Key Drugs, Mnemonics, Study Tips

RXPREP: KEY DRUGS, MNEMONICS, STUDY TIPS1 • HAZARDOUS DRUGS are: o Teratogenic o Carcinogenic o Genotoxic (damage the DNA and can cause cancer) o Have reproductive toxicity o Cause organ toxicity at low doses • Key hazardous drugs that require SPECIAL HANDLING to avoid toxicity to workers: o All pregnancy category X drugs, category D’s and a few C’s, and paroxetine, methotrexate, misoprostol, mifepristone, ribavirin o Antineoplastics (chemotherapeutics) o 5-alpha reductase inhibitors (dutasteride, finasteride) o Hormones (contraceptives, estradiol, testosterone) o Transplant drugs (MMF, tacrolimus, CYA, everolimus, sirolimus) o Others: colchicine, dronedarone, fluconazole, spironolactone, risperidone, raloxifene, rasagiline, ziprasidone • Key drugs most commonly associated with PHOTOSENSITIVITY: o Carbamazepine o Diuretics (thiazide and loop) o MTX o Oral and topical retinoids o Quinolones o St. John’s Wort o Sulfa antibiotics o Tacrolimus o Voriconazole o Others: amiodarone, antihistamines (1st generation), chloroquine, coal tar, fluorouracil, griseofulvin, NSAIDs, quinidine, tigecycline • Key drugs commonly associated with TTP: o Clopidogrel o Ticlopidine o Others: acyclovir, famciclovir, quinine, SMX, valacyclovir • CYP inducers o PS PORCS (big inducers)  Phenytoin  Smoking  Phenobarbital  Oxcarbazepine (and eslicarbazepine)  Rifampin (and rifabutin, rifapentine)  Carbamazepine (also an auto-inducer)  St. John’s Wort • CYP inhibitors o G 3 PACMAN (big inhibitors)  Grapefruit  PIs protease inhibitors (ritonavir)  Azole antifungals (fluconazole, itraconazole, ketoconazole, posaconazole, voriconazole, isavuconazonium)  C: CYA, cimetidine, cobicistat  Macrolides (clarithromycin, erythromycin, not azithromycin)  Amiodarone (and dronedarone)  Non-DHP CCBs (diltiazem and verapamil) • Key SEROTONERGIC drugs: o SSRIs o SNRIs o TCAs o MAOIs (plus linezolid and methylene blue) o Buspirone o Dextromethorphan o Fentanyl o Lithium o Methadone o Mirtazapine o St. John’s Wort o Tramadol o Trazodone o Others: cyclobenzaprine, lorcaserin, meperidine, 5HT3-RA, some triptans • Key drugs required/strongly recommended PGx testing: o Abacavir o Azathioprine o Carbamazepine o Cetuximab and panitumumab o Trastuzumab, ado-transtuzumab, lapatinib, pertuzumab o Others: allopurinol, capecitabine, fluorouracil, clopidogrel, codeine, phenytoin, fosphenytoin, warfarin • Key drugs - DO NOT put these drugs into PVC IV CONTAINERS o LATIN  Lorazepam  Amiodarone  Tacrolimus  Insulin  NTG  Others: cabazitaxel, carmustine, docetaxel, etoposide, ixabepilone, paclitaxel, sufentanil, temsirolimus, teniposide, thiopental • Key drugs - SALINE (no dextrose) o ACID APE  Ampicillin  Caspofungin  Infliximab  Daptomycin (Cubcin)  Ampicillin/sulbactam  Phenytoin  Ertapenem (Invanz)  Others: abatacept, azacitidine, belimumab, bevacizumab, idarucizumab, iron sucrose, sodium ferric gluconate complex, natalizumab, trastuzumab • Key drugs - DEXTROSE (no saline) o ABS  Amphotericin B  Bactrim  Synercid (quinupristin/dalfopristin)  Others: carfilzomib, MMF, pentamidine • Key drugs - common drugs with FILTER requirements o Most: 0.22-micron filter during administration* o Pushy guys in LA LA land  Phenytoin  Golimumab  Lipids - 1.2 micron*  Amphotericin B (lipid formulations)*  Lorazepam  Amiodarone • * larger pore size filter required; ampho prepare using a 5-micron filter  Others: abatacept, abciximab, digoxin immune fab, infliximab, isavuconazonium, mannitol, thiotepa • Key drugs - DO NOT REFRIGERATE o Dear sweet pharmacist, marry me forever, eternally  Dexmedetomidine  SMX-TMP  Phenytoin  Metronidazole  Moxifloxacin  Furosemide  Enoxaparin  Others: acetaminophen, acyclovir, deferoxamine (Desferal), levetiracetam, pentamidine, valproate • Key drugs - PROTECT FROM LIGHT DURING ADMINISTRATION o Deliver every needed medication protected  Doxycycline  Epoprostenol  Nitroprusside  Micafungin  Phytonadione  Others: anthracyclines, dacarbazine, pentamidine • Key drugs - TERATOGENS o Acne: isotretinoin, topical retinoids (including tazarotene) o Abx: quinolones, tetracyclines o Anticoagulants: warfarin o HLD, HF, HTN: statins, RAAS inhibitors (ACEi, ARBs, aliskiren, sacubitril/valsartan) o Hormones: most, including estradiol, progesterone [megesterol (Megace)], raloxifene, Duavee, testosterone, contraceptives o Migraine: dihydroergotamine, ergotamine o Other important teratogens: hydroxyurea, lithium, MTX, misoprostol, paroxetine, ribavirin, thalidomide, topiramate, VPA, divalproex, weight loss drugs • Avoid in PEDIATRICS o Contraindicated  Codeine age 12 y  Tramadol age 12 y  Promethazine age 2 y  Ceftriaxone in neonates 1-28 d o Not generally recommended  Quinolones  Tetracyclines age 8 y  OTC cough and cold preparations in age 6 y • Live vaccines o Injections  MMR  MMRV  Varicella  Zoster  Yellow fever o Other routes  Influenza intranasal  Rotavirus  Cholera  Typhoid • Vaccines for specific conditions o Pregnancy  Influenza vaccine  Tdap x 1 with each pregnancy (optimal time between weeks 27 and 36)  Live vaccines CI during pregnancy o Asplenia  H. influenzae type B (HIB)  Pneumococcal (Prevnar and Pneumovax 23)  Meningococcal • Selected drugs that CAUSE KIDNEY DISEASE o Aminoglycosides o Amphotericin B o Cisplatin o Colistimethate o CYA o Loop diuretics o NSAIDs o Radio graphic contrast dye o Tacrolimus o Vancomycin • Study tip: CrCl vs GFR o CrCl  Cockcroft-Gault equation  CrCl = 140−patient age × 72 x SCr weight in kg (× 0.85 if female)  For CrCl calculation, use ABW if patient is IBW, use IBW is normal weight (by • Select drugs that are CI IN KIDNEY IMPAIRMENT o CrCl 60  Nitrofurantoin o CrCl 50  Elvitegravir/cobicistat/ emtricitabine/TDF (Stribild)  Voriconazole IV o CrCl 30  o GFR BMI) Dosing adjustments and CI’s are generally based on CrCl calculated with Cockcroft-Gault  Avanafil  Bisphosphonates  Dabigatran  Duloxetine  CKD-EPI or MDRD equation  Used for staging kidney disease and for dosing select drugs  Not commonly calculated in the clinical setting, but may be reported by some laboratories  For the exam, if GFR is not provided, CrCl provides a close estimate for doing and CI purposes • Select drugs that require OR