Pharm Final - Bryson
You should prescribe __mg of nitrates for the Nitroglycerin
0.4 mg
__-__ are the levels we want with Digoxin for arrhythmias
0.8-2
4. D/C Bivalirudin __ hour before CABG
1
Baseline INR should be around __
1
3. hold anticoags/antiplatelets for _-_ wks after hemorrhage
1-2
Low Molecular Weigh Heparin is _/_ size of UFH
1/3
Low Molecular Weight Heparin (LMWH)
1/3 the molecular weight of UFH
whats the max dose of simvastatin you can use with verapamil and diltiazem?
10 mg of statin
ezetimibe typical dose
10 mg qd
There is a max dose of __ units in a bolus
10,000
LMWH is __% bioavailable when administered SubQ
100%
How many Americans die each year due to healthcare harm?
100,000
3. D/C Enoxaparin (lovenox) __-__ hours before CABG
12-24
should discontinue LMWH and UFH at least __-__ hours before labor to minimize bleeding
12-24
Don't give factor Xa inhibitors in someone whose CrCl is less than __
15
Dabigatran is a DTI. It is not recommended for people whose CrCL is less than __
15 mL/min
What percentage of TB cases are Extra-pulmonary TB (EPTB)?
15-20%
What is the typical adult dose for Ethambutol?
15-25 mg/kg/d
What is the dose for ethambutol?
15-25 mg/kg/day
Loading dose of amiodarone is: 1. __ mg IV infusion over 10 minutes
150 mg
Inclusion Criteria for tPA: -greater than or equal to __ years old -diagnosis of ischemic stroke within _-__ hours of symptom onset
18 3-4.5
DVT/PE: UFH infusion rate
18-20 units/kg/hr -MAX = 2,300 units/hr
When was TB proven to be contagious? By whom?
1865 Jean-Antoine Villemin
When was M. tuberculosis discovered? By whom?
1882 Robert Koch
When were drugs that could kill TB bacteria discovered?
1940s and 1950s
When was streptomycin (SM) discovered?
1943
class I: __: intermediate __: fast __: slow (Shipp says she sees these the most)
1a 1b 1c
enoxaparin treatment dose
1mg/kg SQ BID or 1.5 mg/kg SQ QD CrCl < 30: 1 mg/kg QD
Before arriving to hospital: 1. NTG SL 1 tab under tongue q 5 min, if no chest pain relief after __ dose, call 911 2. Chew aspirin __mg
1st 325
beta blockers and prostaglandin
1st line therapy for POAG Tx
POAG - treatment
1st line: - beta blockers (eyedrops) - prostaglandin analogs 2nd line: - alpha agonists - topical carbonic anhydrase inhibitors 3rd line: - direct acting cholinergics - indirect acting cholinergics
Class IV agents affect phase __ of the cardiac cycle Action Potential
2
Dabigatran shoudl be give when: 1. less than __ hours prior to scheduled dose of parenteral anticoagulant. 2. Once INR is less than __
2 2
How many people are infected with M. tuberculosis?
2 billion
How many people die of TB each year
2 million
INR range
2-3
can give prophylactic dose __-__ times a day depending on patient factors
2-3
stop _-_ days before procedure Restart __-__ hours afterwards CrCl less than 50 ml/min, get off of it __-__ days before a procedure
2-3 24-48 4-5
take about __-__ Rx and non Rx drug per day
2-9
A-fib dosing of Apixaban parameters
2.5mg BID if: - age >/= 80 years -weight </= 60 kg - serum creatinine >/= 1.5 mg/dL
what is the max dose of simvastatin you can use with amlodopine and amiodarone?
20 mg
niacin max dose
2000 mg/day
Max initial infusion rate is ___ units/hr
2300
after two normal aPTT can check again every ____
24 hours
What is the typical adult dose for Pyrazinamide?
25 mg/kg/d
Most of warfarin is S configuration, so _ _ _ is used to metabolize most frequently
2C9
flagyl impact __ __ __
2C9
Alpha adrenergic agonist and topical carbonic anhydrase inhibitors
2nd line therapy for poag TX
2nd provoked clot, __ months is good
3
INR is higher in patients with mechanical prosthetic heart valves (target __, range of 2.5-3.5)
3
INR of 5.2, you'd have to hold it for about __ days to bring it back to 5.2-2.5
3
Treat VTE for __ months regardless if provoked or unprovoked
3
enoxaparin, dalteparin, tinzaparin
3 LMWH's
treatment of VTE (regardless of anticoagulant ) - 2nd provoked
3 months
treatment of VTE (regardless of anticoagulant) - 1st provoked
3 months
For all patients, isoniazid should be stopped if liver function test results are what?
3 times higher than upper limit of normal range and patient has symptoms OR 5 times higher than upper limit of the normal range and patient has no symptoms
HIT: avoid heparin therapy for at least
3 to 6 months
steady state is acheived after _-_ half lives
3-4
Drugs to use for DES: 1. ASA 325 mg for __-__ months then __mg indefinitely 2. Clopidogrel (plavix) 75 mg daily for at least __ year
3-6 81 1
treatment of VTE (regardless of anticoagulant) - 1st unprovoked
3-6 months
UFH is preferred inpatients with CrCl greater than __ ml/min
30
enoxaparin prophylaxis dose
30 mg SQ BID or 40mg SQ QD CrCl < 30: 30 mg QD
UFH preferred in patients with CrCl<
30 ml/min
What is the typical adult dose for Isoniazid?
300 mg/d
A patient should never be on __mg long term. But baby aspirin is fine long term.
325
bidil: dosing
37.5 mg hydralazine + isosorbide dinitrate 20 mg = goal dose of 2 tabs TID
Azole-fungals increase INR by impacting the _ _ _
3A4
Ex, CYP_ _ _, most common
3A4
Common isotypes of P450 system: 1. _ _ _ 2. _ _ _ 3. _ _ _ 4. _ _ _
3A4 2D6 1A6 2C9
Use cautiously during __ trimester and peripartum period
3rd
direct acting cholinergics and indirect acting cholinergics
3rd line of therapy for POAG Tx (fallen out of favor)
POAG: direct acting cholinergics
3rd line!! pilocarpine: causes contraction of ciliary muscles, increases aqueous humor outflow carbachol: 3rd line!
After bottle opened, it will expire in _ months
4
Pradaxa expiration once bottle open
4 months
If high-risk procedure stop warfarin
4 to 5 days prior -can be put on lovenox up until 12 hours before procedure
Factor VII has the shortest half-life of __-__ hours
4-6 hours
the t1/2 of amiodorone is __-__ days. The reason for this is that it goes to your tissues, sets there and __ leaves
40-60 never
FYI, factor II (thrombin) has a half life of __-__ hours
42-72 hours
factor II clotting factor
42-72 hours
If it has been less than __ hours, then you probs don't have a clot
48
if it has been more than __ hours, then the chances of a clot are significantly raised
48
Remember that Warfarin must be bridged (taken with other antithromotic drugs) for __ days
5
about every __ hours, 50% of the drug concentration will be eliminated.
5
before doing this: 1. D/C Clopidogrel and Ticagrelar 5 days before CABG
5
nitroglycerin can be given every __ minutes (PRN)
5
nitroglycerin should start exerting its effects within __ minutes
5
CHF, HTN, Age, DM, Stroke/TIA hx
5 risk factors for scoring embolic stroke risk
After about __-__ half lives, the drug is 'done'
5-6
usually a __% or more decrease in baseline
50%
Dose ranges for aspirin should be between __-__ mg.
50-325
Ranolazine doeses: 1. __ mg (but can increase dose to __mg
500 mg 1000 mg
__%-__% take at least ONE unnecessary meds
55-59
1st unprovoked can be treated for up to __ months
6
Missed dose: take on same day asap. Skip the missed dose if it cannot be taken at lease __ hours before the next scheduled dose
6
What is the minimum about of time TB must be treated?
6 months
What is the typical adult dose for Rifampin?
600 mg/d
in one pill...you receive __ mg of iodine...when you just need 0.2 to 0.3 mg...Thyroid issues...haha...
6mg
2. D/C Prasugrel__ days before CABG
7
patients that have __ or more meds or __ or more cardiac meds (polypharamcy)
7 3
What is the percentage risk of developing TB disease each year for people who are infected with both TB and HIV?
7-10%
warfarin's full antithrombotic effect is not achieved for
7-15 days after initiation
1. age older than __ yo
75
People over the age of __ are more sensitive to warfarin...so start on a lower dose
75
Long acting Nitrates: 1. take a nitrate-free period (__-__ hours/day) daily
8-12
Relative Contraindication for tPA: 1. older than __ 2. HTN greater than __ /__ 3. Recent bleed within the last _-_ wks 4. __ 5. platelets less than __ 6. Received __ within 48 hours and elevated aPTT 7. Recent __ used and with elevated INR 8. Minor or rapidly improving __
80 185/110 2-4 pregnancy 100,000 heparin antigcoag symptoms
DVT/PE: UFH initial loading dose
80-100 units/kg -MAX = 10,000 units
Medical Management: 1. aspirin __ mg 2. Clopidogrel at least for __ month 3. Continue IV/SQ __ until hospital discharge 4. Continue ___ anticoags after discharge if high-risk for left ventricular thrombus (EF<40%)
81 one anticoagulants PO
a. use aspirin at __-__ mg daily b. __ 75 mg daily c. __ or __ 25/200 mg BID
81-325 mg Clopidogrel (plavix) Aspirin/Dipyridamole
How many people develop TB disease each year?
9 million
door to needle is __ minutes
90
__ mg continuous infusion (amiodarone)
900mg
carbapenems examples
::::::::-enem::::::: -doripenem -ertapenem -meropenem cover gram +, gram -, and anaerobes
penicillins examples
::::::::examples: -cillin:::::::: -amoxicillin -ampicillin -oxacillin -penicillin G
cephalosporins examples
::::::cef-/cefp-/ceph-::::::: -cephalexin -cefoxitin -ceftazidime -cefepime -ceftaroline
diarrhea and warfarin
<in vit K causing increase in INR
-People who have recently come to U.S. from areas where TB is common -People who inject drugs -People who live or work in high-risk congregate settings -Mycobacteriology laboratory workers For these groups of people, a positive Mantoux Tuberculin Skin Test is an induration of what?
> 10 mm
-People with certain medical conditions that increase risk for TB -Children younger than 4 years old -Infants, children, or adolescents exposed to adults in high-risk categories For these groups of people, a positive Mantoux Tuberculin Skin Test is an induration of what?
> 10 mm
For people with no known risk factors, a positive Mantoux Tuberculin Skin Test is an induration of what?
> 15 mm
-People living with HIV -Recent close contacts of people with infectious TB -People with chest x-ray findings suggestive of previous TB disease -People with organ transplants -Other immunosuppressed patients For these groups of people, a positive Mantoux Tuberculin Skin Test is an induration of what?
> 5 mm
fever and warfarin
>catabolism of clotting factors: increase INR
ASA and antianginal tx
A
180/110
A blood pressure greater than _____ is considered hypertensive crisis?
What is rifabutin?
A derivative of Rifampin with less potent enzyme inducer than rifampin (Less interactions with HIV medications)
__ __: depends on stroke risk
A fib
What should be done if a patient has a negative TST result, but has symptoms of TB disease?
A medical evaluation
Stage A
ACCF/AHA stages at high risk for HF but without structural heart disease or symptom of HF
‐pril
ACE inhibitor, lisinopril
pril
ACE inhibitors all end in what?
cough
ACEI block the degradation of bradykinin. What adverse reaction can this cause?
History of an __ __ __
ADR
3. Optimize medical therapy: a. __81mg b. __, use if ASA allergy c. Control __, __, and __ -all patients should be on a BB, ACEI, statin, upon discharge d. Encourage proper __ and __
ASA Clopidogrel HTN, hyperliperdemia, DM Diet, exercise
A B C D E
ASA+ antianginal tx BB+BP Cholesterol+cigarette smoking Diet+Diabetes Education+exercise
gemfibrozil use with statins
AVOID using with statins b/c of risk rhabdomyolysis
In TB disease, CRX are usually?
Abnormal
__: she hardly ever sees this. Can only be used for VENTRICULAR arrhythmias.
Acebutolol
ISA (intrinsic sympathomimetic activity)
Acebutolol, penbutolol, pindolol are examples of what type of beta blockers?
Why does pyrazinamide have the greatest activity against organisms inside of macrophages?
Acid stable
3. __ transport: carrier proteins help move AGAINST concentration gradients (like Na/K pumps)
Active
In TB disease, tubercle bacilli in the body are?
Active (multiplying)
Ethambutol is active against what?
Active against actively dividing bacilli
____ _ _ _: UFH, LMWH, or fondaparinux should be overlapped with Warfarin for more than or equal to 5 days
Acute VTE
Pharmacological Treatment of Paroxysmal SVT
Adenosine: 6 mg IV bolus administered in *less than 30 seconds*; may give 12 mg after 1-2 minutes if needed Calcium Channel Blockers: Diltiazem and Verapamil Beta Blockers Digoxin *All of the above slow conduction through the AV node*
Bleeding
Adverse affect of any anticoagulant
QY prolongation, photosensitivity
Adverse effects of axithromycin
4 wks
After a stroke, you must anticoagulate for at least this long
Warfarin
Agent responsible for causing purple toe syndrom
diabetes or renal impairment
Aliskiren (Tekturna) cannot be used in combination with ACEI or ARBs in patients with _____ or _____ _____?
Amlodipine (Norvasc) and Felodipine (Plendil)
All DHP CCB reduce cardiac contractility except what two?
lol
All beta blockers end in what?
azosin
Alpha-1 blockers all end in what?
BPH (benign prostatic hyperplasia)
Alpha-1 blockers are usually reserved for men with what?
Side Effects of Amiodarone
Also causes severe bradycardia, optic neuropathy/neuritis, and CNS effects
__: Thrombolytic. Max dose for STEMI: 100mg. Used for stroke patients too. DO NOT USE FOR AN UA/NSTEMI. Do this if you can't get PCI quick enough. Max dose for stroke is __ mg
Altepase 90mg
__: a thrombolytic agent. __ __ __ (tPA)
Alteplase (activase) -tissue plasminogen activator
Potassium sparing diuretics
Amiloride (Midamor) is an example from what drug class?
__: impact 3A4. Has a delayed effect on warfarin. Will increase INR in 6-8 weeks
Amiodarone
macrolides, flouraquinalones, QT
Amiodarone should be monitored closely with?
HIT
An adverse effect defined by a 50% drop in platelets
What is the reaction from a Mantoux Tuberculin Skin Test (TST) that indicates TB?
An area of induration (swelling) around injection site (measure in mm; redness is not measured)
apixaban or rivaroxaban
An oral drug that directly and selectively inhibits Xa
dabigitran
An oral drug that is a direct thrombin inhibitor
hair growth (anti androgen effects)
An unwanted side effect, especially in women, of aldosterone receptor blockers is what?
sartan
Angiotensin Receptor Blockers (ARB) all end in what?
antidote to xeralto si __ (not available yet, though)
Annexa
What medicine can not be administered with ethambutol?
Antacids
__: have NO intrinsic activity but BLOCK the activity of an agonist (affinity by no efficacy) -keep endogenous substances off of it
Antagonist
warfarin
Anticoagulant that requires continuous monitoring, patient education, and that has a narrow therapeutic index
UFH, LMWH
Anticoagulants of choice during pregnancy
FQ or TCN
Antimicrobial Therapy for Pneumonia in Adults: Atypical Legionella M. pneumonia C. pneumoniae What is the recommended treatment?
PCN or clindamycin or pip/tazo + AG
Antimicrobial Therapy for Pneumonia in Adults: HCAP, HAP, VAP Aspiration Mouth anaerobes S. aureus enteric Gram (-) bacilli What is the recommended treatment?
Ceftriaxone or FQ
Antimicrobial Therapy for Pneumonia in Adults: HCAP, HAP, VAP No risk factors for MDR S. pneumonia H. influenza MSSA enteric Gram (-) bacilli What is the recommended treatment?
cephalosporin or carbapenem + AG + vancomycin or linezolid
Antimicrobial Therapy for Pneumonia in Adults: HCAP, HAP, VAP Risk factors for MDR If Legionella or MRSA suspected What is the recommended treatment?
cephalosporin or carbapenem + AG
Antimicrobial Therapy for Pneumonia in Adults: HCAP, HAP, VAP Risk factors for MDR P. aeruginosa K. pneumoniae (ESBL) Acinetobacter What is the recommended treatment?
β-lactam + macrolide or FQ + vancomycin or linezolid
Antimicrobial Therapy for Pneumonia in Adults: ICU MRSA suspected What is the recommended treatment?
β-lactam + macrolide or FQ
Antimicrobial Therapy for Pneumonia in Adults: ICU S. pneumonia S. aureus Legionella Gram (-) Baillie H. influenzae What is the recommended treatment?
FQ or β-lactam + macrolide
Antimicrobial Therapy for Pneumonia in Adults: Non-ICU S. pneumonia H. influenza M. pneumonia C. pneumoniae Legionella What is the recommended treatment?
FQ or β-lactam + macrolide
Antimicrobial Therapy for Pneumonia in Adults: Outpatient/CAP Comorbidities What is the recommended treatment?
pip/tazo or cephalosporin or carbapenem
Antimicrobial Therapy for Pneumonia in Adults: Outpatient/CAP Elderly S. pneumonia Gram (-) Bailli What is the recommended treatment?
Macrolide or TCN
Antimicrobial Therapy for Pneumonia in Adults: Outpatient/CAP Previously healthy S. pneumonia M. pneumoniae H. influenza C. pneumonia M. catarrhalis What is the recommended treatment?
Mono-resistant TB is resistant to?
Any one TB treatment drug
Who should be evaluated for TB disease?
Any patient with symptoms of TB disease should be evaluated for TB disease, regardless of his or her skin test reaction.
__: should give when INR is less than 2. Has no reversal agent
Apixaban
4. __: -another DTI -used for the prophylaxis/treatment of thrombosis with HIT.
Argatroban
__ inhibits clot-bound and soluble thrombin.
Argatroban
10-20%
As a rule Warfarin should be increased or decreased by
When should treatment begin in a pregnant woman?
As soon as TB disease is diagnosed
In what areas of the world is TB common?
Asia Africa Russia Eastern Europe Latin America
2. __: irreversibly inhibits cyclooxygenase and throboxane A2, thus inhibiting platelet aggregation.
Aspirin
__ is used to prevent and treat MIs, acute ischemic stroke, TIA, and adjunctive therapy in revascularization procedures (like stent implantations)
Aspirin
ACEI and beta blocker
Asymptomatic individuals with demonstrable ventricular dysfunction should be started on what treatment?
Poly-resistant TB is resistant to?
At least any two TB drugs (but not both isoniazid and rifampin)
Multidrug-resistant (MDR TB) is resistant to?
At least isoniazid and rifampin, the two best first-line TB treatment drugs
Arterial Thrombosis: 1. __ __ 2. __ heart valves -these two things can cause this.
Atrial fibrillation Prosthetic
ARB
Azilsartan (Edarbi) is an example from what drug class?
beta blocker and blood pressure
B
Adverse Effects of __: 1. reflex tachycardia if not titrated down 2. fatigue 3. sexual dysfunction (caused by decreased CO)
BBs
Contraindications for __: 1. Severe bradycardia 2. AV block 3. Unstable HF
BBs
__ are FIRST-LINE therapy for CSA
BBs
__ reduce mortality post-MI, ACS or CHF (unless contraindicated)
BBs
When doing a conservative approach make sure patients leave being on: 1. B__ 2. A__ 3. S__ 4. A__
BBs ACEI Statin Aspirin
__, _ __ __ __, __ __ __ and __ can cause AV nodal blocks
BBs nDHPs CCBs Digoxin
Uses of CCBs: 1. good alternative if __ cannot be used 2. In combo with __ and __ for refractory angina
BBs nitrates, BBs
Propranolol Esmolol Acebutolol
BBs to Know
3. __ __ control: -labetolol over 1-2 mintues, can repeat every 10-20 mintues (max of 300 mg) -Nicardipine titration
BP
β-lactam Antibiotics: (inhibit cell wall synthesis)
BP Can't Make Cash -Penicillins -Cephalosporins -Monobactam -Carbapenems
What happens if the immune system cannot keep the tubercle bacilli under control and the bacilli begin to multiply rapidly?
Bacilli begin to multiply rapidly and cause TB disease
What is the coverage for rifampin?
Bactericidal and broad spectrum: mycobacteria, gram+, gram- bacteria
What can prove the patient has TB disease?
Bacteriologic culture
__ and __ can almost immediately effect INR (increase it)
Bactrim Flagyl (metro)
sulfonamides examples
Bactrim IV/PO -covers gram + and gram -
PCI: 1. __ __ __: -less platelet aggregation on stent -stent restenosis more likely -immediate gratification -long term benefits aren't as good
Bare Metal Stent (BMS)
3. __ __: slows conduction through AV node
Beta Blockers
class II
Beta Blockers are which class
__ __: decrease oxygen demand. Helps with reflex tachycardia due to nitrates. Prevents angina symptoms during nitrate-free period. Reduce remodeling of heart.
Beta-blockers
When were Isoniazid (INH) and p-aminosalicylic acid (PAS) discovered?
Between 1943 and 1952
UFH MOA
Binds to antithrombin inhibiting factors IIa and Xa
__: proportion of drug that reaches the system circulation after administratioin
Bioavailibility
3. __: another DTI FDA approved indication is in patients with unstable angina undergoing percutaneous transluminal coronary agioplasty
Bivalirudin
__ should be adjusted if there is renal impairment.
Bivalirudin
Loop diuretics
Bumetanide (Bumex) is an example from what drug class?
cholesterol and cigarette smoking
C
7. _ _ _: 45% of caregivers give _ _ _ products to their kids Homeopathic remedies (ask them if they are doing that...make sure you ask about homeopathic practices)
CAM (complementary and alternative medicatioins)
2. __ __ __: Diltizem and verapamil (Non-DHPs) slows conduction through AV node
CCB
decreases oxygen demand
CCB
DO NOT USE _ _ _ or _ _ in Heart Failure patients!!!!!!!!!!!!!!! (with low ejection fraction...below 60%)
CCB BB
Adverse Effects of __: 1. hypotension 2. headache 3. constipation 4. gingival hyperplasia
CCBs
___: decrease available calcium, leading to vasodilation
CCBs
decreases heart rate and contractility
CCBs
Not shown to reduce mortality while __ have shown an improvement in mortality
CCBs BBs
Secondary Prevention to Ischemic Stroke: 1. Cardiogenic: -use __ score to determine tx options
CHADS2
allergic conjunctivitis - vasoconstrictors CI, SE
CI: narrow angle glaucoma or narrow angle without glaucoma SE: stinging, blurred vision,mydriasis, increased redness, increased IOP, rebound congestion and hyperemia MAX USE is 72 hours
Aspirin blocks __ __ which reduces clotting
COX-1
1. _ _ _: 2. Give __ during CPR (epinephrine q 3-5 minutes or vasopressin as an alt. to 1st or 2nd dose 3. if there is a pulse: then manage according to most current AHA/ACLS guidelines 4. If PULSELESS: a) shock for _-_ more times +CPR+Vasopressors b) initiate __ therapy -first line is __ -alternative is __
CPR Vasopressor 2-3 antiarrhythmic amiodarone lidocaine
Chronic Stable Angina
CSA
Rosuvastatin metabolized by
CYP2C9
Azole fungals and warfarin
CYP3A4
most statins are metabolized primarily by
CYP3A4; which results in most interactions
3A4
CYP450 pathway with the most drug interactions
Class IV agents are __ channel blockers
Ca2+
__ __ blockers cause bradycardia
Ca2+ channel
Class IV
Calcium Channel Blockers are which class
‐dipine
Calcium channel blocker, amlodipine
yes
Can beta blockers be used in the treatment of a-fib?
yes
Can loop diuretics be used if a patients CrCl is less than 30mL/min?
ARB
Candesartan (Atacand) is an example from what drug class?
BP
Cardiac output x peripheral vascular resistance=?
Where is miliary TB located?
Carried to all parts of body, through bloodstream
mixed alpha and beta blockers
Carvedilol and labetalol are examples of what type of beta blockers?
alpha 1 blockade
Carvedilol is a beta blocker as well as _______
LMWH MOA
Cause endothelium to release tissue factor pathway inhibitor, enhancing inhibition of factor Xa & IIa -- but primarily factor Xa
Verapamil
Causes constipation
fourth generation cephalosporins
Cefepime (Maxipeme) IV -covers pseudomonas -gram - -risk of seizures
fifth generation cephalosporins
Ceftaroline (Teflaro) IV -covers MRSA, only cephalosporin to do so -covers gram + and gram -
third generation cephalosporins
Ceftazidime (Fortaz) IV -You get a "tax" deduction when you have a baby, so cefotaximine is for neonates -Cefotaximine (Claforan) IV - the only single 3rd generation agent that covers Pseduomonas -cover gram + and gram -
Thiazide diuretic
Chlorthalidone (Hygroton) is an example from what drug class?
5. __: inhibitor of phosphodiesterase-3. As a result, cAMP is increased leading to reversible inhibition of platelet aggregation, vasodilation
Cilostazol (Pletal)
Quinidine
Cinchonism is a side effect of which drug?
Classes that Increase Torsades
Class 1 and 3 Rhythm Controllers
Dysrhythmic Classes Based on the Cardiac Action Potential
Class 1: Sodium Channel Blockers (phase 0) Class 2: Beta Blockers Class 3: Potassium Channel Blockers (phase 3) Class 4: Calcium Channel Blockers (phase 2) *Even classes do rate control* *Odd classes do rhythm*
D ouble Q uarter P ounder
Class 1a -Disopyramide -Quindine gluconate and sulfate -Procainamide
F ries P ickles
Class 1c -Flecainide -Propafenone
Procainamide
Class IA agent that produces SLE like symptoms and is only for life-threatening arrhythmias
Disopyramide, Quinidine, Procainamide
Class IA agents
flecainide, propafenone
Class IC agents, both PO with the "Pill in Pocket Dosing"
__ __ agents: block L-type calcium channels in SA and AAV nodal tissues
Class IV agents
verapamil, diltiazem
Class IV agents - calcium channel blockers
IC
Class of antiarrhythmics that report a "funny taste"
___: the intrinsic ability of the body or its organs of eliminatioin (usually the kidneys and liver) to remove the drug from the blood or plasma
Clearance
Alpha-2 agonists
Clonidine (Catapres) is an example from what drug class?
remember that __ is a prodrug
Clopidogrel (Plavix)
if someone is allergic to aspirin, then have them take __
Clopidogril (plavix)
Two types of antagonists: 1. __/__ antagonist: looks like the endogenous product and will be more likely to bind with higher concentrations 2. __/__ antagonist: taking a key and then breaking it off in the receptor
Competitive/reversible Noncompetitive/irreversible
thrombocytopenia, use of other antithrombic therapy, preexisting source of bleeding
Concomitant bleeding risks that increase risk of UFH-induced hemorrhage
2. __ __ __: -hypoxic symptoms (not dysapnea), lethargy, restlessness, confusion
Congestive Heart Failure
Diagnostic __ __: -continue anticoag therapy -Clopidegrel or prasugrel or ticagrelor -Glycopreotin IIb/IIIa inhibitor
Coronary Angiography
In TB disease, symptoms include?
Cough Fever Weight Loss
pradaxa before procedure - related to CrCl
CrCl <50 mL/min stop 4-5 days before procedure
__: breakdown product of muscle that is always present. Eliminates largely by __ filtration. Not significantly __ or __
Creatinine glomerular secreted, reabsorbed
__ __: helps determine an estimate of how well the kidneys are functioning
Creatinine clearance
Digoxin, Amiodorone
Culprits of Drug-drug interactions in the CYP450 system
What determines if specimen contains M. tuberculosis and confirms diagnosis of TB disease?
Culture
Induction and inhibition of __ __ enzymes is not changed
Cyp 50
7. Known ___ variant
CypP450 2C9
diet and diabetes
D
Treatment of Torsades: 1. most patients require and respond to _ _ _
DCC
Acute management: 1. presence of severe symptoms: a) _ _ _ to attempt to restore NSR b) correct any precipitating factors c) __: alternative is vasopressin
DCC Epinephrine
POAG: topical carbonic anhydrase inhibitors - MOA
DECREASE AQUEOUS HUMOR SECRETION
POAG: alpha adrenergic agonists - MOA
DECREASE PRODUCTION OF AQUEOUS HUMOR and INCREASE uveoscleral OUTFLOW
__ may caused reflex tachycardia if not given with BB
DHP
dipine
DHP CCB all end in what?
Adverse Effects of __: reflex tachycardia, peripheral edema
DHPs
__ __ __: work in the periphery -dipines
DHPs
5. __ management
DM
azole antifungals with statins
DO NOT USE (antifungal)
glycopeptides /lipoglycopeptides: (inhibit cell wall synthesis)
DON'T have β-lactam ring -ex: Vancomycin, Televancin, Dalbavancin, Oritavancin cover gram + only and very few anaerobes (c.diff)
_ _ _: directly interact with thrombin. Most used for HIT treatment
DTIs
HIT: Pharmacologic Treatment 1. _ _ _s are drug of choice for HIT(+/-) a thrombosis. ---only __ and __ are FDA approved
DTIs Lepirudin Argatroban
HIT treatment
DTIs drug of choice -only lepirudin and argatroban are FDA approved (LMWHs not recommended)
GI side effects are most common with __
Dabigatran
__: reversible, direct thrombin inhibitor that inhibits both free and fibrin-bound thrombin.
Dabigatran (pradaxa)
What is preferred regimen for isoniazid?
Daily for 9 months (may also be given for 6 months, not as effective)
__ Good at preventing DVTs in cancer patients. Can be cheaper than Lovenox
Dalteparin
2. DTI: __: Use for VTE prophylaxis in patients undergoing elective hip surgery. Reduce dose in __ to __ renal impairment seeing as it is filtered by the kidneys
Desirudin (SubQ) moderate severe
Mycobacterium tuberculosis is notorious for its ability to?
Develop resistance
What is the resistance of isonicotinic acid hydrazide (INH)?
Development associated with complex gene mutations
7. __: decreases vit K, this increases INR, so you need to decrease Warfarin because its affects will be stronger
Diarrhea
4. __: slows conduction through AV node
Digoxin
__ can be used for HF
Digoxin
__ is a rate control drug, NOT rhythm
Digoxin
__ is dose related
Digoxin
bradycardia
Digoxin can cause interactions with beta blockers. What specific side effect can it cause?
__: can cause edema and headache
Diltiazem
Non-DHP 1. __: less poten decrease in HR than verapamil. Avoid in patients with bradycardia or hypoTN 2. __: increased risk of constipation then Diltiazem. Lower oxygen demand to a greater extent than DHP CCBs
Diltiazem Verapamil
4. __: inhibits the activity of adenosine deaminase and phosphodiesterase, this causes an acumulation of adenosine, adenine nucleotides, and cAMP. These mediators then inhibit platelet aggregation and may causes vasodilation
Dipyridamole (Persantine)
Cardioversion: __ __: Generally more effective. However, there is a need for prior sedation and a small risk for serious complications like a. sinus arrest b. ventricular arrhythmias
Direct Cardioversion
Dabigatran Etexilate
Direct Thrombin Inhibitors: oral DTIs
Rivaroxaban, Apixaban
Direct Xa Inhibitors: Oral Xa Inhibitors
Hyperkalemia
Do ACEI cause hyperkalemia or hypokalemia?
increase
Do ACEI increase or decrease serum creatine?
hyperkalemia
Do ARB cause hyperkalemia or hypokalemia?
bradycardia
Do Beta blockers cause bradycardia or tachycardia?
tachycardia
Do DHP CCB cause reflex tachycardia or bradycardia?
yes
Do NHDP CCB cause an interaction with beta blockers?
yes
Do NSAIDs cause an interaction with beta blockers?
Bradycardia
Do Non-DHP CCB cause tachycardia or bradycardia?
hypocalcemia
Do loop diuretics cause hyper or hypocalcemia?
hyperglycemia
Do loop diuretics cause hyper or hypoglycemia
hypokalemia
Do loop diuretics cause hyper or hypokalemia?
hypomagnesaemia
Do loop diuretics cause hyper or hypomagnesaemia?
hyponatremia
Do loop diuretics cause hyper or hyponatremia?
hyperuricemia
Do loop diuretics cause hyper or hypouricemia?
Loop
Do loop or thiazide diuretics cause hypocalcemia?
hyperkalemia
Do potassium sparing diuretics diuretics cause hyper or hypokalemia?
Hypercalcemia
Do thiazide diuretics cause hyper or hypocalcemia?
hypokalemia
Do thiazide diuretics cause hyper or hypokalemia?
hypomagnesaemia
Do thiazide diuretics cause hyper or hypomagnesaemia?
hyponatremia
Do thiazide diuretics cause hyper or hyponatremia?
hypophosphatemia
Do thiazide diuretics cause hyper or hypophosphatemia?
hyperuricemia
Do thiazide diuretics cause hyper or hypouricemia?
hyperkalemia
Does Aliskiren (Texturna) cause hyperkalemia or hypokalemia?
__(aka Tikosyn): adjust for renal dysfunction. K+ channel blocker. MUST MONITOR!!!!!! Does NOT cause HF. Safe to use in HF because it will not exacerbate it.
Dofetilide
__ from the drug affects absorption
Dosage
__: amount of drug given in one dose
Dosage
250 mg Q12h
Dose of Dofetilide with a CrCl of 40-60 --- (half of the full dose)
5000 units q 8-12hrs
Dose of UFH given for VTE prevention by SQ injection
5 mg daily x 3 days
Dose of Warfarin for the general population without Warfarin sensitivity and that are <75 yo with a baseline INR (recheck in 3-5 days)
6 mg IV bolus
Dose of adenosine to be given supa fast for SVT - can give 12 mg 1-2 min after this dose
1 mg per 100 units of UFH max 50 mg
Dose of protamine sulfate to be delivered IV
Alpha-1 blockers
Doxazosin (Cardura)is an example from what drug class?
__: newest out of all of these. It pregnancy category X. Contraindicated in certain types of HF. Some patients do respond well to it. ONLY COMES IN __mg BID
Dronedarone 400mg
NSAIDS
Drug harmful in HF Promoted Na and water retention and blunt diuretic
Corticosteroids
Drug harmful in HF promote NA and water retention
anticholinergic or sympathomimetic
Drug induced PACG
What is an ominous prognostic factor for rifampin?
Drug resistance
PCI 2. __ __ __: -more platelet aggregation on stent Stent restenosis less likely (benefits last longer, although not an immediate result)
Drug-Eluting Stent (DES)
__ and __: intake CHO, protein, fat. Drug/food interaction (like with Warfarin)
Drug/Nutrition
RAAS
Drugs that affect what system should not be used in women of childbearing age?
FFAAB-5 drugs
Drugs that interact with Warfarin - flagyl, flouroquinolones, -azoles, amiodorones, Bactrim
Amiodarone Drug Interactions
Due to 1A2/2D6/2C9/3A4/PgP Inhibition Warfarin (cut dose in 1/2) Digoxin (cut dose in 1/2) Simvastatin (cut dose in 1/2) Atypical Antipsychotics Macrolide Antibiotics Protease Inhibitors
Digoxin Drug Interactions
Due to 3A4 and PgP substrates Dronedarone Itraconazole Quinidine
Diltiazem and Verapamil Drug Interactions
Due to the 3A4 Substrate Inhibition Simvastatin Amiodarone
2. LV __: -IV Digoxin -IV Amiodarone
Dysfunction
2. LV __: a. BB, Digoxin
Dysfunction
education and excersie
E
__: should give with or without food and once INR is below or equal to 2.5. There is no reversal agent
Edoxaban
ED50, recommended doses, need to consider epidemiolgoy
Effective dose 50 (50% of population)
4. __: engulfment of large MW drugs
Endocytosis
__(Lovenox) is used most often
Enoxaparin
Types of Routes of Administration: 1. __ 2. __ 3. __ 4. __
Enteral Parenteral Topical Inhalation
___recirculation---liver---bile---intestine---reabsorbed---general circulation---liver---gallbladder, etc
Enterohepatic
Aldosterone receptor blockers
Eplerenone (Inspra) is an example from what drug class?
__: can cause diaphoresis, nausea, and hypoTN. Not long lasting. Have to be given IV. Has a completely different metabolism pathway. Tis cardioselective. Lowers HR. Used in HTN crisis
Esmolol
Beta Blockers
Esmolol (Brevibloc) is an example from what drug class?
Loop diuretics
Ethacrynic Acid (Edecrin) is an example from what drug class?
What is given as 4 drug initial combo tx for TB until sensitivities known?
Ethambutol
(1) A viral respiratory tract infection that causes mucosal inflammation (2) Leads to obstruction of the sinus ostia (3) Mucosal secretions become trapped, local defenses are impaired, and bacteria from adjacent surfaces begin to proliferate
Explain the pathophysiology of acute bacterial sinusitis.
Bioavailability is labeled with an "__" by pharmacists
F
200 mg. 300 mg
"Pill in Pocket" dose of Flecainide for a patient weighing less that 70 kg? Greater than or equal to 70 kg?
viral conjunctivitis
"pink eye", begins in one eye and spreads to the other, may have recent exposure to URI. Cannot treat pharmacologically
What are the signs/symptoms of hepatitis from isoniazid, rifampin, or pyrazinamide?
(1) Abdominal pain (2) Abnormal liver function test results (3) Dark urine (4) Fatigue (5) Fever for 3+ days (6) Flulike symptoms (7) Lack of appetite (8) Nausea (9) Vomiting (10) Yellowish skin or eyes (Serious)
What are the signs/symptoms of increased uric acid from pyrazinamide
(1) Abnormal uric acid level (2) Joint aches (3) Gout (rare) (not serious unless symptomatic)
What is the continuation phase of TB treatment?
(1) After first 8 weeks of TB disease treatment (2) Bacilli remaining after initial phase are treated with at least 2 drugs
What is BCG vaccination?
(1) Bacille Calmette-Guerin (2) vaccine for tuberculosis (TB) disease. (Many foreign-born persons have been BCG-vaccinated. BCG is used in many countries with a high prevalence of TB to prevent childhood tuberculous, meningitis and miliary disease)
What is the coverage for pyrazinamide?
(1) Bacteriostatic (2) May be bactericidal for actively dividing organisms
Bacilli may reach any part of the body via the bloodstream, but common sites include?
(1) Brain (2) Larynx (3) Lymph node (4) Bone (5) Pleura (6) Lung (7) Kidney (8) Spine
Which groups are at high risk for TB infection (LTBI)?
(1) Close contacts (2) Foreign-born persons (3) Low-income groups and homeless persons (4) Individuals who live and/or work in special settings (5) Health care workers who serve high-risk groups (6) Racial and ethnic minorities (7) Infants, children, and adolescents (8) People who inject drugs
What other names has TB been historically called?
(1) Consumption (2) Wasting disease (3) White plague
What are the symptoms of pulmonary TB disease?
(1) Cough for 3 or more weeks (2) Chest pain (3) Coughing up sputum or blood
What are the second line antituberculosis drugs?
(1) Cycloserine (Seromycin®) (2) Ethionamide (Trecator®) (3) Streptomycin (4) Amikacin (Amikin®)/ kanamycin (5) Capreomycin (Capastat®) (6) p-Aminosalicylic acid (PAS) (7) Levofloxacin (Levaquin®) (8) Moxifloxacin (Avelox® (9) Ciprofloxacin (Cipro®)
Explain the pathogenesis of TB.
(1) Droplet nuclei containing tubercle bacilli are inhaled, enter the lungs, and travel to small air sacs (alveoli) (2) Tubercle bacilli multiply in alveoli, where infection begins (3) Within 2 to 8 weeks the immune system produces macrophages that surround the tubercle bacilli (4) These cells form a barrier shell that keeps the bacilli contained and under control (LTBI) (5) If the immune system CANNOT keep tubercle bacilli under control, bacilli begin to multiply rapidly and cause TB disease (6) This process can occur in different places in the body
What are the signs/symptoms of bleeding problems from rifampin?
(1) Easy bruising (2) Slow blood clotting (serious)
What are the general symptoms of TB?
(1) Fever (2) Chills (3) Night sweats (4) Weight loss (5) Appetite loss (6) Fatigue (7) Malaise
What is the initial phase of TB treatment?
(1) First 8 weeks of treatment (2) Most bacilli killed during this phase (3) 4 drugs used
What are the adverse effects of rifabutin?
(1) GI intolerance (2) Skin rash (3) Neutropenia
Extrapulmonary TB is found more often in?
(1) HIV-infected or other immunosuppressed persons (2) Young children
What are some factors that can cause people to have a false positive reaction?
(1) Infection with nontuberculous mycobacteria (2) BCG vaccination (3) Administration of incorrect antigen (4) Incorrect measuring or interpretation of TST reaction
What may appear on the CXR of a person with TB disease in the lungs?
(1) Infiltrates (collections of fluid and cells in lung tissue) (2) Cavities (hollow spaces within lung)
What drugs should be used for the initial phase of TB treatment?
(1) Isoniazid (INH) (2) Rifampin (RIF) (3) Pyrazinamide (PZA) (4) Ethambutol (EMB)
What are the first line antituberculosis drugs?
(1) Isoniazid (INH)* (2) Rifampin* - Rifabutin (Mycobutin®) - Rifapentine (Priftin®) (3) Pyrazinamide (PZA) (4) Ethambutol (Myambutol®)
What antituberculosis drugs are combination agents?
(1) Isoniazid/Rifampin (Rifamate® ) (2) Isoniazid/Rifampin/ Pyrazinamide (Rifater®)
What is rifapentine?
(1) Long-acting rifamycin that can be used once weekly in the continuation phase of trmt in carefully selected HIV-negative pts (2) 85% as potent an enzyme inducer as rifampin, so similar DIs likely
What are the components of medical evaluation for TB?
(1) Medical history (2) Physical examination (3) Test for TB infection (4) Chest x-ray (5) Bacteriological examination
What is the relapse phase of TB treatment?
(1) Occurs when treatment is not continued for long enough (2) Surviving bacilli may cause TB disease at a later time
What are the signs/symptoms of discoloration of body fluids from rifampin?
(1) Orange urine, sweat, or tears (2) Permanently stained soft contact lenses (minor)
Isoniazid is not recommended for?
(1) People living with HIV (2) Individuals with previous TB disease (3) Children
Which groups are high risk for TB disease?
(1) People living with HIV (2) People with medical conditions known to increase the risk for TB (3) People infected with M. tuberculosis within past 2 years (4) Infants and children younger than 4 years old (5) People who inject drugs
What is ethambutol's coverage?
(1) Primarily bacteriostatic (2) Bacteriocidal at higher doses
What blood tests are known as interferon-gamma release assays (IGRAs)?
(1) QuantiFERON®-TB Gold test (QFT-G) (2) QuantiFERON®-TB Gold In-Tube (QFT-GIT) (3) T-SPOT
What are the signs/symptoms of stomach upset from pyrazinamide?
(1) Stomach upset (2) Vomiting (3) Lack of appetite (serious)
In people with LTBI (but not TB disease), how does the immune system keep the tubercle bacilli under control?
(1) Within 2 to 8 weeks the immune system produces macrophages that surround the tubercle bacilli (2) These cells form a barrier shell that keeps the bacilli contained and under control (LTBI)
What are the signs/symptoms of eye damage from ethambutol?
(1)Blurred or changed vision (2) Changed color vision (serious)
What are the signs/symptoms of drug interactions from rifampin?
(Interferes with certain medications, such as birth control pills, birth control implants, and methadone treatment (serious or minor)
In both cases, you will do a __ __ __ to double check
(TEE) transesophogeal echocardiogram
POAG: selective beta blockers
(beta 1) - betaxolol - less adverse effects on pulmonary fxn - less effective than timolol
Class 1A Agents: Intermediate Sodium Channel Blockers
*Double Quarter Pounder* Know Procainamide SE are important for patient-specific treatment
Class 1C Agents: Slow Sodium Channel Blockers
*Fries and Pickles* Don't have to be monitored Used with chronic A-fib to maintain sinus rhythm (also PRN a-fib)
strong 3a4 inhibitors
*Ketoconazole* itraconazole, clarithromyocin, protease inhibitores
Class 1B Agents: Fast Sodium Channel Blockers
*Lettuce, Mayo* Mexiletine not prescribed *Only effective in ventricular tissue* (Not for SVTs)
Miscellaneous Antiarrhythmic Agents
*MAD* Adenosine is known as the ctrl + alt + delete of the heart (resets the heart)
Class 2 Agents: Beta-Blockers
*MOA: Block β-adrenergic receptors* Decrease conduction velocity Increase refractoriness by prolonging the PR interval and decreasing HR (harder to stimulate) Decreases automaticity of nodal tissues Decreased ventricular contractility strength Negative inotropes Additionally: effective in situations of high sympathetic tone, interfere with calcium entry into the cell by altering catecholamine dependent channels
Class 4: Calcium Channel Blockers
*MOA: blocks L-type calcium channels in the SA and AV nodal tissues* Effects: Reduces rate of phase 0 depolarization Decreases conduction velocity Increases refractoriness by prolonging the PR interval and decreasing HR Decreases ventricular contractility strength Reduces excitability
Class 3 Agents: Potassium Channel Blockers
*MOST COMMONLY USED ARRHYTHMIA DRUG CLASS* Increase the repolarization time Can display "Reverse-Use Dependence"
Amiodarone
*Most commonly prescribed antiarrhythmic* Has electrophysiologic characteristics of all of the classes: fast sodium channel blocker, nonselective β-blocker action, potassium channel blocker, and a small degree of calcium antagonist activity *Major effect: prolonging repolarization* Effective in SVTs and VT
Class 2 Agents: Beta Blockers
*PEA* Metoprolol can also be used for both HTN and HF (succinate extended; tartrate immediate used more in arrhythmias) Rate Control
Class 3 Agents: Potassium Channel Blockers
*SAIDD* Must have normal potassium to use this drug 3.5 is minimum value Rhythm Control
Class 4: Calcium Channel Blockers
*Valentine's Day* Any drug that causes vasodilation has the potential to cause headaches Rate Control
drugs in HF that decrease morbidity/mortality
- ACEI/ARB - Beta blockers - aldosterone antagonist - bidil
beta blockers: monitoring
- BP, HR - increased edema/fluid retention - fatigue or weakness
ARBs: indications/contraindications
- HFrEF with current/prior symptoms who are ACEI intolerant - reduce morbidity and mortality - don't use with an ACEI obvi
ocular hypertension
- IOP > 21 mmHg - normal visual fields - normal optic disc - open angles - absence of ocular disease
harmful drugs in HF****
- NSAIDS (promote water and NA retention) - corticosteroids (Na/water retention) - class I/III antiarrhythmics (DRONEDARONE esp) (except amiodraone and dofetilide) - CCB's - non DHPS (diltiazem and verapamil but amlodipine and felodipine are proven SAFE) - minoxidil (fluid retention, stimulates renin system) - TZDs (fluid retention) - metformin (lactic acidosis) - amphetamines (tachycardia, arrhythmias) - cilostazol (vent arrhythmias) - itraconazole (neg inotrope) - pregabalin (LE edema, exacerbation, etc)
allergic conjunctivitis - pharm therapy
- OTC antihistamine/vasoconstrictor - topical histamine receptor antagonists - recurrent or persistent: mast cell stabilizers
digoxin: toxicity - cardiac s/s
- PVCS - bigeminy/trigeminy - vtach/vfab - AV block - AV junctional, atrial rhythms - sinus bradycardia
POAG: topical carbonic anhydrase inhibitors - CI
- SULFA drugs (don't use with sulfa allergy) - DONT use in renal/hepatic impairment
POAG: systemic carbonic anhydrase inhibitors - types/info
- acetazolamide - methazolamide - 3rd line agents b/c of side effects - don't use!!
angle closure glaucoma - presentation
- acute attack - rapid increase of IOP - blurring or sudden loss of vision - appearance of halos around lights - severe pain
what's special about carvedilol?
- also provides alpha 1 blockade - further decreases SVR (afterload)
digoxin: toxicity - non cardiac s/s
- anorexia - CONFUSION - nausea - vomitting - halos around lights - fatigue - weakness - dizziness - headaches, a ton of stuff basically
herpes conjunctivitis - treatment
- antivirals inhibit DNA synethesis * trifluridine (adverse effects - burning, palpebral edema, irritation, hyperemia, IOP increased) * ganciclovir (adverse effects - blurred vision, irritation, hyperemia) DONT USE STEROIDS!!
dry eye - pharm tehrapy
- artificial tears and lubes - pilocarpine and cevimeline (may cause sjorgen's syndrome) - opthalmic cyclosporine - opthalmic corticosteroids (short term only)
allergic conjunctivitis antihistamine/mast cell stabilizers
- azelastine - epinastine - ketotifen (claritin, visine, zyrtec -OTC meds) - bepotastine - olopatadine
blepharitis - topical antibiotic treatment
- bacitracin, erythromycin, polymyxin B-bacitracin, gentamicin (ointment preferred) - used for staph blepharitis
ACEI: MOA
- balanced preload and afterload reducers - blocks production of angiotensin II - decreases sympathetic stimulation - decreases production of aldosterone and vasopressin - decreases vasoconstriction (afterload) - increases bradykinins (decreases metabolism) - increases vasodilatory prostaglandins - may affect myocardial remodeling
Stage B HF treatments
- beta blockers (carvedilol, metaprolol succinate ER, bisoprolol)
POAG - treatment: beta blockers MOA
- block beta adrenergic receptor in the ciliary epithelium of eye - lower IOP by DECREASING AQUEOUS HUMOR production - first line agents
aldosterone antagonist: MOA
- blocks effects of aldosterone in the kidneys, heart, and vasculature - inhibits RAAS - decreases K and Mg loss (decrease ventricular arrhythmias) - decreases Na retention (fluid retention) - eliminates catecholamine potentiation (decreases BP) - blocks direct fibrotic actions on myocardium
herpes conjunctivitis basic info
- caused by herpes simplex - sometimes caused by herpes zoster - affects eyelids, conjuctiva, cornea - symptoms: pain, tearing, redness, sensitivity to light, irritation, foreign body sensation
dry eye - cevimeline
- cholinergic agonist - sjorgens syndrome
dry eye - pilocarpine
- cholinergic agonist binds to muscarinic receptors and improves tear function - sjogren's syndrome - ADE: sweating - CI: uncontrolled asthma
digoxin: toxicity - predisposing drugs
- clarithromycin - erythromycin - amiodarone - itraconzole - cyclosporine - verapamil - quinidine
dry eye: basic info
- common problem involving bilateral disruption of tear film on ocular surface - increases with age - intermittent or chronic - increased risk of infection
aldosterone antagonist: monitoring
- confirm SCr < 2.5 mg/dl or CrCl > 30 ml/min and K+ < 5 meq/l - measure K+ and renal fxn at baseline and 1 week - then every month for first 3 months, then every 3 months - stop potassium supplements and avoid high K+ foods - restart supplement if K < 4 meq/l
treatment of HFpEF
- control BP (ACE/ARBS, beta blockers) - diuretics for relief of symptoms - may need revascularization in CAD/angina/MI
Stage A HF treatments
- control HTN and lipid disorders - add an ACEI/ARB
POAG: combo therapy
- cosopt (timolol and dorzolamide) - combigan (brimonidine and timolol) - simbrinza (brinzolamide and brimonidine)
goals for treatment of HF
- decrease morbidity/mortality - decrease symptoms - decrease hospitilizations
dry eye - causes
- decreased tear production - excessive tear evaporation - abnormal production of mucus or lipids in tear layer - decreased tear secretion -> inflamm response
conjuctivitis - basic info
- diffusely red eye - purulent or serous discharge - itching, stinging or scratching, foreign body sensation - types: bacterial, fungal, parasitic, viral or allergic
HFrEF: basic info
- ejection fraction < 40% - LV systolic dysfunction - CAD and MI major cause
HFpEF: basic info
- ejection fraction >50% - older women with a history of HTN - obesity, CAD, DM, A fib, hyperlipidemia - cause is HTN - diastolic dysfunction
goals for patient education of HF
- explain importance of meds - keep daily weights - home BP monitoring - weight gain: up to 2-3 lb/day or 5 lb/week IS OKAY
beta blockers: adverse effects
- fatigue - bradycardia - 2nd/3rd degree AV block - fluid retention - acute HF - hypotension - acute exacerbations of bronchospasm - cold extremities (raynaud's, intermittent claudication) - blunting symptoms of hypoglycemia
ACEI: indications
- for pts with HFrEF - reduce morbidity and mortality
hyperacute bacterial conjunctivitis
- gonococcal infection in sexually active patients - caused by n. gonorrhoeae or n. meningitidis - requires IM ceftriaxone (rocephin) - use cipro or ofloxacin if allergic to cephalosporins - topical therapy not necessary but often used
glaucoma - basic info
- group of diseases irreversibly damaging the optic nerve resulting in visual field loss - 2nd leading cause of blindness worldwide - increased intraocular pressure (IOP) is most common risk factor
isosorbide dinitrate: adverse effects
- headache - hypotension - tolerance
stye - treatment
- hot, moist compress 10-15 minutes 2-4x daily for several days - topical abx (bacitracin or erythromycin ointment - for stye that persists)
dry eye - non pharm therapy
- humidifier -breaks from computer or reading - lower computer level to below eye level - evaluate meds that may be exacerbating dry eye
hydralazine and isosorbide dinitrate: MOA/info
- hydralazine: artery dilation - isosorbide: vein dilation - reduce morbidity and mortality in blacks with class II-IV HFrEF on optimal therapy with ACE and beta blockers
diuretics: adverse drug effects
- hypokalemia - hypomagnesemia - hypocalcemia - hyperuricemia - hyperlipidemia - lithium toxicity - ototoxicity - rashes
digoxin: toxicity - predisposing factors
- hypokalemia - hypomagnesemia - hypothyroidism - hypercalcemia - advance age - alkalosis - renal dysfunction
infectious conjunctivitis - pt education
- improvement of symptoms in 48 hrs - NO follow up - no improvement in 48 hours - refer - wash hands - bacterial contagious for 48 hours after start of therapy - viral contagious for up to 14 days
stye
- infection of hair follicles or sebaceous glands of eyelids - caused by staph aureus
blepharitis
- inflammation of eyelid margin -types: *bacterial blepharitis *meibomian gland dysfunction (MGD) blepharitis *seborrheic blepharitis
allergic conjunctivitis - mast cell stabilizers MOA
- inhibit hypersensitivity reactions and prevent the accompanying increase in cutaneous vascular permeability - prescription only
intraocular pressure
- inner pressure of the eye - balanced by aqueous humor production and outflow - maintains curvature of the cornea - tonometry test is used to measure: IOP 10-20 mmHg=normal, IOP > 22 mmHg=suspect glaucoma
allergic conjunctivitis - symptoms & what happens
- itching - tearing - conjunctival swelling - nasal congestion - first site of contact with environmental allergen - mast cell degranulation, histamine release
POAG: prostaglandin analogs - types
- latanoprost, travoprost (preservative free), bimatropost (latisse) tafluprost (preservative free), unoprostone
drugs in HF that decrease symptoms
- loop diuretics - digoxin
allergic conjunctivitis - topical steroids - types
- loteprednol (only one FDA approved) - prednisolone - dexamethasone - fluoromethalone - rimexolone - difluprednate
POAG: prostaglandin analogs side effects
- minimal systemic side effects - local rxns: conjuctival hyperemia, stinging, increase in iris pigment, eyelash lengthening, thickening, darkening of eyelids
viral conjunctivitis basic info
- most common cause is adenovirus - pink eye - present with an upper resp infection or recent exposure - begins in one eye and spreads - self limited - gets worse after 4-7 days, but resolves in 2-4 weeks
bacterial conjunctivitis: chlamydia trachomatis infection
- most common cause of neonatal conjunctivitis - prophylaxis: erythromycin ointment for neonates - DOC: macrolides (azithromycin, erythromycin)
primary open angle glaucoma (POAG) - basic info
- normal anterior chamber angles - DECREASED OUTFLOW (aqueous humor outflow from anterior chamber) - because of degenerative process in trabecular meshwork
aldosterone antagonists: indications
- nyha class II-IV who have LVEF of 35% or less - class II people should have history of prior cardiovascular hospitalizations or elevated BNP plevels - creatinine should be < 2.5 mg/dl in men and < 2.0 mg/dl in women - GFR >30 ml/min - K+ < 5.0 meq/l - monitor K, renal function, diuretic dosing - reduce morbidity and mortality - use after acute MI with LVEF or 40% of less with symptoms of HF or DM
POAG - presentation
- onset is gradual - usually asymptomatic - early stage: defect in visual field - late stage: loss of peripheral vision - some patients have normal-tension glaucoma
dry eye - artificial tears and lubricants
- palliative therapy - increase humidity - contain lipids, salts, proteins, and mucin - OTC drops, gels, and ointments (normal saline, methylcellulose, hydroxypropyl) - preps with preservatives for use 3x daily. use preservative free if need to use more often - preservatives cause AE: reduction of desired effects, allergic response, toxin rxn
bacterial conjunctivitis - ocular abx
- polymyxin B/trimethoprim: ointment - aminoglycosides - tobramycin: ointment - macrolides - azithromycin (durasite carrier, increases retention time on ocular surface) - fluoroquinolones: (don't know individual names) * moxifloxacin (vigamox, moxega) and preservative free options *gatifloxacin (zymar, zmaxid) *besifloxacin *cipro - ointment, generic *ofloxacin - generic
POAG - treatment goals
- prevent further loss of visual fxn - minimize adverse effects of therapy - maintain IOP at or below pressure where further damage is unlikely - educate and involve patient - alter flow and production of aqueous humor
viral conjunctivitis non pharm therapy
- prevent spread of infection - don't share stuff! - avoid close contact with ppl - avoid swimming for 2 weeks - decontaminate stuff - symptomatic relief with cold compress and artificial tears
aqueous humor
- produced by the ciliary body through the diffusion and ultrafiltration of plasma - secreted into posterior chamber - flows through pupil into anterior chamber - provides O2 and nutrition to avascular lens and cornea - 80% of aqueous humor exits ant. chamber through trabecular meshwork - drains into shlemm's canal - other 20% drains through uveoscleral outflow
blepharitis - oral antibiotics
- rare cases of staph blepharitis that don't respond to topical therapy - secondary infections of meibomian glands - tetracyclines for atleast 6 weeks (erthromycin and minocycline as alternatives)
diuretics: basic info
- recommended for HFrEF who have fluid retention! - decrease JVD, improve cardiac function, pulmonary congestion, and peripheral edema - never use as only therapy for HF - initiate and adjust to a result in 1-2 lb of weight loss/day (monitor) - monitor and replace K and Mg (goal: K=4.0meq/l or higher, Mg=2.0 meq/l or higher) - loop diuretics= retain efficacy with decreased renal function - can combine loop and thiazide for synergy - once effect is achieved - increase frequency to 2-3x/day rather than increasing a single dose - use torsemide instead of of furosemide if poor absorption or erratic effect - IV may be necessary - furosemide: 20-40 mg once or twice
allergic conjunctivitis - topical steroids basic info
- reduce inflammation - low dose for 1-2 weeks - no improvement in 48 hours - D/C - limited to acute symptoms - long term use leads to ocular HTN, cataracts, glaucoma, infection - wait 15 min before contacts
beta blockers: indications & MOA
- reduce mortality with HFrEF - blocks effect of norepi and sympathetic neurotransmitters on heart and vascular system - decreases vent. arrhythmias - decreases cardiac hypertrophy and cardiac cell death - decreases vasoconstriction and HR
allergic conjunctivitis - non pharm therapy
- removal and avoidance of allergen - cold compress 4x daily
dry eye - opthalmic cyclosporine
- retasis emulsion - cyclosporine emulsion increases aqueous tear production and decreases ocular irritation - MOA: prevents T cells from activating and releasing cytokines that incite inflammatory response in dry eye - SE: burning, hyperemia, discharge, itching, blurred vision - CI: active ocular infection
ACEI: dosing considerations
- start low and increase/double every 1-4 weeks till target dose - catopril - short acting ACEI used to up-titrate in hospital - don't use fosinopril and quinapril
Stage C HF treatments
- start with ACEI/ARB and beta blocker - then add diuretic.... 1. volume overload (class II-IV) -> add loop diuretic 2. persistently symptomatic African Americans (class III-IV) -> add bidil (hydral-nitrates) 3. creatinine > 30 ml/min and K+ <5.0 mEq/dl and class II-IV -> add aldosterone antagonist
blepharitis - conservative treatment
- strict hygiene with eyescrub, ocusoft or 1:1 mix of baby shampoo and water - warm compresses QD - MGD: eyelid massage after warm compress to remove excess oil - qd or several times/day - selenium anti-dandruff shampoo for seborrheic blepharitis
hydralazine: adverse effects
- tachycardia - tachyphylaxis - SLE - dermatitis - drug fever - peripheral neuropathy - hepatitis - vascular headaches - GI symptoms VIAGRA - CI
POAG: non selective betablockers
- timolol: most commonly prescribed! - timolol gel forming solution - levobunol - metipranolol - may cause burning/stinging - cartelol (partial agonist activity)
herpes zoster conjunctivitis - treatment
- topical abx/steroid combos to reduce risk of 2ndary infection/decrease inflammation - systemic antiviral treatment (acyclovir, valacyclovir, famiclovir) - started within 72 hours of first signs (oral meds)
viral conjunctivitis: pharm therapy
- topical antivirals not used to treat adeno - avoid abx - refer pts who don't get better in 10 days to opthalmologist to rule out herpes - also refer if pain or photophobia
ocular emergencies
- traumatic injuries - splash injuries/ chemical exposure - loss of vision - flashes of light - pain - photophobia - blurred vision - diplopia - ocular hemorrhages -nystagmus - pupil diosrders
when do you add melatazone?
- when you already have an ACE + BB and are maxed out on loop -> take melatazone 30 min before their loop
when should you start on bidil?
- when you max out on loop and you are an African-American
dry eye - exacerbation
- wind - reduced humidity - cig smoke - air conditioning - antihistamines - diuretics - anticholinergic - antidepressants - statins - systemic retinoids
Goal of Antiarrhythmic Activity
-*Depress automaticity in abnormal pacemaker cells* by decreasing the slope of phase 3 repolarization and elevating the threshold potential -*Alter conduction pathways* by eliminating critically timed premature impulses that trigger re-entry and slowing the conduction velocity so abnormal conduction is eliminated -*Reverse heart disease responsible* for conduction abnormalities that led to the arrhythmia ("Reverse Remodeling")
INR target
-2.5
when do you check aPTT with UFH
-6 hours after initial loading dose
Renal toxicities
-Aminoglycosides -Vancomycin -Colistin
reversal of direct Xa inhibitors oral
-Anedexant (Annexa-4) (soon available)
what are the best options of statins to use in patients with chronic renal insufficiency
-Atorvastatin 10-80 mg/day -Pravastatin 10-80 mg/day
Skin toxicities
-Azithromycin -FQs -TCNs -Bactrim
what proteins are natural anti-clotting factors that are dependent on Vitamin K
-C & S
second generation cephalosporins
-Cefoxitin (Mefoxin) IV -Cefotetan (Cefotan) IV The "tan fox" eat anaerobes -cover gram + and anaerobes
Indirect Factor Xa Inhibitor can be used in
-DVT/PE treatment -VTE prophylaxis following orthopedic or abdominal surgery -HIT (off label)
atypical coverage
-Fluroquinolones -Macrolides/Ketolides -Tetracyclines -Tigecycline (kill you) -Chloramphenicol (super rare)
anticoagulants of choice during pregnancy
-Heparin-related compounds (UFH, LMWH) -DTI (category B; limit to those with rxn to heparin or have HIT) -fondaparinux (reserve for HIT)
niacin dose over 2000 mg/day should check LFTS when?
-LFTs at baseline, then q - 6-12 wks for 1st year, then q 6 months
although monitoring is not required for LMWH, you should still check::
-Monitor CBC every 5 to 10 days during the first 2 weeks (2 to 4 weeks thereafter) -also check serum creatinine
Hematologic toxicities
-Nafcillin -Piperacillin/tazobactam -Cefotetan -Chloramphenicol -TMP -Linezolid
HIT: treatment
-Once HIT diagnosis is established or suspected, discontinue all sources of heparin -initiate alternative anticoagulant -do not use oral drugs initially
isomers of warfarin
-R (metabolized by P45-3A4) -S (metabolized by P450-2CP)
Direct Xa Inhibitors: Oral
-Rivaroxaban (Xarelto) -Apixaban (Eliquis)
problematic organisms due to having different MOAs
-Serratia -Pseudomonas -Acinetobacter -Citrobacter -Enterobacter
clinical use of omega-3 fatty acids
-TG lowering -effective when TG>500
what is the best anticoagulant for kidney patients?
-UFH
anticoagulants of choice while breastfeeding
-UFH and LMWH considered safe -warfarin
warfarin FDA-approved indications
-VTE prevention and treatment -prevention of thromboembolic complications associated with a-fib, heart valve replacement, MI
Ear toxicities
-Vancomycin -Aminoglycosides
Hospital-acquired MRSA coverage
-Vancomycin -Linezolid -Daptomycin -Dalfopristin/quinupristin -Televancin -Dalbavancin -Tedezolid all are available IV
UFH monitoring
-aPTT
contraindications of niacin
-active liver disease -active peptic ulcers
factors increasing sensitivity to warfarin?
-age older than 75 years -clinical hyperthyroidism -diarrhea -drug-drug interactions -elevated baseline INR -fever -know CYP2C9 variant
cause diarrhea/colitis
-all antibiotics can cause -*Clindamycin -*FQs (these 2 are associated with C. diff)
host factors that play a role in antibiotic selection
-allergies: adverse vs true allergic rxns -age -pregnancy: fetus at risk; altered pharmacokinetic disposition -metabolic or genetic variation -organ dysfunction: kidneys or liver -concomitant drugs: drug interactions -concomitant disease states
long-term UFH adverse effects
-alopecia -priapism -suppressed aldoseterone synthesis with subsequent hyperkalemia
VRE coverage
-ampicillin (DRUG OF CHOICE) -linezolid (commonly used) -daptomycin (commonly used) -ampicillin/sulbactam -Dalfopristin/quinupristin -Tedezolid -Chloramphenicol
what is HAT
-benign, transient, mild -generally occurs within the 1st few days of treatment in heparin-naive patients
warfarin adverse effets
-bleeding -Purple toe syndrome (rare) -Teratogencitiy
adverse effects of LMWH
-bleeding (most common) -thrombocytopenia, avoid with HIT history/dx
Fonaparinux: Adverse Effects
-bleeding (primary) -NOT associated with HIT
first generation cephalosporins
-cephalexin (Keflex) PO -cefadroxil (Duricef) PO -cefazolin (Ancef) IV often used for surgical prophylaxis; only gram +
what two drugs are available PO for pseduomonas coverage
-ciprofloxacin -levofloxacin
Community-acquired MRSA coverage
-clindamycin -doxycycline -SMX/TMP (Bactrim) -Linezolid -Tedezolid -Ceftraroline all are available PO
contraindications of bile acid sequestrants
-complete biliary obstruction
red yeast rice
-contains lovastatin -lack of regulatory oversight and quality control
direct thrombin inhbitors: oral DTIs
-dabigatran etexilate (Pradaxa)
examples of LMWH
-dalteparin -enoxaparin -tinzaparin
high vitamin k foods
-dark leafy green vegetables -protein shakes/supplements -mayo
primary prevention
-diabetes -CKD
when major bleeding occurs with UFH you should
-discontinue UFH immeadiately -administer IV protamine sulfate
why do antimicrobials sometimes fail
-drug selection -host factors -microorganism resistance
diagnostic tests of DVT
-duplex ultrasonography (most common) -venography or phelbography (gold standard)
nonpharmacological measures for prevention of venous stasis
-elastic compression stockings (fitted) -leg elevation -leg exercises -early postoperative ambulation -IPC of the leg muscles -IVC filters/Greenfield filters
adverse drug reactions of statins
-elevated LFTs - myalgias -rhabdomyolysis
laboratory tests of DVT
-elevated serum D-dimer concentration -elevated erythrocyte sed rate -WBC count elevation
types of LMWH
-enoxaparin (Lovenox) -Dalteparin (Fragmin)
monitor of statins
-fasting lipid profile 6-8 weeks after initiation -routine periodic monitoring of liver enzymes no longer recommended: check before starting and as clinically indicated thereafter -if CPK elevation is moderate or severe, or if rhabdo occurs, statin therapy should be discontinued
what are the TG lowering drugs?
-fibrates -omega-3 fatty acids -niacin
adverse drug reactions of omega-3 fatty acids
-fishy taste/burping; dyspepsia: less common with Lovaza -antiplatelet effect
antibiotics not recommended in pregnancy
-fluoroquinolone -chloramphenicol -tetracyclines
niacin adverse drug reactions
-flushing and itching -elevated LFTs less - less with immediate release -induce hyperurecemia - avoid with history of gout -myopathy - especially with concomitant statin
indirect factor Xa inhibitor (synthetic pentasaccharide)
-fondaparinux
adverse drug reactions of fibrates
-gi upset is most common -can have LFT elevations, myopathy
what does erythromycin cover
-gram + -some gram - -atypicals
what does fidaxomicin cover
-gram + and c. difficle (anaerobe)
with anticoagulants you should regularly monitor ____
-hemoglobin (primary) -hematocrit (primary) -BP (secondary)
HIT diagnosis based on laboratory findings
-heparin antibody formation -platelet activation
antithrombotic agents
-heparins -indirect factor Xa inhibitor -vitam k antagoinst -oral direct thrombin inhbitors -direct Xa inhibitors:oral Xa inhibitors
host factors causing antimicrobials to fail
-immunosuppression -need for surgical intervention
drug selection causing antimicrobials to fail
-inappropriate drug, dose, or route -malabsorption (like taking drug w/ antacids) -metabolism changes/drug interactions
clinical use of niacin
-increases HDL 15% to 35% -lowers LDL and TG as well -consider 2nd line after statin therapy or as add-on to statin therapy
smoking/tobacco use and warfarin
-induce CYP1A2 > warfarin dosing, chew tobacco may contain vitamin K
Cilostazol (Pletal): antiplatelet
-inhibitor of phosphodiesterase 3. -uses: primarily intermitted cladication
Factor Xa inhibitor: oral MOA
-inhibits platelet activation and fibrin clot formation via direct, selective and reversible inhibition of factor Xa -Xa catalyzes the conversion of prothrombin to thrombin
clinical uses of statins
-inhibits platelet aggregation -reduces vascular inflammation -stabilizes atherosclerotic plaques
niacin initial dose
-initial dose of 500 mg at bedtime preceded by 325 mg of aspirin, 200 mg of ibuprofen, or other nsaid 30 mins. before to minimize flushing
microorganism resistance causing antimicrobials to fail
-intrinsic: antibiotic never had activity against bacterial species acquired: antibiotic originally active, but bacteria changed genetic makeup so drug is no longer effective (alteration of target site, change in membrane permeability, efflux pump, drug inactivation)
DTI: Lepirudin
-irreversible thrombin inhibitor -renal elimination; adjust dose for renal impairment -up to 60% of patients treated with lepirudin >/= 10 days develop antibodies -monitor aPTT with prolonged therapy
Aspirin: anti-platelet
-irreversibly inhibits cyclooxygenase and thromboxane A2 -doses range from 50-325 mg
contraindications of simvastatin
-itraconazole -ketoconazole -clarithromycin -gemfibrozil
clincial use of Ezetimibe
-ldl lowering
niacin: help with flushing and itching
-less common wit controlled-release preparations -food, asprin 30 mins prior, night time admin, and slow dose titration can improve
amiodarone with statins
-limit statin doses -simvastatin 20 mg/day
clinical use of bile acid sequestrants
-lowers LDL; may raise TG -almost last line for LDL lowering due to tolerability issues and drug interactions
inhibition of protein synthesis
-macrolides/ketolides -lincosamide -streptogramin -oxazolidinones -chloramphenicol -aminoglycosides -tetracyclines -glycylcycline -polymixins -nitrofurantoin (macrobid)
FDA recommendations for statins
-maintain patients on simvastatin 80 mg/day only if on this dose more than 12 months w/out evidence of muscle toxicity. -do NOT initiate new patients on simvastating 80 mg/day -START new patients on simvastatin 40 mg/day
clinical use of fibrates
-may raise LDL as lowers TG
warfarin requires continuous monitoring and patient education due to
-narrow therapeutic index -many food & drug interactions
pencillins can be:
-natural -anti-staphylococcal -aminopencillins -anti-pseudomonal
Inhibitors of DNA synthesis
-nitroimidazoles -fluorquinolones
blood cultures
-obtain from peripheral sites at two sets (aerobic and anaerobic) from two different sites approx. one hour apart -determine if organism is true pathogen, contaminant, or normal flora
omega-3 fatty acids
-otc -or RX: Lovaza
VTE treatment general principles of thearpy
-parenteral anticoagulants therapy should be overlapped with warfarin for at least 5 days and until the INR is >2 and stable to allow enough time to reach its full effect
antibiotics that should be renally adjusted for decreased kidney function
-penicillins -cephalosporins -carbapenems: -vancomycin -aminoglycosides -polymixins
CNS toxicities
-penicillins -cephalosporins -imipenem/cilastatin -FQs
Pseudomonas coverage
-piperacillin/tazobactam -ceftazidime -ceftazidime/avibactam -ceftolozane/tazobactam -Cefepime -Aztreonam -Meropenem -Imipenem/cilastatin -Doripenem -Gentamicin -Tobramycin -Amikacin -Colistimethate -Ciprofloxacin (available PO) -Levofloxacin (available PO)
what 2 statins are metabolized different than the rest of the statins
-pravastatin -rosuvastatin
advantages of LMWH over UFH
-predictable anticoagulation dose response -longer half-life -lower incidence of thrombocytopenia -reduced need for laboratory montioring
LMWH: pharamaokinetics
-predominantly renal elimination -bioavailability: ~ 100% when administered SQ -half life: 2 to 4 times longer than UFH
warfarin disease interactions
-pregnancy -alcoholism -liver disease -nutritional status -smoking and tobacco use -fever -diarrhea
contraindications of statins
-pregnancy (X) -active liver disease
Aspirin uses
-prevention and treatment of MI, acute ischemic stroke, and TIA, adjunctive therapy in revascularization proceudres
UFH adverse effects
-primary: bleeding -thrombocytopenia: common
Thienopyridine: anti-platelet
-pro-drug that is metabolized to active form and irreversibly blocks P2Y12 -reduces rate of atherothrombotic events in patients with recent MI or stroke or established PAD
DTI: argatroban
-prophylaxis/treatment of thrombosis with HIT -inhibits clot-bound and soluble thrombin: dose adjustment required for hepatic impairment
warfarin ABSOLUTE contraindications
-recent hemorrhagic stroke -pregnancy (first trimester)
dosing and monitoring of bile acid sequestrants
-requires 3-20 grams/day -can bind many drugs (separate by 2 hrs prior or 4-6 hrs after admin of BAS) -colesevelam does not seem as likely to have these interactions
DTI: Bivalirudin
-reversible thrombin inhibitor; transient antithrombotic activity -dose adjust in renal impairment -FDA approved indication: patients with unstable angina undergoing percutaneous transluminal coronary angioplasty
Ticagrelor: antiplatelet
-reversibly and noncompetively binds ADP P2Y12
direct Xa inhibitors:oral Xa inhibitors
-rivaroxaban (Xarelto) -apixaban (Eliquis) -edoxaban (Savaysa)
what are the exceptions for administration
-rosuvastatin (crestor) -atorvastatin (lipitor) due to having long half-lives
Fondaparinux Pearls
-safe in elderly -pregnancy category B -no antidote -does not interact with platelets
what is HIT
-serious -requires immediate intervention
adverse effects of DTI
-serious hemorrhage -minor bleeding
contraindications of fibrates
-significant renal (CrCl <15 ml/min;dialysis) or hepatic dysfunction -gallbladder disease or biliary cirrhosis
adverse drug reactions of ezetimibe
-some complaints of fatigue, abdominal pain, diarrhea, and back pain
what does azithromycin cover
-some gram + -some gram - (active against H. influenza) -atypicals
Indirect Factor Xa Inhibitor MOA
-specifically but reversibly binds antithrombin -selectively inhibits factor Xa activity (prevents thrombus generation and clot formation) -NO effect on platelet function
what are the ldl lowering drugs?
-statins -niacin -ezetimibe -bile acid sequestrants
anticoagulants (besides warfarin) before procedures
-stop 2 - 3 days before procedure -restart 24-48 hours after procedure
missed dose of Pradaxa
-take on the same day asap; skip the missed dose if it cannot be taken at least 6 hrs before next scheduled dose
Presence of concomitant bleeding risk increase risk of UFH-induced hemorrhage
-thrombocytopenia -use of other antithrombotic therapy -preexisting source of bleeding
VTE treatment
-treat VTE quickly & aggressively -assessment of patient's status should focus on search for risk factors
heparins
-unfractionated heparin (UFH) -low molecular weight Heparins (LMWH)
DTI: desirudin
-used for VTE prophylaxis in patients undergoing elective hip surgery -reduce dose in moderate to severe renal impairment
vitamin k antagonist
-warfarin
Inhibition of cell wall synthesis
-β-lactam Antibiotics -glycopeptides /lipoglycopeptides -cyclic lipopetide
digoxin: plasma concentration
.125 - .25 mg/day .5-1mcg/L for HF
CHAD2DS2-VASC score: 1. score of __: no antithrombotic therapy OR aspirin 75-325 mg/day
0 (zero)
bimatoprost
FDA cosmetic use lattisse
what drugs can effect warfarin/INR levels (increase)
FFAAB 5 F-Q's F-lagyl A-miodarone A-zole fungals B-actrim
__ impact 3A4 which can increase INR
FQs
F F A A B
FQs Flagyl (metro) Amiodarones Azole-fungals Bactrim
2. __: diffusion: high to low conc. via specific protein (channels)
Facilitated
__ __ __: inhibit platelet activation and fibrin clot formation via direct, selective and reversible inhibition of factor Xa in both intrinsic and extrinsic pathways
Factor Xa Inhibitors
__ __ __: some drugs given orally are metabolized by the liver before they are given a chance to get into systemic circulation
Fast Pass Metabolism
What is a key barrier to action?
Fear
6. __: increased catabolism of clotting factors, increases INR, so you need to decrease dosage of warfarin
Fever
Class 1c Agents: 1. __: only available PO. Can cause taste disturbances, dizziness, impaired AV conduction (possibly) 2. __: taste disturbances, dizziness, impaired AV conduction (possibly) *good for young patients suffering arrhythmia that don't have any other heart problems. Don't have to monitor.
Flecainide Propafenone
__ can be used in the treatment of HIT
Fondaparinux
__ has no antidote, does not interact with platelets, safe in elderly patients
Fondaparinux
__ is contraindicated in severe renal dysfunction
Fondaparinux
__: an injectable form of Xeralto. Tis a factor Indirect Xa inhibitor. Alternate to heparin and lovenox. Greatly underused. Cannot use alone for a PCI because there is an increased risk for catheter thrombosis
Fondaparinux
Indirect Factor Xa Inhibitor drug name
Fondaparinux (Arixtra)
vitamin K
Foods high in ___ decrease the amount of warfarin
thiazide diuretics or DHP CCB
For African Americans, what drug class is recommended in the treatment of HTN?
low
For elderly patients, should treatment doses initially be high or low compared to the rest of the population?
ACEI
Fosinopril (Monopril) is an example from what drug class?
What are the signs/symptoms of sensitivity to the sun from rifampin?
Frequent sunburn (minor)
___ __ __: contains all coagulant factors in diluted form
Fresh Frozen Plasma (FFP)
Loop diuretics
Furosemide (Lasix) is an example from what drug class?
3. _-__ coupled receptors: generate intracellular second messengers -very commonly used by drugs ex: insulin and cytokines
G-protein
eplerenone dosing
GFR > 50: 25 mg once daily - target 50 mg once daily GFR 30-49: 25 mg once every other day - target 25 mg once daily
spironolactone dosing
GFR >50: 12.5-25 mg once daily - target 25 mg once or twice daily GFR 30-49: 12.5 mg once daily/every other day - target 12.5-25.0 mg once daily
adverse drug reactions of bile acid sequestrants
GI - constipation and obstruction
Types of Drug Receptors: 1. __ __ channels: 2. __ receptors: 3. _-__ Coupled Receptors: 4. __ receptors:
Gated Ion gated Transmembranous G-protein Intracellular
__: liver enzyme activity, concurrent disease states
Genetic
Patient Variables 1. __ 2. __ 3. __ 4. __ background 5. __ and __
Genetics Age Sex Racial Diet/Nutrition
4. __: maintain at below 180 mg/dL
Glucose
Tirofiban
Glycoprotein IIb/IIIa inhibitors:
___: can cause hypoTN, bleeding and Thrombocytopenia. They stick around for forever. Adjust dose for renal function.
Glycoprotein IIb/IIIa inhibitors:
abciximab
Glycoprotein IIb/IIIa inhibitors:
eptifibatide
Glycoprotein IIb/IIIa inhibitors:
Drugs need to be like __
Goldilocks
What is mycobacterium tuberculosis?
Gram positive acid fast bacillus
Monitoring of Amiodarone
Ground Glass CXR
Alpha-2 agonists
Guanfacine (Tenex) is an example from what drug class?
__ __ __: benign, transient, milkd. Generally recover
HAT (heparin associated thrombocytopenia)
Bivalirudin (DTI). Good to use if patient has __
HIT
__ __ __: serious. Requires IMMEDIATE intervention. Antibody mediated adverse affect
HIT (heparin-induced thrombocytopenia
What is the strongest known risk factor for developing TB disease?
HIV
TB is the leading cause of death for people with?
HIV/AIDS
3. __ management
HTN
__ __: the amount of time required for total amount of drug in the body or the plasma drug concentration to decrease by one-half
Half life
Amiodarone Dosing
Half life: 40-60 days (iodine component) For cardioversion: 150 mg IV infused over 10 minutes For NSR: 900 mg IV titration over 24 hrs Maintenance dosage: 200-400 mg PO BID Onset of Action: PO: 2 days - 3 weeks IV: more rapid
Class 1: Sodium Channel Blockers
Has 3 subclasses 1a: Intermediate (Audi) 1b: Fast (Buggatti) 1c: Slow (Chrysler) Subclasses are more about how long they block the channel Rhythm Control
Amiodarone
Has characteristics of all of the classes and its major effect is prolonging repolarization
Kinetics of Amiodarone
Has lipophilic iodine component which allows it to stay in the tissues for longer (6 mg in every 200 mg pill) Inhibits metabolism pathways: 1A2 2D6 2C9 3A4 PgP
2. __ stroke: about 13% of strokes are caused by this
Hemorrhagic
HIT: Therapeutic Outcomes: -__ should be avoided for at least 3-6 months
Heparin
what does HIT stand for?
Heparin-Induced Thrombocytopenia
__ and __ are perfectly fine in breastfeeding
Heparins Warfarin
May decrease the inflammation causing headache, nasal congestion, and facial pain
How do intranasal corticosteroids help acute bacterial sinusitis?
Decrease viscosity of nasal secretions
How do mucolytics help acute bacterial sinusitis?
Reduce inflammation by vasoconstriction
How do nasal decongestant sprays help acute bacterial sinusitis?
May aid in nasal/sinus patency
How do oral decongestants help acute bacterial sinusitis?
Increase mucociliary and cough clearance
How do oral or inhaled bronchodilators help chronic bronchitis?
(1) Reduce patient's exposure to known bronchial irritants (2) Mucolytic aerosols (3) Oral or inhaled bronchodilators (4) Oral or inhaled corticosteroid (5) Antibiotics
How do you approach therapy in chronic bronchitis?
INR
How do you monitor warfarin?
Refer to specialist
How do you treat complicated acute bacterial sinusitis?
Antibiotics
How do you treat uncomplicated acute bacterial sinusitis?
decrease vit K production
How does broad spec antibiotics effect INR
Increases mucosal moisture
How does irrigation of the nasal cavity help acute bacterial sinusitis?
mg/wk
How is Warfarin dosing reported
Vasodilators
Hydralazine (Apresoline) is an example from what drug class?
Thiazide diuretic
Hydrochlorothiazide (HCTZ) (Hydrodiuril) is an example from what drug class?
__: attraction of H+ to an electronegative atom
Hydrogen
Stage C is correlated with what NYHA classes?
I-III
_ _ _ _ has no effects on platelets
IFXI
__ __ __ __: can be used in HIT
IFXI
_ _ _ _: MOA: specifically but reversibly binds to antithrombin. Selectively inhibits factor Xa activity
IFXI (Fondaparinux)
__ __ is discouraged with heparin (could bring about a large hematoma formation)
IM
__: in general, absorption is increased
IM
POAG: prostaglandin analogs - MOA
INCREASE outflow of aqueous humor through the uveoscleral pathway FIRST LINE!!
make sure your patients come back for _ _ _ testing
INR
2-3
INR that you are trying to obtain with Warfarin therapy, noted that full antithrombin effect is not achieved for 7-15 days after initiation
ocular hypertension
IOP>21 mmhg normal visual fields normal optic disk
Drugs given __ are 100% bioavailable
IV
UFH is the only one you can give __ __
IV
__ __: neutralizes UFH in 5 minutes. Actively persists for 2 hrs.
IV Protamine
what is the direct antidote of UFH
IV protamine sulfate 1 mg per 100 units of UFH (maximum 50 mg) slow IV infusion over 10 min -neutralizes UFH in 5 min -activity persists for 2 hours
CCB
If a patient has heart failure, what drug class would you not start them on for HTN?
hypoglycemia
If a patient is on a beta blocker can it mask the symptoms of hypo or hyperglycemia?
angioedema
If a patient is on an ACEI and their lips swell, what is the name of this adverse reaction?
Drug-Drug Interactions: 1. Daltiazem (__) 2. Digoxin 3. Verapamil (__) 4. Amiodarone (__)
Impact cypP450 -inhibitor - -inhibitor -inhibitor
(1) Previously healthy patients who exhibit persistent fever and respiratory symptoms for > 4-6 days (2) Predisposed patients
In acute bronchitis, when would you consider antibiotic therapy?
500mg TID X 10 days
In acute pharyngitis, what is the adult dose for Amoxicillin?
500mg BID X 10 days
In acute pharyngitis, what is the adult dose for Penicillin vk?
20-25mg/kg BID x 10 days
In acute pharyngitis, what is the pediatric dose for Amoxicillin?
17mg/kg TID X 10 days
In acute pharyngitis, what is the pediatric dose for Penicillin vk?
Respiratory FQ β-lactam/β-lactamase inhibitor Add empiric coverage for P. aeruginosa
In chronic bronchitis, what do you prescribe for a patient who has symptoms with risk factors and hospitalization?
2nd generation macrolide 2nd/3rd gen cephalosporin Doxycycline Amoxicillin SMX/TMP
In chronic bronchitis, what do you prescribe for a patient who has symptoms with risk factors, but hospitalization is unlikely?
2nd generation macrolide 2nd/3rd gen cephalosporin Doxycycline Amoxicillin SMX/TMP
In chronic bronchitis, what do you prescribe for a patient who has symptoms without risk factors?
500-875mg BID or TID X 5-7 days
In chronic bronchitis, what is the dose for Amoxicillin/clavulanate?
250-500mg daily X 5-7 days
In chronic bronchitis, what is the dose for Azithromycin?
100mg BID X 5-7 days
In chronic bronchitis, what is the dose for Doxycycline?
500-750mg daily X 5-7 days
In chronic bronchitis, what is the dose for Levofloxacin?
400mg daily X 5-7 days
In chronic bronchitis, what is the dose for Moxifloxacin?
250-500mg BID
In the treatment of acute bacterial sinusitis, what is the adult dose of Cefprozil?
Low dose: 500/125mg TID High dose: 2g/125mg BID
In the treatment of acute bacterial sinusitis, what is the adult dose of amoxicillin/clavulanate?
Low dose: 500mg TID High dose: 1g TID
In the treatment of acute bacterial sinusitis, what is the adult dose of amoxicillin?
7.5-15mg/kg BID
In the treatment of acute bacterial sinusitis, what is the pediatric dose of Cefprozil?
Low dose: 15mg/kg (amox) TID High dose: 45mg/kg (amox) BID
In the treatment of acute bacterial sinusitis, what is the pediatric dose of amoxicillin/clavulanate?
Low dose: 15mg/kg TID High dose: 45mg/kg BID
In the treatment of acute bacterial sinusitis, what is the pediatric dose of amoxicillin?
Patients who are symptomatic for < 48 hours
In which patients are neuraminidase inhibitors effective?
In latent TB infections, tubercle bacilli in the body are?
Inactive (contained)
Inotropes
Increase contractility (think strength = Iron Man) Beta Blockers are negative inotropes
Thiazide diuretic
Indapamide (Lozol) is an example from what drug class?
Fondaparinux
Indirect factor Xa Inhibitor (synthetic Pentassacharide)
The number of deaths due to healthcare harm double when you include ____
Infections from hospitals
(4) __: via the respiratory system
Inhalation
__: rapid absorption due to large surface area
Inhalation
What is the MOA for Rifampin?
Inhibits DNA-dependent RNA polymerase of mycobacteria
What is the MOA for ethambutol?
Inhibits RNA synthesis impairing cell metabolism & multiplication; disrupts formation of cell wall
What is the MOA for isonicotinic acid hydrazide (INH)?
Inhibits synthesis of mycolic acids (essential components of mycobacterial cell walls)
80-100 units/kg, max 10,000 units
Initial (bolused) loading dose of UFH when immediate and full anticoagulation is required
18-20 units/kg/hr, max 2,300
Initial infusion rate of UFH that follows the loading dose
How is the Mantoux Tuberculin Skin Test (TST) administered?
Intradermal injection (0.1 ml of 5 tuberculin units of liquid tuberculin are injected between the layers of skin on forearm)
4. __ receptors: lipid soluble drugs cross the lipid bilayer and make changes by affecting DNA transcription ...think nuclear receptors like for steroids, etc
Intramembraneous
(2)Parenteral 1. __ (IM) 2. __(IV) 3. __(SQ)
Intramuscular Intravenously Subcutaenously
May drug/receptor interaction are a combination of all three of these:
Ionic Van Der Walls Hydrogen
Classifications of Stroke: 1. __ Stroke: -approx 87% of strokes are caused by this. -there is cardiogenic and noncardiogenic causes
Ischemic
What is 1st line for TB, trmt of latent infxn?
Isoniazid
Extensively drug-resistant (XDR TB) is resistant to?
Isoniazid and rifampin, PLUS resistant to any fluoroquinolone AND at least 1 of the 3 injectable second-line drugs (e.g., amikacin, kanamycin, or capreomycin)
What is the preferred initial regimen for a pregnant woman with TB?
Isoniazid, rifampin, and ethambutolfor at least 9 months
Vasodilators
Isosorbide denitrate (Bidil) is an example from what drug class?
Class III agent work on __ channels. They are __ channel blockers. Work best on phase 3.
K+
For K+ blocker drugs (Class III), you must make sure their __ levels are normal before they start on them (and not on the lower end)
K+
MUST MONITOR __ LEVELS IN PATIENTS
K+
When looking at T waves, remember that __ can alter it
K+
5 mg BID unless the patient is older than 80, weih less than 60 kg, or serum creatinine is greater than or eual to 1.5 mg/dL
KNOW THIS SLIDE
Vd is expressed as
L/kg
5. _ _ _: give statin if not contraindicated
LDL
MOA enhance/accelerat antithrombin activity; bind specific pentassacharide sequence
LMWH
Should obtain these labs with __ __ __ __: 1. PT/INR 2. aPTT 3. CBC with platelets 4. Serum creatinine
LMWH
__ __ __ __: predominately renaly eliminated
LMWH
__ __ __ __: proportionally greater antifactor Xa activity
LMWH
___: Plasma t1/2 is 2-4 times longer than UFH
LMWH
monitoring is not necessary for what kind of heparin
LMWH
Both _ _ _ _ and _ _ _ are safe in pregnancy and breast feeding
LMWH UFH
_ _ _ _ are NOT recommended for HITs.
LMWHs
__ __ __ __: 1. Enoxaparin. Will most likely see this.
LMWHs
__ __ __ __: 2. Dalteparin. Good at preventing DVTs in cancer patients. Can be cheaper than Lovenox
LMWHs
Where is a TB bacteriologic examination done?
Laboratory that specifically deals with M. tuberculosis and other mycobacteria
DTIs: 1. __: irreversible thrombin inhibitor.
Lepirudin
__ is indicated as an anticoag in patients with HITand associated thrombus
Lepirudin
Class 1b Agents: 1. __: IV. Can only use in ventricular tissue. When given systemically, it has Na+ channel blocking effects. It is degraded given PO, that's why there are no pills. Can help with ventricular arrhythmias
Lidocaine
Class 1b: L ettuce M ayo
Lidocaine Mexiletine
Mycobacterium tuberculosis has what kind of cell wall?
Lipid-rich and impermeable to many agents
ACEI
Lisonpril (Prinvil, Zestril) is an example from what drug class?
(1) Fluticasone (Flonase, Veramyst) (2) Mometasone (Nasonex)
List 2 intranasal corticosteroids used to treat acute bacterial sinusitis.
Phenylephrine Oxymetolazine
List 2 nasal decongestant sprays used to treat acute bacterial sinusitis?
Pseudoephedrine (Sudafed) Phenylephrine (Sudafed PE)
List 2 oral decongestants used to treat acute bacterial sinusitis?
Levofloxacin (Levaquin) Moxifloxacin (Avelox)
List 2 respiratory fluroroquinolones that are used to treat acute bacterial sinusitis.
Saline Steam inhalation
List 2 ways to irrigate the nasal cavity.
(1) Nasal decongestant sprays (2) Oral decongestants (3) Irrigation of nasal cavity (4) Mucolytics (5) Intranasal corticosteroids (6) Pain managment
List nonpharmacologic therapy for acute bacterial sinusitis
Propanolol, Esmolol, Acebutolol
Listed class II agents
3. __ disease: increase warfarin's effect (Increase INR)
Liver
150 mg over 10 min
Loading dose of amiodorone
ARB
Losartan (Cozaar) is an example from what drug class?
Will have to adjust dose of __ based on CrCl
Lovenox
What part of the body is the most common site for TB disease?
Lungs
What is a mycobacteria that does not cause TB?
M. avium complex
What are 4 other mycobacteria that cause TB disease? (besides the most common)
M. bovis M. africanum M. microti M. canetti
What is the most common mycobacteria that causes TB?
M. tuberculosis
ATypical presenations of Disease States: 1. __ __ present without chest pain have weakness, confusion, sncope, and abdominal pain instead
MI
alpha 2 adrenergic agonists
MOA decreae production of aqueous humor and increase uveoscleral outflow
xaralto, eliquis direct Xa inhibitors oral
MOA is to inhibit platelet activation and fibrin clot formation via direct, selective and reversible inhibition of factor Xa in both intrinsic and extrinsic coagulation pathways
prostaglandin analog
MOA- increase outflow of aqueus humor through the uveoscleral pathway
mast cell stabilizers
MOA- inhibit hypersensitivity reactions and prevent the accompanying increase in cutaneous vascular permeability. Good for allergic conjunctivitus
vasoconstrictors
MOA- stimulate alpha adrenergic receptors reducing ocular congestion and redness (-zoline)
polymixins: (inhibition of protein synthesis)
MOA: acts as a cationic detergent, damaging the bacterial cytoplasmic membrane, and causing leakage of intracellular substances, leading to cell death -ex: Colestimethate (Colistin) IV/INH cover gram -
tetracyclines: (inhibition of protein synthesis)
MOA: bind to 30S ribosomal subunit, inhibiting bacterial protein syntehis ::::examples: -cycline:::::::: -minocycline -doxycycline covers gram +, some anaerobes, and most atypicals
macrolides/ketolides: (inhibition of protein synthesis)
MOA: bind to 50S ribosomal subunit, inhibiting bacterial protein synthesis :::::examples: -mycin:::::: -erythromycin -azithromycin -clarithromycin -telithromycin --also, includes fidaxomicin
Chloramphenicol: (inhibition of protein synthesis)
MOA: bind to 50S ribosomal subunit, inhibiting bacterial protein synthesis (same as macrolides)
oxazolidinones: (inhibition of protein synthesis)
MOA: bind to 50S ribosomal subunit, inhibiting bacterial protein synthesis (same as macrolides) -ex: Linezolid and Tedezolid covers gram +
lincosamide: (inhibition of protein synthesis)
MOA: bind to 50S ribosomal subunit, inhibiting bacterial protein synthesis (same as macrolides) -ex: clindamycin covers gram + and most anaerobes (except c.diff)
streptogramin: (inhibition of protein synthesis)
MOA: bind to 50S ribosomal subunit, inhibiting bacterial protein synthesis (same as macrolides) -ex: synercid covers gram +
cyclic lipopeptide: (inhibit cell wall synthesis)
MOA: binds irreversibly to cell wall, weakening it and allowing essential ions to leak out, causing death -Daptomycin (Cubicin) IV cover gram + only
glycylcycline: (inhibition of protein synthesis)
MOA: binds to 30S ribosomal subunit to prevent binding of tRNA, thus preventing bacterial protein synthesis -example: Tigecycline (Tygacil) covers gram +, gram -, some anaerobes, and provides great coverage of atypicals
calcium channel blockers
MOA: decrease available calcium, leading to vasodilation decreases oxygen demand, heart rate and contractility
Nitrates
MOA: dilate arteries and veins due to nitric oxide production
ranexa (ranolazine)
MOA: inhibits late phase influx of sodium during a cardiac repolarization;decreases calcium influx.
Nitrofurnatoin: (inhibition of protein synthesis)
MOA: inhibits several bacterial enzyme systems including acetyl coenzyme A, interfering with metabolism and possibly cell wall synthesis -Macrobid
Aminoglycosides: (inhibition of protein synthesis)
MOA: irreversibly bind to the 30S and 50S ribosomal subunits, inhibiting bacterial protein synthesis ::::examples: -micin -gentamicin also, can be tobramycin or amikacin -covers gram -
digoxin: MOA/info
MOA: positive inotrope, negative chronotrope - patients with HFrEF - improves symptoms, exercise - no effect on mortality
antihistamines (H1-receptor antagonist)
MOA: prevent histamine response in blood vessels by preventing its binding (-astine)
nitorimidazoles
MOA: reactive intermediates disrupt bacterial DNA -Metronidazole (Flagyl) IV/PO -Tinidazole (Tindamax) PO cover anaerobes only
Fluorquinolones
MOA: target DNA gyrase to prevent relaxation and supercoiling of DNA strands, blocking nucleic acid synthesis :::::::examples: -flox-::::::::::::::: -ciprofloxacin -levofloxacin -moxifloxacin -ofloxacin covers mainly gram - and some gram +. also covers some atypicals
beta blockers
MOA:blocks beta receptors and decreases oxygen demand
topical carbonic anhydrase inhibitors
MOA:decrease in aqueous humor secretion CI with sulfonamides
How is Latent TB Infection (LTBI) detected (diagnosed)?
Mantoux tuberculin skin test (TST) or by blood tests such as interferon-gamma release assays (IGRAs)
40 mg/kg/day
Max dose of ibuprofen
__: enzymatic modification of drug molecules which usually abolishes their pharmacological activity. Happens primarily in the liver
Metabolic
Alpha-2 agonists
Methyldopa (Aldomet) is an example from what drug class?
Thiazide diuretic
Metolazone (Zaroxolyn) is an example from what drug class?
Toprol XL (succinate)
Metoprolol has two brand names. One is preferred in the treatment of heart failure. Which one is it?
cardioselective
Metoprolol, atenolol, bisoprolol, and nebivolol are examples of what type of beta blockers?
2. __: very, very rarely used. Has been shown to help with DM myopathy. Can cause unsteady gait. Only PO. Also a class 1b
Mexiletine
Vasodilators
Minoxidil (Loniten) is an example from what drug class?
Magnesium Sulfate, Adenosine, Digoxin
Miscellaneous antiarrhythmics that we're called to know
Plavix
Most common drug used that inhibits P2Y12
What is the resistance of rifampin?
Mutations in the target, DNA-dependent RNA polymerase, reduce binding of RIF to the polymerase
What does pyrazinamide target?
Mycobacterial fatty acid synthase I gene
In latent TB infections, are the patients considered infectious?
NO
Invasive Approach 1. High risk __ patients -recurrent angin despite med tx -elevated cardiac markers -ST depression indicating severe ischemia -sustained Vtach -Prior CABG, MI or other comorbidities -Left ventricular dysfunction
NSTEMI
Stage III
NYHA functional classification marked limitation of physical activity. comfortable at rest, but less than ordinary activity causes symptoms of HF
stage I:
NYHA functional classification no imitation of physical activity. Ordinary physical activity doe not cause symptoms of HF
stage I
NYHA functional classification no limitations of physical activity. ordinary physical activity does no cause symptoms of HF
Stage II
NYHA functional classification slight limitation of physical activity. comfortable at rest, but ordinary physical activity results in symptoms of HF
Stage IV
NYHA functional classification unable to carry on any physical activity without symptoms of HF or symptoms of HF at rest
Class 1 agents work on phase 0. These are __ channel blockers
Na+
Beta Blockers
Nadolol (Corgard) is an example from what drug class?
(1) Albuterol (Ventolin, ProAir, Proventil) (2) Salmeterol/fluticasone (Advair) 1 inh BID
Name 2 inhaled bronchodilators used to treat chronic bronchitis
Guaifenesin (Mucinex, Robitussin)
Name a mucolytic used to treat acute bacterial sinusitis.
Resistant HTN and hypertensive urgency
Name the two clinical utilizations of Alpha-2 agonists.
Lithium and NSAIDs (another would be meds inducing hyperkalemia)
Name two drug interactions with ARBs.
In latent TB infections, sputum smears and cultures are?
Negative
Adverse Effects of __: 1. Headache (remember this) 2. Flushing 3. Hypotension 4. Dizziness/syncope 5. Tachycardia
Nitrates
__: dilates arteries and veins due to nitric oxide production. Decrease vessel tone and symptoms due to spasm. Decreases oxygen consumption. Decreases demand of the heart, basically.
Nitrates
the main nitrate: __. Tis a short acting nitrate
Nitroglycerin
Are latent TB infections considered a case of TB?
No
Are people with Latent TB Infection (LTBI) infectious?
No
Can a CXR confirm TB disease?
No
In latent TB infections, symptoms include?
No symptoms
2. __-sustained VT a) BBs
Non
A-fib or angina
Non-DHP CCB are especially useful in patients with what? (two things)
CYP450
Non-DHP CCB are potent inhibitors of what? (think metabolism)
Patients with an arrhythmias need to be given __-_ _ _ because they help with that because they are cardioselective
Non-DHPs
__-_ _ _s: Verapemil, diatizem. They are Cardioselective
Non-DHPs
Acute Rate Control for AFib: 1. __ LV function: -IV B-blockers -Diltiazem -Verapamil
Normal
Chronic Rate Control: 1. __ LV function: a) BB, Diltiazem, Verapamil b) adjunct: Digoxin c) alternative: amiodarone
Normal
In latent TB infections, CRX are usually?
Normal
4. __ status: inconsistent intake of vit k. Amount doesn't matter as much as consistency.
Nutritional
ketorolac
ONLY fda approved nsaid for allergic conjunctivitis
ARB
Olmesartan (Benicar) is an example from what drug class?
2. Score of __: aspirin 75-325 mg/day OR Warfarin (INR 2-3) OR Dabigatran OR Factor Xa Inhibitor
One (1)
Tdap
Other name: Boostrix, Adacel Dosage: 5 mL Route: IM Primary immun: Booster: Given in a single dose of the 10 year Td booster for those who haven't previously received Tdap Notes: - pregnant women at >20 weeks need one dose every pregnancy
Hep B
Other name: Engerix-B, Twinrix Route: IM Primary immun: Adult and kids IM for 3 total doses at 0, 1, 6 mo. Notes: - Twinrix is Hep A + Hep B
Influenza
Other name: FluMist (nasal), FluZone Intradermal (ID) Route: Nasal or ID Primary immun: All patients >6 mo need yearly vaccination FluMist: for healthy people age 2-49 (stronger/longer lasting immune response) Children <9 need 2 doses separated by 28 days if first flu vaccine (then only 1 dose per year needed) ID: prefilled syringe Booster: none - new every year Notes: - FluMist is LIVE (LAIV) - Recommended for most patients
HPV
Other name: Gardasil, Gardasil-9, Cervarix (F only) Route: IM Primary immun: 3 total doses at 0, 2, 6 mo for people aged 9-26 Notes: - Gardasil-9 covers a little more
Hep A
Other name: Havrix, Twinrix Dosage: 1 mL Route: IM Primary immun: Booster: Give 6-12 mo following primary dose (2 total doses) Notes: - alternative and accelerated regimens exist - Twinrix is Hep A + Hep B
Polio Virus
Other name: IPOL Route: IM, SQ Primary immun: Incompletely vaccinted: adults with >1 previous dose of OPV, <3 doses of IPV Booster: Completely vaccinated and at increased risk of exposure - 1 dose
MMR
Other name: MMR-II Route: SQ Primary immun: 2 doses given at 1 yo and 5 yo Notes: - LIVE VACCINE
Pneumococcal
Other name: Pneumovax 23, Prevnar 13 Route: IM, SQ Primary immun: Patients >65 get 1 dose PPSV; Smokers, asthmatics & immunocompromised need 1-2 doses of PPSV per lifetime Booster: Max 3 doses per lifetime Notes: - Pneumovax for geriatric (>65) - Prevnar for peds and adults 50+ years
Td
Other name: Tenivac Dosage: 5 total doses in primary series of DTaP Route: IM Primary immun: IM 5 total doses in primary series of DTaP (kids) Booster: IM every 10 years (adults) Notes:
Varicella
Other name: Varivax Route:SQ Primary immun: 2 total doses of separated by 4-8 weeks Notes: - product must remain frozen until administration - LIVE VACCINE
Typhoid
Other name: Vivotif (live, capsule), TyphimVi (inactivated, injection) Route: Oral, IM Primary immun: Oral: one capsule every other day for a total of 4 doses (completed at least one week prior to exposure) IM: given at least 2 weeks prior to exposure Booster: Oral: used for repeated/continued exposure; repeat full course of primary imm. every 5 years IM: TyphimVi - currently a single dose recommended every 2 years with repeated exposure Notes: - LIVE VACCINE
Yellow Fever
Other name: YF-Vax Route: SQ Primary immun: One dose > 10 days before travel Booster: Every 10 years if continues to travel to places of exposure Notes: - may have serious neurological complications - LIVE VACCINE
Zoster
Other name: Zostavax Route: SQ Primary immun: One inj for all patients >60 Notes: - LIVE VACCINE - product must remain frozen until administration
Glycoprotein IIb/IIIa inhibitor: use if high risk patient is undergoing a _ _ _
PCI
What are the drug interactions with Rifamycins
PIs & NNRTIs
_ _ is PO(or)
PO
_ _ meds pose problem (chewable and swallowable)
PO
Monitering of Warfarin: 1. _ _: the time it take for blood to clot 2. __ __ : the method of PT standardization across labs ---target range is __ (range of 2-3)
PT International Ratio (INR) 2.5
When people are taking Lepirudin (a DTI), you should monitor their ___ time when therapy is prolonged
PTT
1. __ managements: -more intense in neonates and infants -some say use a topical lidocaine to ease that
Pain
1. __ diffusion: high to low conc.
Passive
Which patients must have treatment extend to 9 months?
Patients with cavities on chest x-ray and positive sputum cultures at 2 months
How is TB spread?
Person to person through the air via droplet nuclei
__: movement of drug through the body -how the BODY affects the drug -ADME
Pharmacokinetics
__ Conversion: most effective when initiated within 7 days of AFib onset -However there can be significant side effects and drug-drug interactions
Pharmacologic
__: Set processes by which drugs produce specific biochemical or physiologic changes in the body -How a drug effects the body -MOA -how the drug initiates the therapeutic or toxic affect
Pharmodynamics
Use nitrates with Caution when taking ___ inhibitors: 1. Sildenafil (Viagra) 2. Tadalafil 3. Vardenafil
Phosphodiesterase
__ protein concentration may change in relation to concurrent disease states
Plasma
__ is the most commonly prescribed Theinopyridine
Plavix
__ is used primarily for intermittent claudication.
Pletal
__: concomitant use of multiple meds or administration of more meds than are clinically indicated -prevalent in geriatrics
Polypharmacy
In TB disease, TST or blood test results are usually?
Positive
In TB disease, sputum smears and cultures are?
Positive
In latent TB infections, TST or blood test results are usually?
Positive
Class III
Potassium Channel Blockers are which class
Spinal TB is called?
Pott's disease
__ is also a prodrug. More potent than Clopidogrel. Need to be careful in patients who are older or do not weigh as much
Prasugrel
reversal of Pradaxa
Praxbind
Alpha-1 blockers
Prazosin (Minipress) is an example from what drug class?
1. __: warfarin is absolutely contraindicated with this. Is a terratogin
Pregnancy
Xeralto is a __ category C. Can do it, but not the best option. Have to weigh risks vs benefits
Pregnancy
__ of angina: BB CCBs, LA nitrate, ranolazine
Prevention
Norvasc and Cardene are good to use on someone who has __
Prinsmetzel
Class 1a Agents: 1. __: can cause lupus-like syndrome. Available in IV. Can cause hypotension
Procainamide
__: biological transformation of an inactive parent drug to a biologically active metabolite (so goes through liver and gets activated)
Prodrug
What is isonicotinic acid hydrazide (INH)?
Prodrug activated by mycobacterial catalase-peroxidase
__: non-selective BB. Can cause bronchospasms...because it can interact with B2 receptors in the lungs...which will cause bronchoconstriction. IV or PO availability
Propranolol
acute rate control agents are: 1. PE (beta blocker) 2. VD 3. __ (miscellaneous drug)
Propranolol Esmolol Verapamil Diltiazem Digoxin
Nonselective
Propranolol and nadolol are examples of what type of beta blockers?
the reason that warfarin should be avoided as monotherapy is because it rapidly reduced __ _ (which is one of the body's natural anticoag proteins) so it increases risk for clotting with initial Tx)
Protein C
What is tuberculin made from?
Proteins derived from inactive tubercle bacilli
__ __ __ (PCC): contains coagulant factors in conc.25 times that of FFP
Prothrombin Complex Concentrates
‐prazole
Proton pump inhibitor, omeprazole
2. __ toe syndrome: very rare. Microembolism to extremities. Is reversible. Must D/c warfarin
Purple
What is a "sterilizing" agent used during 1st 2 mo tx; allows tx duration shortened to 6 mo?
Pyrazinamide
Which drugs should not be used to treat TB in a pregnant woman?
Pyrazinamide (PZA) Streptomycin (SM)
3. Remove all agents that prolong _ _ interval
QT
__ warfarin is metabolized by P450-3A4
R
__ background: ACEIs give poor response in African Americans
Racial
ACEI
Ramipril (Altace) is an example from what drug class?
Decreases oxygen demand
Ranolazine
Limit does of __ to 500 mg if taking Diltiazem or verapamil (3A4 inhibitors)
Ranolazine
__ can prolong the QT interval because it blocks Na+ channels
Ranolazine
__ contraindications are hepatic impairment
Ranolazine
__: inhibits late phase influx of sodium during cardiac repolarization; decreases calcium influx.
Ranolazine
cardiac relaxation
Ranolazine
maintains cardiac function without reducing HR or BP
Ranolazine
may be used in combo with nitrates, BBs, and CCBs
Ranolazine
What is the frequency of miliary TB?
Rare
What are the adverse effects of Rifamycins?
Rash,thrombocytopenia, hepatotoxicity, flu-like syndrome with intermittent dosing
AV Nodal Block: 1. DO NOT use __ control therapies (they can cause heart blocks)
Rate
__ symptoms and __ stroke risk
Relieve Reduce
adrenergic blockers
Reserpine is an example from what drug class?
Mycobacterium tuberculosis has intracellular pathogens that?
Reside within macrophages and are inaccessible to drugs
What happens if pyrazinamide is used alone?
Resistance develops rapidly
__ and __: thrombolytic. DON'T USE FOR UA/NSTEMI
Reteplase Tenecteplase
Disadvantages of dabigatran: 1. __ agent is expensive (Praxbind)
Reversal
__ agents: agents used to reverse over anticoagulation
Reversal
What 1st line for TB; atypical mycobacterial infxn?
Rifamycins - Rifampin - Rifabutin - Rifapentine
dont give someone __ if they have moderate to severe hepatic impairment
Rivaroxaban
Factor Xa Inhibitors: 1. __ 2. __ 3. __
Rivaroxaban Apixaban Edoxaban
__ warfarin is metabolized by 2C9
S
remember, __ and __ seem to be used interchangably in the English language, so these are connected
S 2C9
Proteins __ and __ are also inhibited by Warfarin (which function as anticoags)
S C
Two isomeres of warfarin: R and S. __ is more potent than __
S R
__ node is conductor of heart. They give the best beat
SA
__/__: rapid and complete if table styas in place
SL/buccal
Vitamin K clotting factors
SN0T -Seven -Nine -0 (10- ten) -Two In order by approx. half-life
Adenosine is when the conductor says "___!!!!!"
STOP
Why choose amiodarone?
Safe in HF Maintains consistent therapeutic levels Minimal anti-adrenergic effects outside of the heart (safe in asthmatics) 70% success rate at 1 year maintaining NSR Has the lowest proarrhythmic potential and does not depress the LV Amiodarone is used in patients with chronic kidney disease (Ticosyn in patients with liver dysfunction)
with caution
Should Alpha-1 blockers be used in the elderly?
Boxed Warning of Amiodarone
Should be initiated in a hospital setting Potential pulmonary toxicity and hepatotoxicity Proarrhythmic risk Patient should be informed
Not recommended (unless you think it is bacterial)
Should empiric therapy be used to treat acute pharyngitis?
What are the signs/symptoms of an allergic reaction to any of the TB drugs?
Skin rash (serious)
3. __ Ventricular Response: -DCC, do NOT attempt without a temporary pacemaker in place!!!
Slow
class I
Sodium channel blockers are which class
__ cannot be used for HF
Sotalol
__: is a beta blocker. Can also block K+ channels. Has rate and rhythm control properties. ADJUST IN RENAL DYSFUNCTION
Sotalol
Beta Blockers
Sotalol (Betapace) is an example from what drug class?
Aldosterone receptor blockers
Spironolactone (Aldactone) is an example from what drug class?
katrina (aka Na+) is trendy and opens up those channels super fast
Stage 1
Dr. Shipp is Ca2+. She follows the trendy Katrina, but is slower than trendy katrina
Stage 2
Dr. Shipp's husband is K+, he is telling Ca2+ to chllix about being trendy
Stage 3
Health care providers are required by law to report TB cases to whom?
State or local health departments
__ _: rapid absopriton in aqueous solution
Sub Q
HIT
Super serious adverse effect of UFH which requires IMMEDIATE intervention and involves the patients own Ab
Chronic Management of Vtach: 1. __ VT a) first line is amiodarone b) alternatives: -procainamide -Sotalol -Lidocaine
Sustained
Restore the rate, Relieve symptoms, prevent Recurrence
Systematic relief of Afib - what do you have to do? Three R's
__: no take in pregnancy
Teratogenic
Alpha-1 blockers
Terazosin (Hytrin) is an example from what drug class?
Cough
The adverse reactions for ARBs are the same as ACEI except ARBs do not cause a what?
What is lymphohematogenous seeding?
The bacterium is phagocytized by a macrophage in the alveoli of the lung, which can then travel into the blood stream or into the lymph nodes via lymph
30ml/min
Thiazide diuretics are ineffective in patients with a GFR of less than what?
1. __: the prodrug that is ingested is metabolized to active form and irreversible blocks the P2Y12 component of ADP receptors on the platelet
Thienopyridine
__ reduces the rate of atherothrobotic events in patients with recent MI or stroke or est PAD
Thienopyridine
pregnancy, stroke, active bleeding
Things contraindicated with Warfarin
ARB
This drug class is first line, but generally reserved for patients with ACEI intolerance.
__ is not a prodrug, so it acts quicker on the body. You need to be careful because of bleeding risk associated with that
Ticagrelor
3. __: Reversibly and noncompetitively binds to ADP P2Y12 (reduces platelet aggregation)
Ticagrelor (Brilinta)
What are the signs/symptoms of peripheral neuropathy from isoniazid?
Tingling sensation in hands and feet (serious)
(3) __: through a cream on the skin, etc
Topical
__ _ __: rapid form of polymorphic VT associated with delayed ventricular repolarization due to blocade of potassium conductance
Torsades de Pointes
Loop diuretics
Torsemide (Demadex) is an example from what drug class?
TD50
Toxic dose 50
ACEI
Trandolapril (Mavik) is an example from what drug class?
2. __ receptors: binding domain is on the cell membrane and goes through the cell
Transmembraneous
__ of angina: short-acting Nitrate
Treatment
50 mg BID or 75 mg QD
Treatment dose of enoxaparin for someone that weighs 50 kg
Potassium sparing diuretics
Triamterene (Dyrenium)is an example from what drug class?
False
True or False: ACEI are not contraindicated in pregnancy.
False
True or False: ACEI do not cause orthostatic HTN.
True
True or False: Abrupt d/c of beta blockers may cause rebound HTN.
True
True or False: Aldosterone receptor blockers are good to use with resistant HTN.
True
True or False: Aliskiren (Texturna) is contraindicated in pregnancy.
True
True or False: All antihypertensive medications are secreted into breast milk.
true
True or False: Beta blockers are contraindicated in patients with decompensated heart failure.
False
True or False: DHP CCB do not cause peripheral edema.
True
True or False: Diabetes is an indication for an ACEI.
True
True or False: Heart failure is an indication for an ACEI.
True
True or False: Lithium has a drug interaction with potassium sparing diuretics.
True
True or False: Post MI is an indiction for an ACEI.
True
True or False: Vasodilators stimulate increase Na and water retention?
Primary adverse effects of _ _ _: bleeding
UFH
__ __ __ is considered safe while breastfeeding
UFH
Dose and Admin: 1. For VTE prevention, __ __ __ is given SubQ injection with a typical dose of 5000 unites q __-__ hours
UFH 8-12
_ _ _: preferred agent for PEs, preferred in patient with severe renal __. Can be IV utilized
UFH insufficiency IV
UFH: Dosing - VTE prevention
UFH is given by SubQ injection -typical dose is 5000 units q 8-12 hours (2X a day for elderly, thin)
protamine sulfate
UFH reversal drug that is not predictable for LMWH
acute VTE dosing with warfarin
UFH, LMWH, or fondaparinux should be overlapped with warfarin for >/= 5 days
3. __ __ __: -dysuria, fever, flank pain may be absent -incontinence, confusion and abdominal pain instead
UTI
__ __ __: potentiates antithombin's effect and in return, inhibits factors IIa (thrombin) and Xa
Unfractionated Heparin
Pradaxa
Used in the U.S for nonvavular Afib
Apixaban dosing are different for
VTE and A-fib
ARB
Valsartan (Diovan) is an example from what drug class?
__: weak, electrostatic bonds
VanDerWalls
total amount of drug in body/plasma concentration of drug=
Vd
__: can cause gingival hyperplasia and constipation (guts use Ca2+ to cause peristalsis)
Verapamil
V D
Verapamil Diltiazem
If INR is 9-10, give patient __ __, even without active bleeding
Vit K
What supplement is recommended for all pregnant women taking isoniazid?
Vitamin B6
warfarin antidote
Vitamin K (orally or IV)
Warfarin
Vitamin K antagonist
HIT: Treatment 2. __ is contraindicated as monotherapy for initial HIT treatment, but it can be used for long-term anticoagulation.
Warfarin
Vit K intake is significant because it will alter the effects of __ on the body (too much will decrease dose potency, too little could increase dose potency)
Warfarin
__ full antithromotic effect is not achieved for 7-15 days after initiation
Warfarin
__ is only things you can use for valvular Afib
Warfarin
__: a vit K antagonist
Warfarin
__: can give, but is not good at anticoag quickly...not good for acute situations because it also inhibits Protein S and C
Warfarin
With AF more than 48 hours, or Unknown: 1. Pre-cardioversion: a) __: target INR 2-3 for at least 3 wks b) alternative--> _ _ _ no thrombus: no need for 3 wks of warfarin Thrombus: wafrafin indefinately and NO cardioversion until thrombus is absent on repeat TEE c) __: for at least 3 wks 2. Post-cardioversion: a) __: continue for at least 4 wks b) __: continue for at least 4 wks
Warfarin TEE Dabigatran warfarin Dabigatran
With AF less than 48 hours: 1. __: non need to pre-treat with it 2. IV __ or _ _ _ _ at presentation, prior to cardioversion 3. If risk factors, perform _ _ _ prior to cardioversion
Warfarin UFH, LMWH TEE (transesophogeal echocardiogram)
methyldopa (alpha-2 agonist), atenolol (Beta blocker), labetalol (beta blocker), nifedipine (DHP CCB), and hydralazine (vasodilator)
What 5 antihypertensive medications are preferred in pregnancy?
dalteparin
What LMWH do you have to decrease the dose after 30 days
direct thrombin inhibitors (bivalirudin ), fondaparinux
What are appropriate acute alternatives for someone experiencing HIT?
(1) Antipyretics are typically all that is needed (2) Bed rest for comfort (3) Drink adequate fluids to prevent dehydration and decrease viscosity of respiratory secretions (4) Mist therapy (vaporizers) promotes thinning and loosening of respiratory secretion
What are some nonpharmacologic therapies for acute bronchitis?
(1) Antipyretic medications (acetaminophen and ibuprofen) (2) Lozenges and sprays (menthol and topical anesthetics)
What are some nonpharmacologic therapies for acute pharyngitis?
(1) β2-agonists (albuterol) (2) Inhaled and/or oral corticosteroids (3) Antihistamines
What are some supportive therapies for acute bronchitis that are not routinely recommended?
Sotalol, Amiodarone, Ibutilide, Dofetilide, Dronedarone
What are the Class III drugs
(1) Neuropsychiatric events (delirium and abnormal behavior) (2) SJS (3) Nausea/vomiting (4) Headache
What are the adverse effects of neuraminidase inhibitors?
(1) High-dose amoxicillin/clavulanate (2) 2nd generation cephalosporin (3) Clindamycin (4) Clarithromycin (5) Azithromycin (6) Doxycycline (7)Sulfamethoxazole/trimethoprim (8) Respiratory fluoroquinolones
What are the alternative treatments for acute bacterial sinusitis?
Ceftazidime Cefepime
What are the cephalosporins with pseudomonas coverage?
Lidocaine, Mexiletine
What are the class IB agents
Digoxin, lithium, NSAIDs, and aminoglycosides
What are the four drug interactions for loop diuretics?
hemolytic anemia, sedation, Na and water retention, and dry mouth
What are the four emphasized adverse effects to alpha-2 agonists?
Streptococcus pneumoniae Haemophilus influenzae
What are the most causative organisms of acute bacterial sinusitis?
(1) S. pneumoniae (2) M. pneumoniae (3) Legionella species (4) C. pneumoniae (5) H. influenzae
What are the most causative organisms of community-acquired pneumonia?
(1) P. aeruginosa (2) Acinetobacter species (3) MRSA
What are the most causative organisms of healthcare-associated pneumonia?
(1) Gram (-) bacilli (2) S. aureus (3) P. aeruginosa (4) Acinetobacter species
What are the most causative organisms of hospital-acquired pneumonia?
(1) Anaerobic bacteria (2) P. aeruginosa (3) MRSA
What are the most causative organisms of ventilator-associated pneumonia?
(1) H. influenza (2) M. catarrhalis (3) S. pneumoniae (4) M. pneumoniae (5) C. pneumoniae
What are the most common causative organisms for chronic bronchitis?
(1) Streptococcus pneumoniae (2) Mycoplasma pneumoniae (3) Chlamydophila pneumoniae (4) Bordetella pertussis
What are the most common organisms that cause acute bronchitis (typically bacterial infection is secondary)?
(!) Rhinovirus (2) Coronavirus (3) Influenza virus (4) Adenovirus
What are the most common viruses that cause acute bronchitis?
(1) 2nd generation cephalosporin (2) 3rd generation cephalosporin
What are the options for treatment failure in acute pharyngitis?
(1) Age > 65 years (2) Diabetes (3) Asplenia (4) Chronic cardiovascular, pulmonary, renal, and/or liver disease (4) Smoking (5) Alcoholism
What are the risk factors for community-acquired pneumonia?
(1) Recent hospitalization for > 2 days within previous 90 days (2) Skilled nursing facility or long-term care resident (3) IV antibiotics in previous 90 days (4) Recent antibiotic use, chemotherapy, wound care, infusion treatment at healthcare facility or home (5) Hemodialysis (6) Contact with a family member with MDR-infection (7) Immunosuppressive illness or treatment
What are the risk factors for healthcare-associated pneumonia?
(1) Witnessed aspiration (2) COPD (3) ARDS (4) Coma (5) Administration of antacids, (6) H2RA, or PPIs (7) Supine position (8) Enteral nutrition, NG tube (9) Reintubation, tracheostomy, or patient transport (10) Prior antibiotic exposure (11) Head trauma (12) Age > 60 years
What are the risk factors for hospital-acquired and ventilator-associated pneumonia?
(1) Rash (may progress to TEN) (2) High doses associated with seizures
What are the side effects of Penicillin (PenVK)?
Diarrhea
What are the side effects of erythromycin?
QT prolongation Photosensitivity
What are the side effects of respiratory fluroroquinolones?
bilateral renal artery stenosis, pregnancy, and angioedema
What are the three contraindication listed for ACEI?
bilateral renal artery stenosis, pregnancy, and angioedema
What are the three contraindication listed for ARB?
Anuria, hyperkalemia, and severe renal or hepatic disease
What are the three contraindications listed for potassium sparing diuretics?
Digoxin, lithium, and NSAIDs
What are the three drug interactions for thiazide diuretics?
Heart failure, post MI, and high CAD risk
What are the three indications listed for beta blockers?
DM, hyperlipidemia, and asthma/COPD
What are the three relative contraindications listed for beta blockers?
(1) Limit antibiotic treatment to those who may benefit (2) Prevent complications (-Reduce signs and symptoms -Achieve and maintain patency of the ostia -Eradicate bacterial infection with appropriate antibiotic therapy -Minimize duration of illness -Prevent progression from acute disease to chronic disease)
What are the treatment goals for acute bacterial sinusitis?
(1) Provide comfort to the patient (2) Treat associated dehydration and respiratory compromise
What are the treatment goals for acute bronchitis?
(1) Improve clinical signs and symptoms (2) Minimize adverse drug reactions (3) Prevent transmission to close contacts (4) Prevent acute rheumatic fever and supporative complications
What are the treatment goals for acute pharyngitis?
(1) Eradication of the offending organism through selection of the appropriate antibiotic (2) Complete clinical cure
What are the treatment goals for pneumonia?
(1) Reduce severity of chronic symptoms (2) Ameliorate acute exacerbations (3) Achieve prolonged infection-free intervals
What are the treatment goals in chronic bronchitis?
non-DHP (non-dihydropyridine) and DHP (dihydropyridine)
What are the two classes of calcium channel blockers (CCB)?
Heart block and sick sinus syndrome
What are the two contraindications for Non-DHP CCB?
anuria and sulfa allergy
What are the two contraindications for loop diuretics?
anuria and sulfa allergy
What are the two contraindications for thiazide diuretics?
Verapamil (Calan) and Diltiazem (Cardizem)
What are the two examples of Non-DHP CCB?
Depression and PUD (peptic ulcer disease)
What are the two highlighted adverse effects of adrenergic blockers?
orthostatic HTN and first dose syncope
What are the two important adverse reactions listed for Alpha-1 blockers?
(1) Acetaminophen (APAP) (2) Ibuprofen (IBU)
What can be used for pain management in acute bacterial sinusitis?
Dextromethorphan
What can you prescribe for a persistent, mild cough in acute bronchitis?
Codeine products
What can you prescribe for a severe cough with sleep disruption in acute bronchitis?
IV beta blocker, CCB, or Digoxin
What do you use for acute rate control in an Afib patient with a normal EF? ("everybody calm down")
loop diuretics
What drug class has this MOA: Binds to the Na, K, Cl co-transport mechanism in the loop of Henle, inhibiting reabsorption of these ions.
adrenergic blockers
What drug class has this MOA: Depletes central and peripheral catecholamines and depresses sympathetic nerve function, resulting in vasodilation and sedation.
Aldosterone receptor blockers
What drug class has this MOA: Inhibits aldosterone by competing for aldosterone receptors in the cortical collecting duct. This decreases reabsorption of Na and water while decreasing the secretion of K.
Vasodilators
What drug class has this MOA: Smooth muscle relaxant in the arteries.
Non-DHP CCB
What drug class has this MOA: act as potent vasodilators of coronary vessels, increasing blood flow and decreasing the HR by strong depression of the AV node conduction.
DHP CCB
What drug class has this MOA: act by relaxing the smooth muscle in the arterial wall, decreasing total peripheral resistance.
Thiazide diuretic
What drug class has this MOA: act on the kidneys to reduce sodium reabsorption in the distal convoluted tubule.
Potassium sparing diuretics
What drug class has this MOA: blocks sodium channels in the kidney collecting tubule.
Beta Blockers
What drug class has this MOA: negative inotropic and chronotropic actions, decrease myocardial oxygen consumption.
ACEI
What drug class has this MOA: prevent conversion of angiotensin I to angiotensin II by inhibiting the angiotensin-converting enzyme, decrease aldosterone secretion.
Alpha-1 blockers
What drug class has this MOA: selective alpha-1 antagonist that work by blocking the action of adrenaline on smooth muscle of the blood vessel walls.
ARB
What drug class has this MOA: selective angiotensin II receptor antagonist, blocks the vasoconstrictor and aldosterone secreting effects of angiotensin II.
Alpha-2 agonists
What drug class has this MOA: stimulate alpha-2 receptors in brain which decrease sympathetic cardiac output and peripheral vascular resistance.
ACEI or ARB
What drug class is recommended to treat HTN in a diabetic patient?
Beta blockers
What drug class is recommended to treat HTN in a patient with coronary artery disease?
Beta blockers
What drug class is recommended to treat HTN in a post MI patient?
Amiodarone
What drug has a box warning of proarrhythmic risk - due to decrease K+ which can lead to torsades
Aliskiren (Texturna)
What drug has this MOA: Decrease plasma renin activity and inhibits conversion of angiotensinogen to angiotensin I.
ACEI, ARB, DHP CCB, and thiazide diuretics
What four drug classes should be use din first line treatment of HTN?
BP, K, BUN, and Scr
What four things should be monitored after initiation of Aliskiren (Texturna)?
Outpatient without risk factors for MDR organisms
What is Community-Acquired Pneumonia (CAP)?
Outpatient with risk factors for MDR organisms
What is Healthcare-Associated Pneumonia (HCAP)?
> 48 hours after admission
What is Hospital-Acquired Pneumonia (HAP)?
> 48-72 hours after intubation
What is Ventilator-Associated Pneumonia (VAP)?
Tendon damage/rupture
What is a major side effect of respiratory fluroroquinolones (black box warning) (also why they aren't used in kids)?
(1) Amoxicillin (high-dose) (2) Clindamycin
What is first line for high suspicion of penicillin resistant S. pneumonia in acute bacterial sinusitis?
(1) Amoxicillin/clavulanate (high-dose) (2) Cephalosporin
What is first line for treatment failure/prior abs therapy in acute bacterial sinusitis?
Amoxicillin
What is first line for uncomplicated acute bacterial sinusitis?
decrease by 50%
What is it recommended that you do with the dose of Warfarin or Digoxin when also giving Amiodorone
Viruses
What is responsible for the majority of acute bacterial sinusitis cases?
Respiratory FQ
What is second line for high suspicion of penicillin resistant S. pneumonia in acute bacterial sinusitis?
Respiratory FQ
What is second line for treatment failure/prior abs therapy in acute bacterial sinusitis?
Inhibits bacterial protein production
What is the MOA for Erythromycin?
Bactericidal: inhibits cell wall synthesis
What is the MOA for Penicillin (PenzVK)?
Inhibits neuraminidase which is responsible for influenza virus entry and release from plasma membranes of infected cells
What is the MOA for neuraminidase inhibitors?
vitamin K antagonist
What is the MOA of Warfarin
vitamin K
What is the antidote to a warfarin overdose
Gram (+), Gram (-), atypicals
What is the coverage from erythromycin?
400 mg BID
What is the dosage of Dronedarone
Aliskiren (Tekturna)
What is the drug example given under the class of Renin inhibitor?
10 days OR At least 7 days after signs and symptoms are under control
What is the duration of treatment for acute bacterial sinusitis?
Penicillin
What is the first line therapy for acute pharyngitis?
Low-dose amoxicillin
What is the first line treatment for acute bacterial sinusitis?
resistant HTN
What is the important clinical utilization of vasodilators in the treatment of HTN?
Group B streptococcus (S. pyogenes)
What is the most causative organism of acute pharyngitis?
Amiodarone
What is the most commonly prescribed antiarrhythmic
Infection of the trachea and bronchi yields hyperemic and edematous mucous membranes with an increase in bronchial secretions
What is the pathophysiology of acute bronchitis?
Neuraminidase Inhibitors
What is the pharmacologic therapy for influenza?
B
What is the pregnancy category for Penicillin (PenVK)?
75mg PO once daily x 10 days
What is the prophylaxis dose for Oseltamivir (Tamiflu)?
(1) 1st generation cephalosporin (2) Erythromycin (or other macrolide)
What is the second line/PCN allergy for acute pharyngitis?
High-dose amoxicillin
What is the second-line treatment for acute bacterial sinusitis?
"pill in pocket" dose
What is the term for an oral loading dose taken on top of a pt's daily dose when they recognize that they are having symtpoms
75mg PO BID x 5 days
What is the treatment dose for Oseltamivir (Tamiflu)?
21 days
What is the treatment duration for C. pneumonia?
10-21 days
What is the treatment duration for Legionella?
> 2 weeks
What is the treatment duration for S. aureus?
10-14 days
What is the treatment duration for S. pneumoniae?
(1) Antipyretics (2) Increased fluid intake (3) Bronchodilators (β2-agonists) (4) Oxygen therapy (5) Ribavirin (PO or inhalation) (6) Antibiotics not recommended unless bacterial pneumonia is suspected
What is the treatment for bronchiolitis?
(1) Clindamycin (2) Respiratory FQ
What is the treatment for non-type 1 allergy for high suspicion of penicillin resistant S. pneumonia in acute bacterial sinusitis?
Cephalosporin
What is the treatment for non-type 1 allergy for treatment failure/prior abs therapy in acute bacterial sinusitis?
Cephalosporin
What is the treatment for non-type 1 allergy in uncomplicated acute bacterial sinusitis?
(1) Clindamycin (2) Respiratory FQ
What is the treatment for type 1 allergy for high suspicion of penicillin resistant S. pneumonia in acute bacterial sinusitis?
Respiratory FQ
What is the treatment for type 1 allergy for treatment failure/prior abs therapy in acute bacterial sinusitis?
(1) Clarithromycin (2) Azithromycin (3)SMX/TMP (4) Doxycycline (5) Respiratory FQ
What is the treatment for type 1 allergy in uncomplicated acute bacterial sinusitis?
first
What line of therapy are ACEI? (first, second, last, etc.)
first
What line of therapy are DHP CCB? (first, second, last, etc.)
last
What line of therapy are adrenergic blockers? (first, second, last, etc.)
first
What line of therapy are thiazide diuretics? (first, second, last, etc.)
N-acetylcysteine (Mucomyst)
What mucolytic aerosol can be used to treat chronic bronchitis?
Phase 0
What phase of the action potential do Class I agents act on
phase 2
What phase of the cardiac AP deals with Ca
Phase 0
What phase of the cardiac action potential deals with sodium
X
What pregnancy category is Warfarin
beta 1
What receptor(s) do cardioselective beta blockers block?
beta 1 and beta 2
What receptor(s) do nonselective beta blockers block?
anuria, acute renal insufficiency, and hyperkalemia
What three things are aldosterone receptor blockers contraindicated with?
ACEI or ARB
What two drug classes are recommended for hypertensive patients with chronic kidney disease?
thiazide diuretics and ACEI or ARB
What two drug classes are recommended for recurrent stroke prevention?
diuretics and beta blockers (to prevent Na/water retention)
What two drug classes should be administered along with a vasodilator?
Scr (serum creatinine) and K (potassium)
What two levels should be monitored after initiation of an ACEI?
Scr and K
What two things need to be watched if a patient is on a aldosterone receptor blocker?
(1) Respiratory fluoroquinolone (2) If (+) for M. pneumonia, azithromycin
What type of antibiotic is recommended in acute bronchitis?
(1) Rhinovirus (2) Coronavirus (3) Adenovirus
What viruses are responsible for most cases of acute pharyngitis?
Bacteria
When acute bacterial sinusitis symptoms last longer than 7 days or become severe, the case may have been caused by what?
What is Extra-pulmonary TB (EPTB)?
When lymphohematogenous seeding occurs and the bacteria spreads the microbes from their pulmonary location to other distant sites of the body
When should a drug susceptibility test be done?
When patient is first found to have positive culture for TB (Determines which drugs kill tubercle bacilli)
When does Latent TB Infection (LTBI) occur?
When tubercle bacilli are in the body, but the immune system is keeping them under control
ascending limb of loop of Henle
Where in the nephron do loop diuretics work?
Distal convoluted tubule (DCT)
Where in the nephron do thiazide diuretics work?
Losartan (Cozaar)
Which ARB can be used in the treatment of Gout?
Sotalol
Which Class III agent has Class II (Beta Blocker) and Class III tendencies?
Clonidine (Catapres)
Which alpha-2 agonist can be used to quickly reduce a patients blood pressure?
Methyldopa (Aldomet)
Which alpha-2 agonist is often given in pregnancy for HTN?
Imipenem/cilastatin Meropenem
Which carbapenems have pseudomonas coverage?
Dronedarone
Which class I agent is pregnancy category X
Sotalol, Dofetilide
Which class III agents ABSOLUTELY must be renal adjusted
Amiodarone, Ibutilide
Which class III agents would be best in acute situations?
Class IB
Which class of agents are only effective with ventricular issues such as VF or VT - not effective on supraventricular tissue
warfarin
Which drug has the possibility of causing skin necrosis
Ethacrynic Acid (Edecrin)
Which loop diuretic does not contain a sulfa group?
Propanolol
Which of the Class II agents is not cardioselective, thus it can cross the BBB (helps with the ol' tremor) and can cause bronchospasm
Piperacillin/tazobactam
Which penicillin has pseudomonas coverage?
Amiloride (Midamor)
Which potassium sparing diuretic can be used to treat resistant HTN?
Chlorthalidone (Hygroton)
Which thiazide diuretic is about twice as potent as HCTZ?
Metolazone (Zaroxolyn)
Which thiazide diuretic is used as an adjunct to loop diuretics?
Minoxidil (Loniten)
Which vasodilator has been linked to hair growth?
Hydralazine (Apresoline)
Which vasodilator is often used in pregnancy?
(1) Antibiotics within the previous 90 days (2) Current hospitalization for > 5 days (3) Immunosuppressive illness or treatment (4) High frequency of resistance in community or hospital (5) Patient at risk for HCAP
Who is at risk for MDR pathogens?
(1) Age < 2 years or > 65 years (2) Β-lactam treatment within the previous 3 months (3) Alcoholism (4) Medical comorbidities (5) Immunosuppressive illness or treatment (6) Exposure to a child in daycare center
Who is at risk for β-lactam-resistant S. pneumoniae?
Anticholinergic effects (dry mouth, urinary retention)
Why should antihistamines not be used to treat acute bacterial sinusitis?
Prevent tolerance and/or rebound congestion
Why should nasal decongestant sprays not be used longer than 3 days?
When is it not ideal to use amiodarone?
With liver or pulmonary dysfunction
When should the forearm be examined after a Mantoux Tuberculin Skin Test (TST)?
Within 48 - 72 hours
warfarin pregnancy category
X
Xeralto is a direct __ inhibitor (oral)
Xa
__ catalyzes the conversion of prothrombin to thrombin
Xa
Remember that __ catalyses the conversion of __ to thrombin
Xa, prothrombin
__: inhibits fact Xa directly, but reversibly
Xarelto
AFib dosing is different than VTE treatment dosing in __
Xeralto
In TB disease, are the patients considered infectious?
Yes
Can first line TB drugs be given to breastfeeding women?
Yes (Only small concentration found in breast milk; Not harmful to infant; Vitamin B6 should be taken daily)
K and Mg
___ and ____ need to be monitored and replaced when using diuretics.
Xarelto dosing
a-fib dosing different than VTE treatment dosing
VTE prophylaxis following __ or abdominal surgery (fondaparinux)
abdominal orthopedic
__: passage of drug from its site of administration into the plasma
absorption
A D M E
absorption distribution metabolism excretion/elimination
macrolides-azithromycin
abx prophylaxis for neonates from chlamydia trachomatis infection
flouroquinolones (ciprofloxacin), cortisporin otic, acetic acid
abx used in otits externa
rocephen, cipro,
abx used to treat hyper actute bacterial conjunctivitis.... ie gonococcal infections
Drugs given chronically do __ in the body
accumulate
heparin dose is based on __ _ _ _
activated PTT
aPTT
activated partial thromboplastin time
contraindications of Pradaxa
active bleeding, CrCl <15mL/min
contraindications of ezetimibe
active hepatic disease
ADL, what does it mean?
activities of daily living
Goals for Afib: 1. evaluate need for __ tx 2. contemplate whether to restore __ ___ __ 3. __ long-term complications
acute normal sinus rhythm Prevent
alcoholism and warfarin
acute <metab: inr > chronic > metab:inr<
gram positive (staph aureus strep pnuemo)
acute bacterial conjunctivitis is caused by _________ organisms
ACS
acute coronary syndrom
amoxicillin 80-90 mg/kg/day
acute otits media inital nonsevere first line abx
augmentin (amoxicillin/clavinulate) 90 mg/kg/day and 6.4 mg/kg/day
acute otits media inital severe or failure nonsevere first line abx
__: 12-16 years old
adolescents
__: attraction of a drug to a receptor. Related to the concentration of drug required to occupy a receptor site
affinity
changes in __ for receptor
affinity
Receptor Responses depend on: 1. __ for drug 2. __ of receptors available 3. __/amount of drug presented to receptors 4.. __ of the drug 5. __ potency of the drug
affinity number quantity efficacy potency
__: differences in dosing neonates, toddlers, adolescents and adults
age
Optimal dosing is hard to find due to differences in __, __ function, and __ state
age organ function disease
__-__ impairment of homeostatic mechanism
age-related
beta blockers
agent of choice for non sustained VT
Class III agents
agents that increase repol time, can display "reverse-use dependence"
__: drugs that display a degree of affinity for a receptor and stimulate response (affinity AND efficacy)
agonist
8. lower __ levels
albumin
__ is a carrier protein in the blood so a lot of drugs will bind to it
albumin
2. __: acute, irritates liver which decreases clotting factors which makes warfarin super effective. Crhonic drinkers actually decrease effects so HIGHER levels of __ are needed
alcoholism -higher
Bactrim and warfarin
almost immediate effect on INR; CYP2C9
Flagyl and warfarin
almost immediate effect on INR; CYP2C9
__ term UFH: alopecia: loss of hair
alopecia
-idine (apraclonidine and brimonidine)
alpha 2 adrenergic agonists
3. __ of dosage forms
alteration
tell your patient to make sure they keep the nitro in the __ colored vial and to not move it!
amber
Peaks and troughs are measured with drugs like __ and __
aminoglycosides vancomycin
It is okay to use in HF
amiodarone
__ can cause pulmonary fibrosis. Stop it immediately if a patient starts to present PF
amiodarone
__ has an iodine componant. This means it can cause THYROID issues
amiodarone
__ is a metabolism inhibitor of 3A4 and 2C9 and many others
amiodarone
a person with liver dysfunction should not be put on __ if it can be avoided
amiodarone
interacts with a lot of drugs (because it impacts the CypP450
amiodarone
2. Mild symptoms of VTach a) Antiarrhythic agents: -First line: __ -Alternative: IV __ b) have _ _ _ readily available
amiodarone lidocaine DCC
It displays small characteristics of all of the other classes (__), but mostly it is a K+ channel blocker
amioradone
__: used IV over ibutilide. Impacts K+ channels
amioradone
diarrhea, HA, rash
amoxicillin adverse effects
what is the drug of choice for VRE
ampicillin
DHP: 1. amlodapine: varspastic __ and or addon for UA 2. Nicardipine: used for __ 3. Nifedipine (good for pregnancy): often used for __
angina (3x)
‐sartan
angiotensin receptor blocker (ARB), valsartan
4. Xa inhibitors: __
annexa
‐conazole
anti fungal, fluconazole
-if an isolated event, no need for long-term __ therapy
antiarrhythmic therapy
Once patient is resuscitated: 1. continue __ until patient's rhythm/status is stable 2. If episode associated with __ ischemia then no long term _ _ _s are necessary 3. If even not associated with acute event, then do an _ _ _ placement
antiarrhythmics AADs ICD
ocular inflammation - treatment
antibacterial/corticosteroid combo eye drops -cortisporin, neo-polycin HC) - blephamide - fml-s liquifilm - maxitrol - pred-g - tobradex - zylet
definitive therapy
antibiotic customized to c&s results (de-escalation) -should be safe, effective, narrow spectrum, and cost effective
empiric therapy
antibiotic given for proven or suspected infection, but responsible organism not yet identified -educated guess
1 day
antibiotic use decreases duration of symptoms by _____
prophylactic therapy
antibiotic used to prevent an infection -primarily limited to immunocompromised patients: cancer, surgery, HIV/AIDS, artificial heart valves
‐micin
antibiotic ‐ aminoglycoside, gentamicin
‐enem
antibiotic ‐ carbapenem, meropenem
cef‐/cefp‐/ceph‐
antibiotic ‐ cephalosporin, cephalexin
‐flox‐
antibiotic ‐ fluoro/quinolone, ciprofloxacin
‐mycin
antibiotic ‐ macrolide, azithromycin
‐cillin
antibiotic ‐ penicillin, amoxicillin
sulfa‐
antibiotic ‐ sulfa, sulfamethoxazole
‐cyline
antibiotic ‐ tetracycline, minocycline
Up to 60% of people taking Lepirudin for 10 days or more develop __
antibodies
drug induced PACG
anticholinergic or sympathomimetic properties (antihistamine/antidepressants) sulfonamides cause lens swelling
enhanced response to __ -warfarin, heparin
anticoags
Put them on an __ for at least 3 weeks (allows body to degrade that clot)
anticoagulant
DTI: Lepirudin indications
anticoagulation in patients with HIT & associated thrombosis
-astine (emedastine, levocabastine)
antihistamines (H1-receptor antagonist)
Clopidogrel or Ticagrelor for their __ properties
antiplatelet
Prasugrel: __, only use if patient needs angiography
antiplatelet
Effient (Prasugrel)
antiplatelet prodrug activate in the liver that has an increased bleedin risk than plavix beneficial post mi or with diabetes ONLY USED WITH ANGIOGRAPHY
Plavix (clopridigrel)
antiplatelet prodrug activated in the liver that is used if in ASA allergy
Brilenta (ticagrelor)
antiplatelet that is not a prodrug and can be used in people with liver damage. Bleeding risk is greater thanplavix but less than effient.
__ not approved for bivalvular afib
apixaban
__: direct, selective and reversible inhibition of factor Xa. (it's an oral Direct Xa inhibitor)
apixaban
5. assess __ of remaining meds
appropriateness
POAG: alpha adrenergic agonists - types
aproclonidine (post op) brimonidine (alternative first line agent!!)
1. __ 81 mg once a day -reduces progression of disease
aspirin
Discharge Meds: 1. __ 2. __ (alt. Ticagrelor, Prasugrel) 3. __ 4. Control __, __and __ 5. encourage __ and __
aspirin clopidogrel BBs HTN, lipids, DM diet, exercise
CHADS2
assess risk for an embolic stroke - only calculated with Afib
Treatment of __: stain
atherosclerosis
Good for ___ and __ arrhythmias
atrial ventricular
Healthcare is a very ____ culture that is grossly ____
autonomous, under-standardized
monobactams examples
azteronam (IV/IM) -only cover gram - , including pseudomonas and enterobacteria
48 hours
bacterial infectious conjunctivitis is contagious for _____ after therapy begins
ACE MOA
balanced preload and afterload reducers by blocking angiotenssin II production and increase bradykinins
GET a __ exam (before you start therapy)
baseline
‐azepam
benzodiazepine, lorazepam
more sensitive to __
benzodiazepines
proper procedure for eye drops
besides obvious hand washing, sterile technique... remember: - pull lower eyelid out - look at tip of bottle, then 1 drop - close lids, dont rub, for 1-3 minutes - 2 drops - wait atleast 3-5 min between
Class II drugs are __ blockers
beta
Primary Prevention of Sudden Cardiac Death: 1. Patient is post MI and had non-sustained VT: LVEF is greater than 35%, then give a __ __
beta blocker
metipranolol
beta blocker with limited use in glaucoma due to increased local side effects.
clavulanic acid
beta lactamase inhibitor
‐olol
beta‐blocker, metoprolol
bile acid seqeustrants MOA
binds bile acid in the intestine, decreasing biliary cholesterol absorption
is it as __ as we want it to be? How __ is it? How __?
bioavailable stable compatible
1.25 mg qd
bisoprolol initial dose
10 mg qd
bisoprolol max dose
Adverse Effects of LMWH: 1. __
bleeding
Adverse reactions of Xeralto: 1. __
bleeding
Contraindications for xeralot is 1. active __
bleeding
Warfarin Adverse Effects: 1. __
bleeding
make sure your patients check urine and stool for __ signs and symptoms
bleeding
Contraindications: 1. active __ 2. CrCl less than __ mL/min
bleeding 15
Adverse Effects of Fondaparinux: 1. __ 2. Has not been associated with _ _ _
bleeding HIT
Digoxin can cause heart __ and __
block bradycardia
beta blockers
block the b-adrengergic receptor in the ciliary epithelium which decreases aqueous humor production
aldosterone anatgonists
blocks effects of aldosterone in the kidneys, heart vasculature
beta blocker MOA
blocks the effect or norepinephrine and other sympathetic neurotransmitters on the heart and vascular system.
Distribution Variables: 1. __ flow to area 2. __ or __ solubility -water stays in smaller area -lipids soluable can go just about anywhere 3. __ binding 4. __ 5. __ across tissue barriers 6. Binding within __ 7. __ partition -weak acid/weak base cannot cross certain membranes 8. __:__ partition
blood lipid, water protein obesity permeability compartments pH fat:water
Factors that may be altered with age affecting distribution: 1. __ flow 2. __ __ binding 3. __ composition
blood plasma protein body
__ __ to the area affects absorption
blood flow
b. antineoplastic meds are often based on __ __ __ (_ _ _) mg/m^2 -used especially with cancer drugs
body surface area (BSA)
UFH doses 20,000 units/day for > 6 months associated with significant ________
bone loss; may lead to osteoporosis -especially during pregnancy
adverse effects of non-dhp (nondihydropyridines)
bradycardia
Watch out for: 1. severe __ 2. __ neuropathy 3. _ _ _ side effects
bradycardia optic CNS
LMWH is safe in __
breastfeeding
Warfarin is safe to use with __
breastfeeding
ineffective
brilinta is ___________ if combined with ASA dose >100 mg
amlodipine and felodipine
calcium channel blockers proven safe in HF
why are fluoroquinolones not recommend in pregnancy?
can interfere with cartilage and tendon development and maintenance
why are chloramphenicol not recommend in pregnancy?
can prevent protein synthesis in human bone marrow cells, causing hematogenic toxicity including fatal aplastic anemia and thrombocytopenia -grey baby syndrome
why are tetracyclines not recommend in pregnancy?
can slow skeletal development and bone growth, and can cause permanent tooth discolaration
NEVER make the correlation that medicine is __ or vice versa. SUPER dangerous
candy
Non-DHP work only on __ cells
cardiac
Ischemic Stroke: 1. __: anticoag therapy 2. __-__: antiplatelet therapy
cardiogenic non-cardiogenic
what does the FDA believe about statins
cardiovascular benefits outweigh the small increased risks
Nonpharm help for PSVT: 1. unilateral __ __ 2. __ maneuver 3. __ water facial immersion 4. induced __ 5. __ DCC: LOW ENERGY LEVELS
carotid massage valsalva ice retching Synchronized
3.125 mg bid
carvedilol initial dose
50 mg bid
carvedilol max dose
3. Drug Refractoriness: a) __ ablation b) _ _ node modification
catheter AV
herpes conjunctivitis
caused by herpes simplex virus or varicell zoster virus and affectrs eylids conjunctiva and cornea
Pseudomonas aeruginosa, staphylococcus, fungi
causes of otitis externa
QT prolongation
caution of ranexa
nutritional status and warfarin
change in dietary vitam K alter response
sensitivity
checks to see what kind of medicine, such as an antibiotic, will work best to treat the illness or infection
__: 1 to 11 years
children
__: mirror image spatial arrangement (enantiomers...direction of rotation (left or right handed?)) of the same drug may not fit into a receptor the same way
chirality
neonatal conjunctivitis
chlamydia trachomatis infection is the most common cause of _________
4. __ management (STATINS)
cholesterol
Ezetimibe MOA
cholesterol absorption inhbitor
types of bile acid sequestrants
cholestyramine, colestipol, colesevelam
drugs given on a __ bases typically do not show wider variation in peak and trough concentrations
chronic
staphylococcus, moraxella
chronic bacterial conjunctivitis is caused by ________
verapamil
class IV that causes gingival hyperplasia - scary gum problem - and constipation
someone with liver disease may not have as great a response to __ because it doesn't break it down fully (which is needed in order to be activated to full potency)
clopidogrel
anticoags are used for __
clots
assess patient factors that predispose them to __
clots
Mayo Clinic's _______ and empowering culture allowed for redesign of workflow to reduce _____ and to protect patients from the frailties of competent human beings.
collaborative infections
simbrinza
combination brinzolamide and brimonidine
cosopt
combination therapy of timolol and dorzolamide
combigan
comination therapy of briomoidine and timolol
1. Poor __ between prescriber and patient
communication
A lack of _____ leads to problems not getting fixed
communication
__ is key!!!!!
communication
encourage them to give you a __ medication list
complete
__ of the drug
concentration
Beta-Blockers: 1. decreased __ velocity 2. Increased refractoriness: prolong __ interval 3. __ heart rate 4. Decreased __ at nodal tissues 5. Decreased __ of ventricular contractility
conduction PR decrease automaticity force
Phase II (__) reactions are NOT affected
conjugated
Patient is post MI or has non-ischemic dilated cardiomyopahty with no history of arrhythmia: 1. LVEF is greater than 35%: Take a __ approach 2. LVEF is less than or equal to 35%, be __ and give ICD OR be conservative and optimize post-MI of HF therapy
conservative aggressive
patients can eat vitamin K food but they must be
consistent with amount
Food high in vit K can be eaten, but it must be eaten __
consistently
Beta-1 receptors increase __(inotropic) and __(rate)
contractility chronotropic
Warfarin and HIT
contraindicated as monotherapy for initial HIT treatment -can be used for long-term anticoagulation
Rivaroxaban Pearls
contraindicated in pregnancy
ACEI: contraindications and adverse effects
contraindications: - NO in pregnancy - history of angioedema adverse effects: - hypotension - increased SCr and BUN - proteinuria - hyperkalemia - angioedema - dry cough - maculopapular rash - taste disturbances
amiodarone can cause __ microdeposits
corneal
CABG:
coronary artery bypass graft
drug induced POAG
corticosteroids
Compliance Issues: 1. __ of meds 2. possible __ __ __ 3. __ to read labels 4. lack of __ or info about med
cost adverse drug reactions inability understanding
drug interactions of ezetimibe
could increase warfarin and cyclosporine -separate dose of bile acid sequestrants and ezetimbe by 2 hours before or 4 hours after
Warfarin is aka __
coumadin
nasolacrimal occlusion
counsel pt on good technique to decrease systemic absorption - close eyes - place index finger over nasolacrimal drainage system in inner corner of eye for 1-3 minutes
UFH
creates an antithrombin complex that is 100-1000 times more potent than antithrombin alone
CPK
creatine phosphokinase
Technology does not take away ______ but can help double check standards
critical thinking
allergic conjunctivitis - mast cell stabilizers - types
crolom alomide alocril alamast
__/__
crushing/mixing
Lab Tests: 1. elevated __-__ conc. 2. elevated __ sedimentation rate (measures inflammation) 3. __ __ __ count elevation
d-dimer erythrocyte WBC
direct thrombin inhbitors: oral DTI
dabigatran etexailate (Pradaxa)
Inpatient has to be done on a __ basis
daily
Purple toe syndrome caused by warfarin
dc warfarin; weeks-months -rare
Vd of water soluble meds is __
decreased
otits externa
decreased canal acitidty which promotes bacterial overgrowth
intermediate term benefits of diuretics
decreased daily symptoms, improved cardiac function, increased exercise tolerance
Short-term benefits of diuretics
decreased jugular venous distension (JVD), pulmonary congestion, and peripheral edema
Amiodarone and warfarin
delayed effect up to 6-8 weeks; CYP3A4
3. __: pooping out vit K, decrease SNOT, so more susceptible to warfarin
diarrhea
Meds affected by decline in Phase 1 metab: D P T Q I L M P
diazepam piroxicam theophylline quinidine impramine lidocaine morphine propranolol
Sick Sinus Syndrome: many times this is a drug-induced state -__ can cause this, so you have to stop the drug -usually have to put these patients on a __ __
digoxin Pacemaker
0.5-1 mcg/L
digoxin therapeutic range
moderate 3a4 inhibitors
diltiazem, verapamil erythromycin, fluconazole, grapefruit juice
__ of adult meds
dilution
Isosorbide __ will act for 4-8 hours
dinitrate
fonraparinux (arixtra)
direct factor Xa inhibitor alternate to heparin but should not be the sole agent for PCI Renally adjust
bivalirudin (angiomax)
direct thrombin inhibitor alternate to heparin for pci or HIT tx.
Hemorrhagic Stroke: 1. __ __ ALL anticoags and/or antiplatelets 2. Use antidotes if possible: a) Warfarin: __ _ b) Dabigatran: __ _ _ _ c) Rivaroxaban: __ (still working on this)
discontinue (D/C) Vit. K PRBC Andexanet
Multiple __ states Muliple __ at or over the age of __ __ decreased __ function high __ use
disease prescribers 85 dementia renal ethanol
__: process through which a drug establishes equilibrium throughout the body fluids and tissues
distribution
‐semide
diuretic ‐ loop, furosemide
‐thiazide
diuretic ‐ thiazide, hydrochlorothiazide
__ (but dont use for renal dysfunction) and __ (but don't use for hepatic issues) are good for HF
dofetilide amiodarone
90 minutes
door to pci time
POAG: topical carbonic anhydrase inhibitors - types
dorzolamide brinzolamide
many meds given to peds are not available in suitable __ forms
dosage
absoprtion depends on __ form and __ of administration
dosage site
5. __ requirements:
dose
Drugs give orally (PO) need much higher __ because the liver eliminates them so quickly
dose
warfarin has large interpatient differences in ___ requirements
dose
d. Wrong __, wrong __ and wrong __ are most common errors
dose drug time
325 mg qd x 1 month and then 81 mg indefinitely
dose of ASA for PCI in bare metal stent
75 mg qd for at least a year
dose of clopidogrel for PCI
500 mg BID
dose of ranexa
warfarin has large interpatient difference in
dose requirements
6. __ interactions
drug
TZDs
drug harmful in HF Fluid retention
minooxidil
drug harmful in HF fluid retention and stimulation of RAAS
metformin
drug harmful in HF increased risk of lactic acidosis
cilostazol
drug harmful in HF inhibition of PDE III causing increase ventricular arrhythmias
pregabilin
drug harmful in HF lower extremity edema, HF exacerbation, inhibition of calcium channels
itraonazole
drug harmful in HF negative inotropic activity
Class I and III drugs
drug harmful in HF negative inotropic activity, proarrhythmic effects; avoid dronedarone
Calcium channel blockers
drug harmful in HF non-DHPs negatice inotropic activity and neurohormonal activity
amphetamines
drug harmful in HF tachycardia, atrial and ventricular arrhythmias
corticosteroids
drug induced POAG glaucoma
Adenosine
drug of choice for PSVT
BiDil
drug preferred in african americans to reduce morbidity and mortality
4. __-__ interactions
drug-drug
Assessing and Monitering Therapy: 1. Determine whether __-__ problems are causing any symptoms or problems
drug-related
adenosine, dobutamine, lexiscan
drugs used in stress tests
Diagnostic tests: 1. __ ultrasonography (gold standard for DVTs)
duplex
So for Dofetilide watch for: -renal __ -good for __ __
dysfunction HF
Contraindications of brilinta
dyspnea, fast offset, increased SCr and uric acid
POAG: indirect-acting cholinergic agents
echothiophate iodide - inhibits cholinesterase - last topical therapy option - miosis and myopia side effects
indirect acting cholinergic
echothiophate iodine inhibits cholinesterase
__: ability of a drug to exert an effect
efficacy
0.125
elderly should not exceed this dose of digoxun
Tx for AV Nodal block: 1. correct any underlying __ abnormalities 2. atropine 3. Epinehprine 4. dopamine 5. isoproterenol
electrolyte
2. LVEF is less than or equal to 35%, then conduct invasive __ studies -if VT/VF is inducible: then do an _ _ _ -if noninducible VT/VF, then give __ or __
electrophysiologic ICD BB, amiodarone
5. __ baseline INR
elevated
elevated LFTs with statins
elevations > 2.5-3 times of upper limit of normal occur in <1% patients
Big concern with Afib is the increased __ stroke risk
embolic
AFib increases risk for __ stroke risk. This is caused by the chaotic movement of the atria with allows blood to __ and thus to clot
embolic pool
allergic conjunctivitis antihistamines (H1 receptor antagonists) - types
emedastine, levocabastine
Dr. Rupp says that his biggest lesson has been to
empower the staff
For someone in a-flutter, they don't need as much __ from the DCC asd those with Afib
energy (joules)
three things that are needed to get medical errors down to zero are:
engaged leaders, practices that work, and great technologies (that make it easy to be safe)
__ __: increase in enzymatic activity due to action of a drug (breaks down drugs faster) ---an inducer
enzyme induction
__ __: decrease in enzyme activity due to action of a drug ---an inhibitor
enzyme inhibition
Drugs can work on liver __ within the microsome
enzymes
25 mg qd
eplerenone initial dose
50 mg qd
eplerenone max dose
bound and unbound drug stay in __, so if free drug decreases, proteins will __ a bound drug so that they can have their effect
equilibrium free
concentration dependent killing
eradication of organism depends on (drug) above the MIC -ex: aminoglycosides, macrolides, fluroquinolones
time dependent killing
eradication of organism depends on amount of time (drug)>MIC -ex: β-lactam antibiotics; vancomycin
why don't we give IM UFH
erratic absorption and risk of large hematoma formation
What drug may cause eye damage?
ethambutol
typically can restart warfarin the __ after surgery
evening
4. Correct __ factors
exacerbating
Kidneys are key for __/__
excretion/elimination
__/__: 1. Kidneys 2. lower GI tract 3. Lungs 4. skin 5. sweat, salivary, and mammary glands
excretion/elimination
what factor has the longest half-life
factor II
beta blockers will cause a patient to feel __...like garbage a lot of the time
fatigued
loteprednol
fda approved topical corticosteroid for allergic conjunctivitis
5. __ of side effects
fear
type of fibrates
fenofibrate and gemfibrozil
6. __: degrading clotting factors quickly (fever wants to fight infection...usually involves inflammation)
fever
Statins are the __
first line for dyslipidemia and for primary and secondary prevention
amiodorone, beta blocker
first line for sustained VT? Nonsustained?
beta blockers
first line therapy for chronic angina syndrome
__ __ metabolism and __/__ wall metabolism is decreased a. increased bioavailability b. higher plasma concentrations of some meds like propranolol and morphine
first pass hepatic/gut
__: Probably safe with pregnancy
fondaparinux
__: full or empty stomach, fat content etc impacts absorption
food
Affect Absoprtion: 1. __ 2. __ __ 3. __ 4. __ 5. __ 6. __ 7. __ 8. __, __
food blood flow dosage physiochemical protein concentration route motility/pH
Requires a lot of monitering because of __ and __ interactions
food drug
1 hour before
for a CABG Bivalirudin need to be d/c
5 days before
for a CABG clopridogrel or tecagrelor needs to be d/c
12-24 hours before
for a CABG enoxaprin needs to be d/c
7 days before
for a CABG prasugrel needs to be d/c
ASA, clopidogrel, beta blocker (acei, statin, etc)
for a CABG the discharge meds will be
continue UH or LMWH, plavix and a GB inhibitor
for diagnostic coronary angiography
never try to __ restrain a child to given them meds
forcefully
Ischemic Stroke: Primary Prevention 1. modified __ stroke 10% risk a) high risk with multiple risk factors, take aspirin, __ mg
framingham 81 mg
Two types of agonists 1. __: maximal response that endogenous would give 2. __ : only a portion of the response of what the endogenous product would give
full partial
Liver enzymes are still not __ developed
fully
ADLs can help you figure out their __ status
functional
1. __ __ channels: open or close channels o allow certain ions to pass through the cell membrane
gated ion
may increase risk for __ syndromes, diminished __ status, and increase __ costs
geriatric functional healthcare
Altered Elimination: Reduction of __ __
glomerular filtration
what does telithromycin cover (ketolide)
gram + and some gram - -also cover peptostreptococcus species and atypicals
_ _ interactions: potent inhibitor of Cyp450 iosenzyme 3A4 (binds to the enzyme and doesn't let it go...) decreases first pass metabolism increased bioavailability exaggerated drug affect
grape fruit juice
digoxin: toxicity - what dose
greater than 2 mcg/L
Contraindication of effient
h/o cva or tia, decreased benefit id <60 or >75
seven has shortest __ life, two has longest
half
Dronedarone has a much shorter __ life than amioadarone and it doesn't cause __ issues
half thyroid
fondaparinux
has no effect on platelet function, but contraindicated in severe renal dysfunction and used in the treatment of HIT
anytime you have vasodilation, you can pretty much assume that a patient will experience a __ with that
headache
adverse effects of nitrates
headache, hypotension, tachycardia, dizziness/syncope, flushing,
The office of Healthcare Quality states they are targeting the reduction, prevention, and elimination of _____ along with the reduction of _____.
healthcare-associated infections medication errors
Beta 1 receptors are in the __
heart
K+ is more correlated with __ function
heart
0.5-1 for __ __
heart failure
Afib: -are they __ stable or unstable? -if unstable, use _ _ _ as first-line therapy -if stable, you have to do something to help fix the __
hemodynamically DCC rate
Monitor __ and __
hemoglobin hematocrit
UFH: Management of Bleeding/Excessive Anticoag: 1. __ can occure at any site. Monitor the __ and __ and __ __
hemoglobin hematocrit BP
Adverse effects of all DTIs: 1. Serious __ 2. Minor __
hemorrhage bleeding
Contraindications for Warfarin: 1. Recent __ __ 2. __ (first trimester especially)
hemorrhagic stroke pregnancy
Once HIT is Dx, est, or suspected D/C all sources of __. Initiate alternative anticoag
heparin
HIT: 1.. look for __ antibody formation 2. __ activation
heparin platelet
what does HAT stand for?
heparin associated thrombocytopenia
A dose adjustment is needed with Argatroban if there is __ impairment
hepatic
__ and __ diseases will make it even more difficult because it is hard for them to clear the drug out
hepatic renal
contraindications of ranexa
hepatic impairment, 3A4 inhibitors
niacin dose over 2000 mg may increase risk of
hepatotoxicity
antivirals- trifuridine, ganciclovir
herpes simplex conjunctivitis treatment DO NOT USE STEROID
topical abx/steroid, systemic antiviral tx
herpes zoster conjuntivitis treatment
__ dose: 20,000 units/day for more than 6 months
high
highly lipophilic drugs and those not tightly bound to protein will have a __ Vd and will distribute __ throughout the body
high widely
__ warfarin dose needed with chronic drinkers (increased liver metabolism)
higher
Be __ about what is being given
honest
Recent __
hospitalization
manitol, glycerin, isorbide
how do you treat angle-closure glaucoma?
topical abx (erythromycin) and oral abx-doxycycline (tetracyclines) for 6 weeks
how to treat blepharitis
System flaws can lead to predictable ____
human errors
arteries
hydralazine dilates ______
__/___: beginning of therapy they will go hyper, but over time, it gets exhausted and goes hypo. To treat: 1. __ dose 2. __/__ thyroid meds 3. start prophlthiouracil
hyper/hypothyroidism reduce start/stop
2. clinical __: increased metabolism
hyperthyroidism
adverse effects of morphine
hypotension, ITCHING, headache, nausea
adverse effects of CCB
hypotension, headache, constipation, and gingival hyperplasia
__: only seen in hospital. Something that you use ACUTELY.
ibutilide
If __, then catheter ablation is a good option
idiopathic
VTE treatment: -treat __ and quickly
immediately
If VT is recurrent: 1. first line needs to be __ __ __ 2 Second line needs to be __
implantable cardioverter-defibrillator (ICD) ablation
bacterial conjunctivitis outcome
improvement in one week! stop abx when inflammation is resolved
flecainide, propafenone, sotalol
in pt with no structural heart dz for rate control
7. __ dosage forms or schedules -find out what the patient can do can they swallow a tablet of a certain size? -tailor to the needs of the patient -convenience of times you can take it -time of day
inconvenient
contraindication of DTI
increase risk of bleeding with GP inhibitors renally adjust
liver disease and warfarin
increase warfarin's effect (increase INR)
Vd of lipid soluble meds is __
increased
2nd unprovoked clot, treatment is __
indefinite
treatment of VTE (regardless of anticoagulant) - 2nd unprovoked
indefinite; unless cause identified
coincide with things like __
independence
fibrates MOA
induces lipoprotein-mediated lipolysis and clearance of TG
Treatment for WPW Syndrome: -Rate control agents are __ (they cause bradycardia which is something that would NOT help) -Class __ and __ agents effective
ineffective rate 1a, III
__: 1 month to one year
infants
stye
infection of hair follicles or sebaceous glands of the eyelids caused by staph aureus.
Safe practices reduce medical errors and help reduce ___ and ____, too
infections and costs
IVC
inferior vena cava
__ can disrupt the Blood Brain Barrier
inflammation
conjunctivitis
inflammation of the conjunctiva
blepharitis
inflammation of the eylid margins
FQ's and warfarin
inhibit CYP3A4
allergic conjunctivitis - NSAIDs MOA
inhibit biosynthesis of prostaglandin by decreasing activity of COX
MOA of statins
inhibits HMG-CoA reductase
broad spectrum
inhibits a variety of gram + AND gram -
bactericidal
inhibits bacterial cell wall synthesis
narrow spectrum
inhibits gram + OR gram -
omega-3 fatty acids MOA
inhibits hepatic secretion of TG and promotes metabolism of TG
azithromycin
inhibits protein synthesis, generally bacteriostatic but can be bacteriocidal at high doses (ie loading dose)
niacin MOA
inhibits the hepatic production of VDL and its metabolite LDL
some of the best knowledge to redesign the system comes from the people caught in the cause and effect that has led to the ___.
injury
intraocular pressure
inner pressure of the eye balanced by aqueus humor production, maintains curvature of the cornea
Digoxin: 1. increases __ 2. decreases __ effect
inotropic chronotropic
2. __ prescribing information -always should have a starting direction -pharmacist is depending on you! They can't read your mind, after all!
insufficient
Cytochrome P450 -100 families exist -important because the different families and what kind you have impacts how you metabolize different drugs. Known the Cyp Ps helps personalize medicine -so has a strong correlation to drug __
interactions
4. Lack of __
interest
IPC
intermittent pneumatic compression
INR stands for
internationalized ratio
Absolute Contraindication: 1. __ hemorrhage (current or past history) 2. __ internal bleed (excluding menses) 3. __ at onset of stroke 4. suspected __ dissection 5. Known __ malignancy 6. Intracranial __/head __/previous ischemic stroke within __ months
intracranial active seizure aortic intracranial surgery/trauma/3
__: reversible bond between two charged atoms
ionic
remember, AFib is __ irregular
irregularly
What drug may cause peripheral neuropathy
isoniazid
What drug may cause hepatitis?
isoniazid rifampin pyrazinamide
veins
isosorbide dilates ________
__ are long acting nitrates.
isosorbides
allergic conjunctivitis - NSAIDS - types
ketorolac - only one FDA approved! the rest are mostly for post op: bromfenac flurbiprofen nepafenac diclofenac
4. examine __ test and __ signs that can moniter the efficacy and toxicity of each med
lab vital
angle closure glaucoma - treatment
laser or surgical intervention! pilocarpine!
ranzolazine is __ __ therapy
last line
What are the three weapons against healthcare harm?
leadership, safe practices, and technology
If antibodies do develop, do NOT use this again (__). There have been reports of fatal anaphylaxis
lepirudin
LD50
lethal dose 50
__: any chemical, endogenous or exogenous (i.e. drugs) that interacts with a receptor (the key to the receptor lock)
ligands
diltiazem and verapamil with statins
limit statin dose -simvastatin 10 mg -lovastatin 20 mg
The more __ it is, the further and better distributed it will be
lipid
In general the rate of absorption is faster from a __ formulation than __ formulations
liquid solid
2.5-5 mg qd
lisinopril initial dose
20 to40 mg qd
lisinopril maximum dose
Use of meds with narrow therapeutic indices such as __, __, and __
lithium theophylline digoxin
CYP450 are in the __
liver
when you think metabolism, think __
liver
some drugs are excreted by the __ into the gallbladder for elimination. This is known as __ elimination
liver Biliary
not all drugs require a __ __
loading dose
A __ __ establishes a therapeutic level of medication. This is done with drugs that have longer half lives so that therapeutic level medication can be est. quickly
loading doses
conjunctival hyperemia, increase in iris pigmentation, darkening of eyelid skin
local reaction of prostaglandins
POAG: topical carbonic anhydrase inhibitors - local side effects
local: burning, stinging, foreign body sensation, dry eyes, conjunctivitis
Conservative Approach: 1. used for __ risk patients (NOT STEMI Patients)
low
Peds have __ fluid volume requirements and limited access to __ sites
low IV
a. __ risk: score is 0. no therapy or aspirin b. __ risk: score of 1. Use aspirin or warfarin or dabigatran c. __ risk: score is greater than or equal to 2. Use warfarin, dabigatran, Rivarxaban, or Apixaban
low intermediate high
stress test and optimize medical therapy
low risk nstemi pt's need a
Just remember is metabolism is slow in older patients, so drug concentration stays around longer. So a __ is often times better
lower
__ warfarin dose needed with acute drinking (decreased metabolism)
lower
highly water soluble or protein bound drugs have a __ Vd. Do not distribute __ body
lower throughout
TB of the skin is called?
lupus vulgaris
2. IV __ sulfate 2g over 1 minute a) supplement __ b) alternative: IV Lidocaine, Mexiletine, Isoproternol
magnesium -potassium
Miscellaneous Drugs: -M__: decrease SA node impulse and AV node conduction -A__: control alt delete of the heart. Stops the heart beat...SLOWS AV node conduction -D__: Inhibits Na/K+ ATPase increase PNS tone, decrease SNS flow
magnesium sulfate Adenosine Digoxin
headache
main adverse effect of nitrates
hyperkalemia
major adverse affect of aldosteron antagonist
myalgias with statins
managed by holding drug for few weeks to see whether symptoms impove, consider retrial -usually without CPK elevation
cromolyn, lodoxaxmide, nedocromil, pemirolast
mast cell stabilizers
3. __ the medical problem list with the drug list
match
100 mg
max dose of altepase for a stemi
1000 mg bid
max dose of ranexa
40 mg/kg/day
max pediatric dose of acetominophen
angle-closure glaucoma
mechanical obstruction of aqueous humor outflow through the trabecular meshwork by the peripheral iris. IOP at extreme levels
angle closure glaucoma - pathophys
mechanical obstruction of aqueous humor outflow through trabecular meshwork by peripheral iris IOP IS EXTREMELY HIGH!! MEDICAL EMERGENCY!!
2. assemble a list of __ problems and a __ list
medical drug
IHI open school utilizes____ to reduce medical errors
medical students' checklists
asa or plavix, proper diet and excersize
medical therapy
4. __ adherence -why they need the meds needs to be reiterated
medication
ADLs can change because of __ you give them
meds
there is variance in __ pathway development
metabolic
12.5 to 25 mg qd
metoprolol succinate ER intitial dose
200 mg once
metoprolol succinate ER maximum dose
Dosage definitions: milligrams milliequivalent International units Units
mg mEq IU Units
doses are usually given in __/__ format
mg/kg
a. usually given in __/__/_ requirements
mg/kg/d
warfarin dosing is reported in
mg/week
opthalmic cyclosporine
moa- prevents t cells from activating and releasing cytokines that incites the inflammatory response in the dry eye and increases aqueous tear production
nsaids
moa:inhibit biosynthesis of prostaglandin by decreasing the activity of cox
limit dose to 500 mg bid
moderate 3a4 inhibitors with ranexa are __________
__ is not necessary wit LMWH
monitering
advantages of dabigatran: -no need to __
monitor
Warfarin has to be __ frequently
monitored
Isosorbide __ lasts for about 8-12 hours
mononitrate
itching is normal in someone who receives __ because it causes histamine release
morphine
Drug Therapy for ACS: M O N A H (like lovenox) B
morphine for pain oxygen if less than 90% nitroglycerin IV Aspirin Heparin (preferably LMWH) BBs IV (decrease O2 consumption)
S. pneumonia, H. influenzae M. catarrhalis
most causative bacterial pathogens (3)
adenovirus
most common cause of viral conjunctivitis
bleeding
most comon AE of lovenox
GI __ and __
motility pH
DHP work on smooth __ endothelial vessels, etc
muscle
Administration
must administer most starting at night or with evening meal
hct/hgb and bleeding
must monitor __________ and ________ with heparin
allergic conjunctivitis - vasoconstrictors - types
naphazoline (clear eyes) oxymetazoline phenlephrine tetrahydrolozine (visine) antihistamine/vasoconstrictor combo: pheniramine/naphazoline
slows hear rate
negative chronotropes
__: 1 day to 1 month old
neonates
Polymixins are _____
nephrotoxic
Goals of stroke therapy: 1. reduce ongoing __ injury 2. decrease __ and life-long __ 3. Prevent complications __ to immobility and neurologic dysfunction 4. Prevent stroke __
neurologic mortality disability secondary recurrence
you MUST have a __-__ period every day
nitrate free
Beta blockers CAN be used in combo with __ and __
nitrates CCBs
If had HIT in the past can you receive LMWH
no
Is Sildenafil okay to use with nitrates?
no
is Vardenafil okay to use with nitrates
no
is tadalafil okay to use with nitrates?
no
Adverse Effects of __: bradycardia
non-DHPs
do not use __ and BBs together
nonDHPs
timoptix XE
nonselective beta blocker that allows once daily dosing because of prolong precorneal residence time and increases ocular bioavailability
timolol
nonselective beta blocker that is most common prescribed glaucoma medication
carteolol
nonselective beta blocker with partial beta adrenergic agonist activity
glaucoma
nonspecific term used for a group of diseases that can irreversibly damage the optic nerve resulting in visual loss
primary open angle glaucoma
normal anterior chamber angles with decreased outflow primarily because of the degenerative process in trabecular meshwork
UFH is __ excreeted in breastmilk
not
Treat the patient, not the __
number
Factors that affect Protein Binding: 1. __ status 2. __ function 3. Levels of __ protein
nutritional renal circulating
__ poses a problem to weight based dosing (ideal vs actual body weight)
obseity
polytrim, aminoglycosides, macrolides and fluoroquinolones (-floxacin)
ocular ABX used in bacterial conjunctivitis
allergic conjunctivitis antihistamines (H1 receptor antagonists) - side effects
ocular stinging headache bitter taste
__ drugs are fairly mapped out for dosing for children
older
Drugs to use with BMS: 1. ASA 325 mg daily x __month, then __ mg indefinitely 2. Clopidegrel __ mg daily for 1 year
one 81 75
Long half-life means slow __
onset
morphine
opioid for refractory angina pain
greater response to __
opoids
Because you need something to work immediately with HIT, you cannot use __ anticoag meds
oral
(1)Enteral 1. __(PO) 2. __ (PR) 3. __ (SL)
oral rectal sublingual
Medications that increase risk of Ischemic stroke: 1. __ contraceptives 2. Female __ __ therapy 3. __ drugs (cocaine and amphetamines) 4. __ consumption (acute and chronic) 5. __ smoking
oral hormone replacement illicit alcohol cigarrette
a. errors occur commonly at __ step
ordering
High dose long term with UFH can increase risk for __,
osteoporosis
Inappropriate prescribing: prescribing __ of bounds of accepted medical standards -prescribing meds that should be avoided because of associated __ -Dose, duration, duplication, drug-interaction problems -__ List
outside risks Beers'
Decline in phase I metabolism (__) is likely due to decrease in __ __ flow, NOT reduced enzyme activity
oxidation hepatic blood
Tx for AV nodal block: -if symptomatic, then put on a permanent __
pacemaker
making PO meds __
palatable
triglycerides over 500 or higher worry about
pancreatitis
Altered Absorption: Most drugs are absorbed via __ diffusion and age-related changes don't affect it much
passive
Types of Absorption: 1. __ diffusion 2. __ diffusion 3. __ transport 4. __
passive facilitated active endocytosis
6. Failure of __ or __ to give meds
patient parent
bare metal stent
pci with less platelet aggregation on stent and restenosis more likely
drug-eluting stent
pci with more platelet aggregation on stent but restenosis less likely
__: less than 18 years old
pediatric
10-15 mg/kg/dose q4h
pediatric dose of acetaminophen
10 mg/kg/dose Q6-8h
pediatric dose of ibuprofen
LMWH is preferred agent in
pediatrics: monitor antifactor Xa
40-75%
percent of ear infections that are caused by viral pathogens
PCI:
percutaneous coronary intervention
e. AHRQ it is recommended that a pediatric __ be on pediatric wards
pharmacist
__: study of therapeutic uses and effects of drugs
pharmacotherapeutics
pilocarpene
pharmocologic drug used in treating dry eyes, that cholinergic agonist bind to muscarininc receptors and improves tear function
ceveline
pharmocologic drug used in treating dry eyes, that is a cholinergic agonist
The reason you should be wary of using Nitrates with __ is because BOTH are vasodilators
phosphodiesterase
amiodarone can cause __ and skin __ (blue color) (remember it stays in skin and never leaves...) -wear sunscreen -wear a hat! -can be reversed
photosensitivity discoloration
__ properties of the drug -hydrophilic or lipophilic?
physiocochemical
direct-acting cholinergics
pilocarpine and carbachol causes contraction of ciliary muscle and increases aqueous humor outflow
antiplatelets are used for __
plaques
Body Compartments: 1. __: 5% of body weight 2. __ fluid: 16% of body weight 3. __ fluid: 35% of body weight 4. __ fluid: 2% of body weight 5. __: 20% of body weight
plasma interstitial intracellular transcellular fat
thrombocytopenia
platelet count of less than 150,000
increasing contractility
positives inotrope
__ alterations ---second action doesn't get done ---gets on receptor...but downstream impacts are diminished/absent
postreceptor
__: ability of a set dose to produce maximal effect (takes less to get same effect, etc)
potency
UFH: MOA
potentiates antithrombin's effect and in return, inhibits Factors IIa (thrombin) & Xa
UFH
potentiates antithrombin's effect and in return, inhibits Factors IIa (thrombin) and Xa
3. Dabigatran: __
praxband
Advantages over UFH: 1. __ anticoag dose reponse
predictable
advantages of LMWH over UFH
predictable dose response, improved bioavailability, lower incidence of thrombocytopenia, reduced need for lab monitoring
Dronedarone is a category X for __. You must think about women who are at child-bearing age.
pregnancy
Risk from UFH causing osteoporosis is esepcially high during __
pregnancy
UFH Special Populations: drug of choice during __
pregnancy
contraindication of ASA
pregnancy, bleeding, or 24 hours of thrombolytic
__; born prior to 37 week gestation
premature
c. Errors occur commonly at __ step
preparation
long acting nitrates
prevent an acute angina attack
allergic conjunctivitis antihistamines (H1 receptor antagonists) - MOA
prevent histamine response in blood vessels by preventing its binding
beta blockers, calcium channel blockers, long acting nitrate, ranolazine
prevention of angina
statin
prevention of atherosclerosis
ASA 81 mg qd
prevention of thrombosis
Class IV agents will __ the QRS complex
prolong
amioadarone __ repolarization
prolongs
LMWH limited activity against thrombin
proportionally greater antifactor Xa activity
latanoprost
prostoglandin thtat is available in generic
2. UFH and LMWH: __ -onset is within 5 minutes
protamine
2. when major bleeding occurs: -discontiue UFH immediately . Reveral: administer IV __ sulfate 1 mg/100 units of UFH (max 50 mg)
protamine
__ binding affects absorption...can kidnap drug affects
protein
drugs bound to __ are not available to interact with receptors and cannot exert their effects
protein
Meds and Body compartments: 1. highly __ bound meds say mainly in plasma and yield small Vd 2. __-__ meds are mainly confined to plasma and interstitial fluids. Most do not enter brain after acute dosing 3. __-__ meds reach ALL compartments and may accumulate in fat (ADEK vitamins)
protein lipid-insoluble lipid-soluble
aqueous humor
provides oxygen and nutrition to the avascular lens and cornea
watchful waiting
pt i 6mo-2y.o without severe symptoms initiate pain management ensure appropriate f/u
INFORM PATIENT of: 1. __ toxicity 2. __ 3. __risk 4. should be initiated in __
pulmonary hepatotoxicity proarryhthmic hospital
some meds go through body more __ because they have a faster Basic Metabolic rate
quickly
They need to let you know if they decided to __ or __ smoking (will affect how you dose)
quit start
Other issues affecting metabolism: R S F S D D-D interaction
race sex frailty smoking diet drug-drug
Do not use __ if someone is taking Ketoconazole (3A4 inhibitor)
ranolazine
Beta blockers are __ controlled
rate
Drug Therapy for PSVT: 1. want to slow down the __ a. __: slows conduction to AV node...a lot...remember it is the conductor that says...STOP! b. 6 mg bolus c. max amount is __ mg d. get in in __ seconds or less
rate adenosine 30 mg 30 sec
the __ of elimination of a drug remains constant. The actual amount of drug eliminated is proportional to the concentration of the drug. SO. the more drug there is, the __ it is eliminated
rate faster
for afib, try __ control first (II or IV) maybe even look at increasing __ period
rate refractory
kidneys: 1. __ or active tubular __ 2. Glomerular __ (have to be low molecular weight or bound to protein...proteins cannot be secreted) 3. Passive __ across tubular epithelium
reabsorption, secretion filtration diffusion
Pharmacodynamics typically occur because a drug interacts with a __
receptor
can be altered changes in __
receptors
diuretic
recommended in pts with HFrEF who have evidence of fluid retention
__: erratic absorption
rectal
Atrial Fibrillation -__ patients symptoms -get them back to _ _ _ -__ another exacerabation of NSR
reduce NSR prevent
what should you do if you're on a beta blocker and you have bradycardia, GI symptoms, headaches, dizziness, fatigue, lethargy, etc?
reduce the dose
3. __ need for lab monitoring
reduced
Short-acting nitrates can have __
refills
adverse effects of DHP (dihydropyridines)
reflex tachycardia (if not given with a Beta Blocker), peripheral edema
adverse effects of beta blockers
reflex tachycardia, bradycardia, fatigue, sexual dysfunction
stage D
refractory HF requiring specialized interventions
Have to really watch __ function and CrCl with LMWH
renal
cephalosporins are cleared by _______
renal elimination
carbapenems decrease seizure threshold in patients with ___________
renal impairment or CNS disease
can be caused by decrease in __ __
renal mass
Lepirudin is __ eliminated and so you must adjust the dose for __ impairment
renal(2x)
UFH is not __ cleared. So that's good for people who have bad kidneys
renally
penicillins are cleared ____
renally
Vancomycin is ___
renally excreted; nephrotoxic potential -> monitor trough levels
aminoglycosides are ______
renally excreted; reversible nephrotoxic potential -> monitor peak and trough levels
Class III: -Increase __ time -Can display "__-Use Dependence"
repolarization Reverse
Sympathetic Relief For Afib: 1. __ the rate 2. __ symptoms 3. Prevent __
restore relieve recurrence
Rivaroxaban has no __ agent and should be given with food and at time with _ _ _ discontinuation and once INR is below __
reversal UFH 3
Bivalirudin is a __ thrombin inhibitor.
reversible
Protein binding is typically __
reversible
rhabdomyolysis with statins
reversible with drug discontinuation -risk factors: advanced age (older than 65), drug interactions -measure CPK
Pradaxa MOA
reversible, direct thrombin inhibitor that inhibits both free and fibrin-bound thrombin
Class III agents are __ control agents as well.
rhythm
Drugs that block Na+ channels will control/change __ of the heart
rhythm
Class IV doesn't affect the slopes of any of the APs, so it will not impact the __ of the heart, but they do influence the __ of the heart
rhythm rate
odd number classes are __ controlled even number classes are __ controlled
rhythm rate
What drug may cause orange discoloration of the urine?
rifampin
__ of administration
route
Bioavailability depends on the __ and the drug's ability to cross __ and __ in the body
route membranes barriers
Aspirin is __ to use in pregnant patients
safe
LMWH is __ in pregnancy, does not cross placenta
safe
8. Medication __
safety
Infected lymph nodes located in the neck/cervical region is called?
scrofula OR cervical tuberculous lymphadenopathy
2. Drug Administration may have many steps involved: a. __ the drug b. __ the dose c. __ the dose d. __ the dose
selecting calculating (ib to kg ratio) preparing Delivering
LMWH MOA
selectively accelerates interaction of antithrombin with Factor Xa
__: preference of a drug for a particular binding site/s
selectivity
bacterial conjunctivitis - info
self limiting, abxfor 5-7 days! acute (pink eye) - caused by gram positive bacteria (strep pneumo, staph aureus, h. aegyptius) chronic - caused by staph, moraxella, or other opportunistic infections
SNOT: depend on vit K (some factors in the anticoag)
seven nine ten two
contraindications of beta blockers
severe bradycardia (<50), AV block, unstable heart failure
Fondaparinux is contraindicated in
severe renal dysfunction
3. lack of understanding about illness __
severity
__: body fat differences, hormone effects
sex
Indications for Nitrates: 1. __acting: terminated acute angina attack 2. __ acting: prevent an acute angina attac
short long
after angiography you must determine if patient has __ coronary disease if if __ is needed
sig PCI
make regimens as __ as you can
simple
__ of compartment is necessary to figure out Vd
size
Adenosine
slows AV nodal conduction - "control-ALT-DLT" drug
2. __ cessation
smoking
5. __ and __ use: induce Cyp1A2. This requires an increased warfarin dose.
smoking tobacco
what does clarithromycin cover
some gram + and some gram - -atypicals
S A I D D
sotalol amiodarone (max 20mg with simvastatin) Ibutlide Dofetilide Dronedarone
__: how well drug interacts/binds to a receptor
specficity
12.5 to 25 mg qd
spironolactone initial daily dose
25 mg qd or bid
spironolactone max dose
aldosterone antagonist: adverse effects
spironolactone: - hyperkalemia - antiandrogen effects - gynecomastia - decreased libido - impotence - menstrual irregularities - hair growth in women eplerenone: - hyperkalemia (higher incidence than spironolactone) - contraindicated with K>5.5 meq/l, CrCl <50ml/min, Scr >1.8 mg/dl in women or > 2 mg/dl in men, type 2 DM with proteinuria - STOP in diarrhea
always start a __
statin
CPK
statins and niacin use together - you should check
fibrates drug interaction
statins interact
__ __: the condition in which the rate of drug administration and the rate of drug elimination are equal
steady state
allergic conjunctivitis - vasoconstrictor MOA
stimulate alpha adrenergic receptors reducing ocular congestion and redness
what should you do if you're on a beta blocker and you have bronchospasms or severe depression
stop the dose!!
2. do a __ test (physical, nuclear, or pharmacological) ONLY DO THIS WHEN THEY ARE STABLE
stress
Paroxysmal Supraventricular Tachycardia: -can be induced by __ -seen in __
stress kids
adenosine, dobutamine, regadenoson can be used for a __ __
stress test
contraindicated
strong 3a4 inhibitors with ranexa are __________
Stage B
structural heart disease but without signs or symptoms of HF
stage C
structural heart disease with prior or current symptoms of HF
nitroglycerin is normally given __
sublingually
Metoprolol is also good to know. --__ is long-acting. Helps with HF --__ is immediate release
succinate tartrate
inhibition of folate synthesis
sulfonamides
4. __ care
supportive
Additional Properties of BBs: 1. effective in situations of high __ tone (like stage fright) 2. Interfere with __ entry into the cell by altering catecholamine-dependent channels.
sympathetic
POAG: alpha agonists - side effects
systemic (brimonidine) - dry nose/mouth, mild hypotension, decreased pulse, lethargy local (apraclonidine) - burning, stinging, blurring, conjuctival follicles, hyperemia, pruritis, edema, foreign body sensation
POAG - treatment: beta blocker side effects
systemic: - tachyphylaxis - bronchospasm - pulmonary edema, cardio: - bradycardia, hypotension local: - stinging - conjunctivis - keratitis - dry eye - uvetis
One stance against criminalization of human error states that in most cases there are obvious explanations for the errors usually involving the ____ in which they were working.
systems
Hospitals need to be responsible for their bad ____ and fix them so that _____ people are not deemed incompetent.
systems, competent
Half-life symbol is
t 1/2
_ _ _ is the only FDA approved agent for ischemic stroke
tPA
3-4.5 hrs
tPA (not preferred) can only be given if ischemic stroke occured within___ of pt presenting/onset of symptoms
.9 mg/kg up to 90 mg (10% bolus over 1 min)
tPA dose and dose rate
2-3
target INR for warfarin
atypical coverage medications all
target something in cell other than cell wall
INR mechanical prosthetic heart valves target/range
target: 3 range: 2.5-3.5
Always consider when prescribing for Peds: 1. __ 2. __ 3. __ 4. __ 5. __ __ 6. __
taste smell color consistency dosing frequency cost
pregnancy and warfarin
teratogenic avoid in pregnancy
short acting nitrates
terminate an acute angina attack
culture
test to find germs (such as bacteria or a fungus) that can cause an infection
What is the leader's blueprint to chasing zero?
the National Quality Forum's safe practices
The Check a Box, Save a Life campaign models what?
the aviation industry's use of standardized checklists
minimum inhibitory concentration (MIC)
the minimum concentration of antibiotic that will inhibit the growth of an isolated microorganism -methods: broth dilution, agar dilution, e-test
Who is often an unused part of the healthcare team?
the patient
__ __: refers to dosage range or blood plasma or serum concentration usually expected to achieve therapeutic effects
therapeutic range
Digoxin
therapy of choice for Afib with decompensated HF (rate control)
What is the essential reason most people go into healthcare?
they care about people, care about health status, and want to save lives
never __ or __ a child into taking a med
threaten shame
2. __: avoid with HIT hx/dx (LMWH)
thrombocytopenia
2. lower incidence of __
thrombocytopenia
Adverse effects: __ is common in UFH (less than 150,000 platelets)
thrombocytopenia
altepase (activase)
thrombolytic that come with prepackaged instructions and cannot be used in NSTEMI pts.
Prevention of __: ASA 81 mg daily
thrombosis
first few days on warfarin, you are actually more prone to __ because of inhibition of Protein C and S
thrombus
Good at treating arrythmias that are contributed to the __
thyroid
You need to start on low doses and __ up when giving BBs
titrate
you don't have to __ down with short-acting nitroglycerin
titrate
patients can develop a __ to nitrates quite easily
tolerance
Short-acting Nitrates: 1. Dissolve table under __ on onset of chest pain and every 5 minutes for a max dose of __ tablets in 15 minutes. 2. Store in original __ glass vial with air-tight seal (sensitive to light, sensitive to moisture) 3. __ after expiration date (even if they haven't had to use any of their vials, chunk them and get a new Rx)
tongue 5 amber discard
__: erratic, but complete
topical
-mide dorozolamide, brinzolamide
topical carbonic anhydrase inhibitors
ocular emergencies - corneal abrasions: treatments
topical nsaids - decrease pain - caution in pts with clotting disorders or ppl on warfarin topical abx - prophylactic - d/c use of contacts until healed and abx is complete - if pt wears contacts - abx should cover psuedomonas aeruginosa like gentamicin or a fluoroquinolone
peaks and troughs are typically looked at for drugs with high __
toxicity
__: studies the effects of poisons
toxicology
allergic conjunctivitis - mast cell stabilizers AE
transient burning, stinging, pruritus, blurred vision, dry eyes, taste alteration, foreign body sensation
allergic conjunctivitis - NSAIDs AE
transient stinging, burning, irritation, inflammation, corneal edema, irits
decrease oxygen demand, increase coronary blood flow, prevent vasospasms
treatment goals for HF
short acting nitrate
treatment of angina
hot, moist compress and topical abx
tx of stye
bacterial , meibommian gland dysfunction, seborrheic
types of blepharitis
Prevent recurrence of Vtach. -correct the __ cause
underlying
Makes antithrombin on "steroids"
unfractionated heparain
heparin
unfractionated heparin, and enoxaprain (lovanox)
8. __ of meds -how does it taste? -something you have to prepare them for -flavor it if you can
unpalatability
UFH: monitoring __ anticoag patient response
unpredictable
affected meds: (mainly) 1. __ 2. __
vancomycin aminoglycosides
age related macular degeneration - treatment of wet form
vascular endothelial growth factor (VEGF) - pathogensis of choroidal neovascularization - use inhibitors as treatment agents (pegaptanib, bevacizumab, ranibizumab)
If patient is hemodynamically STABLE then __ rate control should become your focus. a. __ conduction b. increase __ in the AV Node.
ventricular slow refractoriness
14 days
viral infectious conjunctivitis is contagious for _____
cigarrettes contain __ __
vit K
mayonaise has a lot of __ __
vit K
1. Warfarin: __ __
vitamin K
niacin other name
vitamin b3
use appropriate __ to explain what is being given so kid isn't afraid (children are capable of understanding)
vocab
Vd means
volume of distribution
clearance is expressed as __/__
volume/time
if someone cannot take Plavix or ASA, then put them on __
warfarin
Parenteral anticoagulation therapy should be overlapped with __ for at least 5 days and until the INR is __than 2 an stable to allow enough time to reach its full effect.
warfarin greater
Warfarin has to be adjusted __ once a patient has been established on it
weekly
Can take __ to get INR back to normal after vit K administration, so be judicious about it
weeks
Dose is based on __ for treatment when it comes to Fondaparinux
weight
Fondaparinux is based on _______ for treatment
weight
b. calculations for __ based on dose
weight
Pulmonary fibrosis, hepatotoxicity, photo-sensitivity/smurf syndrome, thyroid issues, corneal microdeposits
what are the adverse effects of Amiodarone
ranexa
what decreases oxygen demand and maintains cardiac function without reducing heart rate or blood pressure
nitrates
what decreases vessel tone and sx due to spasm and decrease oxygen consumption?
Iv Digoxin*, amiodarone
what do you use for acute rate control in a Afib patient with a EF < 40 %
carvedilol
what drug do you have to take with food?
600 mg, 450 mg
what is the pill in pocket dose of Propafenone for a patient that weighs 85 kg? Less that 70 kg?
aPTT
what is used to monitor UFH other than anti-Xa levels (rarely used)
phase 3
what phase of the cardiac action potential deals with K+
renal function (cr cl) and K+
what should be monitored while on aldosterone antagonists
post op
when is apraclonididine used (not in a clinical setting)
heparin
which agent can cause osteoporosis if given for a long time at high doses
Class II & IV
which antiarrhythmics deal with rate (effect the plateau)
Class I & III
which antiarrhythmics work on rhythm (effect the slope)
aspirin
which drug works by irreversibly inhibitng COX-1 pathway
how should you take carvedilol?
with food!
How many board chairs of bottom preforming hospitals thought they were below average?
zero
Ezetimibe other name
zetia
