First 25

Question 1

acetaminophen and codeine (combination)

Answer 1

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

Question 2

adalimumab

Answer 2

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

Question 3

Albuterol

Answer 3

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

Question 4

alendronate

Answer 4

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

Question 5

Allopurinol

Answer 5

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

Question 6

Alprazolam

Answer 6

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

Question 7

Amitriptyline

Answer 7

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

Question 8

Aripiprazole

Answer 8

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

Question 9

Atomoxetine

Answer 9

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

Question 10

Baclofen

Answer 10

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

Question 11

Benztropine

Answer 11

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)

Question 12

Buedesonide

Answer 12

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

Question 13

Buesonide and Formoterol

Answer 13

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

Question 14

Buprenorphine

Answer 14

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

Question 15

Buprenorphine and Naloxone

Answer 15

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

Question 16

Bupropion

Answer 16

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

Question 17

Butalbital, Acetaminophen and Caffeine

Answer 17

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

Question 18

Carisoprodol

Answer 18

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

Question 19

Celecoxib

Answer 19

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

Question 20

Citalopram

Answer 20

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

Question 21

Clonazepam

Answer 21

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

Question 22

Colchicine

Answer 22

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

Question 23

Cyclobenzaprine

Answer 23

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

Question 24

Desvenlafaxine

Answer 24

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

Question 25

Dexmethylphenidate

Answer 25

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