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PHAR 406 > Drug Dosing > Flashcards

Drug Dosing Flashcards

(114 cards)

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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
List Direct Thrombin Inhibitor(s)
Dabigatran [Pradaxa]
26
List Vitamin K antagonist(s)
Warfarin [Coumadin, Jantoven]
27
What clotting factors does Jantoven inhibit?
II, VII, IX, X + Protein C and S
28
Unfractionated Heparin Dosing Prophylactic Dose? Treatment Dose?
Prophylaxis Dose: 5000 IU SC BID/TID TRM Dose: 80 units/kg IV Loading Dose, then 18 units/kg/hr continuous infusion *use ABW*
29
Unfractionated Heparin Reversal: What drug? What dose?
Protamine: 1 mg/ 100 units MAX DOSE is 50 mg IV Bolus over 15 minutes
30
Dosing for Lovenox prophylaxis dosing? Treatment dosing?
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*
31
LMWH is eliminated __________
RENALLY!
32
Monitoring Parameters for Argatroban and Bivalirudin
aPTT
33
Max dose of Simvastatin with Amlodipine
Simvastatin 20 mg
34
Max dose of Simvastatin with Amiodarone
Simvastatin 20 mg
35
Max dose of Lovastatin with Amiodarone
Lovastatin 40 mg
36
Max dose of Lovastatin with Non-DHP CCBs
Lovastatin 20 mg
37
Max dose of Simvastatin with Ranolazine
Simvastatin 20 mg
38
Max dose of Non-DHP CCBs with Simvastatin
Simvastatin 10 mg
39
Absolute Contraindication with cilostazol
Heart Failure
40
Contraindication with Prasugrel
TIA/STROKE
41
HEART FAILURE Dosing for: Hydralazine/Isosorbide dinitrate [BiDil] Is it treating symptoms/ morbidity & mortailty / both?
Starting Dose: 37.5/20mg (1 tablet) po TID Target Dose: 2 tablets po TID Treats Both
42
What are the compensatory responses to myocardial damage?
SNS Activation RAAS Activation Increase Vasopressin
43
Right Ventricular Failure
Peripheral Edema Weight Gain JVD Hypervolemic Hyponatremia
44
Target Digoxin Level in HF
0.5 - 0.9
45
Target Digoxin Level in A fib
0.8 - <2.0
46
What are the Major DDIs with Digoxin (4 drugs)
Amiodarone, Dronedarone, Quinidine, and Verapamil
47
IV Vasodilators
Nitroglycerin, Nesiritide, Nitroprusside
48
IV Inotropes
Dobutamine, Milrinone, (**dopamine**)
49
IV Diuretics
Furosemide, Bumetanide
50
IV Fluids
0.9% NaCl
51
Vasopressors
epinephrine, norepinephrine, [dopamine (if SBP <90)]
52
"Wet" Signs and symptoms of ADHF
Dyspnea, Orthopnea, PERIPHERAL EDEMA, Ascites, JVG, PCWP > 18 mm Hg
53
"Cold" Signs and symptoms of ADHF
Weakness, Fatigue, Altered mental status, Decreased Urine output, worsening renal function, Cold extremities, Hypotension, CI < 2.2 , SaO2 < 90%
54
Max dose: IV Furosemide
200 mg
55
Max dose: IV Bumetanide
5 mg
56
Nitroprusside dose in ADHF
0.2 mcg/kg/min
57
ADR for Nitroprusside
Hypotension (BBW) Cyanide toxicity (BBW) Thiocyanate Toxicity
58
Treatment for Nitroprusside Toxicity
sodium thiosulfate
59
``` Initial Dosing for Ivabradine (Corlanor) **Exceptions? If HR > 60? HR 50-60? HR < 50 OR symptoms of bradycardia ```
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
MAX dose for Ivabradine [Corlanor]
7.5 mg po BID
61
When can you replace Beta Blockers with Ivabradine in HF? Requirements:
pts w/ NSR, EF <35%, and on max beta-blocker therapy/ CI with BB.
62
Contraindications of Corlanor:
``` Acute Decompensated HF HR < 60 before starting therapy BP <90/50 3rd degree AV block Pacemaker CYP3A4 inhibitors Hepatic Impairment Atrial Fibrillation ```
63
When should serum digoxin concentrations be drawn?
at least 6-8 hours after last dose (optimally 12-24 hours after a dose)
64
Digoxin Adverse Effects
GI, Visual, Cardiac (bradycardia, AV block, Ventricular Tachyarrythmia)
65
Factors that increase digoxin toxicity
Electrolyte imbalance: HYPOkalemia, HYPOmagnesimoa Alkalosis Digoxin levels great than 2 ng/mL
66
Antidote for digoxin toxicity:
Digibind
67
Drugs to Avoid in HF:
``` NSAIDs Non-DHP (HFrEF) Thiazolidinediones (Pioglitazone) METFORMIN K-supplements Pseudoephedrine Na containing preparations (fleet enemas) ```
68
Diagnosis of PAD using ABI is
ABI ≤ 0.9
69
Absolute Contraindication for Fibrates
Renal Failure Hepatic Failure Gallbladder disease CrCl < 30 mL/min
70
Main Lipid Lowering effect of Fibrates
Trigs
71
Main Lipid Lowering effect of Fish Oil
TGs
72
Caution in Bile Acid Sequestrants in patients with:
Elevated Trig levels (greater than 300)
73
An adverse effect of BAS
constipation
74
Rule of thumb for administering Cholestyramine and Colestipol
Administer all other drugs 1 HOUR BEFORE or 4-6 HOURS AFTER BAS
75
Rule of thumb for administering Colesevelam
Administer at least 4 HOURS BEFORE WELCHOL
76
Main lipid-lowering effect of BAS
reduces cholesterol
77
What co morbidities are at highest risk for PAD
HTN, DM, Hyperlipidemia
78
QRS complex correlates to which phase(s)?
phase 0
79
QRS complex represents what type of myocyte action potential?
Ventricular Depolarization
80
Using ________ will slow phase 0 and prolong QRS
Na blockers
81
QT interval represent which phase(s)?
Start of phase 0 and end of phase 3
82
Using ________ will lengthen phase 1,2,3 and prolong QT interval
K channel blockers
83
Class 1 antiarrhythmics MOA
Block Na channels (and K channels if class 1a)
84
P wave represents what type of myocyte action potential?
Artial Depolarization
85
T wave represents what type of myocyte potential?
Ventricular Repolarization
86
Duration of Na blockade for: Class 1a antiarrhythmics:
intermediate on-off
87
Duration of Na blockade for: Class 1b antiarrhythmics:
fast on-off
88
Duration of Na blockade for: Class 1c antiarrhythmics:
long on-off
89
K channel blockers will lengthen which phase(s)?
Phases 1, 2, and 3
90
ADR for Quinidine
Cinchonism (poisoning due to excessive ingestion of cinchona alkaloids)
91
Which Class 1a antiarrhythmic(s) have strong anticholinergic effects.
Quinidine and Disopyramide (Norpace)
92
Which drugs can cause "Drug-Induced Lupus Erythematosus like syndrome"
Procainamide and Hydralazine (Apresoline)
93
What is the BBW for all Class 1 antiarrhythmics
Structural Heart Disease
94
Which electrolyte imbalance decreases quinidine efficacy
Hypokalemia
95
Which Class 1 subclass only works on Ventricular arrhythmias?
Class 1b
96
MOA of Class 1b drugs
Binds to both OPEN and INACTIVATED Na Channels`
97
Which Class 1 subclass has high binding affinity to ISCHEMIC TISSUE
Class 1b
98
ADR for Mexiletine (Mexitil)
Hepatoxicity
99
Most potent class 1 antiarrhythmics
Class 1c
100
What do Class 1c drugs do to an ECG
increase QRS
101
CAST Trial proved what?
Only use Class 1 drugs in STRUCTURALLY NORMAL HEARTS
102
ADR for Flecainide (Tambocor)
Dizziness, Blurred Vision
103
ADR Propafenone (Rhythmol)
Dizziness, Blurred Vision, AND Taste Disturbances
104
Pill the Pocket Drugs
Flecainide or Propafenone (Rhymol)
105
Define "Pill in the Pocket"
Self-administration of a single dose of class 1c drugs outside of the hospital at the onset of palpitations
106
Which Drug(s) with the least TdP Risk?
Amiodarone > Dronedarone (Multaq)
107
Monitoring Parameters for Amiodarone
Chest X-Ray Pulmonary Function Tests (PFTs) Liver Function Tests (LFTs) Thyroid Function Tests (TFTs)
108
Amiodarone is an inhibitor of: | inducer of:
inhibitor of: p-gly-p, CYP 1A2, 3A4, 2C9, 2D6 Inducer of: CYP 3A4, 2C8
109
If you give Amiodarone with Digoxin then:
Decrease Digoxin dose by 50%
110
If you give Amiodarone with Warfarin then:
Decrease Warfarin dose by 30-50%
111
Contraindications for Multaq
BBW: Symptomatic HF, NYHA IV HF Permanent AF, HR <50, QTc > 500 ms, Pregancy, Hepatic impairment
112
Unfractionated Low Molecular Weight Heparin Reversal: What drug? What dose?
Protamine: 1 mg/ 1 mg of enoxaparin administered \ | MAX DOSE: 50 mg over 15 mins
113
Which AADs can be used as pre-treatment in order to enhance the success of direct current cardioversion and prevent recurrent AF
``` Amiodarone [Cordarone] Propafenone [Rhymol] Sotalol [Betapace] ibutilide [ Corvert ] Flecainide [Tambocor] ```
114
Which AAD is used for maintenance in rhythm control?
``` "ADD Some Fries Please" Amiodarone [Cordarone] Dronedarone [Multaq] Dofetilide [ Tikosyn ] Sotalol [ Betapace] Flecanide [ Tambocor ] Propafenone [Rhythmol] ```

PHAR 406 (2 decks)

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