Adverse Effects Review for NAPLEX/CPJE
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| Hydralazine | Lupus-like Syndrome
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| Clonidine | DOC for HTN in pt on dialysis
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| Meperidine | Normeperidine is an active metabolite that builds up during renal dysfunction-causes seizures
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| Carbapenems (imipenim) | Seizures
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| carbamazepine | aplastic anemia
agranulocytosis
hepatotoxicity
Stevens Johnson Syndrome
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| Valproic Acid | hepatotoxicity
teratogenicity
pancreatitis
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| topiramate | oligohydrosis
glaucoma
weight loss
Kidney stones
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| zonisamide | oligohydrosis
stevens johnson syndrome
Kidney stones
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| lamotrigine | toxic epidermal necrosis (esp with VA)
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| vigabatrin | permanent vision loss
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| methyldopa | DOC for HTN in pregnancy
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| Ribavirin | Hemolytic Anemia
teratogenicity
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| exenatide (byetta)and liraglutide (victoza) | pancreatitis, dose limiting SE is nausea
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| Pancreatitis | byetta, victoza, valproic acid
stavudine, didanosine
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| oligohydrosis | topiramate, zonisamide
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| hepatotoxicity | valproic acid, carbamazepine, NNRTIs
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| Nevirapine (Viramune) | NNRTI-induces own metabolism
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| Protease Inhibitors | Fat maldistribution, hypertriglyceridemia, hyperglycemia, hyperlipidemia, nephrolithiasis
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| NRTIs | lactic acidosis and severe hepatomegaly
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| "D" NRTIs | Didanosine, Zalcitabine, Stavudine (cause pacreatitis, peripheral neuropathy, and lactic acidosis)
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| Lamivudine (Epivir) | Bone Marrow Suppression NRTI
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| Zidovudine (Retrovir) | BMS (neutropenia, and anemia)NRTI
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| Abacavir (Ziagen) | patients must be tested for HLA-B 5701 to determine risk for hypersensitivity. ANY rxns (rash, cough, N/V, fatigue)- D/C!!!!!!
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| What is in Combivir? | Zidovudine and Lamivudine (both NRTIs)
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| What is in Trizivir? | Zidovudine, Lamivudine, and Abavavir (All NRTIs)
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| HIV and pregnancy | avoid efavirenz, avoid combining stavudine and didanosine, and consider starting tx after the 1st trimaster
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| omalizumab (Xolair) | Anti IgE therapy indicated for severe persistent asthma patients who have frequent trips to the ER. SQ q 2-4 weeks. Most serious ADRs are malignancies and anaphylaxis. Injection site rxn 45% of the time because solution is viscous.
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| What should be inhaled swiftly? | DPIs- Pulmicort (budesonide) Flovent Diskus, Advair Diskus, Asmanex, Foradil (Formoterol) and Serevent (salmeterol)
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| Use bronchodilator and ICS. Which should you use first? | Use the bronchodilator first, wait several minutes then use the ICS-this will allow better penetration of the steroid
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| Therapeutic goal of theophylline? | 5-15mcg/ml (<15= no toxicity, >20 60% toxic and >30 80% toxic) SMOKING induces liver enzymes and will cause theophylline levels to decrease!!
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| Sx of methylxanthine toxicity | N/V, seizures, hyperactivity, ventricular arrhythmias (severe toxicity is not necessarily preceded by milder sx)
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| Zileuton (Zyflo) | hepatotoxicity (leukotriene modifier)
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| Amantadine (Symmetrel) | livedo reticularis (red mottling of the skin-affects 80% of patients)Increase dopaminergic transmission by unknown mechanism
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| Selegiline | Selective MAO-B inhibitor at doses <10mg/day-can decrease levodopa dose by 10-30% (after third dose)
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| Pramipexole (Mirapex)and Ropinirole (Requip) | Falling asleep during ADLs
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| Apomorphine (Apokyn) | SC only (IV admin can cause pulmonary embolism)
Will cause emesis-must pretreat with Trimethobenzamide or Domperidone-Start 3 days prior to use- NOT HT3 ANT-hypotension and loss of consciousness
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| Fluorouracil (Adrucil) | GI and diarrhea
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| Chemotherapy drugs with low risk of BMS | Asparaginase (Elspar), Vincristine (Oncovin), bleomycin and busulfan
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| Bleomycin (Blenoxane) and busulfan (Busulfex) | Pulmonary fibrosis, SOB; hyperpigmentation of skin
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| Cyclophosphamide (Cytoxan) | Metabolized to acrolein causes hemorrhagic cystitis at doses >1g/m2 ; give mesna at doses >1g/m2
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| Cytarabine (ara-C) | Keratitis, conjunctivitis; severe CNS toxicity in doses >1g/m2
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| Cisplatin (Platinol) | Ototoxicity, and CNS toxicity; acute and related emesis; nephrotoxicity (les with carbo; give IV fluids or amifostine)
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| Daunorubicin (Cerubidine), doxorubicin (Adriamycin), epirubicin (Ellence), idarubicin (Idamycin) | Cardiac toxicity if cumulative doses >400mglm2 for daun/dox but less for idarubicin and more for epirubicin; extravasation risk
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| Dexrazoxane | Used to Prevent cardiac toxicity during doxorubicin treatment or treat extravasation
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| Dactinomycin (Cosmegen) | Extravasation risk
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| Ixabepilone (Ixempra) | Peripheral neuropathy
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| Ifosfamide (Ifex) | Metabolized to acrolein causing hemorrhaguc cystitis; give mesna
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| Irinotecan (Camptosar; CPT11) | Severe acute and delayed diarrhea
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| Methotrexate | Mucositis; liver toxicity/fibrosis; leucovorin can be used for toxicity
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| Mechlorethamine (Mustargen) | Extravasation risk
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| Oxaliplatin (Eloxatin) | Oral pharyngeal paraesthia; peripheral neuropathy; avoid exposure to cold stimulus to avoid exacerbation
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| Streptozocin (Zanosar) | Insulin dependent diabetes (historically used to treat pancreatic cancer)
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| Docetaxel (Taxotere), Paclitaxel (Taxol) | Peripheral neuropathy (mainly paclitaxel); edema/fluid retention (mainly docetaxel)
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| Vinblastine (velban), vincristine (oncovin), vinorelbine (navelbine) | Peripheral neuropathy (vincristine>>vinblastine); extravasation risk; vincristine has less risk of BMS
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| Contraindications for Lithium | renal disease, severe cardiovascular disease, hx of leukemia, first trimaster of pregnancy
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| Monitoring parameters for Lithium | Thyroid (Lithium may cause hypothyroidism), SCr and BUN, CBC w/ diff (may cause leukocytosis or reactivate leukemia), electrolytes, ECG (may cause flattened or inverted T waves), urinalysis (may decrease specific gravity)
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| Lithium steady state levels | 4-5 days (half life=24h) maintenance: 0.8-1 mEq/L (draw the level weekly for 4 weeks and then monthly for 3 months
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| Lithium toxicity | 1.5-2.0mEq/L N/V, diarrhea, muscle weakness, fatigue, fine hand tremor, difficulty w/conc &memory
2-2.5mEq/L ataxia,lethargy,nyastgmus, worsening confusion, severe GI upset, coarse tremors, increase DTR
>3.0mEq/L coma,seizures, respir complic/death
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| Pernicious anemia- What deficiency causes this? | B12 (cyanocobalamin)-lack of intrinsic factor in stomach- vegetables have no B12-VEGANS HAVE 12 PROBLEMS-animal derived foods are rich in B12
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| Dose of cyanocobalamin | to treat prenicious anemia: 1000 mcg IM qd x 7 days then 1mg weekly for 1-2 months (until H/H return to normal) then once monthly
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| Thiamine deficiencys | (B1) leads to beriberi and Wernicke's encephalopathy
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| Niacin deficiency | Pellagra- rash sore mouth, diarrhea, mental deterioration
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| Vitamin D deficiency | rickets
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| Vitamin C deficiency | Scurvy-red spots on skin, gums hemorrhage, teeth fall out, hemorrhaging occurs in cells through out the body
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| Daily need for fluid and TBW | 30-35ml/kg; Females (60%) Males (50%)
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| Chromium (what does it do) | essential for incorporation of glucose into the cells and the intracellular metabolism of glucose-refractory hyperglycemia (check for chromium deficiency)
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| Non-isotonic solutions hurt the most when they are injected how? | SQ-in contact the longest and close to nerves
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| HEPA filters | remove 99.97% of air particles 0.3 microns or larger
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| Microdrip set | 60 drops/min (normal drip set is 15-20 drops/min)
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| Drugs that must be protected to light during administration | amphotericin, BiCNU (carmustine), furosemide, nitroprusside, vinblastin (velban), vincristine (oncovin)
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| Reopro (Abciximab) | Antiplatelet agent used for PCI
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| Benzyl Alcohol as solvent in injectables | causes a fatal syndrome "gasping syndrome" in premature infants
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| 3 drugs that are used in propylene glycol for injection | phenytoin, valium, and digoxin
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| SE of propylene gylcol for injection | hypotension, CV collapse, CNS depression (will cause gel formation with other solvents)
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| Only po DMARD? | Arava (leflunomide)
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| Leflunomide (arava) | hepatotoxicity, TEN/ SJS, immunosupp,
CI in women of child bearing age, use cholestyramine for fasting elimination (8g tid) otherwise stays in body for up to 2 years
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| hydroxychloroquine (Plaquenil) | retinopathy- used as antimalaria and RA
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| entanercept (Enbrel) | 50mg SQ weekly- Anti-TNF- watch for infections and neutropenia
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| Inlfiximab (Remicade) | IV q 2-8 weeks (anti TNF)-watch for TB
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| Adalimab (Humira) | SC qoweek (anti TNF)- watch for TB
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| rifmapin | used to tx TB with INH-May impart a red-orange color to urine,
feces, saliva, sputum, sweat, skin &
teeth - will permanently discolor soft
contact lenses.
hepatotoxicity
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| ethambutol (Myambutol) | Never use alone-used with other TB drugs to prevent the development of other resistant strains
(decreases visual activity), MAY PRECIPITATE GOUT
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| TPN in vein should next exceed what percent of glucose? | 10-12.5% peripheral
20-40% central
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| Amino Acid requirement | 1-1.5g/kg/d -AA are 16% N
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| Calcium Phosphate incompatibility | ALWAYS ADD Ca LAST! Can result in massive pulmonary emboli and death!
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| Pulmonary disease and TPN | avoid excess carbs-carbs cause higher CO2 production
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| Felbamate (Felbatol) | Aplastic anemia and hepatic failure
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| fenofibrates | gall stones, rhabdo, absolute CI in severe renal and hepatic dx
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| Niacin | hyperuricemia, decrease insulin sensitivity, rhabdo
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| long term effects of heparin | hyperkalemia, alopecia, and osteoporosis
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| Black box warning for LMWHs | Spinal/epidural hematoma formation
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