51-75 Flashcards
Liraglutide
Brand: Victoza, Saxenda 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: Victoza (DM): 0.6mg SC once daily x 1wk, then 1.2mg SC once daily (max 1.8mg) Saxenda (weight loss): 0.6mg to 3mg once daily Contraindication(s): History or family history of medullary thyroid carcinoma Patients with multiple endocrine neoplasia syndrome type 2 Pregnancy BBW: • Thyroid C-cell tumor risk 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
Lisdexamfetamine dimesylate
Brand: Vyvanse MOA: Promotes release of dopamine and norepinephrine from their storage sites in the presynaptic nerve terminals Schedule: II Dosing: 30mg to 70mg once daily Max: 70mg/day Contraindication(s): MAOI use within 14 days BBW: • Abuse and dependence Key Points: Insomnia decreased appetite XerostomiaIncreased blood pressure
Lorazepam
Brand: Ativan MOA: Enhances the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions Schedule: IV Dosing: Anxiety: 2mg to 6mg in two to three divided doses Insomnia: 0.5mg to 2mg q HS (if >65yo: max 1mg) Contraindication(s): Acute narrow-angle glaucoma Severe respiratory insufficiency Hypersensitivity to polyethylene glycol - IV only Sleep apnea BBW: • Risks from concomitant use with opioids Key Points: Drowsiness and sedation Avoid alcohol or other sedating agents IV formulatoin can cause propylene glycol toxicity
Meloxicam
Brand: Mobic MOA: Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors Schedule: legend Dosing: 7.5mg to 15mg once daily Max 15mg/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 • Serious gastrointestinal bleeding, ulcerations, 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
Memantine
Brand: Namenda MOA: NMDA antagonist Schedule: legend Dosing: IR: 5mg to 20mg daily (Doses greater than 5mg to be given in two evenly divided doses) XR: 7mg to 28 mg once daily Contraindication(s): Hypersensitivity BBW: • None Key Points: Insomnia Hallucinations DizzinessAgitation
Metformin
Brand: Glucophage, Fortamet, Glumetza MOA: Decreases hepatic glucose production, decreasing intestinal absorption of glucose and improves insulin sensitivity Schedule: legend Dosing: IR: 500mg BID or 850mg once daily (Max 2550mg/day) ER: 500mg to 1000 mg once daily (Max 2000mg/day) Contraindication(s): Severe renal dysfunction (CrCl less than 30ml/min Acute or chronic metabolic acidosis BBW: • Lactic acidosis Key Points: Nausea and Vomitting; take with food Gas, bloating, diarrhea- develop tolerance with continued use; Tiitrate dose/XR formulation may reduce GI side effects Risk for lactic acidosis, ensure hydration and follow renal dosing guidelines
Methadone
Brand: Dolophine, Methadose MOA: Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; produces generalized CNS depression Antagonizes NMDA receptors Schedule: II Dosing: Pain: 2.5mg q 8 to 12 hours initially, then titrate up to effective dose Drug detoxification: 80mg to 120mg daily Contraindication(s): Significant respiratory depression Acute or severe asthma GI obstruction, including paralytic ileus (known or suspected) Hypercarbia BBW: • Addiction, abuse, and misuse • Life-threatening respiratory depression • Life-threatening QT prolongation • Accidental ingestion (oral formulations) • Neonatal opioid withdrawal syndrome • Conditions for distribution and use of methadone products for the treatment of opioid addiction • Cytochrome P450 interaction • Risks from concomitant use with benzodiazepines or other CNS depressants Key Points: If for addiction must be prescribed in methadone clinic by “X-DEA” prescriber. If for pain must state “for pain” on prescription Drowsiness, Sedation, and Constipation Complex kinetics, Avoid frequent dose changes (i.e.
Methotrexate
Brand: Rasuvo, Trexall MOA: Irreversibly inhibits dihydrofolate reductase, interfering with DNA sythesis, repair, and cellular replication Schedule: legend Dosing: Psoriasis: 10mg to 25mg PO, SQ, or IM once weekly Rheumatoid arthritis: 7.5mg PO, SQ, or IM mg once weekly Contraindication(s): Breastfeeding Pregnancy Liver disease BBW: • Intrathecal and high-dose therapy • Appropriate use • Pregnancy • Bone Marrow Suppression • Hepatotoxicity • Renal impairment • Pneumonitis • Gastrointestinal toxicity • Secondary malignancy Key Points: Do not take the next dose if the patient is sick Take with folic acid as instructed by the prescriber Side effects such as mucositis, GI upset, nephrotoxicity may occurMake sure to follow instructions on getting routine bloodwork; Make sure patient is NOT pregnant or intends to get pregnant
Methylphenidate
Brand: Concerta, Daytrana, Ritalin MOA: Blocks the reuptake of norepinephrine and dopamine into presynaptic neurons Schedule: II Dosing: IR: 10mg to 60mg daily in 2 to 3 divided doses (Max 60 mg/day) ER: 20mg once daily, Max 60 mg/day (Concerta: Max 72 mg/day) Contraindication(s): MAOI use within 14 days Marked anxiety, tension, or agitation Glaucoma BBW: • Abuse and dependence Key Points: Insomnia Weight Loss TachycardiaHypertension
Methylprednisolone
Brand: Depo-Medrol, Medrol, Solu-Medrol MOA: Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability Schedule: legend Dosing: Asthma: 40mg to 60mg per day. May give in divided doses Allergic Conditions: Taper per Dosepak instructions Anti-inflamatory: 4mg to 48mg in 1 to 4 divided doses initially followed by a gradual reduction to the lowest possible effective dose Contraindication(s): Systemic fungal infection Intrathecal administration Live or attenuated vaccines BBW: • None Key Points: Increase in glucose Poor wound healing Edema, Weight gain
Mirtazapine
Brand: Rameron MOA: Central presynaptic alpha2-adrenergic antagonist effects, which results in increased release of norepinephrine and serotonin. It is also a potent antagonist of 5-HT2 and 5-HT3 serotonin receptors and H1 histamine receptors and a moderate peripheral alpha1 Schedule: legend Dosing: 15mg to 45mg q HS Contraindication(s): MAOI use within 14 days Use with linezolid BBW: • Suicidality and antidepressant drugs Key Points: Drowsiness Weight gain Xerostomia
Mometasone
Brand: Nasonex, Asmanex, Elocon MOA: Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability Schedule: legend Dosing: Nasal: 2 sprays into each nostril once daily Oral inhalation: 1 inhalation once daily to BID Contraindication(s): Hypersensitivity to milk proteins Primary treatment for acute asthma BBW: • None Key Points: Oral thrush Take the medication as scheduled Upper respiratory tract infectionHeadache
Montelukast
Brand: Singulair MOA: Antagonizes leukotriene receptors, leading to relaxation of bronchial smooth muscle Schedule: legend Dosing: 10mg once daily Contraindication(s): Hypersensitivity BBW: • None Key Points: Take in the evening Cough Bronchitis
Naproxen
Brand: Aleve, Anaprox, Naprosyn MOA: Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors Schedule: legend Dosing: IR: RX: 500mg to 1000mg daily in two evenly divided doses 12 hours apart ER: 750-1000 once daily 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 • 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
Nortripyline
Brand: Pamelor MOA: Increases the synaptic concentration of serotonin and/or norepinephrine in the central nervous system by inhibition of their reuptake by the presynaptic neuronal membrane pump Schedule: legend Dosing: 25mg TID or QID, may titrate to 150mg/day Contraindication(s): MAOI use within 14 days Use in acute recovery phase of MI Use with linezolid BBW: • Suicidality in children and adolescents Key Points: Heart arrythymias Dry mouth, dry eyes, constipation, urinary retention (anticholinergic) TremorSedation; take at bedtime if it causes sleepiness
Olanzapine
Brand: Zyprexa MOA: Antagonist of dopamine and seratonin type two receptor sites Schedule: legend Dosing: 5mg to 20mg PO once daily Contraindication(s): None BBW: • Increased mortality in elderly patients with dementia-related psychosis • Postinjection delirium/sedation syndrome (Zyprexa Relprevv) Key Points: Weight gain Increased glucose drowsinessIncreased prolactin levels
Oxycodone
Brand: OxyContin, Roxicodone MOA: Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; produces generalized CNS depression Schedule: II Dosing: IR: 5mg to 20mg q 4 to 6 hours PRN ER tablet: 10mg to 80mg q 12 hours PRN ER capsule: 9mg q 12 hours PRN 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 • Cytochrome P450 3A4 interaction • Risks from concomitant use with benzodiazepines or other CNS depressants • Risk of medication errors (oral solution) Key Points: Drowsiness and sedation Constipation Avoid alcohol or other sedating agentsRespiratory Depression
Oxycodone and APAP
Brand: Endocet, Percocet MOA: See individual agents Schedule: II Dosing: IR: 2.5mg to 10mg q 6 hours PRN. Do not exceed acetaminophen 4 g/day ER: 2 tablets q 12 hours. Do not exceed acetaminophen 4 g/day 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
Paroxetine
Brand: Paxil, Pexeva MOA: Selectively inhibits serotonin reuptake in the presynaptic neurons Schedule: legend Dosing: IR: 20mg to 60mg once daily CR: 25mg to 62.5mg once daily (Max 75mg once daily) Contraindication(s): MAOI use within 14 days Use with linezolid Pregnancy BBW: • Suicidality and antidepressant drugs Key Points: Drowsiness and insomnia Dry mouth Decreaed Libido/Ejaculatory disordersQTc prolongation
Phenytoin
Brand: Dilantin, Phenytek MOA: Stabilizes neuronal membranes and decreases seizure activity by increasing efflux or decreasing influx of sodium ions across cell membranes in the motor cortex during generation of nerve impulses Schedule: legend Dosing: 300mg to 600mg daily in two to three evenly divided doses Contraindication(s): History of acute hepatotoxicity attributable to phenytoin concurrent use of delavirdine BBW: • Cardiovascular risk associated with rapid infusion (injection) Key Points: Altered Mental Status Decrease in WBCs Gingival hyperplasiaHirsutism
Pioglitazone
Brand: Actos MOA: Selective PPARgamma agonist which improves target cell response to insulin Schedule: legend Dosing: 15mg to 45mg once daily Contraindication(s): NYHA Class III/IV Heart failure BBW: • Congestive heart failure Key Points: peripheral edema worsening heart failure weight gaintakes weeks to show effects on BG
Pneumococcal conjugate vaccine
Brand: Prevnar 13 MOA: Promotes active immunization against invasive disease caused by S. pneumoniae Schedule: legend Dosing: Single 0.5mL IM dose Contraindication(s): Severe allergic reaction to any diphtheria toxoid-containing vaccine BBW: • None Key Points: Chills Skin Rash Local Erythema Arthralgia
Pneumococcal Polysaccharide Vaccine
Brand: Pneumovax 23 MOA: Promotes active immunization against invasive disease caused by S. pneumoniae Schedule: legend Dosing: Single 0.5mL IM dose Contraindication(s): Severe allergic reaction to pneumococcal vaccine BBW: • None Key Points: Chills Skin Rash Local ErythemaArthralgia
Potassium Chloride
Brand: K-tab, Klor-Con, Micro-K MOA: Provides potassium, the major intracellular cation, for various metabolic functions Schedule: legend Dosing: 20mEq to 100mEq daily in 1 to 4 evenly divided doses (Max single dose 20mEq to 25mEq) Contraindication(s): Hyperkalemia, renal failure, and conditions in which potassium retention is present Structural, pathological, and/or pharmacologic cause for delay or arrest in passage through the GI tract BBW: • None Key Points: Hyperkalemia IV Form - phlebitis
Prednisone
Brand: Daltasone MOA: Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability Schedule: legend Dosing: 5mg to 60mg once daily Contraindication(s): Administration of live attenuated vaccines with immunosuppressive doses of predisone Systemic fungal infections BBW: • None Key Points: Increase in glucose Poor wound healing EdemaWeight gain
