RLP Flashcards
Name 5 medications that can lead to folic acid deficiency
- MTX
- Phenytoin
- Trimethoprim long term – UTI prophylaxis, PJP prophylaxis
- Sulfasalazine
- Triamterene
- Alcohol use
What is the usual supplemental dose of folic acid?
1 to 5 mg daily. Intake is from food is usually 200mcg per day or 0.2mg
Is folic acid a water soluable vitamin?
Water soluble vitamin. You don’t have to worry about accumulation.
What is the mechanism of action of sacubatril?
Naprolysin inhibitor. Naprolysin breaks down Naturetic peptides; if you inhibit this enzyme, stop breakdown and get more peptides hanging around. End result is more vasodialation, fluid loss, lower BP
What are the 3 Entresto doses?
Initial 24/26 BID – not on ACE/ARB or on low dose
49/51 – for those on greater than 10mg enalapril
Titrate up to 97/103 BID
What is the interaction between lithium and ARBs?
Lithium + Arbs can raise lithium concentrations
What is the ACE washout period with Entresto and why is it critical?
36 hour washout of ACEI before starting Entresto
Greater risk of angioedema when used together
What is normal and geriatric dosing of cetirizine?
10mg per day; high dose is 10mg BID, potential for sedative, anticholinergic effects. Maximum of 5mg in 77 years or older, per manufacturer
What receptors does aripiprazole work on?
Activity on dopamine receptors; not as strong a dopamine receptor agonist as others.
Schizophrenia is attributed to excessive dopamine,
reducing activity of dopamine is part of treatment. Also has action on serotonin re-uptake, mild histamine, mild alpha blocking.
Name 5 ADRs from aripiprazole
Extrapyramidal, weight gain, anticholinergic effects, sedation, QTC prolongation, hypotension, prolactin elevation, akathisia.
Name a prominent ADR from aripiprazole
akathisia – more pronounced than other meds – restlessness, fidgety, can’t sit still, or have internal feelings of crawling out of their skin
Name 3 boxed warnings for Conjugated Estrogens
- alone without progestin, increases risk of endometrial cancer (need intact uterus)
- Risk of DVT, PE, stroke (blood clots)
- Increased risk of breast cancer
Name two interacting medications with Conjugated Estrogens
Anti-estrogen medications like Anastrazole
Warfarin or Apixaban – patient is already at clot risk
What questions should you assess with estrogen replacement?
Not for excessive amount of time, or high doses. Do they continue to need it?
Describe tiotropium’s mechanism of action
Blocks acetylcholine action at M3 receptors. When acetylcholine binds that contributes to airway constriction. Preventing binding, promotes relaxation, better breathing
Name a counseling tip for ziprasidone
Need to take ziprasidone with a meal. Greater than 500 calories. Absorption goes down without a meal. (watch out in non-responders)
Ziprasidone mechanism of action
Mechanism: blockade of dopamine receptors. May have anti-histamine, alpha blockade
Describe tiotropium’s systemic ADRs
Other anticholineric ADRs come from systemic absorption; some systemic absorption (19%) but not significant. If patients complain of these it’s probably from another medication. Elderly may be more prone to have these, especially with renal impairment.
Notable ADR from ziprasidone
One of the worst for QTc prolongation – avoid in electrolyte imbalances, other meds
Name most common ADR from tiotropium
Dry mouth
Name 4 ADRs from ziprasidone
QTc prolongation, metabolic syndrome, sedation, CNS depression, extrapyramidal symptoms, falls, Elevation of prolactin, drop in BP
What is the mechanism of hydralazine?
Direct stimulation of the arterioles to dialate
If you have DM and HTN, no CKD, do you need an ACE/ARB?
Follow ACC/AHA guidelines (HCTZ, chlorthalidone, etc.); If develop proteinuria, then you need to switch
Name 3 dapagliflozin ADRs.
Ketoacidosis, UTIs, genital infections, low BP
What is a unique ADR for hydralazine?
Lupus-like reaction (fever, muscle pain, arthritis)
If you have DM, and HTN and CKD, do you need an ACE/ARB?
Yes, need ACE/ARB
Watch out for in SGLT2 use in immunosuppressed?
More likely to have UTI, genital infections so watch out.
Is it unsafe to use SGLT2s with a low GFR?
No, but mechanism takes place in the kidney. So, if poor function, isn’t going to work well.
If you have DM, no HTN, no CKD, do you need an ACE/ARB?
No, you don’t need an ACE or ARB
What is the mechanism of dapagliflozin?
SGLT2 inhibitor. Inhibits reabsorption of glucose and sodium (water goes with it) in the kidney. Works better with higher glucose levels.
Name 3 ADRs from diphenhydramine
Confusion, fall risk, dry eyes, dry mouth, urinary retention, constipation. Peds – can get paradoxical effect of activation
Name 3 ADRs from levetiracetam
fatigue, dizziness, psychiatric changes (agitation, anxiety), hypersensitivity – skin reactions, BP elevation (peds)
Name 3 electrolytes depleted by torsemide
K, Na, Mg
What is the indication for Palivizumab?
Monoclonal antibody for preventing RSV infections in pediatric patients. AAP Guidelines for administration: less than 32 weeks gestation, especially those less than 29 weeks, significant risk factors, lung disease
If you have DM, no HTN and CKD, do you need an ACE/ARB?
Use proteinuria to direct your therapy
What are the triad of medications that can cause renal issues?
NSAID – ACE/ARB – Loop diuretic
Name 3 ADRS from palivizumab
monoclonal antibody injection; skin reactions, low chance for anaphylaxis, fever, antibody development to the medication
What is the conversion from bumetanide, furosemide, torsemide?
oral furosemide 40mg = torsemide 20mg = bumetanide 1mg