top 35 ippe exam

albuterol/ proair, ventolin, proventil

class: SABA, immediate bronchodilation

ind: asthma, copd

DI: BB, short acting sympathomimetics

ADR: throat irritation, URTI, tremor, tachy, restless, paradoxical bronchospasm, pulm edema

Monitoring: symptom improvement

Pearls: wash mouthpiece. brisk deep breath and hold in

alprazolam/ xanax

class: benzo

ind: anxiety, panic disorder

DI: opioids, 3a4/5, estrogen

ADR: lethargy, seizures, withdrawal, etc.......

Monitoring: the massive amount of side fx

Pearls: for rescue, not maintenance. avoid abrupt dc

amlodipine/norvasc

class: CCB

ind: HTN, angina

DI: cyp3a5, nsaids make less effective, tacrolimus/simvastatin inc concentration

ADR: edema, flushing, headache, dizziness, hepatotox, thrombocytopenia

Monitoring: BP, angina relief

Pearls: low and slow, report fatigue/hypotn/edema, avoid alc/nsaid

amoxicillin/ amoxil, moxatag

class: penicillin

DI: none

ADR: N/V/D, SJS and TEN, C. diff

Monitoring: not that serious, cdiff signs if present

Pearls: none

apixaban/ eliquis

class: direct Xa inhibitor

ind: VTE, afib

DI: antiplate/ssri/nsaid/anticoag inc bleeding risk, cyp3a4/5 rxn/ pgp

ADR: bleeding, major brain/gi bleed

Monitoring: s/s clotting

Pearls: do not dc abruptly, note signs of bleeding, no nsaid/asa, avoid GFJ/SJW

atorvastatin/lipitor

class: statin/ hmg coa reduct inhib

ind: HLD, hypercholest, ASCVD prevention

DI: GPACMAN, fibrates/niacin rhabdo risk, BAS decrease absorp

ADR: myopathy, headache, rhabdo

Monitoring: dec cholest and ldl, inc hdl

Pearls: avoid alc and gfj, monitor for rhabdo

azithromycin/ zithromax, zpak

class: macrolide :

DI: cyp3a4/5 .... etc

ADR: n/v/d, hepatotox, QT PROLONG, sjs, jaundice, etc.

Monitoring: bruising, bleeding

Pearls: monitor for rash, bleeding, yellowing of eyes/skin, tolerability with food

buproprion/ aplenzin, fortivo, wellbutrin, zyban

class: NDRI

ind: depression, SAD, smoking cessation

DI: EVERYTHING... cyp3a4/MAOI/ etc.

ADR: agitation, headache, suicidal ideation, lowers seizure threshold, dont use in history of ED

Monitoring: sucidal thoughts BBW

Pearls: do not dc abruptly

carvedilol/ coreg

class: beta blocker

ind: HTN, HFREF, afib

DI: NSAIDS (decrease anti-htn), amio (bradycardia), antidiabetic drugs (mask hypogly), non dhp CCB (hypo risk)

ADR: cold extremities, dizzy, hypotn, bradyarryth, HF, hepatotox

Monitoring: lowered BP/HR, dec angina, hf improvement

Pearls: do not dc abruptly, avoid nsaids, dizziness, caution in diabetics

cephalexin/ keflex

class: 1st gen cephalosporin

DI: minerals, vitamins separate by 3h

ADR: n/v/d, cdiff

Monitoring: cdiff s/s

Pearls: ^

cyclobenzaprine/ flexeril, amrix, fexmid

class: muscle relaxant

ind: muscle spasms

DI: MAOI, serotonergic drugs, CNS drugs, tramadol

ADR: drowsiness, dizziness, dry mouth, headache

Monitoring: caution in pts with adverse experience w anticholinergics

Pearls: short term (2-3 weeks)

escitalopram/ lexapro

class: SSRI

ind: depression, GAD

DI: LOWKEY EVERYTHING (anticoag, nsaid, snris,s cyp2d6/3a4/2c19)

ADR: anxiety, irritation, sexual dysfunction, etc.

Monitoring: hypona, suicidal ideation

Pearls: taper if D/C, low and slow, multiple weeks to see effect

estradiol/ estrace, climara, minivelle,vagifem, etc.

class: estrogen

ind: menopause, atrophy of vulva/vagina, osteoporosis prophylaxis

DI: cyp3a4/5

ADR: weight changes, mood changes, vaginal bleeding, female tissue related cancers BBW

Monitoring: pap smear and breast exams + bone density

Pearls: inserts at night (estrace, vagifem, premarin), tablets with food to prevent nausea

fluoxetine/ prozac, sarafem

class: SSRI

ind: depression, GAD, OCD, PTSD, etc.

DI: LOWKEY EVERYTHING (anticoag, nsaid, snris,s cyp2d6/3a4/2c19)

ADR: anxiety, irritation, sexual dysfunction, etc.

Monitoring: hypona, suicidal ideation

Pearls: long half life, no taper required, most activating

fluticasone/ flonase, arnuity

class: ICS, decrease inflammation in lungs

ind: copd, asthma

DI: none

ADR: thrush

Monitoring: rinse mouth and spit to prevent thrush

Pearls: not for rescue, maintenance

furosemide/ lasix

class: loop diuretic

ind: edema, htn

DI: ace/arb inc hypotn, nsaids decrease effect, monitor w/ sglt2 inhib, lithium/aminoglyc toxic

ADR: hypokal, hypomg, hyperuric, inc urine, ototox, skin rxn

Monitoring: weight loss, less edema, inc urination

Pearls: sun sensitivity, take in the morning, avoid nsaids

gabapentin/ gralise, neurontin

class: GABA analogue

ind: AUD/withdrawal, GAD, neuropathy, etc......

DI: CNS depressants, alcohol

ADR: resp depression, hypersensitivity rxns, neuropsych effects, etc.

Monitoring: substance of misuse!

Pearls: do not dc abrupt. ER with food

hydrochlorothiazide/ hctz, hydrodiuril, microzide

class: thiazide

ind: edema, htn

DI: ace/arb inc hypotn, nsaids decrease effect, lithium/dofet tox

ADR: hypok and mg, hyperuric, dizziness, inc urine, skin rxn

Monitoring: bp, weight loss, less edema, freq urine

Pearls: take in am, avoid nsaids, sun sensitivity

hydrocodone(APAP)/ norco, lortab

class: opioid antagonist

ind:severe pain

DI: cns depressants, suboxone, maois, anything w serotonin syndrome risk, cyp3a4/5/2d6

ADR: gi upset, constipation, drowsiness, respiratory depression, hypotn, serotonin syn

Monitoring: addiction warning, resp depression, etc.

Pearls: take WF, stool softener, etc.

insulin lispro/ humalog, admelog, lyumjev

class: rapid acting, controls BG after eating

ind: diabetes, tx of hyperk

DI: other glucose lowering agents, beta blockers, FQ

ADR: hypoglyc, weight gain, inject site rxn, hypok

Monitoring: bg, hba1c

Pearls: monitor bg, injection within 15 min of meal in abdomen preferred, etc.

insulin glargine/ lantus, basaglar, semglee

class: long acting, basal coverage

ind: diabetes

DI: other glucose lowering agents, beta blockers, FQ

ADR: hypoglycemia, weight gain, inj site rxn

Monitoring: bg, hba1c

Pearls: monitor bg, injection within 15 min of meal in abdomen preferred, etc.

levothyroxine/ synthroid, levoxyl, unithyroid, euthyrox

class: synthetic t4 replacement

ind: hypothy

DI: antacids, estrogen/rifampin/phenytoin dec effect, inc dose of levothy

ADR: none, palpitations, tachy, hyperthy, CVD aggravation

Monitoring: serum levels, resolution of symp (cold extrem, hair loss, lethargy, etc.)

Pearls: empty stomach with water 30min before food, 6-8 wks to improve, do not dc abruptly

lisinopril/ prinivil, zestril

class: ACE inhibitor

ind: hypoTN, HFREF, etc.

DI: k sparing diuretics/ MRAs, nsaids, diuretics, other RAASi, etc.

ADR: cough, dizziness, hyperk, renal impair, angioedema

Monitoring: bp, hf symptom reduction, urine protein

Pearls: cough/dizzy, no pregnant, angioedema monitoring, no nsaids

losartan/ cozaar

class: ARB

ind: hypertn, diabetic neuro, etc.

DI: k sparing diuretics/ MRAs, nsaids, diuretics, other RAASi, etc.

ADR: hypotn, hyperK, dizziness, angioedema, hepatotox, rhabdo, renal failure

Monitoring: bp lowering, HF symp mgmt

Pearls: do not dc abrupt, no pregnant, avoid nsaid, note jaundice/angioedema

meloxicam/ mobic

class: nonselective nsaid

ind: arthritis, gout, pain

DI: aspirin, anticoag, snri, ssri, other nsaids bleed risk, decreases anti-htn and diuretic response, etc.

ADR: gi upset, bleeding, DRESS/SJS, HTN/HF exacerbation

Monitoring: bleeding, KF, etc.

Pearls: low+slow to decrease risk, do not take ibu/nap with it, take WF

metformin/ glucophage

class: biguanide

ind: PCOS, t2d, prediabetic

DI: contrast media lactic acidosis, FQ alter glucose metab

ADR: gi upset, weight loss, lactic aci, hepatotox

Monitoring: BG, HBA1C

Pearls: take WF, gi upset at dose inc normal, titrate in 500mg inc, no alcohol

methylphenidate/ ritalin, concerta

class: CNS stimulant

ind: ADHD, narcolepsy

DI: MAOI, SSRI, anticonvulsants, etc, opioids

ADR: tachy, insomnia, irritation, dec appetite, etc.

Monitoring: HR/BP

Pearls: abuse and dependence!

metoprolol tartate/ lopressor

class: beta blocker

ind: HTN, angina, post-MI, afib

DI: NSAIDS (decrease anti-htn), amio (bradycardia), antidiabetic drugs (mask hypogly), non dhp CCB (hypo risk)

ADR: cold extremities, dizzy, hypotn, bradyarryth, HF, hepatotox

Monitoring: lowered BP/HR, dec angina, hf improvement

Pearls: do not dc abruptly, avoid nsaids, dizziness, caution in diabetics

metoprolol succ/ toprol

class: beta blocker

ind: HTN, angina, post MI, HF, afib, HFREF (!)

DI: NSAIDS (decrease anti-htn), amio (bradycardia), antidiabetic drugs (mask hypogly), non dhp CCB (hypo risk)

ADR: cold extremities, dizzy, hypotn, bradyarryth, HF, hepatotox

Monitoring: lowered BP/HR, dec angina, hf improvement

Pearls: do not dc abruptly, avoid nsaids, dizziness, caution in diabetics

omeprazole/ prilosec

class: PPI

ind: GERD, PUD, heartburn, indigestion, etc...

DI: CYP2C19/clopidogrel, ph dependent drugs avoid

ADR: headache, pancreatitis, rhabdo, toxic epidermal necrolysis, etc......

Monitoring: resolution of symptoms/ulcers

Pearls: not PRN use, one time daily before first meal, prolonged use= osteoporosis/cdiff. do not use multiple OTC GI products

pantoprazole/ protonix

class: PPI

ind: GERD, PUD, heartburn, indigestion, etc...

DI: CYP2C19/clopidogrel, ph dependent drugs avoid

ADR: headache, pancreatitis, rhabdo, toxic epidermal necrolysis, etc......

Monitoring: resolution of symptoms/ulcers

Pearls: not PRN use, one time daily before first meal, prolonged use= osteoporosis/cdiff. do not use multiple OTC GI products

prednisone/ deltasone

class: glucocorticoid

ind: asthma, inflam, autoimmune, endocrine, etc.

DI: cyp3a4/5, fluoroquinolones tendon rupture, need to wait for live vaccines, warfarin NSAID/ASA Gi ulcers

ADR: hyperglyc. insomnia, irritability,, cushing, infection, adrenocortical insuffic

Monitoring: reduction in symptoms

Pearls: take WFOM, QAM, avoid abrupt dc

rosuvastatin/ crestor

class: statin/ hmg coa reduct inhib

ind: HLD, hypercholest, ASCVD prevention

DI: GPACMAN, fibrates/niacin rhabdo risk, BAS decrease absorp

ADR: myopathy, headache, rhabdo

Monitoring: dec cholest and ldl, inc hdl

Pearls: avoid alc and gfj, monitor for rhabdo

semaglutide/ ozempic, wegovy, rybelsus

class: GLP1

ind: t2d, weight mgmt

DI: hypoglyc agents, corticosteroids/thiazides, delayed gi emptying may impact drugs

ADR: GI upset, weight loss, inj site rxn, pencreatitis, AKI, gallbladder disease

Monitoring: BG, HBA1C. weight

Pearls: low + titrate, injection education on same day/time per week

sildenafil/ viagara, revatio, liqrev

class: PDE5

ind: ED, PAH

DI: cyp3a4/5 DI, no nitrates

ADR: flushing, headache, visual disturbances, angina, priapism, etc...

Monitoring: additive hypotn with alpha agonists

Pearls: take before sexual activity 1-4h, one per day

trazodone/ desyrel

class: SSRI, a1 antag

ind: depression

DI: MAOI use (glaucoma, serotonin syn, etc. ), cyp3a4, digox/pheny/ warfarin

ADR: edema, syncope, fatigue, weight loss, etc.

Monitoring: suicidal ideration

Pearls: off label for sleep, inc suicidal risk, do not DC abrupt

zolpidem/ ambien, intermezzo, zolpimist

Class: hypnotic

ind: insomnia

DI: benzos, cyp3a4, cns/antidepressants

ADR: drowsiness, dizziness, headache, etc.

Monitoring: complex sleep behaviors, suicidal ideation, withdrawal, etc.

Pearls: not indicated for long-term use, controlled med