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2010-05-22 18:33:18
Pharmacy NAPLEX

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  1. Drugs causing prerenal dz
    acei, arbs, cox-2 inhibs, cyclospronine, diuretics, NSAIDSs, radiocontras dye, renin inhib, tacrolimus
  2. Drugs cuasing VASCULAR intrinsic kidney dz
    amphetamines, cisplatin, cyclosporine, and mitomycin C
  3. drugs causing glomerular kidn dz (intrinsic)
    Gold, heroin, lithium, NSAIDs, and phenytoin
  4. casues of interstitial nephritis (intrisnic kidn dz)
    analgesic combo, aristolochic acid (chinese herbs), cyclospronie, lithium, NSAIDs, penicillins, sulfonamides, and tacrolimus
  5. causes of acute tubular necrosis (intrisnic kidn dz)
    aminoglycosides, amphotericin B, chemo agents, cidofovir, cocaine, foscarnet, ifosfamide, radiocon dye, tacrolimus
  6. causes of postrenal (obsturctive)
    acyclovir, mtx, oxalate, sulfonamides, uric acid
  7. causes of nephrolithiasis (postrenal)
    allopurinol, indinavir, sulfadiazine, triamterene
  8. what to do to estimate GFR in unstable kidn funxn
    Jelliffe euqation
  9. specific gravity and osmolality in prerenal?
    elevated b/c stimulatin of na/water retention
  10. Risk factors for contrast nephropathy
    • DM
    • HR
    • Age > 75
    • estimated GFR <60
  11. Ethacrynic acid
    • Edecrin
    • loop diuretic option for sulfa allergy pts
  12. Anemia of CKD lab values for:
    RBC, MCV, serum iron, TIBC, transferrin, ferritin
    • 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
  13. Metabolic acidosis
    • sodium bicarb is <20 mEq/L
    • increased aniongap:
    • anion gap: Na+ - (Cl- + HCO3-)
    • s/sx: hyperventilation, CV/CNS manifestations
  14. Epoetin Elpha
    brand names and dose
    • 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.
  15. Iron supplementation in anemia (CKD)
    • 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.
  16. Phos restriction in CKD
    800-1000 mg /day
  17. Phos binding agents tips (CKD)
    • - 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
  18. Iron sucrose dose in nondialysis and peritoneal dialysis patients
    • 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
  19. Feruxomoxytol?
    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.
  20. cinacalcet?
    calcimimetic agent which controls iPTH in ESRD patients. dose is 30 md / daily titrated no mroe freq. than q 2-4 wks.
  21. Ferrous sulfate PO
    • Fer-In-Sol
    • Feosol
    • Slow FE
  22. Ferrous fumarate PO
    • Femiron
    • Vitron-C
  23. Ferrous gluconate PO
  24. Polysaccharide iron
    • Hytinic
    • Niferec
  25. Heme iron polypeptide
  26. Sodium ferric gluconate
    Ferrlecit (IV) weekly, TIW, or qmo
  27. Iron sucrose (IV)
    • Venofer
    • wk/TIW/qmo
  28. Iron dextran (IV)
    • InFeD
    • Dexferrum
  29. Feraheme
  30. How do you treat iron overload?
    deferoxamine (Desferal)
  31. Sevelamer ADE
    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
  32. Calcium carbonate
    • 40% elemental calcium- phosphate binder
    • Tums, Os-Cal-500, Nephro-Calci, Caltrate 600, CalCarb HD, CaCO3
  33. Calcium acetate (25% elemetnal calcium)
  34. Sevelamer carbonate
  35. sevelamer Hcl
  36. Lanthanum carbonate
  37. Aluminum hydroxide
    • AlternalGel
    • Alu-Cap
    • Alu-tab
    • Amphojel
    • Basaljel
    • used as phosphate binder (but only for short term <30 d)
  38. Magnesium carbonate
  39. Magnesium hydroxide
    • milk of mag, various
    • can be used as phos binders
  40. Name all the Vitamin D prodcuts
    • 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)
  41. Vitamin D drugs activation in body?
    • 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.
  42. tell me about calcimimetics?
    • 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.
  43. water soluble enzymes impt in CKD pts.. but what are ADEs?
    • General: ha/pruririts/flushing
    • B6 (pyrodoxine): neuropathy/ increased AST
    • Vit C (ascorbic acid): hyperoxaluria, dizzziness, fatigue
    • Folic acid: rash, pruritis, ha
  44. Vitamin B complex, vitamin C and folic acid
    Nephrocaps, Nephrovite, Nephrovite Rx, Renavite, Biotin Forte
  45. Vit B complex, Vit C, folic acid, AND iron
    Nephrovite Rx + Iron, NephrPlex Rx
  46. Vit B complex
    Allbee with C
  47. Prorein restriction in CKD?
    • 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.
  48. Pritonititis bugs and drugs
    • 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))
  49. hyperglycemia and dialysis??? how
    glucose content in dialysate soln may cause hyperglycemia
  50. how to manage secndary hyperparathyroidism?
    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.
  51. Secondary causes of hyperlipidemia
    • hypothyroidism
    • obstructive liver dz
    • DM
    • drugs: (BB, thiazides, oral contraceptives, oral estrogens, glucocorticoids, and cyclosporine)
  52. initial lesion of atherosclerosis?
    foam cells which present as result of ingestin of oxidized LDL by macrophages in subintimal space of aftery
  53. polygenic hypercholosterolemia
    common cause of mild-mod elevated LDL (160-250 mg/dL)
  54. how to assess agitation?
    riker Sedation-Agitation Scale
  55. how to assess delerium in ICU?
    use confusion assessment method for ICU CAM-ICU
  56. fentanyl IV
    Sublimaze (used in morphin intol, hemodynamic instability or renal dysfunc.. like hydromorphone)
  57. ketorolac
    Toradol (max use 5 days)
  58. benzos for sedation in the ICU
    • lorazepam (Ativan) used for long-term sedation (>24-72hrs)
    • midazolam (Versed) used for acute/short term (< "")
    • propofol (Diprivan) used when rapid awakening is needed
  59. haloperidol
    • Haldol
    • DOC for delerium
  60. neuromuscular blocking agents
    • 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
  61. monitoring w/ propofol
    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
  62. Precedex
    • 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.
  63. four tissue types for neoplastic malignancies
    • epithelial
    • connective
    • lymphoid
    • nerve
  64. Genetic alterations in cancer:
    • 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
  65. imaging w/ cancer
    • 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
  66. carcinoma?
    epithelial origin and tissue type: surface epithelium
  67. adenocarcinoma?
    epith origin, glandular tissue (tissue type)
  68. fibrosarcoma
    • origin: connective
    • tissue type: fibrous tissue
  69. osteosarcoma
    • origin: connective
    • tissue type: bone (duh)
  70. type of cancer if from connective tissue (smotth or straited muscle)
    Leiomyosarcoma or rhapdosarcoma
  71. type of cancer?- origin connective (tissue: fat)
  72. Lymphoid origin and tissue type is:
    1. bone marrow
    2. lymphoid
    3. plasma cell
    • 1. Leukemia
    • 2. HOdgkin and non-Hodgkin lymphoma
    • 3. Multiple myloma
  73. type of cancer: origin Neural
    Tissue type:
    1. Glial
    2. Nerve sheath
    3. Melanocytes
    • 1. Glioblastoma or astrocytoma
    • 2. Neurofibrosarcoma
    • 3. Malignant melanoma
  74. Mixed origin tissue type (Gonadal tissue)
  75. Response to cancer treatment for solid tumors
    • 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
  76. Cells that rapidly divide (SE for chemo)
    • 1. hair follicles
    • 2. blood cells
    • 3. GI tract
  77. Mechanism of action of alkylation agents
    Cause covalent bond formation of drugs to nucleic acids and proteins --> crosslinking of one or two DNA (are not phase specific)
  78. Alkylation agents: adverse drug events
    • myelosuppression, (leukopenia), mucosal ulceration
    • pulmonary fibrosis (carmustine), intestinal pneumonitis, pyrexia/fatigue (bendamustine), hemorrhagic cystits (cylophosphomide and ifosfamide), encephalopathy (ifosfamide), sezures (polifeprosan and carmustine)
  79. Bendamustine DDI
    strong 1a2 inhibitor
  80. Nitrogen mustards:
    1. mechlorethamine2. cyclophosphamide3. ifosfamide4. melphalan5. chlorambucil6. bendamustine

    they are alkylating agents (nitrogen mustards are a type of alk. agents)
  81. 1. mechlorethamine 2. cyclophosphamide 3. ifosfamide 4. melphalan 5. chlorambucil 6. bendamustine
    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)
  82. Ethylenimines and methylmelamines
    • Altretamine (Hexalen) (ovarian)
    • and Thiotepa (Thioplex) - bladder, breast, ovarian, hl,nhl

    these are in bigger class: alkylating agents
  83. alkyl sulfonates
    busulfan (myleran, busulfex)- cml, bmt

    bigger class: alkylating agents
  84. nitrosoureas
    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
  85. antimetabolites: s-phase specific moa?
    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)
  86. counseling point w/ 5-fu
    chew ice to reduce damage to mucosal lining
  87. trouble urinating w/ what chemo drug?
  88. recievie folic acid and b12 injections w/ what chemo drug?
  89. flic acid antagonists
    • Antimetabolites: s phase specifics
    • 1. pemetrexed (Alimta)
    • 2. methotrexate (Rhumatrex
  90. pyrimidine analogs
    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
  91. Purine analgos
    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
  92. guanosine analogs
    antimetabolite: s phase specific

    nelarabine (Arranon)- t-cell ALL or NHL ==> may cause sleepiness/dizziness
  93. monitoring parameters with antimetabolites: s phase specific
    -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
  94. antitumor antibiotics MOA
    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)
  95. counseling points for antitumor antibiotics (anthracylines and bleomycin)
    • antracylines: urine color or change whites of eyes to blue-green or orange-red
    • bleomycin: cause change in skin color or nail growth
  96. ADE for antitumor abx
    • 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.
  97. PK issues w/ anthracylines and bleo
    • 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
  98. life time doses anthracylines?
    • Doxorubicin: 450-550 mg/m2
    • Epirubicin: 900 mg/m2
    • Idarubicin: 150 mg/m2
  99. Antracylines: name em
    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
  100. Alkylating-like chemo drugs
    • bigger class of antitumor abx
    • 1. mitomycin (Mutamycin)- bladder, breast, NSCLC, cervix, pancrea, colon
  101. Chromomycin group chemo
    bigger class of: antitumor abx

    1. dactinomycin (Cosmegen)- Wilms' tumor, testis, sarcoma
  102. Bleomycin
    Blenoxane- nhl, hl, testis, head, neck, lung, skin
  103. LHRH agonists counseling
    • transient muscle or bone pain, probs urinating, and spinal cord compression may occur initially
    • (Pain...Urin issues.. Cord Compression- PUCC)
  104. aminoglutethmide
    Cytadren- adrenal, breast, prostate cancers
  105. megesterol acetate
    • Megace (type of progestin)
    • breast, endometrial
  106. medroxyprogresterone
    dep-provera- endometrial cancer use
  107. ethinyl estradiol
    • Estinyl - estrogen
    • use for prostate, breast cancers
  108. antiestrogens?
    • use for breast cancer
    • tamoxifen (Volvadex)
    • Fluvestrant (Fasoldex)- not serm
    • Toremifene (Fareston)
  109. aromatase inhibitors
    • exemestane (Aromasin)
    • anastrozole (Arimidex)
    • Letrozole (Femara)
    • breast ca
  110. Androgens
    used for breast ca

    • tesotosterone (Delastryl)
    • fluoxymesterone (Halotesin)
  111. antiandrogens
    • used for prostate ca
    • flutamide (Eulexin)
    • bicalutamide (Casodex)
    • nilutamide (Nilandron)
  112. LHRH agonists
    • triptorelin (Trelstar)- porstate
    • leuprolide (Lupron, Eligard)- prostate, breast
    • goserelin (Zoladex)- prostate, breast
  113. GNRH antagonist
    • degarelix (Firmagon)
    • used inp rostate cancer
  114. Plant alkaloids moa?
    • 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
  115. Counseling points for plant alkaloids
    • pts should recieve porphylaxis for emesis and pretreatment for anaphylaxis or perif edema (taxanes)
    • rx for loperamide for delayed diarrhea w/ irinotecan tx
  116. plant alkaloids ADE
    • 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
  117. taxanes?
    • 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
  118. epothilones?
    bigger class of plant alkaloids

    ixabepilone (Ixempra)- breast
  119. Epipodophyllotoxins
    • topo I/II inhibs (along w/ camptothecins)
    • bigger class: plant alkaloids

    • 1. etoposide (VePesid)- SCLC, testis, NSCLC
    • 2. teniposide (Vumon)- ALL, SCLC
  120. camptothecins?
    topo I/II inhibs (along w/ epepodophyllotoxins- etoposide/teniposide)

    • 1. irinotecan (Campostar) - CRC, NSCLC, SCLC
    • 2. topotecan (Hycamtin)- ovarian, lung, AML, cervical
  121. Vinca alkaloids?
    bigger class: plant alkaloids

    • 1. vincristine (Oncovin)- ALL, HL, NHL, CLL
    • 2. vinblastine (Velban)- HL, NHL, testis
    • 3. vinorelbine (Navelbine)- NSCLC, breast, ovarian
  122. topotecan dosing consideration?
    adjust for CrCl <40 mL/min
  123. biologics two groups:
    • 1. immune therapies
    • 2. monocolonal antibodies
  124. aldesleukin
    Proleukin- immune tx- metastatic renal cell, metastatic melanoma
  125. interferon alpha-2b
    Intron A (malignant melanoma and hairy cell leukemia)
  126. thalidomide
    Thalomid (immune therapy)- multiple myeloma, erythema nodosum leprosum
  127. lenalidomide
    • Revelmid- multiple mylmoa, MDS
    • immune therapy
  128. rituximab
    • Rituxan- NHL, CLL
    • Herceptin- met breast
    • Mylotarg- AML
  129. alemtuzumab
    denileukin diftitox
    • Campath- B-cell CLL
    • Avastin- colorectal, NSCLC, breast, glio, RCC
    • Erbitux- CRC, head/neck
    • Ontak- t-cell lymphoma
  130. ibritumomab tiutexetan
    • Zevalin- NHL
    • Bexxar- NHL
  131. counseling w/ cetuximab and tositumomab
    • cetux- avoid too much sunlight
    • tositumomab- get thyroid checked
  132. drug specific ADEs for rituximab, bev, tositumomab, thalidomide, lanalidomide,
    • 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)
  133. Platinum compounds ADE
    nephrotox, peripheral neurotox, myleosupp, ototox, N/V
  134. cisplatin and carboplatin monitoring/counseling
    • 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
  135. Sorafenib info
    • Nexavar
    • moa: inhibits multiple tyrosine kinases used for tx RCC- on empty stomach
    • ade: fatigue, GI, HFS, HTN, neutropenia, alopecia
  136. Sunitnib
    • Sutent
    • inhibs multipel tyrosine kinases- rcc
    • take w/ or w/o food (diff from sorafinib), CYP3A4 issue :(
  137. Dasatinib
    • 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
  138. lapatinib
    • 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!!!!!!
  139. nilotinib
    • Tasigna
    • BCR-ABL in used for pH+CML. caps taken po on empty stomach --> swallow whole do not crush or open
  140. asparginase
    • 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
  141. hydroxyurea
    • Hydrea
    • moa: DNA synth w/o interfering w/ RNA and protein synthesis
    • ade: 2ndary leukemias, mucositis, rare but fatal hepatotox
  142. imatinib mesylate
    • Gleevec
    • moa:selective inhibitor of philideplphia- CML