exam 2 medicines PP

cyclophosphamide po iv

MOA - form bond with dna, no cell division, dirupt cell replication

Class - alkylating nitrogen mustard

Use - ALL CLL AML CML hodgkin lymphoma, myeloma

AE - bone marrow supression, alopecia, thrombocytopenia, hemorrhagic cytitis (bladder injury and bleed)

Considerations - no contraception within 12 mo

Renal value

hydration

cisplatin iv

MOA - bind to nucleotides, arrest division G1

Class - alkylating platinum components

Use - metastatic testicular, ovarian, bladder cancel, lung, heard, neck

AE - nausea, vomitting, ototoxicity, nephrotoxicity, neuropathy, bone marrow supression

Considerations - renal monitoring

hydration before infusion

ototoxicity

methotrexate (PO, IV, CSF, IM)

MOA - block folic acid (b9) for replication, s phase

Class - antimetabolites antifolate

Use - MTX for rheumatoid arthritis

AE - bone marrow supression, thrombosis (clot formation), thrombocytopenia (bleeding risk)

Considerations - no pregnant, no 6mo after

limit etoh

bleeding monitor

fluorouracil IV

MOA - inhibit thymidylate synthetase, dna inhibition

Class - antimetabolites - pyrimide analong

Use - solid tumors

AE - immune system supression, less appetite, hair loss

Considerations - no pregnant

doxorubicin

MOA - apoptosis, cytotoxicity (slip btwn base pairs)

Class - anthracylcines

Use - hogkin, non hogkin, lymphoma, sarcoma, lung, stomach, breast, ovary, testes, thryoid

AE - bone marrow supression, cardiotoxicity

Considerations - heart failure or cardiomyopathy pt, monitor heart`

uric acid monitor

red discoloration of urine wear tear

vincristine, vinblastine

MOA - m phase cell cycle —> cell arrest apoptosis

Class - vinca alkaloid

Use - hogkins, non hogkin, lymphoma, kaposi sarcoma, breast and bladder cancer, vinblastine is testes

AE - neurotoxicity and peripherial neuropathy, bone marrow supression with vinblastine, alopecia

Considerations - muscular weakness

vincrestine - bone marrow sparing

central line infusion

tamoxifen

MOA - block estrogen

Class - estrogen blocker antagonist

Use - breast

AE - thrombocytopenia, hot flash, hypercalcemia, gi upset,pulmonary embolism (clot travel)

Considerations - contraception 2 mo after use

monitor DVT (leg swell), or PE (short breath)

no grapefruit

take with food/drink

leuprolide im subq

MOA - block androgen by lower estrogen

Class - gonadotropin releasing hormone agonist

Use - prostate cancer, male only

AE - less libido, gynecomastia, low sugar

Considerations - no pregnant

glucose lvl monitor

what to focus on for antineoplastic drugs

double flush fluids and dispose special hamper of body fluid rags

PPE

spill = clean specially

allkylating drugs

bone marrow supression

hydration for no nephrotoxicity

rigning in ears = ototoxicity

peripherial neuropathy can occur

Rifamycin

MOA: inhibit dna dependant RNA polymerase

Treat: infections

AE: discoloration urine, stool, and fluids

Monitor: LFTs

Considerations: contraceptive ineffective

Isoniazid

MOA: inhibit mycolic acid = cell wall

Treat: choice for TB

AE: peripheral neuropathy, hepatotoxicity

Monitor: LFT

Considerations:dont use if have liver disease

vitamin B6 helpful to take with this

use with other medications

pyrazinamide

MOA: Inhibit lipid and nucleic acid synthesis in mycobacteria

Treat: static or cidal

AE:

Monitor: LFT

Considerations: avoid in pregnant

dont use with hepatic (liver) disease and gout

streptomycin

MOA: protein synthesis

Treat:

AE: ototoxicity, nephrotoxicity

Monitor: LFT

Considerations: no pregnant

gout therapy steps

short term is less than 2 a year with NSAIDS, colchicine, glucocorticords

long term = uricosuric drugs

treat first indomethacin, colchicine, then prednisone cortisone or triamcinolone

long term - allopurinol, probenecid, pegloticase,

indomethacin

MOA: inhibit cox1 and cox2

class: NSAID

Treat: inflammation gout

AE: gi distress

Considerations: dont use with any other NSAIDS

dont use if kidney excretion is low

dont use with PUD

colchicine

MOA: inhibit b tubulin polymerization, prevent neutrophil function

class: antimiotic antigou inflammatory

Treat: inflammatory gout

AE: mild

Considerations: only use for gout

can be used with NSAID

effective in first 1-2 days

dont use kidney/renal

loading dose okay

no muscle weakness

steroid: prenisone, cortisone, triamcinolone

MOA: supress migration of PMN leukocytes, tighten capillary

class: corticosteroid

Treat: severe gout inflammatory

AE: insomnia, anxiety, hyperglycemia, weight gain, adrenal supression

Considerations: montior sugar in diabetes

monitor weight

poor wound heaing

short term use only bc adrenal supression

allopurinol (chronic gout)

MOA: lower uric acid levels thru inhibition of XO

class: xanthine oxidase inhibitor

Treat:

AE: mild

Considerations: liver enzyme monitor

renal impairment caution

allele HLA B 5801 = higher sensitivity

probenecid

MOA: inhibit protein transporter of urate = excrete more

class: uricosuric

Treat:

AE: pee more, kidney stone formation

Considerations: more kidney stone risk

hydrate

chronic gout

no use in kidney stones alr or CKD

pegloticase

MOA: uric acid to allantoin

class: urate oxidase enzyme

Treat:

AE: antibody development

Considerations: no heart failure

dont use with other uricosuric agent

use with NSAID/colchicine

infusions

severe iv

calcium and bone mineralization

biphosphonates

end in -dronate

MOA: inhibit osteoclasts function (pre too), non hormonal

treat: osteo

AE: esophagitis, ocular inflammation, osteonecrosis of jaw

considerations: empty stomach with lots water and sit 30 min for esophagitics

cautio renal

once a week

report eye changes

raloxifene po

MOA: bind to estrogen for agonst (release opg = less resorb)

class: hormonal SERM

treat: osteo

AE: hot flashes, thrombosis

considerations: no cardiovascular risk

immobility and risk with this med

teriparatide sq

MOA: stim blasts = up mineralization and calcium

class: hormonal, pth

treat: osteo

AE: osteosarcoma risk, avoid with risk of cancer

considerations: paget disease patient

hx cancer or radiation

sq daily

pain

acetaminophen

MOA: lower prostaglandin (lower pain fever)

class: antipyretic

treat: mild to moderate nociceptive pain, fever

AE:

considerations: 15g fatal bc hepatotoxicity, centrilobular necrosis, renal tubular necrosis

hidden in other otc meds

more than 4g can abnormal liver

aspirin

MOA: inhibit cox 1 2 thru block site

class: ASA

treat: mild to moderate

AE: thrombocytopenia, bleeding, gastric ulcers

considerations: caution in gi PUD

acute bleeding monitor

no asa and nsaid

protective dosing for cardio system (low dose)

avoid in peds

ibuprofen

MOA: less prostaglandin made, block cox

class: NSAID, analgesic, antipyretic

treat:

AE: ulceration, cardiovasc clot

considerations: no renal disease

prolong bleeding time

caution more than 2 wk

naproxen

MOA: inhibit cox 1 2

class: NSAID

treat:

AE: ulcers

Consideration: protein bound

caution renal disease

prolong bleeding time

caution 2 week use

tramadol

MOA;bind on mu receptors = inhibit pain pathways + inhibit norepi

class:opioid analgesic

treat: analgesic

AE: constipation, lethargy

considerations: caution for bleeding disorder, renal and hepatic disease

monitor renal and liver

avoid alc for anything opioid

monitor bowels and urine

morphine

MOA; mu and kappa to slow transmission

class: opioid agonist

treat: mod to servere pain, end of life

AE: respiratory depression, hyptotension

considerations: dont open/crush

monitor vitals

potential abuse

no alc, look at bowels and urine

hydromorphone

MOA; bind to opioid receptors = inhibit pain pathways

class: opioid analgesic

treat: moderate to severe pain

AE: respiratory depression, ortho hypoten

considerations: higher potentcy

beers critera

monitor abuse and dependance

monitor pee poo, no alc

fentanyl iv im top po

MOA; mu kappa, bind to receptor sites in cns, inhibit pain pathways, higher pain tolerance

class: anilidopiperidine opioid

treat: moderate to severe pain (post op)

AE: resiratroy depression (frozen), ortho hypo

considerations: vital sign and conciousness lvl monitor

look at pee poo

MCG not MG

hydrocodone with acetaminophen

MOA; bind to opioid receptors, supress cough

class: opioid analgesic

treat: mod to sev

AE:resp dep, ortho hypo

considerations: lower dose for naive pt and geriatric pt

with food/milk

monitor vital sign and concious

look pee poo

codeine

MOA; bind to opioid receptors, supress cough, CNS depression

class: opioid, antitussive

treat: mod post op pain, cough, dental pain

AE: resp dep

considerations: abuse

vitasl sign and conciousness

pee poo

beers criteria

buprenorphine sl sq top im iv

MOA; mu block kappa, partial mu agonist at high doses then antagonist after

class: mixed antagonist and agonist

treat: opioid withdrawal

AE:resp dep ortho hypo

considerations: LFT, vital signs

naloxone

MOA; mu kappa

class:antagonist

treat: reverse resp dep and opioid addicition, overdose, toxicity

AE: up BP, temors, agression

considerations: monitor RR

keep equitment avail

only work for opioids

Mu?

analgesia, resp dep, sedation, euphoria, physical dep, less gi motility

kappa?

analgesia, sedation, less gi motility