Random stuff Flashcards
What are the drugs of choice for hyperthyroidism during pregnancy?
Thioamides (PTU and methimazole) are the drugs of choice during pregnancy
The choice depends on the trimester in which the drug is initiated.
-Methimazole is preferred to PTU except during the 1st trimester
What drug is Xultophy?
Long-acting insulin and GLP1 agonist combined
Insulin degludec + liraglutide
What QTc intervals do you start thinking about medication adjustment?
Men > 440
Women > 470
What symptoms of hypoglycemia are not masked by B-Blockers?
Sweating and hunger
Common drugs that can cause hypothyroidism?
I TALC
Interferons
Tyrosine kinase inhibitors (sunitinib)
Amiodarone
Lithium
Carbamazepine
Conditions: Hashimoto’s Disease
What is a normal TSH range? Is it high or low in hypothyroidism? What about T4?
TSH is high in hypothyroidism and normal range is 0.3-3 mIU/L
Low free T4 with normal being 0.9-2.3 ng/dL
What is the full replacement dose of levothyroxine?
1.6 mcg/kg/day in IBW
Comon drugs that cause drug-induced lupus erythematosus (DILE)
My Pretty Malar Marking Probably Has A TransIent Quality
Methimazole PTU Methlydopa Minocycline Procainamide Hydralazine Anti-TNF agents Terbinafine Isoniazid Quinidine
How long can it take to see maximum benefit from chronic treatment for SLE? What are the common drugs used?
Can take up to 6 months
HCQ, cyclophosphamide, azathioprine, mycophenolate mofetil, and cyclosporine are all options for chronic treatment
**HCQ only one that has FDA approval for SLE indication
Belimumab is a newer drug approved for SLE
What is Glatiramer acetate used for and what is the brand name? How often dosed? Main side effects
Copaxone and is used in multiple sclerosis
Chest pain, injection site reaction, flushing, dyspnea
Preferred agent in pregnancy
20mg SC QD or TIW
What drug is commonly used for prevention of Raynaud’s phenomenon?
CCB nifedipine is commonly used for prevention but other CCBs can be used (vasodilation to improve blood flow)
Other drugs: iloprost, topical nitroglycerin and PD5i
Drugs that can worsen Raynaud’s?
Beta-blockers
Bleomycin, cisplatin
Sympathomimetics (from vasoconstriction): amphetamines, sudafed, illicit drugs
What is the main treatment for myasthenia gravis? What are side effects of this drug?
Pyridostigmine (Mestinon) is the mainstay of treatment and it is a cholinesterase inhibitor that blocks the breakdown of Ach which improves neuromuscular transmission
Contraindications: mechanical intestinal or urinary obstruction
warnings: cholinergic effects (salivation, lacrimation, excessive urination, diarrhea)
What is the dominant hormone that triggers ovulation? What is the dominant hormone for the rest of the 14 day phase?
LH triggers ovulation and then progesterone is the dominant hormone during the rest of ovulation
Ovulation kits test for LH in the urine and if it is high then person is most fertile
Why is drospirenone used?
Unique progestin used in COCs to reduce adverse effects commonly seen with oral contraceptives
It is a mild potassium-sparing diuretic which decreases bloating, PMS symptoms and weight gain, less acne
Progestin only pills contain no estrogen and why would they be used?
Primarily used in women who are lactating because estrogen decreases milk production
Require much better adherence and must be taken within 3 hours of the scheduled time
When should you avoid a contraceptive patch?
Higher systemic estrogen exposure DO NOT use in anyone with clotting risk
Less effective in women > 198 lbs or BMI > 30
Do NOT use in women >35 yo who smoke
What contraindication with raloxifene? What is the brand name?
CI with history or current VTE/pregnancy
Evista brand name
What are warnings with calcitonin and CI? what is brand name? Is it used for osteoporosis?
Rarely used for osteoporosis and other agents more effective
Warnings: Hypocalcemia, increased risk of malignancy with long term use, hypersensitivity reactions to salmon derived products
Keep the unopened product in the refrigerator
What is the MOA of teriparatide? How long can you use it for? What are the side effects?
Analog of human parathyroid hormone which stimulates osteoblast activity and increases bone formation
Used to treat osteoporosis when there is very high risk of fracture (previous history of vertebral fracture)
Due to safety issues, cumulative lifetime treatment duration is limited to 2 years or less
Boxed warning: Osteosarcoma (bone cancer)
Warnings: Hypercalcemia, caution with urinary stones
Side effects: Arthralgia, leg cramps, nausea, orthostasis/dizziness
Protect from light and daily SC injection
What is the MOA of denosumab and brand name? How often is it dosed? What are the CI and warnings/side effects?
Prolia is a RANKL inhibitor that binds to RANKL and blocks its interaction with RANK (a receptor on osteoclasts) to prevent osteoclast formation which leads to decreased bone resorption and increased bone mass
60mg SC every 6 months
CI: Hypocalcemia (correct before using); pregnancy
Warnings: ONJ, atypical femur fractures, bone pain, hypocalcemia, infections
Sie effects: Hypertension, fatigue, edema, dyspnea, headache, N/V/D, decreased PO4
What is better to take with PPI, calcium carbonate or citrate?
Calcium citrate is better if using PPI
What is the most effective treatment for vasomotor symptoms of menopause? When are local products preferred?
Systemic hormone therapy with estrogen is the most effective due to causing a decrease in LH and more stable temperature control and improves bone density
Local estrogen products are preferred for patients who have vaginal symptoms only
When treating menopause with estrogen, do you have to use progesterone?
Women with a uterus should use in combination with a form of progesterone (progestin). Unopposed estrogen increases the risk of endometrial cancer
What are the criteria for use of hormone therapy with menopause?
Healthy, symptomatic women who are within 10 years of menopause, <=60 years of age and have no CI to use
Extending treatment beyond age 60 may be acceptable (patient has osteoporosis) if the lowest possible dose is used and woman is advised of safety risk
Patients with risk factors (blood clots, heart disease, breast cancer) should use non-hormonal treatments (SSRIs, SNRIs, gabapentin, pregabalin)
What are the typical starting dose for Viagra and Cialis? When do you dose reduce and by how much?
sildenafil (Viagra) 50mg QD and tadalafil (Cialis) 10mg QD starting doses
Reduce by 50% if >65 yo, using alpha blocker, using CYP3A4 inhibitor, severe liver/renal disease
It is an absolute CI to use nitrates or riociguat with PDE-5 inhibitors. How long must you wait to use nitrate if you have angina and have taken a PDE-5 i?
Short-acting nitroglycerin should not be used until after 24 hours for sildenafil or vardenafil and after 48 hours for tadalafil
Selective alpha-1 blockers have less side effects than non-selective. What drugs are what? What is a common side effect of these drugs?
Non-selective: Terazosin, doxazosin
Selective: Tamsulosin (Flomax), alfuzosin, silodosin)
Alpha receptors are on the iris dilator muscle of the eye so most of these patients will have a floppy iris syndrome during cataract surgery
Explain the different types of urinary incontinence
Urge, stress, mixed, functional, overflow
Urge: sudden and unstoppable urge to urinate. Associated with neuropathy
Stress: Urine leaks out during any form of exertion
Mixed: a combination of urge and stress
Functional: No abnormality in the bladder, but patient may be cognitively or physically impaired thus hindering access to toilet
Overflow: Leakage that occurs when quantity of urine stored in bladder exceeds capacity. Often occurs without urge to urinate (BPH most common cause)
What is first line treatment for urge incontinence and mixed?
Anticholinergics (oxybutynin) or Beta-3 agonists (Mirabegron)
What is first line treatment for stress incontinence?
Lack of effective options and not FDA approved
Sudafed and duloxetine
are extended release or immediate release preferred for antimuscarinics for incontinence and why? What drugs are selective for M3 and why are they better?
ER due to lower risk of dry mouth
Solifenacin (Vesicare) is selective for M3 so less CNS side effects than non-selective such as oxybutynin (ditropan)
What temperature should you seek urgent care for a child aged:
<3 months
3-6 months
>6 months
<3 months with temp of 100.4 F rectal
3-6 months with temp of 101 F rectal
> 6 months with temp of 103 F rectal
What is the pediatric dose for tylenol and motrin?
Tylenol: 10-15 mg/kg/dose Q4H (max 75 mg/day)
Motrin: 5-10 mg/kg/dose Q6H (max 40 mg/day)
What are the common bugs in neonate bacterial meningitis and what is first line treatment? What drug can you not use?
Bugs: GBS, E. coli, Listeria, and Klebsiella
1st line: Ampicillin + Cefotaxime OR Gentamicin
CAN NOT USE ceftriaxone because it displaces bilirubin from albumin which can cause bili brain damage
What age is it safe to use each of these drugs in pediatrics?
Codeine Tramodol Promethazine Ceftriaxone Tetracyclines
Codeine <12 Tramadol <12 Promethazine <2 Ceftriaxone 1-28 days old Tetracyclines <8
Inhaled medication order for CF?
- Inhaled bronchodilators (albuterol) to open the airway
- Hypertonic saline (HyperSal) to mobilize mucus to improve airway clearance
- Dornase alfa (Pulmozyme) to decrease viscosity of mucus to promote airway clearance (must protect this product from light and store in fridge)
- Chest physiotherapy to mobilize mucus
- Inhaled antibiotics to control airway infection
What is the difference in MOA of how Ivacaftor, Lumacaftor, Tezacaftor, and Elexacaftor work for CF?
Ivacaftor works by increasing the time the CFTR channels remain open (NOT approved for use in the homozygous F508del mutation)
Lumacaftor/Tezacaftor/Elexacaftor help correct the CFTR folding defect which increases the amount of CFTR delivered to the cell surface
-approved for use in the homozygous F508del mutation
Take all of them with high fat meal
What is the MOA of basiliximab and is it used for induction, maintance or both?
IL-2 receptor antagonist (they are on T lymphocytes) and only used for induction because it does not deplete immature T-cells so can’t be used for treatment of rejection
What is usually contained in maintenance immunosuppression for transplant?
Combination of:
1. Calcineurin inhibitor (CNI) for which tacro is first-line
- Antiproliferative agent for which mycophenolate is first line in most protocols
- With or without steroids (if low immunological risk they don’t need them)
Side effects of tacrolimus?
Increase BP Increased BG Neurotoxicity (tremor, HA, dizzy) Hyperkalemia, Hypomagnesia, HPL QT prolongation
Monitor serum electrolytes (K, Phos, Mg), renal function, LFTs,
CYP3A4 and P-gp substrate
What is unique about Belatacept?
use in EBV seropostive patients only due to highest risk of post-transplant lymphoproliferative disorder in recipients without immunity to EBV
Must treat latent TB prior to use as well
Cyclosporine DDIs?
Inhibitor of 3A4: decrease mycophenolate, increase sirolimus, everolimus, and some statins
Substrate of 3A4 and P-gp
Avoid grapefruit juice and St. John’s wart
What is azathiprine metabolized by and what is unique about it? Avoid what drugs?
Xanthine oxidase so avoid using with xanthine oxidase inhibitors (allopurinol and febuxostat)
Febuxostat is CI
When are weight loss rx drugs appropriate? When should the be d/ced?
BMI >30 or BMI >27 with at least 1 weight-related condition
-dyslipidemia, HTN, or diabetes
Should be d/ced if they DO NOT produce at least a 5% weight loss at 12 weeks
ALL are CI in pregnancy
Weight loss drugs what is Contrave, Qsymia, Orlistat
Contrave: Naltrexone/bupropion (CI in pregnancy, opioid use, HTN, seizure disorder)
Qsymia: Phenteramine/Topirimate (CI in pregnancy)
Orlistat: Lipase inhibitor that decrease absorption of fats (GI issues and need to take fat soluble vitamins and beta carotene at bedtime or >2 hours from drug)
When can you use bariatric surgery for weight loss?
BMI >40 or >35 with obesity related condition
What is the max dose of acetaminophen and ibuprofen for an adult per day? What NSAIDs are COX2 selective and why is this beneficial?
Acetaminophen: 4000 mg/day (usually 650 mg Q4H)
Ibuprofen: 3200 mg/day (usually 800 mg Q6H)
COX2 selective: Celecoxib (Celebrex), Diclofenac (Voltaren), Meloxicam (Mobic) and Nabumetone
-Celebrex has sulfa allergy and highest COX2 selective
COX1 protects gastric mucosa so only blocking COX2 decreases GI side effects
What are the requirements to use fentanyl patch?
Fentanyl is not for opioid naive patients. A patient who has been on morphine 60 mg/day or equivalent for 7+ days can be converted to a fentanyl patch
What is in Norco? Dilaudid? Dolophine? Demerol? Anything unique about any of these?
Norco: Hydrocodone + Acetaminophen
Dilaudid: Hydromorphone
-risk of med error with high potency so use in opioid tolerant patients only
Dolophine: Methadone
- life threatening QT prolongation and can cause serotonin syndrome, major 3A4 substrate
- variable half life so hard to dose and can decrease testosterone
Demerol: Meperidine
- renal impairment and elderly at risk for CNS toxicity
- no longer for chronic pain only short term
- metabolite (normeperidine) is renally cleared toxic metabolite
What is a trick to remember what opioids cross-react with eachother?
They have COD or MORPH in the name except buprenorphine has NORPH instead of MORPH
Codeine, Morphine, Hydrocodone, Hydromorphone, Buprenorphine, Oxycodone, Oxymorphone
What characteristics do migraines need?
- Lasts 4-72 hours
- Has 2+ of the following: unilateral location, pulsating, moderate pain aggravated by routine physical activity
- one of the following occurs: n/v, photophobia, and phonophobia
MOA of triptans and unique things? CI?
Triptans are selective agonists for 5-HT1 receptor and cause vasoconstriction of cranial blood vessels
1st line for acute treatment and taken at first sign of migraine
CI: Cerebrovascular disease (stroke/TIA), uncontrolled HTN, ischemic heart disease, use within 24 hours of another triptan
Sumatriptan (Imitrex), Zolmitriptan (Zomig)
MOA of ergotamine drugs and unique things? CI? What are these drugs used for and what is the name of it?
Ergotamine is a nonselective agonist of serotonin receptors which causes vasoconstriction. If patient has CI to triptan, these can be used next line
Dihydroergotamine (D.H.E. 45, Migranal)
CI: Potent 3A4 inhibitors (PI, azoles, macrolides) due to serious peripheral ischemia). uncontrolled HTN, pregnancy, ischemic heart disease
When would you consider a prophylactic drug for migraines? What are these drugs? How long should you give a trial of them for?
If they use acute treatment 2+ days/week or 3+ times/month, if the migraine decreases their QOL, or if acute treatments failed/CI
Many drugs that are all about the same efficacy and should give trial of 2-6 months
Propranolol Topiramate Amitriptyline Venlafaxine Calcitonin Gene-Related Peptide Receptor Antagonists (CGRP) such as Aimovig, Ajovy, Emgality) Botox only if 15+ migraines/month
Most common side effects with 5-HT3 antagonists (Zofran)?
Headache and constipation
Most common side effects with dopamine receptor antagonists (Prochlorperazine, Promethazine, Metoclompromide, Olanzapine)
Promethazine: Do NOT use in children <2 yo
Metoclopramide: Tardive dyskinesia (TD) that can be irreversible
Sedation, lethargy, acute EPS, can decrease seizure threshold
What is the maximum daily dose of loperamide for chemo induced diarrhea (CID)? What are common chemo drugs that cause this?
24 mg/day
Irinotecan, Fluorouracil, Capecitabine
What drugs commonly are vesicants in cancer? If extravastation occurs what do you do?
Anthracyclines and Vinka Alkaloids
Cold compress for anthra and warm compress for vinka and can use antidotes
Anthra: Dexrazoxane
Vinka: Hyaluronidase
What is 1st line treatment for breast cancer if premenopasual/post?
Premen: Tamoxifen (SERM, estrogen antagonist in breast cells)
-Tamoxifen is a prodrug metabolized by CYP2D6 (Fluoxetine/Paroxetine are 2D6 inhibitors so avoid and use venlafaxine if needed for hot flashes/night sweats)
Postmen: Aromatase inhibitor
Warnings and side effects of SERMS? (Tamoxifen/Fulvestrant)? What about aromotase inhibitors (Anastrazole)
Increase risk of uterine or endometrial cancer and increase risk of thromboembolic events
Do not use with warfarin or history of DVT/PE
Hot flashes, vaginal bleeding, vaginal discharge, dryness, decrease libido, decrease bone density, need vitamin D/calcium
Tamoxifen is teratogenic
ANastrazole: High risk of osteoporosis and higher risk of CVD compared to SERMS
What are the main side effects with Cisplatin?
Highest incidence of nephrotoxicity and chemo induced N/V
Doses > 100 mg/m2/cycle higher risk of side effects and peripheral neuropathy
All require renal dose adjustments for platinum based agents
What is the lifetime dose for doxorubacin and why does it matter?
Lifetime max dose cumulative 450-550 mg/m2 because of cardiotoxicity
Monitor LVEF before and after treatment
What is the issue with bleomycin and what drug class?
Max lifetime dose of 400 units due to pulmonary toxicity risk
Topo 2 inhibitor that block coiling/uncoiling of DNA during G2 phase and cause strand breaks
Major side effects of vincristine? or vinka alkaloids
Peripheral neuropathy as a class
vinCristine associated with more Cns toxicity
vinBlastine with more Bone marrow suppression
What is the MOA of 5-FU or Fluorouracil? What is a similar drug? What is unique? What side effects?
5-FU is a pyrimidine analog antimetabolite and inhibits pyrimidine synthesis during the S phase (F-UMP incorporated into RNA and inhibits cell growth)
-Leucovorin is given with 5-FU to increase the efficacy
Capecitabine is an oral prodrug of 5-FU
Hand/foot syndrome, diarrhea, and mucositis common side effects
Methotrexate what is the MOA? Common side effects? Unique?
Methotrexate interferes with folate synthesis
side effects: Renal damage, hepatoxicity if chronic use, GI toxicity, teratogenic, nephrotoxicity, n/v
High dose methotrexate (>500 mg/m2) requires leucovorin rescue
Hydration + IV sodium bicarbonate must be given to alkalinize the urine and decrease risk of nephrotoxicity
Generic name for Zyvox? Lexapro? Inderal?
Zyvox= Linezolid
Lexapro= escitalopram
Inderal= propranolol
What benzos undergo conjugation and are safest in elderly? there is a mnemonic what is it?
LOT
Lorazepam (Ativan)
Oxazepame
Temazepam (Restoril)
What antidepressants have high risk of withdrawal and need to be tapered? What drug has a long half-life and DOES NOT need to be tapered? What are the most activing and sedating? What ones inhibit 2D6?
Paroxetine and venlafaxine carry high risk of withdrawal due to very short half lifes
Fluoxetine has a very long half life and self tapers itself
Fluoxetine take in am due to activating
Paroxetine take in pm due to sedating
Flu/Dul/Paroxetine inhibit 2D6
What side effects are unique to SNRIs that SSRIs don’t have?
due to NE increase you can get increased BP, dry mouth, excessive sweating, and constipation
increased BP which risk is highest with venlafaxine when dosed >150 mg/day
Tricyclic antidepressants side effects and which ones cause more? Names?
Secondary amine: Nortriptyline (Pamelor) is more selective for NE and less side anticholinergic side effects
Tertiary amine: Amitriptyline (Elavil) has more side effects like sedation and weight gain
What is the MOA of Bupropion? Side effects? CI?
Bupropion is a dopamine and NE inhibitor
CI: seziure disorder, history of anorexia
Side effects: dry mouth, CNS stimulation, tremors, weight loss
What is Phenelzine? Isocarboxid? Tranylcypromine?
all MOA inhibitors
MOA of mirtazapine? Brand name? Side effects?
Remeron is tetracyclic and has alpha 2 antagonist effects
Side effects: Sedation (often used to help with sleep) and increases appetite so helps with weight gain
What antidepressant is preferred if there is cardiac/QT risk involved with the patient?
Sertraline is preferred
Citalopram/escitalopram not great
Why do parkinson patients experience hallucinations or delusions?
Parkinson medications increase dopamine in the brain which relieves the motor symptoms but this increase in dopamine can trigger hallucinations/delusions
What do antipsychotic drugs do?
They block dopamine receptors which decreases dopamine and helps control psychosis
- better at controling positive symptoms
- harder to treat negative symptoms (lack of motivation)
What are first generation antipsychotics? CI? Side effects?
Chlorpromazine, Haloperidol
CI: Elderly patients with dementia related psychosis increase risk of death with these meds
warnings: QT prolongation, orthostasis/falls, anticholingergic, CNS depression, EPS, hyperprolactinemia, neuroleptic malignant syndrome
side effects: Sedation, dizzy, anticholingergic, EPS,
What are second generation antipsychotics? CI? Side effects? Difference from first gen?
Block serotonin unlike FGA so less EPS
Aripiprazole, Clozapine, Lurasidone, Olanzapine (Zyprexa), Quetiapine (Seroquel), Risperidone, Ziprasidone
Somnolence, metabolic syndrome common side effects
For bipolar disorder what is first line treatment for an acute manic episode? acute depressive ? What is the best drug to treat bipolar disorder if pregnant?
Acute manic: Valproate, lithium,
Acute depressive: lithium but lamotrigene can work
Pregnant: Lamotrigine is safest option
What is the therapeutic trough goal for lithium? Side effects? What can alter levels in the body? what drugs?
Trough goal 0.6-1.2 mEq/L
Side effects: GI upset, cogwheel rigidity, tremor, thirst, polyuria, weight gain, hypothyroidism
trough >1.5 : ataxia, tremor, vomiting
trough > 2.5 : CNS depression, arrhythmia, seizure, coma
Need to keep salt levels consistent if you increase salt then you decrease lithium, or visa versa
Drugs: ACE inhibitors and thiazide diuretics increase sodium loss therefor decreasing salt intake so that willl increase lithium levels
What drug helps treat central diabetes insipidous?
Desmopressin which will help decrease urine volume that is increased in this disease
What is a good treatment for SIADH?
Tolvaptian which is an antidiuretic analog
What is the dose of ceftriaxone for meningitis for adult patients? Neonates? Infants and children?
Adults: 4g/day divided into 2g Q12H
Neonates: DO NOT use cuz of biliary sludging
Infants/Children: 80-100 mg/kg/day (12-24 H dosing)
What are the 2 cefs for anaerboic coverage? brand and generic name of both
Cefoxetin (Mefoxin) 2nd gen and one of the only IV cefs to give anerobic coverage
The TAN FOX eats anerboes (Cefotetan: Cefotan OR Cefoxetin: Mefoxin) are the only cefs for anerobic
What is first line treatment for neurosyphillis?
IV Pen G aqueous `
What is the recommended starting dose for Vyvanse?
30mg QAM unless they have a pyshiatric disorder such as anxiety than 10-20mg QAM
What is the MOA of restless leg syndrome? What is the primary treatment?
RLS is thought to be a dysfunction of dopamine in the brains basal ganglia so primary treatment is dopamine agonists
Pramipexole (Mirapex) and Ropinirole (Requip) are first line dopamine agonists and use IR for RLS and ER for parkinson disease
What is Sinemet? What is unique? What is it used for?
Sinemet is levodopa/carbidopa and is used to improved movement in PD
Carbidopa helps prevent the peripheral metabolism of levodopa (prodrug of dopamine)
-need 75-100mg of carbidopa to inhibit dopa decarboxylase
Usual pill comes in 25/100 mg TID
What are COMT inhibitors and what are they used for?
COMT inhibitors increase the duration of action of levodopa by inhibiting catechol-o-methyltransferase
Entacapone
ONLY used with levodopa at 200mg each dose
What is Amantadine used for and MOA?
Blocks dopamine reuptake and is primarily used to treat dyskinesias associated with peak-dose carbidopa/levodopa
What is the mainstay of treatment in alzheimer’s disease? Class and drugs? When are they taken?
Acetylcholinesterase inhibitors (Donepezil, Rivastigmine, Galantamine) are the mainstay of treatment
Used alone or with memantine in more advanced stages
Donepezil is taken at bedtime due to potential for nausea but can be moved to morning if insomnia is a concern
What is the treatment algorithm for status epilepticus?
0-5 min is the stabilization phase: Time it, if BG low treat it
5-20 min is the initial treatment phase: If seizure continues give IV lorazepam (Ativan)
-alternatives if IV unavilable (IM midazolam (Versed) or rectal diazapam)
20-40 min is the second treatment phase: If seizure continues give regular AED such as IV fosphenytoin, valproic acid, or keppra
What drug is used for absence seizures?
Ethosuximide
Side effects of lamotrigine? Brand name? Starting dose? DDI?
Lamictal starting dose of 25mg QD weeks 1 and 2 and increase Q2 weeks until 300-400mg QD
side effects: SJS, alopecia (supplement selenium/zinc), N/V
DDI: Valproic acid increase lamotrigine 2-fold
-carbamazepine, phenytoin, lopinavir, rifampin all decrease lamictal concentrations by 40%
Topiramate side effects? Brand name? DDIs?
Topamax
Side effects: metabolic acidosis, reduce perspiration, kidney stones, angle-closure glaucoma, hyperammonemia, visual problems, fetal harm, somnolence, weight loss, anorexia, electrolytes
DDI: inducer of 3A4 and can decrease oral contraceptive effectiveness and can decrease INR
Phenytoin brand name and side effects? DDIs?
Dilantin therapeutic range is 10-20 mcg/mL (total) and 1-2.5 mcg/mL (free lvl)
IV admin rate should not exceed 50 mg/min if given faster cardiac arrhythmias can occur
Extravasation leading to purple glove syndrome
Avoid in HLA-B*1502 and if reactions to carbamazepine
Side effects: Nystagmus, ataxia, diplopia/blurred vision, gingival hyperplasia, hair growth, hepatoxicity
DDIs: Strong inducers of several enzymes (2B6, 2C19, 2C9, 3A4, P-gp, UGT1A1)
Most AED are enzyme inducers but what is the one inhibitor and what other AED does it affect most?
Valproic acid is an enzyme inhibitor and can increase the level of lamotrigine
What should everyone on AED be supplemented with?
Calcium and vitamin D due to bone loss
Side effects of PPIs? DDIs?
Omeprazole/Esomeprazole can diminish the therapeutic effects of clopidogrel so do not use together (it is prodrug remember)
Side effects: C. diff, B12 deficiency, hypomagnesemia, bone fractures with > 1 year use
What drugs need to be stopped before a urea breath test to test for H. pylori ulcer? and how soon? What is the drug treatment if positive?
PPis, bismuth, and antibiotics need to be stopped 2 weeks prior to test to avoid false negative results
Drugs: Quadruple therapy is first line unless clarithromycin resistance is <15% then you can use triple therapy (triple therapy is amoxicillin 1000mg BIDD, clarithromycin 500mg BID, and PPI)
Take for 10-14 days:
- Bismuth subsalicylate 300mg QID
- Metronidazole 250-500mg QID
- Tetracycline 500mg QID
- PPI BID
Maintance therapy for mild disease in UC? CD?
What about for moderate/severe disease?
UC: Mesalamine (5-ASA) rectal and/or oral
-rectal steroids are for UC ONLY
CD: Oral budesonide for 3 months; after this d/c and change to thiopurine or methotrexate
Mod/severe disease:
UC: Anti-TNF agents, cyclosporine,
CD: Anti-TNF agents
When do you use dual antiplatlet therapy for SIHD (stable ischemic heart disease)? and for how long? What is another preferred drug class in SIHD?
DAPT with aspirin and plavix is used for those who have a bare metal stent (DAPT for 1 month), a drug-elutting stent (DAPT for at least 6 months), or post CABG (DAPT for 12 months)
-avoid plavix with omeprazole/esomeprazole (2C19 inhibitors)
Beta blockers are 1st line in SIDH but AVOID in prinzmetals angina (use CCBs for this)
What is preferred for STEMI? NSTEMI?
NSTEMI: Can be treated with medications alone or with CPI
STEMI: PCI is preferred approach but if cannot be done then fibrinolytics can be used
What is the drug treatment algorithm for actue ACS?
MONA-GAP-BA
Morphine, oxygen, nitrates, aspirin
GP2b3a antagonists
anticoagulants
P2Y12 inhibitors
Beta-blockers, Ace inhibitors
When are fibrinolytics used? How long do you have to use it? How fast does PCI need to be done?
ONLY USED FOR STEMI when PCI cannot be done
-fibrinolytics should be given within 30 min of arrival
PCI is preffered if it can be performed within 90 minutes (door to ballon time) or 120 min of first medical contact
What is used for long term secondary prevention of ACS?
Apsirin
Clopidogrel for 12 months
Beta-blocker
ACEi
Aldosterone antagnoist
Statin
What NSAID has the lowest cardiovascular risk?
Naproxen
What are the only beta blockers rec for heart failure?
Bisoprolol, carvedilol, and metoprolol succinate
Potassium chloride 10% and 20% is what meq/ml in oral solution?
10% = 20 mEq/15 mL
20%= 40 mEq/15 mL
What is the only drug approved for acute treatment of a confirmed acute ischemic stroke?
Alteplase administered within 3 hours of symptom onset and within 4.5 hours of select patients
-max dose of 90 mg
What factors does warfarin inhibit? UFH? Direct thrombin inhibitors?
Warfarin- 2, 7, 9, 10 and C/S
UFH and LMWH (enoxaparin, dalteparin)- 10 more than 2 for LMWH and equal 10/2 for UFH
Direct thrombin (Argatroban, dabigatran)- 2
What CHAD-VASc score do you use DOACs for stroke prevention in afib?
CHAD-VASc 2+ for men and 3+ for women use DOACS for stroke prevention in afib
What is the heparin dose for prophylaxis of VTE? Treatment of VTE? What about treatment of ACS/STEMI? WHen do you check aPTT or anti-Xa levels?
Prophylaxsis of VTE: 5,000 units SC Q8-12H
Treatment of VTE: 80 units/kg IV bolus, followed by 18 units/kg/hr
Treatment of ACS/STEMI: 60 units/kg IV bolus (max 4000 units), followed by 12 units/kg/hr (max 1000 units/hr)
aPTT/Anti-Xa levels: Check 6 hours after initiation and every 6 until therapeutic
Enoxaparin dosing for prophylaxis of VTE? Treatment of VTE/NSTEMI? Treatment of STEMI?
Prophylaxsis of VTE: 30mg SC Q12H or 40mg QD
Treatment of VTE/NSTEMI: 1mg/kg Q12H or 1.5 mg/kg QD
STEMI treatment: 30mg IV bolus + 1 mg/kg Q12H
-if >75 yo no bolus dose and 0.75 mg/kg Q12H
Eliquis dosing for afib and for DVT?
apixiban 5mg BID for afib
DVT: 10mg BID x 7d then 5mg BID
Xarelto dosing for afib and DVT?
Rivaroxaban 20mg QD for afib (doses >15mg must be taken with food)
DVT: 15mg BID x 21d then 20mg QD
What is the only IV ACEi?
Enalaprilant
