Ambulatory Care

Question 0

Naproxen

Answer 0

Brand Name(s): Naprosyn, Aleve
Drug Class: NSAID
MoA: Inhibits prostaglandin production by blocking COX 1 & 2; also inhibits inflammation and immunity
Indications: Pain, RA, OA, or Ankylosing Spondylitis, Dysmenorrhea, Fever, h/a, Myalgia, Toothache, Acute gout
Contraindications: Perioperative, GI bleeds, ASA allergy, renal impairment (CrCl < 30mL/min)
Adverse Reactions: Abd pain, Constipation, Heartburn (3-9%)
Nausea, H/a, Dizziness, Drowsiness
Monitor: Kidney fxn
Dosage: start - 500 mg PO; max - 2000 mg

Question 1

Cyclobenzaprine

Answer 1

Brand Name(s): Flexeril
Drug Class: Skeletal muscle relaxant
MoA: Reduces tonic somatic motor activity influencing both alpha and gamma motor neurons.
Indications: Muscle spasms; off-label for fibromyalgia syndrome
Contraindications: TCA allergy, MAOIs, hyperthyroidism, cardiac pt
Adverse Reactions: Drowsiness, dry mouth, dizzy, h/a
Monitor: LFTs
Dosage: start - 5mg q8hr; max - ???

Question 2

Metformin

Answer 2

Brand Name(s): Glucophage
Drug Class: Antidiabetic, Biguanide
MoA: Decreases hepatic glucose production; decreases GI glucose absorption; increases target cell sensitivity to insulin
Indications: Type 2 DM, off-label for Polycystic Ovarian Syndrome
Contraindications: CHF, acidosis, DKA, Hepatic or Renal disease, w/i 2d of Contrast study, Surgery, Lactation
Adverse Reactions: GI sx, asthenia, myalgia, weakness, URI
Monitor: Cr, LFTs
Dosage: start - 500mg PO q12hr or 850mg PO daily c food; max - 2550mg daily

Question 3

Enalapril

Answer 3

Brand Name(s): Vasotec, enalaprilat
Drug Class: ACEi
MoA: prevents conversion of angiotensin I to angiotensin II (a potent vasoconstrictor) through competitive inhibition of ACE, leading to decreased vasoconstriction, increased renin activity, and decreased aldosterone secretion; ultimately BP is reduced
Indications: HTN, LV dysfxn, CHF
Contraindications: Angioedema, PG (fetal mortality by oligohydramnios), Not c aliskiren in DM pt, B/L renal artery stenosis
Adverse Reactions: Dizziness, Hypotension, H/a, CP, Cough, HyperK+
Monitor: K+, Cr
Dosage: start - 2.5mg PO daily, 1.25mg IV in 5min q6hr; max - 40mg PO daily, 5mg IV q6hr

Question 4

Sumatriptan

Answer 4

Brand Name(s): Imitrex

Drug Class: Serotonin 5-HT receptor agonist

MoA: Selective 5-HT1 receptor agonist in cranial arteries; elicits vasoconstrictive and anti-inflammatory effects

Indications: Migraine, Cluster h/a

Contraindications: ischemic cardiac, cerebrovascular, or peripheral vascular syndromes (ie angina, MI, stroke, ischemic bowel disease), uncontrolled HTN, w/i 2 wk of MAO-A inhibitors, w/i 24 hr of ergot med

Adverse Reactions: 
Paresthesia
Chest, jaw or neck tightness
Fatigue
Warm/cold sensation
(Rare, but important) Cardiac issues

Monitor:

Dosage: start - 25mg PO, 6mg/0.5mL SC; max - 100mg/dose or 200mg/d, 12mg/d SC

Question 5

Losartan

Answer 5

Brand Name(s): Cozaar

Drug Class: ARB
MoA: 
Indications:
Contraindications:
Adverse Reactions:
Monitor:
Dosage: start - ; max -

Question 6

Paroxetine

Answer 6

Brand Name(s): Paxil
Drug Class: SSRI, antidepressant
MoA:
Indications:
Contraindications:
Adverse Reactions:
Monitor:
Dosage: start - ; max -

Question 7

Fluconazole

Answer 7

Brand Name(s): Diflucan
Drug Class: Antifungal (systemic)
MoA:
Indications:
Contraindications:
Adverse Reactions:
Monitor:
Dosage: start - ; max -

Question 8

Gabapentin

Answer 8

Brand Name(s): Neurontin
Drug Class: Anticonvulsant 
MoA:
Indications:
Contraindications:
Adverse Reactions:
Monitor:
Dosage: start - ; max -

Question 9

Ibuprofen

Answer 9

Brand Name(s): 
Drug Class: 
MoA:
Indications:
Contraindications:
Adverse Reactions:
Monitor:
Dosage: start - ; max -

Question 10

Gemfibrozil

Answer 10

Brand Name(s): Lopid
Drug Class: 
MoA:
Indications:
Contraindications:
Adverse Reactions:
Monitor:
Dosage: start - ; max -

Question 11

Fexofenadine

Answer 11

Brand Name(s): Allegra
Drug Class: Antihistamine, H1 blocker
MoA: H1 histamine receptor antagonist; major metabolite of terfenadine
Indications: Seasonal Allergic Rhinitis/ Chronic Idiopathic Urticaria
Contraindications: Hypersensitivity
Adverse Reactions: Vomiting, h/a, cough, diarrhea
Monitor:
Dosage: start - 180mg PO daily; if renal impaired, 60mg PO daily; max - ???