Pharmacy foundations

Question 1

Common CYP inhibitors

Answer 1

G ❤️ PACMAN
Grapefruit
Protease inhibitors
Azole antifungals
Cyclosporine, Cobicistat
Macrolides (not azithromycin)
Amiodarone (and dronedarone)
Non-DHP CCBs

Question 2

Common CYP inducers

Answer 2

PS PORCS
Phenytoin
Smoking
Phenobarbital
Oxcarbazepine
Rifampin (+ rifabutin, rifapentine)
Carbamazepine
St. Johns Wort

Question 3

Tyramine-rich food

Answer 3

aged cheese, air-dried meats, sauerkraut

Question 4

Drugs with additive ototoxicity

Answer 4

Aminoglycosides
Cisplatin
Loop diuretics (Esp rapid IV admin)
Salicylates
Vancomycin

Question 5

Drugs that are nephrotoxic

Answer 5

Anti-infectives: aminoglycosides, amp B, polymyxins, vanco
Cisplatin
CNIs
Loops
NSAIDs
Contrast dye

Question 6

Drugs that cause immune-mediated hemolytic anemia (positive Coombs test)

Answer 6

PCNs & cephalosporins
Isoniazid
Levodopa
Methyldopa
Quinidine
Quinine
Rifampin
Sulfonamides

Question 7

Drugs that increase uric acid

Answer 7

Diuretics
Niacin
Low dose aspirin
Pyrazinamide
Cyclosporine, Tacrolimus
Pancreatic enzyme products
Chemotherapy (d/t TLS)

Question 8

Drugs to be careful of with TPMT (Thiopurine S-methyltransferase) deficiency

Answer 8

Azathioprine
Mercaptopurine
Low doses

Question 9

Carbamazepine: therapeutic range

Answer 9

4-12 mcg/mL

Question 10

Digoxin: therapeutic range

Answer 10

0.8–2 ng/mL (AF)
0.5-0.9 ng/mL (HF)

Question 11

Gentamicin (traditional dosing): therapeutic range

Answer 11

Peak: 5-10 mcg/mL
Trough: < 2 mcg/mL

Question 12

Lithium: therapeutic range

Answer 12

0.6–1.2 mEq/L (up to 1.5 mEq/L for acute symptoms)

Question 13

Phenytoin/Fosphenytoin: therapeutic range

Answer 13

Total: 10-20 mcg/mL
Free: 1-2.5 mcg/mL

Question 14

Procainamide: therapeutic range

Answer 14

4-10 mcg/mL
NAPA (active metabolite): 15–25 mcg/mL
Combined: 10-30 mcg/mL

Question 15

Theophylline: therapeutic range

Answer 15

5-15 mcg/mL

Question 16

Tobramycin (traditional dosing): therapeutic range

Answer 16

Peak: 5-10 mcg/mL
Trough: < 2 mcg/mL

Question 17

Valproic acid:therapeutic range

Answer 17

50-100 mcg/mL (up to 150 mcg/mL in some patients)

Question 18

Vancomycin therapeutic range

Answer 18

Trough: 15-20 mcg/mL for most serious infections
Trough: 10-15 mcg/mL for less serious (e.g. SSTIs)

Question 19

Orange book (FDA)

Answer 19

List of approved drugs that can be interchanged with generics

Question 20

Pink book (CDC)

Answer 20

information on epidemiology & vaccine-preventable diseases

Question 20

Red Book, Pharmacy

Answer 20

Drug pricing information

Question 20

Pink sheet (pharma Intelligence)

Answer 20

News report on regulatory, legislative, legal & business developments

Question 21

Purple book (FDA)

Answer 21

List of biological drug products, including biosimilars

Question 21

Red Book (AAP)

Answer 21

Summaries of pediatric ID, antimicrobial treatment & vaccinations

Question 21

Yellow Book (CDC)

Answer 21

Info on health risks of international travel, required vaccinations & ppx medications

Question 22

Green Book (FDA)

Answer 22

Information on approved animal drug products

Question 23

Phenylalanine C/I

Answer 23

phenylketouria (PKU)

Question 24

Flector (diclofenac patch): admin site & frequency

Answer 24

BID to affected areas

Question 25

Daytrana (Methylphenidate): admin site & frequency

Answer 25

2 hours prior to school on the hip

Question 26

Exelon (Rivastigmine patch): admin site & frequency

Answer 26

Chest, back, upper arm BUT NOT flanks. Once daily

Question 27

Androderm (Testosterone patch): admin site & frequency

Answer 27

NOT on scrotum, nightly

Question 28

Lidoderm: admin site & frequency

Answer 28

1-3 patches PRN, on for 12 hours, off for 12 hours to affected areas

Question 29

Nitroglycerin patch: frequency

Answer 29

on for 12-14 hours, off for 10-12 hours (daily)

Question 30

Duragesic (Fentanyl patch): admin site & frequency

Answer 30

Chest, back, upper arms. Q72H

Question 31

Transderm Scop (Scopolamine): admin site & frequency

Answer 31

Q72H PRN behind the ear

Question 32

Alora, Vivelle-Dot (Estradiol): admin site & frequency

Answer 32

Twice weekly Ville-dot: lower abdomen or buttock

Question 33

Oxytrol (Oxybutinin patch): admin site & frequency

Answer 33

Twice weekly on abdomen, hip or buttock

Question 34

Adlarity (donepezil patch): frequency

Answer 34

weekly

Question 35

Catapres-TTS: frequency + pearls

Answer 35

Weekly Contains metal Comes with its own adhesive

Question 36

Climara (estradiol) patch frequency

Answer 36

Weekly

Question 37

Xulane (norelgestromin / ethinyl estradiol): admin site & frequency

Answer 37

Weekly on back, abdomen, arm or buttock

Question 38

Patches that contain metal & need to be removed prior to MRI

Answer 38

**CAN'T** Catapres-TTS Anderoderm Neupro(rotigotine) Transderm Scop

Question 39

Patches that should be flushed after use

Answer 39

Daytrana Duragesic Butrans **Butrans & duragesic can only be covered with Bioclusive or Tegaderm**

Question 40

Promethazine warning

Answer 40

**Can cause severe tissue injury** Intra-arterial or SC routes should not used.* IM route preferred. ***DO not use in < 2 yrs**

Question 41

Drugs that have issues with leaching/adsorption/absorption issues with PVC containers

Answer 41

***`LATTIN`*** Lorazepam Amiodarone Taxanes (NOT Abraxane) Tacrolimus Insulin Nitroglycerin

Question 42

Drugs that can only be reconstituted in saline (NO dextrose)

Answer 42

Antimicrobials: Ampicillin, Ampicillin/Sulbactam Daptomycin (Cubicin), Caspofungin (Cancidas), Ertapenem (Invanz) Infliximab (Remicade) Phenytoin (Dilantin)

Question 43

Drugs that can only be reconstituted in dextrose (NO saline)

Answer 43

Oxaliplatin Bactrim Amphotericin B Synercid (Quinopristin/Dalfopristin)

Question 44

NEVER mix calcium with the following

Answer 44

Ceftriaxone **LR contains calcium** Phosphate

Question 45

Filter sizes

Answer 45

Most: 0.22 micron Lipids: 1.2 micron

Question 46

Drugs with filter requirements

Answer 46

Golimumab Amphotericin B (lipid formulations) Lipids Isavuconazonium Phenytoin **for continuous infusion, not IV push** Amiodarone Taxanes Mannitol ≥ 20% Parenteral nutrition: 1.2 micron

Question 47

Drugs that CANNOT be refrigerated

Answer 47

Antimicrobials: Bactrim, Metronidazole, Moxifloxacin Dexmedetomidine (Precedex) Phenytoin (Dilantin) Furosemide (Lasix) Enoxaparin (Lovenox)

Question 48

Drugs to protect from light

Answer 48

PENMD Phytonadione (Vit. K) Epoprostenol Nitroprussde **BLUE = cyanide = DONT use** Micafungin Doxycycline

Question 49

Lovenox Dosing

Answer 49

VTE ppx: 40mg SC daily or 30mg SC BID (If CrCl <30, then 30mg SC daily) VTE treatment: 1mg/kg SC Q12H or 1.5mg/kg daily (If CrCl < 30, then 1 mg/kg/day)