Pharmacy Foundations 1 Flashcards
(156 cards)
1
Q
what happens with chelation and what drugs do you want to separate from them?
A
-occurs when a drug binds to polyvalent cations (Mg++, Ca, Fe++) in another compound (antacids or iron supplements) –> passes thru the stool
-quinolones, trtracyclines, levothyroxine, and oral bisphosphonates
2
Q
pharmacodynamics
A
the effect that a drug has on the body. the effect can be therapeutic or toxic
3
Q
pharmacokinetics
A
the effect the body has on the drug as it goes through the ADMW processes
4
Q
if gastrointestinal pH is Increased, aborportion will be _______
A
decreased
ex: H2RAs, PPIs (acidic) taken with itraconazole decrease the funtion of the antifungal and can lead to resistant infections
5
Q
what are the prodrug and active metabolite pairings:
1) Capecitabine:
2) Clopidogrel:
3) Codeine:
4) Colistimethate:
5) Cortisone:
A
1) Fluorouracil
2) active metabolite
3) morphine
4) colistin
5) cortisol
6
Q
what are the prodrug and active metabolite pairings:
6) Famciclovir:
7) Fosphenytoin:
8) Isavuconazonium sulfate:
9) Levadopa:
10) Lisdexametamine:
A
6) Penciclovir
7) Phenytoin
8) Isavuconazole
9) Dopamine
10) Dextroamphetamine
7
Q
what are the prodrug and active metabolite pairings:
11) Prednisone:
12) Primidone:
13) Tramadol:
14) Valacyclovir:
15) Valganciclovir:
A
11) Prednisolone
12) Phenobarbital
13) active metabolite
14) Acyclovir
15) Ganciclovir
8
Q
what effect do CYP enzyme inhibitors have?
A
DECREASE enzyme function and the ability to metabolize compounds
substrates: decrease the rate of metabolism = INCREASED serum drug levels
9
Q
what are common CYP inhibitors involved in drug interactions? (G <3 PACMAN)
A
G: grapefruit
P: protease inhibitors (ritonavir)
A: Azole antifungals (fluconazole, itraconazole, ketoconazole, posaconazole, voriconazole, and isvuconazonium)
C: cyclosporine, cobicistat
A: amiodarone and drondarone
N: non-DHP CCBs: diltiazam, verapamil
10
Q
What effect to CYP enzyme inducers have?
A
increase enzyme production or activity
-substrates for the enzyme will have an INCREASED rate of drug metabolism = DECREASED serum drug level
-actions: increase dose of substratecomm
11
Q
Common CPY inducers involved in drug interactions: (PS PORCS)
A
P: phenytoin
S: smoking
P: phenobarbital
O: oxacarbazepine
R: rafampin, rifabutin, rifapentine
C: carbamazepine (also an auto-inducer)
S: st. johns wort
12
Q
what are P-gp efflux pumps?
A
loacted in many tissue membranes where they protect against foreign substances by moving them out of critical aread
-pump out of the bod by pumping them into the gut, where they can be excreted in the stool
13
Q
Common P-gp substrates:
A
-anticoagulants (apixaban, rivaroxaban)
-cardio drugs (digioxin, diltiazam, verapamil)
-immunosuppressants (cyclosporine, tacrolimus)
-HCV drugs: sofosbuvir
-others: (colchicine)
14
Q
Common P-gp inducers:
A
-carbamazepine
-phenobarbital
-phenytoin
-rifampin
-St. John’s wort
15
Q
Common P-gp inhibitors:
A
-anti-infection: clarithromycin, itraconazole, posaconazole
-cardio drugs: amiodarone, diltiazam, verapamil
-HIV drugs: cobicistat, ritonavir
-HCV drugs: ledipasvir
-others: cyclosporine
16
Q
what is enterohepatic recycling?
A
-the recycling of a already metabolized drug- increases the duration of action of amny drugs, including some abx, NSAIDs and ezetimibe
17
Q
DDI: amiodarone and warfarin
A
-can be used together for afib
-amiodarone inhibits multiple enzymes, including CYP2C9, which metabolizes the more potent warfarin isomer
–> dec warfarin metabolism = inc INR and bleed risk
-want to dec warfarin dose and monitor INR
18
Q
DDI: amiodarine and digoxin
A
-can be used together for afib
-amiodarone inhibits P-gp: digoxin is a P-gp substrate –> dec digixon excretion = inc ADRs/toxicity
-both drugs: inc risk of bradycardia, arrhythmia, fatality
–> dec digixon dose by 50% if used together and monitor HR
19
Q
DDI: Digoxin and loop diuretics
A
-can be used for HF tx
-loop diuretics dec K, Mg, Ca, Na = can worsen arrhythmias
–> digoxin toxicity risk is increased with less K, Mg and inc Ca level
(renal impairment: dec digoxin dose, freq or d/c drug)
20
Q
DDI: statins and strong CYP3A4 inhibitors
A
-inhibitors = ritonavir, cobicistat, clarithromycin, erythromycin, azole antifungals, cyclosporine, grapefruit
-inc levels of lovastatin, simvastatin, atorvastatin = inc myopathy risk, can cause rhabdomyolysis with ARF
–> simvastatin and lovastatin are CI with strong CYP3A4 inhibitors: can use pitavastain, pravastatin, rosuvastatin
21
Q
DDI: warfarin and CYP2C9 inhibitors and inducers
A
-inhibitors: azoles, sulfamethoxazole/trimethoprim, amiodarone, metronidazole –> INC level of warfarin
-inducers: rifampin, St. John’s wort –> DEC levels of warfarin
22
Q
DDI: CYP3A4 inhibitors and CYP3A4 substrates (opioids, fentanyl, hydrocodone, oxycodone, methadone)
A
-dec CYP3A4 substrate metabolism will cause INC drug levels, and INC ADRs/toxicity
23
Q
DDI: Valproate and lamotrigine
A
-valproate DEC lamotrigine metabolism and INC lamotrigine levels causing inc risk of skin reactions: SJS/TEN
24
Q
DDI: MAOIs and drugs/foods that inc sertonin, epi, NE and DA
A
do NOT use together
-use a 2 week washout period when switching between drugs with MAOI inhibition or serotonergic properties (wait 5 weeks for FLUOXETINE)
-avoid tyramine rich foods: wine, ages cheese, dry meats
25
DDI: CYP2D6 inhibitors (amiodarone, fluoxetine, paroxetine, fluvoxamine) and CYP2D6 substrates (codeine, meperidine, tramadol, tamoxifen)
-dec drug substrate metabolism
-inc ADRs/toxicity
*avoid* using together is possible
26
DDI: CYP3A4, P-GP inhibitors and CNIs (tacrolimus, cyclosporin)/ mTOR kinase inhibitors (sirolimus, everolimus)
-DEC drug substrate metabolism = inc ADR/toxicity, inc BP, nephrotoxicity, metabolic syndrome etc
-avoid using together
27
DDI: antiepeliptic drugs CYP inducers and other drugs metabolized by CYP enzymes (BC)
-INC substrate (drug) metabolism will cause DEC drug levels
-dec drug effect with AEDs = loss of seizure control
-monitor drug levels
-if lamotrigine, use starter kit with higher levels first
28
DDI:Rifampin and CYP/P-gp substrates
concentration of substrate drugs will greatly decrease
29
DDI: CYP3A4 inducers and opioids that are CYP3A4 substrates (fentanyl, hydrocodone, oxycodone, methadone)
-inc metabolism = DEC opioid concentration --> analgesia relief will decrease
30
DDI: CYP3A4, P-gp inducers and CNIs/mTORs
-inc drug metabolism = dec transplant drug level and inc risk of transplant/organ rejection
31
DDI: Smoking and some antipsychotics, antidepreaasants, hypnotics, anxiolytics, caffeine, theophylline, warfarin (R-isomer)
-smoker who quit: when cig is stopped, drug concentrations of CYP1A2 substrates with inc = toxicity
-current smoker: CYP1A2 substrate will have dec levels
32
What drugs can cause serotonergic toxicity? (6 classes)
- antidepressants: SSRIs, SNRIs, TCAs, mirtazapine, trazodone
- MAOis
-opioids
-triptans
-natural products: St. John's wort, L-tryptophan
-others: buspirone, lithium, dexatromethorphan
33
what are the risks of serotonergic toxicity?
-autonomic dysfunction: diaphoresis, N/V, hyperthermia
-AMS (akathesia, anxiety, agitation, delirum)
-neuromuscular excitation (hyperreflexia, tremor, regidity, tonic-clonic seizures)
--> avoid using serotonergic drugs together- 2 week wash out or 5 weeks with flouxetine
34
what drugs cal increase bleeding risk? (5 classes)
-anticoagulants (warfarin, DOACs, heprin, fondaparinux)
-antiplatelets (aspirin, clopidogrel, prasagrul, ticagular)
-NSAIDs (ibuprofen, naproxen, dicofenac, indomethacin)
-SSRI/SNRIs (citalopram, ecitalopram, fluuxetine, sertraline etc)
-Natural products (5 Gs: garlic, ginger, ginkgo biloba, ginseng, glucosamine)
35
what drugs increase the risk of hyperkalemia? (3 classes)
-RAAS drugs (ACE, ARBBs, aliskiren, entresto, spirinolactone, eplerenone)
-Potassium-sparing diuretics (amiloride, triamterene)
-others (KCL, CNIs, bactrim, canagliflozin)
36
what drugs can cause QT Prolongation? (7 classes)
-antiarrhythmics
-anti-infectives (antimalaria, azoles, lefamulin, macrolides, quinolones)
-antidepressants (SSRIs- citalopram and ecitalopram, TCAs, mirtazapine, trazodone, venlafaxine)
-antipsychotics (haloperidol, thioridazine)
-antiemetics (ondansetron, droperidol, metoclopramide, promethazine)
-oncology: (leuprolide, nilotinib, oxaliplatin)
-others: (cilostazol, donepezil, fingolimod, hydroxyzine, loperamide, methadone, tacrolimus)
37
what drugs can cause ototoxicity? (5 classes)
-animoglycosides (gentamicin, tobramycin, amikacin)
-cisplatin
-loop diuretics -esp rapid IV injection (furosemide, bumetanide, ethacryinic acid)
-salicylates (aspirin, salslate, magnesium salicylate)
-vancomycin
38
what drugs can cause nephrotoxicity? (6 classes)
-anti-infectives (aminoglycodies, amphotericin B, polymyxines, vancomycin)
-cisplantin (use amifostine (ethyol) to protect kidneys)
-calcineurin inhibitors (cyclosporine, tacrolimus)
-loop diuretics (furosemide, torsemide, bumetanide, ethacrynic acid)
-NSAIDS
-radiographic-contrast dye
39
what drugs are anticholinergic? (6 classes)
-antidepressants/antispychotics (paroxetine, TCAs, 1st gen antipsy)
-sedating antihistamines (diphenhydramine, brompheniramine, doxylamine, hydroxyxine, meclizine)
-centrally acting anticholinergics (benztropine, trihexyphenidyl)
-muscle relaxants (baclofen, carisoprodol, cyclobenzaprine)
-antimuscarinics (oxybutynin, darifenacin, tolterodine)
-others (atropine, belladonna, dicyclomine)
40
what drug classes interact with PDE-5 inhibitors (sildenafil, tadalafil, avanafil, vardenafil) to cause hypotension/orthostasis?
-CYP3A4 inhibitors
-nitrates
-alpha-1 blockers (non-selective: doxazosin, terazosin) or selective: tamsulosin)
41
Common CYP3A4 substrates (8 classes)
-analgesics: fentanyl, hydrocodone, methadone, oxycodone
-anticoagulants: apixaban, rivaroxaban, R-warfarin
-cardiovascular drugs: amiodarone, amlodipine, diltiazem, verapamil
-immunosuppressants: cyclosporine, tacrolumus, sirolimus
-statins: atorvastatin, lovastatin, simvastatin (ALS)
-HIV drugs: NNRTIs
-PDE-5 inhibitors: avanafil, sildanafil, tadalafil, vardenafil
-others: ethinyl
42
Common CYP3A4 inducers
-carbmazepine
-oxacarbazepine
-phenobarbital
-phenytoin
-rifampin
-smoking
-St. John's Wort
43
Common CYP3A4 inhibitors (4 classes)
-anti-infectives: clarithromycin, erythromycin, azoles, isoniazid
-cardio drugs: amiodarone, diltiazam, verapamil
-HIV drugs: cobicistat, ritonavir, protease inhibitors)
-others: cyclosporine, grapefruit,
44
common CYP1A2 substrates
-theophylline
-R-warfarin
45
common CYP1A2 inducers
-carbamazepine
-phenobarbital
-phenytoin
-rifampin
-smoking
-St. john's wort
46
common CYP1A2 inhibitors
-ciprofloxacin
-fluvoxamine
47
common CYP2C8 substrates
-amiodarone
-pioglatazone
-repaglinide
48
common CYP2C8 inducers
-phenytoin
-rifampin
49
common CYP2C8 inhibitors
-amiodarone
-clopidogrel
-bactrim
50
common CYP2C9 substrates
-S-warfarin
51
common CYP2C9 inducers
-carbamazepine
-phenobarbital
-phenytoin
-rifampin
-smoking
-St. John's wort
52
common CYP2C9 inhibitors
-amiodarone
-fluconazole
-metronidazole
-bactrim
53
common CYP2C19 substrates
-clopidogrel
54
common CYP2C19 inducers
-carbamazepine
-phenobarbital
-phenytoin
-rifampin
55
common CYP2C19 inhibitors
-esomerprazole
-omerprazole
56
common CYP2D6 substrates (3 classes)
-analgesics: codeine, meperidine, tramadol
-antipsychotics/antidepressants
-others: tamoxifen
57
Common reference range: Calcium (Ca)
8.5-10.5 mg/dL
**calculate corrected calcium if albumin is low**
- can be increased due to calcium supps, vitamin D, thiazides diuretics
- can be dec due to long term heparin, loop diuretics, bisphosphonates, cincacalcet
--> supp Ca in preganany, osteo and with certain drugs
58
Common reference range: Magnesium (Mg)
1.3-2.1 mEq/L
- can be inc due to mag containing antacids and laxatives
- can be dec due to PPI, diuretics, amphotericin B, diarrhea and chronic alcohol intake
59
Common reference range: Phosphate (PO4)
2.3-4.7 mEq/L
- inc in CDK
-dec due to phosphate binders, foscarnet, oral calcium intake
60
Common reference range: Potassium (K)
3.5-5 mEq/L
-inc due to ACEi, ARB, aldosterone receptor agonists, aliskiren, canagloflozin, cyclosporine, tacrolimus, potassium supps, bactrim
-dec due to beta 2 agonists, diuretics, insulin, sodium polystyrene, sulfonate
61
Common reference range: Sodium (Na)
135-145 mEq/L
-inc due to hypertonic saline, tolvaptan
-dec due to carbamazepine, oxacarbazepine, SSRIs, diuretics
62
Common reference range: Bicarbonate (HCO3)
V: 24-30 A: 22-26 mEq/L (used to assess acid-base status
-inc due to loop diuretics, systemic steroids
-dec due to topiramate, salicylate overdose
63
Common reference range: Blood Urea Nitrogen (BUN)
7-20 mg/dL
-increases in renal impairment and dehydration
--> BUN: SCr ratio is used to assess fluid status and renal function
64
Common reference range: Serum Creatinine (Scr)
0.6-1.3 mg/dL
-inc due to many drugs that impair renal function: aminoglucosides, amphotericin B, cisplatin, colistimethate, cyclosporine, loop diuretics, polymixin, NSAIDs, radioactive contrast dye, tacrolimus, vancomycin)
--> false ince can be due to bactrim, H2RAs, cobicistat
-dec with low muscle mass, ampuation, hemodilution
65
Common reference range: glucose
70-110 mg/dL
66
Common reference range: Anion Gap (AG)
5-12 mEq/L
-an inc anion gap suggests metabolic acidosis
67
Common reference range: white blood cell count (WBCs)
4,000-11,000 cells/mm3
-inc due to systemic steroids, CFS, epi
-dec due to clozapine, chemotherapy, carbamazepine, immunospurants
68
Common reference range: Neutrophils & Bands
45-73% & 3-5%
-used to calculate ANC to assess for neutropenia
-"left shift" in bands when elevated
69
Common reference range: Eosinophils
0-5%
-inc in drug allergy, asthma, inflammation, parasitic infection
70
Common reference range: basophils
0-1%
-inc in inflammation, hypersensitivity reactions, leukemia
71
Common reference range: Lymphocytes
20-40%
-inc in viral infections, lumphoma
-dec in bone marrow suppression, HIV or due to systemic steroids
72
Common reference range: Red Blood Cells (RBC)
male: 4.5-5.5 F: 4.1-4.9 x 10^6 cells/uL
-life span is 120 days
-inc due to ESAs, smoking
-dec due to chemotherapy deficiency anemias, hemolytic anemia, sickle cell anemia
73
Common reference range: Hemoglobin (Hgb, Hb)
males: 13.5-18, f: 12-16 g/dL
-inc due to ESAs
-de in anemias and bleeding
74
Common reference range: Mean Corpuscular Volume (MCV)
80-100 fL
--> reflects the size and average volume of RBCs
-inc (macrocytic anemia) due to B12 or folate deficiency
-dec (microcytic anemia) due to iron deficiency
75
Common reference range: Folic Acid (folate)
5-25 mcg/L
-dec due to phenytoin/fosphenytoin, phenobarbital, primidone, methotrexate, bactrim
-supp in women of childbearing age and alcohol use disorder
76
Common reference range: Vitamin B12
>200 pg/mL
-dec due to PPI, metformin, colchicine, chloramphenicol
77
Common reference range: Reticulocyte count
0.5-2.5%
--> measures the amount of immature RBCs being made by the bone marrow
-inc with blood loss and hemolysis
-dec in untreated anemia and with bone marrow suppression
78
Common reference range: Coombs test
negative
--> used in diagnosis of immune-mediated hemolytic anemia
-drugs that can cause it include: penicillins, cephalosporines, isonaizid, levodopa, methyldopa, quinidine, rifampine and sulfonamides
* if test is +, D/C the drug
79
Common reference range: G6PD
5-14 units/gram
--> used to determine if hemolytic anemia is due to G6PD
-triggered by stress, foods (fava beans), or drugs: dapsone, methylene blue, nitrofurantoin, pegloticase, primaquine, raburicase, quinidine, quinine, and sulfonamides
80
Common reference range: Anti-Xa
-therapeutic doses of LMWH (4 hours after dose) 1-2- IU/mL
-therapeutic dose of unfractionated heparin (6 hours after IV infusion and q 6 hrs until therapeutic) : 0.3-0.7 IU/mL
81
Common reference range: PT/INR
PT: 10-13 secs
INR: < 1.2 --> w/o warfarin, inc can be due to liver disease
82
Common reference range: aPPT/PTT
22-38 seconds
-monitor unfractonated heparin: obtain q 6 hours after IV. infusion
-false inc can occur with oritavacin, telavancin
83
Common reference range: Platelets (PLTs)
150,000-450,000 cells/mm3
--> life span of 7-10 days (bleeding can occur < 20,000 cells
-dec due to heparin, LMWH, fondaparinux, linezolid, valproic acid
84
Common reference range: Albumin
3.5-5 g/dL
- dec due to cirrhosis and malnutrition
-phenytoin and calcium concentrations require correction with low albumin
85
Common reference range: AST/ALT
10-40 units/L
-enzymes released from injured hepatocytes
86
Common reference range: Bilirubin
0.1-1.2 mg/dL
-used to assess causes of liver damage and detect bile duct blockage
87
Common reference range: Amylase and Lipase
A: 60-180 units/L
L: 5-160 units/L
-increase in pancreatitis, which can be caused by didanosine, stavudine, GLP-1 agonists, DPP-4 inhibitors, valproic acid, hypertriglyceridemia
88
Common reference range: Creatinine Kinase (CK)
males: 55-170, F: 30-135 IU/L
-used to assess muscle damage/inflammation
-can inc due to daptomysin, statins, tenofovir, raltegravir, dolutegravir
89
Common reference range: Troponin, BNP, NT-proBNP
T: 0-0.1 ng/mL
BNP: <100 ng/L
pro BNP: M: < 61, F: 12-151
-markers of cardiac stress --> higher values are consistant with liklihood of HF or MI
90
Common reference range: LDL, HDL & TG
LDL: < 100 mg/dL
HDL: 40- >/= 60
TG: < 150
non-HDL = TC - HDL
--> fasting begins 9-12 hours prior to blood draw
91
Common reference range: fasting glucose & A1C
100-125 = + for prediabetes
A1C < 7% (ADA), < 6.5% (AACE)
91
Common reference range: C-reactive protein
0/0/5 mg/dL
-inc CRP = inflammation
91
Common reference range: C-Peptide
0.78 - 1.89 ng/mL
--> insulin breakdown product used to evaluate beta-cell function (distinguishes between type 1 and type 2 dm)
- dec or absent in type 1 dm
92
Common reference range: urinary albumin excretion (UAE)
< 30 mg/24 hr
93
Common reference range: TSH
0.3-3 MIU/L
-inc = hypothyroidism, can be due to tyrosine kinase inhibitors, lithium, carbamazepine
-dec = hyperthyroidism
- inc or dec due to amiodarone, interferons
94
Common reference range: Uric acid
M: 3.5-7 F: 2-6.5 mg/dL
-inc due to diuretics, niacin, low doses of aspirin, pyrazinamide, cyclosporine, tacrolimus
95
Common reference range: CRP, RF, ESR, ANA
CRP: 0-0.5 (high risk = > 3 mg/dL)
RF: neg
ESR: M < 20, F: < 30 mm/hr
ANA: neg
--> used in autoimmune disorders/ inflammation
-drug induced lupus erythematosus (DILE): can be caused by anti-TNF agents, hydralazine, isonazid, methimazole, methyldopa, minocycline, procainamide, etc- drug should be D/C
96
Common reference range: CD4 and viral load
CD4: immunocompromised state = < 200 cells
VL: undetectable
97
Common reference range: pH
7.35-7.45
98
Common reference range: Prostate - specific antigen (PSA)
<4 ng/mL
99
Common reference range: Lactic acid
0.5-2.2 mEq/mL
-inc due to NRTIs, metformin, alcohol use, cyanide
100
Therapeutic Drug Levels: Carbamazepine
4-12 mcg/mL
101
Therapeutic Drug Levels: Digoxin
A fib: 0.8- 2 ng/mL
HF: 0.5 - 0.9 ng/mL
102
Therapeutic Drug Levels: Gentamicin
Peaks: 5-10 mcg/mL
Troughs: < 2 mcg/mL
103
Therapeutic Drug Levels: Lithium
0.6-1.2 mEq/L (up to 1.5)
-drawn as troughs
104
Therapeutic Drug Levels: Phenytoin and free phenytoin
P: 10-20
FP: 1-2.5 mcg/mL
105
Therapeutic Drug Levels: Procainamide, NAPA (active metabolite) & combined
P: 4-10
NAPA: 15-25
Combined: 10-30 mcg/mL
106
Therapeutic Drug Levels: Theophylline
5-15 mcg/mL
107
Therapeutic Drug Levels: Tobramycin
Peak: 5-10 mcg/mL
Tough: < 2 mcg/mL
108
Therapeutic Drug Levels: Valproic acid
50-100 mcg/mL
109
Therapeutic Drug Levels: Vancomycin
Trough: 15-20 (for serious infections --> pneumonia, endocarditis, osteomyelitis, meningitis, and bacteremia)
Trough: 10-15 mcg/mL for others
110
Therapeutic Drug Levels: Warfarin
goal INR : 2-3 for most
111
what informations must be included on OTC drugs?
1- active ingredients: indicate amount and purpose
2- uses for the product
3- specific warnings : when the drug should not be used and when it is appropriate to consult a doc
4- side effects and substances or activities to avoid
5- dosage instructions
6- the inactive ingredients
112
Locating guidelines: Anticoagulation
-American College of Chest Physicians (CHEST)
--> stroke prevention in Afib, venous thromoembolism
113
Locating guidelines: Cardiovascular diseases
-ACC/AHA guidelines
--> ACS, A fib, HF, high cholesterol, HTN
114
Locating guidelines: Diabetes
-AACE, ADA
115
Locating guidelines: Infectious Diseases
-IDSA
-HIV/AIDS: US dept of health and human services
-CDC: sexually transmitted diseases
116
Locating guidelines: oncology
-american society of clinical oncology (ASCO)
-National comprehensive Cancer Network (NCCN)
117
Locating guidelines: Pediatrics
the American Academy of Pediatrics (AAP)
118
Locating guidelines: Pregnancy/womens health
The american Academy of obstetricians and Gynoc (ACOG)
119
Locating guidelines: Psychiatric Conditions
DSM
120
Locating guidelines: Pulmonary Conditions
-Asthma: GINA, and national heart, lung and blood institute (NHLBI)
-COPD: GOLD
121
Locating guidelines: Renal Disease
Kidney disease improving global outcomes (KDIGO)
122
Locating guidelines: Vaccines
ACIP, CDC
123
"color" drug references: Orange book
FDA: list of approved drugs that can be interchanged with generics based on therapeutic equivalence
124
"color" drug references: Pink Book
CDC: Information on epidemiology and vaccine-preventable diseases
125
"color" drug references: Pink Sheet
Pharma Intelligence: news reports on regulatory, legislative, legal and business developments
126
"color" drug references: Purple Book
FDA: list of biological drug products, including biosimiliars
127
"color" drug references: Red Book, Pharmacy
drug pricing information
128
"color" drug references: Red Book, Pediatrics
summaries of pediatric infectious diseases, antimicrobial tx and vaccines
129
"color" drug references: Yellow Book
CDC: info on health risks of international travel, required vaccines, and prophylaxis meds
130
"color" drug references: Green Book
FDA: inof on approved animal drug products
131
Which patches must be applied twice daily?
Diclofenac
132
Which patches must be applied daily?
-Methylphenidate (Daytrana) Qam, 2 hours prior to school - HIP ONLY
-Nicotine (NicoDerm CQ)
-Rivastigmine (Exelon)
-Rotigontine (Neupro)
-Selegiline (Emsam)
-Testosterone (androderm): nightly, not on scrotum
133
Which patches need to be applied daily but have special instructions?
-Lidocaine (Lidoderm): 1-3 patched PRN, on for 12 hours, off for 12 hours
-Nitroglycerin: on for 12-14 hours, then off for 10-12 hours
134
Which patches need to be applied every 72 hours?
-Fentanyl: !72 hr, if it wears off after 48 hours, change to Q48 hrs
-Scopolamine (Transderm Scop): Q72 hrs, PRN- behind the ear
135
Which patches need to be applied twice weekly?
-Estradiol (Alora, Vivelle-Dot- lower abdomin)
-Oxybutynin (Oxytrol) - abdomen, hip or butt
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Which patched need to be applied weekly?
--Donepezil (Adlarity)
-Buprenorphine (Butrans)
-Clonidine (Catapres-TTS)
-Estradiol (Climara)
-Estradiol/Levonrgestrel
-Ethinyl estradiol/norelestromin (Xulane- back abdomen, or butt, Zafemy): weekly for 3 weeks, 1 week off
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Which patches contain metal? (aluminum)
-Clonidine (Catapres-TTS)
-Rotigotine (Neupro)
-Scopolamine (Transderm Scop)
-Testosterone (Androderm)
---> need to be removed before an MRI
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what are some alternative to PVC containers?
-Polyolefin
-Polyproopylene
-glass
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What are drugs with leaching/adsorption/absorption issues with PVC containers: Leaches Absorb To Take In Nutrients
L: lorazepam
A: amiodarone
T: tacrolimus
I: insulin
N: nitroglycerin
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what are some common drugs with SALINE diluent solution requirements : A DIAbetic Cant Eat Pie
A: ampicillin
D: daptomycin (cubicin)
I: infiximab (Remicade)
A: ampicillin/sulbactam (Unasyn)
C: caspofungin (cancidas)
E: ertapenem (Invanz)
P: phenytoin (Dilantin)
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what are some common drugs with DEXTROSE diluent solution requirements: Outrageous Bakers Avoid Salt
O: oxaliplatin
B: bactrim
A: amphotericin B
S: synercid - quinupristin/dalfopristin
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common drugs with filter requirements: my GAL IS PAT who has a MaP
G: golimumab
A: amphotericin B (lipid formualtions)
L: lipids = 1.2 microns
IS: isavuconazonium
P: phenytoin
A: amiodarone
T: taxanes (cabazitaxel and paclitaxel)
M: mannitol > 20%
P: parenteral nutrition - 1.2 microns
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drugs that need to be protected from light during administration: Protect Every Necessary Med from Daylight
P: phytonadione (vitamin K)
E: epoprostenol
N: nitroprusside
M: micafungin
D: doxycycline
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drugs that should NOT be refrigerated: Dear Sweet Pharmacist, Freezing Makes Me Edgy!
D: dexmedetomidine
S: sulfamethoxazole/Trimethoprim
P: pheytoin --> crystalizes
F: furosemide --> crystalizes
M: metronidazole
M: moxifloxacin
E: enoxaparin
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3 IV drugs that come as colored solutions
1: Anthracycline (doxorubicin) red --> dicolor sweat and urine
2: Rifampin- red --> discolor salivia, urine, sweat and tears
3: Mitoxantrone - blue -->discolors skin, eyes, urine
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Antidotes for Anthracycline, Vincristine Extravasation
-give via centeral venous catheters
Antidotes:
--> Anthracyclines: dexrazoxane (Totect) or dimethyl sulfoxide
--> Vinca alkaloids: hyaluronidase
*intrathecal admin of Vincristine is fatal
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Drugs with leaching/adsoprtion/absorption issues with PVC containers
LATTIN:
Lorazepam
Amiodarone
Tacrolimus
Taxanes
Insulin
Nitroglycerin
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Drugs that can only be used in SALINE
Ampicillin
Daptomycin (Cubicin)
Infliximab (Remicade)
Ampicillin/Sulbactam (Unasyn)
Caspofungin (Cancidas)
Ertapenem (Invanz)
Phenytoin (Diltantin)
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Drugs that can only be used in DEXTROSE
Oxaliplatin
Bactrim (SMX/TMP)
Amphoterericin B
Synercid (Quinupristin/Dalfopristin
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Common high-risk Incompatibilities
-Ceftriaxone + calcium containing solutions: risk of precipitates (common ex is mixing with Lactated Ringer)
-Calcium and phosphate: will bind together and create a precipitate that kills the patient
-Amphotericin B + sodium bicarbonate: incompatible with the majority of IV drugs
-Piperacillin/tazobactam: forms a precipitate when it mixes with acyclovir, amphotericin B and many other IV drugs
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Common drugs that REQUIRE a filter
Golimumab
Amphotericin B (lipid formulations)
Lipids- 1.2 microns
Isavuconazonium
Phenytoin (continuous infusion only)
Aminodarone
Taxanes (cabazitaxel, paclitaxel)
Mannitol >/ 20%
Parenteral nutrition- 1.2 microns
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IV drugs that do NOT require refrigeration
Dexmedetomide
Sulfamethoxazole/Trimethoprim
Phenytoin-crystallizes
Furosemide- crystallizes
Metronidazole
Moxifloxacin
Enoxaparin
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Key drugs that need to be protected from light during administration
Phytonadione (vitamin K)
Epopostenol
Nitroprusside
Micafungin
Doxycycline
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