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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)
what class of Biguanide is?

Ex: Metformin (glucophage)
Insulin sensitizers; Increase insulin sensitivity in the hepatic and peripherial
What are the possibile side effects from metformin?
1. GI upset
2. Megalblastic anemia
3. Lactic acidosis
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
What are the common AE of TZD drugs, ex: Actos, avandia?
1. Edema
2. Anemia
3. wt gain
4. excerabation of CHF
What is the MOA of Prandin?
MOA of Prandin (Repaglinide): To stimulate pancreatic beta-cells to secrete insulin
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)
What are the 2 classes of antidiabetes agents that can cause 1) weight gain and 2) hypoglycemia
1) Sulfonylureas
2) Meglitinides
What classes of antidiabetic agent do not cause hypoglycemia?
1. alpha-glucosidase inhibitors (acarbose and miglitol)
2. Insulin sensitizers (biguanide and TZD)
Meformin should be withheld 48 hours after pts undergoing radiological study. True or False?
True
List the 6 drugs contain Metformin.
1. Glucophage
2. Glucophage XR
3. Riomet
4. Glucovance
5. Avandamet
6. Metaglip
What are CIs in metformin?
For female, Cr >1.4
For male, Cr > 1.5
Predisposed to potentially fatal lactic acidosis
TZD (actose, avandia)+ oral contraceptive pills --> ?
Need to increase estrogen dose
What are Contraindications in TZD (actose, avandia)
1. ALT >2.5 normal
2. CHF
3. Hepatic patients
What are the monitoring parameters taking metformin?
1. Renal
2. Liver,
3. serum B12
4. folic acid
5. Hgb
6. Hct
7. CBC
Chlorpropamide + prednisone
--> ??? (DDI)
hyperglycemia
Phenytoin + tolazamide --> ??
Increased BG levels
Glimepiride + itraconazole
--> ??? (DDI)
Dcreased BG level
Which insulin can be adminstered IV?
Regular (clear); glargine is clear but it's low pH=4.0 (no IV)
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
" High TSH
Low T4"; what is the Dx?
Hypothyroidism
What is MOA of Levothyroxine?
To increase oxygen consumption by most of tissues and increase metabolic rate of CHO, lipids and protein
Take Levothyroxine with or without food?
Without food, take 30 mins before breakfast
what is thyroid storm?
thyroid stormis life-threatening, fever, tachycardia, delirium, and coma
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
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
Lithium + Lugol's solution
--> ??? (DDI)
Increased Lugol's solution effects
what is Grave's disease?
Hyperthyrodism
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
What is the MOA of aminoglutethimide?
Inhibits conversion of cholesterol to pregnenolone
What is the MOA of metyrapone?
To decrease cortisol synthesis by inhibition of 11-hydroxylate activity
What are adverse effects of Cytadren?
rash, blood dyscrasias and hypothyrodism; may also decrease effects of warfarin
What is Addison's disease?
Primary adrenocortical deficiency; in result of glucococorticoid and mineralocorticoid deficiency
what are therapeutic uses of desmopressin?
Nocturnal enuresis, diabetes insipidus, hemophilia A, von Willebrand's disease; Also increase clotting factor VII levels
Androgens and anabolic steroids are NOT scheduled drugs. True or False?
False; they are scheduled III
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
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
Climara, once a week or twice weekly?
Once a week
FemPatch once or twice a week?
Once
"Alora, Esclim, Estraderm, Menostar, Vivelle, Vivelle Dot" once a week or twice a week?
Twice a week
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)
What's the frequency of Estring?
90 days ( evry 3 months)
What are the common adverse effects of ERT (Estrogen replacement therapy)?
1. Breast tenderness
2. Heavy bleeding
3. Headache
4. Nausea
What are the common adverse effects of progestin therapy?
1. Depression
2. Irritability
3. Headache
Is Estrogen a CYP450 2D6, 1A2, 2C9 or 3A4 inhibitors?
3A4 inhibitors
Synthroid + Warfarin --> ??? (DDI)
Increased metabolism of Vit-K--> decreased warfarin effects --> may neeed to increased warfarin dose
Estrogen + thyroid hormone
--> ??? (DDI)
Decreased thyroid hormone Weffects
When are "mini-pills" indicated?
1. breastfeeding women
2. Free CVD risks associated with estrogen-containing products
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
What is progestin's MOA in birth control pills?
Block ovulation by increasing the thickness and atrophy of the endometrium
List 3 Oral contraceptive pills are progestin only pills.
1. Camila
2. Ortho Micronor
3. Errin
4. Nor-QD
5. Nora-BE
6. Ovrette
What much estrogen content in high-dose estrogen OC?
50 mcg; ex: Neocon 1/50, Ovcon50, Zovia 1/50
What much estrogen content in low-dose estrogen OC?
from 10 - 35 mcg
List 3 drugs/classes can increase oral contraceptives level.
1. 3A4 inhibitors
2. Atorvastatin
3. Vitamin C
Oral contraceptives + pioglitazone (Actos) --> ??? (DDI)
Decreased OC effects
Oral contraceptives + hypoglycemics (tolbutamide, Diabinese, Orinase, Tolinase)
Decreased effects hypoglycemics agents
Oral contraceptives + cortisone --> ??? (DDI)
Increased toxicity of cortisone
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
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
what are the daily Calcium and Vit-D recommended?
Calcium 1000-1500 mg
Vitamin D 400-800 IU/day
What is the MOA of actonel, fosamax?
Bisphosphonates; Binds to bone (hydroxyapatite) and incorporates into boneto increase and stablize bone mass
Fosamax 10 mg/day + ASA
--> ??? (DDI)
Increased risk of upper GI bleeding
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
Evista + warfarin --> ??? (DDI)
Decreased Warfarin effects
What is the MOA of Miacalcin?
Inhibit bone resorption by binding to osteoclast receptors
What is the MOA of Forteo?
Increased the rate of bone formation by increasing the birth rate of osteoblasts and preventing apoptosis, resulting improve bone density
What type of oral contraceptive pills you will recommend for a smoker woman over 35 years?
Progestin only (mini-pills)
What is the dose Mucomyst (acetylcysteine)for pretreament exposure radiocontrast dye?
Mucomyst 600 mg PO BID for 2 days, begining one day before procedures
What are the adverse effects of osmotic diuretics?
1. Pulmonary edema
2. acute rise of serum K+
3. Blurred vision
4. Rash
What are the E- imbalances from Thiazide and thiazide-like diuretics?
1. Hypokalemia
2. Hyponatremia
3. Hypercalcemia
What are the E- imbalances from loop diuretics?
1. Hypokalemia
2. Hypomagnesemia
3. Hyponatremia
4. Hyperuricemia
5. Hyperglycemia
6. Hypercalciuria
1 mg Bumetanide
= A mg Torsemide
= B mg Furosemide
A= 20 mg
B= 40 mg
Ergocalciferol
Vitamin D precursor (requires hydroxylation within the liver to calcifediol and 2nd hydroxylation in the kidney to form active Vit-D
What should use for iron overload?
Desferal (deferoxamine)
What is the potential risk of administering iron IV? 1
Increased risk of infection
What are the signs of vitamin D intoxication and hypercalcemia?
Weakness, headache, somnolence, nausea, vomiting, bone pain, polyuria
Folic acid + phenytoin
--> DDI (????)
Decreased phenytoin concentration
Hydromorphone
Dilaudid
Fentanyl
Sublimaze
Acetaminophen
Tylenol
Ketorolac
Toradol
Atitvan
Lorazepam
Versed
Midazolam
Diprivan
Propofol
Pancuronium
Pavulon
Norcuron
Vecuronium
Cisatarcurium
Nimbex
Dexmedetomidine
Precedex
Nimotop
Nimodipine; calcium channel block give for 21 days; indicated for treating abeurysmal subarachnoid hemorrhage
Dalteparin
Fragmin (2500-5000 units SC)
Lovenox
enoxaparin
Fondapariunx
Arixtra
Direct thrombin inhibitors:
1. Lepirudin (A)
2. Bivalirudin (B)
3. Agatroban
A --> Refludan

B --> Angiomax
Tegretol
Carbamazepine
Lamictal
Lamotrigine
Keppra
Levetiraccetam
Oxcarbazepine
Trileptal
Tiagabine
Gabitril
Zonisamide
Zonegran
Drotrecogin alfa; an endogenous anticoagulant; recommbinat human activated protein C
Xigris
DDAVP
Desmopressin (for diabetes insipidus)
Pavulon
Pancuronium
Nolvadex
Tamoxifen
Faslodex
Fulvestran
Aromasin
Exemestane
Arimidex
Anasrozole
Femara
Letrozole
Casodex
Bicalutamide
Avastin
Bevacizumab
Erbitux
Cetuximab
Hydroxyurea
Hydrea MOA: inhibits DNA synthesis witout interfering with RNA and protein synthesis
Imatinib mesylate
Gleevec
Erlotinib
Tarceva
Iressa
Gefitnib
Sutent
Sutinib
Sprycet
Dasatiniib
Velcade
Bortezomib
MOA: Inhibits the 26S proteasome; stabilizes regulatory proteins causing apoptosis and disrupting cell proliferation
Dolasetron
Anzemet
Granisetron
Kytril
Palonosetron
Aloxi
Compazine
Prochlorperazine
Thorazine
Chlorpromazine
Phenergan
Promethazine
Emend
Aprepitant
Imatinib mesylate
Gleevec
Erlotinib
Tarceva
Iressa
Gefitnib
Sutent
Sutinib
Sprycet
Dasatiniib
Velcade
Bortezomib
MOA: Inhibits the 26S proteasome; stabilizes regulatory proteins causing apoptosis and disrupting cell proliferation
Dolasetron
Anzemet
Granisetron
Kytril
Palonosetron
Aloxi
Compazine
Prochlorperazine
Thorazine
Chlorpromazine
Phenergan
Promethazine
Emend
Aprepitant
What is the main side effect of Zoladex (Goserelin)?
Bone pain
What the hormones and antagonists can be used for both breast and prostate cancer?
LHRH agonists (Lupron, Eligar and Zoladex)and Ethinyl estradiol
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
What is the MOA of Tacrolimus?
Inhibits IL-2 transcription and synthesis (binding with FKBP-12 and a calcium-calmodulin-calcineurin complex)
What knid of electrolyte imbalance Prograft (Tacrolimus)can cause?
Could cause hyperkalemia
Name 4 common adverse effects of cyclosporine.
1. Hirsutism
2. Nephrotoxicity
3. Ginggival hyperplasia
4. Hyperlipidemia
Prednisone and tacrolimus may cause ????.
Diabetets mellitus
Prograft does not need to monitor trough concentrations. True or False
false
Prograft
Tacrolimus
CellCept
Mycophenolate mofetil
Azathioprine
Imuran
Arava
Leflunomide (anti-proliferative, immunosupressant drugs)
Cholestyramine
Prevalite
Nexium
Esomeprazole
Prilosec
Omeprazole
Prevacid
Lansoprazole
Aciphex
Rabeprazole
Protonix
Pantoprazole
Tagamet
Cimetidine
Zantac
Ranitidine
Axid
Nizatidine
Pepcid
Famotidine
Tritec
Ranitidine + bismuth citrate
Furazolidone
Furoxone (100 mg tid for 10-14 days)
Methocarbamol
Robaxin
Mesalamine
Asacol
Lomotil
diphenoxylate + atropine
Imodium
Loperamide (2 mg after each loose stool, dne: 16 mg/day)
List 4 examples of H2 blockes.
1. Tagamet
2. Zantac
3. Axid
4. Pepcis
List 5 examples of PPI.
1. Aciphex
2. Preveacid
3. Prilosec
4. Protonix
5. Nexium
How does antacids + (tetracyclines, ferrous sulfate and quinolones) reduce the absorption and effectiveness of the drugs?
By forming chealate complex
HOw does antacid the absorption of (azoles and sucrafate)?
By increeasing gastric pH
Drug that may redcue LES pressure.
1. Calcium channel blockers
2. beta-blockers
3. Nitrate
4. batbiturates
5. Anticholinergics
6. Theophylline
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
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)
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
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
Methadone (Dolophine)...
1) MOA?
2)
1) Pure u agonist and NMDA antagoinst
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
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)
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)
1. Sulfonylureas
2. Meglitinides
what is the action site of biguanides?
liver (ex: metformin)
what is the action site of Thiazolidinediones?
muscle
What is action site of alpha-glucosidase inhibitors?
GI
Patient has elevated postprandial glucose. Which classes of antidiabetes are recommended?
1. Meglitinides
2. alpha-glucosidase inhibitors