UNIT 3 DRUGS

methotrexate (MTX) - Class

Class - Folic acid antagonist

methotrexate (MTX) - IND

IND - cancers

methotrexate (MTX) - MOA

MOA - antimetabolite, anitneoplastic, replaces folate in key process, inhibits lymphocyte production

methotrexate (MTX) - AE

AE - death, burning mouth syndrome, NVD, alopeica, high emetic potential, tumor lysis syndrome, plamat plantar erythrodysesthesia, steven johnson syndrome

methotrexate (MTX) - NC

NC - rescue drug = leucovorin; converts repidly to active folate (B9) and helps to preserve healthy cells, assess for liver side effects

methotrexate (MTX) - Contras

Contras - nitrous oxide use, alcohol abuse, peritoneal dialysis, creatinine clearance less than 10 when not on dialysis

methotrexate (MTX) - BBW

BBW - embryofetal toxicity and death, hypersensitivity, impaired drug elim., cocontaiminant NSAID use, hepatotoxicity, pulmonary toxicity, GI toxicity, malignant lymphoma, tumor lysis syndrome, skin rnx, opportunistic infxns, cocontaminant radiotherapy

methotrexate (MTX)

class - folic acid antagonist

IND - cancers

MOA - antimetabolite, antineoplastic, replaces folate in key processes and inhibits lymphocyte production

AE - death, burning mouth syndrome, NVD, alopecia, high emetic potential, tumor lysis syndrome, palmar plantar erythrodysesthesia, steven johnson syndrome

NC - rescue drug = leucovorin which converts rapidly to active Folate (B9) to preserve healthy cells, assess for liver side effects

BBW - embryo-fetal hepatotoxicity and death, hypersensitivity, impaired drug elim., cocominant NSAID use, heaptotoxic, pulmonary toxic, GI toxic, malignant lymphoma, tumor lysis syndrome, skin rxns, opportunistic infxns, cocominant radiotherapy

fluorouracil (5-FU, Efudex(topical), Adrucil(systematic)) - class

class - pyramidine antagonist

fluorouracil (5-FU, Efuedx(topical), Adrucil (systematic) - IND

IND - topical: actinic or solar keratosis, basal or squamous cell CA

• systematic: breast, colon, gastric or pancreatic CA

fluorouracil (5-FU, efudex, adrucil) - MOA

MOA - synthetic analouge of uracil that incorporates into RNA synthesis stopping it.

fluorouracil (5-FU, Efudex, Adrucil) - AE

AE - Skin rxns, BMS, cardiotoxic, gastrotoxic, neurotoxic, hyperammonemic encephalopathy, palmar plantar erythrodysesthesia

fluorouracil (5-FU, efudex, adrucil) - NC

NC - enhanced effect on PT/INR with oral anticoagulants (warfrin)

fluorouracil (5-FU, efudex, adrucil)

class - pyramidine antagonist

IND - topical: acticnic and solar keratosis, basal and squamous cell carcinoma

• Systematic: breast, colon, gastric, rectal, pancreatic CA

MOA - synthetic analouge for uracil that incoroporates during RNA synthesis to stop it.

AE - skin rns, BMS, cardiotoxic, gastrotoxic, neurotoxic, hyperammonemic encephalopathy, plamar-plantar erythrodysesthesia

NC - enhanced effects on PT/INR when taken with anticoagulants (ex: warfrin)

paclitaxel (Taxol) - Class

class - mitotic inhibitor taxoid (plant alkaloid) - plant derived

paclitaxel (Taxol) - IND

IND - cancer

paclitaxel (Taxol) - MOA

MOA - halts the formation of functional microtubules

paclitaxel (Taxol) - AE

AE - lower emetic potential, alopecia, arthralgia, myalgia, flushing, dysrythmias, neuropathy, stomatstis

paclitaxel (Taxol) - NC

NC - extravasation, hydrophobic oil solution, s/sx anaphylaxis - give bendryl, reduce gastric acid - give famotidine(pepcid)

paclitaxel (Taxol) - contras

Contras - ALT/AST >10 x, ULN, ANC <1500, sesnstivity to castro oil

paclitaxel (Taxol) - BBW

BBW - only perscribed by physician, anaphylaxis (premedicate), Burning mouth syndrome: ANC <1500

paclitaxel (Taxol)

Class - mitotic inhibitor taxoid (plant alkaoid - plant derived)

IND - Cancer

MOA - halts formation of functional tubules

AE - lowere emetic potential, alopecia, arthralgia, myalgia, dysrythmias, stomatits, neuropathy, flushing

NC - extravasation, hydrophobic oil solution, for s/sx of anaphylaxis - give bendryl, for too much gastric acid - give famotidine (Pepcid)

contras - ALT/AST >10, ULN, ANC <1500, sensitivity to castor oils

BBW - only perscribed by experienced physician, anaphylaxis, burning mouth syndrome: ANC < 1500

irinotecan (Camptosar/Topotecan) - class

Class - topoisomerase inhibitor 1

irinotecan (Camptosar/Topotecan) - IND

IND - Cancer

irinotecan (Camptosar/Topotecan) - MOA

MOA - binds to topoimerase 1 in S phase breaking DNA strands

irinotecan (Camptosar/Topotecan) - AE

AE - cholinergic syndrome, alopecia, thromboembolism, moderate emetic effect

irinotecan (Camptosar/Topotecan) - NC

NC - given with 5-FU & leucovorin, treat diarrhea w/ atropine then loporemide, contrindicated w/ laxatives and diuretics

irinotecan (Camptosar/Topotecan) - contras

Contras - Billiruben >2, GI obstruction, myelosuppression

irinotecan (Camptosar/Topotecan) - BBW

BBW - Bone marrow suppression, life threatening acute cholinegic diarrhea, or delayed diarrhea

irinotecan (Camptosar/Topotecan)

Class - topoisomerase inhibitor 1

IND - Cancer

MOA - binds to topomerase 1 in the S phase to break DNA strands

AE - cholinergic effects, Alopecia, thromboembolism, moderate emetic potential

NC - taken with 5-FU and leucovorin, treat diarrhea w/ atropine then loperamide, contraindication for diuretics and laxatives

Contras - Bilirubin >2, myelosuppression, GI obstruction

BBW - bone marrow suppression, life threatening acute cholinergic diarrhea or delayed diarrhea

cisplatin (Platinol) - Class

Class - alkylating antineoplastic

cisplatin (Platinol) - IND

IND - Cancer

cisplatin (Platinol) - MOA

MOA - alters DNA by adding alkyl groups, stopping replication

cisplatin (Platinol) - AE

AE - neurotoxic, nephrotoxic, ototoxic, liver enzyme inc., pancytopenia

cisplatin (Platinol) - NC

NC - extravasation, reacts w/ aluminum dec. potency

cisplatin (Platinol) - Contra

Contra - hyerpsenstivitiy to platinum

cisplatin (Platinol) - BBW

BBW - bone marrow suppression, severe NV, neutropenia, peripheral neuropathy

cisplatin (Platinol)

Class -alkylating antineoplastic

IND - Cancer

MOA - adds alkyl groups to DNA to prevent replication

AE - neurotoxic, nephrotoxic, ototoxic, pancytopenia, liver enxymes

NC - extravasation, reacts w/ aluminum dec. potency

Contras - hypersensitive to platinum

BBW - bone marrow suppression, severe NV, nephrotoxic, peripheral neuropathy

doxorubican (Adriamycin) - Class

Class - cytotoxic antibiotic

doxorubican (Adriamycin) - IND

IND - Cancer

doxorubican (Adriamycin) - MOA

MOA - inserts between DNA strands, stopping synthesis and breaking strands

doxorubican (Adriamycin) - AE

AE - hepatotoxic, cardiotoxic, dysrhytmias, HF, NV, alopecia, 11% anaphylactic infusion rxns

doxorubican (Adriamycin) - NC

NC - assess IV Q1hr, cardiac monitoring, cardiac fxn assessment, cumulative dose restrictions

doxorubican (Adriamycin) - contras

Contras - bilirubin >5, recent MI, arrythmia, severe myocaridal insufficiencey, severe myelosuppression

doxorubican (Adriamycin) - BBW

BBW - bone marrow suppression, cardiomyopathy, necrotic extravasation, secondary malignancy

doxorubican (Adriamycin)

class - cytotoxic antibiotic

IND - cancer

MOA - Inserts into DNA strands, inhibiting synthesis, stopping replication

AE - cardiotoxic, hepatotoxic, NV, alopecia, dysrhytmias, HF, 11% anaphylaxis infusion rxn

NC - Asses IV Q1hr, cardiac assessment, cardiac fxn, cumulative dose rxns

Contras - Bilirubin >5, recent MI, arrhythmias, severe myeolsuppresion, severe cardiomyopathy

BBW - bone marrow suppression, cardiomopathy, nectrotic extravasation, secondary malignancy

bevacizumab (Avastin) - Class

Class - angiogenesis inhibitor (first in its class)

bevacizumab ( Avastin) - IND

IND - Cancer

bevacizumab (Avastin) - MOA

MOA - targeted to protect healthy cells, attacks and inhibites vascular endothelial growth factor, preventing tumor angiogenesis

bevacizumab (Avastin) - NC

NC - bleeding risk with surgery and up to 28 days before or after surgery

bevacizumab (Avastin) - AE

AE - HTN, pulmonary hemorrhage, wound dehisance, leukopenia, thrmobocytopneia, GI bleeding, GI perforation, fatal hemorrhage

Bevacizumab (Avastin) - Contra

Contra -unctrolled htn, hemorrhage, major surgery within 28 days of taking, fistula, GI perf, recent hemoptysis

bevacizumab (Avastin) - BBW

BBW - GI perforation, Surgery and wound healing complications, hemorrhage

bevacizumab (Avastin)

Class - angeiogenesis inhibtor

IND - Cancer

MOA - targeted to protect healthy cells, attacks and inhibitrs vascular endothelial growth factors to prevent tumor agniogenesis

AE - HTN, pulmomnary hemorrhage, wound dehesence, Leukopenia, thrombocytopenia, GI bleeding, GI perforation, Fatal hemorrhage

NC - bleeding during surgery, bleeding risk within 28 days before or after surgery

BBW - GI perforation, surgery and wound healing complications hemorrhage

fligastrin (Neupogen) - IND

IND - severe neutropenia

fligastrin (Neupogen) - MOA

MOA - hematopoeitic, granulocyte colony stimulating factor stimulates the production of WBC

fligastim (Neupogen) - AE

AE - fever, splenic rupture( w/ left/abd shoulder pain) myalgia, bone pain, flushing, leukocytosis

fligastrim (Neupogen) - NC

NC - given for infxn but not given 24hrs before chemo, place on neutropenic precautions, given SubQ

fligastrim (Neupogen)

IND - severe neutropenia

MOA - hematopoeitic, granculocyte colony stimulatign factor stimulates the production of WBC

AE - feverl, splenic ruptures (left abd/ shoulder pain), myalgia, bone pain, flushing, leukocytosis

NC - given before infxn but not 24hrs before chemo, place on neutropenic percautions, given subQ

macrolides and ketoliedes - meds

• include meds with -thromycin ending

• erythrormycin(erythrocin), clarithromycin(Klacid), azithromycin(Z-pack)

macrolides and ketolides - IND

IND: skin/tissue, ear, sinus, infxns, STI, empiric trtmnt of PNA if allergic to penicillin

Macrolides/ketolides - MOA

MOA - Protein synthesis inhibitor, bacteriostatic in nature but bacteriocidal in large amount

Macrolides/Ketolides - AE

AE - porlonged QT interval, C-diff, hepatotoxic, ototoxic

macrloides/ketolides - NC

NC - monitor liver enzymes, take w/ food, avoid use w/ of QT prolonging meds

macrolides/ketolides

Class - drugs end w/ -thromycin

IND - Skin/tissue, ear, sinus infxn, STI

MOA - Porton synthesis inhibitor, bacteriostatic by nature, bacteriocidal in large amounts

AE - prolonged QTI, C-diff, heptotoxic, ototoxic,

NC - monitor liver enzymes, take w/ food, avoid use w/ of QTI prolonging meds

Fluoroquinolones - class

Class - drugs ending in -floxacin

• ciproflaxin(Cipro), levoflaxin(Levaquin), Norflaxacin (Noroxin), moxifloxacin (Avelox), Delafloxacin(Baxdela)

fluoroquinolones - IND

IND - pontent and broad spectrum

fluoroquinolones - MOA

MOA - interfere w/ bacterial DNA synthesis via gyrase and topoisomerase

fluoroquinolones - AE

AE - Prolonged QTI, super infxn, poor intrxn w/ antidysrhythmics, HA, dizzy, insomnia, hypoglycemia, psychosis, SI, hepatotoxicity

fluoroquinolones - NC

NC - admin 2hrs before/after antacid w/ Al, Mg, sucralfate, metal cations, multivitamins w/ Zc or didanosine, chewable/buffered tablets, pediatric powders

fluoroquinolones - BBW

BBW - tendon rupture, tendonitis, peripheral neuropathy, seizues, myasthenia gravis exacerbation

fluoroquinolones

class - end in floxacin

IND - potent broad specturm

MOA - interfer w/ bacterial DNA synthesis via toposoimerases, gyrase

AE - prolong QTI, superinfection, poor interact antidysrythmias, HA, dizzy, hypoglycemia, Psychosis, SI, insomnia, hepatotoxicity

NC - admin 2 hrs before antacid w/ Mg,Al, sulcrafate, metal cation, multivitamin w/ Zc, didanose, chewable tabs, pediatric powder

BBW - tendon rupture, tendonitis, periph. neuropathy, seizures, exacerbation myasthesia gravis

tetracyclines - class

Class - meds end in -cycline

• demeclocycline(Declomycin), doxycycline(Vibramycin), minocyclin(Minocin), tigecyclin(Tygacil)

tetracycline - IND

IND - resp infxn, acne, UTI, STI, cholera

tetracycline - MOA

MOA - inhibits bacterial protsyntehsis (bacteriostatic)

tetracycline - AE

AE - photosensitive, candidiasis, TTP, anemia, altered coag.

tetracycline - NC

NC - admin 1-2hrs before or 4hrs after antacid, avoid dairy, avoid breastfeeding, pregnant, children < 8

Tetracyclin

Class - ending in - cycline

IND - Resp. infxn, acne, STI, UTI, cholera

MOA - blocks bacterial protein synthesis (Bacteriostatic)

AE - photosensetive, candidiasis, TTP, anemia, altered coagulation

NC - admin 1-2hrs before or 4hrs after antacid, avoid dairy, avoid breastfeeding, pregnant, children < 8

sulfonamides - class

Class begin w/ Sulfa/Sulfi or end in zine/zole

sulfonamides - IND

IND - Resp., GI infxns, UTI

sulfonamides - MOA

MOA - prevent synthesis of folic acid needed for synthesis of purines/nucleic acids

sulfonamides - AE

AE - hemolytic/aplastic anemia, thrombocytopenia, photosensetive, exfoliative dermatitis, SJS, epidermal necrolysis, NVD, pancreatitis, HA, toxic nephrosis, neuritis

sulfonamides - NC

NC - cross reactive: sulfonylureas, thiazides, loop diuretics, eval. renal fxn, encourage fluid intake (2-3L), inc. toxic w/ phenytoin/warfrin, avoid pregnant, under 2yrs old, sunscreen essential

sulfonamides

Class - end in -Zine/Zole, start with Sulfi/Sulfa

IND - resp., GI infxns, UTI

MOA - inhibits synthesis of folic acid neeeded for synthesis of purines/nucleic acid

AE - hemolytic/aplastic anemia, thrombocytopenia, photosensitive, exfoliative dermatitis, SJS, NVD, HA, epidermal necrosis, pancreatits, epidermal necrosis, neuritis

NC - cross reactive: thiazide, loop diuretics, sulfonylureas, check liver fxn, encourage fluid intake (2-3L), warfrin/phenyotin inc. toxicity, avoid pregnants, child <2, sunscreen essential

Aminoglycosides - Class

Class - Meds that end in -CIN

aminogglycosides - IND

IND -

aminoglycosides - MOA

MOA - prevent protein synthesis - potent bactericidal

aminoglycosides - AE

AE:

• Nephrotoxic - cure with hydration, dose adjustment

• ototoxic - hearing and balance possibly permanently affected

  • Neurotoxic - ALOC, depression, NM paralyisis

aminoglycosides - NC

NC - poor enteral absorptio, synergistic effect, monitor renal fxn, monitor creatinine lvl

aminoglycosides

Class - end in CIN

IND

MOA - blocks protein synthesis - potent bacteriocidal

AE - Nephrotoxic - cured w/ dehydration, dose adjustment, Ototoxic - hearing and balance possibly permanently altered, Neurotoxic - ALOC, depression, NM paralysis

NC - poor eneteral absorption, check renal fxn, check creatanine lvls

Glycopeptide - drug

drug - vancomycin (Vancocin)

glycopeptide - IND

IND -

glycopeptide - MOA

MOA - damages cell wall - bacterialcidal

glycopeptide - AE

AE - nephro, oto, neurotoxic, pancytopenia, redman syndrome

glycopeptides - NC

NC - rapid infusion cause hypotn, vanco infusion syndrome (redman syndrome), check peaks and troughs, check ototoxicity

glycopeptides - BBW

BBW - embryonic/fetal toxic

glycopeptides

Meds - vancomycin

IND

MOA - blocks protein synthesis - bacteriocidal

AE - neuro, otto, nephrotoxic, pancytopenia, red man syndrome

NC - rapid infusion = hypotnsn, redman syndrome, check peaks and troughs, check ototoxicity

BBW - embryo/fetal toxicity

Nitroimidazoles - Class

class - end in -nidazole

Nitroimidazoles - IND

IND -

Nitroimadazoles - MOA

MOA - disrupt DNA synthesis of anaerobic bacteria and protozoa with free radicals that kill cells