rxfiles notes part 2 Flashcards
uncomplicated cystitis treatment duration for nitrofurantoin and septra
nitroFurantoin=Five, sulfamethoxazole Trimethoprim=Three
realisitic decrease (%) in chronic pain
30-50%
analgesics of choice in renal or hepatic failure
renal- hydromorph, oxy, fent, methadone. hepatic- morphine, hydromorph, oxy, fent, methadone
when should NSAIDs be avoided in renal dysfx
crcl less than 40 (unless dialysis)
best for GAD (SSRIs)
EPS- escit, parox, sert
lowest effective antiinflammatory dose for ibu and naprox
ibu- 400mg, naprox 375
what is the saturation point of uric acid
over 405umol/L. Target we want is less than 300-360. If asxatic, can be higher and no big deal may not treat (usually don’t)
do not start, stop or adjust allopurinol during acute gout attack- TF
T- first time, wait 1-2 weeks after inflammation/attack settles before starting as it may destabilize crystals
when can allopurinol be used not in gout attack
to proph while waiting for allopurinol to kick in- 0.6mg OD-BID for 3-6 months when starting allo
allopurinol should be taken AC- TF
F- preferred after food
MOA of ASA, how long does effect last?
irreversible platelet inhibition- lasts 7-10 days
which NSAID has the most CNS effects
indomethacin (CNS confusion esp in elderly). Dosed 25-50mg TID (max 200)
what is the equivalency between oral morphine and fentanyl
90MEq in about 25mg/day patch
what is the watchful dose for morphine and how long should you taper opioids over
200mg, taper over 2-16 weeks
how long does it take to lose tolerance to an opioid dose
as little as 1-2 weeks; careful when tapering off to caution patients not to abruptly go back to previous dose
dose of dimenhydrinate
50-100mg q6h prn
what automatically volumes you up a level on the CAROC scale for OP
pre if greater than or equal to 7.5 mg/day for over 3 months or frag fracture after age 40
bisphosponates should not be used below a crcl of
30
what is etidronate good for
weak antiresorptive; only for vertevral fracture in those at high risk (NOT hip or non vertebral) and must be 2 hours before food… sucks!
what is raloxifine? who is it CI in?
SERM- SE hot flushes/flushing, leg cramps, VTE is rare but serious. CI in women of childbearing potential and active or past thromboembolic events. Only decreases risk of vertebral
how does teriperatide work?
anabolic- only one that works on osteoblasts- it increases activity. SE- N, Dizzy, aching. For vertebral and non vertebral (ie not hip) in postmenopausal if severe OR glucocorticoid induced OR men. Given SC daily
list foods that contain about 300mg calcium
1 cup milk or orange juice, 3/4 cup yogurt, 1/2 pack of cards sized serving of cheese
what does Ca decrease the absorption of? what should it be taken with to increase absorption?
Decreases cipro, iron, PI, tetracyclines, thyroid meds. PPIs can decrease Ca absorption (citrate best in this situation). Usually give carbonate; if with meal it will increase its F (menopausal- 1200mg per day, age 19-50 1000mg daily)
how much vitamin D in OP per day
800-2000IU per day
who to treat for OP
always high (consider patient wants though), consider in moderate but retest q1-3 yrs if don’t, not usually in low and will retest in 5 years
what kind of stiffness is classic of RA
morning for more than 30 minutes
tx for RA
mild dx- HCQ or SSZ. If active DSX, MTX or Leflun or combo therapy (usually MTX+SSZ+HCQ or MTX + HCQ or a biologic with MTX or leflun)
BB approved for migraine proph
MTP (migraine therapy prophylaxis)- metoprolol, timolol, propranolol. ISA activity ones may not be effective, but atenolol and nadolol may be but not first recommended.
ergot vs non ergot derivative DA agonists for parkinsons
ergots are not recommended as fist line due to concerns with cardiac valve dsx ((pulmonary and cardiac fibrosis) bromocriptine, cabergoline) vs non ergot are first line (or start with levodopa) (pramipexole, ropinerole)
interaction between DA agonists and SSRIs MAOIs
increased risk SS
how often do you get the progestin injection for birth control? what drugs might change this?
q12w (3 months) (grace period of up to 14 weeks)- do q10w if on meds that decrease the elvel like carbamaz, griseofulvin, phenobarb, phenytoin, rifampin, st john’s wort, etc
mean weight gain with all progestins
less than 2 kg
drugs good for bipolar- mania or mixed
divalproex/valproate, lithium, atypical psych (esp for acute agitation), carbamazepine as an alternative
how long is a good medication trial in bipolar
2 weeks
what is the best (first line) for bipolar rapid cycling
divalproex/valproate. litium or carbamax as second line added on if necessary
what happens when combining lamotrigine and divalproex
risk of life threatening rash increases
which antidepressants are the worst in bipolar for rapid cycling
TCAs by far, then SSRI, then venla, then bupropion
best for bipolar depression
mithium, lamotrigine, quetiapine. 2nd line olanzapine plus ssri
when is carbamaz’s autoinduction phase complete
about 4 weeks
how to switch from fluoxetine to another antidepressant
35 day washout for all except only 7 for another SSRI or bupropion. 8 week taper may even be required if it was high dose fluoxetine
how to switch from MAOI irreversible (phenelzine, trancypromine) to another antidepressant
wait 10-14 days
