THINGS I NEED TO KNOW & DONT Flashcards
corrected Ca formula
-use when albumin is < 3.5
Ca + [(4-albumin) *0.8]
Phenytoin corrected formula
-use when albumin is < 3.5
(total phenytoin measured) / (0.2 * albumin) + 0.1
What 2 formulas are used to predict drug concentration?
C2 = C1 * e^-kt
Ke= ln (c1/c2) / time
ICR & correction factor formulas for regular insulin
ICR = 450/ TDD = grams of carbs covered by 1 unit of insulin
CF: 1500/TDD = correction factor
ICR & correction factor formulas for rapid-acting insulin
ICR: 500/TDD = g of carbs covered by 1 unit of rapid acting insulin
CF: 1800/TDD = correction factor
formula for calculating insulin correction dose
BG now - target BG / correction factor
Commonly used drugs for specific organisms: MSSA
gram + clusters
-Dicloxicillin, nafcillin, oxacillin (no renal dosing needed)
-Cefazolin (IV/IM), cephalexin (po-keflex)
-Amoxicillin/clavulanate (PO/IV), ampicillin/sulbactam (NS only)
Commonly used drugs for specific organisms: MRSA
gram + clusters
-Vancomycin: 1st line if MIC < 2, (ototoxicity, hepatotoxicity)
-Linezolid: no renal dose (myelosuppression, serotonin syndrome, optic neuropathy)
-Daptomycin: NO DEXTROSE, (myopathy, rhabdomyolysis- CPK weekly)
-SMX/TMP (Bactrim): CA-MRSA SSTI (sulfa allergy, SJS/TENS, TTP, hemolytic anemia)
-Doxycycline, minocycline
-Clindamycin: no renal dose, D-test on S. aureus
(others: ceftoroline, tigacycline, mupirocoin, delfoxacin)
Commonly used drugs for specific organisms: Vancomycin-resistant Enterococcus (VRE)
gram + pairs & chains
-Pen G (IM ONLY) & ampicilin –> E. faecalis only
-Linezolid: no renal dose (myelosuppression, serotonin syndrome, optic neuropathy)
-Daptomycin: NO DEXTROSE, (myopathy, rhabdomyolysis- CPK weekly)
–> Cystitis only: Nitorfuranton (renal imapir crcl < 60, hemolytic anemia), fosomycin, doxycycline
Commonly used drugs for specific organisms: Atypical organisms
chlamydia, legionella, myoplasma pneumoniae, myobacterium tuberculosis
-azithromycin, clarithromycin (QT, hepatotoxicity)
-doxycycline, minocycline
-Quinolones [levo, cipro, moxifloxacin] (tendon rupture, QT, psych disturbances, hypo/hyperglycemia, photosensitivity)
Commonly used drugs for specific organisms: HNPEK
gram -s: H. influenzae, Neisseria, Proteus micobilis, E.coli, Klepsiella
-beta lactams/betalactamase (penicillins)
-Cephalosporins: cefuroxine, ceftotetan, cefoxitin, cefdinir, ceftriaxone, cefotuxine, ceftazidine, cefepime, ceftaroline)
-Carbapenems (meropenem, enteropenem)
-aminoglycosides (genta, tobra, amikacin) –> nephrotoxicty
-Quinolones [levo, cipro, moxifloxacin] (tendon rupture, QT, psych disturbances, hypo/hyperglycemia, photosensitivity)
-SMX/TMP (Bactrim): CA-MRSA SSTI (sulfa allergy, SJS/TENS, TTP, hemolytic anemia)
Commonly used drugs for specific organisms: Psuedomonas aerginosa
gram - rod
-pip/tazo (zyson)
-cefepime (4th gen)
-ceftazidime (3rd gen)
-ceftolozane/tazobactam
-ceftazidine/avibactam
-meropenem
-azteronam
-tobramycin
-colistimethate, polymixin B
Commonly used drugs for specific organisms: CAPES
**gram -s: Citrobacter, Acinobacter, Providencia, Enterobacter, Serratia)
-pip/tazo (zyosn)
-cefepime
-carbepenems
-aminoglycosides (genta. tpbra, amikacin)
-colistimethate, polymixin B
Commonly used drugs for specific organisms: ESBL
gram - rods: E.coli, k. pneumoniae, P. mirabilis)
-carbepenems
-ceftazidime/avibactam
-ceftrolozane/tazobactam
Commonly used drugs for specific organisms: Carbepenem resistant gram - rods (CRE)
-ceftazidime/avibactam
-colistimethate, polymixin B
-meropenem/vaboractam
-imiperem/cilastitin/relebactam
Commonly used drugs for specific organisms: Gram - anaerobes (B. fagiilis)
-metronidazole. (disulfiram rxn with alcohol)
-beta lactams
-ceftetan (disulfiram rxn), cefoxitin
-carbapenems
-moxiflixacin
Commonly used drugs for specific organisms: C. difficile
-Vancomycin (PO)
-Fidaxomicin
-metronidazole (disulfiram rxn with alcohol)
Preferred HIV initial tx for t naive pts: 1 pill daily: Biktarvy
-Bictegravir - INSTI
-Emtricitabine -NRTI
-Tenofovir alfenamide (TAF) - NRTI
Preferred HIV initial tx for t naive pts: 1 pill daily: Triumeq
-Dolutegravir - INSTI
-Abacavir - NRTI- TEST for HLAB5701
-Lamivudine- NRTI
Preferred HIV initial tx for t naive pts: 1 pill daily: Dovato
-Dolutegravir - INSTI
-Lamivudine - NRTI
**do NOT use if:
- HIV RNA > 500,000
-HBV co infection or unknown
-HIV genotype unknown
Preferred HIV initial tx for t naive pts: 2 pills daily: Tivicay + Truvada
-Dolutegravir - INSTI
-Emtribitabine (NRTI)/tenofovir DF (NRTI)
Preferred HIV initial tx for t naive pts: 2 pills daily: Tivicay + Descovy
-Dolutegravir - INSTI
-Emtricitabine (NRTI)/tenofovir AF (NRTI)
ART in pregnancy
-may contin current ART regimen in most cases
-NEW START: Dolutegravir/boosted darunavir PLUS dual NRTI (emtricitabine/tenofovir)
–> perinatal transmission ppx:
-maternal admin of IV zidovudine pre delivery
-neonatal ART if needed
HIV: Stribild products
-Elvitegravir
-Cobicistat (tybost)
-Emtricitabine (Emtriva)
-Tenofovir DF (vibread)
***cannot use of crcl < 50
HIV: Genvoya products
-Elvitegravir
-Cobicistat (tybost)
-Emtricitabine (Emtriva)
-Tenofovir AF
HIV Cabanuva products
-Cabotegravir
-Rilpivirine
HIV: Complera products
-Rilpivirine
-Emtricitabine
-Tenofovir DF
HIV: Odefsey products
-Rilpivirine
-Emtricitabine
-Tenofovir AF
HIV: Descovy Products
-Emtricitabine
-TAF
HIV: Truvada Products
-Emtricitabine
-TDF
PrEP for HIV
Indications: mult sex partners, men f men & IV drug use
*must be HIV neg before starting
–> Truvada (Emtricitabinr/TDF)
–> Descovy (Emtricitabinir/TAF)
–> IM cabotegravir (Apretude) monthly q 2 mon, then 1 2 months
-screen for HIV q 3 month, only give 90 ds at a time
PEP treatment
EXPOSURE to body fluids, unprotected sex, IV drug use, needle stick
-get baseline HIV, Scr and HBV tests
**start rx ASAP (within 72 hrs) x 28 days
–> Truvada (emitribicibine/TDF) if crcl > 60 + dolutegravir OR raltegravir
Common CYP INhibitors
Inhibitors = INCREASE
Grapefruit
PIs (ritanovir)
Azole antifungals
Cyclosporine, colbicstat
Macrolides (eryhtromycin/clarithomycin)
Amiodorine
Non-DHP CCBs (verapamil. diltiazam)
Common CYP INDucers
inDucers= DECREASE
Phenytoin
Smoking
Phenobarbital
Oxacarbazepine
Rifampin
Carbamazepine
St. johns wort
What drugs can cause an immune mediated hemolytic anemia and need a coombs test?
-penicillins
-cephalorins
-isoniazid
-levodopa
-methyldopa
-quinidine
-quinine
-rifampin
-sulfonamides
-rasburicase
Self injectable meds that need to be in the fridge and how long are they able to be outside
-Glatiramer (Copaxone): up to 30d
-Stanercept (Enbrel) up to 14 d
-Adalimumab (Humira) up to 14d
-Certolizuman (Cimzio): up to 7d
-Golimumab (Simponi): up to 30 d
-Teriparatide (Forteo) minimize
-Abaloparatide (Tymlos): up to 30 d
Patches that are worn daily
-Methylphenidate (Daytrana) @ am 2 hrs before school, flush
-Nicotine (NicoDerm)
-Rivastigmine (Exelon) - parkin
-Rotigotine (Neupro) -parkin *MRI
-Selegiline (Emsam) - parkin & depress
-Testosterone (Androderm) *MRI
-Lidocaine (Lidoderm) 1-3 patches, on for 12, off for 12
-Nitroglycerin: on for 12-14 off for 10-12
Patches that are changed q 72 hrs
-Fentanyl (duragestic) - can cover, flush
-Scopolamine (Transderm scop) behind the ear *MRI
Patches that are changed twice weekly
-Estradiol (Vivelle-Dot): lower abd, butt
-Oxybutynin (Oxytrol)
Patches that are changed weekly
-Donepezil (Adlarity) - alz
-Buprenorphine (Butrans) - can cover, flush
-Clonidine (Catapress-TT) *MRI, own patch cover
-Estradiol (Climara)
-Xulane, Twirla (3 week on, 1 week off)
Drugs with Leaching/adsoprtion/issues with PVC containers
Leaches Absorbs To Take In Nutrients
Lorazepam (ativan)
Amiodaraone
Taxines
Tacrolimus
Insulin
Nitroglycerin
Drugs that are only compatible with SALINE
“A DIAbetic Cant Eat Pie”
Ampicillin
Daptomycin (Cubicin)
Infliximab (Remicade)
Ampicillin/sulbacta, (unasyn)
Caspofungin (cancidas)
Ertapenem (Invanz)
Phenytoin (Dilantin)
Drugs that are only compatible in DEXTROSE
“Old Bakers Avoid Salt”
Oxaloplatin
Bactrim (SMX/TMP)
Amphotericin B
Synercid (quinupristine/Dalfopristin)
Common drugs that need a filter when given IV
“my GAL Is PAT who has a MaP”
Golimumab (simponi)
Amphotericin B (lipid formulation)
Lipids (1.2)
ISavuconazonium
Phenytoin (continuous infusion)
Amiodarone
Taxanes (cqbazitaxel, paclitaxel)
Manatol > 20%
Parenteral nutrients (1.2)
DO NOT REFRIGERATE drugs
“Dear Sweet Pharmacist, Freezing Makes Me Edgy!”
Dexmedetomidine (precedex)
SMX/TMP
Phenytoin- crystalizes
Furosemide - crystalizes
Moxifloxican
Metronidazole
Enoxaparin
Protect from sunlight during admin
“Protect Every New Man from Dick”
Phytonasione (vit K)
Epoprostenol
Nitroprusside
Micafungin (Mycamine)
Doxycycline (monodox. Oracea)
What are the Odefsey components?
-emtricitabine
- rilpivirine,
-tenofovir alafenamide
Key drugs that are associated with photosensitivity
-amiodarone
-diuretics (thiazide & loops)
-methotrexate
-oral and topical retinoids
-Quinolones
-St. John’s Wort
-sulfa drugs
-tacrolimus
-tetracycline
-voriconazole
Key drugs associated with severe cutaneous AEs (SJS/TENS)
-allopurinol
-amoxicillin
-ampicillin
-carbamazepine
-ethosuximide
-lamotrigine
-nevirapine
-phenytoin
-sulfamethoxazole
-sulfasalazine
-vancomycin
Invanz
Ertapenem (also a beta lactam)
Testing: Abacavir (Ziagen) in combo drugs like Triumeq & Epzicom
-HLA-B*5701
–> if +, do not use
*test ALL pts prior to use
Testing: Allopurinol (Zyloprim, aloprim)
-HLA-B*5801
–> if +, do not use, inc risk of SJS
Testing: Carbamazepine (Tegretol), Oxcarbazepine (Trileptral), Phenytoin (Dilantin), Fosphenytoin (Cerebyx)
-HLA-B*1502
–> if positive do not use
-must test all Asians for carbamazepine
Testing: Clopidogrel (Plavix)
-CYP2C9
-if poor metabolizer, consider alt therapy
Testing: Codeine
-Cyp2D6
-if ultra-rapid metabolizer, do NOT use = dead babies (whites mainly)
Testing: Warfarin (Coumadin, Jantoven)
-CYP2C9*2 and *3, VKORC1
-risk of inc bleeding, consider lower doses
Testing: Trastuzumab (Herceptin)
-HER2
-if gene NOT present, drug will not be effective
Testing: Cetuximab (Erbitux)
-KRAS mutation
-if + for mutation, do NOT use
Testing: Capecitabine (Xeloda), Fluorouracil
-DPD deficiency
-f deficient, do NOT use
supplements that can cause liver toxicity (hepatoxicity)
-black cohosh
-kava
-chaparral, cornfry
-green tea extract
supplements that increase bleeding risk
- 5G’s: garlic, ginger, ginko, ginseng & glucosamine
-fish oil
-vitamin E
-dong quai
-willow bark (salicylate)
Supplements that increase cardiac toxicity
-Ephiedra
-bitter orange
-DMAA
-yohimbe
(vitamin E - excessive intake can lead to CVD)
Unfractionated heparin dosing
-via antithrombin
-ppx of VTE: 5,000 u SC q 8-12H
-tx of VTE: 80 units/kg IV, 18 u/kg/hr infusion
-tx of ACS/STEMI: 60 u/kg bolus, 12 u/kg/hr infusion
MONITOR: APTT, anti-Xa levels
ANTIDOTE: protamine (1 mg reverses 100 units)
Enoxaparin (Lovanox) dosing
-via anthithrombin
-ppx of VTE: 30 mg SC q12 or 40 mg sc qd
-tx of VTE,UA,NSTEMI: 1 mg/kg sc q 12h. 1.5mg/kg sc q 12h
-tx of STEMI: 30 mg IV bolus, 1 mg/kg SC q12
MONITOR: anti-xa (do it in pregnancy)
ANTIDOTE: protamine
Apixaban (Eliquis) dosing
-factor xa direct inhibitor
-stroke ppx: 5 mg po BID
-tx of DVT/PE: 10 mg PO BID x 7 then 5 mg PO BID
DEC DOSE IF pt has at least 2; age > 80, wt </ 60 kg, Scr >/ 1.5
ANTIDOTE: andexant alpha (Andexxa)
Rivaroxiban (Xarelto) dosing
-factor xa direct inhibitor
-stroke ppx: 20 mg po qd w/ evening meal
-tx of DVT/PE: 15 mg BID x 21d, 20 mg qd w/ evening meal
ANTIDOTE: andexant alpha (Andexxa)
Dabigatran (Pradaxa) PO, Argatraban, Bivalirubicin (Angiomax) IVs
-direct thrombin inhibitors
Pradaxa SEs- dyspepsia, gastrisis like symptoms, bleeding (keep in original cont, discard after 4 mon)
ANTIDOTE: Idarucizumab (Praxbind)
(IV argatraban and bivalirubicin have no antidote and used for pts with hx of HITT)
Warfarin tablet colors
Please Let Greg Bring Big Peaches To Your Wife
Pink: 1 mg
Lavender: 2mg
Green: 2.5 mg
Brown/tan: 3 mg
Blue: 4 mg
Peach: 5 mg
Teal: 6 mg
Yellow: 7.5 mg
White: 10 mg
*test for CYP2C9 *2 & *3, VKORCI gene = inc bleeding
ANTIDOTE: vitamin K (phytonadione), kcentra, novoseven RT
Drug interactions with Warfarin
-INR DEC with: carbamazepine, phenobarbital, phenytoin, rifampin, SJW = risk of clots
-INR INC with: amiodarone, azoles, metronidazole & bactrim = risk of bleeding
Zestoretic
lisinopril/HCTZ
Hyzaar
losartan/HCTZ
Benicar HCT
olmesartan/HCTZ
Diovan HCT
valsartan/HCTZ
Lotrel
benazepril/amlodipine
Exforge
valsartan/amlodipine
Tenoretic
Atenolol/chlorthalidone
Ziac
Bisoprolol/HCTZ
Maxzide/Maxzide-25/Dyazide
Triamterene/HCTZ
Chemo man: neurotoxicity
-carmustine
-lomustine
Chemo man: ototoxicity
-cisplatin
–> limit dose to < 100mg / cycle
–> give amifostine
Chemo man: pulmonary toxicity
-bleomycin (limit dose to 400 mg/life)
-busulfan
-carmustine
chemo man: cardiotoxicity
-doxorubicin
–> limit dose to 450-550/lifetime
–> give dexrazoxane
chemo man: GI tox
-capeciitabine
-fluorouracil
-Irinotecan (DIARRHEA, atropine and loperamide)
-methotreaxte (leucovorin)
chemo man: nephrotoxicity
-cisplatin (give amifostine)
-methotrexate (leucovorin)
chemo man: BMS
all BUT bleomycin, vincristine, asparaginase
chemo man: hemorrhagic cystitis
-cyclophosphamide
-Ifosamide (give mesna)
chemo man: peripheral neuropathy
-vincristine (limit dose to 2 mg)
-cisplatin, oxaplatin (limit cold exposure)
-paclitaxel
LGI: Paliperadone
-Invega Hafyera: 6 mon
-Invega Trinza: 3 mon
-Invega sustenna: 1 mon
LGI: Aripiprazole
-apripiprazole lauroxin (Aristada): 4 weeks
-abilify mantena: 4 weeks
LGI: Haloperidol
Haldol decanonate: 4 weeks
LGI: olanzapine
zyprexa relprevv: 2-4 weeks
LGI: risperidone
risperrdol consta: 2 weeks
LGI: fluphenazine
-fluphenazine deconate: 2 weeks
