Drug Review Week 1

08/17/2017
Surgical Antibiotic Prophylaxis- Top 5
Name Mechanism of Uses Dosing Adverse Effects
Action
Cefazolin Inhibit bacterial Biliary tract IM, IV: 1 to 1.5 Localized
cell wall synthesis infections; Bone grams every 8 phlebitis;
by binding to one and Joint hours, depending Seizure;
or more of the infections; on severity of Pruritus, skin
penicillin-binding Endocarditis; infection. Max= rash; Abdominal
proteins (PBPs) Perioperative 12 grams daily cramps,
which inhibit the prophylaxis; Prophylaxis: IM, anorexia,
final Respiratory tract IV: 1 to 2 grams diarrhea,
transpeptidation infections; initiated 30 to 60 hepatitis;
step of Septicemia; Skin minutes prior to eosinophilia,
peptidoglycan infection; UTI surgery; may leukopenia,
synthesis in repeat after 2 neutropenia
bacterial cell walls hours if lengthy
procedure with
500 mg to 1
gram
intraoperatively,
followed by 500
mg to 1 gram
every 6 to 8
hours for 24
hours
postoperatively
Aztreonam Inhibits bacterial Treat patients Perioperative Neutropenia;
cell wall synthesis with UTI, lower Prophylaxis (off- Increased serum
by binding to PBPs respiratory tract label use): IV: 2 transaminases;
which inhibits final infections, grams within 60 Pain at injection
transpeptidation septicemia, skin minutes prior to site; Phlebitis;
step of infections, intra- surgery. Doses Skin rash
peptidoglycan abdominal may be repeated
synthesis in infections in 4 hours if
bacterial cell walls caused by procedure is
susceptible lengthy or if
gram-negative there is
bacilli excessive blood
loss
Gentamicin Interferes with Serious Use TBW in Edema,
bacterial protein infections underweight and Hypertension,
synthesis by (sepsis, non-obese Hypotension,
 binding to 30S meningitis, UTI, patients for Phlebitis,
ribosomal subunit respiratory tract initial Ataxia,
resulting in infections, mg/kg/dose. erythema,
defective bacterial peritonitis, bone IM,IV: 3 to 5 pruritus, skin
cell membrane infections) mg/kg/day in rash, Casts in
divided doses urine,
every 8 hours Arthralgia,
Prophylaxis: IV: muscle cramps,
5 mg/kg within Visual
60 minutes prior disturbance,
to surgical Auditory
incision with or impairment,
without other Decreased CrCl
antibiotics
Metronidazole Interacts with Anaerobic Surgical Headache;
DNA to cause a bacterial Prophylaxis: IV: Nausea;
loss of helical infections; 15 mg/kg 1 hour Vaginitis;
DNA structure and Bacterial prior to surgical Metallic taste;
strand breakage Vaginosis, incision; Abdominal Pain;
resulting in Surgical followed by 7.5 Flu-like
inhibition of prophylaxis mg/kg 6 and 12 symptoms;
protein synthesis (colorectal hours after initial Bacterial
and cell death in surgery), dose infection
susceptible Trichomoniasis
organisms
Vancomycin Inhibits bacterial C. diff diarrhea; Usual dose: 500 Hypotension;
cell wall synthesis Endocarditis; mg every 6 Local phlebitis;
by blocking Staphylococcal hours or 1,000 Skin rash;
glycopeptide infections mg every 12 Hypersensitivity
polymerization hours (flushing of face
through binding Prophylaxis: IV: and neck);
tightly to D-alanyl- 15 mg/kg within Abdominal pain;
D-alanine portion 120 minutes Peripheral
of cell wall prior to surgical edema;
precursor incision. May be Diarrhea; UTI;
administered in Back pain; Fever
combination
with other
antibiotics
depending upon
procedure

Anticoagulants- Clinical Pearls

Generic Name Brand Name More Specific Class
Edoxaban Savaysa Factor Xa Inhibitor; DOAC
Apixaban Eliquis Factor Xa Inhibitor; DOAC
Rivaroxaban Xarelto Factor Xa inhibitor; DOAC
Dabigatran Pradaxa Direct thrombin inhibitor;
DOAC
Warfarin Coumadin Oral anticoagulant
Fondaparinux Arixtra Factor Xa inhibitor
Dalteparin Fragmin Low-molecular weight
heparin
Enoxaparin Lovenox Low-molecular weight
heparin
Heparin Unfractionated Heparin Heparin
Acenocoumarol Sintrom Vitamin K antagonist
Antithrombin Atryn; Thrombate III Blood product derivative
Argatroban Argatroban Direct thrombin inhibitor
Betrixaban Bevyxxa Factor Xa inhibitor; DOAC
Bivalriduin Angiomax Direct thrombin inhibitor
Danaparoid Orgaran Heparinoid
Desirudin Iprivask Direct thrombin inhibitor

 Patients need to maintain a consistent level of vitamin K intake while on warfarin to

prevent drastic changes in INR
 Heparin has a reversal agent which is protamine sulfate
 Low-molecular weight heparin is contraindicated in patients with epidural/spinal
puncture
 Eliquis should be 2.5 mg BID, instead of 5 mg BID, if two out of three criteria is met:
Age >80 years old, SCr >1.5, and weight <60 kg
 Fondaparinux is contraindicated if the patient is less than 50 kg when used for
prophylaxis in thromboembolic disease.
 Drug Review Week 2
08/24/2017
Antineoplastics- Clinical Pearls
Generic Name Brand Name More Specific Class
Cetuximab Erbitux Monoclonal Antibody
Pertuzumab Perjeta Monoclonal Antibody
Rituximab Rituxan Monoclonal Antibody
Ifosfamide Ifex Alkylating Agent
Carmustine BiCNU Alkylating Agent
Cisplatin Cisplatin Alkylating Agent
Doxorubicin Adriamycin Anthracycline
Epirubicin Ellence Anthracycline
Valrubicin Valstar Anthracycline
Lapatinib Tykerb Anti-HER2
Neratinib Nerlynx Anti-HER2
Axitinib Inlyta Vascular Endothelial Growth
Factor (VEGF) Inhibitor
Lenvatinib Lenvima VEGF Inhibitor
Vandetanib Caprelsa VEGF Inhibitor
Alitretinoin Panretin Retinoic Acid Derivative
Isotretinoin Absorica Retinoic Acid Derivative
Bexarotene Targretin Retinoic Acid Derivative
Thalidomide Thalomid Angiogenesis Inhibitor
Lenalidomide Revlimid Angiogenesis Inhibitor

 Isotretinoin has an iPLEDGE REMS component to prevent fetal exposure and increase
awareness of serious risks and safe-use conditions
 Acute nausea and vomiting includes vomiting, retching or nausea which occurs within 24
hours of administration of chemotherapy. Guidelines for prevention from Pediatric
recommend ondansetron, granisetron, or palonosetron.
 Use caution with cisplatin due to potential to cause or exacerbate syndrome of
inappropriate antidiuretic hormone secretion (SIADH) or hyponatremia; monitor sodium
closely with initiation or dosage adjustments in older adults according to Beers Criteria
2015: potentially inappropriate medication use in older adults >/= 65 years of age
 Greatest risk of occupational exposure to hazardous drugs occurs during preparation and
administration, a risk of exposure can occur throughout the facility from delivery to
disposal and contaminated human waste. Barrier protection through ventilation controls
and PPE should be used to minimize exposure: Class II biological safety cabinet or
compounding aspect containment isolator, closed system transfer devices (CSTDs)
minimize workplace contamination.
  Chemotherapy-induced peripheral neuropathy (CIPN) is a common dose-related
cumulative toxicity associated with many chemotherapeutic agents. CIPN can be
reversible after therapy discontinuation if identified early. Symptoms include numbness,
tingling/burning, paresthesias, hyperalgesia, and loss of tendon reflexes.

Parenteral Opioids- Top 5

Name Mechanism of Use Dosing Adverse Effects
Action
Morphine Binds to opioid Pain IV: Opioid O2 sat
receptors in the management naïve: 2.5-5 mg decreased,
CNS, causing every 3-4 hours drowsiness,
inhibition of Opioid tolerant: headache,
ascending pain 0.8-10 mg/hour; constipation,
pathways, usual range 20- nausea,
altering the 50 mg/hour vomiting, pain at
perception of injection site
and response to
pain; generalized
CNS depression
Fentanyl Binds with Surgery, Slow IV: 25-35 Confusion,
stereospecific postoperative mcg (70 kg dizziness,
receptors at pain, chronic patient) or 0.35- drowsiness,
many sites pain 0.5 mcg/kg fatigue,
within CNS, every 30-60 headache,
increases pain minutes PRN sedation,
threshold, alters dehydration,
pain receptor, constipation,
inhibits nausea, vomiting
ascending pain
pathways
Hydromorphone Binds to opioid Pain IV: Initial: Bradycardia,
receptors in the management of Opioid naïve: flushing (facial),
CNS, causing moderate to 0.2-1 mg every abnormal
inhibition of severe pain 2-3 hours PRN dreams,
ascending pain Continuous abnormal gait,
pathways, infusion: usual pruritus, skin
altering the dosage range rash, urticaria,
perception of 0.5-3 mg/hour increased liver
and response to enzymes
pain; causes
cough
suppression by
direct central
action in the
 medulla; general
CNS depression
Oxymorphone Potent opioid Pain IV: Initial 0.5 Drowsiness,
analgesic; management mg dizziness,
semisynthetic headache,
derivative of pruritus, nausea,
morphine and is constipation,
closely related to vomiting, fever
hydromorphone
chemically
Buprenorphine High-affinity Opioid Slow IV: Initial: Sedation;
binding to mu dependence; 0.3 mg every 6-8 Hypotension;
opiate receptors Pain hours as needed; Dizziness;
in the CNS; management initial dose (0.3 vertigo;
displays partial mg) may be headache;
mu agonist and repeated once in diaphoresis;
weak kappa 30-60 minutes nausea and
antagonist after dose if vomiting
activity. needed