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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