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PHAR 406 > Drug Dosing > Flashcards

Drug Dosing Flashcards

1
Q

Length of VTE Treatment for Provoked w/ cancer

A

Forever

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2
Q

Length of VTE Treatment Provoked, Others

A

3 months

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3
Q

Length of VTE Treatment, Unprovoked, PE

A

Forever

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4
Q

Length of VTE Treatment, Unprovoked, Recurrent (2nd) DVT

A

Forever

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5
Q

Length of VTE Treatment, Unprovoked, 1st DVT, DISTAL

A

3 months

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6
Q

Length of VTE Treatment, Unprovoked, 1st DVT, PROXIMAL

A

Forever

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7
Q

STROKE/A. FIB.

Dosing and Exceptions for: Dabigatran [Pradaxa]

Counseling points?

A

Dosing: 150 BID

If CrCl 15-50 mL/min : 75 mg BID

No pill box
May cause dyspepsia/gastritis

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8
Q

STROKE/A. FIB.

Dosing and Exceptions for: Apixaban [Eliquis]

Counseling Points/Notes?

A

Dose: 5 mg BID

If (2 out of 3) Scr >1.5, Age > 80 yrs, or Wt. < 60 kg: 2.5 mg BID

Best for patients on dialysis, end stage CKD,]/ poor renal function (no dose adjustment required)

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9
Q

STROKE/A. FIB.

Dosing and Exceptions for: Rivaroxaban [Xarelto]

Counseling points?

A

Dose: 20 mg QD

If CrCl 15-50 mL/min: 15 mg QD

TAKE WITH LARGEST FATTY MEAL

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10
Q

STROKE/A. FIB.

Dosing and Exceptions for: Edoxaban [Savayxa]

A

Dose: 60 mg QD

If CrCl 30-60 mL/min (Stroke) or 15-50 mL/min (Afib): 30 mg QD

AVOID: in patients with CrCl > 95 mL/min and in patients with <15 mL/min

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11
Q

STROKE/A. FIB.

Dosing and Exceptions for: Betrixaban [Bevyxxa]

Counseling points?

A

Tricked ya! DO NOT use in stroke/Afib.

Take with food tho…

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12
Q

ACUTE VTE:

Dosing and Exceptions for: Dabigatran [Pradaxa]

Counseling points?

A

Dose: 5 days parenteral AC, 150 mg PO BID

D/C if CrCl < 30 mL/min

No Pill Box
discard 4 months after opening

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13
Q

ACUTE VTE:

Dosing and Exceptions for: Apixaban [Eliquis]

Counseling points?

A

Dose: 10 mg PO BID x 7 days, then 5 mg PO BID

D/C if CrCl < 25 mL/min OR Scr > 2.5 mg/dL

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14
Q

ACUTE VTE:

Dosing and Exceptions for: Rivaroxaban [Xarelto]

Counseling points?

A

Dose: 15 mg PO BID x 21 Days, then 20 mg po ONCE DAILY

D/C if CrCl < 30 mL/min

Take with LARGEST meal of the day

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15
Q

ACUTE VTE:

Dosing and Exceptions for: Edoxaban [Savaysa]

Counseling points?

A

WEIGHT BASED
Dose: 5 days of parenteral AC then,
If > 60 kg: 60mg QD
If ≤ 60 kg: 30 mg QD

D/C if CrCl < 15 mL/min

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16
Q

ACUTE VTE:

Dosing and Exceptions for: Betrixaban [Bevyxxa]

Counseling points?

A

Dose: None

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17
Q

Which Drug(s) are only used for: EXTENDED VTE TREATMENT?

Dosing?

A

Eliquis: 2.5 mg PO BID
Xarelto: 10 mg PO QD

Note: half of maintenance dose

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18
Q

Which Drug(s) are only used for: VTE PROPHYLAXIS?

Dosing?

A

Dabigatran
Apixaban
Rivaroxaban
Betrixaban [Bevyxxa]: 160 mg PO as single dose on day 1, then 80 mg daily

ALL DOACs EXCEPT Savaysa

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19
Q

Monitoring Parameters for DOACs?

A

SCr, Renal Function, LFT, Hgb/Hct/Plt

But No Routine for DOACs

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20
Q

Monitoring Parameters for UFH?

A

aPTT, Scr, Hgb/Hct/Plt

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21
Q

CYP3A4 Inducers

A

Carbamazepine, Rifampin, St. John’s Wart, Phenytoin

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22
Q

CYP3A4 Inhibitors (VAPED)

A 
Verapamil
Amiodarone/Azoles
Protease Inhibitors
Erythromycins
Diltiazem
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23
Q

When do you initiate VTE prophylaxis post-operatively in orthopedic surgery?

What is the drug of choice?

Dose?

A

12 hours post-operatively

Drug of choice: Enoxaparin [Lovanox]

Dose: 30 mg SC BID

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24
Q

List Direct Thrombin Inhibitors

A

Bivalirudin [ Angiomax]

Argatroban

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25
Q

List Direct Thrombin Inhibitor(s)

A

Dabigatran [Pradaxa]

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26
Q

List Vitamin K antagonist(s)

A

Warfarin [Coumadin, Jantoven]

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27
Q

What clotting factors does Jantoven inhibit?

A

II, VII, IX, X

+ Protein C and S

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28
Q

Unfractionated Heparin Dosing

Prophylactic Dose?

Treatment Dose?

A

Prophylaxis Dose: 5000 IU SC BID/TID

TRM Dose: 80 units/kg IV Loading Dose, then 18 units/kg/hr continuous infusion use ABW

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29
Q

Unfractionated Heparin Reversal:

What drug?
What dose?

A

Protamine: 1 mg/ 100 units

MAX DOSE is 50 mg IV Bolus over 15 minutes

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30
Q

Dosing for Lovenox

prophylaxis dosing?
Treatment dosing?

A

Prophylaxis Dose: 40 mg SC daily
if CrCl < 30 mL/min: 30 mg SC daily

TRM dose: 1mg/kg SC BID
if CrCl < 30 mL/min: 1mg/kg SC daily

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31
Q

LMWH is eliminated __________

A

RENALLY!

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32
Q

Monitoring Parameters for Argatroban and Bivalirudin

A

aPTT

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33
Q

Max dose of Simvastatin with Amlodipine

A

Simvastatin 20 mg

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34
Q

Max dose of Simvastatin with Amiodarone

A

Simvastatin 20 mg

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35
Q

Max dose of Lovastatin with Amiodarone

A

Lovastatin 40 mg

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36
Q

Max dose of Lovastatin with Non-DHP CCBs

A

Lovastatin 20 mg

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37
Q

Max dose of Simvastatin with Ranolazine

A

Simvastatin 20 mg

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38
Q

Max dose of Non-DHP CCBs with Simvastatin

A

Simvastatin 10 mg

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39
Q

Absolute Contraindication with cilostazol

A

Heart Failure

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40
Q

Contraindication with Prasugrel

A

TIA/STROKE

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41
Q

HEART FAILURE

Dosing for: Hydralazine/Isosorbide dinitrate [BiDil]

Is it treating symptoms/ morbidity & mortailty / both?

A

Starting Dose: 37.5/20mg (1 tablet) po TID

Target Dose: 2 tablets po TID

Treats Both

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42
Q

What are the compensatory responses to myocardial damage?

A

SNS Activation
RAAS Activation
Increase Vasopressin

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43
Q

Right Ventricular Failure

A

Peripheral Edema
Weight Gain
JVD
Hypervolemic Hyponatremia

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44
Q

Target Digoxin Level in HF

A

0.5 - 0.9

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45
Q

Target Digoxin Level in A fib

A

0.8 - <2.0

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46
Q

What are the Major DDIs with Digoxin (4 drugs)

A

Amiodarone, Dronedarone, Quinidine, and Verapamil

47
Q

IV Vasodilators

A

Nitroglycerin, Nesiritide, Nitroprusside

48
Q

IV Inotropes

A

Dobutamine, Milrinone, (dopamine)

49
Q

IV Diuretics

A

Furosemide, Bumetanide

50
Q

IV Fluids

A

0.9% NaCl

51
Q

Vasopressors

A

epinephrine, norepinephrine, [dopamine (if SBP <90)]

52
Q

“Wet” Signs and symptoms of ADHF

A

Dyspnea, Orthopnea, PERIPHERAL EDEMA, Ascites, JVG, PCWP > 18 mm Hg

53
Q

“Cold” Signs and symptoms of ADHF

A

Weakness, Fatigue, Altered mental status, Decreased Urine output, worsening renal function, Cold extremities, Hypotension, CI < 2.2 , SaO2 < 90%

54
Q

Max dose: IV Furosemide

A

200 mg

55
Q

Max dose: IV Bumetanide

A

5 mg

56
Q

Nitroprusside dose in ADHF

A

0.2 mcg/kg/min

57
Q

ADR for Nitroprusside

A

Hypotension (BBW)
Cyanide toxicity (BBW)
Thiocyanate Toxicity

58
Q

Treatment for Nitroprusside Toxicity

A

sodium thiosulfate

59
Q 
Initial Dosing for Ivabradine (Corlanor)
**Exceptions?
If HR > 60?
HR 50-60?
HR < 50 OR symptoms of bradycardia
A

Initial: 5 mg po BID
2.5 mg BIF conduction defects

HR > 60: increase dose by 2.5 mg
HR 50 - 60: Maintain dose
HR <50: decreased dose by 2.5 mg or D/c if already at 2.5 mg BID

60
Q

MAX dose for Ivabradine [Corlanor]

A

7.5 mg po BID

61
Q

When can you replace Beta Blockers with Ivabradine in HF? Requirements:

A

pts w/ NSR, EF <35%, and on max beta-blocker therapy/ CI with BB.

62
Q

Contraindications of Corlanor:

A 
Acute Decompensated HF
HR < 60 before starting therapy 
BP <90/50
3rd degree AV block 
Pacemaker
CYP3A4 inhibitors 
Hepatic Impairment
Atrial Fibrillation
63
Q

When should serum digoxin concentrations be drawn?

A

at least 6-8 hours after last dose (optimally 12-24 hours after a dose)

64
Q

Digoxin Adverse Effects

A

GI, Visual, Cardiac (bradycardia, AV block, Ventricular Tachyarrythmia)

65
Q

Factors that increase digoxin toxicity

A

Electrolyte imbalance: HYPOkalemia, HYPOmagnesimoa
Alkalosis
Digoxin levels great than 2 ng/mL

66
Q

Antidote for digoxin toxicity:

A

Digibind

67
Q

Drugs to Avoid in HF:

A 
NSAIDs
Non-DHP (HFrEF)
Thiazolidinediones (Pioglitazone)
METFORMIN
K-supplements
Pseudoephedrine
Na containing preparations (fleet enemas)
68
Q

Diagnosis of PAD using ABI is

A

ABI ≤ 0.9

69
Q

Absolute Contraindication for Fibrates

A

Renal Failure
Hepatic Failure
Gallbladder disease
CrCl < 30 mL/min

70
Q

Main Lipid Lowering effect of Fibrates

A

Trigs

71
Q

Main Lipid Lowering effect of Fish Oil

A

TGs

72
Q

Caution in Bile Acid Sequestrants in patients with:

A

Elevated Trig levels (greater than 300)

73
Q

An adverse effect of BAS

A

constipation

74
Q

Rule of thumb for administering Cholestyramine and Colestipol

A

Administer all other drugs 1 HOUR BEFORE or 4-6 HOURS AFTER BAS

75
Q

Rule of thumb for administering Colesevelam

A

Administer at least 4 HOURS BEFORE WELCHOL

76
Q

Main lipid-lowering effect of BAS

A

reduces cholesterol

77
Q

What co morbidities are at highest risk for PAD

A

HTN, DM, Hyperlipidemia

78
Q

QRS complex correlates to which phase(s)?

A

phase 0

79
Q

QRS complex represents what type of myocyte action potential?

A

Ventricular Depolarization

80
Q

Using ________ will slow phase 0 and prolong QRS

A

Na blockers

81
Q

QT interval represent which phase(s)?

A

Start of phase 0 and end of phase 3

82
Q

Using ________ will lengthen phase 1,2,3 and prolong QT interval

A

K channel blockers

83
Q

Class 1 antiarrhythmics MOA

A

Block Na channels (and K channels if class 1a)

84
Q

P wave represents what type of myocyte action potential?

A

Artial Depolarization

85
Q

T wave represents what type of myocyte potential?

A

Ventricular Repolarization

86
Q

Duration of Na blockade for: Class 1a antiarrhythmics:

A

intermediate on-off

87
Q

Duration of Na blockade for: Class 1b antiarrhythmics:

A

fast on-off

88
Q

Duration of Na blockade for: Class 1c antiarrhythmics:

A

long on-off

89
Q

K channel blockers will lengthen which phase(s)?

A

Phases 1, 2, and 3

90
Q

ADR for Quinidine

A

Cinchonism (poisoning due to excessive ingestion of cinchona alkaloids)

91
Q

Which Class 1a antiarrhythmic(s) have strong anticholinergic effects.

A

Quinidine and Disopyramide (Norpace)

92
Q

Which drugs can cause “Drug-Induced Lupus Erythematosus like syndrome”

A

Procainamide and Hydralazine (Apresoline)

93
Q

What is the BBW for all Class 1 antiarrhythmics

A

Structural Heart Disease

94
Q

Which electrolyte imbalance decreases quinidine efficacy

A

Hypokalemia

95
Q

Which Class 1 subclass only works on Ventricular arrhythmias?

A

Class 1b

96
Q

MOA of Class 1b drugs

A

Binds to both OPEN and INACTIVATED Na Channels`

97
Q

Which Class 1 subclass has high binding affinity to ISCHEMIC TISSUE

A

Class 1b

98
Q

ADR for Mexiletine (Mexitil)

A

Hepatoxicity

99
Q

Most potent class 1 antiarrhythmics

A

Class 1c

100
Q

What do Class 1c drugs do to an ECG

A

increase QRS

101
Q

CAST Trial proved what?

A

Only use Class 1 drugs in STRUCTURALLY NORMAL HEARTS

102
Q

ADR for Flecainide (Tambocor)

A

Dizziness, Blurred Vision

103
Q

ADR Propafenone (Rhythmol)

A

Dizziness, Blurred Vision, AND Taste Disturbances

104
Q

Pill the Pocket Drugs

A

Flecainide or Propafenone (Rhymol)

105
Q

Define “Pill in the Pocket”

A

Self-administration of a single dose of class 1c drugs outside of the hospital at the onset of palpitations

106
Q

Which Drug(s) with the least TdP Risk?

A

Amiodarone > Dronedarone (Multaq)

107
Q

Monitoring Parameters for Amiodarone

A

Chest X-Ray
Pulmonary Function Tests (PFTs)
Liver Function Tests (LFTs)
Thyroid Function Tests (TFTs)

108
Q

Amiodarone is an inhibitor of:

inducer of:

A

inhibitor of: p-gly-p, CYP 1A2, 3A4, 2C9, 2D6

Inducer of: CYP 3A4, 2C8

109
Q

If you give Amiodarone with Digoxin then:

A

Decrease Digoxin dose by 50%

110
Q

If you give Amiodarone with Warfarin then:

A

Decrease Warfarin dose by 30-50%

111
Q

Contraindications for Multaq

A

BBW: Symptomatic HF, NYHA IV HF

Permanent AF, HR <50, QTc > 500 ms, Pregancy, Hepatic impairment

112
Q

Unfractionated Low Molecular Weight Heparin Reversal:

What drug?
What dose?

A

Protamine: 1 mg/ 1 mg of enoxaparin administered \

MAX DOSE: 50 mg over 15 mins

113
Q

Which AADs can be used as pre-treatment in order to enhance the success of direct current cardioversion and prevent recurrent AF

A 
Amiodarone [Cordarone]
Propafenone [Rhymol]
Sotalol [Betapace]
ibutilide [ Corvert ]
Flecainide [Tambocor]
114
Q

Which AAD is used for maintenance in rhythm control?

A 
"ADD Some Fries Please"
Amiodarone [Cordarone]
Dronedarone [Multaq]
Dofetilide [ Tikosyn ]
Sotalol [ Betapace]
Flecanide [ Tambocor ]
Propafenone [Rhythmol]

PHAR 406 (2 decks)

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