Top 200
Pesky Interactions
Tricky Trials
Cool Counseling Points
Fascinating Formulations
100

Outside of clindamycin (Cleocin), this drug can be used for the treatment of necrotizing fasciitis via its ability to mimic the effects of clindamycin on toxin-producing bacterial species--it is often the preferrable choice as its ADE profile is more favorable and it is available via oral route.

What is Zyvox (linezolid)?

100

This drug class historically interacts with P2Y12 inhibitors by decreasing the antiplatelet effect, although there is now conflicting data.

What are PPIs/proton pump inhibitors?

100

These trials support the goal of 7 g/dL of hemoglobin (Hgb) as a time for transfusion target.

What are the TRICC and TRISS trials?

100

Amongst the cardiology and neurology spaces, phenytoin is sometimes used as an anti-arrhythmic because of this unique clinical pearl.

What is mimics the action of Class 1B antiarrhythmics?

*IE it works on cardiac cells as it primarily produces a sodium channel blockade. This is NOT to say this is a first-line agent, it is merely something you may see in these specialties.

100

TPN (total parenteral nutrition) can largely increase a patient's risk of this kind of infection (think viral, etc).

What is fungal infection?

200

These drugs can lead to false readings/artifact on continuous blood glucose monitoring devices (think past corticosteroids/beta-blockers)

What are acetaminophen (high-doses only), hydroxyurea, and vitamin C (high-doses only)?

*This is NOT an exhaustive list 

200

This substance should never be consumed while a patient is taking Flagyl (metronidazole) OR Bactrim (sulfamethoxazole/trimethoprim) due to a disulfiram reaction.

What is alcohol?

200

This landmark trial for ACS (acute coronary syndromes) suggested the superiority of ticagrelor over clopidogrel for mortality and efficacy--but proved a higher bleeding risk, which is partially why the contraindication for prior TIA and others exist.

What is the PLATO trial?

200

Lidocaine is sometimes preferred during MI (myocardial infarction) types 1-3 because of this unique mechanism of action.

What is higher selectivity for ischemic tissue?

200

This neuromuscular blocker is unique in that it is depolarizing, and has a very quick wash-out time. It tends to be preferred for conditions like TBI (traumatic brain injury) for these reasons. However, if the patient has a deficiency in pseudocholinesterase, they will be paralyzed for an exponentially longer time and may experience malignant hyperthermia.

What is succinylcholine?

300

This loop diuretic can be used if a patient has a sulfa allergy.

What is ethacrynic acid?

300

This supplement will falsely elevated T3 and T4 (thyroid hormones) and falsely low TSH (thyroid stimulating hormone)--which could lead to a false diagnosis of hyperthroidism or reduction of thyroid hormone dose

What is Biotin (vitamin B7)?

300

These trials looked at the efficacy of aspirin and clopidogrel for ACS--including NSTEMI, ischemic stroke, MI, and vascular death.

What are the CURE and CAPRIE trials?

300

Shortness of breath is a transient side effect of this drug--it is a common occurence with this agent and does NOT necessitate a therapeutic switch, but can be switched if the patient cannot tolerate the side effect.

What is Brillinta (Ticagrelor)?

300

You would use a reduced dose of prophylactic apixaban (Elliquis) if these conditions are present.

SCr >/= 1.5 AND age over 80 OR kg < 60 -->ONLY REDUCE IF BEING USED FOR PROPHYLAXIS*

Specifically for LV thrombus TREATMENT, the dose may also be reduced if the same conditions are met

400

ORAL amiodarone is commonly given and titrated up in divided doses due to this side effect.

What is GI intolerance?


*For oral formulations, GI side effects are much more common than CV side effects. However, IV formulations may cause hypotension if pushed too quickly.

400

This popular class of antibiotics can deplete levels of VPA (valproic acid) hence increasing the risk for seizures.

What are the carbapenems--especially meropenem?

400

This controversial trial suggested 5x therapy (ACEi + ARB + BB + MRA + digoxin) for patients with end-stage heart failure with reduced systolic function with LVAD implantation who were able to tolerate their effects due to mortality benefit (for this trial, defined as the patient is alive after 1 year of LVAD removal/heart transplantation).

What is the RESTAGE-HF clinical trial?


**HEAAL came before this trial, but helped develop some of the dosing protocols

400

This commonly occurs if Topamax is titrated too quickly  OR if the dosing is interrupted for 3+ days and the patient is restarted on the same dose.

Significant decline in executive functioning and learning ability (temporarily)


*Fun fact, on APPEs, many preceptors had the fun nickname of "Stupamax" for this drug

400

This popular beta-lactamase (penicillin-based) antibiotic is often used first-line for empiric treatment of various infections in the inpatient setting. However, it cannot cross the blood-brain barrier in predictable concentrations and therefore should NOT be used for meningitis/ventriculitis.

What is Zosyn (piperacillin/tazobactam)?

500

White clots and red clots occur via differing mechanisms and typically effect different vascular spaces--these drugs primarily reduce the risk of red clots, but do offer some protection against white clots.

What is apixaban and other DOACs?


*White clots are fibrin-rich (hence why they typically do not appear as red), while red clots are rich in erythrocytes. White clots also tend to appear in damaged endothelial tissue (hence the fibrin-rich component).



500

This interaction occurs between ciprofloxacin and tizanidine--but there does not seem to be a lot of data detailing the same reaction regarding the other fluoroquinolones.

What is increased exposure of tizanidine that may lead to hypotension and sedation effects?


*Occurs via inhibiting its cytochrome P450 1A2-mediated pre-systemic metabolism

500

This clinical trial, published in 2024 led to the FDA approval of acoramidis (Attruby) for the treatment of ATTR-CM (transthyretin amyloid cardiomyopathy) due to its perceived greater mortality benefit. Previously, ONLY tafamidis had mortality benefit for this condition.

What is the ATTRibute trial?

500

These capsules should NEVER be opened/crushed/chewed as they exponentially increase the risk of a fatal GI bleed due to vastly increased absorption/bioavailability.

What is Pradaxa (dabigatran)?

500

Risk of this toxicity is a primary reason Ativan (Lorazepam) is not used as a drip; ie continuous/prolonged infusion.

What is metabolic acidosis from the accumulation of toxic alcohol: propylene glycol?


**This is an additive designed to increase the solubility of injectable formulations of lorazepam