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Key Drugs, Mnemonics, Study Tips
Key Drugs, Mnemonics, Study Tips
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
2
• 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)
3
• 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
5
• 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)
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
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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
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• 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
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• 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
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• 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.
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• 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
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