naplex must know concepts

Increased SLUDD effect
-Salivation
-Lacrimation
-Urination
-Diarrhea
-Digestion

Vasoconstriction -Increase BP

Increased contractility, CO, HR

Increased bronchodilation

BBW of profound sedation, respiratory distress, coma, death

G<3PACMAN
1. GFJ
2. Protease inhibitors
3. Azoles
4. Cimetidine, cyclosporine, cobicistat
5. Macrolides (not azithro)
6. Amiodarone
7. Non-DHP CCBs

PS PORCS:
1. Phenytoin
2. Smoking
3. Phenobarbital
4. Oxcarbazepine
5. Rifampin
6. CBZ
7. SJW

4-12 mcg/mL

0.8-2 (afib); 0.5-0.9 (HF)

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

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

10-20mcg/mL (correct for albumin)

1-2.5mcg/mL

4-10 mcg/mL

15-25mcg/mL

10-30 mcg/mL

5-15 mcg/mL

50-100 mcg/mL (up to 150mcg/mL)
-Correct for albumin

Trough = 15-20 (serious infections) or 10-15 for less severe infections

INR = 2-3 for most pts; 2.5-3.5 for mechanical mitral valve

1. Daytrana (QAM)
2. Nicotine
3. Exelon
4. Neupro
5. Emsam
6. Testosterone (QPM)

Lidocaine: 1-3 patches Q12H, then 12H off

NTG: on for 12-14H, off for 12-14h/day

Diclofenac

1. Vivelle Dot, Alora
2. Oxytrol

1. Butrans
2. Catapress TTS
3. Climara, Menostar
4. Climara Pro
5. Xulane

Fentanyl: Q72H (ok to change after 48H)

Scopalamine: Q72H

1. Antineoplastics (chemo)
2. Abx: televancin
3. Anticoag: warfarin
4. Antifungals: fluconazole, voriconazole
5. ART: abacavir, entecavir, nevirapine, zidovudine
7. Antivirals: cidofovir, ganciclovir, valganciclovir
8. Acne: isotretinoin
9. BPH: Dutasteride, finasteride
10. Hormones: androgen, estrogen, progesterone
11. Hyperthyroid: methimazole, PTU
12. Renal: darbepoetin
13. Transplant: azathioprine, cyclosporine, mycophenolate, tacrolimus, sirolimus

Leach Absorbs to Take In Nutrients
1. Lorazepam
2. Amiodarone
3. Tacrolimus
4. Taxanes
5. Insulin
6. NTG
*Use non-PVC (polyolefin, polypropylene, or glass)

A DIAbetic Can't Eat Pie
1. Ampicillin
2. Daptomycin
3. Infliximab
4. Ampicillin/sulbactam
5. Caspofungin
6. Ertapenem
7. Phenytoin

Obese Baker Avoids Salt
1. Oxaliplatin
2. Bactrim
3. Amphotericin
4. Synercid

GAL PLAT
1. Golimumab
2. Amiodarone
3. Lorazepam
4. Phenytoin
5. Lipids
6. Amphotericin
7. Taxanes (except docetaxel)

Dear Sweet Pharmacist, Freezing Makes Me Edgy
1. Dexmedetomidine
2. Sulfamethoxazole-TMP
3. Phenytoin
4. Furosemide
5. Metronidazole
6. Moxifloxacin
7. Enoxaparin

Protect Every Necessary Med from Daylight
1. Phytonadione
2. Epoprostenol
3. Nitroprusside
4. Micafungin
5. Doxycycline

1. Anti-hypertensives
2. Vasodilators
3. Opioids
4. BZDs
5. Anesthetics
6. PDE inhibitors

1. Stimulants
2. Decongestants
3. Beta agonists
4. Theophylline
5. Anticholinergics
6. Bupropion
7. Antipsychotics
8. Excess caffeine/nicotine
9. Illicit drug use
10. Vasodilators

1. Beta blockers
2. Non-DHP CCBs
3. Digoxin
4. Clonidine
5. Guanfacine
6. Antiarrhythmics (class III)
7. Opioids
8. Sedatives
9. Anesthetics
10. Neuromuscular blockers
11. AChE Inhibitors

-Untreated medical condition
-Meds used without indication
-Dose too low/high
-Lack of pt understanding
-Drug allergy
-Drug interaction
-Improper use of med
-Failure to receive med
-Adverse drug reaction
-Non-adherence

1. Aminoglycosides
2. Amphotericin B
3. Cisplatin
4. Cyclosporine
5. Loop diuretics
6. NSAIDs
7. Polymyxins
8. Radiocontrast dye
9. Tacrolimus
10. Vancomycin

-Recommended in all pts w/ albuminuria to prevent kidney disease progression
-Inhibits RAAS, causes efferent arteriolar dilation
-Decreases pressure in the glomerulus, decreases albuminuria and provides CV protection

1. Aminoglycosides
2. Beta lactams
3. Fluconazole
4. FQs (not moxifloxacin)
5. Vancomycin
6. LMWHs
7. Rivaroxaban
8. Lithium
9. Metoclopramide
10. Bisphosphonates
11. H2RAs

CrCl < 60: nitrofurantoin
CrCl < 50: TDF, voriconazole IV (d/t vehicle)
CrCl < 30: TAF, NSAIDs, dabigatran, rivaroxaban, avanafil, bisphosphonates, duloxetine, fondaparinux, K sparing diuretics, tadalafil, tramadol ER
GFR < 30: SGLT2 inhibitors, metformin
Other cutoff: meperidine, dofetilide, edoxaban, glyburide, sotalol

1. ACEI/ARBs
2. Aldosterone receptor antagonists
3. Aliskiren
4. Canagliflozin
5. Drospirenone COC
6. Bactrim
7. Transplant drugs

-Acute
-Fecal oral transmission
-Vaccine available
-Supportive care

-Both acute and chronic
-Bloododily fluids transmission
-Vaccine available
-PEG-INF or NRTI is first line

-Both acute and chronic
-Bloododily fluids transmission
-No vaccine
-First line is DAA combos
-Alternatives are DAA combo + RBV or DAA combo + RBG + PEG-INF

-previr (P for PI)
-Grazoprevir, paritaprevir, simepravir, voxilaprevir

-asvir (A for NS5A)
-Daclatasvir, ledipasvir, ombitasvir, pibrentasvir, velpatasvir

-buvir (B for NS5B)
-Dasabuvir, sofosbuvir

1. APAP
2. Isoniazid
3. Ketoconazole
4. Methotrexate
5. Nefazodone
6. Nevirapine
7. NRTIs
8. PTUs
9. Tipranavir
10. VPA

Very Yucky Monkeys, Rhinos, Cheetahs, In The Zoo
1. Varicella
2. Yellow fever
3. MMR
4. Rotavirus
5. Cholera
6. Influenza (intranasal)
7. Typhoid (oral)
8. Zoster

Prevanar and Menactra should be separated by 4 wks

-Can be given on the same day OR
-Spaced 4 weeks apart if not given on same day
-No separation required for PO rotavirus

-Intervals can be extended w/o restarting, but cannot be shortened
-Increased interval delays complete protection
-Decreased interval interferes w/ antibody response

-Must separate from blood transfusions and antibody containing products (IVIG)
-Give the vaccine, wait 2 weeks, give antibody OR
-Give antibody, wait at least 3 mos, give vaccine

1. Hep A
2. Hep B
3. Rabies
4. Tetanus

-Mild acute illness
-Current abx (exceptions = varicella, zoster, oral typhoid vaccines)
-Previous local skin rxn from vaccine
-Allergies to bird feathers, PCN, products not in vaccine
-Pregnancy (except live vaccines), breastfeeding, preterm birth
-Recent TB skin test
-Immunosuppressed person in the household, recent exposure to disease, convalescence
-Family hx of adverse events to vaccines

-Recommend in all pts >6 mos unless C/I
-Trivalent inactivated (IIV3): Afluria, Fluvirin, Fluzone High dose (only for >65YO), Fluad
-Quadrivalent inactivated (IIV4): Afluria, Fluarix, FluLaval, Flucelvax, Flubok (egg free)
-Quadrivalent live attenuated (LAIV): Flumist (for pts 2-49YO)
-For pts age 6 mos to 8 yrs not previously vaccinated, give 2 doses 4 weeks apart

Prevnar 13: given to children < 5YO, or to pts 6-64YO if never received
-Should only receive one dose in lifetime

Pneumovax 23: given to pts 2-64YO w/ risk factors and all pts > 65
-2-64 immunocompetent: give 1 dose for DM, heart, lung, liver disease, alcohol abuse, smokers
-2-64YO and immuncompromised: give 2 doses (spaced at least 5 years apart)
->65YO: all pts receive 1

-BSS 524-1050mg PO 4x daily with meals and at bedtime is 1st line
-Abx (FQ or rifaximin, rifamycin if resistance) limited to pts at high risk for complications

-Mild: loperamide prn (no abx)
-Moderate: loperamide prn +/- abx
-Severe (w/ dysentery): azithro 1000mg x 1 +/- loperamide

Kill Each And Every Strong Pathogen
1. Klebsiella pneumoniae (ESBL, CRE)
2. Ecoli (ESBL, CRE)
3. Acinetobacter baumannii
4. Enterococcus faecalis, enterococcus faecium (CRE)
5. Staph aureus (MRSA)
6. Pseudomonas aeruginosa

-Avoid all PCNs in pts w/ allergy
-All PCNs increase seizure risk
-PCN VK: 1st line for strep and mild non-purulent skin infection
-Amoxicillin: 1st line for AOM (80-90mg/kg/d) and DOC for infective endocarditis ppx before dental procedure (2g PO x1, 30-60 mins before)
-Augmentin: 1st line for AOM (90mg/kg/d) and sinus infection; use lowest dose clavulanate to decrease diarrhea
-Bicillin LA DOC for syphillis (2.4M units IM x1)--BBW for IV use
-Zosyn is the only active PCN against pseudomonas; EI (4H) can be used to maximize T>MIC
-Nafcillin, oxacillin, dicloxacillin covers MSSA only; no renal dosing

-<10% cross reactivity--do not use w/ PCN allergy
-Risk of seizures if accumulation occurs
-Keflex most common for skin infections and strep
-Cefuroxime used for AOM, CAP, sinus infection
-Cefdinir used for CAP and sinus infection
-Cefazolin common for surgical ppx
-Cefotetan and cefoxitin used for b.fragilis and surgical ppx for colorectal procedures
-Ceftriaxone and cefotaxime used for CAP, meningitis, SBP, pyelonephritis
-Ceftriaxone should not be used in neonates
-Avycaz and Zerbaxa used for MDR GNR
-Ceftaroline is only beta lactam that covers MRSA

-All cover ESBL
-All except ertapenem cover pseudomonas
-Do not use in pts w/ PCN allergy
-Seizure risk
-Does not cover atypicals, VRE, MRSA, c.diff, stentrophomonas
-All are IV only

-Kill gram(-) fast, are synergistic w/ beta lactam for some organisms
-Demonstrate concentration dependent killing
-Has post-abx effect
-Has severe renal and ototoxicity damage
-Target high peaks, low troughs (give larger doses less frequently) to allow kidneys time to recover b/w doses

-Respiratory FQ: levo, moxi, gemifloxacin
-Antipseudomonal FQ: cipro, levofloxacin
-Moxi is the only not renally adjusted (do not use in UTI)
-Levoflox and moxiflox are 1:1 PO conversions
-Caution with FQ use in CVD, decreases K, Mg, and can prolong QT
-Avoid in pts w/ seizure hx or if using seizure drugs
-Avoid in children and pregnancyreastfeeding
-Watch for tendon rupture, neuropathy, CNS, psych SE
-Avoid sun exposure, separate from cations, monitor BG

-All macrolides can be used for CAP and as an alternative to b-lactam for strep
-Azithro: COPD exacerbation, monotx for chlamydia, combo tx for gonorrhea, ppx for MAC, DOC for sever traveler's diarrhea
-Clarithro: H. pylori, GERD, PUD
-Eryhthr: increased GI motility
-Z-pak dosing: two 250mg PO x1, then 250mg QD x 4d
-Risk of QT prolongation
-Clarithro and erythro are strong 3A4 inhibitors

-Doxy and minocycline for CA-MRSA skin infection, acne
-Doxy: 1st line for Lyme disease, Rocky mountain spotted fever (tick born illness), CAP, COPD exacerbations, sinusitis, VRE UTI, monotx for chlamydia, combo tx for gonorrhea
-Tetracycline: used for H. pylori tx
-Do not use in pregnancy, breastfeeding, children <8YO

-Common uses include CA-MRSA skin infections, UTI, PCP
-5:1 ratio of SMX/TMP (dose by TMP)
-SS = 80mg TMP
-DS = 160mg TMP (typical dose is 1 tab BID)
-Most sulfa allergies are rash/hives
-INR can increase when given w/ warfarin

1. Dicloxacillin, nafcillin
2. Ceftriaxone
3. Clindamycin
4. Doxycycline
5. Azithro, erythro
6. Metronidazole
7. Moxifloxacin
8. Linezolid

1. Chloroquine
2. Dapsone
3. Nitrofurantoin
4. Primaquine
5. Probenecid
6. Bactrim

1. Beta lactamase inhibitors
2. Cephalosporins
3. Isoniazid
4. Nitrofurantoin
5. Penicillins
6. Quinine
7. Rifampin
8. Bactrim

1. Isoniazid
2. Minocycline
3. Terbinafine

1. Penicillins
2. Cephalosporins
3. Imipenems
4. Isoniazid

-Prior to surgery, infuse cefazolin or cefuroxime 60 mins before incision. If FQ or vanco, start 120 min before
-During surgery, give additional dose if surgery is >3-4H or w/ major blood loss
-After surgery, abx is not needed. D/c within 24H

Observe w/o abx for 48-72H is an option if non-severe
-Mild otalgia < 48H
-Temp < 102.2F
-Age 6-23mos w/ Sx in one ear only
-Age >2YO w/ Sx in one or both ears

No comorbidities or risk factors
1. Macrolide if resistance <25%
2. High dose amoxicillin (1g TID)
3. Doxycycline

1. Beta lactam (augmentin, cefdinir, cefpodoxime, cefuroxime, ceftriaxone) + macrolide
2. Respiratory FQ montx

1. Beta lactam (ceftriaxone, cefotaxime, Unasyn) + macrolide or doxycycline
2. Respiratory FQ monotx (reserve for PCN allergy)

-IV abx within 90d
-High prevalence of MRSA in hospital
-Positive MRSA nasal swab

-Hospitalization >5d prior to VAP
-Septic shock at time of VAP onset
-ARDS prior to VAP
-Acute renal replacement therapy prior to VAP onset

-All RIPE drugs increase LFTs, including t.bili
-Rifampin: orange body secretions, strong CYP inducer, flu-like Sx
-Isoniazid: peripheral neuropathy, give pyridoxine 25mg daily, monitor for DILE
-Pyrazinamide: increase uric acid (do not use in gout), increase dosing interval if renal impairment
-Ethambutol: visual damage (requires BL and monthly vision exams), confusion, hallucination, increase dosing interval if renally impaired

-D/c abx asap, do not use anti-diarrheas, isolate pts
-Wash hands w/ soap and water (not alcohol containing sanitizers)
-Diagnosis: + c.diff stool toxin (enzyme immunoassay + glutamate dehydrogenase test) or + c.diff culture
-1st episode: vanco 125mg PO QID x10d or fidaxomicin 200mg PO BID x10d (alt = metronidazole 500mg PO TID x10d)
-2nd episode: vanco if metronidazole was used; fiadoximicin if vanco was used, vanco taper and pulse if vanco or fidaxomicin used initially
-Subsequent episodes: vanco pulse/taper, vanco + rifaximin, fidaoxmicin, fecal transplant

-Chlamydia and gonorrhea: genital discharge or no Sx
-Syphilis: painless, smooth genital sores
-HPV: genital warts or no Sx
-Bacterial vaginosis: clear discharge, fishy odor, pH > 4.5, no pain
-Trichomoniasis: yellowreen frothy discharge, soreness, pain w/ sex

-PCN is the only tx option
-Confirm allergy w/ skin test and de-sensitize
-Treat w/ Bicillin LA IM

Ceftriaxone 250mg IM x1 + azithromycin 1g PO x1 or doxycycline 100mg PO BID x7d

-Bacterial infection from borrelia burgdoferi and mayonni
-Sx: bullseye rash, achy joints, fever
-Tx: doxycycline 100mg PO BID x10-21d

-Fungal infection caused by tinea corpis
-Sx: 1+ reddish, raised rings, can be itchy
-Tx: clotrimazole or other topical antifungal

-All cause increased LFTs and have QT prolongation risk (except isavuconaznium)
-SE = HA, nausea, abdominal pain
-Fluconazole: only one that requires renal adjustment, narrower spectrum, C.krusei and C.glabrata resistant
-Voriconazole: DOC for aspergillus
-Posaconazole and isavuconazonium: active against aspergillus and zygomycetes (posaconazole tab is not equivalent to suspension d/t F differences)

INSTI Based:
1. Stribild
2. Genvoya
3. Biktarvy
4. Dovato
5. Juluca

NNRTI Based:
1. Delstrigo
2. Atripla
3. Symfi, Symfi Lo
4. Complera
5. Odefsey

PI Based:
1. Symtuza

-Renal dose adjustment except abacavir
-No CYP interactions
-Take w/o regards to meals except didanosine
-Warnings = lactic acidosis, hepatomegaly w/ steatosis
-Abacavir: test for HLA*5701
-Tenofovir: nephrotoxicity, osteoporosis, Fanconi syndrome

-Name has "vir" in the middle
-No renal dose adjustment
-Mostly inducers
-Hepatotoxicity and rash, including SJS/TEN (worst w/ nevirapine)
-Monitor for erythema, facial edema, skin necrosis, blisters, tongue swelling
-Efavirenz: CNS effects (give QHS on empty stomach)
-Rilpivirine: QT prolongation, depression, suicidality

-Generic name ends in "navir"
-Mainly strong 3A4 inhibitors
-Can decrease INR, decrease efficacy of contraceptives, decrease methadone levels, increase statin and PDE5 levels
-Hepatoxicity risk (tipranavir the worst)
-Take w/ booster to increase drug levels
-Metabolic abnormalities (HLD, lipohypertrophy, insulin resistance, hyperglycemia)
-Increased CVD risk
-GI upset (Take with food)
-Bleeding events in pts w/ hemophilia
-EKG changes

-Generic name ends in "tegravir"
-No renal adjustment needed
-No major CYP interactions
-SE = HA, insomnia, increased CK (worst w/ raltegravir)
-Separate from polyvalent cations

1. Atazanavir, evotaz
2. Darunavir, Prezcobix
3. Indinavir (boosted)
4. Kaletra oral solution
5. Nelfinavir
6. Ritonavir
7. Saquinavir
8. PIs except fosaprenavir suspension
9. Rilpivirine (Complera, Odefsey, Juluca)
10. Tipranavir
11. Genoya
12. Stribild
13. Etravirine (after meal)
14. Symtuza
15. Tenfofovir powder
16. Cobicistat

1. Atripla
2. Symfi, Symfi Lo
3. Fosamprenavir oral suspenison
4. Didanosine
5. Indanivir (unboosted)
6. Efavirenz

Lactic acidosis
-Abacavir: hypersensitivity, increase MI?
-Didanosine and stavudine: pancreatitis, peripheral neuropathy
-Emtricitabine and lamivudine: headache
-Tenofovir: renal toxicity, decreased bone mineral
-Zidovudine: macrocytic anemia, myopathy

Rash
-Efavirenz: CNS
-Nevirapine: hepatotoxicity, hypersensitivity
-Etravirine: SJS/TEN
-Doravirine: hepatotoxicity
-Rilpivirine: depression, insomnia

Metabolic abnormalities, N/V/D
-Darunavir: HA
-Atazanavir: nephrolithiasis, indirect hyperbili
-Fosamprenavir: rash
-Indinavir: nephrolithiasis, urolithiasis
-Lopinaviritonavir: hyperTG
-Nelfinavir: diarrhea
-Ritonavir: N/V/D
-Saquinavir: nausea
-Tipranavir: intracranial hemorrhage

Well tolerated
-Bictegravir: HA
-Raltegravir: increased CK
-Elvitegravir: HA, insomnia
-Dolutegravir: increased SCr w/o affecting GFR

1. Atripla
2. Biktarvy
3. Cimduo
4. Complera
5. Descovy
6. Delstrigo
7. Genvoya
8. Juluca
9. Odefsey
10. Stribild
11. Symfi, Symfi Lo
12. Symtuza
13. Triumeq
14. Truvada
15. Darunavir
16. Dolutegravir 10mg
17. Doravirine
18. Etravirine
19. Indinavir
20. Nelfinavir
21. Raltegravir
22. Ritonavir tab
23. Rilpivirine
24. TDF

1. Protease inhibitors
2. Steroids
3. Diuretics
4. Cyclosporine, tacrolimus
5. Retinoids

1. Fibrates
2. SGLT2 inhibitors
3. Anabolic steroids
4. Progestin

1. IV lipid emulsions
2. Propofol
3. Beta blockers
4. Atypical antipsychotics
5. Estrogen
6. Tamoxifen
7. Clevedipine
8. BAS

High intensity:
1. Clinical ASCVD
2. LDL > 190
3. DM 40-75YO w/ LDL b/w 70-189 and multiple ASCVD risk
4. No DM, 40-75YO w/ LDL b/w 70-189 and ASCVD risk> 20%

-Reduce risk by avoiding DDI
-Do not use simvastatin 80mg/day
-Do not use gemfibrozil + statin
-Hold statin, check CK
-After 2-4 wks, re-challenge w/ same statin at the same or decreased dose. Most pts who did not tolerate a statin will tolerate it when re-challenged or tolerate a different statin
-If myalgias return, d/c statin.
-Once muscle Sx resolve, use a low dose of different statin and gradually increase

Pharmacists Rock At Saving Lives and Preventing Fatty-deposits
Pitavastatin 2mg
Rosuvastatin 5mg
Atorvastatin 10mg
Simvastatin 20mg
Lovastatin 40mg
Pravastatin 40mg
Fluvastatin 80mg

1. Azoles: itra, keto, posa, vori
2. Macrolides: erythro, clarithro
3. Protese inhibitors, cobicistat
4. Nefazodone
5. Cyclosporine
6. Danazol
7. GFJ

-Very high risk and LDL > 70
-Primary hypercholesterolemia (LDL> 190) and LDL remains > 100

1. Amphetamines, ADHD drugs
2. Decongestants
3. Cyclosporine
4. Systemic steroids
5. Cocaine
6. ESAs
7. NSAIDs

-Stage II HTN (>140/90)
-Stage I HTN (130-139/80-89) and clinical CVD or ASCVD > 10%

-Non blacks: thiazides, CCB, ACEI/ARB
-Black: thiazides or CCB
-CKD: ACEI/ARB to slow progression
-DM w/ albuminuria: ACEI/ARB
-Start two first line agents when SBP and DBP > 20/10 above goal

1. Chlorothiazide
2. Clevedipine
3. Diltiazem
4. Enaliprilat
5. Esmolol
6. Hydralazine
7. Labetalol
8. Metoprolol tartrate
9. Nicardipine
10. NTG
11. Nitroprusside
12. Propranolol
13. Verapamil

ABCDE
1. Antiplatelet, anti-anginal drugs (BB, CCB, nitrate)
2. Blood pressure and BB
3. Cholesterol (statin) and cigarettes (cessation)
4. Diet and diaebtes
5. Exercise and education

1. Smoking
2. HTN
3. HLD
4. DM
5. Age > 45 (M), >55 (W) or w/ early hysterectomy
6. Family hx: 1st degree relative w/ ACS < 55 (M), and < 65 (W)
7. Chronic angina
8. Known CAD
9. Lack of exercise
10. Excessive alcohol

MONA-GAP-BA
1. Morphine
2. Oxygen
3. Nitrates
4. Aspirin
5. GPIIb/IIIa antagonists
6. Anticoagulation
7. P2Y12 inhibitors
8. BB
9. ACEI

Drug Information NATION
1. DPP4 inhibitors: alogliptin, saxagliptin
2. Immunosuppressants: TNF inhibitors, interferons
3. Non-DHP CCBs
4. Anti-arrhythmics (class I): procainamide, quinidine, flecainide
5. Thiazolidinediones
6. Itraconazole
7. Oncology: anthracyclines
8. NSAIDs: all NSAIDs, including celecoxib

Decreased mortality
1. ACEI/ARB
2. BB
3. Spironolactone
4. ARNI
5. Bidil (for AA)

Symptomatic relief
1. Loop diuretics
2. Digoxin
3. Ivabridine

1. Antiarrhythmics: class I and III
2. Abx: FQs, macrolides, azoles (except isavuconazonium)
3. Antidepressants: TCAs, SSRIs, SNRIs, mirtazapine, trazodone
4. Antiemetics: 5HT3 antagonists, droperidol, phenothiazines
5. Antipsychotics: chlorpromazine, clozapine, haloperidol, olanzapine, paliperidone, quetiapine, risperidone, thioridazine, ziprasidone

Double Quarter Pounder, Lettuce, Mayo, Fries, Please! Because Dieting During Stress Is Always Very Difficult
1. Ia: disopyramide, quinidine, procainamide
2. IIb: lidocaine, mexiletine
3. Ic: flecainide, propafenone
4. II: beta blockers
5. III: dronedarone, dofetilide, sotaolol, ibutilide, amiodarone
6. IV: verapamil, diltiazem

1. HTN
2. A. fib
3. Gender (W>M)
4. Age > 55
6. Atherosclerosis
7. Diabetes
8. Prior stroke or TIA
9. Smoking
10. Dyslipidemia
11. patent foramen ovale
12. Sickle cell disease

Act FAST
F: face-does one side droop?
A: arms-does one arm drift?
S: speech-are words slurred?
T: time-seek medical attention immediately

Stop warfarin and convert to:
-Rivaroxaban: when INR < 3
-Edoxaban: when INR < 2.5
-Apixaban and dabigatran: when INR < 2

Overlap Xa inhibitor with warfarin until INR is therapeutic

Please Let Greg Brown Bring Peaches To Your Wedding
1. Pink = 1mg
2. Lavender = 2mg
3. Green = 2.5mg
4. Brown = 3mg
5. Blue = 4mg
6. Peach = 5 mg
7. Teal = 6mg
8. Yellow = 7.5mg
9. White = 10mg

-Decrease INR
1. Broccoli
2. Brussel sprouts
3. Cabbage
4. Canola oil
5. Cauliflower
6. Chickpeas
7. Coleslaw
8. Collard greens
9. Coriander
10. Endive
11. Green kale
12. Lettuce
13. Mustard green
14. Parsley
15. Soybean oil
16. Spinach
17. Swiss chard
18. Tea
19. Turnip greens
20. Watercress

1. Surgery
2. Major trauma
3. Immobility
4. Cancer/chemo
5. Previous VTE pregnancy
6. Estrogens, SERMs
7. Paroxysmal nocturnal hemoglobuinuria
8. Central venous catheterization
9. Inherited/acquired thrombophilia
10. Acute medical illness
11. Venous compression
12. IBD
13. Nephrotic syndrome
14. Myeloproliferative disorder
15. ESAs
16. Increasing age
17. Obesity

-Afib > 48H or unknown duration: anticoagulate >3 weeks prior and 4 wks after cardioversion
-Afib < 48H: start anticoagulation, do cardioversion, continue for at least 4 wks

1. CHF
2. HTN
3. Age > 75 (2)
4. DM
5. Stroke/tia (2)
6. Vascular-MI, PAD
7. Age 65-74
8. Sex-female (1)

-100-200mg elemental Fe per day
-SR and ER cause less GI upset, but not recommended for initial therapy
-Increase Hgb by 1g/dL every 2-3 wks
-Cont tx for 3-6 mos after anemia resolved

1. Gluconate: 12%
2. Sulfate: 20%
3. Sulfate (dried; slow Fe): 30%
4. Fumarate: 33%
5. Carbonyl Fe: 100%
6. Polysaccharide Fe complex: 100%

1. Dapsone
2. Methlyene blue
3. Primaquine
4. Pegloticase
5. Rasburicase
6. Levodopa
6. Methyldopa
8. Nitrofurantoin
9. Penicillins
10. Quinidine
11. Sulfonamides
12. Cephalosporins
13. Quinine
14. Rifampin

1. Acute chest syndrome
2. Anemia
3. Cholecystitis
4. Infection
5. Multi organ failure
6. Priapism
7. Spleen sequestration
8. Stroke
9. Vasoocclusive crisis

1. Avascular necrosis
2. Leg ulcers
3. Gallstones
4. Pain
5. Retinopathy
6. Pregnancy complications
7. Pulmonary HTN
8. Renal impairment
9. Recurrent priapism

1. HIB
2. Prevnar 13
3. Meningococcal conjugte series + booster
4. Meningococcal serogroup B >10YO
5. Pneumovax 23 at age >2, then booster 5 years later, then >65

D = decongestant
DM = dextromethorphan
PE = phenylephrine
AC = codeine

< 12 YO: avoid all codeine (FDA)
< 6YO: avoid all OTC cough and cold products (AAP)
<4YO: avoid many OTC cough and cold products (PI)
<2YO: avoid OTC cough and cold products (FDA), avoid promethazine (FDA), avoid topical menthol and camphor (PI)

1. Retinal change: chlorquine, hydroxychloroquine
2. Optic neuropathy: amio, ethambutol, linezolid
3. Floppy iris syndrome: alpha blockers
4. Color discrimination: digoxin (yellowreen vision)< PDE5i (green tinge around objects), voriconazole
5. Vision loss: digoxin, PDE5i, isotretinoin, vigabatrin, voriconazole

1. Anticholinergics: oxybutynin, tolterodine, benztropine, trihexyphenidyl, TCAs
2. Cough/cold, motion sickness: anithistamine, scopalamine
3. Chronic steroids, especially eye drops
4. Topiramate

1. Make less fluid: beta blockers (timolol)
2. Move fluid out: prostaglandin analogs (latanoprost-most effective)
3. Do both: add on brimonidine

1st: topical BPOs and/or retinoids
2nd: add topical retinoid or BPO, switch to another retinoid or topical dapsone

1st: topicals combo or PO abx + BPO + topical retinoid
2nd: other combo, switch PO abx, add combined OCP or spironolactone (females) or PO isotretinoin

1st: combo topicals + PO abx or PO isotretinoin
2nd: switch PO abx, add combined OCP or spironolactone (females), or PO isotretinoin

1. Amiodarone
2. Bleomycin
3. Dronedarone
4. Methotrexate

How much air can be forcefully exhaled in one second

After taking a deep breath, the max volume of air that is exhaled

% of total air capacity ("vital capacity") that can be forcefully exhaled in one second

-Brand names = HFA, respimat, or no suffix
-Delivers dose of aerosolized liquid med
-Slow and deep inhalation
-Spacer can be used
-Shake well except QVAR Redihaler, Alvesco, Respimat products

-Brand names = Diskus, Ellipta, Pressair, Handihaler, Neohaler, RespiClick, Flexhaler
-No propellant
-Requires quick and forceful inhalation
-Spacers cannot be used
-Do not shake
-No need to prime except for Flexhaler

-Wear patch for 24H
-If you have vivid dreams, remove patch at bedtime
-Do not apply to same site for at least 1 week

-Chew slowly several times until there is a peppery flavor in mouth
-Park b/w cheek and gum until flavor goes away
-Begin chewing again slowly until flavor returns and park gum again
-Repeat for 30 mins or until flavor is gone
-Do not eat or drink anything 15 mins before or during use

Wt gain: use gum, lozenge, zyban
Depression: use Zyban
Dentures: avoid gum
Cost: avoid Rx
Skin disease: avoid patch
Lung disease: avoid inhaler or spray

1. Fasting plasma glucose 100-125
2. 2-hr PG of 140-199 after 75g OGTT
3. A1c 5.7-6.4%

1. Fasting plasma > 126
2. 2-h PG > 200 after 75g OGTT
3. A1c > 6.5%
4. Classic sx of hyperglycemia and random PG > 200

-A1c < 7^
-Pre-prandial b/w 80-130
-Post prandial < 180

1. Beta blockers
2. Cough syrups
3. Diuretics
4. Immunosuppressants
5. Niacin
6. Protease inhibitors
7. Quinolones
8. Antipsychotics: cloza, olanza, quetiapine
9. Statins
10. Systemic steroids

1st line: metformin + lifestyle
-If A1c > 8.5, start dual therapy
-If A1c > 10, start insulin

ASCVD: GLP1 agonists, SGLT2i
HF or CKD: SGLT2i, GLP1 agonists
Minimize hypoglycemia: DPP4i, GLP1 agonists, SGLt2
Wt loss: GLP1 agonists, SGLT2i
Cost: SU, TZDs

Rapid: Humalog Kwikpen (200 units/mL)
Regular: Humulin R U500 (500 units/mL)
Long: Tresiba Flextouch (200 units/mL); Toujeo (300 units/mL)

Usually 1:1 with the following exceptions:
-NPH BID to Lantus or Basaglar daily: use 80% of NPH
-Toujeo to Lantus or Basaglar: use 80% of Toujeo dose

Insulin:
1. Flexpen (Novolog products)
2. Kwikpen (Humalog, Humulin, Basaglar)
3. Flextouch (Levemir, Fiasp, Tresiba)
4. Solostar: Lantus, Ademelog, Toujeo

GLP-1 agonists:
1. Byetta
2. Victoza
3. Adlyxin

Pramlinitide:
1. Symlinpen

1. Linezolid
2. Lorcaserin (Belviq)
3. Pentamidine
4. Quinolones
5. Beta blockers

1. Fluids: start with NS, when BG <200, change to D5W 1/2NS
2. Regular insulin: 0.1 units/kg bolus, then 0.1 units/kg/hr continuous infusion or 0.14 units/kg/hr infusion
3. Monitor K and keep K b/w 4-5
4. Only treat acidosis if pH < 6.9 (give Na bicarb)

1. Cold intolerance
2. Dry skin
3. Fatigue
4. Muscle cramps
5. Voice changes
6. Coarse hair/loss of hair
7. Menorrhagia (heavy periods)
8. Goiter
9. Constipation
10. Weight gain
11. Mylagia
12. Weakness
13. Depression
14. Bradycardia

I TALC
1. Interferons
2. Tyrosine kinase inhibitors
3. Amiodarone
4. Lithium
5. CBZ

Orangutans Will Vomit On You Right Before They Become Large, Proud Giants
1. Orange: 25mcg
2. White: 50mcg
3. Violet: 75mcg
4. Olive: 88mcg
5. Yellow: 100mcg
6. Rose: 112mcg
7. Brown: 125mcg
8. Turquoise: 137mcg
9. Blue: 150mcg
10. Lilac: 175mcg
11. Pink: 200mcg
12. Green: 300mcg

1. Heat intolerance
2. Weight loss
3. Agitation/irritability/anxiety
4. Palpitations/tachy
5. Fatigue, muscle weakness
6. Frequent BM or diarrhea
7. Insomnia
8. Tremor
9. Thinning hair
10. Goiter
11. Exophthalmos
12. Light menstruation

1. Fever > 103
2. Tachycardia
3. Tachypnea
4. Dehydration
5. Profuse sweating
6. Agitation
7. Delirium
8. Psychosis
9. Coma

Cute Hot Pharmacists & Physicians Marry Together & Deliver Babies
Cortisone 25mg
Hydrocortisone 20mg
Prednisone 5mg
Prednisolone 5mg
Methylprednisolone 4mg
Triamcinolone 4mg
Dexamethasone 0.75mg
Betamethasone 0.6mg

-Using >2mg/kg/day for or >20mg/day of prednisone for > 2 weeks
-Cannot receive live vaccines
-Must taper dose d/t HPA axis suppression

My Pretty Malar Marking Probably Has a TransIent Quality
1. Methimazole
2. Propylthiuracil
3. Methyldopa
4. Minocycline
5. Procainamide
6. Hydralazine
7. Anti-TNF agents
8. Terbinafine
9. Isoniazid
10. Quinidines

1. Beta blockers
2. Bleomycin
3. Cisplatin
4. Sympathomimetics: amphetamines, pseudoephedrine, illicit drugs

-Lo means <35mcg of estrogen
-Fe indicates iron supplement included
-24 indicates a shorter placebo time: 24 active + 4 placebo = 28d cycle

-Monophasic: Junel Fe 1/20, microgestin Fe 1/20, Sprintec, Loestrin, Yasmin
-Biphasic/Triphasic: Ortho-Tri-Cyclen, Tri-Sprintec, TriNessa
-Extended: Jolessa, Seasonique
-Continuous: Amethyst
-Drospirenone: Yasmin, Yaz
-Patch: Xulane
-Ring: NuvaRing, Annovera
-Progestin only pill: Errin, Camila, Nore-BE
-Injection: Depo-Provera

ACHES
1. Abdominal pain: ruptured liver/cyst, gallbladder, ectopic pregnancy
2. Chest pain
3. Headaches
4. Eye problems
5. Swelling or sudden leg pain

-Do not use estrogen containing products in women > 35 who smoke
-Xualne: higher VTE risk than PO
-Depo-Provera: loss of BMD
-Do not use estrogen in any of these conditions: hx of VTE, stroke, CAD, breast/ovarian/liver cancer, liver disease, uncontrolled HTN, migraines w/ aura

1. Acne: isotretinoin, topical retinoids
2. Abx: FQ, TCs
3. Anticoagulants: warfarin
4. HLD, HF, HTN: Statins, RAAs inhibitors
5. Hormones: including estradiol, progesterone, raloxifene, testosterone, contraceptives
6. Migraine: dihydroergotamine, ergotamine
7. Others: hydroxyurea, lithium, MTX, misoprostol, NSAIDs, paroxetine, ribavirin, thalidomide, topiramate, weight loss drugs, VPA/divalproex

1. AEDs: CBZ, PHT, phenobarbital
2. Aromatase inhibitors
3. Depo-medroxyprogesterone
4. GnRH agonists
5. Lithium
6. PPI
7. Steroids: >5mg day of prednisone > 3 mos
8. Thyroid hormones in excess
9. Heparin
10. Loop diuretics
11. SSRIs
12. TZDs

T score < -2.5 = osteoporosis
T score between -1 to -2.4 = osteopenia
-Screen women > 65, men > 70, or younger pts at higher risk or falling

Ca: recommended is 1000-1200mg elemental Ca/day
-Do not exceed 500-600mg elemental Ca per dose as absorption is saturable
-Ca carb = 40% elemental (absorption acid dependent)
-Ca citrate is 21% elemental

Vit D: 800-2000 IU daily recommended in adults > 50YO-Vit
-Deficiency = serum VitD < 30
-Treat deficiency w/ D3 5000-7000 IU daily or D2 50,000 IU weekly x8-12wks

-1st line for tx and prevention
-PO administration requires staying upright for 30 mins (60 mins for Boniva) and drinking 6-8oz of water
-SE = esophagitis, musculoskeletal Sx, hypoCa, ONJ, atypical femur fractures
-Formulations = weekly/monthly, PO options, quarterly/yearly IV options
-Tx duration is usually 3-5 yrs in pts at low risk of fractures

-Evista and Duavee
-Recommended as alt to bisphosphonates in high risk pts of vertebral fractures
-Increased risk for VTE and stroke
-Raloxifene for pts w/ low VTE risk or high risk breast cancer (SE = vasomotor Sx)
-Duavee only for pts w/ intact uterus (used to treat vasomotor Sx; increase breast cancer risk)

Last line tx b/c it is less effective and has risk for cancer w/ longterm use

-Teriparatide, abaloparatide
-Recommended for very high risk pts (high risk for veretebral fractures)
-Tx duration restricted to two years or less
-SC administration daily
-SE = hyperCa

-Recommended as alternative to bisphosphonates
-For very high risk pts
-SC administration every 6 mos
-SE = hypoCa

-Estrogen is most effective for vasomotor Sx
-In women w/ a uterus, estrogen should be used w/ progsterone b/c unopposed estrogen can increase endometrial cancer risk
-Progestin can be given as combo w/ estrogen or separate tablet (MPA). Causes mood disturbances and spotting. Micronized progestins (Prometrium) considered safer than synthetic (medroxyprogesterone)
-Criteria for hormone tx = healthy, symptomatic women who are within 10y of menopause, age <60, and who have no C/I to use

1. Antidepressants: SSRIs, SNRIs
2. Antihypertensives: BB, clonidine
3. Antipsychotics: chlorpromazine, risperidone, paliperidone
4. BPH: finasteride, dutasteride, silodosin

Starting:
Viagra 50mg = Levitra 10mg = Cialis 10mg = Stendra 100mg

Reduce dose by 50% if:
->65YO
-Using alpha-blocker
-Using 3A4 inhibitor
-Severe renal/liver disease

1. Anticholinergics (benztropine)
2. First gen antihistamines
3. Caffeine
4. Decongestants
5. Diuretics
6. SNRIs
7. TCAs, phenothiazines
8. Testosterone products

1. Age >40
2. DM
3. Restricted mobility
4. Stroke, PD, dementia
5. Obesity
6. Prior vaginal delivery
7. Hysterectomy
8. Pelvic injury

1. Alcohol
2. Cholinesterase inhibitors
3. Diuretics
4. Sedatives

-Use ER formulations, patch or gel, or mirabegron
-Avoid mouthwashes w/ alcohol, suck on ice chips or sugar free candyum
-Consider saliva substitutes OTC

Low: 1-4mcg/kg/min (renal)
Medium: 5-10mcg/kg/min (beta-1 agonist)
High: 10-20mcg/kg/min (alpha-1 agonist)

-Fill the tank: optimize preload w/ IV crystalloids
-Squeeze the pipes: peripheral vasoconstriction (alpha-1 agonism) to increase SVR
-Kick the pump: beta 1 agonist to increase contractility and CO

Mechanical ventilation and foley catheters

-Volume overloaded: loop diuretics, vasodilators
-Hypoperfusion: inotropes

1. Mechanical ventilation > 48H
2. Coagulopathy
3. Sepsis
4. TBI
5. Major burns
6. Acute renal failure
7. High dose steroids

1. Lidocaine (Xylocaine)
2. Benzocaine
3. Liposomal bupivacaine (Exaprel)

1. Desflurane (Suprane)
2. Sevoflurane (Ultaine)
3. Isoflurane (Forane)
4. Nitrous oxide (malignant hyperthermia risk)

1. Bupivacaine (Marcaine, Sensorcaine)
2. Lidocaine (Xylocaine)
3. Ropivacaine (Narcopin)
-Bupivacaine is in epidural (can be fatal if given IV)

Contraindicated:
1. Codeine < 12
2. Tramadol < 12
3. Promethazine < 12
4. Ceftriaxone < 28d

Not recommended:
1. FQs
2. TCs < 8YO
3. OTC teething meds in < 2YO
4. OTC cough/cold in< 6YO

1. Inhaled bronchodilators: open airways
2. Hypertonic saline: mobilize mucus to improve airway clearance
3. Dornase alfa: thins mucus to promote airway clearance
4. Chest physiotherapy: mobilize mucus to improve airway
5. Inhaled abx: control airway infection

-Help pts digest food, maintain weight
-PEP formulations not interchangeable
-Common ones are Creon, Viokace, Zenpep
-Viokace is the only PEP that is a non-enteric coated tablet and must be given w/ PPI
-All other PEPs are capsules: do not crush/chew, DR capsules w/ microspheres can be opened and sprinkled on soft/acidic food, swallow immediately
-Take PEPs before or w/ all meals or snacks
-High fat meals may require higher doses
-Protect from moisture and dispense in original container (except Zenpep)

Given before or at time of transplant to prevent acute rejection during early post-transplant period
-IV biologic or mAb (basiliximab) +/- high dose IV steroids
-Alt = antithymocyte globulin (Equine or rabbit)

Calcineurin inhibitor (tacrolimus is 1st line) + antiproliferative (mycophenolate is 1st line) +/- steroids

1. Influenza
2. Pneumococcal in adults > 19: PCV13 if never received, PPSV23 at least 8 weeks later
3. Varicella: vaccinate pre-transplant

1. Antipsychotics: clozapine, olanzapine, risperidone, quetiapine
2. DM: insulin, meglitinides, SFUs, TZDs
3. Divalproex/VPA
4. Litihum
5. Mirtazapine
6. Steroids
7. Others: BBs, dronabinol, gabapentinoids, hormones, MAOIs, SSRIs (paroxetine), TCAs, minoxidil

1. ADHD drugs
2. GLP-1 agonists
3. SGLT2 inhibitors
4. Pramlinitide
5. Topiramate
6. AChE inhibitors (donepezil, rivastigmine, galantamine), AEDs (zonisamide, ethosuximide), bupropion, interferon, thyroid drugs

1. Pregnancy: avoid all
2. HTN: avoid Contrave (C/I w/ uncontrolled HTN--contains bupropion); caution w/ Qsymia (monitor HR--contains phentermine)
3. Depression: avoid Contrave (suicide risk)
4. Seizures: avoid Contrave; caution w/ Qsymia (must taper slowly--contains topiramate)
5. Taking opioids: avoid Contrave (blocks opioid receptors--contain naltrexone)

Contains "morph", "norph", "cod" in name
1. Codeine
2. Hydrocodone
3. Oxycodone
4. Morphine
5. Hydromorphone
6. Oxymorphone
7. Buprenorphine
8. Heroin (di-acetyl-morphine)

1. Hx of previous overdose
2. Substance abuse
3. Using large doses (>50mg morphine mg equivalent dosing)
4. Using with BZDs
5. Comorbid illness such as respiratory and psych disease

1. Evzio (auto-injector)
2. Narcan (nasal spray): onset slower than injector, single use nasal spray is 4mg in 1 nostril
3. Naloxone (injection)

1. Hormonal changes in women
2. Foods: alcohol, aged cheeses, chocolate, aspartame, overuse of caffeine, MSG, salty foods, processed foods
3. Stress
4. Sensory stimuli: bright lights, sun glare, loud sounds, scents
5. Changes in wake sleep pattern
6. Changes in environment

Tablet:
1. Almotriptan
2. Eletriptan (Relpax)
3. Forvatriptan (Frova)
5. Naratriptan (Amerge)
6. Rizatriptan (Maxalt)
7. Sumatriptan (Imitrex)
8. Zolmatriptain (Zomig)

ODT:
1. Rizatrptan (Maxalt MLT)
2. Zomitriptan (Zomig MLT)

Nasal Spray:
1. Sumatriptan (Imitrex)
2. Zomitriptan (Zomig)

Powder:
1. Sumatriptan (Onzetra, Xsail)

Injection:
1. Prefilled: sumatriptan (Imitrex)
2. Auto-injector: sumatriptan (Imitrex STATdose)

1. ASA (lower doss)
2. Diuretics (loops, thiazides)
3. Select pancreatic enzymes
4. Calcineurin inhibitors
5. Niacin
6. Pyrazinamide
7. Select chemo w/ TLS

-Acute pain: steroids, NSAIDs, or colchicine
-PPX: allopurinol, febuxostat
-If XOI didn't work well and UA >6, add on lesinurad or probenecid to daily XOI
-If still refractory, replace XOI with pegloticase

Lifetime cumulative = 400 units d/t pulmonary toxicity

Lifetime cumulative dose = 450-550mg/m2 d/t cardiotoxicity

Dose per cycle not to exceed 100mg/m2 d/t nephrotoxicity

Single dose capped at 2mg d/t neuropathy

1. Bleomycin
2. Busulfan
3. Carmustine
4. Lomustine

1. Cisplatin
2. Carboplatin

Doxorubicin and other anthracyclines

Methotrexate

1. Lomustine
2. Carmustine

1. Ifosfamide
2. Cyclophosphamide

1. Vinca alkaloids: vincristine, vinblastine, vinorelbine
2. Taxanes: paclitaxel, docetaxel

1. Alkylators
2. Anthracyclines
3. Platinum based compounds
4. Taxanes
5. Topoisomerase I and II inhibitors
6. Antimetabolites
7. Vinca alkaloids

Amifostine (Ethyol) for nephrotoxicity prevention

-Dexrazoxane (Zinecard) for cardiomyopathy prevention
-Dexrazoxane (Totect) for extravasation tx

-Leucovorin or levoleucovorin (Fusilev) to enhance efficacy
-Uridine triacetate (Vistogard) for antidote within 96H

Mesna (Mesnex) for prevention of hemorrhagic cystitis

-Atropine for acute diarrhea
-Loperamide for delayed diarrhea

Leucovorin, levoleucovorin (Fusilev), Glucarparidase given after MTX to decrease myelosuppression, w/ mucositis, and w/ acute renal failure d/t high MTX level

1. Atomexetine
2. Indomethacin
3. Efavirenz (Atripla)
4. Rilpivirine (Odefsey, Complera)
5. BBs (esp propranolol)
6. Hormonal contraceptives
7. Anabolic steroids
8. Others: BZDs, systemic steroids, interferons, varenicline, ethanol

M SIG E CAPS (5 or more Sx in the same 2 week period)
1. Mood (depressed)
2. Sleep (increased or decreased)
3. Interest (diminished)
4. Guilt/feelings of worthlessness
5. Energy (decreased)
6. Concentration (decreased)
7. Appetite (increased or decreased)
8. Psychomotor agitation or retardation
9. Suicidal ideation

Agitation, anxiety, insomnia, dizziness, flu-like
-Highest risk = paroxetine, venlafaxine
-Exception = fluoxetine (long t1/2 = self taper)

Increased risk for suicidal thoughts in children, young adults (med guide required)

-D/c antidepressants if QTc > 500
-Highest risk w/ citalopram and escitalopram
-Additive QT effects w/ SSRIs, venalfaxine, mirtazapine, TCAs

-Avoid weight gain: avoid mirtazapine, consider bupropion
-Cardiac issues: avoid citalopram and escitalopram, consider sertraline
-At risk of seizures, recent ETOH withdrawal, anorexia, bulimia: bupropion is C/I
-Depression and pain: duloxetine is indicated for both
-Insomnia and low body wt: mirtazapine may be helpful
-Trying to avoid sexual dysfunction: avoid SSRIs, SNRIs, consider bupropion or mirtazapine

1. Centrally acting antihcolinergics
2. Dopamine agonists (Requip, Mirapex, Sinemet)
3. Stimulants
4. Systemic steroids (typically w/ lack of sleep or ICU psychosis)
5. Cannabis
6. Dextromethorphan
7. Interferons

-Increased EPS
-Decreased wt gain/metabolic SE

-Decreased EPs
-Increased metabolic effects

EPS:
-Lowest = quetiapine
-Highest = FGA, risperidone, paliperidone

Metabolic SE:
-Lowest = FGA, aripiprazole, ziprasidone, lurasidone, asenapine
-Highest = clozapine, olanzapine, quetiapine

QT prolongation:
-Highest = thioridazine, haloperidol, ziprasidone

Heme SE:
-Highest = clozapine

TIA/stroke
-Highest = risperidone

Proloactin secretion:
-Highest = risperidone, paliperidone

Seizure:
-Highest = clozapine

-SE = GI upset, cognitive effects, cogwheel rigidity, tremor, wt gain, polyuria/polydipsia, hypothyroidism, sedation
-To minimize SE, titrate slowly and possibly shift more of the dose to QHS
-5mL lithium citrate solution = 8mEq = 300mg lithium carbonate tabs/caps

Suspension:
1. Quillivant XR
2. Dynavel XR
3. Adzenys ER

Chewable:
1. QuilliChew ER
2. Vyvanse

Capsule (ok on applesauce):
1. Focalin XR
2. Ritalin LA
3. Aptensio XR
4. Adderall XR
5. Vyvanse: powder can only be mixed in water, OJ, yogurt

1. Albuterol
2. Antipsychotics
3. Bupropion
4. Caffeine in high doses
5. Decongestants
6. Levothyroxine
7. Steroids
8. Stimulants
9. Theophylline
10. Illicit Drugs

-Elderly = LOT (lorazepam, oxazepam, temazepam)
-Anxiety = CLAD (clonazepam,lorazepam, alprazolam, diazepam)
-Sleep = lorazepam or temazepam
-Seizure = BZDs can be given as injection, diazepam available as rectal gel

1. Alcohol
2. Bupropion
3. Caffeine
4. Decongestants
5. Diuretics
6. Fluoxetine
7. Steroids
8. Stimulants
9. Varenicline

1. Phenothiazines (prochlorperazine)
2. Butyrophenones (haloperidol, droperidol)
3. 1st and 2nd gen antipsychotics
4. Metoclopramide

1. Antihistamines/antiemetics
2. Antipsychotics
3. Baributrates
4. BZDs
5. Central anticholinergics
6. Peripheral anticholinergics
7. Skeletal muscle relaxants
8. CNS depressants

1. Bupropion
2. Clozapine
3. Theophylline
4. Varenicline
5. Carbapenems (esp imi)
6. Litihum
7. Meperidine
8. Penicillins
9. Quinolones
10. Tramadol

Hyponatremia, rash, enzyme inducer

Peripheral edema, weight gain, mild euphoria

Sedation, dependence, overdoser isk, enzyme inducers

Weight loss, metabolic acidosis, nephrolithiasis, oligohydrosis/hyperthermia in children

1. Ca and Vit D
2. Women of childbearing age: folate
3. VPA: consider carnitine
4. Lamotrigine: consider Se and Zn for alopecia

-Orange = standard starting dose
-Blue = lower starting dose (use if taking VPA)
-Green = higher starting dose (use if taking an inducer and not VPA)

-IV fosphenytoin NTE 150mg PE/min
-IV phenytoin NTE 50mg/min
-For phenytoin, it must be diluted in NS and be stored at room temp. Hold enteral feeds 1-2H before and after administration as enteral feeds decrease PHT absorption

1. ASA/NSAIDs
2. Bisphosphonates
3. Dabigatran
4. Estrogen
5. Fish oil
6. Iron
7. Nicotine replacement
8. Steroids
9. Tetracyclines

OTC:
-H2RAs: cimetidine, ranitidine, famotidine
-PPIs: esomeprazole, lansoprazole, omeprazole

ODT:
-Lansoprazole, omeprazole

Solution/suspension:
-H2RAs: cimetidine, famotidine, ranitidine, nizatidine
-PPIs: lansoprazole; packet for susp = esomeprazole, omeprazole, pantoprazole

IV:
-H2RAs: famotidine, ranitidine
-PPIs: esomeprazole, pantoprazole

1. ARTs (rilpivirine), atazanavir
2. Azoles (itraconazole, ketoconazole, posaconazole oral susp)
3. Cephalosporins (cefpodoxime, cefuroxime)
4. Iron products
5. Mesalamine
6. Risedronate DR (Atelvia)
7. Tyrosine kinase inhibitors (Dasatinib, pazopanib, erlotinib)

1. INSTIs
2. Bisphosphonates
3. Isoniazid
4. Mycophenolate
5. Quinolones
6. Sotalol
7. Steroids
8. Tetracyclines
9. Thyroid

-Fiber (metamucil) is 1st line for most adults, including pregnancy
-If pt needs to defecate quickly, use glycerin or bisacodyl suppository
-Chronic opioids require stimulant
-If pt is on iron, use docusate
-For children that need to go quickly, use glycerin suppository
-Refer to PCP if no improvement after ~7d

1. Aluminum antacids
2. Anticholinergics: TCAs, antihistamines, phenothiazines, antispasmodics, urge incontinence agents
3. Non-DHP CCBs (esp verapamil)
4. Clonidine
5. Colesevelam
6. Iron
7. Opioids
8. Sucralfate

Oral budesonide for <3 mos, then d/c tx or cahgne to thiopurine or MTX

1. Anti-TNF (adalimumab, infliximab, certolizumab)
2. Thiopurines (azathioprine, mercaptopurine)
3. IL-receptor antagonist (Ustekinumab)
4. Methotrexate

Integrin receptor antagonists
1. Verolizumab
2. Natalizumab

Mesalamine rectal and/or PO preferred

1. Anti-TNF (adalimumab, infliximab, golimumab)
2. Thiopurines (azathioprine, mercaptopurine)
3. Cyclosporine
4. JAK inhibitor (tofacitinib)

Integrin receptor antagonists
1. Vedolizumab

-Apply at least 4H before needed or night before surgery
-Replace every 3d
-Do not drive (high level of sedation, dizzy, confusion)
-Remove prior to MRI

-Use at least 2 patient identifiers
-Timely report critical labs
-Label all meds/containers
-Reduce likelihood of harm associated w/ anticoags (standardize dosing, programmable pumps, education to pts, etc)
-Communicate accurate pt med info (med rec, discharge counseling)
-Comply w/ CDC hand hygiene
-Implement best evidenced based practice (prevent healthcare acquired infections)

1. Amiodarone
2. Methotrexate
3. PO/topical retinoids
4. Quinolones
5. Diuretics
6. SJW
7. Sulfa abx
8. Tacrolimus
9. Tetracyclines
10. Voriconazole

1. Clopidogrel
2. Sulfamethoxazole

1. Abacavir
2. Allopurinol
3. CBZ
4. Ethosuximide
5. Lamotrigine
6. Sulfamethoxazole
7. Modafinil
8. Nevirapine
9. PCNs
10. Phenytoin

-Remove from carrying case
-Pull off blue safety release
-Keep fingers away from orange needle end of device
-Inject into middle outer thigh at 90 degrees
-Hold needle firmly in place while counting to 3
-Remove needle and massage area for 10s
-After injection, orange tip will extend to cover the needle
-Note: normal to see liquid remaining, second dose in opposite leg may be needed, refrigeration not required, can be injected through clothing

Abacavir: HLA-B*5701
Allopurinol: HLA-B*5801
CBZ, OXC, PHT, FosPHT: HLA-B*1502

-Clopidogrel: 2C9*2 or *3 = poor metabolizer (consider alt tx)
-Codeine 2D6: do not use in URM or PM
-Warfarin 2C9 *2 and *3, VKORC1 (increased bleeding risk, if alleles are present, start w/ lower dose)

-HER2: trastuzumab, pertuzumab, lapatinib (only works in HER2+)
-KRAS mutation: cetuximab (only works in KRAS (-))
-TPMT: azathioprine (deficiency increases myelosuppression risk)
-DPD deficiency: capecitabine, 5FU (DPD deficiency increases risk of severe toxicity)

-Symptom: management
-Agitation: sedatives
-Bradycardia: atropine, inotropes
-Seizures: BZDs
-Sedation: protection of airway
-Hypogylcemia: dextrose
-Hypotension: fluids, vasopressors
-QRS widening: Na bicarb
-HTN: IV vasodilator

-Available as Cetylev effervescent tabs for oral solution or Acetadote IV
-PO: 140mg/kg x1, followed by 70mg/kg Q4H x 17 additional doses
-IV: 150mg/kg IV over 1 hr, 50mg/kg IV over 4H then 100mg/kg IV over 16H