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1
Q

Statins with interactions

A

Lovastatin, simvastatin

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2
Q

Bile acid sequestrants can increase what?

A

TG

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3
Q

Fibrate lipid effects

A

Decrease TG, can increase ldl

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4
Q

Colchicine interaction

A

Fibrates and statins

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5
Q

Which fish oil does not increase ldl?

A

Vascepa (icosapent ethyl)

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6
Q

Cholesterol meds that cause liver damage

A

Statins, fibrates, zetia, niacin

Not bile acid sequestrants

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7
Q

When are fish oil products used ?

A

TG > 500

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8
Q

Lipid drugs

A

Clevidipine 2 kcal/ mL

Propofol 1.1 kcal/ mL

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9
Q

Olmesartan unique adr

A

Sprue like enteropathy - severe chronic diarrhea- can happen anytime after starting

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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

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11
Q

Lithium interaction

A

diuretics and ace/ arb- reduced lithium clearance

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12
Q

Spiromolactone vs eplerenone

A

Spir is non selective aldosterone blocker and blocks androgen

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13
Q

Where do aldosterone blockers work

A

Collecting ducts and distal tubule

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14
Q

Beta blockers with intristic sympathomimetics activity - not recommended in post MI

A

Ace, pin, pen

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15
Q

Methyldopa fun facts

A

CI liver dx, and mao inhibitors
Hemolytic anemia
Lupus

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16
Q

Nitrate /pde5I separation

A

Avanafil- 12 h
Sildenafil/vardenafil- 24 h
Tadalafil- 48 h

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17
Q

Clopidigrel ADR

A

Thrombotic Thrombocytopenic purpura

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18
Q

How long to DC antiplatelet before surgery

A

5 days

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19
Q

Preferred anticoagulant for stemi

A

Bibalirudin

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20
Q

Is AC required after ACS

A

No- warfarin if Afib though

Don’t confuse with stroke recs

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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

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22
Q

Washout from ARB to neprilysin inhibitor (entresto)

A

None!

36 hours for AceI

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23
Q

Which form of isosorbide is preferred in HF?

A

Dinitrate- only one studied

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24
Q

What causes digoxin toxicity?

A

HypoK, hypoMG, hyperCa2+
Hypothyroidism, p-gp inhibitor
dehydration!!!!

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25
Q

Potassium strength: KCl 10%

A

20 meq/15 mL

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26
Q

Which azole does NOT prolong QTc ?

A

Isavuconazole

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27
Q

Which SSRI preferred in cardiac pts?

A

Sertraline (less risk QTc)

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28
Q

When are mexilitene and lidocaine used ?

A

Ventricular arrithmias only

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29
Q

Procainamine vs propafenone

A

Procainamide is 1a propafenone is 1c (not used)

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30
Q

When are non-DHPs CI?

A

Reduced ejection fraction HF

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31
Q

Amiodarone

A

It’s an antiarrythmic that is safer in HF (probably why used more than other)

Dig is used for both!

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32
Q

Amiodarone less known drug interaction

A

Sofosbuvir- bradycardia

DNE simvastatin 20 mg or lovastatin 40 mg

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33
Q

All CCBs are..?

A

Cyp 3A4 substrates

Verap and dilt are p-gp substrates too

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34
Q

Non-DHP drug interactions

A

They inhibit CYP3A4- lower simvastatin and lovastatin

Also substrates of 3A4 and pg-p

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35
Q

Amiodarone vs multaq (dronedarone)

A

Dronedarone has no iodine so no thyroid problems, but it’s much more liver toxic

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36
Q

Dig organ concerns

A

Renal NOT liver

Crcl <50 decrease!

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37
Q

Amiodarone organ concerns

A

Liver NOT renal

*also lung/thyroid

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38
Q

ASA for stoke

A

Give 24-48 h after but NOT within 24 h of tPa

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39
Q

DAPT duration

A

ACS- at least 12 months

Stroke- 21 days (risk hemorrhage)

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40
Q

Cardioembolic vs non cardioembolic stroke

A

Cardio- anticoagulation

Non-cardio- antiplatelet

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41
Q

Aggrenox indication

A

Stroke but probably not ACS (does not contain enough ASA)

SE: HA (vasodilation)

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42
Q

Which is the only oral direct thrombin inhibitor?

A

Dabigatran (pradaxa)

IVs: argatroban, bivalirudin

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43
Q

Xarelto dosing

A

20 with dinner (ppx)
15 for crcl<50
Tx: 15 bid x 21 d then 20 qd

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44
Q

Dabigatran dosing

A

150 bid for both ppx and tx

Ppx: Dose reduce for crcl< 30 (75 bid)
Tx: CI crcl<30 (like Xarelto)

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45
Q

2c9 imhibitors

A

Metro/macrolides
Amiodarone/azoles
TMP/SMX, tamoxifen

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46
Q

Natural products increase bleed risk

A

Ginger, ginkgo, garlic, ginseng, glucosamine

Dong quai, vit E, willow tree bark, wintergreen oil, fish oil

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47
Q

Protamine dosing

A

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)

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48
Q

Preferred AC in cancer

A

LMWH

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49
Q

G6PD deficiency drugs

A

Chloroquine, primaquine, dapsone, BACTRIM/nitrofurantoin, methylene blue,
Probenecid, rasburicase

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50
Q

ABX to avoid if G6PD deficiency

A

Bactrim, nitrofurantoin

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51
Q

Missed glp-1 dose

A

Trulicity - not if within 72h of next

Ozempic- skip if >5 d since dose was due

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52
Q

Tricky diabetic meds

A

Meglitinides: secretagogues- repaglinide (prandin) and nateglinide (starlix)

A-glucosidase inhibitor: miglitol (glyset), acarbose (precose)

Amylin analog: pramlintide (symlin)

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53
Q

Which insulins are cloudy?

A

NPH, and mixed (protamine)

*when mixing remember clear before cloudy

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54
Q

Concentrated insulins

A

Humalog 200/ml
Humulin R 500/ml
Tresiba 200/ml
Toujeo 300/ml (only comes like this)

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55
Q

Insulin conversion exceptions

A
  1. NPH to basal (80%)

2. Toujeo to lantus or basaglar (80%)

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56
Q

Insulin BUDs

A

Mostly 28 days
Toujeo/levemir 42
Tresiba/ ozempic 56

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57
Q

Which meds have risk of bladder cancer?

A

Pioglitazone and dapagliflozin

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58
Q

Thiazidenediones risk

A

Hepatotoxicity

Also with alogliptan

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59
Q

Counseling point for protease inhibitors

A

Take with food (except zepatier and fosamprenavir oral susp)

“Previr “

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60
Q

Genetic test for abacavir

A

HLA-B5701

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61
Q

HIV drug to avoid in pregnancy

A

Dolutegravir (Tivicay)

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62
Q

Depression drug interaction on exam

A

Look for St. John’s wort and transplant or birth control

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63
Q

Depression in pregnancy

A

No paxil

SSRI- ok but still has risks

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64
Q

Depression breastfeeding

A

SSRI or TCA- but no doxepin

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65
Q

Preferred SSRI if cardiac risk

A

Sertraline

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66
Q

Unique SSRI adrs

A

Siadh, hyponatremia, bleeding

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67
Q

Converting antidepressants to or from maoi

A

2 week washout

Except from Prozac (5 wks)

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68
Q

Tamoxifen antidepressant

A

Tam is prodrug and needs 2D6

Use venlafaxine

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69
Q

Why use bupropion?

A

Wt loss, smoking, no sexual adrs

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70
Q

Tyramine rich foods

A

Aged cheese, beer, pickled stuff, yeast extract, air dried meats, sauerkraut, soy sauce, fava beans, some red wine

Aged, fermented, pickled, smoked

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71
Q

NT issued with PD, schizo, and Alzheimer’s

A

PD: not enough DA/too much Ach

Schizo: too much DA

Alzheimer’s: not enough Ach

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72
Q

Olz + bzd

A

Interaction: orthostasis

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73
Q

Typical vs atypical antipsychotics

A

Typical: more eps, less metabolic
Atypical: less eps, more metabolic

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74
Q

Lowest risk eps

A

Seroquel

Best for PD

*also clozapine

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75
Q

Highest risk eps

A

Risperidone, paliperidone, lurasidone

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76
Q

Highest metabolic adr

A

Clozapine, OLZ, quetiapine

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77
Q

Lowest metabolic risk

A

FGA, abilify, ziprazidone, lurasidone, asenapine

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78
Q

Antipsych worst QTC

A

Thioridazine, haldol, ziprasidone

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79
Q

Antipsych risk of CVA

A

Risperidone

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80
Q

Antipsych risk of increase prolactin

A

Risperidone, paliperidone

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81
Q

Clozapine

A 
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
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82
Q

Bipolar depression

A

Lamotrigine

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83
Q

Bipolar mania

A

Equetro (CMZ) or valproate

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84
Q

Bipolar mania or bipolar depression

A

Lithium

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85
Q

Bipolar in pregnancy

A

Lamotrigine

Or lurasidone ir bipolar depression

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86
Q

Lithium level

A

0.6-1.2 meq/L

Hand tremor, nausea, confusion, diarrhea if high

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87
Q

Lithium

A

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

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88
Q

Valproate + lamotrigine

A

Valproate inhibits metabolism- start lamictal at lower dose (blue box) 25 mg QOD

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89
Q

When to use meglitinides

A

Alternative to SFU for elderly or renal dysfunction

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90
Q

Which insulin is preferred in pregnancy

A

Regular

Humulin R, novolin R

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91
Q

Which insulins are cloudy?

A

NPH, lente, mixes

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92
Q

Is a medguide required for stimulants?

A

Yes

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93
Q

Separation of stimulants from MAOI

A

2 weeks (same as SSRI except Prozac)

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94
Q

Stimulant warnings

A

Mania- caution w/ psych hx
Seizures
Seratonin syndrome
Anticholinergic

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95
Q

Daytrana

A

Methylphenidate patch
Hips- 2 hrs before desired effect
Remove after 9 hrs
Daily

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96
Q

Straterra separation for maoi

A

14 days

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97
Q

Straterra warnings

A

Suicide, hepatotoxicity
Don’t open capsule
Medguide

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98
Q

Levothyroxine unique ADR

A

Anxiety

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99
Q

St John’s wort warnings

A

Photosensitivity, serotonergic

Inducer

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100
Q

Hepatotoxic herbals

A

Kava, valerian, black cohosh

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101
Q

Anxiety SSRI dosing

A

Half dose for depression

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102
Q

How long until buspar works?

A

2-4 wks

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103
Q

Is buspirone serotonergic ?

A

Yes

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104
Q

Which BZDs are safer in elderly and liver impairment?

Why?

A

LOT- Lorax, oxaz, temaz

Inactive metabolites

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105
Q

Which SSRI is most stimulating?

A

Fluoxetine

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106
Q

Sedating SSRIs

A

Fluvoxamine

Paroxetine

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107
Q

Falling asleep

A

Eszopiclone, zolpidem

Ramelteon, zaleplon

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108
Q

Staying asleep

A

Eszopiclone, zaleplon

Doxepin, suvorexant

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109
Q

Intermezzo and edular formulation

A

SL zolpidem

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110
Q

Zopimist

A

Zolpidem spray

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111
Q

Possible severe adr with modafinil or armodafinil

A

SJS

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112
Q

Preferred antipsychotic in parkinsons

A

Seroquel

Or clozapine maybe or nuplazid (pimavanserin)

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113
Q

Sinemet separation for maoi

A

2 weeks

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114
Q

Sinemet adrs

A 
Dark urine,saliva,sweat
Hemolysis (positive Coombs)
Sexual urges
Orthostasis 
Separate from iron and protein
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115
Q

Dopamine agonist adrs

A

Hypotension, hallucinations, sleep attacks, movement stuff

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116
Q

Pramipexole (mirapex) starting dose

A

0.125 TID

Decrease 50% if crcl<50

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117
Q

Ropinerole (requip) staring dose

A

0.25 mg TID

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118
Q

Apokyn ADRs

A

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

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119
Q

Huge issue with PD and drugs used to treat PD

A

Orthostasis

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120
Q

Calcitonin indication

A

Hypercalcemia or osteoporosis or pagets

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121
Q

DonepeZil ADRs

A

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

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122
Q

Acetylcholinesterase ADR

For AD

A

BRADYCARDIA

nausea, insomnia

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123
Q

Drugs that cause seizures

A

Bupropion, clozapine, varenacline, carbipenems, lithium, meperidine, tramadol, quinolones, pcns, reglan, acyclovir, cephalosporins, valacyclovir, theophylline

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124
Q

Lamotrigine dosing

A 
Lower dose (blue box): 25 QODvalproate

Higher dose (green): inducers, estrogen containing contraceptives: 50 QD
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125
Q

Keppra iv to po

A

1:1

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126
Q

Epilepsy drug big concerns

A

Rash, bone loss, suicide, CNS, interactions

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127
Q

Carbamazepine oxcarb, eslicarbazepine

A

Hyponatremia, rash, enzyme inducer

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128
Q

Topiramate, zonisamide

A

Weight loss, metabolic acidosis, nephrolithiasis and oligohidrosis

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129
Q

Topiramate ADR

A

Metabolic acidosis, nephrolithiasis, glaucoma, hyperanmonemia, vision issues, fetal harm, weight loss, concentration

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130
Q

Only antiepileptic that’s an inhibitor

A

Divalproex

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131
Q

Depakote ADR

A

Hepatic failure , fetal harm, hyperammonemia (give carnatine), thrombocytopenia, DRESS, weight gain
Range: 50-100

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132
Q

Carbamazepine genetic test

A

HLA-B 1502
Risk of serious skin reactions
Asian

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133
Q

Carbamazepine

A

SJS/TEN
Aplastic anemia, agranulocytosis, myelosuppression, hyponatremia (siadh), fetal harm
Range: 4-12

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134
Q

Vimpat (lacosamide) adr

A

Prolongs PR interval, DRESS

CV

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135
Q

Oxcarbazepine genetic test

A

HLA-B 1502
SJS/TEN
Asian

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136
Q

Oxcarbamazepine ADRs

A

SJS/TEN, DRESS, hyponatremia

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137
Q

Oxcarb/carb autoinducer

A

Carb: autoinducer
Oxcarb: not autoinducer

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138
Q

Phenobarbital ADR

A

Hypotension if IV, SJS/TEN, respiratory depression, fetal harm
Range: 20-40

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139
Q

Phenytoin max rate

A

50 mg/min

Hypotension and cardiac arrhythmia

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140
Q

Fosphenytoin max rate

A

150 PE/ minute

1.5 mg= 1 mg PE

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141
Q

Phenytoin equivalent

A

1.5 mg fospehny= 1 mg PE

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142
Q

Phenytoin genetic

A

Avoid in HLA-B 1502

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143
Q

Phenytoin range

A

10-20 total

1-2.5 free

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144
Q

Phenytoin ADRs

A

Extravasation (leads to purple glove), DRESS, fetal harm, bradycardia, SJS/TEN, blood dyscarsias, hepatoroxiy, gingival hyperplasia, hair Growth, nystagmus, ataxia, diplopia, respiratory depression

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145
Q

Phenytoin admin reqs

A 
DNE 50 mg/min
Filter (if continuous infusion)
NS only 
Do not refrigerate 
When adjusting dose do by 30-50% at a time
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146
Q

Enteral feeding and phenytoin

A

Decreases phenytoin absorption so hold feeding 1-2 hrs before and after

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147
Q

Phenytoin PPB

A

High- can displace other drugs and increase levels

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148
Q

Oral contraceptive drug interactions

A

Enzyme inducers!!

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149
Q

Corrected phenytoin

A

Total/(0.2x albumin) +0.1
For albumin <3.5
Free level doesn’t need it

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150
Q

Epilepsy drugs in pregnancy

A
  • 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
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151
Q

Which AEDs can lack of sweating?

A

Topiramate, Zonisamide

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152
Q

Which population has greatest risk of lamotrigine rash?

A

Children

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153
Q

Which epilepsy drugs are best for kids?

A

Lamotrigine and Keppra because available as ODT and liquid/chewable

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154
Q

Supplementation needed if taking seizure med

A

Vitamin d and calcium

Bone loss

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155
Q

Drugs that cause hypothyroidism

A

I TALc
Interferon, TKI, amiodarone,
Lithium, carbamazepine,
(Amio and interferon can also cause hyper)

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156
Q

Condition that causes hypothyroidism

A

Hashimotos

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157
Q

Normal TSH

A

0.3-3

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158
Q

Levithyroxine administration

A

With water 60 mins before breakfast or 3 hours after dinner

separate from food

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159
Q

Levithyroxine starting dose

A

1.6 mcg/kg/day IBW

If CAD 12.5-25

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160
Q

Thyroid dessicated info

A

NP thyroid or armour thyroid
Not recommended bc inconsistent dose
Dosed in grains

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161
Q

Goiter

A

From iodine deficiency (hypothyroid)

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162
Q

Levithyroxine iv to po

A

1:2

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163
Q

Levothyroxine colors

A

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

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164
Q

Cause of hyperthyroidism

A

Graves dx

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165
Q

Thyroid bone and heart effects

A

Hyper- osteoporosis and arrhythmia

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166
Q

Thyroid storm

A

PTU (preferred) + SSKI or lugols 1 hr after PTU + propranolol + dex + aggressive cooling (APAP and cooling blankets) NOT NSAIDS

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167
Q

PTU and methimazole ADRs

A

DILE, gi-upset, hepatitis, agranulocytosis

Severe liver toxicity from PTU

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168
Q

Hyperthyroid in preganancy

A

PTU trimester 1

Methimazole trimester 2-3

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169
Q

Iodine

A

Lugols
SSKI
Temporarily blocks secretion of iodine

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170
Q

Levothyroxine in pregnancy

A

30-50% increased dose

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171
Q

Who steroid mimics aldosterone?

A

Fludrocortison
Mineralcorticoid activity- maintains balance of water and electrolytes
-use for addisons and orthostatic hypotension

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172
Q

Glucocorticoid difference from mineralcorticoid

A

Gluco better for anti inflammatory

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173
Q

Addisons

A

Not enough steroids- can occurs if steroids stopped suddenly (hpa suppression)

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174
Q

Steroid immune suppression dose

A

> 2 mg/kg/day or >20 prednisone equivalent for >2 weeks

  • no live vaccines
  • taper! 10-20%/day
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175
Q

Immunosupression risks

A
  • reactivation of TB/hep B/C
  • live vaccines
  • lymphomas and skin cancers
  • infections
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176
Q

Lab tests for RA

A

RF, ACPA

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177
Q

MTX dosing

A

RA- weekly

Cancer- daily

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178
Q

MTX toxicity

A

Hepatotoxicity, myelosuppression, no pregnancy!, mucositis/bleeding
Pneumocystits pneumonia

DMARD (non-biologic)

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179
Q

Hydroxychloroquine ADR

A

Irreversible retinopathy
Caution G6PD deficiency
-less liver risk that MTX
*non-biological DMARD

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180
Q

SulfasalaZine ADRs

A
  • Sulfa allergy
  • salycilate allergy
  • liver, rash, G6PD deficiency, blood dyscrasias
  • yellow/orange skin and urine
  • non- biological DMARD
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181
Q

DMARD rule

A

Never use two biological together

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182
Q

Arava toxicity

A

Leflunamide

  • fetal/embryo- 2 years after to get pregnant or accelerated via cholestyramine or activated charcoals x11 days
  • Hepatotoxicity
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183
Q

Xeljanz risk

A

Tofacitinib
PE, malignancy (lymphomas )
Non-bio DMARD
*DONT USE WITH BIOLOGIC

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184
Q

Olumiant risks

A

Barcitinib
Non biologic DMARD
PE
Don’t use with biologic

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185
Q

MTX with etoh?

A

NO! Liver toxicity

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186
Q

MTX renal

A

Yes- still a consideration

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187
Q

MTX drug interaction

A

NSAIDs

Bleeding

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188
Q

TNF biologic DMARD warnings

A

Infections (TB/HEP), malignancy

HF, lupus like, hepatotoxicity

No live vaccine- no two biologics

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189
Q

Eteracept and adalimumab storage

A

14 days at room temp

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190
Q

Biologic admin

A

Allow to warm first!

Don’t shake

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191
Q

Non TNF DMARD toxicity

A

Basically the same as TNF

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192
Q

DILE drugs

A

Methimazole, PTU, methyldopa, minocycline, procainamide, hydralazine, anti-TNF agents, terbinafine, isoniazid, quinidine

My pretty malar marking probably has a transIent quality

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193
Q

Benlysta

A

Belimumab
Biologic DMARD
For SLE

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194
Q

Drugs for SLE

A

Hydroxychloroquine, cyclophosphamide, azathioprine, mycophenolate, cyclosporine

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195
Q

Preferred MS drug in pregnancy

A

Glatiramer acetate

Nope…actually glatiramer…

Copaxone

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196
Q

Interferon beta toxicity

A 
Psychiatric (depression/suicide)
Injection site necrosis 
Myelosuppression 
LFTs
Hyper/hypo thyroid
Flu like symptoms 
Infections
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197
Q

Reynauds treatments

A

Nifedipine or other non-DHP CCB

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198
Q

Drugs that worsen reynauds

A

BB, bleomycin, cisplatin , sympathomimetics

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199
Q

Avoid in celiac dx

A

Gluten is found in wheat, barely and rye

*starch may be wheat

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200
Q

Autoimmune disorders

A

Myasthenia gravis

MS , RA, SLE, reynauds, celiac dx, sjogrens

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201
Q

PAH Pulmonary arterial pressure

A

PAP >25

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202
Q

Warfarin goal on PAH

A

1.5-2.5

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203
Q

CCB for PAH

A

LA nifedipine, dilt, and amlodipine

*not verapamil (‘ore pronounce negative iontropic effects )

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204
Q

Drugs that cause pulmonary fibrosis

A

Amiodarone, bleomycin, dronedarone, methotrexate,

nitrofurantoin, sulfasalzine

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205
Q

When to avoid nicotine inhaler or nasal spray

A

Asthma/COPD/ respiratory dx

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206
Q

Nicotine patch dosing

A

> 10 cigs: 21 mcg
-21x6 wk, 14x2, 7x2

<10 cigs: 14 mcg
-14x6 wk, 7x2

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207
Q

Nicotine gum/lozenge dosing

A

<30 mins: 4 mg
>30 mins: 2 mg
Max gun: 24 pc
Max Loz: 20 pc

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208
Q

Nicotine patch MRI

A

Remove!

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209
Q

Zyban details

A
  • start 1 wk before quit date
  • serotonergic
  • max 300 mg
  • use up to 6 months
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210
Q

Chantix details

A
  • 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
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211
Q

When not to treat smoking cessation with meds

A

Pregnancy, adolescence, light smokers (<10 cigs/day)

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212
Q

Nicotine patch details

A

Never cut

Wear for 24 hrs unless bad dreams

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213
Q

Nicotine lozenge detail

A

No acidic beverages

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214
Q

Indication that asthma is poorly controlled

A

Rescue inhaler >2 days per week

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215
Q

General asthma algorithm

A

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

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216
Q

Can you use laba alone?

A

Not for asthma

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217
Q

HFA

A

MDI

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218
Q

Respimat

A

MDI

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219
Q

Diskus

A

DPI

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220
Q

Ellipta

A

DPI

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221
Q

Pressair

A

DPI

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222
Q

Handihaler

A

DPI

Capsule for inhalation

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223
Q

Neohaler

A

DPI

Capsule for inhalation

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224
Q

Respiclick

A

DPI

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225
Q

Flexhaler

A

DPI

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226
Q

MDI details

A
  • slow/deep breath
  • Shake (except: alcesco, respimats, and qvar redihaler
  • can use spacer
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227
Q

DPI details

A
  • quick/forceful breath
  • no spacers
  • do not shake
  • no priming needed
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228
Q

Theophylline range

A

5-15 mcg/mL

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229
Q

Aminophylline to theophylline

A

Multiply by 0.8 (ATM)

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230
Q

Drugs that can increase theophylline

A

Cipro, zafirlukast, zileuton

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231
Q

Asthma pregnancy

A

SABA

Budesonide

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232
Q

How long should proair last

A

12 months

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233
Q

How long should ventolin last

A

15 weeks

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234
Q

How long to wait in between inhaler inhalation’s

A

60 seconds

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235
Q

Order to use beta-2 agonist and ICS

A

Beta-2 (or laba/lama) the ICS

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236
Q

What can you mix montelukast with?

A

Formula or breast milk, applesauce, carrots, rice, ice cream

Take within 15 mins!

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237
Q

Which is reversible asthma or copd?

A

Asthma

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238
Q

Copd diagnosis

A

Post bronchodilator fev1/fvc<0.7

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239
Q

COPD scoring

A

CD
AB

Left: cat<10 mcrc 0-1
Right: cat>10 mcrc 2+
Down: 0-1 exacerbations
Up: 2 or 1 hospitalization

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240
Q

Only way to slow COPD progression

A

Stop smoking- drugs just help symptoms and reduce hospitalizations

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241
Q

First line tx copd

A

Bronchodilators

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242
Q

Copd treatment

A 
A: sama or saba 
B: lama or laba 
C: lama
D: lama or lama+laba
*ics if eos>300
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243
Q

When to use ABX fir copd

A

Increase sputum, purulence, dyspnea,

Inc purulence + one other symptom

mech ventilation

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244
Q

Respimat directions

A

Twist open press (TOP)

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245
Q

Steroid equivalency

A 
Beta: 0.6
/dex: 0.75
Methlypred/triamcin: 4
Pred/pred: 5
Hydrocortisone: 20
Cortisone: 25
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246
Q

Hep c meds not taken with food

A

Zepatier (no regard)

Fosamprenavir oral susp

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247
Q

Hep c drugs avoid acid suppressive therapy

A

HEV: harvoni, epclusa, vosevi

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248
Q

Pangenotypic hep c drugs

A

Mavyret and epclusa

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249
Q

Hep c salvage

A

Vosevi and mavyret

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250
Q

Hep c approved for 8 weeks

A

Mavyret

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251
Q

Hep c/ hiv co infection

A

MEH: mavyret, epclusa, harvoni

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252
Q

Hep c no mono therapy

A

Sofosbuvir and daclatasvir

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253
Q

Typical hep c treatment duration

A

12 weeks

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254
Q

Hemoglobin reqs for epogen

A

Start if <10

Stop if >11

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255
Q

Drugs that you wouldn’t think of that increase k+

A

Cangliflozin, drosperinone, bactrim, cyclosporin, everolimus, tacrolimus

Heparin, glycopyrrolate, nsaids, pentamidine

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256
Q

Does unasyn cover pseudomonas ?

A

No

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257
Q

PCNs that cover anaerobes

A

Beta lactamse inhibitor

Augmenting, unasyn, zosyn

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258
Q

Antistaph pcns

A

Dicloxicillin, nafcillin, oxacillin

No g (-), enterococcus, or anerobic coverage

No renal adjustment!

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259
Q

Why is PO ampicillin rarely used?

A

Poor BA- use amoxicillin for PO

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260
Q

Tx for strep throat (pharyngitis) and mild skin infection

A

Pen vk

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261
Q

First line tx otits media

A

Amoxicillin 80-90 mg/kg/d

*90 mg/kg/d (augmentin)

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262
Q

Infective endocarditis ppx

A

Amoxicillin 2g x1 30-60 min before

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263
Q

Which pcns don’t require renal adjustment ?

A

Naficllin, oxacillin, dicloxacillin

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264
Q

Syphilis tx

A

Bicillin LA (pen g benzathine)

No iv!!!

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265
Q

Drugs for enterococcus

A

PCNs not cephalosporins

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266
Q

Cephalosporins for Anarobes

A

Cefoxiten, cefotetan

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267
Q

Cephalosporins for MDR pseudomonas

A

Ceftaz/avibactam (avycaz)

Ceftolozane/tazobactam (zerbaxa)

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268
Q

Cefotetan weird ADR

A

Bleeding, disulfiram like rx

Due to side chain

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269
Q

Cephalexin common uses

A

Street throat, mssa skin infxn

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270
Q

Cefuroxime common use

A

Otitis media, CAP, sinus infxn

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271
Q

Cefdinir common uses

A

CAP, sinus infxn

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272
Q

Cefazolin common use

A

Surgical ppx

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273
Q

Cefotetan/cefoxitin common use

A

Anerobes, surgical ppx for colerectal procedure

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274
Q

Ceftriaxone/ cefotaxime common use

A

CAP, meningitis, SBP

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275
Q

Ertapenem does not cover

A

Pseudomonas, enterococcus, acintobacter

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276
Q

Carbapenem coverage

A

Yes: ESBL, pseudomonas (except invanz), anerobes

No: atypicals, MRSA, VRE, cdif, stenotrophomonas

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277
Q

Aztreonam coverage

A

Pseudomonas

No g (+) or anerobes

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278
Q

Benefit of extended interval dosing for AMGs

A

Cost and less nephrotoxicity

Not more effective

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279
Q

Gentamicin/tobra dosing

A

Traditional: 1-2.5 mg/kg/dose q8

Extended interval: 4-7 mg/kg/dose

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280
Q

Genta/tobra and amikacin peak and trough

A

Gent/tobra

  • peak: 5-10
  • trough: <2

Amikacin

  • peak: 20-30
  • trough: <5
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281
Q

Which FQ cover pseudomonas

A

Cipro and levo

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282
Q

Which FQ can NOT be used for uti?

A

Moxifloxacin

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283
Q

Which FQ covers mrsa ?

A

Delafloxacin

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284
Q

Cipro weird interaction

A

Don’t use with tizanidine

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285
Q

FQ highest QTc risk

A

Moxifloxacin

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286
Q

Cipro oral suspension rule

A

No NG tube!

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287
Q

Which is the only FQ not renally adjusted?

A

Moxifloxacin

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288
Q

Levofloxacin abd moxifloxacin iv to po ratio

A

1:1

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289
Q

Macrolide with most severe qt prolongation

A

Erythromycin

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290
Q

Are macrolides hepatotoxic?

A

Yes

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291
Q

Which macrolide required renal dose adjustment

A

Clarithromycin

Crcl<30

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292
Q

Which macrolide has fewer drug interactions ?

A

Azithromycin

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293
Q

Doxycycline and minocycline iv:po

A

1:1

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294
Q

Doxycycline renal adjustment

A

No

Yes for tetra and mino

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295
Q

What does bactrim not cover?

A

Pseudomonas, atypicals, anearobes, enterococcus

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296
Q

Bactrim strengths

A

Ss: 400/80

DS: 800/160

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297
Q

Bactrim uti dose

A

1 DS BID x 3 d

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298
Q

Crcl to decrease vanc dosing interval to q24

A

<50

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299
Q

MIC not to use vanc

A

> 2

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300
Q

1:1 ABX

A

Bactrim, metronidazole, levo/moxi, doxy/mino, linezolid, fluconazole,

isavu/posaconazole /vori

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301
Q

Televancin risks

A

Pregnancy, nephrotoxic, incompatible with heparin, red man, false increase ptt/ inr, QTc

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302
Q

Oritavancin and dalbavancin risks

A

No heparin with 5 d (false elevation in ptt)

Red man

Televancin increase QTc

*note: can use single dose regimen

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303
Q

Daptomycin tox

A

Myopathy/rhabdo

False increase ptt/inr

Increase cpk

No D5W

No pna

4mg/kg/d

Dose adjust for renal

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304
Q

Linezolid tox

A

Seratonin syndrome, myelosuppression, thrombocytopenia, hypoglycemia, , HTN, optic neuropathy

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305
Q

Does linezolid required renal adjustment?

A

No

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306
Q

Synercid details

A

Arthralgia/myalgias, infusion rxn, hyperbilirubinemia,

D5W only

Central line only (phlebitis)

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307
Q

Tigecycline details

A

No bloodstream infxns: lipophi

Risk of death

Should be yellow/orange

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308
Q

Colistimethate and polymyxin B tox

A

Nephro and neuro

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309
Q

Chloramphenicol tox

A

Gray syndrome

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310
Q

Clindamycin coverage

A

Anaerobes and g(+)

MRSA (positive D test means do NOT use!!)

*no dose adjustment for renal

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311
Q

Abx susp requiring refrigerator

A

Pen vk, ampicillin, augmentin

*amoxicillin tastes better

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312
Q

ABX don’t refrigerate

A

Cefdinir, azithromycin/clarith
Doxy, FQ, clinda, linezolid, bactrim, acyclovir, fluc/Posa/voriconazole, nystatin

Metronidazole, moxifloxacin

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313
Q

Weird nitrofurantoin adr

A

Pulmonary toxicity

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314
Q

When to start ppx ABX for surgery

A

Cefazolin/cefuroxime: 60 mins prior

FQ/ vanc: 120 min before

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315
Q

Meningitis tx

A

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
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316
Q

Acute otitis media tx

A

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)

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317
Q

Strept throat tx

A

PCN or amo

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318
Q

Sinusitis tx

A

Augmentin

> 10 d of symptoms

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319
Q

Copd exacerbation tx

A

Augmentin, azithromycin, doxycycline

Or FQ! I’d suspect pseudomonas

5-7 d
-ventilated, purulence sputum, dyspnea, increased sputum

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320
Q

CAP (outpatient)

A

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

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321
Q

Inpatient CAP

A

Never monotherapy with macrolide or doxy

Use FQ or add beta lactam

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322
Q

HAP/ VAP

A

7 d

> 48 h hospitalization or vent

Think MRSA and Pseudomonas

Double cover pseudomonas if risk for MDR (recent ABX, etc)

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323
Q

Follow up for TB skin test

A

48-72 hr

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324
Q

TB latent tx

A

INH x 9 month (HIV, pregnant, child) OR

Rifampin x 4 month OR

INH + rifapentine x 12 wk

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325
Q

Active TB tx

A

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

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326
Q

Rifampin toxicity

A

Hemolysis, interactions (use rifabutin), orange discoloration, LFTs, flu-like syndrome
*CI with PI

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327
Q

Isoniazid tox

INH

A

Peripheral neuropathy (use pyridoxine B6), fatal hepatitis!!!, DILE, hemolysis, inhibitor

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328
Q

Pyrazinamide tox

A

LFT, hyperuricemia

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329
Q

Ethambutol tox

A

Optic neuritis

-confusion and hallucinations!!

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330
Q

TB drugs empty stomach and hemolysis

A

RI: rifampin, INH

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331
Q

TB drugs: increase interval for renal impairment

A

PE: pyrizinamide, ethambutol

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332
Q

IE tx

A

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

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333
Q

Dental PPX PCN allergy

A

Clinda 600 or azithromycin 500

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334
Q

SBP tx

A

Ceftriaxone x 5-7d

Cipro or bactrim for ppx

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335
Q

Intraabdominal infxn

A

Cover anaerobes

4-7 d

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336
Q

Impetigo tx

A

Cephalexin 250 qid

Mupirocin

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337
Q

SSTI tx

A
  • Cephalexin
  • clinda if beta lactam allergy
  • bactrim or doxy for MRSA, purulence, or abscess

For severe: iv MRSA ABX

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338
Q

Animal bite ABX

A

Unasyn or augmentin (covers pasturella and anerobes

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339
Q

Diabetic foot infection coverage

A

Mild: beta lactams
Anerobes- mod-sev
PSA and MRSA: if severe infection

MRSA, pseudomonas if at risk

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340
Q

Does zosyn cover anerobes ?

A

Yes

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341
Q

Pylonephritis tx

A

Cipro 500 bid x 7 d

Levo 750 QD x 5 d

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342
Q

Phenazopyridine

A

2 days!

With food or water!

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343
Q

UTI pregnancy

A

Beta lactam: amoxicillin, augmentin, oral cephalosporin

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344
Q

Nitrofurantoin and bactrim pregnancy

A

Ok in 1st trimester

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345
Q

Doxycycline pregnancy

A

No!!!

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346
Q

Direct acting antiviral (Hep C) tox

A

Reactivation of hep B
LFTs
Generally well tolerated

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347
Q

Travelers diarrhea

A

Azithromycin 1g x1 or 500 mg x 3

FQ or rifaximin ok if no dysentery

Loperamide if no dysentery or fever

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348
Q

Cdif tx

A

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

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349
Q

Syphilis tx

A

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

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350
Q

Gonorrhea tx

A

Ceftriaxone 250 IM x 1 + (azithromycin OR doxycycline ) no monotherapy!

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351
Q

Chalmydia tx

A

Azithromycin 1 g x 1

Or doxy 100 bid x 7 (no pregnancy )

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352
Q

Bacterial vaginosis tx

A

Metro 500 bid x7 d or topical x5 d

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353
Q

Trichinoniasis tx

A

Metro 2 g po x 1

Must be PO!

Ok I’m preganancy! Must treat!

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354
Q

Genital warts tx

A

Imiquimod cream

Vaccinate with HPV to prevent

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355
Q

Rocky Mountain spotted fever

A

Doxy 100 bid x5-7 d

*even in kids!!!

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356
Q

When is the only time you can use doxy in kids?

A

Rocky Mountain

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357
Q

Lyme tx

A

Doxy 100 bid x 10-21 d

Alt: amoxicillin

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358
Q

Ribaverin v rifampin tox

A

Both: hemolysis

Ribaverin: no preganancy!

Rifampin: LFTs, interactions, orange, flu-like syndrome
*safe in preganancy

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359
Q

TB drugs (RIPE) in pregnancy

A

Safe

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360
Q

UFH VTE tx

A

Bolus: 80 u/kg
Infusion: 18 u/kg/hr

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361
Q

UFH stroke tx

A

Bolus: 60 u/kg
Infusion: 12 u/kg/hr

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362
Q

LMWH tx crcl<30

A

1 mg/kg Q24

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363
Q

Amophotericin B dose

A

0.1-1.5 mg/kg/day

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364
Q

Liposomal amphoterecin

A

Ambisome, amblicet

Less nephrotoxic, less infusion
rxn

Dose: 5

*filter

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365
Q

Amphoterecin tox

A

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)

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366
Q

Flucytosin indication and tox

A
  • cryptococcal meningitis
  • with ampho- NEVER ALONE!
  • follow with fluconazole for consolidation phase
  • causes myelosuppression
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367
Q

Azole toxicity

A
  • hypoK+
  • liver tox
  • Qt (except isavu)
  • 3a4 inhibition!!
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368
Q

Only azole that needs renal adjustment

A

Fluconazole

so this is the only one that can be used for UTI

Also voriconazole due to additive

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369
Q

Drug of choice for aspergillus

A

Voriconazole

*can also use posa and isavu

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370
Q

Itraconazole tox

A

-heart!

Qt, liver, low k, 3A4

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371
Q

Which azoles can penetrate CNS and treat meningitis?

A

Fluconazole and voriconazole

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372
Q

Voriconazole

A

Visual changes, phototoxic

  • low k, liver, qt, 3A4
  • good for aspergillus, c gal rats and c krusei
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373
Q

Posaconazole

A

Full meal

Suspension and tab are no equivalent

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374
Q

Which azole requires a filter ?

A

Isavuconasonium

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375
Q

Which azoles are separated from antacids ?

A

Itraconazole and ketoconazole, posaconazole suspension

*could give with diet cola

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376
Q

Micafungin and caspofungin

A

Echinocandins

  • histamine mediated symptoms
  • NO renal adjustment
  • QD and IV only
  • only for very resistant infxns
  • good for glabrate or krusei and aspergillus
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377
Q

When to start neurominidase inhibitors (tamiflu and zanamivir)

A

Within 48 h of illness

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378
Q

Tamiflu dosing

A

Tx: 75 bid x 5 d
Ppx: 75 qd x 10 d
*adjust crcl<60
- neuropsychiatric ADRs

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379
Q

Varivax vs shingles

A

Kids take varivax (chickenpox) adults take shingrix

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380
Q

Acyclovir info

A
  • renal adjust (also for valacyclovir and famciclovir )
  • dose with IBW!!!
  • available Iv for hsv encephalitis
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381
Q

Zovirax cream and abreva dosing

A

5 times per day

-Zovirax for 4 days

382
Q

Hsv chronic suppression

A

Acyclovir 400 Bid

For hsv 2 can use valacyclovir or famciclovir as well

383
Q

Hsv 1 tx

A

Valacyclovir 2 g x 1
Acyclovir: ~200-400 bid-tid x 5d
-or can be 5x daily

384
Q

Hsv 2 tx

A

Acyclovir is the same as hsv1
Val: 1 g bid
Or famciclovir

385
Q

Shingles tx

A

Acyclovir 800 5x for 7d
Val: 1 g tid x 7 d
Fam: 500 tid x 7 d

386
Q

CMV tx

A

Valcyte, cytovene

Foscarnet or Cidofovir for refractory

*no primary ppx, secondary ppx can be stopped if cd4>100 x3-6 months

387
Q

Ganciclovir and valcyte tox

A

Myelosuppression

-valcyte: eye issues

388
Q

Cidofovir and foscarnet tox

389
Q

PCP ppx and tx

A

Ppx (CD4<200): bactrim DS daily
-or D.P.L, atovaquone
*can stop if >200 x3 months

Tx: bactrim x21 d + steroid

390
Q

Toxoplasmosis tx and ppx

A

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
Q

MAC tx and ppx

A

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
Q

Hormone replacement : estrogen alone v estrogen + progesterone

A

Alone: no uterus

Both: women with uterus

*risk for endometrial CA

393
Q

Vivelle dot placement and timing

A

Twice weekly

Lower abdomen below waist

NOT breast

394
Q

Xulane patch frequency

A

Weekly

E+P

395
Q

First line tx of chronic allergic rhinitis

A

Intranasal steroids

396
Q

What do oral antihistamines not help with?

A

Nasal congestion

397
Q

Preferred antihistamines in pregnancy

A

Loratidine and Cetirizine

398
Q

Less sedating antihistamines

A

Loratadine and fexofenadine

399
Q

Zinc day limit

A

5-7 d max

Possibly effective for reduction in cold duration

400
Q

Vitamin C ADR

A

Kidney stones

401
Q

OTC products to separate from MAOI

A

DM, pseudophed, phenylephrine

402
Q

DM side effects

A

Serotonergic , NMDA blocker at higher doses

403
Q

Codeine CI

A

Children <12

404
Q

Benzonotate max dose

405
Q

Diphenhydramine unique effect

A

Cough suppression

406
Q

Cough and cold in children

A

Avoid in less than 6 y

Also avoid menthol in under 2 y

407
Q

PE abbreviation

A

Phenyleprhine

408
Q

AC abbreviation

409
Q

Ibuprofen strengths

A

Infant drops (50mg/ 1.25mL)

Children’s (100 mg/5mL)

410
Q

APAP strengths

A

Infants AND children’s are both 160 mg/ 5mL

411
Q

Children APAP dosing

A

10-15 mg/kg /dose q4-6h

*max 5 doses per day!

412
Q

Ibuprofen children’s dosing

A

5-10 mg/kg/dose Q6-8h

*max 40 mg/kg/d

413
Q

Eye and ear sigs

A 
A- ear
O- eye
U-both 
D- right
S- left
414
Q

How many drops in an mL

A

20

1 drop= 0.05 ml

415
Q

What can not be administered in rye with contact lenses

A

Eye ointments

416
Q

Drugs that increase IOP

A

Anticholinergics, antihistamines, steroids (pred-forte), topiramate

417
Q

Prostaglandin analog ADR

A

Iris darkening (brown) and eyelash thickening

Avoid in light eyed people

418
Q

Most effective eye drop for decreasing IOP

A

PG analog

Note: use BB if only one eye

419
Q

Which eye drops require removal on contact lenses?

A

PG analogs and others with BAK

Wait 15 mins to reinsert!

Benzalkonium chloride absorbs and discolored them ( not in travatan z or xelpros )

420
Q

When are PG analogs given

A

Bedtime

Blurred vision

421
Q

PG analog frequency

A

Once per day

422
Q

Timeframe to wait between eye drop admin

A

Same med: 5 min

Different med: 5-10 min

423
Q

Only selective BB eye drop

A

Betaxolol (Betoptic)

424
Q

NSAID eye drop ending

A

“Fenac “

Or fluribiprofen

425
Q

Dry eyes eye drops

A

Systane or refresh are both artificial tears

426
Q

Red eye tx

A

Naphazoline

Visine (tetrahydrozoline)

427
Q

Latisse

A

Bimataprost
PG analog
Cosmetic

428
Q

Drugs that can cause eye issues

A

Hydroxy(chloroquine), amiodarone, ethambutol, linezolid, alpha blockers, digoxin, PDE-5 inh, voriconazole, isotretinoin, vigabatrin,

429
Q

Debrox administration

A

Carbamide peroxide

5-10 drops bid x 4d

430
Q

How to pul ear from ear drops

A

Up and back for adults

Down and back for kids <3

431
Q

Drugs that cause discoloration

A

Entacapone, levodopa, methyldopa

Nitrofurantoin, sulfasalazine, propofol, phenazopyridine, rifampin, anthracycline, methylene blue, mitoxantrone, amiodarone, chloroquine

432
Q

Retinoids

A
  • Teratogenic
  • 4-6 weeks to work
  • acne may worsen initially
  • photosensitivity!!
  • pea sized amount
  • bedtime
433
Q

Alternative acne txs

A

Spironlactone, BPO, salicylic acid, ABX, BC

434
Q

BPO

A

Acne first line

Can bleach clothing

435
Q

I pledge

A
  • 2 forms BC (NO P.O.P)
  • no preganancy 1 month before and after
  • fill within 7 d
  • 1 month at a time
436
Q

Drugs that cause hair loss

A

Chemo, valproate, spironolactone, heparin

Zinc/ vit D deficiency

437
Q

Onychomycosis

A

Nail fungal infxn

Topical NOT enough

Oral terbinafine or itraconazole

20% potassium hydroxide (KOH) to diagnose

438
Q

When to repeat lice treatment with permethrin or piperonyl butoxide

439
Q

Steroid vehicle potency

A

Ointment >cream>lotion>solution> gel>spray

440
Q

Topical steroid potency

A

Clobetasol> fluocinonide >mometasone>triamcinolone> hydrocortisone

441
Q

Who can not receive live vaccines ?

A

Pregnant, immunocompromised, < 12 months

442
Q

PPD and live vaccine

A
  1. Give on same day
  2. PPD 4 weeks after vac
  3. Vac after PPD results
443
Q

When are vaccines started in children?

A

Live: after 12 months
Inactivated: 2 months- except hep B which is given at birth

444
Q

Live vaccine separation time

A

Give on same day- OR separate by 4 weeks

445
Q

Can you shorten or extend vaccine intervals

A

You can extend (no need to restart series) but not shorten

446
Q

Live vaccine separation from IVIG

A

Vac -wait 2 weeks- IVIG

IVIG - wait 3 months - vac

447
Q

Loperamide dose

A 
Max rx: 16 mg/d
Max otc: 8 mg/d
Chemo: 24 mg/d 
Up to 2 days
-don’t use if dysentery!
448
Q

Qvar

A

MDI

Don’t shake

449
Q

Finasteride dose

A

Baldness: 1 mg QD
BPH: 5 mg QD

450
Q

Which contraceptive method has delay in return to fertility

A

Medroxyprogesterone injection

451
Q

When are progestin only pills preferred?

A

Breastfeeding (Estrogen decreases milk)

Migraine with aura (estrogens can cause stoke)

452
Q

Window for progestin only pill

453
Q

How often is depo provera given

A

Q 3 months

Injectable medroxyprogesterone

454
Q

Benefits of drosperinone

A

k+ sparing diuretic, less bloating, less pms, less wt gain, less acne

Yaz, yasmin

Drosperinone is a type of progesterone

455
Q

Progesterone ADR

A

Decreases bone mineral density

Give with calcium/vit D

Drosperinone: clotting risk

456
Q

Estrogen CI

A

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
Q

Adjusting COC

A

Easily spotting: increase estrogen

Late spotting: increase progesterone

ADR: decrease estrogen or use drosperinone containing

458
Q

BC choice if heavy menstrual bleeding

A

Natzia, Mirena (IUD)

459
Q

BC choice: mood disorder

A

Monophasic, extended cycle, or drosperinone

460
Q

BC choice: postpartum

A

POP- no estrogen!

461
Q

BC choice: premenstual disphoric d/o

A

Yaz or antidepressant

462
Q

BC choice: don’t want to bleed

A

Extended (91 d) or continuous

463
Q

Which BC has no interactions?

A

Injection!

464
Q

Back up Contraception needed for rifampin

A

Continue for 6 weeks after d/c rifampin

(Due to induction of birth control)

465
Q

Technivie or viekira pak plus ethinyl estradiol BC

A

CI!!! Liver tox!

466
Q

Back up for BC start

A

Start today: 7 d
Sunday: 7 d
If within 5 d of START of period: no backup

POP: start anytime- 48h

467
Q

Late/ missed BC

A

Combo
-1 missed/<48 h: no backup- double up
-2 missed />48 h: back up x7 d
POP: 3 h need back up

468
Q

Which EC requires RX

469
Q

PCN food

A

Empty stomach

470
Q

Doxycycline food

A 
With food (except oracea)
Minocycline with food

Tetracycline- empty stomach

471
Q

Videx (didanosine) interactions

A

It is like a divalent cation

472
Q

Synercid renal

A

No adjustment!

473
Q

Metronidazole food

474
Q

Bactrim and nitrofurantoin food

475
Q

Voriconazole food

A

No! Empty stomach!

476
Q

Itraconazole food

A

Caps: yes! Needs acid
Solution: not necessary

477
Q

Carvedilol, labetolol, metoprolol- food

478
Q

HTN meds to avoid in pregnancy

A

ACE/ARB, diuretics

479
Q

Women folate/vit d/ca requirements

A

Child bearing age: 400 mcg

Pregnant: 600 mcg folate
-D: 600 u
Ca2+: 1000 mg

480
Q

Drugs not to use in pregnancy

A

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
Q

Pregnancy nausea

A

Pyridoxine (B6), doxylamine

Ginger

482
Q

Pregnancy GERD

A

Calcium carbonate

483
Q

Pregnancy flatulence

A

Simethicone

484
Q

Pregnancy constipation

A

Fiber: psyllium, calcium polycarbophil

Docusate

485
Q

Pregnancy: cough, cold, allergy

A

Chlorpheniramine (DOC), Benadryl,

ICS: budesonide, beclonethasone (B for baby)

No pseudo or oxymetazoline!!!

486
Q

Pregnancy: pain

A

APAP

No nsaids or asa!!!

487
Q

Pregnancy asthma

A

Budesonide, albuterol

488
Q

Pregnancy DM

A

Insulin! Regular!

Sometime Metformin and glyburide

489
Q

Pregnancy ABX

A

PCN, amox/amp, cephalosporin, erythromycin/azithromycin

No: clarithromycin, FQ, tetracyclines, fluconazole,

Nitrofurantoin and bactrim maybe in first trimester

490
Q

Pregnancy VTE

A

LMWH > UFH

No warfarin, XA and thrombin-I not studied so no

491
Q

Breastfeeding considerations

A
  • 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
Q

Progesterone effect on bones

A

Decreases BMD

493
Q

PPI effect on bones

A

Decreases BMD- increase ph will reduce ca2+ absorption

494
Q

Steroid effect on bones

A

Decreases BMD

495
Q

Calcium tips

A
  • Saturable absorption- divide doses
  • citrate better if higher PH (PPI)
  • carbonate- take with food
  • ADR- Constipatjon
496
Q

Calcium strengths

A

Carbonate: 40% elemental
-1 g= 400 mg elemental
Citrate: 21% elemental
-1 g= 210 mg elemental

497
Q

Bisphosphonates info

A
  • 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
Q

Estrogen bone effects

A

Increased BMD

499
Q

Weird estrogen ADR

500
Q

Menopause natural products

A

Black cohosh, evening primrose, red clover, soy

501
Q

Paroxetine interactions

A

Warfarin- increased bleed risk

Tamoxifen- reduced efficacy

502
Q

Meds that can lower testosterone

A

Methadone, cimetidine, spironolactone, chemo

503
Q

Testosterone ADRs

A

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
Q

Is lithium serotonergic?

505
Q

Lithium food

A

Take with meals!

506
Q

Cochcine major ADR

A

Diarrhea, N/V

*note: medguide needed

507
Q

Which type of vit D is active?

A

Calcitriol

D3

508
Q

Medroxyprogesterone pregnancy

A

Category X

509
Q

Meds that cause ED

A

SSRI/SNRI, beta blockers, clonidine, typical AS, risperidone/paliperidone, finasteride, nicotine, chronic opioids (methadone)

510
Q

Natural products for ED

A

Yohimbe, l-arginine, panax ginseng

511
Q

What else is tadalafil used for?

512
Q

ED dosing

A 
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
Q

PDE info

A

Impaired color, hearing loss, vision loss, hypotension, headache, dyspepsia, flushing

  • sildenafil and vardenafil decreased efficacy with high fat/meal
  • no etoh
514
Q

When to take PDEs before sexual activity

A

Avanafil: 15 min
Tadalafil: 30
Sildenafil/vardenafil: 60 min

515
Q

Which natural products are used for BPH (not recommended)

A

Saw palmetto, pygeum

516
Q

Natural products for prostate CA prevention

517
Q

When should 5-alpha reductase inhibitor NOT be used

A

BPH w/o prostate enlargement

*they reduce the size of prostate

518
Q

Meds to worry about with cataract surgery

A

Alpha blockers

Floppy iris syndrome

519
Q

Tadalafil weird ADR

520
Q

When to take tamsulosin

A

30 mins after a meal

520
Q

When to take tamsulosin

A

30 mins after a meal

521
Q

Which drug class worsens dementia?

A

Anticholinergics (obviously)

522
Q

Reducing try mouth from anticholinergic for OAB

A

Oxybutynin Patch or gel or ER

Or mirabegron

523
Q

Nocturia tx

A

Desmopressin
ADR: hyponatremia! Retains water!
Caution: fluid retention

524
Q

Minimum MME for fentanyl patch

A

60 mme x 7 d

525
Q

After applying fentanyl patch…

A

Decrease other opioids by 50% x 12 h before stopping

Takes 8-16 h for effect

526
Q

Fentanyl and other opioid drug interactions

A

What for 3A4 inhibitors

527
Q

Opioid 3A4 substrates

A

Fentanyl, methadone, hydrocodone, oxycodone

528
Q

Natural products for migraine

A

Butterbur, feverfew, magnesium, riboflavin

529
Q

Triptan concerns

A

CV, BP, serotonin , paresthesias

CI in pregnancy!!!

530
Q

Long acting triptans

A

Frovatriptan, naratriptan

531
Q

Triptan drug interaction

A

MAOI

Sumatriptan, rizatriptan, zolmitriptan

532
Q

When not to use ODT triptans

A

Phenylketonuria

Rizatriptan/zolmitriptan MLT

533
Q

Common joint effected by gout

A

Metatarsophalangeal (big toe)

534
Q

Drugs that increase uric acid

A

Aspirin, diuretics, niacin, pyrazinamide

Pancreatic enzymes, calcineurin inhibitors,

535
Q

Goal uric acid level

A

<6

Don’t treat unless a gout attack has occurred

536
Q

Do you stop or continue Uric acid lowering therapy during gout attack

537
Q

Colchicine tx dose

A

1.2 then 0.6 1 hour later

Max: 1.8/ hr; 2.4/ day

Don’t repeat sooner than 3 days

538
Q

Colchicine ppx dose

A

0.6 QD or bid

539
Q

Cochicine info

A
  • Don’t use with cyp3a4 or pg-protein inhibitors!!!!
  • N/D, myelosuppression, myopathy, neuropathy
  • *wait 12 h after tx before resuming ppx**
540
Q

PDA tx in fetus

A

Indomethacin, ibuprofen

541
Q

Big colchicine interaction

A

Pg-protein or 3A4 inhibitors

542
Q

How to start xanthine oxidase inhibitor

A

With colchicine or nsaids

can precipitate attack

543
Q

Allopurinol allele

A

HLA-B*5801

544
Q

Azathioprine/mercaptopurine + XOI

A

Don’t use febuxostat or allopurinol with azathioprine (increases conc of active metabolite Mercaptopurine)

545
Q

How often is clonidine patch changed?

545
Q

How often is clonidine patch changed?

545
Q

How often is clonidine patch changed?

545
Q

How often is clonidine patch changed?

545
Q

How often is clonidine patch changed?

545
Q

How often is clonidine patch changed?

545
Q

How often is clonidine patch changed?

545
Q

How often is clonidine patch changed?

545
Q

How often is clonidine patch changed?

545
Q

How often is clonidine patch changed?

545
Q

How often is clonidine patch changed?

545
Q

How often is clonidine patch changed?

545
Q

How often is clonidine patch changed?

545
Q

How often is clonidine patch changed?

546
Q

Drugs that worsen gerd

A

Aspirin/NSAIds, iron, bisphosphonates, dabigatran, estrogens, fish oil, steroids, tetracyclines, nicotine

547
Q

How long should initial trial of PPI be?

548
Q

H2 blockers ADR

A

Confusion, B12 deficiency, renally adjust <50 (famitidine, ranitidine, nizatidine)

30-60 mins before eating

549
Q

PPI meal timing

A

Before breakfast ESO, Omep, lans

W/o regard: dexilant, pantop, raber

550
Q

PPI ADR

A

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
Q

PPI available as injection

A

Pantoprazole, esomeprazole

552
Q

H2 blockers available as injection.

A

Famitidine, ranitidine

553
Q

OTC PPI

A

Omeprazole, esomeprazole, lansoprazole

554
Q

ODT PPI

A

Lansoprazole, omeprazole

555
Q

OTC h2 blockers

A

Cimetidine, ranitidine, famitidine

556
Q

Metoclopramide MOA

A

Dopamine antagonist + seratonin blocker in CTZ at higher doses

557
Q

Drugs for peptic ulcer dx but not GERD

A

Misoprostol, metoclopramide, sucralfate

558
Q

When to renally adjust reglan

A

Crcl<40, decrease by 50% (2.5-5 qid)

559
Q

Drugs with decreases absorption if taken with antacids

A

Rilpivirine, atazanavir, ledipasvir, velpatasvir/sofosbuvir (epclusa, harvoni) (HEV), itraconazole m, ketoconazole, posaconazole suspension, cefpodoxime, cefuroxime, iron, mesalamine, atelvia (risendronate ER), TKI,

560
Q

Drugs that bind antacids

A

INSTIs, bisphosphonates, isoniazid, mycophenolate, quinolones, soya lol, steroids (budesonide). Tetracyclines, thyroids products

561
Q

H2 blocker- increased QTc

A

Famotidine

562
Q

Bacteria causing peptic ulcers

A

H. Pylori- spiral shaped gram negative

563
Q

Eating and ulcer pain

A

Duodenal (h pylori): worse on empty stomach

Gastric (nsaids): worse with eating

564
Q

Urea breath test

A

Tests for h pylori ulcer

D/c PPI, bismuth, and ABX 2 weeks before

565
Q

H pylori tx

A

Bismuth, metro, tetracycline, PPI
pylera QID + PPI BID

Alt: clarithromycin + amo + metro + PPI BID
CAM BID + PPI BID

These are both quadruple

566
Q

Duration of therapy H pylori tx

A

10-14 d

If triple therapy: 14 d

567
Q

Safer NSAIDs with risk for GI

A

Celecoxib, meloxicam, diclofenac, nabumetone, etodolac

568
Q

Misoprostol issues

A

Abortifacient, diarrhea, abd pain

*200 mg qid

569
Q

Sucralfate issues

A

Constipation, DI (2h before and 4 h after)

1 g QID before meals/bedtime

570
Q

When to seek medical attention for GERD

A

Self tx > 14 d or twice weekly

571
Q

Aluminum: constipation or diarrhea

A

Constipation

572
Q

Prevacid solutab CI

A

Phenylketonuria (contains aspartame)

573
Q

Drugs that increase lipids

A

PAST D
Protease inhibitors, atypicals AS, steroids, transplant, diuretics

Estrogens, tamoxifen, bile acid sequestrants, sglt2

574
Q

Natural products for cholesterol

A

Red yeast rice

575
Q

When statin is indicated

A

ASCVD risk >7.5%, DM, ldl >190, clinical ASCVD

576
Q

Who gets high intensity statin

A

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
Q

Lipid lowering drug CI with statin

A

Gemfibrozil

578
Q

Statin + colchicine

A

Interaction: increased risk myopathy

579
Q

Hydrophilic statins

A

Pravastatin, rosivastatin

Less interaction and mypothay
Pitavastatin also less DI

580
Q

Weird 3a4 inhibitors- reduce statin dose

A

Cyclosporin, nefazodone

*danazole (with simvastatin)

581
Q

What time is niaspan taken

A

Bedtime

With low-fat snack

582
Q

When to start BP med

A

Stage 2 or stage 1 plus CVD or ASCVD >10%

583
Q

When to start two BP meds

584
Q

When to start HTN therapy in pregnancy

585
Q

Thiazides renal

A

Not effective below crcl<30 except metolazone

586
Q

Only IV thiazide

A

Diuril (chlorthiazide )

586
Q

Only IV thiazide

A

Diuril (chlorthiazide )

587
Q

Safest CCB in HFrEF

A

Amlodipine, felodipine

588
Q

BUD of clevidipine and propofol after opening vial

588
Q

BUD of clevidipine after opening vial

589
Q

Which k+ sparing diuretics better at lowering BP

A

Aldosterone antagonists (eplerenone and spironolactone)

590
Q

Non selective BB

A

Nadolol (corgard), pindolol, prop, timolol

591
Q

BB Effect in BG

A

Can increase or decrease

591
Q

BB Effect in BG

A

Can increase or decrease

592
Q

HTN emergency- how fast to decrease BP

A

Max 25% in 1 h

(>180/120)

If urgency use orals

593
Q

Does stable angina count as clinical ASCVD

594
Q

Tx of stable angina

A

ABCDE
Antiplatelet/antianginal, BP/BB, cholesterol (statins), DM, exercise

  • It’s ASCVD so need statin + ASA
  • BB first line
595
Q

When to use DAPT

A 
SIADH
    -bare metal stent x 1 mo 
    -drug eluding stent x 6 mo
    -cabg x 12 mo
Stroke: x 21 d
596
Q

When to avoid BB in angina

A

Prinzametals (use DHP)

597
Q

When to call 911 after nitrate

A

If angina still there after 1st dose

597
Q

When to call 911 after nitrate

A

If angina still there after 1st dose

598
Q

BUD nitro tabs in glass container

A

6 months after opening

598
Q

BUD nitro tabs in glass container

A

6 months after opening

598
Q

BUD nitro tabs in glass container

A

6 months after opening

598
Q

BUD nitro tabs in glass container

A

6 months after opening

598
Q

BUD nitro tabs in glass container

A

6 months after opening

599
Q

NTG admin

A

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
Q

Preferred site for topical NTG

A

Chest

Not below knees or elbows

601
Q

Ranolazine interaction

A

Cyp3a4 substrate

QTc

602
Q

Dabigatran dosing

A

150 BID

Crcl<30: 75 BID

603
Q

Converting dig PO to IV

A

Decrease by 25%

604
Q

Time for referral diarrhea

605
Q

Time for referral: constipation

605
Q

Time for referral: constipation

605
Q

Time for referral: constipation

606
Q

Time for referral: constipation

607
Q

Time for referral: GERD

607
Q

Time for referral: GERD

607
Q

Time for referral: GERD

608
Q

Time for referral: GERD

609
Q

Sodium phosphates risk

A

Fluid and electrolyte abnormalities

*don’t use in renal or cardiac dx

609
Q

Sodium phosphates risk

A

Fluid and electrolyte abnormalities

*don’t use in renal or cardiac dx

610
Q

Sodium phosphates risk

A

Fluid and electrolyte abnormalities

*don’t use in renal or cardiac dx

611
Q

Laxatives/ antacids dangerous in CKD

A

Anything with mg if al

612
Q

Laxative for post MI, post partum, or hemorrhoids

613
Q

What do you avoid with EC bisacodyl

A

Milk, dairy, antacids- within 1 hr

614
Q

Laxative interaction

A

Mineral oil + docusate= increased absorption

615
Q

Issue with mineral oil

A

Take with MV- reduced ADEK

616
Q

Osmoprep boxed warning

A

Nephropathy

617
Q

What can you eat day before colonoscopy

A

Clear liquid diet

No: pulp, red/blue/purple food coloring, milk, alcohol, semi/solid food

618
Q

Amitiza

A

Lubiprostone

Constipation (cl channel)

619
Q

Linzess

A

Constipation

Guanylate cyclase

620
Q

Trulance

A

Plecanatide

Guanylate cyclase

Constipation

621
Q

Drugs that cause diarrhea

A

Cochicine, quinidine, misoprostol

Reglan, ABX, chemo, magnesium, roflumilast

622
Q

Symproic

A

Naldenedine

PAMORA

623
Q

Loperamide risks

A

Torsades, <2 y/o

Don’t exceed 48 h

624
Q

Lomotil max dose

A

20 mg/ d

CV

625
Q

IBS v IBD

A

IBD more severe and associated with inflammation

chrones and UC

626
Q

Ulcerative colitis

A

Superficial, Confined to rectum and colon

*proctotis if just rectum- can use topicals

627
Q

Chrones

A

Deep, affects any part of GI tract

628
Q

Nicotine weird use

A

Protective in Ulcerative colitis

628
Q

Nicotine weird use

A

Protective in Ulcerative colitis

629
Q

Nicotine weird use

A

Protective in Ulcerative colitis

630
Q

Chrones tx

A 
Mild:Oral budesonide,
Mod: humira, remicade, cimzia
    -azathioprine/ mercaptopurine
    -stelara (ustekinumab)
Refractory: vedolizumab, natizumab
631
Q

Ulcerative colitis tx

A 
Mild: mesalamine
Mod: humira, remicade, simponia
  -azathioprine/mercaptopurine
  -cyclosporine 
  -tofacitinib (xeljanz)
Refractory: vedolizumab
632
Q

Tx acute flares of UC and chrones

633
Q

Recital steroids indication

A

Ulcerative colitis only

634
Q

Ghost tablets

A

Desvenlafaxine, nisoldipine (sular), adalat, covera, procardia, asacol, delzicol, glumetza/fortamet, invega, concerta, glucotrol XL, oxybutynin XL

635
Q

Who should not receive promethazine

A

Children- respiratory depression

636
Q

What is not effective for motion sickness

A

Reglan and 5HT-3 antagonists

637
Q

Scopamaline risks

A

Increased IOP- no glaucoma (same with Dramamine and meclizine)

Allergy to belladonna

638
Q

When to apply scopalamine

A

4 h before needed or night before surgery

Press x 30 seconds

No MRI

639
Q

RA v MS tx

A

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
Q

RA v MS tx

A

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
Q

Metformin renal dosing

A

<30 CI

30-45: don’t start- may continue at half normal dose (500 BID)

641
Q

PCI only

A

Abciximab, prasugrel

642
Q

Brillinta dosing

A

LD: 180 mg
90 mg BID x12 mo then 60 BID
*don’t use ASA doses >100 mg
*ticagrelor

643
Q

Plavix LD

A

Pre-pci after fibrinolytics
600 mg if >24 hrs of fibrinolytic
300 mg if within 24 hrs of fibrinolytic

Just pci
600 mg

644
Q

When are fibrinolytics indicated?

A

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
Q

When is ACE indicated after ACS

A

HFrEF <40%, DM, HTN

646
Q

Aldosterone antagonist (eplerenone/spironolactone renal CI

A

Men: scr >2.5
Women: scr>2

647
Q

Lowest CV risk NSAID

648
Q

When is PPI indicated for antithrombotic therapy?

649
Q

Which drug causes yellow-green halos

650
Q

Additional affect of dipyridamole

A

Hypotension (causes HA)

651
Q

Management of hemorrhagic stoke

A
  • reverse AC
  • reduce ICP: mannitol or hypertonic saline
  • PPx anticonvulsants only for SAH
  • nimodipine to prevent cerebral Vadospasm in SAH
652
Q

Which CCB is more lipophillic

A

Nimodipine

653
Q

Mannitol CI

A

Severe renal dx

654
Q

IV bisphosphonates

A

Ibandronate (bonivia) Q mo

Zolendronate (zometa) yearly

655
Q

Zolendronate formulations

A

Reclast: osteoporosis
Zometa: hypercalcemia of malignancy

656
Q

What decreases lithium ?

A

Theophylline, caffeine, salt

657
Q

What increase lithium ?

A

Ace/arb, thiazides, NSAIDs (except sulidac and ASA)

658
Q

Meqs in lithium

A

8 MEQ= 300 mg carbonate or 5mL citrate solution

659
Q

How fast can you correct sodium?

A

12 meq/L in 24 h

660
Q

IV k+: max concentration and rate for peripheral

A

Conc: 10meq/100 mL
Rate: 10 meq/hr

661
Q

IVIG and vaccines

A

Can impair response to vaccination

661
Q

IVIG and vaccines

A

Can impair response to vaccination

661
Q

IVIG and vaccines

A

Can impair response to vaccination

661
Q

IVIG and vaccines

A

Can impair response to vaccination

662
Q

Blue nitroprusside

A

DONT USE- degraded to cyanide

663
Q

Vasopressor of choice for septic shock

A

Norepinephrine

664
Q

Weird lorazepam ADR

A

Propylene glycol toxicity (AKI and metabolic acidosis)

665
Q

Drugs that cause malignant hyperthermia

A

Succinylcholine

Inhaled anesthetics

666
Q

Lysteda

A 
Tranexamic acid (tab)
Could use for heavy men’s that bleeding
667
Q

Amicar

A

Aminocaproic acid

668
Q

Ibuprofen strengths!!

A

Infant : 50/1.25 ml

Child: 100/5 ml

669
Q

Age you can give motrin

A

6 months +

669
Q

Age you can give motrin

A

6 months +

670
Q

Neonatal meningitis (<30 d)

A

Ampicillin + (cefotaxime OR gentamicin)

671
Q

RSV tx and ppx

A

Tx: virazole (inhaled ribaverin)
Ppx: synagis (palivizumab)-
-doses monthly in premature with heart or lung dx during RSV season

672
Q

Order to CYstic fibrosis drugs

A

Bronchodilator > hypertonic saline (nebulized) > dornase Alfa > physiotherapy > inhaled ABX

673
Q

Max pancreatic lipase dose

A

Lipase <2500u/kg/meal or 10,000u/kg/day

674
Q

Pancreatic lipase facts

A
  • can mix with acidic food but not dairy
  • viokace needs PPI
  • original container
  • half mealtime dose for snacks
  • MEDGUIDE*
675
Q

Calcineurin inhibitor info (tacrolimus and cyclosporine)

A

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
Q

Mtor Inhibitors major ADR

A

Increased lipids

677
Q

Monoclonal antibody major ADR

A

Severe reaction: premeditate with steroid, antihistamine, acetaminophen

678
Q

Weight loss drug reqs

A

Must lose 5% in 12 weeks to continue

No preganancy

678
Q

Weight loss drug reqs

A

Must lose 5% in 12 weeks to continue

No preganancy

678
Q

Weight loss drug reqs

A

Must lose 5% in 12 weeks to continue

No preganancy

679
Q

AC of choice it HIT

A

Argatroban

680
Q

If pt on warfarin hey HIT

A

Stop warfarin- (even though high clot risk) and give vit K

*risk limb gangrene and necrosis with low plt and warfarin

681
Q

AC of choice with prosthetic heart valve

682
Q

Xarelto renal dosing

A 
Afib
    -<50: 15 QD 
    -<15: avoid
Tx 
    -<30: avoid

*for tx you take 20 either way- even if renal function 30-50

683
Q

Dabigatran expiration

A

4 months after opening

  • also: !!original container!!
  • and no g-tube!~ dont open capsule!
  • skip missed dose if within 6h of next dose!
684
Q

Warfarin bridge with lmwh

A

Continue x 5 d and until INR > 2 for at least 24 h

685
Q

How to give vit k for warfarin reversal

A

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
Q

When to use vit k

A

If not bleeding: INR> 10
-PO: 2.5-5

Bleeding: 5-10 mg slow IV
-give with PCC

687
Q

When to stop warfarin before surgery

A

5 d

*bridge with LMWH if mechanical heart vale (d/c 24 h before or 4-6 h before if UFH)

688
Q

Preferred tx for DVT or PE

A

DOAC> warfarin

Cancer: LMWH

689
Q

CHA2 DS2 VASc

A

CHF, HTN, Age>75, Diabetes, stroke, vascular dx, age 64-74, sex

Male: 2 needs AC
Female: 3 needs AC

689
Q

CHA2 DS2 VASc

A

CHF, HTN, Age>75, Diabetes, stroke, vascular dx, age 64-74, sex

Male: 2 needs AC
Female: 3 needs AC

689
Q

CHA2 DS2 VASc

A

CHF, HTN, Age>75, Diabetes, stroke, vascular dx, age 64-74, sex

Male: 2 needs AC
Female: 3 needs AC

689
Q

CHA2 DS2 VASc

A

CHF, HTN, Age>75, Diabetes, stroke, vascular dx, age 64-74, sex

Male: 2 needs AC
Female: 3 needs AC

689
Q

CHA2 DS2 VASc

A

CHF, HTN, Age>75, Diabetes, stroke, vascular dx, age 64-74, sex

Male: 2 needs AC
Female: 3 needs AC

689
Q

CHA2 DS2 VASc

A

CHF, HTN, Age>75, Diabetes, stroke, vascular dx, age 64-74, sex

Male: 2 needs AC
Female: 3 needs AC

690
Q

Drugs that can cause hemolytic anemia

A

VALPROATE, dapsone, methylene blue, primaquine, rasburicase, pegloticase, bactrim, nitrofurantoin, levodopa, methyldopa, PCN, cephalosporin, quinine, quinidine, rifampin

Think G6PD deficiency

690
Q

Drugs that can cause hemolytic anemia

A

VALPROATE, dapsone, methylene blue, primaquine, rasburicase, pegloticase, bactrim, nitrofurantoin, levodopa, methyldopa, PCN, cephalosporin, quinine, quinidine, rifampin

Think G6PD deficiency

690
Q

Drugs that can cause hemolytic anemia

A

VALPROATE, dapsone, methylene blue, primaquine, rasburicase, pegloticase, bactrim, nitrofurantoin, levodopa, methyldopa, PCN, cephalosporin, quinine, quinidine, rifampin

Think G6PD deficiency

691
Q

Hep B tx

A

Peg-INF or NRTI

692
Q

Hep C tx

A

DAA combo

+/- RBV +/- PEG-INF

693
Q

Drugs with boxes warnings for liver damage

A

APAP, isoniazid, ketoconazole, amiodarone, MTX, nevirapine, nefazodone, NRTIs, PTU, tipranavir, valproate,

Bosentan, felbamate, flutamide, leflunamide, teriflunamide, lomitapide, maraviroc, mipomersen, tolcapone

694
Q

Antipsyches: high v low potency

A

Low: less EPS, more sedation, and CV (hypotension)

High: more EPS, less sedation

695
Q

Typical antipsych less known ADRs

A

Hypotension (also atypical), seizures, sexual ADRs

696
Q

How to people die from antipsyches (black box)

697
Q

Requirement for invega trinza

A

Only after Sustina monthly x4 months

698
Q

Seroquel food?

A

No, or light meal (ER)

IR doesn’t matter

698
Q

Seroquel food?

A

No, or light meal (ER)

IR doesn’t matter

699
Q

Ziprasidone food

A

With food!

700
Q

Asenapine food

A

No!

Note: tongue numbness

701
Q

Antipsyches food reqs

A

With: lurasidone, ziprasidone
Without: seroquel, asenapine

702
Q

Serious antipsych ADR

A

NMS

  • more with first gen (d/t D2 blockade)
  • seroquel/clozapine less
  • BZDs, dantrolene, bromocriptine (dopamine agonist)
703
Q

Preganancy bipolar

A

Lamotrigine or lurasidone

704
Q

Lithium ADRs

A

GI, cognition/confusion, cogwheel rigidity, hand tremor, wt gain OR anorexia, polyuria/dipsia, hypothyroid, blue skin pigment, impotence, serotonergic

Toxicity: arrhythmias, seizures, coma

705
Q

Amphetamine salts and acid

A

Don’t take with acid juice- decreases absorption

706
Q

Stimulants suicidal ideation?

A

No!

Yes for straterra

707
Q

Stimulant and straterra differences

A

ED, libido, hyperhidrosis, suicide, straterra but NOT stimulants

708
Q

Tamoxifen interactions

A

Prodrug via 2D6 (no fluoxetine or paroxetine)

Cyp2C9 inhibitor- No warfarin!!!

709
Q

Inhibitors

A

Pacman

PIs, azoles, cyclosporin, cimetitinde, cobicistat, macrolide (not azithromycin), amio/dronedarone, non-DHP

710
Q

Pseudomonas abx

A

Zosyn, cefepime, ceftazadime, , ceftazolane-tazobactam, aztreonam, carbapenems (not ertapenem), levofloxacin, cipro, AG

711
Q

Corrected calcium

A

(4-albumin) x 0.8 + calcium

712
Q

Extravasation temp management

A

Cold: anthracyclines (and dimethyl sulfoxide, or dexrazozane “totect”)

Heat: vinca alkaloids (and hyaluronidase)

713
Q

Which DPIs have slow inhalation

A

Ellipta

Also handihaler and neohaler aren’t as forceful

714
Q

Emergency contraception times

A

Plan b: 120hr (labeled 72)
Ella (ullipristal): 120h- rx only
Copper iud- 5 day (better bmi>35)

715
Q

Danazol

A

Androgenic hormone for endometriosis

716
Q

Elagolix (orilissa)

A

GnRH antagonist

Endometriosis

717
Q

Correlation tests

A

Pearson: continuous, normal distribution

Spearman: not normally distributed or ordinal

718
Q

Regression vs correlation

A

Regression shows one variable is dependent on the other (cause and effect)

*regression used for prediction!

719
Q

Survival analysis

A

Kaplan Meier- descriptive

Cox proportional hazards- continuous and test multiple

Log rank

720
Q

Hyperthyroid in pregnancy

A

1st trimester use PTU- switch to methimazole in second trimester

721
Q

Levothyroxine iv to po

722
Q

Thyroid drug pearls

A

Levothyroxine-T4
Liothyronine- T3
Liotrix- T3/T4

Dedicated thyroid 60 mg= levothyroxine 100 mg

Levothyroxine start: 1.6 mcg/kg IBW

723
Q

Pasireotide

A

Cushing’s

724
Q

Antiarrythmics to use in HF

A

Amiodarone or dofetilide

NOT dronedarone

725
Q

Anticoag choice in primary pci

A

Bivalirudin or UFH

726
Q

How long to continue AC after pci

Fibrinolytic?

A

48 hours, up to 8 days

Usually stop after pci

*48 hours after for fibrinolytic

727
Q

ARNI lab issue

A

Use NT-proBNP not BNP

728
Q

ADHF numbers

A

Wet: pcwp >18
Dry: pcwp 15-18
Cold: CI <2.2
Warm: CI >2.2

729
Q

ADHF tx

A

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
Q

Milrinone v dobutamine

A

Milrinone: to avoid stopping BB. don’t bolus

Dobutamine: severe hypotension, bradycardia, renal impairment, thrombocytopenia

731
Q

Tolvaptan

A

Vasopressin ANTAGONIST

makes you urinate

*opposite of desmopressin

732
Q

DOC pulseless VT/VF

A

Amiodarone

733
Q

Ventricular arrhythmia

A

Lidocaine or Mexilitine

734
Q

Fenoldopam

A

Vasodilator for hypertensive crisis

735
Q

DOC acute aortic dissection

A

Labetaolol, esmolol

736
Q

HTN crisis: DOC pulmonary edema

A

Clevidipine, NTG, ntp

No BB

737
Q

Code: v fib or pulseless vtach

738
Q

Code non-shockable rhythms (PEA, asystole)

739
Q

Which antipsychs have less QTc effect

A

Risperidone and olz

740
Q

Stress ulcer ppx indication

A

Mech vent, inr>1.5, or plt<50

741
Q

When to avoid D5W

A

Neurological injury (increases ICP) bc it’s “free to cross any membrane

742
Q

Which fluid should 150 meq sodium bicarb go in

A

Sterile water or D5W (osmolarity issues)

743
Q

Demeclocycline

A

ABX but also for siadh (reduces sensitivity to adh- opposite of desmopressin)

744
Q

Calcium to use in PN

A

Gluconate

Chloride more likely to precipitate

745
Q

Required concentration of AA, ca, and phos

A

AA: 2.5%+ (decreases ph) 4%for TpN
Ca: 6meq/L or less
Phos: 30-40 mmol/L or less

746
Q

Tests for heterogeneity

A

Cochrane Q, X2, I2

P>0.1 means no heterogeneity

747
Q

Postrenal Aki from drug precipitation. Drug examples

A

MTX, sulfonamide, acyclovir, ascorbic acid,

748
Q

Indication for dialysis

A

Acidosis
Electrolyte abnormality
Intoxication
Overload (fluid)
Uremia

749
Q

ESA reqs

A

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
Q

ESA use with caution

A

Hx stroke or cancer, HTN

751
Q

ESA SubQ to IV

A

SubQ is 30% less than iv

752
Q

Iron formulation in dialysis patients

A

IV, NOT oral

753
Q

PPI + IV MTX

A

Risk MTX toxicity

754
Q

Bethanecol

A

Cholinergic AGONIST

For urinary retention

755
Q

Motrin + ASA

A

Give Motrin 30 mins after or 8 hours before aspirin

756
Q

Albumin dosing

A

Paracentesis: 6-8 g/L if >5 L removed

SBP: 1.5 g/kg d1, 1 g/kg d3

757
Q

Ribaverin indication

758
Q

Mavyret

A

Glecaprevir/pibrentasvir

759
Q

DAA interactions

A

3A4/ pgp, acid suppressive therapy, statins

Many can cause liver issues

760
Q

Linaclotide (linzess)

A

Constipation

761
Q

Prucalopride (motegrity)

A

Constipation

Seratonin agonist

Cardiac events and suicide

762
Q

Lubiprostone (amitiza)

A

Constipation

No pregnancy

763
Q

Tenapanor (ibsrela)

A

Constipation

764
Q

Peppermint oil use

A

Nausea, IBS

765
Q

Tegaserod

766
Q

Eluxadoline

A

(Viberzi)

IBS-D (mu agonist)

767
Q

Alosetron

A

IBS-D

Lotronex

768
Q

IBW

A

50 or 45.5 + 2.3(inches over 5ft)

Adjusted: IBW + 0.4(act-IBW)

769
Q

Which drugs used actual body wt in crcl calculation

A

Xarelto, dofetilide, dabigatran

770
Q

Aducanumab

A

Alzheimer’s

771
Q

RA DOC in preganancy

A

Sulfasalazine

772
Q

Meningitis is child

A

0-1 month- amp + gent
1-3 month- amp or vanc + ceftriax
>3 month: vanc + ceftriax

773
Q

Which vaccines have neomycin

A

Polio, varicella, mmr

774
Q

Methylphenidate to dexmethylphenidate

A

50% reduction

775
Q

Viloxazine

A

Like atomoxetine

776
Q

Which common seizure meds don’t effect birth control

A

Valproate, levetiracetam, Zonisamide, lacosamide, ethosuxamide

777
Q

Selegiline patch vs tab

A

Patch: depression

Tab: PD

778
Q

Istradefylline

A

Nourianz

PD

779
Q

Lumateperone

A

Atypical antipsych

No EPS

780
Q

Antipsych movement disorder meds

A

Akathesia: BB, BZD

Dystonia: anticholinergic (po to prevent, iv to treat)

Pseudoparkinsonism: oral anticholinergic

Traduce dyskinesia: valbenazine, deutetrabenazine, tertabenazine…. DO NOT USE ANTICHOLINERGICS

781
Q

Antipsyches highest risk seizure

A

Chlorpromazine, cariprazine, clozapine

If it starts with “c” it causes seizures

782
Q

Seratonin syndrome treatment

A

Cyproheptadine, BZD, anticonvulsant, nifedipine

783
Q

SSRIs with less sexual dysfunction

A

Vortioxetine, vilazodone

Also mirtazapine

784
Q

TCA major ADR

785
Q

Half life

786
Q

Gene that valproate CI in

787
Q

Valproate ER to enteric coated

A

Increase by 8-20%

788
Q

Valproate toxicity

A

Thrombocytopenia, hepatotoxicity, alopecia, pancreatitis, fetal harm,

789
Q

Lamotrigine unique adr

A

Aseptic meningitis

790
Q

Symbyax other use

791
Q

Lemborexant

792
Q

Sleep onset v sleep maintenance

Which can be used long term?

A

Both: zolpidem, eszopiclone, suvorexant, temezepam

Onset: ramelteon, zaleplon, triazolam

Maintenance: doxepin,

Note: ramelteon and z-drugs can be used long term

793
Q

Who should never get anticholinergics? (If you think about it…)

A

Alzheimer’s pts! Duh!

794
Q

Which is the T in LOT BZDs ?

A

Temazepam NOT triazolam

795
Q

Which is given first thiamine or glucose?

A

Thiamine

Cofactor for glucose metabolism

796
Q

Which is the only LAMA for asthma

A

Spiriva

Add to high dose ICS-LABA for very severe cases

797
Q

Which LABAs are indicated in asthma

A

Salmeterol, formoterol, vilanterol

(Salamander for the villains)

** NEVER MONOTHERAPY FOR ASTHMA**

Combos: symbicort, Breo, dulera, advair

798
Q

Indications for LAMA/LABA VS LAMA/ICS combos

A

LAMA/LABA: copd

LABA/ICS: asthma

799
Q

Zileuton and zafirlukast adr

A

Hepatotoxicity

Not with mintelukast

800
Q

Montelukast black box warning

A

Neuropsychiatric events

801
Q

Monoclonals for asthma

When should they be used?

A

Omalizumab, dupilimumab, reslizumab, benralizumab, mepolizumab

These are best for allergy related asthma or high eosinophils!

802
Q

Redihaler

803
Q

Aerosphere

804
Q

Preferred asthma meds in pregnancy

A

ICS: budesonide
LABA: salmeterol

Saba and montelukast okay

805
Q

Is copd what is ICS combined with

A

LABA of LAMA/LABA (category D)

NOT LAMA alone

806
Q

Adjusting COPD therapy

A

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
Q

Copd exacerbation ABX

A

Augmentin, azithromycin, or doxy

Or FQ if suspect pseudomonas

808
Q

Pneumococcal schedule

A

Pcv15 follow by pcv23 in 1 yr

Or just pcv20

*for qualifying 19-64 and everyone over 65if haven’t received before

809
Q

Flu vaccine and egg allergy

A

Severe- RIV or ccIIV4 or vaccinate in medical setting

If hives only- any vaccine okay

810
Q

Which FQs cover PSA?

A

Levo and cipro

Not moxi- important for tx of PNA

811
Q

PNA duration

A

Cap 5 d
Hap/vap- 7 d

812
Q

Baceterial v viral sinusitis

A

Bacterial: >10d, fever, double sickening

Augmentin first line

813
Q

Pyleo or complicated uti

A

Bactrim of FQ, maybe beta lactams (especially ceftriaxone if inpatient )

CAUTI- levaquin

814
Q

Preganancy uti

A

Augmentin, cephalexin, fosfomycin

Nitrofurantoin- avoid I. Trimester 1 and 3

815
Q

Osteomyelitis with prosthetic joint

A

Add rifampin

816
Q

Which FQ cover anaerobes ?

A

Moxifloxacin

*can use for GI infxns without metronidazole!

817
Q

Gi infection

A

Anerobes, PSA if high risk

Treat for 4 days

818
Q

Amphoteracins

A

Deoxycholate: regular

Liposomal ampho: safer

819
Q

Cryptococus ppx

A

No primary (like cmv)

Secondary is fluconazole

820
Q

Posaconazole vs itraconazole Cap v solution with food

A

Itra: solution empty, cap w/food

Posa: solution w/ food, cap no matter

821
Q

Anion gap

A

(Na + k) - (cl + bicarb)

822
Q

MAP equation

A

(Sbp + 2(dbp)) / 3

823
Q

How many kcal per of per day needed for EN?

A

30 kcal/kg/day

824
Q

K=

825
Q

Kcal and protein reqs

And fluid

A

Kcal= 25-30 kcal/kg/day
Protein= 1.3-1.4 g/kg/day
Fluid= 30 ml/kg/day

826
Q

Meningitis ppx

A

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
Q

Rifampin+ bictegravir/ elvitegravir

A

Interaction

828
Q

When are ABX needed for copd exacerbation

A

All three (increases sputum, purulence, and dyspnea)

OR purulence + one other

OR mech vent

829
Q

Levothyroxine po to iv

A

Decrease by 25%

830
Q

When is tdap given in pregnancy

A

Weeks 27-36

831
Q

FENA

A

(Urine na/serum na)/(urine cr/scr) x100

<1% is prerenal

832
Q

Inr to switch from warfarin to doac

A

Apixaban/dabigatran <2
Edoxaban <2.5
Rivarixaban <3

833
Q

Hasbled

A

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
Q

At which dose does fluconazole inhibit cyps

A

2c9: 100 mg
3a4: 400 mg

835
Q

Warfarin alleles

A

2c92, vkorci2- increases metabolism

2c93, vkorci3- decreases metabolism

836
Q

Hysteresis loops

A

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
Q

Pharmacodynamic equation

A

Hill equation

838
Q

Drug levels

A

Phenobarbital: 15-40
Phenytoin: 10-20 (free 1-2)
Cyclosporin: 100-250

839
Q

When to sample digoxin level

A

6-12h after dose- prolonged distribution period

*same for lithium but 12h after

840
Q

When to collect aminoglycoside sample

A

30 mins after infusion

841
Q

AC peri-cardio version

A

3 weeks before and 4 weeks after

842
Q

Warfarin TIR goal

843
Q

Warfarin adjustment

A

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
Q

Dabigatran Bud

Other counseling

A

4 months after opening bottle

Don’t open caps- decreases BA

845
Q

Converting between ACs

A

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
Q

Edoxoban dosing

A

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
Q

Main benefit of doacs over warfarin

A

All
-Less hemorrhagic stroke
-Non-inferior for stroke/VTE

Apixaban
-mortality benefit (significant)
-less major bleeding (also edoxaban)

848
Q

When is warfarin preferred to doac

A

Mech heart valve and anti phospholipid syndrome

849
Q

Can doacs be used in obesity?

A

Yes - xarelto better than Apixaban

850
Q

Can doacs be used in advance renal disease

A

Apixiban and xarelto are preferred

Most are avoid in crcl<15

851
Q

AC and antiplatelet in a pt with NVAF who had pci

A

Usually stop aspirin at discharge and continue p2y12 for 3-12 months

*takeaway is no AC + DAPT!

852
Q

AC in bio prosthetic valves

A

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
Q

Fondaparinux ppx dose

Dalteparin?

Xarelto?

A

2.5 mg QD

Dalteparin: 5000 units qd

Xarelto: 10 mg

854
Q

VTE ppx in trauma pts

A

Lovenox 30 q12 or Dalt 5000 qd

30 q12 also for spinal cord Injury and icu pts

855
Q

When is warfarin better than doac for VTE (yes warfarin is ok for VTE)

A

Renal impairment crcl<30

856
Q

Fondaparinux VTE dose

A

<50 kg: 5 QD
50-100 kg: 7.5 QD
>100kg: 10 QD

Note: ACS tx is 2.5 QD

Crcl<30 CI

857
Q

Dabigatran and edoxaban in VTE

A

Only after 5-10 days of parenteral AC

858
Q

Options for cancer related VTE

A

Lovenox (maybe Xarelto, edoxaban and maybe maybe Apixaban)

859
Q

Protamine for UFH

A

1:100 for hr 1
0.5:100 for hr 2
0.25:100 for hr 3

860
Q

How long to hold doac before surgery

861
Q

Andexxa dose

A

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
Q

What consistories high grace or timi score (MI)

A

Timi: 3+
Grace: >140

863
Q

Antiplatelet surgery hold time

A

Clop/tic: 5 days

Pras: 7 days

At least a day if emergency

*continue Asa for cabg

864
Q

Ticafrelor + Asa caveat

A

Don’t uses Asa doses >100 mg

865
Q

Gpiibiiia inhibitors- who gets them

A

Eptifibitide, tirofiban

Elevated bio markers, DM, undergoing revascularization, inadequate pretreatment with p2y12 inhibitors

Renally dosed

866
Q

AC choice when fibrinolytixs are used for stemi

A

UFH, Lovenox, fondaparinux

867
Q

Fibrinolytic CI

A

Hemorrhagic stoke, ischemic stroke in last 3 months, pregnancy, BP >180/110

868
Q

How long to continue BB after acs

A

3 yrs if no HF

Start within 24 hrs if possible

869
Q

Expected benefit from high intensity statin

A

50% decrease in ldl

If not can add non-statin

*ideally ldl<70

870
Q

Life threatening bradycardia

A

Atropine 1 mg q3-5 mins (max 3 mg)

871
Q

SVT, sinus tachycardia

A

Adenosine 6 mg

If fails: CCB or BB

872
Q

Acute afib of flutter tx

A

Non-dhp CCB, BB, dig

873
Q

Meds for cardio version

A

Ibutilide, amiodarone, propafenone (if within 7 days), dodetilide

I am professor dofus

874
Q

Amio + dig

Amio + warf

A

Decrease dig 50%

Decreases warf 30-50%

875
Q

Antiarrythmics preferred in HF

A

Amiodarone and doefetilide

876
Q

Hypertensive emergency

In stroke?

A

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
Q

NTG indications

A

Only ACS or pulmonary Edema

878
Q

Which sglt2 inhibitors used in hf

A

Dapagliflozin and empagliflozin

879
Q

Afib rhythm control agents

A

Class 1c and III

880
Q

When to start BP med

A

Stage2 or Stage 1 HTN and ASCVD or 10 yr risk >10%

2 drugs if >150/90

881
Q

When to use hypertonic saline

A

Traumatic brain injury
Symptomatic hyponatremia <120

882
Q

Why is desmopressin given in hyponatremia

A

To counteract overcorrection of hypertonic saline

883
Q

When to give calcium gluconate for hyperkalemia

A

K>6.5, extreme muscle weakness, or ecg changes

884
Q

Head of bed elevation

A

30-45 degrees

885
Q

When to use EN 2kcal/ml formulation instead of 1kcal/ml

A

Fluid restriction

886
Q

Filter for 2:1 and 3:1

A

2: 0.22 micron

3: 1.2 micron

887
Q

Hang time lipids

A

12 hours if separated from AA and carbs

888
Q

TpN kcal/g

A

Fat 10
AA 4
Carbs 3.4

889
Q

Asthma symptoms

A

Step 1: 2 or less days/wk-numbers look good
Step 2: >2d per wk- numbers looks good
Step 3: daily, numbers decreased

890
Q

When is MRSA and PSA needed in PNA

A

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
Q

Hap/ vap definition

A

Hospitalization or vent for >48hs

892
Q

Complicated uti or pyelo

A

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
Q

Meningitis tx duration

A

Niserieia and influenza: 7 days
Pneumonia: 10-14 days
Algacaae: 14-21d
Listeria : 21 days

894
Q

HIV regimen in pregnancy

A

Dual nrti + (insti OR ritonavir booster PI)

IV zidovudine near term unless RNA<50

895
Q

When to start ART in people with cryptococcus meningitis?

Crypto regimen?

A

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
Q

Candidemia

A

Fluconazole ONLY IF KNOWN SUSCEPTIBILITY (400 mg/day

Otherwise echinocandin or ampho

14 days from first neg blood cx

897
Q

Drugs for cushing’s

A

Pasireotide, osilodrostat, ketoconazole, mitotane, etomidate, metyrapone, mifepristone (hyperglycemia)

898
Q

Pregnancy DM goal

A

Fasting <95

899
Q

Insulin rules

A

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
Q

When to start Metformin plus a second agent ?

A

When A1c > 1.5% above goal

(A1c >8.5 for most people)

901
Q

Which DM agents best if HF and/ or renal dx

902
Q

Holding Metformin for constrast

A

Hold before and for 48h after

903
Q

Big adr for dpp4 and glp1-

A

Pancreatitis

904
Q

When to give bicarb in DKA

Other tx

A

Ph <6.9

Fluids- 0.45-0.9% nacl til bg<200 the change to D5W/1/2ns

Insulin gtt

K+

905
Q

Which sglt2 have renal benefits

A

Dapagliflozin, cabagliflozin

906
Q

Transplant induction v maintenance

A

Induction: basilixmab, antithymocyte globulin

Maintenance: tacro and mycophenolate first line

Azathioprine

Mtor: everolimus, sirolimus

Belatecept

907
Q

Coefficient if variation calculation

A

SD/mean X 100

908
Q

95% CI calculation

A

2x SEM in both directions

SEM= SD/ sqrt of n

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