Stuff Flashcards
1
Q
Statins with interactions
A
Lovastatin, simvastatin
2
Q
Bile acid sequestrants can increase what?
A
TG
3
Q
Fibrate lipid effects
A
Decrease TG, can increase ldl
4
Q
Colchicine interaction
A
Fibrates and statins
5
Q
Which fish oil does not increase ldl?
A
Vascepa (icosapent ethyl)
6
Q
Cholesterol meds that cause liver damage
A
Statins, fibrates, zetia, niacin
Not bile acid sequestrants
7
Q
When are fish oil products used ?
A
TG > 500
8
Q
Lipid drugs
A
Clevidipine 2 kcal/ mL
Propofol 1.1 kcal/ mL
9
Q
Olmesartan unique adr
A
Sprue like enteropathy - severe chronic diarrhea- can happen anytime after starting
10
Q
What can’t be used with ace/arb
A
Neprilysin inhibitor (sacubitril)- do not confuse with aloskiren (tekturna)- can use with tekturna in patients with diabetes
11
Q
Lithium interaction
A
diuretics and ace/ arb- reduced lithium clearance
12
Q
Spiromolactone vs eplerenone
A
Spir is non selective aldosterone blocker and blocks androgen
13
Q
Where do aldosterone blockers work
A
Collecting ducts and distal tubule
14
Q
Beta blockers with intristic sympathomimetics activity - not recommended in post MI
A
Ace, pin, pen
15
Q
Methyldopa fun facts
A
CI liver dx, and mao inhibitors
Hemolytic anemia
Lupus
16
Q
Nitrate /pde5I separation
A
Avanafil- 12 h
Sildenafil/vardenafil- 24 h
Tadalafil- 48 h
17
Q
Clopidigrel ADR
A
Thrombotic Thrombocytopenic purpura
18
Q
How long to DC antiplatelet before surgery
A
5 days
19
Q
Preferred anticoagulant for stemi
A
Bibalirudin
20
Q
Is AC required after ACS
A
No- warfarin if Afib though
Don’t confuse with stroke recs
21
Q
Weird cardio meds that trip me up
A
Ranolazine (ranexa)- late na channel inhibitor- angina. QTc, no effect on HR/BP
Ivravidine (corlanor)-funny channel- HF. QTc, decrease HR and increase BP
Vorapaxar (zontivity)- PAR- ACS. More of an antiplatelet- no worry of QTc, HR/ BP
22
Q
Washout from ARB to neprilysin inhibitor (entresto)
A
None!
36 hours for AceI
23
Q
Which form of isosorbide is preferred in HF?
A
Dinitrate- only one studied
24
Q
What causes digoxin toxicity?
A
HypoK, hypoMG, hyperCa2+
Hypothyroidism, p-gp inhibitor
dehydration!!!!
25
Potassium strength: KCl 10%
20 meq/15 mL
26
Which azole does NOT prolong QTc ?
Isavuconazole
27
Which SSRI preferred in cardiac pts?
Sertraline (less risk QTc)
28
When are mexilitene and lidocaine used ?
Ventricular arrithmias only
29
Procainamine vs propafenone
Procainamide is 1a propafenone is 1c (not used)
30
When are non-DHPs CI?
Reduced ejection fraction HF
31
Amiodarone
It’s an antiarrythmic that is safer in HF (probably why used more than other)
Dig is used for both!
32
Amiodarone less known drug interaction
Sofosbuvir- bradycardia
DNE simvastatin 20 mg or lovastatin 40 mg
33
All CCBs are..?
Cyp 3A4 substrates
Verap and dilt are p-gp substrates too
34
Non-DHP drug interactions
They inhibit CYP3A4- lower simvastatin and lovastatin
Also substrates of 3A4 and pg-p
35
Amiodarone vs multaq (dronedarone)
Dronedarone has no iodine so no thyroid problems, but it’s much more liver toxic
36
Dig organ concerns
Renal NOT liver
| Crcl <50 decrease!
37
Amiodarone organ concerns
Liver NOT renal
*also lung/thyroid
38
ASA for stoke
Give 24-48 h after but NOT within 24 h of tPa
39
DAPT duration
ACS- at least 12 months
Stroke- 21 days (risk hemorrhage)
40
Cardioembolic vs non cardioembolic stroke
Cardio- anticoagulation
| Non-cardio- antiplatelet
41
Aggrenox indication
Stroke but probably not ACS (does not contain enough ASA)
SE: HA (vasodilation)
42
Which is the only oral direct thrombin inhibitor?
Dabigatran (pradaxa)
| IVs: argatroban, bivalirudin
43
Xarelto dosing
20 with dinner (ppx)
15 for crcl<50
Tx: 15 bid x 21 d then 20 qd
44
Dabigatran dosing
150 bid for both ppx and tx
Ppx: Dose reduce for crcl< 30 (75 bid)
Tx: CI crcl<30 (like Xarelto)
45
2c9 imhibitors
Metro/macrolides
Amiodarone/azoles
TMP/SMX, tamoxifen
46
Natural products increase bleed risk
Ginger, ginkgo, garlic, ginseng, glucosamine
| Dong quai, vit E, willow tree bark, wintergreen oil, fish oil
47
Protamine dosing
1 mg: 100 unit hep given in last 3h
(1, 0.5, 0.25)
1 mg: 100 anti Xa units of dalt
1 mg: 1 mg enoxaparin in last 8 hrs (0.5/1 if >8 h to <12h)
48
Preferred AC in cancer
LMWH
49
G6PD deficiency drugs
Chloroquine, primaquine, dapsone, BACTRIM/nitrofurantoin, methylene blue,
Probenecid, rasburicase
50
ABX to avoid if G6PD deficiency
Bactrim, nitrofurantoin
51
Missed glp-1 dose
Trulicity - not if within 72h of next
Ozempic- skip if >5 d since dose was due
52
Tricky diabetic meds
Meglitinides: secretagogues- repaglinide (prandin) and nateglinide (starlix)
A-glucosidase inhibitor: miglitol (glyset), acarbose (precose)
Amylin analog: pramlintide (symlin)
53
Which insulins are cloudy?
NPH, and mixed (protamine)
*when mixing remember clear before cloudy
54
Concentrated insulins
Humalog 200/ml
Humulin R 500/ml
Tresiba 200/ml
Toujeo 300/ml (only comes like this)
55
Insulin conversion exceptions
1. NPH to basal (80%)
| 2. Toujeo to lantus or basaglar (80%)
56
Insulin BUDs
Mostly 28 days
Toujeo/levemir 42
Tresiba/ ozempic 56
57
Which meds have risk of bladder cancer?
Pioglitazone and dapagliflozin
58
Thiazidenediones risk
Hepatotoxicity
Also with alogliptan
59
Counseling point for protease inhibitors
Take with food (except zepatier and fosamprenavir oral susp)
“Previr “
60
Genetic test for abacavir
HLA-B5701
61
HIV drug to avoid in pregnancy
Dolutegravir (Tivicay)
62
Depression drug interaction on exam
Look for St. John’s wort and transplant or birth control
63
Depression in pregnancy
No paxil
| SSRI- ok but still has risks
64
Depression breastfeeding
SSRI or TCA- but no doxepin
65
Preferred SSRI if cardiac risk
Sertraline
66
Unique SSRI adrs
Siadh, hyponatremia, bleeding
67
Converting antidepressants to or from maoi
2 week washout
| Except from Prozac (5 wks)
68
Tamoxifen antidepressant
Tam is prodrug and needs 2D6
| Use venlafaxine
69
Why use bupropion?
Wt loss, smoking, no sexual adrs
70
Tyramine rich foods
Aged cheese, beer, pickled stuff, yeast extract, air dried meats, sauerkraut, soy sauce, fava beans, some red wine
Aged, fermented, pickled, smoked
71
NT issued with PD, schizo, and Alzheimer’s
PD: not enough DA/too much Ach
Schizo: too much DA
Alzheimer’s: not enough Ach
72
Olz + bzd
Interaction: orthostasis
73
Typical vs atypical antipsychotics
Typical: more eps, less metabolic
Atypical: less eps, more metabolic
74
Lowest risk eps
Seroquel
Best for PD
*also clozapine
75
Highest risk eps
Risperidone, paliperidone, lurasidone
76
Highest metabolic adr
Clozapine, OLZ, quetiapine
77
Lowest metabolic risk
FGA, abilify, ziprazidone, lurasidone, asenapine
78
Antipsych worst QTC
Thioridazine, haldol, ziprasidone
79
Antipsych risk of CVA
Risperidone
80
Antipsych risk of increase prolactin
Risperidone, paliperidone
81
Clozapine
```
3rd line
*start 12.5 mg QD-BID
**dangerous constipation***
Siallorhea
High metabolic
Low eps
ANC >1500 to start- check weekly x 6 months, q2wks x 6 months, then monthly
D/c if ANC<1000
-neutropenia and agranulocytosis
- myocarditis and cardiomyopathy
-seizures
```
82
Bipolar depression
Lamotrigine
83
Bipolar mania
Equetro (CMZ) or valproate
84
Bipolar mania or bipolar depression
Lithium
85
Bipolar in pregnancy
Lamotrigine
Or lurasidone ir bipolar depression
86
Lithium level
0.6-1.2 meq/L
| Hand tremor, nausea, confusion, diarrhea if high
87
Lithium
Hypothyroid!!, teratogenic!!- no pregnancy!!, tremor, GI ADRs, hypercalcemia!, 100% renal cleared, no cyp interactions, low sodium=high lithium (ACE decrease salt and increase lithium
Serotonergic
Don’t use with nsaids (increase lithium)
Dehydration
88
Valproate + lamotrigine
Valproate inhibits metabolism- start lamictal at lower dose (blue box) 25 mg QOD
89
When to use meglitinides
Alternative to SFU for elderly or renal dysfunction
90
Which insulin is preferred in pregnancy
Regular
| Humulin R, novolin R
91
Which insulins are cloudy?
NPH, lente, mixes
92
Is a medguide required for stimulants?
Yes
93
Separation of stimulants from MAOI
2 weeks (same as SSRI except Prozac)
94
Stimulant warnings
Mania- caution w/ psych hx
Seizures
Seratonin syndrome
Anticholinergic
95
Daytrana
Methylphenidate patch
Hips- 2 hrs before desired effect
Remove after 9 hrs
Daily
96
Straterra separation for maoi
14 days
97
Straterra warnings
Suicide, hepatotoxicity
Don’t open capsule
Medguide
98
Levothyroxine unique ADR
Anxiety
99
St John’s wort warnings
Photosensitivity, serotonergic
| Inducer
100
Hepatotoxic herbals
Kava, valerian, black cohosh
101
Anxiety SSRI dosing
Half dose for depression
102
How long until buspar works?
2-4 wks
103
Is buspirone serotonergic ?
Yes
104
Which BZDs are safer in elderly and liver impairment?
Why?
LOT- Lorax, oxaz, temaz
Inactive metabolites
105
Which SSRI is most stimulating?
Fluoxetine
106
Sedating SSRIs
Fluvoxamine
| Paroxetine
107
Falling asleep
Eszopiclone, zolpidem
| Ramelteon, zaleplon
108
Staying asleep
Eszopiclone, zaleplon
| Doxepin, suvorexant
109
Intermezzo and edular formulation
SL zolpidem
110
Zopimist
Zolpidem spray
111
Possible severe adr with modafinil or armodafinil
SJS
112
Preferred antipsychotic in parkinsons
Seroquel
Or clozapine maybe or nuplazid (pimavanserin)
113
Sinemet separation for maoi
2 weeks
114
Sinemet adrs
```
Dark urine,saliva,sweat
Hemolysis (positive Coombs)
Sexual urges
Orthostasis
Separate from iron and protein
```
115
Dopamine agonist adrs
Hypotension, hallucinations, sleep attacks, movement stuff
116
Pramipexole (mirapex) starting dose
0.125 TID
| Decrease 50% if crcl<50
117
Ropinerole (requip) staring dose
0.25 mg TID
118
Apokyn ADRs
Apomorphine
Severe hypotension and N/V, QTc
Test dose in office
No 5ht3 blocker bc worsens Hypotension-give Tigan (trimethobenzamide) 3 days before initial dose
119
Huge issue with PD and drugs used to treat PD
Orthostasis
120
Calcitonin indication
Hypercalcemia or osteoporosis or pagets
121
DonepeZil ADRs
Nausea- take QHS
Insomnia- take in morning if this happens
Bradycardia
Start 5 mg increase to 10 after 4-6 weeks
ODT has less adrs
122
Acetylcholinesterase ADR
| For AD
BRADYCARDIA
| nausea, insomnia
123
Drugs that cause seizures
Bupropion, clozapine, varenacline, carbipenems, lithium, meperidine, tramadol, quinolones, pcns, reglan, acyclovir, cephalosporins, valacyclovir, theophylline
124
Lamotrigine dosing
```
Lower dose (blue box): 25 QODvalproate
Higher dose (green): inducers, estrogen containing contraceptives: 50 QD
```
125
Keppra iv to po
1:1
126
Epilepsy drug big concerns
Rash, bone loss, suicide, CNS, interactions
127
Carbamazepine oxcarb, eslicarbazepine
Hyponatremia, rash, enzyme inducer
128
Topiramate, zonisamide
Weight loss, metabolic acidosis, nephrolithiasis and oligohidrosis
129
Topiramate ADR
Metabolic acidosis, nephrolithiasis, glaucoma, hyperanmonemia, vision issues, fetal harm, weight loss, concentration
130
Only antiepileptic that’s an inhibitor
Divalproex
131
Depakote ADR
Hepatic failure , fetal harm, hyperammonemia (give carnatine), thrombocytopenia, DRESS, weight gain
Range: 50-100
132
Carbamazepine genetic test
HLA-B 1502
Risk of serious skin reactions
Asian
133
Carbamazepine
SJS/TEN
Aplastic anemia, agranulocytosis, myelosuppression, hyponatremia (siadh), fetal harm
Range: 4-12
134
Vimpat (lacosamide) adr
Prolongs PR interval, DRESS
| CV
135
Oxcarbazepine genetic test
HLA-B 1502
SJS/TEN
Asian
136
Oxcarbamazepine ADRs
SJS/TEN, DRESS, hyponatremia
137
Oxcarb/carb autoinducer
Carb: autoinducer
Oxcarb: not autoinducer
138
Phenobarbital ADR
Hypotension if IV, SJS/TEN, respiratory depression, fetal harm
Range: 20-40
139
Phenytoin max rate
50 mg/min
| Hypotension and cardiac arrhythmia
140
Fosphenytoin max rate
150 PE/ minute
| 1.5 mg= 1 mg PE
141
Phenytoin equivalent
1.5 mg fospehny= 1 mg PE
142
Phenytoin genetic
Avoid in HLA-B 1502
143
Phenytoin range
10-20 total
| 1-2.5 free
144
Phenytoin ADRs
Extravasation (leads to purple glove), DRESS, fetal harm, bradycardia, SJS/TEN, blood dyscarsias, hepatoroxiy, gingival hyperplasia, hair Growth, nystagmus, ataxia, diplopia, respiratory depression
145
Phenytoin admin reqs
```
DNE 50 mg/min
Filter (if continuous infusion)
NS only
Do not refrigerate
When adjusting dose do by 30-50% at a time
```
146
Enteral feeding and phenytoin
Decreases phenytoin absorption so hold feeding 1-2 hrs before and after
147
Phenytoin PPB
High- can displace other drugs and increase levels
148
Oral contraceptive drug interactions
Enzyme inducers!!
149
Corrected phenytoin
Total/(0.2x albumin) +0.1
For albumin <3.5
Free level doesn’t need it
150
Epilepsy drugs in pregnancy
- AEDs bad! Valproate/ carb worst
- AED decrease BC (use IUD)
- give folate, ca2+, vit d (baby needs)
- AED levels decline in preganancy (increase dose)
- seizure can harm babies
151
Which AEDs can lack of sweating?
Topiramate, Zonisamide
152
Which population has greatest risk of lamotrigine rash?
Children
153
Which epilepsy drugs are best for kids?
Lamotrigine and Keppra because available as ODT and liquid/chewable
154
Supplementation needed if taking seizure med
Vitamin d and calcium
| Bone loss
155
Drugs that cause hypothyroidism
I TALc
Interferon, TKI, amiodarone,
Lithium, carbamazepine,
(Amio and interferon can also cause hyper)
156
Condition that causes hypothyroidism
Hashimotos
157
Normal TSH
0.3-3
158
Levithyroxine administration
With water 60 mins before breakfast or 3 hours after dinner
*separate from food*
159
Levithyroxine starting dose
1.6 mcg/kg/day IBW
If CAD 12.5-25
160
Thyroid dessicated info
NP thyroid or armour thyroid
Not recommended bc inconsistent dose
Dosed in grains
161
Goiter
From iodine deficiency (hypothyroid)
162
Levithyroxine iv to po
1:2
163
Levothyroxine colors
25-orange, 50-white, 75-violet, 88-olive, 100-yellow, 112-rose, 125-brown, 137-turquoise, 150-blue, 175-lilac, 200-pink, 300-green
Orangutans will vomit on you right before they become large proud giants
164
Cause of hyperthyroidism
Graves dx
165
Thyroid bone and heart effects
Hyper- osteoporosis and arrhythmia
166
Thyroid storm
PTU (preferred) + SSKI or lugols 1 hr after PTU + propranolol + dex + aggressive cooling (APAP and cooling blankets) NOT NSAIDS
167
PTU and methimazole ADRs
DILE, gi-upset, hepatitis, agranulocytosis
Severe liver toxicity from PTU
168
Hyperthyroid in preganancy
PTU trimester 1
| Methimazole trimester 2-3
169
Iodine
Lugols
SSKI
Temporarily blocks secretion of iodine
170
Levothyroxine in pregnancy
30-50% increased dose
171
Who steroid mimics aldosterone?
Fludrocortison
Mineralcorticoid activity- maintains balance of water and electrolytes
-use for addisons and orthostatic hypotension
172
Glucocorticoid difference from mineralcorticoid
Gluco better for anti inflammatory
173
Addisons
Not enough steroids- can occurs if steroids stopped suddenly (hpa suppression)
174
Steroid immune suppression dose
>2 mg/kg/day or >20 prednisone equivalent for >2 weeks
* no live vaccines
* taper! 10-20%/day
175
Immunosupression risks
- reactivation of TB/hep B/C
- live vaccines
- lymphomas and skin cancers
- infections
176
Lab tests for RA
RF, ACPA
177
MTX dosing
RA- weekly
| Cancer- daily
178
MTX toxicity
Hepatotoxicity, myelosuppression, no pregnancy!, mucositis/bleeding
Pneumocystits pneumonia
DMARD (non-biologic)
179
Hydroxychloroquine ADR
Irreversible retinopathy
Caution G6PD deficiency
-less liver risk that MTX
*non-biological DMARD
180
SulfasalaZine ADRs
- Sulfa allergy
- salycilate allergy
- liver, rash, G6PD deficiency, blood dyscrasias
- yellow/orange skin and urine
* non- biological DMARD
181
DMARD rule
Never use two biological together
182
Arava toxicity
Leflunamide
- fetal/embryo- 2 years after to get pregnant or accelerated via cholestyramine or activated charcoals x11 days
- Hepatotoxicity
183
Xeljanz risk
Tofacitinib
PE, malignancy (lymphomas )
Non-bio DMARD
*DONT USE WITH BIOLOGIC
184
Olumiant risks
Barcitinib
Non biologic DMARD
PE
Don’t use with biologic
185
MTX with etoh?
NO! Liver toxicity
186
MTX renal
Yes- still a consideration
187
MTX drug interaction
NSAIDs
| Bleeding
188
TNF biologic DMARD warnings
Infections (TB/HEP), malignancy
HF, lupus like, hepatotoxicity
No live vaccine- no two biologics
189
Eteracept and adalimumab storage
14 days at room temp
190
Biologic admin
Allow to warm first!
| Don’t shake
191
Non TNF DMARD toxicity
Basically the same as TNF
192
DILE drugs
Methimazole, PTU, methyldopa, minocycline, procainamide, hydralazine, anti-TNF agents, terbinafine, isoniazid, quinidine
My pretty malar marking probably has a transIent quality
193
Benlysta
Belimumab
Biologic DMARD
For SLE
194
Drugs for SLE
Hydroxychloroquine, cyclophosphamide, azathioprine, mycophenolate, cyclosporine
195
Preferred MS drug in pregnancy
Glatiramer acetate
| Copaxone
Nope…actually glatiramer…
196
Interferon beta toxicity
```
Psychiatric (depression/suicide)
Injection site necrosis
Myelosuppression
LFTs
Hyper/hypo thyroid
Flu like symptoms
Infections
```
197
Reynauds treatments
Nifedipine or other non-DHP CCB
198
Drugs that worsen reynauds
BB, bleomycin, cisplatin , sympathomimetics
199
Avoid in celiac dx
Gluten is found in wheat, barely and rye
*starch may be wheat
200
Autoimmune disorders
Myasthenia gravis
| MS , RA, SLE, reynauds, celiac dx, sjogrens
201
PAH Pulmonary arterial pressure
PAP >25
202
Warfarin goal on PAH
1.5-2.5
203
CCB for PAH
LA nifedipine, dilt, and amlodipine
*not verapamil (‘ore pronounce negative iontropic effects )
204
Drugs that cause pulmonary fibrosis
Amiodarone, bleomycin, dronedarone, methotrexate,
nitrofurantoin, sulfasalzine
205
When to avoid nicotine inhaler or nasal spray
Asthma/COPD/ respiratory dx
206
Nicotine patch dosing
>10 cigs: 21 mcg
-21x6 wk, 14x2, 7x2
<10 cigs: 14 mcg
-14x6 wk, 7x2
207
Nicotine gum/lozenge dosing
<30 mins: 4 mg
>30 mins: 2 mg
Max gun: 24 pc
Max Loz: 20 pc
208
Nicotine patch MRI
Remove!
209
Zyban details
- start 1 wk before quit date
- serotonergic
- max 300 mg
- use up to 6 months
210
Chantix details
- start one week before quit date
- day1-3: 0.5 mg qd
- days 4-7: 0.5 mg BID
- day 8 on: 1 mg BID
- nausea, seizures, insomnia, dreams, headache
- only med not combined with NRT
- take with food
- use for 12 wks, can use for another 12 if needed
211
When not to treat smoking cessation with meds
Pregnancy, adolescence, light smokers (<10 cigs/day)
212
Nicotine patch details
Never cut
| Wear for 24 hrs unless bad dreams
213
Nicotine lozenge detail
No acidic beverages
214
Indication that asthma is poorly controlled
Rescue inhaler >2 days per week
215
General asthma algorithm
Saba AND prn LD ICS/formoterol——> daily ICS—->LD ICS+laba——> MD ICS+laba—->HD ICS+laba
Basically ICS + laba and increase Add laba before increasing to HD ICS
216
Can you use laba alone?
Not for asthma
217
HFA
MDI
218
Respimat
MDI
219
Diskus
DPI
220
Ellipta
DPI
221
Pressair
DPI
222
Handihaler
DPI
| Capsule for inhalation
223
Neohaler
DPI
| Capsule for inhalation
224
Respiclick
DPI
225
Flexhaler
DPI
226
MDI details
- slow/deep breath
- Shake (except: alcesco, respimats, and qvar redihaler
- can use spacer
227
DPI details
- quick/forceful breath
- no spacers
- do not shake
- no priming needed
228
Theophylline range
5-15 mcg/mL
229
Aminophylline to theophylline
Multiply by 0.8 (ATM)
230
Drugs that can increase theophylline
Cipro, zafirlukast, zileuton
231
Asthma pregnancy
SABA
| Budesonide
232
How long should proair last
12 months
233
How long should ventolin last
15 weeks
234
How long to wait in between inhaler inhalation’s
60 seconds
235
Order to use beta-2 agonist and ICS
Beta-2 (or laba/lama) the ICS
236
What can you mix montelukast with?
Formula or breast milk, applesauce, carrots, rice, ice cream
Take within 15 mins!
237
Which is reversible asthma or copd?
Asthma
238
Copd diagnosis
Post bronchodilator fev1/fvc<0.7
239
COPD scoring
CD
AB
Left: cat<10 mcrc 0-1
Right: cat>10 mcrc 2+
Down: 0-1 exacerbations
Up: 2 or 1 hospitalization
240
Only way to slow COPD progression
Stop smoking- drugs just help symptoms and reduce hospitalizations
241
First line tx copd
Bronchodilators
242
Copd treatment
```
A: sama or saba
B: lama or laba
C: lama
D: lama or lama+laba
*ics if eos>300
```
243
When to use ABX fir copd
Increase sputum, purulence, dyspnea,
Inc purulence + one other symptom
mech ventilation
244
Respimat directions
Twist open press (TOP)
245
Steroid equivalency
```
Beta: 0.6
/dex: 0.75
Methlypred/triamcin: 4
Pred/pred: 5
Hydrocortisone: 20
Cortisone: 25
```
246
Hep c meds not taken with food
Zepatier (no regard)
| Fosamprenavir oral susp
247
Hep c drugs avoid acid suppressive therapy
HEV: harvoni, epclusa, vosevi
248
Pangenotypic hep c drugs
Mavyret and epclusa
249
Hep c salvage
Vosevi and mavyret
250
Hep c approved for 8 weeks
Mavyret
251
Hep c/ hiv co infection
MEH: mavyret, epclusa, harvoni
252
Hep c no mono therapy
Sofosbuvir and daclatasvir
253
Typical hep c treatment duration
12 weeks
254
Hemoglobin reqs for epogen
Start if <10
| Stop if >11
255
Drugs that you wouldn’t think of that increase k+
Cangliflozin, drosperinone, bactrim, cyclosporin, everolimus, tacrolimus
Heparin, glycopyrrolate, nsaids, pentamidine
256
Does unasyn cover pseudomonas ?
No
257
PCNs that cover anaerobes
Beta lactamse inhibitor
| Augmenting, unasyn, zosyn
258
Antistaph pcns
Dicloxicillin, nafcillin, oxacillin
No g (-), enterococcus, or anerobic coverage
No renal adjustment!
259
Why is PO ampicillin rarely used?
Poor BA- use amoxicillin for PO
260
Tx for strep throat (pharyngitis) and mild skin infection
Pen vk
261
First line tx otits media
Amoxicillin 80-90 mg/kg/d
*90 mg/kg/d (augmentin)
262
Infective endocarditis ppx
Amoxicillin 2g x1 30-60 min before
263
Which pcns don’t require renal adjustment ?
Naficllin, oxacillin, dicloxacillin
264
Syphilis tx
Bicillin LA (pen g benzathine)
No iv!!!
265
Drugs for enterococcus
PCNs not cephalosporins
266
Cephalosporins for Anarobes
Cefoxiten, cefotetan
267
Cephalosporins for MDR pseudomonas
Ceftaz/avibactam (avycaz)
| Ceftolozane/tazobactam (zerbaxa)
268
Cefotetan weird ADR
Bleeding, disulfiram like rx
Due to side chain
269
Cephalexin common uses
Street throat, mssa skin infxn
270
Cefuroxime common use
Otitis media, CAP, sinus infxn
271
Cefdinir common uses
CAP, sinus infxn
272
Cefazolin common use
Surgical ppx
273
Cefotetan/cefoxitin common use
Anerobes, surgical ppx for colerectal procedure
274
Ceftriaxone/ cefotaxime common use
CAP, meningitis, SBP
275
Ertapenem does not cover
Pseudomonas, enterococcus, acintobacter
276
Carbapenem coverage
Yes: ESBL, pseudomonas (except invanz), anerobes
No: atypicals, MRSA, VRE, cdif, stenotrophomonas
277
Aztreonam coverage
Pseudomonas
No g (+) or anerobes
278
Benefit of extended interval dosing for AMGs
Cost and less nephrotoxicity
Not more effective
279
Gentamicin/tobra dosing
Traditional: 1-2.5 mg/kg/dose q8
Extended interval: 4-7 mg/kg/dose
280
Genta/tobra and amikacin peak and trough
Gent/tobra
- peak: 5-10
- trough: <2
Amikacin
- peak: 20-30
- trough: <5
281
Which FQ cover pseudomonas
Cipro and levo
282
Which FQ can NOT be used for uti?
Moxifloxacin
283
Which FQ covers mrsa ?
Delafloxacin
284
Cipro weird interaction
Don’t use with tizanidine
285
FQ highest QTc risk
Moxifloxacin
286
Cipro oral suspension rule
No NG tube!
287
Which is the only FQ not renally adjusted?
Moxifloxacin
288
Levofloxacin abd moxifloxacin iv to po ratio
1:1
289
Macrolide with most severe qt prolongation
Erythromycin
290
Are macrolides hepatotoxic?
Yes
291
Which macrolide required renal dose adjustment
Clarithromycin
| Crcl<30
292
Which macrolide has fewer drug interactions ?
Azithromycin
293
Doxycycline and minocycline iv:po
1:1
294
Doxycycline renal adjustment
No
| Yes for tetra and mino
295
What does bactrim not cover?
Pseudomonas, atypicals, anearobes, enterococcus
296
Bactrim strengths
Ss: 400/80
DS: 800/160
297
Bactrim uti dose
1 DS BID x 3 d
298
Crcl to decrease vanc dosing interval to q24
<50
299
MIC not to use vanc
>2
300
1:1 ABX
Bactrim, metronidazole, levo/moxi, doxy/mino, linezolid, fluconazole,
isavu/posaconazole /vori
301
Televancin risks
Pregnancy, nephrotoxic, incompatible with heparin, red man, false increase ptt/ inr, QTc
302
Oritavancin and dalbavancin risks
No heparin with 5 d (false elevation in ptt)
Red man
Televancin increase QTc
*note: can use single dose regimen
303
Daptomycin tox
Myopathy/rhabdo
False increase ptt/inr
Increase cpk
No D5W
No pna
4mg/kg/d
Dose adjust for renal
304
Linezolid tox
Seratonin syndrome, myelosuppression, thrombocytopenia, hypoglycemia, , HTN, optic neuropathy
305
Does linezolid required renal adjustment?
No
306
Synercid details
Arthralgia/myalgias, infusion rxn, hyperbilirubinemia,
D5W only
Central line only (phlebitis)
307
Tigecycline details
No bloodstream infxns: lipophi
Risk of death
Should be yellow/orange
308
Colistimethate and polymyxin B tox
Nephro and neuro
309
Chloramphenicol tox
Gray syndrome
310
Clindamycin coverage
Anaerobes and g(+)
MRSA (positive D test means do NOT use!!)
*no dose adjustment for renal
311
Abx susp requiring refrigerator
Pen vk, ampicillin, augmentin
*amoxicillin tastes better
312
ABX don’t refrigerate
Cefdinir, azithromycin/clarith
Doxy, FQ, clinda, linezolid, bactrim, acyclovir, fluc/Posa/voriconazole, nystatin
Metronidazole, moxifloxacin
313
Weird nitrofurantoin adr
Pulmonary toxicity
314
When to start ppx ABX for surgery
Cefazolin/cefuroxime: 60 mins prior
FQ/ vanc: 120 min before
315
Meningitis tx
Ceftriaxone/cefotaxime + vanc
Add ampicillin if <1 mo, >50, immunocomprimised!!!!
No ceftriaxone or vanc in <1 mo
* Ampicillin is for listeria
* give steroid prior to or with first dose of ABX
316
Acute otitis media tx
Mild- 2-3 d observation
Amoxicillin 80-90 mg/kg/d (bid)
Augmentin 90 mg/kg/d (bid)
Cephalosporin in non-severe PCN allergy (2nd Ir 3rd gen)
317
Strept throat tx
PCN or amo
318
Sinusitis tx
Augmentin
>10 d of symptoms
319
Copd exacerbation tx
Augmentin, azithromycin, doxycycline
Or FQ! I’d suspect pseudomonas
5-7 d
-ventilated, purulence sputum, dyspnea, increased sputum
320
CAP (outpatient)
Macrolide or doxycycline
-add beta Lactam or use mono therapy FQ (MGL) if immunocomproised, comirbidities, or recent ABX use (90 d)
5 days
*never beta lactam alone
321
Inpatient CAP
Never monotherapy with macrolide or doxy
Use FQ or add beta lactam
322
HAP/ VAP
7 d
>48 h hospitalization or vent
Think MRSA and Pseudomonas
Double cover pseudomonas if risk for MDR (recent ABX, etc)
323
Follow up for TB skin test
48-72 hr
324
TB latent tx
INH x 9 month (HIV, pregnant, child) OR
Rifampin x 4 month OR
INH + rifapentine x 12 wk
325
Active TB tx
RIPE x 2 months
Then 2 drugs x 4 months **(RI)**
Don’t do 3x weekly dosing for pts w/ HIV
Latent:
-R for 4 months
-RI for 3 months
326
Rifampin toxicity
Hemolysis, interactions (use rifabutin), orange discoloration, LFTs, flu-like syndrome
*CI with PI
327
Isoniazid tox
| INH
Peripheral neuropathy (use pyridoxine B6), fatal hepatitis!!!, DILE, hemolysis, inhibitor
328
Pyrazinamide tox
LFT, hyperuricemia
329
Ethambutol tox
Optic neuritis
| -confusion and hallucinations!!
330
TB drugs empty stomach and hemolysis
RI: rifampin, INH
331
TB drugs: increase interval for renal impairment
PE: pyrizinamide, ethambutol
332
IE tx
Beta lactam +/- gent
Use gent and rifampin if prosthetic valve
If enterococcus NO cephalosporin
Vanc if MRSA or beta lactam allergy
IV x 4-6 weeks
333
Dental PPX PCN allergy
Clinda 600 or azithromycin 500
334
SBP tx
Ceftriaxone x 5-7d
Cipro or bactrim for ppx
335
Intraabdominal infxn
Cover anaerobes
4-7 d
336
Impetigo tx
Cephalexin 250 qid
Mupirocin
337
SSTI tx
- Cephalexin
- clinda if beta lactam allergy
- bactrim or doxy for MRSA, purulence, or abscess
For severe: iv MRSA ABX
338
Animal bite ABX
Unasyn or augmentin (covers pasturella and anerobes
339
Diabetic foot infection coverage
Mild: beta lactams
Anerobes- mod-sev
PSA and MRSA: if severe infection
MRSA, pseudomonas if at risk
340
Does zosyn cover anerobes ?
Yes
341
Pylonephritis tx
Cipro 500 bid x 7 d
| Levo 750 QD x 5 d
342
Phenazopyridine
2 days!
With food or water!
343
UTI pregnancy
Beta lactam: amoxicillin, augmentin, oral cephalosporin
344
Nitrofurantoin and bactrim pregnancy
Ok in 1st trimester
345
Doxycycline pregnancy
No!!!
346
Direct acting antiviral (Hep C) tox
Reactivation of hep B
LFTs
Generally well tolerated
347
Travelers diarrhea
Azithromycin 1g x1 or 500 mg x 3
FQ or rifaximin ok if no dysentery
Loperamide if no dysentery or fever
348
Cdif tx
Vanc 125 qid x 10 d
Fdx 200 bid x 10 d (preferred)
Met 500 po TID x 10 d (not preferred)
No anti diarrheals
349
Syphilis tx
Bicillin LA 2.4 mil units IM x 1
-weekly x 3 if latent
-desensitize if pregnant!
Doxy (unless pregnancy) 100 bid x 14 d
350
Gonorrhea tx
Ceftriaxone 250 IM x 1 + (azithromycin OR doxycycline ) no monotherapy!
351
Chalmydia tx
Azithromycin 1 g x 1
Or doxy 100 bid x 7 (no pregnancy )
352
Bacterial vaginosis tx
Metro 500 bid x7 d or topical x5 d
353
Trichinoniasis tx
Metro 2 g po x 1
Must be PO!
Ok I’m preganancy! Must treat!
354
Genital warts tx
Imiquimod cream
Vaccinate with HPV to prevent
355
Rocky Mountain spotted fever
Doxy 100 bid x5-7 d
| *even in kids!!!
356
When is the only time you can use doxy in kids?
Rocky Mountain
357
Lyme tx
Doxy 100 bid x 10-21 d
Alt: amoxicillin
358
Ribaverin v rifampin tox
Both: hemolysis
Ribaverin: no preganancy!
Rifampin: LFTs, interactions, orange, flu-like syndrome
*safe in preganancy
359
TB drugs (RIPE) in pregnancy
Safe
360
UFH VTE tx
Bolus: 80 u/kg
Infusion: 18 u/kg/hr
361
UFH stroke tx
Bolus: 60 u/kg
Infusion: 12 u/kg/hr
362
LMWH tx crcl<30
1 mg/kg Q24
363
Amophotericin B dose
0.1-1.5 mg/kg/day
364
Liposomal amphoterecin
Ambisome, amblicet
Less nephrotoxic, less infusion
rxn
Dose: 5
*filter
365
Amphoterecin tox
Nephrotoxic (give NS), infusion reaction (premedication APAP/Benadryl/hydrocortisone for conventional )
Thrombophlebitis (deoxycholate): dilute and slow infusion, add heparin, and central line!
**Cardiopulmonary arrest if dose >1.5 mg/kg/d for conventional!**
Rigors
-decrease K+ and mg+ (supplement)
366
Flucytosin indication and tox
- cryptococcal meningitis
- with ampho- NEVER ALONE!
* follow with fluconazole for consolidation phase
- causes myelosuppression
367
Azole toxicity
- hypoK+
- liver tox
- Qt (except isavu)
- 3a4 inhibition!!
368
Only azole that needs renal adjustment
Fluconazole
**so this is the only one that can be used for UTI**
Also voriconazole due to additive
369
Drug of choice for aspergillus
Voriconazole
*can also use posa and isavu
370
Itraconazole tox
-heart!
Qt, liver, low k, 3A4
371
Which azoles can penetrate CNS and treat meningitis?
Fluconazole and voriconazole
372
Voriconazole
Visual changes, phototoxic
- low k, liver, qt, 3A4
- good for aspergillus, c gal rats and c krusei
373
Posaconazole
Full meal
Suspension and tab are no equivalent
374
Which azole requires a filter ?
Isavuconasonium
375
Which azoles are separated from antacids ?
Itraconazole and ketoconazole, posaconazole suspension
*could give with diet cola
376
Micafungin and caspofungin
Echinocandins
- histamine mediated symptoms
- NO renal adjustment
- QD and IV only
- only for very resistant infxns
* good for glabrate or krusei and aspergillus
377
When to start neurominidase inhibitors (tamiflu and zanamivir)
Within 48 h of illness
378
Tamiflu dosing
Tx: 75 bid x 5 d
Ppx: 75 qd x 10 d
*adjust crcl<60
- neuropsychiatric ADRs
379
Varivax vs shingles
Kids take varivax (chickenpox) adults take shingrix
380
Acyclovir info
- renal adjust (also for valacyclovir and famciclovir )
- dose with IBW!!!
- available Iv for hsv encephalitis
381
Zovirax cream and abreva dosing
5 times per day
| -Zovirax for 4 days
382
Hsv chronic suppression
Acyclovir 400 Bid
For hsv 2 can use valacyclovir or famciclovir as well
383
Hsv 1 tx
Valacyclovir 2 g x 1
Acyclovir: ~200-400 bid-tid x 5d
-or can be 5x daily
384
Hsv 2 tx
Acyclovir is the same as hsv1
Val: 1 g bid
Or famciclovir
385
Shingles tx
Acyclovir 800 5x for 7d
Val: 1 g tid x 7 d
Fam: 500 tid x 7 d
386
CMV tx
Valcyte, cytovene
Foscarnet or Cidofovir for refractory
*no primary ppx, secondary ppx can be stopped if cd4>100 x3-6 months
387
Ganciclovir and valcyte tox
Myelosuppression
-valcyte: eye issues
388
Cidofovir and foscarnet tox
Renal!
389
PCP ppx and tx
Ppx (CD4<200): bactrim DS daily
-or D.P.L, atovaquone
*can stop if >200 x3 months
Tx: bactrim x21 d + steroid
390
Toxoplasmosis tx and ppx
Ppx (CD4<100 and seripositive): bactrim
- or D.P.L, or atovaquone
*can stop if >100 or >200 (secondary ppx) x3-6 months (6 for secondary)
Tx: pyrithin, Lueco, sulfadia
-or bactrim, or atovaquone, or clinda
391
MAC tx and ppx
Ppx (cd4<50 AND not on ART): azithromycin 1200 weekly
**can stop secondary ppx after 12 months therapy and cd4>100 x6 months
Tx: (clarithro or azithro) + ethambutol x 12 months
392
Hormone replacement : estrogen alone v estrogen + progesterone
Alone: no uterus
Both: women with uterus
*risk for endometrial CA
393
Vivelle dot placement and timing
Twice weekly
Lower abdomen below waist
NOT breast
394
Xulane patch frequency
Weekly
E+P
395
First line tx of chronic allergic rhinitis
Intranasal steroids
396
What do oral antihistamines not help with?
Nasal congestion
397
Preferred antihistamines in pregnancy
Loratidine and Cetirizine
398
Less sedating antihistamines
Loratadine and fexofenadine
399
Zinc day limit
5-7 d max
Possibly effective for reduction in cold duration
400
Vitamin C ADR
Kidney stones
401
OTC products to separate from MAOI
DM, pseudophed, phenylephrine
402
DM side effects
Serotonergic , NMDA blocker at higher doses
403
Codeine CI
Children <12
404
Benzonotate max dose
600/ d
405
Diphenhydramine unique effect
Cough suppression
406
Cough and cold in children
Avoid in less than 6 y
Also avoid menthol in under 2 y
407
PE abbreviation
Phenyleprhine
408
AC abbreviation
Codeine
409
Ibuprofen strengths
Infant drops (50mg/ 1.25mL)
Children’s (100 mg/5mL)
410
APAP strengths
Infants AND children’s are both 160 mg/ 5mL
411
Children APAP dosing
10-15 mg/kg /dose q4-6h
| *max 5 doses per day!
412
Ibuprofen children’s dosing
5-10 mg/kg/dose Q6-8h
| *max 40 mg/kg/d
413
Eye and ear sigs
```
A- ear
O- eye
U-both
D- right
S- left
```
414
How many drops in an mL
20
1 drop= 0.05 ml
415
What can not be administered in rye with contact lenses
Eye ointments
416
Drugs that increase IOP
Anticholinergics, antihistamines, steroids (pred-forte), topiramate
417
Prostaglandin analog ADR
Iris darkening (brown) and eyelash thickening
Avoid in light eyed people
418
Most effective eye drop for decreasing IOP
PG analog
Note: use BB if only one eye
419
Which eye drops require removal on contact lenses?
PG analogs and others with BAK
Wait 15 mins to reinsert!
Benzalkonium chloride absorbs and discolored them ( not in travatan z or xelpros )
420
When are PG analogs given
Bedtime
Blurred vision
421
PG analog frequency
Once per day
422
Timeframe to wait between eye drop admin
Same med: 5 min
| Different med: 5-10 min
423
Only selective BB eye drop
Betaxolol (Betoptic)
424
NSAID eye drop ending
“Fenac “
Or fluribiprofen
425
Dry eyes eye drops
Systane or refresh are both artificial tears
426
Red eye tx
Naphazoline
Visine (tetrahydrozoline)
427
Latisse
Bimataprost
PG analog
Cosmetic
428
Drugs that can cause eye issues
Hydroxy(chloroquine), amiodarone, ethambutol, linezolid, alpha blockers, digoxin, PDE-5 inh, voriconazole, isotretinoin, vigabatrin,
429
Debrox administration
Carbamide peroxide
| 5-10 drops bid x 4d
430
How to pul ear from ear drops
Up and back for adults
Down and back for kids <3
431
Drugs that cause discoloration
Entacapone, levodopa, methyldopa
Nitrofurantoin, sulfasalazine, propofol, phenazopyridine, rifampin, anthracycline, methylene blue, mitoxantrone, amiodarone, chloroquine
432
Retinoids
- Teratogenic
- 4-6 weeks to work
- acne may worsen initially
- photosensitivity!!
- pea sized amount
- bedtime
433
Alternative acne txs
Spironlactone, BPO, salicylic acid, ABX, BC
434
BPO
Acne first line
Can bleach clothing
435
I pledge
- 2 forms BC (NO P.O.P)
- no preganancy 1 month before and after
- fill within 7 d
- 1 month at a time
436
Drugs that cause hair loss
Chemo, valproate, spironolactone, heparin
Zinc/ vit D deficiency
437
Onychomycosis
Nail fungal infxn
Topical NOT enough
Oral terbinafine or itraconazole
20% potassium hydroxide (KOH) to diagnose
438
When to repeat lice treatment with permethrin or piperonyl butoxide
Day 9
439
Steroid vehicle potency
Ointment >cream>lotion>solution> gel>spray
440
Topical steroid potency
Clobetasol> fluocinonide >mometasone>triamcinolone> hydrocortisone
441
Who can not receive live vaccines ?
Pregnant, immunocompromised, < 12 months
442
PPD and live vaccine
1. Give on same day
2. PPD 4 weeks after vac
3. Vac after PPD results
443
When are vaccines started in children?
Live: after 12 months
Inactivated: 2 months- except hep B which is given at birth
444
Live vaccine separation time
Give on same day- OR separate by 4 weeks
445
Can you shorten or extend vaccine intervals
You can extend (no need to restart series) but not shorten
446
Live vaccine separation from IVIG
Vac -wait 2 weeks- IVIG
IVIG - wait 3 months - vac
447
Loperamide dose
```
Max rx: 16 mg/d
Max otc: 8 mg/d
Chemo: 24 mg/d
Up to 2 days
-don’t use if dysentery!
```
448
Qvar
MDI
| Don’t shake
449
Finasteride dose
Baldness: 1 mg QD
BPH: 5 mg QD
450
Which contraceptive method has delay in return to fertility
Medroxyprogesterone injection
451
When are progestin only pills preferred?
Breastfeeding (Estrogen decreases milk)
Migraine with aura (estrogens can cause stoke)
452
Window for progestin only pill
3 hours
453
How often is depo provera given
Q 3 months
Injectable medroxyprogesterone
454
Benefits of drosperinone
k+ sparing diuretic, less bloating, less pms, less wt gain, less acne
Yaz, yasmin
Drosperinone is a type of progesterone
455
Progesterone ADR
Decreases bone mineral density
Give with calcium/vit D
Drosperinone: clotting risk
456
Estrogen CI
Migraine w/ aura, breast/ovarian/liver CA, CV/DM/HTN, smoker, >35, postpartum
Beware: abd pain, CP, HA, eye problems, swelling of leg
More risk with xulane patch
Drosperinone has clot risk
457
Adjusting COC
Easily spotting: increase estrogen
Late spotting: increase progesterone
ADR: decrease estrogen or use drosperinone containing
458
BC choice if heavy menstrual bleeding
Natzia, Mirena (IUD)
459
BC choice: mood disorder
Monophasic, extended cycle, or drosperinone
460
BC choice: postpartum
POP- no estrogen!
461
BC choice: premenstual disphoric d/o
Yaz or antidepressant
462
BC choice: don’t want to bleed
Extended (91 d) or continuous
463
Which BC has no interactions?
Injection!
464
Back up Contraception needed for rifampin
Continue for 6 weeks after d/c rifampin
(Due to induction of birth control)
465
Technivie or viekira pak plus ethinyl estradiol BC
CI!!! Liver tox!
466
Back up for BC start
Start today: 7 d
Sunday: 7 d
If within 5 d of START of period: no backup
POP: start anytime- 48h
467
Late/ missed BC
Combo
-1 missed/<48 h: no backup- double up
-2 missed />48 h: back up x7 d
POP: 3 h need back up
468
Which EC requires RX
Ella
469
PCN food
Empty stomach
470
Doxycycline food
```
With food (except oracea)
Minocycline with food
```
Tetracycline- empty stomach
471
Videx (didanosine) interactions
It is like a divalent cation
472
Synercid renal
No adjustment!
473
Metronidazole food
With food
474
Bactrim and nitrofurantoin food
With food
475
Voriconazole food
No! Empty stomach!
476
Itraconazole food
Caps: yes! Needs acid
Solution: not necessary
477
Carvedilol, labetolol, metoprolol- food
With food
478
HTN meds to avoid in pregnancy
ACE/ARB, diuretics
479
Women folate/vit d/ca requirements
Child bearing age: 400 mcg
Pregnant: 600 mcg folate
-D: 600 u
Ca2+: 1000 mg
480
Drugs not to use in pregnancy
Less obvious: quinolones, hormones/BC, raloxifene, ergots, megace, hydroxyurea, lithium, ribaverin, topiramate, paxil, amiodarone/ dronedarone, fluconazole/voriconazole, grisofulvin, lenolidomide, phenytoin, phenobarbital, atenolol, AMG, radioactive iodine,
Obvious: retinoids, statins,
, tetracyclines, warfarin, MTX, misoprostol, nsaids, thalidomide, valproate, CMZ, finasteride/dutasteride, ERAs, leflunamide, methimazole/PTU,RASS,
481
Pregnancy nausea
Pyridoxine (B6), doxylamine
Ginger
482
Pregnancy GERD
Calcium carbonate
483
Pregnancy flatulence
Simethicone
484
Pregnancy constipation
Fiber: psyllium, calcium polycarbophil
Docusate
485
Pregnancy: cough, cold, allergy
Chlorpheniramine (DOC), Benadryl,
ICS: budesonide, beclonethasone (B for baby)
No pseudo or oxymetazoline!!!
486
Pregnancy: pain
APAP
No nsaids or asa!!!
487
Pregnancy asthma
Budesonide, albuterol
488
Pregnancy DM
Insulin! Regular!
Sometime Metformin and glyburide
489
Pregnancy ABX
PCN, amox/amp, cephalosporin, erythromycin/azithromycin
No: clarithromycin, FQ, tetracyclines, fluconazole,
Nitrofurantoin and bactrim maybe in first trimester
490
Pregnancy VTE
LMWH > UFH
No warfarin, XA and thrombin-I not studied so no
491
Breastfeeding considerations
- No codeine/tramadol
- no HIV positive
- supplement baby w
- 400 unit vit D
- 1 mg/kg iron months 4-6
- no amohetamines, ergots, amiodarone, lithium, statins, phenobarbital, or metronidazole
492
Progesterone effect on bones
Decreases BMD
493
PPI effect on bones
Decreases BMD- increase ph will reduce ca2+ absorption
494
Steroid effect on bones
Decreases BMD
495
Calcium tips
- Saturable absorption- divide doses
- citrate better if higher PH (PPI)
- carbonate- take with food
- ADR- Constipatjon
496
Calcium strengths
Carbonate: 40% elemental
-1 g= 400 mg elemental
Citrate: 21% elemental
-1 g= 210 mg elemental
497
Bisphosphonates info
- Sit upright x 30 min (bonivia 60 mins)/ full glass of water
- EMPTY STOMACH
- NO DIVALENT CATIONS
- do dental work before
- ADR: hypocalcemia, osteonecrosis or jaw, dyspepsia, esophagitis
- separate 2 h divalent cations
- caution renal
- missed dose: don’t double up, take next day
498
Estrogen bone effects
Increased BMD
499
Weird estrogen ADR
Dementia
500
Menopause natural products
Black cohosh, evening primrose, red clover, soy
501
Paroxetine interactions
Warfarin- increased bleed risk
| Tamoxifen- reduced efficacy
502
Meds that can lower testosterone
Methadone, cimetidine, spironolactone, chemo
503
Testosterone ADRs
CV/clotting, hepatotoxicity, baldness, acne, gynecomastia
* worsens BPH- don’t give if on finasteride
* secondary exposure to women and children
- remove androderm patch for MRI
- gels are flammable
504
Is lithium serotonergic?
Yes
505
Lithium food
Take with meals!
506
Cochcine major ADR
Diarrhea, N/V
*note: medguide needed
507
Which type of vit D is active?
Calcitriol
| D3
508
Medroxyprogesterone pregnancy
Category X
509
Meds that cause ED
SSRI/SNRI, beta blockers, clonidine, typical AS, risperidone/paliperidone, finasteride, nicotine, chronic opioids (methadone)
510
Natural products for ED
Yohimbe, l-arginine, panax ginseng
511
What else is tadalafil used for?
BPH, PAH
512
ED dosing
```
Sildenafil: 50 mg
Vardenafil (Levitra): 10 mg
Cialis: 10 mg
Avanafil (stendra): 100 mg
*50% if elderly, alpha blocker, cyp3a4 inhibitor, renal or liver dx
```
513
PDE info
Impaired color, hearing loss, vision loss, hypotension, headache, dyspepsia, flushing
* sildenafil and vardenafil decreased efficacy with high fat/meal
- no etoh
514
When to take PDEs before sexual activity
Avanafil: 15 min
Tadalafil: 30
Sildenafil/vardenafil: 60 min
515
Which natural products are used for BPH (not recommended)
Saw palmetto, pygeum
516
Natural products for prostate CA prevention
Lycopene
517
When should 5-alpha reductase inhibitor NOT be used
BPH w/o prostate enlargement
*they reduce the size of prostate
518
Meds to worry about with cataract surgery
Alpha blockers
| Floppy iris syndrome
519
Tadalafil weird ADR
Back pain
520
When to take tamsulosin
30 mins after a meal
520
When to take tamsulosin
30 mins after a meal
521
Which drug class worsens dementia?
Anticholinergics (obviously)
522
Reducing try mouth from anticholinergic for OAB
Oxybutynin Patch or gel or ER
| Or mirabegron
523
Nocturia tx
Desmopressin
ADR: hyponatremia! Retains water!
Caution: fluid retention
524
Minimum MME for fentanyl patch
60 mme x 7 d
525
After applying fentanyl patch…
Decrease other opioids by 50% x 12 h before stopping
Takes 8-16 h for effect
526
Fentanyl and other opioid drug interactions
What for 3A4 inhibitors
527
Opioid 3A4 substrates
Fentanyl, methadone, hydrocodone, oxycodone
528
Natural products for migraine
Butterbur, feverfew, magnesium, riboflavin
529
Triptan concerns
CV, BP, serotonin , paresthesias
CI in pregnancy!!!
530
Long acting triptans
Frovatriptan, naratriptan
531
Triptan drug interaction
MAOI
| Sumatriptan, rizatriptan, zolmitriptan
532
When not to use ODT triptans
Phenylketonuria
| Rizatriptan/zolmitriptan MLT
533
Common joint effected by gout
Metatarsophalangeal (big toe)
534
Drugs that increase uric acid
Aspirin, diuretics, niacin, pyrazinamide
Pancreatic enzymes, calcineurin inhibitors,
535
Goal uric acid level
<6
| Don’t treat unless a gout attack has occurred
536
Do you stop or continue Uric acid lowering therapy during gout attack
Continue
537
Colchicine tx dose
1.2 then 0.6 1 hour later
Max: 1.8/ hr; 2.4/ day
Don’t repeat sooner than 3 days
538
Colchicine ppx dose
0.6 QD or bid
539
Cochicine info
- Don’t use with cyp3a4 or pg-protein inhibitors!!!!
- N/D, myelosuppression, myopathy, neuropathy
* *wait 12 h after tx before resuming ppx**
540
PDA tx in fetus
Indomethacin, ibuprofen
541
Big colchicine interaction
Pg-protein or 3A4 inhibitors
542
How to start xanthine oxidase inhibitor
With colchicine or nsaids
| *can precipitate attack*
543
Allopurinol allele
HLA-B*5801
544
Azathioprine/mercaptopurine + XOI
Don’t use febuxostat or allopurinol with azathioprine (increases conc of active metabolite Mercaptopurine)
545
How often is clonidine patch changed?
Weekly
545
How often is clonidine patch changed?
Weekly
545
How often is clonidine patch changed?
Weekly
545
How often is clonidine patch changed?
Weekly
545
How often is clonidine patch changed?
Weekly
545
How often is clonidine patch changed?
Weekly
545
How often is clonidine patch changed?
Weekly
545
How often is clonidine patch changed?
Weekly
545
How often is clonidine patch changed?
Weekly
545
How often is clonidine patch changed?
Weekly
545
How often is clonidine patch changed?
Weekly
545
How often is clonidine patch changed?
Weekly
545
How often is clonidine patch changed?
Weekly
545
How often is clonidine patch changed?
Weekly
546
Drugs that worsen gerd
Aspirin/NSAIds, iron, bisphosphonates, dabigatran, estrogens, fish oil, steroids, tetracyclines, nicotine
547
How long should initial trial of PPI be?
2 weeks
548
H2 blockers ADR
Confusion, B12 deficiency, renally adjust <50 (famitidine, ranitidine, nizatidine)
30-60 mins before eating
549
PPI meal timing
Before breakfast ESO, Omep, lans
W/o regard: dexilant, pantop, raber
550
PPI ADR
Cdif, B12 deficiency, decreased BMD
30-60 min before breakfast
No omep/ esomeprazole with clopidogrel
No crush: open and caps and mix with applesauce (no chewing)
551
PPI available as injection
Pantoprazole, esomeprazole
552
H2 blockers available as injection.
Famitidine, ranitidine
553
OTC PPI
Omeprazole, esomeprazole, lansoprazole
554
ODT PPI
Lansoprazole, omeprazole
555
OTC h2 blockers
Cimetidine, ranitidine, famitidine
556
Metoclopramide MOA
Dopamine antagonist + seratonin blocker in CTZ at higher doses
557
Drugs for peptic ulcer dx but not GERD
Misoprostol, metoclopramide, sucralfate
558
When to renally adjust reglan
Crcl<40, decrease by 50% (2.5-5 qid)
559
Drugs with decreases absorption if taken with antacids
Rilpivirine, atazanavir, ledipasvir, velpatasvir/sofosbuvir (epclusa, harvoni) (HEV), itraconazole m, ketoconazole, posaconazole suspension, cefpodoxime, cefuroxime, iron, mesalamine, atelvia (risendronate ER), TKI,
560
Drugs that bind antacids
INSTIs, bisphosphonates, isoniazid, mycophenolate, quinolones, soya lol, steroids (budesonide). Tetracyclines, thyroids products
561
H2 blocker- increased QTc
Famotidine
562
Bacteria causing peptic ulcers
H. Pylori- spiral shaped gram negative
563
Eating and ulcer pain
Duodenal (h pylori): worse on empty stomach
Gastric (nsaids): worse with eating
564
Urea breath test
Tests for h pylori ulcer
D/c PPI, bismuth, and ABX 2 weeks before
565
H pylori tx
Bismuth, metro, tetracycline, PPI
*pylera QID + PPI BID*
Alt: clarithromycin + amo + metro + PPI BID
CAM BID + PPI BID
These are both quadruple
566
Duration of therapy H pylori tx
10-14 d
If triple therapy: 14 d
567
Safer NSAIDs with risk for GI
Celecoxib, meloxicam, diclofenac, nabumetone, etodolac
568
Misoprostol issues
Abortifacient, diarrhea, abd pain
| *200 mg qid
569
Sucralfate issues
Constipation, DI (2h before and 4 h after)
| 1 g QID before meals/bedtime
570
When to seek medical attention for GERD
Self tx > 14 d or twice weekly
571
Aluminum: constipation or diarrhea
Constipation
572
Prevacid solutab CI
Phenylketonuria (contains aspartame)
573
Drugs that increase lipids
PAST D
Protease inhibitors, atypicals AS, steroids, transplant, diuretics
Estrogens, tamoxifen, bile acid sequestrants, sglt2
574
Natural products for cholesterol
Red yeast rice
575
When statin is indicated
ASCVD risk >7.5%, DM, ldl >190, clinical ASCVD
576
Who gets high intensity statin
ASCVD (stoke/tia, PAD), ldl>190, age 40-75 ldl 70-189 and ASCVD >20%, age 40-75 DM and mx risk factors for ASCVD
Moderate intensity: ASCVD risk 5-19.9%, or age >75
Add on therapy if <50 ldl dec with high intensity or ldl still >70
577
Lipid lowering drug CI with statin
Gemfibrozil
578
Statin + colchicine
Interaction: increased risk myopathy
579
Hydrophilic statins
Pravastatin, rosivastatin
| Less interaction and mypothay
Pitavastatin also less DI
580
Weird 3a4 inhibitors- reduce statin dose
Cyclosporin, nefazodone
*danazole (with simvastatin)
581
What time is niaspan taken
Bedtime
| With low-fat snack
582
When to start BP med
Stage 2 or stage 1 plus CVD or ASCVD >10%
583
When to start two BP meds
>150/90
584
When to start HTN therapy in pregnancy
>160/105
585
Thiazides renal
Not effective below crcl<30 except metolazone
586
Only IV thiazide
Diuril (chlorthiazide )
586
Only IV thiazide
Diuril (chlorthiazide )
587
Safest CCB in HFrEF
Amlodipine, felodipine
588
BUD of clevidipine and propofol after opening vial
12 h
588
BUD of clevidipine after opening vial
12 h
589
Which k+ sparing diuretics better at lowering BP
Aldosterone antagonists (eplerenone and spironolactone)
590
Non selective BB
Nadolol (corgard), pindolol, prop, timolol
591
BB Effect in BG
Can increase or decrease
591
BB Effect in BG
Can increase or decrease
592
HTN emergency- how fast to decrease BP
Max 25% in 1 h
(>180/120)
If urgency use orals
593
Does stable angina count as clinical ASCVD
Yes
594
Tx of stable angina
ABCDE
Antiplatelet/antianginal, BP/BB, cholesterol (statins), DM, exercise
- It’s ASCVD so need statin + ASA
- BB first line
595
When to use DAPT
```
SIADH
-bare metal stent x 1 mo
-drug eluding stent x 6 mo
-cabg x 12 mo
Stroke: x 21 d
```
596
When to avoid BB in angina
Prinzametals (use DHP)
597
When to call 911 after nitrate
If angina still there after 1st dose
597
When to call 911 after nitrate
If angina still there after 1st dose
598
BUD nitro tabs in glass container
6 months after opening
598
BUD nitro tabs in glass container
6 months after opening
598
BUD nitro tabs in glass container
6 months after opening
598
BUD nitro tabs in glass container
6 months after opening
598
BUD nitro tabs in glass container
6 months after opening
599
NTG admin
SL- don’t chew or swallow!
Max 3 doses in 15 mins
May feel tingling or burning- not an indication of efficacy
HA- indication if efficacy
600
Preferred site for topical NTG
Chest
Not below knees or elbows
601
Ranolazine interaction
Cyp3a4 substrate
| QTc
602
Dabigatran dosing
150 BID
| Crcl<30: 75 BID
603
Converting dig PO to IV
Decrease by 25%
604
Time for referral diarrhea
2 d
605
Time for referral: constipation
7 d
605
Time for referral: constipation
7 d
605
Time for referral: constipation
7 d
606
Time for referral: constipation
7 d
607
Time for referral: GERD
14 d
607
Time for referral: GERD
14 d
607
Time for referral: GERD
14 d
608
Time for referral: GERD
14 d
609
Sodium phosphates risk
Fluid and electrolyte abnormalities
| *don’t use in renal or cardiac dx
609
Sodium phosphates risk
Fluid and electrolyte abnormalities
| *don’t use in renal or cardiac dx
610
Sodium phosphates risk
Fluid and electrolyte abnormalities
| *don’t use in renal or cardiac dx
611
Laxatives/ antacids dangerous in CKD
Anything with mg if al
612
Laxative for post MI, post partum, or hemorrhoids
Docusate
613
What do you avoid with EC bisacodyl
Milk, dairy, antacids- within 1 hr
614
Laxative interaction
Mineral oil + docusate= increased absorption
615
Issue with mineral oil
Take with MV- reduced ADEK
616
Osmoprep boxed warning
Nephropathy
617
What can you eat day before colonoscopy
Clear liquid diet
No: pulp, red/blue/purple food coloring, milk, alcohol, semi/solid food
618
Amitiza
Lubiprostone
Constipation (cl channel)
619
Linzess
Constipation
Guanylate cyclase
620
Trulance
Plecanatide
Guanylate cyclase
Constipation
621
Drugs that cause diarrhea
Cochicine, quinidine, misoprostol
Reglan, ABX, chemo, magnesium, roflumilast
622
Symproic
Naldenedine
| PAMORA
623
Loperamide risks
Torsades, <2 y/o
Don’t exceed 48 h
624
Lomotil max dose
20 mg/ d
CV
625
IBS v IBD
IBD more severe and associated with inflammation
| *chrones and UC*
626
Ulcerative colitis
Superficial, Confined to rectum and colon
| *proctotis if just rectum- can use topicals
627
Chrones
Deep, affects any part of GI tract
628
Nicotine weird use
Protective in Ulcerative colitis
628
Nicotine weird use
Protective in Ulcerative colitis
629
Nicotine weird use
Protective in Ulcerative colitis
630
Chrones tx
```
Mild:Oral budesonide,
Mod: humira, remicade, cimzia
-azathioprine/ mercaptopurine
-stelara (ustekinumab)
Refractory: vedolizumab, natizumab
```
631
Ulcerative colitis tx
```
Mild: mesalamine
Mod: humira, remicade, simponia
-azathioprine/mercaptopurine
-cyclosporine
-tofacitinib (xeljanz)
Refractory: vedolizumab
```
632
Tx acute flares of UC and chrones
Steroids
633
Recital steroids indication
Ulcerative colitis only
634
Ghost tablets
Desvenlafaxine, nisoldipine (sular), adalat, covera, procardia, asacol, delzicol, glumetza/fortamet, invega, concerta, glucotrol XL, oxybutynin XL
635
Who should not receive promethazine
Children- respiratory depression
636
What is not effective for motion sickness
Reglan and 5HT-3 antagonists
637
Scopamaline risks
Increased IOP- no glaucoma (same with Dramamine and meclizine)
Allergy to belladonna
638
When to apply scopalamine
4 h before needed or night before surgery
Press x 30 seconds
No MRI
639
RA v MS tx
RA:
- non-bio: DMARD MTX, hydroxychloroquine, sulfasalazine, leflunamide, tofacitinib, baracitinib
- TNF and non-TNF bio-DMARD
MS: interferon beta, glatiramer acetate,
-teriflunamide, fingolomid, dinethyl fumarate, simponimod, dalfamfridine, tysabri, alemtuzumab, ocrevus, cladrabine
639
RA v MS tx
RA:
- non-bio: DMARD MTX, hydroxychloroquine, sulfasalazine, leflunamide, tofacitinib, baracitinib
- TNF and non-TNF bio-DMARD
MS: interferon beta, glatiramer acetate,
-teriflunamide, fingolomid, dinethyl fumarate, simponimod, dalfamfridine, tysabri, alemtuzumab, ocrevus, cladrabine
640
Metformin renal dosing
<30 CI
| 30-45: don’t start- may continue at half normal dose (500 BID)
641
PCI only
Abciximab, prasugrel
642
Brillinta dosing
LD: 180 mg
90 mg BID x12 mo then 60 BID
*don’t use ASA doses >100 mg
*ticagrelor
643
Plavix LD
Pre-pci after fibrinolytics
600 mg if >24 hrs of fibrinolytic
300 mg if within 24 hrs of fibrinolytic
Just pci
600 mg
644
When are fibrinolytics indicated?
Only stemi!!! Within 3 hr of symptom onset and 30 mins of arrival!
(60 mins for stroke- or 4.5h from symptom onset)
* if can’t do PCI within 90 mins of arrival or 120 mins of first medical contact
* CI if recent stroke!
645
When is ACE indicated after ACS
HFrEF <40%, DM, HTN
646
Aldosterone antagonist (eplerenone/spironolactone renal CI
Men: scr >2.5
Women: scr>2
647
Lowest CV risk NSAID
Naproxen
648
When is PPI indicated for antithrombotic therapy?
DAPT + AC
649
Which drug causes yellow-green halos
Digoxin
650
Additional affect of dipyridamole
Hypotension (causes HA)
651
Management of hemorrhagic stoke
- reverse AC
- reduce ICP: mannitol or hypertonic saline
- PPx anticonvulsants only for SAH
- nimodipine to prevent cerebral Vadospasm in SAH
652
Which CCB is more lipophillic
Nimodipine
653
Mannitol CI
Severe renal dx
654
IV bisphosphonates
Ibandronate (bonivia) Q mo
| Zolendronate (zometa) yearly
655
Zolendronate formulations
Reclast: osteoporosis
Zometa: hypercalcemia of malignancy
656
What decreases lithium ?
Theophylline, caffeine, salt
657
What increase lithium ?
Ace/arb, thiazides, NSAIDs (except sulidac and ASA)
658
Meqs in lithium
8 MEQ= 300 mg carbonate or 5mL citrate solution
659
How fast can you correct sodium?
12 meq/L in 24 h
660
IV k+: max concentration and rate for peripheral
Conc: 10meq/100 mL
Rate: 10 meq/hr
661
IVIG and vaccines
Can impair response to vaccination
661
IVIG and vaccines
Can impair response to vaccination
661
IVIG and vaccines
Can impair response to vaccination
661
IVIG and vaccines
Can impair response to vaccination
662
Blue nitroprusside
DONT USE- degraded to cyanide
663
Vasopressor of choice for septic shock
Norepinephrine
664
Weird lorazepam ADR
Propylene glycol toxicity (AKI and metabolic acidosis)
665
Drugs that cause malignant hyperthermia
Succinylcholine
| Inhaled anesthetics
666
Lysteda
```
Tranexamic acid (tab)
Could use for heavy men’s that bleeding
```
667
Amicar
Aminocaproic acid
668
Ibuprofen strengths!!
Infant : 50/1.25 ml
| Child: 100/5 ml
669
Age you can give motrin
6 months +
669
Age you can give motrin
6 months +
670
Neonatal meningitis (<30 d)
Ampicillin + (cefotaxime OR gentamicin)
671
RSV tx and ppx
Tx: virazole (inhaled ribaverin)
Ppx: synagis (palivizumab)-
-doses monthly in premature with heart or lung dx during RSV season
672
Order to CYstic fibrosis drugs
Bronchodilator > hypertonic saline (nebulized) > dornase Alfa > physiotherapy > inhaled ABX
673
Max pancreatic lipase dose
Lipase <2500u/kg/meal or 10,000u/kg/day
674
Pancreatic lipase facts
- can mix with acidic food but not dairy
- viokace needs PPI
- original container
- half mealtime dose for snacks
* MEDGUIDE*
675
Calcineurin inhibitor info (tacrolimus and cyclosporine)
HTN, renal tox!, hyperglycemia, neurotox, lipids, QTC!, hyperK+, hypomag, PHOTOSENSITIVITY
* Non-PVC for IV
* 3A4 and P-GP interactions!!!
- avoid sun- skin cancer risk with transplant patients
676
Mtor Inhibitors major ADR
Increased lipids
677
Monoclonal antibody major ADR
Severe reaction: premeditate with steroid, antihistamine, acetaminophen
678
Weight loss drug reqs
Must lose 5% in 12 weeks to continue
No preganancy
678
Weight loss drug reqs
Must lose 5% in 12 weeks to continue
No preganancy
678
Weight loss drug reqs
Must lose 5% in 12 weeks to continue
No preganancy
679
AC of choice it HIT
Argatroban
680
If pt on warfarin hey HIT
Stop warfarin- (even though high clot risk) and give vit K
*risk limb gangrene and necrosis with low plt and warfarin
681
AC of choice with prosthetic heart valve
Warfarin
682
Xarelto renal dosing
```
Afib
-<50: 15 QD
-<15: avoid
Tx
-<30: avoid
```
*for tx you take 20 either way- even if renal function 30-50
683
Dabigatran expiration
4 months after opening
* also: !!original container!!
* and no g-tube!~ dont open capsule!
* skip missed dose if within 6h of next dose!
684
Warfarin bridge with lmwh
Continue x 5 d and until INR > 2 for at least 24 h
685
How to give vit k for warfarin reversal
PO/IV NOT SubQ/IM
1 mg/min max!
*give PO if no bleed- give IV if bleed
Inr>10 or >4.5 if risk factors
686
When to use vit k
If not bleeding: INR> 10
-PO: 2.5-5
Bleeding: 5-10 mg slow IV
-give with PCC
687
When to stop warfarin before surgery
5 d
*bridge with LMWH if mechanical heart vale (d/c 24 h before or 4-6 h before if UFH)
688
Preferred tx for DVT or PE
DOAC> warfarin
| Cancer: LMWH
689
CHA2 DS2 VASc
CHF, HTN, Age>75, Diabetes, stroke, vascular dx, age 64-74, sex
Male: 2 needs AC
Female: 3 needs AC
689
CHA2 DS2 VASc
CHF, HTN, Age>75, Diabetes, stroke, vascular dx, age 64-74, sex
Male: 2 needs AC
Female: 3 needs AC
689
CHA2 DS2 VASc
CHF, HTN, Age>75, Diabetes, stroke, vascular dx, age 64-74, sex
Male: 2 needs AC
Female: 3 needs AC
689
CHA2 DS2 VASc
CHF, HTN, Age>75, Diabetes, stroke, vascular dx, age 64-74, sex
Male: 2 needs AC
Female: 3 needs AC
689
CHA2 DS2 VASc
CHF, HTN, Age>75, Diabetes, stroke, vascular dx, age 64-74, sex
Male: 2 needs AC
Female: 3 needs AC
689
CHA2 DS2 VASc
CHF, HTN, Age>75, Diabetes, stroke, vascular dx, age 64-74, sex
Male: 2 needs AC
Female: 3 needs AC
690
Drugs that can cause hemolytic anemia
VALPROATE, dapsone, methylene blue, primaquine, rasburicase, pegloticase, bactrim, nitrofurantoin, levodopa, methyldopa, PCN, cephalosporin, quinine, quinidine, rifampin
Think G6PD deficiency
690
Drugs that can cause hemolytic anemia
VALPROATE, dapsone, methylene blue, primaquine, rasburicase, pegloticase, bactrim, nitrofurantoin, levodopa, methyldopa, PCN, cephalosporin, quinine, quinidine, rifampin
Think G6PD deficiency
690
Drugs that can cause hemolytic anemia
VALPROATE, dapsone, methylene blue, primaquine, rasburicase, pegloticase, bactrim, nitrofurantoin, levodopa, methyldopa, PCN, cephalosporin, quinine, quinidine, rifampin
Think G6PD deficiency
691
Hep B tx
Peg-INF or NRTI
692
Hep C tx
DAA combo
| +/- RBV +/- PEG-INF
693
Drugs with boxes warnings for liver damage
APAP, isoniazid, ketoconazole, amiodarone, MTX, nevirapine, nefazodone, NRTIs, PTU, tipranavir, valproate,
Bosentan, felbamate, flutamide, leflunamide, teriflunamide, lomitapide, maraviroc, mipomersen, tolcapone
694
Antipsyches: high v low potency
Low: less EPS, more sedation, and CV (hypotension)
High: more EPS, less sedation
695
Typical antipsych less known ADRs
Hypotension (also atypical), seizures, sexual ADRs
696
How to people die from antipsyches (black box)
Stroke
697
Requirement for invega trinza
Only after Sustina monthly x4 months
698
Seroquel food?
No, or light meal (ER)
IR doesn’t matter
698
Seroquel food?
No, or light meal (ER)
IR doesn’t matter
699
Ziprasidone food
With food!
700
Asenapine food
No!
Note: tongue numbness
701
Antipsyches food reqs
With: lurasidone, ziprasidone
Without: seroquel, asenapine
702
Serious antipsych ADR
NMS
* more with first gen (d/t D2 blockade)
- seroquel/clozapine less
- BZDs, dantrolene, bromocriptine (dopamine agonist)
703
Preganancy bipolar
Lamotrigine or lurasidone
704
Lithium ADRs
GI, cognition/confusion, cogwheel rigidity, hand tremor, wt gain OR anorexia, polyuria/dipsia, hypothyroid, blue skin pigment, impotence, serotonergic
Toxicity: arrhythmias, seizures, coma
705
Amphetamine salts and acid
Don’t take with acid juice- decreases absorption
706
Stimulants suicidal ideation?
No!
Yes for straterra
707
Stimulant and straterra differences
ED, libido, hyperhidrosis, suicide, straterra but NOT stimulants
708
Tamoxifen interactions
Prodrug via 2D6 (no fluoxetine or paroxetine)
Cyp2C9 inhibitor- No warfarin!!!
709
Inhibitors
Pacman
PIs, azoles, cyclosporin, cimetitinde, cobicistat, macrolide (not azithromycin), amio/dronedarone, non-DHP
710
Pseudomonas abx
Zosyn, cefepime, ceftazadime, , ceftazolane-tazobactam, aztreonam, carbapenems (not ertapenem), levofloxacin, cipro, AG
711
Corrected calcium
(4-albumin) x 0.8 + calcium
712
Extravasation temp management
Cold: anthracyclines (and dimethyl sulfoxide, or dexrazozane “totect”)
Heat: vinca alkaloids (and hyaluronidase)
713
Which DPIs have slow inhalation
Ellipta
Also handihaler and neohaler aren’t as forceful
714
Emergency contraception times
Plan b: 120hr (labeled 72)
Ella (ullipristal): 120h- rx only
Copper iud- 5 day (better bmi>35)
715
Danazol
Androgenic hormone for endometriosis
716
Elagolix (orilissa)
GnRH antagonist
Endometriosis
717
Correlation tests
Pearson: continuous, normal distribution
Spearman: not normally distributed or ordinal
718
Regression vs correlation
Regression shows one variable is dependent on the other (cause and effect)
*regression used for prediction!
719
Survival analysis
Kaplan Meier- descriptive
Cox proportional hazards- continuous and test multiple
Log rank
720
Hyperthyroid in pregnancy
1st trimester use PTU- switch to methimazole in second trimester
721
Levothyroxine iv to po
75%
722
Thyroid drug pearls
Levothyroxine-T4
Liothyronine- T3
Liotrix- T3/T4
Dedicated thyroid 60 mg= levothyroxine 100 mg
Levothyroxine start: 1.6 mcg/kg IBW
723
Pasireotide
Cushing’s
724
Antiarrythmics to use in HF
Amiodarone or dofetilide
NOT dronedarone
725
Anticoag choice in primary pci
Bivalirudin or UFH
726
How long to continue AC after pci
Fibrinolytic?
48 hours, up to 8 days
Usually stop after pci
*48 hours after for fibrinolytic
727
ARNI lab issue
Use NT-proBNP not BNP
728
ADHF numbers
Wet: pcwp >18
Dry: pcwp 15-18
Cold: CI <2.2
Warm: CI >2.2
729
ADHF tx
Wet: diuretics (+\- venodilator (NTG))
Cold: if SBP <90- inotrope
If SBO >90-arterial vasodilator (nitroprusside)
Cold and dry: Pcwp<15- start w/ IVF…if sbp<90 use inotrope, if sbp>90 use arterial vasodilator (nitroprusside)
Generally avoid pressers- use if SBP< 90 and need initrope
730
Milrinone v dobutamine
Milrinone: to avoid stopping BB. **don’t bolus**
Dobutamine: severe hypotension, bradycardia, renal impairment, thrombocytopenia
731
Tolvaptan
Vasopressin ANTAGONIST
makes you urinate
*opposite of desmopressin
732
DOC pulseless VT/VF
Amiodarone
733
Ventricular arrhythmia
Lidocaine or Mexilitine
734
Fenoldopam
Vasodilator for hypertensive crisis
735
DOC acute aortic dissection
Labetaolol, esmolol
736
HTN crisis: DOC pulmonary edema
Clevidipine, NTG, ntp
No BB
737
Code: v fib or pulseless vtach
Shock
738
Code non-shockable rhythms (PEA, asystole)
Epi asap
739
Which antipsychs have less QTc effect
Risperidone and olz
740
Stress ulcer ppx indication
Mech vent, inr>1.5, or plt<50
741
When to avoid D5W
Neurological injury (increases ICP) bc it’s “free to cross any membrane
742
Which fluid should 150 meq sodium bicarb go in
Sterile water or D5W (osmolarity issues)
743
Demeclocycline
ABX but also for siadh (reduces sensitivity to adh- opposite of desmopressin)
744
Calcium to use in PN
Gluconate
Chloride more likely to precipitate
745
Required concentration of AA, ca, and phos
AA: 2.5%+ (decreases ph) 4%for TpN
Ca: 6meq/L or less
Phos: 30-40 mmol/L or less
746
Tests for heterogeneity
Cochrane Q, X2, I2
P>0.1 means no heterogeneity
747
Postrenal Aki from drug precipitation. Drug examples
MTX, sulfonamide, acyclovir, ascorbic acid,
748
Indication for dialysis
Acidosis
Electrolyte abnormality
Intoxication
Overload (fluid)
Uremia
749
ESA reqs
Start Hgb <10
Stop:
-Hgb >11 (HD) or >10 (non-HD)
Increase 25% if <1 change in 4 wk
Decrease 25% if >1 change in 2 wk
750
ESA use with caution
Hx stroke or cancer, HTN
751
ESA SubQ to IV
SubQ is 30% less than iv
752
Iron formulation in dialysis patients
IV, NOT oral
753
PPI + IV MTX
Risk MTX toxicity
754
Bethanecol
Cholinergic AGONIST
For urinary retention
755
Motrin + ASA
Give Motrin 30 mins after or 8 hours before aspirin
756
Albumin dosing
Paracentesis: 6-8 g/L if >5 L removed
SBP: 1.5 g/kg d1, 1 g/kg d3
757
Ribaverin indication
Hep c
758
Mavyret
Glecaprevir/pibrentasvir
759
DAA interactions
3A4/ pgp, acid suppressive therapy, statins
Many can cause liver issues
760
Linaclotide (linzess)
Constipation
761
Prucalopride (motegrity)
Constipation
Seratonin agonist
Cardiac events and suicide
762
Lubiprostone (amitiza)
Constipation
No pregnancy
763
Tenapanor (ibsrela)
Constipation
764
Peppermint oil use
Nausea, IBS
765
Tegaserod
IBS-C
766
Eluxadoline
(Viberzi)
IBS-D (mu agonist)
767
Alosetron
IBS-D
Lotronex
768
IBW
50 or 45.5 + 2.3(inches over 5ft)
Adjusted: IBW + 0.4(act-IBW)
769
Which drugs used actual body wt in crcl calculation
Xarelto, dofetilide, dabigatran
770
Aducanumab
Alzheimer’s
771
RA DOC in preganancy
Sulfasalazine
772
Meningitis is child
0-1 month- amp + gent
1-3 month- amp or vanc + ceftriax
>3 month: vanc + ceftriax
773
Which vaccines have neomycin
Polio, varicella, mmr
774
Methylphenidate to dexmethylphenidate
50% reduction
775
Viloxazine
Like atomoxetine
776
Which common seizure meds don’t effect birth control
Valproate, levetiracetam, Zonisamide, lacosamide, ethosuxamide
777
Selegiline patch vs tab
Patch: depression
Tab: PD
778
Istradefylline
Nourianz
PD
779
Lumateperone
Atypical antipsych
No EPS
780
Antipsych movement disorder meds
Akathesia: BB, BZD
Dystonia: anticholinergic (po to prevent, iv to treat)
Pseudoparkinsonism: oral anticholinergic
Traduce dyskinesia: valbenazine, deutetrabenazine, tertabenazine…. DO NOT USE ANTICHOLINERGICS
781
Antipsyches highest risk seizure
Chlorpromazine, cariprazine, clozapine
If it starts with “c” it causes seizures
782
Seratonin syndrome treatment
Cyproheptadine, BZD, anticonvulsant, nifedipine
783
SSRIs with less sexual dysfunction
Vortioxetine, vilazodone
Also mirtazapine
784
TCA major ADR
Seizures
785
Half life
0.693/k
786
Gene that valproate CI in
Polg
787
Valproate ER to enteric coated
Increase by 8-20%
788
Valproate toxicity
Thrombocytopenia, hepatotoxicity, alopecia, pancreatitis, fetal harm,
789
Lamotrigine unique adr
Aseptic meningitis
790
Symbyax other use
Bipolar
791
Lemborexant
Insomnia
792
Sleep onset v sleep maintenance
Which can be used long term?
Both: zolpidem, eszopiclone, suvorexant, temezepam
Onset: ramelteon, zaleplon, triazolam
Maintenance: doxepin,
Note: ramelteon and z-drugs can be used long term
793
Who should never get anticholinergics? (If you think about it…)
Alzheimer’s pts! Duh!
794
Which is the T in LOT BZDs ?
Temazepam NOT triazolam
795
Which is given first thiamine or glucose?
Thiamine
Cofactor for glucose metabolism
796
Which is the only LAMA for asthma
Spiriva
Add to high dose ICS-LABA for very severe cases
797
Which LABAs are indicated in asthma
Salmeterol, formoterol, vilanterol
(Salamander for the villains)
** NEVER MONOTHERAPY FOR ASTHMA**
Combos: symbicort, Breo, dulera, advair
798
Indications for LAMA/LABA VS LAMA/ICS combos
LAMA/LABA: copd
LABA/ICS: asthma
799
Zileuton and zafirlukast adr
Hepatotoxicity
Not with mintelukast
800
Montelukast black box warning
Neuropsychiatric events
801
Monoclonals for asthma
When should they be used?
Omalizumab, dupilimumab, reslizumab, benralizumab, mepolizumab
These are best for allergy related asthma or high eosinophils!
802
Redihaler
MDI
803
Aerosphere
MDI
804
Preferred asthma meds in pregnancy
ICS: budesonide
LABA: salmeterol
Saba and montelukast okay
805
Is copd what is ICS combined with
LABA of LAMA/LABA (category D)
NOT LAMA alone
806
Adjusting COPD therapy
If LABA can add ICS
If LABA/ICS- add LAMA or change to LAMA/LABA
If LAMA/LABA- add ICS
If exacerbations if the issue- consider roflumilast, or azithromycin (former smoker)- both of these if eos <100
Note: ICS WHEN EOSINOPHILS >100 or >300
807
Copd exacerbation ABX
Augmentin, azithromycin, or doxy
Or FQ if suspect pseudomonas
808
Pneumococcal schedule
Pcv15 follow by pcv23 in 1 yr
Or just pcv20
*for qualifying 19-64 and everyone over 65if haven’t received before
809
Flu vaccine and egg allergy
Severe- RIV or ccIIV4 or vaccinate in medical setting
If hives only- any vaccine okay
810
Which FQs cover PSA?
Levo and cipro
Not moxi- important for tx of PNA
811
PNA duration
Cap 5 d
Hap/vap- 7 d
812
Baceterial v viral sinusitis
Bacterial: >10d, fever, double sickening
Augmentin first line
813
Pyleo or complicated uti
Bactrim of FQ, maybe beta lactams (especially ceftriaxone if inpatient )
CAUTI- levaquin
814
Preganancy uti
Augmentin, cephalexin, fosfomycin
Nitrofurantoin- avoid I. Trimester 1 and 3
815
Osteomyelitis with prosthetic joint
Add rifampin
816
Which FQ cover anaerobes ?
Moxifloxacin
*can use for GI infxns without metronidazole!
817
Gi infection
Anerobes, PSA if high risk
Treat for 4 days
818
Amphoteracins
Deoxycholate: regular
Liposomal ampho: safer
819
Cryptococus ppx
No primary (like cmv)
Secondary is fluconazole
820
Posaconazole vs itraconazole Cap v solution with food
Itra: solution empty, cap w/food
Posa: solution w/ food, cap no matter
821
Anion gap
(Na + k) - (cl + bicarb)
822
MAP equation
(Sbp + 2(dbp)) / 3
823
How many kcal per of per day needed for EN?
30 kcal/kg/day
824
K=
Cl/vd
825
Kcal and protein reqs
And fluid
Kcal= 25-30 kcal/kg/day
Protein= 1.3-1.4 g/kg/day
Fluid= 30 ml/kg/day
826
Meningitis ppx
Niseirria: (for close contacts and oral secretions exposure): rifampin x4 doses, or cipro or ceftriaxone x1 dose
H influenza: (close household contacts if unvaccinated if immunocomprimised): rifampin x4days
827
Rifampin+ bictegravir/ elvitegravir
Interaction
828
When are ABX needed for copd exacerbation
All three (increases sputum, purulence, and dyspnea)
OR purulence + one other
OR mech vent
829
Levothyroxine po to iv
Decrease by 25%
830
When is tdap given in pregnancy
Weeks 27-36
831
FENA
(Urine na/serum na)/(urine cr/scr) x100
<1% is prerenal
832
Inr to switch from warfarin to doac
Apixaban/dabigatran <2
Edoxaban <2.5
Rivarixaban <3
833
Hasbled
HTN (sbp>160), abnormal liver or renal(1 pt each), stoke, bleeding, labile inr, elderly, drugs or alcohol (1 pt each)
*renal- dialysis, transplant, scr>2.26
*liver- bili>2x, LFTs >3x
*drugs- antiplatelet/ nsaid
*etoh 8+/week
834
At which dose does fluconazole inhibit cyps
2c9: 100 mg
3a4: 400 mg
835
Warfarin alleles
2c9*2, vkorci*2- increases metabolism
2c9*3, vkorci*3- decreases metabolism
836
Hysteresis loops
Concentration late after dose produce different effect than same concentration early after a dose
Counterclockwise: Active metabolite, increased sensitivity, delay in concentration equilibrium. Ex digoxin
Clockwise: tolerance, inhibitor metabolite, pseudophed, cocaine
837
Pharmacodynamic equation
Hill equation
838
Drug levels
Phenobarbital: 15-40
Phenytoin: 10-20 (free 1-2)
Cyclosporin: 100-250
839
When to sample digoxin level
6-12h after dose- prolonged distribution period
*same for lithium but 12h after
840
When to collect aminoglycoside sample
30 mins after infusion
841
AC peri-cardio version
3 weeks before and 4 weeks after
842
Warfarin TIR goal
>65-75%
843
Warfarin adjustment
If previously stable and inr +\- 0.5- leave the same and recheck 1-2wk
If within 0.1 of goal leave alone
If inr >4.5 consider holding
Otherwise adjust by 5-20%
844
Dabigatran Bud
Other counseling
4 months after opening bottle
Don’t open caps- decreases BA
845
Converting between ACs
DOAC to warfarin- bridge til inr>2
(Dabigatran different- bridge with dabigatran not parenteral, edoxoban this is optional)
Doac to other AC- give with next doac dose would have been due
Warfarin to doac- give with inr below respective lvl (2, 2.5, or 3)
Other AC to doac- given doac when 0-2 hr (edoxaban 0hr) before next evening dose due ( if hep gtt stop and start doac at same time except edoxoban which is 4h later)
846
Edoxoban dosing
60 QD
Crcl<50: 30 QD
Avoid in crcl>95
**unique bc can use in crcl 15-30 for both ppx and tx- for dabig and Xarelto ppx okay but not for tx!
847
Main benefit of doacs over warfarin
All
-Less hemorrhagic stroke
-Non-inferior for stroke/VTE
Apixaban
-mortality benefit (significant)
-less major bleeding (also edoxaban)
848
When is warfarin preferred to doac
Mech heart valve and anti phospholipid syndrome
849
Can doacs be used in obesity?
Yes - xarelto better than Apixaban
850
Can doacs be used in advance renal disease
Apixiban and xarelto are preferred
Most are avoid in crcl<15
851
AC and antiplatelet in a pt with NVAF who had pci
Usually stop aspirin at discharge and continue p2y12 for 3-12 months
*takeaway is no AC + DAPT!
852
AC in bio prosthetic valves
Aspirin or warfarin if low bleed risk
I’d also afib and valve placement >3 months ago then doac is also ok
For mechanical valve always warfarin!
853
Fondaparinux ppx dose
Dalteparin?
Xarelto?
2.5 mg QD
Dalteparin: 5000 units qd
Xarelto: 10 mg
854
VTE ppx in trauma pts
Lovenox 30 q12 or Dalt 5000 qd
30 q12 also for spinal cord Injury and icu pts
855
When is warfarin better than doac for VTE (yes warfarin is ok for VTE)
Renal impairment crcl<30
856
Fondaparinux VTE dose
<50 kg: 5 QD
50-100 kg: 7.5 QD
>100kg: 10 QD
Note: ACS tx is 2.5 QD
Crcl<30 CI
857
Dabigatran and edoxaban in VTE
Only after 5-10 days of parenteral AC
858
Options for cancer related VTE
Lovenox (maybe Xarelto, edoxaban and maybe maybe Apixaban)
859
Protamine for UFH
1:100 for hr 1
0.5:100 for hr 2
0.25:100 for hr 3
860
How long to hold doac before surgery
1-2 days
861
Andexxa dose
Apix 5 mg or xarel 10 mg or >8 h: 400 mg then 4 mg/kg x2 hr
Apix 10 or xarel 15+ within 8 hr: 800 mg then 8 mg/kg x 2 hr
862
What consistories high grace or timi score (MI)
Timi: 3+
Grace: >140
863
Antiplatelet surgery hold time
Clop/tic: 5 days
Pras: 7 days
At least a day if emergency
*continue Asa for cabg
864
Ticafrelor + Asa caveat
Don’t uses Asa doses >100 mg
865
Gpiibiiia inhibitors- who gets them
Eptifibitide, tirofiban
Elevated bio markers, DM, undergoing revascularization, inadequate pretreatment with p2y12 inhibitors
Renally dosed
866
AC choice when fibrinolytixs are used for stemi
UFH, Lovenox, fondaparinux
867
Fibrinolytic CI
Hemorrhagic stoke, ischemic stroke in last 3 months, pregnancy, BP >180/110
868
How long to continue BB after acs
3 yrs if no HF
Start within 24 hrs if possible
869
Expected benefit from high intensity statin
50% decrease in ldl
If not can add non-statin
*ideally ldl<70
870
Life threatening bradycardia
Atropine 1 mg q3-5 mins (max 3 mg)
871
SVT, sinus tachycardia
Adenosine 6 mg
If fails: CCB or BB
872
Acute afib of flutter tx
Non-dhp CCB, BB, dig
873
Meds for cardio version
Ibutilide, amiodarone, propafenone (if within 7 days), dodetilide
I am professor dofus
874
Amio + dig
Amio + warf
Decrease dig 50%
Decreases warf 30-50%
875
Antiarrythmics preferred in HF
Amiodarone and doefetilide
876
Hypertensive emergency
In stroke?
Dec 25% in first hr, then to 160/100 in next 2-6hr, the normal in 1-2d
If ischemic stoke do no lower BP unless>220/120 unless tpa required and >185/110
In hemorrhagic stroke avoid hydralazine, NTG, NTP
877
NTG indications
Only ACS or pulmonary Edema
878
Which sglt2 inhibitors used in hf
Dapagliflozin and empagliflozin
879
Afib rhythm control agents
Class 1c and III
880
When to start BP med
Stage2 or Stage 1 HTN and ASCVD or 10 yr risk >10%
2 drugs if >150/90
881
When to use hypertonic saline
Traumatic brain injury
Symptomatic hyponatremia <120
882
Why is desmopressin given in hyponatremia
To counteract overcorrection of hypertonic saline
883
When to give calcium gluconate for hyperkalemia
K>6.5, extreme muscle weakness, or ecg changes
884
Head of bed elevation
30-45 degrees
885
When to use EN 2kcal/ml formulation instead of 1kcal/ml
Fluid restriction
886
Filter for 2:1 and 3:1
2: 0.22 micron
3: 1.2 micron
887
Hang time lipids
12 hours if separated from AA and carbs
888
TpN kcal/g
Fat 10
AA 4
Carbs 3.4
889
Asthma symptoms
Step 1: 2 or less days/wk-numbers look good
Step 2: >2d per wk- numbers looks good
Step 3: daily, numbers decreased
890
When is MRSA and PSA needed in PNA
Hap/vap: use PSA but and mssa not MRSA. Use 2 PSA if risk factors and MRSA if risk factors
PSA resistance >to mono-ABX>10%
MRSA incidence >10-20%
Hospitalization>5d, Ards, Rrt, (vap only)
Mortality risk: ventilator, septic shock
Iv ABX past 90 days
891
Hap/ vap definition
Hospitalization or vent for >48hs
892
Complicated uti or pyelo
Bactrim bid x14 d
Cipro bid x7 d
Levo QD x5d
Ceftriaxone or AG in hospital
Pregnant: augmentin, nitrofurantoin (not in trimester 1 or 3), keflex, cefpodoxime, fosfomycin
893
Meningitis tx duration
Niserieia and influenza: 7 days
Pneumonia: 10-14 days
Algacaae: 14-21d
Listeria : 21 days
894
HIV regimen in pregnancy
Dual nrti + (insti OR ritonavir booster PI)
IV zidovudine near term unless RNA<50
895
When to start ART in people with cryptococcus meningitis?
Crypto regimen?
Delay 2-10 wks d/t risk of iris
Note: tx is ampho + flucytosine x2 wk, fluconazole 800 mg x 8 wk then fluconazole 200 mg x 1 yr
Ppx: fluconazole 200 mg QD (for secondary only)- stop after 1 yr of maintenance if cd4>100 x 3 months
896
Candidemia
Fluconazole ONLY IF KNOWN SUSCEPTIBILITY (400 mg/day
Otherwise echinocandin or ampho
14 days from first neg blood cx
897
Drugs for cushing’s
Pasireotide, osilodrostat, ketoconazole, mitotane, etomidate, metyrapone, mifepristone (hyperglycemia)
898
Pregnancy DM goal
Fasting <95
899
Insulin rules
500/TDI= amount of grams of carbs covered by 1 unit of insulin
Correction: 1800/TDI= amount decrease in BG from 1 unit (use 1500 for regular insulin)
900
When to start Metformin plus a second agent ?
When A1c > 1.5% above goal
(A1c >8.5 for most people)
901
Which DM agents best if HF and/ or renal dx
Sglt2
902
Holding Metformin for constrast
Hold before and for 48h after
903
Big adr for dpp4 and glp1-
Pancreatitis
904
When to give bicarb in DKA
Other tx
Ph <6.9
Fluids- 0.45-0.9% nacl til bg<200 the change to D5W/1/2ns
Insulin gtt
K+
905
Which sglt2 have renal benefits
Dapagliflozin, cabagliflozin
906
Transplant induction v maintenance
Induction: basilixmab, antithymocyte globulin
Maintenance: tacro and mycophenolate first line
Azathioprine
Mtor: everolimus, sirolimus
Belatecept
907
Coefficient if variation calculation
SD/mean X 100
908
95% CI calculation
2x SEM in both directions
SEM= SD/ sqrt of n
