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378 Cards in this Set
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alpha-glucosidase inhibitors (AGIs) are including...
1. 2. |
1. Precose (acarbose)
2. Glyset (migitol) |
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what class of Biguanide is?
Ex: Metformin (glucophage) |
Insulin sensitizers; Increase insulin sensitivity in the hepatic and peripherial
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What are the possibile side effects from metformin?
|
1. GI upset
2. Megalblastic anemia 3. Lactic acidosis |
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What is MOA of actos?
|
Actos is TZD (Thiazoladinediones; glitazones/TZD);
1. increase skeletal muscle, adipose tissue, and insulin sensitivity; 2. Decreased hepatic glucose production |
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What are the common AE of TZD drugs, ex: Actos, avandia?
|
1. Edema
2. Anemia 3. wt gain 4. excerabation of CHF |
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What is the MOA of Prandin?
|
MOA of Prandin (Repaglinide): To stimulate pancreatic beta-cells to secrete insulin
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What are the examples of sulfonylurea diabetes drugs?
1) 1st generation? 2) 2nd generation? |
1) 1st Generation:
- Dymelor (acetohexamide) - Diabinese (chlorpropamide) - Tolinase (Tolazamide) - Orinase (Tolbutamide) 2) 2ns generation - Amaryl (glimeperide) - Glucotrol (Glipizide) - Diabeta, Micronase (Glyburide) Glynase (Glyburide micronized) |
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What are the 2 classes of antidiabetes agents that can cause 1) weight gain and 2) hypoglycemia
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1) Sulfonylureas
2) Meglitinides |
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What classes of antidiabetic agent do not cause hypoglycemia?
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1. alpha-glucosidase inhibitors (acarbose and miglitol)
2. Insulin sensitizers (biguanide and TZD) |
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Meformin should be withheld 48 hours after pts undergoing radiological study. True or False?
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True
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List the 6 drugs contain Metformin.
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1. Glucophage
2. Glucophage XR 3. Riomet 4. Glucovance 5. Avandamet 6. Metaglip |
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What are CIs in metformin?
|
For female, Cr >1.4
For male, Cr > 1.5 Predisposed to potentially fatal lactic acidosis |
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TZD (actose, avandia)+ oral contraceptive pills --> ?
|
Need to increase estrogen dose
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What are Contraindications in TZD (actose, avandia)
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1. ALT >2.5 normal
2. CHF 3. Hepatic patients |
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What are the monitoring parameters taking metformin?
|
1. Renal
2. Liver, 3. serum B12 4. folic acid 5. Hgb 6. Hct 7. CBC |
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Chlorpropamide + prednisone
--> ??? (DDI) |
hyperglycemia
|
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Phenytoin + tolazamide --> ??
|
Increased BG levels
|
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Glimepiride + itraconazole
--> ??? (DDI) |
Dcreased BG level
|
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Which insulin can be adminstered IV?
|
Regular (clear); glargine is clear but it's low pH=4.0 (no IV)
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What is myxedema?
What are the S/Sx? |
Myxedema is an end stage of hypothyroidism.
S/Sx: weakness, confusion, hypothermia, hypoventilation, hypoglycemia, hyponatremia, coma and shock |
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" High TSH
Low T4"; what is the Dx? |
Hypothyroidism
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What is MOA of Levothyroxine?
|
To increase oxygen consumption by most of tissues and increase metabolic rate of CHO, lipids and protein
|
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Take Levothyroxine with or without food?
|
Without food, take 30 mins before breakfast
|
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what is thyroid storm?
|
thyroid stormis life-threatening, fever, tachycardia, delirium, and coma
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what is MOA of Propylthiouracil (PTU)?
|
1. The peripheral conversion of T4 to T3
2. Inhibits the synthesis of thyroid hormone by preventing the incorporation of iodine into iodothrosine 3. ..by inhibiting the coupling of monoiodotyrosine nd diiodtyrosine to form T4 abd T3 |
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What is the MOA of methimazole?
|
1. Inhibits the synthesis of thyroid hormone by preventing the incorporation of iodine into iodothrosine
2. ..by inhibiting the coupling of monoiodotyrosine nd diiodtyrosine to form T4 abd T3 |
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Lithium + Lugol's solution
--> ??? (DDI) |
Increased Lugol's solution effects
|
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what is Grave's disease?
|
Hyperthyrodism
|
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What is Cushing's syndrome?
|
1. Increased ACTH by pituitary gland adenomas
(Increased CRH-corticotropin-rleasing hormone --> Increased ACTH --> Increased adrenal cortex to produce cortisol 2. Chronic use of glucocortiocoid excess |
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What is the MOA of aminoglutethimide?
|
Inhibits conversion of cholesterol to pregnenolone
|
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What is the MOA of metyrapone?
|
To decrease cortisol synthesis by inhibition of 11-hydroxylate activity
|
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What are adverse effects of Cytadren?
|
rash, blood dyscrasias and hypothyrodism; may also decrease effects of warfarin
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What is Addison's disease?
|
Primary adrenocortical deficiency; in result of glucococorticoid and mineralocorticoid deficiency
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what are therapeutic uses of desmopressin?
|
Nocturnal enuresis, diabetes insipidus, hemophilia A, von Willebrand's disease; Also increase clotting factor VII levels
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Androgens and anabolic steroids are NOT scheduled drugs. True or False?
|
False; they are scheduled III
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During postmenopausal,
1)Estrogen decreased or increased? 2)Progesterone decreased or increased? 3)FSH decreased or increased? 4)LH decreased or increased? |
1)Estrogen decreased
2)Progesterone decreased 3)FSH increased 4)LH increased |
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To treat a women with an intact uterus for postmenopausal hormone replacement therapy, which hormone is must included?
|
Progestin to reduce the risk of endometrial cancer/hyperplasia
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Climara, once a week or twice weekly?
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Once a week
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FemPatch once or twice a week?
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Once
|
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"Alora, Esclim, Estraderm, Menostar, Vivelle, Vivelle Dot" once a week or twice a week?
|
Twice a week
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What is Vagifem dosing?
|
25 mcg/tab QHS for 2 weeks, and then twice a week for 2 weeks (18 tabs for a month supply)
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What's the frequency of Estring?
|
90 days ( evry 3 months)
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What are the common adverse effects of ERT (Estrogen replacement therapy)?
|
1. Breast tenderness
2. Heavy bleeding 3. Headache 4. Nausea |
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What are the common adverse effects of progestin therapy?
|
1. Depression
2. Irritability 3. Headache |
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Is Estrogen a CYP450 2D6, 1A2, 2C9 or 3A4 inhibitors?
|
3A4 inhibitors
|
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Synthroid + Warfarin --> ??? (DDI)
|
Increased metabolism of Vit-K--> decreased warfarin effects --> may neeed to increased warfarin dose
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Estrogen + thyroid hormone
--> ??? (DDI) |
Decreased thyroid hormone Weffects
|
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When are "mini-pills" indicated?
|
1. breastfeeding women
2. Free CVD risks associated with estrogen-containing products |
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What is estrogen's MOA in birth control pills?
|
1. To prevent development of a dominant follicile by supression of FSH;
2. Do not block ovulation |
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What is progestin's MOA in birth control pills?
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Block ovulation by increasing the thickness and atrophy of the endometrium
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List 3 Oral contraceptive pills are progestin only pills.
|
1. Camila
2. Ortho Micronor 3. Errin 4. Nor-QD 5. Nora-BE 6. Ovrette |
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What much estrogen content in high-dose estrogen OC?
|
50 mcg; ex: Neocon 1/50, Ovcon50, Zovia 1/50
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What much estrogen content in low-dose estrogen OC?
|
from 10 - 35 mcg
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List 3 drugs/classes can increase oral contraceptives level.
|
1. 3A4 inhibitors
2. Atorvastatin 3. Vitamin C |
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Oral contraceptives + pioglitazone (Actos) --> ??? (DDI)
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Decreased OC effects
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Oral contraceptives + hypoglycemics (tolbutamide, Diabinese, Orinase, Tolinase)
|
Decreased effects hypoglycemics agents
|
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Oral contraceptives + cortisone --> ??? (DDI)
|
Increased toxicity of cortisone
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what types of hormone imbalance from the finding "Spotting" and "Early, or mid-cycle? breakthrough bleeding"
How do we adjust that? |
Estrogen deficiency; increased estrogen levels
|
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what types of hormone imbalance from the finding "fatigue" "weight gain" "acne or oily scalp" " depressoin" " increased appetite"?
How do we adjust that? |
Progestin excess;
decreased progestin levels |
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what are the daily Calcium and Vit-D recommended?
|
Calcium 1000-1500 mg
Vitamin D 400-800 IU/day |
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What is the MOA of actonel, fosamax?
|
Bisphosphonates; Binds to bone (hydroxyapatite) and incorporates into boneto increase and stablize bone mass
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Fosamax 10 mg/day + ASA
--> ??? (DDI) |
Increased risk of upper GI bleeding
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What is the MOA of SERM (selective estrogen receptor modulator, ex: Evista)?
|
Raloxifene (Evista; act as estrogen receptor agonist at the skeleton, decrease bone resorption and overall bone turnover
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Evista + warfarin --> ??? (DDI)
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Decreased Warfarin effects
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What is the MOA of Miacalcin?
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Inhibit bone resorption by binding to osteoclast receptors
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What is the MOA of Forteo?
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Increased the rate of bone formation by increasing the birth rate of osteoblasts and preventing apoptosis, resulting improve bone density
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What type of oral contraceptive pills you will recommend for a smoker woman over 35 years?
|
Progestin only (mini-pills)
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What is the dose Mucomyst (acetylcysteine)for pretreament exposure radiocontrast dye?
|
Mucomyst 600 mg PO BID for 2 days, begining one day before procedures
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What are the adverse effects of osmotic diuretics?
|
1. Pulmonary edema
2. acute rise of serum K+ 3. Blurred vision 4. Rash |
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What are the E- imbalances from Thiazide and thiazide-like diuretics?
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1. Hypokalemia
2. Hyponatremia 3. Hypercalcemia |
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What are the E- imbalances from loop diuretics?
|
1. Hypokalemia
2. Hypomagnesemia 3. Hyponatremia 4. Hyperuricemia 5. Hyperglycemia 6. Hypercalciuria |
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1 mg Bumetanide
= A mg Torsemide = B mg Furosemide |
A= 20 mg
B= 40 mg |
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Ergocalciferol
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Vitamin D precursor (requires hydroxylation within the liver to calcifediol and 2nd hydroxylation in the kidney to form active Vit-D
|
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What should use for iron overload?
|
Desferal (deferoxamine)
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What is the potential risk of administering iron IV? 1
|
Increased risk of infection
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What are the signs of vitamin D intoxication and hypercalcemia?
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Weakness, headache, somnolence, nausea, vomiting, bone pain, polyuria
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Folic acid + phenytoin
--> DDI (????) |
Decreased phenytoin concentration
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Hydromorphone
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Dilaudid
|
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Fentanyl
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Sublimaze
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Acetaminophen
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Tylenol
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Ketorolac
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Toradol
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Atitvan
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Lorazepam
|
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Versed
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Midazolam
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Diprivan
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Propofol
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Pancuronium
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Pavulon
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Norcuron
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Vecuronium
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Cisatarcurium
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Nimbex
|
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Dexmedetomidine
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Precedex
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Nimotop
|
Nimodipine; calcium channel block give for 21 days; indicated for treating abeurysmal subarachnoid hemorrhage
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Dalteparin
|
Fragmin (2500-5000 units SC)
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Lovenox
|
enoxaparin
|
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Fondapariunx
|
Arixtra
|
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Direct thrombin inhibitors:
1. Lepirudin (A) 2. Bivalirudin (B) 3. Agatroban |
A --> Refludan
B --> Angiomax |
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Tegretol
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Carbamazepine
|
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Lamictal
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Lamotrigine
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Keppra
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Levetiraccetam
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Oxcarbazepine
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Trileptal
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Tiagabine
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Gabitril
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Zonisamide
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Zonegran
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Drotrecogin alfa; an endogenous anticoagulant; recommbinat human activated protein C
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Xigris
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DDAVP
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Desmopressin (for diabetes insipidus)
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Pavulon
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Pancuronium
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Nolvadex
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Tamoxifen
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Faslodex
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Fulvestran
|
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Aromasin
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Exemestane
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Arimidex
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Anasrozole
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Femara
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Letrozole
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Casodex
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Bicalutamide
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Avastin
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Bevacizumab
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Erbitux
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Cetuximab
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Hydroxyurea
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Hydrea MOA: inhibits DNA synthesis witout interfering with RNA and protein synthesis
|
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Imatinib mesylate
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Gleevec
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Erlotinib
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Tarceva
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Iressa
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Gefitnib
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Sutent
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Sutinib
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Sprycet
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Dasatiniib
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Velcade
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Bortezomib
MOA: Inhibits the 26S proteasome; stabilizes regulatory proteins causing apoptosis and disrupting cell proliferation |
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Dolasetron
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Anzemet
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Granisetron
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Kytril
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Palonosetron
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Aloxi
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Compazine
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Prochlorperazine
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Thorazine
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Chlorpromazine
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Phenergan
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Promethazine
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Emend
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Aprepitant
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Imatinib mesylate
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Gleevec
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Erlotinib
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Tarceva
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Iressa
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Gefitnib
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Sutent
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Sutinib
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Sprycet
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Dasatiniib
|
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Velcade
|
Bortezomib
MOA: Inhibits the 26S proteasome; stabilizes regulatory proteins causing apoptosis and disrupting cell proliferation |
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Dolasetron
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Anzemet
|
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Granisetron
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Kytril
|
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Palonosetron
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Aloxi
|
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Compazine
|
Prochlorperazine
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Thorazine
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Chlorpromazine
|
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Phenergan
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Promethazine
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Emend
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Aprepitant
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What is the main side effect of Zoladex (Goserelin)?
|
Bone pain
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What the hormones and antagonists can be used for both breast and prostate cancer?
|
LHRH agonists (Lupron, Eligar and Zoladex)and Ethinyl estradiol
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what is the MOA of cyclosporine?
|
Inhibits calcineurin-dependent translocation of the cytosolic subunit of NFAT (the promoter gene for IL-2); inhibits IL-2 synthesis
|
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What is the MOA of Tacrolimus?
|
Inhibits IL-2 transcription and synthesis (binding with FKBP-12 and a calcium-calmodulin-calcineurin complex)
|
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What knid of electrolyte imbalance Prograft (Tacrolimus)can cause?
|
Could cause hyperkalemia
|
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Name 4 common adverse effects of cyclosporine.
|
1. Hirsutism
2. Nephrotoxicity 3. Ginggival hyperplasia 4. Hyperlipidemia |
|
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Prednisone and tacrolimus may cause ????.
|
Diabetets mellitus
|
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Prograft does not need to monitor trough concentrations. True or False
|
false
|
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Prograft
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Tacrolimus
|
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CellCept
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Mycophenolate mofetil
|
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Azathioprine
|
Imuran
|
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Arava
|
Leflunomide (anti-proliferative, immunosupressant drugs)
|
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Cholestyramine
|
Prevalite
|
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Nexium
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Esomeprazole
|
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Prilosec
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Omeprazole
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Prevacid
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Lansoprazole
|
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Aciphex
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Rabeprazole
|
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Protonix
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Pantoprazole
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Tagamet
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Cimetidine
|
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Zantac
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Ranitidine
|
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Axid
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Nizatidine
|
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Pepcid
|
Famotidine
|
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Tritec
|
Ranitidine + bismuth citrate
|
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Furazolidone
|
Furoxone (100 mg tid for 10-14 days)
|
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Methocarbamol
|
Robaxin
|
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Mesalamine
|
Asacol
|
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Lomotil
|
diphenoxylate + atropine
|
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Imodium
|
Loperamide (2 mg after each loose stool, dne: 16 mg/day)
|
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List 4 examples of H2 blockes.
|
1. Tagamet
2. Zantac 3. Axid 4. Pepcis |
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List 5 examples of PPI.
|
1. Aciphex
2. Preveacid 3. Prilosec 4. Protonix 5. Nexium |
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How does antacids + (tetracyclines, ferrous sulfate and quinolones) reduce the absorption and effectiveness of the drugs?
|
By forming chealate complex
|
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HOw does antacid the absorption of (azoles and sucrafate)?
|
By increeasing gastric pH
|
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Drug that may redcue LES pressure.
|
1. Calcium channel blockers
2. beta-blockers 3. Nitrate 4. batbiturates 5. Anticholinergics 6. Theophylline |
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Drugs that may have irritant effects on the esophageal mucosa.
|
1. Tetracyclines
2. NSAIDs 3. Aspirin 4. Bisphosphonate 5. Iron 6. quinidine 7. KCl |
|
|
Methotrexate + NSAIDs --> ??? (DDI)
|
Fatal interaction. Severe bone marrow suppression
|
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List 2 drugs use to maange IBS (irritable bowel syndrome).
|
1. Hyoscyamine
2. Dicyclomine (anticholinergic and antimuscarine) |
|
|
Tegaserod
|
Constipation-predominant IBS
|
|
|
Alosetron
|
Severe Diarrhea-predominant IBS
|
|
|
Dicyclomine
|
Mild, diarrhea-predominat IBS
(may add TCA ex: Amitriptyline) |
|
|
What can we use to manage fistula (of IBS)?
|
1. Infliximab
2. High-dose metronidazole 3. Ciprofloxacin 4. azathioprine |
|
|
What DMARDs stands for?
|
Disease-Modifying antirheumatic drugs (DMARDs)
|
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1) What is the most serious adverse effect of Plaquenil?
2) Who are at high risk? |
1. Vision loss (retinal damage)
2. A cumulative dose of 800 g and age >70 years |
|
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All diuretics can cause hyperuricemia. Which diuretic is exception?
|
Spironolactone
|
|
|
Name 3 medications can be used for acute gouty arthritis attack.
|
1. Colchicine
2. NSAIDs (Indomethacin) 3. Corticosteroids |
|
|
1. What is the most common side effect of colchicine?
2. The most severe side effect (but rare)? |
1. Diarrhea (pt should not never exceed a total of 8 mg)
2. Bone marrow suppression |
|
|
What is the dose of colchicine when acute gouty attack?
|
1. 0.6 to 1.2 mg every 2 hours until pain relief, diarrhea or a max dose of 8 mg/day
2, Only effective when initiated within 12-36 hours of the attack |
|
|
What are the 2 drugs used for gout prophylaxis by increasing uric acid secretion?
|
1. Probenecid (Benemid)
2. Anturane (Sulfinpyazone) |
|
|
What are the 2 drugs used for gout prophylaxis by ihbiting uric acid production?
|
1. Zyloprim (Allopurinol)
MOA: inhibits xanthine oxidase formation (XO) |
|
|
What is the most common side effect of allopurinol?
|
Rash (may be as simple as a maculopapular eruption or as serious the life-threating SJS.
|
|
|
List drugs that can cause SLE (Systemic Lupus Erythematosus).
|
1. Procainamide
2. Phenytoin 3. Chlorpromazine 4. hydralazine 5. quinidine 6. methyldopa 7. Isoniazid |
|
|
Arava (Leflunomide) + MTX -->
???? (DDI) |
Increased liver toxicity
|
|
|
Gold therapy + Plaquenil --->
???? (DDI) |
Increased rash
|
|
|
Anakinra (antirheumatic agents).
1. MOA 2. Use as.. 3. Form |
1. IL-1 inhibitor
2. a single or combination agent 3. A single-use prefilled syringe |
|
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Methadone (Dolophine)...
1) MOA? 2) |
1) Pure u agonist and NMDA antagoinst
|
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|
Pentazocine
1) MOA |
1) K-agonist and u-antagoist
(more dysphoriam, less respiratory depression) |
|
|
List 2 drugs are used to reverse opioid overdose.
|
1) Naloxone (Narcan)
2) Naltrexone (ReVia, Trexan) for alcohol dependent/narcotic addiction |
|
|
MAO i + Meperidine (opioids) --> DDI (???)
|
1. Death
|
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Most opioids are required dose reduction in severe liver disease. List drugs that need to reduce dose in renal disease.
|
1. Fentanyl
2. Morphine 3. Methadone |
|
|
What 2 beta-blockers can be used for migraine as 1st line?
|
1. Propanolol
2. Timolol |
|
|
Addiction is....
1. 2. |
1. compulsive use of drug
2. The use of a substance for psychic effects |
|
|
One of severe adverse effect of Methadone is....
|
Torsades de pointes
|
|
|
How does morphine metabolize?
|
By hepatic glucoronidation (NOt CYP450)
|
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|
Oxycodone, hydrocodone and codeine are P450
1) 2D6 2) 3A4 3) 1A2 4) 2C9 |
1) 2D6 substrate
** Also, Tramadol, meperidine, propoxyphene 2D6 substrates*** |
|
|
Hydromorphone has a long or short half-life?
|
A short half-life
|
|
|
What roles of Caffeine in Excedrin Migraine?
|
1) Analgesic
2) Possibile anti-inflammatory 3) Increased gastric acidity and perfusion, enhancing the absorption of aspirin |
|
|
What is the rational behind TCA is most likely worsen opioid-induced constipation?
|
Anticholinergic effects
(TCAs: Elavil, |
|
|
Midrin
|
5 capsules within 12 hours period;
Dose: 2 capsules at once, 1 cap every 1 hour until head is gone. (DNE 5 capsules/12 hours) |
|
|
DOC for new onset seizures.
|
1. Carbamazepine (DOC)
2. Phenytoin 3. Valproic acid |
|
|
DOC for refractory seizures.
|
1. Carbamazepine
2. Phenytoin 3. Valproic acid |
|
|
DOC for generalized seizures (if pt has both absence and generalized tonic-clonic seizures)
|
Ethosuximide
|
|
|
DOC for generalized seizures (if pt > 2years old)
|
Valproic acid
|
|
|
DOC for DOC tonic-clonic seizures.
|
Phenytoin,
Carbamazepine Topiramate Valproic acid |
|
|
List drugs can cause seizures.
|
1. Carbapenem (Imipenem)
2. Meperidine (in patients with renal failure) 3. Local anesthetics (Lidocaine) 4. Metoclopramide 5. Theophylline 6. TCA 7. Anticonvulsants (Carbamazepine, Ethosuximide, Phenytoin, Phenobarbital) |
|
|
What is hydantoin facies?
|
From chronic use of phenytoin
1. Thicken subcutaneous tissues 2. Enlargement of nose and lips |
|
|
What is side effect of inititation of phenytoin?
|
1. Nausea
2. Vomiting 3. Drowsiness and 4. Dizziness |
|
|
What are the 2 life-threatening adverse reaction from Phenytoin?
|
1. Hepatic failure
2. Stevens-Johnson syndrome |
|
|
What are the 2 Black Box Warning of Carbamazepine?
|
1. Direct hepatotoxicity
2. Aplastic anemia (if WBC<2000-3000, or Nu<1000-1500) |
|
|
What are the 3 Black Box Warning of Valproic acid?
|
1. Fatal Hepatoxicity
2. Fetal hemorrhagic pancreatitis 3. Fetal teratogenic |
|
|
How does Gabapentin eliminate?
|
100% renal
|
|
|
What is BBW of Lamotrigine?
|
Rash
|
|
|
What is BBW of Zonisamide and Topirmate?
|
Oligohidrosis (may not sweat) like Topirmate
** also kidney stones but it's not BBW** |
|
|
What are DOCs for acute simple or complex partial seizures?
|
1. Valium and Lorazepam (rectally)
|
|
|
Topirmate --> weight loss
X --> weight gain |
X --> valproic acid
|
|
|
Meperidine may cause seizures in adults patients with renal failure. T or F
|
True
|
|
|
Why is important that to keep good oral hygine when patient is on phenytoin?
|
Becuase phenytoin can cause gingival hyperplasia
|
|
|
What is the MOA of typical antipsychotic drugs?
|
1. Block postsynaptic dopamine-2 receptors
-- They share snticholinergic, antighistamine, and alpha-blocking |
|
|
What are S/Sx of anticholinergic effects?
|
1. Sedation
2. Dry mouth 3. Blurred vision 4. Constipation 5. Urinary hestitancy |
|
|
What is the treatment choice for Dystonic reaction (from antipsychotic drugs's side effects)?
|
1. Cogentin (Bentropine) 1-2 mg IM, or
2. Diphenhydramine 25-50 mg IM every 30 mins until relieved |
|
|
What is the treatment choice for akathisia reaction (from antipsychotic drugs's side effects)?
|
1. Lipophilic beta-blockers (ex: propanolol)
2. Benzodiazepines 3. clonidine 4. Anticholinergics |
|
|
What is the treatment choice for pseudoparkinsonism (from antipsychotic drugs's side effects)?
|
1) Amantadine (symmetrel) 100 mg BID or
2) Anticholinergics |
|
|
What is the treatment choice for Neuroleptic malignant syndrome (NMS) (from long-term use of antipsychotic drugs)?
|
1. ER STAT
2. D/C antipsychotic 3. Bromocriptine (dopamine agonist) 4. Dantrolene (smooth muscle relaxant) |
|
|
Dopamine VS. prolactin?
|
Dopaime regulate prolatin rleased. When dopamine is blocked, prolactin level is increased.
|
|
|
What are the adverse effects of Clozapine (Clozaril)?
|
1. Agranulocytosis
2. Seizure (>600 mg/day) 3. Hypersalivation |
|
|
What can use for acute schizophrenia?
|
1. Haloperidol or fluphenazine (IR) with Lorazpam 2 mg IM q4h prn
2. Olanzapine 3. Ziprasidone |
|
|
What are the monitoring paramters on atypical psychotics?
|
1. Baseline BP, glucose, and lipids and 12 weeks
2. Weight (BMI) at baseline, 4, 8 and 12 weeks and then quarterly 3. Weight circumference baseline then annually 3. |
|
|
How to convert from Haldol PO to Haldol IM?
--> reach steady state in 8-12 weeks |
PO daily dose X 10 = /4 week
ex: 10 mg QD --> 100 mg /4 weeks |
|
|
How to convert prolixin PO to IM?
--> reach steady state in 6 weeks |
1 mg PO = 1.25 mg IM/2 weeks
ex: 10 mg PO QD -->12.5 mg IM/2 weeks |
|
|
What is Ebstein's anomaly?
|
Cardiovascular defects in newborn associated with Lithium use in 1st trimester pregnancy
|
|
|
Whar the 7 monitoring parameters in Lithium use?
|
1. Thyroid panel (baseline and every 6-12 months)
2. Scr/BUN Renal (baseline, 3, 6 and every 12 months) 3. CBC with differential (leucocytosis) 4. electrolytes (hyponatremia) 5. EKG 6. Urinalysis (increased specific gravity) 7. Pregnancy test |
|
|
Lithium can cause hyper- or hypothyroidism?
|
Hypothyroidism
|
|
|
What are the 2 monitoring parameters of Depakote (Divalproex sodium)?
|
1. LFT; liver elimited BBW for hepatoxicity
2. CBC with diff (Valproic acid can cause thrombocytopenia) |
|
|
What is therapeutic level of lithium?
|
acute: 0.6-1.2 (mEq/L)
Maintenance:0.8-1.0 Draw level 2-8 hours post dose |
|
|
What is therapeutic level of valproic acid?
|
50-125 mcg/ml
|
|
|
What is therapeutic level of carbamazepine (CBZ)?
|
4-12 mcg/ml
|
|
|
What is the treatment choice for pseudoparkinsonism (from antipsychotic drugs's side effects)?
|
1) Amantadine (symmetrel) 100 mg BID or
2) Anticholinergics |
|
|
What is the treatment choice for Neuroleptic malignant syndrome (NMS) (from long-term use of antipsychotic drugs)?
|
1. ER STAT
2. D/C antipsychotic 3. Bromocriptine (dopamine agonist) 4. Dantrolene (smooth muscle relaxant) |
|
|
Dopamine VS. prolactin?
|
Dopaime regulate prolatin rleased. When dopamine is blocked, prolactin level is increased.
|
|
|
What are the adverse effects of Clozapine (Clozaril)?
|
1. Agranulocytosis
2. Seizure (>600 mg/day) 3. Hypersalivation |
|
|
What can use for acute schizophrenia?
|
1. Haloperidol or fluphenazine (IR) with Lorazpam 2 mg IM q4h prn
2. Olanzapine 3. Ziprasidone |
|
|
What are the monitoring paramters on atypical psychotics?
|
1. Baseline BP, glucose, and lipids and 12 weeks
2. Weight (BMI) at baseline, 4, 8 and 12 weeks and then quarterly 3. Weight circumference baseline then annually 3. |
|
|
How to convert from Haldol PO to Haldol IM?
--> reach steady state in 8-12 weeks |
PO daily dose X 10 = /4 week
ex: 10 mg QD --> 100 mg /4 weeks |
|
|
How to convert prolixin PO to IM?
--> reach steady state in 6 weeks |
1 mg PO = 1.25 mg IM/2 weeks
ex: 10 mg PO QD -->12.5 mg IM/2 weeks |
|
|
What is Ebstein's anomaly?
|
Cardiovascular defects in newborn associated with Lithium use in 1st trimester pregnancy
|
|
|
Whar the 7 monitoring parameters in Lithium use?
|
1. Thyroid panel (baseline and every 6-12 months)
2. Scr/BUN Renal (baseline, 3, 6 and every 12 months) 3. CBC with differential (leucocytosis) 4. electrolytes (hyponatremia) 5. EKG 6. Urinalysis (increased specific gravity) 7. Pregnancy test |
|
|
Lithium can cause hyper- or hypothyroidism?
|
Hypothyroidism
|
|
|
What are the 2 monitoring parameters of Depakote (Divalproex sodium)?
|
1. LFT; liver elimited BBW for hepatoxicity
2. CBC with diff (Valproic acid can cause thrombocytopenia) |
|
|
What is therapeutic level of lithium?
|
acute: 0.6-1.2 (mEq/L)
Maintenance:0.8-1.0 Draw level 2-8 hours post dose |
|
|
What is therapeutic level of valproic acid?
|
50-125 mcg/ml
|
|
|
What is therapeutic level of carbamazepine (CBZ)?
|
4-12 mcg/ml
|
|
|
Lis 5 drugs can induce depression.
|
1. Corticosteroids
2. Oral contraceptives 3. Propranolol 4. Clonidine 5. Methyldopa |
|
|
What is MOA of TCA (Tricyclic antidepressants)?
|
TCAs inhibit the presynaptic neuronal membrane's reuptake of 5HT and/or NE
|
|
|
List common adverse effects of TCAs.
|
1. Orthostatic hypotension
2. Tachycardia 3. sedation 4. Anticholinergic effects 5. Arrthymias (prolonged QT interval) 6. Weight gain 7. sexual dysfunction |
|
|
What are the CI with TCAs?
|
1. MAO i use in 14 days
2. Pregnancy 3. Lactation and 4. Narrow-angle glaucoma |
|
|
Which SSRIs used in geriatric patients?
|
1. Celexa (Citalopram) few drug interactions
2. Zoloft (Sertrazline) |
|
|
Lexapro v.s. Celexa
|
10 mg Lexapro = 40 mg Celexa
|
|
|
Sarafem = Prozac
|
Fluoxetine
|
|
|
Prozac weekly
|
90 mg Fluoxetine once a week
|
|
|
What is contraindication of Effexor?
|
Uncontrolled BP, recent MI or CV disorder
|
|
|
What is contraindication of Cymbalta?
** Metabolized by 1A2 and 2D6** |
1. Narrow-angle glaucoma
|
|
|
What is MOA of Bupropion?
|
An inhibitor of NE and DA reuptake
|
|
|
What is MAx daily dose for Bupropion?
--> increased risk of seizures |
450 mg/day
(400 mg/day for SR) |
|
|
What are the adverse effects of Mirtazapine?
|
1. sedation
2. Increased appetite 3. WEight gain 4. Constipation 5. elevation LFT and TGs 6. small risk of agranulocytosis and neutropenia |
|
|
Benzodiazepines (BZD).
Quick onset (more lipophilic) |
Benzodiazepines (BZD).
1) Quick onset (more lipophilic): - alprazolam. - diazepam, - chlorazepate and - flurazepam |
|
|
Benzodiazepines (BZD).
slower onset (less lipophilic) |
1. Lrazepam
2. clonazepam 3. Chlordiazepoxide |
|
|
Benzodiazepines (BZD).
Which BZD are preferred in patients with hepatic dysfunction? and why? |
1. LOT (Lorazepam. Oxazepam, and temazepam)
2. Metabolized by conjugation but oxidation |
|
|
What is DOC of TCAs for OCD?
|
Clomipramine
|
|
|
What are DOCs for SAD (social anxiety disorder) or panic disorders?
|
1. Propranolol
2. atenolol |
|
|
When hydroxyzine is DOC?
|
for anxiety and in patients with substance abuse
|
|
|
What are the common side effects of initiating Lithium?
(later onset: WEight gain and mental dulling) |
1. Polyuria
2. Polydispsia 3. Tremor 4. GI upset |
|
|
What are the common adverse effects of SSRIs?
|
Insomnia, GI upset, and headache
|
|
|
What is the MOA of Benzoyl peroxide?
(may bleach hair or dyed fabrics) |
By releleasing oxygen to destory P. acnes
|
|
|
What are the OTC products to treat acne?
|
1. Benzoyl peroxide
2. Sulfur 3. Salicylic acid 4. Resorcinol |
|
|
List OTC products can use for Poison Ivy.
|
1. Burow's solution
2. Domeboro powder 3. Calamine lotion 4. Kaolin 5. Zinc acetate |
|
|
List Rx products for Poison Ivy.
|
1. Decadron, Aristocort, Medrol dosepak
2. IV 100 mg prednisone |
|
|
List a product for Poison Ivy prevention.
|
Ivy Block (Bentoquatam 5% solution) apply 15 minutes before possibile plant contact
|
|
|
What is MOA of RID?
-(Pyrethrins) - Tx repeat in 1 week |
MOA: Blocks transmission of nerve cell impulses in lice causing paralysis
|
|
|
What is MOA of NIX?
- Permethrin - a single-application |
MOA: same as RID
- 1% OTC for head lice - 5% sabies (mites) infestation |
|
|
What is DMEP (dimethyl ether and propane)?
|
FDA approved for OTC removal of common warts and plantar warts
|
|
|
List 3 active ingredients are used in OTC oral decongestant.
MOA: vaspconstrictors; constrict blood flow to nasal mucosa and decrease edema |
1. Phenylephrine
2. Pseudoephedrine 3. Ephedrine (alpha-adrenergic agoinsts) |
|
|
Medicamentosa
|
rebound congestion (use nasal products >3-5 days)
|
|
|
Which one is the shortest-acting topical decogestant?
1. Xylometazoline, 2. Phenylephrine, 3. Naphazoline, 4. Oxymetazoline |
2) Phenylephrine
|
|
|
Which one is the longest-acting topical decogestant?
1. Xylometazoline, 2. Phenylephrine, 3. Naphazoline, 4. Oxymetazolinie |
4) Oxymetazoline
|
|
|
What is chlorpheniramine?
|
Antihistamine
ex: (Chlor-Trimeton)Chlorpheniramine |
|
|
List 4 active ingredients in antitussive/cough suppressants.
|
1. Codeine (narcotic) for night cough
2. Dextromethorphan (DM) 3. Diphenhydramine 4. Benzonatate |
|
|
What is the MAX daily dose of Guaifenesin?
|
2400 mg/day
|
|
|
What is the onset action of bulk-forming laxatives?
|
1) 2-3 days
|
|
|
What drugs may interact with bulk-forming laxatives?
|
1. May bind Digoxin, warfarin and other drugs
2. Ca-complexes may bind with tertracycline, inhibiting its absorption |
|
|
Stool softeners =??
|
Emollient laxatives
|
|
|
Who are good candidates for emollient laxatives?
(Hint: for those should avoid straiing) |
1. Rectal surgery
2. Postpartum 3. Recent MI Onset of action: 2-3 days |
|
|
What is the onset of action of Glycerin?
|
30 minutes
|
|
|
What is milk of magnesia?
CI: 1. Rena; failure 2. CHF 3. HTN |
Mg(OH)2, osmotic laxative
|
|
|
Why lubicant laxatives are contraindicated in children and elderly patients?
Ex: mineral oil, olive oil |
Because increase risk of asipration and lipid penumonitis
|
|
|
Which laxative is Rx only?
|
Lactulose
MOA: Nonabsorbed disacchardide, metabolized by bacteria in GI tract to produce acetic and formic acid (it exerts osmotic effect) |
|
|
Which laxatives are recommended for pregnancy women?
|
1. Bulk-forming laxatives
2. Stool softeners - colace - Surfak - Recent MI |
|
|
What is MAX dose of Imodium AD?
|
4 mg now and 2 mg after each loose stool. (max: 8 mg/dat OTC, if Rx: 16 mg/day)
|
|
|
What is min age of Adsorbent laxatives (ex: Kaolin)?
|
12 years old
|
|
|
What is toxic effect of salicylate toxicity?
|
Tinnitus
|
|
|
What is toxic effect of bismuch toxicity?
|
Neurotoxicity
|
|
|
What hormone in Ovulation predication kit is used to predic ovulation?
|
LH (Testing usually begins 2-4 days prior to ovulation)
|
|
|
Which hormone in pregnancy detection kit is used to detect?
|
hCG in urine (within 1-2 weeks after conception)
|
|
|
Which ingredient try to test in UTI home testing device?
|
Nitrites (and leukocyte esterase)
|
|
|
Colorectal cancer test .....
|
check hidden blood in the stool
|
|
|
PDT-90 (Illicit drug use testing) ....
|
hair testing
|
|
|
Which agency is regulated labeling, safety, and manufacturing of dietary supplements?
|
FDA
|
|
|
Which agency is regulated advertising of dietary supplements?
|
FTC
|
|
|
List 4 functions of Ginkgo biloba.
|
1. Enhance memory and concentration
2. Intermittent 3. Vertigo and tinnitus 4. Impotence (in combination with papaverine) |
|
|
List St. John's wort 2 common uses.
|
1. Depression
2. Anxiety ** Potent 3A4 inducer** |
|
|
Oral contraceptives + St. John's wort--> ??? (DDI)
|
Decreased oral contraceptive effcts (by increased metabolism of OC)
|
|
|
Kava-Kava (root) is used for...
|
for anxiety and stress
|
|
|
What is DHEA?
|
Dihydroepiandrgen
1. Depression 2. General anti-aging effects 3. OSteopoprosis 4. Antidiabetogenic |
|
|
Loperamide can cause drowsiness or Insomnia?
|
drowsiness
|
|
|
All NSAIDs contains aspirin. True or False
|
True
|
|
|
List 2 drugs can cause osteporosis.
|
1. Corticosteroids (decreased Ca absorption from the gut)
2. Long-term anticonvulsant tx (Increased Vit-D breakdown) |
|
|
T-score vs.s Z-score?
T>-1 (normal, low risk) |
T-score: 30 y.o. white female
Z-score: your age group |
|
|
How much daily recommendation for Ca and Vit-D?
(Postmenopausal women on HRT/ERT need less Ca then those who on HRT/ERT) |
Ca: 1000-1500 mg/day
Vit-D: 200-600 IU/day |
|
|
Calcium carbonate vs. Calcium citrate (elemental Ca)
|
Calcium carbonate vs. Calcium citrate = 40% vs.21%
|
|
|
Calcium carbonate vs. Calcium citrate
|
Calcium carbonate: DELIVERS greatest amount of Ca
Calcium citrate: the most bioavailable calcium salt |
|
|
List 3 Bisphosphonate drugs are aprroved for use in osteoporosis.
MOA: inhibits osteoclast activity |
1. Alendronate (Fosamax)
2. Ibandronate (Boniva) 3. Risedronate (Actonel) |
|
|
Which bisphosphonate is indicated for male osteoporosis? and dose?
|
Fosamax (Alendronate)
10 mg/day or 70 mg/week |
|
|
Which Bisphonate are indicated for Paget's disease? and doses?
|
1) Fosamax: 40 mg/day for 6 months
2) Actonel: 30 mg/day for 2 months |
|
|
What is the indication of IV Boniva? dose?
|
1. Treatment of postmenopausal(PMOP) women
2. 3 mg over 15-30 seconds every 3 months |
|
|
What is FDA warning on Zometa and Aredia?
|
Osteonecrosis of the jaw (ONJ)
|
|
|
Patient consulations on Zometa or Aredia.
|
1. May cause hypocalcemia
2. Dental exam at baseline and avoid invasive dental procedures 3. Shoudl Vit-D and Ca daily |
|
|
What is the indication of use Nasal spray Calcitonin (Miacalcin)?
|
Postmenopausal osteoporosis
(One spray each nostril daily 200 IU/spray) |
|
|
What are the indications of use injection Calcitonin (Miacalcin)?
|
1. Postmenopausal osteoprosis
2. Paget's disease 3. Hypercalcemia |
|
|
What is the MOA of Forteo?
Dose: 20 mcg SQ QD BBW: Osteosarcoma |
Parathyroid hormone regulates Calcium concentration in ECF
|
|
|
What is the rationale of adding progestin in HRT for women with intact uterus?
|
To prevent endometrial hyperplasia and cancer
(Estrogen replacement therapy for relief hot flushes and other vasomotor symptoms) |
|
|
What are the adverse effects of progestin?
|
1. weight gain
2. Breast enlargement 3. Somnolence 4. Constipatin 5. Nausea |
|
|
What is the indication of all oral estrogen products indicated for?
|
Moderate-severe vasomotor symptoms
|
|
|
Which oral estrogen product is indicated for abnormal uterine bleeding?
|
Premarin (0.3-2.5 mg)
|
|
|
Which progestin product contains peanut oil?
|
Prometrium (Micronized progesterone)
Use: HRT to prevent endometrial hyperplasia |
|
|
What is the unique indication of Aygesttin (norethindrone acetate)?
|
Endometriosis
5 mg po QD for 2 weeks, increased by 2.5 mg Q 2 weeks to 15 mg/day |
|
|
Hormone Replacement Therapy
vs. oral birth control pills |
Estrogen dose in HRT is much lower than birth control pills.
|
|
|
What is doseage of Femring (estradiol acetate)?
|
Insert ring (0.05 mg/day or 0.1 mg/day) vaginally and replace after 90 days
|
|
|
How long patient should replace Estring?
|
every 90 days
|
|
|
What is the dosage of Vagifem?
|
Insert 1 tab (25 mcg estradiol hemihydrate) QD for 2 weeks and then 1 tab twice a week (14 + 4 = 18 tabs/month)
|
|
|
What is the MOA of Forteo?
Dose: 20 mcg SQ QD BBW: Osteosarcoma |
Parathyroid hormone regulates Calcium concentration in ECF
|
|
|
What is the rationale of adding progestin in HRT for women with intact uterus?
|
To prevent endometrial hyperplasia and cancer
(Estrogen replacement therapy for relief hot flushes and other vasomotor symptoms) |
|
|
What are the adverse effects of progestin?
|
1. weight gain
2. Breast enlargement 3. Somnolence 4. Constipatin 5. Nausea |
|
|
What is the indication of all oral estrogen products indicated for?
|
Moderate-severe vasomotor symptoms
|
|
|
Which oral estrogen product is indicated for abnormal uterine bleeding?
|
Premarin (0.3-2.5 mg)
|
|
|
Which progestin product contains peanut oil?
|
Prometrium (Micronized progesterone)
Use: HRT to prevent endometrial hyperplasia |
|
|
What is the unique indication of Aygesttin (norethindrone acetate)?
|
Endometriosis
5 mg po QD for 2 weeks, increased by 2.5 mg Q 2 weeks to 15 mg/day |
|
|
Hormone Replacement Therapy
vs. oral birth control pills |
Estrogen dose in HRT is much lower than birth control pills.
|
|
|
What is doseage of Femring (estradiol acetate)?
|
Insert ring (0.05 mg/day or 0.1 mg/day) vaginally and replace after 90 days
|
|
|
How long patient should replace Estring?
|
every 90 days
|
|
|
What is the dosage of Vagifem?
|
Insert 1 tab (25 mcg estradiol hemihydrate) QD for 2 weeks and then 1 tab twice a week (14 + 4 = 18 tabs/month)
|
|
|
Ped only vaccine?
|
Hib (Haemophilis influenza)
|
|
|
What the 3 vaccines are STD?
|
Hep A, Hep B and HPV
|
|
|
What the 2 vaccines are recommended for diabetets?
|
1) Influenza
2) Pneumoniae |
|
|
No live vaccine for age < 1 year beacuse ????
|
Maternal antibody
|
|
|
Meningococcal meningitis vaccine has both IM and SC forms. True and False
|
True
MPSV 4 (Menomune) MCV 4 (Menactra) |
|
|
What are patient counseling points of Vivotif Berna?
|
1. Empty stomach
2. Water only 3. Finish in 10 days 4. No ABX |
|
|
?? vaccine. Everyone needs every 10 years.
|
Diphetheria-Tetanus Pertussis
2 months-6 years --> DTaP 7-9 years --> Td 10-64 y.o. --> Tdap > 65 -->Td |
|
|
What is MOA of Zyflo? Generic name? Class?
|
1. 5-lipooxygenase inhibitor
2. Zileuton 3. Leukotriene production inhibitors |
|
|
Singulair
1) MOA 2) Generic name 3) ADR |
1) Leukotriene receptor antagonist
2) Montelukast, take at bedtime 3) Headache, GI upset |
|
|
Oxymetazoline > naphazoline > phenylephrine
|
Afrin (LA)>Naphcon, Clear eye, Vasocon > Neo-synephrine
|
|
|
What is the rationale taking Singulair @HS?
|
Leukotriene production is increased at nighttime
|
|
|
What is rationale that metoformin should avoid use in renal insufficiency patients? (Scr for male >1.5, for female >1.4)
|
Due to increase risk of lactic acidosis
|
|
|
What are the MAX dose of
1) Metformin (Glucophage) 2) Glucophage XR 3) Fortamet (extended release product) |
1) Metformin (Glucophage)max: 2550/d (850 mg TID)
2) Glucophage XR (max: 2000 mg/day) 3) Fortamet (extended release product) (max:2500 mg) |
|
|
List side effects of metformin.
|
1. MEtallic taste
2. diarrhea 3. Lactic acidosis 4. folate and B12 deficiency |
|
|
Which class of anti-diabetic agents needs to avoid use in CHF patient?
|
TZD (Thiazolidinediones)
ex: actos, avandia (can cause fluid retention) |
|
|
What is the MOA of TZD (thiazolidinediones)?
To see effect: 12 weeks |
Increased insulin sensitivity; increased target cell sensitivty
|
|
|
What is MOA of Meglitinides?
|
Stimulates insulin release from pancreatic cells
|
|
|
What is MOA of alpha-glucosidase inhibitors?
|
inhibit small intestine alpha-glucosidase
|
|
|
What type of sugar is used to treat hypoglycemia caused by acarbose or glyset?
|
oral glucose (dextrose)
|
|
|
Which 2 class of oral antidiabetes agents action site is in pancreas? (to stimulate secretion of insulin)
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1. Sulfonylureas
2. Meglitinides |
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what is the action site of biguanides?
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liver (ex: metformin)
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what is the action site of Thiazolidinediones?
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muscle
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What is action site of alpha-glucosidase inhibitors?
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GI
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Patient has elevated postprandial glucose. Which classes of antidiabetes are recommended?
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1. Meglitinides
2. alpha-glucosidase inhibitors |
