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Top 200 prescription drugs and RXPREP

Top 200 Prescription Drugs And Rxprep

by ygvivian9, Apr. 2014

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407 Cards in this Set

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Zovirax	acyclovir -tk wi 1st day of S/S -regardless food	AntiViral
ProAir	albuterol	B2 Receptor Agonist(Lungs)
Proventil	albuterol	Beta Agonist (B2)(Lungs)
Ventolin	albuterol	Bronchodilator
Combivent	albuterol + ipratropium inhaler	Bronchodilator
Zyloprim	allopurinol severe rash, HLA-B580, hepatotox* CKD pt max. starting dose: 50 mg qd w/ meal	Xanthine Oxidase Inhibitor
Xanax	alprazolam	Benzodiazepine (DEA Sch 4)
Amoxil	amoxicillin (IR: w. food ER-within 1hr of finishing a meal)	Antibiotic (Penicillin)
Augmentin	amoxicillin + clavulanate (w.Food, Should Refridge) SE: Rash	Penicillin Antibiotic
Adderall	amphetamine + dextroamphetamine	Stimulant(ADHD) (DEA Sch 2)
Vicodin	APAP + hydrocodone (dose is equavalent to PO morphine)	Pain Relief (DEA Sch 3)
Strattera	atomoxetine	Norephinephrine Reuptake Inhibitor (ADHD)
Lipitor	atorvastatin (for all statins) pregnancy X ⤴: LFT, CPK, D, BG, A1C, Cataracts ⤵dose w/ crcl<30, except Lescol (fluva) & Lipitor; lower dose when crcl<60 w/ Livalo (pitava) avoid concurrent w/ fibrates, niacin, colchicine major 3A4 substrates: simva, lova, atorva	Statin
Zithromax	azithromycin -prevent MAC, DC if CD4>100 -Tab, IR: regardless of food -ER: empty stom	Macrolide Antibiotic
Benztropine	benzatropine	Parkinsons
Tessalon Perles	benzonatate	Cough Supressant
Butrans patch (opioid agonist for pain)	buprenorphine SE: QT, sedation apply above waist qwk don't use at same site > 3 wks	Opioid Recovery (DEA Sch3)
Coreg	carvedilol (Beta-1 and beta-2 blocker and alpha-1 blocker) HTN: start IR 6.25 mg BID ⤵ mortality in HF: start IR 3.125 mg BID, if wt < 85kg, max 25 mg BID CR (qd) dose = 3 x IR (bid) all forms tk w/ food ⤴BG, wt gain, edema	Beta Receptor Blocker
Omnicef	cefdinir (3rd gen) -SE: NVD, rash -tk regardless of food -No refrige	Antibiotic (Cephalosporin)
Ceftin	cefuroxime (2nd gen) -Tk w. food q12hr	Antibiotic
Keflex	cephalexin (1st gen) -Regardless of food q6hr	Antibiotic (Cephalosporin)
Peridex	chlorhexidine gluconate	Anti-Microbial Oral Rinse
Tussionex	chlorpheniramine + hydrocodone	Narc+Anti-Hist (DEA Sch III)
Cipro - FQ whole class	ciprofloxacin - QT,seizures,tendon rupture/swelling, ⤴⤵BG, crystalluria, sun -CI: tizanidine,Class IA & 3	Quinolone Antibiotic
Biaxin	clarithromycin -metalic taste,DN,ab pain -tab,susp: regardless food BID -Not refrige	Antibiotic
Cleocin	clindamycin -Regardless food -Not refrige	Antibiotics
Temovate	clobetasol (topical CSD-high potency)	Corticosteroid
Klonopin	clonazepam	Benzodiazepine (DEA Sch 4)
Catapres	clonidine centrally-acting alpha 2 agonist, slow taper off bc rebound HTN tab: BID, start at HS patch (Catapres-TTS): QWK on upper/outer arm or upper chest SE: sedation, dizziness, fatigue, dry mouth, bradycardia, hypotension, constipation, depression, sexual dysfxn	Alpha Receptor Agonist
Plavix watch for TTP (thrombotic thrombocytopenic purpura-fever, purple skin patches, jaundice)	clopidogrel (antiplatelet: P2Y12 inhibitor) prodrug, 2C19 substrate (D-D: cimetidine, azoles, fluoxetine, fluvoxamine, omeprazole, esomeprazole) maint. dose: 75 mg qd,DC 5 days prior surgery	Platelet Aggregation Inhibitor
Lotrisone	clotrimazole + betamethasone	Anti-Fungal + Steroid
Tylenol 3	codeine + APAP - High degree of GI SE, constipation, N - watch for 2D6 FAST METABOLISER	Pain Relief (DEA Sch 3)
Colcrys	colchicine TX (works if w/i 36 hrs of onset) : 2x0.6 mg tab followed by 1x0.6 mg in 1 hr, max 3 x 0.6 mg Prophylaxis: 0.6 mg BID NVD, myelosuppression, arthrogia (avoid concurrent w/ statins), neuopathy	Anti-Gout
Premarin (x 7-10 yr max)	Conjugated Estrogen: HRT for relief peri-menopausal Hot flashes & good for bone health x 7-10 yr must + Progestrone in women w uretus made from urine of pregnant horse SE: NV, BLOATING, ⤴TG & ⤴HDL, heart attacks, strokes, breast cancer, blood clots, dementia	Estrogen Replacement
Cataflam Voltaren gel - for OA	diclofenac NSAID	N.S.A.I.D.
Bentyl	dicyclomine	Anti-Spasmotic
Lanoxin	digoxin inhibit Na/k/ATPase pump, positive inotrope & negative chronotrope used in HF for ⤵ hospitalization & aFib HF: < 1.0 ng/mL, aFib: 0.8 - 2.0 ng/ml ⤴level due to: RI/hypokalemia/hypoMg/hypercalcemia/hypothyroidism; substrate; addict other drugs ⤵HR	Inotrope
Cardizem Dilt-XR	diltiazem (NDH-CCB) - CI: hypotension, grapefriut, 2nd,3rd degree heart block, sick sunus syndrome, cardiogenic shock, acute MI, pulmonary congestion, HF (⤵contraction force) - SE: edema, constipation, gingival hyperplasia, arrhythmias, HF, hypotension, HA	Calcium Channel Blocker
Depakote	divalproex	Anti-Convulsant
Aricept	donepezil	Cholinesterase Inhibitor
Vibramycin	doxycycline -N,upset,sun -CI-pregnant&BF -Not refrige	Antibiotic
Vasotec	enalapril	ACE Inhibitor
Lunesta	eszopiclone	Sleep Aid (DEA Sch 4)
Ortho Tri- Cyclen	ethinyl estradiol + norgestimate	Birth Control
Zetia	ezetimibe inhibit absp of cholesterol at brush border QD regardless of food CI: liver dis,myopathy when combine w/ statins URTI, D, Arthralgias	Colesterol
Vytorin	ezetimibe + simvastatin	Cholesterol
Pepcid (preferred than cimetidine)	famotidine	Histamine Blocker
Tricor	fenofibrate (fibrates) PPAR alpha activator CI: liver/renal/gallbladder dis, BF Warning: concurrent w/ statins, myopathy, cholelithiasis, reversible ⤴Scr	Cholesterol
Duragesic Q3d apply above the waist on the front or back, or on the upper arm or chest, press for 30 sec; 8hr onset;	fentanyl transdermal patch Not indicated for initial opioid therapy, not for PRN; pt has to been taken morphine >= 60 mg/daily (equivalent) for at least 7 days; if ⤴BTP, ⤴Baseline opioid dose; Shorten dosing interval rather than inc dose; lowest dose is 12.5 mcg/h (12); use large amt of water to remove it w/o soap;	Pain Relief (DEA Sch 2)
Feosol	ferrous sulfate	Iron Deficiency
Allegra	fexofenadine	Antihistamine (H1)
Diflucan	fluconazole -HA,N,Ab pain,liver tox,rash -regardless food qd -CI: PPI/H2RA (Need acidic envir. to work)	Anti-Fungal
Prozac	fluoxetine	S.S.R.I.
Flonase	fluticasone	Inhaled Steroid
Advair	fluticasone + salmeterol	Bronchodilator + Steroid
Folvite	folic acid	Mineral Supp.
Lasix	furosemide No refrige -crystal IV:PO=1:2 cs orthostatic hypotentis	Diuretic
Neurontin	gabapentin	Anti-Convulsant
Lopid - highest risk of myopathy when combined with a statin	gemfibrozil - 600 mg BID, 30 minutes before breakfast and dinner	Cholesterol
Amaryl	glimepiride (preferred SFU:⤴insulin secretion) - Tk w the 1st meal QD - Tolerance, wt gain	Antidiabetic
Glucotrol	glipizide (preferred SFU:⤴insulin secretion) - XR: tk w the 1st meal QD - IR: 30 min b4 breakfast & dinner - tolerance,wt gain, ⤵ BG	Anti-Diabetic
DiaBeta - Not preferred bc has metabolite	glyburide (SFU:⤴insulin secretion) - Has metabolite, CI CRCL<50 - Max dose 20 mg qd - ⤵BG, wt gain, tolerance	Anti-Diabetic
Robitussin	guaifenesin	Cold Syrup
Apresoline	hydralazine	Anti- hypertensive
Microzide	hydrochlorothiazide (HCTZ) ⤵: K, Na, Mg ⤴: Ca, uric acid, BG, cholesterol Dose < 25 preg B	Thiazide Diuretic
Plaquenil	hydroxychloroquine: - DMARD for who has mild RA and want pregnant; also tx SLE - benefit: no hepatotixic & safer for pregnancy - SE: vision change	Arthritis / Lupus
Vistaril	hydroxyzine	Anti-Histamine
Advil	ibuprofen (all NSAIDs) ⤴level of lithium & methotrexate BBW: CV, HF, Renal dis, SSRI, SNRI pre-op before CABG	N.S.A.I.D
long-acting insulin	onset (1-2 hr), controls fasting BG at baseline Lantus (Solostar) - 28d - Clear Levemir (Flexipen) - 42d	Insulin
Avalide	irbesartan (Avapro) + HCTZ	A2RB + Diuretic
Imdur	isosorbide mononitrate BID 1st dose when waking up, 2nd dose on 5 hrs later	Nitrate Vasodilator
Nizoral shampoo	ketoconazole	Anti-fungal
Lamictal	lamotrigine	Anti-convulsant
Xalatan	latanoprost (opthalmic)	Prostaglandin
Prevacid	lansoprazole	Proton Pump Inhibitor
Keppra	levetiracetam	Anti-convulsant
Levaquin	levofloxacin -tab: Regardless food qd -Susp: wo. food -sto upset,crystaluria -Not refrige	Antibiotic (Quinolone)
Synthroid (Levoxyl, levothroid) BBW: wt reduction; use w/ anorectic drugs CI: acute MI, thyrotoxicosis, adrenal impair; Afib, fracture, high protein bound displace (salicylates, heparin, phenytoin, NSAID). IV to PO = 1:2	levothyroxine (T4) - pregnant cat. A monitor in 6-8 wk, 6 mon, yr > 50yo w/ CVD, start 12.5-25 mcg qd, titrate q4-8wks > 50yo w/o CVD & < 50yo w/ CVD, start 50 mcg qd tk on empty stom, at least 30min b4 brf w/a full glass of water; seperate others 4hr	Hormone Replacement
Lidoderm	lidocaine patch - for postherpetic neuralgia - 1-3 patches qd for up to 12 hr/day; cuttable	Topical Anesthetic
Vyvanse	lisdexamfetamine	ADHD (DEA Sch II)
Prinivil (Zestril)	lisinopril - target dose for HF: 20 mg qd	ACE inhibitor
Ativan	lorazepam	Benzodiazepine (DEA Sch 4)
Anti-Vert	meclizine	Anti-Vertigo
Namenda	memantine	Anti-Alzheimer
Glucophage	metformin (⤵BG released by liver) -start IR 500 mg BID w brf & DN, or 850 QD -start ER (Fortamet) 500-1000 w dinner, target dose 2g qd; Max: 2550 mg qd - CI: Scr >=1.5 (men) or 1.4 (women) or crcl < 60, metabolic acidosis, iodinated media, Hypoxia (HF,resp failure,...)	Antidiabetic
Methadose-liquid Dolophine	methadone for opioid detox QT, Serotonergic Difficult equianalgesic dose conversion Variable t1/2	Opioid Dependence (DEA Sch 2)
Rheumatrex	methotrexate (only DMARDs safe for HF) 7.5 - 25 mg qwk for mild RA or psoriasis (suppliment w/ Folic acid), see benefit in 3 mo BBW: Renal, liver & lung tox, BMD, birth defect, mucositis/stomatitis, skin rxn CI: pregnancy&BF (X)-both sexes need prevent pregnancy, alcohol, chronic liver dis SE: Stomatitis, NV, ⤴LFT, Alopecia, sun	D-D: Alcohol (liver tox) Aspirin (81mg for CVD prevention should be continued),NSAID,b-lactam,probenecid (renal elim) sulfonamides,topical tacrolimus (⤴SE) loop diuretics, cyclosporine (⤵effect)
Concerta	methylphenidate	ADHD (DEA Sch 2)
Reglan	metoclopramide	GI Motility Stimulant
Lopressor Toprol XL	metoprolol tartrate IR - HTN: tk w/ food metoprolol succinate, ER (cuttable) - HF - CI: sinus bradycardia (eg. HR = 48 BPM) - target dose 200 mg qd - tk regardless food	Beta Receptor Blocker (B1)
Flagyl	metronidazole -N, darken urine -IR: w food to dec sto upset ER: wo food -No alcohol 3 days afterward	Anti-Microbial
Minocin (Solodyn, Dynacin)	minocycline (DMARDS) -SE: DNV,rash,sun,Lupus-like,Fanconi,BMD -regardless food (no dairy) qd-bid -CI: Retinoic acid der. (pseudotumor cerebri), PCN -Seperate w/ lanthanum carbonate (Fosrenol)...	Anti-biotic
Nasonex	mometasone	Corticosteroid
Singulair	montelukast	Leukotriene Inhibitor
Avelox Vigamox (ophalamics)	moxifloxacin	Antibiotic (Quinolone)
Bactroban	mupirocin Nasal: For prevent MRSA	Topical Anti-Bacterial
Aleve	naproxen OTC dose-220 mg prn bid	N.S.A.I.D
Niaspan ⤵hepatic synthesis of VLDL (⤵TG) & LDL CI: active liver dis, PUD, arterial bleeding; unstable angina, MI ⤴: uric acid, BG, LFT, flushing (PG-MEDIAED, prevent w ASA); ⤵: BP (ortho), phos	Niacin ER (Vit B3) IR (cs more flushing): start low 250 mg tk w/ dinner, avoid hot beverage & spicy food ER (8-12hr; Preferred) & CR (12-24 hr, cs more hepatotox; Slo-Niacin, OTC): QHS after low-fat snack x 4wk, max 2 g qd	Cholesterol
Procardia Adalat CC	nifedipine - dihydropyridine CCB	Calcium Channel Blocker
Furadantin	Nitrofurantoin: Used for tx UTI if cephalosporin allergy Pulmonary tox, discolor urine CI: Crcl<60, pregnancy (at term) tk w/ food to ⤴ absp	Anti-Microbial
Nitroglycerin	nitroglycerine SL (Nitrostat): -go to the ER if one dose does not relieve pain after 5 minutes Nitrolingual Pump Spray (Nitromist): -1st time need prime 5 times, and prime it once if they have not used it for 6 weeks - 400 mcg/spray Nitrogpatches: - Nitrate-free interval prevent tolerance (10-14hr on, 10-12 hr off) on arm/chest, above elbows, above knees	Vasodilator
Benicar	olmesartan - SE: Sprue-like enteropathy (diarrhea)	A2RB + Diuretic
Lovaza (Vascepa)	omega-3 /fish oil Give bad breath, burping, taste perversion, dyspepsia, N, bleeding warning: ⤴LDL; initially worsen A Fib DOC for TG>=500 in addition to low-fat diet	Cholestorol
Prilosec	omeprazole	Proton Pump Inhibitor
Zofran	ondansetron	Anti-nausea
Tamiflu	oseltamivir -Neuraminidase Inh -NVD, neuropsychiatric -regardless food x 5 d -CI: Flumist wi 2 wks	Anti-Viral (Flu)
Ditropan	oxybutynin	Overactive Bladder
Percocet	oxycodone + APAP (C II)	Pain Relief (DEA Sch 2)
Protonix	pantoprazole	Proton Pump Inhibitor
Brisdelle	paroxetine for menopausal hot flush 2D6 inhibitor; Can't use w/ warfarin & tamoxifen PO QHS, lag time to effect ~4 wks pregnancy X	S.S.R.I.
Pen-VK	penicillin vk -DNV, rash -tk wo food q6hr	Antibiotic
Pyridium (Azo, Uristat)	phenazopyridine -HA,dizziness, sto cramps, color urine -only use for 2 days	Analgesic (urinary)
Adipex	phentermine	Appetite Suppressant (DEA Sch 4)
Dilantin	phenytoin (anticonvulsant) Acidic	Anti-Convulsant
Actos	pioglitazone (TZD: PPARr agonist, ⤴ insulin sensitivity) - CI: NYHA-III HF, bladder CA - SE: peripheral edema, wt ⤴, URTIs, bone fracture esp. women, darken urine, hepatox -Benefit: ⤵cholesterol - QAM regardless food	Anti-Diabetic
Glycolax	polyethylene glycol	Laxative
Klor-Con	potassium chloride tk w/ meal to ⤵GI SE Micro-K: can be opened & sprinkle Kor-Con-M: can be cut in half, dissovle in water, then drink immed.	Electrolyte
Lyrica	pregabalin - C V - Dizziness, somnolence - Peripheral edema - Mild euphoria	Anti-convulsant / Neurologic (DEA Sch 5)
Phenergan	promethazine	Anti-Nausea / Anti-emetic
Darvocet	propoxyphene + APAP	Pain Relief (DEA Sch 4)
Inderal	propranolol ⤴/⤵BG can't mask s/s of hypoglycemia: sweating & hunger	Beta Receptor Blocker(B1)
Accupril	quinapril	ACE Inhibitor
Aciphex	rabeprazole	Proton Pump Inhibitor
Evista for pre-menopause women around 50's at risk/fear of breast CA to tx osteoporosis BBW: ⤴ thromboembolic events (same degree of estrogen), ⤴death due to stroke in women w/ coronary heart dis	raloxifene (estrogen agonist/antagonist, SERM; ⤵ bone resorption) CI: breast CA SE: hot flashes, edema, arthralgia, amenorrhea pregnacy C. X clomiphene is for infertility	Estrogen Modulator
Altace	ramipril	ACE Inhibitor
Zantac	ranitidine	Histamine Blocker (H2)
Requip	ropinirole	Parkinsons
Zocor	simvastatin start 20, titrate up to 40, QHS regardless food; Don't use 80mg qd substrate Don't exceed 10mg qd w/ verapamil, diltiazem, dronedarone Don't exceed 20mg qd w/ amiodarone, amlodipine/ranolazine	Statin
Januvia - cs pancreatitis	sitagliptin (DPP4 Inh, incretin enhancer): juvisync (Januvia/simvastatin) -⤵postprandial BG -PO QD, Renal 🗻, wt neutral -SE: Nasopharyngitis, URTI,UTI, hypoBG	Anti-Diabetic
Aldactone	spironolactone - K-Sparing diuretics (aldosterone receptor antagonist) for HTN & HF (dec mortality) - BBW: tumorigenic - CI: CRCL<30	Diuretic
Septra	TMP/SMX -HIV PCP & Toxoplasma prophylaxis, DC if CD4>200 -N,rash,sun -regardless food, No fridge	Antibiotic Combination
Imitrex - 5HT-Agonist constrict cranial vessels - warning: combine w/ serotonergics; CVD or uncontrolled HTN - somnolence, nausea, paresthesias, throat/neck pressure, dizziness, hot/cold sensations, chest pain/tightness	sumatriptan - PO: 25, 50 & 100 mg, can repeat x 1 after 2 hr - Nasal Spray (Zomig): 5, 20 mg, need prime b4 use; can repeat x 1 after 2 hr - SC STAT inj: 4, 6 mg at upper outside arm, can repeat x 1 after 1 hr	Seratonin Agonist
Spiriva	tiotropium	Anti-cholinergic
Detrol	tolterodine	Urinary Anti-spasmotic
Ultram	tramadol (non-controlled for pain) Opioid agonist + NSRI 50 mg Q 4 hours PRN Not sedating as other opioids ⤵dose for RI, ER CI crcl<30 2D6 substrate warning: seizures, serotonergics	Pain Relief (Non-Narcotic)
Nasacort	triamcinolone	Inhaled Steroid
Valtrex	valacyclovir -qd 4 genital herpes prophylaxis; Not cure herpes infxn; tx wi 24hr of onset -regardless food -tiredness,HA,nv,sto pain	Anti-Viral
Levitra	vardenafil	Erectile Dysfunction
Chantix	varenicline	Smoking Cessation
Verelan Calan	verapamil - CI: hypotension, grapefriut, 2nd,3rd degree heart block, sick sunus syndrome, cardiogenic shock, acute MI, pulmonary congestion, HF (⤵contraction force) - SE: edema, constipation, gingival hyperplasia, arrhythmias, HF, hypotension, HA	Calcium Channel Blocker
Ambien	zolpidem	Sleep Aid (DEA Sch 4)
WOF cs Fanconi syndrome (a renal disorder)?	-tenofovir - outdated TCN - AMG - Chemo (Cisplatin, ifosfamide, and 6-merca) - Valproic acid - Rifampin
SE of interferon alfa (for Hep B&C)? warning; inc elderly death	hypo or hyper thyroid & BG skin lesion or rash, hair loss Eye disorders, Flu-like, GI Pancreatitis Myelosuppression Stroke,infxn, CI to elderly
Criteria of antiplatelet prevention (aspirin 81mg) for DMT2	men>50, women>60 w/ +1 risk factors or 10-year risk greater than 10%: FH of CVD HTN Smoking dyslipidemia albuminuria
OTC insulin	- Regular (onset: 0.5-1 hr) Humulin R Novolin R - Intermediate (onset: 1-2 hr) NPH: Humulin N - cloudy - Premixed pen: Humulin 70/30, Novolin 70/30 (Tk 30 min b4 Brkf & dn)
Rapid-acting insulin	Onset (10-30 min), Clear, RT 28d Novolog (insulin aspart) Apidra (insulin glusine) Humalog (insulin lispro)
size of insulin (SC)	25 or 29 G; 0.3, 0.5 & 1 ml needle 3/8'' pens: 3 ml x 5 pen/box most vial: 10 ml, 100 u/ml Humulin R U-100: 3 ml & 10 ml Humulin R U-500: 20 ml, 500u/ml
A1C % eAG? 7 ? 10 ?	154, 240 (150, 250)
Byetta (IR) Bydureon (LA) - Pen, SC qwk, stable 30 d RT	exenatide (GLP-1 agonist & incretin mimetics) -IR: start at 5 mcg SC BID x1mo,then 10 mcg SC BID wi 1 hr b4 brkf & dn (if tk OC, inj it 1 hr after) -BBW: Thyroid CA, Pancreatitis - CI: Crcl<30, GI dis -SE:NVDC,Hypoglycemia,wt ⤵,⤵ OC effect
Symlin	pramlintide - Amylin mimetic for both type 1&2 - ⤵ bolus insulin dose 50% - SC qd prior to meals - Hypoglycemia, N, anorexia, wt loss
Victoza	liraglutide (GLP-1 AG) - 0.6,1.2,1.8 mg SC QD regardless meals, titrate up in 1 wk
Prandin	repaglinide (Meglitinides, secretogoghes) - A1C<8%, 0.5 mg TID - A1C>8%,1-2 mg TID - 15-30 min b4 meals - hypoBG, mild wt gain, URTI
Define Hypoglycemia? Tx?	< 70 mg/dL. if unconscious: glucagon 1 mg SC/IM/IV, or glucose IV FQ ⤵BG
colesevelam	Welchol (Bile acid binding resins) -also benefit DM (⤵a1c 0.5%), but ⤴TG -CI: Bowel obstruction, TG>300, history HyperTG-induced pancreatitis -3 tab BID with meals, tk 4 hr after phenytoin, levothyroxine, glyburide, cyclosporine, and oral contraceptives
DM diagnosis: 1. S/S of 4P's, or Hyperglycemic crisis & a random plasma BG >= ? 2. FPG >= ? 3. OGTT >= ? 4. a1c >= ?	200 126 200 6.5%
Insulin pens expire in 14 days RT?	Humulin N Novolin N Humalog 50/50
DKA DX, s/s, & TX	BG > 300 mg/dl ketones pH < 7.2 bicarb < 15 WBC⤴ 15-40 s/s: Fruity breath, Coma, 3p's, dehydration, blurred vision TX: IV fluids, insulin, electrolytes (⤵K), probably anticoagulant
DM pt goals	a1c < 7% (Not controlled - q3mo; controlled - q6mo) preprandial 70 -130 postprandial < 180 BP < 140/90
who is immunocompromised? They can get flu from Flumist, but not flu shot.	- HIV pt CD4<200 - Taken Prednisone 20 mg qd or 2 mg/kg/d > 2 wks - cancer tx - transplant drug use - Asplenia - tking strong immune suppressants: Biological
steroid equavelent	cortisone-25 mg - 5 hydrocortisone-20 mg - 4 medrol/triamcinolone - 4 mg - 0.8 prednisone - 5 mg - 1 betamethasone - 0.6 mg - 0.12 dexamethasone - 0.75 mg - 0.15 prednisone:dexa = ~ 7:1
sulfasalazine	salicylate allergy, yellow-orange skin/urine, folate supplement
Sterapred Rayos DR tab Intensol solution	prednisone (Bridging therapy in RA)
Biologic agents/Anti-TNF (Tumor necrosis factor) Enbrel (etanercept) - RT 14d Humira (adalimumab) Remicade (infliximab) Simponi (golimumab) Cimzia (certolizumab)	- SC @ ab,thigh,upper arm - CI: HF, systemic infxn, Non-TNF, other Biologic (Never tk 2 Biologicals concurrently), live vaccines	CI: systemic infxn HF (infliximab>5mg/kg) non-TNF inhibitors biological live vaccines Warning: cause HF, liver tox, lupus-like
Non-TNF biologics (for RA) - give w/ MTX in RA	Rituxan (rituximab) - PML Orencia (abatacept) Actemra (tocilizumab)	4 BBW for Rituximab: fatal infusion rxn PML (progressive multifocal leukoencephalopathy) Tumor lysis syndrome severe skin rxn
Imuran	azathioprine (antiproliferative for SLE, transplant) ⤴level by (renal elim): allopurinol aspirin ACEI Bactrim
Muscarinic agonists for dry mouth (Sjogren's syndrome)	pilocarpine cevimeline -SE: diaphoresis... -Avoid high-fat meal
Dry heat	170 degrees x 1-2 hr For Heat-stable powders (ZnO,starch) & empty glassware
Steam autoclaving	121 degree c, 15 lb pressure, for 15-20 minutes heat-stable solutions metal instruments plastic syringes (polypropylene)
chelating agents	EDTA Ascorbic acid citric acid
wof cs PML?	rituximab (Rituxan; Non-TNF biologic for RA) natalizumab (Tysabri; for MS)
wof cs SLE?	hydralazine minocycline
SE of cyclophosphamide for SLE	HEMORRHAGIC CYSTITIS bmd INFXN INFERTILITY
Antidote of Methotrexate (DMARD)	cholestyramine
Fosrenol	lanthanum carbonate - AL&CA-free phosphate binder for CKD - tk w meals - has chewable form - ⤵FQ conc.
Renagel	sevelamer Non-systemically absorbed Cal & Al-free phosphate binder for CKD hyperphosphamia benefit-⤵LDL&TC
drugs cs hypothyroidism (Hashimoto; ⤵FT4 & ⤴TSH)	amiodarone interferons estrogen glucocorticoids hepatic inducers lithium nitroprusside PTU SSRI tyrosine kinase inh (sunitinib)
myxedema	complication of hypothyroidism intense cold intolerance drowsiness unconsciousness
drugs cs hyperthyroidism (thyrotoxicosis, Graves, Thyroid storm)	iodine amiodarone interferons T4 overdose
PTU	Not 1st line of hyperthyroid: inhibit thyroid hormone synthesis BBW: severe liver injury & liver failure Preferred tx: Pregnancy 1st trimester (2nd to 3rd, use methimazole), Thyroid storm (thyroiditis) SE: GI, SLE-like, hepatotox, agranulocytosis tk w/ food; ok to crush for NG tube
BP Goal	>= 60 yo healthy, < 150/90 < 60 yo healthy, < 140/90 All age w/ DM, no CKD < 140/90 All age w/ CKD or Transpant, no DM < 130/80 (JNC-8 < 140/90)
Simulect	basiliximab (IV) chimeric monoclonal AB, IL-2 receptor antag most common transplant induction immunosuppressant to prevent acute rejection SE: HTN, fever...
Cellcept	mecophenolate -transplant maint. BBW: Renal tox, ⤴risk of lymphoma & skin CA, congenial malformation, abortions SE: Diarrhia, GI, ⤵ OC effect, abnormal electrolyte, BP & BF, tachycardia Myfortic: BID w/ empty stom, seperate 2 her w antacids, pip, fq, Flagyl
Prograf	tacrolimus (CNI, maint. immunosuppressant in transplant) BBW: infxn, lymphoma, Not recomm. in liver transplant SE: HTN, nephrotox, hyperBG, tremor, hyperkalemia, QT tk on empty stoma
Neoral, Gengraf Sandimmune (non-modified) Restasis (eye emulsion for Dry eyes/Sjogren symdrome)	cyclosporine (CNI) BBW: Renal tox, Lymphoma & CA, infxn, HTN 3A4 & p-gp substrate SE: HTN, nephropathy, hisutism, gingival hyperplasia, edema, QT, hyperBG, worsen lipid Restasis: 1 drop BID
Zortress, Afinitor (both r everolimus) & Rapamune (sirolimus) are?	mTOR (adjvant w/ CNI in transplant) - renal thrombosis, Worsen lipid panel
osteoporosis is defined by T-score < ? osteopenia?	< -2.5 -1 ~ -2.5
osteoporosis risk factors	> 2 alcohol qd smoking > 5 mg Prednisone PO/IM qd > 3 mon (COPD) ⤵ estrogen or depot medroxyprogesterone anticonvulsants (inducers ⤵VD)-phenytoin warfarin, heparin excess thyroid hormone aromatase inh nafarelin (Synarel) androgen blockers (zoladex, lupron) PPI chonically RA, lupus
bisphosphonates < 3-5 yr -Fosamax (alendronate) - PO QD before brkf -Actonel, Atelvia (risedronate) - PO QD after brkf, higher dose QWK, QMON -Boniva (ibandronate) - PO QMON, IV Q3MON -Reclast (zoledronic acid) - IV QYR	- Fosamax and Reclast are not recommended in patients with a CrCl < 35 mL/min, and Actonel and Boniva cannot be used with a CrCl < 30 mL/min
Fosamax, Binosto	Alendronate: -WARNING: DC after 3-5 yr (prevent atypical femur fracture, esophageal erosion & CA, osteonecrosis of jaw) -10 mg po qd or 70 mg po qwk w. vit D3 & Ca 1st thing in the morning before eat/drink anything except 6 oz plain water, and stay upright for >30min w.o eating/drinking CI: PPI SE: GI, arthragia
Boniva	Ibandronate (bisphosphonate) - stay straight > 60 min w.o eating/drinking - po qmon, IV q3mon
Actonel	risedronate Atelvia - LA -CI: H2RA, PPI -tk after brkf w/ 4 oz water PO QD/QWK/QMON depend on the dose; antacids & minerals in later day
oledronic acid	Reclast: - IV QYR for pt who cannot tolerate an oral bisphosphonate - CI: Crcl < 35 - SE: TPS, flu-like - Zometa (for hypercalcemia of CA)
teriparatide < 2 yrs	Forteo - rDNA origin for high risk for fracture/ already had a fracture due to osteoporosis - SC QD (pen is good for 28 d in frige) @ thigh/ab at sit/lie down position (orthostasis) -BBW: osteosarcoma (if bone pain w. it) -CI: PPI; hx/current urolithiasis (kidney stone) -SE: orthostasis, ⤴ HR
Denosumab	Prolia (monoclonal ab for osteo) Xgeva (for hypercalcemia of CA) Another choice for osteoporosis pt who's too old to use estrogen w/ high risk SC inj q6mo @ MD office warning: combine all osteo drugs SE: fatigue, hypocalcemia, eczema, rash, arthralgia, nausea, dyspnea, cough
Drugs have acidic pH	diphenhydramine HCL morphine sulfate thiamine HCL Ascorbic acid inj MVI
drugs have basic pH	fosphenytoin sodium heparin sodium phenytoin sodium penicillin G potassium sodium bicarbonate aminophylline furosemide
drugs w/ nonaqueous solutions (incompactable w/ small amt of aqueous sln)	diazepam digoxin dimenhydrinate pentobarbital phenytoin
amphotericin B is incompatable w/ other drugs b/c it forms ?	colloidal sln
Vivelle-Dot	Estradiol Transdermal Patch: -Twice a wk apply to lower ab, below waist line, avoid waistline
Androgel	Testosterone Pump: apply 1 push qam on shoulders/upper arms & ab (1% only apply to ab, 1.62% don't put on ab) covered w/ shirt. Wait it dry and dress (it's flammable when it's wet). Wait 2-6 hr before showering
Androderm patch	Testosterone apply 1 patch QPM btw 8-12 @ back, ab, thighs or upper arms. for 4 mg qd, don't apply 2x2 mg patches
Miacalcin or Fortical	Calcitonin nasal spray Inhale 1 spray in one nostril daily nasal irritation alternate which nostril they use (left side one day, right side the next)
HRT (For ⤵ peri-menopausal symptoms)	estradiol patch - Climara, Alora, Estraderm estradiol/levonorgestrel patch - climara pro, combiPatch Rings - Estring, Femring conjugated E. tab - Premarin conjugated E+M tab: Premphase, Prempro progesterone - Provera
Prempro	HRT; conjugated estrogens/medroxyprogesterone tablet - P component stable - constantly give Premarin
Premphase	conjugated estrogens/medroxyprogesterone tablet - P component changes (phasic) - phasicly give Premarin
Avedia	Pamidronate: -Bisphosphonate for Hypercalcemia of malignancy: I.V
SC Administration	- 23 - 25G - 5/8'' needle - 45 degree - Fatty tissue over the triceps - SELF-SC INJECTION: Front of thighs, abdomen (pull skin tight, away from navel)
IM administration	- 22-25 G - Needle: 5/8'' (if wt<130 lb), 1'' (normal wt), 1.5'' (women > 200 lb & men > 260 lb) - 90 degree @ Central, thickest part of the Deltoid
vaccines fridge storage record	- ck temp BID - temp record keep 3 yrs
Meningococcal vaccines	- MCV4 (Menveo): 2 - 55, IM - MCV4 (Menactra): 9 mo - 55, IM - MPSV4 (Menomune): 56+, SC
Varivax and FluMist are separated by ?	- 4 wks - Live vaccines should be administered on the same day or separated by at least 28 days
4 live vaccines that are kept in the freezer (CI: gelatin & Neomycin allergy)	varicella (Varivax) zoster (Zostavax) - 14 times potent than Varivax MMR MMRV (ProQuad) - All need reconstitute SC
Who get Pneumovax?	- All adults 65+ (if 1st dose before 5yrs, need 2nd dose) - Anyone 2 - 64 w/ long-term health problem: Heart/lung disease: Asthma, COPD, smoker sickle cell disease, DM, alcoholism, cirrhosis kidney failure (not ESRD), CA
How long should immuneglobulin seperate from live vaccines?	> 3 month
Candidates for Shingle vaccine	FDA: 50+ ACIP: 60+
vaccines IM/SC ?	- most r IM - SC/IM: Polio, IPV, Pneumovax - SC: Live vaccines, MPSV4 (meningococcal)
Pediarix	DTaP-HepB-IPV
Typhoid vaccine	- capsule (Vivotif Berna): keep Refrige - IM
Flu vaccines	- Flushot: everyone from 6 mo (except previously unvaccinated kids <8, need 2 doses 4 wks apart) - Flublok: adults 18-49 yo w/ egg allergy - Flumist: healthy non-pregnant 2-49 yo, 0.1 ml for ea nostril
Drugs contain metformin?	Riomet Kombiglyze XR Metaglip Glucovance Janumet
tx of hypoBG	Require 15-20 mg Carb: 8 oz of milk 4 oz of orange juice or regular soda 1 serving of glucose gel 3-4 glucose tablets
correcting insulin dose	= (Current BG - Target BG) / Correcting factor
hyperosmolar hyperglycemic syndrome (HHS)	Severe dehydration & ⤵ RF occur, which further ⤴ hyperglycemia
Starlix	nateglinide (Meglitinide)
why give ACEI/ARB to DM pt?	ACEI/ARBs (not combined) are recommended for primary prevention of nephropathy in patients with diabetes who have normal blood pressure and albuminuria
Invokana (canagliflozin)	sodium glucose co-transporter-2 inh (SGLT2) works at proximal renal tubules QD CI to CrCl < 30 cs vaginal yeast infxn & hyperkalemia
Liraglutide Linagliptin	liraglutide (Victoza): GLP-1 agonist linagliptin (Tradjenta): DPP4 Inh.
BID NPH to QD glargine:	80%
Rituxan	Rituximab: - CD 20 B cell antagonist, NON-TNF BIOLOGIC - 4 BBW for Rituximab: fatal infusion rxn PML Tumor lysis syndrome severe skin rxn
wof DMARDs cs acute hepatitis?	methotrexate leflunomide
tx of MS	Copaxone (glatiramer) Avonex (Interferone beta) Tysabri (natalizumab)-PML Gilenya (fingolimod) - PO - CI CVD teriflunomide (Aubagio) - PO Dimethyl (Tecfidera) - PO Ampyra (dalfampridine - PO
Leflunomide	- hepatotox - pregnancy c X
Gilenya	fingolimod (for MS) -PO - CI: CVD - monitor: HR, ECG, Liver fxn
when to use interferons alfa/beta?	Interferon alfa - for Hep B&C, AIDS-related Kaposi’s Sarcoma, CA Interferon beta - for MS (IV: Avonex, SC: Rebif, Betaseron, Extavia)
Tofacitinib	Xeljanz (DMARDs) - Janus kinase (JAKs) inh - PO BID - Not concurrent w/ Biologics & other potent immunosuppressants
Novolog Mix 70/30 (vial & flexpen)	70% - insulin aspart protamine 30% - insulin aspart
basal-bolus insulin calculation	50%-50% basal: NPH = 2/3 x 2/TDD bolus: R = 1/3 x 2/TDD
Initial tx of HTN	ACE Inhibitors, ARBs (for Non-black) CCBs (all races) thiazide-type diuretics (all races)
non-selective (ISA; beta1+bet2) BB	nadolol (Corgard) - for portal HTN & variceal bleeding propranolol (Inderal, Innopran)
Lotrel	amlodipine + benazepril (Lotensin)
Tekturna	aliskiren - direct renin inh - CI: concurrent w/ ACEI or ARB in DM pt
Prinzide Zestoretic	lisinopril (Prinivil, Zestril) + HCTZ
Exforge	amlodipine + valsartan (Diovan)
Ziac	bisoprolol (Zebeta) + HCTZ
Dyazide Maxzide	triamterene (Dyrenium) + HCTZ K-sparing diuretics hyperkalemia w/ ⤵RF
HTN urgency HTN emergency	BP >= 180/110-120 w/o acute organ damage; PO Captopril (Capoten) clonidine (Catapres) labetalol (Trandate) DON'T use Nifedipine SL BP >= 180/110-120 w/ acute organ damage; IV clevidipine (fat emulsion, discard 12 hr), sodium nitroprusside, nicardipine, fenoldopam, nitroglycerin, enelaprilat, hydralazine, labetalol, esmolol
Non-sele. alpha & beta-blocker	1. Coreg (carvedilol) - tk w/ food - for HTN & HF 2. Trandate (labetalol)
beta1 selective blocker & nitric oxide-dependent vasodilation	nebivolol (Bystolic) - start at 2.5 mg qd - adjust dose if crcl<30 & mod liver impairment - HA
HTN in pregnancy	labetolol (Trandate)- 1st line nifedipine methyldopa HTCZ
Inspra	eplerenone - selective aldosterone receptor antagonist for HTN & HF - CI: CRCL<30; strong 3A4 inhibitor (azoles) - DC IF potassium > 5 mEq/L
which diuretics don't have Sulfa?	ethacrynic acid (Edecrin) - most ototoxic in loops
beta 1 selective blockers	acebutolol atenolol betaxolol bisoprolol (Zebeta)-for HF metoprolol
Drugs cs gingival hyperplasia	cyclosporin phenytoin verapamil
belatacept (Nulojix)	Transplant maintanence IV drug admin at MD office come w/ silicone-free disposable syringe BBW: Post-transplant lymphoproliferative disorder (PTLD) Patients must have immunity to Epstein Bar Virus (seropositive) to receive belatacept to avoid PTLD
NNT (ALWAYS ROUND ⤴, even 8.1 round to 9) RRR	NNT = 1/ARR = 1 / (% risk in control grp - in tx grp) RRR = 1 - RR = 1- (risk in tx grp/ - in control grp)
drugs cs hyperglycemia	csd, PI, Atypical antipsychotics, niacin, statins, thiazide & loop diuretics, octreotide, FQ, Beta agonists, BB, cyclosporing, tacrolimus, interferons, diazoxide, cough syrups (phenylephrine)
OC contain progestin drospirenone: K-retaining diuretic ⤵: fluid retension, bloating, wt gain CI: kidney, liver, adrenal gland dis, higher clotting risk	yaz, beyaz, yasmin gianvi ocella syeda zerah safyral ortho evra patch (⤴estrogen, ⤴clot)
OC for PMDD	Fluoxetine (Sarafem) - QD or QWK at 14 & 7 days prior to mense thru 1st full day of bleeding Sertraline Yaz (placebo shorter / give low dose estrogen⤵withdraw symptoms)
OC good for Acne	orthoTri-cyclen estrostep Yaz
oc good for heavy menstrual bleeding (Menorrhagia)	Natazia (4 phasic) IUD Mirena Lysteda
extended cycle COCs:	Seasonale-3 mo; Sunday start;7-day-placebo Seasonique-3 mo;Sunday; 7-day-low estrogen Loseasonique - 3 mo Lybrel (genetic: Amethyst) -1 yr; 28 active pill;cs spotting;1st day start;
emergency OC	PlanB One step: <=3 days, OTC 1x1.5 mg or 2x0.75 levonorol if vomit w/i 2 hrs, repeat dose w/ antiemetic (OTC meclizine (Bonine, Dramamine "Less Drowsy") brand - OTC wo restriction generic & 2-pill version - OTC, require >= 17 & ID (if <17, RX required) Ella (ulipristal): < 5 days, Rx; also prevent implantation; HA,N,Ab pain;
drugs ⤵OC efficacy	Abx: rifampin family only anticonvulsant class smoking mycophenolate, bosentan other inducers
highest risk to get pregnant if miss COC?	either side of the placebo week (wk 1) if miss 2+ pills btw 3rd wk (last wk before placebo) , omit placebo pills and start hormone pills
OC CI to	History of MI, DVT, CVA, active CA severe HTN uncontrolled DM Unexplained vaginal bleeding >35 & SMOKE>15/d
nuvaring	start btw day 1-5 of menses, insert into vagina x 3 wks, out x 1 wk out > 3hr during wk 1, use EC pt store RT 4 mon
ortho evra patch	contan drospirinone apply on buttocks, stomach, upper arm, upper torso qwk x 21 days out of 28 days; start day 1 (no backup needed) or Sunday (7-days-backup) backup if fall off >24hr CI WT>198 LB & >35 yo smokers
type I error (alfa; p-value): False Positive The null hypothesis is true, but is rejected in error; means there is still a chance < 5% that the drug is ineffective	type ii error (beta): False Negative (The null hypothesis is false, but is accepted in error)
confidence interval	gives an estimated range of values which is likely to include an unknown population parameter if CI includes 0 or 1.......NOT statistic significant a higher confidence level will widen the interval
cox-2 selective NSAIDs	highest - celecoxib (Celebrex) - Sulfa drug some - meloxicam (Mobic), etodolac (Lodine), nabumetone (Relafen) ⤵GI SE, ⤴MI/stroke (CI to pt w/ CVD risk), same renal complication
Indomethacin	Non-selective NSAID for gout SE: CNS, GI tox.
Opioids don't have cross-activity with morphine	fentanyl meperidine methadone tramadol tapentadol
Demerol	meperidine For short-term acute/single use, or morphine-grp allergy; Not for chronic pain control (t1/2=3hr), has partial metabolite, cs CNS tox warning: RI, elderly, seizures, serotonergics
antispasmodics w/ analgesic effect	Lioresal (baclofen) Flexmid (cyclobenzaprine) - xerostomia, serotonergics, arrhythmias Zanaflex (tizanidine) - central alpha-1-agonist, CI Cipro BBW: avoid abrupt withdrawal
muscle relaxant exert effects by sedation	Soma (carisoprolol)-Highest abuse potential, ⤴dose in poor 2C19 metabolizer Skelaxin (metaxalone) Robaxin (methocarbamol)
LA opiods CI any alcohol (LA alcohol IR.....lethal)	MS-Contin: can't open LA morphine capsule can be openned: Avinza, Kadian tapentadol: Nucynta ER
Non-aspirin pain reliever	acetaminophine Infant dose 160mg/5ml, children dose 10-15mg/kg q4-6, DNE 4g/d PO antidote: N-acetylcysteine (restore intracellular glutathione) IV antidote - Acetadote
Dilaudid	hydromorphone po equi 7.5 extreme potent opioid naive pt starts 2-4 mg PO or 1-2 mg IV Q4-6 HR
Serotonergic opioids (CI to seizure pt; CNS tox)	Meperidine (partial metabolite) Tramadol Methadone
NSAID can ONLY be used for 5 days (PO/IV)	ketorolac (Toradol) High bleeding risk Never pre-op
opioid conversion	morphine: IV-10, PO-30 hydrocodone: PO-30 oxycodone: PO-20 hydromorphone: IV-1.5, PO-7.5 (x4 morphine)
Arthrotec	diclofenac + misoprostol GI protective; used to be popular before PPI appeared pregnant c X! diarrhea, cramping
Oxecta	oxycodone IR contain nasal irritant, can't be openned
Savella	milnacipran SNRI for fibromyalgia, also help depression watch for bleeding risk w/ antiplatelets, ⤴tox of digoxin, don't concurrent w/ linezolid
Relistor	methylnaltrexone for opioid-induced constipation Self-SC QOD for pts who failed DSS + stimulant laxative
Opana	oxymorphone tk on empty stomach as food ⤵absp Use lower doses in elderly or renal impairment
Treximet	naproxen + sumatriptan
Zohydro ER	Hydrocodone 2013
stimulant laxative	Ex-Lax Bisacodyl Senna
Which NSAID has a high risk of both severe skin reactions and GI toxicity, and should only be used in patients who cannot obtain adequate pain relief with other agents?	piroxicam
opioid antidote	naloxone (Narcan)
Suboxone	buprenorphine + naloxone - prescriber's DEA starts w/ X
Triptan has longest duration of action and may be useful in a patient with recurrent migraine?	Frovatriptan
tx of pre-menstrual migraine with aura	progestin-only-pill (no estrogen): Nor-QD Nora-Be Camila
1st line of migraine prophylaxis	propranolol timolol (Blocadren) metoprolol valproate topiramate (Topamax): lowest hepatotox, pregnancy D (avoid childbearing age) extended-cycle OC NSAID or Triptan: 2 days prior to menses, continue for 5-7d
Maxalt	Rizatriptan
Fiorinol Excedrine	aspirin/butalbital/caffeine (C III) - taper off aspirin/APAP/caffeine
Migranal Nasal Spray	ergot products; Pregnancy Category X BBW: not to use with strong/moderate 3A4 inhibitors (such as cimetidine) due to the risk of cerebral ischemia with higher drug levels.
triptans not CI to MAO-I	Relpax (rizatriptan)...
gout prophalaxis	NSAIDs/colchicine are used to reduce the risk of an acute flare: allopurinol (Zyloprim febuxostat (Uloric) probenecid colchicine-probenicid pegloticase (Krystexxa)
Gout acute attack tx	colchicine probenecid: Require RF (CI CRCL<30) & block renal clearance of penicillins, methotrexate, theophylline and aspirin NSAIDS steroids
Drugs ⤴uric acid	Niacin Diuretics (Thiazide & Loop) aspirin (Bufferin) pyrazinamide (TB) Cyclosporine Tacrolimus
Drugs ⤴ LDL	diuretics cyclosporine tacrolimus glucocorticoids amiodarone
Drugs ⤴ TG	oral estrogen, raloxifene, tamoxifen glucocorticoids bile acid resins PI retinoic acid sirolimus BB (not carvedilol) thiazides atypical antipsychotics interferon-alpha propofol
LDL formula	LDL = TC - HDL - TG/5
4 groups of statin therapy	Secondory prevention: 1. ASCVD <= 75: high ASCVD > 75 : moderate Primary prevention: 2. LDL >= 190: high 3. DM & 40-75, LDL 70-189, 10-yr ASCVD risk>=7.5%: High DM & 40-75, LDL 70-189, 10-yr ASCVD risk<7.5%: Moderate 4. 40-75 with LDL 70-189, 10-yr ASCVD risk<7.5%: Consider risk benefit 40-75 with LDL 70-189, 10-yr ASCVD risk >=7.5%: Mod-to-High
High intensity-daily dose ⤵LDL>=50%: Atorva (Lipitor) 40-80 mg qd rosuva (Crestor) 20-40 mg qd High-intensity statin therapy initiated within 96 hours of hospitalization for an acute coronary syndrome has been shown to reduce the incidence of recurrent ischemia	Mod-intensity-daily dose ⤵LDL 30-49%: atorva 10-20 mg qd rosuva 5-10 simva 20-40 prava 40-80 lova 40 fluva xl 80 fluva 40 BID pitava 2-4
statins potency low to high	Families (fluva 80) Love to play (lova/prava 40) Soccer (simva 20) At (atorva 10) Recreational (rosuva 5) Parks (pitava 2)
Statins can be taken in morning	Crestor Lipitor, livalo, lescol xl Prava
exceptions of Niacin can't concurrent w/ statins	Advicor (lovastatin/niaspan) Simcor (simva/niaspan)
exception of fiberate can't concurrent w/ statin	Trilipix
Global Risk Assessment tool	q 4-6 yrs 9 factors, not include LDL
what's the next step after DC statin in pt got myopathy on statin	If muscle symptoms resolve, restart the same statin at the same or lower dose
cause of HF	hypothyroidism chemo: anthracyclines, TKI, Herceptin, Gleevec, Taxotere amphetamine & systemicmimetics CCB Class I antiarrythmics itraconazole immunomodulators NSAID CSD triptan TZD alcohol Pondimin, Redux,Ergostat, Migranal, Sansert
loop diuretic potency equiva	furosemide 40mg bumetanide 1 mg torsemide (Demadex) 20 mg ethacrynic acid 50 mg
why ACEI used in HF	⤵preload & ⤵afterload
BiDil	isosorbide dinitrate+hydralazine - For the treatment of heart failure as an adjunct to standard therapy in self-identified black patients
Natrecor	nasiritide Recombinant B-type natriuretic peptide Provide both arterial & venous vasodilation
Demadex	torsemide
Acetazolamide	inhibits carbonic anhydrase
HF tx	loop diuretics ACEI/ARB BB (bisoprolol, Toprol XL, carvedilol) *aldosterone receptor antag (spirinolactone, Inspra/eplerinone) hydralazine/nitrate - black digoxin potassium vasodilators (nitropglycerin)
ACEI has shortest t1/2	Captopril
milrinone	- positive inotropes acts via phosphodiesterase-3 inhibition
Theo-24	theophyline
chronic stable angina (ischemic b/c plaque buildup)	Anti-angina agents + Antiplatelet agents: BB (IV/PO) +- Ranolazine(HR&BP low)+ASA (75-162)/Plavix +- CCB (avoid SA) Nitrates
Ranexa	ranolazine used when both HR & BP are low in angina 3a4 substrate CI to severe liver dis QT, dizziness, ha, constipation, n
Prinzmetal's (variant) angina tx	due to vasospasm of artery DOC: LA-CCB (but not BB nor nefedipine IR)
Unstable angina, NSTEMI (Avoid fibrinolytic): STEMI (+PCI/fiibrinolytics: t-PA): NSTEMI & STEMI has biomarkers, UA doesn't: troponin CK-MB	Morphine (anagesic,⤵anxiety, ⤵ O2 demand) O2 NTG PRN, IM ASA 162-325 mg (avoid NSAID) GpIIIb/IIIa inhibitors (abciximab) AC (hep, LMWH) P2Y12 inhibitor (Plavix, Effient, Brilinta) BB ACEI
RISK factors of coronary heart disease	men >45, women>55 family history of coronary event before age 55 years (men) or before age 65 years (women) smoking HTN, DM, hyperlipidemia
abciximab (Reopro) eptifibatide (Integrilin) tirofiban	glycoprotein IIb/IIIa receptor antagonist: Reopro: used for PCI already planned CI: thrombocytopenia, PMH of bleeding diathesis, active internal bleeding, recent major surgery, ⤴PT, stroke, uncontrolled HTN, allergy to murine proteins SE: bleeding, thrombocytopenia, hypotension
Brilinta (ticagrelor) -Non-prodrug Effient (prasugrel) - prodrug Plavix - prodrug	P2Y12 inhibitors: - Brilinta (ticagrelor) - non-prodrug, reversible, faster concurrent ASA MD should NOT > 100mg qd (75-100) bleeding, dyspnea
t-PA (alteplase): only one for stroke as well TNKase (tenecteplase)	Fibrinolytics/Thrombolytics: used if PCI is planned Binds to fibrin and converts plasminogen to plasmin CI: Pregnancy, active bleeding (PUD), stroke wi 3 mon, concurrent anticoagulants, severe uncontrolled HTN >185/110
antithrombin (AT) inhibitors	UFH LMWH Lovenox - Don't expel bubble. Store @RT dalteparin (Fragmin) Fondaparinux (Arixtra) selective factor Xa indirect inhibitor via AT; CI to crcl<30;
UFH - apTT	Dose (use actual wt): VTE prophylaxis: 5000 u sc q8-12h VTE TX: 80 U/kg IV bolus followed by 18 u/kg/hr infusion ACS/STEMI TX: 60 u/kg IV bolus (max 4000u); 12u/kg/hr (max1000u/hr) SE: HIT, hyperkalemiam, osteo Antidote: Protamine 1mg reverse 100 u heparin, max 50mg
LMWH dose & bridging (monitor Anti-Xa if: Significant RI Pregnancy Mechanical heart valves morbidly obese)	Lovenox (DOC of CA pt) VTE prophylaxis: 30 mg SC Q12 or 40 mg SC QD; crcl<30, 30 mg SC QD TX of VTE, UA, NSTEMI: 1 mg/kg SC Q12 or 1.5 mg/kg SC qd; Crcl<30, 1 mg/kg SC QD TX of STEMI: <75, 30 mg IV bolus plus a 1mg/kg SC dose followed by 1 mg/kg SC Q12; >=75, 0.75 mg/kg SC Q12 (max 75 mg for the 1st 2 doses only); Crcl<30, 1 mg/kg SC Bridging: Resume Lovenox 48-72 hr after surgery; Resume warfarin until INR is therapeutic for at least 24 hr;
Factor Xa inhibitors	- Indirect Factor Xa inhibitors: SC Fondaparinux - Direct Factor Xa inhibitors: PO Xarelto (rivaroxaban) - substrate Eliquis (apixaban) 5 mg BID without regards to food for stroke prevention in non-valvular afib BBW: DC without adequate AC w/ an alternative agent ⤴risk of stroke.
Direct thrombin (Factor IIa) inhibitors - DOC of HIT (> 50% drop in platelet count from baseline)	- Direct thrombin inhibitor: IV/SC Argatroban Angiomax (bivalirudin) - for CATH lab - Direct thrombin inhibitor: PO Pradaxa (dabigatran) - prevents more strokes than warfarin
Pradaxa	Direct thrombin inhibitor: dabigatran ind: ⤵ risk of stroke and systemic embolism in non-valvular afib advantage: no lab, food/drug intxn disadvantage: gastritis, BID 150 mg cap BID regardless of food; original bottle, exp. 4 month. Convert from Warfarin: start when INR<2.CI to p-g inducors & inhibitors
DHEA	natural product for menopause
Jantoven	warfarin (for prosthetic heart valvular aFib): healthy outpt: start 10 mg for 1st 2 days, then adjust according to INR; Elderly, malnourished, tking inhibitors, liver dis. and HF...start 5 mg qd Presence of 2C92 or 2C93 allele & CoQ10 ⤵effect of warfarin stable INR monitor q 3mo TX 1st-unprovoked VTE & Orthopedic surgery: x 3 month if INR⤴ >0.4 qd, hold warfarin ⤵dose
warfarin antidote	Vitamin K (NO SC - too slow) - No bleeding, INR>10: PO - Serious bleeding: slow IV injection 10 mg along with four-factor prothrombin complex concentrate to avoid anaphalaxis
flumazenil (Romazicon)	BZD antidote
INR goals	2-3: Mechanical aortic valve & Cardioversion 2.5-3.5: Mechanical mitral valve or mechanical valve in both aortic & mitral position
stroke prevention in aFib pt	CHADS2 = 0, No therapy, if pt wants to, ASA 75-325 QD CHADS2 = 1, PO AC (Pradaxa 150 BID>war) CHADS2 >=2, PO AC IPC devices can replace PO AC if CI CHF HTN Age > 75 DM prior stroke/TA
Kcentra	four factor prothrombin complex concentrate, contains factors II, VII, IX, X, protein C and protein S for urgent reversal of warfarin; administered with vitamin K concurrently CI in patients with HIT
QT drugs	Class IA& III (block K-channel) Abx: FQ, macrolide, telavancin, Bactrim, amantadine, foscarnet, bedaquiline, azoles CA: nilotinib PI: saquinavir, ritonavir Antidepressant: tricyclics, SSRI, SNRI, trazodone, citalopram, escitalopram Antiemetics: 5-HT3 antag Antipsychotics: thioridazine
natural products vs INR	Glucosamine, grapefruit and willow bark can increase the INR. Alfalfa can decrease the INR
Rhythm Control: class I & III convert aFib to normal more SE	Rate Control: class II & IV ⤵ HR (ventricular rate) safer DOC of aFib
Ia (a cute dip) - intermediate-acting block Na & K-channel	Quinidine Disopyramide Procainamide - Acetylation
Ib (lime) - Fast-acting Na	lidocaine mexiletine phenytoin
Ic (flip) - Long-acting Na	flecainide propafenone
III (add ice & sugar) - inhibit K-channel	amiodarone (Pacerone) dofetilide dronedarone (Multaq) ibutilide sotalol
adenosine	Adenosine receptor agonist for paroxysmal supraventricular tachycardia (PSVTs)
amiodarone	Cordarone, Pacerone DOC of pt has HF BBW: pulmonary & liver tox, worsen arrhythmic SE: hypotension, GI upset, hypothyroidism/ hyperthyroidism, ⤴LFT, bradycardia, ataxia, tremor, corneal microdeposits, blue skin, sun IV/PO; t1/2 = 60 days
Multaq	Dronedarone - class III antiarrythmia substrate Only used in pts who can be converted to normal sinus rhythm BBW: Class-IV HF, permanent aFib CI: poor heart hepatic failure, lung tox., QT, bradycardia, ⤴Scr, ND, hypokalemia+Mg pregnancy X
Proscar Propecia	finasteride 5 mg qd - for BPH finasteride 1 mg qd - for alopecia
drugs cs BPH	Alpha agonist: Decongestant Anticholinergics, anhistamine, TCA, phenothiazines SNRI ⤴urine/⤵growth: caffeine, diuretics testosterone
BPH TX	Alpha blockers (caution w/ nitrates) +- 5 Alpha inhibitorase Peripheral-acting anticholinergics Tadalafil (Cilalis; CI nitrates)
natural products for BPH	Pygeum lycopene
non-selective alphaers block	Hytrin (terazosin) Cardura (doxazosin) 1st dose syncope, QHS, slowly titrate (Cardura XL taken w/ brf) floppy iris syndrome
selective alpha blockers	tamsulosin (Flomax) - no renal🗻, 0.4 mg qd alfuzosin - crcl<30, QT silodosin - crcl<30, Retrograde ejaculation substrate, HI, RI ortho, floppy iris, abnormal ejaculation Not well absp w/o food, 30 min after the same meal qs
5 Alpha-reductase inhibitors	finasteride (Proscar) dutasteride (Avodart) block conversion of testosterone to DHT, ⤵prostate size, ⤵PSA, mask proostate CA substrate CI child-bearing age women, pregnancy X, children sexual SE, breast enlarge, ejaculation disturbance
Cialis	tadalafil DOC for BPH + ED CI: crcl<30 & concurrent nitrates color discrimination, vision, hearing
OAB TX	1st-line: Behavioral therapies 2nd-line: ER Anticholinergics (inh M-receptor, block ACH, ⤵detrusor muscle contraction), M3-anticholinergics 3rd-line: onabotulinumtoxin A
tx of depression (6-8 wks trial): SSRI (MAOI, linezolid,bleeding,pregnancy,Sx) SNRI (MAOI, linezolid, bleeding, glaucoma, urinary retension, ⤴BP, Sx) Tricyclics (QT, urinary retension, glaucoma; substrate) MAOI (inh NT brkdown) DNRI (Seizure, bipolar, anorexic, linezolid; No sexual issues)	TX-Resistant: buspirone: Anxiety+Depression low-dose atypical antipsy: CI Dementia, metabolic issues, NMS, TD, leuko/neutropenias Abilify (aripiprazole): Anxiety, insomnia,Constipation Symbyax (olanzapine+fluoxetine): QT Seroquel XR (quetiapine): Sedation, ortho lithium, thyroid hormone, ECT, ketamine
Depression in pregnancy SSRI (except paroxetine - cardiac SE) has a warning: PPHN Tricyclics - preg C	Postpartum depression: SSRI Tricyclics (except Doxepin)
Mevacor	lovastatin no renal adj IR: tk QHS, ER: w/dinner
PTSD	sertraline paroxetine SNRI
Natural products for depression	St. John't wort: CI 5HT drugs SAMe Deplin (L-methylfolate)
SSRI 5HT syn: linezolid/methylene blue QT: pimozide/thioridazine pregnancy: PPHN taper off (fluo, paro)	fluoxetine (MAOI wash-out>5wks): QAM, paroxetine fluvoxamine sertraline: good for heart* citalopram: no children, QT, MAX 40QD escitalopram: no children, QT, MAX 20 *(2D6 inhibitor)**
SE OF SSRI	SIADA restless leg syn. fall risk (ortho) bleeding risk QT: Celexa, lexapro (use Zoloft for Heart dis)
vilazodone (Viibryd)	SSRI & 5ht partial agonist titrate q7d w/food
vortioxetine (Brintellex)	mixed many MOA no sexual dysfxn
SNRI	Effexor (venlafaxine)+GAD, start low 37.5/75 Cymbalta (duloxetine)-depression,GAD,pain,fibr Pristiq (desvenlafaxine) levomilnacipran (2D6 inhibitor)
tricyclics	NE+5HT reuptake inhibitors, block ach+Histamine receptor; 2D6 substrate amitriptyline (Elavil)-100-150 for depression, 10-15 QHS for migraine doxepin(Silenor:Insomnia,Zonalon:Pruritus) 2ndry: nortriptyline (Pamelor) SE: cadio-QT, ortho, tachycardia, anticholinergic
MAOI	isocarboxazid (Marplan) phenelzine (Nardil) tranylcypromine (Parnate) selegiline patch (Emsam) - watch Tyramine foods - qd above waist, rotate 2d
DNRI (CI: Seizure, bipolar, anorexic, linezolid; No sexual issues)	Bupropion (Buproban, Zyban - Smoking cessation, Wellbutrin XL- SAD) Max 450qd, IR 150 per dose Dry mouth, insomnia, tremors, seizures Mirtazapine (Remeron, SolTab - ODT for depression) - ⤴sleepy & appetite Trazodone (Desyrel, Oleptro ⤵seda): ⤴sedation
drugs cs SIADH	SSRI SNRI (ox) carbamazepine
TX of Schizophrenia/Psychosis - BBW: ⤴mortality of elderly (stroke & infx) - NMS (neuroleptic) due to block D2: High fever w/ profuse sweating extrme muscle rigidity change mental status, tachycardia, tachypnea, BP change ⤴CPK & WBC TX: supportive, cool down, BZD/dantrolene	SGA (low EPS) Clozapine (agranu, seizures, myocarditis, QT, metabo. but ⤵TD; Use if fail two trials of antipsy, WBC>=3500 & ANC >=2000) High-potent FGA (⤴EPS, mod sedation, tachycardia,anticholinergic) Low-potent FGA (low EPS, sedation, ortho, tachyc, anticholinergic)
FGA antipsychotics block D2+5HT2a receptor butyrophenone - Hadol All cs sedation, EPS, dystonias-high in young males, akathiasia, Parkinsonism, TD, Dyskinesias, ortho, QT, sexual, Adasuve	Low potency: chlorpromazine thioridazine - QT Mid-potency: loxapine (Adasuve-inhal. powder) perphenazine High potency: fluphenazine (2-wk decanoate inj) haloperidol (qmon decanoate inj) trifluoperazine thiothixene
SGA antipsy (block D2+5HT2a receptors) - MOA of Abilify: DS1 partial agonist, S2 antag *mod metabolic SE	clozapine (Clozaril) olanzapine (Zyprexa) Relprevy last 2-4 wks QHS - sedation, delirium, EPS, low QT risperidone (Risperdal) Risperdal Consta-Q2WK, ⤴prolactin, QT* quetiapine (Seroquel) DOC PKD, tk XR QHS* ziprasidone (Geodon) Highest QT, no wt gain, w/ food aripiprazole (Abilify) no wt gain, low seda, QAM paliperidone Invega Sustenna qmon,* same to Risperdal ⤴prolactin, QT iloperidone (Fanapt) QT asenapine (Saphris) Tongue numbness, QT lurasidone (Latuda) tk w/ food >350kcal
smoking ______level of olanzapine, clozapine, quetiapine	dec
antipsychotics cs metabolic SE	olanzapine (IV can't concurrent w/ BZD) clozapine resperidone paliperidone quetiapine
Asenapine	SL Saphris no food/drink for 10 min after dose
OCD of antipsychotics	Fazaclo - clozapine Discmelt - Abilify M-Tab - risperdal Zydis - zyprexa
Bipolar tx - Mood stablizer +- SGA	- Valproate/Valproic acid (Depakene, Stavzor): for mania -Divalproex (Depakote) - Lamotrigine (Lamictal)-Not for mania - Lithium (Lithobid)-For ania,depression&maint. - caramazepine (Equetro)-For mania - SGA (except clozapine) aripiprazole-depression, mania & mainten. olanzapine quetiapine-depression, mania & mainten. paliperidone iloperidone lurasidone- for bipolar depression
valproate/valproic acid (Depakene Stavzor) divalproex (Depakote)	MOA: ⤴GABA BBW: hepatic failure, teratogenicity, pancreatitis CI: hepatic failure, Pregnancy D/X D-I: valproate+lamotrigine, salicyclate, carbapenems GI upset, tremor, alopecia, wt gain, PCOS, pancreatitis suppliment Ca, Vit D
lamotrigine (Lamictal) - Not used in mania	severe rash - slow titration risk of aspetic meningitis, blood dyscrasias N, insomnia, drowsiness, ataxia, vision, rash, xerostomia
lithium (Lithobid)	range 0.6-1.2 mEq/l; >1.5: tremor, VD, confusion, ataxia; >3: CNS DEPRESSION tk after food, keep constant Na (opposite dir) inc level: NSAID, ACEI/ARB, diuretics serotonergic SE: GI, cognitive, fine hand tremor, wt gain, polyuria/polydiasia, hypothyroid, cardiac
drugs induce PKD (antagonis of DA receptor)	phenothiazine FGA SGA (resperidone, paliperidone) metoclopramide (Reglan)
PKD tx	levodopa (DOC elderly) DA agonist Amantadine (initial tx for tremor in young): dizzy,insomnia, toxic delirium, livedo reticularis (red skin mottling) Selective MAO-BI Centrally-acting anticholinerg (initial tx young) Tricyclic: secondary amine SSRI Quetiapine
Sinemet Parcopa RapiTab - ODT SR - cuttable	carbidopa/levodopa (inh DA-decarboxylase) 70-100 mg carbidopa is required; start from 25/100; Seperate Fe & protein levodopa IR switch to Sinemet CR, levodopa ⤴10% qd CI: MAOI prior in 14d; hx of melanoma; SE: N, ortho, dyskinesia, dystonias, psychosis (tx: Seroquel), darken body excretion, unusual sexual urges, priapism, tolerate
COMT Inh (⤴levodopa's DUA): entacapone (Comtan) Sinemet+entacapone (Stalevo) Tolcapone - hepatotox	NVD, like L-DA: urine discolor
DA-Agonist: - For both PKD & Restless leg syndrome	pramipexole (Mirapex) IR for Restless Leg Syndrome QHS very sedating - sudden daytime sleep attack, slow titrate, ortho, psychosis RI crcl<60 ropinirole (Requip) - same as Mirapex rotigotine (Neupro - patch) - Sulfa-drug, QD rotate in 14d, peripheral edema, HA, ortho, sleep disturbance apomorphine (Apokyn)-SC for hypomobility in advanced PKD. CI: 5HT3-antag; Severe NV, hypotension; QT - tk w. Trimethobenzamide (Tigan)
Cycloset	bromocriptine for DMT2 - pulmonary SE
selective MAO-BI	selegiline (Eldepryl, Zelapar-ODT) rasagiline (Azilect) Emsam patch - for depression
central-acting anticholinergics -Avoid use in elderly due to tremor	benztropine (Cogentin) trihexyphenidyl
ALZ TX	Acetylcholinesterase inhibitors: ⤴Ach Donepezil (Aricept ODT) QHS Rivastigmine (Exelon Patch) QD titrate q4wk Galantamine (Razadyne) - GI, nausea, bradycardia, fainting, insomnia Memantine (Namenda): block NMDA which inh glutamate dizziness, constipation, HA, renal adj
ADHD tx	Stimulants (block NE & DA reuptake): BBW: heart dis. , stroke Non-stimulant: atomoxetine guanfacine (Intuniv): sedating, avoid high-fat-meal, substrate clonidine (Kapvay): for sleep
Stumulants for ADHD nausea, loss appetitie, insomnia, ⤴BP,HR, seizures monitor: baseline ECG, BP, HR, height/wt for kids QAM	methylphenidate (Ritalin; Ritalin LA - 1/2 IR, 1/2 SR): pheochromocytoma methylphenidate IR (ER Concerta): OROS system, prevent abuse Daytrana patch: 2hr before school on alternate hip, remove b4 sleep dexmethylphenidate (Focalin) D ER+A (Adderall) D IR (Dexedrine) Vyvanse (lisdexamfetamine): avoid abuse
Strattera	Atomoxetine (Strattera) selective NE reuptake inh loss appetite, 2D6 substrate, suicidalin kids, liver damage, CVD, ⤴BP, hyperhidrosis, ortho, psychosis, urinary retention
stimulant for improving wakefulness in night-shift - CIV	modafinil (Provigil) -rash, HA, anxiety, agitation, heart; ⤵birth contol armodafanil - rash
qd Stimulants	Concerta Metadate CD Ritalin LA Daytrana patch
SSRI for OCD & SAD	fluvoxamine
anxiety tx: Buspar (Divided dose) buspirone (5-HT1 partial agonist) for anxiety - 3A4 Substrate - start 7.5 mg PO BID, inc by 5mg/d q2-3d until 30 mg qd - SE: N,HA,dizziness - CI:BF, severe liver,kidney dis	SSRI Hydroxyzine (Vistaril)-sedating antihistamine BZD (⤴GABA) for short-term situation symptom relief; confusion, dizziness, fall Buspirone
BZD - preg D: cleft lip - use LOT	Ativan (lorazepam) Xanax (alprazolam) chlordiazepoxide Klonopin (clonazepam) clorazepate Valium (diazepam) oxazepam
tx of status epilepticus	1. BZD: lorazepam (Ativan)-IV diazepam (Valium, Diastat Acudial-rectal) 2. carbamazepine lamotrigine levetiracetam ethosuximide