125-150 use to study Flashcards
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
