Naplex review
[Document title]
DRUGS
Renal:
Loop diuretics: bumetanide, furosemide, torsemide – can harm bones if long-term use
Thiazide diuretics: chlorthalidone, HCTZ, metolazone, indapamide – protective on bones
Aldosterone antagonists: spironolactone, eplerenone
ACE/ARBs – first line to prevent disease progression in CKD, diabetes, HTN if albuminuria is present
increased baseline SCr is expected; only stop treatment if SCr increases >30%
Hyperphosphatemia: calcium acetate, calcium carbonate (Tums); lanthanum carbonate;
sevelamer carbonate (Renvela), sevelamer hydrochloride (Renagel)
Vitamin D deficiency: calcitriol, cinacalcet (Sensipar) – lead to hyper/hypocalcemia respectively
Anemia of CKD: epoetin alfa (Procrit, Epogen), darbepoetin (Aranesp) + iron (empty stomach, dark stools)
Hyperkalemia: calcium gluconate – does not decrease potassium, but stabilizes heart
regular insulin, dextrose, sodium bicarbonate, albuterol
furosemide, sodium polystyrene sulfonate (Kayexalate), patiromer,
sodium zirconium cyclosilicate, hemodialysis
Liver:
Hepatitis C: direct acting antivirals: “previr”, “asvir”, “buvir” + ribavirin + PEG-INF-alfa
sofosbuvir/velpatasvir (Epclusa) – avoid sofosbuvir w/ amiodarone (bradycardia)
glecaprevir/pibrentasvir (Mavyret) – Epclusa and Mavyret approved for all 6 HCV genotypes
Hepatitis B: PEG-INF-alfa – first-line
NRTIs: tenofovir disoproxil fumarate (Viread), tenofovir alafenamide (Vemlidy),
entecavir (Baraclude), adefovir, lamivudine (Epivir HBV)
Cirrhosis: esophageal varices: octreotide (Sandostatin), vasopressin
portal HTN: nadolol, propranolol
hepatic encephalopathy: lactulose, rifaximin (Xifaxan)
ascites: spironolactone +/- furosemide (100:40)
Cardiology: LDL = TC – HDL – TG/5; BNP >100, NT-BNP > 300 = heart failure; DINATION
Dyslipidemia: statins: Pharmacist Rock At Saving Lives and Preventing Fatty-deposits
ezetimibe, alirocumab (Praluent), evolocumab (Repatha), colesevelam (Welchol)
fenofibrate (Antara, TriCor), gemfibrozil (Lopid), niacin (B3), Lovaza, Vascepa
HTN: 1st line: CCBs, thiazides, ACE-Is, ARBs, direct-renin inhibitor (aliskiren)
others: K-sparing diuretics, beta-blockers, alpha-2-agonists, direct vasodilators, alpha-1 blockers
SIHD: aspirin, clopidogrel, beta-blocker, CCBs, long-acting nitrates, short-acting nitrates
ACS: fibrinolytics: alteplase (Activase), tenecteplase (TNKase), reteplase
GPIIb/IIIa antagonists: abciximab, eptifibatide (Integrilin), tirofiban
anticoagulants: LMWH (enoxaparin, dalteparin), UFH, bivalirudin
prevention: aspirin, clopidogrel, nitroglycerin, ACE-I, beta-blocker, K-sparing diuretic, statin
CHF: ACE/ARB or Entresto, beta-blocker, K-sparing diuretic, BiDil, loop diuretic, digoxin, ivabradine (Corlanor
Arrhyth.: class II: beta-blockers; class IV: verapamil, diltiazem; others: digoxin, adenosine (IV only short DOA
, Naplex review
[Document title]
1a: disopyramide, quinidine, procainamide; 1b: lidocaine, mexiletine; 1c: flecainide, propafenone
class III: amiodarone, dronedarone, dofetilide, ibutilide, sotalol
QT: class I/III, quinolones, macrolides, azoles, antidepressants, antiemetics, antipsych., DFMT
Stroke: ischemic (obstruction): alteplase –ASA 162-325, 24-48 hours after onset (not sooner)
hemorrhagic (rupture): ICH: mannitol; SAH: nimodipine – never administer IV
Anticoagulation: HIT = platelets decreased by 50%; UFH/LMWH antidote = protamine; stop warfarin
Anticoagulants: UFH: anti-IIa/Xa activity; LMWH (enoxaparin, dalteparin): mostly anti-Xa
Factor Xa inhibitors: apixaban, rivaroxaban, edoxaban, betrixaban, fondaparinux (indirect)
apixaban/rivaroxaban antidote = andexanet alfa (Andexxa)
Direct-thrombin inhibitors: dabigatran – antidote = idarucizumab (Praxbind), argatroban, bivalirudin
Vitamin K antagonist: warfarin – Please Let Greg Brown Bring Peaches To Your Wedding
Kcentra (prothrombin complex) can be given with vitamin K if major bleeding
VTE: DOACs – AFib: DOACs if CHADS/VASc ≥ 2 men, ≥ 3 women – Pregnancy/Cancer - LMWH
Anemia: microcytic: ↑TIBC, recommend 100-200mg elemental iron/day; ferrous sulfate = 20% elemental
Microcytic: PO iron: ferrous gluconate, sulfate, sulfate dried, fumarate, (carbonyl, polysaccharide, maltol)
IV iron: iron sucrose (Venofer), ferumoxtol (Feraheme), iron dextran
side effects: dark/tarry stools, constipation (can take docusate for prevention)
Macrocytic: cyanocobalamin (B12, neurological); folic acid/folate (B9, mouth/nail/skin/hair)
Normocytic: CKD ↓ EPO: epoetin alfa (Epogen, Procrit), darbepoetin (Aranesp) + iron
Sickle-cell: chelation removes excess iron; vaccines = Hib, Prevnar/Pneumovax, meningococcal
penicillin BID until age 5, hydroxyurea if recurrent pain crises (+ folic acid) – myelosuppression, teratogenic
Allergic rhinitis:
Intranasal steroids: budesonide (Rhinocort), triamcinolone (Nasacort),
fluticasone (Flonase), mometasone (Nasonex)
st
Antihistamines: 1 gen: diphenhydramine, chlorpheniramine, doxylamine (Unisom)
2nd gen: cetirizine, levocetirizine, fexofenadine, loratadine
intranasal: azelastine, olopatadine – can combine w/ intranasal steroids
Decongestants: oral: phenylephrine (Sudafed PE), pseudoephedrine (Sudafed) – avoid in BPH
intranasal: oxymetazoline (Afrin) – rebound congestion if > 3 days
Others: intranasal cromolyn, montelukast
Cough/Cold: natural products = zinc, vitamin C; avoid OTC cough/cold if <4 (package labeling), <2 (FDA)
Expectorants: guaifenesin (Mucinex, Robitussin) – used for productive cough
Suppressants: dextromethorphan (Delsym, “DM”), codeine, benzonatate (Tessalon Perles)
Eye/Ear: drugs that can ↑IOP: anticholinergics, cough/cold meds, chronic steroids, topiramate
Glaucoma: prostaglandin analogues: latanoprost, bimatoprost (Lumigan), travoprost
beta-blocker: timolol (Timoptic)
cholinergics: pilocarpine, carbachol
carbonic anhydrase inhibitors: dorzolamide, brinzolamide
alpha-2-agonist: brimonidine (Alphagan P)
combinations: (timolol + dorzolamide) = Cosopt/Cosopt PF
[Document title]
DRUGS
Renal:
Loop diuretics: bumetanide, furosemide, torsemide – can harm bones if long-term use
Thiazide diuretics: chlorthalidone, HCTZ, metolazone, indapamide – protective on bones
Aldosterone antagonists: spironolactone, eplerenone
ACE/ARBs – first line to prevent disease progression in CKD, diabetes, HTN if albuminuria is present
increased baseline SCr is expected; only stop treatment if SCr increases >30%
Hyperphosphatemia: calcium acetate, calcium carbonate (Tums); lanthanum carbonate;
sevelamer carbonate (Renvela), sevelamer hydrochloride (Renagel)
Vitamin D deficiency: calcitriol, cinacalcet (Sensipar) – lead to hyper/hypocalcemia respectively
Anemia of CKD: epoetin alfa (Procrit, Epogen), darbepoetin (Aranesp) + iron (empty stomach, dark stools)
Hyperkalemia: calcium gluconate – does not decrease potassium, but stabilizes heart
regular insulin, dextrose, sodium bicarbonate, albuterol
furosemide, sodium polystyrene sulfonate (Kayexalate), patiromer,
sodium zirconium cyclosilicate, hemodialysis
Liver:
Hepatitis C: direct acting antivirals: “previr”, “asvir”, “buvir” + ribavirin + PEG-INF-alfa
sofosbuvir/velpatasvir (Epclusa) – avoid sofosbuvir w/ amiodarone (bradycardia)
glecaprevir/pibrentasvir (Mavyret) – Epclusa and Mavyret approved for all 6 HCV genotypes
Hepatitis B: PEG-INF-alfa – first-line
NRTIs: tenofovir disoproxil fumarate (Viread), tenofovir alafenamide (Vemlidy),
entecavir (Baraclude), adefovir, lamivudine (Epivir HBV)
Cirrhosis: esophageal varices: octreotide (Sandostatin), vasopressin
portal HTN: nadolol, propranolol
hepatic encephalopathy: lactulose, rifaximin (Xifaxan)
ascites: spironolactone +/- furosemide (100:40)
Cardiology: LDL = TC – HDL – TG/5; BNP >100, NT-BNP > 300 = heart failure; DINATION
Dyslipidemia: statins: Pharmacist Rock At Saving Lives and Preventing Fatty-deposits
ezetimibe, alirocumab (Praluent), evolocumab (Repatha), colesevelam (Welchol)
fenofibrate (Antara, TriCor), gemfibrozil (Lopid), niacin (B3), Lovaza, Vascepa
HTN: 1st line: CCBs, thiazides, ACE-Is, ARBs, direct-renin inhibitor (aliskiren)
others: K-sparing diuretics, beta-blockers, alpha-2-agonists, direct vasodilators, alpha-1 blockers
SIHD: aspirin, clopidogrel, beta-blocker, CCBs, long-acting nitrates, short-acting nitrates
ACS: fibrinolytics: alteplase (Activase), tenecteplase (TNKase), reteplase
GPIIb/IIIa antagonists: abciximab, eptifibatide (Integrilin), tirofiban
anticoagulants: LMWH (enoxaparin, dalteparin), UFH, bivalirudin
prevention: aspirin, clopidogrel, nitroglycerin, ACE-I, beta-blocker, K-sparing diuretic, statin
CHF: ACE/ARB or Entresto, beta-blocker, K-sparing diuretic, BiDil, loop diuretic, digoxin, ivabradine (Corlanor
Arrhyth.: class II: beta-blockers; class IV: verapamil, diltiazem; others: digoxin, adenosine (IV only short DOA
, Naplex review
[Document title]
1a: disopyramide, quinidine, procainamide; 1b: lidocaine, mexiletine; 1c: flecainide, propafenone
class III: amiodarone, dronedarone, dofetilide, ibutilide, sotalol
QT: class I/III, quinolones, macrolides, azoles, antidepressants, antiemetics, antipsych., DFMT
Stroke: ischemic (obstruction): alteplase –ASA 162-325, 24-48 hours after onset (not sooner)
hemorrhagic (rupture): ICH: mannitol; SAH: nimodipine – never administer IV
Anticoagulation: HIT = platelets decreased by 50%; UFH/LMWH antidote = protamine; stop warfarin
Anticoagulants: UFH: anti-IIa/Xa activity; LMWH (enoxaparin, dalteparin): mostly anti-Xa
Factor Xa inhibitors: apixaban, rivaroxaban, edoxaban, betrixaban, fondaparinux (indirect)
apixaban/rivaroxaban antidote = andexanet alfa (Andexxa)
Direct-thrombin inhibitors: dabigatran – antidote = idarucizumab (Praxbind), argatroban, bivalirudin
Vitamin K antagonist: warfarin – Please Let Greg Brown Bring Peaches To Your Wedding
Kcentra (prothrombin complex) can be given with vitamin K if major bleeding
VTE: DOACs – AFib: DOACs if CHADS/VASc ≥ 2 men, ≥ 3 women – Pregnancy/Cancer - LMWH
Anemia: microcytic: ↑TIBC, recommend 100-200mg elemental iron/day; ferrous sulfate = 20% elemental
Microcytic: PO iron: ferrous gluconate, sulfate, sulfate dried, fumarate, (carbonyl, polysaccharide, maltol)
IV iron: iron sucrose (Venofer), ferumoxtol (Feraheme), iron dextran
side effects: dark/tarry stools, constipation (can take docusate for prevention)
Macrocytic: cyanocobalamin (B12, neurological); folic acid/folate (B9, mouth/nail/skin/hair)
Normocytic: CKD ↓ EPO: epoetin alfa (Epogen, Procrit), darbepoetin (Aranesp) + iron
Sickle-cell: chelation removes excess iron; vaccines = Hib, Prevnar/Pneumovax, meningococcal
penicillin BID until age 5, hydroxyurea if recurrent pain crises (+ folic acid) – myelosuppression, teratogenic
Allergic rhinitis:
Intranasal steroids: budesonide (Rhinocort), triamcinolone (Nasacort),
fluticasone (Flonase), mometasone (Nasonex)
st
Antihistamines: 1 gen: diphenhydramine, chlorpheniramine, doxylamine (Unisom)
2nd gen: cetirizine, levocetirizine, fexofenadine, loratadine
intranasal: azelastine, olopatadine – can combine w/ intranasal steroids
Decongestants: oral: phenylephrine (Sudafed PE), pseudoephedrine (Sudafed) – avoid in BPH
intranasal: oxymetazoline (Afrin) – rebound congestion if > 3 days
Others: intranasal cromolyn, montelukast
Cough/Cold: natural products = zinc, vitamin C; avoid OTC cough/cold if <4 (package labeling), <2 (FDA)
Expectorants: guaifenesin (Mucinex, Robitussin) – used for productive cough
Suppressants: dextromethorphan (Delsym, “DM”), codeine, benzonatate (Tessalon Perles)
Eye/Ear: drugs that can ↑IOP: anticholinergics, cough/cold meds, chronic steroids, topiramate
Glaucoma: prostaglandin analogues: latanoprost, bimatoprost (Lumigan), travoprost
beta-blocker: timolol (Timoptic)
cholinergics: pilocarpine, carbachol
carbonic anhydrase inhibitors: dorzolamide, brinzolamide
alpha-2-agonist: brimonidine (Alphagan P)
combinations: (timolol + dorzolamide) = Cosopt/Cosopt PF
