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Medications Flashcards

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1
Q

Sinemet

A

Levodopa/Carbidopa

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2
Q

Start dose for Sinemet

A

100/25mg

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3
Q

Side effects of Sinemet

A

Common: hallucinations, nightmares, nausea, increased libido
BAD: hypotension, dyskinesia, psychosis, arrhythmia, NMS, decreased impulse control

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4
Q

CI to Levodopa/Carbidopa use

A

MAOI, caution in psychosis history, glaucoma

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5
Q

Treating hypotension in patients on Sinemet

A

inc. water, salt, Midodrine (2.5-5mg BID-TID), domperidone

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6
Q

Prolopa

A

Levodopa/benserazide

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7
Q

Stalevo

A

carbidopa/levodopa/entacapone

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8
Q

COMT inhibitor (decreases GI metabolism of levodopa to prolong the half-life)

A

Entacapone

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9
Q

Pramipexole

A

Mirapex

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10
Q

Mirapex side effects

A

nausea, vomiting, confusion, dyskinesia (less so than levodopa), hallucinations, hypotension, ankle edema, MI, gambling, stroke, seizures
Other side effects worse than in Levodopa

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11
Q

Dopamine agonists

A

Pramipexole, Ropinirole

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12
Q

Ropinirole

A

Requip

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13
Q

Benztropine

A

Cogentin

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14
Q

Cogentin use

A

PD tremor

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15
Q

Anticholinergic side effects

A

Cogentin
- confusion, drowsiness, headache, slow memory, dry mouth, blurred vision, elevated HR
(anticholinergic)

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16
Q

CHADS2VASc

A

CHF, hypertension, diabetes, vascular disease, age >65, female sex

2 points for age >75, previous stroke

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17
Q

Oral anticoagulation options for a.fib

A

Warfarin, apixaban, dabigatran, rivaroxaban

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18
Q

CHADSVASc versus CHADS2

A

CHA2DS2-VASc score is better at categorizing low- or intermediate-risk individuals

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19
Q

Coumadin

A

Warfarin

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20
Q

Apixaban

A

Eliquis

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21
Q

Dabigatran

A

Pradax

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22
Q

Rivaroxaban

A

Xeralto

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23
Q

When is warfarin preferred over other OACs

A

Valvular heart disease, advanced liver/renal dysfunciton, increased risk of dyspepsia and GI bleed, well-controlled INRs
Concerns re: cost

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24
Q

Dabigatran dosing

A

110mg - noninferior (use for 80, or 75 + 1 bld risk)

versus warfarin for prevention of stroke (RELY)

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25
Dabigatran side effects
Bleed, pain, diarrhea, dyspepsia, nausea, major bleed, ICH
26
RELY study
Both doses of dabigatran have decreased hemorrhagic strokes and IC bleeds 150mg BID had - more GI bleeds compared to warfarin and dabigatran 110 BID similar to warfarin for stroke and systemic embolism but less major bleeding than warfarin
27
Pradax CI
``` Prosthetic valves (RE-ALIGN) - because of increased thrombosis and bleeds Renal impairment (CrCl<30), active bleed ```
28
Rivaroxaban
Xarelto
29
Xarelto dosing
20mg daily with food CrCl 30-50 15mg with food CrCl <30 not recommended
30
Xarelto side effects
Bleeding, pruritis | Major bleed, hematoma, syncope, ICH
31
ROCKET-AF
Afib - warfarin versus rivaroxaban - less hemorrhagic strokes, systemic embolism and bleeding versus warfarin - More GI bleeds, transfusions
32
Apixaban
Eliquis
33
Apixaban dosing
5mg po BID
34
Apixaban ARISTOTLE
Apixaban versus warfarin for stroke - superior to warfarin for stroke and systemic embolism - Dec stroke, hemorrhagic stroke, mortality, major bleeds
35
Trials looking at rate versus rhythm control
RACE, AFFIRM
36
Goal HR in management of A.fib
110 (RACE II) | Canadian Cardiovascular society recommends <100 (majority of patients in RACE II had this target)
37
Options for rate control in afib
beta blockers, CCB and digoxin
38
BB of choice for A.fib
Bisoprolol 2.5-10mg daily | Metoprolol 25-200mg BID
39
BB side effects
``` lowers HR (no change in exercise capacity) hypotension, fatigue, dizziness, insomnia, vivid dreams, sexual dysfunction, PAD, cold extremities, hypoglycemia, fluid retention ```
40
BB contraindications
severe/poorly controlled asthma, 2nd-3rd degree heart block (w/o pacemaker), PR>0.24sec, symptomatic bradycardia, SBP <85, decompensated HF
41
Antidote for apixaban and rivaroxaban OD
PCC (octaplex), recombinant factor VIIa
42
Pediatric Asthma mngt continuum (6-11 yo)
``` Salbutamol --> ICS at lowest effective dose --> Increase ICS dose --> Add LABA or LTRA --> Prednisone ```
43
Adult asthma mnagt continuum (>12)
Salbutamol --> ICS --> Add LABA, LTRA or increase ICS --> Prednisone
44
Inhaled corticosteroids names
``` Beclomethasone dipropionate Budesonide Fluticasone propionate Ciclesonide Mometasone ```
45
Beclomethasone dipropionate
QVAR
46
ICS side effects
growth (children), adrenal insufficiency, oral thrush, dysphonia
47
QVAR dosing
Approved for >5y 50-100ug MDI ii puffs BID (usual dose) Dose range 100-800ug/day
48
Pulmicort
Budesonide
49
Pulmicort dosing
Approved for > 6y Turbuhaler 100, 200, 400 ug ii pufts BID [dose range 400-2400ug]
50
Fluticasone propionate
Flovent HFA or Diskus
51
Flovent dosing
>1y (MDI 50, 125, 250ug) ii puffs BID | >5y (Diskus 50, 100, 250, 500ug) inhaled BID
52
Salbutamol
Ventolin
53
Ventolin dosing
MDI 100ug (ages >4) i-ii prn Diskus 200ug inhaled prn Ventolin neb 2.5, 5mg/2.5ml prn
54
Ventolin SE
tremor, nervousness, elevated HR, inc QT, headache, hypokalemia, increased insulin seretion
55
LABA +ICS
Formoterol + Budesonide Salmeterol + Fluticasone Formoterol + Mometasone
56
Symbicort
Formoterol + Budesonide
57
Formoterol + Mometasone
Zenhale
58
Salmeterol + Fluticasone
Advair
59
Advair
Diskus (>4yo) 50ug/(100, 250, 500) - 1 BID | MDI (>12yo) 25/125; 25/250 - 1-2 inh BID
60
Symbicort
Age >12yo | 6/100ug; 6/200ug (1-4 puffs BID)
61
LTRA Singulair
dMontelukast (4 &5mg tabs) - 10mg qhs (standard)
62
LTRA side effects
Side effects include rare eosinophilic vasculitis, neuropsychiatric events (agitation, aggression, suicidal ideation, many others - this is not a black box warning)
63
Long acting LABA use
in COPD ONLY | DO NOT USE IN ASTHMA WITHOUT ICS ON BOARD!
64
Adenosine use
SVT - to abort | 6mg --> 12mg dose

Medicine (5 decks)

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