serotonergic properties (wait 5 weeks for FLUOXETINE)
-avoid tyramine rich foods: wine, ages cheese, dry meats

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25
Q

DDI: CYP2D6 inhibitors (amiodarone, fluoxetine, paroxetine, fluvoxamine) and CYP2D6 substrates (codeine, meperidine, tramadol, tamoxifen)

A

-dec drug substrate metabolism
-inc ADRs/toxicity
avoid using together is possible

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26
Q

DDI: CYP3A4, P-GP inhibitors and CNIs (tacrolimus, cyclosporin)/ mTOR kinase inhibitors (sirolimus, everolimus)

A

-DEC drug substrate metabolism = inc ADR/toxicity, inc BP, nephrotoxicity, metabolic syndrome etc
-avoid using together

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27
Q

DDI: antiepeliptic drugs CYP inducers and other drugs metabolized by CYP enzymes (BC)

A

-INC substrate (drug) metabolism will cause DEC drug levels
-dec drug effect with AEDs = loss of seizure control
-monitor drug levels
-if lamotrigine, use starter kit with higher levels first

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28
Q

DDI:Rifampin and CYP/P-gp substrates

A

concentration of substrate drugs will greatly decrease

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29
Q

DDI: CYP3A4 inducers and opioids that are CYP3A4 substrates (fentanyl, hydrocodone, oxycodone, methadone)

A

-inc metabolism = DEC opioid concentration –> analgesia relief will decrease

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30
Q

DDI: CYP3A4, P-gp inducers and CNIs/mTORs

A

-inc drug metabolism = dec transplant drug level and inc risk of transplant/organ rejection

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31
Q

DDI: Smoking and some antipsychotics, antidepreaasants, hypnotics, anxiolytics, caffeine, theophylline, warfarin (R-isomer)

A

-smoker who quit: when cig is stopped, drug concentrations of CYP1A2 substrates with inc = toxicity
-current smoker: CYP1A2 substrate will have dec levels

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32
Q

What drugs can cause serotonergic toxicity? (6 classes)

A
  • antidepressants: SSRIs, SNRIs, TCAs, mirtazapine, trazodone
  • MAOis
    -opioids
    -triptans
    -natural products: St. John’s wort, L-tryptophan
    -others: buspirone, lithium, dexatromethorphan
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33
Q

what are the risks of serotonergic toxicity?

A

-autonomic dysfunction: diaphoresis, N/V, hyperthermia
-AMS (akathesia, anxiety, agitation, delirum)
-neuromuscular excitation (hyperreflexia, tremor, regidity, tonic-clonic seizures)
–> avoid using serotonergic drugs together- 2 week wash out or 5 weeks with flouxetine

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34
Q

what drugs cal increase bleeding risk? (5 classes)

A

-anticoagulants (warfarin, DOACs, heprin, fondaparinux)
-antiplatelets (aspirin, clopidogrel, prasagrul, ticagular)
-NSAIDs (ibuprofen, naproxen, dicofenac, indomethacin)
-SSRI/SNRIs (citalopram, ecitalopram, fluuxetine, sertraline etc)
-Natural products (5 Gs: garlic, ginger, ginkgo biloba, ginseng, glucosamine)

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35
Q

what drugs increase the risk of hyperkalemia? (3 classes)

A

-RAAS drugs (ACE, ARBBs, aliskiren, entresto, spirinolactone, eplerenone)
-Potassium-sparing diuretics (amiloride, triamterene)
-others (KCL, CNIs, bactrim, canagliflozin)

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36
Q

what drugs can cause QT Prolongation? (7 classes)

A

-antiarrhythmics
-anti-infectives (antimalaria, azoles, lefamulin, macrolides, quinolones)
-antidepressants (SSRIs- citalopram and ecitalopram, TCAs, mirtazapine, trazodone, venlafaxine)
-antipsychotics (haloperidol, thioridazine)
-antiemetics (ondansetron, droperidol, metoclopramide, promethazine)
-oncology: (leuprolide, nilotinib, oxaliplatin)
-others: (cilostazol, donepezil, fingolimod, hydroxyzine, loperamide, methadone, tacrolimus)

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37
Q

what drugs can cause ototoxicity? (5 classes)

A

-animoglycosides (gentamicin, tobramycin, amikacin)
-cisplatin
-loop diuretics -esp rapid IV injection (furosemide, bumetanide, ethacryinic acid)
-salicylates (aspirin, salslate, magnesium salicylate)
-vancomycin

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38
Q

what drugs can cause nephrotoxicity? (6 classes)

A

-anti-infectives (aminoglycodies, amphotericin B, polymyxines, vancomycin)
-cisplantin (use amifostine (ethyol) to protect kidneys)
-calcineurin inhibitors (cyclosporine, tacrolimus)
-loop diuretics (furosemide, torsemide, bumetanide, ethacrynic acid)
-NSAIDS
-radiographic-contrast dye

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39
Q

what drugs are anticholinergic? (6 classes)

A

-antidepressants/antispychotics (paroxetine, TCAs, 1st gen antipsy)
-sedating antihistamines (diphenhydramine, brompheniramine, doxylamine, hydroxyxine, meclizine)
-centrally acting anticholinergics (benztropine, trihexyphenidyl)
-muscle relaxants (baclofen, carisoprodol, cyclobenzaprine)
-antimuscarinics (oxybutynin, darifenacin, tolterodine)
-others (atropine, belladonna, dicyclomine)

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40
Q

what drug classes interact with PDE-5 inhibitors (sildenafil, tadalafil, avanafil, vardenafil) to cause hypotension/orthostasis?

A

-CYP3A4 inhibitors
-nitrates
-alpha-1 blockers (non-selective: doxazosin, terazosin) or selective: tamsulosin)

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41
Q

Common CYP3A4 substrates (8 classes)

A

-analgesics: fentanyl, hydrocodone, methadone, oxycodone
-anticoagulants: apixaban, rivaroxaban, R-warfarin
-cardiovascular drugs: amiodarone, amlodipine, diltiazem, verapamil
-immunosuppressants: cyclosporine, tacrolumus, sirolimus
-statins: atorvastatin, lovastatin, simvastatin (ALS)
-HIV drugs: NNRTIs
-PDE-5 inhibitors: avanafil, sildanafil, tadalafil, vardenafil
-others: ethinyl

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42
Q

Common CYP3A4 inducers

A

-carbmazepine
-oxacarbazepine
-phenobarbital
-phenytoin
-rifampin
-smoking
-St. John’s Wort

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43
Q

Common CYP3A4 inhibitors (4 classes)

A

-anti-infectives: clarithromycin, erythromycin, azoles, isoniazid
-cardio drugs: amiodarone, diltiazam, verapamil
-HIV drugs: cobicistat, ritonavir, protease inhibitors)
-others: cyclosporine, grapefruit,

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44
Q

common CYP1A2 substrates

A

-theophylline
-R-warfarin

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45
Q

common CYP1A2 inducers

A

-carbamazepine
-phenobarbital
-phenytoin
-rifampin
-smoking
-St. john’s wort

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46
Q

common CYP1A2 inhibitors

A

-ciprofloxacin
-fluvoxamine

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47
Q

common CYP2C8 substrates

A

-amiodarone
-pioglatazone
-repaglinide

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48
Q

common CYP2C8 inducers

A

-phenytoin
-rifampin

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49
Q

common CYP2C8 inhibitors

A

-amiodarone
-clopidogrel
-bactrim

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50
Q

common CYP2C9 substrates

A

-S-warfarin

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51
Q

common CYP2C9 inducers

A

-carbamazepine
-phenobarbital
-phenytoin
-rifampin
-smoking
-St. John’s wort

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52
Q

common CYP2C9 inhibitors

A

-amiodarone
-fluconazole
-metronidazole
-bactrim

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53
Q

common CYP2C19 substrates

A

-clopidogrel

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54
Q

common CYP2C19 inducers

A

-carbamazepine
-phenobarbital
-phenytoin
-rifampin

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55
Q

common CYP2C19 inhibitors

A

-esomerprazole
-omerprazole

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56
Q

common CYP2D6 substrates (3 classes)

A

-analgesics: codeine, meperidine, tramadol
-antipsychotics/antidepressants
-others: tamoxifen

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57
Q

Common reference range: Calcium (Ca)

A

8.5-10.5 mg/dL
calculate corrected calcium if albumin is low
- can be increased due to calcium supps, vitamin D, thiazides diuretics
- can be dec due to long term heparin, loop diuretics, bisphosphonates, cincacalcet
–> supp Ca in preganany, osteo and with certain drugs

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58
Q

Common reference range: Magnesium (Mg)

A

1.3-2.1 mEq/L
- can be inc due to mag containing antacids and laxatives
- can be dec due to PPI, diuretics, amphotericin B, diarrhea and chronic alcohol intake

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59
Q

Common reference range: Phosphate (PO4)

A

2.3-4.7 mEq/L
- inc in CDK
-dec due to phosphate binders, foscarnet, oral calcium intake

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60
Q

Common reference range: Potassium (K)

A

3.5-5 mEq/L
-inc due to ACEi, ARB, aldosterone receptor agonists, aliskiren, canagloflozin, cyclosporine, tacrolimus, potassium supps, bactrim
-dec due to beta 2 agonists, diuretics, insulin, sodium polystyrene, sulfonate

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61
Q

Common reference range: Sodium (Na)

A

135-145 mEq/L
-inc due to hypertonic saline, tolvaptan
-dec due to carbamazepine, oxacarbazepine, SSRIs, diuretics

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62
Q

Common reference range: Bicarbonate (HCO3)

A

V: 24-30 A: 22-26 mEq/L (used to assess acid-base status
-inc due to loop diuretics, systemic steroids
-dec due to topiramate, salicylate overdose

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63
Q

Common reference range: Blood Urea Nitrogen (BUN)

A

7-20 mg/dL
-increases in renal impairment and dehydration
–> BUN: SCr ratio is used to assess fluid status and renal function

64
Q

Common reference range: Serum Creatinine (Scr)

A

0.6-1.3 mg/dL
-inc due to many drugs that impair renal function: aminoglucosides, amphotericin B, cisplatin, colistimethate, cyclosporine, loop diuretics, polymixin, NSAIDs, radioactive contrast dye, tacrolimus, vancomycin)
–> false ince can be due to bactrim, H2RAs, cobicistat
-dec with low muscle mass, ampuation, hemodilution

65
Q

Common reference range: glucose

A

70-110 mg/dL

66
Q

Common reference range: Anion Gap (AG)

A

5-12 mEq/L
-an inc anion gap suggests metabolic acidosis

67
Q

Common reference range: white blood cell count (WBCs)

A

4,000-11,000 cells/mm3
-inc due to systemic steroids, CFS, epi
-dec due to clozapine, chemotherapy, carbamazepine, immunospurants

68
Q

Common reference range: Neutrophils & Bands

A

45-73% & 3-5%
-used to calculate ANC to assess for neutropenia
-“left shift” in bands when elevated

69
Q

Common reference range: Eosinophils

A

0-5%
-inc in drug allergy, asthma, inflammation, parasitic infection

70
Q

Common reference range: basophils

A

0-1%
-inc in inflammation, hypersensitivity reactions, leukemia

71
Q

Common reference range: Lymphocytes

A

20-40%
-inc in viral infections, lumphoma
-dec in bone marrow suppression, HIV or due to systemic steroids

72
Q

Common reference range: Red Blood Cells (RBC)

A

male: 4.5-5.5 F: 4.1-4.9 x 10^6 cells/uL
-life span is 120 days
-inc due to ESAs, smoking
-dec due to chemotherapy deficiency anemias, hemolytic anemia, sickle cell anemia

73
Q

Common reference range: Hemoglobin (Hgb, Hb)

A

males: 13.5-18, f: 12-16 g/dL
-inc due to ESAs
-de in anemias and bleeding

74
Q

Common reference range: Mean Corpuscular Volume (MCV)

A

80-100 fL
–> reflects the size and average volume of RBCs
-inc (macrocytic anemia) due to B12 or folate deficiency
-dec (microcytic anemia) due to iron deficiency

75
Q

Common reference range: Folic Acid (folate)

A

5-25 mcg/L
-dec due to phenytoin/fosphenytoin, phenobarbital, primidone, methotrexate, bactrim
-supp in women of childbearing age and alcohol use disorder

76
Q

Common reference range: Vitamin B12

A

> 200 pg/mL
-dec due to PPI, metformin, colchicine, chloramphenicol

77
Q

Common reference range: Reticulocyte count

A

0.5-2.5%
–> measures the amount of immature RBCs being made by the bone marrow
-inc with blood loss and hemolysis
-dec in untreated anemia and with bone marrow suppression

78
Q

Common reference range: Coombs test

A

negative
–> used in diagnosis of immune-mediated hemolytic anemia
-drugs that can cause it include: penicillins, cephalosporines, isonaizid, levodopa, methyldopa, quinidine, rifampine and sulfonamides
* if test is +, D/C the drug

79
Q

Common reference range: G6PD

A

5-14 units/gram
–> used to determine if hemolytic anemia is due to G6PD
-triggered by stress, foods (fava beans), or drugs: dapsone, methylene blue, nitrofurantoin, pegloticase, primaquine, raburicase, quinidine, quinine, and sulfonamides

80
Q

Common reference range: Anti-Xa

A

-therapeutic doses of LMWH (4 hours after dose) 1-2- IU/mL
-therapeutic dose of unfractionated heparin (6 hours after IV infusion and q 6 hrs until therapeutic) : 0.3-0.7 IU/mL

81
Q

Common reference range: PT/INR

A

PT: 10-13 secs
INR: < 1.2 –> w/o warfarin, inc can be due to liver disease

82
Q

Common reference range: aPPT/PTT

A

22-38 seconds
-monitor unfractonated heparin: obtain q 6 hours after IV. infusion
-false inc can occur with oritavacin, telavancin

83
Q

Common reference range: Platelets (PLTs)

A

150,000-450,000 cells/mm3
–> life span of 7-10 days (bleeding can occur < 20,000 cells
-dec due to heparin, LMWH, fondaparinux, linezolid, valproic acid

84
Q

Common reference range: Albumin

A

3.5-5 g/dL
- dec due to cirrhosis and malnutrition
-phenytoin and calcium concentrations require correction with low albumin

85
Q

Common reference range: AST/ALT

A

10-40 units/L
-enzymes released from injured hepatocytes

86
Q

Common reference range: Bilirubin

A

0.1-1.2 mg/dL
-used to assess causes of liver damage and detect bile duct blockage

87
Q

Common reference range: Amylase and Lipase

A

A: 60-180 units/L
L: 5-160 units/L
-increase in pancreatitis, which can be caused by didanosine, stavudine, GLP-1 agonists, DPP-4 inhibitors, valproic acid, hypertriglyceridemia

88
Q

Common reference range: Creatinine Kinase (CK)

A

males: 55-170, F: 30-135 IU/L
-used to assess muscle damage/inflammation
-can inc due to daptomysin, statins, tenofovir, raltegravir, dolutegravir

89
Q

Common reference range: Troponin, BNP, NT-proBNP

A

T: 0-0.1 ng/mL
BNP: <100 ng/L
pro BNP: M: < 61, F: 12-151
-markers of cardiac stress –> higher values are consistant with liklihood of HF or MI

90
Q

Common reference range: LDL, HDL & TG

A

LDL: < 100 mg/dL
HDL: 40- >/= 60
TG: < 150
non-HDL = TC - HDL
–> fasting begins 9-12 hours prior to blood draw

91
Q

Common reference range: fasting glucose & A1C

A

100-125 = + for prediabetes
A1C < 7% (ADA), < 6.5% (AACE)

91
Q

Common reference range: C-reactive protein

A

0/0/5 mg/dL
-inc CRP = inflammation

91
Q

Common reference range: C-Peptide

A

0.78 - 1.89 ng/mL
–> insulin breakdown product used to evaluate beta-cell function (distinguishes between type 1 and type 2 dm)
- dec or absent in type 1 dm

92
Q

Common reference range: urinary albumin excretion (UAE)

A

< 30 mg/24 hr

93
Q

Common reference range: TSH

A

0.3-3 MIU/L
-inc = hypothyroidism, can be due to tyrosine kinase inhibitors, lithium, carbamazepine
-dec = hyperthyroidism
- inc or dec due to amiodarone, interferons

94
Q

Common reference range: Uric acid

A

M: 3.5-7 F: 2-6.5 mg/dL
-inc due to diuretics, niacin, low doses of aspirin, pyrazinamide, cyclosporine, tacrolimus

95
Q

Common reference range: CRP, RF, ESR, ANA

A

CRP: 0-0.5 (high risk = > 3 mg/dL)
RF: neg
ESR: M < 20, F: < 30 mm/hr
ANA: neg
–> used in autoimmune disorders/ inflammation
-drug induced lupus erythematosus (DILE): can be caused by anti-TNF agents, hydralazine, isonazid, methimazole, methyldopa, minocycline, procainamide, etc- drug should be D/C

96
Q

Common reference range: CD4 and viral load

A

CD4: immunocompromised state = < 200 cells
VL: undetectable

97
Q

Common reference range: pH

A

7.35-7.45

98
Q

Common reference range: Prostate - specific antigen (PSA)

A

<4 ng/mL

99
Q

Common reference range: Lactic acid

A

0.5-2.2 mEq/mL
-inc due to NRTIs, metformin, alcohol use, cyanide

100
Q

Therapeutic Drug Levels: Carbamazepine

A

4-12 mcg/mL

101
Q

Therapeutic Drug Levels: Digoxin

A

A fib: 0.8- 2 ng/mL
HF: 0.5 - 0.9 ng/mL

102
Q

Therapeutic Drug Levels: Gentamicin

A

Peaks: 5-10 mcg/mL
Troughs: < 2 mcg/mL

103
Q

Therapeutic Drug Levels: Lithium

A

0.6-1.2 mEq/L (up to 1.5)
-drawn as troughs

104
Q

Therapeutic Drug Levels: Phenytoin and free phenytoin

A

P: 10-20
FP: 1-2.5 mcg/mL

105
Q

Therapeutic Drug Levels: Procainamide, NAPA (active metabolite) & combined

A

P: 4-10
NAPA: 15-25
Combined: 10-30 mcg/mL

106
Q

Therapeutic Drug Levels: Theophylline

A

5-15 mcg/mL

107
Q

Therapeutic Drug Levels: Tobramycin

A

Peak: 5-10 mcg/mL
Tough: < 2 mcg/mL

108
Q

Therapeutic Drug Levels: Valproic acid

A

50-100 mcg/mL

109
Q

Therapeutic Drug Levels: Vancomycin

A

Trough: 15-20 (for serious infections –> pneumonia, endocarditis, osteomyelitis, meningitis, and bacteremia)
Trough: 10-15 mcg/mL for others

110
Q

Therapeutic Drug Levels: Warfarin

A

goal INR : 2-3 for most

111
Q

what informations must be included on OTC drugs?

A

1- active ingredients: indicate amount and purpose
2- uses for the product
3- specific warnings : when the drug should not be used and when it is appropriate to consult a doc
4- side effects and substances or activities to avoid
5- dosage instructions
6- the inactive ingredients

112
Q

Locating guidelines: Anticoagulation

A

-American College of Chest Physicians (CHEST)
–> stroke prevention in Afib, venous thromoembolism

113
Q

Locating guidelines: Cardiovascular diseases

A

-ACC/AHA guidelines
–> ACS, A fib, HF, high cholesterol, HTN

114
Q

Locating guidelines: Diabetes

A

-AACE, ADA

115
Q

Locating guidelines: Infectious Diseases

A

-IDSA
-HIV/AIDS: US dept of health and human services
-CDC: sexually transmitted diseases

116
Q

Locating guidelines: oncology

A

-american society of clinical oncology (ASCO)
-National comprehensive Cancer Network (NCCN)

117
Q

Locating guidelines: Pediatrics

A

the American Academy of Pediatrics (AAP)

118
Q

Locating guidelines: Pregnancy/womens health

A

The american Academy of obstetricians and Gynoc (ACOG)

119
Q

Locating guidelines: Psychiatric Conditions

A

DSM

120
Q

Locating guidelines: Pulmonary Conditions

A

-Asthma: GINA, and national heart, lung and blood institute (NHLBI)
-COPD: GOLD

121
Q

Locating guidelines: Renal Disease

A

Kidney disease improving global outcomes (KDIGO)

122
Q

Locating guidelines: Vaccines

A

ACIP, CDC

123
Q

“color” drug references: Orange book

A

FDA: list of approved drugs that can be interchanged with generics based on therapeutic equivalence

124
Q

“color” drug references: Pink Book

A

CDC: Information on epidemiology and vaccine-preventable diseases

125
Q

“color” drug references: Pink Sheet

A

Pharma Intelligence: news reports on regulatory, legislative, legal and business developments

126
Q

“color” drug references: Purple Book

A

FDA: list of biological drug products, including biosimiliars

127
Q

“color” drug references: Red Book, Pharmacy

A

drug pricing information

128
Q

“color” drug references: Red Book, Pediatrics

A

summaries of pediatric infectious diseases, antimicrobial tx and vaccines

129
Q

“color” drug references: Yellow Book

A

CDC: info on health risks of international travel, required vaccines, and prophylaxis meds

130
Q

“color” drug references: Green Book

A

FDA: inof on approved animal drug products

131
Q

Which patches must be applied twice daily?

A

Diclofenac

132
Q

Which patches must be applied daily?

A

-Methylphenidate (Daytrana) Qam, 2 hours prior to school - HIP ONLY
-Nicotine (NicoDerm CQ)
-Rivastigmine (Exelon)
-Rotigontine (Neupro)
-Selegiline (Emsam)
-Testosterone (androderm): nightly, not on scrotum

133
Q

Which patches need to be applied daily but have special instructions?

A

-Lidocaine (Lidoderm): 1-3 patched PRN, on for 12 hours, off for 12 hours
-Nitroglycerin: on for 12-14 hours, then off for 10-12 hours

134
Q

Which patches need to be applied every 72 hours?

A

-Fentanyl: !72 hr, if it wears off after 48 hours, change to Q48 hrs
-Scopolamine (Transderm Scop): Q72 hrs, PRN- behind the ear

135
Q

Which patches need to be applied twice weekly?

A

-Estradiol (Alora, Vivelle-Dot- lower abdomin)
-Oxybutynin (Oxytrol) - abdomen, hip or butt

136
Q

Which patched need to be applied weekly?

A

–Donepezil (Adlarity)
-Buprenorphine (Butrans)
-Clonidine (Catapres-TTS)
-Estradiol (Climara)
-Estradiol/Levonrgestrel
-Ethinyl estradiol/norelestromin (Xulane- back abdomen, or butt, Zafemy): weekly for 3 weeks, 1 week off

137
Q

Which patches contain metal? (aluminum)

A

-Clonidine (Catapres-TTS)
-Rotigotine (Neupro)
-Scopolamine (Transderm Scop)
-Testosterone (Androderm)
—> need to be removed before an MRI

138
Q

what are some alternative to PVC containers?

A

-Polyolefin
-Polyproopylene
-glass

139
Q

What are drugs with leaching/adsorption/absorption issues with PVC containers: Leaches Absorb To Take In Nutrients

A

L: lorazepam
A: amiodarone
T: tacrolimus
I: insulin
N: nitroglycerin

140
Q

what are some common drugs with SALINE diluent solution requirements : A DIAbetic Cant Eat Pie

A

A: ampicillin
D: daptomycin (cubicin)
I: infiximab (Remicade)
A: ampicillin/sulbactam (Unasyn)
C: caspofungin (cancidas)
E: ertapenem (Invanz)
P: phenytoin (Dilantin)

141
Q

what are some common drugs with DEXTROSE diluent solution requirements: Outrageous Bakers Avoid Salt

A

O: oxaliplatin
B: bactrim
A: amphotericin B
S: synercid - quinupristin/dalfopristin

142
Q

common drugs with filter requirements: my GAL IS PAT who has a MaP

A

G: golimumab
A: amphotericin B (lipid formualtions)
L: lipids = 1.2 microns
IS: isavuconazonium
P: phenytoin
A: amiodarone
T: taxanes (cabazitaxel and paclitaxel)
M: mannitol > 20%
P: parenteral nutrition - 1.2 microns

143
Q

drugs that need to be protected from light during administration: Protect Every Necessary Med from Daylight

A

P: phytonadione (vitamin K)
E: epoprostenol
N: nitroprusside
M: micafungin
D: doxycycline

143
Q

drugs that should NOT be refrigerated: Dear Sweet Pharmacist, Freezing Makes Me Edgy!

A

D: dexmedetomidine
S: sulfamethoxazole/Trimethoprim
P: pheytoin –> crystalizes
F: furosemide –> crystalizes
M: metronidazole
M: moxifloxacin
E: enoxaparin

144
Q

3 IV drugs that come as colored solutions

A

1: Anthracycline (doxorubicin) red –> dicolor sweat and urine
2: Rifampin- red –> discolor salivia, urine, sweat and tears
3: Mitoxantrone - blue –>discolors skin, eyes, urine

145
Q

Antidotes for Anthracycline, Vincristine Extravasation

A

-give via centeral venous catheters
Antidotes:
–> Anthracyclines: dexrazoxane (Totect) or dimethyl sulfoxide
–> Vinca alkaloids: hyaluronidase

*intrathecal admin of Vincristine is fatal

146
Q

Drugs with leaching/adsoprtion/absorption issues with PVC containers

A

LATTIN:
Lorazepam
Amiodarone
Tacrolimus
Taxanes
Insulin
Nitroglycerin

147
Q

Drugs that can only be used in SALINE

A

Ampicillin
Daptomycin (Cubicin)
Infliximab (Remicade)
Ampicillin/Sulbactam (Unasyn)
Caspofungin (Cancidas)
Ertapenem (Invanz)
Phenytoin (Diltantin)

148
Q

Drugs that can only be used in DEXTROSE

A

Oxaliplatin
Bactrim (SMX/TMP)
Amphoterericin B
Synercid (Quinupristin/Dalfopristin

149
Q

Common high-risk Incompatibilities

A

-Ceftriaxone + calcium containing solutions: risk of precipitates (common ex is mixing with Lactated Ringer)
-Calcium and phosphate: will bind together and create a precipitate that kills the patient
-Amphotericin B + sodium bicarbonate: incompatible with the majority of IV drugs
-Piperacillin/tazobactam: forms a precipitate when it mixes with acyclovir, amphotericin B and many other IV drugs

150
Q

Common drugs that REQUIRE a filter

A

Golimumab
Amphotericin B (lipid formulations)
Lipids- 1.2 microns
Isavuconazonium
Phenytoin (continuous infusion only)
Aminodarone
Taxanes (cabazitaxel, paclitaxel)
Mannitol >/ 20%
Parenteral nutrition- 1.2 microns

151
Q

IV drugs that do NOT require refrigeration

A

Dexmedetomide
Sulfamethoxazole/Trimethoprim
Phenytoin-crystallizes
Furosemide- crystallizes
Metronidazole
Moxifloxacin
Enoxaparin

152
Q

Key drugs that need to be protected from light during administration

A

Phytonadione (vitamin K)
Epopostenol
Nitroprusside
Micafungin
Doxycycline

153
Q
A

NAPLEX BABY (23 decks)

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