study tip gal

Daytrana (QAM 2h before school)
Nicoderm
Exelon
Neupro
Emsam
Androderm (nightly)
Daily Patches

Lidoderm (1-3 on for 12 h - 12 h off)
Nitroglycerin (on for 12-14 h - 10-12 h off)

Flector

Alora, Vivelle-Dot
Oxytrol

Butrans
Catapres-TTS
Climara, Menostar
ClimaraPro
Xulane (qwk for 3 wks - 1 wk off)

Duragesic (q72h or q48h)
Transderm Scop (q72h)

2 patient identifiers (name, DOB, MRN)

Report critical test results

Label all medications

Anticoagulant therapy safety measures

Med information (med rec + D/C counseling)

Prevent HC-associated infections

CDC hand hygiene

Must test, and if positive, desensitize

PCN is the only acceptable treatment

May use 2nd or 3rd gen cephalosporin

Cefdinir, Cefpodoxime, Ceftriaxone, Cefuroxime

Abacavir

If (+) --> risk of fatal hypersensitivity
(Test ALL patients prior)

Allopurinol

If (+) --> risk of SJS
(Consider testing in Korean + renal impairment, Han, or Thai)

Carbamazepine, Oxcarbazepine, Phenytoin

If (+) --> risk of SJS/TEN
(Test all Asian pts prior to Carbamazepine)

Clopidogrel

If *2 or *3 --> Poor metabolizers
(consider alt tx)

Codeine

Ultra-rapid --> risk of OD

Warfarin

If CYP*2 or *3 or VKOR G>A --> increased bleeding risk
(start with lower dose)

Trastuzumab

HER2 (-) --> drug not effective

Cetuximab

If KRAS (+) --> Do not use

Azathioprine

TPMT activity low/absent --> risk of myelosuppression
(Use lower dose or consider alt tx)

Capecitabine, Fluorouracil

If DPD deficient --> risk of toxicity
(Do not use)

Agitation - Sedatives (BZDs)
Bradycardia - Atropine, inotropes
Seizure - BZDs
Hypertension - IV vasodilator
Hypoglycemia - Dextrose
Hypotension - IVF, vasopressors
QRS widening - Sodium bicarb
Sedation - Intubation

140 mg/kg x 1
70 mg/kg q4h x 17

(Repeat dose if emesis w/i 1 h of dose)

150 mg/kg over 60 min
50 mg/kg over 4 h
100 mg/kg over 16 h

Metformin
SGLT2 Inhibitors

<IBW --> TBW

Normal weight --> IBW

OW/Obese --> AdBW

WHO - All pts w/ albuminuria
WHY - Prevent KD progression
HOW - Inhibit RAAS --> efferent arteriole dilation
WHAT - Dec. pressure in glomerulus, dec. albuminuria, CV protection

CA BIG K Drop

Stabilize - Ca gluconate

Move it - Albuterol, Bicarb, Insulin, Glucose

Remove it - Kayexelate, Furosemide, Patiromer, Dialysis

Acute
Fecal-Oral
Vaccine

Tx - Supportive

Acute + Chronic
Blood, body fluid
Vaccine

Tx - PEG-INF or NRTI (tenofovir, entecavir)

Acute + Chronic
Blood, body fluid
NO vaccine

Tx-naive - DAA combo
(select pts - DAAs + RBV or DAAs + RBV + PEG-INF)

-previr

(P for PI)

-asvir

(A for NS5A)

-buvir

(B for NS5B)

PIG (Protease Inhibitors + Grub)

TAKE WITH FOOD
(except elbasvirrazoprevir and fosamprenavir PO susp)

Harvoni
Epclusa
Vosevi

HBV, HCV
Some cancers

(No cure and not well tolerated)

Multiple Sclerosis

Honey, Bring Vi a LATTE

Lamivudine
Adefovir
TDF
TAF
Entecavir

AST = 2x ALT

Inc. AST/ALT, Alk Phos, Tbili, LDH, INR

Dec. Albumin

Inc. AST/ALT

Usually can be given at same time/visit

Multiple live vaccines given on SAME DAY or spaced 4 wks

It is better to extend rather than shorten

WIth Asplenia, Prevnar and Menactra separated by 4 weeks

No separation required for PO rotavirus vaccines

Vaccines -- 2 weeks --> Ab product

Ab product -- 3 months --> vaccine

Simultaneous administration of both is rec for PEP of Hep A, Hep B, rabies, tetanus

Mild illness
Current Abx therapy
Previous local skin reaction (mild/mod)
Allergies: Bird feathers, PCN
Pregnancy (EXCEPT LIVE VACCINES)
Recent PPD
Immunosuppressed person in household
FH of ADR to vaccine

Chemo/Transplant drugs
Immunosuppressant drugs for AI disease
HIV with CD4 <200
Systemic steroids for 14+ days at >20 mg pred qd
Chronic renal failure

GIve 2 doses (4 weeks apart)

May receive any INACTIVATED vaccine (avoid live)

Pt should be supervised for 15 min after vaccine

Flublok is egg-free but only for age 18+

Fluzone High-Dose
Fluad

(Pts should only receive 1 dose or childhood series in life)

Give 1 dose if never received:
IC pts age 6-64 years
Anyone age 65+

Give 1 dose before 65 years:
DM, heart, lung or liver disease, alcoholism, smokers

Give 2 doses before 65 years:
IC pts age 2-64

Give 1 dose at age 65+ years
All pts (whether or not 0-2 doses received before)

Varicella
Zostacax
MMRV
Oral Cholera

MMR, MMRV
Varicella, Zostavax
Yellow Fever

PPSV23

Typhoid - caps
Cholera - sol
Rotavirus - sol

BSS 524-1050 mg PO QID

Abx (RIFAMIXIN / rifamycin or quinolones if low resistance)

MILD
Loperamide PRN

MOD
Loperamide PRN +/- Abx

SEVERE (INCLUDING DYSENTERY)
Azithromycin 1,000 mg x 1 +/- Loperamide

Kill Each And Every Strong Pathogen

Klebsiella pneumoniae (ESBL, CRE)
Escherichia coli (ESBL, CRE)
Acinetobacter baumannii
Enterococcus faecalis/faecium (VRE)
Staph aureus (MRSA)
Pseudomonas aeruginosa

BIKTARVY
(bictegravir/emtricitabine/TAF)
TRIUMEQ
(dolutegravir/abacavir/lamivudine)
TIVICAY + TRUVADA
(dolutegravir + emtricitabine/TDF)
TIVICAY + DESCOVY
(dolutegravir + emtricitabine/TAF)
ISENTRESS + TRUVADA
(raltegravir + emtricitabine/TDF)
ISENTRESS + DESCOVY
(dolutegravir + emtricitabine/TAF)

Abacavir requires HLA-B*5701 testing
Use TDF with caution in renal insufficiency
Lamivudine and Emtricitabine = interchangeable

Single tablet regimens cannot be renally adjusted:
Do not start Triumeq at CrCl <50
Do not start Biktarvy at CrCl <30

Renal dose adjustment requires (except abacavir)

No CYP DDI

No regard to meals (except didanosine)

WARNING: lactic acidosis + steatosis
(zidovudine, stavudine, didanosine > others)

TeNOFovir - Nephtotoxic, Osteoporosis, Fanconi
(TAF has less ADRs)

No renal dose adjustment
(Avoid Complera + Atripla if CrCl <50)

Primarily CYP inducers
(efavirenz is induce > inhibit; rilpi + dora are substrates)

Hepatotoxicity + Rash (SJS/TEN) [Nevira > others]

W/ Food: Etra; Rilpi
W/O Food: Efavirenz

Efavirenz - CNS effects; give QHS on empty stomach
Rilpi - QT prolong; depression/suicidality
Key Features of PIs

Primarily CYP inhibitors
Taken with PK booster (rotinavir or cobicistat)
No renal dose adjustments

HEPATOtoxicity (highest with tipranavir)
Rash (SJS/TEN)

METABOLIC ABNORMALITIES
Hyperglycemia (highest with indina, lopin / rito)
Lipohypertrophy (ataza, daruna < other PIs)

CVD risk (ataza, daruna < other PIs)

GI upset - take w/ food (EXCEPT fosam + lopin / rito)

Bleeding events (pts w/ hemophilia)

ECG changes (saquin / rito, lopin / rito, ataza / rito)

Alfuzosin
Amiodarone
Dronedarone
Carbamazepine
Phenobarbital
Phenytoin
Rifampin
St. John's
Lovastatin
Simvastatin
Key Features of INSTIs

No renal dose adjustment
Do not start Stribild if CrCl <70
Do not start Biktarvy/Genvoya if CrCl <30

No major CYP DDIs
Interacts with polyvalent ions

Inc. CPK (Ralte > others)

HA, Insomnia

PIs (except fosamprenavir suspension)

Genvoya
Stribild
Rilpivirine (+ combos)
Etravirine (after meals)
Symtuza
Tenofovir powder
Cobicistat

Atripla
Efavirenz (+ combos)
Symfi + Symfi Lo
Fosamprenavir suspension
Didanosine
Indinavir (unboosted)

Lactic Acidosis

Hypersensitivity + Inc risk of MI

Pancreatitis + Peripheral Neuropathy

HA

HA

Pancreatitis + Peripheral Neuropathy

Nephrotoxicity (Fanconi) + Dec. BMD

MACROcytic anemia + Myopathy

Rash

CNS effects

Hepatotoxicity + Hypersensitivity

SJS/TEN

Hepatotoxicity

Depression + Insomnia

Metabolic abnormalities + NVD

HA

Nephrolithiasis + Indirect hyperbili

Rash

Nephrolithiasis + Urolithiasis

HyperTG

Diarrhea

NVD

Nausea

Intracranial hemorrhage

HA

Inc. CPK, Myopathy, Rhabdomyolysis

HA + Insomnia

Inc. SCr w/o affecting GFR

Clinical ASCVD
Diabetes
LDL >190

High-Intensity Statin

High-Intensity Statin

MULTIPLE ASCVD RF
High-Intensity Statin

REGARDLESS OF ASCVD RISK
Mod-Intensity

ASCVD RISK >20%
High-Intensity Statin

ASCVD RISK 7.5-19.9%
Mod-Intensity Statin

Pharmacists Rock At Saving Lives + Preventing Fatty-D

Pitava - 2
Rosuva - 5
Aorva - 10
Simva - 20
Lova - 40
Prava - 40
Fluva - 80

Avoid DDIs
Do not use Simvastatin 80 mg/day
Do not use Gemfibrozil + Statin

Hold statin, check CPK

After 2-4 weeks, re-challenge same statin or decrease dose

If myalgias return, D/C statin. Once myalgia resolves, use low dose of alt statin

Itra, Keto, Posa, Voriconazole
Erythro, Clarithromycin
HIV PI
Cobicistat
Nefazodone
Cyclosporine
Danazol
Grapefruit Juice
When to Add-On Non-Statin Treatment

Very-high risk + LDL >70
Primary Hyperchol + LDL >100

Stage 2 HTN

Stage 1 HTN PLUS:
Clinical CVD (stroke, HF, CHD)
ASCVD risk >10%

<130/80

(ADA says <130/80 for ASCVD risk and <140/90 for lower risk)

Thiazide, CCB, ACEI, ARB

Thiazide, CCB

ACEI, ARB

ACEI, ARB

Start 2 first-line agents

BP = 160/105

AMEBBA
Atenolol
Metoprolol
Esmolol
Bisoprolol
Betaxolol
Acebutolol

Nebivolol

Nadolol
Pindolol
Propranolol
Timolol

Carvedilol
Labetalol

A - Antiplatelet + Antianginal drugs
B - BP + Beta Blockers
C - Cholesterol (statins) + Cigarette Cessation
D - Diet + Diabetes
E - Exercise + Education

MONA-GAP-BA

Morphine, O2, Nitrates, Aspirin

GPIIb/IIIa antagonists, Anticoagulants, P2Y12 Inhibitors

BB, ACEI

(NSTE-ACS = +/- PCI; STEMI = + PCI or fibrinolytic)

ASPIRIN
81 mg qd indefinitely

P2Y12I
Med Tx Pts - Tica/Clop + ASA for 12 mo (at least)
PCI Pts - Tica/Clop/Pras + ASA for 12 mo (at least)
[continuation considered at not high bleeding risk]

NTG
Indefinitely

BB
3 years (indefinite prn HF or HTN)

ACEI
Indefinitely is LVEF <40%, HTN, CKD, DM

ALDOSTERONE ANTAGONIST
Indefinitely if LVEF <40% + symptomatic HF or DM on ACEI + BB

STATIN
High-intensity
(consider Mod or High for age >75)

Inc. BNP + NT-proBNP

(help distinguish between cardiac + non-cardiac causes of dyspnea)

Dyspnea (SOB at rest or exertion)
Cough
Fatigue, Weakness
Reduced exercise capacity

Orthopnea (SOB lying flat)
Paroxysmal Nocturnal Dyspnea
Bibasilar Rales
S3 Gallop
Hypoperfusion

Peripheral edema
Ascites
Jugular Venous Distension
Hepatojugular Reflux
Hepatomegaly

ACEI or ARB
Block RAAS --> vasodilation + inc EF

ARNI
In Sx HF where pt tolerates ACEI/ARB, ARNI is preferred to further dec. mortality

BB
Block SNS activation + dec arrhythmia risk

ALDOSTERONE ANTAGONISTS
Added diuresis

Hydralazine + Nitrate (BiDil)

When added to Tx of Black pts w/ ACEI/ARB + BB or in pts who could not tolerate and ACEI/ARB

LOOPS
Dec. edema

DIGOXIN
Inc. CO + Dec. hospitalizations

IVABRADINE
Dec. hospitalizations

SA node can be firing at abnormal rate or rhythm
Scar tissue can block/divert signal transmission
Another part of the heart may be acting as pacemaker

Double Quarter Pounder, Lettuce, Mayo, Fries Please!
Because Dieting During Stress Is Always Very Difficult

CLASS I
Ia: Disopyramide, Quinidine, Procainamide
Ib: Lidocaine, Mexiletine
Ic: Flecainide, Propafenone

CLASS II - Beta Blockers

CLASS III
Dronedarone, Dofetilide, Sotalol, Ibutilide, Amiodarone

CLASS IV - Verapamil, Diltiazem

If Afib is permanent, avoid Rhythm Control (risk > benefit)

Intrinsic

FII, VII, IX, X

Extrinsic (X --> Xa)

Common (Thrombin [IIa])

READ

Riva when INR <3
Edox when INR <2.5
Apix when INR <2
Dabig when INR <2

Overlap Xa inhibitor until INR is therapeutic OR

Stop Xa inhibitor + start parenteral AC + Warfarin at next dose

Start Warfarin 1-3 days before stopping Dabigatran

Please Let Greg Brown Bring Peaches To Your Wedding

Pink - 1
Lavender - 2
Green - 2.5
Brown - 3
Blue - 4
Peach - 5
Teal - 6
Yellow - 7.5
White - 10

Broccoli
Brussel Sprouts
Cabbage
Kale, Lettuce, Greens
Spinach
Tea

Reduce or skip warfarin dose

Hold 1-2 doses of warfarin

(may use Vit K if urgent surgery necessary)

PO Vitamin K 2.3-5 mg

IV Vitamin K 5-10 mg + 4F-PCC

CHF
HTN
Age 75+ = 2
DM
Prior Stroke/TIA = 2
Vascular disease (MI, PAD, aortic plaque)
Age 65-74
Sex (female)

Dec. Hgb, MCV, reticulocytes
Dec. Fe, ferritin, TSAT

Inc. TIBC

100-200 mg elemental Fe/day
Take Fe on empty stomach
Avoid H2RAs + PPIs

SR or EC not rec for initial Tx

Inc. Hgb by 1 q2-3 weeks

Gluconate - 12%
Sulfate - 20%
Fumarate - 33%
Carbonyl Iron - 100%
Polysaccharide - 100%

Acute allergic rxns (+/- epinephrine)
Premed for allergic rxns
Allergic rhinitis
Cough
Sleep
Dystonic reactions
Motion sickness

(Can worsen BPH, constipation, dementia, glaucoma)

Avoid Codeine (FDA)

Avoid all OTC cough/cold products (AAP)

Avoid many OTC cough/cold products (package labeling)

Avoid OTC cough/cold products (FDA)
Avoid Promethazine (FDA)
Avoid topical Menthol + Camphor (package labeling)

D - Decongestant
PE - PhenylEphrine
DM - DextroMethorphan
AC - Codeine

Make less fluid - BB
Move fluid out - Prostaglandin Analogs
Both - Brimonidine

BROWN
ENtacapone
Levodopa
Methyldopa

BROWN/YELLOW
Nitrofurantoin
Metronidazole

ORANGLE/YELLOW
Sulfasalazine

YELLOW-GREEN
Propofol

RED-ORANGE
Phenazopyridine
Rifampin

RED
Anthracyclines

BLUE
Methylene Blue
Mitoxantrone

BLUE-GRAY
Amiodarone
Chloroquine

FIRST-LINE
Topical BPO and/or Retinoid

ALT
Add topical retinoid or BPO
Switch to another retinoid or topical dapsone

FIRST-LINE
Topical combination (BPO, Abx, Retinoid) OR
PO Abx + BPO + topical Retinoid (+/- topical Abx)

ALT
Other combo
Switch PO Abx
Add combined OCP or Spironolactone (F) or Isotretinoin

FIRST-LINE
Topical combo + PO Abx OR
Isotretinoin

ALT
Switch PO Abx
Add combined OCP or Spironolactone (F) or Isotretinoin

How much air can be exhaled in 1 sec

After taking deep breath, maximum air that is exhaled

Percentage of total air capacity that can be exhaled in 1 sec
Step 1 Asthma Treatment

PRN LD ICS + Formoterol OR
LD ICS taken with SABA
Step 2 Asthma Treatment

Daily LD ICS OR
PRN ICS + Formoterol

(Alt: LTRA or LD ICS taken w/ SABA)
Step 3 Asthma Treatment

LD ICS + LABA
Step 4 Asthma Treatment

Medium-dose ICS + LABA

(Alt: HD ICS, add on Tiotropium or LTRA)
Step 5 Asthma Treatment

HD ICS + LABA

(Consider adding: Tiotropium, PO steroid or MABs)

HFA, Respimat, no suffix

Aerosolized liquid medication
Some have propellant (HFA)
Slow + Deep inhalation at same time as pressing canister
SPACER
SHAKE WELL
(except QVar Redihaler, Alvesco, Respimats)

Diskus, Ellipta, Pressair, Handihaler, Neohaler, RespiClick, Flexhaler

Powdered medication
No propellant
Quick + Forceful inhalation
NO Spacer
DO NOT shake
NO priming (except first use of Flexhaler)
COPD vs Asthma

>40 vs. <40
COPD vs Asthma

>10 years vs. Uncommon
COPD vs Asthma

Common vs. Infrequent
COPD vs Asthma

Uncommon vs. Common
COPD vs Asthma

Persistent vs. Intermittent/Variable
COPD vs Asthma

Progressive vs. Stable (does not worsen with time)
COPD vs Asthma

Common complication
COPD vs Asthma

Bronchodilators vs. ICS

SABA or SABA PRN,
LABA or LAMA

LAMA or LABA

LAMA

LAMA OR
LAMA + LABA (highly symptomatic) OR
LABA + IOS (eosinophilia)
Treatment Considerations for Tobacco Cessation

WEIGHT GAIN
Gum, Lozenge, Bupropion delay wt gain

DEPRESSION
Bupropion

DENTURES
Avoid Gum

COST
Avoid Rx only

SKIN CONDITION
Avoid Patch

ASTHMA/COPD
Avoid Inhaler or Spray

FG <95
1h PPG <140
2h PPG <120

FG 100-125
2h PPG 140-199
A1c 5.7-6.4%

FPG >126
2h PPG >200
A1c >6.5%

MICROvascular
Retinopathy
Diabetic Kidney Disease
Peripheral Neuropathy
Autonomic Neuropathy

MACRvascular
CAD
Cerebrovascular
PAD

A1c <7%
FG 80-130
PPG <180

Lifestyle mod + Metformin

A1c 8.5% --> Dual Tx
A1c 10% --> Insulin

GLP-1 Agonist (Lira, Sema, Exen)

SGLT2-I (Empa, Cana)

SGLT2-I (Empa, Cana)

If CI, GLP-1 (Lira, Sema, Exen)

DPP-4
GLP-1
SGLT2
TZD

GLP1
SGLT2

SU
TZD

Humalog Kwikpen 200 U/mL
Humulin R U-500
Tresiba Flextouch 200 U/mL
Toujeo Solostar 300 U/ml

1. TDD = 0.5 U/kg/day (TBW)
2. 50% bolus + 50% basal
3. Divide bolus by 3 meals

0.1-0.2 U/kg/day (TBW) OR
10 U/day

All 1:1 EXCEPT

NPH bid --> Glargine (use 80% of NPH dose)

Toujeo --> Basaglar or Lantus (80% of dose)

FlexPen
KwikPen
FlexTouch
SoloStar

Byetta, Victoza, Adlyxin
SymlinPen

FLUIDS
Start with NS
When BG = 200 --> D5W1/2NS

REGULAR INSULIN INFUSION
0.1 U/kg bolus --> 0.1 U/kg/h OR
0.14 U/kg/h

PREVENT HYPOK

TREAT ACIDOSIS (only if pH <6.9)
Selecting DM Drug Tx

Insulin
Metformin
SU
TZDs
GLP1
Selecting DM Drug Tx

Insulin
Meglitinides
SU
Pramlintide (w/ insulin(
Selecting DM Drug Tx

Cana/Empagliflozin
Lira/Semaglutide, Exenatide
Selecting DM Drug Tx

Insulin
SU
Meglitinides
TZDs
Selecting DM Drug Tx

SGLT2
GLP1
Pramlintide
Selecting DM Drug Tx

Metformin
SU
TZDs
Selecting DM Drug Tx

Insulin
GLP1
Pramlintide

Cold intolerance
Dry skin
Fatigue, Weakness
Muscle cramps, Myalgia
Voice changes
Weight gain
Depression
Bradycardia
Coarse hair (or hair loss)
Menorrhagia
Mental/Memory impairment
Goiter

Orangutans Will Vomit On You Right Before They Become Large Proud Giants

25 Orange
50 White
75 Violet
88 Olive
100 Yellow
112 Rose
125 Brown
137 Turquoise
150 Blue
175 Lilac
200 Pink
300 Green

Heat intolerance
Weight loss
Agitation, Anxiety
Palpitations + Tachycardia
Fatigue + Muscle weakness
Frequent BM
Insomnia
Tremor
Thinning hair
Exophthalmos, Diplopia
Light or absent menstruation
Goiter

Fever (>103F)
Tachycardia
Tachypnea
Dehydration, Profuse sweating
Agitation, Delirium, Psyschosis
Coma

Taking 2 mg/kg/day or 20 mg/day of Prednisone for >2 wks

Tapering methods include dec. by 10-20%/d over 7-14 d

BB
Bleomycin, Cisplatin
Sympathomimetics

All E-containing:
Women >35 yo who smoke

E + P TD Patch:
Risk of VTE

Depo-Provera:
Loss of BMD with prolonged use

DVT/PE, Stroke, CAD
Breast, Ovarian or Liver cnacer
Liver disease
Uncontrolled HTN
Migraines w/ Aura

ACHES

Abdominal pain (severe) - liver problems, ectopic pregnancy

Chest pain - MI, PE

Headaches (severe + vomiting or weakness) - stroke

Eye problems - clot in eye

Swelling/Sudden leg pain - DVT

Clomiphene acts like Estrogen --> Inc. LH/FSH

Gonadotropins act like LH, FSH, hCG --> ovulation

Advanced age
Ethnicity (Caucasian + Asian)
Family history
Females
Low body weight

Anorexia
DM
GI disease
Hyperthyroidism
Hypogonadism
Menopause
RA, Autoimmune diseases
Epilepsy
HIV
Parkinson

Smoking
Excess alcohol intake
Low Ca or Vit D intake
Physical inactivity

Anticonvulsants
Aromatase inhibitors
Depo-Medroxyprogesteron
GnRH Agonists
Lithium
PPIs
Steroids (5+ mg prednisone for 3+ mo)
Thyroid hormones 9excess)
Heparin
Loops
SSRIs
TZDs

Women 65+ and Men 70+
Younger pts at-risk for fracture

Normal = >-1
Osteopenia = -1 to -2.4
Osteoporosis = <-2.5

1,000 - 1,200 mg elemental

(Do not exceed 500-600 mg elemental per dose)

Carbonate = 40% Ca
Acid-dependent
Must take with meals

Citrate = 21% Ca
NOT acid-dependent
Take w/ or w/o meals

Deficiency <30 ng/mL

Treat with D2 or D3
5,000-7,000 IU qd or 50,000 IU qwk

OSTEOPOROSIS
PM women or men >50 + T-score <-2.5 OR
Presence of fragility Fx

OSTEOPENIA
T-score -1 to -2.5 AND FRAX >20% MOF or 3% Hip

Most effective for Vasomotor Sx

If women has uterus --> USE PROGEST COMBO

Significant warnings for VTE, stroke, dementia, breast cancer

Mood disturbances
If taken intermittently --> Spotting

Micronized considered safer than synthetic

Healthy, symptomatic women (w/i 10 yrs menopause) aged <60

Extending Tx beyond 60 may be ok if lowest possible dose and awareness of safety rosks

Age 65+
Using an alpha-blocker
CYP3A4 inhibitor
Severe renal or liver disease

PERIPHERAL
Dry mouth
Dry eyeslurred vision
Urinary retention
Constipation

CENTRAL
Sedation
Dizziness
Cognitive impairment

Extended-release
Oxybutynin Gel or Patch
Mirabegron
"Renal Dose" Dopamine

1-4 mcg/kg/min
Medium-Dose Dopamine

5-10 mcg/kg/min
High-Dose Dopamine

10-20 mcg/kg/min

VOLUME OVERLOAD
Loop diuretics
Vasodilators (may be added)

HYPOPERFUSION*
Inotropes (dobutamine, milrinone)
Vasopressor (if HoTN)

*Avoid vasodilators
Avoid in Pediatrics

Codeine <12 yrs
Tramadol <12 yrs
Promethazine <2 yrs
Ceftriaxone in neonates
Avoid in Pediatrics

Quinolones
Tetracyclines <8 yrs
Benzocaine (teething) <2 yrs
OTC cough/cold <6 yrs (AAP)

1. Bronchodilators
2. Hypertonic Saline
3. Dornase alfa
4. Chest physiotherapy
5. Abx

Formulations are NOT interchangeable

Viokace is the only tablet (non-EC + must be given w/ PPI)

All others are CAPSULES (DR caps may be sprinkled on acidic foods)

Take with all meals + snacks (50% meal dose)

Protect from moisture + do NOT refrigerate

Basiliximab
Antithymocute globulin (higher risk pts)
Maintenance drugs a higher doses

CNIs - Tacrolimus* or Cyclosporine

ADJUVANTS
Antiproliferative - Mycophenolate or Azathioprine
mTORI - Evero/Sirolimus
Belatacept

STEROIDS

Pts must self-monitor

Ppx Abx are likely

Treat OI (like in HIV)

NEPHRO - Tacrolimus + Cyclosporine
DM - Tacrolimus, Cyclosporine + Steroids
LIPIDS - mTORI, Cyclosporine + Steroids
HTN - Tacrolimus, Cyclosporine + Steroids

Required vaccines should be given pre-transplant

INactivated vaccines can be given 3-6 mo after

Live vaccines are CI

INFLUENZA annually

PNEUMOCOCCAL (>19 yo)
PCV13 1st (if never received)
PPSV23 (8 wks later --> 5 yrs later)

VARICELLA (high risk for severe)
Vaccinate pre-transplant _ vaccinate close contacts

AVOID ALL

AVOID
Contrave (bup/nal)

CAUTION
Qsymia (phen/top)

Avoid Contrave in YA/Adolescents

AVOID
Contrave (bup/nal)

CAUTION
Qsymia (phen/top)

AVOID
Contrave (bup/nal)

Restores intracellular glutathione

Available PO + IV

Common drugs in same chemical class have -COD or -MORPH in the name

CODeine, hydro/oxyCODone
MORPHine, hydro/oxyMORPHone
bupreNORPHine

(Tramadol has warning of cross-rxn)

Does not improve over time w/o Tx

1st-line - Stimulant laxatives +/- Stool softener
2nd-line - PAMORAS
3rd-line - Lubiprostone

Lifetime dose = 400 U

Pulmonary toxicity

Lifetime dose = 450-550 mg/m2

Cardiotoxicity

Dose per cycle = 100 mg/m2

Nephrotoxicity

Single dose = 2 mg

Neuropathy

Amifostine

(Nephro)

Dexrazoxane

(Cardiomyopathy + Tx for extravasation)

Leucovorin

(Enhance efficacy)

Uridine triacetate

(Antidote)

Mesna

(Hemorrhagic cystitis)

Atropine
(Acute diarrhea [prevent or Tx])

Loperamide
(Delayed diarrhea)

Leucovorin, Glucarpidase

(Given AFTER MTX to dec. myelosuppression, with mucositis [antidote], and with ARF)

All Awesome Pharmacists

Alkylating
Anthracyclines
Platinums

Tax My Vin!

Taxanes
Vinca

AT the S-phase, DNA replicATes

Antimetabolites
Topoisomerase I Inhibitors

1 SIA, 2 Tops

G1 - Steroids, IFNs, Asparaginase
G2 - Topoisomerase II Inhibitors
BevaCIzumab, RamuCIrumab

Target = VEGF
Inhibits BV growth (solid tumors, NSCLC + colon)

HTN --> Proteinuria
Hemorrhage + Thrombosis
Impaired wound healing
CeTUximab, PaniTUmumab

Cet EGgs in Pan

Target = EGFR
Inhibits GF from binding to tumor (solid tumors, colon)

EGFR --> epidermis --> Skin toxicity
(rash correlated with response to Tx)
TrasTUzumab, PerTUzumab

Per Trust, HER2

Target = HER2
Inhibits GF from binding to tumor (BC)

Cardiotoxicity
Fetal toxicity
RiTUximab, BrenTUximab, DaraTUmumab, InoTUzumab

RIBD CDs

Target = CD antigens
Hematologic malignancies
(Bren vedotin is ADC for CD30 (HL))

BM suppression

Ino ozogamicin + Bren vedotin are ADC
IpiLImumab, AtezoLIzumab, NioLumab, PembroLIzumab

Target = IS (PD1, PDL1, CTLA4)
Increased immune recognition (solid tumors, NSCLC + melanoma)

Immune-mediated rxns --> Colitis, Hepatotoxicity, Thyroid, Myocarditis

-RAF

MET

a Lot of Fats Get fit

Erlotinib
Afatinib
Gefitinib

Alect Cray Cray ALKs

Alectinib
Cerotinib
Crizotinib

MSIGECAPS

Mood - Depressed
Sleep - Inc./Dec.
Interest - Diminished
Guilt or Worthlessness
Energy - Dec.
Concentration - Dec.
Appetite - Inc./Dec.
Psychomotor agitation or retardation
Suicidality
Tertiary TCA

Ami TrICles Down 3 rungs

Amitriptyline
Trimipramine
Clomipramine
Imipramine
Doxepin

Avoid Mirtazapine
Consider Bupropion

Avoid Citalopram, Escitalopram
Consider Sertraline

Bupropion is CI
Do not exceed 450 mg/d

Avoid SSRIs + SNRIs
Consider Bupropion + Mirtazapine

Consider Mirtazapine

Consider Duloxetine

LOW - Quetiapine
HIGH - FGA, Ris/Paliperidone

LOW - FGA, Aripiprazole, Zip/Lurasidone, Asenapine
MOD - Ris/Paliperidone
HIGH - Clozapine, Olanzapine, Quetiapine

HIGH - Thioridazine, Haloperidol, Ziprasidone

Clozapine (agranulocytosis)

Ris/Paliperidone

Clozapine

Distractibility
Insomnia
Grandiosity
Flight of Ideas
Activity (goal-oriented(
Speech (pressured)
Talkativeness

SUSPENSION
Quillivant XR, Dyanavel XR, Adzenys ER

CHEWABLE TAB
QuilliChew ER, Vyvanse

CAPSULE (SPRINKLABLE)
Focalin XR, Ritalin LA, Aptensio XR, Adderall XE

CAPSULE (MIX W/ WATER, OJ, YOGURT)
Vyvanse

ODT
Cotempla XR, Adzenys XR

PATCH
Daytrana

Clonaz
Loraz
Alpraz
Diaz

Eszopiclone
Zolpidem

Zaleplon
Ramelteon
Help Staying Asleep

Eszopiclone
Zolpidem

Suvorexant
Doxepin

TRAP

Tremor (at rest)
Rigidity
Akinesia/Bradykinesia
Postural instability

Micrographia
Shuffling walk
Muffled speech, Drooling, Dysphagia
Depression, Anxiety, Psychosis
Constipation, Incontinence

0-5 MIN
Time the seizure, start EEG, O2
Check E-lytes, [AED], BG

5-20 MIN
IV Lorazepam
IM Midaz, Rectal Diaz

20-40 MIN
IV Fosphenytoin, VPA, Levetiracetam
(Phenobarbital if others unavailable)

Brian Leaves Lambs To Val

Levetiracetam
Lamotrigine
Topiramate
Valproate