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Ceftol/Tazo Linezolid
IV:PO 1:1 Light Protection D5W Only NS Only NS/LR Only No food
Ampicillin (cap/susp)
Levofloxacin, moxifloxacin Dalbavancin Azithromycin ER susp
Doxycycline, minocycline Oritavancin Ceftibuten susp
SMX/TMP Doxycycline Pentamidine Ampicillin Levofloxacin susp
Caspofungin
Linezolid, tedizolid Micafungin Quinupristin/dalfopristin Ampicillin/sulbactam Metronidazole ER
Daptomycin
Metronidazole Pentamidine SMX/TMP Ertapenem Penicillin
Fluconazole, isavuconazole, voriconazole, Ampho B Rifampin, isoniazid
posaconazole (tablets) (Ambisome, Abelcet) Voriconazole
Itraconazole solution
G6PD (+) Coombs Test Lupus (DILE) False ↑aPTT False ↑INR False ↑Urine Glucose No Refrigeration (IV)
Penicillins
Chloroquine Cephalosporins
Penicillins Acyclovir
Primaquine Imipenem, meropenem Isoniazid Oritavancin
Oritavancin Cephalosporins Metronidazole
Dapsone Nitrofurantoin Minocycline Telavancin
Telavancin Imipenem Moxifloxacin
Nitrofurantoin Rifampin, isoniazid Terbinafine Daptomycin
Isoniazid SMX/TMP
SMX SMX
Quinine
Carbapenems (DRESS)
Quinolones (SJS/TENS)
Pen VK, amoxicillin (± clav), ampicillin, dicloxacillin Macrolides Beta lactams
Azithromycin (all) Quinolones
Cefaclor, cefprozil, cefuroxime, cefdinir, cefixime, Tetracyclines Quinolones
Tetracyclines (DRESS) Tetracyclines Quinolones
cefpodoxime, ceftibuten SMX/TMP SMX/TMP
SMX/TMP (SJS/TENS) SMX/TMP Macrolides
Quinolones (except gatifloxacin) Linezolid, tedizolid Linezolid
Vancomycin (SJS/TENS) Tigecycline
Metronidazole, tinidazole Clindamycin Metronidazole
Metronidazole
(SJS/TENS)
1st Generation 2nd Generation 3rd Generation 4th Generation 5th Generation
Cefdinir (Omnicef) PO
Cefixime (Suprax) PO
Cefpodoxime (Vantin) PO
Cefaclor (Ceclor) PO
Ceftriaxone (Rocephin) IV/IM
Cefuroxime (Ceftin, Zinacef) PO/IV/IM
Cefazolin (Ancef, Kefzol) IV/IM Cefotaxime (Claforan) IV/IM
Cefotetan (Cefotan) IV/IM Cefepime (Maxipime) IV/IM Ceftaroline (Teflaro) IV
Cephalexin (Keflex) PO
Cefoxitin (Mefoxin) IV/IM
Ceftazidime (Fortaz,
Cefprozil (Cefzil) PO IV/IM
Tazicef)
IV
+Avibactam (Avycaz)
IV
Ceftolozane/Tazo (Zerbaxa)
Rocephin + pseudomonas,
Staphylococci, streptococci, HNPEK, Staphylococci, streptococci, HNPEK,
Staphylococci, streptococci, citrobacter, acinetobacter, Rocephin + MRSA
GP anaerobes GP anaerobes
PEK, GP anaerobes providencia, enterobacter, Broadest GP coverage
+ GN anaerobes (B. fragilis) + pseudomonas
serratia
HNPEK: Haemophilus, Neisseria, Proteus, E Coli, Klebsiella
Lab Values & monitoring
Calcium Vitamin D Magnesium Phosphate Potassium Sodium Bicarbonate
ACE/ARB/ARA,
aliskiren, NSAIDs,
cyclosporine,
Mg-containing tacrolimus,
Calcium, vitamin D, Loop diuretics
↑ laxatives/antacids, Renal failure mycophenolate, Hypertonic saline
thiazide diuretics Steroids
renal impairment drospirenone BCP,
SMX/TMP, chronic
heparin, canagliflozin,
pentamidine
False:
SMX/TMP, H2RAs
True: AG, amphoB, Drug allergy
Steroids ESA
Renal impairment, cisplatin, colistin, Asthma Viral infections
↑ CSF Infection Smoking
dehydration cyclosporine, loop Inflammation Lymphoma
Epinephrine Polycythemia
diuretics, NSAIDs, Parasitic infection
contrast, tacrolimus,
vancomycin
Clozapine, Chemo
carbamazepine, Low production
Muscle mass, Bone marrow
cephalosporins, Blood loss
↓ amputation, suppression, HIV,
procainamide, B12/folate deficiency
hemodilution steroids
vancomycin, chemo, hemolytic/sickle cell
immunosuppressants anemia
Hbg/Hct MCV Iron Folic Acid Vitamin B12 (+) Coombs Test G6PD
↑ Heparins,
Drugs affected:
True: UFH, DTIs fondaparinux, valproic Liver Muscle
False: daptomycin,
False: oritavancin, acid, Gp IIb/IIIa Biliary tract Brain Liver
oritavancin, telavancin Warfarin, phenytoin,
↓ telavancin antagonists, linezolid, Bone Liver
valproic acid, calcium
chemo
Anti-TNF, hydralazine,
isoniazid, methimazole,
Daptomycin, statins,
Lithium, Diuretics, niacin, methyldopa,
Valproic acid tenofovir, raltegravir,
↑ Didanosine, stavudine carbamazepine, pyrazinamide minocycline,
Topiramate dolutegravir,
Liver, biliary tract, GLP-1 agonists oxcarbazepine Cyclosporine, procainamide,
quinupristin/
pancreas Valproic acid tacrolimus, ribavirin, propylthiouracil,
dalfopristin, fibrates,
DPP-4 inhibitors high-dose ASA, quinidine, terbinafine
emtricitabine,
pancreatic enzymes
tipranavir, telbivudine
↑/↓ amiodarone,
↓ Lactulose CRP, RF, ESR, ANA
interferons
Haloperidol,
NRTIs, metformin, risperidone,
↑
alcohol, cyanide paliperidone,
methyldopa
Regulated by
↓
dopamine
Carbamazepine Carbamazepine,
St. John’s wort
Diuretics celecoxib,
Sulfa antibiotics Abacavir, isavuconazonium, doxycycline,
(loop/thiazide) Clopidogrel (Key)
Tacrolimus carbamazepine, letrozole, nevirapine, ethosuximide,
Methotrexate Ticlopidine Allopurinol
Tetracycline caspofungin, oseltamivir, fosphenytoin,
Retinoids Lamotrigine
Voriconazole clindamycin, oxcarbazepine, gabapentin,
Quinolones Penicillins clopidogrel, peramivir, ibuprofen,
Phenytoin deferasirox, phenobarbital, quinine, lacosamide,
Others: Acyclovir, Piroxicam ethosuximide, terbinafine, ticlopidine, minocycline,
Others: Amiodarone, antihistamines (1st gen), fosphenytoin, tiagabine, varenicline, oxcarbazepine,
famciclovir, quinine, Sulfamethoxazole
chloroquine, Coal Tar, fluorouracil, griseofulvin, hydroxychloroquine, voriconazole, zonisamide sulfasalazine,
sulfamethoxazole,
NSAIDs, quinidine, tigecycline terbinafine, valproate,
valacyclovir
vancomycin
Drug Interactions
CYP ENZYMES
Inducers PS PORCS
Phenobarbital
Strong ≥ 80 ↓ AUC Phenytoin Oxcarbazepine (eslicarbazepine)
Moderate 50 - 80% ↓ AUC Smoking Rifampin (rifabutin, rifapentine)
Weak 20 - 50% ↓ AUC Carbamazepine (autoinducer)
St. John’s wort
Inhibitors G PACMAN
PI’s (+ ritonavir)
Strong ≥ 5-fold ↑ AUC Azole’s
Moderate ≥ 2-fold ↑ AUC Grapefruit Cyclosporine, Ci metidine, Cobicistat
Weak ≥ 1.25-fold ↑ AUC Macrolides (NOT azithromycin)
Amiodarone (dronedarone)
Non-DHP CCB’s (diltiazem, verapamil)
3A4
Anti-infectives (azole’s, clarithromycin, erythromycin, isoniazid)
Substrates CV drugs (amiodarone, dronedarone, diltiazem, verapamil, quinidine, ranolazine)
Analgesics HIV Drugs (efavirenz, fosamprenavir, indinavir, nelfinavir, nevirapine, saquinavir)
Anticoagulants Others (aprepitant, cimetidine, cyclosporine, fluvoxamine, grapefruit, haloperidol,
Diabetics nefazodone, sertraline)
Antiplatelet
CV drugs
Immunosuppressants
Statins
HIV drugs
PDE-5 inhibitors
P-gp
Apixaban, edoxaban, rivaroxaban, dabigatran, carvedilol, digoxin, ranolazine, cyclosporin, sirolimus, tacrolimus, dasabuvir, paritaprevir, ombitasvir simeprevir, sofosbuvir,
atazanavir, colchicine, dolutegravir, fexofenadine, posaconazole, raltegravir, saxagliptin
Agar
Alginates
Aquaphor Syrups, oils
Alginic acid Guar gums
Aquabase Sucrose
Polacrilin potassium Acacia
Vaseline Cellulose acetate Aspartame Magnesium stearate Glycerin
(Amberlite) Gelatins
Petrolatum phthalate Saccharin Silica Sorbitol
Cellulose products Tragacanth
Polybase shellac Glycerin Propylene glycol
Compressible sugar Bentonite
Eucerin Lactose
(Nu-Tab) Carbomer
Cetaphil Phenylalanine
Cellulose
starches
Hydrophilic solvents Hydrophobic solvents Levigating agents Lubricants Preservatives Suppository bases Surfactants
Lifetime cumulative dose: 400 Lifetime cumulative dose: 450-550 Dose/cycle not to exceed: 100 Single dose
units2 mg/m2 mg/m2 capped at: 2 mg
Fluorouracil
All except: Cisplatin
Capecitabine Fluorouracil
Asparaginase Doxorubicin Vincristine
Irinotecan Capecitabine
Bleomycin Epirubicin Pomalidomide
Methotrexate Irinotecan
Vincristine Cyclophosphamide Thalidomide
Many TKIs (afatanib, ponatinib, Many TKIs
Most monoclonal ABs,TKIs Ifosfamide
sorafenib, sunitinib)
BM frequency
Monitoring: CBC w/diff, Temp, s/sx superinfection (oral ulcers
Hydration status Hydration status BM frequency
bleeding, fatigue, SOB HSV, thrush candida)
K+/electrolytes
Management:
Neurokinin-1 receptor antagonist
Neutropenia: CSFs IV/PO fluid hydration
(NK1-RA) Symptomatic treatment:
Anemia: RBC transfusions, and Antimotility agents (loperamide) Stimulant laxatives
5HT3-RA Mucosal coating agents
ESAs PEG
Dexamethasone Topical local anesthetics
Thrombocytopenia: platelet Irinotecan: atropine
IV/PO fluid hydration
transfusions
QT prolongation
Cardiomyopathy Arsenic trioxide Pulmonary fibrosis
Pneumonitis
Anthracyclines Leuprolide
Methotrexate (chronic)
HER2 inhibitors (ado trastuzumab, Many TKI (dasatinib, nilotinib, Bleomycin
Radiation to head/neck Immunotherapy agents
trastuzumab, pertuzumab) vemurafenib, dabrafenib, Busulfan
(atezolizumab, ipilimumab,
Fluorouracil trametinib, crizotinib, ceritinib, Carmustine
nivolumab, pembrolizumab)
Lapatinib erlotinib, gefitinib, lapatinib, Lomustine
sorafenib, sunitinib)
LVEF
O2 Sat, ABGs, Max lifetime dose (bleomycin):
Dry mouth Lifetime cumulative dose/LCD ECG, K/Mg/Ca
Symptoms (SOB, DOE) 400 mg (IU)
(anthracycline)
Symptomatic therapy
Do not exceed LCD for doxorubicin Stop therapy
Artificial saliva substitutes Hold if QTc > 500 ms
Dexrazoxane ppx in select patients Corticosteroids (if an autoimmune mechanism is suspected) for some
Pilocarpine K/Mg/Ca within range
(Doxorubicin) immunotherapy agents
Hepatotoxicity Nephrotoxicity Hemorrhagic cystitis Neuropathy Thromboembolic
LFTs, jaundice, ascites BUN, SCr, urinalysis, UOP,CrCl Urinalysis for blood, dysuria Vincristine: limiting dose/week to S/sx DVT/PE, stroke, MI
2 mg
Symptomatic management Amifostine (Ethyol) ppx reduces Oxaliplatin: causes acute
Mesna (Mesnex) always for ppx to
Consider stopping therapy nephrotoxicity of cisplatin cold-mediated sensory
reduce risk
Corticosteroids (if an autoimmune neuropathy. Avoid cold Consider thromboprophylaxis
mechanism is suspected) for PD1 Do not exceed max dose temp/beverages
Adequate hydration
immunotherapy agents Adequate hydration Bortezomib: SC < IV neuropathy
Diabetes- Stability at Room Temperature
10 days 14 days 21 days 28 days 40 days 56 days
Humalog pens/vials
Novolog pens/vials
Apidra pens/vials
Humulin N pen
Afrezza unopened Lantus pens/vials
Novolog MIX pen
Humalog MIX pens Bydureon pens/vials
Soliqua pen Xultophy pen Humulin R U-500 vial
Humulin MIX pen Humalog MIX vials
Trulicity pen
Novolog MIX vial
Adlyxin pen
Humulin R U-500 pen
Tanzeum pen
Basaglar pen
Exenatide (Byetta)
-ER (Bydureon)
Glucophage Sitagliptin (Januvia) Pioglitazone (Actos)
Liraglutide (Victoza) Canagliflozin (Invokana)
Humulin 70/30 mix = Fortamet Saxagliptin (Onglyza) Rosiglitazone (Avandia)
weight loss (Saxenda) Empagliflozin (Jardiance)
70% NPH/30% R Glumetza Linagliptin (Tradjenta)
Lixisenatide (Adlyxin) Dapagliflozin (Farxiga)
Riomet (liquid) Alogliptin (Nesina) MedGuide
Albiglutide (Tanzeum)
Dulaglutide (Trulicity)
SGLT2 inhibitors
Glipizide (Glucotrol) Pioglitazone
Repaglinide (Prandin) Acarbose (Precose) Exenatide
Symlin Glimepiride (Amaryl) Dapagliflozin
Nateglinide (Starlix) Miglitol (Glyset) Metformin
Glyburide (Glynase)
Glyburide