Key Drugs Guy/Study Tip Gal RxPrep 2025

What are common characteristics of a drug that may make it considered hazardous? (4)

Carcinogenic

Teratogenic

Causes organ toxicity at low doses

Genotoxic (damages DNA)

What medication is considered NIOSH because it is an abortifacient?

Misoprostol, mifepristone

Which antibiotics are considered NIOSH? (2)

not on key drugs

Chloramphenicol

Telavancin

What anticoagulant is considered NIOSH?

Warfarin

Which antifungals are considered NIOSH? (2)

not on key drugs

Fluconazole

Voriconazole

Which anti-HIV medications are considered NIOSH? (4)

not on key drugs

Abacavir

Entecavir

Nevirapine

Zidovudine

Which anti-virals medications are considered NIOSH? (3)

Cidofovir

Ganciclovir

Valganviclovir

Which acne medications are considered NIOSH?

Isotretinoin, tretinoin

Which antiarrhythmic is considered NIOSH?

not on key drugs

Dronedarone

Which medications for autoimmune conditions are considered NIOSH? (5)

Acitretin

azathioprine

Leflunomide

Teriflunomide

Fingolimod

Which medications for BPH are considered NIOSH? (2)

Dutasteride

Finasteride

Which SSRI is considered NIOSH?

Paroxetine

Which medication for diabetes is considered NIOSH?

not on key drugs

Bydureon BCise (Exenatide)

Which medication for dyslipidemia is considered NIOSH?

Lomitapide

Which anti-epileptics are considered NIOSH? (5)

Carbamazepine

Oxcarbazepine

Divalproex

Fosphenytoin

Phenytoin

Topiramate

Vigabatrin

Zonisamide

Which benzodiazepines are considered NIOSH? (2)

Clobazam

Clonazepam

Temazepam

Which anti-gout medication is considered NIOSH?

not on key drugs

Colchicine

Which heart failure medications are considered NIOSH?

Ivabradine

Spironolactone

Which medication for hepatitis is considered NIOSH?

Ribavirin

Which hormones are considered NIOSH? (5)

Androgens (testosterone)

Estrogens

Progesterone's

SERD/SERMS (raloxifene/tamoxifen, fulvestrant)

Ulipristal

oxytocin

Which medications for hypercalcemia of malignancy are considered NIOSH? (1)

not on key drugs list

Zoledronic acid

Which medications for hyperthyroidism are considered NIOSH? (2)

Methimazole

Propylthiouracil

Which medication for migraines is considered NIOSH?

not on key drugs

Dihydroergotamine

Which medications for Parkinson Disease are considered NIOSH? (2)

not on key drugs

Apomorphine

Rasagiline

Which medications for PAH are considered NIOSH? (4)

Ambrisentan

Bosentan

Macitentan

Riociguat

Which medication for schizophrenia is considered NIOSH?

not on key drugs

Ziprasidone

Which medications for transplant are considered NIOSH? (4)

Cyclosporine

Mycophenolate

Tacrolimus

Sirolimus

patches with q72 h frequency

fentanyl: q72h, if it wears off after 48 hours, then change to q48h

scopolamine (transderm scop): q72h prn

Common resistant pathogens

Kill Each And Every Strong Pathogen

Klebsiella pneumoniae (ESBL, CRE)

Escherichia coli (ESBL, CRE)

Acinetobacter baumanii

Enterococcus faecalis, Enterococcus faecium (VRE)

Staphylococcus aureas (MRSA)

Pseudomonas aeruginosa

CYP inducers

PS PORCS: phenytoin, smoking, phenobarbital, oxcarbazepine, rifampin, carbamazepine, St. John's wort

CYP inhibitors

G PACMAN: grapefruit, protease inhibitors, azole antifungals, cyclosporine (also cimetidine, cobicistat), macrolides (clarithro, erythro), amiodarone, non-DHP CCBs (diltiazem and verapamil)

key drugs that increase LDL and TG

Diuretics

Efavirenz

Steroids

Immunosuppressants (eg cyclosporine, tacrolimus)

Atypical antipsychotics

Protease inhibitors

key drugs that increase LDL only

Fish oils (except Vascepa)

fibrates

key drugs that increase TG only

IV lipid emulsions

propofol

clevidipine

bile acid sequestrants (~5%)

key conditions that increase LDL

obesity, poor diet, alochol use disorder, hypothyroidism, smoking, diabetes, renal/liver disease, nephrotic syndrome

select drugs that can increase or prolong the QT interval

antiarrhythmics

Class Ia, Ic and III

anti-infectives

antimalarials (eg: hydroxychloroquine)

azole antifungals (all except isavuconazonium)

macrolides

FQNs

lefamulin

antidepressants

SSRIs (highest risk with citalopram and escitalopram)

TCAs

mirtazapine, trazodone, venlafaxine

antiemetics

5-HT3 antagonists (eg ondandsetron)

droperidol, metoclopramide, promethazine

antipsychotics

FGAs (haldol, chlorpromazine, thioridazine)

SGAs (highest risk with ziprasidone)

oncology meds

andogen deprivation therapy (leuprolide)

tyrosine kinase inhibitors (nilotinib)

arsenic trioxide

others

cilostazol, donepezil, fingolimod, hydroxyzine, loperamide, methadone, ranolazine, solifenacin

B1 selective beta blockers

"Be selective about your MAN BABE"

Be selective = beta 1 selective

Metoprolol

Atenolol

Nebivolol (+nitric oxide dependent vasodilation)

Bisoprolol

Acebutolol

Betaxolol

Esmolol

Drugs with leaching/adsorption issues with PVC containers

Lorazepam, Amiodarone, Taxanes, Tacrolimus, Insulin, Nitroglycerin

Only compatible in saline

("A DIAbetic Can't Eat Pie")

Ampicillin, Daptomycin, Infliximab, Amp/Sulbactam, Caspofungin, Ertapenem, Phenytoin

Only compatible in dextrose

("Obese Bakers Avoid Salt")

Oxaliplatin, Bactrim, Amphotericin B, Synercid

Common drugs with filter requirements

*My GAL Is PAT who has a MaP

Golimumab

Ampho B (lipid formulations) - 5 micron

Lipids (1.2 micron - larger pore size filter required)

Isavuconazonium*

Phenytoin

Amiodarone

Taxanes (cabazitaxel and conventional paclitaxel*

Lipids (1.2 micron - larger pore size filter required)

Mannitol >/- 20%

Parenteral nutrition - 1.2 micron

Do not refrigerate

(Dear Sweet Pharmacist, Freezing Makes Me Edgy)

Dexmedetomidine, SMX/TMP, Phenytoin, Furosemide, Moxifloxacin, Metronidazole, Enoxaparin

Protect from light during administration

(Protect Every Necessary Med from Daylight)

Phytonadione, Epoprostenol, Nitroprusside, Micafungin, Doxycycline

Others: Ampho B Deoxycholate, Anthracyclines, Dacarbazine, Pentamidine

What is the focus of USP <797>?

minimize the risk of microorganisms or other contaminants in sterile preparations

What is the focus of USP <800>?

keep the compounder safe and reduce risk of exposure to the HD

xylitol (sweetener) avoid in

dogs; can cause xylitol toxicosis (hypoglycemia and hepatotoxicity)

humans that have GI upset with xylitol use

sucrose (sweetener) avoid in

diabetes

sorbitol (sweetener) avoid in

IBS; can cause GI distress

preservatives avoid in

neonates

lactose (sweetener, to compress tablets, filler/diluent) avoid in

lactose intolerance or lactose allergy

aspartame (sweetener) avoid in

phenylketonuria (PKU), pts cannot metabolize phenylalanine

alcohol (diluent) avoid in

children

CSP category: immediate use BUD

4 hours regardless of temp, fridge or frozen

CSP category 1: ISO 5 PEC in SCA, room temp BUD

12 hours

CSP category 1: ISO 5 PEC in SCA, refrigerated BUD

24 hours

CSP category 1: ISO 5 PEC in SCA, frozen BUD

N/A

CSP category 2: ISO 5 PEC in cleanroom, room temp BUD

1-45 days

CSP category 2: ISO 5 PEC in cleanroom, refridgerated BUD

4-60 days

CSP category 2: ISO 5 PEC in cleanroom, frozen BUD

45-90 days

CSP category 3: ISO 5 PEC in cleanroom with additional requirements room temp BUD

60-90 days

CSP category 3: ISO 5 PEC in cleanroom with additional requirements refrigerated BUD

90-120 days

CSP category 3: ISO 5 PEC in cleanroom with additional requirements frozen BUD

120-180 days

Key drugs that require dose reduction or increasing the interval in CKD

-anti-infectives: aminoglycosides, beta-lactams (most), fluconazole, quinolones (except moxi), vancomycin

-CV drugs: LMWHs (enoxaparin), DOACs (for AFib)

-GI drugs: metoclopramide, H2RAs

-Others: bisphosphonates, lithium

Other drugs that require dose reduction or interval increase in CKD

anti-infectives: amphotericin B, ethambutol, pyrazinamide, acyclovir, (valacyclovir, ganciclovir, valganciclovir), oseltamivir, aztreonam, NRTIs, polymyxins, sulfamethoxazole/trimethoprim

CV drugs: antiarrhythmics (digoxin, disopyramide, dofetilide, procainamide, sotalol), apixaban, dabigatran, statins

pain/gout drugs: allopurinol, colchicine, gabapentin, pregabalin, morphine, codeine, tramadol ER

others: cyclosporine, tacrolimus, topiramate

Drugs contraindicated with CrCl < 60

-nitrofurantoin

-do not initiate TDF if < 70

-glyburide not recommended in CKD

Drugs contraindicated with CrCl < 50

-tenofovir disoproxil fumarate: Stribild, delstrigo, Complera, Symfi, Truvada (during treatment)

-voriconazole IV

Drugs contraindicated with CrCl < 30

-tenofovir alafenamide: Genvoya, Odefsey, Descovy, Biktarvy, Symtuza

-NSAIDs

-dabigatran (DVT/PE)

-Others: bisphosphonates, duloxetine, fondaparinux, K-sparing diuretics, tadalafil, tramadol ER, avanafil

-sotalol (Betapace AF) at < 40

Drugs contraindicated with GFR < 30

metformin

other Drugs contraindicated in CKD

mepiridine

rivaroxaban

-SGLT2 inhibitors

Steps for treating severe hyperkalemia

1. Stabilize the heart - prevent arrhythmias with calcium gluconate

2. Move it - shift excess K intracellularly with albuterol, bicarb, insulin/dextrose

3. Remove it - enhance K elimination with Kayexalate/SPS, dialysis, loop diuretics, patiromer, sodium zirconium cyclosilicate

key drugs that cause nephrotoxicity

aminoglycosides

amphotericin B

cisplatin

cyclosporine

loop diuretics

NSAIDs

polymixins

radiographic contrast dye

tacrolimus

vancomycin

Key drugs that raise potassium levels

ACE inhibitors, ARBs, aliskiren, aldosterone-receptor antagonists, canagliflozin, drospirenone-containing COCs, Bactrim, calcineurin inhibitors (cyclosporine, tacrolimus)

Others: glycopyrrolate, heparin (chronic use), NSAIDs, IV fluids, K supplements, pentamidine

potassium chloride: a hard pill to swallow

extended release capsules

- capsule contents can be sprinkled on a small amount of applesauce or pudding

extended release tablets

- K tab, klor con: swallow whole; do not chew, crush, cut or suck on the tablet

- klor con M: if difficult to swallow hole; can be cut in half or disollved in water (stir for two minutes and drink immediately); do not chew, crush, or suck on the tablet

oral packet

- dissolve content in water and drink immediately

oral solution

- KCl 10% = 20 mEq/15 mL

- mix each 15 ml with 6 oz of water

Warning for sofosbuvir-containing products

serious symptomatic bradycardia when taken with amiodarone

-Sovaldi, Harvoni, Epclusa

HCV treatment that is pan-genotypic and approved for treatment-naive patients

Epclusa

Mavyret

key drugs with boxed warnings for liver damage

Acetaminophen (high doses, acute or chronic), isoniazid, ketoconazole, methotrexate, nefazodone, nevirapine, propylthiouracil, valproic acid, zidovudine

Others: amiodarone, bosentan, felbamate, flutamide, leflunamide, lomitapide, maraviroc, tolcapone, tipranavir

Which beta-lactams do not require renal dose adjustments?

anti-staph PCNs: nafcillin, oxacillin, dicloxacillin

ceftriaxone

Key Features of Carbapenems

Class effects:

-all cover ESBL-producing organisms

-Do not use with PCN allergy on NAPLEX!!

-All except ertAPEnem cover Pseudomonas

-seizure risk with higher doses, renal failure, or imipenem/cilastatin

-do NOT cover atypicals, VRE, MRSA, C. diff, Stenotrophomonas

-ertapenem does not cover Pseudomonas, Acinetobacter, Enterococcus

-all are IV only, ertapenem must be diluted in normal saline

-Common uses: polymicrobial infections, empiric therapy when resistance expected

Key features of aminoglycosides

-Spectrum: G- bacteria (including PsA), synergy for G+ infections (usually with beta lactam)

-dosing: extended-interval vs traditional, weight-based

-toxicities: nephrotoxicity, ototoxicity

-monitoring: peaks, troughs, random for extended-interval

common live vaccines

MICRO-VY

MMR

Intranasal Influenza

Cholera

Rotavirus

Oral Typhoid

Varicella

Yellow Fever

vaccine timing and spacing

General Rules for All Vaccines

- Vaccines can usually be given at the same time (same visit or same day)

- Multiple live vaccines can be given on the same day or (if not given on the same day) spaced 4 weeks apart

- if vaccine series requires > 1 dose, intervals between doses can be extended w/o restarting series, but they shouldn't be shortened in most cases

Live vaccines and antibody

- Vaccine -> 2 weeks -> antibody containing product

- antibody containing product -> 3 months or longer -> vaccine

- simultaneous admin of vaccine and antibody (immunoglobulin) recommended for post exposure prophylaxis (hep A and B, rabies, tetanus)

invalid contraindications to vaccines

- mild acute illness or antimicrobial therapy

disease exposure

- pregnant (except live vaccine, breastfeeding, premature birth

- PCN allergy

- family history of adverse effects

- previous mild-moderate skin reaction to vaccine

TB skin test or multiple vaccines

influenza vaccine tips

- Recommended annually at age 6 months

- all brand names have FLU in name - Alfuria, Fluzone (high-dose >65), FluMist (age 2-49, two nostrils), Flubok (egg-free), Fluad (>65)

-Age 6 months- 8 years (not previously vaccinated)- give 2 doses 4 weeks apart

- Egg allergy: can receive any age-appropriate inactivated influenza; supervised by healthcare professional; Flubok- egg-free approved for >/=18 y.o.; flucelvax

- Pregnant: do not administer FluMist

- >/=65 y.o.: Fluzone high-dose, Fluad, or Flublok

Quinolones: coverage

"My Good Lungs" / respiratory FQs: levofloxacin, moxifloxacin, gemifloxacin

-used for Strep pneumo, pneumonia

antipseudomonal FQs: ciprofloxacin, levofloxacin

-used for Pseudomonas infections (including pneumonia), UTIs, intra-abdominal infections, travelers' diarrhea (without dysentery)

Quinolones: safety issues

All the black box warnings:

tendonitis/tendon rupture

peripheral neuropathy

CNS effects: seizures*

*avoid in patients with myasthenia gravis

*use LAST LINE for acute bacterial sinusitis, uncomplicated UTI, bronchitis

Warnings:

-QT prolongation (moxi worst)

-hypoglycemia/hyperglycemia

-psychiatric disturbances

-photosensitivity

-aortic aneurysm and dissection

-avoid in children and pregnancy

-do not use moxifloxacin in UTI

-separate from cations

ciprofloxacin is contraindicated with

tizanidine

Key features of macrolides

-atypical coverage

-QT prolongation

-drug interactions: clarithromycin and erythromycin contraindicated with simvastatin and lovastatin

-azithromycin and erythromycin do not require renal dose adjustments

Key features of tetracyclines

-atypical coverage

-avoid in pregnancy and children < 8 years except Rocky Mountain Spotted Fever in children

-photosensitivity, separate from cations

Bactrim: key features

-5:1 ratio of sulfamethoxazole to trimethoprim

-dosed on trimethoprim component

-side effects: photosensitivity, hemolytic anemia, hyperkalemia

-interacts with warfarin

Vancomycin: key features

-covers MRSA, C. diff (PO)

-use TOTAL BODY WEIGHT for dosing

-target trough for MRSA cellulitis 10-15

-more severe infections (pneumonia, endocarditis, osteomyelitis, meningitis) target trough 15-20

-MRSA MIC cutoff 2 - use another drug

-infusion-related reaction: Red Man Syndrome NOT an allergy, slow the rate to 1 gram/hr

Which antibiotics cover Pseudomonas?

cefepime, Zosyn, ceftazidime, ceftolozane/tazobactam, ceftazidime/avibactam, ciprofloxacin, levofloxacin, carbapenems (except erta), aminoglycosides, aztreonam, Colistin, polymyxin B

Which antibiotics cover MRSA?

-community-acquired MRSA SSTIs: Bactrim, clindamycin, doxycycline, minocycline, linezolid

-more severe SSTI, need IV treatment or hospitalization: vancomycin (unless MIC>2), linezolid, tedizolid, daptomycin, ceftaroline, telavancin, oritavancin, dalbavancin, tigecycline, quinupristin/dalfopristin

-adjunct: rifampin

Which antibiotics cover VRE?

daptomycin, linezolid, Synercid, tigecycline

-cystitis only: nitrofurantoin, fosfomycin, doxycycline

Which antibiotics cover B fragilis?

metronidazole, Augmentin, Unasyn, cefotetan, cefoxitin, carbapenems, tigecycline

-others with reduced activity: clindamycin, moxifloxacin

Which antibiotics cover CRE?

ceftazidime/avibactam, Colistin, polymyxin B

Drugs that increase LDL and triglycerides

protease inhibitors, steroids, diuretics, cyclosporine, tacrolimus

drugs that increase only LDL

fibrates, SGLT2 inhibitors

drugs that increase only triglycerides

IV lipid emulsions, propofol, beta blockers, atypical antipsychotics

CAP guidelines category 1 patients

no comorbidities or risk factors for MRSA or Pseudomonas

-no heart, liver, lung dz, alcoholism, not immunocompromised

-no abx in last 90 days, hospitalizations

-treatment: high dose amoxicillin, doxycycline or macrolide (if local R<25%) monotherapy

CAP guidelines category 2 patients AND nonsevere inpatient CAP (non-ICU)

comorbidities, immunocompromised, risk factors for MRSA or Pseudomonas

-treatment: beta-lactam + macrolide/doxycycline OR respiratory FQ monotherapy (cannot have a seizure history!!!)