Staying on Track Quiz 2 Flashcards
meropenem
Brand: Merrem
Class: Carbapenem
Indication: abd infections, meningitis, SSTIs
MOA: Inhibits bacterial cell wall synthesis by binding to PBPs, eventually leading to cell lysis
BBW: N/A
SE: Nausea, HA, painq
ertapenem
Brand: INVanz
Class: Carbapenem
Indication: pelvic infections, CAP, abd infections, SSTIs, UTI, ppx in colorectal surgery
MOA: Inhibits bacterial cell wall synthesis by binding to PBPs, eventually leading to cell lyses
BBW: N/A
SE: N/V/D
valacyclovir
Brand: Valtrex
Class: Antiviral Agent
Indication: Herpes zoster (shingles); genital herpes; varicella, herpes labialis (cold sores)
MOA: Converted to acyclovir. Acyclovir is converted to acyclovir monophosphate by viral thymidine kinase then further converted to acyclovir triphosphate by other cellular enzymes. Acyclovir triphosphate inhibits DNA synthesis and viral replication by competing with deoxyguanosine triphosphate for viral DNA polymerase and being incorporated into viral DNA
BBW: N/A
SE: abd pain, nausea, HA, nasopharyngitis, increased AST/ALT
valganciclovir
Brand: Valcyte
Class: Antiviral Agent
Indication: CMV
MOA: Metabolized to ganciclovir, gets phosphorylated, competitively inhibits the binding of deoxyguanosine triphosphate to DNA polymerase, gets incorporated into DNA, inhibits viral DNA synthesis
BBW: can cause leukopenia, neutropenia, anemia, thrombocytopenia, pancytopenia, bone marrow aplasia and aplastic anemia; can be teratogenic, carcinogenic, & aspermatogenic
SE: HTN, headache, insomnia, D/N/V, abd pain, anemia, thrombocytopenia, neutropenia, graft rejection, tremor, retinal detachment, increased SCr, fever
acyclovir
Brand: Zovirax
Class: Antiviral Agent
Indication: genital herpes, herpes simplex, herpes zoster, herpes labialis, varicella
MOA: Acyclovir is converted to acyclovir monophosphate by virus-specific thymidine kinase then further converted to acyclovir triphosphate by other cellular enzymes. Acyclovir triphosphate inhibits DNA synthesis and viral replication by competing with deoxyguanosine triphosphate for viral DNA polymerase and being incorporated into viral DNA.
BBW: N/A
SE: malaise
dapsone
Brand: Aczone
Class: Miscellaneous antibiotic
Indication: acne vulgaris, dermatis herpetiformis, leprosy
MOA: Competitive antagonist of PABA & prevents normal bacterial utilization of PABA for the synthesis of folic acid
BBW: N/A
SE: Dryness, redness, peeling of skin
ritonavir
Brand: Norvir
Class: Protease Inhibitor
Indication: HIV
MOA: Binds to the site of HIV protease activity & inhibits cleavage of viral Gag-Pol protein precursors into individual functional proteins required for infectious HIV, resulting in the formation of immature, noninfectious viral particles
BBW: Coadministration with sedative hypnotics, antiarrhythmics, or ergot alkaloid preparations may result in potentially serious and/or life-threatening adverse reactions (hepatic metabolism effects)
SE: increased gamma-glutamyl transferase, flushing, raised serum cholesterol/tigylcerides, D/N/V, dyspepsia, dysgeusia, asthenia, paresthesia, dizziness, arthralgia, skin rash, pruritis, cough, oropharyngeal pain, fatigue
tenofovir + emtricitabine + elvitegravir + cobicistat
Brand: Stribild
Class: nuceotide RTI + nuceloside RTI + integrase inhibitor + CYP450 inhibitor
Indication: HIV
MOAs: Elvitegravir inhibits the catalytic activity of integrase, thus preventing integration of the proviral gene into human DNA. Cobicistat inhibits enzymes of the CYP3A subfamily and enhances systemic exposure to elvitegravir. Emtricitabine and tenofovir interfere with HIV viral RNA dependent DNA polymerase activities resulting in inhibition of viral replication.
BBW: lactic acidosis, severe hepatomegaly, postreatment exacerbation of hepatitis B
SE: proteinuria, N/D, increased SCr
atazanavir
Brand: Reyataz
Class: Protease Inhibitor
Indication: HIV
MOA: Binds to the site of HIV-1 protease activity and inhibits cleavage of viral Gag-Pol polyprotein precursors into individual functional proteins required for infectious HIV. This results in the formation of immature, noninfectious viral particles.
BBW: N/A
SE: increased bilirubin, cholesterol, creatine phosphokinase & serum amylase, rash, abdominal pain, jaundice, N/V/D, cough, fever
atazanavir + cobicistat
Brand: Evotaz
Class: protease inhibitor + CYP450 inhibitor
Indication: HIV
MOA: Atazanavir prevents the formation of mature virions by selectively inhibiting viral Gag and Gag-Pol polyproteins in HIV-1 infected cells. Cobicistat boosts atazanavir exposure.
BBW: N/A
SE: abnormal bilirubin, jaundice, scleral icterus
lopinavir + ritonavir
Brand: Kaletra
Class: Protease Inhibitors (but here ritonavir used as CYP450 inhibitor)
Indication: HIV
MOA: Lopinavir- binds to site of HIV-1 protease activity and inhibits cleavage of viral Gag-Pol polyprotein precursors into individual functional proteins required for infectious HIV, resulting in immature, noninfectious viral particles
Ritonavir- inhibits CYP3A metabolism of lopinavir, allowing increased levels of lopinavir
BBW: N/A
SE: increased serum cholesterol/TG/ALT/GGT, D/V/N, dysgeusia, abd pain, URTI,
tenofovir + emtricitabine
Brand: Truvada
Class: nucelotide RTI + nucleoside RTI
Indication: HIV; pre-exposure prophylaxis (PEP) of HIV
MOA: each drug interferes with reverse transcriptase by getting incorporated into DNA, resulting in inhibition of viral replication
BBW: Lactic acidosis/severe hepatomegaly with steatosis; post-treatment acute exacerbation of Hep B; risk of drug resistance with use for PEP
SE: abnormal dreams & rash; insomnia, depression, diarrhea, dizziness, fatigue, headache, nausea
tenofovir alafenamide + emtricitabine
Brand: Descovy
Class: nucelotide RTI + nucleoside RTI
Indication: HIV (in combo w/ other antiretrovirals)
MOA: each drug interferes with reverse transcriptase by getting incorporated into DNA, resulting in inhibition of viral replication
BBW: Lactic acidosis/severe hepatomegaly with steatosis; post-treatment acute exacerbation of Hep B
SE: nausea
tenofovir alafenamide + emtricitabine + rilpivirine
Brand: Odefsey
Class: nucelotide RTI + nuceloside RTI + NNRTI
Indication: HIV
MOA: Tenofovir alafenamide & emtricitabine - compete with natural substrates and incorporate into viral DNA, resulting in termination of the DNA chain. Rilpivirine - binds to reverse transcriptase, blocking the RNA-dependent and DNA-dependent DNA polymerase activities, including HIV-1 replication.
BBW: Lactic acidosis/severe hepatomegaly with steatosis; post-treatment acute exacerbation of Hep B
SE: nausea, HA, somnolence
tenofovir alafenamide + emtricitabine + elvitegravir + cobicistat
Brand: Genvoya
Indication: HIV
Class: nucleotide RTI + nuceloside RTI + integrase inhibitor + CYP450 inhibitor
MOA: Tenofovir alafenamide & emtricitabine - compete with natural substrates and incorporate into viral DNA, resulting in termination of the DNA chain. Elvitegravir - inhibits the catalytic activity of integrase, preventing integration of the proviral gene into human DNA. Cobicistat - inhibits enzymes of the CYP3A subfamily & enhances systemic exposure to elvitegravir.
BBW: lactic acidosis, severe hepatomegaly, postreatment exacerbation of hepatitis B
SE: decreased bone mineral density, nausea
abacavir + lamivudine
Brand: Epzicom
Class: both are nucleoside RTIs
Indication: HIV
MOA: each drug interferes with reverse transcriptase by getting incorporated into DNA, resulting in inhibition of viral replication
BBW: Hypersensitivity reactions (esp. w/ HLA-B*5701 allele); Lactic acidosis/severe hepatomegaly with steatosis; post-treatment exacerbations of Hep B
SE: depression, headache, insomnia
abacavir + lamivudine + dolutegravir
abacavir + lamivudine + dolutegravir Brand: Triumeq
Class: nucleoside RTI + nucleoside RTI + integrase inhibitor
Indication: HIV
MOA: Abacavir & lamivudine - inhibit HIV-1 reverse transcriptase; they get incoporated into viral DNA and halt replication. Dolutegravir - inhibits the catalytic activity of integrase, thus preventing integration of the proviral gene into human DNA.
BBW: Hypersensitivity reactions (esp. in pts. w/ HLA-B*5701 allele); Lactic acidosis/severe hepatomegaly with steatosis; post-treatment exacerbations of Hep B
SE: hypersensitivity rxn to abacabvir component
lamivudine + zidovudine
Brand: Combivir
Class: both are nucleoside RTIs
Indication: HIV
MOA: both act synergistically to inhibit reverse transcriptase b/c they are phosphorylated in the cell & are incorporated into the DNA chain
BBW: hematologic toxicity in advanced HIV-1; Lactic acidosis/severe hepatomegaly with steatosis; post-treatment exacerbations of Hep B
SE: HA, N/V/D, nasal symptoms, cough dizziness, insomnia, neuropathy, sleep disorder, musculoskeletal pain,
dolutegravir
dolutegravir Brand: Tivicay Class: Integrase Inhibitor Indication: HIV MOA: Binds to the integrase active site and inhibits the strand transfer step of HIV-1 DNA integration into the host cell genome necessary for the HIV replication cycle BBW: N/A SE: hyperglycemia, ALT/SGPT raised
raltegravir
Brand: Isentress
Class: Integrase Inhibitor
Indication: HIV
MOA: Raltegravir inhibits the catalytic activity of integrase, thus preventing integration of the proviral gene into human DNA
BBW: N/A
SE: headache, nausea, insomnia & fatigue
darunavir + cobicistat
Brand: Prezcobix
Class: protease inhibitor + CYP450 inhibitor
Indication: HIV
MOA: inhibits HIV protease, which selectively inhibits the cleavage of HIV-encoded Gag-Pol polyproteins in virus infected cells and prevents the formation of mature infectious virus particles. Cobicistat increases darunavir exposure via inhibition of CYP3A metabolism
BBW: N/A
SE: N/V/D, HA, rash, abd pain
oseltamivir
Brand: Tamiflu
Class: Neuraminidase inhibitor
Indication: Influenza A & B treatment and prophylaxis
MOA: Inhibits neuraminidase, preventing viral release. Neuraminidase is an enzyme that clips the viral hemagluttin from the sialic acid on the cell, causing viral release from the cell.
BBW: N/A
SE: vomiting & nausea
daclatasvir
Brand: Daklinza Class: NS5A Inhibitor Indication: Hepatitis C (1,3) MOA: binds to the N-terminus within Domain 1 of HCV nonstructural protein 5A (NS5A) and inhibits viral RNA replication and virion assembly BBW: N/A SE: HA, nausea, fatigue
elbasvir + grazoprevir
Brand: Zepatier
Class: NS5A inhibitor + protease inhibitor
Indication: Hepatitis C (1,4)
MOA: Elbasvir - binds to the N-terminus within Domain 1 of HCV nonstructural protein 5A (NS5A) and inhibits viral RNA replication and virion assembly. Grazoprevir - inhibiting the protease necessary for proteolytic cleavage of HCV encoded polyproteins used for viral replication
BBW: N/A
SE: HA, nausea, fatigue
sofosbuvir + velpatasvir
Brand: Epclusa
Class: NS5B RNA polymerase inhibitor + NS5A inhibitor
Indication: Hepatitis C. (1-6)
MOA: Velpatasvir inhibits the HCV NS5A protein necessary for viral replication. Sofosbuvir - prodrug converted to its pharmacologically active form (GS-461203), which inhibits NS5B RNA-dependent RNA polymerase, also essential for viral replication, and acts as a chain terminator.
BBW: N/A
SE: HA, nausea, fatigue
sofosbuvir + ledipasvir
Brand: Harvoni
Class: NS5B RNA polymerase inhibitor + NS5A inhibitor
Indication: Hepatitis C (1,4,5,6)
MOA: Ledipasvir inhibits the HCV NS5A protein necessary for viral replication; sofosbuvir is a prodrug converted to its pharmacologically active form (GS-461203), inhibits NS5B RNA-dependent RNA polymerase, also essential for viral replication, and acts as a chain terminator.
BBW: N/A
SE: HA, fatigue, asthenia
ombitasvir + paritaprevir + ritonavir + dasabuvir
ombitasvir + paritaprevir + ritonavir + dasabuvir Brand: Viekira Pak
Indication: Hepatitis C (1a, 1b)
Class: NS5A inhibitor + protease inhibitor + CYP3A4 inhibitor + NS5B RNA polymerase inhibitor
MOA: Ombitasvir inhibits HCV NS5A, and interferes with viral RNA replication and virion assembly. Paritaprevir inhibits HCV NS3/4A protease and interferes with HCV coded polyprotein cleavage necessary for viral replication. Dasabuvir inhibits HCV RNA-dependent RNA polymerase (encoded by the NS5B gene) which is also necessary for viral replication. Ritonavir is a CYP3A inhibitor that increases concentrations of paritaprevir.
BBW: N/A
SE: Skin reactions, pruritis, nausea, insomnia, fatigue
peginterferon alfa-2a
Brand name: Pegasys
Class: Interferon
Indication: Hep B & C
MOA: Interferons interact with cells through high affinity cell surface receptors. Following activation, multiple effects can be detected including induction of gene transcription. Interferons inhibit cellular growth, alter the state of cellular differentiation, interfere with oncogene expression, alter cell surface antigen expression, increase phagocytic activity of macrophages, and augment cytotoxicity of lymphocytes for target cells.
BBW: fatal or life-threatening neuropsychiatric, autoimmune, ischemic, and infectious disorders
SE: alopecia, dermatitis, injection site inflammation/rxn, pruritus, rash, high TG, weight loss, abdominal pain, N/V/D, loss of appetite, arthralgia, myalgia, dizziness, HA, insomnia, anxiety, dyspnea, fatigue, fever, influenza-like illness, rigor
ribavirin
Brand name: Virazole
Class: Antihepaciviral, Nucleoside (Anti-HCV)
Indication: Chronic Hep C (in combo w/ peginterferon), RSV
MOA: Inhibits replication of RNA and DNA viruses; inhibits influenza virus RNA polymerase activity and inhibits the initiation and elongation of RNA fragments resulting in inhibition of viral protein synthesis
BBW: don’t use alone for treatment of Hep C; Hemolytic anemia (which could lead to CV complications); Teratogenicity
SE: injection site rxn, weight loss, diarrhea, loss of appetite, N/V, neutropenia, asthenia, dizziness, HA, insomnia, fatigue, influenza-like illness
lidocaine
Brand: Lidoderm
Class: Local Anesthetic
Indication: postherpetic neuralgia
MOA: blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane’s permeability to sodium ions, which results in inhibition of depolarization with resultant blockade of conduction
BBW: N/A
SE: skin pigmentation, skin edema, bruise, local irritation
fentanyl
Brand: Sublimaze, Actiq, Duragesic
Class: Opioid analgesic
Indication: Pain
MOA: Binds with mu-receptors at sites within the CNS, increases pain threshold, alters pain perception, inhibits ascending pain pathways
BBW: Addiction, abuse, and misuse; life-threatening respiratory depression; accidental exposure; neonatal opioid withdrawal syndrome; CYP450 interaction; Exposure to heat increases transdermal absorption
SE: bradycardia, chest wall rigidity, edema, central nervous system depression, confusion, dizziness, drowsiness, fatigue, HA, sedation, diaphoresis, dehydration, constipation, N/V, xerostomia, application site erythema, muscle rigidity, weakness, miosis, dyspnea, respiratory depression
morphine
Brand: various
Class: Analgesic, Opioid
Indication: Management of pain
MOA: Binds to opioid receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; produces generalized CNS depression
BBW: Astramorph PF, Infumorph, Duramorph: Because of the risk of severe adverse effects when the epidural or intrathecal route of administration is employed, patients must be observed in a fully equipped and staffed environment for at least 24 hours after the initial dose.
Infumorph: Infumorph is not recommended for single-dose intravenous (IV), intramuscular (IM), or subcutaneous administration because of the very large amount of morphine in the ampul and the associated risk of overdosage.
SE: pruritus, constipation, nausea, vomiting, dizziness, HA, lightheadedness, somnolence, miosis, urinary retention
oxycodone
Brand: Oxycontin, M-Oxy
Class: Analgesic, Opioid
Indication: Management of pain
MOA: Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; produces generalized CNS depression
BBW: Addiction, abuse, and misuse; life-threatening respiratory depression; accidental ingestion; neonatal opioid withdrawal syndrome; CYP450 3A4 interaction; concentrated oral solution
SE: drowsiness, dizziness, pruritus, constipation, N/V
hydromorphone
Brand: Dilaudid
Class: Analgesic, Opioid
Indication: Management of pain
MOA: Binds to opioid receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; causes cough supression by direct central action in the medulla; produces generalized CNS depression
BBW: Addiction, abuse, and misuse; life-threatening respiratory depression; accidental ingestion; neonatal opioid withdrawal syndrome
SE: constipation, N/V, asthenia, dizziness, HA, somnolence
oxymorphone
Brand: Opana, Opana ER
Class: Analgesic, Opioid
Indication: Management of pain
MOA: pure opioid agonist that is relatively selective for the mu receptor
BBW: addiction/abuse/misuse, respiratory depression, accidental ingestion, neonatal withdrawal, alcohol interaction
SE: drowsiness, dizziness, HA, pruritus, nausea, constipation, vomiting, fever
warfarin
Brand: Coumadin
Class: Vitamin K Antagonist
Indication: Ppx & tx of thromboembolic disorders and embolic complications (after Afib, prosthetic valves), adjunct to reduce risk of systemic embolism after MI
MOA: Inhibits synthesis of factors II, VII, IX, and X, proteins C & S; inhibits vitamin K epoxide reductase, which leads to vitamin K depletion.
BBW: Bleeding risk
SE: Bleeding, hemorrhage, alopecia
enoxaparin
Brand: Lovenox
Class: LMWH
Indication: acute coronary syndromes (UA, NSTEMI, STEMI), DVT prophylaxis for abd surgery, immobile patients, & following hip/knee replacement, acute DVT treatment
MOA: inhibits thrombin (IIa) and to a larger extent factor Xa
BBW: Spinal/epidural hematomas
SE: anemia, hemorrhage
dalteparin
Brand: Fragmin
Class: LMWH
Indication: ABD surgery postop DVT ppx; ACS; VTE in cancer; DVT ppx in hip replacements
MOA: inhibits Factor IIa (thrombin) and to a greater extent factor Xa by means of antithrombin
BBW: Spinal/epidural hematomas
SE: hematomas, injection site pain, thrombocytopenia
dabigatran
Brand: Pradaxa
Class: Direct Thrombin Inhibitor
Indication: DVT/PE treatment and ppx in pts who have been treated on a parenteral anticoag for 5-10 days, afib, ppx after hip replacement
MOA: prodrug; inhibits both free and fibrin bound thrombin. Inhibits coagulation by preventing thrombin mediated effects
BBW: premature discontinuation increases risk for thrombotic events; spinal/epidural hematoma
SE: GI symptoms, hemorrhage
epoetin alfa
Brand: Epogen, Procrit
Class: Erythropoiesis-Stimulating Agent; CSF
Indication: Treatment of anemia in cancer, CKD, zidovudine usage
MOA: Induces erythropoiesis by stimulating the division and differentiation of committed erythroid progenitor cells; induces the release of reticulocytes from the bone marrow into the bloodstream, where they mature to erythrocytes. There is a dose response relationship with this effect. This results in an increase in reticulocyte counts followed by a rise in hematocrit and hemoglobin levels.
BBW: CKD- increased risk of death, serious adverse CV reactions, stroke
Cancer- shortens overall survival and/or increased risk of tumor progression or recurrence
Perisurgery- increased risk of DVT
SE: HTN, fever, HA, pruritus, rash, N/V, injection site reaction, arthralgia, cough
darbepoetin alfa
Brand name: Aranesp
Class: Erythropoiesis-Stimulating Agent (ESA); CSF
Indication: anemia IN CANCER (nonmyeloid malignancies) & in CKD
MOA: Induces erythropoiesis by stimulating the division and differentiation of committed erythroid progenitor cells; induces the release of reticulocytes from the bone marrow into the bloodstream, where they mature to erythrocytes. There is a dose response relationship with this effect. This results in an increase in reticulocyte counts followed by a rise in hematocrit and hemoglobin levels.
BBW: CKD- increased risk of death, serious adverse CV reactions, stroke
Cancer- shortens overall survival and/or increased risk of tumor progression or recurrence
SE: HTN, peripheral edema, edema, abdominal pain, dyspnea, cough
fondaparinux sodium
Brand: Arixtra
Class: Factor Xa Inhibitor
Indication: DVT prophylaxis in hip/knee replacement, treatment of acute pulmonary embolism, treatment of acute DVT
MOA: Fondaparinux is a synthetic pentasaccharide that causes an antithrombin III-mediated selective inhibition of factor Xa. Neutralization of factor Xa interrupts the blood coagulation cascade and inhibits thrombin formation and thrombus development.
BBW: Spinal/epidural hematomas
SE: Anemia
filgrastim
Brand: Neupogen
Class: Hematopoietic Agent; CSF
Indication: febrile neutropenia ppx in myelosuppressive chemo recipients with nonmyeloid malignancies; AML following induction or consolidation chemo; neutropenia with BMT; Hematopoietic radiation injury syndrome; Peripheral blood progenitor cell collection and therapy; Severe chronic neutropenia
MOA: stimulate the production, maturation, and activation of neutrophils to increase both their migration and cytotoxicity.
BBW: N/A
SE: chest pain, fatigue, dizziness, pain, increased lactate dehydrogenase, increased uric acid, skin rash, splenomegaly, thrombocytopenia, petechiae, increased ALP, fever, ostealgia in lower back, epistaxis, cough, dyspnea, fever
tbo-filgrastim
Brand: Granix Class: Hematopoieic Agent; CSF Indications: neutropenia MOA: increases neutrophil counts and activity by binding to G-CSF receptors and stimulating differentiation commitment and some end-cell functional activation BBW: n/a SE: leukocytosis and bone pain
pegfilgrastim
Brand: Neulasta
Class: Hematopoietic Agent; CSF
Indication: hematopoeic radiation injury; To decrease the incidence of infection, by stimulation of granulocyte production, in patients with nonmyeloid malignancies receiving myelosuppressive chemo associated with a significant risk of febrile neutropenia
MOA: Stimulates the production, maturation, and activation of neutrophils, pegfilgrastim activates neutrophils to increase both their migration and cytotoxicity. Pegfilgrastim has a prolonged duration of effect relative to filgrastim and a reduced renal clearance
BBW: N/A
SE: ostealgia, limb pain
sodium ferric gluconate
Brand: Ferrlecit
Class: Iron Salt
Indication: iron deficiency anemia
MOA: Supplies a source of elemental iron necessary to the function of hemoglobin, myoglobin and specific enzyme systems; allows transport of oxygen via hemoglobin
BBW: N/A
SE: Hypotension, HTN, tachycardia, HA, dizziness, N/V/D, abnormal erythrocytes, injection site reaction, cramps, dyspnea
ferumoxytol
Brand: Feraheme
Class: Iron Salt
Indication: iron-deficiency anemia in adults with CKD
MOA: releases iron within vesicles in the macrophages of the liver, spleen, and bone marrow where it then enters into either the intracellular storage iron pool, or is transferred to plasma transferrin and is incorporated into hemoglobin by erythroid precursor cells
BBW: Fatal and serious hypersensitivity reactions
SE: diarrhea, nausea, dizziness, constipation, peripheral edema
