Quickies

HIV drugs

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NRTI stands for ____ _____ ______ ______. There are 5 drugs in this category (name them.) They _____ prevent the _____ of HIV _____ to _____. _____ is delivered during labor and delivery to prevent HIV transmission.

The key side effects are _____ and _______. And common side effects are ____ and ______. ____ causes hemolytic toxicity. Severe HBV exacerbations can happen if you discontinue ____/___ and _____.

Nucleoside reverse transcriptase inhibitor ; Zidovudine, Lamivudine, abacavir, TAF, TDF, emtricitabine ; conversation RNA to DNA ; Zidovudine

Lactic acidosis and fatty liver ; Nausea and diarrhea ; Zidovudine ; TAF/TDF and emtricitabine

InSTI stands for ___ ____ _____ _____ and they block the _____ enzyme, thereby preventing viral DNA from _____ into the host cell. The suffix for these drugs are _____.

All INSTIs cause ___, ____ and _____ (like depression and SI with pre-existing conditions). Do not use them with _____

_____ and ____ → increase SCr without effection GFR

_____, _____ → CPK/hypersensitivity

____ → hepatotox

Integrase strand transfer inhibitors ; integrase ; inserting ; -gravir

weight gain, insomnia, psych events ; cations

bitegravir, dolutegravir

dolutegravir, raltegravir

dolutegravir

NNRTIs stand for ___ ____ _____ _____ ______ and they work by ______ inhibition of ______. They have _____ in their name. Remember REDEN.

All NNRTIs are associated with ____ and ______. Efavirenz is associated with ____ and high _______. Rilpivirine is associated with ____ and _______

Non-nucleoside reverse transcriptase inhibitor ; non-competative ; reverse transcriptase ; -vir-

Hepatotixicity and hypersensitivity ; neuro/psych events and high cholesterol ; depression and false elevated SCr.

Do NOT use rilpivirine with _____.

PPIs (seperate from H2Rs and antacids)

The two protease inhibitors are _______ and _____. Inhibiting the protease enzyme prevents long viral chains from being broken down into the smaller chains needed to produce ____ _____ during the ___ and ____ stage. They must be taken with a _____ (ritonavir or cobicistat).

All PIs cause _____, ______, (like NNRTIs), and diarrhea and nausea. They all also ____ ______ thereby posing a CV risk. _____ needs an acidic environment

atazanavir and darunavir ; mature viruses ; budding and maturation ; booster

Hepatotox, hypersensitivity ; metabolic disturbances ; Atazanavir

The boosters are _____ and _____ which are strong ______. That’s why they work

ritonavir and cobicistat ; CYP3A4

What hepatitis c drugs are CYP3A4 substrates? ___ found in ____

gelcapravir ; mayvret ;

What drugs two drugs in epsclusa require acidic environment?

velpatasvir and ledipasvir

Descovy contains →

Truvada contains →

Emtricitabine/TAF

Emtricitabine/TDF

Genvoya contains →

Stribild contains →

Symtuza contains →

Elvetagravir / cobicistat / emtricitabine TAF

Elvetagravir / cobicistat / emtricitabine / TDF

Darunavir / cobicistat / emtricitabine TAF

Odefsey contains →

Complera contains →

Cabanevua →

Rilpivirine / Emtricitabine / TAF

Rilpivirine / Emtricitabine / TDF

Rilpivirine /Cabotegravir

Triumeq →

Dovato →

Delstrigo →

Lamivudine / abacavir / dolutegravir

Lamivudine / dolutegravir

Lamivudine / doravirine / TDF

PrEP oral drugs are____ or _____ taken every day. IM drugs are taken monthly for ____ and then _____ (___). Start PEP asap and then continue for ____

descovy (emtr/taf) or truvada (emtri/tdf) ; 2 months ; every 2 months (cabotegravir) ; 28 days

Common one-pill/once daily regimens are ____ and ____. Common two pills one daily regimens are _____+______ or ______

Biktarvy (biteg/emtri/taf) and dovato (dolutegravir / lamivudine). Tivicay + truvada (emtri/TDF) or descovy (emtri/TAF)

Bone density

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Most bisphosphonates are oral but ____ is ____/___ and given _____.

____ and _____ are _____ and given every ___ for prevention and ____ for treatment

ibandronate po/iv (both) and given IV: 3 months, PO: one month

Zoledronic acid and zometa are IVs and given 2 yrs; 1 yr

Reclast

Zoledronic acid

Teriperatide and abaloperatide are

Parathyroid hormones

Xgeva

Denosumab

MISC. high yield

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Pregnancy teratogens:

Neuro: ____,____, ____

Psych: ____, ____

Sickle: ____

Infectious: ____, ____

Valproate ; topiramate ; ergotamine

Psych: paroxetine, lithium

Sickle: Hydroxyurea

Infectious: Ribavirin, metronidazole

What to use in seizure for pregnancy

Levetiracetam (first line) ; lamotrigine

Avoid while breastfeeding:

Psych: ____, ____

neuro: ____, ____

CV: ____, ______

and infectious: ______

amphetamines ; lithium

phenobarb, ergotamines

amiodarone, statins

metronidazole

Statin risk categories for primary prevention

10-year ASCVD risk 7.5%-19 → moderate

DM + 40-75 → moderate (unless multiple ASCVD risk factors)

GINA steps 1-5

Step 1: Sx less than 4-5 days/week (prn meds)

Step 2: Sx >4-5 days/week (low dose ICS or low dose smart)

Step 3: Nighttime awakenings (low dose ICS+LABA)

Step 4: Daily symptoms + nighttime awakening with low function (medium/high dose ICS+LABA)

Step 5: Add LAMA and refer. High dose maintenance or other drugs

1 Oz = ___ g

28.4

Non PCV drugs:

Lorazepam, amiodarone, tacrolimus, taxanes, insulin, NTG

Filter required drugs: PAT GAL

Phenytoin/parenteral, amiodarone, taxanes, golimumab, amphoteracin, lipids

Do not refrigerate

dexmedetomidine, SMX/TMP, phenytoin, furosemide, metronidazole, moxifloxacin, enoxeparin

Protect from light: Protect every necessary med daylight

phytonadione, epoprostenol,, nitroprusside, micafungin, doxycycline

Biostats 1 SD →

2 SD →

3 SD →

68%; Mean +1x Standard Deviation

95 %; Mean + 2x Standard Deviation

99 %; Mean +3x Standard Deviation

Premarin ; comes as ___, ____ and ____

Estrogen Patches: ___, _____

Etrace is

Conjugated estrogen ; cream, tablet, injection

Vivelle-dot ; climara

a cream

Prometrium ; is ____

Progestin

Vagifem

estradiol inserted tablet

Transdermal estrogen only patches

Climara, vivelle-dot

Extended cycle formulation

Seasonique

Transdermal estrogen and progestin patch

Xulane

Errin, camila, Nora-BE, Slynd

progestin only pill

Unexpcetd CYP3A4 substrates

Budesonide, estrogen contraceptives,PDE-% inhibitors, analgesics, dhp-ccbs, anti-coags,

CYP3A4 inhibitors

MADVAP

In the setting of renal or hepatic impairment, ____ therapy is contraindicated with concurrent use of P-glycoprotein [eg, Norvir (ritonavir)] or strong CYP450 3A4 (eg, ritonavir, darunavir) inhibitors due to an increased risk for toxicity.

colchicine

Dopamine agonists

Ropinorole, Mirapex

Rivastigmine is a(n) ____ that _____ acetylcholine

acetylcholinesterase inhibitor ; increases

What are the Ache inhibitors?

Rivastigmine, donepazil, galantamine

SGA highest risk: of metabolic syndromes?

EPS/Procalcitonin?

Sedation?

QT prolongation?

Cholinergic effects?

Clozapine (Clozaril), olanzapine (Zyprexa)

Paliperidone (Invenga), risperidone (Risperidol)

Clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (seroquel)

Ziprasidone (geodon)

Clozapine (Clozaril)

SGA lowest risk:

QT prolongation?

EPS?

abilify, lurasidone

clozapine, quetiapine

_______ and ________ can lower valproate levels while ______ can lower _____

Estrogen contraceptives and carbapenems ; topiramate can lower contraceptives

Valporate increases levels of ___, _____/______, _____ and ______

warfward, phenobard/phenytoin, lamotrigine, zidovudine

Lithium levels are increased with: _____, ______. They are decreased with ____, and _______.

____ lithium citrate syrup = _____ mEq of lithium ion = _____ of lithium

Therapeutic level: _____

decreased salt (ACE/ARBs, thiazides), and NSAIDS ; increased salt intake or caffiene/theophyline

• rmbr RAAS = renin-angiotensin-ALDOSTERONE

5 ml = 8 meq = 300 mg

0.6-1.2 mEq/L

SC only vaccines

yellow fever, dengue

oral only (vaccine)

vivotix, cholera, rotavirus

What drugs require an ac idic environment

• Iron → Iron products

• Kings → Ketoconazole

• Prefer → Posaconazole

• Icy → Itraconazole

• Coffee → Cefpodoxime

• Cream → Cefuroxime

• Dessert → Direct-acting antivirals

What drugs bind to cations

• I → INSTIs

• Bought → Bisphosphonates

• Iron → Isoniazid

• My → Mycophenolate

• Sister → Sotalol

• Bought → Budesonide

• Quartz → Quinolones

Tysabri

Natalizumab

Relistor

Methylnaltrexone

Entereg

Alvimopan

Amitiza

Lubiprostone

Don’t correct sodium faster than

12 mEq/day

Samsca ; ADE

Tolvaptan ; hepatotox (limit to 30 days)

Peripheral potassium can be infused no more than a rate of ____ at a concentration of _____

10 mEq/hr ; 10 mEq/100ml

Pediatric patients: Seek medical care when their temp is

>100.4F in < 3 months old (or for 2 days)

or

>104F in > 3 months

NMDA receptor antagonists?

amantadine and namenda (memantine)

Sulfa allergies

acetazolamide, zonisamide, darunavir

soy, peanut allergy

propofol, clevidipine

eggs

propofol, clevidipine, yellow fever

How to get Clearance?

F x dose = Cl x AUC

How to get loading dose?

Loading dose = (desired concentration x vd) / F

What to do with a CYP2C9*2 and 3*VKORC1 mutations?

Lower starting dose of warfwarf

If KRAS mutation

don’t use cetuximab

What azathiprine test will you run? What should you do if it’s low or absent?

TMPT → do a low dose or alternative treatment due to myelosupression

If someone has a DPD deficiency

Do NOT use cabcitabine

5 Gs

garlic, ginger, ginseng, ginko (dimentia), glucosamine

Cardiotoxic natural products

Ephedra and bitter orange → weight loss

Yohimbe → ED

Hepatotoxic natural products

Kava

Black kohosh → menopause

NAC works by acting as the _____ precursor to change NAPQI into inactive substance

glutathion s-transferase (GSH)

Anticholinergics → (which is also used in what)

Benzodiazepines →

Beta blockers →

CCbs →

5-fluorouracil, capcitabine →

Neostigmine, pyridostigmine →

Salicylates →

TCAs →

Valproic acid or topiramate →

Physostigmine

Flumazenil (be care can cause seizures in chronic user)

Glucose + supportive

Same as BBs + calcium replacement

Uridine triacetate

Paradoxime

Alkalinize

Sodium bicarb

Levocarnitine

What are the brand/generics TNF alpha inhibitors? ___, ___, ____, _____, ____.

Warnings: ____, _____, ____, _____, _____

Etanercept (enbrel), Adalimumab (humira), infliximad (remicade), certolizumab (cimzia), golimumab (simponi)

latent infection (hep b), malignancy, heart failure, demyelination, hepatotox

enbrel and humira can be stored in room temp for

14 days

Zonisamide and topiramate both can cause ____ and _____ because they’re _____

Increased ICP ; glaucoma ; carbonic anhydrase inhibitors

Vaccines that can be stored in the freezer

Varicella containing vaccines, smallpox and monkeypox

Select Drugs that are Contraindicated in CKD

CrCl <60: _____

CrCl <50: TDF-containing HIV treatment (e.g. _____, _____, _____) and _____IV (d/t vehicle)

CrCl <30: TAF-containing HIV treatment (e.g. _____, _____, _____, _____, _____), _____, _____, _____

GFR <30: _____ (also avoid bisphosphonate bt it’s not CI_

others: _____

CrCl <60: Nitrofurantoin

CrCl <50: TDF-containing HIV treatment (e.g. Complera, Delstrigo, Stribild) and voriconazole IV (d/t vehicle)

CrCl <30: TAF-containing HIV treatment (e.g. Biktarvy, Descovy, Genvoya, Symtuza, Odefsey), NSAIDS, Dabigatran, potassium-sparing diuretics, colchicine

GFR <30: metformin

others: meperidine

Varivax allergic contraindications

neomycin, gelatin

With amiodarone tha max dose of simvastatin is _____. And with lovastatin it’s _____. This statin is not extensively metabolized ____. What statins need to be taken in the evening? With amlodipine max both max is ____. With NDHP max dose is _____

20 ; 40 ; rosuvastatin ; SFL ; halved

How many units will protamine reverse? Do NMT than..

1 mg = 100 units, 50 mg

Standard tylenol concentration?

160 mg/5ml

Name all the phos binders

Calcium: Calphron, calcitrate, tums

Iron: Aurixya, Velphoro

Lanthanum Carbonate: Fosrenol

Sevelamer: Revela, Renagel

Name all the drugs for hypocalcemia

Vitamin D analogs: Calcitriol (Rocaltrol)

calcimimetics:Cinacalcet (Sensipar)

Name potassium binders

Sodium polysyrene (SPS)

Patiromir (Veltessa)

Lokelma

Risk factors for ACS ages in M vs F?

Males → 45

Females → 55

Aw > 0.6 BUD?

Aw < 0.6?

Water + fridge → 14 days

Preservative → 35 days

Oral liquid → 90

Other non Aq → 180

Category 1 BUD

Category 2 BUD

Category 3 BUD

Category 1 BUD → 12 hea, 24 hrs fridge

Category 2 BUD → 1-45 days, 4-60 days (fridge), 45-90 (frozen)

Category 3 BUD → 60-90, 90-120 (fridge), 120-180 (frozen)

Limit doxorubicin to _____ ; limit bleomycin to _____

450-550 mg/m² ; 400 units TOTAL EVER

front

back

theapeutic lithium ____

Phenyotin ____

Carbamazepine _____

0.6-1.2 mEq/L

10-20 mcg/mL total

4-12 mcg/mL

% ionizatoin

100/1+10^(pka-ph) (or backawards if its a weak base)

Vd is?

amoutn of drug in body/concentration in plasma

LD formular?

Desired concentration x vd / f

All PPIs must be taken ___ before a meal before ____ excepot ____ and ____ which can be taken ______. Except the _____

60 minutes ; delixant and pantoprazole ; without regard to meals ; except oral pantoprazole

Normal phosphate level →

Normal magnesium →

TSH →

Normal phosphate level → 2.3-4.7

Normal magnesium → 1.3-2.1

TSH → 0.3-3