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1
Q

What are the drugs of choice for hyperthyroidism during pregnancy?

A

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

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2
Q

What drug is Xultophy?

A

Long-acting insulin and GLP1 agonist combined

Insulin degludec + liraglutide

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3
Q

What QTc intervals do you start thinking about medication adjustment?

A

Men > 440

Women > 470

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4
Q

What symptoms of hypoglycemia are not masked by B-Blockers?

A

Sweating and hunger

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5
Q

Common drugs that can cause hypothyroidism?

A

I TALC

Interferons

Tyrosine kinase inhibitors (sunitinib)
Amiodarone
Lithium
Carbamazepine

Conditions: Hashimoto’s Disease

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6
Q

What is a normal TSH range? Is it high or low in hypothyroidism? What about T4?

A

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

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7
Q

What is the full replacement dose of levothyroxine?

A

1.6 mcg/kg/day in IBW

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8
Q

Comon drugs that cause drug-induced lupus erythematosus (DILE)

A

My Pretty Malar Marking Probably Has A TransIent Quality

Methimazole
PTU
Methlydopa
Minocycline
Procainamide
Hydralazine
Anti-TNF agents
Terbinafine
Isoniazid
Quinidine
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9
Q

How long can it take to see maximum benefit from chronic treatment for SLE? What are the common drugs used?

A

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

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10
Q

What is Glatiramer acetate used for and what is the brand name? How often dosed? Main side effects

A

Copaxone and is used in multiple sclerosis

Chest pain, injection site reaction, flushing, dyspnea

Preferred agent in pregnancy

20mg SC QD or TIW

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11
Q

What drug is commonly used for prevention of Raynaud’s phenomenon?

A

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

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12
Q

Drugs that can worsen Raynaud’s?

A

Beta-blockers

Bleomycin, cisplatin

Sympathomimetics (from vasoconstriction): amphetamines, sudafed, illicit drugs

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13
Q

What is the main treatment for myasthenia gravis? What are side effects of this drug?

A

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)

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14
Q

What is the dominant hormone that triggers ovulation? What is the dominant hormone for the rest of the 14 day phase?

A

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

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15
Q

Why is drospirenone used?

A

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

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16
Q

Progestin only pills contain no estrogen and why would they be used?

A

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

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17
Q

When should you avoid a contraceptive patch?

A

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

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18
Q

What contraindication with raloxifene? What is the brand name?

A

CI with history or current VTE/pregnancy

Evista brand name

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19
Q

What are warnings with calcitonin and CI? what is brand name? Is it used for osteoporosis?

A

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

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20
Q

What is the MOA of teriparatide? How long can you use it for? What are the side effects?

A

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

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21
Q

What is the MOA of denosumab and brand name? How often is it dosed? What are the CI and warnings/side effects?

A

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

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22
Q

What is better to take with PPI, calcium carbonate or citrate?

A

Calcium citrate is better if using PPI

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23
Q

What is the most effective treatment for vasomotor symptoms of menopause? When are local products preferred?

A

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

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24
Q

When treating menopause with estrogen, do you have to use progesterone?

A

Women with a uterus should use in combination with a form of progesterone (progestin). Unopposed estrogen increases the risk of endometrial cancer

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25
Q

What are the criteria for use of hormone therapy with menopause?

A

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)

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26
Q

What are the typical starting dose for Viagra and Cialis? When do you dose reduce and by how much?

A

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

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27
Q

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?

A

Short-acting nitroglycerin should not be used until after 24 hours for sildenafil or vardenafil and after 48 hours for tadalafil

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28
Q

Selective alpha-1 blockers have less side effects than non-selective. What drugs are what? What is a common side effect of these drugs?

A

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

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29
Q

Explain the different types of urinary incontinence

Urge, stress, mixed, functional, overflow

A

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)

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30
Q

What is first line treatment for urge incontinence and mixed?

A

Anticholinergics (oxybutynin) or Beta-3 agonists (Mirabegron)

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31
Q

What is first line treatment for stress incontinence?

A

Lack of effective options and not FDA approved

Sudafed and duloxetine

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32
Q

are extended release or immediate release preferred for antimuscarinics for incontinence and why? What drugs are selective for M3 and why are they better?

A

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)

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33
Q

What temperature should you seek urgent care for a child aged:

<3 months
3-6 months
>6 months

A

<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

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34
Q

What is the pediatric dose for tylenol and motrin?

A

Tylenol: 10-15 mg/kg/dose Q4H (max 75 mg/day)

Motrin: 5-10 mg/kg/dose Q6H (max 40 mg/day)

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35
Q

What are the common bugs in neonate bacterial meningitis and what is first line treatment? What drug can you not use?

A

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

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36
Q

What age is it safe to use each of these drugs in pediatrics?

Codeine
Tramodol
Promethazine
Ceftriaxone
Tetracyclines
A 
Codeine <12
Tramadol <12
Promethazine <2
Ceftriaxone 1-28 days old
Tetracyclines <8
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37
Q

Inhaled medication order for CF?

A
  1. Inhaled bronchodilators (albuterol) to open the airway
  2. Hypertonic saline (HyperSal) to mobilize mucus to improve airway clearance
  3. Dornase alfa (Pulmozyme) to decrease viscosity of mucus to promote airway clearance (must protect this product from light and store in fridge)
  4. Chest physiotherapy to mobilize mucus
  5. Inhaled antibiotics to control airway infection
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38
Q

What is the difference in MOA of how Ivacaftor, Lumacaftor, Tezacaftor, and Elexacaftor work for CF?

A

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

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39
Q

What is the MOA of basiliximab and is it used for induction, maintance or both?

A

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

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40
Q

What is usually contained in maintenance immunosuppression for transplant?

A

Combination of:
1. Calcineurin inhibitor (CNI) for which tacro is first-line

  1. Antiproliferative agent for which mycophenolate is first line in most protocols
  2. With or without steroids (if low immunological risk they don’t need them)
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41
Q

Side effects of tacrolimus?

A 
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

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42
Q

What is unique about Belatacept?

A

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

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43
Q

Cyclosporine DDIs?

A

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

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44
Q

What is azathiprine metabolized by and what is unique about it? Avoid what drugs?

A

Xanthine oxidase so avoid using with xanthine oxidase inhibitors (allopurinol and febuxostat)

Febuxostat is CI

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45
Q

When are weight loss rx drugs appropriate? When should the be d/ced?

A

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

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46
Q

Weight loss drugs what is Contrave, Qsymia, Orlistat

A

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)

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47
Q

When can you use bariatric surgery for weight loss?

A

BMI >40 or >35 with obesity related condition

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48
Q

What is the max dose of acetaminophen and ibuprofen for an adult per day? What NSAIDs are COX2 selective and why is this beneficial?

A

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

49
Q

What are the requirements to use fentanyl patch?

A

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

50
Q

What is in Norco? Dilaudid? Dolophine? Demerol? Anything unique about any of these?

A

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
51
Q

What is a trick to remember what opioids cross-react with eachother?

A

They have COD or MORPH in the name except buprenorphine has NORPH instead of MORPH

Codeine, Morphine, Hydrocodone, Hydromorphone, Buprenorphine, Oxycodone, Oxymorphone

52
Q

What characteristics do migraines need?

A
  1. Lasts 4-72 hours
  2. Has 2+ of the following: unilateral location, pulsating, moderate pain aggravated by routine physical activity
  3. one of the following occurs: n/v, photophobia, and phonophobia
53
Q

MOA of triptans and unique things? CI?

A

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)

54
Q

MOA of ergotamine drugs and unique things? CI? What are these drugs used for and what is the name of it?

A

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

55
Q

When would you consider a prophylactic drug for migraines? What are these drugs? How long should you give a trial of them for?

A

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
56
Q

Most common side effects with 5-HT3 antagonists (Zofran)?

A

Headache and constipation

57
Q

Most common side effects with dopamine receptor antagonists (Prochlorperazine, Promethazine, Metoclompromide, Olanzapine)

A

Promethazine: Do NOT use in children <2 yo

Metoclopramide: Tardive dyskinesia (TD) that can be irreversible

Sedation, lethargy, acute EPS, can decrease seizure threshold

58
Q

What is the maximum daily dose of loperamide for chemo induced diarrhea (CID)? What are common chemo drugs that cause this?

A

24 mg/day

Irinotecan, Fluorouracil, Capecitabine

59
Q

What drugs commonly are vesicants in cancer? If extravastation occurs what do you do?

A

Anthracyclines and Vinka Alkaloids

Cold compress for anthra and warm compress for vinka and can use antidotes

Anthra: Dexrazoxane
Vinka: Hyaluronidase

60
Q

What is 1st line treatment for breast cancer if premenopasual/post?

A

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

61
Q

Warnings and side effects of SERMS? (Tamoxifen/Fulvestrant)? What about aromotase inhibitors (Anastrazole)

A

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

62
Q

What are the main side effects with Cisplatin?

A

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

63
Q

What is the lifetime dose for doxorubacin and why does it matter?

A

Lifetime max dose cumulative 450-550 mg/m2 because of cardiotoxicity

Monitor LVEF before and after treatment

64
Q

What is the issue with bleomycin and what drug class?

A

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

65
Q

Major side effects of vincristine? or vinka alkaloids

A

Peripheral neuropathy as a class

vinCristine associated with more Cns toxicity
vinBlastine with more Bone marrow suppression

66
Q

What is the MOA of 5-FU or Fluorouracil? What is a similar drug? What is unique? What side effects?

A

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

67
Q

Methotrexate what is the MOA? Common side effects? Unique?

A

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

68
Q

Generic name for Zyvox? Lexapro? Inderal?

A

Zyvox= Linezolid

Lexapro= escitalopram

Inderal= propranolol

69
Q

What benzos undergo conjugation and are safest in elderly? there is a mnemonic what is it?

A

LOT

Lorazepam (Ativan)
Oxazepame
Temazepam (Restoril)

70
Q

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?

A

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

71
Q

What side effects are unique to SNRIs that SSRIs don’t have?

A

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

72
Q

Tricyclic antidepressants side effects and which ones cause more? Names?

A

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

73
Q

What is the MOA of Bupropion? Side effects? CI?

A

Bupropion is a dopamine and NE inhibitor

CI: seziure disorder, history of anorexia

Side effects: dry mouth, CNS stimulation, tremors, weight loss

74
Q

What is Phenelzine? Isocarboxid? Tranylcypromine?

A

all MOA inhibitors

75
Q

MOA of mirtazapine? Brand name? Side effects?

A

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

76
Q

What antidepressant is preferred if there is cardiac/QT risk involved with the patient?

A

Sertraline is preferred

Citalopram/escitalopram not great

77
Q

Why do parkinson patients experience hallucinations or delusions?

A

Parkinson medications increase dopamine in the brain which relieves the motor symptoms but this increase in dopamine can trigger hallucinations/delusions

78
Q

What do antipsychotic drugs do?

A

They block dopamine receptors which decreases dopamine and helps control psychosis

  • better at controling positive symptoms
  • harder to treat negative symptoms (lack of motivation)
79
Q

What are first generation antipsychotics? CI? Side effects?

A

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,

80
Q

What are second generation antipsychotics? CI? Side effects? Difference from first gen?

A

Block serotonin unlike FGA so less EPS

Aripiprazole, Clozapine, Lurasidone, Olanzapine (Zyprexa), Quetiapine (Seroquel), Risperidone, Ziprasidone

Somnolence, metabolic syndrome common side effects

81
Q

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?

A

Acute manic: Valproate, lithium,

Acute depressive: lithium but lamotrigene can work

Pregnant: Lamotrigine is safest option

82
Q

What is the therapeutic trough goal for lithium? Side effects? What can alter levels in the body? what drugs?

A

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

83
Q

What drug helps treat central diabetes insipidous?

A

Desmopressin which will help decrease urine volume that is increased in this disease

84
Q

What is a good treatment for SIADH?

A

Tolvaptian which is an antidiuretic analog

85
Q

What is the dose of ceftriaxone for meningitis for adult patients? Neonates? Infants and children?

A

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)

86
Q

What are the 2 cefs for anaerboic coverage? brand and generic name of both

A

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

87
Q

What is first line treatment for neurosyphillis?

A

IV Pen G aqueous `

88
Q

What is the recommended starting dose for Vyvanse?

A

30mg QAM unless they have a pyshiatric disorder such as anxiety than 10-20mg QAM

89
Q

What is the MOA of restless leg syndrome? What is the primary treatment?

A

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

90
Q

What is Sinemet? What is unique? What is it used for?

A

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

91
Q

What are COMT inhibitors and what are they used for?

A

COMT inhibitors increase the duration of action of levodopa by inhibiting catechol-o-methyltransferase

Entacapone

ONLY used with levodopa at 200mg each dose

92
Q

What is Amantadine used for and MOA?

A

Blocks dopamine reuptake and is primarily used to treat dyskinesias associated with peak-dose carbidopa/levodopa

93
Q

What is the mainstay of treatment in alzheimer’s disease? Class and drugs? When are they taken?

A

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

94
Q

What is the treatment algorithm for status epilepticus?

A

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

95
Q

What drug is used for absence seizures?

A

Ethosuximide

96
Q

Side effects of lamotrigine? Brand name? Starting dose? DDI?

A

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%

97
Q

Topiramate side effects? Brand name? DDIs?

A

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

98
Q

Phenytoin brand name and side effects? DDIs?

A

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)

99
Q

Most AED are enzyme inducers but what is the one inhibitor and what other AED does it affect most?

A

Valproic acid is an enzyme inhibitor and can increase the level of lamotrigine

100
Q

What should everyone on AED be supplemented with?

A

Calcium and vitamin D due to bone loss

101
Q

Side effects of PPIs? DDIs?

A

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

102
Q

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?

A

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:

  1. Bismuth subsalicylate 300mg QID
  2. Metronidazole 250-500mg QID
  3. Tetracycline 500mg QID
  4. PPI BID
103
Q

Maintance therapy for mild disease in UC? CD?

What about for moderate/severe disease?

A

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

104
Q

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?

A

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)

105
Q

What is preferred for STEMI? NSTEMI?

A

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

106
Q

What is the drug treatment algorithm for actue ACS?

A

MONA-GAP-BA

Morphine, oxygen, nitrates, aspirin

GP2b3a antagonists
anticoagulants
P2Y12 inhibitors

Beta-blockers, Ace inhibitors

107
Q

When are fibrinolytics used? How long do you have to use it? How fast does PCI need to be done?

A

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

108
Q

What is used for long term secondary prevention of ACS?

A

Apsirin

Clopidogrel for 12 months

Beta-blocker

ACEi

Aldosterone antagnoist

Statin

109
Q

What NSAID has the lowest cardiovascular risk?

A

Naproxen

110
Q

What are the only beta blockers rec for heart failure?

A

Bisoprolol, carvedilol, and metoprolol succinate

111
Q

Potassium chloride 10% and 20% is what meq/ml in oral solution?

A

10% = 20 mEq/15 mL

20%= 40 mEq/15 mL

112
Q

What is the only drug approved for acute treatment of a confirmed acute ischemic stroke?

A

Alteplase administered within 3 hours of symptom onset and within 4.5 hours of select patients
-max dose of 90 mg

113
Q

What factors does warfarin inhibit? UFH? Direct thrombin inhibitors?

A

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

114
Q

What CHAD-VASc score do you use DOACs for stroke prevention in afib?

A

CHAD-VASc 2+ for men and 3+ for women use DOACS for stroke prevention in afib

115
Q

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?

A

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

116
Q

Enoxaparin dosing for prophylaxis of VTE? Treatment of VTE/NSTEMI? Treatment of STEMI?

A

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

117
Q

Eliquis dosing for afib and for DVT?

A

apixiban 5mg BID for afib

DVT: 10mg BID x 7d then 5mg BID

118
Q

Xarelto dosing for afib and DVT?

A

Rivaroxaban 20mg QD for afib (doses >15mg must be taken with food)

DVT: 15mg BID x 21d then 20mg QD

119
Q

What is the only IV ACEi?

A

Enalaprilant

NAPLEX (6 decks)

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