NAPLEX Grouping
ANTIBIOTICS
Take with food
● Amoxicillin
● Augmentin
● Cefuroxime
● Flagyl IR
● Nitrofurantoin
● Clarithromycin
Take before/after meal
● Penicillin VK
● Azithromycin XR
● Flagyl XR
● Levofloxacin
● Doxycycline
● Minocycline
Refrigerate
● Amoxicillin
● Augmentin
● Cephalexin
● Cefuroxime
● Penicillin VK
● Erythromycin
Do not refrigerate
● Cefdinir
● Clindamycin
● Azithromycin
● Ciprofloxacin
● Bactrim
● Clarithromycin
● Doxycycline
Separate from antacids:
● FQ
● Nitrofurantoin
● Doxycycline
Take with full glass of water:
● Bactrim
● FQ
● Clindamycin
● Doxycycline
● Minocycline
EVERYTHING ELSE
Photosensitivity
● Bactrim
● FQ
● Doxycycline
● MTX
● Thiazides/Loops
Interacts with OC:
● Colesevelam
Drug Timing:
● Evening:
○ Zocor
○ Lescol
● Evening meal:
○ Mevacor
● Bedtime
○ Altoprev
Safe for Pregnancy
● HTN:
○ Labetalol
○ Nifedipine ER
○ Methyldopa
Sulfa allergy:
● Thiazides
● Darunavir
● Bactrim
● Loops except ethacrynic acid
(not likely to react)
● Fosamprenavir
● Celecoxib
● Zonisamide
Causes constipation:
● All non-DHP CCBs (verapamil
the most)
● A2 agonists
● Amiodarone
● Vinca alkaloids
● Immunomodulators
May cause DILE:
● Hydralazine
● Methyldopa
● BiDil
● Quinidine
● Procainamide
● Amiodarone
● Minocycline
Dec renal clearance of Li:
● Diuretics
● Entresto
● Salt intake
● ACE-i’s/ARB’s
Use actual body weight for dosing:
● UFH
● Lovenox
● Chemotherapy (use actual BW
for BSA)
● Vancomycin
● Insulins
Avoid EtOH:
● Flagyl
● Warfarin
● Nilutamide
Do not shake:
● ESA’s
● Anti-TNF Biologic DMARDs for
RA
Need ‘time off’ interval
● Lidocaine (12 hrs)
● NTG (12-14 hrs)
● 36 hr washout between ACE &
●
Trokendi XR
●
●
NTG TL Spray
Natalizumab
Avoid taking at bedtime:
● Fluoxetine (activating)
● Bupropion (activating)
● Pseudoephedrine
Smoking reduces levels:
● Clozapine
● Olanzapine
Screen for HLA-B*1502:
● Phenytoin
● Fosphenytoin
● Carbamazepine
● Oxcarbazepine
Drugs that discolor:
● Brown: levodopa, entacapone,
methyldopa
● Brown/black/green:
methocarbamol
● Purple/orange/red:
chlorzoxazone
● Brown/yellow: metronidazole,
tinidazole, nitrofurantoin, B2
● Orange/yellow: sulfasalazine
● Yellow-green: propofol,
flutamide
● Red-orange: phenazopyridine,
rifapentine, rifampin
● Red: anthracyclines, deferasirox
(urine)
● Blue: mitoxantrone, methylene
blue
● Blue-gray: Chloroquine,
amiodarone
ARNI
May cause priapism:
● Sinemet
● Trazodone
● Stimulants
● Lorcaserin
● PDE-5 Inhibitors
ONCOLOGY (more in depth because this info is from class)
Take with food:
● Imatinib
● Thalidomide
● Capecitabine
● Exemestane
Empty stomach:
● Nilotinib
● Erlotinib
● Sorafenib
● Temozolomide
● Abiraterone
● Pomalidomide
Extravasation
● Anthracyclines
● IV promethazine
Chemo that needs a buddy
● Pemetrexed needs B12 or folic
acid supplementation to lower
levels (dec toxicity)
● Taxanes need H1 & H2 blockers
and corticosteroids to prevent
infusion reactions
● Immunotherapy agents need a
corticosteroid to reduce
immune related rxns
● Pemetrexed needs to be admin
with dexamethasone to prevent
rash
● Pembrolizumab needs tx with
Major DDIs:
Neurotoxicity
● Antifolates with omeprazole &
● Vincristine (Cr for cranium)
NSAIDs→ dec CL from body
● Taxanes
● Erlotinib with CYP3A4 &
● Cisplatin
warfarin
● Oxaliplatin (think of Olaf
● BCR-ABL Inhibitors CYP3A4,
because of the cold sensitivity
CYP2D6, and statins
after chemo)
● Erlotinib reacts with omeprazole
and ranitidine
● Tamoxifen metabolized by
CYP3A4, CYP2C19, and CYP2D6
so DI with fluoxetine and
paroxetine
● Endoxifen: most important
●
●
●
●
prednisone to prevent immune
related rxns
Androgen Deprivation Therapy
needs the addition of
bisphosphonates (Zoledronic
Acid or Alendronate) for the
bone SE + Ca and Vit D
supplementation
Abiraterone needs to be given
with prednisone to replace the
cortisol
Docetaxel or Cabazitaxel (2nd
line) used with prednisone for
prostate cancer chemo
(standard of care)
AI causes inc risk for OP so must
supplement with Vit D and Ca
●
●
●
metabolite
Capecitabine interacts with
warfarin to inc INR
Finasteride may lower PSA
Enzalutamide interacts with
CYP3A4, CYP2C8, CYP2C9 and
CYP2C19 substrates
Special Considerations in
administration
● Vincas are fatal if given
intrathecally
○ Need central line
● Anthracyclines need a central
line because they are vesicants
and can cause extravasation
Alopecia:
● Vemurafenib
● Carboplatin
● Etoposide
● Doxorubicin
QT Prolongation:
● Ondansetron
● Vemurafenib
● Crizotinib
Let’s Treat Nausea:
● Anticipatory: BZD, olanzapine
● Acute: BZD, dexamethasone,
5HT3 antagonists, cannabinoids,
olanzapine
● Delayed: -prepitants,
dexamethasone (most effective
for delayed), metoclopramide +
dex,
● Breakthrough Tx (in addition to
scheduled): Phenothiazines
(primarily), 5HT3 antagonists,
metoclopramide, corticosteroid,
dronabinol, olanzapine,
lorazepam
● Not recommended as single
agents: lorazepam,
diphenhydramine
Let’s Treat Diarrhea:
● Normal Diarrhea: Loperamide,
Atropine/diphenoxylate
(Lomotil) if loperamide fails,
octreotide (last line)
● Irinotecan Associated Early
Diarrhea: Atropine
● Irinotecan Associated Late
Diarrhea: Loperamide (L for
Late)
Let’s Treat Constipation:
● Laxatives: senna, bisacodyl
● Stool softeners: docusate
sodium
● Osmotics: PEG, lactulose
● Prokinetic: metoclopramide
● Saline: Mg citrate for rescue
● Opioid receptor antagonists:
methylnaltrexone
● AVOID:
● Bulk forming→ makes it worse
● Suppositories
● Enemas
Neuropathy
● Oxaliplatin--DO NOT give to pts
with DPN or >70 YO
● Bortezomib
● Carboplatin
● Paclitaxel--biggest problem
● Cisplatin
Hypersensitivity Rxns:
● Alkylating Agents
● Murine MoABs (-o)
● Trastuzumab
● Abiraterone
● Carbitaxel (do NOT use if pt had
rxn with docetaxel)
Infusion Rxns
● Taxanes
● Rituximab
● Cetuximab
Constipation
● Vincristine
● Vinblastine
● Cisplatin
● Thalidomide
Let’s Treat Acneiform Rash:
● Topical HC or clindamycin
● Severe: doxycycline or
minocycline
● AVOID:
○ OTC acne meds like
benzoyl peroxide
Let’s Treat Hypercalcemia:
● IV fluids: NS bolus, maintenance
fluids prn
● Bisphosphonates: Zoledronic
acid and Pamidronate
● Calcitonin
● Denosumab: max 4 doses
● D/c any Ca or phosphate
supplements
Mnemonics:
● BAS gives you gas→ most common SE are constipation, abdominal pain, cramping, gas, bloating, and inc TG
● ThiaziDe: Distal convoluted tubule
● Nebivolol→ Nitric oxide dependent vasodilator beta blocker
● Prasugrel can only be given with PCI in ACS management
● Carvedilol: comer (eat) → take with food
● Class IB antiarrhythmics cross the BBB
● TrazoBONE: causes priapism→ emergency where your boner stays for a v long time
● Paliperidone and risperidone have the highest prolactin risk
● V is later in the alphabet so you would wait longer to discontinue Vedolizumab (14 weeks) than Natalizumab (12
weeks) if no response
● Vasopressors are all vesicants
● Dobamine: Dopamine is a DA agonist at low doses, B1 agonist at moderate doses, and A1 agonist at higher doses
● I am positive that you are more sensitive when you are on your period
○ Sensitivity: the percentage of time that a test is positive when a disease is present
Oncology Mnemonics:
● Alkylating agents and anthracyclines work at any phase of the cell cycle
● Carboplatin dose is calculated by the Calvert equation
● Oxaliplatin is exacerbated by the cold (Olaf)
● Bevacizumab bleedvacizumab: has mostly bleeding SE because it works to prevent angiogenesis, so think of bleeding,
BBW for wound breaking, thrombosis, HTN, and fatal hemoptysis
● BCR-ABL Inhibitors eliminate the Philadelphia chromosome of CML and SE are mostly in the peritonium→ fluid
retention, pleural effusion, pericardial effusion, ascites, LFT elevation
● Of the drugs with infusion reactions, rituximab is mainly seen as rigors and you can rechallenge
● ALWAYS REMEMBER: PACLITAXEL BEFORE CARBOPLATIN to lessen myelosuppression
● The most common cytotoxic treatments for breast cancer are TATAs: Taxanes Anthracyclines
● No mnemonic for this yet, but random observation→ all of the most common drugs for renal cell carcinoma cause HTN
as a SE so check BP
● Interferon is generally inferior→ no survival benefit when added and causes flu-like sx
● Dacarbazine and Temozolomide are good for met skin cancer bc it crosses BBB to tx brain mets. No mnemonic, just
remember
○ But Temozolomide better than Dacarbazine→ Temozolomide is terrific for the top (of your head) → better CNS
penetration and less emetogenic
● Erlotinib needs to be taken on an empty stomach!
● HER2 inhibitors have BBW for heart failure and hepatotoxicity
● If she’s 5’3 she’s a cute!
○ Acute nausea is caused by 5HT3
● Delayed nausea is caused by DA
● Equivalent dosing for 5HT3 Antagonists: They go in order of increasing dose when you spell out the word GOD
○ Granisetron 2 mg
○ Ondansetron 24 mg
●
○ Dolasetron 100 mg
Rectal cancer→ Radiation; Colon Cannot
○ You cannot do RT in colon cancer bc it is always moving