STG and KDG Flashcards
1
Q
Major CYP inhibitors
A
G-PACMAN Grapefruit Protease inhibitors Azole antifungals Cyclosporine, cimetidine, cobicistat Macrolides (not azithro) Amiodarone Non-DHP CCBs
2
Q
Major CYP inducers
A
CROPPSS Carbamazepine Rifampin Oxycarbamazepine Phenytoin Phenobarb St. John's word Smoking
3
Q
What does the orange book contain
A
List of approved drugs that can be interchanged with generics based on therapeutic equivalence
4
Q
What does the pink book contain
A
Info on epidemiology and vaccine-preventable diseases
5
Q
What does the pink sheet contain
A
News report on regulatory, legislative, legal and business
6
Q
What does the Purple book contain
A
List of biological drug products, including biosimilars
7
Q
What does the red book contain
A
Drug pricing information
8
Q
What does the Red book, pediatric contain?
A
Summaries of pediatric infectious diseases, antimicrobial treatment and vaccinations
9
Q
What does the yellow book contain?
A
Travel vaccines and prophylaxis meds
10
Q
What does the green book contain
A
Info on approved animal drug products
11
Q
What patches are applied BID?
A
Diclofenac
12
Q
What patches are applied twice weekly?
A
Estradiol
Oxybutynin
13
Q
What patches are applies weekly?
A
Buprenorphine Clonidine Estradiol Estradiol/levonorgestrel Ethinyl estradiol/norelgestromin
14
Q
What medications have sorption or leaching issues with PVC
A
Lorazepam Amiodrone Tacrolimus Taxanes Insulin Nitroglycerine
15
Q
What IV drugs are only compatible with saline?
A
A DIAbetic Can't Eat Pie Ampicillin Dapto Infliximab Ampicillin/sulbactam Caspofungin Ertapenem Phenytoin
16
Q
What IV drugs are only compatible with dextrose?
A
Bactrim
Oxaliplatin
Amphotericin B
Quinupristin/Dalfopristin
17
Q
What IV drugs require a filter? What size?
A
0.22 micron Golimumab Amiodarone Lorazepam Phenytoin Lipids - 1.2 micron Amphotericin B (lipids) Taxanes (except docetaxel)
18
Q
What IV meds should not be refrigerated?
A
Dexmedetomidine Bactrim Phenytoin Furosemide Metronidazole Moxifloxacin Enoxaparin
19
Q
What IV meds are protect from light during administration?
A
Phytonadione (vitamin K) Epoprostenol Nitroprusside Micafungin Doxycycline
20
Q
How many mL in one pint?
A
473
21
Q
How many grams per ounce?
A
28.4g
22
Q
How many grains per gram?
A
15.432
23
Q
How many kcal/g in enteral carbs, fat, and protein??
A
Carbs: 4
Fat: 9
Protein: 4
24
Q
How many kcal/g in parenteral carbs, fat, and protein?
A
Dextrose: 3.4 Glycerol: 4.3 10% lipid: 1.1 kcal/ml 20% lipid: 2 kcal/ml 30% lipid: 3 kcal/ml Amino acid: 4
25
What drugs can cause kidney disease?
```
Aminoglycosides
Amphotericin B
Cisplatin
Cyclosporine
Loops
NSAIDs
Polymyxins
Radiographic contrast dye
Tacrolimus
Vancomycin
```
26
CrCl calculation
(140-age)*(IBW or ABW)
---------
72*SCr
MULTIPLY BY 0.85 FOR WOMEN
27
What drugs require decreased dose or increased dosing interval in CKD?
```
Aminoglycosides
Beta-lactams (not ceftriax)
Fluconazole
Quinolones
Vanc
LMWH
Rivarox, apix, and dabigatran for Afib
H2RAs
Metoclopramide
Bisphosphonates
Lithium
```
28
What drugs are CI with CrCl <60
Nitrofurantoin
29
What drugs are CI with CrCl <50
```
Tenofovir disoproxil fumarate
Voriconazole IV (d/t vehicle)
```
30
What drugs are CI with CrCl <30
TAF
NSAIDs
Dabigatran (DVT/PE)
Rivaroxaban (DVT/PE)
31
What drugs are CI with GFR <30
SGLT2 inhibitors
| Metformin
32
What drugs raise potassium?
```
ACEi
Aldosterone receptor antagonists
Aliskiren
ARBs
Canagliflozin
Drospirenone-containing COCs
Potassium-containing IV fluids
Bactrim
Transplant drugs
```
33
Steps for treating hyperkalemia
Stabilize the heart (Calcium gluconate)
Move K intracellularly
Eliminate K from body
34
Drug classes used to treat hepatitis C
2-3 DAAs with different MOAs
NS3/4A: -previr
NS5a: -asvir
NS5B: -buvir
35
```
What lab tests indicate
Acute liver toxicity
Chronic liver disease
Alcoholic liver disease
Hepatic encephalopathy
Jaundice
```
Acute liver tox: Increased AST/ALT
Chronic liver disease: increased AST/ALT, alk phos, Tbili, LDH, PT/INR; decreased albumin
Alcoholic liver disease: AST double ALT, increased GGT
Hepatic encephalopathy: increased ammonium
Jaundice: increased Tbili
36
What drugs have BBW for liver damage?
```
APAP
Amiodarone
Isoniazid
Ketoconazole
Methotrexate
Nefazodone
Nevirapine
NRTIs
Propylthiouracil
Tipranavir
Valproic acid
```
37
What are common live vaccines?
```
COZY IV RM
Cholera
Oral thyphoid
Zoster
Yellow fever
Intranasal influ
Varicella
Rotavirus
MMR
```
38
If patient is age _____ to ____ and not previously vaccinated, give 2 flu vaccines ____ weeks apart
6 months - 8 years
| 4 weeks
39
When to give PREVNAR 13 and PNEUMOVAX 23 before 65 and after 65
Prevnar
1 dose if 6-64 and immunocompromised or 65 and older
Pneumovax
1 dose before 65 if immunocompetent 2-64 years with diabetes, heart, lung or liver disease, alcohol abuse, smokers
2 doses before 65 if immunocompromised 2-64 years
1 dose after 65 to ALL patients even if received 0, 1, or 2 doses before 65
40
What drugs are used as prophylaxis and treatment of travelers' diarrhea?
Prophylaxis: bismuth subsalicylate QID; rifaximin (only if high risk of complications)
Treatment: loperamide or bismuth subsalicylate; loperamide +/- abx (axithro preferred in severe)
41
What vaccines should travelers receive?
```
Inactivated:
Hep A and B
Japanese encephalitis
Meningococcus
Polio
Typhoid
Live:
Cholera - PO
Typhoid - PO
Yellow fever - SQ
```
42
What can beta-lactam accumulation cause?
Seizures
43
Penicillin VK PO DOC for what
Strep throat and mild nonpurulent skin infections
44
Amoxicillin PO DOC for what
Acute otitis media
Infective endocarditis prophylaxis before dental procedure
H. pylori
45
Amox/clav PO DOC for what
Acute otitis media and sinus infections
46
Diclox and oxacillin PO used to treat what
Cover MSSA only (no MRSA)
| No renal dose adjustment needed
47
Penicillin G IM DOC
Syphilis (2.4m x 1)
| Not for IV use, can cause death
48
Nafcillin IV DOC
MSSA only (no MRSA)
49
Piperacillin/Tazobactam used for what bug
Pseudomonas (only PCN that works against it)
50
1st gen cephalosporines
Cefazolin
Cephalexin (Keflex)
Cefadroxil
51
2nd gen cephalosporines
Cefuroxime
| Cefotetan (Cefotan)
52
3rd gen cephalosporines
Cefdinir
Ceftriaxone
Cefotaxime
Ceftazidime
53
4th gen cephalosporines
Cefepime
54
5th gen cephalosporine
Ceftaroline fosamil (Teflaro)
55
Cephalexin generation and common uses
```
1st gen
Skin infection (MSSA), strep throat
```
56
Cefuroxime generation and common uses
2nd gen
| Acute otitis media, CAP, sinus infection
57
Cefdinir generation and common uses
3rd gen
| CAP, sinus infection
58
Cefazolin generation and common uses
1st gen
| Surgical prophylaxis
59
Cefotetan and cefoxitin generation and common uses
2nd gen
Anaerobic coverage
Surgical prophylaxis (colorectal procedures)
60
Which cephalosporine can have disulfiram-like reaction when consumed with alcohol?
Cefotetan
61
Ceftriaxone and cefotaxime generation and common uses
3rd gen
| CAP, meningitis, spontaneous bacterial peritonitis, pyelonephritis
62
Ceftazidime and cefepime generation and common uses
Ceftaz: 3rd gen
Cefep: 4th gen
Active against pseuomonas
63
What beta lactams are used for MDR gram-negative organisms (including pseudomonas)
Ceftolozane/Tazobactam
| Ceftazidime/Avibactam
64
What is the only beta-lactam active against MRSA?
Ceftaroline
65
Which carbapenems cover ESBL? Pseudomonas?
ESBL: all
Pseudomonas: all but ertapenem
66
Can you use carbapenems with PCN allergy?
No
67
What do carbapenems not cover?
Atypicals, VRE, MRSA, C diff, stenotrophomonas
| ErtAPenem does not cover Enterococcus, Acinetobacter, or pseudomonas
68
What are carbapenems commonly used for?
Polymicrobial infections
Empiric therapy when resistant organisms are suspected
Resistant Pseudomonas or Acinetobacter infections (except ertapenem)
69
Which carbapenem must be diluted in NS?
Ertapenem
70
What are AG active against?
Gram-negatives
| Synergistic with beta lactams for some organisms
71
Which abx have post-antibiotic effect
AG
72
Which are respiratory FQ and what are they used for?
Levofloxacin
Moxifloxacin
Gemifloxacin
Used for pneumonia
73
Which FQ have activity against pseudomonas?
Cipro
| Levo
74
Which FQ is not renally adjusted? What can it not be used to treat
Moxifloxacin
| Do not use to treat UTI
75
Which FQ are 1:1 IV:PO?
Levo and Moxi
76
Counseling and key features of FQ
Caution with CVD, low K/Mg, and other QT prolonging drugs
Avoid in pts with seizure hx
Avoid in children
Tendon rupture, neuropathy, CNS or psych SE
Avoid sun exposure
Separate from cations
Monitor BG
77
Common uses of macrolides
All: CAP and strep throat if beta-lactam activity
Azithro: COPD exacerbation, chlamydia, gonorrhea, prophylaxis for MAC, travelers' diarrhea
Clarithromycin: H. pylori
Erythromycin: increase gastric motility
78
Macrolide SE and interactions
SE: QT prolongation
Interaction: clarithromycin and erythromycin strong CYP3A4 inhibitors - DO NOT USE with lovastatin and simvastatin
79
Common uses of tetracyclines
Doxy and mino: CA-MRSA skin infection, acne
Doxy: lyme disease, rocky mountain spotted fever, CAP, COPD, sinusitis, VRE UTI, monotherapy for chlamydia, gonorrhea
Tetracycline: H. pylori
80
When to not use tetracyclines
Pregnancy, breastfeeding, children < 8
81
Common uses of bactrim, components, interaction
Uses: CA-MRSA skin infection, UTI, PCP
SMX/TMP SS 400/80
SMX/TMP DS 800/160
Increase INR with warfarin - use different abx
82
Nitrofurantoin uses, CI, dosing, and counseling points
```
DOC for uncomplicated UTI
CI: CrCl < 60
Dosing: macroBID is BID, macrodantin is QID
Take with food to prevent nausea
Can discolor urine (brown)
```
83
DOC for MSSA infection
Diclox, nafcillin, oxacillin
Cefazolin, cephalexin
Amox/clav
Amp/sulbactam
84
DOC for CA-MRSA
Bactrim
Doxy, mino
Clinda
Linezolid
85
DOC for severe SSTI requiring IV treatment or hospitalization
***Cover for MRSA and strep
Vanc (do not use if MIC 2 or higher)
Linezolid, Dapto, ceftaroline
86
DOC for nosocomial MRSA (MRSA from hospital)
Vanco
Linezolid
Dapto (not in pneumonia)
87
DOC for VRE faecalis
Pen G or ampicillin
Linezolid
Dapto
Cystitis: nitrofurantoin, fosfomycin, doxy
88
DOC for VRE faecium
Dapto
Linezolid
Cystitis: nitrofurantoin, fosfomycin, doxy
89
DOC for pseudomonas
```
Pip/tazo
Cefepime
Ceftazidime +/- avibactam
Ceftolozaine/tazobactam
Carbapenems (except erta)
Cipro, levofloxacin
Aztreonam
AG
Colistimethate, polymyxin B
```
90
DOC for ESBL GNR (e. coli, K. pneumoniae, P. mirabilis)
Carbapenems
Ceftolozane/Tazobactam
Ceftazidime/avibactam
91
DOC for carbapenem resistant GNR
Ceftazidime/Avibactam
| Colistimethate, polymyxin B
92
DOC for aceinetobacter baumannii
Carbapenems (except erta)
93
DOC for bacteroides fragilis
Metronidazole
Beta-lactam+BL inhibitor
Cefotetan, cefoxitin
Carbapenems
94
DOC for C. diff
ORAL vanc
| Fidaxomicin
95
DOC for atypical organisms
Azithromycin, doxy, FQ
96
What abx do not require renal adjustment?
```
Diclox, nafcillin
Ceftriazone
Clindamycin
Doxycycline
Azithro and erythromycin
Metronidazole
Moxifloxacin
Linezolid
```
97
Meningitis empiric therapy for neonate (<1 month), 1month-50years, >50 years or immunocompromised
Neonate: Ampicillin + (cefotaxime or gent)
1 month-50 years: (Ceftriaxone or cefotaxime) + vanc
>50 or immunocompromised: Ampicillin + (ceftriaxone or cefotaxime) + vanc
98
When to observe for Acute Otitis Media (AOM) and not do abx
Observe for 2-3 days if sx are non-severe (mild pain < 48 hours or temp <102.2 and:
Age 6-23 months w/ sx in on ear
Age 2 and older with sx in one or both years
99
Outpatient CAP empiric therapy
No comorbidities: amox 1g TID or doxy or macrolide
Comorbidities (Chronic heart, lung, liver, renal disease, DM, alcoholism, malignancy, or asplenia): (amox/clav or cephalosporine) + (macrolide or doxy); Respiratory FQ monotherapy
100
Tuberculosis therapy
```
RIPE
Rifampin
Isoniazid (INH)
Pyrazinamide
Ethambutol
```
101
RIPE therapy drug-specific key points
All: increased LFTs
Rifampin: orange body secretions, strong CYP inducer
Isoniazid: peripheral neuropathy, hemolytic anemia
Rifampin: hemolytic anemia
Ethambutol: visual damages, confusion/halqlucinations
102
Primary C. diff treatment
1st episode non-severe or severe: vanc or fidaxomycin
| 1st episode fulminant/complicated: vanc PLUS metronidazole
103
Sx of chlamydia, gonohhrea, syphilis, HPV
Gonorrhea and Chlamydia: genital discharge and no sx
Syphilis: painless, smomoth genital sores (chancre)
HPV: genital warts or no sx
104
How to treat gonorrhea and chlamydia
Chlamydia: Azithro 1g or doxy 100 bid x 7
Gonorrhea: chlamydia + ceftriaxone 250mg IM
105
DOC for syphilis in pregnacy
PCN - even if PCN allergy!
| IM Pen G benzathine
106
Lyme disease and ringworm appearance and treatment
Lyme disease: bullseye rash, achy joints, fever; treat with doxy 100mg BID
Ringworm: raised rings, can be itchy; treat clotrimazole
107
Azole antifungal class effect and specifics for fluconazole, ketoconazole, itraconazole, voriconazole
Increased LFTs
Risk of QT prolongation
MANY drug interactions (cyp inhibitors)
Fluconazole: renal dose adjustment
Ketoconazole: hepatotoxicity that can lead to liver transplant
Itraconazole: HF
Voriconazole: visual changes and phototoxicity
108
What medications are preferred treatments for HIV and are taken once daily?
Biktarvy (2 NTRI and 1 INSTI) - contains TAF
Triumeq (2 NRTIs and 1 INSTI)
Dovato (1 NRTI and 1 INSTI)
109
What medications are preferred treatments for HIV and are 2 tablets once daily? Do they contain TAF or TDF?
(Tivicay or Isentress) + (Truvada or Descovy)
Truvada contains TDF
Descovy contains TAF
110
Triumeq indication and important note
HIV
| contains abacavir - test for HLA-B*5701
111
TDF vs TAF
TDF has more renal and bone issues than TAF
| Do not use TDF if renal impairment or high fracture risk
112
What are 2 boosters for HIV drugs? What are their interactions? What combo meds contain these boosters?
Ritonavir and Cobicistat
CYP3A4, 2D6, and P-gp transporter INHIBITORS
Contain cobicistat: Stribild, genvoya, symtuza, evotaz, prezcobix
Contain ritonavir: none - on it's own
113
HIV PEP vs PrEP
| Difference between the 2 - when to use and what drugs to use
PEP - POST exposure prophylaxis; use within 72-hours and take for 28 days
PEP Drugs: Truvada (TDF) + (Dolutegravir (Tivicay) or Raltegravir (Isentress)
PrEP - PRE exposure prophylaxis; use before high-risk activity and taken daily
PrEP Drugs: Truvada (TDF) or Descovy (TAF)
114
Key drugs that increase LDL and TG, LDL only, TG only
LDL and TG: diuretics, efavirenz, steroids, immunosuppressants, atypical antipsychotics, protease inhibitors
LDL: fish oils (except Vaxcepa)
TG: lipid emulsions, propofol, bile acid sequestrants
115
Who falls into each statin benefit group?
* **Clinical ASCVD - high
* **LDL 190 or higher - high
* **Diabetes, 40-75, LDL 70-189 - moderate/high
* **40-75 with LDL 70-189 - moderate/high
116
What are the statin equivalence doses?
```
Mod-intensity statins:
Pitava 2
Rosuva 5
Atorva 10
Simva 20
Lova 40
Prava 40
Fluva 80
```
Pharmacists Rock At Saving Lives and Preventing Fatty-deposits
117
How to reduce the risk fo myalgias with statins?
Avoid drug interactions - CYP inhibitors (GPACMAN)
Do not use simva 80mg/d
Do not use gemfibrozil + statin
118
Key drugs that increase BP
```
Amphetamines and ADHD drugs
Cocaine
Decongestants
ESA
Immunosuppressants
NSAIDs
Systemic steroids
```
119
When to start HTN treatment
Stage 2 HTN (SBP >140 or DBP > 90)
| Stage 1 HTN (SBP 130-139 or DBP 80-89) and clinical CVD or 10 year ASCVD risk >10%
120
BP goal for all patients
<130/80
121
```
Initial BP drug selection for
Non-black
Black
CKD
DM + albuminuria
```
Non-black: thiazide, CCB, ACEi or ARB
Black: thiazid or CCB
CKD: ACEi or ARB
DM + albuminuria: ACEi or ARB
122
Key IV HTN medications
```
Chlorothiazide
Clevidipine
Diltiazem
Enalaprilat
Esmolol
Hydralazine
Labetalol
Metoprolol tart
Nicardipine
Nitroglycerine
Nitroprusside
Propanolol
Verapamil
```
123
Treatment for Stable Ischemic Heart Disease (SIHD)
A - antiplatelet and antianginal drugs (BB, CCB, and nitrates)
B - BP and BB
C - Cholesterol (statins) and cigarettes (cessation)
D - Diet and diabetes
E - Exercise and education
124
Unstable angina, NSTEMI, and STEMI sx, cardiac enzymes, ECG changes, and blockage
Sx (all): chest pain
Cardiac enzymes: UA (-), NSTEMI and STEMI (+)
ECG changes: UA and NSTEMI - none or transient; STEMI - ST elevation
Blockage: UA and NSTEMI - partial; STEMI - complete
125
Drug treatment for Acute coronary syndromes (NSTEMI, ACS, and STEMI)
NSTEMI/ACS: MONA-GAP-BA +/- PIC
STEMI: MONA-GAP-BA + PCI or fibrinolytic
GpIIb/IIIa antagonsits (abciximab, eptifibatide)
Anticoagulants (LMWH, UFH, bivalirudin)
P2Y12 inhibitors
Beta Blockers
Ace inhibitors
126
What drugs are used for secondary prevention after ACS?
Aspirin 81 - indefinate
P2Y12 inhibitor - at least 12 months
Nitro 0.4 SL - indefinate
Beta blockers - at least 3 years; indefinate if HF or HTN management
ACEi - indefinate if EF <40%, HTN, CKD, DM
Aldosterone antagonist - indefinate if EF <40%
Statin - high intensity; indefinate
127
Labs indicating HF
```
Increased BNP (norm <100)
Increased NT-proBNP (norm <300)
```
128
S/sx of left vs right sided HF
Left: Orthopnea, nocturnal cough and SOB, crackling lung sounds, S3 gallop, hypoperfusion
Right: Peripheral edema, ascites, jugular venous distention, hepatojugular reflux, hepatomegaly
129
What drugs can worsen HF
```
DPP4 inhibitors (alo and saxagliptin)
Immunosuppressants nad interferons
Non-DHP CCBs
Antiarrhythmics
Thiazolidinediones
Itraconazole
Oncology drugs
NSAIDs
```
130
What medications are used to treat HF? Which decrease mortality? Which only improve sx?
Decrease mortality: ACEi/ARB, ARNI, Beta blockers, Aldosterone receptor antagonists; (hydralazine and nitrates in black patients)
Decrease mortality: Loop diuretics, digoxin, ivabradine
Unsure: SGLT2 inhibitors
131
Options if pt is unable to swallow potassium pill
Klor-Con M - can cut in half or dissolve in water
| Micro-K, Klor-Con Sprinkle: can sprinkle capsule contents on small amount of applesauce or pudding
132
What are 3 causes of arrhythmias?
- SA node firing abnormally
- Scar tissue from MI
- Another part of the heart is acting as a pacemaker too
133
Drugs that increase or prolong QT interval
```
Antiarrhythmics
FQ and macrolides
TCAs
SSRI/SNRI
5-HT3 RA, droperidol, phenothiazines
Antipsychotics (most)
Donepezil, fingolimod, methadone, tacrolimus
```
134
Which drugs are antiarrhythmics and what class are they?
Class I: Disopyramide, quiniidne, procainamide, lidocaine, mexiletine, flecainide, propafenone
Class II: beta blockers
Class III: Dronedarone, dofetilide, sotalol, ibutilide, amiodarone
Class IV: Verapamil, diltiazem
135
Which medications are used in rate control in afib?
Beta blockers
Non-DHP CCBs
Digoxin
136
Which medications are used in rhythm control in afib?
Cardioversion
| Dronedarone, dofetilide, sotalol, ibutilide, amiodarone
137
What factors does warfarin inhibit?
```
SN(1)OT
Seven
Nine
Ten (10)
Two
```
138
What factors do rivaroxaban, apixaban, edoxaban, and betrixaban inhibit?
Factor Xa (DIRECT)
139
What factors does fondaparinux inhibit?
Factor Xa (INDIRECT via antithrombin)
140
What factors do UFH and LMWH inhibit?
Xa and IIa via antithrombin
| LMWH Xa>IIa
141
Which factors do argatroban, bivalrudin, and dabigatran inhibit?
Thrombin IIa
142
When to use DOAC vs Warfarin in patients with afib
DOAC: most of the time
Warfarin: moderate-to-severe mitral stenosis or mechanical heart falve
143
When to use DOAC vs LMWH in patients with VTE?
DOAC: most of the time
LMWH: if pt has cancer
144
How to switch from warfarin to DOAC?
```
Stop warfarin and convert when INR is:
Rivaroxaban <3
Edoxaban 2.5 or less
Apixaban <2
Dabigatran <2
READ
```
145
What are the warfarin tablet colors
```
Please Let Greg Brown Bring Peaches To Your Wedding
Pink - 1
Lavender - 2
Green - 2.5
Brown - 3
Blue - 4
Peach - 5
Teal - 6
Yellow - 7.5
White - 10
```
146
What foods are high in vitamin K? What will this do to INR in someone on warfarin?
```
Broccoli
Brussel sprouts
Cabbage
Spinach
Tea (green/black)
Decrease INR
```
147
CHADSVASc Score calculation; when to anticoagulate?
```
C - CHF
H - HTN
A - Age >75 (2)
D - Diabetes
S - Stroke (2)
V - Vascular disease
A - Age 65-74
S - sex (F=1)
```
Recommended if score 2 or higher in males or 3 or higher in females
148
How much elemental iron is recommended in someone with iron deficiency anemia?
What percentage of elemental iron is in each oral iron product?
```
100-200 mg elemental iron/d
Ferrous gluconate - 12%
Ferrous sulfate - 20%
Ferrous sulfate, dried - 30%
Ferrous fumarate - 33%
Carbonyl iron, polysaccharide iron complex, ferric maltol - 100%
```
149
What drugs can cause hemolytic anemia?
```
Cephalosporins
Dapsone
Isoniazid
Levodopa
Methyldopa
Methylene blue
Nitrofurantoin
Pegloticase
PCN
Primaquine
Quinidine
Quinine
Rasburicase
Rifampin
Sulfonamides
```
150
What vaccines are recommended in sickle cell disease?
Childhood: H. influe type B (Hib) and PCV13 or Prevnar
Functional asplenia: Meningococcal conjugate, Meningococcal serogroup B (Bexsero, Trumenba), Pneumonia (PPSV23, Pneumovax 23), Pneumococcal conjugate x1 (PCV13, Prevnar)
151
Diphenhydramine class, indications, and disease states it can worsen
First generation antihistamine
Indications: allergic reaction treatment and prevention, allergic rhinitis, cough, sleep, dystonic reactions, motion sickness\
Can worsen BPH, constipation, dementia, glaucoma
152
```
What do the following mean when included in cough and cold combo products?
D
PE
DM
AC
```
D - decongestant
PE - phenylephrine
DM - dextromethorphan
AC - codeine
153
What cough and cold meds should be cautioned in patients <18, <4, and <2
<18 - codeine and hydrocodone-containing cough and cold products
<4 - avoid OTC cough and cold products (package labeling)
<2 - avoid OTC cough and cold products (FDA), avoid promethazine (FDA), avoid topical methol and camphor (Package labeling)
154
What drugs can increase intraocular pressure?
Anticholinergics
Cough, cold, and motion sickness medications
Chronic steroids, especially eye drops
Topiramate
155
What medications are used to treat glaucoma and how do they work?
Reduce aqueous humor production: beta blockers (timolol)
Increase aqueous humor outflow - prostaglandin analogs (latanoprost, bimatoprost, travoprost, bimatoprost)
Both - alpha-2 agonists (brimonidine)
156
What medications are known to cause
| retinal changes/retinopathy
Chloroquine
| Hydroxychloroquine
157
What medications are known to cause
| Optic neuropathy
Amiodarone (plus corneal deposits)
Ethambutol
Linezoid
158
What medications are known to cause
| Floppy iris syndrome
Alpha-blockers (doxazosin)
159
What medications are known to cause
| Color discrimination
Digoxin - yellow/green
PDE-5 inhibitors - greenish tinge
Voriconazole - color vision changes
160
What medications are known to cause
| Vision loss/abnormal vision
```
Digoxin (with toxicity)
PDE-5 inhibitors
Isotretinoin
Vigabatrin
Voriconazole
```
161
What drugs can cause pulmonary arterial hypertension (PAH)?
Cocaine
SSRI use during pregnancy (in baby)
Weight loss drugs
Methamphetamines/Amphetamines
162
What drugs can cause pulmonary fibrosis?
```
Amiodarone/dronedarone
Bleomycin
Busulfan
Carmustine
Lomustine
```
163
FEV1, FVC, adn FEV1/FVC definitions
FEV1: how much air can be forcefully exhaled in one second
FVC: After taking deep breath, max volume of air exhaled
FEV1/FVC: percentage of total air capacity that can be forcefully exhaled in one second
164
If a patient is at ___% of personal best on the peak flow meter, what should they do?
>80% - continue
50-80% - caution, requires action plan
<50% - medical alert, go to ER
165
```
What tobacco cessation medication should be used in patients who:
Want to avoid weight gain
Have depression
Have dentures
Asthma/COPD
Skin conditions
Seizures
```
```
Avoid weight gain: bupropion SR, gum, lozenge
Depression: bupropion SR
Dentures: avoid gum
Asthma/COPD: avoid inhaler or spray
Skin conditions: avoid patch
Seizures: avoid bupropion, varenicline
```
166
A1c, FPG, and 2hr PPG after OGTT to diagnose pre-diabetes and diabetes
Diabetes: A1c 6.5 or higher; FPG 126 or higher; 2-hr PPG 200 or higher
Pre-diabetes: A1c 5.7-6.4; FPG 100-125; 2-hr PPG 140-199
167
What 3 medications are used first line in T2DM?
Metformin
GLP-1 RA - use if CrCl <30
SGLT2i - if HF or CKD issue, add to metformin first
168
If changing from NPH dosed BID or Toujeo dosed daily to lantus or basaglar dosed daily, what dose should you use?
How are other insulins converted?
80% of TDD of NPH given once daily
| Others are 1:1 conversion
169
What insulin comes in concentration greater than 100u/mL?
Rapid: humalog KwikPen (lispro): 200u/mL
Regular: humulin R U-500 Kwiken AND vial: 500u/mL
Long-acting: Tresiba FlexTouch (degludec) 200u/mL; Toujeo SoloStar, Toujeo Max SoloStar pens (glargine) 3000 u/mL
170
What drugs increase BG?
```
Beta blockers
Thiazides and loops
Diuretics
Tacrolimus
Cyclosporien
Protease inhibitors
Quniolones
Antipsychotics
Statins
Steroids
Cough syrups
Niacin
```
171
What drugs decrease BG?
```
Linezolid
Lorcaserin
Pentamidine
Beta blockers
Quinolones
Tramadol
```
172
What drugs to use in DKA and HHS
Aggressive fluids and insulin to lower BG (0.1 unit/kg bolus then 0.1 u/kg/hr)
Give potassium and sodium bicarb as needed
173
Drugs and conditions that can cause hypothyroidism
```
Interferons
Tyrosine kinase inhibitors (suitinib)
Amiodarone
Lithium
Carbamazepine
```
Hashiomoto's disease
174
Levothyroxine tablet colors
```
Orangutans Will Vomit On You Right Before They Become Large, Proud Giants
Orange - 25
White - 50
Violet - 75
Olive - 88
Yellow - 100
Rose - 112
Brown - 125
Turquoise - 137
Blue - 150
Lilac - 175
Pink - 200
Green - 300
```
175
S/sx of thyroid storm
```
Fever >103F
Tachycardia
Tachypnea
Dehydration
Profuse sweating
Agitation
Delirium
Psychosis
Coma
```
176
Steroids least to most potent
```
Cortisone
Hydrocortisone
Perdnisone
Prednisolone
Methylprednisolone
Triamcinolone
Dexamethasone
Betamethasone
```
177
A patient is considered immunosuppressed when taking >___ mg/kg/d or >___mg/d of prednisone equivalent for >2 weeks
2 mg/kg/d or more
| 20 mg/d or more
178
What drugs can cause DILE?
```
***Hydralazine (BiDil)
Methimazole
Propylthiouracil
Methyldopa
Minocyclilne
Procainamide
Anti-TNF agents
Terbinafine
Isoniazid
Quinidine
```
179
What drugs can cause or worsen Raynaud's
Beta blockers
Bleomycin
Cisplatin
Sympathomimetics
180
If a birth control product contains the following in it's name, what does the product contain?
Lo
Fe
24
Lo - low dose estrogen (35 mcg or less)
Fe - iron supplement
24 - shorter placebo
181
What are the severe and rare adverse effects of estrogen?
```
ACHES
Abdominal pain - liver, gallbladder
Chest pain - MI, PE
HA - stroke
Eye problems - blood clot in eye
Swelling in leg - DVT
```
182
What medications are used to treat infertility and how do they work?
Clomiphene - SERM which causes surge in LH/FSH and causes ovulation
Gonadotropins - act as LH, FSH, or hCG and cause ovulation
***can result in multiple births
183
What acne medications are teratogenic?
Isotretinoin
| Topical retinoids
184
What antibiotics are teratogenic?
FQ and tetracyclines
185
What migraine medications are teratogenic?
Dihydroergotamine, ergotamine
186
How is osteoporosis diagnosed?
T-score of -2.5 or less
Osteopenia is -1 to -2.4
Normal: is -1 or higher
187
How much calcium and vitamin D is recommended in most adults?
Calcium: 1000-1200 mg elemental calcium
| Vitamin D 5000-7000 units/d or 50,000/week
188
What % elemental calcium is calcium carbonate (Tums)? calcium citrate (citracal)? Which needs to be taken with food?
Tums: 40%
Calcium citrate: 21%
Take tums with food
189
What is considered a low Vitamin D level?
<30 ng/mL
190
What is 1st line therapy for osteoporosis? Administration notes? SE? Treatment duration? Alternative therapy if can't use
Bisphosphonates (PO: Alendronate, risendronate, ibandronate; IV: ibandronate, zometa)
PO: take with glass of water and stay upright for 30 minutes
SE: esophagitis, hypocalcemia, GI effects
Treatment duration: 3-5 years
Alternate therapy: Denosumab
191
Hormonal therapy options for menopause
Estrogen: most effective but if uterus present MUST GIVE WITH progesterone to prevent increased risk of endometrial cancer
Progestin: can be given alone or in combo with estrogen, can cause mood disturbances
192
What drugs can cause erectile/sexual dysfunction
```
Alcohol
Antidepressants (SSRI/SNRI)
Antihypertensives (BB, clonidine)
Antipsychotics
BPH medications
```
193
Typical starting dose of viagra and cialis? When to reduce dose
V: 50mg
C: 10mg
Reduce dose if 65 or older, using alpha-blocker, using CYP3A4 inhibitor, severe renal or liver disease
194
What drugs can worsen BPH?
```
Benztropine
Anticholinergics
Caffeine
Diuretics
SNRIs
Testosterone products
```
195
What are the low, medium, and high doses of dopamine? What receptors do they act on?
Low: 1-4 mcg/kg/min - dopamine 1 agonist
Medium: 5-10 mcg/kg/min - beta-1 agonist
High: 10-20 mcg/kg/min - alpha 1 agonist
196
General principles when treating shock
Hydrate with crystalloids (as needed)
Peripheral vasoconstrictors to increase SVR
Beta-1 agonist to increase myocardial contractility and cardiac output
197
What are the 2 most common infections in the ICU?
VAP and UTI from catheter
198
How to treat acute decompensated HF (ADHF)?
Volume overload - Loops +/- vasodilators
| Hypoperfusion - inotropes (dobutamine, milrinone) +/- vasopressor (dopamine, norepi)
199
What medications are contraindicated and not generally recommended in pediatrics?
CI: Codeine and tramadol <12; Promethazine <2; ceftriaxone <28 days
Not recommended: Quinolones, tetracyclines <8 years, OTC teething medications containing benzocaine in age <2, OTC cough and cold preparations in age <6
200
When treating CF, what 5 medications are used and in what order?
1) Inhaled bronchodilators (opens airway)
2) Hypertonic saline (mobilizes mucous)
3) Dornase alfa (Decreases viscosity of mucus)
4) chest physiotherapy (mobilizes mucous)
5) inhaled abx (controls airway infection)
201
What medications are used for induction immunosuppression? Maintenance immunosuppression?
Induction: Basilizimab (IL-2 receptor ant), antithymocyte globulin, maintenance drugs at high doses
Maintenance: Calcineurin inhibitors (tacrolimus or cyclosporine), antiproliferative agents (mycophenolate or azathioprine), mTOR inhibitors (everolimus or sirolimus), belatacept; steroids
202
What BBW do transplant drugs carry
Infection risk
| Cancer risk
203
What drugs can cause weight gain
```
Antipsychotics
Diabetes drugs (insulin, meglitinides, sulfonylureas, TZDs)
Divalproex/valproic acid
Gabapentin, pregabalin
Lithium
Mirtazapine
Steroids
TCAs
```
204
What drugs can cause weight loss?
```
ADHD drugs
Bupropion
GLP-1 agonists
Pramlintide
Roflumilast
SGLT2 inhibitors
Topiramate
```
205
How does NAC work as an antidote for APAP overdose?
Restores glutathione
206
What do NSAIDS cause an issue with if given to a pregnant lady within 14 days of birth?
ductus arteriosus
207
First line therapy for opioid induced diarrhea
Stimulant laxatives bisacodyl +/- senna OR PMAORAS [Methylnaltreone (Relistor) or Naloxegol (Movantic)]
208
What are common migraine triggers
```
Hormonal changes in women
Foods
Stress
Sensory stimuli (light, smell)
Changes in wake-sleep pattern
Changes in environment
```
209
What triptans come as tablets, ODTs, Nasal sprays, powder, SQ injection?
```
Tablets: all
ODTs: rizatriptan, zolmitriptan
Nasal spray: sumatriptan, zolmitriptan
Powder: sumatriptan
SQ: Sumatriptan
```
210
What drugs increase uric acid
```
ASA - low dose
Calcineurin inhibitors (tacrolimus and cyclosporine)
Diuretics
Niacin
Pyrazinamide
Select chemo (tumor lysis syndrome)
```
211
Why is colchicine given initially with xanthine oxidase inhibitor (XOI)?
XOI can cause uric acid levels to increase and colchicine prevents this
212
When treating gout - if pt is on xanthine oxidase inhibitor (XOI) and uric acid is >6, what should be added on?
Probenedic or lesinurad daily + XOI
OR
Replace XOI with IV pegloticase (Krystexxa)
213
Maximum lifetime doses for bleomycin, doxorubicin, cisplatin, and vincristine - why?
Bleomycin: 400 units - pulmonary toxicity
Doxorubicin: 450-550 mg/m2 - cardiotoxicity
Cisplatin: 100 mg/m2 per cycle - nephrotoxicity
Vincristine: 2mg single dose - neuropathy
214
What oncology meds cause pulmonary fibrosis
Bleomycin
Busulfan
Carmustine
Lomustine
215
What oncology meds cause nephrotoxicity and ototoxicity?
Platinum-based (Cisplatin, carboplatin)
216
What oncology meds cause cardiotoxicity?
Doxorubicin
| Anthracyclines
217
What oncology meds cause mucositis
Methotrexate
218
What oncology meds cause neurotoxicity
Nitrosoureas
Lomustine
Carmustine
219
What oncology meds cause hemorrhagic cystitis
Ifosfamide and cyclophosphamide
220
What oncology meds can cause peripheral neuropathy
Vinca alkaloids: vincristine, vinblastine nad vinorelbine
| Taxanes: paclitaxel, docetaxel
221
What oncology meds can cause autoimmune syndromes?
Immunotherpay targeting CTLA-4 or PDL-1 ipilimumab, atezolizumab, durvalumab, nivolumab, pembrolizumab
222
What is given with cisplatin to try to prevent nephrotoxicity?
Amifostine
223
What is given with doxorubicin to try to prevent cardiomyopathy?
Dexrazoxane
224
Doxorubicin extravasation treatment
Dexrazoxane
225
What is given with flurouracil to enhance efficacy
Leucovorin or levoleucovorin
226
What is given with ifosfamide to prevent hemorrhagic cystitis?
Mesna
227
What is given with irinotecan to prevent acute diarrhea? Delayed diarrhea?
Acute: atropine
Acute: loperamide
228
What oncology meds are VEGF inhibitors?
Bevacizumab
| Ramucirumab
229
What oncology meds inhibit EGFR
Cetuximab
| Panituuab
230
What onchology meds inhibit HER2
Trastuzumab
| Pertuzumab
231
What are DSM-5 criteria for depression?
Depressed mood, diminished interest/pleasure, and at least 3 of the following in the same 2 week period
M SIGECAPS
```
Mood - depressed
Sleep - increased/decreased
Interest pleasure - diminished
Guilt or feelings of worthlessness
Energy - decreased
Concentration - decreased
Appetite - increased/decreased
Psychomotor agitation or retardation
Suicidal ideation
```
232
Drugs that can cause or worsen depression
```
Atomoxetine (Strattera)
Indomethacin
Efavirenz
Rilpivirine
Beta blockers (propranolol)
Hormonal contraceptives
Benzos
Antidepressants
Systemic steroids
Interferns
Ethanol
```
233
How long to separate MAOi from SSRI, SNRI, TCAs and bupropion?
All 2 weeks except fluoxetine which needs 5 weeks before starting MAOi d/t long half life
234
Which antidepressant should be used if cardiac/QT risk?
Sertraline preferred
| Do not use citalopram or escitalopram
235
Which antidepressant should be used if the patient is a smoker?
Bupropion SR
236
Which antidepressant should be used in peripheral neuropathy/pain
Duloxetine
237
Which antidepressant should not be used in seizure disorder?
NOT bupropion
238
Which antidepressant should be used in pregnancy
NOT paroxetine
| Severe depression - SSRI
239
Which antidepressant should be used in someone with daytime sedation?
take fluoxetine or bupropion in the morning
240
Which antidepressant should be used in someone with insomnia
Take sedating medications at night - paroxetine, mirtazpine, trazodone
241
What meds can cause psychotic symptoms?
```
Anticholinergics
Dextromethorphan
Dopamine
Interferons
Stimulants
Systemic steroids
Bath salts
Cannabis
Cocaine
LSD
Methamphetamine
PCP
```
242
DOC for mania
Lithium
243
Lithium equivalents when converting to lithium citrate syrup to lithium carbonate. How many mEq lithium ion in each
5mL lithium citrate syrup = 300 mg lithium carbonate tabs/caps
8mEq of lithium ion
244
Which ADHD meds are given in the morning vs at night?
Morning: Concerta, Daytrana, Ritalin, Vivanse, Adderall, Strattera
Night: clonidine, diphenhydramine, melatonin
245
What drugs can cause anxiety?
```
Albuterol
Antipsychotics (aripiprazole, haloperidol)
Bupropion
Caffeine
Decongestants
Illicit drugs
Levothyroxine
Steroids
Stimulants
Theophylline
```
246
What are benzos not preferred for? Which are preferred when they are used?
NOT preferred for anxiety or sleep
Anxiety: clonazepam, lorazepam, alprazolam, diazepam
Sleep: lorazepam or temazepam
247
Which benzos are preferred in elderly and liver impaired pts
LOT
Lorazepam
Oxazepam
Temazepam
248
What drugs can worsen insomnia?
```
Donepezil
Alcohol
Emtricitamine, INSTIs
Aripiprazole
Atomoxetine
Bupropion
Caffeine
Decongestants
Diuretics
Fluoxetine (if taken later in the day)
Steroids
Stimulants
Varenicline
```
249
What drugs are used to help pts fall AND stay asleep?
Eszopiclone
| Zolpidem
250
Major symptoms of parkinson's disease
```
TRAP
Tremor
Rigidity
Akinesia/bradykinesia
Postural instability
```
251
What drugs can worsen parkinsons disease?
Phenothiazines (prochlorperizine)
Halopericol, droperidol
Risperidone, paliperidone
Metoclopramide
252
What drugs can worsen dementia?
```
Antiemetics
Diphenhydramine
Doxylamine
Chlorpromazine, aripiprazole
Phenobarb, butalbital
Benzos
Benztropine
Peripheral anticholinergics
Skeletal muscle relaxants
Opioids
Sedative hypnotics
```
253
What drugs can lower seizure threshold?
```
Bupropion
Clozapine
Theophylline
Varenicline
Carbapenems
Lithium
Meperidine
PCN
Quinolones
Tramadol
```
254
Which medications MUST be dialed and locked by the pharmacist before dispensing?
Diastat
255
Safety considerations for carbamazepine, oxcarbazepine, adn eslicarbazepine
Hyponatremia
Rash
Enzyme inducers
256
Safety considerations for gabapentin and pregabalin
weight gain, peripheral edema, mild euphoria
257
Safety considerations for phenobarb and primidone
Sedation, dependence/tolerance/overdose risk, enzyme inducer
258
Safety considerations for topiramate and zonisamide
Weight loss, metabolic acidosis, nephrolithiasis and oligohidrosis/hyperthermia (in children)
259
What vitamins to supplement on antiepileptic drugs
All: Calcium and vitamin D
Women: folate
Valproic acid: carnitine
Lamotrigine and valproic acid: selenium and zinc for alopecia
260
What do the colors of the lamotrigine starting kits mean?
Orange: standard
Blue: low (if also taking valproic acid)
Green: higher (if also taking inducer)
261
Fosphenytoin and phenytoin administration notes
Fosphenytoin: max of 150mg/min, monitor BP
Phenytoin: max of 50mg/min, requires filter, dilute in NS
262
How to calculate pheytoin corrected dose
Use if albumin is <3.5 and CrCl >10
Total phenytoin measured
----------------------------
(0.2xalbumin)+0.1
***DO NOT use for free phenytoin levels!
263
What are the therapeutic levels of phenytoin?
Total: 10-20 mcg/mL
Free: 1-2.5
