Brands/Generics/Class Flashcards
Anzemet
- Forms
- Class
Dolasetron
- Form: IV & PO
- Class: 5-HT3 Serotonin Receptor Inhibitors
Kytril
Sancuso
- Form
- Sancuso
- Kytril
- Class
Granisetron
- Form IV/PO
- Sancuso: Transdermal 1 patch Q24-48H b/4 chemo. Can be worn for 7 days. Avoid sun
- Class: 5-HT3 Serotonin Receptor Inhibitors
Zofran
Zuplenz
- Form
- Class
Odansetron
- Zofran IV/IM/PO/ODT
- Zuplenz: thin strip melts on tongue
- Class: 5-HT3 Serotonin Receptor Inhibitors
Aloxi
- Form
- Half life
- Class
PaLONosetron
- IV/PO
- LONg t1/2. Use this if worry ~ QT
- Class: 5-HT3 Serotonin Receptor Inhibitors
Decadron
Dexamethasone
- Corticosteroids
Medrol
Methylprednisolone
- Corticosteroids
Emend
- Metabolize
- Class
- Use in combo:
Fosaprepitant (pro-drug): IV
Aprepitant PO
- Rapidly convert to aprepitant
- Class: Neurokinin-1-receptor antagonists => working by blocking substance P
- Used in combo with corticosteroid or 5HT3 inhibitors
Marinol
- Class
- Storage
- Frequency
- CS:
DRONabinol
- Class: Cannabinoids
- Refridgerated
- TID-QID
- CS: III
Cesamet
- Class
- Storage
- Frequency
- CS
NaBilone
- Class: Cannabinoids
- Non-refrigerated
- BID
- CS: II
Reglan
- Form
- MOA
- Give w/ what to reduce what SEs
Metoclopramide
- PO/IV/IM
- MOA: Block dopamine in brain
- Give w/ Benadryl to reduce extrapyramidal SEs
Diphenhydramine
- Benadryl
- Class: Antihistamines
Atarax
- Class
HyDROXyzine
- Class: Antihistamines
Lorazepam
- Class
Ativan
- Class: Benzodiazepines
Alprazolam
- Class
Xanax
- Class: Benzodiazepines
Epogen
Procrit
- Indication:
- Dose/Form/Frequency
- Exp of Multi-vial
Erythropoietin
- Indication: for chemo induced anemia
- 150-300 units/kg SC/IV 3x/wk
- Multi-dose vials: discard 21 days after initial entry
Aranesp
- Indication:
- Dose/Frequency
- Counseling on bottle
- Storage:
- – Epogen and Aranesp —-
- CI
- Warning
- Monitoring
DARbepoetin alfa
- Indication: for chemo induced anemia
- 2.25 mg/kg SC weekly
- Do not shake
- Refrigerate/protect from light
—— Epogen, Procrit, Aranesp—-
- CI: Uncontrolled HTN
- Warning: CVD, thromboembolic event, tumor progression.
D/C if Hgb b/w 10-12.
- Monitor:
BP, CBC w/ diff, Hgb
Ferritin: low (give iron, B12, and folate)
Neumega
- Indication:
- MOA:
- Dose/Route
- Monitor
Oprelvekin (Oh Prel ve kin)
- I: chemo induced thrombocytopenia
- MOA: Interleukin -11 (IL-11) is a thrombopoietic growth factor that increases platelet production
- Dose: 50 mcg/kg SQ QD start 6-24H after chemo & cont until platelets count is >50000 cells/mL
- Monitor: Fluid retention and electrolyte => CHF and arrhythmia
Neupogen
- Indication
- Storage
- Dose
- SEs
FilgrasTIM GCSF
- I: granulocytes to tx neutopenia. Use to reduce febrile neutropenia after chemo
- Refrigerate: use w/in 24H if at RT
- D: 5mcg/kg/day ingle dose SC or IV infusion over 15-30min
- SE: bone pain
Neulasta
- Indication:
- Storage
- Dose
- SEs
PegfilgrasTIM
- I: granulocytes to tx neutopenia. Use to reduce febrile neutropenia after chemo
- Refridgerate/protect from light. Use w/in 48H at RT
- Dose: 6mg SC x 1 each chemo cycle
- SE: bone pain
Kayexalate
Sodium polystyrene sulfonate (SPS)
- I: Shift K intracellular
Chemo drugs are never in mg/kg, it’s in:
- mg/m2
One inch = ? cm
1’ = 2.54 cm
1kg = ? lb
1 kg = 2.2 pounds
PLANTINol
- Class:
- SEs
- Cause most:
- Give w/ what as ppx to prevent nephrotoxic
- Give what for promote excretion
- Reduce nephrotoxicity by:
CisPlatin
- Alkylating agents
SEs
- Nephrotoxicity
- Ototoxicity
- Peripheral Neuropathy
- Electrolyte imbalance: decr PO4, K, Ca, Mg
- Cause MOST GI upset
- Amifostine: given as ppx to prevent nephrotoxicity
- Manitol: promote excretion
Reduce Nephrotoxicity by:
- Hydration: 2-3L NS over 8-12H
- Mannitol 25-50g IV b/4
- Amifostine: start b/4 chemo
Ethyol
- Indication
- SEs
- D/C which med:
Amifostine
- Give as ppx to prevent nephrotoxicity in cisplatin
SEs
- Severe HyperTN
- Infusion rxn: flushing, chills, hiccups, sneezing, n/v
- D/c all HTN med
Paraplatin
- Is amifostine indicated for this drug?
Carboplatin
- Amifostine is no indicated => cause less nephrotoxicity
Eloxatin
- Indication
- SE
OxaliPtin
- Use for colorectal cancer w/ 5-FU + leucovorin
- SE: Peripheral neuropathy
Myleran
- SEs
Busulfan
SEs
- Increase uric acid (Hyperuricemia):
Watch for other drugs (thiazide, loop, niacin, low dose ASA)
- Pulmonary fibrosis (SOB & chest x-ray)
- Hyperpigmentation of skin: stop ASAP and give steroid
- SZ
- BMS
Cytoxan
- Prevent hemorhagic cystitis
- SEs
- Monitor
C(4)yclophoSphamide
Prevent hemorhagic cystitis
- Mesna to bind to acrolein
- Hydration
SEs
- Hemorhagic cystitis: cause by acrolein
- Renal tubular necrosis
- Hepatotoxicity
- Cardiac SEs
- Alopecia
- Sterility
Monitor
- CBC, plt, BUN, UA, Electrolytes, SrCr
Ifex
- Mesna
Ifosfamide
- Mesna comes with the ifosfamide package
Mesna indication
- Bind to acrolein as ppx to prevent hemorhage cystitis in cyclophosphamide and ifosfamide
BiCNU
- Indication:
- SEs
C(2)ARMustine
- I: lipid soluble => treat cns malignancies (brain tumor)
SEs
- Hepatotoxicity
- Nephrotoxicity
- Pulmonary fibrosis => CAR = carbon dioxine = lung toxic
- Bone marrow suppression
CeeNu
- Indication:
- SEs
Lomustine
- I: lipid soluble => treat cns malignancies (brain tumor)
SEs
- Hepatotoxicity
- Nephrotoxicity
- Bone marrow suppression
- Pulmonary fibrosis
Zanocar
- SEs
- Dose limiting due to
StrEptozocin
SEs
- Pancreatic damage
- Nephrotoxicity
- Extravasation
- Dose limiting - 90% get DM I
Alkeran
- SEs
Melphalan
SEs
- Fertility Impairment
- BMS
Which drug cause fertility imp and no pharmacist can work while pregnant
- Melphalan (Alkeran)
- Mechlorethamine (Mustargen)
- Altretamine (Hexalen)
Mustargen
- SEs
mEchlorethamine
SEs
- Extravasation: severe necrosis => tx w/ Na thiosulfate
- Fertility impairment
Hexalen
- Route
- Indication
- SEs
- MOAIs:
Altretamine
- PO
- I: tx ovarian cancer
SEs
- Peripheral Neuropathy
- Fertility Impairment
- MOAIs: may cause severe othostatic hypoTN
Mutalane
- SEs in Pediatric
- Monitor:
- Give with MOAIs
Procarbazine
- SEs in Ped: tremors, convulsion
- Disulfiram rxn
- M: CBC, renal, hepatic
- MOAIs: high tyramines or MOAIs = fatal HTNsive crisis
Drugs that have MOAI effects
- Altretamine (Hexalen)
- Procarbazine (Mutalane)
Drugs Cause Tumor Lysis Syndrome
- Bendamustin (Trenda)
Anti-Metabolites
Anti-Metabolites
Folinic acid
- Indication
Leukovorin
- Give with methotrexate as a rescue drug to save the good cells
- Give with 5-FU to increase its action. When used together, 5-FU works better, thus use less amt of 5-FU
Glucarpidase (Voraxaze)
- Indication
- An injectable carboxypeptidase enzyme that breaks down MTX in the body so the drug can be easily eliminated when the kidneys are not working properly
5-FU
Adrucil
- INR
- SEs
FluOrouracil
- Increase INR
SEs
- Hand & foot syndrome
- Mucositis
- Neurotoxiticy
- Alopecia
- Ocular toxicity
- Photosensitivity
- Light sensitive
Light sensitive drugs
- Methotrexate
- 5-FU
- Cisplatin
Xeloda
- Indication
- Dose:
- Administration
Capecitabine - prodrug of 5-FU
Indication
- Metastatic breast cancer resistant to paclitaxel
- 1st line for metastatic colorectal carcinoma
- Dosage Form: PO 150 mg and 500 mg Tab
- D: Cyclical 1250 mg/m2 BID - 2 wk on 1 wk off
- Take with water w/in 30 min after AM and PM meals
Purinethol
Purixan
- SEs
- DDIs
Mercaptopurine (6-MP)
SEs:
- Hepatotoxicity
- Hyperuricemia
- Hyperpigmentation of skin
- Rash
- Mucositis
- Diarrhea
DDIs
- Allopurinol: will increase 6-MP. 6MP active metabolite is catalyzed by xanthine oxidase. Allopurinol is a xanthine oxidase inhibitor
- Bactrim: inc 6-MP
Cytosar
- SEs
Cytarabine => PPPH
SEs
- Conjunctivitis/CNS
- Hepatotoxicity
- Pancreatitis
- Pulmonary tox
- Peripheral neuropathy
- Cytarabine syndrome: fever, myalgia, bone pain, occasional chest pain, rash
- *CNS changes when used IV intrathecal
- *Vision change: conjunctivitis & Keratitis => use dexamethasone eye drops w/ high doses
Fludara
- SEs
FludarabiNe
SEs
- Sig immunosuppression “AIDS in a bottle”
- Neurotoxicity: irreversible blindness, coma, death
Trenda
- Diluent use:
- Storage
- Solution color
- SEs
BENdaMustin
- D: 100mg/m2 IV on day 1 & 2 of a 28 days cycle up to 6 cycles
- Diluent: NS
- Stable 24H refrigerated or 3H RT
- Colorless/clear lightly yellow soln
- Protect from light
SEs
- Myelosuppression
- Infusion rxn & anaphylaxis
- Tumor Lysis syndrome
Rheumatrex
Otrexup
Trexall
- Indication
- Dose
- SEs
- Drugs impair MTX excretion
- Monitor
- Rescue drugs
Methotrexate
Dose
- RA: 7.5mg/wk PO single dose or 2.5 mg PO Q12H x 3 doses given once weekly. Max 20mg weekly
- Intrathecal - 12 mg
- High dose: 500-12000 mg/m2 IV q2-3wks
SEs
- Hepatotoxicity
- Renal insufficiency: keep urine alkaline w/ NaHCO3 to prevent crystallization & well hydrated to avoid renal tox
- Pulmonary tox
- Photosensitivity => use sunscreen
- Light sensitive
- Mucositis
- Folic acid antagonist => give 1mg/d
Impair MTX excretion:
- NSAIDs, ASA, Penicillins, Bactrim, PPI => stop b/4 MTX
Monitor
- LFT, Renal fxn, CXR, and CBC
Rescue
- Leukovorin
- Glucarpidase
Antibiotics
Antibiotics
Bleomycin
- SEs
- Blenoxane
SEs
- Pulmonary tox: non productive cough. Occur when acc dose > 450-500mg. Never give > 500mg life time
- Skin tox: hyper-pigmentation: red spots that are not uniform
Adriamyacin
Doxil
- SEs
- Accumulate life time dose
DoxoRUbicin
SEs:
- CHF: irreversible due to Fe
- Urine color: red
- ** Preg Cat D
- Extravasation: apply COLD (december is cold)
Accumulate life time dose
- 550 mg/m2
DaunoXone: Liposomal
Cerubidine: Conventional
- SEs
- Accumulate life time dose
DaunoRUbicin
SEs:
- CHF: irreversible due to Fe
- Urine color: red
- Extravasation: apply COLD (december is cold)
Acc life time dose
- 900 mg/m2
Zinecard
- Indication
Dexrazoxane
- Iron chelator: protects against cardiotoxicity of doxorubicin and daunorubicin
- Comes in liposomal form => less toxicity
Valstar
- Turn urine color:
- SEs:
ValRUbicin
- Transient urine discoloration RED
- Irritable bladder symptoms
Cosmegen
- SEs
- CIs
DACtomycin
- Extravasation ass w/ severe necrosis
- CI: active chicken pox or herpes zoster
Novoantrone
- SEs
Mitoxantrone
- Turn urine to a blue/blue green color and the white part of your eyes turn a bluish colors => this is normal and not a cause for concern
Plant Alkaloids
- Docetaxel, paclitaxel
- Etoposide, Teniposide
- Irinotecan, Topotecan
Taxotere
- SEs
Docetaxel
SEs
- Hypersensitivity => premed w/ dexamethasone 8mg BID 3-5d, start 1 day prior
- Fluid retention/Pulmonary edema => use lasix
Taxol
- SE
- Tube to use
- Diluent contains
- CI:
PacliTAXel
- SE: Hypersensitivity => PreMed
- use NON-PVC tubing
- Diluent contains: contain EtOH => disulfram rxn
- CI: Castor oil
Toposar
- SEs
EtoPOside
- Etoposide VP-16: cap refrigerate
SE
- HypoTN due to rapid infusion
TeniPOside (Vumon)
- SEs
Vumon
SE
- HypoTN due to rapid infusion
Camptosar
- SE
- Early treatment
- Late treatment
Ironotecan
SES
- Diarrhea & dehydration: life threatening
- Early: tx w/ atropine - anticholinergic
- Late: Loperimide: regardless of max dose
=> OTC max = 8mg
=> Rx max = 16 mg
=> Replenish fluid & electrolytes
Hycamtin
- SEs
Topotecan
SES
- Diarrhea & dehydration: life threatening
- Early: tx w/ atropine - anticholinergic
- Late: Loperimide: regardless of max dose
=> OTC max = 8mg
=> Rx max = 16 mg
=> Replenish fluid & electrolytes
Vinka Plant Alkaloids
Vinka Plant Alkaloids
Oncovin
Marqibo: liposome
- SEs
VinCristine
SEs
- Most *CNS tox
- Peripheral neuropathy: most w/ vincristine
- Constipation: start stool softener
Velban
- SEs
VinBlastine
SEs
- *BMS
- Peripheral neuropathy: most w/ vincristine
- Constipation: start stool softener
Navelbine
- SEs
VinOrelbine
SEs:
- Most *alopecia
- Peripheral neuropathy: most w/ vincristine
- Constipation: start stool softener
Preparing Vinca Plant Akaloids
- Label required:
- Prepared only in small volume infusion bag for rapid IV infusion per nursing standards
- Labeled “For IV USE ONLY - FATAL if given intrathecally”
Dispensing Intrathecal Chemo
- Labels for intrathecal route
- No other chem/med dispense at the same time
- The person ordered will review w/ pharmacist, verify his/her status w/ MD, fellow or chemo certified nurse by signing of the med
Tyrosine Kinase Inhibitors
Tyrosine Kinase Inhibitors
- Form: Only come in PO forms
- SEs: Diarrhea and Nausea
Gleevec
- Class
- SEs
- DDI
- Monitor
Imatinib
- Class: Tyrosine kinase inhibitors
- SEs: fluid retention
- Substrate; strong inhibitor of 3A4
- Monitor: CBC, LFT, wt gain
Tarceva
- Indication
- Administration
- SEs
ErLOtinib
- Class: Tyrosine kinase inhibitors
- Indication: lung & pancreatic cancer
- Adm: 100-150mg PO on Empty stomach
SEs
- Increase LFT
- Pulmonary sx
- GI bleeding
- Corneal ulceration
Tykerb
- Class
- Indication
Lapatinib
- Class: Tyrosine kinase inhibitors
- I: breast cancer
Tasigna
- Class
- Indication
- Watch out for
NilOTinib
- Class: Tyrosine kinase inhibitors
- I: Leukemia
- Watch for QT prolongation
Bosulif
- Class
Bosutinib
- Class: Tyrosine kinase inhibitors
Iclusig
- Class
Ponatinib
- Class: Tyrosine kinase inhibitors
Inlyta
- Class
Axitinib
- Class: Tyrosine kinase inhibitors
CarBOXantinib (Cometriq)
- Administration
- Class
CarBOXantinib
- Take on empty stomach = Empty BOX
- Class: Tyrosine kinase inhibitors
Sprycel
- Class
Dasatinib
- Class: Tyrosine kinase inhibitors
Iressa
- Class
Gefitinib
- Class: Tyrosine kinase inhibitors
PaZOpanib (Votrient)
- Class
PaZOpanib
- Class: Tyrosine kinase inhibitors
SORAfenib (Nexavar)
- Class
SORAfenib
- Class: Tyrosine kinase inhibitors
Sutent
- Class
Sunitinib
- Class: Tyrosine kinase inhibitors
VANdetanib (Caprelsa)
- Class
VANdetanib
- Class: Tyrosine kinase inhibitors
REGOrafenib (Stivarga)
- Administration
- Class
REGOrafenib
- Take with food
- Class: Tyrosine kinase inhibitors
VorinOstat (Zolinza)
- Class
- Indication
- Administration
- Caution
VorinOstat
- Class: Histone Deacetylase Inhibitor
- I: lymphoma
- Adm: 400 mg cap PO with FOOD
- Caution: QT prolongation
RomiDEPsin (Istodax)
- Class
- Indication
- DF
RomiDEPsin
- Class: Histone Deacetylase Inhibitor
- I: cutaneous T-cell lymphoma
- DF: IV
Hydrea
- Indication
Hydroxyurea
- Indication: antineoplastic use, sickle cell anemia
Thalomide
- SEs
- Special program
Thalidomide
SEs
- Birth defect
- Thrombo-embolitic events
- Peripheral neuropathy
=> Require Thalidomide Education & Prescribing Safety (STEPS): dispensing right to authorized MDs or pharmaCIES
=> Pt must be on 2 forms of contraceptive
Pomalidomide (Pomalyst)
- Indication
- Derivative of
- Special Program:
Pomalidomide
- I: mulitple myeloma
- Derivative of thalidomide
- Program: Women of reproductive potential must use 2 forms of contraception or continuously abstain from heterosexual sexual intercourse during and for 4 weeks after stopping treatment. Pomalidomide is only available through a restricted distribution program called Pomalyst Risk Evaluation and Mitigation Strategy (REMS)
Chemo Man
Chemo Man
Erythropoetin/Darbepoetin
- CI
- Warning/Precaution
- Monitoring Parameters
CI:
- Uncontrolled HTN
Warning/Precaution
- Thromboembolism events
- Tumor Progression
=> High Hgb: inc risk of MI, stroke, clot
=> Keep Hgb b/w 10-12g/dL
=> Once chemo stop, stop Epogen or Aranesp
Monitoring
- BP, CBC w/ diff, platelet, Hgb
- Sr Ferritin => start Fe if Start if saturation Correct Fe, B12, Folate prior to tx
How long does the followings live?
- Platelets
- RBC
- Granulocytes
- Platelets: 10 days
- RBC: 120 days
- Granulocytes: 6-8H => neutropenia occurs w/in hrs of chemo.
Tumor lysis syndrome
- Results in:
- Problems
Result in ARF, multiple organ failure, death
- Hyperkalemia
- Hyperuricemia
- Hyperphosphatemia
- Hypocalemia
Problems
- Cardiac arrhythmia: hyperK = arrhythmia. HypoCa = QT int lengthening = V. arrhythmia
- Electrolytes: transcellular shift of K
- Hyperuricemia: give allopurinol & hydration to prevent uric acid crystal within collecting ducts = ARF
Treatment of tumor lysis syndrome
Administer IV CaCl
- Tx HyperK or HypoCa
- Protect myocardium from arrhythmias
- CaCl contains 3x Ca++ element (1g = 290mg) than Ca gluconate (1g = 90 mg).
Na Bicarbonate
- Shift K intracellular
Insulin (Novolin, Humulin) & dextrose
- Shift K intracellular
Kayexalate
- Exchange Na for K and binds to K in gut => decr total body K.
- OSA: PO 2-12H. Per rectal = longer osa
- Give as 2nd stage of therapy to reduce total body K
- SEs: constipation
- Don’t give w/ sorbital = GI necrosis
General Policy & Procedures of Fan/Blower
See Book page 5
Disulfiram reaction
- Procarbazine
- PacliTAXel
Alterna Gel
- Class
- Indication
Aluminum hydroxide
- Class: Phosphate binder
- Indication: hyperphosphatemia
PhosLow
- Class
- Indication
Calicium acetate
- Class: Phosphate binder
- Indication: hyperphosphatemia
Fosrenol
- Class
- Indication
Lanthanum carbonate
- Class: Phosphate binder
- Indication: hyperphosphatemia
Renagel
- Class
- Indication
Sevelamer
- Class: Phosphate binder
- Indication: hyperphosphatemia
Velphoro
- Class
- Indication
Sucroferric oxyhydroxide
- Class: Phosphate binder
- Indication: hyperphosphatemia
CaCl and Ca-gluconate
Which has more Ca
CaCl has more Ca
1gCaCl = 270mg Ca
1g CaG = 90 mg Ca
Aloprim
Allopurinol
Zyloprim
Allopurinol
Elitek
Rasburicase
Kayexalate
- SEs
Sodium polystyrene sulfonate
- SEs: constipiation
Chemo induced neuropathy
- Drugs
PPT
P = platinum drug P = Plan alkaloids T = Taxanes
Valchlor
- Storage
- Form
- Major SE:
Mechlorethamine
- Storage: fridge
- Form: topical gel
- Major SEs: Fertility imp
Voraxaze
- Indicatio
Glucarpidase
- Indication: MTX rescue med
Vectibix
- Form
- Class
- Indication
Panitumumab
- Form: IV
- Class: EGFR
- Indication: Colorectal cancer
Erbitux
- Form
- Class
Ceteximab
- Class: EGFR
- Form: IV
Avastin
- Mix with
- Class
Bevacizumab
- Mix with NS
- Class: VEGF
Beleodaq
- Class
- Indications
- Form
Belinostat
- Class: histone deacetylase inhibitor
- Indication: lymphoma
- Form: IV