Top drugs (detailed)

Question 1

Ziagen

Answer 1

Abacavir
Class: Nucleoside/Nucleotide Reverse Transcriptase Inhibitor (NRTI)
Use: HIV
MOA: inhibits reverse transcriptase at stage 3 of the HIV life cycle
Warning:
- lactic acidosis
- hepatomegaly w/ steatosis
- inc risk of MI in CKD
ADE:
- nausea, diarrhea, HA, inc LFTs
Notes:
- screen for HLA-B*5701 before starting (inc risk of HSR)

Question 2

Epzicom

Answer 2

Abacavir / Lamivudine
Class: NRTI
MOA: inhibits reverse transcriptase at stage 3 of HIV life cycle
Use: HIV
Warning:
- Lactic acidosis
- Hepatomegaly w/ steatosis
- inc MI risk in CKD
ADE: nauesa, diarrhea, HA, inc LFTs
Notes:
- available in once & twice daily formulations
- screen for HLA-B*5701 prior to starting (inc risk of HSA)

Question 3

Tylenol

Answer 3

Acetaminophen
Use: pain/fever
Notes:

Question 4

Tylenol with Codeine #3 & #4

Answer 4

Acetaminophen / Codeine
Use: pain
Notes:

Question 5

Zovirax

Answer 5

Acyclovir
Use: Herpes (simplex/zoster), Varicella, Cytomegalovirus
Caution in:
- renal impairment
- elderly patients
- co-ad with other nephrotoxic drugs
Notes: oral, buccal, inj, topical
- IBW for dosing (including obese patients)

Question 6

Differin

Answer 6

Adapalene
Class: topical retinoid
Use: Acne, Rosacea
Admin: pea-sized amount nightly, 20 min after washing face
- if irritation occurs -> lower strength or every other night app
ADE:
- photosensitivity
Notes:
- avoid in pregnancy
- may worsen acne initially
- 4-12 weeks to effect

Question 7

ProAir, Proventil, Ventolin

Answer 7

Albuterol
Class: SABA
Use: Asthma/COPD
Formulations: MDI & DPI
Admin: 1-2 inh Q4-6H PRN
ADE:
- nervousness
- tremor
- tachycardia
- palpitations
- cough
- hyperglycemia
- dec potassium levels
Notes:
- MDI (HFA products): shake well
- most contain 200 inh/canister (except Ventolin -> 200 & 60 inh/canister products)

Question 8

Combivent Respimat

Answer 8

Generic: Albuterol / Ipratropium
SABA/SAMA
Use: Asthma / COPD
Warnings: caution in pts w/
- narrow angle glaucoma
- myasthenia gravis
- urinary retention or BPH
ADE: dry mouth, URIs, bitter taste
Notes: MDI (shake prior to use)

Question 9

Fosamax

Answer 9

Generic: Alendronate
Use: Osteoporosis (prevention & treatment)
CI:
- hypocalcemia
- inability to sit upright for 30 min
- CrCl < 35
ADE:
- ONJ
- Femur fractures
- dyspepsia, N/V
- hypocalcemia
Notes: take at least 30 min before breakfast with 6-8oz of water, then remain upright for 30 min
Separate from Ca, antacids, Mg, & Fe by at least 2 hours

Question 10

Zyloprim (PO), Aloprim (inj)

Answer 10

Generic: Allopurinol
Class: Xanthine Oxidase Inhibitor -> decreases uric acid production
Use: Gout
CI: HLA-B*5801 positive (SJS/TENS risk)
Warning: Hepatotoxicity
ADE: rash, acute gout attacks, nausea
Notes: due to high rate of gout attacks at beginning of treatment, take with colchicine or NSAID for first 3-6 months

Question 11

Xanax

Answer 11

Generic: Alprazolam
Class: Benzodiazepine
Use: Anxiety
BW:
- use w/ opioids inc sedation, resp depression, & death
- addiction risk
- taper slowly to avoid withdrawal sx
CI: severe liver disease
Warnings: avoid in pregnancy (birth defects & neonatal withdrawal syndrome)
ADE: drowsiness, dizziness
Notes:
- C4
- antidote -> flumazenil

Question 12

Entereg

Answer 12

Generic: Alvimopan
Class: Peripherally acting Mu opioid receptor antagonist (PAMORA)
Use: decrease risk of post-op ileus
BW: MI risk with long term use
CI: therapeutic doses of opioids for > 7 consecutive days immediately prior to use
Notes: maximum 15 doses

Question 13

Pacerone (oral), Nexterone (injection)

Answer 13

Generic: Amiodarone
Use: rate/rhythm control
BW:
- Pulmonary toxicity (baseline CXR & PFTs)
- Hepatotoxicity
- Proarrhythmic; must be hospitalized for IV loading dose
CI: iodine hypersensitivity, heart block (unless using artificial pacemaker)
Warnings: hypothyroidism, visual impairment, photosensitivity (slate-blue skin discoloration), peripheral neuropathy, SJS/TEN
ADE: Hypotension, bradycardia, corneal microdeposits, photosensitivity
Notes:
- drug of choice in heart failure
- avoid in pregnancy/BF if possible
- Infusions > 2hrs use Non-PVC containers (tubing is ok)
- use 0.22 micron filter
- incompatible with heparin (saline flush)
- many y-site incompatibilities

Question 14

Elavil, Vanatrip

Answer 14

Generic: Amitriptyline
Class: TCA
Use: Depression, Migraine pain
CI:
- use with MAOi’s, linezolid, IV methylene blue
- MI
ADE: QT prolongation w/ overdose, orthostasis, tachycardia, anticholinergic ADEs, weight gain, sedation
Notes: Beer’s list

Question 15

Norvasc

Answer 15

Generic: Amlodipine
Class: DHP CCB
Use: HTN
Warning: Hypotension, caution in heart failure
ADE:
- peripheral edema/HA/flushing/palpitations
- gingival hyperplasia
Notes: safest DHP CCB in HFrEF

Question 16

Lotrel

Answer 16

Generic: Amlodipine / Benazepril
Use: HTN
Notes: see amlodipine & benazepril details

Question 17

Amoxil

Answer 17

Generic: Amoxicillin
Class: aminopenicillin
Coverage: Gram + & some Gram - (H. influenzae, Salmonella, Shigella)
CI: ER formulations if CrCl < 30
ADE: seizure (with accumulation), GI upset, rash, hemolytic anemia

Question 18

Prevpac

Answer 18

Generic: Amoxicillin / Clarithromycin / Lansoprazole
Use: H. Pylori infection
See notes on individual meds

Question 19

Augmentin

Answer 19

Generic: Amoxicillin / Clavulanate
Use: antibiotic
Coverage: Gram + (MSSA, Strep), Gram - (E coli, Proteus, Klebsiella)
ADE: seizure (w/ accumulation), GI upset, diarrhea, rash, hemolytic anemia
Notes: do not use ER formulations if CrCl < 30

Question 20

Adderall, Mydayis

Answer 20

Generic: Amphetamine / Dextroamphetamine
Use: ADHD, narcolepsy
Boxed warnings:
- misuse can cause sudden death and serious CV events
Notes: do not take w/ acidic foods or juices (dec absorption)

Question 21

Principen

Answer 21

Generic: Ampicillin
Use: Antibiotic
Coverage:
-Gram + : strep
- Gram - : E Coli, Proteus, N meningitidis
ADE: seizure (w/ accumulation, GI upset, diarrhea, rash, hemolytic anemia
Notes
- PO poor bioavailability
- IV diluted in NS only

Question 22

Arimidex

Answer 22

Generic: Anastrazole
Use: Breast Cancer
CI: pregnancy
ADE: Hot flashes/night sweats, arthralgia/myalgia, dec BMD, CVD risk

Question 23

Eliquis

Answer 23

Generic: Apixaban
Use: Anticoagulant
BW: risk of hematoma/paralysis in pts undergoing a spinal puncture
CI: active bleed
Warning: not recommended with prosthetic heart valves
ADE: bleeding
Antidote: andexanet alpha (Andexxa)

Question 24

Eliquis dosing:
1.) Nonvalvular AF (stroke prophylaxis)
2.) DVT/PE treatment
3.) DVT prophylaxis

Answer 24

1.) 5mg PO BID -OR- 2.5mg BID if 2 of the following…
- 80 years or older
- weight < 60 kg
- SCr >/= 1.5 mg/dL

2.) 10mg PO BID x 7 days -> 5 mg PO BID

3.) 2.5mg PO BID starting 12-24 hrs after surgery x 12 days (knee) or 35 days (hip)

Question 25

Emend

Answer 25

Generic: Aprepitant
Use: Antiemetic
Class: NK1-RA
ADE: Dizziness, fatigue, constipation, weakness, hiccups
Notes: CYP3A4 inhibitor, may need to decrease dexamethasone dose

Question 26

Abilify

Answer 26

Generic: Aripiprazole
Use: Second gen antipsychotic
ADE: akathisia, activating
Notes:
- lower risk of weight gain
- some QT prolongation
- EPS (in children)

Abilify Maintena- IM monthly
Aristada- IM Q4-8 weeks

Question 27

Reyataz

Answer 27

Generic: Atazanavir
Use: HIV
Class: Protease inhibitor
Notes:
- recommended to take with a booster (ritonavir or cobicistat)
- no renal dose adj
- take with food
- needs acidic stomach for absorption (separate from antacids)

Question 28

Tenormin

Answer 28

Generic: Atenolol
Use: HTN, rate control, MI
Class: Beta 1 selective beta blocker
BW: do not DC abruptly, taper
CI: severe bradycardia, AV block
Warnings:
- can worsen hyper or hypoglycemia & mask hypoglycemic symptoms
- caution in COPD/asthma, but preferred over non-selective BB
ADE: bradycardia, fatigue, hypotension, dizziness, depression, dizziness