151-175

Question 1

Liothyronine

Answer 1

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

Question 2

Lisinopril

Answer 2

Brand: Zestril, Prinivil MOA: Inhibits angiotensin converting enzyme, preventing the coversion of angiotensin I to angiotensin II Schedule: legend Dosing: 5mg to 40 mg once daily Contraindication(s):  Angioedema related to previous treatment with an ACE inhibitor  Cocomitant use of aliskerin 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

Question 3

Lisinopril and Hydrochlorothiazide

Answer 3

Brand: Zestoretic MOA: See individual agents Schedule: legend Dosing: See individual agents Max 80mg/50mg once daily Contraindication(s):  Hypersensitivity to sulfonamide-derived drugs  Angioedema related to previous treatment with an ACE inhibitor  Cocomitant use of aliskerin in patients with diabetes  Idiopathic or heredetary angioedema BBW: • Fetal toxicity Key Points:  See Individual Agents

Question 4

Losartan

Answer 4

Brand: Cozaar MOA: Antagonizes angiotensin receptors, blocking the vasoconstrictor and aldosterone secreting effects of angiotensin II Schedule: legend Dosing: 50mg to 100mg once daily Contraindication(s):  Cocomitant use of aliskerin 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

Question 5

Losartan and Hydrochlorothiazide

Answer 5

Brand: Hyzaar MOA: See individual agents Schedule: legend Dosing: See individual agents Contraindication(s):  Hypersensitivity to sulfonamide-derived drugs  Cocomitant use of aliskerin in patients with diabetes  anuria BBW: • Fetal toxicity Key Points:  See Individual Agents

Question 6

Medroxyprogesterone

Answer 6

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

Question 7

Metoprolol

Answer 7

Brand: Lopressor, Toprol MOA: Selectively blocks beta1-receptors Schedule: legend Dosing: IR: Angina, afib, HTN: 50mg to 100 mg BID Does not treat HF ER: Angina and HTN: 25mg to 100 mg once daily Afib: 50mg to 400 mg once daily HF: Initiate 12.5mg to 25mg once daily and titrate to target 200mg once daily Contraindication(s):  Second or third degree heart block  Sinus bradycardia  Cardiogenic shock BBW: • Ischemic heart disease Key Points:  Fatigue and Lethargy  Bradycardia (or rebound tachycardia if stopped abruptly)  ImpotenceSuccinate = long acting  Tartrate = short acting

Question 8

Metronidazole

Answer 8

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

Question 9

Minocycline

Answer 9

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)

Question 10

Moxifloxacin

Answer 10

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)

Question 11

Mupirocin

Answer 11

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

Question 12

Niacin

Answer 12

Brand: Niaspan MOA: Inhibits of release of free fatty acids from adipose tissue and increases lipoprotein lipase activity Schedule: legend Dosing: IR: 1.5g to 3g daily in two to three evenly divided doses (Max 6g/day) ER: 1g to 2g q HS (Max 2g/day) Contraindication(s):  Active liver disease  Active peptic ulcer  Arterial hemorrhage BBW: • None Key Points:  Flushing reaction  Hepatic injury  Can take with cold water or food to reduce flushingFlushing will get less severe with time

Question 13

Nifedipine

Answer 13

Brand: Adalat, Procardia, Afeditab MOA: Acts on vascular smooth muscle to produce peripheral arterial vasodilation by inhibiting calcium ions from entering select voltage-sensitive areas of vascular smooth muscle Schedule: legend Dosing: IR: Angina only: 10mg to 20mg TID (Max 180mg/day) ER: HTN and angina: 30mg to 90mg once daily (Max 120mg/day) Contraindication(s):  Use in patients with STEMI BBW: • None Key Points:  Peripheral edema  Flushing  hypotensiongingival hyperplasia

Question 14

Nitrofurantoin

Answer 14

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

Question 15

Nitroglycerin

Answer 15

Brand: Nitrostat, Nitro-Bid, Nitro-Dur, Nitrolingual MOA: Activates cGMP leading to dephosphorylation of myosin light chains and smooth muscle relaxation Schedule: legend Dosing: Sublingual tablet: 0.3mg to 0.6mg q 5 minutes (Max 3 tablets within 15 mintues) PO tablet: 2.5mg to 6.5 mg TID or QID Contraindication(s):  Concurrent use with phosphodiesterase inhibitors or riociguat BBW: • None Key Points:  Place under tongue, do not swallow or chew  Keep in original bottle - Replace routinely and check expiration date  May use up to 3 doses q5 min. If no symptom relief after 1 dose, call 911.Used for chest pain, sit before taking dose, may cause dizziness

Question 16

Norethindrone

Answer 16

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.)

Question 17

Olmesartan

Answer 17

Brand: Benicar MOA: Antagonizes angiotensin receptors, blocking the vasoconstrictor and aldosterone secreting effects of angiotensin II Schedule: legend Dosing: 20mg to 40mg once daily Contraindication(s):  Concomitant use of aliskerin 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

Question 18

Olmesartan and Hydrochlorothiazide

Answer 18

Brand: Benicar HCT MOA: See individual agents Schedule: legend Dosing: See Individual Agents Contraindication(s):  Concomitant use of aliskerin in patients with diabetes  Anuria BBW: • Fetal toxicity Key Points:  See Individual Agents

Question 19

Omega-3 fatty acids

Answer 19

Brand: Lovaza MOA: Reduction in hepatic production of VLDL and a reduction in the hepatic synthesis of triglycerides Schedule: legend Dosing: 2g BID or 4g once daily Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Diarrhea  Nausea/Dyspepsia  Abdominal PainEnsure no seafood allergies

Question 20

Omeprazole

Answer 20

Brand: Prilosec 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):  Hypersensitivity to other PPIs BBW: • None Key Points:  Headache  Diarrhea  Take 30 minutes before food.May diminish effect of clopidogrel

Question 21

Ondansetron

Answer 21

Brand: Zofran, Zuplenz MOA: Selective 5-HT3-receptor antagonist Schedule: legend Dosing: 8mg to 16mg po 30min to 1 hour before therapy Contraindication(s):  Hypersensitivity  Use with apomorphine BBW: • None Key Points:  Headache  Malaise  FatigueConstipation

Question 22

Oseltamivir

Answer 22

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

Question 23

Oxybutynin

Answer 23

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

Question 24

Pantoprazole

Answer 24

Brand: Protonix MOA: Suppresses gastric acid secretion by inhibition of the H+/K+-ATPase in the gastric parietal cell Schedule: legend Dosing: 40mg once daily or BID Contraindication(s):  Hypersensitivity to other PPIs BBW: • None Key Points:  Headache  Diarrhea  Take 30 minutes before food.

Question 25

Penicillin g

Answer 25

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