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  • 7/29/2019 Naplex Kat


    Kats NAPLEX questions


    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


    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


  • 7/29/2019 Naplex Kat


    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


    o Albuterol (Ventolin, Proventil)MDI, nebulizer soln, syrupo Levalbuterol (Xopenex)nebulizer soln, aerosol (MDI)

    Long-acting beta-agonists

    o SalmeterolServent Diskus

    o FormoterolForadil Aerolizer


    o Ipratropium (Atrovent)MDI, nebulizer soln, nasal spray

    o Tiotropium (Spiriva)capsule inhaler

    Preventing a child allergic to pollen from having an asthma attack


    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








    Drugs to tx lupus

    ArthritisNSAIDs, glucocorticoids


    Refractory casescyclophosphamide, splenectomy

    Amiodarone SE


    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.


  • 7/29/2019 Naplex Kat


    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

    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


  • 7/29/2019 Naplex Kat



    Rubella (Together in MMR)



    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


    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


    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


    Zyprexa (Olanzapine)


    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


    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


    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 ex