Pharmacy foundations Flashcards
Sentinel event
death or serious physical or psychological injury of a patient
Prospective Study
A prospective study watches for outcomes, such as the development of a disease, during the study period and relates this to other factors such as suspected risk or protection factor(s). The study usually involves taking a cohort of subjects and watching them over a long period. Prospective studies usually have fewer potential sources of bias and confounding than retrospective studies.
Retrospective Study
A retrospective study looks backwards and examines exposures to suspected risk or protection factors in relation to an outcome that is established at the start of the study. Most sources of error due to confounding and bias are more common in retrospective studies than in prospective studies.
-EX: case-control studies (but not exclusively)
Continuous
-measure continuous data
-weight, height, length, time, and temperature
-Infinite number of fractional values between any two values.
The Joint Commission (TJC)
independent, not for profit organization that accredits and certifies
-set national patient safety goals annually
high alert medications
Anesthetic inhaled or IV (propofol)
Antiarrhythmics IV (amiodarone)
Anticoagulants/antithrombotics (heparin, warfarin)
Chemotherapy
epidural/intrathecal drugs
hypertonic saline
immunosupressants
inotropics
insulins
mag sulfate
NMBA
opioids
oral hypoglycemic
PN
KCl/KPhos
SWi
5 rights of medication administration
right patient
right time and frequency
right dose
right route
right drug
type A reactions
dose-dependent related to known pharmacologic actions
type B reactions
not dose-dependent, unrelated to the pharmacologic actions
-allergies
-intolerances
-idiosyncratic reactions
Type 1 reactions
IgE-mediated and immediated within 60 min
Type 2 reactions
antibody-mediated occuring several days (5-8 days) after drug expsoure
Type 3 reactions
immune-complex reactions ocurring >1 week after drug exposure
Type 4 reactions
cell-mediated or delayed hypersensitivity reactions, occurring anytime from 48 hr to several weeks after drug exposure
medication guides
FDA-approved patient handouts that details a drug important adverse event
drugs associated with photosensitivity
amiodarone, diuretics, methotrexate, oral and topical retinoids, quinolones, st. johns wort, sulfa antibiotics, tacrolimus, tetracyclines, voriconazole
drugs associated with thrombotic thrombocytopenic purpura (TTP)
oral P2Y12 inhibitors
sulfamethoxazole
drugs commonly associated with severe skin reactions
abacavir, allopurinol, carbamazepine, ethosuximide, lamotrigine, modafinil, nevirapine, penicillins, phenytoin, sulfamethoxazole
Vd
amount of drug in body / concentration of drug in plasma
corrected calcium
= calcium + [(4.0 - albumin) x 0.8]
Cl
dose / AUC
elimination rate constant
ke = cl/ vd
t1/2
= 0.693 / ke
loading dose
= desired concentration x vd / F
HLA-B*5701
Abacavir (containing agents Triumeq, Epzicom)
-incr risk of hypersensitivity reactions
-fatal hypersensitivity reactions
HLA-B*5801
allopurinol (Zyloprim, Aloprim)
-incr risk of SJS
HLA-B*1502
Carbamezapine, oxcarbazepine, phenytoin, fosphenytoin
-incr riskf of SJS and TEN
-most common in asian patients
CYP2C19
clopidogrel
-poor emtabolizers (*2 or *3) have incr risk of cardiovascular events
CYP2D6
codeine
-ultra rapid metbaolizers have incr risk of OD
-infant deaths when nursing mothers who were URM took codeine for pain
CYP2C9*2 and *3 and VORKC1
warfarin
-increased bleeding
HER2
trastuzumab (herceptin)
KRAS
Cetuximab (Erbitux)
DPD deficiency
Capecitabine (Xeloda)
Flurouracil
drugs that require pharmacogenomic testing
abacavir
azathiopurine
carbamazepine
cetuximab and other EGFR inhibitors
trastuzumab and other HER2 inhibitors
supplements that increase bleeding risk
garlic, ginger, ginkgo, ginseng, and glucosamine
fish oils
vitamin E
dong quai
willow bark
supplements with risk of liver toxicity
black cohosh
kava
chaparral
supplements with cardiac toxicity
ephedra (bitter orange - citrus aurantium or synephrine)
DMAA
Licorice
Yohimbe
Tylenol poisoning
N-acetylcysteine: free radical scavenger and precursor to glutathione –> converting NAPQI to mercapturic acid which is really cleared
opioids
naloxone
anticholinergics
physostigmine
antipsychotics
benztropine
BZD
flumazenil
BB
glucagon
CCB
calcium chloride/gluconate
cyanide
hydroxocobalamin (cyanokit)
digoxin
digoxin immune fab (Digifab)
ethanol
thiamine
heavy metals
dimercaprol: arsenic, gold, mercury
penicillamine: copper
hydrocarbons (petroleum products)
do not induce vomitting NPO
isoniazid
pyridoxine (vitamin B6)
iron
deferoxamine
organophosphate (insecticides)
-SLUDD symptoms (Salvation, lacrimations, urination, diarrhea, defecation)
-atropine: blocks the effects of acetylcholine
-pralidoxime (protopam): reactivates cholinesterase
methotrexate
leucovorin
methemoglobinemia
methylene blue (do not use in G6PD deficiency)
neostigmine, pyridostigmine
pralidoxime
salicylates
sodium bicarb
toxic alcohols
fomepizole
TCA
sodium bicarbs
valproic acid or topiramate induced hyperammonemia
levocartinine
animal bites
rabies vaccine + human rabies immune globulin
black widow
antivenin
scorpion stings
antivenin
snake bites
crotalidae polyvalent iune FAB for copper head and rattlesnake
G <3 PACMAN (CYP inhibitors)
Grapefruit
Protease inhibitors (PI)
Azole antifungals
Cyclosporine, cobicistat
Macrolides (not azithromycin)
Amiodarone
Non-DHP CCBs
CYP inhibitors effect on substrates
-decreased metabolism
-increased serum levels and clinical effects
-INhibitors = INcreased effects/levels/ADRs/toxicities
CYP inhibitor’s effects on prodrugs
decreased conversion to the active drug
PS PORCS (CYP inducers)
Phenytoin
Smoking
Phenobarbital
Oxcarbazepine
Rifampin (and rifabutin, rifapentine)
Carbamazepine
St. Johns wart
CYP inducers effects on substrates
-incr metabolism
-decreased serum levels and clinical effects
-inDucers = Decreased effects/levels
CYP inducers effects on prodrugs
increased conversion to the active drug (incr serum levels and clinical effects)
P-gp substrates
-anticogaulants: apixaban, edoxaban, dabigatran, rivaroxaban
-CV drugs: digoxin, diltiazem, carvedilol, ranolazine, verapamil
-immunosuppressants: cyclosporine, sirolimus, tacrolimus
-HCV drugs: dasabuvir, ombitasvir, paritaprevir, sofosbuvir
-others: atazanavir, colchicine, dolutegravir, posaconazole, raltegravir, saxagliptin
P-gp inducers
carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampin, st. johns wort
P-gp inhibitors
-ID: clarithromycin, itraconazole, posaconazole
-CV: amiodarone, crvedilol, conivaptan, diltiazem, dronedarone, quinidine, verapamil
-HIV drugs: ledipasvir, paritaprevir
others: cyclosporine
orange book
approved drugs that can be interchanged with generics based on therapeutic equivalence
pink book
epidemiology and vaccine-preventable disease
pink sheet
news report on regulatory, legislative, legal, and buisness
purple book
list of biological drug products, including biosimilars
red book
drug pricing information
red book pediatrics
pediatric infectious diseases, antimicrobial tx and vaccinations
yellow book
international travel, required vaccines and ppx meds
green book
animal drug products
drugs with absorption or leaching issues with PVC: Leach Absorbs To Take In Nutrients
lorazepam, amiodarone, tacrolimus, taxanes, insulin, nitroglycerin
drugs that can only be diluted with saline: A DIAbetic Cant Eat Pie
Ampicillin
Daptomycin
Infliximab
Ampicillin/sulbactam
Caspofungin
Ertapenem
Phenytoin
drugs that can only be diluted with dextrose: Outrageous Bakers Avoid Salt
Oxaliplatin
Bactrim
Amphotericin B
Synercid
drugs with filter requirements:
GAL PLAT
Goliumab
Amiodarone
Lorazepam
Phenytoin
Lipids - 1.2 micron
Amphotericin B (lipid formulations)
Taxanes except docetaxel
drugs that should not be refrigerated:
Dear Sweat Pharmacist Freezing Makes Me Edgy
Dexmedetomidine
Sulfamethoxazole/Trimethoprim
Phenytoin
Furosemide
Metronidazole
moxifloxacin
Enoxaprin
Drugs that should be protected from light:
Protect Every Necessary Med from Daylight
Phytonadione
Epoprostenol
Nitroprusside
Micafungin
Doxycycline
