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135 Cards in this Set
- Front
- Back
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Penicillin MOA
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interfere will cell wall synthesis, inhibit peptidoglycan cross-linking
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List three penicillins
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penicilln, amoxicillin, ampicilln, methicillin
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Penicillin coverage
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Gram positive cocci/rods, spirochetes, some anaerobes
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Penicillin with Pseudomonas coverage
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Piperacillin
pip/taz = Zosyn |
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Penicillin for ear infections
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Amoxicillin
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Amoxicillin coverage
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HELPS (H. flu, E. col, listeria, proteus, salmonella) + enterococcus
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Cross reactivity between penicillin and cephalosporins
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4-10%
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Name 2 1st gen cephalosporins
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cephalexin, cefazolin
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1st gen cephalosporin coverage
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Gram + PEcK (Proteus, E. coli, Klebsilla)
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Name 2 2nd gen cephalosporins
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cefuroxime, cefaclor, cefprozil
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2nd gen cephalosporin coverage
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Gram + HEN PEcK (H. influ, Enterobacter, Neisseria, Proteus, E. coli, Klebsilla)
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Name 2 3rd gen cephalosporins
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ceftriaxone, ceftazidime
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3rd gen cephalosporin coverage
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more gram -,Pseudomonas, Lyme, gonorrhea, meningitis
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Name 4th gen cephalosporins
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cefepime
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4th gen cephalosporin coverage
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pseudomonas, G+ like 1st
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Name three macrolides
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erythromycin, clarithromycin, azithromycin
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Coverage of macrolides
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Atypical pna (Mycoplasma, Legionella, Chlamydia), G+
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Macrolide side effects
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abd. pain
ototoxic metallic taste |
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Deadly side effect of macrolides
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Long QT
rhadomyolysis with statins |
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Effects of statins
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+HDL 30%
-TG 10-20% -LDL 50-60% |
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Strongest statin
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Crestor (rosuvastatin)
monitor proteinuria |
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Shortest 1/2 life statin
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Zocor (simvastatin)
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Statin with least drug-drug interactions
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Pravachol
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Side effects of statins
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Myalgias
rhabdomyolysis Elevate Liver enzymes (stop if 3x above normal) |
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List four contraindications to NSAIDS
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Peptic Ulcer/GI bleed
Renal dysfunction Samter's Triad Pregnancy |
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What is Samter's Triad
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nasal polyps
aspirin allergy asthma |
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List worst patient subgroups for NSAIDS
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elderly
HTN Female diuretics DM |
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Common SE of NSAIDS
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gastritis
fluid retention |
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COX II Drug
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Celebrex
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List three corticosteroids
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Prednisone, prednisolone, cortisone,
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How long before you need to start steroid taper
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3 weeks
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List three uses for corticosteroid
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inflammatory disorders
severe allergic reactions croup |
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Adverse effects of steroids
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Cushings
HTN Diabetes |
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Contraindications to steroids
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GI bleeds
Diabetes HTN latent TB psychiatric disorders |
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Causes of C. diff
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Clindamycin
quinolones |
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Treatment of C. diff
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stop antibiotic
oral metronidazole oral vancomycin stool transplant |
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List three Quinolones
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ciprofloxicin
levofloxicin moxifloxacin |
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Coverage for ciprofloxicin
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Gram (-), pseudomonas
UTIs Poor gram(+) |
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Locations of pseudomonas infection
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Foot puncture
Otitis externa |
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Coverage for levoflxacin
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Pneumonia
UTI sinusitis skin prostatitis |
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Coverage for moxifloxacin
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Pneumococcus
NOT for UTI (hepatic) |
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S/E of quinolones
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tendon rupture
neurotoxic phototoxic prolonged QT |
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Contraindications to Beta blockers
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asthma
peripheral vscular dz - gangrene 2nd degree heart block |
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Uses of Beta blockers
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HTN
heart failure public speaking hyperthyroidism |
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BB with both alpha and beta
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labetalol
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Most B1 selective antagonists
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atenolol
metoprolol bisoprolol |
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Beta blocker drug interactions
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adrenergic drugs:
cocaine amphetamine ergots adrenaline (Causes unopposed alpha HTN) |
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List three serious drug drug
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macrolides + statins
cyclosporine + St. John's wort warfarin + anything SSRI + MAOI |
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List three members of ACEI
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lisinopril
enalapril captopril |
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Uses for ACEI
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HTN
CHF kidney protection diabetics |
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S/E for ACEI
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cough
angioedema increase K increase Cr |
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Name one ARB
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losartan
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Benefits of ARB
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less cough
less angioedema |
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3 best drugs for tx of microalbuminuria
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ACEI
ARB Diltiazem |
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Best combination for tx of microalbuminuria
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ACEi+ARB
(but may increase morbidity and mortality) |
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Best way to reduce hyperkalemia when seen with ACE or ARB
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Loop diuretic
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List three contraindications to Triptans
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complex migraine
pregnancy HTN & coronary dz |
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List 2 uses of Triptans
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migraine
Cluster HA |
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What is a complex migraine
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Migraine with neurologic symptoms: weakness, loss of vision, difficulty speaking
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Contraindications to OCP
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Smokers > 35
thromboembolic dz migraines with aura pregnancy endometrial Ca HTN liver dz |
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Number 18
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??? any fun fact about David
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What is a sulfa moiety
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sulfonamide (R-S(=O)2-NH2)
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Name two sulfa drugs
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antibiotics (TMP/sulfamethozazole)
diuretics: hydrochlorothiazide loop: furosemide COX2: celecoxib |
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A/E of sulfas
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Stevens-Johnson syndrome
itchy rash -fixed drug rxn |
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Which diuretic class keeps Ca?
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Thiazide
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Which diuretic class losses K and Na?
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Both thiazides and loops
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Contraindicatons to metformin
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Pts with dehydration
Pts with Cr > 1.5 Pts getting IV contrast |
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A/E of metformin
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metabolic acidosis
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Metformin MOA
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decreases gluconeogenesis and increases insulin sensitiviity
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Name two thiazolidinediones
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piogitazone (Actos)
rosiglitazone (Avandia) |
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MOA of thiazolidinediones
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decrease peripheral insulin resistance
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sitagliptin (Januvia) MOA
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Inhibits DPP-4, preventing breakdown of GLP-1 and GIP -> potentiates insuline secretion
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S/E of thiazolidinediones
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hepatitis (check LFTs)
edema (Avoid in CHF) hypoglycemia |
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What is FDA approved
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Studies done for this use
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What is off-label use
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If standard of care- everyone uses it but not FDA studied
New- puts you at higher legal risk Illegal for company to promote off-label use. |
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Sulfa vs. TMP/Sulfa vs. TMP alone
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Sulfa: sinusitis (G+,G-), UTIs
TMP/SMX: UTI, PCP, MRSA, parasitic, nocardia TMP: UTI if sulfa allergy, quick resistance develops |
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TMP MOA
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dihydrofolate reductase inhibitor -> blocks folate
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Digoxin Side-effects
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arrythmias (Torsades)
N/V xanthosmia (yellow vision) |
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How to treat Digoxin OD?
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Digibind (Fab)
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SSRI with longest 1/2 life
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Prozac (fluoxitine)
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SSRI with least side effects
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Celexa (citalopram)
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Common SSRI S/E
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Decreased libido
Diarrhea weight gain headache SEROTONIN SYNDROME |
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List 2 SNRIs
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Venlafaxine (Effexor)
Duloxetine (Cymbalta) |
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Uses of SNRIs
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depression
chronic pain |
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S/E of SNRIs
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diastolic HTN
worse withdrawal SI |
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Strongest Narcotic
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Fentanyl
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S/E of narcotics
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nausea
constipation respiratory depression addiction |
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Treatment of narcotic overdose
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naloxone (Narcan)
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List three benzodiazepines
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Lorazepam (Ativan)
alprazolam (Xanax) diazepam (Valium) |
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Use of Benzodiazepines
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anxiety
hypnotic seizures sedation parasomnias amnestic |
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Typical antipsychotic S/E
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EPS (akathisia, parkinsonism, tardive dyskinesia, dystonic rxn)
anticholinergic NMS |
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Atypical antipsychotic S/E
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metabolic syndrome
cardiac death NMS also possible |
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Treatment of EPS
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benadryl
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Treatment of NMS
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dantrolene
bromocriptine |
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Overdose of levothyroxine
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osteoporosis
cardiac arrhythmias hypoglycemia |
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Underdosing of levothyroxine
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wt gain
constipation dry mouth increased triglycerides |
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Frequency of TSH monitoring on synthroid?
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Every 3 mo until stable, then yearly
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What are A/B rated generics?
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Equivalent within 3-5% of brand name (pharmacist can substitute)
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What makes macrodantin unique and what does it treat?
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Complete first pass metabolism (no tissue levels)
Treats UTI |
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What are S/E of macrodantin (nitrofurantoin)
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hepatic/pulmonary fibrosis
N/V (colors urine orange) |
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Spironolactone vs. Eplerenone
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Spironolactone - K sparing diuretic for Class 3/4 HF. Causes gynecomastia
Eplerenone - less gynecomastic |
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Tramadol Use, S/E
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pain (opioid + SSNRI)
S/E: nausea, decreases seizure threshold, serotonin toxicity (with SSRIs) |
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Nasal steroid use & SE
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use: allergic rhinitis
SE: nosebleeds |
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Inhaled steroids use & SE
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use: asthma, eosinophilic esophagitis
SE: thrush, hoarseness |
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Name two short acting Beta-adrenergics
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albuterol, purbuterol
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Name two long acting Beta-adrenergics
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fometerol, salmeterol
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What is advair
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Combination of fluticasone + salmeterol
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PPI vs. H2
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PPI blocks stimulated acid (give with food). Stronger
H2: weaker, quicker |
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Risks of PPI/H2
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decrease Ca2+ bone density
Increase pna risk cimetidine - blocks P450 |
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Name two dihydropyridine CCB, use,SE
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nifedipine, amlodipine
vasodilitation (HTN, spasm) SE: edema |
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Name two non-dihydropyridine CCB, use,SE
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Verapamil, diltiazem
Angina, arrhythmia, migraines SE: constipation, |
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Name three tetracyclines
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tetracycline
doxycycline minocycline |
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Uses of tetracyclines
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acne - minicycline
Lyme - doxycycline MRSA - doxycycline chlamydia, gonorrhea, atypicals |
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S/E of tetracyclines
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photosensitivity
grey teeth - no kids esophagitis |
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Name two fibrates and use
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gemfibrozil & fenofibrate
Use: reduce triglycerides |
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S/E of fibrates, interaction, mortality
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stomach upset
rhabdomyolysis with statins Does not decrease all cause mortality (+GI/colon CA) |
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Fish oil vs. lovaza
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lovaza - purified, prescription
fish oil - "fish burp" (freeze pills) |
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Aspirin MOA
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irreversibly acetylates platelets
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Aspirin S/E
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GI bleeding
tinnitus (ototoxic) metabolic acidosis |
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Epinephrine Use
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alpha & beta agonist
anaphylaxis, asthma, hypotension |
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Strongest antihistamine
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hydroxyzine
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Least sedating antihystamine
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fexofenadine (Allegra)
loratadine similar (Claritin) |
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Phenytoin DPH use
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seizures
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Phenytoin DPH toxicity syndrome
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vertical nystagmus
gingival hyperplasia teratogenic |
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Phenytoin drug interaction
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other anticonvulsants
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Metronidazole uses
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C.diff
anaerobic parasitic |
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Metronidazole SE
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peripheral neuropathy
metallic taste disulfiram-like rxn with EtOH |
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Niacin use
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Vit B3
medium doses increases HDL |
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Niacin S/E
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Flushing
block with ASA |
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Wellbutrin contraindication
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decreases seizure threshold
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Wellbutrin uses
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antidepressant
Smoking cessation (Less weight gain/sex SEs) |
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Trazadone uses
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antidepressant
Insomnia |
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Trazadone S/E
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sedation
priapism |
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Bisphosphonates use
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inactivate osteoclasts
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Bisphosphonates SE
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osteonecrosis of the jaw
gastritis risk of a. fib. |
