NAPLEX RxPrep 2023 Course Book for Pharmacist Licensure Exam Preparation [2023, 2023 ed.] 0578369850, 9780578369853

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The RxPrep* Difference NAPLEXf MPJE® & CPJE Reviews Not sure how to learn it all? Prepare for the NAPLEX the smart way with our comprehensive RxPrep online course. The RxPrep video lectures and QBanks match to each chapter in this course book. The questions in the QBank cover the must-know basic competency drug information. Track your progress, then test your readiness prior to exam day. READ: Includes th e simplest and m ost com plete calculations and biostatistics reviews. It’s all here, in easy steps, fo r com plete exam kno w -h ow . The RxPrep course book is the student-preferred resource for the NAPLEX. It includes all topics tested w ith m ust-know key drugs and study tips. W A T C H : Pair the course book w ith video lectures th a t em phasize th e required drug inform ation. Focus on topics that need a fresh review, or use a video lecture to bring up a topic score. PRACTICE: O v e r 3 ,7 0 0 Q B ank questions to apply w h a t y o u ’ve learned and assess your perform ance. The RxPrep Q Bank contain case-rich, exam -style questions that c o verall the required material, plus a cum ulative practice exam.

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i

^ x P re 0 P a rt o f t h e U W o r ld F a m ily

2023

NAPLEX COURSE BOOK Study Guide for the NAPLEX^ for those testing in 2023

EDITO RS

I

CHELSEA BOMBATCH, PharmD, BCPS

LAUREN DEVINE, PharmD, BCPS, BCCP

STEPHANIE BRIAN, PharmD. BCPS

A M Y DREW, PharmD, BCPS

PETER COLLEY, PharmD, BCPS AQ-ID, AAHIVP CAITLIN DAVIS, PharmD, BCPS

STEPHANIE D. GARRETT, PharmD, BCPS ANGIE VEVERKA, PharmD, BCPS

2023 Associate Editors

Bool< Design and Production

DEEATRA CRA D DO CK , PharmD, BCACP

JO N I H U T T O N

YASARTASNIF, PharmD, BCPS. FAST BOBBIE VARGHESE, PharmD

CHAPTER TABLE OF CONTENTS INCLUDING REQUIRED FORMULAS

Anion G ap ..............

PREPARING FOR THE NAPLEX Preparing fo r th e N A P LEX w ith RxPrep..

....3

Quick Guides....................................................... Top Prescription Drugs.................................... Top Prescription Drugs: Injectable Qnly......

.1 1 .1 2

Top QTC Drugs................................................. Required Formulas............................................ Diagnostic Tests................................................ Medical Terms.................................................... Common Medical Abbreviations.

PHARMACY FO UNDATIO NS PART 1

.... 181

.... 182 pH Calculations..... .... 185 Percent Ionization. Drug Conversions.............................................................................. 186 Absolute Neutrophil Count............................................................. 187

.1 8 .2 0

1 3 C alculations V: E xam -S tyle M a th P ractice.........................1 8 8

.2 2 .2 4 .2 7

BIOSTATISTICS

201

1 4 B iostatistics...................................................................................... 2 0 2 Mean, Median and M o d e ................................................................ 204 Risk, Relative Risk (RR)..................................................................... 209

.3 5

41

Relative Risk Reduction (RRR)........................................................ 210

Drug Interactions...............................................

... 5 3

Lab Values & Drug M o n ito rin g .....................

... 6 7

Absolute Risk Reduction (ARR)...................................................... 210 Number Needed to Treat (N N T ).....................................................211 Number Needed to Harm (N N H )................................................... 212 Odds Ratio (OR)..................................................................................212

Drug R eferences................................................

... 7 7

Hazard Ratio (HR)...............................................................................213

Drug Formulations & Patient C o un selin g .

... 86

Incremental Cost-Effectiveness Ratio.......................................... 223

Basic Science C oncepts...................................

...4 2

Intravenous M ed icatio n Principles.............

...9 9

Answ ering Case-Based Exam Q uestion s..

.1 0 6

Temperature Conversions...................................

..108

1 5 Com pounding I: Basics................................................................2 2 6

115

II

C O M P O U N D IN G & HAZA RDO US DRUGS 225 1 6 Com pounding II: Equipm ent, Stability & E xcipients......2 4 8

CALCULATIONS 9

Calculations I: M a th Basics........................................

,.1 1 6

II

Liquid (Volume) Conversions.........................................

..117

Solid (Weight) Conversions............................................

..117

Minimum Weighable Quantity (M W Q )........................................ 251

1 7 C om p ou nd ing III; D o cu m e n ta tio n & P re p a ra tio n .......... 2 6 5

RENAL & LIVER DISEASE

283

Height Conversions.........................................................

..117

1 8 Renal Disease

.2 8 4

1 0 Calculations II: C om pounding..................................

.1 2 8

1 9 H e p a titis & Liver Disease...............................

.2 9 6

Percentage Strength........................................................

..128

Ratio Strength................................................................... Parts Per Million...............................................................

..132

IM M U N IZ A T IO N S & TRAVELERS

309

Specific Gravity.................................................................

..135

2 0 Im m un izatio ns.

.3 1 0

Dilution and Concentration............................................ Alligation............................................................................

..136

2 1 Travelers............

.3 2 7

INFECTIO US DISEASES

335

Qsmolarity.......................................................................... Isotonicity...........................................................................

..134

..137

Moles and Millimoles........................................................

..139 ..142 ..144

Milliequivalents.................................................................

..146

2 2 Infectio us Diseases I: B a c k g ro u n d & A n tib io tic s by D rug Class.........................................

.3 3 6

.1 4 9

2 3 Infectious Diseases II: Bacterial In fectio n s.............

.3 6 8

Determining Fluid Needs................................................. Total Energy Expenditure................................................

..150

2 4 Infectio us Diseases III: A n tifun gals & Antivirals....

.3 8 9

..151

2 5 Infectio us Diseases IV: O p p o rtu n is tic Infections..

,.4 0 3

Calories from Parenteral Nutrition Components. Calories from Enteral Nutrition Components....... Grams of Nitrogen from Protein..............................

..152

2 6 H u m an Im m u n o d e fic ie n c y V iru s .................................

.4 0 6

CARDIOVASCULAR C O N D IT IO N S

421

Corrected Calcium for Albumin < 3 .5 .....................

..152 ..153 ..160

12 Calculations IV: C linical.........................................

.1 6 9

2 7 D y s lip id e m ia ....................................

.4 2 2

..169

II

..423

..170 ..170 ,.171

2 8 H y p e rte n s io n ..................................

.4 3 4

2 9 Stable Ischem ic H e a rt D is e a s e .

.4 4 9

3 0 A c u te C o ro n a ry S y n d ro m e s ......

.4 5 5

,.172

3 1 C hronic H e a rt Failure...................

.4 6 3

Dehydration..................................................................

,.175 ,.177

3 2 A rrh y th m ia s .....................................

,.4 7 8

The Cockcroft-Gault Equation. Arterial Blood Gases (ABG)......

,1 7 8 ,.180

3 3 S tro k e .................................................

.4 9 0

11 Calculations III: Parenteral & Enteral N u tritio n .

Body Mass Index (B M I).............................................. Ideal Body Weight (IB W )........................................... Adjusted Body Weight (AdjBW^^)........................... Which Weight to Use for Drug Dosing (mg/kg)?.. Flow Rates..................................................................... Drop Factor...................................................................

Friedewald Equation........................

CHAPTER TABLE OF CONTENTS IN C LU D IN G REQUIRED FORMULAS

ANTICO AG ULATION & BLOOD DISORDERS____________________ W

ONCOLOGY

787

6 1 Oncology I: O v e rv ie w & Side Effect M an agem ent.

.7 8 8

3 4 A n tico ag ulation ..............................................................................4 9 8

6 2 O ncology II: Com m on Cancer Types & Treatm ent..

.8 0 7

3 5 A n e m ia .............................................................................................. 5 1 6

I® Body Surface Area (BSA) Calculations................................

..817

PSYCHIATRIC CO NDITIO NS

833

6 3 D ep ressio n ............................................................................

,.8 3 4

3 6 Sickle Cell Disease.........................................................................52 3

EYES, EARS, NOSE & SKIN C O N D ITIO N S

529

37 Allergic Rhinitis, Cough & C o ld ............................................... 5 3 0

6 4 Schizophrenia/Psychosis.................................................

.8 4 5

3 8 Com m on Conditions of the Eyes & E a rs ..............................5 4 0

6 5 Bipolar D is o rd e r..................................................................

,.8 5 3

39 Com m on Skin C o nd itio ns.......................................................... 54 6

6 6 A tte n tio n D eficit H y p eractivity Disorder ( A D H D ) .

.8 5 7

II

6 7 A n xiety Disorders...............................................................

..8 6 4

6 8 Sleep D isorders...................................................................

.868

NEUROLOGIC CO N D ITIO N S

875

4 0 Pulm onary A rterial H y perten sion ........................................... 5 6 4

6 9 Parkinson D is e a se ....................................

.8 7 6

4 1 A s th m a .............................................................................................. 57 1

7 0 A lzh eim er’s D is e a se ................................

.8 8 1

4 2 Chronic O bstructive Pulm onary Disease............................. 5 8 8

7 1 Seizures/Epilepsy......................................

.886

4 3 Tobacco Cessation........................................................................ 5 9 8

II

..898

Time to Burn (TTB)............................................................................ 562 .

IIJ I I

lOh'

II

Phenytoln Correction for Albumin < 3,5..

Pack-Year Smoking History............................................................. 598

GASTROINTESTINAL C O N D ITIO N S

901

7 2 Gastroesophageal Reflux Disease & Peptic U lcer D is e a se ......................

.9 0 2

7 3 Constipation & D ia rrh e a ...................

.9 1 1

7 4 Inflam m atory Bowel Disease..........

.9 2 1

7 5 M o tio n Sickness...................................

.9 2 8

PHARM ACY FO UNDA TIO N S PART 2

931

Correction Factor for Rapid-Acting Insulin

7 6 M ed icatio n Safety & Q u a lity Im provem ent..

.9 3 2

Correction Dose

7 7 D rug Allergies & Adverse Drug Reactions....

.9 4 7

ENDOCRINE CO N D ITIO N S _______________ ^ 4 4 D ia b e te s ............................................................................................6 0 4 l i ! Insulin Calculations:..................................................... begins at 617 ! Initiating Basal-Bolus Insulin In Type 1 Diabetes Starting a Regimen with NPH and Regular Insulin I Insulin-to-Carbohydrate Ratio for Regular Insulin Insulin-to-Carbohydrate Ratio for Rapid-Acting Insulin Correction Factor for Regular Insulin

4 5 Thyroid D isorders......................................................................... 6 2 7

7 8 P h arm aco kinetics ..................................................

.9 5 6

4 6 Systemic Steroids & A u to im m un e C o n d itio n s ...................6 3 4

II

Bioavailability............................................................ Calcium and Phenytoin Correction.......................

..958 ..959

Volume of Distribution (Vd)....................................

,.959 ,,960 ,,963 ,.963 ,,964

5 0 Sexual D y s fu n c tio n ......................................................................6 8 9

Clearance (Cl)............................................................ Elimination Rate Constant (Ke)............................... Predicting Drug Concentrations............................ Half-Life (t'/2 ).............................................................. Loading Dose (LD)....................................................

5 1 Benign Prostatic Hyperplasia (B P H )..................................... 6 9 4

7 9 Pharm acogenom ics...............................................

,.968

5 2 Urinary In c o n tin e n c e .................................................................. 6 9 9

8 0 D ietary Supplements, Natural & Com plem entary M e d ic in e ...............

.9 7 3

8 1 Toxicology & A n tid o te s .......................................

.9 8 2

PATIENT CASES

989

MALE & FEMALE HEALTH________________ ^ 4 7 Contraception & In fe rtility ........................................................6 5 6 4 8 Drug Use in Pregnancy & L a c ta tio n ...................................... 6 6 9 4 9 Osteoporosis, M enopause & Testosterone U s e ................6 7 5

SPECIAL POPULATIONS__________________ 705 5 3 A cu te & Critical Care M e d ic in e ...............................................7 0 6 II

Mean Arterial Pressure (MAP)........................................................ 713

5 4 Pediatric C o nditions.....................................................................7 2 1

8 2 Cases, Exam -Style Practice.

..966

...9 9 0

55 Cystic Fibrosis................................................................................ 7 3 1

998

5 6 Transplant........................................................................................7 3 6

INDEX

5 7 W e ig h t Loss.....................................................................................7 4 5

By Classification + Drug N a m e ....................................................9 9 8

5 8 P a in ....................................................................................................7 5 2 5 9 M ig rain e ........................................................................................... 7 7 3 6 0 G o u t...................................................................................................7 8 1

CONTENT LEGEND I I

= Required Formula

KEY DRUG GUY AND STUDY TIP GAL

PAGE NUMBERS BIOSTATISTICS

201

Basic Science Concepts................................................................ 4 2 Common Receptors, Substrates and Drug Examples..................46 Common Enzyme Targets for Medications....................................47

1 4 Biostatistics..

,.202

Drug In te ra c tio n s ............................................................................ 5 3

.

PHARMACY FO UNDATIONS PART 1

41

.

Central Tendency Calculations...................................................... 2 04 Interpreting Confidence Intervals...................................................207 Rounding Rules for N N T and N N H .............................................. 212

Pharmacodynamics: Pharmaco + Dynamics................................. 53 Risk with Concurrent Use of Benzodiazepines and Opioids.... 54

C O M P O U N D IN G & HAZA R D O U S DRUGS 225

Pharmacokinetics: Pharmaco + Kinetics........................................ 54 Common Prodrugs and Example Safety Considerations............ 56

1 5 C om p ou nd ing I: Basics...............................................................2 2 6 ,

Common CYP Inhibitors Involved in Drug Interactions.............. 57 Common CYP Inducers Involved in Drug Interactions............... 58 Lab Values & Drug M o n ito rin g .................................................. 6 7 .7 6 Therapeutic Drug Levels..

USP Compounding Chapters......................................................... 227 Interpreting USP Terminology.........................................................228 ISO A irQ uality Inside the PEC........................................................230

.

Drug R eferences............................................................................. 7 7

Positive Pressure Non-Hazardous Drug Cleanroom................232 Hazardous Key Drugs on the NIOSH List................................... 233 Negative Pressure Hazardous Drug Cleanroom..........................236

/ '

Locating Guidelines for Common Conditions...............................82

1 6 C om p ou nd ing II: E quipm ent, S tab ility & E xcip ien ts...... 2 4 8

.

"Color" Drug References................................................................... 85

V

The HLB Num ber............................................................................. 256

6

Drug Formulations & Patient C o un selin g ............................. 8 6

.

Excipients to Be Avoided in Some Patients................................ 264

.

Patch Frequency................................................................................. 91

1 7 C om p ou nd ing III: D o cu m e n ta tio n & P re p a ra tio n ...........2 6 5

7

Intravenous M ed icatio n Principles.......................................... 9 9

.

Drugs with Leaching/Adsorption/Absorption Issues with PVC Containers....................................................................... 101 / ' Common Drugs with Diluent Solution Requirements...............101 / ' Common Drugs with Filter Requirements.................................. 103

Use of Suppositories........................................................................ 273 Beyond-Use Dates for Non-Sterile Compounded Products... 274

. .

Determining the CSP Risk Level.................................................... 279 Beyond-Use Dates for Compounded Sterile Products............ 279

Z ' Do Not Refrigerate........................................................................... 103 ^ Protect from Light During Administration...................................104

RENAL & LIVER DISEASE

8

Answering Case-Based Exam Q u e s tio n s ............................ 1 0 6

1 8 Renal D isease.................................................................................. 2 8 4

.

Select Drugs and Conditions that Alter Vital Signs.................. 109

.

How to Look for Medication Problems in a Patient Case...... 110

283

Select Drugs that Cause Kidney Disease..................................... 286 .

CrClvs.G FR.........................................................................................286

.

ACE Inhibitors and ARBs for Albuminuria....................................287 Select Drugs that Require 4, Dose or T Interval in CK D ........ 288

115

^

9

Calculations I: M a th Basics........................................................1 1 6

y

. .

Common Conversions......................................................................117 How to Round on the Exam............................................................117 Setting up Proportions.....................................................................118

1 9 H e p a titis & Liver Disease........................................................... 2 9 6

.

Drug-Dose Conversions.................................................................. 125 Ratio Relationships............................................................................125

. .

Follow the Rules of Math.................................................................127 Ready to Submit Your Answer?...................................................... 127

CALCULATIONS

Select Drugs that are Contraindicated in C K D ...........................288 Select Drugs that Raise Potassium Levels...................................292 Steps for Treating Severe Hyperkalemia......................................293 Comparison of Hepatitis Viruses................................................... 297 DAA Mechanisms and Regimens................................................... 297 Interferons.......................................................................................... 300 ;

Lab Tests for Liver Disease............................................................. 302

y

Select Drugs with a Boxed Warning for Liver Damage.............303

10 Calculations II: Com pounding...................................................1 2 8 .

Common IV Fluids............................................................................. 129

IM M U N IZ A T IO N S & TRAVELERS__________^

Dissociation Particles vs. Valence.................................................. 147 11 Calculations III: Parenteral & Enteral N u tritio n ................ 1 4 9 .

Calories Provided from Macronutrients....................................... 152

12 Calculations IV: C linical...............................................................1 6 9

2 0 Im m u n iza tio n s ................................................................................ 3 1 0

y

Common Live Vaccines.................................................................... 312

.

Vaccine Timing & Spacing................................................................ 313 Invalid Contraindications to Vaccination......................................314

.

Influenza Vaccine Tips...................................................................... 319

.

Height in Inches................................................................................. 171

.

Final Volume of Compounded IV Solutions................................. 174 Interpreting ABGs.............................................................................. 180

2 1 Travelers............................................................................................ 3 2 7

1 3 Calculations V: Exam -S tyle M a th P ractice............................1 8 8

Drugs for Travelers' Diarrhea.......................................................... 329 Travel Vaccines................................................................................... 330

.

Assessing Readiness for M ath ........................................................ 200

CONTENT LEGEND " Study Tip Cal

" Key Dfug Cuy

KEY DRUG GUY AND STUDY TIP GAL

PAGE NUMBERS

INFECTIOUS DISEASES

335

2 9 Stable Ischemic H e a rt D is e a se ................................................4 4 9 Treatment Approach for Stable Ischemic Heart Disease........450

2 2 Infectious Diseases I: Background & Antibiotics by Drug Class....................................................... 3 3 6

3 0 A cu te C oronary S y n drom es.....................................................4 5 5 .

Gram Stain for Select Bacterial Organisms.................................. 338 Example Culture and Susceptibility Report................................. 339 Key Features of Penicillins............................................................... 345 Key Features of Cephalosporins.................................................... 347

Drug Treatment Options for ACS.................................................. 456 Drugs for Secondary Prevention After A CS............................... 462 3 1 Chronic H e a rt Failure..................................................................4 6 3 Signs and Symptoms of Systolic Heart Failure........................... 464

Key Features of Carbapenems........................................................ 348 Aminoglycosides: Good News, Bad News................................... 350

Select Drugs that Cause or Worsen Heart Failure.....................465 Treatment of Chronic Systolic Heart Failure.............................. 466

Key Features of Quinolones............................................................ 353

Potassium Chloride: A Hard Pill to Swallow............................... 475

Key Features of Macrolides............................................................. 354 Key Features of Tetracyclines......................................................... 355 Key Features of Sulfamethoxazole/Trimethoprim..................... 356 Key Features of Nitrofurantoin...................................................... 363 Commonly Used/Active Drugs for Specific Pathogens..........364

Comparing UA, NSTEMI and STEM!............................................ 456

3 2 A rrh y th m ia s ................................................................................... 4 7 8 . ^

The Heart’s Natural Pacemaker and Arrhythmias..................... 479 Select Drugs that Can Increase or Prolong the QT Interval..,.481

No Renal Dose Adjustment Required........................................... 365

Classifying Drugs with Vaughan Williams................................... 482 AF: Rate vs. Rhythm Control & Stroke Prophylaxis.................. 483

2 3 Infectious Diseases II: Bacterial Infectio ns......................... 3 6 8

3 3 S tro k e ...............................................................................................4 9 0

Timing of Perioperative Antibiotics............................................... 368 Meningitis: Empiric Treatment........................................................370 AOM Treatment in Kids: When to Consider Observation.....370 Outpatient CAP Assessment and Treatment............................... 373 HAP/VAP: Selecting an Empiric Regimen.................................... 374 RIPE Therapy fo rT B .........................................................................377 C. d/ff/c//e Guideline Recommendations...................................... 385

.

TIA Versus Stroke.............................................................................491 Signs and Symptoms of Stroke...................................................... 491 Bleeding Risks with Alteplase........................................................491

ANTICO AG ULATION & BLOOD DISORDERS

497

3 4 A n tic o ag u la tio n ............................................................................ 4 9 8

Symptoms of Common STIs............................................................386 Syphilis: Penicillin Desensitization Required?............................. 387 Lyme Disease or Ringworm?...........................................................388

Anticoagulants are for Blood Clots..............................................498 Coagulation Cascade.......................................................................499 DOACs Versus W arfarin.................................................................500 Bleeding Types and Causes............................................................ 501 Conversion Between Anticoagulants........................................... 506

2 4 Infectious Diseases III: Antifungals & A ntlvlrals............... 3 8 9 Key Issues with Azole Antifungals................................................ 391 2 5 Infectious Diseases IV: O pportunistic Infections.............4 0 3

Warfarin Tablet Colors....................................................................509

2 6 H um an Im m unodeficiency V iru s ............................................ 4 0 6

3 5 A n e m ia .............................................................................................5 1 6

Preferred Initial ART Regimens in Most Treatment-NaTve Adults.................................................................. 409 NRTI Key Features and Safety Issues.......................................... 410 INSTI Key Features and Safety Issues...........................................411

. ^

Assessing and Treating Iron Deficiency Anemia........................ 518 Select Drugs that Can Cause Hemolytic Anemia...................... 522

3 6 Sickle Cell D isease....................................................................... 5 2 3 y " Key Vaccines in Sickle Cell Disease.............................................. 524

NNRTI Key Features and Safety Issues........................................412 PI Key Features and Safety Issues.................................................413 Booster Drug Interactions.............................................................. 414

EYES, EARS, NOSE & SKIN C O N D ITIO N S

PrEPorPEP?......................................................................................418

3 7 Allergic Rhinitis, Cough & C o ld .............................................. 5 3 0

CARDIOVASCULAR C O N D ITIO N S

Select Drugs/Conditions that Can Raise LDL and/or Triglycerides........................................................................ 423 Determining Statin Treatment Intensity Based on Patient Risk..................................................................... 425 Statin Equivalent Doses................................................................. 426 Managing Myalgias......................................................................... 426 2 8 H y p e rte n s io n ................................................................................ 4 3 4

.

Diphenhydramine in Pharmacy: It's Everywhere...................... 533 Cough and Cold Combination Products: What's in a Name? ,„ 538

421

2 7 D yslip id em ia.................................................................................4 2 2

Blood Pressure Monitoring........................................................... 436 Drugs that Can Increase Blood Pressure....................................436 Hypertension Guideline Recommendations............................. 437 Key IV Hypertension Medications................................................448

529

Pediatric Cough and Cold Treatment - Caution Needed....... 539 3 8 Com m on Conditions o f th e Eyes & E a rs ............................ 5 4 0 y ' Drugs That Can increase lO P ........................................................541 , y

Glaucoma Treatment Goal: Decrease lO P .................................. 541 W hy Do Most Eye Drops Burn?....................................................544 Common Drugs Known to Cause Vision Changes or Damage............................................................545

3 9 Com m on Skin C o nd itio ns.........................................................5 4 6 Drugs that Can Discolor Skin and Secretions............................546 Acne Treatment Summary..............................................................548

k e y d r u g g u y a n d s t u d y t ip g a l

PAGE NUMBERS CONT PULMONARY CO NDITIO NS & TOBACCO CESSATION

MALE & FEMALE HEALTH 563

4 7 C o ntraception & In fe rtility ........................................................6 5 6 Select Contraceptive Types.............................................................661 Severe & Rare Adverse Effects of Estrogen................................662

4 0 P u lm o n atY A rte ria l H y p e rte n s io n ..........................................5 6 4 y

Select Drugs that Can Cause P A H ...............................................565 Select Drugs that Can Cause Pulmonary Fibrosis..................... 570

4 1 A s th m a ........................................................................................... Spirometry: Tests Lung Function (How Well the Lungs W ork)...........................................................572 Key Differences Between MDIs and DPIs.................................. 579

655

Infertility Drugs Act Like Endogenous Hormones to Trigger Ovulation..........................................................................668 4 8 Drug Use in Pregnancy & L a c ta tio n ...................................... 6 6 9 Teratogens: Danger in Pregnancy..................................................671 4 9 Osteoporosis, M en o pause & T estosterone U s e ...............6 7 5

With a Spacer, More Drug Gets Into the Lungs........................ 583

Select Factors and Conditions with Osteoporosis Risk............676

4 2 Chronic O bstructive Pulm onary D isease............................5 8 8

Diagnosis of Osteoporosis..............................................................676 Calcium and Vitamin D .....................................................................677

Key Differences of COPD vs. Asthma.......................................... 589

Drug Summary for Osteoporosis Treatment and Prevention...678 Hormone Therapy: Health Risks and Appropriate Use............ 683

4 3 Tobacco Cessation....................................................................... 5 9 8

.

Nicotine Patch, Gum and Lozenge Dosing................................. 600 Treatment Considerations for Tobacco Cessation.................... 601

5 0 Sexual D y s fu n c tio n ......................................................................6 8 9

Nicotine Patch Administration...................................................... 601

y

Drugs that Can Cause Erectile/Sexual Dysfunction................. 6 90

How to Chew Nicotine Gum.......................................................... 602

.

PDE-5 Inhibitor Dosing Guide........................................................691

5 1 Benign P rostatic H yperplasia (B P H ).....................................6 9 4

603

ENDOCRINE CO NDITIO NS

...6 0 4

4 4 Diabetes.... Diagnostic Criteria for Diabetes.

....606

Glycemic Targets in Diabetes......

....606 ....607 ....608

Drugs that Can Worsen BPH......................................................... 694 5 2 U rin a ry In c o n tin e n c e .................................................................. 6 9 9 Anticholinergic Side Effects............................................................702 Decreasing Risk of Dry M o u th ...................................................... 702

SPECIAL POPULATIONS

.

Diabetes Complications............... Treatment Algorithm.... Starting a Basal-Bolus Insulin Regimen in Type 1 Diabetes.... 617

.

.

Converting Between Insulins.......................................................... 620 Dispensing Insulin............................................................................ 620

5 3 A cu te & C ritical C are M e d ic in e ............................................... 7 0 6

. . y

Treating A D H F ......................................................

S/Sx of Hypothyroidism.................................................................. 628 Select Drugs and Conditions that Can Cause Hypothyroidism..................................................................... 628

.

Levothyroxine Tablet Colors........................................................... 630 S/Sx of Hyperthyroidism................................................................ 630

.

S/Sx of Thyroid Storm..................................................................... 632

Avoid in Pediatrics............................................................................. 728 5 5 Cystic Fibrosis................................................................................. 7 3 1 .

Inhaled Medications for CF............................................................. 732

.

W h at’s In a Name?............................................................................ 734 Common Issues with Pancreatic Enzyme Products...................734

5 6 T ransp lant......................................................................................... 7 3 6 .

Transplant Drugs: What's Used, W hen......................................... 741 Boxed Warnings for Transplant Drugs: There's a Lot of Overlap................................................................... 742 Vaccine-Preventable Illness in Transplant Recipients............... 743

4 6 Systemic Steroids & A u to im m un e C o n d itio n s ...................6 3 4 .

................... 714

5 4 Pediatric C o nd itio ns..................................................................... 7 2 1

Summary of Drug Safety Issues.....................................................625

4 5 Thyroid Disorders......................................................................... 6 2 7

Dopamine Dosing.............................................................................. 711 ................... 713 ................... 714 Two Common Causes of ICU Infections........ General Principles for Treating Septic Shock.

Room Temperature Stability of Insulin.......................................... 621 Drugs that Affect Blood Glucose................................................... 623 DKA and H HS Treatment................................................................ 624

705

Steroids: Least Potent to Most Potent........................................ 636

.

Immunosuppression from Steroids................................................637

.

Treating Acute Inflammation with Steroids................................ 637 Select Drugs that Can Cause Drug-Induced Lupus Erythematosus (DILE)........................................................... 644

/ ' Select Drugs/Conditions that Can Cause Weight Gain............746 Select Drugs/Conditions that Can Cause Weight Loss............746

Drug-Induced Raynaud's................................................................ 649

Prescription Weight Loss Drugs: Avoid or Use Caution...........747

.

5 7 W e ig h t Loss......................................................................................7 4 5

5 8 P a in ...................................................................................................... 7 5 2 ,

Acetaminophen Overdose...............................................................7 54 NSAIDs and the Ductus Arteriosus................................................755 Opioid Boxed Warnings....................................................................758 Opioid Allergy...................................................................................... 764 Opioid-Induced Constipation..........................................................764 Opioid-Induced Respiratory Depression (OIRD) Risks.............. 767 Opioid Overdose Management.......................................................767

5 9 M ig r a in e ............................................................................................. 7 7 3 Common Migraine Triggers..............................................................774 Triptan Formulations..........................................................................776

CONTENT LEGEND

6 0 G o u t ..................................................................................................... 7 8 1

fi .

“ Study Tip Cal

■.»

Key Drug Cuy

■> ^

Drugs that Increase Uric Acid.......................................................... 781 .

Gout Treatment Basics......................................................................782

KEY DRUG GUY AND STUDY TIP GAL

PAGE NUMBERS CONT.

ONCOLOGY

787

GASTROINTESTINAL C O N D ITIO N S

6 1 O ncology I: O v e rv ie w & Side Effect M a n a g e m e n t.

.7 8 8

Dosing Considerations for Select Highly Toxic Drugs.....

..791

7 2 Gastroesophageal Reflux Disease & Peptic Ulcer D isease............................................................... 9 0 2

Chemoman and Major Toxicities of Common Chemotherapy Drugs........................................... Chemotherapy Adjunctive Treatment................................. Myelosuppression Recovery................................................. Irinotecan (l-Run-To-The-Can)..............................................

..793 ..794 .,795 ..802

6 2 O ncology II: Com m on Cancer Types & T reatm en t..

,.8 0 7

Reduce Doxorubicin Cardiotoxicity..................................... Which Folate Analog, and W hen?.......................................

..820 ,,824

7 4 Inflam m ato ry Bowel Disease................................................... 9 2 1

Hints for Understanding Monoclonal Antibodies Used in Oncology...................................................................

,,..827

Maintenance of Remission: Comparison of Common CD and UCTreatments..................................................923

. .

PSYCHIATRIC C O N D ITIO N S

833

6 3 D epressio n ............................................................................

.8 3 4

Depression Diagnosis............................................................ Select Drugs that Cause or Worsen Depression..............

..835 ..835

MAO Inhibitors - Keep Them Separated........................... Selecting the Best Antidepressant.....................................

..841

6 4 Schizophrenia/Psychosis.................................................

.8 4 5

..842

901

Key Drugs that Can Worsen GERD Symptoms..........................903 H2RA and PPI Formulations to Know..........................................905 Key Drugs with Decreased Absorption........................................906 7 3 C onstipation & D ia rrh e a ............................................................9 1 1

y

Drugs that are Constipating............................................................912 Which OTC to Recommend for Constipation.............................912 Select Drugs that Can Cause Diarrhea.........................................918

7 5 M o tio n Sickness............................................................................9 2 8 Scopolamine (Transderm Scop) Patch.......................................... 930

PHARM ACY FO UNDA TIO N S PART 2

931

7 6 M ed icatio n Safety & Q u a lity Im p ro v e m e n t....................... 9 3 2 Do Not Use Abbreviations.............................................................936 Select High-Alert Medications......................................................937 Safe Injection Practices for Healthcare Facilities...................... 946

Medications/Recreational Drugs that Can Cause Psychotic Symptoms.............................................................. Treatment Considerations....................................................

....846 ....850

65 Bipolar D iso rd er..................................................................

...8 5 3

W hat is Mania?....................................................................... Converting Between Lithium Formulations......................

....853 ....855

Epinephrine Auto-Injector Administration.................................. 953

6 6 A tten tio n D e fic it H yperactivity Disorder ( A D H D ) .

...8 5 7

A Penicillin Allergy, or Not?............................................................953

Patient-Friendly Formulations for Stimulants.................. Treatment of A D H D ..............................................................

....858

7 8 P harm acokinetics........................................................................9 5 6

....859

6 7 A n xiety D isorders...............................................................

...8 6 4

Drug Absorption.............................................................................. 957 Dose Adjustments for Michaelis-Menten Kinetics................... 962

Select Drugs that Cause Anxiety........................................

....864

7 9 Pharm acogenom ics.................................................................... 9 6 8

Safe Use of Benzodiazepines...............................................

....866

6 8 Sleep D isorders...................................................................

...868

Does a Positive or Negative Test Require Action?.................... 972 y ' Select Drugs with Pharmacogenomic Implications................... 972

Z ' Select Drugs that Can Worsen Insomnia..........................

....869

EZ Tip for Excellent Zzzzzz (sleep)......................................

....869

8 0 D ie ta ry Supplem ents, N atural & C o m p lem entary M e d ic in e ................................................... 9 7 3

NEUROLOGIC C O N D ITIO N S

875

8 1 Toxicology & A n tid o te s .............................................................9 8 2

6 9 Parkinson D isease..................................................

,.8 7 6

Parkinson Disease Symptoms.................................. Dopamine Blocking Drugs that Can Worsen P D . Parkinson Disease Treatment Principles...............

..876 ..877 ..877

7 0 Alzheim er's D is e a s e ...............................................

.8 8 1

^

..882

Key Drugs that Can Worsen Dementia.................

7 1 Seizures/Epilepsy....................................................

.886

^

Drugs that Can Lower the Seizure Threshold......

..887

Diastat AcuDial Dispensing...................................... AED Cousins...............................................................

..888

Take Your Vitamins on AEDs!................................... Lamictal Starter Kits By Color.................................. Phenytoin/Fosphenytoin Administration..............

..889

Adjusting Phenytoin Doses...................................... AEDs Have a Lot of Drug Interactions.................. AEDs are CNS Depressants.....................................

..889 ..890 ..895 ..898 ..898 ..898

7 7 D rug Allergies & Adverse Drug R eactions......................... 9 4 7 Intolerance or Allergy?................................................................... 950 Drugs Most Commonly Associated with Photosensitivity.....951 Drugs Commonly Associated with TTP....................................... 951 Drugs Commonly Associated with Severe Skin Reactions.....952

Differences Between Dietary Supplements and Drugs........... 974 N-Acetylcysteine (NAC) Treatment..............................................985 Organophosphate Overdose........................................................ 987 Overdose? Mixed Overdose? Matching the Symptoms to the Antidote................................................................................. 988

PATIENT CASES

989

8 2 Cases, Exam -Style P ra c tic e .................................................... 9 9 0

»

m

m

m

PREPARING FOR THE NAPLEX CONTENTS CHAPTER 1

3 Preparing for the NAPLEX with RxPrep 11 Quick Guides 12 Top Prescription Drugs 18 Top Prescription Drugs: Injectable Only 20 Top O TC Drugs 22 Required Formulas 24 Diagnostic Tests 27 Medical Terms 35 Common Medical Abbreviations

I

> Jlj

r Percentage strength

filove the decimal left 4 places

Percentage strength -» PPfifl

Move the decimal right 4 places

IBW

Theophylline (norm al weight, obese) A m inoglycosides (obese)

Specific Gravity (SG) p. 135

AdjBW „^

Flow R ates/Drop Factor (drops/m in) p. 172 & p. 175

weight of substance (g) or

SG = -

SG

# drops

mL

hr

mL

hr

60 min

mL

Dilution & Concentration (Changing Strength or Quantity) p. 136

D ehydration p. 177

Q1 x 01 = Q2 X 0 2

B U N :S C r> 2 0 :1

Q1 = old quantity

Q2 = new quantity

01 = old concentration

C2 = new concentration

Alligation p. 137

C ockcroft-G ault Equation p. 178 OrCI

High %

# drops

=

w eight of equal volume of w ater (g)

X parts of High %

1 4 0 - ( a g e o f patient)

(m Um in)

x w eight (kg) (x 0,85 if fem ale)

“

72 X SCr

Arterial Blood Gas (ABG) p. 180

Low %

X parts of Low %

ABG: p H /p C O j/p O j/H C O j/O j Sat 1. pH < 7,35 -> acidosis. pH > 7.45 -> alkalosis 2. Respiratory: pCO^ < 35 -> alkalosis, pCO^ > 45 -> acidosis HOO 3 > 26 -> alkalosis, HCO 3 < 22 -» acidosis

M etabolic: Use proportions to calculate am ount of high % and/or low % required

3. W hich abnorm al value (pOO^ or HOO,) m atches the pH from Step #1 ? Ex: i pH + t pCO^ -> respiratory acidosis

Osm olarity p. 140 mOsmol/L

W t of substance (g/L) = -----------------------------------------f^W (g/mole)

Ex: 4, pH + i HOO 3 -> m etabolic acidosis x

(# of particles)

x

^

Anion Gap p. 181 Anion gap (AG) = Na - Cl - HOO 3

Isotonicity (E Value) p. 143 ^

1,000

pH Calculations p. 182

(58.5)(i)

Weak acid

W eak base

(ltflW o fd ru g )( 1 .8) pH

=

pK^

+

Moles and Millim oles p. 144 mols

= IVlW

or

m m ols

=

mg x valence = ---------------------------MW

Percent Ionization p. 185

MW

W eak acid % ionization

pH

=

pK^

+

base

log

salt

W eak base =

100 1+10""'*''"'

% ionization ‘

=

100 1+1 O'"" I**'

Absolute Neutrophil C ount (ANC) p. 187 or

mEq

=

mmols x valence

ANC (cells/m m “) = WBC x [(% segs + % bands)/100j

Answering Case-Based Exam Questions

Enteral Nutrition Calories p. 152 Garbs, Protein = 4 kcal/gram

Fat = 9 kcal/gram

Tem perature Conversions (Fahrenheit Celsius) p. 108 “C = ( ° F - 3 2 ) /1 .8

Parenteral Nutrition C alories p. 152 Dextrose monohydrate = 3.4 kcal/gram

ILE 10% = 1.1 kcal/mL

Amino acid solutions = 4 kcal/gram

ILE 20% = 2 kcal/mL ILE 30% = 3 kcal/mL

22

acid

mg

Milllequivalents p. 146

mEq

log

salt

“F = ( ° C x 1 .8 ) + 32

Common Sl400

Compounding II M inim um W e ighable Q u a n tity (MWQ) p. 251 =

1 mg IV :P 0 = 1:2

Torsemide

Other Loops

IV :P 0 = 1:1

80 mg

IV:PO = 1:2.5

20 mg

In s u lin p. 620

L e v o th y ro x in e p. 629 IV:PO = 0.75:1

HDL ^

MWQ

Bumetanide Furosemide

10 mg 20 mg

Usually, 1:1 conversion Exceptions: NPH dosed BID glargine dosed daily, use 80% of NPH dose Toujeo -» other forms of glargine or detemir, use 80% of Toujeo dose

correction factor

LDL

L oo p D iu re tic s p, 470 Ethacrynic acid 50 mg Furosemide 40 mg

Simvastatin

Iron, Elem ental p, 518 Ferrous Sulfate = 20% elemental iron (e.g., 325 mg x 0.2 = 65 mg)

C orre ctio n Dose p. 619 (blood glucose now) - (target blood glucose)

40 mg 40 mg

5 mg

M e to p ro lo l p. 445

_____________------------------------------ _ correction factor for 1 unit total daily dose of insulin (TDD) “ of regular insulin

total daily dose of insulin (TDD)

2 mg

Lovastatin Pravastatin Fluvastatin

Rosuvastatin Atorvastatin

Sensitivity requirement Acceptable error rate (usually 0.05)

Oncology II B SA C a lc u la tio n s , M o ste lle r p. 817 (review how to use D ubois-Dubolsj

S te ro id s p. 636 Cortisone 25 mg Hydrocortisone 20 mg

Methylprednisolone Triamcinolone

4 mg 4 mg

Prednisone Prednisolone

Dexamethasone Betamethasone

0.75 mg 0.6 mg

5 mg 5 mg

O p io id s (m e th o d o lo g y ) p. 762 Ht (cm) X Wt (kg) BSA (m2) = 3,600

L ittilu m p. 855 5 mL lithium citrate syrup = 300 mg lithium carbonate = 8 mEq Li* ion 23

1 I Q U I C K G U I D E : D I A G N O S T I C TE ST S

D IA G N O S T IC TESTS D IS O R D E R /C O N D IT IO N

D IA G N O S T IC TES TS (R E FE R T O S P E C IF IC C H A P T E R F O R M O R E IN F O R M A T IO N )

A U T O IM M U N E C O N D IT IO N S Autoimmune, Various

T e ry th ro c y te s e d im e n ta tio n ra te (ESR), t C -re a c tiv e p ro te in (CRP), p o s itiv e rh e u m a to id fa c to r (RF) a ntib o d ie s, p o sitive a n ti-n u cle a r a n tib o d y (ANA)

Rheumatoid Arthritis (RA)

A b o ve a u to im m u n e te sts plus p o s itiv e a n ti-c itru llin a te d p e p tid e a n tib o d y (ACPA)

Systemic Lupus Erythematosus

A b o ve a u to im m u n e te sts plus p o s itiv e a n ti-d s D N A a n tib o d ie s

(SLE) Multiple Sclerosis

M a gn e tic resonance im aging (MRI)

A N TIC O A G U L A T IO N A N D B LO O D DISORDERS Anemia

A ll: 4. Hgb/Hct/RBCs

Microcytic (or Fe-deficlency): 4. M C V (cell size is sm aller, M C V < 8 0 fL) Macrocytic (or B12 or folate deficiency): t M C V (cell size is larger, M C V > 1 0 0 fL), S chilling te s t Venous Thromboembolism (VTE)

D-dlmer te s t (m arker o f fib rin o lys is ) D eep ve in th ro m b o sis (DVT): ultrasound (US), ve nography, MRI P ulm onary em bo lism (PE): p u lm o n a ry c o m p u te d to m o g ra p h ic a ng io g ra p h y (C IA )

Stroke Prevention

CHAjDSj-VASc sco rin g system (score d ire c ts need fo r a n tic o a g u la tio n in p a tie n ts w ith a tria l fib rilla tio n )

Heparin-Induced

U ne xp lain ed 4. platelets (> 50% drop from baseline) 5 -1 4 days a fte r s ta rtin g hep a rin, p o s itiv e a n tib o d ie s

Thrombocytopenia (HIT)

based o n a h e p a rin -p la te le t fa c to r 4 (PF4) ELISA a n d /o r se ro to n in release assay (SRA)

CARDIOVASCULAR C O N D IT IO N S Acute Coronary Syndromes

E lectroca rd iog ra m (ECG, o r EKG), cardiac enzym es [cre a tin e kinase m u s c le /b ra in (C K -M B ), troponin I, I ]

(ACS) Arrhythmias

ECG (or EKG), Holter monitor (a p o rta b le ECG device), h e a rt ra te (HR)

Cerebrovascular Accident (CVA,

C o m p u te d to m o g ra p h y (CT), MRI

or Stroke) Chronic Heart Failure

E chocardiogram (echo), T B -ty p e n a triu re tic p e p tid e (BNP), t N -te rm in a l p ro B N P (N T -p roB N P )

Stable Ischemic Heart Disease

Cardiac stress test, a ng io gra p h y

(SIHD)/Chronic Stable Angina Dyslipidemia

t TC, Non-HDL, LDL, TGs, co ro n a ry a rte ry calcium (GAG, a n o n -in v a s iv e CT scan o f th e h e a rt th a t m easures c a lciu m -co n ta in in g plaque)

Hypertension

T systo lic b lo o d pressure (S B P )/diastolic b lo o d pressure (DBP)

Hypertensive Emergency or

Em ergency: t BP (> 1 8 0 /1 2 0 mmHg) with acute target organ damage

Urgency 10-Year Risk for Atherosclerotic

U rgency: t BP (£ 1 8 0 /1 2 0 mmHg) without acute target organ damage 1 0 -ye a r ASCVD risk tool [use if n o h is to ry o f A S C V D (A C S /IH D , s tro ke , PAD)]

Cardiovascular Disease (ASCVD) E N D O C R IN E C O N D IT IO N S Diabetes, Prediabetes

Fasting plasma glucose (FPG), oral glucose to le ra n c e te s t (OGTT), h e m o g lo b in A l C (A lC )

Hyperthyroidism

4, th y ro id s tim u la tin g h o rm o n e (TSH), T fre e 1 4 (FT4)

Hypothyroidism

t TSH, 4. FT4

FEMALE HEALTH

24

Ovulation

L u te in izin g h o rm o n e (LH), peak va lue p rovid e s o p tim a l tim in g fo r in te rc o u rs e to b e co m e p re g n a n t

Pregnancy

P ositive hum an ch o rio n ic g o n a d o tro p in (hCG) in u rin e (o u tp a tie n t te s t k it) o r in b lo o d

Bacterial Vaginitis

Clear, w h ite o r g ray vaginal discharge, w ith a fishy odor and pH > 4.S, little o r n o pain

Candida Vaginitis

W hite, thicker vaginal discharge, pruritus

Trichomoniasis

Yellow, green frothy, fo u l-s m e llin g vaginal discharge, pH > 4.5, soreness and pain w ith in te rc o u rs e

1

R«PRE: P 2 0 2 3 C O U R S E B O O K 1 R x P R E P © 2 0 2 2 , © 2 0 2 3

Diagnostic Tests Continued D IS O R D E R /C O N D IT IO N

D IA G N O S T IC TES TS (R EFER T O S P E C IF IC C H A P T E R F O R M O R E IN F O R M A T IO N )

G A S TR O IN TES TIN A L DISORDERS Peptic Ulcer Disease

U p p e r g a stro in te stin a l endo sco py (m o u tti to small intestin e )

Duodenal ulcer: pain 2 -3 hrs a fte r eatin g (without food In stomach), pain relief w it li fo o d /a n ta c id s Gastric ulcer: pain rig tit a fte r eatin g (with food in stomach), lit tle / n o pain relief w it ii fo o d /a n ta c id s GERD

Esophageal pH monitoring, endoscopy

H. p y lo ri

Urea breath test (UBT), fecal a ntigen te s t

Inflammatory Bowel Disease

Endoscopy (fo r C rohn's disease, w fiic li a ffe c ts m ore o f tfie Gl tra ct)

(Ulcerative Colitis, Crohn's

S igm oidoscopy (fo r u lce ra tive co litis, w h ic ii a ffe c ts tfie co lon and rectum )

Disease)

For b oth : c o lo n o s c o p y b io p s y CT, MRI

P U L M O N A R Y DISORDERS Bronchospastic Diseases

Spirometry, measures th re e m ain variables; FE V l: h o w m uch a ir can be fo rc e fu lly exhaled in one second FVC: th e m axim um a m o u n t o f a ir th a t can be fo rc e fu lly exhaled FE V l/FV C : th e percentage o f to ta l a ir ca pa city (“v ita l capacity") th a t can be fo rc e fu lly exhaled in one second

Asthma

FVC, FE V l and peak e x p ira to ry flo w rate (PEFR) A lle rg ic asthm a: skin test (to d e te c t an allergen)

Chronic Obstructive Pulmonary

Post-bronchodilator FE V l/F V C < 0.7

Disease (COPD)

Eosinophils > 3 0 0 c e lls /|iL indicates in fla m m a tio n and b e tte r response to inhaled c o rtic o s te ro id s

A C ID /B A S E DISORDERS Metabolic Acidosis

Arterial blood gas, measures pH, pC 02, H C 03 i pH, i H C 0 3 : com pe n sa tion : re s p ira to ry alkalosis

Respiratory Acidosis

4, pH. t p C 0 2 : com pe n sa tion : m e ta b olic alkalosis

Metabolic Alkalosis

T pH, t H C 0 3 : com pe n sa tion : re s p ira to ry acidosis

Respiratory Alkalosis

T pH. 4, p C 0 2 : com pe n sa tion : m e ta b olic acidosis

Anion Gap Metabolic Acidosis

A n io n gap > 12 m E q /L

IN FE C TIO N S General Infection

Fever (te m p era ture > 1 00 .4°F o r 38°C), t W BC co un t, le ft s h ift (T bands, o r im m a tu re neu trop h ils)

C. d iffic ile

Positive C. d iffic ile stool toxin [enzym e im m unoassay plus g lu ta m a te dehydrogenase (GD H ) te s t] o r PCR

H IV

H IV antigen/antibody immunoassay, H IV -l/H IV -2 antibody d iffe re n tia tio n im m unoassay, H IV RNA viral load, nucleic acid te s t

Infective Endocarditis

Echo (to check fo r ve ge tatio n ), blo o d c u ltu re (to id e n tify causative organism )

Lyme Disease

Round, red bullseye rash, enzym e -lin ke d im m u n o s o rb e n t assay (ELISA) te s t

Meningitis

Lumbar puncture (LP), plus sym p to m s o f severe headache, s tiff neck and altered m ental status

Onychomycosis (Fungal

20% KOH smear

Infection of Toenail or Fingernail) Lice (Pediculosis)

Pruritus, visible lice on th e scalp and nits (eggs) on h air shafts

Pinworm (Verm icularis)

Tape test (on skin adja ce nt to anus to check presence o f eggs), helminths (worm s) in blood, feces o r u rine

Pneumonia

Chest X-ray sh ow in g in filtra te s , c o nso lida tio ns o r o pacities

Syphilis

P ositive n o n trep o ne m a l assay [rapid plasma reagin (RPR) o r Venereal Diseases Research L ab o ra to ry (VDRL)

Toxoplasma g o n d ii Encephalitis

blo o d te st] and tre p o n e m a l assay -------- " Toxoplasma IgG te s t

Tuberculosis (TB)

\ ................

.

L ate nt TB: p o sitive tu b e rc u lin skin te s t (TST) [also kn o w n as a p u rifie d p ro te in d e riv a tiv e (PPD)j, o r in te rfe ro n gamma release assay (IGRA) b lo o d te s t A c tiv e TB: p o sitive sp utu m acid-fast bacilli (AFB) stain and c u ltu re , ch est X -ray w ith ca vita tio n

Urinary Tract Infection (UTI)

Urinalysis (p ositive le u k o c y te esterase o r W B C > 10 c e lls /m m ’ , n itrite s , bacteria), u rin e cu lture 25

1 I Q U I C K G U I D E : D I A G N O S T I C TE ST S

Diagnostic Tests Continued D IS O R D E R /C O N D IT IO N

D IA G N O S T IC TE S TS (R E FE R T O S P E C IF IC C H A P T E R F O R M O R E IN F O R M A T IO N )

1 CANCER 1 In itia l screenings; all fo llo w e d b y bio p sy (tissue sam ple sent to p ath olo gy) Breast

Mammogram, ultrasound, MRI

Cervical

Pap smear, HPV test

Colon

Colonoscopy, sigmoidoscopy, d o u b le -c o n tra s t b a riu m enem a, C T c o lo n o gra p h y, sto o l D N A , fecal o c c u lt blo o d te s t (FOBT), fecal im m un o ch em ica l te s t

Lung

CT chest

Skin

Skin bio p sy

Prostate

Digital rectal exam (DRE), prostate-specific antigen (PSA)

G eneral

C a rcin o e m b ryo n ic a ntig e n (CEA) te s t (a m a rk e r to id e n tify cancer), p o s itro n em ission to m o g ra p h y (PET)

1 A D D ITIO N A L C O M M O N CONDITIO NS Allergic Reactions Bleeding

Skin prick (scratch) te s t (im m ediate), im m u n o g lo b u lin E (IgE) antibodies (blood) i H g b /H c t, visib le b lo o d o r b ruising, c o ffe e g ro u n d em esis o r d a r k /ta r r y s to o ls (u pp e r Gl bleeding), red b lo o d in sto o l (lo w e r Gl b le e d in g o r h e m o rrh o id )

Cholestasis (Bite Duct Blockage)

t alka lin e phosphatase (A ik Phos), t to ta l b iliru b in (Tbiii), t g a m m a -g lu ta m y ltra n s fe ra s e (GGT)

Cognitive Impairment

M in i-m e n ta l sta te exam (MMSE), score < 2 4 ind ica te s im p a irm e n t

(e.g., Alzheimer's) Cystic Fibrosis

Sweat test

Glaucoma

T in tra o c u la r pressure (lOP), visual fie ld te s t (to id e n tify o p tic n erve damage)

Gout

t u ric acid (UA) level

Liver Disease

L ive r fu n c tio n te s ts (LFTs): t AST/ALT, t Aik Phos, t Tbili, t lac ta te dehyd ro ge n a se (LD H )

Cirrhosis (chronic liv e r disease): t P T/IN R , i Albumin A lc o h o lic liv e r disease: t AST > t ALT, t GG T

Hepatic encephalopathy: t ammonia level (blood) Movement Disorders

Abnormal involuntary movement scale (AIMS), ra tin g scale used to m easure in v o lu n ta ry m o vem e n ts, o r

(e.g. Parkinson Disease)

ta rd iv e dyskinesias, as m o n ito rin g fo r p a tie n t im p ro v e m e n t

Myopathy

T c re a tin e kinase o r creatine phosphokinase (CPK)

Neuropathy, Peripheral

Assess sensation w ith 10-g monofilament, p in p ric k , te m p e ra tu re a n d /o r v ib ra tio n te s ts

Osteoarthritis

X -ray, MRI

Osteoporosis

Bone m ine ra l d e n s ity (BM D) using dual e n e rg y X -ra y a b s o rp tio m e try (DEXA o r DXA), T-score s -2.5

Osteopenia: T-score -1 to -2.4 Pain

Pain scales, n o n -v e rb a l signs (e.g., m oaning, grim a cing , a g ita tio n )

Pancreatitis

t amylase/lipase

Psychiatric Disease

D S M -5 d ia g n o stic c rite ria

(e.g., Depression, Schizophrenia) Renal Disease

D e p re ssio n -sp e cific: Ham -D o r HDRS assessment scale

t BUN/SCr, cre a tin in e clearance (CrCI), g lo m e ru la r filtr a tio n ra te (eGFR), urine albumin Dehydration: BUN/SCr ratio > 20:1, plus sy m p to m s (e.g., i u rin e o u tp u t, d ry m ucus m em branes, tachycardia)

Seizures/epilepsy

E lectroe n ce ph a log ra m (EEG)

Weight: Underweight, Normal

B M I (plus waist circumference fo r risks associated w ith o v e rw e ig h t/o b e s ity ), ideal b o d y w e ig h t (IBW), to ta l b o d y w e ig h t (TBW)

Weight, O verfreight, Obesity

25

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M E D IC A L TE R M S This is not a com plete list. Some medical definitions are described in the chapters that follow (e.g., blood cell term inology in the Lab Values & Drug M onitoring and Anem ia chapters, com pounding term inology in the Com pounding chapters, oncology term inology in the Oncology I chapter).

C O M M O N PREFIXES A N D SUFFIXES A-

N ot, no. o r lack o f

-algia

Pain o r soreness

A u d io -

H earing

B rady-

Slow

Dys-

D iffic u lt, abnorm al o r p ain fu l

-e cto m y

Surgical rem oval

H em -

Blood

H epato-

Liver

H ype r-

H igh, above norm al o r excessive

H ypo -

Low o r b e lo w norm al

-itis

In fla m m atio n

M yo -

M uscle

N ep h ro -

K idney

O ligo -

Too fe w o r to o little

Patho- o r- p a th y

Disease o r su ffe rin g

-pnea

Breathing

Tachy-

Fast

I

M E D IC A L TER M S Abscess

A local co lle ctio n o f pus a nyw h e re In th e body.

A g ran u locytosis

A lack o f gran u locytes (w h ite blo o d cells) p roduced b y th e b one m arrow .

A kathlsla

A n in a b ility to stay still w ith co n s ta n t m o ve m e n t (restlessness).

Akinesia

A lack o f b o d y m ovem ent.

Alogla

A lack o f speech (also called aphasia).

A lopecia

H air loss. The absence o r cessation o f m e nstrua tio n .

A m enorrhea

1 Am nesia, a nterograde

A loss o f m e m ory related to events th a t o c c u r a fte r a tra u m a tic event.

Am nesia, retrograde

A loss o f m e m ory related to events o c c u rrin g before a tra u m a tic event.

A naphylaxis

A severe, life -th re a te n in g allergic re actio n o c currin g w ith in 3 0 -6 0 m inu te s o f an exposure. Sym ptom s can include h ypo ten sion , sw ellin g o f th e m o u th and th ro a t, d iffic u lty b rea thin g (bronchospasm , w heezing), hives, abdom inal pain.

A ngloedem a

S ubcutaneous o r subm ucosal sw elling, ty p ic a lly in th e tissues o f th e face, lips, m o u th and th ro a t. Can o ccur in Isolation o r as a co m p o n e n t o f anaphylaxis.

A n io n

A n eg a tive ly charged ion (e.g. chloride).

A norexia

A s ig n ifica n t loss o f a pp e tite o r aversion to food.

Anorgasm la

A n In a b ility to achieve orgasm.

A n u ria

No u rin e o u tp u t.

1 I QUICK GUIDE

MEDIC AL TERMS

Medical Terms Continued A o rtic D issection

A te a r in th e v^rall o f th e aorta, w h ich a llo w s b lo o d to flo w b e tw e e n th e w all layers, sepa ra tin g (dissecting) th e m .

Aphasia

A lack o f speech (also called alogia).

A p o p to sis

Cell death.

A rrh y tlim ia

A n a bn o rm a l h e a rt rh yth m .

A rth ra lg ia

Jo in t pain.

A rth ritis

J o in t in fla m m a tio n .

A scites

Fluid a ccum u la tion w ith in th e p e rito n e a l space o f th e abdom en.

A splenia

D ecreased spleen fu n c tio n o r th e absence o f a spleen.

A sth e n ia

Lack o f e n e rg y and stre n g th ; w eakness.

A taxia

A lack o f m uscle c o n tro l and u n co o rd in a te d b o d y m ovem ents.

A th e ro scle ro sis

The b u ild u p o f fats, ch ole ste ro l and o th e r substances w ith in a rte ria l w alls, w h ic h leads to plaques and a n a rro w in g o f th e a rte ria l space.

A tte n u a te d

W eakened.

A ty p ic a l

U nusual.

A u s c u lta tio n

Listen in g to In te rn a l organs (e.g., h e a rt and lungs) w ith a s te th o sco pe .

A x illa ry

A rm p it.

A v o litio n

A to ta l lack o f m o tiv a tio n .

A zo te m ia

A b u ild u p o f urea (a n itro g e n w a ste p ro d u c t n o rm a lly e lim in a te d by th e kidneys) in th e b lo o d (also called urem ia).

B eyond Use D ate (BU D)

A n e xp ira tio n d ate app lied to a co m po u n de d p ro d u c t, b eyo n d w h ic h th e d ru g sh ou ld n o t be used.

B ilateral

O n b o th sides o f th e body.

B io a v a ila b ility

The p ro p o rtio n (expressed as a percentage) o f a d ru g th a t e n te rs in to th e system ic c irc u la tio n and is a vailable to e x e rt its bio lo gica l a ction .

B lep h a ritis

Eyelid In fla m m a tio n .

Bolus

A single in tra ve n o u s dose o f a m e d ica tio n a d m in is te re d all a t once o v e r a s h o rt p e rio d o f tim e .

Bradycardia

S low h e a rt ra te (< 6 0 bpm).

B radykinesia

S low b o d y m o vem e n t.

B ro n c h itis

In fla m m a tio n o f th e b ro n ch ia l tu b e s in th e lungs.

Bulim ia

A n e a tin g d iso rd e r c h a ra cterize d by b in g in g (o ver-e a tin g) fo llo w e d by s e lf-in d u c e d v o m itin g .

Cachexia

E xtrem e w e ig h t loss and m uscle w a s tin g due to a c h ro n ic illness.

C arbuncle

A red, in fla m e d c lu s te r o f fu ru n c le s (boils) th a t c o n ta in pus and can fo rm an abscess.

C ard iom e g a ly

Enlarged hea rt.

C atap le xy

A sudden, te m p o ra ry loss o f m uscle co n tro l and an in a b ility to m o ve w h ile th e perso n is aw ake, o fte n trig g e re d by

C atara ct

A clou d ine ss co ve rin g th e lens in th e eye, caused b y a b re a k d o w n o f p ro te in s and re s u ltin g in b lu rre d vision.

C atio n

A p o s itiv e ly charged ion (e.g., sodium ).

C e llu litis

A spreading b a cte ria l in fe c tio n in th e skin o r s u bcu tan e o us tissue, ch a ra cte rize d b y redness, sw ellin g , w a rm th and pain.

C entral line

A lon g c a th e te r in se rte d in to a neck, u p p e r ch est o r g roin ve in and g uid e d in to a large c e n tra l ve in (s u p e rio r vena cava)

stro n g e m o tio n s such as laughing, cry in g o r fear.

to a d m in is te r in tra ve n o u s m e d ica tio n s and fluids.

28

C ere b ro vascu lar

W h e n b lo o d flo w to a p a rt o f th e brain is b lo cke d (e.g., by a c lo t o r a ru p tu re d vessel) and brain cells die. A ls o called a

A c c id e n t

stro ke .

C erum en

Ear w ax.

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M edical Terms Continued C hancre

A painless ulcer (usually located on th e genitals) associated w ith p rim a ry syphilis.

C helation

The process by w h ich ions and m olecules (e.g., drugs) bind to m etal ions, fo rm in g a n on-absorbable com plex.

C ho le cyste cto m y

Surgical rem oval o f th e gallbladder.

C holelithiasis

The fo rm a tio n o f stones (calculi) in th e gallbladder.

Cholestasis

A re d u ctio n o r blockage o f bile flo w .

C irrhosis

Advanced, irreve rsible fib rosis (scarring) o f th e liver.

C oa g u lo p ath y

A co n d itio n associated w ith excessive blee d in g and im paired c lo t fo rm a tio n .

C o n ju n ctivitis

In fla m m atio n o f th e th in clear m em brane th a t covers th e eyeball and lines th e inside o f th e eyelid.

C o n tin u ou s Positive

A tre a tm e n t fo r o b s tru c tiv e sleep apnea th a t uses a m achine to pum p a ir th ro u g h th e airw ays, keeping th e w in d p ip e

A irw a y Pressure (CPAP)

open d u rin g sleep.

C rystalluria

The presence o f crystals in th e u rin e caused by m eta b olic disorders o r drugs.

C ystitis

Bladder in fla m m a tio n , usually due to a bacterial in fe ctio n .

D eliriu m

A n a cute change in m ental status characterized b y in co h e re n t th o u g h ts and speech, d is o rie n ta tio n , a gita tio n , hallucinations, delusions a n d /o r paranoia.

D elusion

A false o r irra tio n a l b e lie f based on an in c o rre c t in te rp re ta tio n o f reality.

D em entia

M e m o ry loss and d iffic u lty w ith th in k in g , p ro b le m -so lvin g and language th a t in te rfe re s w ith d aily life.

D esiccant

A substance th a t preserves so m eth in g by rem ovin g m o isture and keeping it dry.

D ia b e tic K etoacidosis

A life -th re a te n in g h yperglycem ic crisis characterized by high blo o d glucose, anion gap m eta b olic acidosis and ketones

(DKA)

in th e blo o d o r urine.

Dialysis

The process o f re m ovin g w aste p ro d u cts and excess e le c tro ly te s and flu id fro m th e blood.

Diaphoresis

Excessive o r abnorm al sw ea tin g n o t explained by th e e n v iro n m e n ta l te m p e ra tu re o r a perso n ’s a c tiv ity level.

D iplopia

D ou b le vision.

D issection

A te a r w ith in th e w all o f a blo o d vessel (e.g.. th e aorta), w h ic h a llow s blo o d to flo w b e tw e e n th e w all layers, separating

Dyscrasia

A n y disease o r abnorm al c o n d itio n o f th e body.

D ysen te ry

An in fe c tio n o f th e intestin e s characterized b y severe, b lo o d y diarrhea and abdom inal pain.

Dysgeusia

An altere d sense o f taste.

D yskinesia

A bn orm a l, in v o lu n ta ry m ovem ents.

D ysm enorrhea

D is c o m fo rt and pain d u rin g th e m enstrual period.

Dyspepsia

Indigestion.

D ysphagia

D iffic u lty sw allow ing.

D ysphonia

A n im p a irm e n t o f th e voice (e.g., hoarseness) and d iffic u lty speaking.

D yspnea

D iffic u lt o r labored b reathing; shortness o f breath.

(dissecting) them .

D ystonia

In vo lu n ta ry m ovem ents and prolo n ge d c o n tra c tio n s o f m uscles th a t re sult in tw is tin g b od y m o tio n s and abnorm al posture.

Ectopic

In an a bnorm al place o r p ositio n .

Em bolism

A fo re ig n substance o r blo o d c lo t th a t travels th ro u g h th e blo o d stre am and lodges in a blo o d vessel causing an

Empyema

A c o lle ctio n o f pus and flu id in a b o d y cavity, usually th e pleural space (the space b e tw e e n th e lung and th e inner

o b stru ctio n .

surface o f th e chest wall). Encephalitis

In fla m m atio n o f th e brain.

Encephalopathy

Brain disease, damage, o r m a lfu n c tio n th a t results in an altere d m ental state.

29

1 I Q U I CK G UI DE : M E D I C A L TERMS

M e d ic a l Term s C o n tin u e d Endocarditis

In fla m m a tio n o f th e h e a rt valves o r lin ing o f th e h e a rt cham bers.

E ndom etriosis

A p ain fu l c o n d itio n in w/hich tissue th a t n o rm a lly lines th e u te ru s (e nd o m e trium ) has g ro w n o u ts id e th e u terus.

Enteral

In vo lvin g th e in te stin e .

Enuresis

In v o lu n ta ry u rin a tio n .

Epistaxis

N osebleed.

E ructa tio n

B urping o r belching.

E rythem a

Skin redness.

E tio lo g y

The cause (e.g., o f a disease).

E uplioria

A fe e lin g o f happiness; ele va te d m ood.

E uth yro id

N orm a l th y ro id gland fu n c tio n .

E xacerbation

A n increase o r w o rse n in g (e.g., in th e s e v e rity o f a disease).

E xco ria tio n

The scraping o r v^^earing o ff o f skin re su ltin g in a skin abrasion.

Exophthalm os

Bulging (p ro tru d in g ) eyeballs.

E xtravasation

W h e n flu id (e.g., drug, b lo o d ) leaks o u ts id e o f a vessel in to th e su rro u n d in g tissue.

Fibrom yalgia

A c o n d itio n o f w id e sp re a d pain accom p a n ie d b y s tiffn e s s , fa tig u e , sleep disturb a n ces, headaches and e m o tio n a l o r

Fibrosis

Scarring (w ith stiffn e ss) in c o n n e c tiv e tissue.

Flatulence

Excess gas in th e g a stro in te stin a l tra ct.

Fo llicu litis

H air fo llic le in fla m m a tio n , usually caused by in fe c tio n : can lo o k like acne.

G alactorrhea

T h e p ro d u c tio n o f b rea st m ilk in m en o r w o m e n w h o are n o t b rea stfe ed ing .

G a stritis

In fla m m a tio n , irrita tio n o r e rosio n o f th e lin in g o f th e stom ach.

m e nta l distress (e.g., a nxiety).

Gastroparesis

D ecreased fu n c tio n o f th e nerves c o n tro llin g th e s to m a ch m uscles, re s u ltin g in in a d e q u a te d ig e s tio n and delayed g astric e m p tyin g .

G e n o typ e

The set o f u n iq u e genes th a t d e te rm in e a s p e c ific tr a it in an in d iv id u a l.

G ingival B leeding

B leeding o f th e gum s (gingiva).

G ingival H yperplasia

G um (gingiva) o ve rg ro w th .

G lossitis

Tongue in fla m m a tio n .

G ynecom astia

Breast e n la rg e m e n t in men.

H allucin a tion

A d is to rtio n o f re a lity w h e re b y a person hears, sees o r feels s o m e th in g th a t is n o t the re .

H eim lich M a n e u ve r

The p ro ce d u re fo r re m o vin g o r d islo d g in g an o b s tru c tio n (e.g., fo o d ) fro m a p erso n 's a irw a y b y a p p ly in g fo rc e fu l abd o m ina l th ru s ts in an in w a rd and u p w a rd d ire c tio n .

H em atem esis

V o m itin g blood.

H em a to lo gic

H avin g to d o w ith b lo o d o r b lo o d disorders.

H em atom a

A c o lle c tio n o f b lo o d w ith in an organ o r localized b o d y tissue.

H em a tu ria

B loo d in th e urine.

H em olysis

The d e s tru c tio n o f red b lo o d cells (RBCs).

H em o p tysis

C ou g h in g o r s p ittin g up b lo o d fro m th e re s p ira to ry tra c t.

H e m o rrh o id

A n enla rg ed o r s w o lle n b lo o d vessel n ea r th e anus o r w ith in th e re ctu m .

H em ostasis

The s to p p in g o f b lo o d flo w .

H e p a to to x ic ity

Liver damage.

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M edical Terms Continued H irsu tism

M a le -p a tte rn hair g ro w th in w om en.

H o t Flashes

Episodes o f flushing w ith a sensation o f w a rm th or heat in the upp e r b ody and face.

H yp e rb iliru b in e m ia

Increased b iliru b in in th e blood; can cause jaundice.

H yperhidrosis

Excessive sweating.

H ype ro sm o la r

A hyperglycem ic crisis characterized by very high blood glucose, severe d eh yd ra tion , and confusion.

H ype rg lyce m ic State (HHS) H yperplasia

An increase in th e num ber o f cells in an organ o r body tissue.

H yp e rth e rm ia

A body te m p e ra ture w e ll above norm al.

H yp e rtrich o sis

Excessive hair g ro w th : can be all over the b od y o r in patches.

H y p e rtro p h y

The enlargem ent o f an organ o r tissue re sulting fro m an increase in cell size.

H ypo h idro sis

Reduced sw eat p ro d u c tio n (also called oligohydrosis).

In tra a rticu la r

In to th e jo in t.

Intracranial H em orrhage

Bleeding in th e brain.

(ICH)_________________ Intrathecal

In troduced in to o r occurrin g in th e space betw e e n th e layers o f tissue th a t cover th e brain and spinal cord.

Ischemia

An inadequate blood supply to an organ o r p art o f th e body.

Jaundice

A ye llo w in g o f th e skin and sclerae (the w h ite s o f th e eyes).

Leukocytosis

Increased (higher th a n norm al) w h ite blood cell count.

Libido

Sexual desire.

Lym phadenopathy

S w ollen lym ph node (also called glands).

Lyophllized

Freeze-dried.

Malaise

A general fe e lin g o f d is c o m fo rt o r illness.

M a lig na n t

Severe and progressively w orsening. In cancer, th e a b ility to spread to o th e r parts o f th e b od y and invade and destroy tissue.

M e dica tio n Guide

A h an d o ut th a t provides drug -sp e cific in fo rm a tio n to help th e p a tie n t avoid serious adverse events.

(M edG uide) Melasma

Skin p ig m entation, usually appearing as dark spots on th e cheeks o f th e face.

M enorrhagia

Heavy m enstrual bleeding.

M etatarsophalangeal

The big to e jo in t.

Jo in t M o rb id ity

Illness o r disease.

M o rta lity

Death.

M ucositis

In fla m m atio n o r ulceration o f th e m ucous mem branes in th e digestive tra c t (o ften in th e m outh).

M yalgia

M uscle pain.

M ydriasis

Pupil d ilation.

M yelosuppression

Decreased bone m a rrow a c tiv ity resulting in lo w w h ite blood cells (WBCs), red blood cells (RBCs) and platelets.

M yocardial In farction

A heart attack.

M yo card itis

In fla m m atio n o f th e m yocardium (heart muscle).

M yoclonus

In vo lu n ta ry and abnorm al muscle co ntractions.

M y o p a th y

M uscle weakness o r any m uscle disease.

1

QUICK GUIDE

m e d ic a l

TERMS

Medical Terms Continued N ecrosis

Cell o r tissue death.

N ep h ro lith iasis

The fo rm a tio n o f kidn e y stones.

N e p h ro to x ic ity

K idn e y (renal) to x ic ity o r damage.

N eu ro p a th y

N erve damage.

N osocom ial

O rig in a tin g in a hospital.

N ystagm us

R epetitive, u n c o n tro lle d m ovem e n ts o f th e eye.

O ligo h idro sis

Reduced sw ea t p ro d u c tio n (also called hypohidrosis).

O rth o p n e a

S hortness o f b reath w h e n lyin g fla t.

O rth o sta sis

A d ro p in b lo o d pressure th a t happens soon a fte r standing.

O steom alacia

S o fte n in g o f th e bones.

O s te o m ye litis

An in fe c tio n inside th e bone.

O steo p o rosis

Low b one mass (density) re su ltin g in p o ro u s and b r ittle bones.

O talg ia

Ear pain.

O to rrh e a

D rainage o f liq u id fro m th e ear.

O to to x ic ity

Ear damage.

P alliative care

^ M e dica l (or c o m fo rt) care to im p ro ve th e q u a lity o f life and p ro v id e s y m p to m re lie f in p a tie n ts w ith a serious, life th re a te n in g o r te rm in a l illness, b u t does n o t cure th e disease.

Pallor

Pale skin color.

Parasomnia

U nusual, odd , o r d angerous b e h a v io r o c c u rrin g d u rin g sleep.

Paresthesia

A b u rn in g, p ric k lin g o r “ pins and needles" sensation.

Peak Level

The h ig h e st c o n c e n tra tio n o f a d ru g in th e b lo o d stre am .

P ediculosis

Lice in fe s ta tio n .

P egylation

The a d d itio n o f p o ly e th y le n e g lyco l (PEG) to a m o lecule.

Perinatal

The tim e im m e d ia te ly b e fo re and a fte r b irth .

P eripheral Line

A s h o rt c a th e te r in se rte d In to a p e rip h e ra l ve in , usually in th e hand o r th e lo w e r p a rt o f th e arm o r fo o t, to a d m in is te r in tra ve n o u s m e d ica tio n s and flu id s.

P e rip h e rally Inserted

A ce ntra l lin e in se rte d p e rip h e ra lly (in a ve in in th e arm ) and advanced th ro u g h th e ve in u n til th e tip reaches

C en tra l Line (PICC)

a large vessel (o fte n th e su p e rio r vena cava).

P eripheral N e u ro p a th y

Peripheral w eakness, num bness, and pain fro m n erve dam age.

Peristalsis

W a ve -like m uscle m o vem e n ts o f th e g a s tro in te s tin a l tra c t th a t help d ig e st fo o d and push th e c o n te n ts fo rw a rd .

P harm acodynam ics

The e ffe c t th a t a d ru g has o n th e body.

P harm acokinetics

The e ffe c t th a t th e b o d y has on a d ru g as it goes th ro u g h th e processes o f a b s o rp tio n , d is trib u tio n , m e ta b o lis m and e xcre tio n .

32

P haryn g itis

In fla m m a tio n o f th e p h a ryn x re su ltin g in a sore th ro a t.

P h e no typ e

A n o b se rva b le tra it (e.g., h a ir color) th a t is th e o u tw a rd expression o f a p e rs o n ’s g e n o ty p e .

P hle b itis

In fla m m a tio n o f a vein.

P h o to s e n s itiv ity

A n o v e rs e n s itiv ity o f th e skin to lig h t.

Pleural E ffusio n

Fluid b e tw e e n th e layers o f th e pleura, th e th in m e m bra n e s th a t lin e th e o u ts id e o f th e lungs.

P neum onia

A n in fe c tio n th a t infla m e s one o r b o th lungs.

Polydipsia

E xtrem e th irs t.

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Medical Terms Continued Polyp

An abnorm al g ro w th o f tissue p ro je c tin g fro m a m ucous m em brane.

Polyphagia

Excessive h unger o r increased app e tite .

Polyuria

Excessive u rin a tio n.

Porphyria

A grou p o f disorders (com m only a ffe c tin g th e skin and n ervous system ) re sultin g fro m a b n o rm a litie s in hem e (an oxygen tra n sp o rte r) p ro d u ctio n and a su bsequent increase in th e fo rm a tio n o f in te rm e d ia te chem icals (porphyrins).

Postprandial

A fte r a meal.

Preeclampsia

A serious, p o te n tia lly fa ta l co m p lic a tio n o f pregnancy characterized b y high blo o d pressure, p ro te in in th e u rin e and peripheral edema.

Preprandial

Before a meal.

Priapism

Prolonged, o fte n pain fu l, e re ctio n o f th e penis.

Prophylaxis

Prevention (e.g., o f a disease).

Pruritus

Itchy skin.

Pulse O x im e try

A n oninvasive te s t th a t measures th e level o f oxygen in th e blo o d (also called oxygen saturation).

P urulent

C onsisting of, co nta in ing , o r discharging pus.

P yelonephritis

A typ e o f u rin a ry tra c t in fe c tio n w h e re one o r b o th kidneys becom e infecte d.

Pyrexia

Fever,

Rales

A n a bnorm al ra ttlin g o r crackling sound heard w he n e xam ining th e lungs w ith a stethoscope.

Rhonchi

C on tin u ou s, deep ra ttlin g sounds (th a t resem ble snoring) heard w h e n e xam ining th e lungs w ith a stethoscope.

Risk Evaluation and

A d rug safety program required by th e FD A fo r som e m edica tio ns w ith serious s a fe ty concerns to ensure th e b en e fits

M itig a tio n Strategy

o f th e m e dica tio n o u tw e ig h th e risks.

(REMS) R etrograde Ejaculation R habdom yolysis

Semen ente rs th e bla d d er instead o f e x itin g th ro u g h th e penis d u rin g orgasm. A c o n d itio n w h e re skeletal m uscle breaks d ow n , releasing cre atin e phosphokinase (CPK), m yoglo b in and o th e r muscle co m po n e nts in to th e blo o d : can lead to kidn e y failure.

R hinitis

In fla m m atio n and sw ellin g in th e nose.

R hinorrhea

Runny nose, w ith a th in m ucus nasal discharge.

R igidity

S tiffness o r an in a b ility to bend.

Rigor

A sudden fe e lin g o f cold w ith sh ivering accom panied by a rise in te m p e ra ture .

Scabies

A n in fe sta tio n o f th e skin by an itchy, conta gio us m ite (Sarcoptes scabiei).

Sepsis

A life -th re a te n in g im m un e response to in fe c tio n th a t can lead to tissue damage, organ d y s fu n c tio n and death.

Septicem ia

A severe b loodstream in fe c tio n (also called bacterem ia o r blo o d poisoning).

Shock

A m edical em ergency (w ith high m o rta lity ), m o st o fte n characterized by severe h ypo ten sion and h y p o p e rfu s io n o f vital organs.

Sialorrhea

Excessive salivation o r drooling.

Sinusitis

In fla m m atio n o f th e sinuses (the h o llo w areas o f th e skull a round th e nose).

Som nam bulism

Sleepw alking,

Som nolence

Sleepiness o r drow siness.

S piro m e try

A p u lm o n a ry fu n c tio n te s t th a t m easures th e vo lu m e o f a ir som eone can inhale, th e vo lu m e th e y can exhale and h ow fa st th e y can exhale.

Steatorrhea

Excess fa t in th e feces due to decreased in testin a l fa t a bso rp tio n.

Steatosis

A bn orm a l fa t accum ulation.

Stenosis

The n a rro w in g o f a b o d y space.

33

1 I QU IC K GUIDE: ME DI CA L TERMS

Medical Terms Continued S tevens-Johnson

A severe system ic re actio n th a t causes rash, b liste rs and p eeling o f th e skin and th e m ucus m em branes o f th e m o u th ,

S yndrom e/T oxic

airw ays, eyes and genitalia.

Epiderm al N ecrolysis (SJS/TEN) S to m a titis

In fla m m a tio n a n d /o r u lce ra tio n o f th e m o uth .

Striae

S tre tch m arks on th e skin.

S trictu re

A n abnorm al n a rro w in g o f a b o d y passage.

S u b th e ra p e u tic

Low e r th a n w h a t is co nsidered to be safe and e ffe c tiv e (e.g., d ru g level, dose, la b o ra to ry value).

S u p ra the ra pe u tic

A b o ve w h a t is considered to be safe and e ffe c tiv e (e.g., d rug level, dose, la b o ra to ry value).

S yncope

A te m p o ra ry loss o f consciousness caused by a d ro p in b lo o d pressure and blo o d flo w to th e brain (also called fa intin g ).

Synergy

W h e n th e co m bin e d e ffe c t is g re a te r th a n th e sum o f th e parts.

S ystem ic Lupus

A n a u to im m u n e c o n d itio n th a t causes in fla m m a tio n and tissu e dam age in m any p arts o f th e b o d y in c lu d in g th e jo in ts ,

E ryth e m a to sus (SLE)

skin, brain, lungs, kid n e y and h e a rt (also called lupus).

Tachycardia

Fast h e a rt rate (> 1 0 0 bpm).

Tachyphylaxis

A d im in ish e d response to successive doses o f a drug.

Tardive D yskinesia

U n c o n tro lla b le , in vo lu n ta ry, re p e titiv e m o vem e n ts o f th e face (m ost com m on) and o th e r b o d y parts.

Teratogenic

A d ru g th a t w ill cause b irth d e fe cts if ta ke n d u rin g pregnancy.

T h ro m b o cyto p e n ia

L ow p la te le t co u n t.

T h ro m b o tic

A serious b lo o d d iso rd e r th a t causes b lo o d c lots (th ro m b o s is fro m p la te le t c lum p ing ) to fo rm in sm all b lo o d vessels

T h ro m b o c y to p e n ic

th ro u g h o u t th e body. This leads to a lo w p la te le t c o u n t and su b s e q u e n t b le e d in g u n d e r th e skin w h ic h appears as

P urpura (TTP)

p u rp le bruises (purpura).

Thrush

A ye ast in fe c tio n chara cterize d by w h ite patches in th e m o u th a n d /o r th ro a t caused b y C andida albicans.

T in n itu s

A rin g in g o r b uzzing in th e ears.

Torsades de Pointes

A life -th re a te n in g ty p e o f v e n tric u la r ta ch yca rdia ch ara cterize d by changes in th e QRS co m plexes and a p ro lo n g e d Q T

(TdP)

interva l.

Tra n sie n t Ischem ic

A te m p o ra ry b lockage o f b lo o d flo w to th e brain th a t causes s y m p to m s o f a stro ke th a t resolve w ith in a s h o rt p e rio d o f

A tta c k (TIA)

tim e (also called a “ m in i-s tro k e ”).

Trough Level

The lo w e s t co n c e n tra tio n o f a d ru g in th e b lo o d s tre a m o r th e c o n c e n tra tio n m easured im m e d ia te ly b e fo re th e n e x t dose.

U nilate ra l

O n o ne side o f th e body.

Urem ia

A b u ild u p o f urea (a n itro g e n w a ste p ro d u c t n o rm a lly e lim in a te d b y th e kidneys) in th e b lo o d (also called azotem ia).

U rethra

The tu b e th a t carries u rin e fro m th e b la d d e r o u t o f th e body. It ru ns th ro u g h th e penis in m ales and th e vaginal o p e n in g in fem ales.

34

U re te r

The tu b e s th a t run fro m each kid n e y in to th e bladder, d e liv e rin g th e “ renal filtra te " th a t w ill be e x c rete d as u rine.

U rolith ia sis

The fo rm a tio n o f stones in th e kidney, u re th ra , b la d d e r o r u reters.

U rtica ria

Raised, itc h y areas o f skin (also called hives).

V esicant

A d ru g th a t can cause severe tissu e dam age o r b liste ring .

X e rop h th a lm ia

E xtre m e dryness o f th e eyes (co n ju n ctiva and cornea).

X erostom ia

Severe d ry m o u th caused by decreased saliva.

RxPRI . F’ 2 0 2 3 C O U R S L B O O K 1 R x P R E P f g 2 0 2 2 . 'e;2023

C O M M O N M E D IC A L A B B R E V IA T IO N S

A B B R E V IA T IO N

M E A N IN G

A B B R E V IA T IO N

M E A N IN G

5 -H T

S erotonin

AS

L eft Ear

A&O

A le rt & O rie nte d

ASCVD

A th e ro s c le ro tic C ardiovascular Disease

ABG

A rte ria l B lood Gas

AST

A s p a rta te A m ino tra n sfe ra se

AC

Before Meals

ATC

A ro un d The C lock

ACE

A n g io te n sin C on ve rtin g Enzyme

ATN

A c u te Tubular Necrosis

ACh

A ce tylch o lin e

AU

Each Ear

ACIP

A d viso ry C o m m itte e on Im m unization

AVP

A rg in in e Vasopressin

BEE

Basal Energy E xpenditure

G ynecologists

BG

B lood G lucose

ACS

A cu te C oro n a ry Syndrom e

BGM

ACTH

A d re n o c o rtic o tro p ic H orm o n e

BID

Tw ice a Day

AD

Right Ear

B IW

Tw o Tim es Per W e e k

ADH

A n tid iu re tic H orm o n e

BM

B ow el M o ve m e n t

ADHD

A tte n tio n D e fic it H y p e ra c tiv ity D iso rd er

BMD

Bone M ineral D en sity

ADHF

A cu te D ecom pensated H ea rt Failure

BMI

B ody Mass Index

ADL

A c tiv ity o f D aily Living

BMP

Basic M e ta b o lic Panel

AD R

A dverse D rug Reaction

BP

B lood Pressure

ADT

A lte rn a te Day Therapy, A ndrogen D e p riv a tio n

BPH

Benign P rostatic H yperplasia (or H yp e rtro p h y)

BPM

Beats Per M in u te , Breaths Per M in u te

Practices ACOG

A m erican College o f O b ste tricia n s and

t

B lood Glucose M o n ito rin g

Therapy AED

A n tie p ile p tic D rug, A u to m a te d External D e fib rilla to r

BSA

B ody Surface Area

AF. A Fib

A tria l F ib rillatio n

BUN

B lood Urea N itrog e n

AGEP

A cu te Generalized E xanthem atous Pustulosis

c o rw (/

W ith

AIDS

A cq u ire d Im m u n o d e ficie n cy Syndrom e

C -I,C -II,C -III.C -IV ,

Refers to C o n tro lle d Substance Schedule

C-V

A IN

A cu te In te rstitia l N e p h ritis

AKI

A cu te K idney Injury

ALT

A lanine A m inotransferase

ANA

A n tin u c le a r A n tib o d y

ANC

A b so lu te N e u tro p h il C ou n t

ANS

A u to n o m ic N ervous System

AOM

A cu te O titis M edia

aPTT, PTT

A ctiva te d Partial T h ro m b o p la stin Tim e

ARA

A ld o ste ro n e R eceptor A n ta g o n ist

CAP

C o m m u n ity-A cq u ire d Pneum onia

ARB

A n g io te n sin R eceptor Blocker

CAPES

Citrobacter, Acinetobacter. Providencia.

ARDS

A cu te R espiratory D istress Syndrom e

ARF

A cu te Renal Failure

ARNI

A n g io te n sin R eceptor and N ep rilysin In h ib ito r

ART

A n tire tro v ira l Therapy

C u ltu re and S u sce ptib ility

C&S -I-

c /o

C om plaining o f

CA

Cancer, Cardiac A rre s t

CABG

C oro n a ry A rte ry Bypass G ra ft

CAD

C oro n a ry A rte ry Disease

cA M P

C yclic A denosine M o no p h osp h a te

C A -M R SA

C o m m u n ity -A c q u ire d M e th icillin -R e sista n t Staphylococcus aureus

Enterobacter, Serratia CBC

C om p lete B lood C ou n t

CBT

C o g n itive Behavioral Therapy

CC

C hie f C om p lain t

CCB

C alcium C hannel Blocker

35

1 I Q UICK GUIDE: C O M M O N

ME DI CA L ABBREVIATIONS

Common Medical Abbreviations Continued A B B R E V IA T IO N

M E A N IN G

A B B R E V IA T IO N

M E A N IN G

CD

C rohn's Disease

DOE

D yspnea o n E xertion

CDI

C. d ifficile In fe ctio n

DPI

D ry P o w d e r Inhaler

CF

C ystic Fibrosis

DRESS

D rug Reaction w ith E o sinophilia and System ic S ym ptom s

C HF

C hro n ic (or C ongestive) H ea rt Failure

Cl

C ardiac Index, C on tra in dica te d

CK

C rea tin e Kinase (same as CPK)

CKD

C hro n ic K idn e y Disease

CMV

C yto m eg a loviru s

CNS

C entral N ervous System

CO

C ardiac O u tp u t

COC

C o m b in a tio n O ral C o n tra ce p tive

COPD

C h ro n ic O b s tru c tiv e P u lm onary Disease

CP

C he st Pain, C erebral Palsy

CPAP

C o n tin u o u s P ositive A irw a y Pressure

CPK

C rea tin e Phosphokinase (same as CK)

CPR

C a rd io p u lm o n a ry R esuscitation

CrCI

C re a tin in e Clearance

CRE

C arb a p en e m -R e sista n t Enterobacteriaceae

CRF

C h ro n ic Renal Failure

CRP

C -re a ctive P ro te in

CSF

C erebrospinal Fluid, C o lo n y S tim u la tin g

d td

O f Such Doses

D VT

D eep V ein T h ro m bo sis

Dx

D iagnosis

EC

E nteric C oated

ECG, EKG

E lectroca rd iog ra m

ED

E m ergency D e p a rtm e n t, E rectile D y s fu n c tio n

EF

E jectio n Fraction

Epi

E p inephrine

EPS

E xtra p yra m id a l S ym ptom s

ERA

E n d othe lin R ece p to r A n ta g o n is t

ESBL

E xte n d e d -S p e ctru m Beta-Lactam ase

ESR

E ry th ro c y te S e d im e n ta tio n Rate

ESRD

End Stage Renal Disease

ETOH

Ethanol

f/u

F o llo w -U p

FBG

Fasting B loo d G lucose

FD A

Food and D ru g A d m in is tra tio n

Factor

FEVl

Forced E x p ira to ry V o lu m e in 1 Second

CTCAT

C o m p u te rize d (or C om p u te d ) T om ography

FPG

Fasting Plasma G lucose

CV

C ardiovascular

FSH

Follicle S tim u la tin g H o rm o n e

CVA

C ere b ro vascu lar A c c id e n t

FT4

Free T h y ro x in e (T4)

CVP

C entral V enous Pressure

G 6 PD

G lu co se - 6 -P h osp h a te D ehydrogenase

CXR

C he st X-R ay

GERD

G astroesophageal R eflux Disease

D /C

D isco n tin u e , D ischarge

GFR

G lo m e ru la r F iltra tio n Rate

D 5W

5% D e xtro se in W a te r

Gi

G a s tro in te s tin a l

DA

D o p a m in e

GNR

G ra m -N e g a tiv e Rod

D DI

D ru g -D ru g In te ra ctio n

GnRH

G o n a d o tro p in -R e le a s in g H o rm o n e

DHPCCB

D ih y d ro p y rid in e C alcium C hannel B locker

g tt, g tts

D rop , D rop s

DILE

D ru g -In d u ce d Lupus E ryth e m a to us

h /o

H is to ry o f

DJD

D e g e n e ra tive J o in t Disease (O ste o a rth ritis)

HA

H eadache

DKA

D ia b e tic K etoacidosis

HACEK

Haemophilus, A ctinobacillus, C ardiobacterium ,

DM

D ia b e te s M e llitu s

DMARD

D is e a s e -M o d ify in g A n tirh e u m a tic D rug

DOAC

D ire c t-A c tin g O ral A n tic o a g u la n t (same as

Eikenella, Kingella

N O AC ) DOC

36

D ru g o f C hoice

HAP

H o s p ita l-A c q u ire d Pneum onia

HBV

H e p a titis B V iru s

hCG

H um an C h o rio n ic G o n a d o tro p in

R x PREP 2 0 2 3 C O U R S L B O O K | Rx PREP C ; 2 0 2 2 . «:- 2023

Common Medical Abbreviations Continued A B B R E V IA T IO N

M E A N IN G

A B B R E V IA T IO N

M E A N IN G

H ct

H e m a to c rit

lU D

In tra u te rin e D evice

HCTZ, H CT

H yd ro ch lo ro th ia zid e

IV

Intravenous

HCV

H e p a titis C V irus

IVP

Intra ve n ou s Push

HDL. HDL-C

High D en sity L ip o p rotein

IVPB

Intra ve n ou s Piggyback

HEENT

H ead, Eyes. Ears, Nose and T h ro a t

LABA

Lon g -A ctin g B eta-2 A g o nist

HF

H ea rt Failure

LAM A

L o n g -A ctin g M u scarin ic A n ta g o n is t

HFrEF

H ea rt Failure w ith Reduced Ejection Fraction

LD

Loading Dose

HFpEF

H ea rt Failure w ith Preserved E jection Fraction

LDH

Lactate D ehydrogenase

H gb

H em o g lo b in

LDL, LDL-C

L o w -D e n s ity L ip o p rotein

H ealth Insurance P o rta b ility and

LFT

Liver F unction Test

1u Ln

Luteinizing H orm o n e

LM W H

Low M o le c u la r W e ig h t H eparin

1D L r

LUiTiDdr ru n c iu re

LR

Lactated R inger’s

HIPAA

A c c o u n ta b ility A ct HIT

H e p a rin -Ind u ced T h ro m b o cyto p e n ia

H IV

H um an Im m u n o d e ficie n cy V irus

HJR

H e p a to ju g u la r Reflux

HNPEK

Haemophilus influenzae. Neisseria sp p „ Proteus mirabilis, Escherichia co/i, Klebsiella pneum onia

LVEF

Left V e n tric u la r E jection Fraction

HPA

H yp o th a la m ic-P itu ita ry-A d re n a l

LVH

Left V e n tric u la r H y p e rtro p h y

HPI

H is to ry o f Present Illness

M .ft.

M ix and M ake

HR

H e a rt Rate

MAO

M o no a m ine Oxidase

HS

A t B e dtim e

MAP

M ean A rte ria l Pressure

HSV

Herpes Sim plex V irus

MCH

M ean C orpuscular H em oglobin

HTN

H ype rte n sion

MCHC

M ean C orpuscular H em o g lo b in C on ce n tra tion

HUS

H e m o ly tic U rem ic Syndrom e

MCV

M ean C orpuscular Volum e

Hx

H isto ry

MD

M a in te n a nce Dose

l& O

Intake and O u tp u t, In p u t and O u tp u t

MDI

M e te re d -D o s e Inhaler

IBD

In fla m m a to ry Bow el Disease

MDR

M u ltid ru g -R e s is ta n t

IBS

Irrita b le Bow el Syndrom e

Ml

M yo card ia l In fa rctio n

IB W

Ideal Body W e ig h t

M IC

M in im u m In h ib ito ry C on ce n tra tion

ICD

In te rn a tio n a l C lassification o f Diseases

mL

M illilite r

ICH

Intracranial H em orrhage

mPAP

M ean P ulm onary A rte ry Pressure

ICS

Inhaled C o rtico ste ro id

MRI

M a gn e tic Resonance Im aging

ICU

Intensive Care U n it

MRS A

M e th ic illin -R e s is ta n t Staphylococcus aureus

ID

Intraderm al, In fe ctio u s Disease

MS

M u ltip le Sclerosis (D o n o t use this a bb re viatio n fo r M o rp h in e S ulfate -

IE

In fe ctive E ndocarditis

IFIS

In tra o p e ra tive Floppy Iris Syndrom e

MSSA

M e th ic illin -S e n s itiv e Staphylococcus aureus

IH D

Ischem ic H ea rt Disease

MVA

M o to r Vehicle A ccide n t

IM

Intram uscular

MVC

M o to r Vehicle Crash (or Collision)

Inj

In jectio n

MVI

M u ltiv ita m in In jectio n

INR

In te rn a tio n a l N orm alized Ratio

MW

M o le c u la r W e ig h t

lO P

In tra o cu la r Pressure

p o te n tia l m ed error)

37

1 I QU ICK GUIDF: C O M M O N

MEDICAL ABBREVIATIONS

Common Medical Abbreviations Continued A B B R E V IA T IO N

M E A N IN G

A B B R E V IA T IO N

M E A N IN G

N /V , N & V

Nausea and V o m itin g

PCI

P ercutaneous C o ro n a ry In te rv e n tio n

N /V /D

Nausea, V o m itin g , D iarrhea

PCN

Penicillin

NE

N o re p in e p h rin e

PCOS

P o lycystic O v a ry S yndrom e

NG

N asogastric

PCP

P rim ary Care Physician (o r Provider)

NJ

N asojejunai

P C V 13

P neum ococcal C o n ju ga te Vaccine {1 3 -v a le n t)

NKA

N o K n o w n A lle rg ie s

PCV15

Pneum ococcal C o n ju ga te Vaccine (1 5 -va le nt)

NKDA

N o K n o w n D rug A llergies

PC V20

P neum ococcal C o n ju ga te Vaccine (2 0 -v a le n t)

NMS

N e u ro le p tic M a lig n a n t Syndrom e

PCW P

P u lm o n a ry C ap illa ry W e d ge Pressure

NOAC

N o n -V ita m in K O ral A n tic o a g u la n t (same as

PD

Parkinson Disease

PDA

P a te n t D u c tu s A rte rio s u s

C hannel B locke r

PE

P u lm o n a ry Em bolus, Physical Exam

N o n o ccu p a tio n a l P ost-E xposure Prophylaxis

PEK

D O AC ) N o n -D H P C C B

nPEP

N o n -D ih y d ro p y rid in e C alcium

Proteus mirabilis, Escherichia coli. Klebsiella pneum onia

38

NPO

N o th in g By M o u th

NR

N o Refills

NRT

N ic o tin e R eplacem ent T h e rap y

NS

N orm a l Saline

N SA ID

N o n -S te ro id a l A n ti-In fla m m a to ry D rug

NSR

N orm a l Sinus R hythm

N STEM I

N on -S T S egm ent E levation M yo card ia l

PEP

P o st-E xposure P rophylaxis

PET

P o sitron Em ission Tom o gra p h y

PFT

P u lm o n a ry F u n ctio n Test

PHN

P o s th e rp e tic N euralgia

PICC

P e rip h e rally Inse rte d C en tra l C a th e te r

PKU

P h e nylke to nu ria

In fa rctio n

PMH

Past M edical H is to ry

NTE

N o t To Exceed

PO

By M o u th , O ral

NTG

N itro g ly c e rin

POP

P ro g e s tin -O n ly Pill

O B -G Y N

O b s te tric s and G yn e co lo g y

PPD

P u rifie d P ro te in D e riv a tiv e

OCP

O ral C o n tra c e p tiv e Pill

PPG

P ostp ra nd ial G lucose

OD

R ight Eye

PPI

P ro to n Pum p In h ib ito r, P a tie n t Package In se rt

ODT

O ra lly -D is in te g ra tin g T ablet

PPSV23

O G TT

O ral G lucose Tolerance Test

oPEP

O ccu p a tio n a l P ost-E xposure Prophylaxis

OROS

O s m o tic Release D e liv e ry System

OS

L e ft Eye

OSA

O b s tru c tiv e Sleep Apnea

OTC

O v e r-T h e -C o u n te r

OU

Each Eye

P-gP

P -g lyco p ro te in

PAD

P eripheral A rte ria l Disease

PAP

P u lm o n a ry A r te ry Pressure

PCA

P a tie n t-C o n tro lle d Analgesia

PC

A fte r M eals

PCC

P ro th ro m b in C om p lex C on ce n tra te

P neum ococcal P olysaccharide Vaccine (2 3-va le nt)

PRBCs

Packed Red B loo d Cells

PR

Per R ectum

PrEP

P re-E xposure P rophylaxis

PRN

As N eeded

PSA

P rostate S pecific A n tig e n

PT

P ro th ro m b in Tim e, Physical T h e rap y

Pt

P atient

PTH

P a rath yroid H o rm o n e

PUD

Peptic U lce r Disease

PV

Per Vagina

PVC

P o lyvin yl C h lo rid e

0

Every

QD

Every Day

Rx P RTP 2 0 2 3 C O U R S E B O O K | RxPREP © 2 0 2 2 , C q 2023

Common Medical Abbreviations Continued A B B R E V IA T IO N

M E A N IN G

A B B R E V IA T IO N

M E A N IN G

Q ID

Four Tim es a Day

Supp, sup

S u p po sito ry

QOD

Every O th e r Day

SVR

System ic Vascular Resistance

QS

S u fficie n t Q u a n tity

TB

Tuberculosis

QS AD

S u fficie n t Q u a n tity to Mal 6 0 years), liv e r disease o r w ith

as w ith renal o r liv e r disease.

SSRIs: h ig h e st risk w ith cita lo p ra m , e scitalo p ram

enzym e in h ib ito rs th a t decrease clearance. ■ M u ltip le Q T -pro lon g ing drugs

TCAs

used to g e th e r.

;j

■ E lde rly (> 6 0 years) and

Antipsychotics

p a tie n ts w ith C VD, in clu d in g

F irs t-g e n e ra tio n (e.g., h a lo p e rid o l, th io rid a zin e )

arrhythm ia s, HF, M l.

D o n o t exceed e scitalo p ram 2 0 m g d a ily o r

10 m e d aily in e ld e rly .

O th e rs : m irta za p in e , tra zo d o n e , ve n la fa xine □

A m o n g SSRIs, s e rtra lin e is co nsid e red s a fe st in p a tie n ts w ith C V D .

I A v o id c o n c u rre n t Q T -p ro lo n g in g drugs, i f possible.

S e c o n d -g e n e ra tio n : h ig h e st risk w ith zipra sido n e

I A v o id use o f in h ib ito rs th a t b lo c k a Q T -p ro lo n g in g

Antiemetics

d ru g ’s m etabolism .

5 -H T 3 re c e p to r a n ta g o n ists (e.g., o n d a n setron )

I D o n o t use d ro p e rid o l fo r in p a tie n t N /V (d ro p e rid o l

O th e rs : d ro p e rid o l, m etocloprannide, p ro m e th a zin e

is in je c tio n o n ly and has re s tric te d use d u e to Q T

Oncology medications

p ro lo n g a tio n risk).

A n d ro g e n d e p riv a tio n th e ra p y (e.g., leu p ro lid e) T yro sine kinase in h ib ito rs (e.g., n ilo tin ib ) O th e r: o x a lip ia tin

Others C ilo sta zo l, d o n e p ezil, fin g o lim o d , h ydro xyzin e, lop e ra m id e , ra nolazine, so life n a cin , m e th a do n e, ta c ro lim u s

CNS DEPRESSION Many Drugs/Drug Classes

CNS d e p re s s a n t-e ffe c ts :

O p io id s

som nolence, dizziness, c o n fu s io n /

Skeletal m uscle relaxants

consciousness/d e liriu m , g a it in s ta b ility /im b a la n c e /ris k o f fa lls /

Benzodiazepines

accidents, in c lu d in g m o to r ve hicle

A n tih y p e rte n s iv e s : p ro p ra n o lo l, c lo n id in e C an n a b is-re la te d drugs: d ro n a b in o l, n ab ilon e S ed atin g a n tih is ta m in e s C ough syru ps w ith an a n tih is ta m in e o r o p io id

■ D o n o t o p e ra te a ca r o r o th e r v e hicle s/m a chin es. ■ Can increase risk o f falls, co n fu s io n .

accidents.

M o n ito r fo r se da tio n , s lo w and s h a llo w b re a th in g , and

B enzodiazepines are a d rug o f

sh ortn ess o f breath. A v o id c o m b in in g CNS depressants

a bu se , and are o fte n prescribed

w h e n possible.

in a p p ro p ria te ly (fo r a n x ie ty o r

Suggest a lte rn a tiv e s fo r a n x ie ty (e.g., SSRI, SNRI),

B a rb itu ra te s H y p n o tic s

■ D o n o t use a lc o h o l.

c o g n itiv e im p a irm e n t, altere d

A n tie p ile p tic drugs

A n tid e p re ssa n ts: m irta za p in e , tra zo d o n e

P rovide p a tie n t counseling:

insom nia), add in g unnecessary

insom nia (life s ty le tre a tm e n ts p re fe rre d ) o r pain (e.g.,

risk o f CNS depression.

a ceta m in o ph e n , NSAID s, antidepressants).

B enzodiazepines are a p p ro p ria te

For opioids specifically:

fo r sta tu s e pile p tic u s , alcohol w ith d ra w a l, as an a n tid o te fo r s tim u la n t overdose, p rio r to

■ D o n o t use in c o m b in a tio n w ith b e n zo d ia ze p in e s; use o f o th e r CNS depressants, in c lu d in g a lc o h o l, have a high risk o f fa ta lity w ith opio ids.

Som e N SAID s

m edical procedures, in acute

Highest risk for fatality when used in

h ig h -a n x ie ty s itu a tio n s and

combination:

fo r a n tic ip a to ry em esis w ith

several b ecom e s h o rte r-a c tin g w h e n ta ke n w ith

c h e m o th e ra p y

a lc o h o l, w h ic h increases th e risk o f fa ta lity .

O p io id s + B en zod iaze p ine s o r o th e r C NS depressants

O p ioid s: due to th e risks o f abuse, d e p e n de n ce and a dd ictio n, reserve fo r severe pain th a t is n o t re spo n sive to o th e r m easures.

■ E xte n d ed -re le a se fo rm u la tio n s have a d d itio n a l risk:

■ R ecom m end nalo xo ne fo r a t-ris k p a tie n ts , in c lu d in g use o f high doses, rapid dose increases o r re duced clearance (e.g., renal im p a irm e n t w ith m o rph in e). ■ A vo id c o de in e if p ha rm a co ge n o m ic p ro file is u n k n o w n (highest risk w ith C Y P 2D 6 UMs). See o th e r C Y P 3A 4 and 2 D 6 in te ra c tio n in fo rm a tio n discussed previously.

r

RxPREP 2 0 2 3 C O U R S E B O O K I RxPREP C ' 2 0 2 2 . 0 2 0 2 3

A D D IT IV E S ID E E FFEC T

R IS K

A C T IO N S B Y P H A R M A C IS T /N O T E S

H earing loss, tin n itu s , ve rtigo .

■ C onsider an aud io lo g y co n su lt a t s ta rt o f tre a tm e n t

O T O T O X IC IT Y Aminoglycosides G entam icin, to b ra m ycin , am ikacin, others

fo r baseline hearing assessment, co n tin u e to

Cisplatin

m onito r. ■ A void using m u ltip le o to to x ic drugs a t th e same

Loop diuretics (especially rapid IV administration)

tim e , w he n possible.

Furosem ide. b um etanide, e th a cryn ic acid

Salicylates A sp irin , salsalate, m agnesium salicylate, oth e rs

Vancomycin N E P H R O T O X IC ITY Anti-infectives

W o rse nin g renal fu n c tio n /

A m inoglycosides, a m p h o te ricin B, polym yxins.

acute renal fa ilu re (ARE), can be

vancom ycin

evidenced by i in u rin e o u tp u t

Cisplatin

and T S C r/B U N .

■ C isplatin: use a m ifo s tin e (Ethyol) to p ro te c t kidneys. ■ M a in ta in adequate h y d ra tio n (dehydration can w orsen kidn e y fu n ctio n). ■ M o n ito r drug levels (e.g., am inoglycosides.

Calcineurin inhibitors

vancom ycin, tacrolim us), as appropriate.

C yclosporine, tacro lim u s

■ D isco n tin ue o ffe n d in g drugs if acute renal failu re

Loop diuretics Furosem ide, torse m id e . b um etanide. e th a crynic acid

M o n ito r u rine o u tp u t, S C r/B U N .

NSAIDs Radiographic-contrast dye A N TIC H O L IN E R G IC T O X IC IT Y Antidepressants/antlpsychotics

A n tich o lin e rg ic sym ptom s: CNS

Recom m end a ltern a tive s to sedating a ntihistam ines,

Paroxetine, TCAs, firs t-g e n e ra tio n antip sych o tics

depression, in clu d in g sedation,

such as loratadine, fexofenadine, cetirizin e, or

and peripheral a n tic h o lin e rg ic side

suggest saline nasal sp ray/d ro p s th a t clear allergens

e ffe c ts o f d ry m o u th , d ry eyes,

o u t o f th e nasal passages.

Sedating antihistamines D ip h e nh yd ram in e , brom p h e nira m in e , ch lo rp h en iram in e , doxyiam ine, hydroxyzine, cyp ro h e p ta din e , m eclizine

Centrally-acting anticholinergics

b lu rry vision, co n stip a tio n , urin a ry re te n tio n .

If using diph e nh yd ra m in e o r o th e r sedating a ntih ista m ine s fo r sleep, suggest life s ty le changes

H ig h e st risk in e ld e rly .

B enztropine, trih e x y p h e n id y l

(sleep hygiene). Recom m end tre a tm e n ts fo r d ry m o uth , d ry eyes

Muscle relaxants

(see Sjogren's Syndrom e in th e System ic S teroids

Baclofen, cariso p ro do l, cyclobenzaprine

& A u to im m u n e C o n d ition s chapter); recom m end laxatives fo r co n stip a tio n (see C on stip a tion &

Antimuscarinics (for urinary incontinence)

D iarrhea chapter).

O xyb u tyn in , d arifenacin, to lte ro d in e

Others A tro p in e , belladonna, dicyclo m in e

H Y P O T E N S IO N /O R T H O S T A S IS PDE-5 inhibitors

W ith C YP 3A 4 in h ib ito rs :

Sildenafil, tadalafil, avanafil, vardenafil

i

PDE-5 in h ib ito r m etabolism

causes T side e ffe c ts , inclu d in g

If taking a CYP3A4 inhibitor ■ S tart w ith half th e usual s ta rtin g dose o f th e PDE-5 in h ib ito r (see Sexual D y s fu n c tio n chapter).

headache, dizziness, flushing

CYP3A4 inhibitors

(causing t risk o f fa lls /in ju ry ).

PDE-5 inhibitors and nitrates

or

PDE-5 in h ib ito rs , n itrate s and

■ D o n o t use to g e th e r (co ntrain d ica te d ): check fo r use

Nitrates

alp h a -1 blockers all cause

o f sublingual n itro g ly c e rin PRN fo r chest pain; can

va so d ila tio n . A d d itiv e e ffe c ts can

co nsid e r use o f n itro g ly c e rin in em erg e n t situ atio n s

lead to h y p o te n s io n /o rth o s ta s is ,

(U A /N S T E M I/S T E M I) w ith close m o nito rin g.

or Alpha-1 blockers N on -se le ctive (e.g., doxazosin, terazosin) or se lective (e.g., tam sulosin)

dizziness and falls.

PDE-5 inhibitors and alpha-1 blockers W ith n itrates, severe hypo ten sion can cause ch est pain and CV events, w hich can be fatal.

■ S tart w ith a lo w dose w he n adding a d rug fro m e ith e r class (e.g., if ta king an alpha - 1 blocker, s ta rt a t h a lf th e usual PDE-5 in h ib ito r s ta rtin g dose). Do n o t s ta rt a PDE-5 in h ib ito r unless stable (e.g., no sym ptom s o f hypo ten sion ) on an alpha - 1 blocker.

3 I DRUG INTERACTIONS

C Y P 4 5 0 E N Z Y M E S : C O M M O N SUBSTRATES, IN D U C E R S A N D IN H IB IT O R S IN D U C E R S

IN H IB IT O R S

Analgesics (b u p re n o rp h in e , d iclo fe n ac, fe n ta n yl, h yd ro co d o n e ,

C arbam azepine,

Anti-infectives (c la rith ro m y c in ,

m eloxicam , m e th a do n e, o xyco d o n e , tra m a do l)

efavirenz, e tra virin e ,

e ry th ro m y c in , azole a n tifu n g a ls ,

CYP

SUBSTRATES

3A4

o xcarbazepine,

isoniazid)

p h e n o b a rb ita l,

Cardiovascular drugs (a m lo d a ro n e ,

Cardiovascular drugs (a m lo d a ron e , a m lo d lp ln e , bosentan. d iltia z e m ,

p h e n y to in , p rim id on e ,

d iltia z e m , dron e d aro n e , q u in id in e ,

e pie re no n e , ivabradine, n ife d ip in e , q uin idin e, ranolazine, to lvap tan ,

rifa b u tin , rifa m p in ,

ranolazine, ve rap a m il)

v e ra p a m il)

rifa p e n tin e , sm o kin g ,

Immunosuppressants (cyclosp o rin e , ta cro lim u s, sirolim us)

St, J o hn ’s w o r t

Anticoagulants (apixaban, rivaroxaban, R -w a rfa rIn )

Key H IV drugs (c o b ic is ta t, efa vire n z, rito n a v ir and o th e r protease

Statins (a to rv a s ta tin , lova sta tin , sim va sta tin )

inh ib ito rs )

Key H IV drugs (atazanavir, e fa vire n z and o th e r N NR TIs, rito n a vir,

Others (a pre p ita nt, cim e tid in e ,

tip ra n a vir)

c y c lo s p o rin e , flu v o x a m in e , g ra p e fru it juice , h a lo p e rid o l, n efazodone,

PDE-5 inhibitors (avanafil, sild e n afil, ta d a la fil, va rd e n a fil)

sertraline)

Others (alfuzosin, a p re p ita n t, arip ipra zo le, benzodiazepines, b re xp ip razo le, b u sp iro ne , carbam azepine, cita lo p ra m , c la rith ro m y c in , c o lch icin e , dapsone, d uta ste rid e , e ry th ro m y c in , escitalopram , e th in y l e s tra d io l, fe lb a m a te , h a lo p e rid o l, keto co na zo le , levonorgestrel, m irta za p in e , m o d a fin il, o nd a n se tro n , p arita p re vir, progesterone, q u e tia p in e , ta m o x ife n , tra zo d o n e , ve nla fa xine , zolpidem )

1A2

A lo s e tro n , a p re p ita n t, clozapine, cyclob e n zap rine , dulo xe tine ,

C arbam azepine,

A tazanavir, cim e tid in e , c ip ro flo x a c in ,

e th in y l e stra d io l, flu vo xa m in e , m e th a do n e, m irta zap in e, olanzapine,

p h e n o b a rb ita l,

flu v o x a m in e , zile u to n

o n d a n se tro n , pim o zide , p ro p ra n o lo l, rasagiline, ro p in iro le , th e o p h y llin e ,

p h e n y to in , p rim id on e ,

tiza n id in e , R -w a rfa rin , zo lp id em

rifa m p in , rito na vir, sm oking, St. John's w o r t

2C8

A m io d a ro n e , dasabuvir, p io g lita zo n e , repaglinide, rosiglitazone

P he nytoin , rifa m p in

A m io d a ro n e , atazanavir, c lo p id o g re l, g e m fib ro zil, keto co na zo le , trim e th o p rim /s u lfa m e th o x a z o le , rito n a v ir

2C9

A lo s e tro n , ca rve d ilo l, ce le co xib, diazepam , d iclo fe n ac, flu va s ta tin ,

A p re p ita n t,

A m io d a ro n e , atazanavir,

g ly b u rid e , g lip izid e , g iim e p irid e , m eloxicam , nateglinid e, p h e n y to in ,

c a rbam azepine,

c a pe cita b in e , c im e tid in e , e favirenz,

ra m e lte o n , S -w a rfa rin , ta m o x ife n , zo lp id e m

p h e n o b a rb ita l,

e tra v irin e , g e m fib ro z il, flu c o n a z o le ,

p h e n y to in , p rim id o n e ,

flu v o x a m in e , flu o ro u ra c il, isoniazid,

rifa m p in , rifa p e n tin e ,

keto co na zo le . m e tro n id a z o le ,

rito n a v ir, s m o k in g ,

o rita v a n c in , ta m o x ife n ,

St. Jo hn ’s w o r t

trim e th o p rim /s u lfa m e th o x a z o le , v a lp ro ic acid, vo rico n a zole , z a firlu k a s t

2C19

C lo p id o g re l, p h e n y to in , th io rid a z in e , vo rico n a zo le

C arbam azepine,

C im e tid in e , e s o m e p ra zole ,

p he n o ba rb ita l,

efa vire n z, e tra v irin e . flu o x e tin e ,

p h e n y to in , rifa m p in

flu v o x a m in e , isoniazid, ke to co na zo le , m o d a fin il, o m e p ra z o le , to p ira m a te , v o ric o n a z o le

2D 6

Analgesics (co d e in e , h yd ro co d o n e , m e p e rid in e , m eth a do n e,

A m io d a ro n e , b u p ro p io n , cim e tid in e ,

o xycod o n e, tra m a d o l)

co b ic is ta t, d a rife n a c in , d ron e d aro n e ,

Antipsychotics/Antidepressants (aripiprazole, brexp ip razo le, d oxepin, flu o x e tin e , h a lo p e rid o l, m irta za p in e , risp e rid o n e , th io rid a zin e , tra zo d o n e , tric y c lic antid e p ressa n ts, ve nla fa xine )

Others (a to m o xe tin e , c a rve d ilo l, d e x tro m e th o rp h a n , fle cain ide , m e th a m p h e ta m in e , m e to p ro lo l, p rop a fe n on e , p ro p ra n o lo l, ta m o x ife n )

d u lo x e tin e , flu o x e tin e , m irabegron, p a ro x e tin e , p ro p a fe n o n e , q u in id in e , rito n a v ir, s e rtra lin e

P H A R M A C Y F O U N D A T IO N S PART 1

CHAPtER tO N T E N f

Complete Blood Count.....;