101-125

Question 1

Amoxicillin and Clavulanic acid

Answer 1

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

Question 2

Apixaban

Answer 2

Brand: Eliquis MOA: Inhibits platelet activation and fibrin clot formation via direct, selective, and reversible inhibition of free and clot-bound factor Xa Schedule: legend Dosing: AF: 5mg BID PE/DVT Tx: 10mg BID x 7 days followed by 5mg BID PE/DVT Prophylaxis: 2.5mg BID Contraindication(s):  Hypersensitivity  Active pathological bleeding BBW: • Discontinuation • Spinal/Epidural hematoma Key Points:  Risk of bleeding  Signs/Symptoms bleeding/clotting  No routine lab monitoring, Missing a single dose increases clotting risk

Question 3

Atenolol

Answer 3

Brand: Tenormin MOA: Selectively blocks beta1-receptors Schedule: legend Dosing: 25mg to 50mg once daily, may increase to 100mg once daily BID doses are acceptable Contraindication(s):  Sinus bradycardia  Heart block greater than 1st degree  Uncompensated cardiac failure  Cardiogenic shock BBW: • Cessation of therapy Key Points:  Bradycardia (or rebound tachycardia if stopped abruptly)  Fatigue and Lethargy  ImpotenceHypotension

Question 4

Atorvastatin

Answer 4

Brand: Lipitor MOA: Inhibits 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase Schedule: legend Dosing: 10mg to 80mg once daily Contraindication(s):  Active liver disease  Preganacy or wormen who may become pregnant  Breastfeeding  Unexplaned persistent elevations of serum transaminases BBW: • None Key Points:  Muscle pain and weakness  Diarrhea

Question 5

Azithromycin

Answer 5

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.)

Question 6

Benazepril

Answer 6

Brand: Lotensin MOA: Inhibits angiotensin converting enzyme, preventing the coversion of angiotensin I to angiotensin II Schedule: legend Dosing: 20mg to 80mg daily as a single dose or 2 evenly divided doses Contraindication(s):  History of angioedema  Concurrent use of aliskiren in patients with diabetes BBW: • Fetal toxicity Key Points:  May cause dry cough  Certain lab tests (K+ and sCr) may be increased and should be checked within 1-2 weeks of starting  Angioedema, Lightheadedness, dizziness, orthostasis, hypotension

Question 7

Bisoprolol

Answer 7

Brand: Zebeta MOA: Selective inhibitor of beta1-adrenergic receptors Schedule: legend Dosing: 5mg to 10mg once daily Max 20mg/day Contraindication(s):  Sinus bradycardia  Heart block greater than 1st degree  Cardiogenic shock  Overt cardiac failure BBW: • None Key Points:  Bradycardia (or rebound tachycardia if stopped abruptly)  Fatigue and Lethargy  Impotence, Hypotension

Question 8

Carvedilol

Answer 8

Brand: Coreg MOA: Nonselectively blocks beta-adrenoreceptors and alpha-adrenoreceptors Schedule: legend Dosing: HTN: 6.25mg to 25mg BID (Max 25mg BID) HF Target: 25mg BID (Max 50mg BID) Contraindication(s):  Severe bradycardia  Severe hepatic impairment  Bronchial asthma or related bronchospastic conditions  Second or third degree AV block BBW: • None Key Points:  Bradycardia (or rebound tachycardia if stopped abruptly)  Fatigue and Lethargy  Impotence, Orthostatic hypotension

Question 9

Cefdinir

Answer 9

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

Question 10

Cefuroxime

Answer 10

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

Question 11

Cephalexin

Answer 11

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

Question 12

Ciprofloxacin

Answer 12

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)

Question 13

Clarithromycin

Answer 13

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

Question 14

Clindamycin

Answer 14

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

Question 15

Clonidine

Answer 15

Brand: Catapres MOA: Stimulates alpha2-adrenoceptors in the brain stem, thus activating an inhibitory neuron, resulting in reduced sympathetic outflow from the CNS Schedule: legend Dosing: 0.1mg BID Max 2.4mg/day Contraindication(s):  Hypersensitivity BBW: • Epidural use Key Points:  Dry mouth, dry eyes, constipation, urinary retention (anticholinergic)  Lightheadedness, dizziness, orthostasis, hypotension  Rebound hypertension if dc’ed abruptlyNa/Water retention

Question 16

Clopidogrel

Answer 16

Brand: Plavix MOA: Irreversibly blocks the P2Y12 component of ADP receptors on the platelet surface Schedule: legend Dosing: 75mg once daily 300mg to 600mg loading dose Contraindication(s):  Hypersensitivity  Active pathological bleeding BBW: • Diminished antiplatelet effect in patients with two loss-of-function alleles of the CYP2C19 gene Key Points:  Rash  Increased bleeding risk

Question 17

Conjugated Estrogens

Answer 17

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

Question 18

Dabigatran

Answer 18

Brand: Pradaxa MOA: Specific, reversible, direct thrombin inhibitor that inhibits both free and fibrin-bound thrombin Schedule: legend Dosing: AF: 150mg BID PE/DVT Tx and Prevention: 150mg BID (after 5-10 days parenteral anticoagulation) Contraindication(s):  Hypersensitivity  Active pathological bleeding  Patients with mechanical prosthetic heart valves BBW: • Thrombotic events • • Spinal/Epidural hematoma Key Points:  do NOT chew/crush/open capsule. Must dispense in manufacturers bottle  Signs/Symptoms bleeding/clotting  No routine lab monitoringMissing a single dose increases clotting risk

Question 19

Darunavir

Answer 19

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

Question 20

Dicylomine

Answer 20

Brand: Bentyl MOA: Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS Schedule: legend Dosing: 20mg to 40mg QID Contraindication(s):  Obstructive diseases of the GI tract  Severe ulcerative colitis  Breastfeeding  Reflux esophagitis BBW: • None Key Points:  Dizziness  Blurred Vision  XerostomiaNausea

Question 21

Digoxin

Answer 21

Brand: Digox, Digitek, Lanoxin MOA: Inhibits the sodium/potassium ATPase pump in myocardial cells leading to increased contractility Directly suppresses AV node conduction to increase effective refractory period and decrease conduction velocity Schedule: legend Dosing: 0.125mg to 0.25mg once daily Contraindication(s):  Hypersensitivity  Ventricular fibrilation BBW: • None Key Points:  Can cause bradycardia  Hyperkalemia  Toxicity: vision halos, Nausea and VomittingNarrow therapuitic index. Monitor levels.

Question 22

Diltiazem

Answer 22

Brand: Cardizem, Cartia, Taztia, Tiazac MOA: Inhibits calcium ions from entering select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization Schedule: legend Dosing: 120mg to 320mg daily Max 480mg/day Contraindication(s):  Sick sinus syndrome  second or thrid degree AV block  Hypotension  Acute MI BBW: • None Key Points:  Bradycardia  Constipation  Peripheral edemaLightheadedness, dizziness, orthostasis, hypotension

Question 23

Doxazosin

Answer 23

Brand: Cardura MOA: Competitively inhibits postsynaptic alpha1-adrenergic receptors Schedule: legend Dosing: 1mg to 8mg once daily Max 8mg/day Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Dizziness  Orthostatic hypotension  LethargyTake at bedtime

Question 24

Doxycycline

Answer 24

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)

Question 25

Duasteride

Answer 25

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