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Hepatoxic Drugs

👊🏻 Drug-induced liver injury 🥊⁠

💊 There are SO many medications that can cause liver injury through various mechanisms. However, some key medications have black box warnings for liver toxicity and are more well-known for their risk. These are the ones that you should know for exams! 🗒️⁠

🔺 Hepatoxic drugs are usually well tolerated unless high doses are administered. In most cases, the primary treatment is to STOP the drug, especially when liver enzymes (AST and ALT) rise 3 times above their upper limit of normal.⁠

🧠 Some other helpful memory tips:⁠
-Acetaminophen’s brand name is Tylenol which looks similar to ‘Tired Liver’. ⁠
-Nefazodone and Nevirapine are never used anymore due to their severe liver toxicity so think never-zodone and never-apine. ⁠
-KEToconazole can KILL your liver⁠

🤔Some of them are a stretch but if you’re willing to try them out and they help you retain the information then that’s a win in my books. ✌🏻⁠

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ACE inhibitors vs. ARBs.

                                                               What’s the difference?⁠

💊Angiotensin converting enzymes (ACE) inhibitors and angiotensin receptor blockers (ARBs) are antihypertensive medications used to treat high blood pressure and other comorbid conditions.⁠

💊While the enzyme inhibitors work by reducing the level of angiotensin II in the body, the receptor blockers inhibit the function of angiotensin II by directly blocking the specific receptor. ⁠

⭐️Key Takeaways⭐️⁠

-ACE inhibitors and ARBs have similar benefits, and both work equally well in the body though ARBs are thought to have less side effects. ⁠
-ACE inhibitors and ARBs are both considered first line for the treatment of hypertension. ⁠
-ACE inhibitors remain first line for HFrEF with ARBs as an alternative. ⁠
-For those who cannot tolerate an ACE inhibitor, ARBs are reasonable substitutes (ex: dry cough)⁠
-It is NOT recommended to treat hypertension patients with both ACE inhibitor and ARB as it can increase adverse effects. ⁠

ACE inhibitors vs. ARBs. Read More »


If drugs came to life – Meet Ampho-terrible the fungal foe that packs a punch! 🥊 ⁠

🍄Amphotericin B is an antifungal medication that’s used to treat serious and life-threatening systemic fungal infections. But remember, with great power comes… well, some side effects! 😅⁠

✨The two main side effects to watch out for are nephrotoxicity and infusion-related reactions such as chills and fevers (often referred to as ‘shake and bake’). Because of its large side effect profile, it is often referred to as Ampho-TERRIBLE. ⁠

✨Some key things to keep in mind:⁠

-Liposomal amphotericin B (AmBisome) is a lipid formulation that a significantly improved toxicity profile compared to amphotericin B deoxycholate. ⁠

-Fevers, chills, and rigors are minimized by providing pre-medication with acetaminophen, diphenhydramine, and/or hydrocortisone 30–60 minutes prior to amphotericin B infusion.⁠

-The incidence and severity of nephrotoxicity can be reduced by providing 500–1000 mL bolus of normal saline before and after amphotericin B infusion.⁠

-Because it precipitates in normal saline, it must be given in a solution with 5% dextrose in water.⁠

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⌛️ Time to get HIV Protease Outta Here with Atazanavir! 🦠💊 ⁠

🌟 Let’s talk about Atazanavir’s nickname, Bananavir. 🍌⁠

🌟 Atazanavir is used with other antiretroviral medications to treat human immunodeficiency virus (HIV). 🦠💊 It belongs to a class of drugs known as protease inhibitors. ⁠

🌟 One of the most common side effects with atazanavir is hyperbilirubinemia (35-49% of adults) causing yellow discoloration of the eyes and skin (jaundice) hence why this drug is often nicknamed BANANAVIR! 🍌Other common side effects include rash, nausea, headache, cough, fever, and hypercholesterolemia. ⁠

🌟 Key Points to Know For Exams⁠

-It is marketed under the brand name Reyataz⁠

-It works to inhibit HIV protease from breaking up large viral proteins into new mature HIV particles⁠

-It comes as a capsule and as a powder to be taken with food once a day to increase absorption⁠

-Hypersensitivity reaction can occur (Stevens-Johnson syndrome, toxic skin eruptions)⁠

-Beware of drug interactions as atazanavir is metabolized via CYP3A4 and it requires an acid gastric environment for optimal absorption (PPIs are contraindicated with use)⁠

-Atazanavir is often given with ritonavir to help boost levels of atazanavir concentrations⁠

Atazanavir Read More »

ototoxic drugs⁠

Ototoxic Drugs⁠

ototoxic drugs⁠

Hear me out as we discuss ototoxic drugs⁠

👂 Ototoxicity is a medication side effect involving damage to your inner ear. It can cause symptoms like ringing in your ears (tinnitus), hearing loss and balance problems.⁠

🌟 The risk for ototoxicity depends on the type of medication (common in some medications than others), the dose and duration of the medication, if you’re taking a combination of ototoxic drugs, and genetics. ⁠

🛑 The treatment is to stop the offending ototoxic agent. This often helps reverse the symptoms, although some ear damage may be permanent. ⁠

🌟 The most common drugs associated with ototoxicity includes aminoglycosides, chemotherapy such as cisplatin, loop diuretics, and salicylates. Check out today’s post to learn a fun mnemonic on other drugs that can cause ototoxicity. ⁠

Ototoxic Drugs⁠ Read More »

Dual Antiplatelets


🌟WHEN do you use dual antiplatelet therapy (DAPT)?

1️⃣ Patients who have had acute coronary syndrome event (ACS) such as a heart attack

2️⃣ Patients who have stable ischemic heart disease and receive a stent placement (in other words, non-ACS setting)

🤫 pssst – if you don’t know what an ACS is – it is ANY condition brought on by a sudden reduction or blockage of blood flow to the heart. This is often caused by plaque rupture or clot formation in the heart’s arteries leading to sx of chest pain.

🌟 Okay great, we know when but WHY?

ACS is considered a medical emergency; treatment is needed to reopen the arteries and restore blood flow to the heart so it can work properly. This is usually done with a combination of medications + procedures such as a PCI (percutaneous coronary intervention) where a small structure called a stent is placed to open up the blocked blood vessel.

Afterward, the patient is at higher risk of future thrombotic events since they just had an occurrence and increased risk of stent thrombosis. This is where DAPT is recommended to prevent recurrent ischemic events.

🌟 Cool – but WHAT are dual antiplatelets?

Dual antiplatelet therapy recommendations include:

Aspirin PLUS ticagrelor, prasugrel, or clopidogrel

🌟 P2Y12 inhibitor considerations:

-Prasugrel is the most potent followed by ticagrelor, then clopidogrel (🧠TIP: Prasugrel is the most Potent ‘P’ for potent – but with increased potency comes increased bleeding risks. Avoid prasugrel in pt. age >75, hx of TIA/stroke, and hepatic dysfunction

-All of them are dosed once daily except ticagrelor which is dosed twice daily (🧠TIP: Ticagrelor is dosed ‘T’ for Twice daily) – can your patient be compliant?

-Clopidogrel and prasugrel are affordable and available in generic versions while ticagrelor is not. Can your patient afford it?


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Let’s 👏🏻 talk 👏🏻 diabetes👏🏻!⁠

🌟American Diabetes Association (ADA) and the European Society of Cardiology (ESC) released new 2023 guidelines recently and I just had to do a doodle note on it. 🤓⁠

🌟There has been lots of debates regarding whether metformin should still be first-line for all patients with type 2 diabetes. ⁠

🌟 It still is a great first-line option for most patients due to it’s proven efficacy, safety, and low cost. There are also some speculation that it m-a-y have cardiovascular benefits as well considering many patients in the clinical trials were also on metformin. ⁠

💗🫘However, in patients with ASCVD or high ASCVD risks, heart failure, and chronic kidney disease, the ADA/ESC guidelines recommend starting a SGLT-2 inhibitor or GLP-1 agonists with cardiovascular and renal benefits regardless if they have type 2 diabetes. ⁠

🌟 It is still important to look at patient specific factors (cost, comorbidities, side effects) when deciding which agent to start first or to add on. ⁠

👉🏻GLP-1 agonists commonly have GI side effects and carry warnings for rare pancreatitis and gallbladder disease. It can cost patients $1000/month. Most of the agents are injectables and supply is not consistent.⁠

👉🏻SLGT-2 inhibitors are linked to genital yeast infections, and volume depletion. Cost is about $600/month but they do come in oral formulations.⁠

Reference: Diabetes Care. 2023 Jan 1;46 (suppl 1):S140-S157⁠

Diabetes Read More »


Let’s talk H. Pylori Treatment! 💊

⭐️ H. pylori is a type of bacteria that infects your stomach and causes damage to the tissue leading to peptic ulcers, inflammation, and gastritis.

⭐️ Treatment includes:

1️⃣ Medications that decrease stomach acid to help decrease damage to tissues (ex: PPI or H2-antagonist)

2️⃣ Medications such as bismuth subsalicylate (AKA Pepto-Bismol) that coats the stomach protecting it from stomach acid (also has anti-inflammatory properties and antimicrobial activity against H. Pylori)

3️⃣ At least 2 antibiotics in the regimen to prevent the bacteria from developing resistance to the antibiotics (ex: amoxicillin, tetracycline, metronidazole, or clarithromycin)

⭐️ Initial therapy for H. Pylori includes:

👉 Bismuth quadruple therapy and concomitant (non-bismuth quadruple therapy), both administered for 10-14 days, are recommended FRIST-LINE treatments.

👉 In penicillin-allergic patients, bismuth quadruple therapy is the preferred initial treatment. Consider referral for allergy testing in patients who fail initial therapy, since many patients who report penicillin allergy are not truly allergic.

👉 Alternative initial therapies include sequential, hybrid, levofloxacin-tripe, levofloxacin sequential, and LOAD therapies.

H.Pylori Read More »

Heart Failure Drugs

💔 Let’s talk about HF medications 👏🏻⁠

🧠 Understanding heart failure (HF) medications can be difficult if you don’t understand the underlying pathophysiology of the condition. ⁠

🤓 Check out the slides to learn more about the pathophysiology of heart failure that leads to the common symptoms seen. ⁠

✨ Goals of therapy are to manage structural heart disease, reduce morbidity and mortality, decrease Na+ and water retention, and eliminate or minimize HF symptoms. ⁠

✨ The cornerstones of HF treatment are medications targeted towards decreasing the activity of compensatory mechanisms and improving cardiac workload, controlling excess fluid, and enhancing cardiac contractility. ⁠

⭐️ Loop diuretics: control symptoms of fluid overload (e.g., shortness of breath, edema)⁠
⭐️ ACE/ARBs/ARNIs: shown to decrease mortality; recommended in ALL pt. with HFrEF ⁠
⭐️ Beta-blockers: shown to decrease mortality when added to an ACE inhibitor; recommended in ALL patients with HFrEF⁠

👉🏻 Check out the full review of HF medications in our F-R-E-E Heart Failure Guide which includes a mind map coloring page and heart failure drug table!

Heart Failure Drugs Read More »


1️⃣ In Type 1 Diabetes, the pancreas is unable to produce insulin⁠

2️⃣ In type 2 diabetes, the body does not respond normally to insulin, and over time, the pancreas starts to produce less and less insulin⁠
⭐️ What is insulin?⁠
IN-sulin is a hormone that helps glucose get IN-side cells to be used as energy⁠
⭐️ Counseling Tips:⁠
👉🏻 Educate patients on the symptoms of hypoglycemia (fatigue, hunger, increased anxiety dizziness, palpitations)⁠
👉🏻 Inject the exact dose of insulin subcutaneously into the abdomen (preferred), upper arms, thighs, or buttocks⁠
👉🏻 Rotate injection sites every 1-2 weeks⁠
👉🏻 Monitor blood glucose in frequent intervals (2- 4 times a day) as directed by the doctor⁠.

Insulin Read More »

Drug Mechanisms of Action Part II

⭐ Continuing on with PART TWO ✌🏻 of this series, let’s look over some tips and tricks on remembering the mechanisms of action of the following drugs: ⁠⠀
👉🏻 Canagliflozin, dapagliflozin, empagliflozin – antidiabetic medications ⁠⠀
👉🏻 Pantoprazole (Protonix)– anti-acid medication⁠⠀
👉🏻 Levothyroxine, liothyronine – thyroid replacement medications⁠⠀
👉🏻 Clopidogrel – antiplatelet medication⁠⠀
👉🏻 Lantoprost, bimatoprost – antiglaucoma agents⁠⠀

Drug Mechanisms of Action Part II Read More »

Drug Mechanisms of Action Part I

💊 In pharmacology, the mechanism of action (MOA) is the specific biological process through which a drug produces its pharmacological effect AKA how it works. ⁠⠀
📚 Not only is knowing the mechanism of action important for exams and NAPLEX (as they are popular test questions), it gives you a baseline to understand/remember the drug indication, side effects, and underlying pathophysiology of the disease state.⁠⠀
⭐ Some MOAs are more complicated than others while some MOAs are unknown. Often, we get lucky and the drug class hints at the mechanism of action such as calcium channel blockers, angiotensin receptor blockers, beta-blockers, etc. but this may not always be the case. ⁠⠀
🧠 Check out some tips and tricks on how to remember the MOA of some other common medications below:⁠⠀
-Rivaroxaban, apixaban, edoxaban – anticoagulants⁠⠀
-Montelukast (Singulair) – used for allergic rhinitis and asthma⁠⠀
-Sulfamethoxazole – used in combination with trimethoprim as an antibiotic ⁠⠀
-Metformin (Glucophage) – antidiabetic medication⁠⠀
-Nitroglycerin – antianginal agent⁠⠀

Drug Mechanisms of Action Part I Read More »

Drug Interactions Review

 Let’s talk drug-drug interactions 💊

🌟 With millions of potential drug interactions, figuring out what you need to commit to memory can be overwhelming 😵 . However, with the right approach and some (or a lotta 😆) practice, you’ll be able to see more of a pattern.


1. Know the interactions that are STRONG. 💪🏻 A strong inhibitor or inducer can lead to 5x the concentration of a drug while a weak inhibitor or inducer will cause less of a change. Higher concentrations lead to adverse side effects. Check out today’s post to help you remember the major inducers and inhibitors of CYP450 enzymes.

2. Know the interactions where the outcome is BAD. ❌ For example, tamoxifen is a prodrug. Strong 2D6 inhibitors such as fluoxetine, paroxetine, and bupropion can prevent the conversion of tamoxifen to its active form, therefore, increasing the risk that your patient will experience a reoccurrence of cancer. The same goes for the antiplatelet prodrug clopidogrel.

3. Start with the most COMMON drug interactions seen as they will likely be on exams and boards. 📝 Check out today’s post to see some examples of some of the major drug interactions.

4. Understand the MECHANISM of the drug interaction. 🧐 Inducers can ramp up the metabolism of a medication leading to decrease drug levels while inhibitors block the enzymes that break down the drug leading to higher drug concentrations.

Drug Interactions Review Read More »

Antibiotic Coverages

⭐ Knowing antibiotic coverage starts with memorizing the antibiotics that cover the major categories of bacteria such as anaerobes, atypical, MRSA, and pseudomonas. ⁠

⭐ Studying for an upcoming exam? >>LISTEN<< These are a MUST for you to know. Review the post and quiz yourself to see how much you can remember. 🧠⁠

Antibiotic Coverages Read More »

Hypertension in Pregnancy

Anti-hypertensives in pregnancy 🤰🏻⁠

✏️ Hypertension is defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. Chronic hypertension occurs before pregnancy or before 20 weeks gestation and gestational hypertension occurs after 20 weeks⁠

⚠️ Complications of high blood pressure include increased risks for preeclampsia/eclampsia/stroke for the mother and preterm delivery for the baby⁠

📖 As with most medications in pregnancy, antihypertensives have not been evaluated in robust randomized controlled trials. Check out the post for the preferred anti-hypertensive drugs used in pregnancy. ⁠

⭐ Methyldopa is recommended first-line due to its proven safe and effective use in pregnancy due to its long history of safety in pregnancy but its use in clinical practice may be less due to adverse reactions (e.g., fatigue, dizziness).⁠

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