Random Medication PANCE review

Antibiotics that cannot be given in Pregnancy

"FAST"

Fluoroquinolones (arthropathy)

Aminoglycosides (CN8 toxicity)

Sulfonamides (Kernicterus)

Tetracyclines (Tooth/bone problems)

Other medications that should not be used in pregnancy

Metronidazole

Warfarin

Statins

Sulfas

ACE-inhibitors

NSAIDS

Ondansteron (cleft palate)

Any seizure med except those beginning with "L"

ABX associated with ototoxicity

Aminoglycosides (e.g. gentamicin = permanent)

Minocycline (transient)

ABX associated with Nephrotoxicity

Aminoglycosides (ATN classically Gent)

Vancomycin

What med causes discolored teeth?

Tetracyclines

What med causes yellow babies

Sulfonamides

MC med associated with C. Diff

Clinda! then FQs

______ + Epstein-Barr causes a maculopapular rash

Ampicillin

MOA of penicillin

Arrests cell wall synthesis

What is the only Cef- with MRSA coverage?

Ceftaroline

MOA for tetracyclines

inhibits 30S bacterial ribosome

Macrolide MOA

inhibits 50S bacterial ribosome

What is a black box warning for macrolides?

Not to be used with oxycontin

Aminoglycosides MOA

inhibit 30S bacterial ribosome

Fluoroquinolone MOA

inhibit bacterial DNA topoisomerases

Which meds can cause QT prolongation effects?

Macrolides

Fluroquinolones

Fluconazole

Anti-arrhythmics (amiodarone, etc)

Methadone

Promethazine

TCAs (amitriptaline, nortriptyline)

SSRIs (Citalopram/exscitalopram)

Anti-emetics

1st gen antipsychotics (haloperidol/chlorpromazine)

Adverse drug reactions of FQ?

Tendinopathy (tendon rupture) and aortic dissection

Contraindicated in kids <18)

TMP-SMX MOA

Inhibition of folate synthesis

With TMP-SMX, what medications needs to be watched closely?

Warfarin. Prevents warfarin from breaking down and will increase INR.

ACE/ARB. Retains K+.

In what populations should you not give TMP-SMX?

G6PD and Pregnant

What medication must be given with Isoniazid?

Vit B6 (pyrioxine)

What medication needs to be monitored with Rifampin?

Warfarin. Will make it work 5x faster and patients will clot.

Primary treatment for deep antifungal treatment

Amphotericin B

Aspirin MOA

COX 2A inhibition. Decreases platelet aggregation

Only two reasons to give kids Aspirin

Kawasaki disease

Rheumatic fever

What CYP enzyme handles Warfarin?

CYP2C9

Same as quinolones, TMPSMX

What deficiency can Warfarin cause?

B12 deficiency

What deficiency can Metformin cause?

B12 deficiency

Statin MOA

Inhibition of HMG CoA decreases serum LDL

With statin use will glucose go up or down?

Up

Which calcium channel blockers are considered anti-arrhythmic good for SVT and A-fib?

diltiazem > Verapamil

Common side effects of CCBs

Constipation, hypotension, headache

Side effects of amiodarone (Class III anti-arrhythmic)?

Photosensitivity (suggest sunscreen)

Sun exposure may cause bluish skin

Thyroid toxicity

Optic neuritis

Hepatitis

Pulmonary fibrosis

MOA of digoxin

inhibition of Na/K pump, increases contractility

What are some side effects of Digoxin?

Yellow-green vision change (Chromotopsia)

Can cause PVCs and Heart Failure.

MOA loop diuretics

interferes with Na/K exchange in ascending LOOP of Henle

MOA of Thiazides

Interferes with Na/K exchange in distal convoluted tubule

Loops and Thiazides can cause toxicity when combined with what other medications?

Digoxin and Lithium

ACE inhibitor MOA

Vasodilates efferent arteriole, decreasing glomerular pressure

Which Beta blocker is B1 selective and is therefore good for heart failure?

Metroprolol succinate

Which Beta blocker is both Alpha and Beta?

Carvedilol

Clinical use for beta blockers

Hypertension PLUS:

- Stable/unstable angina

- Heart failure

- A-fib

Beta blockers can decrease the effectiveness of ________

Epinephrine (Epi-Pen)

MOA of CCBs

no intracellular CA influx causes vasodilation

Clinical use for CCBs

HTN esp in African Americans

Prinzmetal angina

Raynaud phenomenon

Any time there is small vessel spasm

Which CCB is associated with gingval hyperplasia?

Nifedipine

Suffix of SABAs

"buterol"

albuterol, levalbterol

Suffix of LABAs

"m_terol"

salmeterol, formoterol

What are the adverse reactions of inhaled beta agonists?

Tachycardia

Palpitations

Tremor

Name a SAMA

Ipratropium

When is a SAMA useful?

in the hospital for bronchospasm (e.g. Duoneb contains albuterol)

Name a LAMA

Tiotropium

side effects of the LAMAs

Xerostomia (dry mouth)

Urinary retention and increased intraoccular pressure (careful with Glaucoma and BPH)

LAMA is an ANTIcholinergic

Name some inhaled corticosteroids

Fluticasone, budesonide (nebulized)

("-son")

When to use ICS?

1st line persistent asthma

C&D class patients in COPD

ICS are contraindicated with what meds?

HIV medications

Side effects of ICS?

Thrush

Theophylline acts like _____

Caffeine.

Adverse reaction of Acetaminophen?

Hepatotoxicity. Concern with ETOH.

What populations should NOT use NSAIDS?

1. CKD

2. PUD

3. Pregnant women

4. Others (asthma, HTN, heart failure).

What important medication do NSAIDS interfere with?

Aspirin.

Interferes with antiplatelet effect. NSAIDS should be stopped indefinitely in AMI patients.

MOA of opioids

Mu receptor modulates analgesia, euphoria, respiratory depression, and physical dependency properties

H2 blocker MOA

Inhibits gastric secretion by blocking histamine

Good for PRN use

MOA of PPIs

inhibits parietal cell H/K pump

Should be administered 30-60 minutes before first meal.

What are some adverse effects of PPIs?

Anemia (iron deficiency, pernicious)

Fractures

C-diff infections and pneumonia

Black box warning with Regalin

Causes acute dystonia

What is the first line treatment for allergic rhinitis?

Fluticasone

MOA of metformin

decrease hepatic glucose production

Black box warning on Metformin

Can cause lactic acidosis

What populations cannot use metformin?

Renal and liver dysfunction

MOA of Sulfonylureas

Stimulates insulin secretion

Education about how to take thyroid meds

Take alone on empty stomach with a full glass of water at least 30 minutes before breakfast.

Steroids can cause what adverse reactions?

Cushingoid

Skin atrophy

Cataracts

Poor wound healing

Weight gain due to hunger

What medication causes blue color vision?

Sildenafil

PDE-5 inhibitors are contraindicated with what?

Nitrates, causes hypotension

Treatment of absence seizures

Ethosuccimide

What medication is Fluoxetine and paroxetine contraindicated with because of CTP2D6?

Metoprolol.

MC SSRI side effect

Decreased labido.

Torsades De Pointes can be caused by

TCA (tricyclic antidepressants)

Or any QT prolonging med

Black box warning on antipsychotics

dementia-related psychosis and suicidality

Which psych med is associated with granulocytopenia?

clozapine. Monitor blood counts.

What medications can cause Neuroleptic malignant syndrome?

1st gen antipsychotics.

Haloperidol, Chlorpromazine

Side effects of 2nd gen antipsychotics (Risperidone, Olanzapine, Quetiapine, ziprasidone, Aripiprazole)

Weight gain

Diabetes

Hyperlipidemia

What is the "backbone" therapy for HIV?

2 NRTI +

1 Protease inhibitor ("-navir) -or-

1 Non-nucleoside reverse transcriptase inhibitors ("-virine")

1 Integrase Strand Transfer Inhibitors ("-egravir")

Emitricitabine (FTC) + Tenofovir (TAF) + Raltegravier (RAL) -or- Darunavir (DRV)

CD4 count <200 should be PPX'd with _____ for PCP

Bactrim

CD4 count <100 should be PPX'd with Bactrim for what issue?

Toxoplasmosis

CD4 count <50 should be PPX'd with ______ for Mycobacterium avium complex.

Azithromycin

Pregnant women with Lyme disease are treated with ______

Amoxicillin

Pregnant women Rocky Mountain Spotted Fever are treated with _______

Chloramphenicol

Treatment for Cholera

1. Doxycycline

2. Ciprofloxacin

Treatment for Giardia

Metronidazole or Tinidazole

Treatment for C. Diff

Metronodazole (Mild)

Oral vancomycin (Moderate-severe)

Shigella treatment

Ciprofloxacin - adults

Azithromycin - kids

Campylobacer jejuni treatment

Azithromycin

Salmonella treatment

Fluoroquinolone