Known to Impact Lipid Levels
Name a few (2 or three) conditions that are known to INCREASE lipid levels
Diabetes Mellitus
Metabolic syndrome
Smoking
HYPOthyroidism
Renal/liver disease
AUD (alcohol use disorder)
We all know chronic opioids are going to cause constipation. We also know that unlike some of the other adverse effects, this one does not get better...it must be treated.
These OTC products are the first line treatment options for OIC.
Stimulant laxative like senna or bisacodyl (with or without a stool softener)
Osmotic laxative like PEG --Miralax
These cardiac meds are known to cause or worsen depression
Beta-blockers --> beta blues
This OTC drug can color the skin and secretions RED-ORANGE
Phenazopyridine (AZO standard)
Examples of conditions (we will go over drugs in the following questions) that cause secondary hypertension include these (name one)
Renal disease
Adrenal disease
Obstructive sleep apnea
These types of diuretics increase BOTH LDL and TG
loop and thiazides
LDL we want the level to be less than 100
TG we want the level to be less than 150
These three medications are RX only drugs used to treat OIC
Methylnaltrexone (Relistor)
Naloxegol (Movantik)
Naldemedine (Symproic)
List 5 RX only medications that cause/worsen anxiety
Albuterol (esp. when used too much)
Antipsychotics
Bupropion (-->but any SSRI could in the first few weeks)
Levothyroxine (in high dose/overdose)
Steroids
Stimulants (methylphenidate, etc.
Theophylline
This drug can color skin/secretions YELLOW (orange-yellow--more bright than brown)
Sulfasalazine
Nitrofurantoin ---> yellow brown
Levodopa, Methyldopa, Entacapone --> BROWN
Medications with higher concentrations of THIS hormone increase blood pressure
estrogen
These drugs are known to increase LDL only
fibrates and fish oils
This opioid is no longer recommended as an analgesic --especially in older adults and those with renal impairment because its metabolite is renally cleared --which means it can accumulate causing CNS toxicity including seizures
Meperidine (Demerol)
Name the FOUR extrapyramidal side effects that could occur with antipsychotics
1. Akathisia --> restlessness, anxiety, can't stay still; occurs in days to weeks; treated with benzos or propranolol
2. Dystonia --> prolonged, painful muscle contraction/spasm; could be life-threatening if airway is impacted; 24-96 hours; treated with diphenhydramine, benztropine
3. Parkinsonism (another name for Pseudo-parkinsons) --> tremors, gait abnormalities, bradykinesia; days to weeks; treat with anticholinergics or amantadine
4. Tardive dyskinesia --> abnormal/uncontrolled movements in tongue, mouth, face, extremities; months/years; treat with VMAT2 inhibitors (ingrezza and Austedo) ---> can be irreversible
This drug can color the skin/secretions a blue-gray
amiodarone
These drugs are known to increase SODIUM and water retention ---> which then causes an increase in blood pressure
NSAIDS
Immunosuppressants (such as cyclosporine)
Systemic steroids
These drugs are known to increase TG ONLY
IV lipid emulsions (propofol, clevidipine)
Bile acid sequestrants
500 or higher = hypertriglyceridemia = SUPER high triglycerides
This opioid has been known to cause respiratory depression and death in children who were found to be ultra-rapid CYP2D6 metabolizers
Codeine
CI in use for kids under 12 for ANY indication and also for kids under 18 following tonsillectomy/adenectomy surgery (this is where the deaths happened)
What do these drugs have in common?
Carbapenems/cephalosporins/penicillins and lithium, and TCAs ---> high doses or with renal impairment increased risk
Opioids
Antipsychotics
All can cause seizures
This drug can color the skin/secretions green
Propofol
This type of drug (aka: drug class) are known to increase blood viscosity which leads to increase in blood pressure
Erythropoiesis stimulating agents (such as epoetin alfa)
Other than certain types of diuretics (hint: this is another question), what are three other classes of drugs known to increase both LDL and TG
2nd Gen antipsychotics (olanzapine, quetiapine, etc.
Immunosuppressants (systemic steroids, cyclosporine, tacrolimus, etc. )
Dosing conversions for opioids use a ratio conversion EXCEPT when converting from morphine to these two medications
Fentanyl patches (there is a dosing table in the package insert)
Methadone (methadone has a highly variable half-life!! and the conversion ranges are all over the place. Leave this one to a specialist.)
These two medications used for ADHD have a boxed warning for suicidal ideation
Atomoxetine (Strattera) and Viloxazine (Qelbree)
This drug CLASS can color the skin/secretions red
anthracyclines (doxorubicin, mitoxantrone, etc.)
These classes of drugs increase sympathomimetic activity which leads to an increase in blood pressure
Stimulants: such as amphetamine, PSE, cocaine, caffeine, stimulant ADHD meds
Antidepressants such as SNRIs --especially Effexor at higher doses, MAO-I and TCAs