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1
Q

ANC equation

A

ANC = WBC * (% seg neuts + % bands)

Neutropenia ANC < 500
Must have ANC > 1500 to be eligible for chemotherapy

2
Q

Dexrazoxane

A

Prevent cardiomyopathy in doxorubicin > 300 mg/m2
Give 10% of doxo dose as dexrazoxane

Also used for extravasation

3
Q

Amifostine

A

Use for nephrotoxicity from cisplatin

4
Q

Leucovorin

A

Use after MTX doses > 1000, rescue tx in MTX > 500

Can add on glucarpidase but do not administer leucovorin 2 hours before or afterwards

5
Q

Tumor lysis syndrome

A

Rasburicase tx, use allopurinol or fluids as prophylaxis

Increased uric acid

6
Q

Hypercalcemia (cancer related)

A

Ca > 14

Fluids, loop diuretics, bisphosphonates, calcitonin

7
Q

Corrected Ca equation

A

= (4-albumin)* 0.8 + Ca
Normal is 12-14

use if albumin < 3.5

8
Q

Leapfrog Hospital Safety Grades

A

VA hospitals, critical access hospital excluded
Issued 2x per year
Barcode scanning on med admin one of the criteria - goal is to reduce preventable mistakes

9
Q

HEDIS

A

NCQA - part of CMS

Not required to report to HEDIS, but used for ratings

10
Q

IRB required members

A

5 members

1 scientific, 1 nonscientic, 1 not affiliated with org, and one that represents perspectives of research participants

11
Q

Cost Benefit
Cost effectiveness
Cost minimize
cost utilization

A

Cost Benefit: Looks at tx + costs saved with benefit outcomes
Cost effectiveness: Looks at measured clinical uses or outcomes (years of lives saved)
Cost minimize: Compares therapies
Cost utilization: Looks at mortality / QALY

12
Q

ivabradine (Corlanor)

A

Used in HF EF < 35% and on max tolerated BB with HR > 70 bmp.
ADE: bradycardia, atrial fibrillation, HTN
Lowers hospitalizations

13
Q

Criteria for antibiotics in COPD

A

Dyspnea OR increase sputum volume
+ increased sputum purulence

OR mechanical ventilation

Augmentin, macrolide, doxycyline if GOLD 1 or 2
Levo/cipro if GOLD 3 or 4 (pseudo coverage)

14
Q

Theoyphilline

A

MOA - phosphodiesterase inhibitor, methylxanthine. No longer recommended for acute tx of asthma

Can lower seizure threshold

15
Q
FEV cut-off's
GOLD 1
GOLD 2
GOLD 3
GOLD 4
A

GOLD 1 >= 80%
GOLD 2 50-79%
GOLD 3 30-49%
GOLD 4 < 30%

16
Q

Pneumococcal vaccine recommendations

A

Age 19-64 w/ chronic medical condition (give if FEV1 < 40%) - 1 dose of PPSV23

Immunocompromised > 19 yoa: 1 dose PPSV13, 8 weeks later PPSV23, then 5 years later booster PPSV23

65 and older - PPSV 13 and PPSV 23 one year later

17
Q

Hyponatremia

A

If due to dehydration, give NaCl 0.9%, check in q4h
Na < 120, symptomatic - use hypertonic saline NaCl 3%
1 mEq/L/hr (severe), 0.5 mEq/L/hr in moderate. Can give NaCl 0.45% to slow down the rise.

Do not correct more than 10-12mEq per 24 hours, or > 18 mEq in 48 hours.

Treating hypokalemia will help increase Na as well! If Euvolemic or edematous, fluid restriction (<800mL/day) or vasopressin antagonists like tolvaptan

Med induced = thiazides, antiepileptics, SSRI’s, hypothyroid, SIADH

18
Q

Hypernatremia

A

Na > 145 - caused by dehydration, sodium retention, brain injuries. Requires H2O! Must give by mouth or via D5W, never SW infusion!
If hypotensive, can give NaCl 0.9%

19
Q

Hypokalemia

A

K < 3.5
Causes: insulin, beta agonists (albuterol), alkalosis, hypothermia, diuretics, GI losses

K 3-3.5 –> PO KCl 40-80 mEq/day
K 2-3 –> IV or PO (IV 10-20 mEq/hr)
K < 2 give 20 - 40 mEq/hr IV (ECG monitor)

Divide doses > 60 mEq to reduce GI SE
Max peripheral IV is 60-80 mEq
Don’t mix K in dextrose

20
Q

Hyperkalemia

A

K > 5; if > 6.5 it is an emergency !
If symptomatic:
- Calcium gluc 1 g IV push to reduce cardiac risk
- Insulin 10 units IV + 25-50 g glucose via 50% IVpush
- Sodium bicarbonate 50 mEq IV push
- Albuterol 10-20 mg neb (if on BB, pt will not respond - not as effective)

If asx, give sodium polystyrene sulfonate alone 15 g q6h

Causes: succ, K sparing diuretics, acei, arbs, trimethoprim. If CAD, CHF, DM - higher risk of sudden death

21
Q

Hypomagnesium / hypermagnesium

A

Mg < 1.7
Oral supplementation, mag oxide - SE is diarrhea
1-4 g slow IV infusion, lower dose by 50% in renal
Can give push if emergency

Mg > 2.3
0.9% NaCl, loops, IV calcium if sx

22
Q

Hypocalcemia

A
Corrected Ca if Ca < 8.5
Sx: muscle twitch/seizure
CaCl 1g via central line
CaGluc 2-3 g via peripheral line
max rate 60 mg/min
23
Q

Hyperpcalcemia

A

Due to malignancy: NaCl 0.9% plus bisphosphonate (zolendronic acid 4 mg IV - can take up to 7 days for nadir to be reached) + calcitonin (if symptomatic)

24
Q

Medicare Access and CHIP Reauth Act (MACRA)

A

Fee for service to a value-based or pay for performance model

25
Q

NDA
ANDA
INDA

A

NDA - Submitted after Phase III studies before market approval

ANDA - generic drugs, submitted 3-5 years after market exclusivity by brand company. Retain a 180 day exclusivity of generic product.

INDA - used for new drug, new indication, off-label use. Must be submitted after pre-clinical trials, before Phase I trials.

26
Q

Orange Book

A

A - both pharmaceutical equivalents and bioequivalent, may be interchanged
B - pharmaceutical equivalents only, cannot be interchanged

Biosimilars - purple book, availavlee for biological products after 12 years exclusivity

27
Q

Medwatch Form FDA 3500, 3500A, 3500B

A

Form 3500 - voluntary reporting by HCP, can disclose PHI
Form 3500A - IND reporters, manufacturers, distributors, etc
Form 3500B - Consumers and patients

28
Q

HITECH Act

A

Promote healthcare information tech, authorizes DHHS to promote

CMS gives financial incentives for “meaninful use” of EMR (under ARRA)

29
Q

Orphan Drug Act

A

Grants, assistance, for patient populations of < 200,000
Grants market exclusivity for 7 years after FDA approval
Grants 20 year patent life (starts when molecule is invented)

30
Q

New Drug Process

A

Preclinical trials > INDA > Phase I: PK/PD in ~ 50 human volunteers > Phase 2: Indication for drug in several hundred patients > Phase 3: Efficacy and safety evaluation > NDA > Phase 4: Postmarketing studies

31
Q

Drug causes of SIADH

A

SSRI’s
Carbamazepine
Barbiturates
Narcotics