Misc Pharm Flashcards
What are the two classes of antineoplastic agents?
cell cycle-specific (CCS) AND cell cycle-nonspecific (CCNS)
Why are antineoplastics given over short intervals?
so good cells don’t die, less immunosuppression, work on actively dividing DNA
When are CCS antineoplastics used?
hematologic malignancies or tumors that have a large portion of cells in proliferation
What are some examples of CCS antineoplastics?
methotrexate, bleomycin, vincristine
When are CCNS antineoplastics used?
more effective in tumors that are slower to proliferate
What are some examples of CCNS antineoplastics?
cyclophosphamide, doxorubicin, cisplatin
What chemo drugs are alkylating agents?
cyclophosphamide, cisplatin
What chemo drugs are antimetabolites?
methotrexate
What chemo drugs are natural products?
vincristine
What chemo drugs are antitumor antibiotics?
bleomycin, doxorubicin
What is an uncommon but fatal side effect of bleomycin?
pulmonary fibrosis, particularly in older patients.
What is a consideration if a patient has had bleo in the last year?
use as low as possible FiO2 to prevent damage
What is an adverse effect of doxorubicin?
bone marrow suppression and CARDIAC TOXICITY d/t excessive intracellular production of free radicals within the myocardium
What are the 3 main types of hormones/steroids created in the adrenal cortex?
Mineralocorticoids (aldosterone), Glucocorticoids (cortisol), and androgenic hormones (sex hormones)
What’s the MOA of steroids?
bind to corticosteroid binding globulin in the plasma, unbind and reach a cell, cross through cellular membrane and bind to intracellular receptor
What do steroids do?
alter gene transcription and create tissue specific responses
What effects do steroids have on the tissues?
stimulate gluconeogenesis, muscle protein breakdown, stimulate insulin secretion, increase lipolysis, lipogenesis, osteoporosis, immunosuppression, anti-inflammatory, behavioral changes
What is acute adrenal crisis?
sudden onset/exacerbation of severe adrenal insufficiency, can happen in preop phase d/t stress of surgery in a patient with inadequate adrenal reserves. considered medical EMERGENCY b/c leads to CV collapse if not treated
What are the S/S of acute adrenal crisis?
weakness, nausea, hypotension (refractory/transient), fever, CNS changes
What is the treatment of Acute adrenal crisis?
steroids, electrolyte correction, fluids, inotropic support
Who needs perioperative steroid replacement?
patients at risk for adrenal insufficiency, prednisone 5mg/day, >2-3 weeks, during last 12 months
How do you perioperatively replace steroids?
mixed glucocorticoid/mineralocorticoid (hydrocortisone) so you can hit both systems. 0.8glucocorticoid/1.0mineralocorticoid.
Dose 25-150mg depending on type of surgery
True/false. You cannot give ancef if someone is allergic to PCN.
False, there is a cross sensitivity but important to know what the allergy actually is to PCN. If its rash/fever, ancef probably ok.
What is the weight based dosing of Ancef?
<80kg 1gm, 80-120kg 2gm, >120kg 3gm
What is the severe side effect of beta-lactams?
severe allergic reaction, seizures
What is the MOA of beta-lactams?
target cell wall, bactericidal (kill), partially bacterialstatic (inhibit), effective against gram + and -
What are examples of beta lactams?
PCN, cephalosporins, carbapenem, monobactam
What is ancef used for?
mostly gram - but does have some gram + effects, used in surgery to kill skin flora
How is ancef eliminated?
renal excretion, adjust dose for renal function
When should ancef be given?
within 60 min of surgical incision and redosed q3h
What are examples of beta-lactamase inhibitors?
vancomycin, bacitracin
What is the MOA of beta-lactamase inhibitors?
bind irreversibly to B-lactamase
What are some s/e of vanco?
red man’s syndrome, hypotension–infuse slowly
Describe vanco.
Bactericidal, widely distributed, body weight used for dosing, renal dependent–adjust dose
What are aminoglycosides for?
treat gram -, bactericidal
What are some examples of aminoglycosides?
streptomycin, gentamycin
What are the s/e of aminoglycosides?
ototoxicity, nephrotoxicity, prolong action of NMBD
What abx do you give for cardiac/thoracic/gi/gyn/neuro?
ancef
What abx do you give for GI obstruction?
flagyl + ancef
What abx do you give for cystoscopy?
ciprofloxacin PO before the come back to OR, add more in OR
What are considerations in an asthmatic patient?
what inhalers do they take, how often, when was the last time they took it, have they had any ED visits in last 6 months, lung sounds, have albuterol out and ready with filter for vent tubing. (remove CO2 line before use.
What is the goal of nitric oxide and how does it work?
goal improved perfusion to lung by direct pulmonary arterioles vasodilator, decreases intrapulmonary shunt.
What is the FDA approved use of Nitric?
infants with respiratory distress syndrome
What should you monitor if you use nitric over 24hours?
methemoglobin levels
What are the inhaled adrenergic agonists?
albuterol (short acting) and saleterol/formoterol. (long acting)
When do they recommend a long acting inhaler?
when short acting is used more than 2x/week. always used in combination therapy
What are the side effects of albuterol & saleterol/formoterol?
tremors, tachycardia…albuterol for hyperkalemia
What is an inhaled cholinergic antagonist and how does it work?
ipatropium (short acting), acts on muscarinic receptors in airway to reduce tone.
What is ipatropium used for?
maintenance therapy for COPD and rescue therapy for asthma and COPD
What are the side effects of ipatropium?
poor systemic absorption so few SE: dry mouth, urinary retention, pupillary dilation, blurred vision
Which anesthetics have a beneficial effect on bronchomotor tone?
Volatiles: sevo/iso. IV: propofol, midazolam, ketamine
What is HPV?
Hypoxic Pulmonary Vasoconstriction: an intrinsic response within the lungs that occurs with hypoxia, vasculature in a hypoxic area will constrict to direct more BF to hypoxic area.
What medications inhibit HPV?
all volatiles in dose dependent fashion, systemic vasodilators: nitroglycerine/nipride
