176-200

Question 1

Penicillin v Potassium

Answer 1

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

Question 2

Phenazopyridine

Answer 2

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

Question 3

Pravastatin

Answer 3

Brand: Pravachol MOA: Inhibits 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase Schedule: legend Dosing: 40mg to 80mg once daily Contraindication(s):  Active liver disease  Unexplained persistent elevations of transaminases  Pregnancy and breastfeeding BBW: • None Key Points:  Diarrhea  Muscle pain and weakness

Question 4

Promethazine

Answer 4

Brand: Phenadoz, Phenergan, Promethegan MOA: Blocks postsynaptic mesolimbic dopaminergic receptors in the brain; exhibits a strong alpha-adrenergic blocking effect and depresses the release of hypothalamic and hypophyseal hormones; competes with histamine for the H1-receptor Schedule: legend Dosing: Allergies, N/V: 12.5mg to 25mg po or PR q HS or q 4 to 6 hours PRN Motion sickness: 25mg po or PR 30min to 1 hour before departure Contraindication(s):  Hypersensitivity  treatment of lower respiratory tract symptoms, including asthma  Children under 2 years old BBW: • Respiratory depression - Pediatrics • Severe tissue injury, including gangrene (injection) Key Points:  Sedation  Possible EKG changes

Question 5

Propranolol

Answer 5

Brand: Inderal MOA: Nonselective beta-adrenergic blocker; competitively blocks response to beta1- and beta2-adrenergic receptors Schedule: legend Dosing: IR: 80mg to 240mg daily in 2 to 3 evenly divided doses ER: 80mg to 160mg once daily Contraindication(s):  Uncompensated congestive heart failure  Severe sinus bradycardia  Heart block greater than 1st degree  Bronchial asthma BBW: • Cardiac ischemia after abrupt discontinuation (Inderal LA, Inderal XL, Innopran XL) Key Points:  Fatigue and Lethargy  Bradycardia (or rebound tachycardia if stopped abruptly)  ImpotenceDepression/vivid dreams

Question 6

Rabeprazole

Answer 6

Brand: Aciphex MOA: Suppresses gastric acid secretion by inhibition of the H+/K+-ATPase in the gastric parietal cell Schedule: legend Dosing: 20mg once daily H. pylori eradication: 20mg BID Contraindication(s):  Hypersensitivity to other PPIs BBW: • None Key Points:  Headache  Diarrhea  Take 30 minutes before food.

Question 7

Ranitidine

Answer 7

Brand: Zantac MOA: Competitively inhibits histamine at H2 receptors of the gastric parietal cells, which inhibits gastric acid secretion Schedule: legend Dosing: 150mg BID or 300mg q HS Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Headache  Diarrhea

Question 8

Rivaroxaban

Answer 8

Brand: Xarelto 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: 20mg once daily DVT Prophylaxis: 10mg once daily DVT Tx/Recurrent Prophylaxis: 20mg once daily Contraindication(s):  Hypersensitivity  active pathological bleeding BBW: • Premature discontinuation increases the risk of thrombotic events • Spinal/Epidural hematomas Key Points:  No routine lab monitoring  Signs/Symptoms bleeding/clotting  Missing a single dose increases clotting riskTake with food for doses 15mg or higher

Question 9

Rosuvastatin

Answer 9

Brand: Crestor MOA: Inhibits 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase Schedule: legend Dosing: 10mg to 20mg once daily, may titrate to 40mg/day Contraindication(s):  Active liver disease  Unexplained persistent elevations of transaminases  Pregnancy and breastfeeding BBW: • None Key Points:  Diarrhea  Muscle pain and weakness 

Question 10

Sildenafil

Answer 10

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  DizzinessPriapism

Question 11

Simvastatin

Answer 11

Brand: Zocor MOA: Inhibits 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase Schedule: legend Dosing: 5mg to 40mg once daily Contraindication(s):  Active liver disease  Unexplained persistent elevations of transaminases  Pregnancy and breastfeeding  Concomitant use of strong CYP3A4 inhibitors BBW: • None Key Points:  Diarrhea  Muscle pain and weakness

Question 12

Simvastatin and Ezetimibe

Answer 12

Brand: Vytorin MOA: See individual agents Schedule: legend Dosing: See Individual Agents Contraindication(s):  Active liver disease  Unexplained persistent elevations of transaminases  Pregnancy and breastfeeding  Concomitant use of strong CYP3A4 inhibitors BBW: • None Key Points:  See Individual Agents

Question 13

Sofosbuvir and Ledipasvir

Answer 13

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

Question 14

Solifenacin

Answer 14

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

Question 15

Spironolactone

Answer 15

Brand: Aldactone MOA: Competes with aldosterone for receptor sites in the distal renal tubules, increasing sodium chloride and water excretion while conserving potassium and hydrogen ions Blocks the effect of aldosterone on arteriolar smooth muscle Schedule: legend Dosing: 25mg to 100mg once daily HF: Max 50mg/day Contraindication(s):  Anuria, or significant impairment of renal excretory function  hyperkalemia  Addison Disease  Concomitant use with eplerenone BBW: • Tumorigenic Key Points:  Hyperkalemia  Gynecomastia

Question 16

Sulfamethoxazole and Trimethoprim

Answer 16

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

Question 17

Tadalafil

Answer 17

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

Question 18

Tamsulosin

Answer 18

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

Question 19

Tenofovir alafenamide and emtricitabine

Answer 19

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

Question 20

Terazosin

Answer 20

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

Question 21

Testosterone

Answer 21

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  CHFErythrocytosis

Question 22

Triamterene and hydrochlorothiazide (combination)

Answer 22

Brand: Dyazide, Maxzide MOA: Triamterene: Blocks epithelial sodium channels in the late distal convoluted tubule (DCT) and collecting duct which inhibits sodium reabsorption from the lumen, decreasing the function of Na+/K+ ATPase, leading to potassium retention and decreased calciu Hydrochlorothiazide: Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions Schedule: legend Dosing: 37.5mg/25mg to 75mg/50mg once daily Contraindication(s):  Anuria  Acute or chronic renal insufficiency or significant renal impairment  Patients receiving other potassium sparing diuretics or potassium supplements  Hyperkalemia BBW: • Hyperkalemia Key Points:  Photosensitivity  Hyperkalemia, monitor renal function

Question 23

Valacyclovir

Answer 23

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

Question 24

Valsartan and hydrochlorothiazide (combination)

Answer 24

Brand: Diovan HCT MOA: Valsartan: Antagonizes angiotensin receptors, blocking the vasoconstrictor and aldosterone secreting effects of angiotensin II Hydrochlorothiazide: Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions Schedule: legend Dosing: 160mg/12.5mg to 320mg/25mg once daily Contraindication(s):  anuria  concomitant use with aliskerin in patients with diabetes BBW: • Fetal toxicity Key Points:  Hypotension  Rarely angioedema  Incr in SCr

Question 25

Verapamil

Answer 25

Brand: Calan, Verelan MOA: Inhibits calcium ions from entering select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization Schedule: legend Dosing: IR: 80mg to 160mg TID ER: 240mg to 480mg daily in one dose or in two evenly divided doses Contraindication(s):  Hypotension or cardiognic shock  sick sinus syndrome  second or thrid degree AV block  Wolf-Parkinson-White syndrome BBW: • None Key Points:  Bradycardia  Constipation  Peripheral edemaLightheadedness, dizziness, orthostasis, hypotension

Question 26

Warfarin

Answer 26

Brand: Coumadin, Jantoven MOA: Inhibits subunit 1 of the multi-unit VKOR complex, leading to depletion of factors II, VII, IX, and X, as well as proteins C and S. Schedule: legend Dosing: 2mg to 10mg once daily Contraindication(s):  Hemorrhagic tendencies  Spinal puncture or recent CNS or eye surgery  Patients with high potential for noncompliance  Pregnancy BBW: • Bleeding risk Key Points:  Monitor INR  Diet should be consistent for Vitamin K intake  Inform pharmacist or prescriber of new medications and herbal productsBleeding