126-150 Flashcards
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
Enalapril
Brand: Vasotec MOA: Inhibits angiotensin converting enzyme, preventing the coversion of angiotensin I to angiotensin II Schedule: legend Dosing: 5mg to 40mg daily as a single dose or in 2 evenly divided doses Doses 20mg or greater should be taken BID Contraindication(s): Angioedema related to previous treatment with an ACE inhibitor Concurrent use with 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 AngioedemaLightheadedness, dizziness, orthostasis, hypotension
Enoxaparin
Brand: Lovenox MOA: Strong inhibitor of factor Xa Schedule: legend Dosing: DVT Prophylaxis: 30mg SQ q 12 hours or 40mg SQ once daily PE/DVT Tx: 1mg/kg q 12 hours or 1.5mg/kg once daily Contraindication(s): Hypersensitivity to heparin or pork products Thrombocytopenia associated with a positive test for antiplatelet antibodies in the presence of enoxaparin Active major bleeding BBW: • Spinal/Epidural hematoma Key Points: Bleeding No routine lab monitoring Inject in the fatty areas at the sides of the waistInject prefilled air bubble with medication
Esomeprazole
Brand: Nexium MOA: Suppresses gastric acid secretion by inhibition of the H+/K+-ATPase in the gastric parietal cell Schedule: legend Dosing: 20mg to 40mg once daily Contraindication(s): Severe hypersensitivity to PPIs BBW: • None Key Points: Headache Take 60 minutes before food.
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.)
Ezetimibe
Brand: Zetia MOA: Inhibits absorption of cholesterol at the brush border of the small intestine via the sterol transporter, Niemann-Pick C1-Like1 (NPC1L1) Schedule: legend Dosing: 10mg once daily Contraindication(s): Concurrent use with a statin in patients with active hepatic disease Pregnancy and breastfeeding when used with a statin BBW: Key Points: Fatigue Diarrhea Arthralgia
Famotidine
Brand: Pepcid MOA: Competitively inhibits histamine at H2 receptors of the gastric parietal cells, which inhibits gastric acid secretion Schedule: legend Dosing: 20mg to 40mg once daily or BID Contraindication(s): Hypersensitivity to other H2 antagonists BBW: Key Points: Headache Diarrhea
Fenofibrate and Derivatives
Brand: Tricor, Trilipix, Fenoglide, Fibricor, Lipofen MOA: Agonist for the nuclear transcription factor peroxisome proliferator-activated receptor-alpha (PPAR-alpha), downregulates apoprotein C-III (an inhibitor of lipoprotein lipase) and upregulates the synthesis of apolipoprotein A-I, fatty acid transport prote Schedule: legend Dosing: 30mg to 160mg once daily Contraindication(s): Active liver disease Severe renal impairment or ESRD BBW: • None Key Points: Abdominal Pain Hepatic injury Myalgia, Diarrhea
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
Furosemide
Brand: Lasix MOA: Inhibits reabsorption of sodium and chloride in the ascending loop of Henle and proximal and distal renal tubules, interfering with the chloride-binding cotransport system, thus causing increased excretion of water, sodium, chloride, magnesium, and calciu Schedule: legend Dosing: 20mg to 80mg once daily up to q 6 hours Contraindication(s): Hypersensitivity Anuria BBW: • Fluid/electrolyte loss Key Points: Hypokalemia Take in the morning HyperuricemiaPossible sulfa cross-allergy
Gemfibrozil
Brand: Lopid MOA: Inhibits lipolysis and decreases subsequent hepatic fatty acid uptake, inhibits hepatic secretion of VLDL Schedule: legend Dosing: 600mg BID 30 minutes before breakfast and dinner Contraindication(s): Hepatic or severe renal dysfunction Primary biliary cirrhosis Preexisting gallbladder disease Concurrent use with dasabuvir, repaglinide, or simvastatin BBW: • None Key Points: Upset stomach Fatigue and Lethargy Abdominal Pain
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.)
Hydralazine
Brand: Apresoline MOA: Direct vasodilation of arterioles Schedule: legend Dosing: 10mg to 50mg QID Max 300mg/day Contraindication(s): Coronary artery disease Mitrial valve rheumatic heart disease BBW: • None Key Points: Headache palpitations/increase in HR Rarely lupus-like syndrome
Hydrochlorothiazide
Brand: Microzide MOA: Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions Schedule: legend Dosing: 12.5mg to 50mg once daily Contraindication(s): Hypersensitivity Anuria BBW: • None Key Points: Hypokalemia Photosensitivity possible sulfa cross-allergy
Irbesartan
Brand: Avapro MOA: Antagonizes angiotensin receptors Schedule: legend Dosing: 150mg to 300mg once daily Contraindication(s): Hypersensitivity Concurrent use with aliskiren in patients with diabetes BBW: • Fetal toxicity Key Points: Certain lab tests (K+ and sCr) may be increased and should be checked within 1-2 weeks of starting Lightheadedness, dizziness, orthostasis, hypotension
Irbesartan and Hydrochlorothiazide
Brand: Avalide MOA: See individual agents Schedule: legend Dosing: See individual agents Contraindication(s): Hypersensitivity Concurrent use with aliskiren in patients with diabetes Anuria BBW: • Fetal toxicity Key Points: See Individual Agents
Isosorbide Dinitrate
Brand: Isordil MOA: Activates cGMP leading to dephosphorylation of myosin light chains and smooth muscle relaxation Schedule: legend Dosing: IR: 10mg to 40mg BID ro TID; SR: 40mg to 160mg once daily >14 hour nitrate free time for IR, >18 hour nitrate free time for SR Contraindication(s): Concurrent use with phosphodiesterase inhibitors or riociguat BBW: • None Key Points: May cause headache, dizziness For angina, should be dosed to preserve a nitrate-free period
Isosorbide mononitrate
Brand: Imdur MOA: Activates cGMP leading to dephosphorylation of myosin light chains and smooth muscle relaxation Schedule: legend Dosing: IR: 20mg BID given+B125 7 hours apart; XR: 60mg to 120mg once daily Contraindication(s): Concurrent use with phosphodiesterase inhibitors or riociguat BBW: • None Key Points: May cause headache, dizziness For angina, should be dosed to preserve a nitrate-free period
Lansoprazole
Brand: Prevacid MOA: Suppresses gastric acid secretion by inhibition of the H+/K+-ATPase in the gastric parietal cell Schedule: legend Dosing: Ulcer/GERD: 15mg to 30mg once daily H. pylori eradication: 30mg BID or TID Contraindication(s): Hypersensitivity BBW: • None Key Points: Headache Diarrhea Take 30 minutes before food.
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
