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P2 Top 200 > All 200 > Flashcards

All 200 Flashcards

1
Q

acetaminophen and codeine (combination)

A

MOA: Inhibit the synthesis of prostaglandins in the central nervous system and peripherally block pain impulse generation; produces antipyresis from inhibition of hypothalamic heat-regulating center. Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; causes cough suppression by direct central action in the medulla; produces generalized CNS depression Schedule: III Dosing: 300mg/30mg q 4 hours PRN Max 4000mg/360mg per 24 hours Contraindication(s):  Significant respiratory depression  postoperative pain management in children who have undergone tonsillectomy and/or adenoidectomy  GI obstruction, including paralytic ileus (known or suspected)  concurrent use with monoamine oxidase inhibitors (MAOIs) or use of MAOIs within the last 14 days. BBW: • Risk of medication errors • Addiction, abuse, and misuse • Life-threatening respiratory depression • Accidental ingestion • Neonatal opioid withdrawal syndrome • Death related to ultra-rapid metabolism of codeine to morphine • Hepatoxicity • Interactions with drugs affecting cytochrome P450 • Risks from concomitant use with benzodiazepines or other CNS depressants Key Points:  Drowsiness and sedation  Constipation  PruritisAvoid alcohol or other sedating agents and other APAP products

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2
Q

adalimumab

A

MOA: Binds to human tumor necrosis factor alpha (TNF-alpha), thereby interfering with binding to TNFα receptor sites and subsequent cytokine-driven inflammatory processes Schedule: legend Dosing: 40mg SQ every other week Contraindication(s):  None BBW: • Serious infections • Malignancy 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

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3
Q

Albuterol

A

MOA: Relaxes bronchial smooth muscle by action on beta2-receptors Schedule: legend Dosing: 1 to 2 inhalations q 4 to 6 hours PRN Contraindication(s):  Severe hypersensitivity to milk proteins BBW: • None Key Points:  Upper respiratory tract infections  Cough

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4
Q

alendronate

A

MOA: Inhibits bone resorption via actions on osteoclasts or on osteoclast precursors; decreases the rate of bone resorption, leading to an indirect increase in bone mineral density Schedule: legend Dosing: Prophylaxis (females): 5mg once daily or 35mg once weekly Treatment (females/males): 10mg once daily or 70mg once weekly Contraindication(s):  Hypocalcemia  Esophageal abnormalities  Inablility to sit or stand upright for 30 minutes BBW: • None Key Points:  Take on an empty stomach before breakfast with a full glass of water. Do not eat or drink, or take other meds for at least 30 mins post dose. Remain upright for 30 minutes after dose  Notify your dentist that you are taking this medicine (due to very rare osteonecrosis of the jaw)  Maintain calcium & Vit D supplementation if diet inadequate Bone pain

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5
Q

Allopurinol

A

MOA: Inhibits xanthine oxidase, the enzyme responsible for the conversion of hypoxanthine to xanthine to uric acid Schedule: legend Dosing: Initiate 100mg once daily and increase every week by 100mg/day until desired uric acid level is achieved Max 800mg/day Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Diarrhea  Skin Rash  Keep taking even if you are not experiencing a gout flare

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6
Q

Alprazolam

A

MOA: Enhances the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions Schedule: IV Dosing: 0.25mg to 1mg TID Usual range 4mg/day to 6mg/day Contraindication(s):  Acute narrow-angle glaucoma  Concurrent use with potent CYP 3A4 inhibitors BBW: • Risk from concomitant use with opiods Key Points:  Drowsiness and sedation  Avoid alcohol or other sedating agents  Skin Rash

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7
Q

Amitriptyline

A

Generic : elavil 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 to 50mg daily at bedtime or in divided doses and gradually increase to 100mg to 300mg daily Ususal range 100mg to 300mg Contraindication(s):  MAOI use within 14 days  Acute recovery phase following MI BBW: • Suicidality and antidepressant drugs Key Points:  Heart arrythymias  Dry mouth, dry eyes, constipation, urinary retention (anticholinergic)  TremorSedation; take at bedtime if it causes sleepiness

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8
Q

Aripiprazole

A

Brand: Abilify MOA: Partial agonist of D2 and 5-HT1A receptors, and an antagonist at the 5-HT2A receptor Schedule: legend Dosing: Deperession adjunct: 2mg to 5mg ocne daily (Max: 15mg/day) Schizophrenia: 10mg to 15mg once daily (Max 30mg/day) Bipolar I: 15mg to 30mg once daily (Max 30mg/day) Contraindication(s):  Hypersensitivity BBW: • Increased mortality in elderly patients with dementia-related psychosis • Suicidality and antidepressant drugs Key Points:  Headache  Increased glucose  SedationPotential extrapyramidal reactions

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9
Q

Atomoxetine

A

Brand: Straterra MOA: Selectively inhibits the reuptake of norepinephrine Schedule: legend Dosing: 40mg to 80mg daily in a single dose or 2 evenly divided doses Max 100mg/day Contraindication(s):  MAOI use within 14 days  Narrow-angle glaucoma  History of pheochromocytoma  Cardiac or vascular disorders that will deteriorate and cause increases in blood pressure or pulse BBW: • Suicidal ideation in children and adolescents Key Points:  Headache  Insomnia  Decreased appetiteDry mouth

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10
Q

Baclofen

A

Brand: Lioresal MOA: Inhibits the transmission of both monosynaptic and polysynaptic reflexes at the spinal cord level, possibly by hyperpolarization of primary afferent fiber terminals Schedule: legend Dosing: 5mg to 20mg TID Max 80mg/day Contraindication(s):  Hypersensitivity  Intrathecal: IV, IM, SubQ, or epidural administration BBW: • Abrupt withdrawal (injection) Key Points:  Hypotonia  Drowsiness and confusion  Nausea and VomittingHeadache

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11
Q

Benztropine

A

Brand: Cogentin MOA: Possesses both anticholinergic and antihistaminic effects Schedule: legend Dosing: 1mg to 2mg 2 to 3 times daily Max 6mg/day Contraindication(s):  Hypersensitivity  Children less than 3 years old BBW: • None Key Points:  Tachycardia  Dry mouth, dry eyes, constipation, urinary retention (anticholinergic)

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12
Q

Buedesonide

A

Brand name: Rhinocort, Pulmicort, Uceris, Entocort MOA: Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability Schedule: legend Dosing: Oral: 9mg q AM for 8 weeks Intranasal: 1 to 2 sprays (32mcg to 64mcg) in each nostril once daily Inhaled: 360mcg BID up to 720mcg BID Contraindication(s):  Primary treatment of acute asthma episodes  Severe hypersensitivity to milk proteins BBW: • None Key Points:  Inhaled: Oral thrush; upper respiratory tract infection; cough  Topical: Apply thin layer and avoid broken skin and sensiteve areas  Oral: Headache; Diarrhea; Respiratory tract infection; Decreased cortisol; Take with food

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13
Q

Buesonide and Formoterol

A

Brand: Symbicort MOA: Decreases inflammation by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability Formoterol relaxes bronchial smooth muscle by selective action on beta-2 receptors Schedule: legend Dosing: 2 inhalations BID Titrate dose by choosing higher strength Contraindication(s):  Primary treatment of acute asthma or COPD episodes BBW: • Asthma-related death Key Points:  Oral thrush  Cough  Upper respiratory tract infectionHeadache

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14
Q

Buprenorphine

A

Brand: Buprenx, Butrans MOA: Binds to mu opiate receptors in the CNS; displays partial mu agonist and weak kappa antagonist activity Schedule: III Dosing: Oral SLT: 12mg to 16mg once daily Buccal Film: 150mcg q 12 hours Contraindication(s):  Significant respiratory depression  Acute or severe asthma  GI obstruction, including paralytic ileus (known or suspected) BBW: • Addiction, abuse, and misuse (buccal film, injection, transdermal patch) • Life-threatening respiratory depression (buccal film, injection, transdermal patch) • Accidental exposure (buccal film, transdermal patch) • Neonatal opioid withdrawal syndrome (buccal film, injection, transdermal patch) • Risk associated with insertion and removal (Probuphine implant) • Risks from concomitant use with benzodiazepines or other CNS depressants (buccal film, injection, transdermal patch) Key Points:  Headache  Sedation  REMS drug

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15
Q

Buprenorphine and Naloxone

A

Brand: Suboxone, Zubsolv MOA: Buprenorphine binds to mu opiate receptors in the CNS; displays partial mu agonist and weak kappa antagonist activity Naloxone is a pure opioid antagonist that competes and displaces opioids at opioid receptor sites Schedule: III Dosing: SL: 16mg/4mg once daily Buccal Film: 8.4mg/1.4mg once daily Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Headache  Withdrawal syndrome  PainDiaphoresis

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16
Q

Bupropion

A

Brand: Wellbutrin, Zyban MOA: Inhibits the reuptake of norepineprhine and dopamine Schedule: legend Dosing: IR: 100mg BID (Max 150mg each dose) SR: 150mg BID (Max 200mg in each dose) XR: 150mg daily (Max 300mg/day) Contraindication(s):  Seizure disorder or conditions that increase seizure risk, including severe head injury or severe stroke  History of anorexia/bulimia  MAOI use within 14 days BBW: • Suicidality and antidepressant drugs Key Points:  Seizures  Insomnia  AggitationWeight loss

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17
Q

Butalbital, Acetaminophen and Caffeine

A

Brand: Esgic, Fioricet MOA: Butalbital depresses the sensory cortex, decreases motor activity, and alters cerebellar function Acetaminophen inhibits the synthesis of prostaglandins in the central nervous system and peripherally blocks pain impulse generation Caffeine inhibits phosphodiesterase, causing vasodilation Schedule: legend (controlled in UT) Dosing: 1 to 2 tablets/capsules q 4 hours Max 6 tablets/capsules per day Contraindication(s):  Hypersensitivity  Porphyria BBW: • Hepatotoxicity Key Points:  Dizziness  Sedation  Nausea and VomittingAvoid alcohol or other sedating agents and other acetaminophen containing products

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18
Q

Carisoprodol

A

Brand: Soma MOA: Blocks interneuronal activity and depresses polysynaptic neuron transmission in the spinal cord and reticular formation of the brain Schedule: IV Dosing: 250mg to 350mg TID and at bedtime for max duration of 2-3 weeks Contraindication(s):  Hypersensitivity  History of acute intermittent porphyria BBW: • None Key Points:  Drowsiness  Dizziness  HeadacheAvoid with other sedating agents

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19
Q

Celecoxib

A

Brand: Celebrex MOA: Inhibits prostaglandin synthesis by decreasing the activity of cyclooxygenase-2 (COX-2) Schedule: legend Dosing: 100mg twice daily up to 200mg once or twice daily Contraindication(s):  Hypersensitivity to sulfonamides, aspirin, or other NSAIDs  History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDS  Use in the setting of CABG surgery BBW: • Serious cardiovascular risk • Serious gastrointestinal risk 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

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20
Q

Citalopram

A

Brand: Celexa MOA: Selectively inhibits serotonin reuptake in the presynaptic neurons Schedule: legend Dosing: 20mg to 40mg once daily Max 20mg/day in patients over 60 years old Contraindication(s):  MAOI use within 14 days  Concomitant use with linezolid BBW: • Suicidality and antidepressants Key Points:  Drowsiness and insomnia  Dry mouth  Decreaed Libido/Ejaculatory disordersQTc prolongation

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21
Q

Clonazepam

A

Brand: Klonopin MOA: Enhances the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions Schedule: IV Dosing: Panic Disorder: 0.5mg to 2mg BID (Max 4mg/day) Seizure Disorder: 2mg to 8mg In 1 or 2 divided doses (Max: 20mg/day) Contraindication(s):  Acute narrow-angle glaucoma  Significant liver disease BBW: • Risk from concomitant use with opioids Key Points:  Drowsiness/Confusion  Avoid abrupt discontinuation  Avoid alcohol or other sedating agents

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22
Q

Colchicine

A

Brand: Colcrys MOA: Inhibits β-tubulin polymerization into microtubules, preventing activation, degranulation, and migration of neutrophils associated with mediating some gout symptoms Schedule: legend Dosing: Flare: 1.2mg once, then 0.6mg one hour later (Max 1.8mg within an hour) Prophylaxis: 0.6mg q day or BID (Max 1.2mg/day) Contraindication(s):  Concomitant use of a P-glycoprotein or strong CYP3A4 inhibitor in the presence of hepatic impairment BBW: • None Key Points:  Diarrhea  Fatigue and Lethargy  NauseaDose adjustment if concomittent CYP3A4 or P-Glycoprotein inhibitors

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23
Q

Cyclobenzaprine

A

Brand: Amrix, Flexeril MOA: Reduces tonic somatic motor activity influencing both alpha and gamma motor neurons Schedule: legend Dosing: 5mg to 10mg TID PRN Contraindication(s):  MAOI use within 14 days  Hyperthyroidism  Heart failure  Arrhythmias BBW: • None Key Points:  Drowsiness and sedation  Avoid alcohol or other sedating agents  Dry Mouth

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24
Q

Desvenlafaxine

A

Brand: Pristiq MOA: Selectively inhibits the reuptake of serotonin and norepinephrine Schedule: legend Dosing: 50mg once daily Contraindication(s):  MAOI use within 14 days  Use with linezolid  Hypersensitivity to venlafaxine BBW: • Suicidal thoughts and behavior Key Points:  Nausea  Insomnia  HyperhidrosisXerostomia

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25
Q

Dexmethylphenidate

A

Brand: Focalin MOA: Blocks the reuptake of norepinephrine and dopamine, and increases their release into the extraneuronal space. Schedule: II Dosing: IR: 2.5mg to 5mg BID (Max 20mg/day) ER: 10mg to 40mg once daily (Max 40mg/day) Contraindication(s):  Marked anxiety, tension, and agitation  glaucoma  MAOI use within 14 days BBW: • Drug dependence Key Points:  Headache  Insomnia  Anxiety and JitterinessDecreased appetite

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26
Q

Dextroamphetamine and Amphetamine

A

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

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27
Q

Diazepam

A

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

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28
Q

Diclofenac

A

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

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29
Q

Duloxetine

A

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

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30
Q

Escitalopram

A

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

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31
Q

Eszopiclone

A

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

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32
Q

Etanercept

A

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

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33
Q

Exanatide

A

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

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34
Q

Fentanyl

A

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

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35
Q

Fluoxetine

A

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

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36
Q

Fluticasone

A

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

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37
Q

Fluticasone and Salmeterol

A

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

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38
Q

Folic acid

A

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

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39
Q

Gabapentin

A

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

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40
Q

Hydrocodone and Acetaminiphen

A

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

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41
Q

Ibuprofen

A

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

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42
Q

Insulin Aspart

A

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

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43
Q

Insulin Detemir

A

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

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44
Q

Insulin Glargine

A

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

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45
Q

Insulin Lispro

A

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

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46
Q

Insulin Regular

A

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

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47
Q

Ipratropium bromide and albuterol

A

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

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48
Q

Lamotrigine

A

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

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49
Q

Latanoprost

A

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

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50
Q

Lidocaine

A

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

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51
Q

Liraglutide

A

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

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52
Q

Lisdexamfetamine dimesylate

A

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

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53
Q

Lorazepam

A

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

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54
Q

Meloxicam

A

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

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55
Q

Memantine

A

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

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56
Q

Metformin

A

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

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57
Q

Methadone

A

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.

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58
Q

Methotrexate

A

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

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59
Q

Methylphenidate

A

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

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60
Q

Methylprednisolone

A

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

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61
Q

Mirtazapine

A

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

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62
Q

Mometasone

A

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

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63
Q

Montelukast

A

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

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64
Q

Naproxen

A

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

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65
Q

Nortripyline

A

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

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66
Q

Olanzapine

A

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

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67
Q

Oxycodone

A

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

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68
Q

Oxycodone and APAP

A

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

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69
Q

Paroxetine

A

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

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70
Q

Phenytoin

A

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

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71
Q

Pioglitazone

A

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

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72
Q

Pneumococcal conjugate vaccine

A

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

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73
Q

Pneumococcal Polysaccharide Vaccine

A

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

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74
Q

Potassium Chloride

A

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

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75
Q

Prednisone

A

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

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76
Q

Pregabalin

A

Brand: Lyrica MOA: Binds to alpha2-delta subunit of voltage-gated calcium channels within the CNS and modulates calcium influx at the nerve terminals, thereby inhibiting excitatory neurotransmitter release Schedule: V Dosing: 150mg to 300mg BID or TID Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Weight gain  Drowsiness  DizzinessEdema

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77
Q

Quetiapine

A

Brand: Seroquel MOA: Antagonist of dopamine and seratonin type two receptor sites Schedule: legend Dosing: IR and ER: 300mg to 800 mg once daily Contraindication(s):  Hypersensitivity BBW: • Increased mortality in elderly patients with dementia-related psychosis • Suicidal thoughts and behavior Key Points:  Weight gain  Increased glucose  drowsinessIncreased prolactin levels

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78
Q

Risedronate

A

Brand: Actonel MOA: Inhibits bone resorption via actions on osteoclasts or on osteoclast precursors; decreases the rate of bone resorption, leading to an indirect increase in bone mineral density Schedule: legend Dosing: Treatment or Prevention (females): 5mg once daily OR 35mg once weekly OR 150mg once monthly Treatment (males): 35mg once weekly Contraindication(s):  Hypocalcemia  Esophageal abnormalities  Inablility to sit or stand upright for 30 minutes BBW: • None Key Points:  Take on an empty stomach before breakfast with a full glass of water. Do not eat or drink, or take other meds for at least 30 mins post dose. Remain upright for 30 minutes after dose  Notify your dentist that you are taking this medicine (due to very rare osteonecrosis of the jaw)  Maintain calcium & Vit D supplementation if diet inadequateBone pain

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79
Q

Risperidone

A

Brand: Risperdal MOA: Antagonist of dopamine and seratonin type two receptor sites Schedule: legend Dosing: Schizophrenia: 1mg BID, may titrate to 18mg/day Bipolar I Disorder: 2mg to 3mg once daily, may titrate 6mg/day Contraindication(s):  Hypersensitivity BBW: • Increased mortality in elderly patients with dementia-related psychosis Key Points:  Weight gain  Increased glucose  drowsinessIncreased prolactin levels

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80
Q

Saxagiptin

A

Brand: Onglyza MOA: Inhibits dipeptidyl peptidase IV (DPP-IV) enzyme resulting in prolonged active incretin levels Schedule: legend Dosing: 2.5mg to 5mg once daily Contraindication(s):  Hypersensitivity BBW: • None Key Points:  congestion, sore throat  unlikely, but symptoms of pancreatitis: severe stomach/upper abdominal pain, persistent N/V

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81
Q

Sertraline

A

Brand: Zoloft MOA: Selectively inhibits serotonin reuptake in the presynaptic neurons Schedule: legend Dosing: 50mg to 200mg once daily Contraindication(s):  MAOI use within 14 days BBW: • Suicidality and antidepressant drugs Key Points:  Drowsiness and insomnia  Dry mouth  Decreaed Libido/Ejaculatory disordersQTc prolongation

82
Q

Sitagliptin

A

Brand: Januvia MOA: Inhibits dipeptidyl peptidase IV (DPP-IV) enzyme resulting in prolonged active incretin levels Schedule: legend Dosing: 100mg once daily Contraindication(s):  Hypersensitivity BBW: • None Key Points:  congestion, sore throat  unlikely, but symptoms of pancreatitis: severe stomach/upper abdominal pain, persistent N/V

83
Q

Sitagliptin and Metformin

A

Brand: Janumet MOA: See individual agents Schedule: legend Dosing: See Individual Agents Contraindication(s):  Severe renal dysfunction (CrCl less than 30ml/min  Acute or chronic metabolic acidosis BBW: • Lactic acidosis Key Points:  See Individual Agents

84
Q

Sumatriptan

A

Brand: Imitrex, Sumavel MOA: Selective agonist for serotonin on intracranial blood vessels and sensory nerves of the trigeminal system Schedule: legend Dosing: 25mg to 100mg single dose at onset Contraindication(s):  Ischemic heart disease, uncotrolled hypertension, PVD, or cerebrovascular syndromes  MAOI use within 14 days  Use of ergotamine derivatives within 24 hours  Severe hepatic impairment BBW: • None Key Points:  Paresthesia  Dizziness  FlushingRisk of serotonin syndrome if used with serotonergic agents

85
Q

Temazepam

A

Brand: Restoril MOA: Enhances the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions Schedule: IV Dosing: 15mg to 30mg q HS Contraindication(s):  Pregnancy BBW: • Risks from concomitant use with opioids Key Points:  Drowsiness and sedation  Avoid alcohol or other sedating agents

86
Q

Timolol

A

Brand: Betimol, Timoptic MOA: Blocks both beta1- and beta2-adrenergic receptors and reduces intraocular pressure by reducing aqueous humor production and possibly increases the outflow of aqueous humor Schedule: legend Dosing: Gel: Instill 1 gtt into affected eye(s) once daily Solution: Instill 1 drop into affected eye(s) BID, may decrease to once daily if well controlled Contraindication(s):  Bronchial asthma or severe COPD  Sinus bradycardia  Second or third degree AV block BBW: • None Key Points:  Burning/stinging of eyes  rarely bradycardia

87
Q

Topiramate

A

Brand: Topamax MOA: Blocks neuronal voltage-dependent sodium channels, enhances GABA(A) activity, antagonizes AMPA/kainate glutamate receptors, and weakly inhibits carbonic anhydrase Schedule: legend Dosing: Epilepsy: 25mg to 200mg BID Migraine Prophylaxis: 25mg to 50mg once daily or BID Contraindication(s):  XR Formulation: Recent alcohol use (within 6 hours before or after administration) BBW: • None Key Points:  Confusion, mental slowing, difficulty with speech  Weight loss  Kidney stones

88
Q

Tramadol

A

Brand: Ultram MOA: Binds to μ-opiate receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain; also inhibits the reuptake of norepinephrine and serotonin Schedule: IV Dosing: IR tab, ODT tab: 50mg to 100mg q 4 to 6 hours ER: 100mg once daily (Max 300mg/day) Contraindication(s):  Significant respiratory depression  Acute or severe asthma  GI obstruction, including paralytic ileus (known or suspected)  MAOI use within 14 days BBW: • Addiction, abuse, and misuse • Life-threatening respiratory depression • Accidental ingestion • Neonatal opioid withdrawal syndrome • Cytochrome P450 interaction • Risks from concomitant use with benzodiazepines or other CNS depressants Key Points:  Dose adjust in renal impairment/elderly  Seizure risk

89
Q

Travoprost

A

Brand: Travatan MOA: Prostaglandin analog which increases the outflow of aqueous humor Schedule: legend Dosing: 1 gtt in affected eye(s) q PM Contraindication(s):  None BBW: • None Key Points:  Ocular hyperemia  Increased growth of eyelashes  Burning/stinging/itching of eyes, Decreased visual acuity

90
Q

Trazodone

A

Brand: Desyrel MOA: Inhibits reuptake of serotonin, causes adrenoreceptor subsensitivity, and significantly blocks histamine (H1) and alpha1-adrenergic receptors Schedule: legend Dosing: IR: 50mg to 100mg po BID to TID (Max 400mg/day) Contraindication(s):  MAOI use within 14 days  Use with linezolid BBW: • Suicidality and antidepressant drugs Key Points:  Drowsiness and sedation  Avoid alcohol or other sedating agents  Risk of serotonin syndrome if used with serotonergic agents

91
Q

Valproic acid and derivatives

A

Brand: Depacon, Depakote, Depakene MOA: Causes increased availability of gamma-aminobutyric acid (GABA) to brain neurons Schedule: legend Dosing: 15mg/kg/day Max: 60mg/kg/day Contraindication(s):  Hepatic disease or significant impairment  Pregnamt women for the prevention of migraine  Known mitochondrial disorders BBW: • Hepatotoxicity • Patients with mitochondrial disease • Fetal risk • Pancreatitis Key Points:  Acute pancreatitis  Liver Failure  Thrombocytopenia, Weight Gain

92
Q

Vareniciline

A

Brand: Chantix MOA: Partial neuronal α4 β2 nicotinic receptor agonist; prevents nicotine stimulation of mesolimbic dopamine system associated with nicotine addiction Schedule: legend Dosing: 0.5mg once daily for 3 days, then 0.5mg BID for 4 days, then 1mg BID for 11 weeks Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Headache, Nausea, Vomitting  Insomnia  abnormal dreamsSuicidal ideation

93
Q

Varicella Vaccine

A

Brand: Varivax MOA: Induced cell mediated and humoral immune responses Schedule: legend Dosing: Two 0.5mL doses separated by at least 4 weeks Contraindication(s):  Hypersensitivity to the vaccine, neomycin, or gelatin  Immunosuppressed/deficient individuals  Active, untreated TB or other current febrile illness  Pregnancy BBW: • None Key Points:  Injection site reaction  Fever

94
Q

Venlafaxine

A

Brand: Effexor MOA: Selectively inhibits the reuptake of serotonin and norepinephrine Schedule: legend Dosing: IR: 75mg to 225mg daily in 2 to 3 evenly divided doses ER: 75mg to 225mg once daily Contraindication(s):  MAOI use within 14 days  Use with linezolid BBW: • Suicidality and antidepressant drugs Key Points:  Seizures  Insomnia  HyperhidrosisXerostomia

95
Q

Zolpidem

A

Brand: Ambien MOA: Enhances activity of GABA via selective agonism at the benzodiazepine-1 (BZ1) receptor Schedule: IV Dosing: IR: 5mg (female) or 5mg to 10 mg (male) q HS ER: 6.25mg (female) or 6.25mg to 12.5mg (male) q HS Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Drowsiness/Sedation  Lethargy  Memory Impairment

96
Q

Zoster Vaccine

A

Brand: Zosavax MOA: Stimulates active immunity to disease caused by the varicella-zoster virus Schedule: legend Dosing: Single 0.65mL SC dose Contraindication(s):  Hypersensitivity to the vaccine, neomycin, or gelatin  Immunosuppressed/deficient individuals  Pregnancy BBW: • None Key Points:  Injection site reaction  Chicken pox-like rash may develop post administration (rare)

97
Q

Acyclovir

A

Brand: Zovirax 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: 200mg - 800mg 3 to 5 times daily Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Can crystalize in kidney and cause AKI  Nausea and Vomitting  Malaise

98
Q

Amlodipine

A

Brand: Norvasc 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: 5mg to 10mg once daily Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Peripheral edema  Flushing  Lightheadedness, dizziness, orthostasis, hypotension

99
Q

Amlodipine and Benazepril

A

Brand: Lotrel MOA: See individual agents Schedule: legend Dosing: See individual agents Contraindication(s):  History of angioedema  Concurrent use of aliskiren BBW: • Fetal toxicity Key Points:  See Individual Agents

100
Q

Amoxicillin

A

Brand: Moxatag MOA: Binds to penicillin-binding proteins (PBPs) which inhibits peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis Schedule: legend Dosing: 500mg q 8 hours or 875mg q 12 hours Contraindication(s):  Serious hypersensitivity to amoxicillin BBW: • None Key Points:  Diarrhea (AAD & CDAD)  Allergy  Take entire course and contact provider if symptoms do not improve within a few days of startingN/V, take with food to avoid upset stomach if needed

101
Q

Amoxicillin and Clavulanic acid

A

Brand: Augmentin MOA: Amoxicillin binds to penicillin-binding proteins (PBPs) which inhibits peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis Clavulanic acid binds and inhibits beta-lactamases that inactivate amoxicillin Schedule: legend Dosing: 500mg q 8 hours or 875mg q 12 hours Dosing based on amoxicillin component Contraindication(s):  Serious hypersensitivity to amoxicillin or clavulanate  History of cholestatic jaundice or hepatic dysfunction with Augmentin  Augmentin XR: Severe renal impairment (CrCl less than 30ml/min BBW: • None Key Points:  Diarrhea (AAD & CDAD)  Allergy  Take entire course and contact provider if symptoms do not improve within a few days of startingN/V, take with food to avoid upset stomach if needed

102
Q

Apixaban

A

Brand: Eliquis 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: 5mg BID PE/DVT Tx: 10mg BID x 7 days followed by 5mg BID PE/DVT Prophylaxis: 2.5mg BID Contraindication(s):  Hypersensitivity  Active pathological bleeding BBW: • Discontinuation • Spinal/Epidural hematoma Key Points:  Risk of bleeding  Signs/Symptoms bleeding/clotting  No routine lab monitoring, Missing a single dose increases clotting risk

103
Q

Atenolol

A

Brand: Tenormin MOA: Selectively blocks beta1-receptors Schedule: legend Dosing: 25mg to 50mg once daily, may increase to 100mg once daily BID doses are acceptable Contraindication(s):  Sinus bradycardia  Heart block greater than 1st degree  Uncompensated cardiac failure  Cardiogenic shock BBW: • Cessation of therapy Key Points:  Bradycardia (or rebound tachycardia if stopped abruptly)  Fatigue and Lethargy  ImpotenceHypotension

104
Q

Atorvastatin

A

Brand: Lipitor MOA: Inhibits 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase Schedule: legend Dosing: 10mg to 80mg once daily Contraindication(s):  Active liver disease  Preganacy or wormen who may become pregnant  Breastfeeding  Unexplaned persistent elevations of serum transaminases BBW: • None Key Points:  Muscle pain and weakness  Diarrhea

105
Q

Azithromycin

A

Brand: Z-pak, Zithromax, Zmax, Azasite MOA: Inhibits RNA-dependent protein synthesis by binding to the 50S ribosomal subunit Schedule: legend Dosing: CAP: 500mg once, then 250mg daily on days 2 to 5 STI: 1g as a single dose Contraindication(s):  Hypersensitivity  History of cholestatic jaundice or hepatic dysfunction with prior azithromycin use BBW: • None Key Points:  Diarrhea (AAD & CDAD)  Nausea and Vomitting  QTc prolongationMay bind with certain cations. Avoid taking with certain multivitamins and minerals (calcium, aluminum, magnesium, etc.)

106
Q

Benazepril

A

Brand: Lotensin MOA: Inhibits angiotensin converting enzyme, preventing the coversion of angiotensin I to angiotensin II Schedule: legend Dosing: 20mg to 80mg daily as a single dose or 2 evenly divided doses Contraindication(s):  History of angioedema  Concurrent use of aliskiren 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  Angioedema, Lightheadedness, dizziness, orthostasis, hypotension

107
Q

Bisoprolol

A

Brand: Zebeta MOA: Selective inhibitor of beta1-adrenergic receptors Schedule: legend Dosing: 5mg to 10mg once daily Max 20mg/day Contraindication(s):  Sinus bradycardia  Heart block greater than 1st degree  Cardiogenic shock  Overt cardiac failure BBW: • None Key Points:  Bradycardia (or rebound tachycardia if stopped abruptly)  Fatigue and Lethargy  Impotence, Hypotension

108
Q

Carvedilol

A

Brand: Coreg MOA: Nonselectively blocks beta-adrenoreceptors and alpha-adrenoreceptors Schedule: legend Dosing: HTN: 6.25mg to 25mg BID (Max 25mg BID) HF Target: 25mg BID (Max 50mg BID) Contraindication(s):  Severe bradycardia  Severe hepatic impairment  Bronchial asthma or related bronchospastic conditions  Second or third degree AV block BBW: • None Key Points:  Bradycardia (or rebound tachycardia if stopped abruptly)  Fatigue and Lethargy  Impotence, Orthostatic hypotension

109
Q

Cefdinir

A

Brand: Omicef MOA: Binds to penicillin-binding proteins (PBPs) which inhibits peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis Schedule: legend Dosing: 300mg q 12 hours Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Diarrhea (AAD & CDAD)  Allergy  Liquid suspension: Do not refrigerate, keep at room temperature.Take 2 hrs before or after antacids or iron supplements; If taking iron supplement, may pass red colored stools

110
Q

Cefuroxime

A

Brand: Ceftin, Zinacef MOA: Binds to penicillin-binding proteins (PBPs) which inhibits peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis Schedule: legend Dosing: 250mg to 500mg q 12 hours Contraindication(s):  Hypersensitivity to cefuroxime or other beta-lactam drugs BBW: • None Key Points:  Diarrhea (AAD & CDAD)  Allergy  Take entire course and contact provider if symptoms do not improve within a few days of startingNausea and Vomitting, take with food to avoid upset stomach if needed

111
Q

Cephalexin

A

Brand: Keflex MOA: Binds to penicillin-binding proteins (PBPs) which inhibits peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis Schedule: legend Dosing: 250mg q 6 hours or 500mg q 12 hours Streptococcal Skin Infxns: 500mg q 6 hours Contraindication(s):  Hypersensitivty BBW: • None Key Points:  Diarrhea (AAD & CDAD)  Allergy  Take entire course and contact provider if symptoms do not improve within a few days of startingN/V, take with food to avoid upset stomach if needed

112
Q

Ciprofloxacin

A

Brand: Cipro, Ciloxa, Otiptrio MOA: Inhibits DNA-gyrase and promotes breakage of double-stranded DNA Schedule: legend Dosing: 500mg to 750mg q 12 hours Contraindication(s):  Hypersensitivity to other quinolones  Concurrent use of tizanidine BBW: • Serious adverse reactions (tendinitis and tendon rupture, peripheral neuropathy, and CNS effects) • Exacerbation of 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)

113
Q

Clarithromycin

A

Brand: Biaxin MOA: Binds to 50S ribosomal subunit resulting in inhibition of protein synthesis Schedule: legend Dosing: 250mg to 500mg q 12 hours Contraindication(s):  History of cholestatic jaundice/hepatic dysfunction associated with prior use of clarithromycin  Use with drugs extensively metabolized by CYP3A4  Use with colchicine in patients with renal or hepatic impairment BBW: • None Key Points:  Diarrhea (AAD & CDAD)  Nausea and Vomitting  qtc prolongation, Take entire course and contact provider if symptoms do not improve within a few days of starting

114
Q

Clindamycin

A

Brand: Cleocin, Evoclin, Clindesse MOA: Binds to 50S ribosomal subunit resulting in inhibition of protein synthesis Schedule: legend Dosing: 300mg to 450mg q 6 hours Contraindication(s):  Hypersensitivity BBW: • Colitis Key Points:  Diarrhea (AAD & CDAD)  Rash  Nausea and Vomitting, take with food to avoid upset stomach if neededTake entire course and contact provider if symptoms do not improve within a few days of starting

115
Q

Clonidine

A

Brand: Catapres MOA: Stimulates alpha2-adrenoceptors in the brain stem, thus activating an inhibitory neuron, resulting in reduced sympathetic outflow from the CNS Schedule: legend Dosing: 0.1mg BID Max 2.4mg/day Contraindication(s):  Hypersensitivity BBW: • Epidural use Key Points:  Dry mouth, dry eyes, constipation, urinary retention (anticholinergic)  Lightheadedness, dizziness, orthostasis, hypotension  Rebound hypertension if dc’ed abruptlyNa/Water retention

116
Q

Clopidogrel

A

Brand: Plavix MOA: Irreversibly blocks the P2Y12 component of ADP receptors on the platelet surface Schedule: legend Dosing: 75mg once daily 300mg to 600mg loading dose Contraindication(s):  Hypersensitivity  Active pathological bleeding BBW: • Diminished antiplatelet effect in patients with two loss-of-function alleles of the CYP2C19 gene Key Points:  Rash  Increased bleeding risk

117
Q

Conjugated Estrogens

A

Brand: Premarin MOA: Modulates the pituitary secretion of gonadotropins, luteinizing hormone, and follicle-stimulating hormone through a negative feedback system, thereby reducing elevated levels of these hormones in postmenopausal women Schedule: legend Dosing: Oral: 0.3mg to 0.625mg once daily Topical: 0.5g/day, 21 days on, 7 days off Contraindication(s):  Angioedema or anaphylactic reaction to estrogens  Current history of PE or DVT or other known thrombophilic disorders  Undiagnosed abnormal genital bleeding  Pregnancy BBW: • Endometrial cancer • Cardiovascular disease • Breast cancer • Dementia • Risk vs benefit Key Points:  cream: dispense with applicators; insert amount & frequency directed by physician at bedtime  Tablet: progestin required for intact uterus  tablet: signs & symptoms of thrombosis (VTE & stroke)tablet: lowest effective dose, shortest duration

118
Q

Dabigatran

A

Brand: Pradaxa MOA: Specific, reversible, direct thrombin inhibitor that inhibits both free and fibrin-bound thrombin Schedule: legend Dosing: AF: 150mg BID PE/DVT Tx and Prevention: 150mg BID (after 5-10 days parenteral anticoagulation) Contraindication(s):  Hypersensitivity  Active pathological bleeding  Patients with mechanical prosthetic heart valves BBW: • Thrombotic events • • Spinal/Epidural hematoma Key Points:  do NOT chew/crush/open capsule. Must dispense in manufacturers bottle  Signs/Symptoms bleeding/clotting  No routine lab monitoringMissing a single dose increases clotting risk

119
Q

Darunavir

A

Brand: Prezista MOA: Binds to the site of HIV-1 protease activity and inhibits cleavage of viral Gag-Pol polyprotein precursors into individual functional proteins required for infectious HIV Schedule: legend Dosing: 800mg once daily Contraindication(s):  Coadministration with drugs highly dependent on CYP3A4 for clearence BBW: • None Key Points:  Increased LDL  Skin Rash  Diarrhea

120
Q

Dicylomine

A

Brand: Bentyl MOA: Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS Schedule: legend Dosing: 20mg to 40mg QID Contraindication(s):  Obstructive diseases of the GI tract  Severe ulcerative colitis  Breastfeeding  Reflux esophagitis BBW: • None Key Points:  Dizziness  Blurred Vision  XerostomiaNausea

121
Q

Digoxin

A

Brand: Digox, Digitek, Lanoxin MOA: Inhibits the sodium/potassium ATPase pump in myocardial cells leading to increased contractility Directly suppresses AV node conduction to increase effective refractory period and decrease conduction velocity Schedule: legend Dosing: 0.125mg to 0.25mg once daily Contraindication(s):  Hypersensitivity  Ventricular fibrilation BBW: • None Key Points:  Can cause bradycardia  Hyperkalemia  Toxicity: vision halos, Nausea and VomittingNarrow therapuitic index. Monitor levels.

122
Q

Diltiazem

A

Brand: Cardizem, Cartia, Taztia, Tiazac MOA: Inhibits calcium ions from entering select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization Schedule: legend Dosing: 120mg to 320mg daily Max 480mg/day Contraindication(s):  Sick sinus syndrome  second or thrid degree AV block  Hypotension  Acute MI BBW: • None Key Points:  Bradycardia  Constipation  Peripheral edemaLightheadedness, dizziness, orthostasis, hypotension

123
Q

Doxazosin

A

Brand: Cardura MOA: Competitively inhibits postsynaptic alpha1-adrenergic receptors Schedule: legend Dosing: 1mg to 8mg once daily Max 8mg/day Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Dizziness  Orthostatic hypotension  LethargyTake at bedtime

124
Q

Doxycycline

A

Brand: Adoxa, Monodox, Oradea, Vibramycin, Doryx MOA: Inhibits protein synthesis by binding with the 30S ribosomal subunit Schedule: legend Dosing: 100mg q 12 hours Contraindication(s):  Hypersensitivity to tetracyclines BBW: • None Key Points:  Photosensitivity  Avoid < 8 years old  Adequate fluid intake otherwise esophagitisdiarrhea (AAD & CDAD)

125
Q

Duasteride

A

Brand: Avodart MOA: Selectively inhibits 5α-reductase, resulting in inhibition of the conversion of testosterone to dihydrotestosterone and markedly suppressed serum dihydrotestosterone levels Schedule: legend Dosing: 0.5mg once daily Contraindication(s):  Clinically significant hypersensitivity to other 5-alpa-reductase inhibitors  Use in pediatric patients, women of childbearing potential, or pregnancy BBW: • None Key Points:  Dicreased Libido  Impotence  Gynecomastia

126
Q

Emtricitabine, Tenofovir, and Efavirenz

A

Brand: Atripla MOA: Efavirenz: Non-nucleoside reverse transcriptase inhibitor of HIV-1, thereby blocking the RNA-dependent and DNA-dependent DNA polymerase resulting in inhibition of viral replication Emtricitabine: Nucleoside reverse transcriptase inhibitor, which interferes with HIV viral RNA dependent DNA polymerase resulting in inhibition of viral replication Tenofovir: Nucleotide reverse transcriptase inhibitor, interferes with the HIV viral RNA dependent DNA polymerase resulting in inhibition of viral replication Schedule: legend Dosing: 1 tablet once daily Contraindication(s):  Clinically significant hypersensitivity  Coadministration with voriconazole BBW: • Hepatitis B coinfection Key Points:  Hypercholesterolemia  Abnormal dreams  HyperglycemiaDiarrhea

127
Q

Enalapril

A

Brand: Vasotec MOA: Inhibits angiotensin converting enzyme, preventing the coversion of angiotensin I to angiotensin II Schedule: legend Dosing: 5mg to 40mg daily as a single dose or in 2 evenly divided doses Doses 20mg or greater should be taken BID Contraindication(s):  Angioedema related to previous treatment with an ACE inhibitor  Concurrent use with aliskiren 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

128
Q

Enoxaparin

A

Brand: Lovenox MOA: Strong inhibitor of factor Xa Schedule: legend Dosing: DVT Prophylaxis: 30mg SQ q 12 hours or 40mg SQ once daily PE/DVT Tx: 1mg/kg q 12 hours or 1.5mg/kg once daily Contraindication(s):  Hypersensitivity to heparin or pork products  Thrombocytopenia associated with a positive test for antiplatelet antibodies in the presence of enoxaparin  Active major bleeding BBW: • Spinal/Epidural hematoma Key Points:  Bleeding  No routine lab monitoring  Inject in the fatty areas at the sides of the waistInject prefilled air bubble with medication

129
Q

Esomeprazole

A

Brand: Nexium 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):  Severe hypersensitivity to PPIs BBW: • None Key Points:  Headache  Take 60 minutes before food.

130
Q

Ethinyl Estradiol and Etonogestrol

A

Brand: Nuvaring MOA: Combination hormonal contraceptives inhibit ovulation via a negative feedback mechanism on the hypothalamus, which alters the normal pattern of gonadotropin secretion of a follicle-stimulating hormone (FSH) and luteinizing hormone by the anterior pituitar Schedule: legend Dosing: Insert 1 ring for 3 weeks then remove for 7 days Contraindication(s):  Breast cancer or other estrogen/progestin sensitive cancer  hepatic tumors or hepatic disease  Use in women at high risk of thrombotic disease  Undiagnosed abdominal uterine bleeding BBW: • Cigarette smoke and serious cardiovascular events Key Points:  Weight Gain  Increased risk of blood clots  Nausea and Vomting, Consider various factors that may decrease effectiveness (abx, missed dose, time to onset, etc.)

131
Q

Ezetimibe

A

Brand: Zetia MOA: Inhibits absorption of cholesterol at the brush border of the small intestine via the sterol transporter, Niemann-Pick C1-Like1 (NPC1L1) Schedule: legend Dosing: 10mg once daily Contraindication(s):  Concurrent use with a statin in patients with active hepatic disease  Pregnancy and breastfeeding when used with a statin BBW: Key Points:  Fatigue  Diarrhea  Arthralgia

132
Q

Famotidine

A

Brand: Pepcid MOA: Competitively inhibits histamine at H2 receptors of the gastric parietal cells, which inhibits gastric acid secretion Schedule: legend Dosing: 20mg to 40mg once daily or BID Contraindication(s):  Hypersensitivity to other H2 antagonists BBW: Key Points:  Headache  Diarrhea

133
Q

Fenofibrate and Derivatives

A

Brand: Tricor, Trilipix, Fenoglide, Fibricor, Lipofen MOA: Agonist for the nuclear transcription factor peroxisome proliferator-activated receptor-alpha (PPAR-alpha), downregulates apoprotein C-III (an inhibitor of lipoprotein lipase) and upregulates the synthesis of apolipoprotein A-I, fatty acid transport prote Schedule: legend Dosing: 30mg to 160mg once daily Contraindication(s):  Active liver disease  Severe renal impairment or ESRD BBW: • None Key Points:  Abdominal Pain  Hepatic injury  Myalgia, Diarrhea

134
Q

Finasteride

A

Brand: Proscar, Propecia MOA: Selectively inhibits 5α-reductase, resulting in inhibition of the conversion of testosterone to dihydrotestosterone and markedly suppressed serum dihydrotestosterone levels Schedule: legend Dosing: BPH: 5mg once daily Contraindication(s):  Pregnancy or women of childbearing potential BBW: • None Key Points:  Decreased libido  Pregnancy category X

135
Q

Fluconazole

A

Brand: Diflucan MOA: Interferes with fungal cytochrome P450 activity (lanosterol 14-α-demethylase), and decreases ergosterol synthesis which inhibits cell membrane formation Schedule: legend Dosing: Vaginal Candidiasis: 150mg once Candidemia: 800mg on day 1, then 400mg once daily thereafter Contraindication(s):  Coadministration with CYP3A4 substrates which may lead to QTc prolongation BBW: • None Key Points:  Headache  Nausea, vomiting, and Diarrhea  Hepatitis & jaundice, Take entire course and contact provider if symptoms do not improve within a few days of starting

136
Q

Furosemide

A

Brand: Lasix MOA: Inhibits reabsorption of sodium and chloride in the ascending loop of Henle and proximal and distal renal tubules, interfering with the chloride-binding cotransport system, thus causing increased excretion of water, sodium, chloride, magnesium, and calciu Schedule: legend Dosing: 20mg to 80mg once daily up to q 6 hours Contraindication(s):  Hypersensitivity  Anuria BBW: • Fluid/electrolyte loss Key Points:  Hypokalemia  Take in the morning  HyperuricemiaPossible sulfa cross-allergy

137
Q

Gemfibrozil

A

Brand: Lopid MOA: Inhibits lipolysis and decreases subsequent hepatic fatty acid uptake, inhibits hepatic secretion of VLDL Schedule: legend Dosing: 600mg BID 30 minutes before breakfast and dinner Contraindication(s):  Hepatic or severe renal dysfunction  Primary biliary cirrhosis  Preexisting gallbladder disease  Concurrent use with dasabuvir, repaglinide, or simvastatin BBW: • None Key Points:  Upset stomach  Fatigue and Lethargy  Abdominal Pain

138
Q

Group: Biphasic Oral Contraceptives

A

Brand: Kariva, Mircette, Ortho Novum 10/12 MOA: Combination hormonal contraceptives inhibit ovulation via a negative feedback mechanism on the hypothalamus, which alters the normal pattern of gonadotropin secretion of a follicle-stimulating hormone (FSH) and luteinizing hormone by the anterior pituitar Schedule: legend Dosing: 1 tablet once daily Contraindication(s):  Breast cancer or other estrogen/progestin sensitive cancer  Use in women at high risk of thrombotic disease BBW: • Cigarette smoke and serious cardiovascular events Key Points:  Nausea and Vomting  Increased risk of blood clots  Weight Changes; Fluid Retention, Consider various factors that may decrease effectiveness (abx, missed dose, time to onset, etc.)

139
Q

Group: Monophasic Oral Contraceptives

A

Brand: Avaine, Loestrin, Tasmin, Yaz, Oral MOA: Combination hormonal contraceptives inhibit ovulation via a negative feedback mechanism on the hypothalamus, which alters the normal pattern of gonadotropin secretion of a follicle-stimulating hormone (FSH) and luteinizing hormone by the anterior pituitar Schedule: legend Dosing: 1 tablet once daily Contraindication(s):  Breast cancer or other estrogen/progestin sensitive cancer  Use in women at high risk of thrombotic disease BBW: • Cigarette smoke and serious cardiovascular events Key Points:  Nausea and Vomting  Increased risk of blood clots  Weight Changes; Fluid RetentionConsider various factors that may decrease effectiveness (abx, missed dose, time to onset, etc.)

140
Q

Group: Triphasic oral Contraceptives

A

Brand: Ortho Tri-Cyclen, Tri-Sprintec, Trivora MOA: Combination hormonal contraceptives inhibit ovulation via a negative feedback mechanism on the hypothalamus, which alters the normal pattern of gonadotropin secretion of a follicle-stimulating hormone (FSH) and luteinizing hormone by the anterior pituitar Schedule: legend Dosing: 1 tablet once daily Contraindication(s):  Breast cancer or other estrogen/progestin sensitive cancer  Use in women at high risk of thrombotic disease BBW: • Cigarette smoke and serious cardiovascular events Key Points:  Nausea/Vomting  Increased risk of blood clots  Weight Changes; Fluid RetentionConsider various factors that may decrease effectiveness (abx, missed dose, time to onset, etc.)

141
Q

Hydralazine

A

Brand: Apresoline MOA: Direct vasodilation of arterioles Schedule: legend Dosing: 10mg to 50mg QID Max 300mg/day Contraindication(s):  Coronary artery disease  Mitrial valve rheumatic heart disease BBW: • None Key Points:  Headache  palpitations/increase in HR  Rarely lupus-like syndrome

142
Q

Hydrochlorothiazide

A

Brand: Microzide MOA: Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions Schedule: legend Dosing: 12.5mg to 50mg once daily Contraindication(s):  Hypersensitivity  Anuria BBW: • None Key Points:  Hypokalemia  Photosensitivity  possible sulfa cross-allergy

143
Q

Irbesartan

A

Brand: Avapro MOA: Antagonizes angiotensin receptors Schedule: legend Dosing: 150mg to 300mg once daily Contraindication(s):  Hypersensitivity  Concurrent use with aliskiren 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 

144
Q

Irbesartan and Hydrochlorothiazide

A

Brand: Avalide MOA: See individual agents Schedule: legend Dosing: See individual agents Contraindication(s):  Hypersensitivity  Concurrent use with aliskiren in patients with diabetes  Anuria BBW: • Fetal toxicity Key Points:  See Individual Agents 

145
Q

Isosorbide Dinitrate

A

Brand: Isordil MOA: Activates cGMP leading to dephosphorylation of myosin light chains and smooth muscle relaxation Schedule: legend Dosing: IR: 10mg to 40mg BID ro TID; SR: 40mg to 160mg once daily >14 hour nitrate free time for IR, >18 hour nitrate free time for SR Contraindication(s):  Concurrent use with phosphodiesterase inhibitors or riociguat BBW: • None Key Points:  May cause headache, dizziness  For angina, should be dosed to preserve a nitrate-free period 

146
Q

Isosorbide mononitrate

A

Brand: Imdur MOA: Activates cGMP leading to dephosphorylation of myosin light chains and smooth muscle relaxation Schedule: legend Dosing: IR: 20mg BID given+B125 7 hours apart; XR: 60mg to 120mg once daily Contraindication(s):  Concurrent use with phosphodiesterase inhibitors or riociguat BBW: • None Key Points:  May cause headache, dizziness  For angina, should be dosed to preserve a nitrate-free period

147
Q

Lansoprazole

A

Brand: Prevacid MOA: Suppresses gastric acid secretion by inhibition of the H+/K+-ATPase in the gastric parietal cell Schedule: legend Dosing: Ulcer/GERD: 15mg to 30mg once daily H. pylori eradication: 30mg BID or TID Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Headache  Diarrhea  Take 30 minutes before food.

148
Q

Levofloxacin

A

Brand: Levaquin MOA: Inhibits DNA-gyrase and promotes breakage of double-stranded DNA Schedule: legend Dosing: 500mg to 750mg once daily Contraindication(s):  Hypersensitivity BBW: • Serious adverse reactions • Exacerbation of myasthenia gravis Key Points:  May bind with certain cations. Avoid taking with certain multivitamins and minerals (calcium, aluminum, magnesium, etc.)  QTC prolongation  DysglycemiaDiarrhea (AAD & CDAD)

149
Q

Levothyroxine

A

Brand: Levoxyl, Synthroid, Tirosint, Unithroid MOA: Synthetic form of thyroxine (T4), which is converted to active thyroid hormone Schedule: legend Dosing: 25mcg to 300mcg once daily About 1.7mcg/kg/day Contraindication(s):  Acute MI  Untreated subclinical or overt thyrotoxicosis of any etiology  uncorrected adrenal insufficiency BBW: • Weight reduction Key Points:  Empty stomach; may or may not be first thing in the morning  Symptoms of hyperthyroidism if dosed too aggresively  Chelates with numerous drugs, vitamins, and mineralsRemind patient to have labs checked if new rx or changing dose

150
Q

Levothyroxine and Liothyronine

A

Brand: Thyrolar MOA: Active (T3) and synthetic (T4) thyroid hormone Schedule: legend Dosing: 50mcg/12.5mcg to 100mcg/25mcg once daily Contraindication(s):  Uncorrected adrenal insufficiency  Untreated thyrotoxicosis BBW: • Weight reduction Key Points:  Empty stomach; may or may not be first thing in the morning  Symptoms of hyperthyroidism if dosed too aggresively  Chelates with numerous drugs, vitamins, and mineralsRemind patient to have labs checked if new rx or changing dose

151
Q

Liothyronine

A

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

152
Q

Lisinopril

A

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

153
Q

Lisinopril and Hydrochlorothiazide

A

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

154
Q

Losartan

A

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

155
Q

Losartan and Hydrochlorothiazide

A

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

156
Q

Medroxyprogesterone

A

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

157
Q

Metoprolol

A

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

158
Q

Metronidazole

A

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

159
Q

Minocycline

A

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)

160
Q

Moxifloxacin

A

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)

161
Q

Mupirocin

A

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

162
Q

Niacin

A

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

163
Q

Nifedipine

A

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

164
Q

Nitrofurantoin

A

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

165
Q

Nitroglycerin

A

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

166
Q

Norethindrone

A

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.)

167
Q

Olmesartan

A

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

168
Q

Olmesartan and Hydrochlorothiazide

A

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

169
Q

Omega-3 fatty acids

A

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

170
Q

Omeprazole

A

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

171
Q

Ondansetron

A

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

172
Q

Oseltamivir

A

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

173
Q

Oxybutynin

A

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

174
Q

Pantoprazole

A

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.

175
Q

Penicillin g

A

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

176
Q

Penicillin v Potassium

A

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

177
Q

Phenazopyridine

A

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

178
Q

Pravastatin

A

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

179
Q

Promethazine

A

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

180
Q

Propranolol

A

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

181
Q

Rabeprazole

A

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.

182
Q

Ranitidine

A

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

183
Q

Rivaroxaban

A

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

184
Q

Rosuvastatin

A

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 

185
Q

Sildenafil

A

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

186
Q

Simvastatin

A

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

187
Q

Simvastatin and Ezetimibe

A

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

188
Q

Sofosbuvir and Ledipasvir

A

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

189
Q

Solifenacin

A

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

190
Q

Spironolactone

A

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

191
Q

Sulfamethoxazole and Trimethoprim

A

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

192
Q

Tadalafil

A

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

193
Q

Tamsulosin

A

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

194
Q

Tenofovir alafenamide and emtricitabine

A

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

195
Q

Terazosin

A

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

196
Q

Testosterone

A

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

197
Q

Triamterene and hydrochlorothiazide (combination)

A

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

198
Q

Valacyclovir

A

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

199
Q

Valsartan and hydrochlorothiazide (combination)

A

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

200
Q

Verapamil

A

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

201
Q

Warfarin

A

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

P2 Top 200 (19 decks)

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