51-75 Flashcards
FINASTERIDE
Proscar, Propecia
• Dosage Forms.Oral Tablet:1 mg, 5 mg
• Common Indication: Benign prostatic hyperplasia, male pattern alopecia
• MOA.Finasteride inhibits the conversion of testosterone to 5α-dihydrotestosterone (DHT) by 5α-reductase, isoform 2.
• Efficacy Monitoring Parameters.American Urologic Association (AUA) Symptom Score, decrease in residual urine volume, increased urine flow if using for BPH; increased hair growth if using for male pattern alopecia.
• Key Patient Counseling Points.For hair loss, you may need to take this medicine for 3 mo or longer before you see an effect. For an enlarged prostate, you may need to take this medicine for up to 6 mo to see the full effect. Women who are pregnant or may become pregnant should avoid touching or handling this medicine. This medicine can get into the body through the skin and may prevent development of genitalia in an unborn male baby. They should also avoid semen of a man taking finasteride.
• Adverse Reactions: Common (>10%): impotence, reduced libido; Less Common (1-10%): gynecomastia, dizziness; Rare but serious (<1%): heart failure, angioedema, allergic skin reactions, male breast cancer
Calcium Carbonate
Tums
• Class:Mineral Supplement, Antacid
• Dosage Forms.Tablet:364 mg, 625 mg, 1250 mg, 1500 mg;Chewable Tablet:260 mg, 420 mg, 500 mg, 750 mg 1250 mg;Capsule:200 mg, 364 mg, 1250 mg;Suspension:1250 mg/5 mL
• Common Self-Care Indication: Antacid
• MOA.Calcium salts neutralize gastric acidity.
• Self-Monitoring Parameters.Relief from indigestion. Seek medical attention if severe headache, decreased urination, and severe constipation occur.
• Key Patient Counseling Points.May take with or without food, although most foods can enhance absorption. Bran, foods high in oxalates, or whole grain cereals may decrease calcium absorption. Consider lifestyle modifications, including avoidance of late and large meals, staying upright for at least 3 h after a meal, weight loss, smoking cessation, and elevating the head of their bed to resolve heartburn symptoms
• Adverse Reactions: Common (>10%): diarrhea, cramping, abdominal pain, constipation; Less Common (1-10%): nausea, vomiting, dehydration; Rare but serious (<1%): electrolyte imbalance, fluid imbalance
Warfarin
Coumadin
• Class:Anticoagulant, Vitamin K Antagonist
• Dosage Forms.Oral Tablet:1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg, 10 mg
• Common Indication: atrial fibrillation, myocardial infarction, prosthetic cardiac valve component embolism, pulmonary embolism, thrombosis, postmyocardial infarction, venous thromboembolism
• MOA.Warfarin prevents the conversion of vitamin K back to its active form from vitamin K epoxide. This impairs formation of the vitamin K–dependent clotting factors II, VII, IX, and X (prothrombin) and proteins C and S (physiologic anticoagulants).
• Efficacy Monitoring Parameters.Measure initial INR after the first 2-3 doses and subsequently at intervals no longer than every 4 wk, once stable dose has been achieved; may monitor every 12 wk in stable patients, use clinical judgment; patients at high risk of bleeding require more frequent monitoring. INR target and therapeutic range depend on indication. Atrial fibrillation/atrial flutter: target 2.5 (range 2-3); prosthetic heart valves: target 2.5 (range 2-3); mechanical mitral or aortic valve: target 3 (range 2.5-3.5); myocardial infarction, ST segment elevation: target 3 (2.5-3.5, with aspirin); venous thromboembolism, prophylaxis and treatment (including pulmonary embolism, DVT, hip/knee arthroplasty): target 2.5 (range 2-3).
• Key Patient Counseling Points.Report signs/symptoms of hemorrhage, skin and tissue necrosis. Avoid situations/activities in which cuts, bruising, or injury is likely to occur. Many significant drug-drug interactions, consult health-care professional prior to new prescription or OTC use. Avoid alcohol, cranberry products, and drastic changes in vitamin K consumption from diet (cruciferous vegetables).
• Adverse Reactions: Common (>10%): bleeding; Less Common (1-10%): anemia, epistaxis, rash; Rare but serious (<1%): hemorrhage (particularly GI tract), purple toe syndrome, tissue necrosis, calciphylaxis
Divalproex
Depakote
• Class:Anticonvulsant
• Dosage Forms.Oral Tablet, Extended Release:250 mg, 500 mg;Oral Tablet, Delayed Release:125 mg, 250 mg, 500 mg;Oral Capsule, Delayed Release Sprinkles:125 mg
• Common Indication: Absence seizure, simple and complex, complex partial epileptic seizure, manic bipolar disorder, migraine prophylaxis
• MOA.Divalproex is composed of sodium valproate and valproic acid. Valproic acid is a carboxylic acid compound whose anticonvulsant activity might be mediated by an inhibitory neurotransmitter, GABA. Valproic acid might increase GABA levels by inhibiting GABA metabolism or enhancing postsynaptic GABA activity. Valproic acid also limits repetitive neuronal firing through voltage- and usage-dependent sodium channels.
• Efficacy Monitoring Parameters.Reduction in number of seizures, control of manic symptoms or reduction in number and severity of migraine headaches. Therapeutic range for epilepsy, 50-100 mcg/mL. Therapeutic range for acute mania, 50-125 mcg/mL.
• Key Patient Counseling Points.Avoid activities requiring mental alertness until drug effects are realized; drug may cause somnolence or dizziness. Take with food to avoid GI irritation. Do not discontinue drug abruptly, as this may precipitate status epilepticus. Avoid alcohol. Sprinkle capsules can be swallowed whole or opened and sprinkled onto soft food; do not chew.
• Adverse Reactions: Common (>10%): abdominal pain, alopecia, asthenia, diarrhea, diplopia, dizziness, headache, nausea, somnolence, tremor, vomiting; Less Common (1-10%): amblyopia, blurred vision, feeling nervous, hyperammonemia, indigestion, infection, insomnia, loss of appetite, rash, weight gain; Rare but serious (<1%): hepatitis, palpitation, pancreatitis, tachycardia, thrombocytopenia, suicidal ideation or behavior
Pregablin
Lyrica
• Class: Analgesic, Anticonvulsant. C-V
• Dosage Forms.Oral Capsule:25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg;Oral Solution:20 mg/mL
• Common Indication: Neuropathic pain, diabetes associated or spinal cord injury associated, fibromyalgia partial seizure, postherpetic neuralgia
• MOA.Pregabalin is a GABA analogue that strongly binds to the α2-delta site (a subunit of voltage-gated calcium channels) in CNS tissues. Binding to the α2-delta subunit may be involved in pregabalin’s effects on neuropathic pain and seizure control. Pregabalin reduces the calcium-dependent release of several neurotransmitters; however, the exact mechanism of action is unknown.
• Efficacy Monitoring Parameters.Reduction in seizure frequency, improvement in pain, reduced symptoms of fibromyalgia.
• Key Patient Counseling Points.Solution must be used within 45 d of first opening the bottle. Avoid activities requiring mental alertness or coordination until drug effects are realized. Avoid sudden discontinuation of drug due to risk of withdrawal, including increased seizure frequency. Avoid drinking alcohol
• Adverse Reactions: Common (>10%): dizziness, somnolence, ataxia, headache, peripheral edema Less Common (1-10%): arthralgia, asthenia, blurred vision, confusion, constipation, diplopia, disturbance in thinking, euphoria, fatigue, incoordication, increased appetite, muscle spasm, tremor, vomiting, weight gain, xerostomia; Rare but serious( <1%):angioedema
Topiramate
Topamax
• Class:Anticonvulsant
• Dosage Forms.Oral Capsule, Sprinkle:15 mg, 25 mg;Oral Tablet:25 mg, 50 mg, 100 mg, 200 mg;Oral Capsule, Extended Release, 24 H: 25 mg, 50 mg, 100 mg, 200 mg;Oral Capsule, Extended Release, 24 H Sprinkle:25 mg, 50 mg, 100 mg, 150 mg, 200 mg
• Common Indication: Partial or tonic-clonic seizure, monotherapy or adjunct, migraine prophylaxis
• MOA.The exact mechanisms by which topiramate exerts its anticonvulsant and migraine prophylaxis effects are unknown. Electrophysiological and biochemical evidence suggests that topiramate blocks voltage-dependent sodium channels, augments the activity of the neurotransmitter gamma-aminobutyrate at some subtypes of the GABA-A receptor, antagonizes the AMPA/kainate subtype of the glutamate receptor, and inhibits the carbonic anhydrase enzyme, particularly isozymes II and IV.
• Efficacy Monitoring Parameters.Decreased seizure frequency or frequency of migraine headaches.
• Key Patient Counseling Points.Avoid activities requiring mental alertness and coordination until drug effects are realized. Drug may cause dizziness and somnolence, especially if taken with alcohol or other CNS depressants. May cause nausea, diplopia, nervousness, confusion, and many other CNS effects. Do not discontinue drug abruptly, as this may cause increased seizure activity. Seek medical attention for new eye problems or high body temperature. May decrease sweating; avoid hot temperatures (including hot tubs and saunas)
• Adverse Reactions: Common (>10%): ataxia, loss of appetite nausea dizziness, impaired psychomotor performance, somnolence, fatigue, nystagmus, low serum bicarbonate; Less Common (1-10%): Disorder of language, diplopia, weight loss, depression, nausea, nephrolithiasis; Rare but Serious ( <1%): Erythema multiforme, Stevens-Johnson syndrome, hypohidrosis, increased body temperature, metabolic acidosis, liver failure, glaucoma, myopia, suicidal ideation, visual field defects
Meclizine
Antivert, Dramamine
• Class: Antihistamine, Antiemetic
• Dosage Forms.Oral Tablet:12.5 mg, 25 mg, 32 mg;Oral Tablet, Chewable:25 mg
• Common Indication: Motion sickness, vertigo
• MOA.Meclizine is an antihistamine that suppresses the vasodepressor response to histamine while only slightly inhibiting acetylcholine.
• Efficacy Monitoring Parameters.Improvement in nausea or vertigo symptoms.
• Key Patient Counseling Points.May cause drowsiness; avoid driving or operating dangerous machinery until you know how this medication affects you. Avoid alcoholic beverages and other CNS depressants while taking this drug. Take with food to decrease GI symptoms. Because of its potential anticholinergic action, this drug should be used with caution in patients with asthma, glaucoma, or enlargement of the prostate gland.
• Adverse Reactions: Common (>10%); Less Common (1-10%): Sedation, headache, dry mouth, fatigue, and nausea; Rare but Serious ( <1%):
Metoclopramide
Reglan
• Class:Dopamine Antagonist
• Dosage Forms.Oral Tablet:5 mg, 10 mg;Oral Solution:5 mg/5 mL, 10 mg/2 mL 10 mg/10 mL;Oral Dispersible Tablet:5 mg, 10 mg
• Common Indication: Diabetic gastroparesis, gastroesophageal reflux disease
• MOA.Metoclopramide stimulates motility of the upper GI tract without stimulating gastric, biliary, or pancreatic secretions. Its mode of action is unclear. It seems to sensitize tissues to the action of acetylcholine. It is also a dopamine receptor antagonist at dose >5 mg/kg.
• Efficacy Monitoring Parameters.Reduction in nausea and vomiting.
• Key Patient Counseling Points.Take this medicine on an empty stomach, 30 min before each meal and at bedtime. Not for long-term use. If using the oral dispersible tablet, make sure your hands are dry. Place the tablet in your mouth. It should melt quickly. After the tablet has melted, swallow or take a drink of water.
• Adverse Reactions: Common (>10%) asthenia, somnolence; Less Common (1-10%): dizziness, headache, visual disturbances; Rare but Serious (<1%): malignant hypertension, arrhythmias, galactorrhea, amenorrhea, gynecomastia, and impotence secondary to hyperprolactinemia, agranulocytosis, dystonia, extrapyramidal reactions, tardive dyskinesia, hallucinations
Promethazine
Phenergan
• Class: Phenothiazine Antihistamine
• Dosage Forms.Oral Syrup:6.25 mg/5 mL;Oral Tablet:12.5 mg, 25 mg, 50 mg;Oral Solution:6.25 mg/5 mL;Rectal Suppository:12.5 mg, 25 mg, 50 mg
• Common Indication: Motion sickness, allergy, nausea and vomiting
• MOA.Promethazine hydrochloride is a phenothiazine derivative that competitively blocks histamine H1receptors without blocking the secretion of histamine. The drug has sedative, antimotion sickness, antiemetic, and anticholinergic effects, but it has no dopaminergic action due to a structural difference with other phenothiazines.
• Efficacy Monitoring Parameters.Relief of nausea or allergy symptoms.
• Key Patient Counseling Points.May cause drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol.
• Adverse Reactions: Common (>10%) somnolence, xerostomia; Less Common (1-10%): constipation, nausea; Rare but Serious (<1%): respiratory depression, hypotension, neuroleptic malignant syndrome, agranulocytosis, extrapyramidal symptoms, seizures, photosensitivity
Metformin
Glucophage
• Class:Biguanide, Hypoglycemic
• Dosage Forms.Oral Tablet:500 mg, 850 mg, 1000 mg;Oral Tablet, Extended Release:500 mg, 750 mg, 1000 mg;Oral Solution:500 mg/5 mL
• Common Indication: Diabetes mellitus
• MOA.Metformin is a biguanide antihyperglycemic agent. It does not affect insulin secretion; rather, it reduces hepatic glucose production and enhances glucose utilization by muscle.
• Efficacy Monitoring Parameters.HbA1c<7%, monitored every 3-6 mo.
• Key Patient Counseling Points.Take with meals. Drink plenty of liquids to improve elimination of metformin. Avoid alcohol; this increases the risk of lactic acidosis.
• Adverse Reactions: Common (>10%) diarrhea, malabsorption, nausea, asthenia, vomiting, flatulence; Less Common (1-10%): headaches, indigestion, cobalamin deficiency, weight loss; Rare but Serious ( <1%): lactic acidosis, hepatotoxicity, hemolytic anemia, hypersensitivity
Ranitidine
Zantac
• Class:Histamine H2Receptor Antagonist
• Dosage Forms.Oral Tablet:75 mg, 150 mg, 300 mg;Oral Capsule:150 mg, 300 mg;Oral Syrup:15 mg/mL;Oral Suspension:22.4 mg/mL
• Common Indication: Duodenal ulcer, acute or maintenance, gastric ulcer, acute or maintenance, erosive esophagitis, acute or maintenance, indigestion, prevention or treatment, H. pylori GI tract infection
• MOA.Ranitidine competitively inhibits histamine H2receptors and inhibits gastric acid secretion. Both the acid concentration and volume of gastric secretion are suppressed by ranitidine, while changes in pepsin secretion are proportional to volume output.
• Efficacy Monitoring Parameters.Resolution of GERD symptoms, resolution of peptic ulcers, gastric pH (if indicated).
• Key Patient Counseling Points.Advise patients to take at bedtime. Patients may take with food or antacids, if needed.
• Adverse Reactions: Common (>10%) constipation, diarrhea, nausea; Less Common (1-10%): skin rash; Rare but Serious ( <1%): Stevens-Johns
Insulin Aspart
NovoLog, NovoLog FlexPen
• Class:Insulin, Rapid-Acting
• Dosage Forms.Injection Solution:100 units/mL;Pen and Refills (Administration Device): 100 units/mL
• Common Indication: Diabetes mellitus, type 1 and 2
• MOA.Insulin promotes cellular uptake of glucose, fatty acids, and amino acids, and their conversion to glycogen, triglycerides, and proteins.
• Efficacy Monitoring Parameters.Preprandial blood glucose between 70 and 130 mg/dL, HbA1c<7%.
• Key Patient Counseling Points.Monitor blood glucose in frequent intervals (2-4 times per day); if <70 mg/dL, eat non-sugar free candy, glucose tablets, or drink a glass of juice and contact prescriber. Store unopened vials in refrigerator. You may choose to keep open vials at room temperature if it is painful to inject cold insulin. Dispose needles in sharps container. Do not share needles; this increases the risk of transmission of infectious diseases. Rotate injection sites.
• Adverse Reactions: Common (>10%) injection site reactions, weight gain, hypoglycemia; Less Common(1-10%): pruritus, rash, lipodystrophy; Rare but Serious ( <1%): severe hypersensitivity, insulin resistance
