NAPLEX Review

acei, arbs, cox-2 inhibs, cyclospronine, diuretics, NSAIDSs, radiocontras dye, renin inhib, tacrolimus

amphetamines, cisplatin, cyclosporine, and mitomycin C

Gold, heroin, lithium, NSAIDs, and phenytoin

analgesic combo, aristolochic acid (chinese herbs), cyclospronie, lithium, NSAIDs, penicillins, sulfonamides, and tacrolimus

aminoglycosides, amphotericin B, chemo agents, cidofovir, cocaine, foscarnet, ifosfamide, radiocon dye, tacrolimus

acyclovir, mtx, oxalate, sulfonamides, uric acid

allopurinol, indinavir, sulfadiazine, triamterene

Jelliffe euqation

elevated b/c stimulatin of na/water retention

• DM
• HR
• Age > 75
• estimated GFR <60

• Edecrin
• loop diuretic option for sulfa allergy pts

• RBC <4.2 x 10^6 / mm2
• MCV <80 femoliters
• serum iron: <50mg/dL
• Total Iron Binding Capacity: <250 mg/dL
• Transferrin saturation (TSat): <16%
• Serum ferritin: <12 ng/mL

• sodium bicarb is <20 mEq/L
• increased aniongap:
• anion gap: Na+ - (Cl- + HCO3-)
• s/sx: hyperventilation, CV/CNS manifestations

• Epogen
• Procrit

initial doses are 50-100 units/kg IV or SC 3x/wk. allow 2-4 wks before making change in dose. if change in hgb is <1 g/dL in a 4-wk period and iron stores are adequate, increase ESA by 25%, if change in hgb is >1g/dL in 2-wk period or hgb is approaching 12, reduce ESA by 25%.

iron defieciency: cause of resistance to tx w/ ESA.

• ensure not def. b/c this can cause resistance to ESA tx.
• recommended dose is 200 mg elemental iron.

• Iron sucrose: 100 mg dose diluted in 100 mL of normal saline and given IV over 15 mins or adminsitered undiluted over 2-5 mins
• Iron dextran: 100 mg dose may be administered over 2 mins IV push, must give 25 mg test dose b/c of anaphylactic rxns
• sodium ferric gluconate: 125 mg dose diluted in1 00 mL NS and admin over 1 hour or admin undiluted at a rate upt o 12.5 mg/min.

800-1000 mg /day

• - titrate doses on basis of phos and ca product (phos X ca)
• - limit use of calcium containing phosphate binders if hypercalcemia occurs
• -aluminum is not 1st line agent.. use ONLY for short term (<30 days) to min rsk of accum

• nondialysis CKD pts: 200 mg over 2-5 mins on 5 diff occasions w/n 14 day period
• peritoneal dialysis: 300 mg in NS IV over 1.5 hrs f/u 2nd infusion of 300 mg 14 days later ---> 400 mg over 2.5 hrs 14 days later

IV form of iron approved for tx of iron deficiency in adults w/ CKD. dose is 510 mg (17 mL) as single dose! f/u 2nd 510 mg dose 3-8 days after initial dose.

calcimimetic agent which controls iPTH in ESRD patients. dose is 30 md / daily titrated no mroe freq. than q 2-4 wks.

• Fer-In-Sol
• Feosol
• Slow FE

• Femiron
• Vitron-C

Fergon

• Hytinic
• Niferec

Proferrin

Ferrlecit (IV) weekly, TIW, or qmo

• Venofer
• wk/TIW/qmo

• InFeD
• Dexferrum

ferumoxytol

deferoxamine (Desferal)

Sevelamer HCl (Renagel) and Sev. Carbonate (Renvela) can result in decreased LDL and increased LDL :) but Renvela has less risk of lowering bicarb than REnagel. Renvela!!!!!! will eventually replace Renagel

they are phosphate binders

• 40% elemental calcium- phosphate binder
• Tums, Os-Cal-500, Nephro-Calci, Caltrate 600, CalCarb HD, CaCO3

Phos-Lo

Renvela

Renagel

Fosrenol

• AlternalGel
• Alu-Cap
• Alu-tab
• Amphojel
• Basaljel
• used as phosphate binder (but only for short term <30 d)

Mag-Carb

• milk of mag, various
• can be used as phos binders

• Vitamin D precursor
• Ergocalciferol (Drisdol- po)
• " (Calciferol, po or iv)

• Active Vitamin D
• Calcitriol (Calcijex- iv)
• Calcitriol (Rocaltrol- po)

• Vitamin D analogs
• Paricalcitol (Zemplar- po/iv)
• Doxercalciferol (Hectorol- po/iv)

• ergocalciferol requires hydroxylation w/n liver to form calcifediol and second hydroxylation w/n kidney to form active vit d
• doxercalciferol requires conversion to active form 1a,25-dihydroxyvitamin D2 in liver.

• Cinacalcet (Sensipar)
• for stage 5 CKD who are on dialysis.
• used w/ phos binder and vit D. initial dose is 30 mg titrated q2-4 wks on iPTH levels. DON'T start tx if corrected serumc a is <8.4 mg/dL.
• Sensipar binds w/ ca-sensing receptor of parathyroid gland and increases senstivity of receptor to extracellular ca, thereby decreasing pth secr.
• TAKE WITH FOOD

• General: ha/pruririts/flushing
• B6 (pyrodoxine): neuropathy/ increased AST
• Vit C (ascorbic acid): hyperoxaluria, dizzziness, fatigue
• Folic acid: rash, pruritis, ha

Nephrocaps, Nephrovite, Nephrovite Rx, Renavite, Biotin Forte

Nephrovite Rx + Iron, NephrPlex Rx

Allbee with C

• 0.6-0.8 g/kg/d but weigh risk/benefit
• icnreased protein req. should be considered for pts on dialysis (1.2 g/kg/d) and even more for pts on peritoenal dialysis b/c of increased protein loss w/ procedure.

• gram positive: staph epidermidis and staph aureus
• gram neg: enterobacteriacae and P. aeruginosa

emepiric therapy: graph pos (1str gen cephalo or vanco if MRSA AND gram-neg (ceftaz/aminoglyc))

glucose content in dialysate soln may cause hyperglycemia

control serum calcium/phosphorus and adminsitration of Vitamin D tx including precursors in early CKD based on kidney fucntion (Drisdol/Calciferol) and active Vit D tx for more severe dz (Calcijex/Rocaltrol, Zemplar, Hectorol). Sensipar is indicatred in stage 5.

• hypothyroidism
• obstructive liver dz
• DM
• drugs: (BB, thiazides, oral contraceptives, oral estrogens, glucocorticoids, and cyclosporine)

foam cells which present as result of ingestin of oxidized LDL by macrophages in subintimal space of aftery

common cause of mild-mod elevated LDL (160-250 mg/dL)

riker Sedation-Agitation Scale

use confusion assessment method for ICU CAM-ICU

Sublimaze (used in morphin intol, hemodynamic instability or renal dysfunc.. like hydromorphone)

Toradol (max use 5 days)

• lorazepam (Ativan) used for long-term sedation (>24-72hrs)
• midazolam (Versed) used for acute/short term (< "")
• propofol (Diprivan) used when rapid awakening is needed

• Haldol
• DOC for delerium

• pancuronium (Pavulon) general NMB agent of choice (lost cost) causes tachy
• vecuronium (Norcuron) used in hemodynamic instability/renal dysfunc/cardiac dz
• cisatracurium (Nimbex) used in renal/hepatic dysfunction
• ------------
• onset is <5 mins for all. 60-90 min duration for pan. and 30-60 mins for others.
• pan excreted reanlly, ver is 50/50 (ren/hep), and cis is NOT organ dependent

BP/HR/RR/intracranial pressure, serum triglycerides (made w/ fat) at baseline and 1-2 x a wk during long-term use

general note: if continuously sedated- daily wakening and assessment results in decr sedative use and shorter lenth of stay in ICU

• provides 1 kcal/mL (lipid vehicle) CAUTION in egg allergy.. potentail medium for bacteria- max hang time is 12 hrs
• MOA unk- possibly GABA realted activity

• dexmedetomidine (central alpha-2 agonist) sedation.
• continuous IV infustion for 24 hrs, less resp depression (AE: hypotension, brady)
• new data: safe for longer than 24 hrs and less delerium and shorter ICU stay than midazolam.

• epithelial
• connective
• lymphoid
• nerve

• Oncogenes that promote growth adv (ras, c-myc)
• inactivation of tummor supp genes (p.53)
• anti-apoptotic genes (bcl-2)
• DNA repari genes expereince reduced activity

• x-ray: spread of cancer to bones/lungs
• computed tomography (CT): size, shape, position of tumor and detects masses in lymph onodes, brain, adrenal glands
• MRI (magnetic resonance imaging): evaluation of the spread of cancer to brain or spinal cord
• positron emission tomography (PET) evaluates lymph and other metasatic invovlement
• bone scan: presence of bone met

epithelial origin and tissue type: surface epithelium

epith origin, glandular tissue (tissue type)

• origin: connective
• tissue type: fibrous tissue

• origin: connective
• tissue type: bone (duh)

Leiomyosarcoma or rhapdosarcoma

liposarcoma

• 1. Leukemia
• 2. HOdgkin and non-Hodgkin lymphoma
• 3. Multiple myloma

• 1. Glioblastoma or astrocytoma
• 2. Neurofibrosarcoma
• 3. Malignant melanoma

Teratocarcinoma

• Cure: 5 years of cancer-free survival for msot tumor types
• Complete response: absence of all neoplastic disease for a minimum of 1 month after cesation of treatment
• Partial response: >50% decrease in tumor size or other disease markers for a min of 1 month
• Stable disease: no chagne or no meeting of criterea for partial response or progression
• Progression: >25% increase in tumor size or new lesion

• 1. hair follicles
• 2. blood cells
• 3. GI tract

Cause covalent bond formation of drugs to nucleic acids and proteins --> crosslinking of one or two DNA (are not phase specific)

• myelosuppression, (leukopenia), mucosal ulceration
• pulmonary fibrosis (carmustine), intestinal pneumonitis, pyrexia/fatigue (bendamustine), hemorrhagic cystits (cylophosphomide and ifosfamide), encephalopathy (ifosfamide), sezures (polifeprosan and carmustine)

strong 1a2 inhibitor

1. mechlorethamine2. cyclophosphamide3. ifosfamide4. melphalan5. chlorambucil6. bendamustine

they are alkylating agents (nitrogen mustards are a type of alk. agents)

these are alkylating agents (more spec. nitrogen mustards)

• 1. Mustargen (HL, NHL), 2. cytoxan, Neosar)
• 2. Cytoxan/Neosar (ALL, CLL, HL, NHL, myeloma, testis, neruoblastoma, breast, ovary lung, cervix)
• 3. Ifex (HL, NHLlung, bladder, sarcoma)
• 4. Alkeran (Myeloma, breast, ovary),
• 5. Leukeran (CLL, HL, NHL)
• 6. Treanda (CLL, NHL)

• Altretamine (Hexalen) (ovarian)
• and Thiotepa (Thioplex) - bladder, breast, ovarian, hl,nhl

these are in bigger class: alkylating agents

busulfan (myleran, busulfex)- cml, bmt

bigger class: alkylating agents

bigger class: alkylating agnets

• 1. carmustine (BiCNU)- hl, nhl, brain myeloma
• 2. streptozocin (Zanosar)- islet cell carcinoma
• 3. polifeprosan 20 w/ carmustine implant (Gliadel)- glioblastoma multiforme

structural analogues ofnatural metabolites--> insert themsleves inp lace of pyrimidne or purine ring, causing interference in nucelic acid synth. most active ins phase in tumors w/ high growth fraction (subdivided: folate, purine, pyrmidine antags)

chew ice to reduce damage to mucosal lining

clofarabine

pemetrexed

• Antimetabolites: s phase specifics
• 1. pemetrexed (Alimta)
• 2. methotrexate (Rhumatrex

antimetabolites: s specific

• 1. azacitidine (Vidaza)- MDS
• 2. 5fu (adrucil)- colorectal, breast, head, neck
• 3. cytarabine (Cytosar-U-drip, Depocyt-intrathecal) --> ALL, AML, CML
• 4. capcitabine (Xeloda)- breast, colorectal
• 5. gemcitabine (Gemzar)- pancreatic, NSCLC, bladder
• 6. decitabine (Dacogen)- MDS

antimetabolites: s-phase specific

• 1. clofarabine (Clolar)- ALL -peds
• 2. mercaptopurine (Purinethol)- ALL
• 3. thioguanine (Tabloid)- ALL, AML
• 4. pentostatin (Nipent)- CLL, hairy cell leuk, ALL
• 5. cladribine (Leustatin)- nhl, hairy cell luk, cll
• 6. fludarabine (Fludara)- CLL, NHL

antimetabolite: s phase specific

nelarabine (Arranon)- t-cell ALL or NHL ==> may cause sleepiness/dizziness

-mucositis or mouth sorenss, monitor neurotox (ask pt to write name), cbc w/ diff prior to each dose, hepatic/renal func, monitor for tingling/swelling of palms of hands and soles of feet

includes anthacylines.. etc

• moa: block DNA/RNA transcription through intercalation (insertion) of adjoining nuclec acid pairs in DNA--> results in DNA strand breakage
• also: inhibit topoisomerase II
• Mitomycin: alkylating-like agent that cross-links DNA
• Dactinomycin blocks RNA synthesis
• Bleomycin: inhibits DNA synthesis in mitosis AND G2 stages of growth (only one that is cell cycle specific)

• antracylines: urine color or change whites of eyes to blue-green or orange-red
• bleomycin: cause change in skin color or nail growth

• antracylines and cardiac tox - acute and chronic: doxorubicin=daunorubicin>idarubicin>epirubicin>mitoxantrone
• all are vesicants and associated w/ secondary AML.

• Dactinomycin may cause renal tox/leukopenia, increased pigmentation of radiated skin
• Belo- pulm fibrosis/interstital, pneumonitis
• Mitomycin: hemolytic uremic syndrome.

• antracylines: large volumes of distrubtion and long half-lives. excreted in bile-- DOSE ADJ necessary in patients w/ hepatic impairment.
• bleomycin: renallly excreted and requires dosing adjustments in impaired pts

• Doxorubicin: 450-550 mg/m2
• Epirubicin: 900 mg/m2
• Idarubicin: 150 mg/m2

bigger class: antitumro antibiotics

• 1. doxorubicin (Adriamycin, Doxil (liposomal)- all, aml, nhl, hl, solic tumors of major organ
• 2. daunorubicin (Cerubidine, Daunoxome (liposomal)- all, aml, nhl
• 3. epirubicin (Ellence, Pharmarubicin)- breast, bladder, lung, ovarian, gastric
• 4. Idarubicin (Idamycin)- aml, all, breast
• 5. mitoxantrone (Novantrone)- prostate, nhl, aml, breast
• 6. valrubicin (Valstar)- bladder

• bigger class of antitumor abx
• 1. mitomycin (Mutamycin)- bladder, breast, NSCLC, cervix, pancrea, colon

bigger class of: antitumor abx

1. dactinomycin (Cosmegen)- Wilms' tumor, testis, sarcoma

Blenoxane- nhl, hl, testis, head, neck, lung, skin

• transient muscle or bone pain, probs urinating, and spinal cord compression may occur initially
• (Pain...Urin issues.. Cord Compression- PUCC)

Cytadren- adrenal, breast, prostate cancers

• Megace (type of progestin)
• breast, endometrial

dep-provera- endometrial cancer use

• Estinyl - estrogen
• use for prostate, breast cancers

• use for breast cancer
• tamoxifen (Volvadex)
• Fluvestrant (Fasoldex)- not serm
• Toremifene (Fareston)

• exemestane (Aromasin)
• anastrozole (Arimidex)
• Letrozole (Femara)
• breast ca

used for breast ca

• tesotosterone (Delastryl)
• fluoxymesterone (Halotesin)

• used for prostate ca
• flutamide (Eulexin)
• bicalutamide (Casodex)
• nilutamide (Nilandron)

• triptorelin (Trelstar)- porstate
• leuprolide (Lupron, Eligard)- prostate, breast
• goserelin (Zoladex)- prostate, breast

• degarelix (Firmagon)
• used inp rostate cancer

• inhibit replication of cancerious cells.
• taxanes and vincas: interfere w/ microtubule assembly in M phase
• camphothecins and eipipodophyllotoxins inhibits topoisomerase I and II enzymes respectively --> DNA breaks

• pts should recieve porphylaxis for emesis and pretreatment for anaphylaxis or perif edema (taxanes)
• rx for loperamide for delayed diarrhea w/ irinotecan tx

• ADE: n/v/alopec/edema.. bla bla
• hand-foot syndrome (docetaxel)
• hypotension/hypersenstivitiy (paclitaxel)
• neurotox (vincristine)
• peripheral neuropathy and myalgia or arthralgia (xabepilone and placlitaxel)
• secondary maligancies- topo II inhibs
• SIADH- vincas

• bigger class: plant alkaloids
• microtubule
• 1. docetaxel (gastric)- Taxotere- NSCLC, breast, ovarian, head, neck, gastric
• 2. paclitaxel (Taxol) - NSCLC breast ovarian head
• 3. " (Abraxane)- breast

bigger class of plant alkaloids

ixabepilone (Ixempra)- breast

• topo I/II inhibs (along w/ camptothecins)
• bigger class: plant alkaloids

• 1. etoposide (VePesid)- SCLC, testis, NSCLC
• 2. teniposide (Vumon)- ALL, SCLC

topo I/II inhibs (along w/ epepodophyllotoxins- etoposide/teniposide)

• 1. irinotecan (Campostar) - CRC, NSCLC, SCLC
• 2. topotecan (Hycamtin)- ovarian, lung, AML, cervical

bigger class: plant alkaloids

• 1. vincristine (Oncovin)- ALL, HL, NHL, CLL
• 2. vinblastine (Velban)- HL, NHL, testis
• 3. vinorelbine (Navelbine)- NSCLC, breast, ovarian

adjust for CrCl <40 mL/min

• 1. immune therapies
• 2. monocolonal antibodies

Proleukin- immune tx- metastatic renal cell, metastatic melanoma

Intron A (malignant melanoma and hairy cell leukemia)

Thalomid (immune therapy)- multiple myeloma, erythema nodosum leprosum

• Revelmid- multiple mylmoa, MDS
• immune therapy

• Rituxan- NHL, CLL
• Herceptin- met breast
• Mylotarg- AML

• Campath- B-cell CLL
• Avastin- colorectal, NSCLC, breast, glio, RCC
• Erbitux- CRC, head/neck
• Ontak- t-cell lymphoma

• Zevalin- NHL
• Bexxar- NHL

• cetux- avoid too much sunlight
• tositumomab- get thyroid checked

• tumo lysis syndrome- rituximab
• bleed/hemrg, htn, protenuira, skinr ash (bev)
• cutaneous and severe ifusion rxns and interstitial lung dz (cetuximab)
• hypothyroidism (tositumomab)
• neurotoxicity (talidomide)
• neutropenia (talidomide/lanildomide)
• DVT/PE (talid/lanild)

nephrotox, peripheral neurotox, myleosupp, ototox, N/V

• cisplatin (Platinol)- hydration and premeds.. it interacts w/ doxorubicn/ rituxan, topotecan, aminoglycosides, tacrolimus
• carbo (Paraplatin)- needs monitoring for thrombocytopenia
• oxaliplatin (Eloxatin)- unique neurotix- boronchial spasms

• Nexavar
• moa: inhibits multiple tyrosine kinases used for tx RCC- on empty stomach
• ade: fatigue, GI, HFS, HTN, neutropenia, alopecia

• Sutent
• inhibs multipel tyrosine kinases- rcc
• take w/ or w/o food (diff from sorafinib), CYP3A4 issue :(

• Sprycel
• specifically targets BCR-ABL (incl those reistant to imatinib)- inhibs leukemic cell growth. used for tx of CML and pH+ acute lymphocytic leukema (all)
• ade: edema, SOB, infection, electrolyte changes, arrhthmias

• Tykerb
• inhibs multiple tyrosine kinase- tx EGFR (HER2)- breast cancer
• ade: increased liver enzymes, palmar-planta erythro-dysesthesia
• take 1 hour prior to or 2 hours after meal!!!!!!

• Tasigna
• BCR-ABL in used for pH+CML. caps taken po on empty stomach --> swallow whole do not crush or open

• Elsapar, Oncaspar
• moa: removes exogenous aspargines frm leukemic cells that are required for their survival.
• intradermal skin testing is needed b/c of severe anaphylactic
• ade: hyperuricemia, hyperglycemia, renal issues

• Hydrea
• moa: DNA synth w/o interfering w/ RNA and protein synthesis
• ade: 2ndary leukemias, mucositis, rare but fatal hepatotox

• Gleevec
• moa:selective inhibitor of philideplphia- CML