Pharm

Question 1

HIV ppx

Answer 1

CD4 < 200 trimethoprim sulfamethoxazole for PCP
CD4 < 150 itraconazole for histo (if risk factors)
CD4 < 100 trimethoprim sulfamethoxazole for toxo
CD4 < 50 azythromycin for MAC

Question 2

Anticoagulants

Answer 2

Heparin = mostly ATIII (10a, 2a), intrinsic, PTT
Warfarin = vit K (10,9,7,2), extrinsic, PT/INR
Enoxaparin (LMWH) = mostly 10a, avoid in ESRD
Argatroban, bivalirudin, dabigatran = direct thrombin inhibitors
Contraindications: GI bleed, ICH, surgery <72hrs

Question 3

Levothyroxine

Answer 3

Absorption reduced by PPIs, cholestyramine
TBG reduced by androgens, steroids
TBG increased by estrogen, SERMs, heroin
Clearance increased by rifampin, phenytoin, carbamazepine

Question 4

Antipsychotics side effects

Answer 4

Both 1st and 2nd gen may cause asymptomatic LFTs elevation
1st gen (haloperidol, perphenazine, chlorpromazine) have higher risk of extrapyramidal symptoms, hyperprolactinemia (along with risperidone)
2nd gen may cause metabolic syndrome (monitor BMI, fasting glucose and lipids, BP, weight)
clozapine may cause agranulocytosis (weekly CBCs)

Question 5

MAOIs adverse rxns

Answer 5

Phenelzine, tranylcypromine, used in atypical depression
Serotonin syndrome - with SSRIs, meperidine
hyperreflexia, myoclonus, confusion, hyperthermia, death
Hypertensive crisis - with tyramine rich foods (wine, cheese)
high BP, headache, ICH

Question 6

Acetaminophen toxicity

Answer 6

Glutathione depletion and fulminant liver failure
especially with EtOH, high INR, asterixis, ammonemia
Tx with n-acetylcysteine
less nephrotoxicity than ibuprofen

Question 7

Ibuprofen toxicity

Answer 7

AKI due to AIN, ATN, or papillary necrosis
GI ulcers and bleeding
especially with hypovolemia

Question 8

2nd line antidepressants

Answer 8

First line SSRI, then add drug with diff mechanism of action:
Atypical antipsychotics - metabolic side effects
Bupropion - no metabolic or sexual side effects
Avoid MAOIs

Question 9

Anti arrhythmics

Answer 9

Atropine for bradycardia
Rate control with CCBs, BBs, adenosine, digoxin (may affect AV node conduction)
procainamide (Na channel) or amiodarone, ibutilide (K channel) can be used for Afib with WPW, ventricular arrhythmias
lidocaine for ventricular arrhythmias

Question 10

Amiodarone

Answer 10

Pulmonary fibrosis (PFTs)
also order LFTs, thyroid labs
inhibits warfarin metabolism
Peripheral neuropathy, corneal deposits
QT prolongation