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DRUGS THAT ARE ONLY COMPATIBLE IN D5W


Amphotericin B
SMX/TMP
Amiodarone
Levophed
Sodium Nitroprusside
Quinupristin/Dalfopristin

DRUGS THAT ARE ONLY COMPATIBLE IN NS


Dexmedetomidine
Phenytoin (max infusion rate 50mg/min) - Fosphenytoin can mix in D5/NS and pushed at 150mg/min
Ampicillin
Daptomycin
Caspofungin

Drugs with PVC Leaching - tic, tac, toe, craving delicious pho!
Tacrolimus
Tesirolimus
Teniposide
Cabazitaxel
Docetaxel
Paclitaxel

Drugs with PVC Sorption - ACLS TIN


Amiodarone (if infusion > 2hrs)
Caramustine
Lorazepam
Sufentanil
Thiopental
Inuslin (Regular)
NTG

Select IV Drugs
Amiodarone - stable for 24hrs in polyolefin/glass, only 2hrs in PVC - use D5W only
Amphotericin B - use D5W only
Furosemide - IV:PO is 1:2 - protect from light, do not give if solution is yellow
Levothyroxine - IV:PO is 1:2 - protect from light
Metronidazole - IV:PO is 1:1 - protect from light
Phenytoin - IV:PO is 1:1 - max infusion rate 50mg/min - use in-line filter and saline flush
SMX/TMP - IV:PO is 1:1 - use D5W only - protect from light - stability based on concentration

Antidotes For Select Toxicities


Warfarin - Phytonadione (Mephyton)
Anticholinesterase Insecticides/Organophosphates - Atropine/Pralidoxime (Protopam)
BZDs - Flumazenil
BBs - Glucagon
Ethylene Glycol/Methanol - Ethanol or Fomepizole (Antizole)
Heavy Metals - Dimercaprol
Heparin - Protamine
Iron - Deferoxamine (Desferal)
Isoniazid - Pyridoxine (B6)
Opioids - Naloxone
Snake Bites - Crotalidea polyvalent (Antivenin, Crofab)
Drugs with Genetic Testing
CBZ - HLA-B*1502 - asians must get tested - if +, cannot take (SJS/TENS risk)
Clopidogrel - decreased effectiveness if CYP2C19*2 or *3 alleles

Therapeutic Ranges of Meds


VPA - 50-125mcg/mL
Lithium - 0.8-1.2 mEq/L (Trough) - up to 1.5 for acute symptoms
CBZ - 4-12 mcg/ML
Phenobarb - adults 20-40 mcg/mL, children 15-30 mcg/mL
Phenytoin - 10-20 mcg/mL (Total Phenytoin), 1-2.5 mcg/mL (free phenytoin)
Theophylline - 5-15 mcg/mL
Digoxin - 0.8-2.0 ng/mL for a.fib and 0.5-0.9 for CHF
Procainamide - 4-10 mcg/mL
NAPA - 15-25 mcg/mL
Warfarin - INR 2-3 for most, 2.5-3.5 for mechanical mitral valves
Vanco - Trough 15-20 mcg/mL

Causes of Elevated Anion Gap Acidosis (>12) - CUTE DIMPLES


Cyanide, Uremia, Toluene, Ethanol, DKA, Isoniazid, Menthol, Propylene Glycol, Lactic Acidosis,
Ethylene Glycol, Salicylic Acid

Shock
Dobutamine - B agonist - for Cardiogenic Shock
Norepinephrine - a > B - DOC for Septic Shock - Brand Levophed
If extravasation of NE occurs treat with Phentolamine

Propofol (Diprivan) has 1.1kcal/mL

With Clozapine must have WBC > 3500 and ANC > 2000

BZDs that are Less Harmful for Elderly - L-O-T


Lorazepam, Oxazepam, Temazepam

FGA > SGA can cause neuroleptic malignancy syndrome - treat with DANTROLENE

Inhaled Anesthetics can cause Malignant Hyperthermia - treat with DANTROLENE

Phenytoin Effects Pneumonic


P - purple glove syndrome
H - hirsutism
E - enlarged gums (gingival hyperplasia)
N - nystagmus
Y - yucky blood dyscrasias and purple glove syndrome
T - teratogenicity
O - osteomalacia/osteoprosis
I - impaired absorption of folic acid/Ca/VitD
N - neuropathies

Drugs with Risk of SJS/TENS


Lamotrigine (esp if VPA is given too)
CBZ/Oxcarbazepine
Zonisamide
Phenobarb/Primidone
Never use Felbamate (bad anticonvulsant)

Drugs with Saturable/Michaelis Menton Kinetics


Phenytoin
Theophylline
Voriconazole

Drug Interactions:
Strong CYP Inducers - PS PORCS
Phenytoin/Fosphenytoin
Smoking
Phenobarb/Primidone
Oxcarbazepine
Rifampin
CBZ
StJW
Topiramate > 200mg

Strong CYP Inhibitors - G PACMAN


Grapefruit
Protease Inhibitors
Azole Antifungals
Cimetidine
Macrolides - Clarithromycin, Erythromycin, Telithromycin
Amiodarone/Dronedarone
Non-DHP CCBs - Verapamil/Diltiazem
Divalproex - inhibits 2C9 - increases levels of lamotrigine, CBZ, phenobarb,
warfarin, zidovudine
Isoniazid

Drugs That Are Highly Protein Bound and Can Displace Each Other
Phenytoin
Depakote
Warfarin
Salicylates (including pepto)

Drugs That MUST be kept In Fridge


Augmentin Susp
Penicillin VK Susp
Erythromycin EES Suspension
Cefprozil
Cefuroxime
Cephalexin

DO NOT Refrigerate These ABX - Clarithromycin, Clindamycin, Voriconazole, SMX/TMP

ABX that Decrease Effectiveness of OCP


PCNs
Cephalosporins
Tetracyclines - Doxy/Mino

Hydrophillic ABX - BAG DC - B-lactams, AGs, Glycopeptides, Daptomycin, Colistin


Liiophillic ABX - FML RTC - FQs, Macrolides, Linezolid, Rifampin, Tetracyclines, Chloramphenicol
Drugs That Need Premedication For Infusion Rxns
Amphotericin B
Interferon Alpha - APAP and Diphenhydramine

BBs
BB + ISA = CAPP - Carteolol, Acebutolol, Pindolol, Penbutolol
B1 Selective = AMEBBA - Atenolol, Metoprolol, Esmolol, Bisoprolol, Betaxolol, Acebutolol

HF Drugs - ACE+BB for everyone, may add loop, aldosterone antagonist, dig, or hydralazine+nitrate(AA)
BBs - metoprolol succinate (ER), carvedilol, bisoprolol

Treatment for UA/NSTEMI - MONA + GAP-BA


If STEMI - give same thing, but may add thrombolytic (if not getting PCI within 90 mins, give in 30 mins)

Take on Empty Stomach


Iron
Tacrolimus
Mycophenolate
Namenda IR (memantine)
Sildenafil/Vardenafil
Trospium (Sanctura)
Pen VK
Azithromycin
Doxycycline/Minocycline
Rifampin
Isoniazid
Itraconazole liquid

Take With Food


Vilazidone (Viibryd)
Lithium
Namenda XR
Pramipexole
Ropinirole
Itraconazole capsules
Nitrofurantoin

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