Term
|
Definition
neutrophils: PMNs, polys, segs, bands; left shift = increase in bands
eosinophils: parasites, allergic reactions
eosinophils: parasites, allergic reactions
basophils |
|
|
Term
|
Definition
monocytes: cancer and TB
lymphocytes: viral or fungal infections
agraulocytosis = lack of agranulocytes |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
140-age*wt/72*SrCr
*0.85 for a woman |
|
|
Term
|
Definition
liver dysfunction
bilirubin, albumin, PT/INR, ascites, hepatic encephalopathy, liver enzymes are NOT included |
|
|
Term
|
Definition
partial - simple and complex
generalized - results in loss of consciousness
tonic clonic
absence - DOC are ethosuximide and valproic acid
myoclonic
infantile
status epilepticus - treated with BZDs (diazepam, lorazepam) and follow with phenytoin (or fosphenytoin) |
|
|
Term
|
Definition
dosing: 1-5 mg/kg/day
metabolism: inducer (most anticonvulsants are inducers - carbamazepine, oxcarbamazepine, phenytoin, phenobarbital), inhibitors (valproic acid - the one that is different)
excretion: biliary or renal; gabapentin and levetiracetam are renally cleared
t1/2 = 3-5 days
therapeutic concentration = 15-40
SE:
CNS - seizures
GI 2
BMS - R (macrocytic anemia due to folate inhibition)
derm - rash (a lot of the newer anticonvulsants, and lamotrigine) |
|
|
Term
|
Definition
metabolized to phenobarbital
SE: osteomalacia (decrease Ca absorption) |
|
|
Term
|
Definition
effective for all seizure types except absence
dosage: 4-6 mg/kg/day
LOADING DOSE: 15-20 mg/kg; often with fosphenytoin
with phenytoin you can give it at 50 mg/min (hypotension)
with fosphenytoin you can give it at 150 mg/min
once daily dosing is for Kapseals only!
adjust doses in small increments - Mikalis-Menton (saturable kinetics)
absorption - tube feeds, protein, plastic can decrease absorption; hold tube feeds around it or switch to IV
therapeutic level = 10-20...but have to know ALBUMIN
low albumin creases phenytoin levels
free phenytoin level (therapeutic level = 1-2)
SE:
CNS 1 2 - nystagmust with toxicity
CV - hypotension with loading doses
GI 2
BMS - R (macrocytic anemia due to folate malabsorption)
derm - rash including SJS
other - lupus like reaction; gingival hyperplasia |
|
|
Term
|
Definition
used in trigeminal neuralgia
dosing = 300-600 mg BID
therapeutic level = 4-12
SE:
CNS 1 2
GI 1 2 - drug induced hepatitis
BMS R W - leukopenia
endo - SIADH (too much antidiuretic hormone, hyponatremia); oxcarbamazepine is worse)
unique metabolism: inducer and it's an autoinducer |
|
|
Term
|
Definition
DOC for absence seizures
SE:
CNS 1 2 - psychosis
GI 2
BMS W (leukopenia)
derm - rash
other - parkinsonian like syndrome (tremors) |
|
|
Term
| valproic acid (Depakene) or divalproex (Depakote) |
|
Definition
therapeutic level of 50-100
dosing: 500-1500 mg/day
used for migraine prophylaxis and bipolar disorder
VPA is an enzyme inhibitor
SE:
CNS 1 2
GI 1 2 - hepatitis
BMS T - thrombocytopenia
endocrine - menstrual cycle changes
derm - RASH including SJS
others - alopecia and weight gain |
|
|
Term
|
Definition
used in grand mal seizures
SE: aplastic anemia (1:3000 patients) and acute hepatic failure (1:10,000) |
|
|
Term
|
Definition
used off-label for neuropathic pain
dose: 1200 mg/day for seizures, much higher for pain up to 3600-4500 mg/day
PK: renally excreted!!
SE:
CNS 1 2
other - peripheral edema and weight gain |
|
|
Term
|
Definition
used for diabetic neuropathic pain, post herpetic neuralgia, fibromyalgia
similar SEs to gabapentin
angioedema |
|
|
Term
|
Definition
SE:
CNS 1 2 (diplopia)
RASH!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! |
|
|
Term
|
Definition
SE:
CNS - slowed speech, difficulty concentrating
renal - kidney stones (carbonic anhydrase inhibitor)
weight loss
used for migraine prophylaxis |
|
|
Term
|
Definition
SE: sedation
renally excreted like gabapentin
has an IV formulation (also phenytoin, fosphenytoin, valproic acid) |
|
|
Term
|
Definition
| SE: oligohydrosis, kidney stones, metabolic acidosis |
|
|
Term
|
Definition
isocarbaoxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate)
hypertensive crisis precipitated by certain foods (tyramine containing foods - wine, aged cheese, pickled herring, chicken livers)
how to treat HTN crisis: phentolamine (alpha antagonist)
serotonin syndrome: agitation, restlessness, confusion, HTN, tachycardic, sweating, diarrhea, shivering, goosebumps, myoclonus, fever
drug interactions: meperidine (Demerol), tramadol, linezolid (weak MAOI)
takes 2 weeks for the drug to wash out |
|
|
Term
|
Definition
class wide SE:
CNS 2 (in toxic doses CNS 1 - seizures)
GI 2
CV - arrhythmias
anticholinergic - urinary retention, blurred vision, constipation, dry mouth
tertiary amines: imipramine (Tofranil), amitriptyline (Elavil) - lots of sedation and anticholinergic SEs, doxepin (Sinequan)
secondary amines: amoxapine (Asendin), desipramine (Norpramin) - less anticholinergic SEs compared to amitriptyline, nortriptyline (Pamelor) |
|
|
Term
| tetracyclic antidepressant |
|
Definition
mirtazapine (Remeron)
MOA: central presynaptic alpha 2 antagonist; 5HT2 and 3 antagonist; H1 antagonist
dosing: higher doses give less sedation
SE:
CNS 2 - lots of sedation
GI - weight gain |
|
|
Term
|
Definition
paroxetine (Paxil) - most sedating, highest incidence of discontinuation syndrome (shortest t1/2), strong 2D6 inhibitor - watch tramadol
fluoxetine (Prozac) - most stimulating (insomnia), least incidence of discontinuation syndrome due to prolonged t1/2 ~7-9 days of metabolite norfluoxetine, stronge 2D6 inhibitor
citalopram (Celexa)
escitalopram (Lexapro) - maybe less SE
sertraline (Zoloft)
fluvoxamine (Luvox) - used in OCD
SE:
GI 2 - N/V/D can be really bad when starting therapy, counsel patients
takes weeks for full effect |
|
|
Term
|
Definition
great hypnotic often combined with SSRI
SE:
CV - EKG changes (QT prolongation)
other - priapism |
|
|
Term
|
Definition
promotes dopamine
3S: smoking cessation, seizures (doses >/= 450 mg/day can cause), lack of sexual dysfunction
highly activating |
|
|
Term
|
Definition
SNRI
SE:
CNS 2
CV - hypertension (diastolic BP increases doses > 225 mg/day)
GI 2 |
|
|
Term
|
Definition
| used for diabetic neuropathy, fibromyalgia |
|
|
Term
|
Definition
PT/INR for warfarin
aPTT for heparin
ACT (activated coagulation time) used for heparin in cath lab or surgery |
|
|
Term
|
Definition
vitamin K antagonist
MOA: factors 2, 7, 9, 10, and protein C and S
INR goals
Afib 203
mitral valve replacement 2.5-3.5
DVT/PE 2-3
dosing: usually start at 5 mg/day but highly individualized
start lower doses: elderly, liver disease, on concurrent amiodarone (reducing 25-50%)
pregnancy category X
SE:
bleeding
purple toes syndrome
questions to ask patients: bleeding/bruising; diet - stable in vitamin K containing foods; any new medications
drug interactions:
drugs that decrease INR - phenobarbital, carbamazepine, phenytoin, rifampin, cholestyramine (space it out), nafcillin
drugs that increase INR - amiodarone*****, antibiotics especially Bactrim, fluconazole, clarithromycing, erythromycing (not azithromycin), metronidazole, FQs
patients with high INRs:
vitamin K and fresh frozen plasma
low doses of vitamin K (1-2.5 mg) for most cases
IV vitamin K = risk of anaphylaxis when given push |
|
|
Term
|
Definition
direct thrombin inhibitor = no antidote
approved only for non-valvular afib
renally excreted (80%); adjust for renal dysfunction
SE: bleeding, dyspepsia
hemodialysis will remove it |
|
|
Term
|
Definition
MOA: binds to antithrombin III to facilitate anticoagulation
heparin: bolus plus an IV infusion
LMWH: SQ injections
SE:
bleeding
heparin - osteoporosis
how to reverse heparin - protamine
how to reverse LMWH - ?????
LMWH is renally excreted must adjust in renal dysfunction
use actual body weight for dosing
enoxaparin (Lovenox) dosing: 1 mg/kg BID or 1.5 mg/kg daily
heparin induced thrombocytopenia (HIT): clot kills; usually within 5-14 days of heparin initiation unless previous exposure
treatment: stop the drug; argatroban (hepatically metabolized); lepirudin (renally cleared), bivalirudin (cleared by enzymes - short t1/2)
fondaparinux (Arixtra)
dosing - 2.5 mg SQ daily or weight based for treatment
renally cleared with longer t1/2 than enoxaparin
no good reversal agent |
|
|
Term
|
Definition
doses: 81-325 mg daily
used in afib with clopidogrel (not as effective)
SE: GI 1 2 - GI bleeding |
|
|
Term
| dipyridamole with ASA (Aggrenox) |
|
Definition
used in TIA/strokes refractory to ASA
SE: high incidence of treatment discontinuation due to HA |
|
|
Term
|
Definition
ADP receptor antagonist
SE: rash (TTP)
BMS W (leukopenia) |
|
|
Term
|
Definition
ADP receptor antagonist
activated to 3A4 to active metabolite
used in combination with ASA for afib or post stents due to ACS
loading doses of 300-600 mg x1 then 75 mg daily
how long to wait prior to CABG? 5 days
SE: bleeding TTP |
|
|
Term
|
Definition
ADP receptor antagonist
does not have to be activated
dosing: 60 mg LD; 10 mg daily used for ACS
more effective than Plavix; higher bleeding than Plavix
contraindicated in previous TIA or stroke, >75 years, active bleeding, low weight <60 kg
low long to wait prior to CABG? 7 days
TTP rare |
|
|
Term
|
Definition
abciximab (Reopro) - MAB acute thrombocytopenia immune mediated response
eptifibitide (Integrelin)
tirofiban (Aggrestat) |
|
|
Term
|
Definition
narrow therapeutic index drug
used for bipolar disorder
PK: renally excreted which can cause toxicity when fluid status or renal perfusion is affected
therapeutic levels:
1-1.5 (acute mania)
0.8-1 (maintenance)
toxic above 2
hemodialysis removes
SE:
CNS 2 - tremor
GI 2
BMS W (leukocytosis)
endocrine - diabetes insipidus; thyroid (usually hypo)
nephrotoxicity
drug interactions: anything that affects sodium (take away sodium, increase Li)
NSAIDs and ACEIs can increase levels as well as volume depletion |
|
|
Term
|
Definition
opiates - morphine, codeine, hydrocodone, oxycodone
synthetic narcotics - fentanyl, meperidine
SE:
CNS 1 2 - delirium, hallucinations
respiratory depression
CV - hypotension primarily due to morphine derivatives (histamine release)
GI 2 - constipation that does not get tolerant; bowel regimens needed for chronic narcotic therapy
derm - rash/flush due to histamine release |
|
|
Term
|
Definition
dosing: PO, IM, IV, SR product (DO NOT CRUSH)
PK: hepatically metabolized to an active metabolite that is renally cleared (accumulation in CrCL < 30 mL/min)
Avinza (long acting morphine) - immediate and ER beads that can be sprinkled on food - cannot crush or chew
Kadian (long acting morphine) - alcohol increases release of drug; max dose of 1600 mg/day due to jumaric acid causing renal toxicity |
|
|
Term
|
Definition
| metabolized to morphine by 2D6 (some people cannot metabolize it) |
|
|
Term
|
Definition
huge euphoric effect
poor absorption of oral therapy
neurotoxicity due to accumulation of normpeteridine (active metabolite) in renally impaired patients and high doses
used for rigors
no MAOIs within 14 days of meperidine |
|
|
Term
|
Definition
less histamine release, very short acting
patch therapy:
opioid naive patients not candidates
change every 72 hours
NOT FOR ACUTE PAIN
do not add heat to patch
disposal: fold it and flush it |
|
|
Term
|
Definition
| more potent than morphine |
|
|
Term
|
Definition
| extremely long t1/2 can accumulate |
|
|
Term
|
Definition
| given often with acetaminophen (Percocet) |
|
|
Term
|
Definition
weak mu agonist, inhibits NE and 5HT reuptake)
watch drug interactions
reaally excreted, adjust in renal dysfunction |
|
|
Term
|
Definition
| used in opiate withdrawal clincs |
|
|
Term
| buprenorphine and naloxone (Suboxone) |
|
Definition
| used for narcotic dependence |
|
|
Term
| methylnaltrexone (Relistor) |
|
Definition
indication: opioid induced constipation refractory to laxative therapy
SQ injection 0.5 mg/kg SQ every other day x2 weeks
mu antagonist in the gut |
|
|
Term
|
Definition
mu antagonist in the gut
used preoperatively (30 minutes - 5 hours prior) for partial bowel resections to speed up bowel recovery
contraindicated: chronic opioid therapy
only dispense int he hospital up to 15 doses |
|
|
Term
|
Definition
dose limit 3-4 g/day
peds dose: 10-15 mg/kg/dose
IV, PO, PR
SE: hepatotoxicity due to metabolite (normally is conjugated with glutathione and excreted)
N-acethylcystein: dose is 140 mg/kg first dose then 70 mg/kg q4 hours for 17 doses |
|
|
Term
|
Definition
class wide SEs:
CNS 2
respiratory - allergic reactions
CV - some concern over MIs (naproxen is the safest)
GI 1 2 - ulcers (celecoxib less ulcers due to COX 2
BMS - thrombocytopenia (reversible inhibition of platelets)
renal - AKI
drug interactions:
decrease effectiveness of diuretics and ACEIs
increase methotrexate levels |
|
|
Term
|
Definition
vert potent prostaglandin inhibitor
use: gout attacks, RA flares
short term use b/c the risk of GI ulcers if very high |
|
|
Term
|
Definition
Flector patch, Voltaren 1% gel, or Pennsaid 1.5% topical solution
SE: hepatotoxicity |
|
|
Term
|
Definition
IV and PO
5 day BBW on duration of therapy due to toxicity (liver and renal) |
|
|
Term
|
Definition
| better GI tolerability but less effective |
|
|
Term
|
Definition
dose is once daily
more toxicity than traditional NSAIDs (GI) |
|
|
Term
|
Definition
COX 2 inhibitor with less risk of ulceration
ASA therapy with celecoxib negates the benefit
can cause rash due to sulfa moiety |
|
|
Term
|
Definition
high uric acid plus crystals
patients at risk are obesity, HTN, hyperlipidemia, high purine diet
medications that can precipitate a gout attack: diuretics (loops or thiazides), niacin, pyrazinamide, low dose ASA, cyclosporine
goals of therapy:
control the current attack
prevent further attacks
reduce modifiable risk factors |
|
|
Term
|
Definition
NSAIDs (indomethacin)
colchicine
MOA - inhibits phagocytosis of urate crystals by neutrophils
used for both the acute and prophylaxis
dose: 1.2 mg x1; may repeat with 0.6 mg x1 2 hours later
SE: GI 2 (bad diarrhea), BMS neutropenia and anemia, IV formulation can cause extravastation
corticosteroids
used in refractory cases or when other drugs are contraindicated
SE: CNS 1 2 (psychoses), CV (fluid retention, GI 1 2 (ulcers, appetite simulation), endocrine (hyperglycemia, osteoporosis), adrenal suppression (14 days), immunosuppression |
|
|
Term
| prevention of gout attacks |
|
Definition
reduce purine rich foods and alcohol - red meat, shellfish, beer, peas, beans
stay hydrated
weight loss
allopurinol (Zyloprim)
MOA: xanthine oxidase inhibitor
use with acute agents to prevent further attacks
SE: GI 2, derm (rash), other (vasculitis or interstitial nephritis
drug interactions: 6-MP (metabolized by xanthine oxidase, reduce 6-MP by 75% when given with allopurinol)
feboxustat (Uloric)
dose: 40-80 mg daily
GI 1 - liver enzyme elevation, arthralgias, rash
rasburicase (Elitek)
use for prevention of tumor lysis syndrome
0.2 mg/kg IV over 30 minutes up to 5 days
SE: methemoglobinemia
check for G6PD deficiency |
|
|
Term
|
Definition
clinical presentation: SOB, dyspnea, wheezing, chest tightness, cough***
goals of treatment:
prevent chronic troublesome symptoms
keep near pulmonary function
require infrequent use of B2 agonist
normal activity levels
prevent exacerbations
limit ED or clinic visits |
|
|
Term
| beta-2 agonists (short acting) |
|
Definition
albuterol (Proventil)
levalbuterol (Xopenex) - less tachycardia
SE:
CNS 1 2 - anxiety, insomnia, agitation
CV - tachycardia or arrhythmias
GI 2 - metallic taste, hoarseness, throat irritation |
|
|
Term
| beta-2 agonists (long acting) |
|
Definition
formoterol (Foradil)
salmeterol (Serevent)
not for acute exacerbations
not for asthma monotherapy (long acting) |
|
|
Term
|
Definition
STANDARD OF CARE FOR ASTHMA
chronic persistent asthma get inhaled corticosteroids
fluticasone with salmeterol (Advair)
mometasone with formoterol (Dulera)
budesonide with formoterol (Symbicort)
SE:
local SEs - dry mouth, hoarseness, oral candidiasis |
|
|
Term
|
Definition
zafirlukast (Accolate)
montelukast (Singulair)
less effective than corticosteroids for asthma
useful for exercise induced or allergic rhinitis
singulair oral chewable tablet as well as granules
SE: well tolerated
Churg-Sstrauss syndrome - eosinophilic vasculitis |
|
|
Term
|
Definition
zileuton (Zyflo)
dose 600 mg QID
SE: liver enzyme elevation (requires monitoring frequently |
|
|
Term
|
Definition
chromolyn (Intal)
takes 4-6 weeks for full effect |
|
|
Term
|
Definition
aminophylline is the IV version
aminophyllin is 80% of theophylline
therapeutic levels = 10-20
toxicities:
CNS 1 2 - seizures
CV - tachycardia and arrhythmias
GI 2 |
|
|
Term
|
Definition
little role in asthma, first line in COPD
ipratropium (Atrovent)
tiotropium (Spiriva)
used for acute asthma exacerbations
ipratropium/albuterol (Combivent) - avoid in peanut allergy (nebs okay) |
|
|
Term
|
Definition
Xolair
SQ injection given in office
patient has to be monitored for 2 hours after 1st injection; 30 minutes after subsequent injections |
|
|
Term
|
Definition
first line are bronchodilators (anticholinergics and beta agonists)
anticholinergics are first line
what are the role of steroids? prevent exacerbations, severe disease (FEV1 <60%), asthma component |
|
|
Term
|
Definition
PDE-4 inhibitor
oral agen: 500 mcg PO daily
NOT for acute exacerbations, to prevent COPD exacerbations
hard to tolerate
CNS 1 2 suidical ideation and depression
GI - weight loss |
|
|
Term
| drugs that increase incidence of PUD and GERD |
|
Definition
NSAIDs****, corticosteroids, alcohol, smoking
goals of PUD and GERD therapy:
promote ulcer healing
relieve ulcer pain
prevent complications
prevent recurrences |
|
|
Term
|
Definition
2 antibiotics and a PPI
amoxicillin + macrolide (clarithromycin, NOT azithromycin) + BID PPI
sequential therapy: 5 days of amoxicillin followed by 5 days of clarithromycing and PPI the whole time |
|
|
Term
|
Definition
inferior to PPIs for reflux healing and symptoms
cimetidine (Tagamet)
ranitidine (Zantac)
famotidine (Pepcid)
nizantadine (Axid)
SE:
CNS 2 - dizziness, disorientation in elderly patients or in renally insufficient
BMS T (thrombocytopenia)
cimetidine - gynecomastia; LOTS of drug interaction; STRONG INHIBITOR of enzymes |
|
|
Term
|
Definition
very short acting
usually have a combination of 2 cations: Al, Mg, Ca (associated with a lot of rebound)
Al and Ca can be constipating
Mg = diarrhea
drug interactions due to binding in the GI tract |
|
|
Term
|
Definition
esomeprazole (Nexium) - IV and PO formulations
lansoprazole (Prevacid) - PO and solutab formulation
omeprazole (Prilosec)
pantoprazole (Protonix) - PO and IV; IV drips used for acute GI bleeds
rabeprazole (Acephex)
SE:
GI 1 2 - C. diff
CNS 2
hypoagnesemia |
|
|
Term
| drugs that lower LES tone |
|
Definition
| estrogen, CCBs, peppermint, smoking |
|
|
Term
|
Definition
used in place of PPIs for ulcer healing
SE:
GI 2 (severe diarrhea)
spontaneous abortion
Arthrotec (diclofenac with misoprostol) |
|
|
Term
|
Definition
NO ORAL AGENTS
insulin only |
|
|
Term
|
Definition
|
|
Term
|
Definition
fasting blood sugar >/= 126 mg/dL on 2 occasions
2-h glucose >/= 200 on OGTT or classic signs of DM + random glucose >/= 200
A1c >6.5% |
|
|
Term
| only insulin you can give IV |
|
Definition
|
|
Term
|
Definition
pump insulin from pancreas
SE: hypoglycemia, rash, weight gain
renally cleared...accumulate and cause more hypoglycemia in AKI or CKD
glipizide is preferred over glyburide |
|
|
Term
|
Definition
first line T2DM drug
generally, you need 1500 mg/d for effectiveness; titrate upward slowly
max dose of 2550 mg/day
SE:
GI 1 2 - lactic acidosis, diarrhea
no hypoglycemia as monotherapy
weight neutral or weight loss |
|
|
Term
| alpha glucosidase inhibitors |
|
Definition
MOA: digestion of carbohydrates (postprandial hyperglycemia)
SE:
GI 2 - flatulence
no hypoglycemia as monotherapy
acarbose (Precose)
miglitol (Glyset) |
|
|
Term
| thiazolidinediones (TZDs) |
|
Definition
MOA: decrease insulin resistance at PPAR gamma receptor
SE:
CV - edema (watch in HR)
GI 2
endo - osteoporosis |
|
|
Term
|
Definition
repaglinide (Prandin)
nateglinide (Starlix)
MOA: short acting insulin secreting drugs
hypoglycemia is skip meal |
|
|
Term
|
Definition
liraglutide (Victoza) 1.2-1.8 mg/day
exenatide (Byetta or Bydureon)
Byetta 5-10 mcg BID
Bydureon 2 mg q7d
MOA: hypoglycemia rare due to control on glucagon
SE: GI 1 2 pancreatitis, weight loss common |
|
|
Term
|
Definition
oral agents
saxagliptin (Onglyza)
sitagliptin (Januvia)
GI 2 - N/V
bladder cancer |
|
|
Term
|
Definition
prehypertension: SBP 120-139 or DBP 80-89
Stage I: 140-159 or 90-99
Stage II: >/= 160 or >/= 100 |
|
|
Term
|
Definition
work in the distal tubule
chlorthalidone (Hygroton)
chlorthiazide (Diuril) - IV syndergy with loops
HCTZ
indapamide (Lozol)
metolazone (Zaroxolyn) - used in synergy with loops in HF patients
SE:
hypokalemia, hyperuricemia, hypercalcemia (different from loops!!!), hyperglycemia, hyponatremia, hypomagnesemia
monitoring: BP, fluid losses, renal function (BUN/SrCr) |
|
|
Term
|
Definition
remove more fluid
cause hypocalcemia
potential in high doses for ototoxicity
bumetanide (Bumex)
furosemmide (Lasix)
torsemide (Demadex)
ethacrynic acid (Edecrin) - no sulfa group
when to use loops over thiazide in HTN? CrCl < 30 mL/min |
|
|
Term
| K sparing diuretics/aldosterone antagonists |
|
Definition
work in the late distal tubule and collecting ducts
spironolactone (Aldactone)
elperenone (Inspra)
triamterene (Dyrenium) - usually in combination with HCTZ
SE:
electrolytes - hyperkalemia
monitoring kidney function (BUN/SrCr)
spironolactone - gynecomastia |
|
|
Term
| beta blocker with intrinsic sympathomimetic activity |
|
Definition
|
|
Term
| B1 selective beta blockers |
|
Definition
atenolol (Tenormin) - renally excreted
bisoprolol (Zebeta) - good in HF but not FDA approved
metoprolol (Lopressor - tartrate BID; Toprolo XL - succinate daily); good data in HF for succinate
esmolol (Brevibloc) - IV agent for HTN emergency (drip)
nebivolol (Bystolic) - promotes nitric oxide
betaxolol (kerlone) |
|
|
Term
| nonselective beta blockers |
|
Definition
nadolol (Corgard)
propranolol (Inderal) - off label for tremors, cirrhosis with esophageal varices, and migraine prophylaxis |
|
|
Term
| nonselective beta blockers with alpha blockade (alpha 1) |
|
Definition
labetalol (Normodyne)
carvedilol (Coreg or Coreg CR)
Coreg CR dumps with alcohol
not 1st line for HTN; must have compelling indication (afib)
SE:
CNS 1 2 - depression
CV 1 2 - complete heart block, bradycardia
respiratory - bronchospasms (especially nonselective agents or high doses of selective agents)
endocrine - mask hypoglycemia |
|
|
Term
| peripheral alpha blockers |
|
Definition
bad data
only use is concomitant BPH
doxazosin (Cardura)
prazosin (Minipres)
terazosin (Hytrin)
SE: orthostatic hypotension and first dose syncope |
|
|
Term
| centrally acting alpha agonists |
|
Definition
oral dosing 2-3 times daily bad for compliance
clonidine patch given q7 days
guanfacine (Tenex)
methyldopa (Aldomet) - DOC in pregnancy (and hydralazine)
SE:
CNS 2 - sedation
GI 2 - dry mouth
CV - withdrawal hypertension
derm - contact dermatitis from the patch |
|
|
Term
|
Definition
first line for DM patients especially with microalbuminuria; post MI with depressed EF or anterior wall MI; high coronary disease risk (ramipril); CKD
SE:
cough
angioedema (do not rechallenge)
GI 2 - loss of taste with captopril
derm - rash (captopril)
renal - AKI; CI'd in bilateral renal artery stenosis
electrolyte - hyperkalemia (due to aldosterone blockade)
CI: pregnancy, angioedema, bilateral renal artery stenosis |
|
|
Term
|
Definition
only in refractory ACEI patients b/c no cough
telmisartan (Micardis)
HTN: irbesartan and telmisartan
DM: ADA recommends for T2DM patients with microalbuminuria or proteinuria
HF: candesartan or valsartan |
|
|
Term
|
Definition
verapamil (Calan)
diltiazem (Cardizem)
work centrally, directly on the heart to slow down heart rate
not great for BP control |
|
|
Term
|
Definition
amlodipine (Norvasc)
felodipine (Plendil)
isradipine (Dynacirc)
nifedipine (Adalat or Procardia)
nisoldipine (Sular)
nicardipine (Cardene) - IV drip for HTN emergencies (target organ damage of stroke)
SE:
CNS 2 - HA
GI 2
misc - peripheral edema (DHP)
verapamil - constipation |
|
|
Term
|
Definition
hydralazine (Apresoline) - in patients usually dosed 3-4 times daily
minoxidil (Loniten) - HTN resistant patients
SE:
CV - tachycardia and NA and fluid retention (usually on beta blocker and diuretic already)
hydralazine can cause drug induced systemic lupus
minoxidil - hirsutism |
|
|
Term
| compelling indications for HTN drugs |
|
Definition
DM with proteinuria: ACEI
HF: ACEI, beta blocker, ARB, aldosterone antagonist
post MI: beta blockers, ACEI (anterior wall MIs)
angina: beta blockers, CCBs
cyclosporoine induced HTN: CCB (DHP)
essential tremor: beta blockers
migraine prophylaxis: beta blockers
renal insufficiency: ACEI and ARB |
|
|
Term
|
Definition
screening test: ELISA - detecting HIV antibodies
confirmatory test: Western blot |
|
|
Term
| who are good candidates for antiretroviral therapy? |
|
Definition
CD4 count <500 cells/mm3
symptomatic disease (opportunistic infection or AIDS defining illness)
HBV coinfection
pregnancy |
|
|
Term
|
Definition
2 nucleoside reverse transcriptase inhibitors
emtricitabine and tenofovir
PLUS one of the following:
NNRTI (efavirenza, Sustiva) - Atripla combination product
protease inhibitors: atazanavir or darunavir plus ritonavir (to boost effects of the drug)
integrase inhibitor: raltegravir |
|
|
Term
|
Definition
class wide SEs:
lactic acidosis, hepatic steatosis (fatty liver), lipodystrophy (more common with PIs) |
|
|
Term
|
Definition
dose: 300 mg daily
SE: nephrotoxicity (acute or chronic), reduce bone mineral density
caution: stopping therapy may cause HBV flares |
|
|
Term
| emtricitabine (FTC, Emtriva) |
|
Definition
dose: 200 mg daily (capsule), 240 mg daily (solution)
SE: hyperpigmentation of palms, soles
caution: stopping therapy may cause HBV flares |
|
|
Term
| zidovudine (AZT, Retrovir) |
|
Definition
300 mg BID or 200 mg TID
renally cleared (have to adjust in CKD or AKI
SE: BMS - macrocytic anemia or neutropenia
hyperpigmentation
lactic acidosis |
|
|
Term
|
Definition
dose: 300 mg BID of 600 mg daily
SE: life threatening rash with fever, respiratory distress, GI effects, SOB
test for HLA-B 5701 - if positive do not use (have a higher risk of the hypersensitivity reaction)
not used in patients with baseline viral load > 100,000 |
|
|
Term
|
Definition
SE: pancreatitis (especially in children)
caution: stopping may increase HBV flair |
|
|
Term
|
Definition
>60 kg - 400 mg daily; < 60 kg - 250 mg daily
SE: pancreatitis (high risk); peripheral neuropathy; optic neuritis |
|
|
Term
|
Definition
dosing > 60 kg - 40 mg BID; < 60 kg - 30 mg BID
SE: fatal lactic acidosis!; lipodystrophy, peripheral neuropathy; hyperlipidemia; DM; rapid neuromuslcular weakness |
|
|
Term
|
Definition
key treatment principle: resistance to one = resistance to class
class wide SE: RASH |
|
|
Term
|
Definition
dosing 600 mg HS
SE:
rash
CNS 1 2 - dizziness, HA, insomnia, vivid dreams and nightmares, inability to concentrate
contraindicated in first trimester of pregnacy |
|
|
Term
|
Definition
SE: life threatening rash...including SJS and hepatotoxicity
CI: women with CD4 > 250 or men > 400; they have increased risk of hepatotoxicity |
|
|
Term
|
Definition
| rash including SJS; peripheral neuropathy |
|
|
Term
|
Definition
combination product with tenofovir and emtricitabine called Complera
Complera not to be used in patients with baseline viral load > 100K
SE: depression, insomnia, fat redistribution |
|
|
Term
|
Definition
class wide SE: hyperlipidemia, hyperglycemia
all are combined with ritonavir |
|
|
Term
|
Definition
SE: increased indirect hyperbilirubinemia; rash; prolonged QT interrval; fat redistribution; nephrolithiasis
caution: do not give with PPIs due to decreased absorption (>20 mg of omeprazole) |
|
|
Term
|
Definition
SE: rash including SJS, new onset DM, increased liver enzymes
caution: has a sulfonamide moiety |
|
|
Term
| lopinavir with ritonavir (Kaletra) |
|
Definition
refrigerated
SE:
GI 2
hyperlipidemia - TG predominant
increased liver enzymes |
|
|
Term
|
Definition
SE: rash, oral paresthesias, hyperlipidemia, hypertriglyceridemmia, fat redistribution
caution: sulfa allergic patients |
|
|
Term
|
Definition
| SE: rash, hepatitis, transaminitis |
|
|
Term
|
Definition
not boosted with ritonavir
SE:
GI 2 - flatulence
transaminitis
phenylketonuria |
|
|
Term
|
Definition
| SE: PR and QT prolongation; hepatotoxitiy, transaminitis |
|
|
Term
|
Definition
SE: crystaluria causing AKI
patient counseling: drink lots of water |
|
|
Term
|
Definition
integrase inhibitor
SE:
GI2
myalgias
CPK elevations |
|
|
Term
|
Definition
CCR5 antagonist
SE: hepatotoxicity; coughing spells, drug fever, rash
have to do tropism testing prior to ensure effectiveness |
|
|
Term
|
Definition
elvitegravir/emtricitabine/tenofovir/cobicistat
cobicistat inhibits metabolism of elvitegravir |
|
|
Term
|
Definition
fusion inhibitor
SE: injection site reactions, increased risk of bacterial pneumonia; hypersensitivity reaction
injection site reactions expected to occur in every patient; site rotation necessary |
|
|
Term
| opportunistic infection prophylaxis |
|
Definition
CD4 < 200 - primary prophylaxis vs pneumocystis
bactrim or if allergic dapsone or pentamidine (inhaled)
CD4 < 100 - toxoplasmosis
bactrim or if allergic then atovaquone or dapsone plus pyramethamine plus leucovorin
MAC
initiate primary prophylaxis when < 50
preferred: azithromycing 1200 mg once weekly
alternative: clarithromycin 500 mg BID or rifabutin |
|
|
Term
| cell cycle dependent - chemotherapy |
|
Definition
resting phase (G0): alkylating agents, nitrosoureas, antitumor antibiotics, cisplatin/carboplatin, procarbazine, dacarbazine
S phase (DNA synthesis or replication): 5-FU, gemcitabine, methotrexate, hydroxyurea, 6-MP
mitotic phase (M phase): vinca alkaloids, paclitaxel, docetaxel |
|
|
Term
|
Definition
nitrogen mustards - low emetogenic potential
nitrosoureas |
|
|
Term
|
Definition
nitrogen mustard
use: CML
oral
SE: hepatic veno-occlusive disease, pulmonary fibrosis |
|
|
Term
|
Definition
nitrogen mustard
oral
SE: pulmonary toxicity (not as much as busulfan); thrombocytopenia |
|
|
Term
| cyclophosphammide (Cytoxan) |
|
Definition
nitrogen mustard
use: breast, ovarian, prostate, lung
non-oncology uses: RA, glomerulonephritis
SE: metabolite is acrolein which causes hemorrhagic cystitis
prevent this with lots of hydration and optional infusion of mesna (binds acrolein in the bladder)
also can cause SIADH (metabolite) |
|
|
Term
|
Definition
nitrogen mustard
structural analog of cyclophosphamide
use: lung, testicular, lymphomas, and sarcomas
always give with mesna to prevent hemorrhagic cystitis |
|
|
Term
| mechlorethamine (Mustargen) |
|
Definition
nitrogen mustard
one of the original nitrogen mustards
use: multiple including polycythemia vera, CLL, CML, and Hodgkins disease
part of the MOPP regimen |
|
|
Term
|
Definition
nitrogen mustard
use: lymphoma, breast, ovarian
SE: BMS (thrombocytopenia)
do NOT crush tablets |
|
|
Term
|
Definition
nitrogen mustard
use: bladder
SE: BMS |
|
|
Term
|
Definition
carmustine (BiCNU)
lomustine (CeeNU)
strepozocin (Zanosar)
all used for brain malignancies
SE:
leukopenia about 3-5 weeks after therapy (more delayed than the other)
lots of N/V
prolonged carmustine associated with pulmonary toxicity |
|
|
Term
|
Definition
platinum analogue
use: ovarian (orally)
SE: GI 2 |
|
|
Term
|
Definition
platinum analog
cisplatin analog with less nephrotoxicity (but still there) but more BMS
calculate dose using AUC values and targets |
|
|
Term
|
Definition
platinum analog
use: testicular, ovarian, lung, head and neck
SE:
high emetogenic potential
nephrology: high incidence of AKI
ototoxicity
peripheral neuropathy
hypomagnesemia |
|
|
Term
|
Definition
platinum analog
use: melanomas, Hodgkin's idsease, sarcomas
SE: severe N/V |
|
|
Term
|
Definition
platinum analog
use: Hodgkin's disease and other lymphomas
drug interactions with MAOIs and TCAs and tyramine containing foods
disulfiram reaction
SE: CNS 1 2 - depression |
|
|
Term
| antibiotics and anthracyclines |
|
Definition
cardiotoxicity!!!!
patients get pre-treatment with either ECHO or MUGA |
|
|
Term
| daunorubicin (Cerubidine) |
|
Definition
anthracycline
SE: cardiotoxicity, alopecia, stomatitis
dose limit of 550 mg/2 |
|
|
Term
| doxorubicine (Adriamycin) |
|
Definition
anthracycline
same dose limit of 550 mg/m2
urine discoloration (red) |
|
|
Term
|
Definition
anthracycline
lifetime dose is 137.5 mg/m2 |
|
|
Term
| mitoxantrone (Novantrone) |
|
Definition
anthracycline
lifetime dose is 160 mg/m2
urine discoloration (blue-green)
used in MS patients |
|
|
Term
| Doxil - doxorubicine liposomal formulation |
|
Definition
| used to decrease the cardiotoxicity |
|
|
Term
|
Definition
iron chelator used to prevent oxygen free radicals and cardiotoxicity
dose: 500 mg/m2 of Zinecard for every 50 mg/m2 of doxorubicine |
|
|
Term
|
Definition
antibiotic
use: Hodgkin's lymphoma (ABVD), testicular cancer
SE: pulmonary toxicity especcially with doses > 200 units/m2
mucositis, BMS |
|
|
Term
|
Definition
antibiotic
SE:
GI 2 - mucositis
BMS |
|
|
Term
|
Definition
antibiotic
SE:
stomatitis
GI 2 |
|
|
Term
| methotrexate (MTX, Amethopterin) |
|
Definition
antimetabolite
folic acid antabonist
uses: variety of cancers and RA, psoriasis, ectopic pregnancy abortion
SE: BMS and GI 2
leucovorin rescue: 10-100 mg/m2 q6h until MTX levels start falling; done with high doses of methotrexate
other non chemo uses oral dosing (once weekly); IM doses can also be once weekly |
|
|
Term
| cytarabein (Cytosar, ARA-C) |
|
Definition
antimetabolite
use: induction of AML
SE: myelosuppression common with HIDAC (high dose cytarabine), can cause conjunctivitis (give them corticosteroid eye drops) |
|
|
Term
|
Definition
antimetabolite - purine antagonist
use: CLL
SE: myelosuppression, neurotoxicity, pulmonary toxicity
BMS severe sometimes you will prophylaxis with Bactrim for PCP |
|
|
Term
|
Definition
antimetabolite
use: ALL and chronic leukemia
dose reduce when given with allopurinol (75%)
SE: cholestatic liver dysfunction |
|
|
Term
|
Definition
antimetabolite
use: hairy cell leukemia
SE: neutropenia and drug fever |
|
|
Term
|
Definition
antimetabolite
SE: nephrotoxic (hydrate well), drug fever
use: hairy cell leukemia |
|
|
Term
|
Definition
pyrimidine antagonist
use: pancreatic cancer
SE: neutropenia (rare), increased liver enzymes |
|
|
Term
| fluorouracil (Adrucil, 5-FU) |
|
Definition
pyrimidine antagonist
use: breast, colon, head/neck
may add leucovorin for increased colon cancer response
SE: BMS and mucositis, nausea very low |
|
|
Term
|
Definition
pyrimidine antagonist
use: colorectal cancer and metastatic breast cancer
oral 5-FU
SE: GI 2 a lot of patients stop due to GI SEs
treat in 2 week oral cycles |
|
|
Term
|
Definition
pyrimidine antagonist
drying or darkening of nails and hair (sunlight can worsen this) |
|
|
Term
|
Definition
vincristine (Oncovorin)
vinorelbine (Navelbine)
vinblastine (Velban)
SE: vincristing and vinblastine are vesicants
neurotoxic medications
dose maximum for vincristine is 2 mg
vincristine not to be given intrathecally!!! |
|
|
Term
|
Definition
etoposide (Vepesid): PO and IV
refrigerate
SE: well tolerated; alopecia and mucositis
tenoposide (Vumon)
SE: hypotension and hypersensitivity due to castor oil |
|
|
Term
|
Definition
taxane
use: lung, ovarian, and breast
SE: neutropenia (greater with 24 hour infusion)
CV - bradycardia, hypersensitivity reaction (premed with H2 antagonists, steroids, H1 antagonists)
CNS - neurotoxicity with parasthesia |
|
|
Term
|
Definition
taxanes
SE: neutropenia, fluid retention with high cumulative doses > 500 mg/m2 |
|
|
Term
|
Definition
topotecan (Hycamtin)
irinotecan (Camptosar)
SE: severe diarrhea (give some loperamide in case it happens) |
|
|
Term
|
Definition
biologic
HER2 positive good candidate for Herceptin
use: breast cancer
SE: cardiotoxicity (baseline ECHO or MUGA) |
|
|
Term
|
Definition
biologic
monoclonal antibody that binds to CD20 antigen expressed in many b-cell NHL lymphomas
use: b-cell lymphomas as well as follicular lymphoas (CD-20 positive)
SE: infusion related reactions that have resulted in death, especially the initial infusion!!! hypoxia, pulmonary infiltrates, ARDS, MI, vfib
start low and go slow |
|
|
Term
|
Definition
requires a test dose for administration
used in ALL
SE: hyperglycemia, CNS disturbances, pancreatitis |
|
|
Term
|
Definition
| used in oncology (leukemia); used in sickle cell disease as well as essential thrombocytosis) |
|
|
Term
|
Definition
antiestrogenic compound (PO)
use: breast cancer
SE: flushing, weight gain
premenopausal patients |
|
|
Term
|
Definition
anastrazole (Arimidex)
letrozole (Femera)
used in postmenopausal patients
SE: HTN, flushing, mood disturbances
amifostine
used to prevent cisplatin induced nephro and neurotoxicity
SE: transietn hypotension during the infusion |
|
|
Term
| chemotherapy induced nausea and vomiting |
|
Definition
5-HT3 (trons): very effective agents with low toxicity
palonesetron (Aloxi) has a 40 hour t1/2 - give 1 dose
aprepitant (Emend): used with refractory N/V or in cisplatin containing regimens
corticosteroids: useful for prevention of delayed N/V
anticipatory N/V: BZDs like lorazepam |
|
|
Term
| colony stimulating factors |
|
Definition
G-CSF (Neupogen or Neulasta)
refrigerate
Neulasta is pegfilgrastim (6 mg SQ injection one time 24 hours after cycle
SE: bone pain can be severe
GM-CSF (sargramostim or Leukine(
refrigerate |
|
|
Term
|
Definition
epidermal growth factor
oral EGRF
GI 2 |
|
|
Term
|
Definition
epidermal growth factor
SE: hypertension, HA, GI 2 |
|
|
Term
|
Definition
epidermal growth factor
SE: infusion reactions, fever, sepsis, PE, kidney failure (monitor urinalysis or protein in urine) |
|
|
Term
| epoetin alpha (Epogen/Procrit) |
|
Definition
used for chemotherapy induced enemia or in CKD induced anemia
SE: hypersensitivity to the albumin (CI)
increased risk of CV events (MI and stroke)
may increase risk of certain cancers (breast, cervical, head and neck)
targeting Hgb of 10-12
darbepoetin (Aranesp) - longer t1/2 than epsoetin alpha |
|
|
Term
|
Definition
family history of early heart disease: MI or sudden death in parent or 1st degree relative (males < 55 or females < 65)
age: males > 45 or females > 55
current smoker
HTN
low HDL (<40)
high HDL (>60 is a negative risk factor) |
|
|
Term
|
Definition
nonabsorbable resins
bind bile acids in GI tract disrupting enterohepatic reuptake
decrease LDL by 5-30%; may increase TG
cholestyramine (Questran)
coclestipol (Colestid)
colesevelam (Welchol)
GI 2
drug interactions due to binding - thiazides, digoxin, amiiodarone, warfarin, MTX, levothyroxine, NSAIDs
separate 1 hour before or 4-6 hours after
drink plenty of water to limit constipation |
|
|
Term
|
Definition
best HDL increasing drug but outcome data not good so far
SE:
derm - flushing (prostaglandin mediated vasodilation); pruritis and dry skin; take 325 mg ASA 30-60 minutes prior to dose to limit flushing. ETOH and hot beverages can increase flushing
GI - liver toxicity with SR products
endo - hyperglycemia or hyperuricemia
myopathy when given with statins or gemfibrozil |
|
|
Term
| HMG CoA reductase inhibitors |
|
Definition
statins
very well studied for decreasing morbidity and mortality for both primary and secondary prevention
SE:
CNS 2
GI 2
endo - new onset DM (benefit must higher than the risks)
musculoskeletal - myalgias, myositis, muscle weakness...rhabdomyolysis); simvastatin has the highest risk of musculoskeltal SE (if occurs try pravastatin or rosuvastatin)
CI with protease inhibitors, gemfibrozil, clarithromycin, erythromycin, ketoconazole
10 mg max of simvastatin with dilt/verap
20 mg max with amio/amlodipine, ranolazine
pravastatin - safe med for drug interactions
fluvastatin - problem with warfarin (2D9)
monitoring: SEs, lipid panels usually q4-6 weeks |
|
|
Term
|
Definition
gemfibrozil (Lopid)
fenofibrate (Tricor)
SE:
CNS 2
GI 1 2 - gallstones
fenofibrate can cause photosensitivity
used to lower TG |
|
|
Term
|
Definition
decreases intestinal absorption of cholesterol
clinically decreases LDL about 18%
SE: GI 1 2 increased liver enzymes
drug interactions: Al and Mg can bind and lower levels |
|
|
Term
|
Definition
omega 3 fatty acids (Lovaza)
primarily used to decrease TGs
Lovaza 1 g capsule (need 4 g/day for efficacy)
SE: GI 2 taste perversions, burping, dyspepsia
monitor: liver enzymes while on therapy
can increase LDL |
|
|
Term
|
Definition
dilate primarily veins and some arterial dilation as well
relax smooth muscle
nitrate tolerance - when you continuously give the drug you get tolerant to the effect and need more for effect
try to give a 12 hour nitrate free interval to prevent tolerance from happening
purely for symptom control
dosage forms:
SL tablet - once bottle is opened, can keep it for 6 months; can take it 3 times, then need to go to the ER; very quick onset
translingual spray: quick onset
sustained release capsule
ointment 2% paste
transdermal patch - apply usually on for 12 hours, off for 12 hours
IV drip - comes in glass bottle (not stable in plastic bottles); used for rapid titration
SE:
CNS - lots of HAs, facial flushing
CV - hypotension, reflex tachycardia due to rapid vasodialtion
GI 2 - tingling under tongue with SL dosage form
derm - contact dermatitis with ointment and transdermal patch
drug interactions: avoid with PDE 5 inhibitors (get profound hypotension) |
|
|
Term
|
Definition
SE:
CV - QT prolongation
GI 2
CNS 2
used for angina, reduces oxygen demand
weak-moderate 2D6 inhibitor |
|
|
Term
| what to do if diuretic resistance occurs |
|
Definition
increase the dose to a point; then may switch from furosemide to bumetaide or torsemide for improved absorption
if high IV doses aren't working convert to a continuous drip (Lasix drips or Bumex drips)
add thiazides for potentiation (metolazone or IV chlorthiazide (Diruil) |
|
|
Term
|
Definition
candesartan - has data to preserve EF
valsartan - decreased morbidity in HR |
|
|
Term
|
Definition
does not affect mortality, only morbidity (hospitalizations)
DIG trial - averag elevels < 1
increasing the strength of contraction through Na/K/ATPase
monitoring: renal function!!!!
what electrolytes potentiate digoxin toxicity? hypomagnesemia and hypokalemia and hypercalcemia
therapeutic levels: 0.8-2
SE:
CV - bradycardia, multiple arrhythmias
toxicity manifested by severe N/V, green halos
toxicity treatment - make sure electrolytes repleted (K and Mg); Digibind antibody if needed) |
|
|
Term
|
Definition
inhibit cell wall formation by binding to the penicillin binding protein
penicillin G (IV)/VK (PO): still excellent coverage against Strep species
antistaphylococcal PCNs: methicillin, nafcillin, oxacillin, dicloxacillin
DOC for MSSA
aminopenicillins: ampicillin (IV) and amoxicillin (PO)
better gram (-) coverage than PCN
antipseudomonal penicillins: piperacillin
beta lactam/beta lactamase inhibitors: amoxicillin/clavulanate (Augmentin), ampicillin/sulbactam (Unasyn), ticarcillin/clavulanate (Timentin), piperacillin/tazobactam (Zosyn)
beta lactamase inhibitors add anaerobic coverage and better gram negative coverage
SE:
hypersensitivity reactions including anaphylaxis: do not challenge anaphylaxis with cephalosporins; 5-10% cross reactivity with cephs and carbapensems (mild reactions only)
BMS - hemolytic anemia
hypernatremia due to ticarcillin
nephron - acute interstitial nephritis (nafcillin) |
|
|
Term
|
Definition
NO ENTEROCOCCUS activity (ampicillin is DOC)
E. faecalis
E. faecium (more drug resistant strain; VRE) |
|
|
Term
| 1st generation cephalosporins |
|
Definition
primarily gram (+) coverage (Staph and Strep species)
cefazolin (Ancef) IV version used in surgical prophylaxis
cephalexin (Keflex) PO version
active against MSSA |
|
|
Term
| 2nd generation cephalosporins |
|
Definition
add more gram negative coverage
cephamycins: cefoxitin (Mefoxin) - good anaerobic coverage (surgical phrophylaxis with colorectal cases)
cefuxoime (Zinacef) IV; ceftin PO
cefaclor (Ceclor) - lots of rash
cefdinir (Omnicef) - good for kids b/c it tastes good |
|
|
Term
| 3rd generation cephalosporins |
|
Definition
more gram (-) coverage, lose some gram positive coverage
cefotaxime (Claforan) - studied well in SBP, used in infant sepsis
ceftriaxone (Rocephin)
dosed once daily except in meningitis where it is dosed q12 hours for BBB penetration
biliary sluddging
do not give with Ca containing foods (precipitation)
cefpodoxime (Vantin)
oral agent for step down for Rocephin
cefixime (Suprax)
not good coverage against Strep species
good for gonorrhea (STIs)
ceftazidime (Ceftaz)
has pseudomonal coverage
lacks good Strep coverage |
|
|
Term
| 4th generation cephalosporin |
|
Definition
cefepime (Maxipime)
good gram (+) and gram (-) coverage including Pseudomonas
SE: neurotoxicity (seizures with cefipime) |
|
|
Term
|
Definition
imipenem with cilastin (Primaxin)
cilastatin is a renal dihydropeptidase inhibitor (brush border cells will break down imipenem without this)
meropenem (Merrem)
doripenem (Doribax(
ertapenem (Invanz)
differnet from others b/c no Pseudomonas coverage
dosed once daily
broad coverage!!!!!!!!
holes in coverage are MRSA and Stenotrophomonas
SE: seizures (most with imipenem), use meropenem with meningitis patients |
|
|
Term
|
Definition
aztreonam (Azactam)
aerobic gram negative coverage only including Pseudomonas
niche drug in patients with anaphylactic reactions to penicillin |
|
|
Term
|
Definition
vancomycin
gram (+) activity only except VRE
oral vancomycin used for severe C. diff colitis
targeting troughs of 15-20 for invasive MRSA infections
dosing usually 15-20 mg/kg IV q8-12 hours
SE:
red man syndrome - flushing, pruritis over neck and trunk; how to fix? slow the injusion plus antihistamines if needed
nephrotoxicity
ototoxicity (rare)
BMS (leukopenia and thrombocytopenia)
daptomycin (Cubicin)
NOT for pneumonia (gets in the lung but surfactant inactivates it)
mainly for MRSA skin ans MRSA bacteremia and endocarditis
monitor CPK weekly due to risk of myalgias, CPK elevation (potential additive toxicity with statins)
IV only...no PO version
bactericidal activity
quinupristin/dalfopristin (Synercid)
gram (+) activity only including VRE (only E. faecium NOT faecalis)
SE:
GI 1 2 - hyperbilirubinemia and increased liver enzymes
skin - phlebitis and pain at infusion site (give via a central line)
flu like symptoms
linezolid (Zyvox)
gram (+) activity only
some activity vs. mycobacterium including TB
used for skin infections, pneumonia, not bacteremia
oral dosage form (100% bioavailable)
SE:
GI 2
BMS R W T - thrombocytopenia is the more important one (risk increases after 2 weeks of therapy!)
other: peripheral neuropathy; lactic acidosis; optic neuritis
drug interactions: it is a weak MAOI; SSRIs, tyramine containing foods, venlafaxine, etc. |
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Term
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Definition
only anti-MRSA cephalosproin
has littel gram (-) activity; no enterococcus activity
bacteriidal: used for skin/soft tissue infections and CAP (MRSA was excluded) |
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Term
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Definition
gram (-) agents including Pseudomonas but used with other agents for gram (+) synergy (endocarditis with enterococcus b/c vancomycin or ampicillin by themselves not cidal, with aminoglycosides becomes cidal)
concentration dependent killers
single daily dosing vs. traditional dosing
SDD may offer greater killing and less nephrotoxicity
SE:
nephrotoxicity!!!!!!!!!
ototoxicity both hearing and balance
neuromuscular blockade with NM blockers |
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Term
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Definition
erythromycin (not really used except for GI motility)
clarithromycin (Biaxin): H. pylori; tastes like metal; peds suspension keep at room temp
azithromycin (Zithromax): 5 day dosing due to very long tissue t1/2 of about 60 hours
used for respiratory infections and for STI (Chlamydia - 1 gram)
watch for drug interactions with erythromycin and clarithromycin (stron 3A4 inhibitors) |
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Term
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Definition
tetracycline (not the best)
doxycycline - better tolerated
minocycline - better toleraged
used primarily in MRSA uncomplicated skin/skin structure infections
not great activity vs. Strep species
avoid in pregnancy and in kids < 8 years old (discolors teeth)
drug interactions: cations can bind tetracycline products |
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Term
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Definition
gram (+) coverage including gram (+) anaerobes
used for gram (+) anaerobes above the diaphragm (metronidazole for anaerobes below the diaphragm)
IV dose is more than PO dose
used in toxic shock with Strep to shut toxin production down (protein synthesis inhibitor) |
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Term
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Definition
used clinically for UTIs (E. coli), Pneumocystis infection or prophy, MRSA skin abscess, Stenotrophomonas
dose based on trimethoprim component
doses are hight for Pneumocycstis (15-20 mg/kg/day)
SE:
GI 1 2
BMS W T R
electrolytes: hyperkalemia
Derm - rash including SJS or TEN
counsel patients on photosensitivity
bad drug with warfarin
be careful with G6PD deficiency
falsely increases SrCr (competes for active tubular secretion)
kernicterus (avoid in newborns or 3rd trimester) |
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Term
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Definition
great activity against anaerobes and (C. difficile (mild-moderage disease) and Trichomonas vaginalis (2 g x 1)
used in Chron's disease as an anti-inflammatory
SE:
GI 2 - metallic taste; disulfiram reaction with ETOH
neuro - peripheral neuropathy |
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Term
| nitrofurantoin (Macrodantin - QID; Macrobid - BID) |
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Definition
only for uncomplicated UTIS, not for pyelonephritis; cystitis only
SE:
GI 2
CI in CrCl < 60 mL/min
increased hemolytic anemia in G6PD deficiency
peripheral neuropathy and pulmonary toxicity |
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Term
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Definition
dose: 3 g single dose sachet dissolved in water
similar to nitrofurantoin only for cystitis
SE: GI 2 |
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