Mnemonics pass Naplex now PNN

Which drugs are negative chronotrops?

ABCD: amiodarone, beta blockers, calcium channel blockers, digoxin

Which beta blockers are B1 selective?

AMEBBBA: atenolol, metoprolol, esmolol, bisoprolol, betaxolol, Bystolic, acebutolol

Which beta blockers come in IV form?

"MAPLES": metoprolol, atenolol, propranolol, labetalol, esmolol, sotalol

Which beta blockers have intrinsic sympathomimetic activity?

APP: acebutolol, penbutolol, pindolol

Which beta blockers are primarily through renal excretion?

"BreNALS"

Bisoprolol

Nadolol

Atenolol

Labetalol

Sotalol

What are the common side effects of beta blockers?

"BLOCKER"

B: bradycardia/bronchospasm

L: increased lipids/decreased libido

O: orthostatic hypotension

C: conduction abnormalities

K: konstriction of peripheral vasculature (Raynauds)

E: exhaustion/emotional depression

R: reduced recognition of hypoglycemia

What are the 4 treatment considerations for CHF?

4 D's: Diuretics, diet, digoxin (or any + inotrope), dilators

What are the common side effects of ACEI?

"CAPTOPRIL"

C: cough

A: angioedema

P: potassium (hyperkalemia)

T: taste change

O: orthostasis

P: pregnancy (C 1st trimester, D 2-3rd trimester)

R: rash, bilateral renal stenosis

I: increase in K

L: leukocytosis (for captopril)

What are the common side effects of amiodarone?

"AMIODARONE"

A: Alevoli - pulmonary toxicity; AV blocker - bradycardia

IOD: iodine - TSH

O: Eye - corneal mico-deposits

D: DDI - check LFT

O: photosensitivity

N: non-PVC if infuse > 2hr

E: Electrolyte (Hypo Mg, K increase QTc)

Which medications increase lipid?

"PAS BLT"

P: protease inhibitor (LAND FIRST)

A: antipsychotics

S: SGLT-2

B: Beta-blocker

L: Loop diuretics

T: Thiazide

Which pathway is blocked by warfarin?

Extrinsic

What are the colors for warfarin tablets?

"party like girls then bring peaches to your wedding"

1 mg: pink

2 mg: lavender

2.5 mg: green

3 mg: tan

4 mg: blue

5 mg: peach

6 mg: teal/greenish-blue

7.5 mg: yellow

10 mg: white

What medications are given for the initial management of ACS?

MONAA BAS: morphine (or meperidine), oxygen, nitrates, aspirin, antiplatelets (loading dose), beta blocker, ACEI, statin

Avoid Beta-blocker in cocaine-induced AMI

Avoid NSAID d/t increased CV risk

Discharge after ACS: NAABAS

What are the statin dose equivalents for 38% LDL reduction (moderate statin)?

"Passionate Real Americans Simply Love Playing Football"

Pitavastatin = 2 mg

Rosuvastatin = 5 mg

Atorvastatin = 10 mg

Simvastatin = 20 mg

Lovastatin = 40 mg

Pravastatin = 40 mg

Fluvastatin = 80 mg

Which statins should be given at night?

"Simply Love F*cking" at night

Simvastatin

Lovastatin

Fluvastatin

What are the major side effects / important cautions with statins?

"HMG-CoA"

H = hepatotoxicity, HA (AST/ALT >3xULN – STOP DRUGS)

M = myopathy, memory loss (reversible)

G = girl during pregnancy (Category X) / increase glucose + HbA1c / GI distress

-: URTI

C = increase Coumadin (except atorvastatin), CPK, increase Cataracts risk,

O = ocular effects (blurred vision)

A = alopecia

Which statins are metabolized by CYP3A4?

3A4 = 3 drugs

"Americans Simply Love Grapefruit"

Atorvastatin

Simvastatin

Lovastatin

Grapefruit = major 3A4 inhibitor

Which statins are metabolized by CYP2C9?

2C9 = 2 drugs

"Real food"

Rosuvastatin and Fluvastatin

What are the generic names for the different vitamin B's?

"The Rabbi Needs Prayer For Comfort"

The = thiamine (B1)

Rabbi = riboflavin (B2)

Needs = niacin (B3)

Prayer = pyridoxine (B6)

For = folic acid (B9)

Comfort = cyanocobalamin (B12)

What are the common causes of high anion gap metabolic acidosis?

MUDPILES: methanol, uremia, DKA, paraldehyde, iron/INH, lactic acidosis, ethylene glycol/EtOH, salicylate

What is the #1 cause of hyperthyroidism?

"Graves caused Credence to go HYPERnova"

Graves Disease = HYPERthyroidism

What is the equivalent dosing conversion for glucocorticoids?

"Cute Hot Pretty Pharmacist Makes Triple Digits Bloom!"

Which drugs increase uric acid level?

"ABCDE-T"

- Aspirin, Alcohol

- Beta-blocker, B-3, Bempedoic acid

- CCB, chemo

- Diuretics (thiazide, loop)

- Ethambutol, pyrazinamide

- Ticagrelor, Tacrolimus, Paliperidone

What are the common side effects of steroid long-term use?

"PREDNISONE"

P: PUD/psychiatric

R: retention of Na & H2O (high BP)

E: eye (cataracts/glaucoma)

D: diabetes (increase glucose)

N: neurologic (CNS, insomnia)

I: immunosuppression

S: swelling (Cushing's)

O: osteoporosis

N: nausea (used for CINV tx)

E: electrolyte changes (decreased K)

How to manage DKA?

"DIABETES"

Dehydrated --> hydrate with NS

Insulin (IV 0.1 U/kg/h)

Acidosis

Bicarbonate (if aPH < 6.9)

Electrolyte monitoring (K, Mg, PO4, HCO3)

Time (check glucose qh)

Electrolyte

Sugars (when BG drops below 200-250)

What are the common side effects of GLP-1 agonists?

"GLP-1" --> 1 looks like a "T"

G: gallbladder dx/GI

L: lowers weight

P: pancreatitis

1 (T): thyroid tumors BBW

What are the common side effects of DPP-4?

DPP-4

Pancreatitis, joint Pain

What drugs are DPP-4 inhibitors?

"SALSA! JNTO"

Sitagliptin (Januvia)

Alogliptin (Nesina)

Linagliptin (Tradjenta)

Saxagliptin (Onglyza)

What are the common side effects of SLGT2 inhibitors?

"SGLT2"

S: increased SCr (renal impairment)

G: genital fungal infections

L: increased LDL, lower weight + BP, labs (increase K, Mg, PO)

T: bone fracTures

2(K): increased K and ketoacidosis

What can you use to reduce cisplatin nephrotoxicity?

"Cisplatin goes HAM on your kidneys"

H: hydrate (aggressive IV fluid)

A: amifostine

M: Mannitol IV

What chemo cause peripheral neuropathy?

makes "PPT" for neuropathy topic

- Platinum (cisplatin)

- Plant alkaloids including vinca alkaloids

- Taxans

What are important facts you have to remember about paclitaxel?

PAC-TAX:

P: no PVC

A: Alcohol in diluent

C: castor oil allergy is CI

Taxne: hypersensitivity, peripheral neuropathy

Premedicate with dexamethasone, IV diphenhydramine, IV histamine H2 antagonist (ranitidine/famotidine)

What PO antibiotics are recommended for MRSA?

"MRSA likes BCD tofu with LIght DEcent RIce "

MRSA recommended PO: Bactrim, clindamycin, doxycycline, linezolid, delafloxacin, rifampin

What antibiotics cover pseudomonas?

MAFIA Pseudomonas Challenge Clinicians

Meropenem

Azetreonam

Fluoroquinolone (except Moxi)

Imipenem/cilastatin

Aminoglycoside (-mycin)

Pip/tazo

cefepime

ceftazidime

What antibiotics covers anaerobic (clostridium, bacteroides fragilis)?

CAMP CUM

Clindamycin

Augmentin

Metronidazole

Pip/tazo

Carbapenems

Unasyn

Moxifloxacin, Delafloxacin

What drugs belongs to TNF alpha blockers?

"ICE AGe!"

I: Infliximab

C: Certolizumab

E: Etanercept

A: Adalimumab

G: Golimumab

What are the side effects of methotrexate?

"Methotrexate"

M: myelosuppression, mucositis

H: Hepatoxicity

O: photosensitivity

R: rash, renal (urine alkaline Na bicarb, hydrated)

X: pregnancy X, CXR

What are the atypical bugs?

"MCL use Doxycycline"

M: mycoplasma

C: chlamydia

L: legionella

Treatment:

These are treated with MQT (me cutie)

macrolide(azith, clarith

Quinolones(cipr, levo

Tetracyclimes(Doxy, minocycline

What is an important side effect to remember about voriconazole?

VVV: Voriconazole (Vfend) can cause vision changes

Which penicillins are penicillinase resistant and what are they used for?

"CONDM used for MSSA"

C: cloxacillin

O: oxacillin

N: nafcillin

D: dicloxacillin

M: methicillin

What class do second generation cephalosporins have greater activity against?

"HENPEKS" Gram (-) organisms

H. influenzae

Enterobacter aerogenes

Neisseria

Proteus mirabilis

E. coli

Klebsiella pneumonia

Serratia

What antibiotics are consider safe in pregnancy?

"P.A.C.E"

penicillins

azithromycin

cephalosporins

erythromycin

Which cephalosporins are first line for N. gonorrhea?

"Please TRI to fix MY gonorrhea"

First line: cefTRIaxone 500 mg IM x 1 dose (1g if greater than 150 kg)

If did not exclude chlamydia:

Add Doxycycline (VibraMYcin) 100 mg PO BID x 7 days

Cephalosporin Allergy: azithroMYcin + gentaMicin

Neonatal ocular ppx: ErythroMYcin eye cream

What are the side effects of fluroquinolones?

“CiPRO”

C: Crystalluria, CNS (seizure, delirium), C diff colitis

P: photosensitivity, peripheral neuropathy (myasthenia gravis), hyPer + hyPOglycemia

R: Rupture of the tendon (increased with steroid) + aortic

O (Q): QT prolongation

OATP inhibitors decrease cipro: Orange, Apple, Tea

QuinALONE: Give alone, sepetate antacids, vitamins and didanosine, Not for pt <18 (cannot live alone)

What bacterias are not covered by Tigecycline?

"Tigers don't pee"

Tigecycline doesn't cover the Ps (Pseudomonas, Proteus, Providencia)

Which are the respiratory fluoroquinolones? And urinary quinolones?

MGLD = my good lung day

- respiratory

- Moxi, Gemi, levo, dela

CL

- urinary quinolones

- cipro, levo

What are the facts and side effects of tetracycline?

"Tetracycline"

T

- thirty S subunit

- teeth discoloration

- teratogenic

- aTypical pathogens (Chlamydia, mycoplasma)

- toxicity (hepatotoxic, nephrotoxic except doxycycline, phototoxicity)

- Ten: avoid use < 8 years old

What are the facts about metronidazole?

"METRONIDazole"

M: metallic taste

E: Empty stomach

T: TID

R: re dissolved crystal on warming to room temp. May be refrigerated

O: protect from light

N: neuro (seizure, peripheral, optic neuropathy)

I: gI upset, contraindicated 1st trimester, 1st line for bacterial vaginosis

D: Disulfiram reaction with alcohol, Darkens urine

What antibiotics increase warfarin level?

Warfrin level increases by MAT

Macrolides, metronidazole

Azole, Amiodarone

Ttrimethiprim/ sulfa

Which disease states require a higher vancomycin trough?

"POEMS"

Pneumonia

Osteomyelitis

Endocarditis

Meningitis

Sepsis/severe infection

What are the drugs used for TB?

"RIPES"

Rifampin (Rifadin) - empty stomach

Isoniazid

Pyrazinamide

Ethambutol (Myambutol)

Streptomycin

Bedaquiline (Sirturo)

Which benzos can be used in the elderly? or patients with liver dysfunction?

LOT: lorazepam, oxazepam, temazepam

At Sea Re-storing = Ativan, Serax, Restoril

Because they are "over the liver". They are not hepatically cleared

What is the diagnostic for MDD?

5+ nearly every day for 2 weeks of SIGECAPS:

Sleep changes

Interest (loss)

Guilt (worthlessness)

Energy (lack)

Cognition/concentration

Appetite (weight loss or gain)

Psychomotor agitation or retardation

Suicidal thoughts/ideation

What are the side effects of SSRI?

"HOWS G"

H: hypotension, HA, Hyponatremia

O: bOne fracture, eyes (glaucoma)

W: weight gain

S: sexual dysfunction

G: GI bleed (caution with warfarin, NSAID use)

What side effects do you have to worry about for lithium?

LITHIUM:

L: levels (0.6 - 1 mEq/L) / leukocytosis

I: increased urination (polyuria/polydipsia)

T: tremor / TSH / take with food

H: hypercalcemia / hyperthyroidism

I: increased CNS / dermatologic

U: BUN and SCr (renal function)

M: monitor WEB (weight, EKG, Beta-hCG)

What are common side effects of antipsychotics?

"WASH MEN"

Weight gain (Olanzapine, Clozapine)

Anticholinergic (Clozapine)

Sedation

Hypotension (Clozapine, iloperidone), Hyperprolactinemia

Movement disorders

EPSE: dystonic reaction, akathisia, pseudoparkinsonism, Tardive dyskinesia

Neuroleptic malignant syndrome

What are the side effects of anticholinergic?

Anti-SLUDGE

Anti

S: salivation

L: lacrimation

U: urination

D: defecation/diaphoresis

G: GI motility

E: excretion/emesis

What are the side effects of barbituates?

BARBituates:

B: bone disease/bone marrow suppression

A: ataxia

R: rash/respiratory depression

B: behavior changes, bradycardia

What are the major CYP inducers?

SR COP

S: smoking, St. John's Wort

R: rifampin

C: carbamazepine

O: oxcarbazepine

P: phenobarbital, phenytoin

What are the major CYP inhibitors?

G-PACMAN

G: grapefruit

P: protease inhibitors (i.e. ritonavir)

A: azole antifungals

C: cyclosporine, cimetidine, cobicistat

M: macrolides (not azithromycin)

A: amiodarone

N: non-DHP CCBs

Which drugs should not be put into PVC IV containers?

LATIN

L: lorazepam

A: amiodarone

T: tacrolimus

I: insulin

N: nitroglycerin

Which antibiotics have photosensitivity?

"Too Much ****ing Sunlight"

T: tetracyclines

M: macrolides

F: fluoroquinolones

A: sulfonamides

Which IV drugs cannot be used with D5W?

"ACID APE"

A: ampicillin

C: caspofungin (Cancidas)

I: infliximab (Remicade)

D: daptomycin (Cubicin)

A: ampicillin/sulbactam (Unasyn)

P: phenytoin

E: ertapenem (Invanz)

Which IV drugs cannot be used with saline?

"ABS"

A: amphotericin B

B: Bactrim

S: Synercid

Which IV drugs require a 0.22 micron filter?

"PLAAG" needs a filter cuz of his dirty language

P: phenytoin

L: lorazepam

A: amiodarone

A: abciximab

G: golimumab (Symponi)

Lipids require 1.2 microns. Ampho B requires 5 micron

What are MAOI side effects?

WAOI

W: weight gain

A: anticholinergic

O: orthostatic hypotension

I: insomnia

Which IV drugs need to be protected from light?

"Deliver Every Needed Medication" with a light protective cover

D: doxycycline

E: epoprostenol

N: nitroprusside

M: micafungin (Mycamine)

What are the symptoms of anticholinergic overdose?

Hot as a hare: fever

Dry as a bone: dry skin and mucous membrane

Blind as a bat: mydriasis (blown up pupils) with double or blurry vision

Red as a beet: flush

Mad as a hatter: altered mental status

Which drugs can cause hypothyroidism?

"PACE IS LOW" - hypothyroidism slows down metabolism

P: phenytoin

A: amiodarone

C: carbamazepine

E: eslicarbazepine

I: interferons

S: sunitinub

L: lithium

O: oxcarbazepine

What are the live vaccines?

COZY IV RM

Cholera

Oral Typhoid

Zoster (Zostavax)

Yellow Fever

Intranasal Influenza

Varicella

Rotavirus

MMR

Which drugs belong to class 1a antiarrthymics?

"Double Quarter Pounder - QDP"

Quinidine, Disopyramide, Procainamide

*intermediate

(atrial and ventricular arrhythmias)

Which drugs belong to class 1b antiarrthymics?

"Lettuce and Mayo - PLM"

Phenytoin, Lidocaine, Mexiletine

(ventricular arrhythmias)

*Mexiletine only comes in PO

*fast/rapid

Which drugs belongs to class 1c antiarrthymics?

"Fries Please - PF"

propafenone, flecainide

(atrial and ventricular arrhythmias)

*slowest

Which drugs belongs to class 3 antiarrthymics?

"IASDDD"

Ibutilide, Amiodarone, Sotalol, Dofetilide, Dronedarone (Multaq)

Which proton pumps inhibitors are injectable?

POLE (first and last has injectables)

pantoprazole

Omeprazole: has ODT

lansoprazole: has ODT

Esomeprazole

what encapsulated bacteria should you be treated for asplenia patients?

Please shine my sky

Pseudomonas

S. pneumoniae, Streptococcus agalactiae

Haemophilus influenzae

Neisseria meningitidis

E. coli

salmonella

klebsiella

What drugs are nucleoside reverse transcriptase inhibitors?

“ZALES DT”

Zidovudine (Retrovir)

Abacavir (Ziagen)

Lamivudine (Epivir)

Emtricitabine (Emtriva)

Stavudine (Zerit)

Didanosine (Videx)

Tenofovir (nucleotide)

- TDF (viread)

- TAF (vemlidy)

What drugs are non-nucleoside reverse transcriptase inhibitors?

"RNEEDD"

Rilpivirine (Edurant)

Nevirapine (Viramune)

Efavirenz (Sustiva)

Etravirine (Intelence)

Doravirine (Pifelto)

Delavirdine (Rescriptor)

What drugs are protease inhibitors?

"LAND FIRST" ("navir")

Lopinavir/ritonavir (Kaletra)

Atazanavir (Reyataz)

Nelfinavir (Viracept)

Darunavir (Prezista)

Fosamprenavir (Lexia)

Indinavir (crixivan)

Ritonavir (Norvir)

Saquinavir (Invirase)

Tipranavir (Aptivus)

What drugs are integrase inhibitors?

"RBEDC"("tegravir")

Raltegravir (Isentress)

Bictegravir

Elvitegravir

Dolutegravir (Tivicay)

Cabotegravir (Vocabria)

What drugs are in the Viekira pak for Hep B?

"PORD"

Paritaprevir + Ombitasvir + Ritonavir + Dasabuvir

What are the combinations for TAF and TDF?

"DOG has TICS"

Descovy: Emtricitabine + TAF

Odefsey: Descovy + Rilpivirine

Genvoya: Descovy + Elevitegravir + cobistat

Truvada: Emtricitabine + TDF

Complera: Truvada + Rilpivirine

Stribild: Truvada + Elevitegravir + cobistat

What are the colors and strengths for levothyroxine?

orangutans will vomit on your right before they become large proud giants.

25 mcg = Orange

50 mcg = White

75 mcg = Violet

88 mcg = Olive

100 mcg = Yellow

112 mcg = Rose

125 mcg = Brown

137 mcg = Teal

150 mcg = Blue

175 mcg = Lila's

200 mcg = Pink

300 mcg = Green

How do you take Nicorette, Nicorelief, Thrive?

if < 25 cig/day, use 2 mg gum

if >= 25 cig/day, use 4 mg gum

" 6, 3, 3. 1-2, 2-4, 4-8."

take 1 gum q1-2h for 6 weeks, then 1 gum q2-4h for 3 weeks, then 1 gum q4-8h for 3 weeks.

Nicoderm CQ is 6,2,2 and 21, 14, 7 mg with a cutoff of 10 cig/day. skinner than 45mg, start at 14.

Nicorrette lozenge

first cigarette within 30 min of awakening, 4mg

after, 2mg

What are the side effects of tracrolimus?

"Tacrolimus"

Tremor

Alopecia, Acne (indication for Protopic)

Cardiovascular (HTN, QT prolongation)

Renal (nephrotoxicity)

Oncology (cause skin cancer, wear sunscreen)

Liver (CYP3A4 substrate)

Infection, Immunosuppression, increased K, IDDM

Monitor level (check trough), Malignancy

Uric acid increases

Seizure (neurotoxicity)

Cyclosporine SE is just like tacrolimus, but with the addition of "gingival hyperplasia, hirsutism". non-PVC only

What drugs are use for overactive bladder?

"SOFT BladDAR" (relaxed bladder)

Solifenacin (Vesicare)

Oxybutynin (Ditropan, Oxytrol-OTC)

Fesoterodine (Toviaz)

Tolterodine (Detrol)

Trospium - less CNS SE

Beta-3 adrenergic agonist

DARifenacin (Enablex) - less CNS SE

*Beta-3 adrenergic agonist (-begron) for pt > 70 y/o or with cognitive impairment

Mirabegron (Myrbetriq): severe HTN

Vibegron (Gemtesa)

What are the side effects of FLibAnSeriN (Addyi)?

FLibAnSeriN

L: Liver

A: contraindicated with alcohol

S: serotonin mixed agonist and antagonist, syncope, CYP3A4 substrate

N: take it at Night qhs

Add-yi 淫

Anticholinergic Drugs/Combos with SABA

"SALT IS Salty Crunchy Delicious"

S= Spiriva Handihaler - Tiotropium DPI

A= Atrovent HFA - Ipratropium MDI

L= Lonhala Magnair - Glycopyrrolate NEB

T= Tudorza Pressair - Aclidinium DPI

I= incruse Ellipta - Umeclidinium DPI

S= Spiriva Respimat - Tiotropium MDI

Salty = Seebri Neohaler - Glycopyrrolate

Crunchy = Combivent Respimat - Alb/Ipra

Delicious = Duoneb - Alb/Ipra NEB

LABA/Anticholinergic

Steak Under A Broil

Stiolto Respimat - Tiotropium/Olodaterol

Utibron Neohaler - Indacat/Glycopyr

Anoro Ellipta - Vilanterol/Umeclidinium

Bevespi Aerosphere - Formoterol/Glycopyr

LABA/Corticosteroid

BAS

(Think of the fish Bass)

Breo Ellipta - Vilanterol/Fluticasone

Advair Diskus - Salmeterol/Fluticasone

Symbicort - Formoterol/Budesonide

LABA

"Open In Fridge And Seek Vanilla" = LABA's only

Olodaterol - Striverdi Respimat MDI

Indacaterol - Arcapta Neohaler DPI

Formoterol - Perforomist NEB

Aformoterol - Brovana NEB

Salmeterol - Serevent Diskus DPI

Vilanterol -

*Both Formoterol and Aformoterol are refrigerated ;)

*Vanilla sounds like Ellipta, vilanterol comes in combos only that are Ellipta's.

Know your chemo man

Which SSRI are stimulating? and sedating?

Fly to the sky. pee and floss at night

Fluoxetine is stimulating SSRIs. Take in AM

Paroxetine and Fluvoxamine are sedating SSRI. Take in PM

What are the key things to watch for Topiramate and Zonisamide?

Zoning your kidney, Sit on Top of your head

Zonisamide (Zonegran) and Topiramate (Topamax) both has watch out for Kidney stones (signs of flank pain, recommend to drink lots of water).

Topiramate is also indicated for Migraine prophylaxis.

What are the side effects and monitoring parameters for Leflunomide?

“Leflunomide (Arava)”

L: LFT, check ALT level QMonthly for 6 months, then every 6-8 weeks. Looooong half life, can take up to 2 years to become undetectable

A: Alopecia

what are the side effects and monitoring parameters for hydroxychloroquine?

“hydroxychloroquine” OCLN

O:

eye- retinal toxicity. eye exam at baseline then q3month for prolonged therapy

ear- tinnitus

C: check CBC and CNS

L: Liver function

N: neuroMyopathy (muscle strength)

what beta-blockers are used for glaucoma?

Tim Loves Beta's Car

Timolol

Levobunolol

Betaxolol

Carteolol

Which factors are blocked by warfarin?

2+7 = 9 Not 10

2, 7, 9, 10

Which lab is used to measure warfarin?

PT/INR: prothrombin time, international normalized ratio