Counseling Closeout Drug Review Flashcards
Tenormin
Generic Name: Atenolol
Class: Beta Blocker
Indication: Hypertension, MI, Angina
Side Effects: Bradycardia, Initial Fatigue, dizziness, decreased exercise tolerance, sexual dysfunction in men
CAUTION IN ASTHMA due to Beta 2 receptors in lungs
Monitor blood pressure
Follow up in around 4 weeks
Lisinopril
Brand Names: Zestril, Prinivil
Class: Ace Inhibitor
Indication: Hypertension, renal protection
Dosing: qd or bid
Side effects: Initial dizziness when you first start or if you increase the dose, cough (which may occur months later), angiodema, hyperkalemia (make sure your doctor is aware if you are on potassium supplements as well as ace inhibitor)
Monitor Blood pressure
Norvasc
Generic name: Amlodipine Class: CCB Indication: Hypertension Dosing: qd Adverse Effects: peripheral edema, dizziness (associated with hypotension; body usually adjusts)
HCTZ
Generic Name: Hydrochlorothiazide
Brand Names: Hydrodiuril, microzide
Class: Diuretic
Indication: Hypertension, also used to treat edema
Side effects: Increased urination (does level off after a while), initial dizziness possible, hypokalemia, photosensitivity
Monitor Blood Pressure
DOSING SHOULD OCCUR IN MORNING
Spironolactone
Brand name: Aldactone
Indication: CHF, hypertension
Side effects: Increased urination, dizziness, take with food if there is any GI upset
Monitor blood pressure levels, especially if used with ACE inhibitors, ARBs or salt substitutes (see if they are all from the same physician - ask if their doctor talked about their potassium levels followed with “when are they going to monitor your potassium levels”)
Dosing should occur in the morning due to increased urination
Losartan
Brand Name: Cozaar
Class: ARB
Indication: Hypertension, diabetic nephropathy
Dosing: 25-100mg once a day
Side effects: Dizziness, postural hypotension, cough (much less than ACE inhibitors)
Patient information: Should take around the same time each day, avoid salt substitutes and caution with potassium sparing diuretics, watch for dizziness (especially when first starting)
Lasix
Generic: Furosemide
Class: Loop diuretic (much more potent type of diuretic)
Indication: CHF, Hypertension
Dosing: Once daily in the morning, sometimes BID (later afternoon, avoid second dose late at night)
Side effects: Dizziness, orthostatic hypotension, photosensitivity
This medication is much more potassium wasting than other diuretics (ASK ABOUT SUPPLEMENTS or at least ask about when they are going to have their potassium levels checked) Patients should usually be on a potassium supplement
Simvastatin
Brand name: Zocor
Class: HMG CoA Reductase Inhibitors
Indication: Cholesterol lowering (lower LDL, raise HDL)
Dosing: HS due to higher cholesterol production while sleeping
Side effects: Myopathy (patient should check with physician at first sign of muscle pain, could be a sign that more severe damage is occurring)
Patient should monitor LFTs and cholesterol
Advise patient to watch diet and get exercise
There should be some follow-up within at least a few months (liver function tests since there is the rare possibility of toxicity, cholesterol levels, etc)
NO GRAPEFRUIT JUICE
Lantus
Generic name: Glargine
Class: Insulin - Long Acting
Dosing: Once daily at night, sometimes twice; adjust dose to needs of patient
Side effects: Hypoglycemia (make sure patient knows the signs of hypoglycemia), injection site irritation
Make sure patient knows the proper injection technique.
Storage: Up to 28 days at room temperature after opening
Counsel on managing diabetes
FIND OUT WHAT THEY ALREADY KNOW IN ORDER TO SAVE TIME
Aspart
Brand Name: Novolog
Class: Insulin, rapid acting
Dosing: Subcutaneous injection before meals
Side effects: Hypoglycemia
Storage and expiration
Metformin
Brand Name: Glucophage
Indication: Type 2 diabetes, Polycystic ovary syndrome
Mechanism: Reduction of hepatic glucose production, increase of insulin sensitivity
Dosing: With meals (qd, bid, tid - depends on individual and dosage forms)
Side effects: GI adverse effects including nausea, vomiting and diarrhea as well as flatulence (these effects should resolve with time)
Counsel patient to maintain a health diet, exercise and monitor blood glucose
Hydrocodone/Acetaminophen
Brand Names: Vicodin, Norco, Lortab
Indication: Pain, sometimes cough
Side effects: Drowsiness, constipation
POTENTIALLY HABIT FORMING, RISK OF ABUSE
NO ACOHOL WHILE ON THIS MEDICATION
Caution patient when it comes to using APAP containing medications alongside this medication; watch the max dose of APAP
What is the max daily dose of acetaminophen?
4000 mg
Oxycodone Immediate Release and Extended Release
Brand Names: OxyIR and Oxycontin (respectively)
Indication: Moderate to severe pain; acute and chronic pain
Side effects: Sedation, constipation (especially with chronic use - can be managed with laxatives)
HABIT FORMING AND RISK FOR ABUSE
Also available with APAP (percocet) and aspirin (Percodan)
Tramadol
Brand Name: Ultram
Indication: Moderate to moderate severely pain
Dose: 50 to 100mg q4-6h prn (not to exceed 400 mg/day)
Side effects: dizziness, headache, drowsiness, constipation, nausea, flushing
POTENTIAL FOR ABUSE
Sumatriptan
Brand name: Imitrex
Class: Selective serotonin agonist (triptans)
Indication: Migraine headaches
Dosing: One at onset and MR in 2 hours
Side effects: dizziness, chest pain, pressure, tightness
Diclofenac Sodium/Diclofenac Potassium
Brand Names: Cataflam, Voltaren
Class: NSAID - oral and topical
Indication: Osteoarthritis, rheumatoid arthritis, pain
Dosing: bid or tid
Voltaren tablets - delayed release, enteric coated
Cataflam - immediate release
Take with food to minimize GI upset
DO NOT USE IN THIRD TRIMESTER OF PREGNANCY
Flexeril
Generic Name: cyclobenzaprine
Class: Skeletal muscle relaxant
Dosing: 5 to 10mg tid prn
Side effects: Sedation, dry mouth, fatigue, headache
Patient information: Do not drink alcohol, may cause drowsiness, do not operate machinery
Tizanidine
Brand Names: Zanaflex
Class: Skeletal Muscle Relaxant
Dosing: 2 to 4mg q6-8h prn
Side effects: Sedation (not as much as cyclobenzaprine), dry mouth, asthenia, hypotension
Patient Information: Do not drink alcohol, may cause drowsiness, do not operate machinery
Paroxetine
Brand Name: Paxil
Class: SSRI
Indication: Depression, Panic Disorder, OCD, PTSD
Dosing: 10-40mg/day
Side effects: Drowsiness, insomnia, nausea, dry mouth, sexual dysfunction
SUCIDAL IDEATION
4-6 weeks for the full effect
Patient should have follow up within 2 to 4 weeks of starting this.
Amitriptyline
Brand name: Elavil
Mechanism: Inhibits reuptake of serotonin and norepinephrine
Dosing: 25mg to 150mg usually HS but can be divided doses
Indications: Neuropathic pain, depression, migraine HA prophylaxis, fibromyalgia
Side effects: Drowsiness, nausea, dry mouth (anticholinergic), weight gain, sexual dysfunction in men
(not a very specific medication so tons of side effects at higher doses used for depression)
SUICIDAL IDEATION
4-6 weeks for full effect if used for depression
Trazadone
Brand name: Desyrel
Indications: Depression, insomnia
Side effects: Sedation, dizziness, headache, priapism
May see anticholinergic side effects at high doses (dry mouth, blurred vision, constipation, sedation, hallucinations)
Bupropion SR, XL, IR
Brand Names: Wellbutrin, Zyban (smoking cessation)
Mechanism: Blocks reuptake of dopamine and norepinephrine
Dose: bid for SR, qd for XL, tid for IR
Side Effects: Insomnia, dry mouth, nervousness
4 to 6 weeks to see full effect
Venlafaxine
Brand Names: Effexor, Effexor XR
Class: SNRI
Mechanism: Blocks reuptake of serotonin and norepinephrine
Dose: XR 37.5 to 75 mg start; BID to TID for immediate release formulation
Side Effects: Insomnia, dry mouth, nervousness, dizziness
4 to 6 weeks for the full effect
