26-50

Question 1

Dextroamphetamine and Amphetamine

Answer 1

Brand: Adderall MOA: Promotes release of dopamine and norepinephrine from their storage sites in the presynaptic nerve terminals Schedule: II Dosing: IR: 5mg to 40mg daily in 1 to 3 divided doses ER: 20mg to 60mg once daily Contraindication(s):  Advanced arteriosclerosis, moderate to severe hypertension, or symptomatic cardiovascular disease  Agitated states  Glaucoma  MAOI use within 14 days BBW: • Abuse potential • Cardiovascular events Key Points:  Hypertension  Tachycardia  InsomniaWeight loss

Question 2

Diazepam

Answer 2

Brand: Valium, Diastat MOA: Enhances the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions Schedule: IV Dosing: 2mg to 10mg BID to QID PRN Contraindication(s):  Acute narrow-angle glaucoma  Untreated open-angle glaucoma  Severe respiratory impariment or sleep apnea  Severe hepatic impairment BBW: • Risks from concomitant use with opioids Key Points:  Drowsiness and sedation  Avoid alcohol or other sedating agents

Question 3

Diclofenac

Answer 3

Brand: Voltaren, Flector, Pensaid, Diclo gel MOA: Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors Schedule: legend Dosing: 50mg BID to TID or 75mg BID Contraindication(s):  History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDS  Use in the setting of CABG surgery  Patients with moderate to severe renal impairment in the perioperative period and who are at risk for volume depletion (injection only) 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 prescriberTake only as directed or as needed for pain

Question 4

Duloxetine

Answer 4

Brand: Cymbalta MOA: Selectively inhibits the reuptake of serotonin and norepinephrine, weakly inhibits dopamine reuptake Schedule: legend Dosing: 30mg to 60mg daily as a single dose or in 2 evenly divided doses Contraindication(s):  MAOI use within 14 days  Use with linezolid BBW: • Suicidal thoughts and behavior Key Points:  Headache  drowsiness and fatigue  XerostomiaWeight Loss

Question 5

Escitalopram

Answer 5

Brand: Lexapro MOA: Selectively inhibits serotonin reuptake in the presynaptic neurons Schedule: legend Dosing: 10mg to 20mg once daily Contraindication(s):  MAOI use within 14 days  Use with linezolid BBW: • Suicidality and antidepressant drugs Key Points:  Drowsiness and insomnia  Dry mouth  Decreaed Libido/Ejaculatory disorders

Question 6

Eszopiclone

Answer 6

Brand: Lunesta MOA: May interact with GABA-receptor complexes at binding domains located close to or allosterically coupled to benzodiazepine receptors Schedule: IV Dosing: 1mg to 3mg q HS 3mg max Contraindication(s):  Hypersensitivity BBW: • None Key Points:  May distort taste  Drowsiness  Avoid alcohol or other sedating agents

Question 7

Etanercept

Answer 7

Brand: Enbrel MOA: Binds tumor necrosis factor (TNF) and blocks its interaction with cell surface receptors Schedule: legend Dosing: 50mg SQ once weekly Contraindication(s):  Sepsis BBW: • Serious infections • Malignancies Key Points:  Do not start or take the next dose if the patient is sick  Patient should complete Hepatitis B virus and tuberculosis screening prior to starting the first dose  Injection site reaction (burning, itching, pain, rash, and/or redness) are common but usually well-toleratedThe drug takes some time to work (RA); do not stop the drug when patients do not see results immediately

Question 8

Exanatide

Answer 8

Brand: Byetta, Bydrueron MOA: Glucagon-like peptide 1 (GLP-1) analog which increases glucose-dependent insulin secretion, decreases inappropriate glucagon secretion, increases B-cell growth/replication, slows gastric emptying, and decreases food intake Schedule: legend Dosing: IR: 5mcg to 10mcg BID within 60 minutes prior to meals XR: 2mg SQ once weekly Contraindication(s):  History or family history of medullary thyroid carcinoma  Patients with multiple endocrine neoplasia syndrome BBW: • Risk of thyroid C-cell tumors (Bydureon) Key Points:  Hypoglycemia, especially when used in combination with sulfonylureas  Injection site reaction; Rotate injection sites  Pancreatitis symptoms: severe stomach/upper abdominal pain radiating to back, persistent n/vNausea and Vomitting- eat slower & smaller meals to avoid overeating

Question 9

Fentanyl

Answer 9

Brand: Sublimaze, Actiq, Duragesic, Fentora MOA: Binds with stereospecific receptors at many sites within the CNS, increases pain threshold, alters pain reception, inhibits ascending pain pathways Schedule: II Dosing: Individualized to patient Contraindication(s):  Hypersensitivity  Significant respiratory depression  Acute or severe bronchial asthma  GI obstruction including paralytic ileus (known or suspected) BBW: • Life-threatening respiratory depression • Addiction, abuse, and misuse • Accidental exposure • Cytochrome P450 3A4 Interaction • Neonatal opioid withdrawal syndrome • Risks from concomitant use with benzodiazepines or other CNS depressants • Risk of medication errors (buccal, intranasal, lozenge, sublingual) • REMS program • Exposure to heat (Duragesic only) Key Points:  Change patch every 72 hours  Do not cut patch and avoid exposing application site to external heat sources  Dizziness, Drowsiness, and ConstipationAvoid alcohol or other sedating agents

Question 10

Fluoxetine

Answer 10

Brand: Prozac, Saracen MOA: Selectively inhibits serotonin reuptake in the presynaptic neurons Schedule: legend Dosing: 20mg to 80mg once daily Contraindication(s):  MAOI use within 5 weeks of discontinuing fluoxetine or within 14 days of discontinuing the MAOI  Use with linezolid BBW: • Suicidality and antidepressant drugs Key Points:  Insomnia  Anxiety  Decreaed Libido/Ejaculatory disordersLong half life

Question 11

Fluticasone

Answer 11

Brand: Flonase, Flovent MOA: Potent vasoconstrictive and anti-inflammatory activity Schedule: legend Dosing: Inhaled: 88mcg BID (Max 880mcg/day) Nasal: 2 spays each nostril daily or 1 spray (50mcg) each nostril BID Contraindication(s):  Severe hypersensitivity to milk proteins  Primary treatment for acute asthma BBW: • None Key Points:  Oral thrush  Take the medication as scheduled  Upper respiratory tract infectionHeadache

Question 12

Fluticasone and Salmeterol

Answer 12

Brand: Advair, Airduo MOA: Fluticasone: Potent vasoconstrictive and anti-inflammatory activity Relaxes bronchial smooth muscle by selective action on beta2-receptors Schedule: legend Dosing: Diskus: 1 inhalation BID HFA: 2 inhalations BID Contraindication(s):  Severe hypersensitivity to milk proteins  Primary treatment for acute asthma BBW: • Asthma-related death Key Points:  Oral thrush  Cough  Upper respiratory tract infectionHeadache

Question 13

Folic acid

Answer 13

Brand: Folic Acid MOA: Necessary for formation of a number of coenzymes in many metabolic systems Schedule: legend Dosing: 0.4mg to 1mg once daily Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Take it regularly, even on days not taking methotrexate  Side effects are mild and well-tolerated

Question 14

Gabapentin

Answer 14

Brand: Neurontin MOA: May modulate the release of excitatory neurotransmitters which participate in epileptogenesis and nociception Schedule: legend Dosing: 900mg to 1800mg daily in 3 divided doses Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Drowsiness  Dizziness  FatigueTremor

Question 15

Hydrocodone and Acetaminiphen

Answer 15

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 productsRespiratory Depression

Question 16

Ibuprofen

Answer 16

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 prescriberTake only as directed or as needed for pain

Question 17

Insulin Aspart

Answer 17

Brand: Novolog MOA: Facilitates the uptake of glucose from the bloodstream into cells Schedule: legend Dosing: 0.5 to 1 unit/kg/day in divided doses Contraindication(s):  Use during episodes of hypoglycemia BBW: • None Key Points:  Used to treat mealtime blood glucose  inject within 15 min of meal  signs, symptoms, & management of hypoglycemiainject subcutaneously into prefered 1. abdomin; or alternate 2. anterolateral thight, 3. upper arm

Question 18

Insulin Detemir

Answer 18

Brand: Levemir MOA: Facilitates the uptake of glucose from the bloodstream into cells Schedule: legend Dosing: About 1/3 of the total daily insulin requirement given in one or two divided doses Contraindication(s):  Use during episodes of hypoglycemia BBW: • None Key Points:  Long Acting Insulin  inject once to twice daily as directed by prescriber  inject into prefered 1. abdominal area; or alternate 2. anterolateral thigh, 3. SQ of armsigns, symtoms & management of hypoglycemia

Question 19

Insulin Glargine

Answer 19

Brand: Lantus, Toujeo MOA: Facilitates the uptake of glucose from the bloodstream into cells Schedule: legend Dosing: About 1/3 to 1/2 of the total daily insulin requirement administered once daily Doses greater than 40 units can be split in to BID doses Contraindication(s):  Use during episodes of hypoglycemia BBW: • None Key Points:  Long Acting Insulin  inject once to twice daily as directed by prescriber  inject into prefered 1. abdominal area; or alternate 2. anterolateral thigh, 3. SQ of armsigns, symtoms & management of hypoglycemia

Question 20

Insulin Lispro

Answer 20

Brand: Humalog MOA: Facilitates the uptake of glucose from the bloodstream into cells Schedule: legend Dosing: 0.5 to 1 unit/kg/day in divided doses Contraindication(s):  Use during episodes of hypoglycemia BBW: • None Key Points:  Used to treat meal time blood glucose  inject within 15 min of meal  signs, symtoms & management of hypoglycemiainject into prefered 1. abdominal area, alternate 2. anterolateral thigh, 3. SQ of arm

Question 21

Insulin Regular

Answer 21

Brand: Humlin R, Novolin R MOA: Facilitates the uptake of glucose from the bloodstream into cells Schedule: legend Dosing: 0.5 to 1 unit/kg/day in divided doses Contraindication(s):  Use during episodes of hypoglycemia BBW: • None Key Points:  Used to treat meal time blood glucose  inject within 30 min of start of meal  signs, symtoms & management of hypoglycemiainject into prefered 1. abdominal area, alternate 2. anterolateral thigh, 3. SQ of arm

Question 22

Ipratropium bromide and albuterol

Answer 22

Brand: Combivent MOA: Ipratropium: Blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation Albuterol: Relaxes bronchial smooth muscle by action on beta2-receptors Schedule: legend Dosing: 2 inhalations QID Max 12 inhalations/day Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Upper respiratory tract infection  Cough  TremorRhinitis

Question 23

Lamotrigine

Answer 23

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

Question 24

Latanoprost

Answer 24

Brand: Xalatan MOA: Prostaglandin analog which increases the outflow of aqueous humor Schedule: legend Dosing: 1 gtt in affected eye(s) q PM Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Erythema of eyelid  Conjuntival hyperemia  Burning/stinging/itching in eyes

Question 25

Lidocaine

Answer 25

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