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NAPLEX Review > STG and KDG > Flashcards

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
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2
Q

Major CYP inducers

A 
CROPPSS
Carbamazepine
Rifampin
Oxycarbamazepine
Phenytoin
Phenobarb
St. John's word
Smoking
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3
Q

What does the orange book contain

A

List of approved drugs that can be interchanged with generics based on therapeutic equivalence

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4
Q

What does the pink book contain

A

Info on epidemiology and vaccine-preventable diseases

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5
Q

What does the pink sheet contain

A

News report on regulatory, legislative, legal and business

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6
Q

What does the Purple book contain

A

List of biological drug products, including biosimilars

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7
Q

What does the red book contain

A

Drug pricing information

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8
Q

What does the Red book, pediatric contain?

A

Summaries of pediatric infectious diseases, antimicrobial treatment and vaccinations

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9
Q

What does the yellow book contain?

A

Travel vaccines and prophylaxis meds

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10
Q

What does the green book contain

A

Info on approved animal drug products

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11
Q

What patches are applied BID?

A

Diclofenac

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12
Q

What patches are applied twice weekly?

A

Estradiol

Oxybutynin

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13
Q

What patches are applies weekly?

A 
Buprenorphine
Clonidine
Estradiol
Estradiol/levonorgestrel
Ethinyl estradiol/norelgestromin
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14
Q

What medications have sorption or leaching issues with PVC

A 
Lorazepam
Amiodrone
Tacrolimus
Taxanes
Insulin
Nitroglycerine
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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
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16
Q

What IV drugs are only compatible with dextrose?

A

Bactrim
Oxaliplatin
Amphotericin B
Quinupristin/Dalfopristin

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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)
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18
Q

What IV meds should not be refrigerated?

A 
Dexmedetomidine
Bactrim
Phenytoin
Furosemide
Metronidazole
Moxifloxacin
Enoxaparin
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19
Q

What IV meds are protect from light during administration?

A 
Phytonadione (vitamin K)
Epoprostenol
Nitroprusside
Micafungin
Doxycycline
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20
Q

How many mL in one pint?

A

473

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21
Q

How many grams per ounce?

A

28.4g

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22
Q

How many grains per gram?

A

15.432

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23
Q

How many kcal/g in enteral carbs, fat, and protein??

A

Carbs: 4
Fat: 9
Protein: 4

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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
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25
Q

What drugs can cause kidney disease?

A 
Aminoglycosides
Amphotericin B
Cisplatin
Cyclosporine
Loops
NSAIDs
Polymyxins
Radiographic contrast dye
Tacrolimus 
Vancomycin
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26
Q

CrCl calculation

A

72*SCr

MULTIPLY BY 0.85 FOR WOMEN

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27
Q

What drugs require decreased dose or increased dosing interval in CKD?

A 
Aminoglycosides
Beta-lactams (not ceftriax)
Fluconazole
Quinolones
Vanc
LMWH
Rivarox, apix, and dabigatran for Afib
H2RAs
Metoclopramide
Bisphosphonates
Lithium
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28
Q

What drugs are CI with CrCl <60

A

Nitrofurantoin

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29
Q

What drugs are CI with CrCl <50

A 
Tenofovir disoproxil fumarate
Voriconazole IV (d/t vehicle)
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30
Q

What drugs are CI with CrCl <30

A

TAF
NSAIDs
Dabigatran (DVT/PE)
Rivaroxaban (DVT/PE)

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31
Q

What drugs are CI with GFR <30

A

SGLT2 inhibitors

Metformin

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32
Q

What drugs raise potassium?

A 
ACEi
Aldosterone receptor antagonists
Aliskiren
ARBs
Canagliflozin
Drospirenone-containing COCs
Potassium-containing IV fluids
Bactrim
Transplant drugs
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33
Q

Steps for treating hyperkalemia

A

Stabilize the heart (Calcium gluconate)
Move K intracellularly
Eliminate K from body

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34
Q

Drug classes used to treat hepatitis C

A

2-3 DAAs with different MOAs
NS3/4A: -previr
NS5a: -asvir
NS5B: -buvir

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35
Q 
What lab tests indicate 
Acute liver toxicity
Chronic liver disease
Alcoholic liver disease
Hepatic encephalopathy
Jaundice
A

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

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36
Q

What drugs have BBW for liver damage?

A 
APAP
Amiodarone
Isoniazid
Ketoconazole
Methotrexate
Nefazodone
Nevirapine
NRTIs
Propylthiouracil
Tipranavir
Valproic acid
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37
Q

What are common live vaccines?

A 
COZY IV RM
Cholera
Oral thyphoid
Zoster
Yellow fever
Intranasal influ
Varicella
Rotavirus
MMR
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38
Q

If patient is age _____ to ____ and not previously vaccinated, give 2 flu vaccines ____ weeks apart

A

6 months - 8 years

4 weeks

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39
Q

When to give PREVNAR 13 and PNEUMOVAX 23 before 65 and after 65

A

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

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40
Q

What drugs are used as prophylaxis and treatment of travelers’ diarrhea?

A

Prophylaxis: bismuth subsalicylate QID; rifaximin (only if high risk of complications)
Treatment: loperamide or bismuth subsalicylate; loperamide +/- abx (axithro preferred in severe)

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41
Q

What vaccines should travelers receive?

A 
Inactivated: 
Hep A and B
Japanese encephalitis
Meningococcus
Polio
Typhoid
Live: 
Cholera - PO
Typhoid - PO
Yellow fever - SQ
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42
Q

What can beta-lactam accumulation cause?

A

Seizures

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43
Q

Penicillin VK PO DOC for what

A

Strep throat and mild nonpurulent skin infections

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44
Q

Amoxicillin PO DOC for what

A

Acute otitis media
Infective endocarditis prophylaxis before dental procedure
H. pylori

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45
Q

Amox/clav PO DOC for what

A

Acute otitis media and sinus infections

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46
Q

Diclox and oxacillin PO used to treat what

A

Cover MSSA only (no MRSA)

No renal dose adjustment needed

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47
Q

Penicillin G IM DOC

A

Syphilis (2.4m x 1)

Not for IV use, can cause death

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48
Q

Nafcillin IV DOC

A

MSSA only (no MRSA)

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49
Q

Piperacillin/Tazobactam used for what bug

A

Pseudomonas (only PCN that works against it)

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50
Q

1st gen cephalosporines

A

Cefazolin
Cephalexin (Keflex)
Cefadroxil

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51
Q

2nd gen cephalosporines

A

Cefuroxime

Cefotetan (Cefotan)

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52
Q

3rd gen cephalosporines

A

Cefdinir
Ceftriaxone
Cefotaxime
Ceftazidime

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53
Q

4th gen cephalosporines

A

Cefepime

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54
Q

5th gen cephalosporine

A

Ceftaroline fosamil (Teflaro)

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55
Q

Cephalexin generation and common uses

A 
1st gen 
Skin infection (MSSA), strep throat
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56
Q

Cefuroxime generation and common uses

A

2nd gen

Acute otitis media, CAP, sinus infection

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57
Q

Cefdinir generation and common uses

A

3rd gen

CAP, sinus infection

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58
Q

Cefazolin generation and common uses

A

1st gen

Surgical prophylaxis

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59
Q

Cefotetan and cefoxitin generation and common uses

A

2nd gen
Anaerobic coverage
Surgical prophylaxis (colorectal procedures)

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60
Q

Which cephalosporine can have disulfiram-like reaction when consumed with alcohol?

A

Cefotetan

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61
Q

Ceftriaxone and cefotaxime generation and common uses

A

3rd gen

CAP, meningitis, spontaneous bacterial peritonitis, pyelonephritis

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62
Q

Ceftazidime and cefepime generation and common uses

A

Ceftaz: 3rd gen
Cefep: 4th gen
Active against pseuomonas

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63
Q

What beta lactams are used for MDR gram-negative organisms (including pseudomonas)

A

Ceftolozane/Tazobactam

Ceftazidime/Avibactam

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64
Q

What is the only beta-lactam active against MRSA?

A

Ceftaroline

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65
Q

Which carbapenems cover ESBL? Pseudomonas?

A

ESBL: all
Pseudomonas: all but ertapenem

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66
Q

Can you use carbapenems with PCN allergy?

A

No

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67
Q

What do carbapenems not cover?

A

Atypicals, VRE, MRSA, C diff, stenotrophomonas

ErtAPenem does not cover Enterococcus, Acinetobacter, or pseudomonas

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68
Q

What are carbapenems commonly used for?

A

Polymicrobial infections
Empiric therapy when resistant organisms are suspected
Resistant Pseudomonas or Acinetobacter infections (except ertapenem)

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69
Q

Which carbapenem must be diluted in NS?

A

Ertapenem

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70
Q

What are AG active against?

A

Gram-negatives

Synergistic with beta lactams for some organisms

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71
Q

Which abx have post-antibiotic effect

A

AG

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72
Q

Which are respiratory FQ and what are they used for?

A

Levofloxacin
Moxifloxacin
Gemifloxacin
Used for pneumonia

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73
Q

Which FQ have activity against pseudomonas?

A

Cipro

Levo

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74
Q

Which FQ is not renally adjusted? What can it not be used to treat

A

Moxifloxacin

Do not use to treat UTI

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75
Q

Which FQ are 1:1 IV:PO?

A

Levo and Moxi

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76
Q

Counseling and key features of FQ

A

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

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77
Q

Common uses of macrolides

A

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

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78
Q

Macrolide SE and interactions

A

SE: QT prolongation
Interaction: clarithromycin and erythromycin strong CYP3A4 inhibitors - DO NOT USE with lovastatin and simvastatin

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79
Q

Common uses of tetracyclines

A

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

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80
Q

When to not use tetracyclines

A

Pregnancy, breastfeeding, children < 8

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81
Q

Common uses of bactrim, components, interaction

A

Uses: CA-MRSA skin infection, UTI, PCP
SMX/TMP SS 400/80
SMX/TMP DS 800/160
Increase INR with warfarin - use different abx

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82
Q

Nitrofurantoin uses, CI, dosing, and counseling points

A 
DOC for uncomplicated UTI
CI: CrCl < 60
Dosing: macroBID is BID, macrodantin is QID
Take with food to prevent nausea
Can discolor urine (brown)
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83
Q

DOC for MSSA infection

A

Diclox, nafcillin, oxacillin
Cefazolin, cephalexin
Amox/clav
Amp/sulbactam

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84
Q

DOC for CA-MRSA

A

Bactrim
Doxy, mino
Clinda
Linezolid

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85
Q

DOC for severe SSTI requiring IV treatment or hospitalization

A

***Cover for MRSA and strep
Vanc (do not use if MIC 2 or higher)
Linezolid, Dapto, ceftaroline

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86
Q

DOC for nosocomial MRSA (MRSA from hospital)

A

Vanco
Linezolid
Dapto (not in pneumonia)

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87
Q

DOC for VRE faecalis

A

Pen G or ampicillin
Linezolid
Dapto
Cystitis: nitrofurantoin, fosfomycin, doxy

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88
Q

DOC for VRE faecium

A

Dapto
Linezolid
Cystitis: nitrofurantoin, fosfomycin, doxy

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89
Q

DOC for pseudomonas

A 
Pip/tazo
Cefepime
Ceftazidime +/- avibactam
Ceftolozaine/tazobactam
Carbapenems (except erta)
Cipro, levofloxacin
Aztreonam
AG
Colistimethate, polymyxin B
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90
Q

DOC for ESBL GNR (e. coli, K. pneumoniae, P. mirabilis)

A

Carbapenems
Ceftolozane/Tazobactam
Ceftazidime/avibactam

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91
Q

DOC for carbapenem resistant GNR

A

Ceftazidime/Avibactam

Colistimethate, polymyxin B

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92
Q

DOC for aceinetobacter baumannii

A

Carbapenems (except erta)

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93
Q

DOC for bacteroides fragilis

A

Metronidazole
Beta-lactam+BL inhibitor
Cefotetan, cefoxitin
Carbapenems

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94
Q

DOC for C. diff

A

ORAL vanc

Fidaxomicin

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95
Q

DOC for atypical organisms

A

Azithromycin, doxy, FQ

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96
Q

What abx do not require renal adjustment?

A 
Diclox, nafcillin
Ceftriazone
Clindamycin
Doxycycline
Azithro and erythromycin
Metronidazole
Moxifloxacin
Linezolid
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97
Q

Meningitis empiric therapy for neonate (<1 month), 1month-50years, >50 years or immunocompromised

A

Neonate: Ampicillin + (cefotaxime or gent)
1 month-50 years: (Ceftriaxone or cefotaxime) + vanc
>50 or immunocompromised: Ampicillin + (ceftriaxone or cefotaxime) + vanc

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98
Q

When to observe for Acute Otitis Media (AOM) and not do abx

A

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

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99
Q

Outpatient CAP empiric therapy

A

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

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100
Q

Tuberculosis therapy

A 
RIPE
Rifampin
Isoniazid (INH)
Pyrazinamide
Ethambutol
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101
Q

RIPE therapy drug-specific key points

A

All: increased LFTs
Rifampin: orange body secretions, strong CYP inducer
Isoniazid: peripheral neuropathy, hemolytic anemia
Rifampin: hemolytic anemia
Ethambutol: visual damages, confusion/halqlucinations

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102
Q

Primary C. diff treatment

A

1st episode non-severe or severe: vanc or fidaxomycin

1st episode fulminant/complicated: vanc PLUS metronidazole

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103
Q

Sx of chlamydia, gonohhrea, syphilis, HPV

A

Gonorrhea and Chlamydia: genital discharge and no sx
Syphilis: painless, smomoth genital sores (chancre)
HPV: genital warts or no sx

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104
Q

How to treat gonorrhea and chlamydia

A

Chlamydia: Azithro 1g or doxy 100 bid x 7
Gonorrhea: chlamydia + ceftriaxone 250mg IM

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105
Q

DOC for syphilis in pregnacy

A

PCN - even if PCN allergy!

IM Pen G benzathine

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106
Q

Lyme disease and ringworm appearance and treatment

A

Lyme disease: bullseye rash, achy joints, fever; treat with doxy 100mg BID
Ringworm: raised rings, can be itchy; treat clotrimazole

107
Q

Azole antifungal class effect and specifics for fluconazole, ketoconazole, itraconazole, voriconazole

A

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
Q

What medications are preferred treatments for HIV and are taken once daily?

A

Biktarvy (2 NTRI and 1 INSTI) - contains TAF
Triumeq (2 NRTIs and 1 INSTI)
Dovato (1 NRTI and 1 INSTI)

109
Q

What medications are preferred treatments for HIV and are 2 tablets once daily? Do they contain TAF or TDF?

A

(Tivicay or Isentress) + (Truvada or Descovy)
Truvada contains TDF
Descovy contains TAF

110
Q

Triumeq indication and important note

A

HIV

contains abacavir - test for HLA-B*5701

111
Q

TDF vs TAF

A

TDF has more renal and bone issues than TAF

Do not use TDF if renal impairment or high fracture risk

112
Q

What are 2 boosters for HIV drugs? What are their interactions? What combo meds contain these boosters?

A

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
Q

HIV PEP vs PrEP

Difference between the 2 - when to use and what drugs to use

A

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
Q

Key drugs that increase LDL and TG, LDL only, TG only

A

LDL and TG: diuretics, efavirenz, steroids, immunosuppressants, atypical antipsychotics, protease inhibitors
LDL: fish oils (except Vaxcepa)
TG: lipid emulsions, propofol, bile acid sequestrants

115
Q

Who falls into each statin benefit group?

A
  • **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
Q

What are the statin equivalence doses?

A 
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
Q

How to reduce the risk fo myalgias with statins?

A

Avoid drug interactions - CYP inhibitors (GPACMAN)
Do not use simva 80mg/d
Do not use gemfibrozil + statin

118
Q

Key drugs that increase BP

A 
Amphetamines and ADHD drugs
Cocaine
Decongestants
ESA
Immunosuppressants
NSAIDs
Systemic steroids
119
Q

When to start HTN treatment

A

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
Q

BP goal for all patients

A

<130/80

121
Q 
Initial BP drug selection for
Non-black
Black
CKD
DM + albuminuria
A

Non-black: thiazide, CCB, ACEi or ARB
Black: thiazid or CCB
CKD: ACEi or ARB
DM + albuminuria: ACEi or ARB

122
Q

Key IV HTN medications

A 
Chlorothiazide
Clevidipine
Diltiazem
Enalaprilat
Esmolol
Hydralazine
Labetalol
Metoprolol tart
Nicardipine
Nitroglycerine
Nitroprusside
Propanolol
Verapamil
123
Q

Treatment for Stable Ischemic Heart Disease (SIHD)

A

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
Q

Unstable angina, NSTEMI, and STEMI sx, cardiac enzymes, ECG changes, and blockage

A

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
Q

Drug treatment for Acute coronary syndromes (NSTEMI, ACS, and STEMI)

A

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
Q

What drugs are used for secondary prevention after ACS?

A

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
Q

Labs indicating HF

A 
Increased BNP (norm <100)
Increased NT-proBNP (norm <300)
128
Q

S/sx of left vs right sided HF

A

Left: Orthopnea, nocturnal cough and SOB, crackling lung sounds, S3 gallop, hypoperfusion
Right: Peripheral edema, ascites, jugular venous distention, hepatojugular reflux, hepatomegaly

129
Q

What drugs can worsen HF

A 
DPP4 inhibitors (alo and saxagliptin)
Immunosuppressants nad interferons
Non-DHP CCBs
Antiarrhythmics
Thiazolidinediones
Itraconazole
Oncology drugs
NSAIDs
130
Q

What medications are used to treat HF? Which decrease mortality? Which only improve sx?

A

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
Q

Options if pt is unable to swallow potassium pill

A

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
Q

What are 3 causes of arrhythmias?

A
  • SA node firing abnormally
  • Scar tissue from MI
  • Another part of the heart is acting as a pacemaker too
133
Q

Drugs that increase or prolong QT interval

A 
Antiarrhythmics
FQ and macrolides
TCAs
SSRI/SNRI
5-HT3 RA, droperidol, phenothiazines
Antipsychotics (most)
Donepezil, fingolimod, methadone, tacrolimus
134
Q

Which drugs are antiarrhythmics and what class are they?

A

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
Q

Which medications are used in rate control in afib?

A

Beta blockers
Non-DHP CCBs
Digoxin

136
Q

Which medications are used in rhythm control in afib?

A

Cardioversion

Dronedarone, dofetilide, sotalol, ibutilide, amiodarone

137
Q

What factors does warfarin inhibit?

A 
SN(1)OT
Seven
Nine
Ten (10)
Two
138
Q

What factors do rivaroxaban, apixaban, edoxaban, and betrixaban inhibit?

A

Factor Xa (DIRECT)

139
Q

What factors does fondaparinux inhibit?

A

Factor Xa (INDIRECT via antithrombin)

140
Q

What factors do UFH and LMWH inhibit?

A

Xa and IIa via antithrombin

LMWH Xa>IIa

141
Q

Which factors do argatroban, bivalrudin, and dabigatran inhibit?

A

Thrombin IIa

142
Q

When to use DOAC vs Warfarin in patients with afib

A

DOAC: most of the time
Warfarin: moderate-to-severe mitral stenosis or mechanical heart falve

143
Q

When to use DOAC vs LMWH in patients with VTE?

A

DOAC: most of the time
LMWH: if pt has cancer

144
Q

How to switch from warfarin to DOAC?

A 
Stop warfarin and convert when INR is: 
Rivaroxaban <3
Edoxaban 2.5 or less
Apixaban <2
Dabigatran <2
READ
145
Q

What are the warfarin tablet colors

A 
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
Q

What foods are high in vitamin K? What will this do to INR in someone on warfarin?

A 
Broccoli
Brussel sprouts
Cabbage
Spinach
Tea (green/black)
Decrease INR
147
Q

CHADSVASc Score calculation; when to anticoagulate?

A 
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
Q

How much elemental iron is recommended in someone with iron deficiency anemia?
What percentage of elemental iron is in each oral iron product?

A 
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
Q

What drugs can cause hemolytic anemia?

A 
Cephalosporins
Dapsone
Isoniazid
Levodopa
Methyldopa
Methylene blue
Nitrofurantoin
Pegloticase
PCN
Primaquine
Quinidine
Quinine 
Rasburicase
Rifampin
Sulfonamides
150
Q

What vaccines are recommended in sickle cell disease?

A

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
Q

Diphenhydramine class, indications, and disease states it can worsen

A

First generation antihistamine
Indications: allergic reaction treatment and prevention, allergic rhinitis, cough, sleep, dystonic reactions, motion sickness\
Can worsen BPH, constipation, dementia, glaucoma

152
Q 
What do the following mean when included in cough and cold combo products?
D
PE
DM
AC
A

D - decongestant
PE - phenylephrine
DM - dextromethorphan
AC - codeine

153
Q

What cough and cold meds should be cautioned in patients <18, <4, and <2

A

<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
Q

What drugs can increase intraocular pressure?

A

Anticholinergics
Cough, cold, and motion sickness medications
Chronic steroids, especially eye drops
Topiramate

155
Q

What medications are used to treat glaucoma and how do they work?

A

Reduce aqueous humor production: beta blockers (timolol)
Increase aqueous humor outflow - prostaglandin analogs (latanoprost, bimatoprost, travoprost, bimatoprost)
Both - alpha-2 agonists (brimonidine)

156
Q

What medications are known to cause

retinal changes/retinopathy

A

Chloroquine

Hydroxychloroquine

157
Q

What medications are known to cause

Optic neuropathy

A

Amiodarone (plus corneal deposits)
Ethambutol
Linezoid

158
Q

What medications are known to cause

Floppy iris syndrome

A

Alpha-blockers (doxazosin)

159
Q

What medications are known to cause

Color discrimination

A

Digoxin - yellow/green
PDE-5 inhibitors - greenish tinge
Voriconazole - color vision changes

160
Q

What medications are known to cause

Vision loss/abnormal vision

A 
Digoxin (with toxicity)
PDE-5 inhibitors
Isotretinoin
Vigabatrin
Voriconazole
161
Q

What drugs can cause pulmonary arterial hypertension (PAH)?

A

Cocaine
SSRI use during pregnancy (in baby)
Weight loss drugs
Methamphetamines/Amphetamines

162
Q

What drugs can cause pulmonary fibrosis?

A 
Amiodarone/dronedarone
Bleomycin
Busulfan
Carmustine
Lomustine
163
Q

FEV1, FVC, adn FEV1/FVC definitions

A

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
Q

If a patient is at ___% of personal best on the peak flow meter, what should they do?

A

> 80% - continue
50-80% - caution, requires action plan
<50% - medical alert, go to ER

165
Q 
What tobacco cessation medication should be used in patients who: 
Want to avoid weight gain
Have depression
Have dentures
Asthma/COPD
Skin conditions
Seizures
A 
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
Q

A1c, FPG, and 2hr PPG after OGTT to diagnose pre-diabetes and diabetes

A

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
Q

What 3 medications are used first line in T2DM?

A

Metformin
GLP-1 RA - use if CrCl <30
SGLT2i - if HF or CKD issue, add to metformin first

168
Q

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?

A

80% of TDD of NPH given once daily

Others are 1:1 conversion

169
Q

What insulin comes in concentration greater than 100u/mL?

A

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
Q

What drugs increase BG?

A 
Beta blockers
Thiazides and loops
Diuretics
Tacrolimus
Cyclosporien
Protease inhibitors
Quniolones
Antipsychotics
Statins
Steroids
Cough syrups
Niacin
171
Q

What drugs decrease BG?

A 
Linezolid
Lorcaserin
Pentamidine
Beta blockers
Quinolones
Tramadol
172
Q

What drugs to use in DKA and HHS

A

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
Q

Drugs and conditions that can cause hypothyroidism

A 
Interferons
Tyrosine kinase inhibitors (suitinib)
Amiodarone
Lithium
Carbamazepine

Hashiomoto’s disease

174
Q

Levothyroxine tablet colors

A 
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
Q

S/sx of thyroid storm

A 
Fever >103F
Tachycardia
Tachypnea
Dehydration
Profuse sweating
Agitation
Delirium
Psychosis
Coma
176
Q

Steroids least to most potent

A 
Cortisone
Hydrocortisone
Perdnisone
Prednisolone
Methylprednisolone
Triamcinolone
Dexamethasone
Betamethasone
177
Q

A patient is considered immunosuppressed when taking >___ mg/kg/d or >___mg/d of prednisone equivalent for >2 weeks

A

2 mg/kg/d or more

20 mg/d or more

178
Q

What drugs can cause DILE?

A 
***Hydralazine (BiDil)
Methimazole
Propylthiouracil
Methyldopa
Minocyclilne
Procainamide
Anti-TNF agents
Terbinafine
Isoniazid
Quinidine
179
Q

What drugs can cause or worsen Raynaud’s

A

Beta blockers
Bleomycin
Cisplatin
Sympathomimetics

180
Q

If a birth control product contains the following in it’s name, what does the product contain?
Lo
Fe
24

A

Lo - low dose estrogen (35 mcg or less)
Fe - iron supplement
24 - shorter placebo

181
Q

What are the severe and rare adverse effects of estrogen?

A 
ACHES
Abdominal pain - liver, gallbladder
Chest pain - MI, PE
HA - stroke
Eye problems - blood clot in eye
Swelling in leg - DVT
182
Q

What medications are used to treat infertility and how do they work?

A

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
Q

What acne medications are teratogenic?

A

Isotretinoin

Topical retinoids

184
Q

What antibiotics are teratogenic?

A

FQ and tetracyclines

185
Q

What migraine medications are teratogenic?

A

Dihydroergotamine, ergotamine

186
Q

How is osteoporosis diagnosed?

A

T-score of -2.5 or less
Osteopenia is -1 to -2.4
Normal: is -1 or higher

187
Q

How much calcium and vitamin D is recommended in most adults?

A

Calcium: 1000-1200 mg elemental calcium

Vitamin D 5000-7000 units/d or 50,000/week

188
Q

What % elemental calcium is calcium carbonate (Tums)? calcium citrate (citracal)? Which needs to be taken with food?

A

Tums: 40%
Calcium citrate: 21%
Take tums with food

189
Q

What is considered a low Vitamin D level?

A

<30 ng/mL

190
Q

What is 1st line therapy for osteoporosis? Administration notes? SE? Treatment duration? Alternative therapy if can’t use

A

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
Q

Hormonal therapy options for menopause

A

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
Q

What drugs can cause erectile/sexual dysfunction

A 
Alcohol
Antidepressants (SSRI/SNRI)
Antihypertensives (BB, clonidine)
Antipsychotics
BPH medications
193
Q

Typical starting dose of viagra and cialis? When to reduce dose

A

V: 50mg
C: 10mg
Reduce dose if 65 or older, using alpha-blocker, using CYP3A4 inhibitor, severe renal or liver disease

194
Q

What drugs can worsen BPH?

A 
Benztropine
Anticholinergics
Caffeine
Diuretics
SNRIs
Testosterone products
195
Q

What are the low, medium, and high doses of dopamine? What receptors do they act on?

A

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
Q

General principles when treating shock

A

Hydrate with crystalloids (as needed)
Peripheral vasoconstrictors to increase SVR
Beta-1 agonist to increase myocardial contractility and cardiac output

197
Q

What are the 2 most common infections in the ICU?

A

VAP and UTI from catheter

198
Q

How to treat acute decompensated HF (ADHF)?

A

Volume overload - Loops +/- vasodilators

Hypoperfusion - inotropes (dobutamine, milrinone) +/- vasopressor (dopamine, norepi)

199
Q

What medications are contraindicated and not generally recommended in pediatrics?

A

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
Q

When treating CF, what 5 medications are used and in what order?

A

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
Q

What medications are used for induction immunosuppression? Maintenance immunosuppression?

A

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
Q

What BBW do transplant drugs carry

A

Infection risk

Cancer risk

203
Q

What drugs can cause weight gain

A 
Antipsychotics
Diabetes drugs (insulin, meglitinides, sulfonylureas, TZDs)
Divalproex/valproic acid
Gabapentin, pregabalin
Lithium
Mirtazapine
Steroids
TCAs
204
Q

What drugs can cause weight loss?

A 
ADHD drugs
Bupropion
GLP-1 agonists
Pramlintide
Roflumilast
SGLT2 inhibitors
Topiramate
205
Q

How does NAC work as an antidote for APAP overdose?

A

Restores glutathione

206
Q

What do NSAIDS cause an issue with if given to a pregnant lady within 14 days of birth?

A

ductus arteriosus

207
Q

First line therapy for opioid induced diarrhea

A

Stimulant laxatives bisacodyl +/- senna OR PMAORAS [Methylnaltreone (Relistor) or Naloxegol (Movantic)]

208
Q

What are common migraine triggers

A 
Hormonal changes in women
Foods
Stress
Sensory stimuli (light, smell)
Changes in wake-sleep pattern
Changes in environment
209
Q

What triptans come as tablets, ODTs, Nasal sprays, powder, SQ injection?

A 
Tablets: all
ODTs: rizatriptan, zolmitriptan
Nasal spray: sumatriptan, zolmitriptan
Powder: sumatriptan
SQ: Sumatriptan
210
Q

What drugs increase uric acid

A 
ASA - low dose
Calcineurin inhibitors (tacrolimus and cyclosporine)
Diuretics
Niacin
Pyrazinamide
Select chemo (tumor lysis syndrome)
211
Q

Why is colchicine given initially with xanthine oxidase inhibitor (XOI)?

A

XOI can cause uric acid levels to increase and colchicine prevents this

212
Q

When treating gout - if pt is on xanthine oxidase inhibitor (XOI) and uric acid is >6, what should be added on?

A

Probenedic or lesinurad daily + XOI
OR
Replace XOI with IV pegloticase (Krystexxa)

213
Q

Maximum lifetime doses for bleomycin, doxorubicin, cisplatin, and vincristine - why?

A

Bleomycin: 400 units - pulmonary toxicity
Doxorubicin: 450-550 mg/m2 - cardiotoxicity
Cisplatin: 100 mg/m2 per cycle - nephrotoxicity
Vincristine: 2mg single dose - neuropathy

214
Q

What oncology meds cause pulmonary fibrosis

A

Bleomycin
Busulfan
Carmustine
Lomustine

215
Q

What oncology meds cause nephrotoxicity and ototoxicity?

A

Platinum-based (Cisplatin, carboplatin)

216
Q

What oncology meds cause cardiotoxicity?

A

Doxorubicin

Anthracyclines

217
Q

What oncology meds cause mucositis

A

Methotrexate

218
Q

What oncology meds cause neurotoxicity

A

Nitrosoureas
Lomustine
Carmustine

219
Q

What oncology meds cause hemorrhagic cystitis

A

Ifosfamide and cyclophosphamide

220
Q

What oncology meds can cause peripheral neuropathy

A

Vinca alkaloids: vincristine, vinblastine nad vinorelbine

Taxanes: paclitaxel, docetaxel

221
Q

What oncology meds can cause autoimmune syndromes?

A

Immunotherpay targeting CTLA-4 or PDL-1 ipilimumab, atezolizumab, durvalumab, nivolumab, pembrolizumab

222
Q

What is given with cisplatin to try to prevent nephrotoxicity?

A

Amifostine

223
Q

What is given with doxorubicin to try to prevent cardiomyopathy?

A

Dexrazoxane

224
Q

Doxorubicin extravasation treatment

A

Dexrazoxane

225
Q

What is given with flurouracil to enhance efficacy

A

Leucovorin or levoleucovorin

226
Q

What is given with ifosfamide to prevent hemorrhagic cystitis?

A

Mesna

227
Q

What is given with irinotecan to prevent acute diarrhea? Delayed diarrhea?

A

Acute: atropine
Acute: loperamide

228
Q

What oncology meds are VEGF inhibitors?

A

Bevacizumab

Ramucirumab

229
Q

What oncology meds inhibit EGFR

A

Cetuximab

Panituuab

230
Q

What onchology meds inhibit HER2

A

Trastuzumab

Pertuzumab

231
Q

What are DSM-5 criteria for depression?

A

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
Q

Drugs that can cause or worsen depression

A 
Atomoxetine (Strattera)
Indomethacin
Efavirenz
Rilpivirine
Beta blockers (propranolol)
Hormonal contraceptives
Benzos
Antidepressants
Systemic steroids
Interferns
Ethanol
233
Q

How long to separate MAOi from SSRI, SNRI, TCAs and bupropion?

A

All 2 weeks except fluoxetine which needs 5 weeks before starting MAOi d/t long half life

234
Q

Which antidepressant should be used if cardiac/QT risk?

A

Sertraline preferred

Do not use citalopram or escitalopram

235
Q

Which antidepressant should be used if the patient is a smoker?

A

Bupropion SR

236
Q

Which antidepressant should be used in peripheral neuropathy/pain

A

Duloxetine

237
Q

Which antidepressant should not be used in seizure disorder?

A

NOT bupropion

238
Q

Which antidepressant should be used in pregnancy

A

NOT paroxetine

Severe depression - SSRI

239
Q

Which antidepressant should be used in someone with daytime sedation?

A

take fluoxetine or bupropion in the morning

240
Q

Which antidepressant should be used in someone with insomnia

A

Take sedating medications at night - paroxetine, mirtazpine, trazodone

241
Q

What meds can cause psychotic symptoms?

A 
Anticholinergics
Dextromethorphan
Dopamine
Interferons
Stimulants
Systemic steroids
Bath salts
Cannabis
Cocaine
LSD
Methamphetamine
PCP
242
Q

DOC for mania

A

Lithium

243
Q

Lithium equivalents when converting to lithium citrate syrup to lithium carbonate. How many mEq lithium ion in each

A

5mL lithium citrate syrup = 300 mg lithium carbonate tabs/caps
8mEq of lithium ion

244
Q

Which ADHD meds are given in the morning vs at night?

A

Morning: Concerta, Daytrana, Ritalin, Vivanse, Adderall, Strattera
Night: clonidine, diphenhydramine, melatonin

245
Q

What drugs can cause anxiety?

A 
Albuterol
Antipsychotics (aripiprazole, haloperidol)
Bupropion
Caffeine
Decongestants
Illicit drugs
Levothyroxine
Steroids
Stimulants
Theophylline
246
Q

What are benzos not preferred for? Which are preferred when they are used?

A

NOT preferred for anxiety or sleep
Anxiety: clonazepam, lorazepam, alprazolam, diazepam
Sleep: lorazepam or temazepam

247
Q

Which benzos are preferred in elderly and liver impaired pts

A

LOT
Lorazepam
Oxazepam
Temazepam

248
Q

What drugs can worsen insomnia?

A 
Donepezil
Alcohol
Emtricitamine, INSTIs
Aripiprazole
Atomoxetine
Bupropion
Caffeine
Decongestants
Diuretics
Fluoxetine (if taken later in the day)
Steroids
Stimulants
Varenicline
249
Q

What drugs are used to help pts fall AND stay asleep?

A

Eszopiclone

Zolpidem

250
Q

Major symptoms of parkinson’s disease

A 
TRAP
Tremor
Rigidity
Akinesia/bradykinesia
Postural instability
251
Q

What drugs can worsen parkinsons disease?

A

Phenothiazines (prochlorperizine)
Halopericol, droperidol
Risperidone, paliperidone
Metoclopramide

252
Q

What drugs can worsen dementia?

A 
Antiemetics
Diphenhydramine
Doxylamine
Chlorpromazine, aripiprazole
Phenobarb, butalbital
Benzos
Benztropine
Peripheral anticholinergics
Skeletal muscle relaxants
Opioids
Sedative hypnotics
253
Q

What drugs can lower seizure threshold?

A 
Bupropion
Clozapine
Theophylline
Varenicline
Carbapenems 
Lithium
Meperidine
PCN
Quinolones
Tramadol
254
Q

Which medications MUST be dialed and locked by the pharmacist before dispensing?

A

Diastat

255
Q

Safety considerations for carbamazepine, oxcarbazepine, adn eslicarbazepine

A

Hyponatremia
Rash
Enzyme inducers

256
Q

Safety considerations for gabapentin and pregabalin

A

weight gain, peripheral edema, mild euphoria

257
Q

Safety considerations for phenobarb and primidone

A

Sedation, dependence/tolerance/overdose risk, enzyme inducer

258
Q

Safety considerations for topiramate and zonisamide

A

Weight loss, metabolic acidosis, nephrolithiasis and oligohidrosis/hyperthermia (in children)

259
Q

What vitamins to supplement on antiepileptic drugs

A

All: Calcium and vitamin D
Women: folate
Valproic acid: carnitine
Lamotrigine and valproic acid: selenium and zinc for alopecia

260
Q

What do the colors of the lamotrigine starting kits mean?

A

Orange: standard
Blue: low (if also taking valproic acid)
Green: higher (if also taking inducer)

261
Q

Fosphenytoin and phenytoin administration notes

A

Fosphenytoin: max of 150mg/min, monitor BP
Phenytoin: max of 50mg/min, requires filter, dilute in NS

262
Q

How to calculate pheytoin corrected dose

A

Use if albumin is <3.5 and CrCl >10
Total phenytoin measured
—————————-
(0.2xalbumin)+0.1

***DO NOT use for free phenytoin levels!

263
Q

What are the therapeutic levels of phenytoin?

A

Total: 10-20 mcg/mL
Free: 1-2.5

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