Pharmacy Foundations 1 Flashcards
what happens with chelation and what drugs do you want to separate from them?
-occurs when a drug binds to polyvalent cations (Mg++, Ca, Fe++) in another compound (antacids or iron supplements) –> passes thru the stool
-quinolones, trtracyclines, levothyroxine, and oral bisphosphonates
pharmacodynamics
the effect that a drug has on the body. the effect can be therapeutic or toxic
pharmacokinetics
the effect the body has on the drug as it goes through the ADMW processes
if gastrointestinal pH is Increased, aborportion will be _______
decreased
ex: H2RAs, PPIs (acidic) taken with itraconazole decrease the funtion of the antifungal and can lead to resistant infections
what are the prodrug and active metabolite pairings:
1) Capecitabine:
2) Clopidogrel:
3) Codeine:
4) Colistimethate:
5) Cortisone:
1) Fluorouracil
2) active metabolite
3) morphine
4) colistin
5) cortisol
what are the prodrug and active metabolite pairings:
6) Famciclovir:
7) Fosphenytoin:
8) Isavuconazonium sulfate:
9) Levadopa:
10) Lisdexametamine:
6) Penciclovir
7) Phenytoin
8) Isavuconazole
9) Dopamine
10) Dextroamphetamine
what are the prodrug and active metabolite pairings:
11) Prednisone:
12) Primidone:
13) Tramadol:
14) Valacyclovir:
15) Valganciclovir:
11) Prednisolone
12) Phenobarbital
13) active metabolite
14) Acyclovir
15) Ganciclovir
what effect do CYP enzyme inhibitors have?
DECREASE enzyme function and the ability to metabolize compounds
substrates: decrease the rate of metabolism = INCREASED serum drug levels
what are common CYP inhibitors involved in drug interactions? (G <3 PACMAN)
G: grapefruit
P: protease inhibitors (ritonavir)
A: Azole antifungals (fluconazole, itraconazole, ketoconazole, posaconazole, voriconazole, and isvuconazonium)
C: cyclosporine, cobicistat
A: amiodarone and drondarone
N: non-DHP CCBs: diltiazam, verapamil
What effect to CYP enzyme inducers have?
increase enzyme production or activity
-substrates for the enzyme will have an INCREASED rate of drug metabolism = DECREASED serum drug level
-actions: increase dose of substratecomm
Common CPY inducers involved in drug interactions: (PS PORCS)
P: phenytoin
S: smoking
P: phenobarbital
O: oxacarbazepine
R: rafampin, rifabutin, rifapentine
C: carbamazepine (also an auto-inducer)
S: st. johns wort
what are P-gp efflux pumps?
loacted in many tissue membranes where they protect against foreign substances by moving them out of critical aread
-pump out of the bod by pumping them into the gut, where they can be excreted in the stool
Common P-gp substrates:
-anticoagulants (apixaban, rivaroxaban)
-cardio drugs (digioxin, diltiazam, verapamil)
-immunosuppressants (cyclosporine, tacrolimus)
-HCV drugs: sofosbuvir
-others: (colchicine)
Common P-gp inducers:
-carbamazepine
-phenobarbital
-phenytoin
-rifampin
-St. John’s wort
Common P-gp inhibitors:
-anti-infection: clarithromycin, itraconazole, posaconazole
-cardio drugs: amiodarone, diltiazam, verapamil
-HIV drugs: cobicistat, ritonavir
-HCV drugs: ledipasvir
-others: cyclosporine
what is enterohepatic recycling?
-the recycling of a already metabolized drug- increases the duration of action of amny drugs, including some abx, NSAIDs and ezetimibe
DDI: amiodarone and warfarin
-can be used together for afib
-amiodarone inhibits multiple enzymes, including CYP2C9, which metabolizes the more potent warfarin isomer
–> dec warfarin metabolism = inc INR and bleed risk
-want to dec warfarin dose and monitor INR
DDI: amiodarine and digoxin
-can be used together for afib
-amiodarone inhibits P-gp: digoxin is a P-gp substrate –> dec digixon excretion = inc ADRs/toxicity
-both drugs: inc risk of bradycardia, arrhythmia, fatality
–> dec digixon dose by 50% if used together and monitor HR
DDI: Digoxin and loop diuretics
-can be used for HF tx
-loop diuretics dec K, Mg, Ca, Na = can worsen arrhythmias
–> digoxin toxicity risk is increased with less K, Mg and inc Ca level
(renal impairment: dec digoxin dose, freq or d/c drug)
DDI: statins and strong CYP3A4 inhibitors
-inhibitors = ritonavir, cobicistat, clarithromycin, erythromycin, azole antifungals, cyclosporine, grapefruit
-inc levels of lovastatin, simvastatin, atorvastatin = inc myopathy risk, can cause rhabdomyolysis with ARF
–> simvastatin and lovastatin are CI with strong CYP3A4 inhibitors: can use pitavastain, pravastatin, rosuvastatin
DDI: warfarin and CYP2C9 inhibitors and inducers
-inhibitors: azoles, sulfamethoxazole/trimethoprim, amiodarone, metronidazole –> INC level of warfarin
-inducers: rifampin, St. John’s wort –> DEC levels of warfarin
DDI: CYP3A4 inhibitors and CYP3A4 substrates (opioids, fentanyl, hydrocodone, oxycodone, methadone)
-dec CYP3A4 substrate metabolism will cause INC drug levels, and INC ADRs/toxicity
DDI: Valproate and lamotrigine
-valproate DEC lamotrigine metabolism and INC lamotrigine levels causing inc risk of skin reactions: SJS/TEN
DDI: MAOIs and drugs/foods that inc sertonin, epi, NE and DA
do NOT use together
-use a 2 week washout period when switching between drugs with MAOI inhibition or serotonergic properties (wait 5 weeks for FLUOXETINE)
-avoid tyramine rich foods: wine, ages cheese, dry meats
DDI: CYP2D6 inhibitors (amiodarone, fluoxetine, paroxetine, fluvoxamine) and CYP2D6 substrates (codeine, meperidine, tramadol, tamoxifen)
-dec drug substrate metabolism
-inc ADRs/toxicity
avoid using together is possible
DDI: CYP3A4, P-GP inhibitors and CNIs (tacrolimus, cyclosporin)/ mTOR kinase inhibitors (sirolimus, everolimus)
-DEC drug substrate metabolism = inc ADR/toxicity, inc BP, nephrotoxicity, metabolic syndrome etc
-avoid using together
DDI: antiepeliptic drugs CYP inducers and other drugs metabolized by CYP enzymes (BC)
-INC substrate (drug) metabolism will cause DEC drug levels
-dec drug effect with AEDs = loss of seizure control
-monitor drug levels
-if lamotrigine, use starter kit with higher levels first
DDI:Rifampin and CYP/P-gp substrates
concentration of substrate drugs will greatly decrease
DDI: CYP3A4 inducers and opioids that are CYP3A4 substrates (fentanyl, hydrocodone, oxycodone, methadone)
-inc metabolism = DEC opioid concentration –> analgesia relief will decrease
DDI: CYP3A4, P-gp inducers and CNIs/mTORs
-inc drug metabolism = dec transplant drug level and inc risk of transplant/organ rejection
DDI: Smoking and some antipsychotics, antidepreaasants, hypnotics, anxiolytics, caffeine, theophylline, warfarin (R-isomer)
-smoker who quit: when cig is stopped, drug concentrations of CYP1A2 substrates with inc = toxicity
-current smoker: CYP1A2 substrate will have dec levels
What drugs can cause serotonergic toxicity? (6 classes)
- antidepressants: SSRIs, SNRIs, TCAs, mirtazapine, trazodone
- MAOis
-opioids
-triptans
-natural products: St. John’s wort, L-tryptophan
-others: buspirone, lithium, dexatromethorphan
what are the risks of serotonergic toxicity?
-autonomic dysfunction: diaphoresis, N/V, hyperthermia
-AMS (akathesia, anxiety, agitation, delirum)
-neuromuscular excitation (hyperreflexia, tremor, regidity, tonic-clonic seizures)
–> avoid using serotonergic drugs together- 2 week wash out or 5 weeks with flouxetine
what drugs cal increase bleeding risk? (5 classes)
-anticoagulants (warfarin, DOACs, heprin, fondaparinux)
-antiplatelets (aspirin, clopidogrel, prasagrul, ticagular)
-NSAIDs (ibuprofen, naproxen, dicofenac, indomethacin)
-SSRI/SNRIs (citalopram, ecitalopram, fluuxetine, sertraline etc)
-Natural products (5 Gs: garlic, ginger, ginkgo biloba, ginseng, glucosamine)
what drugs increase the risk of hyperkalemia? (3 classes)
-RAAS drugs (ACE, ARBBs, aliskiren, entresto, spirinolactone, eplerenone)
-Potassium-sparing diuretics (amiloride, triamterene)
-others (KCL, CNIs, bactrim, canagliflozin)
what drugs can cause QT Prolongation? (7 classes)
-antiarrhythmics
-anti-infectives (antimalaria, azoles, lefamulin, macrolides, quinolones)
-antidepressants (SSRIs- citalopram and ecitalopram, TCAs, mirtazapine, trazodone, venlafaxine)
-antipsychotics (haloperidol, thioridazine)
-antiemetics (ondansetron, droperidol, metoclopramide, promethazine)
-oncology: (leuprolide, nilotinib, oxaliplatin)
-others: (cilostazol, donepezil, fingolimod, hydroxyzine, loperamide, methadone, tacrolimus)
what drugs can cause ototoxicity? (5 classes)
-animoglycosides (gentamicin, tobramycin, amikacin)
-cisplatin
-loop diuretics -esp rapid IV injection (furosemide, bumetanide, ethacryinic acid)
-salicylates (aspirin, salslate, magnesium salicylate)
-vancomycin
what drugs can cause nephrotoxicity? (6 classes)
-anti-infectives (aminoglycodies, amphotericin B, polymyxines, vancomycin)
-cisplantin (use amifostine (ethyol) to protect kidneys)
-calcineurin inhibitors (cyclosporine, tacrolimus)
-loop diuretics (furosemide, torsemide, bumetanide, ethacrynic acid)
-NSAIDS
-radiographic-contrast dye
what drugs are anticholinergic? (6 classes)
-antidepressants/antispychotics (paroxetine, TCAs, 1st gen antipsy)
-sedating antihistamines (diphenhydramine, brompheniramine, doxylamine, hydroxyxine, meclizine)
-centrally acting anticholinergics (benztropine, trihexyphenidyl)
-muscle relaxants (baclofen, carisoprodol, cyclobenzaprine)
-antimuscarinics (oxybutynin, darifenacin, tolterodine)
-others (atropine, belladonna, dicyclomine)
what drug classes interact with PDE-5 inhibitors (sildenafil, tadalafil, avanafil, vardenafil) to cause hypotension/orthostasis?
-CYP3A4 inhibitors
-nitrates
-alpha-1 blockers (non-selective: doxazosin, terazosin) or selective: tamsulosin)
Common CYP3A4 substrates (8 classes)
-analgesics: fentanyl, hydrocodone, methadone, oxycodone
-anticoagulants: apixaban, rivaroxaban, R-warfarin
-cardiovascular drugs: amiodarone, amlodipine, diltiazem, verapamil
-immunosuppressants: cyclosporine, tacrolumus, sirolimus
-statins: atorvastatin, lovastatin, simvastatin (ALS)
-HIV drugs: NNRTIs
-PDE-5 inhibitors: avanafil, sildanafil, tadalafil, vardenafil
-others: ethinyl
Common CYP3A4 inducers
-carbmazepine
-oxacarbazepine
-phenobarbital
-phenytoin
-rifampin
-smoking
-St. John’s Wort
Common CYP3A4 inhibitors (4 classes)
-anti-infectives: clarithromycin, erythromycin, azoles, isoniazid
-cardio drugs: amiodarone, diltiazam, verapamil
-HIV drugs: cobicistat, ritonavir, protease inhibitors)
-others: cyclosporine, grapefruit,
common CYP1A2 substrates
-theophylline
-R-warfarin
common CYP1A2 inducers
-carbamazepine
-phenobarbital
-phenytoin
-rifampin
-smoking
-St. john’s wort
common CYP1A2 inhibitors
-ciprofloxacin
-fluvoxamine
common CYP2C8 substrates
-amiodarone
-pioglatazone
-repaglinide
common CYP2C8 inducers
-phenytoin
-rifampin
common CYP2C8 inhibitors
-amiodarone
-clopidogrel
-bactrim
common CYP2C9 substrates
-S-warfarin
common CYP2C9 inducers
-carbamazepine
-phenobarbital
-phenytoin
-rifampin
-smoking
-St. John’s wort
common CYP2C9 inhibitors
-amiodarone
-fluconazole
-metronidazole
-bactrim
common CYP2C19 substrates
-clopidogrel
common CYP2C19 inducers
-carbamazepine
-phenobarbital
-phenytoin
-rifampin
common CYP2C19 inhibitors
-esomerprazole
-omerprazole
common CYP2D6 substrates (3 classes)
-analgesics: codeine, meperidine, tramadol
-antipsychotics/antidepressants
-others: tamoxifen
Common reference range: Calcium (Ca)
8.5-10.5 mg/dL
calculate corrected calcium if albumin is low
- can be increased due to calcium supps, vitamin D, thiazides diuretics
- can be dec due to long term heparin, loop diuretics, bisphosphonates, cincacalcet
–> supp Ca in preganany, osteo and with certain drugs
Common reference range: Magnesium (Mg)
1.3-2.1 mEq/L
- can be inc due to mag containing antacids and laxatives
- can be dec due to PPI, diuretics, amphotericin B, diarrhea and chronic alcohol intake
Common reference range: Phosphate (PO4)
2.3-4.7 mEq/L
- inc in CDK
-dec due to phosphate binders, foscarnet, oral calcium intake
Common reference range: Potassium (K)
3.5-5 mEq/L
-inc due to ACEi, ARB, aldosterone receptor agonists, aliskiren, canagloflozin, cyclosporine, tacrolimus, potassium supps, bactrim
-dec due to beta 2 agonists, diuretics, insulin, sodium polystyrene, sulfonate
Common reference range: Sodium (Na)
135-145 mEq/L
-inc due to hypertonic saline, tolvaptan
-dec due to carbamazepine, oxacarbazepine, SSRIs, diuretics
Common reference range: Bicarbonate (HCO3)
V: 24-30 A: 22-26 mEq/L (used to assess acid-base status
-inc due to loop diuretics, systemic steroids
-dec due to topiramate, salicylate overdose
Common reference range: Blood Urea Nitrogen (BUN)
7-20 mg/dL
-increases in renal impairment and dehydration
–> BUN: SCr ratio is used to assess fluid status and renal function
Common reference range: Serum Creatinine (Scr)
0.6-1.3 mg/dL
-inc due to many drugs that impair renal function: aminoglucosides, amphotericin B, cisplatin, colistimethate, cyclosporine, loop diuretics, polymixin, NSAIDs, radioactive contrast dye, tacrolimus, vancomycin)
–> false ince can be due to bactrim, H2RAs, cobicistat
-dec with low muscle mass, ampuation, hemodilution
Common reference range: glucose
70-110 mg/dL
Common reference range: Anion Gap (AG)
5-12 mEq/L
-an inc anion gap suggests metabolic acidosis
Common reference range: white blood cell count (WBCs)
4,000-11,000 cells/mm3
-inc due to systemic steroids, CFS, epi
-dec due to clozapine, chemotherapy, carbamazepine, immunospurants
Common reference range: Neutrophils & Bands
45-73% & 3-5%
-used to calculate ANC to assess for neutropenia
-“left shift” in bands when elevated
Common reference range: Eosinophils
0-5%
-inc in drug allergy, asthma, inflammation, parasitic infection
Common reference range: basophils
0-1%
-inc in inflammation, hypersensitivity reactions, leukemia
Common reference range: Lymphocytes
20-40%
-inc in viral infections, lumphoma
-dec in bone marrow suppression, HIV or due to systemic steroids
Common reference range: Red Blood Cells (RBC)
male: 4.5-5.5 F: 4.1-4.9 x 10^6 cells/uL
-life span is 120 days
-inc due to ESAs, smoking
-dec due to chemotherapy deficiency anemias, hemolytic anemia, sickle cell anemia
Common reference range: Hemoglobin (Hgb, Hb)
males: 13.5-18, f: 12-16 g/dL
-inc due to ESAs
-de in anemias and bleeding
Common reference range: Mean Corpuscular Volume (MCV)
80-100 fL
–> reflects the size and average volume of RBCs
-inc (macrocytic anemia) due to B12 or folate deficiency
-dec (microcytic anemia) due to iron deficiency
Common reference range: Folic Acid (folate)
5-25 mcg/L
-dec due to phenytoin/fosphenytoin, phenobarbital, primidone, methotrexate, bactrim
-supp in women of childbearing age and alcohol use disorder
Common reference range: Vitamin B12
> 200 pg/mL
-dec due to PPI, metformin, colchicine, chloramphenicol
Common reference range: Reticulocyte count
0.5-2.5%
–> measures the amount of immature RBCs being made by the bone marrow
-inc with blood loss and hemolysis
-dec in untreated anemia and with bone marrow suppression
Common reference range: Coombs test
negative
–> used in diagnosis of immune-mediated hemolytic anemia
-drugs that can cause it include: penicillins, cephalosporines, isonaizid, levodopa, methyldopa, quinidine, rifampine and sulfonamides
* if test is +, D/C the drug
Common reference range: G6PD
5-14 units/gram
–> used to determine if hemolytic anemia is due to G6PD
-triggered by stress, foods (fava beans), or drugs: dapsone, methylene blue, nitrofurantoin, pegloticase, primaquine, raburicase, quinidine, quinine, and sulfonamides
Common reference range: Anti-Xa
-therapeutic doses of LMWH (4 hours after dose) 1-2- IU/mL
-therapeutic dose of unfractionated heparin (6 hours after IV infusion and q 6 hrs until therapeutic) : 0.3-0.7 IU/mL
Common reference range: PT/INR
PT: 10-13 secs
INR: < 1.2 –> w/o warfarin, inc can be due to liver disease
Common reference range: aPPT/PTT
22-38 seconds
-monitor unfractonated heparin: obtain q 6 hours after IV. infusion
-false inc can occur with oritavacin, telavancin
Common reference range: Platelets (PLTs)
150,000-450,000 cells/mm3
–> life span of 7-10 days (bleeding can occur < 20,000 cells
-dec due to heparin, LMWH, fondaparinux, linezolid, valproic acid
Common reference range: Albumin
3.5-5 g/dL
- dec due to cirrhosis and malnutrition
-phenytoin and calcium concentrations require correction with low albumin
Common reference range: AST/ALT
10-40 units/L
-enzymes released from injured hepatocytes
Common reference range: Bilirubin
0.1-1.2 mg/dL
-used to assess causes of liver damage and detect bile duct blockage
Common reference range: Amylase and Lipase
A: 60-180 units/L
L: 5-160 units/L
-increase in pancreatitis, which can be caused by didanosine, stavudine, GLP-1 agonists, DPP-4 inhibitors, valproic acid, hypertriglyceridemia
Common reference range: Creatinine Kinase (CK)
males: 55-170, F: 30-135 IU/L
-used to assess muscle damage/inflammation
-can inc due to daptomysin, statins, tenofovir, raltegravir, dolutegravir
Common reference range: Troponin, BNP, NT-proBNP
T: 0-0.1 ng/mL
BNP: <100 ng/L
pro BNP: M: < 61, F: 12-151
-markers of cardiac stress –> higher values are consistant with liklihood of HF or MI
Common reference range: LDL, HDL & TG
LDL: < 100 mg/dL
HDL: 40- >/= 60
TG: < 150
non-HDL = TC - HDL
–> fasting begins 9-12 hours prior to blood draw
Common reference range: fasting glucose & A1C
100-125 = + for prediabetes
A1C < 7% (ADA), < 6.5% (AACE)
Common reference range: C-reactive protein
0/0/5 mg/dL
-inc CRP = inflammation
Common reference range: C-Peptide
0.78 - 1.89 ng/mL
–> insulin breakdown product used to evaluate beta-cell function (distinguishes between type 1 and type 2 dm)
- dec or absent in type 1 dm
Common reference range: urinary albumin excretion (UAE)
< 30 mg/24 hr
Common reference range: TSH
0.3-3 MIU/L
-inc = hypothyroidism, can be due to tyrosine kinase inhibitors, lithium, carbamazepine
-dec = hyperthyroidism
- inc or dec due to amiodarone, interferons
Common reference range: Uric acid
M: 3.5-7 F: 2-6.5 mg/dL
-inc due to diuretics, niacin, low doses of aspirin, pyrazinamide, cyclosporine, tacrolimus
Common reference range: CRP, RF, ESR, ANA
CRP: 0-0.5 (high risk = > 3 mg/dL)
RF: neg
ESR: M < 20, F: < 30 mm/hr
ANA: neg
–> used in autoimmune disorders/ inflammation
-drug induced lupus erythematosus (DILE): can be caused by anti-TNF agents, hydralazine, isonazid, methimazole, methyldopa, minocycline, procainamide, etc- drug should be D/C
Common reference range: CD4 and viral load
CD4: immunocompromised state = < 200 cells
VL: undetectable
Common reference range: pH
7.35-7.45
Common reference range: Prostate - specific antigen (PSA)
<4 ng/mL
Common reference range: Lactic acid
0.5-2.2 mEq/mL
-inc due to NRTIs, metformin, alcohol use, cyanide
Therapeutic Drug Levels: Carbamazepine
4-12 mcg/mL
Therapeutic Drug Levels: Digoxin
A fib: 0.8- 2 ng/mL
HF: 0.5 - 0.9 ng/mL
Therapeutic Drug Levels: Gentamicin
Peaks: 5-10 mcg/mL
Troughs: < 2 mcg/mL
Therapeutic Drug Levels: Lithium
0.6-1.2 mEq/L (up to 1.5)
-drawn as troughs
Therapeutic Drug Levels: Phenytoin and free phenytoin
P: 10-20
FP: 1-2.5 mcg/mL
Therapeutic Drug Levels: Procainamide, NAPA (active metabolite) & combined
P: 4-10
NAPA: 15-25
Combined: 10-30 mcg/mL
Therapeutic Drug Levels: Theophylline
5-15 mcg/mL
Therapeutic Drug Levels: Tobramycin
Peak: 5-10 mcg/mL
Tough: < 2 mcg/mL
Therapeutic Drug Levels: Valproic acid
50-100 mcg/mL
Therapeutic Drug Levels: Vancomycin
Trough: 15-20 (for serious infections –> pneumonia, endocarditis, osteomyelitis, meningitis, and bacteremia)
Trough: 10-15 mcg/mL for others
Therapeutic Drug Levels: Warfarin
goal INR : 2-3 for most
what informations must be included on OTC drugs?
1- active ingredients: indicate amount and purpose
2- uses for the product
3- specific warnings : when the drug should not be used and when it is appropriate to consult a doc
4- side effects and substances or activities to avoid
5- dosage instructions
6- the inactive ingredients
Locating guidelines: Anticoagulation
-American College of Chest Physicians (CHEST)
–> stroke prevention in Afib, venous thromoembolism
Locating guidelines: Cardiovascular diseases
-ACC/AHA guidelines
–> ACS, A fib, HF, high cholesterol, HTN
Locating guidelines: Diabetes
-AACE, ADA
Locating guidelines: Infectious Diseases
-IDSA
-HIV/AIDS: US dept of health and human services
-CDC: sexually transmitted diseases
Locating guidelines: oncology
-american society of clinical oncology (ASCO)
-National comprehensive Cancer Network (NCCN)
Locating guidelines: Pediatrics
the American Academy of Pediatrics (AAP)
Locating guidelines: Pregnancy/womens health
The american Academy of obstetricians and Gynoc (ACOG)
Locating guidelines: Psychiatric Conditions
DSM
Locating guidelines: Pulmonary Conditions
-Asthma: GINA, and national heart, lung and blood institute (NHLBI)
-COPD: GOLD
Locating guidelines: Renal Disease
Kidney disease improving global outcomes (KDIGO)
Locating guidelines: Vaccines
ACIP, CDC
“color” drug references: Orange book
FDA: list of approved drugs that can be interchanged with generics based on therapeutic equivalence
“color” drug references: Pink Book
CDC: Information on epidemiology and vaccine-preventable diseases
“color” drug references: Pink Sheet
Pharma Intelligence: news reports on regulatory, legislative, legal and business developments
“color” drug references: Purple Book
FDA: list of biological drug products, including biosimiliars
“color” drug references: Red Book, Pharmacy
drug pricing information
“color” drug references: Red Book, Pediatrics
summaries of pediatric infectious diseases, antimicrobial tx and vaccines
“color” drug references: Yellow Book
CDC: info on health risks of international travel, required vaccines, and prophylaxis meds
“color” drug references: Green Book
FDA: inof on approved animal drug products
Which patches must be applied twice daily?
Diclofenac
Which patches must be applied daily?
-Methylphenidate (Daytrana) Qam, 2 hours prior to school - HIP ONLY
-Nicotine (NicoDerm CQ)
-Rivastigmine (Exelon)
-Rotigontine (Neupro)
-Selegiline (Emsam)
-Testosterone (androderm): nightly, not on scrotum
Which patches need to be applied daily but have special instructions?
-Lidocaine (Lidoderm): 1-3 patched PRN, on for 12 hours, off for 12 hours
-Nitroglycerin: on for 12-14 hours, then off for 10-12 hours
Which patches need to be applied every 72 hours?
-Fentanyl: !72 hr, if it wears off after 48 hours, change to Q48 hrs
-Scopolamine (Transderm Scop): Q72 hrs, PRN- behind the ear
Which patches need to be applied twice weekly?
-Estradiol (Alora, Vivelle-Dot- lower abdomin)
-Oxybutynin (Oxytrol) - abdomen, hip or butt
Which patched need to be applied weekly?
–Donepezil (Adlarity)
-Buprenorphine (Butrans)
-Clonidine (Catapres-TTS)
-Estradiol (Climara)
-Estradiol/Levonrgestrel
-Ethinyl estradiol/norelestromin (Xulane- back abdomen, or butt, Zafemy): weekly for 3 weeks, 1 week off
Which patches contain metal? (aluminum)
-Clonidine (Catapres-TTS)
-Rotigotine (Neupro)
-Scopolamine (Transderm Scop)
-Testosterone (Androderm)
—> need to be removed before an MRI
what are some alternative to PVC containers?
-Polyolefin
-Polyproopylene
-glass
What are drugs with leaching/adsorption/absorption issues with PVC containers: Leaches Absorb To Take In Nutrients
L: lorazepam
A: amiodarone
T: tacrolimus
I: insulin
N: nitroglycerin
what are some common drugs with SALINE diluent solution requirements : A DIAbetic Cant Eat Pie
A: ampicillin
D: daptomycin (cubicin)
I: infiximab (Remicade)
A: ampicillin/sulbactam (Unasyn)
C: caspofungin (cancidas)
E: ertapenem (Invanz)
P: phenytoin (Dilantin)
what are some common drugs with DEXTROSE diluent solution requirements: Outrageous Bakers Avoid Salt
O: oxaliplatin
B: bactrim
A: amphotericin B
S: synercid - quinupristin/dalfopristin
common drugs with filter requirements: my GAL IS PAT who has a MaP
G: golimumab
A: amphotericin B (lipid formualtions)
L: lipids = 1.2 microns
IS: isavuconazonium
P: phenytoin
A: amiodarone
T: taxanes (cabazitaxel and paclitaxel)
M: mannitol > 20%
P: parenteral nutrition - 1.2 microns
drugs that need to be protected from light during administration: Protect Every Necessary Med from Daylight
P: phytonadione (vitamin K)
E: epoprostenol
N: nitroprusside
M: micafungin
D: doxycycline
drugs that should NOT be refrigerated: Dear Sweet Pharmacist, Freezing Makes Me Edgy!
D: dexmedetomidine
S: sulfamethoxazole/Trimethoprim
P: pheytoin –> crystalizes
F: furosemide –> crystalizes
M: metronidazole
M: moxifloxacin
E: enoxaparin
3 IV drugs that come as colored solutions
1: Anthracycline (doxorubicin) red –> dicolor sweat and urine
2: Rifampin- red –> discolor salivia, urine, sweat and tears
3: Mitoxantrone - blue –>discolors skin, eyes, urine
Antidotes for Anthracycline, Vincristine Extravasation
-give via centeral venous catheters
Antidotes:
–> Anthracyclines: dexrazoxane (Totect) or dimethyl sulfoxide
–> Vinca alkaloids: hyaluronidase
*intrathecal admin of Vincristine is fatal
Drugs with leaching/adsoprtion/absorption issues with PVC containers
LATTIN:
Lorazepam
Amiodarone
Tacrolimus
Taxanes
Insulin
Nitroglycerin
Drugs that can only be used in SALINE
Ampicillin
Daptomycin (Cubicin)
Infliximab (Remicade)
Ampicillin/Sulbactam (Unasyn)
Caspofungin (Cancidas)
Ertapenem (Invanz)
Phenytoin (Diltantin)
Drugs that can only be used in DEXTROSE
Oxaliplatin
Bactrim (SMX/TMP)
Amphoterericin B
Synercid (Quinupristin/Dalfopristin
Common high-risk Incompatibilities
-Ceftriaxone + calcium containing solutions: risk of precipitates (common ex is mixing with Lactated Ringer)
-Calcium and phosphate: will bind together and create a precipitate that kills the patient
-Amphotericin B + sodium bicarbonate: incompatible with the majority of IV drugs
-Piperacillin/tazobactam: forms a precipitate when it mixes with acyclovir, amphotericin B and many other IV drugs
Common drugs that REQUIRE a filter
Golimumab
Amphotericin B (lipid formulations)
Lipids- 1.2 microns
Isavuconazonium
Phenytoin (continuous infusion only)
Aminodarone
Taxanes (cabazitaxel, paclitaxel)
Mannitol >/ 20%
Parenteral nutrition- 1.2 microns
IV drugs that do NOT require refrigeration
Dexmedetomide
Sulfamethoxazole/Trimethoprim
Phenytoin-crystallizes
Furosemide- crystallizes
Metronidazole
Moxifloxacin
Enoxaparin
Key drugs that need to be protected from light during administration
Phytonadione (vitamin K)
Epopostenol
Nitroprusside
Micafungin
Doxycycline
