New Drug Encounter #2 Flashcards
Nurtec ODT (rimegepant) indication
Migraine treatment
* QD for 1 dose max 75 mg/day
Migraine prophylaxis
* QOD max 18 tablets per month
Nurtec moa simplify
Blocks a vasodilator in the brain
* more active during migraine
Blocks receptor of calcitonin gene related peptide CGRP
Class: CGRP inhibitor
Nurtec side effects THINK
N for nausea & abdominal pain
GI only: Nausea & abdominal pain
How long does it take for nurtec to work
May take up to 2 hours
** Triptan - repeat in 2 hours if needed *
How effective is Nurtec preventative?
Prevents about 1 migraine day per month
- one less migraine per month
I have a migraine while taking nurtec every other day as a preventative, what should I do?
For breakthrough, use NSAID or triptan
Rare side effect associated with nurtec or CGRP inhibitor drug class?
Rare BP spike, especially when just starting
- monitor blood pressure & inform your doctor
Report if you have CP, SHB or vision change
Injectable CGRP inhibitor #3
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
Aimovig
Ajovy
Emgality
How and where to inject?
SQ into thigh, abdomen or upper arms
Name the 3 oral CGRP inhibitor drugs
Qulipta - for migraine prevention
Ubrelvy - migraine treatment
Nurtec ODT - for treatment and prevention
Qulipta indication
How to take?
Take daily to prevent migraine
- take with or without food
How to take Qulipta
With or without food
- avoid grapefruit juice
Ubrelvy indication
Migraine treatment
Ubrelvy dosing
50 to 100 mg at onset of migraine, may repeat in 2 hours if needed max 200 mg
** similar to sumatriptan
Qulipta side effects 3
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
Ubrelvy common side effects 2
Nausea
Fatigue
** nausea and fatigue seems to be a class effect
* class: Ubrelvy, Nurtec, Qulipta
Oral CGRP inhibitors seem to cause
Nurtec
Qulipta
Ubrelvy
All may cause Fetal Harm - if pregnant must inform doctor
- all cause nausea, can be taken with or without food
Colace drug class
Emollient laxative - pulls water and fat into the stool
Can I take colace and mineral oil at same time?
No, increase absorption of mineral oil
How do I take colace liquid?
Shake well, mix with milk or fruit juice before taking to prevent throat irritation
Colace common side effect #1
Stomach cramp
Trintillex generic
Vortioxetine
Trintellix dosing
Once daily with or without food
- max 20 mg per day
Trintellex side effect #2
Think GI: NAusea, vomiting and diarrhea
- may cause dizziness
** in study, should not affect driving
Weight gain & sexual dysfunction are concerns related to antidepressants in general, how is trintellix?
Trintellix is weight neutral and seems to be least likely to cause sexual dysfunction
Trintellix drug class and simple moa
Serotonin modulator
* inhibit reuptake of serotonin
* like fluoxetine
* same class as trazodone
Trintellix pregnancy and lactation
No. May cause harm
Trintellix how to take
With or without food but swallow whole do not crush or chew
Warning associated with serotonin modulators #5
* Trintellix
* trazodone
* viibryd
- Suicidal thoughts
- Serotonin syndrome
- Increase risk for bleeding
* nsaid, warfarin - Pregnancy & lactation
- Glaucoma patient
* report eye pain, redness or chance in vision
Serotonin syndrome symptoms
Think fast and slow movements
Fast heart rate (palpitations)
Sweating
Confusion - too much fast
Muscle stiffness & spasms
Viibryd generic
Vilazodone
- think trazodone
How to take viibryd
Take with Food ** must
- relate to trazodone with food
Viibryd drug class and moa
Serotonin modulator
It’s a serotonin reuptake inhibitor and serotonin agonist at receptor
Viibryd side effects #3
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
Januvia
Sitagliptan
** DPP-4 inhibitor
- inhibit enzyme that breaks down incretin glp-1 and GIP. Responsible for insulin release in response to meal
Januvia drug class
DPP-4 inhibitor
- inhibit enzyme that breaks down incretin glp-1 and gip
What does incretin do to your body?
GLP-1 and GIP
Stimulate insulin release
Decrease glucagon level
Delay gastric empty- feel full
Januvia side effects 3
Upper respiratory tract infection
Nose and throat flu symptoms
* running nose, sneezing
Edema - report in case HF and kidney
Headache
Hallmark symptom of acute pancreatitis
Persistent severe abdominal pain, sometimes goes to your back and may or may not have vomiting
Warning for Januvia or DPP-4 inhibitor drug class #6
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 **
Alogliptan brand name
Nesina
- dpp4 inhibitor
- inhibit enzyme that breaks down incretin
DPP-4 inhibitor
Monitor?
Pancreatitis
Heart failure
Liver toxicity
Kidney acute failure
Alogliptin most common side effects 3
Upper respiratory tract infection
Nasal throat symptoms flu like
Headache
2 classic symptoms of heart failure
- Shortness of breath- unable to walk far distance ** think of your dad
- Swelling of feet ** remember your dad
How to take Januvia
Once daily anytime with or without food
How to take alogliptan
Once daily anytime with or without food
Onglyza generic
Saxagliptan
Onglyza drug class
DPP-4 inhibitor
- inhibit enzyme that breaks down incretin
Onglyza how to take
Once daily anytime with or without food
** do not spit or cut***
Film coated tablet
Onglyza side effects 3
Upper respiratory tract infection
Urinary tract infection
*** different than Januvia, not listed but Januvia has nasopharyngitis
Headache
** watch for edema
How to take alogliptan
Once daily anytime with or without food
** do not cut or chew swallow whole **
Belsomra moa
Orexin receptor antagonist
** orexin (a peptide or transmitter) is responsible for WAkefullness
** orexin is a wake prompting neurotransmitter
Belsomra
How do I take it? Consultation point
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
Belsomra main side effect & 3 other common side effects
Main: Somnolence
Abnormal dream
Dry mouth, upper respiratory infection
Belsomra 5 warnings
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
Tradjenta
Linagliptin
- DPP-4 inhibitor
Tradjenta warnings 5
** apply to all DPP-4 inhibitors
Pancreatitis - d/c and consult doctor
Hypoglycemia - when combined with sulfonylurea
Joint pain - report
Blister - stop consult
Heart failure- shortness of breath or edema
How do I take tradjenta
Take once daily anytime with or without food
Tradjenta side effects 3
- Nasopharyngitis - stuffy nose & sore throat
- Diarrhea
- Cough
Bullous pemphigold
Large fluid filled blister
- can’t be cure but can be treated
Nasopharyngitis symptoms
Stuffing nose
Sore throat
Cough
Name 3 SGLT2 inhibitors
- Faxiga dapagliflozin
- Invokana canagliflozin
- Jardiance ** (empagliflozin)
Explain how SGLT-2 work
Sodium glucose co-transporter 2
** Jardiance
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
Jardiance 2 indication
- Diabetes
- HF
* Jardiance also increase sodium excretions, decreasing blood volume good for HF
- Jardiance increase urination
Jardiance is not indicated for people 2
- Type 1 diabetes
** increase risk for keto acidosis - Pt on dialysis
** needs kidney function
How to take Jardiance
Take in the Morning ** with or without food
Jardiance most common side effects 2
- UTI
- Yeast infection
Other:
3. Upper respiratory tract infection
- Increase urinating
Net effects of Jardiance 2
Increase glucose excretion
Increase sodium excretion
Jardiance most important information to remember 4
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
Warnings associated with Jardiance and SGLT-2
- farxiga
- invokana
- Jardiance
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
What is keto acidosis and symptoms to help recognize
How serious?
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
Farxiga indication
Diabetes
Heart failure
Reduce worsening of kidney
*** but can cause acute kidney injury
Farxiga side effects 4
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
SGLT2 inhibitor pregnancy and lactation
Not recommended
If pregnant must inform doctor
How to take farxiga
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
Invokana
Canagliflozin
SGLT2 inhibitor
Invokana indication
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
Invokana side effects
- similar as other SGLT2 inhibitor
Yeast & UTI infection
Increase urinating
*** abdominal pain - not listed under Jardiance or farxiga
Invokana warnings
Compare to other SGLT2 inhibitor, what is different
** 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
SGLT2 inhibitors, difference in how you take them and their warnings
Jardiance
Invokana
Farxiga
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
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
Symproic (naldemedine) 2017
Movantik (naloxegol)
Relistor (methyl naltrexone)
Symproic
Generic & drug class
Naldemedine
Peripheral opioid antagonist- for opioid induced constipation
Symproic dose
Take 0.2 mg once daily with or without food
- stop if opioid treatment is stop
Symproic side effects 3
Abdominal pain: if severe or persistent, stop and contact doctor
Nausea
Diarrhea- if severe stop & call doctor
Symproic most important information 2
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
Symproic moa
Mu receptor antagonist, decreased constipating affect of opioid
- opioid decreases GI motility
- symproic blocks mu opioid gut receptors (competitive)
How is symproic related to naltrexone?
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
What is p-glycoprotein transporter
These are transporter that pumps drug out of the CNS brain
Movantik
Generic & drug class
Naloxegol
Peripheral opioid antagonist for OIP
How to take Movantik
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
Movantik side effects 3
Ab pain - if severe, persistent or worsening contact doctor
GI: NVD , gas
- Headache
Relistor
Movantik
Symproic
3 warnings
- Tear in stomach or intestinal wall
* report severe worsening AP - Opioid withdrawal symptoms
* sweat, chill, flushing, NVD, AP, sneezing - Severe abdominal pain and diarrhea
Relistor generic & drug class
Methylnaltrexone
Peripheral opioid antagonist to treat opioid induced constipation
Relistor how to take
Take at least 30 minutes prior to first meal
Take on empty stomach with Plain water
Relistor side effects 2
- GI: AP NVD - could be related to withdrawal symptoms
- Headache
Relistor
Movantik
Symproic
Differences
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
Multaq
Generic & drug class
Dronedarone
Atrial fibrillation anti arrhythmia
Multaq consultation 4
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
Multaq
How to take
Take twice daily with MEAL
- do not take with grapefruit or grapefruit juice
Which organs affected by Multaq
Liver
Lung
Kidney
Heart-new or worsening HF
Is Multaq safe in pregnancy and lactation
No. Multaq is a teratogen
Risk of Multaq
Can cause new onset HF or worsening HF
- watch for wt gain, edema, shb
Can you cut suboxone film?
No not recommended to cut
Lotemax
Generic and drug class
Loteprednol
Opthalamic corticosteroid
* inhibit the inflammation process
Lotemax indication 2
Eye inflammation
Post operative eye inflammation
* begin 24 hours after surgery
Lotemax common side effects 3
Blurry vision
Burning on administer
Dry eye
** can increase IOP, short term use only
Lotemax consulting
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
Lotemax dosing frequency
QID
Soliqua
Generic and drug class
Indication
Insulin glargine + lixisenatide
Long acting human insulin analog and GLP1 receptor agonist
For type 2 DM not for type 1 dm
Soliqua dosing and administration
SQ once daily in the morning
Inject within 1 hour of first meal
Soliqua most common side effects 4
- Think NAUSEA
- Hypoglycemia
- GI: NVD
- Sinus: stuffy nose, sneezing, cough sore throat
** increase risk of upper respiratory tract infection
Soliqua warnings 5
Pancreatitis
Hypoglycemia
Gallbladder gallstone
Acute kidney injury
Hypokalemia
Define lipoatropy
Depression of skin
Define lipohypertrophy
Thickening of skin
Gallstone symptoms 3
Pain in upper abdomen
Jaundice
Clay colored stool
Soliqua consultation tips
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
Soliqua delay gastric emptying, which drug is affected
Birth control meds
Tylenol
Antibiotics
Take 1 hour PT Soliqua or 11 hours after Soliqua, absorption may be affected
Dymista
Generic & indication
Azelastine + fluticasone nasal spray
For seasonal allergy
Dymista dosing
1 spray each nostril twice a day
** think Flonase: max BID
Dymista warnings 4
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
How to use Dymista
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
Dymista consultation 4
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
Intuniv moa
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
Phenelzine
Brand name
Drug class & indication
Nardil
MAO-I inhibitor
For people with anxiety, depression and phobic
** not first line, only for patient who had failed other medications
Phenelzine common side effects
CNS: dizzy, drowsy, tired
Dry mouth
Weight gain, edema
Sexual dysfunction
** has lots of side effects **
How to take Phenelzine
Can take with or without food
** avoid coffee - can increase blood pressure
Warning with Phenelzine
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
Perseris
Generic & indication
Risperidone injection
Once monthly
Stiolto respimat
Generic
Indication & dosing
Tiotropium & olodaterol
Once daily for COPD
Tiotropium - LAMA (long acting muscarinic antagonist)
Olodaterol (long acting beta agonist)
Tiotropium is Spiriva
Olodaterol is Striverdi
Spiriva (tiotropium) moa
Long acting muscarinic antagonist
** inhibit M3 receptor (muscarinic) at smooth muscle in lung , leading to bronchodilation
Cosopt
Generic
Indication & dosing
Cosopt has company
Dorzolamide & timolol
Twice a day for glaucoma
Dorzolamide is Trusopt
Timolol is betimol, timoptic
Trusopt
Generic
Dosing & indication
Trusopt is the “true” one, only one
Dorzolamide
Three times a day for glaucoma
Dorzolamide is a carbonic anhydrase inhibitor ** decrease production of fluid
Azopt
Generic
Dosing & indication
Brinzolamide
** both have z in name
3 times a day for glaucoma
Brinzolamide is a carbonic anhydrase inhibitor
Simbrinza
Generic
Dosing & indication
Simbrinza = 2 b
Brinzolamide & brimonidine
3 times a day for glaucoma
Yupelri (revefenacin)
Drug class
Dosing & indication
Antimuscarinic - blocks M3 muscarinic receptor leading to bronchodilation
Neb once daily for COPD
- same as tiotropium but nebulize
Yupelri
Common side effect 1
Nasopharyngitis symptoms
* sneezing
* cough
* stuffy nose
Upon use, if symptoms worsen, stop and get medical help
Ongentys (opicapone)
Dosing & indication
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
Adjunct treatment means
Give with other drugs, does not work by itself
** ongentys
How to take ongentys
Empty stomach 1 hour before or 1 hour after meal
Give with carbidopa / levodopa
Ongentys
Moa
Why must it given with carbidopa & levodopa?
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
Carbidopa/levodopa (sinemet)
Indication
Explain each components of sinemet
For Parkinson’s
Levodopa - is dopamine, converted to dopamine
Carbidopa - blocks conversation of levodopa to dopamine outside of CNS (peripheral); inhibits peripheral side effects
Ongentys warnings 4
- Falling asleep without been drowsy or without warning (somnolence)
- Lower BP
- Hallucination or psychosis - mood change
- Unusual urge & the inability to control these urge
Ongentys side effects 4
- constipation
- decrease BP and Weight
Dyskinesia- abnormalities in voluntary movements
Tardive dyskinesia
Involuntary rolling of tongue
Twitching of face or limb
- side effects of antipsychotics drugs
Max Nurtec tablets per month
18 Tablets
What is stiolto respimat use for
Copd
Stiolto dosing
2 puffs QD max 2 puffs
Generic for stiolto respimat
Tiotropium + olodaterol
Tiotropium = Spiriva
Olodaterol = Striverdi
Stiolto moa
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
Stiolto side effects 3
Nasopharyngitis
* nose and Throat infection
Cough
Back pain (unique)
