Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
326 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
what does the increased Ph of omeprazole do to absorption of drugs?
|
itracon, ketocon, calcium carb, iron
|
|
|
|
which PPI has lowest inxns?
|
pantoprazole
|
|
|
|
what cyp does the PPI;s effect/
|
2c19--prevents conversion of clopidogrel to active form....increase warf, voriconazole, phenytoin
|
|
|
|
diagnostic of Heart failure
|
B type natriuretic peptide used (synth and released from ventricles in response to pressure or volume overload)(BNP will increase diureiss, renal sodium excretion,vasodilation)(degree correlates with prognosis)....echocardiogram....LVEF done by echo, nuclear imaging scans, cardiac catheterization
|
|
|
|
how is LVEF done?
|
echo, nuclear imaging, cardiac catheterization (swan ganz-pulm arterery)
|
|
|
|
Treatment of stage C heart failure
|
ACE, diuretic, Bblocker...others can be ARB, digoxin, ald antag, hydralazineiso dinitrate
|
|
|
|
does hydralazine-isosorbide dinitrate have a mortality benefit for HF?
|
yes, ACE however is superior...BESt in african americans when added to therapy
|
|
|
|
digoxin MOA?
|
Na K atpsase pumps resulting in increase in calcium, thus increase positive inotropic
|
|
|
|
digoxin brand names lanoxin and lanoxicaps dosage forms?
|
lanoxin: oral tablet, IV, elixer....lanoxicaps: oral capsules
|
|
|
|
half life in normal renal function?
|
36 hours
|
|
|
|
bioavailability of the different digoxin dosage forms
|
tabs is most variable (0.5-0.9)..elixer (0.75-o.85)....capsules (0.9-1.0)
|
|
|
|
what is the kinetics of digoxin?
|
60-80% eliminated unchanged in kidney (Dose reduction in renal failure)
|
|
|
|
when to take drug levels after digoxin, what is the optimal range?
|
6-12 hours afterwards...0.5-1.0
|
|
|
|
5 things to monitor with digoxin
|
serum conc, heart rate, K and Mg, renal fxn, Heart failure
|
|
|
|
what are the 3 main sets of AE of digoxin
|
CV (arrhythmia, brady, heart block).....GI (anorexia, ab pain, N/V).....neuro (vision issues, disorientation, confusion, fatigue)
|
|
|
|
what is the inxn of digoxin and diuretics?
|
if hypokalemia and hypomagn
|
|
|
|
lots of inxns of digoxin
|
k
|
|
|
|
need to go over the uncompensated HF meds
|
l
|
|
|
|
what is the AE if meperidine accumlation? what is max dose for CNS or renal pts
|
seizures....no more than 48 hours and no more than 600mg q24hrs
|
|
|
|
what inxns with fentanyl
|
3a4
|
|
|
|
fentanyl actiq SL fent losenge, hjow many cancer pain episodes can be treated per day?
|
4
|
|
|
|
opiod equianalgesic dosing
|
k
|
|
|
|
Meningitis or endocarditis for the diff likely organisms and empiric treatments?
|
meningitis
|
|
|
|
ness meningitis carrier
|
During periods of endemic disease, about 10 % of the general population harbour Neisseria meningitidis in the nasopharynx. Since N. meningitidis is a strict human pathogen and most patients have not been in contact with other cases, asymptomatic carriers are presumably the major source of the pathogenic strains. ...Frequent nasopharyngeal colonization with related bacteria like Neisseria lactamica improves natural immunity to meningococci by the formation of cross-reacting antibodies. ....minocycline, rifampin
|
|
|
|
self monitoring question...
|
can self monitor Lh and hcg (pregnancy), gonadotropins are LH and fsh
|
|
|
|
other home monitoring available
|
UTI (nitrates in urine and leukocyte esterase (for gram negative))....HTN (merc column, aneroid devices, digital)...total cholesterol (cholestrak home cholesteral)...biosafe total chol panel (fingerstick then sent off to lab), cardiocheck (TC, hdl, ldl)...Fecal occult blood tests (Toilet tests (3 kinds) (look for hemoglobin)....acquired immune deficiency syndrome (aids) (fingerstick blood put on card, result in 7 days to f3 days)...test for antibodies for hiv
|
|
|
|
for smoking cessation who should be offered pharmacotherapy?
|
everyone attempting to quit smoking...double abstinence rates
|
|
|
|
out of the gum, patch, lozenge, inhaler, nasal spray which are otc and prescription?
|
gum, patch lozeng are otc...inhaler and nasal spray are prescription
|
|
|
|
dry eye
|
tear film instability caused by deficiency of any component of the tear film
|
|
|
|
how does dry eye present?
|
ocular discomfort, blurred vision, desire to rub eyes, burning or redness
|
|
|
|
treat dry eye
|
artificial tears (cellulose (carboxymethylcellulose), polyvinyl alcohol, providone...ocular emollients (lanolin, mineral oil, petrolatum, white ointment, white wax, yellow wax)
|
|
|
|
red eye causes?
|
airborne pollutants, chlorinated water ,infectious diseass, glaucoma
|
|
|
|
treat red eye?
|
opthalmic vasoconstricters (phenylephrine, naphozoline, tetrahydrozoline, oxymetazoline)(visin LR, clare eyes, pretrin)...clear eyes (naphazolin is docXXXX)
|
|
|
|
allergic eye syndrome symptoms
|
chronic and recurring itching, eyes red and tear and burn
|
|
|
|
treatments of allergic conjunctivitis
|
antihistamine and mast cell stabilizer (ketotifen fumarate)....combo products (opthalmic vasoconstricters and antihistamines) naphazoline, pheniramine, antazoline (naphcon, vasocon visine A)
|
|
|
|
what are the 4 things that need to refer to physician for eye
|
Corneal edema (foggy vision, photophobia, irritatoin, halos around lights, extreme pain)(treat with sodium chloride)....foreign body in eye....ocular trauma...chemical exposure
|
|
|
|
what is impacted cerumen?
|
filled ear
|
|
|
|
how do the ocular vasoconstricters name end? -oline
|
-oline
|
|
|
|
treat impacted cerumen?
|
cerumen softening agents
|
|
|
|
dry eye has lots of causes
|
vit A def, allergic conjun, contacts, drug induced (antichol, antihist), sjugrens syndrome, biepharitis, aqueous tear deficiency, exposure to dry air
|
|
|
|
products for cerumen softening
|
carbamide peroxide 6.5% in glycerin, hydrogen peroxide, glycerin, olive oil
|
|
|
|
treat water clogged ears?
|
95% isopropyle alc in 5% anhydrous glycerin (swim ear, auro dri drops)...50/50 acetic acid and isopropyl alc
|
|
|
|
how to treat ear boils?
|
when hair follicles in the ear canal become infected...typically self limitin, treated with warm compress
|
|
|
|
kcal/kg/day for adults with little stress, infections or skeletal trauma, major trauma, over 50% body burned
|
25....30...35...40
|
|
|
|
what is the rec daily allowance for protein? minor stress? major trauma or infection, severe head injury sepsis severe thermal injury?
|
0.8g/kg/day...1.0...1.5...2.0
|
|
|
|
what is the desired nitrogen balance for undernourished aptients? for critically ill pts?
|
+4-+6...-2 to +2
|
|
|
|
what are some of the major indications for TPN?
|
severe acute pancreatitis...short bowel syndrom...ileus (intestinal obstruction)...also: chrones, neonates who cannot eat on day 1, preop for undernourished pts, preg and cannot tolerate oral therapy, GI fistulae
|
|
|
|
what is the limit for dextrose?
|
5mg/kg/min
|
|
|
|
what are the typical needs for protein, fat, dextrose
|
protein (usually not over 2g/kg/day)....fat (1g/kg/d)...dextrose (3-4mg/kg/min)
|
|
|
|
after phosphate addition, the remaining anions are added on the basis of acid base status (acetate or chloride)
|
k
|
|
|
|
anion, cation
|
anion negative charge...cation positive charge
|
|
|
|
potassium can be added as acetate and chloride as well based on acid base
|
k
|
|
|
|
phos and mag need to be eliminated or reduced in renal failure
|
k
|
|
|
|
what electrolyte should be dosed higher in pts with alcoholism or large bowel losses and in patietns taking drugs that cause renal wasting (loop diuretics, AG, ampho B, cisplatin)
|
magnesium
|
|
|
|
advant and disadvant of the PN and central vain PN
|
k
|
|
|
|
what generally should be added first to the tpn?
|
phosphate
|
|
|
|
what generally should be added last to the tpn?
|
calcium
|
|
|
|
what form of calcium should be used in tpn for phosphate issues
|
gluconate (not chloride)
|
|
|
|
generally add the multivitamins last...due to vit A and C degradation
|
k
|
|
|
|
what to do to TPN if met acidosis
|
DVT, increase acetate salts
|
|
|
|
what is the most severe complication of enteral nutrition?
|
pulm aspiratoin pneumonia....elevate head of bed to 30%, frequently access patient abdomen to ensure tolerence, asses the placement of the feeding tube
|
|
|
|
which is the more complicated long term enter nutrition access?
|
jejunostomy
|
|
|
|
when is PN usually cycled for home nutrition?
|
at night over 10-16 hours
|
|
|
|
interactions of enteral tube feeding
|
phenytoin (hold pheny for 2 hours before and after)...increase rate afterwards to make up for this...only 1 hour for the suspension..........incrases INR (hold EN 1 hour before and after)......
|
|
|
|
what are the 4 types of malnutrition?
|
marasmus (depleted fat and muslce stores, normal biochem, intact immune)....kwashiorkor (normal or elevated fat and body weight, abnormal biochem and depressed immune)....kwashiokor/marasmus (all are low)....obesity
|
|
|
|
hypercatabolism
|
increased urinary excretion via nitrogen
|
|
|
|
pedes definitions?
|
preterm under 36wks, term over 36 weeks......neonate (under f1 month), infant 1 month-1 year...child is 1-11, adolescent is 12-16
|
|
|
|
which acid-base status meds affect drug therapy?
|
increased bioavail for basic drugs...increased for acid labile drugs
|
|
|
|
GET is longer for pedes
|
due to peristalsis and decreased motility
|
|
|
|
pedes are achlorhydria...
|
low stomach acid
|
|
|
|
more in the pediatric section
|
k
|
|
|
|
pediatric apap dose?
|
10-15mg/kg q4-6...no more than 5 doses...if under 12..............
|
|
|
|
how is migraine defined?
|
chronic neurovascular disorder characterized by recurrent attacks of severe headache and autonomic nervous system dysfunction (some have aura)
|
|
|
|
criteria for diagnosing migraine without aura
|
at least 5 HA lasting 4-72 hours each....at least 2 of the following (unilat location, pulsating, mod to sever intensity, aggravatoin with doing physical activity)...during HA has N/V or photphobia or phonophobia
|
|
|
|
criteria for diagnosing WITH aura
|
at least 2 attacks with three of the following four (reverse aura, 2 or more at a time, no aura lastas over 60 minutes, HA follows aura in under 1 hour...
|
|
|
|
when should migraine prevention therapy be considered?
|
attacks unresponsive to abortive meds..attacks cause disability....attacks twice or more monthly....patient at risk of rebound....trending to increased frequency.....overall decreases occurance by 50%
|
|
|
|
what is the minimum trial of migraine prevention therapy?
|
2-3 months
|
|
|
|
ergotamine abortive therapy MOA
|
in the cranial arteries, ergotamine acts directly to promote constriction and reduce the amplitue of pulsations, and can affect blood flow by depressing vasomotor center
|
|
|
|
Can ergotamines be taken daily on a regular basis?
|
no, due to dependence
|
|
|
|
hwo is ergo eliminated?
|
hepatic (bad oral bioavailability
|
|
|
|
AE of the ergos?
|
well tolerated, but can stim chemorece N/V in 10%, tachy, brady, angina pain....ergotism (biggest risk if sepsis, periph vascular disease, renal or hepatic impairment)
|
|
|
|
what should ergos not be given with?
|
SSRI (vasospastic)
|
|
|
|
ergos dosing schedules and routes?
|
SL, tab, suppository, nsals spray, injection.....all give q30min-1hr prn
|
|
|
|
how is DHE given?
|
spray or injection (migranal, DHE 45)
|
|
|
|
AE profile of DHE?
|
less n/v, dependence, vasoconstriction....more diarrhea
|
|
|
|
CI of dhe and ergo?
|
CAD, periph vascular disease, sepsis, preg, hep and renal impairment....also avoud ssri within 24 hours
|
|
|
|
DHE inxns?
|
CI in 3a4 inh like PI, macrolides (can increase the levels leading to more vasospasm leading to cerebral ischemia and ischemia of extremities)
|
|
|
|
what are the selective serotonin receptor agonists
|
triptans...activate 5-ht
|
|
|
|
SE profile for the triptans are very good, but what is the major one?
|
"chest symtpoms" and coronary vasospasm (angina) (caution in CAD high risk pts)
|
|
|
|
inxns of the triptans?
|
avoid within 24 horus of ergos....dont administer if MAOi withing 2 weeks....CI if MI, ischemic heart disease, uncontrolled htn, othe rheart disease, pregnancy
|
|
|
|
imitrex? maxalt? xomig?
|
sumatriptan, rizatriptn, zolmitriptan
|
|
|
|
imitrex dosage forms?
|
tablet, nasal, injection (most of the class)
|
|
|
|
zomig dosage forms?
|
tablet or wafer, nasal
|
|
|
|
DOC for migrain proph
|
propranolol (and timolol)...aslo divalproex and sodium valproate
|
|
|
|
only antidep tested lots for migraine proph
|
amitriptyline...some for fluoxetine
|
|
|
|
what other meds besides anticonv, BB, and antidepressants can be used for migraine proph
|
CCB (verap and diltiazem Nondihydros)...also ergot alkaloid methysergide
|
|
|
|
Valproid acid metabolism? protein binding?
|
extensive hepatic, high protein binding
|
|
|
|
What sort of monitoring for valporic acid?
|
LFT's
|
|
|
|
partial seizure DOC's
|
carbamazepine, lamotrigine, levetiracetam, oxcarb
|
|
|
|
meds with knows fetal risk epilepsy
|
phenytoin, valproate, clonazepam, carbamaz, phenobarb
|
|
|
|
gen tonic clonic DOC
|
lamotrigine, valproate, levetiracetam
|
|
|
|
which 2 meds are part of the DOC for generalized and partial seizures? preg cat?
|
lamotrigine and levetiracetam....cat C
|
|
|
|
dilantin generic?
|
phenytoin
|
|
|
|
phenytoin issues with longterm therapy, Serious skin reactions, and toxicity symptoms, Target range 10-20
|
k
|
|
|
|
lamotrigine major SE
|
serious skin rxns
|
|
|
|
topamax dosing issue
|
titrate upward to 200mg BID (keep hydrated)
|
|
|
|
what is the benzo used for seizure?
|
clonazepam (klonapin IV)
|
|
|
|
keppra generic?
|
levetiracetam
|
|
|
|
What is a major benefit of keppra
|
no inxns
|
|
|
|
lamotrigine lamictal BBW?
|
skin rxns...NEED TO TITRATE
|
|
|
|
oxcarb AE
|
serious skin rxns, hyponatremia
|
|
|
|
phenobarb issues
|
its a barbiturate (SEDATION), cog impariment, dizzy ataxia
|
|
|
|
lots of inxn profiles for the different anticonvulsants
|
k
|
|
|
|
which 2 anticonvulsants to be carefule if renal failure
|
gabapentin, topiramate
|
|
|
|
which anticonv to be careful if hepatic failure
|
phenobarb, phenytoin, VPA, carbamazapine
|
|
|
|
Can anticonv be stopped suddenly?
|
NONO
|
|
|
|
Carbamazapine AE profile?
|
3a4, Serious skin rxns, check LFT's, low Na
|
|
|
|
what to monitor with carbamaz?
|
lfts, cbc, platelets
|
|
|
|
which to supplement if taking phenytoin?
|
folic acid, calcium, vit D
|
|
|
|
VPA can also cause pancreatitis
|
k
|
|
|
|
what is cerebyx
|
fosphenytoin
|
|
|
|
if albumin is low, what is the phenytoin issue?
|
it will appear artificially low
|
|
|
|
phenytoin toxicity symptoms?
|
confusion, double vision, nystagmus, shakiness/walkin unsteady
|
|
|
|
phenytoin BC inxn?
|
it lowers effectiveness
|
|
|
|
what meds can decrease sweating and cause a heat stroke in children....also need to be takend with lots of water due to increased kidney stones?
|
topiramae, zonisamide
|
|
|
|
MOA of anticonvulsants?
|
variety: enhance sodium channel inactivation...reduce current through t calcium channels....enhance gaba (Yaminobutyric acid....enhance antiglutamate activity
|
|
|
|
what is the most widely used anticonvulsant for adults and children...and DOC for complex partial seizures
|
carbamazapine
|
|
|
|
tonic phase and clonic phase
|
k
|
|
|
|
what is tegretol and carbitrol
|
carbamazapine
|
|
|
|
how long before carbamazapine will work?
|
21 days
|
|
|
|
SE profile of carbamaz
|
hyponatremia (antidiuretic), folate deficiency...BBW fatal derm rxns, aplastic anemia...FDA warning hepatotoxicity, increased suicide behavior, teratogenic class D
|
|
|
|
tegretol comes as a suspension and chewable tab
|
k
|
|
|
|
what is enbrel?
|
etanercept
|
|
|
|
what is humira?
|
adalimumab
|
|
|
|
dosing of enbrel?
|
bi weekly SC or weekly SC
|
|
|
|
dosing of humira
|
every other week SC
|
|
|
|
what is remicade?
|
RA infliximab...IV week 0,2,4, q4wks
|
|
|
|
what is rheumatrex?
|
methotrex
|
|
|
|
dosage forms of reumatrex?
|
IV, po, sc, iv
|
|
|
|
how is rheumatrex dosed?
|
every week
|
|
|
|
what is voltaren?
|
diclofenac
|
|
|
|
CI with celecoxib
|
sulfa allergy...very high Cox 2 selectivity
|
|
|
|
should NSAIDS be considered for monotherapy in RA? why?
|
NO, do not alter the course of the conditoin...dont inhibit joint destruction
|
|
|
|
how long can you use dmards before they lose effectiveness?
|
2 years typically
|
|
|
|
when should biological dmards be used
|
reserved for those who fail on nonbio or have very serious
|
|
|
|
AE profile of methotrex
|
liver (liver damage), bone marrow, lung (pulm toxicity), GI (N/V)
|
|
|
|
MOA of humira, remicade, enbrel?
|
anti TNF
|
|
|
|
anti TNF AE profile?
|
infection risk BBW, , careful with live vaccines
|
|
|
|
what is zyloprim
|
allopurinol
|
|
|
|
moa of allopur
|
xanthin oxidase
|
|
|
|
SLE symptoms
|
malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, proteinuria, CNS probs, antinuc antibodies, anemia, fatigue, fever, skin rash, N/V/D, raynauds, wieght loss
|
|
|
|
what is the hallmark symtpom of RA
|
morning stiffness
|
|
|
|
what is the symptoms that distiguishes OA from RA?
|
pain goes away with some movement
|
|
|
|
DOC for OA
|
apap
|
|
|
|
tamoxifen increases what cancer?
|
endometrial, blood clots and stroke
|
|
|
|
what pop of woman can have aromitase inh anastrazole?
|
if ovaries are not making estrogen, thus postmenopause
|
|
|
|
if INR outside range within 1.0, change dose and check in 1-2 weeks
|
k
|
|
|
|
if INR outside range >1.0, change dose, check in 1 week
|
k
|
|
|
|
between 5-9 INR, hold dose 1-2 days and check in 24-48 hours, consider oral vit K
|
k
|
|
|
|
over 9 INR
|
k
|
|
|
|
for sedation, analgesia and neuro muscular blockade....drugs?
|
opiates, nsaids, benzos, haloperidol, propofol (MOA unknown)(related to gaba), NMB agents (postsynaptic cholinergic rec antags, no analgesia or sedation)
|
|
|
|
what is diprovan?
|
propofol
|
|
|
|
what is an advantage of propofol?
|
use when the patient needs to raplidly awake
|
|
|
|
what is the doc of delerium
|
haloperidol (IV OR PO)
|
|
|
|
what is the short and long term sedation benzos?
|
ativan long term, versed acute and short term
|
|
|
|
what is ativan? versed?
|
lorazepam, midazolam
|
|
|
|
what is the opiate of choice in acute care? when to use the secondary choice?
|
morphine sulf...morphine intol, hemodynamic instability, renal dysfunction (hydromorphone (dilaudid)
|
|
|
|
max duration of use for toradol?
|
5 days
|
|
|
|
what is toradol?
|
ketorolac
|
|
|
|
what to do to long term sedation patients to reduce stay?
|
daily wake up and reasses
|
|
|
|
whaqt vehicle is propofol in, and makes an issue with egg allergies?
|
highly lipid
|
|
|
|
what is GCS
|
glasgow coma score, ct scan also used for assessments, intracranial pressure also
|
|
|
|
3 basics to help decrease ICP
|
1) osmotic agents and diuretics (mannitol, loop diuret, hypertonic NaCl 3.0% or 7.5%)...2) sedation (prefer short acting (fentanyl, propofol)....3) NMB agents (short acting....vecuronium)
|
|
|
|
what is pentobarb used for?
|
refractory intracranial htn
|
|
|
|
name 2 major NMB agents, MOA of these
|
postsyn chol antags....pancuronium (pavulon), vecuronium (norcuron)
|
|
|
|
4 nondrug interventions for traumatic head injury?
|
raise head of bed, vent drainage of cerebrospinal fluid (ventriculostomy), mild hyperventilation (PCO2 30-35), surgery
|
|
|
|
what is the anticonvulsant of choice for seizure prevention in traumatic brain injury?
|
phenytoin (dilantin) (LOAD) (continue for 7 days if they actually had a seizure)
|
|
|
|
Meds for actue spinal injury
|
Load with methylprenisolone 30mg/kg IV (do not give if it has been more than 8 hours)...careful of hypERglycemia
|
|
|
|
what are the 3 things for DVT diagnostics?
|
radiocontrast dye, ultrasonagraphy, serum D dimer concentrations
|
|
|
|
what is the dosing of heparin in DVT?
|
80units/kg load THEN 18 units/kg/hrw
|
|
|
|
dosing of enoxaparin in DVT?
|
1mg/kg q12 or 1.5mg/kg/day
|
|
|
|
timeline for the heparins and warfarin initiation in DVT
|
begin concurrently
|
|
|
|
druation of warfarin?
|
if it was a reversable cause 3 months, if idiopathic 6-12 months, high risk 12 months
|
|
|
|
what is DTI role in dvt
|
use when heparin cannot
|
|
|
|
fonda moa?
|
factor Xa inh
|
|
|
|
what is arixtraz/
|
fonda
|
|
|
|
what is fragmin
|
dalteparin
|
|
|
|
name the 3 major DTI?
|
lepirudin (refludan) bivalirudin (angiomax) argatroban
|
|
|
|
what is the reversal agent for heparins?
|
protamine sulfate
|
|
|
|
what to monitor for Heparin
|
PTT, also can check anti Xa
|
|
|
|
any monitoring required for fonda?
|
no
|
|
|
|
DTI monitorin?
|
PTT
|
|
|
|
LMWH renally cleared and has a half life how much longer than heparin?
|
2-4 times
|
|
|
|
Fonda is renally cleared and has long half life
|
k
|
|
|
|
which DTI is renally cleared
|
lepirudin XXXXX
|
|
|
|
half life of the DTI?
|
30-90 minutes
|
|
|
|
Fonda reversal agent? HIT?
|
no reversal,,,,very unlikely (thought not rec in ASHP bood)
|
|
|
|
DTI reversal agetn?
|
no
|
|
|
|
what is an example of organ dysfunciton with sepsis?
|
hypotension responsive to fluids, oliguria, acute mental status change, lactic acidosos, respiratory insuficiency, coagulopathy
|
|
|
|
systemic manifestations of sepsis, imbalances in the inflammatory, immune, and coagulation systems lead to organ hypoperfusion and organ dysfunction w/ or w/o refractory hypotension
|
k
|
|
|
|
human activated protein C (drotrecogin alfa) for sepsis
|
k
|
|
|
|
what is the rec agent for severe sepsis and septic shock vasopres and inotrope
|
dopamine, Nepi
|
|
|
|
dosing of dopamine?
|
under 5mcg/kg/min=increased renal perfusion....5-10 increased cardiac output/hr bp...10-20 even mreo
|
|
|
|
what is vasopressin role?
|
add to catecholamine vasopressor in nonresponsive patients
|
|
|
|
Xigris role (drotrecogin alfa)
|
add to antimicrobial therpy within 48 hours of onset of severe septis, decreases mortality (apache II score over 25, monitor bleeding, Expensive but cost effective
|
|
|
|
what is DDAVP? (desmopressin)
|
for hypernatremia severe
|
|
|
|
10mEq of potassium increases serum potassium by 0.1 mEq/L
|
k
|
|
|
|
what is the 3 step treatment of hypERkalemia
|
1) K removal (Na polystyrene sulfonate (kayexelate) po or pr; loop diuretics, hemodialysis....2) intracellular K shift (rapid onset), insulin + dextrose, albuterol, Na bicarb .....3) potassium antag of cardiac effects (IV calcium)
|
|
|
|
5.5 to 6 is mild...6.1-7.0 is moderate....7 + is severe
|
what is the treatments for each section?
|
|
|
|
treat hyperphos is CKD
|
phosphate binding agents (sevelemer or Calcium/lanthanum, aluminum, magnesium)
|
|
|
|
hyperchloremia
|
give Na acetate
|
|
|
|
which of the calciums are less iritating?
|
calcium carbonate less than calcium chloride
|
|
|
|
rapid acting insulins
|
aspart (novoLOG), lispro (humaLOG), glulisine (apidra)
|
|
|
|
Long acting insulins
|
glargine (lantus), detemir (levemir)
|
|
|
|
insulin should be considered an initial agent if A1c is over X%
|
10%
|
|
|
|
when to draw up regular insulin when mixing?
|
FIRST every time
|
|
|
|
ductus arteriosus
|
regulated by prostaglandins, can be fixed by indomethacin /ibuprofen (nsaids)
|
|
|
|
know mrsa agents
|
k
|
|
|
|
mydriasis?
|
excessive pupil dilation
|
|
|
|
what is the cause of 90% of primary hypothyroid? what causes secondary hypothyroid
|
hashimotos, pituitary failure
|
|
|
|
what is the main test for hypothyroid?
|
TSH, free t4 is secondary (confirms)
|
|
|
|
what is the issues iwth T3 and T4
|
T4 converted to T3 (more potent)
|
|
|
|
for thyroid therapy, typically for life, directions?
|
in morning 30 minutes before breakfast
|
|
|
|
AE of thyroid
|
CV (tachy, arrhythmia, MI, angina)...CNS (tremor, HA, nervous, insomnia, hyperactivity)...GI (diarrhea, vomiting, cramps)...mis (weight loss, fatigue, sweating, heat intolerence)
|
|
|
|
how much to seperate antacids, calciu, and iron from levothyroxine?
|
4 hours
|
|
|
|
Lots of interactions with levo, go over
|
k
|
|
|
|
what is the monitoring schedule for levothyro
|
TSH q6-8 weeks, then 6-12 months, Coronary art disease and angina risk monitored
|
|
|
|
half life of levo?
|
7 days
|
|
|
|
wha tis a drawback of T3?
|
more cardiac SE
|
|
|
|
what is graves?
|
autoimmune leading to thyroid overactivity
|
|
|
|
what are 2 meds that may cause hypERthyroid?
|
amiodarone, iodine
|
|
|
|
how to diagnose graves (or hypERthyroid)
|
elevated T3 or T4 in presence of decreased TSH
|
|
|
|
treatment of hypERthyroid? 3
|
surgery, radioactive iodine, antithyroid(thioamide)
|
|
|
|
what is the main thioamide meds?
|
methimazole, propylthiouracil
|
|
|
|
what ar eth main SE of antithyroids?
|
GI (hepatitis) Heme issues
|
|
|
|
what is cushings?
|
chronic glucocorticoid excess
|
|
|
|
def of iatrogenic
|
caused by medical system
|
|
|
|
typical cuas eof cushings?
|
iatrogenic
|
|
|
|
presentation of cushings?
|
htn, hirsutism (hair), acne, depression, DM, obesity
|
|
|
|
how to diagnose cushing?
|
dexameth supp test or 24 hour urine cortisol measurement
|
|
|
|
4 meds for cushings, suppressing cortisol
|
ketoconazole, aminoglutethimide, mitotane, meyrapone
|
|
|
|
what is addisons
|
adrenal deficiency (autoimmune)
|
|
|
|
causes of addisons?
|
autoimmune...cessation of chronic exogenous corticosteroid use
|
|
|
|
presentation of addisons 2
|
glucocorticoid pres (weight loss, malais, ab pain, depression)...minercor pres (dehydration, hypotension, hyperkal, salt craving)
|
|
|
|
scholarship award, grant, fellowship
|
مِنْحة
|
مِنَح
|
|
|
what is the main mineralcorticoid?
|
aldosterone-inhances reabsorption of sodium and water and increase urinary potassium excretione
|
|
|
|
chronic exog steroid supp promotes what
|
HPA axis suppression, lowering ACTH secretion (leading to decreased body cortisol release)
|
|
|
|
how to diag addisons?
|
ACTH stim test
|
|
|
|
what is DOC for adrenal crisis?
|
hydrocortisone 100mg IV q8
|
|
|
|
glucocorticoid effects?
|
1) increase blood glucose by sim gloconeogen and glycogenolysis, fat deposition is INCREASED 2)catabolic effects in bone muscle fat skin 3) inh of inflammation and immunosupp, vasoconstriction, reduce prostaglandin, decrease neutrophils
|
|
|
|
ophtamic effects of steroids?
|
cataracts, glaucoma...also many others
|
|
|
|
vasopressin and desmopressin
|
vaso: shock, vent fibrillation (ADH hormone) causes vasoconstricion in protal and splanchic vessels....desmo (synth deriv of vaso) minimal vasoconstricitve prop, factor 8 increase (von Willebrands)
|
|
|
|
use steroids with lowest dose for shortest possible time
|
k
|
|
|
|
what is ocreotide
|
mimics somatostatin...inh secretion of MANY hormones
|
|
|
|
uses of ocreotide
|
Antidirrhea, acromegaly (too much growth hormone), esoph varices, sulfonylurea poisoning (inh insulin), congenital hyperinsulinemia
|
|
|
|
vasopressin is adjunct treatment in esophageal varices
|
k
|
|
|
|
IBS go over
|
k
|
|
|
|
doc for esoph bleeding
|
ocreotide
|
|
|
|
what is the hallmark symptom of UC?
|
bloody diarrha, recal urgency
|
|
|
|
mild, mod, severe, fulminant UC def?
|
under 4, 4-6, over 6, more than 10 and bleeding/toxicity, etc
|
|
|
|
chrones symtpoms not as pronounced, but what are some
|
ab pain, nocturnal diarrhea, weight loss, fever, rectal bleeding
|
|
|
|
mild to severe to fulminant
|
depends on responsivelness to meds, toxicity etc, no numbers of bowel movements
|
|
|
|
what are the treatment principles in IBD (UC and chrons)
|
anti-inflammatory, immunosuppressive, biologic agents, nutritional support
|
|
|
|
distal UC treatment?
|
topical aminosalicylates w/ or w/o rectal steroids...oral if that doesnt work
|
|
|
|
mild to moderat distal colitis treat
|
oral aminosalicylates, topical mesalamine, topical steroids
|
|
|
|
mod to severe distal colitis treat
|
BID enemas with or without oral or topical aminosalicylates....ORAL corticosteroids reserved if failed therapy
|
|
|
|
if mild to mod Extensive UC, treat?
|
oral aminosalicylates (add oral corticosteroid if failed)
|
|
|
|
mod to severe extensive UC
|
infliximab may be used
|
|
|
|
sever or fulminat colitis treat
|
hospitlization and complet bowel rest....IV steroids, topical...if refractory then surgery or IV cyclosporine...azathioprine for remission maintenance
|
|
|
|
abdominal xray to exclude toxic megalocolon
|
k
|
|
|
|
mild to mod localized Chrons treat
|
oral budesonide as initial controlled release (better than oral mesalamine)
|
|
|
|
mod to severe chrones treat
|
oral corticosteroids (pred 40-60 mg qd until symtpoms resolve and weight gain begins)....azathioprine may be added, methotrex to induce remission, natalizumab
|
|
|
|
severe to fulminatn chrones treat?
|
hospital, IV steroids, hydration
|
|
|
|
manage fistulas in severe chrones
|
azathioprine, infliximab
|
|
|
|
what are the staploes of maintenace therapy for ibd
|
mesalamine, sulfasalazine (not long term corticosteroid)
|
|
|
|
also infliximab, azathioprine, methotrex, natalizumab for maintenance
|
k
|
|
|
|
MOA of metronidazole and cipor in IBD are unkjnown
|
k
|
|
|
|
inflix is inh of TNF
|
k
|
|
|
|
what is asacol?
|
mesalamine
|
|
|
|
what is remicade?
|
infliximab
|
|
|
|
sulfasalazine patient counseling
|
take after meals, avoid sun, supp folic acid, orange urine and skin
|
|
|
|
mesalamine counseling
|
enemas
|
|
|
|
methotrex counseling
|
preg cat X, alcohol, sunlight, salicylates
|
|
|
|
mesalamine is better tolerated than sulfasalazine
|
k
|
|
|
|
azathioprine and allopurinol inxn
|
k
|
|
|
|
IBS treat?
|
loperamide improves stool consistency and decreases stool freq....lots of drug classes
|
|
|
|
loperamide moa
|
opiod ag
|
|
|
|
what is imodium
|
loperamide antidiarrhea
|
|
|
|
hycosamine moa?
|
antichol
|
|
|
|
dicyclomine moa?
|
antichol, antispasmic
|
|
|
|
max dose of loperamide imodium?
|
2mg after each loose stool...max 16mg/day
|
|
|
|
most of the IBD meds are hepatic met
|
k
|
|
|
|
key points of GI 446
|
k
|
|
|
|
For H pylori eradication treatment?
|
PPI plus 2 abx agents (amoxicillin, clarithromycin) if pcn allergic... metro and tetracycline
|
|
|
|
if suggestive of cardiac issues with hyperkalemia need calcium carb
|
k
|
|
|
|
5 A's regarding smoking cessation
|
ask about tobacco use, advise to quite, assess willingness to make an attempt to quite, assist in quit attemp, arrange a followup
|
|
|
|
what is chantix
|
varenicline
|
|
|
|
can you combine the patch with other gum or nasal spray for smoking cess?
|
YES
|
|
|
|
3 CI with NRT?
|
under 2 weeks following MI, serious arrhythmias, seriou or worsening angina....specifi to the gum is esophagitis and peptic ulcer....specific to nasal spry NO allergies, asthma, sinus condition
|
|
|
|
how many lozenges at a time can you use?
|
1
|
|
|
|
what are some abnormal SE from the patich
|
vivid dreams, insomnia, HA (can reduce by using the 16 hour patch or removing at night)
|
|
|
|
what is the piece limit for gum /day?
|
24
|
|
|
|
what are the drug classes that can cause sexual dysfunction
|
BP meds (clonidine, BB, methyldopa), antipsychotics, SSRI, SNRI, Cimetidine, opiods
|
|
|
|
ED meds intracavernosal and transurethral alprostadil (muse and caverject) and NGT?
|
OK
|
|
|
|
what is cialis?
|
tadalafil
|
|
|
|
dosing of cialis?
|
1 hourprior to intercourse, Renal issues, hepatic issues
|
|
|
|
what is levitra?
|
vardenafil 10mg, 1 hour before intercouse, like cialis
|
|
|
|
waht is viagra
|
sildenafil (50mg, 1 hour prior)
|
|
|
|
what is avinza?
|
morphine er
|
|
|
|
what is roxanol?
|
liquid morphine
|
|
|
|
what is actiq
|
fentanyl transbucal
|
|
|
|
what is the ANA test?
|
autoimmune antibody
|
|
|
|
what are the 3 main drugs for drug induced lupus?
|
procainamide (Pronestyl)
hydralazine (Apresoline) quinidine (Quinaglute). |
|
|
|
go over nonprescription meds in ashp
|
k
|
|
|
|
what is raynauds?
|
discoloration of fingers toes
|
|
|
|
cause of raynauds?
|
Lots, including drugs
|
|
|
|
what drugs can be cause raynauds?
|
chemo, BB, ergotamine, sulfasalazine
|
|
|
|
treamtne of raynauds?
|
norvasc, BB, alpha blockers (counteract Nepi)
|
|
|
|
what is avelox?
|
moxiflox
|
|
|
|
what is primaxin?
|
imipenem cilastin
|
|
|
|
what is toradol? limitations?
|
ketorolac, 5 days
|
|
|
|
what is norvasc?
|
amlodipine
|
|
|
|
nifedipine
|
dihydro
|
|
|
|
when taking phenytoin, monitoring?
|
ECG every hour
|
|
|
|
what is dilantin?
|
phenytoin
|
|
|
|
what is colace?
|
docusate
|
|
