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NAPLEX Mnemonics Study Guide Summary
1. Orangutans Will Vomit On You Right Before They Become Large Proud Giants -
levothyroxine color & dose: Orange 25 mcg White 50 mcg - no dye Violet 75 mcg Olive 88 mcg Yellow 100 mcg Rose 112 mcg Brown 125 mcg Turquoise 137 mcg Blue 150 mcg Lilac 175 mcg Pink 200 mcg Green 300 mcg
2. TKI shortcut: -tinib for leukemia or NSCLC
-fenib for melanoma
3. Wt-based dosing: TBW < IBW - use TBW for all meds
TBW HI B W (or < 120% of IBW) - use TBW for most meds EXCEPT IBW for aminophylline, theophylline, acyclovir, levothyroxine TBW e 1 2 0 % of IBW - use TBW for LMWHs, UFH, vanco IBW for aminophylline, theophylline, acyclovir, levothyroxine & AdjBW for AGs To calculate CrCL TBW < IBW - use TBW BMI e2 5 - use AdjBW everything else - use IBW
4. CUTE DIMPLES (reasons for gap acidosis) - not as important: Cyanide Uremia
Toluene Ethanol (alcoholic ketoacidosis) Diabetic ketoacidosis Isoniazid Methanol Propylene glycol Lactic acidosis Ethylene glycol Salicylates
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5. CA-MRSA SSTI drugs: SMX/TMP
doxycycline, minocycline clindamycin (D-test req) linezolid
6. I TALC - cause hypothyroidism: Interferon - also cause hyperthyroidism TKIs
Amiodarone - also cause hyperthyroidism Lithium Carbamazaepine Hashimoto's disease
7. Cute Hot Pharmacist & Physician Marry Together to Deliver Babies - steroid equivalence:
Cortisone 25 mg Hydrocortisone 20 mg Prednisone 5 mg Prednisolone 5 mg Methylprednisone 4 mg Triamcinolone 4 mg Dexamethasone 0.75 mg Betamethasone 0.6 mg
8. Please Let Greg Brown Bring Peaches To Your Wedding - warfarin color & dose: Pink 1
mg Lavender 2 mg Green 2.5 mg Brown 3 mg Blue 4 mg Peach 5 mg Teal 6 mg Yellow 7.5 mg White 10 mg
9. READ - stop warfarin & convert to AC: Rivaroxaban INR < 3 Edoxaban
INR = 2.
Apixaban INR < 2 Dabigatran INR < 2
10. H. Pylori therapies: bismuth subsalicylate 300 mg QID + metronidazole 250-500 mg QID + tetracycline 500 mg
QID + PPI BID x 10-14 d amoxicillin 1000 mg BID + clarithromycin 500 mg BID + metronidazole 250-500 mg QID + PPI BID x 10-14 d amoxicillin 1000 mg BID + clarithromycin 500 mg BID + PPI BID x 10-14 d Replace w/ metronidazole 500 mg TID if PCN allx
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HIV
Immunosuppressed (incl steroid-induced)
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21. PPSV23: e6 5 y.o.
2-64 y.o.
1 dose:
heart, liver, lung disease, DM, alcoholic abuse, smoker
2 doses (8 wks after PCV13):
Sickle cell disease Asplenia Chronic renal failure Malignancy Transplant HIV Immunosuppressed (incl steroid-induced)
22. Dear Sweet Pharmacist Freezing Makes Me Edgy - do NOT refrigerate: -
Dexmedetomidine Sulfamethoxazole/trimethoprim Phenytoin Furosemide Metronidazole Moxifloxacin Enoxaparin
23. Protect Every Necessary Med from Daylight - light protection REQ during
administration: Phytonadione Epoprostenol Nitroprusside Micafungin Doxycycline
24. GAL PLAT - filter REQ: Golimumab (Simponi)
Amiodarone Lorazepam Phenytoin Lipids Amphotericin B Taxane EXCEPT docetaxel
25. Leech Absorbs To Take In Nutrients - leaching tube: Lorazepam
Amiodarone Taxane Tacrolimus Insulin NTG
26. Obese Baker Avoids Salt - dextrose compatibility only: Oxaliplatin
Bactrim Amphotericin B Synercid
27. A DIAbetic Can't Eat Pie - NS compatibility only: Ampicillin
Daptomycin (Cubicin RF)
7 / 19 Amiodarone (Nexterone, Pacerone)
8 / 19 Class IV DHP-CCBs (verapamil, diltiazem)
32. ATM - convert aminophylline to theophylline: Multiple by 0.
33. Pharmacists Rock At Saving Lives & Preventing Fatty-deposits - statin equiv-alent
dose: Pitavastatin 2 mg Rosuvastatin 5 mg Atorvastatin 10 mg Simvastatin 20 mg Lovastatin 40 mg Pravastatin 40 mg Fluvastatin 80 mg
34. ACHES - serious ADRs of estrogen: Abdominal pain (severe) CP
HA
Eye problem Swelling or sudden leg pain
35. LOT - BZDs safer for elderly & hepatically impaired: Lorazepam
Oxazepam Temazepam
36. CLAD - BZDs for anxiety: Clonazepam
Lorazepam Alprazolam Diazepam
37. SPEF - 1st line SSRIs for anxiety: Sertraline
Paroxetine Escitalopram Fluoxetine
38. CE - 1st lineSNRIs for anxiety: Cymbalta
Ettexor
39. FRANSEZ - triptan meds: Frovatriptan
Rizatriptan Almotriptan Naratriptan Sumatriptan Eletriptan Zolmitriptan FN - long lasting RZ
- ODT avail RSZ - 14 days from MAOIs AZ -
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47. RIPE - active TB treatment (total duration = 6 mos): INTENSIVE PHASE (2 MOS):
Rifampin = RIF Isoniazid = INH Pyrazinamide = PZA Ethambutol CONTINUOUS PHASE (4 MOS): Isoniazid = INH Rifampin = RIF
48. TRAP - Parkinson sx:
Tremor Rigidity Akinesia/Bradykinesia Postural instability - include falls
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49. ANMEBBA - beta-1 selective BBs (all QD dosing EXCEPT esmolol): Atenolol Nebivolol -
nitric oxide dep dilation; renal & hepatic adj Metoprolol - Lopressor BID/TID Esmolol - IV only Bisoprolol Betaxolol Acebutolol
50. ABCDE - treatment approach for ischemic heart disease aka stable angina-
: Antiplatelet + Antianginal BP + BBs (titrate to resting HR 55-60) Cholesterol + Cigarettes Diet + DM Exercise + Education DAPT only if BMS (1 mos), DES (6 mos), post-CABG (12 mos)
51. MONA-GAP-BA - treatment approach for ACS: Morphine
Oxygen NTG ASA GPIIb/IIIa antagonist (abciximab, eptifibatide, tirofiban) AC (LMWH, UFH, bivalirudin-preferred in STEMI) P2Y12 inhibitors (clopidogrel, ticagrelor, prasugrel-must take with ASA) BB - 3 yrs or indefinitely if HF ACEi/ARB - indefinitely if EF < 40%, CKD, DM, or HTN
52. MONA-GAP-BA + (PCI* or fibrinolytic) - tx approach for STEMI: Morphine Oxygen
NTG ASA
GPIIb/IIIa antagonist AC P2Y12 inhibitors BB ACEi/ARB PCI = preferred (within 120 min of 1st medical contact & within 90 min door to needle) If unable to perform PCI
1) transfer to another facility or
2) fibrinolytic (< 30 min door to needle) or
3) urgent CABG if multi-vessel dz in coronary art.
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62. IZ - IV bisphosphonates dosing frequency: Ibandronate (Boniva) - Q3M
Zoledronic acid (Reclast) - annually Zoledronic acid (Zometa) - hypercalcemia malignancy
63. COZY IV RM - live vaccines: Cholera
Oral typhoid Zostavax Yellow fever Intranasal influenza (FluMist) Varicella Rotavirus MMR
64. Kill Each And Every Strong Pathogen - common resistant pathogens: Klebsiella
pneumoniae (ESBL, CRE) Escherichia coli (ESBL, CRE) Acinetobacter baumannii Enterococcus faecalis, Enterococcus faecium (VRE) Staphylococcus aureus (MRSA) Pseudomonas auruginosa
65. VIP IF K - azole antifungals: Voriconazole (Vfend)
Isavuconazonium sulfate (Cresemba) Posaconazole (Noxadil) Itraconazole (Sporanox) Fluconazole (Diflucan) Ketoconazole (Nizoral) K & Itra: high pH = low absorption, take w/ non-diet soda to incr acidicity if concurrently using PPI/H2RA Itra: soln (EMPTY stomach) better absorption than cap/tab (w/ FOOD); CI in ventricular dysfunction/HF F: 50% dose reduction if CrCL d5 0 V: take on EMPTY stomach; do NOT refrigerate susp; phototoxicity, optic neuritis, visual changes (cautious when driving), hallucination, HA; DOC for Aspergillus; 50% dose reduction if hepatically impaired; switch to PO if CrCL d5 0 d/t IV vehicle SBECD accumulation P: take w/ FOOD; tab better absorbed than susp; switch to PO if CrCL d5 0 d/t IV vehicle SBECD accumulation; active vs. Aspergillus, Mucor, Rhizopus Isa: active vs. Aspergillus, Mucor, Rhizopus, QT SHORTENING; REQ filter
66. Coffee MeetS Bagel - BB for HF: Carvedilol
14 / 19 Metoprolol succinate Bisoprolol
67. APP - BBs w/ ISA (avoid in post-MI): Acebutolol
Pentbutolol Pindolol
68. DI NATION - meds that worsen HF: DPP4 inhibitors
Immunosuppressants Non-DHP CCBs Antiarrythmics Thiazolidinediones Itraconazole Oncology agents NSAIDs
69. FAST - s/sx of stroke: Face - unilateral droop/numbness
Arm - unilateral weakness Speech - slurred Time - call 911 ASAP
70. Drugs that cause hemolytic anemia: Dapsone
Methylene blue Primaquine Pegloticase Rasburicase Valproic acid Cephalosporines Levodopa Methyldopa Nitrofurantoin PCNs Quinidine Quinine Rifampin
71. CDEMN - COX-2 selective NSAIDs: Celecoxib
Diclofenac Etodolac Meloxicam Nabumatone
72. DOG P - 5HT3 RA for CINV: Dolasetron
Ondansetron Granisetron Palonosetron
16 / 19 Duloxetine Venlafaxine
78. Protease Inhibitor & Grub (PIG) - take w/ food: EXCEPTION
elbasvir/grazoprevir (Zepatier) - w/ or w/o food OK fosamprenavir susp (w/o food)
79. MRSA + strep for severe SSTIs (IV drugs): vancomycin
linezolid daptomycin ceftaroline dalbavancin, oritavancin, televancin quinupristine/dalfopristin tigecycline
80. Nosocomial MRSA:
vancomycin linezolid daptomycin (NOT PNA) televancin rifampin (NEVER alone)
81. VRE: Pen G or
ampicillin linezolid daptomycin tigecycline Cystitis only: nitrofurantoin, fosfomycin, doxycycline
82. VRE (E. faecium):
daptomycin linezolid quinupristin/dalfopristin tigecycline Cystitis only: nitrofurantoin, fosfomycin, doxycycline
83. Pseudomonas drugs: piperacillin/tazobactam
cefepime ceftazidime ceftazidime/avibactam ceftolozane/tazobactam carbapenems (EXCEPT erta) ciprofloxacin, levofloxacin aztreonam colistimethate, polymyxin B
84. Acinetobacter: carbapenems (EXCEPT erta)
ampicillin/sulbactam minocycline tigecycline FQ
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SMX/TMP
colistimethate, polymyxin B
85. ESBL-GNR:
carbapenems ceftolozane/tazobactam ceftazidime/avibactam cefepime (high doses) AGs Cystitis only: fosfomycin
86. CRE:
ceftazidime/avibactam colistimethate, polymyxin B
87. Bacteroides:
metronidazole beta-lactam/beta- lactamase inhibitor cefotetan, cefoxitin carbapenems tigecycline reduced activity: clindamycin, moxifloxacin
88. CDI: vancomycin
(PO) fidaxomicin metronidazole
89. Atypicals:
azithromycin doxycycline FQs clarithromycin minocycline
90. HNPEK: beta-lactam/beta-lactamase
inhibitor amoxicillin (if no beta- lactamase) cephalosphorins (EXCEPT 1st gen) SMX/TMP AGs FQs
91. 1st generation cephalosporins: cefazolin (Ancef)
19 / 19 cefixime (Suprax) cefpoxodime (Vantin) ceftibuten (Cedax) ceftazidime (Fortaz, Tazicef) ceftazidime/avibactam (Avycaz) ceftolozane/tazobactam (Zerbaxa)
94. 4th generation cephalosporins: cefepime (Maxipime)
95. 5th gen cephalosporins: ceftaroline (Teflaro)
