The crap never ends Flashcards
What is prinzmetal’s angina
Vasospasm that occurs at rest
What is Regadenoson used for
pharmacologic stress test
Lexiscan
Regadenoson
Treatment of ischemic heart disease - antiplatelet
aspirin (or clopidogrel if allergic)
Treatment of ISHD - anti-anginal
Beta–blockers (first line)
CCBs
Ronalazine (can be with beta-blockers)
Nitrates
HR goal for beta-blockers in ISHD
55-60bpm
First-line treatment for prinzmetal’s angina
CCBs (NOT nifedipine IR)
Ronalazine ADEs
QT prolongation
CYP3A4 inhibitor
Does NOT lower HR/BP
Nitrates vasodilate veins or arteries more?
Veins
Nitrostat
SL tablet
NitroMist
nasal spray
GoNitro
SL powder
How long nitrate free period to prevent tachyphylaxis?
10-12 hours
How is nitroglycerin ointment measured?
With the dose measuring applicator it comes with
Where should nitrate patch be applied?
to chest
Monoket
Isosorbide mononitrate
What treatment modalities for ISHD?
A - antiplt/anticoag B - blood pressure/beta blocker C - cholesterol, cigs D - diet and DM E - exercise and education
What can be a HD?
Teratogen
Reduced fertility
organ toxicity at lower doses
What is the list of HD found?
NIOSH
Some drugs you might not have known were hazardous - 8
Ribavirin Colchicine Fluconazole Spironolactone Risperidone Rasagiline Ziprasidone Dronedarone
How far apart to separate sterile and non-sterile C-PECs?
1 meter
Required ACPH for C-SEC and buffer room?
C-SEC: 12
Buffer room: 30
Class I or Class II BSC is non-steirl HD?
Class I
When are closed system transfer devices REQUIRED?
administering antineoplastics
What are requirements for receiving HDs?
single loves and N-95 mask
What types of HD require full face respirator or faceshield and goggles?
gas/vapors/splashes
Where to store antineoplastics?
negative pressure room
PPE for administering HD?
2 gloves for antineoplastics
gown for antineoplastics
How to crush HD?
In a plastic pouch
How to dispose of HD?
Yellow bin - trace; outer gowns, shoe cover
Black bin - bulk
Sanitization order of HD
- Deactivation and decontamination (remove HDs - bleach/peroxide)
- Clean (Germicidal detergent)
- Disinfect (IPA)
How often to check for HD residue (environmental monitoring)
6 months
Heparin/LMWH antidote
protamine
Beta-blocker antidote
glucagon
CCB antidote
Calcium
Drugs that can worsen PD
Metoclopramide
Antipsychotics
Antiemetics
Major symptoms of parkinson’s
Tremor
Rigidity
Akinesia
Posture
Treatment options for PD
- Carbidopa/levodopa
- Dopamine agonists
- Amantadine/MAO-B inhibitors
Carbidopa dose
75-100mg/day
Rytary
carbidopa/levodopa capsule (can be sprinkled)
Sinemet
Carbidopa/levodopa
Mirapex
Pramipexole
Requip
ropinirazole
Neupro
Rotigotine patch
ADEs of Sinemet
nausea, dark urine, priapism, positive Coombs test, dyskinesia
CI of Sinemet
MAO-Is
what is entacopone
COMT inhibitor - increases duration of levodopa
200 mg with each dose of levodopa
ADEs of dopamine agonist
somonlence
orthostasis
hallucination
What are the dopamine agonists?
ropinirole
pramipexole
riotigotine
What is apomorphine and what ADE?
Rescue injection for parkinson’s
Causes severe N/V
How to treat N/v with apomorphine
Trimethobenzamide (Serotonin antagonists contraindicated)
Amantadine MOA
blocks DA reuptake
Amantadine ADEs
decreased BP, somnolence, psychosis
MAO-B inhibitors
selegiline, rasagiline, safinamide
MAOB inhibitors CI (3 drug classes)
with MAOIs, opioids, SNRIs
ADEs of MAO-B inhibitors
HTN, activating (selegiline), serotonin syndrome
Droxidopa use
orthostatic hypotension
What can cause osteoporosis (5)
Heparin Steroids Lithium SSRIs excess thyroid
Normal t-score
> = -1
Rickets
Vitamin D deficiency
Calcium daily dose
500-600mg
Ca citrate or Ca carbonate has better absorption with PPIs?
Calcium citrate
Vitamin D deficiency level
<30
Which bisphosphonates are monthly>
PO ibandronate, risedronate
Atelvia CI
DR risedronate - with PPIs and H2RAs
Reclast
zoledronic acid
Evista
raloxifene
Duavee
estrogen/bazedoxifene
Forteo
teriparatide
Evista is used for treatment or prevention?
Both (raloxifene)
ADEs of raloxifene
arthralgias
leg cramps
VTE/stroke
Max use of teriparatide and why
2 years - osteosarcoma risk
ADEs of teriparatide
arthralgias, increased Ca, cramps, pain, nausea, dizziness
Does teriparatide need fridge?
yep
Denosumab MOA
decreases osteoclasts
Denosumab ADEs
ONJ, AFF, increased BP N/V/D edema SOB low phosphate
Calcitonin ADE
inhibits osteoclasts
Calcitonin ades
hypercalcemia, increased malignancy risk
Do not use if HSR to salmon
estrogen increases risk of what without progestin?
endometrial cancer
estrogen ades
breast cancer
clots
dementia
Which estrogen patches are applied twice weekly?
Vivelle-Dot
Alora
Which estrogen patches are applied weekly?
Climara
Provera
medroxyprogesterone
Natural prodcuts for menopause
Black cohosh Dong quai red clover soy flaxseed primrose oil SJW
SSRIs for vasomotor symptoms?
paroxetine (Brisdelle)
CI medication for paroxetine?
NOT with tamoxifene
Meds for vasomotor symptoms
SSRIs SNRIs clonidine gabapentin pregabaline
Ospemifine use
painful intercourse (SERM)
What drugs cause hypogonadism in males
Methadone
Cimetidine
Spironolactone
Chemo
Who should get testosterone treatment?
men who are symptomatic and have confirmed low testosterone
Risk with testosterone treatmetn?
CV
Clotting
Increased HcT
increased prostate (avoid with BPH)
ADEs of testosterone
hepatotoxicity, decreased sperm, edema
Where to apply AndroGel
Upper body
When to apply AndroDerm
(patch)
nightly
Striant
testosterone buccal tablet
Depo-Testosterone
testosterone cypionate - IM injection
Risk if kids get into testosterone?
Virilization
Neurotransmitters that affect depression
serotonin NE DA EPI glutamine Acetylcholine
What’s the depression scale?
HAM-D, HDS
How long to treat with antidepressant before counting as failure?
6-8 weeks
Risk of SSRIs and pregnancy?
Pulmonary hypertension
Preferred drug in post-partum?
SSRIs
TCAs
Which improves first - physical or mood symptoms of depression?
Physical
Max dose of citalopram - and why?
40mg (20mg in elderly)
QT prolongation
ADEs of SSRIs
Dry mouth Sweating Weakness Tremor HA Bleeding Sexual dysfunction SIADH
Vilazodone MOA
SSRI and 5HT1A partial agonist
SNRI ADEs
dilatd pupiles
constipation
dry mouth
sweating
Max dose of venlafaxine and why
375mg
QT prolongation
TCA ADEs
QT prolongation (overdose)
orthostasis
anticholinergics
Tertiary TCAs
doxepin
amitriptyline
(more effect but more ADEs)
Secondary TCA
nortriptyline
MAO-Is
Isocarboxazide
Phenelizine
Tranylcypromine
contraindication with MOAIs
Tyramine foods
Drugs that increase DA, NE, EPI, 5-HT
How long to wash out other antidepressants before starting MAOIs?
2 weeks
5 for fluoxetine
Bupropion MOA
DA and NE reuptake inhibitor
Buprpion ADEs
dry mouth
insomnia
tremors
decreased weight
Benefit of bupropion
No sexual dysfunction
Mirtazapine ADEs
sedation
increased appetite/weight gain
Trazodone ADEs
sedation
priapism
Nefazodone ADEs
hepatotoxicity
What atypical antipsychotics for depression?
quetiapine
brexipiprazole
olanzapine/fluoxetine
What medications for induction of immunosuppression?
Basiliximab (simulect)
Antithymocyte globulines
ATGAM and thymoglobulin - which is horse and which is rabbit
ATGAM - horse
thymoglobulin - rabbit
Antithymocyte globulin ADE
infusion reaction - pre-medicate (benadryl, APAP, steroids)
Prednisone ADEs that I forget (3)
osteoporosis
fluid retention
acne
Antiproliferate agents
Mycophenolate Mofetil
Mycophenolic acid
Azathioprine
ADEs of mycophenolate
spontaneous abortion
GI upset
lymphoma
take on EMPTY STOMACH
azathioprine pharmacogenomics
TPMT deficiency - increased myelosuppression
Calcineurin inhbitors
tacrolimus (Prograf)
Cyclosporine (NEoral, Gengraf, Sandimmune)
ADEs if calcineurin inhibitors
QT prolongation
Neurotoxicity
Lymphoma
Increased lymphoma
Cyclosporine ADEs
Hirsutisim Gingival hyperplasia Neurotoxicity Edema Lymphoma low Mg
Which cyclosporine brands have better bioavailability?
Gengraf
Neoral
MTOR Kinase inhibitors
Everolimus
Sirolimus
Everolimus ADEs
edema
HTN
Sirolimus ADEs
increased lipids/BS
irreversible pneumonia/cough
Everolimus should not be used for __ days post-transplant
30 days
Belatacept MOA
CD80/CD86 blockade - blocks T cell production of inflammatory molecules
Belatacept can only be used if patients is ___ positive
EBV+
Risk with belatacept
post-transplant lymphproliferative disorder
Which of the tranpslant meds can cause DM
Tacrolimus
steroids
cyclosporine
Which of the transplant meds increase lipids
mTOR
steroid
cyclosporine
which of the transplant meds increase BP
cyclosporine
tacrolimus
Primary PPX for
PCP
Toxoplasma
MAC
PCP: Bactrim (<200)
Toxo: Bactrim (<100)
MAC: azithromycin weekly (<50)
Second-line primary PPX for PCP/taxo
PCP: Dapsone (pyrimethamine + leucovorin)
Toxo: Dapsone + pyrimethamine + leucovorin
How long to do MAC?
3 months on ART and CD4>100
How long on PCP/toxo PPX?
3 months with CD4 above 200
Treatment of candidiasis
- fluconazole
2. itraconazole
Treatment of cryptococcal meningitis
- ampho B + flucytosine
- Fluconazole + flucytosine
secondary ppx: fluconazole
Treatment of CMV
- valganciclovir/ganciclovir
2. cidofovir/foscarnet
Treatment of MAC
ethambutol + macrolide
Continue for secondary ppx
Treatment of PCP
- Bactrim
- Petamidine
Secondary ppx: Bactrim or dapsone
Treatment of toxoplasmosis
- pyrimethamine + leucovorine + sulfadiazine
- Bactrim
secondary ppx: same as tx
UC v Crohn’s
Which is deep?
Which is at colon/rectum?
Which is continuous?
UC - superficial CD- deep UC - colon/rectum CD - throughout GI UC - continuous Crohn's - non-continuous
Probitics useful for UC/CD?
Yup
Treatment for acute exacerbation
steroids
Which steroids available rectally?
budesonide and hydrocortisone
for UC only!
Uceris
budesonide - for UC
Entocort
budesonide - for CD
Azulfidine
sulfasalazine
Aminosalicylates for UC or CD?
UC
When to use rectal aminosalicylate?
If localized to distal UC
ADEs of sulfasalazine
HSR
Yellow/orange skin
Giazo
Balsalazide
MALES ONLY
Colazol ADE
stains teeth if chewed (think Colgate)
Thiopurine ADEs
malignancy, hematologic toxicities
Myelosuppression with TPMT
MTX dosage forms
IM or SC
MTX for UC or CD?
CD
Cyclosporine for UC or CD?
UC
Anti-TNF agents for UC or CD? Which ones?
Both
Golimuab
Infliximab
Adalimumab
Ustekinumab mechanism and use?
Anti-IL12/23
CD who haven’t tried anti-TNF
Tofacitinib mechanism and use?
JAK STAT
UC
Integrin antagonists - what drugs and what are they used for?
natalizumab - CD
Vedolizumab - CD/UC
Natalizumab ADE
PML
How long to continue integrin inhibitors/wait for response?
Natalizumab - 12 weeks
vedolizumab - 14 weeks
FMEA vs RCA?
FMEA - prospective
RCA - retrospective
Do not use abbreviations
u for unit
IU
MS/MgSO4/MSO4
Precautions with high-alert medications
Pre-mixed when possible
Store in pharmacy (not on floor)
Limit concentrations available
Contact precautions - for what bugs
MRSA and Cdif
How to reuce catheter infections
chlorhexidine and antibiotic impregnated central venous catheters
Is alcohol or soap/water better for cleaning hands?
Usually alcohol - unless CDIF
What drugs increase LDL (but not TG)
fibric acid
SGLT2 inhibitors
TZDs
Ezetimibe can decrease CV events in what patients?
with recent ACS
Who are the 4 statin benfit groups
LDL >190
Clinical ASCVD
DM 40-75 years
ASCVD risk >7.5%
What intensity of statin for DM?
> 7.5% ASCVD risk - high
otherwise moderate
What intensity of statin for ASCVD risk >7.5% w/o diabetes?
moderate
Low intensity statins
Fluvastatin 20-40 Lovastatin 20 pravastatin 10-20 pitatavastatin 1 simvastatin 10
Which statins have drug interactions?
Simvastatin
Lovastatin
Atorvastatin (not as much)
Which statins have to be taken in evening?
Simvastatin
Lovastatin
Which meds can increase myopathy with statins? (2)
Niacin
Colchicine
Cyclosporine can be used with what statin?
Rosuvastatin 5mg
Ezetimibe ADE
myalgias
Bile acid sequestrants ADEs
INCREASE TGs
Constipation/bloating/gas
Bile acid sequestrant indication
Decreases BS for DM!!
What is the DOC for hyperlipidemia in pregnancy?
colesevelam
Bile acid sequestrants can decrease absorption of ….?
ADEK everything else (separate from all drugs)
Fibrates mechanism
PPAR alpha activators
Fibrates effect on lipid profile
Decrease TG
Decrease LDL (or increase if TG are high)
Increase LDL
Fibrates ADEs
Dyspepsia, myopathy
Contraindications of fibrates
gallbladder disease
severe liver disease
Niacin other name
Vitamin D
Nian effect on lipid profile
Decrease LDL and Increase HDL
Which niacin has the least flushing?
IR
Niaspin ADEs
Flushing rhabdomyolysis hepatotoxicity Increase BS Increase Uric acid N/V/D
How to treat flushing from niacin?
aspirin
Which niacin has least hepatotoxicity?
Niaspan
Fish oil indication
TG >500
Which fish oil has no change in LDL
Vascepa
Lova increases it
PCSK9 inhibitors indications
familial hypercholesterenmia or clinical ASCVD
Praluent
alivocumab (PSCK9)
Repatha
Evolocumab (Repatha)
Mipomerson and lomitapide use
homozygous familiar hypercholestermia
Mipomerson and lomitapide have REMS - why?
liver disease
Welchol
Colesevalam
Antara
Fenofibrate
Lopid
Gemfibrozil
Where can find info about immunizations?
CDC
Pink book
Morbidity and mortality report
Which vaccines are live
Zostavax Yellow fever Tyhpoid Cholera MMR Varicella
IVIG and what issue with vaccines?
Separate from live vaccines - either 3 months before or 2 weeks after vaccine
What vaccine can cause false negative PPD?
Live
Contraindications to live vaccines?
Pregnancy
Immunosuppression
When to give TDaP in pregnancy?
weeks 27-36
Vaccines for asplenia
Hib, pneumococcal, menigococcal (encapsulated bacteria)
HIV CD4 <200 vaccine requirements
meningococcal
Hib
Hep b
Hep B is given when?
within 24 hours of birth CLD HC workers HIV DM
HPV indication (and how many based on age)
F: 9-26
M: 9-21
Give 2 doses if <15, 3 otherwise
Earliest age to give flu ?
6 months
Who needs 2 doses of flu?
anyone less than 8 who is getting the flu vaccine for the first time
What are the HD flu vaccines?
fluzone HD
FluAd
What is PICC?
Inserted into small vein and maneuvered into the vena cava
What meds are vesicants?
Vasopressors
Anthracycline
Vinka alkaloids
What is the problem with PVC containers?
Contain DEHP - leaches into solution
What meds can’t be used with PVC?
Lorazepam Amiodarone Taxanes Tacrolimus Insulin Nitroglycerin
What IV meds require NS?
Ampicillin Daptomycin Infliximab Amp/sul Caspofungin Ertapenem Phenytoin
D5W only
Bactrim
Oxalaplatin
Amphoterrible
Synercid
Ceftriaxone is incomptible with???
calcium!
What meds require a filter
Golimumab amiodarone lorazepam phenytoin lipids (1.2) ampho b taxanes GAL PLAT
What 2 meds should not be fridge?
Phenytoin
Furosemide
What meds should be protected from light during administration
Doxycycline Epoprostenol Micafungin Nitroprusside Phytanodione
What med turns blue when toxic?
Nitroprusside
What med turns pink but is not toxic?
Dobutamine
What drug turns urine blue?
mitoxantrone
What flu vaccine is egg free?
FluBlok
What age can get FluMist?
2-49
Which meds stored in freezer?
MMRV
zostavax
varicella
Rotavirus is live or nah?
Livee
Varivax and zostavax are contraindicated with??
gelatin
neomycin
Antivirals can get in the way of reaction to what vaccine?
Live vaccines - varivax and zostavax
ROA of varivax and zostavax?
subcutaneous
Typhoid oral vaccine storage
Refrigerate
Yellow fever vaccine allergies
egg, gelatin
Cholera storage
freezer
How long to keep temperature logs
3 years
Which vaccines need freezed?
MMRV
zostavax
varicella
cholera
Risk of using antidepressants in bipolar disorder?
can cause mania
acute treatment of bipolar disorder - mania
valproate
lithium + antipsychotic
acute treatment of bipolar disorder - depression
lithium
lamotrigine
preferred for BPD in depression
latuda
lamotrigine
carbamazepine for mania or depression
mania
can antipsychotics be used as monotherapy for bpd
no
lithium goal monitoring
0.6-1.2mEq/L (trough0
ADEs of lithium
GI upset cognitive effects Cogwheel rigidity Tremor Increased weight Polyuria Hypothyroidism
Toxicity of lithium
> 1.5: tremor, vomiting/D, confusion, ataxia
>2.5: arrhythmia, sz, CNS depression
How is lithium cleared?
RENAL
Lithium Drug interactions
Serotonergic
Clearance - diuretics, ACE/ARB increase levels
SALT intake matters a lot
OTC self-treatment for insomnia
Doxylamine
Diphenhydramine
What drugs help with just falling asleep
Ramelteon
Zaleplon
What drugs help with just staying asleep
Doxepin
Suvorexant
what drugs help with falling asleep and staying asleep
zolpidem
eszopiclone
Schedule of all the sleep meds (benzos, Z-drugs, orexin)
CIV
ADEs of non-benzo sleep meds
ataxia
parasomnias
zolpidem DF
Edluar (SL)
Intermezzo (SL)
Suvorexant MOA
Orexin antagonist
Which benzos preferred for sleep
Lorazepam
Temazepam
How to treat RLS??
Dopamine agonists (pramipexole, ropinirole) 1-3 hours before bed
OR
gabapentin
ADEs of dopamine agonists
orthostasis and somonlence
Narcolepsy treatment
Modafinil
Armodafinil
Sodium oxybate
Schedule of stimulants for narcolepsy
CIV
Schedule of sodium oxybate
CIII (date rape drug -REMS)
Osmolarity equation
mOsm/L = Wt (g/L)/MW x * of particles * 1000
kalories in carbs
3.4kcal/g
calories in fat (EN)
9kcal/g
calories in protein
4kcal/g
calores in PN fat emulsions
10%: 1.1kcal/mL
20%: 2kcal/mL
30%: 3kcal/ML
Max lifetime dose of Bleomycin Doxycycline vincristine cisplatin
Bleomycin: 400 units
Doxycycline: 450-550mg/m2
Vincristine: 2mg at one time
Cisplatin: 100mg/m2 per cycle
What chemo drugs don’t cause myelosuppression?
vincristine
pegasparaginase
bleomycin
which drugs cause lots of N/V
Platinums
cyclophosphamide
ifosfamide
Mucositosis drugs
5-FU MTX capecitabine irinotecan -nibs
What chemo drugs cause QT prolongation
arsenic trioxide
TKIs
What chemo drugs cause pulmonary fibrosis
busulfan
carmustine/lomustine
What chemos cause neuropathy
vinka alkaloids
taxanes
platinums
What chemos cause hemorrhagic cystitis
cyclophosphamide
ifosfamide
(prevent with Mesna)
What drugs cause nephrotoxicity
MTX
Cisplatin (prevent with amifostene)
What drugs cause thromboembolism
SERMs
aramatose inhibitors
thalidomides
Zinecard
dexrazoxane for cardioprotection
Tocect
Dexrazoxane for extravasation
Uridine triacetal - antidote fr what?
5-FU
capecitabine
Glucarparidase - antidoate for what?
MTX
Dolasetron ADE
QT prolongation (no IV administration)
Sancuso
granisetron patch
Decadron
dexamethasone
Drugs that cause hand-foot syndrome
Capecitabine
5-FU
liposomal doxorubicin
cytarabine
Hypercalcemia of malginancy treatment
calcitonin
loops/hydration
xgeva, zometa
Vesicant chemo drugs
vinka alkaloids
anthracyclines
Which vesicants should have warm compress?
vinka alkaloids
anthracyclines
(the rest use cold)
How to treat vincristine extravastation
Hyaluronidase
and warm compress
Max lifetime dose of Bleomycin Doxycycline vincristine cisplatin
Bleomycin: 400 units
Doxycycline: 450-550mg/m2
Vincristine: 2mg at one time
Cisplatin: 100mg/m2 per cycle
What chemo drugs don’t cause myelosuppression?
vincristine
pegasparaginase
bleomycin
which drugs cause lots of N/V
Platinums
cyclophosphamide
ifosfamide
Mucositosis drugs
5-FU MTX capecitabine irinotecan -nibs
What chemo drugs cause QT prolongation
arsenic trioxide
TKIs
What chemo drugs cause pulmonary fibrosis
busulfan
carmustine/lomustine
What chemos cause neuropathy
vinka alkaloids
taxanes
platinums
What chemos cause hemorrhagic cystitis
cyclophosphamide
ifosfamide
(prevent with Mesna)
What drugs cause nephrotoxicity
MTX
Cisplatin (prevent with amifostene)
What drugs cause thromboembolism
SERMs
aramatose inhibitors
thalidomides
Zinecard
dexrazoxane for cardioprotection
Tocect
Dexrazoxane for extravasation
Uridine triacetal - antidote fr what?
5-FU
capecitabine
Glucarparidase - antidoate for what?
MTX
Dolasetron ADE
QT prolongation (no IV administration)
Sancuso
granisetron patch
Decadron
dexamethasone
Drugs that cause hand-foot syndrome
Capecitabine
5-FU
liposomal doxorubicin
cytarabine
Hypercalcemia of malginancy treatment
calcitonin
loops/hydration
xgeva, zometa
Vesicant chemo drugs
vinka alkaloids
anthracyclines
Which vesicants should have warm compress?
vinka alkaloids
anthracyclines
(the rest use cold)
How to treat vincristine extravastation
Hyaluronidase
and warm compress
