mnemonics + GOOD TO KNOW Flashcards
Beta-selective BBs
AMEBBBA
atenolol
metoprolol
esmolol
bisoprolol
betaxolol
bystolic (nebivolol)
acebutolol
BB in IV Form
MAPLES
metoprolol
atenolol [D/C’ed in US]
propanolol
labetalol
esmolol
sotalol
Beta Blocker SEs
BLOCKERS
brady/broncho
lipid increase/decrease libido
orthostatic HTN (dizziness)
conduction abnormalities (AV block)
K(c)onstriction of peripheral vasculature (Raynaud’s)/potassium increase
exhaustion/emotional depression
reduced recognition of hypoglycemia (decreased ability to recognize tachycardia)
AV blockers
cause bradycardia/can treat afib (also capable of causing atrial fib) [CAN HELP W/ VENTRICULAR RATE]
amiodarone (dronedarone - multaq)
BB
CCBs/corlanor - ivabradine
digoxin
[for afib = first line = BB and non-DHP CCB]
displaces digoxin (increase digoxin concentration)
VAQC
verapamil
amiodarone
quinidine (SE: think ear ringing)
clarithromycin
ACEi adverse effects
CAPTOPRIL
cough (d/t increase in bradykinin)
angioedema
potassium
taste change (metallic, sweet, salty taste; occurs since ACEi chelates Zn)
orthostasis (hypotension)
pregnancy –> NO (1st trim = cat C // 2nd/3rd trim = cat D)
rash (contra w/ renal artery stenosis)
increase in potassium
leukocytosis (captopril)
BB in HF
the cardinal met the bishop
carvedilol (with food)
metoprolol succinate
bisoprolol
increase lipids
PASS on the BLT
protease inhibitors
antipsychotics
SGLT2i // STEROIDS
BB
loops
thiazides
cyp3a4 inhibitors
GPAC [ increases substrate concentrations]
grapefruit juice
protease inhibitors
azoles, amiodarone, androgen (specific) –> Danazol
CCB (verapamil, diltiazem, amlodipine), clarithromycin (also erythromycin)
cyp3a4 inducers
SR CuP
S = St. John’s Wort (OTC), Sustiva (efavirenz)
R = Rifampin (remember, turns you red)
C = Carbamazepine (also oxcarbazepine)
P = Phenytoin, Phenobarbital
*also garlic
*also goldenseal (induces 3A4 and 2D6)
warfarin colors
party like girls then bring peaches to your wedding
pink
lavender
green
tan
blue
peach
teal or blue green
YELLOW (7.5 mg)
WHITE (10 mg)
OTCs that increase bleed risk
NOT a mnemonic
NSAIDs
garlic
ginger
gingko biloba
vitamin E
fish oils –> can prolong bleeding time
additionally (rx) –> alcohol, SSRIs
anticholinergic SEs
hot as a hare (increase body temperature)
blind as a bat (mydriasis - dilated pupils)
dry as a bone (“anhidrosis”; dry mouth, dry eyes, decreased sweat)
red as a beat (flushed face)
mad as a hatter (delirium, altered mental status)
full as a flask (urinary retention)
also:
tachycardia
worsening of glaucoma
constipation
short term memory loss
random: urinary incontinence = LEAKING of urine
anticholinergic (adrenergic) impact
increased heart rate (+ chronotrope)
increased contractility (+ inotrope)
increased cardiac output
increased BP
bronchodilation
fat lipolysis/glycogenolysis (increase glucose)
uterus relaxation
what are the vitamin Bs
the rabbi needs prayer for comfort
thiamin B1
riboflavin B2
niacin B3
pyridoxine B6
folic acid B9
cyanocobalamin B12
increased uric acid
ABCDET
asa, alcohol, ALSO abaloparatide - Tymlos (new PTH analog for osteo)
B3 (niacin), bempedoic acid
calcineurin inhibitors (tacrolimus, cyclosporine), chemo agents
diuretics (loops + thiazides)
ethambutol (“E” = effects the eyes), Empirozenimide (TB drug)
ticagrelor (brilinta), Teriparatide - Forteo (for osteo), tacrolimus
also pyrazinamide (the “P” in the TB “RIPES” mnemonic)
statin SEs
HMG-CoA reductase inhibitors
hepatotoxicity, HA
myopathy/rhabdo, memory
glucose increase, GI (flatulence, abdominal pain)
CPK (check only if myopathy is being considered)
ophthalmic (blurred vision)
alopecia
DKA treatment
DIABETES
dehydrated (hydrate w/ NS (6 - 8L)
insulin (regular): IV preferred 0.1 U/kg/hr
acidosis (this is just indicating the pt is in an acidotic state)
bicarbonate (this used to be given)
electrolytes (monitor): for every 1 U of insulin given –> 1 U of potassium pulled into the cell [if pt has low K+, giving insulin WON’T be effective]; checking electrolytes to not give TOO much
time
electrolyties
sugar (when glucose drops below 200 or 250..maybe give more)
GLP-1 agonist SEs
gall bladder disease, GI symptoms
weight Loss
pancreatitis
1 –> “T” –> thyroid tumors [US boxed warning]
DPP-4 SEs
pancreatitis
joint Pain
SGLT2i SEs
genital yeast infections
L x4: LDL increase, lowers weight, lowers bp, LABs (increases K, Mg, Phosphate)
bone fracTures
*all given once daily in the AM
*canagliflozin should be taken b4 first meal
hypercalcemia signs/symptoms
ways it can be increased: increase PTH, thiazide, lithium
stones (kidney)
bones (disease)
groans (abdominal)
PSYCH overtones (anxiety, depression)
metabolic acidosis causes
MUDPILES
methanol
uremia
DKA
paraldehyde
iron, INH (isoniazid)
lactic acidosis
ethylene glycol, etoh
salicylate // STARVATION
glucocorticoid equivalent doses
CUTE HOT PRETTY PHARMACISTS MAKE TRIPLE DIGITS BOOOOOM
25mg - Cortisone
20mg - Hydrocortisone
5mg - Prednisolone
5mg - Prednisone
4mg - Methylprednisolone
4mg - Triamcinolone
0.75mg - Dexamethasone
0.6 - 0.75mg - Betamethasone
steroid systemic SEs
PREDNISONE (w/ long term use) - oral, not inhaled
PUD/Psychiatric: effects (at high PO doses) delirium, mania, depression, euphoria, mood swings
Retention: of Na & H2O
Eye: Cataracts, glaucoma
Diabetes: increased glucose –> decreased wound healing
Neurologic: CNS - HA, insomnia, seizure
Immunosuppression: however, WBC count increases
Swelling: Cushing’s Syndrome
Osteoporosis
Nausea (used to treat - very effective)
Electrolyte changes (decreased K, increased Na)
equivalent statin doses
Pharmacists Rock At Saving Lives and Prevent Fatty deposits
2- Pitavastatin
5- Rosuvastatin
10 - Atorvastatin
20 - Simvastatin
40 - Lovastatin
40 - Pravastatin
80 - Fluvastatin
divalproex sodium
what to remember
[PNN migraine chapter]
depakote [when you die (DIvalproex), you put your coat (depaKOTE) on]
a = think alopecia, ammonia increase
l = liver, check LFTs
p = pancreatitis
t (in brand name) = thrombocytopenia
mtx symptoms
METHOTREXATE
m = myelosuppression // mucositis
h = hepatotoxicity
o = (make it a sun) photosensitivity
r = rash // renal (keep urine alkaline w/ Na Bicarb)
x = pregnancy cat X // chest x-ray
ANTIDOTE = LEUCOVORIN
leflunomide (Arava) symptoms
L = LFT, looong half life of the active metabolite (monitor AST, ALT. Check ALT qmonth for 6 months)
A = alopecia
also a lot of nausea
antidote = cholestyramine 8 g TID x11 days OR activated charcoal (50g in a suspension) x11 days
hydroxychloroquine (plaquenil)
symptoms // monitoring
HYDROXYCHLOROQUINE
monitoring: CBC/CNS, liver function, muscle strength
o = ophthalmologic
c = CBC // CNS
o = tinnitus (decreased hearing acuity)
l = liver function
n = neuroMyopathy
“PLAQ PLAQ PLAQ IN THE EYES”
eye exam at baseline, annual screening beginning after 5 years of use
amiodarone (Pacerone) SEs
AMIODARONE
BLUE = can turn pt blue
a = alveoli (check CXR); AV blocker (monitor EKG)
iod = IODine = check TSH (can cause hypo+hyperthyroidism)
o = “eye” = check corneal micro deposits = check eyes
d = DDI = inc warfarin/digoxin (would dec dose of war/dig) = INHIBITOR; 100% liver (CHECK LFTS; don’t worry about renal system); long t1/2 [don’t give w/ sofosbuvir or Harvoni (sofosbuvir + ledipasvir)]
o = sun = PHOTOSENSITIVITY (must wear sunscreen)
n = if waiting > 2 hr and need to make, use NON-PVC
e = check EKG (HR) & BP; check electrolytes (inc K, inc Mg)
CHA2DS2-VASc
CHF = 1 pt
HTN = 1 pt
A2GE >/= 75 –> 2 pts
DM = 1 pt
S2TROKE // TIA = 2 pts
VASCULAR DZ = 1pt
AGE 65 - 74 = 1pt
SEX = FEMALE = 1pt
CHEST
Men >/= 1; Women >/= 2 –> anticoagulate
[at least 1 non-sex risk factor]
AHA/ACC
Men >/= 2; Women >/= 3 –> anticoagulate
[at least 2 non-sex risk factors]
Men 1; Women 2 –> MAY consider anticoagulate
[at least 1 non-sex risk factor]
class I antiarrhythmics
Sodium channel blockers (I = QDP, II = PLM, III = PF)
Ia = QDP [quinidine, disopyramide, procainamide]
(atrial & ventricular arrhythmias)
IIb = PLM [phenytoin, lidocaine, mexiletine]
(ventricular arrhythmias)
IIIc = PF [propafenone, flecainaide]
(atrial & ventricular arrhythmias)
class II antiarrhythmics
Beta Blockers –> RATE CONTROL IN AFIB
IV (acute) = metoprolol, esmolol (brevibloc; shortest half-life), propanalol (inderal)
Oral (long-term rate control) = BBs are 1st line for pts w/ systolic HF & AF requiring rate control: carvedilol, metoprolol succinate or bisoprolol
BB antidote = glucagon
class III antiarrhythmics
Potassium channel blockers
IASDD
ibutilide (Corvert = IV; chemical cardioversion)
amiodarone (Pacerone = PO; Nexterone = IV)
sotalol (Betapace, Betapace AF = PO/IV; contra <40 CrCl)
dofetilide (Tikosyn = PO; D/C <20 CrCl; 125 - 500 mcg caps)
dronedarone (Multaq = PO; amio deriv: no thyroid, lung, eye SE; SE = liver failure // HF)
class IV antiarrhythmics
non-DHP Ca channel blockers
verapamil and diltiazem
major 2D6 inhibitor
fluoxetine, paroxetine, quinidine, sertraline - zoloft (weak/moderate inhibitor), duloxetine - cymbalta, bupropion - wellbutrin + Zyban, mirabegron - myrbetriq
these inhibitors will decrease effectiveness of the following:
-tamoxifen: for breast cancer –> needs to be converted to active form using 2D6
-codeine (prodrug of morphine)
major 1A2 inhibitors
fluvoxamine, ciprofloxacin, cimetidine (tagamet), isoniazid, viloxazine (Qelbree, non-stimulant that only increases norepi, similar to Strattera)
[drugs can decrease concentration of warfarin and theophylline]
general antipsychotic SEs
[from PNN schizophrenia chapter]
EPSE (dystonic reaction, akathisia, pseudoparkinsonism)
tardive dyskinesia (TD) - repetitive, involuntary movements
neuroleptic malignant syndrome (NMS)
sedation: (w/ aripiprazole and cariprazine: sedation)
anticholinergic effects (most with clozapine; rare w/ ziprasidone, aripiprazole, paliperidone, asenapine, lurasidone)
orthostasis: dizziness (most w/ clozapine, iloperidone; rare w/ aripiprazole, brexipiprazole, cariprazine, asenapine, lurasidone)
hyperprolactinemia: elevated prolactin levels (think risperidone AND paliperidone; aripiprazole has NOT been shown to increase this)
weight gain (think clozapine and olanzapine)
*all typical antipsychotics (block dopamine) have these SEs but w/ newer meds, some have less of these SEs
antipsychotic SE mnemonic
[from PNN schizophrenia chapter]
WASH MEN
weight gain - block histamine H1 receptors
anticholinergic - block cholinergic receptors
sedation - block histamine receptors
hypotension - BLOCK alpha-adrenergic
movement disorders
EPSE - extrapyramidal symptoms i.e., movement dysfunction
neuroleptic malignant syndrome (NMS) i.e., life-threatening mental status change
another anticholinergic mnemonic
[from PNN schizophrenia chapter]
ANTI - SLUDGE
ANTI-
Salivation
Lacrimation
Urination
Defecation / Diaphoresis (excessive sweating)
GI motility
Excretion / Emesis
ATYPICALS // TYPICALS for rapid tranquilization mnemonic
HZZ
rapid IM for ACUTE agitation:
Haloperidal (Haldol)
Ziprasidone (Geodon)
Zyprexa (Olanzapine) –> watch for severe orthostatic hypotension
LONG ACTING INJECTABLE ANTIPSYCHOTICS for pts who are noncompliant
ADD DETAIL? P432 IN PNN
decanoate means can last for long periods of time (e.g., weeks, months, etc)
Haldol decanoate [typical]
-oral monthly
Fluphenazine decanoate [typical]
-every 2 to 4 weeks
Risperidone (Risperdal = Consta)
-IM every 2 weeks
Risperidone (Perseris)
-subQ monthly
Paliperidone palmitate
-invega sustenna = IM every month
-invega TRInza = IM every 3 months
Aripiprazole (Abilify Maintena)
-IM once monthly
Aripiprazole lauroil (Aristada)
-IM every 4 to 6 weeks
Aripiprazole lauroil (Aristada initio)
-IM is only to be used as a single dose to initiate Aristada “booster”
Olanzapine pamoate (Zyprexa Relprevv)(olanzapine ER)
-every 2 weeks or once a month
loss of dopamine results in
[mnemonic; from PNN parkinsons]
TRAMPP
tremor: “resting tremor”, bilateral (initially unilateral), absent during sleep
rigidity: stiff “cog wheel rigidity”
akinesia: initiation of movement is difficult. Bradykinesia = slowed movement
mask face: can’t smile or make facial expressions d/t the stiffness of facial muscles
pill rolling with fingers
postural instability later in the disease state
contra // caution to anticholinergics
[from PNN parkinsons]
BPH
narrow-angle glaucoma
bladder neck obstruction
myasthenia gravis
meds with anticholinergic effects
atropine
scopolamine
TCAs
dicyclomine (bentyl)
hyoscyamine
BZDs for elderly mnemonic
LOT
lorazepam (ativan)
oxazepam
temazepam (RESToril) = insomnia only (BZDs also insomnia only: estazolam - ProSom, triazolam - Halcion)
BZDs that don’t have many DDIs (i.e., not a substrate) mnemonic
LOT
lorazepam (ativan)
oxazepam
temazepam (RESToril) = insomnia only (BZDs also insomnia only: estazolam - ProSom, triazolam - Halcion) [CONFIRM ESTAZOLAM AND TRIAZOLAM CAN ALSO BE USED FOR SLEEP]
DSM-5 diagnostic criteria mnemonic
five or more symptoms present nearly every day, for 2 weeks. at least one of the symptoms is (1) depressed mood or (2) loss of interest/pleasure
SIG E CAPS:
sleep changes
interest (loss)
guilt (worthless)
energy (lack): fatigue
cognition/concentration
appetite (wt loss or wt gain)
psychomotor agitation (anxiety) or retardation (lethargic)
suicidal thoughts or suicide attempt
SSRIs SE mnemonic
HOWS G
H = hypotension, HA, hyponatremia
O = bOne (increased risk of fractures), ocular effects
W = wt gain
S = suicidal thinking, sexual dysfunction, serotonin syndrome caution
G = GI (can exacerbate loose stools) // GI Bleed
lithium SEs mnemonic
[from PNN anxiety, depression, bipolar disorder]
LITHIUM
L = Li levels 0.6 - 1 mEq/L (mainten.), leukocytosis (inc WBC)
I = increase urination (polyuria // polydipsia; concern for nephrogenic diabetes insipidus –> check electrolytes)
T = tremor, TSH (concern for hypothyroidism - low T3 & T4)
H = hypercalcemia, hyperparathyroidism
I = increase CNS // dermatologic (acne, alopecia)
bUn and scr = lithium is excreted renally
M = monitor WEB (Weight // EKG // Electrolytes // Beta-hCG)
2C19 inhibitors
omeprazole and esomeprazole
[can increase phenytoin and R-warfarin; can decrease impact of plavix]
TB Drugs mnemonic
RIPES [all drugs are bactericidal except for ethambutol]
Rifampin (rifadin) - empty stomach
Isoniazid (INH) - empty stomach
Pyrazinamide
Ethambutol (Myambutol) - bacteriostatic
Streptomycin
bedaquiline (Sirturo)
combinations:
-rifamate (isoniazid + rifampin) - empty stomach
-rifater (isoniazid + rifampin + pyrazinamide) - empty stomach
2C9 inhibitors
isoniazid, erythromycin
rifampin an inducer of
3A4, 1A2 and 2C9
decreases efficacy of oral contraceptives, decreases INR w/ warfarin. avoid using with protease inhibitors d/t increased risk of hepatotoxicity
NRTIs mnemonic
ZALES DT
zidovudine (AZT,ZDV)(retrovir)
abacavir (ABC)(Ziagen)
lamivudine (3TC)(Epivir, Epivir-HBV)
emtricitabine (FTC)(Emtriva)
stavudine (d4T)(Zerit)
didanosine (ddI)(Videx, Videx EC)
tenofovir
NNRTIs mnemonic
RNEEDD
rilpivirine (RPV)(Edurant)
nevirapine (NVP)(Viramune)
efavirenz (EFV)(Sustiva)
etravirine (ETR)(Intelence)
doravirine (Pifeltro)
delavirdine (DLV)(Rescriptor)
Integrase inhibitors mnemonic
RBED
raltegravir (RAL)(Isentress - PO)
bictegravir (+ emtricitabine + TAF = Biktarvy)
elvitegravir (+ cobicistat + TDF + emtricitabine = Stribild; + cobicistat + emtricitabine + TAF = Genvoya)(PO)
dolutegravir (DTG)(Tivicay)(PO)
cabotegravir (Apretude - IM; PrEP; Vocabria - PO; + rilpivirine = Cabenuva - IM)
protease inhibitors mnemonic
LAND FIRST
lopinavir/ritonavir (RTV)(Kaletra)
atazanavir (ATZ)(Reyataz) w/ cobicistat (Evotaz)
nelfinavir (NFV)(Viracept)
darunavir (DRV)(Prezista) w/ cobicistat (Prezcobix)
fosamprenavir (FPV)(Lexiva)
indinavir (IDV)(Crixivan)
ritonavir (RTV)(Norvir)
Saquinavir (SQV)(Invirase)
tipranavir (TPV)(Aptivus)
barbiturates SE mnemonic
ex: phenobarbital, pentobarbital, primidone
BARB
bone disease, bone marrow suppression
ataxia (loss of full control of body movements)
rash, respiratory depression
behavior changes, bradycardia
seizure med levels
phenobarbital
-infants + children: 15 - 40 mcg/mL
-adult: 20 - 40 mcg/mL
primidone: 5 - 12 mcg/mL
fosphenytoin // phenytoin: 10 - 20 mg/L or mcg/mL
valproic acid (divalproex sodium): 50 - 100 mcg/mL
carbamazepine: 4 - 12 mcg/mL
oxcarbazepine: 12 - 30 mcg/mL
ethosuximide: 40 - 100 mcg/mL
what enhances GABA (4)
-benzodiazepines
-propofol (diprivan)
-ethanol
-phenobarbital
Purpose of GABA:
-inhibitory
-agonize = calming effect
-reduce stress // anxiety
-improve sleep
how will alcohol impact phenytoin // warfarin (INR)
acute alcohol intake = increase phenytoin levels // increase INR
chronic alcohol intake = decrease phenytoin levels // decrease INR
valproic acid and lamictal
weak inhibitor of 2C9, 2D6, 3A4
increases blood levels of lamotrigine
_______ serotonin ________ sodium
increase; decrease
adverse effects of COCs:
progestational
androgenic
estrogenic
progestational:
-breast tenderness, HA, HTN, acne, oily skin, hirsutism, decreased libido
-progestins have chemical structure similar to testosterone thus have some androgenic activity
androgenic:
-acne, oily skin, INCREASED APPETITE, WT GAIN, DEPRESSION, fatigue, lethargy
estrogenic:
-nausea, edema, fluid retention, HA, wt gain, increased breast size, THROMBO-EMBOLIC EVENTS (PE, DVT, CVA), skin pigment changes
[ESTROGEN THICKENS BLOOD]
ABSOLUTE CONTRAINDICATIONS FOR COCs
thromboembolic disorder or hx (DVT, CVA)
hx of breast / uterus or any estrogen-dependent neoplasia (abnormal growth of cells)
undiagnosed vaginal bleeding
liver issues (jaundice, general hepatic disease)
pregnancy
World Health Organization (WHO) Contraindications:
-lactation < 6 weeks postpartum (had a baby –> female is in a hypercoagulable state)
-age > 35 & smoke > 15 cigs/day
-HTN
-migraines (IF HAVING AURAS)
-DM w/ end organ disease
-chest pain
[IF BREAST CANCER = NO ESTROGEN]
If on COC, contact MD if
[mnemonic]
ACHES
abdominal pain (severe)
chest pain, cough, SOB –> concern for PE
headache, dizziness, numbness –> concern for stroke
eye problems (vision loss/burning)
severe leg pain (calf or thigh) –> concern for DVT
SEs will decrease w/ consistent use after 3 months
concerning DDIs w/ COC
antibiotics / antifungal
-griseofulvin
cyp3A4 inducers
-rifampin
-anticonvulsants (phenytoin, phenobarbital, carbamazepine, oxcarbamazepine)
if taking these meds, should not use hormonal contraception (EXCEPT depo-provera / IUD). If must use COC, some clinicians may recommend COC with 50 mcg of estrogen
NORETHINEDRONE // PROGESTERONE ONLY
(MINI PILL)
+ counseling points
-Micronor
-Nor-QD
-Aygestin
-Camila
-Errin
-Jolivette
-Nora-BE
^norethindrone: 0.35 mg
TAKE SAME TIME EVERY DAY
INITIATE ON FIRST DAY OF MENSES or on first Sunday after menses begins
USE BACK-UP FOR 2 DAYS IF > 3 HOURS LATE ON DOSE
[progesterone has short half-life –> result –> lining can thin and allow sperm penetration]
EVERY PILL IS THE SAME
good candidates for progestin only birth control
indicated for contraception / endometriosis
contraception of >1 year duration is desired
pts in whom estrogens should be avoided
non-compliant w/ COC (forgetful)
when breastfeeding is desired
pts w/ a hx of seizures
when amenorrhea is desired
when considered w/ DDIs
[progesterone is sedating // relaxing - estrogen is excitatory]
AVOID progesterone in pts w/
hx of depression or HAs
how to choose the right form of birth control:
acne
wt gain
how to choose the right form of birth control:
dysmenorrhea (menstrual cramps) or PMS (premenstrual syndrome)
bloating
menstrual migraine
how to choose the right form of birth control:
women w/ coexisting medical condition
women w/ DM
women w/ hx of DVT / PE, CAD, CHF, or CVA
women w/ migraines & depression
FLibAnSeriN (Addyi) info
mixed serotonin agonist / antagonist for premenopausal women w/ hypoactive (decrease in physical or behavioral activity) sexual desire
-dose = SQ 45 min before sexual activity
-is a major 3A4 substrate –> CONTRA w/ 3A4 inhibitors
-SEs: hypotension, syncope
FLibAnSeriN
L = liver
A = alcohol contraindication
S = serotonin, syncope, substrate: CYP3A4 (CONTRA w/ inhibitors)
N = take it at Night (QHS)
allergies to be aware of:
cleviprex
diprivan
prometrium
paclitaxel
LMWH
Hyalgan
Calcitonin
Pramlintide
clevidipine –> soy & egg
propofol –> soy & egg
progesterone –> peanut
paclitaxel –> Cremophor EL (polyoxyethylated castor oil)
LMWH (enoxaparin, dalteparin) –> pork allergy
Hyaluronate –> eggs, avian protein, feathers
Miacalcin –> salmon
Symlin –> Metacresol
cigarette smoking and drug interactions:
CYP enzyme of concern
what drugs concerned about
what do when quit smoking
cigarette smoking induces CYP1A2 substrates
theophylline (Theo-Dur), olanzapine (Zyprexa), clozapine (Clozaril), & fluvoxamine (Luvox) [may need higher dose of these drugs in pts who smoke]
when quit smoking, may need to reduce the dose of CYP1A2 substrates and caffeine [caffeine levels increase when a pt quits smoking; counsel them to reduce their caffeine intake after they quit]
how reduce nephrotoxicity w/ cisplatin and carboplatin
ALL B4 CHEMO AGENTS
hydrate 2-3L NS
mannitol 25-50 g IV
amifostine (ethyl) [cisplatin ONLY; carboplatin less nephrotoxic than cisplatin]
how premedicate:
BuSulfan
premedicate w/ prophylactic anticonvulsants (phenytoin, levetiracetam, BZDs, or valproate)
how premedicate:
cyclophosphamide and ifosfamide
hydrating AND MESNA which binds to acrolein (this is responsible for hemorrhagic cystitis)
MTX antidote
Leucovorin (folinic acid)
how improve effect of fluorouracil (5-FU)
ADD leucovorin
precursors of:
Fluorouracil (5-FU) and Mercaptopurine (6-MP)
Capecitabine (Xeloda) is PRO-DRUG of Fluorouracil (5-FU)
Azathioprine turns into Mercaptopurine (6-MP)
Azathioprine // Mercaptopurine (6-MP) major DDI
allopurinol // febuxostat are xanthine oxidase inhibitors which increase the concentration of Azathioprine and Mercaptopurine (6-MP)
solution = decrease dose of Azathioprine and Mercaptopurine (6-MP) if need to give together
life time doses of:
Bleomycin
Doxorubicin
Daunorubicin
400 units
550 mg/m2
550 mg/m2
how premedicate:
Doxorubicin and Daunorubicin
Dexrazoxane IV (Zinecard: iron chelator) protects against cardiotoxicity
how premedicate:
docetaxel (Taxotere)
corticosteroids:
dexamethasone 8 mg BID x3-5 days, start 1 day prior
how premedicate:
paclitaxel (Taxol)
d/t hypersensitivity premedicate before starting taxol w/ dexamethasone, IV diphenhydramine, and IV histamine H2 antagonists (cimetidine, ranitidine or famotidine)
how treat diarrhea and dehydration:
irinotecan // topotecan
early form –> atropine
late form –> loperamide (no MAX dose HERE)
also replenish fluids and electrolytes
tacrolimus SEs
tacrolimus mnemonic
t - tremor
a - alopecia, acne
c - cardiovascular (HTN, QT increase)
r - renal
o - oncology (skin cancer; avoid sun & UV light exposure)
l - liver (CYP3A4 substrate)
i - infection, immunosuppression, increase in K, IDDM (insulin dependent DM)
m - monitor levels, malignancy
u - uric acid increase
s - seizures (neurotoxicity)
elemental iron values
mnemonic for MAOi
MAO Takes Pride In Shanghai
T –> tranylcypromine (Parnate)
P –> phenelzine (Nardil)
I –> isocarboxazid (Marplan)
S –> selegiline (Emsam; Zelapar)(MAO-B > MAO-A at low doses i.e., 10 mg or less)
*MAO-A degrades: serotonin, dopamine, norepi, epi, tyramine, other chemicals
*MAO-B degrades: dopamine, other chemicals
[ only MAOi w/ preferential inhibition (ONLY at low doses) is selegiline; other 3 inhibit MAO-A and MAO-B EQUALLY ]
opportunistic infection prophylaxis:
PCP
Toxoplasmosis
MAC
Abx w/ NMTT side chain
[MNEMONIC]
man met operator 4 tea
cefamandole
cefmetazole
cefoperazone
cefotetan
PPI Side Effects
all PPIs cause a reduction in calcium absorption
