CPJE Preparation Flashcards

Terms Definitions
How often do you change Scopolamine patch?
Q3 days
How do you use Scopolamine patch?
Place behind the ear, 4H prior to travel.
What are the routes of admin for Epinephrine?
What is the DoC for cocaine overdose/hypertensive crisis?
Phentolamine (Regitine)
BP goal for patients with CAD
BP goal for patients with CHF
What forms does Diuril come in?
Chlorothiazide; tabs, susp, and IV (only thiazide in injectable)
What are the SE of Thiazides?
Decreases Mg, K, Na, Cl.
Increases Ca, Uric Acid, Glucose, and Lipids.
Rash, Sulfa allergy, Preg Cat. D
Can you use Thiazides in patients with renal failure (CrCl<30mL/min)?
Can you use Thiazide-like diuretics for renal patients?
Yes. Metolazone (Zaroxolyn, Mykrox) and Indapamide (Lozol).
What forms does Lasix come in?
IV, IM, PO (tabs, oral solution)
SE for LOOP diuretics?
Decrease in Mg, K, Ca, Na, Cl.
Increase in Uric Acid, Lipids, Glucose.
Rash, Lupus, Ototoxicity.
Can you use a LOOP diuretic for patients with Sulfa allergy?
Yes, Ethacrynic acid (Edecrin).
What diuretics are used in Renal patients?
List the Potassium-Sparing diuretics
Amiloride (Midamor)
Triamterene (Dyrenium)
Spironolactone (Aldactone)
Eplerenone (Inspra)
Aldactone Side Effects?
Gynecomastia & Hirsutism (similar to ketoconazole & cimetidine)
What are the 2 diuretics used for end-stage HF?
Spironolactone & Eplerenone
What is the dosing for Inspra? Contraindicated in what?
50mg BID.
CI: K > 5.5mEq/L
CrCl <30mL/min
Strong inhibitors
SE for K-Sparing diuretics?
Increase in K
Decrease in Na
Rash and Headache
What is the DoC (diuretic) for Hypercalcemia?
What are the Beta Blockers used for CHF?
Carvedilol (Coreg)
Metoprolol succinate (Toprol)
Bisoprolol (Zebeta)
What is Brevibloc and its indication?
Esmolol; HTN emergency
What beta blockers are taken with food?
Coreg, Lopressor, Inderal
What is the indication for Betapace?
Sotalol; used for arrythmias
Can you use Bystolic for renal patients?
Dose adjust if CrCl <30mL/min
What Beta Blockers can you use for patients with Asthma/COPD?
Atenolol, Metoprolol, Esmolol, Bisoprolol, Betaxolol, Bystolic, Acebutolol
What Beta Blockers come in IV?
Metoprolol, Atenolol, Labetalol, Esmolol, Propranolol
SE for Calcium Channel Blockers (CCB)?
Flushing, Constipation, Bilateral Edema, Gingival Hyperplasia
Are CCB's substrates, inhibitors or inducers?
Subtrate and Inhibitor
What is Nimodipine used for? Contraindicated in what allergy?
Subarachonoid hemorrhage; soy & egg allergy
How long can you use Cleviprex after puncturing the stopper?
4 hours then discard
Can you use Nicardipine SR for angina?
No, only for HTN. Regular Cardene may be used for angina not the SR.
What CCB can be used for CHF?
Nicardipine (Cardene) since it does not decrease myocardial contractility
What is the DoC for Prinzmetal angina and Reynaud's Phenomenon?
Calcium Channel Blockers
Can you crush Plendil?
No, because it is an extended release tablet
Can you cut Toprol XL?
Yes, even if it's an extended release tab.
What is the indication for Nifedipine IR?
Angina and Reynaud's
How do you give Captopril?
BID/TID bec of its short half-life and on EMPTY stomach
What ACE Inh can you give to patients with renal failure?
Moexipril (Univasc)
Fosinopril (Monopril)
What are the contraindications for using ACE Inh?
Renal failure (SCr >3mg/dL)
Renal artery stenosis = Hyperkalemia
Pregnancy Cat. D
What is the DoC for African-Americans?
CCB and diuretics
ACE Inh is the DoC for what?
What happens when a patient is taking both ACE Inh and Lithium?
Lithium levels increase by 300% bec ACE Inh decreases levels of Na.
What is Tekturna? SE?
Aliskiren, a direct renin inhibitor; diarrhea.
What is the dosing for Tekturna?
150mg or 300mg QD
Can you use Uroxatral for renal patients
Alfuzosin has to be used with caution in patients with CrCl <30mL/min
Can you use Silodosin for renal patients?
4mg daily with meals if CrCl = 30-50mL/min; don't use for CrCl <30mL/min
What is the other name for Cialis?
Tadalafil (generic)
Adcirca, 40mg for pulmonary HTN
What is Vardenafil?
What are the other names for Sildenafil?
Revatio, 20mg QD for pulmonary HTN
What is Caverject? Dosing?
Alprostadil for erectile dysfunction given as a 2.5mcg injection. Max: 60mcg no more than 3x QW.
What is Muse?
Alprostadil pellet
Which alpha adrenergic blockers are also 3A4 substrates?
Alfuzosin (Uroxatral) and Silodosin (Rapaflo)
What are the indications for Guanfacine?
Tenex, for HTN
Intuniv, for ADHD.
What is Aldomet? SE?
SE: Liver, Lupus
Major SE for Reserpine?
What is Apresoline?
What is Loniten?
Minoxidil; Rogaine, OTC for hair growth
What is Lotrel?
Benazepril and Amlodipine
What is Exforge?
Valsartan and Amlodipine
What is Lexxel?
Enalapril and felodipine
What is Tarka?
Trandolapril and Verapamil
What is Ziac?
Bisoprolol and HCTZ
What is Azor?
Amlodipine and Olmesartan
What is Twynsta?
Telmisartan and Amlodipine
HTN medications used for pregnant patients?
What are signs and sympoms of end organ damage present in HTN emergencies?
Brain: severe HA/neuro S/S
Heart: angina/shortness of breath/EKG changes
Eyes: Papilledema/blurry vision
Kidneys: major acute renal dysfunction
What's the goal BP reading when dealing with HTN emergency?
Decrease BP by 10-15% or DPB 110
What are the drugs used for HTN urgencies?
What are the meds used for HTN emergency (IV drugs)?
Sodium nitroprusside (Nipride, Nitropress)
Esmolol (Brevibloc), Enalapril
What is the antidote for cyanide poisoning?
Sodium nitrate + sodium thiosulfate
What forms does Hydralazine come in?
Tabs, IV, IM
What are the therapuetic levels for Digoxin in CHF?
0.5 - 0.8 mg/mL
What are the therapeutic levels of Digoxin when treating arrythmias?
0.8 - 2.0 mg/mL
What drugs displace Digoxin?
What is the half-life of Digoxin?
36 hours
What is the dosing for Digoxin?
Loading dose
1st: 0.5mg IV
2nd & 3rd: 0.25mg IV

Maintenance dose
0.125mg to 0.375mg IV or PO
What drugs have an additive effect on Digoxin?
Beta Blockers
What are the signs of Digoxin toxicity?
Xanthopsia (yellow vision)
Anorexia, N/V, Diarrhea
Somnolence & muscle weakness
What do you give to bind Digoxin?
Digibind (38mg/vial)
Digifab (40mg/vial) - powders in the fridge.
What is the DoC for AV block?
Atropine 0.5 - 1.0mg IV; avoid dosing <0.5mg bec it will give the opposite effect
What is Inocor?
Inamrinone is an inotropic agent
What are the SE and contraindications of Inamrinone?
CI: Sulfa allergy
What is Primacor?
Contraindications for using ACE Inh
SCr >2.5mg/dL
What is Natrecor?
Nesiritide causes diuresis and vasodilation; it is a recombinant form of BNP
What does a high BNP signify?
What is the DoC for PSVT?
Adenosine (Adenocard), given as rapid IV push (0.6mg then 12mg)
What class does Quinidine belong? What is it used for?
Class IA
Used for atrial and ventricular arrythmias
What are the SE for Quinidine?
Therapeutic levels for Quinidine?
SE for Pronestyl?
ANA + Lupus like syndrome
Therapeutic levels for Pronestyl?
What drugs belong to Class IB?
Mexilitine (Mexitil)
Tocainide (Tonocard)
What drugs belong to Class IA?
Disopyramide (Norpace)
Procainamide (Pronestyl)
What drugs belong to Class IC?
Propafenone (Rythmol)
Morizicine (Ethmozine)
Flecainide (Tambocor)
What is the dosing for Lidocaine? What is the therapeutic plasma level?
IV bolus: 1mg/kg
IV infusion: 1-4 mg/min

Plasma levels: 1-5mcg/mL
What group do Beta Blockers belong to for treating arrythmias?
Group II
Group III Anti-Arrythmic medications
K Channel blockers (IASD2)
What is Corvert?
Ibutilide, Grp III Anti-arrythmic
What is Betapace? Can you use it for renal patients?
Sotalol, Grp III Anti-Arrythmic; dose adjust if CrCl<60mL/min
What is Multaq? Dosing?
400mg BID with food
What is Dofetilide? Who can give it? Can be used by renal patients?
Tikosyn; must be given by prescribers who have received education; CI if CrCl<20mL/min
PTT is monitored when using what?
INR is monitored when using what?
Therapeutic PTT level?
45s - 70s
Therapeutic INR?
2.0 - 3.0
Therapeutic INR for patients with mechanical or prosthetic heart valves?
2.5 - 3.5
What is Activase?
Alteplase (t-PA/rt-PA)
What is Eminase?
Anistreplase (APSAC)
What is Retavase?
Reteplase (r-PA)
What is TNKase?
Tenecteplase (TNK-tPA)
What is Abbokinase?
Which Thrombolytic agents are tissue specific?
Alteplase (Activase, t-PA)
Retaplase (Retavase, r-PA)
Patient is on oral anticoagulant and heparin use 2 days ago. Is it okay to give Thrombolytics?
Patient has BP>185/110 mmHG. Is it okay to give a thrombolytic?
t-PA comes in what form?
Can you give aspirin with t-PA?
No, don't give patient aspirin within 24 use from use of t-PA.
Dose of r-PA for acute mania?
10U IV over 2 min followed by a 2nd dose 30 minutes later
Retavase is produced from?
E. coli
Retaplase can be used within how many hours of reconstitution?
Streptokinase dosing for AMI?
1.5 MU IV over 60 minutes
Streptokinase dosing for PE?
3.0 MU IV over 24 hours
Brand names for Amiodarone?
Amiodarone indications?
Atrial arrythmias
Unapproved: refractory atrial fibrillation
Oral dose for Amiodarone?
LD: 800 - 1600 mg x 3 weeks
MD: 200 - 600mg
IV dose for Amiodarone?
150mg IV bolus, 1mg/min x 6 hours then 0.5mg/min x 18 hours
What is the recommended concentration for Amiodarone?
Amiodarone SE?
AV blockage/Bradycardia
Check the eyes
What is the half life for Amiodarone?
30-60 days
Dosing for Heparin IV infusion?
IV bolus: 5,000-10,000 bolus
IV infusion: 1,000 depending on patient's PTT
Weight based dosing for Heparin?
LD: 50 - 80 U/kg
MD: 15 - 20 U/kg/hr
Patient who is on a Heparin weight based IV infusion has a PTT reading of 32s. What should you recommend?
Give another bolus dose of 80 U/kg, and increase infusion rate by 4 U/kg/hr
Patient on a weight-based Heparin IV infusion has an aPTT of 40s; what would you do?
Give another bolus dose of 40U and increase infusion rate by 2 U/kg/hr
Patient on a weight-based Heparin IV infusion has an aPTT of 50s; what would you do?
No action needed.
Patient on a weight-based Heparin IV infusion has an aPTT of 75s; what would you do?
Decrease infusion rate by 2 U/kg/hr
Patient on a weight-based Heparin IV infusion has an aPTT of 91s; what would you do?
Hold infusion by 1Hr, then decrease infusion rate by 3 U/kg/hr
Patient is on Heparin and a couple of OTC products. Which herbal products should the patient avoid?
Ginger, garlic, Ginko
Horse chestnut
Vit. E
What Cephalosporins increase the risk of bleeding?
What thyroid medications increase the risk of bleeding?
What is the normal platelet count?
150,000 - 400,00 mm
What can you use to prevent or treat thrombosis in patients with HIT?
Bivalrudin (Angiomax)
Agatroban (Novastin)
Lepirudin (Refludin)
What is Normiflo?
Ardeparin given SC Q12H
What is Fragmin?
Dalteparin, given SC QD
What is Enoxaparin?
What is Tinzaparin?
What is Arixtra? Dosing?
Fondaparinux; 2.5mg SC QD
Can you use Arixtra for renal patients?
Contraindicated in CrCl<30mL/min
Dosing for Arixtra?
Prevention: 2.5 SC QD
Treatment: 5 - 10 SC QD
Lovenox dose for DVT Px in hip/knee replacement
30mg SC Q12H x 7 - 10 days
Lovenox dose for DVT Px in immobility or abdomen surgery
40mg SC QD (if CrCl<30mL/min, reduce dose to 30mg QD)
Lovenox dose for PE/DVT treatment?
1mg/kg Q12H until warfarin overlap (CrCl<30mL/min, give 1mg/kg QD)
Where do you store Lovenox?
Shelf! Room Temperature!!!!
Which Low Molecular Weight Heparins are contraindicated in pork allergy?
Which Low Molecular Weight Heparins are contraindicated in sulfa allergy?
What do you need to monitor with LMWH use?
CBC @ baseline
Hemoglobin (Hgb)
Hematocrit (Hct)
DoC for LMWH overdose?
Protamine dose as antidote?
Heparin: 1mg for 90U of beef hep
1mg for 115U of pork

Dalteparin & Arderparin

Enoxaparin 1mg for 1mg
What drugs increase bleeding with Warfarin?
What drugs decrease effectiveness of Warfarin?
Patient is on Warfarin and has UTI. Which Abx should not be given?
Bactrim DS bec any sulfa drug will displace Warfarin therefore increasing its concentration.
What is the drug used to reverse effects of Warfarin?
Vit K; if INR is 5-9 with high risk of bleeding give:
1 - 2.5mg Vit. K
Rx Vit K comes in 5mg tabs
What is ReoPro?
Abciximab; GPIIb/IIIa; IV infusion
What is Integrilin? Form?
Eptifabatide; IV infusion
What is Aggrastat? Form?
Tirofiban; IV infusion
What is Pletal? Dose?
Cilostazol; 100mg BID
What is Plavix?
What is Ticlid? Dose?
Ticlodipine; 250mg BID with food
What is Effient? Dose?
Prasugrel, 10mg QD
What do you worry about with the use of Ticlid?
Neutropenia; watch out for fever, chills, sore throat. Check CBC
What is Persantine?
Dipyridamole; reversible inhibitor of platelet aggregation.
What is Aggrenox?
Aspirin + Dipyridamole, 1 cap BID
What is the LDL goal for patients with CHD and DM?
Normal LDL optimal levels?
What is Questran?
What is Colestid? Max Dose?
Powder: 5mg/packet; Max: 30mg
Tab: 2gm/tab; Max: 16 grams
What is Welchol? Max dose?
Tabs: 3 tabs BID
Max: 7 tabs
What is the normal TG level?
Can Welchol increase TG?
Yes, esp when given with insulin or sulfonylureas
SE for Niacin?
Flushing and Itching
GI distress
Increases (HUG) Hepatotoxicity, Uric Acid, Glucose
Patient counseling on Niacin
Give with food
Titrate slowly
Take 325mg 30-60 min prior
Max dose for regular Niacin?
4.5 grams QD
Max dose for Niaspan ER?
2 grams QD
What is Simcor?
Simvastatin + Niacin
What is Advicor?
Lovastatin + Niacin
How should a patient take Mevacor?
Lovastatin should be taken with food.
What is Crestor? Max dose?
Max: 40mg
Can you use Crestor in renal patients? What if patient is on Lopid?
Yes, but max dose is 10mg/d
What is the max dose for Zocor if patient is on Diltiazem?
Max dose of Zocor is 10mg if patient is on what other medications?
What is Livalo? Max dose? What about in renal patients?
Max: 4mg
Renal patients, max: 2mg
What is Caduet?
Amlodipine + Atorvastatin
Which Statins need to be given QHS?
SE of Statins?
GI distress
Ocular effects
Respiratory effects
Avoid the use of Fibrates in patients with?
Renal disease
Liver disease
Gallbladder disease
What is Atromid-S?
What is Tricor?
Which Fenofibrates need to be taken with food? Why?
Antara 130mg = Lofibra 200mg
Taken with food to increase concentration.
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