Kats NAPLEX questions Luridefluroide Available as 0.25mg, 0.

.5 mg, 1 mg tablets Dont give with milk, but do take with food Dont eat/drink for 30 mins after taking When to hold Metformin SCr of 1.5 in males, 1.4 in females 24h before and 48h after contrast media CrCl Formula (140-age) x IBW Scr x 72 x 0.85 if female IBWmales=50 + (2.3 x in>5ft) IBWfemales=45.5 + (2.3 x in>5 ft) Normal values: men: 0.8-1.3 mg/dl mg/dl female: 0.6-1.0

References PDR: mgf info, monographs AHFS: hospital, off label uses, hospital coding system Facts & Comparisons: general info, investigational, OTC & rx, Canadian products Martindales: US Equivalents Meylers: Ses Red Book: Poison control center, AWP, Mfg info, herbal guides, otc info Harriet Lane Handbook: Peds Index Nominum: US Equivalents Briggs: Pregnancy Category Trissels: IV Hale: Meds and Mothers Milk Kings: Guide to Parental Admixtures Hanstens: Drug Interactions Analysis and Mgmnt Mandells: Principles and Practice of Infectious Diseases Harrisons: Principles of Internal Med Dipiro: Pharmacotherapy: A Pathophysiologic Approach RemingtonThe Science and Practice of Pharmacy: chemistry stuff, nomenclature, structure, solubility Chi Square Testanswers ?s about rates, proportions or frequencies Tell if there is a difference b/t populations for the rate at which outcomes happen, but wont tell you where the difference is AsthmaDrug Dosage Forms Inhaled Corticosteroids o Beclomethasone (Beconase AQ, QVAR)MDI, nasal spray 1

o Budesonide (Pulmicort, Rhinocort)powder for oral inhalation, nose spray, nebulizer soln o Flunisolide (AeroBid)MDI, nose spray=Nasarel o Fluticasone (Flonase, FloventHFA)MDI, nasal spray o Triamcinolone (Azmacort)MDI, Nasacort AQnasal spray o Fluticasone + Salmeterol (Advair Diskus) Cromolyn (Intal)MDI, nebulizer soln, NasalCromnasal spray Beta-agonists o Albuterol (Ventolin, Proventil)MDI, nebulizer soln, syrup o Levalbuterol (Xopenex)nebulizer soln, aerosol (MDI) Long-acting beta-agonists o SalmeterolServent Diskus o FormoterolForadil Aerolizer Anticholinergics o Ipratropium (Atrovent)MDI, nebulizer soln, nasal spray o Tiotropium (Spiriva)capsule inhaler

Preventing a child allergic to pollen from having an asthma attack Antihistamines o Claritin: 5 mg daily (2-5 yo) o Zyrtec: 2.5-5 mg daily (2-5 yo) o Allegra: 30 mg BID (6-11 yo) o Clarinex: 1.25 mg daily (1-5 yo), 2.5 mg daily (6-11) Cromolyn + inhaled corticosteroids o Cromolyn: 1 spary each nostril 3-4x/day Drugs that can cause lupusthese are the ones with the most evidence Procainamide Methyldopa Hydralazine Penicillamine Isoniazid Quinidine Chlorpromazine Drugs to tx lupus ArthritisNSAIDs, glucocorticoids Dermatologichydroxychloroquine Refractory casescyclophosphamide, splenectomy Amiodarone SE CVhypotension CNSdizziness, HA, fatigue, coordination problems Photosensitivity N/V, anorexia, constipation, AST & ALT Risk of pulmonary issues as dose goes about 300 mg/day Tests to test drug absorption in GINo idea & didnt think it was that important Hardness of tab influences the ability to break apart in the stomach. Tab must disintegrate in the stomach before you can have dissolution. 2

Abx use in otitis mediainflammatory process in the middle ear Happens b/c kids tubes are shorter and more horizontal than adults, drainage cant drain ~1/2 of cases are viral Bacterial causes: Strep pneumo, H.flu, Moraxella catarrhalis DOC: Amoxicillin 80-90 mg/kg/day x 7-10 days Amox/Clavsame dosing based on Amox content PCN Allergic: o Cefdinir (Omnicef), Cefuroxime (Ceftin), Cefpodoxime (Vantin) o Azithromycin, clarithromycin Use APAP & ibuprofen for pain relief Abx Use in CF 2 IV Abx for 14-21 days Coverage for: Staph aureus, H. flu, and Pseudomonas If suspect Pseud. Use antipseudomonal PCN or ceph w/ an AG o FQonly oral abx w good pseudomonal coverage Chronic inhaled abx therapy w/ tobramycinexpensive Sulfasalzinemetabolized into 5-aminosalicylic acid Ulcerative colitis MOA: Acts in colon to inflammatory response, interferes w/ secretions by inhibiting prostaglandin synthesis Pulmozymeused in a jet nebulizier Used in CF to infxns and improve pulmonary fxn Vaccine Use in AIDSDont use ones that are live (varicella) Vaccines in Pregnancy Avoid MMR b/c of rubella part Avoid any live vaccines, inactivated vaccines shouldnt be given until 2 nd trimester Diphtheria, tetanus, Hep B, inactivated polio and pneumococcal are recommended If pregnant during flu seasonget flu vaccine Vaccines in Asthma Ptswww.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf Persistent asthmaflu vaccine Varicella for kids getting intermittent systemic corticosteroid tx Polio Vaccineavailable orally and SQ (apparently this person had lots on vaccines) PrevnarPneumococcal conjugate vaccineIM Age for PrevnarSheet says Peds up to 5 yo and usually delayed until 2 yo APHAPrevnar for children 2-23 months and certain children 24-59 months Final shot in series to be given when child is at least 1 yo Live Vaccines Influenza Measles 3

Mumps Rubella (Together in MMR) Typhoid-oral

Varicella Vaccinia (smallpox) Yellow fever

Chemo Drugs that must be stored in fridgethis is pretty ridiculous to know if you ask me Melphalan tablet (Alkeren) Docetaxel (Taxotere)IV Chloramubucil (leukeran)PO Teniposide (Vumon)IV Thiotepa (Thioplex)IV All of the vinca alkaloids o Vincristine (Oncovin) Busulfan (Myleran, Busulfex)IV o Vinblastine (Velban) CarmustineIV o Vinorelbine (Novelbine) Streptozocin (Zanosar)IV Aldesleukin (Proleukin)IV o Stable at room temp for 1 yr Interferon-alfa 2b (Intron A)IV and SC Carmustine w/ Polifeprosan 20 (Gliadel) Rituximab (Rituxan)IV o Implant All MABs Pentostatin (Nipent)--IV o Trastuzumab (Herceptin)IV and SC Cladribine (Leustatin)IV o Gemtuzumab (Mylotarg)IV Fludarabine (Fludara)IV o Alemtuzumab (Campath)IV Doxorubicine (Adriamycin)IV o Bevacizumab (Avastin) Epirubicine (Ellence)IV o Cetuximab (Erbitux)--IV Idarubicine (Idamycin)IV Denileukin difitox (Ontk)IVfrozen Mitoxantrone (Novantrone)IV Ibritumomab tiuxetan (Zevallin) Valdrubicin (Valstar)intravesically Tositumomab (Bexxar) o Bladder CA Asparaginase (Elspar)IV BleomycinIV, IM, SC Drugs to Mix with Sterile WaterOnly went through the top 100 b/c had to look up each drug Zithromax Prevacid, Nexiumthen further diluted with NS, LR or D5W before administration Warfarin Zyprexa (Olanzapine) BPH Sx: weak urinary stream, incomplete bladder emptying, straining Drugs that reduce static factorinterfere w/ testosterones stimulating effect on prostate enlargement o Finasteride (Proscar)5 mg daily SE: ejaculation disorders, ED Pregnancy Category X Drugs that reduce dynamic factorrelax prostatic smooth muscle o Prazosin (Minipress)2 mg BID-TID SE: 1st dose syncope, orthostatic hypotension, dizziness o Terazosin (Hytrin)1-10 mg daily o Doxazosin (Cardura)1-4 mg daily o Tamsulosin (Flomax)0.4-0.8 mg daily Dont have to titrate to dose, b/c hypotension isnt a common AE 4

Remember TURP from GA reviewenlarges opening at bladder neck

CHF (APHA book, p 191-192) Cause: heart cant pump enough blood for the body o Most common causes: CAD & HTN Compensatory mechanisms help maintain cardiac output o These lead to HF sx and disease progression Avoid drugs that can precipitate or worsen HFNSAIDs, verapamil, diltiazem Goal of diuretic tx: get rid of fluid, which will minimize sx ACEIsimprove survival & slow disease progression BBsrecommended for all pts w/ systolic dysfxn & mild-mod sx o Improve survival, hospitalization, slow disease progression o Proven benefits: bisoprolol, carvedilol, and metoprolol xl Start @ low doses & titrate up Digoxinno improvement on survival, but provides symptomatic benefits Spironolactone & eplerenoneimprove survival in mod-severe HF Advanced or decompensated HFhospitalization, IV diuretics, vasodilators, (+) inotropes Herbs for Depression St. Johns Wort: o Interactions: PCs, protease inhibitors, MAOIs, antidepressants, cyclosporine, dig, iron, warfarin Valerian: o SE: GI complaints, withdrawal sx o Interactions: barbiturates, BDZs Mugwort, California poppy, lemon balm, basil, passion flower, marijuana, kava-kava Remember Saw Palmettono longer recommended for BPH

Monitoring in RA Each visit: Degree of joint pain Duration of morning stiffness Duration of fatigue

Presence of actively inflamed joints Limitation of fxn

Periodically to evaluate disease activity or progression: Evidence on physical examloss of motion, instability, malalignment, deformity ESR or C-reactive protein elevation Progression of radiographic damage of joints MDs assessment, pts assessment, using standardized questionnaires to evaluate fxnl status & QOL Monitoring of IBS Improve sx and QOL Monitor for IBS sxabdominal pain, diarrhea, constipation, heartburn, dyspepsia, nausea Lab Valuesp 828-830 in APHA book 5

How to tx High K+ Normal: 3.5-5.1 mEq/L Sx: muscle cramps, weakness, cardiac arrhythmias Tx Options: o Remove K+--slower acting Kayexalatesodium polystyrene sulfonatePO or PRmust give with sorbitol (most forms have) Loop diuretics Hemodialysis (if severe) o Shift K+ back into cellsquick Regular insulin + IV dextrosecan do insulin by itself if diabetic or if glucose > 250 Albuterol Sodium bicarb o Antagonize cardiac effects of K+--rapid onset IV Calcium Repeat until have normal EKG b/c its short acting ANCabsolute neutrophil countp. 5 of GA calculations pack Segs + Bands = ANC Drugs Used to Prevent Cold/Flu Echinaceastart when sx start & continue until o Allergic rxns possible o Limit use to 6-8 wks b/c tolerance can develop Zicamnasal spray, oral mist, rapid melts, chewables, nasal swabs o Start using when you feel sx & for another 48 hrs after sx are gone o Active ingredient: zincum gluconicum Vit C o Mega doses of Vit C dont help tx or prevent cold o Ppl exposed briefly to severe physical exercise & cold weather may benefit o Regular Vit C supplementation did show small in duration & severity of cold sx Zinc-- duration & severity of cold sx o Give w/in 24 h of sx AirborneVit A, C, E, riboflavin, Mg, Zn, selenium, manganese, K+, amino acids, ginger, echinaces, etc. o Effervescent tablets Triptans5HT receptor agonists -DDI: SSRIs Questions to ask before heme guaic exam Vit C useantioxidant that can interfere w/ test Visual limitationssomething to do with card turning blue I think HemorrhoidsCould cause a false (+) Aminophylline to theophylline conversion Theophylline has 80% bioavailability Going from theophylline to aminophyllinedivide theo dose by 0.8 6

Going from aminophylline to theophyllinemultiply aminoph dose by 0.8 Greenwoods calc pkt & GA pkt have examples

PhosLoCa Acetatephosphate binder Use: Orallyhyperphosphotemia in ESRD, doesnt promote aluminum absorption, give w/ meals o IVCA supplement in IV nutrition Combines w/ phosphate & is then excreted through feces Hypermagnesemia Normal Mg: 1.5-2 mEq/Lmost is stored in bone Death d/t muscle relaxation (heart failure) Usually secondary to renal failure or taking in too much Mg Tx: o CaCl1 g over 5-10 mins (or calcium gluconate) Antagonizes neuromuscular & CV effects Quickly reverses sxmay need multiple doses o Loop diuretics & salineonly if pt has enough renal fxn Initial dose: 40 mg IV o Dialysistx choice w/ renal dysfxn MTX in juvenile RAoral or IM dosing 10 mg/m2 once weekly, then 5-15 mg/m2/week as a single dose or 3 divided doses given 12 hours apart Monitoring TB Drugs Isoniazid o Periodic LFTs (Review said exam said AST & ALT) o Monthly sputum cultures o Prodromal signs of hepatitis Rifampin o LFTsAST, ALT, bilibaseline and every 2-4 wks o CBC o Hepatic, mental status o Sputum culture, CXR after 2-3 months of tx Pyramizinamide o Periodic LFTs o Serum uric acid o Sputum, CXR MOA of Allopurinol (Zyloprim)xanthine oxidase inhibitor Xanthine oxidaserate-limiting step in the formation of uric acid Also has an active metabolite Clear more water soluble precursors of uric acidoxypurines MOA of Uricosuric Drugs Benemid (Probenecid) Anturane (sulfinpyrazone) Promote excretion of uric acid by blocking its reuptake at the proximal convoluted tubule 7

Drink at least 2 L of water/day to chance of uric acid stones forming

Zyvox dosage formsLineazolidan oxazolidinone Infusion, powder for oral susp, 600 mg tabs Biaxin storageClarithromycin DO NOT REFRIGERATEmight gel Stable 14 days @ room temp after reconstitution Prilosec in OJNot stable in an acidic environment Compound is made with sodium bicarb Tobramycin w/ dialysis Dialyzableall AGs are Dose after dialysis Topical tocolyticstocolytics stop labor, but oxytocin induces labor Oxytocin is NOT topical PGE-2-dinoprostoneCervidil, Prepidil, ProstinE2gel applied to cervix to induce labor o Also a vaginal suppository Precose (Acarbose)take with 1st bite of meal Same for Miglitol (Glyset)both are alpha-glucosidase inhibitors Meglitinides are also taken before mealtime o Starlix (Nateglinide) o Prandin (Repaglinide) Diabeta is most like Prandin Both are secretagoguesthey squeeze the pancreas Diabeta (glyburide)2nd generation sulfonylureasqueezes pancreas all day Prandin (repaglinide)meglitinidequick squeeze of pancreas Filgrastim (Neupogen)used to tx agranulocytosis (I think this ? was about which drugs did/did not cause agranulocytosis) Granulocyte colony stimulating factor Used for neutropenia, BMT or if pt is getting their cells collected SE: fever, alopecia, N/V/D, bone pain NOT stable in NS, must be refrigerated MOA: Stimulates production, maturation & activation of neutrophils Glyset (Miglitol)twill not cause hypoglycemia Alpha-glucosidase inhibitorcauses carbs to be absorbed slower Drugs that can cause hypoglycemia: sulfonylureas, insulin, Symlin (Pramlintidethe new amylin agonist) Medroxyprogesteroneneeded for uterine cancer prevention Provera, Depo-Provera400-1000 mg IM q week Drugs that come in a nasal sprayI went through the top 200 Stadol (Butorphanol) 8

Miacalcin (Calcitonin) Desmopressin (DDAVP) Fluticasone (Flonase) Mometasone (Nasonex) Budesonide (Rhinocort Aqua) Sumatriptan (Imitrex)

Calculating a TMP dose from Bactrim Bactrim: SMX 400 mg, TMP 80 mg Bactrim DS: SMX 800 mg, TMP 160 mg Epogen=Epoetin Alfa Epogen & HTNHTN was apparently hidden in the profile This is the only connection I can find HTN can lead to kidney disease In ESRD you develop normochromic, normocytic anemialack erythropoietin b/c kidneys cant make it o Requires use of Epogen (or Procrit) o Given IV or SQ o Epoeitin is DOC for long-term correction and maintenance of Hct levels in pts with CKD or ESRD Tegretol and DM while pregnant Gestational DM o Risk factors: obesity, h/o DM, glycosuria, family hx o Low riskmust meet all: < 25 yo, normal pregnancy wt, no known DM in 1 st degree relatives, not in ethnic group with high prevalence, no h/o abnormal glucose tolerance, no h/o abnormal pregnancy outcome o Ethnic groups prone to GDM: AAs, Hispanic/:atino, American Indians o 1st line therapy: exercise & nutrition, caloric intake for obese women o Next: Insulin (human) o Glyburide can be considered after 11 weeks TegretolPregnancy Category D(+) evidence of risk

Nimotop (Nimodipine)CCB30 mg capsules CCBs (including verapamil) being investigated for use as mood stabilizers Could consider if pt couldnt take Lithium, carbamazepine or valproic acid or if pt didnt respond to these Has anticonvulsant properties, high lipid solubility, good CNS penetration Shown effective in rapid cyclers SE: bradycardia, hypotension Low teratogenecityconsider for pregnancy, breastfeeding Danger of BS in DKA too quickly can lead to cerebral edema DKA usually results from: o Type I not getting insulin o Infection in I or II Fluid, Na & K deficits Loading dose of insulin: 0.5u/kggive IM for better absorption o Insulin drip: 0.1u/kg/hr Replace K10 mEq/100 mL/hr peripherally 9

o 20-30 mEq/100 mL/hr central line For every 100 units of glucose over 200-->need to add 1 mEq of Na back

Bentyl (Dicyclomine)Not used for GERD Anticholinergic Use: GI motility problems like IBS 10 mg capsule, 30 mg tab, syrup, injection Feverfew for migrainesprophylaxis & tx Possible antithrombotic effects Possible interaction w/ NSAIDs Orally Disintegrating Tabletsfrom top 200 Maxalt Claritin Zofran Niravam (Alprazolam) Prevacid SoluTab Risperdal M-Tabs Remeron (Mirtazapine)

Demerol & MAOIsusually Nardil MAOIs can enhance the serotonergic effect of meperidine & lead to serotonin syndrome Concurrent use w/in 14 days is CI MAOIs: o Eldepryl (Selegiline) o Nardil (Phenelzine) o Marplan (Isocarboxazid) o Parnate (Tranlcypromine) Egg-like allergic rxn to vaccinesMumps, measles, flu Vaccines that are CI if egg allergy: Influenza (inactivated) & yellow fever Pts with splenectomy get which vaccines Must have protection from encapsulated bacteria: pneumococcus, meningococcus & Haemophilus Also protect from common viral infxns Ok if theyve completed series like measles, varicella & polio before Tetanus & diptheria every 10 years Sqanz Ganz Cathetermeasures pulmonary capillary wedge pressure Methanol/Ethylene glycol ODFomepizole Injection Loading dose: 15 mg/kg 10 mg/kg every 12 hrs x 4 doses 15 mg/kg every 12 hrs until ethylene glycol levels are ok Silicosispulmonary disorder Inhalation of silica dustscarring, inflammation Tx: no specificbronchodilators, antibiotics, at high risk for TB Lithiumcan cause hyponatremia 10

No interaction b/t probenecid & colchicines Colchicineinhibits phagocytosis of urate crystals, anti-inflammatory, NOT an analgesic o SE: N/D, bloating, emesis, rarely: bone marrow suppression o Dosing: 0.6-1.2 mg PO q 2h until pain relieved or diarrhea OR max of 8 mg o Most effective w/in 12-36 hrs of attack o Monitor SCr, LFT, CBC o Dose adjust in renal impairment Probenecidbenemiduricosuric agentblocks reuptake of uric acid in proximal convoluted tubule o Drink 2L of water daily to prevent uric acid stone formation o DDI: PCNs, cephs, nitrofurantoin, rifampin Dont use with ASA o Dont use if CrCl<50 Avandia(rosiglitazone)requires AST before starting therapy If ALT>3x normal limit & stays that waytherapy should be Dced Depakote Dosage Formsvalproic acid Depakene250 mg capsule Depakote Sprinkle125 mg capsule Injection, syrup Depakoted delayed release tab125, 250, 500 mg Depakote ER250, 500 mg Ampho Bno electrolytes (in mixing), mix in D5W & reconstitute w/ water Not compatibile with Ca gluconate, KCl, NaCl Anit-fungal to tx life-threatening systemic fungal infxns MOA: Binds in fungal cell wall--> permeability-->cell death o Aspergillus, Cryptococcus, Candida SE: Infusion rxns (pre med): fever chills, hypotension, rigors o Nephrotoxicity is dose-limiting-hypokalemia, hypocalcemia, hypomagnesemia o Renal tubular acidosis & nephrocalcinosis possible o Anemias, LFTs, alk phos & bili Genetic polymorphism exists as acetylation

OTC Smoking Cessation 1st line: Nicotine replacementgum, patch, inhaler (rx), nasal spray (rx); bupropion (rx) SE: Insomnia/sleep problemsuse 16h patch or take patch off at night o Irritation topicallyrotate sites, use HC or TAC CI to nicotine replacement: o CV: <2 wks post-MI, serious arrhythmias, serious/worsening angina o Esophagitis, PUD (Gum) o Pregnant/breastfeeding Tegretol can NOT be given for status epilepticus Status Epilepticusseizure lasts longer than 5 mins OR 2 or more seizures b/t which pt doesnt regain consciousness 11

o Pg 523 in APHA book for all tx options o 1st line: BDZsprefer lorazepam o Adult dosing: 4 mg given slowly over 2-5 mins o IV Phenytoinonly mix w/ NS o Can be admixed w/ any IV soln o Rate given: 150 mg/min max o 1 mg phenytoin=1.5 mg fosphenytoin o Phenobarb-- likelihood of respiratory depression w/ BDZs on board o Midazolam continuous infusion o Medically induced comaw/ phenobarb Drugs that cause Raynauds or make worse: BBs Leukeren (Chlorambucil)alkylating agent MOA: Form covalent bonds, DNA cross-linking (Also cyclophosphamide, ifosfamide, carmustine) SE: myelosuppression, mucositis, alopecia, N/V, amenorrhea, & azospermia Witch hazel + talc + starchmakes a suspension or paste Talc & starch wont dissolve ISMO & proper dosage timesisosorbide mononitrate Need to have @ least 8 hrs b/t doses (Lexi says 7) Must have a nitrate-free interval so tolerance doesnt develop Give BID rather than QID Extended releasegive only once daily in AM AZO Drug aggravating UTI?pyridiumalso in Uristat (phenazopyridine) Only acts as an analgesic, wont tx UTI Should only be used for 2 days Doxorubicin (Adriamycin)turns urine (and all other bodily fluids) red Anthracyclines: daunorubicin, idarubicin (dark yellow) MOA: Insert pairs in DNA-->strand breaks, inhibit topoisomerase II Cardiac toxicitydoxorubicin is worst Riopan Substituteshas been DChad magoldrate & simethicone Antiflatulent & antigas Simethicone products: o Gas-X, Mylanta Gas, Mylicon Infants, Phazyme Quick Dissolve & Ultra-Strength Magnesium stearatelubricant in tablet mfging Extra Mg stearatechanges in tablet dissolution b/c of decreased rate of tablet break up Would slow down dissolution Home measuringAsthmapeak flow 1. Stand. 2. Make sure indicator is at bottom of scale. 3. Dont let fingers block the opening. 12

4. Inhale as deep as possible, put mouthpiece in mouth, form a tight seal. 5. blow out as fast as possible. Dont force air w/ tongue. 6. Repeat 2-5x, record 3 highest readings (Do this for 2 wks) If use short-acting inhaled beta-agonist in AMcheck PEF before & then repeat 15 mins after given drug Green Zone: 80-100% of their best reading (Controller meds) Yellow Zone: 50-80% of best peak flow o May need extra inhaled steroids & increased albuterol use o To MD if not out of this zone in 24-48h Red Zone: <50%to MD o Prednisone 40 mg x 5 days minimum

Liquid KClBrand names: Kaon-Cl, Kay-Ciel, Rum-K Diarrhea is associated w/ liquid KCl b/c soln is hypertonic Where do you find thrush? Mouth Fungal infxn (Candida) in mouth that appears as white spots Nystatinantifungal Uses: oral candidiasissuspensionswish & swallow o 400,000-600,000u QID topically capsules, cream, ointment, powder, suspension, tablet, vaginal tablet Morphine to Dilaudid conversionsaid was easy b/c there was a chart to help w/ conversion Morphine 8: Dilaudid 1 Fanconis syndrome: congenital anemia d/t low RBC production Can be induced by anything that causes failure of proximal renal tubules Polyuria (Cant concentrae urine), osteomalacia, decrease growth size Used to be associated w/ use of out of date tetracyclinefiller was the problem DOC for Tourettes 1for simple tics & 1st lineshort-acting BDZs 2Clonidine May also use intermediate-acting BDZs Sever cases: antipsychotic, like haloperidol or pimozide o Can cause tardive dyskinesia, dysphoria & pseudo-Parkinsons Mentioned stimulantsI would think logically that you would want to stay away from these d/t the nature of the disorder This question is ridiculoustell me how many times youve seen a pharmacist do this Measure scrotum to fit swimmers athletic support Mycologused to tx what? Triamcinolone + nystatin (corticosteroid + antifungal) Question was asking about an ileostomy pouch, so it was used to tx inflammation from tape burns EESerythromycin ethyl stearate Reacts w/ theophylline by altering hepatic metabolism 13

What to do if INR=3.0continued same dose 1grain=64.8 mg 1avoirdupois pound-454 g 1 fl oz=29.57 mL 1 US gallon=128 fl oz=3785 mL=4 qts=8 pints SpGr=g/mL % Error= Error x 100% quantity desired Minimum weighable quantitiy=sensitivity requriment x(100/%error) Temperature conversion: 9C=5F-160 Zidovudine dosage forms (Retrovir) Reverse transcriptase inhibitorinterferes w/ viral RNA dependent DNA polymerase 100 mg capsule, 300 mg tablet syrup: 50 mg/ml injection: 10 mg/ml Redose oral Imitrexif no response from initial dose, may repeat in 2 hrs. t-testused to compare 2 groups Latest PCP tx found in what bookthey didnt list any choices, but they chose the CDC book Chemo drug toxicity cyclophosphamide & ifosfamidehemorrhagic cystitis o urinalysis to look for RBC o hydration & MESNA therapy neurotoxicitycytarabine, fludarabine, MTX, vincristine o Ask pt to write name to check for neurotoxicity Cardiotoxicityanthracyclines o Mostly doxorubicine & daunorubicin o Also can be idarubicine, epirubicine, mitoxantrone o Limits on cumulative lifetime dosing o Are also vesicants o Monitor LVEF & how much theyve had in their lifetime Fosamax (Alendronate)implement after D/Cing Evista Priloseccapsule can be opened, sprinkled in applesauce Can give in NG tube, mix in an acidic juice 14 1 US pint=473 mL 1in=2.54 cm 1.73=Avg adult BSA

Which of the following are not immune modulating? 5-FU was not an optionIm not sure if they mean they wouldve picked this if it had been an option or not Prednisone was a choiceI wouldnt call this immune modulating Did comment that they could easily eliminate 3 of the choices Question about vincristinewasnt about intrathecal administration Beth whatever her last name is nowsaid to look at the 1 st CA packet Plant alkaloidinterferes w/ microtubule assembly Pretx for anaphylaxis or peripheral edema Neurotoxicity, SIADH DDI: phenytoin, l-asparaginase, carbamazepine, dig, filgrastim, nifedipine, zidovudine Vincas are vesicantsmonitor for extravasation Do NOT give intrathecally or in doses > 2 mg 2 Questions about which was an improper dose? They chose Ticlid 250 mg Lexi says: Ticlid 250 mg BID Inderal dosage forms InnoPranXL80 mg, 120 mg Inderal LA60, 80, 120, 160 mg Inj, oral soln Tablet10, 20, 40, 60, 80 mg Which are light sensitive when preparing for a ptNitroprusside, promethazine I think nitroglycerineits in an amber bottle Comment was made that dopamine was NOT usually light-sensitive as it is usually used Metforminbiguanide What would help diabetic neuropathy They chose TCAs & Neurontin, apparently steroids can be used sometimes as well Dont get tripped up if ACEIs are a choicetheyre for diabetic nephropathy Graph of a drop in BP/HRw/ a set of antihypertensives (Im assuming these were choices) They chose labatalolalpha and beta effects Mask-like expression is indicative of whatthey gave you the information that the pt had schizophrenia Asking about an ADRatypical antipsychoticssomnolence Should you take Prevacid 1 hr before a meal? Before food, best to take before brkfst Metformin must be stopped before what diagnostic test? Answer was angiogramuses iodinated radiographic contrast media EEG & EKG were choicesbut these dont use contrast media Desmopressincomes IV, also intranasal & tablet 15

Question about captoprilthat was all it said Dont forget it should be taken w/ food Metabolic acidosisgive sodium acetateacetate ion converts to bicarbonate Sodium bicarb isnt usually added to TPNs, but both sodium & potassium acetates are usually used Do what w/ heparin w/ a high PTT?they chose to decrease dose, but not D/C Could also hold the dose & restart at a lower dose What do you monitor when a pt is on Lovenox & warfarin Not apt Yes PT & INR Question about sepsiswasnt about Xigris Empiric antimicrobial selectionmost narrow spectrum possible Fluid therapyonly use vasopressors if fluids dont work Vasopressorspreferred: dopamine & NE o Epinephrine, phenylephrine, dobutamine o AE: tachycardia, arrhythmias, organ & extremity ischemia, HTN ImmunomodlatorDrotrecogin alfa (Xigris) o Recombinant human activated protein C, an endogenous anticoagulant o Exact MOA unknownmodulates coagulation & inflammatory cascades o SE: bleeding o CI: active internal bleeding, recent trauma or stroke, epidural catheter o DDI: Anticoags, antiplatelet therapy Cipro ear drop o Ciprodexcipro + dexamethasonetx acute otitis media o Cipro HCcipro + hydrocortisonetx acute otitis externa (swimmers ear) o CiloxanEYE drop IBSIrritable Bowel Syndrome o Abdominal discomfort assoc. w/ altered bowel habits o Sx: abdominal pain or discomfort o Diarrhea or constipation predominate, or alternating o Tx: o Dicyclomine (Bentyl)antispasmodic-- GI motility by relaxing smooth muscle in the gut o Hyoscyamineanticholinergic-- GI motility by smooth muscle by antimuscarinic activity in the gut o TCAsdelay intestinal transit, blunt perception of visceral distention o Tegaserod (Zelnorm)5 HT4 antagnoiststimulates peristaltic reflex & intestinal secretion o Lactulose, milk of mag, polyethylene glycolosmotic laxativesIBS w/ constipation o Fiber supplementsbulk laxatives-- stool bulk & water o Loperamideinhibits peristalsis o Diphenoxylatedirect effect on circular smooth muscle in gutslows GI transit time o Alosetron (Lotronex)selective 5HT3 antagonistinhibits nonselective cation channels in gut o SSRIs-Citalopramperipheral effects on colonic tone & sensitivity Paroxetinepotent anticholinergic 16

Resistance to PCN o Change in drug targetPCN binding proteinMRSA does this o Alteration in outer membrane permeabilityGm (-) bacteria o Produce deactivating enzymes or beta-lactamases** most important CrCl with overweight malecorrect answer was to use the actual wt, not ideal or adjusted H.flu type B vaccineinfant use o If PRP-OMP (Pedvax HIB) or ComVax is given at 2 & 4 months, dont have to give it at 6 months o DtaP/Hib combination products shouldnt be used as primary immunization in infants at 2, 4, or 6 months o Can be used as boosters after any Hib vaccine o Final dose needs to be given > 12 months Which pneumococcal vaccine can be given before age 2?had to choose from brand names o Prevnar (7-valent conjugated polysaccharide vaccine) o Pneumovax (23-valent polysaccharide vaccine)not effective in children <2 yo Prozacshould be given in AM to avoid stimulation at night Question about a woman barely losing weightpossibly recommend exercising more o Sibutramine (Meridia)CIV3A4 substrate o SE: HA, insomnia, dry mouth, anorexia, constipation o toxicity w/: SSRIs (serotonin syndrome), sumatriptan, lithium, venlafaxine o effect w/: phenytoin, phenobarb, carbamazepine, rifampin o MOA: Blocks reuptake of NE, 5HT & DA o Dosing: Initially 10 mg daily, after 4 wks may go up to 15 mg daily Use up to 2 years Generic name for Lescolfluvastatin Drip rate for calcs5 or 6 steps Calcs a/b % conc in Rxsaid was straight fwd MEq ? a/b sodium citrate & trisodium citrate, another ? said none had any charges about 1+ (I have no idea what that means.) Macrocytic Anemiamegaloblastic anemia, Vit B12 deficiency, pernicious anemia, folic acid deficiency o Tx: Give Vit B12 orally if absorption is not the problem o Folic Acid deficiency: 1 mg qd x 3-4 months Difference in txing PUD w/ H2 & PPIs o PPIsfaster healing rates & relief o H2sless expensive 2 or 3 ?s about calories from TPNmust find source in profile Raynaudsvasoconstriction d/t cold intolerance 17

Dilaudid=hydromorphone How to monitor a weird drug (yes, that is what they said) o Bathroom scale was a choicethink about for HF Tx UTI o Cause: Usually Gm (-) anaerobic rodsE.coli!! o In the hospitalthink about pseudomonas & staph o S, sx: dysuria, urgency, frequency, nocturia, suprapubic heaviness or pain, rarely have fever o Upper UTIs: flank pain, fever o Tx: FQs, Cephs, TMP-SMX, doxypay attention to allergies o Length of tx varies o Acute, uncomplicated cystitstmp/smx x 3 days, FQ x 3 days o Acute pyelonephritisFQ x 14 days, tmp/smx x 14 days o ProstatitisFQ x 4-6 wks, TMP/SMX x 4-6 weeks ADR from Alzheimers drugall have N/V o Donepezil (Aricept) o Rivastigmine (Exelon) o Galantamine (Razadyme) Surfactantused to decrease surface or interfacial tension o Ex: polysorbate 80, sodium lauryl sulfate, sorbitan monopalmitate Colchicinefor an acute gout attack Theophyllinemay cause sleeping problems Drugs that are found Rx & OTCdiphenhydramine o Others I thought of: APAP, ibuprofen, phenylephrine, pseudophedrine, naproxen, guaifenesin, meclizine (Bonine is the OTC version) Symbyaxolanzapine & fluoxetine (atypical antipsychotic & SSRI) o Tx of depressive episodes assoc w/ bipolar disorders o SE: somnolence, D, wt gain, increased appetite, dry mouth, weakness o Capsules (olanz/fluox): 6/25, 6/50, 12/25, 12/50 Baby born to Mom w/ gestational diabetesmacrosmiaabnormally large fetal body size Moms profile givenhas eclampsia & gestational diabeteswhat will baby haveK type o Large wt, diabetes, deformities What does drinking alcohol while pregnant do to the baby? o Fetal alcohol syndromemental retardation o Down syndrome, stunted growth, short limbs Enbrel MOAEtanerceptTumor Necrosis Factor (TNF) Blocking Agent MTX does not cause alopecia 18

Dobutamine MOAStimulates beta1causes increased contractility & HR o Little effect on beta2 or alpha Dopamine dosing o Low: 1-5mcg/kg/minincreased renal blood flow & urine output o Intermediate: 5-15 mcg/kg/minincreased renal blood flow, HR, cardiac contractility o High: >15 mcg/kg/minalpha effectsvasoconstriction, increased BP In 1 L of normal saline154 mEq Na Tx of enetrococcus faecalis o Enterococcus speciesinfxns in abdomen & urinary tract o DOC for Enterococcus (+ an AG)-ampicillin, sulbactam (Unasyn) o 3rd generation Cephscefotaxime, cefoperazone, ceftizoxime, ceftriaxone, ceftaxidime o Tigecyline (Tygacil)VRE & VSE o Doubt this will be on there b/c its new o Quinupristin/Dalfopristin (Synercid), Linezolid (Zyvox), Daptomycin (Cubicin) Carvedilol (Coreg)MOA & advantage o MOA: Non-selective beta & alpha blocker, no intrinsic sympathomimetic activity o Dont have to adjust for renal or hepatic HIV pt should NOT get what vaccine: o Kids up to 16 yo w/ HIVstandard schedules of hep B, DaPT, HIB, IPV & flu o MMR-NOT for severely immunocompromised o Varicellaonly if no evidence of immunosuppression o Pneumococcal recommended for HIV pts >2 yo o Killed vaccines are fine o Avoid live typhoid vaccine & only use yellow fever vaccine if absolutely necessary What does a Sunday start for BC pills mean?Start Sunday after period starts Plavix MOABlocks ADP receptors, prevents fibrinogen binding, decrease possibility of platelet adhesion and aggregation Palivizumabused for RSV in neonates Brand: Synagis Elemental Calcium o Ca Carb=40% elemental400 mg elemental/1 g ca carb o Ca Citrate=21% elemental BBswill worsen Raynauds Relative vs Absolute bioavailability o Absolute: fraction or % of a dose given non IV that is systemically available o Relative: fraction of a dose given as a test formulation that is systemically available as compared to a reference formulation EKG Change w/ hyperkalemiagive Ca gluconate 19

2 Questions on drug interactions w/ herbalsLook @ Nemeczs handout or packet from GA Buildup of Demerol metabolitecan cause seizures, not reversed by naloxone o Normeperidine o Renal impairment pts are at risk At home, asthma pts should use peak flow meters To give albuterol 0.5%--must use nebulizer What strength albuterol 0.5% will become based on drug order to mix w/ 2.5 mL NSAnswer was 0.083% K Question asking which drug was used for long-term asthma control o Choices: steroid inhaler, prednisone, serevent o Prednisonenoonly during exacerbations o Steroid inhaler or Serevent (steroid + long acting beta agonist)I would think these would both be ok answers Pt Counseling for sulfa eye dropsburn Tx of aspergillusAmph B, itraconazole, caspofungin, voriconazole Tx of systemic fungal infxnchoose diflucan, NOT nystatin Tx recurrent otitis media (Chronic=recurrent?) o No longer recommend prophylaxis w/ abx in high-risk pts b/c of drug-resistant organisms o Recurrentabx effective short term o Insert tympanostomy tubes Find a dosing rate given a chart & based on pts wt & renal fxn Tetanus & diptheriaok in pregnancyboth are inactivated Pt going in for splenectomyneeds pneumococcal vaccine Max dose of Reminyl (Galantamine)Changed name to Razadyne b/c of med errors o Dose range: 16-24 mg once daily o Intermediate release tabs or soln: 4 mg BID x 4 wks 8 mg BID x 4 wks12 mg BID o Extended release caps: 8 mg qd x 4 wks 16 mg qd x 4 wks24 mg qd Bicitrasodium citrate & citric acidalkalinzing agent o Use: tx metabolic acidosis, conditions where need long-term maintenance of alkaline urine o effects of: amphetamines, pseudoephedrine, quinidine, quinine o effects of: lithium, chlorpropamide, saliscylates o Dosing: 10-30 m: w/ H20 after meals & at bedtime o Dilute w/ 30-90 mL of water to help taste What needs to be added to TPN for pt who is acidotic? Acetate salts provide bicarbonate ion 20

Thrombolytics are CI in pt w/ NSTEMI Most likely bug for otitis mediaUp to 50% may be viral Bacterial o 40-50% Strep pneumo o 20-30% H.flu o 10-15% Moraxella catarrhalis Drugs that can cause hyponatremiacarbamazepine, lithium Ethylene glycol/methanol antidoteFomepizole (Brand: Antizol)injection o Used alone or with hemodialysis o AE: HA, N Giving ethanol in methanol poisoningcompetitively inhibits metabolism of ethanol & decreases formation of toxic metabolites Albuminimportant for measure Ca levels PCP TxBactrim o Prophylaxis: 1 DS tab QD or TIW o Tx: 15-20 mg TMP/kg/day in 3-4 divided doses Which drug will worsen esophagitis? Fosamax Which drug will interfere w/ Zoloft metabolismDiltiazem o Zoloftmajor substrate of 2C19, 2D6 o Diltiazeminhibits 2D6 Progestroneused to decrease endometrial CA Octreotide (Generic: sandostatin)used for diarrhea secondary to CA Counseling for nicotine gumchew slowly for 30 mins & then discard Bite & park o Bite piece slowly until peppery taste or tingling occurs o Place gum b/t upper or lower cheek & gums for approximately 1 min o After peppery taste fades, repeat the process o Keep piece in mouth ~ 30 mins

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