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KEY DRUGS/FACTS/ETC Flashcards

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1
Q

where do thiazide diuretics work at

A

distal convoluted tubule

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2
Q

where do K-sparing diuretics work at

A

distal convoluting tubule & collecting duct

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3
Q

where do SGLT2 inhibitors work at

A

proximal tubule

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4
Q

where do loop diuretics work at

A

ascending loop of Henle

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5
Q

key drugs that cause kidney disease

A

AMGs
AmpB
Cisplatin
Cyclosporine
Loop diuretics
NSAIDs
Polymyxins
Radiographic contrast dye
Tacrolimus
Vancomycin

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6
Q

key drugs that need ↓dose or↑interval in CKD

A

Anti-Infectives
- Aminoglycosides [↑dosing interval primarily]
- Beta-lactam antibiotics [except antistaphylococcal penicillins & ceftriaxone]
- Fluconazole
- Quinolones [except moxifloxacin]
- Vancomycin
Cardiovascular Drugs
- LMWHs [enoxaparin]
- Rivaroxaban [for AF]
- Apixaban [for AF]
- Dabigatran [for AF]
Gastrointestinal Drugs
- H2RAs [famotidine, ranitidine]
- Metoclopramide
Other
- Bisphosphonates
- Lithium

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7
Q

key drugs that are CI in CKD

A

CrCl <60 mL/min
- Nitrofurantoin
CrCl <50 mL/min
- TDF-containing products [Atripla, Complera, Delstrigo, Stribild, Symfi, Symfi Lo]
- Do not start stribild if <70 mL/min
- Voriconazole IV [due to vehicle]
CrCl <30 mL/min
- TAF-containing products [Biktarvy, Descovy, Genvoya, Odefsey, Symtuza]
- NSAIDs
- Dabigatran [DVT/PE]
- Rivaroxaban [DVT/PE]
GFR <30 mL/min/1.73m2
- SGLT2-i
- Metformin [don’t start if ≤45]
Other
- Meperidine

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8
Q

what level Hgb is considered anemia

A

<13 g/dL

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9
Q

key drugs that raise K+ levels

A

ACE-I
Aldosterone receptor antagonists
Aliskiren
ARBs
Canagliflozin
Drospirenone-containing COCs
Potassium-containing IV fluids [including parenteral nutrition]
Potassium supplements
SMX/TMP
Transplant drugs [cyclosporine, everolimus, tacrolimus]

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10
Q

mavyret

A

glecaprevir/pibrentasvir

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11
Q

epclusa

A

sofosbuvir/velpatasvir

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12
Q

key drugs with BBW for liver damage

A

APAP [high doses, acute or chronic]
Amiodarone
Isoniazid
Ketoconazole [oral]
Methotrexate
Nefazodone
NRTIs
Propylthiouracil
Valproic acid

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13
Q

common pathogens for cns/menigitis ifx

A

Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Group B Streptococcus/E. Coli (young)
Listeria (young/old)

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14
Q

common pathogens for mouth ifx

A

Mouth flora (Peptostreptococcus)
Anaerobic GNR (Prevotella, others)
Viridans group Streptococci

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15
Q

common pathogens for upper respiratory ifx

A

Streptococcus pyogenes
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

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16
Q

common pathogens for lower respiratory [community] ifx

A

Streptococcus pneumoniae
Haemophilus influenzae
Atypicals: Legionella, Mycoplasma, Chlamydophilia
Enteric GNR (alcoholics)

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17
Q

common pathogens for lower respiratory [hospital] ifx

A

Staphylococcus aureus, including MRSA
Pseudomonas aeruginosa
Acinetobacter baumannii
Enteric GNR (including ESBL, MDR)
Streptococcus pneumoniae

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18
Q

common pathogens for heart/endocarditis ifx

A

Staphylococcus aureus, including MRSA
Staphylococcus epidermidis
Streptococci
Enterococci

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19
Q

common pathogens for intra-abdominal ifx

A

Enteric GNR
Enterococci/Streptococci
Bacteroides species

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20
Q

common pathogens for skin/soft tissue ifx

A

Staphylococcus aureus
Streptococcus pyogenes
Staphylococcus epidermidis
Pasteurella multocida ± aerobic/anaerobic GNR (in diabetes)

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21
Q

common pathogens for urinary tract ifx

A

E. coli, Proteus, Klebsiella
Staphylococcus saprophyticus
Enterococci

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22
Q

common pathogens for bone/joint ifx

A

Staphylococcus aureus
Staphylococcus epidermidis
Streptococci
Neisseria gonorrhoeae
GNR (only in specific situations)

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23
Q

common resistant pathogens

A

Kill Each And Every Strong Pathogen
Klebsiella pneumoniae [ESBL, CRE]
Escherichia coli [ESBL, CRE]
Acinetobacter baumannii
Enterococcus faecalis, Enterococcus faecium [VRE]
Staphylococcus aureus [MRSA]
Pseudomonas aeruginosa

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24
Q

hydrophilic ABX

A

beta-lactams
AMGs
vancomycin
daptomycin
polymyxins

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25
hydrophilic ABX characteristics
small Vd renal elimination low intracellular concentrations increased clearance poor-moderate bioavailability
26
lipophilic ABX
quinolones macrolides rifampin linezolid tetracyclines
27
lipophilic ABX characteristics
large Vd hepatic metabolism intracellular concentrations clearance/distribution is charged minimally in sepsis excellent bioavailability
28
concentration-dependent ABX
AMGs, quinolones, daptomycin
29
time-dependent ABX
beta-lactams
30
exposure-dependent ABX
vancomycin, macrolides, tetracyclines, polymyxins
31
first line antihypertensive for CKD, HTN & albuminuria
ACE-I or ARB
32
first line trx for CKD, T2DM & eGFR ≥30
metformin + SGLLT2-i
33
trx for hyperphosphatemia
- restrict dietary phos - phosphate binders - aluminum-based: aluminum hydroxide - calcium-based [1st line]: calcium acetate - aluminum-free, calcium-free: sucroferric oxyhydroxude, ferric citrate, lanthanum carbonate [Fosrenol], sevelamer carbonate [Renvela], sevelamer hydrochloride [Renagel]
34
trx for secondary hyperparathyroidism
- vitamin D analogs: calcitriol, califediol, doxercalciferol, paricalcitol - calcimimetic: cinacalcet [Sensipar], etecalcetide [Parsabiv]
35
trx for anemia of CKD
- ESAs: epoetin [Procrit, Epogen, Retacrit], darbepoietin [Aranesp]
36
trx for hyperkalemia
- sodium polystyrene sulfonate [SPS, Kayexalate] - patiromer [Veltassa] - sodium zirconium cyclosilicate [Lokelma]
37
trx for severe hyperkalemia
- stabilize heart: calcium gluconate - move it [shift intracellularly]: regular insulin, dextrose, sodium bicarb, albuterol - remove it [furosemide, kayexalate, patiromer, HD
38
trx for metabolis acidosis
sodium bicarbonate sodium citrate
39
trx for hepA
supportive
40
trx for hepB
PEG-INF or NRTI [pref tenofovir or entecavir] NRTIs: - tenofovir disoproxil [Viread] - tenofovir alafenamide [Vemlidy] - entecavir [Baraclude] - lamivudine [Epivir HBV] - adefovir [Hepsera]
41
trx for hepC
- DAA combination + RBV - DAA combination + RBV + PEG-INF DAAs: *pref Mavyret or Epclusa - glecaprevir/pibrentasvir [Mayvet] - sofosbuvir/velpatasvir [Epclusa] - sofosbuvir/ledipasvir [Harvoni] - sofosbuvir/velpatasvir/voxilaprevir [Vosevi] - sofosbuvir [Sovaldi] - paritaprevir/ritonavir/ombitasvir + dasabuvir [Viekira Pak] - elbasavir/grazoprevir [Zepatier]
42
tenofovir disoproxil fumarate [TDF]
Viread
43
tenofovir alanafenamide [TAF]
Vemlidy
44
entecavir
Baraclude
45
trx for alcohol-associated liver disease
- alcohol cessation - inpatient: BZD - outpatient: AED
46
trx for portal hypertension & variceal bleeding
- band ligation or sclerotherapy [first line] - octreotide [selective] - vasopressin [non-selective]
47
trx for hepatic encephalopathy
- 1st line: lactulose - 2nd line: rifaximin
48
trx for ascites
- spironolactone monotherapy -> 50-100mg/day, increased to max 400mg/day - furosemide 40mg + spironolactone 100mg
49
trx for spontaneous bacterial peritonitis
- ceftriaxone - alt: amp, genta or FQ - ppx: bactrim, ofloxacin or cipro
50
trx for hepatorenal syndrone
albumin, octreotide & midodrine
51
abx for surgery ppx [cardiac, orthopedic, vascular]
- cefazolin - alt: clinda or vanco
52
abx for surgery ppx [GI]
- cefazolin + flagyl, cefoxitin, cefotetan or unasyn - alt: clinda, AMG + flagyl, or FQ + flagyl
53
abx for surgery ppx [genitourinary]
- cipro or bactrim
54
trx for meningitis
- <1 month: ampicillin + cefotaxime or gentamicin - 1 month - 50 years: ceftriaxone [or cefotaxime] + vanco - >50 years or immunocompromised: ampicillin + ceftriaxone [or cefotaxime] + vanco
55
trx for acute otitis media
- 1st line: high dose amoxicillin or augmentin - 90mg/kg/day of amox in 2 divided doses - non-severe PCN allergy: 2nd or 3rd gen cephalosporin [cefdinir, cefuroxime, cefpodoxime] - trx failure: augmentin or CTX IM QD x3 days
56
trx for acute bronchitis
abx not recommended
57
trx for acute bacterial exacerbation of COPD
- 1st line: augmentin - others: azithromycin, doxy, respiratory FQ
58
trx for outpatient CAP
healthy pts: - amoxicillin high dose - doxy - macrolide high-risk pts: - beta-lactam + macrolide or doxy - respiratory FQ *beta-lactam: augmentin, cefpodozime, or cefuroxime *respiratory FQ: moxi, levo, gemi
59
trx for inpatient CAP
nonsevere - beta-lactam + macrolide or doxy - CTX, cefotaxmine, unasyn - respiratory FQ severe: - beta-lactam + macrolide - beta-lactam + respiratory quinolone *MRSA: vanco or line *PSA: zosyn, cefepime, ceftazidime, imipenem/cilastatin or meropenem
60
trx for HAP/VAP
no MRSA or MDRO risk: - beta-lactam MRSA risk but no MDRO risk: - anti-PSA + vanco/line MRSA & MDRO risk: - 2 anti-PSA + vanco/line *PSA: cefepime, zosyn, imipenem/cilastatin, meropenem, aztreonam, cipro, levo, AMGs
61
trx for latent TB
- INH + rifapentine once weekly x12 weeks via ODT - INH + rifampin QD x3 months - rifampin QD x4 months - INH QD x6-9 months
62
trx for active TB
intensive phase [2 months]: - rifampin + INH + pyrazinamide + ethambutol continuous phase [4 months]: - rifampin + INH
63
trx for infective endocarditis
empiric: - vanco + CTX viridans strep: - PCN or CTX - PCN allergy: vanco enterococci: - PCN or amp + gentamicin - alt: amp + HD CTX - beta-lactam allergy: vanco genta - VRE: dapto or line staphylococci: - MSSA: naf, oxa, cefazolin - MRSA or beta-lactam allergy: vanco or dapto - prosthetic valve: add rifampin + genta
64
abx for infective endocarditis dental ppx
- 1st line: amox 2g PO - NPO: amp 2g IM/IV or cefazolin 1g IM/IV - PCN allergy: azithromycin or clarithromycin 500mg PO, doxy 100mg PO
65
trx for impetigo
- topical abx like mupirocin - cephalexin if numerous lesions
66
trx for folliculitis/furuncles/carbuncles
- systemic signs: cephalexin - non-responsive: bactrim or doxy
67
trx for cellulitis
- cephalexin - clindamycin
68
trx for mild-mod purulent ssti
- I&D - bactrim, doxy, mino or clinda
69
trx for severe purulent SSTI
- vanco - dapto - line
70
trx for necrotizing fasciitis
- vanco + beta-lactam [zosyn, imipenem/cilastatin or meropenem] - clinda
71
trx for diabetic foot ifx
monotherapy [MSSA]: - unasyn, zosyn, carbapenem or moxi combo therapy [MRSA & PSA]: - vanco - ceftazidime, cefepime, zosyn, aztreonam or carbapenem [no erta]
72
trx for acute uncomplicated cystitis
- nitrofurantoin [Macrobid] 100mg PO BID x5 days - bactrim DS 1 tab PO BID x3 days - fosfomycin x1 dose pregnant: - amoxicillin - cephalexin
73
trx for acute pyelonephritis
moderately ill outpatient - cipro or levo - CTX, erta or AMG x1 then FQ - bactrim - beta-lactam [augmentin, cefidinir, cefadroxil, cefpodoxime] severely ill inpatient: - CTX, zosyn, quinolone or carbapenem
74
trx for complicated UTI
- similar for pyelo trx
75
trx for c.diff
- fidaxomicin - PO vanco - flagyl - bezlotoxumab [only to decrease risk of recurrence, doesn't treat active c.diff]
76
trx for traveler's diarrhea
dysentery, fever, pregnancy or pediatric: - azithromycin no dysentery: - quinolones x1-3 days - rifaximin x3 days
77
trx of syphilis
- penicillin B, benzathine [Bicillin L-A] 1.4 million units IM - primary, secondary or early latent: x1 month - late latent or early: x3 weeks - alt: doxy
78
trx for neurosyphilis
- penicillin G aqueous IV
79
trx for gonorrhea
- CTX 500mg IM x1 [<150kg] - add doxy if chlamydia not excluded
80
trx for chlamydia
- doxy 100mg PO BID x7 days - pregnant: azithro 1g PO x1
81
trx for bacterial vaginosis
- flagyl - flagyl 0.75% gel
82
trx for trichomoniasis
- flagyl
83
trx for genital warts
- imiquimod cream
84
trx for rocky mountain spotted fever
- doxy [DOC even in peds]
85
trx for typhus
- doxy
86
trx for lyme disease
- doxy
87
trx for ehrlichiosis
- doxy
88
trx for tularemia
- genta or tobra
89
trx for invasive cryptococcal meningitis
ampB + flucytosine
90
which azole needs renal dose adjustment
fluconazole
91
IV to PO for azoles
IV:PO = 1:1
92
does isavuconium cause QT prolongation
no, QT shortening
93
trx for oropharyngeal ifx [candida albicans]
mild: topical antifungal mod-severe: fluconazole
94
trx for esophageal ifx [candida albicans]
fluconazole
95
trx for candida krusei & glabrata, all bloodstream ifx
echinocandin
96
trx for aspergillus
voriconazole
97
trx for dermatophyles [nail bed ifx]
terbinafine or itraconazole
98
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
99
topical trx for herpes labialis
- docosanol [Abreva] OTC 5x daily at first sign of outbreak - acyclovir [Zovirax] Rx 5x daily x4 days
100
systemic trx for herpes labialis
- acyclovir - valacyclovir - famciclovir
101
trx for genital herpes in non-HIV
- acyclovir - valacyclovir - famciclovir
102
trx for herpes zoster
- acyclovir x7 days - valacyclovir x7 days - famciclovir x7 days
103
trx for cytomegalovirus
- ganciclovir - valganciclovir - cidofovir - foscarnet [CMV retinitis, resistant HIV]
104
ppx for pneucystic jirovecii pneumonia [PJP/PCP]
- CD4 <200 cells/mm3 - pref: bactrim DS QD - alt: - dapsone - dapsone + pyrimethamine + leucovorin - atovaquone *stop when CD4 >200 for >3 months
105
ppx for toxoplasma gondii encephalitis
- CD4 <100 cells/mm3 - pref: bactrim DS QD - alt: - dapsone + pyrimethamine + leucovorin - atovaquone
106
ppx for mycobacterium avium complex [MAC]
- if not on ART & CD4 <50 - pref: azithromycin 1200mg weekly stop if pt taking fully suppressive ART
107
MOA of maraviroc
- CCR5 antagonist - stage 1
108
MOA of fostemsavir
- attachment inhibitor - stage 1
109
MOA of ibalizumab-uiyk
- post-attachment inhibitor - stage 1
110
MOA of enfuvirtide
- fusion inhibitor - stage 2
111
MOA of NRTIs
- nucleoside reverse transcriptase inhibitors - stage 3
112
MOA of NNRTIs
- non-nucleoside reverse transcriptase inhibitors - stage 3
113
MOA of INSTIs
- integrase strand reverse inhibitors - stage 4
114
MOA of PIs
- protease inhibitors - stage 7
115
pgx test for abacavir
HLA-B*5701
116
pgx test for maraviroc
tropism assay
117
NRTIs
Abacavir [Ziagen] Emtricitabine [Emtriva] Lamivudine [Epivir] Tenofovir disoproxil fumarate [Viread] Tenofovir alafenamide [only in combo for HIV drugs, Vemlidy is single drug for HBV] Zidovudine [Retrovir]
118
NNRTIs
Efavirenz [Sustiva] Rilpivirine [Edurant] Doravirine [Pifeltro] Etravirine [Intelence] Nevirapine [Viramune XR] Delavirdine [no longer recommended]
119
INSTIs
Bictegravir [only in combo Biktarvy] Cabotegravir [Vocabra, Apretude] Dolutegravir [Tivicay] Elvitegravir [only in combo Genvoya & Stribild] Raltegravir [Isentress, Isentress HD]
120
PIs
Atazanavir [Reyataz] Darunavir [Prezista] Fosamprenavir [Lexiva] lopinavir/ritonavir [Kaletra] Saquinavir [Invirase] Tipranavir [Aptivus] Indinavir [no longer recommended] Nelfinavir [no longer recommended]
121
PK boosters
Ritonavir [Norvir] → difficult to co-formulate Cobicistat [Tybost] → can be co-formulated
122
INSTI-based combo pills
Biktarvy: bictegravir/emtricitabine/tenofovir alafenamide Cabenuva: cabotegravir/rilpivirine Triumeq: dolutegravir/abacavir/lamivudine Dovato: dolutegravir/lamivudine Juluca: dolutegravir/rilpivirine Stribild: elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate Genvoya: elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide
123
NNRTI-based combo pills
Delstrigo: doravirine/lamivudine/tenofovir disoproxil fumarate Atripla: efavirenz/emtricitabine/tenofovir disoproxil fumarate Symfi, Symfi Lo: efavirenz/lamivudine/tenofovir disoproxil fumarate Complera: rilpivirine/emtricitabine/tenofovir disoproxil fumarate Odefsey: rilpivirine/emtricitabine/tenofovir alafenamide
124
PI-based combo pills
Symtuza: darunavir/cobicistat/emtricitabine/tenofovir alafenamide
125
NRTI-based combo pills
Epzicom: abacavir/lamivudine Trizivir: abacavir/lamivudine/zidovudine Descovy: emtricitabine/tenofovir alafenamide Truvada: emtricitabine/tenofovir disoproxil fumarate Combivir: lamivudine/zidovudine Cimduo: lamivudine/tenofovir disoproxil fumarate
126
PrEP regimen
truvada or descovy
127
PEP regimen
truvada + dolutegravir [Tivicay] or raltegravir [Isentress]
128
key abx w/ no renal dose adjustments
Antistaphylococcal penicillins [dicloxacillin, nafcillin] Ceftriaxone Clindamycin Doxcycline Macrolides [azithromycin & erythromycin only] Metronidazole Moxifloxacin Linezolid
129
trx for hypotonic HYPERvolemic hyponatremia
diuresis with fluid restriction
130
trx for hypotonic ISOvolemic hyponatremia
diuresis, fluid restriction - demeclocycline off-label for SIADH - arginine vasopressin [AVP] receptor antagonists: conivaptan & tolvapan
131
trx for hypotonic HYPOvolemic hyponatremia
- hypotonic NaCl if severe symptoms and/or Na <120 - add desmopressin to reduce water diuresis & avoid overcorrection - arginine vasopressin [AVP] receptor antagonists: conivaptan & tolvapan
132
trx for HYPOvolemic hypernatremia
fluids
133
trx for HYPERvolemic hypernatremia
diuresis
134
trx for ISOvolemic hypernatremia
desmopressin
135
what is the max infusion rate & concentration for IV KCl peripherally
max rate: ≤10 mEq/hr max conc: 10mEq/100mL
136
MOA of phenylephrine
alpha-agonist that increases SVR w/o increasing HR
137
MOA of Epi & NE
mixed alpha & beta-agonists -> increase SVR, CO & HR
138
MOA of DA
Low [renal] dose: 1-4 mcg/kg/min → dopamine-1 agonist → renal vasodilation Medium dose: 5-10 mcg/kg/min → beta-1 agonist → positive inotropic High dose: 10-20 mcg/kg/min → alpha-1 agonist → vasopressor effects
139
MOA of vasopressin
acts directly on vasopressin receptors
140
MOA of AngII
increases BP by vasoconstriction & aldosterone release
141
trx of extravasation of vasopressors
phentolamine [alpha-1 blocker]
142
trx of thiocyanate toxicity
hydroxycobalamin
143
trx of cyanide toxicity
sodium thiosulfate + sodium nitrate
144
MOA of nitroprusside
mixed arterial & venous vasodilator
145
MOA of dobutamine
- beta-1 agonist [increase contractility] - weak beta-2 agonist [vasodilation] - weak alpha-1 agonist
146
MOA of milrinone
- selective PDE-3 inhibitor - inotrope w/ significant vasodilation
147
trx for hypovolemic shock
fluid resuscitation w/ crystalloids
148
trx or septic shock
- fluid resuscitation w/ IV crystalloids + broad-spectrum ABX - alpha-1 agonist to ↑SVR - beta-1 agonist to ↑myocardial contractility & CO
149
MAP formula
MAP =[(2 * DBP) + SBP]/3
150
trx of cardiogenic shock
diuretics & IV vasodilators
151
trx of ADHF
- volume overload: loop diuretics - hypoperfusion: inotropes [milrinone, dobutamine] - add vasodilator if hypotensive: DA, NE or phenylephrine
152
trx of hypoperfusion
- dobutamine - milrinone
153
trx for agitation & sedation
- BZDs - non-BZDs [propofol or dexmedetomidine] - dexmedetomidine [Precedex]: for both intubated & non-intubated pts
154
when to seek urgent care for a child
- <3 months with a temp of 100.4°F/38°C [rectal] - 3-6 months with a temp of 101°F/38.3°C [rectal] - >6 months with a temp of 103°F/39.4°C [rectal]
155
standard meds given at birth
- IM vit K - opthalmic erythromycin - first dose of HepB vaccine
156
trx for PDA
- NSAIDs: IV indomethacin or ibuprofen - APAP
157
trx for persistent pulmonary HTN of newborns
- inhaled nitric oxide
158
trx for respiratory distress syndrome
- poractant alfa [Curosurf] calfactant [Infasurf]
159
trx for croup
- dexamethasone 0.6mg/kg - nebulized racemic Epi [adrenergic agonist for bronchodilation]
160
trx for nocturnal enuresis
- desmopressin
161
trx for cystic fibrosis
1. Inhaled bronchodilators [i.e. albuterol] → to open airways 2. Hypertonic saline [e.g. HyperSol] → to move mucus to improve airway clearance 3. Dornase alfa [Pulmozyme] → to decrease viscosity of mucus to promote airway clearance 4. Chest physiotherapy → to move mucus to improve airway clearance 5. Inhaled ABX → controls airway infection
161
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
162
trx for intermittent ifx in CF
- 2 IV anti-PSA ABX x2-4 weeks
163
trx for chronic ifx in CF
- inhaled ABX [aztreonam Q8H or tobramycin Q12H] 28 days on, 28 days off
164
which CTFR modulator cannot be used in homozygous F508del mutation
ivacaftor
165
MOA of ivacaftor
- CFTR modulator that increases the time CFTR channels stay open
166
MOA of lumacaftor, texacaftro & elexacaftor
- CFTR modulators that increase amount of CFTR delivered to cell surface
167
induction immunosuppression trx
IV med [polyclonal or monoclonal antibody] + HD IV steroids - monoclonal antibody: alemtuzumab (T-lymphocyte depleting) & basiliximab (T-lymphocyte non-depleting) - polyclonal antibody: antithymocyte globulin [Algam (equine) & Thymoglobumin (rabbit)]
168
maintenance immunosupression trx
calcineurin inhibitor + antiproliferative +/- steroids CNIs: - tacrolimus [1st line] - cyclosporine antiproliferative: - mycophenolate [1st line] - azathioprine - mTOR inhibitors: everolimus, sirolimus steroids: - prednisone
169
trx for acute rejection
HD steroids + increased levels of maintenance immunosuppression antibody-mediated: plasmapheresis, IVIG & steroids, then rituximab
170
key drugs that cause weight gain
Antipsychotics [clozapine, olanzapine, risperidone, quetiapine] Diabetes drugs [insulin, meglitinides, sulfonylureas, TZDs] Divalproex/VPA Gabapentin, pregabalin Lithium Mirtazapine Steroids TCAs [aitriptyline, nortriptyline] Conditions: hypothyroidism
171
key drugs that cause weight loss
ADHD drugs [amphetamine, methylphenidate] Bupropion GLP-1 agonists [exenatide, liraglutide] Pramlintide Roflumilast SGLT2-Is Topiramate Conditions: hyperthyroidism, celiac disease, IBD
172
breast cancer screening
45-54 years: begin yearly mammogram ≥55 years: mammogram Q2 years or continue yearly
173
cervical cancer screening
21-29 years: pap smear Q3 years 30-65 years: pap smear + HPV
174
colon cancer screening
≥45 years: stool-based tests, visual exams [colonoscopy Q10 years, sigmoidoscopy Q5 years]
175
lung cancer screening
55-74 years: CT chest IF - good health - 30 pack-year smoking history - still smoking or quit in past 15 years
176
prostate cancer screening
>50 years: PSA +/- DRE
177
max dose of bleomycin
lifetime cumulative dose of 400 units
178
max dose of doxorubicin
lifetime cumulative dose 450-550 mg/m2
179
max dose of cisplatin
max 100mg/m2 per cycle
180
max dose of vincristine
2mg max per dose
181
chemo drugs that cause myelosuppression
Almost all chemotherapy drugs except asparaginase, bleomycin, vincristine, most mAbs, many TKIs trx: - neutropenia: CSFs - anemia: ESAs [palliative only], RBC transfusions - thrombocytopenia: platelet transfusions
182
chemo drugs that cause N/V
Cisplatin, cyclophosphamide, ifosfamide, doxorubicin, epirubicin trx: NK1-RA, 5HT3-RA, dexamethasone,
183
chemo drugs that cause mucositis trx: symptomatic trx
Fluorouracil, methotrexate, capecitabine, irinotecan, many TKIs trx: symptomatic trx
184
chemo drugs that cause diarrhea
Irinotecan, capecitabine, fluorouracil, methotrexate, many TKIs trx: - IV/PO fluid hydration, antimotility medications [e.g. loperamide] - Irinotecan: atropine for early-onset diarrhea
185
chemo drugs that cause constipation
Vincristine, pomalidomide, thalidomide trx: stimulant laxatives, PEG 3350
186
chemo drugs that cause xerostomia
radiation therapy trx: artificial saliva substitutes, pilocarpine
187
chemo drugs that cause cardiotoxicity
Cardiomyopathy: Anthracyclines, HER2 inhibitors [ado-trastuzumab, trastuzumab, pertuzumab, lapatinib, fluorouracil] trx: dexrazoxane for doxorubicin QT prolongation: Arsenic trioxide, many TKIs, leuprolide
188
chemo drugs that cause pulmonary toxicity
Pulmonary fibrosis Bleomycin, busulfan, carmustine, lomustine Pneumonitis Methotrexate [with chronic use] & mAbs targeting CTLA-4 or PD-1 trx: steroids
189
chemo drugs that cause hepatotoxicity
Antiandrogens [bicalutamide, flutamide, nilutamide], folate antimetabolites [e.g. methotrexate], pyrimidine analog antimetabolites [e.g. cytarabine], many TKIs, some mAbs trx: symptomatic management
190
chemo drugs that cause nephrotoxicity
Cisplatin Methotrexate [high doses], pemetrexed, pralatrexate, some mAbs trx: - amifostine [Ethyol] for cisplatin
191
chemo drugs that cause hemorrhagic cystitis
Ifosfamide [all doses], cyclophosphamide [higher doses >1 g/m2] - mesna [Mesnex] for ifosfamide [always] & cyclophosphamide [sometimes]
192
chemo drugs that cause neuropathy
Peripheral Neuropathy Vinca alkaloids [vincristine, vinblastine, vinorelbine] Platinums [cisplatin, oxaliplatin] Taxanes [paclitaxel, docetaxel, cabazitaxel] Proteosome inhibitors [bortezomib, carfilzomib], thalidomide, ado-trastuzumab, cytarabine [high doses], brentuxmab trx: - avoid cold things w/ oxaliplatin Autonomic Neuropathy Vinca alkaloids
193
chemo drugs that cause thromboembolic risk
Aromatase inhibitors [e.g. anastrozole, letrozole], SERMs [e.g. tamoxifen, raloxifene], immunomodulators [thalidomide, lenalidomide, pomalidomide]
194
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
195
adjunctive therapy for cisplatin
amifostine [Ethyol] & hydration
196
adjunctive therapy for doxorubicin
dexrazoxane [Tofect]
197
adjunctive therapy for fluorouracil
leucovorin or levoleucovorin
198
adjunctive therapy for fluorouracil or capecitabine
uridine triacetate [use within 96 hours]
199
adjunctive therapy for ifosfamide
mesna [Mesnex] & hydration
200
adjunctive therapy for irinotecan
atropine & loperamide
201
adjunctive therapy for methotrexate
leucovorin or levoleucovorin glucarpidase
202
normal Hgb levels
females: 12-16 g/dL males; 13.5-18 g/dL
203
what level can you start ESAs
Hgb <10 g/dL
204
trx for acute CINV
5HT3-RA + NK1-RA + steroid ± olanzapine
205
trx for delayed CINV
5HT3-RA + NK1-RA + steroid + olanzapine
206
trx for anticipatory CINV
BZD
207
trx for high emetic risk
3-4 drugs: - NK1-RA + 5HT3-RA + olanzapine + dexamethasone [preferred] - Palonosetron + olanzapine + dexamethasone - NK1-RA + 5HT3-RA + dexamethasone
208
trx for mod emetic risk
2-3 drugs: - NK1-RA + 5HT3-RA + dexamethasone - 5HT3-RA + dexamethasone - Palonosetron + olanzapine + dexamethasone
209
trx for low emetic risk
1 drug [any except NK1-RA]
210
trx for breakthrough CINV
5HT3-RAs, dopamine receptor antagonists, cannabinoids, olanzapine, lorazepam, dexamethasone or scopolamine
211
which chemo drugs cause hand-foot syndrome
capecitabine & fluorouracil
212
trx for tumor lysis syndrome
- allopurinol: xanthine oxidase inhibitor - rasburicase: add on to allopurinol
213
trx for mild hypercalcemia of malignancy
hydration with NS & loop diuretics
214
trx for mod-severe hypercalcemia of malignancy
calcitonin [Miacalcin]
215
trx for mild, mod, severe hypercalcemia of malignancy
IV bisphosphonates zoledronic acid [Zometa] - not reclast [for osteoporosis
216
trx for mod-severe hypercalcemia of malignancy
denosumab [Xgeva] - not prolia [for osteoporosis]
217
trx for breast cancer
premenopausal: - tamoxifen [SERM] - fulvestrant [SERD] - toremifene [SERM] postmenopausal: - aromatase inhibtors [anastrozole] - raloxifene [also for ppx] HER2(+) - trastuzumab [Herceptin] HER2(-) - abemaciclib - everolimus metastatic: - capecitabine, carboplatin, cyclophosphamide, docetaxel, paclitaxel, doxorubicin & methotrexate
218
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
219
trx for prostate cancer
ADT:
220
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
221
trx for prostate cancer
ADT: GnRH antagonist alone or GnRH agonist [combo with antiandrogen] - GnRH antagonist: Degarelix, Relugolix - GnRH agonist: Leuprolide [Lupron], Goserelin [Zoladex] - Antiandrogen: bicalutamide, flutamide, nilutamide
222
trx for prostate cancer
ADT: GnRH antagonist alone or GnRH agonist [combo with antiandrogen] - GnRH antagonist: Degarelix, Relugolix - GnRH agonist: Leuprolide [Lupron], Goserelin [Zoladex] - Antiandrogen: bicalutamide, flutamide, nilutamide
223
chemo drugs that work at S phase
- Antimetabolites → methotrexate, pemetrexed, 5-FU, capecitabine - Topoisomerase I Inhibitors → irinotecan, topotecan
224
chemo drugs that work at G2 phase
- Topoisomerase II Inhibitors [block DNA coiling & uncoiling] → etoposide, bleomycin
225
chemo drugs that work at M phase
- Taxanes → paclitaxel, docetaxel - Vinca Alkaloids → vincristine, vinblastine
226
chemo drugs that are cell-cycle independent
- Alkylating Agents → cyclophosphamide, ifosfamide, carmustine, busulfan - Anthracyclines → doxorubicin, mitoxantrone - Platinum Compounds → cisplatin, carboplatin
227
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
228
mAbs that target VEGF
229
mAbs that target VEGF
bevacizumab ramucirumab
230
mAbs that target EGFR
cetuximab panitumumab
231
mAbs that target HER2
trastuzumab pertuzumab
232
mAbs that target CD antigens on cell surface
rituximab brentuximab
233
mAbs that target immune system [PD-1, PDL-1, CTLA-A]
ipilimumab pembrolizumab
234
types of TKIs
- BCR-ABL inhibitors: imatinib [Gleevec], dasatinib, nilotinib - BRAF inhibitors: vemurafenic, dabrafenib - Mitogen-activated extracellular kinase 1&2 inhibitors: cobimetinib - EGFR inhibitors: afatinib, erlotinib - Anaplastic lymphoma kinase inhibitors: alectinib, brigatinib - Others: lapatinib, neratinib, sorafenib, sunitinib
235
key drugs that cause/worsen depression
ADHD medications - Atomoxetine [Strattera] Analgesics - Indomethacin Antiretrovirals [NNRTIs] - Efavirenz [in Atripla] - Rilpivirine [in Complera, Odefsey] Cardiovascular medications - Beta-blockers [esp propranolol] - Hormones - Hormonal contraceptives - Anabolic steroids Other - Antidepressants - Benzodiazepines - Systemic steroids - Interferons - Varenicline - Ethanol
236
trx for postpartum depression
SSRI, TCAs [except doxepin] brexanolone [Zulresso]: C-IV FDA-approved
237
serotonin syndrome symptoms
severe nausea, dizziness, HA, diarrhea, agitation, tachycardia, hallucinations or muscle rigidity
238
antidepressant withdrawal symptoms
anxiety, agitation, insomnia, dizziness & flu-like symptoms
239
extrapyramidal side effects
dystonia, akathsia, parkinsonism, tardive dyskinesia
240
key drugs that cause psychotic symptoms
Anticholinergics [centrally-acting, high doses] Dextromethorphan Dopamine or dopamine agonists [Requip, Mirapex, Sinemet] Interferons Stimulants, esp if already at risk [includes amphetamines] Systemic steroids [typically with lack of sleep - ICU psychosis] Illicit/recreational substances
241
trx for tardive dyskinesia
valbenazine
242
trx for neuroleptic malignant syndrome
BZDs, dantrolene [Ryanodex, Dantrium, Revonto]
243
trx for bipolar disorder
Manic episode: first-line trx is valproate, lithium or antipsychotic - Combo of antipsychotic + lithium or valproate is preferred for severe episodes Depressive episode: first-line trx is antipsychotic [quetiapine, lurasidone] - Lithium, valproate or lamotrigine can be added or used as alternatives
244
conversion of lithium
8 mEq lithium ion = 300mg lithium carbonate tabs/caps
245
trx for ADHD
- first line: stimulants - atomoxetine [non-stimulant] - guanfacine ER [intuniv] & clonidine ER [kapvay]: alone or combo with stimulants - to help sleep at night: clonidine IR [Catapres], diphenhydramine, melatonin
246
key drugs that cause anxiety
Albuterol [if used too frequently or incorrectly] Antipsychotics [e.g. aripiprazole, haloperidol] Bupropion Caffeine, in high doses Decongestants [e.g. pseudoephedrine] Illicit drugs [e.g. cocaine, LSD, methamphetamine] Levothyroxine [if therapeutic overdose occurs] Steroids Stimulants [e.g. amphetamine, methylphenidate] Theophylline
247
trx for anxiety
First Line: SSRIs & SNRIs → escitalopram [Lexapro], fluoxetine [Prozac], paroxetine [Paxil], sertraline [Zoloft], duloxetine [Cymbalta], venlafaxine XR [Effexor XR] Second Line: buspirone, TCAs [amitriptyline & nortriptyline (Pamelor)], hydroxyzine, pregabalin, gabapentin Special situations: propranolol [Inderal]
248
LOT BZDs
lorazepam, oxazepam, temazepam
249
key drugs that worsen insomnia
Acetylcholinesterase inhibitors [e.g. donepezil] Alcohol Antiretrovirals [e.g. emtricitabine, INSTIs] Aripiprazole Atomoxetine Bupropion Caffeine Decongestants [e.g. pseudoephedrine] Diuretics [due to nocturia] Fluoxetine, if taken late in the day Steroids Stimulants [methyphenidate, phentermine] Varenicline
250
trx for insomnia [falling asleep]
Eszopiclone Zolpidem Ramelteon Zaleplon
251
trx for insomnia [staying asleep]
Eszopiclone Zolpidem Doxepin Suvorexant
252
trx for insomnia [both falling & staying asleep]
Eszopiclone Zolpidem
253
trx for RLS
- dopamine agonists: ropinirole IR, pramipexole IR, rotigotine patch [Neupro] - gabapentin enacarbil [Horizant]
254
trx for narcolepsy
- stimulants: modafinil - GABA derivations: sodium oxybate [Xyren] or calcium, magnesium, potassium and sodium oxybate (Xywav) - histamine-3 receptor antagonist/inverse agonist: pitolisant - dopamine & NE reuptake inhibitor: solreamfetol
255
trx for PD
- carbidopa/levodopa - COMT inhibitors: entacapone [Comtan], entacapone/carbidopa/levodopa [Staleva], opicapone [Ogentys], tolcapone [Tasmar] - DA agonists: pramipexole [Mirapex], ropinirole [Requip], rotigotine [Neupro] - amantadine: blocks DA reuptake - selective MAO-B inhibitors: selegiline, rasagiline, safinamide - centrally acting anticholinergics: benztropine [Cogentin], trihexyphenidyl - adenosine receptor antagonist: istradefylline - alpha/beta agonist: droxidopa
256
key drugs that can worsen dementia
Antiemetics → promethazine AHs → diphenhydramine, doxylamine Antipsychotics → chlorpromazine, aripiprazole Barbiturates → phenobarbital, butalbital BZDs → alprazolam, clonazepam Central anticholinergics → benztropine Peripheral anticholinergics → incontinence & IBS drugs Skeletal muscle relaxants → baclofen Other CNS depressants → opioids, sedative hypnotics
257
trx for Alzheimers'
- acetylcholinesterase inhibitors: donepezil [Aricept], rivastigmine [Exelon], galantamine - memantine [namenda]: w/ or w/o donepezil - aducanumab [Aduhelm] - antidepressants: sertraline, citalopram, escitalopram
258
trx for acute seizure
- BZD inj - IM midazolam not urgent - diazepam rectal gel - intranasal or buccal midazolam
259
trx for chronic seizure
AEDs - Broad-spectrum AEDs: lamotrigine [Lamictal], levetiracetam [Keppra], topiramate [Topamax], valproic acid, divalproex [Depakote] - Narrow-spectrum AEDs: carbamazepine [Tegretol], lacosamide [Vimpat], oxcarbazepine [Trileptal], phenobarbital, phenytoin [Dilantin] & fosphenytoin [Cerebryx]
260
MOA of AEDs
- Benozodiazepines: ↑GABA - Valproic Acid : ↑GABA - Phenobarbital: Enhance/potential GABA effect - Levetiracetam: Ca channel blocker & ↑GABA - Ethosuximide: T-type Ca channel blocker - Pregabalin/Gabapentin: Ca channel blocker - Oxcarbazepine: Na & Ca channel blocker - Carbamazepine : Na channel blocker - Lamotrigine: Na channel blocker - Phenytoin/Fosphenytoin: Na channel blocker - Topiramate : Na channel blocker
261
therapeutic range of PHT
10-20 mcg/mL [total level] 1-2.5 mcg/mL [free level]
262
live vaccines
MMR Intranasal influenza Cholera Rotavirus Oral typhoid Varicella Yellow fever
263
which vaccines are PO
typhoid [Vivotif] & rotavirus [Rotateq, Rotarix]
264
key drugs that can raise LDL and/or TGs
↑LDL & TG: - Diuretics - Efavirenz - Steroids - Immunosuppressants [e.g. cyclosporine, tacrolimus] - Atypical antipsychotics - Protease inhibitors [e.g. darunavir, ritonavir] ↑LDL Only: - Fish oils [except Vascepa] ↑TG Only: - IV lipid emulsions - Propofol - Bile acid sequestrants [~5%] Conditions - Obesity, poor diet, hypothyroidism, alcoholism, smoking, diabetes, renal/liver disease, nephrotic syndrome
265
cholesterol classifications
non-HDL: <130 LDL: <100 - ≥190 very high HDL - men: ≥40 - women: ≥50 TG: <150 - ≥500 very high
266
how to determine statin trx
secondary prevention - clinical ASCVD: high-intensity primary prevention - LDL ≥190: high-intensity - ASCVD risk ÷20%: high - DM & age 40-75 w/ LDL 70-189 + multiple risk factors: moderate intensity - age 40-75 w/ LDL 70-189 + risk-enhancing factors: moderate-intensity
267
statin equivalent doses
Pitavastatin 2mg Rosuvastatin 5mg Atorvastatin 10mg Simvastatin 20mg Lovastatin 40mg Pravastatin 40mg Fluvastatin 80mg
268
max statin doses [DDIs]
- Cyclosporine, Cobicistat: Rosuvastatin 5mg/day max with cyclosporine only Atorvastatin 20mg/day max with cobicistat only - Amiodarone: Simvastatin 20mg/day Lovastatin 40mg/day - Diltiazem & Verapamil Simvastatin 10mg/day Lovastatin 20mg/day
269
normal BP
SBP <120 AND DBP <80
270
elevated BP
SBP 120-129 AND DBP <80
271
stage 1 HTN BP
SBP 130-139 OR DBP 80-89
272
stage 2 HTN BP
SBP ≥140 OR DBP ≥90
273
key drugs that increase BP
Amphetamines & ADHD drugs Cocaine Decongestants [e.g. pseudoephedrine, phenylephrine] Erythropoiesis-stimulating agents Immunosuppressants [e.g. cyclosporine] NSAIDs Systemic steroids
274
initial trx for HTN
ACE-I, ARBs, DHP-CCBs or thiazide diuretics
275
when to start trx for HTN
Stage 2 HTN [SBP ≥140mmHG or DBP ≥90mmHg] Stage 1 HTN [SBP 130-139 or DBP 80-89mmHg AND - Clinical CVD [stroke, HF or coronary heart disease] - 10-year ASCVD risk ≥10% - Doesn’t meet BP goal after 6 months of lifestyle modifications
276
beta-1 selective blockers
atenolol [Tenormin] esmolol [Brevibloc] metoprolol tartrate [Lopressor] metoprolol succinate [Toprol] acebutolol bisoprolol nebivolol [has nitric oxide-dependent vasodilation]
277
non-selective beta-blockers
propranolol [Inderal] nadolol [Corgard]
278
non-selective beta & alpha-1 blockers
carvedilol [Coreg] labetalol
279
key IV HTN drugs
Chlorothiazide Clevidipine Diltiazem Enalaprilat Esmolol Hydralazine Labetalol Metoprolol tartrate Nicardipine Nitroglycerin Nitroprusside Propranolol Verapamil
280
trx for stable ischemic heart disease
A - antiplatelet & antianginal drugs - aspirin - aspirin + clopidogrel [≥1 month for bare metal stent, ≥6 months for drug-eluting stent, 12 months for post-CABG] B - blood pressure & beta-blockers - beta-blockers 1st line - CCBs [pref for Prinzmetal] - nitrates - ranolazine C - cholesterol [statins] & cigarettes [cessation] D - diet & diabetes E - exercise & education
281
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
282
key drugs that can leave the seizure threshold
Bupropion Clozapine Theophylline Varenicline Carbapenems [esp imipenem]* Lithium* Meperidine* Penicillin* Quinolones* Tramadol* *high doses & renal impairment ↑risk
282
trx for ACS
MONA-GAP-BA Morphine Oxygen Nitrates Aspirin GPIIb/IIIa antagonists Anticoagulants P2Y12 inhibitors Beta-blockers ACE-Is NSTE-ACS: MONA
283
trx for ACS
MONA-GAP-BA Morphine Oxygen Nitrates Aspirin GPIIb/IIIa antagonists Anticoagulants P2Y12 inhibitors Beta-blockers ACE-Is NSTE-ACE: MONA-GAP-BA ± PCI STEMI: MONA-GAP-BA + PCI or fibrinolytic (PCI preferred)
284
secondary prevention for ACS
aspirin 81mg indefinitely P2Y12 inhibitor - medical therapy: ticagrelor or clopidogrel + aspirin 81mg for ≥12 months - PCI: any P2Y12-i + aspirin 81mg for ≥12 months NTG indefinitely beta-blocker for 3 years or indefinitely for HF/HTN ACE-I indefinitely if EF<40%, HTN, CKD or DM - consider for all MI pts with no CI aldosterone antagonist indefinitely if EF <40% & symptomatic HF or DM on target doses of ACE-I & beta-blocker statin indefinitely; high-intensity for most
285
ACC/AHA HF Stages
A: At risk for development of HF, but without symptoms of HF & without structural heart disease or elevated biomarkers - Ex: pts with HTN, ASCVD, or DM B: Pre-HF; structural heart disease, abnormal cardiac function or elevated biomarkers, but without signs or symptoms of HF - Ex: pts with LVH, low EF, valvular disease C: Structural and/or functional cardiac abnormality with prior or current symptoms of HF - Ex: pt with known structural heart disease [e.g. LVH] + SOB, fatigue & reduced exercise tolerance D: Advanced HF with severe symptoms, symptoms at rest or recurrent hospitalizations despite maximal treatment [refractory HF requiring specialized interventions]
286
NYHA HF Stages
I: No limitations of physical activity. Ordinary physical activity doesn’t cause symptoms of HF [e.g. fatigue, palpitations, dyspnea] II: Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity [i.e. walking up stairs] results in symptoms of HF III: Marked limitation of physical activity. Comfortable at rest but minimal exertion [e.g bathing, dressing] causes symptoms of HF IV: Unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest [e.g. SOB while sitting in a chair] I match with ACC/AHA stage B & C II & III match with ACC/AHA stage C IV match with ACC/AHA stage D
287
cardiac output equation
CO = HR * SV
288
cardiac index equation
CI = CO/BSA
289
drugs that worsen HF
⭐Drug Information NATION⭐ Dipeptidyl peptidase 4 inhibitors → alogliptin & saxagliptin Immunosuppressants → TNF-inhibitors [adalimumab & etanercept] & interferons Non-DHP CCBs → diltiazem & verapamil [in systolic HF] Antiarrhythmics - Class I agents [quinidine & flecainide] & dronedarone - Amiodarone & dofetilide are preferred in pts with HF Thiazolidinediones → rosiglitazone, pioglitazone → increase risk of edema Itraconazole Oncology drugs → anthracyclines [doxorubicin, daunorubicin] NSAIDs → all of them [even celecoxib]
290
trx for HF
primary: ARNI/ACE-I/ARB + beta-blocker + loop diuretic + SGLT2-i secondary: ARAs, BiDil, ivabradine [Corlanor] additional: digoxin, vericiguat
291
cardiac conduction pathway
SA node right & left atria AV node bundle of HIs right & left bundle branches purkinje fibers
292
cardiac action potential
phase 0: rapid ventricular depolarization -> influx of Na -> contraction phase 1: repolarization -> Na closes phase 2: plateau -> influx of Ca & efflux of K phase 3: rapid ventricular repolarization -> efflux of K -> relaxation phase 4: atrial depolarization -> resting potential
293
select drugs that can increase/prolong the QT interval
Antiarrhythmics - Class Ia, Ic & III Anti-infectives - Antimalarials → hydroxychloroquine - Azole antifungals → except isavuconazonium - Macrolides - Quinolones - Lefamulin Antidepressants - SSRIs → highest risk with citalopram & escitalopram - Tricyclic antidepressants - Mirtazapine, trazodone, venlafaxine Antiemetics - 5-HT3 receptor antagonists - Droperidol, metoclopramide, promethazine Antipsychotics - First generation → haloperidol, chlorpromazine, thioridazine - Second generation → highest risk with ziprasidone Oncology medications - Androgen deprivation therapy → leuprolide - Tyrosine kinase inhibitors → nilotinib - Oxaliplatin Other - Cilostazol, donepezil, fingolimod, hydroxyzine, loperamide, methadone, ranolazine, solifenacin, tacrolimus
294
class I antiarrhythmics
Ia: Disopyramide, Quinidine, Procainamide Ib: Lidocaine, Mexiletine Ic: Flecainide, Propafene
295
Class II antiarrhythmics
Beta-blockers
296
class III antiarrhythmics
Dronedarone, Dofetilide, Sotalol, Ibutilide, Amiodarone
297
class IV antiarrhythmics
Verapamil, Diltiazem
298
trx for arrhythmias [rate control]
- pt stays in AF & takes meds to control the HR - beta-blockers or non-DHP CCBs
299
trx for arrhythmias [rhythm control]
- goal to restore & maintain NSR - Class Ia, Ic, or III antiarrhythmic drugs or electrical cardioversion - amiodarone [PO & IV], dofetilide, flecainide, ibutilide & propafenone - maintenance of NSR: dofetilide, dronedarone, flecainide, propafenone or sotalol
300
amiodarone DDIs with digoxin, warfarin & statins
Decrease digoxin by 50% Decrease warfarin by 30-50% Do not exceed 20 mg/day of simvastatin or 40mg/day of lovastatin
301
meds for secondary prevention of ischemic stroke
antiplatetlet [noncardioemolic stroke or TIA] - aspirin 50-325mg QD - clopidogrel 75mg QD - aspirin/ER dipyradimole 25/200mg BID anticoagulants [cardioembolic stroke] - preferredL DOAC - alternative: warfarin antihypertensive - thiazides, ACE-I/ARB, and or DHP CCB - goal BP <130/80mmHg statin - atorvastatin 40-80mg QD - rosuvastatin 20-40mg QD
302
trx for intracerebral hemorrhage
- anticoagulant reversal - mannitol for osmotic diuresis
303
trx for acute subarachnoid hemorrhage
- PO nimodipine for preventing vasoprasm
304
microcyctic anemia
MCV <80 iron deficiency
305
macrocytic anemia
MCV >100 vitamin B12 or folate deficiency
306
normocytic anemia
MCV 80-100 acute blood loss, malignancy, CKD, bone marrow failure [aplastic anemia], hemolysis
307
labs with iron-deficiency anemia
↓Hgb, MCV <80 fL, ↓RBC production [low reticulocyte count] ↓serum iron, ferritin & TSAT [transferrin saturation] ↑TIBC [total iron binding capacity]
308
trx for iron-deficiency therapy
- 100-200mg elemental iron/day
309
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
310
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
311
% elemental ferrous
312
% elemental iron in ferrous gluconate
12%
313
% elemental iron in ferrous sulfate
20%
314
% elemental iron in ferrous sulfate, dried
30%
315
% elemental iron in ferrous fumarate
33%
316
% elemental iron in carbonyl iron, polysaccharide iron complex, ferric maltol
100%
317
trx of macrocytic anemia
vitB12 injection
318
trx of anemia of CKD
epotein or darbepoietin
319
trx of aplastic anemia
immunosuppressants, blood transfusions or stem cell transplant eltrombopag [Promacta]
320
select drugs that can cause hemolytic anemia
Cephalosporins Dapsone → must avoid Isoniazid Levodopa Methyldopa Methylene blue → must avoid Nitrofurantoin → must avoid Pegloticase → must avoid Penicillins Primaquine → must avoid Quinidine Quinine Rasburicase → must avoid Rifampin Sulfonamides [sulfa ABX] → must avoid
321
what abx is given as pnuemococcal ppx in young children with SCD
penicillin BID until age 5
322
trx for SCD
- hydroxyurea: main disease-modifying therapy that stimulates production of HgbF - L-glutamine [Endaril]: for ≥5 years - voxelotor [Oxybryta]: inhibits HgbS polymerization - crizanlizumab: mAb that reduces frequency of VOC - iron chelation therapy: deferasirox & deferiprone
323
sx of cold
Thick, dark mucus Sore throat Body aches Symptoms take ~3 days to appear & usually last for a week
324
sx of allergy
Thin, clear mucus Wheezing Red, watery eyes Symptoms can last for days or months after contact with allergens
325
trx for chronic, mod-severe allergic rhinitis
intranasal steroids: decrease inflammation
326
trx for mild/intermittent allergic rhinitis
antihistamines
327
trx for allergic rhinitis w/ congestion
decongestants: alpha-adrenergic agonists that cause vasoconstriction - phneylephrine - pseudoephrine
328
intranasal cromolyn
NasalCrom - OTC mast cell stabilizer - must use regularly, not PRN
329
indications of montelukast
allergic rhinitis & asthma
330
dextromethorphan
- cough suppressant - serotonin reuptake inhibitor - high doses = NMDA-receptor blocker -> euphoria & hallucinations
331
cough & cold product restrictions in children <18
avoid codeine & hydrocodone
332
cough & cold product restrictions in children <4
avoid OTC cough/cold products [package labeling]
333
cough & cold product restrictions in children <2
- avoid OTC cough/cold products [FDA] - avoid promethazine [FDA] - avoid topical menthol & camphor [package labeling]
334
AD
right ear
335
AS
left ear
336
AU
each ear
337
OD
right eye
338
OS
left eye
339
OU
each ear
340
how many mL in 1 drop
0.05 mL
341
trx for glaucoma
- decrease IOP!! - Reduce aqueous humor production [make less fluid] - Beta-blockers [timolol] - Carbonic anhydrase inhibitors [dorzolamide] - Increase aqueous humor outflow [move fluid out] - Prostaglandin analogs [latanoprost] - Both Alpha-2 agonists [brimonidine]
342
trx of conjunctivitis
self-limiting
343
drugs that cause retinopathy
Chloroquine Hydroxychloroquine
344
drugs that cause optic neuropathy
Amiodarone [plus corneal deposits] Ethambutol Linezolid
345
drugs that cause intraoperative floppy iris syndrome
Alpha-blockers [e.g. tamsulosin]
346
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
347
drugs that cause color discrimination
- Digoxin [with toxicity] → yellow/green vision - -PDE-5 inhibitors [e.g. sildenafil] → greenish tinge around objects - Voriconazole → color vision changes Vision loss/abnormal vision Digoxin [with toxicity] → blurriness, haloes PDE-5 inhibitors → vision loss [one or both eyes; can be permanent] Isotretinoin → decreases night vision [can be permanent], dryness, irritation Topiramate → visual field defects Vigabatrin → permanent vision loss [high risk] Voriconazole → abnormal vision, photophobia
348
drugs that cause color discrimination
- Digoxin [with toxicity] → yellow/green vision - -PDE-5 inhibitors [e.g. sildenafil] → greenish tinge around objects - Voriconazole → color vision changes
349
drugs that cause vision loss/abnormal vision
- Digoxin [with toxicity] → blurriness, haloes - PDE-5 inhibitors → vision loss [one or both eyes; can be permanent] - Isotretinoin → decreases night vision [can be permanent], dryness, irritation - Topiramate → visual field defects - Vigabatrin → permanent vision loss [high risk] - Voriconazole → abnormal vision, photophobia
350
trx of otitis externa
ciprofloxacin & dexamethasone [Ciprodex]
351
trx of ear wax [cerumen]
carbamide peroxide [Debrox]
352
drugs that can cause brown discoloration
Entacapone Levodopa Methyldopa
353
drugs that can cause brown/black/green discoloration
Iron [black stool] Methocarbamol Nitrofurantoin Metronidazole Tinidazole Riboflavin [B2] Chlorzoxazone Sulfasalazine Propofol Flutamide Phenazopyridine Rifampin Rifapentine Anthracyclines Deferasirox [urine] Methylene blue Mitoxantrone Amiodarone Chloroquine
353
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
354
drugs that can cause brown/black/green discoloration
Iron [black stool] Methocarbamol
355
drugs that can cause brown/yellow discoloration
Nitrofurantoin Metronidazole Tinidazole Riboflavin [B2]
356
drugs that can cause purple/orange/red discoloration
Chlorzoxazone
357
drugs that can cause orange/yellow discoloration
Sulfasalazine
358
drugs that can cause yellow-green discoloration
Propofol Flutamide
359
drugs that can cause red-orange discoloration
Phenazopyridine Rifampin Rifapentine
360
drugs that can cause red discoloration
Anthracyclines Deferasirox [urine]
361
drugs that can cause blue discoloration
Methylene blue Mitoxantrone
362
drugs that can cause blue-gray discoloration
Amiodarone Chloroquine
363
trx of acne
OTC benzoyl peroxide and salicylic acid, retinoids, topical or systemic ABXs & systemic isotretinoin
364
trx for onychomycosis
itraconazole & terbinafine
365
trx for pinworms
Anthelmintics: mebendazole, pyrantel pamoate, albendazole
366
trx for scabies
5% permethrin cream [Elimite]
367
trx for lice
1% permethrin cream [Nix]
368
trx for head lice
topical ivermectin [Sklice]
369
highest to lowest potency of topical steroids
ointment cream lotion solution gel spray
370
which topical steroids are OTC
hydrocortisone 0.5% cream hydrocortisone 1% cream [Cortaid, Cortisone, Cortizone-10]
371
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
371
key drugs that cause PAH
372
key drugs that cause PAH
Cocaine SSRI use during pregnancy INCREASES risk of persistent HTN of a new born [PPHN] Weight-loss drugs [diethylpropion, phendimetrazine, phentermine] Methamphetamines/Amphetamines
373
vasodilator substances
endotheline-1 & thromboxane 2 [TXA2]
374
vasodilator substances
prostacyclin
375
which drugs are used for vasoreactivity testing in PAH
Short-acting vasodilators [inhaled nitric oxide, IV epoprostenol or IV adenosine]
376
trx for PAH responders
PO CCB: long-acting nifedipine, diltiazem & amlodipine
377
trx for PAH non-responders
Prostacyclin analogues and receptor agonists, endothelin receptor antagonists [ERAs], phosphodiesterase-5 [PDE-5] inhibitors, and/or soluble guanylate cyclase [sGC] stimulator
378
prostacyclin analogues & receptor agonists
- potent vasodilators & inhibit platelet aggregation - selexipag [Uptravi] - epoprostenol & treprostinil: continuous IV infusion at home
379
endothelin receptor antagonists
- vasoconstrictor with cellular proliferative effects - bosentan - ambrisentan - macitenten
380
PDE-5 inhibitors for PAH
- tadalafil
381
soluble guanylate cyclase stimulator
- riociguat [Adempas]: sensitizes sGC to endogenous NO & directly stimulates receptor at diff binding sites
382
trx for pulmonary fibrosis
pirfenidone [Esbriet] & nintedanib [Ofev]
383
key drugs that cause pulmonary fibrosis
Amiodarone/dronedarone Bleomycin Busulfan Carmustine Lomustine
384
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
385
SABAs for asthma
386
rescue drugs for asthma
- low dose ICS + formoterol - SABA - systemic steroids - inhaled epinephrine - SAMAs
387
maintenance drugs for asthma
- ICS - LABAs - LTRAs - theophylline - LAMAs - mAbs
388
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
388
SABAs for asthma
Albuterol [ProAir HFA, ProAir RespiClick (DPI), Proventil HFA, Ventolin HFA, levalbuterol [Xopenex] epinephrine [Asthmanefrin]
389
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
390
albuterol
ProAir, Proventil, Ventolin
391
dose of albuterol
- 90 mcg/inh - 1-2 inhalations Q4-6 PRN
392
LABAs for asthma
salmeterol [Serevent DIskus]
393
salmeterol
Serevent DIskus
394
ICSs for asthma
beclomethasone [QVAR RediHaler] budesonide [Pulmicort] budesonide + formoterol [Symbicort] fluticasone [Flovent HFA, Flovent Diskus, Arnuity Ellipta] fluticasone + salmeterol [Advair] fluticasone + vilanterol [Breo Ellipta] mometrasone [Asmanex] mometasone + formoterol [Dulura] ciclesonide [Alvesco]
395
Leukotriene modifying agents
montelukast [Singulair]
396
montelukast
singulair - BBW: neuropsychiatric events
397
beclomethasone
QVAR RediHaler
398
budesonide
pulmicort flexhaler [DPI] pulmicort respules [nebulizer]
399
budesonide + formoterol
Symbicort [MDI]
400
fluticasone
flovent HFA [MDI] flovent diskus [DPI] arnuity ellipta [DPI]
401
fluticasone + salmeterol
Advair Diskus, Advair HFA
402
fluticasone + vilanterol
Breo Ellipta
403
mometasone + formoterol
Dulera
404
therapeutic range for theophylline
5-15 mcg/mL
405
omalizumab
Xolair - must give in healthcare setting w/ medical supervision
406
tiotropium
Spiriva Respimat [asthma & COPD] Spiriva HandiHaler [COPD]
407
MDI characteristics
- HFA, Respimat or no suffix - liquid - propellant - can use spacer - shake except for QVAR Redihaler, Alvesco & Respimat products - prime
408
which MDIs do you NOT shake?
QVAR Redihaler, Alvesco & Respimat products
409
DPI characteristics
- Diskus, Ellipta, Pressair, HandiHaler, RespiClick, Flexhaler - powder - quick, forceful inhalation - don't shake - can't use spacer - no priming
410
MOA of leukotriene modifying agents
- reduce airway edema, constriction & inflammation - Zileuton inhibits leukotriene formation - montelukast inhibits leukotriene D4
411
MOA of theophylline
blocks PDE
412
IL-5 receptor antagonists for asthma
mepolizumab reslizumab benralizumab
413
ILE-4 & IL-3 receptor antagonist for asthma
dupilumab
414
COPD assessment
A: CAT <10, mMRC 0-1 & 0 or 1 exacerbation not leading to hospitalization B: CAT ≥10, mMRC ≥2 & 0 or 1 exacerbation not leading to hospitalization C: CAT <10, mMRC 0-1 & ≥2 or ≥1 exacerbation leading to hospitalization D: CAT ≥10, mMRC ≥2 & ≥2 or ≥1 exacerbation leading to hospitalization
415
COPD trx
A: bronchodilator: SABA prn, SAMA prn, LABA or LAMA B: LAMA or LABA C: LAMA D: LAMA or LAMA + LABA [if highly symptomatic] or LABA + ICS [if eosinophils ≥300 cells/uL]
416
albuterol/ipratropium
Combivent Respimat
417
olodaterol
Striverdi Respimat
418
olodaterol/tiotropium
Stiolto Respimat
419
tioptropium
Spiriva Respimat Spiriva Handihaler
420
acidinium
Turdoza Pressair
421
fluticasone/vilanterol
Breo Ellipta
422
umeclidinium
Incruse Ellipta
423
umeclidinium/vilanterol
Anoro Ellipta
424
umeclidinium/vilanterol/fluticasone
Trelegy Ellipta
425
trx for smoking cessation
- NRT - bupropion: blocks reuptake of DA and/or NE - varenicline: partial nicotinic receptor agonist
426
conversion of A1c to eAG
A1C of 6% = eAG of 126 mg/dL → each addition 1% increase = ~28 mg/dL
427
metformin
- Glucophage, Fortamet, Glumetza - ↓hepatic glucose production, ↑insulin sensitivity & ↓intestinal absorption of glucose
428
SGLT2 inhbitors
- Canagliflozin [Invokana] - Dapagliflozin [Farxiga] - Empagliflozin [Jardiance] - Ertugliflozin [Steglatra] - in proximal renal tubules to reduce reabsorption of glucose & increase urinary glucose excretion
429
GLP-1 agonists
- Liraglutide [Victoza, Saxenda (for weight loss) - Dulaglutide [Trulicity] - Exenatide [Byetta] - Exenatide ER [Bydureon, Bydureon BCise] - Lixisenatide [Adlyxin] - Semaglutide [Ozempic (SC), Rybelsus (PO), Wegovy (for weight loss)] - ↑glucose-dependent insulin secretion, ↓glucagon secretion, slows gastric emptying, improves satiety & can result in weight loss
430
liraglutide
victoza saxenda for weight loss
431
dulaglutide
trulicity
432
exenatide
byetta
433
exenatide ER
bydureon, bydureon BCise
434
lixisenatide
adlyxin
435
semaglutide
ozempic SC rybelsus PO wegovy for weight loss
436
sulfonylureas
- Glipizide [Glucotrol], Glimepiride [Amaryl], Glyburide [Glynase] - stimulate insulin secretion from pancreatic beta-cells to decrease postprandial BG
437
meglitinides
- Repaglinide, Nateglinide [Starlix] - stimulate insulin secretion from pancreatic beta-cells to decrease postprandial BG
438
glipizide
glucotrol
439
glimepiride
amaryl
440
glyburide
glynase
441
DPP4 inhibitors
- Sitagliptin [Januvia], Linagliptin [Tradjenta], Saxagliptin [Onglyza], Alogliptin [Nesina] - prevent DPP-4 from breaking down incretin hormones GLP-1 & GIP
442
sitagliptin
januvia
443
linagliptin
tradjenta
444
saxagliptin
onglyza
445
alogliptin
nesina
446
thiazolidinediones
- Pioglitazone [Actos], Rosiglitazone [Avandia] - PPARγ]agonists that ↑peripheral insulin sensitivity [↑uptake & utilization of glucose by peripheral tissues (insulin sensitizers)
447
pioglitazone
Actos
448
rosiglitazone
avandia
449
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
450
acarbose
prec
451
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
452
alpha glucosidase inhibitors
prec
453
alpha glucosidase inhibitors
Acarbose [Precose] & Miglitol [Glyset]
454
bile acid binding resins
Colesevelam [Welchol]
455
dopamine agonist
Bromocriptine [Cycloset]
456
amylin analog
Pramlintide [Symlin] - risk for severe hypoglycemia
457
actoplus met
metformin/pioglitazone
458
janumet
metformin/sitagliptin
459
invokamet
metformin/canagliflozin
460
basal insulin
glargine [Lantus, Toujeo], determir [Levemir] & ultra-long acting degludec [Tresiba]
461
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
462
insulin glargine
glargine [Lantus, Toujeo], determir [Levemir] & ultra-long acting degludec [Tresiba]
463
insulin glargine
Lantus, Toujeo
464
insulin detemir
Levemir
465
insulin degludec
Tresiba
466
intermediate-acting insulin
Insulin NPH [Humulin N, Novolin N]
467
insulin NPH
humulin N, novolin N
468
rapid-acting insulin
aspart [Novolog], lispro [Humalog] & glulisine [Apidra]
469
insulin aspart
Novolog
470
insulin lispro
Humalog
471
insulin glulisine
Apidra
472
short-acting insulin
regular insulin U-100 [Humulin R, Novolin R]
473
regular insulin U-100
Humulin R, Novolin R
474
starting TDD for insulin
0.5 units/kg/day
475
room temp stability of humalog mix 50/50 & 75/25
10 days
476
room temp stability of humulin 70/30
10 days
477
room temp stability of humulin N
14 days
478
room temp stability of novolog mix 70/30 pens
14 days
479
room temp stability of Apidra, Humalog, Novolog, Admelog, Lyumjev, Fiasp vials & pens
28 days
480
room temp stability of Humalog Mix 50/50 & 75/25 vials
28 days
481
room temp stability of Novolog Mix 70/30 vial
28 days
482
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
483
room temp stability of Novolog Mix 70/30 vial Novolin R U-100, N & 70/30 pens Humulin R U-500 pen Lantus, Basaglar, Semglee vials & pens Humulin R U-100, N & 70/30 vials
484
room temp stability of Novolin R U-100, N & 70/30 pens
28 days
485
room temp stability of Humulin R U-500 pen
28 days
486
room temp stability of Lantus, Basaglar, Semglee vials & pens
28 days
487
room temp stability of Humulin R U-100, N & 70/30 vials
31 days
488
room temp stability of Humulin R U-500 vial
40 days
489
room temp stability of Novolin R U-100, N and 70/30 vials
42 days
490
room temp stability of Levemir vial & pen
42 days
491
room temp stability of Tresiba pen
56 days
492
room temp stability of Toujeo pen
56 days
493
key drugs that increase BG
Beta-Blockers* Thiazide & loop diuretics Tacrolimus, Cyclosporine Protease Inhibitors Quinolones* Antipsychotics [e.g. olanzapine, quetiapine] Statins Steroids [systemic] Cough syrups Niacin
494
key drugs that decrease BG
Beta-Blockers Quinolones Tramadol
495
trx for DKA
IV fluids [normal saline to start] IV regular insulin infusion Monitor potassium & pH, treat if necessary
496
labs in HYPOthyroidism
deficiency in T4 & elevation in TSH
497
key drugs that cause HYPOthyroidism
I TALC Interferons [can also cause hyper] Tyrosine kinase inhibitors [i.e. sunitinib] Amiodarone [can also cause hyper] Lithium Carbamazepine Conditions: Hashimoto’s
498
levothyroxine tab colors
Orangutans Will Vomit On You Right Before They Become Large, Proud Giants 25 mcg - orange 50 mcg - white [no dye] 75 mcg - violet 88 mcg - olive 100 mcg - yellow 112 mcg - rose 125 mcg - brown 137 mcg - turquoise 150 mcg - blue 175 mcg - lilac 200 mcg - pink 300 mcg - green
499
labs in HYPERthyroidism
high FT4 & low TSH
500
trx for hyperthyroidism
- propylthiouracil - methimazole - beta-blockers for symptom control
501
trx for thyroid storm
- antithyroid: PTU pref - inorganic iodide therapy: SSKI or Lugol's solution - beta-blockers: propranolol - systemic steroids: dexamethasone - cooling!!!
502
trx of hyperthyroid is pregnancy
T1: PTY T2-T3: either one, usually methimazole
503
cushing vs addison
cushing = too much cortisol addison = too little cortisol
504
doses of steroid immunosuppression
≥2mg/kg/day or ≥20mg/day of prednisone or equivalent for >2 weeks
505
trx of RA
- DMARDs - MTX pref for initial therapy - mod-high: combo of DMARDs or TNF-inhibitor biologic or non-TNF biologic
506
key drugs that cause DILE
My Pretty Malar Marking Probably Has A Transient Quality Methimazole Propylthiouracil Methyldopa Minocycline Procainamide Hydralazine Anti-TNF agents Terbinafine Isoniazid Quinidine
507
trx for SLE
Hydroxychloroquine, cyclophosphamide, azathioprine, mycophenolate mofetil & cyclosporine → may take up to 6 months
508
trx for MS
- relapsing MS: Interferon beta formulations [Betaseron, Avonex, Rebif, Extavia, Plegridy] & glatiramer acetate [Copaxone, Glatopa]
509
how often is Plegridy dosed
14 days
510
trx for Raynaud
nifedipine for ppx
511
trx for myasthenia gravis
- cholinesterase inhibitors → pyridostigmine [Mestinon] - immunosuppressants - Efgartigimod alfa [Vyvgart]: if antiacethylcholine receptor antibody positive
512
types of estrogen in PO contraceptives
ethinyl estradiol
513
types of progestin in PO contraceptives
norethinedrone, levonorgestrel, drospirenone
514
other indications for COCs
dysmenorrhea [menstrual cramps], premenstrual syndrome [PMS], acne, anemia, PCOS, endometriosis
515
SEs of estrogen
nausea, breast tenderness, bloating, weight gain, increased BP
516
SEs of progestin
breast tenderness, HA, fatigue & depression - drospirenone has higher risk of clotting
517
plan B one-step
levonorgestrel
518
ella
ulipristal acetate
519
ca & vit D requirements/day
1000mg/day of calcium & 15mcg/day [600IU/day] of vit D
520
teratogens
Acne - Isotretinoin, topical retinoids Antibiotics - Quinolones, tetracyclines Anticoagulants - Warfarin Dyslipidemia, Heart Failure & HTN - Statins, RAAS inhibitors [ACE-Is, ARBs, aliskiren, sacubitril/valsartan] Hormones - Most, including estradiol, progesterone [including megestrol], raloxifene, Duavee, testosterone, contraceptives Migraine - Dihydroergotamine, ergotamine Other important teratogens - Hydroxyurea, lithium, methotrexate, misoprostol, NSAIDs, paroxetine, ribavirin, thalidomide, topiramate, weight loss drugs, valproic acid/divalproex
521
key drugs to avoid in lactation
amphetamines, amiodarone, ergotamines, lithium, metronidazole, phenobarbital & statins!!!!
522
lab for osteoporosis
T-score ≤-2.5
523
trx for osteoporosis
- bisphosphonates: 1st line - denosumab [Prolia] - teriparatide [Forteo], abaloparatide [Tymlos] - raloxifene [Evista], bazedoxifene/estrogens [Duavee] - last line: estrogen & calcitonin
524
trx duration for parathyroid hormones
2 years or less
525
trx for menopause
local hormone therapy: - 17-Beta-Estradiol → cream [Estrace], ring [Estring], tab [Vagifem] - Conjugated Equine Estrogen → cream [Premarin] systemic hormone therapy: - Estradiol → patch [Alora, Climara, Vivelle-Dot] - Conjugated Equine Estrogen → tab [Premarin], inj [Premarin] - Medroxyprogesterone →tab [Premarin], inj [Premarin] - Micronized progesterone → tabs [Prometrium]
526
brisdelle
paroxtine for mod-severe vasomotor symptoms associated with menopause
527
osphena
ospemifene - estrogen agonist/antagonist indicated for dyspareunia
528
key drugs that can cause erectile/sexual dysfunction
Alcohol Antidepressants [esp SSRIs & SNRIs (including ↓libido)] Antihypertensives [beta-blockers, clonidine, thiazides] Antipsychotics [first-gen (chlorpromazine) & prolactin-raising second-gen (risperidone, paliperidone)] BPH meds [finasteride, dutasteride & silodosin (mostly retrograde ejaculation)]
529
trx for ED
PDE-5 inhibitors - sildenafil [viagra] - vardenafil [levitra] - tadalafil [cialis] - avanafil [stendra] prostaglandin E1 - alprostadil
530
which PDE5-i is also for BPH
tadalafil [cialis]
531
which PDE5-i is also for PAH
sildenafil [Revatio] tadalafil [Advirca]
532
rx for hypoactive sexual desire disorder
- flibanserin - bremelanotide
533
drugs that can worsen BPH
Centrally-acting anticholinergics [e.g. benztropine] Drugs with anticholinergic effects: Antihistamines [e.g. diphenhydramine] Decongestants [e.g. pseudoephedrine] Phenothiazines [e.g. prochlorperazine] TCAs [e.g. amitriptyline] Caffeine Diuretics SNRIs Testosterone products
534
trx for BPH
alpha-blockers - Non-selective: doxazosin [Cardura], terazosin - Selective: tamsulosin [Flomax], alfuzosin [Uroxatral], silodosin [Rapaflo] 5 alpha-reductase inhibitors: - Finasteride [Proscar, Propecia for alopecia (lower doses)], dutasteride [Avodart] peripherally-acting anticholingerics - tolterodine beta-3 receptor agonists - mirabegron PDE5-i +/- finasteride - tadalafil
535
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
536
trx for urge incontinence/mixed incontinence
first-line: - anticholinergics [oxybutynin] - beta-3 receptor agonist [mirabegron]
537
trx for urge incontinence/mixed incontinence
first-line: - anticholinergics [oxybutynin] - beta-3 receptor agonist [mirabegron] - onabotulinumtoxinA [Botox] has higher efficacy but isn’t first-line last-line: - nerve stimulation or surgical interventions
538
trx for stress incontinence
no FDA-approved meds - pseudoephedrine for adrenaline effects --> tachycardia, palpitations - duloxetine for incontinence/depression
539
anticholinergic side effects
peripheral: - Dry mouth - Dry eyes/blurred vision - Urinary retention - Constipation - Tachycardia central: - Sedation - Dizziness - Cognitive impairment
540
morphine conversion to fentanyl
Morphine 60mg TDD = 25mcg/hr fentanyl patch
541
which opioid shouldnt be taken with food
oxymorphoe
542
trx for OIC
- stimulant laxatives - PAMORAs: methylnaltrexone [Relistor], naloxegol [Movantik], naldemedine [Symproic] - Chloride channel activator: Lubiprostone [Amitiza]
543
MOA of centrally-acting analgesics
- tramadol & tapentadol - mu-opioid receptor agonists & inhibitors of norepinephrine reuptake
544
opioid abuse agents
- buprenorphine - naloxone - naltrexone - Naloxone [Narcan], Buprenorphine [Suboxone (with naloxone SL film), Zubsolv (with naloxone SL tabs)], lofexidine [Lucemyra]
545
adjuvants for pain management
- neuropathy: AEDs [pregabalin, gabapentin, CBZ], TCAs [amitriptyline, desipramine] & SNRIs [milnacipran, duloxetine] - musculoskeletal pain: - Antispasmodics with analgesic effects: baclofen [Lioresal], cyclobenzaprine [Amrix, Fexmid, Flexeril], tizanidine [Zanaflex] - Antispasmodics with sedative effects: carisoprodol [Soma], metaxalone [Skelaxin], methocarbamol [Robaxin]
546
maxalt
rizatriptan
547
imitrex, onzetra xsall
sumatriptan
548
zomig
zolmitriptan
549
trx for migraines
- triptans - ergotamine
550
fioricet
APAP/butalbital/caffeine [Fioricet]
551
fiorinal
aspirin/butalbital/caffeine [Fiorinal] + codeine = C-III
552
ppx for migraines
- beta-blockers [propranolol (Inderal), metoprolol tartrate (Lopressor), metoprolol succinate (Toprol XL), timolol] - antiepileptics [divalproex (Depakote), topiramate (Topamax)] - CGRP receptor antagonists - rimegepant [Nurtec ODT]
553
key drugs that increase uric acid
Aspirin [lower doses] Calcineurin inhibitors [tacrolimus & cyclosporine] Diuretics [loops & thiazides] Niacin Pyrazinamide Select chemotherapy [with tumor lysis syndrome] Select pancreatic enzyme products
554
trx for gout
Treat acute pain with anti-inflammatory drugs - Colchicine - Steroids [including intra-articular injections] - NSAIDs [often with high starting dose] Treat chronically to prevent future attacks - Xanthine oxidase inhibitor [XOI]: allopurinol [preferred] or febuxostat - Acute gout flare can occur so give initially with colchicine If XOI didn’t work well enough & UA still >6mg/dL - Add on probenecid or lesinurad to daily XOI - Replace XOI with IV pegloticase [Krystexxa]
555
trx for acute gout attack
NSAID [i.e. indomethacin, naproxen, sulindac & celecoxib], steroid [prednisone/prednisolone, methylprednisolone] or colchicine
556
ppx for gout attack
- colchicine, steroids or NSAIDs for ppx to reduce risk of attacks - xanthine oxidase inhibitors: allopurinol & febuxostat - uricosurics: probenecid & lisinurad
557
key drugs that can worse GERD
Aspirin/NSAIDs Bisphosphonates Dabigatran Estrogen products Fish oil products Iron supplements Nicotine replacement therapy Steroids Tetracyclines
558
trx for GERD
initial: - PPI x8 weeks maintenance: - PPI at lowest effective dose
559
key drugs that need acidic gut
Antiretrovirals: rilpirvirine [NNRTI], atazanavir [PI] Antivirals: ledipasvir, velpatasvir/sofosbuvir Azole antifunagls: Sporanox [itraconazole capsules], ketoconazole, posaconazole oral suspension Cephalosporins [oral]: cefpodoxime, cefuroxime Iron products Mesalamine Risedronate DR Tyrosine kinase inhibitors: dasatinib, erlotinib, pazopanib
560
medical conditions that can cause constipation
Irritable bowel syndrome [constipation predominant] Anal disorders [fissures, fistulae, rectal prolapse] Multiple sclerosis Cerebrovascular events Parkinson disease Spinal cord tumors Diabetes Hypothyroidism
561
key drugs that can cause constipation
Antacids [aluminum & calcium containing] Antidiarrheals Clonidine Colesevelam Drugs w/ anticholinergic effects: AHs [diphenhydramine], antispasmodics [baclofen], phenothiazines [prochlorperazine], TCAs [amitriptyline], urge incontinence [oxybutynin] Iron non-DHP CCBs [esp verapamil] Opioids Sucralfate [contains aluminum complex]
562
trx for constipation
- bulk-forming: first-line - osmotics - stimulants: - stool softeners - lubricants - calcium channel activator: lubiprostone [Amitiza] - guanylate cyclase C agonists: linaclotide, plecanatide [Trulance] - PAMORAs: alvimopan [Entereg], methylnaltrexone [Relistor], naloxegol [Movantik]
563
bulk-forming laxatives
Psyllium [Metamucil], calcium polycarbophil [FiberCon], methylcellulose [Citrucel], wheat dextrin [Benefiber]
564
osmotic laxatives
Magnesium hydroxide [Milk of Magnesia], polyethylene glycol 3350 [MiraLax], glycerin [Fleet Liquid, Pedia-Lax, Glycerin Supp], lactulose [Constulose, Enulose], sodium phosphates [Fleet Enema], lactitol [Pizensy], sorbitol
565
stimulant laxatives
Senna [Ex-Lax, Senokot], senna + docusate [Senna S, Senokot S], bisacodyl [Dulcolax (supp)]
566
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
567
stool softeners
docusate
568
stool softeners
Docusate sodium [Colace], docusate + senna [Senna S, Senokot S]
569
lubricant laxatives
mineral oil
570
lubricant laxatives
mineral oil
571
induction trx for CD
Steroids [± thiopurine or methotrexate] Anti-TNF ± thiopurine Ustekinumab [Stelara]
572
maintenance trx for CD
Mild disease of the ileum and/or right colon: - Oral budesonide for ≤3 months; after this course, d/c trx or change to thiopurine or methotrexate Moderate-Severe disease: - anti-TNF agents - Adalimumab [Humira] - Infliximab [Remicade] - Certolizumab [Cimzia] - Thiopurine [azathioprine, mercaptopurine] - Methotrexate - IL-receptor antagonist - Ustekinumab [Stelara] Refractory to above treatments and/or steroid-dependent: - Integrin receptor antagonists - Vedolizumab [Entyvio] - Natalizumab [Tysabri]
573
induction trx for UC
Aminosalicylates/5-ASA [oral and/or rectal] ± steroids [oral or rectal] Anti-TNF agents Ustekinumab [Stelara] Tofacitinib [Xeljanz] Vedolizumab [Entyvio] IV cyclosporine
574
maintenance trx for UC
Mild disease: - Mesalamine [5-ASA] rectal and/or oral preferred Moderate-Severe disease: - anti-TNF agents - Adalimumab [Humira] - Infliximab [Remicade] - Golimumab [Simponi] - Thiopurine [azathioprine, mercaptopurine] - Cyclosporine - IL-receptor antagonist - Ustekinumab [Stelara] - Janus kinase inhibitor - Tofacitinib [Xeljanz] → not first-line Refractory to above treatments and/or steroid-dependent: - Integrin receptor antagonists - Vedolizumab [Entyvio]
575
steroids for IBD
PO steroids: prednisone [Deltasone tab], budesonide [Entocort EC for CD, Uceris for UC] Rectal steroids: hydrocortisone, budesonide
576
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
577
aminosalicylates
Mesalamine ER [Pentase (cap), Asocol HD (tab), Rowasa (enema), Canasa (supp)], FOR UC
578
dramamine vs dramamine all day less drowsy
dramamine = dimenhydrinate dramamine all day less drowsy = dramamine all day less drowsy
579
5 Gs
garlic, gingko, ginseng, glucosamine, ginger
580
PGX tests
Abacavir and any combination products containing abacavir [HLA-B*5701] Azathioprine [TMPT] Carbamazepine [HLA-B*1502] Cetuximab and other EGFR inhibitors [KRAS] Trastuzumab and other HER2 inhibitors [HER2] Allopurinol [HLA-B*5801] Capecitabine & fluorouracil [DPD] Clopidogrel [CYP2C19] Codeine [CYP2D6] Phenytoin & fosphenytoin Warfarin [CYP2C9*2, CYP2c9*3, VKORC1]
581
key drugs that cause photosensitivity
Amiodarone Diuretics [thiazide & loops] Methotrexate PO & topical retinoids Quinolones St. John’s Wort Sulfa ABXs Tacrolimus Tetracyclines Voriconazole
582
key drugs that cause TTP
PO P2Y12 inhibitors Sulfamethoxazole
583
key drugs that cause severe skin reactions
Abacavir Allopurinol Carbamazepine Ethosuximide Lamotrigine Modafinil Nevirapine Penicillins Phenytoin Sulfamethoxazole
584
BUD for non-sterile compounded products
nonaqueous = 6 month water-containing PO = 14 days in fridge water-containing topical = 30 days
585
low risk CSP
1-3 sterile components
586
medium risk CSP
>3 sterile components
587
high risk CSP
non-sterile products & then sterilize at the end
588
room temp BUD for low risk CSP
48 hours
589
room temp BUD for med risk CSP
30 hours
590
room temp BUD for high risk CSP
24 hours
591
fridge BUD for low risk CSP
14 days
592
fridge BUD for med risk CSP
9 days
593
fridge BUD for high risk CSP
3 days
594
low HLB = ?
more lipid soluble
595
high HLB = ?
more water-soluble
596
primary engineering control
sterile hood for compounding has ISO 5 air
597
laminar airflow workbench
type of PEC where parallel air streams flow in 1 direction
598
containing primary engineering control
ventilated chemo hood [w/ negative pressure] for HDs
599
biological safety cabinet
type of C-PEC - chemo hood [class II or III for sterile HD]
600
secondary engineering control
ISO 7 buffer room where the sterile hood [PEC] is room where we go in to compound
601
containment secondary engineering control
ventilated buffer room w/ negative pressure for HDs - that smol room for chemo
602
segregated compounding area
designated space with ISO 5 hood but not part of cleanroom suite
603
containing segreated compounding area
same as regular one but for HDs & has negative pressure
604
compounding aseptic isolator
glovebox for NON-HDs
605
compounding aseptic containment isolator
glovebox for HDs
606
restricted access barrier system
glovebox/closed-front sterile hood
607
closed system transfer device
prevents escape of HD/vapors
608
containment ventilated enclosure
ventilated "powder hodo" for non-sterile products
609
fridge temp
2-8C
610
freezer temp with CSP
-25 to -10 C
611
freezer temp wth vaccines
-50 to -15 C
612
muscarinic agonist
pilocarpine bethanechol
613
muscarinic antag
atropine oxybutynin
614
nicotinic agonist
nicotine
615
nictonic antag
neuromuscular blockers [rocuronium]
616
alpha-1 [peripheral] agonist
phenylephrine dopamine [dose dependent]
617
alpha-1 [peripheral] antag
alpha-1 blockers: doxazosin, carvedilol, phentolamine
618
alpha-2 [brain, central] agonist
clonidine, brimonidine [opthalmic for glaucoma]
619
alpha-2 [brain, central] antag
ergot alkaloids, yohimbine
620
beta-1 [heart] agonist
dobutamine isopreoterenol dopamine [dose-dependent]
621
beta-1 [heart] antag
beta-1 selective blockers [meto] & non-selective beta-blockers [propra, carve]
622
beta-2 [lungs] agonist
albuterol terbutaline isoproterenol
623
beta-2 [lungs] antag
non-selective beta-blockers [propra, carve]
624
dopamine agonist
levodopa pramipexole
625
dopamine antag
1st gen APs [haloperidol, metoclopramide]
626
serotonin agonist
triptans
627
serotonin antag
zofran, 2nd gen APs
628
CYP INHIBITORS
G♥PACMAN Grapefruit ♥ Protease inhibitors, esp ritonavir Azole antifungals [flu, itra, keto, posa, vori, isavu] Cyclosporine, cobicistat Macrolides [not azithro] Amiodarone [and dronedarone] Non-DHP CCBs
629
CYP INDUCERS
PS PORCS Phenytoin Smoking Phenobarbital Oxcarbazepine Rifampin [and rifabutin, rifapentine] Carbamazepine [also auto-inducer] St. John’s wort
630
PGP SUBSTRATES
- Anticoagulants [apixaban, edoxaban, dabigatran, rivaroxaban] - Cardiovascular drugs [digoxin, diltiazem, carvedilol, ranolazine, verapamil] - Immunosuppressants [cyclosporine, sirolimus, tacrolimus] - HCV drugs [dasabuvir, ombitasvir, paritaprevir, sofosbuvir] - Others [atazanavir, colchicine, dolutegravir, posaconazole, raltegravir, saxagliptin]
631
PGP INDUCERS
Carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampin, St. John’s wort, tipranavir
632
PGP INHIBITORS
Carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampin, St. John’s wort, tipranavir
633
CBZ therapeutic range
4-12 mcg/mL
634
digoxin therapeutic range for AFIB
0.8-2 ng/mL
635
digoxin therapeutic range for HF
0.5-0.9 ng/mL
636
gentamicin therapeutic range
Peak: 5-10 mcg/mL Trough: <2 mcg/mL
637
lithium therapeutic range
0.6-1.2 mEq/L [up to 15 mEq/L for acute symptoms], drawn as a trough
638
phenytoin/fosphenytoin therapeutic levels
10-20 mcg/mL; if albumin is low, calculate a corrected level
639
free phenytoin therapeutic level
1-2.5 mcg/mL
640
procainamide therapeutic level
4-10 mcg/mL
641
NAPA [procainamide active metabolite] therapeutic level
15-25 mcg/mL
642
procainamide + NAPA combined therapeutic level
10-30 mcg/mL
643
tobramycin [traditional dosing] therapeutic range
Peak: 5-10 mcg/mL Trough: <2 mcg/mL
644
valproic acid therapeutic level
50-100 mcg/mL [up to 150 mcg/mL in some patients]
645
vancomycin therapeutic level
Trough: 15-20 mcg/mL for most serious ifx [pneumonia, endocarditis, osteomyelitis, meningitis & bacteremia] Trough: 10-15 mcg/mL for others
646
warfarin therapeutic level
Goal INR is 2-3 for most indications, use higher range [2.5-3.5] for high-risk conditions, such as mechanical mitral valves
647
key drugs with leaching issues
Leach Absorbs To Take In Nutrients Lorazepam Amiodarone Tacrolimus Taxanes [most require non-PVC, exception is Paclitaxel-albumin bound] Insulin Nitroglycerin
648
key drugs only diluted in saline
SALINE [No Dextrose] → A DIAbetic Can’t Eat Pie Ampicillin Daptomycin [Cubicin] Infliximab [Remicade] Ampicillin/Sulbactam [Unasyn] Caspofungin [Cancidas] Ertapenem [Invanz] Phenytoin [Dilantin]
649
key drugs only diluted in dextrose
DEXTROSE [No Saline] → Outrageous Bakes Avoid Salt Oxaliplatin Bactrim [SMX/TMP] Amphotericin B [all] Synercid [Quinupristin/Dalfopristin]
650
key drugs with filter requirements
That’s my GAL PLAT [who’s head is flat] Golimumab [Simponi] Amiodarone Lorazepam* [continuous filtration only] Phenytoin* [continuous filtration only] Lipids → 1-2 micron** Amphotericin B [lipid formulations] Taxanes, except docetaxel *phenytoin & lorazepam need filters when given by continuous filtration; not needed for IV push **larger pore size filter required, ampho: use 5 micron filter
651
key drugs to NOT PUT IN FRIDGE
Dear Sweet Pharmacist, Freezing Makes Me Edgy Dexmedetomidine [Precedex] [diluted form can be cold] SMX/TMP [Bactrim] Phenytoin → crystallizes Furosemide → crystallizes [diluted form can be cold] Metronidazole Moxifloxacin [Avelox] Enoxaparin [Lovenox]
652
key drugs to protect from light during administration
Protect Every Necessary Med from Daylight Phytonadione [vit K; Mephyton] Epoprostenol [Flolan] Nitroprusside [Nitropress] Micafungin [Mycamine] Doxycycline
653
daily patches
Methylphenidate [Daytrana]: QAM, 2 hours prior to school Nicotine [NicoDerm CQ] Rivastigmine [Exelon] Rotigotine [Neupro] Selegiline [Emsam] Testosterone [Androderm]: nightly, not on scrotum
654
dialy patches w/ special instructions
Lidocaine [Lidoderm]: 1-3 patches [prn], on for 12 hours, off for 12 hours Nitroglycerin: on for 12-14 hours, then off for 10-12 hours
655
twice daily patch
Diclofenac
656
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
657
twice weekly patch
Diclofenac
658
twice weekly patch
Diclofenac Estradiol [Alora, Vivelle-Dot] Oxybutynin [Oxytrol]
659
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
660
twice weekly patch
Estradiol [Alora, Vivelle-Dot] Oxybutynin [Oxytrol]
661
weekly patch
Buprenorphine [Butrans] Clonidine [Catapres-TTS] Estradiol [Climara] Estradiol/Levonorgestrel Ethinyl estradiol/Norelgestromin [Xulane]: weekly for 3 weeks, off for 1 week
662
alpha glucosidase inhibitors
Acarbose [Precose] & Miglitol [Glyset]
662
twice weekly patch
Estradiol [Alora, Vivelle-Dot] Oxybutynin [Oxytrol]
662
key drugs that can leave the seizure threshold
Bupropion Clozapine Theophylline Varenicline Carbapenems [esp imipenem]* Lithium* Meperidine* Penicillin* Quinolones* Tramadol* *high doses & renal impairment ↑risk
662
trx for prostate cancer
ADT: GnRH antagonist alone or GnRH agonist [combo with antiandrogen] - GnRH antagonist: Degarelix, Relugolix - GnRH agonist: Leuprolide [Lupron], Goserelin [Zoladex] - Antiandrogen: bicalutamide, flutamide, nilutamide
662
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]
663
Q72H patches
Fentanyl [Duragesic]: Q72H, if it wears off after 48 hours, change to Q48H Scopolamine [Transderm Scop]: Q72H if needed
663
stool softeners
Docusate sodium [Colace], docusate + senna [Senna S, Senokot S]
664
trx for influenza
- neuraminidase inhibitors: oseltamivir, zanamibir, peramivir - endonuclease inhibitor: baloxavir [Xofluza]

NAPLEX (9 decks)

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