naplex kat
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Kats NAPLEX questions
Luridefluroide
Available as 0.25mg, 0.5 mg, 1 mg tablets
Dont give with milk, but do take with food
Dont eat/drink for 30 mins after taking
When to hold Metformin
SCr of 1.5 in males, 1.4 in females
24h before and 48h after contrast media
CrCl Formula
(140-age) x IBW x 0.85 if femaleScr x 72
IBWmales=50 + (2.3 x in>5ft)IBWfemales=45.5 + (2.3 x in>5 ft)
Normal values: men: 0.8-1.3 mg/dl female: 0.6-1.0mg/dl
References
PDR: mgf info, monographs
AHFS: hospital, off label uses, hospital coding system
Facts & Comparisons: general info, investigational, OTC & rx, Canadian products
Martindales: US Equivalents
Meylers: Ses
Red Book: Poison control center, AWP, Mfg info, herbal guides, otc info
Harriet Lane Handbook: Peds
Index Nominum: US Equivalents Briggs: Pregnancy Category
Trissels: IV
Hale: Meds and Mothers Milk
Kings: Guide to Parental Admixtures
Hanstens: Drug Interactions Analysis and Mgmnt
Mandells: Principles and Practice of Infectious Diseases
Harrisons: Principles of Internal Med
Dipiro: Pharmacotherapy: A Pathophysiologic Approach
RemingtonThe Science and Practice of Pharmacy: chemistry stuff, nomenclature, structure, solubility
Chi Square Testanswers ?s about rates, proportions or frequencies
Tell if there is a difference b/t populations for the rate at which outcomes happen, but wont tell you where the
difference is
AsthmaDrug Dosage Forms
Inhaled Corticosteroids
o Beclomethasone (Beconase AQ, QVAR)MDI, nasal spray
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o Budesonide (Pulmicort, Rhinocort)powder for oral inhalation, nose spray, nebulizer soln
o Flunisolide (AeroBid)MDI, nose spray=Nasarel
o Fluticasone (Flonase, FloventHFA)MDI, nasal spray
o Triamcinolone (Azmacort)MDI, Nasacort AQnasal spray
o Fluticasone + Salmeterol (Advair Diskus)
Cromolyn (Intal)MDI, nebulizer soln, NasalCromnasal spray
Beta-agonists
o Albuterol (Ventolin, Proventil)MDI, nebulizer soln, syrupo Levalbuterol (Xopenex)nebulizer soln, aerosol (MDI)
Long-acting beta-agonists
o SalmeterolServent Diskus
o FormoterolForadil Aerolizer
Anticholinergics
o Ipratropium (Atrovent)MDI, nebulizer soln, nasal spray
o Tiotropium (Spiriva)capsule inhaler
Preventing a child allergic to pollen from having an asthma attack
Antihistamines
o Claritin: 5 mg daily (2-5 yo)
o Zyrtec: 2.5-5 mg daily (2-5 yo)
o Allegra: 30 mg BID (6-11 yo)
o Clarinex: 1.25 mg daily (1-5 yo), 2.5 mg daily (6-11)
Cromolyn + inhaled corticosteroids
o Cromolyn: 1 spary each nostril 3-4x/day
Drugs that can cause lupusthese are the ones with the most evidence
Procainamide
Hydralazine
Isoniazid
Chlorpromazine
Methyldopa
Penicillamine
Quinidine
Drugs to tx lupus
ArthritisNSAIDs, glucocorticoids
Dermatologichydroxychloroquine
Refractory casescyclophosphamide, splenectomy
Amiodarone SE
CVhypotension
CNSdizziness, HA, fatigue, coordination problems Photosensitivity
N/V, anorexia, constipation, AST & ALT
Risk of pulmonary issues as dose goes about 300 mg/day
Tests to test drug absorption in GINo idea & didnt think it was that important
Hardness of tab influences the ability to break apart in the stomach.
Tab must disintegrate in the stomach before you can have dissolution.
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Abx use in otitis mediainflammatory process in the middle ear
Happens b/c kids tubes are shorter and more horizontal than adults, drainage cant drain
~1/2 of cases are viral
Bacterial causes: Strep pneumo, H.flu, Moraxella catarrhalis
DOC: Amoxicillin 80-90 mg/kg/day x 7-10 days
Amox/Clavsame dosing based on Amox content
PCN Allergic:
o Cefdinir (Omnicef), Cefuroxime (Ceftin), Cefpodoxime (Vantin)o Azithromycin, clarithromycin
Use APAP & ibuprofen for pain relief
Abx Use in CF
2 IV Abx for 14-21 days
Coverage for: Staph aureus, H. flu, and Pseudomonas
If suspect Pseud. Use antipseudomonal PCN or ceph w/ an AG
o FQonly oral abx w good pseudomonal coverage
Chronic inhaled abx therapy w/ tobramycinexpensive
Sulfasalzinemetabolized into 5-aminosalicylic acid
Ulcerative colitis
MOA: Acts in colon to inflammatory response, interferes w/ secretions by inhibiting prostaglandin synthesis
Pulmozymeused in a jet nebulizier
Used in CF to infxns and improve pulmonary fxn
Vaccine Use in AIDSDont use ones that are live (varicella)
Vaccines in Pregnancy
Avoid MMR b/c of rubella part Avoid any live vaccines, inactivated vaccines shouldnt be given until 2 nd trimester
Diphtheria, tetanus, Hep B, inactivated polio and pneumococcal are recommended
If pregnant during flu seasonget flu vaccine
Vaccines in Asthma Ptswww.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
Persistent asthmaflu vaccine
Varicella for kids getting intermittent systemic corticosteroid tx
Polio Vaccineavailable orally and SQ (apparently this person had lots on vaccines)
PrevnarPneumococcal conjugate vaccineIM
Age for PrevnarSheet says Peds up to 5 yo and usually delayed until 2 yo
APHAPrevnar for children 2-23 months and certain children 24-59 months
Final shot in series to be given when child is at least 1 yo
Live Vaccines
Influenza Measles
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Mumps
Rubella (Together in MMR)
Typhoid-oral
Varicella
Vaccinia (smallpox)
Yellow fever
Chemo Drugs that must be stored in fridgethis is pretty ridiculous to know if you ask me
Melphalan tablet (Alkeren)
Chloramubucil (leukeran)PO Thiotepa (Thioplex)IV
Busulfan (Myleran, Busulfex)IV
CarmustineIV
Streptozocin (Zanosar)IV
o Stable at room temp for 1 yr
Carmustine w/ Polifeprosan 20 (Gliadel)
o Implant
Pentostatin (Nipent)--IV
Cladribine (Leustatin)IV
Fludarabine (Fludara)IV
Doxorubicine (Adriamycin)IV
Epirubicine (Ellence)IV
Idarubicine (Idamycin)IV
Mitoxantrone (Novantrone)IV
Valdrubicin (Valstar)intravesically
o Bladder CA
BleomycinIV, IM, SC
Docetaxel (Taxotere)IV
Teniposide (Vumon)IV All of the vinca alkaloids
o Vincristine (Oncovin)
o Vinblastine (Velban)
o Vinorelbine (Novelbine)
Aldesleukin (Proleukin)IV
Interferon-alfa 2b (Intron A)IV and SC
Rituximab (Rituxan)IV
All MABs
o Trastuzumab (Herceptin)IV and SC
o
Gemtuzumab (Mylotarg)IVo Alemtuzumab (Campath)IV
o Bevacizumab (Avastin)
o Cetuximab (Erbitux)--IV
Denileukin difitox (Ontk)IVfrozen
Ibritumomab tiuxetan (Zevallin)
Tositumomab (Bexxar)
Asparaginase (Elspar)IV
Drugs to Mix with Sterile WaterOnly went through the top 100 b/c had to look up each drug Zithromax
Prevacid, Nexiumthen further diluted with NS, LR or D5W before administration
Warfarin
Zyprexa (Olanzapine)
BPH
Sx: weak urinary stream, incomplete bladder emptying, straining
Drugs that reduce static factorinterfere w/ testosterones stimulating effect on prostate enlargement
o Finasteride (Proscar)5 mg daily
SE: ejaculation disorders, ED Pregnancy Category X
Drugs that reduce dynamic factorrelax prostatic smooth muscle
o Prazosin (Minipress)2 mg BID-TID
SE: 1st dose syncope, orthostatic hypotension, dizzinesso Terazosin (Hytrin)1-10 mg daily
o Doxazosin (Cardura)1-4 mg daily
o Tamsulosin (Flomax)0.4-0.8 mg daily
Dont have to titrate to dose, b/c hypotension isnt a common AE
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Remember TURP from GA reviewenlarges opening at bladder neck
CHF (APHA book, p 191-192)
Cause: heart cant pump enough blood for the body
o Most common causes: CAD & HTN
Compensatory mechanisms help maintain cardiac output
o
These lead to HF sx and disease progression Avoid drugs that can precipitate or worsen HFNSAIDs, verapamil, diltiazem
Goal of diuretic tx: get rid of fluid, which will minimize sx
ACEIsimprove survival & slow disease progression
BBsrecommended for all pts w/ systolic dysfxn & mild-mod sx
o Improve survival, hospitalization, slow disease progression
o Proven benefits: bisoprolol, carvedilol, and metoprolol xl
Start @ low doses & titrate up
Digoxinno improvement on survival, but provides symptomatic benefits
Spironolactone & eplerenoneimprove survival in mod-severe HF
Advanced or decompensated HFhospitalization, IV diuretics, vasodilators, (+) inotropes
Herbs for Depression
St. Johns Wort:
o Interactions: PCs, protease inhibitors, MAOIs, antidepressants, cyclosporine, dig, iron, warfarin
Valerian:
o SE: GI complaints, withdrawal sx
o Interactions: barbiturates, BDZs
Mugwort, California poppy, lemon balm, basil, passion flower, marijuana, kava-kava
Remember Saw Palmettono longer recommended for BPH
Monitoring in RAEach visit:
Degree of joint pain
Duration of morning stiffness
Duration of fatigue
Presence of actively inflamed joints
Limitation of fxn
Periodically to evaluate disease activity or progression:
Evidence on physical examloss of motion, instability, malalignment, deformity
ESR or C-reactive protein elevation
Progression of radiographic damage of joints
MDs assessment, pts assessment, using standardized questionnaires to evaluate fxnl status & QOL
Monitoring of IBS
Improve sx and QOL
Monitor for IBS sxabdominal pain, diarrhea, constipation, heartburn, dyspepsia, nausea
Lab Valuesp 828-830 in APHA book
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How to tx High K+
Normal: 3.5-5.1 mEq/L
Sx: muscle cramps, weakness, cardiac arrhythmias
Tx Options:
o Remove K+--slower acting
Kayexalatesodium polystyrene sulfonatePO or PRmust give with sorbitol (most forms have)
Loop diuretics
Hemodialysis (if severe)o Shift K+ back into cellsquick
Regular insulin + IV dextrosecan do insulin by itself if diabetic or if glucose > 250
Albuterol
Sodium bicarbo Antagonize cardiac effects of K+--rapid onset
IV Calcium
Repeat until have normal EKG b/c its short acting
ANCabsolute neutrophil countp. 5 of GA calculations pack
Segs + Bands = ANC
Drugs Used to Prevent Cold/Flu
Echinaceastart when sx start & continue until
o Allergic rxns possible
o Limit use to 6-8 wks b/c tolerance can develop
Zicamnasal spray, oral mist, rapid melts, chewables, nasal swabs
o Start using when you feel sx & for another 48 hrs after sx are gone
o Active ingredient: zincum gluconicum
Vit C
o Mega doses of Vit C dont help tx or prevent coldo Ppl exposed briefly to severe physical exercise & cold weather may benefit
o Regular Vit C supplementation did show small in duration & severity of cold sx
Zinc-- duration & severity of cold sx
o Give w/in 24 h of sx
AirborneVit A, C, E, riboflavin, Mg, Zn, selenium, manganese, K+, amino acids, ginger, echinaces, etc.
o Effervescent tablets
Triptans5HT receptor agonists-DDI: SSRIs
Questions to ask before heme guaic exam
Vit C useantioxidant that can interfere w/ test
Visual limitationssomething to do with card turning blue I think
HemorrhoidsCould cause a false (+)
Aminophylline to theophylline conversion
Theophylline has 80% bioavailability
Going from theophylline to aminophyllinedivide theo dose by 0.8
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Going from aminophylline to theophyllinemultiply aminoph dose by 0.8
Greenwoods calc pkt & GA pkt have examples
PhosLoCa Acetatephosphate binder
Use: Orallyhyperphosphotemia in ESRD, doesnt promote aluminum absorption, give w/ meals
o IVCA supplement in IV nutrition
Combines w/ phosphate & is then excreted through feces
Hypermagnesemia
Normal Mg: 1.5-2 mEq/Lmost is stored in bone
Death d/t muscle relaxation (heart failure)
Usually secondary to renal failure or taking in too much Mg
Tx:
o CaCl1 g over 5-10 mins (or calcium gluconate)
Antagonizes neuromuscular & CV effects
Quickly reverses sxmay need multiple doseso Loop diuretics & salineonly if pt has enough renal fxn
Initial dose: 40 mg IVo Dialysistx choice w/ renal dysfxn
MTX in juvenile RAoral or IM dosing10 mg/m2 once weekly, then 5-15 mg/m2/week as a single dose or 3 divided doses given 12 hours apart
Monitoring TB Drugs
Isoniazid
o Periodic LFTs (Review said exam said AST & ALT)
o Monthly sputum cultures
o Prodromal signs of hepatitis
Rifampino LFTsAST, ALT, bilibaseline and every 2-4 wks
o CBC
o Hepatic, mental status
o Sputum culture, CXR after 2-3 months of tx
Pyramizinamide
o Periodic LFTs
o Serum uric acid
o Sputum, CXR
MOA of Allopurinol (Zyloprim)xanthine oxidase inhibitor Xanthine oxidaserate-limiting step in the formation of uric acid
Also has an active metabolite
Clear more water soluble precursors of uric acidoxypurines
MOA of Uricosuric Drugs
Benemid (Probenecid)
Anturane (sulfinpyrazone)
Promote excretion of uric acid by blocking its reuptake at the proximal convoluted tubule
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Drink at least 2 L of water/day to chance of uric acid stones forming
Zyvox dosage formsLineazolidan oxazolidinoneInfusion, powder for oral susp, 600 mg tabs
Biaxin storageClarithromycinDO NOT REFRIGERATEmight gelStable 14 days @ room temp after reconstitution
Prilosec in OJNot stable in an acidic environmentCompound is made with sodium bicarb
Tobramycin w/ dialysis
Dialyzableall AGs are
Dose after dialysis
Topical tocolyticstocolytics stop labor, but oxytocin induces labor
Oxytocin is NOT topical
PGE-2-dinoprostoneCervidil, Prepidil, ProstinE2gel applied to cervix to induce laboro Also a vaginal suppository
Precose (Acarbose)take with 1st bite of meal
Same for Miglitol (Glyset)both are alpha-glucosidase inhibitors
Meglitinides are also taken before mealtime
o Starlix (Nateglinide)
o Prandin (Repaglinide)
Diabeta is most like Prandin
Both are secretagoguesthey squeeze the pancreas
Diabeta (glyburide)2nd generation sulfonylureasqueezes pancreas all day
Prandin (repaglinide)meglitinidequick squeeze of pancreas
Filgrastim (Neupogen)used to tx agranulocytosis (I think this ? was about which drugs did/did not cause agranulocytosis)
Granulocyte colony stimulating factor
Used for neutropenia, BMT or if pt is getting their cells collected
SE: fever, alopecia, N/V/D, bone pain
NOT stable in NS, must be refrigerated
MOA: Stimulates production, maturation & activation of neutrophils
Glyset (Miglitol)twill not cause hypoglycemia Alpha-glucosidase inhibitorcauses carbs to be absorbed slower
Drugs that can cause hypoglycemia: sulfonylureas, insulin, Symlin (Pramlintidethe new amylin agonist)
Medroxyprogesteroneneeded for uterine cancer prevention
Provera, Depo-Provera400-1000 mg IM q week
Drugs that come in a nasal sprayI went through the top 200
Stadol (Butorphanol)
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Miacalcin (Calcitonin)
Desmopressin (DDAVP)
Fluticasone (Flonase)
Mometasone (Nasonex)
Budesonide (Rhinocort Aqua)
Sumatriptan (Imitrex)
Calculating a TMP dose from Bactrim Bactrim: SMX 400 mg, TMP 80 mg
Bactrim DS: SMX 800 mg, TMP 160 mg
Epogen=Epoetin Alfa
Epogen & HTNHTN was apparently hidden in the profile
This is the only connection I can find
HTN can lead to kidney disease
In ESRD you develop normochromic, normocytic anemialack erythropoietin b/c kidneys cant make it
o Requires use of Epogen (or Procrit)
o
Given IV or SQo Epoeitin is DOC for long-term correction and maintenance of Hct levels in pts with CKD or ESRD
Tegretol and DM while pregnant
Gestational DM
o Risk factors: obesity, h/o DM, glycosuria, family hx
o Low riskmust meet all: < 25 yo, normal pregnancy wt, no known DM in 1st degree relatives, not in ethnic
group with high prevalence, no h/o abnormal glucose tolerance, no h/o abnormal pregnancy outcomeo Ethnic groups prone to GDM: AAs, Hispanic/:atino, American Indians
o 1st line therapy: exercise & nutrition, caloric intake for obese women
o Next: Insulin (human)
o Glyburide can be considered after 11 weeks
TegretolPregnancy Category D(+) evidence of risk
Nimotop (Nimodipine)CCB30 mg capsules
CCBs (including verapamil) being investigated for use as mood stabilizers
Could consider if pt couldnt take Lithium, carbamazepine or valproic acid or if pt didnt respond to these
Has anticonvulsant properties, high lipid solubility, good CNS penetration
Shown effective in rapid cyclers
SE: bradycardia, hypotension
Low teratogenecityconsider for pregnancy, breastfeeding
Danger of BS in DKA too quickly can lead to cerebral edema
DKA usually results from:
o Type I not getting insulin
o Infection in I or II
Fluid, Na & K deficits
Loading dose of insulin: 0.5u/kggive IM for better absorption
o Insulin drip: 0.1u/kg/hr
Replace K10 mEq/100 mL/hr peripherally
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o 20-30 mEq/100 mL/hr central line
For every 100 units of glucose over 200-->need to add 1 mEq of Na back
Bentyl (Dicyclomine)Not used for GERD
Anticholinergic
Use: GI motility problems like IBS
10 mg capsule, 30 mg tab, syrup, injection
Feverfew for migrainesprophylaxis & tx
Possible antithrombotic effects
Possible interaction w/ NSAIDs
Orally Disintegrating Tabletsfrom top 200
Maxalt
Claritin
Zofran
Niravam (Alprazolam)
Prevacid SoluTab
Risperdal M-Tabs
Remeron (Mirtazapine)
Demerol & MAOIsusually Nardil
MAOIs can enhance the serotonergic effect of meperidine & lead to serotonin syndrome
Concurrent use w/in 14 days is CI
MAOIs:
o Eldepryl (Selegiline)
o Marplan (Isocarboxazid)
o Nardil (Phenelzine)
o Parnate (Tranlcypromine)
Egg-like allergic rxn to vaccinesMumps, measles, flu
Vaccines that are CI if egg allergy: Influenza (inactivated) & yellow fever
Pts with splenectomy get which vaccines Must have protection from encapsulated bacteria: pneumococcus, meningococcus & Haemophilus
Also protect from common viral infxns
Ok if theyve completed series like measles, varicella & polio before
Tetanus & diptheria every 10 years
Sqanz Ganz Cathetermeasures pulmonary capillary wedge pressure
Methanol/Ethylene glycol ODFomepizoleInjection
Loading dose: 15 mg/kg 10 mg/kg every 12 hrs x 4 doses
15 mg/kg every 12 hrs until ethylene glycol levels are ok
Silicosispulmonary disorder
Inhalation of silica dustscarring, inflammation
Tx: no specificbronchodilators, antibiotics, at high risk for TB
Lithiumcan cause hyponatremia
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No interaction b/t probenecid & colchicines
Colchicineinhibits phagocytosis of urate crystals, anti-inflammatory, NOT an analgesic
o SE: N/D, bloating, emesis, rarely: bone marrow suppression
o Dosing: 0.6-1.2 mg PO q 2h until pain relieved or diarrhea OR max of 8 mg
o Most effective w/in 12-36 hrs of attack
o Monitor SCr, LFT, CBC
o Dose adjust in renal impairment
Probenecidbenemiduricosuric agentblocks reuptake of uric acid in proximal convoluted tubule
o Drink 2L of water daily to prevent uric acid stone formation
o DDI: PCNs, cephs, nitrofurantoin, rifampin
Dont use with ASAo Dont use if CrCl3x normal limit & stays that waytherapy should be Dced
Depakote Dosage Formsvalproic acid
Depakene250 mg capsule Depakote Sprinkle125 mg capsule
Injection, syrup
Depakoted delayed release tab125, 250, 500 mg
Depakote ER250, 500 mg
Ampho Bno electrolytes (in mixing), mix in D5W & reconstitute w/ water
Not compatibile with Ca gluconate, KCl, NaCl
Anit-fungal to tx life-threatening systemic fungal infxns
MOA: Binds in fungal cell wall--> permeability-->cell death
o Aspergillus, Cryptococcus, Candida SE: Infusion rxns (pre med): fever chills, hypotension, rigors
o Nephrotoxicity is dose-limiting-hypokalemia, hypocalcemia, hypomagnesemia
o Renal tubular acidosis & nephrocalcinosis possible
o Anemias, LFTs, alk phos & bili
Genetic polymorphism exists as acetylation
OTC Smoking Cessation
1st line: Nicotine replacementgum, patch, inhaler (rx), nasal spray (rx); bupropion (rx)
SE: Insomnia/sleep problemsuse 16h patch or take patch off at night
o Irritation topicallyrotate sites, use HC or TAC
CI to nicotine replacement:
o CV:
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o Pg 523 in APHA book for all tx options
o 1st line: BDZsprefer lorazepam
o Adult dosing: 4 mg given slowly over 2-5 mins
o IV Phenytoinonly mix w/ NS
o Can be admixed w/ any IV soln
o Rate given: 150 mg/min max
o 1 mg phenytoin=1.5 mg fosphenytoin
o
Phenobarb-- likelihood of respiratory depression w/ BDZs on boardo Midazolam continuous infusion
o Medically induced comaw/ phenobarb
Drugs that cause Raynauds or make worse: BBs
Leukeren (Chlorambucil)alkylating agent
MOA: Form covalent bonds, DNA cross-linking (Also cyclophosphamide, ifosfamide, carmustine)
SE: myelosuppression, mucositis, alopecia, N/V, amenorrhea, & azospermia
Witch hazel + talc + starchmakes a suspension or paste
Talc & starch wont dissolve
ISMO & proper dosage timesisosorbide mononitrate
Need to have @ least 8 hrs b/t doses (Lexi says 7)
Must have a nitrate-free interval so tolerance doesnt develop
Give BID rather than QID
Extended releasegive only once daily in AM
AZO Drug aggravating UTI?pyridiumalso in Uristat (phenazopyridine)
Only acts as an analgesic, wont tx UTI
Should only be used for 2 days
Doxorubicin (Adriamycin)turns urine (and all other bodily fluids) red
Anthracyclines: daunorubicin, idarubicin (dark yellow)
MOA: Insert pairs in DNA-->strand breaks, inhibit topoisomerase II
Cardiac toxicitydoxorubicin is worst
Riopan Substituteshas been DChad magoldrate & simethicone
Antiflatulent & antigas
Simethicone products:
o Gas-X, Mylanta Gas, Mylicon Infants, Phazyme Quick Dissolve & Ultra-Strength
Magnesium stearatelubricant in tablet mfging
Extra Mg stearatechanges in tablet dissolution b/c of decreased rate of tablet break up
Would slow down dissolution
Home measuringAsthmapeak flow1. Stand.2. Make sure indicator is at bottom of scale.3. Dont let fingers block the opening.
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4. Inhale as deep as possible, put mouthpiece in mouth, form a tight seal.5. blow out as fast as possible. Dont force air w/ tongue.6. Repeat 2-5x, record 3 highest readings (Do this for 2 wks)
If use short-acting inhaled beta-agonist in AMcheck PEF before & then repeat 15 mins after given drug
Green Zone : 80-100% of their best reading (Controller meds)
Yellow Zone : 50-80% of best peak flow
o May need extra inhaled steroids & increased albuterol use
o
To MD if not out of this zone in 24-48h Red Zone :
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What to do if INR=3.0continued same dose
1grain=64.8 mg1avoirdupois pound-454 g1 fl oz=29.57 mL1 US gallon=128 fl oz=3785 mL=4 qts=8 pints
1 US pint=473 mL1in=2.54 cm1.73=Avg adult BSA
SpGr=g/mL
% Error= Error x 100%quantity desired
Minimum weighable quantitiy=sensitivity requriment x(100/%error)
Temperature conversion:9C=5F-160
Zidovudine dosage forms (Retrovir) Reverse transcriptase inhibitorinterferes w/ viral RNA dependent DNA polymerase
100 mg capsule, 300 mg tablet
syrup: 50 mg/ml
injection: 10 mg/ml
Redose oral Imitrexif no response from initial dose, may repeat in 2 hrs.
t-testused to compare 2 groups
Latest PCP tx found in what bookthey didnt list any choices, but they chose the CDC book
Chemo drug toxicity
cyclophosphamide & ifosfamidehemorrhagic cystitis
o urinalysis to look for RBC
o hydration & MESNA therapy
neurotoxicitycytarabine, fludarabine, MTX, vincristine
o Ask pt to write name to check for neurotoxicity
Cardiotoxicityanthracyclines
o Mostly doxorubicine & daunorubicin
o Also can be idarubicine, epirubicine, mitoxantrone
o Limits on cumulative lifetime dosingo Are also vesicants
o Monitor LVEF & how much theyve had in their lifetime
Fosamax (Alendronate)implement after D/Cing Evista
Priloseccapsule can be opened, sprinkled in applesauce
Can give in NG tube, mix in an acidic juice
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Which of the following are not immune modulating?
5-FU was not an optionIm not sure if they mean they wouldve picked this if it had been an option or not
Prednisone was a choiceI wouldnt call this immune modulating
Did comment that they could easily eliminate 3 of the choices
Question about vincristinewasnt about intrathecal administration
Beth whatever her last name is nowsaid to look at the 1st CA packet
Plant alkaloidinterferes w/ microtubule assembly Pretx for anaphylaxis or peripheral edema
Neurotoxicity, SIADH
DDI: phenytoin, l-asparaginase, carbamazepine, dig, filgrastim, nifedipine, zidovudine
Vincas are vesicantsmonitor for extravasation
Do NOT give intrathecally or in doses > 2 mg
2 Questions about which was an improper dose?They chose Ticlid 250 mgLexi says: Ticlid 250 mg BID
Inderal dosage forms
InnoPranXL80 mg, 120 mg
Inderal LA60, 80, 120, 160 mg
Inj, oral soln
Tablet10, 20, 40, 60, 80 mg
Which are light sensitive when preparing for a ptNitroprusside, promethazine
I think nitroglycerineits in an amber bottle
Comment was made that dopamine was NOT usually light-sensitive as it is usually used
Metforminbiguanide
What would help diabetic neuropathy
They chose TCAs & Neurontin, apparently steroids can be used sometimes as well
Dont get tripped up if ACEIs are a choicetheyre for diabetic nephropathy
Graph of a drop in BP/HRw/ a set of antihypertensives (Im assuming these were choices)
They chose labatalolalpha and beta effects
Mask-like expression is indicative of whatthey gave you the information that the pt had schizophrenia
Asking about an ADRatypical antipsychoticssomnolence
Should you take Prevacid 1 hr before a meal?
Before food, best to take before brkfst
Metformin must be stopped before what diagnostic test?
Answer was angiogramuses iodinated radiographic contrast media
EEG & EKG were choicesbut these dont use contrast media
Desmopressincomes IV, also intranasal & tablet
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Question about captoprilthat was all it said
Dont forget it should be taken w/ food
Metabolic acidosisgive sodium acetateacetate ion converts to bicarbonate
Sodium bicarb isnt usually added to TPNs, but both sodium & potassium acetates are usually used
Do what w/ heparin w/ a high PTT?they chose to decrease dose, but not D/CCould also hold the dose & restart at a lower dose
What do you monitor when a pt is on Lovenox & warfarinNot aptYes PT & INR
Question about sepsiswasnt about Xigris
Empiric antimicrobial selectionmost narrow spectrum possible
Fluid therapyonly use vasopressors if fluids dont work
Vasopressorspreferred: dopamine & NE
o
Epinephrine, phenylephrine, dobutamineo AE: tachycardia, arrhythmias, organ & extremity ischemia, HTN
ImmunomodlatorDrotrecogin alfa (Xigris)
o Recombinant human activated protein C, an endogenous anticoagulant
o Exact MOA unknownmodulates coagulation & inflammatory cascades
o SE: bleeding
o CI: active internal bleeding, recent trauma or stroke, epidural catheter
o DDI: Anticoags, antiplatelet therapy
Cipro ear dropo Ciprodexcipro + dexamethasonetx acute otitis media
o Cipro HCcipro + hydrocortisonetx acute otitis externa (swimmers ear)
o CiloxanEYE drop
IBSIrritable Bowel Syndromeo Abdominal discomfort assoc. w/ altered bowel habits
o Sx: abdominal pain or discomfort
o Diarrhea or constipation predominate, or alternating
o Tx:
o Dicyclomine (Bentyl)antispasmodic-- GI motility by relaxing smooth muscle in the gut
o Hyoscyamineanticholinergic-- GI motility by smooth muscle by antimuscarinic activity in the gut
o TCAsdelay intestinal transit, blunt perception of visceral distentiono Tegaserod (Zelnorm)5 HT4 antagnoiststimulates peristaltic reflex & intestinal secretion
o Lactulose, milk of mag, polyethylene glycolosmotic laxativesIBS w/ constipation
o Fiber supplementsbulk laxatives-- stool bulk & water
o Loperamideinhibits peristalsis
o Diphenoxylatedirect effect on circular smooth muscle in gutslows GI transit time
o Alosetron (Lotronex)selective 5HT3 antagonistinhibits nonselective cation channels in gut
o SSRIs-Citalopramperipheral effects on colonic tone & sensitivity
Paroxetinepotent anticholinergic
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Resistance to PCNo Change in drug targetPCN binding proteinMRSA does this
o Alteration in outer membrane permeabilityGm (-) bacteria
o Produce deactivating enzymes or beta-lactamases** most important
CrCl with overweight malecorrect answer was to use the actual wt, not ideal or adjusted
H.flu type B vaccineinfant useo If PRP-OMP (Pedvax HIB) or ComVax is given at 2 & 4 months, dont have to give it at 6 months
o DtaP/Hib combination products shouldnt be used as primary immunization in infants at 2, 4, or 6 months
o Can be used as boosters after any Hib vaccine
o Final dose needs to be given > 12 months
Which pneumococcal vaccine can be given before age 2?had to choose from brand nameso Prevnar (7-valent conjugated polysaccharide vaccine)
o Pneumovax (23-valent polysaccharide vaccine)not effective in children
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Dilaudid=hydromorphone
How to monitor a weird drug (yes, that is what they said)o Bathroom scale was a choicethink about for HF
Tx UTIo Cause: Usually Gm (-) anaerobic rodsE.coli!!
o In the hospitalthink about pseudomonas & stapho S, sx: dysuria, urgency, frequency, nocturia, suprapubic heaviness or pain, rarely have fever
o Upper UTIs: flank pain, fever
o Tx: FQs, Cephs, TMP-SMX, doxypay attention to allergies
o Length of tx varies
o Acute, uncomplicated cystitstmp/smx x 3 days, FQ x 3 days
o Acute pyelonephritisFQ x 14 days, tmp/smx x 14 days
o ProstatitisFQ x 4-6 wks, TMP/SMX x 4-6 weeks
ADR from Alzheimers drugall have N/V
o Donepezil (Aricept)o Rivastigmine (Exelon)
o Galantamine (Razadyme)
Surfactantused to decrease surface or interfacial tensiono Ex: polysorbate 80, sodium lauryl sulfate, sorbitan monopalmitate
Colchicinefor an acute gout attack
Theophyllinemay cause sleeping problems
Drugs that are found Rx & OTCdiphenhydramineo Others I thought of: APAP, ibuprofen, phenylephrine, pseudophedrine, naproxen, guaifenesin, meclizine (Bonine is
the OTC version)
Symbyaxolanzapine & fluoxetine (atypical antipsychotic & SSRI)o Tx of depressive episodes assoc w/ bipolar disorders
o SE: somnolence, D, wt gain, increased appetite, dry mouth, weakness
o Capsules (olanz/fluox): 6/25, 6/50, 12/25, 12/50
Baby born to Mom w/ gestational diabetesmacrosmiaabnormally large fetal body sizeMoms profile givenhas eclampsia & gestational diabeteswhat will baby haveK type
o Large wt, diabetes, deformities
What does drinking alcohol while pregnant do to the baby?o Fetal alcohol syndromemental retardation
o Down syndrome, stunted growth, short limbs
Enbrel MOAEtanerceptTumor Necrosis Factor (TNF) Blocking Agent
MTX does not cause alopecia
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Dobutamine MOAStimulates beta1causes increased contractility & HRo Little effect on beta2 or alpha
Dopamine dosingo Low: 1-5mcg/kg/minincreased renal blood flow & urine output
o Intermediate: 5-15 mcg/kg/minincreased renal blood flow, HR, cardiac contractility
o High: >15 mcg/kg/minalpha effectsvasoconstriction, increased BP
In 1 L of normal saline154 mEq Na
Tx of enetrococcus faecaliso Enterococcus speciesinfxns in abdomen & urinary tract
o DOC for Enterococcus (+ an AG)-ampicillin, sulbactam (Unasyn)
o 3rd generation Cephscefotaxime, cefoperazone, ceftizoxime, ceftriaxone, ceftaxidime
o Tigecyline (Tygacil)VRE & VSE
o Doubt this will be on there b/c its new
o Quinupristin/Dalfopristin (Synercid), Linezolid (Zyvox), Daptomycin (Cubicin)
Carvedilol (Coreg)MOA & advantageo MOA: Non-selective beta & alpha blocker, no intrinsic sympathomimetic activity
o Dont have to adjust for renal or hepatic
HIV pt should NOT get what vaccine:o Kids up to 16 yo w/ HIVstandard schedules of hep B, DaPT, HIB, IPV & flu
o MMR-NOT for severely immunocompromised
o Varicellaonly if no evidence of immunosuppression
o Pneumococcal recommended for HIV pts >2 yo
o Killed vaccines are fine
o Avoid live typhoid vaccine & only use yellow fever vaccine if absolutely necessary
What does a Sunday start for BC pills mean?Start Sunday after period starts
Plavix MOABlocks ADP receptors, prevents fibrinogen binding, decrease possibility of platelet adhesion and aggregation
Palivizumabused for RSV in neonatesBrand: Synagis
Elemental Calciumo Ca Carb=40% elemental400 mg elemental/1 g ca carb
o Ca Citrate=21% elemental
BBswill worsen Raynauds
Relative vs Absolute bioavailabilityo Absolute: fraction or % of a dose given non IV that is systemically available
o Relative: fraction of a dose given as a test formulation that is systemically available as compared to a reference
formulation
EKG Change w/ hyperkalemiagive Ca gluconate
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2 Questions on drug interactions w/ herbalsLook @ Nemeczs handout or packet from GA
Buildup of Demerol metabolitecan cause seizures, not reversed by naloxoneo Normeperidine
o Renal impairment pts are at risk
At home, asthma pts should use peak flow meters
To give albuterol 0.5%--must use nebulizer
What strength albuterol 0.5% will become based on drug order to mix w/ 2.5 mL NSAnswer was 0.083%
K Question asking which drug was used for long-term asthma controlo Choices: steroid inhaler, prednisone, serevent
o Prednisonenoonly during exacerbations
o Steroid inhaler or Serevent (steroid + long acting beta agonist)I would think these would both be ok answers
Pt Counseling for sulfa eye dropsburn
Tx of aspergillusAmph B, itraconazole, caspofungin, voriconazole
Tx of systemic fungal infxnchoose diflucan, NOT nystatin
Tx recurrent otitis media (Chronic=recurrent?)o No longer recommend prophylaxis w/ abx in high-risk pts b/c of drug-resistant organisms
o Recurrentabx effective short term
o Insert tympanostomy tubes
Find a dosing rate given a chart & based on pts wt & renal fxn
Tetanus & diptheriaok in pregnancyboth are inactivated
Pt going in for splenectomyneeds pneumococcal vaccine
Max dose of Reminyl (Galantamine)Changed name to Razadyne b/c of med errorso Dose range: 16-24 mg once daily
o Intermediate release tabs or soln: 4 mg BID x 4 wks8 mg BID x 4 wks12 mg BID
o Extended release caps: 8 mg qd x 4 wks16 mg qd x 4 wks24 mg qd
Bicitrasodium citrate & citric acidalkalinzing agento Use: tx metabolic acidosis, conditions where need long-term maintenance of alkaline urine
o effects of: amphetamines, pseudoephedrine, quinidine, quinine
o effects of: lithium, chlorpropamide, saliscylates
o Dosing: 10-30 m: w/ H20 after meals & at bedtime
o Dilute w/ 30-90 mL of water to help taste
What needs to be added to TPN for pt who is acidotic?Acetate salts provide bicarbonate ion
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Thrombolytics are CI in pt w/ NSTEMI
Most likely bug for otitis mediaUp to 50% may be viralBacterial
o 40-50% Strep pneumo
o 20-30% H.flu
o 10-15% Moraxella catarrhalis
Drugs that can cause hyponatremiacarbamazepine, lithium
Ethylene glycol/methanol antidoteFomepizole (Brand: Antizol)injectiono Used alone or with hemodialysis
o AE: HA, N
Giving ethanol in methanol poisoningcompetitively inhibits metabolism of ethanol & decreases formation of toxicmetabolites
Albuminimportant for measure Ca levels
PCP TxBactrimo Prophylaxis: 1 DS tab QD or TIW
o Tx: 15-20 mg TMP/kg/day in 3-4 divided doses
Which drug will worsen esophagitis? Fosamax
Which drug will interfere w/ Zoloft metabolismDiltiazemo Zoloftmajor substrate of 2C19, 2D6
o Diltiazeminhibits 2D6
Progestroneused to decrease endometrial CA
Octreotide (Generic: sandostatin)used for diarrhea secondary to CA
Counseling for nicotine gumchew slowly for 30 mins & then discardBite & park
o Bite piece slowly until peppery taste or tingling occurs
o Place gum b/t upper or lower cheek & gums for approximately 1 min
o After peppery taste fades, repeat the process
o Keep piece in mouth ~ 30 mins