Pain, Hematology, And Oncology Flashcards
Transdermal: Duragesic; IV: Sublimaze
fentanyl (transdermal, IV)
Pharmacologic category: opioid analgesic
Common indication: pain
Key side effects: dizziness, drowsiness, nausea, vomiting, constipation, respiratory depression (dose-related)
US Boxed Warnings: use exposes to risks of opioid addiction, abuse, and misuse which can lead to overdose and death; serious, life-threatening, or fatal respiratory depression may occur; accidental ingestion, especially in children, may result in fatal overdose; prolonged use in pregnancy may result in neonatal opioid withdrawal syndrome; concomitant use of opioids with benzodiazepines or CNS depressants (including alcohol), may result in profound sedation, respiratory depression, coma, and death; concomitant use with cytochrome P450 3A4 inhibitors may increase serum concentrations; exposure of application site to direct external heating sources (e.g., heating pads, heating lamps, hot baths, saunas) may increase absorption and lead to overdose and/or death
Other Notes: ISMP-high alert medication
PO: Exalgo; PO, IV: Dilaudid
hydromorphone (PO, IV)
Pharmacologic category: opioid analgesic
Common indication: pain
Key side effects: dizziness, drowsiness, nausea, vomiting, constipation, respiratory depression (dose-related)
US Boxed Warnings: use exposes to risks of opioid addiction, abuse, and misuse which can lead to overdose and death; serious, life-threatening, or fatal respiratory depression may occur; accidental ingestion, especially in children, may result in fatal overdose; prolonged use in pregnancy may result in neonatal opioid withdrawal syndrome; concomitant use of opioids with benzodiazepines or CNS depressants (including alcohol), may result in profound sedation, respiratory depression, coma, and death; several other formulations available including concentrated solution, take care to avoid dosing errors among strengths and between mg and ML
Other Notes: ISMP-high alert medication
MS Contin, MorphaBond, Kadian
morphine (extended release) (PO)
Pharmacologic category: opioid analgesic
Common indication: pain
Key side effects: dizziness, drowsiness, nausea, vomiting, constipation, respiratory depression (dose-related)
US Boxed Warnings: use exposes to risks of opioid addiction, abuse, and misuse which can lead to overdose and death; serious, life-threatening, or fatal respiratory depression may occur; accidental ingestion, especially in children, may result in fatal overdose; prolonged use in pregnancy may result in neonatal opioid withdrawal syndrome; concomitant use of opioids with benzodiazepines or CNS depressants (including alcohol), may result in profound sedation, respiratory depression, coma, and death; several formulations available including concentrated solution, take care to avoid dosing errors among strengths and between mg and mL; avoid alcohol consumption with ER capsules as alcohol may increase plasma morphine levels
Other Notes: ISMP-high alert medication
PO: Roxanol; IV: Duramorph
morphine (immediate release) (PO, IV)
Pharmacologic category: opioid analgesic
Common indication: pain
Key side effects: dizziness, drowsiness, nausea, vomiting, constipation, respiratory depression (dose-related)
US Boxed Warnings: use exposes to risks of opioid addiction, abuse, and misuse which can lead to overdose and death; serious, life-threatening, or fatal respiratory depression may occur; accidental ingestion, espeically in children, may result in fatal overdose; prolonged use in pregnancy may result in neonatal opioid withdrawal syndrome; concomitant use of opioids with benzodiazepines or CNS depressants (including alcohol), may result in profound sedation, respiratory depression, coma, and death; several formulations available including concentrated solution, take care to avoid dosing errors among strengths and between mg and mL; avoid alcohol consumption with ER capsules as alcohol may increase plasma morphine levels
Other Notes: ISMP-high alert medication
Oxycontin, Roxicodone, Oxaydo, Xtampza ER
oxycodone (PO)
Pharmacologic category: opioid analgesic
Common indication: pain
Key side effects: dizziness, drowsiness, nausea, vomiting, constipatoin, respiratory depression (dose-related)
US Boxed Warnings: use exposes to risks of opioid addiction, abuse, and misuse which can lead to overdose and death; serious, life-threatening, or fatal respiratory depression may occur; accidental ingestion, especially in children, may result in fatal overdose; prolonged use in pregnancy may result in neonatal opioid withdrawal syndrome; concomitant use of opioids with benzodiazepines or CNS depressants (including alcohol), may result in profound sedation, respiratory depression, coma, and death; concomitant use with cytochrome P450 3A4 inhibitors may increase serum concentrations; several formulations available including concentrated solution, take care to avoid dosing errors among strengths and between mg and mL
Other Notes: ISMP-high alert medication
Dolophine, Methadose
methadone (PO, IV)
Pharmacologic category: opioid analgesic
Common indication: opioid use disorder, severe chronic pain
Key side effects: dizziness, drowsiness, nausea, vomiting, constipation, respiratory depression (dose-related), QTc prolongation
US Boxed Warnings: use exposes to risks of opioid addiction, abuse and misuse which can lead to overdose and death; serious, life-threatening, or fatal respiratory depression may occur; accidental ingestion, especially in children, may result in fatal overdose; prolonged use in pregnancy may result in neonatal opioid withdrawal syndrome; for detoxification and maintenance of opioid dependence, methadone should be administered in accordance with documented treatment standards, including limitations on unsupervised administration; QTc interval prolongation and serious arrhythmia (torsades de pointes) have occurred during treatment with methadone
PO: Tylenol; IV: Ofirmev
acetaminophen (PO, IV)
Pharmacologic category: analgesic (non-opioid), antipyretic
Common indication: pain, fever
Key side effects: nausea, vomiting, increased hepatic transaminases
US Boxed Warnings: dosing errors (confusion with mg and mL) can lead to accidental overdose and death; total daily dose from all sources should not exceed maximum daily limit; hepatotoxicity
Ultram, Ultram ER
tramadol (PO)
Pharmacologic category: central analgesic
Common indication: pain
Key side effects: dizziness, drowsiness, nausea, vomiting, constipation, respiratory depression (dose-related)
US Boxed Warnings: serious, life-threatening, or fatal respiratory depression may occur
Other Notes: lowers seizure threshold (use caution in patients with a seizure history, those at risk of seizures, and those on other drugs that may lower seizure threshold)
Ultracet
tramadol and acetaminophen (PO)
Pharmacologic category: central analgesic and nonopioid analgesic combination
Common indication: pain
Key side effects: dizziness, nausea, vomiting, constipation, respiratory depression (dose-related)
US Boxed Warnings (all acetaminophen products): products containing acetaminophen have been associated with acute liver failure (maximum daily dose is 4000mg from all sources)
Other Notes: lowers seizure threshold (use caution in patients with a seizures history, those at risk of seizures, and those on other drugs that may lower seizure threshold)
Lortab, Vicodin, Norco, Xodol
hydrocodone and acetaminophen (PO)
Pharmacologic category: opioid and nonopioid analgesic combination
Common indication: pain
Key side effects: dizziness, drowsiness, nausea, vomiting, constipation, respiratory depression (dose-related)
US Boxed Warnings: use exposes to risks of opioid addiction, abuse, and misuse which can lead to overdose and death; serious, life-threatening, or fatal respiratory depression may occur; accidental ingestion, especially in children, may result in fatal overdose; prolonged use in pregnancy may result in neonatal opioid withdrawal syndrome; concomitant use with cytochrome P450 3A4 inhibitors may increase serum concentrations
US Boxed Warnings (all acetaminophen products): products containing acetaminophen have been associated with acute liver failure (maximum daily dose is 4000mg from all sources)
Percocet, Endocet, Roxicet, Xartemis XR
oxycodone and acetaminophen (PO)
Pharmacologic category: opioid and non-opioid analgesic
Key Side Effects: dizziness, drowsiness, nausea, vomiting, constipation, respiratory depression (dose-related)
US Boxed Warnings: use exposes to risks of opioid addiction, abuse, and misuse which can lead to overdose and death; serious, life-threatening, or fatal respiratory depression may occur; accidental ingestion, especially in children, may result in fatal overdose; prolonged use in pregnancy may result in neonatal opioid withdrawal syndrome; concomitant use with cytochrome P450 3A4 inhibitors may increase serum concentrations
US Boxed Warnings (all acetaminophen products): products containing acetaminophen have been associated with acute liver failure (maximum daily dose is 4000mg from all sources)
Tylenol with Codeine #3, Tylenol with Codeine #4
codeine and acetaminophen (PO)
Pharmacologic category: opioid and nonopioid analgesic combination
Common indication: pain
Key side effects: dizziness, drowsiness, nausea, vomiting, constipation, respiratory depression (dose-related)
US Boxed Warnings: use exposes to risks of opioid addiction, abuse, and misuse which can lead to overdose and death; serious, life-threatening, or fatal respiratory depression may occur; accidental ingestion, especially in children, may result in fatal overdose; prolonged use in pregnancy may result in neonatal opioid withdrawal syndrome
US Boxed Warnings (all acetaminophen products): products containing acetaminophen have been associated with acute liver failure (maximum daily dose is 4000mg from all sources)
Subutex
buprenorphine (PO, IV, IM, transdermal)
Pharmacologic category: partial opioid agonist
Common indication: opioid use disorder, pain
Key side effect: headache, opioid withdrawal syndrome in opioid-dependent populations, pain, diaphoresis
Other Notes: potentially life-threatening respiratory depression (particularly when combined with other CNS and respiratory depressants); prescribing for treatment of opioid use disorder limited to physicians meeting qualifying criteria and with a specific DEA number (begins with “X”); addition of naloxone to buprenorphine reduces possibility of parenteral misuse by producing opioid withdrawal symptoms when injected
Narcan
naloxone (IV, IM, subcutaneous, intranasal)
Pharmacologic category: opioid antagonist
Common indication: opioid overdose
Key side effects: headache, opioid withdrawal syndrome in opioid-dependent populations, pain, diaphoresis
Other Notes: potentially life-threatening respiratory depression (particularly when combined with other CNS and respiratory depressants); prescribing for treatment of opioid use disorder limited to physicians meeting qualifying criteria and with a specific DEA number (being with “X”); addition of naloxone to buprenorphine reduces possibility of parenteral misuse by producing opioid withdrawal symptoms when injected
Suboxone
buprenorphine and naloxone (PO)
Pharmacologic category: partial opioid agonist and opioid antagonist
Common indication: opioid use disorder
Key side effects: headache, opioid withdrawal syndrome in opioid-dependent populations, pain, diaphoresis
Other Notes: potentially life-threatening respiratory depression (particularly when combined with other CNS and respiratory depressants); prescribing for treatment of opioid use disorder limited to physicians meeting qualifying criteria and with a specific DEA number (begins with “X”); addition of naloxone to buprenorphine reduces possibility of parenteral misuse by producing opioid withdrawal symptoms when injected
Trexall, Rheumatrex
methotrexate (PO, IV)
Pharmacologic category: antimetabolite (folic acid antagonist)
Common indication: rheumatoid arthritis, psoriasis, various hematologic and solid tumors
Key side effects: stomatitis, diarrhea, nausea, vomiting, thrombocytopenia, leukopenia, increased hepatic transaminases, pulmonary fibrosis (rare), pneumonitis (rare)
US Boxed Warnings: serious toxic reactions (only use in life-threatening neoplasticism disease, severe psoriasis, or severe rheumatoid arthritis); may cause fetal death and/or congenital abnormalities (avoid in pregnancy); severe (sometimes fatal) bone marrow suppression, aplastic anemia, and toxicity have been reported with concomitant administration of methotrexate and NSAIDs; elimination is reduced in impaired renal function, ascites, or in patients with pleural effusions (careful monitoring necessary); may cause hepatotoxicity, fibrosis, and cirrhosis (generally only after prolonged use); methotrexate-induced lung disease, including acute or chronic interstitial pneumonitis may occur; severe (sometimes fatal) gastrointestinal toxicity has been reported with concomitant administration of methotrexate and NSAIDs; secondary malignancy may occur; may induce tumor lysis syndrome in patients with rapidly growing tumors; severe (sometimes fatal) dermatologic toxicity has been reported; potentially fatal opportunistic infections (especially Pneumocystis jirovecii pneumonia) may occur
Other Notes: ISMP-high alert medication, folic acid supplementation may be taken during use to reduce hematologic, gastrointestinal, and hepatic side effects; harmful (sometimes fatal) errors have been associated with incorrect dosing (verify dosing frequency based on indication - for most indications, oral doses are often only given once weekly)
Arimidex
anastrozole (PO)
Pharmacologic category: aromatase inhibitor
Common indication: hormone receptor-positive breast cancer
Key side effects: rash, flushing, hot flashes, arthralgia, nausea, vomiting, hypertension, peripheral edema, osteoporosis
Other Notes: cardiovascular side effects (i.e., hypercholesterolemia, CAD); fetal toxicity (CI in pregnancy)
Fioricet, Esgic, Zebutal
butalbital, acetaminophen, and caffeine (PO)
Pharmacologic category: analgesic
Common indication: tension headaches
Key side effects: dizziness, drowsiness, lightheadedness
US Boxed Warnings (all acetaminophen products): products containing acetaminophen have been associated with acute liver failure (maximum daily dose is 4000mg from all sources)
Adipex-P, Lomaira
phentermine (PO)
Pharmacologic category: CNS stimulant
Common indication: Obesity
Key side effects: hypertension, nausea, dizziness, xerostomia, primary pulmonary hypertension (rare)
Other Notes: only approved for short-term use (a few weeks); CI in those with a history of cardiovascular disease or drug abuse, pregnancy, hyperthyroidism, or within 14 days of MAOI inhibitor therapy
Cyanocobalamin (vitamin B12) (PO, IM)
Pharmacologic category: water-soluble vitamin
Common indication: vitamin B12 deficiency (manifests as macrocytic anemia)
Key side effects: no major side effects
Folic acid (PO, IV)
Pharmacologic category: water-soluble vitamin
Common indication: folic acid deficiency (manifests as macrocytic anemia), prevention of neural tube defects in pregnancy
Key side effects: no major side effects
