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128 Cards in this Set
- Front
- Back
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what are the 6 major GI bleed risk factors |
age over 65, anticoag use, oral steroid use, PUD hx, HTN and DM, previous GI bleed
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What happens to potassium as you correct acidosis?
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potassium goes into cell in exchange for H+, need to add potassium to IV fluids once K begins to correct in DKA pts
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What is a role a clinical pharmacist can take in a DKA pt?
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DVT proph, important due to high osmolarity of the blood
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What is the pathophys of cerebral edema in DKA?
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lowering blood glucose too rapidly, therefore blood osmolarity too quickly
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what are the zones for asthma?
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yellow 50-79, red under 50
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What are the disease states that lower theophylline clearence?
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hepatitis and decompensated HF
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which SE of inhaled corticosteroids are reduced from using a spacer?
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candidiasis
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what is the theophylline range?
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5-15 (old is 10-20)
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budesonide is another good inhaled corticosteroid
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ll
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MDIs have large particles, thus have difficult time penetrating in very cold temps
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k
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Long term phenytoin use SE?
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diff falling or staying asleep, abnormal body movements, confusion/slowed thinking/slurred speech, unwanted hair growth, enlargement of lips, overgrowht of gums, pain or curving of the penis
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tardive dyskinesia is not reversable
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k
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naproxen BID dosing, celebrex less GI
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k
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HLA testing...2c9 VKOR testing, her2
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carbamaz 1502 , abacavir 5701 hla.....2c9 and VKOR for warfarin.....HER2 herceptin
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MTX dosing?
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weekly (what dosage form?)
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MTX monitoring?
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WBC, PLATELETS q4weeks
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hydroxychlor and sulfasalazine dosing ?
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daily
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CI of sulfasalazine?
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plt under 50,000, LFTs high
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psoriasis biologics, chrohs biologics
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etanercept, abalibuma, infliximab, efaliz.....adalimuub, cerolizib, inflix
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BBW of biologics enbrel and humira
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opp infections (like Tb), malignancies, check CBC's, LFT's, dont use if HF
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what is an additional test (also CBC, LFT, Cr) if RA and hydroxychlor
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opthal
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what are additional tests (besides CBC, LFT, Cr) for MTX and leflud
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Hep B and C
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who should get influenza vaccine if RA and getting meds?
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ALL
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which vaccines should RA patients needing biologics get?
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pneumococc, influenza, HepB, NO live nasal
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what vaccines if getting MTX and leflud with RA
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pneumococc, Hep B, influenza
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sulfasal if RS vaccines?
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influenza and pneumococ
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sulfonylurea old ones? sig hypoglycemia, not recommended
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chlorpromaide, glyburide...glipizide and glimeperide best
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sulfa allergy
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chlorpromadine
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sulfonylurea alcohol issues?
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alcohol
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Precose moa? and accompanying SE profile and hypoglycemic treatment? Other one similar?
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alpha glucosidase inh (delaty digestion of carbs to simple sugars)....flatulence (no hypoglycemia or weight gain)....dont treat with sucrose of fructose hypoglycemia? simple glucose treat
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Why would you avoid precose (acarbose) or miglitol?
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chrohns, IBD etc, LFT increase, renal dose
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how to take acarbose?
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w/ full glass of water and w/ 1st bite of food
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metformin? sulfa? exenatide? pioglitazone? a1c decrease?
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1-2 metformin, 1-2 sulfa, 0.5-1% exenatide, pioglit 0.5-1.4%
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what happens, word, if you dont cycle insulin injection sites
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lipohypoertrophy
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what 3 factors play into making insulin adjustments?
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dietary intake, physical activity, BG
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what happens to the fetus if GDM
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macrosomia (large fetal body)
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metformin heme complications?
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megaloblastic anemia....changes in folic acid and vit B12absorption??
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what is somogyi?
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the initial "honeymoon" phase of DM1 when beta cells are destroyed and insulin released at night (hypoglycemia) then in the morning hyperglycemia...overcompensation of the night hypoglycemia...tells liver to convert glycogen to glucose
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glucophage
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metformin
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what are the 3 DM meds that need LFT monitoring?
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rosiglitazone, acarbose, metformin
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ascorbic acid, ergotam
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K
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diaphoresis
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sweating
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hypoglycemia symptoms
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k
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what is pramlintide
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DM1 med, synthetic inj of human amylin
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What is Niacins issue with diabetes?
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increase in BG
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fasting glucose wanted? wanted postprandial glucose (2hrs after eating)....according to who?
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according to ADA...fasting 90-130....postprandial under 180
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actos
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pioglitazone
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monitoring for ace
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Cr and k
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what is the ace inh that is shortest acting? needs TID dosing
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TID
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What are the indications of Digibind, 3
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Acute ingestion of over 10mg, chronic ingestion leading to over 6ng/ml, or manifested toxicity of overdose (N/V)
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symptoms of digi toxicity? optimal levels, usual doses, usual dose if renal issues?
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N/V and confusion, visual changes.....levels 0.5-0.8, 0.125-0.25 mg, 0.125 QOD
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furosemide bumetanide torsemide monitoring
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ototoxicity
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doribax
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doripenem
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invanz
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ertapenem
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cubicin
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daptomycin
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daptomycin clinical
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G+, inferior in bacteremia and endocarditis....MRSA..
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where not to use daptomycin?
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lungs (binds), dont use in pneumonia
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echinocandin monitoring...some clinicla
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new IV antifungals....candia and aspergillus....
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bacteriostatic cidal for the newer abx...tigecycline, aztreonam, lzd
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.
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echinocandin moa
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prevent fungi from forming essential component of their cell wall
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caspofungin dose adjustments?
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sever liver dysfunction
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micafungin and anidulafungin dose adjustments? adverse drug events?
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NO dose adjustments
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micafungin and anidulafungin vs caspofungin indications?
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caspofungin tx of aspergillosis refractory
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which abx are you concerned about as a weak MAOinh, serotenergic inxn?
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linezolid (CI for within 2 weeks of MAO inh, taking pseudoephedrine, epinephrin, dopaminergic agents (dopamine, dobutamine), SSRI, tricyclics, sertotonin agonsits, meperidine, buspirone
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which azole has absorption issues
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capsule form of itracon, take with cola drink
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if pregnant and UTI, which?
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nitrofur, bactrim to avoid in 3rd trimester
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4 meds for drug induced SLE
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phenytoin, procainimide, quinidine, hydralazine
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lidocain antiarrhythmic class, amiodarone, BB, CCB, digoxin
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lido 1b, amiodarone III, BB II, CCB IV, dig V
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amiodarone monitoring
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eyes, liver, thyroid, pulm
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which diuretic is an issue with gynecomastia
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spironolactone
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the 2 meds for maternity htn?
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methyldopa, labetelol
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which 2 meds could give you a sense of coldness in extremities?
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BB and ergotamine
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ADHD 1st line second line etc
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1st=stimulants...2nd=tricyclic antichol (desipramine, imipramine....2nd=bupropion....clonidine, Nepi reuptake inh
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when to avoid exenatide?
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hx of pancreatitis gallstones, alcoholism or high Tglycerides....THYROID NEOPLASMS
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exenatide MOA
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incretin mimetic (increases insulin, decreases glucagon)
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why avoid alcohol in meformin?
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lactic acidosis
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gliptin moa?
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incretin meds...pp4 inh
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gliptin SE profile
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pancreatitis, allergic rxns
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which med might work for stage fright
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propranolol
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digoxin clinical
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afib second line...1st line if HF also (no mortality issues with the hf)
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moa if digoxin
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heart beats stronger (na pot pump, increase in intracellular Calcium)..ultimately rate controlled
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isosorbide dinitrate
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lupus like syndrome
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diuretic for sulfa allergy
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thiazide, loops
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HIV brand and generic...insulins brand....chemo SE and classes of improtant drugs
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k
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BP goals if DM?
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130/80
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RF and patient situations requiring ASA or antiplat if DM
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over 40yo...FH of CV, htn, smoking, dyslipid, albuminuria
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vaccines if DM
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yearly influenza, pneumococcol
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other care if DM?
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foot exams (daily self, annual comprehensive)....skin care...annual dental...annual dilated eye exam
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DM se major
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20-40% neuropathy, retinopathy, polyneuropathy, autonomic neur, feet
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what may precipitate DKA
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infxns, stress, omission of insulin, trauma
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DKA symptoms
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kussmaul asira (deep and rapid)
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which DM is DKA typically found? what about hyperosmolar hyperglyc (gluc over 500, dehydrated,
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type 1...type 2
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what could lactic acidosis lead to
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acute mi, chf, severe resp disease, shock
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issue with rosiglitazone?
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30-40% increase in MI
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BBW with rosiglitazone and pioglitazone?
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HF
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thiazolidinediones major SE?
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water retention and hepatic toxicity
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aricept....also galantamine...moa?
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donepezil...cholinesterase inh acetylcholine
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what does memantine effect, used for?
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glutamate, alzheimers
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memantine dose adjustments?
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renal
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dosing issues with aricept and galantamine
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titrate to optimal dose
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name an inxn with SSRI?
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warfarin increased bleeding
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remeron? why a good option for seniors?
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mirtazapine, weight gain plus sedation
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mirtazapine (remeron moa)...other indications
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tetracyclinc antidepressant....ptsd
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paroxetine SE pneumogram
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flat effect and fat
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is tardive dyskinesia reversable
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no
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symptoms of tardive dyskinesia
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lip smacking, choreoathetosis (profusion of tongue)...monitor with AIMS
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atypical clincial pearl
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no real def of atypical antidepressants...Less severe SE (EPS, less TD, lower prolactin), MORE weight gain and lipid issues and DM ris) dose dependent risk of dysrrhythmia and sudden death (qt?)
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BBW of clozaril risper (maybe)
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seizure, agranulocytosis, no eps or TD, weight gain...weekly CBC, DC if wbc under 3000 or ANC under 1500
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quetiapine (seroquel) SE profile
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eye issues, sedation
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aripiprazole dosing?
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once daily
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ZIPRASIDONE se profile?
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qt prolongation
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what are the 2 main options for actue schizo?
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haloperidol, lorazepam 2 mg IM q4
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what is the BBW for ALL antidepressants?
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increase suicidal ideation and behavior in children under 24
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dosing of amitryptyline and nortrypt? concerns?
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titrate upwards...OD
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indications for amitrypt and nortrypt?
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periph neuropathy migrain proph antidepressant
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which SSRI does not need a taper when D/C?
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fluoxetine prozac
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venlafaxine SE effexor?
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increase in BP
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triptans and antidepressant inxn issue
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serotonin syndrome
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max dose of bupropion? Why..NE and dopamine
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450mg/day...seizures
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what is the seperation of Mao and the other sert meds? fluoxetine?
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2 weeks...5 weeks when going fluoxetine to MAO
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chads2 score, RF for after afib therapy, length of warf?
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CHF, HTN, ago over 75, Diabetes, Stroke counts as 2
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effect of VKORC1 group A and B? who has it?
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asians have A polymorphism leading to warf sens (reach INR faster).....africans have B leading to resistance
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what is the 2Ca poly? how many people have it?
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effects time to over 4 INR slower
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when doing surgery what is the timeline diff for antiplatelets vs anticoags?
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need to stop antiplatelets earlier
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Hep bleeding natural products?
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gingko, garlic, ginsent
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what is seasonel? seasonesque
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91 pills (7 innactive), 7 are low dose estrogen
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what is lybrel?
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continuous OC
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which are the OC inxn main abx concerins?
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rifampin, ampicillin, sulfa, tetracyclines
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