Drugs for Most 1 PDF

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Summary

Drugs post midterm...

Description

Anemia & Hematopoietic Growth Factors Increase neutrophil production

Drug Name

Classification

Clinical Use

Side Effects

Notes

Sargamostim

GM-CSF

Decreased duration of neutropenia in stem cell transplant, cancer, chemotherapy, and AIDS

Acute reaction to first dose in sensitive patients: flushing, hypotension, nausea, vomiting, and dyspnea

MOA: cytokine, JAK/STAT, phosphorylated STAT dimer enters the nucleus to promote gene expression leading to neutrophil production Slow IV infusion or SC injection

Filgrastim

Pegfilgrastim

Lipegfilgrastim

G-CSF

G-CSF

G-CSF

Same CU as Sagramostin Decreases duration of neutropenia and reduces morbidity secondary to bacterial and fungal infections

Bone Pain, N/V

Same CU as Sagramostin Decreases duration of neutropenia and reduces morbidity secondary to bacterial and fungal infections

Bone Pain, N/V

Same CU as Sagramostin Decreases duration of neutropenia and reduces morbidity secondary to

Bone Pain, N/V

IV infusion or SC injection MOA: same as Sagramostin

IV infusion or SC injection Longer DOA than Filgrastim MOA: same as Sagramostin

IV infusion or SC injection Longer DOA than Filgrastim MOA: same as Sagramostin

bacterial and fungal infections Deferoxamine

Fe toxicity

Chelates circulating iron

Drug Name

Classification

Clinical Uses

Side Effects

Notes

Romiplostim

TRA Thrombopoietin receptor agonist

Increases platelet production

Immune thrombocytopeni a (ITP)

Genetically engineered protein in which Fc components of a human Ab are fused to multiple copies of a peptide that stimulates TRA. SC injection

Fatigue, headache, dizziness, and fluid retention

Restricted use due to hepatotoxicity and hemorrhage Oral drug

Fatigue, headache, dizziness, & fluid retention, tachycardia, palpitation, edema & SOB

Recombinant of IL-11 Produced by expression in E. coli SC Injection

Immune thrombocytopeni a (ITP), severe aplastic anemia (SAA) who has failed to respond to more conventional treatments Eltrombopag

TRA

Increases platelet production Immune thrombocytopeni a (ITP), severe aplastic anemia (SAA) who has failed to respond to more conventional treatments

Oprelvekin

Megakaryocyte Growth Factor: IL-11

Increases platelet production

Drug Name

Classification

Epoetin-Alfa

Erythropoiesisstimulating agent (ESA)

Clinical Use

Side Effects

Notes

Stimulate RBC production. Anemias of CKD, cancer chemotherapy or HIV treatment.

Black Box Warnings: thrombotic events and tumor progression

Recombinant human EPO IV or SC

N/V, HTN, HA, tachycardia, SOB, vomiting, edema Darbepoetin-alfa

Stimulate RBC production. Anemias of CKD & cancer therapy. No HIV clinical use

Black Box Warnings: thrombotic events and tumor progression

Longer half-life than Epoetinalfa.

N/V, HTN, HA, tachycardia, SOB, vomiting, edema

Oral Iron Therapies Drug Name

Classification

Clinical Use

Side Effects

Ferrous sulfate 325mg(65mg) $ Ferrous gluconate 324mg(38mg) $ Ferrous Fumarate 324mg(106mg) $$

Notes Take on an empty stomach

Oral iron supplement

Prevention and treatment of IDA

Nausea, abdominal pain, heartburn, constipation

Take on an empty stomach

Take on an empty stomach

Polysaccharideiron complex

Take on an empty stomach

Parenteral Iron Therapies

Drug

Classification

Iron Dextran

Clinical Use

Side Effects

Intolerance to oral supplementation Iron malabsorption Parenteral Iron Therapy

Sodium Ferric Gluconate Complex

Chronic dialysis patients who cannot be maintained with oral iron alone

Arthralgia, myalgia

Notes anaphylactic risk; test dose needed; no cross reaction to other parenteral iron therapies listed below for patients with allergic reaction to Iron Dextran

Significant blood loss

Iron-Sucrose Complex Ferric Carboxymaltose

Chronic Iron Toxicity Drug Name

Classification

Clinical Use

Deferoxamine

Parenteral

Iron toxicity

Deferasirox

Oral

Side Effects

Notes Chelates circulating iron. Also used for Acute Iron Toxicity

Vitamin B12 Deficiency Anemia Drug Name Cyanocobalamin

Classificati on

Cyanocobalamin

Side Effects

Nasal Parenteral

Hydroxocobalamin

Vitamin B12 deficiency -> leads to RBC production slowing

Notes Required DNA Synthesis and RBC Production

Oral

Vitamin B12 Nascobal

Clinical Use

Common: injection site reactions

Pernicious anemia & anemia caused gastric restriction

May result in neurologic deficits. Vitamin B12 = Myelin Production → decrease in Vitamin B12 will cause a decrease in myelin production. Essential for maintenance of cellular integrity, amino acid & fatty acid metabolism

Folic Acid Deficiency Drug Name

Classification

Clinical Use

Folic Acid

supplement?

Folic acid deficiency

Side Effects

Notes Required DNA Synthesis and RBC Production FA deficiency in pregnant women increases the risk of neural tube defects in the fetus.

Urinary Incontinence Drug Name

Classification

Clinical Use

Oxybutynin

Anticholinergics Tolterodine

Side Effects

Notes

Terrible, dry mouth

Non-selective for M receptors (IR, ER, Topical)

Urinary Incontinence

M3 selective (IR, ER)

Trospium

Non-selective, Low lipophilicity → Less CNS effects (IR, ER)

Solifenacin

QT Prolongation; well-tolerated

Darifenacin

well-tolerated

Fesoterodine

M3 selective Uro-Selective () Prodrug for Tolterodine, hypersensitivity

ALL anticholinergics: ● cannot be administered to elderly patients (may cause dizziness & confusion) ● May cause urinary retention ● May cause narrow-angle glaucoma ● Only for Irritative Symptoms when used for BPH Mirabegron

Diarrhea B3-Adrenergic Agonists

Urinary incontinence

Hypertension Headache

Vibegron Dry mouth Constipation UTI Tachycardia Nausea Dizziness

Relaxes bladder detrusor muscle Do not use in patients with hypertension Better tolerated than anticholinergics: less dry mouth and constipation Onset: up to 8 weeks

Nasopharyngitis ●

Only for Irritative Symptoms when used for BPH

Onabotulinumtox Neuromuscular in A blocker

Last line of therapy for urinary incontinence

Higher risk of UTI

Invasive Prevents vesicle membrane from fusing to the presynaptic membrane, which inhibits the release of ACh leading to relaxation

BPH Drug Name

Classification

Clinical Use

Side Effects

Notes

Finasteride

5 AlphaReductase Inhibitors

BPH

Sexual Dysfunction

Inhibits type 2 5alpha-reductase

Pregnancy category X

Inhibits type 1 & 2 5-alpha-reductase

Dutasteride

Orthostatic Hypotension Alfuzosin Terazosin

Alpha1Adrenergic Antagonists

(ER) (IR)

Doxazosin Tamsulosin Silodosin

Tadalafil 5 mg SIldenafil Vardenafil

(IR,ER) Alpha1-A Adrenergic Antagonists

BPH

More sexual side effects; fewer hypotensive side effects

Phosphodiestera se Inhibitors

Inhibits PDE5 in prostate, bladder neck, urethra, bladder & pelvic

Headache, dizziness, nasal congestion, dyspepsia, back

Used to treat Erectile Dysfunction (Relaxes prostate)

blood vessels Relaxes prostate and bladder neck

Avanafil

pain, myalgie, hearing loss

Enhance the effect of nitric oxide (NO) on smooth muscle in men urogenital

Vitamin D Analogs and Phosphate Binders Drug Name

Classification

Clinical Use

Side Effects

Notes

High incidence of hypercalcemia & hyperphosphat emia

Doesn’t require hepatic or renal activation

Vitamin D & Analogs

Suppress PTH production Management of hypocalcemia & sPTH

Calcitriol

Paricalcitol Doxercalciferol Calcium Carbonate (Tums)

Hypercalcemia, Cheap calcification, GI (constipation, N/V), DI

Ca based Pbinders

Calcium Acetate (Phoslo) Sucrose ferric oxyhydroxide (Velphoro)

non-Ca based P-binder

Tenapanor

Mineral bone disorder

Hyperphosphatemia

Diarrhea, discolored feces, nausea, abnormal taste

Iron-based Additional advantage of absorbing Fe Inhibits the transport of phosphate in the intestine Different than other P-binders because it inhibits in the GI to reduce P transport In a clinical study

Sevelamer

Lanthanum CO3

non-Ca based P-binder

Hyperphosphatemia

Decreases LDL Use in patients Avoid in GI with hyperCa obstruction

Kidney (prevention of chronic kidney disease?) Drug Name

Classification

Clinical Use

Thiazide like

HTN Fluid Balance

Side Effects

Notes

Indapamide Metolazone

Take PRN with Loop Diuretic

Calcimimetics** Drug Name

Classification

Clinical Use

Side Effects

Cinacalcet

Calcimimetics

Suppress PTH, Risk of Increase Hypocalcemia sensitivity and Hypophos N/V diarrhea

Notes CYP450 2D6 metabolism Ketoconazole INC. cinacalcet concentration up to 2X. 30 mg initial dose (irrespective of PTH level) Baseline of Ca is 8.4 (don't use if...