Pain, Hematology, and Oncology 1 (PDF)

PAIN, HEMATOLOGY, AND ONCOLOGY 1 Pharmacologic Common Generic Name Brand Name Essential Knowledge Category...

PAIN, HEMATOLOGY, AND ONCOLOGY 1 Pharmacologic Common Generic Name Brand Name Essential Knowledge Category Indications fentanyl Transdermal: Duragesic, Key Side Effects: dizziness, drowsiness, itching, nausea, vomiting, (transdermal, IV) IV: Sublimaze constipation, respiratory depression (dose-related) hydromorphone (PO, IV) Dilaudid US Boxed Warnings (all opioid analgesics): risk of opioid addiction, abuse, morphine (extended and misuse which can lead to overdose and death; serious, life-threatening, MS Contin, Kadian or fatal respiratory depression may occur; accidental ingestion may result in release) (PO) Pain morphine (immediate fatal overdose; prolonged use in pregnancy may result in neonatal opioid IV: Duramorph withdrawal syndrome; abrupt discontinuation may result in serious opioid- release) (PO, IV, IM, PR) Opioid analgesic induced withdrawal syndrome; concomitant use of opioids with oxycodone (PO) Oxycontin, Roxicodone benzodiazepines or CNS depressants (including alcohol), may result in profound sedation, respiratory depression, coma, and death Key Side Effects: dizziness, drowsiness, nausea, vomiting, constipation, Opioid use respiratory depression (dose-related), QTc prolongation methadone (PO, IV) Dolophine disorder, severe US Boxed Warnings (all opioid analgesics): See above chronic pain US Boxed Warnings (only for methadone): QTc interval prolongation and serious arrhythmia (Torsades de Pointes) have occurred during treatment Analgesic (non- Key Side Effects: nausea, vomiting, increased hepatic transaminases acetaminophen PO/PR: Tylenol, opioid), Pain, fever US Boxed Warnings: total daily dose from all sources should not exceed (PO, PR, IV) * IV: Ofirmev antipyretic maximum daily limit; hepatotoxicity Key Side Effects: dizziness, drowsiness, nausea, vomiting, constipation, Central analgesic; Ultram, respiratory depression (dose-related) partial opioid tramadol (PO) Pain Ultram ER US Boxed Warnings: serious or fatal respiratory depression may occur agonist Other Notes: lowers seizure threshold hydrocodone and Lortab, Vicodin, Norco Opioid and acetaminophen (PO) Key Side Effects: dizziness, drowsiness, nausea, vomiting, constipation, nonopioid oxycodone and Percocet, Endocet, Roxicet Pain respiratory depression (dose-related) analgesic acetaminophen (PO) US Boxed Warnings (all opioid analgesics): See above combination codeine and Tylenol with Codeine #3, acetaminophen (PO) Tylenol with Codeine #4 naloxone Opioid Key Side Effects: headache, opioid withdrawal syndrome in opioid- Opioid antagonist Narcan (IV, IM, SQ, intranasal) overdose dependent populations, pain, diaphoresis Other Notes: potentially life-threatening respiratory depression (when Partial opioid combined with other CNS and respiratory depressants); addition of naloxone buprenorphine and Opioid use agonist and Suboxone to buprenorphine reduces possibility of parenteral misuse by producing naloxone (SL) disorder opioid antagonist opioid withdrawal symptoms when injected *: OTC product available  PAIN, HEMATOLOGY, AND ONCOLOGY 2 Pharmacologic Category Generic Name Brand Name Common Indications Essential Knowledge Key Side Effects: stomatitis, diarrhea, nausea, vomiting, thrombocytopenia, leukopenia, increased hepatic transaminases, pulmonary fibrosis (rare) US Boxed Warnings: serious toxic reactions (only use in life-threatening neoplastic disease, severe psoriasis, or severe rheumatoid arthritis); may cause Rheumatoid arthritis, fetal death and/or congenital abnormalities (avoid in pregnancy); severe Crohn’s Disease, (sometimes fatal) bone marrow suppression, aplastic anemia, and toxicity have Antimetabolite methotrexate (PO) Trexall psoriasis, various been reported with concomitant administration of methotrexate and NSAIDs; (folic acid antagonist) hematologic and solid may cause hepatotoxicity; methotrexate-induced lung disease, including acute tumors or chronic interstitial pneumonitis may occur; severe (sometimes fatal) gastrointestinal toxicity has been reported with concomitant administration with NSAIDs Other Notes: folic acid supplementation may be taken during use to reduce hematologic, gastrointestinal, and hepatic side effects Key Side Effects: fatigue, rash, flushing, hot flashes, arthralgia, nausea, Hormone receptor- vomiting, hypertension, peripheral edema, osteoporosis Aromatase inhibitor anastrozole (PO) Arimidex positive breast cancer Other Notes: cardiovascular side effects (i.e., hypercholesterolemia, CAD); fetal toxicity (CI in pregnancy) Key Side Effects: hypertension, nausea, dizziness, xerostomia, primary pulmonary hypertension (rare) CNS stimulant phentermine (PO) Adipex-P Obesity Other Notes: only approved for short-term use; CI in those with a history of cardiovascular disease or drug abuse, pregnancy, hyperthyroidism, or within 14 days of MAOI inhibitor therapy Boxed Warning: Accidental overdose of iron is leading cause of fatal poisoning FeroSul, Iron deficiency in children under 6 years old Iron supplement ferrous sulfate (PO)* SlowFe anemia Key Side Effects: nausea, stomach upset, constipation (dose-related), dark and tarry stools cyanocobalamin Vitamin B12 deficiency (vitamin B12) (PO, IM, --- (manifests as Key Side Effects: no major side effects SL, intranasal)* macrocytic anemia) Folic acid deficiency Water-soluble vitamin (manifests as macrocytic anemia), folic acid (PO)* --- Key Side Effects: no major side effects prevention of neural tube defects in pregnancy *: OTC product available