Miscellaneous Meds Flashcards
2 classes of antineoplastic agents and how they are used:
1) cell cycle-specific (useful in hematological malignancies or tumors with large # of cells in proliferation)
2) cell cycle-nonspecific (slowly proliferating tumors)
Cell cycle-specific antineoplastics:
Methotrexate
Bleomycin
Vincristine
Cell cycle-nonspecific antineoplastics:
Cyclophosphamide
Doxorubicin
Cisplatin
2 alkylating chemotherapeutics:
Cyclophosphamide
Cisplatin
Antimetabolite chemotherapeutic:
Methotrexate
Natural product chemotherapeutic:
Vincristine
Antitumor antibiotics:
Bleomycin
Doxorubicin
Metabolite of Cyclophosphamide:
Acrolein
Uses of Cyclophosphamide:
breast CA
ovarian CA
non-Hodgkin’s
neuroblastoma
s/s of toxicity of Cyclophosphamide:
- cardiac dysfxn
- pulmonary toxicity
- SIADH
How to reduce build-up of acrolein:
good hydration
Uses of cisplatin:
- testicular CA
- bladder CA
- lung CA
- ovarian CA
s/s of toxicity of cisplatin:
- acoustic nerve damage
- nephrotoxicity
MOA of methotrexate:
inhibits dihydrofolate reductase –> interferes with nucleic acid and protein metabolism
Uses of Methotrexate:
- choriocarcinoma
- bladder CA
- non-hodgkin’s
- leukemia
- RA
- psoriasis
s/s of methotrexate toxicity:
- hepatotoxicity
- pulmonary fibrosis
- lymphoma
Cyclophosphamide is metabolized through which method?
CYP450
Uses of vincristine:
- neuroblastoma
- Wilms tumor
- non-small cell lung CA
s/s of toxicity of vincristine:
peripheral neuropathy
Bleomycin is part of a series of antineoplastic abx produced from which organism?
Streptomyces verticillus
Which 3 drugs have synergistic actions in treating testicular CA?
- Bleomycin
- Vincristine
- Cisplatin
Uses for bleomycin:
- testicular CA
- squamous cell CA of head, neck, cervix, penis, rectum
- ovary and breast intracavitary therapy
What fatal adverse effect can be seen with bleomycin?
- pulmonary fibrosis
- older patients
- worse when exposed to high O2 levels
- (use <30% O2 to maintain sats >90%)
Uses for doxorubicin:
- many cancers
- sarcomas
- hematologic CA
Adverse effects of doxorubicin:
- bone marrow suppression
- cardiac toxicity
How does cardiac toxicity occur with doxorubicin?
excessive intracellular production of free radicals within the myocardium
The adrenal cortex synthesizes 3 main types of hormones:
1) mineralcorticoid (aldosterone)
2) glucocorticoid (cortisol)
3) adrenergic hormone
How do steroids move and work in the body?
- bind to corticosteroid-binding globulin in plasma
- unbinds when it reaches a cell
- crosses through the cell membrane and binds to an intracellular receptor
- alter gene transcription
- create tissue-specific responses
List the effects that steroids have on the body:
- stimulate gluconeogenesis
- muscle protein breakdown
- stimulate insulin secretion
- increase lipolysis & lipogenesis
- osteoporosis
- immunosuppression
- anti-inflammatory
- behavior changes
Natural glucocorticoids:
Synthetic glucocorticoids:
natural: cortisol
synthetic: prednisone, dexamethasone
Daily cortisol production:
15-30mg
What substance regulates (and is regulated by) cortisol?
adrenocorticotropin (ACTH)
Which hormone functions to control the body’s response to stress?
cortisol
Natural mineralcorticoid:
Synthetic mineralcorticoid:
natural: aldosterone
synthetic: fludocortisone
Aldosterone maintains BP through which 2 mechanisms?
1) retention of Na+ and H2O by the kidney
2) excretion of K+ and H+ ions by the kidney
Definition, s/s, and tx of acute adrenal crisis:
- definition: sudden onset or exacerbation of several adrenal insufficiency
- s/s: weakness, nausea, hypotension, fever, CNS changes
tx: steroids, electrolyte correction, fluids, inotropic support
What is the standard method of perioperative steroid replacement?
mixed glucocorticoid/mineralcorticoid (cortisone/hydrocortisone)
- 0.8 glucocorticoid / 1.0 mineralcorticoid activity
- 25-150mg based on stress/type of surgery
Give the dosages for weight-based dosing of Ancef:
<80kg = 1g
80-120kg = 2g
>120kg = 3g
Define an allergic response to an abx:
delayed reaction characterized by maculopapular rash or fever
Describe an immediate hypersensitivity to an abx:
IgE mediated and medical emergency including laryngeal edema, bronchospasm, and CV collapse
MOA of beta-lactams:
target the cell wall to kill or inhibit bacteria
What types of bacteria are beta-lactams effective against?
List some examples:
- effective against gram + and gram -
- Examples = PCN, cephalosporin, carbapenem, monobactam
SE of beta-lactams:
- severe allergic reactions
- seizures
Important things about Ancef:
- mostly g- but also some g+
- kills skin flora
- dose adjusted for renal fxn
- 10% cross reactivity with PCN
- give within 60min of incision and re-dose Q3h during sx
MOA of beta-lactamase inhibitors:
2 examples?
bind irreversibly to beta-lactamase
1) Vancomycin
2) Bacitracin
How is Vanco dosed? What are some side effects?
body weight dosing (adjusted for renal fxn)
SE = Red Man’s Syndrome, hypotension (infuse slowly)
What type of bacteria do aminoglycosides target?
gram -
Examples of aminoglycosides
1) Streptomycin
2) Gentamicin
SE of aminoglycosides:
- ototoxicity
- nephrotoxicity
- prolong NMBAs!
What types of procedures is Ancef given for?
- cardiac
- thoracic
- GI
- gyn
- neuro
What drug do you add to ancef for a GI obstruction?
metronidazole
Cipro is given for which procedure type?
Cystoscopy
3 questions for asthmatic patients:
1) What inhalers do they take and how often?
2) Last time they used their inhaler?
3) Been to ED for asthma in last 6 months?
2 things to remember before administering an albuterol inhaler via the vent:
1) needs a filter to be used with vent tubing
2) remove CO2 line before administrating
MOA of nitric oxide:
- direct vasodilator of pulmonary arteries
- decreases intrapulmonary shunt
*monitor methemoglobin levels if used >24 hours
MOA/uses/SE of albuterol:
- MOA: short-acting B2 agonist
- uses: rapid relief of wheezing, bronchospasm, airflow obstruction
- SE= tremors, tachycardia
Albuterol can be used to correct which electrolyte imbalance? How?
- hyperkalemia
- agonist effect on B2 receptors and stimulation of Na+/K+ pump
MOA of Saleterol/Formoterol:
- long-acting B2 agonist
- recommended when short-acting used >2x/wk
MOA/uses/SE of ipatropium:
- MOA: short-acting inhaled cholinergic antagonist; acts on muscarinic receptors in airway to reduce tone
- uses: maintenance for COPD, rescue for COPD & asthma
- SE: dry mouth, urinary retention, pupillary dilation, blurred vision
List the anesthetics that have a favorable effect on bronchomotor tone:
- Sevo
- Iso
- Propofol
- Midazolam
- Ketamine
Define hypoxic pulmonary vasoconstriction
intrinsic response within the lungs that occurs with hypoxia; vasculature in a hypoxic area will constrict to direct more blood flow to the well-ventilated areas
- all volatiles cause this in a dose-dependent fashion
- also caused by systemic vasodilators nitroglycerine, nitroprusside
