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Antibiotic and Antivirals > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Opioid toxidromes

A

decreased BP, HR, RR, T depressed mental status decreased pupils and peristalsis

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2
Q

Mycophenolate moftil (Cellcept)

A
  • immunosuppresant-antirejection
  • inhibits guanosine–no T and B synthesis
  • Cellcept-80-90% bioavailability
  • Myfortic- 70% bioavailability
  • ADEs
    • GI
    • thrombocytopenia, leukopenia, anemia
  • use in combo with CNI or mTOR
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3
Q

hyperacute rejection

A
  • minutes to hours after transplant
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4
Q

Bevacizumab (Avastin)

A
  • humanized monoclonal antibody–reduced production of blood vessels for cancer cells
  • Uses: retinopathy of prematurity in neonates
  • IV, intravitreal: 15 mg/kg (weight based)
  • Black Box Warning
    • ​Gi perf
    • impaired wound healing
    • hemorrhage, thrombotic events
    • PRES
  • Side Effects
    • ​nephritic syndrome
    • hypertensive crisis
    • infusion reactions
    • dry skin
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5
Q

Ethosuximide (Zarontin) mechanism of action

A

anti-epileptic Na+ and Ca+ channel blocker

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6
Q

Vitamins for seizures

A

B6

folic acid

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7
Q

Ketogenic diet

A

used to treat intractable epilepsy fat provides majority of calories protein: minimum RDA carbs: severely restricted in conjunction with anti-epileptics: watch CHO content avoid liquids content of carbs can vary from brand to brand

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8
Q

Imatinib (GLEEVEC)

A
  • chemo–antineoplastic
  • tyrosine kinase inhibitor
  • PO
    • do not crush, but can be dissolved in water or apple juice
    • renal and hepatic dose adjustments
  • side effects
    • fluid retention, edema, weight gain, pleural effusions
    • hypotension
    • increased LFTs
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9
Q

Azoles

A

Ketoconazole flucanazole voriconazole

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10
Q

Morphine pharmacokinetics

A
  • converted in liver
  • renally excreted metabolites
    • morphine-6-glucuronide (active)
    • morphine-3-glucuronide (inactive)
  • half life varies
    • 10-20 hours in preterm neonates
    • 6 hours-neonates and infants up to 3 mos
    • 2.9 hours in 6 mos - 2.5 years
    • 1-3 hours children 6-9 years
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11
Q

Thrush treatment

A
  • Nystatin
    • agent of choice
    • swish and swallow 3-4 x/day
    • do not eat/drink 20-30 min after dose
  • Clotrimazole
    • availble as troche-sucker
    • caution in young kids–choking
    • CYP3A4 interactions
  • Fluconazole
    • agent of choice-systemic prophylaxis
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12
Q

chronic rejection

A
  • develops over months to years
  • can have acute on chronic
  • B-cell
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13
Q

Antimetabolites

A
  • MOA:
    • inhibits DNA synthesis
    • S-phase specific
  • agents
    • folic acid analog-Methotrexate
    • purine analog-6-mercatpopuring (6MP) and nelarbine (Ara-G)
    • pyramidine analogs:
      • 5-fluorouicil
      • cytarabine (Ara-C)
      • Gemcitabine
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14
Q

Dactinomycin

A
  • anti-tumor antibiotic
  • cell-phase non-specific
  • IV
  • vesicant-watch for extravasation
  • avoid use with radiation
  • Side effects
    • myelosuppression
    • photosensitivity
    • hepatotoxicity
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15
Q

Decarbazine (DTIC)

A
  • alkylating agent
  • used for solid and heme malignancies
  • IV only
  • side effects:
    • myelosuppression
    • N/V
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16
Q

REMS program

A

Risk Evaluation and Mitigation Strategy to ensure that the benefits of a drug outweigh its risks -strategy to manage known or potential serious risks associated with a drug product and is required by the FDA to help ensure that a drug’s benefits outweigh its risks.

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17
Q

Tacrolimus ADEs

A
  • seizures/tremors
  • hyperglycemia
  • alopecia
  • HTN
  • nephrotoxicity
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18
Q

Platinum Alkylating Agents

A
  • cancer tx
  • contain platinum
  • cell-phase non-specific
  • MOA:
    • bond with DNA-DNA cannot repair-cell death
  • TOXICITY
  • commonly used in peds
    • Cisplatin
    • Carboplatin
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19
Q

Beta Lactamase Inhibitors

A

piperacillin/tazaobactam (Zosyn) Ampicillin/sulbactam ticarcillin/Clavulanate Amoxicillin/clavulanate (Augmentin)

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20
Q

Oxycodone

A
  • binds to opioid receptors in CNS, inhibits ascending pathways, alters perception and response to pain
  • no injectible form
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21
Q

Beta Lactam categories

A

natural PCN, Amino PCN PRSP (penicillin resistant synthetic) ESPCN (extended spectrum) B-Lact Inhibitors Cephalosporins Carbapenem monobactam

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22
Q

Cisplatin

A
  • IV
  • side effects
    • Nephrotoxicity
      • cation wasting
      • requires aggressive hydration and high urine output–fluids should contain K+ and Mg+
    • Ototoxicty
    • ​peripheral neuropathy (use gabapentin)
    • N/V
    • hepatotoxicity
    • myelosuppression, thrombocytopenia
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23
Q

Zonisamide (Zonegran) mechanism of action (anticonvulsant)

A

Na+ and Ca+ channel blockers increased GABA potentiation CAH inhibition

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24
Q

Macrolide ADEs

A

abd. discomfort ototoxicity taste

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25
Q

macrolides

A

erythromycin (QT prolongation) azithromycin clarithromycin (not if pregnant)

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26
Q

Rituxumab (Rituxan)

A
  • Anti-CD20 chimeric monoclonal antibody
    • B-cells
    • prolonged B-cell depletion (12 months)
  • uses:
    • actue organ transplant rejection
    • NMDA receptor encephalitis
    • rheumatoid arthritis
  • IV: 375 mg/m2
  • Black Box Warning:
    • infusion reactions-tylenol (and steroids) and antihistamine
    • multifocal leukoencephalopathy
    • reactivation of Hep B
  • Side effects
    • fever, nausea, diarrhea
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27
Q

Evirolimus (Afinitor)

A
  • cancer tx
  • mTOR inhibitor
  • PO
  • dose depends on therapeutic monitoring
    • range 5-15 mg/mL
  • drug interactions
    • CYP 3A4, 3A5, adn 2C8
  • side effects
    • non-infectious pneumonitis
    • stomatitis, oral ulceration
    • rash
    • hyperglycemia, increased LFTs
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28
Q

Opioid withdrawal

A

ARMY FINDS aches, rhinorrhea, mood disorders, yawning fever, insomnia, N/V, diarrhea, diaphorsis

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29
Q

6-Mercaptopurine (6MP) and 6-thioguanine (6TG)

A
  • purine analog
  • PO
  • 1x daily x3 days–ALL maintenance therpy
  • non-oncologic indications
  • Side effects
    • myelosuppression
    • hepatic-cholestasis, hepatic necrosis
    • mucositis (rare)
  • monitor LFTs
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30
Q

Levitracetam (Keppra)

A

MOA: Ca+ channel blocker, GABA and glutamate reducer indications: adjunct therapy, neonatal seizures, status epilepticus *increasingly becoming 1st line monotherapy ADEs somnolence asthenia nervousness

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31
Q

NSAID use

A
  • mild to moderate pain
  • antipyretic
  • anti-inflammatory
  • analgesic
  • COX-2 selective and non-selectve:
    • ibuprofen (Advil)
    • ketorolac (Torodol, IV/PO)
    • Naproxen (Aleve)
    • Celecoxib (Celebrex)-COX-2 selecvtive
      • juvenile rheumatoid arthritis
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32
Q

Valproic Acid, Divalproex Sodium (Depakote, Depakene) ADEs

A
  • pancreatitis
  • alopecia
  • rash (including Stevens-Johnson)
  • GI–abd. pain, N/V/D
  • thrombocytopenia
  • hepatotoxicity (especially neonates)
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33
Q

Medications that require REMS

A
  • Anticonvulsants
  • ACE inhibitors
  • warfarin
  • diethylstilbestrol (DES)
  • Vitamin A derrivatives
  • Chemotherapy
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34
Q

antibiotics that treat MSSA

A
  • PRSP-naficillin
  • nafcillin, oxacillin, cefazolin or ceftriaxone
  • Fluoroquinolones: ciprofloxacin, levofloxacin, moxifloxacin
  • Tetracyclines: minocycline, doxycycline, tetracycline
  • Sulfonamide: bactrim
  • Clindamycin (lincosamide)
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35
Q

acetaminophen (Tylenol)

A
  • most commonly used analgesic in peds
  • mild to moderate pain
  • synergistic with opioids
  • anitpyretic
  • available dosage forms
    • IV ($$$0
    • PO: 10-15 mg/kg; max daily dose = 75 mg/kg/day
    • PR: 20 mg/kg = max dose
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36
Q

aminoglycosides

A

gentamycin tobromycin amikacin

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37
Q

acetaminophen (Tylenol) metabolism

A

liver

small amounts metabolized by CYP enzymes

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38
Q

Insotretinoin (Accutane)

A
  • all trans-retinoic acid
  • used for neuroblastoma–80mg/m2 daily x 14 days per cycle
  • Side effects
    • dry skin
    • photosensitivity
    • arthralgias
    • increased LFTs
    • differentiation syndrome
  • TERATOGEN
  • REMS program
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39
Q

Lidocaine Topical Patch 5% (Lidoderm)

A
  • 12 hours on/ 12 hours off
  • patches can be cut
  • caution with toxicity in little kids
  • local pain only
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40
Q

Carbamazepine (Tegretol)

A
  • indications:
    • tonic clonic
    • focal seizures
  • ADEs:
    • ataxia
    • diplopia
    • hyponatremia
    • Steven-Johnson’s syndrome
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41
Q

Levitracetam (Keppra) mechanism of action

A
  • anti-epileptic
  • Ca+ channels
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42
Q

Flouroquinolones

A

ciprofloxacin levofloxacin moxifloxacin ofloxacir

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43
Q

Carboplatin

A
  • platinum alkylating agent
  • IV
  • Side effects
    • more myelosuppressive than Cisplatin
    • less emetogenic, nephrotoxic, and neurotoxic than Cisplatin
  • renal excretion–so good hydration and kidney function
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44
Q

Allopurinol

A
  • for tx and prevention of tumor lysis syndrome
  • best when used prophylactically
    • high tumor burden
    • cytotoxic therapy
  • ADEs
    • rash
    • increased LFTs
    • increased alkaline phosphatase
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45
Q

Mesna

A
  • used to prevent bladder toxicity
  • binds to urotoxic metabolites (acrolein and 4-hydoxyifosfamide)
  • with ifosfamide doses >1.2g/m2 mensa should be administered
  • 60-100% ifosfamide dose
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46
Q

High dose Methotrexate

A
  • range from 5-15g/m2
  • infusion time: 4-24 hours
  • MTX levels: drawn at 24 hours
    • if infusion over, draw immediately
    • must be a peripheral stick
  • requires LEUCOVORIN rescue by hour 42 or the dose is considered lethal
    • starts at hour 30-36 from start of infusion
  • IV hydration until MTX clears
  • maintain alkaline urine pH (>7)
  • MTX–protected from light
  • labs need to be drawn in the dark and covered
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47
Q

Benzodiazepine antidote

A

Flumazenil competitve bezo/GABA receptor antagonist give in controlled setting–seizures may be precipitated

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48
Q

REMS types

A

Medication guide

Communication plan

Elements to Assure Safe Use

Implementation

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49
Q

Vancomycin ADEs

A

ototoxicity nephrotoxicity Red man neutropenia

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50
Q

Sulfonamides

A

sulfamethoxazole/trimethoprim (Bactrim)

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51
Q

Valproic Acid, Divalproex Sodium (Depakote, Depakene) therapeutic monitoring

A

therapeutic: 50-100mcg/mL toxicity: >100mcg/mL–can see toxic effects, but sometimes have to get close to 100 to see therapeutic effects *used for migraine prophylaxis

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52
Q

aminoglycoside ADEs

A

nephrotoxicity ototoxicity

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53
Q

Bleomycin

A
  • anti-tumor antibiotic
  • cell-phase non-specific-best in G phase
  • IV, SC, intrapleural
  • max lifetime dose-400 mg/m2
  • not myelosuppressive
  • pre-medication to minimize pyrogen release
  • Side effects
    • pulmonary toxicity (get baseline PFTs)
    • mucositis
    • skin hyperpigmentation
    • hypersensitivity reaction
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54
Q

Granulocyte Colony Stimulating Factors (GCSF)

A
  • risks
    • can induce cancer cell proliferation
    • avoid use in actue Leukemia patients
  • benefits
    • stimulates WBC production-minimizes infection risk
  • agents
    • Filgrastim (Neupogen)
    • Pegrilfrastim (Neulasta)
    • Sargomigrastim (Leukine)
  • side effects: bone pain
  • Warnings:
    • splenic rupture
    • ARDS
    • edema
    • anaphylactic reactions
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55
Q

visceral pain

A

originating from internal organs

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56
Q

Penicillin ADEs

A

rash, seizure, fever, abd. discomfort, neutropenia, fever, acute renal failure, high LFT

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57
Q

acetylsalicylic acid (ASA, Aspirin)

A
  • not used regularly in peds
    • Reye’s Syndrome
  • MOA:
    • irreversibly binds to COX 1-2 enzymes
      • decreased effects of prostaglandins and thromboxane A2–knocks them out of comission
  • analgesia, antipyretic, anti-inflammatory
  • anti-platelet (most common ped. indication)*
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58
Q

Valproic Acid, Divalproex Sodium (Depakote, Depakene) pharmacokinetics

A

Absorption–variable depending on dosage form Distribution–highly protein bound (80-90%) Metabolism–extensive hepatic metabolism via glucurondination dosage forms: capsules and tablets (IR and ER), sprinkles in capsules, IV, oral solution

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59
Q

Acetaminophen antidote

A

N-acetylcysteine (NAC, Mucomyst) IV most beneficial if used within 8 hours

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60
Q

antibody-mediated rejection

A
  • days to weeks after transplant
  • B-cell
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61
Q

Valacyclovir and Acylovir ADEs

A

headaches GI effects increased SCr neutropenia anemia thrombocytopenia

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62
Q

Amino PCNs

A

Ampicillin (IV/PO) Amoxicillin (PO)–go-to oral agent

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63
Q

Methotrexate drug and food interactions

A
  • avoid:
    • Bactrim
    • penicillins
    • tetracyclines
    • ASA
    • folic acid
    • NSAIDs
  • avoid acidic foods
  • pt. with Downs more susceptible to toxicity
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64
Q

Tetracyclines

A

minocycline doxycycline tetracycline

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65
Q

Ifosamide

A
  • alkylating agent
  • prodrug
  • IV
  • side effects:
    • neurotoxicity
    • hemorrhagic cystitis–urine checks imp.
    • nephrotoxicity
    • peripheral neuropathy
    • cardiotoxicity
    • interstitial pneumonitis
    • marrow suppression, alopecia
  • drug interactions: anything that inhibits CYP
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66
Q

Oxacarbazepime (Trileptal) mechanism of action

A

anti-epileptic Na+ and Ca+ channel blocker

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67
Q

Ethosuximide (Zarontin)

A

indication: ABSENCE SEIZURES *only indication ADEs: pancytopenia (blood dyscrasias) *many drug interactions (CYP3A4) *can measure serum concentrations

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68
Q

Temsirolimus (Torisel)

A
  • mTOR inhibitor
  • IV
  • interactions: CYP 3A4 inhibitors (decrease dose 50%)
  • side effects:
    • rash
    • asthenia
    • mucositis
    • N/V
    • edema, interstitial lung disease
    • hyperglycemia, hyperlipidemia
    • impaired wound healing, opportunistic infections
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69
Q

Erwinaze

A
  • gram neg bacteria
  • given for ADEs from pegaspargase
  • IM only
    • 2500 units/m2
    • 3x week for 6 doses
  • contraindications
    • hypersensitivity
    • hx of pancreatitis, hemorrhagic events or thrombosis
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70
Q

Benzodiazepines

A

indications: absence seizures myclonic seizures delirium tremens status epilepticus *drug of choice if pt. is actively seizing ADEs respiratory depression hypotension bradycardia delirium

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71
Q

antibiotics that treat stenotrophomonas

A

sulfonamides: bactrim tetracyclines: minocycline, doxycycline, tetracycline

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72
Q

Anthracyclines

A
  • anti-tumor antibiotics
  • all IV
    • doxorubicin (lifetime dose max)
    • daunorubicin
  • Side effects
    • cardiotoxicity
    • myelosuppression
    • mucositis
    • extravasion
    • red urine
  • drug interactions-hepatic metabolism
  • avoid during radiation**
  • max lifetime dose
    • ​doxurubicin–450 mg/m2
    • daunorubicin–900 mg/m2
73
Q

Clindamycin (lincosamide) ADEs

A

pseudomembranous colitis taste

74
Q

CYP inducers

A
  • rifampin
  • pheytoin
  • carbamazepine
  • pheonobarbital
75
Q

Valproic acid, Depakote mechanism of action

A

anti-epileptic GABA potentiation–inhibits neuronal activity

76
Q

Ethanol ADEs

A

SAMS GIN slurred speech attention impairment memory impairment stupor or coma gait unsteady incoordination nystagmus

77
Q

Carbamazepine (Tegretol) mechanism of action

A

anti-epileptic Na+ channel blocker decreases frequency and voltage of nerve cells

78
Q

Flouroquinolone ADEs

A

photosensitivity seizures abd. discomfort QT prolongation CNS stim. BBW–tendon rupture, peripheral neurop, CNS

79
Q

Fludarabine

A
  • purine analog
  • IV
  • Uses:
    • ​F in FLAG regimen
    • stem cell transplant conditioning
  • Toxicities
    • ​myelosuppression
    • edema
    • interstitial pneumonitis
    • CNS toxicity with higher doses (PRES, seizures, …)
  • drug interaction-allopurinol
80
Q

Topiramate (Topamax)

A
  • MOA: multiple receptors, Ca+, Na+, CAH inhibition, GABA potentiation and glutamate antagonism
  • indications: focal seizures, generalized seizures, migraine prophylaxis
  • ADEs:
    • concentration difficulties *
    • anorexia
    • hyperthermia
  • *caution in pt with existing behavioral or learning disabilities
81
Q

NSAIDs

A
  • MOA:
    • inhibition of COX 1 and 2- decreased prostaglanding synthesis
  • onset of action: 60-120 min after oral dose
  • Half life
    • ibuprofen: 1-2 hours (shortest)
    • ketorolac: 3-6 hours
    • naproxen: 8-17 hours (2x/day)
  • metabolism: liver
  • metabolites excreted via kidney
82
Q

Lamotrigine (Lamictal) mechanism of action

A

anti-epileptic Na+ and Ca+ channel blockers

83
Q

PCA

A
  • post-op pain
  • most effective in children > 6 years
  • alone or in conjunction with low-dose continuous infusion
84
Q

Cholinergic ADEs

A

SLUDGE and DUMBBELLS salivation lacrimation urination diarrhea gi distress emesis diarrhea, urination, miosis, bradycardia, bronchospasms, emesis, lacrimation, lethargy, salivation and seizures

85
Q

Ethylene Glycol and Methanol antidote

A

Fomepizole allows for elimination of alcohol

86
Q

codeine

A
  • prodrug that turns to morphine
  • often in combination with acetaminophen
  • FDA warning < 18 years
  • avoid use in children
87
Q

Anticholinergic ADEs

A

blind as a bat mad as a hatter red as a beet hot as a hare dry as a bone

88
Q

Leucovorin

A
  • folinic acid (active form of folic acid)
  • doses >50mg must be given IV
  • MTX doses >500mg/m2 require leucovorin
  • must initiate rescue by 42 hours post high dose of MTX-or doses are fatal
  • dose based off levels of MTX
89
Q

antibiotics that treat MRSA

A

vancomycin * sulfonamide: bactrim tetracyclines: minocycline, doxycycline, tetracycline clindamucin daptomycin

90
Q

ESPCN

A

piperacillin ticarcillin *IV only

91
Q

Valganciclovir treats

A

CMV

92
Q

Interleukin-2 (IL-2, Aldesleukin)

A
  • IV-short half life, given as constant infusion
  • Side Effects
    • fever, chills, flu-like symptoms
    • thrombocytopenia, leukocytosis
    • elevated SCr and LFTs
    • electrolyte abnormalities (Ca, Mag, Phos)
    • severe symptoms: anaphylaxis, capillary leak
  • do not shake
  • requires close monitoring for ADEs
93
Q

Topiramate (Topamax) mechanism of action

A

anti-epileptic multiple receptors Na+, Ca+ Glutamate receptor antagonist increased GABA potentiation CAH inhibition

94
Q

Flucanazole treats

A

candida cytococcus, blastomy…

95
Q

CMV treatment

A
  • Ganicyclovir/ Valganicyclovir
  • Acyclovir
  • CMV-IVIG
96
Q

Cephalosporin ADEs

A

rash (delayed) seizures abd discomfort neutropenia fever billiary sludging

97
Q

Pediatric Cancer Treatment Principles

A
  • kids get more than adults
  • curative if at all possible
  • prevent long-term complications
    • minimize damage to growing bodies
    • minimize exposure to cargiver
  • Dosing:
    • BSA–mosteller equation
    • weight (kg) sometimes–often <1 year
  • Routes:
    • IV, PO, SC, IM, IT, topically
98
Q

antibiotics that threat anaerobic organisms

A

ESPCNs: piparicillin, ticarcillin B-lact inhibitors: piperacillin/ticarcillin (Zosyn) ampicillin/sulbactam (Unasyn) ticarcillin/clavulanate (Timentin) amoxicillin/clavulanate (augmentin) 2nd generation Cephalosporin: cefoxitan, cefotetan, cefuroxine Clindamycin (lincosamide) Metronidazole (flagyl)

99
Q

somatic pain

A

originating from bones, joints, muscles, skin, or connective tissue

100
Q

Anticholinergic antidote

A

Physostigmine acetylchoinesterase inhibitor IV must monitor HR, RR, and ECG

101
Q

Cyclosporin (Gengraf, Neoral, Sandimmune)

A
  • not interchangeable
  • modified form–better absorption, non-bile dependent, reliable systemic exposure
  • ADEs
    • nephrotoxicity
    • hirsutism
    • gingival hyperplasia
    • hyperlipidemia
    • HTN
    • seizures/tremors
    • hyperglycemia
102
Q

Cytarabine (Ara-C)

A
  • pyrimidine analog
  • IV- ​lower dose
  • IT- ​in combination with methotrexate and hydrocortisone
  • Uses
    • ​pediatric AML–high dose (>1000mg/m2/dose)
    • new diagnosis of ALL and AML get IT at onset–given with first LP
  • Side Effects
    • ​Myelosuppression
    • Nausea, vomiting
    • Conjunctivitis
    • elevated LFT
    • maculopapular rash
    • neurotoxicity
  • ***neurochecks required for high doses
  • ***opthalmic dexamethasone–with high doses
103
Q

Benzodiazepine mechanism of action

A

anti-epileptic increases GABA potentiation-inhibits neuronal activity

104
Q

Benzodiazepines-available agents

A

diazepam (Diastat (rectal)/valium)–IV/PO/PR (diastat) lorazepam (Ativan)–IV/PO midazolam (Versed)–IV/PO clonazepam (Klonipin)–long-term 1x-2x/day *both lorazepam and midaz–intranasally *kids can have paradoxical reaction

105
Q

Pegaspargase (Oncaspar)

A
  • from E. Coli originally
  • ALL
  • MOA: depletion of asparagine (building block for proteins in cancer cells)
  • IV, IM: 2500 units/m2
  • enzyme-do not shake
  • max IM volume- 2mL
  • run IV over 2 hours
  • Serious ADEs–give Erwinaze
    • anaphylaxis–give epi and methylpred
      • occurs after 1st cycle
      • monitor for 60 min after dose
    • thrombosis
    • hepatotoxicity
    • pancreatitis
    • hyperglycemia
106
Q

Vinca alkaloids

A
  • natural plant cancer med
  • periwinkle plant
  • agents
    • Vincristine-no myelosuppression
    • Vinblastine
    • Vinorelbine
  • ONLY IV
  • Side effects
    • neurotoxicities
      • cumulative and reversible
      • constipation
      • peripheral neuropathy
    • jaw pain
    • SIADH
    • myelosuppression (not with vincristine)
  • vesicant
  • fatal if given intrathecally****
107
Q

Alpha-2 agonists as adjuvant analgesic

A
  • reduce central sympathetic output
  • increase firing of inhibitory neurons
  • Clonidine
    • sedation and analgesia without respiratory compromise
    • can use to wean off long-term precedex
108
Q

Anticonvulsant as adjuvant analgesic

A
  • reduce neuronal excitability
  • used for neuropathic pain
  • gabapentin
  • carbamazepine
109
Q

CYP inhibitors

A
  • azole antifungals
  • macrolide antibiotics
  • diltiazem, verapamil
  • fruit (grapefruit, pomegranate)
110
Q

Linezolid ADEs

A

thrombocytopenia peripheral neuropathy optic neuropathy lactic acidosis

111
Q

Carbamazepine (Tegretol) drug-drug interactions

A

CYP3A4 substrate and inducer inhibitor for CPY2C19, 2C9, 1A2 moderate inhibitor of 2B6

112
Q

Oxacarbazepime (Trileptal)

A

ADEs: hyponatremia pancytopenia hypothyroidism (altered TFTs) hypersensitivity skin reaction (Steven Johnsons) DRESS–drug reaction with eisinophilic and systemic… *bioavailability is not equal with immediate and extended release *does not auto-induce metabolism (?)

113
Q

partial opioids

A
  • effective for mild to moderate pain
    • with or without a non-opioid
  • ex: nalbuphine
  • if inadequate pain control, change to opioid
114
Q

PRSP

A

Oxacillin Nafcillin-“for staph, think naf” Dicloxacillin

115
Q

Cyclophosfamide

A
  • alkylating agent
  • prodrug–must be activated in the liver (CYP2B6 to 4-HC)
  • dosage forms:
    • IV doses for cancers
    • PO-for other indications
  • Side effects:
    • Hemorrhagic cystitis * (high doses require MESNA)
    • myelosuppression
    • N/V (acute and delayed)
    • SIADH
    • nasal stuffiness
    • pulmonary and cardiotoxicity
    • alopecia

***doses > 1800mg/m2 should be infused over 1-6 hours

hydration with higher doses is 125ml/m2/hr (D5 1/2)

monitor urine output; specific gravity <1.01

116
Q

Gabapentin (Neurontin)

A

indications: focal seizures, neuropathy dosing: start ow and titrate up to decrease side effects* ADEs somnolence weight gain neutropenia nystagmus *may exacerbate myoclonic and absence seizures

117
Q

Fentanyl

A
  • synthetic opioid narcotic analgesic
  • 50-100 x more potent than morphine
  • high lipid solubility–penetrates CNS
  • metabolized: liver
  • excreted: kidneys
  • half life: highly variable 2-21 hours
  • IV
  • Patch (outpatient) - takes up to 72 hours to work
  • Sucker/Losenge
118
Q

Lamotrigine (Lamictal)

A

indications: focal, generalized, and potential absence seizures ADEs skin rash (delayed) Stevens-Johnson Toxic epidermal necrolysis *significant drug interactions (valproate–increases serum concentration of lamotrigine) *titrate up

119
Q

Valocyclovir and Acyclovir treat

A

Herpes Simplex 1 and 2 Varicella Zoster virus

120
Q

Topical anesthetics

A
  • localized therapy
    • act on peripheral sensory nerves or pain modulators
  • reduce systemic toxicity
  • effective for acute procedural pain
  • BSA vs. weight ratio-different in kids
121
Q

Vorconazole treats

A

candida aspergillus mold requires therapeutic drug monitoring major interactions with CYP enzymes

122
Q

Gram positive

A

thick peptidoglycan wall cocci bacilli

123
Q

NSAID ADEs

A
  • edema
  • fluid retention
  • actue kidney damage
    • risk with ketorolac
    • avoid in pt with renal disfunction
  • abd. pain
  • GI bleed
124
Q

Phenytoin (Dilantin) pearls

A

dose-limiting ADEs due to 1/2 life, will take 1 week to reach steady state with dose changes drug-drug interactions–inducer of CYP3A4 CYP2C9 and CYP2C19 substrate

125
Q

4th gen cephalosporins

A

cefepime

126
Q

hemorrhagic crisis

A
  • side effect of :
    • cyclophosfamide
    • ifosfamide
  • inflammation and damage to bladder epithelium-hematuria
  • caused by metabolite-acrolein
  • Mesna-binds to the metabolite and limits exposure to the bladder
  • hydration is important
  • may require bladder irrigations
127
Q

Etoposide

A
  • natural plant cancer med
  • mandrake
  • G phase specific
  • IV and PO
  • Side Effects
    • mucositis
    • hypotension–monitor vitals, acute BP drop
    • hypersensitivity reactions
    • myelosuppression
    • mucositis
    • secondary malignancies
  • irritant
  • avoid rapid infusions
128
Q

natural PCNs

A

PCN-G (IV) PCN-VK (PO)

129
Q

Sirolimus

A
  • should not be used sooner than 30 days post-transplant
  • Black Box Warning
    • ​liver tx: hepatic artery thrombosis
    • lung tx: pulmonary fibrosis
  • agent of choice for pt with nephrotoxicity from CNIs and chronic heart rejection
  • half life 13 hours in kids
  • tablets and oral = not bioequivalent
130
Q

Antithymocyte Globulin

A
  • transplant immunosuppression therapy
  • rabbit (Thymoglobulin) or horse (Atgam)
  • depletes T-cells to depleat CD4 lymphocytes
    • within 24 hours
    • duration of action can last up to 1 year
    • half life 2-3 days
  • ADEs
    • leukopenia
    • thrombocytopenia
    • serum sickness
    • infusion-related reactions
  • typically administered for 5 days
  • also used for cellular rejection
  • use the rabbit (Thymoglobulin)
131
Q

Phenytoin (Dilantin)

A

*highly protein bound to albumin *variable absorption indications: neonatal seizures status epilepticus post-trauma/surgery seizure prevention ADEs lethargy bradycardia hirsutism gingival hyperplasia

132
Q

acute cellular rejection

A
  • days to weeks after transplant
  • T-cell mediated
133
Q

acetaminophen (Tylenol) absorption

A

oral: well-absorbed

peak serum concentration: 60 minutes after oral dose

rectal: variable and prolonged (q6 dosing)

134
Q

antibiotics that treat atypical organisms

A

macrolides: erythromycin, azithromycin, clarithromycin

135
Q

Opioid antidote

A

Naloxone (Narcan) IV/IM/nasal spray quick onset and duration caution with rapid reversal especially with someone in pain

136
Q

Alkylating agents

A
  • Common in peds:
    • Cylcophosfamide
    • Ifosamide
    • Busulfan
  • MOA-forms covalent bonds within DNA-intereferes wtih cell replication
  • cell-cycle non-specific
137
Q

What is a toxidrome?

A

a group of signs or symptoms constituting the basis for a diagnosis of poisoning

138
Q

Zonisamide (Zonegran)

A

MOA: Na+, Ca+; CAH inhibition, GABA potentiation, glutamate inhibition indications: adjunct for focal seizures ADEs cognitive impairment oligohydrosis (deficient sweat production) fatigue *not commonly used in kids

139
Q

Opioid ADEs

A

SAD slurred speech attention impairment drowsiness

140
Q

Monoclonal Antibodies

A
  • binds to B and T cells to produce lysis
  • alemtuzumab (campath)
  • basiliximab (simulect)
  • causes significant immunosuppression
    • up to 1 year
141
Q

Antineoplastic vesicants (extravasation risks)

A
  • cisplatin
  • anthracyclines
    • doxorubicin
    • daunorubicin
  • vinca alkaloids
    • vincristine
    • vinbalstine
    • vinorelbine
  • dactinomycin
142
Q

Azathiprine (Imuran)

A
  • inhibits replication
  • use
    • renal and heart transplantation
    • ulcerative colitis, IBD
  • IV/PO
  • ADEs
    • N/V/D
    • leukopenia, thrombocytopenia (BM suppression)
    • hepatotoxicity
143
Q

Benzodiazepine other uses

A

nausea and vomiting pre-procedure sedation anxiety

144
Q

sulfonamide ADEs

A

rash photosensitivity neprotoxicity obstructive uropathy neutropenia thrombocytopenia hyper K

145
Q

Calcineurin Inhibitors

A
  • Tacrolimus (Prograf)
    • IV (BMT)/PO
  • Cyclosporine (Gengraf, Neoral, Sandimmune)
    • modified
    • non-modified
  • dosing based on drug levels
  • ADEs
    *
146
Q

Methadone

A
  • long-acting* narcotic analgesic
    • moderate to severe pain unresponsive to non-narcotics
    • tx of neonatal abstinence syndrome and opioid dependence
  • binds to opioid receptors in CNS, inhibits ascending pathways, alters perception and response to pain
  • onset of action
    • oral: within 30-60 min
    • parenteral: within 10-20 min
  • Half life: 4-62 hours
  • metabolized-live; excreted-kidneys
147
Q

Daptomycin

A

CPK elevations myopathies (if with statin)

148
Q

Methotrexate side effects

A
  • myelosuppression
  • mucosistis
  • N/V
  • nephrotoxicity
  • hepatotoxicity
  • alopecia
  • photosensitivity–wear sunscreen
149
Q

Taxanes

A
  • plant-based cancer med
  • Yew trees
  • cell-phase specific
  • Side effects:
    • myelosuppression
    • mucositis
    • neurotoxicity
    • CYP 450 interactions (esp. carboplatin and cisplatin)
  • Agents
    • Paclitaxel-infusion related reactions-use premeds
    • Docetaxel-fluid retention, rash, nail changes, less infusion reactions
150
Q

rufinamide (Banzel)

A

approved for: Lennox-gaustaut syndrome >1 year of age MOA: Na+ channels ADEs dizziness headache fatigue nausea severe: Stevens-Johnson and DRESS *tables and suspension *contraind. in pts with familial shortened QT

151
Q

Gabapentin (Neurontin) mechanism of action

A

anti-epileptic Ca+ channel blocker GABA potentiator–inhibits neuronal activity

152
Q

Phenytoin mechanism of action

A

anti-epileptic Na+ channel blocker decreases frequency and voltage of nerve cells

153
Q

antibiotics that treat E. Coli

A

1st gen ceph: cefazolin, cephalexin, cefadroxil flouroquinolonee: ciprofloxacin, levoflozacin, moxifloxacin

154
Q

Methotrexate

A
  • IV, PO, SC, IT (leukemia)
  • IV
    • capizzi dosing–escalate based on patient tolerance
  • PO
    • maintenance phase for ALL
  • IT
    • all patients with ALL get IT
    • dosing is fixed based on age**
155
Q

Hydromorphone

A
  • more potent than morphine
  • used in opioid-tolerant patients
  • binds to opiate receptors in CNS
156
Q

Anticholinergic toxidromes

A

increased BP, HR, T delirium increased pupils decreased peristalsis and diaphoresis

157
Q

Azole ADEs

A

LFT elevation abd. discomfort QT prolongation VORI–hallucinations

158
Q

neuropathic pain

A

originating from peripheral or central nervous system

159
Q

Anion gap acidosis

A

MUDPILES methanol, uremia, diabetic ketoacidosis, propylene glycol, isoniazid, lactic acidosis, ethylene glycol, salicylates (??? what is all of this)

160
Q

Corticosteroids in cancer treatment

A
  • MOA: promotes decrease in lymphocytic cell line
  • prednisone, dexamethasone, methylprednisolone
  • Side Effects:
    • hyperglycemia
    • fluid retention/ facial swelling
    • increased appetite
    • hypertension
    • mood changes (cranky)
    • risk of GI ulcers
    • resolve once tx stops
  • should be on acid suppression–PPI or H2 blocker
  • *dexamethasone penetrates spinal fluid better than prednisone
161
Q

Ethanol Withdrawal Symptoms

A

PAST NITE psychomotor agitation, anxiety, seizures, transient hallucinations nausea/vomiting, insomnia, tremor, excitability

162
Q

3rd gen cephalosporins

A

cefoxatime/cefpodoxime ceftriaxone/cefixime ceftazidime/cefinir

163
Q

Metronidazole (Flagyl) ADEs

A

peripheral neuropathy taste flushing abd discomfort seizures

164
Q

Tetracycline ADEs

A

photosensitivity abdominal dis. stains teeth

165
Q

Phenobarbital mechanism of action

A

anti-epileptic Glutamate receptor antagonist increased GABA potentiation–inhibits neuronal activity

166
Q

sedatives/hypnotics/anxiolytics as adjuvant analgesics

A
  • block reputake of neurotransmitters
  • rapid onset of analgesic effect
  • reduce anxiety, muscle relaxant, pre-medication for painful procedures
  • diazepam
  • lorazepam
  • midazolam
167
Q

Temozolamide (Temodar)

A
  • new alkylating agent
  • PO
  • for gliobastoma and refractory astrocytoma therapies
  • in peds for
    • meduloblastoma
    • PNS tumors
168
Q

Gram negative

A

think peptidoglycan cell wall addition of a thick outer lipid membrane coccobacilli cocci bacilli

169
Q

antibiotics that treat pseudomonas

A

ESPCN: piperacillin, ticarcillin 3rd gen Ceph: ceftazidime 4th gen Ceph: cefipime aminoglycosides: tobramycin fluoroquinolone: ciprofloxacin *

170
Q

2nd gen. cephalosporins

A

cefoxitan cefotetan cefuroxine

171
Q

Camptothecins

A
  • MOA: prevents completion of DNA spiraling
  • Topotecan: IV, PO
172
Q

1st gen. cephalosporins

A

cefazolin cephalexin cefadroxil

173
Q

Fosphenytoin (Cerebyx)

A

short-term parenteral admin. for: neonatal seizures status epilepticus post trauma/surgery prevention of seizures *always dose in milligrams of phenytoin equivalents (PE) *optimal IV choice in peds because of extravasation of phenytoin

174
Q

Tacrolimus (Prograf, FK506)

A
  • absorption-small intestine; will stick to enteral feeding tubes
    • in kids, GI motility time effects absorption
  • Sublingual–almost complete, capsules can be placed under tongue
  • highly protein bound
  • dist slightly > in children
  • metabolized by CYP3A enzymes
  • excreted by billiary tract
  • hepatic blood flow plays a role in elimination
  • dosing q12
  • therapeutic monitoring-trough levels
175
Q

PCP pneumonia Tx

A
  • 1st line: Bactrim 5 mg/kg/day divided q12 3x/week
  • 2nd line: inhaled pentamidine 300 mg q28 days
176
Q

Morphine

A
  • widely studied in infants and children
  • narcotic analgesic-stimulates brain opioid receptors
  • increases venous capacitance–release of histamine and supression of adrenergic tone
  • decreased GI motility
177
Q

PCP treatment

A
  • Bactrim***- 1st line agent; dose based on trimethoprim, 3x weekly
  • Dapsone-agent of choice for sulfa allergy; must test G6PD before
  • Petamidine
    • IV- every 14-21 days
    • Inhaled- every 21-30 days
    • ADEs
      • cough, fatigue, fever, appetite suppression
178
Q

vigabatrin (Sabril)

A

approved: complex partial seizures >10 years old, infantile spasms Major ADE: VISION LOSS*** MOA: increases GABA dosage: 500 mg tablet or powder dissolve in 10mL water (final concentration 50mg/mL) draw up dose and discard the remainder

Antibiotic and Antivirals (1 decks)

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