RXPREP:

KEYDRUGS,
MNEMONI
CS,
STUDY CYPi nhibitors
o G<3PACMAN( bi gi nhi bitors)
TI
PS  Gr apef rui t
 HAZARDOUSDRUGSar e:  PI spr ot easei nhi bitor s(ritonav ir
)
o Ter at ogeni c  Azol eant i
f ungal s( fluconazol e,
o Car ci nogeni c itraconazol e, ket oconazol e,
o Genot oxi c( damaget heDNAandcancause posaconazol e, vor i
conazol e,
cancer ) isav uconazoni um)
o Hav er epr oduct i
v et oxi ci ty  C: CYA, cimet idine, cobi cist at
o Causeor gant oxi cityatl owdoses  Macr ol i
des( clarithromy cin,
 Keyhazardousdr ugst hatr equi reSPECI AL er y thromy cin, notazi thromy cin)
HANDLINGt oav oidt oxi ci t
yt owor ker s:  Ami odar one( anddr onedar one)
o Al l pregnancycat egor yXdr ugs, cat egor yD’ s  Non- DHPCCBs( dilti
azem and
andaf ewC’ s, andpar oxet ine, met hotrexat e, v er apami l
)
mi sopr ost ol, mi fepr istone, r i
bav ir
in  KeySEROTONERGI Cdr ugs:
o Ant ineopl ast ics( chemot her apeut i
cs) o SSRI s
o 5- alphar educt asei nhi bi tor s( dut asteride, o SNRI s
fi
nast er ide) o TCAs
o Hor mones( cont racept iv es, estr adiol, o MAOI s( plusl i
nezol idandmet hy l
enebl ue)
test ost er one) o Buspi rone
o Tr anspl antdr ugs( MMF, tacr oli
mus, CYA, o Dext romet hor phan
ever ol imus, sir olimus) o Fent any l
o Ot her s: col chi ci ne, dr onedar one, fl
uconazol e, o Li thium
spir onol act one, ri
sper idone, raloxi fene, o Met hadone
rasagi li
ne, zi pr asidone o Mi rtazapi ne
 Keydrugsmostcommonl yassoci at edwi t
h o St .John’ sWor t
PHOTOSENSI TI VITY: o Tr amadol
o Car bamazepi ne o Tr azodone
o Di ur et i
cs( thiazi deandl oop) o Ot her s:cy clobenzapr ine, lorcaser i
n,
o MTX meper i
di ne, 5HT3- RA, somet riptans
o Or al andt opi cal retinoi ds  Keydr ugsr equi red/ strongl yr ecommendedPGx
o Qui nol ones test
ing:
o St .John’ sWor t o Abacav ir
o Sul faant i
bi ot ics o Azat hiopr ine
o Tacr olimus o Car bamazepi ne
o Vor iconazol e o Cet uxi mabandpani tumumab
o Ot her s: ami odar one, ant ihi stami nes( 1st o Tr ast uzumab, ado- transt uzumab, lapat ini
b,
gener at i
on) , chl or oqui ne, coal tar, pertuzumab
fl
uor our aci l, gr i
seof ulv i
n, NSAI Ds, quini dine, o Ot her s:al lopur inol ,capeci tabi ne, f
luor ouraci
l,
ti
gecy cline cl
opi dogr el, codei ne, pheny toi n, f
ospheny toi
n,
 Keydrugscommonl yassoci atedwi thTTP: warfar in
o Cl opi dogr el  Keydr ugs-DONOTputt hesedr ugsi ntoPVCI V
o Ti clopi dine CONTAI NERS
o Ot her s: acy clov i
r ,famci cl ov ir,qui nine, SMX, o LATI N
valacy clov ir  Lor azepam
 CYPinducer s  Ami odar one
o PSPORCS( bigi nducer s)  Tacr olimus
 Pheny t
oi n  I nsul in
 Smoki ng  NTG
 Phenobar bital  Ot her s: cabazi taxel ,car must i
ne,
 Oxcar bazepi ne( and docet axel , etoposi de, ixabepi lone,
esl icar bazepi ne) pacl itaxel ,suf entani l
, temsi r olimus,
 Ri fampi n( andr ifabut i
n, rifapent ine) teni posi de, t
hi opent al
 Car bamazepi ne( al soanaut o- 
inducer )
 St .John’ sWor t


1
 Keydr
ugs-SALINE( nodext rose) Keydrugs-TERATOGENS
o ACI DAPE o Acne: isot ret i
noi n, topi cal retinoi ds( i
ncluding
 Ampi cill
in tazar otene)
 Caspof ungi n o Abx: qui nol ones, tetracy clines
 I nf liximab o Ant icoagul ant s: war farin
 Dapt omy ci n o HLD, HF, HTN: st atins, RAASi nhi bitors( ACEi
,
 Ampi cill
in/ sul bact am ARBs, al i
ski ren, sacubi tril
/ val
sar t
an)
 Pheny toin o Hor mones: most ,incl udingest radiol,
 Er tapenem pr ogest er one[ megest erol (Megace) ]
,
 Ot her s: abat acept ,azaci tidine, raloxi fene, Duav ee, test ost erone,
bel i
mumab, bev aci zumab, cont racept ives
i
dar uci zumab, ironsucr ose, sodi um o Mi gr aine: dihy droer got ami ne, ergotami ne
ferricgl uconat ecompl ex , o Ot heri mpor tantt er atogens: hy droxy urea,
nat alizumab, t
rast uzumab l
ithi um, MTX, mi sopr ost ol,par oxet i
ne,
 Keydr
ugs-DEXTROSE( nosal ine) ribav irin, thal idomi de, topi ramat e,VPA,
o ABS div alproex, wei ghtl ossdr ugs
 Amphot er icinB  Avoi
di nPEDI ATRI CS
 Bact rim o Cont raindi cat ed
 Sy ner ci d( qui nupr istin/dal fopr isti
n)  Codei neage<12y
 Ot her s: car f i
lzomi b,MMF,  Tr amadol age<12y
pent ami di ne  Pr omet hazi neage<2y
 Keydr
ugs-commondr ugswi t
hFI LTERr equi rement s  Cef tr iaxonei nneonat es1- 28d
o Most :0.22- mi cr onf il
terdur ing o Notgener allyr ecommended
administr
at ion*  Qui nol ones
o Pushyguy sinLALAl and  Tet racy clinesage<8y
 Pheny toin  OTCcoughandcol dpr epar ationsin
 Gol imumab age<6y
 Li pids-1. 2mi cr on*  Li
vev accines
 Amphot er icinB( l
ipidf or mul ations) * o I nject ions
 Lor azepam  MMR
 Ami odar one  MMRV
 *l argerpor esi zef il
ter  Var icel la
r equi red; amphopr epar e  Zost er
usi nga5- mi cronf ilter  Yel lowf ev er
 Ot her s: abat acept ,abci ximab, o Ot herr out es
digoxi ni mmunef ab, infliximab,  I nf l
uenzai nt ranasal
i
sav uconazoni um, manni tol,  Rot av ir
us
thiot epa  Chol er a
 Keydr
ugs-DONOTREFRI GERATE  Ty phoi d
o Dearsweetphar maci st, mar rymef or ev er,  Vacci
nesf orspeci f i
ccondi tions
eter
nally o Pr egnancy
 Dexmedet omi dine  I nf l
uenzav acci ne
 SMX- TMP  Tdapx1wi t heachpr egnancy
 Pheny toin (opt imal timebet weenweeks27
 Met roni dazol e and36)
 Moxi floxaci n  Li v ev acci nesCIdur ingpr egnancy
 Fur osemi de o Aspl eni a
 Enoxapar in  H.i nf luenzaet ypeB( HI B)
 Ot her s: acet ami nophen, acycl ov i
r,  Pneumococcal (Prev narand
def er oxami ne( Desf eral) , Pneumov ax23)
l
ev et iracet am, pent ami di ne,  Meni ngococcal
valpr oat e  Sel
ecteddr ugst hatCAUSEKI DNEYDI SEASE
 Keydr
ugs-PROTECTFROM LI GHTDURI NG o Ami nogl ycosi des
ADMINI
STRATION o Amphot er icinB
o Del i
verev eryneededmedi cationpr ot ect ed o Ci splat in
 Doxy cy cline o Col ist i
met hat e
 Epopr ost enol o CYA
 Ni t
r opr ussi de o Loopdi uret ics
 Mi caf ungi n o NSAI Ds
 Phy tonadi one o Radi ogr aphi ccont rastdy e
 Ot her s: ant hr acy clines, dacar bazi ne, o Tacr olimus
pent ami di ne o Vancomy ci n
 

2
 Studytip:CrCl vsGFR Selectdrugst hatar eCII NKI DNEYI MPAI RMENT
o Cr Cl o Cr Cl <60
 Cockcr oft-Gaul tequat ion  Ni trof ur ant oin
140- pat i
enta g e o Cr Cl <50
 Cr Cl= ×we ightinkg
72xS Cr  El vitegr av ir/cobi cistat/
(×0.85i ff ema l
e ) emt ri
ci tabi ne/ TDF( Stribild)
 ForCr Cl cal culation, useABW i f  Vor iconazol eI V
pat i
enti s<I BW, useI BW isnor mal o Cr Cl <30
wei ght( byBMI )  Av anaf il
 Dosi ngadj ust ment sandCI ’
sar e  Bi sphosphonat es
gener allybasedonCr Cl calculated  Dabi gat ran
withCockcr oft-Gaul t  Dul oxet i
ne
o GFR  El vitegr av ir/cobi cistat/
 CKD- EPIorMDRDequat i
on emt ri
ci tabi ne/ TAF( Genv oy a)
 Usedf orst agingki dneydi sease  Fondapar inux
andf ordosi ngsel ectdr ugs  NSAI Ds
 Notcommonl ycal culat edint he  Pot assi um spar i
ngdi uretics
cli
ni cal setting, butmayber eported  Ri var oxaban
bysomel abor atories  Tadal af i
l
 Fort heexam, i
fGFRi snotpr ovided,  Tr amadol ER
CrCl pr ov i
desacl oseest i
mat ef or o GFR<30
doingandCIpur poses  Genv oy a
 Selectdrugst hatrequi r e OR I NTERVALWI TH  SGLT2i nhi bitors( canagl i
f l
ozin,
I
MPAI REDKI DNEYFUNCTI ON dapagl iflozi n,empagl if
lozi n)
o Ant i-i
nfectives  Met f ormi n
 Ami nogl ycosi des( dosi ngi nterval
, o Ot her s
primar ily)  Dof et il
ide
 Azt reonam  Edoxaban
 Bet a-lact ams  Gl ybur ide
 Pol ymy xins  Meper idine
 Qui nol ones( exceptmoxi f
loxacin)  Sot alol
 SMX- TMP  Keydr ugsthat KLEVELS
 Vancomy cin o ACEi
 Ant i-tuber cul osi smedi cations o ARBs
 Ant iviral s o Al dost eroner ecept orant agonists( ARAs)
 Amphot erici nB o Canagl iflozin
 Fl uconazol e o Dr ospi renone- cont ainingCOCs( combi ned)
 NRTI s, includi ngt enof ovir o Kcont ainingI VF( includi ngTPNs)
o CV o Ksuppl ement s
 Ant iar r
hy thmi cs( digoxi n, o SMX- TMP
disopy rami de, dof etil
ide, o Tacr ol i
mus
procai nami de, sot alol) o Ot her s:al i
ski ren, CYA, ev er
olimus,
 Dabi gat ran glycopy rrolat e, hepar in( chronicuse) ,NSAIDs,
 LMWHs pentami dine
 Ri var oxaban  Directacti
ngant ivir
als: pref er r
edHCVr egimens
 St at ins i
ncl ude2-3DAAswi thdi fferentMOAs( ofteni n1
o Pai n/gout tablet)
 Al lopur inol
Mechani
sm Namecl
ue
Exampl es
 Col chi cine
Grazopr evi
r
 Gabapent in, pregabal in -
prevai
r
NS3/4Apr otease Paritaprevi
r
 Mor phi neandcodei ne
i
nhibi
tors Simepr evir
 Tr amadol ER PforPI
Voxilaprevir
o GI
Daclatasv i
r
 Famot idine, r
ani ti
dine
-
asvir Ledipasv i
r
 Met ocl opr ami de NS5Ar epl
icati
on
Ombi t
asvir
o Ot her s complexinhibit
ors
Af
orNS5A Pibrentasvir
 Bi sphosphonat es
Velpatasv i
r
 CYA
 Li thium -buvir
NS5Bpol ymerase Dasabuv i
r
 Topi r amat e i
nhibi
tor Sofosbuv ir
Bf
orNS5B



3
 Keydrugswi thboxedwar ningsf orLI VERDAMAGE  Ext
endedinf
usi
on(4h)
o Acet ami nophen( highdoses, acut eor canbeusedtomaxi
mizeT
chr oni c) >MI C
o I soni azi d 
o Nev irapi ne
o NRTI s
o Ti pr anav ir
o Val pr oi caci d
o Ot her s: ami odar one, bosent an, felbamat e,
flutami de, ket oconazol e( hi ghestr i
sk) ,ot her
azol es, lef l
unomi deandt eriflunomi de,
lomi tapi de, mar av i
roc, MTX, mi pomer sen,
nef azodone, pr opy lthi our aci l
, tolcapone
 Keydrugs-Ant i
bi oticswi thNORENALDOSE
ADJUSTMENTREQUI RED
o Di cloxaci l
li
n, naf cil
lin, oxaci l
lin
o Cef triaxone
o Moxi floxaci n
o Azi thr omy cin, ery thromy cin
o Doxy cy cline, mi nocy cline, tigecy cline
o Li nezol i
d, t
edi zol id
o Qui nupr istin/dal f oprist in
o Cl i
ndamy cin
o Met roni dazol e,tinidazol e
o Fi daxomi cin
o Vancomy cin( POonl y)
o Ri f axi mi n
o Ri f ampi n
o Chl or ampheni col
 Studyti
p:peni cillin’s
o Out pat ient( or al)
 PCNVK
 Fi rstl inef orst rept hroat
andmi ldnon- pur ulentski n
infect i
ons( noabscess)
 Amoxi ci ll
in( Amoxi l
)
 Fi rstl inef orot i
t i
smedi a
(80- 90mg/ kg/ d)
 DOCf orI EPPxbef or e
dent al procedur es( 2gPO
x130- 60mi nbef ore
procedur e)
 Usedi nH.py lori treat ment
 Amoxi ci ll
in/ clav ulanat e( Augment in)
 Fi rstl inef orot i
t i
smedi a
(90mg/ kg/ d)andf orsi nus
infect i
on( ifabxi ndi cat ed)
 Choosi ngapr oduct : use
thel owestdoseof
clav ul anat et o di arr hea
o I npat ient( par ent eral )
 PCNGbenzat hi ne( Bi cilli
nL- A)
 DOCf orsy phi li
s( 2.4
mi lli
onuni tsI M x1)
 Notf orIVuse; cancause
deat h
 Pi per aci ll
in-tazobact am ( Zosy n)
 Act iv eagai nst
Pseudomonas
 Dosagest rengt hi st he
sum oft hei ngr edi ent s:
3.375g=3gpi per aci ll
in+
0.375gt azobact am

4
 Naf cill
in, oxaci llin,dicloxaci ll
in St
udyt
ip:carbapenems
 Cov erMSSAonl y( no o Br oadspect rum
MRSA)  Al lcov erESBLpr oduci ng
 Nor enal doseadj ust ment organi sms
needed  Al lexcepter tapenem cov er
 St
udyt
ip:
cephalospor i
ns Pseudomonas
o Outpati
ent( or al
) o Rememberwhatt heydonotcov er:
 1stgener ation: cephal exi n( Kef lex)  At ypical s, VRE, MRSA, C.di fficile,
 Commonuse: ski n Stenot rophomonas
infect i
ons( MSSA) ,st rep  Er tapenem doesnotcov er
thr oat Pseudomonas, Aci net obact eror
 2ndgener at i
on: cef ur oxime( Cef tin) Ent erococcus
 Commonuse: otitismedi a, o Commonuses:
CAP, si nusi nf ect ion( ifabx  Pol ymi crobi al infect ions( e.g. ,
indi cat ed) moder at e-sev eredi abet icf oot
 3rdgener ation: cef dinir( Omni cef ) i
nf ect ion)
 Commonuse: CAP, sinus  Empi rict her apywhenr esi st ant
infect i
on( ifabxi ndi cat ed) organi smsar esuspect ed
 Cl assef fect : duet osmal lrisk  Resi st antPseudomonasor
(<10%)ofcr ossr eact i
v i
t y,ont he Aci net obact eri nfect i
ons( except
exam donotchoosea ertapenem)
cephal ospor i
ni fthepat ienthasa o Av oidi nPCNal lergy
PCNal l
er gy; except ion: sy phi li
si na o Sei zur erisk
pregnantpat ient ,otitismedi a  Ri sk wi thdose, renal i
mpai rment
o Inpat
ient(par ent eral) oruseofi mi penem- ci l
ast atin
 1stgener ation: cef azol i
n o Al lareI Vonl y( er tapenem mustbedi lut edi n
 Commonuse: sur gical PPx NS)
 2ndgener at i
on: cef ot etan, cef oxi tin  St
udyt
ip:ami nogl ycosi des-goodnewsandbadnews
 Anaer obecov er age( B. o Goodnews
fragi lis)  Ami nogl ycosi deski l
l gram
negat ivesf ast , aresy ner gi st i
cwi th
 Commonuse: sur gical PPx
bet al act amsf orsomeor gani sms,
(col or ect al procedur es)
andhav el owr esistanceanddr ug
 Cef otet ancancause
cost
disul f
iram- li
ker eact ion
o Badnews
wi thETOHi ngest ion
 Theyhav enot ablet oxici ties: r enal
 3rdgener ation: cef tri
axone,
damageandhear ing
cefot axime
l
oss/ tinni tus/ bal ancepr obl ems
 Commonuse: CAP,
(otot oxi city )andr equi remoni tor ing
meni ngi ti
s, SBP,
o Smar tidea
py elonephr iti
s
 Takeadv ant ageoft he
 Cef tri
axonenor enal
concent rat iondependentki net ics
adj ust ment
gi vel ar gerdosesl essf requent l
y
 Donotusecef tri
ax onei n gi veski dney stimebet ween
neonat es( age0- 28d) dosest or ecov er
 Cef tazidime( 3rdgener at i
on)and  Ext endedi nter val dosi ng
th
cefepi me( 4 gener at i
on) nomogr amscannotbeusedwi t h
 Act i
v eagai nst ESRD, bur nsandaf ewot her
Pseudomonas condi ti
ons
 Cef tolozane- tazobact am,  Ami nogl ycosi desdemonst r atea
ceftazi dine- av i
bact am postant i
bi oticef fect : bact er i
al
 Usedi ncasesofMDR kill
ingcont inuesaf tert heser um
gr am negat iveor gani sms l
ev el dr opsbel owt heMI C
(incl udi ngPseudomonas)  St
udyt
ip:quinol ones
 Cef taroline o Respi ratoryqui nol ones
 Onl ybet alact am t hathas  Lev of l
oxaci n, moxi fl
oxaci n,
cov erageagai nstMRSA gemi floxaci n
  Usedf orPNA( reliableS.
pneumoni aeact i
vity)
o Ant ipseudomonal qui nol ones
 Ci pr ofloxaci n,levof loxaci n
 Usedf orPseudomonasi nfect ions,
UTI , i
nt ra-abdomi nal inf ect ions,
trav eler s’di arrhea( wi thout
5
 dy sent ery ) Studyti
p: SMX- TMP( or al)
o Delafloxaci n o Commonuses
 Usedf orski ninf ect ions, act ive  CA- MRSAski ni nf ect ions, UTI ,
PCP
agai nstMRSA o SMX- TMPdosei sal way sa5: 1r atio
o IVt oPOr at io=1: 1  SSt abcont ai ns80mgTMP
 Lev of l
oxaci nandmoxi floxaci n  DSt abcont ains160mgTMP-
o Pr ofil
er ev iewt ips usual dosei s1t abBI D
 Wat chf orQTpr ol ongat ion( e.g., o Sul f
aal lergy
azol eant ifungal s, ant ipsy chot ics,  Mostsul faal lergi esoccurwi thSMX
met hadone) -TMP; r arel y,sev er eski nr eactions
 Av oi dusei npat ientwi thsei zur es canoccur ; i
fr ashi saccompani ed
 Av oi di nchi ldren byf ev er ,sy stemi csy mpt oms, seek
 Wat chf ort endonr upt ure emer gencycar e
(especi allyi nol derpat ient s, steroid o I NR whenusedwi thwar far i
n, use
use) ,neur opat hy al t
ernativewhenpossi ble
 Renal doseadj ust menti sr equi r
ed  Studyti
p: ni
trofurant oin
foral l exceptmoxi floxaci n o DOCf oruncompl icat edUTI
o Counsel ing o Donotuse
 Av oi dsunexposur e, separ atef rom  CIwhenCr Cl <60mL/ mi n
cat ions, moni torbl oodgl ucose( DM) o Dosi ng
 St
udyt
ip:macr olides  Macr obi di sBI D
o Commonuses:  Macr odant i
ni sQI D
 Al l canbeusedf orCAPandasa o Counsel ing
bet al actam al ter nat ivef orst rep  Takewi thf oodt opr ev entnausea,
throat crampi ng
 Azi thr omy ci nisusedf orCOPD  Candi scol orur ine( brown)
exacer bat ions, asmonot her apyf or  RIPEtherapy
chl amy dia, combi nat iont herapyf or o Moni t
oring:
gonor rhea, andPPxf orMAC  Sput um cul tur e
 DOCf ordy sent er y( TD  CXR
wi thbl oodyst ool s)  CBC( isoni azi d)
 Cl ar ithr omy cini susedi nH.py l
or i  LFTs, incl udi ngTbi l
i (all)
treat ment  Renal funct ion( py razi nami de,
o Azi thromy ci ncommondosi ng ethambut ol)
 ( 2)250mgt abPOx1, then250mg  Ur i
caci d( py r
azi nami de)
POdai lyx4d  Vi siont est smont hly( et hambut ol)
o QTpr olongat ion-wat chf oraddi tiveef f
ect s  Ment al st atus( et hambut ol)
o Cl arit
hromy ci nander ythr omy cinar est rong o Ot her:
3A4i nhibi tor s  Py ridoxi ne23mgPOdai l
yt oreduce
 Lov ast at i
nandsi mv ast at inar eCI ther i
skofI NH- associ ated
( r iskofmuscl et oxi city) per ipher al neur opat hy
o Er ythromy cincausest hemostGIupset  Ri fabut i
ni susedi nst eadof
( gast ricmot il
ity )
,rar elyusedf or rif
ampi ni funaccept abl edr ug-dr ug
i
nfect i
ons inter act ions
 St
udyt
ip:t
etracy clines  Fungalcl
assi fi
cat i
ons
o Commonuses: o Yeast s
 Doxy cy cli
neandmi nocy cl i
ne: CA-  Candi daspeci es( C.al bicans, C.
MRSAski ni nfect ions tropi cal is, C.par apsi losi s,C.
 Doxy cy cli
ne: f
irstl inef orLy me glabr at a, C.kr usei )
disease, RockyMount ai nSpot ted  Cr ypt ococcusneof or mans
Fev er( t
ickbor nei ll
nesses) ,CAP, o Mol ds
COPDexacer bat ion, sinusi tis( i
fabx  Asper gillusspeci es
i
ndi cat ed) ,VREUTI ,monot herapy  Zy gomy cet es( Mucorspeci es,
forchl amy dia, combi nat iont her apy Rhi zopusspeci es)
forgonor rhea o Di mor phicf ungi (mol di nt hecol d;y easti n
 Tet racy cline: H.py l
or i treat ment theheat )
 Donotusei npr egnancy ,  Hi st opl asmacapsul at um
breast feedi ng, chi ldrenage<8y  Bl ast omy cesder mat i
tidis
  Cocci di oidesi mmi ti
s


6
 Studyti
p: azol eant ifungal s Keyfeat
uresofPI s
o Al lcancause≠LFTs o Gener i
cnamesendi n“ -nav ir”
o Onl yf luconazol er equi resr enal dose o Pr imar i
lyCYP450i nhibi tors( al way scheck
adjust ment forDI s)
o Fl uconazol ehasnar r owerspect rum  3A4
o Cov ersC.al bi
canswel l  Ri tonav i
rst rongCYP3Ai nhibi tor
 Usef ul forv agi nal candi diasi s( non- usedt o PIorboost
pr egnant ) concent rat i
ons
 C.gl abr atacanber esist antandC. o Nor enal doseadj ustmentneeded, butmay
krusei isinher ent lyr esist ant beusedaspar tofar egi menwi t
hr enal
o Vor iconazol e rest rictions
 DOCf orAsper gi ll
us o Hepat otoxi city( highestr iskwi tht ipranav i
r)
 Moni t
orf orv isual changes, o Takenwi t haPKboost er( r
itonav ir
, cobi ci
stat
)
phot ot oxici ty to l evel soft hePI
o Posaconazol eandi sav uconazoni um o Met abol icabnor mal i
tiessuchasHLD,
 Act iveagai nstmol dsi ncl udi ng li
pohy per trophy( atazanav i
r, dar unav ir>
Asper gill
usandZy gomy cet es otherPI s) ,insulinr esist ance/ hy per gl
y cemia
 Posaconazol e: tabletdose≠ (highestr iskwi thi ndinav i
r,lopi nav ir/
r)
suspensi ondoseduet odi ff erent o CVDr isk( lowestwi that azanav ir,
bioav ailabi lity dar unav ir)
 KeyfeaturesofNRTI s o GIupset( N/ V/D) ,takewi thf oodt o GISEs
o Renal doseadj ust mentr equi red( except (except ions: fosampr enav i
r ,lopinav i
r/r)
abacav ir
) o Bl eedi ngev ents( i
npat ientswi t
hhemophi l
ia)
o NoCYP450DI s o ECGchanges( especi allysaqui nav i
r /
r,
o Takewi t
houtr egar dst omeal s( except lopinav ir/r,at azanav i
r/ r)
didanosi ne) o Rash( incl udingSJS/ TEN)
o Boxedwar ning: lact i
caci dosi sand  Keyfeat
uresofI NSTI s
hepat omegal ywi t
hst eat osi s( zidov udine, o Gener i
cnamesendi n“ -tegr av ir
”
stav udi ne, didanosi ne>ot herNRTI s) o Nor enal doseadj ustmentneeded( avoi d
o Abacav ir:hy persensi tiv ityr eact ions, testf or Stribi l
di fCr Cl <70mL/ mi n, av oidGenv oyaif
HLA- B* 5701 CrCl <30mL/ mi n)
o Tenof ov irtoxici ti
es: nephr otoxi city , o Nomaj orCYPi nter actions
ost eopor osi s,Fanconi sy ndr ome( thoughtt o o CPK( raltegr av i
r>ot herI NSTI s)
be wi thTAF) o HA, insomni a
o Li poat rophy( stav udi ne, zidov udi net oa o Takewi thoutr egar dst of ood( except ion:
l
esserext ent ) elvitegr av irwi thf ood)
 KeyfeaturesofNNRTI s o I nter act i
onswi thpol yv alentcat ions-must
o Nor enal doseadj ust mentneeded( av oid separ at edose
Atripl aandCompl er ai fCr Cl <50mL/ mi n)  Ant acidswi thal umi num, calcium,
 Mayr equi rehepat icdose magnesi um, zinc, MVIwi thmi nerals
adj ustment  I NSTI sactaschel at ors
o Pr imar yCYP450i nducer s( except ions:  Sel
ectdrugst hatCANCAUSEPAH
efav irenzi sani nducer>i nhi bitor ,ri
lpi v
irine o Cocai ne
i
sasubst rate) o Dasat i
nib( Spr ycel )
o Hepat ot oxici t
yandr ash, incl udingSJS/ TEN o Di azoxi de( Pr ogl ycem)
(nev irapine>ot herNNRTI s) o Met hamphet ami nes
 Moni t
orf orer y thema, faci al edema, o SSRIusedur ingpr egnancy( r iski n
ski nnecr osi s, bl i
st ersandt ongue newbor ns)
swel li
ng o Wei ghtl ossagent s( diet hylpr opi on,
o Foodr equi rement s lorcaser in, phendi met razi ne, phent ermi ne)
 Wi thf ood: et rav irine, ri
lpi viri
ne  Sel
ectdrugst hatCANCAUSEPF
 Wi thoutf ood: ef av i
renz o Ami odar one
o Ef av irenz: CNSef fect s bygi v i
ngat o MTX
bedt i
meonanempt yst omach o Ni trof ur ant oin
o Ri lpiv i
rine: QTpr olongat ion, depr essi on, o Sul f asal azi ne
suici dal i
ty 


7
 Pediat
ri
ccoughandcol dt reat ment-caut ionneeded Asthma
o Chi l
dren<12y  Ageofonset : usual l
y<40y
 Av oi dcodei ne- cont ainingpr oduct s  Smoki nghi story :uncommon
(FDA)  Sput um pr oduct i
on: i
nfrequent
o Chi l
dren<6y  Al l
ergies:common
 Av oi dal lOTCcoughandcol d  Sy mpt oms: i
nter mittentand
product s( AAP) vari
able
o Chi l
dren<4y  Di seasepr ocess: stable,doesnot
 Av oi dmanyOTCcoughandcol d worsenov ert ime
product s( packagel abeling)  Exacer bations: common
o Chi l
dren<2y compl i
cation
 Av oi dOTCcoughandcol dpr oducts  Fi r
st-l
i
net reat ment :inhaled
(FDA) corti
costeroids
 Av oi dpr omet hazi ne( FDA)  Studyt
ip:NICOTINEPATCHdosi ngand
 Av oi dt opi cal ment hol andcamphor admini
str
ation
(packagel abel i
ng) o Thenumberofci gar ettesy ousmokedai l
y
 Studyti
ps:MDIsandDPI s willdet
erminewhi chpat chdosey oushoul
d
o MDI s start
 Br andnamei dent i
f i
ers: HFA, Ci
gar
ett
euse W 1-
6 W 7-
8 W 9-
10
Respi matornosuf fi
x( e.g.,QVAR)
14
 Del iverdoseofaer osol izedl i
quid >10perday 21mg 7mg
mg
medi cat ion
No
 Someuseapr opel lant( HFA)
≤10perday 14mg 7mg recommendat
io
 Admi nistrat ionr equi resasl owdeep
n
i
nhal at i
onatt hesamet i
meas
pressi ngt hecani st ertodel iverthe o Remov ethepat chpr iortobedt i
mei fy ou
dose havev ividdr eams
 Aspacercanbeusedf orpat ients  GoalsforDIABETESI NPREGNANCY
whocannotcoor dinat ebr eathwi th o Fast ing:≤95mg/ dL
dosedel iv er y o 1hrpostmeal :≤140mg/ dL
 Shakewel linmostcases; o 2hrpostmeal :≤120mg/ dL
except i
onsar e: QVAR, Alvesco,  Diabet
esdiagnost iccr it
er i
a
Respi matpr oduct s o Di agnosi sofpr edi abet es
o DPI s  FPG100- 125mg/ dLor
 Br andnamei dent i
f i
ers: Diskus,  2hpl asmagl ucoseof140- 199
Ell
ipta, Pr essai r,Handi hal er
, mg/ dLaf tera75gor al glucose
Neohal er, Respi Cl i
ck tolerancet estor
 Del iveradoseoff inepowder ed  A1c5. 7-6. 4%
medi cat ion o Di agnosi sofdi abet es
 Nopr opel lant  Cl assi csy mpt omsof
 Admi nistrat ionr equi resaqui ckand hy pergl y
cemi a( polyuri
a, pol ydipsia,
forcef ulinhal ation( noneedt o unexpl ai
nedwei ghtloss) ,or
pressany thi ngatt hesamet ime) hy pergl y
cemi ccr isi
sandar andom
 Spacer scannotbeused; thedr ugis plasmagl ucose≥200mg/ dLor
deliveredbyt hebr eathandno  FPG≥126mg/ dLf asti
ngi sdef ined
coor dinat ioni sneeded asnocal or ici ntakef oratl east8h
 Donotshake or
 Studyti
p:COPDv s.ast hma  2hrpl asmagl ucose≥200mg/ dL
o COPD aftera75gOGTT
 Ageofonset :usual ly>40y  A1c≥6. 5%
 Smoki nghi st oryusual ly:>10y  Diabet
esadul ttr
eat mentgoal s( ADA)
 Sput um pr oduct i
on: common o A1c<7%
 Al l
er gies: uncommon o Pr e-prandial plasmagl ucose80- 130mg/ dL
 Sy mpt oms: per si stent o Peakpost -prandi al pl asmagl ucose<180
 Di seasepr ocess: pr ogressiv e, mg/ dL
wor sensov ert i
me  Keydrugs- BLOODGLUCOSE
 Exacer bat i
ons: common o Bet abl ocker s( mayal socausehy pogl ycemi a)
compl ication o Di ureti
cs( thiazi des, loops)
 Fi r
st -
linet r eat ment :bronchodi l
ators o I mmunosuppr essant s( CYA, t
acr oli
mus)
o o Ni acin
o Pr oteasei nhi bitors
o Qui nolones( mayal socausehy pogl ycemi a)
o 2ndgener ation( aty pi cal)ant i
psy chot ics
(cl
ozapi ne, olanzapi ne, quet i
apine)
8
 o Stati
ns Concent r
atedi nsul inpr oduct s
o Systemi csteroids o Rapi dact ingi nsul i
n
o Others: azoleanti
fungal
s(posaconazol
e),  Humal ogKwi kPen: 200uni t
s/ mL
beta-agonists,coughsyrups(OTCandRx), o Regul ar( shor tact ing)i nsul in
di
azoxi de,inter
feronalf
as,oct
reot
ide(may  Humul inRU- 500: 500uni t
s/ mL
al
socausehy poglycemia) o Longact ingi nsul in
  Tr esi baFl exTouch( insul i
n
degl udec) : 200uni ts/ mL
 Touj eoSol oSt ar( insul ingl argine) :
300uni ts/ mL
 Selectdrugst hatcanLOWERBLOODGLUCOSE
o Li nezol id
o Lor caser in( Bel v iq)
o Oct reot ide( canal socausehy per glycemi a)
o Pent ami dine
o Pr opr anol ol andot hernon- sel ect i
v ebet a
blocker s( canal socausehy per glycemi a)
o Qui nine
o Qui nol ones( canal socausehy per glycemi a)
 Studytip:S&SofHYPOTHYROI DI SM
o Col di nt oler ance/ sensi tiv i
ty
o Dr yski n
o Fat igue
o Muscl ecr amps
o Voi cechanges
o Const ipat i
on
o Wei ghtgai n
o Goi ter( possi bl e, canbed/ tlowi odi nei ntake)
o My al gias
o Weakness
o Depr essi on
o Br ady car di a
o Coar senessorl ossofhai r
o Menor rhagi a( heav iert hannor mal menst rual
periods)
o Memor yandment al i
mpai rment
 Selectdrugsandcondi tionst hatcancause
HYPOTHYROI DI SM
o Hashi mot o’sdi sease-mostcommoncause
o Pi tuitar yf ailur e
o Sur gical remov al ofpar toral l ofthet hy r
oid
o Congeni t al hy pot hy roidi sm
o Thy roi dgl andabl at i
onwi thr adioact ive
iodine
o Ext er nal irradi at ion
o I odinedef iciency
o Dr ugs: ami odar one, car bamazepi ne,
eslicar bamazepi ne, int er ferons, l
ithium,
oxcar bazepi ne, pheny toi n,ty rosineki nase
inhibi tors( suni tinib)
 Studytip:LEVOTHYROXI NETABLETCOLORS
o Or angut answi llv omi tony our ightbef ore
theybecomel ar ge, pr oudgi ant s
 25mcg-or ange
 50mcg-whi te( nody e)
 75mcg-v iolet
 88mcg-ol ive
 100mcg-y ellow
 112mcg-r ose
 125mcg-br own
 137mcg-t ur quoi se
 150mcg-bl ue
 175mcg-l il
ac
 200mcg-pi nk
9
  300mcg-gr een Selectf
actorsandcondi ti
onswi thOSTEOPOROSI S
 St
udyti
p:S&SofHYPERTHYROI DISM RISK
o Heati ntoleranceori ncreasedsweat i
ng o Pat ientchar act eristics
o Wei ghtl oss(orgai n)  Adv ancedage
o Agi tat ion, ner
v ousness, i
rri
tabi
li
ty,anxiet
y  Et hni city( whi teandAsi anAmer ican
o Pal pi tationsandt achy cardia womenat r i
sk)
o Fat igueandmuscl eweakness  Fami lyhx
o Fr equentBM’ sordi arrhea  Gender( F>M)
o I nsomni a  Lowbodywei ght
o Tr emor o Medi caldiseases/ condi tions
o Thi nni nghai r  Anor exi a
o Goi ter( possible)  Di abet es
o Exopht hal mos, diplopi a  GIdi seases( I
BD, celiacdi sease,
o Li ghtorabsentmenst rual peri
ods gast ricby pass, ot hermal absor ption
 St
udyti
p:S&SofTHYROI DSTORM sy ndr omes)
o Fev er( >103F)  Hy per thy roi dism
o Tachy car dia  Hy pogonadi sm i nmen
o Tachy pnea  Menopause
o Dehy drat i
on  RAandot heraut oi mmunedi seases
o Pr of usesweat ing  Ot her s: epi l
epsy , HI V/ AIDS,
o Agi tat ion Par kinson’ s
o Del irium o Li fest y
lefact or s
o Psy chosi s  Smoki ng
o Coma  Excessi veETOH
 St
udyti
p:STEROI DSLEASTPOTENTTOMOST  cal cium andv itami nDi ntake
POTENT  Phy si cal inact iv i
t y
o Cut ehotphar maci st sandphy si
ciansmar ry o Medi cati
ons
toget heranddel i
v erbabi es  Ant iconv ulsant s( car bamazepi ne,
pheny t
oi n, phenobar bital)
Corti
sone 25mg
Shor
t-
act
ing  Ar omat asei nhibi tors
Hydrocortisone 20mg
 Depo- medr oxy pr ogest er one
Predni
sone 5mg  GnRH( gonadot ropi nr eleasi ng
Predni
sol one 5mg Int
ermedi
ate- hor mone)agoni st s
Methylprednisol
one 4mg acti
ng  Li thi um
Tri
amci nolone 4mg  PPI s( gast ri
cpH~ Ca
Dexamet hasone 0.
75 absor pt i
on)
Long-
act
ingand
mg  St er oids( ≥5mg/ dofpr edni sone
pot
ency
Bet
amet
hasone 0.
6mg equi v alentf or≥3m)
 KeydrugsthatcancauseDRUGI NDUCEDLUPUS  Thy roi dhor mones( inexcess)
ERYTHEMATOSUS( DI LE)  Ot her s: hepar in, loopdi ur etics,
o Ant i-
TNFagent s SSRI s, TZDs
o Hy dralazine( alone,andi nBiDil
)  Studyti
p:diagnosi sofost eopor osi s
o I soniazi d o T- scor es
o Met himazol e  Nor mal : ≥- 1
o Met hy ldopa  Ost eopeni a: -1t o- 2.4
o Mi nocy cline  Ost eopor osi s:≤- 2.5
o Pr ocai nami de  Studyti
p:CALCI UM ANDVI TAMI ND
o Pr opy l
thiour acil o Cal cium
o Qui nidine  Donotexceed500- 600mgper
o Ter binafine dose( sat urabl e)
 Studyti
p:SEVEREANDRAREADVERSEEFFECTSOF  Cacar bonat e
CONTRACEPTI VES  40%el ement al calcium
o ACHES  Aci ddependentabsor ption
 Abdomi nalpaint hatissevere:can  Mustt akewi thmeal s
indicat ear upturedlivertumor ,cy
st,  Caci trat e
orect opicpr egnancy  21%el ement al calcium
 CP:cani ndicateahear tattack,SOB  Notaci ddependent
cani ndicateaPE  Cant akewi thoutr egar ds
 Headaches:cani ndicateast r
oke tomeal s
 Ey epr oblems: canindicateablood o Vi tami nD
cloti ntheey e  Requi redf orcal ci um absor ption
 Swel l
ingorsuddenl egpain:can  Def iciency : ser um v it
ami nD
indicat eabl oodcl otinthelegs [25( OH) D]<30ng/ mL
  Tr eatdef iciencywi thchol ecal cif
er ol
10
 (D3)orer gocal ciferol (D2) ,dosed St
udyti
p:STATI
NTREATMENTI
NTENSI
TY
dai l
yorweekl y DEFI
NITI
ONSANDSELECTI
ONOPTIONS
 OPIOIDCONVERSI ONS-st epst oconv er t Highintensi
ty Moder ateintensit
y Lowi ntensi
ty
o Cal cul at et het otal 24hdoser equi rementf or LDL≥50% LDL30- 49% LDL<30%
thecur rentdr ug Ator
vastati
n40- Atorvast ati
n10- 20 Simvastati
n10
o Usear atioconv er siont ocal cul atet hedose 80 Rosuv ast ati
n5- 10 Pravastati
n10-
oft henewdr ug Rosuvastat
in20- Simvast at i
n20- 40 20
o Cal cul at et he24hdoseoft henewdr ugand 40 Pravast atin40-80 Lovastati
n20
reducedosebyatl east25% Lovast atin40 Fl
uvastatin20-
o Di v i
det ogetappr oxi mat ei nt erval anddose Fl
uvast at i
nXL80 40
fornewdr ug Fl
uvast at i
n40mg Pit
avastatin1
o BTPdoser angesf rom 5- 17%oft het otal BID
dai l
yopi oiddose Pit
avast at i
n2- 4
 Studyti
p:mor phi ne- typeal lergy Al
lmgdai
l
yunl
essot
her
wisenot
ed
o Thecommondr ugsi nt hesamechemi cal  Studyti
p:managi ngMYALGI AS( muscl esor eness,
classt hatcr oss- reactwi theachot herhav e tender
ness)
codormor phi nt hename; bupr enor phine o Fi rst, holdst atini fi ntol erable,checkCPK,
hasnor phi nst eadofmor ph invest igat eot herpossi blecauses
 Codei ne, hy drocodone, oxy codone o Af t er2- 4w: re- chal lengewi thsamest ati
nat
 Mor phi ne, hydr omor phone, samedoseor dose
oxy mor phone o Mostpat i
ent swhodi dnott olerateast ati
n
 Bupr enor phi ne, her oine will toleratei twhenr e-chal l
enged, orwi l
l
(diacet ylmor phi ne) toler ateadi ffer entst at in
 Keydrugst hat URI CACI D o I fmy algiasr etur nwhent heor i
ginal stati
nis
o ASA, higherdoses reinitiated, discont inueor i
ginalstatin
o Di ur et i
cs( loopsandt hiazides)  Oncemuscl esy mpt omsr esolve,
o Ni acin useal owdoseofadi f
ferentst ati
n
o Py razi nami de o I flowdoseofadi ffer entst atinistolerated,
o Ri bav iri
n gradual l
y dose
o Cal cineur ini nhi bitor s( tacr olimusandCYA)  Studyti
p:STATI NEQUI VALENTDOSI NG
 Studyti
p:GOUTTREATMENTBASI CS o Phar maci st sr ockatsav ingl i
vesand
o Goutpai ni ssev ere prev ent i
ngf lu
o Tr eatacut epai nqui cklyandusedr ugst hat  Pi tav ast at in2mg
hitinf lammat ionhar d:ster oids( i
ncl uding  Rosuv ast atin5mg
intra-ar ticul ari nject ions) , NSAI Ds( of t
enwi th  At or vast atin10mg
highst artingdose) ,orcol chicine  Si mv ast at in20mg
o Oncegouthasst ruck( butnotbef or e)itis  Lov ast at in40mg
treat edchr oni cal lywi thaPPxdr ugbecause  Pr av ast at in40mg
gouti snotapl easantexper ience  Fl uv ast at i
n80mg
 Xant hi neoxi dasei nhi bitors( XOI):  Keydrugsthatcan BP
allopur inol orf ebuxost at o Amphet ami nesandot herADHDdr ugs
 Anacut egoutf lar ecanhappen o Cocai ne
whenXOI ’sar est arted, sogi ve o Decongest ant s( pseudoephedr i
ne,
i
ni ti
al l
ywi thcol chi cineoranNSAI D pheny lephr ine)
 I fXOIdi dn’ twor kwel l enough( UA> o Er y thropoi esi sst imul at ingagent s
6mg/ dL) o I mmunosuppr essant s
 Addonl esinur ad o NSAI Ds
(Zur ampi c)orpr obeneci d- o Sy stemi cst eroi ds
takewi tht hedai lyXOIor o Ot her s:ETOH, appet itesuppr essant s,
 Repl acet heXOIwi th caf feine, her bal s( gi nseng, l
icori
ce, yohimbe) ,
pegl oticase( Kr ystexxa)- mi rabegr on, or al cont racept iv
es, select
IVandhasar iskof oncol ogyagent s( bev aci zumab, tyrosine
anaphy l
axi s kinasei nhi bitor s), SNRI s
 Classi
fi
cationofCHOLESTEROLANDTGLEVELS 
(mg/dL)
o LDL:<100
o HDL:
 <40( M)l ow
 <50( W)l ow
o TG:<150


11
 Keyupdatesf orHYPERTENSI ON Studyt i
p:LONGTERM MANAGEMENTAFTERACS
o Tr eat mentdef init i
ons: (secondarypr ev ent i
on)
 Nor mal : <120/ 80mmHg o ASA: indef initel y( 81mgdai ly),unl ess
 El ev at ed: 120- 129/ <80mmHg cont raindi cat ed
 St age1HTN: 130-139/ 80-89mmHg o P2Y12i nhi bi tor :
 St age2HTN: ≥140/ 90mmHg  Medi cal ther apypat ient s: ti
cagr elor
o I ni
tiati
ngt reat ment : orcl opi dogr el wi t
haspi rin81mg
 Cl inical CVD( CHD, CHF, str
oke)or foratl east12m
anASCVDr i
sk≥10%shoul dbe  PCIt reat edpat i
ent s( incl udi ngany
treat edi fBP≥130/ 80mmHg typeofst ent ) :clopi dogr el, prasugr el
 Wi t houtcl inical CVDandanASCVD ort icagr elorwi t haspi rin81mgf or
risk<10%shoul dbet r
eat edifBP≥ atl east12m
140/ 90mmHg o NTG: indef ini tely( SLt absorspr ayPRN)
 I fASCVDr iski sunknown, o Bet abl ocker : 3y ;cont inuei ndef ini telyifHF
i
tcanbeassumedt hat orifneededf ormanagementofHTN
mostel derlypat i
ents( ≥65 o ACEi : i
ndef ini telyi fEF<40%, HTN, CKDor
y)andpat ientwi th diabet es; consi derf oral lMIpat ient swi thno
comor bidcondi ti
ons cont raindi cat ions
i
ncl udi ngCKDand o Al dost er oneant agoni st s: i
ndef initel yifEF≤
diabet eswi llhav ean 40%andei thersy mpt omat icHForDM
ASCVDr i
sk≥10% receiv i
ngt ar getdoseofanACEi andbet a
 BPgoal sf oral lpatient s<130/ 80 blocker
mmHg  CI : signi ficantr enal impai rment( sCr
o I ni
tialdr ugsel ect ion: >2. 5mg/ dLi nwomen)or
 I nitiat ionof2dr ugsi s hy per kal emi a( K>5mEq/ L)
recommendedi npat i
ent switha o St atin:
basel i
neBP≥140/ 90mmHg( stage  Pat ient s≤75yhi ghi ntensi tystatin
2HTN)andi fBPi s>20/ 10mmHg  Pat ient s>75ymoder at ei ntensi t
y
abov egoal st at i
n
 Thi azi de- typedi uretic,DHPCCB,  Keydr ugsthatCAUSEOFWORSENHF
ACEi orARBshoul dbeusedf i
rst o Ant i
ar rhy thmi cs: av oi dcl assIagent s
l
ine (procai nami de, qui ni dine, f
lecai ni de)i nHF;
 Bl ackpat ientsshoul dbepr eferably ami odar oneanddof et ili
dehav el essr i
skof
treat edwi that hiazideorCCB wor seni ngHF
 Anypat ientwi thst age3CKD, stage o Oncol ogyagent s: ant hracy clines
1or2CKDwi thal bumi nuriaor (doxor ubi cin, daunor ubi cin)
diabet eswi t
hal bumi nuriashoul d o Non- DHPCCBs: dilti
azem andv er apami l
recei v eanACEi orARBf i
rstli
ne (especi al lyi nsy stol i
cHF)
 Treat
mentappr oachf orSI HD o Thi azol idi nedi ones: r iskofedema
o A: anti-
PLTandant iangi nal drugs o NSAI Ds: all (incl udi ngcel ecoxi b)
o B: bl oodpr essur eandbet abl ocker s o I mmunosuppr essant s: TNFi nhi bitor s
o C: cholest er ol ( stat ins)andci gar ett
es (etaner ceptandr i
tuxi mab)andi nter ferons
(cessat ion) o I tr
aconazol e
o D: dietanddi abet es o Ot her s: sy st emi cst er oids, amphet ami nes,
o E: exer ciseandeducat ion othersy mpat homi met ics, ill
icitdr ugs,
 Studyti
p:DRUGTREATMENTOFACS tri
ptans( CIwi thhi stor yofCVdi seaseor
o MONA- GAP- BA uncont rol l
edHTN) ,oncol ogyagent s,TKI s
 Mor phi ne (l
apat ini b, suni tinib)andagent st hatcause
 O2 fl
uidr et ent ion( trast uzumab, imat inib,
 Ni trat es docet axel ), excessi veETOHuse
 Aspi rin  Keydr ugsthatcan ORPROLONGTHEQT
 GPI Ib/ III
aant agoni sts I
NTERVAL
 Ant icoagul ant s o Ant i
ar rhy thmi cs: classI( especi allyI aand
 P2Y12i nhi bitors classI II)
 Bet abl ocker s o Abx: qui nol ones, macr olides
 ACEi nhi bitors o Azol eant i
fungal s: (most )
 NSTE- ACS: MONA- GAP- BA o Ant i
depr essant s: TCAs( ami tri
pt yline,
¬+/ -PCI clomi pr ami ne, desi prami ne, doxepi n,
 STEMI :MONA- GAP- BA+ imiprami ne) , SSRI s( ci talopr am, esci talopram,
PCIORf i
br i
nol yti
c(PCI other s), SNRI s, mi rtazapi neandt razodone
pref erred) (sertralinei spr ef er redi ncar diacpat ients)
 o Ant i
emet icagent s: 5HT3ant agoni sts,
droper i
dol ,phenot hiazi nes
o Ant i
psy chot ics: chl orpr omazi ne, cl ozapi ne,
12
 haloper idol ,olanzapi ne, paliperidone, o Let
tuce
quet i
api ne, ri
sper idone, t
hior i
dazi ne, o Mustardgreens
ziprasidone o Par
sley
o Soybeanoil
o Ot hers: donepezi l
, met hadone
o Spi
nach
 Studyt
ip:VaughanWi l
liamscl assi fi
cat ion o Swisschard
o Doubl equar terpounder ,lettuce, may o,fries o Tea
pleasebecausedi etingdur ingst ressi s o Tur
nipgreens
alway sv er ydi fficult o Watercr
ess
 Cl assI  CHA2DS2VAScscor ingsy stem
 I a: disopy r ami de, qui nidine, o CHF
procai nami de o HTN
 I b: l
idocai ne, mexi let i
ne o Age2≥75y
 I c:f l
ecai nide, pr opaf enone o Di abet es
 Cl assI I o Pr iorst r
oke/ TIA
 Bet abl ocker s o Vascul ardisease( pri
orMI , PAD, aor ti
c
 Cl assI II plaque)
 Dr onedar one, dof etili
de, o Age65- 74y
sot al ol,i
but il
ide, o Sex, femal e
ami odar one  Studyti
p:diagnosi sandt reatmentofi rondef iciency
 Cl assI V anemia
 Ver apami l,dil
tiazem o Labf indings
 Studyt
ip:conv ersi onbet weenant i
coagul ants  Hgb, mi crocy tosis( MCV<80f L)
o Fr om war farint oanot herant icoagul ant and RBCpr oduct ion(
 St opwar farinandconv ertt o reticul
ocy tecount )
(READ) :  serum i r
on, fer ri
ti
n, andTSAT
 Ri v ar oxabanwhenI NRi s<  Manyi r
onbi ndingsi t
esav ailable
3 ( TI BC)
 EdoxabanwhenI NRi s≤ o Tr eat ment :orali
ront herapy
2.3  Recommendeddose: 100- 200mg
 Api xabanwhenI NRi s<2 element al i
ronperday
 Dabi gat r
anwhenI NRi s<2  Absor ptioni s wi t
h:
o Fr om or al Xai nhi bitors( apixaban, edoxaban  Food: takeonempt y
andr ivar oxaban)t owar farin: stomach
 St opXai nhi bitor.St artpar ent eral  gast ricpH: avoi d
ant i
coagul antandwar farinatnext H2RAsandPPI s,separ ate
schedul eddoseoft hef act orXa from ant acids
inhibit or.  SRorent eri
ccoat ed
o Fr om dabi gatrant owar fari
n: formul as
 St artwar farin1- 3dbef orest oppi ng o Goal s: i nser um Hgbby1g/ dLev ery2-3w,
dabi gat ran( det ermi nedbyr enal cont i
nuet reatmentf or3- 6m af teranemi a
funct ion) . hasr esolvedunt ilironst or esr eturnt o
 Studyt
ip:WARFARI NTABLETCOLORS nor mal
o Pl easel etGr egBr ownbr ingpeachest oy our %element alir
oninor
alpr
oducts
weddi ng Fer
rousgluconat e 12%
 Pi nk1mg Fer
roussulfate 20%
 Lav ender2mg Fer
roussulfate,dri
ed 30%
 Gr een2. 5mg Fer
rousfumur ate 33%
 Br own/ tan3mg Car
bonyl i
ron 100%
 Bl ue4mg Pol
ysaccharideironcompl
ex 100%
 Peach5mg
 Teal 6mg  Keydr
ugst
hatcancausehemol
yti
canemi
a
 Yel l
ow7. 5mg o Dr
ugi
nduced( acquired)
 Whi te10mg  Bet al actamasei nhibitors
(clav ulanate,sulbactam, tazobact
am)
 Foodshighinv itami nK
o Broccoli
 Cephal ospor i
ns( ceftr
iaxone,
o Brusselsprout
s cef otetan)
o Cabbage  I soni azid
o Canolaoil  Lev odopa
o Caulif
lower  Met hyldopa
o Chickpeas  PCN( piperacil
l
in)
o Coleslaw  Pl at i
num basedchemot herapyagent
s
o Coll
ardgreens (car bopl at
in,ci
spl at
in,oxali
plat
in)
o Coriander  Qui nidine
o Endive  Qui nine
o Greenkale
13
  Ribavir
in KeydrugsthatCAUSEORWORSENDEPRESSI ON
 Rifampin o ADHD: met hy lpheni dat e, at omoxet i
ne
o Hi
ghri
skwi
thG6PDdef ici
ency(
inher
it
ed) o Anal gesi cs: indomet haci n, met hadone
 Chloroquine o ART: ef av i
r enz( inAt ripla) ,r i
lpi vrine( in
 Dapsone Compl er a, Odef sey )
 Met hyl
eneblue o CV: BB( propr anol ol ),cl oni di ne, met hy l
dopa,
 Nitrof
urantoi
n procai nami de, reser pi ne
 Primaquine
o Hor mones: cont racept i
v es, anabol icst eroids
 Probenecid
o Ot her s: ant idepr essant s, sy st emi cst er oids,
 Rasbur i
case
 Sulfonamides
CYA, ETOH, isot retinoi n, int er fer ons,
var eni cline

o Medi cal condi tions: stroke, Par ki nson’ s,
dement ia, MS, thy roi ddi sor der s, v itami nD
level s, met abol iccondi tions, mal ignancy
 KeydrugsthatcancausePSYCHOTI CSYMPTOMS
o Ant ichol iner gi cs( cent rally -
act ing, highdoses)
o Cannabi s
o Dext romet hor phan
o Dopami neordopami neagoni stsusedi n
Par kinson’ sdi sease( Requi p, Mi rapex,
Sinemet )
o I ll
i
ci tsubst ances: bat hsal ts, cocai ne, LSD,
met hamphet ami nes, PCP
o I nter fer ons
o St imul ant s
o Sy stemi cst er oids
 Studyti
p:impor tantADVERSEEFFECTSOF2ND
GENERATI ONANTI PSYCHOTI CS
o Met abol i
cSEs
 Hi ghestr isk: cl ozapi ne, ol anzapi ne,
quet iapi ne
 Moder at er isk: risper idone,
pal iper idone
 Lowerr isk: ar i
pi pr azol e, zipr asidone,
lur asi done, asenapi ne
o EPS
 Hi ghestr isk: pal iper idone,
risper idone
 Lowestr isk: quet i
api ne
(recommendedi npat ient swi th
Par kinson’ swhor equi re
ant i
psy chot i
cs)
o Hemat ologi cef fect s
 Hi ghestr isk: cl ozapi ne
(agr anul ocy t
osi s)
o QTpr ol ongat i
on
 Hi ghestr isk: zipr asi done,
thi oridazi ne
o pr ol act in
 Hi ghestr isk: risper idone,
pal iper idone
o Sei zur e
 Hi ghestr isk: cl ozapi ne( dose
dependent )
 Studyti
p:LITHI UM noteasyt oi nitiat e
o CommonSEs
 Nausea, anor exi a, abdomi nal pain,
thi rst, sedat i
on, conf usi on, tremor
o Suggest i
onst ohel p
 Ti trat esl owl y ,possi blyshi ftmor e
oft hedoset oQHS
 Suggestt aki ngdoseatendofmeal ,
foodi nt hest omachhel ps
 Dr inkadequat ef luidsav oid
14
 dehy dr at i
on  Keydrugst hatcauseANXI ETY
o Dosecor r ect l
y o Al but er ol (ifusedt oof r equent lyor
 5mLl ithium ci tratesol uti
on=8 incor rect ly)
mEq o Ant ipsy chot i
cs( ar ipipr azol e, haloperidol )
 8mEq=300mgl i
thi um car bonat e o Bupr opi on
tabs/ caps o Caf f eine
 Studyti
p:PDt hecause, sy mpt omsandpr i
mar ydr ugs o Decongest ant s
tr
eatment o I l
licitdr ugs
o Neur onsdeepwi thi nt hebr ai nst em, int he o Lev ot hy roxine
subst ant iani grar egi ondegener at i
on o St er oi ds
 Thi spar toft hebr ai ncont rols o St imul ant s
mot orf unct i
on, i
ncl udi ng o Theophy l
line
mov ementandbal ancebyr eleasi ng  Studyti
p:met abol ism andsaf et yofBZDs
theNTdopami ne, whi cht ransmi ts o LOT
themov ementi nst ruct ionst oot her  Lor azepam
par tsoft hebr ai n  Oxazepam
o I nPD: DA i
nst ruct ions mov ement  Temazepam
pr oblems, whi char ecal ledt heTRAPmaj or  Theseagent sare
sy mpt oms consi der edt obe
 TRAP pot ent iallyl esshar mf ul for
 Tr emor : whenr est i
ng, olderadul t
sandpat ients
wor senedbyanxi ety wi t
hl iveri mpai rmentsi nce
 Ri gidit y: i
nl egs, ar ms, theyar emet aboli
zedi n
trunk, andf ace( maskl ike i
nact ivecompounds
face) (glucur oni des)
 Aki nesi a/ brady kinesi a:  Keydrugs/condi tionst hatcanLOWERTHESEI ZURE
lackof / slowst artin THRESHOLD
mov ement o Ant ipsy chot i
cs
 Post ur al inst abi l
ity: o Ant iv irals
imbal ance, f all
s o Bupr opi on
 Addi t
ional sy mpt oms o Car bapenems, especi al lyi mipenem ( with
 Smal l,cr amped higherdosesand/ orr enal i
mpai rment )
handwr iting o Cephal ospor ins
 Shuf flingwal kbentov er o Li thi um
body o Li ndane
 Muf fledspeech, drool ing, o Mef loqui ne
dy sphagi a o Meper idine( chr oni cdosagewi thpoorr enal
 Depr essi on, anxiet y funct ion)
 Const ipat ion, incont i
nence o Met ocl opr ami de
o Pr imar yt reat ment : repl aceDA o PCNs
 Gi v eapr ecur sort oDAt hat o Qui nol ones
becomesDAi nt hebr ain( levodopa o ETOHwi thdrawal
i
nSi nemet ) o I nfect ionandf ev er( especi allyinchi l
dren)
 Gi v enadr ugt hatact sl i
keDA( DA o Theophy l
line
agoni st s) o Tr amadol
 KeydrugsDAbl ocki ngdr ugst hatcanwor senPD o Var eni cline
o Pr ochl or per az ineandot herphenot hiazines  Studyti
p:AEDsar eCNSdepr essant s
usedf orpsy chosi s, nausea, agi tati
on o AEDsDEPRESSel ect rical act i
v i
tyinthebr ain;
o Hal oper idol ordr oper idol theyar eCNS- DEPRESSant sandcause
o 2ndgener ationant ipsy chot i
cssuchas dizzi nessconf usi on, sedat ionand
risper idoneandpal i
per idone ataxi a/ coor dinat i
ondi fficul ti
es
o Met ocl opr ami de, renal l
ycl ear edt hatcan o They t her iskf ori mpai rment ,fall
sand
accumul at ei nt heel der ly injur ies
 Keydrugst hatcanWORSENDEMENTI A o Someoft heAEDscausemor eCNS
o Ant ihist ami nesandant iemet i
cs depr essi ont hanot her s; thisi sani mpor tant
o Ant ipsy chot ics consi der ationf orschool -agedchi ldrenand
o Bar bitur at es frail el der l
yatr i
skf orf al ls
o BZDs  Studyti
p:AEDshav eal otofdr ugi nteract i
ons
o Cent r
al ant ichol i
ner gics( benzt ropine) o St r ongenzy mei nduci ngAEDs
o Per ipher al ant ichol iner gi cs( i
ncl uding  Car bamazepi ne
incont i
nenceandI BSdr ugs)  Oxcar bamazepi ne
o Skel etal muscl er elaxant s  Pheny toin
o Ot herCNSdepr essant s  Fospheny toin
 Phenobar bital
15
  Pr i
mi done St
udyt
ip:ADJUSTI NGPHENYTOI NDOSES
 Topi ramate( doses≥200mg/ d) o Pheny t
oinhasMi chaelis-Mentenkinet
ics,
o Val pr
oicacid l amot rigi
nelevel
s alsocall
edsat ur
ableki neti
cs
 St
udyt
ip:AEDsandt eratogenicity o Asmal l i ndosecancauseal arge i n
o AEDscancausef et
alhar m drugleveliftheenzymeshav ebecome
o Cont racepti
oni srequiredforwomenofchild saturat
ed
beari
ngage o I fal
bumi nislow( <3.5g/ dL),
andCr Cl≥10
o Enzy mei nducingAEDsdecr easetheef
fi
cacy mL/ min,adjustt
het otallevel
swiththe
oforalcontraceptiv
es formula
 Phenyt
oinc or
rect
ion=
tot
alphenytoinmeasured
(0.
2×a lbumin)+0.1
o Fr eelevelsdonotr equi reanycor rect i
on
 Studyt
ip:allMedgui der equi red
o War ni
ngs: sui cider isk; moni tormood
o Ter atogeni cit y:cont r acept ionmaybeneeded
o Rash, hyper sensi ti
v i
tyr eact i
onscanbe
severe
 Studyt
ip:Lamictal st arterki t-col orshel psaf ety
o Or ange
 St andar dst ar tingdose
 Usei fnoi nt er actingmedi cations
o Bl ue
 Lowerst artingdose
 Usei ft akingVPA
o Gr een
 Hi gherst ar tingdose
 Usei ft akinganenz y meinducer
(car bamazepi ne,pheny t
oin,
phenobar bital ,primidone)andnot
taki ngVPA
 Studyt
ip:pheny t
oinadmi nist rat i
on
o I Vfospheny toin
 Donotexceed150mgPE/ minute
moni torBP, respirat oryfunction
andECG
 Lowerr i
skpur plegl ov esy ndrome
thanpheny toin, whi chcanr esulti
n
tissuenecr osi s
o I Vpheny toi n
 Donotexceed50mg/ min( sl
ower
i
nf usi on)samemoni t
ori
ngasabov e
 Requi resaf ilter,stabl ef
or4h
o Gt ubepheny toi n
 Ent er al f
eedi ng pheny toin
absor pt i
on
 Hol df eedi ng1- 2hbef or
eandaf t
er
admi ni stration
 CausesofGAPACI DOSI S
o CUTEDI MPLES
 Cy ani de
 Ur emi a
 Tol uene
 ETOH
 DKA
 I soni azi d
 Met hanol
 Pr opy lenegl ycol
 Lact i
caci dosi s
 Et hy l
enegl ycol
 Sal icy l
ates


16
 Keydrugswi th ABSORPTI ON Keydrugst hatcauseDI ARRHEA
o Agent st hatr equi reanaci dicgut( absor pti
on o Ant aci dscont ainingmagnesi um
byant aci ds, H2Ras, PPI s) o Abx, especi allybr oad- spect r
um ( clindamy cin,
 ART: del av irdine( NRTI ),r
ilpivi
r i
ne EES)
(NNRTI ),at azanav ir(PI) o Ant ineopl ast i
cs
 Ant iv i
ral s: l
edi pasv i
r, o Col chi cine
vel pat asv i
r/ sof osbuv ir o Laxat ives
 Azol eant i
fungal s o Met ocl opr ami de
 Cephal ospor ins( PO) :cefdi t
or en, o Mi sopr ost ol
cef podoxi me, cef uroxi me o Qui nidi ne
 I ronpr oduct s  Keydrugst hatcancauseED/ SEXUALDYSFUNCTI ON
 Mesal ami neEC o Ant idepr essant s: SSRI sandSNRI s( most l
y
 Ri sedr onat edel ay ed-release libido)
 TKI s: dasat ani b, er l
otinib, o Ant i-HTNs: BBs, cl oni di
ne, ot her s
pazopani b, ot her s o Ant ipsy chot i
cs: 1stgener ati
on( hal oper i
dol,
o Ot herdr ugs/ drugcl assest hatant acidsbi nd fluphenazi ne, chl or promazi ne) ,pr olactin
 ART( INSTI )dol ut egr avir, raisi ng2ndgener at ion( risper idone,
elv i
tegr av i
r, raltegr av i
r pal iper i
done)
 Bi sphosphonat es o BPH: finast eride, dut ast er i
de, silodosi n
 I soni azi d (most l
yr et r
ogr adeej acul ation)
 MMF o Ot her s: ETOH, ant icancerdr ugs( leupr ol
ide,
 Qui nol ones flut ami de) ,ant i
chol iner gics, atomoxet i
ne,
 Sot al ol digoxi n, H2Ras, nicot ine, opioi ds( chr onic,
 St eroi ds( budesoni de) esp.met hadone)
 Tet racy clines  Keydrugst hatcanWORSENBPH
 Thy roidpr oduct s o Ant ichol iner gics
 Medicalcondi ti
onst hatcauseCONSTI PATI ON o Ant ihist ami nes
o I BS- C o Caf fei ne
o Anal disor der s( fissur es, fistulae, rectal o Decongest ant s
pr olapse) o Di ur et i
cs
o MS o SNRI s
o CVev ent s o TCAs, phenot hi azines
o PD o Test ost er onepr oduct s
o SCt umor s  Keydrugst hatcan I OP
o Di abet es o Ant ichol iner gics
o Hy pot hy roidi sm o Cough, col dandmot ionsi ckness
 Keydrugst hatar eCONSTI PATI NG medi cat i
ons
o Al umi num ant aci ds o Chr oni cst eroids, especi all
yey edr opssuch
o Ant ichol iner gicdr ugs aspr edni sol one
o Non- DHPCCBs( especi allyv erapami l) o Topi r amat e
o Bi smut h  Studyti
p:gl aucomat reat ment- I OP
o Cl oni dine o Make f luid( BBl iket imol ol )
o Col esev elam o Mov ef l
ui dout( wi thPGanal ogs, like
o I ron latanopr ost )
o Opi oids o Ordobot h, addonbr imoni dine
o Sucr alf ate( cont ai nsanal umi num compl ex)  Keydrugst hatar eknownt oCAUSEVI SION
o Ot her s: 5-HT3r ecept orant agoni st s CHANGESORDAMAGE
(ondanset ron) ,ar ipipr azol e, mi l
naci pran, o Al phabl ocker s
phent ermi ne/ topi ramat e, ranol azine, o Ami odar one
tramadol /tapent adol , var enecl ine o Di goxi n
 Studyti
p:whatt or ecommendf orOTC o Chl or oqui ne
CONSTIPATI ON o Et hambut ol
o Adul ts o Ezogabi ne
 Most :fiber( Met amuci l
) o Hy dr oxy chl oroqui ne
 Onopi oi ds: senna, bisacody lsupp. o I sot r etinoi n
 Oni ronori fst ool i
sv eryhar d: o Li nezol id
docusat e o PDE5i nhi bitors
 Needt ogobutneedsomet hing o Tamoxi fen
gent l
e: glycer i
nsupp. o Vor iconazol e
o Chi ldr en 
 Gl ycer insupp.


17
 Dr
ugst
hatcandi scol orskinandsecr eti
ons Keydr
ugs/conditionst hatcancauseWEI GHTGAI N
o Br own: lev odopa, entacapone, met hyl
dopa o I nsuli
n,sul fony l
ureas, gli
tazones
o Br own/ black/ green: met hocarbamol o Ant ipsychot ics
o Pur ple/or ange/red: chlorzoxazone o St eroids
o Br own/ yel l
ow: met r
oni dazole,ti
nidazol
e, o Mi r
tazapi ne
ni
trofurant oin,ri
boflavin( B2) o Dr onabi nol,megest rol
o Or ange/ yel l
ow: sulf
asal azine o Condi ti
ons: hypot hy roidism
o Yel l
ow- green: propof ol,fl
utamide o Ot hers: divalproex ,VPA, TCAs, MAOI s,
SSRIs
o Red- orange: phenazopy ri
dine,ri
fapenti
ne, (paroxetine) ,l
ithi
um, pr egabal i
nand
ri
fampin gabapent i
n
o Red: ant hr acycl
ines, deferasir
ox( uri
ne)  Keydr
ugs/conditionst hatcancauseWEI GHTLOSS
o Bl ue:mi toxant r
one, met hy l
eneblue o St imulant s
o Bl ue-
gray : chloroquine, amiodarone o Exenat i
de( By etta),li
r aglutide(Victoza,
 Saxenda)
o Topi ramat e
o Ot hers: AEDs, praml int i
de( Syml i
n),
bupropion, acet ylchol inesterasei nhi
bit
ors
(donepezi l,ri
vast i
gmi ne,gal antamine)
 Hy pot hyroidism, Lupus, cel
iac
diasease, Chr on's

CommonCYPdr ugsandt hei

rmet abolicpathways
CYP1A2 CYP2C9 CYP2C19 CYP2D6 CYP3A4
Caff
eine War f
ari
n Omepr azole Codei ne Clarithromy ci
n
Theophyl
li
ne Phenytoin Esomepr azole Dext romet hor
phan Erythromy cin
Gli
pizi
de Lansopr azole Hy drocodone Quinidi ne
Glyburi
de Pant oprazole Oxy codone Midazol am
Citalopram (mi nor) Alprazol am
Vor i
conazole Fl uoxet ine Diazepam
Clopidogr el Hal oper i
dol CYA
Venl afaxine Tacr olimus
Par oxetine Aml odi pine
Duloxet ine Dil
tiazem
Risper i
done Nifedi pine
Propr anol ol Verapami l
Met opr olol Ator vast ati
n
Tamoxi fen Lov ast atin
Simv ast atin
Estrogens
Carbamazepi ne
Oxy codone
(maj or)

18