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Steroid of choice in pregnancy?
Antihistamine of choice in pregnancy?
Which hormone should you increase if there is mid-cycle break through bleeding?
Which hormone should you increase if there is late-cycle break through bleeding?
In Parkinson's patients, what is the antidepressant class of choice?
In Parkinson's, what is the antipsychotic of choice?
Why should you NOT use antipsychotics for demential related psychoses?
Increased risk of death from infection or cardiovascular complications
What is the benzo of choice in treating status epilepticus?
Which 3 benzos are consider less harmful in the elderly?
- L - lorazepam
- O - oxazepam
- T - temazepam
Which 2 seizure medications are preferred for treating absence seizures?
Valproic acid and ethosuximide
What are considered 2 first-line seizure medications?
Keppra and Lamictal
What is chloral hydrate used for?
Sedation in children
Which is the weaker class of diuretics - thiazides or loops?
Why do thiazides have a protective effect on bone?
They increase calcium reabsorption
Which NSAIDs are similar to celebrex in terms of low GI risk?
meloxicam, nabumetone, and etodolac
Systolic dysfunction is characterized by a LV EF less than what %?
CO = stroke volume x heart rate
Sodium restriction in heart failure
Beta-blockers used in heart failure
- Metoprolol succinate
Drugs with mortality benefit in heart failure
- ACE-Is (or ARBs in pt cannot tolerate ACEI)
- Beta blockers
- Aldosterone antagonists
- Bidil (in black people only!!)
Heart failure drugs
- 2nd line:
- Aldosterone antagonists
- Loop diuretics - prn fluid overload
- Digoxin - to increase QOL and reduce exacerbations
- ARBs - when cant tolerate ACEI
- BiDil -in blacks
Why would beta blockers be stopped in HF?
In cases of acute decompensated HF if hypotension or hypoperfusion is present
IV ionotropes used in HF to treat hypoperfusion
Dobutmaine = beta agonist, use when SBP >90
Milrinone = PDE3 inhibitor
Dopamine = use when SBP <90
Heparin-induced thrombocytopenia (HIT)
Reduction in platelets >50% from baseline
30 mg Q12 or 40 mg daily
CrCl < 30 = 30 mg daily
Lovenox treatment of VTE/UA/NSTEMI
1 mg/kg Q12 or 1.5 mg/kg daily
CrCl <30 = 1 mg/kg daily
Lovenox treatment for STEMI
<75 = 30 mg IV bolus + 1 mg/kg SC THEN treat like the others
>75 = No bolus, just 0.75 mg/kg Q12
Due to vasospasm in arteries, NOT plaque buildup
Preferred treatment is CCBs
First line treatment for chronic stable angina?
Beta blockers for antianginal therapy + aspirin for antiplatelet therapy
Can use CCBs or long-acting nitrates as alternative when BBs CI or need more relief
Use clopidogrel when ASA CI
Secondary prevention for cardioembolic stroke?
Secondary prevention for non-cardioembolic stroke or TIA?
Rectum and colon (more distal)
More bleeding in stool, smoking improves symptoms
Can affect any part of the GI tract - mostly ileum
Deep ulcerations, transmural
Lesions skip around - not continuous
What do we use to treat acute exacerbations of IBD?
Short courses of IV or oral steroids
Chronic opioid use can worsen pain sensitivity
3 classes of drugs that can cause physical dependence?
Why are NSAIDS so bad for the stomach?
Because they inhibit prostaglandin synthesis, and one of the functions of prostaglandins is to protect the stomach lining
Why is some aspirin enteric coated?
To reduce nausea
When can you be started on fentanyl patch if inpatient?
60mg morphine or equivalent for 7 or more days
Which 3 opioids should you absolutely avoid alcohol with?
Avinza, Opana ER, Nucynta ER
Therapeutic range: 5-15 mcg/ml
Caution in patients with CVD and seizures
AEs: nausea, loose stool
Aminophylline contains 80% theophylline
What drug can increase beta-lactam concentrations (particularly penicillin)?
MOA for beta lactams?
Inhibit cell wall synthesis by binding to PBPs
RIPE for active TB
- All heptatotoxic except ethambutol
- Rifampin can change urine red/orange
When can you schedule albuterol inhalers?
COPD only, NOT asthma
Give to children <7
Both varicella vaccines and MMR are contraindicated with allergies to what 2 things?
Neomycin and geltain
Inactivated polio virus vaccine contraindicated with allergies to what 3 things?
Streptomycin, neomycin, and polymyxin B
Live vaccines are contraindicated in what 2 patient groups?
Pregnancy and immunocompromised
What dose of steroids is thought to induce immunnosuppression?
>= 20mg per day or 2 mg/kg/day of prednisone
Hep A vaccine
3 dose series: 0, 1, 6
Can give at birth!
HPV 2 strain vaccine for cervical caner
3 series: 0,1-2, 6
For women ONLY aged 9-26
HPV 4 strain vaccine for cervical cancer, genitcal warts, and PAP smear abnormalities
For males and females aged 9-26
Which flu vaccine is completely egg free? (Recombinant)
When is it appropriate to get 2 shots of flu vaccine?
Unvaccinated children <8 or those with <2 shots since 2010
Give 4 weeks apart
Fluzone intradermal for what ages?
Labeled for children >5, but ACIP recommends giving it at age 9
Vaccines with egg components
Flu, yellow fever, rabies
Vaccines given SC
Varicella vaccines, MMR, Menomune
- Menomune = 56+
- Menactra = 9 months-55
- Menveo = 2-55
1 dose at 11-12, booster at 16-18
OR just 1 dose 13+
2 doses if HIV+
- -Start at 6 weeks
- -4 doses if children
- -Can give at 2
- >65 = 1 dose
- 19-64 if have asthma/COPD, smoke
- 2-64 if chronic illness
- Revaccinate if received 1st dose <65 and 5 years ago
Dehydration is indicated by what BUN:Scr ratio?
Which calcium salt is preferred in IV admixtures?
What do you add first, calcium or phosphate?
NTE 45 meq/L
2 factors to keep calcium and phosphate from precipitating?
Low pH and low temp
How many half-lives to reach steady state?
Using only the confidence interval, how do you tell if results are statistically significant?
If the range DOES NOT cross 0
If using RR CI, significant if DOES NOT include 1
Which drug is first line in RA?
Methotrexate, however the biologics can be used if severe
Biggest side effect of cyclophosphamide?
Black box warning for Tysarbi?
Can cause PML - progressive multifocal leukoencephalopathy
Auto-immune disease causing dry eyes and dry mouth
Goal INR for patients with PAH treated with warfarin?
Reduced bloody supply to fingers/toes that causes discoloration
Common in PAH
All chemo drugs can cause myleosuppression except which 2?
Bleomycin and vincristine
What drug is used to treat neutropenia in cancer?
Can cause bone pain!!
Can also use Neulasta (pegfilgrastim)
Which cancer drug has highest risk of emesis?
Which can drugs are classified as high emetic risk?
Anthracyclines, cyclophosphamide, cisplatin, dacarbazine
- Treat with 3 drug anti-emetic combo:
- Aprepitant(or fosaprepitant IV) + steroid(dexamethasone) + 5HT3 antagonist
Aloxi is first line, IV push, lasts a week
For Hodgkins lymphoma
- FOLinic acid (leucovorin)
For colorectal cancer
Main side effect with bleomycin?
3 HIV drugs that can co-treat Hep B
emtricitabine, lamivudine, and tenofovir
DOC for surgical prophylaxis
DOC for VRE facelis
Pen G or ampicillin
DOC for VRE faceium
DOC for ESBL producing bacteria
DOC for treating acinetobacter
Drugs used in meningitis
Usually ceftriaxone/cefotaxime + vancomycin
+ampicillin if >50
DOC for acute otitis media
High dose amoxicillin 90mg/kg/day
If fail, can try Augmentin or ceftriaxone for 3 days
DOC for sinusitis
Amoxicillin, Bactrim, or Doxycycline
DOC for pharyngitis
Penicillin, amoxicillin, 1/2 gen cephalosporins, macrolides
Drugs used in severe bronchitis (>14 days)
DOC for outpatient CAP
Healthy: Doxycycline or macrolide
Not: Respiratory FQ, Beta lactam + macrolide
DOC for inpatient CAP
Respiratory FQ, Beta lactam + macrolide
DOC for sphyilis
Penicillin G (Bicillin LA)
DOC for gonorrhea
Ceftriaxone + azithromycin
can sub doxy for azith
Can treat chlamydia too (azith)
DOC for Bacterial vaginosis/trichomoniasis