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Heparin Dosage
5000 Units followed by 20,000-40,000 units/24 hours
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Septra Dosage for PJP
20mg/kg TMP/100mg/kg SMX in 3-4 divided doses/day
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Zidovudine Dosage
200mg TID or 300mg BID
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Warfarin dosage
2-10mg po qday
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HAART
- 2NRTI+PI
- 2NRTI+1NNRTI (protease sparing therapy)
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Zidovudine
- NRTI
- Adverse: bone marrow depression (give epoetin), nausea, severe HA, insomnia, myalgia
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Didanosine
- NRTI
- Adverse: painful peripheral neuropathy, GI upset, wt gain
- FDA warning: acute pancreatitis
- do NOT mix w/juices, carbonated drinks
- take w/ empty stomach
- DDI: ketoconazole
-
Lamivudine
- NRTI
- also used to tx chronic Hep B
- used with zidovudine. increases zidovudine effect
- Adverse: GI, neutropenia, peripheral neuropathy
-
Indinavir
- PI
- good oral bioavailability, resistance develops slowly
- mild elevation indirect bilirubin (liver fxn test)
- kidney stones (rec 48oz H20/day)
- best on empty stomach, light carb meal OK
- long term toxicity: hyperglycemia, DM, hyperlipidemia
- lipodystrophy--chubby in waist, skinny arms/legs
- DDI: midazolam, triazolam
-
Efavirenz
- NNRTI
- Good CNS penetration
- Adverse: skin rash, Stevens Johnson, GI CNS (dizziness, abnormal dreams)
- avoid high fat meals
- contraindicated in pregnancy
- DDI: midazolam, triazolam, warfarin
-
Enfuvirtide
- injectable SQ, rotate inj sites
- Adverse: local injection site rxn, pain, induration, erhythemia
- increase risk of pna
- roll vial. must refridgerate
-
Raltegravir
- for multilpe resistant HIV
- Adverse: GI, MI, renal failure
- rhabdomyolysis (m/s destruction)
- has additive drug interxn with statins
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What OI is Septra/Bactrim used for?
PCP/PJP
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TMP/SMX
- tx: PCP/PJP
- Adverse: GI, skin rash, erythema multiforme, Stevens Johnson, blood dyscrasias
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Pentamindine Isethionate
- tx of PCP, African Trypanosomiasis 'sleeping sickness'
- can be used prophylactically-given via inhalation
- Adverse: hypotension, blood dyscrasis, hypoglycemia, hyperglycemia, pancreatitis
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Heparin indications
pre-surgery, cardiovascular, orthopedic (hip, knee), abd, thoracic
-
Heparin FDA warning
HIT-heparin induced thrombocytopenia
-
Heparin precautions
- blood dyscrasis, peptic ulcer, any bleeding, undergoing brain/spinal surgery
- avoid giving meds IM
-
Heparin DDI
ASA, any anticoagulant
-
Enoxapin FDA warning
should not be used pt in epidural, spinal anesthesia, spinal tap.
-
Enoxapin Test--indications
- Antifactor 10A
- done for multi-organ dysfxn
- obese
- liver
- pregancy
- pediatrics
-
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Warfarin clinical uses
- long term control
- chronic occlusive disease
- previous heart attacks
-
-
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Warfarin Precautions
- Pregnancy X category
- if severe bleeding, give blood/plasma
-
Warfarin DDI
- corticosteroids
- ASA
- gingko
- megadoses of vit E
- EtOH
- causes subdural hematoma
-
ASA
- prevent MI
- post MI
- TIA-prevent stroke
-
Dipyrimadole
- coronary vasodilator w/ antiplatelet activity
- adverse effects: GI distress, HA, dizziness, hypotension
-
Clopidogrel
- prevent MI, stroke/vascular death, acute coronary syndrome
- Adverse: HA, URTI, chest pain, flu-like sxs
- DDI: ASA, atorvastatin, ginko, giner, garlic, warfarin, PPI
- Precaution: lactation, active bleeding
-
Cyclophosphamide
- n/v
- thrombocytopenia
- alopecia
- immunosuppression
- hemorrhagic cystitis--drink fluids
-
Cisplatin
- Severe N/v. Pre-treat with ondansetron
- give 1/2 hr before, then 4, 8 after, then prn
- kidney damage-flush w IV hydration+mannitol flush
- anaphylaxis, ototoxicity
- do NOT use aluminum needles/IV sets
-
Methotrexate
- folic acid antagonist
- Adverse: ulcerative stomatitis, bone marrow depression, diarrhea, immunosuppressant
- Leucovorin to 'rescue' bone marrow, antidote for MTX OD
-
Doxorubicin
- VESSICANT
- red urine
- adverse: cardiomyopathy, dysrhythmia, CHF
- Maximum cumulative lifetime dose
- lipid form allows better penetration
-
Bleomycin
- Adverse: pulmonary toxicity
- Maximum cumulative life dose
- anaphylatic. give test dose
-
Vincristine
- VESSICANT
- Adverse: neurologic rxn, numbness, nerve pain, parathesia
- NEVER give intrathecal--Fatal
-
Paclitaxel
- Severe allergic rxn
- pretreat with: dexamethasone, diphenhydramine, cimetidine
-
Irinotecan
- VESSICANT
- genetic differences in metabolism + potential for adverse effects
- Adverse: severe diarrhea. Tx w/ loperamide
-
Name the 3 vessicant drugs
- Vincristin
- Irinotecan
- Doxorubicin
-
Name the 2 drugs that have lifetime maximum doses
-
Which drug turns urine red?
Doxorubicin
-
What drug treats for severe diarrhea?
Loperamide
-
What drug treats severe N/V
ondansetron
-
Name the 3 drugs used in supportive cancer treatment
- Allopurinol
- Analgesics
- Antiemetics
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