High Yield Naplex Info PNN pass Naplex now Appendix

Acetaminophen antidote

N-acetylcysteine (acetadote IV) (Cetylev (oral)

Anticholinergics/ Antihistamine antidote

Physostigmine (Antilirium)

Organophosphates/ Pesticides/ Malathion Cholinergics antidote

Atropine Or Pralidoxime (Protopam, 2-PAM) (ATNAA, Duodote)

Cyanide antidote

Hydroxocobalamin (Cyanide antidote kit)

Hypoglycemic agents antidote

Glucagon

Beta-Blockers antidote

Glucagon

Calcium Channel Blockers antidote

Calcium Chloride and or/ Glucagon

Digitalis antidote

Dig Immune Fab

Theophylline antidote

Beta-Blockers

Serotonin Syndrome antidote

Cyproheptadine (5-HT2 receptor antagonist)

Dystonic Reaction antidote

Benztropine (Cogentin) or diphenhydramine (Benadryl)

Neuroleptic Malignant Syndrome antidote

Bromocriptine, Dantrolene

Ethylene Glycol (antifreeze) antidote

Fomepizole (Antizol), Ethanol 10%

Methanol (Wood alcohol) antidote

Fomepizole (Antizol) (Ethanol 10%)

Lead antidote

Dimercaprol (BAL in oil), EDTA- Calcium, DMSA (Succimer)

Arsenic antidote

Dimercaprol (BAL oil) or DMSA

Heavy Metals antidote

Dimercaprol or penicillamine

gold antidote

Dimercaprol

Mercury antidote

D-Penicillamine

Copper (Wilson disease) antidote

Penicillamine

Iron (Hemochromatosis disease) antidote

Deferoxamine (Desferal)

Heparin antidote

Protamine Sulfate

Warfarin antidote

Vitamin K (Phytonadione, Mephyton)

Dabigatran (Pradaxa) antidote

Idarucizumab (Praxbind)

Eliquis (apixaban) and Xarelto (rivaroxaban) antidote

Andexanet alfa (Andexxa)

Benzodiazepines / Zolpidem antidote

Flumazenil (Romazicon)

Opiates antidote

Naloxone (Narcan)

Lithium antidote

No antidote. Correct Na+. Supportive care, Hemodialysis

Barbiturates antidote

No antidote. Use charcoal if early and alkalinize urine with NaHCO3/ supportive care

TCAs antidote

NaHCO3 (sodium bicarb)

Acetaminophen + Opiate combos antidote

N-Acetyl Cysteine and Naloxone

Micromedex

Complete drug reference:

Trissel's IV Check

POISINDEX (tox)

IDENTIDEX (pill identifier)

Red Book (drug prices, dosage forms, strength, pack sizes)

ReproRisk (risks during preg)

Neofax Essentials (neonatal care)

MSDS (material safety data sheet)

Facts and Comparisons

drug/ OTC information & comparison, immunization schedules Pill identification, Briggs pregnancy and lactation, Trissels IV-Check, Martindale (foreign drugs), Toxicology, Pt. ed)

Lexicomp

Drug monographs organized alphabetically; includes useful appendices like drug class comparisons and equivalent drug dosing charts

AHFS

American Hospital Formulary Service Drug Information

UpToDate

Evidence based-clinical resource, includes lexicomp

Pharmacists letter

Monthly newsletter

PDR

Physician's Desk Reference

Merck Index

Comprehensive drug reference boo

Merck Manual

manual of disease states, diagnosis and treatment

Martindale

worldwide drug reference book to look up foreign brand name drugs

Harriet lane

handbook for pediatric information

Pubmed. MEDLINE

Journals - summaries of articles from NLM

Briggs

Drugs in Pregnancy and Lactation

Sanford Guide

guide to empiric antibiotic treatment of different infections

Trissels

For injectable drugs compatibility and stability

Koda Kimble

book of applied therapeutics and clinical use of drugs

Red book

drug pricing, dosage forms, strength package sizes, manufacturers info

FDA's Orange Book

Therapeutic equivalence

Purple Book

Biological products and bio similar interchangeables

CDCs yellow book

international TRAVEL reccs

Vaccine reqs for tx and PPX

CDCs pink book

Epidemiology and Prevention of Vaccine-Preventable Diseases. Routinely used vaccines and diseases they prevent

FDAs green book

drug products rated for safety and effectiveness for VET use

GINA

Global Initiative for Asthma

NCCN

Chemotherapy guidelines National Comprehensive Cancer Network)

Drugs that can cause seizure

Abx: Quinolones & Imipenem

Antidepressants: TCAs & Bupropion (Wellbutrin & Zyban)

Analgesics: Merperidine (Demerol) by its metabolite normeperidine, Tramadol (ultram), & Tapentadol (Nucynta)

Antipsychotics: Phenothiazines, Clozaril, Chlorpromazine

Lithium Toxicity, Anesthetics (lidocaine)

Theophylline or sympathetic agents toxicity

Metoclopramide (reglan)

Withdrawal from downers; benzos, alcohol, sleep aids, anticonvulsants

Status Epilepticus Algorithm

Seizures that last >30 minutes. After each step evaluates seizure, if the seizure continues go to the next step:

1st therapy phase: Lorazepam IV or diazepam IV, or midazolam IM

2nd therapy phase: IV fosphenytoin or IV valproic acid or IV levetiracetam

3rd therapy phase: Repeat 2nd line therapy or anesthetic doses of either midazolam, propofol, thiopental, or pentobarbital

Drugs that can cause Lupus-like syndrome

Hydralazine & Methyldopa (both used in HTN in pregnancy)

Procainamide & Quinidine (both are anti-arrhythmic)

Isoniazid

Phenytoin

Sulfasalazine (for UC)

Penicillamine (antidote for arsenic, lead copper, and many heavy metals)

Chlorpromazine

Sulfanamide Drugs

These drugs shouldn't be given to people with a Sulfa allergy

Antimicrobials: Silver sulfadiazine (silverdene crm), Sulfamethoxazole (bactrim), Sulfisoxazole (Gantrisin)

Diuretics: HCTZ, Metolazone (Zaroxolyn), Methazolamide, Bumetanide (bumex), Furosemide (lasix), Torsemide (Demadex), Chlorothiazide (diuril), Chlorthalidone (thalitone)

Hypoglycemics: Chlorpropamide (Diabinese), Glimepiride (Amaryl), Glipizide (Glucotrol), Tolazamide, Tolbutamide

HIV PIs: Fosamprenavir, Darunavir, Tipranavir

Carbonic anhydrase inhibitors: Acetazolamide (Diamox), Methazolamide, Brinzolamide ophthalmic, Dorzolamide ophthalmic

Others: Celecoxib (CelebrexPC), Dapsone, Sulfasalazine, Sumatriptan (Imitrex), Zonisamide (Zonegran), Flomax (tamsulosin)

PCP prophylaxis CD4 count <200

1st line: Bactrim SS or DS QD

Alternative: Dapsone 100mg QD or Dapsone + pyrimethamine + leucovorin OR aerosilized pentamidine OR atovaquone (Mepron)

Histoplasma capsulatum Prophylaxis- Only in endemic areas with CD4 count

Itraconazole 200mg QD

Toxoplasma gondii- Only if seropositive (IgG) and CD4 <100

1st line: Bactrim 1 DS QD

Alternative: Bactrim 1 SS QD, Dapsone + pyrimethamine + Leucovorin OR atovaquone (Mepron)

Cryptococcus neoformans-only if seropositive (IgG) and CD3 <100

Fluconazole 800mg QD

MAC (mycobacterium avium complex-ONLY if delay in starting ART, or not on fully suppressive ART & CD4 count <50

Azithromycin 1200 mg weekly or 600mg 2x weekly or Clarithromycin 500mg BID

Alternative: Rifabutin

Coccidioidomycosis- Only in endemic areas with CD4 count < 250

1st choice: Fluconazole 400mg QD

TB in HIV ONLY if positive >5 mm OR contact with a person with active TB

Rifapentine 750-900mg + INH 300mg + Pyridoxine 50mg once weekly for 12 weeks

Alternative: INH 300mg + Pyridoxine 50mg PO daily for 9 months

VZV (varicella-zoster virus)- Pre-exposure with CDR 4 >/ 200 % no hx of infection. Post-exposure

1st line Pre: Varivax 2 doses 3m apart

Alternative: Vaccinate household

1st line Post: VZIG (immunoglobulin)

Alternative: Acyclovir 800 mg PO 5x/day for 5-7 days

Recommended Vaccines for HIV pts at any CD4 count

Pneumococcal vaccine

HepB

Influenza A/B

HPV

Meningococcal

Covid

Zoster

Tdap

Mpox

MMR and varicella (if CD4 count >/ 200 and no evidence of immunity

AVOID LIVE VACCINES IN CD4 count <200

morphine equivalents

PO: 30mg

IV/IM: 10 mg

Oxymorphone equivalents

PO: 10mg

IV/IM: 1

Hydromorphone equivalents

PO: 7.5mg

IV/IM: 1.5 mg

Oxycodone equivalents

PO: 20mg

IV/IM: not available

Hydrocodone equivalents

PO: 30mg

IV/IM: Not available

Codeine equivalents

PO: 200-300 mg

IV: 120

Meperidine (Demerol) equivalents

PO: 300mg

IV/IM: 75mg

Fentanyl

PO: none

IV/IM: 0.1mg

Steps for converting one opioid to another

1. Add up the total daily dose of the current opioid (both long-acting & rescue doses)

2. Using the table calculate the equivalent total daily dose of the new opioid

3. Reduce this dose by 25-50% to offset incomplete cross tolerance

4. Divide total daily dose of the new opiod into BID or QD for most CR or SR formulas

5. Calculate the breakthrough "rescue" dose: 5-15% of the patients daily dose. The rescue dose is even PRN every few hours in IR from instant release for break-through pain.

Example of opioid conversion:

Patient is on 10mg IV morphine Q3 Hours, Doc wants to discharge him on PO hydromorphone.

TTD of current opioid:

10 mg IV morphine Q3 Hrs= 80mg of IV morphine per 24 hours

10 mg of IV morphine = 7.5 mg of PO hydromorphone

80mg if IV morphine =X mg of PO hydromorphone

-> x=(80)(7.5) / 10 = 60 mg TDD PO hydromorphone

-> Then reduce by 25%

(60mg) (0.75)=45 mg daily dose of PO hydromorphone

Breakthrough pain: 10% of 45mg= Approx 4.5mg IR hydromorphone

IV meds in D5W only

Outrageous Bakers Avoid Salt

Bactrim (DO NOT refrigerate)(lasts 6 hours)

Amphotericin B (1mg/ 10 mL)

NitroprussiDe (EXP: 1 day RT) (Protect from light; stored in its carton until it's stored)

Amiodarone

Quinipristin/ Dalfopristin (Synercid)

Oxaliplatin

IV Meds in D5W or NS

Fosphenytoin (Cerebyx)

Vancomycin

Rifampin

Lorazepam (Exp day RT)

Abciximab (Reopro) (refrig/do not freeze/ don't shake)

Tirofiban (Aggrastat)

Primaxin (Exp 4 hrs RT/ 24 HRS fridge

Light protected meds

Linezolid (infusion bags should be kept in the overwrap until ready to use)

Levaquin (vials and pre-mixed solutions should be protected from light)

Argatroban (retain in the original carton to protect from light)

Amph B lipid (solutions should be protected from light during admin)

Doxycycline (protected from direct sunlight during storage and infusion)

Epinephrine

Furosemide

Nitroprusside

Nicardipine (Cardene IV)

Phytonadione (Vit K)

Rifampin

Non-PVC bag meds for products that exacerbate leaching:

Paclitaxel/ Docetaxel

Etoposide/ Teniposide

Cyclosporine

Non-PVC bag meds to avoid absorbing PVC medical products

Nitroglycerin

Lorazepam

Diazepam

Insulin Room Temp 28 days

Lispro (Humalog)

Aspart (Novolog)

Glulisine (Apidra)

Glargine (Lantus)

Exenatide ER (Bydureon)

Insulin Room temp 30 days

Pramlinitide (Symlin) (PEN)

Exenatide (Byetta)

Liraglutide (Victoza)

Insulin Room temp 31 days

Humulin R/ N/ Combos

Insulin Room Temp 14 days

Dulaglutide (Trulicity)

Lixisenatide (Adlyxin)

Insulin Room temp 10 days

Afrezza

Refrigerated Drops

Xalatan (Latanoprost)

Travatan (Travoprost)

Trifluridine 1% ophthalmic (Viroptic)

Azithromycin ophthalmic (Azasite) (RT 14 days)

Ciprofloxacin 6% otic (Otiprio)

Refrigerated HIV meds

Lopinavir/ ritonavir oral solution (kaletra) (RT 2 months)

Ritonavir capsules (RT 30 days)

Emtricitabine oral solution (RT 3 months)

Tipranavir capsules (Aptivus)(RT 60 days)

Freezer storage vaccines

Varicella vaccine (varivax)

MMR and varicella vaccine (ProQuad)

Misc fridge storage

Fosphenytoin (Cerebyx)

Dronabinol capsules (Marinol)

Calcitonin (Miacalcin nasal) (RT 35 days)

Lactobacillus (lactinex)

Epoetin alfa (Epogen, Procrit)

Darbepoetin alfa (aranesp)

Combipatch (RT 6 months)

Nuvaring (RT 4 months)

Promethazine suppository

Famotidine injection

Ampho

Succinylcholine

Nebulized arformoterol (brovana)

Formoterol (perforomist)

Lorazepam injection

Lorazepam oral conc

Filgrastim (neupogen) (RT 24 h)

Pegfilgrastim (neulasta) ( RT 48 h)

CYP1A2 substrates

Caffeine

Theophylline

Warfarin

Clozapine

Olanzapine

Asenapine

CYP1A2 inhibitors

cimetidine (tagamet)

ciprofloxacin (Cipro)

fluvoxamine (Luvox)

CYP1A2 inducer

Phenytoin (weak)

Phenobarbital (weak)

Carbamazepine (Tegretol)

Rifampin

Smoking

Charbroiled food

St. Johns Wart

CYP2D6 substrates

Tamoxifen (prodrug)

Tramadol (prodrug)

Codeine (prodrug)

Amitriptyline (Elavil)

Carvedilol

Metoprolol

Propranolol

Thioridazine

Aripiprazole (CYP3A4)

Brexpiprazole (CYP3A4)

Iloperidone

Risperidone

CYP2D6 inducers

Paroxetine

Sertraline

Fluoxetine

Duloxetine

Bupropion

Quinidine

Mirabegron

Rolapitant (varubi)-inhibitory effect may last 7 days or longer

CYP2C9 substrates

Warfarin (major)

Fluvastatin

CYP2C9 inhibitors

Amiodarone

Fluconazole

Miconazole (vagistat-3)

Voriconazole

Zafirlukast

CYP2C9 inducers

Phenytoin

Phenobarbital

Carbamazepine

Rifampin

Secobarbital (CII)

St. Johns wart