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185 Cards in this Set
- Front
- Back
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Donepezil aka
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aricept
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classification of donepezil
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cholinesterase inhibitor
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donepezil moa
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prevent the breakdown of ACh by acetycholinesterase and thereby increases the availability of ach at cholinergic synapses
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adverse effects of donepezil
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gi effects, dizziness, headache, bronchoconstriction, caution in clients with asthma and copd
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donepezil drug interactions
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antihistamines, tricyclic antidepressants, conventional antipsychotics
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what donepezil used for
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alzheimers; does not cure or stop progresson; slows down progression
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which med is better to give than donepezil if experiencing GI effects
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memantine (namenda)
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memantine aka
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namenda
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moa of memantine
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modulates effects of glutamate at nmda receptors
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adverse effects of memantine
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dizziness, HA, confusion, constipation
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drug interactions with memantine
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NMDA antagonist, sodium bicarb
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what is the major excitatory transmitter in the cns
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glutamate
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how often is memantine given
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twice daily
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which clients should have reduced dosage of memantine
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renal patients
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ergotamine aka
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cafergot
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classification of ergotamine
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ergot alkaloids
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moa of ergotamine
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promotes vasoconstriction and reduces amplitude of pulsations
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adverse effects of ergotamine
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n/v, leg weakness, myalgia, parathesias to fingers, toes; angina like pain, tachycardia, bradycardia
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ergotamine is the drug of choice for ? and can also be used for ?
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aborting migraines; cluster headaches
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ergotamine is contraindicated with
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triptans, hepatic or renal impairment, sepsis, CAD, PVD, pregnancy
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what should we monitor during ergotamine therapy
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bp, peripheral pulses, possible ergotism, n/v
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baclofen aka
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lioresal
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classification of baclofen
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drug for spasticity
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MOA of baclofen
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acts in the CNS, decreases spasticity, allows increased performance,
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baclofen is used to treat
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spinal cord injury, MS, CP
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adverse effects of baclofen
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CNS effects, GI symptoms, urinary retention, withdrawal problems; oral=visual hallucinations, paranoid ideation, seizures; intrathecal=fever, altered mental status, rebound spasticity, muscle rigidity, rhabdomyolysis
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what happens if you overdose on baclofen
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coma, resp depression; no antidote
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does baclofen cause dependence
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NO
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dantrolene aka
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dantrium
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classification of dantrolene
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drugs used for spasticity
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moa of dantrolene
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acts directly on skeletal muscle; suppresses release of calcium from sarcoplasmic reticulum
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uses for dantrolene
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spasticity assoc with MS, CP, spinal cord injury and malignant hyperthermia
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what effect does dantrolene have that would not be good for a "walky talky" patient
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causes a reduction in strength
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adverse effects of dantrolene
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hepatic toxicity, muscle weakness, drowsiness, anorexia, n/v, diarrhea, acne like rash, physical dependence (do not stop abruptly)
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what test is super important to monitor with dantrolene
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liver enzymes
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mitoxantrone aka
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novantrone
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mitoxantrone classification
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immunosuppressant
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moa of mitoxantrone
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suppress production of immune system cells and decreases autoimmune destruction of myelin
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adverse effects of mitoxantrone
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myelosuppression, cardiotoxicity, fetal harm, hair loss, GI distress, menstrual irregularities, blue green tint to urine, skin and sclera
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use for mitoxantrone
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MS who have decreased neurologic disabilities and clinical relapses; worsening relapsing or remitting MS, secondary progressive relapsing; NOT FOR PRIMARY PROGRESSIVE
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how is mitoxantrone administered
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IV every 3 months
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tests to monitor with mitoxantrone
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CBC, LFT, pregnancy test, echocardiogram
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entacapone aka
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comtan
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entacapone class
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COMT inhibitors
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moa of entacapone
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inhibits breakdown of levodopa in periphery
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adverse effects of entacapone
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dyskinesias, orthostatic hypotension, nausea, hallucinations, sleep disturbance
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entacapone is contraindicated with
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methyldopa, dobutamine, isoproterenol (all cardiac meds)
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entacapone may cause what unusual side effect
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brownish orange urine
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levodopa/carbidopa aka
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sinemet, sinemet CR
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class of levodopa/carbidopa
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dopamine replacements
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levodopa/carbidopa moa
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levodopa is converted to dopamine in cns; carbidopa prevents peripheral destruction of levodopa
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adverse effects of levodopa/carbidopa
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n/v, dyskinesias, postural hypotension, dysrhythmias, psychosis, darkened sweat and urine, akinetic spells, loss of effect
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why can we not just give a dopamine pill to increase dopamine levels
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does not cross the blood brain barrier
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contraindications with levodopa/carbidopa
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history of melanoma, narrow angle glaucoma, vitamin B6, MAO inhibitors, antipsychotic drugs
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use fo levodopa/carbidopa
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parkinsons
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which vitamin decreases the amount of levodopa that reaches the CNS
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B6
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sumatriptan aka
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imitrex
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class of sumatriptan
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serotonin receptor antagonists
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moa of sumatriptan
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actions of vasoconstriction and suppression of inflammation
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adverse effects of sumatriptan
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vertigo, tingling sensations, chest symptoms, coronary vasospasms, headache
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sumatriptan contraindications
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ergot alkaloids, other triptans, MAOIs, hx of CAD, MI, or HTN
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uses for sumatriptan
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migraine abortive; NOT prevention
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pyridostigmine aka
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mestinon
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moa of pyridostigmine
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prevents breakdown of acetylcholine
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adverse effects of pyridostigmine
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excessive muscarinic (increased sweating, salivation, diarrhea, urgency with urination), stimulation, paralysis of resp muscles in toxic doses
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pyridostigmine contraindications
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clients with obstruction of GI or urinary tract
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uses for pyridostigmine
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myasthenia gravis
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pyridostigmine drug interactions
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muscarinic antagonists, nondepolarizing and depolarizing neuromuscular blockers
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describe a myasthenic crisis
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inadequate meds, extreme muscle weakness, treat with cholinesterase inhibitor
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interferon beta 1a aka
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avonex, rebif
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interferon beta 1b aka
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betaseron
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moa of interferons
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suppresses autoimmune destruction of myelin
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adverse effects of interferons
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flu like symptoms, hepatotoxicity, myelosuppression, injection site reactions, depression
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interferon drug reactions
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other drugs that can cause bone marrow suppression or liver injury
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interferon are administered by what method
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injection
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interferons are used for
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relapsing or remitting, secondary progressive MS who still experience acute exacerbations
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how often is avonex given
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IM, once a week
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Rebif is given
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subq, 3x weekly
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betaseron is given
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subq, every other day
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which tests should we monitor with interferon injections
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LFT, CBC
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moa of copaxone
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protects myelin by inhibiting immune response to myelin basic protein
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adverse effects of copaxone
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injection site reaction, self limited post injection reaction
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labs to monitor with copaxone
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LFT, CBC
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use of copaxone
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relapsing and remitting MS
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copaxone is given
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subq every day
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describe self limited post injection reaction; which drug causes this
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pain, flushing, palpitations, severe chest pain, anxiety, laryngeal spasms, urticaria; copaxone
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tadalafil aka
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cialis
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tadalafil class
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PDE5 inhibitor II
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moa of tadalafil
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causes selective inhibition of PDE5 which in turn increases and preserves cGMP levels in penis
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adverse effects of tadalafil
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HA
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vardenafil aka
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levitra
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vardenafil class
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PDE5 inhibitor II
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moa of vardenafil
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causes selective inhibition of PDE5 which in turn increases and preserves cGMP levels in penis
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adverse effects of vardenafil
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HA
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what serious side effect can vardenafil cause
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prolonged QT interval which = serious dysrhythmias
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what is the main difference between cialis and viagra/levitra
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cialis lasts up to 36 hours and is not affected by food
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sildenafil aka
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viagra
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sildenafil class
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PDE5 inhibitor I
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moa of sildenafil
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causes selective inhibition of PDE5 which in turn increases and preserves cGMP levels in penis
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adverse effects of sildenafil
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hypotension, priapism, HA, flushing, dyspepsia
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sildenafil contraindications
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nitrates, alpha blockers, inhibitors of CYP3A4, grapefruit juice
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why would a woman take sildenafil
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pulmonary hypertension
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when should client take sildenafil
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approx 1 hour before "sexy time'
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dutasteride aka
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avodart
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dutasteride class
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5 alpha reductase inhibitors
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dutasteride moa
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interferes with conversion of testosterone to 5 alpha dihydrotestosterone (DHT)
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adverse effects of dutasteride
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can be absorbed through skin, harmful to developing male fetus,
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what is the major difference between dutasteride and finasteride
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dutasteride will decrease PSA in every man even if they have cancer; finasteride will not so if levels don't decrease they should be tested for CA
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tamsulosin aka
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flomax
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tamsulosin class
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alpha1 adrenergic antagonist
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tamsulosin was originally for
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decreasing bp
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moa of tamsulosin
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relaxes smooth muscle in bladder neck, prostate capsule, prostatic urethra to decrease dynamic obstruction of urethra
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adverse effects of tamsulosin
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abnormal ejaculation
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tamsulosin drug interactions
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antihypertensives, organic nitrates, PDE5 inhibitors, strong inhibitors of CYP3A4 (grapefruit, tagamet, erythromycin)
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finasteride aka
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procar
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finasteride class
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5 alpha reductase inhibitors
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moa of finasteride
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interferes with conversion of testosterone to 5 alpha dihydrotestosterone (DHT)
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adverse effects of finasteride
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decreased ejaculate volume and libido, gynecomastia
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finasteride use
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bph
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ciprofloxacin aka
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cipro
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ciprofloxacin class
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fluoroquinolones
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moa of ciprofloxacin
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inhibits bacterial dna gyrase so that dna replication cannot take place
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adverse effects of ciprofloxacin
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gi reactions, cns effects, candida, seizure, tendon rupture
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who should we not give ciprofloxacin too
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under 18 due to risk of tendon rupture
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monitor what test with ciprofloxacin
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PT/INR, can increase warfarin levels
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nitrofurantoin aka
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macrodantin, macrobid
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nitrofurantoin class
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urinary tract antiseptics
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nitrofurantoin moa
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injures bacteria by causing damage to DNA
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adverse effects of nitrofurantoin
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gi, pulmonary, hematologic, periperhal neuropathy, the "penias"
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nitrofurantoin is only useful for ?
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urinary tract, broad spectrum, bacterialstatic (low) and bactericidal (high concentrations)
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therapeutic uses of nitrofurantoin
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acute UTI and recurrent lower UTI prophylaxis
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what unusual side effects does nitrofurantoin cause
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brownish discoloration to urine
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methenamine aka
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madelamine, urex
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methenamine class
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urinary tract antiseptic
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moa of methenamine
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breaks down into ammonia and formaldehyde and formaldehyde denatures bacterial proteins to cause cell death
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adverse effects of methenamine
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gi distress, bladder irritation (dysuria, frequency, urgency, proteinuria, hematuria)
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when is methenamine contraindicated
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liver dysfunction and renal impairment
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enteric coated PO methenamine can cause what
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crystaluria
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pyridium aka
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azostandard
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pyridium class
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analgesic
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pyridium moa
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used for symptomatic relief of urinary burning, itching, frequency and urgency
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unusual side effect of pyridium
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orange urine
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MOA of trimethoprim/sulfamethoxazole
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inhibits consecutive steps in the synthesis of tetrahydrofolic acid
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adverse effects of TMP/SMZ
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N/V, rash, stevens johnson syndrome, blood dyscrasias, renal damage, agranulocytosis, leukopenia, thrombocytopenia
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therapeutic uses of TMP/SMZ
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med of choice for UTI caused by e coli and other infections
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tmp/smz contraindication
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folate deficiency, pregnancy, lactation, caution in renal dysfunction (decrease dose)
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how should client take tmp/smz
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on empty stomach with full glass of water
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epoetin alfa aka
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epogen, procrit
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epoetin class
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hematopoietic growth factor
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moa of epoetin alfa
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stimulates erythrocyte production
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uses for epoetin alfa
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chronic renal failure, anemia secondary to chemo, anemia in HIV, chronic anemia
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things to assess/monitor with epoetin alfa
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loc, speech, sudden headache, numbness, tingling, bp, extremities for clots
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epoetin alfa may cause need for which vitamin replacements
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B12 and folic acid
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when drawing up epoetin alfo what do we NOT do
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do NOT shake the vial
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adverse effects of epoetin alfa
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HTN, clotting, MI
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epoetin alfa contraindications
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uncontrolled HTN and caution in bone marrow cancers
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normal H&H
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hgb 10-12
hct 40% |
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filgrastim aka
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neupogen
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filgrastim class
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granulocyte colony stimulating factor
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moa of filgrastim
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stimulates neutrophil production
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uses of filgrastim
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chemo induced neutropenia, severe chronic neutropenia
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do not admin filgrastim when?
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within 24 hours before or after chemo
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adverse effects of filgrastim
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bone pain, leukocytosis, splenomegaly
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things to monitor with filgrastim
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cbc, vs, hr, rhythm, s/s of infection
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filgrastim contraindications
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clients who are sensitive to e coli protein; use caution in bone marrow cancer pts
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oprelvekin aka
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neumega interleukin 11
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use for oprelvekin
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thrombocytopenia caused by CA chemotherapy
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adverse effects of oprelvekin
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fluid retention of sodium and water = peripheral edema and cardiac dysrhythmias; increase in plasma volume, hgb and hct decrease=anemia; dyspnea
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what should we do daily with oprelvekin
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weigh daily
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cinacalcet aka
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sensipar
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moa of cinacalcet
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calcimimetic; increases sensitivity of calcium sparing receptors on cells of parathyroid gland
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use of cinacalcet
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hyperparathyroidism, secondary hyperparathyroidism
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adverse effects of cinacalcet
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n/v, diarrhea, hypocalcemia
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sevelamer aka
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renagel
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moa of sevelamer
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binds phosphate in GI tract
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sevelamer class
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phosphate binder
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adverse effects of sevelamer
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diarrhea, n/v, dyspepsia, abdominal pain, constipation, hypocalcemia, hypophosphatemia
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sevelamer must be administered with what
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food
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sevelamer uses
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clients with ESRD to decrease serum phosphorus levels
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terazosin class
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alpha 1 adrenergic antagonist
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terazosin aka
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hytrin
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moa of terazosin
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relaxes smooth muscle in bladder neck, prostate capsule and prostatic urethra to decrease dynamic obstruction of urethra
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terazosin was originally used to treat
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HTN
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adverse effects of terazosin
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hypotension, fainting, dizziness, somnolence, nasal congestion
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terazosin interactions
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antihypertensives, organic nitrates, PDE5 inhibitors, strong inhibitors of CYP3A4 (grapefruit juice, tagamet, erythromycin)
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