Notes

Naplex Notes:
Anemia Chapter
- Recommended dose for iron deficiency anemia is 100-200 mg elemental iron per day
- Anemia will resolve in 6-8 weeks but iron should be taken for several months after to replete stores
- Iron sulfate is the most used and contains 20% elemental iron
- Intrinsic factor is required for vitamin B12 absorption, if pt doesn't have intrinsic factor they are at risk for this
- Macrocytic anemia - largely due to vit B/folate deficiency and common causes are : Chrone's dz, metformin, PPI chronic use
- G6PD deficiency: leads to hemolytic anemia: avoid sulfonamides and nitrofurantoin
- Drug induced hemolytic anemia:
- beta-lactamase inhibitors, cephalosporin, isoniazid, levodopa, methyldopa, penicillin, quinidine, ribavirin, rifampin,
platinum based chemotherapy
- Docusate is the preferred treatment for iron constipation
- Ferrous fumarate is 30% elemental iron

Anxiety:
- buspirone takes 2-4 weeks for maximum effect
- valerian, kava, St. John's wort, passionflower
- LOT for elderly pts (Temazepam is longer acting and not for anxiety, only sleep!)

Arrythmias
- Positive ANA indicitive of DILE: procainamide can cause DILE
- hypokalemia increases risk of digoxin toxicity
-Dofetilide must monitor RENAL and ECG
- What is the goal heart rate for patients with symptomatic afib? < 80; may have a goal of <110 if asymptomatic with pEF
- Flecainide and encainide associated with increasted mortality
- lopressor is metoprolol and blocks calcium channel blocker in the SA node
- digoxin is renally eliminated: hypokalemia and poor renal function can increase toxicity risk
- Amiodarone AEs: corneal deposits, hypothyroidism, photosensitivity, nausea, dizziness, hOTN, bradycardia
- Dronedarone has boxed warnings against mod- severe heart failure (Class IV) and don't use in pts with perm afib
- For rate control strategy, need rate med plus either ASA/oral anticoag. P2Y12 along not ok, need it with aspirin
- Amiodarone is the preferred antiarrythmic for pts with heart failure
- When going from oral digoxin to IV, reduce dose by 20-25% (or calculate 80% of dose)
- Multaq is dronedarone
- Anzemet is dolasetron and norco does not cause qt prolongation
- afib therapeutic digoxin levels are .8-2, but hf levels are .5-.9
- When starting digoxin and amiodarone, decrease levels of digoxin by 30-50%
- Diltiazem is Class IV antiarrythmic

Asthma
- advair diskus contains long-acting beta-2 agonist (which opens the airways) and an inhaled corticosteroid (which reduces inflammation).
-Severent Diskus has salmeterol (LABA)
- FLOVENT contains fluticasone
- The therapeutic range for theophylline is 5-15 mcg/mL (peak levels at stead state are appropriate)
- steady state peak levels are appropriate, use IBW for dosing for most patients, but if actual is < ideal, then use the total
body weight
- Prevnar 13 is not indicated in asthma, but Pneumovax 23 is recommended for al a2-64, with second dose after the age of 65
- Major side effects of inhaled beta-2 agonists: nervousness, tremor, shakiness, cough, tachycardia, hyperglycemia, hypokalemia
- Cipro, clarithromycin, and zafirlukast can increase levels of theophylline
- Respiclick inhalers are DPIs, and have a similar shape to MDI but shoudl NOT be shaken and the dose should be administered with a quick, forceful inhalation
-Regarding peak flow meters.... if the value is <150 mL go to the hospital immediately regardless of symptoms, and record the HIGHEST number each day in a log book