new informations Flashcards

Question

Wegovy generic

Answer 1

Semaglutide

Answer 2

Weight loss Wegovy * W - weight loss * W - once weekly injection

Answer 3

1. GI: N, V, D or Constipation. Abdominal pain 2. Dizziness or headache

Answer 4

Wegovy injection - With or without food

Answer 5

Liraglutide

Answer 6

weight loss Saxenda * Sax = sexy

Answer 7

once daily Victoza (liaglutide) - dose once daily

Answer 8

1. GI: N, V, D, or Constipation. Abdominal pain. 2. Headache

Answer 9

saxenda - with or without food

Answer 10

liraglutide

Answer 11

1. victoza 2. saxenda

Answer 12

once daily

Answer 13

Tirzepatide

Answer 14

once weekly

Answer 15

Dual action - GIP and GLP-1 agonist 1. activates glucose-dependent insulinotropic polypeptide (GIP) 2. GLP-1 receptor agonist - resulting in * increase insulin secretion * decrease glucagon secretion * increase insulin sensitivity * delay gastric emptying Insulinotropic means = stimulate insulin release

Answer 16

levothyroxine (liquid gel capsule)

Answer 17

1. cleaner - less inactive inactive ingredients * gelatin * glycerin * water * thyroxine (T4) 2. better absorption 3. can take WOW food

Answer 18

NP - natural product * thyroid derive from pigs' thyroid gland - contains both T4 and T3

Answer 19

Pig thyroid extract (T4 and T3) * same as NP thyroid

Answer 20

man-made synthetic thyroid (T4 only) SYNThroid = synthetic man made in lab

Answer 21

synthetic T3 only * T3 - is the active form (T4 is converted to T3) T3 - triidothyronine

Answer 22

alcohol dependence

Answer 23

666 mg TID - WoW food

Answer 24

For alcohol abuse, alcohol cause GI symptoms (nausea) and without alcohol- you can’t sleep or relax (insomnia & anxiety) 1. GI: diarrhea 2. anxiety, insomnia,

Answer 25

Kidney function

Answer 26

antagonize glutamate * glutamate is an excitatory neurotransmitter (glutamate - animate)

Answer 27

a period of abstinence is recommended before starting acamprosate

Answer 28

relapsed is okay * any reduction in drinking is desirable continue treatment even with relapsed

Answer 29

about 1 week

Answer 30

inhibitory * makes you sleepy * anxiolytic

Answer 31

1. rybelsus (PO) 2. Ozempic - once weekly for diabetes 3. Wegovy - once weekly for weight loss

Answer 32

glp-1 receptor agonists (mimics glp-1) - leading to insulin secretion * glp-1 glucagon like peptides - increase insulin secretion decrease glucagon, slow gastric emptying reduce food intake promotes beta-cell proliferation

Answer 33

exactly 30 minutes before first food, beverage or other oral meds with no more than 4 oz of water * wait less than 30 min to eat - may decrease absorption * wait more than 30 min to eat - may increase absorption ** food decrease absorption

Answer 34

wait until next day for next dose

Answer 35

semaglutide

Answer 36

weight loss

Answer 37

wegovy injection - no regards to timing of food

Answer 38

if you have 48 hours before next dose, take it, then resume schedule * you have 5 days to inject missed dose

Answer 39

semaglutide

Answer 40

ozempic - can be injected with or without food (no regard)

Answer 41

if you have 48 hours until next dose, take it, then resume schedule

Answer 42

if you have 48 hours until next dose, take it, then resume schedule * you have 5 days to inject missed dose

Answer 43

1. GI: N, V, D and decreased appetite = GI most common 2. CNS: HA, dizziness, or fatigue * can decrease blood pressure and cause orthostatic hypotension

Answer 44

1. gallbladder - may cause gallstone 2. decrease renal function 3. increase LFT (liver function) 4. Pancreatitis - pancreatic cancer 5. Hypotension 6. Hair loss 7. increase HR - if consistent increased in resting HR - stop medication 8. Thyroid cancer.

Answer 45

persistent severe abdominal pain, sometimes radiating to the back may or may not accompany by VOMITING

Answer 46

Yes Bathing will not affect patch

Answer 47

Atomoxetine

Answer 48

Take with or without food in the morning

Answer 49

Most common: NAusea Dry mouth Headache & insomnia Decrease appetite Strattera is a stimulant; stimulant will lead to wt loss by causing NAUSEA & DECREASE APPETITE and also cause DRY MOUTH A stimulant also wires you brain causing INSOMNIA & HEADACHE

Answer 50

No. Powder is an eye irritant

Answer 51

Arrhythmia (ventricular)

Answer 52

Take with food - to prevent nausea * can take with tums or antacid

Answer 53

Liver damage * needs lab work Think: liver toxicity, Nausea and dizziness

Answer 54

Think arrhythmia as “Fast “; cause Nausea and dizziness, tremors Most common: NAUSEA (40%) * take with food Dizzy Tremors, uncoordinated

Answer 55

Blocks sodium channel in heart * slows down abnormal electricity in heart

Answer 56

Brinzolamide

Answer 57

Carbonic anhydrase inhibitor Generic: brinzolamide * think acetazolamide

Answer 58

Lower fluid in the eye to reduce pressure

Answer 59

Blurry vision Unusual or taste change

Answer 60

Sulfa allergy - avoid

Answer 61

Brinzolamide & brimonidine Brinzolamide (Azopt) - carbonic anhydrase inhibitor Brimonidine (Alphagan P) - alpha agonist * reduce intraocular fluid Both REDUCE introcular fluid

Answer 62

Blurry vision Unusual taste or sour taste Dry mouth

Answer 63

Sulfa allergy - avoid * Brinzolamide is a sulfa

Answer 64

Brimonidine

Answer 65

Alpha 2 agonist * Alphagan = alpha 2 agonist

Answer 66

Eye drop causes eye irritation 1. Eye irritation: redness, itching, burning and may affect vision DRY mouth Tired (somnolence) - related to clonidine

Answer 67

OTC brimonidine for red eye * recommend for 5 years and older

Answer 68

Linaclotide

Answer 69

Irritable bowel syndrome with constipation IBS-C Linzess = L for lazy bowel - constipation

Answer 70

Agonist on GC-C receptors in gut * increase intestinal fluid * increase motility * reduce intestinal pain

Answer 71

Think GI: diarrhea and abdominal pain

Answer 72

30 minutes prior to 1st meal * similar to Levoxyl Capsules can be open and sprinkle onto applesauce or water and swallow whole without chewing

Answer 73

No. The units will not be the same

Answer 74

Make sure there’s 72 hours before your next scheduled dose You have the next 3 days to inject missed dose and resume normal schedule

Answer 75

Low blood pressure, usually when standing ** orthostatic hypotension

Answer 76

Three times a day, but not every 8 hours ** take last dose at least 3 hours before bedtime ** ** do not take before bedtime - can cause high blood pressure while laying down (supine hypertension)

Answer 77

Do not take late right before bedtime, can cause high blood pressure while laying down leading to heart attack and stroke. Take last dose at least 3 hours before going to sleep Sleep with head elevated ***

Answer 78

Droxidopa is class: alpha and beta agonist (think of it as an oral EpiPen) converted to norepinephrine NE in the brain, increase NE level NE is a vasoconstrictor - increase blood pressure and heart rate Alpha agonist = Increase HR & BP Beta agonist = lung dilation breathing easier

Answer 79

No. Capsule can’t be open.

Answer 80

Monitor blood pressure ** if too high don’t lie down, stand up or sit until blood pressure returns to normal Lying down will only cause blood pressure to go up Monitor for pancreatitis * upper stomach pain going to the back

Answer 81

Headache Dizzy Nausea

Answer 82

Sleep with head elevated

Answer 83

Glaucoma (pressure in the eye)

Answer 84

Netarsudil

Answer 85

Once daily in the evening

Answer 86

Rhopressa is a ROCK Rho Kinase Inhibitor- blocks enzyme called rho kinase ** increase outflow * similar to xalatan RhoPressa Rho kinase inhibitor **

Answer 87

Can be stored at RT for 6 weeks or in frig * like xalatan- can be store at RT 6 wks

Answer 88

Skip until next dose at night * dose once daily at night**

Answer 89

Pink eye or Red eye Deposit on cornea - reversible Pain cause by eye drop * red spot cause by broken blood vessels

Answer 90

Once daily, anytime, with food ** for better absorption, do not take on empty stomach Do not crush or chew, swallow whole

Answer 91

For BPH enlarged prostate Alpha 1 receptor blocker- relax muscles around prostate and bladder to make it easier to urinate Does not shrink prostate

Answer 92

Floppy iris syndrome * tell eye doctor before surgery * may affect EYE Priapism * erection lasting longer than 4 hours Orthostatic hypotension

Answer 93

Think: dizzy and HA d/t alpha blocker Fatigue

Answer 94

Alpha 1 blocker like flomax- relax muscles doesn’t shrink prostate Take with food, better absorption, anytime of the day. Swallow whole May cause orthostatic hypotension, priapism and floppy iris syndrome * may cause dizziness

Answer 95

Take in morning with Food ** remember, Calcitriol is a vitamin D and you know vitamin d is best absorb with food

Answer 96

Calcitriol is the most active or potent vitamin d . Vitamin d is needed to stimulate intestinal calcium absorption Calcitriol is used in predialysis or dialysis patients to increase calcium in the blood or patient with hypo parathyroidism

Answer 97

Hypercalcemia Hyper phosphatemia Elevated creatinine level

Answer 98

GI: nausea vomiting or AP Other: tire (somnolence) Decrease appetite

Answer 99

Don’t take additional vitamin d supplement without doctor approval Avoid magnesium (antacid) - can lead to high magnesium level causing breathing or heart problems Keep calcium intake the same, do not increase intake

Answer 100

1. Rheumatoid arthritis 2. Psoriasis

Answer 101

Methotrexate reduce pain, swelling and slows down joint damage and disease progression ** methotrexate is a DMARD

Answer 102

Methotrexate blocks DNA, RNA synthesis and new cell formulation It disrupts the process of RA

Answer 103

Methotrexate decreases your body’s folic acid. Folic acid supplement prevents side effects from methotrexate such as mouth sores ** do not take folic acid on the same day as methotrexate

Answer 104

Avoid live vaccines- consult with doctor first Live vaccines MMR and varicella

Answer 105

3 to 6 weeks

Answer 106

Best on empty stomach, but can take with food if nausea

Answer 107

Think: cell toxicity Most common: mouth sores (stomatitis) Next: GI NVD Increase risk of infection Sun sensitivity Hair loss - remember chemo drug

Answer 108

Once weekly with or without food * take folic acid on off day ** make sure patient understand it is once weekly and not daily - can be fatal

Answer 109

No. Birth defects. Make sure to use a reliable birth control method Women - do not get pregnant for 6 months after last dose Men - wait for 3 months after last dose ** young adult - consult to use a reliable birth control **

Answer 110

Yes. Decrease sperm counts, menstrual problem. These may not be reversible

Answer 111

1. Liver - monitor yellowing of the eye, dark urine 2. Lung - difficulty breathing, coughing 3. Kidney - report edema ankle * NSAID should be avoid 4. Skin - mouth sores, Sun sensitivity

Answer 112

Fetal harm - birth defects * do not get pregnant * women 6 months * men wait 3 months Allergic reaction - skin, tongue lip swelled Increase infection risk * report new fever Gastrointestinal * can cause ulceration - report bloody or black tarry stool * mouth sores * report severe abdomen pain Hepatotoxic Lung: report coughing breathing sx Skin rash - Sun sensitivity Kidney- report any changes in urine output more or less

Answer 113

Once weekly with or without food Must not get pregnant or get a woman pregnant A lot of warning- review all the warnings Reduce inflammation, joint pain, slow down the process of RA

Answer 114

The body’s own immune system attacking your joint, especially the joint cartilage or lining * autoimmune disease *

Answer 115

Pancreas - pancreatitis (report upper stomach pain going to the back) Thyroid- risk for thyroid cancer (rat) Gallbladder- gallstone Kidney- decrease function output Liver - report jaundice Heart - increase HR & resting HR (report) GI: n, v, d or decrease appetite (most common side effects)

Answer 116

Nausea- take with food, tums or antacid Liver damage- jaundice, lab work

Answer 117

Low parathyroid hormones PTH * low PTH causes low calcium and high phosphate in the blood What is the main function of PTH? * causes release of calcium from bone into blood stream * cause absorption of calcium from food by intestines * decrease calcium excretion (preserve calcium) What is the role of calcium? 1. Build strong bone & teeth 2. Plays a role in clotting 3. Send nerves signal 4. Muscle contraction & relaxation

Answer 118

Yes. Monitor jaundice

Answer 119

NERI = a NE reuptake inhibitor * increase NE level in brain This increase in NE = increase ATTENTION spam and FOCUS Also Increase NE = reduce HYPERACTIVITY and IMPULSIVE behavior

Answer 120

Alpha 2 adrenergic agonist Works 2 ways (alpha 2) * decrease production of fluid * increase fluid outflow

Answer 121

Alpha agonist Alpha agonist causes vasoconstriction - get increase blood pressure

Answer 122

Bacterial infections

Answer 123

1. take with or without food * if nausea or upset stomach, take with food or milk 2. avoid alcohol * during and for at least 3 days after last dose

Answer 124

1. GI - n/v/d or constipation 2. metallic taste - swallow whole 3. HA or dizziness

Answer 125

Rash * can cause steven johnson syndrome

Answer 126

Yes * same as tablet - avoid alcohol during and for at least 3 days after last dose

Answer 127

No * avoid sex for 7 days or until symptoms resolve

Answer 128

Yes, apply metrogel first

Answer 129

Yes * you can apply moisturizer after metrogel

Answer 130

Yes * you can apply moisturizer immediately before or after * helps prevent irritation * this doesn't affect effectiveness

Answer 131

3 weeks * may take up to 3 weeks to see improvement

Answer 132

Breastfeeding - yes, but avoid breastfeeding for 12 hours after a 2 gram dose pregnancy - yes * risk for spontaneous abortion

Answer 133

take with or without food * no regard for food

Answer 134

1. Headache (13%) 2. GI: nausea and abdominal pain

Answer 135

1. Rash * may cause Steven Johnson Syndrome 2. Liver toxicity * report jaundice, extreme tiredness, severe nausea

Answer 136

Pregnancy - avoid during 1st trimester * increased risk of cleft palate - birth defect Breastfeeding - defer to doctor (no recommendation)

Answer 137

Swallow whole * do not crush or chew - may cause anesthesia of the mouth and throat and could cause choking

Answer 138

1. GI: nausea 2. Mental: dizziness, drowsiness, and HA * in general, benzonatate is well tolerated

Answer 139

20 minutes - onset of action * last about 3 to 8 hours

Answer 140

3 to 8 hours * take 20 minutes to work (onset of action)

Answer 141

Migraine treatment * QD for 1 dose max 75 mg/day Migraine prophylaxis * QOD max 18 tablets per month

Answer 142

Blocks a vasodilator in the brain * more active during migraine Blocks receptor of calcitonin gene related peptide CGRP Class: CGRP inhibitor

Answer 143

N for nausea & abdominal pain GI only: Nausea & abdominal pain

Answer 144

May take up to 2 hours ** Triptan - repeat in 2 hours if needed *

Answer 145

Prevents about 1 migraine day per month * one less migraine per month

Answer 146

For breakthrough, use NSAID or triptan

Answer 147

Rare BP spike, especially when just starting * monitor blood pressure & inform your doctor Report if you have CP, SHB or vision change

Answer 148

All once monthly injection Aimovig ** SQ once a month Ajovy - 225 mg SQ once a month or 675 mg once every 3 month Emgality - start 240 mg for first month, then 120 mg SQ once monthly

Answer 149

SQ into thigh, abdomen or upper arms

Answer 150

Qulipta - for migraine prevention Ubrelvy - migraine treatment Nurtec ODT - for treatment and prevention

Answer 151

Take daily to prevent migraine * take with or without food

Answer 152

With or without food * avoid grapefruit juice

Answer 153

Migraine treatment

Answer 154

50 to 100 mg at onset of migraine, may repeat in 2 hours if needed max 200 mg ** similar to sumatriptan

Answer 155

The large work que makes me want to throw up NAUSEA and CONSTIPATION. It makes me TIRED when the que is finished. Think: GI side effects *** Nausea constipation Fatigue

Answer 156

Nausea Fatigue ** nausea and fatigue seems to be a class effect * class: Ubrelvy, Nurtec, Qulipta

Answer 157

All may cause Fetal Harm - if pregnant must inform doctor * all cause nausea, can be taken with or without food

Answer 158

Emollient laxative - pulls water and fat into the stool

Answer 159

No, increase absorption of mineral oil

Answer 160

Shake well, mix with milk or fruit juice before taking to prevent throat irritation

Answer 161

Stomach cramp

Answer 162

Vortioxetine

Answer 163

Once daily with or without food * max 20 mg per day

Answer 164

Think GI: NAusea, vomiting and diarrhea * may cause dizziness ** in study, should not affect driving

Answer 165

Trintellix is weight neutral and seems to be least likely to cause sexual dysfunction

Answer 166

Serotonin modulator * inhibit reuptake of serotonin * like fluoxetine * same class as trazodone

Answer 167

No. May cause harm

Answer 168

With or without food but swallow whole do not crush or chew

Answer 169

1. Suicidal thoughts 2. Serotonin syndrome 3. Increase risk for bleeding * nsaid, warfarin 4. Pregnancy & lactation 5. Glaucoma patient * report eye pain, redness or chance in vision

Answer 170

Think fast and slow movements Fast heart rate (palpitations) Sweating Confusion - too much fast Muscle stiffness & spasms

Answer 171

Vilazodone * think trazodone

Answer 172

Take with Food ** must * relate to trazodone with food

Answer 173

Serotonin modulator It’s a serotonin reuptake inhibitor and serotonin agonist at receptor

Answer 174

A bird with DIARRHEA poops on me, makes me NAUSEA and can’t sleep with poop INSOMNIA. Since I can’t sleep, it makes me TIRED (somnolence) Think first: Diarrhea Nausea vomiting diarrhea Insomnia ** can cause sedation

Answer 175

Sitagliptan ** DPP-4 inhibitor * inhibit enzyme that breaks down incretin glp-1 and GIP. Responsible for insulin release in response to meal

Answer 176

DPP-4 inhibitor * inhibit enzyme that breaks down incretin glp-1 and gip

Answer 177

Stimulate insulin release Decrease glucagon level Delay gastric empty- feel full

Answer 178

Upper respiratory tract infection Nose and throat flu symptoms * running nose, sneezing Edema - report in case HF and kidney Headache

Answer 179

Persistent severe abdominal pain, sometimes goes to your back and may or may not have vomiting

Answer 180

Pancreatitis Heart failure- report shb or edema Joint pain Blisters and peeling Acute kidney failure * look for edema, change in urine output Hypoglycemia when combined with sulfonylurea ** these are things patients should watch for **

Answer 181

Nesina * dpp4 inhibitor * inhibit enzyme that breaks down incretin

Answer 182

Pancreatitis Heart failure Liver toxicity Kidney acute failure

Answer 183

Upper respiratory tract infection Nasal throat symptoms flu like Headache

Answer 184

1. Shortness of breath- unable to walk far distance ** think of your dad 2. Swelling of feet ** remember your dad

Answer 185

Once daily anytime with or without food

Answer 186

Once daily anytime with or without food

Answer 187

Saxagliptan

Answer 188

DPP-4 inhibitor * inhibit enzyme that breaks down incretin

Answer 189

Once daily anytime with or without food ** do not spit or cut*** Film coated tablet

Answer 190

Upper respiratory tract infection Urinary tract infection *** different than Januvia, not listed but Januvia has nasopharyngitis Headache ** watch for edema

Answer 191

Once daily anytime with or without food ** do not cut or chew swallow whole **

Answer 192

Orexin receptor antagonist ** orexin (a peptide or transmitter) is responsible for WAkefullness ** orexin is a wake prompting neurotransmitter

Answer 193

Take 30 minutes before bed Best on empty stomach, but can be with or without food- food delays onset Make sure you have 7 hours before needing to wake up Main side effect: somnolence (tire) If you drink alcohol that evening, do not take belsomra

Answer 194

Main: Somnolence Abnormal dream Dry mouth, upper respiratory infection

Answer 195

Daytime sedation - decrease alertness and awareness Suicidal thoughts- change in thoughts or mood Sleep walking, sleep driving or engaging in activity while not fully awake Sleep paralysis - an inability to move or speak for up to several minutes

Answer 196

Linagliptin * DPP-4 inhibitor

Answer 197

Pancreatitis - d/c and consult doctor Hypoglycemia - when combined with sulfonylurea Joint pain - report Blister - stop consult Heart failure- shortness of breath or edema

Answer 198

Take once daily anytime with or without food

Answer 199

1. Nasopharyngitis - stuffy nose & sore throat 2. Diarrhea 3. Cough

Answer 200

Large fluid filled blister * can’t be cure but can be treated

Answer 201

Stuffing nose Sore throat Cough

Answer 202

1. Faxiga dapagliflozin 2. Invokana canagliflozin 3. Jardiance ** (empagliflozin)

Answer 203

SGLT-2 is the main transporter responsible for reabsorption of glucose back into circulation By blocking SGLT-2, you increase excretion of glucose in your urine reducing blood glucose

Answer 204

1. Diabetes 2. HF * Jardiance also increase sodium excretions, decreasing blood volume good for HF * Jardiance increase urination

Answer 205

1. Type 1 diabetes ** increase risk for keto acidosis 2. Pt on dialysis ** needs kidney function

Answer 206

Take in the Morning ** with or without food

Answer 207

1. UTI 2. Yeast infection Other: 3. Upper respiratory tract infection 4. Increase urinating

Answer 208

Increase glucose excretion Increase sodium excretion

Answer 209

UTI - maybe serious Hypoglycemia- especially when combined with insulin or sulfonylurea Skin infection of skin around genital or anal area ** Fournier’s Gangrene Yeast infection

Answer 210

Keto acidosis Dehydration- volume depletion Urinary tract infection Hypoglycemia Skin infection of genital or anal areas * pain, tenderness, redness or swelling in that areas * called Fournier gangrene

Answer 211

High level of ketone in blood or urine Symptoms: nausea vomiting abdominal pain, fatigue or shortness of breath Needs to treated in hospital, can be fatal leading to death

Answer 212

Diabetes Heart failure Reduce worsening of kidney *** but can cause acute kidney injury

Answer 213

Yeast infection or UTI Nasopharyngitis- stuffy nose, running nose, cough or sore throat More urinating- related to moa Hypoglycemia- related to moa and increase when taking insulin or other diabetes medications

Answer 214

Not recommended If pregnant must inform doctor

Answer 215

Take once daily with or without food ** once daily - was not time specific Jardiance - take in Morning with or without food Invokana - best taken before 1st meal

Answer 216

Canagliflozin SGLT2 inhibitor

Answer 217

Diabetes Reduce risk of stroke or heart attack in patients with diabetes Reduce risk of end stage renal disease or worsening of kidney * may cause acute kidney injury

Answer 218

Yeast & UTI infection Increase urinating *** abdominal pain - not listed under Jardiance or farxiga

Answer 219

** risk of lower limb amputation - monitor pain, tenderness, sores or ulcers of lower limb or toes ** bone fracture Keto acidosis Dehydration - volume depletion UTI Hypoglycemia Fournier gangrene * skin infection of genital or anal area

Answer 220

Jardiance * take in the morning with or without food * approve for heart failure Farxiga * take with or without food, did not specify morning Invokana * take before 1st meal * risk of lower limb amputation and bone fracture- reported in study

Answer 221

Symproic (naldemedine) 2017 Movantik (naloxegol) Relistor (methyl naltrexone)

Answer 222

Naldemedine Peripheral opioid antagonist- for opioid induced constipation

Answer 223

Take 0.2 mg once daily with or without food * stop if opioid treatment is stop

Answer 224

Abdominal pain: if severe or persistent, stop and contact doctor Nausea Diarrhea- if severe stop & call doctor

Answer 225

Can cause tearing of stomach or intestinal wall * report severe or worsening AP Opioid withdrawal symptoms * sweating, chills, flushing * sneezing * NVD and AP * report to doctor

Answer 226

Mu receptor antagonist, decreased constipating affect of opioid * opioid decreases GI motility * symproic blocks mu opioid gut receptors (competitive)

Answer 227

Naldemedine is a derivative of naltrexone by adding a side chain This side increase naldemedine weight and reduce its ability to cross the blood brain barrier BBB

Answer 228

These are transporter that pumps drug out of the CNS brain

Answer 229

Naloxegol Peripheral opioid antagonist for OIP

Answer 230

Take on Empty Stomach at least 1 hr prior to first meal or 2 hrs after 1st meal Tablet can be crushed Avoid grapefruit or grapefruit juice

Answer 231

Ab pain - if severe, persistent or worsening contact doctor GI: NVD , gas 3. Headache

Answer 232

1. Tear in stomach or intestinal wall * report severe worsening AP 2. Opioid withdrawal symptoms * sweat, chill, flushing, NVD, AP, sneezing 3. Severe abdominal pain and diarrhea

Answer 233

Methylnaltrexone Peripheral opioid antagonist to treat opioid induced constipation

Answer 234

Take at least 30 minutes prior to first meal Take on empty stomach with Plain water

Answer 235

1. GI: AP NVD - could be related to withdrawal symptoms 2. Headache

Answer 236

Symproic * take with or without food Movantik * empty stomach, 1 hr prior to first meal or 2 hours after *** drug interaction- contraindicated with strong CYP3a4 inhibitor (clarithomycin, ketoconazole) Relistor * 30 minutes prior to meal, empty stomach * stay close to bathroom once starting All : avoid in pregnancy & lactation

Answer 237

Dronedarone Atrial fibrillation anti arrhythmia

Answer 238

Take with food morning and evening meal * do not take with grapefruit juice Most common side effects: Diarrhea Nausea vomiting Ab Pain Report: edema or weight gain, or new shortness of breath May affect Liver: jaundice, dark urine Lung: SHB, dry cough Kidney: change in urine output

Answer 239

Take twice daily with MEAL * do not take with grapefruit or grapefruit juice

Answer 240

Liver Lung Kidney Heart-new or worsening HF

Answer 241

No. Multaq is a teratogen

Answer 242

Can cause new onset HF or worsening HF * watch for wt gain, edema, shb

Answer 243

No not recommended to cut

Answer 244

Loteprednol Opthalamic corticosteroid * inhibit the inflammation process

Answer 245

Eye inflammation Post operative eye inflammation * begin 24 hours after surgery

Answer 246

Blurry vision Burning on administer Dry eye ** can increase IOP, short term use only

Answer 247

For eye inflammation, redness swelling Make sure not to touch tip of dropper May cause: blurry vision, burning and dry eye ** if condition worsens after 2 days, let your doctor know

Answer 248

Insulin glargine + lixisenatide Long acting human insulin analog and GLP1 receptor agonist For type 2 DM not for type 1 dm

Answer 249

SQ once daily in the morning Inject within 1 hour of first meal

Answer 250

1. Think NAUSEA 2. Hypoglycemia 3. GI: NVD 4. Sinus: stuffy nose, sneezing, cough sore throat ** increase risk of upper respiratory tract infection

Answer 251

Pancreatitis Hypoglycemia Gallbladder gallstone Acute kidney injury Hypokalemia

Answer 252

Depression of skin

Answer 253

Thickening of skin

Answer 254

Pain in upper abdomen Jaundice Clay colored stool

Answer 255

For diabetes Inject within 1 hour to first meal * once inject, must eat in the next hour 60 minutes Side effects: NAusea , diarrhea * increase risk for upper respiratory tract infection and symptoms * stuffy nose, sneezing coughing sore throat Can cause hypoglycemia ** monitor for pancreatitis

Answer 256

Birth control meds Tylenol Antibiotics Take 1 hour PT Soliqua or 11 hours after Soliqua, absorption may be affected

Answer 257

Azelastine + fluticasone nasal spray For seasonal allergy

Answer 258

1 spray each nostril twice a day ** think Flonase: max BID

Answer 259

Somnolence - may cause drowsiness, use caution when driving Alcohol - can decrease alertness Epistaxis - nosebleed Glaucoma & cataract - have been associated with the use of nasal corticosteroid

Answer 260

Shake bottle gently Prime pump first until fine mist Tilt head forward not backward to prevent going to back of throat Pinch other nostril Gently breath through nostrils

Answer 261

For allergy, running nose sneezing Shake gently, tilt head forward not backward, insert and pinch other nostril, spray then breath through nostril gently May cause * drowsiness , cautions driving & alcohol * nose bleed * taste change * headache

Answer 262

A central alpha-2 adrenergic receptor agonist * similar to clonidine * Intuniv moa in adhd is unknown Guanfacine is a known anti hypertensive agent * NE output * decrease peripheral vascular resistance and decrease heart rate

Answer 263

Nardil MAO-I inhibitor For people with anxiety, depression and phobic ** not first line, only for patient who had failed other medications

Answer 264

CNS: dizzy, drowsy, tired Dry mouth Weight gain, edema Sexual dysfunction ** has lots of side effects **

Answer 265

Can take with or without food ** avoid coffee - can increase blood pressure

Answer 266

Hypertensive crisis * avoid food high in tyramine & dopamine (food that had been fermented) * cheese, beer, wine, etc * avoid stimulant (Adderall, cocaine) * avoid OTC medications - need to check interaction first

Answer 267

Risperidone injection Once monthly

Answer 268

Tiotropium & olodaterol Once daily for COPD Tiotropium - LAMA (long acting muscarinic antagonist) Olodaterol (long acting beta agonist) Tiotropium is Spiriva Olodaterol is Striverdi

Answer 269

Long acting muscarinic antagonist ** inhibit M3 receptor (muscarinic) at smooth muscle in lung , leading to bronchodilation

Answer 270

Cosopt has company Dorzolamide & timolol Twice a day for glaucoma Dorzolamide is Trusopt Timolol is betimol, timoptic

Answer 271

Trusopt is the “true” one, only one Dorzolamide Three times a day for glaucoma Dorzolamide is a carbonic anhydrase inhibitor ** decrease production of fluid

Answer 272

Brinzolamide ** both have z in name 3 times a day for glaucoma Brinzolamide is a carbonic anhydrase inhibitor

Answer 273

Simbrinza = 2 b Brinzolamide & brimonidine 3 times a day for glaucoma

Answer 274

Antimuscarinic - blocks M3 muscarinic receptor leading to bronchodilation Neb once daily for COPD * same as tiotropium but nebulize

Answer 275

Nasopharyngitis symptoms * sneezing * cough * stuffy nose Upon use, if symptoms worsen, stop and get medical help

Answer 276

Give at night on empty stomach, 1 hr before or 1 hr after meal Give with carbidopa / levodopa (sinemet) * adjunct treatment for Parkinson’s - it’s an add-on treatment, but not to treat by itself

Answer 277

Give with other drugs, does not work by itself ** ongentys

Answer 278

Empty stomach 1 hour before or 1 hour after meal Give with carbidopa / levodopa

Answer 279

COMT - an enzyme that breaks down dopamine * dopamine is needed in PK pt Ongentys blocks this enzyme COMT * stops the breakdown of dopamine, more dopamine available Carbidopa/levodopa = levodopa is the precursor to dopamine Given with sinemet, more dopamine for CNS

Answer 280

For Parkinson’s Levodopa - is dopamine, converted to dopamine Carbidopa - blocks conversation of levodopa to dopamine outside of CNS (peripheral); inhibits peripheral side effects

Answer 281

1. Falling asleep without been drowsy or without warning (somnolence) 2. Lower BP 3. Hallucination or psychosis - mood change 4. Unusual urge & the inability to control these urge

Answer 282

* constipation * decrease BP and Weight Dyskinesia- abnormalities in voluntary movements

Answer 283

Involuntary rolling of tongue Twitching of face or limb * side effects of antipsychotics drugs

Answer 284

18 Tablets

Answer 285

2 puffs QD max 2 puffs

Answer 286

Tiotropium + olodaterol Tiotropium = Spiriva Olodaterol = Striverdi

Answer 287

Long acting muscarinic antagonist plus long acting beta agonist LAMA + LABA Stiolto = tiotropium + olodaterol Tiotropium is a LAMA Olodaterol is a LABA Both helps relax and keep airway opened

Answer 288

Nasopharyngitis * nose and Throat infection Cough Back pain (unique)

Answer 289

A build up of lactic acid in the blood. Symptoms include * feeling weak * unusual muscle pain * trouble breathing

Answer 290

Keppra Lamictal

Answer 291

Not recommended, can be fetal.

Answer 292

Yes, labetalol is compatible with breastfeeding

Answer 293

Yes. About 5%

Answer 294

Vasodilator - relaxed peripheral smooth muscle Take with or without food * be consistent

Answer 295

Take with or without food, but be consistent * food can increase absorption

Answer 296

1. Headache- all nitrate cause this 2. Fast heartbeat * all related to vasodilation Can cause GI symptoms: nausea

Answer 297

For blood pressure - dilate blood vessels Take with or without food, be consistent Side effects: HA, fast Heart Rate, and nausea

Answer 298

Class: nitrate, vasodilator IR - twice daily, ** dose every 7 hours apart not every 12 hours ** need 12 hours nitrate free period to avoid tolerance ER - once daily in the morning

Answer 299

Take in the morning with or without food ** if dose twice daily, dose every 7 hours, not every 12 hours

Answer 300

Headache - an indication drug is working, can take Tylenol, will not affect drug effectiveness Dizzy or lightheaded - upon standing

Answer 301

Viagra * can cause vasodilation, dangerous low blood pressure

Answer 302

For chest pain or prevention Take in morning with or without food May cause headache, dizziness ** if dose twice daily, take every 7 hours, not every 12 hours, needs 12 hours nitrate free period ** check viagra interaction

Answer 303

Otrexup- a SQ methotrexate injection Inject once weekly for RA

Answer 304

Antimetabolite Blocks DNA synthesis and prevent new cell growth

Answer 305

Folic acid (a vitamin) or leucovorin Prevents side effects from methotrexate such as mouth sores Do not administer on day you are taking methotrexate Folic acid 1 mg per day; 5 days a week Leucovorin 5 my once weekly

Answer 306

3 to 6 weeks to see benefits About 1 month

Answer 307

An auto injection- similar mechanism as epipen but SQ Once you here click; hold for 3 second

Answer 308

1. Think organ system Skin - Sun sensitivity Liver - monitor for jaundice Lung - monitor SHB Kidney - monitor fluid retention; edema Immune - increase risk of infection 2. GI: nausea vomiting diarrhea * tablet - best empty stomach but can be taken with food 3. Hair loss

Answer 309

1. Lots of drug interaction 2. Live vaccines- consult md first 3. Fertility * not safe in pregnancy * women 6 months to get pregnant * men 3 months * may cause infertility and may not be reversible

Answer 310

A ready to use form of folate; but not use as a vitamin Use to prevent side effects from Methotrexate Leucovorin is “folinic acid”

Answer 311

Itchy skin rash

Answer 312

1. Bactrim - decrease bactrim effectiveness 2. Dose once weekly

Answer 313

For hyperprolactinemia * high level of prolactin in blood Cabergoline is a “Long acting synthetic dopamine agonist “ - blocks the release of prolactin from pituitary gland Long acting - dose twice weekly only ** pituitary gland is also called the “master gland” - monitor and regulate bodily’s function

Answer 314

1. Unwanted increase in breast growth and milk production 2. Menstrual problem (irregular, missed period) 3. Fertility problems in both men and women 4. Can be tumors of pituitary gland

Answer 315

NAUSEA and constipation *** take with Food Other side effects 1. Dizzy OSH b/c can lower BP * avoid or limit alcohol intake

Answer 316

1. Nausea- take with food 2. Dizzy - can decrease BP cause OSH 3. Not safe in pregnancy 4. Impulse or behavior change * more aggressive * uncontrollable urge to gamble, sex, spend money, binge eating 5. Heart - doctor will check heart function before prescribing

Answer 317

Dupixent is a monoclonal antibody- blocks IL4 and IL 13 (interleukin) * Interleukins release chemical that causes inflammation What is monoclonal antibody? * clone made in labs * works like the natural antibody your body makes to fight illness What is antibody? * a large Y-shape protein used by immune system to identify and neutralize pathogens such as bacteria and viruses Dupixent is a biologic means ** drug made from living cells Bottom line: Dupixent is a monoclonal antibody made in lab from live cell made to recognize and block IL4 and IL13 - decreasing the inflammation process * eczema is an inflammatory skin condition leading to itching and rash

Answer 318

SQ once every other week ** abdomen, outer thigh or upper arm

Answer 319

1. Injection site reaction 2. Pink eye (redness, itching) - if painful or bothersome report 3. Cold sores of mouth or lips

Answer 320

Not a steroid or immunosuppressant ** but avoid live vaccines during dupixent treatment

Answer 321

No. Not a cure for eczema. Dupixent reduces symptoms only such as flare and itch. ** there is no cure for eczema

Answer 322

1. Glaucoma- eye problem * report any eye pain or change in vision 2. Joint pain * report worsening pain or unable to walk

Answer 323

Duxipent is store in refrigerator * can be store at RT for upto 14 days

Answer 324

Have 7 days to inject missed dose and resume regular schedule; no need to change next schedule injection

Answer 325

Let it sit at RT for 30 minutes

Answer 326

An acetylcholinesterase inhibitor * acetylcholinesterase is an enzyme that breaks down acetylcholine What is acetylcholine? * a NT involve in learning, memory, attention, and involuntary muscle movements What happened if a lack of acetylcholine * pt have difficulty in forming and recalling memories like dementia What is the function of acetylcholine * a NT of the autonomic nervous system that contracts smooth muscle (bladder, GI tract), dilate blood vessels (dizzy, fainting), increase bodily secretion (stomach acid), and slows heart rate. ** opposite of fight or flight response

Answer 327

Take with or without food in the evening before bed * to minimize side effects

Answer 328

Nausea vomiting diarrhea * due to increase acid secretion Decrease HR or dizziness and fainting * use caution when getting up from bed

Answer 329

1. Nausea vomiting diarrhea ** 2. Fatigue 3. Insomnia, abnormal dreams 4. Muscle cramps 5. Decrease appetite- weight loss

Answer 330

Dementia * blocks acetylcholinesterase - an enzyme that breaks down acetylcholine * acetylcholine is involved in learning and memory

Answer 331

Decrease HR and fainting * excess acetylcholine NT Vomiting and nausea * acid secretion increase Stomach ulcer or intestinal bleeding * more acid secretion with additional acetylcholine * monitor dark tar stool, or blood Worsening of asthma * tiotropium is an anticholinergic * with donepezil - you have more acetylcholine which can worsen asthma symptoms Urinary retention * interaction with anticholinergic medications (bladder med) Seizure

Answer 332

1. Take with or without food in the evening just before bedtime 2. For dementia 3. Most CSE: NVD 4. Can decrease HR and cause fainting; use caution when getting up from bed 5. Report Vomiting, blood in stool or black tar stool - increase ulcer due to increase acid secretion

Answer 333

Memantine Namenda = NMDA receptor antagonist For Alzheimer’s dementia Or Dementia

Answer 334

Blocks action of glutamate at the NMDA receptor It is postulated that glutamate overactivity results in overstimulation and neuronal (nerve) damage ** this neuronal damage linked to Alzheimer’s dementia Glutamate- is the main excitatory NT *** no evidence that memantine slows neurodegeneration in Alzheimer’s dementia

Answer 335

Usually well tolerated Think: dizzy and headache Other: constipation or diarrhea ** can make you drowsy but not very common

Answer 336

1. For dementia 2. Can be taken with or without food * limit or avoid alcohol- can increase dizziness 3. Common side effects: dizzy and HA * can also cause constipation or diarrhea

Answer 337

Rivastigmine Acetylcholinesterase inhibitor * stops the enzyme that breaks down acetylcholine Acetylcholine is needed in learning, forming and recalling memories Acetylcholine is the NT of the autonomic nervous system (rest and digest) * opposite fight and flight response

Answer 338

* take with FOOD- nausea and vomiting * if treatment is interrupted for more than 3 days, contact doctor since dose needs to be restarted at 1.5 mg twice a day Patch - is once daily * patch can be applied on back or upper arms, rotation You can shower with patch on; if it falls off, put a new one on, then replace this new patch when it’s time for your scheduled dose * it’s okay to wear a patch for less than 24 hours Patch: avoid heat sources * hot tub, sauna, heating blanket

Answer 339

No. There’s no evidence that Exelon slows the progression of Alzheimer’s dementia

Answer 340

Provide the brain and body more acetylcholine * acetylcholine is NT involved in learning, forming and recalling memories

Answer 341

Think: Nausea and Vomiting Others: diarrhea, decrease appetite and weight loss Dizziness and headache * caution driving ** hallucination has been reported

Answer 342

No interaction, but alcohol can worsen symptoms (dizziness)

Answer 343

1. Nausea and vomiting * if therapy interrupted for 3 days, needs to be restarted at 1.5 mg BID * one case of severe nausea leading to esophageal ruptured b/c therapy was restarted at 4.5 mg BID dose 2. Wt loss and decrease appetite 3. Stomach ulcer and intestinal bleeding * monitor blood in stool or black tar stool * due to more acetylcholine or cholinergic activity (rest and digestion) - increased acid secretion d/t to acetylcholine 4. decrease HR may cause dizziness * report of dizziness & fainting * d/t acetylcholine- rest and digestion 5. Seizure has been reported - related to increased acetylcholine 6. Pulmonary- worsening of Copd or asthma * acetylcholine or muscarinic activity causes bronchospasm ** that’s why you have drug like Spiriva (anticholinergic) 7. May cause EPS symptoms - d/t acetylcholine * may worsen Parkinson’s symptoms

Answer 344

1. Take with food d/t N and V 2. If treatment is stopped for more than 3 days, treatment needs to be restarted at 1.5 mg BID 3. May cause stomach bleeding - monitor for blood in stool or black tar stool 4. May cause dizziness and drowsy- be careful with driving

Answer 345

Blocks calcitonin gene-related peptide CGRP receptors * CGRP is a potent vasodilator; cause of pain and inflammation associated with migraine

Answer 346

Treat an acute migraine (within 4 hours) ; not prevent migraine

Answer 347

Take with or without food Take at or after onset of migraine, can repeat 2nd dose after 2 hours * max 200 mg per day * no safety data on treating more than 8 migraine with Ubrelvy

Answer 348

Think: nausea, sleepiness (somnolence) Can also cause: dry mouth

Answer 349

Drug interactions and grapefruit juice * need to check references

Answer 350

1. Consume grapefruit juice 2. Verapamil 3. Fluconazole 4. Cyclosporine 5. Cipro

Answer 351

Contraindicated

Answer 352

Biaxin - usually with h. Pylori tx Itraconazole- usually not prescribe Ketoconazole

Answer 353

Cipro Fluconazole Grapefruit juice

Answer 354

Phenytoin Barbiturates Rifampin

Answer 355

Drug interactions

Answer 356

Moderate CYP3a4 inhibitor

Answer 357

A sedative hypnotic drug makes you feel sleepy ** barbiturates increase GABA, the brain inhibitory neurotransmitter

Answer 358

Butalbital- found in esgic; fioricet Phenobarbital- sz med Primidone- Sz med

Answer 359

Strong CYP3a4 inducer Other strong CYP3a4 inducers: Phenytoin Rifampin

Answer 360

Take in morning with or without food ** do not crush or chew

Answer 361

Nausea, decrease appetite, wt loss, increase BP Can cause: HA, dizzy or insomnia Increase sweating ** may cause upper abdominal pain ** decrease growth rate in children has been reported

Answer 362

Mechanism of action in ADHD is not known ** it has been thought that blocking the reuptake of NE and dopamine into presynaptic neurons

Answer 363

Glaucoma Marked anxiety, tension, agitation MAO-I inhibitor (ex: Phenelzine) * due to Concerta ability to inhibit reuptake of NE and dopamine

Answer 364

1. Sudden death d/t cardiovascular * caution in pt with heart problems 2. Increase BP and Increase HR 3. Seizure - lower seizures threshold * stop if occur 4. Priapism *** 5. Poor peripheral blood profusion * Raynauld’s syndrome 6. Decrease growth in children 7. Blurry vision or change in vision * can actually affect driving

Answer 365

Hypertension & ADHD Moa: central alpha2 agonist (negative feedback on presynaptic neuron) * decrease NE into synapses *** Less EP = decrease peripheral vascular resistant Less EP = decrease renal vascular resistant Less EP = decrease HR decrease BP ** however OSH is mild & infrequent

Answer 366

Take with or without food * take last dose before bed

Answer 367

Do not stop abruptly- may cause rebound hypertension

Answer 368

Dry mouth (40%) Drowsy & Dizzy DD May cause constipation

Answer 369

1. Schizophrenia 2. Adjunct treatment for depression * take along with antidepressants

Answer 370

Take once daily (anytime) with or without food

Answer 371

Think: TREx - big (wt gain) and have to move all the time (restlessness) Weight gain & Restlessness (akathisia) * an inability to stay still or a feeling like you have to move all the time Others 1. Metabolic syndrome = increase glucose, increase cholesterol, wt gain) 2. Somnolence (tired; drowsy) * caution driving 3. Dyspepsia (nausea)

Answer 372

Increase risk of suicidal thoughts or behavior * especially in dementia patient

Answer 373

Serotonin and dopamine agonist * both are feel good hormones 5HT1a agonist; dopamine D2 agonist 5HT2a antagonist

Answer 374

1. Do not drive- until you know how this medication affects you * Rexulti can make you feel drowsy or tired 2. Avoid excessive exercise or heat exposure * risk for heat stroke

Answer 375

1. Increase glucose- diabetes risk 2. Increase cholesterol 3. Weight gain

Answer 376

1. Suicidal thoughts 2. Increase risk of stroke especially in patients with dementia 3. Tardive dyskinesia- involuntary movements of face or tongue 4. Potential for cognitive impairment * decrease judgement; thinking or motor skill - caution driving 5. Pathologic gambling & compulsive behavior * inability to control impulse 6. WBC counts decrease - nasopharyngitis 7. OSH & syncope * decrease BP and HR * risk of fall 8. Seizure- caution in patients with hx 9. Heat stroke * avoid strenuous exercise or excessive heat exposure- stay hydrated 10. Serotonin syndrome (NMS) * fever; change in HR and BP; stiff muscle; confusion (mental changes); sweating * get emergency help

Answer 377

1. Schizophrenia 2. Adjunct tx for depression 3. *** bipolar Abilify can be use for bipolar and not Rexulti

Answer 378

1. Akathisia = unable to stay still 2. Nausea 3. Insomnia 4. Somnolence - driving

Answer 379

Abilify has some alpha-1 antagonist

Answer 380

Serotonin and dopamine agonist

Answer 381

Take once daily with or without food * anytime (night - may cause insomnia) Swallow whole - not recommended to cut or crushed

Answer 382

1. Driving 2. Excessive heat - increase risk for heat stroke

Answer 383

1. Fever 2. Muscle stiffness 3. Changes in HR and BP 4. Confusion (mental changes) 5. Sweating

Answer 384

1. Increase risk stroke 2. NMS - serotonin syndrome 3. Tardive dyskinesia 4. Metabolic syndrome 5. Pathologic gambling & compulsive behavior 6. OSH dizzy, risk of FALL 7. WBC count decreases 8. Seizure 9. Cognitive impairment 10. Suicidal 11. Heat stroke

Answer 385

For dry mouth (xerostomia) d/t head and neck cancer treatment Take with or without food TID

Answer 386

Cholinergic AGONIST (rest and digest) * works like acetylcholine * stimulant secretion of gland (salivary, sweat, lacrimal, gastric, intestinal) That’s why it is used for dry mouth

Answer 387

SWEATING Other: * HA and dizziness * GI symptoms: N D

Answer 388

1. Take with or without food 2. For dry mouth - may take up to 3 months to work 3. Most common side effect is increase sweating. Others side effects include * NV * HA or Dizziness

Answer 389

Cholinergic agonist * works like acetylcholine to stimulate muscarinic receptors 1. Glaucoma 2. Eye surgery- miosis * constriction of pupil (pin point) * decrease light penetration into eye Glaucoma * increase outflow by stimulating eye smooth muscle (iris sphincter and ciliary muscle) to contract

Answer 390

Mydriasis- to dilute pupil * opposite pilocarpine (pin point) Anticholinergic * blocks acetylcholine, relaxed smooth muscle eye

Answer 391

BURNING Vision change, light sensitivity increase IOP - opposite pilocarpine

Answer 392

Mydriasis- dilate ANTICHOLINERGIC * relaxes and dilate eye pupil * blocks acetylcholine

Answer 393

BURNING Vision change Light sensitivity

Answer 394

Atropine is an anticholinergic * blocks secretion of salivary gland * decrease saliva

Answer 395

Atropine * both cause eye dilation * both are ANTICHOLINERGIC

Answer 396

1. Cholesterol 2. Reduce risk of HEART attack, stroke and cardiovascular surgery

Answer 397

Take once daily anytime with or without food

Answer 398

1. Myopathy and rhabdo 2. Increase LFT liver toxicity

Answer 399

GI: Nausea Vomiting Diarrhea Joint muscle pain - report to doctor Increase risk Upper respiratory tract infection URTI * bronchitis

Answer 400

1. Muscle pain 2. Liver damage 3. Increase glucose A1c - increase risk for diabetes 4. No in pregnancy and lactation

Answer 401

1. For cholesterol or to reduce risk of HEART attack; STROKE 2. Take once daily with or without food anytime 3. Side effects may include: NVD 4. Report unexplained or worsening muscle or joint pain

Answer 402

1. High triglycerides ** different from other statin 2. High cholesterol ** no indication for reduction of heart attack or stroke in PI**

Answer 403

Take once daily anytime with or without food

Answer 404

1. Myopathy and rhabdo 2. Increase LFT liver toxicity

Answer 405

HEADACHE and Nausea Muscle or joint pain

Answer 406

Yes Limit to no more than 2 drinks per day

Answer 407

Yes. Separate doses by 2 hours

Answer 408

Unexplained muscle pain or weakness, especially if you have a FEVER or feels more TIRED than usual

Answer 409

No. Contraindication All statin are contraindicated in pregnancy and lactation

Answer 410

1. High cholesterol 2. Primary prevention of Heart Disease or Heart attack 3. SLOW progression of coronary atherosclerosis Atherosclerosis: deposit of plaque of fat on the inner wall of blood vessels Difference: * primary prevention * slows atherosclerosis

Answer 411

1. Myopathy and rhabdo 2. LFT LIVER TOXICITY

Answer 412

HEADACHE and Nausea Abdominal pain Muscle pain or aches

Answer 413

Parkinson’s Parkinson’s is thought due to decrease dopamine in CNS * levodopa- is converted into dopamine; providing CNS more dopamine * carbidopa- blocks the breakdown of levodopa to dopamine in the peripheral, providing more levodopa to cross BBB * carbidopa does not cross BBB Levodopa is DOPAMINE

Answer 414

Main: NAUSEA Involuntary muscle movements * dyskinesia Dizziness * levodopa & carbidopa can cause OSH Abnormal dreams * sinemet can cause hallucination & psychotic like behaviors Dry mouth

Answer 415

Best on empty stomach but can be taken with or without food * avoid high protein: meat, cheese and other dairy products - decrease absorption

Answer 416

1. Suicidal thoughts 2. Sudden falling asleep during activities * such as driving * there has been reports of car accidents 3. Serotonin syndrome * likely to occur during dose reduction or discontinuation 4. Dyskinesia- involuntary muscle movements * dose may need to be decrease 5. Mental changes: hallucination or psychotic like behavior * insomnia and abnormal dreams 6. Inability to control impulse and impulsive behaviors * urge to gamble, have sex, spend money, binge eating 7. Melanoma- skin examination * increase risk of melanoma * Parkinson’s itself- increase risk of melanoma

Answer 417

1. Dark color fluid may appear in saliva, urine or sweat * red, brown or black bodily fluid * no clinical significance 2. Multivitamins and Iron - may decrease absorption 3. Reported sudden onset of sleep during activity of daily living without prior warnings of being tired 4. Impulsive urge

Answer 418

Prevent more kidney damage Prevents HEART attack and hospitalization ** specifically for patient with type 2 diabetes ** ** first line treatment

Answer 419

First Mineralocorticoid receptor (MR) ANTAGONIST Blocks MINeralocorticoid from binding to its receptor of the HEART, blood vessels and KIDNEY What is the role of mineralocorticoid * promote Na reabsorption in kidney * cause sodium and water retention * active secretion of potassium Kerendia blocks all this effects * decrease Na * increase K Aldosterone is an example of a mineralocorticoid

Answer 420

Take once daily with or without food **** AVOID grapefruit ***

Answer 421

Increase Potassium (monitor) * nausea, numbness and tingling Increase Na sodium Decrease BLOOD pressure * may get dizzy, feeling tired

Answer 422

1. Grapefruit 2. Strong CYP3A4 inhibitors

Answer 423

1. Macrolides: clarithromycin, erythromycin 2. Diltiazem and verapamil 3. Azole antifungal: itraconazole, ketoconazole 4. GRAPEFRUIT

Answer 424

No. Must wait 24 hours after last dose

Answer 425

Hyperkalemia (increase K) ** monitor

Answer 426

Anticholinergic and antispasmodic Inhibit acetylcholine * especially smooth muscle of the stomach and intestines AND HEART and kidney * slows down the natural movement of the gut

Answer 427

Used for a variety of stomach issues 1. IBS - pain and cramping 2. Stomach ulcer 3. Bladder and kidney pain

Answer 428

Take before meals

Answer 429

Decrease effectiveness of hyoscyamine Take hyoscyamine before meal and take antacid after meal

Answer 430

DRY MOUTH and DRY EYE Urinary retention Constipation Dizzy & drowsy- caution driving Decrease ability to focus and think

Answer 431

Serious allergic reaction ** Angioedema Hallucination - mental changes * psychosis Irregular heart beat or fast HR Heat stroke * avoid excessive heat - body’s ability to sweat decrease

Answer 432

Urinary analgesic - for bladder pain Works by binding to wall of bladder and acts as a barrier to protect bladder from irritating substances in urine *** similar as Sucralfate **

Answer 433

Relieve bladder pain (cystitis) Cystitis is * an inflammation of the bladder caused by bladder infection Symptoms: pain and burning when you pee

Answer 434

Take on an Empty Stomach * 1 hour before or 2 hours after meal

Answer 435

1. EYE damage- retina bleeding ** report in changes in vision or eye pain 2. Blood thinner * report any blood in stool * report bruising 3. Alopecia HAIR loss * usually in one spot - reversible upon dc

Answer 436

3 to 6 months *** Elmiron treats bladder pain**

Answer 437

RECTAL bleeding * blood in stool Hair loss Nausea Vomiting and Headache Change in Vision- report

Answer 438

Eucrisa is for ATOPIC Dermatitis PDE-4 inhibitor (blocks PDE-4) * PDE-4 is a protein that controls inflammation

Answer 439

PAIN ON APPLICATION SITE Burning & Stinging

Answer 440

1 wk to 4 wk 1 wk: to see improvement 4 wk: to see clear skin

Answer 441

Eucrisa is a non-steroidal ointment for atopic dermatitis

Answer 442

Sacubitril and valsartan Sacubitril is a neprilysin inhibitor * breaks down natriuretic peptides * cause water and sodium retention Valsartan * ARB at AT1 receptor * causes vasodilation

Answer 443

Heart Failure * to reduce risk of hospitalization and death from heart failure Dose TWICE daily

Answer 444

No. Black box warning of fetal harm and death All drug affecting RASA system not recommended in pregnancy and lactation

Answer 445

Concomitant use with ACE-inhibitor or ARB

Answer 446

Need 36 hours washout period * to decrease risk of Angioedema

Answer 447

1. Decrease BP, may cause dizziness 2. Cough 3. Increase potassium HYPerkalemia

Answer 448

May worsen kidney function * nsaid may worsen kidney * Entresto can cause acute kidney failure

Answer 449

1. Angioedema 2. Hypotension 3. Acute kidney failure- monitor 4. Hyperkalemia 5. Pregnancy and lactation- fetal harm

Answer 450

Sacubitril is a NEPRILYSIN inhibitor * blocks the breakdown of natriuretic peptides in the body * natriuretic peptides cause NA and Water to pass in urine - reducing workload for the heart and reduces strain on the heart

Answer 451

Sacubitril causes elevation of angiotensin 2 Losartan blocks angiotensin 2 When Sacubitril + ace inhibitor- increase risk of Angioedema

Answer 452

1. Dilate artery- helps reduce BP 2. Decrease HEART muscle cell enlargement * decrease workload on heart by promoting sodium and water excretion 3. Increase URInation of excess FLUID sand Sodium

Answer 453

Take with or without food TWICE Daily

Answer 454

Anti-malaria Dose once weekly WITH FOOD Start 2 weeks before travel and continue for 4 weeks after travel

Answer 455

Prevention of malaria Treatment of acute malaria

Answer 456

May cause psychotic behavior * depression, anxiety, schizophrenia, hallucination

Answer 457

1. Dizziness * may continue for months after tx 2. Insomnia may occur 3. If psychiatric behavior (mood changes) * may need to d/c 4. Not 100% effective * use protective measures (net) 5. Any fever after returning from travel * inform doctor

Answer 458

DIZZINESS Extrasystole = skipped heartbeat or heart hiccups

Answer 459

1. QT prolongation * ketoconazole and mefloquine separate by at least 15 weeks apart 2. Psychiatric behaviors * depression, anx, hallucination 3. Eye disorder * any vision change- inform MD 4. Liver toxicity

Answer 460

1. Dizziness - may continue for months after tx 2. Take WITH FOOD (increase absorption) 3. QT prolongation (ketoconazole) 4. Psychiatric behaviors 5. Liver and eye toxicity

Answer 461

More cardioselective than metoprolol and atenolol

Answer 462

Take with or without food

Answer 463

HEADACHE and FATIGUE Dizziness Diarrhea

Answer 464

1. Worsening of CHF 2. Do not abruptly STOP 3. Asthmatic 4. Diabetics 5. Major Surgery 6. Raynaud syndrome: decrease peripheral perfusion

Answer 465

Use to lower pH in vagina Not a spermicide but more effective than spermicide Use to prevent pregnancy 86%

Answer 466

Take with meal and full glass of water ** take anytime, but take at night may help with sleep

Answer 467

1. Better sleep 2. More energy 3. Improve mood

Answer 468

Take once daily for seizure Can be taken with or without food Swallow whole do not crush or chew

Answer 469

SOMNOLENCE (sleepy) DIZZY and double vision (diplopia) Headache

Answer 470

1. Driving: make sure you know how medication affects you 2. Do not drink alcohol

Answer 471

1. DRESS = drug reaction with eosinophilia and systemic symptoms ** a SERIOUS SKIN Reaction accompany with FEVER, RASH, facial swelling and lymph node enlargement 2. QT shortening (not prolongation) * report palpitation and CP 3. Suicidal thoughts or behavior 4. SOMNOLENCE, fatigue or vision change = caution driving 5. DC gradually to minimize seizure

Answer 472

1. Bacterial infections 2. ENT infection 3. UTI 4. Skin infection

Answer 473

NVD Itching Elevated liver enzymes

Answer 474

1. Cross sensitivity reaction 10% 2. C Dif

Answer 475

Can be taken with or without food Take with food - more tolerable

Answer 476

1. Finish treatment * may feel better after a couple days 2. Diarrhea is common * diarrhea should stop after treatment * if diarrhea is watery or have bloody stool wit or without fever, contact MD

Answer 477

myasthenia gravis * a weakness of muscle under voluntary control example: droopy eyelids and mouth

Answer 478

a weakness of muscle under voluntary control example: droopy eyelid and mouth

Answer 479

myasthenia gravis is an autoimmune disorder the body's immune system attacks muscle protein

Answer 480

acetylcholinesterase inhibitors * prevents breakdown of acetylcholine, * acetylcholine is needed for muscle contraction

Answer 481

GI: nausea, vomiting and diarrhea

Answer 482

1. eczema 2. vitiligo (a condition where the skin loses its color)

Answer 483

JAK inhibitors (janus kinase inhibitors) * decrease function of immune system

Answer 484

1. Infection (risk increase due to decreased immune system) 2. stroke and heart attack 3. lymphoma and skin cancer risk increase 4. clot (PE and DVT) 5. death (from all cause)

Answer 485

nasopharyngitis (flu-like symptoms) * sneezing, coughing, sore throat

Answer 486

do not cover area unless directed by physician

Answer 487

With or without food * some literature may suggest taking on empty stomach

Answer 488

1. For prevention of chest pain * not for immediate relief (not like NTG) 2. Take with or without food * some reference may suggest empty stomach 3. Headache and dizziness

Answer 489

1. Viagra related drug - due to increased risk of severe hypotension 2. Alcohol - increase risk for dizziness

Answer 490

Can be taken with or without food

Answer 491

After taking it, do not lay down for 4 hours * can increase blood pressure

Answer 492

WOW - can cause diarrhea or stomach upset

Answer 493

Alpha 1 agonist * vasoconstrictor * raise blood pressure for patient with OSH

Answer 494

Do not LAY down for 4 hours * do not take late at night

Answer 495

1. Goosebumps - tingling or prickling feeling 2. Painful urination

Answer 496

Schizophrenia

Answer 497

With or without food

Answer 498

Akathisia - restlessness, inability to sit still EPS - involuntary muscle movements Nausea and dizzy or drowsy

Answer 499

Atomoxetine

Answer 500

ADHD Pt must be over 6 years old

Answer 501

Selective norepinephrine reuptake inhibitor (NRI) Increases NE is thought to help with ATTENTION and lower impulsive behavior

Answer 502

GI: dry mouth, nausea, decreased appetite Somnolence- makes you feel tired, dizzy * caution driving, alcohol makes it worse Erectile dysfunction *** Can cause priapism

Answer 503

With or without food Swallow whole, do not crush or chew or do not open capsule

Answer 504

No. Eye irritant

Answer 505

Suicidal thoughts Liver damage Heart problems (stroke or Heart attack) Worsening of bipolar * can precipitate mania episodes Priapism Slow growth rate * although with continued use, does not affect over growth height

Answer 506

May see minor improvement after 1 week

Answer 507

Capsules must be swallowed whole, do not open (eye irritant) Can make you feel sleepy or dizzy * caution driving * alcohol not recommended Report any changes in mood or suicidal thoughts

Answer 508

QAM max 100 mg

Answer 509

Oxycodone ER capsules

Answer 510

Twice daily ; every 12 hours

Answer 511

Take with Food * capsules can be open, but do not crush, chew or dissolve Taking on empty stomach can decrease absorption leading to less effective

Answer 512

Less absorption on empty stomach Not as effective

Answer 513

Nause vomiting and constipation Somnolence- makes you feel tired and sleepy Dizzy and blurred vision- caution driving and avoid alcohol

Answer 514

Addiction dependence Breathing problems Overdose Extreme tiredness OSH can cause decreased BP from sitting to standing position

Answer 515

Once daily (maintenance)

Answer 516

Hyperthyroidism

Answer 517

Rash Drowsy Headache

Answer 518

Yes Common side effects Rash, drowsy and headaches

Answer 519

1st trimester- not recommended 2nd and 3rd trimester - preferred drug Methimazole is preferred over PTU due to less liver toxicity

Answer 520

Blocks thyroid gland from making thyroid hormones

Answer 521

Liver toxicity - less likely compared to PTU Bleeding and bruising Decrease WBC - increase risk of infection - nose and throat Birth defects - do not use during 1st trimester

Answer 522

May cause stomach upset- take with food Increase risk of bleeding * monitor for sx of liver toxicity

Answer 523

Thyroid gland uses iodine to make thyroid hormone You decrease consumption of iodine, you will decrease production of thyroid hormones - good for hyperthyroidism

Answer 524

Methimazole - drug of choice except in 1st trimester of pregnancy - lower risk of liver toxicity - drug of choice in 2nd and 3rd trimester PTU - preferred in 1st trimester - more risk of liver toxicity

Answer 525

3 times a day - compared to once daily with methimazole

Answer 526

Nausea Loss of taste Joint pain ** liver damage- monitor to itchiness and upper right abdominal pain

Answer 527

Decrease WBC counts- risk of infection Liver damage Increase risk for bleeding and bruising Skin reaction: rash and blisters ** rash - same with methimazole

Answer 528

1. Prefer in pregnancy P for pregnancy 2. Can make you feel d/d caution driving 3. Can take WOW - be consistent 4. Report sx of infection. PTU can dec WBC 5. Alcohol - increase risk of liver toxicity

Answer 529

PDE 5 inhibitor - relax penis muscles, allow it fill with blood causing an erection PDE 5 - an enzyme

Answer 530

Take 30 minutes to 4 hours before Empty stomach preferably- works faster

Answer 531

Max once daily Taking more can increase side effects such as changes in vision or decreased BP

Answer 532

Priapism Vision loss Decrease BP * avoid with nitrates

Answer 533

1. Headache- vasodilation 2. Flushing- vasodilation 3. Decrease BP - avoid nitrates 4. Change in Vision

Answer 534

1. Had a headache attack or stroke last 6 months 2. Can’t combine with Nitrate

Answer 535

Works faster on empty stomach Priapism- call 911 if erection last longer than 4 hours No nitrates (NTG, IMDUR)

Answer 536

Prevent typhoid fever * causes by salmonella TYPHI

Answer 537

Live weaken vaccine * used weakened salmonella typhi

Answer 538

Take on empty stomach Take every OTHER day - finish course at least 7 days before travel Take with cold or Luke warm water * hot water may kill weakened salmonella typhi Swallow whole do not crush or chew

Answer 539

Nausea Stomach pain

Answer 540

Typhim Vi See typhIM im = intramuscular

Answer 541

Malaria prevention * must take at least 2 days prior to travel and continue for 4 weeks after travel

Answer 542

Adalimumab * same as humira for rheumatoid arthritis Dose SC every 2 weeks

Answer 543

800 mg buccally as a single dose * 400 mg right cheek and 400 mg left cheek - hold for 30 minutes then swallowed

Answer 544

Robitussin DM

Answer 545

Chlortrimeton preferred (most studies) Claritin Sudafed

Answer 546

Metamucil Colace Dulcolax Milk of magnesium MOM

Answer 547

Immodium Gas-x simethicone for gas

Answer 548

Tylenol Not Motrin (avoid)

Answer 549

Preparation H (cream or rectal) Tucks wipe

Answer 550

Maalox Tums Rolaids

Answer 551

Emetrol Vitamin b-6 pyridoxine

Answer 552

Cepacol Tylenol

Answer 553

Proscar - PROstate

Answer 554

Take WOW do not open capsule

Answer 555

Once daily

Answer 556

No Power is a mouth irritant

Answer 557

5 alpha reductase inhibitor Blocks production of dihydrotesterone 5HT Dihydrotesterone 5HT is responsible for prostate growth

Answer 558

Getting or maintaining an erection Lower sex drive Ejaculation problems - difficulty in getting an ejaculation

Answer 559

Yes. Dutasteride can be taken alone or with flomax

Answer 560

Proscar (finasteride)

Answer 561

Birth defect - women of childbearing age should not touch tablets PSA level or testing - can lower psa level, harder to detect prostate cancer Higher risk of developing severe form of prostate cancer Don’t donate blood for 6 months after last dose Decrease sperm count or volume

Answer 562

Take WOW anything

Answer 563

Blocks enzyme 5 alpha reductase Block’s production of 5 hydro testosterone, responsible for growth of prostate

Answer 564

Impotence: inability to get or maintain an erection Lower sex drive Decrease sperm counts or semen volume

Answer 565

Several months up to 6 month to see benefits

Answer 566

Birth defects: women of childbearing age needs to avoid touching Decrease PSA levels: harder to detect prostate cancer Higher risk of developing severe form of prostate cancers Decrease sperm counts and semen volume

Answer 567

Budesonide Ulcerative colitis

Answer 568

Crohn disease * an inflammatory bowel condition

Answer 569

Take in morning swallow whole Usually not more than 3 months at a time ** think prednisone- same class

Answer 570

Corticosteroid - works inside your intestine to lower inflammation, swelling and irritation

Answer 571

Headache GI: Nausea, indigestion and diarrhea Increase risk of infection (nose and throat)

Answer 572

Contraindicated with SOLID a potassium - increase risk of GI ulcers due to delayed GI transit ** consider liquid potassium **

Answer 573

Can weaken immune system - increase risk of infection - report any symptoms of infection Avoid in pregnancy Avoid taking with grapefruit

Answer 574

Albuterol (Proair) Levalbuterol (xopenex) ** beta stimulation in smooth muscle of lung cause relaxation and dilation ** same as Epipen (norepinephrine)

Answer 575

Arformoterol (brovana) Formoterol Vilanterol Salmeterol (serevent)

Answer 576

Budesonide / formoterol

Answer 577

Fluticasone / Vilanterol

Answer 578

Umeclidinium / Vilanterol

Answer 579

Fluticasone / umeclidinium / Vilanterol

Answer 580

Fluticasone

Answer 581

Ipratropium (Atrovent)

Answer 582

Tiotropium (Spiriva) Aclidinium (tudorza) Umeclidinium (incruse)

Answer 583

Tiotropium

Answer 584

Aclidinium

Answer 585

Umeclidinium

Answer 586

Montelukast Zafirlukast (accolate) * empty stomach

Answer 587

Roflumilast PDE-inhibitor; prevents contractions of lung smooth muscle

Answer 588

Means given at the same (or almost the same) time

Answer 589

Clascoterone * androgen receptor inhibitor * ACNE treatment

Answer 590

omalizumab * food allergies * blocks IgE --> reduce allergic reactions from accidental exposure to food allergy (peanuts, eggs, milk) * first 3 doses - needs to be admin in office setting * allergic reaction to omalizumab have been reported even after 1 year use * not to treatment allergic reaction - always carry EpiPen

Answer 591

albuterol and budesonide * first "dual-action" rescue inhaler for asthma

Answer 592

budesonide and formoterol * formoterol - works within 5 minutes, but last 12 hours * * albuterol - works in 5 minutes, but LAST ONLY 6 HOURS

Answer 593

mometasone and formoterol

Answer 594

mometasone

Answer 595

emtricitabine and tenofovir DISOPROXIL FUMARATE * go to for "PrEP" --> pre-exposure prophylaxis medication HIV * avoid in CrCl < 60 ml/min

Answer 596

emtricitabine and tenofovir ALAFENAMIDE * see salt different between truvada and descovy * avoid in crcl < 30 ml/min - (truvada < 60 ml/min)

Answer 597

Cabotegravir * PrEP --> pre-exposure prophylaxis med HIV * gluteal injection given by healthcare provider

Answer 598

dizziness, nausea, headache * QT prolongation - more than citalopram

Answer 599

Gepirone ER * depression * first selective serotonin 1A receptor agonist * think of it similar to buspirone

Answer 600

DAPT - dual anti platelet therapy * ASA + clopidogrel QD x 21 days * 10 days for patient high risk for bleeding * Start within 72 hours of stroke * after 21 days - continue 1 anti platelet (ASA) QD indefinitely (long-term)

Answer 601

Yes * slow benzene formation * benzene is a carcinogen - more production especially in high heat

Answer 602

a vitamin A - increase cell turnover (acne tx)

Answer 603

1. adapalene 0.1% 2. Tretinoin vitamin A products

Answer 604

photosensitivity - use sunscreen

Answer 605

clascoterone * androgen receptor inhibitor - for acne

Answer 606

don't recommend alone needs to be use with benzoyl peroxide to limit resistance

Answer 607

25 minutes work (focus) follow by 5 minute breaks

Answer 608

No. It is to prevent allergic reaction for ACCIDENTAL exposure only it doesn't allow a patient to eat freely whatever they want

Answer 609

apply ice and take ibuprofen PRN * do not recommend HEAT or massage - may worsen symptoms

Answer 610

fenugreek, milk thistle do not recommend due to no evidence that it works

Answer 611

latent tuberculosis infection

Answer 612

1. rifampin QD x 4 months 2. INH + rifapentine (Priftin) Weekly for 12 doses (84 days) 3. INH QD for 6 to 9 months 4. Rifapentine QD x 3 months

Answer 613

No. Rifapentine is an alternative if rifampin is not available

Answer 614

drug intxn with HIV treatment (rifampin - inducer)

Answer 615

Vit B6 25 mg to 50 mg QD * to prevent peripheral neuropathy

Answer 616

weight loss * increases GLP-1 secretion - called "nature's ozempic" * many drug interaction

Answer 617

total usually 6 months 2 months (intensive) = RIPE therapy * 4 drugs 4 months (continuation) = 1 to 2 drugs

Answer 618

R = Rifampin I = isoniazid P = pyrazinomide E = Ethambutol

Answer 619

10 mg/kg PO daily (max: 600 mg) * or BIW - TIW

Answer 620

Protease inhibitor * rifampin - do not use with protease inhibitor (HIV treatment)

Answer 621

Increased LFT Orange-red discoloration

Answer 622

empty stomach

Answer 623

5 mg/kg PO daily (max 300 mg) * can be give once, twice or 3 times a week

Answer 624

empty stomach

Answer 625

liver disease ACTIVE * increase LFT

Answer 626

vitamin b6 25 mg daily * prevent neuropathy

Answer 627

increase LFT DILE - drug induced lupus * isoniazid is a DILE drug

Answer 628

25 mg/kg per daily * dose ONCE daily (in active TB) * not once, twice or 3 times a week * other TB meds can be dose once or twice or 3 times a week

Answer 629

acute gout - can increase uric acid Liver disease (active)

Answer 630

increase LFT increase uric acid - gout flare

Answer 631

20 mg/kg daily 30 mg/kg TIW 50 mg/kg BIW * can be dose once daily, BIW or TIW

Answer 632

E = ethambutol = eye * optic neuritis (inflammation of optic nerves) * can lead to pain, loss of vision

Answer 633

increase LFT Optic neuritis (inflammation of optic nerves = pain, loss of vision) CNS: confusion, hallucination

Answer 634

INH + rifapentine: QWK for 12 dose INH + Rifampin: QD for 3 months Rifampin: 600 mg QD for 4 months INH: 300 mg QD for 6 to 9 months * preferred in HIV patient (less intxn)

Answer 635

adjust for renal function

Answer 636

Need an 8 hour gap - if less than 8 hours before next dose - skip and resume shedule

Answer 637

Prednisone 20 mg QD for 14 days - Avoid

Answer 638

400 mg per day

Answer 639

25 mg every 2 weeks

Answer 640

best to gave at same time * if atorvastatin given later after rifampin, can decrease level of atorvastatin

Answer 641

no dose adjustment for renal function

Answer 642

a reversal of the colostomy process * reconnect bowel and close stoma

Answer 643

a surgically created opening in the abdomen that allows waste, such as stool or urine to the exite the body when the digestive or urinary system is malfunctioning. The opening, called a STOMA, enables waste to be collected in a pouch worn on the outside of the body. Common types include COLOSTOMY (large intestine), ILEOSTOMY (small intestine), or UROSTOMY (urinary system)

Answer 644

a surgical procedure that creates an opening (stoma) in the abdominal wall to divert stool from the colon (large intestine) to an external bag

Answer 645

1,500 mg regular release 1,080 mg /day extended release

Answer 646

2 doses 6 to 12 months apart

Answer 647

symbicort, advair and breo

Answer 648

formoterol and mometasone

Answer 649

salmeterol and fluticasone

Answer 650

vilanterol and fluticasone

Answer 651

likely duplicate clindamycin covers mrsa

Answer 652

cellulitis

Answer 653

10 mg once daily

Answer 654

manufacturer does not recommend

Answer 655

dissolve with 2.1 ml Sterile water for injection

Answer 656

2.1 ml lidocaine 1%

Answer 657

Cr Cl < 30 mg/dl

Answer 658

pulmonary hypertension

Answer 659

bid frequency max: 3,200 mg per day

Answer 660

osteoporosis

Answer 661

non-formulary

Answer 662

once daily - recommended

Answer 663

PO: 20 mg/day IM: 30 mg/day NOTE: at cdcr - dose up to 50 mg per day PO

Answer 664

4,000 mg 800 mg 5 times a day

Answer 665

motrin decrease renal blood flow, decrease renal clearance of lithium increase lithium level

Answer 666

a legal document filed by a law enforcement agency with a prison to hold an inmate it prevents an inmate from being released

Answer 667

pneumococcal 21-valent conjugate vaccine

Answer 668

FDA restricts COVID vaccine to older adults or those with pre-existing conditions California Department of Public Health went a different direction = recommends everyone age 6 months and older have access to receive the latest COVID-19 vaccine

Answer 669

80 mg biggest strength is 40mg x 2

Answer 670

Mavyret Hepatitis C "genotype" taken once daily for 8 weeks **note epclusa is 84 days (12 weeks)

Answer 671

formoterol - mometasone

Answer 672

mometasone

Answer 673

provides no additional pain relief increase risk of side effects * GI bleed * kidney damage * CV: heart attack or stroke * liver injury

Answer 674

3 doses series NOTE: Heplisav is only 2 doses

Answer 675

2 doses NOTE: engerix b is 3 doses

Answer 676

2 doses 4 weeks apart

Answer 677

3 doses 0, 1, and 6 months

Answer 678

Hepatitis A 2 doses series 0, 6 months apart

Answer 679

2 doses 0, and 2 to 6 months

Answer 680

an implanted port a small device placed under the skin to provide long-term access to the bloodstream for medical treatment the catheter is thread to major vein (usually into heart)

Answer 681

200 mg elemental calcium

Answer 682

Think: cosopt is CO = means 2 dorzolamide and timolol

Answer 683

no specific dosage recommendation drug may worsen renal function in those with pre-existing impairment. Risk and benefits must be evaluated.

Answer 684

Epinephrine nasal spray Ne = norephinephrine N = nasal **give second dose after 5 mintues in SAME NOSTRIL**

Answer 685

Epinephrine injection ~ epipen **talking pen**

Answer 686

epinephrine prefilled syringes Sy = syringes **eip = epinephrine**

Answer 687

HIV pre-exposure prophylaxis **not recommended for individuals at risk from vaginal sex or injection durg use**

Answer 688

PrEP and HIV treatment **descovy is not recommended for individuals at risk from vaginal sex**

Answer 689

adults > 75 yo - 800 units per day adults with prediabetes pregnant patients

Answer 690

estrogen increases levels of clotting factors note: progestins modulate estrogen's effect * modulate - exert a modifying or controlling influence on

Answer 691

OTC topical gel for ED NOTE: may cause localized burning or headache

Answer 692

an initial bump in serum creatinine Note: should stabilized or improves with continued use

Answer 693

semaglutide (ozempic)

Answer 694

Kerendia indications: 1. CKD associated with Type 2 DM 2. Heart Failure

Answer 695

non-steroidal mineralcorticoid receptor antagonist (MRA) blocks the effects of aldosterone --> this helps reduce inflammation and fibrosis (key drivers of organ damage in both the heart and kidneys)

Answer 696

direct contact with the rash, scabs or items with lesion secretions (such as bedding) or through respiratory secretions **but it requires prolong contact such as sharing a bed**

Answer 697

monkey pox vaccine

Answer 698

NO re-infection is very RARE

Answer 699

2 doses - 4 weeks apart **never too late to get second dose**

Answer 700

in general, don't recommend it **apoequorin - an ingredient in prevagen - is a protein and protein will be digested in GI tract and will make it to the brain**

Answer 701

plaque buildup (atherosclerosis) --> in the coronary arteries

Answer 702

plaque build in arteries

Answer 703

NSTEMI * non-ST segment elevation ACS STEMI * ST-segment revelation MI

Answer 704

inflating a small balloon inside a coronary artery to widen and improve blood flow usually a stent (metal mesh) is placed to keep the artery open a non-surgical option used to improved blood flow to the heart (minimally invasive)

Answer 705

medicines alone or PCI (an early invasive strategy)

Answer 706

PCI or Fibrinolysis

Answer 707

Anti-anginal * MONA - morphine, oxygen, nitrates Anti-platelets * aspirin * plavix, prasugrel, ticagrelor Anti-coagulants * GP2b/3a antagonists * Alteplase (Activase)

Answer 708

NSTE-ACS: MONA-GAP-BA +/- PCI STEMI: MONA-GAP-BA + PCI or fibrinolytic (preferred - alteplase) MONA * morphine *oxygen *nitrate *Aspirin (325 mg chewable) GAP * GP2b/3a (eptifibatide - Integrillin) * Anticoagulant: enoxaparin, heparin & bivalirudin (preferred in STEMI) * P2y12 inhibitors: clopidogrel, prasugrel, ticagrelor BA * Beta-blocker (nebivolol, metoprolol ER, carvedilol) * Ace-inhibitor

Answer 709

treatment for STEMI - must use PCI or fibrinolytic (preferred) NSTE-ACS: PCI (optional) and no fibrinolytic

Answer 710

Integrilin (Brand d/c in US) GP2b/3a receptor antagonists * prevent platelet aggregation (can stick to each other)

Answer 711

irreversibly INHIBITS cox-1 and cox-2 * decreases production of thromboxane A2 (TXA2) and prostaglandin (PG) TXA2 - inducer of platelet aggregation * potent vasoconstrictor also

Answer 712

Binds to the platelet ADP-P2y12 receptors --> prevents ADP mediated (causes) activation of the GP2b/3a receptor complex on platelets * ADP - adenosine diphosphate GP2b/3a - platelet aggregations with fibrinogen * clopidogrel: prodrug --> needs CYP2C19 to convert to active drug - Omeprazole and esomeprazole (2C19 inhibitor) * Prasugrel - also a prodrug - higher bleeding risk than plavix - only INDICATED for ACS managed with PCI (stent) - Effient - has stent in drug name * Ticagrelor (Brilinta) - do not use ASA > 81 mg (decrease efficacy, except ASA 325 mg in first dose of ACS tx) - 3A4 substrate (lovastatin, simvastatin keep dose < 40 mg) - tablets can be crushed NG tube

Answer 713

300 to 600 mg * 600 mg --> use if patient PCI

Answer 714

Omeprazole and Esomeprazole 2C19 inhibitors plavix is a prodrug - requires 2C19 conversion to active metabolite

Answer 715

60 mg PO (no later than 1 hour after PCI) MD: 10 mg daily WITH aspirin

Answer 716

in original container

Answer 717

ONLY indicated for ACS management with PCI (balloon and stent) * if CABG --> do not use if CABG likely

Answer 718

if CABG likely --> do not use

Answer 719

Plavix * avoid prasugrel (Effient) and Ticagrelor (Brilinta)

Answer 720

Integrilin GP2b/3a (glycoprotein) receptor antagonist for medical (medication) management of ACS or pt receiving a PCI +/- stent **if use in PCI --> give with heparin**

Answer 721

Thrombocytopenia * low platelet count Severe uncontrolled hypertension * bleeding risk

Answer 722

tPA * tissue plasminogen activator * converts plasminogen to plasmin

Answer 723

protein in blood that dissolves clot

Answer 724

within 30 minutes of hospital arrival

Answer 725

Plavix * guideline recommend using plavix in patient who received fibrinolytics (alteplase)

Answer 726

ASA - indefinitely Medical management: * Plavix or Ticagrelor (Brilinta) for 12 months PCI (stent): * any P2Y12 for 12 months

Answer 727

Naproxen * avoid cox-2 specific (celebrex) - highest risk for CV

Answer 728

plaque build up within the inner wall of coronary arteries ** atherosclerosis**

Answer 729

vasospastic angina ** coronary artery vasospasm**

Answer 730

Antiplatelet - prevent plaque build up * ASA * Plavix * Xarelto (low dose) + ASA Anti-anginal * Beta-blocker * DHP or NDH CCB * Long acting nitrates (Imdur) * Ranolazine - can be added if still symptomatics

Answer 731

inhibits COX-1 and COX-2 (occurs inside platelet) Decrease prostaglandin and thromboxane A2 (TXA2) * TXA2 - a potent vasoconstrictor and inducer of platelet aggregration

Answer 732

P2Y12 inhibitors * blocks binding of ADP (released by platelets) to P2Y12 receptors * this binding causes platelets to express GP2b/3a receptors on surface * GP2b/3a binds to fibrin --> platelet aggregation

Answer 733

omeprazole and esomeprazole inhibits 2C19 2C19 converts Plavix (a prodrug) to active metabolites

Answer 734

decreases myocardial oxygen demand * not for acute treatment of chest pain * no clinical effect on HR or BP **can be used with amiodarone and plaquenil - remember CFP case**

Answer 735

Hypotension Tachycardia * PDE-5 inhibitors - sildenafil and vardenafil 24 hrs apart - tadalafil 48 hours apart * can be use in emergency situation, must monitor BP

Answer 736

Ranolazine is a CYP 3A4 substrate interact with strong 3A4 inhibitor and inducer ** G love PACMAN --> inhibitors** ** PS PORCS --> inducers**

Answer 737

do not shake Prime pump before 1st use, if not used in 6 weeks spray onto or under tongue, close mouth, do not inhale do not spit/rinse mouth for 5 minutes

Answer 738

atorvastatin and rosuvastatin * high intensity means it can lower LDL > 50% from baseline**

Answer 739

Hold med, wait 2 to 4 weeks, re-challenged at same or lower dose can re-challenged twice, second re-challenged at lower dose after 2nd re-challenged --> avoid statin

Answer 740

yes * you can re-challenged twice* * 2nd re-challenged at lower dose*

Answer 741

40 mg * Asian patient - may need to lower dose - exposure are 2x higher in Asian*

Answer 742

40 mg ** do not use 80 mg**

Answer 743

ASL atorvastatin simvastatin lovastatin ** pravastatin and rosuvastatin have less interaction **

Answer 744

amlodipine inhibits 3A4 ASL (ator, simv, lova) - substrate of 3A4 amlodipine can increase level of ASL Max dose: atorvastatin 10 mg simvastatin 20 mg Lovastatin 40 mg ** note: these are also equivalent dose**

Answer 745

CYP 3A4 inhibitors (strong) G - grapefruit P - protease inhibitor (HIV tx) A - azole antifungal C - cyclosporine, cobicstat M - macrolide (x azithromycin) A - amiodarone N - Non DHP CCB

Answer 746

blocks absorption of cholesterol

Answer 747

eGFR < 60 ** do not exceed simv 20 mg**

Answer 748

increase risk of cholelithiasis ** do not use combo**

Answer 749

PCSK9 - is an enzyme that breaks down LDL receptors when it binds to LDL receptors LDL receptors clears circulating LDL ** PCSK9 maB (inhibitors) prevent PCSK9 from binding to LDL receptors

Answer 750

Sequestrant - binds to or absorp Bile acid sequestrants bind to bile acid, prevents its reabsorption Body has to use more cholesterol to make bile acid

Answer 751

cholesterol DIABETES * also approved for glycemic control in type 2 DM * decrease AC1 ~ 0.5%

Answer 752

DO NOT USE when Triglyceride is > 300 mg/dL Bile acid sequestrants increase TG ~ 5%

Answer 753

Mix with water and take with FOOD Take all other drugs at least 4 hours before or 4 hours after bile acid sequestrants

Answer 754

PPAR-alpha agonist upregulate expression of lipoprotein lipase activity (increase activity) Lipoprotein lipase - breaks down VLDL This decreases TG, but can increase LDL in the setting of very high TG

Answer 755

the breakdown of complex molecule in body

Answer 756

decrease TG ~ 50% can increase LDL in the setting of very high TG Gemfibrozil SHOULD NOT be use with ezetimibe or statin

Answer 757

Sulfonylureas * fibrates can increase hypoglycemic affect Warfarin

Answer 758

nicotinic acid Vitamin B3

Answer 759

decrease hepatic synthesis of VLDL decrease TG and decrease LDL

Answer 760

Rhabdomyolysis * when combine with statin when doses > 1 gram/day Hepatotoxicity Increase BG, uric acid

Answer 761

take ASA 325 mg or motrin 200 mg 30 to 60 minutes before niacin take with FOOD, avoid spicy food

Answer 762

omega-3 fatty acids

Answer 763

Reduce hepatic synthesis of TG

Answer 764

Lovaza * increase LDL * contains DHA and EPA Vascepa * EPA - see in name * approved for ASCVD risk reduction * NO LDL increase Both increased risk of bleeding - stop prior to surgery

Answer 765

prolong bleeding time * use caution with other drugs that can increase bleeding risk

Answer 766

inhibits cholesterol synthesis in the liver inhibits an enzyme call ACL * adenosine triphosphate-citrate lyase * upstream of HMG-CoA reductase

Answer 767

bempedoic Acid - approved for HeFH or ASCVD in combo with statin HeFH - Familial Hypercholesterolemia

Answer 768

Hyperuricemia - gout Tendon rupture

Answer 769

inhibits intracellular production of PCSK9 via RNA interference * result in increased activity of LDL receptors PCSK9 - an enzyme that degrades LDL receptors (LDL receptors - clear circulating LDL)

Answer 770

Do not use with PCKS9 mAb due to overlapping moa

Answer 771

Fat-soluble vitamins ADEK

Answer 772

cholelithiasis (gallstone) Pancreatitis

Answer 773

take at bedtime after a low-fat snack

Answer 774

Hyperglycemia Liver Damage Flushing * flush free niacin is not effective

Answer 775

HDL (protein): high density lipo-protein * takes cholesterol from the blood and delivers it to the liver for removal from the body * high HDL lowers ASCVD risk Desirable level > 40 (men) > 50 (women)

Answer 776

acute pancreatitis

Answer 777

LDL < 100 * > 190 is very high HDL * > 40 men * > 50 women TG < 150 * > 500 is very high

Answer 778

Fibrates Fish oils (x Vascepa)

Answer 779

Red yeast rice - contains naturally occurring HMG-CoA reductase inhibitors (statin) Fish oils - can lower TG - INCREASE LDL Garlic - marketed BUT NOT effective

Answer 780

Rosuvastatin: 5 mg Atorvastatin: 10 mg Simvastatin: 20 mg Lovastatin: 40 mg Pravastatin: 40 mg ** lovastatin and pravastatin 1:1 ratio

Answer 781

aka primary hypertension - cause of hypertension is unknown - about 90% of all hypertension is essential HTN

Answer 782

Norepinephrine (NE) * SNS - increase BP, HR Angiotensin II * II --> looks like Blood vessel * aldosterone secretion -> increase Na and water * vasoconstriction Aldosterone * increase Na and water retention

Answer 783

increase norepinephrine NE SNS stimulation

Answer 784

SBP < 120 AND DBP < 80 120/80 Key word is AND

Answer 785

SBP > 130 OR DBP > 80 Remember: normal BP is SBP < 120 AND DBP < 80 ** DBP > 80 is consider HTN ** SBP > 130

Answer 786

Thiazide diuretic ** preferred in BLACK without CKD DHP CCB ** preferred in BLACK without CKD ACE-I or ARB * * preferred in CKD eGFR < 60

Answer 787

Labetalol Nifedipine ER Methyldopa ** methyldopa - less effective **do not use ACE or ARB

Answer 788

new onset HTN after 20 weeks gestation ** pre-eclampsia is further characterized by the presence of proteinuria

Answer 789

ASA 81 mg daily after first-trimester Pre-eclampsia - new onset HTN after 20 weeks of pregnancy with the presence of proteinuria

Answer 790

Thiazide - one of the four preferred agents for HTN regimen Loop - primarily in heart failure patients - think water pill (edema)

Answer 791

inhibits Na and Water REABSORPTION in the distal convoluted tubules increase excretion of: Na and Water Na and CL = NaCL Potassium = hypokalemia

Answer 792

Increase LDL and TG * affect cholesterol increase BG * diabetes Increase CA and UA --> gout

Answer 793

25 mg dose > 25 mg have limited clinical benefits and increase SE

Answer 794

50 mg dose > 50 mg have limited clinical benefits and increase SE

Answer 795

Chlorthalidone ** more effective at lowering BP due to LONGER duration of action and increased POTENCY**

Answer 796

NSAID - cause body to retain water and sodium decrease thiazide effectiveness increase BP (Na and water retention)

Answer 797

Thiazide decreased LITHIUM clearance monitor or decrease Lithium dose

Answer 798

Dihydropyridine CCB Non-dihydropyridine CCB N❤️N = heart

Answer 799

N❤️N-DHP CCB are more selective for heart muscle Decreased BP are due to: - negative inotrope (decrease force of contraction) - negative chronotrope (decrease rate HR)

Answer 800

do not use for chronic HTN or ACUTE reduction in HTN ** significant hypotension, MI and/or DEATH has occur

Answer 801

Nifedipine ER

Answer 802

control HR - in arrhythmia (ex: AFib) Vasospastic angina

Answer 803

Diltiazem (Cardizem CD) Verapamil (Calan, Verelan)

Answer 804

Heart Failure - Worsen

Answer 805

Constipation (more with verapamil) Edema (more with diltiazem)

Answer 806

Diltiazem, Verapamil, Amlodipine - inhibits 3A4 Statin - metabolized by 3A4 increase STATIN level ** use statin not metabolized by 3A4: pravastatin, rosuvastatin ASL - atorvastatin, simvastatin, lovastatin

Answer 807

Angiotensin II - constrict the efferent arteriole in the nephron - decreased filtration pressure and workload in the glomerulus ARB and ACE-I blocks the vasoconstricting affect to the efferent arteriole by angiotensin II efferent arteriole vs afferent arteriole ** efferent - E - Escape: takes blood away **afferent - A - Accept: brings blood to glomerular

Answer 808

Efferent = E = Escape --> takes blood away Afferent = A = Accept --> brings blood to glomerular

Answer 809

protects the heart muscle from the remodeling effects of angiotension II

Answer 810

angiotensin II causes: VASOconstriction aldosterone secretion: results in sodium and water retention ** note: aldosterone --> increase K secretion * aldosterone inhibitor (spironolactone) --> retains K

Answer 811

Entresto + ACE = need a 36 hours washout period Entresto + ARB = no wash out period, start at next dose

Answer 812

blocks angiotensin II from binding to AT1 receptor --> prevents vasoconstriction blocks angiotensin II from binding to AT1 receptor on ADRENAL gland --> prevents aldosterone release Aldosterone --> increase Na and water retention and K secretion

Answer 813

Keep in original container

Answer 814

can cause sprue-like enteropathy ** severe, chronic DIARRHEA with substantial weight loss sprue - a condition that affects the intestine ability to absorb nutrients causing diarrhea

Answer 815

ARB and ACE-I prevents Angiotensin II binding to AT1 receptors on the ADRENAL gland Angiotensin II causes the release of aldosterone Aldosterone causes Na and Water retention (increase BP) Aldosterone also cause K excretion (hypokalemia) **if you block aldosterone --> no K excretion --> HYPERKALEMIA

Answer 816

Potassium sparing diuretics MOA: aldosterone-receptor antagonist * aldosterone causes Na and water retention, also increases K excretion By blocking aldosterone --> NO sodium and water retention (excretion) and NO K excretion (retain K)

Answer 817

eplerenone - selective aldosterone receptor antagonist (NO androgen side effects such as gynecomastia)

Answer 818

Eplerenone is a MAJOR substrate of CYP3A4 * do not use with strong 3A4 inhibitors G❤️PACMAN Grapefruit Protease inhibitor Azole antifungal Cyclosporine, Cobicstat Macrolide (x azithro) Amiodarone Non-DHP CCB

Answer 819

decrease HR and myocardial contractility | **similar to NON-DHP CCB** ## Footnote Note recommended first line for HTN - unless pt has comorbid conditons (Post-MI, stable angina, HT)

Answer 820

Carvedilol Labetalol | alpha-1 blockade --> decreased peripheral vasoconstriction

Answer 821

Bisoprolol Carvedilol Metoprolol Succinate | **not metoprolol tartrate (lopressor)**

Answer 822

Use the same total daily dose 1:1

Answer 823

can worsen hypoglycemia and mask symtoms of hypoglycemia | masked: shakiness, palpitation, anxiety some beta-blockers can decrease ## Footnote sweating and hunger will still be present

Answer 824

Propranolol has high LIPID solubility (lipophilic) | able to cross blood brain barrier

Answer 825

to decrease rate of absorption to decrease orthostatic hypotension

Answer 826

Coreg 3.125 mg BID = Coreg CR 10 mg daily | not 1;1 conversion

Answer 827

stimulate PRE-synaptic alpha-2 adrenergic receptors in brain | works as a negative feedback --> decreases NE

Answer 828

methyldopa

Answer 829

direct vasodilator of arterioles | little effect on veins

Answer 830

concurrent use of MAO inhibitors

Answer 831

DILE | drug-induced lupus erythematosus (LUPUS)

Answer 832

DILE (lupus)

Answer 833

build up of fluid in the pericardium | pericardium - double layer saclike structure around the heart ## Footnote minoxidil: can cause pericardial effusion must use with beta-blocker and loop diuretics

Answer 834

potent vasodilator | like hydralazine

Answer 835

Hair growth Tachycardia (fast HR) Fluid retention (vasodilation)

Answer 836

alpha-1 blockers peripheral vasodila | inhibitors alpha-1 adrenergic receptors (peripheral) ## Footnote peripheral vasodilation of arterioles and veins

Answer 837

NOT recommended in HTN | may be use in MEN with HTN and BPH

Answer 838

BP > 180/120 | two types: hypertensive emergency and hypertensive urgency

Answer 839

Chest PAIN, pressure, tightness or discomfort | usually cause by ischemia of the heart muscle

Answer 840

Stable angina * predictable chest pain - brought on by exertion or stress * Relieved with minutes by rest or NTG Unstable angina * ACS - acute coronary syndrome (medical emergency) * chest pain increases and NOT relieved with NTG or REST

Answer 841

Atherosclerosis | plaque build up within the inner walls of the coronary arteries ## Footnote known as: CAD

Answer 842

atherosclerosis (plaque) build up within the inner walls of the coronary arteries

Answer 843

1. antiplatelet agents (for secondary prevention) 2. anti-anginal (to prevent chest pain) | Antiplatelet: ASA, plavix or low dose xarelto + asa

Answer 844

Dual Antiplatelet Therapy * not useful in secondary prevention in patient with stable angina * only after ACS or PCI

Answer 845

to reduce the risk of cardiovascular events in SELECT patients with CAD or PAD

Answer 846

Beta blocker * more efffective than nitrates and ccb DHP or NON-DHP CCB * DHP preferred when used with beta-blockers * avoid nifedipine IR - short acting DHP * Preferred for vasospastic angina Nitrates (Imdur, Isordil) * vasodilation of veins more than arterioes * a nitrate free interval is required to prevent tolerance Ranolazine (Ranexa) * decrease myocardial oxygen demand * as an add-on after the above

Answer 847

QT prolongation | seen: used with amiodarone (QT prolongation)

Answer 848

NO | Not for acute treatment of CP ## Footnote Has little to no effects on HR or BP

Answer 849

inhibits COX-1 and COX-2 enzymes decreases prostaglandin (PG) and thromboxane A2 (TXA2) | TXA2 - inducer of platelet aggregation ## Footnote PG - increase blood flow to kidney * NSAID - damage kidneys

Answer 850

inhibits P2Y12 receptors * prevents binding of ADP-P2Y12 receptors on surface of platelets

Answer 851

indefinitely | decrease CV events and death

Answer 852

ASA 325 mg loading dose

Answer 853

decrease effectiveness of plavix * plavix is a prodrug - converted to active by CYP2C19 * omeprazole/esomeprazole - inhibits CYP2C19

Answer 854

Both produce vasodilation lower BP leading to fainting and death | sildenafil, vardenafil: 24 hours apart from nitrate tadalafil: 48 hours ## Footnote can be use together in emergency --> monitor BP

Answer 855

Ranolazine - major substrate of CYP 3A4 Avoid strong 3A4 inhibitors

Answer 856

occurs when the heart is not able to supply sufficient oxygen rich blood to the body | SX: fluid overload (edema), shortness of breath

Answer 857

Ejection Fraction < 40% | normal: EF > 55%

Answer 858

1. Vasoconstriction 2. aldosterone release: Na and water retention, K excretion 3. Vasopression release from pituitary gland: vasoconstriction and water retention

Answer 859

sacubitril - a neprilysin inhibitor neprilysin is an enzyme that breaks down vasodilatory peptides (natriuretic peptides), bradykinin if you inhibit neprilysin --> you get vasodilation and diuresis (decrease edema)

Answer 860

entresto 93/103 BID

Answer 861

40 mg daily

Answer 862

20 mg BID | enalapril and quinapril - same target dose

Answer 863

10 mg daily

Answer 864

1. Candesartan (Atacand) 2. Losartan (Cozaar) 3. Valsartan (Diovan)

Answer 865

32 mg daily

Answer 866

150 mg daily (heart failure) | max: 100 mg, in heart failure = 150 mg target dose

Answer 867

160 mg BID

Answer 868

can decrease lithium clearance

Answer 869

1. Metoprolol ER --> lopressor is not recommended 2. Bisoprolol 3. Carvedilol (Ir or ER) | beta-blockers are recommended for all patient with HF ## Footnote only d/c if pt has decompensated HF, hypotension or hypoperfusion

Answer 870

200 mg daily

Answer 871

10 mg daily

Answer 872

< 85 kg (190 lb): 25 mg BID > 85 kg (190 lb): 50 mg BID | typical adult obese male will be greater than 85 kg (190 lb) ## Footnote look at me

Answer 873

metoprolol ER sprinkle | can open and sprinkle onto applesauce

Answer 874

50 mg daily

Answer 875

50 mg daily | Eplerenone and spironolactone: same target dose

Answer 876

Eplerenone * selectie aldosterone receptor antagonist * MAJOR SUBSTRATE of CYP3A4 - avoid strong inhibitors * increase TG Spironolactone * endocrine side effects (no selective) * less side effects | Same target dose: 50 mg daily

Answer 877

K > 5 mEq/L eGFR (CrCL) < 30

Answer 878

Hyper-kalemia Increase Serum Creatinine

Answer 879

Reduced sodium reabsorption --> diuresis Decreases preload and afterload

Answer 880

Dapagliflozin (Farxiga): 10 mg daily Empagliflozin (Jardiance): 10 mg daily

Answer 881

Blocks Na and Chloride reabsorption in the loop of Henle Increase excretion: * Sodium and Chloride * Potassium --> hypokalemia * Magnesium * Calcium

Answer 882

Dual SGLT1 and 2 inhibitor Sotagliflozin | S = multiple (SGLT1 and SGLT2)

Answer 883

FTB Furosemide Torsemide Bumetanide

Answer 884

600 mg per day

Answer 885

10 mg per day

Answer 886

200 mg per day

Answer 887

1. ototoxicity 2. Acute kidney injury - due to volume depletion

Answer 888

1. Uric Acid (UA) --> gout 2. Blood glucose --> monitor in diabetics 3. TG and total cholesterol

Answer 889

FTB Furosemide 40 mg = Torsemide 20 mg = bumetanide 1 mg

Answer 890

Ratio 1:2 Furosemide 20 mg IV = Furosemide 40 mg PO

Answer 891

Hydralazine + Isosorbide Dinitrate Hydralazine - direct arteriole vasodilator (decrease afterload) Isosorbide DN - venous vasodilator (decrease preload) ## Footnote Not recommended along in tx of HF

Answer 892

DILE - drug induced lupus

Answer 893

Ivabradine Iva-Brad-ine = bradycardia disrupt current in SA node --> decrease rate of firing and ULTIMATELY decreases HR ** DECREASE HEART** - BRADYCARDIA

Answer 894

NO **loop diuretics are for symptomatic relief only**

Answer 895

HR: 50 to 60 BPM

Answer 896

Inhibits Na/K ATPase Pump Clinical Effects: * Positive inotrope (stronger heart) --> increase CO * Negative chronotrope (decrease HR) For symptomatic relief, does not improve survival

Answer 897

In patient with Atrial Fib (rate control), HFrEF and low blood pressure

Answer 898

Potassium 4-5 mEq/L Magnesium > 2 mEq/L

Answer 899

0.5 - 0.9 ng/mL

Answer 900

Klor-Con M can be dissolve in water (stir for 2 minutes and drink) | K-Tab and Klor-Con M = interchangeable at CDCR

Answer 901

3.5 to 5 mEq/L

Answer 902

magnesium level

Answer 903

blood flow to an area of the brain is interrupted

Answer 904

Ischemic stroke Hemorrhagic Stroke

Answer 905

1. thrombus (localized clot) - similar to MI 2. Embolus - a clot that forms in the heart and travels to the brain

Answer 906

bleeding in the brain

Answer 907

AKA: tissue plasminogen activator (tPA) MOA: binds to fibrin in a thrombus (clot) an converts plasminogen to plasmin, resulting in fibrinolysis

Answer 908

Bleeding risk 1. Active internal bleeding (ex: head trauma, surgery) 2. Severe HBP > 185/110 mmHg * make sure BP is < 185/110 * treat with IV labetalol, nicardipine 3. Labs (INR and platelet counts) 4. Anticoagulant (is patient taking any anticoagulant)

Answer 909

0.9 mg/kg (max 90 mg) tPA: t = 10% administe 10% of the calculated dose as a bolus over 1 minute infuse the remainder over 60 minutes ## Footnote must rule out hemorrhagic stroke

Answer 910

1. active internal bleeding 2. history of recent stroke (within the past 3 months) 3. uncontrolled HTN BP > 185/110 4. Labs: INR > 1.7, low platelet counts < 100,000 5. Tx with LMWH (within 24 hours), direct thrombin inhibitor or direct factor Xa (within last 48 hours) 6. Blood glucose < 50

Answer 911

ASA should not be given within 24 hours of alteplase

Answer 912

Prasugrel (Effient) | C/I in anyone with hx of stroke --> increase risk of bleeding

Answer 913

ASA Aggrenox (asa + dipyridamole) clopidrogel ASA + plavix: stop after 90 days ASA + ticagrelor (brilanta): stop after 30 days

Answer 914

inhibits platelet aggregation

Answer 915

Headache | dipyridamole - causes vasodilation

Answer 916

Increased intracranial pressure (ICP) | caused by increased blood flow in the intracranial space

Answer 917

IV osmotic theray - hypertonic SALINE NaCL 3% NaCL 23.4% MANNITOL | draws water of the brain into the blood vessels for renal excretion

Answer 918

bleeding in the space between the brain and the surrounding membrane (subarachnoid space) | space between brain and skull

Answer 919

Nimodipine (Nymalize) | amlodipine has been use also

Answer 920

60 mg Q4H for 21 days

Answer 921

Empty stomach 1 hr before or 2 hours after meal

Answer 922

DO NOT ADMIN IV or by parenteral routes Death have occurred

Answer 923

1. Prevent blood clots 2. keep existing clots from becoming larger **they do not break down clots (Fibrinolytics = alteplase)**

Answer 924

1. VTE - Venous Thromboembolism (DVT) 2. PE - pulmonary embolism | Prevent and tx: DVT and PE ## Footnote immediate tx of ACS and prevention of cardioembolic stroke

Answer 925

a clot that travel

Answer 926

Coagulation - the process by which blood clots from

Answer 927

Fibrin Fibrin strands crosslink to hold the clot together | Blood clot - a solid mass of blood component (platelet and protein)

Answer 928

FACTOR 2, 7, 9, 10 | 2 + 7 = 9 and 10

Answer 929

**Factor Xa** Factor Xa converts Prothrombin (II) to Thrombin (2a) Thrombin (2a) --> converts Fibrinogen to Fibrin (end goal)

Answer 930

Thrombokinase

Answer 931

Oral Anticoagulant (Warfarin, DOAC) --> mainly for * AF (for stroke prevention) * DVT/PE (treatment and prevention) Parenteral anticoagulant * Acute tx of ACS * Prevention and treatment of DVT/PE | Parenteral --> can be use in ACS

Answer 932

ACS - platelet aggregation is the main target of drug therapy USE antiplatelet

Answer 933

CAD (coronary artery disease) --> in ACS Prevent recurrent ischemic stroke ## Footnote NOT sufficient to treat DVT and PE

Answer 934

DOACs are preferred for STROKE prevention in patient with AF DOACs are preferred for VTE treatment

Answer 935

Mechanical heart valve or triple-positive antiphospholipid syndrome

Answer 936

vitamin K antagonist Vitamin K is required for the activation of clottin factors 2, 7, 9, and 10

Answer 937

Antithrombin (AT) **This is the body's natural ANTI-COAGULANT** INACTIVE: FACTOR 2A (THROMBIN) and Xa (Thrombokinase) | Anti-thrombin: essential to understand moa of heparin and LMWH (lovenox)

Answer 938

Binds to Antithrombin (AT) - the body's natural anti-coagulant Cause a conformational change --> which increases AT activity Antithrombin (AT) --> inactive Xa and 2a Xa --> converts Prothrombin (2) to Thrombin (2a) Thrombin (2a) --> converts Fibrinogen to Fibrin (end goal) | WORKS indirectly via antithrombin (AT)

Answer 939

Thrombin | Thrombin => making thrombus (clot)

Answer 940

ProThrombin

Answer 941

direct Factor Xa inhibitor DOAC = direct-acting oral anticoagulants Review: Xa --> converts Prothrombin (2) to Thrombin (2a) Thrombin 2a --> converts Fibrinogen to Fibrin (end goal) --> crosslink fibrin strands

Answer 942

Direct THROMBIN (2A) inhibitor Do not cross-react with Heparin Induced Thrombocytopenia (HIT) antibodies Review: Thrombin (2a) Thrombin (2a) --> converts fibrinogen to fibrin (cross-liken fibrin strands)

Answer 943

oral Direct Thrombin (2a) Inhibitor NOT Xa inhibitor (eventhough in name Xa) Review: Thrombin (2a) --> converts fibrinogen to fibrin (end goal - crosslink fibrin strands)

Answer 944

nose bleed

Answer 945

blood in vomit

Answer 946

blood in urine

Answer 947

5,000 units SC every 8 to 12 hours

Answer 948

80 units/kg IV bolus follow by 18 units/kg/hour infusion

Answer 949

60 units/kg IV bolus follow by 12 units/kg/hour infusion

Answer 950

TOTAL BODY WEIGHT

Answer 951

NO Risk of hematoma

Answer 952

Platelet --> thrombocytopenia (HIT) anti-Xa level (antithrombin): check 6 hours after initation | anti-Xa level: 0.3-0.7 units/ml

Answer 953

to keep IV line opens usually available as: 10 or 100 units per ml

Answer 954

40 mg SC daily

Answer 955

**1 mg/kg SC every 12 hours (outpatient)** 1.5 mg/kg SC daily (inpatient)

Answer 956

30 mg IV bolus plus 1 mg/kg SC dose follow by 1 mg/kg SC Q12H (max 100 mg for the first 2 SQ dose | same as outpatient tx of NSTEMI + 30 mg IV bolus

Answer 957

1. Platelets - thrombocytopenia (HIT) 2. Bleeding: HgB and Hct

Answer 958

NO hematoma

Answer 959

Thrombosis Pro-coagulant state * heparin - is an anticoagulant --> but in this case can increase risk for thrombosis

Answer 960

HIT The immune system forms antibodies against Heparin. The complex (antibodies + heparin + platelets) --> causes platelet activation --> procoagulant state

Answer 961

Argatroban for management of HIT complicated by thrombosis

Answer 962

d/c warfarin and administer vit K why --> warfarin + low platelet --> high risk of warfarin-induced limb gangrene and necrosis Do not restart warfain until platelet > 150,000

Answer 963

Bivalirudin preferred anti-coagulant in this case

Answer 964

Fondaparinux indirect inhibitor of factor Xa via binding to AT

Answer 965

Eliquis (apixaban) Xarelto (rivaroxaban)

Answer 966

Fondaparinux Indirect factor Xa inhibitor via binding to AT

Answer 967

5 mg BID | mechanical heart valve: use WARFARIN

Answer 968

10 mg BID x 7 days then 5 mg BID

Answer 969

age > 80 years body weigt < 60 kg (120 lb) = small or SCr > 1.5 mg/dl | must meet 2 of the above

Answer 970

eliquis is dose twice daily take immediately on same day (dose should not be double) Resume twice daily dosing

Answer 971

IF: 15 mg BID --> can take both tablets together IF: once daily --> take immediately on the same day, otherwise skip

Answer 972

CrCL -- 50 mL/min CrCL > 50: 20 mg daily CrCL < 50: 15 mg daily

Answer 973

20 mg daily

Answer 974

2.5 mg SC daily

Answer 975

5 mg SC daily

Answer 976

CrCL < 30 mL/min

Answer 977

substrates of CYP and p-gp Avoid strong CYP inducers and inhibitors G❤️PACMAN = inhibitors PS PORCS = Inducers

Answer 978

1. Pradaxa (Dabigatran) 2. Argatroban 3. Bivalirudin (Angiomax)

Answer 979

150 mg BID

Answer 980

CrCL CrCL < 30: use 75 mg BID

Answer 981

Praxbind (Idarucizumab) | Praxbind = bind to pradaxa

Answer 982

in original container NOTE: discard 4 months after opening

Answer 983

for HIT and in patients undergoing PCI who are at risk for HIT

Answer 984

no cross-reaction with HIT antibodies Safe with active HIT or history of HIT

Answer 985

take immediately on same day do not double dose the next day to make up for a missed dose

Answer 986

in general, contraindicated except: mechanical heart valve at high risk for thromboembolism

Answer 987

INR: 2 to 3 (target 2.5)

Answer 988

INR: 2.5 to 3.5 (target 3)

Answer 989

after 3rd dose

Answer 990

Strong CYP Inducer and Inhibitors G❤️PACMAN = inhibitors PS PORCS = inducers

Answer 991

decrease dose of warfarin by 30 to 50% Amiodarone = inhibitor

Answer 992

warfarin takes about 5 days to reach steady state Continue both for a minimum of 5 days (can be longer) and until the INR > 2 for at least 24 hours (measure on 2 consecutive days)

Answer 993

Phenytoin Valproic Acid

Answer 994

combines with Heparin or LMWH to form a stable complex neutralizing anticoagulant effect

Answer 995

1 mg protamine = will reverse 100 units of heparin Consider only heparin given in the last 2.5 hours Max protamine dose: 50 mg

Answer 996

1 mg protamine = will reverse 1 mg of enoxaparin Consider only enoxaparin given within last 8 hours > 8 hours: use 0.5 mg protamine

Answer 997

5 gm IV given as 2 separate 2.5 gm doses no more than 15 minutes apart

Answer 998

IV infusion only: slow infusion rate no more than 1 mg/min SC and IM - not recommended

Answer 999

Kcentra or Balfaxar URGENT REVERSAL OF WARFARIN contains Factor 2, 7, 9, 10 and Protein C and S Administer with vitamin K

Answer 1000

1. Slow infusion: no more than 1 mg/min 2. dilute dose in minimum of 50 ml compatible solution and infusion over 20 minutes

Answer 1001

Reduce or skip warfarin dose Resume warfarin when INR therapeutic Dose reduction may not be needed

Answer 1002

NO bleeding: routine use of vitamin K is not recommended Hold 1 to dose: monitor INR - resume at lower dose when INR therapeutic level Vitamin K (less than 5 mg) can be used if urgent surgery or if bleeding risk is high (vit k 1 mg or 2.5 mg)

Answer 1003

HOLD warfarin Give vitamin K (2.5 mg or 5 mg) EVEN IF NOT BLEEDING Monitor INR - resume at lower dose when INR therapeutic

Answer 1004

HOLD warfain Give vitamin K (5 to 10 mg) by slow IV infusion (in 50 ml compatible solution) AND Four Factor Prothrombin Complex Concentrate (PCC) PCC - preferred with FFP (fresh frozen plasma) due to risks of allergic reactions

Answer 1005

Antiplatelet P2Y12 Inhibitor (plavix, ticagrelor, prasugrel)

Answer 1006

LMWH NOTE: * Warfarin is teratogenic * pregnant with mechanical heart valve: can use warfarin after 13 weeks --> change back to LMWH close to delivery * DOAC and Pradaxa (direct thrombin inhbitor) --> has not been studied in pregnancy

Answer 1007

decrease in RBC, hemoglobin (Hgb) and/or Hematocrit (Hct) below the normal range

Answer 1008

Iron-rich protein inside RBC Carries oxygen NOTE: that's why we use iron for anemia

Answer 1009

an percentage percent of RBC volume compared to total blood volume

Answer 1010

Reticulocytes --> immature RBC form in the bone marrow Erythrocytes --> mature RBC Think: reticulocytes is the baby and mature into erythrocytes

Answer 1011

1. Impaired RBC or Hgb production 2. Increased RBC destruction (hemolysis) 3. Blood loss

Answer 1012

1. Iron 2. Folate 3. Vitamin B12

Answer 1013

RBC destruction

Answer 1014

Ferrous gluconate: 12% --> least nausea & GI symptoms Ferrous Sulfate: 20% Ferrous Fumarate: 33% Carbonyl Iron, polysaccharide iron complex: 100%

Answer 1015

No difference in efficacy or adverse effects between products

Answer 1016

Poor absorption --> not recommended NOTE: does cause less GI side effects

Answer 1017

Deferoxamine (Desferal)

Answer 1018

Acidic stomach --> best for iron absorption H2RA, PPI and antacids - can decrease iron absorption, separate by 4 hours Vitamin C --> provides acidic environment - may increase absorption

Answer 1019

Binding Quinolone, tetracycline Bisphosphonate Levothyroxine Integrase strand transfer inhibitors (INSTI)

Answer 1020

microcytic anemia - iron deficiency macrocytic anemia - vitamin B-12 or folate deficiency

Answer 1021

pernicious anemia: an autoimmute disorder antibodies to intrinsic factor - requires for adequate B12 absorption Pernicious anemia - the most common cause of B12 deficiency

Answer 1022

metformin H2RA PPI

Answer 1023

1. Cognitive Impairment 2. Peripheral neuropathy

Answer 1024

1,000 to 2,000 mcg daily

Answer 1025

Folic acid = vitamin B9

Answer 1026

Folic Acid 0.4 mg to 5 mg daily 5 mg daily is okay

Answer 1027

EPO - a hormone produced by kidneys that stimulates the bone marrow to produce RBC NOTE: ESA (erythropoiesis-stimulating agent) --> initiated when the Hgb is < 10 g/dL

Answer 1028

Epogen Procrit

Answer 1029

50 to 100 units/kg IV or SC 3 times a week **Just remember 100 units/kg **

Answer 1030

HgB level > 11 g/dL **only start if Hgb level < 10 g/dl** Hypertenison VTE risk

Answer 1031

Jesduvrog an ORAL ESA for CKD patients who have been receiving dialysis for at least 4 months

Answer 1032

Aranesp ESA (erythropoiesis stimulating agent) = same as Procrit, Epogen

Answer 1033

darbepoetin half-life is 3x longer than epoetin darbepoetin can be dose weekly vs 3 times weekly with epoetin

Answer 1034

HD: 0.45 mcg/kg IV or SC WEEKLY or 0.75 mcg/kg IV or SC every 2 weeks **Non-HD: 0.45 mcg/kg IV or SC every 4 weeks** **NOTE: every 4 weeks if patient is not on hemo-dialysis**

Answer 1035

detects antibodies that are stuck to the surface of RBC antibodies (to medication) --> binds to surface of RBC and trigger RBC destruction **Immune mediated hemolysis**

Answer 1036

21 days Once vial is open (store in frig)

Answer 1037

Immune-Mediated (Positive Coombs test) 1. Penicillins 2. Cephalosporins 3. Isoniazid 4. Levodopa 5. Methyldopa 6. Rifampin 7. Sulfonamide G6PD deficiency 1. Dapsone 2. Nitrofurantoin 3. Sulfonamides

Answer 1038

G6PD - an inherited disorder G6PD = an enzyme that protects RBC from oxidant injury Without sufficient G6PD --> RBC hemolyze after exposure to oxidative stress

Answer 1039

Blood clot Hypertension

Answer 1040

Belly Upper Arm Anterlateral Thigh (front)

Answer 1041

RBC contains ADULT HEMOGLOBIN A = HgbA RBC shapes like a donut without the hole Sickle cell disease (SCD) = RBC contains ABNORMAL hemoglobin called Hemoglobin S * HgbS = sickle hemoglobin * Abnormal hemoglobin froms strand - have "sickle" shape RBC * Sickle RBC - hemolyze after 10 to 20 days = anemia What is hemoglobin? * iron-rich protein found in RBC = carries oxygen

Answer 1042

Protein Iron-rich protein found inside RBC - carries oxygen

Answer 1043

vascular occulsion by sickle RBC leading to ischemia

Answer 1044

blockade of smaller blood vessels by sickle cell RBC ** irregular shape RBC stick together and blocks blood vessels**

Answer 1045

vascular occlusion causing chest pain and pulmonary infection

Answer 1046

1. Removal of old or damage RBC 2. Immune Function * Storing WBC and removing pathogen 3. Pathogens: * Streptococcus pneumoniae * Haemophilus influenza * Neisseria meningitidis

Answer 1047

1. Chest pain 2. Avascular necrosis (bone death) 3. Pulmonary HTN 4. Renal Impairment

Answer 1048

decreased or absent of spleen function (not no spleen) In SCD: spleen becomes fibrotic and shrinks in size due to repetitive sickling and infarctions * typically first year of life

Answer 1049

1. immunization - due to asplenia 2. Antibiotics 3. Chelation therapy (iron overload from blood transfusion) 4. Analgesics (pain due to vascular occlusion)

Answer 1050

Stimulate production of HgbF F - fetal hemoglobin IN SICKLE CELL DISEASE (SCD) * reduces the frequency of acute pain crises * acute chest pain * need for blood transfusion recommended for all pediatric > 9 months

Answer 1051

HydroxyUREA disease modifying therapy

Answer 1052

Once daily

Answer 1053

35 mg/kg/day

Answer 1054

Absolute Neutrophil Counts ANC 2,000 to 4,000 cells/mm

Answer 1055

Myelosuppression (decrease WBC and platelets)

Answer 1056

1. Fetal toxicity (pregnancy) 2. Avoid live vaccines 3. Pulmonary toxicity

Answer 1057

CBC: if ANC < 2,000 hold until bone marrow recover the restart at a dose of 5 mg/kg/day

Answer 1058

Contraception required for male and female during treatment and for 12 months after treatment

Answer 1059

3 to 6 months

Answer 1060

L-Glutamine -> an amino acid shown to reduce acute complication of SCD MOA: decrease oxidative stress which can damage sickled RBC

Answer 1061

inhibits hemoglobin S (Hgb S) polymerization --> prevents RBC sickling INDication: SCD

Answer 1062

mab = monoclonal antibody Binds and inhibits P-Selectin P-Selectin --> involved in adhesion of sickled erythrocytes to vessels (causing vaso-occlusion) Dose: 5 mg/kg IV every 2 weeks for 2 doses, then 5 mg/kg IV every 4 weeks

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