alpha-glucosidase inhibitors (AGIs) are including...

1. Precose (acarbose)
1.
2. Glyset (migitol)
2.

what class of Biguanide is?

Insulin sensitizers; Increase insulin sensitivity in the hepatic and peripherial
Ex: Metformin (glucophage)

1. GI upset
What are the possibile side effects from metformin? 2. Megalblastic anemia
3. Lactic acidosis

Actos is TZD (Thiazoladinediones; glitazones/TZD);

What is MOA of actos? 1. increase skeletal muscle, adipose tissue, and insulin sensitivity;
2. Decreased hepatic glucose production

1. Edema
2. Anemia
What are the common AE of TZD drugs, ex: Actos, avandia?
3. wt gain
4. excerabation of CHF
 MOA of Prandin (Repaglinide): To stimulate pancreatic beta-cells to secrete
What is the MOA of Prandin?
insulin

1) 1st Generation:
- Dymelor (acetohexamide)
- Diabinese (chlorpropamide)
- Tolinase (Tolazamide)
What are the examples of sulfonylurea diabetes drugs? - Orinase (Tolbutamide)
1) 1st generation?
2) 2nd generation? 2) 2ns generation
- Amaryl (glimeperide)
- Glucotrol (Glipizide)
- Diabeta, Micronase (Glyburide)
Glynase (Glyburide micronized)

What are the 2 classes of antidiabetes agents that can cause 1) weight gain 1) Sulfonylureas
and 2) hypoglycemia 2) Meglitinides

1. alpha-glucosidase inhibitors (acarbose and miglitol)

What classes of antidiabetic agent do not cause hypoglycemia?
2. Insulin sensitizers (biguanide and TZD)

Meformin should be withheld 48 hours after pts undergoing radiological

True
study. True or False?
 1. Glucophage
2. Glucophage XR
3. Riomet
List the 6 drugs contain Metformin.
4. Glucovance
5. Avandamet
6. Metaglip

For female, Cr >1.4

What are CIs in metformin? For male, Cr > 1.5
Predisposed to potentially fatal lactic acidosis

TZD (actose, avandia)+ oral contraceptive pills --> ? Need to increase estrogen dose

1. ALT >2.5 normal

What are Contraindications in TZD (actose, avandia) 2. CHF
3. Hepatic patients

1. Renal
2. Liver,
3. serum B12
What are the monitoring parameters taking metformin? 4. folic acid
5. Hgb
6. Hct
7. CBC
 Chlorpropamide + prednisone
hyperglycemia
--> ??? (DDI)

Phenytoin + tolazamide --> ?? Increased BG levels

Glimepiride + itraconazole
Dcreased BG level
--> ??? (DDI)

Which insulin can be adminstered IV? Regular (clear); glargine is clear but it's low pH=4.0 (no IV)

Myxedema is an end stage of hypothyroidism.

What is myxedema?
What are the S/Sx? S/Sx: weakness, confusion, hypothermia, hypoventilation, hypoglycemia,
hyponatremia, coma and shock
 " High TSH
Hypothyroidism
Low T4"; what is the Dx?

To increase oxygen consumption by most of tissues and increase metabolic

What is MOA of Levothyroxine?
rate of CHO, lipids and protein

Take Levothyroxine with or without food? Without food, take 30 mins before breakfast

what is thyroid storm? thyroid stormis life-threatening, fever, tachycardia, delirium, and coma

1. The peripheral conversion of T4 to T3

2. Inhibits the synthesis of thyroid hormone by preventing the incorporation
what is MOA of Propylthiouracil (PTU)? of iodine into iodothrosine
3. ..by inhibiting the coupling of monoiodotyrosine nd diiodtyrosine to form
T4 abd T3
 1. Inhibits the synthesis of thyroid hormone by preventing the incorporation
of iodine into iodothrosine
What is the MOA of methimazole?
2. ..by inhibiting the coupling of monoiodotyrosine nd diiodtyrosine to form
T4 abd T3

Lithium + Lugol's solution

Increased Lugol's solution effects
--> ??? (DDI)

what is Grave's disease? Hyperthyrodism

1. Increased ACTH by pituitary gland adenomas

(Increased CRH-corticotropin-rleasing hormone --> Increased ACTH -->
What is Cushing's syndrome?
Increased adrenal cortex to produce cortisol
2. Chronic use of glucocortiocoid excess

What is the MOA of aminoglutethimide? Inhibits conversion of cholesterol to pregnenolone

 What is the MOA of metyrapone? To decrease cortisol synthesis by inhibition of 11-hydroxylate activity

rash, blood dyscrasias and hypothyrodism; may also decrease effects of

What are adverse effects of Cytadren?
warfarin

Primary adrenocortical deficiency; in result of glucococorticoid and

What is Addison's disease?
mineralocorticoid deficiency

Nocturnal enuresis, diabetes insipidus, hemophilia A, von Willebrand's

what are therapeutic uses of desmopressin?
disease; Also increase clotting factor VII levels

Androgens and anabolic steroids are NOT scheduled drugs. True or False? False; they are scheduled III
 During postmenopausal,
1)Estrogen decreased
1)Estrogen decreased or increased?
2)Progesterone decreased
2)Progesterone decreased or increased?
3)FSH increased
3)FSH decreased or increased?
4)LH increased
4)LH decreased or increased?

To treat a women with an intact uterus for postmenopausal hormone

Progestin to reduce the risk of endometrial cancer/hyperplasia
replacement therapy, which hormone is must included?

Climara, once a week or twice weekly? Once a week

FemPatch once or twice a week? Once

"Alora, Esclim, Estraderm, Menostar, Vivelle, Vivelle Dot" once a week or

Twice a week
twice a week?
 25 mcg/tab QHS for 2 weeks, and then twice a week for 2 weeks (18 tabs
What is Vagifem dosing?
for a month supply)

What's the frequency of Estring? 90 days ( evry 3 months)

1. Breast tenderness
What are the common adverse effects of ERT (Estrogen replacement 2. Heavy bleeding
therapy)? 3. Headache
4. Nausea

1. Depression
What are the common adverse effects of progestin therapy? 2. Irritability
3. Headache

Is Estrogen a CYP450 2D6, 1A2, 2C9 or 3A4 inhibitors? 3A4 inhibitors

 Increased metabolism of Vit-K--> decreased warfarin effects --> may neeed
Synthroid + Warfarin --> ??? (DDI)
to increased warfarin dose

Estrogen + thyroid hormone

Decreased thyroid hormone Weffects
--> ??? (DDI)

1. breastfeeding women
When are "mini-pills" indicated?
2. Free CVD risks associated with estrogen-containing products

1. To prevent development of a dominant follicile by supression of FSH;

What is estrogen's MOA in birth control pills?
2. Do not block ovulation

What is progestin's MOA in birth control pills? Block ovulation by increasing the thickness and atrophy of the endometrium
 1. Camila
2. Ortho Micronor
3. Errin
List 3 Oral contraceptive pills are progestin only pills.
4. Nor-QD
5. Nora-BE
6. Ovrette

What much estrogen content in high-dose estrogen OC? 50 mcg; ex: Neocon 1/50, Ovcon50, Zovia 1/50

What much estrogen content in low-dose estrogen OC? from 10 - 35 mcg

1. 3A4 inhibitors
List 3 drugs/classes can increase oral contraceptives level. 2. Atorvastatin
3. Vitamin C

Oral contraceptives + pioglitazone (Actos) --> ??? (DDI) Decreased OC effects

 Oral contraceptives + hypoglycemics (tolbutamide, Diabinese, Orinase,
Decreased effects hypoglycemics agents
Tolinase)

Oral contraceptives + cortisone --> ??? (DDI) Increased toxicity of cortisone

what types of hormone imbalance from the finding "Spotting" and "Early, or
mid-cycle? breakthrough bleeding" Estrogen deficiency; increased estrogen levels
How do we adjust that?

what types of hormone imbalance from the finding "fatigue" "weight gain"
Progestin excess;
"acne or oily scalp" " depressoin" " increased appetite"?
decreased progestin levels
How do we adjust that?

Calcium 1000-1500 mg
what are the daily Calcium and Vit-D recommended?
Vitamin D 400-800 IU/day
 Bisphosphonates; Binds to bone (hydroxyapatite) and incorporates into
What is the MOA of actonel, fosamax?
boneto increase and stablize bone mass

Fosamax 10 mg/day + ASA

Increased risk of upper GI bleeding
--> ??? (DDI)

What is the MOA of SERM (selective estrogen receptor modulator, ex: Raloxifene (Evista; act as estrogen receptor agonist at the skeleton, decrease
Evista)? bone resorption and overall bone turnover

Evista + warfarin --> ??? (DDI) Decreased Warfarin effects

What is the MOA of Miacalcin? Inhibit bone resorption by binding to osteoclast receptors
 Increased the rate of bone formation by increasing the birth rate of
What is the MOA of Forteo?
osteoblasts and preventing apoptosis, resulting improve bone density

What type of oral contraceptive pills you will recommend for a smoker
Progestin only (mini-pills)
woman over 35 years?

What is the dose Mucomyst (acetylcysteine)for pretreament exposure

Mucomyst 600 mg PO BID for 2 days, begining one day before procedures
radiocontrast dye?

1. Pulmonary edema
2. acute rise of serum K+
What are the adverse effects of osmotic diuretics?
3. Blurred vision
4. Rash

1. Hypokalemia
What are the E- imbalances from Thiazide and thiazide-like diuretics? 2. Hyponatremia
3. Hypercalcemia
 1. Hypokalemia
2. Hypomagnesemia
3. Hyponatremia
What are the E- imbalances from loop diuretics?
4. Hyperuricemia
5. Hyperglycemia
6. Hypercalciuria

1 mg Bumetanide
A= 20 mg
= A mg Torsemide
B= 40 mg
= B mg Furosemide

Vitamin D precursor (requires hydroxylation within the liver to calcifediol

Ergocalciferol
and 2nd hydroxylation in the kidney to form active Vit-D

What should use for iron overload? Desferal (deferoxamine)

What is the potential risk of administering iron IV? 1 Increased risk of infection
What are the signs of vitamin D intoxication and hypercalcemia? Weakness, headache, somnolence, nausea, vomiting, bone pain, polyuria

Folic acid + phenytoin

Decreased phenytoin concentration
--> DDI (????)

Hydromorphone Dilaudid

Fentanyl Sublimaze

Acetaminophen Tylenol
 Ketorolac Toradol

Atitvan Lorazepam

Versed Midazolam

Diprivan Propofol

Pancuronium Pavulon
 Norcuron Vecuronium

Cisatarcurium Nimbex

Dexmedetomidine Precedex

Nimodipine; calcium channel block give for 21 days; indicated for treating
Nimotop
abeurysmal subarachnoid hemorrhage

Dalteparin Fragmin (2500-5000 units SC)

 Lovenox enoxaparin

Fondapariunx Arixtra

Direct thrombin inhibitors:

A --> Refludan
1. Lepirudin (A)
2. Bivalirudin (B)
B --> Angiomax
3. Agatroban

Tegretol Carbamazepine

Lamictal Lamotrigine
 Keppra Levetiraccetam

Oxcarbazepine Trileptal

Tiagabine Gabitril

Zonisamide Zonegran

Drotrecogin alfa; an endogenous anticoagulant; recommbinat human

Xigris
activated protein C
DDAVP Desmopressin (for diabetes insipidus)

Pavulon Pancuronium

Nolvadex Tamoxifen

Faslodex Fulvestran

Aromasin Exemestane
Arimidex Anasrozole

Femara Letrozole

Casodex Bicalutamide

Avastin Bevacizumab

Erbitux Cetuximab
 Hydrea MOA: inhibits DNA synthesis witout interfering with RNA and
Hydroxyurea
protein synthesis

Imatinib mesylate Gleevec

Erlotinib Tarceva

Iressa Gefitnib

Sutent Sutinib
 Sprycet Dasatiniib

Bortezomib
Velcade MOA: Inhibits the 26S proteasome; stabilizes regulatory proteins causing
apoptosis and disrupting cell proliferation

Dolasetron Anzemet

Granisetron Kytril

Palonosetron Aloxi
 Compazine Prochlorperazine

Thorazine Chlorpromazine

Phenergan Promethazine

Emend Aprepitant

Imatinib mesylate Gleevec

Erlotinib Tarceva

Iressa Gefitnib

Sutent Sutinib

Sprycet Dasatiniib

Bortezomib
Velcade MOA: Inhibits the 26S proteasome; stabilizes regulatory proteins causing
apoptosis and disrupting cell proliferation
Dolasetron Anzemet

Granisetron Kytril

Palonosetron Aloxi

Compazine Prochlorperazine

Thorazine Chlorpromazine
 Phenergan Promethazine

Emend Aprepitant

What is the main side effect of Zoladex (Goserelin)? Bone pain

What the hormones and antagonists can be used for both breast and prostate
LHRH agonists (Lupron, Eligar and Zoladex)and Ethinyl estradiol
cancer?

Inhibits calcineurin-dependent translocation of the cytosolic subunit of

what is the MOA of cyclosporine?
NFAT (the promoter gene for IL-2); inhibits IL-2 synthesis
 Inhibits IL-2 transcription and synthesis (binding with FKBP-12 and a
What is the MOA of Tacrolimus?
calcium-calmodulin-calcineurin complex)

What knid of electrolyte imbalance Prograft (Tacrolimus)can cause? Could cause hyperkalemia

1. Hirsutism
2. Nephrotoxicity
Name 4 common adverse effects of cyclosporine.
3. Ginggival hyperplasia
4. Hyperlipidemia

Prednisone and tacrolimus may cause ????. Diabetets mellitus

Prograft does not need to monitor trough concentrations. True or False false
 Prograft Tacrolimus

CellCept Mycophenolate mofetil

Azathioprine Imuran

Arava Leflunomide (anti-proliferative, immunosupressant drugs)

Cholestyramine Prevalite
Nexium Esomeprazole

Prilosec Omeprazole

Prevacid Lansoprazole

Aciphex Rabeprazole

Protonix Pantoprazole
Tagamet Cimetidine

Zantac Ranitidine

Axid Nizatidine

Pepcid Famotidine

Tritec Ranitidine + bismuth citrate

 Furazolidone Furoxone (100 mg tid for 10-14 days)

Methocarbamol Robaxin

Mesalamine Asacol

Lomotil diphenoxylate + atropine

Imodium Loperamide (2 mg after each loose stool, dne: 16 mg/day)

 1. Tagamet
2. Zantac
List 4 examples of H2 blockes.
3. Axid
4. Pepcis

1. Aciphex
2. Preveacid
List 5 examples of PPI. 3. Prilosec
4. Protonix
5. Nexium

How does antacids + (tetracyclines, ferrous sulfate and quinolones) reduce

By forming chealate complex
the absorption and effectiveness of the drugs?

HOw does antacid the absorption of (azoles and sucrafate)? By increeasing gastric pH

1. Calcium channel blockers

2. beta-blockers
3. Nitrate
Drug that may redcue LES pressure.
4. batbiturates
5. Anticholinergics
6. Theophylline
 1. Tetracyclines
2. NSAIDs
3. Aspirin
Drugs that may have irritant effects on the esophageal mucosa. 4. Bisphosphonate
5. Iron
6. quinidine
7. KCl

Methotrexate + NSAIDs --> ??? (DDI) Fatal interaction. Severe bone marrow suppression

1. Hyoscyamine
List 2 drugs use to maange IBS (irritable bowel syndrome). 2. Dicyclomine
(anticholinergic and antimuscarine)

Tegaserod Constipation-predominant IBS

Alosetron Severe Diarrhea-predominant IBS

 Mild, diarrhea-predominat IBS
Dicyclomine
(may add TCA ex: Amitriptyline)

1. Infliximab
2. High-dose metronidazole
What can we use to manage fistula (of IBS)?
3. Ciprofloxacin
4. azathioprine

What DMARDs stands for? Disease-Modifying antirheumatic drugs (DMARDs)

1) What is the most serious adverse effect of Plaquenil? 1. Vision loss (retinal damage)

2) Who are at high risk? 2. A cumulative dose of 800 g and age >70 years

All diuretics can cause hyperuricemia. Which diuretic is exception? Spironolactone

 1. Colchicine
Name 3 medications can be used for acute gouty arthritis attack. 2. NSAIDs (Indomethacin)
3. Corticosteroids

1. Diarrhea (pt should not never exceed a total of 8 mg)

1. What is the most common side effect of colchicine?
2. The most severe side effect (but rare)?
2. Bone marrow suppression

1. 0.6 to 1.2 mg every 2 hours until pain relief, diarrhea or a max dose of 8
mg/day
What is the dose of colchicine when acute gouty attack?
2, Only effective when initiated within 12-36 hours of the attack

1. Probenecid (Benemid)
What are the 2 drugs used for gout prophylaxis by increasing uric acid
secretion?
2. Anturane (Sulfinpyazone)

What are the 2 drugs used for gout prophylaxis by ihbiting uric acid 1. Zyloprim (Allopurinol)
production? MOA: inhibits xanthine oxidase formation (XO)
 Rash (may be as simple as a maculopapular eruption or as serious the
What is the most common side effect of allopurinol?
life-threating SJS.

1. Procainamide
2. Phenytoin
3. Chlorpromazine
List drugs that can cause SLE (Systemic Lupus Erythematosus). 4. hydralazine
5. quinidine
6. methyldopa
7. Isoniazid

Arava (Leflunomide) + MTX -->

Increased liver toxicity
???? (DDI)

Gold therapy + Plaquenil --->

Increased rash
???? (DDI)

Anakinra (antirheumatic agents).

1. IL-1 inhibitor
1. MOA
2. a single or combination agent
2. Use as..
3. A single-use prefilled syringe
3. Form
 Methadone (Dolophine)...
1) MOA? 1) Pure u agonist and NMDA antagoinst
2)

Pentazocine 1) K-agonist and u-antagoist

1) MOA (more dysphoriam, less respiratory depression)

1) Naloxone (Narcan)
List 2 drugs are used to reverse opioid overdose.
2) Naltrexone (ReVia, Trexan) for alcohol dependent/narcotic addiction

MAO i + Meperidine (opioids) --> DDI (???) 1. Death

1. Fentanyl
Most opioids are required dose reduction in severe liver disease. List drugs
2. Morphine
that need to reduce dose in renal disease.
3. Methadone
 1. Propanolol
What 2 beta-blockers can be used for migraine as 1st line?
2. Timolol

Addiction is....
1. compulsive use of drug
1.
2. The use of a substance for psychic effects
2.

One of severe adverse effect of Methadone is.... Torsades de pointes

How does morphine metabolize? By hepatic glucoronidation (NOt CYP450)

Oxycodone, hydrocodone and codeine are P450

1) 2D6 substrate
1) 2D6
2) 3A4
** Also, Tramadol, meperidine, propoxyphene 2D6 substrates***
3) 1A2
4) 2C9
 Hydromorphone has a long or short half-life? A short half-life

1) Analgesic

2) Possibile anti-inflammatory
What roles of Caffeine in Excedrin Migraine?
3) Increased gastric acidity and perfusion, enhancing the absorption of
aspirin

Anticholinergic effects
What is the rational behind TCA is most likely worsen opioid-induced
constipation?
(TCAs: Elavil,

5 capsules within 12 hours period;

Midrin
Dose: 2 capsules at once, 1 cap every 1 hour until head is gone. (DNE 5
capsules/12 hours)

1. Carbamazepine (DOC)
DOC for new onset seizures. 2. Phenytoin
3. Valproic acid
 1. Carbamazepine
DOC for refractory seizures. 2. Phenytoin
3. Valproic acid

DOC for generalized seizures (if pt has both absence and generalized
Ethosuximide
tonic-clonic seizures)

DOC for generalized seizures (if pt > 2years old) Valproic acid

Phenytoin,
Carbamazepine
DOC for DOC tonic-clonic seizures.
Topiramate
Valproic acid

1. Carbapenem (Imipenem)
2. Meperidine (in patients with renal failure)
3. Local anesthetics (Lidocaine)
4. Metoclopramide
List drugs can cause seizures.
5. Theophylline
6. TCA
7. Anticonvulsants
(Carbamazepine, Ethosuximide, Phenytoin, Phenobarbital)
 From chronic use of phenytoin
What is hydantoin facies?
1. Thicken subcutaneous tissues
2. Enlargement of nose and lips

1. Nausea
2. Vomiting
What is side effect of inititation of phenytoin?
3. Drowsiness and
4. Dizziness

1. Hepatic failure
What are the 2 life-threatening adverse reaction from Phenytoin?
2. Stevens-Johnson syndrome

1. Direct hepatotoxicity
What are the 2 Black Box Warning of Carbamazepine?
2. Aplastic anemia (if WBC<2000-3000, or Nu<1000-1500)

1. Fatal Hepatoxicity

What are the 3 Black Box Warning of Valproic acid? 2. Fetal hemorrhagic pancreatitis

3. Fetal teratogenic
 How does Gabapentin eliminate? 100% renal

What is BBW of Lamotrigine? Rash

Oligohidrosis (may not sweat) like Topirmate

What is BBW of Zonisamide and Topirmate?
** also kidney stones but it's not BBW**

What are DOCs for acute simple or complex partial seizures? 1. Valium and Lorazepam (rectally)

Topirmate --> weight loss

X --> valproic acid
X --> weight gain
Meperidine may cause seizures in adults patients with renal failure. T or F True

Why is important that to keep good oral hygine when patient is on

Becuase phenytoin can cause gingival hyperplasia
phenytoin?

1. Block postsynaptic dopamine-2 receptors

What is the MOA of typical antipsychotic drugs?
-- They share snticholinergic, antighistamine, and alpha-blocking

1. Sedation
2. Dry mouth
What are S/Sx of anticholinergic effects? 3. Blurred vision
4. Constipation
5. Urinary hestitancy

1. Cogentin (Bentropine) 1-2 mg IM, or

What is the treatment choice for Dystonic reaction (from antipsychotic
drugs's side effects)?
2. Diphenhydramine 25-50 mg IM every 30 mins until relieved
 1. Lipophilic beta-blockers (ex: propanolol)

2. Benzodiazepines
What is the treatment choice for akathisia reaction (from antipsychotic
drugs's side effects)?
3. clonidine

4. Anticholinergics

1) Amantadine (symmetrel) 100 mg BID or

What is the treatment choice for pseudoparkinsonism (from antipsychotic
drugs's side effects)?
2) Anticholinergics

1. ER STAT

2. D/C antipsychotic
What is the treatment choice for Neuroleptic malignant syndrome (NMS)
(from long-term use of antipsychotic drugs)?
3. Bromocriptine (dopamine agonist)

4. Dantrolene (smooth muscle relaxant)

Dopaime regulate prolatin rleased. When dopamine is blocked, prolactin

Dopamine VS. prolactin?
level is increased.

1. Agranulocytosis

What are the adverse effects of Clozapine (Clozaril)? 2. Seizure (>600 mg/day)

3. Hypersalivation
 1. Haloperidol or fluphenazine (IR) with Lorazpam 2 mg IM q4h prn

What can use for acute schizophrenia? 2. Olanzapine

3. Ziprasidone

1. Baseline BP, glucose, and lipids and 12 weeks

2. Weight (BMI) at baseline, 4, 8 and 12 weeks and then quarterly

What are the monitoring paramters on atypical psychotics?
3. Weight circumference baseline then annually

3.

How to convert from Haldol PO to Haldol IM? PO daily dose X 10 = /4 week

--> reach steady state in 8-12 weeks ex: 10 mg QD --> 100 mg /4 weeks

How to convert prolixin PO to IM? 1 mg PO = 1.25 mg IM/2 weeks

--> reach steady state in 6 weeks ex: 10 mg PO QD -->12.5 mg IM/2 weeks

Cardiovascular defects in newborn associated with Lithium use in 1st

What is Ebstein's anomaly?
trimester pregnancy
 1. Thyroid panel (baseline and every 6-12 months)

2. Scr/BUN Renal (baseline, 3, 6 and every 12 months)

3. CBC with differential

(leucocytosis)
Whar the 7 monitoring parameters in Lithium use?
4. electrolytes (hyponatremia)

5. EKG

6. Urinalysis (increased specific gravity)

7. Pregnancy test

Lithium can cause hyper- or hypothyroidism? Hypothyroidism

1. LFT; liver elimited BBW for hepatoxicity

What are the 2 monitoring parameters of Depakote (Divalproex sodium)?
2. CBC with diff (Valproic acid can cause thrombocytopenia)

acute: 0.6-1.2 (mEq/L)

Maintenance:0.8-1.0
What is therapeutic level of lithium?
Draw level 2-8 hours post dose

What is therapeutic level of valproic acid? 50-125 mcg/ml

 What is therapeutic level of carbamazepine (CBZ)? 4-12 mcg/ml

1) Amantadine (symmetrel) 100 mg BID or

What is the treatment choice for pseudoparkinsonism (from antipsychotic
drugs's side effects)?
2) Anticholinergics

1. ER STAT

2. D/C antipsychotic
What is the treatment choice for Neuroleptic malignant syndrome (NMS)
(from long-term use of antipsychotic drugs)?
3. Bromocriptine (dopamine agonist)

4. Dantrolene (smooth muscle relaxant)

Dopaime regulate prolatin rleased. When dopamine is blocked, prolactin

Dopamine VS. prolactin?
level is increased.

1. Agranulocytosis

What are the adverse effects of Clozapine (Clozaril)? 2. Seizure (>600 mg/day)

3. Hypersalivation
 1. Haloperidol or fluphenazine (IR) with Lorazpam 2 mg IM q4h prn

What can use for acute schizophrenia? 2. Olanzapine

3. Ziprasidone

1. Baseline BP, glucose, and lipids and 12 weeks

2. Weight (BMI) at baseline, 4, 8 and 12 weeks and then quarterly

What are the monitoring paramters on atypical psychotics?
3. Weight circumference baseline then annually

3.

How to convert from Haldol PO to Haldol IM? PO daily dose X 10 = /4 week

--> reach steady state in 8-12 weeks ex: 10 mg QD --> 100 mg /4 weeks

How to convert prolixin PO to IM? 1 mg PO = 1.25 mg IM/2 weeks

--> reach steady state in 6 weeks ex: 10 mg PO QD -->12.5 mg IM/2 weeks

Cardiovascular defects in newborn associated with Lithium use in 1st

What is Ebstein's anomaly?
trimester pregnancy
 1. Thyroid panel (baseline and every 6-12 months)

2. Scr/BUN Renal (baseline, 3, 6 and every 12 months)

3. CBC with differential

(leucocytosis)
Whar the 7 monitoring parameters in Lithium use?
4. electrolytes (hyponatremia)

5. EKG

6. Urinalysis (increased specific gravity)

7. Pregnancy test

Lithium can cause hyper- or hypothyroidism? Hypothyroidism

1. LFT; liver elimited BBW for hepatoxicity

What are the 2 monitoring parameters of Depakote (Divalproex sodium)?
2. CBC with diff (Valproic acid can cause thrombocytopenia)

acute: 0.6-1.2 (mEq/L)

Maintenance:0.8-1.0
What is therapeutic level of lithium?
Draw level 2-8 hours post dose

What is therapeutic level of valproic acid? 50-125 mcg/ml

What is therapeutic level of carbamazepine (CBZ)? 4-12 mcg/ml

1. Corticosteroids

2. Oral contraceptives

Lis 5 drugs can induce depression. 3. Propranolol

4. Clonidine

5. Methyldopa

TCAs inhibit the presynaptic neuronal membrane's reuptake of 5HT and/or

What is MOA of TCA (Tricyclic antidepressants)?
NE

1. Orthostatic hypotension

2. Tachycardia

3. sedation

List common adverse effects of TCAs. 4. Anticholinergic effects

5. Arrthymias (prolonged QT interval)

6. Weight gain

7. sexual dysfunction

1. MAO i use in 14 days

2. Pregnancy
What are the CI with TCAs?
3. Lactation and

4. Narrow-angle glaucoma
 1. Celexa (Citalopram) few drug interactions
Which SSRIs used in geriatric patients?
2. Zoloft (Sertrazline)

Lexapro v.s. Celexa 10 mg Lexapro = 40 mg Celexa

Sarafem = Prozac Fluoxetine

Prozac weekly 90 mg Fluoxetine once a week

What is contraindication of Effexor? Uncontrolled BP, recent MI or CV disorder

 What is contraindication of Cymbalta?
1. Narrow-angle glaucoma
** Metabolized by 1A2 and 2D6**

What is MOA of Bupropion? An inhibitor of NE and DA reuptake

What is MAx daily dose for Bupropion? 450 mg/day

--> increased risk of seizures (400 mg/day for SR)

1. sedation

2. Increased appetite

3. WEight gain
What are the adverse effects of Mirtazapine?
4. Constipation

5. elevation LFT and TGs

6. small risk of agranulocytosis and neutropenia

Benzodiazepines (BZD).

Benzodiazepines (BZD). 1) Quick onset (more lipophilic):

- alprazolam.
Quick onset (more lipophilic) - diazepam,
- chlorazepate and
- flurazepam
 1. Lrazepam
Benzodiazepines (BZD).
2. clonazepam
slower onset (less lipophilic)
3. Chlordiazepoxide

Benzodiazepines (BZD). 1. LOT (Lorazepam. Oxazepam, and temazepam)

Which BZD are preferred in patients with hepatic dysfunction? and why? 2. Metabolized by conjugation but oxidation

What is DOC of TCAs for OCD? Clomipramine

1. Propranolol
What are DOCs for SAD (social anxiety disorder) or panic disorders?
2. atenolol

When hydroxyzine is DOC? for anxiety and in patients with substance abuse
 1. Polyuria
What are the common side effects of initiating Lithium?
2. Polydispsia
3. Tremor
(later onset: WEight gain and mental dulling)
4. GI upset

What are the common adverse effects of SSRIs? Insomnia, GI upset, and headache

What is the MOA of Benzoyl peroxide?

By releleasing oxygen to destory P. acnes
(may bleach hair or dyed fabrics)

1. Benzoyl peroxide
2. Sulfur
What are the OTC products to treat acne?
3. Salicylic acid
4. Resorcinol

1. Burow's solution
2. Domeboro powder
List OTC products can use for Poison Ivy. 3. Calamine lotion
4. Kaolin
5. Zinc acetate
 1. Decadron, Aristocort, Medrol dosepak
List Rx products for Poison Ivy.
2. IV 100 mg prednisone

Ivy Block (Bentoquatam 5% solution) apply 15 minutes before possibile

List a product for Poison Ivy prevention.
plant contact

What is MOA of RID?

-(Pyrethrins) MOA: Blocks transmission of nerve cell impulses in lice causing paralysis
- Tx repeat in 1 week

MOA: same as RID

What is MOA of NIX?
- Permethrin
- 1% OTC for head lice
- a single-application
- 5% sabies (mites) infestation

What is DMEP (dimethyl ether and propane)? FDA approved for OTC removal of common warts and plantar warts
 1. Phenylephrine
List 3 active ingredients are used in OTC oral decongestant.
2. Pseudoephedrine
3. Ephedrine
MOA: vaspconstrictors; constrict blood flow to nasal mucosa and decrease
edema
(alpha-adrenergic agoinsts)

Medicamentosa rebound congestion (use nasal products >3-5 days)

Which one is the shortest-acting topical decogestant?

1. Xylometazoline,
2) Phenylephrine
2. Phenylephrine,
3. Naphazoline,
4. Oxymetazoline

Which one is the longest-acting topical decogestant?

1. Xylometazoline,
4) Oxymetazoline
2. Phenylephrine,
3. Naphazoline,
4. Oxymetazolinie

Antihistamine
What is chlorpheniramine?
ex: (Chlor-Trimeton)Chlorpheniramine
 1. Codeine (narcotic) for night cough

2. Dextromethorphan (DM)
List 4 active ingredients in antitussive/cough suppressants.
3. Diphenhydramine

4. Benzonatate

What is the MAX daily dose of Guaifenesin? 2400 mg/day

What is the onset action of bulk-forming laxatives? 1) 2-3 days

1. May bind Digoxin, warfarin and other drugs

What drugs may interact with bulk-forming laxatives?
2. Ca-complexes may bind with tertracycline, inhibiting its absorption

Stool softeners =?? Emollient laxatives

 1. Rectal surgery
Who are good candidates for emollient laxatives? 2. Postpartum
3. Recent MI
(Hint: for those should avoid straiing)
Onset of action: 2-3 days

What is the onset of action of Glycerin? 30 minutes

What is milk of magnesia?

CI:
Mg(OH)2, osmotic laxative
1. Rena; failure
2. CHF
3. HTN

Why lubicant laxatives are contraindicated in children and elderly patients?

Because increase risk of asipration and lipid penumonitis
Ex: mineral oil, olive oil

Lactulose
Which laxative is Rx only?
MOA: Nonabsorbed disacchardide, metabolized by bacteria in GI tract to
produce acetic and formic acid (it exerts osmotic effect)
 1. Bulk-forming laxatives

2. Stool softeners
Which laxatives are recommended for pregnancy women?
- colace
- Surfak
- Recent MI

4 mg now and 2 mg after each loose stool. (max: 8 mg/dat OTC, if Rx: 16
What is MAX dose of Imodium AD?
mg/day)

What is min age of Adsorbent laxatives (ex: Kaolin)? 12 years old

What is toxic effect of salicylate toxicity? Tinnitus

What is toxic effect of bismuch toxicity? Neurotoxicity

What hormone in Ovulation predication kit is used to predic ovulation? LH (Testing usually begins 2-4 days prior to ovulation)

Which hormone in pregnancy detection kit is used to detect? hCG in urine (within 1-2 weeks after conception)

Which ingredient try to test in UTI home testing device? Nitrites (and leukocyte esterase)

Colorectal cancer test ..... check hidden blood in the stool

PDT-90 (Illicit drug use testing) .... hair testing

Which agency is regulated labeling, safety, and manufacturing of dietary
FDA
supplements?

Which agency is regulated advertising of dietary supplements? FTC

1. Enhance memory and concentration

2. Intermittent
List 4 functions of Ginkgo biloba.
3. Vertigo and tinnitus
4. Impotence (in combination with papaverine)

1. Depression
2. Anxiety
List St. John's wort 2 common uses.
** Potent 3A4 inducer**

Oral contraceptives + St. John's wort--> ??? (DDI) Decreased oral contraceptive effcts (by increased metabolism of OC)
 Kava-Kava (root) is used for... for anxiety and stress

Dihydroepiandrgen

1. Depression
What is DHEA?
2. General anti-aging effects
3. OSteopoprosis
4. Antidiabetogenic

Loperamide can cause drowsiness or Insomnia? drowsiness

All NSAIDs contains aspirin. True or False True

1. Corticosteroids (decreased Ca absorption from the gut)

List 2 drugs can cause osteporosis.
2. Long-term anticonvulsant tx (Increased Vit-D breakdown)
 T-score vs.s Z-score? T-score: 30 y.o. white female

T>-1 (normal, low risk) Z-score: your age group

How much daily recommendation for Ca and Vit-D? Ca: 1000-1500 mg/day

(Postmenopausal women on HRT/ERT need less Ca then those who on

HRT/ERT) Vit-D: 200-600 IU/day

Calcium carbonate vs. Calcium citrate (elemental Ca) Calcium carbonate vs. Calcium citrate = 40% vs.21%

Calcium carbonate: DELIVERS greatest amount of Ca

Calcium carbonate vs. Calcium citrate
Calcium citrate: the most bioavailable calcium salt

1. Alendronate (Fosamax)
List 3 Bisphosphonate drugs are aprroved for use in osteoporosis.
2. Ibandronate (Boniva)
MOA: inhibits osteoclast activity
3. Risedronate (Actonel)
 Fosamax (Alendronate)
Which bisphosphonate is indicated for male osteoporosis? and dose?
10 mg/day or 70 mg/week

1) Fosamax: 40 mg/day for 6 months

Which Bisphonate are indicated for Paget's disease? and doses?
2) Actonel: 30 mg/day for 2 months

1. Treatment of postmenopausal(PMOP) women

What is the indication of IV Boniva? dose?
2. 3 mg over 15-30 seconds every 3 months

What is FDA warning on Zometa and Aredia? Osteonecrosis of the jaw (ONJ)

1. May cause hypocalcemia

Patient consulations on Zometa or Aredia. 2. Dental exam at baseline and avoid invasive dental procedures
3. Shoudl Vit-D and Ca daily
 Postmenopausal osteoporosis
What is the indication of use Nasal spray Calcitonin (Miacalcin)?
(One spray each nostril daily 200 IU/spray)

1. Postmenopausal osteoprosis

What are the indications of use injection Calcitonin (Miacalcin)? 2. Paget's disease

3. Hypercalcemia

What is the MOA of Forteo?

Dose: 20 mcg SQ QD Parathyroid hormone regulates Calcium concentration in ECF

BBW: Osteosarcoma

To prevent endometrial hyperplasia and cancer

What is the rationale of adding progestin in HRT for women with intact
uterus? (Estrogen replacement therapy for relief hot flushes and other vasomotor
symptoms)

1. weight gain
2. Breast enlargement
What are the adverse effects of progestin? 3. Somnolence
4. Constipatin
5. Nausea
 What is the indication of all oral estrogen products indicated for? Moderate-severe vasomotor symptoms

Which oral estrogen product is indicated for abnormal uterine bleeding? Premarin (0.3-2.5 mg)

Prometrium (Micronized progesterone)

Which progestin product contains peanut oil?
Use: HRT to prevent endometrial hyperplasia

Endometriosis
What is the unique indication of Aygesttin (norethindrone acetate)?
5 mg po QD for 2 weeks, increased by 2.5 mg Q 2 weeks to 15 mg/day

Hormone Replacement Therapy

vs. Estrogen dose in HRT is much lower than birth control pills.
oral birth control pills
 What is doseage of Femring (estradiol acetate)? Insert ring (0.05 mg/day or 0.1 mg/day) vaginally and replace after 90 days

How long patient should replace Estring? every 90 days

Insert 1 tab (25 mcg estradiol hemihydrate) QD for 2 weeks and then 1 tab
What is the dosage of Vagifem?
twice a week (14 + 4 = 18 tabs/month)

What is the MOA of Forteo?

Dose: 20 mcg SQ QD Parathyroid hormone regulates Calcium concentration in ECF

BBW: Osteosarcoma

To prevent endometrial hyperplasia and cancer

What is the rationale of adding progestin in HRT for women with intact
uterus? (Estrogen replacement therapy for relief hot flushes and other vasomotor
symptoms)
 1. weight gain
2. Breast enlargement
What are the adverse effects of progestin? 3. Somnolence
4. Constipatin
5. Nausea

What is the indication of all oral estrogen products indicated for? Moderate-severe vasomotor symptoms

Which oral estrogen product is indicated for abnormal uterine bleeding? Premarin (0.3-2.5 mg)

Prometrium (Micronized progesterone)

Which progestin product contains peanut oil?
Use: HRT to prevent endometrial hyperplasia

Endometriosis
What is the unique indication of Aygesttin (norethindrone acetate)?
5 mg po QD for 2 weeks, increased by 2.5 mg Q 2 weeks to 15 mg/day
 Hormone Replacement Therapy
vs. Estrogen dose in HRT is much lower than birth control pills.
oral birth control pills

What is doseage of Femring (estradiol acetate)? Insert ring (0.05 mg/day or 0.1 mg/day) vaginally and replace after 90 days

How long patient should replace Estring? every 90 days

Insert 1 tab (25 mcg estradiol hemihydrate) QD for 2 weeks and then 1 tab
What is the dosage of Vagifem?
twice a week (14 + 4 = 18 tabs/month)

Ped only vaccine? Hib (Haemophilis influenza)

 What the 3 vaccines are STD? Hep A, Hep B and HPV

1) Influenza
What the 2 vaccines are recommended for diabetets?
2) Pneumoniae

No live vaccine for age < 1 year beacuse ???? Maternal antibody

True
Meningococcal meningitis vaccine has both IM and SC forms. True and
False MPSV 4 (Menomune)
MCV 4 (Menactra)

1. Empty stomach
2. Water only
What are patient counseling points of Vivotif Berna?
3. Finish in 10 days
4. No ABX
 Diphetheria-Tetanus Pertussis

2 months-6 years --> DTaP

?? vaccine. Everyone needs every 10 years.
7-9 years --> Td
10-64 y.o. --> Tdap
> 65 -->Td

1. 5-lipooxygenase inhibitor
What is MOA of Zyflo? Generic name? Class? 2. Zileuton
3. Leukotriene production inhibitors

Singulair
1) Leukotriene receptor antagonist
1) MOA
2) Montelukast, take at bedtime
2) Generic name
3) Headache, GI upset
3) ADR

Oxymetazoline > naphazoline > phenylephrine Afrin (LA)>Naphcon, Clear eye, Vasocon > Neo-synephrine

What is the rationale taking Singulair @HS? Leukotriene production is increased at nighttime
What is rationale that metoformin should avoid use in renal insufficiency
Due to increase risk of lactic acidosis
patients? (Scr for male >1.5, for female >1.4)

What are the MAX dose of

1) Metformin (Glucophage)max: 2550/d (850 mg TID)
1) Metformin (Glucophage) 2) Glucophage XR (max: 2000 mg/day)
2) Glucophage XR 3) Fortamet (extended release product) (max:2500 mg)
3) Fortamet (extended release product)

1. MEtallic taste
2. diarrhea
List side effects of metformin.
3. Lactic acidosis
4. folate and B12 deficiency

TZD (Thiazolidinediones)
Which class of anti-diabetic agents needs to avoid use in CHF patient?
ex: actos, avandia (can cause fluid retention)

What is the MOA of TZD (thiazolidinediones)?

Increased insulin sensitivity; increased target cell sensitivty
To see effect: 12 weeks
 What is MOA of Meglitinides? Stimulates insulin release from pancreatic cells

What is MOA of alpha-glucosidase inhibitors? inhibit small intestine alpha-glucosidase

What type of sugar is used to treat hypoglycemia caused by acarbose or

oral glucose (dextrose)
glyset?

Which 2 class of oral antidiabetes agents action site is in pancreas? (to 1. Sulfonylureas
stimulate secretion of insulin) 2. Meglitinides

what is the action site of biguanides? liver (ex: metformin)

 what is the action site of Thiazolidinediones? muscle

What is action site of alpha-glucosidase inhibitors? GI

Patient has elevated postprandial glucose. Which classes of antidiabetes are 1. Meglitinides
recommended? 2. alpha-glucosidase inhibitors