Test 1 Flashcards
What is the recommendation for the agent (Alendronate+D) used to treat osteoporosis?
Alendronate (Fosamax) is taken weekly.
Calcium is taken twice daily.
Risedronate (Actonel) is now available as a 75 mg tablet for monthly dosing, but patients have to take it on 2 consecutive days each month instead of 1 day a month, like ibandronate (Boniva).
Reclast (Zoledronic acid) is the first once-a-year bisphosphonate for treating postmenopausal osteoporosis. It can be given as a 15-minute infusion in a doctor’s office.
Formula that can be used to change the strength or quantity in Dilution and Concentration calculations
Q1XC1= Q2xC2
Q1 = old quantity C1 = old concentration Q2 = new quantity C2 = new concentration
Cardizem LA (diltiazem) increases the serum concentration of Zocor (simvastatin). Why?
Simvastatin (Zocor) and diltiazem (Cardizem) are substrates of 3A4; diltiazem is also an inhibitor of 3A4.
Patients should not exceed Zocor 10 mg daily if taking it with Cardizem LA.
PS PORCS {BIG INDUCERS)
Phenytoin Smoking Phenobarbital Oxcarbazepine Rifampin (and rifabutin, rifapentine) Carbamazepine (and is an auto-inducer) St. John's Wort
G PACMAN (BIG INHIBITORS)
Grapefruit
PIs Protease inhibitors (dont miss ritonavir) but check all Pls since many are potent inhibitors
Azole antifungals, the agents that are used oral and IV fluconazole, itraconazole, ketoconazole, posacoriazole, and voriconazole
C - cyclosporine and cimetidine, the H2RA that is the most difficult to use due to DIs and androgen-blocking effects (that can cause gynecomastia - swollen, or painful breast tissue or impotence)
Macrolides (clarithromycin and erythromycin), not azithromiycin, but DO include the related compound telithromycin
Amiodarone (and dronedarone)
Non-DHP CCBs diltiazem and verapamil
Important counseling point for Januvia (sitagliptin)
- Januvia (sitagliptin) may be taken without regard to meals at any time of the day as long as the time is generally consistent. It does not need to be taken with the first meal of the day.
- It should be stored in a cool dry place away from pets or small children.
- Blood sugars should also be monitored with the HbA1c rechecked in 3 months.
- There are no interactions with the other medications (Lipitor and Qsymia). Therefore, they do not need to be separated by 1 hour
What would be the effect of esomeprazole therapy in a CYP2C19 poor metabolizer when compared to an extensive metabolizer?
Even though there is a significant difference in systemic drug exposure between PM and EM of CYP2C19, both esomeprazole and omeprazole are well tolerated by the PM as the active enantiomer has a wide therapeutic index. The conversion of R- to S-enantiomer is mediated by CYP2C19, which exhibits genetic polymorphism. Therefore, the use of the pure isomer could in theory produce the same pharmacological effect in both PM and EM. The incidence of drug interaction is usually much higher in EM
What drug is the most appropriate for pulseless ventricular fibrillation resuscitation?
1 Digoxin 1mg IV
2 Atropine 1mg IV
3 Epinephrine 1mg IV
4 Amiodarone 300mg IV
- Digoxin is ineffective for terminating ventricular fibrillation and takes hours to exert its vagal effects.
- Atropine was considered as an alternative for non-shockable rhythms such as aystole or PEA but is no longer supported as later findings suggest vagal activity during PEA/asystole makes ROSC unlikely.
- Epinephrine has been considered the first choice agent for pulseless VT/VF and most benefits likely during the first two doses. When multiple doses of epinephrine are administered in attempts to restore spontaneous circulation, epinephrine may contribute to acidosis or be cardiotoxic, making return to spontaneous circulation more unlikely.
- Alternatively, vasopressin may be used once after the first two shocks are provided.
- Amiodarone would be selected following the administration of vasopression or epinephrine.
Should metoprolol be switched to sotalol to prevent Premature ventricular contractions (PVCs)?
Sotalol is reserved as a maintenance drug when electrolytes are repleted and the QRS is known to be regular and normal. SWORD discovered increased mortality when sotalol was used for treating PVCs teaching us that suppression of PVCs with antiarrhythmic drugs is associated with worse outcomes. Beta-blockers (without class III K+ channel blocking properties) are ideally suited for rate control without increasing mortality.
Galantamine (Razadyne) is indicated for?
mild to moderate Alzheimer’s disease
Niaspan side effect
Niaspan is a controlled release niacin compound that is used to treat high cholesterol. One of this drug’s most common and well-documented side effects is flushing. The flushing can also include itching, headache, and a heating sensation.
Which of the following Federal laws is related to approval of generic drugs?
Waxman-Hatch Act (1984)
Patient education for Fenofibrate (Tricor)
- follow up with regular blood work to check renal function.
- renal function should be assessed at baseline, within 3 months, then every 6 months thereafter.
- caution about the risk of allergic reaction to the medication (rash, swelling, hives) and advised to seek medical attention immediately if it happens.
Lorazepam (Ativan) side effects
Sedation, dizziness, weakness, and unsteadiness are the most frequent side effects of Ativan (Lorazepam). Memory impairment, confusion, depression, disinhibition, euphoria, suicidal ideation/attempt, ataxia, extrapyramidal symptoms, convulsions/seizures, vertigo, eye-function/visual disturbance, dysarthria/slurred speech, respiratory depression, jaundice, hypersensitivity reactions, alopecia, SIADH, and pancytopenia are some other recognized side effects of Ativan.
Patient education for Ezetimibe (Zetia)
Common side effects associated with Zetia include diarrhea and arthralgia and elevated liver function tests, especially if used in combination with a statin. Zetia has a drug interaction with cholestyramine, leading to a reduction in Zetia absorption. Patients on concomitant therapy should be counseled to administer Zetia at least 2 hours before or 4 hours after cholestyramine.
