EOR #4 pharm part 1 Flashcards
Dosage forms of duloxetine
20 mg, 30 mg, 60 mg
Average daily dosages of duloxetine
MDD: 40-60 mg/day
Peripheral neuropathy: 60 mg/day
GAD: 60-120 mg/day
Common indications of duloxetine
MDD
Neuropathic pain associated with diabetic peripheral neuropathy
GAD
MOA of duloxetine
Inhibits neuronal reuptake of serotonin and norepinephrine primarily, and dopamine to a slight extent
Common AEs of duloxetine
Nausea Dry mouth Constipation Insomnia Dizziness
Renal or hepatic dose adjustments of duloxetine
CrCl <30: use not recommended
Mild-mod renal impairment use low dosing
Not recommended in hepatic impairment
BBW for duloxetine
Antidepressants increase risk of suicidal thinking and behavior in children, adolescents, and young adults with MDD and other psychiatric d/os
Clinically significant drug interactions of duloxetine
CI-ed with MAOIs, inhibitors of CYP1A2 and CYP2DC increase levels of duloxetine. Chronic use of NSAIDs increases risk of GI bleeds.
Major counseling points of duloxetine
Pay close attention to mood or behavioral changes- this drug may increase suicidal thoughts or actions.
Benefits may not be seen before 2 wks of continued drug therapy;
May cause drowsiness; Avoid alcohol while taking this medication
Do not abruptly d/c
Store in a cool, dry place…
If a dose is missed, skip it and return to nl dosing schedule
Monitoring parameters of duloxetine
Improvement in S/sx of anxiety/depression/pain
Abrupt changes in mood
Dosage forms of risperidone
Orally disintegrating tabs: 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg
Powder for injection
Oral solution
Average daily dosages of risperidone
Oral: 1 mg BID on day 1, 2 mg BID on day 2, 3 mg BID on day 3, then titrate on a weekly basis
Max dose: 16 mg
Injection: 25 mg IM q2w
Common indications for risperidone
Bipolar mania Bipolar I maintenance Shizophrenia PTSD Tourette's syndrome Agitation
MOA of risperidone
Dopamine and serotonin antagonism
Common AEs of risperidone
EPS Tachycardia Priapism Rash Somnolence Agitation/anxiety
Renal or hepatic dose adjustments for risperidone
Recommended
BBW for risperidone
Increased mortality in elderly pts with dementia-related psychosis
Clinically significant drug interactions of risperidone
Fluoxetine, carbamazepine, and clozapine may increase risperidone
Major counseling points of ripseridone
May cause fainting during initial doses,
May impair judgement
Avoid EtOH
Avoid excessive exposure to sunlight and heat during therapy
Monitoring parameters
Decrease of S/sx of bipolar, schizophrenia, PTSD and Tourette’s syndrome
Dosage forms of alprazolam
IR tabs: 0.25 mg, 0.5 mg, 1 mg, 2 mg
ER tabs: 0.5 mg, 1 mg, 2 mg, 3 mg
Oral solution concentrate: 1 mg/mL
Average daily dosages for alprazolam
Anxiety: 0.25 mg to 0.5 mg IR tabs initially 3x/day, titrate to individual needs
Panic d/o: IR tabs: 5-6 mg/day. ER tabs: 3-6 mg/day
MOA of alprazolam
Facilitates the inhibitory neurotransmitter action of GABA in pre- and post-synapse
Common AEs of alprazolam
Drowsiness
Xerostomia
Renal or hepatic dose adjustments of alprazolam
Caution in advanced liver dz
Clinically sig drug interactions for alprazolam
Taking other CNS depressants along with alprazolam can increase drowsiness and risk of respiratory depression
Major counseling points of alprazolam
May cause drowsiness Avoid taking with EtOH May be habit-forming XR tabs should be swallowed whole This med should not be abruptly d/c-ed
Monitoring parameters of alprazolam
Anxiety/panic/depression sx
Misuse/abuse
Dosage forms of bupropion
IR tabs: 75 mg, 100 mg
SR tabs: 100 mg, 150 mg, 200 mg
XL tabs: 150 mg, 300 mg
Zyban: 150 mg
Average daily dose for bupropion
300 mg/day
Common indications for bupropion
Depression
Anxiety
Aid in smoking cessation
MOA of bupropion
Weak inhibitor of neuronal uptake or norepinephrine, serotonin, and dopamine
Common AEs of bupropion
Tremor
Wt loss
Insomnia
Renal or hepatic dose adjustments of bupropion
Hepatic/renal: consider reducing dose and frequency
BBW for bupropion
Suicidality
Clinically sig drug interactions of bupropion
EtOH may lower seizure threshold
Toxicity is increased by monoamine oxidase inhibitors
Chronic use with NSAIDs increases risk of GI bleeds
Major counseling points of bupropion`
Swallow XL and SR tabs whole
Avoid EtOH
Wt loss or gain may be temporary
May need up to 2 wks to show noticeable improvement
Pay attention to sudden mood/thought change
Do not abruptly d/c
Monitoring parameters for bupropion
Improvement in mood/smoking frequency
Unusual changes in behavior/suicidality
Dosage forms of diazepam
Tabs: 2 mg, 5 mg, 10 mg
Injection: 5 mg/mL
Rectal gel: 2.5 mg/0.5 mL
Average daily doses of diazepam
2-10 mg 2-4 times daily
Common indications for diazepam
Acute EtOH withdrawal Anticonvulsant Anxiety Muscle spasm Sedation Status epilepticus
MOA of diazepam
Enhances the inhibitory effect of GABA
Common AEs of diazepam
Drowsiness Ataxia Fatigue Sedation Cognitive impairment
Renal or hepatic dose adjustments for diazepam
Daily 50% reduction of dose for cirrhosis pts
Clinically sig drug interactions with diazepam
Additive effect with other CNS depressants
Cimetidine delays clearance
Grapefruit juice may increase plasma level
Major counseling points of diazepam
May cause drowsiness
May be habit forming
Avoid EtOH while taking this medication
Do not abruptly d/c
Monitoring parameters for diazepam
Improvement in S/sx of anxiety
Muscle spasticity
Seizure control
Abuse, misuse
