CPJE Secrets CLINICAL PORTION Flashcards PDF

CPJE Secrets CLINICAL PORTION: Flashcards *have gone through 3 times Study CPJE Secrets CLINICAL PORTION: Flashcards *have gone through 3 times Leave the first rating Students also viewed english 6 test 1 english 25 terms koketlizz RESPIRATORY - CH29 + pptx questio... 45 terms msnead2024 P...

CPJE Secrets CLINICAL PORTION: Flashcards *have gone through 3 times Study CPJE Secrets CLINICAL PORTION: Flashcards *have gone through 3 times Leave the first rating Students also viewed english 6 test 1 english 25 terms koketlizz RESPIRATORY - CH29 + pptx questio... 45 terms msnead2024 Preview pelvic girdles and lower limb 22 terms Preview rabrahim413 Senior English First Semester Final E... 11 terms Preview nataleehahn 53 terms Preview JayaF78 Mental health Preview key405902 Terms in this set (1254) The aminoglycosides have these black box warnings? Neurotoxicity Gentamicin Nephrotoxicity: reversible Tobramycin Vancomycin Ototoxicity: IRREVERSIBLE Cardura (Doxazosin) IR: start at 1mg; titrate slow up to 8mg NIGHTLY Dosing for the BPH drugs? Cardura (Doxazosin) Hytrin (Terazosin) Minipress (Prazosin) Flomax (Tamsulosin) Uroxatral (Alfuzosin) Rapaflo (Silodosin) XL: start at 4mg daily with breakfast, max of 8mg Hytrin (Terazosin) start at 1mg; titrate slow to max of 20mg Minipress (Prazosin) -5mg BID/TID Flomax (Tamsulosin) 0.4mg QD 30 min after same meal each day Uroxatral (Alfuzosin) -10mg QD immediately after same meal each day Rapaflo (Silodosin) -8mg QD with a meal Actos (Pioglitazone) Actos (Pioglitazone): initial is 15-30mg daily, max is 45mg daily starting dose? max? Evista (Raloxifene) for breast cancer? ONLY FOR PROPHYLAXIS benefits? increases bone density; also indicated for osteoporosis prevention and treatment in select postmenopause women Penicillins: major concerns? Renal toxicity *coverage? Veetids (Penicillin VK) Pregnancy category B Timentin (Ticarcillin/Clavulanic) Zosyn (Pip/Tazo) Decrease effectiveness of birth control Principen (Amp/sulbactam) Amoxil (Amoxicillin) *coverage : mostly GM+ Augmentin (Amox/Clav) How is Amoxil (Amoxicillin dosed)? Q8-12h with OUT food Acute otitis media Augmentin (Amox/Clav) is the drug of choice for what? H.pylori Endocarditis MSSA, Strep Extended spectrum penicillin's are used for what? *For skin & soft tissue infections Nafcil, Nallpen (Nafcillin) Bactocill (Oxacillin) IV endocarditis Dynapen (Dicloxacillin) bone & joint infections *1st gen cephalosporins for Gm+ skin and soft tissue infections Duricef (Cefadroxil) Duricef (Cefadroxil): PO 1g once daily or 500mg BID Ancef, Kefzol (Cefazolin) Ancef, Kefzol (Cefazolin): Cephalexin (Keflex) 1-2g Q8H Use? Dosing? Keflex (Cephalexin) 250-500mg Q6H-Q12H Duricef (Cefadroxil) PO dosing? 1g once daily or 500mg BID Keflex (Cephalexin) PO dosing? 250-500mg Q6-12H 2nd Gen cephalosporin for GM+ or - Respiratory Mefoxin (Cefoxitin) Cefzil (Cefprozil) Ceclor (Cefaclor) Ceftin, Zinacef (Cefuroxime) Use? Doses? Mefoxin (Cefoxitin): 1-2g Q4-6H IV Cefzil: (Cefprozil) 250-500mg Q12-24H Ceclor: (Cefaclor) 250-500 mg Q8H Ceftin, Zinacef (Cefuroxime): 0.25-1.5g Q8-Q12H Cefzil (Cefprozil) PO dosing? 250-500mg Q12-24H Ceclor (Cefaclor) PO dosing? 250-500mg Q8H pnja 24 terms 17 terms Preview milena_pierzga 3rd Gen streptococcal infections CPJE Secrets CLINICAL PORTION: Flashcards *have gone through 3 times Omnicef (Cefdinir) Omnicef (Cefdinir): 300mg BID or 600mg daily Fortaz (Ceftazidime) Fortaz: Ceftazidime 1-2g Q8H IV Rocephin (Ceftriaxone) Rocephin (Ceftriaxone): Claforan (Cefotaxime) 1-2g Q12-24H IV Suprax (Cefixime) Claforan (Cefotaxime): 1-2g Q6-8H IV Use? Doses? Suprax (Cefixime): 400mg Q12-24 Cefdinir (Omnicef) PO dosing? 300mg BID or 600mg daily Suprax (Cefixime) PO dosing? 400mg once daily This cephalosporin goes through hepatic metabolism and is not dose reduced in kidney disfunction? Rocephin: Ceftriaxone This cephalosporin has an active metabolite? Claforan: Cefotaxime pseudomonas Fortaz (Ceftazidime): is used for what? 1-2g Q8H IV Maxipime (Cefepime): pseudomonas use? 0.5-2g IV Q8H dose? Teflaro (Ceftaroline) MRSA use? 400-600mg IV Q12H dose? If CrCl greater than what you will not have to dose reduce cephalosporins? These are the main concerns with cephalosporins? Duricef, Ancef, Kefzol, Keflex, Mefoxin, Cefzil, Ceclor, Ceftin, Zinacef, Omnicef, Fortaz, Rocephin, Claforan, Suprax, Maxipime, Teflaro >50 C diff colitis Pregnancy Category B *IF PCN Allergy: use 3rd gen cephalosporin Zerbaxa (Ceftolozane/tazobactam) These are cephalosporins that are given for intra-abdominal infections/UTIs? Avycaz (Ceftazidime/Avibactam) This is a siderophore cephalosporin that is used for complicated UTIs and has Gm- coverage Fetroja (Cefiderocol) Gram + or - infections; Anaerob Primaxin (Imipenem/Cilastin) Merrem (Meropenem) Invanz (Ertapenem) Doribax (Doripenem) *Use? *doses? *all cover pseudomonas EXCEPT Invanz (ertapenem) Primaxin (Imipenem/Cilastin): 1g Q6H IV Merrem (Meropenem): 2g Q8H Invanz (Ertapenem) 1g DAILY Doribax (Doripenem) 500mg Q8H Risks for Carbapenems? SEIZURES Primaxin (Imipenem/Cilastin) Merrem (Meropenem) Renal tox Invanz (Ertapenem) Doribax (Doripenem) This carbapenem is used for complicated UTIs or intra-abdominal infections? Pregnancy Category B/C: Imipenem Recarbio (Imipenem/Cilastin/Relebactam) Azactam (Aztreonam) Gram - and pseudomonas Use? Dose? 2g Q8H Zithromax, Z-Pak (Azithromycin) Dose? 500mg day 1 + 250mg days 2-5 OR 500mg x 3 days Zithromax, Z-Pak (Azithromycin) with or w/out food counseling points? Suspension: empty stomach AND do NOT refrigerate Gram + or - Macrolides are used for what? upper respiratory infection Zithromax, Z-Pak (Azithromycin) Chlamydia Biaxin (Clarithromycin) Atypicals EES, Ery-Tab, Erythrocin (Erythromycin) CAP anaerobes Biaxin (Clarithromycin) 1g daily WITH FOOD -500mg if Cr<30 dose? counseling? METALLIC TASTE Macrolide concerns? QT prolongation CPJE Secrets CLINICAL PORTION: Flashcards *have gone through 3 times Zithromax, Z-Pak (Azithromycin) Pregnancy Cat B Biaxin (Clarithromycin) EES, Ery-tab, Erythrocin (Erythromycin)? GI Ketek (Telithromycin) 800mg daily Dose? broad spectrum Ketek (Telithromycin) BBW: do not use in myastenia gravis (respiratory failure) black box warning? counseling: monitor for visual adverse effects and loss of consciousness counseling points? Cleocin (Clindamycin) C Diff colitis black box warning? Cleocin (Clindamycin) 450mg PO TID-QID dose? GM+ use? Cleocin (Clindamycin) Do NOT refrigerate counseling point? Fluoroquinolones BBW: tendon rupture, peripheral neuropathy, CNS effects Floxin, Ocuflox (Ofloxacin) Cipro (Ciprofloxacin) counseling: Baxdela (Delafloxacin) -avoid sun Levaquin (Levofloxacin) -hypoglycemia Avelox, Vigamox (Moxifloxacin) -hydrate due to risk of crystalluria Factive (Gemifloxacin) -seizures (avoid if h/x) -C.diff diarrhea Black box warning? Counseling? This is the only fluoroquinolone that doesn't need dose adjustment in renal dysfunction? This flouroquinolone is only used for eye infections? Drug interactions for Fluoroquinolones? Avelox, Vigamox (Moxifloxacin) Factive (Gemifloxacin) CYP450: Increase INR with warfarin Floxin, Ocuflox (Ofloxacin) Cipro (Ciprofloxacin) interact with a LOT of multivalent cations (iron, antacids, multivitamin, etc) Baxdela (Delafloxacin) Levaquin (Levofloxacin) Avelox, Vigamox (Moxifloxacin) Factive (Gemifloxacin) What fluoroquinolone is the most potent CYP inhibitor? Cipro 750mg Q24H normal dose > 750mg Q48 How do you dose reduce Levaquin (Levofloxacin) for renal? 500mg Q24H > 500mg x1, 250mg Q24H 250mg Q24H > no dose adjustment Dosing for Avelox, Vigamox (Moxifloxacin) 400mg Q24H Dosing for Baxdela (Delafloxacin) 450mg PO Q12H use? *skin and soft tissue Cipro (Ciprofloxacin) dosing? 250-750mg PO BID or daily Vibramycin, Doryx (Doxycycline) major:Atypicals, VRE Minocin, Dynacin, Solodyn (Minocycline) others: rickettsial, anthrax, syphilis, MRSA, lyme, Rocky mountain spotted fever, skin & urinary infections. Sumycin (tetracycline) Tygacil (Tigecycline) Use? Dosing of: 100mg Q12H Vibramycin, Doryx (Doxycycline) Minocin, Dynacin, Solodyn (Minocycline) Must take this tetracycline with food? Dosing for Tygacil (Tigeycline)? Vibramycin, Doryx: take with food to decrease GI 100mg x1 THEN 50 mg Q12H IV Vibramycin, Doryx (Doxycycline) avoid sun Minocin, Dynacin, Solodyn (Minocycline) take w/water and sit upright for 30 mins after Sumycin (tetracycline) CI if <8: tooth discoloration Tygacil (Tigecycline) Pregnancy Cat B Counseling? Vibramycin, Doryx (Doxycycline) CPJE inhibit CYP450: INCREASE INRthrough and warfarin3 times Secrets CLINICAL PORTION: Flashcards *have gone Minocin, Dynacin, Solodyn (Minocycline) multivalent cations: like all of them (iron, multivit, antacids) Sumycin (tetracycline) Tygacil (Tigecycline) drug interactions? Nuzyra (Omadacycline) community acquired pneumonia and skin infections *new tetracycline use? Xerava (Eravacycline) complicated intra-abdominal infections *new tetracycline use? Synercid (quinupristin/dalfopristin) D5W; volume must be >250ml to be given peripheral should only be diluted in? GM+, MRSA, VRE use? Synercid (quinupristin/dalfopristin) Hyperbilirubinemia, phlebitis, myalgias SE? Cubicin, Dapzura (Daptomycin) NS only must be diluted in? GM+, NOT pneumonia, MRSA, VRE use? Cubicin, Dapzura (Daptomycin) main SE? Rhabdo (monitor CPK) pregnancy cat C Vibativ (Telavancin) has this black box warning? *do pregnancy test prior to therapy Vibativ (Telavancin) Gm+, MRSA use? Zyvox (Linezolid) 600mg Q12 PO or IV *NO RENAL DOSE ADJUSTMENT NEEDED Dose? GM+, MRSA, VRE Use? Do NOT refrigerate Zyvox (Linezolid) MAO inibitor: counseling? -avoid tyramine foods (wine, fermented foods) -avoid serotonin and adrenergic drugs major SE? SE: myelosuppresion Flagyl (Metronidazole) 500mg Q6H Tindamax (Tindazole) anaerobic coverage, bacterial vaginosis, amoebiasis, giardiasis, trichomniasis dose? use? TAKE WITH FOOD Flagyl (Metronidazole) Tindamax (Tindazole) Counseling? and METALLIC TASTE darkened urine disulfram like rxn with alcohol do NOT refigerate IV form Flagyl (Metronidazole) CNS and convulsive seizures Tindamax (Tindazole) most serious side effects? Flagyl (Metronidazole) increase INR Tindamax (Tindazole) decrease effectiveness of birth control. drug interactions? Solosec (Secindazole) only approved for bacterial vaginosis 2g SINGLE DOSE dose? SE: vulvovaginal candidiasis SE? Dicloxacillin, Nafcillingone through 3 times CPJE Secrets CLINICAL PORTION: Flashcards *have Cetriaxone Clindamycin Doxycycline Key antimicrobials that do NOT require renal dose reductions? Azithromycin and Erythromycin Metronidazole Moxifloxacin Linezolid Bactrim Doxycycline, Minocycline Common drugs used for skin and soft tissue infections caused by community associated MRSA (CA-MRSA)? Clindamycin Linezolid Vanco (consider alternative if MIC>2) Linezolid Common drugs used for severe SSTIs requiring IV treatment of hospitalization (cover MRSA and Strep) Daptomycin Cetraroline Vancomycin Common drugs for nosocomial MRSA? Linezolid Dapto Pen G or ampicillin (E. faecalis only, not E. faceium) Common drugs for VRE? Linezolid Daptomycin azithromycin Common drugs to treat atypical organisms? doxycycyline quinolones Pip/Tazo Cefepime Ceftazidime Ceftazidime/Avibactam Ceftolozane/Tazobactam Common drugs to treat pseudomonas? Carbapenems (not ertapenem) Cipro, Levofloxacin Aztreonam Aminoglycosides Colistimethate, polymyxin B Carbapenems (except Ertapenem) Minocycline Tigecycline Common drugs to treat Acinetobacter baumannii Quinolones Bactrim Amikacin Amp/Sulbactam Carbapenems Common drugs to treat extended spectrum beta lactamase producing gram negative rods (ESBL GNR)?? Ceftazidime/Avibactam Ceftolozane/Tazobactam Ceftazidime/Avibactam Common drugs to treat carbapenem resistant Gm- rods (CRE) Colistimethate/polymyxin B metronidazole beta-lactam/beta lactamase inhibitor Common drugs to treat bacteroides fragilis? cefotetan, cefoxitin carbapenems Dicloxacillin, Nafcillin, Oxacillin Common drugs used for MSSA? Cefazolin, Cephalexin (and other 1st and 2nd gen cephalosporins) This aminoglycoside is not really used anymore due to having a black box warning of blood dycrasias and it can cause irreversible bone marrow suppression? Chloramphenicol Gentamicin Tobramycin C/D sadly *have gone through 3 times CPJE Secrets CLINICAL PORTION: Flashcards Vancomycin aminoglycosides> pregnancy class? This aminoglycoside COULD be used for a complicated UTI Rates greater than this for vancomcyin can cause red man syndrome? Zemdri (Plazomicin) 15 mg/min Fosfomycin (Monurol) Bactrim, Septra (Sulfamethoxazole/ Trimethorpim) Nitrofurantoin (MacroBID, Macrodantin) Drug options for UTIs Fluroquinolones (Cipro and Levoflox) Methenamine (UREX) Phenazopyridine (Azo, Uristat, Pyridium) Dosing for Monurol (Fosfomycin) 3g x1 se? causes diarrhea SS: Dosing for Septra, Bactrim (Sulfamethaxazole/Trimethoprim) 400mg/80mg TMP DS: 800mg SMX/160mg TMP *Adults: DS tab BID x 7-10 days Hydrate to avoid kidney stones Counseling points for Septra, Bactrim wear sunscreen (Sulfamethaxazole/Trimethoprim) increase INR if on warfarin serious skin rashes You should only compound Septra, Bactrim in this dilutent? D5W (Sulfamethaxazole/Trimethoprim) *also has very short stability (6 hours) *other compounding facts to know? *DO NOT refrigerate Dosing difference between Nitrofurantoin products? MacroBID: 100mg BID MacroBID: Macrodantin: 100mg FOUR times daily Macrodantin: Counseling points for Nitrofurantoin products? Dark urine SERIOUS lung problems and C. diff MacroBID: Macrodantin: Pregnancy category D near term Urex (Methenamine) UTI (urinary antiseptic to prevent reocurring UTIs) use? counseling points? Azo (Phenazopyridine) counseling? red orange coloring of the urine must be treated for at least 7 days to prevent premature birth Nitrofurantoin (if <37 week) Pregnant women UTI tx options? B-lactams Fosfomycin INH (Isoniazid) Fatal hepatitis black box warning? Neurotox (GIVE Vitamin B6- Pyridoxine to prevent neuropathy) INH (Isoniazid) SE/counseling? Lupus/Flu like symptoms take on empty stomach empty stomach: INH-isoniazid Rifadin- Rifampin TB drugs how to take (food/no food)? WITH food: Priftin: Rifapentine Rifadin: Rifampin These two TB drugs can cause orange urine/body fluids? Priftin: Rifapentine Rifadin: Rifampin inducers of CYP450; so increased clearance of other meds (DECREASE effectiveness of birth control) Priftin: Rifapentine flu like syndrome drug interactions? SE? Myambutol (Ethambutol): CPJE optic neuritis: need togone get monthly vision tests Secrets CLINICAL PORTION: Flashcards *have through 3 times major SE: INH and Rifapentine once weekly for 12 weeks via directed observed therapy or Rifampin 600mg daily for 4 months (drug interactions biggest barrier to doing this) How do you treat latent TB? or INH with Rifampin daily for 3 months or alternate if drug interactions or HIV+ = INH 300mg daily for 6 or 9 months two phases: intensive and continuation How do you treat active TB? intensive phase: RIPE (Rifampin, INH, Pyrazinamide, Ethambutol) for 2 months continuation: Rifampin + INH for 4 months Major toxicity of TB drugs? Hepatotox INH: Isoniazid watch for liver tests Rifadin: Rifampin Priftin: Rifapentine Myambutol: Ethambutol Amphotericin products are only compatible in? D5W only Amphocin reconstitue 50mg w/10mL SWFI for 5mg/mL Abelect (Lipid complex) withdraw dose and further dilute to 500mL (<0.1 mg/ml) or 250 ml (<0.2mg/ml) Ambisome (Liposomal) other compounding facts to know? Major concerns with Amphotericin products? Amphocin (Amphotericin B) Abelcet (Amphotericin lipid complex) Ambisome (Amphotericin Liposomal) PREGNANCY category B Decrease K (enhances digoxin tox) Decrease Mg Nephrotoxic *Do NOT use with cyclosporine, aminoglycosides, flucytosine, cisplatin Ancobon, 5-FC (Flucytosine) causes bone marrow suppression. major concern? Avoid use as monotherapy due to rapid resistance. 70mg on day 1; then 50mg IV daily Cancidas (Caspofungin) dose? how to compound? NS only Mycamine (Micafungin) dose? 100mg IV daily Nizoral (Ketoconazole) dose? 400mg QD BBW: Hepatotox Nizoral (Ketoconazole) concerns? Need acidic pH for absorption: avoid use w/antacids, PPIs, etc. Diflucan (Fluconazole) 400mg QD dose? (IV to PO?) *150mg tab ONCE for vaginal fungus single dosing for what? IV to PO is 1/1 Diflucan (Fluconazole) counseling? Sporanox (Itraconazole)black box warning? possible hepatotox or serious skin rash Heart failure 200mg PO daily-BID Sporanox (Itraconazole) dosing? oral caps need food for absorption; oral soln can be empty stomach oral caps v. solution? need acidic pH for absorption so avoid antacids, H2 block, PPI This is the drug of choice for Aspergillus infections? VFEND (Voriconazole) visual changes (avoid at night) Major side effects of Vfend (voriconazole) photosensitivity hepatotox take on empty stomach Vfend (voriconazole) counseling? do not refrigerate suspension This azole antifungal has the least number of drug interactions? Noxafil (Posaconazole) counseling? MUST be taken with a full meal This azole antifungal is used for invasive aspergillosis/mucormycosis? Cresemba (Isavuconazonium) load: 372mg*have IV or POgone Q8H x 6through doses (2 days) CPJE Secrets CLINICAL PORTION: Flashcards 3 times Dosing for Cresemba (isavuconazonium) then 372mg IV or PO daily What to give for oral yeast infections? Mycostatin (Nystatin) suspension 4-5 times daily OR Mycelex (clotrimazole lozenge) Diflucan (Fluconazole): 150mg x1 can repeat and Sporanox (Itraconazole) What to give for vaginal candida infections? Brexafemme: 150mg; 2 pills in the AM and 2 pills in the PM. Prenancy: intravaginal/topical candida infections? the use of topical antifunagls is safe (7 day regimen) Vivjoa (Otesconazole) New drug for recurrent vulvovaginal candidiasis? Day 1:600 mg dosing? Day2: 450mg Day 14: 150mg PO Q Week for 11 weeks Rifampin The only antibiotic that has been proven to clinically decrease birth control pills effectiveness? *others can theoretically have an effect aminoglycosides Pseudomonas infection? B-lactams: Cefepime, Ceftazidime, Pip/Tazo, Ticarcillin-Clavulanate what do you do/options? Aztreonam and Carbapenems (Imipenem/Meropenem/Doripenem NOT Ertapenem) FQ: Cipro and Levoflox B-lactams: PCNs, cephalosporins, carbapenems (except Imipenem) These are the Antiboitics that CAN be used safely in pregnancy? Clindamycin Macrolides: Azithromycin, Erythromycin (NOT clarithromycin) all need to be labeled w/the following: What to know about oral antibiotic suspensions? shake take until gone refrigerate after mixed Azithromycin Clarithromycin Do NOT refrigerate these antibiotic suspensions? Clindamycin Fluoroquinolones Voriconazole Firvanq (Vancomycin PO): 125mg QID C Diff Infection treatment guidelines? And/OR Fidaxomicin 200mg BID x 10 days Metrondiazole Alternative options for C.Diff? Zinplava (Bezlotoxumab): indicated for recurrent Cdiff 50mg/kg Pediatric dosing for amoxicillin? *suspension is 50mg/mL; so for every kg the kid weights he gets 1mL Ampicillin oral caps and suspension Ceftibuten suspension Levofloxacin oral solution Most antimicrobials should be taken with food to help lessen GI effects, but these exceptions should be taken on an EMPTY stomach? Penicillin VK Rifampin Isoniazid Itraconazole solution Voriconazole Levofloxacin/Moxifloxacin Doxycycline, Minocycline Linezolid/Tedizolid These antimicrobials have 1/1 IV to oral dosing? Metronidazole Bactrim Fluconazole/Cresemba/Posaconazole/Voriconazole doxycycline These antimicrobials MUST BE PROTECTED FROM LIGHT during administration? Micafungin Flagyl (Metronidazole) Avelox (Moxifloxacin) Do NOT refrigerate these antimicrobials? Bactrim Acyclovir (Zovirax)- causes crystallization Macrobid, Macrodantin (Nitrofurantoin) at what CrClSecrets is it contraindicated? CPJE CLINICAL CrCl<60 ml/min PORTION: Flashcards *have gone through 3 times 16mg per day Max dose of loperamide 4mg initially, 2mg after each loose stool Azithromycin Levofloxacin Ciprofloxacin Travelers' diarrhea tx options? Ofloxacin Rifamycin Rifaximin 200mg TID for 3 days Lariam (Mefloquine) is CI if? neuro/psych disorders Malaria Prophylaxis? bone marrow suppression Fansidar (Sulfadoxine-Pyrimethamine) hemolysis w/G6PD deficiency side effects? sulfa allergy Plaquenil (Hydroxychloroquine) SE? What to do for severe malaria? toxicity in the eye with chronic use Artesunate IV followed by Malarone, doxycycline or Mefloquine chloroquine phosphate or Hydroxychloroquine How to treat malaria in pregnancy? or Quinine + Clindamycin OR Mefloquine What is Krintafel (Tafenoquine) used for? antimalarial to prevent relapse of P.vivax infection Malaria treatment? Malarone (Atovaquone-Proguanil) treatment duration for malaria 3 days Coartem (Artemether-Lumefantrine) treatment duration for malaria 3 days SE: Cinchonism Quinine X 3-7 days plus Doxycycline/Tetracycline/Clindamycin for malaria overdosage may lead to cardiotox. concerns? monitor for hypoglycemia Aralen (Chloroquine) dosing for malaria 600mg base + 300mg base PO at 6,24, and 48 hours Dosing for Oral Herpes Simplex (HSV): 200-400mg x5 daily for 7-10 days Zovirax (Acyclovir) Varicella Zoster (VZV): 600-800 mg x 5 daily for 10 days Dosing for Valtrex (Valacyclovir)? SE of ganciclovir (Cytovene, Cymevene) and valganciclovir (Valcyte) Dosing for Valcyte (Valganciclovir)? 1g TID for 7-14 days. bone marrow suppression (leukopenia) 900mg daily 60mg/kg Q8H IV Foscavir (Foscarnet) dosing? Use? for acyclovir or ganciclovir resistant HSV, VZV, AND CMV (Cytomegalovirus) IV 5mg/kg weekly Vistide (Cidofovir) dosing? use? acyclovir/ganciclovir/foscarnet resistant HSV and CMV This drug is used for suppression of CMV (cytomegalovirus) post transplant? Prevymis (Letermovir) Denavir (Penciclovir) Zoster Famvir (Famciclovir) genital HSV use? topical for HSV labialis Viroptic (Trifluridine) These are the ocular antivirals? Idoxuridine powder 0.1% Vira-A (Vidarabine) 3% ointment 75mg BID for 5 days gone through 3 times CPJE Secrets CLINICAL PORTION: Flashcards *have *renal dosing is 75mg for once dose, then 30mg BID Tamiflu (Ostelamivir) dosing? *prophy dosing is once daily for 10 days * Tamiflu is for >1 years old 40mg (if 40-80kg) or 80mg (if >80kg) Xofluza (Baloxavir) dosing? *for age>12 oral inhalation 10mg BID x 5 days Relenza (Zanamivir) dosing? age >7 600mg IV x 1 within 2 days of symptoms Rapivab (Peramivir) dosing? age >18 3 tabs Paxlovid (Nirmatrelvir/Ritonavir) dosing? (2 tabs nirmatrelvir + 1 tab ritonavir) PO BID x 5 days mid/mod COVID Paxlovid (Nirmatrelvir/Ritonavir) indication? >12 years old and >40kg CI in renal failure Lagevrio (molnupiravir) 800mg (4 x 200mg caps) PO Q12H x 5 days dosing? mid/mod COVID high risk for progression to severe Lagevrio (molnupiravir) indication? >18 years old as can affect bone and cartilage growth CI in pregnancy Veklury (remdesivir) IV only dosing? 3 days of IV admin Ebola virus? Inmazeb and Ebanga (monoclonal Antibodies) sustained virological response (SVR) How is hepatitis C (HCV) treatment efficacy measured? HCV guidelines define a SVR as an undetectable HCV RNA level 12 weeks after finishing therapy. Havrix Hep A vaccines? Vaqta Engerix B Hep B vaccines? Recombivax HB Vaccine for both Hep A and B? No vaccine is available for these versions of hepatitis? This hepatitis drug is pregnancy category X Twinrix Hep C, D, and E Ribavarin (Rebetol, Copegus) and you must use 2 forms of birth control and take pregnancy test prior to use? Pegasys (Peg Interferon 2a) These are the drugs that can be used for all genotypes of Hep C virus? Peg-Intron (Peg Interferon 2b) How long do you treat for? Ribavirin (Rebetol, Copegus) 48 weeks of treatment Intron A (Interferon alfa-2B) Intron A (Interferon alfa-2B): 3 MU 3x week (not used much bc of frequent dosing) Pegasys (Peg interferon 2a) pegasys (2a): 180 mcg SC weekly v. peg-intron (2b): 1.5 mcg/kg SC weekly Peg-Intron (Peg interferon alfa 2b) dosing? Interferon products for Hep C BBW: worsening autoimmune, infection, psych, ischemic (chest pain, heart attack), blood (neutropenia, thrombocytopenia) -Black box? -Monitoring? monitor: chest x-ray, ECG, CBC, LFT, SrCr, Electrolytes, TGs, thryoid -Counseling? Counseling: refrigerate, inject 45-90 degrees in thigh, abdominal, or upper arm Intron A (Interferon alfa-2B) Pegasys (Peg interferon 2a) Peg-Intron (Peg interferon alfa 2b) This drug treats interferon related thrombocytopenia? Promacta (Eltrombopag) Rebetol, Copegus (Ribavirin) for HepC dosing: 400-600mg BID weight based with FOOD dosing? BBW: hemolytic anemia (monitor CBC). If patient is anemic, decrease dose or treat with erythropoietin BBW: NS3 protease inhibitors for Hep CCPJE anemia that*have requires ESA use through 3 times Secrets CLINICAL PORTION: Flashcards gone *SE? Olysio causes photosensitivity *Combo? *Use? may need combo with Ribavirin +/- interferon Olysio- Simeprevir use: genotypes 1 and 4 for 12-48 weeks Paritaprevir (component of Viekira Pak and Technivie) Grazoprevir (component of Zepatier) most Hep C drugs should be taken with food? true true/false Preferred initial antiretroviral therapy (ART) regimens in most treatment naïve adults? chart The single tablet regimen (one pill once daily) DOVATO for HIV should not be used if? do not use in treatment naive adults IF HIV RNA >500,000, known as hepatitis B virus (HBV) co-infection or HIV genotypic testing not yet available *Dovato is Dolutegravir/Lamivudine test for HLA-B 5701 allele due to Triumeq containing Abacavir In order to start a patient on Triumeq you must do this? *if positive it indicates a higher risk for severe hypersensitivity reaction fixed dose combos have less flexibility with renal dosing If patients have renal issues, try to avoid these HIV meds and why? *Biktarvy, Triumeq, Dovato, Truvada, Descovy: do not use if CrCl<30 mL/min Didanosine Boxed warning for lactic acidosis and hepatomegaly with these HIV NRTI meds? Stavudine Zidovudine Emtricitabine (Emtriva) If these products are discontinued a severe HBV exacerbation may occur (this is a boxed warning)? Lamivudine (Epivir) Tenofovir This HIV med can cause hyperpigmentation of the palms of the hands or soles of feet Emtriva (Emtricitabine) TDF higher risk of renal impairment and decreased bone mineral density TDF vs TAF *TAF does have a higher risk of lipid abnormalities tho hematologic tox: neutropenia and anemia Retrovir (Zidovudine) issues? myopathy pancreatitis ; peripheral neuropathy that can be irreversible Didanosine (Videx) and Stavudine issues? *NO LONGER RECOMMENDED increase Scr both Bictiegravir and Dolutegravir Bictiegravir (in Biktarvy) and Dolutegravir (in Tivicay) Dolutegravir (in Tivicay) -Hypersensitivity rxns with severe rash and organ dysfunction (including hepatotox) concerns? -small risk of neural tube defects in women (though still a preferred drug for treatment of HIV during pregnancy) -increased CPK, myalgia Raltegravir (Isentress) issues? increased CPK, myopathy, rhabdomyolysis Counseling point when taking a INSTI HIV med separate from polyvalent cations Bictegravir (in Biktarvy) take INSTIs 2 hours before or 6 hours after aluminum, mag, calcium, and iron containing products. Cabotegravir (Vocabria) Dolutegravir (Tivicay) Elvitegravir (in Genvoya and Stribild) Raltegravir (Isentress) Renal dosing implications for the following HIV drugs Stribild Biktarvy or Genvoya This HIV drug is admin IV during labor and delivery in women with HIV RNA >1,000 copies/mL to protect the Stribild: -do not start if CrCl<70; discontinue once less than 50 Biktarvy/Genvoya: -do not start if <30 ml/min Retrovir (Zidovudine) baby? take with water and a meal (do not take w/protein drink) Edurant (Rilpivirine) counseling points on how to take med? requires acidic environment for absorption, do not use with PPIs and separate from H2 blockers and antacids Sustiva (Efavirenz) counseling point on how to take? take on empty stomach QHS to decrease CNS effects as food increases bioavailability NNRTIs for HIV are not first line agents; all have these major concerns? hepatotox Sustiva (Efavirenz) severe rash including SJS/TEN; highest risk is with Viramune (Nevirapine) Edurant (Rilpivirine) Viramune (Nevirapine) *Many drug interactions Pifeltro (Doravirine) psych symptoms (depression, suicidal thoughts) Sustiva (Efavirenz) conerns? CNS effects (impaired concentration, abnormal dreams, confusion) total cholesterol and TG depression *have gone through 3 times CPJE Secrets CLINICAL PORTION: Flashcards increased Scr with no effect on GFR Edurant (Rilpivirine) concerns? NEEDS an acidic gut for absorption -PPIs avoid -separate H2 blockers and antacids metabolic abnormalities: BG, lipids, body fat. increased CVD risk Protease Inhibitors: not 1st line due to these concerns? hepatic dysfunction Reyataz (Atazanavir) hypersensitivity rxns (including SJS/TEN) Prezista (Darunavir) diarrhea, nausea Lexiva (Fosamprenavir) *MANY MANY Drug interactions: do not use with Invirase (Saquinavir) -alfuzosin -colchicine Aptivus (Tiprinavir) -dronedarone -simvastatin and lovastatin -anticoag/antiplatelet -hep C drugs -steroids hyperbilirubinemia ( jaundice) it is reversible tho Reyataz (Atazanivir) issues? requires acidic gut for absorption: avoid PPIs, separate H2 blockers and antacids Kaletra (Lopinavir/Ritonavir) concern? Aptivus (Tipranavir) concern? oral soln contains 42% alcohol: can cause a disulfiram reaction if taken with metronidazole intracranial hemorrahge The boosting agents used in HIV are: Cobicistat is in: -Ritonavir (Norvir) -Stribild -Cobicistat (Tybost) -Genvoya -Symtuza *these are major culprits of drug interactions, and they are found in the following combo products so be careful? -Evotaz -Prezcobix *Ritonavir is hard to coformulate, so usually just by itself in combo regimen This HIV drug is a CCR5 antag in stage 1 of the HIV life cycle that requires a tropism assay test prior to use to Selzentry (Maraviroc) ensure it will be useful? Fuzeon (enfuvirtide) for HIV admin SC self-injection into the abdomen, front thigh or back of arm things to know? store at room temp; but once reconstituted refrigerate and use within 24 hours Delstrigo Atripla If CrCl<50 ml/min do not start TDF products which are what? Symfi *exception: Stribild is <70 ml/min Complera *Stribild is <70ml/min Epzicom These combo HIV products require HLA-B 5701 allele testing prior to use due to being abacavir containing? Trizivir Descovy and Truvada are part of 1st line regimens for HIV 30 ml/min *do not use if CrCl is less than what? PrEp (ie Prep) vs PEP (Post exposure) for HIV? Atripla (Efavirenz + TDF + Emtricitabine) Take these HIV drugs at night due to drowsiness? Symfi (Efavirenz + TDF + Lamivudine) *This is due to the Efavirenz (Sustiva) component Complera (Rilpivirine + TDF + Emtricitabine) Stribild (Elvitegravir/ cobicistat + TDF + emtricitabine) Take these single tablet daily regimen HIV drugs with food? Odefsey (Emtricitabine + Rilpivirine + TAF) Genvoya (Elvitegravir/ cobicistat+ emtricitabine+TAF Symtuza (Darunavir/cobicistat+emtricitabine+TAF) renal and bone tox TDF (tenofovir disoroxil fumarate) can cause? TAF is a prodrug with improvements in renal and bone safety You must take this HIV drug with at least 48oz water daily to prevent kidney stones? Do not take Zerit (Stavudine) with these other drugs? This drug is used for patients with multidrug resistant HIV-1 infection? Crixivan (Indinavir) Retrovir or Combivir Trogarzo (ibalizumab) Descovy (TAF + Emtricitabine) CPJE Secrets CLINICAL PORTION: Flashcards *have gone through 3 times OR HIV pre-exposure (PrEP) daily HIV regimens? Truvada (TDF + Emtricitabine) 1 tab a day Truvada (TDF + Emtricitabine) with Raltegravir BID or Dolutegravir QD HIV Post Exposure (PEP) HIV prophylaxis? Truvada (TDF + Emtricitabine) with Darunavir QD and Ritonavir QD 28 days of treatment These are all the single tablet daily regimens for HIV? How is the HIV drug Cabenuva given (Cabotegravir + Rilipivirine) How is the HIV drug Fuzeon (Enfuvirtide) given? IM Monthly 90mg SC BID Aptivus (Tipranavir) Do NOT use these HIV drugs if the patient has a sulfa allergy? Prezista (Darunavir) Lexiva (Fosamprenavir) Crixivan (Indinavir) You should take these HIV drugs on an empty stomach? Sustiva (Efavirenz) Videx EC (Didanosine) Thiazide ACEi First line therapy for HTN? ARB CCB (if black not ACEi/ARB) This drug class is usually used first in HTN due to mild SE? Thiazides This is the diuretic of choice if NO renal impairment? Thiazides Thiazides Diuril (Chlorothiazide) Microzide/Hydrodiuril (Hydrochlorothiazide) Don't use this HTN drug class if sulfa allergy? Thalidone, Hygroton (Chlorthalidone) Zaroxolyn (Metolazone) Lozol (Indapamide) Target Dosing for Thiazides? Diuril (Chlorothiazide): 500mg Diuril (Chlorothiazide) Microzide/Hydrodiuril (Hydrochlorothiazide): 12.5-50mg Microzide/Hydrodiuril (Hydrochlorothiazide) Thalidone, Hygroton (Chlorthalidone): 12.5-25mg Thalidone, Hygroton (Chlorthalidone) Zaroxolyn (Metolazone): 2.5-5mg daily Zaroxolyn (Metolazone) Lozol (Indapamide): 1.25-5mg daily Lozol (Indapamide) Diuril (Chlorothiazide) dosing? Microzide/Hydrodiuril (Hydrochlorothiazide) dosing? Thalidone, Hygroton (Chlorthalidone) dosing? Zaroxolyn (Metolazone) dosing? Lozol (Indapamide) dosing? 500mg 12.5-50mg daily Thalidone, Hygroton (Chlorthalidone): 12.5-25mg Zaroxolyn (Metolazone): 2.5-5mg daily Lozol (Indapamide): 1.25-5mg daily Loop Diuretic Dosing? Lasix: Furosemide: 20-40mg BID Lasix: Furosemide Demadex: Torsemide: 10mg-20mg QD Demadex: Torsemide Bumex: Bumetanide: 0.5-1mg BID Bumex: Bumetanide Edecrin: Ethacrynic acid: 50-200mg daily or divided oral Edecrin: Ethacrynic acid Lasix: Furosemide dosing? Demadex: Torsemide: dosing? Edecrin: Ethacrynic acid dosing? Bumex (Bumetanide) dosing? Lasix: Furosemide: 20-40mg BID Demadex: Torsemide: 10mg-20mg QD Edecrin: Ethacrynic acid: 50-200mg daily or divided oral Bumex: Bumetanide: 0.5-1mg BID Loop Diuretic things toCPJE know? Secrets ototoxicity (especially ethacrynic acid) CLINICAL PORTION: Flashcards *have gone through 3 times Lasix: Furosemide Demadex: Torsemide Bumex: Bumetanide Edecrin: Ethacrynic acid Diuretics (loop and thiazides) cause these electrolyte changes? Metabolic ALKALOSIS Diuril (Chlorothiazide) HYPOkalemia (K) Microzide/Hydrodiuril (Hydrochlorothiazide) HYPOnatremia (Na) Thalidone, Hygroton (Chlorthalidone) Zaroxolyn (Metolazone) INCREASE: BG, TG, uric acid Lozol (Indapamide) Lasix: Furosemide Demadex: Torsemide Bumex: Bumetanide Edecrin: Ethacrynic acid Aldosterone antag (potassium sparing diuretics) Dyrenium (Triamterene) These HTN drugs are contraindicated in pregnancy? Midamor (Amiloride) Aldactone, Carospir (Spironolactone) Inspra (Eplerenone) Dosing for these potassium sparing aldosterone antag? Dyrenium (Triameterene): 100-300mg daily in 1-2 divided doses Dyrenium (Triameterene) Midamor (Amiloride): 5-20mg QD Midamor (Amiloride) Aldactone, Carospir (Spironolactone): 25-100mg daily in 1-2 divided doses Aldacone, Carospir (Spironolactone) Inspra (Eplerenone): 50mg daily or BID Inspra (Eplerenone) Dyrenium (Triameterene) dosing? Midamor (Amiloride) dosing? Aldactone, Carospir (Spironolactone) dosing? Inspra (Eplerenone) dosing? Electrolyte changes w/Aldosterone antag? Dyrenium (Triameterene): 100-300mg daily in 1-2 divided doses Midamor (Amiloride): 5-20mg QD Aldactone, Carospir (Spironolactone): 25-100mg daily in 1-2 divided doses Inspra (Eplerenone): 50mg daily or BID INCREASE K Dyrenium (Triamterene) CI if CrCrl<30 Midamor (Amiloride) gout Aldactone, Carospir (Spironolactone) Inspra (Eplerenone) Benazepril (Lotensin) 5-40mg Captopril (Capoten) 12.5mg BID-50mg TID Enalapril (Vasotec): 5-20mg daily or BID → injectable 0.625-5mg Q6H Enalaprilat(Vasotec IV) Fosinopril (Monopril) 10-40mg Dosing for ACE inhibitors? Lisinopril (Zestril, Prinivil, + HCTZ= Prinzide, Zestorectic) 5-40mg Moexipril (Univasc) 3.75mg-30mg Quinapril (Accupril) 5mg-40mg Ramipril (Altace): 2.5mg-20mg Trandolapril (Mavik): 1-8mg Benazepril (Lotensin) dosing? Benazepril (Lotensin) 5-40mg Captopril (Capoten) dosing? Captopril (Capoten) 12.5mg BID-50mg TID Enalapril (Vasotec) oral and IV dosing? Fosinopril (Monopril) dosing? Lisinopril (Zestril, Prinivil) Enalapril (Vasotec): 5-20mg daily or BID → injectable 0.625-5mg Q6H Enalaprilat(Vasotec IV) Fosinopril (Monopril) 10-40mg Lisinopril (Zestril, Prinivil, + HCTZ= Prinzide, Zestorectic) 5-40mg Lisinopril + HCTZ (Prinzide, Zestoretic) dosing? Moexipril (Univasc) dosing? Moexipril (Univasc) 3.75mg-30mg Quinapril (Accupril) dosing? Quinapril (Accupril) 5mg-40mg Ramipril (Altace) Ramipril (Altace): 2.5mg-20mg Trandolapril (Mavik) dosing? Trandolapril (Mavik): 1-8mg This HTN med causes gynecomastia? CPJE Secrets Aldactone, *have Carospir (Spironolactone) CLINICAL PORTION: Flashcards gone through 3 times Black box warning for ACE/ARB? pregnancy and bilaterial renal artery stenosis Candesartan (Atacand): 8-32mg Eprosartan (Teveten) 400-800mg in 1-2 doses Irbesartan (Avapro, +HCTZ= Avalide) 75-mg-300mg Losartan (Cozaar, +HCTZ= Hyzaar): 25- 100mg in 1-2 doses Dosing for ARBs? Valsartan (Diovan) : 80-320mg Olmesartan (Benicar) 10-40mg Telmisartan (Micardis) 20-80mg Azilsartan (Edarbi): 40-80mg Candesartan (Atacand) dosing? Eprosartan (Teveten) dosing? Irbesartan (Avapro) dosing? Candesartan (Atacand): 8-32mg Eprosartan (Teveten) 400-800mg in 1-2 doses Irbesartan (Avapro, +HCTZ= Avalide) 75-mg-300mg Losartan (Cozaar) dosing? Losartan (Cozaar, +HCTZ= Hyzaar): 25- 100mg in 1-2 doses Valsartan (Diovan) dosing? Valsartan (Diovan) : 80-320mg Olmesartan (Benicar) dosing? Olmesartan (Benicar) 10-40mg Telmisartan (Micardis) dosing? Telmisartan (Micardis) 20-80mg Azilsartan (Edarbi) dosing? Azilsartan (Edarbi):40-80mg 1. Diabetes (caution use with thiazides) 2. Asthma & COPD B-blockers are contraindicated in? 3. Bradycardia (HR<60 bpm) (*additive effects w digoxin used in CHF and non-DHP CCBs*) 4. Heart block 5. Caution in unstable heart failure and peripheral vascular disease (cold hands, feet) 1. Dyslipidemia and weight gain 2. Fluid retention- May combine w diuretics B-blockers side effects? 3. Fatigue, depression,  libido 4. Dizziness: Take w food. Avoid operating cars/ machines until you are used to the drug. Avoid abrupt withdrawal- Gradual dose reduction necessary. ➢ HTN 2nd Line ➢ Post-MI Uses for B-blockers? ➢ Angina ➢ Tachyarrhythmias ➢ Stable Heart Failure ➢ Migraine & glaucoma This is a cardioselective B-blocker that also increases nitric oxide production (vasodilation) Nebivolol (Bystolic) Cardioselective B-blockers (B-1=heart) that are preferred due to decreased SE? with dosing? Atenolol (Tenormin) dosing? Metoprolol tartrate (Lopressor) dosing? Metoprolol succinate (Toprol XL) dosing? Nebivolol (Bystolic) dosing? 25-100mg daily IR tablet: 100-450mg daily in 2-3 divided doses 25-100mg daily; max dose is 400mg daily 5-40mg daily These are the beta blockers that are non selective (B1 and B2. B2 is bronchodilator)? dosing? Nadolol (Corgard) dosing? 40-320mg daily These are the combo b-blockers that have alpha 1 blocker (vasodialtor) effects? Pindolol (Visken) dosing? 5-30mg BID IR and LA: 80-160mg BID ; max dose is 640mg daily Propanolol (Indereal LA, Inderal XL) dosing? XL: 80mg daily; max dose is 120mg daily Coreg = 6.25-25mg BID Carvedilol (Coreg, Coreg CR) dosing? CR: 20-80mg daily betaxolol These are the eye preps available for glaucoma that are b-blockers? timolol carteolol Cardizem (Diltiazem) more BRADYCARDIA so contraindicated AV block, acute MI, b-blocker use CPJE Secrets CLINICAL PORTION: Flashcards *have gone throughin32-3rd times Calan, Isoptin, Verelan, Covera (Verapamil) preferred if CKD and diabetic nephropathy *Effective for arrhythmias contraindications? preferred if? SE: gingival hyperplasia, CONSTIPATION SE? DHP CCB's: more potent vasodilators= TACHYCARDIA -side effects? -okay to give with b-blockers but contraindicated if acute MI -ineffective for? ineffective for arrhythmias Amlodipine (Norvasc, Katerzia oral susp) SE: headache, flushing, EDEMA of the ankle Amlodipine + Benazepril= Lotrel Amlodipine + Vaslartan = Exforge Amlodipine + Olmesartan= Azor Plendil (Felodipine) DynaCirc (Isradipine CR) Cardene (Nicardipine) Adalat CC, Procardia XL (Nifedipine ER) Sular (Nisoldipine) Amlodipine (Norvasc, Katerzia oral susp): 2.5- 10mg Amlodipine + Benazepril= Lotrel (10mg) Amlodipine (Norvasc, Katerzia oral susp) Amlodipine + Vaslartan = Exforge (10mg) Amlodipine + Benazepril= Lotrel Amlodipine + Vaslartan = Exforge Amlodipine + Olmesartan= Azor (10mg) Amlodipine + Olmesartan= Azor Plendil (Felodipine) Plendil (Felodipine) DynaCirc (Isradipine CR) DynaCirc (Isradipine CR) 2.5-10mg Cardene (Nicardipine) Adalat CC, Procardia XL (NIfedipineER) Cardene (Nicardipine) Sular (Nisoldipine) IR:20-40mg TID; SR: 30-60mg BID dosing? Adalat CC, Procardia XL (NIfedipineER) 30-90mg Sular (Nisoldipine) 8.5-34mg Amlodipine (Norvasc) dosing? 2.5-10mg daily Plendil (Felodipine) dosing? 2.5-10mg daily IR: 20-40mg TID Cardene (Nicardipine) dosing? SR: 30-60mg BID Adalat CC, Procardia XL (Nifedipine ER) dosing? 30-90mg daily Sular (Nisoldipine) dosing? 8.5-34mg daily CHF (due to them being vasodilators) -all of these below are CI in CHF Amlodipine (Norvasc, Katerzia oral susp) Amlodipine + Benazepril= Lotrel CCB's other than verapamil and diltiazem are contraindicated in this disease state? Amlodipine + Vaslartan = Exforge Amlodipine + Olmesartan= Azor Plendil (Felodipine) DynaCirc (Isradipine CR) Cardene (Nicardipine) Adalat CC, Procardia XL (NIfedipineER) Sular (Nisoldipine) Covera (verapamil) These CCB drugs can have ghost shells that show up in the feces? Adalat CC (Nifedipine ER) Sular (Nisoldipine) bradycardia dry mouth fatigue Problems with using Catapres (Clonidine) and Aldomet (Methyldopa)? depression/psych rxns impotence rebound HTN Dosing for clonidine? 0.1-0.3 mg BID clonidine is used for? used for resistant HTN and in patients who cannot swallow (patch) Cardura (Doxazosin) Cardura (Doxazosin) dosing? IR: start at 1mg; tirate slow up to 8mg NIGHTLY XL: start at 4mg daily with breakfast, max of 8mg Hytrin (Terazosin) dosing? Uroxatral (Alfuzosin) dosing? Hytrin (Terazosin) start at 1mg; titrate slow to max of 20mg Uroxatral (Alfuzosin) -10mg QD immediately after same meal each day Rapaflo (Silodosin) CPJE Secrets CLINICAL PORTION: Flashcards *have gone through 3 times Rapaflo (Silodosin) dosing? -8mg QD with a meal Dosing for Aldomet (Methyldopa)? 500mg BID (max of 3000 mg/day!) SE? SE: lupus like symptoms, hepatitis, myocarditis, hemolytic anemia. Apresoline (Hydralazine) 75mg QID or 20mg/ml inj dosing? SE: lupus like symptoms; reflex tachy SE? Loniten (Minoxidil) 40mg dosing? SE: hair growth; reflex tachycardia SE? Key thing to know about dosing with centrally adrenergic drugs? Do NOT stop abruptly; must taper over 2-5 days Cardura (Doxazosin) Hytrin (Terazosin) Minipress (Prazosin) Flomax (Tamsulosin) Uroxatral (Alfuzosin) Rapaflo (Silodosin) Catapres (Clonidine) Aldomet (Methyldopa) Apresoline (Hydralazine) Loniten (Minoxidil) Serpasil (Reserpine) Serpasil (Reserpine) 0.05-0.25mg dosing? caution: bradycardia, depression caution? Nipride (Nitroprusside) This is the most effective IV agent for hypertensive crisis? acts in seconds and disappears within minutes Aldomet (Methyldopa) 1st line therapy for for HTN in pregnancy? Normodyne, Trandate (Labetalol) *2nd line: hydralazine, nifedipine, and BBlock Two options of what to do if a patient has a STEMI? ie ST elevated myocardial infarction. 300-600mg clodipogrel Dosing for the two drug options that you give prior to PCI for a patient in STEMI? or 60mg prasugrel M: morphine 2-5mg IV PNR O: oxygen NSTEMI treatment *ie unstable angina? *hint: think acronym? N: Nitrates SL followed by IV Nitro A: Aspirin 325mg chewed *as well as: -IV anti-thrombotics (abciximab) + antiplatelet (Clopidogrel) + anticoag (Heparin) When a patient with acute coronary syndrome (ie STEMI or NSTEMI) is discharging, make sure these drugs are prescribed? Reopro- Abciximab What drugs are the platelet aggregation inhibitors? Aggrastat- Tirofiban Integrillin- Eptifibatide Platelet aggregation inhibitors differences? What is the benefit of Kengreal (Cangrelor) and Brilinta (Ticagrelor) over the other antiplatelets like clodipogrel, they are reversible and have a faster offset ticlodipine, prasugrel? previous stroke/TIA Effient (Prasugrel) is contraindicated if? *Prasugrel is limited in use for PCI 300mg-600mg load gone through 3 times CPJE Secrets CLINICAL PORTION: Flashcards *have Plavix (Clopidogrel) dosing? 75mg daily Ticlid (Ticlopidine) dosing? 250mg BID 60mg load/ 10mg daily Effient (Prasugrel) dosing? *5mg is <60kg or >75years old IV BOLUS Kengreal (Cangrelor) dosing? 30 mcg/kg *infuse 4mcg/kg/min 180mg load Ticagrelor (Brilinta) dosing? 90mg BID *60mg BID after 12 months Ticlid (Ticlopidine) has this risk? If on Plavix (clopidogrel) you should avoid taking these? Plavix (Clopidogrel) can cause this? risk of neutropenia and hematopoietic disorders omeprazole and cimetidine thrombotic thrombcytopenic purpura (TTP) Effient (Prasugrel) These oral antiplatelet has the highest risk for bleeding? Brilinta (Ticagrelor) causes dyspnea Kengreal (Cangrelor) has these side effects? worsens renal function dyspnea Brilinta (ticagrelor) can cause? increased bleeding This is a good oral antiplatelet option if a patient has CKD? Brilinta (Ticagrelor) This is a good oral antiplatelet option for a diabetic patient? Effient (Prasugrel) Anticoagulants and antiplatelet drugs should be discontinued how far in advance of surgery? 5-7 days BBW: fetal bleeding, skin necrosis, purple toe SE of Coumadin, Jantoven (Warfarin)? *goes through hepatic adjustment can it be used in pregnancy? *Pregnancy cat X Main advantage for Coumadin, Jantoven (Warfarin) Afib/Cardiac valve Vit K -5 to 10mg Reversal agent for Coumadin, Jantoven? Prothrombin complex concentrate (PCC) Frozen plasma Heparin 60-85 seconds -what is the range for aPTT? Major advantage to using heparin? no renal adjustment! Protamine How do you reverse Heparin? *1mg Protamine = 100 units Heparin LMWH CI if pork/heparin allergy Lovenox- Enoxaparin renal adjust Fragmin- Dalteparin Innohep- Tinzaparin more predictable response compared to heparin *SE?/CI? *dose adjust? *benefits? LMWH Protamine Lovenox- Enoxaparin 1mg protamine = 100 antiXa IU dalteparin Fragmin- Dalteparin Innohep- Tinzaparin *reversal agent? 2.5mg prophy Arixtra (Fondaparinux) dosing? 5-10mg treatment Arixtra (Fondaparinux) dose adjust? CI if CrCl<30; renally adjusted Xa inhibitors: AndexXa (Andexanet-alfa) Arixtra (Fondaparinux) -preferred Xarelto (Ribaroxaban) Savasysa (Edoxaban) or Eliquis (Apixaban) Bevyxxa (Betrixaban) *reversal? PCC (Kcentra) Xa inhibitors: no monitoring needed; CPJE Secrets CLINICAL PORTION: Flashcards *have gone through 3 times Arixtra (Fondaparinux) Xarelto (Ribaroxaban) all are oral admin except for Arixtra (Fondaparinux) Savasysa (Edoxaban) Eliquis (Apixaban) Bevyxxa (Betrixaban) monitoring? 20mg Daily Xarelto (Rivaroxaban) dosing? renal: 15mg 60mg daily Savaysa (Edoxaban) dosing? *30mg if renal >80 y/o Eliquis (Apixaban) weight <60 kg how to know when to dose reduce to 2.5mg BID from 5mg BID? SCr>1.5 *2 of these 3 160mg and then Bevyxxa (Betrixaban) 80mg daily with food for 35-42 days dosing? renal: 80mg then 40mg QD Xa inhibitors: Arixtra (Fondaparinux) -DVT/PE; HIT Xa inhibitors: Arixtra (Fondaparinux) Xarelto (Ribaroxaban) Savasysa (Edoxaban) Eliquis (Apixaban) Bevyxxa (Betrixaban) *indication differences? Xarelto (Ribaroxaban) -Stroke ppx in nonvalvular AFIB; DVT/PE Savasysa (Edoxaban) -Stroke ppx in nonvalvular AFIB; DVT/PE Eliquis (Apixaban) -Stroke ppx in nonvalvular AFIB;DVT surgical ppx Bevyxxa (Betrixaban) -Hospital and extended duration VTE prophy Pradaxa (Dabigatran) dosing? 150mg BID dose adjust? *dose adjust: renal 75mg BID increased bleeding Pradaxa (Dabigatran) SE? dyspepsia (10%) stroke prophylaxis with AFIB Pradaxa (Dabigatran) indications? DVT/PE Praxbind (Idarucizumab) Pradaxa (Dabigatran) reversal? 5mg IV *alteranative: activated charcoal How long does it take warfarin to work? 5 days. Thats why we have to overlap warfarin with another form of IV/SC anticoag (heparin, enoxparin) for 5 days SC abdomen Counseling point on how to give enoxparin? 90 degree angle do not expel the air bubble in the syringe prior to inj LMWH or UFH This is the preferred anticoagulant to use in pregnant women? do not cross placenta 1mg = pink 2mg = lavender 2.5mg = green 3mg = tan Colors of the different warfarin tablets? 4mg = blue 5mg = peach 6mg = teal 7.5mg = yellow 10mg = white Ginger Ginko bilboba Garlic These herbs can INCREASE your INR and increase risk of bleeding? Grapefruit Fish oil Cannabis Ginseng *have gone through 3 times CPJE Secrets CLINICAL PORTION: Flashcards Green tea These herbs can DECREASE INR and increase your likelihood of antithromboelic events? Soya St.Johns Wart Leafy green veggies all anti-inflammatories antibiotics These drugs can increase your INR and increase the likelihood of bleeding? antidepressants: SSRIs aspirin, clopdiogrel, ticlopidine azole antifungals carbamazpine oral contraceptive These drugs can decrease your INR and increase your likelihood of thromboembolic events? Rifabutin/ Rifampin Sucralfate take same time each day avoid alcohol Important counseling points about warfarin? keep diet same notify provider if surgery antithrombotic: dabigatran, rivaroxaban, or warfarin Atrial Fibrillation: treatment? *may also need rate controllers such as Bblocker or CCB, or digoxin non-DHP CCB If a patient has Heart failure and Afib what drug class will they probably need? (Diltiazem, Verapamil) ONLY if ejection fraction is normal. Warfarin is recommended to treat Afib if a patient has this? mechanical heart valve Antiarrhythmics have this hemodynamic change so should avoid in this disease state? decrease HR, so avoid in unstable HF Quinidine *you can use amiodarone and dofetilide Procainamide Norpace- Disopyramide Xylocaine- Lidocaine Mexitil- Mexiletine Cordarone- Amiodarone Tikosyn- Dofetilide Multaq- Dronedarone Corvert- Ibutilide Betapace- Sotalol Adenocard- Adenosine Lanoxin, Digitex- Digoxin beta-blockers non-DHPs (Diltiazem & verapamil) First line therapy for rate control? digoxin *they all decrease HR Must be careful as the class Ia antiarrhythmics do this? they increase the QT interval Quinidine Procainamide Disopyramide- norpace Quinidine BBW? increase mortality, thrombocytopenia (monitor CBC) SE? SE: diarrhea, strong anticholinergic > cinchonishm (tinnitus, blurred vision, h/a, hearing loss, nausea) digoxin (must decease dig dose by 50%) Quinidine drug interactions? warfarin (will increase INR) diltiazem, verapamil Procainamide- BBW? You should NEVER use this class of antiarrhythmics? agranulocytosis (i.e. ANC<100) -monitor CBC Class 1c- Flecainide and Propafenone HF SE with Norpace (Disopyramide) anticholinergic effects- avoid if urinary retention, BPH, glaucoma, or myasthenia gravis You must monitor this with Monitor liver function Mexitil- Mexiletine Xylocaine- Lidocaine amiodarone Drugs that can increase Lidocaine levels? b-block 3-A4 inhibitors- dilitazem, verapamil, erythromycin, clarithromycin, itraconazole, ketoconazole B-blockers *have gone through 3 times CPJE Secrets CLINICAL PORTION: Flashcards These are the class II antiarrhythmics? Esmolol (Brevibloc) Propranolol (Inderal LA, InnoPran XL) This is a broad spectrum antiarrhythmic that should only be used for life threatening arrhythmias Cordarone- Amiodarone *it is safe in heart failure and post MI Class III antiarrthymics can have this effect? increase QT interval Cordarone- Amiodarone Tikosyn- Dofetilide Multaq- Dronedarone Corvert- Ibutilide Betapace- Sotalol loading dose: 10g Dosing for Cordarone- Amidoarone? maintenance: 100-400mg daily half life? *half life of 55 days use non-PVC/glass for infusions Special compounding instructions for Cordarone (Amidoarone) D5W only vision changes / corneal microdeposits / photosensitivity SE of Cordarone (Amiodarone) hypotension / bradycardia / dizziness tremor Cordarone (Amiodarone) can cause your skin to do this? cause it to turn blue Thyroid Should monitor these things if a patient is on Cordarone (Amiodarone) Liver Lungs digoxin warfarin quinidine Must use lower doses of these drugs if using Cordarone (Amidoarone) procainamide simvastatin lovastatin atorvastatin This class III antiarrhythmic requires continuous hospital monitoring? Tikosyn- Dofetilide dose? Dose for Multaq (Dronedarone) This class III antiarrhythmic has a BBW for patients with Heart Failure as there is an increased risk of stroke, death, and HF in patients with decompensated HF. Tikosyn- Dofetilide 500 MCG BID; dose reduce if CrCl <60ml/min 400 MG BID Multaq- Dronedarone *other SE= hepatic/renal failure This antiarrhythmic is pregnancy category X? Multaq- Dronedarone This antiarrhythmic is IV only? Covert- Ibutilide Dosing for Betapace- Sotalol? 160mg BID ; CrCl<60 need to reduce frequency bradycardia hypotension SE for Betapace (Sotalol)? torsades HF dizziness if asthma/COPD You should use Verapamil or Diltiazem as an antiarrythmic OVER b-blockers if what? *need to avoid B-blockers in these disease states Dosing for Adenocard (Adenosine) 6mg IV push HF= 0.5-0.9 ng/mL Therapeutic range for Digoxin in AFib vs. HF? AFib= 0.5-2 ng/mL **toxic = >2.5 ng/mL Most common cause of angina (chest pain that occurs with routine physical activity)? What is stable angina? What is Prinzmetal's angina? Pharmacy treatment goal for angina? coronary heart disease (CHD) predictable chest pain due to atherosclerosis coronary arteries vasospasm at rest angina attack prevention and decrease the risk of acute coronary syndrome (ACS) This is the drug class to use for Prinzmetal's angina? use CCB *must avoid this drug class as its CI in Prinzmetal's angina? *must AVOID Blockers as they are CI Must Have *have gone through 3 times CPJE Secrets CLINICAL PORTION: Flashcards 1. Aspirin 81mg 2. B-blockers: 1st line (CI if Prinzmetal's) 3. Nitrates: for immediate relief (SL or spray) or add on therapy Treatment algorithm for angina "chronic chest pain" Add on 4. CCB: 1st line if Prinzmetal's, otherwise its add on therapy 5. May also need ACE inhibitor if pt at risk for Heart Failure 6. Annual influenza vaccine 7. May also need statin to decrease LDL avoid alcohol Nitrates counseling? use caution when driving nitrate free interval (10-12 hours/day) is recommended Nitrates are CI with? PDE-5 inhibitors (sildenafil, tadalafil) Tridil (Nitroglycerin IV) 5 mcg/min every 5 minutes and up; max= 400 mcg/min dosing? need to use glass bottles; absorption occurs to soft plastic (PVC) things to know about compounding? use administration sets intended for nitroglycerin apply 1/2 to 2 inches; max of 2 doses a day Nitro-Bid (Nitroglycerin Ointment) 2% include a nitrate free interval of 12 hours counseling? apply to chest or back with the applicator or dose measuring paper place applicator on skin and tape it in place (1/2 inch = 7.5 mg) titrate to 0.4-0.8mg/hour Nitro-Dur, Minitran (Nitroglycerin Patch) used for prevention of angina dosing? rotate patch sites/12 hours on and 12 hours off 1-2 sprays onto or under tongue every 5 minutes for 3 doses MAX NitroMist, Nitrolingual (Nitroglycerin spray) do NOT shake container counseling/dosing? Prior to use, the pump must be primed by spraying 5 times (Nitrolingual) or 10 times (Nitromist) into the air CLOSE your mouth after admin Nitrostat (Nitroglycerin sublingual tablet) 0.3-0.6 mg every 5 minutes for a max of 3 doses in 15 minutes dosing/counseling? place under tongue and allow dissolving 2.5mg capsule TID/QID Nitro-Time (Nitroglycerin extended release) dosing? max dose= 26mg QID Dosing for isosorbide MONOnitrate products Ismo, Monoket (IR): 5-60mg BID Ismo, Monoket (IR) Imdur ER (ER): 10-120mg DAILY Imdur ER (ER) Isosorbide DiNITRATE products are used in this disease state as they decrease mortality when used in Heart Failure conjunction with hydralazine? *Isordil *Dilatrate-SR Isosorbide DiNITRATE dosing? *extensive first pass metabolism = increased frequency dosing Isordil (IR)? Isordil (IR): 5-40mg BID-TID Dilatrate-SR (SR)? Dilatrate-SR: 40mg daily/BID Dosing used for isosorbide Dinitrate in HF? BiDil what is the product called? 75mg hydralazine/40mg isosorbide dinitrate TID Ranexa, Aspruzyo Sprinkle: use? add on therapy for angina to decrease number of attacks? *Ranolazine Ranexa (ranolazine) and Aspruzyo Sprinkle (ranolazine) dosing? 500 mg BID to decrease O2 demand dizziness Ranexa (ranolazine) and Aspruzyo Sprinkle (ranolazine) SE? constipation QT prolongation: monitor ECG, BP, K+ 1. ACE/ARB or Entresto 2. B-blocker Heart Failure treatment 3. Mineralocorticoid receptor antag (spironolacone/eplernone) 1st line therapies? 4. Hydralazine and isosorbide Dinitrate in African Americans 5. Diuretics as needed ARNis (ie ENTRESTO) *ACE inibitors are then next if Entresto is not feasible; then ARB This drug class is first line to reduce morbidity and mortality in HFrEF (LVEF<40%)? so order goes: Entresto > ACE > ARB Washout period for starting Entresto? CPJE Secrets Entresto shouldn't given within 36 hours3oftimes the last dose of ACEi CLINICAL PORTION: Flashcards *havebegone through angioedema Do NOT give Entresto or ACE inhibitor if history of? *African americans and smokers have a higher risk Dosing for Entresto? 49mg sacubitril/51mg valsartan BID start? target = 97 mg sacubitril/103mg valsartan BID target? Captopril (Capoten) starting and target dose? Enalapril (Vasotec) starting and target dose? Fosinopril (Monopril) starting and target dose? Lisinopril starting and target dose? Perindopril (Aceon) starting and target dose? Quinapril (Accupril) start and target dose? Ramipril (Altace) starting and target dose? Trandolapril (Mavik) starting and target dose? Candesartan (Atacand) starting and target dose? Losartan (Cozaar) starting and target dose? Valsartan (Diovan) starting and target dose? B-Blocker therapy for Heart Failure start=6.25mg TID, 1 hour before meals target=50mg TID start= 2.5mg BID target= 10mg-20mg BID start= 5-10mg once daily target= 40mg once daily start= 2.5-5mg daily target= 20-40mg once daily start= 2mg daily target=8-16 mg once daily start=5mg BID target=20mg BID start= 1.25-2.5mg daily target=10mg once daily start=1mg daily target=4mg once daily start=4-8mg once daily target=32 mg once daily start=25-50mg daily target-50-150mg once daily start= 40mg BID target= 160mg BID start super low; slow upward titration Q2 weeks how to tirate? bradycardia fatigue B-Blockers sexual dysfunction SE? imparied glucose control bronchospasm in patients w/asthma Bisoprolol (Zebeta) starting dose and target? 1.25mg once daily; target = 10mg daily 3.125mg BID carvediolol (Coreg) starting dose and target? target= 25-50mg BID Carvedilol CR 10mg once daily starting dose/target? target= 80 mg once daily Metoprolol Succinate (Toprol XL) starting and target dose? starting= 12.5-25mg daily target=200mg once daily Spironolactone (Aldactone) monitor GFR >30 mg/ML Eplernone (Inspra) and monitoring needed? K is <5 mEq/L Spironolactone (Aldactone) risk? gynecomastia in men is 10% risk; use Eplernone (Inspr