Rxprep Tables

ALLERGIC RHINITIS
sneezing, itchy nose, eyes or throat, watery eyes, rhinorrhea (runny nose), nasal congestion, post-nasal drip.
NON-PHARM Tx: DRUG Tx:
1. AVOID exposure to allergens.
1. Chronic, Mod-Severe rhinitis
2. IgE – mediated or Blood test.
a. 1st LINE = Intranasal Corticosteroid
3. Nasal irrigation – saline, propylene/polyethylene glycol
2. MILD sx = Oral Antihistamine
4. Neti Pot
a. Decongestants can be used or other agents for itchy eyes.
5. Boiled/Distilled H2O – NEVER use faucet water.
Intranasal Corticosteroids
*1st LINE = for mod-severe most effective class of med to decrease inflammation Have different names for allergy relief & asthma.
GENERIC BRAND ADRs BBW COUNSELING NOTES
Beclomethasone Beconase, Qnasl - Adrenal suppression w/ long-term FLONASE & NASACORT Counseling:
Budesonide Rhinort Aqua use. 1. Shake bottle 1. May take 1 week to get relief.
Fluticasone Flonase HA, dry nose, bad taste, - Delayed wound healing 2. Flonase = Prime 7-days no use 2. Pregnancy - Use Budesonide
Mometasone Nasonex epistaxis (nose bleed), - Avoid if nasal ulcers or trauma. 3. Nasacort = Prime 14-days no use 3. Get nasal exams for long use.
Triamcinolone Nasacort and local infection. - Stunt growth in children 4. Point away when priming 4. AVOID contagious people
- IOP , open-angle glaucoma, 5. Tilt head forward & inhale while 5. Shake well before use
Ciclesonide Omnaris, Zetonna spraying in nose.
Flusinolide cataracts.
Oral Antihistamines 1st generation (more drowsiness)

1st LINE = Mild-Mod Sx. Effective relief of itching, sneezing, rhinorrhea, other immediate hypersensitivity rxns. Has little effect on nasal congestion.
GENERIC BRAND ADRs BBW CONTRAINDICATIONS NOTES
Benadryl
*Do NOT use <6 YO - AVOID use in elderly

Diphenhydramine HCL - Caution in CVD,
Infants, lactating women,
ADULTS = 25-50mg Somnolence, cognitive - Prostate enlargement Lactating women should use 2nd gen
narrow-angle glaucoma,
PO Q4-6H impairment, strong - Glaucoma ALL should be D/C before allergy skin testing.
asthma, AVOID MAOi,
anticholinergic effects - Asthma 1st gen cause photosensitivity
Clemastine Tavist, Dayhist symptomatic BPH, peptic ulcer
- Excessive sedation.
Chlor-Trimeton,
Chlorpheniramine - AVOID use in <2 YO
Chlorphen
Carbinoxamine Arbinoxa, Karbinal
Oral Antihistamines 2nd generation (preferred due to less sedation & more cognitive function)
Cetirizine Zyrtec
Levocetirzine Xyzal - CNS depression 1. Fexofenadine: Take w/ H2O
Fexofenadine Allegra Somnolence occasionally - Sedation w/ other sedating Levocetirizine w/ ESRD 2. AVOID Al+/Mg+ products
Loratadine Claritin meds 3. PREGO - Loratadine/Cetirizine best
Desloratadine Clarinex
Intranasal Antihistamines
Azelastine Astelin, Astepro Somnolence, bitter taste,
Helps w/ Nasal congestion
Olopatadine Patanase HA, nosebleed
Oral Decongestants
α-Adrenergic-Agonist Products containing "D" contain Phenylephrine or Pseudoephedrine Vasoconstriction of sinus vessels
Phenylephrine HCL Sudafed PE 14 Days w/ MAOi Phenylephrine low BA
Sudafed, Nexafed, CV + CNS stimulation - AVOID in <2 YO Phenylephrine: HTN, PSE more effective
Pseudophedrine
Zephrex-D tachycardia ONSET 15-60 mins
Topical (Intranasal) Decongestants
Oxymetazoline Afrin Stingy, burning, sneezing, Effective in 5-10 mins
- AVOID in <2 YO
Naphazoline Privine dryness, rebound *Limit use to <3 days to potential rebound
- MAOi use
Tetrahydrozolline Tyzine congestion after 3 days congestion.
Other
GENERIC BRAND MOA ADRs BBW CONTRAINDICATIONS NOTES
Intranasal Cromolyn Nasalcrom MAST-cell Stabilizer Can be used as Tx + Px
Ipratroprium Bromide Atrovent Anticholinergic GOOD for Rhinitis by drying nose out
Montelukast Singulair leukotriene antagonist 10 mg PO QD, can be used as adjunctive tx
Allergy Shots - 1st dose MUST be
Sublingual Immunotherapy given in doctor's office w/ PT *PT should get RX for Epinephrine Pen
monitored 1st 30 mins
COLD
Viral infxn of URT caused by Rhinovirus/Coronavirus. Transmit through hands or by air. Practice correct hand-washing technique. Self-limiting
NON-PHARM Tx: DRUG Tx:
1. Expectorants
1. Zinc
2. Cough suppressants
2. Vitamin C (Absorbic acid)
3. Decongestants (refer to allergic rhinitis for drug chart)
3. Echinacea
4. Analgesics/Antipyretics
Expectorant – removes phlegm

GENERIC BRAND ADRs BBW CONTRAINDICATION NOTES
N/V/D, dizzy, HA, rash, MAX = 2000 mg/day
Guaifenesin Mucinex, Robitussin Child < 2 yo
upset stomach (Adult)
Cough Suppressants
DM = 5-HT + NMDA blocker Benzonatate = Topical anesthetic
DM =
N/V, drowsiness, Serotonin
Dextromethorphan Delysm, DayQuil MAOi use 14 days Dextromethorphan
Syndrome
Must be > 18 yo to buy
N/V, sedation, constipation, BBW: Respiratory Additive CNS effect w/
Codeine Child < 12 yo
hypotension depression other CNS depressants
Somnolence, confusion, *AVOID in child < 10
Benzonatate Tessalon. Zonatuss
hallucination yo
Diphenhydramine Benadryl
Combination Products Pediatric Concerns/Dosing for Cold medications

GENERIC BRAND Cough/Cold Products Acetaminophen in Infants Ibuprofen in Infants
Dextromethorphan/Promethazine Per FDA, don’t use
Brompheniramine/PSE/DM BromFed DM • OTC meds in < 2 yo Drops: 50mg/1.25 mL
Promethazine • Codeine in child < 12 yo
Promethazine/Phenylephrine/Codeine
VC/Codeine Per manufacturer (relabeled) Suspension: 100
{160mg/5mL}
GuaiFENesin/Codeine Robafen AC, Virtussin AC • NO child < 4 yo mg/5 mL
GuaiFENesin/Codeine/PSE Cheratussin, Mytussin DAC Per AAP - NO child < 6 yo
TussiCaps, Tussionex, Dose: 10-15 mg/kg/dose Dose: 5-10
Chlorpheniramine/Hydrocodone Do NOT use Promethazine in < 2 yo
Vituz Q4-6H PRN mg/kg/dose
Use Q4-6H PRN
Max: 5 doses/24hr
1. Hydration, nasal bulbs, saline
drop/spray Max = 40
2. Ibuprofen or Acetaminophen mg/kg/day
a. Do NOT use ASA (Reyes Sx)
ASTHMA
Inflammation & bronchoconstriction  Airway obstruction and low expiratory exhalation.
Characteristics of Disease Control Risk Factors
1. Recurrent wheezing, breathlessness, chest tightness, & coughing. (Freq. at night & waking)
2. Reversible w/ meds.
1. Avoid Smoking
3. Exacerbations can be mild-severe-fatal.
2. Avoid Triggers
4. Triggered by environment & inflammatory mediators: Histamine, Leukotriene, Cytokines, Mast cells, Eosinophil, or genetics (IgE). Can be any of the
3. Keep exercising (even if EIB)
following:
4. Annual Flu shot
a. Allergens, dust, smoke, chemicals, weather,
5. PPSV23: Age 2-64 yo
b. Lifestyle (stress/exercise), respiratory infxns
6. PCV-13: Age 6-18 yo
c. Meds: ASA, NSAIDs, BB's
5. Comorbidities: Allergy, GERD, Obesity, Sleep apnea, Anxiety, Depression.
Diagnosis Classification
Assess Expiratory volume Impairment Criteria Intermittent Mild-Persistent Mod-Persistent Severe-Persistent
1. Spirometry Daytime Sx ≤ 2 days/wk > 2 days/wk NOT daily Daily Throughout Day
a. Test Forced Vital Capacity (FVC) in 1 second (FEV1)
2. Peak Expiratory Flow (PEF) Night time awakenings ≤ 2x/month 3-4x/month > 1x/wk NOT nightly Often 7x/wk
a. use Peak Flow Meter measuring daily (see below) Rescue Inhaler use ≤ 2 days/wk > 2 days/wk OR > 1x/day Daily Several times a day
Activity Limitations none Minor Some Extreme
Peak Flow Meter Lung Fxn - FEV1% > 80% > 80% 60-80% < 60%
1. Use every morning before any asthma meds. FEV1/FVC Normal Normal 5% Reduction 5% Reduction
2. Stand up straight  Exhale
3. Inhale deeply then blow out HARD & FAST into PEFR & Risk Criteria Intermittent Mild-Persistent Mod-Persistent Severe-Persistent
record the highest of 3 tries. Exacerbations req. PO steroid 0-1 per year ≥2 per year
4. Clean 1x/wk
GREEN Zone = 80-100%
YELLOW Zone = 50-80% Steps for Initiation STEP 1 STEP 2 STEP 3 – consider PO steroid STEP 4/5 – consider PO steroid
(Need Action Plan)
RED Zone = < 50% of personal best
(Go to Emergency Room)
Treatment Algorithm Effectiveness of Therapy General Information

Well Controlled: Spacers:
1. Sx/SABA use ≤ 2 days/wk
STEP 1 SABA PRN (ALL PTs must have SABA PRN) • Helps to coordinate inhalation w/ MDI into lungs & prevents
2. Nightime awake ≤ 2x/month
Alternate Tx: Cromolyn, LTRA, thrush.
STEP 2 Low Dose ICS 3. No limits to activity
Theophylline • Clean 1x/wk soap water
Maintain step/step down if controlled for 3 mons. Nebulizer:
STEP 3 Low-dose ICS + LABA or Med-dose ICS Alternate Tx: Zileuton, LTRA,
Theophylline NOT Controlled: • Turns liquid meds into fine mist.
STEP 4 Med-dose ICS + LABA 1. Sx/SABA use > 2 days/wk If prescribed >1 inhaler PT must wait 60 secs b/t each:
STEP 5 High-dose ICS + LABA Consider adding Tiotroprium for 2. Nightime awake 1-3x/wk • 1st: SABA
PTs > 6 yo if Hx of 3. Some limits to activity • Any other Bronchodilator
STEP 6 High-dose ICS + LABA + PO steroid exacerbation.
Step up 1 step • LAST: ICS
POORLY Controlled: Exercise induced bronchospasms (EIB):
1. Follow up in 2-6 wks 5. Review action plan
1. Sx/SABA use several times/day • SABA is preferred 5-15 mins before exercise but Salmeterol
2. Check Adherence to meds 6. Determine step-up/down Tx
2. Nighttime awake ≥ 4x/wk (LABA) can be used unless it is being used for maintenance.
3. Counsel technique/cleaning 7. Follow up 1-6 months if controlled.
3. Extreme limits to activity Montelukast must be taken 2 hrs prior to exercise.
4. Control risks, triggers, comorbidities
• Rescue Inhalers: should last 12 months w/ good asthma control.
Step up 1-2 steps
ASTHMA
Drug chart
β Agonists - Relax smooth muscle  Bronchodilation
GENERIC BRAND ADRs BBW CONTRAINDICATIONS/CAUTIONS NOTES
ProAir HFA
- MDI's (HFA): Shake well before use
ProAir RespiClick
Albuterol (SABA) - Albuterol inhalers = 200 puffs/inhaler
Ventolin HFA Nervousness o Except Ventolin HFA = 60 inhales
Proventil HFA Tremor - EIB: 2 inhales 5 min. before exercise
Levabuterol (SABA) Xopenex Tachycardia Caution w/ CVD, Glaucoma,
Palpitations Hyperthyroidism, Seizures, Diabetes - ONLY used for PTs on ICS but symptoms not controlled
Hyperglycemia Risk of Asthma - ADD on therapy to Medium dose ICS before
Salmeterol (LABA) Serevent Diskus (DPI)
K+  related death increasing to High dose ICS
- NEVER use NON-Selective β agonists
Racepinepherine OTC (SABA)
Inhaled Corticosteroids (ICS) – inhibits inflammation
Beclomethasone QVAR
Budesonide Pulmicort Flexhaler
Dysphonia (Hard to talk) - Not used for primary Tx of
Flovent HFA
Fluticasone Oral Thrush Asthma or acute episodes of - 1st Line for ALL w/ Persistent Asthma
Arnuity Ellipta - DPI
Cough asthma - Rinse mouth w/ warm H2O or use spacer to prevent
Asmanex HFA -MDI
Mometasone URTI - Adrenal suppression, risk of thrush.
Asmanex Twisthaler - DPI
Hyperglycemia fractures, stunt child growth
Ciclesonide Alvesco
Flunisolide Aerospan
Leukotriene Receptor Antagonists – reduces airway inflammation
Montelukast Singulair Headache Neuropsychiatric events - Mostly used in Children
Zileuton Zyflo Dizzy - Montelukast: 10 mg PO QHS
Ab pain o Granules: must be used w/in 15 mins.
Hepatic imp.
Zafirlukast Accolate URTI - Zileuton: taken with food
LFTs  - Zafirlukast: taken on empty stomach
Anticholinergic
Hyperthermia
Dry skin/dry mouth
- Approved for > 6 YO for Asthma w/ Hx of
Tiotropium Spiriva Respimat Mydriasis
exacerbations despite ICS/LABA Tx.
Constipation
Urinary retention
Xanthines - Blocks Phosphodiesterase  cAMP  Bronchodilation
- MANY DRUG interactions due to IA2/3A4/2E1
- CVD, Hyperthyroidism, PUD,
N/V/HA inhibition
Theo-24 Seizures
HR increase - Monitor Serum Conc.  Tx Range = 5-15 mcg/mL
Theophylline Theo-Cron - Small increase in dose → Large
Insomnia o Measure PEAK
Elixophyllin increase in concentration
Tremor/Nervous - Active metabolites: Caffeine & 3-methylxanthine
o Loading dose based on IBW
- Aminophylline → Theophylline: Multiply 0.8x
Monoclonal antibody - inhibits IgE
Injection site rxn
Given SC Q2-4 wks only in Hospital Indication: Allergic asthma in PT > 6 YO & positive allergen
Omalizumab Xolair Arthralgias Anaphylaxis
under medical supervision. skin test & ICS isn’t enough.
Dizzy/Fatigue
Interleukin-5 (IL5) Antagonist – inhibits IgE
Mepolizumab Nucala Injection site rxn Indication: >12 YO given SC route for Eosinophillic Asthma
Arthralgias
Reslizumab Cinqair Dizzy/Fatigue Anaphylaxis IV only
ASTHMA
Counseling
Meter Dosed Inhalers (MDI)
1. HFA, Respimat, or if there is Suffix (QVAR)
DIRECTIONS FOR USE:
2. Aerosolized liquid med
1. Shake 5 secs before spray
3. HFA uses Propellant
General 2. Exhale fully
4. Req. SLOW DEEP inhalation same time as pressing button.
3. Inhale slowly/deeply while pressing button.
5. SPACER can be used
4. Hold breath 10 secs or long as possible.
6. SHAKE Well except for QVAR, Alvesco, Respimat
Ventolin HFA PRIME: CLEAN:
ProAir HFA Spray 4x: into air while shaking between sprays. Prime if not used for 14 days or if dropped. Remove metal canister (do not get wet) & rinse mouthpiece w/ warm H2O then AIR DRY (1x/wk).
CLEAN:
Flovent HFA
PRIME: Use clean cotton swab to wipe mouthpiece then AIR DRY.
Spray 4x into air while shaking between sprays. Prime if not used for >7 days or >5 days for Dulera CLEAN:
Dulera
Wipe mouthpiece w/ clean dry cloth. NEVER put in H2O.
Symbicort PRIME: CLEAN:
QVAR Spray 2x into air while shaking between sprays. Prime if not used for 7 days or ≥10 days for QVAR Wipe mouthpiece w/ clean dry cloth. NEVER put in H2O
Dry Powder Inhalers (DPI) Soft Mist Inhaler/Inhalation Spray

1. Diskus, Ellipta, Pressair, Handihaler, Neohaler, RespiClick. Combivent, Spiriva, Striverdi, Stiolto
2. Fine powder inhalation 1. Propellant free and delivers drug in fine mist
3. NO Propellant 2. Better lung deposition and requires less inhalation effort
General 3. To use for first time (keep cap closed until step 5)
4. Req. forceful quick inhalation w/o pressing button same time
5. NO SPACERS a. Press safety catch and pull off clear base
6. Do NOT Shake b. Insert cartridge into inhaler and push against surface
c. Replace clear base
1. Pull Thumb-grip away til mouthpiece shows. d. Turn base in direction of arrow until you hear a click
2. Slide lever until it clicks. e. Flip open cap until it clicks into open position
3. Exhale away from mouth. f. Point inhaler toward ground and press dose release button until a cloud is visible then
Advair Diskus 4. Inhale quick/deep repeat 3 more times before use
5. HOLD long as possible or 10 sec 4. Daily use (T.O.P)
6. Rinse mouth w/ H2O & spit. a. Turn base in direction of arrow until you hear a click (keep cap closed)
Do NOT wash just AIR DRY b. Open cap until it clicks into open position
c. Close lips around inhaler and Press button while taking in a slow deep breath
1. Twist off white cover while twisting brown base far as it will go in other
direction til you hear a click. (Loaded) Combination Products
2. Do NOT shake the inhaler.
Pulmicort Flexhaler 3. Turn head away & exhale fully.
4. Inhale deep/forcefully.
5. Rinse out mouth and spit.
ICS/LABA Combos:
Let AIR DRY no H2O Budesonide/Formoterol (Symbicort)
1. Open cap all the way til it clicks. Fluticasone/Salmeterol (Advair Diskus/HFA)
a. Opening/Closing cap w/o inhaling wastes medication. Mometasone/Formoterol (Dulera)
ProAir RespiClick 2. Exhale all the way away from inhaler.
AirDuo RespiClick 3. Inhale deeply & HOLD long as possible or 10 secs
NO PRIMING needed. Only use dry cloth NO H2O to clean.
SMOKING CESSATION
GENERAL INFORMATION The "5-A's" Model:
1. Providers must inquire about Tobacco use. 6. E-Cigs should not be recommended. 1. ASK about tobacco use.
2. 1-800-QUIT-NOW 7. Counsel all pregnant women, children, & light smokers (<10 cigs/day). 2. ADVISE to quit.
3. Counseling is just as important as medications. 8. Smokers 19-64 YO need Flu + Pneumovax 23 vaccines. 3. ASSESS willingness to quit.
4. Combination Tx can be used 1st LINE. 9. Smoke induces CYP450-A12 → Supratherapeutic levels of med. 4. ASSIST in quit attempt.
5. Meds are always recommended unless CI. 10. Women > 35 YO should not take Oral Contraceptive (CVD risk) 5. ARRANGE follow up.
GENERIC BRAND ADRs BBW C/I NOTES

Nicotine Patch NicoDerm CQ 1. HA/Dizzy 1. >18 yo + ID for purchase
Nicotine Polacrilex Gum Nicorette Nicotine Replacement Tx 2. Insomnia 2. Combo w/ short-acting = Most
AVOID in post-MI,
Nicotine Polacrilix Lozenge Nicorette Mini (mostly OTC) - ALL products; 3. Nervousness effective
arrhythmias, angina, and
Nicotine inhaler Nicotrol inhaler (RX) wait 15 mins after eating or 3. Remove patch before MRI.
*Patch: vivid dreams pregnancy.
drinking for use 4. Gum/Lozenge (4mg) shown to
Nicotine Nasal Spray Nicotrol Spray (RX) *Inhaler: throat irritation reduce weight gain.
Other Medications
GENERIC BRAND MOA ADRs BBW CONTRAINDICATIONS NOTES
1. Dry mouth 3. Agitation 1. Seizure disorder
- Do NOT use w/ other forms of Buproprion.
Dopamine/NE Blocker 2. Insomnia 4. Headache 2. Anorexia/Bulimia
Suicidal behavior in young pts - Start 1 week before quitting smoke.
Buproprion SR Zyban N/V/Dizzy, constipation, tremors, 3. MAOi 14 days
tapering not needed like other Anti-depressants. - MAX Dose = 300 mg/day
blurred vision, anxiety, tachycardia, 4. Benzos, AEDs,
- Wait 8 hrs if splitting dose.
sweating. Barbiturates
3. Abnormal - START 1 week before quit date OR START and quit
1. Serious Psychiatric behavior pts unable to quit
α-4-β-2 nicotinic agonist 1. Insomnia dreams between 8-35 days.
2. Seizures immediately should cut
Varenicline Chantix 2. Nausea 4. Headache - Take after meal + glass of H20.
tapering not needed 3.  ETOH + Blackout risk smoking by 50% every 4
- Decrease ETOH use.
Constipation, vomiting, flatulence. 4. Sleep walking weeks.
- Caution serious rxns (facial swelling, rash, peeling skin)
Counseling & Dosing

DRUG COUNSELING DOSING
1. Apply new patch start of each day, dispose used in Pouch.
2. Apply to clean, dry, hairless skin & hold for 10 secs.
3. Wear the patch for 24 hrs. Only remove before sleep if abnormal dreams occur. Cigarette use Week 1-6 Week 7-8 Week 9-10
Nicotine Patch 4. Fold inward & discard in pouch then place in trash. > 10 cigs/day 21 mg patch 14 mg patch 7 mg patch
5. Wash hands before/after use. ≤ 10 cigs/day 14 mg patch 7 mg patch No recommendation
6. Rotate site of patch. Don’t use same site for 1 week.
7. NEVER cut patch or use > 1 patch at a time.
1. Chew slowly til "tingle" or "flavored taste" then PARK gum in cheek.
a. Repeat when tingle/flavor goes away *Min 9 pieces/lozenges per day for the 1st 6 wks
Nicotine Gum Chew/Dissolve 1 piece every:
2. Use for 30 mins.
3. Use 1 piece Q1-2hrs No more than 24 pieces per day Smoke 1st cigarette Dose Weeks 1 – 6 Q1 – 2H
> 30min after waking 2mg  Weeks 7 – 9 Q2 – 4H
1. Place in mouth let DISSOLVE slowly ≤ 30 min after waking 4mg Weeks 10 – 12 Q4 – 8H
Nicotine Lozenge 2. Move side to side for 20-30 mins.
3. NEVER use > 1 at a time. No more than 20 lozenges per day
1. Puff inhaler in short/freq breaths + inhale deeply.

2. Each cartridge gives 20 minutes of continuous puffing.
Nicotine Inhaler
3. Clean mouthpiece w/ soap + water regularly.
4. Keep at room temp (in pocket).
1. Spray once in each nostril while breathing through mouth.
Nicotine Nasal Spray 2. Do NOT sniff, swallow, or inhale through nose
3. Wait 5 mins after use before driving or heaving machines.
PULMONARY ARTERIAL HYPERTENSION (PAH)
continuous high BP in the pulmonary arteries. PAH = mean PAP (mPAP) ≥ 25 mmHg.
Signs & Symptoms Causes of Pulmonary Fibrosis: NON-PHARM Tx: DRUG Tx:
1. Anti-Coagulation w/ Warfarin: INR Goal = 1.5 - 2.5.
2. Loop Diuretics for volume overload.
Fatigue 3. Digoxin to improve CO or control HR.
Dyspnea Amiodarone 1. Sodium restrict < 2.4 g/day 4. Perform Acute Vasoreactive Testing.
Chest pain Methotrexate 2. Flu/Pneumonia Vaccines a. During which drugs are given to illicit a response.
Syncope Nitrofurantoin 3. Avoid High Altitudes. i. RESPONDER: mPAP falls by at least ≥10 to a value less than <40.
Edema Sulfasalazine 4. O2 Sat > 90. 1. Give CCB: Nifedipine, Diltiazem, and Amlodipine.
Tachycardia a. NOT Recommended = Verapamil.
ii. NON-RESPONDERS: or PTs failing CCB Tx need ≥1 vasodilator.
1. Prostacyclins, ERAs, PDE-5, or sGC.
Treatment Algorithm Prostacyclin Analogues (Prostanoids) - Potent Vasodilator + Inhibit platelet aggregation.
Flolan (IV)
Epoprestenol Vasodilation Rxns Heart failure - Parenteral = most potent.
Veltri (IV) - Avoid interruption in Tx.
- (Hypotension, HA,
Remodulin (IV, SQ) Rebound PAH - Avoid large/sudden dose
Dizzy, Flushing)
Trepostinil Tyvaso (inhaled) (Don't DC Hepatic imp. reductions.
N/V/D
Orenitram (ER tab) abruptly) - Epoprostenol = Protect
Jaw Pain
IV infusions → from light
Anxiety/Tremor
Iloprost Ventavis (inhaled) Infections - Flolan = reqs. ice packs for
Thrombocytopenia
solution.
Infusion-site Pain
Selexipag Uptravi (tab) - Avoid NSAIDs
Endothelin Antagonist (ERA) - Blocks Endothelin vasoconstriction.

Bosentan Tracleer HA Embryo-Fetal toxicity
URTI - Women need Neg.
Prego test before use & - REMS Program
Ambrisentan Letairis Flushing
Hypotension monthly. Pregnancy Bosentan = ↓ effectiveness
Fluid Retention of Contraceptives.
Bosentan = Hepatotoxicity
Macitentan Opsumit Hgb/Hct (ALT/AST)
PDE-5 inhibitor - Pulmonary relaxation/vasodilation.

Sildenafil Revatio HA
Flushing Hypotension Use of
Dyspepsia Hearing/Vision loss Nitrates or
Tadalafil Adcirca Extremity/Back pain Priapism Riociguat.
Epitaxis
Soluble Guanylate Cyclase (sGC)

Headache Embryo-Fetal toxicity

WHO-FC: World Health Organization Functional Classification - REMS Program
Bleeding - Women need - Pregnancy
- Class I = patients with PH but without limitation of physical activity - Space out
Riociguat Adempas Pulmonary edema Neg. Prego test - use of PDE-5 or
- Class II = patients with PH resulting in slight limitation of physical activity o Sildenafil = 24 hrs
Hypotension before use & Nitrates
- Class III = patients with PH with marked limitation of physical activity o Tadalafil = 48 hrs
N/V/D monthly.
- Class IV = patients with PH unable to be physically active and with signs of right heart failure
GOUT
Uric acid built up in joints – end-product of Purine metabolism. → PT may be Asymptomatic → Sx - painful, burning, swelling joint. → Typically starts in 1 joint (Big Toe)
Risk Factors Treatment Pearls DRUG Tx

Chronic Urate-Lowering Treatment
Acute Gout Attacks
• Male • HTN, CKD 1. NEVER treat asymptomatic - Use NSAID, steroid, or Colchicine
- ULT should be given to those w/ gout who had an attack, intermittent
• Obese • Age sx or tophi.
hyperuricemia. - Use meds at 1st sign of attack
• Excess ETOH • Meds - Gout ppx: NSAIDs or Colchicine
2. ONLY Tx after Gout Attack. - Combination Tx w/ any 3 for severe
- 1st LINE = Allopurinol (XOi) or Febuxostat
3. GOAL = Uric acid < 6mg attacks.
- 2nd LINE = Probenecid (if XOi is C/I) or added if UA level isnt below
Reduce risk: AVOID organ meats high- 4. Drugs used to Tx different - Ice packs or IA injection
<6mg/dL while maxed out on XOi.
fructose corn syrup, ETOH. from ppx - Chronic urate-lowering Tx (ULT) should
o Lesinurad is also 2nd Line taken w/ XOi.
continue w/o interruption
- Peglitocase - reserved for Severe Refractory dx
Anti-gout = interference with migration of neutrophils
NVD 1. Start w/I 36 hrs of Sx onset.
Myelosuppression GI Sx
2. Ppx dose should be held for 12 hrs AFTER Tx dose begins.
Myopathy Myopathy
Colcrys 3. AVOID Cyclosporine
Colchicine Neuropathy Myelosuppression P-GP or CYP3A4 inhibitor
Mitigare - Dose: 1.2 mg PO (2x 0.6 mg) followed by 0.6 mg in 1 hr.
Cramping Use w/ gemfibrozil,
Loose stools o Do NOT Exceed 1.8mg/hr or 2.4mg/day.
statins, non-DHP CCBs
ACUTE TX
Vit-B12  o Dose every 3 days (NO earlier)
NSAIDs
Indomethacin Indocin
Naproxen Naprosyn - AVOID use severe Renal Dx.
Refer to pain handout
Celecoxib Celebrex - Celecoxib has most CVD risk
Sulindac Clinoril
Steroids – can be given PO, IV, IM, ACTH
Prednisolone Prednisolone Hyperglycemia, HTN,
- 0.5 mg/kg/day 5-10 days OR 0.5 mg/kg/day 2-5 days followed by
Methylprednisolone Medrol insomnia, appetite Refer to steroids handout
increase taper over 7-10 days
Triamcinolone
Xanthine Oxidase Inhibitors
Rash, Nausea, Gout Hepatotoxicity (in - Hypersensitivity (SJS/TEN)
Allopurinol Zyloprim attacks, diarrhea, Asians HLA- - Do not use for asymptomatic - Lower dose w/ CKD
LFTs  B*5801test prior) hyperuricemia - Take w/ FOOD
- Didanosine - 1st 3-6 mons. use w/ Colchicine or NSAID
Hepatotoxicity, - Mercaptopurine - AVOID Antacids use
Rash, nausea,
Febuxostat Uloric Thrombosis, Gout - Azathioprine - Allopurinol - Start 100mg titrate up to 300mg divide BID
arthralgia, LFTs 
attack - Peglitocase
Uriosurics
Warning: CrCl <30 - Combination with Colchicine available (Col-Benemid)
Do NOT with use ASA
Hypersensitivity - Probenecid can be used to  Beta-Lactam levels
Probenecid Hemolytic anemia in Blood dyscrasias, nephrolithiasis
Hemolytic Anemia - Decrease clearance of ASA, PCNs, cephalosporins, carbapenems.
G6PD deficiency G6PD deficiency, child <2 yo
CHRONIC TX
- Decreases efficacy of Loop diuretics while increasing toxicity.
SCr , renal failure, CrCl <30, ESRD, Dialysis,
Lesinurad Zurampic Acute Renal failure - Take QAM w/ XOI + FOOD + H2O
nephrolithiasis, HA Kidney Transplant
Recombinant Uriocase
Anaphylaxis – (pre-
AB formation, gout - Injection ONLY
medicate w/
Pegloticase Krystexxa flare, infusion rxn, G6PD deficiency - Give NSAID or Colchicine 1 week prior to infusion for 6 months.
Anti-histamines &
nausea, skin probs - NEVER use w/ Allopurinol or Febuxostat
Steroids.)
- Injection ONLY
- PT's at risk for TLS should receive IV hydration
Edema, HA, anxiety,
ONLY USED FOR: Tumor Lysis - Monitor CBC
Rasburicase Elitek rash, NV, ab pain, Anaphylaxis
Syndrome - Life-threatening complication of Chemo-Tx or Cancer. Cells lyse open and
diarrhea, constipation
purines are released quickly converting to uric Acid, aka "Acute Gout"
attack causing electrolyte abnormalities.
MOTION SICKNESS
Signs & Symptoms NON-PHARM Tx: DRUG Tx:
1. Sea-Band
1. Nausea 3. Diphenhydramine (Benadryl)
(acupuncture) 1. Transderm Scop
2. Dizziness 4. Promethazine (not for children)
2. Ginger Tea 2. Meclizine
3. Fatigue 5. Cyclizine (Marezine)
3. Peppermint
Anti-Histamine/Anti-Cholinergic
MOST commonly prescribed NOT more effective than OTC
Dry mouth
CNS effects (drowsy,
dizzy, confusion) Belladonna Allergy
Scopolamine 3-Day Transderm Applied behind EAR
Eyes Stinging Angle Closure
Patch Scop Lasts 3 days.
Pupil Dilation Glaucoma
Risk of IOP
Tachycardia (rare)
Anti-Histamine
Dramamine
WARNING:
Bonine Sedation
CNS Depression Oral agents must be
Day-Less Dry mouth
Meclizine Impairment taken 30 - 60 mins
Drowsy Dry/Blurry Vision
Worsens BPH Sx prior.
Motion Time Tachycardia
Increase IOP
Travel Sickness
TRANSDERM SCOP – Counseling Instructions

1. Apply to clean, dry, hairless area behind the ear.
2. Press firmly for at least 30 seconds to seal edges of patch.
3. Apply 4 hrs. before needed effect
4. Wash hands w/ soap before & after. (Avoid Eyes)
5. Renew patch only every 3 days & only one at a time.
6. Causes drowsiness so avoid ETOH.
7. Remove patch before MRI.
ERECTILE DYSFUNCTION
Most commonly caused by reduced blood flow to penis. Common in CVD such as HTN, Atherosclerosis, or Diabetes.
Psychological Causes NON-PHARM Tx DRUG Tx: Drugs Causing ED
SSRIs/SNRIs
Beta-Blockers
1. Weight Loss Clonidine
• Depression
2. Quit smoking/ETOH 1st Gen Anti-Psychotics
• Stress • 1st Line = PDE-5 inhibitors
3. Yohimbe • (Haloperidol, Fluphenazine,
• Spinal cord injury 4. L-Arginine • 2nd Line = Alprostadil Chlorpromazine, Risperidone,
• Stroke 5. Panax Ginseng Paliperidone)
BPH Meds
• Finasteride, Dutasteride, Silodosin
PDE-5 Inhibitors
Release NO  cGMP increase  Smooth muscle relaxation  Increase BF to penis.
Viagra HA/Dizzy Use w/ Nitrates or Riociguat
Sildenafil Flushing Start 50mg 1hr before sex.
Revatio (for PAH) WARNING:
Dyspepsia Viagra/Cialis
Cialis Blurred vision Color discrimination Daily 2.5-5 mg
Tadalafil Hearing/Vision loss 50% dose reduction if:
Adcirca (for PAH) Tinnitus PRN 5-20 mg
Hypotension • ≥ 65 yo
Photosensitivity
Epistaxis Priapism • Using Alpha-Blocker
Avanafil Stendra
Diarrhea Chest Pain - Refer to (HypoTN)
Myalgia/Back pain PCP • Using CYP3A4 inhibitor
Levitra
Vardenafil • Severe Renal/Liver Dx
Staxyn ODT • mostly Cialis
Prostaglandin E1 - vasodilator that allows blood to flow

Alprostadil - Caverject Penile implants
(Injections) Edex Penile abnormalities
Penile pain
Priapism Conditions that predispose Must refrigerate
Alprostadil - (Urethral HA/Dizzy
Muse to priapism (sickle-cell
Pellets)
anemia, myeloma, leukemia)
5-HT1A agonist/5-HT2A antagonist - does NOT enhance sexual performance

• For premenopausal women
• ETOH causes
Dizzy ONLY
Hypotension +
Somnolence Syncope. • REMS Program
Nausea ETOH • Treatment for hypo-active
Flibanserin Addyi
Fatigue • AVOID CYP3A4 Pregnancy
inhibitors sexual desire disorder (HSDD):
Dry mouth o Low sexual desire that is
Insomnia • Hepatic
not caused by health
impairment
condition or drugs.
BENIGN PROSTATE HYPERPLASIA
General Information Signs & Symptoms (LUTS) Drugs that Worsen BPH AUA Guidelines for Tx
Anticholinergic medications
• Enlarged gland leads to Lower urinary tract Sx (LUTS) Hesitancy
Antihistamines • Depends on severity of Sx.
• Bladder outlet obstruction (BOO) + contractions lead to freq. urination. Intermittency • No natural product recs.
Caffeine
• DRE - Digital Rectal exam Weak stream of urine
Decongestants 1. Alpha-blockers
Urgency
• Study urinalysis + Prostate specific antigen (PSA) Leaking/Dribbling
Diuretics
2. 5α-reductase inhibitors
• NOT associated with prostate cancer Testosterone products
Incomplete emptying a. Do NOT use in BPH w/o enlargement.
• Sx are similar to prostate cancer SNRIs
Frequency 3. Tolterodine optional
TCA's
• UTI infections are uncommon Nocturia 4. PDE-5 inhibitors
Phenothiazines
α-blockers - relax smooth muscle leading to improved urinary flow

GENERIC BRAND ADRs BBW CONTRAINDICATION NOTES COUNSELING
Terazosin (Non-selective) • Non-selective α-blockers must be • Alone or combo w/ 5-alpha
titrated
• 1st Line for Mod-Sev Sx.
• Usually taken at bedtime to avoid
Doxazosin (Non-selective) Cardura • Non-selective = More side Fx.
Dizziness/HA Orthostatic hypotension first dose effect of orthostatic HTN.
Fatigue Syncope
Silodosin/Alfuzosin + CYP3A4 • Caution w/ PDE-5 inhibitors (BP)
Hepatic imp. (Child-Pugh C) 0.4mg 30 min after same meal each • Alpha-Blockers do NOT shrink
Tamsulosin (Selective Alpha-1A Blocker) Flomax Abnormal Ejaculation Floppy Iris Syndrome
Renal imp. day. prostate or alter PSA levels.
Fluid retention Priapism
Rhinitis Angina • Counseling:
Alfuzosin (Selective Alpha-1A Blocker) Uroxatral Do NOT use if risk for QT Prolongation.
1. Caution standing up
Can cause retrograde ejaculation 2. CNS Fx
Silodosin (Selective Alpha-1A Blocker) Rapaflo 3. Avoid ETOH
(reduced or NO semen)
5α-reductase inhibitors - blocks conversion of Testosterone  DHT

Finasteride Proscar Impotence • Pregnant women should not

Libido Women of child-bearing age handle/take.
Increase risk of Prostate
Ejaculation disturbance
cancer.
Pregnancy • Shrink prostate + PSA level Only used in BPH + enlargement
Breast Children • Do NOT use Proscar in a PT using
Dutasteride Avodart
enlargement/tender Propecia for hair loss.
PDE-5 inhibitors
HA/Dizzy Color discrimination

Flushing Hearing loss
Cialis Dyspepsia Vision loss Do NOT use w/ nitrates or
Tadalafil 5mg daily same meal.
Adcirca Blurred vision Hypotension Riociguat
Myalgia Priapism
Diarrhea Chest pain
OVERACTIVE BLADDER
General Information NON-PHARM Tx DRUG Tx: How to Minimize Dry Mouth Sx
• Urinary urgency w/ or w/o
incontinence (lacking control). Non-Drug Tx is 1st line Drug Tx is 2nd line
• Increased frequency + nocturia Combo w/ Non-Pharm tx. • Avoid combo Anti-cholinergics
• M3-Muscarinic receptors via ACH 1. Bladder training • Try Extended-Release
trigger stimulation of detrusor 2. Kegel exercises 1. Anti-Cholinergics • Try Oxybutynin gel/patch
muscles  involuntary 3. Dietary changes 2. B-3 Agonists
• Mirabegron - less dry mouth
contractions. 4. Weight loss 3. Onabotulinumtoxin-A
• 1st Line Tx = Behavioral therapy
Anticholinergics - block ACH binding to Muscarinic receptors. XR formulations are preferred (less dry mouth)
Oxybutynin Ditropan
Oxybutynin Patch Oxytrol Dizzy/Drowsy
Tolterodine Detrol Agitation Urinary retention
Xerostomia Oxybutynin Patch/Gel = Less
Confusion Gastric retention
Trospium XR Sanctura XR Constipation dry mouth.
Drowsiness Low gastric motility
Solifenacin Vesicare Blurred vision Trospium XR = Empty Stomach
Angioedema Narrow Angle Glaucoma
Darifenacin Enablex Urinary retention
Fesoterodine Toviaz
Beta-3 agonist - causes less dry mouth

HTN
Nasopharyngitis
Angioedema
Mirabegron Myrbetriq UTI Caution w/ Digoxin
Urinary retention in BPH
HA/Dizzy
Constipation
Inhibit ACH release – 3rd Line Tx

UTI
Swallowing trouble Prophylaxis with abx before
Onabotulinumtoxin-A Botox Urinary retention Infection at injection site
Breathing trouble admin.
Dysuria
Anti-Diuretic Hormone
Risk for Hyponatremia
Loop diuretics
Noctiva Hyponatremia
Desmopressin CKD
DDAVP injection Nasal conditions
SIADH
Fluid retention
SICKLE CELL ANEMIA
General Information NON-PHARM Tx: DRUG Tx: Immunizations
• Inherited RBC genetic disorder (most common in Blacks)
• PTs have abnormal hemoglobin called HgbS. 1. Immunizations
• Give concave sickle shape of RBC shortening lifespan of RBCs 2. ABX
1. Blood Transfusions:
to 10-20 days  anemia & fatigue. a. GOAL Hgb = < 10 3. Analgesics
• PTs lack O2 transport & clumping in blood vessels. g/dL. a. Mild-Mod Pain:
1. Influenza Type B
• Sickle Cell Crises: b. Risk of Iron overload. i. Tx w/ NSAIDs or
Vaccine (HiB)
o Vascular occlusion leads to ischemia + O2-deprivation. 2. Chelation Therapy: acetaminophen, rest,
2. Pneumococcal
o Vaso-occlusive Crisis (VOC) aka Acute Pain Crisis. a. Used to remove compresses.
vaccine
▪ Leads to pain in lower back, abdomen, chest, & excess Iron. b. Severe Pain:
3. Meningococcal
extremities. i. IV Opioids
vaccine.
• Functional Asplenia: ii. PT-Controlled
o Decreased or absence of spleen function. Analgesia (PCA)
Only cure is bone marrow 4. Chelation Tx
▪ Spleen becomes fibrotic & shrinks in size. transplant but risky + cost.
▪ PT unable to recycle RBCs & store/produce WBCs. 5. Hydroxyurea or L-Glutamine
a. Reduce complications
• PTS are risk for Infections. Should get
immunizations, ABX.
Stimulates Hgb-F production

• IND: ≥ 3 Mod-Sev Pain crises in 1
LFTs year
Uric Acid Embryo-Fetal toxicity • Contraception is required - During
BUN/SCr Avoid Live Vaccines & up to 1 year after
N/V/D Skin ulcers
Hydroxyurea
Droxia
Mouth ulcers
Myelosuppression
Pancreatitis • Hazardous - Wash hands & wear
Hydrea Leukemia/Skin cancer Gloves
Anorexia Macrocytosis
Hyperpigmentation • Supplement Folic Acid
Atrophy of Skin/Nails Use Sun Screen to protect skin. • Monitor:
Low Sperm count o CBC w/ Differential
o ANC < 2000
Unknown
Constipation
Nausea Mix each dose in 8 oz. of COLD or
L-Glutamine Endari HA ROOM temp. beverage OR in 4-6 oz.
Back/Extremity pain of food.
Cough
BIPOLAR DISORDER
General Information Mania Diagnosis DRUG Tx:
• Mood disorder w/ fluctuations from extreme sadness or
hopelessness  abnormally elevated overexcitement or 1st line: SGAs are preferred for Tx of Bipolar disorders.
irritable mood called mania or hypomania. 1. Toxicology should be performed if due to illicit drug use.
• Each episode is a drastic change in mood/behavior. • Abnormally 2. GOAL: to stabilize mood w/o inducing fluctuations.
• Bipolar PTs are more susceptible to Drug-Induced elevated/irritable mood 3. Anti-Psychotics: only used if PT has psychosis.
extrapyramidal symptoms (EPS) esp. with first generation for 1 week OR any 4. Anti-Depressants: NOT recommended - induce mania
antipsychotics duration req. a. ONLY given if PT is already on Mood Stabilizer
hospitalization.
BIPOLAR 1: BIPOLAR 2: • Depression ACUTE Tx: MAINTENANCE Tx:
• Severe Mania • Hypomania • Inflated Self-esteem
1st line for manic state Bipolar Depression:
• Intense Depression • Does NOT affect social/work • Talkative
• Valproate + Anti-Psychotic • Lamotrigine
• May be • NO cause of psychosis • One topic to next Bipolar Mania:
• Lithium + Anti-Psychotic
Psychotic/Delusional • Intense Depression • Easily distracted 1st line for bipolar depression • Valproate
(may req. • PTs feel better during Mania so • High risk activities • Lithium • Carbamazepine (Equetro)
hospitalization) often misdiagnosed for only Mania + Depression:
• Lamotrigine
Depression during that phase. • Lithium +/- SGA
Mood Stabilizers Pregnancy Medication Guides
Avoid
Treatment for both mania + depression • Valproate
Lithium Anti-Depressants
o Causes fetal syndrome
Valproate • MedGuide for Suicide risk.
• Carbamazepine
Lamotrigine o Causes fetal syndrome Anti-Psychotics
• NOT used for acute mania due to slow titration & • Lithium • MedGuide for Death risk in elderly PTs
severe rash. o Causes abnormalities w/dementia-related psychosis
Carbamazepine
SGAs = Preferred d
GENERIC BRAND ADRs BBW C/I NOTES DOSING

INITIATION:
Lithium toxicity 1. Titrate slowly  QHS
2. Take w/ FOOD
GI upset Risk of Serotonin Syndrome 3. Drink plenty of FLUIDS
• Nausea, Anorexia, • SSRIs/SNRIs Dose Correctly:
Ab-pain Factors affecting concentration
• Triptans • 5 mL Solution = 8 mEq
Cognitive Fx • Mild-Mod Renal Imp. Lithium levels
• Linezolid • 300mg Tab/Cap = 8
Lithium Lithobid Cogwheel Rigidity (Lithium is 100% •  sodium intake
mEq
Tremor
Risk of Neurotoxicity
renally cleared) • ACEi/ARBs
Weight gain • NSAIDs (use ASA)
(Ataxia, tremor, nausea) Therapeutic Range: 0.6 - 1.2
Polyuria/Polydipsia Lithium levels
Hypothyroidism • Non-DHP CCBs
• Phenytoin •  sodium Intake
• Carbamazepine • Caffeine
• Theophylline
ANXIETY
General Information NON-PHARM Tx: DRUG Tx: Benzodiazepines
1st line = SSRI or SNRI 2nd line: Metabolism + Safety

Cognitive Behavioral Tx (CBT)
• Escitalopram • Buspirone
1. Continuous + Severe amount of great AVOID Drug-induced Anxiety • Lorazepam
• Fluoxetine o takes 2-4 wks
distress, fear, & worry. • Albuterol • Oxazepam
• Paroxetine • Amitriptyline (Elavil)
2. Inability to focus at school/work. • Anti-Psychotics • Temazepam
• Sertraline • Imipramine (Tofranil)
3. Harmful to relationships.
• Bupropion • Duloxetine • Nortriptyline (Pamelor) "L-O-T" are less harmful for
• Caffeine • Hydroxyzine (Vistaril) PTs w/ Liver impairment
DSM-5 Classifcation of Major Types of Anxiety: • Venlafaxine XR
• Decongestants (PSE) o Sedating since metabolized to inactive
General Anxiety Disorder (GAD) compounds (Glucuronides)
Panic Disorder (PD) • Illicit Drugs 1. Start at 1/2 initial dose Anti-histamine
Social Anxiety Disorder (SAD) • Steroids 2. Slowly Titrate o NOT used long-term 1. Used short-term & fast
Obsessive Compulsive Disorder (OCD) • Stimulants 3. Take 4-wks for relief • Pregabalin (Lyrica) relief.
Post-Traumatic Stress Disorder (PTSD) • Levothyroxine o C5 - Tx anxiety + 2. Used for acute-anxiety.
neuropathy 3. D/C after 1-2 wks.
• Theophylline
• Propranolol (Inderal) 4. ANTI-DOTE = Flumazenil
Nausea/Headache • MAOi w/in 14 days

Buspirone Dizziness • Avoid Serotonergic Meds
Drowsiness (Serotonin Syndrome)
Benzodiazepines (C4)
Lorazepam Ativan
Alprazolam Xanax BBW: Diazepam:

Respiratory Depression • Lipophilic
Clonazepam Klonopin Coma/Death • Opioids • Fast Onset/Long Half-life
Somnolence WARNINGS: • Pregnancy • High Abuse potential
Diazepam Valium Dizziness • Dependence/Tolerance in • AVOID other CNS Depressants
Lightheadedness chronic use so must taper off Used for ETOH Withdrawal Sx:
Oxazepam Weakness (if using > 10 days) ALPRAZOLAM: • Lorazepam
Ataxia • Amnesia • C/I with Ketoconazole/Itraconazole • Diazepam
Chlordiazepoxide • CNS depression (Strong CYP3A4) • Chlordiazepoxide
• Abuse
Clorazepate Tranxene-T • > 65 yo: safety risks.
Temazepam Restoril NOT FOR ANXIETY

ALZHEIMER’S DISEASE
General Information Signs & Symptoms Drugs that WORSEN Dementia: NON-PHARM Tx: DRUG Tx:
• Cognitive decline  dementia

w/ noticeable memory loss. • Memory loss • Anti-Histamines
• Tx does very little for neurotic • Difficulty communicating • Anti-Cholinergics • ACH inhibitors - slows progression
plaques & tangles. • Inability to learn • Anti-Emetics 1. Vitamin-E o Donepezil - Take at
• DIAGNOSIS: Mini-Mental • Difficulty planning or • Anti-Psychotics 2. Gingko Biloba bedtime.
State Exam (MMSE organizing (bleed risk) o Memantine - Alone or
• Barbiturates 3. Vitamin-D Adjunct to other meds
Score < 24) • Poor coordination/
• BZDs (helps memory) • Anti-Psychotics/Anti-Depressants
• ELDERLY PTs: motor fxn
• Benztropine 4. Diet & Exercise may be used but risk of:
o AVOID use of Anti- • Personality changes
Cholinergics such as • Muscle Relaxants o Death in elderly (Psychotics)
• Paranoia/agitation/
Diphenhydramine or hallucination • Other CNS Depressants
Benztropine.
ACH Inhibitors - inhibit Acetylcholinesterase (ACH)

Donepezil Aricept • Avoid drugs that  HR due to
risk of dizziness/falls. Start at low dose  Titrate
N/V/D
Donepezil + Memantine Namzaric Bradycardia • Avoid Anti-Cholinergics Recommended:
Fainting = efficacy
Insomnia • Exelon Patch or Donepezil
Rivastigmine Exelon • Give Donepezil at NIGHT
QT-Prolongation ODT
to  nausea. (5 - 10 mg o  GI side fx.
Galantamine Razadyne QHS)
NMDA Blocker
Dizziness • Oral Solution available

Memantine Namenda Headache • ER Caps: Do not crush/chew
Constipation • May sprinkle on applesauce
STEROIDS
General Information Reduce Systemic Risks by Medrol Dose-Pak Dosing PO Dosing Equivalence
• Steroids have stronger anti-inflammatory ability
than NSAIDs.
• Adrenal Insufficiency: endogenous steroids that Cortisone 25 mg
• Every-Other-Day dosing (21 x 4 mg Tabs) Hydrocortisone 20
Short-acting
the adrenal gland is not producing.
• Taper Off Prednisone 5
• Cortisol - may be replaced by any steroid. • DAY 1: 2 before breakfast, 1 after lunch, 1 after dinner, 2 QHS
• Use injections - drug Prednisolone 5
• Steroids must be TAPERED off. stays local • DAY 2: 1 before breakfast, 1 after lunch, 1 after dinner, 2 QHS Intermediate-acting
• Addison's disease - adrenal gland not making • DAY 3: 1 before breakfast, 1 after lunch, 1 after dinner, 1 QHS Methylprednisolone 4
• Inhaled steroids - for Triamcinolone 4
enough cortisol. asthma • DAY 4: 1 before breakfast, 1 after lunch, 1 QHS
o Opposite of Cushing's syndrome • DAY 5: 1 before breakfast, 1 QHS Dexamethasone 0.75
• Use low absorption Betamethasone 0.6 mg
Long-acting
o Treat with fludrocortisone • DAY 6: 1 before breakfast.
▪ Replacement therapy to mimic • Lowest effective dose
Cute Hot Pharmacists & Physicians Marry Together & Deliver Babies
Aldosterone ( mineralocorticoid
activity to balance H20 + electrolytes.
Steroids - Glucocorticoid activity and anti-Inflammatory effect

Cortisone
Celestone Soluspan Strong Anti-Inflammatory effects
Betamethasone SHORT-TERM FX:
Ready Sharp
(<1 Month)
DexPak 6-10-13 Day • Cortisone = Pro-Drug of Cortisol
Dexamethasone Appetite
Double Dex • Prednisone - Pro-Drug of
Weight Gain Prednisolone
Solu-Cortef Fluid Retention
Hydrocortisone • Prednisolone used often for child
Cortef Mood Swings WARNING:
Medrol Insomnia Adrenal Suppression (HPA axis) Live Vaccines Treatment Indications
Solu-Medrol Indigestion Serious Systemic Infections
Methylprednisolone Bitter Taste Taper Off when use is >14 days • Replacement therapy
A-Methapred
BP • Auto-Immune diseases
Depo-Medrol
BG • Post-Transplant
Prednisone Deltasone • Asthma
Millipred LONG-TERM FX:
Prednisolone Orapred ODT QD Dosing = Take 7am - 8am to mimic
Refer to Cushing's syndrome body cortisol release
Prediapred
Triamcinolone Kenalog
Cushing’s Syndrome High Steroid Intake/Production SE Key Concepts
- GI Bleed/Ulcers - Buffalo Hump
• Adrenal gland produces too much cortisol, causing - Growth Retardation - Diabetes • Immunosuppressed dosing = ≥2 mg/kg/day OR ≥20 mg/day of Prednisone or
many side effects (refer to  box) - Glaucoma/Cataracts - Dysmenorrhea Prednisone-EQ for >2 weeks.
• Exogenous Steroids in high doses may also increase - Psychiatric Changes - Hypothyroidism
• Immunosuppressed PT cannot get Live Vaccines & there is  risk of Infxn.
cortisol - Poor Bone Health - Muscle Wasting
- Pink-Purples Stretch Marks - Infection • Taper off to reduce HPA-axis Suppression and  chance of Addison's disease
o Cortisol  Negative FB  Cortisol
- Moon Face - Impaired Wound Heal • Common Method =  dose by 10 - 20% every few days (7 - 14 days)
• Ultimately causing HPA-axis Suppression
- Acne - Women - Hirsutism
THYROID DISORDERS
General Information Drugs that  Thyroid hormone levels Levothyroxine Colors
Ca+, Fe+, Mg+, Al+3 (antacids) 25 mcg = Orange 100 mcg = Yellow 150 mcg - Blue
Thyroid Pathophysiology Multivitamins - ADEK, Folate 50 mcg = White 112 mcg = Rose 175 mcg - Lilac
Cholestyramine
• T3 = Triiodothyronine 75 mcg = Violet 125 mcg = Brown 200 mcg = Pink
Orlistat (Xenical, Alli)
• T4 = Thyroxine Sevelamer
88 mcg = Olive 137 mcg = Turquoise 300 mcg - Green
1. Thyroid cells absorb Iodine/Tyrosine to make hormones. Sucralfate Orangutans Will Vomit On You Right Before They Become Large Proud Giants
2. Thyroid produces T3/T4. Kayexalate
3. TSH secreted by Pituitary gland in Hypothalamus. Counseling
Estrogen
4.  T4 =  TSH (Negative FB loop) SSRIs 1. Different brands are not equal.
5. Active Form = Free T4 (FT4) BB's 2. Safe in pregnancy + breastfeeding.
Amiodarone 3. Take w/ H2O 60 mins before breakfast or 3 hrs after dinner.
Hypothyroidism = T4/TSH (low Metabolism)

Signs/Sx: Treatment:
Fatigue 1. Levothyroxine (T4) = 1st Line
Weight gain 2. Consistent preparation minimizing Diagnosis:
Cold intolerance variability.  FT4 | Normal = 0.9-2.3 Thyroid Replacement
Muscle cramps 3. PTs who "don't feel right" may  TSH | Normal = 0.3-3.0 GENERIC BRAND ADRs BBW C/I NOTES DOSING
Constipation use other formulations. Screen at age 60 Synthroid
Myalgias -------------------------------------------- Levoxyl - Decrease dose in
----------------------------------- Levothyroxine (T4)
Bradycardia Hashimoto's Disease: Tirosint CVD - Full Dose = 1.6
Monitor: Euthyroid = No Sx
Coarse/Loss of hair - Autoimmune - AB's attack Thyroid Unithroid - IV to PO ratio = mcg/kg/day
Check TSH q4-6 wks til levels - Acute MI
Memory impairment - Caused by conditions + drugs: 0.75-1 (IBW) for
are normal then q4-6 months. Thyroid Not used for - Thyrotoxicosis
Menorrhagia o Amiodarone - Levothyroxine is healthy,
Too high dose leads to Desiccated USP Armour Thyroid obesity/weight - Uncorrected
Goiter - due to iodine o Carbamazepine  dose = safe & young-middle
Afib + fractures. (T3/T4) reduction Adrenal
-------------------------------- o Eslicarbazepine hyperthyroidism recommended in age (<50)
----------------------------------- Cytomel insufficiency
Myxedema Coma: o Oxcarbazepine Liothyronine (T3) sx. pregnancy - CAD = 12.5-
Pregnancy: Triostat
Occurs when pt is o Interferon (requiring 30-50% 25 mcg/day
causes low birth weight, loss
untreated for a long o Lithium Liotrix (T3/T4) Thyrolar increase in dose)
of pregnancy, premature
period of hypothyroidism. o Phenytoin birth, lower IQ in children
(Life-threatening o Tyrosine Kinase inhibitors
emergency) (esp. Sunitinib)
Hyperthyroidism = T4/TSH
Signs/Sx: Treatment: Overview:
- Over-Production of thyroid Anti-Thyroid Medications
Heat intolerance 1. BB's for Sx control hormones. GENERIC BRAND ADRs BBW C/I NOTES
Weight loss or gain 2. PTU or Methimazole - Mostly caused by Grave's disease Beta-Blockers Used for Sx control: Palpitations, tremors, tachycardia.
Tremor (temporary til (autoimmune in women 30-40's that
Palpitations/Tachycardia surgery) stimulates too much T4) Propylthiouracil PTU GI upset
Freq bowel movements 3. RAI-131(Takes 1-3 - Drugs that cause hyperthyroidism: HA Pregnancy:
Liver failure
Agitation, nervous, anxiety months of HIGHER o iodine Rash 1st trimester = use PTU
(PTU)
Fatigue/Muscle weakness doses to control Sx o amiodarone Methimazole Tapazole Hepatitis 2nd/3rd trimester = Methimazole
Insomnia but later must o Interferon Agranulocytosis (rare)
Thinning hair REDUCE dose to - Thyroid Storm - life-threatening
Goiter (possible) avoid emergency that is treated w/ PTU. Potassium Iodide Lugol's Solution Rash
Exophthalmos hypothyroidism) o Fever (> 103), tachycardia, Hypersensitivity Temporarily inhibits secretion of T4/T3
Metallic taste
Light/Absent menses tachypnea, dehydration, SSKI to Iodine for only weeks
Saturated K+ Iodide GI upset
sweating, agitation, delirium, Thyroshield
psychosis, coma.
TRAVELER’S DISEASES
Traveler’s Diarrhea (TD)
1. BSS - tabs/liquid dose 525-1050 mg QID w/ FOOD & QHS.

Treatment: Prophylaxis
General Information Prevention 2. Rifaximin - preferred for pt at high risk.
1. Hydrate (fluid/salt).
1. Travelers should carry a list of all medical 1. Cook it, peel it, or forget it! 2. Loperamide (Imodium A-D)
conditions & medications (Rx/OTC). 2. Bismuth Subsalicylate (BSS) a. Primary Tx for acute Dose:
2. Pack any medical supplies on Carry-On luggage. a. Pepto-Bismol
Mild TD • Loperamide PRN (NO ABX) 4mg after 1st loose stool.
diarrhea.
3. "YELLOW Book" has all CDC travel information. b. Anti-Secretory b. Decreases freq/urgency 2mg after for each loose stool.
4. Consider food/H2O, blood/body fluids, & insects Anti-Diarrheal 3. Macrolides, FQ's, or Rifaximin Moderate TD • Loperamide PRN +/- ABX MAX Dose = 16 mg/day
for transmission. c. S/E of black tongue/stool MAX Use = 2 days.
preferred.
5. Dysentery TD occurs if blood in stool - Worse Sx. d. Caution: Reye’s Syndrome 4. Azithromycin = Severe TD
6. Mostly caused by Bacterial (E. coli). 3. ABX only used for HIGH risk. or Dysentery TD. Severe/Dysentery TD • Azithromycin 1000mg x 1 dose +/- Loperamide
Malaria
GENERIC BRAND WHEN TO USE CONTRAINDICATION NOTES
Take daily & STOP 1 Pregnancy
General Information Atovaquone/Proguanil Malarone
week after travel Breastfeeding
• Plasmodium Vivax is most common cause and resistant to Child < 8 yo
drugs. QUICK START Px: Doryx Take daily & STOP 4 Pregnancy
• P. Faciparum - MOST deadly! Doxycycline
Initiate 1-2 days Vibramycin weeks after travel Breastfeeding ALL do not use in Pregnancy.
• Prophylaxis is recommended and Tx varies depending on prior to travel. *Photosensitivity
region.
G6PD - Deficiency
• Malaria drugs cause nausea & GI stress so need to be taken Take daily & STOP 1
Primaquine Pregnancy
w/ FOOD + H2O/Milk. week after travel
Breastfeeding
Insect Bites Transmitting Disease: ADRs:
• Vector is usually Mosquitoes: Japanese Encephalitis, Yellow Skin Rxns
Fever, Dengue, Malaria, Zika virus. Chloroquine Visual changes
ADVANCE Start Px: Blue/Grey skin - Safe in children/pregnancy
• Protect from insect bites is key. Start 1-2 weeks prior Taken WEEKLY - Choice depends on regional
pigmentation
• DEET 20-50% is the active ingredient in insect repellant. to travel. resistance
• Permethrin is used to Tx clothing. Psychiatric conditions
Mefloquine Lariam Seizures
Arrhythmias
Other Diseases
Hepatitis-B: Meningococcal Meningitis:

Cholera: Polio: Typhoid Fever: Zika Virus: Yellow Fever:
1. Neiserria meningitis
1. Spread by Blood/Body Air Travel 1. Caused by 1. Transmitted by - ASA/NSAIDs = Bleeding
- Vibrio CDC 2. Fever, HA, stiff neck Sx Dengue Fever: Japanese
fluids Compression stockings Salmonella Typhi. Mosquitoes, sexual do NOT use.
Cholera recommends req UREGENT care. - NO vaccine Encephalitis:
2. Avoid high risk -------------------------- 2. Spread by contact, or blood - LIVE Vaccine: YF-VAX.
- Food/H2O 1-Lifetime 3. Spread by Respiratory available - AVOID
behaviors. Acute Mountain contaminated Feces. transfusions. - Given certificate for
contaminants Booster dose secretions. - AVOID Mosquitoes
3. Dose vaccine 6 months Sickness 3. Vaccines: Vivotif or 2. Causes Microcephaly vaccination & must be
- Vaccine: 4 wks before 4. HAJJ & Umrah Mosquitoes - Vaccine:
to complete. Administer Need Acetazolamide Typhim Vi. (IM). 3. NO Vaccine completed w/in 10 days
Vaxchora travel for pilgrimages from Saudi is crucial. Ixiaro
as MANY doses as (CI = Sulfa allergy) Give ≥2 wks 4. Use contraception w/ before arrival.
(PO, Live) adults. Arabia to req vaccines
possible before travel. before travel. sex. - C/I = Egg Allergy.
during travel.
WEIGHT LOSS
AACE/ACE Guidelines = Exercise > 150 mins/wk for 3-5 days/wk + resistance training.
General Information Drugs that cause Weight Gain Drugs that cause Weight Loss Bariatric Surgery Caution/Avoid
• Meds not appropriate for small weight loss.
• BMI > 40 or >30 + condition
• ONLY indicated for BMI ≥30 OR BMI ≥27
+1 weight-related condition (DLD, HTN, • Nutrient Deficiency:
• Insulin o Ca+ Citrate is preferred. • Pregnancy
and DM). • Sulfonylureas o Vit-B12 & Iron supplements o Avoid all WL drugs
• Rx meds only used adjunct to diet plan + • ADHD Stimulants
• Glitazones o Iron/Ca+ 2 hrs. before or 4 hrs. • Depression
exercise. (Ritalin, Concerta, Adderall,
• Anti-Psychotics Vyvanse) after antacids. o Contrave (contains
• Drugs are selected based on PT’s comorbid o Supplement Vit-ADEK for LIFE.
• Steroids • Exenatide
bupropion)
conditions. • Medication Concerns:
• Mirtazapine (Remeron) (Byetta/Bydureon) • Hypertension
• Older stimulant agents are ONLY used • May need to crush, liquid, or o Qsymia, Contrave
short-term to jump-start a diet. • Dronabinol (Marinol) • Liraglutide (Victoza)
• Megestrol (Megace) transdermal for 2 months post- • Opioid Use
• Newer agents are used Long-term for • Saxenda (at high dose) surgery o Contrave
maintenance. (Qsymia, Belviq, Contrave, • Topiramate (Topamax) • PT’s may need Ursodiol for • Seizures
Saxenda) gallstones.
• Condition – Hypothyroidism o Qsymia, Contrave
• Weight loss drugs should be D/C if they • AVOID GI irritants (NSAIDs +
don’t produce at least 5% weight loss at Bisphosphonates)
12 weeks.
GENERIC BRAND MOA ADRs BBW CONTRAINDICATION NOTES

- Phentermine -
Anxiety - Hyperthyroidism
Sympathomimetic stimulant
Depression - Glaucoma
Phentermine/Topiramate Qsymia (C4) amphetamine like  NE. Taper off due to seizure.
Suicidal thoughts - MAOi in 14 days
- Topiramate -
Tachycardia Pregnancy
GABA/Glutamate.
- NOT approved for MDD - Opioid use
- Suicidal ideation - Uncontrolled HTN
N/V/C/HA Naltrexone - blocks opioids +
- Caution in - Seizure disorder
Naltrexone/Buproprion Contrave Decreases cravings/appetite. Dizziness
psychiatric/seizures buprenorphine  blocking
- Bulimia/Anorexia
Dry Mouth analgesia.
disorders. - Bupropion-containing
- Can  HR/BP products
Dizzy/HA
Serotonin 5HT-2C agonist Fatigue Serotonin Syndrome w/ other
Lorcaserin Belviq (C4) Pregnancy
(increasing satiety) Nausea serotonergic agents
Dry mouth
- Family Hx of Medullary
Nausea/Vomiting - Victoza - for Diabetes.
Thyroid Carcinoma (MTC)
Liraglutide Saxenda GLP-1 agonist Diarrhea/Constipation Pregnancy - Saxenda - REMS for MTC +
- Hypoglycemia
Dizzy/HA/Fatigue Pancreatitis
-  HR
Phentermine (C4) Adipex-P - AVOID in HTN, PAH,
Sympathomimetic Stimulants Tachycardia - Stimulants are used for 12
Diethylproprion (C4) Tenuate Hyperthyroidism, or
(Similar to amphetamines, Agitation Adipex-P: Avoid in Pregnancy weeks to jump start a diet.
Phendimetrazine (C3) Glaucoma.
increasing NE)  BP - Monitor - HR/BP
Benzphetamine (C3) Regimex - MAOi in 14 days
Orlistat Rx Xenical - Take Vitamin ADEK + Beta-
Carotene at bedtime or
- Liver damage - Pregnancy
Gas w/ Discharge separate by 2 hours.
Lipase inhibitor - decreases - Cholelithiasis - Cholelithiasis
Fecal urgency - Do NOT use Cyclosporine or
Orlistat OTC Alli fat absorption by 30% - Kidney Stones - Malabsorption
Fatty stool separate by 3 hrs.
- Hypoglycemia Syndrome
- Separate Levothyroxine by 4
hrs.
MIGRAINE
Chronic headaches causing pain for hours or days.
General Information Diagnosis Treatment
RX Options:
NON-DRUG Tx: Prophylactic Tx: - Triptans (5HT)
Used to decrease frequency of - Ergotamine
1. Avoid Triggers - Butalbital (barbiturate used for combo meds)
2. Stress management migraines.
• Most cause N/V, sensitivity to light, or auras of ≥5 attacks not attributed to o NOT recommended due to OTC Tx:
3. Massage Consider 2-6 month use if: abuse/dependency & need to be tapered
flashing lights, blind spots or tingling in arms or other disorders with: - Acetaminophen
4. Spinal manipulation 1. Using Acute Tx ≥2 off due to worsening of headaches.
legs. • Last 4-72 hrs. + recur 5. Cold compress/Ice pack
- Advil (Ibuprofen)
days/wk OR o Fioricet: - Excedrin (ASA +
• May be due to NT's, especially Serotonin - 5HT sporadically. 6. Acupuncture ≥3x/month. Acetaminophen/Butalbital/Caffeine APAP + Caffeine)
• Identify and avoid migraine "triggers" (Female • ≥2 characteristics: 2. If migraines decrease
hormonal changes, food, stress, sleep pattern, Unilateral location, Natural Products: o Fiorinal: ASA/Butalbital/Caffeine - Aleve (Naproxen)
QOL. o BOTH are used in combo w/ Codeine = C3
weather) pulsating, mod-severe pain, • Caffeine combo w/ 3. If acute tx are
aggravated by physical - Opioids
• Women who have migraine w/ aura = ASA or Tylenol ineffective or - Diclofenac
 Stroke risk. activity. • Butterbur contraindicated.
o Should AVOID Estrogen-containing • If N/V, photophobia, or • CoQ-10 • Avoid Opioid, Tramadol, and Tapentadol for last line.
contraceptives. phonophobia occurs. Ex. Beta-Blockers, Topiramate
• Feverfew Valproic Acid, TCAs, • Some PTs benefit from OTC products + Triptan
• Magnesium Peppermint Venlafaxine, or • Medication "Overuse" (MOH) = REBOUND Headaches:
• Riboflavin Botox (chronic migraines only) o Headaches that occur >10-15 days/month
o MUST limit medication 2-3x/wk. & taper off Butalbital.

Imitrex ALL injections are SQ (Lateral Thigh
Onzetra Xsail or Upper Arm)
Sumatriptan
Zembrace SymTouch - Paresthesia - CV Disease (Stroke/TIA)
Sumavel Protect from light.
(tingling/numbness) - Uncontrolled HTN
Sumatriptan + Naproxen (Child >12 yo) Treximet - Hot/Cold sensations -  BP - Ischemic Heart Dx 1. 1st Line for Acute Tx
- Dizzy/Somnolence - Cardiac/CV events - Peripher Vascular Dx 2. MUST take at 1st sign of
Almotriptan (Tab, Child >12 yo) Axert 5HT-1 Agonist - Dry mouth - Arrhythmias Migraine
Eletriptan Relpax Vasoconstriction of - Nausea - Serotonin Syndrome 3. ODTs, nasal spray, injections are
cranial blood vessels - Chest pain/tightness - Medication Overuse HA (MOH) Use w/in 24 hrs. of other useful if PT has nausea.
Frovatriptan Frova - Triptan Sensations - Seizures (Sumatriptan ONLY) Triptan or Ergotamine. 4. Imitrex/Zomig Nasal spray
(Chest/Neck pressure - Caution in Hepatic/Renal imp (Do NOT Prime)
Naratriptan Amerge or heaviness) AVOID Maxalt-ODT in 5. Frovatriptan/Naratriptan =
Rizatriptan (Child 6-17 yo) Maxalt Phenylketonuria (PKU) Long-Acting but SLOWER onset.
6. D/I: SSRI, SNRI, MAOi, or
Zolmitriptan (Nasal Spray, Child >12 yo) Zomig CYP3A4 inhbitors.

Dihydroergotamine DHE 45 Nasal Spray: Uncontrolled HTN
(Injection, Nasal Spray) Migranal Ergotamines: Life-threaten Peripheral Ischemia - Must PRIME 4x for nasal spray.
Rhinitis Ischemic Heart Dx
ONLY for PTs who get Avoid CYP3A4 inhibitors - Do NOT inhale deeply
Ergotamine + Caffeine Cafergot Nausea/Dizziness Pregnancy
no relief from Triptans. CV/Cerebral Vascular events - Let drug absorb into nose skin.
(Tablet, Suppository) Migergot Dysguesia (altered taste) Strong CYP3A4 inhibitors

Propanolol Inderal LA
Propranolol + Timolol:
Lopressor
Metoprolol Beta-Blockers Propranolol = MOST Lipophilic Non-selective so avoid in
Toprol XL
COPD/Asthma
Timolol

Depakote Liver Toxicity
Teratogenic
Divalproex Depakene Pancreatitis Pregnancy
Thrombocytopenia
Valproic Acid Weight Gain
Anti-Epileptics
Weight LOSS
Topamax
Topiramate Parasthesia Pregnancy
Trokendi XR
Cognitive Impairment
ATTENTION DEFICIT HYPERACTIVITY DISORDER
General Information DSM-5 Diagnostic Criteria DRUG Tx Dosing Formulations
1st Line: Stimulants (C2) LA Suspensions: Sprinkle Capsules:
INATTENTION = >6 Sx • Quillivant XR • Focalin XR
Concerta, Daytrana Patch, Ritalin, Vyvanse,
Adderall o Shake bottle 10 secs. • Ritalin LA
• Chronic inattention, hyperactivity, & HYPER-ACTIVITY & o Push plunger down.
• Dose in QAM • Aptensio XR
impulsivity. IMPULSIVE = >6 Sx o Measure to white end.
• Titrate up every 7 days • Adderall XR
• Due to Dopamine + Norepinephrine. • Dyanavel XR • When SPRINKLING capsules
3 Conditions MUST Be Met: • No need to taper
• 1st LINE Tx = Cognitive Behavioral 1. Sx must be present Chewable Tabs: into food, use small amount of
Tx (CBT) 2nd Line or Suspected Abuse Risk: food, do not chew the beads,
before age 12 yo. • Quillichew ER
• Non-Drug Tx = Fish Oils Non-stimulants do not warm the food, take
2. Sx must be present in 2 • Vyvanse
Strattera immediately.
or more settings.
3. Sx interfere w/ ADJUNCT/Alone: Intuniv, Kapvay ODT:
functioning. • Contempla XR PATCH:
Sleep Aids: Clonidine, Diphenhydramine • Adzenys XR • Daytrana

Ritalin
Methylphenidate IR
Methylin
Ritalin LA
Methylin ER
• MAOi in 14 Days Concerta:
Methylphenidate ER Aptensio XR
• HF/Recent MI/Arrhythmias Start 18-36 mg QAM (Ghost Tablet)
Metadate ER
Concerta (OROS Tab) o PTs do NOT use if Heart
problems.
Quillichew ER Methylphenidate Stimulants
• Mod-Sev HTN
Methylphenidate XR Quillivant XR BBW:
Contempla XR-ODT Abuse/Dependence • Ritalin = Pheochromocytoma
Nausea WARNING: Apply 2 hrs before desired Fx &

Methylphenidate
Daytrana Insomnia remove after 9 hrs.
(Transdermal Patch) • Caution in Psychiatric Alternate Hips daily.
Loss of appetite Check:
conditions: Exacerbate
Dexmethylphenidate Focalin
Stunt Growth Suicidal thoughts, • Contact PCP if chest
Headache Mania in Bipolar PTs, pain/SOB
Adzenys XR-ODT Irritability • Check BP + HR regularly
Seizures.
Amphetamine Dyanavel XR Blurry Vision • Consider ECG prior to Tx
Evekeo Dry mouth • Serotonin Syndrome
• Certain food coloring • Check Ht/Wt regularly (esp
Amphetamines: Cardiac/CNS Sx AVOID acidic FOOD/JUICE or
Dextro-amphetamine or preservatives may in children)
Adderall (Approved in Child ≥ 3 yo) Vitamin-C
+ Amphetamine IR worsen hyperactive
Dextro-amphetamine Adderal XR behavior.
+ Amphetamine ER MyDayis
• Can MIX: H20 | Yogurt | Orange
Juice
Prodrug of
Lisdexamfetamine Vyvanse
Dextroamphetamine • Take Right Away
• Low Abuse Potential: Fx muted if
injected/snorted.
Methamphetamine Desoxyn Methamphetamine

Headache
Insomnia
Somnolence
HTN Aggressive behavior
Tachycardia Psychotic or Manic Sx
Atomoxetine Straterra SNRI Suicidal Ideation Do NOT open capsules
Dry mouth Hepatotoxicity
Nausea CVD Events
Abdominal Pain
 Appetite
Sex Dysfxn/ED/Libido
Guanfacine ER Intuniv Somnolence WARNING: Do NOT discontinue abruptly - Must
Central Alpha-2 Agonists Dizziness/Headache Sedation, drowsiness TAPER off
Clonidine ER Kapvay  BP: Bradycardia/Hypotension dose-dependent CVD Fx Guanfacine = rare SKIN rash.
PARKINSON’S DISEASE
General Information Symptoms DRUG Tx:
• Brain disorder where Substantia Nigra is damaged  Failure MOST Effective = Levodopa = Prodrug
to produce Dopamine. MOTOR Sx: "TRAP" Sx 1st LINE = Replace DOPAMINE: • Give w/ Carbidopa to prevent
• Disease will continue to progress despite tx w/ extended "OFF" Bradykinesia (slow move) 1. Give DA-Precursors peripheral metabolism of Levodopa.
periods Akinesia (lack of move) 2. Give DA-Agonists • Important to give RIGHT AMOUNT of
o Disease worsens before next dose. Shaking/Tremors 3. Other Rx to control Sx. (ex. Tremors) Carbidopa = 70-100mg QD to block
• Depression - use Secondary Amines Leg/Trunk Rigidity metabolism w/o causing excess S/E
o ex. Desipramine or Nortriptyline Postural Instability Amantidine = Treat Tremors • ELDERLY: initial Tx should be
▪  Efficacy  S/E MAO-B inhibitors Carbidopa/Levodopa
o SSRIs: used but contribute to Tremor + Serotonin Syndrome Additional Sx: Catecholo-Methyltransferase (COMT)
Small/Cramped Handwriting • YOUNG: Usually give Dopamine-
• Psychosis: use Quetiapine or Clozapine or inhibitors
agonists to limit "OFF" periods &
Pimavanserin (Nuplazid) Bent over body • Also blocks Levodopa metabolism.
Shuffling walk dyskinesia.
o New approved drug for hallucinations or delusions. • C/I with Dopamine drugs.
Muffled Speech or Drooling • Tremor dominant: Tx w/ Central-Acting
• Drugs that WORSEN Parkinson's Dx: Anti-Cholinergic
Depression/Anxiety NOT Recommended: Bromocriptine
Prochlorperazine, Phenothiazines, Haloperidol, Risperidone or
• BEERS: Avoid in Elderly due to S/E.
SGAs, Metoclopramide
GENERIC BRAND MOA ADRs BBW C/I NOTES

Nausea/Dizziness
Orthostasis
Levodopa Dyskinesias Long-term use can
Sinemet DA Precursor • Titrate Cautiously
Dystonias lead to response
Carbidopa/Levodopa Rytary
Brown/Black/Dark urine, saliva, sweat fluctuations + • CR-Tab may cut in ½
Duopa Carbidopa
Unusual Sexual urges dyskinesia • Must separate from Iron products.
inhibit Decarboxylase
Priapism
Coombs Test: D/C due to Hemolysis
Pramipexole Mirapex
Ropinirole Requip Somnolence
Daytime sleep attack 1. Apply QD same time each day.
Nausea/Dizziness Patch: 2. Do NOT apply to same site for
Dopamine-Agonist
Orthostasis may cause 14days.
Rotigotine Neupro Hallucinations Skin-site rxns 3. No Heat source over patch.
Dyskinesia 4. Remove patch before MRI.
5. Avoid in SULFITE allergies.
DA INJECTION 5HT-3 Antagonist
Severe N/V CAUTION
Apomorphine Apokyn "Rescue" agent for (Ondansetron due to
Hypotension Dose written in mL NOT mg.
"OFF" period hypotension)

Entacapone Comtan COMT inhibitor • Give 200mg w/ EACH dose of
Entacapone + Inhibit COMT to Carbidopa/Levodopa.
Stelvo Similar S/E to Levodopa
Levodopa/Carbidopa prevent conversion of •  Levodopa dose by10-30%
Tolcapone Tasmar Levodopa. when giving COMT inhibitor.
Livedo Reticularis -
Toxic Delirium w/
Amantadine Block DA-Reuptake Dizziness cutaneous reddening
Renal imp.
skin rxn.
Eldepryl
Other MAOi
Selegeline Zelapar Serotonin Syndrome
Emsam Linezolid
MAO-B inhibitors HTN Xadago = Severe Hepatic Imp.
Opioid/TCA
Rasagiline Azilect CNS Depression
SNRIs
Safinamide Xadago
Benztropine Cogentin
Anti-Cholinergic/Histamine  Anti-Cholinergic effects Used primarily for Tremors
Trihexphenidyl
Syncope/Headache
Droxidopa Northera Alpha+Beta agonist Used for Neurogenic Hypotension
Falls
SLEEP DISORDERS
Insomnia
General Information
1. Difficulty initiating sleep or sleep latency Sleep Hygiene Methods Drugs WORSEN Insomnia:
2. Non-Drug Tx: 1. Keep bedroom dark, quiet, comfortable. ETOH/Caffeine
a. Includes Cognitive Behavior Tx (CBT) & Sleep Hygiene. 2. Keep regular sleep schedule. Sleep ONSET: Appetite Suppressants
Sleep MAINTENANCE:
b. Natural products such as St. John's Wort & Chamomile tea 3. Avoid daytime naps even after poor night of sleep (limit 30 min.) Eszopiclone Buproprion
3. Drug Tx: 4. Reserve bedroom for sleep appropriate activities. Doxepin
Ramelteon Decongestants
a. Do NOT use OTC products long-term 5. Turn clock face away to minimize anxiety to fall sleep. Suvorexant
Temazepam Fluoxetine
(Ex. Diphenhydramine or Doxylamine) 6. Get up do something to take mind off sleeping. Eszopiclone
Triazolam MAO-B inhibitors
b. Different drugs for sleep onset vs sleep maintenance. 7. Establish pre-bedtime ritual to condition for sleep. Temazepam
Zaleplon Steroids
c. Non-BZDs preferred long-term 8. Relax before sleep w/ soft music, reading, stretching. Zolpidem
Zolpidem Stimulants
i. Limit BZDs to 7-10 days 9. Avoid exercise before bedtime. Drugs causing
4. NOT Recommended: Diphenhydramine, Melatonin, Tiagabine, 10. No heavy meals before bed or caffeine in afternoon. Nocturia/Urinary retention
Trazodone, & Valerian
Ambien
Zolpimist Somnolence CNS Depression
Zolpidem
Edluar SL Dizziness Next-Day impairment
Intermezzo SL Non-BZD GABA agonist (C4) 1st LINE
Ataxia Respiratory Depression
Zaleplon Sonata Parasomnias (abnormal sleep movements) Potential Abuse/Dependence
Eszopiclone Lunesta
Somnolence
Suvorexant Belsomra Orexin-Receptor Antagonist (C4) Dizziness/HA Narcolepsy
Abnormal Dreams
Somnolence
Ramelteon Rozerem Do NOT take w/ FATTY food
Dizziness
Melatonin Agonist
Headache
Tasimelteon Hetlioz Takes weeks to affect
Abnormal Dreams
Doxepin Silenor Anti-Depressant
Diphenhydramine Benadryl Sedation
Tolerance after 10 days
Anti-Histamines Anti-Cholinergic effects (Dry mouth, BPH & Glaucoma
Doxylamine Unisom urinary retention, BPH, blurry vision,
constipation)
Lorazepam Ativan
Temazepam Restoril
Quazepam Doral BZDs: C4 BEERs Criteria
Triazolam Halcion Potentiate GABA - Avoid in > 65 yo
Estazolam
Flurazepam
Restless Leg Syndrome Narcolepsy
Dopamine-Agonist:
- Pramipexole (Mirapex)
- Ropinirole (Requip) GENERIC BRAND MOA ADRs BBW C/I NOTES
- Excessive daytime
- "Creeping" sensation IR Formulations - Take 1-3 hrs. before Modafinil Provigil Headache/Dizziness Med Guides: Life-
sleepiness w/
or urge to move lower bedtime. Stimulants Anxiety/Agitation threatening risk of
Cataplexy (sudden Armodafinil Nuvigil
legs. - Rotigotine (Neupro) - Patch applied Risk of severe Rash severe rash.
loss of muscle tone)
- Worsens at night and daily. Do NOT use same site for 14 - Contains high
+ sleep paralysis.
relieved by days. Sodium
- PT's fall asleep
movement. - Gabapentin (Horizant): Req reduced - REMS Program
anywhere during
- Due to Dopamine dose if CrCl <62 Sodium ETOH - "Date-Rape"
day & have trouble Xyrem Dizzy/Somnolence CNS Depressant
imbalance Oxybate Sedating agents drug GHB
ALL cause orthostasis + somnolence (dose- sleeping at night.
- Primary Tx = DA- - Indication for
related) - May also be Tx w/
agonist narcolepsy and
- Titrate ADHD stimulant
cataplexy
- Monitor: Psychiatric hallucination or
abnormal dreams.
EPILEPSY
Drugs/Conditions Lowering
General Information Status Epilepticus (SE) NON-PHARM: Anti-Epileptic Drugs (AEDs) AEDs w/ Most DDI
Seizure Threshold
• Selection is PT-specific w/ seizure type, age,
Anti-Psychotics pregnancy, S/E.
• Diagnosis = Electro- Anti-Virals
Encephalogram (EEG) • Seizure lasting >5 mins • ALL AEDs cause CNS Depression.
Buproprion
• Focal Seizure: start on o Initial 5 - 20 mins: Carbapenems (Imipenem • Consider other formulations for kids w/ difficulty
1-side of the brain & ▪ Initial Tx = IV Lorazepam esp) swallowing. Carbamazepine
spread. (Ativan) Cephalosporins • AEDs cause bone-loss + increase fracture risk. Oxcarbamazepine
• Focal Aware Seizure: no • NO IV Access = IM ETOH Withdrawal • Supplement PTs w/ Ca+ & Vitamin-D. Phenytoin
loss of consciousness Midazolam (Versed) Ketogenic Diet Lithium • AEDs have many drug interactions. Fosphenytoin
(Simple Partial) • NO Hospital: may be used in Lindane • Many AEDs are teratogenic &  Oral Phenobarbital
• Focal Seizure Impaired Diazepam rectal gel Refractory Mefloquine Contraceptive efficacy. Primidone
Awareness: loss of (Diastat AcuDial) Seizures Meperidine • Use Non-Hormonal Contraceptives Topiramate
consciousness (Complex o Phase 2 Tx (20 - 40 mins): Metoclopramide (> 200mg/day)
• Dosage adjustment is required to maintain Tx levels
Partial Seizure) ▪ IV Fosphenytoin PCNs
& safety. Valproic Acid 
• Generalized Seizure: start ▪ Valproic Acid FQ's Lamotrigine levels
Infection & Fever • ALL AEDs require MEDGUIDE: Suicide, Teratogenic,
on both sides of the brain. ▪ Levetiracetam SJS/TEN.
• Absence Seizure: present ▪ Phenobarbital Theophylline
Tramadol • Chronic Seizure Management:
as "staring spells" o AVOID meds that lower seizure threshold.
Varenicline
o NEVER stop AEDs abruptly.

Irritability
WARNING:
Dizziness - NO significant Drug Interactions
Levetiracetam Keppra Ca+ Blocker + GABA Psychiatric Rxns - Psychotic Sx
Weakness - IV:PO = 1:1
Somnolence, Fatigue
Asthenia
- Lamotrigine levels = Valproic Acid = Use
Low-dose (BLUE)
Lamictal Rash - Lamotrigine levels = Carbamazepine,
Lamotrigine Chewable, ODT, Na+ Blocker N/V Serious Skin Rxn: SJS/TEN Phenytoin, Phenobarbital, Primidone,
Tab Somnolence Dizzy Rifampin, Navir (PI's), Oral Contraceptives
- Use Higher Dose = GREEN
- Standard Dose Kit = ORANGE
Na+ Blocker N/V Aplastic Anemia - Monitor: CBC, Na+, Platelets
Tegretol MAOi
Dry Mouth Agranulocytosis - CYP450 Inducer + Auto-Inducer
Carbamazepine GOAL Level = 4-12 Nefazodone
Chew Tab, Caps Rash Photosensitivity SJS/TEN (Asian HLA-B*1502 -  levels of drugs + itself
mcg/mL NNRTIs
Blurred Vision testing) - Use Non-Hormonal Contraceptive
N/V
WARNING:
Somnolence
Oxcarbamazepine Trileptal Na+/Ca+ Blocker HLA-B*1502 Test (Asians) Monitor: Na+
Dizzy
Hyponatremia
Visual Disturbances
WARNING:
 GABA Physiological Dependence
Habit Forming
Phenobarbital Tolerance - Monitor: LFTs, CBC w/ Diff
GOAL = 20-40 mcg/mL Respiratory Depression
(C4) Hangover Fx - Use Non-Hormonal Contraceptive
Child = 15-40 mcg/mL Fetal Harm
CNS Fx
SJS/TEN
Dilantin Na+ Blocker Nystagmus
Phenytoin Dilantin Infatabs - Fosphenytoin always Ataxia - Highly Protein-Bound
IV PHT = Do NOT exceed 50 HLA-B*1502 Test
Phenytek dose in Phenytoin Diplopia - Use Non-Hormonal Contraceptives
mg/min (Asians)
Equivalents (PE) Blurred Vision - Monitor: LFTs, CBC w/ Diff
IV Fos-PHT = NOT exceed Fetal Harm
Fosphenytoin - 1mg PE = 1 mg PHT Gingival Hyperplasia - Trough Level = 10 - 20 mcg/mL
Cerebyx 150 mg/min Blood Dyscrasias
(Pro-Drug) - 1 mg PE = 1.5 Fos-PHT Hair Growth - Free Trough = 1 - 2.5 mcg/mL
- IV:PO = 1:1 Hepatotoxicity
WARNING:
Metabolic Acidosis
- Monitor:
Topomax Weight Loss Oligohydrosis (less sweating)
Topiramate Na+ Blocker - Electrolytes - Bicarbonate
Trokendi CNS Fx Nephrolithiasis
- Intra-Ocular Pressure
Hyperammonemia
Fetal Harm
N/V WARNING:
Lacosamide (C5) Vimpat Diplopia Prolong PR-Interval
Blurred Vision  Arrhythmias
Depakene GABA Weight Gain Hyperammonemia
Valproic Acid Hepatic Failure - Monitor:
Depacon CNS Fx Thrombocytopenia
GOAL Level = 50-100 Fetal Harm - LFTs @ Baseline + 6 months
Edema Lamotrigine
Divalproex Depakote mcg/mL Neural Tube Defects - CBC w/ Diff | Platelets
PCOS - Serious Rash
Other AEDs
Eslicarbazepine Felbamate Vigabatrin Ethosuximide Gabapentin Zonisamide Primidone
Clobazam (Onfi) Pregabalin (Lyrica)
(Aptiom) (Felbatol) (Sabril) (Zarontin) (Neurontin) (Zonegran) (Mysoline)
Brivaracetam (Briviact)
Used for Absence Sulfonamide
Perampanel (Fycompa) Active metabolite of BBW: seizure Peripheral Edema, Allergy Peripheral Edema
BBW: Permanent Pro-Drug of
Oxcarbamazepine Hepatic Failure ADR: N/V, Ab Weight Gain, Oligohydrosis Weight Gain
Vision Loss Phenobarbital
Rufinamide (Banzel)  Na+ Aplastic Anemia pain, Weight Loss, Mild Euphoria Hyperthermia Mild Euphoria
Hiccups Nephrolithiasis
Tiagabine (Gabitril)
STROKE (TIA) : CEREBROVASCULAR ACCIDENT (CVA)
General Information Treatment Secondary Prevention
• Blood flow is restricted to an area of the brain Goals:
• Early recognition of stroke is essential to 1. Restore blood flow to brain. 1. HTN - Goal = < 140/90
survival. • AHA/ASA Guidelines 2. Maintain normal intracranial pressure (ICP). 2. Dyslipidemia
• Call 911 immediately to save brain tissue. 3. Control cerebral perfusion. 3. Diabetes
• Signs/Sx: ACT "FAST"
• CT Scan to differentiate b/t Ischemic vs 4. Manage blood pressure (BP) a. BG should be maintained in
o Face - ask person to smile. Is 1-side
Hemorrhagic within 45 minutes of arrival to ER is the range of 140 -180
droopy or numb?
crucial. Alteplase (TPA): mg/dL.
o Arms - raise both arms. Does 1 arm shift
Only Fibrinolytic agent used to Tx acute ischemic 4. Lifestyle Mods:
• Ischemic Stroke - caused by thrombus in the down?
stroke. a. Sodium = <2.4 grams
brain, aka Non-Cardioembolic Stroke. o Speech - repeat a sentence. Are the
1. Must be given in 3 hrs of Sx. or <1.5 grams to control
• Cardioembolic Stroke - embolus in heart words slurred?
2. May be given 4.5 hrs for some. BP.
traveling to brain. o Time - Call 911 if any of Sx.
3. 60-minute door-to-needle time. b. Physical Activity
• Hemorrhagic Stroke - ICH or SAH or Subdural • The 5 "SUDDENS": 4. BP must be lowered to ≤185/110 mmHg to be c. BMI = 18.5 - 24.9
hematoma are bleeding events in the brain due 1. Sudden numbness/weakness in arms, given. d. Waist = < 35 (F) / < 40
to ruptured blood vessels. face, or leg? 5. Anti-Coags should NOT be given w/in 24 hrs of (M)
o Intracerebral Hemorrhage (ICH) 2. Sudden confusion? Alteplase e. Stroke due to AFIB - Anti-
▪ Is associated w/ increased intracranial 3. Sudden trouble seeing? Coag
pressure (ICP) and should be controlled. 4. Sudden dizziness? Aspirin (ASA) Tx: 5. Anti-Platelet Tx:
▪ Prophylactic Anti-Convulsants should 5. Sudden severe headache? - ASA 325mg PO should be given in 24-48 hrs a. Recommended to reduce
NOT be used. - STROKE Risk Factors: after stroke onset. risk of recurrent stroke.
▪ Tx = MANNITOL o HTN - most important o Hx of Stroke/TIA - Recommended for most PTs to prevent early i. ASA
o AFIB o Smoking
o Subarachnoid Hemorrhage (SAH) o Dyslipidemia
recurrent stroke. ii. Dipyridamole XR
▪ Bleeding results from cerebral aneurysm o African American - NOT to be given w/in 24 hrs of Fibrinolytic Tx iii. Clopidogrel
o Age > 55 yo o Sickle-Cell Dx
& presents w/ severe headache. (Worst o Patent Foramen b. ASA + Clopidogrel DAPT
HA ever) o Atherosclerosis Ovale (PFO) HTN Management: should NOT be used
▪ Prophylactic Anti-Convulsants may be o Diabetes - BP meds given to lower BP prior to Alteplase use. longterm due to risk of
considered. - If PT is not receiving Alteplase, BP meds should hemorrhage
▪ Tx = NIMODIPINE NOT be given unless it is > 220/120.
WARNING: - MUST keep BP ≤185/110
Active bleed (ICH, SAH)
Major bleeding (ICH) - 0.9 mg/kg (MAX = 90 mg
Alteplase Activase Fibrinolytic Recent Trauma (3 months)
Angioedema - MUST exclude Intracranial
Uncontrolled BP
Cholesterol embolization (rare) Hemorrhage before use.
Bayer Irreversible COX-1/2 inhibitor
Bufferin  Prostaglandins (PG) Dyspepsia WARNING:
Aspirin (ASA) Ecotrin  Thromboxane (TXA2) Heartburn Bleeding Yosprala - is for PTs at risk of
Ascriptin Anti-platelet Nausea GI Bleed/Ulcers NSAID or Salicylate allergy developing gastric ulcers
Durlaza Anti-Pyretic Tinnitus Reye's Syndrome Asthma associated w/ ASA
Analgesic Children/Teens with Viral Infxn
ASA + Omeprazole Yosprala
Anti-Inflammatory
Dipyridamole XR + Headache WARNING:
Aggrenox Inhibits Adenosine/cAMP 
Aspirin Diarrhea Hypotension
Bleeding risk
Stop 5 days before surgery Used only if PT is allergic or
GI Hemorrhage
Irreversible P2Y12 inhibitor contraindicated to ASA.
Clopidogrel Plavix Hematoma AVOID: Serious Bleed
(Pro-Drug) Do NOT use DAPT + ASA long
Pruritus Omeprazole/Esomeprazole term.
TTP
Fluid/Electrolyte Loss
Renal Disease
Dehydration
WARNING: Anuria
Promotes Osmotic Diuresis to Hyperosmolar
Mannitol Osmitrol May accumulate in the brain Dehydration
reduce ICP in ICH Hyperkalemia
causing Rebound ICP Heart Failure
Acidosis
Pulmonary Edema/Congestion
 Osmolar GAP
- For ORAL use ONLY
Hypotension
- If capsule cannot be
Bradycardia
Do NOT administer as IV or swallowed, may be
Nimodipine Nymalize DHP-CCB Headache Hypotension risk
any Parental route = DEADLY. transferred to syringe but
Nausea
w/o needle and squirted into
Edema
mouth.
ANGINA
General Information Pathophysiology Diagnosis Risk Factors Treatment
• Angina: chest pain, pressure, or • Cardiac stress test performed. Making PT Drug Tx:
tightness caused by Ischemic heart exercise to look for Sx or by using drugs 1. ASA
HTN, smoking, DLD, Treatment Approach: 2. Clopidogrel (Plavix) if PT has ASA
muscles of coronary arteries. like: Dipyridamole, Adenosine (AdenoScan), DM, obesity, lack of A. Antiplatelet/Anti-Anginal allergy or C/I.
• Stable Angina: aka "Stable Ischemic • Chest pain occurs Regadenoson (LexiScan) or Dobutamine. exercise. B. Beta-Blockers 3. DAPT = Plavix (75) + ASA (81) for 6
Heart Dx" (SIHD), is a form of ASCVD due to imbalance • Evaluation: C. Cholesterol (Statins)/Smoke Cessation months after Stent or 12 months post-
w/ predictable chest pain triggered of Myocardial O2 o Hx/Physical D. Diet / Diabetes CABG
by exertion or emotional stress but demand & blood o CBC Non-Drug Tx: E. Exercise / Education
relieved w/in mins by Nitroglycerin. flow supply. o CK-MB Anti-Anginal Tx:
• Unstable Angina: is a form of ACS, • SIHD is due to o Troponin I/T Anti-Platelet Tx: - 1st LINE = Beta-Blockers
medical emergency that is NOT Atherosclerosis o aPTT, PT/INER - Eat healthy
- BMI = 18.5-24.9 1. Take w/o regard to meals - 2nd LINE = CCBs or LA Nitrates;
relieved by Nitroglycerin. aka Coronary o Lipid panel 2. Helps to prevent clotting issues Ranolazine ± BB
• Prinzmetal's Angina: chest pain Artery Dx (CAD) o ECG, Cardiac Stress Test, - Waist = 35/40 in.
- Exercise 3. Bleeding/Bruising is common
caused by vasospasms or coronary o Catheterization/Angiography 4. AVOID ETOH due to stomach bleeds Immediate Relief
arteries, occurs at rest, and caused by • EVERYONE should get Pneumococcal - ETOH = ½ drinks
- Nitroglycerin (SL, powder, or
illicit drug use such as Cocaine. Vaccine Transublingual Spray)
Anti-platelet Agents
Irreversible COX 1-2 Warning:
Dyspepsia - NSAID or ASA allergy
Prostaglandin (PG) - Bleeding - Tx is for LIFE
Bayer, Bufferin, Ecotrin heartburn - Asthma patients
Aspirin (ASA) Thromboxane A2 (TXA2) - AVOID ETOH - Chewable ASA 325 is preferred
+ Omeprazole (Yosprala) nausea - Children w/ Viral infxn
(Anti-platelet, anti-pyretic, analgesic, and other - Durlaza/Yosprala NOT to be used when rapid onset is needed.
Tinnitus (Reye's Syndrome)
anti-inflammatory properties) blood thinners
- Bleeding risk- stop 5 days before surgery.
Irreversibly inhibits P2Y12-ADP GI hemorrhage
Test 2C19 - AVOID w/ Omeprazole or Esomeprazole.
Clopidogrel Plavix preventing platelet activation & hematoma Serious bleeding
genotype - TTP has been reported.
aggregation (Prodrug) pruritus
- Prodrug converted to active metabolite by CYP2C19.
Anti-anginal Tx:
DRUG TREATMENT PREFERENCE HOW IT WORKS ADRs C/I NOTES
Reduces O2 demand, Warning: AVOID in - Titrate to resting HR 55-65 BPM
Beta-Blockers 1ST LINE drug in SIHD
HR, contractility. Prinzmetal's angina - Can be alone or in combo w/ CCBs, Nitrates, or Ranolazine.
Warning: AVOID
- 2nd Line = if BB's C/I or Add-on Tx + BB
Calcium Channel Blockers Preferred: Prinzmetal's angina short-acting CCB
- DHP's preferred as ADD-ON w/ BB
(Nifedipine IR)
Dizzy Warning: - Has NO effect on HR or BP
Inhibits Na+ current &
HA QT Prolongation - Limit dose to 500mg BID if taken w/ MOD CYP3A4 (Azole/Non-DHP CCB)
Ranolazine (Ranexa) Ca+ to decrease O2
Constipation Liver cirrhosis - Can be used w/ other drugs
demand
Nausea CYP3A4 inhibitor/inducer - AVOID Grapefruit juice
Nitrates - AVOID Sildenafil, Tadalifil, Vardenafil, Avanafil, and Riociguat. Flushing/HA lessens over time. AVOID getting up too fast
GENERIC BRAND MOA ADRs BBW C/I NOTES COUNSELING
1. Let dissolve under tongue or between cheek &
Nitroglycerin SL Tablet Nitrostat - Call 911 if chest gums/teeth.
pain does NOT go 2. Keep stored in glass amber vial at room temp.
Short-Acting NITRATES: away after SL,
O2 demand  1. Prime pump before use
Spray, or Powder.
2. Prime again if not used w/in 6 months.
Nitroglycerin TL Spray NitroMist O2 supply  - Use PRN for
3. Do NOT shake
Preload  immediate relief
Warning: 4. Spray onto or under tongue w/o inhaling the spray
PDE-5 Inhibitors - Keep in OG glass
Hypotension (AVOID for 12-48 amber vial. Dispense packet contents under tongue and let dissolve
Nitroglycerin SL Powder GoNitro Dizzy
HA hrs. after) or w/o swallowing.
Lightheadedness
Nitroglycerin Ointment Nitro-BID Tachyphylaxis (tolerance) Riociguat Can stain clothing.
Flushing
Syncope 1. Apply to clean, dry, hairless skin on ANY AREA
CAUTION w/ Intracranial
Pressure  except below the knee.
Antihypertensives - LA-Nitrates: ONLY
Long-Acting NITRATES: 2. Must have 12-14 hr. free period
Nitroglycerin Patch Nitro-DUR used 2nd Line to ±BB 3. Apply new patch to different area of skin.
O2 demand 
- Req. 10-12 hr. 4. Dispose by folding in half & discard away from
O2 supply 
nitrate-free period children/pets.
Preload  to reduce tolerance.
Isosorbide Mononitrate Monoket
Isordil
Isosorbide Dinitrate
Titradose/Dilatrate
DEPRESSION
General Information DSM-5 Criteria Treatment Drugs that Worsen Depression Warnings
DSM-5 Criteria: req. ≥5 symptoms in BLACK-BOX WARNINGS:
• Depression: aka "Major Depressive Disorder" (MDD) same 2-wk period BUT must include • 1st choice: start w/ agent based on S/E profile, safety, & PT-
• Caused by imbalances of NTs: Glutumate, Acetylcholine, Dopamine, specific Sx. • ALL anti-depressants carry BBW for
depressed mood OR diminished 1. ADHD: Methylphenidate or increased suicidal ideation in child,
Norepinephrine, Epinephrine, mostly Serotonin. interest/pleasure • 1st Line = SSRI, SNRI, Mirtazapine, or Bupropion is preferred. Atomoxetine (Strattera) teens, or young adults in the 1st few
• Medication trial 6-8 wks. then switch in same class or combo w/ different • AVOID: MAOi such as Phenelzine, Tranylcypromine, stimulants.
class if there is no change. months of Tx or dose changed.
DSM-5 Criteria: Isocarboxazid are all LAST LINE due to Serotonin Syndrome. 2. Analgesics: Indomethacin,
• MUST rule out Bi-Polar disorder before initiating Anti-Depressant Tx due to • Mood - Depressed • ALL Anti-Depressant must be tapered off for D/C except Methadone, other Opioids. RISK OF SEIZURES:
inducing mania or rapid-cycling. • Sleep - / Fluoxetine, which self-tapers due to long half-life. 3. Retrovirals: Efavirenz or • Bupropion is C/I
• Benzos should NOT be used alone in when Tx depression • Interest/Pleasure - diminished • Tx-Resistant Depression: Rilpivirine. o Do NOT exceed 450 mg dose
+ anxiety as it leaves depression untreated. • Guilt - feeling worthless o Trial of 6-8 wks. to determine if no response then proceeds: 4. BP: Beta-blockers, Clonidine,
• Natural Products: St. John's Wort or SAMe (S-adenosyl-L-methionine may be • Energy -  1. Dosage increase Methyldopa, Procainamide, CARDIAC ISSUES:
helpful Tx of depression but should NOT be used w/ Serotonergic agents 2. Combo w/ agent of other MOA Reserpine.
• Concentration -  • Avoid Citalopram/Escitalopram
(Serotonin Syndrome). 3. Augment w/ Buspirone, Aripiprazole, Quetiapine XR, 5. Hormones: Contraceptives or
• Appetite - / Anabolic steroids. • Preferred: Sertraline
• Bereavement Period is ok for 6 months. or Olanzapine + Fluoxetine (Symbyvax)
• TSH levels can contribute to depression as well. • Psychomotor Agitation or 4. Recommended for augmentation is Lithium, Thyroid 6. Others: Systemic steroids,
Retardation Cyclosporine, Isotretinoin, WEIGHT ISSUES:
• Sleep & appetite improve in 1st 4-6 wks so you usually see Benzo use. hormone, or Electroconvulsive Tx (ECT)
• Suicidal Ideation Interferons, Varenicline. • Avoid Mirtazapine if weight gain
• May try different drugs w/in same class then try different class. • Depression + Pain: Duloxetine is indicated for both concerns
• M-SIG-E-CAPS • Insomnia or Low-Body Weight: Mirtazapine S/E are beneficial
• Paroxetine = most sedating, Escitalopram = least amount of drug interactions. o ≥5 Sx in 2 wks • Use Bupropion for weight loss

Fluoxetine Sexual/Erectile dysfunction
Prozac
(2D6/2C19 inhibitor) SSRI's: Libido, Ejaculation, Anorgasmia - ALL req 2 week washout period between MAOi &
Fluoxetine + Olanzapine Symbyvax Somnolence SSRi. EXCEPT Fluoxetine - Long half-life  5 week
Paroxetine - Fluoxetine - Needs to be taken Insomnia BBW: washout period.
Paxil AM due to activation. Suicidal risk in child, teen, Concurrent use of MAOi,
(2D6 inhibitor) Nausea - Fluvoxamine has most drug interactions.
Fluvoxamine Luvox - Others - Usually taken AM Dry mouth young adults. Linezolid, IV Methylene Blue - Switching Fluoxetine from daily to weekly dose must
- Sedating - Take PM Diaphoresis start 7 days after last daily dose.
Sertraline Zoloft
- ALL increase BLEEDING RISK: Dizziness/Headache WARNING: Pregnancy – Brisdelle - QT-Prolong: Most in Citalopram & Escitalopram.
Citalopram Celexa
o Anti-Coags, Anti-Platelets, Tremor/Weakness QT-Prolongation (dose > 20/10)
NSAIDs SIADH/Hyponatremia (elderly) - Limit Citalopram dose < 40 mg or < 20 mg in elderly
Escitalopram Lexapro -  Tamoxifen efficacy Restless Leg Syndrome (> 60 yo)
Fall risk - caution in osteoporosis
Combined SSRIs: N/V/D Suicidal risk - Take w/ FOOD
Vilazodone Viibryd Use w/in 14 days of MAOi
Libido AVOID in Hx of seizure - LESS sexual S/E
Vortioxetine Tintellix 5HT-1A agonist + SSRI N/V/C Suicidal risk Use w/in 14 days of MAOi
Venlafaxine Effexor SNRI: Similar S/E to SSRI + NE re-uptake:
Duloxetine Cymbalta  HR - Additive QT-Prolong - Venlafaxine
Serotonin + NE re-uptake inhibitor
Pristiq Dilated pupils Suicidal risk Lethal MAOi washout period - Decreased Tamoxifen efficacy
Desvenlafaxine Bleeding Risks: Avoid Anti-Coags, Dry mouth - AVOID Linezolid, methylene blue
Khedezla
Anti-platelets, NSAIDs  BP risk: at higher doses.
Levomalnicipran Fetzima
Amitriptyline Elavil
Doxepin Cardiotoxicity: QT-Prolong
Nortriptyline Pamelor TCA's: Orthostasis (Orthostatic HTN) MAOi
Desipramine Norpramin Tachycardia Suicidal risk Linezolid Additive QT-Prolongation
Maprotiline NE, 5HT, Ach, Histamine Anti-Cholinergic Fx: (Dry mouth, blurred vision, Methylene Blue
Clomipramine urinary retention, constipation)
Trimipramine
Isocarboxazid Marplan Anti-Cholinergic Fx CVD/CVA
Orthostasis
- NOT commonly used
Sedation 2-Wk Washout Period with:
Phenelzine Nardil MAOi Suicidal risk - Lethal Drug-Drug + Drug-Food Rxns.
Sexual Dysfunction SSRI, SNRI, TCA, Bupropion,
- Hypertensive Crisis & Serotonin Sx.
Weight Gain Linezolid, Methylene Blue
Tranylcypromine Parnate Insomnia/HA 5-Wk = Fluoxetine
Emsam (PATCH)
Selegiline MAOi-B inhibitor Foods high in Tyramine
Zelepar
Wellbutrin
DA + NE re-uptake inhibitor: Dry mouth - Sexual Dysfxn is RARE
Zyban - smoke cessation Seizure disorder
1. Avoid at bedtime. Insomnia - Do NOT use multiple formulation of this drug
Buproprion Contrave = + Naltrexone Suicidal risk Anorexia
2. Avoid in seizure, anorexia, Tremors concurrently.
Aplenzin Bulimia
and bulimia. Seizures (dose-related) - Decreases Tamoxifen efficacy
Forfivo
Sedation
Mirtazapine Remeron
 Appetite/Weight Gain
Miscellaneous: Suicidal risk AVOID: MAOi, SSRI
Oleptro
Trazodone Take ALL at BEDTIME Sedation Additive QT-Prolongation
Desyrel
Priapism
Nefazodone Hepatotoxicity Rarely used due to Hepatotoxicity
Resistant Depression Tx
Aripiprazole Abilify Anxiety, insomnia, constipation
Olanzapine/Fluoxetine Symbyvax ADJUNCT Agents: Sedation, weight gain, QT-Prolong Symbyvax: Caution w/ QT-
Used to augment after 2 failed Suicidal risk ALL cause Orthostasis
Quetiapine Seroquel Sedation, weight gain Prolong
trials
Brexipiprazole Rexulti Weight Gain
ANEMIA
General Information Signs & Symptoms Types of Anemia
• APLASTIC Anemia:
Fatigue/Weakness o Bone marrow fails to make RBCs, WBCs, • Normocytic Anemia = Normal Hgb | Normal MCV (80-100). Anemia of Chronic Kidney Dx (CKD)
SOB and Platelets. o Primarily due to deficiency in Erythropoietin (EPO)
Exercise Intolerance o Tx: Eltrombopag (Promacta) - increases o EPO produced in kidneys & stimulates RBC production in bone marrow.
HA/Dizzy Platelet count. o Treatment:
Anorexia 1. Iron Therapy
• HEMOLYTIC Anemia: 2. EPO Stimulating Agents (ESA) - maintain Hgb levels & reduce need for blood transfusions.
•  Hgb/Hct in immature RBCs, Pallor o RBCs are destroyed before lifespan of Do NOT SHAKE vials or syringe or ESA's will not work. Rotate injection sites.
aka Reticulocytes. 120 days.
% Elemental Iron (PO) • Macrocytic Anemia =  Hgb | MCV (>100). AKA Pernicious Anemia - occurs due to lack of
•  O2 carrying capacity in o Can be drug-induced
Intrinsic Factor. Caused by Vitamin-B12 or Folate deficiency, alcoholism, poor nutrition, GI disorders,
blood. ▪ Beta-Lactamase inhibitors
long term use of (>2 yrs) Metformin, H2RAs, or PPIs.
• Caused by nutritional deficiency ▪ Cephalosporin’s
o Vit-B12 Deficiency Anemia:
(Iron, Folate, Vit-B12) ▪ Isoniazid
▪ Neurological dysfxn (may be irreversible), Peripheral Neuropathy, Visual disturbance,
• Also caused by CKD or ▪ Levodopa/Methyldopa
• Ferrous Gluconate 12% Psychiatric Sx
Malignancy. ▪ PCNs (esp. Piperacillin) o Folic Acid Deficiency:
• Chronic Anemia - less O2 leads • Ferrous Sulfate 20% ▪ Platinum-Based Chemo Tx ▪ Ulcerations of tongue, oral mucosa, skin, nails.
to ischemia  organ damage • Dried Ferrous Sulfate 30% (Carbaplatin, Cisplatin) o Treatment: 1st Line = Vitamin-B12 injections (Cyanocobalamin) & Folic Acid
 Tachycardia compensation  • Ferrous Fumurate 33% o Can be genetic (G6PD-deficiency)
• Microcytic Anemia =  Hgb | MCV (<80). Caused by Iron deficiency
Heart Failure. • Carbonyl Iron 100% ▪ Chloroquine ▪ Primaquine
o Iron-Deficiency Anemia:
• Polysaccharide Iron ▪ Dapsone ▪ Probenacid
▪ Glossitis, Koilonychias (thin/concave nails), Pica (craving non-foods like clay)
Complex 100% ▪ Methylene Blue ▪ Rasburicase
▪ Hgb (< 80); RBC; Iron; Ferritin, TSAT; TIBC
▪ Nitrofurantoin ▪ Ribavirin
▪ Treatment: Oral Iron Therapy = 100-200mg Iron per day.
▪ Quinidine ▪ Rifampin
▪ Quinine ▪ Sulfonamides • PARENTAL Iron Tx: is more effective (100% absorption). Leads to more S/E + cost.
▪ PTs w/ CKD on Hemodialysis need IV iron.
o Coombs Test - detects ABs.
Ferrous Sulfate - Docusate for constipation.
Dried Ferrous Sulfate - ANTIDOTE = Deferoxamine (Desferal)
Nausea
Ferrous Fumurate Accidental overdose = Hemolytic anemia - AVOID: H2RAs, PPIs, Antacids
PO Elemental Upset Stomach
FATAL in child. Hemochromatosis - SEPARATE: FQ's/Tetracyclines ABX, Bisphosphonates, Levothyroxine, Vitamin-C
Ferrous Gluconate Iron Constipation
Call poison control center. Hemosiderosis - Take Iron on an empty stomach (1 hr before or 2 hrs after).
Carbonyl Iron Dark/Tarry stools
- Some may cause GI irritation.
Polysaccharide Iron Complex - All iron formulations are equal if dosed properly.
Iron Dextran INFED ALL Hypersensitivity Risk Iron Dextran & Ferumoxytol
Sodium Ferric Gluconate Ferrlecit Hypo/Hypertension Have FATAL anaphylactic
Iron Sucrose Venofer Muscle aches rxns. - Triferic is only indicated for PTs w/ CKD on Hemodialysis
IV Iron Meds
Ferumoxytol Feraheme Tachycardia - Must add Bicarbonate concentrate to hemodialysate.
Ferric Carboxymaltose Injectafer Chest pain Must use TEST DOSE w/ Iron
Ferric Pyrophosphate Citrate Triferic Peripheral Edema Dextran.
B-12 Compliance WARNING:

Cyanocobalamin Vit-B12 Rash Contains Al+ & Benzyl ETOH
Nascobal
Pain w/ Injection
Vitamin-B12
Peripheral Edema • May accumulate causing Hypersensitivity
Folic Acid | Folate FA-8 Polycythemia Vera CNS + Bone toxicity if
renally imp.
- Monitor: Hgb, Hct, TSAT, serum Ferritin, BP

Epogen Arthralgia/Bone pain CKD: risk of death, CV - Do NOT shake vials/syringes
Epoetin Alfa N/V/HA events, Stroke if Hgb >11
Procrit - Use lowest effective dose to avoid need for Blood Transfusion.
EPO Pruritus/Rash g/dL. - NOT indicated for a CURE outcome
Stimulating Cough/Dyspnea Cancer: Shortened overall Uncontrolled HTN - Initiate when Hgb <10 g/dL
Agents (ESA) Edema survival. Increased Tumor
- Dose/DC if Hgb >11 g/dL (for CKD or Hemodialysis)
Darbepoetin Aranesp Dizziness progression or Tumor
Injection site pain - Do NOT  dose in less than Q4wks
recurrence.
- Store ALL ESA in Fridge.
ACUTE CORONARY SYNDROME
General Information Signs & Symptoms DRUG Tx:
• Chest pain MONA-GAP-BA ALL PTs should get HIGH INTENSITY STATIN
• Reduced blood flow  myocardial oxygen supply &
• Pressure/chest tightness • Morphine - NSTE-ACS: MONA-GAP-BA +/- PCI I
demand imbalance.
• Dyspnea • Oxygen
• Caused by plaque buildup in arteries (Atherosclerosis). - STEMI: MONA-GAP-BA + PCI or Fibrinolytic (PCI preferred)
o Fatty streaks build up leading to clots or ischemia. • Diaphoresis • Nitrates
• Syncope o Fibrinolytics used if PT isn’t able to get PCI w/in 2 hours of 1st
• NSTE-ACS: is Unstable Angina (UA) or NSTEMI. • Aspirin contact.
• STEMI: relates to ST-elevation • Palpitations o NEVER use NSAIDs other o CABG surgery is also an option
UA NSTEMI STEMI • Pain may radiate to arms, than ASA (in hospital setting)
Sx Chest pain back, neck or epigastric area. • GP2B/3A Antagonists Long-Term Management after ACS (2nd Prevention)
Cardiac • Sx can occur at rest w/ little • Anti-coagulants
Enzymes
- + + • ASA - 81mg QD for LIFE
exertion or caused by o LMWHs for NSTEMI
ECG None/ transient ischemic changes exercise or stress. o UFH or Bivalirudin for STEMI • P2Y12 - Ticagrelor/Clopidogrel + ASA for 12 months
 ST-segment • PCI Patients - Prasugrel/Ticagrelor/Clopidogrel + ASA 12 mo.
Changes ST depression / T-wave inversion
Risk Factors o Warfarin Use: May use
Blockage Partial blockage Complete blockage lesser goal of 2-2.5. Use for • NTG - for LIFE (Spray or SL)
1. Men >45, Women >55 shortest time possible. • Beta-Blocker - 3 years or LIFE (if HTN or HF)
• Diagnosis: 2. Family Hx 1st degree - Men ▪ PPI's should be given to o O2, BP, HR, Ischemia 
o 12-Lead ECG w/I 10 mins. of 1st medical contact. <55, Women <65 all Pt w/ Hx of GI o PO Low dose Beta-1 Selective BB w/o ISA activity preferred &
o PTs w/ MI need to be taken to hospital w/ PCI 3. Smoking bleed on Triple ABX started w/I 24 hrs.
capability. 4. HTN Tx. o If BB is contraindicated - Use NON-DHP CCB (Verapamil or
o Cardiac enzymes - Troponin I & T are biomarkers 5. Dyslipidemia • P2Y12 inhibitors Diltiazem)
for ACS. 6. Diabetes
• Beta-blockers • ACEi/ARBs - for LIFE in all pts w/ LVEF <40%, HTN, DM, CKD
▪ Must have w/in 3-6 hrs. after Sx onset. 7. Chronic Angina
o IR Nifedipine NEVER used o PO started w/in 24 hrs
o CK-MB & Myoglobin may also be used. 8. CAD
9. Sedentary/ETOH use • ACE inhibitors • Statin - High ≥75 yo, Moderate <75 yo

- Hypotension
- Bradycardia
Morphine Arterial/Venous dilation - May be used w/ or w/o NTG
- N/V
Sulfate  decreasing O2 demand - 2-5 mg IV Q5-30 min PRN
- sedation
- respiratory depression
Oxygen - Given if O2 saturation (SaO2) <90% or in resp. distress
SBP <90 mmHg
Dilate coronary arteries
Nitrates HR <50 bpm - NEVER use w/ PDE-5 inhibitor
02 demand  Preload 
Right Ventricle infarction
- NEVER use ER ASA products
Irreversible COX-1/2 inhibitor
Aspirin - Maintenance = 81-162 mg for LIFE
 inhibit TXA2
- Non-enteric coated, chewable ASA (162-325mg) for ALL Pts
Abciximab ReoPro - Thrombocytopenia
GP2B/3A Antagonists Bleeding (Platelet <100,000) - NOT for medical management
Eptifibatide Integrillin Blocks Fibrinogen  inhibit Thrombocytopenia - Hx of bleeding/stroke - If used in PCI must be given w/ Heparin
platelet aggregation Hypotension - Uncontrolled HTN - Abciximab must be FILTERED for reconstitution
Tirofiban Aggrastat - Recent surgery/trauma
- Stop 5 days before surgery.
Thienopyridines: - AVOID Omeprazole, Esomeprazole (CYP2C19 inhibitors)
Clopidogrel Plavix Serious bleeding
Pro-drugs that bind irreversibly - TTP has been reported
to P2Y12 receptors - D/C = Clotting risk 
- Only given if PCI.
Given + ASA = DAPT i Serious bleed
Prasugrel Effient Bleeding - Keep in OG container.
Hx of TIA or Stroke
Hematoma - NOT used for Pt > 75 yo
Pruritus - Serious bleeding - Stop 5 days before surgery.
- ASA >100 mg must AVOID Serious bleed - NOT a Prodrug
Ticagrelor Brilinta
P2Y12 inhibitors Ticagrelor due decrease Hx of ICH - Maintenance Dose = 90 mg BID for 1 year
Inhibit receptors  prevent effectiveness. o After 1 year = 60 mg BID
platelet aggregation - Transition to Oral P2Y12: Ticagrelor 180 mg can be given
Cangrelor Kengreal during or after stopping Cangrelor infusion BUT Prasugrel 60
mg or Clopidogrel 600 mg only after Cangrelor NOT during
Alteplase Activase Fibrinolytics: - Only given if STEMI & Hx of ICH - Accelerated Infusion: 100 mg IV over 1.5 hrs
Bleeding
Convert Plasminogen  Plasmin unable to perform PCI in Hx of bleeding/stroke
Tenecteplase TNKase Intracranial Hemorrhage
90-120 min. Uncontrolled HTN - Door to needle <30 min.
Hypotension
Reteplase Retavase ONLY for STEMI I - MUST be given w/in 30 min. Recent surgery/trauma
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Persistent airflow limits NOT reversible unlike asthma
General Information Assessment Treatment
1. Mostly caused by Tobacco smoke (also • Non-Pharm Tx/Px:
MUST assess Airflow limitation, Sx, Risks of exacerbation, comorbidities o Smoking cessation (Only 1 to slow progression)
other smoking).
2. Genetic Alpha-1 Anti-Trypsin deficiency Comorbidities o Flu vaccine/Pneumococcal vaccine
(AATD) high risk 1. CVD 4. Depression/Anxiety Symptom Assessment: • Drug Tx:
2. Osteoporosis 5. Muscle Dysfxn 1. Chronic cough o ICS is NOT 1st line in COPD. Bronchodilators are 1st LINE.
3. Chronic inflammation leads to lung
3. Diabetes 6. Lung cancer 2. Sputum o COPD meds do NOT help declining lung fxn.
damage.
4. DIAGNOSIS: 3. Dyspnea o Meds decrease Sx, prevent complications/exacerbations.
Poor control  mortality 
a. Dyspnea o SAMA/SABA = PRN. LAMA/LABA = Regular use
b. Chronic cough/sputum o PO meds or ICS as mono Tx is not recommended.
c. Hx of exposure to smoke
Combined Assessment of COPD:
o Combining bronchodilators can decrease side effects
d. Spirometry required
i. FEV1/FVC <0.70 = COPD • mMRC: Dyspnea scale ≥ 2 or ≥ 1 lead to Drug Tx ABCD Scale for COPD
C D
ii. MUST differentiate from Asthma assess breathlessness hospital admit Patient Group Initial Tx Assessment Tx Escalation
5. Key features: 0-4 scale. Try different class of
a. Usually >40 YO SABA or SAMA PRN Sx NOT well
• CAT Score: Assess Sx A
LABA or LAMA controlled
bronchodilator for
b. >10 Smoking Hx 0-40 scale. Mono Tx
0 or 1 not hospital A B
c. Sputum production • Assess Sx + Risk of
d. Unlikely allergies B LABA or LAMA Persistent Sx LAMA + LABA
exacerbation to drive
e. Persistent Sx drug Tx. CAT < 10 CAT ≥ 10 Further LAMA + LABA
f. Progressive Dx Exacerbation Risk Hx C LAMA
mMRC > 10 mMRC ≥ 2 Exacerbations Alt: LABA + ICS
g. Exacerbations common
h. 1st LINE = Bronchodilator LABA + LAMA Persistent Sx +
Degree of Post-Bronchodilator Airflow Limitation: D LAMA + LABA + ICS
6. COPD Inhaler Products: Alt: LABA + ICS Exacerbations
a. Budesonide/Formoterol (Symbicort) GOLD 1 Mild FEV1 ≥ 80% predicted
b. Fluticasone/Salmeterol (Advair Diskus) GOLD 2 Mod 50% ≤ FEV1 < 80% • COPD Exacerbations:
c. Fluticasone/Vilanterol (Breo Ellipta) GOLD 3 Severe 30% ≤ FEV1 < 50% o Lead to URTIs typically Tx w/ SABA +/- SAMA + Steroid
d. Glycopyrrolate/Formoterol (Bevespi o If sputum purulence, volume, increased dyspnea, or req. mechanical vent
GOLD 4 Very Severe FEV1 < 30%
Aerosphere) = ABX needed for 5-10 days.

SAMA:
Ipratropium Bromide Atrovent HFA
Muscarinic antagonist
Anti-Cholinergic
Ipratropium Bromide Block Acetylcholine  Dilate bronchioles WARNING:
Combivent Respimat 1. Dry mouth - AVOID spraying into Eyes.
+ Albuterol Caution in Myasthenia Gravis,
MDI or Nebulizer i 2. URTI - Do NOT swallow capsules.
Narrow-angle glaucoma, Urinary
Spiriva Handihaler 3. Cough - Monitor smoking status & COPD
Tiotropium retention, BPH, bladder
Spiriva Respimat 4. Bitter taste questionnaires
LAMA: obstruction.
Glycopyrrolate Seebri Neohaler
Umeclidinium Incuse Ellipta DPI only i
Aclidinium Turdoza Pressair
ProAir HFA
WARNING: - MDI's (HFA): Shake well before use
ProAir RespiClick
Albuterol SABA: Caution w/ CVD, - Most Albuterol inhalers = 200
Ventolin HFA
Beta-2 agonist  Relax smooth muscle Nervousness Glaucoma, inhalations/canister
Proventil HFA
Levabuterol Xopenex  Bronchodilation Tremor Hyperthyroidism, - Except Ventolin HFA = 60 inhales
Tachycardia Seizures, Diabetes - EIB: 2 inhales 5 min. before exercise
Racepinepherine OTC
Palpitations
Salmeterol Serevent Diskus (DPI)
Hyperglycemia - Do NOT swallow capsules
Formoterol Perforomist LABA: Status asthmaticus,
K+  - ONLY for PTs on ICS but not controlled
Aformoterol Brovana MONO Tx ONLY (unlike Asthma which  Risk of Asthma death acute asthma or
- NEVER use MONO Tx in Asthma but ok
Indaceterol Arcapta Neohaler uses ICS) COPD episodes.
for COPD
Olodaterol Striverdi Respimat
Diarrhea
- CYP3A4 substrate
Weight Loss
PDE-4 inhibitor: WARNING: - AVOID Carbamazepine, Phenobarbital,
Roflumilast Daliresp Appetite decrease Mod-Sev Liver imp
 cAMP  inflammation  Psychiatric events (Behavior) Phenytoin, Rifampin, Erythromycin,
Nausea
Azoles, Fluvoxamine, and Cimetidine.
HA
Atrovent HFA: Respimat Products: Spiriva Handihaler: Turdoza Pressair: Ellipta Products: Neohaler Products:
1. Turn clear base to click. 1. Place capsule from blister pack 1. Ready when control window
1. No Shaking
2. Open cap turn away & & insert into chamber. changes RED  GREEN. 1. Accidental double-dose is 1. Insert capsule from blister
2. Keep eyes closed while inhaling.
exhale. 2. Press Green button ONCE. 2. Inhale til it CLICKS. NOT possible. pack into chamber.
Counseling 3. Inhale SLOW/DEEP.
3. Inhale SLOW/DEEP 3. Turn away exhale. 3. Inhale fully. 2. Inhale but do NOT block 2. Turn away & exhale fully.
4. Hold breath long/10 sec.
4. Hold long/10 sec 4. Inhale DEEP/FULLY 4. Hold breath & exhale AIR VENT. 3. Capsule chamber must be
5. Wait 15 secs b/t inhales.
5. Priming required 5. Spiriva capsule VIBRATES through NOSE. 3. Rinse mouth for ICS. empty of ALL POWDER.
6. Prime 2x (3 days no use)
6. Clean w/ damp cloth or 6. MUST inhale 2x to get full dose. 5. Check window for RED 4. Cleaning NOT required. 4. Cleaning NOT required.
7. Clean w/ H2O & air dry WEEKLY
tissue weekly. 7. Clean H2O + Air dry shows full dose was used.
TRANSPLANT
General Information Complications DRUG Tx: Immunosuppression
• Prior to transplant crossmatching to assess • Goal is to ↓ toxicity risk & graft
compatibility for Human Leukocyte Antigen (HLA) & • Immunosuppressant Drugs MAINTENANCE Tx:
o cause metabolic syndrome rejection
ABO Blood Group to prevent immune rejection. - 1st Line = Tacrolimus (CNI) • Monitor: trough levels
• Auto-Rejection = requires Biopsy + High Dose • High risk for CVD INDUCTION Tx: - 1st Line Anti-Proliferate
Steroids o Control BP, BG, cholesterol, weight Agent: Mycophenolate Pre-Transplant Vaccines:
- Given before or at time - Flu vaccine (inactivated) annually
• Allograft - Transplant of organ/tissue from person to • Cancer of transplant to prevent
o High risk of skin cancer so sunscreen Other drug options: - Pneumococcal if ≥ 19 yo PCV13
person. acute rejection.
must be used. - Azathioprine →8wks →PPSV23
• Isograft - Transplant from genetically identical twin. - Varicella (Pre-transplant)
• Autograft - Transplant from one site to another in • ALL drugs ↑ BP, BG, Lipids - Most Common Drug: - Everolimus
• Use Daily Log: - Sirolimus - Vaccinate PT's household members
same PT. Basiliximab - IL2
o Temp, Weight, BP, BG antagonist - Belatacept Reduce Infection Risk:
Blood Matching - Steroids 1. Hand washing
• AVOID OTC | Herbal
Type A React w/ Type B | AB - Antithymocyte globulin (at 2. Keep away from contaminates
- if High-Risk of Rejection:
Type B React w/ Type A | AB higher dose than in induction) 3. Vaccinations (no live when post-
Type O • Tacrolimus & cyclosporine Antithymocyte globulin
React w/ Type A | B | AB o Nephrotoxicity, diabetes, HTN - Basiliximab (at higher dose transplant)
only matches O than in induction) 4. Treat infections (prophylactic tx is
• MTOR inhibitors, cyclosporine = lipids common)
Type AB Matches A | B | AB
Induction Therapy
GENERIC BRAND MOA ADRs BBW NOTES
• Infusion Rxns
ATGAM AB's attack T- Pre-medicate for infusion-related rxn
Antithymocyte Globulin
Thymoglobulin lymphocytes: • Leukopenia Dose Difference: ATGAM (equine) | Thymoglobulin (rabbit)
Should only be given by
• Thrombocytopenia experienced physician.
Basiliximab Simulect
Interleukin-2 (IL-2) RA: • N/V/D
Chimeric Human MAB (Well Tolerated)
Maintenance Therapy
Short Term SE: Fluid
retention, Upset stomach, Long Term: Adrenal suppression, Cushing's, Poor
Prednisone Steroid Mood swings, Insomnia, wound heal, HTN, Diabetes, Acne, Osteoporosis,
↑Appetite/Weight gain, Stunted growth
↑BP, ↑BG
Mycophenolate Counseling:
CellCept Infection NEVER take on Empty stomach - REMS Program
Mofetil Anti-Proliferatives: Take missed dose if <4
Leukopenia Lymphoma - Drugs NOT
hrs passed, > 4hrs = skip
↓ Hormonal Contraception Diarrhea Skin cancer interchangeable
Take on EMPTY stomach.
Levels GI upset Birth defects - Protect from light
Mycophenolic Acid Myfortic Avoid in pregnancy.
Cyclosporine = ↓ levels Vomiting Spontaneous - CellCept = D5W
AVOID: Antacids, Multi-
abortions only
vitamins
Leukopenia
Anemia
Imuran Thrombocytopenia
Azathiopurine Hepatotoxicity
Azasan
Myelosuppression
(if genetic ↓TPMT)
Tacrolimus Prograf HTN Infection Never START/STOP other meds.
Calcineurin inhibitors (CNI): Hyperglycemia (diabetes) Hirsutism *Never switch Brands w/o PCP consent.
Inducers = ↓ CNI conc. Renal impairment
Neoral Nephrotoxicity Gingival Hyperplasia *Never START/STOP other meds
Inhibitors = ↑ CNI conc. Edema
Cyclosporine Gengraf Neurotoxicity *Do NOT give solution from plastic/Styrofoam cup.
AVOID: St. John's Wort, Sandimmune NOT
SandImmune ↑K+, ↓Mg+ Monitor: Trough, Electrolytes, *Causes BP, kidney issues, Gingival Hyperplasia
Grapefruit interchangeable
QT-prolong Renal Fxn, BP, BG DDI = CYP3A4 + P-gp
Peripheral Edema
HTN
Everolimus Zotress Hepatic Artery Thrombosis CYP3A4 Substrate
(Do NOT use w/I 30 days
of transplant)
mTOR inhibitors Hyperglycemia Infection
Irreversible ADRs
Monitor: Trough
Pneumonitis Poor Wound Healing
Sirolimus Rapamune Tabs vs. Oral Sol = NOT EQ
Bronchitis Hyperlipidemia
CYP3A4 Substrate
Cough
D/C Tx if this happens
CD-80 ONLY use in EBV+
Belatacept Nulojix Common ADRs (N/V/D) Tx Latent TB inxn BEFORE use
CD-86 Pts
DYSLIPIDEMIA
ACC/AHA Guidelines: Statins are 1st Line unless not tolerated.
General Information Labs Treatment Algorithm
• Elevations in non-HDL, LDL, & TG increase risk of atherogenic disease.

Non-HDL LDL HDL TG
↑TC, LDL, TG or ↓HDL
>40 (men)
• Aim for 5-6% Sat fat, physical activity, BMI, avoid tabacco/ETOH. Desirable <130 <100
>50 (women)
<150
• STOP all liver toxic drugs if AST/ALT (10-40) is >3x ULN. Above desirable 130-159 100-129
• For Simvastatin & Lovastatin: avoid strong CYP3A4 inhibitors Borderline high 160-189 130-159 150-199
o Azoles, erythromycin, clarithromycin, HIV protease inhibitors, High 190-219 160-189 200-499
cobicistat, nefazodone, cyclosporine, danazol, grapefruit juice
Very high >220 >190 >500
High Dose Low Dose EQ Doses
Atorvastatin 40-80 mg Simvastatin 10 mg Pitavastatin = 2
Rosuvastatin 20-40 mg Pravastatin 10-20 mg Rosuvastatin = 5 When to treat (risk factors):
Lovastatin 20 mg Atorvastatin = 10 1. LDL >160 + genetic DLD
Fluvastatin 20-40 mg Simvastatin = 20 2. Family Hx of ASCVD (Men >55 | Women >65)
Pitavastatin 1 mg Lovastatin = 40 3. High CRP = > 2
Pravastatin = 40 4. Ankle/Brachial Index = > 0.9
Fluvastatin = 80 mg
Pharmacist Rock At Friedewald EQ: [LDL = TC - HDL - (TC/G)]
Saving Lives & a. PT should be on 9-12 hr fast or LDL will be lower than measured.
Preventing Flu • Primary (Familial) - Genetic, cholesterol ↑
• Secondary (Acquired) - Diet, drugs, ASCVD
GENERIC BRAND MOA ADRs BBW CONTRAINDICATION NOTES COUNSELING

Atorvastatin Lipitor 1. ONLY Simvastatin, Lovastatin, & Lescol
Lovastatin Mevacor/Altoprev XL must be taken QHS. 1. AVOID Gemfibrozil
2. Rosuvastatin - start 5mg for Asians 2. AVOID Niacin > 1 g
Rosuvastatin Crestor Active liver Dx
STATINS: Skeletal muscle 3. Simvastatin - Max 10mg (Verapamil, 3. AVOID Colchicine
Pregnancy
Simvastatin Zocor Inhibit HMG-CoA reductase Myalgias, arthralgia, Fx, diabetes, Diltiazem, Dronedarone) 4. Contact PCP - muscle Sx
Breast-feeding
preventing the rate-limiting myopathy, diarrhea Hepatotoxicity Max 20mg - (Amiodarone, 5. Contact PCP - dark urine
Pravastatin Pravachol Use w/ Cyclosporine
step for cholesterol cognitive imp. Amlodipine, Lomitapide, Ranolazine). 6. Take Zocor & Lescol QHS
(LFT's ↑) Simvastatin/Lovastatin
Pitavastatin Livalo synthesis. 4. Lovastatin - Max 20mg (Verapamil, 7. AVOID in Pregnancy +
(CYP3A4)
Amlodipine, Diltiazem, Dronedarone, Nursing
Fluvastatin Lescol Danazol). 8. Titrate dose to limit Sx
Simvastatin + Ezetimibe Vytorin Max 40mg - (Amiodarone, Ticagrelor)
1. Monitor LFT's when used w/ Statin or 1. Contact PCP - dark urine

Fibrate 2. Contact PCP - muscle Sx
AVOID in
Diarrhea, URTI's, 2. Give 2 hours before or 4 hrs after 3. w/ or w/o food
Inhibits cholesterol at brush Hepatic imp.,
Ezetimibe Zetia arthralgia, myalgias BAS. (Decrease levels) 4. Give 2 hrs before or 4 hrs
border of small intestine. Skeletal muscle
sinusitis 3. AVOID use w/ Gemfibrozil. after Bile Acid Sequestrants.
Fx
4. Cyclosporine - causes increase of 5. May increase Cyclosporine lvl
levels of both drugs. 6. Monitor INR w/ Warfarin
Cholestyramine
Cholestyramine Questran Constipation, NOT taken w/ Biliary obstruction
dyspepsia, PKU. 1. Welchol: Take w/ FOOD + DRINK 1. Take w/ FOOD + H20
Bile Acid Sequestrants ab pain, cramping, 2. Space out Drugs/Multivitamin by 4 2. May need laxative for
(BAS): Binds bile acid in Bowel obstruction, TG hrs constipation.
Colesevelam Welchol gas, bloating, TG ↑,
the intestine to be excreted >500 3. ACC/AHA do NOT recommend use if 3. Space out Multivitamins as it
esophageal
in the feces. TG >300 may decrease absorption of
obstruction,
4. Monitor Warfarin INR ADEK, Folate, Iron.
Colestipol Colestid LFTs ↑
Fenofibrate Fibricor/TriCor/Lipofen
Fenofibric Acid Antara/Trilipx/Triglide Fibrates: Myopathy risk 1. Liver Dx 1. Contact PCP - muscle Sx, dark
• Can ↑LDL when TG are high.
PPAR-α Activators - Dyspepsia, ab pain, w/ Statin 2. Renal Dx urine, or ab pain, N/V.
Express Apo-C to LFTs, CPK, URTI's ↑ Cholelithiasis, 3. Gallbladder Dx • Fenoglid/Lofibra/Lipofen - w/ FOOD 2. Lopid - BID 30 mins before
VLDL ↓+ TG ↓. SCr ↑ 4. Use w/ Repaglinide • Do NOT give Gemfibrozil + Statin breakfast/dinner.
Gemfibrozil Lopid
DYSLIPIDEMIA
GENERIC BRAND MOA ADRs BBW CONTRAINDICATION NOTES COUNSELING
1. Check LFTs 1. Niaspan - Take QHS & less
2. Niacin IR - flushing/itching flushing than IR
Hepatotoxicity,
Flushing, pruritis, NVD, 3. CR/SR - more Hepatotoxicity 2. ALL - Take w/ FOOD
Nicotinic acid/Vitamin B3: Rhabdo w/
Hyperglycemia, Liver Dx, PUD, arterial 4. BEST choice is Niacin XR 3. AVOID spicy food + ETOH
Niacin Niacor/Niaspan Decreases synthesis of Statin.
Hyperuricemia, cough, bleed 5. Take ASA 30-60 mins before or 4. Contact PCP - dark urine
VLDL, TG, LDL Caution: Angina
orthostatic hypotension w/food to reduce flushing. 5. Monitor other Hepatotoxic
or MI
6. Take 4-6 hrs before BAS drugs
7. Monitor other hepatotoxic drugs 6. Take 4-6 hrs after BAS
1. Take whole
Omega -3 Acid Lovaza 2. Vascepa w/ FOOD
Fish Oils: Unknown LDL ↑, Eructation Caution: 1. No LDL increase w/ Vascepa
3. Indigestion, burping, bad
(Used adjunct to diet in PTs (burping), dyspepsia, Fish/Shellfish 2. Prolong bleeding time (INR).
taste
w/ TG >500) flatulence. allergy 3. Monitor LFTs
Icosapent Ethyl Vascepa 4. Monitor INR w/ Warfarin
(May prolong bleeding time)
1. Common Cold Sx
Alirocumab Oraluent Expensive 2. Prior to use - Let syringe
Special storage warm to room temp 30-45
PCSK-9 Inhibitors: Injection site Rxn, NLA Recommended mins & inspect for color
Nasopharyngitis, Flu,
Monoclonal AB - LDL ↓ Alirocumab - SQ injection in thigh, changes or particulates.
Repatha, SureClick, URTI, UTI
Evolocumab abdomen, upper arm. Store in fridge 3. AVOID freezing/extreme
Pushtronex heat.
Evolocumab - SQ injection. Store in fridge
4. Rotate injection sites.
NVD, Dyspepsia ab 1. Capsule ONLY

Inhibits MTP to reduce VLDL Hepatotoxicity 2. Expensive
Lopitapide Juxtapid pain, constipation Pregnancy
+ LDL ↓ (REMS) 3. CYP3A4 (Max 30mg)
flatulence, LFTs ↑
4. Limit dose of Simvastatin/Lovastatin
Inhbits Apo-B to VLDL + Nausea, HA, fatigue, Hepatotoxicity

Mipomersen Kynamro Active Liver Dx Injection ONLY
LDL ↓ ALT ↑ (REMS)
Recombinant Human Leptin REMS -
Metreleptin Myalept Leptin AB's Used to Tx Leptin deficiency
Analog Lymphoma Risk
INFLAMMATORY BOWEL DISEASE
General Information NON-Pharm Tx Ulcerative Colitis vs. Crohn’s Disease
Differences in signs & symptoms Maintenance of Remission
Crohn’s UC Crohn’s UC
- Group of inflammatory Bloody/Non-bloody Mild Dx PO Budesonide Mesalamine (5-ASA) PO/Rectal
diseases of Colon & Small Diarrhea (nocturnal diarrhea is Bloody Anti-TNF:
intestine. 1. Eat smaller meals very common) Adalimumab (Humira)
- Intermittent chronic disease frequently low in Smoking Risk factor Protective Infliximab (Remicade)
with flares & remission. fat/dairy. Entire GI tract Descending colon Certolizumab (Cimzia) Anti-TNF:
- Major Types: 2. Drink plenty of H20 - Location
(esp. ileum & colon) (esp. rectum) Adalimumab (Humira)
o Ulcerative Colitis (UC) avoid ETOH/Caffeine. Depth Transmural Superficial Thiopurine: Infliximab (Remicade)
o Crohn's disease. 3. Avoid Sorbitol & Lactose. Pattern Non-continuous Continuous Azathioprine Golimumab (Simponi)
- Triggered by infxns, NSAIDs, (Excipients - tab binders) Fistulas/Strictures Common Uncommon Mercaptopurine
food 4. Anti-Diarrheals or Mod-Severe Dx
- IBD is different from IBS Anti-Spasmodics may Thiopurine:
Induction of Remission IL-antagonist:
which has NO inflammation help. Azathioprine
Ustekinumab (Stelara) Mercaptopurine
- General signs & symptoms Ex. Dicyclomine (Bentyl) Crohn’s UC
o Bloody Diarrhea, 5. Vitamin Supplements Methotrexate
1. Steroids +/- Thiopurine
rectal urgency, prevent deficiencies. 1. Steroids (PO/Rectal) +/- (immunosuppressant) is Cyclosporine (only for severe)
or MTX (Methotrexate)
tenesmus (Feeling to 6. Lactobacillus or Thiopurine or 5-ASA. recommended in PTs who cannot
2. Anti-TNF +/- Thiopurine.
GO), abdominal pain, Bifidobaterium may help 2. Anti-TNF +/- Thiopurine. tolerate Azathioprine.
3. Interleukin-receptor
weight loss, N/V, pain/bloating. 3. IV Cyclosporine Dose is 1x/week IM/SC
antagonist
constipation, night
sweats 1. Short courses of PO or IV steroids used to Tx exacerbations. Integrin-antagonist:
Refractory/Steroid
2. Steroid doses are tapered off 8-12 weeks after remission. Natalizumab Vedolizumab
dependent Dx
3. Systemic steroids NOT recommended for maintenance. Vedolizumab

SHORT-Term:
Deltasone ↑ Appetite/Weight
Prednisone
Rayos Fluid retention
Oral Steroids Mood swings
1. Avoid long-term use.
Insomnia Budesonide has extensive 1st Pass
Entocort (CD Only) 2. May use alternate day Tx
Budesonide GI upset metabolism - Swallow WHOLE.
Uceris (UC Only) (ADT)
↑ BP/BG - CYP3A4: Avoid Grapefruit
3. Taper off doses > 2 wks. Systemic Fungal infections
LONG-Term: 4. Long-term use: assess Bone Live Vaccines
Cortifoam Adrenal suppression density by optimizing Ca+ &
Hydrocortisone (Rectal) Cushing's Syndrome
Cortenema Vit-D → Bisphosphonates
Immunosuppression Rectal steroids:
Rectal Steroids PRN. Indicated only for UC
Poor wound healing
Osteoporosis NOT effective for maintenance.
Budesonide (Rectal) Uceris Cataracts
↑ BP/BG
Do NOT crush/chew.
Abdominal pain Mesalamine is best tolerated.
Mesalamine (5-ASA) Aprisol Aminosalicylates:
N/HA/Flatulence Intolerance/Hypersensitivity Distal Dx/Proctitis = Use Rectal
Indicated = UC Mesalamine.
Topical anti-inflammatory Fx Belching (More w/ Sulfasalazine)
Mesalamine (5-ASA) used most. Pharyngitis
Sulfasalazine Azulfidine
Other formulations need to be Salicylate allergy
converted to Mesalamine to Colazal capsule may be sprinkled.
Balsalazide Giazo (Males only) N/V/D/HA
have Fx. Gastric retention (beads are not coated → may
(INDUCTION) Colazal Abdominal pain
Sulfasalazine used LESS due to chew but will stain teeth/tongue)
Olsalazine many side Fx. Diarrhea
Dipentum
(MAINTENANCE) Abdominal pain
Azasan - Hematologic Toxicity
Azathioprine Thiopurines: N/V/D (Leukopenia/Thrombocytopenia)
Imuran Immunosuppression = ↑ Risk of
Immunosuppressive drugs used Rash Pregnancy - Genetic deficiency of Thiopurine
for Induction & Maintenance. Malignancy
Mercaptopurine Purixan LFTs ↑ Methyltransferase (TPMT) →
Risk of Myelosuppression.
Infusion Rxns
Dosed Q4wk
Headache
Natalizumab Tysabri Integrin-receptor Antagonists: Approved for Crohn's Dx. 12 wk No-Response = DC
Fatigue
Monoclonal AB's used for REMS Program
Arthralgia Progressive Multifocal
Induction & Maintenance for
Leukoencephalopathy (PML)
Inadequate PT response or Nasopharyngitis
Vedolizumab Entyvio Steroid dependent. Headache Approved for Crohn's + UC. DC if no response by 14 wk.
Arthralgia
SCHIZOPHRENIA
General Information Signs & Symptoms Drug Formulations NEUROLEPTIC Syndrome Drug Tx
- Acute IM Injections: 1st-Gen Anti-Psychotics (FGAs):
Provide "STAT" relief - Haloperidol: High-potency w/ ↑ EPS
- Due to brain structure/chemistry inovling DA & Glutamine. - ODT : Neuroleptic Malignant Syndome - Cogentin can be added to level off Ach/Dopamine imbalance.
- Symptoms: Hallucination, Delusions, Disorganized behavior. Used for "Cheeking" PTs (NMS) Moderate risk of sedation
- Diagnosis: Negative & Positive Signs/Sx based on DSM-5. NEGATIVE: who spit out medication - Rare but highly lethal - Thioridazine = ↑ QT-Prolong Risk
o DSM-5 Diagnostic Criteria for Schizophrenia: Loss of Interest - Long-Acting Injections: - Signs/Sx:
▪ 1 month of Sx Lack of Emotion (Apathy) Good for o Hyperthermia - ↓ Risk of:
▪ Delusions, Hallucinatiions, OR Disorganized Speech Loss of Motivation adherence/compliance (fever/sweat) o Orthostasis, tachycardia, anti-Cholinergic effects
MUST be present. Social Withdrawal o Muscle Rigidity
- Treatment: adherence is important but difficult to obtain. Poor Hygiene Drugs Causing Psychotic Sx o Altered mental status 2nd Gen Anti-Psychotics (SGAs):
o Anti-Psychotics mainly block Dopamine (DA) but newer Lack of Speech (Alogia) o Tachycardia, - Preferred as 1st option
agents blocking additional receptors are beneficial. Inability to plan/do activities o Tachypnea, ↑BP - Metabolic S/E (+ weight gain, lipid abnormalities): Avoid in overweight pts
o Always assess adherence before changing Tx. - TREATMENT: o Highest risk: Clozapine, Olanzapine, Quetiapine
Anti-Cholinergics
o Assess cost, formulations, side effects. POSITIVE: o Taper off Anti-Psychotics o Mod. Risk: Risperidone, Paliperidone
Cannabis
o Drug Tx: select according to S/E profile but 2nd Gen Hallucinations quickly o Low risk: Aripiprazole, Ziprasidone
Illicit Drugs
Anti-Psychotics (SGAs) have less Extrapyramidal S/E Delusions o Consider - Hyperglycemia
Interferons
(EPS). Disorganized Behavior Amphetamine Stimulants Olanzapine/Clozapine - ↑ Prolactin Levels: Risperidone, Paliperidone = highest risk
o 1st Gen Anti-Psychotics (FGAs) have better PT response. Difficulty paying attention Systemic Steroids o Cool the PT down - QT-Prolongation: Ziprasidone = highest Risk
o BBW: ALL have risk of Mortality in elderly w/ DA-Agonist (Requip, Mirapex, o Dantrolene or BZD for - Agranulocytosis: Clozapine = highest risk. Only consider after 2 trials
dementia-related psychosis. Sinemet) muscle relaxation - Extrapyramidal S/E (EPS): Quetiapine = lowest risk (used for Parkinson’s)
- Seizure: Clozapine = highest risk
MONITOR = Weight, DLD, BG, BP, Family Hx

Chlorpromazine - Sedation Low-Potency FGA
- EPS ↑ Sedation | ↓ EPS
Thioridazine - Dyskinesias
Loxitane - Akathisia (restlessness)
Loxapine o Treat with diphenhydramine, Benztropine,
Adasuve (inhalation) Adasuve: REMS Drug
BZDs, or Propranolol Mid-Potency FGA
Bad taste, Bronchospasms, Sedation
Perphenazine First generation - Parkinsonism (tremors, bradykinesia) Dementia-related Psychosis
antipsychotic (FGA) o Anticholinergics, Propranolol ↑ Death Risk
Fluphenazine Decanoate = 2 weeks Dopamine-2 Blocker - Dystonia (painful muscle spasm) - ↑ Risk in (↑ risk death due to stroke)
young Males. IV Haloperidol: ↑ Risk of CVD effects
Haloperidol Haldol o Treat with Benadryl or benztropine (Orthostasis, Tachycardia, QT-prolongation)
Class: Butyrophenone Decanoate = Monthly High Potency FGA Haldol Cocktail: Haloperidol, Lorazepam,
- Tardive Dyskinesia (Irreversible)
(face, tongue, mouth movements) ↑ EPS | ↓ Sedation Benadryl
Thiothixine Navane o Replace w/ SGA like quetiapine or
clozapine
Trifluoperazine
Akathisia
Abilify
Aripiprazole Anxiety
Aristada (injection)
Insomnia
Asenapine Saphris (SL tab) Tongue numbness
Weight gain BBW: Agranulocytosis Decreases suicide by 3x
Clozaril Sialorrhea (hypersalivation) Monitor every week x 6 months Monitor ANC REMS Program:
Clozapine Fazaclo ODT Agranulocytosis Every 1-2 weeks x 7-12 months Start only if ANC > 1500 Pharmacy must be certified
Versacloz (suspension)
↑ Lipids/Glucose Every month x > 12 months Some ethnic groups can start lower.
Zyprexa Somnolence
Weight Gain Zyprexa Relprevv: monitor PTs 3 hrs MUST be ANC ≥ 1,500/mm to Olanzapine NOT used w/ BZD due to
Olanzapine Zydis ODT
post-injection START Tx Orthostasis Risk.
Relprevv (injections) ↑ Lipids/Glucose
2nd-Gen SGAs: ↑ Prolactin
Invega Galactorrhea
Paliperidone D2 + 5HT-2A EPS (esp. high doses) Irregular menstrual cycles
Sustenna/Trinza (injections)
blockers Sexual Dysfunction
Somnolence Weight Gain
Quetiapine Seroquel Take XR at night w/o FOOD
Orthostasis ↑Lipids/Glucose
↑ Prolactin Irregular menstrual cycles
Risperdal EPS (esp. high doses) Weight Gain
Risperidone Risperdal Consta = Q2wk injection
M-Tab ODT Sexual Dysfunction
↑ Lipids/Glucose
Galactorrhea
Ziprasidone Geodon (IM) QT-Prolong or QT-risk Take w/ FOOD
Iloperidone Fanapt
Lurasidone Latuda
Brexpiprazole Rexulti
Cariprazine Vraylar
Pimvanserin Nuplazid Used to Tx Psychosis in Parkinson's Dx
Valbenzine Ingrezza Somnolence Used to Tx Tarditive Dyskinesia (TD)
OSTEOPOROSIS
General Information Lifestyle Mods. Calcium Supplements Vitamin D Deficiency
- Important: children | pregnancy | menopause
- Dietary intake is best
- Most common in Post-Menopausal Women. - Weight-bearing exercise Daily Dose Recommended: 800 - 2,000 Units
- May occur as normal age-related bone loss. - Muscle strengthening <1 yr. 200-260mg daily
- Vertebral fractures w/o a fall and is - Quit smoking 1-3 yr. 700mg daily - Child Deficiency = Rickets
unnoticeable. - ETOH >4 yr. 100-1300mg daily - Adults deficiency = Osteomalacia
- Hip fractures are most devastating.
- Wrist fractures occur in the young. - Risk Factors - Ca+ absorption is saturable: - Serum Vit-D level [25(OH)D] should be
- Caution: o Lifestyle + Family Hx + Dx o Dose >500 – 600mg must divide measured
o Avoid sedating and orthostatic drugs state - Ca+ Citrate: Calcitrate - Maintain level = 30 ng/mL
o Ensure good lighting o Anti-Convulsant o Less elemental Ca+ (21% elemental) o (D2) Ergocalciferol
o have reasonable storage heights o Carbamazepine, Phenytoin, o Better absorption: NOT acid dependent, take w/o regard for meal o (D3) Cholecalciferol
o Safety bars in bathroom Phenobarbital, PPI's, o Preferred is gastric PH is high - Tx for 8-12 wks, followed by maintenance
o Handrails on stairs Steroids - Ca+ Carbonate: TUMS 1000 - 2000 U/day
o 40% elemental Ca+
o Absorption = Acid-dependent, must take with food
DEXA Scan Drug Tx
- Tx must include Vit-D & Ca+ Bisphosphonates
intake When to start treatment: - 1st Line for Tx + Px of Osteoporosis in most PTs.
DEXA | DXA = T-score - Treatment + Prevention = - Osteoporosis: >50 yo if - Oral meds: take before food or H2O staying upright for 30 mins & drinking 6-8 oz plain
Gold standard X-ray test. o Bisphosphonates or BMD T-score ≤2.5 at neck, H2O. Must swallow whole
Women ≥ 65, Men ≥ 70. Need BMD testing Raloxifene hip, spine - Common ADR = Esophagitis | Muscle Sx | Hypocalcemia
Z-scores have more parameters. - Prevention ONLY = or presence of fragile - Rare ADR = Osteonecrosis of Jaw - ONJ + atypical femur fractures.
o Estrogen-based meds structure (regardless of Dental work should be performed before starting these medications.
T-Score - Weekly or Monthly PO options are available for adherence - Upright 60 mins w/ Boniva
- Treatment ONLY: BMD)
Normal ≥ -1 o IV Ibandronate, - High risk osteopenia: Low monthly
o High risk pts only: T-score = -1 to -2.5 at - Tx Duration = 3 - 5 years in PTs at low risk of fracture.
Osteopenia – Low Teriparatide (Forteo), neck, hip, spine Estrogen Agonist/Antagonist Tx: BOTH drugs ↑ risk of VTE + Stroke = BBW
From = -1 to 2.4
bone mass Abaloparatide (Tymlos), or FRAX score = 10 yr. - RALOXIFENE = for Tx + Px
Osteoporosis ≤ -2.5 Denosumab (Prolia) fracture probability ≥20%, o ↓ risk of Breast cancer, causes Vasomotor Sx
o Last Line Tx: Calcitonin, hip fracture ≥3% - DUAVEE = Only Px in Post-menopausal women who have a Uterus.
Estrogens o helps Vasomotor Sx but ↑ risk of Breast cancer.
Fosomax Separate Ca+, Fe+, Mg+
Alendronate Hypocalcemia antacids at least 2 hrs
Binosto Osteonecrosis - ONJ
Hypophosphatemia Atypical Femur fractures
Alendronate + D3 Fosamax Plus-D Oral Bisphosphonates:
N/V Esophagitis Hypocalcemia Atelvia = DR -
Inhibit Osteoclasts
Dyspepsia, Heartburn Inability to stand/sit reqs acidic gut to work
Actonel Inhibit bone resorption Must correct ↓ Ca+ before use
Risedronate Abdominal pain upright for 30 mins - Avoid H2RA + PPI
Atelvia 1st Line = Tx + Px Do NOT use in Renal imp
Dysphagia completely
Muscle pain CrCl < 30-35 - Take after Breakfast
Ibandronate Boniva
w/ 4 oz water
Ibandronate IV Boniva Same PO except NO Esophagitis
IV Bisphosphonates Renal impairment Hypocalcemia
Zoledronic Acid Reclast Acute-phase Injection rxn
Hot Flashes
Pregnancy
Raloxifene Evista Peripheral Edema ↑ DVT | PE | Stroke Tx + Px for Post-menopausal
VTE
Estrogen Agonist/Antagonist: Arthralgia
SERM - ↓ Bone resorption ↑ VTE | Stroke
Conjugated Estrogen + Pregnancy
Duavee GI Sx Endometrial Cancer Px for Post-meno w/ Uterus
Bazedoxifene Breast Cancer
Breast Cancer
↑ Cancer
Inhibit Osteoclastic bone- Muscle | Back pain Nasal Spray: 1 spray in 1 nostril QD -
Calcitonin Miacalcin Hypersensitivity reaction
resorption Injection Rxn Alternate nostril daily. Must Prime
Hypocalcemia
Teriparatide Forteo PTH 1-34: Arthralgias
↑ Bone Formation Leg Cramps | Pain Osteosarcoma - Bone Cancer Hypercalcemia Use in HIGH risk of Fracture
Abaloparatide Tymlos Tx Duration = Limit to <2 yrs Nausea | Dizziness | Orthostasis
HTN Refrigerate Medication
Fatigue Must find a place to sit or lie down if
Edema Osteonecrosis - ONJ dizziness occurs after injection.
RANKL inhibitor: Pregnancy
Denosumab Prolia Dyspnea Atypical Femur Fractures Inject = Abdomen | Thigh
Prevent Osteoclast Formation Hypocalcemia
N/V/D/HA Hypocalcemia Discard = > 28 days
↓ PO4-
CHRONIC KIDNEY DISEASE
General Information Functions of the Kidney Drugs Inducing Kidney Disease
- Most common cause is DM or Loop of Henle: Aminoglycosides
HTN (control BP/BG) Glomerulus Proximal Tubule Ampho-B
- ADH - "Vasopressin"
- Dehydration is a primary cause - Healthy = Protein-bound Na+, Cl-, Ca+, H2O ↑ Collecting Duct: Cisplatin
Nephron - ↑H20 - Aldosterone:
of kidney dx. drugs not filtered, Distal Tubule Colistimethate
- Functional unit of the - Loop Diuretics: inhibit
- BUN: measures nitrogen in urea remain in blood. Thiazides inhibit ↑ Na+/H20 & ↓ K+ Contrast Dye
kidney Na+/K+ pump in
(waste of protein metabolism) - Damage = Albuminuria Na+/Cl- pump and ↑ - Blocking leads to ↑ K+ Cyclosporine
- Control H2O & Na+ ascending limb. Also
- Creatinine: waste product of - Glomerular Filtration Ca+ reabsorption. o Spironolactone Loop Diuretics
- Regulates BV→BP ↑ Ca+ leading to
muscle metabolism ↑ Cr = Bad Rate (GFR) assesses Weaker diuretic but o Eplerenone NSAIDs
- SGLT-2, Metformin use eGFR severity of damage effects on bone Tacrolimus
protective for kidneys.
- Staging = GFR + Albuminuria density. Vancomycin
Drug Considerations Classifications CKD-MBD (Mineral and bone disorder) Tx

ACEi & ARBs: Proteinuria Kidney Protection
1. Tx Proteinuria regardless of BP
2. Starting - ↑SCr up to 30% is OK, Greater >30% = STOP. ↑ PO4 = Phosphate restriction and/or phosphate Binders
eGFR Categories
3. Both may cause Hyperkalemia - Monitor 1-2 wks if CKD - If dose is missed & food is absorbed = Skip dose
GFR Rate KDIGO KDOQI
4. AVOID K+ Supplements | Salt-Substitute (KCL)
≥ 90 + Kidney
Normal or ↑ G1 Stage 1 ↑PTH (secondary hyperparathyroidism) → ↓Ca+ = Vitamin-D
Drugs requiring dose adjustments w/ CrCl 50-60 (↑interval or damage
↓dose) 60-89 + supplements and/or calcimimetic to ↓PTH
Mild ↓ G2 Stage 2
Many ABX damage - Caution Ca+ based PO4 binders + Vit-D = ↑Ca+
Bisphosphonates Gabapentin 45-59 Mild-Mod ↓ G3a - ↑ PTH must be treated w/ Vitamin-D
Anti-Arrhythmic Stage 3
Cyclosporine Pregabalin 30-44 Mod-Severe ↓ G3b o Vit-D3 | Cholecalciferol - synthesized in skin sun
Dabigatran
Lithium Morphine exposure.
Enoxaparin 15-29 Severe ↓ G4 Stage 4
Topiramate Statin Codeine o Vit-D2 | Ergocalciferol - is primary dietary source.
Colchicine < 15 or Kidney Failure
Allopurinol Famotidine G5 Stage 5
Rivaroxaban Dialysis (ESRD) o Calcitriol - active form of D3 & used to ↑Ca+
Metoclopramide Ranitidine
Tramadol ER absorption and ↓PTH
Albumin to Creatinine Ratio = Albuminuria o Vit-D Analogs = ↓ Hypercalcemia
Contraindicated Drugs in Kidney Dx:
ACR mg/g ACR mg/mmol KDIGO Stage
CrCl < 60 Nitrofurantoin
Normoalbuminur Anemia = ↓EPO → ↓RBCs = Iron supplements or ESAs
CrCl < 50 Stribild, IV Voriconazole < 30 <3 A1
ic - Hemoglobin < 13
CrCl < 30 Avanafil, Bisphosphonates, Dabigatran, Duloxetine,
Microalbuminuri - ESA agents are required = Procrit | Epogen | Darbepoetin
Genvoya, NSAIDs, Fondaparinux, K+ Sparing 30-300 3-30 A2
a Alfa (Aranesp)
Diuretics, Tadalifil, Xarelto
Macroalbuminur o ONLY Tx use if Hgb < 10. Hold dose if Hgb > 11 (↑
GFR < 30 Genvoya, SGLT-2, Metformin > 300 > 30 A3
ia risk of clots)
Other Dofetilide, Edoxaban, Glyburide, Meperidine,
Sotalol
Hyperkalemia
General Information
- K+ >5
Drug Treatment
- Diabetes & Hospitalized PTs are GENERIC BRAND ADRs BBW NOTES
Shifts K+ Intracellularly: Eliminates K+: (last line)
at ↑ risk. Sodium
Calcium Gluconate (1 st Furosemide SPS Monitor:  Na+  Ca+
- Causes: Aldosterone, Diuretics Polystyrene Binds other Drugs: Give at
line) Sodium Polystyrene Kayexalate  K+ Mg+
(Loops > Thiazides) Sulfonate least 3 hrs. before or
Insulin Sulfonate
- Symptoms: Muscle weakness, Constipation Long Duration of Action after
Sodium Bicarbonate Patiromer Patiromer Veltassa
Bradycardia, Fatal Arrhythmias ↓Mg+ NOT for Emergency use
Albuterol Hemodialysis
- Monitor w/ ECG, d/c all K
sources, stabilize myocardial cells
CHRONIC KIDNEY DISEASE
GENERIC BRAND MOA ADRs NOTES
Poor Taste
Aluminum Hydroxide Alternagel Aluminum-Based: Rarely used due to accumulation & Bone Toxicity - Limit Tx to 4 weeks
"Dialysis Dementia"
PhosLo
Calcium Acetate
Phoslyra
Hypercalcemia 1st line – avoid use with vitamin D
Calcium Carbonate Tums
Phosphate Binders:
ALL cause Constipation & N/V
Sucroferric Oxyhydroxide Velphoro
DDI: Levothyroxine, FQs, Al+/Ca+ Free: more Expensive
Discolored/Black Feces
Tetracyclines Ferric Citrate → impairs Iron absorption. May need to ↑ Iron dose
Ferric Citrate Auryxia
Lanthanum Carbonate Fosrenol Must CHEW tablet thoroughly to reduce GI Fx

Diarrhea
Renvela
Sevelamer Carbonate Al+/Ca+ Free, additional benefit of ↓ Total Cholesterol + LDL by 15-30%
Renagel
GENERIC BRAND MOA ADRs NOTES

Calcitriol Rocaltrol
Calcifediol Rayaldee
Vit-D Analogs: N/V/D
Monitor for  Ca+
 Ca+ intestinal absorption Hypercalcemia
Doxercalciferol Hectorol
Paricalcitol Zemplar
Cinacalcet Sensipar Calcimimetics: Hypocalcemia

 Ca+ sensitivity Monitor for  Ca+
Muscle Spasms
Etelcalcetide Parsabiv  PTH  Ca+  PO4 Paresthesias
ARRHYTHMIAS
General Information Signs & Symptoms Causes Cardiac Action Potential
- Normal Sinus Rhythm = 60-100 BPM
- Normal HR = 60-100 (Freq. of depolarized ventricles) - Most common cause is MI
- DIAGNOSIS: Electrocardiogram (ECG) but also: cardiac
- Arrhythmia = Irregular heartbeats caused by dysfxn of electrical impulses. Palpitations damage, valve
o Bradyarrhythmia’s = Slow HR Dizziness disorders, HTN, HF. Rapid Ventricular depolarization initiates heart beat
o Tachyarrhythmias = Fast HR Lightheadedness - Electrolyte imbalances: PHASE 0
due to Na+ Influx *QRS Complex*
o Supraventricular Arrhythmias SOB/Chest pain o K+ PHASE 1 Early rapid repolarization; Na+ Channels close
▪ Tachycardia Fatigue o Mg+
PHASE 2 Plateau in response to Ca+ Influx & K+ Efflux
▪ AFIB, Atrial Flutter, PSVTs o Na+
Rapid ventricular repolarization in response to K+
Most PTs are o Ca+ PHASE 3
▪ A-fib is most common → mostly rapid Ventricular response → less Efflux *T-Wave*
symptomatic, but some - Elevated Sympathetic
blood in Atria → Hypotension + Blood Clots → Brain Strokes Resting membrane potential (RMP) - arterial
can be silent (only states: PHASE 4
▪ Most people are unaware detected w/ physical o Hyperthyroidism depolarization *P-Wave*
o Ventricular Arrhythmias exam o Infection
▪ V-tach, V-fib, Premature Ventricular Contractions (PVC) o Rx Drugs/Illicit
▪ V-Tach (VT) = HR >100 BPM (Due to a series of PVCs in a row) Drugs
▪ V-Fib - MEDICAL EMERGENCY (Due to untreated VT)
QT Prolongation VAUGHN-WILLIAMS Classification of AAD:
CLASS 1:
1A: Disopyramide, Quinidine, Procainamide. - ALL cause QT-Prolongation
- QT Prolongation = >440 ms. 1B: Lidocaine, Mexiletine - ALL, especially Class 1C have BBW for PTs w/ recent Post-MI
- Dose-dependent & additive when drug-induced. 1C: Flecainide, Propafenone
- K+/Mg+ ↓ increase risks. - Indirectly block Ca+ channel
- Torsade de Pointes (TdP): Prolongation of QT interval that may lead to CLASS 2: Beta-Blockers
- Slow Ventricular rate
Cardiac death. - Block K+ channel
KEY QTc Prolongation Causing Drugs Other Drugs (may cause) - ALL have additive QT-prolong
o Anti-Psychotics CLASS 3: Dronedarone, Dofetilide, Sotalol, Ibutilide, - Caution w/ (-) Inotropes (ex. BB + Non-DHP CCBs)
o Anti-Arrhythmias (Class 1) Foscarnet Amiodarone - Electrolyte Imbalance must be corrected.
o FQ's
o Azoles Telavancin - AVOID Grapefruit juice, Ephedra, St. John's Wort.
o Droperidol
o Anti-Depressants Chemo Tx (Nibs + Mibs) - Decrease Digoxin dose by 50% & Warfarin dose 30-50%
o Phenothiazines
(Sertraline preferred) HIV Drugs CLASS 4: Non-DHP CCB's (Verapamil, Diltiazem)
o Donepezil
o Anti-Emetics (5HT-3) (Navirs + Rilpivirine)
o Methadone
Memory Tool: DQP Double Quarter Pounder LM Lettuce + Mayo FP Fries Please B Because
DDSIA Dieting During Stress Is Always VD Very Difficult
Treatment
RATE Control RHYTHM Control
- Asymptomatic Goal HR = < 80 BPM
- Symptomatic Goal HR = < 110 BPM - Goal is to restore/maintain NSR
- BB preferred or Non-DHP CCBs (Non-DHP CCBs for A-fib) - Use Class 1A, 1C, or Class 3 meds // or electrical cardioversion
- Digoxin may be added for Refractory PTs or cannot take BB or CCBs. - Amiodarone is LAST option due to toxicity. Ex. Heart Failure.
- Non-DHP CCB: do NOT give if HF or HFrEF. - Prior to taking any meds for Arrhythmias - Electrolytes + Toxicology screen should be done.
- Requires stroke prophylaxis for life: based on CHADSVASC score (OAC or ASA)
ARRHYTHMIAS
2nd/3rd Heart Block
Anticholinergic effects Pro-Arrhythmic, HF Cardiogenic Shock
Disopyramide Norpace
Hypotension BPH Congenital QT syndrome
Sick Sinus Syndrome
Class 1A:
Diarrhea
Na+ Blockers May increase Mortality in Afib Use w/ FQ's or Ritonavir
Stomach cramping AVOID changes in electrolyte intake.
Pro-Arrhythmic or A-Flutter 2nd/3rd Heart Block
Quinidine Cinchonism
(-) Inotropy Drug-Induced Lupus (DILE) Thrombocytopenia (TTP)
(ear, eyes, HA, delirium) Take w/ FOOD
Strong Anti-Cholinergic effects Hemolysis in G6PD Myasthenia Gravis
N/V/Rash
ALL cause QT-Prolong
Fatal Blood Dyscrasias
2nd/3rd Heart Block
Hypotension (Agranulocytosis) N-Acetyl-Procainamide (NAPA) is the
Procainamide SLE
Rash Long term use → ANA active metabolite.
TdP
DILE
Class 1B:
2nd/3rd Heart Block
Na+ Blockers
Lidocaine Xylocaine Wolf-Parkinson’s
ONLY useful for Ventricular
N/V/Dizzy Allergy to Corn
Arrhythmias
CNS Fx
Cross BBB → CNS Fx Tremor/incoordination
2nd/3rd Heart Block
Cardiogenic Shock
Mexiletine - Hepatotoxicity
Blood Dyscrasias
Severe Skin Rxns (DRESS)
Class 1C: Dizziness
Flecainide - Na+ Blockers Visual Disturbances Pro-Arrhythmic
HF
Propafenone has BB Fx Dyspnea
LV Hypertrophy
Metallic Taste
Recent MI
Propafenone Rhythmol Dizziness MOST increase in Mortality BBW
Visual Disturbance
- Must decrease dose of Digoxin

50% or Warfarin 30-50%.
- Photosensitivity
- AVOID Grapefruit
Hypotension - DOC: in Pts w/ HF
Class 3: K+ Blockers Bradycardia - Infusions > 2 hrs MUST be given in
Additive QT-Prolongation Corneal Micro-Deposits Sick Sinus Syndrome Non-Polyvinyl Cl- (PVC) container
Pacerone Caution w/ (-) Inotropes Dizziness Pro-Arrhythmic 2nd/3rd Heart Block such as Polyolefin or Glass.
Amiodarone
Nexterone Correct Electrolyte Imbalances Ataxia Pulmonary Bradycardia - Pre-mixed Nexterone comes in
Do NOT use Grapefruit juice, N/V Hepatotoxicity Cardiogenic shock
GALAXY container (non-PVC +
Ephedra or St. John's Wort Tremor
DILE non-DEHP).
- Pre-mixed IV bag = Stable longer.
- Slow the infusion rate or DC if
Hypotension or Bradycardia
occurs.
ARRHYTHMIAS
QT-Prolong
AVOID CYP3A4 or drugs
SCr ↑ Increase risk of death in
Dronedarone Multaq Pregnancy QT-prolong.
N/V/D HF or A-fib Pts.
Take with food
Class 3: K+ Blockers Bradycardia
Additive QT-Prolongation Bradycardia Adjust dose w/ Creatine Sick Sinus Syndrome
Betapace
Sotalol Caution w/ (-) Inotropes Palpitations clearance 2nd/3rd Heart Block
Sotylize CrCl 40-60: must ↓Frequency.
(Non-Selective BB) Correct Electrolyte Imbalances Chest Pain QT-Prolong is directly related Bradycardia
Sorine Do NOT use Grapefruit juice, Dizziness/Fatigue to concentration of Sotalol. Cardiogenic shock
Dofetilide Tikosyn Ephedra or St. John's Wort Hospital only
V-tachycardia
Ibutilide Corvert QT-Prolong Fatal Arrhythmias QT syndromes Monitor: ECG, BP, HR.
Hypotension
Edema
Diltiazem Cardizem HA/Dizziness
Hypotension
Class 4: Non-DHP CCBs Only Non-DHP CCBs are used as
Arrhythmias
Calan Slow Ventricular rate Anti-Arrhythmic
HF
Verapamil Covera Constipation (Verapamil)
Verelan Gingival Hyperplasia
2nd/3rd Heart Block
Arrhythmias
Adenosine Adenocard *Restores NSR in PSVTs Bradycardia
Facial flushing
SSS
- Tx Range = 0.8-2.0
2nd/3rd Heart block - Toxicity: N/V, loss appetite,
Digitek Dizziness
AV Node suppression: bradycardia Sx.
Digoxin Digox N/V/D/HA K+/Mg+↓ or Ca+↑ = V-Fib
Enhances Vagal tone - NOT 1st Line
Lanoxin Mental disturbances Toxicity ↑ - Ineffective during exercise
- ANTIDOTE = DigiFab
DIABETES
General Information Signs/Symptoms Complications of DM Diagnosis Criteria
Hyperglycemia: Hypoglycemia: (BG = <70) Macrovascular Complications: PRE-Diabetes
Polyuria Shakiness Microvascular Complications: - CVD - Fasting Plasma Glucose (FPG) = 100 -
Polyphagia Irritability - Retinopathy o ASCVD in DM is leading 125 mg/dL
Polydipsia Hunger - Kidney Disease cause of death in pts - 2-Hour Plasma Glucose = 140-199
Blurred vision Headache, Dizziness o Use ACEi/ARB o ADA recommends after 75-gram OGTT
Type-1 Diabetes: Fatigue Confusion, blurred vision - Peripheral Neuropathy Empagliflozin & Liraglutide - A1C% = 5.7 - 6.4%
- Caused by autoimmune Weak/Sleepy o Duloxetine/Pregabalin (1st line) in PTs w/ longstanding Diabetes
destructions of Beta-cells in Sweating (Diaphoresis) o Foot Care: DM + ASCVD (shown to - Polyuria, Polydipsia, Polyphagia
Pancreas. Fast Heartbeat, Anxiety ▪ Inspect feet everyday decrease CVD & mortality) - Random (RPG) = ≥ 200 mg/dL
- PT cannot produce insulin. Lifestyle Modifications ▪ Clean & Trim them o Aspirin is not recommended - FPG ≥ 126 mg/dL (no meal for at
- Genetic - mostly young 1. Reduce weight, BP, cholesterol. *DASH Diet* ▪ NO bare foot walking. for primary prevention. least 8 hours)
- MUST Tx w/ insulin. a. Cholesterol control: any patient with ▪ Keep circulation to foot. Recommended for - 2-Hour PG ≥ 200 after 75-gram
- Most common & due to insulin diabetes and ASCVD or ASCVD risk ▪ Keep away from Hot/Cold. secondary prevention in any OGTT
resistance & deficiency. >20% should receive a high-intensity - Autonomic Neuropathy patient with ASCVD - A1C% ≥ 6.5%
- Linked to obesity, inactivity, statin. - CAD/PAD ADA Treatment Goals
family hx b. Blood pressure control: a goal BP of ADA GUIDELINES For TYPE-2 Diabetes Tx
<130/80 mmHg is appropriate for A1C% = < 7% (Q3Months)
Pre-Diabetes: patients with diabetes and ASCVD or Pre-Prandial = 80 - 130
- Refers to increased risk for DM. ASCVD risk >15%. Post-Prandial = < 180
- Lifestyle changes needed. 2. Reduce calories to < 3500 to lose 1 pound a Monotherapy Lifestyle Mod + Metformin (unless C/I)
Start if A1C is ≥ 8.5% at baseline Diabetes in Pregnancy:
- Metformin can be used. week. FASTING = ≤ 95 mg/dL
- Annual monitoring req. & Tx of 3. Waist circumference < 35 inches (F) & < 40 Select second drug based on pt comorbid risks:
- Patient has ASCVD: choose drug with CV benefit, 1-Hr Post-Meal = ≤ 140 mg/dL
CVD risks are needed. inches (M).
either a GLP-1 agonist (liraglutide, semaglutide or 2-Hr Post-Meal = ≤ 120 mg/dL
- NORMAL Test results should be 4. Use Omega-3 FA (EPA/DHA) + Omega-3
retested every 3 years. Linolenic acid (ALA) Dual-Tx (start if exenatide extended release) or an SGLT2 inhibitor Hypoglycemia Treatment
5. Type-1 DM PTs need to count carbs. A1C not at target (empagliflozin or canagliflozin). - Hypoglycemia may lead to seizure,
TYPE-2 Diabetes RISK Factors 6. Moderate exercise 150 mins/wk at least 3 after 3mons.) - Patient has HF or CKD (eGFR ≤ 60 mL/min/1.73 m2 coma, and death. Mostly d/t SU's,
- 1st degree relative days/wk. or albuminuria): SGLT2 inhibitor (empagliflozin or Meglitinides, & Pramlintide.
- Physical inactivity 7. Vaccines (Flu, Pneumo, Hep-B) canagliflozin).
- HTN Drugs affecting BG - Patient has no ASCVD, heart failure or CKD: choose Treatment
- Hx of CVD Hyperglycemia Hypoglycemia a drug from any of the remaining medication classes. 1. Take 15-20 g of glucose.
- Race (non-whites) BB's Linezolid MOST 3-drug combos are acceptable EXCEPT: 2. Recheck BG in 15 mins.
- Overweight - BMI >25, >23 FQ's Lorcaserin (Belviq) Triple-Tx - Metformin + DPP-4 + GLP-1 3. If still hypo repeat step 1.
(Asians) STATINS Octreotide (Hyper too) - Metformin + Basal insulin + SU 4. Once BG normal eat a small meal or
- HDL < 35 STEROIDS Pentamidine Combo Injection snack to prevent recurrence.
- LDL > 250 Diuretics Quinine Tx (If BG ≥300 Start basal insulin + bolus insulin OR GLP-1 agonist 5. GLUCAGON: Only given for risk of
- A1C% ≥ 5.7 Immunosuppressants BB's or A1C ≥10%) severe hypoglycemia. Give if PT is
- Hx of Gestational DM (Cyclosporine/tacrolimus) (Propranolol/NSBB) unconscious or not conscious enough to
- Polycystic Ovary Syndrome Niacin FQ's 1. If already on PO med → Switch to injectable self-tx. Lay PT in recumbent position
Protease Inhibitors 2. If on GLP-1 agonist → ADD Basal insulin (side) & give 1 mg SC, IM, or IV.
2nd Gen Anti-Psychotics 3. If Basal insulin optimally titrated → ADD GLP-1 or bolus insulin Check BG in 15 mins.
4. Different MOA should be selected for COMBO Tx. 15grams of Simple Carbs: 3-4 Glucose
5. NEVER Sulfonylureas + Meglitinides together (Hypoglycemia) tabs, 1 Serving of Gel tube, 2 tbsp of
Raisins, 4 oz Juice or Soda (not diet), 1Tbsp
of Sugar/honey, 8 oz (1 cup) of Milk
DIABETES
ORAL MEDS
GENERIC BRAND MOA ADRs BBW/Warnings CONTRAINDICATION NOTES
BIGUANIDE: - Take w/ FOOD
Glucophage ↓Glucose production N/V/D Lactic Acidosis
- ETOH increase Lactic Acidosis risk
Metformin Fortamet Flatulence Hepatic/Renal imp eGFR < 30 (Do NOT start
(Gluconeogenesis) - D/C before imaging procedure & restart
*1st-Line in Type-2* Glumetza Abdominal Intravascular Iodinated Contrast if eGFR 30-40)
Riomet ↓Intestinal glucose absorption cramping ETOH
48 hrs after.
↑Insulin sensitivity - Leaves ghost shell in stool.
Meglitinides: Weight gain
Repaglinide Prandin Type-1 DM
HA Hypoglycemia - Take 15-30 mins BEFORE meal.
↑Insulin secretion DKA
URTI Liver/Renal imp. - SKIP dose if skipping meal.
Nateglinide Starlix ↓Post-Prandial BG Gemfibrozil
Glipizide Glucotrol Sulfonylureas:
Type-1 DM - ALL SU's 30 mins BEFORE Breakfast
↑Insulin secretion Weight gain Hypoglycemia
Glimperide Amaryl DKA - Glipizide IR - 30 mins before meals.
↓Post-Prandial BG Nausea G6PD Deficiency
Glyburide Glynase Sulfa allergy - Glyburide - Avoid renal imp.
(Glucose Independent)
Thiazolidinediones (TZD): Weight gain
Pioglitazone Actos Exacerbate HF/MI
↑Peripheral Insulin sensitivity Peripheral Edema
Hepatic failure - Take w/o regard to meals
PPAR - gamma receptors URTI NYHA Class 3-4 HF
Edema - May take several weeks to work
Rosiglitazone Avandia Effect transcription on cells so takes Good lipid profile
Urinary Bladder tumors
time - weeks to months. (HDL, TG's, TC)
Canagliflozin invokana ↑ Risk of Leg/Foot amputations.

- Caution: Diuretics, RAAS, NSAIDs.
SGLT-2 Inhibitors: Ketoacidosis
(Hypotension & AKI)
Reduce Glucose reabsorption in renal Genital Mycotic Infxns - Monitor K+ (Capagliflozin)
tubules + increase glucose excretion. Weight Loss Urosepsis
Empagliflozin Jardiance eGFR < 30 - Genital yeast infxns.
60-80 grams of sugar excreted Hypoglycemia Pyelonephritis - Dehydration due to urination.
Weight loss effect due to osmotic Hypotension
- Urinary Tract infxns
effect and sugar losing calories. AKI
Dapagliflozin Farxiga - Leg/Foot amputations (Canagliflozin)
Hyperkalemia (Capagliflozin)
Sitagliptin Januvia Nasopharyngitis

DPP-4 inhibitors: - Take in the morning.
Saxagliptin Onglyza URTI/UTI Risk of Heart Failure
↑Insulin resistance Acute Pancreatitis - May cause pain & inflammation in
Linagliptin Tradjenta Peripheral Edema (Saxagliptin & Alogliptin)
↓Glucagon secretion pancreas.
Alogliptin Nesina Rash
Acarbose Precose Flatulence
- Hypoglycemia can be Tx w/ Sucrose
Diarrhea
- Take with 1st bite of each meal.
Miglitol Glyset Abdominal Pain
Only used in SPECIFIC situations.
Colesevelam Welchol Constipation Binds to ADEK vitamins
Breastfeeding (Inhibits Do NOT use w/ Metoclopramide or other
Bromocriptine Cycloset
Lactation) Dopamine agonists.
DIABETES
INJECTABLE MEDS
Exenatide Byetta
Exenatide XR Bydureon
GLP-1 Agonists: - Byetta & Adlyxin 60 mins BEFORE meal.
Victoza Nausea Thyroid C-cell tumors
Liraglutide Family Hx of Thyroid - ALL others w/o regard for food.
Saxenda ↑Insulin secretion V/D/Constipation Pancreatitis
cancer - Bydureon, Trulicity, Tanzeum 1x/wk
Dulaglutide Trulicity ↓Glucagon secretion Weight Loss Do not use in severe GI disease
(dosing)
Albiglutide Tanzeum
Lixisenatide Adlyxin
N/V/HA
- May be used in both TYPE 1 and 2 DM
Pramlinitide SymlinPen Synthetic Amylin analogue Weight loss Severe Hypoglycemia Gastroparesis
- Must REDUCE meal-time insulin by 50%.
Anorexia
INSULIN
Aspart Novolog RAPID-Acting Insulin:
Hypoglycemia
Glulisine Apidra AKA Post-Prandial or Meal-time
Hypokalemia
Lispro Hunalog Onset = 10 -30 mins
(Oral Inhalation Peak = 0.5 - 3 hrs. Acute Bronchospasm Asthma
Afrezza Duration = 3 - 5 hrs. NOT recommended in PTs who smoke.
Powder) (Asthma/COPD) COPD
SHORT-Acting Insulin:
AKA Prandial or Meal-time insulin
Humulin-R Hypoglycemia Can be used in IV solutions.
Regular Insulin Onset = 15 -30 mins Give 30 mins BEFORE meal
Relion Hypokalemia Available w/o prescription
Peak = 2.5 - 5 hrs.
Duration = 4 - 12 hrs.
MUST have Rx U-500 insulin
Onset = 15 -30 mins
Concentrated syringe. Do NOT mix w/ other *5x concentration of U-100.
Humulin R U-500 Peak = 4 - 8 hrs.
Regular Insulin NO dose conversions. insulins. Recommended if PT req. >200 units/day
Duration = 13 - 24 hrs.
Do NOT use other syringe.
INTERMEDIATE- Acting Insulin: Weight Gain
Humulin-N - NPH insulins are CLOUDY.
Onset = 1 - 2 hrs Lipodystrophy
NPH Insulin Novolin N Available w/o Prescription. - Can MIX w/ Rapid or Short (draw up
Peak = 4 - 12 hrs
Novolin-N Relion rapid/short 1st - Clear BEFORE Cloudy)
Duration = 14 - 24 hrs
Detemir Levemir
Lantus
LONG-Acting Insulin:
Lantus Solostar
Glargine ONSET = 3 -4 hrs Hypoglycemia Do NOT mix w/ other insulins.
Basaglar
DURATION = 6 - 24 hrs Hypokalemia
Toujeo
Degludec Tresiba
Novolog Mix 70/30
Humalog Mix 75/25
Pre-Mixed Insullins Humalog 50/50 Pre-Mixed Insulins Available w/o Prescription NPH & Protamine insulin is CLOUDY.
Humalin 70/30
Novolin 70/30
DIABETES
Insulin Dosing Insulin General Info
Type 1 Type 2
1. Use Basal Bolus strategy = Long-acting + Rapid-acting. Basal insulin is used for PTs who fail multiple PO agents. 1. MOST contain 100 units/mL
Administration
2. Start at Total Daily Dose (TDD) of 0.6 units/kg/day [ABW] 1. Start Basal = 0.1-0.2 units/kg/day [ABW] OR 2. MOST contain 3 mL pens.
1. Wash hands
3. Divide TDD into 50% Basal & 50% Bolus (rapid). 10 Units/day. 3. MOST delivery 1 unit/increment.
2. Check for discoloration
4. Divide Bolus Rapid insulin over 3 meals. 2. Dose is titrated 10-15% or 2-4 units weekly to a. EXCEPT U-500, 1 increment = 5 U OR
3. Do NOT shake Suspensions
5. Final regimen = 1 Basal + 3 Bolus. reach Fasting Goal. Tresiba 200 U, 1 increment = 2 U.
4. Invert Pens 4-5x
3. If A1C still remains above goal → ADD 1-3 4. ONLY rapid/short acting should be used w/
Meal-time insulin may be adjusted based on CARBS in a meal. 5. Clean injection sites
Rapid bolus insulin doses Insulin Pumps (delivers Continuous Basal &
- Use "Rule of 500" (Rapid) OR "Rule of 450" (Regular) 6. Dial units or add air in INJ.
4. Use 1:1 (unit per unit) conversion of TDD when Bolus. NOT for NEW DM Pts.)
𝟓𝟎𝟎 𝒐𝒓 𝟒𝟓𝟎 7. Mixing = Clear before Cloudy
converting from different insulins. 5. Needles are NOT included in Multi-Dose
= 𝒈 𝒐𝒇 𝒄𝒂𝒓𝒃𝒔 𝒄𝒐𝒗𝒆𝒓𝒆𝒅 𝒃𝒚 𝟏 𝒖𝒏𝒊𝒕 𝒐𝒇 𝒊𝒏𝒔𝒖𝒍𝒊𝒏 8. Abdomen is preferred site.
𝑻𝑫𝑫 a. Except NPH BID → Glargine QD = Use pens.
9. Rotate site of injxn.
- Correction Factor = Amount of insulin needed to return 80% of NPH a. Multi-Dose Products:
10. Properly dispose.
to Normal BG. May be added to regular Bolus insulin b. Toujeo QD → Lantus or Basaglar QD = i. FlexPen
dose to cover carbs. (Rule of 1800 for rapid, Rule of Use 80% of Toujeo ii. KwikPen
Insulin Stability:
1500 for regular) iii. FlexTouch
1. Refrigerated + unopened is
iv. SoloStar
𝟏𝟖𝟎𝟎 𝒐𝒓 𝟏𝟓𝟎𝟎 stable until expiration date.
= 𝒄𝒐𝒓𝒓𝒆𝒄𝒕𝒊𝒐𝒏 𝒇𝒂𝒄𝒕𝒐𝒓 v. Byetta
𝑻𝑫𝑫 2. Stability of room temp varies.
vi. Victoza
(from 12 days to 42 days, most
𝐁𝐆 𝐧𝐨𝐰 – 𝐓𝐚𝐫𝐠𝐞𝐭 𝐁𝐆 vii. Adlyxin
- Correction dose = commonly 28 days)
𝒄𝒐𝒓𝒓𝒆𝒄𝒕𝒊𝒐𝒏 𝒇𝒂𝒄𝒕𝒐𝒓 viii. SymlinPen
Hospitalized Patients Factors to consider for treatment Medications to avoid in specific situations
GOAL = 140-180 mg/dL
1. Use Sliding Scale Insulin (SSI) alone is NOT recommended.
2. Use basal, bolus, + correction. Metformin, SGLT-2, Exenatide,
3. Use Regular U-100 insulin. eGFR or CrCl < 30
Glyburide
- Usually occurs in Type-1 DM. Biggest A1C% Insulin, Metformin, SU's, TZDs, GLP-1 Heart Failure TZDs, Alogliptin, Saxagliptin
- Due to insulin Non-Compliance. Decrease (> 1%) agonist Peripheral Neuropathy,
Diabetic
- BG > 250 mg/dL Biggest PAD, or Diabetic Foot Canagliflozin
Ketoacidosis Insulin, SU's, Meglitinides, Pramlintide
- Ketones present "Fruity breath". Hypoglycemic Risk Ulcers
(DKA):
- Anion Gap - Metabolic Acidosis Gastroparesis or GI
- pH < 7.35 | Anion gap > 12 Weight Gain Insulin, SU's Meglitinides, TZDs GLP-1, Pramlintide
disorder
- Usually occurs in Type-2 DM. Sulfa allergy SU's
- Ketones are absent. Weight Loss SGLT-2, GLP-1, Pramlintide G6PD deficiency SU's
Hyperglycemia - BG > 600 mg/dL Lactic Acidosis Metformin
Hyper-Osmolar - Serum Osnolality > 320 mOsm/L Cardiac Benefits Empagliflozin, Liraglutide
Hepatotoxicity TZDs, Alogliptin
State (HHS): - Extreme Dehydration. Hypotension/Dehydration SGLT-2
- Altered mental status Cheapest Metformin, SU's, TZDs
UTI/Genital infections SGLT-2
- pH > 7.3 | Bicarb > 15 mEq/L Injection K+ abnormalities Canagliflozin (Hyper), Insulin (Hypo)
1. Fluids - NS until BG < 250 then change to Insulin, GLP-1, Pramlintide
Formulations Pancreatitis DPP-4, GLP-1
D5W + ½ NS Ketoacidosis SGLT-2
Treatment for
2. Regular insulin infusion Cancer Pioglitazone, Dapagliflozin, GLP-1
both:
3. Potassium to prevent Hypokalemia
4. Give Sodium Bicarb for acidosis Tx.
HUMAN IMMUNODEFICIENCY VIRUS
General Information HIV Life Cycle
- HIV: RNA retrovirus attack CD4+ T-helper cells.

- Transmitted through blood, semen, vaginal secretions,
Stage 1 Stage 2 Stage 3 Stage 4
pregnancy, birth, and breastfeeding.
- Anti-HIV Abs (HIV Ab) undetectable for 4-8 weeks. Attachment: Fusion: Reverse Integration:
- HIV p24-antigen will be present. HIV must attach to Fusion of HIV Transcription: HIV DNA
BOTH CD4-receptor envelope allows Single-stranded transported into
HIV SCREENING: & Co-receptor entry into host cell. RNA converts to nucleus &
1. Combo HIV-Ab & p24-antigen immunoassay test. (CCR5 or CXCR4). →Uncoating double-stranded integrated into host
2. P24-antigen is detected early than HIV-Abs. Drug Class Target: →release HIV-RNA HIV DNA by DNA.
3. If initial Test is + then perform confirmatory test for HIV- CCR5-Antagonist into cytoplasm. Reverse Drug Class Target:
1/2 Drug Class Target: Transcriptase. INSTI
Fusion inhibitors Drug Class Target:
DIAGNOSIS:
NRTI
- Both HIV immunoassay (ELISA) & Confirmatory test are +
NNRTI
"Home Access" & OraQuick OTC: Stage 5 Stage 6 Stage 7
- Home tests for HIV Ab screen. Transcription/Translation: Assembly: Budding/Maturation:
- Tests should only be use after 3 months (False Neg result HIV DNA transcribed & New RNA + viral proteins Newly formed HIV virus
before) translated into new RNA migrate to host cell-surface buds off from cell to infect
virus + proteins. to form new immature HIV other CD4+ cells.
MONITOR:
virus w/ Protease enzyme. Drug Class Target:
1. CD4+ count.
Protease inhibitors
2. Viral load - assess Tx response.
3. Tx GOAL = Undetectable viral load.
Anti-Retroviral Therapy (ART) Prophylactic Treatment

Initial ART for most HIV-Tx Naïve Infected Patients:
INSTI-Based Regimen: ART for HIV-Tx in Naïve Pregnant Women:
GOALS - Dolutegravir/Abacavir/Lamivudine Regimen should include: 2 NRTI's + Boosted PI or
1. To restore & preserve immune system. - Dolutegravir + Emtricitabine/Tenofovir Disoproxil Fumarate INSTI. A pregnancy test should be done before.
2. Suppress HIV viral load to undetectable - Dolutegravir + Emtricitabine/Tenofvir Alafenamide START WITH EITHER Pre-Exposure Prophylaxis - PrEP:
levels. - Raltegravir + Emtricitabine/Tenofovir Disoproxil Fumarate - Abacavir + Lamuvidine - Emtricitabine + TDF (Truvada)
3. Reduce HIV-associated morbidity, - Raltegravir + Emtricitabine/Tenofovir Alafenamide - Tenofovir Disorpoxil Fumurate + - 1 Tab PO QD
prolong survival & prevent transmission. Emtricitabine OR Lamuvidine - Follow up visits EVERY 3 Months
PI-Based Regimen: then ADD
4. ART is recommended to ALL HIV infected
- Darunavir + Ritonavir + Emtricitabine/Tenofovir Disproxil Fum. - Atazanvir + Ritonavir Non-Occupational Post-Exposure Prophylaxis
persons.
- Darunavir + Ritonavir + Emtricitabine/Tenofovir Alafenamide - Darunavir + Ritonavir - nPEP:
5. Reqs: Adherence rate of ≥ 95% in order
to be effective long-term. 1. Use of Abacavir reqs test for HLA-B5701 allele. Do NOT use if + or ADD - MUST be given w/in 72hrs of exposure
2. Tenofovir Disoproxil Fumurate - Caution w/ Renal insufficiency. - Raltegravir - PREFERRED = INSTI-based: Truvada +
Complications of ART: Raltegravir or Dolutegravir.
3. Stribild should ONLY be started w/ Baseline CrCl ≥ 70.
- NRTI: stop if Lactic Acidosis, Protease Inhibitor & BOOSTER Drug Interactions: - ALT = PI-base: Truvada + Darunavir.
4. Genvoya ONLY initiated w/ Baseline CrCl ≥ 30.
Hepatomegaly, Steatosis Ritonavir | Cobicistat | PI's
5. Lamuvidine & Emtricitabine are interchangeable.
- NRTI + Stavudine: changes in fat 1. Be sure to LOOK for them on PT profile. Occupational Post-Expsure - PEP:
distribution Lipodystrophy/Atrophy Recommended Initial Regimens in Certain Clinical Situations: 2. KNOW which combos contain these meds. - Give w/in 72 hrs
- Protease Inhibitor: Diarrhea | - Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil Fumarate 3. Of the PREFERRED Tx-Naive PT's remember: - PREFERRED Tx: Raltegravir (Isentress)
Lipohypertrophy - Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide a. Stribild | Genvoya - contains + Truvada (4-Week Course)
- Fat accumulation in back & neck - Doravirine/lamivudine/tenofovir disoproxil fumarate (DELSTRIGO) Cobicistat
"Buffalo Hump" - Only in certain situations d/t risk of drug-drug interactions with b. Boosted Prezista - contains Darunavir +
cobicistat and a lower threshold for resistance with elvitegravir. Ritonavir
Abacavir - ABC Ziagen Abacavir: Test for HLA-B5701 or face FATAL
ABC + Lamuvidine Epzicom N/V/HA hypersensitivity rxns.
Rash Hx of Hypersensitivity
ABC + Lamuvidine +
Triumeq Increased risk of MI
Dolutegravir ↑LFTs/Lipids
N/V/D Do NOT use Epivir-HBV for HIV
Lamuvidine - 3TC Epivir
HA (contains lower dose)
3TC + Zidovudine Combivir BID dosing
Emtricitabine - FTC Emtriva Cap: 200mg QD
FTC + TDF Truvada
FTC + Rilpivirine + TDF Complera N/V/D/HA
FTC + TDF + Elvitegravir + Nucleoside Reverse Transcriptase Rash
Stribild Inhibitors (NRTI): Dizziness 1. ALL: take 1 Tab ONCE daily.
Cobicistat
- Results in DNA termination & Insomnia Exacerbation of HBV 2. Take Atripla at BEDTIME + Empty
FTC +TAF Descovy stops viral DNA synthesis (Stage Hyperpigmentation stomach. Dose is 600mg QD
3). (Mostly in child 3. Genvoya, Odefsey, Stribild, Complera
FTC + TAF + Rilpivirine Odefsey - ALL have BBW for Lactic palms/soles) w/ FOOD.
FTC + TAF + Elvitegravir + Acidosis + Severe
Genvoya Hepatomegaly w/ Steatosis.
Cobicistat
FTC + Efavirenz + TDF Atripla Zidovudine > Stavudine >
Didanosine > Other NRTIs
Tenofovir Disporxil
Viread Renal Toxicity
Fumarate TDF Key Features: N/V/D/HA Dose: 300 mg daily
NOT approved for HBV Tx. Osteomalacia (↓BMD)
Tenofovir Alafenamide - 1. Renal dose adj. req. (except Depression Dispense in OG Container.
Fanconi Sydrome
TAF Abacavir)
2. NO CYP450 rxns. Myopathy Monitor: MCV
Neutropenia
Zidovudine - ADV or AZT Retrovir Macrocytic Anemia IV Zidovudine should be used during LABOR
Anemia
↑ LFTs for HIV-infected pregnancy.
N/V/D
Peripheral
Oral Solution:
Neuropathy
Stavudine - D4T Zerit Hyperbilirubinemia Pancreatitis Stable for 30 days in FRIDGE.
Lipoatrophy SHAKE vigorously.
↑ LFTs
N/V/D Oral Solution:
Peripheral Stable for 30 days in FRIDGE.
Didanosine - DDL Videx Pancreatitis (some Fatal)
Neuropathy SHAKE vigorously.
↑ Amylase Take on EMPTY stomach.
CNS (confusion, Serious psychiatric sx (suicidal
abnormal dreams, ideation/depression)
Stustiva Non-Nucleoside RT Inhibitors dizziness, ↓Methadone Levels – watch for withdrawal
Efavirenz - EFV CNS effects (resolves in 2-4 wks)
Atripla (NNRTIs): ↓ contraceptive levels – unintended pregnancy
↓concentration) QT-Prolongation
Bind to RT Rash Fetal Toxicity
Edurant Key features: Depressive Disorders
Concurrent use PPIs Take w/ FULL MEAL
Rilpivirine - RPV Complera - ALL CYP450 Inducers Mood Changes
Strong CYP3A4 Inducers Keep in OG container
Odefsey - Efavirenz = Inducer + Inhibitor Insomnia
- WATCH for Drug Interactions Hepatotoxicity ↓Methadone Levels – watch for withdrawal
Rash (SJS/TEN) Do NOT start in Women:
- Monitor: Erythema, Facial Liver Failure/Death ↓ contraceptive levels – unintended pregnancy
Nevirapine - NVP Viramune CD4 >250, Men: CD4 >
edema ↑LFTs Serious Skin Rxn (SJS/TEN) *Requires 14-day lead-in period to decrease
400
Skin Necrosis, Blisters/Swelling Hypersensitivity rash & hepatotoxicity
Etravirine - ETR Intelence Rash (SJS/TEN) Take AFTER meal
Doravirine Pifeltro
Enfuvirtide - T19 Fuzeon Fusion Inhibitor Local Injection Site rxn Sub-Q injections BID
Protease Inhibitors: N/V/D For Tx-Naïve = Take QD w/ Cobicistat or
Darunavir - DRV Prezista SULFA allergy
- Inhibit Stage 7 Rash Ritonavir
- Should ONLY give w/ Cobicistat Drug-induced Hepatitis
↑LFTs
DRV + Cobicistat Prezcobix Srs Skin Rxns (SJS/TEN)
or Ritonavir HA Swallow whole w/ FOOD
Key features: Hyperbilirubinemia
Atazanavir - ATV Reyataz 1. Names end in "navir" (Jaundice, Scleral PR-interval Prolongation
2. CYP450 Inhibitors Icterus) Hyperbilirubinemia
Atazanavir: Avoid Antacids
3. NO Renal adj. Cholelithiasis Nephrolithiasis
(reduce absorption, ↓ levels) Take QD w/ FOOD + H2O
4. Metabolic Abnormalities N/V/D/HA Cholethiasis
ATV + Cobicistat Evotaz (Lipids, Glucose) Depression Hepatotoxicity
5. ↑ CVD risk Myalgia Skin Rxns (SJS/TEN)
6. GI upset (NVD) Skin Rxns
Fosamprenavir - FPV Lexiva 7. Bleeding Events Rash SULFA allergy Oral Suspension = Take W/O food
8. ECG changes OG container w/ Desiccant to protect from
9. Rash (SJS/TEN) Moisture
Indinavir - IDV Crixivan N/V/D/HA Nephrolithiasis, Urolithiasis
Take w/ FOOD + 48 oz of H2O - due to
Drug interactions: Ritonavir component
- Rifampin For Tx-Naïve = Take QD or 400/100 mg BID
- St. John's Wort N/V/D
Lopinavir + RTV Kaletra Solution = Refrigerate + take w/ FOOD
- Dronedarone, Amiodarone ↑Lipids, ↑TG
Contains 42% ETOH
Nelfinavir - NFV Viracept - Apixaban, Edoxaban, Xarelto, Diarrhea NO Boosting w/ Ritonavir Take w/ FOOD
Ticagrelor Take w/ FOOD or w/in 2hrs of full meal.
Saquinavir – SQV Invirase - Alfuzosin Nausea V/D/HA
Must be given w/ Ritonavir
- ↓INR in Warfarin PTs
- Anti-Convulsants
- ↓ Methadone = Withdrawal
- ↓Contraceptives Clinical Hepatitis
Take w/ FOOD
Tipranavir - TPV Aptivus - ↑PDE-5 Level Toxicity N/V/D Hepatic Decompensation SULFA allergy
Must give w/ Ritonavir
- Lovastatin, Simvastatin Intracranial Hemorrhage
(Rosuvastatin/Atorvastatin
preferred)
Ritonavir Norvir MANY Deadly Drug Interactions Drug Interactions: CYP3A4
- Anti-Arrhythmics Alfuzosin, Amiodarone, Take w/ FOOD
NVD
BOOSTERS: - Ergot Alkaloids Carbamazepine, Solution = 43% ETOH
ONLY used to boost other PI's. - Sedatives/Hypnotics Phenobarbital, Phenytoin,
Cobicistat Tybost NOT interchangeable. Dronedarone, Lovastatin,
Rifampin, Simvastatin, Take w/ FOOD
St. John's Wort
Integrase Strand Transfer Inhibitors Stribild = 1 Tab QD
Stribild (INSTI): Proteinuria Genvoya: 1 Tab QD
Elvitegravir - EVG CrCl < 70 = Do NOT start
Genvoya Key features: HA/Insomnia CrCl < 30 = Do NOT start
CrCl < 50 = D/C
1. Names end in "teravir"
2. NO Renal adj. Dolutegravir should not be used in women who
Tivicay 3. NO CYP Rxns HA/Insomnia are pregnant or who might become pregnant
Dolutegravir - DTG
Triumeq 4. Cation interaction ↑SCr w/o GFR effect due to a risk for neural tube defects in the
(separate dose by infant.
2 hrs BEFORE or 6 hrs AFTER)
5. Take w/o regard for meal Myopathy Take BID
Raltegravir - RAL Isentress (except Elvitegravir w/ food) Rhabdomyolysis Hemodialysis = 1200 mg daily (600 mg BID)
6. Interactions: Antacids, ↑CPK
Multivitamins, Iron Supplements
- MUST undergo Tropism Test before Tx
CCR-5 Antagonist: - Will only work in PTs w/ CCR-5 Tropic
Maraviroc - MVC Selzentry Hepatotoxicity
Prevents HIV cell Entry disease. PT must be NEG for CXCR-4 or
Dual/Mixed-Tropic
CHRONIC HEART FAILURE
General Information Signs & Symptoms Ejection Fraction Ranges Drugs that worsen HF
- Heart not able to supply enough O2-rich blood to General Signs/Sx: Dyspnea (SOB), cough, fatigue, exercise
- Anti-Arrhythmic: Procainamide, Quinidine,
body. capacity ↓
Amiodarone, Dofetilide
- Impaired Ventricular filling/ejection of blood. Left-Sided (Preserved) Right Sided (Reduced) 55-70% Normal Normal - Oncology (Anthracyclines): Doxorubicin,
- Mostly due to damage from MI or long-term HTN. HF + Preserved Impaired Ventricle Daunorubicin
- Labs: ↑BNP (norm <100 pg/mL) - Orthopnea ≥ 50% EF (HFpEF) relax/filling during - NON-DHP CCBs: Diltiazem, verapamil
↑NT-Pro BNP (norm <300 pg/mL) - Peripheral edema Diastolic Dysfxn Diastole - NSAIDs, including celecoxib
- Paroxysmal nocturnal
- Medicare penalizes hospitals for excessive - Ascites - Abdominal fluid Mixed - TNF-α inhibitors: Etanercept, Rituximab
dyspnea (PND) HF + Mid-range
readmissions - JVD - neck vein distention 40-49% Systolic/Diastolic - Thiazolidinediones
- Cough/SOB at night EF (HFmrEF)
- Hepatojugular Reflux (HJR) Dysfxn - Itraconazole
ACC/AHA/HFSA Guideline - Rales - Crackling sound
Neck vein distention when HF + Reduced EF Impaired ability to - Systemic steroids
DIAGNOSIS: - S3 Gallop - abnormal
pressure applied abdomen. < 40% (HFrEF)Systolic eject blood during - Amphetamines, illicit drugs, alcohol
1. CHF Sx due to systolic contraction/diastolic heart sound.
- Hepatomegaly - enlarged Dysfxn Systole - Triptans
relaxation. - Hypoperfusion - renal
liver due to fluid congestion. - (Other oncology agents): Lapatinib, sunitinib,
2. Echocardiography (ECHO) imp. or cold extremities.
3. LVEF = <40% imatinib, trastuzumab, docetaxel
Pathophysiology Staging/Classification Non-Pharm Tx Treatment

- Main PHARM Tx:
• CO = HR x SV ACC/AHA Staging o ACEi, ARBs, or ARNI
• CI = CO/BSA [CI = Cardiac Index] High risk for developing HF but has no Sx or ▪ ALL Risk of Hyperkalemia
(related to CO to size of patient's body) Structural heart Dx ▪ Combo w/ ARNI common
A
Ex. PTs w/ HTN, CAD, DM, Obesity, Metabolic ▪ NEVER combine ALL 3
syndrome 1. Monitor body weight daily. ▪ Use w/ NSAIDs worsens Renal Fxn
1. During low cardiac output 2. Sodium restrict <1500mg/day
neurohormones are released and Structural Heart Dx but no Signs/Sx of HF. ▪ ACEi/ARBs = Lithium toxicity
B 3. Fluid restrict < 1.5-2 L/day
increase BV & force/speed of Ex. LVH, Low EF, Valvular Dx, previous MI. o BB's
C Structural Heart Dx + Prior/Current Sx of HF 4. Stop smoking, ETOH, drugs.
contractions, leading to temporary ▪ ONLY 3 recommended in HF: Bisoprolol, Toprol XL,
Advanced Structural Heart Dx + Sx of HF at rest 5. Get flu/pneumo vaccines
increase in CO. Overtime this remodels Carvedilol.
D 6. Wt reduction - BMI < 30
the heart. despite medical Tx. ▪ AVOID BB w/ ISA activity
7. Exercise
2. Cardiac Remodeling = involves RAAS, 8. Notify PCP if weight increases ▪ STOP if Hypotension OR Hypoperfusion
SNS, & Vasopressin. NYHA Classification 2-4 lbs/day OR 3-5 lbs/wk ▪ MASKS Hypoglycemia Sx
3. RAAS + Vasopressin = Vasoconstriction 1 No limits to physical activity - No Sx of HF OR if Sx worsen (SOB, cough, ▪ Metoprolol IV:PO not EQ
+ H2O retention. Slight limitation of physical activity. Comfy at rest wheeze, edema, more fatigue, ▪ Non-Selective BB: ↓ Insulin secretion = Hyperglycemia.
2
4. SNS = Increase HR, Contractility BUT Sx occur w/ physical activity. pillow # Orthopnea. o Loop Diuretics
(Inotropy), vasoconstriction. Marked limitation of physical activity. Comfy at rest - OTC Tx:
3
5. Natriuretic Peptides - normally BUT Sx caused by minimal exertion. o Omega-3 FA - 1 gram
counteract hormones but are Unable to carry any physical activity w/o Sx of HF o Hawthorn
insufficiently expressed during this time. 4
OR Sx occur at rest. o CO-Q10
o Avoid Ephedra/Ephedrine (Decongestants)
Drugs Shown to ↓ Mortality Drugs with no mortality benefit (morbidity only)

ACEi/ARBs Recommended for EVERYONE
ARNI - Sacubitril/Valsartan Reduce BV, edema, congestion -
NYHA Class 2-4 PTs who have ↓EF Loop Diuretics
(Entresto) Most PTs need for Sx Relief
Beta-Blockers Recommended for EVERYONE Provides small increase in CO to
Digoxin
Aldosterone receptor improve Sx
NYHA Class 2-4 PTs
Antags (ARA's) NYHA Class 2-3 w/ Normal Sinus
BLACK PTs NYHA Class 3-4 (Add Ivabradine (Corlanor) rhythm
Hydralazine OR Nitrates
to ACEi/ARBs) OR other PTs who + Resting HR ≥70 BPM
(BIDIL)
CANNOT TOLERATE ACEi/ARB

HCO3 (Alkalosis)
Furosemide Lasix Hyperuricemia (UA) Anuria - Furosemide INJ must be ROOM TEMP
Hyperglycemia (BG) Sulfa allergy - May add to Thiazide if Loop isn’t enough.
Torsemide Demedex LOOP Diuretics: TG's AVOID NSAIDs (Na+/H2O) (Metolazone)
Works on THICK Ascending Loop of Profound Diuresis leading
Total Cholesterol Cause retention - DOSE CONVERSION
Henle to fluid + electrolyte
Orthostatic Monitor renal fxn, fluid PO Furosemide 40mg = Torsemide 20mg =
Bumetanide Bumex depletion
Na+/Cl-/K+/Mg+/Ca+/H2O ↓ Hypotension status, BP, Bumetanide 1mg = Ethacrynic Acid 50mg
Photosensitivity electrolytes - FUROSEMIDE IV:PO = Ratio 1:2
Ethacrynic Acid Edecrin Ototoxicity (Tinnitus) Audiology testing 20mg IV = 40mg PO
Lithium Toxicity
CHRONIC HEART FAILURE
Enalapril Vasotec Angioedema
Ramipril Altace ACEi: Use w/ Aliskiren - Monitor: BP, K+, Renal Fxn, Signs/Sx of HF.
Lisinopril Prinivil/Zestril/QBRELIS Cough
Block Ang-1 → Ang-2 Renal impairment - TITRATE to Target Dose
Dizziness
Quinapril Accupril Vasoconstriction Pregnancy Hyperkalemia - Can combine w/ ARAs
Headache
Captapril Capoten Aldosterone secretion Hypotension - NEVER w/ ARB
Rash
Fosinopril - Block Bradykinin degradation Wait 36 hrs for Neprilisyn - BLACK = higher risk of Angioedema
Trandolapril Mavik (Sacubitril/Valsartan)
LESS Angioedema
Candesartan Atacand
ARBs: LESS Cough (than ACEi) Use w/ Aliskiren
Monitor: BP, K+, Renal Fxn, Signs/Sx of HF.
Block binding Ang-2 -> AT1 Dizziness Renal impairment
Losartan Cozaar Pregnancy Can combine w/ ARAs
Headache Hyperkalemia
RAAS ↓ NEVER w/ ACEi
Rash Hypotension
Valsartan Diovan
NO Washout period
Use with ACEi/ARNI
Angiotensin-Receptor +
Hx of Angioedema
Neprilisyn Inhibitor (ARNI):
WASHOUT w/ ACEi
Degrade vasodilation peptides Cough Indication: PTs who cannot tolerate ACEi/ARBs.
Sacubitril/Valsartan Entresto Pregnancy (36 hours)
Adrenomedullin Dizziness Monitor: BP, K+, Renal Fxn, Signs/Sx of HF.
Warning: Angioedema,
Substance P
Renal imp, Hyperkalemia,
Bradykinin
Hypotension.
Bisoprolol Zebeta
Beta-Blockers: HR ↓ TG ↑ Bradycardia ONLY 3 recommended in HF
Block Catecholamines (NE) Hypotension 2nd/3rd Heart Block AVOID BB w/ ISA activity
Metoprolol Abrupt Discontinuation
Toprol XL Vasoconstriction ↓ Fatigue Sick Sinus Syndrome STOP if Hypotension OR Hypoperfusion
Succinate ER TAPER off over 1-2 wks
Improve Cardiac Fxn Dizziness (Carvedilol - Hepatic Imp.) Metoprolol IV:PO not EQ
Coreg *Carvedilol = Non-selective Libido/Impotence MASK Hypoglycemia Sx Monitor: BP, K+, Renal Fxn, Signs/Sx of HF.
Carvedilol
(take with food)
Aldactone/CaroSpir Hyperkalemia
Spironolactone (Non-Selective = Block SCr ↑ Hyperkalemia
Androgens) Aldosterone Receptor - Do NOT initiate in HF PTs who: K+ >5 or
Dizziness Spironolactone: Addison’s Dx
Antagonists: SCr: >2.0 (F), >2.5 (M)
Inspra Spironolactone: Tumorigenic Anuria
DCT of Collecting ducts. - Monitor: BP, K+, Renal Fxn, Signs/Sx of HF.
Eplerenone (Selective - No gynecomastia/breast Renal Imp (CrCl <30)
Endocrine Fx) tenderness, impotence.
Hydralazine: HA
Arterial Vasodilator WARNING: Drug-Induced
Hydralazine + Reflex Tachycardia CAD
BiDil Lupus Erythematosus
Isosorbide Dinitrate Afterload ↓ Palpitations Mitral Rheumatic Heart Dx
(DILE) Indication:
Decreases Nitrate tolerance Fluid retention
1. Cannot tolerate ACEi/ARBs
HA 2. BLACK Class 3-4 w/ Sx despite Optimal Tx.
Nitrates: Dizzy/Lightheaded Avanafil: wait 12 hrs
Isosorbide NO causes Vasodilation Flushing Sildenafil: wait 24 hrs CI: Use of PDE-5 inhibitors Tachyphylaxis - Need 10-12 hr Nitrate-free period.
Imdur/Monoket
Mononitrate Hypotension Vardenafil: wait 24 hrs OR Riociguat
Preload ↓
Tachyphylaxis Tadalafil: wait 48 hrs
Syncope
Digitek/Digox/Lanoxin WARNING: 2nd/3rd Ventricular Fibrillation Improves QOL, Sx, Exercise Tolerance
Inhibits Na+/K+ ATPase Pump: Dizzy
Heart Block Lower Dose in: Female, small size, renally imp.
Digoxin Tx Range HF: 0.5-0.9 + Inotropy N/V/D/HA Monitor renal fxn &
TOXICITY: N/V, loss of No mortality benefits
ng/nL ↑CO Mental Disturbances
appetite, Bradycardia electrolytes K+↑/Mg+↓/Ca+↑ = ↑risk of Digoxin Toxicity.
HCN Blocker: Bradycardia
Acute Decompensated HF
Blocks "Funny" (IF) current in Sinus HTN Bradycardia Target Resting HR: 50-60 BPM
BP < 90/50
Ivabradine Corlanor Mode AFIB QT Prolongation Indicated for NYHA Class 2-3 w/EF <35 + Sinus
Sick Sinus Syndrome
Luminous Phenomena Arrhythmias Rhythm + HR > 70 BPM
HR ↓ AV Block
(Flashing lights)
Take with food
N/V/D
Klor-Con/Klor-Con Supplementation: - Micro-K: may open & sprinkle capsules.
Hyperkalemia
Potassium Chloride M20 Counteract Loop diuretic loss of K+ Renal Imp/Hyperkalemia - K-Tab/Klor-Con: swallow whole.
Flatulence
Micro-K and Arrhythmia risk w/ Digoxin. - Klor-Con M20: swallow whole OR cut 1/2
Abdominal pain
OR dissolve in 4 0z. H2O.
ANTICOAGULANTS
General Information Clotting Cascade Treatment VTE Risk Factors Heparin Induced Thrombocytopenia
- CHEST Guidelines used for guidance 1. Anti-Coags (if contraindicated or there is a high risk for
- Medications prevent clots but do NOT bleeding - Intermittent Pneumatic Compression (IPC) or
break down clots. Compression Stockings)
- Mostly used for ACS, Px of stroke & 2. VTE should be treated for at least 3 months.
VTE, DVT, TIA, or PE. 3. Estrogen meds + SERMs are contraindicated in VTE. Heparin-Induced-Thrombocytopenia (HIT):
- Anti-coags work by inhibiting the 4. PT's w/o cancer - Dabigatran or Oral Factor Xa inhibitors - Immune-mediated IgG drug rxn associated
clotting cascade. are preferred over Warfarin for the 1st 3 months. w/ thrombosis.
Surgery
- Watch out for other drugs that 5. PT's w/ cancer - LMWH is preferred over all anti- - IgG AB's complex bind w/ Heparin & bind to
Major trauma
increase bleeding. coagulants. FC-receptors → Platelet activation → Pro-
Immobility
- Red or black stools is a sign of 6. PT's w/ Mechanical heart valve - Tx w/ Warfarin only. Thrombotic state.
Cancer/Chemo Tx
bleeding so caution w/ use. 7. PTs w/ Non-valvular AFIB - Tx according to CHADVASC - DIAGNOSIS: unexplained Platelet drop
Previous VTE
- HIGH-ALERT Meds: Anti-Coags cause system. (> 50% drop from baseline)
Pregnancy
bleeding so Joint Commission - Management:
CHA2DS2-VASC Score Score = 0, no anti-coag rec. EPO Agents
regulates protocols for ordering, 1. STOP all forms of Heparin/LMWHs.
C - CHF = 1 Score = 1, ASA considered Estrogen Meds
dispensing, administration, monitoring, 2. D/C Warfarin & administer Vitamin-K.
H - HTN = 1 Score = 2, OAC rec. SERMs
education. 3. Argatroban is recommended.
A - Age ≥75 = 2 (warfarin, Xarelto, 4. Bivalirudin is preferred for Cardiac
Clotting-Cascade: D - Diabetes = 1 Eliquis, or Pradaxa) Surgery or PCI.
1. Activated by blood vessel injury, S - Stroke/TIA Hx = 2
stasis, or pro-thrombotic. V - Vascular Dx = 1 (Prior MI, PAD, CAD, plaque)
2. Platelets and clotting-cascade A - Age 65-74 = 1
activated until Fibrin is formed. S = Sex (Female) = 1
GENERIC BRAND + Dosing MOA ADRs BBW C/I NOTES

UFH: (ABW) 1972-6: Fatal dosing errors so verify that - HIT antibodies sensitive to LMWH
VTE Px = 5,000 units SC Q8-12H Bleeding Active Bleed (ex. ICH)
Binds to Anti-Thrombin (AT) → concentration is correct. - Antidote = Protamine
Thrombocytopenia Hx of HIT
Unfractionated VTE Tx = 80 U/kg IV bolus → inactivates Thrombin SAFETY NOTE: 1mg Protamine for 100 U of UFH, Max dose=50
HIT Thrombocytopenia
Heparin + 18 U/kg/hr IV infusion. (2a, 10a, 9a, 7a, 6a + Plasmin) Heparin Lock-Flush used for keeping open IV - Response is unpredictable.
Hyperkalemia Pork allergy
ACS/STEMI = 60 U/kg IV bolus → → prevents conversion of lines are dosed 10-100 Units. Careful w/ - MONITOR: aPTT q6H til 1.5-2.5x Baseline, Anti-10a
Osteoporosis (long-term use) Caution in babies/pregnancy
12 U/kg/hr infusion. Fibrinogen → Fibrin. mistaking for UFH injections. Level = 0.3-0.7, Platelets, Hgb, Hct daily
Lovenox
VTE Px = 30 mg SC Q12H
Enoxaparin
or 40 mg SC daily.
(Injections - Do
CrCl <30 = 30 mg SC QD
NOT expel air
VTE/UA/N-STEMI Tx = 1 mg/kg SC Q12H
bubble in
or 1.5 mg/kg SC QD Bleeding - Monitoring Anti-10a not req.
syringe before
CrCl <30 = 1 mg/kg SC QD LMWH: Anemia Active Major Bleed - Antidote = Protamine.
injections unless Spinal punctures (Epidural) is a risk for
STEMI Tx = 30 mg IV Bolus + 1 mg/kg SC Bind to AT w/ more affinity for Thrombocytopenia Hx of HIT - MONITOR: Platelets, Hgb, Hct, SCr, Anti-10a
PCP has Hematomas or Paralysis.
PT >75 yo = 0.75 mg/kg SC Factor 10a + 2a. Hyperkalemia Pork allergy only for Pregnancy Q4H Post-dose
advised you to
Q12H no bolus - MAX 75 mg. LFTs - aPTT NOT used.
do so.)
PCI = if last dose given 8-12H before
balloon inflation → Give 0.3 mg/kg IV Bolus
Fragmin
Dalteparin VTE Px = 2,500-5,000 SC QD
UA/STEMI = 120 U/kg SC Q12
Indirect injectable synthetic
pentasaccharide selectively
Fondaparinux Arixtra - CrCl < 30 = do NOT use
inhibits Factor 10a via AT.
(Off-label use for HIT)
Eliquis
- Avoid Dual inducers (3A4 + P-gp)
Apixaban DVT/PE = 10mg PO BID x 7 days then 5mg
Active Pathological Bleed (no - When switching from warfarin = INR <2
PO BID. 1. Spinal punctures (Epidural) is a risk for
antidotes available)
Betrixaban Bevyxxa Hematomas or Paralysis.
Bleeding Caution in pregnancy
Savaysa 2. Pre-mature D/C = Thrombosis risk.
Anemia
Edoxaban DVT/PE: 60mg daily started after 5-10 days 3. Edoxaban: do NOT use in - When switching from warfarin = INR ≤2.5
Monitor: Hgb, Hct, SCr, LFTs,
of parenteral use. Direct Factor Xa inhibitors CrCl > 95
no efficacy monitoring needed
Xarelto
DVT/PE: 15mg PO BID x 21 days then 20mg
PO daily, with food - Avoid Dual inducers (3A4 + P-gp)
Rivaroxaban
Take missed doses immediately even two 15 - When switching from warfarin = INR <3
mg tabs for 30 QD.
AFIB = 15mg QD w/ evening meal.
- Take missed doses immediately unless within 6 hrs.
Pradaxa
- Antidote: Idarucizumab (Praxbind)
DVT/PE: 150mg BID start after 5-10 days of Dyspepsia
Active Bleeding - Keep in OG container & discard 4 mon. after opening.
Dabigatran parenteral coags. Gastritis-like Sx
Prosthetic Heart Valves - Do NOT give by NG-Tube.
Take w/ FULL glass of H2O. Do NOT chew, Bleeding + GI bleed
- No need to monitor efficacy
crush. Open. Spinal punctures (Epidural) is a risk for
Direct Thrombin (Factor 2a) - When switching from warfarin = INR <2
Hematomas or Paralysis.
Argatroban
- Indication: undergoing PCI.
(IV/SC) Bleeding
- Used in PTs w/ Hx of HIT.
Bivalirudin Anemia Active Major Bleed
Angiomax - NO cross-rxn w/ HIT AB's.
(IV/SC) Hematoma
Desirudin Iprivask -
ANTICOAGULANTS
Coumadin
Jantoven Major/Fatal Bleeding Pregnancy - Except for
Normal Dose = 10mg daily Mechanical Valve
Warfarin - Antidote = Vitamin K.
Adjust dose per INR values Competitive inhibitor of VKORC1: Bleeding WARNING: Bleeding
(R+S Enantiomers) - MONITOR
Low Dose = 5mg or Less Reduces Vitamin-K epoxide & depletes active Skin Necrosis Tissue necrosis/Gangrene Traumatic surgery
S-enantiomer = Goal INR = mostly 2 - 3
elderly, malnourished, liver dx, HF, clotting factors 1972 + Protein C + S Purple-Toe syndrome HIT Carditis
More Potent Mechanical heart valves = 2.5-3.5
2C9*2 or *3 alleles Blood dyscrasias
↑risk of bleed, or drugs/food
VKORC1 Polymorphism Uncontrolled HTN
affecting INR.
Warfarin Drug/Food Interactions Key Points Reversal

1. Healthy PTs get 10 mg daily for 1st 2 days then adjust per INR
2. DVT/PE: start Warfarin same day as Parenteral Anti-Coags (Enoxaparin or UFH) & continue both for a
Warfarin Drug minimum of 5 days & until INR is ≥ 2 for at least 24 hrs. BOTH criteria MUST be met. 1. Vitamin-K (2.5 - 5mg) preferred
Interactions: Herbal/Natural 3. Stable INR Pts may have INR testing every 12 weeks instead of 4. unless significant or major bleed.
AVOID: (Increase Products: 4. STOP Warfarin 5 days before major surgery. 2. AVOID SC/IM administration.
- CYP2C9 Inducers ↓
risk of bleeding, No ↓Warfarin 5. PTs w/ mechanical heart valve, AFIB, or VTE need Bridging Therapy w/ LMWH or UFH. (PTs at Low risk for 3. IV injection ONLY when serious
INR: (↑Bleeding, NOT Vitamin-K = ↓
INR effect) Efficacy: thromboembolism do not require bridging). bleed is occurring because of risk
Rifampin INR) INR:
- NSAIDs - Alfalfa of Anaphylaxis, must infuse slowly.
- CYP2C9 Inhibitors - Garlic - Green Leafy
- Anti-Platelets - Green Tea
↑ INR: - Anti- - Ginger Vegetables - INR: 4.5-10 w/o bleed = Do not
- Co-Q10
Amiodarone Coagulants - Ginko - key is to stay give Vit-K, HOLD 1-2 Warfarin
- St. John's
(decrease 30-50%), - SSRIs - Ginseng consistent. doses.
Wort
Azoles, - SNRIs - Glucosamine - INR > 10 w/o bleed = PO Vit-K
Metronidazole, - Grapefruit 2.5-5mg.
TMP/SMX - Major Bleed = IV Vit-K.
Please Let Greg Brown Bring Peaches To Your Wedding
Reversal Agents
Hypotension Hypotension
Protamine 1mg will reverse
Protamine Stable Salt Complex Bradycardia Cardiovascular
100 Units of Heparin
Flushing Pulmonary
HA
WARNING:
Idarucizumab Praxbind Dabigatran Antidote Delirium
Thromboembolic risk
Constipation
Anaphylaxis
Vitamin-K (Phytonadione) Provides vitamins for Liver Flushing SC not recommended due to Variable Absorption.
Mephyton Severe allergic rxns
PO/IV only synthesis of clotting factors. Rash IM not recommended due to risk of Hematoma.
Dizziness
Kcentra Human prothrombin
4-Factor Prothrombin Disseminated Intravascular Coag (DIC)
Bebulin Indicated for URGENT reversal N/V/D/HA Thromboembolic events MUST administer Vitamin-K concurrently
Complex Concentrate Known HIT
Profilnine of Warfarin.
GASTROESOPHAGEAL REFLUX DISEASE
Drugs w/ Decreased Absorption w/ Antacids, H2RAs, PPIs
General Information Signs & Symptoms Diagnosis Treatment Algorithm
----Separate by 2-4 hrs BEFORE or 2-6 hrs AFTER----
Anti-Retrovirals
- Lower Esophageal Sphincter (LES) Dolutegravir
Heartburn Delavirdine
usually protects from acidic gastric Elvitegravir Iron Products FQ's
Hypersalivation Rilpivirine
contents Raltegravir
Regurgitation Weight Loss Atazanavir
- PT's w/ GERD have reduced LES Elevation of Bed Anti-Virals
Epigastric pain
pressure. Sx ≥ 2x/week Lifestyle Mods: Avoid High Fat meals 2-3 hrs before bedtime. Ledipasvir
Nausea Bisphosphonates Mesalamine Sotalol
- Gastric contents backflow into the Risk Factors: Avoid foods/beverages that trigger reflux: Velpatasvir
Cough
esophagus. - Family Hx Caffeine, chocolate, acidic/spicy foods, carbonated beverages Sofosbuvir
Sore throat/Hoarseness
- GERD can decrease QOL leading - Diet Steroids +
Chest pain PPI Once Daily for 8 weeks: May increased to BID for partial Azoles
to erosion, strictures, bleeding, - Sleep position Isoniazid Risedronate DR Thyroid
Alarm Sx: Initial Tx: response of Nocturnal Sx. Itra, Keto, Posa
Barrett's esophagus (abnormal cell Invasive testing NOT products
Odynophagia (pain swallowing) STOP Tx at 8 weeks → Sx still present → Maintenance Tx
growth) leading to cancer. required when typical Cephalosporins
Dysphagia 1st Line: PPI at lowest effective dose. Tyrosine
- PT's w/ ALARM Sx who do NOT Sx present. Maintenance Cefditoren
N/V Alt Tx: H2RA if no erosive Sx & relieves Sx. Mycophenolate Kinase Tetracyclines
respond to OTC products after 2 Tx: Cefpodoxime
Hematemesis NOT Recommended: Metoclopramide or Sucralfate. inhibitors
weeks should see PCP. Cefuroxime
Black bloody stools
- Infrequent heartburn Tx w/
Weight loss
Antacids or H2RA's PRN Avoid completely: Delavirdine, Dasatanib, Pazopanib, Erlotinib, Rilpivirine
Velpatasvir/Sofosbuvir (Epclusa), Risedronate (Altevia), Erlot

Calcium Carbonate Tums
Phillip's Milk of Magnesia
Magnesium Antacids:
(MOM) Unpleasant Taste - Pregnancy: use Ca+ products
Neutralize gastric acid → pH ↑ - Antacids - last 30-60 min: Mg+ =
Mylanta Supreme Constipation NOT recommended in
Magnesium & Al+/Ca+ Gaviscon Do NOT req. Systemic Bloating CrCl < 30 diarrhea
Rolaids Absorption Belching Al+ & Mg+ accumulates Al+ = constipation.
Provide relief in minutes. Hypophosphatemia Renally
Maalox
Mg + Al + Simethicone Duration = 30 - 60 mins Loose stools
Mylanta Classic
May req. 4-6x/day dosing.
- Alka-Seltzer = Antacid + ASA: may
Sodium Bicarb + ASA Alka-Seltzer
cause serious bleeding.
Famotidine Pepcid - ECG/QT-prolong
H2RA's: - AVOID use in Elderly w/ Delirium,
Reversibly inhibit H2 receptors. Headache Dementia, or Cognitive Imp. due to CNS Fx
Ranitidine Zantac Confusion (Reversible) - ↑ ALTs
Vomiting in Child < 1yo - Tachyphylaxis (Tolerance)
↓ Acid secretion. Risk Factors: Severely ill,
Cimetidine - Decrease Dose:
Tagamet Less long-term S/E than PPI. Cimetidine – Gynecomastia, Impotence, SCr ↑ Renal or Hepatic imp. - AVOID USE
(2C19 inhibitor) Cimetidine = < 30 CrCl
Take 30-60 mins before meal. Others = < 50 CrCl
Nizatidine -
Dexlansoprazole Dexilant - Take w/o regard to meals.
Esomeprazole Nexium C. Difficile (CDAD)
Prevacid PPI's:
Osteoporosis Fractures - 30-60 mins before Breakfast
Irreversible H+/K+ ATPase
Lansoprazole Prevacid SoluTab: contains Hypomagnesemia - Rabeprazole Capsules can be
Pump inhibitor N/D/HA 2C19 Inhibitors will ↓ Clopidogrel effect
Aspartame - NOT use in PKU. Vitamin B12 def. sprinkled into Apple Sauce
Blocks gastric acid secretion Thrombophlebitis (IV Protonix) Do NOT use Nelfinavir
Omeprazole Prilosec Nephritis - Pantoprazole & Esomeprazole are
MOST effective agents SJS/TEN (IV Protonix) ↑ Methotrexate toxicity
Pantoprazole Protonix SLE only PPIs available IV.
8-week course at Lowest Fx dose
Rabeprazole Aciphex GI infections
for maintenance Tx.
Omeprazole + Sodium Pneumonia - Can control Nocturnal sx if taken at
Zegerid
Bicarb Bedtime.
BBW: Tardive Dyskinesia
Drowsiness WARNING:
Restlessness Depression CrCl <40 = ↓ Dose 50%
Metoclopramide Dopamine Antagonist: - Take QID before Meals + Bedtime
Reglan Fatigue EPS CNS effects are dose-related + Elderly
(Used w/ co-existing - Food must be in gut
Metozolv ODT ↑ Gastric Emptying HTN Acute Dystonia AVOID use in Parkinson's
Gastroparesis) - do NOT use ETOH or heavy machinery.
Pro-Arrhythmic Parkinson-like Sx AVOID Anti-Psychotics
Diarrhea Neuroleptic Malignant
Syndrome (NMS)
PEPTIC ULCER DISEASE
General Information Signs & Symptoms H. Pylori NSAIDs Induced Ulcers
Dyspepsia Treatment:
- Ulcerations in Duodenum & stomach. Treatment:
Gastric pain (Middle/Upper COX-2 Selective = ↓ GI Risk
o H. Pylori - Ulcers: Gram (-) 1st Line = QUADRUPLE Tx
stomach) Diagnosis: (↑CVD risk) Risk Factors:
Spirochete 10-14 Days
Eating lessens the pain. 1. Urea Breath Test (UBT) Celecoxib Age >60
o NSAID-induced ulcers
NSAIDs worsen pain. 2. Fecal Antigen test Meloxicam Hx of PUD
o Stress ulcers (Occur in Critical Triple Tx is ONLY 1st line
Heartburn (D/C PPIs, Bismuth, Abx Nabumetone NSAID high dose
illness or Mechanically ventilated) if Clarithromycin
Belching 2 weeks prior to tests Diclofenac Using >1 NSAID
o Less common causes: Zollinger resistance rates are low &
Bloating/Cramping (FN)) Etodolac Anti-Coag, Steroid, SSRI
Ellis Sx (ZES), viral infections, PT has no Hx of other
Nausea Yosprala: Combo ASA +
radiation therapy, Crohn's Dx Macrolide use.
Anorexia Omeprazole
1st line QUAD Therapy: Take 10-14 days Alternative 1st Line QUAD Tx: Take 10-14 Days Triple Drug Tx: Take 10-14 Days (Conditional, refer above)
Therapy Notes
PPI BID or Nexium 40mg H2RA ok to sub-in if intolerant
QD to PPI PPI BID or Nexium 40mg QD
PPI BID or Nexium 40mg QD If PCN allergy: replace
Bismuth Subsalicylate Pylera (Bismuth Subcitrate) + Tinidazole may be Amoxicillin 1000mg BID Amoxicillin w/ Metronidazole
Amoxicillin 1000mg BID
300mg QID PPI = 3 in 1 subbed for Clarithromycin 500mg BID TID or use Quadruple Tx.
Clarithromycin 500mg BID
Metronidazole No ETOH Metronidazole
Metronidazole 500mg QID
250-500mg QID Ok to substitute for Tinidazole Prevpac – blister card containing all three medications
Tetracycline 500mg QID Avoid Pregnancy + Child <8 yo
1. Do NOT Substitute Regimens 2. No H2RAs unless PPI intolerant. 3. No switching ABX.

Misoprostol Diarrhea Abortifacient - Avoid in
Cytotec Prostaglandin E1 Analog
(Alternative for PPI) Abdominal pain Pregnancy
Sucrose-Sulfate-Aluminum Drink fluids + laxatives
Sucralfate Carafate Constipation Caution in Renal imp.
Complex for constipation.
CONSTIPATION
General Information Non-Pharm Tx Treatment Colonoscopy Prep Drug Induced Constipation
- AGA Guidelines Al+ containing acids
- Defined as Infrequent/No bowel movements over 3 days or - Mg+ counteracts
straining, lumpy/hard stool, incomplete evacuation, pushing • 1st Line = gradually increase Fiber (Psyllium) Anti-cholinergic
for >10 mins. o DOC for Pregnancy. - TCAs, Anti-Histamines,
- Caused by lifestyle, drugs, GI disorders, pregnancy. • Osmotic agent (MOM or PEG) or stool softener Phenothiazine, Anti-
(Docusate) 1. PEG (GoLytely)
- Medical Condition Causes: Spasmodic
o Avoid MOM in Renal imp. 2. Sodium Phosphates
o IBS-C Increase Fluid intake NON-DHP CCBs
o Causes fluid +
o Anal disorders Limit Caffeine/ETOH Adults Fiber (Metamucil) Bismuth
electrolyte
o Multiple Sclerosis Physical activity Must use Stimulants (Senna or Clonidine
Opioids abnormalities so
o Cerebrovascular Accidents (CVA) Diet Bisacodyl) +/- Docusate Aripiprazole
risky for Renal or
o Parkinson's Dx Avoid delaying On Fe+ or Milnacipran
Docusate Cardiac Dx.
o Spinal Cord tumors defecation Hard Stools Colesevelam
o caution w/ Loop
o Diabetes Need Iron
diuretics + NSAIDs
o Hypothyroidism Immediate Glycerin Suppository Opioids
- Unknown Cause = Idiopathic Relief Sucralfate
- Lifestyle modification is preferred for tx 5HT-3 (Ondansetron)
Children Glycerin Suppository
- IBS-C: idiopathic constipation is frequent & associated w/ chronic Tramadol/Tapentadol
recurring abdominal discomfort that is relieved by defecation. Phentermine/Topiramate
Psyllium Metamucil Bulk-Forming Agents: Gas/Bloating
Fecal impaction Take 2 hrs apart other Meds.
Calcium Polycarbophil FiberCon Create Gel-Matrix Bowel Obstruction
GI obstruction Req. Adequate Fluids
Methylcellulose Citrucel Soaks up fluid in loose stools Choking (take w/ fluid)
Milk of Magnesia
Magnesium Hydroxide
(MOM)
Miralax
Polyethylene Glycol
Gavilax
(PEG)
Glycolax Osmotics: Electrolyte Imbalance
Anuria (Sorbitol) Mg+ caution w/ Renal imp.
Pedia-Lax Retains fluid in bowel lumen Gas
Glycerin Low Galactose Diet (Lactulose)
Sani-Supp Fleet Increase fluid secretion to small Dehydration
GI obstruction (MiraLax) Suppository – take 30 min after meal
Sorbitol intestines -> Peristalsis Rectal irritation (Supp)
Constulose
Enulose
Lactulose
Kristalose
Generlac
Ex-Lax Abdominal Pain - Opioid use requires stimulants.
Senna Stimulants: Abdominal Cramping Avoid if stomach pain, N/V, Obstruction - Oral formulations - Take at
Senokot
Stimulant Colonic Neurons Electrolyte Imbalance sudden change in bowel Appendicitis (Senna) Bedtime
Bisacodyl Dulcolax → Peristalsis Rectal Irritation (Supp) movements. N/V (Bisacodyl) - Suppository – take 30 min after
Colitis Ulcerosa meal
Abdominal Pain
- Preferred to avoid Straining.
Docusate Sodium Colace Emollients: Soften Fecal mass N/V
- For Hard +/- Dry stools.
Use w/ Mineral Oil
Age <6 yo
Pregnancy
Bedridden Usually NOT recommended due to
Mineral Oil Lubricant: Coats waterproof film
Aspiration risk safety Aspiration concerns
Elderly
Difficulty Swallowing
N/D/HA
Lubiprostone Amitiza Activates Cl- channels Bowel Obstruction
Hypokalemia
Hypokalemia
Peripheral Mu-Opioid Dyspepsia
Alvimopan Entereg Risk of MI long-term use PTs taking Opioids > 7 Days
Antagonist: (PAMORAs) Anemia
Urinary Retention
CONSTIPATION
Colyte Ileus
- Clear Liquid diet consumed day
Gavilyte Obstruction/Perforation
prior to Colonoscopy.
Polyethylene Glycol GoLytley Gastric Retention
N/V - Do NOT Consume:
(PEG) MoviPrep Toxic Colitis Megacolon
Abdominal discomfort o Red/Blue/Purple coloring
NuLtyely OsmoPrep:
Osmotics Bloating o Milk
TriLyte - Phosphate
Used for Whole Bowel Irrigation Electrolyte Nephropathy (OsmoPrep) o Cream
Sodium Picosulfate - Nephropathy
(Bowel Prep) Abnormalities o Tomato
+ Magnesium Oxide Prepopik - Gastric Bypass
Arrhythmias o Orange
+ Citric Acid - Stapling surgery
Seizures o Grapefruit Juice
PrePopik:
Fleet Enema o ETOH
Sodium Phosphates - Renal/Liver imp
OsmoPrep o Solid or Semi-solid Foods
- CHF
Diarrhea Death due to
Linaclotide Linzess
Abdominal Distention Dehydration Age < 6 yo
Guanylate Cyclase-C Agonist
Flatulence AVOID in GI Obstruction
Plecanatide Trulance
Headache Pediatrics
DIARRHEA
General Information Drug Induced Diarrhea Irritable Bowel Syndrome (IBS)
- Most cases are due to viruses but E. coli is common bacterial cause.
- Must rule out Lactose-Intolerance due to Milk products. Mg+ Antacids Laxatives
Treatment options:
- NON-PHARM Tx = Fluids + Electrolytes Clindamycin/Erythromycin Metoclopramide
Loperamide or Rifaximin (Xifaxan)
o Ex. Oral Rehydration Solution (ORS), PediaLyte, Gatorade. Anti-Neoplastics Misoprostol
Alosetron (Women only)
- Bismuth-Subsalicylate (Pepto-Bismol) or Loperamide for Sx relief. Colchicine Quinidine
o ONLY for PTs w/ Non-infectious diarrhea.

Black Tongue/Stool Salicylate Allergy
Salicylate Toxicity Other Salicylate use Caution Child/Teen with viral infxn
Bismuth subsalicylate Pepto-Bismol
(Sx = N/V, ↑ RR, Black/Bloody stool (Flu/Chicken Pox) due to Reye's Syndrome.
Tinnitus, Diaphoresis) Coagulopathy
Abdominal Cramping 4 mg PO after 1st loose stool then 2 mg
Dysentery
Imodium A-D Constipation Torsade’s De Pointes after each loose stool
Loperamide Colitis
Loperamide A-D Antidiarrheal Nausea Cardiac Arrest/Death occurs - MAX Dose = 16 mg/day
Abdominal pain w/o Diarrhea
QT-Prolong - No self-tx >48h of symp.
Sedation
Constipation
Diarrhea caused by Entero-Toxin
Diphenoxylate/Atropine Urinary Retention
Lomotil bacteria MAX Dose = 20 mg/day
(Sched = C-5) Blurred Vision
Colitis
Dry mouth
Tachycardia
GI Obstruction
Dizziness
Ulcerative Colitis
Dry Mouth Anti-Cholinergic
Dicyclomine Bentyl Anti-Spasmodic Reflux Esophagitis
Nausea Caution Age >65
Breast feeding
Blurred Vision
Narrow Angle Glaucoma
Gallbladder/Biliary Duct obstruction
Constipation Pancreatic Dx
Eluxadoline Peripheral Mu-Opioid Nausea/Dizzy Pancreatitis Alcoholism
Viberzi REMS Program
(Sched: C-4) Agonist Abdominal Pain CNS Depression Hepatic Imp (Child-Pugh C)
Rash Hx of Severe Constipation
Sphincter of Oddi Dysfxn
HYPERTENSION
General Information JNC-8 Guideline Lifestyle Modifications Treatment Key Drugs Increase BP
- HTN increases risks for 1. BMI = 18.5 - 24.9 1. Use ACEi/ARB/CCB/Thiazide
heart, stroke, and kidney dx 1. BP Goal <60 yo = 140/90 2. Women = 1 / Men = 2 drinks 2. Blacks - use CCB/Thiazide - Amphetamines - ETOH
- Absence of sx → Non- 2. CKD/Diabetes = 140/90 3. 30-40 min exercise 3. CKD - use ACEi/ARB - Cocaine - Appetite
adherence 3. BP >60 yo = 150/90 4. Limit salt = <1500 mg/day 4. Max dose before adding or add 2nd before maxing 1st. - Pseudoephedrine Suppressant
- Primary HTN - Unknown 4. BP >160/100 or 20/10 5. DASH diet 5. Most PT's req. more than 1 drug - EPO agents (Phentermine)
cause but related to lifestyle above goal = consider 6. Titrate dose - Not at goal 1 mon. - Immunosuppressan - Caffeine, Herbals
- Secondary HTN - caused by starting 2 drugs PREGNANCY: 7. Never use ACEi+ARB+Aliskiren t - Oral
renal or adrenal dx, drugs, 1. Tx for Chronic HTN - NSAIDs Contraceptives
or sleep apnea. KDIGO has 130/80 for CKD + if >160/105 HTN Crisis: (>180/120) - Systemic Steroids - Mirabegron
o Increase in SNS + Albuminuria 2. Use Labetalol, Nifedipine XR, 1. Urgency - No organ damage. Use ORAL meds - SNRI's - Cancer drugs
RAAS. or Methyldopa. 2. Emergency - Organ damage. Use IV meds
GENERIC BRAND MOA ADRs BBW/Warning CONTRAINDICATION NOTES

Chlorthalidone available IV
Chlorthalidone
Hypokalemia Better than HCTZ
Loop Diuretics Dizzy, Photosensitivity, Rash
Chlorothiazide Diuril Hypochloremic alkalosis (rare) Thiazides not effective Sulfa Drugs
Inhibit Na+ reabsorption in DCT
HCTZ Microzide CrCl <30 Combo w/ Dofetilide Acute myopia & angle-closure glaucoma (ADR)
Excretion of Na, Cl, H2O, K, H+ Ca, UA, LDL, TG, BG ↑
Indapamide Need to supplement K+ (QT Prolongation)
Take early in day before 4pm K, Mg, Na ↓
Methyclothiazide Lithium toxicity
Metolazone GOOD in PTs w/ renal imp.
Adalat CC
Nifedipine ER Ghost tablet
Procardia XL
Note: Protect from light + NOT used for HTN or BP reduction in non-
Nifedipine IR Procardia Hypotension (titrate dose)
DHP-CCBs moisture, except for Amlodipine. pregnant adults due to severe hypotension
Nicardipine IV Cardene IV Worsen angina/MI
Inhibit Ca+ causing peripheral Dizzy, Flushing, HA, Fatigue Nicardipine + Clevidipine mostly used in HTN
Severe Hepatic imp.
Nisoldipine ER Sular arteriole vasodilation Peripheral edema Nifedipine IR - NOT used for Crisis
Caution w/ HF
Amlodopine Norvasc Reflex tachycardia HTN due to severe hypotension Safest CCBs, must be used in PTs w/ HF +
Felodipine ER Major CYP3A4 - AVOID Gingival hyperplasia reduced EF
Isradapine Grapefruit
Hypotension, reflex - Milky white color
Clevidipine Cleviprex (IV) tachycardia, TG increase, Soy + Egg allergies - Use strict aseptic technique
infections - Use 12hrs after vial puncture
Cardizem,
Non-DHP CCBs Bradycardia Hypotension (SBP <90)
Diltiazem Diltzac, Dilt-XR, Dizzy, HA, edema, gingival Used for Angina
(-) Inotropic + Chronotropic effect AV block Cardiogenic Shock
Taztia, Tiazac hyperplasia, constipation
Inhibit CYP3A4 (increase conc.) Hypotension AV Block
Calan, Covera, (More w/ Verapamil)
Verapamil AVOID Grapefruit HF Sick Sinus Syndrome Covera HS leaves Ghost tab
Verelan
Gynecomastia, Breast tender,
Spironolactone Aldactone K+ Sparing Diuretic impotence, amenorrhea,
irregular menses. Hyperkalemia - Minimal BP lowering FX
Spironolactone - Non-selective
Epleronone Inspra TG ↑ (Amiloride & Hyperkalemia (>5.5) - Spironolactone/Epleronone used in HF
(Blocks Androgen)
Triamterene) Anuria - AVOID K+
Triamterene Dyrenium Epleronone - Selective ↑Dehydration, dizzy Tumorigenic Renal imp. - Epleronone = Major CYP3A4
Amiloride aldosterone blocker (No Metabolic acidosis (Spironolactone) - Diuretics - lithium toxicity
Carospir endocrine FX) Hyperkalemia
Spironolactone
(Suspension) Na + Cl ↓
- Patch avail. for PT's who cannot swallow
Clonidine Catapres Catapres TTS: skin stuff (patch)
- Apply 1x/wk & remove for MRI
Dry mouth, somnolence, HA, Do not D/C abruptly
Guanfacine Tenex, Intuniv Centrally Acting α-2 agonists: fatigue, dizzy, hypotension, Taper over 2-4 days to
Act on the brain reducing NE - Positive Coombs Test (Hemolytic Anemia)
Methyldopa constipation, HR↓ avoid Rebound HTN. Active Liver Dx or using MAOi's
- Wt gain, DILE (Drug-induced Lupus)
Kapvay - Used for ADHD
HA, hypotension, palpitations,
Hydralazine Mitral Valve Heart DX, CAD DILE - Lupus
Direct Vasodilators: reflex tachycardia
Vasodilation of arterioles Fluid retention, tachycardia, Pericardial effusion & OTC for hair growth
Minoxidil Pheochromocytoma
hair growth angina Use BB + Loop for HTN
Doxazosin Cardura Orthostatic Hypotension &
Alpha-1 Blocker:
Prazosin Minipress Syncope - CYP3A4, Liver imp.
NOT recommended by JNC8 - Dizzy, fatigue, HA, edema
Caution w/ PDE-5 - Cardura XL - Ghost tablet
Terazosin Only used in men with BPH
Priapism
HYPERTENSION
GENERIC BRAND MOA ADRs BBW/Warning CONTRAINDICATION NOTES
Benazepril Lotensin
Vasotec
Enalapril
Epaned (Powder) Angioedema (Esp. Blacks)
Prinivil, Zestril, Angiotensin Converting Hyperkalemia
Lisinopril - QD can be dosed BID if needed
Qbrelis Enzyme Inhibitors Hypotension Hx of Angioedema
Quinapril Accupril - ACEi prevent cardiac remodeling in PT's w/
Block Ang I → Ang II Renal imp. Use of Neprilysin in last
HF
Ramipril Altace Decrease vasoconstriction + Dizzy 36 hours
- AVOID K+
Captropril Aldosterone HA (Sacubitril/Valsartan)
- Lithium toxicity
Enalaprilat Vasotec IV Kidney protective Rash
Moexipril Cough Pregnancy
Perindopril Aceon
Trandolapril Mavik
Irbesartan Avapro - Olmesartan: Sprue-like Enteropathy =
Losartan Cozaar Angiotensin Receptor Blocker Same as ACEi severe diarrhea + Wt loss months to years
Olmesartan Benicar Hx of Angioedema after initiation
Block Ang II binding to AT-1 w/ less cough & angioedema
Valsartan Diovan Prevents vasoconstriction - Azilsartan: Keep in original container to
Do NOT use w/ Entresto protect from light + moisture
Candesartan Atacand Kidney + Heart protective (like NO washout period with
(Sacubutril) - AVOID K+
Azilsartan Edarbi ACEi) Neprilysin
Eprosartan Teveten - Lithium toxicity
Acebutolol Sectral
Atenolol Tenormin HR ↓
Betaxolol - Masks Sx of Hypoglycemia &
Hypotension Bradycardia, AV block, Sick
β-1 Selective BB's Hypothyroidism
Bisoprolol Zebeta Fatigue Sinus Syndrome
Decreases HR & contractility - Use caution w/ Broncho problems
Esmolol Brevibloc Dizziness - Take Metoprolol w/ food
Metoprolol Depression Esmolol – do not use in
Lopressor AMEBBA - Switching b/t Tartrate & Succinate must use
Tartrate Libido Pulmonary HTN
same TDD.
Metoprolol Impotence
Toprol XL Do not D/C abruptly
Succinate
Taper over 1-2 wks to
β-1 Selective + Nitric Oxide avoid tachycardia. Severe Liver imp. (Child
Nebivolol Bystolic Nausea, diarrhea, TG, HLD ↑
Vasodilation Pugh >B)
Nadolol Cogard - May cause Hyperglycemia in DM2 by
Pindolol HR ↓, Hypotension, fatigue, decreasing insulin.
Propanolol Inderal, InnoPran Non-Selective BB: TPPN dizziness, depression, libido, - Propranolol has high lipid solubility so it
impotence. crosses BBB to cause more CNS FX - Useful
Timolol Timoptic for Migraine prophylaxis
Carvedilol Coreg - Take w/ FOOD
Non-Selective BB + α-1 Blocker Edema, Wt gain, TG, HDL ↑ Severe Liver imp.
Labetolol - Coreg to Coreg CR = 3x
- CYP3A4
Direct Renin Inhibitor Angioedema, hyperkalemia, - Do NOT use w/ ACEi or ARB in Diabetes.
Aliskiren Tecturna Pregnancy - AVOID Grapefruit
Blocks Ang → Ang-1 hypotension, renal imp.
- Decreases levels of furosemide
- AVOID High fat foods
Key points to remember Key Combination Drugs

Diuretics ACEi's/ARBs/Aliskiren BB's CCBs Clonidine Losartan/HCTZ Hyzaar Trandolapril/Verapamil Tarka
- Dose no - Birth defects - Take the same time QD - Swelling of ankles, - Do NOT stop Olmesartan/HCTZ Benicar HCT Aliskiren/HCTZ Tekturna HCT
later than - Hyperkalemia - Dizzy, fatigue, sexual Fx irregular heartbeat abruptly Valsartan/HCTZ Diovan HCT Clonidine/Chlorthalidone Clorpres
4pm. - ACEi has most - Enhance/Masks Sx of hypoglycemia - AVOID Grapefruit - Patch - Change
Lisinopril/HCTZ Zestoretic Methyldopa/HCTZ
- Get up angioedema - Non-selective BB's careful w/ - Adalat - Take on weekly, apply
slowly - ACEi cause cough breathing difficulty. empty stomach. May to hairless Benazepril/HCTZ Lotensin HCT Atenolol/Chlorthalidone Tenoretic
(dizzy) - Slows CKD - Coreg - Take w/ food. leave ghost tablet upper arm or Irbesartan/HCTZ Avalide Bisoprolol/HCTZ Ziac
- Supplement progression - Metoprolol - Take WF - DHP CCB = "Pine" chest, apply to Enalapril/HCTZ Vaseretic Metoprolol Tartrate/HCTZ Lopressor HCT
K+ - Helps w/ Cardiac - 1st Line = Post MI, Heart Dx, HF - Amlodopine + different area Olmesartan/Amlodipine Azor Metoprolol Succ/HCTZ Dutoprol
- K+ Sparing remodeling - NO longer preferred for HTN Felodopine are safest each time, do
AVOID K+ - Use together is C/I in - Acebutolol, Pindolol, Penbutolol - CCB & must be used in not apply of Quinapril/HCTZ Accuretic, Nadolol + Corzide
- Epleronone Diabetes & should Have ISA activity do NOT use w/ PT's w/ HF + reduced broken skin, Quinaretic Bendroflumethiazide
= CYP3A4 AVOID if eGFR >60 Post MI. EF and remove for Benazepril/Amlodipine Lotrel Nebivolol/Valsartan Byvalson
- Do NOT use w/ - Esmolol, Labetolol, Lopressor - used - Non-DHP CCB's mainly MRI. Azilsartan + Edarbyclor Triamterene/HCTZ Maxzide,
Entresto for HTN Crisis. used in arrhythmias. Chlorthalidone Diazide
- Use BB caution w/ other drugs that - ALL CCB's = CYP3A4 Valsartan/Amlodipine Exforge Spironolactone/HCTZ Aldactazide
decrease HR (Non-DHP CCBs) Telmisartan/Amlodipine Twynsta Olmesartan/Amlodo/HCTZ Tribenzor
Perindopril/Amlodipine Prestalia Valsartan/Amlodo/HCTZ Exforge HCTZ
SKIN
Alopecia (Hair Loss) Eczema - Atopic Dermatitis Pinworm - Vermicularis
Male-Pattern Baldness
Skin inflammation - crusty/scaly, itchy/red skin may Rx:
Hair Thinning
blister. Triggered by weather or soaps OTC: Albendazole
- C/I in Pregnancy Hydration is key - Moisturize Pyrantel Pamoate Mebendazole
Finasteride -
- Females should not handle Hydrate Skin Aquaphor, Petrolatum Reese's Pinworm - both cause HA/Nausea
Propecia
- Sexual S/E Topical Steroids - both are Hepatotoxic
Minoxidil - Rogaine Antihistamines for itching Tape worms
Calcineurin Inhibitors Tacrolimus, Pimecrolimus - Give Abendazole w/ high-dose glucocorticoid +
Eyelash Extension Topical PDE-4 inhibitor Crisabrorole (Eucrisa) Anti-Convulsant to ↓ CNS inflammation & also take
Apply nightly to skin at the w/ High-Fat meal.
Bimatoprost Sol. - Hemorrhoids
base of the upper
Latisse
eyelashes only Many products contain: Zinc Oxide (desiccant) Fungal Infections
Pramoxine (anesthetic)
Cold Sores Phenylephrine Athlete's Foot – OTC:
Caused by HSV-1 or HSV-2 vasoconstrict to shrink Tinea Pedis: Terbinafine - Lamasil
(Preparation-H)
(Natural product) Lysine: used to Tx Cold Sore. Hydrocortisone Fungal infxn of foot Butenafine - Lotrimin
suppository for inflammation Ringworm - Tinea Clotrimazole - Lotrimin
OTC: Rx: Topical Acyclovir - Zovirax (Anusol-HC)
Docosanol Acyclovir Buccal Tabs - Sitavig Witch Hazel Corporis: Circular flat Miconazole - Lotrimin Spray
(Abreva) Topical Penciclovir - Denavir (Tucks Pads) sore Tolnaftate - Tinactin
Head - Tinea Capitis Undecylenic Acid - Fungi-Nail
Genital Warts: HPV Lice & Scabies Rx:
Jock Itch - Tinea Cruris: Betamethasone/Clotrimazole
Vaccines: Tx: Imiquimod Cream OTC DOC in Infants Pyrethrins - Permethrin Genitals, Inner thigh, (Lotrisone)
Gardasil, Cervarix Aldara | Zyclara Malathion Lotion - Ovide Butt Ketoconazole
Benzyl EOTH - Ulesfia Luliconazole
Others
Diaper Rash Lindane Shampoo (No longer Skin Infxn - Candida:
Keep skin dry if possible used – Neurotoxicity) Groin, Armpits, Skin Mupirocin (Bactroban)
Petrolatum - Desitin Skin protectant Folds
Minor Cuts | Abrasions | Burns Fungal Toe/Fingernails Itraconazole (Sporanox)
Miconazole,
used for fungal infxn Terbinafine (Lamasil) PO
Clotrimazole OTC:
limit length of use over - Neosporin - Triple ABX Diagnose: 20% Ciclopirox
Hydrocortisone Rx: Potassium Hydroxide - Tavaborole
time Polymixin|Bacitracin|Neomycin
Mupirocin KOH Smear Elfinaconazole
Butt Paste, Triple Paste - Polysporin Alone
(Bactroban) OTC:
- Bacitracin Alone
Dandruff - Hydrocortisone - Cortisporin Butoconazole (Gynazole-1)
Clotrimazole (Gyne-Lotrimin)
Dandrex Poison Ivy | Oak | Sumac Miconazole (Monistat)
Selenium Sulfide: Head & Shoulders Yeast infection
Terconazole (Terazol)
Selsun Colloidal Oatmeal - Aveeno
Rx:
Ketoconazole Calamine Lotion (anesthetic)
Nizoral A-D Fluconazole - Diflucan
Shampoo Aluminum Acetate = Astringent
150 mg PO x 1 dose
SKIN
Acne Topical Steroids Drugs Causing Discolored Skin/Secretions
AVOID high glycemic (sugary) foods & dairy foods. - Inflammation = use Topical Steroids, Antihistamine
- Topical Steroid Potency = Ointments > Creams > Lotion > Levodopa
OTC
Solutions > Gels > Sprays. Brown Methyldopa
Benzoyl Peroxide (BPO)
- Thin Skin: Face | Eyelids | Genitals - should only use LOW Entacapone
Erythromycin + BPO potency steroids. Avoid prolonged use. Use Fingertip to
(Benzamycin) Metronidazole
Limit Sun exposure measure Tinidazole
Clindamycin + BPO Avoid Eye contact Brown, Yellow
- Clobetasol Proprionate Nitrofurantoin
(Acanya, BenzaClin, Duac)
Clobex 0.05% Lotion|Spray|Shampoo Riboflavin (B2)
Salicylic Acid
Olux Foam 0.05% Brown, Black, Green Methocarbamol
Adapalene - Differin 1st OTC Topical Retinoid
Temovate 0.05% Propofol
Yellow, Green
RX VERY HIGH - Betamethasone Diproprionate Flutamide
- Limit Sun exposure Potency Diprolene Ointment 0.05% Yellow, Orange Sulfasalazine
- Takes 1-3 months for Fx - Halobetasol Proprionate Phenazopyridine
Tretinoin cream/gel
- May worsen acne initially Ultravate 0.05% Red, Orange Rifapentine
(Atralin, Renova, Retin-A
- Mild Skin irritations - Fluocinonide Rifampin
Avita)
- Teratogenic: Vanos cream 0.1% Red, Orange, Purple Chlorzoxazone
Pregnancy, Breastfeeding - Betamethasone Diproprionate Anthracyclines
Teratogenic: REMS, iPledge Red
Diprolene Cream AF 0.05% Deferasirox (urine)
Reqs: - Mometasone Furoate Mitoxantane
- 2 forms of birth control HIGH Potency Blue
Elocon Ointment 0.1% Methylene Blue
- Signed consent of harm - Fluocinonide Chloroquine
Isotretinoin Blue, Gray
- 2 Neg pregnancy tests Lidex Ointment 0.05% Amiodarone
(Claravis, Amnesteem)
before Tx HIGH-MEDIUM
- 1-month Rx at a time Fluocinonide - Lidex-E Cream 0.05%
Potency
- Pharmacy must be - Mometasone Furoate
registered Elocon Cream 0.1%
Photosensitivity MEDIUM - Triamcinolone Acetonide
Minocycline (Solodyn) Fetal Harm Potency Kenalog Cream/Spray 0.1%
C/I in Child <8 yo - Hydrocortisone Valerate
Westcort Ointment 0.2%
- Desonide = DesOwen Lotion 0.05%
LOW Potency - Hydrocortisone Valerate
Westcort Cream 0.2%
- Fluocinonide Acetonide
MILD Potency
Derma-Smoothe/FS Oil 0.01%
LOWEST - Hydrocortisone
Potency Cortaid Cream/Spray/Ointment
INFECTIOUS DISEASE
General Information Minimum Inhibitory Concentration (MIC) Antibiogram
1. Look for allergies, culture & sensitivity, and medical Hx.
2. Assess hydrophilicity vs lipophilic drugs for distribution. - Lowest concentration w/o growth (clear) after 24 hrs = MIC
Provides susceptibility patterns at a specific hospital over a
3. Dose Optimization: Time vs Concentration dependence. - If MIC ≤ Breakpoint = Susceptible
period and used to monitor resistance-patterns.
a. Time-dependent ABX: Dose MORE frequently. Extending infusion - Breakpoint = beyond susceptible → Intermediate or Antibiograms aid in selecting empiric Tx = Look for ↑ %
time or continuous infusion. *Beta-Lactams* Resistant
b. Concentration-dependent ABX: Dose LESS frequently. Higher doses
Gram + Bacteria = Thick cell wall, stains purple & blue Gram – Bacteria = Thin cell wall, stains pink & red Atypicals
Cocci Rods Anaerobes Rods Cocci Coccobacili Anaerobes
- Staphylococcus - Pseudomonas aeruginosa - Acinetobacter baumannii
- Bacteroides fragilis
MRSA or MSSA - Haemphilus influenzae - Neisseria spp - Bordetella pertussis Chlamydia spp.
- Provetella spp.
- Streptococcus - Clostridium spp. - Providencia spp. - Moraxella catarrhalis Legionella spp.
Listeria
(Strep. Pneumoniae - Actinomyces spp. Spiral Rods Enteric Rods Mycoplasma pneumoniae
monocytogenes
= diplococci) - Peptostreptococcus - Treponema spp - Proteus mirabilis - Serratia spp Mycobacterium tuberculosis
- H. pylori
- Enterococcus (VRE - - Borrelia spp - Escherichia coli - Enterobacter Cloacae
- Campylobacter spp
Vanco-resistant) - Leptospira spp - Klebsiella spp - Citrobacter spp.
MOAs of ABX
Cell Wall inhibitors Cell Membrane inhibitors Protein Synthesis inhibitors DNA/RNA inhibitors Folic Acid inhibitors
Beta-Lactams:
Penicillins, Cephalosporins, Carbapenems Aminoglycosides
Telavancin Macrolides FQs
Monobactams: Aztreonam Sulfonamides
Oritavancin Tetracyclines Rifampin
Vancomycin Trimethoprim
Daptomycin Clindamycin Metronidazole
Telavancin Dapsone
Polymyxin (Colistimethate) Linezolid, Tedizolid Tinidazole
Dalbavancin Quinupristin/Dalfopristin
Oritavancin
Hydrophilic Abx Lipophilic Abx

Beta-Lactams • Small VD • Poor tissue penetration FQ's • Large VD • Great tissue penetration
Aminoglycosides Macrolides
• Renally eliminated • Nephrotoxic • Hepatic metabolism • Hepatotoxic + DDI
Daptomycin Rifampin
Polymyxin • NO activity vs intracellular pathogens • Consider loading dose Linezolid • Active vs intracellular pathogens • NO dose adj in sepsis
Glycopeptides • Poor Bioavailability • Aggressive dose in sepsis Tetracyclines • Excellent Bioavailability • PO:IV ratio = 1:1
GENERIC BRAND INDICATION ADRs BBW CONTRAINDICATION NOTES

Penicillin Pen-VK - Pen-VK: 1st Line for strep-throat & Covers mouth G+ anaerobe
Penicillin G Benzanthin Bicillin L-A mild-non purulent skin infection
Amoxil (no abscess)
Amoxicillin - Amoxicillin: 1st Line for otitis media
Moxatag Chewable tab available
DOC: infective endocarditis
Amoxicillin + Clavulanate Augmentin prophylaxis for dental procedure. GI upset
Pen-G Benzanthine Augmentin & Unasyn
- Augmentin: 1st Line for otitis media Diarrhea
Ampicillin Cardiorespiratory Hx of Cholestatic jaundice
and sinus infection. ↓dose to Rash
arrest or death if Hepatic dysfunction
Amipicillin + Sulbactam Unasyn PCN allergy Rxns
↓diarrhea given IV CrCl <30
Seizure w/ accumulation
Piperacillin + Tazobactam Zosyn - Pen-G: Do NOT use IV Extended infusion > 4hrs
Nafcillin DOC: Syphilis
- Pip-Tazo: active for Pseudomonas
Oxacillin Covers MSSA only Covers MSSA
Dicloxacillin No renal dose adj.
INFECTIOUS DISEASE
Doripenem Doribax Carbapenems: IV/IM only
Meropenem Merrem - Like other B-lactams they bind to PBP to CNS Fx
inhibit cell wall synthesis & are time- Diarrhea Seizure NO Coverage against:
dependent. Rash/Severe skin rxn Avoid in PCN allergy Pseudomonas, Acinetobacter
Ertapenem Invanz - Common Use: ESBL-producing bacteria (DRESS) Enterococcus
- NO Coverage against: ↑ LFTs Do not use Dori in
Atypicals, VRE, MRSA HAP/VAP Must be diluted in Normal Saline
Imipenem + Cilastatin Primaxin Stenotrophomonas, C. Diff
Similar to PCNs
Aztreonam Azactam Monobactam: OK for B-Lactam/PCN allergy Rash
N/V/D
Cefadroxil 1st Gen:
Ancef - Cephalexin PO: skin infxn (MSSA) & strep
Cefazolin
Kefzol throat common use.
Cephalexin Keflex - Cefazolin IV: Surgical prophylaxis
Ceftin
Cefuroxiime 2nd Gen:
Zinacef
- Cefuroxime (Ceftin) PO:
Cefotetan Cefotan
Otitis media, CAP, Sinus infection
Cefoxitin Mefoxin - Cross Sensitivity w/
- Cefotetan & Cefoxitin IV:
Cefaclor Ceclor B. fragilis, Surgical prophylaxis PCN allergy
Cefprozil Cefzil - Do NOT use in PCN Ceftriaxone: biliary
Cefdinir Omnicef GI upset allergy sludging in neonates
Ceftriaxone Rocephin 3rd Gen: Group 1 Diarrhea - Cefotetan contains (hyperbilirubinemia). NO Renal Adj.
Cefotaxime Claforan - Cefdinir (Omnicef) PO: Rash NMTT side chain which
CAP, Sinus infxn Allergic may ↑risk for Concurrent use of IV Ca+
Cefixime Suprax Chew-tab available
- Ceftriaxone & Cefotaxime IV: Seizures w/ Accumulation containing products in
Cefpodoxime Vantin Hypoprothrombinemia
CAP, Meningitis, Pyelonephritis neonates < 28 days old.
Ceftibuten Cedax (bleeding) or Disulfiram-
Spontaneous Bacterial Peritonitis
Cefditoren Spectracef like Rxn w/ ETOH
Fortaz ingestion.
Ceftazidime
Tazicef
3rd Gen : Group 2
Ceftazidime +
Avycaz - Ceftazidime IV: Pseudomonas, MDR Gram Covers some CRE
Avibactam
Neg
Ceftolozane +
Zerbaxa
Tazobactam
Cefepime Maxipime 4th Gen: Pseudomonas
Ceftaroline Fosamil Teflaro 5th Gen: MRSA
Aminoglycosides: Nephrotoxic Drugs (avoid) Peak 5-10 | Trough < 2
Gentamicin - Amphotericin-B
- Concentration - dependent Nephrotoxicity Gentamicin = 7 mg/kg dose
- Post-ABX Fx (PAE) - Cisplatin
Tobramycin Ototoxicity Peak: 20-30 | Trough < 5
- Extended Interval Dosing = gram – Nephrotoxicity - Colistimethate
Neuromuscular Blockade
(Achieve peak while ↓nephrotoxicity & $) Hearing loss - Cyclosporine
Respiratory Paralysis
Amikacin Impaired balance - Loop Diuretics Peak: 20-30 | Trough < 5
- Always round ↑ on Nomogram AVOID Nephrotoxic agents
(Vertigo) - NSAIDs
- Underweight = ABW AVOID Neurotoxic agents
- Contrast Dye
Obese = AJBW Pregnancy - Fetal Harm
Streptomycin - Tacrolimus
- Monitor: Renal Fxn, Drug levels - Vancomycin
Myelosuppression MAOi w/ì 2 weeks
Oxazolidinones: ↓ Platelets, HgB, WBC
Linezolid Zyvox Thrombocytopenia Caution w/ Serotonergic or Do NOT shake suspension
- Binds to 50s Ribosome N/V/HA (Duration-Related) Adrenergic drugs.
- Coverage similar to Vancomycin BUT also
Less GI and
Tedizolid Sivextro covers VRE. N/D/HTN Neutropenia Approved for SSTI
Myelosuppression
INFECTIOUS DISEASE
Ciprofloxacin Cipro - Tizanidine + Ciprofloxacin
FQ's:
Levofloxacin Levaquin - Chelates w/ Cations Moxifloxacin = NO Renal Adj
- Topoisomerase IV & DNA Gyrase
WARNING: Moxi: No use in UTI's
Moxifloxacin Avelox - Concentration - dependent N/D/HA
- Tendon inflammation/rupture - QT-Prolong (Won't distribute to urine)
- Respiratory FQs: Levo, Moxi, Gemi Dizziness
Delafloxacin Baxdela - Peripheral Neuropathy (Moxifloxacin = highest risk)
- Anti-Pseudomonal FQs: Cipro, Levo Insomnia
Ofloxacin - CNS Fx/Seizures - Hypo/Hyperglycemia Cipro Oral Susp: Never give
- Delafloxacin: IV to PO = 1:1 SJS/TEN
- Hepatotoxicity through NG or feed tube.
Gatifloxacin Zymaxid - Used for Skin infxn
- Photosensitivity Cipro Tabs: Feed tube ok
Gemifloxacin Factive - Active against MRSA
- Muscle toxicity (Avoid in Child)
Zithromax Macrolides: works on 50S Ribosome
Azithromycin Z-Max - Strong 3A4 inhibitors (Azithromycin = Least)
Z-Pak - ALL used for CAP GI upset Z-Pak:
Clarithromycin Biaxin - ALT Tx for Strep Throat (Erythromycin = WARNING: Do not use w/ Lovastatin, 500 mg PO Day 1
- Azithromycin: MOST) QT-Prolong (Highest risk = Simvastatin 250 mg PO Day 2-5
EES COPD Exacerbations Erythromycin) causes potential Muscle Toxicity
Ery-Tab Chlamydia Hepatotoxicity (ALL except Azithromycin) Azithromycin ER Suspension
↑ LFTs
Erythromycin EryPed Gonorrhea (Z-Max NOT EQ to Zithromax)
SJS/TEN/DRESS
Erythrocin
MAC prophylaxis
PCE
DOC for Traveler's Diarrhea
Doryx Photosensitivity
Adoxa Drug-induced Lupus (DILE)
Doxycycline Tetracyclines: works on 30S Ribosome
Monodox Chelation:
- Doxy, Mino = CA-MRSA skin or acne. IV:PO = 1:1
Oracea - Antacids = Mg+, Al+, Ca+
- Doxy = used in N/V/D Pregnancy/Breastfeeding
Minocin - Iron products
Lyme Dx, Rocky Spotted Fever, CAP, COPD, SJS/TEN Child <8 YO Oracea = take EMPTY stomach
Minocycline Solodyn - Sucralfate
VRE UTI, Chlamydia, Gonorrhea (1 hr before or 2 hr after meal)
Monolira - Bismuth Salicylate
- Tetracycline = H. Pylori Tx
- Bile Acid Resins
Tetracycline (Separate dose)
N/V/D
Anorexia
Sulfonamide (SMX): Skin Rxns Dose based on TMP component
Bactrim - Dose always 5:1ratio = 400/80, 800/160 Photosensitivity SS = 400/80, DS = 800/160
Sulfamethoxazole Pregnancy/Breastfeeding
Septra Crystalluria
+ Trimethoprim - Caution w/ Warfarin ↑ INR Sulfa allergy
Sulfatrim Hypoglycemia Uncomplicated UTI:
- Tx: CA-MRSA, UTI, PCP 1 DS Tab BID x 3 Days
↑ K+, ↓Folate
Positive Coombs Test
- Systemic = 15-20 mg/kg IV Q8-12H Monitor: Renal Fxn, Trough at SS
- C. Diff = 125-500mg PO QID x 10-14 days - Goal Trough = 15-20
Abdominal pain Nephrotoxicity
- Inhibits cell wall D-alanyl-Dalanine. - Pneumonia, Endocarditis
Nausea Ototoxicity
Vancomycin Vancocin - PO only for C. Diff or Enterocolitis Osteomyelitis, Meningitis,
Myelosuppression Infusion rxn (Red Man
- PO NOT for systemic infections Sepsis
SJS/TEN syndrome)
- 1st Line = MRSA. - Goal Trough 10-15
Consider ALT if MRSA MIC ≥2 Any other infection
- Concentration - dependent Myopathy | Rhabdomyolysis Compatible w/ NS (no
Daptomycin Cubicin - Covers MRSA | VRE ↑ CPK Monitor: CPK level weekly
False ↑ PT/INR dextrose)
- Do NOT use to Tx Pneumonia
Fetal risk Red Man Syndrome: must give
N/V QT prolongation
Telavancin Vibativ Nephrotoxicity IV over ≥60 min
Lipoglycopeptides: Metallic Taste False ↑ PT/INR
↑ Mortality --REMS--
Concentration - dependent
Oritavancin Orbactiv Red Man syndrome False ↑ PT/INR up to 12 hrs Oritavancin = IV use of Heparin > Extreme Long Half-Life
Dalbavancin Dalvance Infusion Rxn False ↑ aPTT up to 120 hrs 120 hrs. Interferes w/ aPTT Single-dose regimen
INFECTIOUS DISEASE
Streptogramin: Arthralgia, Myalgia
- Bind to 50s Ribosome Infusion Rxn, Phlebitis
Quinupristin/Dalfopristin Synercid - NOT active vs E. Faecalis - NOT well Edema, Pain
tolerated Hyperbilirubinemia
- Use is limited to VRE infection ↑ CPK
Related to Tetracyclines:
NO Renal Adj
- AVOID use in Blood infections
Tigecycline Tygacil N/V/D ↑Death risk NO activity vs 3-P's: Pseudomonas,
- Reconstituted is Yellow-Orange color
Proteus, Providencia
Discard if not this color
Polymixins:
Colitimethate | Colistin Coly-Mycin M Dose carefully
- AUC:MIC Dependent Nephrotoxicity (dose-dep.)
Inhalation Solution must be mixed
- Main use MDR Gram-Neg infxn Neurologic Disturbance
Polymixin B Sulfate 1st
- Always use combo w/ other ABX
Gray Syndrome
Blood
Chloramphenicol 50s Ribosome Myelosuppression Circulatory Collapse Monitor: CBC
dyscrasias
or Cyanosis
N/V/D Colitis
Clindamycin Cleocin Lincosamide SJS, TEN skin rxn D-Test req for Staph Aureus
Rash C. Diff
Flagyl Pregnancy, Breastfeeding
Metronidazole Metallic Taste
Metro Helical DNA structure: ETOH use (3 days after D/C)
Rash (SJS/TEN) Mild-Mod C. Diff:
- Use for anaerobes, Protozoal Infxns Carcinogenic Propylene Glycol products (3 days)
Dark Urine 500mg IV/PO TID x 10-14 days
Tinidazole Tindamax Vaginosis, Trichomonas, C. Diff Disulfuram Rxn:
Furry Tongue
Stomach cramp, N/V/HA, Flushing
Fidaxomicin Dificid
Rifaximin Xifaxan
Fosfomycin Monurol
Macrodantin
Nitrofurantoin
Macrobid
Bactroban
Mupirocin Nasal
Nasal
PAIN
General Information Treatment NSAID Drug Interaction Ketorolac Spary (Sprix) Diclofenac Gel
- Nociceptive: sensory nerves sense tissue
damage.
- Use lowest dose & medicines w/ 1. Use dosing card in package.
- Visceral: Internal organ pain. - Steroids = ↑ bleeding risk
multiple MOA's gives additive healing 2. Do NOT use >32 g/day
- Somatic: musculoskeletal pain. - Ototoxic = AG's/Loops
effect - Each bottle is 1-day supply 3. Dose for hands, wrists, elbows = 2 g
- Pathophysiologic: damage or - If using ASA + Ibuprofen for
- Non-Opioid drugs can be added to - Throw away after 24 hrs each application. MAX 8 g/day.
malfunctioning nervous system, aka cardio protection take
opioid treatment to lower opioid - Must prime 5x before use 4. Dose feet, ankles, knees = 4 g/day
"Neuropathic" pin. ASA 1-hr before or 8 hrs after
dosing & provide superior analgesia. - Closed = Fridge MAX = 16 g/day
- Acute: sudden & sharp pain. Ibuprofen.
- Severe (7-10) = Opioid +/- other - Open = Room temp 5. Cover affected area fully no open
- Chronic: persisting beyond normal time. - AVOID Prednisone or blood
- Moderate (4-6) = Opioid +/- other wounds.
- Pain is the "5th Vital Sign" & pain thinners.
- Mild (1-3) = Non-opioid +/- adjuvant 6. Do NOT wash/shower for 1 hour
scales are used to treat the severity of
pain and required by hospital care.

Tylenol/FeverAll Skin rash, SJS, TEN. - AVOID "APAP" - Ofirmev = injection
Acetaminophen
Ofirmev (Stop & seek medical) Abbreviation - MAX dose = 4,000 mg/day
w/ Hydrocodone Norco Inhibits PG synthesis in CNS - Order in mg NOT mL. - Max 325 mg per Rx combo
w/ Oxycodone Percocet/Endocet Overdose antidote: Hepatotoxicity = >4g/day - ALL IV formulation should product
Reduces pain & fever but NOT
w/ Codeine Tylenol #2,3,4 NAC, Mucomyst, be prepped in the - 325mg Tabs = Max 3,250/day
anti-inflammatory.
w/ Tramadol Ultracet Cetylev, Adetadote by pharmacy. - 500mg Tabs = Max 3000/day
w/ Diphenhydramine Tylenol PM restoring Glutathione. - AVOID ETOH - Peds: 10-15 mg/kg Q4-6h
Motrin/Advil - Neoprofen = Injection
Ibuprofen - GI bleed, CV, & Post-Op
Caldolor/Neoprofen - Ped Dose = 5-10 mg/kg Q6-8H
Non-Selective COX-1/2 CABG risks (Use ASA).
Indomethacin Indocin/Tivorbex High CNS side effect (Avoid Psych PT)
NSAIDs: - Toradol: Max 5 days - Warning: AVOID in renal
Aleve/Naprelan Convert Arachidonic acid to
Naproxen Acute renal/liver failure failure Preferred for BID dosing
Naprosyn/Anaprox PG's & TXA2 to decrease - MED-GUIDE required - Steroids, SSRI's, SNRI's are
inflammation, pain, fever. for ALL - Used after surgery, NEVER before
Ketorolac Sprix/Toradol high risk for GI events. AVOID in 3rd Trimester
- Nausea - Take w/ - 1 Spray in each Nostril Q6-8H
Blocking TXA2 ↑clotting risk. - CV risks even 1st weeks
Piroxicam Feldene food or enteric use. High GI toxicity, SJS/TEN skin rxns
Sulindac Clinoril coated if needed.
- Photosensitivity AVOID in women of child-
Celecoxib Celebrex - Kidney clearance Sulfonamide allergy AVOID in pregnancy
bearing potential
- Increase BP (Caution - Not bioequivalent formulation
COX-2 Selective NSAIDs: w/ HTN) - Misoprostol promotes uterine
- AVOID in Arthrotec AVOID in
Diclofenac Voltaren/Diloject Less gastric bleeding Fx contractions – pregnancy warning
uncontrolled HTN pregnancy (Misoprostol)
More MI/Stroke risk - AVOID - Flector = place patch over most
in CVD painful area
Meloxicam Mobic
Etodoloac Lodine
Nabumetone Relafen
Bufferin/Ecotrin/ Salicylate NSAID: Dyspepsia, nausea,
Aspirin (ASA) Durlaza/Bayer/ - Irreversible COX-1 inhibitor heartburn, bleeding, - EC or food to decrease nausea
Severe skin rash SJS/TEN
Excedrin - Cardio-protective dose = BP↑, renal imp. AVOID ASA in child/teens who - Salicylate overdose causes Tinnitus
Increase bleeding risk
81-162 CNS Fx, have viral infxn due to Reyes - PPI's may help protect gut
GI ulceration/bleed
- Durlaza = 162.5 mg QD photosensitivity, edema, Syndrome. - Do NOT use Durlaza or Yosprala
Salsalate AVOID 3rd Tri pregnancy
- Analgesic = 350-650 Q4- hyperkalemia, blurred when immediate effect is needed.
6H vision.
OPIOIDS
General Information CHRONIC (Non- Cancer) Pain Tx Fentanyl Patch Counseling Opioid Counseling
- Mu-receptor Agonists in CNS for pain relief, but causes euphoria & 1. Opioids NOT 1st Line should not be routinely used.
1. Do not heat patch or skin when applying. 1. Do NOT crush, chew, break CR forms
respiratory depression. 2. Reach LOW pain rather than no pain is the GOAL.
2. Do not cover w/ heat pad or bandage. 2. Avoid ETOH
- Tx Mod-Sev or Chronic pain. 3. Start low go slow.
3. Call PCP if you experience fever. 3. Causes drowsiness/fatigue
- Naloxone = to reverse respiratory depression. 4. Check PDMP for high doses & multiple prescribers.
4. ONLY use H20 to clean transdermal gel on skin. 4. Take w/ H20 + Food
- Naltrexone = given w/ opioid to block other opioids taken at the same time. 5. Use Adj. meds to lower Opioid dose.
5. Dispose patch in toilet. 5. OPANA take on empty stomach
- REMS Program = for all ER/LA opioids & Methadone. Requires prescriber 6. AVOID Benzos - 4x risk of overdose death.
6. Keep away from Children/Animals. 6. Causes constipation
education. 7. Follow-up, taper, and then D/C.
Opioid Dosing Opioid ADR Management Opioid Abuse
Opioid Conversions: (1) Calculate total 24hr dose. (2) Calculate - Suboxone is an opioid combo product w/ Naltrexone or Naloxone to deter
1. Use lowest dose to provide
total 24hr dose of new drug. (3) Reduce new drug dose by at - ALL opioid side effects lessen over time except abuse.
pain relief.
least 25%, on exam only do so if the Q asks to reduce dose. (4) Constipation. - OxyContin/Hysingla uses technology to deter crushing, dissolving.
2. Do not increase dose but
Divide dose to attain appropriate dosing interval. (5) Always o Stimulant Laxatives (Bisacodyl) w/ or w/o stool - Opioid Overdose Sx:
instead increase frequency
have Breakthrough pain medication available while making softener should be given. o Extreme sleepy, slow breathing, lips/fingers turning blue, pinpoint pupils,
3. Only increase dose if
changes (5-17%) of TDD of baseline opioid dose. o Methylnaltrexone (Relistor), Naloxegol (Movantik), slow heartbeat, or low BP.
medication is not effective.
4. Always round DOWN when Naldemadine (Symproic) Buprenorphine: Butrans (Patch), Belbuca (Buccal film), Zubsolv (SL tablet)
opioid conversions. Drug IV/IM (mg) Oral (mg) ▪ Indicated for OIC. - Rx for Opioid dependence.
Hydrocodone - 30 ▪ Block opioid receptors in the gut to reduce OIC - Partial Mu-opioid agonist at low dose & antagonist at high dose.
Oxycodone - 20 w/o affecting analgesia aka (PAMORAs) - Low dose = Tx Pain, High dose = Tx Addiction
Fentanyl Conversion: Fentanyl 0.1 - ▪ Peripherally acting - Patch upper chest, outer arm, back, change WEEKLY.
1. Find TDD Oxymorphone 1 10 ▪ Typically only given if PTs fail OTC laxatives. - Caution Respiratory depression & fatal accidental ingestion.
2. Convert to Mcg (x1000) Hydromorphone 1.5 7.5 ▪ Lubiprostone (Amitiza) - also used (Cl- activator) - ADR: Sedation
3. Divide by 24 for patch Morphine 10 30 - Opioid allergies: Naloxone: (Narcan)
4. Patch is mcg/hr Meperidine 75 300 o True opioid allergy is rare. - Opioid antagonist used for overdose.
Morphine 60 mg TDD = 25 o Itching and rash are not allergy. - Given if suspected respiratory depression.
mcg/hr Fentanyl patch. EXAMPLE: 30 mg PO Morphine/1.5 mg IV Hydromorphone o True = Breathing, low BP, swelling of tongue, lips. - Repeat dosing may be req. due to opioid lasting longer than Naloxone
--Find TDD then follow the = X mg PO Morphine/12 mg IV Hydromorphone o Use different chemical class for true opioid allergy. - Causes acute withdrawal & pain
chart-- X = 240 mg PO Morphine - Evzio (injector) - comes w/ voice & visual instructions. Narcan (nasal spray)
GENERIC BRAND DOSING ADRs BBW CONTRAINDICATION NOTES
Codeine + Children = Rapid 2D6 polymorphism leads to respiratory depression.
Tyelonol #2,3,4 C/I = Child < 12 yo
Acetaminophen Codeine = C-II, Combo product Tab/Cap = C-III, Oral solution = C-V
NEVER more than 1 patch Ionsys = Transdermal Potential Med Errors
Duragesic/Sublimaze Apply 1 patch Q72H 1. Addiction, abuse, ONLY use in Hospital Caution w/ CYP3A4 inhibitors
Fentanyl misuse w/ ER
Remifentanil = IV ONLY Remove before MRI Must wear gloves and remove device Out-PT = Chronic pain ONLY
Dispose in the toilet forms may lead to before D/C. PT on Morphine 60 mg/day for 7 days, can switch to Fentanyl patch
Hydrocodone IR Norco/Lorcet/ OD/Death.
+ Acetaminophen Lortab/Vicodin 2. Respiratory
CNS depression - depression
Zohydro = 10mg Q12H
Hydrocodone ER Zohydro/Vantrela ER REMS Drugs Do NOT drive or 3. Crushing, BBW: CYP3A4 inhibitor
Hysingla = 20mg Q4-6H
operate dissolving, chewing
Hydromorphone Dilaudid Oral = 2-4mg Q4-6H Potent - start slow (High risk for Overdose)
machinery. of LA form may
lead to fatal dose. - Variable Half-Life - Hard to dose
(Tolerance may
Dolophine/Methandone 4. Kadian/Embeda/ - AVOID Serotonergic drugs (Serotonin Syndrome)
Methadone REMS Drug develop) BBW: QT-Prolong, Arrhythmias
Intensol/Methadose Zohydro/ Nucynta - Decrease Testosterone/Sexual Dysfxn
do NOT take w/ - Major CYP3A4 substrate
OIC - Constipation
ETOH - leads to - NOT used for analgesic anymore
Normeperidine metabolite Renal imp/Elderly at risk for CNS toxicity
Meperidine Demerol Codeine = High - AVOID for chronic pain, Short duration
causing seizures levels ↑ & fatal - Avoid MAOi
N/V/D - Risk of Serotonin Syndrome
dose.
Roxanol = Q4H Prn 5. Benzo use -
MS Contin/Kadian ADR: N/V, dizzy, anti-histamine, pruritis
Morphine ER = Q8-12H sedation, resp.
Arymo ER/Roxanol (IR) Renally imp = Start at low dose
IV = Q3-4H depression, coma,
IR = RoxyBond/Roxicodone death.
CR = OxyContin
OxyCODONE BBW: 3A4 inhibitors Renally imp = Start low dose
+ Acetaminophen =
Endocet/Percocet/Roxicet
OxyMORphone Opana Take on EMPTY stomach
Ultram/Conzip Warning: Seizure risk, Serotonin
TraMADol
+ Acetaminophen = Ultracet syndrome, 2D6/3A4 inhibitors.
Inhibits Serotonin reuptake
Centrally-Acting Analgesics: Less GI side
Same as Opioids AVOID in Breastfeeding, Child <12 yo, or
Mu-Opioid agonist + NE inhibitor effects C/I: MAOi in 14 days
Tapentadol Nucynta Child< 18 yo following Tonsillectomy or
Adenoidectomy surgery Seizure risk/Serotonin syndrome
COMMON PAIN ADJUVANTS
General Information Muscle Relaxants Lidoderm PT Counseling Capsaicin PT Counseling
1. Apply thin layer gently rub in.
- Adjuvants = Muscle relaxants, anti-epileptics, anti- - Caution w/ other CNS
1. May cut patch into smaller pieces w/ scissors. 2. Use 3-4x daily
depressants, topical anesthetics may be used for pain depressants (Somnolence,
2. Fold inward & discard away from kids & pets. 3. Best results after 2-4 weeks of use so do NOT use PRN.
management but not classed as analgesics. dizzy, confusion)
3. Apply up to 3 patches at once (12hr on, 12hrs off) 4. Wash hands after use
- Mostly used for Neuropathy, fibromyalgia, or Neuralgia. - Counsel: Somnolence,
4. Do not use on open wounds or damaged skin 5. Never cover w/ bandage or heat pad.
- Muscle relaxants = for pain which MOA is not known. fatigue, & avoid ETOH.
6. Don’t touch genitals, eyes, nose, or mouth.

Neurontin C-IV: Req Med Guide
Gabapentin
Horizant/Gralise Take w/ FOOD
Somnolence, ataxia, dizzy, Angioedema,
Pregabalin Lyrica Anti-Epileptic dry mouth, edema, weight anaphylaxis, increase C-V
gain. suicide (all AEDs)
Carbamazepine Tegetrol/Cabatrol
Baclofen Lioresal Do not D/C abruptly

Exert effect thru
Cyclobenzaprine Fexmid/Flexeril/Amrix Dry mouth
analgesia
Hypotension, dry mouth, weakness,
Tizandine Zanaflex
Sedation, dizzy, confusion QT prolongation
Anti-Spasmodic
(All muscle relaxants) Increase conc. w/ Poor 2C19
Carisoprodol Soma
metabolizers
Exert effect through
Metaxalone Skelaxin Hepatotoxic
Sedation
Methocarbamol Robaxin Hypotension
Milnacipran Savella IND: Fibromyalgia ONLY
Amitriptyline Elavil N/HA/Constipation Take QHS

SNRI (see depression
Increase suicidal thoughts
chapter)
Desipramine Norpramin MAOi 14 days
Duloxetine Cymbalta
May cut into smaller pieces
Lidocaine 5% Patch Lidoderm Do NOT apply >3 patches at once
Burning, itching, rash on skin Approved for Shingles
Topical Anesthetics
Methyl Salicylate Topical OTC BenGay, IcyHOT, SalonPas Contact PCP if skin rash > 7 days
Capsaicin 0.025% Zostrix Burning lessens over time Decreases Substance-P

ONCOLOGY
General Information 7 Warning Signs = CAUTION Karnofsky & ECOG Score Cell Cycle
- Tx GOAL = Achieve remission w/ curative
intent OR to reduce tumor size &
symptoms. - C = Change in bowel/bladder habits Physical functioning test to
- If PT remains cancer-free for 5 years = - A = A sore that does not heal assess PT's for severe
unlikely cancer will recur. - U = Unusual bleeding or discharge common S/E of Chemo Tx
- Primary Tx = Surgery if cancer is - T = Thickening lump agents:
resectable. - I = Indigestion or difficult swallowing 1. Diarrhea
- Neoadjuvant Tx = Radiation/Chemo Tx - O = Obvious change in wart/mole 2. Alopecia
prior to surgery to shrink tumor. - N = Nagging cough or hoarseness 3. Myelosuppression
- Adjuvant Tx = Radiation/Chemo Tx after
surgery to Px recurrence.
Common ADRs of Cancer/Chemo
Oral Mucositis Hand-Foot Syndrome Pregnancy & Breastfeeding Myelosuppression
Occur several days after Chemo.
Nadir definition =
Practice good oral hygiene.
AVOID chemo Tx as it is WBC's & Platelets
- Tx = Mucosal Spray (Lidocaine Palmar-Plantar
teratogenic & avoid reaching lowest levels.
2% topical solution) Erythrodysesthesia
handling chemo drugs as it Occurs 7-14 days after
- Xerostomia: Tx = Emollients
may cause sterility. Chemo Tx. Recovers 3-4
Tx = Pilocarpine (Salagen)
wks after D/C.
Caution hepatic impairment
Common Toxicities Chemo Man
Neutropenia Hypercalcemia of Malignancy Thrombocytopenia
- Low Neutrophils = ↑ Infxn Risk
- Neutropenia = <1000 ANC - Tx = Bisphophonates, Denosumab,
- Severe = <500 ANC Calictonin (Miacalcin), Zolendronic Platelet transfusions are Myelosuppression Almost ALL
- Profound = <100 ANC Acid (Zometa) indicated when count N/V Cisplatin
- CSF agents: Tx neutropenia to ↓ mortality of - Do NOT use w/Reclast, falls <10,000. Fluorouracil
infections & given prophylactically for PTs at high Denosumab (Xgeva) or Prolia Capecitabine
Mucositis
risk of Febrile Neutropenia. Irinotecan
Febrile Neutropenia Anemia MTX
Fluorouracil
- ANC < 500 or expected w/I 48 hrs + Capecitabine
Oral Temp = >38.3 C (101 F) - ESA shortens survival & ↑ tumor progression/recurrence in PTs w/ Diarrhea
breast, small-cell lung, head & neck, lymphoid, & cervical cancers. Irinotecan
OR Oral Temp = >38.0 C (100.4 F) TKI's
sustained for > 1 hour. - Only initiate if Hgb < 10 g/dL + use lowest effective dose.
Vincristine
- Tx = Empirical Tx must include coverage - Serum Ferritin, TSAT, TIBC may be used to assess Iron storage.
Constipation Thalidomide
for P. Aeruginosa - ESA's may NOT work if Fe+ levels are low. Pomalidomide
- Low Risk = ANC <500 x 7 days = PO Xerostomia Radiation
Neupogen Bone pain 1st Dose = Given
Abx [Cipro + Augmentin, Cipro +/- Filgrastim SERMs
Zarxio Fever NO sooner than Clotting
Aromatase Inhibitors
Clindamycin, Levofloxacin] CSF: Tx
Tbo-Filgrastim Granix Arthralgia 24 hrs after Anthracyclines
- High Risk = ANC <100 or >7 days = IV Anemia Cardiotoxicity
Peg-Filgrastim Neulasta Myalgia chemo tx. TKI's
Abx [Cefepime, Ceftazidime, Meropenem, Rash Monitor: CBC
Sargramostim Leukine Hepatotoxicity MABs, TKI's, MTX
Imipenem-Cilastin, Pip-Tazo]
Bleomycin
Dosing Considerations for Chemo Tx Agents Chemo Adjunctive Meds Pulmonary Busulfan
Toxicity Carmustine
Cisplatin - Nephrotoxic Amifostine
Iomustine
Doxorubicin - Cardiomyopathy Dexrazoxane Nephrotoxicity Cisplatin, MTX
Fluorouracil - Efficacy Leucovorin Vinca Alkaloids
Drug Max Dose Reason
Ifosfamide - Hemorrhagic Cystitis Mesna Neuropathy Platinums
Bleomycin Lifetime Dose = 400U Pulmonary Toxicity
Atropine Taxanes
Doxorubicin Lifetime Dose = 450-550mg Cardiotoxicity Irinotecan - Diarrhea
Cisplatin Dose per cycle = <100 mg Nephrotoxicity Loperamide Hemorrhagic Cyclophosphamide
Leucovorin Cystitis Ifosfamide
Vincristine Single Dose = 2mg Neuropathy MTX - Myelosuppression
Glucarpidase
Fluorouracil OR Capecitabine
Uridine Triacetate
Toxicity Antidote
ONCOLOGY
Cyclophosphamide Cytoxan ALL have BBW: Hemorrhagic Cystitis - Must prevent w/ MESNA
Ifosfamide Ifex Neurotoxicity Myelosuppression (Mesnex) & Hydration
Alkylating Agents: Pulmonary Toxicity
Carmustine BiCNU
NON-Specific Agents (Busulfan, Carmustine,
Bendamustine Bendeka, Treanda WARNING:
(DNA disruption) Lomustine) Pulmonary Toxicity
Busulfan Myleran, Busulfex SJS | TEN Skin Rxns
Melphalan Alkeran, Evomela Reactivation of Viral Infxns
Nephrotoxicity, Ototoxicity
Myelosuppression
Cisplatin Amifostine (Ethyol) for Highest Nephrotoxicity & CINV
Anaphylaxis Rxn
prophylaxis
Platinum-Based: Peripheral Neuropathy - ↑ risk w/
Calvert Formula used for
Carboplatin Non-Specific Agents Ototoxicity repeated dosing
(DNA disruption) Nephrotoxicity exposure
Acute Sensory Neuropathy
- Caution > 6
Oxaliplatin Exacerbated by
cycles
COLD weather
RED-Urine Cardiotoxicity = related to TOTAL cumulative
Discoloration anthracycline dose received over LIFETIME
Doxorubicin Myelosuppression
Anthracyclines: Hand-Foot Syndrome - MAX Dose = 450-550
Myocardial Toxicity
NON-Specific Agents CINV - prophylaxis = Dexrazoxane (Zinecard)
Vessicant
BLUE-Urine
Mitoxantrone Totect - Extravasation Antidote
Discoloration
MAX DOSE = 2 mg/Dose
Neuropathy Dose in small IV bag (Piggy Back)
Vincristine NOT Myelosuppressive
Vinca Alkaloids: (Paresthesia) IV Only - NO MOST CNS Toxicity
M-Phase Gastroparesis Intrathecal Intrathecal Administration: DEATH + PARALYSIS
Vinblastine Constipation
Myelosuppressive B = Bone Marrow Suppression
Vincorelbine
Paclitaxel - Infusion Hypersensitive
Neuropathy Myelosuppression
Docetaxel Rxns = pre-Medicate w/ Taxanes: Give Taxanes BEFORE Fluid Retention
Myalgia Hypersensitivity Rxns
Benadryl, Steroid, or M-Phase Platinums
Paclitaxel Arthralgia Fatal Anaphylaxis
H2RA
Cholinergic Sx:
Irinotecan N/V/D Delayed Diarrhea (Early + Late)
Flushing, Sweat, Cramps Topoisomerase 1
Diarrhea
Delayed Diarrhea inhibitor: Myelosuppression
Abdominal Pain
Toptecan Homo UGT1A1*28: causes S-Phase
Alopecia
neutropenia
Etoposide IV Topoisomerase 2 Infusion Rate-Hypotension
Hypersensitivity
inhibitor: Myelosuppression Use Non-PVC IV Bag + Tubing
Etoposide Capsules VePesid Anaphylaxis
G2-Phase Refrigerate Capsules
Leucovorin = Efficacy
Fluoruracil 5-FU Hand-Foot Syndrome DPD Deficiency = Toxicity
Cardiotoxicity
Pyrimidine Analogs: Pro-Drug of 5-FU
Capecitabine Xeloda Photosensitivity ↑ INR CrCl <30
S-Phase DPD Deficiency = Toxicity
Diarrhea
Cytarabine ARA-C
Mucositis
Gemcitabine
Methotrexate Give Folic Acid, Vit-B12 for S/E
Intrathecal should ONLY be given if Preservative-
Nephrotoxicity Myelosuppression
Folate Anti-Metabolites: Free formulation
Hepatotoxicity Mucositis NSAID, Salicylate = DDI
Pemetrexed S-Phase Dose >500 mg req. Leucovorin
Mucositis Diarrhea
Must Hydrate + IV Sodium Bicarb to
Nephrotoxicity
Everolimus Zortress DLD, Stomatitis, Rash, Interstitial Lung Dx
MTOR inhibitor:
Temsirolimus INJ Torisel indication = Transplant DLD, Hyperglycemia, Myelosuppression, Interstitial Lung Dx Use NON-PVC Bag
ONCOLOGY
Tretinoin Retinoic Acid RA-APL Differentiation Syndrome
QT-Prolong
Arsenic Trioxide
RA-APL Differentiation Syndrome
Asparaginase Hypersensitivity, Pancreatitis
Miscellaneous Agents
Pegaspargase Prolong Pro-Thrombin/INR Time
No Myelosuppression
Bleomycin Pulmonary Fibrosis
MAX LIFE Dose = 400 units
Mitomycin
Lenalidomide Revlimid Fetal Risk
Neutropenia
Pomalidomide Immunomodulator Pregnancy Pregnancy REMS Drug - Pregnancy
Thrombocytopenia
Thalidomide Thalomid DVT, PE risk
Peripheral Neuropathy
Bortezomib Velcade Neutropenia Give Acyclovir, valacyclovir to prevent Herpes reactivation
Proteasome Inhibitor
Thrombocytopenia
Carfilzomib Kyprolis Peripheral Neuropathy
MONOCLONAL ANTIBODIES (MAB)

Bevacizumab Avastin HTN Fatal Bleeding Poor Wound Heal = AVOID 28
VEGF Affects circulatory system
Ramucirumab Cyramza Poor clotting GI Perforation days before/after SURGERY
Trastuzuab Herceptin MONITOR: LVEF w/ ECG or MUGA Scan @ Baseline &
Cardiotoxicity
Ado-Trastuzumab Emtansine Kadcyla HER-2 During Tx
Fetal Toxicity
Pertuzumab Trastuzumabs NOT Interchangeable
Cetuximab Erbitux EGFR + Gene Expression = BETTER Response in NSCLC -
EGFR Skin rashes
Panitumumab Vectibix Must be KRAS-Wild Type to use.
Ipilimumab Yervoy CTLA inhibitor MED GUIDE - REMS Drug
Rituximab Rituxan Myelosuppression
Viral infections Must be CD20 + to use
Blinatumomab Blincyto
Colitis
CD-Antigen
Pembrolizumab Keytruda Hepatotoxicity
Thyroid Dsyfxn MED GUIDE Required
Nivolumab Opdivo
Myocarditis
TYROSINE KINASE INHIBITORS (TKI)

Imatinib Gleevec QT-Prolong
BCR-ABL - Tx CML Must be Philadelphia BCR-ABL +
Dasatinib Fluid Retention
Vemurafenib TYROSINE-KINASE Toxicities:
BRAF - Tx Melanoma New Malignancies Must be BRAF V600E or V600K +
Dabrafenib Hypothyroidism
Afatinib - ALL are PO Hepatotoxicity
Acneiform Rash
Erlotinib - Req Genomic EGFR - Tx NSCLC Diarrhea Must be EGFR +
Dry Skin
Gefitinib Testing QT-Prolong
Crizotinib - Food alters Rash (EGFR)
Ceritinib Bioavailability ALK HTN (VEGF) Must be ALK +
Alectinib Hand-Foot (VEGF)
QT-Prolong
Lapatinib Other Must have HER-2 Overexpression
↓ LVEF
ONCOLOGY
BREAST CANCER
GENERIC BRAND MOA ADRs BBW C/I NOTES General Information
DVT | PE
Tamoxifen Soltamox Menopause Sx | Hot Flash
Flushing Med Guide Warfarin - HER-2+ OR Metastatic = Tx Trastuzumab +/- Pertuzumab
Raloxifene Evista Edema Endometrial Cancer DVT/PE Hx
SERMs Use Venlafaxine for - ER/PR+ = Tx SERMs (Tx both Pre/Post Meno)
Weight Gain Blood Clot Pregnancy
hot flashes - Pre-Menopausal = Tamoxifen x 5 yrs → Reassess & change.
Fulvestrant Faslodex HTN Cataracts Breastfeeding
- Post-Menopausal = Aromatase Inhibitor or Tamoxifen x 5 yrs.
Mood changes QT-Prolong
Toremifene Fareston Amenorrhea
Vaginal Bleed/Discharge
DVT | PE Treatment Algorithm
Anastrozole Arimidex Menopause Sx | Hot Flash
N/V | Rash High Risk of:
AVOID:
Edema - Osteoporosis
Letrozole Femara Aromatase Tamoxifen or
Osteoporosis - CVD
Inhibitors Estrogen
HTN - Arthralgia
Lethargy | Fatigue - Myalgia
Exemestane Aromasin Hepatotoxicity
HTN | DLD
Cyclin-Kinase Must use w/ Letrozole
Palbociclib Ibrance
Inhibitor or Fulvestrant
PROSTATE CANCER
GENERIC BRAND MOA ADRs BBW C/I NOTES General Information
Lupron
Leuprolide Depot
Eligard Hot Flashes
Gynecomastia Osteoporosis Risk Pregnancy
Goserelin Zoladex Impotence SC | IM ADT Tx = ↓ the concentration of Testosterone.
GnRH Agonist: Tumor Flares Breastfeeding
Peripheral Edema
Histrelin Supprelin Luteinizing Bone pain S/E of ADT Tx:
(LHRH) agonists Injection site pain - Hypogonadism
QT Prolong - Hot Flashes
Triptorelin Trelstar
DLD | BG ↑ - Libido | Impotence
- Gynecomastia
Degarelix Firmagon Osteoporosis Risk Hypersensitivity Rxns SC - Hair Thinning
Hot Flash - Peripheral Edema
Bicalumatide Casodex ONLY used Combo
Flutamide Gynecomastia w/ GnRH agonist
Anti-Androgens Peripheral Edema Hepatotoxicity Tumor Flare Sx = Bone pain or problems w/ urination.
Nilutamide PO - Prophylaxis = Give Anti-Androgens for several weeks in
CVD Pregnancy
Enzalutamide Xtandi Mono Tx OK conjunction w/ GnRH agonist initiation
N/V/D Breastfeeding
Androgen
Abiraterone Zytiga Biosynthesis Edema | HTN | K+ ↓
Inhibitor
ONCOLOGY
CHEMO INDUCED NAUSEA/VOMITING (CINV)
General Information Treatment Algorithm Treatment
- MUST administer at least 30 mins prior to High Emetic Risk > - NK-1 + 5HT-3 + Dexamethasone
Chemo Tx. ACUTE w/I 24 hrs 5HT-3 antagonists 90% (3 Drug Tx) - Netupitant/Palonosetron (Akynzeo) + Dexamethasone
- MUST provide take-home meds for break NK-1 antagonist - Olanzapine + Palonosetron + Dexamethasone
Mod Risk 30 - 90%
through N/V: DELAYED 1 - 7 days after Corticosteroids - 5HT-3 + Dexamethasone (Tx Mod-risk only)
(2-3 Drug Tx)
- First Line: Ondansetron, Prochlorperazine Palonosetron
Low Risk 10 - 30% 5HT-3, Dexamethasone, Prochlorperazine,
Metoclopramide ANTICIPATORY Before chemo Benzos
- 2nd LINE = Cannabinoids (Any 1 except NK-1) Metoclopramide

Aprepirtant Emend Dizziness
Fosaprepitant IV Emend Fatigue
Substance-P, NK-1
Constipation
Netupitant + Palonosetron Akynzeo Antagonist
Weakness
Rolapitant Varubi Hiccups
Zofran
Ondansetron
Zuplenz Film
Kytril
Granisetron Sancuso Headache
Sustol Fatigue Dolasetron IV has NO indication for CINV due to QT Prolong.
5HT-3 Antagonist Apomorphine
Dizziness ODT: Must dry hands 1st
Dolasetron Anzemet Constipation
Palonosetron Aloxi
Compazine
Prochlorperazine
Compro
Phenergan
Promethazine Phenadoz Sedation
Promethegan Lethargy
Dopamine Antagonist EPS Droperidol: QT prolong + Arrhythmias
Metoclopramide Reglan ↓ Seizure threshold
Droperidol
Dexamethasone Decadron Corticosteroid See Steroids

Dronabinol - C3 Marinol Somnolence Must refrigerate
Cannabinoids Euphoria
Nabilone - C2 Cesamet ↑ Appetite

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ALLERGIC RHINITIS

Oral Antihistamines 1st generation (more drowsiness)

*Do NOT use <6 YO - AVOID use in elderly

Expectorant – removes phlegm

Combination Products Pediatric Concerns/Dosing for Cold medications

Treatment Algorithm Effectiveness of Therapy General Information

Dry Powder Inhalers (DPI) Soft Mist Inhaler/Inhalation Spray

GENERIC BRAND ADRs BBW C/I NOTES

Counseling & Dosing

1. Puff inhaler in short/freq breaths + inhale deeply.

Endothelin Antagonist (ERA) - Blocks Endothelin vasoconstriction.

PDE-5 inhibitor - Pulmonary relaxation/vasodilation.

Soluble Guanylate Cyclase (sGC)

Headache Embryo-Fetal toxicity

Risk Factors Treatment Pearls DRUG Tx

TRANSDERM SCOP – Counseling Instructions

Prostaglandin E1 - vasodilator that allows blood to flow

5-HT1A agonist/5-HT2A antagonist - does NOT enhance sexual performance

α-blockers - relax smooth muscle leading to improved urinary flow

5α-reductase inhibitors - blocks conversion of Testosterone  DHT

Finasteride Proscar Impotence • Pregnant women should not

HA/Dizzy Color discrimination

Beta-3 agonist - causes less dry mouth

Inhibit ACH release – 3rd Line Tx

Stimulates Hgb-F production

GENERIC BRAND ADRs BBW C/I NOTES DOSING

1st line = SSRI or SNRI 2nd line: Metabolism + Safety

GENERIC BRAND ADRs BBW CONTRAINDICATIONS NOTES

Nausea/Headache • MAOi w/in 14 days

Alprazolam Xanax BBW: Diazepam:

Temazepam Restoril NOT FOR ANXIETY

• Cognitive decline  dementia

ACH Inhibitors - inhibit Acetylcholinesterase (ACH)

Dizziness • Oral Solution available

Steroids - Glucocorticoid activity and anti-Inflammatory effect

Hypothyroidism = T4/TSH (low Metabolism)

1. BSS - tabs/liquid dose 525-1050 mg QID w/ FOOD & QHS.

Hepatitis-B: Meningococcal Meningitis:

GENERIC BRAND MOA ADRs BBW CONTRAINDICATION NOTES

GENERIC BRAND MOA ADRs BBW CONTRAINDICATION NOTES

GENERIC BRAND MOA ADRs BBW CONTRAINDICATION NOTES

GENERIC BRAND MOA ADRs BBW CONTRAINDICATION NOTES

GENERIC BRAND MOA ADRs BBW CONTRAINDICATION NOTES

GENERIC BRAND MOA ADRs BBW CONTRAINDICATION NOTES

Nausea WARNING: Apply 2 hrs before desired Fx &

GENERIC BRAND MOA ADRs BBW CONTRAINDICATION NOTES

GENERIC BRAND MOA ADRs BBW C/I NOTES

GENERIC BRAND MOA ADRs BBW C/I NOTES

GENERIC BRAND MOA ADRs BBW C/I NOTES

GENERIC BRAND MOA ADRs BBW C/I NOTES

B-12 Compliance WARNING:

- Monitor: Hgb, Hct, TSAT, serum Ferritin, BP

GENERIC BRAND MOA ADRs BBW C/I NOTES

GENERIC BRAND MOA ADRs BBW C/I NOTES

• Elevations in non-HDL, LDL, & TG increase risk of atherogenic disease.

GENERIC BRAND MOA ADRs BBW CONTRAINDICATION NOTES COUNSELING

1. Monitor LFT's when used w/ Statin or 1. Contact PCP - dark urine

NVD, Dyspepsia ab 1. Capsule ONLY

Inhbits Apo-B to VLDL + Nausea, HA, fatigue, Hepatotoxicity

GENERIC BRAND MOA ADRs BBW C/I NOTES

GENERIC BRAND MOA ADRs BBW C/I NOTES