100-125 P2 Flashcards
acetaminophen and codeine (combination)
MOA: Inhibit the synthesis of prostaglandins in the central nervous system and peripherally block pain impulse generation; produces antipyresis from inhibition of hypothalamic heat-regulating center.
Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; causes cough suppression by direct central action in the medulla; produces generalized CNS depression
Schedule: III
Dosing: 300mg/30mg q 4 hours PRN Max 4000mg/360mg per 24 hours
Contraindication(s): Significant respiratory depression postoperative pain management in children who have undergone tonsillectomy and/or adenoidectomy GI obstruction, including paralytic ileus (known or suspected) concurrent use with monoamine oxidase inhibitors (MAOIs) or use of MAOIs within the last 14 days.
BBW: • Risk of medication errors
- Addiction, abuse, and misuse
- Life-threatening respiratory depression • Accidental ingestion
- Neonatal opioid withdrawal syndrome
- Death related to ultra-rapid metabolism of codeine to morphine
- Hepatoxicity
- Interactions with drugs affecting cytochrome P450
- Risks from concomitant use with benzodiazepines or other CNS depressants
Key Points:
Drowsiness and sedation
Constipation
Pruritis
Avoid alcohol or other sedating agents and other APAP products
Alprazolam
MOA: Enhances the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions
Schedule:
IV Dosing: 0.25mg to 1mg TID Usual range 4mg/day to 6mg/day
Contraindication(s):
Acute narrow-angle glaucoma
Concurrent use with potent CYP 3A4 inhibitors
BBW: • Risk from concomitant use with opiods
Key Points:
Drowsiness and sedation
Avoid alcohol or other sedating agents
Skin Rash
Amitriptyline
Generic : elavil
MOA: Increases the synaptic concentration of serotonin and/or norepinephrine in the central nervous system by inhibition of their reuptake by the presynaptic neuronal membrane pump
Schedule: legend
Dosing:
25mg to 50mg daily at bedtime or in divided doses and gradually increase to 100mg to 300mg daily Ususal range 100mg to 300mg
Contraindication(s):
MAOI use within 14 days
Acute recovery phase following MI
BBW: •
Suicidality and antidepressant drugs
Key Points:
Heart arrythymias
Dry mouth, dry eyes, constipation, urinary retention (anticholinergic)
Tremor
Sedation; take at bedtime if it causes sleepiness
Aripiprazole
Brand: Abilify
MOA: Partial agonist of D2 and 5-HT1A receptors, and an antagonist at the 5-HT2A receptor
Schedule: legend
Dosing:
Deperession adjunct: 2mg to 5mg ocne daily (Max: 15mg/day)
Schizophrenia: 10mg to 15mg once daily (Max 30mg/day)
Bipolar I: 15mg to 30mg once daily (Max 30mg/day)
Contraindication(s):
Hypersensitivity
BBW:
- Increased mortality in elderly patients with dementia-related psychosis
- Suicidality and antidepressant drugs
Key Points: Headache
Increased glucose
Sedation
Potential extrapyramidal reactions
Atomoxetine
Brand: Straterra
MOA: Selectively inhibits the reuptake of norepinephrine
Schedule: legend
Dosing:
40mg to 80mg daily in a single dose or 2 evenly divided doses
Max 100mg/day
Contraindication(s):
MAOI use within 14 days
Narrow-angle glaucoma
History of pheochromocytoma
Cardiac or vascular disorders that will deteriorate and cause increases in blood pressure or pulse
BBW:
• Suicidal ideation in children and adolescents
Key Points:
Headache Insomnia Decreased appetite Dry mouth
Baclofen
Brand: Lioresal
MOA: Inhibits the transmission of both monosynaptic and polysynaptic reflexes at the spinal cord level, possibly by hyperpolarization of primary afferent fiber terminals
Schedule: legend
Dosing: 5mg to 20mg TID Max 80mg/day
Contraindication(s):
Hypersensitivity Intrathecal: IV, IM, SubQ, or epidural administration
BBW: • Abrupt withdrawal (injection)
Key Points: Hypotonia Drowsiness and confusion Nausea and Vomitting Headache
Benztropine
Brand: Cogentin
MOA: Possesses both anticholinergic and antihistaminic effects
Schedule: legend
Dosing: 1mg to 2mg 2 to 3 times daily Max 6mg/day
Contraindication(s): Hypersensitivity Children less than 3 years old
BBW: • None
Key Points: Tachycardia Dry mouth, dry eyes, constipation, urinary retention (anticholinergic)
Buprenorphine
Brand: Buprenx, Butrans
MOA: Binds to mu opiate receptors in the CNS; displays partial mu agonist and weak kappa antagonist activity
Schedule: III
Dosing:
Oral SLT: 12mg to 16mg once daily
Buccal Film: 150mcg q 12 hours
Contraindication(s): Significant respiratory depression Acute or severe asthma GI obstruction, including paralytic ileus (known or suspected)
BBW:
- Addiction, abuse, and misuse (buccal film, injection, transdermal patch)
- Life-threatening respiratory depression (buccal film, injection, transdermal patch)
- Accidental exposure (buccal film, transdermal patch)
- Neonatal opioid withdrawal syndrome (buccal film, injection, transdermal patch)
- Risk associated with insertion and removal (Probuphine implant)
- Risks from concomitant use with benzodiazepines or other CNS depressants (buccal film, injection, transdermal patch)
Key Points: Headache Sedation REMS drug
Buprenorphine and Naloxone
Brand: Suboxone, Zubsolv
MOA:
Buprenorphine binds to mu opiate receptors in the CNS; displays partial mu agonist and weak kappa antagonist activity
Naloxone is a pure opioid antagonist that competes and displaces opioids at opioid receptor sites
Schedule: III
Dosing:
SL: 16mg/4mg once daily
Buccal Film: 8.4mg/1.4mg once daily
Contraindication(s): Hypersensitivity
BBW: • None
Key Points: Headache Withdrawal syndrome PainDiaphoresis
Bupropion
Brand: Wellbutrin, Zyban
MOA: Inhibits the reuptake of norepineprhine and dopamine
Schedule: legend
Dosing:
IR: 100mg BID (Max 150mg each dose)
SR: 150mg BID (Max 200mg in each dose)
XR: 150mg daily (Max 300mg/day)
Contraindication(s):
Seizure disorder or conditions that increase seizure risk, including severe head injury or severe stroke
History of anorexia/bulimia
MAOI use within 14 days
BBW:
• Suicidality and antidepressant drugs
Key Points: Seizures Insomnia Aggitation Weight loss
Butalbital, Acetaminophen and Caffeine
Brand: Esgic, Fioricet
MOA:
Butalbital depresses the sensory cortex, decreases motor activity, and alters cerebellar function
Acetaminophen inhibits the synthesis of prostaglandins in the central nervous system and peripherally blocks pain impulse generation Caffeine inhibits phosphodiesterase, causing vasodilation
Schedule: legend (controlled in UT)
Dosing:
1 to 2 tablets/capsules q 4 hours Max 6 tablets/capsules per day
Contraindication(s):
Hypersensitivity Porphyria
BBW: • Hepatotoxicity
Key Points:
Dizziness Sedation Nausea and Vomitting
Avoid alcohol or other sedating agents and other acetaminophen containing products
Carisoprodol
Brand: Soma
MOA: Blocks interneuronal activity and depresses polysynaptic neuron transmission in the spinal cord and reticular formation of the brain
Schedule: IV
Dosing:
250mg to 350mg TID and at bedtime for max duration of 2-3 weeks
Contraindication(s):
Hypersensitivity History of acute intermittent porphyria
BBW: • None
Key Points:
Drowsiness Dizziness Headache Avoid with other sedating agents
Celecoxib
Brand: Celebrex
MOA: Inhibits prostaglandin synthesis by decreasing the activity of cyclooxygenase-2 (COX-2)
Schedule: legend
Dosing:
100mg twice daily up to 200mg once or twice daily
Contraindication(s):
Hypersensitivity to sulfonamides, aspirin, or other NSAIDs History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDS Use in the setting of CABG surgery
BBW:
• Serious cardiovascular risk • Serious gastrointestinal risk
Key Points:
Take with food
May cause nephrotoxicity; look for changes in urine frequency/production
May cause GI bleed; report any blood in vomit, sputum and/or black tarry stool, or severe upper GI pain immediately to prescriber
Take only as directed or as needed for pain
Clonazepam
Brand: Klonopin
MOA: Enhances the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions
Schedule: IV
Dosing:
Panic Disorder: 0.5mg to 2mg BID (Max 4mg/day) Seizure Disorder: 2mg to 8mg In 1 or 2 divided doses (Max: 20mg/day)
Contraindication(s):
Acute narrow-angle glaucoma Significant liver disease
BBW: •
Risk from concomitant use with opioids
Key Points:
Drowsiness/Confusion Avoid abrupt discontinuation Avoid alcohol or other sedating agents
Cyclobenzaprine
Brand: Amrix, Flexeril
MOA: Reduces tonic somatic motor activity influencing both alpha and gamma motor neurons
Schedule: legend
Dosing: 5mg to 10mg TID PRN
Contraindication(s):
MAOI use within 14 days
Hyperthyroidism Heart failure Arrhythmias
BBW: • None
Key Points:
Drowsiness and sedation Avoid alcohol or other sedating agents Dry Mouth
Desvenlafaxine
Brand: Pristiq
MOA: Selectively inhibits the reuptake of serotonin and norepinephrine
Schedule: legend
Dosing: 50mg once daily
Contraindication(s):
MAOI use within 14 days
Use with linezolid
Hypersensitivity to venlafaxine
BBW:
• Suicidal thoughts and behavior
Key Points: Nausea Insomnia Hyperhidrosis Xerostomia
Dextroamphetamine and Amphetamine
Brand: Adderall
MOA: Promotes release of dopamine and norepinephrine from their storage sites in the presynaptic nerve terminals
Schedule: II
Dosing: IR: 5mg to 40mg daily in 1 to 3 divided doses ER: 20mg to 60mg once daily
Contraindication(s):
Advanced arteriosclerosis, moderate to severe hypertension, or symptomatic cardiovascular disease Agitated states Glaucoma MAOI use within 14 days
BBW: • Abuse potential • Cardiovascular events
Key Points: Hypertension Tachycardia Insomnia Weight loss
Diazepam
Brand: Valium, Diastat
MOA: Enhances the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions
Schedule: IV
Dosing: 2mg to 10mg BID to QID PRN
Contraindication(s): Acute narrow-angle glaucoma Untreated open-angle glaucoma Severe respiratory impariment or sleep apnea Severe hepatic impairment
BBW: • Risks from concomitant use with opioids
Key Points: Drowsiness and sedation Avoid alcohol or other sedating agents
Diclofenac
Brand: Voltaren, Flector, Pensaid, Diclo gel
MOA: Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors
Schedule: legend
Dosing: 50mg BID to TID or 75mg BID
Contraindication(s):
History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDS
Use in the setting of CABG surgery
Patients with moderate to severe renal impairment in the perioperative period and who are at risk for volume depletion (injection only)
BBW:
- Serious cardiovascular thrombotic events
- Serious gastrointestinal bleeding, ulceration, and perforation
Key Points:
Take with food
May cause nephrotoxicity; look for changes in urine frequency/production
May cause GI bleed; report any blood in vomit, sputum and/or black tarry stool, or severe upper GI pain immediately to prescriber
Take only as directed or as needed for pain
Duloxetine
Brand: Cymbalta
MOA: Selectively inhibits the reuptake of serotonin and norepinephrine, weakly inhibits dopamine reuptake S
chedule: legend
Dosing: 30mg to 60mg daily as a single dose or in 2 evenly divided doses
Contraindication(s): MAOI use within 14 days Use with linezolid
BBW: • Suicidal thoughts and behavior
Key Points: Headache drowsiness and fatigue Xerostomia Weight Loss
Escitalopram
Brand: Lexapro
MOA: Selectively inhibits serotonin reuptake in the presynaptic neurons
Schedule: legend
Dosing: 10mg to 20mg once daily
Contraindication(s):
MAOI use within 14 days
Use with linezolid
BBW: • Suicidality and antidepressant drugs
Key Points:
Drowsiness and insomnia
Dry mouth
Decreaed Libido/Ejaculatory disorders
Eszopiclone
Brand: Lunesta
MOA: May interact with GABA-receptor complexes at binding domains located close to or allosterically coupled to benzodiazepine receptors
Schedule: IV
Dosing: 1mg to 3mg q HS 3mg max
Contraindication(s): Hypersensitivity
BBW: • None
Key Points:
May distort taste Drowsiness Avoid alcohol or other sedating agents
Fentanyl
Brand: Sublimaze, Actiq, Duragesic, Fentora
MOA: Binds with stereospecific receptors at many sites within the CNS, increases pain threshold, alters pain reception, inhibits ascending pain pathways
Schedule: II
Dosing: Individualized to patient
Contraindication(s):
Hypersensitivity
Significant respiratory depression
Acute or severe bronchial asthma
GI obstruction including paralytic ileus (known or suspected)
BBW:
- Life-threatening respiratory depression • Addiction, abuse, and misuse
- Accidental exposure
- Cytochrome P450 3A4 Interaction
- Neonatal opioid withdrawal syndrome •
Risks from concomitant use with benzodiazepines or other CNS depressants
- Risk of medication errors (buccal, intranasal, lozenge, sublingual)
- REMS program
- Exposure to heat (Duragesic only)
Key Points:
Change patch every 72 hours
Do not cut patch and avoid exposing application site to external heat sources
Dizziness, Drowsiness, and Constipation
Avoid alcohol or other sedating agents
Fluoxetine
Brand: Prozac, Saracen
MOA: Selectively inhibits serotonin reuptake in the presynaptic neurons
Schedule: legend Dosing: 20mg to 80mg once daily
Contraindication(s):
MAOI use within 5 weeks of discontinuing fluoxetine or within 14 days of discontinuing the MAOI
Use with linezolid
BBW:
• Suicidality and antidepressant drugs
Key Points: Insomnia Anxiety Decreaed Libido/Ejaculatory disorders Long half life
Gabapentin
Brand: Neurontin
MOA: May modulate the release of excitatory neurotransmitters which participate in epileptogenesis and nociception
Schedule: legend
Dosing: 900mg to 1800mg daily in 3 divided doses
Contraindication(s):
Hypersensitivity
BBW: • None
Key Points: Drowsiness Dizziness Fatigue Tremor
Hydrocodone and Acetaminiphen
Brand: Lorcet, Lortab, Vicodin, Xodol
MOA:
Hydrocodone: Binds to opiate receptors in the CNS, altering the perception of and response to pain
Acetaminophen: Inhibits the synthesis of prostaglandins in the CNS and peripherally blocks pain impulse generation
Schedule: II
Dosing: 2.5mg to 10mg hydrocodone q 4 to 6 hours Max 4000mg acetaminophen/day; Max 60 mg/day hydrocodone
Contraindication(s): Significant respiratory depression Acute or severe asthma GI obstruction, including paralytic ileus (known or suspected)
BBW: • Addiction, abuse, and misuse • Life-threatening respiratory depression • Accidental ingestion • Neonatal opioid withdrawal syndrome • Cytochrome P450 3A4 interaction • Hepatotoxicity • Risks from concomitant use with Benzodiazepines or other CNS depressants
Key Points:
Drowsiness and sedation
Constipation
Avoid alcohol or other sedating agents and other acetaminophen containing products Respiratory Depression
Ibuprofen
Brand: Motrin, Advil
MOA: Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors
Schedule: legend
Dosing: 200mg to 800mg TID to QID Max 3200mg/day
Contraindication(s):
History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDS
Use in the setting of CABG surgery
BBW:
- Serious cardiovascular thrombotic events (excluding NeoProfen)
- Serious gastrointestinal bleeding, ulcerations, and perforation (excluding NeoProfen)
Key Points:
Take with food
May cause nephrotoxicity; look for changes in urine frequency/production
May cause GI bleed; report any blood in vomit, sputum and/or black tarry stool, or severe upper GI pain immediately to prescriber
Take only as directed or as needed for pain
Lamotrigine
Brand: Lamictal
MOA: Inhibits release of glutamate and voltage-sensitive sodium channels, which stabilizes neuronal membranes
Schedule: legend
Dosing: IR: 225mg to 375mg in 2 divided doses XR: 300mg to 400mg once daily Adjustments needed based on concomitant use of inducers or inhibitors
Contraindication(s):
Hypersensitivity
BBW:
• Serious skin rashes
Key Points:
Steven Johnson Syndrom / Rash
Follow titration schedule (slow titration) to reduce risk of SJS
Should contact prescriber if any rash occurs
Lidocaine
Brand: Xylocaine, Lidoderm
MOA: Blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane’s permeability to sodium ions
Schedule: legend
Dosing: 1-3 patches applied topically for up to 12h within a 24h period
Contraindication(s):
Hypersensitivity to another amide type local anesthetic Traumatized mucousa Bacterial infection at the site of application
BBW: • Life-threatening and fatal events in infants and young children
Key Points: Erythema Skin Edema
Lisdexamfetamine dimesylate
Brand: Vyvanse
MOA: Promotes release of dopamine and norepinephrine from their storage sites in the presynaptic nerve terminals
Schedule: II
Dosing:
30mg to 70mg once daily Max: 70mg/day
Contraindication(s):
MAOI use within 14 days
BBW: • Abuse and dependence
Key Points: Insomnia decreased appetite Xerostomia Increased blood pressure
Lorazepam
Brand: Ativan
MOA: Enhances the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions
Schedule: IV
Dosing:
Anxiety: 2mg to 6mg in two to three divided doses
Insomnia: 0.5mg to 2mg q HS (if >65yo: max 1mg)
Contraindication(s):
Acute narrow-angle glaucoma Severe respiratory insufficiency Hypersensitivity to polyethylene glycol - IV only Sleep apnea
BBW: • Risks from concomitant use with opioids
Key Points:
Drowsiness and sedation
Avoid alcohol or other sedating agents
IV formulatoin can cause propylene glycol toxicity
Meloxicam
Brand: Mobic
MOA: Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors
Schedule: legend
Dosing:
7.5mg to 15mg once daily Max 15mg/day
Contraindication(s):
History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDS
Use in the setting of CABG surgery
BBW:
- Serious cardiovascular thrombotic events
- Serious gastrointestinal bleeding, ulcerations, and perforation
Key Points:
Take with food
May cause nephrotoxicity; look for changes in urine frequency/production
May cause GI bleed; report any blood in vomit, sputum and/or black tarry stool, or severe upper GI pain immediately to prescriber
Take only as directed or as needed for pain
Memantine
Brand: Namenda
MOA: NMDA antagonist
Schedule: legend
Dosing:
IR: 5mg to 20mg daily (Doses greater than 5mg to be given in two evenly divided doses)
XR: 7mg to 28 mg once daily
Contraindication(s):
Hypersensitivity
BBW: • None
Key Points:
Insomnia Hallucinations Dizziness Agitation
Methadone
Brand: Dolophine, Methadose
MOA: Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; produces generalized CNS depression Antagonizes NMDA receptors
Schedule: II
Dosing:
Pain: 2.5mg q 8 to 12 hours initially, then titrate up to effective dose
Drug detoxification: 80mg to 120mg daily
Contraindication(s):
Significant respiratory depression Acute or severe asthma GI obstruction, including paralytic ileus (known or suspected) Hypercarbia
BBW:
• Addiction, abuse, and misuse • Life-threatening respiratory depression • Life-threatening QT prolongation • Accidental ingestion (oral formulations) • Neonatal opioid withdrawal syndrome • Conditions for distribution and use of methadone products for the treatment of opioid addiction • Cytochrome P450 interaction • Risks from concomitant use with benzodiazepines or other CNS depressants
Key Points:
If for addiction must be prescribed in methadone clinic by “X-DEA” prescriber. If for pain must state “for pain” on prescription
Drowsiness, Sedation, and Constipation
Complex kinetics, Avoid frequent dose changes (i.e.
Methylphenidate
Brand: Concerta, Daytrana, Ritalin
MOA: Blocks the reuptake of norepinephrine and dopamine into presynaptic neurons
Schedule: II
Dosing:
IR: 10mg to 60mg daily in 2 to 3 divided doses (Max 60 mg/day)
ER: 20mg once daily, Max 60 mg/day (Concerta: Max 72 mg/day)
Contraindication(s):
MAOI use within 14 days
Marked anxiety, tension, or agitation
Glaucoma
BBW: • Abuse and dependence
Key Points:
Insomnia Weight Loss TachycardiaHypertension
Mirtazapine
Brand: Rameron
MOA: Central presynaptic alpha2-adrenergic antagonist effects, which results in increased release of norepinephrine and serotonin. It is also a potent antagonist of 5-HT2 and 5-HT3 serotonin receptors and H1 histamine receptors and a moderate peripheral alpha1
Schedule: legend
Dosing:
15mg to 45mg q HS
Contraindication(s):
MAOI use within 14 days Use with linezolid
BBW: •
Suicidality and antidepressant drugs
Key Points: Drowsiness Weight gain Xerostomia
Naproxen
Brand: Aleve, Anaprox, Naprosyn
MOA: Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors
Schedule: legend
Dosing:
IR: RX: 500mg to 1000mg daily in two evenly divided doses 12 hours apart
ER: 750-1000 once daily
Contraindication(s):
History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDS
Use in the setting of CABG surgery
BBW:
• Serious cardiovascular thrombotic events • Serious gastrointestinal bleeding, ulceration, and perforation
Key Points:
Take with food
May cause nephrotoxicity; look for changes in urine frequency/production
May cause GI bleed; report any blood in vomit, sputum and/or black tarry stool, or severe upper GI pain immediately to prescriber
Take only as directed or as needed for pain
Nortripyline
Brand: Pamelor
MOA: Increases the synaptic concentration of serotonin and/or norepinephrine in the central nervous system by inhibition of their reuptake by the presynaptic neuronal membrane pump
Schedule: legend
Dosing:
25mg TID or QID, may titrate to 150mg/day
Contraindication(s):
MAOI use within 14 days
Use in acute recovery phase of MI
Use with linezolid
BBW: • Suicidality in children and adolescents
Key Points:
Heart arrythymias
Dry mouth, dry eyes, constipation, urinary retention (anticholinergic)
Tremor
Sedation; take at bedtime if it causes sleepiness
Olanzapine
Brand: Zyprexa
MOA: Antagonist of dopamine and seratonin type two receptor sites
Schedule: legend
Dosing:
5mg to 20mg PO once daily
Contraindication(s): None
BBW:
- Increased mortality in elderly patients with dementia-related psychosis
- Postinjection delirium/sedation syndrome (Zyprexa Relprevv)
Key Points:
Weight gain Increased glucose drowsiness
Increased prolactin levels
Oxycodone
Brand: OxyContin, Roxicodone
MOA: Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; produces generalized CNS depression
Schedule: II
Dosing: IR: 5mg to 20mg q 4 to 6 hours PRN
ER tablet: 10mg to 80mg q 12 hours PRN
ER capsule: 9mg q 12 hours PRN
Contraindication(s):
Significant respiratory depression Acute or severe asthma GI obstruction, including paralytic ileus (known or suspected)
BBW:
• Addiction, abuse, and misuse • Life-threatening respiratory depression • Accidental ingestion • Neonatal opioid withdrawal • Cytochrome P450 3A4 interaction • Risks from concomitant use with benzodiazepines or other CNS depressants • Risk of medication errors (oral solution)
Key Points:
Drowsiness and sedation Constipation Avoid alcohol or other sedating agentsRespiratory Depression
Oxycodone and APAP
Brand: Endocet, Percocet
MOA: See individual agents
Schedule: II
Dosing: IR: 2.5mg to 10mg q 6 hours PRN. Do not exceed acetaminophen 4 g/day
ER: 2 tablets q 12 hours. Do not exceed acetaminophen 4 g/day
Contraindication(s):
Significant respiratory depression Acute or severe asthma GI obstruction, including paralytic ileus (known or suspected)
BBW:
• Addiction, abuse, and misuse • Life-threatening respiratory depression • Accidental ingestion • Neonatal opioid withdrawal syndrome • Cytochrome P450 3A4 Interaction • Hepatotoxicity • Risks from concomitant use with benzodiazepines or other CNS depressants
Key Points:
Drowsiness and sedation Constipation Avoid alcohol or other sedating agents and other acetaminophen containing productsRespiratory Depression
Paroxetine
Brand: Paxil, Pexeva
MOA: Selectively inhibits serotonin reuptake in the presynaptic neurons
Schedule: legend
Dosing:
IR: 20mg to 60mg once daily
CR: 25mg to 62.5mg once daily (Max 75mg once daily)
Contraindication(s):
MAOI use within 14 days
Use with linezolid Pregnancy
BBW:
• Suicidality and antidepressant drugs
Key Points:
Drowsiness and insomnia Dry mouth Decreaed Libido/Ejaculatory disordersQTc prolongation
Phenytoin
Brand: Dilantin, Phenytek
MOA: Stabilizes neuronal membranes and decreases seizure activity by increasing efflux or decreasing influx of sodium ions across cell membranes in the motor cortex during generation of nerve impulses
Schedule: legend
Dosing:
300mg to 600mg daily in two to three evenly divided doses
Contraindication(s):
History of acute hepatotoxicity attributable to phenytoin concurrent use of delavirdine
BBW: • Cardiovascular risk associated with rapid infusion (injection)
Key Points:
Altered Mental Status Decrease in WBCs Gingival hyperplasia
Hirsutism
Pregabalin
Brand: Lyrica
MOA: Binds to alpha2-delta subunit of voltage-gated calcium channels within the CNS and modulates calcium influx at the nerve terminals, thereby inhibiting excitatory neurotransmitter release
Schedule: V
Dosing:
150mg to 300mg BID or TID
Contraindication(s):
Hypersensitivity
BBW: • None
Key Points:
Weight gain Drowsiness DizzinessEdema
Quetiapine
Brand: Seroquel
MOA: Antagonist of dopamine and seratonin type two receptor sites
Schedule: legend
Dosing:
IR and ER: 300mg to 800 mg once daily
Contraindication(s): Hypersensitivity
BBW:
• Increased mortality in elderly patients with dementia-related psychosis • Suicidal thoughts and behavior
Key Points:
Weight gain Increased glucose drowsiness
Increased prolactin levels
Risperidone
Brand: Risperdal
MOA: Antagonist of dopamine and seratonin type two receptor sites
Schedule: legend
Dosing:
Schizophrenia: 1mg BID, may titrate to 18mg/day
Bipolar I Disorder: 2mg to 3mg once daily, may titrate 6mg/day
Contraindication(s):
Hypersensitivity
BBW:
• Increased mortality in elderly patients with dementia-related psychosis
Key Points:
Weight gain Increased glucose drowsiness
Increased prolactin levels
Sertraline
Brand: Zoloft
MOA: Selectively inhibits serotonin reuptake in the presynaptic neurons
Schedule: legend
Dosing: 50mg to 200mg once daily
Contraindication(s):
MAOI use within 14 days
BBW:
• Suicidality and antidepressant drugs
Key Points:
Drowsiness and insomnia Dry mouth Decreaed Libido/Ejaculatory disorders QTc prolongation
Sumatriptan
Brand: Imitrex, Sumavel
MOA: Selective agonist for serotonin on intracranial blood vessels and sensory nerves of the trigeminal system
Schedule: legend
Dosing: 25mg to 100mg single dose at onset
Contraindication(s):
Ischemic heart disease, uncotrolled hypertension, PVD, or cerebrovascular syndromes MAOI use within 14 days Use of ergotamine derivatives within 24 hours Severe hepatic impairment
BBW: • None
Key Points:
Paresthesia Dizziness Flushing
Risk of serotonin syndrome if used with serotonergic agents
Temazepam
Brand: Restoril
MOA: Enhances the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions
Schedule: IV
Dosing: 15mg to 30mg q HS
Contraindication(s):
Pregnancy
BBW:
• Risks from concomitant use with opioids
Key Points: Drowsiness and sedation Avoid alcohol or other sedating agents
Topiramate
Brand: Topamax
MOA: Blocks neuronal voltage-dependent sodium channels, enhances GABA(A) activity, antagonizes AMPA/kainate glutamate receptors, and weakly inhibits carbonic anhydrase
Schedule: legend
Dosing:
Epilepsy: 25mg to 200mg BID
Migraine Prophylaxis: 25mg to 50mg once daily or BID
Contraindication(s):
XR Formulation: Recent alcohol use (within 6 hours before or after administration)
BBW: • None
Key Points:
Confusion, mental slowing, difficulty with speech Weight loss Kidney stones
Tramadol
Brand: Ultram
MOA: Binds to μ-opiate receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain; also inhibits the reuptake of norepinephrine and serotonin
Schedule: IV
Dosing:
IR tab, ODT tab: 50mg to 100mg q 4 to 6 hours
ER: 100mg once daily (Max 300mg/day)
Contraindication(s):
Significant respiratory depression Acute or severe asthma GI obstruction, including paralytic ileus (known or suspected) MAOI use within 14 days
BBW: • Addiction, abuse, and misuse • Life-threatening respiratory depression • Accidental ingestion • Neonatal opioid withdrawal syndrome • Cytochrome P450 interaction • Risks from concomitant use with benzodiazepines or other CNS depressants
Key Points:
Dose adjust in renal impairment/elderly Seizure risk
Trazodone
Brand: Desyrel
MOA: Inhibits reuptake of serotonin, causes adrenoreceptor subsensitivity, and significantly blocks histamine (H1) and alpha1-adrenergic receptors
Schedule: legend
Dosing:
IR: 50mg to 100mg po BID to TID (Max 400mg/day)
Contraindication(s):
MAOI use within 14 days
Use with linezolid
BBW: • Suicidality and antidepressant drugs
Key Points:
Drowsiness and sedation Avoid alcohol or other sedating agents Risk of serotonin syndrome if used with serotonergic agents
Valproic acid and derivatives
Brand: Depacon, Depakote, Depakene
MOA: Causes increased availability of gamma-aminobutyric acid (GABA) to brain neurons
Schedule: legend
Dosing: 15mg/kg/day
Max: 60mg/kg/day
Contraindication(s):
Hepatic disease or significant impairment
Pregnamt women for the prevention of migraine Known mitochondrial disorders
BBW:
- Hepatotoxicity
- Patients with mitochondrial disease
- Fetal risk
- Pancreatitis
Key Points:
Acute pancreatitis Liver Failure Thrombocytopenia, Weight Gain
Vareniciline
Brand: Chantix
MOA: Partial neuronal α4 β2 nicotinic receptor agonist; prevents nicotine stimulation of mesolimbic dopamine system associated with nicotine addiction
Schedule: legend
Dosing: 0.5mg once daily for 3 days, then 0.5mg BID for 4 days, then 1mg BID for 11 weeks
Contraindication(s): Hypersensitivity
BBW: • None
Key Points:
Headache, Nausea, Vomitting Insomnia abnormal dreams Suicidal ideation
Venlafaxine
Brand: Effexor
MOA: Selectively inhibits the reuptake of serotonin and norepinephrine
Schedule: legend
Dosing:
IR: 75mg to 225mg daily in 2 to 3 evenly divided doses
ER: 75mg to 225mg once daily
Contraindication(s):
MAOI use within 14 days Use with linezolid
BBW:
• Suicidality and antidepressant drugs
Key Points: Seizures Insomnia HyperhidrosisXerostomia
Zolpidem
Brand: Ambien
MOA: Enhances activity of GABA via selective agonism at the benzodiazepine-1 (BZ1) receptor
Schedule: IV
Dosing:
IR: 5mg (female) or 5mg to 10 mg (male) q HS
ER: 6.25mg (female) or 6.25mg to 12.5mg (male) q HS
Contraindication(s): Hypersensitivity
BBW: • None
Key Points:
Drowsiness/Sedation Lethargy Memory Impairment
Acyclovir
Brand: Zovirax
MOA: Inhibits DNA synthesis and viral replication by competing with deoxyguanosine triphosphate for viral DNA polymerase and being incorporated into viral DNA
Schedule: legend
Dosing: 200mg - 800mg 3 to 5 times daily
Contraindication(s): Hypersensitivity
BBW: • None
Key Points:
Can crystalize in kidney and cause AKI Nausea and Vomitting Malaise
Amoxicillin
Brand: Moxatag
MOA: Binds to penicillin-binding proteins (PBPs) which inhibits peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis
Schedule: legend
Dosing: 500mg q 8 hours or 875mg q 12 hours
Contraindication(s):
Serious hypersensitivity to amoxicillin
BBW: • None
Key Points:
Diarrhea (AAD & CDAD)
Allergy
Take entire course and contact provider if symptoms do not improve within a few days of startingN/V, take with food to avoid upset stomach if needed
Amoxicillin and Clavulanic acid
Brand: Augmentin
MOA:
Amoxicillin binds to penicillin-binding proteins (PBPs) which inhibits peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis
Clavulanic acid binds and inhibits beta-lactamases that inactivate amoxicillin
Schedule: legend
Dosing: 500mg q 8 hours or 875mg q 12 hours Dosing based on amoxicillin component
Contraindication(s):
Serious hypersensitivity to amoxicillin or clavulanate
History of cholestatic jaundice or hepatic dysfunction with Augmentin
Augmentin XR: Severe renal impairment (CrCl less than 30ml/min
BBW: • None
Key Points:
Diarrhea (AAD & CDAD) Allergy
Take entire course and contact provider if symptoms do not improve within a few days of startingN/V, take with food to avoid upset stomach if needed
Azithromycin
Brand: Z-pak, Zithromax, Zmax, Azasite
MOA: Inhibits RNA-dependent protein synthesis by binding to the 50S ribosomal subunit
Schedule: legend
Dosing:
CAP: 500mg once, then 250mg daily on days 2 to 5
STI: 1g as a single dose
Contraindication(s):
Hypersensitivity History of cholestatic jaundice or hepatic dysfunction with prior azithromycin use
BBW: • None
Key Points:
Diarrhea (AAD & CDAD) Nausea and Vomitting
QTc prolongationMay bind with certain cations. Avoid taking with certain multivitamins and minerals (calcium, aluminum, magnesium, etc.)
Cefdinir
Brand: Omicef
MOA: Binds to penicillin-binding proteins (PBPs) which inhibits peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis
Schedule: legend
Dosing: 300mg q 12 hours
Contraindication(s):
Hypersensitivity
BBW: • None
Key Points:
Diarrhea (AAD & CDAD) Allergy
Liquid suspension: Do not refrigerate, keep at room temperature.Take 2 hrs before or after antacids or iron supplements; If taking iron supplement, may pass red colored stools
Cefuroxime
Brand: Ceftin, Zinacef
MOA: Binds to penicillin-binding proteins (PBPs) which inhibits peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis
Schedule: legend
Dosing: 250mg to 500mg q 12 hours
Contraindication(s):
Hypersensitivity to cefuroxime or other beta-lactam drugs
BBW: • None
Key Points:
Diarrhea (AAD & CDAD)
Allergy
Take entire course and contact provider if symptoms do not improve within a few days of startingNausea and Vomitting, take with food to avoid upset stomach if needed
Cephalexin
Brand: Keflex
MOA: Binds to penicillin-binding proteins (PBPs) which inhibits peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis
Schedule: legend
Dosing:
250mg q 6 hours or 500mg q 12 hours
Streptococcal Skin Infxns: 500mg q 6 hours
Contraindication(s): Hypersensitivty
BBW: • None
Key Points:
Diarrhea (AAD & CDAD) Allergy
Take entire course and contact provider if symptoms do not improve within a few days of startingN/V, take with food to avoid upset stomach if needed
Ciprofloxacin
Brand: Cipro, Ciloxa, Otiptrio
MOA: Inhibits DNA-gyrase and promotes breakage of double-stranded DNA
Schedule: legend
Dosing:
500mg to 750mg q 12 hours
Contraindication(s):
Hypersensitivity to other quinolones Concurrent use of tizanidine
BBW:
• Serious adverse reactions (tendinitis and tendon rupture, peripheral neuropathy, and CNS effects) • Exacerbation of myasthenia gravis
Key Points:
May bind with certain cations. Avoid taking with certain multivitamins and minerals (calcium, aluminum, magnesium, etc.)
QTc prolongation Dysglycemia, Diarrhea (AAD & CDAD)
Clarithromycin
Brand: Biaxin
MOA: Binds to 50S ribosomal subunit resulting in inhibition of protein synthesis
Schedule: legend
Dosing: 250mg to 500mg q 12 hours
Contraindication(s):
History of cholestatic jaundice/hepatic dysfunction associated with prior use of clarithromycin Use with drugs extensively metabolized by CYP3A4 Use with colchicine in patients with renal or hepatic impairment
BBW: • None
Key Points:
Diarrhea (AAD & CDAD) Nausea and Vomitting
qtc prolongation, Take entire course and contact provider if symptoms do not improve within a few days of starting
Clindamycin
Brand: Cleocin, Evoclin, Clindesse
MOA: Binds to 50S ribosomal subunit resulting in inhibition of protein synthesis
Schedule: legend
Dosing: 300mg to 450mg q 6 hours
Contraindication(s): Hypersensitivity
BBW: • Colitis
Key Points:
Diarrhea (AAD & CDAD) Rash
Nausea and Vomitting, take with food to avoid upset stomach if neededTake entire course and contact provider if symptoms do not improve within a few days of starting
Conjugated Estrogens
Brand: Premarin
MOA: Modulates the pituitary secretion of gonadotropins, luteinizing hormone, and follicle-stimulating hormone through a negative feedback system, thereby reducing elevated levels of these hormones in postmenopausal women
Schedule: legend
Dosing:
Oral: 0.3mg to 0.625mg once daily
Topical: 0.5g/day, 21 days on, 7 days off
Contraindication(s):
Angioedema or anaphylactic reaction to estrogens
Current history of PE or DVT or other known thrombophilic disorders
Undiagnosed abnormal genital bleeding
Pregnancy
BBW:
- Endometrial cancer
- Cardiovascular disease
- Breast cancer
- Dementia • Risk vs benefit
Key Points:
cream: dispense with applicators; insert amount & frequency directed by physician at bedtime
Tablet: progestin required for intact uterus tablet: signs & symptoms of thrombosis (VTE & stroke)tablet: lowest effective dose, shortest duration
Darunavir
Brand: Prezista
MOA: Binds to the site of HIV-1 protease activity and inhibits cleavage of viral Gag-Pol polyprotein precursors into individual functional proteins required for infectious HIV
Schedule: legend
Dosing: 800mg once daily
Contraindication(s):
Coadministration with drugs highly dependent on CYP3A4 for clearence
BBW: • None
Key Points:
Increased LDL Skin Rash Diarrhea
Doxycycline
Brand: Adoxa, Monodox, Oradea, Vibramycin, Doryx
MOA: Inhibits protein synthesis by binding with the 30S ribosomal subunit
Schedule: legend
Dosing: 100mg q 12 hours
Contraindication(s):
Hypersensitivity to tetracyclines
BBW: • None
Key Points:
Photosensitivity
Avoid < 8 years old
Adequate fluid intake otherwise esophagitisdiarrhea (AAD & CDAD)
Dutasteride
Brand: Avodart
MOA: Selectively inhibits 5α-reductase, resulting in inhibition of the conversion of testosterone to dihydrotestosterone and markedly suppressed serum dihydrotestosterone levels
Schedule: legend
Dosing: 0.5mg once daily
Contraindication(s):
Clinically significant hypersensitivity to other 5-alpa-reductase inhibitors
Use in pediatric patients, women of childbearing potential, or pregnancy
BBW: • None
Key Points:
Dicreased Libido Impotence Gynecomastia
Emtricitabine, Tenofovir, and Efavirenz
Brand: Atripla
MOA: Efavirenz: Non-nucleoside reverse transcriptase inhibitor of HIV-1, thereby blocking the RNA-dependent and DNA-dependent DNA polymerase resulting in inhibition of viral replication Emtricitabine: Nucleoside reverse transcriptase inhibitor, which interferes with HIV viral RNA dependent DNA polymerase resulting in inhibition of viral replication Tenofovir: Nucleotide reverse transcriptase inhibitor, interferes with the HIV viral RNA dependent DNA polymerase resulting in inhibition of viral replication
Schedule: legend
Dosing: 1 tablet once daily
Contraindication(s):
Clinically significant hypersensitivity
Coadministration with voriconazole
BBW: • Hepatitis B coinfection
Key Points:
Hypercholesterolemia Abnormal dreams HyperglycemiaDiarrhea
Ethinyl Estradiol and Etonogestrol
Brand: Nuvaring
MOA: Combination hormonal contraceptives inhibit ovulation via a negative feedback mechanism on the hypothalamus, which alters the normal pattern of gonadotropin secretion of a follicle-stimulating hormone (FSH) and luteinizing hormone by the anterior pituitar
Schedule: legend
Dosing:
Insert 1 ring for 3 weeks then remove for 7 days
Contraindication(s):
Breast cancer or other estrogen/progestin sensitive cancer
hepatic tumors or hepatic disease
Use in women at high risk of thrombotic disease Undiagnosed abdominal uterine bleeding
BBW: • Cigarette smoke and serious cardiovascular events
Key Points:
Weight Gain
Increased risk of blood clots
Nausea and Vomting, Consider various factors that may decrease effectiveness (abx, missed dose, time to onset, etc.)
Finasteride
Brand: Proscar, Propecia
MOA: Selectively inhibits 5α-reductase, resulting in inhibition of the conversion of testosterone to dihydrotestosterone and markedly suppressed serum dihydrotestosterone levels
Schedule: legend
Dosing:
BPH: 5mg once daily
Contraindication(s):
Pregnancy or women of childbearing potential BBW: • None
Key Points:
Decreased libido Pregnancy category X
Fluconazole
Brand: Diflucan
MOA: Interferes with fungal cytochrome P450 activity (lanosterol 14-α-demethylase), and decreases ergosterol synthesis which inhibits cell membrane formation
Schedule: legend
Dosing:
Vaginal Candidiasis: 150mg once
Candidemia: 800mg on day 1, then 400mg once daily thereafter
Contraindication(s):
Coadministration with CYP3A4 substrates which may lead to QTc prolongation
BBW: • None
Key Points:
Headache Nausea, vomiting, and Diarrhea Hepatitis & jaundice, Take entire course and contact provider if symptoms do not improve within a few days of starting
Group: Biphasic Oral Contraceptives
Brand: Kariva, Mircette, Ortho Novum 10/12
MOA: Combination hormonal contraceptives inhibit ovulation via a negative feedback mechanism on the hypothalamus, which alters the normal pattern of gonadotropin secretion of a follicle-stimulating hormone (FSH) and luteinizing hormone by the anterior pituitar
Schedule: legend
Dosing:
1 tablet once daily
Contraindication(s):
Breast cancer or other estrogen/progestin sensitive cancer Use in women at high risk of thrombotic disease
BBW:
• Cigarette smoke and serious cardiovascular events
Key Points:
Nausea and Vomting
Increased risk of blood clots
Weight Changes; Fluid Retention, Consider various factors that may decrease effectiveness (abx, missed dose, time to onset, etc.)
Group: Monophasic Oral Contraceptives
Brand: Avaine, Loestrin, Tasmin, Yaz, Oral
MOA: Combination hormonal contraceptives inhibit ovulation via a negative feedback mechanism on the hypothalamus, which alters the normal pattern of gonadotropin secretion of a follicle-stimulating hormone (FSH) and luteinizing hormone by the anterior pituitar
Schedule: legend
Dosing: 1 tablet once daily
Contraindication(s):
Breast cancer or other estrogen/progestin sensitive cancer
Use in women at high risk of thrombotic disease
BBW:
• Cigarette smoke and serious cardiovascular events
Key Points:
Nausea and Vomting Increased risk of blood clots Weight Changes; Fluid RetentionConsider various factors that may decrease effectiveness (abx, missed dose, time to onset, etc.)
Group: Triphasic oral Contraceptives
Brand: Ortho Tri-Cyclen, Tri-Sprintec, Trivora
MOA: Combination hormonal contraceptives inhibit ovulation via a negative feedback mechanism on the hypothalamus, which alters the normal pattern of gonadotropin secretion of a follicle-stimulating hormone (FSH) and luteinizing hormone by the anterior pituitar
Schedule: legend
Dosing: 1 tablet once daily
Contraindication(s):
Breast cancer or other estrogen/progestin sensitive cancer
Use in women at high risk of thrombotic disease
BBW:
• Cigarette smoke and serious cardiovascular events
Key Points:
Nausea/Vomting Increased risk of blood clots Weight Changes; Fluid RetentionConsider various factors that may decrease effectiveness (abx, missed dose, time to onset, etc.)
Levofloxacin
Brand: Levaquin
MOA: Inhibits DNA-gyrase and promotes breakage of double-stranded DNA
Schedule: legend
Dosing: 500mg to 750mg once daily
Contraindication(s):
Hypersensitivity
BBW:
• Serious adverse reactions • Exacerbation of myasthenia gravis
Key Points:
May bind with certain cations. Avoid taking with certain multivitamins and minerals (calcium, aluminum, magnesium, etc.) QTC prolongation DysglycemiaDiarrhea (AAD & CDAD)
Levothyroxine
Brand: Levoxyl, Synthroid, Tirosint, Unithroid
MOA: Synthetic form of thyroxine (T4), which is converted to active thyroid hormone
Schedule: legend
Dosing: 25mcg to 300mcg once daily About 1.7mcg/kg/day
Contraindication(s):
Acute MI Untreated subclinical or overt thyrotoxicosis of any etiology uncorrected adrenal insufficiency
BBW: • Weight reduction
Key Points:
Empty stomach; may or may not be first thing in the morning
Symptoms of hyperthyroidism if dosed too aggresively
Chelates with numerous drugs, vitamins, and mineralsRemind patient to have labs checked if new rx or changing dose
Levothyroxine and Liothyronine
Brand: Thyrolar
MOA: Active (T3) and synthetic (T4) thyroid hormone
Schedule: legend
Dosing:
50mcg/12.5mcg to 100mcg/25mcg once daily
Contraindication(s):
Uncorrected adrenal insufficiency Untreated thyrotoxicosis
BBW:
• Weight reduction
Key Points:
Empty stomach; may or may not be first thing in the morning
Symptoms of hyperthyroidism if dosed too aggresively
Chelates with numerous drugs, vitamins, and mineralsRemind patient to have labs checked if new rx or changing dose
Liothyronine
Brand: Cytomel
MOA: Active (T3) thyroid hormone
Schedule: legend
Dosing: 25mcg to 75mcg once daily Max: 100mcg/day
Contraindication(s):
Uncorrected adrenal insufficiency
Untreated thyrotoxicosis
BBW: • Weight reduction
Key Points:
Empty stomach; may or may not be first thing in the morning Sxs of hyperthyroidism if dosed too aggresively Chelates with numerous drugs, vitamins, and mineralsRemind patient to have labs checked if new rx or changing dose
Medroxyprogesterone
Brand: Provera, Depo-Provera
MOA: Inhibits secretion of pituitary gonadotropins, which prevents follicular maturation and ovulation and causes endometrial thinning
Schedule: legend
Dosing: 5mg to 10 mg PO once daily
Depo-Provera: 150 mg IM every 3 months
Contraindication(s):
DVT or PE Active or history of thromboembolic disease breast cancer Pregnancy
BBW:
- Cardiovascular disorders (tablet)
- Breast cancer (tablet)
- Dementia (tablet)
- Long-term use (injection)
- Loss of bone mineral density (injection)
- Patient education (subcutaneous injection) • Risk vs benefits (tablet)
Key Points:
amenorrhea Weight gain Headache
Metronidazole
Brand: Flagyl, MetroGel, MetroCream, MetroLotion
MOA: Interacts with DNA to cause a loss of helical DNA structure and strand breakage resulting in inhibition of protein synthesis and cell death
Schedule: legend
Dosing:
500mg to 750mg BID to TID
Trichomoniasis: 250mg q 8 hours x 7 days OR 1gm BID x 1 day OR 2gm once as a single dose
Contraindication(s):
First trimester of pregnancy Use of alcohol within 3 days use of disulfiram within the past 2 weeks
BBW: • Carcinogenic (systemic)
Key Points: Avoid alcohol Metallic taste Headache, Nausea
Minocycline
Brand: Minocin, Solodyn
MOA: Inhibits protein synthesis by binding with the 30S ribosomal subunit
Schedule: legend
Dosing:
Acne Vulgaris: 50mg to 100mg BID
Infection: 200mg once daily x 1 dose, followed by 100mg BID
Contraindication(s):
Hypersensitivity
BBW: • None
Key Points:
Photosensitivity Avoid < 8 years old Adequate fluid intake otherwise esophagitisdiarrhea (AAD & CDAD)
Moxifloxacin
Brand: Avelox, Moxeza, Vigamox
MOA: Inhibits DNA-gyrase and promotes breakage of double-stranded DNA
Schedule: legend
Dosing: 400mg PO or IV once daily
Contraindication(s):
Hypersensitivity to other quinolones
BBW: • Serious adverse reactions • Myasthenia gravis
Key Points:
May bind with certain cations. Avoid taking with certain multivitamins and minerals (calcium, aluminum, magnesium, etc.) QTC prolongation Dysglycemia, Diarrhea (AAD & CDAD)
Mupirocin
Brand: Bactroban
MOA: Binds to bacterial isoleucyl transfer-RNA synthetase resulting in the inhibition of protein synthesis
Schedule: legend
Dosing: AAA topically TID
Contraindication(s):
Hypersensitivity
BBW: • None
Key Points: Localized burning or stinging sensation Rhinitis Respiratory congestion
Nitrofurantoin
Brand: Macrobid, Macrodantin
MOA: Inactivates or alters bacterial ribosomal proteins leading to inhibition of protein synthesis, aerobic energy metabolism, DNA, RNA, and cell wall synthesis
Schedule: legend
Dosing:
Macrobid: 100mg BID for 7 days
Macrodantin: 50mg to 100mg q 6 hours
Contraindication(s):
Anuria, oliguria, or impairment of renal function (CrCl less than 60ml/min)
History of cholestatic jaundice or hepatic dysfunction associated with prior use of nitrofurantoin
BBW: • None
Key Points:
GI Upset Do not use with poor renal function Pulmonary fibrosis with long term use
Norethindrone
Brand: Nor-QD, Camila, Heather, Errin
MOA: Suppresses ovulation, thickens cervical mucus (which inhibits sperm penetration), alters follicle-stimulating hormone (FSH) and luteinizing hormone (LH) concentrations, slows the movement of ovum through the fallopian tubes, and alters the endometrium
Schedule: legend
Dosing: 1 tablet once daily at the same time each day
Contraindication(s):
Hepatic impairment or disease Breast Cancer - known, suspected, or history of Pregnancy Undiagnosed abdominal genital bleeding
BBW: • None
Key Points:
Nausea and Vomting
Increased risk of blood clots
Weight Changes; Fluid RetentionSticter dosing parmeters than other BCs. Consider various factors that may decrease effectiveness (time of dose, abx, missed dose, time to onset, etc.)
Oseltamivir
Brand: Tamiflu
MOA: Inhibits influenza virus neuraminidase
Schedule: legend
Dosing: Influenza prophylaxis: 75mg once daily Influenza treatment: 75mg BID
Contraindication(s):
Hypersensitivity
BBW: • None
Key Points:
Headache Nausea/Vomiting Give within 48 hours of flu symptoms
Oxybutynin
Brand: Oxytrol, Ditropan
MOA: Direct antispasmodic effect on smooth muscle and inhibits the action of acetylcholine
Schedule: legend
Dosing:
ER: 5mg to 10mg po once daily (Max 30mg/day)
Contraindication(s):
Patients with or at risk for uncontrolled narrow-angle glaucoma, urinary retention, gastric retention, or conditions with severely decreased GI motility
BBW: • None
Key Points:
Anticholinergic AE (dry mouth, sedation, constipation,e tc.) dizziness vision disturbance
Penicillin g
Brand: Bicillin L-A
MOA: Interferes with bacterial cell wall synthesis during active multiplication, causing cell wall death and resultant bactericidal activity against susceptible bacteria
Schedule: legend
Dosing: 1.2 million to 2.4 million units IM x1
Contraindication(s):
Hypersensitivity
BBW: • Appropriate administration
Key Points:
Diarrhea Allergy Take entire course and contact provider if symptoms do not improve within a few days of starting
Penicillin v Potassium
Brand: Apo-pen VK, Novo-Pen VK, Nu-Pen VK
MOA: Interferes with bacterial cell wall synthesis during active multiplication, causing cell wall death and resultant bactericidal activity against susceptible bacteria
Schedule: legend
Dosing: 125mg to 500mg q 6 to 8 hours
Contraindication(s): Hypersensitivity
BBW: • None
Key Points:
Diarrhea Allergy Take entire course and contact provider if symptoms do not improve within a few days of starting
Phenazopyridine
Brand: Pyridium
MOA: Unknown - Local urinary tract anesthetic
Schedule: legend
Dosing: 200mg TID after meals
Contraindication(s): Hypersensitivity renal insufficiency
BBW: • None
Key Points: Do not exceed 48-72h Urine color change
Sildenafil
Brand: Viagra, Revatio
MOA: Inhibits phosphodiesterase type 5 (PDE-5), causing increased levels of cGMP, resulting in smooth muscle relaxation and increased blood flow
Schedule: legend
Dosing:
ED: 25mg to 100mg PRN 1 hour prior to actvivity (Max 100 mg once daily)
Pulmonary HTN: 5mg to 20mg TID
Contraindication(s):
Concurrent use of organic nitrates or riociguat
BBW: • None
Key Points:
Headache Flushing Dizziness Priapism
Sofosbuvir and Ledipasvir
Brand: Harvoni
MOA: Ledipasvir inhibits the HCV NS5A protein necessary for viral replication sofosbuvir inhibits NS5B RNA-dependent RNA polymerase
Schedule: legend
Dosing: 400mg/90mg once daily
Contraindication(s): None
BBW: • Hepatitis B virus reactivation
Key Points:
Hyperkalemia Gynecomastia Monitor renal function regularly
Solifenacin
Brand: Vesicare
MOA: Inhibits muscarinic receptors resulting in decreased urinary bladder contraction, increased residual urine volume, and decreased detrusor muscle pressure
Schedule: legend
Dosing:
5mg once daily, may increase to 10mg/day
Contraindication(s):
Urinary retention gastric retention uncontrolled narrow-angle glaucoma
BBW: • None
Key Points:
Don’t crush/chew Dry mouth, dry eyes, constipation, urinary retention (anticholinergic) drink plenty of water to avoid crystaluria
Sulfamethoxazole and Trimethoprim
Brand: Bactrim, Sulfatrim
MOA: Sulfamethoxazole interferes with bacterial folic acid synthesis trimethoprim inhibits bacterial folic acid metabolism
Schedule: legend
Dosing: 800mg/160mg q 12 to 24 hours
Contraindication(s):
History of drug induced immun thrombocytopenia with sulfonamides
megaloblastic anemia due to folate deficiency
Marked hepatic damage or severe renal disease Cocomitant use with dofetilide
BBW: • None
Key Points:
Steven Johnson Syndrome Rash Diarrhea (AAD & CDAD) Photosensitivitydrink plenty of water to avoid crystaluria
Tadalafil
Brand: Cialis, Adcirca
MOA: Inhibits phosphodiesterase type 5 (PDE-5), causing increased levels of cGMP, resulting in smooth muscle relaxation and increased blood flow
Schedule: legend
Dosing:
ED: 2.5mg to 5mg once daily or 10mg to 20mg once daily PRN 30 min prior activity
BPH: 5mg once daily
Contraindication(s): Concurrent use of organic nitrates or riociguat
BBW: • None
Key Points:
Headache Flushing DizzinessPriapism
Tamsulosin
Brand: Flomax
MOA: Antagonist of alpha1A-adrenoreceptors leading to relaxation of smooth muscle in the bladder and prostate
Schedule: legend
Dosing: 0.4mg once daily
Contraindication(s):
Hypersensitivity
BBW: • None
Key Points:
Don’t crush/chew Take on empty stomach Tiredness
Tenofovir alafenamide and emtricitabine
Brand: Descovy
MOA: Each drug interferes with HIV viral RNA dependent DNA polymerase activities resulting in inhibition of viral replication
Schedule: legend
Dosing: 1 tablet once daily
Contraindication(s): None
BBW: • Hepatitis B coinfection
Key Points:
nausea Bone weakness Hypercholesterolemia
Terazosin
Brand: Hytrin
MOA: Competitively inhibits postsynaptic alpha1-adrenergic receptors leading to smooth muscle relaxation
Schedule: legend
Dosing: 1mg to 10mg q HS (Max 20mg/day)
Contraindication(s): Hypersensitivity
BBW: • None
Key Points:
Dizziness Orthostatic hypotension at bedtime
Testosterone
Brand: Androderm, Androgel, Axiron, Testim
MOA: Principle endogenous androgen responsible for growth and development of male sex organs and maintaining secondary sex characteristics
Schedule: III
Dosing:
Gel: 50mg q AM (Max 100mg/day)
Patch: 1 patch once daily
INJ: 50mg to 400mg IM q 2 to 4 weeks
Contraindication(s):
Breast or prostate cancer
Pregnant women or women who may become pregnant
Breastfeeding
BBW:
- Secondary exposure (transdermal gel, transdermal solution)
- Pulmonary oil microembolism (testosterone undecanoate)
Key Points:
Edema Hypertension CHF
Erythrocytosis
Valacyclovir
Brand: Valtrex
MOA: Inhibits DNA synthesis and viral replication by competing with deoxyguanosine triphosphate for viral DNA polymerase and being incorporated into viral DNA
Schedule: legend
Dosing:
Genital HSV (Initial Episode):1000mg q 12 hours; (Suppression): 1000mg once daily
Cold Sores (Episode): 2000mg q 12 hours x 1 day
Shingles: 1000mg q 8 hours
Contraindication(s): Hypersensitivity
BBW: • None
Key Points:
Nausea and Vomiting Headache
