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rxfiles notes Flashcards

1
Q

2 antibiotics used in acne products; when should they be stopped

A

clinda and eryth; mostly for inflammatory lesions, always use with BP to prevent resistance, d/c when no further inflammation

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2
Q

how long to see noticeable improvement in acne, and how long long to max effect

A

2-4 weeks see worsening, 8-12w to improve, /max response

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3
Q

which acne product must be refrigerated? which doesn’t but has an expiry anyway

A

benzaclin (3 month expiry), clindoxyl can be at room temp but 2 month expiry

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4
Q

oral acne ABX

A

tetracycline, doxycycline, monocycline, erythromycin (2n line- increased GI and resistance), trimethoprim (3rd line)

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5
Q

which tetracycline is the most photosensitizing? hardest on stomach? what must you take on empty stomach? which do youseparatefrom cations?

A

doxy, tetra, tetra (abs decreased by dairy and food), all separate

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6
Q

what is pulse therapy with acne abx

A

use for 2-4 months, then follow with topical ABX and BP

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7
Q

which tetracyclines have cross resistance

A

doxy and tet

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8
Q

before starting acutane

A

need 2 negative pregnancy tests, and 2 reliable forms of contraception for one month before and one after using

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9
Q

SE of acutane

A

dryness (worst in first 8 weeks), sun sensitivity, minor aches

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10
Q

dose of accutane

A

0.5mg/kg/day divided BID CC for 4 weeks, then 1mg/kg/day for 3-7months (max 2mg/kg/day)

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11
Q

what to avoid with accutane

A

other acne topicals (increased dry), and vitamin a supplements (increased tox)

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12
Q

order of potency (high to low) of topical steroids

A

clobestasol (1-2), betamethasone diproprionate (2-4), beta valerate (5), HC (6-7)

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13
Q

how long to see the optimal effects of nasal steroids

A

3-14 days. best if given regularly and about 1 week before onset of allergen exposure

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14
Q

when should oral testosterone be taken

A

after meals- sig increase in absorption

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15
Q

where should transdermal gel (does not apply to patch, which is treated like any other patch) testosterone gel be applied, precautions

A

shoulder, abdomen or upper arms and wash hands. wait at least 6 hours before showering, can transfer to partners and kids so change t shirt

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16
Q

normal testosterone injection dose IM

A

100-150mg q2-3 weeks

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17
Q

disadvantages of testosterone injection

A

yoyo effect, more prone to AE. oral and transdermal def provide more stable levels

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18
Q

benefits and risks of testosterone therapy

A

B; decrease body fat, increase lean body mass and bone density and grip strength, improvement in mood and possibly libido (DOES NOT treat erectile dysfx). R; CV increased risk, fluid retention and HF exacerbation (made even worse with steroids), gynecomastia, testicular atrophy/infertility, increased prostate size and difficult urinating, acne, exacerbation of aggression,

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19
Q

how long should you wait after a dose change or new med before taking a TSH level

A

6-8 weeks

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20
Q

should we treat subclinical hypothyroid

A

research shows doesnt improve survival or CV mort. but monitor q6-12 months. If tSH >10 recheck in 6-8 weeks, and if still high treat on trial basis. If >4.5-10, consider tx expecially if sx or DM or lipids/HTN/pregnancy/planning, depression, etc

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21
Q

which drugs cause increased/decreased TSH

A

Inc; amiodarone (usually this), interferon, lithium, opiates, metoclopramide. Decr; amiodarone, dopamine, glucocorticoids, metformin, somatostatin, endogenous hormones too

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22
Q

when do patients see clinical improvement with thyroid tx

A

hypo- 2 weeks, hyper 3-4 weeks

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23
Q

how to space levothyroxine

A

1/2 hour before meals or 4 hours after, 1 hour after coffee/tea, 2-4 from al, ca, fe, mg, supplements, cholestyramine, cipro, colesevelam, orlistat, sevelamer, simethicone, etc, 8-12 from raloxifene

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24
Q

which drugs can decrease levothyrox levels

A

SSRI

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25
Q

what might levothyrox increase the effect of (drug)

A

TCAs- increase arrythmogenic effect/stimulatory effect - monitor for cardiac arrhythmia and CNS stimulation

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26
Q

average levothyroxine dose to start

A

1.6ug/kg/day (IBW) *entire dose may be given once weekly if non compliant

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27
Q

drugs that can cause constipation

A

NSAIDs, opioids, antipsych, benztropine, oxybutinin, antiparkinsons (amantadine, bromocriptine, pramipexole), anticonvulsants (gaba, pheny, pregabalin), TCA, antidiarrheals, antiemetics, 1st gena antihist, alpha agonists (clonidine), BB, CCB (esp verap), diuretics, dicyclomine (antispasmodic), Ca/Fe/bismuth/Al, chemo (vincristine/cyclophosphamide), resins

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28
Q

alarm sx of constipation

A

50 or over with new onset, rectal bleed, nocturnal sx, significant weight loss, fever, anemia

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29
Q

how to increase fibre, and what goals for adults should be for constipation

A

by 5g/week. 20-35g/day

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30
Q

treating constipation in infant (<1)

A

glycerin supp, lactulose or PEG okay. If over 6 months, may try apple/pear or prune juice (has sorbitol)

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31
Q

children >/= 1 yr for constipation

A

peg (0.4-1g/kg/day-max 17g.day), then MOM or lactulose.

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32
Q

constipation in pregnancy

A

increase fibre/fluid/activity, then bulk forming (psyllium etc), then osmotic lax (peg/lact), then short term stimulant

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33
Q

constipation in opioid use

A

tolerance doesn’t devlop, not thought to be dose dependent either;start a stimulant laxative with or wihtout stoool softener when opioid is started (1-2 tabs senokot HS)

34
Q

bulk forming agents for constipation counselling

A

improve stool weight and consistency by increasing stool fluid content, onset 12-72 hours, psyllium has most efficacy data, take with full glass of water to prevent esophageal irritation and fecal impact. AE- flatuance, bloating; titrate slowly to minimize. Space by 2 hours from all others meds.

35
Q

osmotics counselling constipation

A

poorly absorbed sugars to draw water into lumen and stimulate peristalsis. PEG: 48-96hrs, dissolve in water/juice/soda/coffee/tea (tasteless and odorless), less bloating vs lactulose. 17g=1sachet=1capfull per day. Not approved for 18 and under. Lactulose= 24-48hrs, sweet, safe in DM bc not absorbed, 15-30ml up to TID max 90mL/day. Glycerin supp: 15-60min, local irritation, moisten in lukewarm water before insert and hold in 15-30min. MOM; 0.5-6hours, CI renal or cardiac impairment.

36
Q

stimulants counselling constipation

A

alter electrolyte transport in colon, increase intralumin fluids, stimulate peristalsis. Bisacodyl: 6-12 hrs (rectal 15-60 min), stronger vs senna, space milk, antacids (decrease acidity causes early disintegration), PPIs by 1 hr. Senna: 6-12hrs, mildest stimulant, may discolor urine/feces, SE dose dependent, no known clinical DI, DOSE: 2 tabs HS max 2 BID for preg and kids 6-12, and 2-4tabs HS or 4 tabs BID is max except in palliative- 4 tabs TID

37
Q

5asa vs asa

A

5asa does not actually contain asa- no antplatelet effects

38
Q

probiotics in IBD

A

more promise in UC vs CD

39
Q

name some live vaccines. Who are they CI in? Preg?

A

MMR, varicella, zoster, yellow fever, oral typhoid/polio, rotavirus, flumist, BCG; do not give if planning immunosuppressives in 2-12 weeks. avoid in immunodef patients. avoid live in preg too but assess benef/risk (absolute CI MMR, varicella, zoster)

40
Q

therapy used for UC

A

acute; 5asa (oral and PR), steroids, might use sulfasalazine, inflix if mod-sev and inadequate response or refractory to steroids. Maint; 5asa po or pr (pr is 2x/wk), mesalamine enema, sulfasalazine, infliximab if used to induce maintenance in mod to sev

41
Q

therapy used for CD

A

acute; prednisone (may add AZA or 6-MP due to slow onset), sulfasalazine, if ineffective consider MTX, inflix or adalimumab. main; tx not always required if mild, can use 5ASA, MTX, AZA or 6MP, if mod to sev and induction successful with it continue inflix or other anti tnf.

42
Q

what is the only 5asa form that covers all parts of GI system? Which are only good for colitis and not crohns? What covers least?

A

all- pentasa. Only colitis- topicals and enemas. Least- suppository (rectum only)

43
Q

what is cleaved into 5asa and sulfapuridine- who is this CI in? what should you consider with it? What are the main SE? what if you don’t tolerate one?

A

sulfasalazine- CI in hypersensitivity to sulfonamides or salicylates. Caution in G6PD. Consider folic acid supplement as it decreases its absorption. SE; dose related=GI and HA and arthralgia. Non dose related- rash (SJS), hepatotox, bone marrow supp, pancreatitis, nephrotoxic, photosens, can discolor skin/tears/urine, oligospermia (reversible when stop)- start low dose and increase q2-3days to decrease SE. If don’t tolerate SSZ 80% tolerate 5ASA

44
Q

time to effect of IBD agents

A

sulfasal, 5 asa; 2-4 weeks, CS; 7-10 days, purine antimetabolites (ASA and 6MP); 3-6 months, biologics; 2 weeks

45
Q

what’s up with the enteric coated tabs of 5asa

A

for IBD- pH dependent release in terminal illeum for the rectum

46
Q

which purine antimetabolite has to be adjusted for kidney and liver?

A

azathioprine- mercapto you don’t have to

47
Q

how do ppis help with gastric ulcer

A

decrease re bleed risk and need for surg, but NOT mortality

48
Q

acid suppression in preg

A

tums/alginates preferred, ranitidine and omeprazole safe, lansoprazole and pantoprazole and cimetidine/famotidine likely safe

49
Q

when should DAPT be using gastric protection (PPI)

A

hx of GI bleed or ulceration, multiple concurrent risk factors (65 or older, concurrant anticoagulant, h pylori infection, NSAIDs, steroids); ie these are high and med risk. If lw risk (no GI risk factors), w/o ppi is okay

50
Q

ppis most and least likely to have DI

A

most- omeprazole and esomep. least- pantoprazole and rabeprazole

51
Q

only ppi available IV

A

pantoprazole

52
Q

what adjustments need to be made to ppis and H2blockers for organ fx

A

ppis- adjust for liver, H2 adjust kidney

53
Q

how to get most accurate readings for urea breath test and h pylori

A

prevent false neg by stopping ABX x4weeks, bismuth xat least 2w, ppis at least 3d, and H2blockers at least 1 day before testing. Can use antacids prn

54
Q

what is triple h pylori therapy, and what is used if it fails

A

triple= amox, clarith, ppi x7-14 days (10-14 usually recommended). Fail? repeat with alternate regimen (metro, clarith, ppi) OR treat for 2 weeks or use quad therapy (metro, tetra, bismuth-use suspension or caplets to prevent DI with tetra, ppi). Another quad option= ppi, amox, metro, clarith

55
Q

non pharm N/V

A

avoid unpleasant odors, get fresh air, smaller meals, loose clothing, distraction, avoid rapid head movements if motion induced

56
Q

when to repeat a dose of meds it vomit up

A

within 30 minutes orally

57
Q

what to use for post op or for chemo induced NV

A

post op; dexameth, granisetron, dolasetron, droperidol, metoclop, ondansetron, diminhydr, haloperidol. Chemo- use seratonin antagonists (ondans, graniset, dolasetron)

58
Q

all therapies used for NV are _____ of different receptors. Name classes and where they work

A

antagonists. DA; haloperiodol, metoclopramide, domperidone (act at CRTZ- good for opioid induced esp halop bc most potent). Weak DA phenothiazines (prochlorperazine) (sig AE), sertatonin antagonists (5HT3)=ondans, granis, dolasetron (act centrally and peripherally- CTZ and gut- but no action on DA therefore not for opioid induced, well tolerated). Antihist (histamine and muscarinic ie cholinergic), esp for motion. Antichol (M1)- scopalamine (sedation, blurry vision, dry mouth, limit)- mostly for motion tx and prevention. Benzos (no direct effect, can be for post chemo, usually to reduce anx and psych factor of NV). CS (dexa)-preferred for severe or refractory. Somatostatin analogues (octreotide) and neurokinin 1 ie substance p antag (aprepitant and fosaprepitant)- used with CS for highly emetogenic regimens

59
Q

increased risk of post op NV if

A

female, hx of it or motion sick, non smoke, taking opioids post op

60
Q

what is betahistine used for

A

BID prn for motion related NV- meniere’s, vestibular disorders (vertigo) etc

61
Q

comment on PDE5 inh onset and duration

A

onset about 30-60 minutes, SV last 4-12h, T lasts 36 or less.

62
Q

how far should alpha blockers be spaced from pde5 inh

A

4-6 hours or avoid

63
Q

which pde5inh can increase QT

A

vardenafil

64
Q

name 3a4 inhibitors- what is the significance with pde5inh?

A

azole anttifungals, cimetidine, cipro, erythro, clarithro, tac, doxy, grapefruit, isoiazid, PI, quinidine, verapamil -USE lowest dose of PDE5 inh as it can increase the levels

65
Q

high fat meals may delay abs and decrease efficacy of these pde5inh

A

silden, varden

66
Q

which pde5inh doesn’t have to be adjusted for renal fx

A

vardenafil; ALL must be adjusted for liver

67
Q

intercavernosal injections dosing

A

no more than 3 per week and must have 24 hours between doses

68
Q

how to apply antifungal topical

A

1-2inches beyond rash, continue one week after sx gone and skin looks healed, keep area clean and dry

69
Q

tx of choice for syphillis

A

benzathig pen G (1 IM dose). Doxy 100mg BID x14days alternative if allergy

70
Q

tx of choice gonnorhea

A

cetriaxone 250mg IM OR cefixime 800mg PO stat + azithro 1g po stat (for chlamydia coverage). If severe ceph allergy, do azith 2g po x1 stat

71
Q

tx of choice chlamydia

A

azith 1g x1 dose or doxy 100mg BID x7days

72
Q

when treating STIs do you treat partners? How long abstain sex?

A

all partners test and treat 60days or less. abstain f7d after tx

73
Q

amox vs ampicillin

A

recommend amox- both PO, but amox has better absorption, is given q8h vs 6, decreased rash and diarrhea- unless shigella/citrobacter/enterobacter/listeria

74
Q

amox clav must be givin with food- TF?

A

T- increased absorption. also may decrease stomach upset. higher ratio formulations give less diarrhea as given q12h

75
Q

only penicillin that needs to be adjusted for renal fx

A

ampicillin

76
Q

antibiotics adjusted for renal dysfx

A

ampicillin, cefuroxime, cephalexin, FQ, clarith, septra, tetracycline, nitro (avoid under 60), probenacid

77
Q

what is the estolate form of eryth more useful for

A

kids as it is most acid stable. Not recommended in adults or pregnancy!

78
Q

how long to separate tetracyclines from ca and fe

A

take tetra 1 hour before or 2 hours after them

79
Q

which tetracycline must be on an empty stomach with water

A

tetracycline

80
Q

nitrofurantoin is used for ___ only and should be avoided in this part of pregnancy

A

UTI (also proph)- avoid at term ie 3rd tri/36 weeks

81
Q

what is the most potent antacid

A

calcium carbonate

OTC (21 decks)

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