RXPREP:

KEY DRUGS, MNEMONICS, STUDY TIPS • CYP inhibitors

o G <3 PACMAN (big inhibitors)
• HAZARDOUS DRUGS are:
§ Grapefruit
o Teratogenic § PIs protease inhibitors (ritonavir)
o Carcinogenic § Azole antifungals (fluconazole,
o Genotoxic (damage the DNA and can cause cancer) itraconazole, ketoconazole,
o Have reproductive toxicity posaconazole, voriconazole,
o Cause organ toxicity at low doses
isavuconazonium)
• Key hazardous drugs that require SPECIAL HANDLING to
§ C: CYA, cimetidine, cobicistat
avoid toxicity to workers: § Macrolides (clarithromycin, erythromycin,
o All pregnancy category X drugs, category D’s and a not azithromycin)
few C’s, and paroxetine, methotrexate, § Amiodarone (and dronedarone)
misoprostol, mifepristone, ribavirin § Non-DHP CCBs (diltiazem and verapamil)
o Antineoplastics (chemotherapeutics) • Key SEROTONERGIC drugs:
o 5-alpha reductase inhibitors (dutasteride,
o SSRIs
finasteride)
o SNRIs
o Hormones (contraceptives, estradiol, testosterone)
o TCAs
o Transplant drugs (MMF, tacrolimus, CYA,
o MAOIs (plus linezolid and methylene blue)
everolimus, sirolimus)
o Buspirone
o Others: colchicine, dronedarone, fluconazole,
o Dextromethorphan
spironolactone, risperidone, raloxifene,
o Fentanyl
rasagiline, ziprasidone
o Lithium
• Key drugs most commonly associated with
o Methadone
PHOTOSENSITIVITY:
o Mirtazapine
o Carbamazepine
o St. John’s Wort
o Diuretics (thiazide and loop)
o Tramadol
o MTX
o Trazodone
o Oral and topical retinoids
o Others: cyclobenzaprine, lorcaserin, meperidine,
o Quinolones
5HT3-RA, some triptans
o St. John’s Wort
• Key drugs required/strongly recommended PGx testing:
o Sulfa antibiotics
o Abacavir
o Tacrolimus
o Azathioprine
o Voriconazole
o Carbamazepine
o Others: amiodarone, antihistamines (1st
o Cetuximab and panitumumab
generation), chloroquine, coal tar, fluorouracil,
o Trastuzumab, ado-transtuzumab, lapatinib,
griseofulvin, NSAIDs, quinidine, tigecycline
pertuzumab
• Key drugs commonly associated with TTP:
o Others: allopurinol, capecitabine, fluorouracil,
o Clopidogrel clopidogrel, codeine, phenytoin, fosphenytoin,
o Ticlopidine warfarin
o Others: acyclovir, famciclovir, quinine, SMX,
• Key drugs - DO NOT put these drugs into PVC IV
valacyclovir
CONTAINERS
• CYP inducers
o LATIN
o PS PORCS (big inducers) § Lorazepam
§ Phenytoin § Amiodarone
§ Smoking § Tacrolimus
§ Phenobarbital § Insulin
§ Oxcarbazepine (and eslicarbazepine) § NTG
§ Rifampin (and rifabutin, rifapentine) § Others: cabazitaxel, carmustine,
§ Carbamazepine (also an auto-inducer) docetaxel, etoposide, ixabepilone,
§ St. John’s Wort paclitaxel, sufentanil, temsirolimus,
teniposide, thiopental

1
 • Key drugs - SALINE (no dextrose) • Key drugs - TERATOGENS
o ACID APE o Acne: isotretinoin, topical retinoids (including
§ Ampicillin tazarotene)
§ Caspofungin o Abx: quinolones, tetracyclines
§ Infliximab o Anticoagulants: warfarin
§ Daptomycin o HLD, HF, HTN: statins, RAAS inhibitors (ACEi, ARBs,
§ Ampicillin/sulbactam aliskiren, sacubitril/valsartan)
§ Phenytoin o Hormones: most, including estradiol, progesterone
§ Ertapenem [megesterol (Megace)], raloxifene, Duavee,
§ Others: abatacept, azacitidine, testosterone, contraceptives
belimumab, bevacizumab, o Migraine: dihydroergotamine, ergotamine
idarucizumab, iron sucrose, sodium o Other important teratogens: hydroxyurea, lithium,
ferric gluconate complex, natalizumab, MTX, misoprostol, paroxetine, ribavirin,
trastuzumab thalidomide, topiramate, VPA, divalproex,
• Key drugs - DEXTROSE (no saline) weight loss drugs
o ABS • Avoid in PEDIATRICS
§ Amphotericin B o Contraindicated
§ Bactrim § Codeine age <12 y
§ Synercid (quinupristin/dalfopristin) § Tramadol age <12 y
§ Others: carfilzomib, MMF, pentamidine § Promethazine age <2 y
• Key drugs - common drugs with FILTER requirements § Ceftriaxone in neonates 1-28 d
o Most: 0.22-micron filter during administration* o Not generally recommended
o Pushy guys in LA LA land § Quinolones
§ Phenytoin § Tetracyclines age <8 y
§ Golimumab § OTC cough and cold preparations in age
§ Lipids - 1.2 micron* <6 y
§ Amphotericin B (lipid formulations)* • Live vaccines
§ Lorazepam o Injections
§ Amiodarone § MMR
• * larger pore size filter required; § MMRV
ampho prepare using a 5- § Varicella
micron filter § Zoster
§ Others: abatacept, abciximab, digoxin § Yellow fever
immune fab, infliximab, o Other routes
isavuconazonium, mannitol, thiotepa § Influenza intranasal
• Key drugs - DO NOT REFRIGERATE § Rotavirus
o Dear sweet pharmacist, marry me forever, eternally § Cholera
§ Dexmedetomidine § Typhoid
§ SMX-TMP • Vaccines for specific conditions
§ Phenytoin o Pregnancy
§ Metronidazole § Influenza vaccine
§ Moxifloxacin § Tdap x 1 with each pregnancy (optimal
§ Furosemide time between weeks 27 and 36)
§ Enoxaparin § Live vaccines CI during pregnancy
§ Others: acetaminophen, acyclovir, o Asplenia
deferoxamine (Desferal), § H. influenzae type B (HIB)
levetiracetam, pentamidine, valproate § Pneumococcal (Prevnar and Pneumovax
• Key drugs - PROTECT FROM LIGHT DURING 23)
ADMINISTRATION § Meningococcal
o Deliver every needed medication protected • Selected drugs that CAUSE KIDNEY DISEASE
§ Doxycycline o Aminoglycosides
§ Epoprostenol o Amphotericin B
§ Nitroprusside o Cisplatin
§ Micafungin o Colistimethate
§ Phytonadione o CYA
§ Others: anthracyclines, dacarbazine, o Loop diuretics
pentamidine o NSAIDs
o Radio graphic contrast dye
o Tacrolimus
o Vancomycin

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 • Study tip: CrCl vs GFR • Select drugs that are CI IN KIDNEY IMPAIRMENT
o CrCl o CrCl < 60
§ Cockcroft-Gault equation § Nitrofurantoin
140−patient age o CrCl < 50
§ CrCl = × weight in kg (×
72 x SCr
§ Elvitegravir/cobicistat/ emtricitabine/TDF
0.85 if female)
(Stribild)
§ For CrCl calculation, use ABW if patient is
§ Voriconazole IV
< IBW, use IBW is normal weight (by
o CrCl < 30
BMI)
§ Dosing adjustments and CI’s are generally § Avanafil
based on CrCl calculated with § Bisphosphonates
Cockcroft-Gault § Dabigatran
o GFR § Duloxetine
§ CKD-EPI or MDRD equation § Elvitegravir/cobicistat/ emtricitabine/TAF
§ Used for staging kidney disease and for (Genvoya)
dosing select drugs § Fondaparinux
§ Not commonly calculated in the clinical § NSAIDs
setting, but may be reported by some § Potassium sparing diuretics
laboratories § Rivaroxaban
§ For the exam, if GFR is not provided, CrCl § Tadalafil
provides a close estimate for doing and § Tramadol ER
CI purposes o GFR < 30
• Select drugs that require # OR $ INTERVAL WITH IMPAIRED § Genvoya
§ SGLT2 inhibitors (canagliflozin,
KIDNEY FUNCTION
dapagliflozin, empagliflozin)
o Anti-infectives
§ Metformin
§ Aminoglycosides (# dosing interval,
o Others
primarily)
§ Dofetilide
§ Aztreonam
§ Edoxaban
§ Beta-lactams
§ Glyburide
§ Polymyxins
§ Meperidine
§ Quinolones (except moxifloxacin)
§ Sotalol
§ SMX-TMP
• Key drugs that # K LEVELS
§ Vancomycin
§ Anti-tuberculosis medications o ACEi
o ARBs
§ Antivirals
o Aldosterone receptor antagonists (ARAs)
§ Amphotericin B
o Canagliflozin
§ Fluconazole
o Drospirenone-containing COCs (combined)
§ NRTIs, including tenofovir
o K containing IVF (including TPNs)
o CV
o K supplements
§ Antiarrhythmics (digoxin, disopyramide,
o SMX-TMP
dofetilide, procainamide, sotalol)
o Tacrolimus
§ Dabigatran
o Others: aliskiren, CYA, everolimus, glycopyrrolate,
§ LMWHs
heparin (chronic use), NSAIDs, pentamidine
§ Rivaroxaban
§ Statins • Direct acting antivirals: preferred HCV regimens include 2-3
o Pain/gout DAAs with different MOAs (often in 1 tablet)

§ Allopurinol Mechanism Name clue Examples

§ Colchicine Grazoprevir
§ Gabapentin, pregabalin -prevair
NS3/4A protease Paritaprevir
§ Morphine and codeine
inhibitors Simeprevir
§ Tramadol ER P for PI
Voxilaprevir
o GI Daclatasvir
§ Famotidine, ranitidine -asvir Ledipasvir
§ Metoclopramide NS5A replication
Ombitasvir
o Others complex inhibitors
A for NS5A Pibrentasvir
§ Bisphosphonates Velpatasvir
§ CYA -buvir
§ Lithium NS5B polymerase Dasabuvir

§ Topiramate inhibitor Sofosbuvir
B for NS5B

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 • Key drugs with boxed warnings for LIVER DAMAGE § Nafcillin, oxacillin, dicloxacillin
o Acetaminophen (high doses, acute or chronic) • Cover MSSA only (no MRSA)
o Isoniazid • No renal dose adjustment
o Nevirapine needed
o NRTIs • Study tip: cephalosporins
o Tipranavir o Outpatient (oral)
o Valproic acid § 1st generation: cephalexin (Keflex)
o Others: amiodarone, bosentan, felbamate, • Common use: skin infections
flutamide, ketoconazole (highest risk), other (MSSA), strep throat
azoles, leflunomide and teriflunomide, § 2nd generation: cefuroxime (Ceftin)
lomitapide, maraviroc, MTX, mipomersen, • Common use: otitis media, CAP,
nefazodone, propylthiouracil, tolcapone sinus infection (if abx
• Key drugs - Antibiotics with NO RENAL DOSE ADJUSTMENT indicated)
REQUIRED § 3rd generation: cefdinir (Omnicef)
o Dicloxacillin, nafcillin, oxacillin • Common use: CAP, sinus
o Ceftriaxone infection (if abx indicated)
o Moxifloxacin § Class effect: due to small risk (<10%) of
o Azithromycin, erythromycin cross reactivity, on the exam do not
o Doxycycline, minocycline, tigecycline choose a cephalosporin if the patient
o Linezolid, tedizolid has a PCN allergy; exception: syphilis in
o Quinupristin/dalfopristin a pregnant patient, otitis media
o Clindamycin o Inpatient (parenteral)
o Metronidazole, tinidazole § 1st generation: cefazolin
o Fidaxomicin • Common use: surgical PPx
o Vancomycin (PO only) § 2nd generation: cefotetan, cefoxitin
o Rifaximin • Anaerobe coverage (B. fragilis)
o Rifampin • Common use: surgical PPx
o Chloramphenicol (colorectal procedures)
• Study tip: penicillin’s • Cefotetan can cause disulfiram-
o Outpatient (oral) like reaction with ETOH
§ PCN VK ingestion
• First line for strep throat and § 3rd generation: ceftriaxone, cefotaxime
mild non-purulent skin • Common use: CAP, meningitis,
infections (no abscess)
SBP, pyelonephritis
§ Amoxicillin (Amoxil)
• Ceftriaxone no renal adjustment
• First line for otitis media (80-90
• Do not use ceftriaxone in
mg/kg/d)
neonates (age 0-28 d)
• DOC for IE PPx before dental
§ Ceftazidime (3rd generation) and cefepime
procedures (2 g PO x 1 30-60
(4th generation)
min before procedure)
• Active against Pseudomonas
• Used in H. pylori treatment
§ Ceftolozane-tazobactam, ceftazidine-
§ Amoxicillin/clavulanate (Augmentin) avibactam
• First line for otitis media (90 • Used in cases of MDR gram
mg/kg/d) and for sinus
negative organisms
infection (if abx indicated)
(including Pseudomonas)
• Choosing a product: use the
§ Ceftaroline
lowest dose of clavulanate to • Only beta lactam that has
$ diarrhea coverage against MRSA
o Inpatient (parenteral)
§ PCN G benzathine (Bicillin L-A)
• DOC for syphilis (2.4 million
units IM x 1)
• Not for IV use; can cause death
§ Piperacillin-tazobactam (Zosyn)
• Active against Pseudomonas
• Dosage strength is the sum of
the ingredients: 3.375 g = 3 g
piperacillin + 0.375 g
tazobactam
• Extended infusion (4 h) can be
used to maximize T > MIC

4
 • Study tip: carbapenems § Avoid in children
o Broad spectrum § Watch for tendon rupture (especially in
§ All cover ESBL producing organisms older patients, steroid use),
§ All except ertapenem cover Pseudomonas neuropathy
o Remember what they do not cover: § Renal dose adjustment is required for all
§ Atypicals, VRE, MRSA, C. difficile, except moxifloxacin
Stenotrophomonas o Counseling
§ Ertapenem does not cover Pseudomonas, § Avoid sun exposure, separate from
Acinetobacter or Enterococcus cations, monitor blood glucose (DM)
o Common uses: • Study tip: macrolides
§ Polymicrobial infections (e.g., moderate- o Common uses:
severe diabetic foot infection) § All can be used for CAP and as a beta
§ Empiric therapy when resistant organisms lactam alternative for strep throat
are suspected § Azithromycin is used for COPD
§ Resistant Pseudomonas or Acinetobacter exacerbations, as monotherapy for
infections (except ertapenem) chlamydia, combination therapy for
o Avoid in PCN allergy gonorrhea, and PPx for MAC
o Seizure risk • DOC for dysentery (TD with
§ Risk # with dose, renal impairment or use bloody stools)
of imipenem-cilastatin § Clarithromycin is used in H. pylori
o All are IV only (ertapenem must be diluted in NS) treatment
• Study tip: aminoglycosides - good news and bad news o Azithromycin common dosing
o Good news § (2) 250 mg tab PO x 1, then 250 mg PO
§ Aminoglycosides kill gram negatives fast, daily x 4 d
are synergistic with beta lactams for o QT prolongation - watch for additive effects
some organisms, and have low o Clarithromycin and erythromycin are strong 3A4
resistance and drug cost inhibitors
o Bad news § Lovastatin and simvastatin are CI (# risk of
§ They have notable toxicities: renal muscle toxicity)
damage and hearing o Erythromycin causes the most GI upset (## gastric
loss/tinnitus/balance problems motility), rarely used for infections
(ototoxicity) and require monitoring • Study tip: tetracyclines
o Smart idea o Common uses:
§ Take advantage of the concentration § Doxycycline and minocycline: CA-MRSA
dependent kinetics " give larger doses skin infections
less frequently " gives kidneys time § Doxycycline: first line for Lyme disease,
between doses to recover Rocky Mountain Spotted Fever (tick
§ Extended interval dosing nomograms borne illnesses), CAP, COPD
cannot be used with ESRD, burns and a exacerbation, sinusitis (if abx
few other conditions indicated), VRE UTI, monotherapy for
§ Aminoglycosides demonstrate a post chlamydia, combination therapy for
antibiotic effect: bacterial killing gonorrhea
continues after the serum level drops § Tetracycline: H. pylori treatment
below the MIC § Do not use in pregnancy, breastfeeding,
• Study tip: quinolones children age <8 y
o Respiratory quinolones
§ Levofloxacin, moxifloxacin, gemifloxacin
§ Used for PNA (reliable S. pneumoniae
activity)
o Antipseudomonal quinolones
§ Ciprofloxacin, levofloxacin
§ Used for Pseudomonas infections, UTI,
intra-abdominal infections, travelers’
diarrhea (without dysentery)
o Delafloxacin
§ Used for skin infections, active against
MRSA
o IV to PO ratio = 1:1
§ Levofloxacin and moxifloxacin
o Profile review tips
§ Watch for QT prolongation (e.g., azole
antifungals, antipsychotics,
methadone)
§ Avoid use in patient with seizures
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 • Study tip: SMX-TMP (oral) • Study tip: azole antifungals
o Common uses o All can cause ≠ LFTs
§ CA-MRSA skin infections, UTI, PCP o Only fluconazole requires renal dose adjustment
o SMX-TMP dose is always a 5:1 ratio o Fluconazole has narrower spectrum
§ SS tab contains 80 mg TMP o Covers C. albicans well
§ DS tab contains 160 mg TMP - usual dose § Useful for vaginal candidiasis (non-
is 1 tab BID pregnant)
o Sulfa allergy § C. glabrata can be resistant and C. krusei
§ Most sulfa allergies occur with SMX-TMP; is inherently resistant
rarely, severe skin reactions can occur; o Voriconazole
if rash is accompanied by fever, § DOC for Aspergillus
systemic symptoms, seek emergency § Monitor for visual changes, phototoxicity
care o Posaconazole and isavuconazonium
o INR ## when used with warfarin, use alternative § Active against molds including Aspergillus
when possible and Zygomycetes
• Study tip: nitrofurantoin § Posaconazole: tablet dose ≠ suspension
o DOC for uncomplicated UTI dose due to different bioavailability
o Do not use • Key features of NRTIs
§ CI when CrCl < 60 mL/min o Renal dose adjustment required (except abacavir)
o Dosing o No CYP450 DIs
§ Macrobid is BID o Take without regards to meals (except didanosine)
§ Macrodantin is QID o Boxed warning: lactic acidosis and hepatomegaly
o Counseling with steatosis (zidovudine, stavudine,
§ Take with food to prevent nausea, didanosine > other NRTIs)
cramping o Abacavir: hypersensitivity reactions, test for HLA-
§ Can discolor urine (brown) B*5701
• RIPE therapy o Tenofovir toxicities: nephrotoxicity, osteoporosis,
o Monitoring: Fanconi syndrome (thought to be $ with TAF)
§ Sputum culture o Lipoatrophy (stavudine, zidovudine to a lesser
§ CXR extent)
§ CBC (isoniazid) • Key features of NNRTIs
§ LFTs, including T bili (all) o No renal dose adjustment needed (avoid Atripla
§ Renal function (pyrazinamide, and Complera if CrCl <50 mL/min)
ethambutol) § May require hepatic dose adjustment
§ Uric acid (pyrazinamide) o Primary CYP450 inducers (exceptions: efavirenz is
§ Vision tests monthly (ethambutol) an inducer > inhibitor, rilpivirine is a substrate)
§ Mental status (ethambutol) o Hepatotoxicity and rash, including SJS/TEN
o Other: (nevirapine > other NNRTIs)
§ Pyridoxine 23 mg PO daily to reduce the § Monitor for erythema, facial edema, skin
risk of INH-associated peripheral necrosis, blisters and tongue swelling
neuropathy o Food requirements
§ Rifabutin is used instead of rifampin if § With food: etravirine, rilpivirine
unacceptable drug-drug interactions § Without food: efavirenz
• Fungal classifications o Efavirenz: CNS effects $ by giving at bedtime on an
o Yeasts empty stomach
§ Candida species (C. albicans, C. tropicalis, o Rilpivirine: QT prolongation, depression, suicidality
C. parapsilosis, C. glabrata, C. krusei)
§ Cryptococcus neoformans
o Molds
§ Aspergillus species
§ Zygomycetes (Mucor species, Rhizopus
species)
o Dimorphic fungi (mold in the cold; yeast in the
heat)
§ Histoplasma capsulatum
§ Blastomyces dermatitidis
§ Coccidioides immitis

6
 • Key features of PIs • Pediatric cough and cold treatment - caution needed
o Generic names end in “-navir” o Children <12 y
o Primarily CYP450 inhibitors (always check for DIs) § Avoid codeine-containing products (FDA)
§ 3A4 o Children <6 y
§ Ritonavir strong CYP3A inhibitor used to § Avoid all OTC cough and cold products
# PI or boost concentrations (AAP)
o No renal dose adjustment needed, but may be used o Children <4 y
as part of a regimen with renal restrictions § Avoid many OTC cough and cold products
o Hepatotoxicity (highest risk with tipranavir) (package labeling)
o Taken with a PK booster (ritonavir, cobicistat) to # o Children <2 y
levels of the PI § Avoid OTC cough and cold products (FDA)
o Metabolic abnormalities such as HLD, § Avoid promethazine (FDA)
lipohypertrophy (atazanavir, darunavir > other § Avoid topical menthol and camphor
PIs), insulin resistance/hyperglycemia (highest (package labeling)
risk with indinavir, lopinavir/r) • Study tips: MDIs and DPIs
o # CVD risk (lowest with atazanavir, darunavir) o MDIs
o GI upset (N/V/D), take with food to $ GI SEs § Brand name identifiers: HFA, Respimat or
(exceptions: fosamprenavir, lopinavir/r) no suffix (e.g., QVAR)
o Bleeding events (in patients with hemophilia) § Deliver dose of aerosolized liquid
o ECG changes (especially saquinavir/r, lopinavir/r, medication
atazanavir/r) § Some use a propellant (HFA)
o Rash (including SJS/TEN) § Administration requires a slow deep
• Key features of INSTIs inhalation at the same time as pressing
o Generic names end in “-tegravir” the canister to deliver the dose
o No renal dose adjustment needed (avoid Stribild if § A spacer can be used for patients who
CrCl <70 mL/min, avoid Genvoya if CrCl <30 cannot coordinate breath with dose
mL/min) delivery
o No major CYP interactions § Shake well in most cases; exceptions are:
o # CPK (raltegravir > other INSTIs) QVAR, Alvesco, Respimat products
o HA, insomnia o DPIs
o Take without regards to food (exception: § Brand name identifiers: Diskus, Ellipta,
elvitegravir with food) Pressair, Handihaler, Neohaler,
o Interactions with polyvalent cations - must separate RespiClick
dose § Deliver a dose of fine powdered
§ Antacids with aluminum, calcium, medication
magnesium, zinc, MVI with minerals § No propellant
§ INSTIs act as chelators § Administration requires a quick and
• Select drugs that CAN CAUSE PAH forceful inhalation (no need to press
o Cocaine anything at the same time)
o Dasatinib (Sprycel) § Spacers cannot be used; the drug is
o Diazoxide (Proglycem) delivered by the breath and no
o Methamphetamines coordination is needed
o SSRI use during pregnancy (# risk in newborns) § Do not shake
o Weight loss agents (diethylpropion, lorcaserin, • Study tip: COPD vs. asthma
phendimetrazine, phentermine) o COPD
• Select drugs that CAN CAUSE PF § Age of onset: usually >40 y
o Amiodarone § Smoking history usually: >10 y
o MTX § Sputum production: common
o Nitrofurantoin § Allergies: uncommon
o Sulfasalazine § Symptoms: persistent
§ Disease process: progressive, worsens
over time
§ Exacerbations: common complication
§ First-line treatment: bronchodilators

7
 o Asthma • Concentrated insulin products
§ Age of onset: usually <40 y o Rapid acting insulin
§ Smoking history: uncommon § Humalog KwikPen: 200 units/mL
§ Sputum production: infrequent o Regular (short acting) insulin
§ Allergies: common § Humulin R U-500: 500 units/mL
§ Symptoms: intermittent and variable o Long acting insulin
§ Disease process: stable, does not worsen § Tresiba FlexTouch (insulin degludec): 200
over time units/mL
§ Exacerbations: common complication § Toujeo SoloStar (insulin glargine): 300
§ First-line treatment: inhaled units/mL
corticosteroids • Select drugs that can LOWER BLOOD GLUCOSE
• Study tip: NICOTINE PATCH dosing and administration o Linezolid
o The number of cigarettes you smoke daily will o Lorcaserin (Belviq)
determine which patch dose you should start o Octreotide (can also cause hyperglycemia)

Cigarette use W 1-6 W 7-8 W 9-10 o Pentamidine

> 10 per day 21 mg 14 mg 7 mg o Propranolol and other non-selective beta blockers
No (can also cause hyperglycemia)
≤ 10 per day 14 mg 7 mg o Quinine
recommendation
o Quinolones (can also cause hyperglycemia)
o Remove the patch prior to bedtime if you have • Study tip: S&S of HYPOTHYROIDISM
vivid dreams o Cold intolerance/sensitivity
• Goals for DIABETES IN PREGNANCY o Dry skin
o Fasting: ≤ 95 mg/dL o Fatigue
o 1 hr post meal: ≤ 140 mg/dL o Muscle cramps
o 2 hr post meal: ≤ 120 mg/dL o Voice changes
• Diabetes diagnostic criteria o Constipation
o Diagnosis of prediabetes o Weight gain
§ FPG 100-125 mg/dL or o Goiter (possible, can be d/t low iodine intake)
§ 2 h plasma glucose of 140-199 mg/dL o Myalgias
after a 75 g oral glucose tolerance test o Weakness
or o Depression
§ A1c 5.7-6.4% o Bradycardia
o Diagnosis of diabetes o Coarseness or loss of hair
§ Classic symptoms of hyperglycemia o Menorrhagia (heavier than normal menstrual
(polyuria, polydipsia, unexplained periods)
weight loss), or hyperglycemic crisis o Memory and mental impairment
and a random plasma glucose ≥ 200 • Select drugs and conditions that can cause
mg/dL or HYPOTHYROIDISM
§ FPG ≥ 126 mg/dL fasting is defined as no o Hashimoto’s disease - most common cause
caloric intake for at least 8 h or o Pituitary failure
§ 2 hr plasma glucose ≥ 200 mg/dL after a o Surgical removal of part or all of the thyroid
75 g OGTT o Congenital hypothyroidism
§ A1c ≥ 6.5% o Thyroid gland ablation with radioactive iodine
• Diabetes adult treatment goals (ADA) o External irradiation
o A1c < 7% o Iodine deficiency
o Pre-prandial plasma glucose 80-130 mg/dL o Drugs: amiodarone, carbamazepine,
o Peak post-prandial plasma glucose < 180 mg/dL eslicarbamazepine, interferons, lithium,
• Key drugs - # BLOOD GLUCOSE oxcarbazepine, phenytoin, tyrosine kinase
o Beta blockers (may also cause hypoglycemia) inhibitors (sunitinib)
o Diuretics (thiazides, loops) • Study tip: LEVOTHYROXINE TABLET COLORS
o Immunosuppressants (CYA, tacrolimus) o Orangutans will vomit on you right before they
o Niacin become large, proud giants
o Protease inhibitors § 25 mcg - orange
o Quinolones (may also cause hypoglycemia) § 50 mcg - white (no dye)
o 2nd generation (atypical) antipsychotics (clozapine, § 75 mcg - violet
olanzapine, quetiapine) § 88 mcg - olive
o Statins § 100 mcg - yellow
o Systemic steroids § 112 mcg - rose
o Others: azole antifungals (posaconazole), beta- § 125 mcg - brown
agonists, cough syrups (OTC and Rx), diazoxide, § 137 mcg - turquoise
interferon alfas, octreotide (may also cause § 150 mcg - blue
hypoglycemia) § 175 mcg - lilac
§ 200 mcg - pink
§ 300 mcg - green
8
 • Study tip: S&S of HYPERTHYROIDISM • Select factors and conditions with OSTEOPOROSIS RISK
o Heat intolerance or increased sweating o Patient characteristics
o Weight loss (or gain) § Advanced age
o Agitation, nervousness, irritability, anxiety § Ethnicity (white and Asian American
o Palpitations and tachycardia women at # risk)
o Fatigue and muscle weakness § Family hx
o Frequent BM’s or diarrhea § Gender (F>M)
o Insomnia § Low body weight
o Tremor o Medical diseases/conditions
o Thinning hair § Anorexia
o Goiter (possible) § Diabetes
o Exophthalmos, diplopia § GI diseases (IBD, celiac disease, gastric
o Light or absent menstrual periods bypass, other malabsorption
• Study tip: S&S of THYROID STORM syndromes)
o Fever (> 103 F) § Hyperthyroidism
o Tachycardia § Hypogonadism in men
o Tachypnea § Menopause
o Dehydration § RA and other autoimmune diseases
o Profuse sweating § Others: epilepsy, HIV/AIDS, Parkinson’s
o Agitation o Lifestyle factors
o Delirium § Smoking
o Psychosis § Excessive ETOH
o Coma § $ calcium and vitamin D intake
• Study tip: STEROIDS LEAST POTENT TO MOST POTENT § Physical inactivity
o Cute hot pharmacists and physicians marry o Medications
together and deliver babies § Anticonvulsants (carbamazepine,
phenytoin, phenobarbital)

Cortisone 25 mg
Short-acting § Aromatase inhibitors
Hydrocortisone 20 mg
§ Depo-medroxyprogesterone
Prednisone 5 mg
§ GnRH (gonadotropin releasing hormone)
Prednisolone 5 mg agonists
Intermediate-acting
Methylprednisolone 4 mg § Lithium
Triamcinolone 4 mg § PPIs (# gastric pH ~ $ Ca absorption)
Dexamethasone 0.75 mg Long-acting and # § Steroids (≥ 5 mg /d of prednisone
Betamethasone 0.6 mg potency equivalent for ≥ 3 m)

• Key drugs that can cause DRUG INDUCED LUPUS § Thyroid hormones (in excess)
ERYTHEMATOSUS (DILE) § Others: heparin, loop diuretics, SSRIs,
o Anti-TNF agents TZDs
o Hydralazine (alone, and in BiDil) • Study tip: diagnosis of osteoporosis
o Isoniazid o T-scores
o Methimazole § Normal: ≥ -1
o Methyldopa § Osteopenia: -1 to -2.4
o Minocycline § Osteoporosis: ≤ -2.5
o Procainamide • Study tip: CALCIUM AND VITAMIN D
o Propylthiouracil o Calcium
o Quinidine § Do not exceed 500-600 mg per dose
o Terbinafine (saturable)
• Study tip: SEVERE AND RARE ADVERSE EFFECTS OF § Ca carbonate
CONTRACEPTIVES • 40% elemental calcium
o ACHES • Acid dependent absorption
§ Abdominal pain that is severe: can • Must take with meals
indicate a ruptured liver tumor, cyst, or § Ca citrate
ectopic pregnancy • 21% elemental calcium
§ CP: can indicate a heart attack, SOB can • Not acid dependent
indicate a PE • Can take without regards to
§ Headaches: can indicate a stroke meals
§ Eye problems: can indicate a blood clot in o Vitamin D
the eye § Required for calcium absorption
§ Swelling or sudden leg pain: can indicate a § Deficiency: serum vitamin D [25(OH)D] <
blood clot in the legs 30 ng/mL
§ Treat deficiency with cholecalciferol (D3)
or ergocalciferol (D2), dosed daily or
weekly

9
 • OPIOID CONVERSIONS - steps to convert • Study tip: STATIN TREATMENT INTENSITY DEFINITIONS AND
o Calculate the total 24 h dose requirement for the SELECTION OPTIONS

current drug
High intensity Moderate intensity Low intensity
o Use a ratio conversion to calculate the dose of the
$ LDL ≥ 50% $ LDL 30-49% $ LDL < 30%
new drug
Atorvastatin 40-80 Atorvastatin 10-20 Simvastatin 10
o Calculate the 24 h dose of the new drug and reduce
Rosuvastatin 20-40 Rosuvastatin 5-10 Pravastatin 10-20
dose by at least 25%
Simvastatin 20-40 Lovastatin 20
o Divide to get approximate interval and dose for
Pravastatin 40-80 Fluvastatin 20-40
new drug
Lovastatin 40 Pitavastatin 1
o BTP dose ranges from 5-17% of the total daily
Fluvastatin XL 80
opioid dose
Fluvastatin 40 mg BID
• Study tip: morphine-type allergy
Pitavastatin 2-4
o The common drugs in the same chemical class that All mg daily unless otherwise noted
cross-react with each other have cod or morph • Study tip: managing MYALGIAS (muscle soreness,
in the name; buprenorphine has norph instead tenderness)
of morph o First, hold statin if intolerable, check CPK,
§ Codeine, hydrocodone, oxycodone investigate other possible causes
§ Morphine, hydromorphone, o After 2-4 w: re-challenge with same statin at same
oxymorphone dose or $ dose
§ Buprenorphine, heroine o Most patients who did not tolerate a statin will
(diacetylmorphine) tolerate it when re-challenged, or will tolerate a
• Key drugs that # URIC ACID different statin
o ASA, higher doses o If myalgias return when the original statin is
o Diuretics (loops and thiazides) reinitiated, discontinue original statin
o Niacin § Once muscle symptoms resolve, use a low
o Pyrazinamide dose of a different statin
o Ribavirin o If low dose of a different statin is tolerated,
o Calcineurin inhibitors (tacrolimus and CYA) gradually # dose
• Study tip: GOUT TREATMENT BASICS • Study tip: STATIN EQUIVALENT DOSING
o Gout pain is severe o Pharmacists rock at saving lives and preventing flu
o Treat acute pain quickly and use drugs that hit § Pitavastatin 2 mg
inflammation hard: steroids (including intra- § Rosuvastatin 5 mg
articular injections), NSAIDs (often with high § Atorvastatin 10 mg
starting dose), or colchicine § Simvastatin 20 mg
o Once gout has struck (but not before) it is treated § Lovastatin 40 mg
chronically with a PPx drug because gout is not a § Pravastatin 40 mg
pleasant experience § Fluvastatin 80 mg
§ Xanthine oxidase inhibitors (XOI): • Key drugs that can # BP
allopurinol or febuxostat o Amphetamines and other ADHD drugs
§ An acute gout flare can happen when o Cocaine
XOI’s are started, so give initially with o Decongestants (pseudoephedrine, phenylephrine)
colchicine or an NSAID o Erythropoiesis stimulating agents
§ If XOI didn’t work well enough (UA > 6 o Immunosuppressants
mg/dL) o NSAIDs
• Add on lesinurad (Zurampic) or o Systemic steroids
probenecid - take with the o Others: ETOH, appetite suppressants, caffeine,
daily XOI or herbals (ginseng, licorice, yohimbe), mirabegron,
• Replace the XOI with oral contraceptives, select oncology agents
pegloticase (Krystexxa) - IV (bevacizumab, tyrosine kinase inhibitors), SNRIs
and has a risk of anaphylaxis
• Classification of CHOLESTEROL AND TG LEVELS (mg/dL)
o LDL: < 100
o HDL:
§ < 40 (M) low
§ < 50 (W) low
o TG: < 150

10
 • Key updates for HYPERTENSION • Study tip: LONG TERM MANAGEMENT AFTER ACS
o Treatment definitions: (secondary prevention)
§ Normal: < 120/80 mmHg o ASA: indefinitely (81 mg daily), unless
§ Elevated: 120-129/< 80 mmHg contraindicated
§ Stage 1 HTN: 130-139/80-89 mmHg o P2Y12 inhibitor:
§ Stage 2 HTN: ≥ 140/90 mmHg § Medical therapy patients: ticagrelor or
o Initiating treatment: clopidogrel with aspirin 81 mg for at
§ Clinical CVD (CHD, CHF, stroke) or an least 12 m
ASCVD risk ≥ 10% should be treated if § PCI treated patients (including any type of
BP ≥ 130/80 mmHg stent): clopidogrel, prasugrel or
§ Without clinical CVD and an ASCVD risk < ticagrelor with aspirin 81 mg for at
10% should be treated if BP ≥ 140/90 least 12 m
mmHg o NTG: indefinitely (SL tabs or spray PRN)
• If ASCVD risk is unknown, it can o Beta blocker: 3 y; continue indefinitely if HF or if
be assumed that most needed for management of HTN
elderly patients (≥ 65 y) and o ACEi: indefinitely if EF < 40%, HTN, CKD or diabetes;
patient with comorbid consider for all MI patients with no
conditions including CKD and contraindications
diabetes will have an ASCVD o Aldosterone antagonists: indefinitely if EF ≤ 40%
risk ≥ 10% and either symptomatic HF or DM receiving
§ BP goals for all patients < 130/80 mmHg target dose of an ACEi and beta blocker
o Initial drug selection: § CI: significant renal impairment (sCr > 2.5
§ Initiation of 2 drugs is recommended in mg/dL in women) or hyperkalemia (K >
patients with a baseline BP ≥ 140/90 5 mEq/L)
mmHg (stage 2 HTN) and if BP is > o Statin:
20/10 mmHg above goal § Patients ≤ 75 y high intensity statin
§ Thiazide-type diuretic, DHP CCB, ACEi or § Patients > 75 y moderate intensity statin
ARB should be used first line • Key drugs that CAUSE OF WORSEN HF
§ Black patients should be preferably o Antiarrhythmics: avoid class I agents
treated with a thiazide or CCB (procainamide, quinidine, flecainide) in HF;
§ Any patient with stage 3 CKD, stage 1 or 2 amiodarone and dofetilide have less risk of
CKD with albuminuria or diabetes worsening HF
with albuminuria should receive an o Oncology agents: anthracyclines (doxorubicin,
ACEi or ARB first line daunorubicin)
• Treatment approach for SIHD o Non-DHP CCBs: diltiazem and verapamil (especially
o A: anti-PLT and antianginal drugs in systolic HF)
o B: blood pressure and beta blockers o Thiazolidinediones: # risk of edema
o C: cholesterol (statins) and cigarettes (cessation) o NSAIDs: all (including celecoxib)
o D: diet and diabetes o Immunosuppressants: TNF inhibitors (etanercept
o E: exercise and education and rituximab) and interferons
• Study tip: DRUG TREATMENT OF ACS o Itraconazole
o MONA-GAP-BA o Others: systemic steroids, amphetamines, other
§ Morphine sympathomimetics, illicit drugs, triptans (CI with
§ O2 history of CV disease or uncontrolled HTN),
§ Nitrates oncology agents, TKIs (lapatinib, sunitinib) and
§ Aspirin agents that cause fluid retention (trastuzumab,
§ GPIIb/IIIa antagonists imatinib, docetaxel), excessive ETOH use
§ Anticoagulants • Key drugs that can # OR PROLONG THE QT INTERVAL
§ P2Y12 inhibitors o Antiarrhythmics: class I (especially Ia and class III)
§ Beta blockers o Abx: quinolones, macrolides
§ ACE inhibitors o Azole antifungals: (most)
• NSTE-ACS: MONA-GAP-BA +/- o Antidepressants: TCAs (amitriptyline,
PCI clomipramine, desipramine, doxepin,
• STEMI: MONA-GAP-BA + PCI OR imipramine), SSRIs (citalopram, escitalopram,
fibrinolytic (PCI preferred) others), SNRIs, mirtazapine and trazodone
(sertraline is preferred in cardiac patients)
o Antiemetic agents: 5HT3 antagonists, droperidol,
phenothiazines
o Antipsychotics: chlorpromazine, clozapine,
haloperidol, olanzapine, paliperidone,
quetiapine, risperidone, thioridazine, ziprasidone
o Others: donepezil, methadone
• Study tip: Vaughan Williams classification

11
 o Double quarter pounder, lettuce, mayo, fries please o CHF
because dieting during stress is always very o HTN
difficult o Age2 ≥ 75 y
§ Class I o Diabetes
• Ia: disopyramide, quinidine, o Prior stroke/TIA
procainamide o Vascular disease (prior MI, PAD, aortic plaque)
• Ib: lidocaine, mexiletine o Age 65-74 y
• Ic: flecainide, propafenone o Sex, female
§ Class II • Study tip: diagnosis and treatment of iron deficiency anemia
• Beta blockers o Lab findings
§ Class III § $ Hgb, microcytosis (MCV < 80 fL) and $
• Dronedarone, dofetilide, sotalol, RBC production ($ reticulocyte count)
ibutilide, amiodarone § $ serum iron, ferritin, and TSAT
§ Class IV § Many iron binding sites available (# TIBC)
• Verapamil, diltiazem o Treatment: oral iron therapy
• Study tip: conversion between anticoagulants § Recommended dose: 100-200 mg
o From warfarin to another anticoagulant elemental iron per day
§ Stop warfarin and convert to (READ): § Absorption is $ with:
• Rivaroxaban when INR is < 3 • Food: take on empty stomach
• Edoxaban when INR is ≤ 2.3 • # gastric pH: avoid H2RAs and
• Apixaban when INR is < 2 PPIs, separate from antacids
• Dabigatran when INR is < 2 • SR or enteric coated formulas
o From oral Xa inhibitors (apixaban, edoxaban and o Goals: # in serum Hgb by 1 g/dL every 2-3 w,
rivaroxaban) to warfarin: continue treatment for 3-6 m after anemia has
§ Stop Xa inhibitor. Start parenteral
resolved until iron stores return to normal
anticoagulant and warfarin at next % elemental iron in oral products
scheduled dose of the factor Xa Ferrous gluconate 12%
inhibitor. Ferrous sulfate 20%
o From dabigatran to warfarin: Ferrous sulfate, dried 30%
§ Start warfarin 1-3 d before stopping Ferrous fumurate 33%
dabigatran (determined by renal Carbonyl iron 100%
function). Polysaccharide iron complex 100%
• Study tip: WARFARIN TABLET COLORS

o Please let Greg Brown bring peaches to your • Key drugs that can cause hemolytic anemia
wedding o Drug induced (acquired)
§ Pink 1 mg § Beta lactamase inhibitors (clavulanate,
sulbactam, tazobactam)
§ Lavender 2 mg
§ Cephalosporins (ceftriaxone, cefotetan)
§ Green 2.5 mg
§ Isoniazid
§ Brown/tan 3 mg § Levodopa
§ Blue 4 mg § Methyldopa
§ Peach 5 mg § PCN (piperacillin)
§ Teal 6 mg § Platinum based chemotherapy agents
§ Yellow 7.5 mg (carboplatin, cisplatin, oxaliplatin)
§ White 10 mg § Quinidine
• Foods high in vitamin K § Quinine
o Broccoli § Ribavirin
o Brussel sprouts § Rifampin
o Cabbage o High risk with G6PD deficiency (inherited)
o Canola oil § Chloroquine
o Cauliflower § Dapsone
o Chickpeas § Methylene blue
o Cole slaw § Nitrofurantoin
o Collard greens § Primaquine
o Coriander
o Endive § Probenecid
o Green kale § Rasburicase
o Lettuce § Sulfonamides
o Mustard greens
o Parsley
o Soybean oil
o Spinach
o Swiss chard
o Tea
o Turnip greens
o Watercress
• CHA2DS2 VASc scoring system
12
 • Key drugs that CAUSE OR WORSEN DEPRESSION § This part of the brain controls motor
o ADHD: methylphenidate, atomoxetine function, including movement and
o Analgesics: indomethacin, methadone balance by releasing the NT dopamine,
o ART: efavirenz (in Atripla), rilpivrine (in Complera, which transmits the movement
Odefsey) instructions to other parts of the brain
o CV: BB (propranolol), clonidine, methyldopa, o In PD: $ DA " $ instructions " movement
procainamide, reserpine problems, which are called the TRAP major
o Hormones: contraceptives, anabolic steroids symptoms
o Others: antidepressants, systemic steroids, CYA, § TRAP
ETOH, isotretinoin, interferons, varenicline • Tremor: when resting,
o Medical conditions: stroke, Parkinson’s, dementia, worsened by anxiety
MS, thyroid disorders, $ vitamin D levels, • Rigidity: in legs, arms, trunk, and
metabolic conditions, malignancy face (mask like face)
• Key drugs that can cause PSYCHOTIC SYMPTOMS • Akinesia/bradykinesia: lack
o Anticholinergics (centrally-acting, high doses) of/slow start in movement
o Cannabis • Postural instability: imbalance,
o Dextromethorphan falls
o Dopamine or dopamine agonists used in § Additional symptoms
Parkinson’s disease (Requip, Mirapex, Sinemet) • Small, cramped handwriting
o Illicit substances: bath salts, cocaine, LSD, • Shuffling walk bent over body
methamphetamines, PCP • Muffled speech, drooling,
o Interferons dysphagia
o Stimulants • Depression, anxiety
o Systemic steroids • Constipation, incontinence
• Study tip: important ADVERSE EFFECTS OF 2ND GENERATION o Primary treatment: replace DA
ANTIPSYCHOTICS § Give a precursor to DA that becomes DA
o Metabolic SEs in the brain (levodopa in Sinemet)
§ Highest risk: clozapine, olanzapine, § Given a drug that acts like DA (DA
quetiapine agonists)
§ Moderate risk: risperidone, paliperidone • Key drugs DA blocking drugs that can worsen PD
§ Lower risk: aripiprazole, ziprasidone, o Prochlorperazine and other phenothiazines used
lurasidone, asenapine for psychosis, nausea, agitation
o EPS o Haloperidol or droperidol
§ Highest risk: paliperidone, risperidone o 2nd generation antipsychotics such as risperidone
§ Lowest risk: quetiapine (recommended in and paliperidone
patients with Parkinson’s who require o Metoclopramide, renally cleared that can
antipsychotics) accumulate in the elderly
o Hematologic effects • Key drugs that can WORSEN DEMENTIA
§ Highest risk: clozapine (agranulocytosis) o Antihistamines and antiemetics
o QT prolongation o Antipsychotics
§ Highest risk: ziprasidone, thioridazine o Barbiturates
o # prolactin o BZDs
§ Highest risk: risperidone, paliperidone o Central anticholinergics (benztropine)
o Seizure o Peripheral anticholinergics (including incontinence
§ Highest risk: clozapine (dose dependent) and IBS drugs)
• Study tip: LITHIUM not easy to initiate o Skeletal muscle relaxants
o Common SEs o Other CNS depressants
§ Nausea, anorexia, abdominal pain, thirst, • Key drugs that cause ANXIETY
sedation, confusion, tremor o Albuterol (if used too frequently or incorrectly)
o Suggestions to help o Antipsychotics (aripiprazole, haloperidol)
§ Titrate slowly, possibly shift more of the o Bupropion
dose to QHS o Caffeine
§ Suggest taking dose at end of meal, food o Decongestants
in the stomach helps o Illicit drugs
§ Drink adequate fluids avoid dehydration o Levothyroxine
o Dose correctly o Steroids
§ 5 mL lithium citrate solution = 8 mEq o Stimulants
§ 8 mEq = 300 mg lithium carbonate o Theophylline
tabs/caps • Study tip: metabolism and safety of BZDs
• Study tip: PD the cause, symptoms and primary drugs o LOT
treatment § Lorazepam
o Neurons deep within the brain stem, in the § Oxazepam
substantia nigra region degeneration § Temazepam

13
 • These agents are considered to • Study tip: ADJUSTING PHENYTOIN DOSES
be potentially less harmful o Phenytoin has Michaelis-Menten kinetics, also
for older adults and patients called saturable kinetics
with liver impairment since o A small # in dose can cause a large # in drug level if
they are metabolized in the enzymes have become saturated
inactive compounds o If albumin is low (< 3.5 g/dL), and CrCl ≥ 10 mL/min,
(glucuronides) adjust the total levels with the formula
• Key drugs/conditions that can LOWER THE SEIZURE

total phenytoin measured

Phenytoin correction =
THRESHOLD
(0.2 × albumin) +0.1
o Antipsychotics o Free levels do not require any correction
o Antivirals • Study tip: all Medguide required
o Bupropion o Warnings: suicide risk; monitor mood
o Carbapenems, especially imipenem (with higher o Teratogenicity: contraception may be needed
doses and/or renal impairment) o Rash, hypersensitivity reactions can be severe
o Cephalosporins • Study tip: Lamictal starter kit - colors help safety
o Lithium o Orange
o Lindane § Standard starting dose
o Mefloquine § Use if no interacting medications
o Meperidine (chronic dosage with poor renal o Blue
function) § Lower starting dose
o Metoclopramide § Use if taking VPA
o PCNs o Green
o Quinolones § Higher starting dose
o ETOH withdrawal § Use if taking an enzyme inducer
o Infection and fever (especially in children) (carbamazepine, phenytoin,
o Theophylline phenobarbital, primidone) and not
o Tramadol taking VPA
o Varenicline • Study tip: phenytoin administration
• Study tip: AEDs are CNS depressants o IV fosphenytoin
o AEDs DEPRESS electrical activity in the brain; they § Do not exceed 150 mg PE/minute monitor
are CNS-DEPRESSants and cause dizziness BP, respiratory function and ECG
confusion, sedation and ataxia/coordination § Lower risk purple glove syndrome than
difficulties phenytoin, which can result in tissue
o They # the risk for impairment, falls and injuries necrosis
o Some of the AEDs cause more CNS depression than o IV phenytoin
others; this is an important consideration for § Do not exceed 50 mg/min (slower
school-aged children and frail elderly at risk for infusion) same monitoring as above
falls § Requires a filter, stable for 4 h
• Study tip: AEDs have a lot of drug interactions o G tube phenytoin
o Strong enzyme inducing AEDs § Enteral feeding $ phenytoin absorption
§ Carbamazepine § Hold feeding 1-2 h before and after
§ Oxcarbamazepine administration
§ Phenytoin • Causes of GAP ACIDOSIS
§ Fosphenytoin o CUTE DIMPLES
§ Phenobarbital § Cyanide
§ Primidone § Uremia
§ Topiramate (doses ≥ 200 mg/d) § Toluene
o Valproic acid # lamotrigine levels § ETOH
• Study tip: AEDs and teratogenicity § DKA
o AEDs can cause fetal harm § Isoniazid
o Contraception is required for women of child § Methanol
bearing age § Propylene glycol
o Enzyme inducing AEDs decrease the efficacy of oral § Lactic acidosis
contraceptives § Ethylene glycol
§ Salicylates

14
 • Key drugs with $ ABSORPTION • Key drugs that cause DIARRHEA
o Agents that require an acidic gut (absorption $ by o Antacids containing magnesium
antacids, H2Ras, PPIs) o Abx, especially broad-spectrum (clindamycin, EES)
§ ART: delavirdine (NRTI), rilpivirine o Antineoplastics
(NNRTI), atazanavir (PI) o Colchicine
§ Antivirals: ledipasvir, o Laxatives
velpatasvir/sofosbuvir o Metoclopramide
§ Azole antifungals o Misoprostol
§ Cephalosporins (PO): cefditoren, o Quinidine
cefpodoxime, cefuroxime • Key drugs that can cause ED/SEXUAL DYSFUNCTION
§ Iron products o Antidepressants: SSRIs and SNRIs (mostly $ libido)
§ Mesalamine EC o Anti-HTNs: BBs, clonidine, others
§ Risedronate delayed-release o Antipsychotics: 1st generation (haloperidol,
§ TKIs: dasatanib, erlotinib, pazopanib, fluphenazine, chlorpromazine), prolactin raising
others 2nd generation (risperidone, paliperidone)
o Other drugs/drug classes that antacids bind o BPH: finasteride, dutasteride, silodosin (mostly
§ ART (INSTI) dolutegravir, elvitegravir, retrograde ejaculation)
raltegravir o Others: ETOH, anticancer drugs (leuprolide,
§ Bisphosphonates flutamide), anticholinergics, atomoxetine,
§ Isoniazid digoxin, H2Ras, nicotine, opioids (chronic, esp.
§ MMF methadone)
§ Quinolones • Key drugs that can WORSEN BPH
§ Sotalol o Anticholinergics
§ Steroids (budesonide) o Antihistamines
§ Tetracyclines o Caffeine
§ Thyroid products o Decongestants
• Medical conditions that cause CONSTIPATION o Diuretics
o IBS-C o SNRIs
o Anal disorders (fissures, fistulae, rectal prolapse) o TCAs, phenothiazines
o MS o Testosterone products
o CV events • Key drugs that can # IOP
o PD o Anticholinergics
o SC tumors o Cough, cold and motion sickness medications
o Diabetes o Chronic steroids, especially eye drops such as
o Hypothyroidism prednisolone
• Key drugs that are CONSTIPATING o Topiramate
o Aluminum antacids • Study tip: glaucoma treatment - $ IOP
o Anticholinergic drugs o Make $ fluid (BB like timolol)
o Non-DHP CCBs (especially verapamil) o Move fluid out (with PG analogs, like latanoprost)
o Bismuth o Or do both, add on brimonidine
o Clonidine • Key drugs that are known to CAUSE VISION CHANGES OR
o Colesevelam DAMAGE
o Iron o Alpha blockers
o Opioids o Amiodarone
o Sucralfate (contains an aluminum complex) o Digoxin
o Others: 5-HT3 receptor antagonists (ondansetron), o Chloroquine
aripiprazole, milnacipran, o Ethambutol
phentermine/topiramate, ranolazine, o Ezogabine
tramadol/tapentadol, varenecline o Hydroxychloroquine
• Study tip: what to recommend for OTC CONSTIPATION o Isotretinoin
o Adults o Linezolid
§ Most: fiber (Metamucil) o PDE5 inhibitors
§ On opioids: senna, bisacodyl supp. o Tamoxifen
§ On iron or if stool is very hard: docusate o Voriconazole
§ Need to go but need something gentle:
glycerin supp.
o Children
§ Glycerin supp.

15
 • Drugs that can discolor skin and secretions • Key drugs/conditions that can cause WEIGHT GAIN
o Brown: levodopa, entacapone, methyldopa o Insulin, sulfonylureas, glitazones
o Brown/black/green: methocarbamol o Antipsychotics
o Purple/orange/red: chlorzoxazone o Steroids
o Brown/yellow: metronidazole, tinidazole, o Mirtazapine
nitrofurantoin, riboflavin (B2) o Dronabinol, megestrol
o Orange/yellow: sulfasalazine o Conditions: hypothyroidism
o Yellow-green: propofol, flutamide o Others: divalproex, VPA, TCAs, MAOIs, SSRIs
o Red-orange: phenazopyridine, rifapentine, rifampin (paroxetine), lithium, pregabalin and gabapentin
o Red: anthracyclines, deferasirox (urine) • Key drugs/conditions that can cause WEIGHT LOSS
o Blue: mitoxantrone, methylene blue o Stimulants
o Blue-gray: chloroquine, amiodarone o Exenatide (Byetta), liraglutide (Victoza, Saxenda)
o Topiramate
o Others: AEDs, pramlintide (Symlin), bupropion,
acetylcholinesterase inhibitors (donepezil,
rivastigmine, galantamine)
§ Hypothyroidism, Lupus, celiac diasease,
Chron's

Common CYP drugs and their metabolic pathways

CYP1A2 CYP2C9 CYP2C19 CYP2D6 CYP3A4
Caffeine Warfarin Omeprazole Codeine Clarithromycin
Theophylline Phenytoin Esomeprazole Dextromethorphan Erythromycin
Glipizide Lansoprazole Hydrocodone Quinidine
Glyburide Pantoprazole Oxycodone (minor) Midazolam
Citalopram Fluoxetine Alprazolam
Voriconazole Haloperidol Diazepam
Clopidogrel Venlafaxine CYA
Paroxetine Tacrolimus
Duloxetine Amlodipine
Risperidone Diltiazem
Propranolol Nifedipine
Metoprolol Verapamil
Tamoxifen Atorvastatin
Lovastatin
Simvastatin
Estrogens
Carbamazepine
Oxycodone (major)

16