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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
macrolides
erythromycin (QT prolongation) azithromycin clarithromycin (not if pregnant)
26
Rituxumab (Rituxan)
* 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
27
Evirolimus (Afinitor)
* 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
28
Opioid withdrawal
ARMY FINDS aches, rhinorrhea, mood disorders, yawning fever, insomnia, N/V, diarrhea, diaphorsis
29
6-Mercaptopurine (6MP) and 6-thioguanine (6TG)
* purine analog * PO * 1x daily x3 days--ALL maintenance therpy * non-oncologic indications * Side effects * myelosuppression * hepatic-cholestasis, hepatic necrosis * mucositis (rare) * monitor LFTs
30
Levitracetam (Keppra)
MOA: Ca+ channel blocker, GABA and glutamate reducer indications: adjunct therapy, neonatal seizures, status epilepticus \*increasingly becoming 1st line monotherapy ADEs somnolence asthenia nervousness
31
NSAID use
* 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
32
Valproic Acid, Divalproex Sodium (Depakote, Depakene) ADEs
* pancreatitis * alopecia * rash (including Stevens-Johnson) * GI--abd. pain, N/V/D * thrombocytopenia * hepatotoxicity (especially neonates)
33
Medications that require REMS
* Anticonvulsants * ACE inhibitors * warfarin * diethylstilbestrol (DES) * Vitamin A derrivatives * Chemotherapy
34
antibiotics that treat MSSA
* PRSP-naficillin * nafcillin, oxacillin, cefazolin or ceftriaxone * Fluoroquinolones: ciprofloxacin, levofloxacin, moxifloxacin * Tetracyclines: minocycline, doxycycline, tetracycline * Sulfonamide: bactrim * Clindamycin (lincosamide)
35
acetaminophen (Tylenol)
* 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
36
aminoglycosides
gentamycin tobromycin amikacin
37
acetaminophen (Tylenol) metabolism
liver small amounts metabolized by CYP enzymes
38
Insotretinoin (Accutane)
* 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**
39
Lidocaine Topical Patch 5% (Lidoderm)
* 12 hours on/ 12 hours off * patches can be cut * caution with toxicity in little kids * local pain only
40
Carbamazepine (Tegretol)
* indications: * tonic clonic * focal seizures * ADEs: * ataxia * diplopia * hyponatremia * Steven-Johnson's syndrome
41
Levitracetam (Keppra) mechanism of action
* anti-epileptic * Ca+ channels
42
Flouroquinolones
ciprofloxacin levofloxacin moxifloxacin ofloxacir
43
Carboplatin
* 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
44
Allopurinol
* for tx and prevention of tumor lysis syndrome * best when used prophylactically * high tumor burden * cytotoxic therapy * ADEs * rash * increased LFTs * increased alkaline phosphatase
45
Mesna
* 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
46
High dose Methotrexate
* 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
47
Benzodiazepine antidote
Flumazenil competitve bezo/GABA receptor antagonist give in controlled setting--seizures may be precipitated
48
REMS types
Medication guide Communication plan Elements to Assure Safe Use Implementation
49
Vancomycin ADEs
ototoxicity nephrotoxicity Red man neutropenia
50
Sulfonamides
sulfamethoxazole/trimethoprim (Bactrim)
51
Valproic Acid, Divalproex Sodium (Depakote, Depakene) therapeutic monitoring
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
52
aminoglycoside ADEs
nephrotoxicity ototoxicity
53
Bleomycin
* 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
54
Granulocyte Colony Stimulating Factors (GCSF)
* 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
55
visceral pain
originating from internal organs
56
Penicillin ADEs
rash, seizure, fever, abd. discomfort, neutropenia, fever, acute renal failure, high LFT
57
acetylsalicylic acid (ASA, Aspirin)
* 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)\*
58
Valproic Acid, Divalproex Sodium (Depakote, Depakene) pharmacokinetics
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
59
Acetaminophen antidote
N-acetylcysteine (NAC, Mucomyst) IV most beneficial if used within 8 hours
60
antibody-mediated rejection
* days to weeks after transplant * B-cell
61
Valacyclovir and Acylovir ADEs
headaches GI effects increased SCr neutropenia anemia thrombocytopenia
62
Amino PCNs
Ampicillin (IV/PO) Amoxicillin (PO)--go-to oral agent
63
Methotrexate drug and food interactions
* avoid: * Bactrim * penicillins * tetracyclines * ASA * folic acid * NSAIDs * avoid acidic foods * pt. with Downs more susceptible to toxicity
64
Tetracyclines
minocycline doxycycline tetracycline
65
Ifosamide
* 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
66
Oxacarbazepime (Trileptal) mechanism of action
anti-epileptic Na+ and Ca+ channel blocker
67
Ethosuximide (Zarontin)
indication: ABSENCE SEIZURES \*only indication ADEs: pancytopenia (blood dyscrasias) \*many drug interactions (CYP3A4) \*can measure serum concentrations
68
Temsirolimus (Torisel)
* mTOR inhibitor * IV * interactions: CYP 3A4 inhibitors (decrease dose 50%) * side effects: * rash * asthenia * mucositis * N/V * edema, interstitial lung disease * hyperglycemia, **hyperlipidemia** * i**mpaired wound healing, opportunistic infections**
69
Erwinaze
* 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
70
Benzodiazepines
indications: absence seizures myclonic seizures delirium tremens status epilepticus \*drug of choice if pt. is actively seizing ADEs respiratory depression hypotension bradycardia delirium
71
antibiotics that treat stenotrophomonas
sulfonamides: bactrim tetracyclines: minocycline, doxycycline, tetracycline
72
Anthracyclines
* 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
Clindamycin (lincosamide) ADEs
pseudomembranous colitis taste
74
CYP inducers
* rifampin * pheytoin * carbamazepine * pheonobarbital
75
Valproic acid, Depakote mechanism of action
anti-epileptic GABA potentiation--inhibits neuronal activity
76
Ethanol ADEs
SAMS GIN slurred speech attention impairment memory impairment stupor or coma gait unsteady incoordination nystagmus
77
Carbamazepine (Tegretol) mechanism of action
anti-epileptic Na+ channel blocker decreases frequency and voltage of nerve cells
78
Flouroquinolone ADEs
photosensitivity seizures abd. discomfort QT prolongation CNS stim. BBW--tendon rupture, peripheral neurop, CNS
79
Fludarabine
* 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
Topiramate (Topamax)
* 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
NSAIDs
* 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
Lamotrigine (Lamictal) mechanism of action
anti-epileptic Na+ and Ca+ channel blockers
83
PCA
* post-op pain * most effective in children \> 6 years * alone or in conjunction with low-dose continuous infusion
84
Cholinergic ADEs
SLUDGE and DUMBBELLS salivation lacrimation urination diarrhea gi distress emesis diarrhea, urination, miosis, bradycardia, bronchospasms, emesis, lacrimation, lethargy, salivation and seizures
85
Ethylene Glycol and Methanol antidote
Fomepizole allows for elimination of alcohol
86
codeine
* prodrug that turns to morphine * often in combination with acetaminophen * FDA warning \< 18 years * avoid use in children
87
Anticholinergic ADEs
blind as a bat mad as a hatter red as a beet hot as a hare dry as a bone
88
Leucovorin
* 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
antibiotics that treat MRSA
vancomycin \* sulfonamide: bactrim tetracyclines: minocycline, doxycycline, tetracycline clindamucin daptomycin
90
ESPCN
piperacillin ticarcillin \*IV only
91
Valganciclovir treats
CMV
92
Interleukin-2 (IL-2, Aldesleukin)
* 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
Topiramate (Topamax) mechanism of action
anti-epileptic multiple receptors Na+, Ca+ Glutamate receptor antagonist increased GABA potentiation CAH inhibition
94
Flucanazole treats
candida cytococcus, blastomy...
95
CMV treatment
* Ganicyclovir/ Valganicyclovir * Acyclovir * CMV-IVIG
96
Cephalosporin ADEs
rash (delayed) seizures abd discomfort neutropenia fever billiary sludging
97
Pediatric Cancer Treatment Principles
* 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
antibiotics that threat anaerobic organisms
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
somatic pain
originating from bones, joints, muscles, skin, or connective tissue
100
Anticholinergic antidote
Physostigmine acetylchoinesterase inhibitor IV must monitor HR, RR, and ECG
101
Cyclosporin (Gengraf, Neoral, Sandimmune)
* **not interchangeable** * modified form--better absorption, non-bile dependent, reliable systemic exposure * ADEs * **nephrotoxicity** * **hirsutism** * **gingival hyperplasia** * **hyperlipidemia** * HTN * seizures/tremors * hyperglycemia
102
Cytarabine (Ara-C)
* 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
Benzodiazepine mechanism of action
anti-epileptic increases GABA potentiation-inhibits neuronal activity
104
Benzodiazepines-available agents
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
Pegaspargase (Oncaspar)
* 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
Vinca alkaloids
* 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
Alpha-2 agonists as adjuvant analgesic
* 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
Anticonvulsant as adjuvant analgesic
* reduce neuronal excitability * used for neuropathic pain * gabapentin * carbamazepine
109
CYP inhibitors
* azole antifungals * macrolide antibiotics * diltiazem, verapamil * fruit (grapefruit, pomegranate)
110
Linezolid ADEs
thrombocytopenia peripheral neuropathy optic neuropathy lactic acidosis
111
Carbamazepine (Tegretol) drug-drug interactions
CYP3A4 substrate and inducer inhibitor for CPY2C19, 2C9, 1A2 moderate inhibitor of 2B6
112
Oxacarbazepime (Trileptal)
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
partial opioids
* effective for mild to moderate pain * with or without a non-opioid * ex: nalbuphine * if inadequate pain control, change to opioid
114
PRSP
Oxacillin Nafcillin-"for staph, think naf" Dicloxacillin
115
Cyclophosfamide
* 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 ## Footnote \*\*\*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
Gabapentin (Neurontin)
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
Fentanyl
* 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
Lamotrigine (Lamictal)
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
Valocyclovir and Acyclovir treat
Herpes Simplex 1 and 2 Varicella Zoster virus
120
Topical anesthetics
* 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
Vorconazole treats
candida aspergillus mold requires therapeutic drug monitoring major interactions with CYP enzymes
122
Gram positive
thick peptidoglycan wall cocci bacilli
123
NSAID ADEs
* edema * fluid retention * actue kidney damage * risk with ketorolac * avoid in pt with renal disfunction * abd. pain * GI bleed
124
Phenytoin (Dilantin) pearls
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
4th gen cephalosporins
cefepime
126
hemorrhagic crisis
* 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
Etoposide
* 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
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natural PCNs
PCN-G (IV) PCN-VK (PO)
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Sirolimus
* **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
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Antithymocyte Globulin
* 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)
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Phenytoin (Dilantin)
\*highly protein bound to albumin \*variable absorption indications: neonatal seizures status epilepticus post-trauma/surgery seizure prevention ADEs lethargy bradycardia hirsutism gingival hyperplasia
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acute cellular rejection
* days to weeks after transplant * T-cell mediated
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acetaminophen (Tylenol) absorption
oral: well-absorbed peak serum concentration: 60 minutes after oral dose rectal: variable and prolonged (q6 dosing)
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antibiotics that treat atypical organisms
macrolides: erythromycin, azithromycin, clarithromycin
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Opioid antidote
Naloxone (Narcan) IV/IM/nasal spray quick onset and duration caution with rapid reversal especially with someone in pain
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Alkylating agents
* Common in peds: * Cylcophosfamide * Ifosamide * Busulfan * MOA-forms covalent bonds within DNA-intereferes wtih cell replication * cell-cycle non-specific
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What is a toxidrome?
a group of signs or symptoms constituting the basis for a diagnosis of poisoning
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Zonisamide (Zonegran)
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
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Opioid ADEs
SAD slurred speech attention impairment drowsiness
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Monoclonal Antibodies
* binds to B and T cells to produce lysis * alemtuzumab (campath) * basiliximab (simulect) * causes significant immunosuppression * up to 1 year
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Antineoplastic vesicants (extravasation risks)
* cisplatin * anthracyclines * doxorubicin * daunorubicin * vinca alkaloids * vincristine * vinbalstine * vinorelbine * dactinomycin
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Azathiprine (Imuran)
* inhibits replication * use * renal and heart transplantation * ulcerative colitis, IBD * IV/PO * ADEs * N/V/D * leukopenia, thrombocytopenia (BM suppression) * hepatotoxicity
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Benzodiazepine other uses
nausea and vomiting pre-procedure sedation anxiety
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sulfonamide ADEs
rash photosensitivity neprotoxicity obstructive uropathy neutropenia thrombocytopenia hyper K
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Calcineurin Inhibitors
* Tacrolimus (Prograf) * IV (BMT)/PO * Cyclosporine (Gengraf, Neoral, Sandimmune) * modified * non-modified * dosing based on drug levels * ADEs *
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Methadone
* 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
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Daptomycin
CPK elevations myopathies (if with statin)
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Methotrexate side effects
* myelosuppression * mucosistis * N/V * nephrotoxicity * hepatotoxicity * alopecia * photosensitivity--wear sunscreen
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Taxanes
* 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
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rufinamide (Banzel)
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
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Gabapentin (Neurontin) mechanism of action
anti-epileptic Ca+ channel blocker GABA potentiator--inhibits neuronal activity
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Phenytoin mechanism of action
anti-epileptic Na+ channel blocker decreases frequency and voltage of nerve cells
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antibiotics that treat E. Coli
1st gen ceph: cefazolin, cephalexin, cefadroxil flouroquinolonee: ciprofloxacin, levoflozacin, moxifloxacin
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Methotrexate
* 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\*\*
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Hydromorphone
* more potent than morphine * used in opioid-tolerant patients * binds to opiate receptors in CNS
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Anticholinergic toxidromes
increased BP, HR, T delirium increased pupils decreased peristalsis and diaphoresis
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Azole ADEs
LFT elevation abd. discomfort QT prolongation VORI--hallucinations
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neuropathic pain
originating from peripheral or central nervous system
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Anion gap acidosis
MUDPILES methanol, uremia, diabetic ketoacidosis, propylene glycol, isoniazid, lactic acidosis, ethylene glycol, salicylates (??? what is all of this)
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Corticosteroids in cancer treatment
* 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
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Ethanol Withdrawal Symptoms
PAST NITE psychomotor agitation, anxiety, seizures, transient hallucinations nausea/vomiting, insomnia, tremor, excitability
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3rd gen cephalosporins
cefoxatime/cefpodoxime ceftriaxone/cefixime ceftazidime/cefinir
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Metronidazole (Flagyl) ADEs
peripheral neuropathy taste flushing abd discomfort seizures
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Tetracycline ADEs
photosensitivity abdominal dis. stains teeth
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Phenobarbital mechanism of action
anti-epileptic Glutamate receptor antagonist increased GABA potentiation--inhibits neuronal activity
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sedatives/hypnotics/anxiolytics as adjuvant analgesics
* block reputake of neurotransmitters * rapid onset of analgesic effect * reduce anxiety, muscle relaxant, pre-medication for painful procedures * diazepam * lorazepam * midazolam
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Temozolamide (Temodar)
* new alkylating agent * PO * for gliobastoma and refractory astrocytoma therapies * in peds for * meduloblastoma * PNS tumors
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Gram negative
think peptidoglycan cell wall addition of a thick outer lipid membrane coccobacilli cocci bacilli
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antibiotics that treat pseudomonas
ESPCN: piperacillin, ticarcillin 3rd gen Ceph: ceftazidime 4th gen Ceph: cefipime aminoglycosides: tobramycin fluoroquinolone: ciprofloxacin \*
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2nd gen. cephalosporins
cefoxitan cefotetan cefuroxine
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Camptothecins
* MOA: prevents completion of DNA spiraling * **Topotecan:** IV, PO
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1st gen. cephalosporins
cefazolin cephalexin cefadroxil
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Fosphenytoin (Cerebyx)
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
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Tacrolimus (Prograf, FK506)
* 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
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PCP pneumonia Tx
* 1st line: Bactrim 5 mg/kg/day divided q12 3x/week * 2nd line: inhaled pentamidine 300 mg q28 days
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Morphine
* 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
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PCP treatment
* **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
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vigabatrin (Sabril)
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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