pharm exam 2

from reduced blood flow to the kidneys

ex. Hypovolemia, hemorrhage, reduce cardiac output, medication, infection (sepsis)

blockage by BPH, nephrolithiasis, pelvic tumor

Be careful about giving NSAIDs to an elderly patient who is also on an ACE or ARB.

dopamine

Kidneys are responsible for the regulation of fluid and electrolyte balance, regulation of acid-base balance, activation of vitamin D and production and secretion of erythropoietin (EPO)

NOTE: should not give if Hgb is higher than 10 and should stop once Hgb gets to 12. Studies have shown that prolonged use of EPO stimulating agents is associated with increased mortality.

Important to monitor Ca, Phosphorus and PTH serum levels
Non-pharmacotherapy: dietary phosphorus restriction, parathyroidectomy (monitor Ca levels carefully after this procedure, since Ca levels can drop immediately), avoid giving aluminum containing antacids in patients with GFR < 30, due to risk of aluminum toxicity and potential uptake into the bone

ringer's Lactate

do not give to liver dx- can cause lactic acidosis

Therapy: 0.9% NS or LR (long term infusion of LR or over hydration with NS can lead to acidosis)

Low molecular weight and high molecular weight dextran are also plasma expanders, but also have a high risk of hypersensitivity and bleeding.
Studies have shown that infusing colloids have found no increased benefits over crystalloid use in preventing mortality.

hyponatremia

hypervolemic hyponatremia

SIADH

hypovolemic hyponatremia

treatment would be with 0.9%, 3% or 5% NS. Rapid replacement of sodium can cause central pontine myelinolysis causing severe neurologic damage. Symptoms of sudden hypernatremia are confusion, hallucinations, decreased skin turgor, intracranial bleed and/or coma or death

may cause arrhythmias

catalyzes and activates more than 300 enzymes, provides neuromuscular stability and is involved in myocardial contraction (usually not gotten with standard electrolyte panel and might need to be ordered separately

can also be used for tx. Of status asthmaticus, premature labor (short duration), migraines and torsades

A treatment regimen usually consists of bismuth subsalicylate (pepto-bismol), metronidazole (flagyl), tetracycline and a PPI like omeprazole or pantoprazole

cimetidine

Note: H2 Blockers are sometimes also given for allergic reactions along with an H1 blocker
Note: in 2020 the original ranitidine was taken off the market because it contained higher levels of the carcinogen N-nitrosodimethylamine (NDMA). Now it is being marketed over the counter as Zantac 360 which contains famotidine instead of ranitidine
Note: Use H2 blockers with caution in elderly with renal insufficiency, can cause dementia, change in mental status
Note: No significant finds that high doses of cimetidine can kill warts!
Note: famotidine is stronger than cimetidine or nizatidine for treating gastritis

Side/Adverse effects: decreased effectiveness of clopidogrel, increased risk of fractures if use for 1 year or more, low Vitamin B12 absorption, diarrhea, C. Diff colitis, hypomagnesemia, increased incidence of pneumonia, headache, nausea

Note: PPIs should be taken regularly to be effective

CONTRAINDICATION: Pregnancy - can cause uterine contractions. One of the drugs used for 1st trimester abortions.

Side/Adverse effects: aluminum hydroxide tends to cause constipation and magnesium hydroxide causes diarrhea, use cautiously in patients with renal insufficiency - meds can accumulate

Note: GI cocktail - mixture of Maalox and viscous lidocaine. Studies have shown that adding lidocaine does not significantly reduce the discomfort of gastritis

pepto bismol

Apple cider vinegar
Ginger
Aloe vera juice
Bananas
Turmeric
DGL (deglycyrrhizinated licorice)
D-limonene
Honey
Marshmallow
Slippery elm

Other remedies available include lifestyle changes, such as:
Avoid trigger foods
Eat smaller meals
Don't eat within three to four hours of bedtime
Aim for and maintain a healthy weight
Change your sleep position or elevate the head of your bed
Avoid tight-waisted clothes
Decrease stress
Quit smoking, if you smoke

drowsiness, dizziness, tardive dyskinesia (Reglan, Compazine), headache (Zofran), prolonged QT (Phenergan)

diphenoxylate (Lomotil), loperamide (Imodium)

can cause uterine contractions

(Mesalamine enema and suppository - (need to retain at least for 8 hours)

headache, nausea, fatigue, hemolytic anemia, immunosuppression, nephrotoxicity, fever, rash, Stevens-Johnson syndrome, decreased folate absorption, diarrhea

immunosuppression

folic acid

help maintain remission in active Crohn's and reduce the need of steroid use

•These meds can also cause hypokalemia by moving K intracellular. They can also increase or decrease blood sugar. In insulin dependent diabetics in can cause hypoglycemia, in non-insulin dependent diabetes they can increase blood sugar

Rescue inhaler, asthma attacks

Has no anti-inflammatory effects

•Drugs of choice for long-term control of patients with asthma or COPD, allergic rhinitis
•Steroids have direct anti-inflammatory properties in the airways, but must be used regularly to achieve this effect. Can also be given orally or IV or IM

•IV or IM corticosteroid is usually methylprednisolone (125mg usual dose)
•Dexamethasone IV can be given PO to pediatric children suffering with an acute asthma attach, provided they can tolerate PO. Sometimes given after a respiratory treatment (0.6mg/kg maximum 16mg)

•Singulair has a new black box warning: potential change in behavior/mood including suicidal ideations, aggression, depression, hallucinations, sleep disorders. The FDA is now saying use alternate drugs if possible.

•Action: is an anti-inflammatory agent that inhibits mast cell degranulation and the release of histamine. Not a bronchodilator.

•NOT used for an acute asthma attack because it's not a bronchodilator

•Use: Asthma, COPD. However, mostly replaced by B2 agonists and ICS due to its narrow therapeutic window, adverse effects profile and potential drug interactions
•Side/adverse effects: tremors, tachycardia, seizures, arrhythmias

•LABAs - aformoterol (Brovana), Formoterol (Foradil, Performist), Indacaterol (Arcapta), olodaterol (Striverid Respimat);
• LAMAs - aclidinium (Tudorza pressair), glycopyrrolate (Seebri), tiotropium (Spiriva), umeclidinium (Incruse ellipta)
•Roflumilast (Daliresp) - a PDE4 (an enzyme linked to COPD progression) inhibitor, is NOT a bronchodilator so it will not relieve bronchospasm.
•Inhaled or oral corticosteroids - only recommended in acute exacerbation. Long term use for these patients can lead to immunosuppression and pneumonia

•Diphenhydramine (Benadryl) and chlorpheniramine (Chlor-trimeton) can also be used by has side effects of drowsiness, tachycardia. Constipation, diarrhea, n/v, depression or excitation

•Afrin used more than 3 days can cause rebound nasal congestion called rhinitis medicamentosa

•A common disorder that usually occurs between the ages of 12-24 years of age due to increased androgen production

•clindamycin (ex. Cleocin-T solution or gel), erythromycin (cream, lotion or gel)
•Side effects: burning, itching, redness, skin sensitivity

•doxycycline, minocycline, erythromycin, azithromycin
•Side/adverse effects: GI disturbance.
Shorten dose time and amount and stop when acne is cleared

•ADVERSE side effect: psychiatric changes, birth defects (category X) drug

•a lotion that interferes with bacterial growth and is combined with sulfur

•Side/adverse effects: hypersensitivity to sulfonamide products, Stevens-Johnson syndrome, topical epidermal necrolysis, erythema, skin sensitivity
•Also used in medication for bacterial conjunctivitis, seborrheic dermatitis, bacterial infection of the skin

mupirocin

•Major side/adverse effect is IMMUNOSUPPRESSION THAT CAN LEAD TO INCREASED RISK OF INFECTION

•- DO NOT USE IN PREGNANCY, DO NOT GET PREGNANT FOR 3 YEARS AFTER DISCONTINUING THIS DRUG, NO ALCOHOL WITH THIS DRUG.
•Adverse effect: teratogenic, cheilitis, pruritis, hyperlipidemia

severe psoriasis

used in psoriasis

•Adverse effects: Long term use of constant topical steroids use are skin atrophy, striae, acne, dermatitis, hypopigmentation
•In children, prolonged use can cause depression of the hypothalamic-pituitary-adrenal axis and growth retardation

•Contraindication: This drug should NOT be handled by pregnant women as it can cause hypospadias in the male fetus.

•Rare adverse effect: Cutaneous T-cell lymphoma

•oral med used off-label in smaller dose (risk of infection, nephrotoxicity, GI disturbance) Med usually used tor the prevention of graft vs host disease, prevention of transplant rejection

• approved but try to avoid in children. Also, steroids over a length of time must be tapered ex. Prednisone, Medrol dose pack

•are the drug of choice for open angle glaucoma by increasing uveoscleral outflow - topical drops: bimatoprost (Latisse, Lumigan), latanoprost (Xalatan), tafluprost (Zioptan)
•Side /adverse effects: conjunctival hyperemia, irreversible darkening of the iris, thickening and darkening of the eyelashes, irritation, dryness, blurred vision

•Side/adverse effects: may have systemic effects of fatigue, dizziness, bradycardia and respiratory depression. Use with caution in patients with asthma, bradycardia or COPD

alpha agonists [plopidine, lumify, alphagan]

•Works by contracting the ciliary muscle leading to increased outflow of aqueous humor; Drug-pilocarpine
•Side/adverse effects: ciliary spasm that causes brow ache, decreased visual acuity in dim light, retinal detachment,
•Also used as emergency therapy with Acute Angle Closure Glaucoma

•can lower IOP by 25% but need 6-8 daily doses to sustain a decrease in IOP!

•Dry or non-neovascular from which forms the accumulation of drusen , which causes a slow reduction in central vision,
•90% of patients have this form
•No established treatment for this form of AMD

•Wet or neovascular form due to newly developed leaky vessels growing from the choroid into the subretinal space, which causes a rapid reduction in central vision, 10% of patients

•Given for wet or neovascular AMD
•Periodic intravitreal injections
•Drugs: ranibizumab (Lucentis), bevacizumab (Avastin), brolucizumab (Beovu), pegaptanib sodium (Macugen)
•Side/adverse effects: increased IOP, retinal detachment, loss of vision

•Sulfacetamide is not highly effective and can rarely cause Stevens-Johnson syndrome
•Neomycin causes sensitization and adverse effects
•Bacitracin and erythromycin are not good against gram-negative organisms
•Polymyxin B is only active against gram-negative organisms
•Trimethoprim (Bactrim) is good against MRSA infections
•Azithromycin (Zithromax) is good against gram positive infections
•All fluoroquinolones are active against most bacteria associated with conjunctivitis
•FIRST LINE TREATMENT: Erythromycin or trimethoprim/polymyxin B
•NEXT LINE OF TREATMENT: Bacitracin/polymyxin B or fluoroquinolone
•For those who wear contact lens and get conjunctivitis - fluoroquinolone

•Visine is not artificial tears - it is a vasoconstrictor to decrease eye redness, should not be used with glaucoma

Sometimes steroid eye drops are used for irritation relief, however, simply using steroid drops when the eye is infected with something like herpes, could cause issues of worsening epithelial keratitis!
If you suspect eye irritation to be caused by herpes, refer immediately to an ophthalmologist who will prescribe anti-viral eye drops (acyclovir) and/or steroid eye drops depending on how serious the problem is. These patients are watched closely since they can have loss of vision.

•olopatadine (Pataday), naphazoline/pheniramine (Naphcon, Clear eyes), ketotifen (Alaway), azelastine (Astelin), oxymetazoline (Afrin)

They also contain decongestants that relieve congestion by vasoconstricting blood vessels which in turn reduces mucus and erythema

•Side/Adverse effects: headache, blurred vision, stinging, eyelid swelling
•Besides eye drops patient can use OTC oral anti-histamines ex. Diphenhydramine (Benadryl), loratadine (Claritin), cetirizine (Zyrtec, fexofenadine (Allegra)

avoid if you suspect tympanic membrane rupture

Do not use aminoglycoside antibiotics drops if you suspect tympanic membrane rupture due to ototoxicity

Common side/adverse effects: drowsiness, dry mouth, dizziness, hypotension, tachycardia, mucous thickening, difficulty urinating/constipation

Common side/adverse effects: headaches, fatigue, sore throat, abd. Pain, nausea/vomiting

•If you suspect the patient may have a nasal infection ex. Staph, stop the steroid and use an antibiotic. Nasal application of Bactroban

PCN; •Penicillin V or Amoxicillin for 10 days; if the patient is PCN allergic, can try cephalosporins or doxycycline. More resistance with Bactrim and fluoroquinolones

•Pharyngitis can be caused by tonsilitis, tonsillar abscess, viral illness (Mononucleosis), STD - send a general throat culture, STD culture, Monospot (heterophile antibodies)

carbonic anhydrase inhibitors

•Baroreflexes act by changing the activity of the sympathetic and parasympathetic nervous system ex. A fall in BP causes baroreceptors in the carotid and aortic arch to send fewer impulses to the CV centers in the spinal cord. This prompts a reflex response with increased sympathetic and decreased parasympathetic response which then leads to vasoconstriction, increased CO, which results in increased BP

Renin converts angiotensinogen to angiotensin I and then to angiotensin II which causes potent vasoconstriction of the arterioles, increasing BP. Angiotensin II also stimulates the release of aldosterone, which increases renal reabsorption of sodium to also increase BP

•Activation of Beta 1 adrenoceptors of the heart leads to decreased CO, which leads to decreased PVR, which then decrease BP

oral meds may take several weeks to stabilized BP, IV meds can work faster

•Caution: beta blockers must be weaned off, abrupt stopping can cause an MI, severe HTN

•Metoprolol is usually the Beta Blocker drug of choice post-MI

•Used as first line agents to reduce HTN and give renal protection for patients with CVD, diabetes, stroke, heart failure, MI and chronic renal disease

•Serum K and creatinine levels should be monitored. It may bump up creatinine levels. There may be an initial bump of Creatinine levels about 30% above baseline.

ace inhibitors

•ACE inhibitors should be stopped if patient gets hyperkalemic and/or the creatinine level jumps higher than 30% of their baseline creatinine, or any indication the patient is progressing into renal failure

•Should not be used in patients with renal artery stenosis due to the efferent arteriolar vasodilatory effects of ACE inhibitors causing decreased renal function

•Similar to ACE, however, less coughing and both ACE and ARBS should NOT be given together

•Verapamil - constipation and 1degree AVB, Verapamil and Diltiazem -avoid in patients with heart failure due to its decreased chronotropic and dromotropic effects, all others - flushing, dizziness, HA, hypotension, peripheral edema

JNC 8 states that African American patients not use ACEI or ARB for blood pressure control

Still use for renoprotection

Agents are effective in DUAL therapy

•JNC 8 recommends that Black Americans should be given a thiazide and a CCB to control BP. However, every patient needs to be treated individually and if the CCB doesn't work, the provider can add an ACE inhibitor.

•used for gestational HTN and hypertensive emergencies

hypotension
•Stopping Clonidine abruptly can cause rebound HTN, so should be weaned off

•Note: can be used in patient with renal insufficiency since it doesn't doesn't decrease renal blood flow

•Methyldopa is mainly used for management of HTN during pregnancy

reflex stimulation of the heart (tachycardia) that could cause a cardiac event (MI, CHF, Angina

Can be used in pregnancy related HTN

Use to reduce BP, interacts with oxyhemoglobin to produce relaxation of vascular smooth muscle, more active on veins, which then reduces preload, but can also dilate coronary arteries

•most widely used diuretics because of their antihypertensive effect by its diuretic action, in addition to its ability to reduce PVR.
•Thiazides are sulfonamide derivatives, but generally do not cause hypersensitivity reactions in patients with Sulfa allergies

•Furosemide (Lasix) is the most commonly used loop diuretic, however, the use of bumetanide and torsemide is increasing since they have better bioavailability and are more potent.

best if given through IV

•Meds: ACE inhibitors, ARBs, aldosterone antagonists, B-blockers, diuretics, vasodilators, hyperpolarization-activated cyclic nucleotide-gated channel blockers, inotropic agents, combination of a neprilysin inhibitor with an angiotensin receptor blocker, recombinant B-type natriuretic peptide.

•hypotension, angioedema, ACE inhibitors must be stopped 36 hours before starting this med.

•Positive inotropic drugs increase cardiac contractility and increase cardiac output by increasing intracellular calcium. However, these meds, with the exception of digitalis, need to be used short-term to decrease the chances of morbidity/mortality.

•increased cardiac contractility, regulation of intracellular Na and Calcium, increases the force of contractility (positive inotropy), slows HR (negative chronotropy) so myocardial oxygen demand decreases, slows conduction through the AV node (decreased dromotropy)

digoxin has a very narrow therapeutic index and must be monitored carefully!

•hypotension, decreased CO, improve renal blood flow -such as in hemodynamic shock, sepsis, trauma, MI, sepsis

short term is recommended!

side effects: peripheral necrosis

•Use: cardiogenic shock, but not as useful in patients in heart failure unless it's being used to improve heart function until coronary revascularization, mechanical circulatory support or heart transplant

•Norepinephrine - potent alpha 1 activity leading to marked peripheral vasoconstriction!
•Use: primarily septic shock

•Epinephrine - has inotropic, chronotropic and vasoconstrictive effects -drug of choice during cardiac arrest to assist with spontaneous circulation
•Use: cardiac shock and arrest, anaphylaxis - avoid in MI due to it's effect of increased HR and contractility leading to increased myocardial demand

•Phenylephrine - alpha 1 agonist causing vasoconstriction
•Use in cardiac cath lab used to treat transient hypotension ex. During balloon angioplasty

•Tachycardia, arrhythmias, increase myocardial ischemia, hypertension

•These drugs are not used as often due to their proarrhythmic effects especially in patient with LVHF and atherosclerotic heart disease

class IB agents

Lidocaine, mexiletine

•Lidocaine has a wide therapeutic index and Mexitil has a narrow therapeutic index

•negative inotropic effects - mostly avoided unless refractory to other anti-arrhythmics

•sublingual NTG is the drug of choice for immediate relief of angina, works within 1-3 minutes (avoids first pass through the liver), isosorbide mononitrate (Imdur) works within 30 min and can last between 12-24 hours and stable against hepatic breakdown, isosorbide dinitrate (Isordil) onset within 5 min (SL) lasts about 1 hour or 30 min (PO) lasts about 8 hours.

•Other: Sodium Channel Blocker - Ranolazine used if angina is refractory to nitrates, works better in men than women and can prolong QT intervals.

animal products like meat, cheese, poultry, or fish

•Type 2 DM
•Metabolic syndrome
•Hypothyroidism
•Genetic condition
•Medication like diuretics, estrogen/progesterone, steroids, beta blockers, immunosuppressants

ASCVD score calculation 10 year risk will calculate your 10 year risk of heart disease or stroke. 5-7.5% are borderline risk, above 7.5% depending on age and co-morbidities are considered at risk. This is the information needed to calculate

statins

rosuvastatin, then atorvastatin, then simvastatin have the highest rate for LDL reduction; while atorvastatin and pravastatin have the highest rate of triglyceride production

•a person must consume approx. 1-3 grams of niacin to be effective - for most people this causes flushing, warmth and pruritis. Taking an aspirin prior to taking niacin can help. Other: abd. Pain nausea, slows the secretion of uric acid leading to increased levels which can cause gout.
•Should be avoided in patients with active liver disease and peptic ulcers

•GI disturbance, predisposition to forming gallstones (drug increases biliary cholesterol excretion, myositis,

•Gemfibrozil should not be used in combination with statins due to report of myopathy and rhabdomyolysis
•Both fibrates could increase the effects of warfarin
•Should not be used in patients with pre-existing hx of gallstones or biliary cirrhosis, hepatic or renal disease

•Patients with moderate to severe hepatic insufficiency should not use this drug since it is mostly metabolized and excreted through the liver and kidneys

•Prolong allograft (transplant) survival, treat various CA, treat RA, Lymphoma, Melanoma, IBS, MS

•monoclonal antibody that induces apoptosis (cell death) of the DHL 4 human B cell lymphoma cells, inhibits RA factor production, T-cell activation, and pro-inflammatory cytokine production of RA
•Use: Chronic lymphoid leukemia, non-Hodgkin's lymphoma, RA, Graft vs. Host disease, Thrombotic thrombocytopenia purpura, SLE
•Side/adverse effects: edema, anemia, fever, cardiogenic shock, GI bleed, reactivation of Hep B, nephrotoxic, rash, bronchospasm

•prevention of allograft rejection in renal, liver and heart transplantation. These drugs are sometimes used in conjunction with other immunosuppressants (corticosteroids)
•Side/adverse effects: nephrotoxicity, neurotoxicity, HTN, hyperglycemia, hyperkalemia

glucocorticoids and mineralocorticoids,

•The adrenal glands are located at the top of both kidneys and are responsible for producing hormones that regulate our metabolism, immune system, blood pressure and response to stress

•produces cortisol which helps control the body's use of fats, proteins and carbohydrates. It also suppresses inflammation, regulates blood pressure, increase blood sugar and decrease bone formation. Controls sleep/wake cycle, and our level of energy

•produces aldosterone (mineralocorticoid) that helps regulate our BP, blood pH by signaling out kidneys to absorb more sodium into our body while releasing more potassium into our urine, thereby regulating our electrolytes

•produces precursor hormone that are converted to estrogen in the ovaries and testosterone in the testes.

•controls the hormones responsible for the fight or flight mechanism - epinephrine and norepinephrine - increasing our HR, cardiac contractions, blood flow to the muscles and brain, glucose metabolism, vasoconstriction. Excess adrenaline causes pheochromocytoma

•(including endogenous cortisol) have primarily anti-inflammatory and immunosuppressive properties by inhibiting the production and activity of inflammatory cells, as well as re-distributing them to other parts of the body, leaving less inflammatory cells in the circulation

•(including endogenous aldosterone) work to balance salt and water in our bodies. Sodium is reabsorbed through our renal tubules, while potassium is excreted

•Various steroids have various potencies, as well as glucocorticoid and mineralocorticoid effects

•Uses: asthma, allergic rhinitis, uticaria, atopic dermatitis, COPD, musculoskeletal pain, lupus, IBD, multiple sclerosis, rheumatoid arthritis, osteoarthritis, organ transplant, COVID-19, autoimmune conditions, prevention of transfusion reactions (ex. Amphotericin), various skin conditions, uveitis, fetal lung development in premature infants

•increased appetite, weight gain, mood changes, glaucoma, increased growth of body hair, bruising, immunosuppression, acne, osteoporosis, increased blood sugar, insulin resistance, HTN, GI distress, insomnia, water retention, skin thinning (esp. if used on the face), nausea, redistribution of adipose tissue -buffalo hump), reduction in height due to suppressed bone growth if used in pediatrics, osteoporosis, leukocytosis (due to demargination when the WBCs migrate from the endovascular lining into the circulation. The overall numbers of WBCs do not increase. This makes ruling out an infection more difficult), increase intraocular pressure

it is metabolized to prednisolone in the liver, so may not be the best choice for someone with liver disease

give prednisolone instead

•Varicella and measles can be more serious with steroids because of immunosuppression

•Patients receiving steroids, should not receive a live vaccine

•If the patient is on diabetic meds or warfarin - dosing may need to be adjusted

•Steroids during pregnancy can cause fetal harm

•Dexamethasone is stronger and has a longer half-life (36-72 hours) than prednisone (3-4 hours)

•Dexamethasone is being used for Covid-19 patients who are having extreme respiratory problems (6mg IV QD for no longer than 10 days)

•For extended or long term therapy, never withdraw the steroid abruptly
•Long term therapy leads to hypothalamic-pituitary-adrenal suppression because while taking the steroid, the body can stop or slow down the production of endogenous cortisol.
•Side effects of withdrawal: fever, fatigue, dizziness, arthralgia, anorexia, dyspnea, hypotension, hypoglycemia...and death!
•If your patient has been on steroids for longer than 2 weeks, best to decrease the dose by 5-10mg per week

•These drugs are used as replacement therapy in aldosterone deficiency and to prevent hyponatremia and hyperkalemia, especially in patients with Addison's disease

•Aldosterone helps regulate blood pressure by increasing the amount of sodium is reabsorbed which then passively reabsorbs water
•If the BP drops (hypotension, sepsis, hemorrhage etc), the renin-angiotensin mechanism is stimulated resulting in the production of angiotensin II which then stimulates aldosterone release
•Primary aldosterone antagonist - spironolactone: decreases BP and is potassium sparing, also has feminizing effects

increase glucose
increase WBC

• interfere with enzymes involved in copying DNA . Major concern is these drugs could cause heart damage if given in high doses Example: Daunorubicin, Doxorubicin (Adriamycin), Valrubicin

•: These are plant alkaloids, they interfere with enzymes called topoisomerases which help separate the strands of DNA. These drugs can increase the risk of developing a second cancer. Example: Irinotecan, etoposide, teniposide

•also are plant alkaloids, work by stopping cells from dividing to form new cancer cells. These drugs can cause nerve damage. Example: cabazitaxel, docetaxel, vinblastine, vincristine

•GI distress or disturbance(constipation, nausea, abd. Pain), iron overdose can be toxic to the brain and liver
•Tests: Serum Iron, TIBC, Ferritin and CBC (Hgb, HCT, MCV)

•Lab: folate and Vitamin B12 levels should be checked if a patient has macrocytic anemia (decreased H/H, increased MCVs).

•Side/Adverse effects: medication should be stopped once anemia is corrected at 10-11 Hgb. Overuse of this med could cause thrombosis, HTN, tumor progression, n/v, edema, pruritis
•This med is not used for immediate correction of anemia due to hemorrhaging since it has a delayed onset of action
•Lab: serum CBC,

•used for the treatment of anemia due to end stage renal disease, HIV, viral infections, bone marrow disorders, prematurity and malignancy

•This med is not used for immediate correction of anemia due to hemorrhaging since it has a delayed onset of action

Hydroxyurea

to stop platelet aggregation

•Heparin - injectable rapid acting anticoagulant to interfere with thrombi formation by preventing fibrin formation

protamine sulfate

anticoagulation is with Argatroban

•Heparin is useful for thrombi in pregnancy, does not cross the placental barrier

PTT

enoxaparin (Lovenox)preferred to either unfractionated heparin (UFH) or fondaparinux (Arixtra). Therapy was recommended for a minimum of 48 hours.

•Warfarin's peak effect is within 72-96 hours, however, once effective it has a very narrow therapeutic index

•Warfarin is highly bound to plasma albumin, therefore, if a patient has hypoalbuminemia, can have increased levels of warfarin, increased INR

bleeding

vitamin K
whole blood
plasma

No, category X

apixaban (Eliquis), betrixaban (Bevyxxa), edoxaban (Savaysa), rivaroxaban (Xarelto), fondaparinux (Arixtra)

prevention of CVA in non-valvular atrial fib, prevention or tx of DVT, PE

not necessary to follow PT/INR, do not stop abruptly

•IV UFH stop 4-6 hours before
•SQ LMWH stop approximately 24 hours before
•SQ fondaparinux stop 4-5 days before
•Argatroban - stop 4-6 hours before
•Dabigatran (Pradaxa) - stop 2 days before
•Factor Xa inhibitors -edoxaban (Savaysa), rivaroxaban (Xarelto) - stop 48 hours before
•Warfarin stop 5 days before

•Use: for rapid clot dissolution to lead to better perfusion - PE, Acute MI

•Side/Adverse effects: not selective to offending thrombus and therefore could cause dissolution of beneficial hemostatic plug ex. May lead to gastric bleeding, post-op bleeding.

thrombolysis related to a cardiac event

cortex and medulla