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Drug > New Drug Encounter #2 > Flashcards

New Drug Encounter #2 Flashcards

1
Q

Nurtec ODT (rimegepant) indication

A

Migraine treatment
* QD for 1 dose max 75 mg/day

Migraine prophylaxis
* QOD max 18 tablets per month

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2
Q

Nurtec moa simplify

A

Blocks a vasodilator in the brain
* more active during migraine

Blocks receptor of calcitonin gene related peptide CGRP

Class: CGRP inhibitor

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3
Q

Nurtec side effects THINK

A

N for nausea & abdominal pain

GI only: Nausea & abdominal pain

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4
Q

How long does it take for nurtec to work

A

May take up to 2 hours

** Triptan - repeat in 2 hours if needed *

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5
Q

How effective is Nurtec preventative?

A

Prevents about 1 migraine day per month

  • one less migraine per month
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6
Q

I have a migraine while taking nurtec every other day as a preventative, what should I do?

A

For breakthrough, use NSAID or triptan

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7
Q

Rare side effect associated with nurtec or CGRP inhibitor drug class?

A

Rare BP spike, especially when just starting

  • monitor blood pressure & inform your doctor

Report if you have CP, SHB or vision change

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8
Q

Injectable CGRP inhibitor #3

A

All once monthly injection

Aimovig ** SQ once a month

Ajovy - 225 mg SQ once a month or 675 mg once every 3 month

Emgality - start 240 mg for first month, then 120 mg SQ once monthly

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9
Q

Aimovig
Ajovy
Emgality

How and where to inject?

A

SQ into thigh, abdomen or upper arms

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10
Q

Name the 3 oral CGRP inhibitor drugs

A

Qulipta - for migraine prevention

Ubrelvy - migraine treatment

Nurtec ODT - for treatment and prevention

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11
Q

Qulipta indication

How to take?

A

Take daily to prevent migraine

  • take with or without food
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12
Q

How to take Qulipta

A

With or without food

  • avoid grapefruit juice
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13
Q

Ubrelvy indication

A

Migraine treatment

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14
Q

Ubrelvy dosing

A

50 to 100 mg at onset of migraine, may repeat in 2 hours if needed max 200 mg

** similar to sumatriptan

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15
Q

Qulipta side effects 3

A

The large work que makes me want to throw up NAUSEA and CONSTIPATION. It makes me TIRED when the que is finished.

Think: GI side effects ***

Nausea constipation

Fatigue

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16
Q

Ubrelvy common side effects 2

A

Nausea
Fatigue

** nausea and fatigue seems to be a class effect
* class: Ubrelvy, Nurtec, Qulipta

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17
Q

Oral CGRP inhibitors seem to cause

Nurtec
Qulipta
Ubrelvy

A

All may cause Fetal Harm - if pregnant must inform doctor

  • all cause nausea, can be taken with or without food
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18
Q

Colace drug class

A

Emollient laxative - pulls water and fat into the stool

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19
Q

Can I take colace and mineral oil at same time?

A

No, increase absorption of mineral oil

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20
Q

How do I take colace liquid?

A

Shake well, mix with milk or fruit juice before taking to prevent throat irritation

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21
Q

Colace common side effect #1

A

Stomach cramp

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22
Q

Trintillex generic

A

Vortioxetine

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23
Q

Trintellix dosing

A

Once daily with or without food

  • max 20 mg per day
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24
Q

Trintellex side effect #2

A

Think GI: NAusea, vomiting and diarrhea

  • may cause dizziness

** in study, should not affect driving

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25
Q

Weight gain & sexual dysfunction are concerns related to antidepressants in general, how is trintellix?

A

Trintellix is weight neutral and seems to be least likely to cause sexual dysfunction

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26
Q

Trintellix drug class and simple moa

A

Serotonin modulator
* inhibit reuptake of serotonin
* like fluoxetine
* same class as trazodone

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27
Q

Trintellix pregnancy and lactation

A

No. May cause harm

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28
Q

Trintellix how to take

A

With or without food but swallow whole do not crush or chew

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29
Q

Warning associated with serotonin modulators #5
* Trintellix
* trazodone
* viibryd

A
  1. Suicidal thoughts
  2. Serotonin syndrome
  3. Increase risk for bleeding
    * nsaid, warfarin
  4. Pregnancy & lactation
  5. Glaucoma patient
    * report eye pain, redness or chance in vision
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30
Q

Serotonin syndrome symptoms

A

Think fast and slow movements

Fast heart rate (palpitations)

Sweating

Confusion - too much fast

Muscle stiffness & spasms

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31
Q

Viibryd generic

A

Vilazodone

  • think trazodone
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32
Q

How to take viibryd

A

Take with Food ** must

  • relate to trazodone with food
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33
Q

Viibryd drug class and moa

A

Serotonin modulator

It’s a serotonin reuptake inhibitor and serotonin agonist at receptor

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34
Q

Viibryd side effects #3

A

A bird with DIARRHEA poops on me, makes me NAUSEA and can’t sleep with poop INSOMNIA. Since I can’t sleep, it makes me TIRED (somnolence)

Think first: Diarrhea

Nausea vomiting diarrhea

Insomnia

** can cause sedation

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35
Q

Januvia

A

Sitagliptan

** DPP-4 inhibitor

  • inhibit enzyme that breaks down incretin glp-1 and GIP. Responsible for insulin release in response to meal
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36
Q

Januvia drug class

A

DPP-4 inhibitor

  • inhibit enzyme that breaks down incretin glp-1 and gip
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37
Q

What does incretin do to your body?

GLP-1 and GIP

A

Stimulate insulin release
Decrease glucagon level
Delay gastric empty- feel full

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38
Q

Januvia side effects 3

A

Upper respiratory tract infection

Nose and throat flu symptoms
* running nose, sneezing

Edema - report in case HF and kidney

Headache

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39
Q

Hallmark symptom of acute pancreatitis

A

Persistent severe abdominal pain, sometimes goes to your back and may or may not have vomiting

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40
Q

Warning for Januvia or DPP-4 inhibitor drug class #6

A

Pancreatitis

Heart failure- report shb or edema

Joint pain

Blisters and peeling

Acute kidney failure
* look for edema, change in urine output

Hypoglycemia when combined with sulfonylurea

** these are things patients should watch for **

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41
Q

Alogliptan brand name

A

Nesina

  • dpp4 inhibitor
  • inhibit enzyme that breaks down incretin
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42
Q

DPP-4 inhibitor

Monitor?

A

Pancreatitis
Heart failure
Liver toxicity
Kidney acute failure

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43
Q

Alogliptin most common side effects 3

A

Upper respiratory tract infection

Nasal throat symptoms flu like

Headache

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44
Q

2 classic symptoms of heart failure

A
  1. Shortness of breath- unable to walk far distance ** think of your dad
  2. Swelling of feet ** remember your dad
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45
Q

How to take Januvia

A

Once daily anytime with or without food

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46
Q

How to take alogliptan

A

Once daily anytime with or without food

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47
Q

Onglyza generic

A

Saxagliptan

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48
Q

Onglyza drug class

A

DPP-4 inhibitor

  • inhibit enzyme that breaks down incretin
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49
Q

Onglyza how to take

A

Once daily anytime with or without food

** do not spit or cut***
Film coated tablet

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50
Q

Onglyza side effects 3

A

Upper respiratory tract infection

Urinary tract infection
*** different than Januvia, not listed but Januvia has nasopharyngitis

Headache

** watch for edema

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51
Q

How to take alogliptan

A

Once daily anytime with or without food

** do not cut or chew swallow whole **

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52
Q

Belsomra moa

A

Orexin receptor antagonist

** orexin (a peptide or transmitter) is responsible for WAkefullness

** orexin is a wake prompting neurotransmitter

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53
Q

Belsomra

How do I take it? Consultation point

A

Take 30 minutes before bed

Best on empty stomach, but can be with or without food- food delays onset

Make sure you have 7 hours before needing to wake up

Main side effect: somnolence (tire)

If you drink alcohol that evening, do not take belsomra

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54
Q

Belsomra main side effect & 3 other common side effects

A

Main: Somnolence

Abnormal dream

Dry mouth, upper respiratory infection

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55
Q

Belsomra 5 warnings

A

Daytime sedation - decrease alertness and awareness

Suicidal thoughts- change in thoughts or mood

Sleep walking, sleep driving or engaging in activity while not fully awake

Sleep paralysis - an inability to move or speak for up to several minutes

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56
Q

Tradjenta

A

Linagliptin

  • DPP-4 inhibitor
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57
Q

Tradjenta warnings 5

** apply to all DPP-4 inhibitors

A

Pancreatitis - d/c and consult doctor

Hypoglycemia - when combined with sulfonylurea

Joint pain - report

Blister - stop consult

Heart failure- shortness of breath or edema

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58
Q

How do I take tradjenta

A

Take once daily anytime with or without food

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59
Q

Tradjenta side effects 3

A
  1. Nasopharyngitis - stuffy nose & sore throat
  2. Diarrhea
  3. Cough
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60
Q

Bullous pemphigold

A

Large fluid filled blister

  • can’t be cure but can be treated
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61
Q

Nasopharyngitis symptoms

A

Stuffing nose

Sore throat

Cough

62
Q

Name 3 SGLT2 inhibitors

A
  1. Faxiga dapagliflozin
  2. Invokana canagliflozin
  3. Jardiance ** (empagliflozin)
63
Q

Explain how SGLT-2 work
Sodium glucose co-transporter 2

** Jardiance

A

SGLT-2 is the main transporter responsible for reabsorption of glucose back into circulation

By blocking SGLT-2, you increase excretion of glucose in your urine reducing blood glucose

64
Q

Jardiance 2 indication

A
  1. Diabetes
  2. HF
    * Jardiance also increase sodium excretions, decreasing blood volume good for HF
  • Jardiance increase urination
65
Q

Jardiance is not indicated for people 2

A
  1. Type 1 diabetes
    ** increase risk for keto acidosis
  2. Pt on dialysis
    ** needs kidney function
66
Q

How to take Jardiance

A

Take in the Morning ** with or without food

67
Q

Jardiance most common side effects 2

A
  1. UTI
  2. Yeast infection

Other:
3. Upper respiratory tract infection

  1. Increase urinating
68
Q

Net effects of Jardiance 2

A

Increase glucose excretion

Increase sodium excretion

69
Q

Jardiance most important information to remember 4

A

UTI - maybe serious

Hypoglycemia- especially when combined with insulin or sulfonylurea

Skin infection of skin around genital or anal area
** Fournier’s Gangrene

Yeast infection

70
Q

Warnings associated with Jardiance and SGLT-2

  • farxiga
  • invokana
  • Jardiance
A

Keto acidosis

Dehydration- volume depletion

Urinary tract infection

Hypoglycemia

Skin infection of genital or anal areas
* pain, tenderness, redness or swelling in that areas
* called Fournier gangrene

71
Q

What is keto acidosis and symptoms to help recognize

How serious?

A

High level of ketone in blood or urine

Symptoms: nausea vomiting abdominal pain, fatigue or shortness of breath

Needs to treated in hospital, can be fatal leading to death

72
Q

Farxiga indication

A

Diabetes

Heart failure

Reduce worsening of kidney
*** but can cause acute kidney injury

73
Q

Farxiga side effects 4

A

Yeast infection or UTI

Nasopharyngitis- stuffy nose, running nose, cough or sore throat

More urinating- related to moa

Hypoglycemia- related to moa and increase when taking insulin or other diabetes medications

74
Q

SGLT2 inhibitor pregnancy and lactation

A

Not recommended

If pregnant must inform doctor

75
Q

How to take farxiga

A

Take once daily with or without food

** once daily - was not time specific

Jardiance - take in Morning with or without food

Invokana - best taken before 1st meal

76
Q

Invokana

A

Canagliflozin

SGLT2 inhibitor

77
Q

Invokana indication

A

Diabetes

Reduce risk of stroke or heart attack in patients with diabetes

Reduce risk of end stage renal disease or worsening of kidney
* may cause acute kidney injury

78
Q

Invokana side effects

  • similar as other SGLT2 inhibitor
A

Yeast & UTI infection

Increase urinating

*** abdominal pain - not listed under Jardiance or farxiga

79
Q

Invokana warnings
Compare to other SGLT2 inhibitor, what is different

A

** risk of lower limb amputation - monitor pain, tenderness, sores or ulcers of lower limb or toes

** bone fracture

Keto acidosis
Dehydration - volume depletion
UTI
Hypoglycemia
Fournier gangrene
* skin infection of genital or anal area

80
Q

SGLT2 inhibitors, difference in how you take them and their warnings

Jardiance
Invokana
Farxiga

A

Jardiance
* take in the morning with or without food
* approve for heart failure

Farxiga
* take with or without food, did not specify morning

Invokana
* take before 1st meal
* risk of lower limb amputation and bone fracture- reported in study

81
Q

3 peripheral opioid antagonists use to treat opioid induced constipation IOC

  • peripheral - not within the CNS
  • these drugs will not cross blood brain barrier effectively
A

Symproic (naldemedine) 2017

Movantik (naloxegol)

Relistor (methyl naltrexone)

82
Q

Symproic

Generic & drug class

A

Naldemedine

Peripheral opioid antagonist- for opioid induced constipation

83
Q

Symproic dose

A

Take 0.2 mg once daily with or without food

  • stop if opioid treatment is stop
84
Q

Symproic side effects 3

A

Abdominal pain: if severe or persistent, stop and contact doctor

Nausea

Diarrhea- if severe stop & call doctor

85
Q

Symproic most important information 2

A

Can cause tearing of stomach or intestinal wall
* report severe or worsening AP

Opioid withdrawal symptoms
* sweating, chills, flushing
* sneezing
* NVD and AP
* report to doctor

86
Q

Symproic moa

A

Mu receptor antagonist, decreased constipating affect of opioid

  • opioid decreases GI motility
  • symproic blocks mu opioid gut receptors (competitive)
87
Q

How is symproic related to naltrexone?

A

Naldemedine is a derivative of naltrexone by adding a side chain

This side increase naldemedine weight and reduce its ability to cross the blood brain barrier BBB

88
Q

What is p-glycoprotein transporter

A

These are transporter that pumps drug out of the CNS brain

89
Q

Movantik

Generic & drug class

A

Naloxegol

Peripheral opioid antagonist for OIP

90
Q

How to take Movantik

A

Take on Empty Stomach at least 1 hr prior to first meal or 2 hrs after 1st meal

Tablet can be crushed

Avoid grapefruit or grapefruit juice

91
Q

Movantik side effects 3

A

Ab pain - if severe, persistent or worsening contact doctor

GI: NVD , gas

  1. Headache
92
Q

Relistor
Movantik
Symproic

3 warnings

A
  1. Tear in stomach or intestinal wall
    * report severe worsening AP
  2. Opioid withdrawal symptoms
    * sweat, chill, flushing, NVD, AP, sneezing
  3. Severe abdominal pain and diarrhea
93
Q

Relistor generic & drug class

A

Methylnaltrexone

Peripheral opioid antagonist to treat opioid induced constipation

94
Q

Relistor how to take

A

Take at least 30 minutes prior to first meal

Take on empty stomach with Plain water

95
Q

Relistor side effects 2

A
  1. GI: AP NVD - could be related to withdrawal symptoms
  2. Headache
96
Q

Relistor
Movantik
Symproic

Differences

A

Symproic
* take with or without food

Movantik
* empty stomach, 1 hr prior to first meal or 2 hours after
*** drug interaction- contraindicated with strong CYP3a4 inhibitor (clarithomycin, ketoconazole)

Relistor
* 30 minutes prior to meal, empty stomach
* stay close to bathroom once starting

All : avoid in pregnancy & lactation

97
Q

Multaq

Generic & drug class

A

Dronedarone

Atrial fibrillation anti arrhythmia

98
Q

Multaq consultation 4

A

Take with food morning and evening meal
* do not take with grapefruit juice

Most common side effects: Diarrhea
Nausea vomiting Ab Pain

Report: edema or weight gain, or new shortness of breath

May affect
Liver: jaundice, dark urine
Lung: SHB, dry cough
Kidney: change in urine output

99
Q

Multaq

How to take

A

Take twice daily with MEAL

  • do not take with grapefruit or grapefruit juice
100
Q

Which organs affected by Multaq

A

Liver
Lung
Kidney
Heart-new or worsening HF

101
Q

Is Multaq safe in pregnancy and lactation

A

No. Multaq is a teratogen

102
Q

Risk of Multaq

A

Can cause new onset HF or worsening HF

  • watch for wt gain, edema, shb
103
Q

Can you cut suboxone film?

A

No not recommended to cut

104
Q

Lotemax

Generic and drug class

A

Loteprednol

Opthalamic corticosteroid
* inhibit the inflammation process

105
Q

Lotemax indication 2

A

Eye inflammation

Post operative eye inflammation
* begin 24 hours after surgery

106
Q

Lotemax common side effects 3

A

Blurry vision

Burning on administer

Dry eye

** can increase IOP, short term use only

107
Q

Lotemax consulting

A

For eye inflammation, redness swelling

Make sure not to touch tip of dropper

May cause: blurry vision, burning and dry eye

** if condition worsens after 2 days, let your doctor know

108
Q

Lotemax dosing frequency

A

QID

109
Q

Soliqua

Generic and drug class
Indication

A

Insulin glargine + lixisenatide

Long acting human insulin analog and GLP1 receptor agonist

For type 2 DM not for type 1 dm

110
Q

Soliqua dosing and administration

A

SQ once daily in the morning

Inject within 1 hour of first meal

111
Q

Soliqua most common side effects 4

A
  1. Think NAUSEA
  2. Hypoglycemia
  3. GI: NVD
  4. Sinus: stuffy nose, sneezing, cough sore throat

** increase risk of upper respiratory tract infection

112
Q

Soliqua warnings 5

A

Pancreatitis

Hypoglycemia

Gallbladder gallstone

Acute kidney injury

Hypokalemia

113
Q

Define lipoatropy

A

Depression of skin

114
Q

Define lipohypertrophy

A

Thickening of skin

115
Q

Gallstone symptoms 3

A

Pain in upper abdomen

Jaundice

Clay colored stool

116
Q

Soliqua consultation tips

A

For diabetes

Inject within 1 hour to first meal
* once inject, must eat in the next hour 60 minutes

Side effects: NAusea , diarrhea
* increase risk for upper respiratory tract infection and symptoms
* stuffy nose, sneezing coughing sore throat

Can cause hypoglycemia

** monitor for pancreatitis

117
Q

Soliqua delay gastric emptying, which drug is affected

A

Birth control meds
Tylenol
Antibiotics

Take 1 hour PT Soliqua or 11 hours after Soliqua, absorption may be affected

118
Q

Dymista

Generic & indication

A

Azelastine + fluticasone nasal spray

For seasonal allergy

119
Q

Dymista dosing

A

1 spray each nostril twice a day

** think Flonase: max BID

120
Q

Dymista warnings 4

A

Somnolence - may cause drowsiness, use caution when driving

Alcohol - can decrease alertness

Epistaxis - nosebleed

Glaucoma & cataract - have been associated with the use of nasal corticosteroid

121
Q

How to use Dymista

A

Shake bottle gently

Prime pump first until fine mist

Tilt head forward not backward to prevent going to back of throat

Pinch other nostril

Gently breath through nostrils

122
Q

Dymista consultation 4

A

For allergy, running nose sneezing

Shake gently, tilt head forward not backward, insert and pinch other nostril, spray then breath through nostril gently

May cause
* drowsiness , cautions driving & alcohol
* nose bleed
* taste change
* headache

123
Q

Intuniv moa

A

A central alpha-2 adrenergic receptor agonist

  • similar to clonidine
  • Intuniv moa in adhd is unknown

Guanfacine is a known anti hypertensive agent

  • NE output
  • decrease peripheral vascular resistance and decrease heart rate
124
Q

Phenelzine

Brand name

Drug class & indication

A

Nardil

MAO-I inhibitor

For people with anxiety, depression and phobic

** not first line, only for patient who had failed other medications

125
Q

Phenelzine common side effects

A

CNS: dizzy, drowsy, tired

Dry mouth

Weight gain, edema

Sexual dysfunction

** has lots of side effects **

126
Q

How to take Phenelzine

A

Can take with or without food

** avoid coffee - can increase blood pressure

127
Q

Warning with Phenelzine

A

Hypertensive crisis

  • avoid food high in tyramine & dopamine (food that had been fermented)
  • cheese, beer, wine, etc
  • avoid stimulant (Adderall, cocaine)
  • avoid OTC medications - need to check interaction first
128
Q

Perseris

Generic & indication

A

Risperidone injection

Once monthly

129
Q

Stiolto respimat

Generic
Indication & dosing

A

Tiotropium & olodaterol

Once daily for COPD

Tiotropium - LAMA (long acting muscarinic antagonist)

Olodaterol (long acting beta agonist)

Tiotropium is Spiriva

Olodaterol is Striverdi

130
Q

Spiriva (tiotropium) moa

A

Long acting muscarinic antagonist

** inhibit M3 receptor (muscarinic) at smooth muscle in lung , leading to bronchodilation

131
Q

Cosopt

Generic

Indication & dosing

A

Cosopt has company

Dorzolamide & timolol

Twice a day for glaucoma

Dorzolamide is Trusopt

Timolol is betimol, timoptic

132
Q

Trusopt

Generic

Dosing & indication

A

Trusopt is the “true” one, only one

Dorzolamide

Three times a day for glaucoma

Dorzolamide is a carbonic anhydrase inhibitor ** decrease production of fluid

133
Q

Azopt

Generic

Dosing & indication

A

Brinzolamide

** both have z in name

3 times a day for glaucoma

Brinzolamide is a carbonic anhydrase inhibitor

134
Q

Simbrinza

Generic

Dosing & indication

A

Simbrinza = 2 b

Brinzolamide & brimonidine

3 times a day for glaucoma

135
Q

Yupelri (revefenacin)

Drug class

Dosing & indication

A

Antimuscarinic - blocks M3 muscarinic receptor leading to bronchodilation

Neb once daily for COPD

  • same as tiotropium but nebulize
136
Q

Yupelri

Common side effect 1

A

Nasopharyngitis symptoms
* sneezing
* cough
* stuffy nose

Upon use, if symptoms worsen, stop and get medical help

137
Q

Ongentys (opicapone)

Dosing & indication

A

Give at night on empty stomach, 1 hr before or 1 hr after meal

Give with carbidopa / levodopa (sinemet)

  • adjunct treatment for Parkinson’s - it’s an add-on treatment, but not to treat by itself
138
Q

Adjunct treatment means

A

Give with other drugs, does not work by itself

** ongentys

139
Q

How to take ongentys

A

Empty stomach 1 hour before or 1 hour after meal

Give with carbidopa / levodopa

140
Q

Ongentys

Moa

Why must it given with carbidopa & levodopa?

A

COMT - an enzyme that breaks down dopamine
* dopamine is needed in PK pt

Ongentys blocks this enzyme COMT
* stops the breakdown of dopamine, more dopamine available

Carbidopa/levodopa = levodopa is the precursor to dopamine

Given with sinemet, more dopamine for CNS

141
Q

Carbidopa/levodopa (sinemet)

Indication

Explain each components of sinemet

A

For Parkinson’s

Levodopa - is dopamine, converted to dopamine

Carbidopa - blocks conversation of levodopa to dopamine outside of CNS (peripheral); inhibits peripheral side effects

142
Q

Ongentys warnings 4

A
  1. Falling asleep without been drowsy or without warning (somnolence)
  2. Lower BP
  3. Hallucination or psychosis - mood change
  4. Unusual urge & the inability to control these urge
143
Q

Ongentys side effects 4

A
  • constipation
  • decrease BP and Weight

Dyskinesia- abnormalities in voluntary movements

144
Q

Tardive dyskinesia

A

Involuntary rolling of tongue

Twitching of face or limb

  • side effects of antipsychotics drugs
145
Q

Max Nurtec tablets per month

A

18 Tablets

146
Q

What is stiolto respimat use for

A

Copd

147
Q

Stiolto dosing

A

2 puffs QD max 2 puffs

148
Q

Generic for stiolto respimat

A

Tiotropium + olodaterol

Tiotropium = Spiriva
Olodaterol = Striverdi

149
Q

Stiolto moa

A

Long acting muscarinic antagonist plus long acting beta agonist

LAMA + LABA

Stiolto = tiotropium + olodaterol

Tiotropium is a LAMA

Olodaterol is a LABA

Both helps relax and keep airway opened

150
Q

Stiolto side effects 3

A

Nasopharyngitis
* nose and Throat infection

Cough

Back pain (unique)

Drug (12 decks)

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