Pain Medications
Patients on opioids + benzodiazepines + gabapentin. What is the greatest risk?
Additive CNS/respiratory depression leading to overdose
A patient with ANC <500 and fever requires immediate empiric therapy. What class of antibiotics should be started and when can you discontinue/deescalte?
Cefepime, after 72hrs of being afebrile
Category: Pain (Generic > Brand)
1. Fentanyl patch (50 points)
2. Oxycodone/acetaminophen (50 points)
1. Duragesic
2. Percocet
Risk factors for gout
male, obesity, excessive alcohol consumption, medications that can increase uric acid
Follow up: What are medications that can increase uric acid? Bonus points: 50 points
Odds ratio = 1.3 means what?
The odds of an event occuring in one group are 1.3 times (30%) higher than the odds of it occuring in a comparison group
Which patient population can be switched to fentanyl patch and lozenge?
Patients who have been using to equivalent to morphine 60mg/day or more for at least 7 days can be converted.
Which chemo drug class has lifetime culumative dose limits?
Anthracycline (Doxorubicin, Daunorubicin, etc)
Follow Up: What is lifetime cumulative dose? (50 points)
Category: Antiemetics (Generic > Brand)
1. Palonosetron (100 points)
2. Aprepitant IV (50 points)
3. Aprepitant PO (50 points)
1. Aloxi
2. Cinvanti
3. Emend
Name 2 DDI with triptans
1. serotonergic drugs (SSRI, SNRI, MAO inhibitors)- serotonin syndrome
2. CI with MAO inhibitors (sumatriptan, rizatriptan, and zolmitriptan)
3. CYP3A4 inhibitors: eletriptan is CI and reduce dose of almotriptan
The ARR in triptan study was = 5%, NNT = ?
Calculate the number of patients that need to be treated with triptan to prevent one case of migraine progression.
NNT = 1 / 0.05 = 20
You need to treat 20 patients to prevent 1 event
A patient is taking oral morphine 60 mg every 12 hours. They are being switched to oral hydromorphone.
What is the appropriate total daily hydromorphone dose?
1. 60 mg q12h → 120 mg/day
2. Oral morphine: oral hydromorphone; 4:1
3. 120mg / 4 = 30mg hydromorophone/day
4. Cross-tolerance: reduce by ~25%, so 30mg > ~15–22.5 mg/day after reduction
Calculate the carboplatin dose for:
Target AUC = 5
CrCl = 60 mL/min
Use Calvert Formula: Target AUC x (GFR +25)
Dose= 5×(60+25)= 425 mg
Category: Infectious PPX (Brand > Generic)
1. Vfend (150 points)
2. Cresemba (150 points)
1. Voriconazole
2. Isavuconazonium sulfate
Colchicine: Is this for acute or chronic gout attack? What are warnings and side effects associated with this drug? DDI?
Acute Gout attack
Myelosuppression, D/N, myopathy, neuropathy
DDI with CYP3A4 and Pgp inhibitors
Hazard ratio of 0.7 means? Hazard ratio is used in what type of analysis?
30% relative reduction in risk
Time-to-event (Survival) analysis
Name two oral adjuvants for neuropathic pain and 3 major side effects
Gabapentin and Pregabalin
Dizziness, somnolence, peripheral edema/weight gain
Patient given methotrexate, what are rescue regimens, monitoring parameters?
Initiate leucovorin rescue starting at 24 hours and adjust based on methotrexate levels.
We monitor renal function, electrolytes, urine pH (goal >7), CBC, and ensure aggressive hydration with urine alkalinization to prevent nephrotoxicity.
Category: Oncology (Brand > Generic)
1. Zarxio (200 points)
2. Neulasta (200 points)
1. Filgrastim-sndz
2. pegfilgrastim
A 58-year-old patient with a history of CAD presents with acute migraine. She previously used sumatriptan but was told to stop. Which medication is the most appropriate acute treatment?
lasmiditan or CGRP antagonists (Ubrelvy, Nurtec like gepants)
Study: RR = 0.6
Pls interpret this by calculating RRR.
Relative Risk Reduction (RRR) = 1 − 0.6 = 0.4 = 40%
The treatment reduces risk by 40% compared to control.
A patient with advanced cancer and CrCl 20 mL/min is receiving hydromorphone IV for pain control. After several days, they develop agitation, myoclonus, and hallucinations, despite stable pain control. Explain why pt experiencing this and what is the most appropriate next step?
opioid-induced neurotoxicity (OIN) from accumulation of hydromorphone-3-glucuronide (H3G)
Next step: switch to renally safe opioid > Methadone, Fentanyl, can bridge with benzos while rotating
A 62-year-old patient with newly diagnosed AML (WBC 120k) is started on induction chemotherapy.
Within 24 hours, labs show: K⁺ 6.1, Phosphate 5.8, Uric acid 9.5, Calcium 7.2, SCr rising (AKI)
The patient was started on allopurinol prophylaxis. What are next steps in managing whatever this patient has? What are they going through?
TLS
Pt has AKI, Hyperkalemia, Hyperphosphatemia, Hyperuricemia, Hypocalcemia
Initiate rasburicase and aggressive IV hydration for treatment of tumor lysis syndrome?
Category: Migraine and Gout (Generic > Brand)
1. Colchcine (200 points)
2. Allopurinol (100 points)
3. Febuxostat (200 points)
1. Colcrys/Mitigare
2. Zyloprim/Aloprim
3. Uloric
Describe the diagnosis criteria for migraines (fill in the blank)
1. Headaches last ______ hours
2. Headaches have >/ 2 of the following characteristics: ____, ______, moderate-severe pain and aggravated by routine physical activity
3. One of the following occurs during headache: _____and/or _____, photophobia, and ____
1. 4-72 hours
2. unilateral location, pulsating
3. nausea and/or vomiting, phonophobia (sensitivity to sound)
Explain the difference between
- Case-control studies
- Cohort studies
- Randomized controlled studies
- Meta-analysis
- Case-control studies are retrospective compairsons of cases/experiemental and controls
- Cohort studies are retrospective or prospective comparisons of pts with an exposure to those w/o exposure
- Randomized controlled studies: prospective comparison of pts who were randomly assigned to groups
- Meta-analysis: analyze the results of multiple studies