Miscelaneous agents Flashcards
adalimumab
Brand - Humira, Amjevita
Class - Antibody, antirheumatic, TNF blocking agent
Indication - Crohns, Hidradenitis suppurativa, juvenile idiopathic arthritis, plaque psoriasis, rheumatoid arthritis
Pregnancy - Weigh risks/benefits
Black Box - Antibody formation, Hematologic disorders, active infection, HIV, live vaccines
Counseling - Closely monitor CBC, autoiimune disorder, malignancy, hepatomegaly, abdominal pain, fever, night sweats, weight loss; SQ admini tech, rotate injection site, leave at room temp up to 30 min before use.
MoA - Antibioty binds to human tumor necrosis factor alpha, interfering w/ cytokine-driven inflammatory processes - decreases symptoms of arthritis and progression of structural damage, reduces epidermal thickeness in osiruasus and maintains remission in Chron disease and ulcerative colitis.
adapalene
Brand - Differin, Plixda
Class - Retinoid (antiacne)
Indication - Acne vulgaris
Counseling - Avoid eyes, lips, nose folds, mucous membranes, cuts/scapes/burns. Avoid UV*. May take up to 12 weeks. Wash and dry area prior to application, follow up with moisturizer.
MoA - Second generation of retinoic acid that is more selective (less irritating) > normalizing the differentiation of skin cells to prevent microcomedone formation and thus acne lesions
alendronate
Brand - Fosamax, Binosto
Class - Bisphosphonate
Indication - Osteoporosis (including postmenopausal, glucocorticod-induced, and prophylaxis), Paget disease
Contraindications - Esophageal abnormalities or risk, hypocalcemia, inability to sit/stand upright for 30 min
Pregnancy - Risk
Counseling - Swallow (or dissolve for 5 min if effervescent) w/ a large glass of plain water and remain upright for 30 min and don’t eat/drink anything, and then do not lie down until after you have eaten food.
MoA - Binds to hydroxyapatite and inhibits osteoclast activity to inhibit bone resorption
allopurinol
Brand - Zyloprim
Class - Xanthine oxidase inhibitor, Antigout
Indication - Gout, hyperuricemia, nephrolithiasis prophylaxis
Contraindications - Concurrent use of diadanosine
Pregnancy - No data
Counseling - Tk after meals for GI upset, maintain hydration, avoid alcohol/caffeine. Seek medical attention if signs of myelosuppression, agranulocytosis (neutropenia), or Stevens-Johnson syndrome (flu-like, red rash, mucousal blistering)
MoA - Decreases production of uric acid by inhibiting xanthine oxidase (hypoxanthine > xanthine > uric acid)
benzonatate
Brand - Tessalon Perles
Class - Antitussive
Indication - Cough
Pregnancy - Weigh risks/benefits
Counseling - Tk w/ food if GI upset. Accidental ingestion by kids <2 can kill. Do not chew capsules.
MoA - Anesthetizing the stretch receptors in the resp passages by dampening activity (reduces cough reflex)
brimonidine [tartrate]
Brand - Lumify, Alphagan P
Class - Adrenergic agonist, antiglaucoma agent
Indication - Ocular hypertension, open-angle glaucoma, ocular redness
Contraindications - Concurrent MAOIS, children <2y
Counseling - Drop into the pocket between lower lid and eyeball, close eye and hold for 1 min. Put cap on bottle asap, reinsert contacts after 15 min or wait 5 min for other drops.
MoA - Selective alpha agonist, reduces aqueous humor production and increases uveoscleral outflow (used to lower IOP)
calcium / cholecalciferol
Class - Supplement, Ca2+ containing Antacid
Indication - Vitamin deficiency
Contraindications - Hypercalcemia, Hypervitaminosis D
Counseling - Overdose symptoms (nausea, loss of appetite, thirst, urinating more or less than usual, body aches, stiffness, confusion, or irregular heartbeats).
MoA - Vitamin D3 regulates Ca2+, phosphate, and citric acid metabolism, promotes the intestinal absorption of calcium and controls the incorporation of calcium into the organic bone matrix.
cholecalciferol
Brand - Adrovance
Class - Vitamin D3 analog
Indication - Vitamin D deficiency, Refractory rickets, hypoparathyroidism, familial hypophosphatemia
Contraindications - Hypercalcemia, Hypervitaminosis D, Hyperlipidemia, Hyperphosphatemia, Liver disease, renal impairment/osteodystrophy, sarcoidosis, arteriosclerosis, cardiac conditions, thiazide diuretics
Pregnancy - Fetal risk cannot be ruled out
Counseling - Warn patient to report symptoms of hypercalcemia. Side effects with excessive use may include nausea, anorexia, weight loss, constipation, polyuria, polydispsia, hypertension, weakness, and muscle aches or stiffness. Instruct patient to maintain adequate intake of calcium with drug. Avoid additional vitamin D supplements.
MoA - Vitamin D3 regulates both the calcium and phosphate as well as citric acid metabolism, promotes the intestinal absorption of calcium and controls the incorporation of calcium into the organic bone matrix
clobetasol (topical)
Brand - Impoyz, Temovate
Class - (Topical) Corticosteroid
Indication - Skin disorders, Plaque psoriasis
Pregnancy - Risk
Counseling - Apply thin layer to clean, intact, affect skin, avoiding eyes, mouth, and occlusive clothing; wash hands after admin.
MoA - Anti-inflammatory, antipruritc, vasoconstrictive. Induce lipocortins that control inflammatory mediators by inhibiting release of arachidonic acid by phospholipase A2.
colchicine
Brand - Colcrys, Gloperba
Class - Antigout
Indication - Gout (acute/prophylaxis), Familial Mediterranean fever
Contraindications - Concurrent use of CYP3A4/5 inhibitors in renal/hepatic failure
Counseling - Instruct on dosing strategy for flares
MoA - May interrupt the cycle of Na+ urate crystal deposition in joint tissues and inflamm response that initiates/sustains an attack (probably by inhibiting oxidation of glucose and lactic acid production in leukocytes)
cyanocobalmin
Brand - Cobolin-M
Class - Essential B Vitamin, B-12
Indication - Cobalamin deficiency (malabsorption or normal)
Contraindications - Hypersensitivity to cobalt
Counseling - Avoid alcohol (inhibits absorption), tk ER w/ food, may require several weeks for max effect
MoA - B12 is required for the synthesis of methionine from homocysteine, which is needed for DNA synthesis so deficiency presents as macrocytic anemia when RBC can’t extrude their nucleus.
epinephrine [autoinjector]
Brand - EpiPen, Adrenaclick
Class - Anaphylaxis agent, alpha/beta agonist
Indication - Emergency treatment of acute anaphylaxis due to allergic reaction
Pregnancy - Risk, but i mean life or death yo
Counseling - Instruct admin technq, seek medical assist, inject into anterolateral aspect of thigh (IM or SQ, not IV)
MoA - Stimulates alpha/beta receptors. Alpha > Vascular constriction +BP, Beta1 > +HR & contractility, Beta2> bronchial relaxation (thus alleviating dyspnea). Also alleviates pruitus, urticaria, and angioedema.
ergocalciferol
Brand - Drisdol
Class - Vitamin D analog
Indication - hypoparathyroidism, Refractory rickets, familial hypophosphatemia
Contraindications - Hypercalcemia, malabsorption syndrome, abnormal sensitivity to the toxic effects of vitamin D, and hypervitaminosis D
Counseling - Best absorbed when taken after a meal, but may be taken with or without food. Bile acid sequestrants can decrease the absorption of Vitamin D - separate at least 2 hours if possible.
MoA - After the activation of the vitamin D receptor, mobilize and accretion of calcium and phosphorus in the bone, absorption of calcium and phosphorus in the intestine, and reabsorption of calcium and phosphorus in the kidney
ferrous sulfate
Class - Iron mineral supplement
Indication - Iron deficiency
Contraindications - Anemia other than iron-deficiency anemia, hemochromatosis, hemosiderosis
Black Box - Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6.
Counseling - Works best when taken on an empty stomach, but tk w/ food if GI upset. May tk up to 4 w to feel full effect (feel better after 1 w). side effect constipation/diarrhea
MoA - Ferrous sulphate contains iron, hope that helps
finasteride
Brand - Proscar, Propecia
Class - 5alpha-reductase inhibitor
Indication - Benign prostatic hyperplasia, male pattern alopecia
Contraindications - Pregnancy or use in children
Pregnancy - Contraindicated
Counseling - Takes 3mo for hair loss, 6mo for prostate. Can get into body through the skin and spread through semen, pregnant people must avoid it (prevent fetal genitalia development). Report any shortness of breath, breast swelling, or breast mass.
MoA - Inhibits conversion of testosterone into DHT
folic acid
Brand - FA-8
Class - Essential B Vitamin, B9
Indication - Folic acid deficiency
Counseling - Avoid alcohol (inhibits absorption), may require several weeks for max effect
MoA - Required for conversion of deoxyuridylate to thymidylate (rate-limiting step in DNA synthesis), thus deficiency presents as macrocytic anemia when RBC are unable to extrude their nucleus.
hydrocortisone (topical)
Class - (Topical) Corticosteroid
Indication - Skin disorders
Pregnancy - Risk
Counseling - Apply thin layer to clean, intact, affect skin, avoiding eyes, mouth, and occlusive clothing; wash hands after admin.
MoA - Anti-inflammatory, antipruritc, vasoconstrictive. Induce lipocortins that control inflammatory mediators by inhibiting release of arachidonic acid by phospholipase A2.
hydroxyzine
Brand - Atarax, Vistaril
Class - 1st Gen H1 antagonist, piperazine derivative
Indication - Pruritus (itching), anxiety, sedation
Counseling - May cause dizziness/sedative effects
MoA - Rapid-acting agent that suppresses activity in CNS - skeletal muscle relaxation, bronchodilator activity, antiemetic effects, and antihistaminic and analgesic effects
latanoprost
Brand - Xalatan
Class - Prostaglandin, antiglaucoma agent
Indication - Ocular HTN, open-angle glaucoma
Counseling - Drop into the pocket between lower lid and eyeball, close eye and hold for 1 min. Put cap on bottle asap, reinsert contacts after 15 min or wait 5 min for other drops.
MoA - Prostaglandin F2-alpha analog, reduces IOP by increasing outflow of aqueous humor, may increase uveoscleral outflow
methotrexate
Brand - Trexall
Class - Antimetabolite
Indication - severe Psoriasis or Rheumatoid arthritis (or juvenile), non-hodgkin lymphoma
Contraindications - Nursing/pregnancy, existing blood dyscrasias in patients w/ psoriasis/RH arthritis
Pregnancy - Contraindicated
Black Box - Bone marrow suppression, renal impairment, hepatotoxicity, pneumonitis, GI toxic, 2ndy malignancy, tumor lysis synd, opportunistic infections, radiotherapy
Counseling - Emphasize dose schedule (weekly/daily), avoid pregnancy (male and female), will cause vomiting (counsel antiemetics), avoid sun/UV, can take w/ food.
MoA - Reversibly inhibits DHFR (dihydrofolates > tetrahydrofolates) before use in DNA synthesis, interfering w/ DNA repair/synthesis/cell replication
methylprednisolone
Brand - Medrol
Class - Adrenal corticosteroid
Indication - Diseases of allergies, dermatologic, endocrine, GI, hematologic, neoplastic, nervous, renal, respiratory, or rheumatic
Contraindications - Admin of live vaccines, fungal infections
Pregnancy - Weigh risks/benefits
Counseling - Short-term: tk w/ food for GI upset. High/long: Monitor for hyperglycemia, osteoporosis, adrenocortical insufficiency, and infection
MoA - Varied metabolic effects, modify the body’s immune responses to stimuli, and are used for anti-inflammatory effects in many disorders
oxybutynin
Brand - Ditropan
Class - Urinary antispasmodic
Indication - Overactive/neurogenic bladder
Contraindications - Gastric rentention, glaucoma, urinary retention
Counseling - Warn about possible anticholinergic effects (constipation, urinary retention, blurred vision, dyspepsia, xeostomia). Decreased sweating can cause overheating in hot environment
MoA - Competitive muscarinic antagonist in the bladder smooth muscle
phentermine
Brand - Adipex-P, Lomaira
Class - C-IV, Centrally acting appetite suppressant
Indication - Obesity
Contraindications - Use in agitated states, CV disease, history of drug abuse, glaucoma, mod-severe HTN, hyperthyroidism
Pregnancy - Contraindicated
Counseling - Tk during day to avoid insomnia; may impair ability to engage in hazardous activities like driving
MoA - Sympathomimetic amine (similar to amphetamine activity), stimulates CNS & +BP, weight loss is due to anorectic effect (appetite suppression and other metabolic effects)
potassium [KCl]
Brand - Klor-Con
Class - Potassium Electrolyte supplement
Indication - Hypokalemia
Contraindications - Acute renal failure, disorders that delay tab passage through GI tract, hyperkalemia, Addison disease, acute dehydration
Counseling - Tk w/ food, instruct dosage instructions (dissolve, crush, swallow, liquid, etc)
MoA - K+ is need for excitation of neuromuscular tissues, membrane potentials of cells, etc
prednisolone
Brand - Orapred
Class - Adrenal Glucocorticosteroid
Indication - Treatment of many diseases associated w/ allergies, dermatologic, endocrine, GI, hematologic, neoplastic, nervous, renal, respiratory, and rheumatic diseases
Contraindications - Admin of live vaccines, fungal infections
Pregnancy - Risk
Counseling - Tk w/ food in morning for GI upset and insomnia. For high/long dose: monitor for signs of hyperglycemia, osteoporosis, adrenocortical insufficiency, and infection
MoA - Steroids cause varied metabolic effects, modify the body’s immune responses to stimuli, and are used for their anti-inflammatory effects in many disorders
prednisone
Brand - Deltasone
Class - Adrenal Corticosteroid
Indication - Treatment of many diseases associated w/ allergies, dermatologic, endocrine, GI, hematologic, neoplastic, nervous, renal, respiratory, and rheumatic diseases
Contraindications - Admin of live vaccines, fungal infections
Pregnancy - Risk
Counseling - Tk w/ food in morning for GI upset and insomnia. For high/long dose: monitor for signs of hyperglycemia, osteoporosis, adrenocortical insufficiency, and infection
MoA - Steroids cause varied metabolic effects, modify the body’s immune responses to stimuli, and are used for their anti-inflammatory effects in many disorders
promethazine
Brand - Phenergan
Class - Phenothiazine antihistamine
Indication - Motion sickness, allergy, nausea/vomiting
Contraindications - Asthma, comatose state, children <2y
Black Box - Children <2y (fatal respiratory depression)
Counseling - May cause drowsiness, avoid alcohol, caution driving
MoA - Competitively blocks H1 receptors w/o blocking secretion of H, has sedative, antimotion sickness, antiemetic, and anticholinergic effects (no dopaminergic action)
sidenafil
Brand - Viagra, Revatio
Class - ED agent, pulmonary HTN agent
Indication - Erectile dysfunction, Pulmonary HTN
Contraindications - Concurrent nitrates, HIV protease inhibitors, guanylate cyclase stimulators
Counseling - Tk 30min-4h prior to sex, but not more frequently than once q24h.
MoA - Inhibition of PDE5 increases GMP (NO normally stimulates GMP to cause smooth muscle relaxation +blood flow)
tadalafil
Brand - Cialis, Adcirca
Class - ED agent, pulmonary HTN agent
Indication - Erectile dysfunction, Benign prostatic hyperplasia, pulmonary HTN
Contraindications - Concurrent nitrates or guanylate cyclase stimulators
Pregnancy - Weigh risk/benefits
Counseling - Tk 30min prior to sex, but not more frequently than once q24h; realize mental alertness. Seek medical attention if severe skin rash, chest pain, erection lasting >4h, tinnitus, dizziness, or shortness of breath
MoA - Inhibition of PDE5 increases GMP (NO normally stimulates GMP to cause smooth muscle relaxation +blood flow)
triamcinolone (topical)
Class - (Topical) Corticosteroid
Indication - Skin disorders
Counseling - Apply thin layer to clean, intact, affect skin, avoiding eyes, mouth, and occlusive clothing; wash hands after admin
MoA - Anti-inflammatory, antipruritc, vasoconstrictive. Induce lipocortins that control inflammatory mediators by inhibiting release of arachidonic acid by phospholipase A2
