naplex random notes 68 pages
TRANSCRIPT
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NAPLEX SECRET 2015
Calculations:
ung-ointment WA-while awake
PR-per rectum BM-bowel movement
1 pint= 473 ml 1 uart = !4" ml
1 gallon = 37#$ ml 1 poun% = 4$4 g
Percentage &trength' g(1))ml *w(v+, ml(1))ml *v(v+ ,
g(1))g *w(w+
Ratio &trength' *1'+ e./ )/)40 = )/)4g(1))ml =
1g($))ml = 1'$)) 22Put in gram
PPM' *part o %rug(15)))5)))+ part o whole e./
)/)))g(1))ml = /g(15)))5))) = /PPM
BM6' *kg(m+ 2/$4cm(inch 1#/$ = 8n%erweight5 1#/$-4/! = normal $-!/!=overweight 93) =obee
6BW' Male' $):/3 *inche above $ eet+ ;emale' 4$/$ :
/3*inche 9 $ eet+
A%r .7 Multipl b )/#$ or
emale
ilution' *>hanging a trength or uantit+ C1 2 >1 = C 2
>
Alligation' *>ombining two trength to get a trength in
between+ 22Watch or ADD TO
**Corrected Calciu: Ca2!"#ro la$% ! &"'(al$uin%
)"0+%,
** P-en.toin correction/ PT easured&"02) Al$% !
01,
• >hooe calcium gluconate over chlori%e bc it
%iociate le an% le chance o bin%ing to
phophate an% precipitating
mD ' Dlectrical charge provi%e% per mole
mEmol(F = ?*g(F+(*g(mole+@ . * G o particle it plit up
into+ . 1)))
6otonicit *omolarit in bo% Hui%5 when we want to make
omething iotonic to bloo%+' ID JalueK
• ;irt Ln% out how much a>l woul% make it iotonic/
)/!g(1))ml = g( mF• D= o%ium chlori%e euivalent o a %rug = *$#/$ . i+ (
*MW o %rug . 1/#+ 2i = %iociation actor o %rug
• e.ample' i calculate% D value i )/3 an% ou have
)/4g o %rug5 thi repreent )/4g . /3 = )/)! g a>l
• hen ubtract them rom each other/
;ahrenheit = *> . 1/#+ :3
pN = pka : log *alt(aci%+ ;or Aci%
pN = 14 O p b : log *bae(alt+ ;or Bae
eAQ' *#/7 . A1>+ O 4"/7
>alcium >arbonate' 4)0 elemental calcium >alcium
>itrate' 10 elemental calcium
Abolute eutrophil >ount' WB> . **0eg:0ban%+(1))+
Anion Qap' a:->l-N>E3- 291 i high *gappe%+
Minimum Weighable Cuantit *MWC+ ' &R(error
Abolute Bioavailabilit' ; = *A8>e.travacular
. oeintravenou+(*A8>intravenou . oee.travacular+
6J Bolu J= oe(>o or >o = oe(J
Eral J= *oe . ;+ (*ke .A8>+ >l=*oe . ;+(A8>
>l=ke . J
ke= ?ln*>ma.(>min+@( ime interval
EnteralParental Nutrition:
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>arb' Dnteral *4kcal(gram+ Parenteral *e.troe 3/4
kcal(gram+
Protein' *4kcal(gram+
;at' Dnteral *!kcal(gram+ Parenteral 6J;D *1)0 - 1/1
kcal(ml5 )0 - kcal(ml5 3)0 -3kcal(ml+ 2oten weekl an%
might have to %ivi%e b 7 or %ail
DD = BDD . activit actor . tre actor 2uuall %oentue protein calorie
BDD etimate' 1$-$kcal(kg *a%ult+
ail ;lui% ee%' 1$))mF : *)mF+*g-)+
itrogen 6ntake' gram o protein intake("/$
Cooundin3:
DmuliLer( &uractant'
ween *polorbate+5 Mrot-DTectivene anali O Now eTective the t. wa or
what it wa uppoe% to %o
>ot-MinimiSation anali O two %rug health beneLt are
eual5 ot-BeneLt Anali O Eutcome in %ollar *monetar+
>ot-8tilit Anali O 6nclu%e Cualit o Fie variable
Case(Control: Nave a %ieae an% look back or rik actor
Co-ort: Prosecti6e or Retrosecti6e &tart with rik
actor to ee i the get a %ieae/Cross(Sectional: Fook at a peciLc point in time/
RCT: inter6entional
7eta(Anal.sis: Co$inin3 an. RCT8s and dra4in3 a
conclusion
P-araco3enoics:
- " ultra rapi% metaboliSer have increae% rik o>o%eine Morphine to.icit
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(LA(9*1502 "ainl. Asians% on car$aaeine: 5(
10 c-ance o# S;S 4it- car$aaeine
(SLCO191 Pol.or-is ( statin .oat-. increased
-NDR(eu Encogene O nee%e% or Nerceptin *tratuSumab+
an% a%cla *a%o-tratuSumab+ to work
(*2 and 2C>*? and @ORC1 "A
-alot.e% = reBuire lo4er doses or t-e. 4ill $leed"oo.3ous #or *? is -as 3reatest ris o# $leedin3%
(LA(9*501: # ositi6e #or t-isF do not 3i6e A$aca6ir
"Gia3en%
(2C1>: Cloido3rel is a rodru3 and needs t-is en.e
to con6ert to acti6e #or
-&elSentr *Maraviroc+ O mut be >>R$ poitive onl to
receive %rug
Dru3 Aller3iesADR8s
-Naranjo scale i ue% to help pharmacit %etermine i the
dru3 caused t-e ADR
-&evere &kin Rahe *&U&5 D5 RD&&5 P+ - &top the
oTen%ing agent 2corticoteroi% >6 in D
-&tomach upet(auea rom a %rugO not a true allerg5 it i
an intolerance( Niacin and Statins taen to3et-er -a6e an increased
ris o# uscle to)icit.
-
Photoenitivit' &ula Antibiotic5 etraccline5
;luorouinolone5 iuretic5 ;lagl5 acrolimu5 >cloporine5
&A65 voriconaSole5 methotre.ate/
-Penicillins' Allergic to one preume allergic to all/ &mall
rik or cephaloporin an% carbapenem cro reaction but
houl% till avoi% on the e.am/
(Sul#aSul#onaides Motl with ulametho.aSole
*Bactrim5 &eptra+ but houl% alo avoi% ulapri%ine5
ula%iaSine5 an% ulLo.aSole/ 22Hor e)a also a6oid loo
diureticsF t-iaide diureticsF sul#on.lureasF
acetaolaideF onisaideF and celoco)i$+5 daruna6ir
"Preista% here i no cro-reactivit with ulLte or
ulate/
-7or-ine t.e oioid aller3ies %o not cro react with;entanl *urageic+5 meperi%ine *emerol+5 or metha%one
*olophine+/
-Peanuts and so. are in the ame amil an% can have
cro reactivit/ &o i in ome me%ication'
• clevi%ipine *>levipre.+5 propool *iprovan+5 an%
progeterone in *Prometrium+
-6 allergic to e33s avoi%'
• clevi%ipine *>levipre.+5 propool *iprovan+5
6nHuenSa vaccine "**Hlu$lo is o%
-rue rug Allergie(Anaphla.i *Me%iate% b 6gD an%
Nitamine releae+'
• &welling5 poible hive5 bronchocontriction5 low
bloo% preure
• . with epinephrine *Dpipen5 Dpipen Ur/5 A%renaclick5
Auvi-C+ an% %iphenh%ramine *$mg.+ 2rub the area
ater in
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-Root(Cause Anal.sis "RCA% i %one retropectivel to ee
what le% to a entinel event/ Hailure 7ode and EIects
Anal.sis "H7EA% i %one propectivel to ee what potential
coul% lea% to a problem/
-Error o# Oission i leaving omething out that i nee%e%
or aet/ Error o# Coission i when omething wa
%one incorrectl/
-7edication reconciliation i up%ating the patient
me%ication lit/ 6t houl% be %one at ever tranition o care/
-RE7S i an ;A program that reuire peciLc training an%
reuirement or certain me% e.' cloSapine5 iotretinoin
*iPFDQD+5 erthropoietin in oncolog *APPR6&D+/ Qoal i to
make ure the beneLt o the %rug outweigh the rik/
-7edication 3uides are ;A-approve% printe% han%out or
over 3)) me%ication that that tell patient o important
a%vere event and s-ould $e disensed e6er. tie/ >anbe part o RDM&/
-Iall man letterK can be ue% or look-alike oun%-alike
%rug/ e./ celeA an% celeBRD
-I8e A irecte%K i not acceptable
- Alcohol ha poor activit againt pore like >/ iVcile/ 8e
oap an% water to wah han% when in contact/
->ontact precaution or patient coloniSe% with MR&A an%
JRD/ Airborne precaution or patient with meale5 varicella*chickenpo.+5 an% uberculoi/
-Barco%ing i great an% help prevent error
HDA Dru3 Aro6al9ioeBui6alence:
ew rug Approval'
1 Pre(Clinical Anial Researc-
/ ND-6nvetigational ew rug
• Phae 1- Ae sa#et.P(P parameter with
low %oe in )-#) -ealt-. eole
• Phae - Sa#et. and EJcac. in 1))-3))
people 4it- indication
• Phae 3( ConKr re6ious studies in 1008s(
10008s o# eole 4it- t-e indication at the
%oe oure eeking approval/
3/ NDA &ubmitte% O Dither Approve%5 Re
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- Sa4 Paletto ue% or BPN
- in3er or nauea(motion ickne
- Tea Tree Oil or acne
- L.sine or canker ore
- 7elatonin or inomnia an% % tarte% 1 month beore pregnanc/ 4))-
#))mcg %ail/
- P.rido)ie "9M% upplemente% in uberculoi treatment
that have 6oniaSi% in them
- T-iaine"91% %eLcienc can caue Wernickeencephalopath/
- iacin *B3+ %eLcienc caue pellagra
- @itain C %eLcienc can caue curv
-@itain E houl% not e.cee% 150 da.
- L(Ar3inine can have -.otensi6e eIectsF it8s a
recursor to NO
- ron: Breat-e% babie nee% 1mg(kg(%a rom 4-" month
ol% an% anemic patient ma nee% upplementation too *e./
Renal problem or mentruating emale+
- Pro$iotics: 6 taking antibiotic5 %ont take the probiotic at
the ame time o %a a the antibiotic
- Dchinacea5 Sinc5 el%erberr5 garlic5 vitamin >- ue% or
col%(Hu/ inc can caue lo o mell/
- A%euate Calciu and @itain D nee%e% or low bone
%enit5 pregnanc *etu %eplete tore+5 menopaue5
chil%ren5 an% men who take teroi% or an%rogen blocker/
• >alcium aborption i aturable o %oe houl% be
%ivi%e%/
• 10003da. or women 1!-$) an% 12003da.
or9$)
• >itracal *calcium citrate+ preerre% in low aci%
environment *e./ with N blocker an% PP6 ue+/ Can
$e taen 4it- or 4it-out #ood "21 Eleental%
OscalF Tus "calciu car$onate% -as acid(deendent a$sortion5 tae 4it- #ood Saller
ills than the >itracal an% provi%e more elemental
calcium/ "'0 Eleental%
• @itain D: M00 dail. #or 0F +00 dail. #or
0 *c-olecalci#erol "D?% is t-e re#erred
source+/ Pol. @i Sol multivitamin contain Jit an%
i ea or inant to take/ Breat-e% babie or ormula
e% babie who %rink le than 1 liter(%a nee% 4))68
Jit /
Dru3 nteractions:
nducers *low to have thi eTect+' car$aaeine
"Te3etrol%F -en.toin "Dilantin%F O)car$aeine
"Triletal%F soin3F ri#ainF St ;o-n8s
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O).codone and 7et-adone are metaboliSe% b 3A4
*watch or in%ucer an% inhibitor+
Aiodarone ue O ecreae Di3o)in an% onuion5
Nallucination5 iarrhea5 Mucle rigi%it5 &hivering5
achcar%ia5 &weating5 Nperthermia
C-elation: Tetrac.clines and Buinolones can chelate oeparate% rom Al5 >a5 Mg5 ;e compoun%5 inclu%ing %air/
9leedin3 Ris: SNRF SSRF NSADSF in3oF Ks- oilF
3arlicF 3rae#ruit
*Wellbutrin *Bupropion+ O oent aTect $N o %oent
increae blee%ing rik
.eraleia: ACEiF AR9F ailorideF triatereneF
eleronone "nsra%F sironolactone "Aldactone%F >l5
tacrolimu*Progra+5 ccloporine *eoral+5 trimethoprim5
cana3liQoin "n6oana%F drosirenone "asin%
Ototo)icit.: salic.latesF 6anco.cinF aino3l.cosidesF
cislatinF loo diuretics
T Prolon3ation: uinolonesF 7acrolidesF 7et-adoneF
TCA8sF Soe SSR8s "Citalora and Paro)etine%F Aole
anti#un3alsF S7XT7PF soe Protease n-i$itors
Renal Disease and Dosin3 Considerations:
-he level o Albumin in urine can gauge the everit o
ki%ne %amage/ *Micro an% Macroalbuminuria+
- &erum >reatinine *&>r+ i ue% a a marker o renal unction
- B8 increae in renal impairment but not ue% alone a a
marker b(c it can increae or other reaon uch a
%eh%ration/
-Foop iuretic inhibit a:( : pump in acen%ing limb o loop
o Nenle
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-hiaSi%e iuretic inhibit a:(>l- pump in the %ital tubule
-Al%oterone antagonit( Potaium &paring iuretic O work
in the collecting %uct
- T-e 3oal 9P in CD is 1'0>0
- ACEi8s and AR9s are reno(rotecti6e in that the low
%own the progreion o nephropath in %iabetic an% non-
%iabetic with proteinuria/
- ACEi8s and AR9s can cause a ?0 rise in SCr and is
not a reason to sto t-era. # ?0 t-en it s-ould
$e discontinued SCr and ! s-ould $e onitored 1(2
4ees a#ter initiatin3
-.er-os-ateia:
1/ Retrict ietar Phophate
/ Phophate Bin%er' Bin% IMeal-timeK phophate in the gut
rom the %iet o onl take them with meal/ ****T-e. don8t4or i# taen a#ter a eal
• Aluminum bae% *Alternagel+- can accumulate an% i
to.ic o not ue% much
• >alcium bae% O Hirst line t-era. Calciu
acetate **"P-osloF P-osl.ra% or Calciu
car$onate *um+ 2>an caue hpercalcemia
• Aluminum ;ree5 >alcium ;ree O E)ensi6e
o **lant-anu"Hosrenol% - mut be chewe%thoroughl/
o **se6elaer"Ren6elaRena3el%/ O a%%e% beneLt
o lo4erin3 LDL
-Secondar. .erarat-.roidis: Calcitriol "Rocaltrol%
i given to > patient with secondar.
-.erarat-.roidis to in-i$it PT secretion / 6t i the
active orm o Jitamin 3/
• %o.ercalcierol *Nectoral+ an%
paricalcitol*emplar+ are newer active Jit %rug
with le hpercalcemia/
• cinacalcet "Sensiar% = calcimimetic to
increae enitivit to calcium an% %ecreae PN/
-@itain D deKcienc.: C-olecalci#erol "D?% an% Er3ocalci#erol "D2%
-.eraleia: 8uall rom renal ailure an%(or %rug that
increae :/ 7uscle 4eanessF $rad.cardiaF c-est ainF
arest-esias an% #atal arr-.t-ias ma occur/
reatment'
• @ Calciu to tabiliSe the car%iac tiue
• lucose and nsulin to %rive : into cell
• sodiu ol.st.rene sul#onate "a.e)elate% i a
cation e.change rein given orall or rectall/ Rectal
preerre% in emergenc ituation/ &i%e DTect'
auea5 Jomiting5 Constiation5 Fo o Appetite/
• Loo Diuretics
-7eta$olic Acidosis: . with o%ium bicarbonate or
o%ium citrate *Bicitra+
Coon: dru3s t-at need dose adustents in renall.
iaired: acclovir5 valacclovir5 amphotericin5amanta%ine5 5 Allopurinol5 aminiglcoi%e5 aSole antiungal5
antiarrhthmic5 aStreonam5 colchicine5 %abigatran5 FMWN5
macroli%e5 uinolone5 metocloprami%e5 penicillin5
morphine(co%eine5 Maraviroc5 R65 tatin5 &M(MP5
trama%ol5 venlaa.ine5 Solen%ronic aci%/
Dru3s not to use in se6ere renal iairent:
Biphophonate5 %abigatran*Pra%a.a+5 %ulo.etine5
on%aparinu. *Ari.tra+5 glburi%e5 Fithium5 meperi%ine5
metormin5 &A65 nitrourantoin5 potaium paring
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%iuretic5 rivaro.aban *arelto+5 ta%alaLl5 tenoovir5 trama%ol
DR5 voriconaSole 6J/
Dru3s in Pre3nanc.:
- A a general rule5 tr to avoi% all %rug %uring the 1
t
trimeter/
- Pre3nanc. e)osure regitrie are %eigne% to collect
ino rom women who take variou me% %uring pregnanc
an% breatee%ing/
-
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-@a3inal #un3al in#ections: se toical anti#un3als #or
da.s "e) cloitraole%
-Ast-a: n-aled Corticosteroids are 1st line
"$udesonide re#erred% Al$uterol in-aler is used #or
rescue
- .ot-.roidis: ue le6ot-.ro)ine "Cate3or. A%
-.ert-.roidis: PT and 7et-iaole arere3nanc. D PT is used in t-e 1st triester and
7et-iaole is a#ter t-at 9ot- can cause serious li6er
daa3e
Dru3 Re#erences:
A6era3e 4-olesale rices and su33ested retail rices
o# dru3s: Re% Book
Princiles o# uniation: Pink Book rom the >>
PatentsF 7anu#acturin3F ndustr. issues: Pink &heet
Tra6eler8s ealt-: Yellow Book
T-eraeutic eBui6alence: Erange Book, publihe% b the
;A >DR*>enter or rug Dvaluation an% Reearch+
Clinical Trials: >linicaltrial/gov b the national intitute o
health
Core-ensi6e Patient n#oration: Me%linePlu5 ;A5>>
Natural 7edicines: atural Me%icine >omprehenive
atabae an% atural &tan%ar%
Pre3nanc.Lactation: Breatee%ing' A gui%e or the
me%ical proeion5 Brigg5 Factme%5 Microme%e.5 Nale5
>>
Pediatrics: AN;&5 Microme%e.5 Narriet Fane5 Pe%iatric
oage Nan%book5 eoa.5 elon5 >>5 Proeional>olleague
@ Dru3s: riel5 ing5 Package 6nert5 Microme%e.5 AN;&
Dru3 D: 6%ent-A-rug5 Microme%e.5 ;act an% >omparion5
>lin Pharm etc//
7edication Sa#et.: Me%watch *A%vere Reaction+ an%
6ntitute or &ae Me%ication Practice *6&MP+
Horei3n Dru3 D' Martin%ale5 microme%e.
n#ectious Disease:
-Qram Poitive &tain Purple(Blue5 Qram egative &tain Pink
-Breakpoint' level o M6> at which the bacteria i %eeme%
uceptible or reitant
-Beta Factam *ime-epen%ent+ can be ma.imiSe% b
e.ten%ing the inuion time or giving a continuou inuion
Anti$acterials:
-Aino3l.cosides: *Bacterici%al+
• bin% to ?0S and 50s riboome unit an% interere with
protein nthei
• concentration deendent illin3 an% ost
anti$iotic eIect "PAE%
• Nigh %oe e.ten%e% interval %oing i le nephroto.ic
an% more cot-eTective
99< #or Neuroto)icit. and Ne-roto)icit.
entTo$ra: '(33 "ea 5(10 trou3- 2% F
#or s.ner3. e) 4it- 6anco ea "?('% Aiacin: 15(20 33 "ea 20(?0 trou3- 5%
*%oe bae% on 9
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• amo.icillin : clavulanate *Augmentin+ O rerigerate
upenion
• ampicillin : ulbactam *8nan+
• penicillin J *Eral+ an% Penicillin Q *6J+ O take Pen J
on an empt tomach
• piperacillin : taSobactam *on+ Oanaero$ic
co6era3e and seudoonas
•
na#cillinF o.acillin5 %oclo.acillin *PE+ Iantista-cnK O no renal dose adustin35 i a 6esicant
• $one arro4 suression with long-term ue or
seiures with accumulation
-Ce-alosorins: *bacterici%al+
• ame mechanim a P>
acti6it. a3ainst sta- decrease 4it-
3enerations $ut stre and 3ra ne3
increases
• 1t Qen' ce#aolin "e#olFAnce#%"i6%Fce-ale)in "eQe)%"o% - cover PE
*proteu5 Dcoli5 lebiella+
• n% Qen' ce#uro)ie "Ce#tinFGinace#%"i6o%5
ceotetan *avoi% alcohol+ or ceo.itin *co6er
soe anaero$es+ O more gram negative
coverage than 1t gen/ NPE O *N/;lu5
eieria5 proteu5 Dcoli5 lebiella+
3r% Qen' ce#dinir"Onice#%"o%F ce#tria)one
"Roce-in%"i6%F ce#taidie "Horta%"i6%Fce#odo)ie "@antin%"o% O le taph
an% more trep activit/ More gram negative
acitivit O cover serratia "NPES%
**Ce#taidie co6ers Pseudoonas
4th Qen' ce#eie "7a)iie%"i6% ( bet gram
negative activitF co6ers "NPES% and
SerratiaF Pseudoonas F Acineto$acterF
Citro$acterF Entero$acter "SPACE $u3s%
$th Qen' ce#taroline "TeQaro%"i6% = Bet gram
poitive activit O co6ers 7RSA5 noPeu%omonal coverage
**Ce#tria)one"Roce-in% is t-e onl. one
t-at can $e dosed once dail. t s-ould not
$e used 6ia (site or 4it- calciu
containin3 stuI DOC #or riar.
eritonitis in#ections
-Caraenes: *bacterici%al+
• ame mechanim a P>
Broa% &pectrum againt Qram !(F Anaero$esF
Pseudoonas "e)cet Ertaene%F A7PC
and ES9LS
iienecilastatin "Pria)in%F
eroene "7erre%F ertaene
"n6an%F doriene "Dori$a)%
&i%e DTect' >an caue seiures
ertaene "n6an% can $e dosed once
dail.
-Atreona"Aacta%:
no ra ! acti6it. $ut 3ood #or
Pseudoonas
can $e used in PCN aller3ic atients
-HluoroBuinolones: *Bacterici%al+
• 6nhibit A grae an% topoiomerae 6J
concentration deendent illin3
• ciroQo)acin "Ciro or cipro%e. *otic+%F
le6oQo)acin "Le6aBuin%F o)iQo)acin
"A6elo) or Jigamo. *ee++F oHo.acin *;lo.in
*otic++
• >ipro an% Fevo have Peu%omonal coverage5 not
Mo.i
• mo.i cover ome anaerobe
At.ical Co6era3e
Le6o and 7o)i reerre% to a the Uresirator.
H8sV becaue the have ore StrePneuo co6era3e
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**99< #or Tendon nQaationRuture
and a. e)acer$ate uscle 4eaness in
7.ast-enia ra6is Pre3nanc. D #or
cartila3e daa3e
T rolon3ationF Q6 upet5 Nepatoto.icit5
seiuresF peripheral neuropath5
**-.o3l.ceia "soeties #atal%F
eri-eral neuroat-.F and-otosensiti6it.
>ipro Eral &upenion houl% not be given via
ee%ing tube b(c it a%here to the tubing/
C-elation 4it- cations o eparate %oe
rom thing like antaci%5 mutivaitmin etc//
Ciro C 4it- tianidine "GanaQe)%
-7acrolides: *Bacteriotatic+
• bin% to $)& riboome to inhibit protein
nthei
ait-ro.cin "G(PaF Git-roa)%F
er.t-ro.cin "Er.t-rocin%F clarit-ro.cin
"9ia)in%
At.ical co6era3e
T rolon3ationF Q6 upet5 Nepatoto.icit
er.t-ro.cin and clarit-ro.cin are
in-i$itors o# ?A'
ait-ro.cin -as less dru3(dru3
interactions
(Tetrac.clines: *Bacteriotatic+
• bin% to ?0s riboome to inhibit protein nthei
tetrac.clineF do).c.clineF inoc.cline
P-otosensiti6it.
Pre3nanc. Cate3or. D "teet- discoloration
and seletal 3ro4t- suression%
do).c.cline @ to PO is 1:1
C-elation 4it- cations
do not use in c-ildren + .rs old
do). doesn8t need renal dose adustin3
-Sul#onaides: "9actericidal 4-en S7XT7P are used
to3et-er%
inhibit the olic aci% pathwa
MR&A coverage
9actri and Setra
Al4a.s in a 5:1 "S7X:T7P%
C: Pre3nanc.F Sul#a Aller3.5 breatee%ing5
anemia %ue to olate %eLcienc5 marke%
renal(hepatic %ieae5 inant month
Side EIects: P-otosensiti6it.F Sin
reactionsF -.eraleiaF -.o3l.ceiaF
cr.stalluria "tae 4it- +o% o# 4ater
@ to PO is 1:1
**n-i$itor o# 2C> so caution 4it- 4ar#arin
[email protected] "@ancocin%: *Bacterici%al+
• block glcol-pepti%e polmeriSation o the cell
wall
• can be ue% orall or >/ iT 1$-$))mg C6 .
1)-14 %a
• &i%e eTect' Ne-roto)icit.F Ototo)icit.5
inuion r.n(re%man n%rome*hpotenion5
Huhing5 chill5 etc//- o give 3) min inuion or
each $))mg+
• rough' 1$-)mcg(ml or pneumonia5
en%ocar%iti5 oteomeliti5 meningiti5 an%
bacteremia, 1)-1$ or other/
7RSAF PRSPF Enterococcus "Not @RE%
-Tela6ancin "@i$ati6%: *Bacterici%al+
• %erivative o vancomcin
red an s.ndroeF ne-roto)icit.F T
rolon3ation
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-Lineolid "G.6o)%: *Bacteriotatic+
bin% to 3& riboomal RA o the $)& ubunit
C 4it- 7AO in-i$itors or 4it-in 2 4ees
use o# t-e
@ to PO 1:1 "M003 12%
7RSAF PRSPF @RE
• aociate% with bone marrow uppreion an%
peripheral neuropath
-Dato.cin "Cu$icin%: *Bacterici%al+
o %epolariSe cell membrane
o 7RSAF PRSPF @REo &i%e DTect' 227.oat-. and increased C o **Do not use #or neuonia $c its inacti6ated
$. sur#actanto can cause #alse ele6ations in NR 4it- no
increased $leedin3o coati$le 4it- NS $ut not D5<
(Ti3ac.cline "T.3acil%:
o relate% to tetraccline
o 99e%inir*Emnice++5 Drthomcin
Do Not Re#ri3erate: >e%inir5 ASithromcin5 >larithromcin5
>lin%amcin5 >iproHo.acin5 FevoHo.acin5 o.ccline5
;luconaSole5 JoriconaSole5 lineSoli% *vo.+5 &M(MP
SeciKc Disease Treatents 4it- Anti$iotics:
Sur3er. Pro-.la)is:
• 8uall initiate% within ") minute beore the
proce%ure unle ;C or Janco i ue% then it 1)
min/ beore/
• &econ% %oe ma nee% to be given or longer
proce%ure or i there i igniLcant bloo% lo/
• 1st or 2nd en Ce-alosorins uuall given
unless PCN aller3. t-en @anco i ue%/
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• # $o4el arts are in6ol6edF need anaero$ic
co6era3e suc- as ce#otetanF ertaeneF or
Roce-in 4it- Hla3.l
7enin3itis:
7ost coon at-o3ens: &trep/Pneumo5 N/;lu5
eieria Meningiti5 an% Fiteria T) 4it- Ce#tria)one "Roce-in% ! @anco.cin
usuall. #or (1' da.s ! de)aet-asone
Hor iunocoroised or 50F add Aicillin
#or Listeria co6era3e
# 9eta Lacta Aller3.: C-lora-enicol ! @anco
! 9actri "Listeria%
n#ecti6e Endocarditis:
• 8uall rom &taph5 &trep5 or Dnterococcu
**Prost-etic 6al6e E usuall. #ro Sta- and
reBuires addition o# Ri#ain
entaicin o#ten used #or s.ner3.F ea ?('
c3lF trou3- 1F do not use e)tended(inter6al
dosin3
usuall. '(M 4ees o# treatent 4it- a PCNF
Ce-alosorin "ce#tria)one%F or @anco
Pro-.la)is #ro dental rocedure: **Ao)icillinF clinda.cinF or ait-ro.cin ?0(M0
in $e#ore rocedure
RT:
Acute Otitis 7edia: suall. use **i3- dose
ao)icillin >033da. or Au3entin
7ost are caused $. 6iruses
LRT:
Acute 9ronc-itis: suall. @iral O Antituive an%
Broncho%ilator 8e%
CAP: uuall caue b &trep/ Pneumo5 N/;lu5 or M/
>atarrhali/ suall. use a acrolideF or $eta(
lacta ! acrolideF or a H #or 5(10 da.s
AP:
Earl. Onset "5da.s%: 8uall ame bug a>AP
Late Onset "5da.s%: 8uall 7DR pathogen
*MR&A5 Peu%omona+/ . or 7-# %a unle
peu%omona then it 14 %a/
Tu$erculosis:
• caue% b mcobacterium tuberculoi
• high contagiou
• iagnoe% with uberculin kin tet *aka PP+/
Fook or raie% area with 4#-7 hr/Fatent uuall treate% with riampin an%
ioniaSi%
# acti6eF T) 4it- RPE re3ien 4-ic- is
Ri#ainF soniaide "N%F P.rainaideF
and Et-a$utol
Direct o$ser6ed t-era. "DOT% i poible to
make ure the take all the me%
• Patient houl% be in isolatedF ne3ati6e
ressure roos• Recommen% .rido)ine "@it 9M% to prevent
neuropath with isoniaid "N%
• Ri#ain and N taken on an et.
stoac-
Et-a$utol can cause otic neuritis
.rainaide C in acute 3out and -eatic
daa3e
N can cause -eatic daa3e too
ri#ain can cause red(oran3e secretions
and stain contacts
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RPE7 i# resistant to ot-ers
"7/o)iQo)acin%
ntra(A$doinal n#ections:
Priar. eritonitis: motl rom stre and enteric
3ra ne3ati6e rods "PE% T) 4it- ce#tria)one
"Roce-in% #or 5( da.s
&econ%ar peritoniti rom traumatic event *urger5ulceration5 ichemia5 obtruction+ uuall trep5 gram
neg/ ro% an% anaero$es
Sin and So#t Tissue n#ections:
Cellulitis: ATect all laer o the kin an% uuall
caue% b Sta- Aureus or Stre P.o3enes
• abcee nee% inciion an% %rainage *6Z+
Purulent"us%: reBuires 7RSA co6era3e
non(urulent: "eQe)%
• 6J antibiotic ma be necear or evere inection
T:
• more common in emale b(c o horter urethra
all ale T8s are considered colicated
&ign(&mptom' %uria5 urgenc5 reuenc5burning5 nocturia5 uprapubic heavine5 hematuria 5
*ever i uncommon+
Poitive 8rinali when there i .uria(pu in urine
*poitive leukocte eterae5 or 91) WB>(ml+ an%
$acteriuria 91)$ or uncomplicate% or 91)3 or
complicate%/
PhenaSopri%ine*ASo+ oten given or urinar pain
*%uria+ O can cause redoran3e urine/ 7a) o# 2
da.s $c .ou don8t 4ant to co6er s.tos t-at
can 4orsen
As.toatic "no #e6er or urinar. s.tos%
does not need to $e treated unless re3nant
t-en .ou treat #or da.s
Nitro#urantoin "C i# CrCl M0 lin% #or
uncolicated T or S7XT7P
Can use H #or colicated T or S7XT7P
CDiJcile:
• 8uall rom Antibiotic use eseciall. Clinda.cin5
Ampilcillin5 >ephaloporin5 an% ;C/
Reo6e oIendin3 a3ent
a6oid anti(otilit. a3ents due to ris o# to)ic
e3acolon
• wah han% with oap an% water to prevent
tranmiion5 alcohol %oe not kill the pore
T): 7etronidaole 5003 TD *mil%-mo%+ or Oral
@anco 1$mg C6 *mo%-evere+ or both #or se6ere
colicated 10(1' da.s 4it- Qa3.l $ein3 @ L%a.omicin in clinical trial how lower recurrence
rate
Tra6eler8s Diarr-ea
9acterial "+0%: enteroto)i3enic EColiF
Ca.lo$acter euniF s-i3ellaF salonella
• Jiral ometime
• ProtoSoal ometime T): HluoroBuinolones are t-e t-e DOC lus
loeraide
.dration is 6er. iortant
ro-.la)is is not recoended $ut can use
Peto(9isol to reduce incidence
No He6er and No $lood in stool can use
loeraide: '3 t-en 23F a) 1M3da.
Hun3al n#ections:
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A-otericin 9: *ungici%al+
• $inds to er3osterolF altering cell membrane
permeabilit5 cauing cell %eath
• >ome in con6entional an% liid #orulation
*Abelcet5 Ambiome+
99< t-at edication errors occur due to t-e
i)(u $et4een con6entional and liid
#orulation dosin3 diIerences Con6entional-as a a) dose o# 1533da.
Side EIects: ;ever5 chill5 hea%ache5 malaie5 rigor5
hpokalemia5 hpomagneemia5 22ne-roto)icit.
Liid #orulation reduce t-e ris #or in#usion
reactions and **ne-roto)icit.
# usin3 con6entionalF re(edicate #or in#usion
related reactions 4it-: acetaminophen or &A6
iphenh%ramine an%(or h%rocortione
7eeridine to reduce duration o# ri3ors
Hui% bolue to re%uce nephroto.icit
Hluc.tosine "Anco$on%: *ungici%al+
penetrate into ungal cell an% i converte% to
Huorouracil which compete with uracil5 interering with
ungal RA an% protein nthei
99< to use e)tree caution in renal d.s#unction
and closel. onitor renalF -eaticF and -eatolo3icstatus
Side EIects: 9one arro4 suressionF -eatitisF
ne-roto)ic increae B8 an% &cr
Aoles: *ungici%al an% ungitatic+
decrease er3osterol s.nt-esis an% thu cell
membrane ormation
Hluconaole is t-e DOC #or t-rus- in N6J patient
or non-N6J with mo%erate-evere %ieae/ N.statin
also 3ood #or t-rus- @oriconaole is t-e DOC #or Aser3illus
traconaole "Sorano)%F Quconaole "DiQucan%F
6oriconaole "@HEND%F osaconaole "No)aKl%
etoconaole *iSoral topical5 generic or tablet+
Hluconaole @ to PO is 1:1
@oriconaole s-ould $e taen on an et.
stoac-F osaconaole 4it- #ull eal
@oriconaole C 4it- an. ?A'
su$stratesin-i$itorsinducers t starts 1st
ordert-en is 0 order P so sall dose increases can
-a6e lar3e aIects "ic-aelis enton%
Onl. Hluconaole and @oriconaole enetrate t-e
CNS 4ell enou3- to treat #un3al enin3itis
**All are ?A' in-i$itors
**Side EIects o# all: ncrease LHT8sF T
rolon3ation
Side eIects o# @oriconaolePosaconaole:
**@isual c-an3esF -allucination
traconaole is C in -eart #ailure
Ec-inoCANDns:
o inhibit nthei o B*153+ O - Qlucan o the cell wall/
o DOC #or ost s.steic Candidao Caso#un3in "Cancidas%F .ca#un3in "7.caine%F
ani%ulaungin *Dra.i+o Side eIects: ncreased LHT8s5 hpotenion5 ever5
%iarrhea5 hpokalemia5 hpomagneemia5 rah
o 3ood #or C rusei and 3la$rata tooo all once dail. and no renal adustents
Ter$inaKne "Laisil%: 6nhibit ualene epo.i%ae
&i%e eTect' ncreasedLHT8sF -eadac-e
N.statin: riseo#ul6in "ri#ul6inFris(PE%:
photoenitivit Z pregn/cat
@iral n#ections :
nQuena:
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8/8/2019 NAPLEX Random Notes 68 Pages
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Neuraidase n-i$itorso %ecreae the releae o viral particle
o s-ould $e used 4it-in '+ -ours o# illness
onseto Oseltai6ir "TaiQu% = T): 53 9D ) 5
da.s Pre6ention: 53 9D ) 10 da.so TaiQu can cause 6oitin3
o anamivir *RelenSa ikhaler+ O BBWbronchopam rik
o amanata%ine
Anti6irals #or eres Sile) @irus "S@%F
@aricella Goster @irus "@G@% and C.toe3alo6irus
"C7@%:
o ac.clo6ir "Go6ira)%F 6alac.clo6ir "@altre)%F
6al3anciclo6ir "@alc.te%F amciclovir * ;amvir+
ganciclovir *>tovene+5 ci%oovir *Jiti%e+5 ocarnet
*;ocavir+o **6al3anciclo6ir -as a 99< #or
.elosuression and
carcino3enicterato3enic eIects **Preared
in 6ertical air -oodo ci%oovir ha a BBW or nephropatho valganciclovir i taken with oo%
o 3anciclo6ir and 6al3anciclo6ir are t-e DOC #or
C7@o i# resistant to ac.clo6ir .ou 4ill $e resistant
to 6alac.clo6ir and #aciclo6iro T-era. #or S@ s-ould $e 4it-in 2' -ours o#
s.tos and t-era. #or @G@ s-ould $e
4it-in 2 -ours o# ras-
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8/8/2019 NAPLEX Random Notes 68 Pages
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• 6 li6e parenteral vaccine *MMR5 Jaricella5 oter5 an%
ellow ever5+ or live intranaal inHuenSa *FA6J+ are not
a%minitere% at the ame viit5 then searate t-e
$. ' 4ees
• 6ncreaing the %oing interval between multi-%oe
vaccine %oent %ecreae eTectivene but ma %ela
more complete protection/
•
ecreaing the %oing interval between multi-%oevaccine ma interere with antibo% repone an%
protection/
• &i%e eTect'
Focal O pain5 welling5 re%ne at ite
&temic O ever5 malaie5 malgia5 hea%ache5
lo o appetite "LA@ can cause runn. nose% Allergic or Anaphlactic O Nive5 %iVcult
breathing5 hpotenion5 welling o mouth an%
throat/ &evere reaction >6 ubeuent %oe o
the vaccine/ All provi%er mut have emergencprotocol an% upplie to treat anaphla.i/
**A$solute C8s to li6e 6accines "e) GosterF
@aricellaF LA@ "Hluist%F and 77R%: Pre3nanc.
and unosuression
• Tda: Pregnant women houl% receive %ap with each
pregnanc5 mot eTective in week 7-3"/ Alo5 a one-
time %oe or thoe "$ or 9"$ who have cloe
contact with chil%ren who are le than " month/
%ap i 6M/
• Pneuo6a) "PPS@2?%: All patient 9 "$ . 1 %oe5
1!-"4 who moke or have athma5 -"4 who have
chronic illnee/
Hlu: # a erson can eat li3-tl. cooed e33s or i#
t-e. onl. e)erience -i6es a#ter eatin3 e33(
containin3 roductsF t-en t-e. can recei6e
inacti6ated Qu 6accine $ut s-ould $e o$ser6ed
#or ?0 in a#ter adinistration nacti6ated #or
e6er.one M ont-s 7ild(illness is not a C to
inQuena 6accine LA@ onl. #or -ealt-. eole2('> .ears old
@ar6a)Gosta6a)77R@ "oster and c-iceno)%
s-ould not $e 3i6en to an.one 4it- a true
3elatin or neo.cin aller3. Store 6accine in
#reeer and diluent in #rid3e or roo te
• NPJ vaccine *Qar%ail5 >ervari.+ or male *to re%uce
genital wart or anal cancer+ or emale !-" r ol%/
*3 oe+/ Male onl ue Qar%ail/
7 is 3i6en into t-e deltoid uscle 4it- a 1Vneedle "4oen 200l$s and en 2M0 l$s need
1 and WV% SC is 3i6en into t-e #att. tissue
a$o6e t-e trice 4it- a 5+V needle PPS@2? is
SC or 7 $ut PPS@1? is 7 onl.
**LA@ F @aricellaGoster and 77R are li6e
**SC is 6aricellaF GOSTER "Gosta6a)% and 77R
**@aricella and Goster are stored in t-e #reeer
C-ildren 3et DTa and adults 3et Tda
***CDC does not recoend usin3
acetaino-en $e#ore a 6accine $c it candecrease iune resonse
Ne6er i) 6accines to3et-er
n HloridaF -aracists 3i6e nQuenaF S-in3lesF
and Pneuococcal @accines
Tra6eler8s 7edicine:
• ello4 9oo or travel inormation
• 7alaria paraite protection i provi%e% b oral eds
rior to tra6el se DEET Plamo%ium Jiva. caue"$0 o cae in 6n%ia/ Plasodiu #alciaru is t-e
ost deadl.Treatent:
o 7eQoBuine "Lariu%: Nigh reitance an%
man pchiatric an% neurologic i%e eTect/
Ence weekl/ &tarte% 1- week beore an% 4
week atero C-loroBuine: Ence weekl/ &tarte% 1- week
beore an% 4 week ater
o Ato6aBuonePro3uanil "7alarone%:Started 1(2 da.s $e#ore travel an% or 7
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%a pot travel/ Well tolerate% but C in
re3nanc. Ence ail/o PriaBuine: Ence %ail Started 1(2 da.s
$e#ore travel an% or 7 %a pot travel C in
re3nanc. CDC reBuires screenin3 #or
MPD deKcienc. $e#ore use
• 7enin3ococcal 6accine: reBuired #or Saudi Ara$ia
Alo prevalent in the meningiti belt o Arica/ 7enactra
* %oe or !-3 month5 1 or -$$ r+5 7en6eo *-$$
r/+5 7enoue *$" an% ol%er+/ (10 da.s #or
rotecti6e anti$odies
• ello4 He6er @irus @accine: or certain part in ub-
aharan Arica an% &outh America/ Watch or allergie to
egg an% gelatin/ 6t i a live vaccine o %ont ue in
immunocompromie%/ A&A an% &A6 houl% not be
ue% b(c o increae% rik o blee%ing/
T.-oid He6er: bacteria prea% through conumption o oo%(water contaminate% with ece or e.ual contact/
se sa#e #ood and 4ater recautions Jaccine i
@i6ito# 9ernaF ' casulesF 1 e6er. ot-er da. taen
4it- cool liBuid or 7 s-ot 2 4ees $e#ore
e)osure
Altitude Sicness: acetaolaide "Diao)
SeBuels% C in sul#a aller3.
nternational certiKcate o# 6accination "ello4
Card%
@:
• CD'! counts are t-e aor la$orator. indicator
o# iune #unction and need #or ro-.la)is
a3ainst oortunistic in#ections
@(1 RNA "@iral Load%: ost iortant indicator
o# resonse to anti(retro6iral t-era. "ART%
8e% to help ae %ieae progreion an% poible
%rug reitance/ 7easured at $aseline and t-en on
a re3ular $asis t-erea#ter
&prea% through $loodF seenF an% 6a3inal
secretions Alo prea% through vertical tranmiion
durin3 re3nanc.5 at $irt-5 or $reast#eedin3
**ART is recoended in ALL @(in#ected
atients
**Need ad-erence o# >5 or 3reater to $e
eIecti6e lon3(ter
P8s and sta6udine aociate% with
liod.stro-.lioatro-. an% #at
redistri$utionlio-.ertro-.
• Diarr-ea i a common i%e eTect o AR/
Cro#eleer"Hul.aB% i approve% or non-inectiou
%iarrhea in a%ult patient on AR/
NRT8s: *A$aca6irF lai6udineF etricita$ineFteno#o6ir5 %i%anoine5 tavu%ine5 Si%ovu%ine+
**All -a6e 99< #or lactic acidosis and
-eatoe3al. 4it- steatosis"#att. li6er%
Susend treatent i# t-ere is lactic
acidosis or -eatoe3al. 4it- steatosis
a$aca6ir: 99< #or se6ere -.ersensiti6it.
reaction 7ust test #or LA(9*501
iagen *abacavir+DpSicom *abacavir : lamivu%ine+ O Ence ail
etricita$ine: 99< #or e 9 e)acer$ation
once discontinued or 9@ resistance Can
cause -.eri3entation o# soles and #eet Dmtriva *emtricitabine+ **Tru6ada "etricita$ine ! teno#o6ir%: Once
Dail. 22Atrila "etricita$ine ! teno#o6ir !
e#a6iren%: Ence ail/ ake on empt tomach/
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8/8/2019 NAPLEX Random Notes 68 Pages
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lai6udine: 99< #or e 9 e)acer$ation once
discontinued or 9@ resistance 99< to not
use Ei6ir(9@ #or @"contains lo4er dose o#
lai6udine% Pre#erred in Pre3nanc. Dpivir *lamivu%ine+ DpSicom *abacavir : lamivu%ine+
teno#o6ir: 99< #or e 9 e)acer$ation once
discontinued or 9@ resistance Hanconi
s.ndroeF renal #ailureF osteoalaciaF
decreased $one densit. Jirea% *tenoovir+ Tru6ada "teno#o6ir ! etricita$ine% Atrila "teno#o6ir ! etricita$ine ! e#a6iren%
i%ovu%ine' 99< #or -eatolo3ic to)icit.
"neutroenia and aneia% and .oat-.
Pre#erred in re3nanc.
NNRT8s *E#a6iren5 %elavir%ine5 etravirine5 nevirapine5
rilpivirine+
• 22All can caue S;S"ras-% and eatoto)icit.
• **n-i$itor o# 2C>F 2C1>F and ?A'F and
stron3 NDCER o# ?A' / an. dru3
interactions
• e#a6iren "Susti6a%:M00 3 dail. on et. stoac- CNS side
eIects "6i6id dreasF dro4s.F iairedconcentration% and s.c-iatric side eIects
"deressionF aranoiaF aniaF suicide%
CNS side eIects usuall. resol6e in 2('
4ees Pre3nanc. D
• Atripla * tenoovir : emtricitabine : eavirenS+
Protease n-i$itors: *ataana6irF daruna6irF ritona6irF
loina6irritona6irF oamprenavir5 in%inavir5 nelLnavir5
auinavir5 tipranivir+
**All stron3 N9TORS o# ?A' / an. dru3
nteractions
**Side EIects: .er3l.ceiaF nsulin ResistanceF
Dia$etesF #at aldistri$utionF -eatitisF iune
reconstitution s.ndroe
• ataana6ir "Re.ata+' PR interval prolonging5
-.er$iliru$ineia "aa U$anan6irV%5 rah5 tae
4it- 15 L o# 4ater to reduce ne-rolit-iasisNeeds AcidFA6oid acid suressants $c t-e. can
decrease le6elsF tae 4it- #ood and 4ater "1st
line%
daruna6ir "Preista%: Rah5 Sul#a Aller3. "1st line%
• ritona6ir "Nor6ir%: PR prolonging
loina6irritona6ir "aletra% : PR prolonging5
Pre#erred in Pre3nanc.
nte3rase n-i$itors: *Ralte3ra6ir5 %olutegravir5
elvitegravir+
ralte3ra6ir "sentress%: '003 9D
Husion n-i$itor: en#ur6itide "Hueon%
local inection site reactions in 100 o# atients
CCR5 anta3onist: ara6iroc "Selentr.%
onl. 4ors #or CCR5 t.e @ so ust $e
screened $e#ore usin3
BBW or hepatoto.icit
&i%e DTect' 8R65 ever5 rah5 muculokeletal
mptom5 %iSSine
Pre3nanc.: Co$i6ir "lai6udine ! ido6udine% !
aletra "loina6irritona6ir% OR ataSanavir : ritonavir OR nevirapine *R6+
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Pre(E)osure Pro-.la)is: Tru6ada 1 ta$ PO D
Occuational ost(e)osure ro-.la)is ( Tru6ada !
Ralte3ra6ir "sentress% ) ' 4ees
Oortunistic n#ections:
PCP "CD'200%: Pro-.la)is: S7XT7P T):
S7XT7P !( corticosteroids
To)olasa 3ondii "CD'100%: Pro-.la)is:S7XT7P T): P.riet-aine ! sul#adiaine
7.co$acteriu A6u "CD'50% Pro-.la)is:
Ait-ro.cin T): Ait-ro.cin ! Et-a$utol
C7@ = @al3anciclo6ir
Cr.tococcal 7enin3itis: Liosoal
A-otericin 9 ! Hluc.tosine
eatitis Li6er Disease:
• eatic Ence-aloat-.: ;rom Ammonia Buil%upT): Lactulose or ria.imin *ia.an+ : 22lo4 rotein
diet
• Ascites: ;uroemi%e an% &pironolactone
eatitis 9: Jaccine preventable/ 8uall treat or 1
ear/T): e3.lated inter#eron "Pe3as.s% : 99< #or
an. t-in3s e)acer$ate or cause autoiune
disordersF in#ectious disordersF C@AF deression
"20% **e3.lation increases -al#(li#e #or once
4eel. dosin3 NRT8s teno#o6ir "@iread%F* lai6udine
"Ei6ir 9@% enteca6ir"9araclude%
eatitis C' ot Jaccine Preventable/ 3 %iTerent
tpe *Qenotpe 155 an% 3+/ 1 i the mot %iVcult to
treat an% treate% or 4# week/ Qenotpe an% 3
treate% or 4 week/
T): e3.lated inter#eron "Pe3as.s or Pe3intron%:
99< #or an. t-in3s *&ee above+ Ri$a6irin: 99< #or terato3enic SE:
-eol.tic aneia Protease n-i$itor: "e) $oceri6ir%: onl. #or
3enot.e 1 so#os$u6ir "So6aldi%: in-i$its C@ NS59 RNA
ol.erase
Dia$etes:
• pe 1' Autoimmune %etruction o beta cell in the
pancrea
• pe ' 6nulin reitance or relative %eLcienc
eA: "2+ ) A1C% = 'M
Dia3nosis: Classic si3ns
"Pol.uriaol.disiaol.-a3ia4ei3-t loss% !
A1C M5 or HP 12M or Rando 200 or
2-r 3lucose 200 a#ter 5 3ra OTT Coon dru3s t-at alter 3lucose:
Nperglcemina- Corticosteroids 5
hiaSi%e(Foop iuretic5 &tatin5 ;C5 Protease
n-i$itorsNpoglcemia' ;C5 Forcaerin *Belvi atiet
%rug+
Treatent oals: ADA: A1C Pre(Prandial
0(1?0 3dl Post(Prandial: 1+0 3dl AA>D' A1> "/$0 Pre-
Pran%ial 11) mg(%l Pot-Pran%ial' 14) mg(%l• .' Fiettle Mo%iation' Weight Fo5 iet5 D.ercie5
wait circumerence 3$ or emale an% 4) or
male plu rug
• ephropath &creening' *Annuall+
microalbuminuria' 3)-!! macroalbuminuria' 93)) Add ACEi or AR9
• Retinopath &creening' *Annuall+
• ;oot &creening' *Annuall+
All dia$etics s-ould insect t-eir #eet dail.
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T.e 2 Dia$etes Treatent: 7et#orin is t-e
initial treatent # not at 3oal in ? ont-sF add
a second oral a3ent # not at 3oal ? ont-s #ro
t-enF add a ?rdF usuall. $asal insulin
Dru3s:
9i3uanides: *Metormin+
2%ecreae% hepatic glucoe pro%uction5 2increaeinulin enitivit5 %ecreae aborption o glucoe
et#orin "luco-a3eF luetaF Hortaet%
";anuet -as sita3litin%
**99
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SLT2 n-i$itors:
cana3liQoin "n6oana%
SE: Heale 3enital .cotic in#ectionsF T8s F
-.eraleiaF increased urination
Pramlinti%e *&mlin+' Amlin analogue that increae atiet5
prevent glucagon ecretion ater a meal5 low gatric
empting/ aken with inulin at mealtime with eparate
incloet+ ' Doaine a3onist t-at 4ors
in CNS to increase insulin sensiti6it. ake with oo% to
%ecreae nauea/
cosele6a "6 with Q9$))/ &ome me% that nee% to
be taken 4 hour beore a%minitration o thi' &ulonlurea5
Phentoin5 levothro.ine5 oral contraceptive
nsulin:
***All insulins -a6e a concentration o# 100
unitsl e)cet uulin R (500 4-ic- is 500
unitsl
**Consider startin3 T.e 2 4it- insulin i#
A1C10 or 9?00• Raid(Actin3: asart "No6olo3(ovolog ;le.pen+5
lisro "ualo3(Numalog wikpen +5 3lulisine
"Aidra( Api%ra &olotar+ ' 2+ da.s
Re3ularS-ort Actin3: "uulin RF No6olin R%: ?1
da.s"% and '2 da.s"N%
NP or nterediate: uulin NF No6olin N hi
i clou% an% can be mi.e% with Rapi% an% &hort
acting inulin/ Alwa mi. clear beore clou%/ 2+"%
and '2"N%F ens 1'
Lon3 Actin3: 3lar3ine "Lantus% 2+ da.sF deteir
"Le6eir% '2 da.s
NP to 3lar3ine: # NP is once dail.F 1:1 TDD
# NP is 9DF t-en reduce dail. dose 20
NP to deteir: 1:1 TDD
Hor T.e 1: 0M units3da. "Total Dail. Dose%
9asal(9olus: 50 TDD $asalF 50 TDD $olus
"di6ided e6enl. #or ? eals%
NP(re3ular: 2? TDD NPF 1? TDD re3ular "$ot-
di6ided 9D%
Hor countin3 car$s: nsulin to car$o-.drate ratio:
500TDD / 3ras o# car$ co6ered $. 1 unit
raid(actin3 '50TDD / 3ras o# car$ co6ered $. 1 unit
re3ular(actin3
** Correction #actor: "9lood lucose No4 ( 9lood
lucose Tar3et% Correction #actor
>orrection actor i rule o 1#)) or rapi%-acting inulin *>;=
1#))(+ or rule o 1$)) or regular-acting 6nulin *>; =
1$))(+
Hor T.e 2: 02 units3da. = usuall. lon3(actin3 in
t-e ornin3
.o3l.ceia: "9 0 3dl%
o S.tos: >onuion5 weating5 tachcar%ia5
hunger5 blurre% viion/ 229eta $locers can as
t-e s.tos e)cet s4eatin3 and -un3er
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o Treatent: 1$-) gram o glucoe * 3-4 glucoe
tab5 1 erving glucoe gel5 4 oS orange 6 with ula allerg an% Q6 obtruction/
&D' anore.ia5 oligopermia5 rah5 olate %eLcienc5
ellow-orange colore% urine5 impaire% olate
aborption/
minoccline' &D' photoenitivit
leHunomi%e *Arava+' Nepatoto.ic5 Pre3nanc.
Cate3or. X toactinib *el
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inQi)ia$ "Reicade%: "@%n#usion reactions and
dela.ed -.ersensiti6it. reactions i6en onl. in
co$o 4it- et-otre)ate 3oliua$ "Sioni%: Su$ i6en onl. in
co$o 4it- et-otre)ate
9iolo3ic non(TNH D7ARDs:
ritu)ia$ "Ritu)an%: Deletes CD20 9 Cells 99<
#or se6ere#atal in#usion reactionsF ras-es etc
i6en in co$o 4it- et-otre)ate a$atacet "Orencia% tociliua$ "Actera%: 99< #or serious
in#ections Can cause -eatoto)icit.
S.steic Luus Er.t-eatous "SLE%:
• Auto-antibo%ie orm that %amage tiue/ here i
Hare-up with perio% o remiion/ 9utterQ. ras- on ace tpical
renal "Ne-ritis in 50 o# atientsF
-eatolo3icF and neurolo3ic ani#estations%
.dralaine can cause dru3(induced SLEF
***#ound $. ANA test
Treatent:o Anti-malarial' -.dro).c-loroBuine "PlaBuenil+ or
chlorouine, ma take " month to worko Prednisoneo .co-enolate o#etil "CellCet%: 99< #or
increased ris o# in#ectionF sin cancersF
con3enital al#orations &D' pain5 tachcar%ia5
electrolte abnormalitie *hperkalemia5
hpomagneemia5 hpocalcemia+5 hpotenion5
hpertenion5 hpercholeterolemia5 %iarrhea5
e%ema5vomiting5 tremor5 acne etc//o $eliua$ "9enl.sta% : 6gQ1-labm%a antibo% that
prevent urvival o B cell b blocking the bin%ing oB lmphocte timulator protein *Bl&+
7ultile Sclerosis:
• 6mmune tem attack melin heath on
neuron in the brain an% pinal cor%
• unknown caue
7ost atients e)erience eriods o#
disease 4it- inter6als o# reission
Treatent:
intereron beta %rug
3latiraer acetate "Coa)one%
nataliua$ "T.sa$ri%: 3i6en e6er. ' 4eesF can
cause ro3ressi6e ulti#ocal
leuoence-aloat-. Man %rug ue% or mptom control can woren
other mptom
Celiac Disease:
une resonse to 3luten Diarr-eaF
a$doinal ainF $loatin3F 4ei3-t loss
3luten is in 4-eatF $arle.F and r.e
n an. #oods and an. dru3
Ue)ciientsV T-e actual dru3 doesn8t
contain 3luten
>heck or e.cipient on aca3e insert an%
look or the 4ord Ustarc-V he tarch willeither be corn5 potato5 tapioca5 or wheat/ 6 it
%oent a which tarch then call the
manuacturer to Knd out i# t-e starc- is
4-eat You can alo tr the webite IQluten
;ree rug an% the
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• Dlevation in 4 will inhibit ecretion o &N via
negative ee%back loop
• 3 i more potent than 4
• 6t important to meaure #ree T' level ince it i the
acti6e #or
.ot-.roidis:
• 4ill -a6e -i3- TS and lo4 T' "as-ioto8s is
t-e ost coon cause%
• T): le6ot-.ro)ine *&nthroi%5 Fevothroi%5 Fevo.l+
= Pre3nanc. Sa#e
• liothronine *35C.toel+5 InaturalK throi%
*porcine 3 an% 45 Armour hroi%+
• rug >aue' Amio%arone5 6ntereron
• Tae on an et. stoac- ?0 in $e#ore
$rea#ast 4it- a #ull 3lass o# 4ater
• @ to PO is 1:2
• S.tos:
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PP8s can increase #racture ris
Ensure adeBuate Calciu and @itain D 4it- an.
treatento calciu citrate "Citracal%: ?153 eleentalF
lar3er illo calciu car$onate "OscalF Tus%: acid deendentF
5003 eleentalo c-olecalci#erol "@it D?% re#erred M00 #or 0F
+00 #or 1!
Treatent: 9is-os-onates "1st line%: alendronate
"Hosaa)% = 0 3 4eel.F risendronate
"ActonelFAtel6ia%F i$andronate "9oni6a%F
oledronic acid "Reclast%(.earl. in#usion HDA
4arnin3 to sto a#ter ?(5 .ears due to
eso-a3eal cancerF osteonecrosis o# a4F and
at.ical #eur #racture Tae Krst t-in3 in t-e
ornin3 $e#ore eatin3 or drinin3 an.t-in34it- M(+ ounces o# 4ater Sta. uri3-t #or at
least ?0 inutesF M0 in #or 9oni6a
ralo)i#ene "E6ista%: SER7F o#ten used in 4oen
at ris o# $reast CA SE: ot Qas-esF 6a3inal
$leedin3F aenorr-ea etc teriaratide "Horteo%: uan PTF #or -i3- ris
#racturesF Su$ dail.F a): 2 .ears denosua$ "Prolia%: anti$od. to RANL
orone T-era.:
Hor 4oen: "orone Relaceent%
ecreae% etrogen at menopaue caue high FN
which can reult in hot Hahe an% night weat/ Alo
can caue vaginal %rne5 painul e.5 moo% change
etc// se t-e lo4est ossi$le dose #or t-e s-ortest
aount o# tie Estro3en can $e used to re6ent ost(
enoausal osteoorosis $ut not treat it
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Contracetion:
Pro3estin(Onl. Pills "POPs%
Estro3en and Pro3estin Pills "COCs%
&D' auea5 breat ten%erne(ullne5
bloating5 weight gain5 elevate% BP/ Can tae at
ni3-t or $edtie to reduce nausea
Serious ad6erse eIects: **Clottin3,
6ncreae% rik rom soin35 age5 N5%iabete5 long be%ret5 overweight5 an% an.
t-at contain drosirenone "Ort-o(E6ra
Patc-F AGF ainF 9e.aF OcellaF etc%
9est to a6oid t-ese
Drosirenone acts as a otassiu sarin3
diuretic T-is is 4-. 4oen lie it $ecause
it decreases $loatin3 and 4ei3-t 3ain $ut
-i3- ris #or clottin3
Dru3s t-at decrease eIecti6eness
"nducers%: Ri#ainF Anticon6ulsantsF St
;o-n8s now or all
age/ 6 ou vomit within hour o
taking5 ma want to take another %oe/ Ella: Qoo% or $ %a ater e.5
precription onl
Para3ard Coer D
i3-er t-an noral doses o# re3ular
dail. oral contraceti6es can $e used
Pain Ihe Lth vital ignK
• A%%ition o a non-opioi% can oten re%uce the
amount o opioi% nee%e% an% provi%e uperior
analgeia• 6t i important to %itinguih between
-.siolo3ical adatation"Tolerance% and
addiction
• Addiction -as stron3 coulsion and
desire to tae dru3F desite -ar alon3
4it- dru3(seein3 $e-a6ior
• Peu%o-a%%iction' Fook like a%%iction but coul%
be rom uncontrolle% pain
• >hronic opioi% ue nee% constiation
ro-.la)is• Sedation s-ould $e onitored $c it is t-e
ost iortant redictor o# resirator.
deressionF t-e usual cause o# #atalit. in
o6erdose
Acetaino-en:
T.lenol5 h%roco%one:APAP "@icodinF Lorta$F
NorcoF Lorcet%F o.co%one:APAP "PercocetFEndocetF Ro)icet%F co%eine:APAP "T.lenol Y2F?F'%F
trama%ol:APAP "ltracet%
**99< #or eatoto)ic: o6erdose can $e #atalF
"7a): '0003da.% O6erdose T): N(
Acet.lc.steine to restore lutat-ione DOC #or ain in re3nanc.
**A6oid in -ea6. driners or no4n -eatitis
"23 da.%
AsirinNSADs:
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A&A irreveribl inhibit while other &A6 reveribl
inhibit >E A&A' Baer5 BuTerin5 : caTeine(APAP *D.ce%rin+5
alalate ibuproen *Motrin5 A%vil+5 napro.en *Aleve5 apron5
Anapro.+5 naro)en ! esoeraole "@io6o%F
%icloenac "@oltaren%F in%omethacin "ndocin%F
piro.icam "Heldene%F ketorolac "Toradol%F ulin%ac
*>linoril+ preerre% with re%uce% renal unction
Selecti6e COX(2 n-i$itors: celeco.ib "Cele$re)% -
ost selecti6eF melo.icam "7o$ic%F eto%olac
"Lodine%F nabumetone "Rela#en%
NSAD 99& i%e eTect o
avoi% in pch con%ition ketorolac *ora%ol+ can onl be ue% or 5 da.s a)
Cele$re) C 4it- sul#a aller3.
P-otosensiti6it. Tae 4it- #ood
Oioids:
99< #or resirator. deression
o tolerance to contipation o nee% a la.ative with all
or-ine "7S ContinF A6inaF adianF Oraor-
SRF Ro)anol% *AvinSa an% a%ian can be opene% an%prinkle% on appleauce 2PO to @ is ?:1
#entan.l "Dura3esicF A$stralF Hentora SL%
-.droor-one "Dilaudid% o).codoneF O).continF EndocetF PercocetF
Ro)icetF Ro)icodone: Avoi% with 3A4 inhibitor o).or-one "Oana%: tae on et. stoac-
et-adone "Dolo-ine%: 99< #or T
rolon3ationF serotoner3ic eeridine "Deerol%: serotoner3ic
-.drocodone "Lorta$F LorcetF NorcoF @icodin% codeine "T.lenol Y2F?F'%
traadol "ltraF ltracet%: serotonin s.ndroe
risF increased seiure ris
taentadol "Nuc.nta%
Aller3ic to or-ineF -.drocodone etc : Can use
#entan.lF or-ineF eeridine
7uscle Rela)ants:
o $aclo#en "Lioresal%F c.clo$enarine "Hle)erilF
He)i#%F tianidine "GanaQe)%F carisorodol
"Soa%F eta)alone "Sela)in%F et-ocar$aol
"Ro$a)in%o c.clo$enarine and tianidine can cause
)erostoia "dr. out-%o tianidine C 4it- CiroQo)acin
Neuroat-ic Pain A3ents:
re3a$alin "L.rica% a): M003da.
dulo)etine "C.$alta%
3a$aentin "Neurontin% a): ?FM00 3da.
aitrit.line "Ela6il% ( antic-oliner3ic
ilnaciran "Sa6ella% ( #or K$ro.al3ia
Toical #or Localied Pain :
lidocaine "Lidoder 5% = can cut into maller
piece5 1 hour on 1 hour oT5 approve% or pot-
herpetic neuralgia/ Casaicin
diclo#enac "@oltaren el%
7i3raine:
• Qoo% to tr an% i%enti an Utri33ersV o
migraine/
• Tritan %rug are serotonin(recetor
a3onists an% contrict cranial bloo% veelue% to UtreatV acute migraine/
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• suatritan "itre)%: POF Nasal sra.F
Su$
riatritan "7a)alt% ( eletritan "Rela)%
Prophla.i' Beta blocker like metoprol an% propanolol
out:
• Ever-pro%uce or un%er-e.crete uric aci%
• Purine anthine E.i%ae 8ric Aci%• People can be hperuricemic an% never get a gout
attack
• rug that increae uric aci%' iuretic5 iacin5 A&A
*Nigh %oe+5 PraSinami%e5 >cloporine5 acrolimu
T): Acute attac:
colc-icine "Colcr.s% 1/mg orall then
)/"mg one hour later *%o not e.cee% 1/#mg+/
N@D in +0 o# atients Onl. 3ood
4it-in t-e Krst ?M -ours o# onset NSAD8s: ndoet-acinF naro)enF
sulindacF cele$re) *oT-label+ &temic >orticoteroi%' pre%nione5
methlpre%niolone
rate Lo4erin3 T-era.:
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get angioe%ema5 all other in the cla inclu%ing
ARB an% Alikiren are >6/ 6t can be atal/
ACE n-i$itors: 222>an caue dr. cou3- # soF s4itc- to
AR9 $enaeril "Lotensin%
enalaril "@asotec% lisinoril "Prin6ilF Gestril%
Buinaril "Accuril%
rairil "Altace%
AR98s: 6alsartan "Dio6an%
losartan "Coaar%
olesartan "9enicar%: ***>an caue Srue(
lie enteroat-. *evere %iarrhea+ telesartan "7icardis%
ir$esartan "A6aro% Direct Renin n-i$itor:
alikiren *ekturna+
Do not use 4it- 4it- ACEi or AR9 in
atients 4it- dia$etes
9eta 9locers:
***NOT HRST LNE HOR PERTENSON
AN7ORE
>an alter bloo% glucoe level roranolol "nderal%: Non(selecti6e
atenolol "Tenorin% etorolol tartrate "Loressor%: ake with oo%
etorolol succinate "Torol XL%: sed in -eart
#ailure too 7a) in H is titratin3 to 2003da. ne$i6olol "9.stolic%: Also releases Nitric O)ide
car6edilol "Core3%: sed in -eart #ailure too
Al-a and 9eta 9locer Tae 4it- #ood oing converion between >oreg an% >oreg >R'
3/1$ B6 >oreg
1)mg >oreg >R ail5"/$B6)mg5 1/$mg B64)mg5 $mg B6#)mg
la$etalol "Trandate%: Al-a and 9eta 9locer 1st
line o#ten in TN in re3nanc.
&i%e note' Beta Blocker with 6&A' *acebutolol5 carteolol5
penbutolol5 pin%olol+- he %ont %ecreae NR a much/
Calciu C-annel 9locers:
222>an caue eri-eral edea an% 3in3i6al
-.erlasia
on-NP' *Work in the heart5 mainl or arrhthmia+
?A' su$strates and in-i$itors
diltiae "Cardie%
6eraail "CalanF @erelan%: Can $e constiatin3
NP' *;or N an% Angina+
alodiine "Nor6asc%
ni#ediine "Adalat CCF Procardia XLF Procardia% nicardiine "Cardene%: Coes @ also
clevi%ipine *>levipre.+' o no ue with o or egg
allerg
Centrall. actin3 al-a 2 a3onists:
clonidine "CataresF Catares(TTS atc-%: Patch i
applie% 4eel. Do not sto a$rutl. or it cancaue se6ere -.ertension Na man oT-label ue
*opioi% with%rawal5 an.iet5 leep etc/+ Na man i%e
eTect *bra%car%ia5 %rowine5 e.ual %unction5
%epreion5 naal tuVne+ gaunacine *ene.+' ntuni6 is #or ADD
Direct @asodilators:
N%ralaSine
%irectl vao%ilate arterie5 litte eTect on vein
.dralaine: can caue a rare luus(lie s.ndroe
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Al-a 9locers: *8e% motl or BPN5 not Lrt line or N+
teraosin ".trin%
do)aosin "CarduraF Cardura XL%
Co$o Products:
alodiine ! $enaeril "Lotrel%
alodiine ! 6alsartan "E)#or3e%
lisinoril ! CTG "PrinideF Gestoretic%
losartan ! CTG ".aar%
6alsartan ! CTG "Dio6an CT% olesartan ! CTG "9enicar CT%
$isorolol ! CTG "Giac%
triaterene ! CTG "D.aideF 7a)ide%
;NC + ";oint National Coittee%:
M0 .rs old "150>0%
M0 .rs old "1'0>0%
1+ .rs old 4it- CD or Dia$etes "1'0>0%
Non(9lacs nitial T) *inclu%ing iabete+' ACEiF
AR9F CC9F or T-iaide 9lacs nitial T) *inclu%ing iabete+' CC9 or
T-iaide # CDF ust -a6e ACEi or AR9 re3ardless o# race
D.sliideia:
• FF = > O NF O *Q($+
Non(statin t-eraies are not recoended
unless statins are not tolerated
StatinsF K$rateF and niacin reBuire LHT c-ec at
$aseline Hor statinsF rec-ec in '(12 4ees
a#ter initiation or titration t-en e6er. ?(12
ont-s t-erea#ter
K$rates "4-en T are -i3-% and Ks- oil canincrease LDL
$ile acid seBuestrant can increase T8s
' 3rous s-ould $e initiated on statin t-era.: Clinical ASC@D includin3 coronar. -eart
disease "ACSF SP 7F sta$le or unsta$le
an3inaF coronar. or arterial
re6asculariation%F stroeF TAF or PAD LDL 1>0
Dia$etes and '0(5 .rs old 4it- LDL$et4een 0(1+>
'0(5 .rs old 4it- LDL $et4een 0(1+>
4it- estiated 10(.ear ASC@D ris 5
T-e aroriate statin intensit. is $ased on t-e
atient8s le6el o# ris:
i3- ntensit. Statins: "decreases LDL 50%o Ator6astatin '0(+03da.
o Rosu6astatin 20('03da.
7oderate ntensit.: "decreases LDL ?0('>%o Ator6astatin 10(203da.
o Rosu6astatin 5(103da.o Si6astatin 20('03da.
o Pra6astatin '0(+03da.o Lo6astatin '03da.
o Pita6astatin 2('3da.
Lo4 ntensit.: "Decreases LDL ?0%o Si6astatin 10 3da.o Pra6astatin 10(203da.
o
Lo6astatin 203da.o Pita6astatin 13da.
Statins: 7(CoA reductase in-i$itors
**Li6er en.es need to $e onitored Sto dru3
i# ALT or AST ? ties uer liit o# noral O$6iousl. t-e. can cause r-a$do.ol.sis
ncreased ris 4it- Niacin or 3eK$roil "Loid%
use
C in Pre3nanc.
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SAL are ?A' su$strates
si6astatin "Gocor%F si6astatin ! eetii$e
"@.torin% 203F **tae in t-e e6enin3o not e.cee% 1)mg(%a with verapamil5 %iltiaSem5 or
%rone%aroneo not e.cee% )mg(%a with amio%arone5
alodiine5 or ranolaSine
ator6astatin "Liitor%: eBui6alent dose: 103o not ue with ccloporineo not e.cee% )mg(%a with clarithromcin or
lopinavir(ritonaviro not e.cee% 4)mg(%a with nelLnavir an% boceprevir
*Nep >+
lo6astatin "7e6acorF Altore6% '03F
**7e6acor 4it- e6enin3 ealF Altore6
$edtieo not e.cee% )mg(%a with verapamil5
%iltiaSem5 or %rone%aroneo not e.cee% 4)mg(%a with amio%arone
rosu6astatin"Crestor% 53
ra6astatin "Pra6ac-ol% '03 ita6astatin "Li6alo%: ost otentF 23
C-olesterol a$sortion in-i$itor:
eetii$e "Getia%
si6astatin ! eetii$e "@.torin%
9ile Acid seBuestrant:
colese6ela "/ ake with meal an% liui%/ >an
caue constiation5 bloating5 ga5 cramping5
increased tri3l.cerides or neutralF ipping or
hol%ing in mouth can lea% to tooth %eca/ 7an. eds need to $e taen ' -ours $e#ore or 4-
" hour ater or it can bin% them/
e) Oral Contraceti6esF -en.toinF
le6ot-.ro)ineF olesartanF sul#on.lureasF
tetrac.clines and an. ot-ers
Hi$rates: PPARa Acti6ators
#enoK$rateF #enoK$ric acid "TricorF Trilii)%
**Onl. Trilii) -as indication #or use 4it- a statin 3eK$roil "Loid%: a6oid i# on a statin Can increase LDL i# tri3l.cerides are -i3-
Can cause .oat-. and -eato)icit.
Niacin: "nicotinic acid or @it 9?%
ER Niacin "Niasan 500F 50F or 1F000 3%:***
Less Qus-in3 and Less eatoto)ic eatoto)ic "onitor LHT8s% and causes
Hlus-in3tc-in3 Can cause -.eruriceia
"3out% and ort-ostatic -.otension
Slo(Niacin: i3-est ris o# -eatoto)icit.
R 7a): M 3da. ERCR 7a): 23da.
;luh-ree %oent work or choleterol
His- Oils:
ot completel un%ertoo%
Oe3a(? acid "Lo6aa% or Jacepa
ndicated as an adunct in atients 4it- T8s
500
Can increase LDL u to '' "Onl. Lo6aa%@ascea can cause oint ain "art-ral3ia%
Can rolon3 $leedin3 tie
eart Hailure:
• Mot commonl caue% b isc-eic -eart disease
"7% an% TN
• Non(P-aracolo3ic T-era.:
onitor $od. 4ei3-t dail.
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noti provi%er i mptom woren or weight
increae o%ium retriction to 1$)) mg(%a
weight re%uction
e.ercie a tolerate%
omega-3 at are goo%
A6oid NSAD8s inclu%ing >E- inhibitor
P-aracot-era.: **ACEiAR9 and 9eta 9locers iro6e
sur6i6al and s-ould $e used in ALL -eart
#ailure atients "E)cet 4-en C% Titrate
dru3 to tar3et doses "#ro clinical trials%
Diuretics "suall. Loo%s-ould $e used to
control Quid 6olue "not s-o4n to alter
sur6i6al% Aldosterone Recetor Anta3onist: Reduce
or$idit. and ortalit. and s-ould $e
added to t-ose 4-o ro3ress to NA
Class @
**Alodiine -as a neutral eIect on -eart
#ailure ood #or #urt-er 9P control t is a class eIect 4it- ACEiAR9s $ut not
4it- 9eta(9locers Onl. certain 9eta(
9locers are used
9eta 9locers #or H:
7etorolol succinate "Torol XL%: Tar3et
dose is 2003 dail.
Car6edilol "Core3F Core3 CR%: Tar3et
dose #or R is 253 9D "nless +53
t-en its 503 9D% and #or Core3 CR is
+03 dail. Bioprolol *ebeta+' arget oe' 1)mg %ail
Beta blocker are onl toppe% i
hpotenion or hpoperuion i preent/
Aldosterone Anta3onists:
sironolactone "Aldactone% : Tar3et
dose 253da. epleronone *6npra+' arget %oe
$)mg(%a
.dralaineNitrate:
.dralaine is a direct arterial dilatort-at decreases a#terload Nitrates
are 6enous 6asodilators t-at reduce
reload
ndicated #or 9lac eole 4it- NA
Class @ -eart #ailure 4-o are
s.toatic desite otial
t-era. can $e used in atients 4-o cannot
tolerate ACEiAR9s
isosor$ide dinitrate.dralaine"9iDil%: >6 with PD-$ inhibitor
isosor$ide ononitrate "7onoet%: >6
with PD-$ inhibitor
Di3o)in "Lano)in%:
6nhibit the a:( : AP pump reulting in
ositi6e inotroic "#orce% and ne3ati6e
c-ronotroic "rate%Does not iro6e sur6i6al $ut can
decrease -ositaliations ro6es s.tosF e)ercise toleranceF
and OL Antidote: Di3iHa$
Lo4er doses #or renal insuJcienc.F
sallerF olderF #eale T-eraeutic ran3e #or H: 05(0> n3l
*Nigher or ALb+
Si3ns o# to)icit.: 1st
si3ns are nauseaF6oitin3F loss o# aetiteF $rad.cardia
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9lurred @isionF altered color ercetionF
3reenis-(.ello4 -alosF con#usionF deliriu .oaleiaF -.oa3neseiaF and
-.ercalceia increase t-e ris o# to)icit.
Acute Decoensated eart Hailure:
>ongetion' iuretic an%(or 6J vao%ilator
Npoperuion or >ar%iogenic &hock' 7ilrinone or
obutamine Jao%ilator ue% in AN;'
o itroglcerin' Jenou at low %oe5 Arterial at
higher %oe5 eTectivene limite% to -3 %a/o itroprui%e *itropre+' eual arterial an%
venou5 protect rom light b covering with oil or
opaue material5 blue olution in%icate
%egra%ation to cani%e/o neiriti%e *atrecor+' B-tpe natriuretic pepti%e5
arterial an% venou %ilation/
Anticoa3ulation:
• &ome rik actor or JD' &urger5 Maancer5 previou JD5 Pregnanc5 etrogen
or &DRM ue etc//
Neparin an% FMWN can caue T' Bo% orm
antibo%ie to heparin which lea% to urther platelet
activation an% pro-thrombotic tate/ Dia3nosed $. a
ro#ound dro in latelets 50 #ro $aseline
**Ar3atro$an is t-e DOC i# t-is -aens DT8s
do not cross react 4it- -earin induced
anti$odies
n#ractionated earin:
o bin% to antithrombin an% inactivate ;actor a an%
66a/o @TE ro-.la)is: 5F000 units SC +(12-rs
o Alo ue% or JD treatment an% A>&(&DM6 treatment
@TE: +0 units3 @ $olus then 1# unit(kg(hr
inuion A>&(&DM6' ") unit(kg 6J bolu then 1 unit(kg(hr
inuiono o not mi.-up the heparin in
o osteoorosis with long term ue
L7
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N;ECTA9LE Su$ indirect #actor Xa
in-i$itor/ Work via antithrombin like heparin/ C in se6ere renal iairent "CrCl ?0
lin% no anti%ote
Ri6aro)a$an "Xarelto%:o ORAL direct #actor Xa in-i$itoro A Lb' )mg PE C *>r>l 9 $)+, 1$ mg PE C *>r>l
1$-$)+ 4it- e6enin3 ealo J prophla.i *ater knee(hip replacement+'
1)mg PE C 4it-out re3ards to ealso J(PD .' 1$ mg PE B6 . 1 %a then )mg PE
C 4it- #oodo **Can start 4-en NR is ?0o ?A' su$strateo o not ue with >r>l 1$ ml(min
o no anti%ote
• Api.aban *Dliui+' &imilar to arelto
Direct T-ro$in n-i$itors: *actor 66a+
%irectl inhibit ;actor 66a *hrombin+
Ar3atro$an: sed in atients 4it- TF no
antidote
$i6alrudin "An3ioa)%
da$i3atran "Prada)a% :o **ORALo Hor non(6al6ular A(Hi$o 150 9D 5 9D i# CrCl 15(?0 lino **Can start 4-en NR is 20o &wallow whole5 %o not put in Q tube/
o 50 -a6e d.sesiao 22ee in ori3inal container and ee lid
ti3-tl. closed to rotect #ro oisture
Discard a#ter ' ont-s o# oenin3 $ottleo Store in coolF dr. lace Not in a $at-rooo no onitorin3 or antidote
Jit b(c o variable aborption an%
avoi% 6M %ue to hematoma/ Side EIects: 9leedin3F Sin NecrosisF Purle Toe
S.ndroe S(enantioer ore otent
P-araco3enoincs: 2C>*2 and *? reBuire
lo4er doses
@OR ol.or-iss reBuire
lo4er doses
C-ronic Sta$le An3ina:
• plaue buil%up in coronar arterie re%uce bloo% How toheart
• >oul% be rom PrinSmetal angina which i vaopam o
coronar arterie5 not plaue/ >alcium channel blocker
preerre% or thi tpe/
• Predicta$le chet pain
Treatent:
9eta $locers are 1st line
ASA or Cloido3rel "#or ASA aller3.%
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SL or sra. nitro3l.cerin #or iediate relie#
Fong acting nitrate can be ue% or chronic therap a
an a%%-on but reBuire nitrate(#ree inter6also nitro3l.cerin SL ta$s "Nitrostat 0?F 0'F
0M3%o nitro3l.cerin SL 0'3 "'00c3% sra.
"NitroistF Nitrolin3ual u sra.%: do
not s-aeF rie it o isosor$ide ononitrate RER "7onoet% =
tae 4-en .ou 4ae u and t-en 2nd dose
5 -ours latero SE: EADACE "3ets less $ot-ersoe%F
diiness 7oderate to -i3- dose statin i# not C
Annual nQuena
RanolaSine *Rene.a+ alo an option or angina/ T
rolon3ation5 no eTect on NR or BP/ *anti-anginal+
Acute Coronar. S.ndroes: "ANSTE7STE7%:
• 8A' chet pain5 enSme negative5 no or tranient DQ
change
• &DM6' chet pain5 car%iac enSme *troponin5 >-
MB+5 no or tranient DQ change
• &DM6' chet pain5 car%iac enSme *troponin5 >-
MB+5 & Dlevation
nitial Treatent: "7ONA%
Morphine5 E.gen5 itrate5 Apirin *1"-3$mg5 then
#1mg %ail+
T-enF ot-er t-eraies added $ased on 4-at is
lanned #or t-e atient "AP(9A%
QP 11b(666a anatagonit *a$ci)ia$ "ReoPro%F
etiK$atide "nte3relin%F tiroLban+' Abci.imab
irreveribl block/ >an caue $leedin3F
t-ro$oc.toeniaF -.otension
Anticoagulant *Neparin5 FMWN5 on%aparinu.5
bivalru%in+'
PY1 inhibitor *clopi%ogrel5 praugrel5 ticagrelor+'
Praugrel not or >ABQ/ >lopi%ogrel reuire >1! or
activation/
Beta Blocker' 4it-in 2' -ours without >6
A>D inhibitor' 4it-in 2' -ours without >6
PC is usuall. re#erred i# #acilities are a6aila$le
;ibrinoltic ue% when acilitie or P>6 are not available or
when P>6 cannot be %one within !) min/ ;ibrinoltic houl%
be tarte% within 3) min/ o arrival to hopital/
;ibrinoltic' alteplae5 tenecteplae
NSADs not recoended ost(7 due to ris o# re(
in#arction "se ASA or T.lenol%
Antiarr-.t-ics:
• 8uall rom mocar%ial ichemia or inarction/ Alo
rom thing that %amage the heart like N5 heart
ailure5 hperthroi%im5 inection etc//
• Electrol.te i$alances can caue arrhthmia
"otassiuF sodiuF a3nesiuF calciu%
• Dru3s5 inclu%ing %rug to treat arrhthmia can
caue it/
• AK$ is t-e ost coon sura6entricular
arr-.t-ia and usuall. results in a raid
6entricular resonse
• T rolon3ation is a ris #actor #or Tosades de
PointesF usuall. dru3(induced and can lead to
sudden cardiac deat-
• Additi6e T Prolon3ation: >la 1a an% >la 666
antiarthmic5 BuinolonesF acrolides5
S7XT7P5 aole anti#un3als5 >A5 ome &&R6
*CitaloraF aro)etineF Huo.etine5ecitalopram+5 antis.c-oticsF et-adone5 $N3
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anatagonit "ondansetron%F P8s5 anti-cancer
%rug etc//
• Class a' *uini%ine an% procainami%e+ block
o%ium an% potaium channel/ Additi6e T
rolon3ation
• Class $: *li%ocaine+ pure o%ium channel blocker/
Onl. #or 6entricular arr-.t-ias Cross 999
and so can -a6e CNS eIects
• Class c: *Hecaini%e5 propaenone+ o%ium channel
blocker/ C in -eart #ailure and acute 7
• Class : 9eta 9locers *emolol5 propranolol+
used to slo4 6entricular rate
Class : "aiodarone "CordaroneF PaceroneF
Ne)terone%5 do#etilide "Tios.nF -as RE7S
ro3ra calls TPS+5 %rone%arone5 ibutili%e5
otalol+ mainl block potaium channel/
Aiodarone is t-e DOC i# t-e. -a6e
concoitant eart Hailure t can causeCorneal deositsF -otosensiti6it.F
neuroat-.F increased LHT8s and $lue(3ra.is-
sinF ulonar. K$rosis All -a6e Additi6e T
rolon3ation
• Class @: Calciu C-annel 9locers "diltiaeF
6eraail%
• Ot-ers: Di3o)in "Lano)in%: .oaleiaF
-.oa3neseiaF and -.ercalceia
increase ris o# di3o)in to)icit.
**T-eraeutic ran3e #or AK$: 0+(2 n3l
En-ances 6a3al tone
Pulonar. Arterial .ertension:
Qroup 1 i PAN' can be i%iopathic5 genetic5 liver %ieae5 N6J
etc/
Wararin titrate% to 6R o 1/$-/$
protacclin analogue en%othelin receptor antagonit
oluble guanlate cclae timulator' rioci3uat
"Adeas%: >6 with PD-$ PDE(5 in-i$itors: il%enaLl *Revalo+ or a%alaLl
*A%circa+ ' iTerent Bran% an% %oe than ue% in D/
>6 with nitrate/ 6 a patient i taking a PD-$ inhibitor
an% ha chet pain5 hol% nitrate or 4 hour with
il%enaLl an% var%enaLl an% 4# hour or ta%alaLl
*ta%alaLl ha longer hal-lie+/
Qroup i PN5 which i pulmonar venou N orm let-
i%e% heart ailure/
Ast-a:
• bronchial hper-reponivene an% un%erling
inHammation
• chronic inHammator %ior%er o the airwa
•Naving patient %emontrate correct techniue i otena goo% i%ea
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LA9A: "***99< to onl. used 4it- steroidsF not
onot-era. $c increased ris o# deat-%
Once ast-a is controlledF assess #or stedo4n
t-era. "reo6al o# LA9A% 4it-out loss o# ast-a
control
saleterol ! Quticasone "Ad6air Disus or HA%
#ooterol ! $udesonide "S.$icort%
n-aled Corticosteroids: "1st line t-era.%
$eclaet-asone "@AR%: ** re#erred in re3nanc.
$udesonide "Pulicort%
Quticasone "Hlo6ent%
oetasone "Asane)%
SE: Oral Candidiasis "T-rus-%F d.s-oniaF cou3-
**Pre6ent t-rus- 4it- sacer or rinsin3 out- 4it-
4ar 4ater and sit a#ter use
Oral Steroids: "#or se6erel. uncontrolled ast-a%
>ortione5 -.drocortisone "Solu(Corte#%F
et-.lrednisolone "7edrolF 7edrol DoseaF
Solu(7edrol%F PrednisoneF Prednisolone "7illiredF
OraredF Prelone%F triamcinolone *enalog+5
de)aet-asone "Decadron%F betamethaone
# on it ore t-an 10(1' da.sF reBuires a taer
Lon3(Ter SE: >uhing &n%rome5 6mmunouppreion5
Acne5 6nomnia(ervoune5 Npokalemia5 Amenorrhea5
Eteoporoi5 Weight Qain5 iabete5 Q6 Blee% etc//
7et-.lrednisolone '3 /PrednisonePrednisolone 53 / 053
De)aet-asone
Leuotriene Recetor Anta3onist:
onteluast "Sin3ulair%:103 DF 1(5 .rs old "'3%F 5(1'.rs old
"53%
can cause -eadac-e and neuros.c-iatric
$e-a6ior
Hor E9F onl. 4ors in 50 o# atientsFtae 2 -ours $e#ore e)ercise
ha phenalanine in it or a weetener o %ont
ue in P8
T-eo-.lline:
• not the mot eTective an% ha an. dru3
interactionsside eIects
T-eraeutic ran3e: 5(15 c3l
SE: nauseaF loose stools
Aino-.lline to T-eo-.lline ultile $. 0+T-eo-.lline to Aino-.lline di6ide $. 0+
Oaliua$ "Xolair%:
Hor se6ereF aller3ic ast-a n-i$its 3E $indin3
on ast cells and $aso-ils
S-ould al4a.s $e 3i6en in t-e doctor8s oJce
can cause Ana-.la)is
COPD:
• caue b cigarette moke an% other no.iou
chemical
d.sneaF c-ronic cou3-sutu roduction
soin3 ceation i the onl thing that low the
progreion
SA9A and SA7A: ratroiu "Atro6ent%F
iratroiu ! al$uterol "Co$i6ent Resiat%
LA9A and LA7A: tiotroiu "Siri6a andi-aler%
or acli%inium *u%orSa+ 7ore eIecti6e and ore
con6enient SE: Dr. out-
• PD-4 inhibitor' roHumilat *alirep+' increae >AMP
an% %ecreae lung inHammation
• &teroi%' long term onot-era. are not
recommen%e% in >EP5 not ver eTective/ 8e% in
combo with FABA/ *A%vair an% &mbicort+
• Qet Jaccine
Soin3 Cessation:
>ouneling an% me%ication are more eTective ue%together than either alone Stron3 correlation
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$et4een counselin3 intensit. and Buittin3
success
5 UA8sV: AsF Ad6iseF AssessF AssistF Arran3e
*;ollow 8p+
Patients o#ten #ail 4-en t-e. do not use enou3-
NRT #or a clinical eIect
uF Loen3eF and Patc- are OTC onl. to 1+ .rs
and older
icotine Qum *icorette mg or 4mg+ a): 2'
iecesda. apere% %oe/ Ene C1-hr/ . M4ees5
then C-4 hr/ ) ? 4ees5 then C4-# hr/ ) ? 4ees/
Avoi% aci%ic beverage *1$ min/ beore or %uring .5
water i ok/+ $ cig(%a = mg 9$ cig(%a
=4mg
icotine FoSenge *>ommit mg or 4mg+ a): 20
loen3esda. 3)min to moke in the AM =4mg,
93)min to moke =mg
•
icotine Patche *ico%erm >C 7mg5 14mg5 1mg+'>an remove to avoi% inomnia/ Local sin reaction
coon 1) cig(%a = 14mg 91)cig(%a=1
mg/ " week *1mg+5 then week *14mg+5 then
week *7mg+ or " week *14mg+5 then week *7mg+
• icotine 6nhaler' ;reuent5 continuou puVng or )
min/ >lean mouthpiece/ 6n col% temp5 keep in warm
area like pocket/ Ence a cartri%ge i open5 onl goo%
or 1 %a/
e-cigarette' not ;A approve%5 but popular
9urorion SR "G.$anF 9uro$an%: &tart 1 week
beore uitting5 a): '503da. $c o# seiures/
&D: Dr. out-insonia BBW or neuropchiatric
event/
@arenicline "C-anti)%: icotine agonit( antagonit,
&tart 1 week beore uitting/ Do not use 4it-
nicotine roducts 99< #or neuros.c-iatric
e6ents nsonia and @i6id Dreas
Qet Jaccine' Soers 1>(M' s-ould 3et t-e
Pneuo6a)
Onl. 3u and loen3e nicotine are re3nanc. CF
ot-ers are D
Aller3ic R-initisF Cou3- and Cold:
Aller3ic R-initis Ua. He6erV:
• Avoi% e.poure to allergen
Mo%erate to evere' ntranasal Steroids 1st line :
Quticasone "Hlonase or @er.st%F oetasone
"Nasone)%F triacinolone "Nasacort%F
$eclaet-asone "nasl or 9econase%F
$udesonide "R-inacort%
Mil% to Mo%erate' Oral anti-istaines "suall. 2nd
en%: Qoo% or neeSing5 itching5 rhinorrhea5 but ha
22inial eIect on con3estion di-en-.draine "9enadr.l%: 1st 3enF 25(
503 PO '(M -rs Sedatin3 c-lor-eniraine "C-lor(Trieton%: 1st 3en
re#erred in re3nanc. cetiriine "G.rtec%
le6ocetiriine "X.al%
loratidine "Claritin%
desloratidine "Clarine)%
#e)o#enadine "Alle3ra%
aelastine "Astelin%: ntranasal
• Decon3estants: alpha agonit that caue
vaocontriction to re%uce congetion' Eral' phenlephrine *&u%ae% PD+ ' low
bioavailabilit seudoe-edrine "Suda#ed%: 7a)
a$le to $u.: ?M 3da. or > 3ont-F 7a)
intae is 2'03da. aal' O).etaoline "A#rin% or
-en.le-rine "Neo(S.ne-rine% Liit use
to ?da.s to re6ent re$ound con3estion
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• Ether' cromoln *aalcrom+5 6ntranaal ipratropium
*or rhinorrhea to %r mucu+5 &ingulair5 aal
irrigation
ColdCou3-:
• inc' can %ecreae %uration o a col%
• Jitamin >' ma help prevent a col%
• 8uall a Jiral 6nection *e./ Rhinoviru+
• A%vie patient to ta well h%rate%
Numi%iLer an% JaporiSer can be ueul Do not use
toical ent-ol or ca-or in c-ildren less t-an
2 .rs old
C-ildren: OTC cou3-coldain or ac-es roducts
s-ould not $e used in c-ildren ' .rs old /
>ombo cough(col% pro%uct houl% not be ue% in
chil%ren 2 er HDA or M er Aerican Acade.
o# Pediatrics Do not use ASA due to ris o#
Re.e8s s.ndroei$uro#en "5(10 33 M(+ -rs%
Horulation 50 3125L or 10035l
APAP "10(15 33 '(M -rs%
Horulation 1M0 35L se cali$rated s.rin3e #or easurin3 i# it8s
an oral liBuid disensed
Decon3estant: Do not use in c-ildren M .rs old
e)cet PSE "not ' .rs% # re3nantF use
intranasal sra. lie O).etaoline or
-en.le-rine $c oral PSE can decrease $loodQo4 to in#ant
Cou3-:
De)troet-or-an "Dels. or UD7V in t-e
nae%: Man mechanim but i alo a erotonin
reuptake inhibitor/ Eten abue% b people when taken
in larger %oe %ue to it ketamine(P>P like
hallucinagenic aTect/ Pro$a$l. sa#e durin3
re3nanc.
Anti-istaines: %ont work or col% mptom/ Ma
help cough/
Codeine: Ne6er disense codeine to a
$reast#eedin3 4oan can cause #atal
resirator. deression in an in#ant
aui#enasin "7ucine)%: %ecreae phlegm vicoit5
unclear beneLt/
C.stic Hi$rosis:
• genetic %ior%er that %irupt >;R protein cauing
abnormal tranport o o%ium an% chlori%e acro cell
• leads to t-icF 6iscous lun3 secretions5 %iVcult
breathingF in#ections5 an% %igetive complication
*ill the pancrea+/
• n#ections usuall. interittent at Krst and
e6entuall. $ecoe c-ronic 4-ere t-e. a. need
in-aled anti$iotics
• 6 intermittent peu%omona5 treat with two 6J anti-
peu%omonal agent/
Mot common bug' &taph/ Aureu5 N/ ;lu5
Peu%omona/
Treatent:
9ronc-odilators: 8e beore giving inhale%
antibiotic to help antibiotic get in/ .ertonic Saline ".ersal+' hr%rate airwa
mucu to thin ecretion DNAse en.e: dornase al#a "Pulo.e% to
thin mucou n-aled anti$iotics: To$ra.cin n-aled
Solution "TO9% or TO9 Pod-aler or
Atreona L.sine n-alation "Ca.ston% to
prevent an% treat lung an% inu inection with
chronic inection/ ake %oe EB6 " hour apart
an% >aton 4 hour apart/ &olution tore% in
ri%ge5 Po%haler .capule at room temp/ in a %rplace/ 2+ da.s onF 2+ da.s oI c.cle
O l A it- i % i
RDM& h i h Al l
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Oral Ait-ro.cin: to re%uce airwa
inHammation an% %irupt Peu%omona bioLlm
i3- HatF calorie(dense diet
Pancreatic En.es: Peancrealiase
"CreonFPancreaeF GeneF @ioase%: contain
liaseF a.laseF and rotease oe a%hemo might get place% on
hol%5 %oe re%uction5 or a tranuion*1)5))) or
)5))) with active blee%+
• Nepatoto.ic' Man
• ephroto.ic( Bla%%er o.ic' Man, N%ration help
Huh %rug out/ Amiotene ue% to re%uce rik o
ciplatin renal to.icit/ Mena*Mene.+ given with
ioami%e to prevent hemorrhagic ctiti/
•
Mucoiti' high rik with $-;85 capecitabine5 irinotecan5an% methotre.ate/ 8e saline rinses %ail/
• Nan%-;oot &n%rome' $-;85 an% capecitabine
• >lotting' Eten rom &DRM&
• Alopecia' a.ane an% anthraccline
• >ar%ioto.icit' Anthraccline
• auea(Jomiting' Mot >hemo rug epeciall
cislatinF %o.orubicin5 epirubicin5 cclophophami%e5
iooami%e/ > receptor are $N5 opamine5 Ach5
Nitamine5 Epioi%5 an% &ubtance P/
o uuall ue a combination o anti-emetic %rugo Ondansetron "Go#ranF Gule Kl%F
3ranisetron "ranisol%F dolasetron "Aneet%F
alonosetron "Alo)i%: $-N3 antagonit5 ris o#
T rolon3ationo roc-loreraine "Coro% and roet-aine
"P-ener3an%: block %opamine receptor in >&/
&D' sedationF let-ar3.F acute EPSo de)aet-asone "Decadron%o areitant"Eend% an% #osareitant "Eend
@+' ubtance P(eurokinin-1 receptor antagonit
% bi l *M i l+ > bi i% &D %
*t t ith t i + D l d Di - *t t ith
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o %ronabinol *Marinol+' >annabinoi%/ &D' %row5
euphoria5 increae% appetite
Soe C-eo dru3s used in an. cancers:
• Al.lators: C.clo-os-aide "C.to)an+ an%
i#os#aide "#e)% he cro-link A preventing
replication/ &D' 9ladder To)icit.99<***eorr-a3ic C.stitis so 3i6e 7esne) to
prevent/
Ant-rac.clines: DOXOru$icin"Adria.cin% and
DANOru$icin "Ceru$idine% 6ntercalate into A/
&D' 99ro link A
cauing apoptoi/ SE: Ne-roto)icF Ototo)icF
neuropath/ Cislatin -as se6ere N@Ai#ostene to reduce cislatin ne-roto)icit.
7et-otre)ate: olate antimetabolite that prevent
A nthei in the &-Phae Leuco6orin rescue to%ecreae to.icit/ SE: and(#oot s.ndroe
P.riidine Analo3ues: caecita$ine "Xeloda% and
Hluorouracil "5(H%/ 6nhibit primi%ine nthei in
the &-Phae/ SE: and Hoot s.ndroe/ >6 with P
%eLcienc Leuco6orin increases eJcac. o# 5(H/
• Tooisoerase 1 in-i$itors: ironotecan
"Catosar% Block coiling an% uncoiling o A in &-
Phae with ingle tran% break/ &D' Acute Diarr-ea
*treat with atropine+5 Dela.ed Diarr-ea *treat with
loperami%e+
Tooisoerase 2 in-i$itors: etooside"@ePesid%
Block coiling an% uncoiling o A in Q Phae with
ingle tran% break/ &D' .otension
Ta)anes' aclita)el "Ta)ol% an% doceta)el
"Ta)otere%: 6nhibit microtubule unction in M-Phae/Mut ue non-pvc 6J bag an% tubing/ &D' eri-eral
neuroat-. 99< #or neutroenia Al4a.s 3i6e
$e#ore latins
• @inca Alaloids: 6incristine "@incasar% an%
6in$lastine "@el$an%: 6nhibit microtubule unction in
M-Phae/ &D' @esicantsF ner6e
daa3eneuroat-. "ostl. 6incrist