What OTC antifungals for 1st trimester and 2nd/3rd trimesters?2nd/3rd: miconazole 7 day cream 1st: clotrimazole 7 day cream Citro-mag, Milk of Magnesia, Epsom Salts and Fleet Enema. What type of medication are they and what precaution needs to be taken? Osmotic/saline agents for constipation. Avoid in renal failure, risk of hypermagnesia (first 3) or hyperphosphatemia (Fleet enema) Decongestant CIs and cautions CIs: Severe HTN, CAD, MOAI within past 14 days. Cautioned in: CVD, diabetes, hyperthyroidism, prostatic hypertrophy and angle-closure glaucoma Medications to be cautious of in asthma Beta-blockers ASA/NSAIDs/COX-2 inhibitors Beano CI when? Anaphylactic penicillin allergy or taking acarbose. Factors affecting passage into breast milk? molecular weight, weak bases are trapped, weak acids can reabsorb, degree of ionization [only ionized can pass], lipid solubility Drugs that enter breast milk? 1) alcholol 2) narcotics 3) barbituates 4) bdz 5) antidepressants 6) metoclopramide 7) anticholinergics 8) antipsychotics FGA or SGA, which cause prolactin levels to increase? *** risperidone increases levels slightly*** Medications that decrease prolactin levels FGA (eg. haloperidol) bromocriptine, ergot alkaloids, levodopa Medications that increase prolactin levels metoclopramide, methyldopa, haloperidol, phenothiazines (eg. chlorpromazine), theophylline, amphetamines Which antibiotic would you use to treat otitis media? Amoxicillin In renal disease what are the pain killer and diuretic one should consider? (APAP > NSAIDs/ASA) Diuretic: furosemide (loop diuretic > thiazides) Target serum levels for digoxin Target serum levels for lithium 0.8-2.0 ng/ml 0.6-1.2 mmol/L Pain killer: acetaminophen Which UTI Abx do we avoid in pregnancy? 1st trimester: TMP Last 6 weeks: SMX/TMP At term (36+ weeks): Nitrofurantoin *Cipro ALWAYS! Two anti-epileptic medications that cause folate deficiency Why is cloxacillin good for staph aureus? CBZ, PHT Long R-chain that beta-lactamase can not bind. Monitor ammonia. treat What do you monitor in hepatic encephalopathy and what is used to treat it? with lactulose (or a non-absorbed Abx) If patient has gonorrhoea, what do you assume they are coinfected with? What do you empirically treat with? Chlamydia 3rd gen ceph + azithromycin How do you treat Lithium induced tremor? beta-blocker (propranolol) Progestins Corticosteroids. 3x weekly) What DI would we see with anti-cholinergics and metoclopramide? Time to maximal effect in BPH for finasteride? What does SSZ cause a deficiency in? Folate 6 months ACs blunt the pro-motility effects OC with highest failure rate due to non-compliance? micronor (progesterone only) . OxCBZ] Young women should make what adjustment when on epilepsy medications? EE/alternative contraception.5g Children: 200mg/kg What are the 4 classifications of hypersensitivity reactions [Grooms] "ACID" ACID Type I Anaphylaxis Type II Cytotoxic-mediated Type III Immune-complex Type IV Delayed hypersensitivity Teratogenic drugs (Major non-Abx) "TAP CAP" TAP CAP: Thalidomide. Therapeutic dosage: toxicity values for most commonly monitored medications "The magic 2s" "The magic 2s": Digoxin (. VPA (2) Myoclonus: VPA (3) Primary Generalized TC: VPA [CBZ] (4) Partial & Secondary Generalized TC: CBZ [LTG.*Note: monitor thyroid and renal function every 6 months at least LTG effects on BCP and patient weight? Weight neutral Topiramate's effects on weight? rarely decreases effect of BCP Loss possible Antiepileptics/bipolar medications that cause hepatotoxicity? Divalproex. Use BCP with 50ug . Also should take folic acid 5mg or less per day.0) Toxicity = 2.3 hour window.22 microns advantage of darbopoetin vs.8-2. At what APAP ingestion do you consider acetylcysteine? Adults: 6. Androgens. EPO Longer half-life (once weekly dosing vs. Phenytoin Epilepsy DOCs for (1) Absence Sz (2) Myoclonus (3) Primary Generalized TC (4) Partial & Secondary Generalized TC (1) Absence Sz: Ethosuximide. LTG Which NSAID has the greatest risk fo GI bleeds with chronic use? What medication class causes SIADH? SSRIs UVA light Ketorolac What is responsible for phototoxic reactions? What is the filter size for cold filtration? 0. VPA. Aspirin & indomethacin. 5g adults] Phenytoin adverse effects: "PHENYTOIN" PHENYTOIN: P-450 interactions Hirsutism Enlarged gums NYSTAGMUS Yellow-browning of skin TERATOGENICITY Osteomalacia Interference with B12 metabolism (hence anemia) Neuropathies: vertigo.6-1. and headache SSRIs side effects: "SSRI" SSRI: Serotonin syndrome Stimulate CNS Reproductive dysfunctions in male Insomnia Cholinergics (eg organophosphates) effects: "LESS DUMB" LESS DUMB: Lacrimation Excitation of nicotinic synapses Salivation Sweating Diarrhea Urination Micturition Bronchoconstriction BDZ safe in liver failure "LOT" LOT: Lorazepam Oxazepam Temazepam Teratogenic drugs "W/ TERATOgenic" "W/ TERATOgenic": Warfarin Thalidomide Epileptic drugs: phenytoin. Phenytoin (10-20) Toxicity = 20.2) Toxicity = 2. Theophylline (10-20) Toxicity = 20.Lithium (. ataxia. carbamazepine Retinoid ACE inhibitor Third element: lithium OCP and other hormones (eg danazol) Benzodiazepenes: drugs which decrease their metabolism "I'm Overly Calm" "I'm Overly Calm": Isoniazid Oral contraceptive pills . APAP (1-30mg/kg) Toxicity = 200mg/kg (kids) [6. valproate. Which are the Osmotic diuretics? "GUM" "GUM": Glycerol Urea Mannitol Sodium valproate side effects "VALPROATE" "VALPROATE": Vomiting Alopecia Liver toxicity [LTG also hepatotoxic] Pancreatitis/ Pancytopenia Retention of fats (weight gain) Oedema (peripheral oedema) Appetite increase Tremor Enzyme inducer (liver) Nitrofurantoin major side effects "NitroFurAntoin" "NitroFurAntoin": Neuropathy (peripheral neuropathy) Fibrosis (pulmonary fibrosis) Anemia (hemolytic anemia) Zero order kinetics drugs (most common ones) "PEAZ (sounds like pees) out a constant amount": PEAZ out a constant amount: Phenytoin Ethanol Aspirin Zero order • Someone that pees out a constant amount describes zero order kinetics (always the same amount out) Steroids side effects "BECLOMETHASONE" "BECLOMETHASONE": Buffalo hump Easy bruising Cataracts Larger appetite Obesity Moonface Euphoria Thin arms & legs Hypertension/ Hyperglycaemia Avascular necrosis of femoral head Skin thinning Osteoporosis Negative nitrogen balance Emotional liability Hepatic necrosis: drugs causing focal to massive necrosis "Very Angry Hepatocytes" "Very Angry Hepatocytes": Valproic acid Acetaminophen .Cimetidine • These drugs increase calming effect of BZDs by retarding metabolism. which medication should you avoid? Medications that cause dysglycemia • β-blockers • Glucocorticoids • Niacin • Protease Inhibitors • Phenytoin • Thiazide Diuretics • Atypical antipsychotics Cimetidine . VPA. • Warfarin • Anticonvulsants: PHT. • Antibiotics: tetracycline. • Androgens (male hormones). Deontology Beneficence Rightness and wrongness must consider the nature of one's actions as well as the result. • Cocaine. doxycycline and streptomycin.Halothane Antibiotics contraindicated during pregnancy "MCAT""MCAT": Metronidazole Chloramphenicol Aminoglycoside Tetracycline Lithium: side effects "LITH" "LITH": Leukocytosis Insipidus [diabetes insipidus. a hormone. • DES (diethylstilbestrol). tied to polyuria] Tremor/ Teratogenesis Hypothyroidism What are the 5 components of the Canada Health Act? Comprehensiveness Universality Portability Accessibility Public Administration Consequentialism or Utilitarianism Result is all that matter. paramethadione and CBZ • Lithium • Antimetabolite/anticancer drugs: MTX and aminopterin • Antirheumatic agent and metal-binder penicillamine • Antithyroid drugs: thiouracil/PTU and carbimazole/MMI. In one's actions. one should strive for good consequences Non-malificence In one's actions. trimethadione. one should strive for the prevention of harmful consequences Veracity (truth-telling): one should deal honestly and truthfully with others Extensive list of teratogenic drugs • ACEIs • Isotretinoin • Alcohol ingested chronically or in binges. not how you got there. • Thalidomide GERD in renal dysfunction. Ceftaz 3 . Macrolide ICU: 3rd gen ceph + macrolide. influenza If comorbidities w/o oral CS or ABx in past 3 months: 4) Chlamydophila pneumo 5) M. 4th generation ceph. Salmonella spp. 2) Azithromycin [if FQ resistant . FQ Define academic detailing Help physicians adopt better prescribing practices Which liver enzyme elevates first in APAP overdose? AST Define type 1 and type 2 errors Type 2: False Negative Type 1: False positive Antibiotics Most likely to be administered via piggyback IV method? Common Traveller's Diarrhea bugs? E.How long is the minimum nitrate free interval for those wearing a nitro patch for angina? 10 hours Common CAP bugs 1) Strep pneumo 2) Mycoplasma pneumo 3) H. campylobacter] 500mg OD x 3 days or 1000mg as one dose.Imipenem 4 . ciproflox) 3 days schedule or a single dose. Doxycycline. coli.Tobra Drugs to treat CAP More severe: Resp. 3rd gen ceph + resp. catarrhalis If comorbidities AND recent ABx or oral CS use in past 3 months ADD: 6) Legionella Common HAP bugs General ward admission: 1) Strep pneumo 2) Mycoplasma pneumo 3) H.Cipro 2 .eg. Macrolide. Amoxicillin. oflox. 3rd. Drugs to treat HAP General Ward: 2nd. FQ Amoxicillin. Amoxi/Clav. influenza 4) Chlamydophila pneumo 5) Legionella ICU ADD: 1) Gram neg rods (Kleb. Campyrobacter Traveller's Diarrhea treatment options? Prophylactic: 1) Bismuth subsalicylate QID with food 2) Cholera vaccine (B subunit) 2 doses 7-42 days apart Acute: 1) FQs (norflox. Serratia.Gent 5 . Entero. . Acinetobacter) 2) Staph aureus ***Pseudomonas possible in severe cases Aspiration: 1) Anaerobes Medications to treat HAP with pseudomonasTwo of the following: 1 . Shigella spp. has LARGE weight gain and is HUGELY anticholinergic. penicillin. gold. 4 weeks after] Mefloquine-resistance: Doxycycline [qDaily start 1 day prior. Atovaquone/Proguanil [qDaily start 1 day prior. 1 week after] Early delusions or hallucinations in dementia can be indicative of? Time to affect for atomoxetine in ADHD? Lewy body Dementia 6-12 weeks (only 2-3 weeks for stimulants) What does cost utility analysis mean? A measure of years in full health relative to cost of a healthcare intervention. *Can progress to tardive dyskinesia. MMI. PTU. akathisia. can cause agranulocystosis. rabbit syndrome.3) SMX/TMP * loperamide * oral rehydration salts Which medications have additive ionotropic effects if used together? 2) b-blockers 3) digoxin 4) non-DHP CCBs 1) Amiodarone Which dyslipidemia medications can you use in pregnancy and children? cholestyramine) Best medications for HDL & TGs niacin. fenofibrate. NSAIDs and mirtazapine. 4 weeks after]. What are the glaucoma medication classes and how does each lower IOP? decrease aqueous humour formation CAIs (eg. fib? procainamide . Often expressed as QALY [quality-adjusted life years] Maximum dose amoxicillin in children? 90mg/kg/day divided BID or TID What is the Somogyi effect? Rebound hyperglycemia in response to low blood sugar. chloramphenicol. dorzolamide): decrease aqueous humour formation Prostaglandin analogues (eg. High phosphate leads to high PTH which in turn lowers serum calcium levels. Why give calcium carbonate in end-stage renal disease? To reduce serum phosphate levels. CBZ. latan. Often occurs with too high insulin dose at bedtime. timolol): *Note: Clozapine causes constipation 60% of the time. Clozapine and smoking. 4 weeks after] CHQ-resistance: Mefloquine [qWeekly: start 1 week prior. cytotoxic drugs. Medications that cause agranulocytosis? Clozapine. Decreased clozapine levels. fibrates (eg. b-blockers eg. pilocarpine): increase trabecular outflow List types of EPS Dystonia. SMX/TMP. gemfibrozil) Doubling a statin dose increases LDL lowering effect by how much? 6% Resins (eg. Which antiarrhythmic increases HR when treating a. travo): increase uveoscleral outflow Bimatoprost: increase uveoscleral and trabecular outflow Cholinergic agonists (eg. Malaria treatments? DOC: Chloroquine [qWeekly: start 1-2 weeks prior. parkinsonium. 10 days protamine sulfate (1mg per 100 units heparin) MTX (official indication) TGs Visual Disturbances infliximab MUST be used with what medication? What blood serum level can be increased by iostretinoin? Carbamazepine side effects all go away if you slowly titrate except? How do you treat methanol toxicity? ethanol (and vice versa) 60) What is the advantage of PTU over MMI in thyroid storm?PTU prevents the conversion of t4 to t3 Which osteoporosis medication is indicated for MEN with osteoporosis? Prinzmetal angina .what is the DOC? risedronate Amlodipine (CCB) [nitrates also used] Furosemide [not thiazide] Bupropion Patient with hypercalcemia. LTG Which antiepileptics DON'T decrease BCP levels? [CBZ. azithromycin. what do you give? A patient has suicidal ideation. Ethosuximide. SMX. PHT. Topiramate do] Which antibiotics are hepatically eliminated? norfloxacin. VPA. minocycline What is the duration of treatment for cellulitis? What is used to treat heparin overdose? erythromycin. clindamycin.What anticoagulant do you substitute in for a patient with (or past) heparin induced thrombocytopenia? lepirudin How to treat DM in pregnancy? Diet and if necessary insulin Divalproex. moxifloxacin. Which of the following should not be given? Where to find the unapproved indications of drugs? Martindale What should be done if narcotics are stolen from the pharmacy? substances within 30 days How long can insulin be kept out of the fridge? 30 days Report to the office of controlled . Gabapentin.