week 1 & 2

Question 1

Amiodarone (Pacerone) Common ADRs

Answer 1

Pulmonary and Liver Toxicity
Hyperthyroidism
Hypothyroidism
Optic Neuropathy
Bradycardia
Heart Block

Question 2

Amiodarone (Pacerone) Serious ADRs

Answer 2

Contraindicated in pts with Cardiogenic shock, Sinus Node dysfunction, marked sinus bradycardia, AV block, Syncope, Iodone Hypersensitvity

Question 3

Levothyroxine (synthroid) Counseling Points

Answer 3

Start at low doses (especially in elderly and CAD)
morning or evening doses
empty stomach (30min before food)
Avoid antacids w/in 4 hours

Question 4

Colchicine (Colcrys) Drug Interactions

Answer 4

Azole Antifungals
Protease Inhibitors
Statins
Diltiazem

Question 5

Amiodarone (Pacerone) Counseling

Answer 5

Digoxin dose needs to be reduced by 50% in combo
Can be safely used in patients in HFrEF
Potent 1A2, 2C9, 2D6 and 3A4 and PGP inhibitor
Can take months to reach full therapeutic effect

Question 6

Colchicine (Colcrys) Counseling

Answer 6

initiate therapy at 0.3mg daily in patients w/ CrCl <30ml/min
Warn nausea/vomiting
Look out for Strong PGP or CYP 3A4 inhibitors
monitor renal function and diarrhea

Question 7

Diltiazem ADRs

Answer 7

flushing
headache
dizziness
constipation

Question 8

Diltiazem (Cardizem, Dilacor, Tiazac) Counseling

Answer 8

Monitor for signs of hypotension (dizziness fall risks) or slowed heart rate
Don’t take w/ Grapefruit

Question 9

Paroxetine (Paxil) ADRs

Answer 9

Sexual Dysfunction, Nausea, Insomnia, HA

Suicidal ideation, Serotonin Syndrome, Hyponatremia

Question 10

Paroxetine (Paxil) Counseling

Answer 10

Highest risk of withdrawal (short T 1/2)
Take at bedtime (drowsiness)
Avoid Abrupt Discontinuation
6-8 weeks for full effect

Question 11

Sumatriptan (Imitrex) ADRs

Answer 11

common: Bad taste, nausea/vomiting, jaw/neck tightness, peripheral tingling

Serious: Cerebral Hemorrhage, serotonin syndrome, Raynauds, GI ischemia

Question 12

Sumatriptan (imitrex) Counseling

Answer 12

Don’t use in pts w/ history of CVD
Max dose = 200mg
Inc risk of Serotonin Syndrome w/ SSRIs and SNRIs
Don’t use ergotamine derivatives w/in 24hrs (CId)

Question 13

Ketoconazole (Nizoral) ADRs

Answer 13

common = rash, nausea, vomiting diarrhea

Serious = Hepatotoxicity, prolonged QT, Torsades, Dysrhythmia, rare gynecomastia

Question 14

Ketoconazole (Nizoral) Counseling

Answer 14

Systemic: watch the fuck out, not used for first line fungals due to risk of Hepatotoxicity and adrenal insuffcieicny and man boobs

topical: probably be fine

Question 15

Rivaroxaban (Xarelto) ADRs

Answer 15

Common: Bleeding

Serious: Syncope, GI hemorrhage, hematoma, angioedema

Question 16

Rivaroxaban (Xarelto) Counseling

Answer 16

Take with food

Don’t take w/ Rifampin

Question 17

Rivaroxban (Xarelto) Dosing

• Non valvular a fib and Renal changes
• Acute DVT/PE and Renal changes
• Conversion from warfarin
• Conversion to Warfarin

Answer 17

Non-valve
- 20mg QD –> (renal) avoid if <15ml/min

Acute DVT/PE
- 15mg BID –> (renal) avoid if <30ml/min

Conversion from warfarin
- D/C and initiate when INR <3

Conversion to warfarin
- D/C and initiate when next dose due