NAPLEX Random Notes 68 Pages

8/8/2019 NAPLEX Random Notes 68 Pages

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NAPLEX SECRET 2015

Calculations:

ung-ointment WA-while awake

PR-per rectum BM-bowel movement

1 pint= 473 ml 1 uart = !4" ml

1 gallon = 37#$ ml 1 poun% = 4$4 g

Percentage &trength' g(1))ml *w(v+, ml(1))ml *v(v+ ,

g(1))g *w(w+

Ratio &trength' *1'+ e./ )/)40 = )/)4g(1))ml =

1g($))ml = 1'$)) 22Put in gram

PPM' *part o %rug(15)))5)))+ part o whole e./

)/)))g(1))ml = /g(15)))5))) = /PPM

BM6' *kg(m+ 2/$4cm(inch 1#/$ = 8n%erweight5 1#/$-4/! = normal $-!/!=overweight 93) =obee

6BW' Male' $):/3 *inche above $ eet+ ;emale' 4$/$ :

/3*inche 9 $ eet+

A%r .7 Multipl b )/#$ or

emale

ilution' *>hanging a trength or uantit+ C1 2 >1 = C 2

>

Alligation' *>ombining two trength to get a trength in

between+ 22Watch or ADD TO

**Corrected Calciu: Ca2!"#ro la$% ! &"'(al$uin%

)"0+%,

** P-en.toin correction/ PT easured&"02) Al$% !

01,

• >hooe calcium gluconate over chlori%e bc it

%iociate le an% le chance o bin%ing to

phophate an% precipitating

mD ' Dlectrical charge provi%e% per mole

mEmol(F = ?*g(F+(*g(mole+@ . * G o particle it plit up

into+ . 1)))

6otonicit *omolarit in bo% Hui%5 when we want to make

omething iotonic to bloo%+' ID JalueK

• ;irt Ln% out how much a>l woul% make it iotonic/

)/!g(1))ml = g( mF• D= o%ium chlori%e euivalent o a %rug = *$#/$ . i+ (

*MW o %rug . 1/#+ 2i = %iociation actor o %rug

• e.ample' i calculate% D value i )/3 an% ou have

)/4g o %rug5 thi repreent )/4g . /3 = )/)! g a>l

• hen ubtract them rom each other/

;ahrenheit = *> . 1/#+ :3

pN = pka : log *alt(aci%+ ;or Aci%

pN = 14 O p b : log *bae(alt+ ;or Bae

eAQ' *#/7 . A1>+ O 4"/7

>alcium >arbonate' 4)0 elemental calcium >alcium

>itrate' 10 elemental calcium

Abolute eutrophil >ount' WB> . **0eg:0ban%+(1))+

Anion Qap' a:->l-N>E3- 291 i high *gappe%+

Minimum Weighable Cuantit *MWC+ ' &R(error

Abolute Bioavailabilit' ; = *A8>e.travacular

. oeintravenou+(*A8>intravenou . oee.travacular+

6J Bolu J= oe(>o or >o = oe(J

Eral J= *oe . ;+ (*ke .A8>+ >l=*oe . ;+(A8>

>l=ke . J

ke= ?ln*>ma.(>min+@( ime interval

EnteralParental Nutrition:


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>arb' Dnteral *4kcal(gram+ Parenteral *e.troe 3/4

kcal(gram+

Protein' *4kcal(gram+

;at' Dnteral *!kcal(gram+ Parenteral 6J;D *1)0 - 1/1

kcal(ml5 )0 - kcal(ml5 3)0 -3kcal(ml+ 2oten weekl an%

might have to %ivi%e b 7 or %ail

DD = BDD . activit actor . tre actor 2uuall %oentue protein calorie

BDD etimate' 1$-$kcal(kg *a%ult+

ail ;lui% ee%' 1$))mF : *)mF+*g-)+

itrogen 6ntake' gram o protein intake("/$

Cooundin3:

DmuliLer( &uractant'

ween *polorbate+5 Mrot-DTectivene anali O Now eTective the t. wa or

what it wa uppoe% to %o

>ot-MinimiSation anali O two %rug health beneLt are

eual5 ot-BeneLt Anali O Eutcome in %ollar *monetar+

>ot-8tilit Anali O 6nclu%e Cualit o Fie variable

Case(Control: Nave a %ieae an% look back or rik actor

Co-ort: Prosecti6e or Retrosecti6e &tart with rik

actor to ee i the get a %ieae/Cross(Sectional: Fook at a peciLc point in time/

RCT: inter6entional

7eta(Anal.sis: Co$inin3 an. RCT8s and dra4in3 a

conclusion

P-araco3enoics:

- " ultra rapi% metaboliSer have increae% rik o>o%eine Morphine to.icit


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(LA(9*1502 "ainl. Asians% on car$aaeine: 5(

10 c-ance o# S;S 4it- car$aaeine

(SLCO191 Pol.or-is ( statin .oat-. increased

-NDR(eu Encogene O nee%e% or Nerceptin *tratuSumab+

an% a%cla *a%o-tratuSumab+ to work

(*2 and 2C>*? and @ORC1 "A

-alot.e% = reBuire lo4er doses or t-e. 4ill $leed"oo.3ous #or *? is -as 3reatest ris o# $leedin3%

(LA(9*501: # ositi6e #or t-isF do not 3i6e A$aca6ir

"Gia3en%

(2C1>: Cloido3rel is a rodru3 and needs t-is en.e

to con6ert to acti6e #or

-&elSentr *Maraviroc+ O mut be >>R$ poitive onl to

receive %rug

Dru3 Aller3iesADR8s

-Naranjo scale i ue% to help pharmacit %etermine i the

dru3 caused t-e ADR

-&evere &kin Rahe *&U&5 D5 RD&&5 P+ - &top the

oTen%ing agent 2corticoteroi% >6 in D

-&tomach upet(auea rom a %rugO not a true allerg5 it i

an intolerance( Niacin and Statins taen to3et-er -a6e an increased

ris o# uscle to)icit.

-

Photoenitivit' &ula Antibiotic5 etraccline5

;luorouinolone5 iuretic5 ;lagl5 acrolimu5 >cloporine5

&A65 voriconaSole5 methotre.ate/

-Penicillins' Allergic to one preume allergic to all/ &mall

rik or cephaloporin an% carbapenem cro reaction but

houl% till avoi% on the e.am/

(Sul#aSul#onaides Motl with ulametho.aSole

*Bactrim5 &eptra+ but houl% alo avoi% ulapri%ine5

ula%iaSine5 an% ulLo.aSole/ 22Hor e)a also a6oid loo

diureticsF t-iaide diureticsF sul#on.lureasF

acetaolaideF onisaideF and celoco)i$+5 daruna6ir

"Preista% here i no cro-reactivit with ulLte or

ulate/

-7or-ine t.e oioid aller3ies %o not cro react with;entanl *urageic+5 meperi%ine *emerol+5 or metha%one

*olophine+/

-Peanuts and so. are in the ame amil an% can have

cro reactivit/ &o i in ome me%ication'

• clevi%ipine *>levipre.+5 propool *iprovan+5 an%

progeterone in *Prometrium+

-6 allergic to e33s avoi%'

• clevi%ipine *>levipre.+5 propool *iprovan+5

6nHuenSa vaccine "**Hlu$lo is o%

-rue rug Allergie(Anaphla.i *Me%iate% b 6gD an%

Nitamine releae+'

• &welling5 poible hive5 bronchocontriction5 low

bloo% preure

• . with epinephrine *Dpipen5 Dpipen Ur/5 A%renaclick5

Auvi-C+ an% %iphenh%ramine *$mg.+ 2rub the area

ater in


4/57

-Root(Cause Anal.sis "RCA% i %one retropectivel to ee

what le% to a entinel event/ Hailure 7ode and EIects

Anal.sis "H7EA% i %one propectivel to ee what potential

coul% lea% to a problem/

-Error o# Oission i leaving omething out that i nee%e%

or aet/ Error o# Coission i when omething wa

%one incorrectl/

-7edication reconciliation i up%ating the patient

me%ication lit/ 6t houl% be %one at ever tranition o care/

-RE7S i an ;A program that reuire peciLc training an%

reuirement or certain me% e.' cloSapine5 iotretinoin

*iPFDQD+5 erthropoietin in oncolog *APPR6&D+/ Qoal i to

make ure the beneLt o the %rug outweigh the rik/

-7edication 3uides are ;A-approve% printe% han%out or

over 3)) me%ication that that tell patient o important

a%vere event and s-ould $e disensed e6er. tie/ >anbe part o RDM&/

-Iall man letterK can be ue% or look-alike oun%-alike

%rug/ e./ celeA an% celeBRD

-I8e A irecte%K i not acceptable

- Alcohol ha poor activit againt pore like >/ iVcile/ 8e

oap an% water to wah han% when in contact/

->ontact precaution or patient coloniSe% with MR&A an%

JRD/ Airborne precaution or patient with meale5 varicella*chickenpo.+5 an% uberculoi/

-Barco%ing i great an% help prevent error

HDA Dru3 Aro6al9ioeBui6alence:

ew rug Approval'

1 Pre(Clinical Anial Researc-

/ ND-6nvetigational ew rug

• Phae 1- Ae sa#et.P(P parameter with

low %oe in )-#) -ealt-. eole

• Phae - Sa#et. and EJcac. in 1))-3))

people 4it- indication

• Phae 3( ConKr re6ious studies in 1008s(

10008s o# eole 4it- t-e indication at the

%oe oure eeking approval/

3/ NDA &ubmitte% O Dither Approve%5 Re


5/57

- Sa4 Paletto ue% or BPN

- in3er or nauea(motion ickne

- Tea Tree Oil or acne

- L.sine or canker ore

- 7elatonin or inomnia an% % tarte% 1 month beore pregnanc/ 4))-

#))mcg %ail/

- P.rido)ie "9M% upplemente% in uberculoi treatment

that have 6oniaSi% in them

- T-iaine"91% %eLcienc can caue Wernickeencephalopath/

- iacin *B3+ %eLcienc caue pellagra

- @itain C %eLcienc can caue curv

-@itain E houl% not e.cee% 150 da.

- L(Ar3inine can have -.otensi6e eIectsF it8s a

recursor to NO

- ron: Breat-e% babie nee% 1mg(kg(%a rom 4-" month

ol% an% anemic patient ma nee% upplementation too *e./

Renal problem or mentruating emale+

- Pro$iotics: 6 taking antibiotic5 %ont take the probiotic at

the ame time o %a a the antibiotic

- Dchinacea5 Sinc5 el%erberr5 garlic5 vitamin >- ue% or

col%(Hu/ inc can caue lo o mell/

- A%euate Calciu and @itain D nee%e% or low bone

%enit5 pregnanc *etu %eplete tore+5 menopaue5

chil%ren5 an% men who take teroi% or an%rogen blocker/

• >alcium aborption i aturable o %oe houl% be

%ivi%e%/

• 10003da. or women 1!-$) an% 12003da.

or9$)

• >itracal *calcium citrate+ preerre% in low aci%

environment *e./ with N blocker an% PP6 ue+/ Can

$e taen 4it- or 4it-out #ood "21 Eleental%

OscalF Tus "calciu car$onate% -as acid(deendent a$sortion5 tae 4it- #ood Saller

ills than the >itracal an% provi%e more elemental

calcium/ "'0 Eleental%

• @itain D: M00 dail. #or 0F +00 dail. #or

0 *c-olecalci#erol "D?% is t-e re#erred

source+/ Pol. @i Sol multivitamin contain Jit an%

i ea or inant to take/ Breat-e% babie or ormula

e% babie who %rink le than 1 liter(%a nee% 4))68

Jit /

Dru3 nteractions:

nducers *low to have thi eTect+' car$aaeine

"Te3etrol%F -en.toin "Dilantin%F O)car$aeine

"Triletal%F soin3F ri#ainF St ;o-n8s


6/57

O).codone and 7et-adone are metaboliSe% b 3A4

*watch or in%ucer an% inhibitor+

Aiodarone ue O ecreae Di3o)in an% onuion5

Nallucination5 iarrhea5 Mucle rigi%it5 &hivering5

achcar%ia5 &weating5 Nperthermia

C-elation: Tetrac.clines and Buinolones can chelate oeparate% rom Al5 >a5 Mg5 ;e compoun%5 inclu%ing %air/

9leedin3 Ris: SNRF SSRF NSADSF in3oF Ks- oilF

3arlicF 3rae#ruit

*Wellbutrin *Bupropion+ O oent aTect $N o %oent

increae blee%ing rik

.eraleia: ACEiF AR9F ailorideF triatereneF

eleronone "nsra%F sironolactone "Aldactone%F >l5

tacrolimu*Progra+5 ccloporine *eoral+5 trimethoprim5

cana3liQoin "n6oana%F drosirenone "asin%

Ototo)icit.: salic.latesF 6anco.cinF aino3l.cosidesF

cislatinF loo diuretics

T Prolon3ation: uinolonesF 7acrolidesF 7et-adoneF

TCA8sF Soe SSR8s "Citalora and Paro)etine%F Aole

anti#un3alsF S7XT7PF soe Protease n-i$itors

Renal Disease and Dosin3 Considerations:

-he level o Albumin in urine can gauge the everit o

ki%ne %amage/ *Micro an% Macroalbuminuria+

- &erum >reatinine *&>r+ i ue% a a marker o renal unction

- B8 increae in renal impairment but not ue% alone a a

marker b(c it can increae or other reaon uch a

%eh%ration/

-Foop iuretic inhibit a:( : pump in acen%ing limb o loop

o Nenle


7/57

-hiaSi%e iuretic inhibit a:(>l- pump in the %ital tubule

-Al%oterone antagonit( Potaium &paring iuretic O work

in the collecting %uct

- T-e 3oal 9P in CD is 1'0>0

- ACEi8s and AR9s are reno(rotecti6e in that the low

%own the progreion o nephropath in %iabetic an% non-

%iabetic with proteinuria/

- ACEi8s and AR9s can cause a ?0 rise in SCr and is

not a reason to sto t-era. # ?0 t-en it s-ould

$e discontinued SCr and ! s-ould $e onitored 1(2

4ees a#ter initiatin3

-.er-os-ateia:

1/ Retrict ietar Phophate

/ Phophate Bin%er' Bin% IMeal-timeK phophate in the gut

rom the %iet o onl take them with meal/ ****T-e. don8t4or i# taen a#ter a eal

• Aluminum bae% *Alternagel+- can accumulate an% i

to.ic o not ue% much

• >alcium bae% O Hirst line t-era. Calciu

acetate **"P-osloF P-osl.ra% or Calciu

car$onate *um+ 2>an caue hpercalcemia

• Aluminum ;ree5 >alcium ;ree O E)ensi6e

o **lant-anu"Hosrenol% - mut be chewe%thoroughl/

o **se6elaer"Ren6elaRena3el%/ O a%%e% beneLt

o lo4erin3 LDL

-Secondar. .erarat-.roidis: Calcitriol "Rocaltrol%

i given to > patient with secondar.

-.erarat-.roidis to in-i$it PT secretion / 6t i the

active orm o Jitamin 3/

• %o.ercalcierol *Nectoral+ an%

paricalcitol*emplar+ are newer active Jit %rug

with le hpercalcemia/

• cinacalcet "Sensiar% = calcimimetic to

increae enitivit to calcium an% %ecreae PN/

-@itain D deKcienc.: C-olecalci#erol "D?% an% Er3ocalci#erol "D2%

-.eraleia: 8uall rom renal ailure an%(or %rug that

increae :/ 7uscle 4eanessF $rad.cardiaF c-est ainF

arest-esias an% #atal arr-.t-ias ma occur/

reatment'

• @ Calciu to tabiliSe the car%iac tiue

• lucose and nsulin to %rive : into cell

• sodiu ol.st.rene sul#onate "a.e)elate% i a

cation e.change rein given orall or rectall/ Rectal

preerre% in emergenc ituation/ &i%e DTect'

auea5 Jomiting5 Constiation5 Fo o Appetite/

• Loo Diuretics

-7eta$olic Acidosis: . with o%ium bicarbonate or

o%ium citrate *Bicitra+

Coon: dru3s t-at need dose adustents in renall.

iaired: acclovir5 valacclovir5 amphotericin5amanta%ine5 5 Allopurinol5 aminiglcoi%e5 aSole antiungal5

antiarrhthmic5 aStreonam5 colchicine5 %abigatran5 FMWN5

macroli%e5 uinolone5 metocloprami%e5 penicillin5

morphine(co%eine5 Maraviroc5 R65 tatin5 &M(MP5

trama%ol5 venlaa.ine5 Solen%ronic aci%/

Dru3s not to use in se6ere renal iairent:

Biphophonate5 %abigatran*Pra%a.a+5 %ulo.etine5

on%aparinu. *Ari.tra+5 glburi%e5 Fithium5 meperi%ine5

metormin5 &A65 nitrourantoin5 potaium paring


8/57

%iuretic5 rivaro.aban *arelto+5 ta%alaLl5 tenoovir5 trama%ol

DR5 voriconaSole 6J/

Dru3s in Pre3nanc.:

- A a general rule5 tr to avoi% all %rug %uring the 1

t

trimeter/

- Pre3nanc. e)osure regitrie are %eigne% to collect

ino rom women who take variou me% %uring pregnanc

an% breatee%ing/

-


9/57

-@a3inal #un3al in#ections: se toical anti#un3als #or

da.s "e) cloitraole%

-Ast-a: n-aled Corticosteroids are 1st line

"$udesonide re#erred% Al$uterol in-aler is used #or

rescue

- .ot-.roidis: ue le6ot-.ro)ine "Cate3or. A%

-.ert-.roidis: PT and 7et-iaole arere3nanc. D PT is used in t-e 1st triester and

7et-iaole is a#ter t-at 9ot- can cause serious li6er

daa3e

Dru3 Re#erences:

A6era3e 4-olesale rices and su33ested retail rices

o# dru3s: Re% Book

Princiles o# uniation: Pink Book rom the >>

PatentsF 7anu#acturin3F ndustr. issues: Pink &heet

Tra6eler8s ealt-: Yellow Book

T-eraeutic eBui6alence: Erange Book, publihe% b the

;A >DR*>enter or rug Dvaluation an% Reearch+

Clinical Trials: >linicaltrial/gov b the national intitute o

health

Core-ensi6e Patient n#oration: Me%linePlu5 ;A5>>

Natural 7edicines: atural Me%icine >omprehenive

atabae an% atural &tan%ar%

Pre3nanc.Lactation: Breatee%ing' A gui%e or the

me%ical proeion5 Brigg5 Factme%5 Microme%e.5 Nale5

>>

Pediatrics: AN;&5 Microme%e.5 Narriet Fane5 Pe%iatric

oage Nan%book5 eoa.5 elon5 >>5 Proeional>olleague

@ Dru3s: riel5 ing5 Package 6nert5 Microme%e.5 AN;&

Dru3 D: 6%ent-A-rug5 Microme%e.5 ;act an% >omparion5

>lin Pharm etc//

7edication Sa#et.: Me%watch *A%vere Reaction+ an%

6ntitute or &ae Me%ication Practice *6&MP+

Horei3n Dru3 D' Martin%ale5 microme%e.

n#ectious Disease:

-Qram Poitive &tain Purple(Blue5 Qram egative &tain Pink

-Breakpoint' level o M6> at which the bacteria i %eeme%

uceptible or reitant

-Beta Factam *ime-epen%ent+ can be ma.imiSe% b

e.ten%ing the inuion time or giving a continuou inuion

Anti$acterials:

-Aino3l.cosides: *Bacterici%al+

• bin% to ?0S and 50s riboome unit an% interere with

protein nthei

• concentration deendent illin3 an% ost

anti$iotic eIect "PAE%

• Nigh %oe e.ten%e% interval %oing i le nephroto.ic

an% more cot-eTective

99< #or Neuroto)icit. and Ne-roto)icit.

entTo$ra: '(33 "ea 5(10 trou3- 2% F

#or s.ner3. e) 4it- 6anco ea "?('% Aiacin: 15(20 33 "ea 20(?0 trou3- 5%

*%oe bae% on 9


10/57

• amo.icillin : clavulanate *Augmentin+ O rerigerate

upenion

• ampicillin : ulbactam *8nan+

• penicillin J *Eral+ an% Penicillin Q *6J+ O take Pen J

on an empt tomach

• piperacillin : taSobactam *on+ Oanaero$ic

co6era3e and seudoonas

•

na#cillinF o.acillin5 %oclo.acillin *PE+ Iantista-cnK O no renal dose adustin35 i a 6esicant

• $one arro4 suression with long-term ue or

seiures with accumulation

-Ce-alosorins: *bacterici%al+

• ame mechanim a P>

acti6it. a3ainst sta- decrease 4it-

3enerations $ut stre and 3ra ne3

increases

• 1t Qen' ce#aolin "e#olFAnce#%"i6%Fce-ale)in "eQe)%"o% - cover PE

*proteu5 Dcoli5 lebiella+

• n% Qen' ce#uro)ie "Ce#tinFGinace#%"i6o%5

ceotetan *avoi% alcohol+ or ceo.itin *co6er

soe anaero$es+ O more gram negative

coverage than 1t gen/ NPE O *N/;lu5

eieria5 proteu5 Dcoli5 lebiella+

3r% Qen' ce#dinir"Onice#%"o%F ce#tria)one

"Roce-in%"i6%F ce#taidie "Horta%"i6%Fce#odo)ie "@antin%"o% O le taph

an% more trep activit/ More gram negative

acitivit O cover serratia "NPES%

**Ce#taidie co6ers Pseudoonas

4th Qen' ce#eie "7a)iie%"i6% ( bet gram

negative activitF co6ers "NPES% and

SerratiaF Pseudoonas F Acineto$acterF

Citro$acterF Entero$acter "SPACE $u3s%

$th Qen' ce#taroline "TeQaro%"i6% = Bet gram

poitive activit O co6ers 7RSA5 noPeu%omonal coverage

**Ce#tria)one"Roce-in% is t-e onl. one

t-at can $e dosed once dail. t s-ould not

$e used 6ia (site or 4it- calciu

containin3 stuI DOC #or riar.

eritonitis in#ections

-Caraenes: *bacterici%al+

• ame mechanim a P>

Broa% &pectrum againt Qram !(F Anaero$esF

Pseudoonas "e)cet Ertaene%F A7PC

and ES9LS

iienecilastatin "Pria)in%F

eroene "7erre%F ertaene

"n6an%F doriene "Dori$a)%

&i%e DTect' >an caue seiures

ertaene "n6an% can $e dosed once

dail.

-Atreona"Aacta%:

no ra ! acti6it. $ut 3ood #or

Pseudoonas

can $e used in PCN aller3ic atients

-HluoroBuinolones: *Bacterici%al+

• 6nhibit A grae an% topoiomerae 6J

concentration deendent illin3

• ciroQo)acin "Ciro or cipro%e. *otic+%F

le6oQo)acin "Le6aBuin%F o)iQo)acin

"A6elo) or Jigamo. *ee++F oHo.acin *;lo.in

*otic++

• >ipro an% Fevo have Peu%omonal coverage5 not

Mo.i

• mo.i cover ome anaerobe

At.ical Co6era3e

Le6o and 7o)i reerre% to a the Uresirator.

H8sV becaue the have ore StrePneuo co6era3e


11/57

**99< #or Tendon nQaationRuture

and a. e)acer$ate uscle 4eaness in

7.ast-enia ra6is Pre3nanc. D #or

cartila3e daa3e

T rolon3ationF Q6 upet5 Nepatoto.icit5

seiuresF peripheral neuropath5

**-.o3l.ceia "soeties #atal%F

eri-eral neuroat-.F and-otosensiti6it.

>ipro Eral &upenion houl% not be given via

ee%ing tube b(c it a%here to the tubing/

C-elation 4it- cations o eparate %oe

rom thing like antaci%5 mutivaitmin etc//

Ciro C 4it- tianidine "GanaQe)%

-7acrolides: *Bacteriotatic+

• bin% to $)& riboome to inhibit protein

nthei

ait-ro.cin "G(PaF Git-roa)%F

er.t-ro.cin "Er.t-rocin%F clarit-ro.cin

"9ia)in%

At.ical co6era3e

T rolon3ationF Q6 upet5 Nepatoto.icit

er.t-ro.cin and clarit-ro.cin are

in-i$itors o# ?A'

ait-ro.cin -as less dru3(dru3

interactions

(Tetrac.clines: *Bacteriotatic+

• bin% to ?0s riboome to inhibit protein nthei

tetrac.clineF do).c.clineF inoc.cline

P-otosensiti6it.

Pre3nanc. Cate3or. D "teet- discoloration

and seletal 3ro4t- suression%

do).c.cline @ to PO is 1:1

C-elation 4it- cations

do not use in c-ildren + .rs old

do). doesn8t need renal dose adustin3

-Sul#onaides: "9actericidal 4-en S7XT7P are used

to3et-er%

inhibit the olic aci% pathwa

MR&A coverage

9actri and Setra

Al4a.s in a 5:1 "S7X:T7P%

C: Pre3nanc.F Sul#a Aller3.5 breatee%ing5

anemia %ue to olate %eLcienc5 marke%

renal(hepatic %ieae5 inant month

Side EIects: P-otosensiti6it.F Sin

reactionsF -.eraleiaF -.o3l.ceiaF

cr.stalluria "tae 4it- +o% o# 4ater

@ to PO is 1:1

**n-i$itor o# 2C> so caution 4it- 4ar#arin

[email protected] "@ancocin%: *Bacterici%al+

• block glcol-pepti%e polmeriSation o the cell

wall

• can be ue% orall or >/ iT 1$-$))mg C6 .

1)-14 %a

• &i%e eTect' Ne-roto)icit.F Ototo)icit.5

inuion r.n(re%man n%rome*hpotenion5

Huhing5 chill5 etc//- o give 3) min inuion or

each $))mg+

• rough' 1$-)mcg(ml or pneumonia5

en%ocar%iti5 oteomeliti5 meningiti5 an%

bacteremia, 1)-1$ or other/

7RSAF PRSPF Enterococcus "Not @RE%

-Tela6ancin "@i$ati6%: *Bacterici%al+

• %erivative o vancomcin

red an s.ndroeF ne-roto)icit.F T

rolon3ation


12/57

-Lineolid "G.6o)%: *Bacteriotatic+

bin% to 3& riboomal RA o the $)& ubunit

C 4it- 7AO in-i$itors or 4it-in 2 4ees

use o# t-e

@ to PO 1:1 "M003 12%

7RSAF PRSPF @RE

• aociate% with bone marrow uppreion an%

peripheral neuropath

-Dato.cin "Cu$icin%: *Bacterici%al+

o %epolariSe cell membrane

o 7RSAF PRSPF @REo &i%e DTect' 227.oat-. and increased C o **Do not use #or neuonia $c its inacti6ated

$. sur#actanto can cause #alse ele6ations in NR 4it- no

increased $leedin3o coati$le 4it- NS $ut not D5<

(Ti3ac.cline "T.3acil%:

o relate% to tetraccline

o 99e%inir*Emnice++5 Drthomcin

Do Not Re#ri3erate: >e%inir5 ASithromcin5 >larithromcin5

>lin%amcin5 >iproHo.acin5 FevoHo.acin5 o.ccline5

;luconaSole5 JoriconaSole5 lineSoli% *vo.+5 &M(MP

SeciKc Disease Treatents 4it- Anti$iotics:

Sur3er. Pro-.la)is:

• 8uall initiate% within ") minute beore the

proce%ure unle ;C or Janco i ue% then it 1)

min/ beore/

• &econ% %oe ma nee% to be given or longer

proce%ure or i there i igniLcant bloo% lo/

• 1st or 2nd en Ce-alosorins uuall given

unless PCN aller3. t-en @anco i ue%/


13/57

• # $o4el arts are in6ol6edF need anaero$ic

co6era3e suc- as ce#otetanF ertaeneF or

Roce-in 4it- Hla3.l

7enin3itis:

7ost coon at-o3ens: &trep/Pneumo5 N/;lu5

eieria Meningiti5 an% Fiteria T) 4it- Ce#tria)one "Roce-in% ! @anco.cin

usuall. #or (1' da.s ! de)aet-asone

Hor iunocoroised or 50F add Aicillin

#or Listeria co6era3e

# 9eta Lacta Aller3.: C-lora-enicol ! @anco

! 9actri "Listeria%

n#ecti6e Endocarditis:

• 8uall rom &taph5 &trep5 or Dnterococcu

**Prost-etic 6al6e E usuall. #ro Sta- and

reBuires addition o# Ri#ain

entaicin o#ten used #or s.ner3.F ea ?('

c3lF trou3- 1F do not use e)tended(inter6al

dosin3

usuall. '(M 4ees o# treatent 4it- a PCNF

Ce-alosorin "ce#tria)one%F or @anco

Pro-.la)is #ro dental rocedure: **Ao)icillinF clinda.cinF or ait-ro.cin ?0(M0

in $e#ore rocedure

RT:

Acute Otitis 7edia: suall. use **i3- dose

ao)icillin >033da. or Au3entin

7ost are caused $. 6iruses

LRT:

Acute 9ronc-itis: suall. @iral O Antituive an%

Broncho%ilator 8e%

CAP: uuall caue b &trep/ Pneumo5 N/;lu5 or M/

>atarrhali/ suall. use a acrolideF or $eta(

lacta ! acrolideF or a H #or 5(10 da.s

AP:

Earl. Onset "5da.s%: 8uall ame bug a>AP

Late Onset "5da.s%: 8uall 7DR pathogen

*MR&A5 Peu%omona+/ . or 7-# %a unle

peu%omona then it 14 %a/

Tu$erculosis:

• caue% b mcobacterium tuberculoi

• high contagiou

• iagnoe% with uberculin kin tet *aka PP+/

Fook or raie% area with 4#-7 hr/Fatent uuall treate% with riampin an%

ioniaSi%

# acti6eF T) 4it- RPE re3ien 4-ic- is

Ri#ainF soniaide "N%F P.rainaideF

and Et-a$utol

Direct o$ser6ed t-era. "DOT% i poible to

make ure the take all the me%

• Patient houl% be in isolatedF ne3ati6e

ressure roos• Recommen% .rido)ine "@it 9M% to prevent

neuropath with isoniaid "N%

• Ri#ain and N taken on an et.

stoac-

Et-a$utol can cause otic neuritis

.rainaide C in acute 3out and -eatic

daa3e

N can cause -eatic daa3e too

ri#ain can cause red(oran3e secretions

and stain contacts


14/57

RPE7 i# resistant to ot-ers

"7/o)iQo)acin%

ntra(A$doinal n#ections:

Priar. eritonitis: motl rom stre and enteric

3ra ne3ati6e rods "PE% T) 4it- ce#tria)one

"Roce-in% #or 5( da.s

&econ%ar peritoniti rom traumatic event *urger5ulceration5 ichemia5 obtruction+ uuall trep5 gram

neg/ ro% an% anaero$es

Sin and So#t Tissue n#ections:

Cellulitis: ATect all laer o the kin an% uuall

caue% b Sta- Aureus or Stre P.o3enes

• abcee nee% inciion an% %rainage *6Z+

Purulent"us%: reBuires 7RSA co6era3e

non(urulent: "eQe)%

• 6J antibiotic ma be necear or evere inection

T:

• more common in emale b(c o horter urethra

all ale T8s are considered colicated

&ign(&mptom' %uria5 urgenc5 reuenc5burning5 nocturia5 uprapubic heavine5 hematuria 5

*ever i uncommon+

Poitive 8rinali when there i .uria(pu in urine

*poitive leukocte eterae5 or 91) WB>(ml+ an%

$acteriuria 91)$ or uncomplicate% or 91)3 or

complicate%/

PhenaSopri%ine*ASo+ oten given or urinar pain

*%uria+ O can cause redoran3e urine/ 7a) o# 2

da.s $c .ou don8t 4ant to co6er s.tos t-at

can 4orsen

As.toatic "no #e6er or urinar. s.tos%

does not need to $e treated unless re3nant

t-en .ou treat #or da.s

Nitro#urantoin "C i# CrCl M0 lin% #or

uncolicated T or S7XT7P

Can use H #or colicated T or S7XT7P

CDiJcile:

• 8uall rom Antibiotic use eseciall. Clinda.cin5

Ampilcillin5 >ephaloporin5 an% ;C/

Reo6e oIendin3 a3ent

a6oid anti(otilit. a3ents due to ris o# to)ic

e3acolon

• wah han% with oap an% water to prevent

tranmiion5 alcohol %oe not kill the pore

T): 7etronidaole 5003 TD *mil%-mo%+ or Oral

@anco 1$mg C6 *mo%-evere+ or both #or se6ere

colicated 10(1' da.s 4it- Qa3.l $ein3 @ L%a.omicin in clinical trial how lower recurrence

rate

Tra6eler8s Diarr-ea

9acterial "+0%: enteroto)i3enic EColiF

Ca.lo$acter euniF s-i3ellaF salonella

• Jiral ometime

• ProtoSoal ometime T): HluoroBuinolones are t-e t-e DOC lus

loeraide

.dration is 6er. iortant

ro-.la)is is not recoended $ut can use

Peto(9isol to reduce incidence

No He6er and No $lood in stool can use

loeraide: '3 t-en 23F a) 1M3da.

Hun3al n#ections:


15/57

A-otericin 9: *ungici%al+

• $inds to er3osterolF altering cell membrane

permeabilit5 cauing cell %eath

• >ome in con6entional an% liid #orulation

*Abelcet5 Ambiome+

99< t-at edication errors occur due to t-e

i)(u $et4een con6entional and liid

#orulation dosin3 diIerences Con6entional-as a a) dose o# 1533da.

Side EIects: ;ever5 chill5 hea%ache5 malaie5 rigor5

hpokalemia5 hpomagneemia5 22ne-roto)icit.

Liid #orulation reduce t-e ris #or in#usion

reactions and **ne-roto)icit.

# usin3 con6entionalF re(edicate #or in#usion

related reactions 4it-: acetaminophen or &A6

iphenh%ramine an%(or h%rocortione

7eeridine to reduce duration o# ri3ors

Hui% bolue to re%uce nephroto.icit

Hluc.tosine "Anco$on%: *ungici%al+

penetrate into ungal cell an% i converte% to

Huorouracil which compete with uracil5 interering with

ungal RA an% protein nthei

99< to use e)tree caution in renal d.s#unction

and closel. onitor renalF -eaticF and -eatolo3icstatus

Side EIects: 9one arro4 suressionF -eatitisF

ne-roto)ic increae B8 an% &cr

Aoles: *ungici%al an% ungitatic+

decrease er3osterol s.nt-esis an% thu cell

membrane ormation

Hluconaole is t-e DOC #or t-rus- in N6J patient

or non-N6J with mo%erate-evere %ieae/ N.statin

also 3ood #or t-rus- @oriconaole is t-e DOC #or Aser3illus

traconaole "Sorano)%F Quconaole "DiQucan%F

6oriconaole "@HEND%F osaconaole "No)aKl%

etoconaole *iSoral topical5 generic or tablet+

Hluconaole @ to PO is 1:1

@oriconaole s-ould $e taen on an et.

stoac-F osaconaole 4it- #ull eal

@oriconaole C 4it- an. ?A'

su$stratesin-i$itorsinducers t starts 1st

ordert-en is 0 order P so sall dose increases can

-a6e lar3e aIects "ic-aelis enton%

Onl. Hluconaole and @oriconaole enetrate t-e

CNS 4ell enou3- to treat #un3al enin3itis

**All are ?A' in-i$itors

**Side EIects o# all: ncrease LHT8sF T

rolon3ation

Side eIects o# @oriconaolePosaconaole:

**@isual c-an3esF -allucination

traconaole is C in -eart #ailure

Ec-inoCANDns:

o inhibit nthei o B*153+ O - Qlucan o the cell wall/

o DOC #or ost s.steic Candidao Caso#un3in "Cancidas%F .ca#un3in "7.caine%F

ani%ulaungin *Dra.i+o Side eIects: ncreased LHT8s5 hpotenion5 ever5

%iarrhea5 hpokalemia5 hpomagneemia5 rah

o 3ood #or C rusei and 3la$rata tooo all once dail. and no renal adustents

Ter$inaKne "Laisil%: 6nhibit ualene epo.i%ae

&i%e eTect' ncreasedLHT8sF -eadac-e

N.statin: riseo#ul6in "ri#ul6inFris(PE%:

photoenitivit Z pregn/cat

@iral n#ections :

nQuena:


16/57

Neuraidase n-i$itorso %ecreae the releae o viral particle

o s-ould $e used 4it-in '+ -ours o# illness

onseto Oseltai6ir "TaiQu% = T): 53 9D ) 5

da.s Pre6ention: 53 9D ) 10 da.so TaiQu can cause 6oitin3

o anamivir *RelenSa ikhaler+ O BBWbronchopam rik

o amanata%ine

Anti6irals #or eres Sile) @irus "S@%F

@aricella Goster @irus "@G@% and C.toe3alo6irus

"C7@%:

o ac.clo6ir "Go6ira)%F 6alac.clo6ir "@altre)%F

6al3anciclo6ir "@alc.te%F amciclovir * ;amvir+

ganciclovir *>tovene+5 ci%oovir *Jiti%e+5 ocarnet

*;ocavir+o **6al3anciclo6ir -as a 99< #or

.elosuression and

carcino3enicterato3enic eIects **Preared

in 6ertical air -oodo ci%oovir ha a BBW or nephropatho valganciclovir i taken with oo%

o 3anciclo6ir and 6al3anciclo6ir are t-e DOC #or

C7@o i# resistant to ac.clo6ir .ou 4ill $e resistant

to 6alac.clo6ir and #aciclo6iro T-era. #or S@ s-ould $e 4it-in 2' -ours o#

s.tos and t-era. #or @G@ s-ould $e

4it-in 2 -ours o# ras-


17/57

• 6 li6e parenteral vaccine *MMR5 Jaricella5 oter5 an%

ellow ever5+ or live intranaal inHuenSa *FA6J+ are not

a%minitere% at the ame viit5 then searate t-e

$. ' 4ees

• 6ncreaing the %oing interval between multi-%oe

vaccine %oent %ecreae eTectivene but ma %ela

more complete protection/

•

ecreaing the %oing interval between multi-%oevaccine ma interere with antibo% repone an%

protection/

• &i%e eTect'

Focal O pain5 welling5 re%ne at ite

&temic O ever5 malaie5 malgia5 hea%ache5

lo o appetite "LA@ can cause runn. nose% Allergic or Anaphlactic O Nive5 %iVcult

breathing5 hpotenion5 welling o mouth an%

throat/ &evere reaction >6 ubeuent %oe o

the vaccine/ All provi%er mut have emergencprotocol an% upplie to treat anaphla.i/

**A$solute C8s to li6e 6accines "e) GosterF

@aricellaF LA@ "Hluist%F and 77R%: Pre3nanc.

and unosuression

• Tda: Pregnant women houl% receive %ap with each

pregnanc5 mot eTective in week 7-3"/ Alo5 a one-

time %oe or thoe "$ or 9"$ who have cloe

contact with chil%ren who are le than " month/

%ap i 6M/

• Pneuo6a) "PPS@2?%: All patient 9 "$ . 1 %oe5

1!-"4 who moke or have athma5 -"4 who have

chronic illnee/

Hlu: # a erson can eat li3-tl. cooed e33s or i#

t-e. onl. e)erience -i6es a#ter eatin3 e33(

containin3 roductsF t-en t-e. can recei6e

inacti6ated Qu 6accine $ut s-ould $e o$ser6ed

#or ?0 in a#ter adinistration nacti6ated #or

e6er.one M ont-s 7ild(illness is not a C to

inQuena 6accine LA@ onl. #or -ealt-. eole2('> .ears old

@ar6a)Gosta6a)77R@ "oster and c-iceno)%

s-ould not $e 3i6en to an.one 4it- a true

3elatin or neo.cin aller3. Store 6accine in

#reeer and diluent in #rid3e or roo te

• NPJ vaccine *Qar%ail5 >ervari.+ or male *to re%uce

genital wart or anal cancer+ or emale !-" r ol%/

*3 oe+/ Male onl ue Qar%ail/

7 is 3i6en into t-e deltoid uscle 4it- a 1Vneedle "4oen 200l$s and en 2M0 l$s need

1 and WV% SC is 3i6en into t-e #att. tissue

a$o6e t-e trice 4it- a 5+V needle PPS@2? is

SC or 7 $ut PPS@1? is 7 onl.

**LA@ F @aricellaGoster and 77R are li6e

**SC is 6aricellaF GOSTER "Gosta6a)% and 77R

**@aricella and Goster are stored in t-e #reeer

C-ildren 3et DTa and adults 3et Tda

***CDC does not recoend usin3

acetaino-en $e#ore a 6accine $c it candecrease iune resonse

Ne6er i) 6accines to3et-er

n HloridaF -aracists 3i6e nQuenaF S-in3lesF

and Pneuococcal @accines

Tra6eler8s 7edicine:

• ello4 9oo or travel inormation

• 7alaria paraite protection i provi%e% b oral eds

rior to tra6el se DEET Plamo%ium Jiva. caue"$0 o cae in 6n%ia/ Plasodiu #alciaru is t-e

ost deadl.Treatent:

o 7eQoBuine "Lariu%: Nigh reitance an%

man pchiatric an% neurologic i%e eTect/

Ence weekl/ &tarte% 1- week beore an% 4

week atero C-loroBuine: Ence weekl/ &tarte% 1- week

beore an% 4 week ater

o Ato6aBuonePro3uanil "7alarone%:Started 1(2 da.s $e#ore travel an% or 7


18/57

%a pot travel/ Well tolerate% but C in

re3nanc. Ence ail/o PriaBuine: Ence %ail Started 1(2 da.s

$e#ore travel an% or 7 %a pot travel C in

re3nanc. CDC reBuires screenin3 #or

MPD deKcienc. $e#ore use

• 7enin3ococcal 6accine: reBuired #or Saudi Ara$ia

Alo prevalent in the meningiti belt o Arica/ 7enactra

* %oe or !-3 month5 1 or -$$ r+5 7en6eo *-$$

r/+5 7enoue *$" an% ol%er+/ (10 da.s #or

rotecti6e anti$odies

• ello4 He6er @irus @accine: or certain part in ub-

aharan Arica an% &outh America/ Watch or allergie to

egg an% gelatin/ 6t i a live vaccine o %ont ue in

immunocompromie%/ A&A an% &A6 houl% not be

ue% b(c o increae% rik o blee%ing/

T.-oid He6er: bacteria prea% through conumption o oo%(water contaminate% with ece or e.ual contact/

se sa#e #ood and 4ater recautions Jaccine i

@i6ito# 9ernaF ' casulesF 1 e6er. ot-er da. taen

4it- cool liBuid or 7 s-ot 2 4ees $e#ore

e)osure

Altitude Sicness: acetaolaide "Diao)

SeBuels% C in sul#a aller3.

nternational certiKcate o# 6accination "ello4

Card%

@:

• CD'! counts are t-e aor la$orator. indicator

o# iune #unction and need #or ro-.la)is

a3ainst oortunistic in#ections

@(1 RNA "@iral Load%: ost iortant indicator

o# resonse to anti(retro6iral t-era. "ART%

8e% to help ae %ieae progreion an% poible

%rug reitance/ 7easured at $aseline and t-en on

a re3ular $asis t-erea#ter

&prea% through $loodF seenF an% 6a3inal

secretions Alo prea% through vertical tranmiion

durin3 re3nanc.5 at $irt-5 or $reast#eedin3

**ART is recoended in ALL @(in#ected

atients

**Need ad-erence o# >5 or 3reater to $e

eIecti6e lon3(ter

P8s and sta6udine aociate% with

liod.stro-.lioatro-. an% #at

redistri$utionlio-.ertro-.

• Diarr-ea i a common i%e eTect o AR/

Cro#eleer"Hul.aB% i approve% or non-inectiou

%iarrhea in a%ult patient on AR/

NRT8s: *A$aca6irF lai6udineF etricita$ineFteno#o6ir5 %i%anoine5 tavu%ine5 Si%ovu%ine+

**All -a6e 99< #or lactic acidosis and

-eatoe3al. 4it- steatosis"#att. li6er%

Susend treatent i# t-ere is lactic

acidosis or -eatoe3al. 4it- steatosis

a$aca6ir: 99< #or se6ere -.ersensiti6it.

reaction 7ust test #or LA(9*501

iagen *abacavir+DpSicom *abacavir : lamivu%ine+ O Ence ail

etricita$ine: 99< #or e 9 e)acer$ation

once discontinued or 9@ resistance Can

cause -.eri3entation o# soles and #eet Dmtriva *emtricitabine+ **Tru6ada "etricita$ine ! teno#o6ir%: Once

Dail. 22Atrila "etricita$ine ! teno#o6ir !

e#a6iren%: Ence ail/ ake on empt tomach/


19/57

lai6udine: 99< #or e 9 e)acer$ation once

discontinued or 9@ resistance 99< to not

use Ei6ir(9@ #or @"contains lo4er dose o#

lai6udine% Pre#erred in Pre3nanc. Dpivir *lamivu%ine+ DpSicom *abacavir : lamivu%ine+

teno#o6ir: 99< #or e 9 e)acer$ation once

discontinued or 9@ resistance Hanconi

s.ndroeF renal #ailureF osteoalaciaF

decreased $one densit. Jirea% *tenoovir+ Tru6ada "teno#o6ir ! etricita$ine% Atrila "teno#o6ir ! etricita$ine ! e#a6iren%

i%ovu%ine' 99< #or -eatolo3ic to)icit.

"neutroenia and aneia% and .oat-.

Pre#erred in re3nanc.

NNRT8s *E#a6iren5 %elavir%ine5 etravirine5 nevirapine5

rilpivirine+

• 22All can caue S;S"ras-% and eatoto)icit.

• **n-i$itor o# 2C>F 2C1>F and ?A'F and

stron3 NDCER o# ?A' / an. dru3

interactions

• e#a6iren "Susti6a%:M00 3 dail. on et. stoac- CNS side

eIects "6i6id dreasF dro4s.F iairedconcentration% and s.c-iatric side eIects

"deressionF aranoiaF aniaF suicide%

CNS side eIects usuall. resol6e in 2('

4ees Pre3nanc. D

• Atripla * tenoovir : emtricitabine : eavirenS+

Protease n-i$itors: *ataana6irF daruna6irF ritona6irF

loina6irritona6irF oamprenavir5 in%inavir5 nelLnavir5

auinavir5 tipranivir+

**All stron3 N9TORS o# ?A' / an. dru3

nteractions

**Side EIects: .er3l.ceiaF nsulin ResistanceF

Dia$etesF #at aldistri$utionF -eatitisF iune

reconstitution s.ndroe

• ataana6ir "Re.ata+' PR interval prolonging5

-.er$iliru$ineia "aa U$anan6irV%5 rah5 tae

4it- 15 L o# 4ater to reduce ne-rolit-iasisNeeds AcidFA6oid acid suressants $c t-e. can

decrease le6elsF tae 4it- #ood and 4ater "1st

line%

daruna6ir "Preista%: Rah5 Sul#a Aller3. "1st line%

• ritona6ir "Nor6ir%: PR prolonging

loina6irritona6ir "aletra% : PR prolonging5

Pre#erred in Pre3nanc.

nte3rase n-i$itors: *Ralte3ra6ir5 %olutegravir5

elvitegravir+

ralte3ra6ir "sentress%: '003 9D

Husion n-i$itor: en#ur6itide "Hueon%

local inection site reactions in 100 o# atients

CCR5 anta3onist: ara6iroc "Selentr.%

onl. 4ors #or CCR5 t.e @ so ust $e

screened $e#ore usin3

BBW or hepatoto.icit

&i%e DTect' 8R65 ever5 rah5 muculokeletal

mptom5 %iSSine

Pre3nanc.: Co$i6ir "lai6udine ! ido6udine% !

aletra "loina6irritona6ir% OR ataSanavir : ritonavir OR nevirapine *R6+


20/57

Pre(E)osure Pro-.la)is: Tru6ada 1 ta$ PO D

Occuational ost(e)osure ro-.la)is ( Tru6ada !

Ralte3ra6ir "sentress% ) ' 4ees

Oortunistic n#ections:

PCP "CD'200%: Pro-.la)is: S7XT7P T):

S7XT7P !( corticosteroids

To)olasa 3ondii "CD'100%: Pro-.la)is:S7XT7P T): P.riet-aine ! sul#adiaine

7.co$acteriu A6u "CD'50% Pro-.la)is:

Ait-ro.cin T): Ait-ro.cin ! Et-a$utol

C7@ = @al3anciclo6ir

Cr.tococcal 7enin3itis: Liosoal

A-otericin 9 ! Hluc.tosine

eatitis Li6er Disease:

• eatic Ence-aloat-.: ;rom Ammonia Buil%upT): Lactulose or ria.imin *ia.an+ : 22lo4 rotein

diet

• Ascites: ;uroemi%e an% &pironolactone

eatitis 9: Jaccine preventable/ 8uall treat or 1

ear/T): e3.lated inter#eron "Pe3as.s% : 99< #or

an. t-in3s e)acer$ate or cause autoiune

disordersF in#ectious disordersF C@AF deression

"20% **e3.lation increases -al#(li#e #or once

4eel. dosin3 NRT8s teno#o6ir "@iread%F* lai6udine

"Ei6ir 9@% enteca6ir"9araclude%

eatitis C' ot Jaccine Preventable/ 3 %iTerent

tpe *Qenotpe 155 an% 3+/ 1 i the mot %iVcult to

treat an% treate% or 4# week/ Qenotpe an% 3

treate% or 4 week/

T): e3.lated inter#eron "Pe3as.s or Pe3intron%:

99< #or an. t-in3s *&ee above+ Ri$a6irin: 99< #or terato3enic SE:

-eol.tic aneia Protease n-i$itor: "e) $oceri6ir%: onl. #or

3enot.e 1 so#os$u6ir "So6aldi%: in-i$its C@ NS59 RNA

ol.erase

Dia$etes:

• pe 1' Autoimmune %etruction o beta cell in the

pancrea

• pe ' 6nulin reitance or relative %eLcienc

eA: "2+ ) A1C% = 'M

Dia3nosis: Classic si3ns

"Pol.uriaol.disiaol.-a3ia4ei3-t loss% !

A1C M5 or HP 12M or Rando 200 or

2-r 3lucose 200 a#ter 5 3ra OTT Coon dru3s t-at alter 3lucose:

Nperglcemina- Corticosteroids 5

hiaSi%e(Foop iuretic5 &tatin5 ;C5 Protease

n-i$itorsNpoglcemia' ;C5 Forcaerin *Belvi atiet

%rug+

Treatent oals: ADA: A1C Pre(Prandial

0(1?0 3dl Post(Prandial: 1+0 3dl AA>D' A1> "/$0 Pre-

Pran%ial 11) mg(%l Pot-Pran%ial' 14) mg(%l• .' Fiettle Mo%iation' Weight Fo5 iet5 D.ercie5

wait circumerence 3$ or emale an% 4) or

male plu rug

• ephropath &creening' *Annuall+

microalbuminuria' 3)-!! macroalbuminuria' 93)) Add ACEi or AR9

• Retinopath &creening' *Annuall+

• ;oot &creening' *Annuall+

All dia$etics s-ould insect t-eir #eet dail.


21/57

T.e 2 Dia$etes Treatent: 7et#orin is t-e

initial treatent # not at 3oal in ? ont-sF add

a second oral a3ent # not at 3oal ? ont-s #ro

t-enF add a ?rdF usuall. $asal insulin

Dru3s:

9i3uanides: *Metormin+

2%ecreae% hepatic glucoe pro%uction5 2increaeinulin enitivit5 %ecreae aborption o glucoe

et#orin "luco-a3eF luetaF Hortaet%

";anuet -as sita3litin%

**99


22/57

SLT2 n-i$itors:

cana3liQoin "n6oana%

SE: Heale 3enital .cotic in#ectionsF T8s F

-.eraleiaF increased urination

Pramlinti%e *&mlin+' Amlin analogue that increae atiet5

prevent glucagon ecretion ater a meal5 low gatric

empting/ aken with inulin at mealtime with eparate

incloet+ ' Doaine a3onist t-at 4ors

in CNS to increase insulin sensiti6it. ake with oo% to

%ecreae nauea/

cosele6a "6 with Q9$))/ &ome me% that nee% to

be taken 4 hour beore a%minitration o thi' &ulonlurea5

Phentoin5 levothro.ine5 oral contraceptive

nsulin:

***All insulins -a6e a concentration o# 100

unitsl e)cet uulin R (500 4-ic- is 500

unitsl

**Consider startin3 T.e 2 4it- insulin i#

A1C10 or 9?00• Raid(Actin3: asart "No6olo3(ovolog ;le.pen+5

lisro "ualo3(Numalog wikpen +5 3lulisine

"Aidra( Api%ra &olotar+ ' 2+ da.s

Re3ularS-ort Actin3: "uulin RF No6olin R%: ?1

da.s"% and '2 da.s"N%

NP or nterediate: uulin NF No6olin N hi

i clou% an% can be mi.e% with Rapi% an% &hort

acting inulin/ Alwa mi. clear beore clou%/ 2+"%

and '2"N%F ens 1'

Lon3 Actin3: 3lar3ine "Lantus% 2+ da.sF deteir

"Le6eir% '2 da.s

NP to 3lar3ine: # NP is once dail.F 1:1 TDD

# NP is 9DF t-en reduce dail. dose 20

NP to deteir: 1:1 TDD

Hor T.e 1: 0M units3da. "Total Dail. Dose%

9asal(9olus: 50 TDD $asalF 50 TDD $olus

"di6ided e6enl. #or ? eals%

NP(re3ular: 2? TDD NPF 1? TDD re3ular "$ot-

di6ided 9D%

Hor countin3 car$s: nsulin to car$o-.drate ratio:

500TDD / 3ras o# car$ co6ered $. 1 unit

raid(actin3 '50TDD / 3ras o# car$ co6ered $. 1 unit

re3ular(actin3

** Correction #actor: "9lood lucose No4 ( 9lood

lucose Tar3et% Correction #actor

>orrection actor i rule o 1#)) or rapi%-acting inulin *>;=

1#))(+ or rule o 1$)) or regular-acting 6nulin *>; =

1$))(+

Hor T.e 2: 02 units3da. = usuall. lon3(actin3 in

t-e ornin3

.o3l.ceia: "9 0 3dl%

o S.tos: >onuion5 weating5 tachcar%ia5

hunger5 blurre% viion/ 229eta $locers can as

t-e s.tos e)cet s4eatin3 and -un3er


23/57

o Treatent: 1$-) gram o glucoe * 3-4 glucoe

tab5 1 erving glucoe gel5 4 oS orange 6 with ula allerg an% Q6 obtruction/

&D' anore.ia5 oligopermia5 rah5 olate %eLcienc5

ellow-orange colore% urine5 impaire% olate

aborption/

minoccline' &D' photoenitivit

leHunomi%e *Arava+' Nepatoto.ic5 Pre3nanc.

Cate3or. X toactinib *el


24/57

inQi)ia$ "Reicade%: "@%n#usion reactions and

dela.ed -.ersensiti6it. reactions i6en onl. in

co$o 4it- et-otre)ate 3oliua$ "Sioni%: Su$ i6en onl. in

co$o 4it- et-otre)ate

9iolo3ic non(TNH D7ARDs:

ritu)ia$ "Ritu)an%: Deletes CD20 9 Cells 99<

#or se6ere#atal in#usion reactionsF ras-es etc

i6en in co$o 4it- et-otre)ate a$atacet "Orencia% tociliua$ "Actera%: 99< #or serious

in#ections Can cause -eatoto)icit.

S.steic Luus Er.t-eatous "SLE%:

• Auto-antibo%ie orm that %amage tiue/ here i

Hare-up with perio% o remiion/ 9utterQ. ras- on ace tpical

renal "Ne-ritis in 50 o# atientsF

-eatolo3icF and neurolo3ic ani#estations%

.dralaine can cause dru3(induced SLEF

***#ound $. ANA test

Treatent:o Anti-malarial' -.dro).c-loroBuine "PlaBuenil+ or

chlorouine, ma take " month to worko Prednisoneo .co-enolate o#etil "CellCet%: 99< #or

increased ris o# in#ectionF sin cancersF

con3enital al#orations &D' pain5 tachcar%ia5

electrolte abnormalitie *hperkalemia5

hpomagneemia5 hpocalcemia+5 hpotenion5

hpertenion5 hpercholeterolemia5 %iarrhea5

e%ema5vomiting5 tremor5 acne etc//o $eliua$ "9enl.sta% : 6gQ1-labm%a antibo% that

prevent urvival o B cell b blocking the bin%ing oB lmphocte timulator protein *Bl&+

7ultile Sclerosis:

• 6mmune tem attack melin heath on

neuron in the brain an% pinal cor%

• unknown caue

7ost atients e)erience eriods o#

disease 4it- inter6als o# reission

Treatent:

intereron beta %rug

3latiraer acetate "Coa)one%

nataliua$ "T.sa$ri%: 3i6en e6er. ' 4eesF can

cause ro3ressi6e ulti#ocal

leuoence-aloat-. Man %rug ue% or mptom control can woren

other mptom

Celiac Disease:

une resonse to 3luten Diarr-eaF

a$doinal ainF $loatin3F 4ei3-t loss

3luten is in 4-eatF $arle.F and r.e

n an. #oods and an. dru3

Ue)ciientsV T-e actual dru3 doesn8t

contain 3luten

>heck or e.cipient on aca3e insert an%

look or the 4ord Ustarc-V he tarch willeither be corn5 potato5 tapioca5 or wheat/ 6 it

%oent a which tarch then call the

manuacturer to Knd out i# t-e starc- is

4-eat You can alo tr the webite IQluten

;ree rug an% the


25/57

• Dlevation in 4 will inhibit ecretion o &N via

negative ee%back loop

• 3 i more potent than 4

• 6t important to meaure #ree T' level ince it i the

acti6e #or

.ot-.roidis:

• 4ill -a6e -i3- TS and lo4 T' "as-ioto8s is

t-e ost coon cause%

• T): le6ot-.ro)ine *&nthroi%5 Fevothroi%5 Fevo.l+

= Pre3nanc. Sa#e

• liothronine *35C.toel+5 InaturalK throi%

*porcine 3 an% 45 Armour hroi%+

• rug >aue' Amio%arone5 6ntereron

• Tae on an et. stoac- ?0 in $e#ore

$rea#ast 4it- a #ull 3lass o# 4ater

• @ to PO is 1:2

• S.tos:


26/57

PP8s can increase #racture ris

Ensure adeBuate Calciu and @itain D 4it- an.

treatento calciu citrate "Citracal%: ?153 eleentalF

lar3er illo calciu car$onate "OscalF Tus%: acid deendentF

5003 eleentalo c-olecalci#erol "@it D?% re#erred M00 #or 0F

+00 #or 1!

Treatent: 9is-os-onates "1st line%: alendronate

"Hosaa)% = 0 3 4eel.F risendronate

"ActonelFAtel6ia%F i$andronate "9oni6a%F

oledronic acid "Reclast%(.earl. in#usion HDA

4arnin3 to sto a#ter ?(5 .ears due to

eso-a3eal cancerF osteonecrosis o# a4F and

at.ical #eur #racture Tae Krst t-in3 in t-e

ornin3 $e#ore eatin3 or drinin3 an.t-in34it- M(+ ounces o# 4ater Sta. uri3-t #or at

least ?0 inutesF M0 in #or 9oni6a

ralo)i#ene "E6ista%: SER7F o#ten used in 4oen

at ris o# $reast CA SE: ot Qas-esF 6a3inal

$leedin3F aenorr-ea etc teriaratide "Horteo%: uan PTF #or -i3- ris

#racturesF Su$ dail.F a): 2 .ears denosua$ "Prolia%: anti$od. to RANL

orone T-era.:

Hor 4oen: "orone Relaceent%

ecreae% etrogen at menopaue caue high FN

which can reult in hot Hahe an% night weat/ Alo

can caue vaginal %rne5 painul e.5 moo% change

etc// se t-e lo4est ossi$le dose #or t-e s-ortest

aount o# tie Estro3en can $e used to re6ent ost(

enoausal osteoorosis $ut not treat it


27/57

Contracetion:

Pro3estin(Onl. Pills "POPs%

Estro3en and Pro3estin Pills "COCs%

&D' auea5 breat ten%erne(ullne5

bloating5 weight gain5 elevate% BP/ Can tae at

ni3-t or $edtie to reduce nausea

Serious ad6erse eIects: **Clottin3,

6ncreae% rik rom soin35 age5 N5%iabete5 long be%ret5 overweight5 an% an.

t-at contain drosirenone "Ort-o(E6ra

Patc-F AGF ainF 9e.aF OcellaF etc%

9est to a6oid t-ese

Drosirenone acts as a otassiu sarin3

diuretic T-is is 4-. 4oen lie it $ecause

it decreases $loatin3 and 4ei3-t 3ain $ut

-i3- ris #or clottin3

Dru3s t-at decrease eIecti6eness

"nducers%: Ri#ainF Anticon6ulsantsF St

;o-n8s now or all

age/ 6 ou vomit within hour o

taking5 ma want to take another %oe/ Ella: Qoo% or $ %a ater e.5

precription onl

Para3ard Coer D

i3-er t-an noral doses o# re3ular

dail. oral contraceti6es can $e used

Pain Ihe Lth vital ignK

• A%%ition o a non-opioi% can oten re%uce the

amount o opioi% nee%e% an% provi%e uperior

analgeia• 6t i important to %itinguih between

-.siolo3ical adatation"Tolerance% and

addiction

• Addiction -as stron3 coulsion and

desire to tae dru3F desite -ar alon3

4it- dru3(seein3 $e-a6ior

• Peu%o-a%%iction' Fook like a%%iction but coul%

be rom uncontrolle% pain

• >hronic opioi% ue nee% constiation

ro-.la)is• Sedation s-ould $e onitored $c it is t-e

ost iortant redictor o# resirator.

deressionF t-e usual cause o# #atalit. in

o6erdose

Acetaino-en:

T.lenol5 h%roco%one:APAP "@icodinF Lorta$F

NorcoF Lorcet%F o.co%one:APAP "PercocetFEndocetF Ro)icet%F co%eine:APAP "T.lenol Y2F?F'%F

trama%ol:APAP "ltracet%

**99< #or eatoto)ic: o6erdose can $e #atalF

"7a): '0003da.% O6erdose T): N(

Acet.lc.steine to restore lutat-ione DOC #or ain in re3nanc.

**A6oid in -ea6. driners or no4n -eatitis

"23 da.%

AsirinNSADs:


28/57

A&A irreveribl inhibit while other &A6 reveribl

inhibit >E A&A' Baer5 BuTerin5 : caTeine(APAP *D.ce%rin+5

alalate ibuproen *Motrin5 A%vil+5 napro.en *Aleve5 apron5

Anapro.+5 naro)en ! esoeraole "@io6o%F

%icloenac "@oltaren%F in%omethacin "ndocin%F

piro.icam "Heldene%F ketorolac "Toradol%F ulin%ac

*>linoril+ preerre% with re%uce% renal unction

Selecti6e COX(2 n-i$itors: celeco.ib "Cele$re)% -

ost selecti6eF melo.icam "7o$ic%F eto%olac

"Lodine%F nabumetone "Rela#en%

NSAD 99& i%e eTect o

avoi% in pch con%ition ketorolac *ora%ol+ can onl be ue% or 5 da.s a)

Cele$re) C 4it- sul#a aller3.

P-otosensiti6it. Tae 4it- #ood

Oioids:

99< #or resirator. deression

o tolerance to contipation o nee% a la.ative with all

or-ine "7S ContinF A6inaF adianF Oraor-

SRF Ro)anol% *AvinSa an% a%ian can be opene% an%prinkle% on appleauce 2PO to @ is ?:1

#entan.l "Dura3esicF A$stralF Hentora SL%

-.droor-one "Dilaudid% o).codoneF O).continF EndocetF PercocetF

Ro)icetF Ro)icodone: Avoi% with 3A4 inhibitor o).or-one "Oana%: tae on et. stoac-

et-adone "Dolo-ine%: 99< #or T

rolon3ationF serotoner3ic eeridine "Deerol%: serotoner3ic

-.drocodone "Lorta$F LorcetF NorcoF @icodin% codeine "T.lenol Y2F?F'%

traadol "ltraF ltracet%: serotonin s.ndroe

risF increased seiure ris

taentadol "Nuc.nta%

Aller3ic to or-ineF -.drocodone etc : Can use

#entan.lF or-ineF eeridine

7uscle Rela)ants:

o $aclo#en "Lioresal%F c.clo$enarine "Hle)erilF

He)i#%F tianidine "GanaQe)%F carisorodol

"Soa%F eta)alone "Sela)in%F et-ocar$aol

"Ro$a)in%o c.clo$enarine and tianidine can cause

)erostoia "dr. out-%o tianidine C 4it- CiroQo)acin

Neuroat-ic Pain A3ents:

re3a$alin "L.rica% a): M003da.

dulo)etine "C.$alta%

3a$aentin "Neurontin% a): ?FM00 3da.

aitrit.line "Ela6il% ( antic-oliner3ic

ilnaciran "Sa6ella% ( #or K$ro.al3ia

Toical #or Localied Pain :

lidocaine "Lidoder 5% = can cut into maller

piece5 1 hour on 1 hour oT5 approve% or pot-

herpetic neuralgia/ Casaicin

diclo#enac "@oltaren el%

7i3raine:

• Qoo% to tr an% i%enti an Utri33ersV o

migraine/

• Tritan %rug are serotonin(recetor

a3onists an% contrict cranial bloo% veelue% to UtreatV acute migraine/


29/57

• suatritan "itre)%: POF Nasal sra.F

Su$

riatritan "7a)alt% ( eletritan "Rela)%

Prophla.i' Beta blocker like metoprol an% propanolol

out:

• Ever-pro%uce or un%er-e.crete uric aci%

• Purine anthine E.i%ae 8ric Aci%• People can be hperuricemic an% never get a gout

attack

• rug that increae uric aci%' iuretic5 iacin5 A&A

*Nigh %oe+5 PraSinami%e5 >cloporine5 acrolimu

T): Acute attac:

colc-icine "Colcr.s% 1/mg orall then

)/"mg one hour later *%o not e.cee% 1/#mg+/

N@D in +0 o# atients Onl. 3ood

4it-in t-e Krst ?M -ours o# onset NSAD8s: ndoet-acinF naro)enF

sulindacF cele$re) *oT-label+ &temic >orticoteroi%' pre%nione5

methlpre%niolone

rate Lo4erin3 T-era.:


30/57

get angioe%ema5 all other in the cla inclu%ing

ARB an% Alikiren are >6/ 6t can be atal/

ACE n-i$itors: 222>an caue dr. cou3- # soF s4itc- to

AR9 $enaeril "Lotensin%

enalaril "@asotec% lisinoril "Prin6ilF Gestril%

Buinaril "Accuril%

rairil "Altace%

AR98s: 6alsartan "Dio6an%

losartan "Coaar%

olesartan "9enicar%: ***>an caue Srue(

lie enteroat-. *evere %iarrhea+ telesartan "7icardis%

ir$esartan "A6aro% Direct Renin n-i$itor:

alikiren *ekturna+

Do not use 4it- 4it- ACEi or AR9 in

atients 4it- dia$etes

9eta 9locers:

***NOT HRST LNE HOR PERTENSON

AN7ORE

>an alter bloo% glucoe level roranolol "nderal%: Non(selecti6e

atenolol "Tenorin% etorolol tartrate "Loressor%: ake with oo%

etorolol succinate "Torol XL%: sed in -eart

#ailure too 7a) in H is titratin3 to 2003da. ne$i6olol "9.stolic%: Also releases Nitric O)ide

car6edilol "Core3%: sed in -eart #ailure too

Al-a and 9eta 9locer Tae 4it- #ood oing converion between >oreg an% >oreg >R'

3/1$ B6 >oreg

1)mg >oreg >R ail5"/$B6)mg5 1/$mg B64)mg5 $mg B6#)mg

la$etalol "Trandate%: Al-a and 9eta 9locer 1st

line o#ten in TN in re3nanc.

&i%e note' Beta Blocker with 6&A' *acebutolol5 carteolol5

penbutolol5 pin%olol+- he %ont %ecreae NR a much/

Calciu C-annel 9locers:

222>an caue eri-eral edea an% 3in3i6al

-.erlasia

on-NP' *Work in the heart5 mainl or arrhthmia+

?A' su$strates and in-i$itors

diltiae "Cardie%

6eraail "CalanF @erelan%: Can $e constiatin3

NP' *;or N an% Angina+

alodiine "Nor6asc%

ni#ediine "Adalat CCF Procardia XLF Procardia% nicardiine "Cardene%: Coes @ also

clevi%ipine *>levipre.+' o no ue with o or egg

allerg

Centrall. actin3 al-a 2 a3onists:

clonidine "CataresF Catares(TTS atc-%: Patch i

applie% 4eel. Do not sto a$rutl. or it cancaue se6ere -.ertension Na man oT-label ue

*opioi% with%rawal5 an.iet5 leep etc/+ Na man i%e

eTect *bra%car%ia5 %rowine5 e.ual %unction5

%epreion5 naal tuVne+ gaunacine *ene.+' ntuni6 is #or ADD

Direct @asodilators:

N%ralaSine

%irectl vao%ilate arterie5 litte eTect on vein

.dralaine: can caue a rare luus(lie s.ndroe


31/57

Al-a 9locers: *8e% motl or BPN5 not Lrt line or N+

teraosin ".trin%

do)aosin "CarduraF Cardura XL%

Co$o Products:

alodiine ! $enaeril "Lotrel%

alodiine ! 6alsartan "E)#or3e%

lisinoril ! CTG "PrinideF Gestoretic%

losartan ! CTG ".aar%

6alsartan ! CTG "Dio6an CT% olesartan ! CTG "9enicar CT%

$isorolol ! CTG "Giac%

triaterene ! CTG "D.aideF 7a)ide%

;NC + ";oint National Coittee%:

M0 .rs old "150>0%

M0 .rs old "1'0>0%

1+ .rs old 4it- CD or Dia$etes "1'0>0%

Non(9lacs nitial T) *inclu%ing iabete+' ACEiF

AR9F CC9F or T-iaide 9lacs nitial T) *inclu%ing iabete+' CC9 or

T-iaide # CDF ust -a6e ACEi or AR9 re3ardless o# race

D.sliideia:

• FF = > O NF O *Q($+

Non(statin t-eraies are not recoended

unless statins are not tolerated

StatinsF K$rateF and niacin reBuire LHT c-ec at

$aseline Hor statinsF rec-ec in '(12 4ees

a#ter initiation or titration t-en e6er. ?(12

ont-s t-erea#ter

K$rates "4-en T are -i3-% and Ks- oil canincrease LDL

$ile acid seBuestrant can increase T8s

' 3rous s-ould $e initiated on statin t-era.: Clinical ASC@D includin3 coronar. -eart

disease "ACSF SP 7F sta$le or unsta$le

an3inaF coronar. or arterial

re6asculariation%F stroeF TAF or PAD LDL 1>0

Dia$etes and '0(5 .rs old 4it- LDL$et4een 0(1+>

'0(5 .rs old 4it- LDL $et4een 0(1+>

4it- estiated 10(.ear ASC@D ris 5

T-e aroriate statin intensit. is $ased on t-e

atient8s le6el o# ris:

i3- ntensit. Statins: "decreases LDL 50%o Ator6astatin '0(+03da.

o Rosu6astatin 20('03da.

7oderate ntensit.: "decreases LDL ?0('>%o Ator6astatin 10(203da.

o Rosu6astatin 5(103da.o Si6astatin 20('03da.

o Pra6astatin '0(+03da.o Lo6astatin '03da.

o Pita6astatin 2('3da.

Lo4 ntensit.: "Decreases LDL ?0%o Si6astatin 10 3da.o Pra6astatin 10(203da.

o

Lo6astatin 203da.o Pita6astatin 13da.

Statins: 7(CoA reductase in-i$itors

**Li6er en.es need to $e onitored Sto dru3

i# ALT or AST ? ties uer liit o# noral O$6iousl. t-e. can cause r-a$do.ol.sis

ncreased ris 4it- Niacin or 3eK$roil "Loid%

use

C in Pre3nanc.


32/57

SAL are ?A' su$strates

si6astatin "Gocor%F si6astatin ! eetii$e

"@.torin% 203F **tae in t-e e6enin3o not e.cee% 1)mg(%a with verapamil5 %iltiaSem5 or

%rone%aroneo not e.cee% )mg(%a with amio%arone5

alodiine5 or ranolaSine

ator6astatin "Liitor%: eBui6alent dose: 103o not ue with ccloporineo not e.cee% )mg(%a with clarithromcin or

lopinavir(ritonaviro not e.cee% 4)mg(%a with nelLnavir an% boceprevir

*Nep >+

lo6astatin "7e6acorF Altore6% '03F

**7e6acor 4it- e6enin3 ealF Altore6

$edtieo not e.cee% )mg(%a with verapamil5

%iltiaSem5 or %rone%aroneo not e.cee% 4)mg(%a with amio%arone

rosu6astatin"Crestor% 53

ra6astatin "Pra6ac-ol% '03 ita6astatin "Li6alo%: ost otentF 23

C-olesterol a$sortion in-i$itor:

eetii$e "Getia%

si6astatin ! eetii$e "@.torin%

9ile Acid seBuestrant:

colese6ela "/ ake with meal an% liui%/ >an

caue constiation5 bloating5 ga5 cramping5

increased tri3l.cerides or neutralF ipping or

hol%ing in mouth can lea% to tooth %eca/ 7an. eds need to $e taen ' -ours $e#ore or 4-

" hour ater or it can bin% them/

e) Oral Contraceti6esF -en.toinF

le6ot-.ro)ineF olesartanF sul#on.lureasF

tetrac.clines and an. ot-ers

Hi$rates: PPARa Acti6ators

#enoK$rateF #enoK$ric acid "TricorF Trilii)%

**Onl. Trilii) -as indication #or use 4it- a statin 3eK$roil "Loid%: a6oid i# on a statin Can increase LDL i# tri3l.cerides are -i3-

Can cause .oat-. and -eato)icit.

Niacin: "nicotinic acid or @it 9?%

ER Niacin "Niasan 500F 50F or 1F000 3%:***

Less Qus-in3 and Less eatoto)ic eatoto)ic "onitor LHT8s% and causes

Hlus-in3tc-in3 Can cause -.eruriceia

"3out% and ort-ostatic -.otension

Slo(Niacin: i3-est ris o# -eatoto)icit.

R 7a): M 3da. ERCR 7a): 23da.

;luh-ree %oent work or choleterol

His- Oils:

ot completel un%ertoo%

Oe3a(? acid "Lo6aa% or Jacepa

ndicated as an adunct in atients 4it- T8s

500

Can increase LDL u to '' "Onl. Lo6aa%@ascea can cause oint ain "art-ral3ia%

Can rolon3 $leedin3 tie

eart Hailure:

• Mot commonl caue% b isc-eic -eart disease

"7% an% TN

• Non(P-aracolo3ic T-era.:

onitor $od. 4ei3-t dail.


33/57

noti provi%er i mptom woren or weight

increae o%ium retriction to 1$)) mg(%a

weight re%uction

e.ercie a tolerate%

omega-3 at are goo%

A6oid NSAD8s inclu%ing >E- inhibitor

P-aracot-era.: **ACEiAR9 and 9eta 9locers iro6e

sur6i6al and s-ould $e used in ALL -eart

#ailure atients "E)cet 4-en C% Titrate

dru3 to tar3et doses "#ro clinical trials%

Diuretics "suall. Loo%s-ould $e used to

control Quid 6olue "not s-o4n to alter

sur6i6al% Aldosterone Recetor Anta3onist: Reduce

or$idit. and ortalit. and s-ould $e

added to t-ose 4-o ro3ress to NA

Class @

**Alodiine -as a neutral eIect on -eart

#ailure ood #or #urt-er 9P control t is a class eIect 4it- ACEiAR9s $ut not

4it- 9eta(9locers Onl. certain 9eta(

9locers are used

9eta 9locers #or H:

7etorolol succinate "Torol XL%: Tar3et

dose is 2003 dail.

Car6edilol "Core3F Core3 CR%: Tar3et

dose #or R is 253 9D "nless +53

t-en its 503 9D% and #or Core3 CR is

+03 dail. Bioprolol *ebeta+' arget oe' 1)mg %ail

Beta blocker are onl toppe% i

hpotenion or hpoperuion i preent/

Aldosterone Anta3onists:

sironolactone "Aldactone% : Tar3et

dose 253da. epleronone *6npra+' arget %oe

$)mg(%a

.dralaineNitrate:

.dralaine is a direct arterial dilatort-at decreases a#terload Nitrates

are 6enous 6asodilators t-at reduce

reload

ndicated #or 9lac eole 4it- NA

Class @ -eart #ailure 4-o are

s.toatic desite otial

t-era. can $e used in atients 4-o cannot

tolerate ACEiAR9s

isosor$ide dinitrate.dralaine"9iDil%: >6 with PD-$ inhibitor

isosor$ide ononitrate "7onoet%: >6

with PD-$ inhibitor

Di3o)in "Lano)in%:

6nhibit the a:( : AP pump reulting in

ositi6e inotroic "#orce% and ne3ati6e

c-ronotroic "rate%Does not iro6e sur6i6al $ut can

decrease -ositaliations ro6es s.tosF e)ercise toleranceF

and OL Antidote: Di3iHa$

Lo4er doses #or renal insuJcienc.F

sallerF olderF #eale T-eraeutic ran3e #or H: 05(0> n3l

*Nigher or ALb+

Si3ns o# to)icit.: 1st

si3ns are nauseaF6oitin3F loss o# aetiteF $rad.cardia


34/57

9lurred @isionF altered color ercetionF

3reenis-(.ello4 -alosF con#usionF deliriu .oaleiaF -.oa3neseiaF and

-.ercalceia increase t-e ris o# to)icit.

Acute Decoensated eart Hailure:

>ongetion' iuretic an%(or 6J vao%ilator

Npoperuion or >ar%iogenic &hock' 7ilrinone or

obutamine Jao%ilator ue% in AN;'

o itroglcerin' Jenou at low %oe5 Arterial at

higher %oe5 eTectivene limite% to -3 %a/o itroprui%e *itropre+' eual arterial an%

venou5 protect rom light b covering with oil or

opaue material5 blue olution in%icate

%egra%ation to cani%e/o neiriti%e *atrecor+' B-tpe natriuretic pepti%e5

arterial an% venou %ilation/

Anticoa3ulation:

• &ome rik actor or JD' &urger5 Maancer5 previou JD5 Pregnanc5 etrogen

or &DRM ue etc//

Neparin an% FMWN can caue T' Bo% orm

antibo%ie to heparin which lea% to urther platelet

activation an% pro-thrombotic tate/ Dia3nosed $. a

ro#ound dro in latelets 50 #ro $aseline

**Ar3atro$an is t-e DOC i# t-is -aens DT8s

do not cross react 4it- -earin induced

anti$odies

n#ractionated earin:

o bin% to antithrombin an% inactivate ;actor a an%

66a/o @TE ro-.la)is: 5F000 units SC +(12-rs

o Alo ue% or JD treatment an% A>&(&DM6 treatment

@TE: +0 units3 @ $olus then 1# unit(kg(hr

inuion A>&(&DM6' ") unit(kg 6J bolu then 1 unit(kg(hr

inuiono o not mi.-up the heparin in

o osteoorosis with long term ue

L7


35/57

N;ECTA9LE Su$ indirect #actor Xa

in-i$itor/ Work via antithrombin like heparin/ C in se6ere renal iairent "CrCl ?0

lin% no anti%ote

Ri6aro)a$an "Xarelto%:o ORAL direct #actor Xa in-i$itoro A Lb' )mg PE C *>r>l 9 $)+, 1$ mg PE C *>r>l

1$-$)+ 4it- e6enin3 ealo J prophla.i *ater knee(hip replacement+'

1)mg PE C 4it-out re3ards to ealso J(PD .' 1$ mg PE B6 . 1 %a then )mg PE

C 4it- #oodo **Can start 4-en NR is ?0o ?A' su$strateo o not ue with >r>l 1$ ml(min

o no anti%ote

• Api.aban *Dliui+' &imilar to arelto

Direct T-ro$in n-i$itors: *actor 66a+

%irectl inhibit ;actor 66a *hrombin+

Ar3atro$an: sed in atients 4it- TF no

antidote

$i6alrudin "An3ioa)%

da$i3atran "Prada)a% :o **ORALo Hor non(6al6ular A(Hi$o 150 9D 5 9D i# CrCl 15(?0 lino **Can start 4-en NR is 20o &wallow whole5 %o not put in Q tube/

o 50 -a6e d.sesiao 22ee in ori3inal container and ee lid

ti3-tl. closed to rotect #ro oisture

Discard a#ter ' ont-s o# oenin3 $ottleo Store in coolF dr. lace Not in a $at-rooo no onitorin3 or antidote

Jit b(c o variable aborption an%

avoi% 6M %ue to hematoma/ Side EIects: 9leedin3F Sin NecrosisF Purle Toe

S.ndroe S(enantioer ore otent

P-araco3enoincs: 2C>*2 and *? reBuire

lo4er doses

@OR ol.or-iss reBuire

lo4er doses

C-ronic Sta$le An3ina:

• plaue buil%up in coronar arterie re%uce bloo% How toheart

• >oul% be rom PrinSmetal angina which i vaopam o

coronar arterie5 not plaue/ >alcium channel blocker

preerre% or thi tpe/

• Predicta$le chet pain

Treatent:

9eta $locers are 1st line

ASA or Cloido3rel "#or ASA aller3.%


36/57

SL or sra. nitro3l.cerin #or iediate relie#

Fong acting nitrate can be ue% or chronic therap a

an a%%-on but reBuire nitrate(#ree inter6also nitro3l.cerin SL ta$s "Nitrostat 0?F 0'F

0M3%o nitro3l.cerin SL 0'3 "'00c3% sra.

"NitroistF Nitrolin3ual u sra.%: do

not s-aeF rie it o isosor$ide ononitrate RER "7onoet% =

tae 4-en .ou 4ae u and t-en 2nd dose

5 -ours latero SE: EADACE "3ets less $ot-ersoe%F

diiness 7oderate to -i3- dose statin i# not C

Annual nQuena

RanolaSine *Rene.a+ alo an option or angina/ T

rolon3ation5 no eTect on NR or BP/ *anti-anginal+

Acute Coronar. S.ndroes: "ANSTE7STE7%:

• 8A' chet pain5 enSme negative5 no or tranient DQ

change

• &DM6' chet pain5 car%iac enSme *troponin5 >-

MB+5 no or tranient DQ change

• &DM6' chet pain5 car%iac enSme *troponin5 >-

MB+5 & Dlevation

nitial Treatent: "7ONA%

Morphine5 E.gen5 itrate5 Apirin *1"-3$mg5 then

#1mg %ail+

T-enF ot-er t-eraies added $ased on 4-at is

lanned #or t-e atient "AP(9A%

QP 11b(666a anatagonit *a$ci)ia$ "ReoPro%F

etiK$atide "nte3relin%F tiroLban+' Abci.imab

irreveribl block/ >an caue $leedin3F

t-ro$oc.toeniaF -.otension

Anticoagulant *Neparin5 FMWN5 on%aparinu.5

bivalru%in+'

PY1 inhibitor *clopi%ogrel5 praugrel5 ticagrelor+'

Praugrel not or >ABQ/ >lopi%ogrel reuire >1! or

activation/

Beta Blocker' 4it-in 2' -ours without >6

A>D inhibitor' 4it-in 2' -ours without >6

PC is usuall. re#erred i# #acilities are a6aila$le

;ibrinoltic ue% when acilitie or P>6 are not available or

when P>6 cannot be %one within !) min/ ;ibrinoltic houl%

be tarte% within 3) min/ o arrival to hopital/

;ibrinoltic' alteplae5 tenecteplae

NSADs not recoended ost(7 due to ris o# re(

in#arction "se ASA or T.lenol%

Antiarr-.t-ics:

• 8uall rom mocar%ial ichemia or inarction/ Alo

rom thing that %amage the heart like N5 heart

ailure5 hperthroi%im5 inection etc//

• Electrol.te i$alances can caue arrhthmia

"otassiuF sodiuF a3nesiuF calciu%

• Dru3s5 inclu%ing %rug to treat arrhthmia can

caue it/

• AK$ is t-e ost coon sura6entricular

arr-.t-ia and usuall. results in a raid

6entricular resonse

• T rolon3ation is a ris #actor #or Tosades de

PointesF usuall. dru3(induced and can lead to

sudden cardiac deat-

• Additi6e T Prolon3ation: >la 1a an% >la 666

antiarthmic5 BuinolonesF acrolides5

S7XT7P5 aole anti#un3als5 >A5 ome &&R6

*CitaloraF aro)etineF Huo.etine5ecitalopram+5 antis.c-oticsF et-adone5 $N3


37/57

anatagonit "ondansetron%F P8s5 anti-cancer

%rug etc//

• Class a' *uini%ine an% procainami%e+ block

o%ium an% potaium channel/ Additi6e T

rolon3ation

• Class $: *li%ocaine+ pure o%ium channel blocker/

Onl. #or 6entricular arr-.t-ias Cross 999

and so can -a6e CNS eIects

• Class c: *Hecaini%e5 propaenone+ o%ium channel

blocker/ C in -eart #ailure and acute 7

• Class : 9eta 9locers *emolol5 propranolol+

used to slo4 6entricular rate

Class : "aiodarone "CordaroneF PaceroneF

Ne)terone%5 do#etilide "Tios.nF -as RE7S

ro3ra calls TPS+5 %rone%arone5 ibutili%e5

otalol+ mainl block potaium channel/

Aiodarone is t-e DOC i# t-e. -a6e

concoitant eart Hailure t can causeCorneal deositsF -otosensiti6it.F

neuroat-.F increased LHT8s and $lue(3ra.is-

sinF ulonar. K$rosis All -a6e Additi6e T

rolon3ation

• Class @: Calciu C-annel 9locers "diltiaeF

6eraail%

• Ot-ers: Di3o)in "Lano)in%: .oaleiaF

-.oa3neseiaF and -.ercalceia

increase ris o# di3o)in to)icit.

**T-eraeutic ran3e #or AK$: 0+(2 n3l

En-ances 6a3al tone

Pulonar. Arterial .ertension:

Qroup 1 i PAN' can be i%iopathic5 genetic5 liver %ieae5 N6J

etc/

Wararin titrate% to 6R o 1/$-/$

protacclin analogue en%othelin receptor antagonit

oluble guanlate cclae timulator' rioci3uat

"Adeas%: >6 with PD-$ PDE(5 in-i$itors: il%enaLl *Revalo+ or a%alaLl

*A%circa+ ' iTerent Bran% an% %oe than ue% in D/

>6 with nitrate/ 6 a patient i taking a PD-$ inhibitor

an% ha chet pain5 hol% nitrate or 4 hour with

il%enaLl an% var%enaLl an% 4# hour or ta%alaLl

*ta%alaLl ha longer hal-lie+/

Qroup i PN5 which i pulmonar venou N orm let-

i%e% heart ailure/

Ast-a:

• bronchial hper-reponivene an% un%erling

inHammation

• chronic inHammator %ior%er o the airwa

•Naving patient %emontrate correct techniue i otena goo% i%ea


38/57

LA9A: "***99< to onl. used 4it- steroidsF not

onot-era. $c increased ris o# deat-%

Once ast-a is controlledF assess #or stedo4n

t-era. "reo6al o# LA9A% 4it-out loss o# ast-a

control

saleterol ! Quticasone "Ad6air Disus or HA%

#ooterol ! $udesonide "S.$icort%

n-aled Corticosteroids: "1st line t-era.%

$eclaet-asone "@AR%: ** re#erred in re3nanc.

$udesonide "Pulicort%

Quticasone "Hlo6ent%

oetasone "Asane)%

SE: Oral Candidiasis "T-rus-%F d.s-oniaF cou3-

**Pre6ent t-rus- 4it- sacer or rinsin3 out- 4it-

4ar 4ater and sit a#ter use

Oral Steroids: "#or se6erel. uncontrolled ast-a%

>ortione5 -.drocortisone "Solu(Corte#%F

et-.lrednisolone "7edrolF 7edrol DoseaF

Solu(7edrol%F PrednisoneF Prednisolone "7illiredF

OraredF Prelone%F triamcinolone *enalog+5

de)aet-asone "Decadron%F betamethaone

# on it ore t-an 10(1' da.sF reBuires a taer

Lon3(Ter SE: >uhing &n%rome5 6mmunouppreion5

Acne5 6nomnia(ervoune5 Npokalemia5 Amenorrhea5

Eteoporoi5 Weight Qain5 iabete5 Q6 Blee% etc//

7et-.lrednisolone '3 /PrednisonePrednisolone 53 / 053

De)aet-asone

Leuotriene Recetor Anta3onist:

onteluast "Sin3ulair%:103 DF 1(5 .rs old "'3%F 5(1'.rs old

"53%

can cause -eadac-e and neuros.c-iatric

$e-a6ior

Hor E9F onl. 4ors in 50 o# atientsFtae 2 -ours $e#ore e)ercise

ha phenalanine in it or a weetener o %ont

ue in P8

T-eo-.lline:

• not the mot eTective an% ha an. dru3

interactionsside eIects

T-eraeutic ran3e: 5(15 c3l

SE: nauseaF loose stools

Aino-.lline to T-eo-.lline ultile $. 0+T-eo-.lline to Aino-.lline di6ide $. 0+

Oaliua$ "Xolair%:

Hor se6ereF aller3ic ast-a n-i$its 3E $indin3

on ast cells and $aso-ils

S-ould al4a.s $e 3i6en in t-e doctor8s oJce

can cause Ana-.la)is

COPD:

• caue b cigarette moke an% other no.iou

chemical

d.sneaF c-ronic cou3-sutu roduction

soin3 ceation i the onl thing that low the

progreion

SA9A and SA7A: ratroiu "Atro6ent%F

iratroiu ! al$uterol "Co$i6ent Resiat%

LA9A and LA7A: tiotroiu "Siri6a andi-aler%

or acli%inium *u%orSa+ 7ore eIecti6e and ore

con6enient SE: Dr. out-

• PD-4 inhibitor' roHumilat *alirep+' increae >AMP

an% %ecreae lung inHammation

• &teroi%' long term onot-era. are not

recommen%e% in >EP5 not ver eTective/ 8e% in

combo with FABA/ *A%vair an% &mbicort+

• Qet Jaccine

Soin3 Cessation:

>ouneling an% me%ication are more eTective ue%together than either alone Stron3 correlation


39/57

$et4een counselin3 intensit. and Buittin3

success

5 UA8sV: AsF Ad6iseF AssessF AssistF Arran3e

*;ollow 8p+

Patients o#ten #ail 4-en t-e. do not use enou3-

NRT #or a clinical eIect

uF Loen3eF and Patc- are OTC onl. to 1+ .rs

and older

icotine Qum *icorette mg or 4mg+ a): 2'

iecesda. apere% %oe/ Ene C1-hr/ . M4ees5

then C-4 hr/ ) ? 4ees5 then C4-# hr/ ) ? 4ees/

Avoi% aci%ic beverage *1$ min/ beore or %uring .5

water i ok/+ $ cig(%a = mg 9$ cig(%a

=4mg

icotine FoSenge *>ommit mg or 4mg+ a): 20

loen3esda. 3)min to moke in the AM =4mg,

93)min to moke =mg

•

icotine Patche *ico%erm >C 7mg5 14mg5 1mg+'>an remove to avoi% inomnia/ Local sin reaction

coon 1) cig(%a = 14mg 91)cig(%a=1

mg/ " week *1mg+5 then week *14mg+5 then

week *7mg+ or " week *14mg+5 then week *7mg+

• icotine 6nhaler' ;reuent5 continuou puVng or )

min/ >lean mouthpiece/ 6n col% temp5 keep in warm

area like pocket/ Ence a cartri%ge i open5 onl goo%

or 1 %a/

e-cigarette' not ;A approve%5 but popular

9urorion SR "G.$anF 9uro$an%: &tart 1 week

beore uitting5 a): '503da. $c o# seiures/

&D: Dr. out-insonia BBW or neuropchiatric

event/

@arenicline "C-anti)%: icotine agonit( antagonit,

&tart 1 week beore uitting/ Do not use 4it-

nicotine roducts 99< #or neuros.c-iatric

e6ents nsonia and @i6id Dreas

Qet Jaccine' Soers 1>(M' s-ould 3et t-e

Pneuo6a)

Onl. 3u and loen3e nicotine are re3nanc. CF

ot-ers are D

Aller3ic R-initisF Cou3- and Cold:

Aller3ic R-initis Ua. He6erV:

• Avoi% e.poure to allergen

Mo%erate to evere' ntranasal Steroids 1st line :

Quticasone "Hlonase or @er.st%F oetasone

"Nasone)%F triacinolone "Nasacort%F

$eclaet-asone "nasl or 9econase%F

$udesonide "R-inacort%

Mil% to Mo%erate' Oral anti-istaines "suall. 2nd

en%: Qoo% or neeSing5 itching5 rhinorrhea5 but ha

22inial eIect on con3estion di-en-.draine "9enadr.l%: 1st 3enF 25(

503 PO '(M -rs Sedatin3 c-lor-eniraine "C-lor(Trieton%: 1st 3en

re#erred in re3nanc. cetiriine "G.rtec%

le6ocetiriine "X.al%

loratidine "Claritin%

desloratidine "Clarine)%

#e)o#enadine "Alle3ra%

aelastine "Astelin%: ntranasal

• Decon3estants: alpha agonit that caue

vaocontriction to re%uce congetion' Eral' phenlephrine *&u%ae% PD+ ' low

bioavailabilit seudoe-edrine "Suda#ed%: 7a)

a$le to $u.: ?M 3da. or > 3ont-F 7a)

intae is 2'03da. aal' O).etaoline "A#rin% or

-en.le-rine "Neo(S.ne-rine% Liit use

to ?da.s to re6ent re$ound con3estion


40/57

• Ether' cromoln *aalcrom+5 6ntranaal ipratropium

*or rhinorrhea to %r mucu+5 &ingulair5 aal

irrigation

ColdCou3-:

• inc' can %ecreae %uration o a col%

• Jitamin >' ma help prevent a col%

• 8uall a Jiral 6nection *e./ Rhinoviru+

• A%vie patient to ta well h%rate%

Numi%iLer an% JaporiSer can be ueul Do not use

toical ent-ol or ca-or in c-ildren less t-an

2 .rs old

C-ildren: OTC cou3-coldain or ac-es roducts

s-ould not $e used in c-ildren ' .rs old /

>ombo cough(col% pro%uct houl% not be ue% in

chil%ren 2 er HDA or M er Aerican Acade.

o# Pediatrics Do not use ASA due to ris o#

Re.e8s s.ndroei$uro#en "5(10 33 M(+ -rs%

Horulation 50 3125L or 10035l

APAP "10(15 33 '(M -rs%

Horulation 1M0 35L se cali$rated s.rin3e #or easurin3 i# it8s

an oral liBuid disensed

Decon3estant: Do not use in c-ildren M .rs old

e)cet PSE "not ' .rs% # re3nantF use

intranasal sra. lie O).etaoline or

-en.le-rine $c oral PSE can decrease $loodQo4 to in#ant

Cou3-:

De)troet-or-an "Dels. or UD7V in t-e

nae%: Man mechanim but i alo a erotonin

reuptake inhibitor/ Eten abue% b people when taken

in larger %oe %ue to it ketamine(P>P like

hallucinagenic aTect/ Pro$a$l. sa#e durin3

re3nanc.

Anti-istaines: %ont work or col% mptom/ Ma

help cough/

Codeine: Ne6er disense codeine to a

$reast#eedin3 4oan can cause #atal

resirator. deression in an in#ant

aui#enasin "7ucine)%: %ecreae phlegm vicoit5

unclear beneLt/

C.stic Hi$rosis:

• genetic %ior%er that %irupt >;R protein cauing

abnormal tranport o o%ium an% chlori%e acro cell

• leads to t-icF 6iscous lun3 secretions5 %iVcult

breathingF in#ections5 an% %igetive complication

*ill the pancrea+/

• n#ections usuall. interittent at Krst and

e6entuall. $ecoe c-ronic 4-ere t-e. a. need

in-aled anti$iotics

• 6 intermittent peu%omona5 treat with two 6J anti-

peu%omonal agent/

Mot common bug' &taph/ Aureu5 N/ ;lu5

Peu%omona/

Treatent:

9ronc-odilators: 8e beore giving inhale%

antibiotic to help antibiotic get in/ .ertonic Saline ".ersal+' hr%rate airwa

mucu to thin ecretion DNAse en.e: dornase al#a "Pulo.e% to

thin mucou n-aled anti$iotics: To$ra.cin n-aled

Solution "TO9% or TO9 Pod-aler or

Atreona L.sine n-alation "Ca.ston% to

prevent an% treat lung an% inu inection with

chronic inection/ ake %oe EB6 " hour apart

an% >aton 4 hour apart/ &olution tore% in

ri%ge5 Po%haler .capule at room temp/ in a %rplace/ 2+ da.s onF 2+ da.s oI c.cle

O l A it- i % i

RDM& h i h Al l


41/57

Oral Ait-ro.cin: to re%uce airwa

inHammation an% %irupt Peu%omona bioLlm

i3- HatF calorie(dense diet

Pancreatic En.es: Peancrealiase

"CreonFPancreaeF GeneF @ioase%: contain

liaseF a.laseF and rotease oe a%hemo might get place% on

hol%5 %oe re%uction5 or a tranuion*1)5))) or

)5))) with active blee%+

• Nepatoto.ic' Man

• ephroto.ic( Bla%%er o.ic' Man, N%ration help

Huh %rug out/ Amiotene ue% to re%uce rik o

ciplatin renal to.icit/ Mena*Mene.+ given with

ioami%e to prevent hemorrhagic ctiti/

•

Mucoiti' high rik with $-;85 capecitabine5 irinotecan5an% methotre.ate/ 8e saline rinses %ail/

• Nan%-;oot &n%rome' $-;85 an% capecitabine

• >lotting' Eten rom &DRM&

• Alopecia' a.ane an% anthraccline

• >ar%ioto.icit' Anthraccline

• auea(Jomiting' Mot >hemo rug epeciall

cislatinF %o.orubicin5 epirubicin5 cclophophami%e5

iooami%e/ > receptor are $N5 opamine5 Ach5

Nitamine5 Epioi%5 an% &ubtance P/

o uuall ue a combination o anti-emetic %rugo Ondansetron "Go#ranF Gule Kl%F

3ranisetron "ranisol%F dolasetron "Aneet%F

alonosetron "Alo)i%: $-N3 antagonit5 ris o#

T rolon3ationo roc-loreraine "Coro% and roet-aine

"P-ener3an%: block %opamine receptor in >&/

&D' sedationF let-ar3.F acute EPSo de)aet-asone "Decadron%o areitant"Eend% an% #osareitant "Eend

@+' ubtance P(eurokinin-1 receptor antagonit

% bi l *M i l+ > bi i% &D %

*t t ith t i + D l d Di - *t t ith


42/57

o %ronabinol *Marinol+' >annabinoi%/ &D' %row5

euphoria5 increae% appetite

Soe C-eo dru3s used in an. cancers:

• Al.lators: C.clo-os-aide "C.to)an+ an%

i#os#aide "#e)% he cro-link A preventing

replication/ &D' 9ladder To)icit.99<***eorr-a3ic C.stitis so 3i6e 7esne) to

prevent/

Ant-rac.clines: DOXOru$icin"Adria.cin% and

DANOru$icin "Ceru$idine% 6ntercalate into A/

&D' 99ro link A

cauing apoptoi/ SE: Ne-roto)icF Ototo)icF

neuropath/ Cislatin -as se6ere N@Ai#ostene to reduce cislatin ne-roto)icit.

7et-otre)ate: olate antimetabolite that prevent

A nthei in the &-Phae Leuco6orin rescue to%ecreae to.icit/ SE: and(#oot s.ndroe

P.riidine Analo3ues: caecita$ine "Xeloda% and

Hluorouracil "5(H%/ 6nhibit primi%ine nthei in

the &-Phae/ SE: and Hoot s.ndroe/ >6 with P

%eLcienc Leuco6orin increases eJcac. o# 5(H/

• Tooisoerase 1 in-i$itors: ironotecan

"Catosar% Block coiling an% uncoiling o A in &-

Phae with ingle tran% break/ &D' Acute Diarr-ea

*treat with atropine+5 Dela.ed Diarr-ea *treat with

loperami%e+

Tooisoerase 2 in-i$itors: etooside"@ePesid%

Block coiling an% uncoiling o A in Q Phae with

ingle tran% break/ &D' .otension

Ta)anes' aclita)el "Ta)ol% an% doceta)el

"Ta)otere%: 6nhibit microtubule unction in M-Phae/Mut ue non-pvc 6J bag an% tubing/ &D' eri-eral

neuroat-. 99< #or neutroenia Al4a.s 3i6e

$e#ore latins

• @inca Alaloids: 6incristine "@incasar% an%

6in$lastine "@el$an%: 6nhibit microtubule unction in

M-Phae/ &D' @esicantsF ner6e

daa3eneuroat-. "ostl. 6incrist

NAPLEX Random Notes 68 Pages

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