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New Drug Encounter #3 Flashcards

1
Q

Hydralazine

Drug class

How to take it?

A

Vasodilator - relaxed peripheral smooth muscle

Take with or without food
* be consistent

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2
Q

How to take hydralazine

A

Take with or without food, but be consistent
* food can increase absorption

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3
Q

Hydralazine common side effects

A
  1. Headache- all nitrate cause this
  2. Fast heartbeat
  • all related to vasodilation

Can cause GI symptoms: nausea

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4
Q

Hydralazine consultation 3

A

For blood pressure - dilate blood vessels

Take with or without food, be consistent

Side effects: HA, fast Heart Rate, and nausea

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5
Q

Isosorbide mononitrate

Drug class

Dosing IR vs ER

A

Class: nitrate, vasodilator

IR - twice daily, ** dose every 7 hours apart not every 12 hours
** need 12 hours nitrate free period to avoid tolerance

ER - once daily in the morning

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6
Q

How to take isosorbide mononitrate?

A

Take in the morning with or without food

** if dose twice daily, dose every 7 hours, not every 12 hours

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7
Q

Isosorbide mononitrate or nitrate side effects 2

A

Headache - an indication drug is working, can take Tylenol, will not affect drug effectiveness

Dizzy or lightheaded - upon standing

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8
Q

IMDUR or nitrate one interaction to remember

A

Viagra

  • can cause vasodilation, dangerous low blood pressure
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9
Q

IMDUR consultation

A

For chest pain or prevention

Take in morning with or without food

May cause headache, dizziness

** if dose twice daily, take every 7 hours, not every 12 hours, needs 12 hours nitrate free period

** check viagra interaction

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10
Q

Otrexup

What is this drug?

Indication

A

Otrexup- a SQ methotrexate injection

Inject once weekly for RA

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11
Q

Otrexup

Drug class and simplify moa

A

Antimetabolite

Blocks DNA synthesis and prevent new cell growth

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12
Q

Otrexup is usually give with ___ and ___

Why?

A

Folic acid (a vitamin) or leucovorin

Prevents side effects from methotrexate such as mouth sores

Do not administer on day you are taking methotrexate

Folic acid 1 mg per day; 5 days a week

Leucovorin 5 my once weekly

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13
Q

How long does it take for methotrexate to work?

A

3 to 6 weeks to see benefits

About 1 month

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14
Q

Otrexup

Injection mechanism

A

An auto injection- similar mechanism as epipen but SQ

Once you here click; hold for 3 second

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15
Q

3 side effects methotrexate Otrexup

A
  1. Think organ system
    Skin - Sun sensitivity
    Liver - monitor for jaundice
    Lung - monitor SHB
    Kidney - monitor fluid retention; edema
    Immune - increase risk of infection
  2. GI: nausea vomiting diarrhea
    * tablet - best empty stomach but can be taken with food
  3. Hair loss
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16
Q

Otrexup what to watch for 3

A
  1. Lots of drug interaction
  2. Live vaccines- consult md first
  3. Fertility
    * not safe in pregnancy
    * women 6 months to get pregnant
    * men 3 months
    * may cause infertility and may not be reversible
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17
Q

Leucovorin is similar to ____

Real chemical name

A

A ready to use form of folate; but not use as a vitamin

Use to prevent side effects from Methotrexate

Leucovorin is “folinic acid”

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18
Q

Can you take both folic acid and leucovorin

A

No

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19
Q

Leucovorin side effect

A

Itchy skin rash

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20
Q

Leucovorin

What to watch for

A
  1. Bactrim - decrease bactrim effectiveness
  2. Dose once weekly
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21
Q

Cabergoline

Indication

Moa

What it is?

A

For hyperprolactinemia
* high level of prolactin in blood

Cabergoline is a “Long acting synthetic dopamine agonist “ - blocks the release of prolactin from pituitary gland

Long acting - dose twice weekly only

** pituitary gland is also called the “master gland” - monitor and regulate bodily’s function

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22
Q

Cabergoline is for hyperprolactinemia

What is the consequences of hyperprolactinemia, high level of prolactin

A
  1. Unwanted increase in breast growth and milk production
  2. Menstrual problem (irregular, missed period)
  3. Fertility problems in both men and women
  4. Can be tumors of pituitary gland
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23
Q

Cabergoline is associated with what side effect

And other side effects

A

NAUSEA and constipation
*** take with Food

Other side effects
1. Dizzy OSH b/c can lower BP

  • avoid or limit alcohol intake
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24
Q

Cabergoline warnings or what to remember

A
  1. Nausea- take with food
  2. Dizzy - can decrease BP cause OSH
  3. Not safe in pregnancy
  4. Impulse or behavior change
    * more aggressive
    * uncontrollable urge to gamble, sex, spend money, binge eating
  5. Heart - doctor will check heart function before prescribing
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25
Q

Dupixent

What is Dupixent?

Indication

A

Dupixent is a monoclonal antibody- blocks IL4 and IL 13 (interleukin)
* Interleukins release chemical that causes inflammation

What is monoclonal antibody?
* clone made in labs
* works like the natural antibody your body makes to fight illness

What is antibody?
* a large Y-shape protein used by immune system to identify and neutralize pathogens such as bacteria and viruses

Dupixent is a biologic means
** drug made from living cells

Bottom line:
Dupixent is a monoclonal antibody made in lab from live cell made to recognize and block IL4 and IL13 - decreasing the inflammation process
* eczema is an inflammatory skin condition leading to itching and rash

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26
Q

How is dupixent dose for eczema

A

SQ once every other week

** abdomen, outer thigh or upper arm

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27
Q

Dupixent side effects 3

A
  1. Injection site reaction
  2. Pink eye (redness, itching) - if painful or bothersome report
  3. Cold sores of mouth or lips
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28
Q

Dupixent is not a ____ or _____

A

Not a steroid or immunosuppressant

** but avoid live vaccines during dupixent treatment

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29
Q

Is dupixent a cure for eczema?

A

No. Not a cure for eczema. Dupixent reduces symptoms only such as flare and itch.

** there is no cure for eczema

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30
Q

Duxipent warnings 2

A
  1. Glaucoma- eye problem
    * report any eye pain or change in vision
  2. Joint pain
    * report worsening pain or unable to walk
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31
Q

Dupixent storage

A

Duxipent is store in refrigerator

  • can be store at RT for upto 14 days
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32
Q

Dupixent missed dose

A

Have 7 days to inject missed dose and resume regular schedule; no need to change next schedule injection

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33
Q

Dupixent injection information to remember

A

Let it sit at RT for 30 minutes

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34
Q

Donepezil

Class: Explain how it works

A

An acetylcholinesterase inhibitor
* acetylcholinesterase is an enzyme that breaks down acetylcholine

What is acetylcholine?
* a NT involve in learning, memory, attention, and involuntary muscle movements

What happened if a lack of acetylcholine
* pt have difficulty in forming and recalling memories like dementia

What is the function of acetylcholine
* a NT of the autonomic nervous system that contracts smooth muscle (bladder, GI tract), dilate blood vessels (dizzy, fainting), increase bodily secretion (stomach acid), and slows heart rate.
** opposite of fight or flight response

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35
Q

How to take donepezil

A

Take with or without food in the evening before bed
* to minimize side effects

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36
Q

Donepezil

Think of what side effects

A

Nausea vomiting diarrhea
* due to increase acid secretion

Decrease HR or dizziness and fainting
* use caution when getting up from bed

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37
Q

Donepezil common side effects

A
  1. Nausea vomiting diarrhea **
  2. Fatigue
  3. Insomnia, abnormal dreams
  4. Muscle cramps
  5. Decrease appetite- weight loss
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38
Q

Donepezil indication

A

Dementia

  • blocks acetylcholinesterase - an enzyme that breaks down acetylcholine
  • acetylcholine is involved in learning and memory
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39
Q

Donepezil warnings 6

A

Decrease HR and fainting
* excess acetylcholine NT

Vomiting and nausea
* acid secretion increase

Stomach ulcer or intestinal bleeding
* more acid secretion with additional acetylcholine
* monitor dark tar stool, or blood

Worsening of asthma
* tiotropium is an anticholinergic
* with donepezil - you have more acetylcholine which can worsen asthma symptoms

Urinary retention
* interaction with anticholinergic medications (bladder med)

Seizure

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40
Q

Donepezil consultation

A
  1. Take with or without food in the evening just before bedtime
  2. For dementia
  3. Most CSE: NVD
  4. Can decrease HR and cause fainting; use caution when getting up from bed
  5. Report Vomiting, blood in stool or black tar stool - increase ulcer due to increase acid secretion
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41
Q

Namenda

Generic name
Class & indication

A

Memantine

Namenda = NMDA receptor antagonist

For Alzheimer’s dementia
Or Dementia

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42
Q

Explain Namenda (memantine) moa

A

Blocks action of glutamate at the NMDA receptor

It is postulated that glutamate overactivity results in overstimulation and neuronal (nerve) damage ** this neuronal damage linked to Alzheimer’s dementia

Glutamate- is the main excitatory NT

*** no evidence that memantine slows neurodegeneration in Alzheimer’s dementia

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43
Q

Common side effects

A

Usually well tolerated

Think: dizzy and headache

Other: constipation or diarrhea

** can make you drowsy but not very common

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44
Q

Consultation Namenda (memantine)

A
  1. For dementia
  2. Can be taken with or without food
    * limit or avoid alcohol- can increase dizziness
  3. Common side effects: dizzy and HA
    * can also cause constipation or diarrhea
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45
Q

Exelon

Exelon patch

Generic name & class

A

Rivastigmine

Acetylcholinesterase inhibitor
* stops the enzyme that breaks down acetylcholine

Acetylcholine is needed in learning, forming and recalling memories

Acetylcholine is the NT of the autonomic nervous system (rest and digest)
* opposite fight and flight response

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46
Q

How to take Exelon (rivastigmine) and how to use Exelon patch

Dosing and what is important to remember about dosing

A
  • take with FOOD- nausea and vomiting
  • if treatment is interrupted for more than 3 days, contact doctor since dose needs to be restarted at 1.5 mg twice a day

Patch - is once daily
* patch can be applied on back or upper arms, rotation

You can shower with patch on; if it falls off, put a new one on, then replace this new patch when it’s time for your scheduled dose
* it’s okay to wear a patch for less than 24 hours

Patch: avoid heat sources
* hot tub, sauna, heating blanket

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47
Q

Is Exelon a cure for dementia

A

No. There’s no evidence that Exelon slows the progression of Alzheimer’s dementia

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48
Q

What is Exelon (rivastigmine) main mechanism of action

A

Provide the brain and body more acetylcholine

  • acetylcholine is NT involved in learning, forming and recalling memories
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49
Q

Exelon (rivastigmine) side effects

Think of

A

Think: Nausea and Vomiting

Others: diarrhea, decrease appetite and weight loss

Dizziness and headache
* caution driving

** hallucination has been reported

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50
Q

Exelon (rivastigmine) and alcohol

A

No interaction, but alcohol can worsen symptoms (dizziness)

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51
Q

Exelon (rivastigmine) warnings 7

A
  1. Nausea and vomiting
    * if therapy interrupted for 3 days, needs to be restarted at 1.5 mg BID
    * one case of severe nausea leading to esophageal ruptured b/c therapy was restarted at 4.5 mg BID dose
  2. Wt loss and decrease appetite
  3. Stomach ulcer and intestinal bleeding
    * monitor blood in stool or black tar stool
    * due to more acetylcholine or cholinergic activity (rest and digestion) - increased acid secretion d/t to acetylcholine
  4. decrease HR may cause dizziness
    * report of dizziness & fainting
    * d/t acetylcholine- rest and digestion
  5. Seizure has been reported - related to increased acetylcholine
  6. Pulmonary- worsening of Copd or asthma
    * acetylcholine or muscarinic activity causes bronchospasm ** that’s why you have drug like Spiriva (anticholinergic)
  7. May cause EPS symptoms - d/t acetylcholine
    * may worsen Parkinson’s symptoms
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52
Q

Exelon (rivastigmine)

3 things to remember

A
  1. Take with food d/t N and V
  2. If treatment is stopped for more than 3 days, treatment needs to be restarted at 1.5 mg BID
  3. May cause stomach bleeding - monitor for blood in stool or black tar stool
  4. May cause dizziness and drowsy- be careful with driving
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53
Q

Ubrelvy moa simplify

A

Blocks calcitonin gene-related peptide CGRP receptors
* CGRP is a potent vasodilator; cause of pain and inflammation associated with migraine

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54
Q

Ubrelvy indication

A

Treat an acute migraine (within 4 hours) ; not prevent migraine

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55
Q

How to take Ubrelvy

A

Take with or without food

Take at or after onset of migraine, can repeat 2nd dose after 2 hours
* max 200 mg per day

  • no safety data on treating more than 8 migraine with Ubrelvy
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56
Q

Common side effects Ubrelvy

A

Think: nausea, sleepiness (somnolence)

Can also cause: dry mouth

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57
Q

Ubrelvy

What should you think of?

A

Drug interactions and grapefruit juice

  • need to check references
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58
Q

You should not take a second dose of Ubrelvy in the next 24 hours if you take:

A
  1. Consume grapefruit juice
  2. Verapamil
  3. Fluconazole
  4. Cyclosporine
  5. Cipro
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59
Q

If you take strong CYP3a4 inhibitor; you should not take Ubrelvy concomitant

A

Contraindicated

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60
Q

3 strong CYP3a4 inhibitor to know

A

Biaxin - usually with h. Pylori tx

Itraconazole- usually not prescribe

Ketoconazole

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61
Q

3 moderate CYP3A4 inhibitor

A

Cipro

Fluconazole

Grapefruit juice

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62
Q

Avoid Ubrelvy with strong CYP3a4 inducers

Name 3

A

Phenytoin

Barbiturates

Rifampin

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63
Q

Disadvantage of Ubrelvy

A

Drug interactions

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64
Q

Grapefruit juice is a ____

A

Moderate CYP3a4 inhibitor

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65
Q

What is a barbiturate?

A

A sedative hypnotic drug makes you feel sleepy

** barbiturates increase GABA, the brain inhibitory neurotransmitter

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66
Q

Name 3 drugs that are considered barbiturates

A

Butalbital- found in esgic; fioricet

Phenobarbital- sz med

Primidone- Sz med

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67
Q

Barbiturates are _____

A

Strong CYP3a4 inducer

Other strong CYP3a4 inducers:
Phenytoin
Rifampin

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68
Q

Concerta - methylphenidate ER tablets

How to take it?

A

Take in morning with or without food
** do not crush or chew

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69
Q

Concerta

Side effects, think of…

A

Nausea, decrease appetite, wt loss, increase BP

Can cause: HA, dizzy or insomnia

Increase sweating

** may cause upper abdominal pain

** decrease growth rate in children has been reported

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70
Q

Concerta

How does it work in adhd

A

Mechanism of action in ADHD is not known

** it has been thought that blocking the reuptake of NE and dopamine into presynaptic neurons

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71
Q

Concerta contraindication

A

Glaucoma

Marked anxiety, tension, agitation

MAO-I inhibitor (ex: Phenelzine)
* due to Concerta ability to inhibit reuptake of NE and dopamine

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72
Q

Concerta warnings 7

A
  1. Sudden death d/t cardiovascular
    * caution in pt with heart problems
  2. Increase BP and Increase HR
  3. Seizure - lower seizures threshold
    * stop if occur
  4. Priapism ***
  5. Poor peripheral blood profusion
    * Raynauld’s syndrome
  6. Decrease growth in children
  7. Blurry vision or change in vision
    * can actually affect driving
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73
Q

Clonidine

Indication & moa

A

Hypertension & ADHD

Moa: central alpha2 agonist (negative feedback on presynaptic neuron)
* decrease NE into synapses ***

Less EP = decrease peripheral vascular resistant

Less EP = decrease renal vascular resistant

Less EP = decrease HR decrease BP
** however OSH is mild & infrequent

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74
Q

How to take clonidine

A

Take with or without food

  • take last dose before bed
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75
Q

Clonidine: what should patients not do while taking clonidine 1

A

Do not stop abruptly- may cause rebound hypertension

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76
Q

What are the two most common side effects associated with

Clonidine

A

Dry mouth (40%)

Drowsy & Dizzy DD

May cause constipation

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77
Q

Rexulti (brexpiprazole)
** name is similar aripiprazole

2 indication

A
  1. Schizophrenia
  2. Adjunct treatment for depression
    * take along with antidepressants
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78
Q

How to take Rexulti?

A

Take once daily (anytime) with or without food

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79
Q

Rexulti side effects

Most common 3

Others

A

Think: TREx - big (wt gain) and have to move all the time (restlessness)

Weight gain & Restlessness (akathisia)
* an inability to stay still or a feeling like you have to move all the time

Others
1. Metabolic syndrome = increase glucose, increase cholesterol, wt gain)

  1. Somnolence (tired; drowsy)
    * caution driving
  2. Dyspepsia (nausea)
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80
Q

Rexulti black box warning

A

Increase risk of suicidal thoughts or behavior

  • especially in dementia patient
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81
Q

Rexulti moa

A

Serotonin and dopamine agonist
* both are feel good hormones

5HT1a agonist; dopamine D2 agonist

5HT2a antagonist

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82
Q

What should I avoid while taking Rexulti 2

A
  1. Do not drive- until you know how this medication affects you
    * Rexulti can make you feel drowsy or tired
  2. Avoid excessive exercise or heat exposure
    * risk for heat stroke
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83
Q

What is metabolic syndrome 3

A
  1. Increase glucose- diabetes risk
  2. Increase cholesterol
  3. Weight gain
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84
Q

Rexulti warnings

** can be applied to all antipsychotics *

A
  1. Suicidal thoughts
  2. Increase risk of stroke especially in patients with dementia
  3. Tardive dyskinesia- involuntary movements of face or tongue
  4. Potential for cognitive impairment
    * decrease judgement; thinking or motor skill - caution driving
  5. Pathologic gambling & compulsive behavior
    * inability to control impulse
  6. WBC counts decrease - nasopharyngitis
  7. OSH & syncope
    * decrease BP and HR
    * risk of fall
  8. Seizure- caution in patients with hx
  9. Heat stroke
    * avoid strenuous exercise or excessive heat exposure- stay hydrated
  10. Serotonin syndrome (NMS)
    * fever; change in HR and BP; stiff muscle; confusion (mental changes); sweating
    * get emergency help
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85
Q

Abilify (aripiprazole) indication 3

What is different compared to Rexulti

A
  1. Schizophrenia
  2. Adjunct tx for depression
  3. *** bipolar

Abilify can be use for bipolar and not Rexulti

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86
Q

Abilify side effects 4

A
  1. Akathisia = unable to stay still
  2. Nausea
  3. Insomnia
  4. Somnolence - driving
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87
Q

Abilify can cause OSH due to

A

Abilify has some alpha-1 antagonist

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88
Q

Abilify moa simplify

  • same as Rexulti
A

Serotonin and dopamine agonist

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89
Q

How to take Abilify

A

Take once daily with or without food
* anytime (night - may cause insomnia)

Swallow whole - not recommended to cut or crushed

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90
Q

What should I avoid while taking Abilify?

  • same for Rexulti
A
  1. Driving
  2. Excessive heat - increase risk for heat stroke
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91
Q

Abilify and Rexulti can cause serotonin syndrome NMS

What are the symptoms

A
  1. Fever
  2. Muscle stiffness
  3. Changes in HR and BP
  4. Confusion (mental changes)
  5. Sweating
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92
Q

Abilify warnings 11

  • same as Rexulti
A
  1. Increase risk stroke
  2. NMS - serotonin syndrome
  3. Tardive dyskinesia
  4. Metabolic syndrome
  5. Pathologic gambling & compulsive behavior
  6. OSH dizzy, risk of FALL
  7. WBC count decreases
  8. Seizure
  9. Cognitive impairment
  10. Suicidal
  11. Heat stroke
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93
Q

Pilocarpine tablet

Indication & how to take it?

A

For dry mouth (xerostomia) d/t head and neck cancer treatment

Take with or without food TID

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94
Q

Pilocarpine tablet

Drug and moa

A

Cholinergic AGONIST (rest and digest)
* works like acetylcholine
* stimulant secretion of gland (salivary, sweat, lacrimal, gastric, intestinal)

That’s why it is used for dry mouth

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95
Q

Pilocarpine

Most common side effects

A

SWEATING

Other:
* HA and dizziness
* GI symptoms: N D

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96
Q

Pilocarpine tablet consultation tips

A
  1. Take with or without food
  2. For dry mouth - may take up to 3 months to work
  3. Most common side effect is increase sweating. Others side effects include
    * NV
    * HA or Dizziness
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97
Q

Pilocarpine eye drop

Drug class MOA and indication

A

Cholinergic agonist
* works like acetylcholine to stimulate muscarinic receptors

  1. Glaucoma
  2. Eye surgery- miosis
    * constriction of pupil (pin point)
    * decrease light penetration into eye

Glaucoma
* increase outflow by stimulating eye smooth muscle (iris sphincter and ciliary muscle) to contract

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98
Q

Cyclopentolate (cyclogyl)

Drug class and moa

A

Mydriasis- to dilute pupil
* opposite pilocarpine (pin point)

Anticholinergic
* blocks acetylcholine, relaxed smooth muscle eye

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99
Q

Cyclopentolate (cyclogyl)

Most common side effects

A

BURNING

Vision change, light sensitivity

increase IOP - opposite pilocarpine

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100
Q

Atropine ophthalmic

Drug class and moa

A

Mydriasis- dilate

ANTICHOLINERGIC
* relaxes and dilate eye pupil
* blocks acetylcholine

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101
Q

Atropine ophthalmic

Most common side effects

A

BURNING

Vision change
Light sensitivity

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102
Q

Why is atropine drop under tongue or in mouth?

A

Atropine is an anticholinergic
* blocks secretion of salivary gland
* decrease saliva

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103
Q

What is a substitute for Cyclopentolate

A

Atropine

  • both cause eye dilation
  • both are ANTICHOLINERGIC
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104
Q

Pravastatin (Pravachol)

Indication 2

A
  1. Cholesterol
  2. Reduce risk of HEART attack, stroke and cardiovascular surgery
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105
Q

How to take pravastatin

A

Take once daily anytime with or without food

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106
Q

Pravastatin

2 warnings

A
  1. Myopathy and rhabdo
  2. Increase LFT liver toxicity
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107
Q

Pravastatin common side effects

Think

A

GI: Nausea Vomiting Diarrhea

Joint muscle pain - report to doctor

Increase risk Upper respiratory tract infection URTI
* bronchitis

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108
Q

Pravastatin patients info 4

A
  1. Muscle pain
  2. Liver damage
  3. Increase glucose A1c - increase risk for diabetes
  4. No in pregnancy and lactation
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109
Q

Pravastatin consultation tips 4

A
  1. For cholesterol or to reduce risk of HEART attack; STROKE
  2. Take once daily with or without food anytime
  3. Side effects may include: NVD
  4. Report unexplained or worsening muscle or joint pain
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110
Q

Rosuvastatin (crestor)

Indication 2

A
  1. High triglycerides
    ** different from other statin
  2. High cholesterol

** no indication for reduction of heart attack or stroke in PI**

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111
Q

How to take rosuvastatin

A

Take once daily anytime with or without food

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112
Q

Rosuvastatin warnings 2

A
  1. Myopathy and rhabdo
  2. Increase LFT liver toxicity
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113
Q

MOST common side effects of rosuvastatin

A

HEADACHE and Nausea

Muscle or joint pain

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114
Q

Can I drink alcohol while taking rosuvastatin?

A

Yes

Limit to no more than 2 drinks per day

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115
Q

Any interaction between rosuvastatin and antacid MAALOX

A

Yes. Separate doses by 2 hours

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116
Q

What kind of muscle pain do I need to report while taking rosuvastatin or STATIN

A

Unexplained muscle pain or weakness, especially if you have a FEVER or feels more TIRED than usual

117
Q

Rosuvastatin in pregnancy and lactation

A

No. Contraindication

All statin are contraindicated in pregnancy and lactation

118
Q

Lovastatin indication 3

  • how different from other statin
A
  1. High cholesterol
  2. Primary prevention of Heart Disease or Heart attack
  3. SLOW progression of coronary atherosclerosis

Atherosclerosis: deposit of plaque of fat on the inner wall of blood vessels

Difference:
* primary prevention
* slows atherosclerosis

119
Q

Lovastatin warnings

Same as other statin

A
  1. Myopathy and rhabdo
  2. LFT LIVER TOXICITY
120
Q

Common side effects Lovastatin

A

HEADACHE and Nausea

Abdominal pain

Muscle pain or aches

121
Q

Carbidopa & levodopa

Indication and moa simplify

A

Parkinson’s

Parkinson’s is thought due to decrease dopamine in CNS
* levodopa- is converted into dopamine; providing CNS more dopamine
* carbidopa- blocks the breakdown of levodopa to dopamine in the peripheral, providing more levodopa to cross BBB
* carbidopa does not cross BBB

Levodopa is DOPAMINE

122
Q

Main side effects with carbidopa and levodopa 4

A

Main: NAUSEA

Involuntary muscle movements
* dyskinesia

Dizziness
* levodopa & carbidopa can cause OSH

Abnormal dreams
* sinemet can cause hallucination & psychotic like behaviors

Dry mouth

123
Q

How to take carbidopa and levodopa

A

Best on empty stomach but can be taken with or without food

  • avoid high protein: meat, cheese and other dairy products - decrease absorption
124
Q

Carbidopa and levodopa warnings 7

A
  1. Suicidal thoughts
  2. Sudden falling asleep during activities
    * such as driving
    * there has been reports of car accidents
  3. Serotonin syndrome
    * likely to occur during dose reduction or discontinuation
  4. Dyskinesia- involuntary muscle movements
    * dose may need to be decrease
  5. Mental changes: hallucination or psychotic like behavior
    * insomnia and abnormal dreams
  6. Inability to control impulse and impulsive behaviors
    * urge to gamble, have sex, spend money, binge eating
  7. Melanoma- skin examination
    * increase risk of melanoma
    * Parkinson’s itself- increase risk of melanoma
125
Q

Carbidopa and levodopa patient information 4

A
  1. Dark color fluid may appear in saliva, urine or sweat
    * red, brown or black bodily fluid
    * no clinical significance
  2. Multivitamins and Iron - may decrease absorption
  3. Reported sudden onset of sleep during activity of daily living without prior warnings of being tired
  4. Impulsive urge
126
Q

Kerendia (finerenone)

Indication

A

Prevent more kidney damage

Prevents HEART attack and hospitalization

** specifically for patient with type 2 diabetes **

** first line treatment

127
Q

Kerendia drug class and moa simplify

A

First Mineralocorticoid receptor (MR) ANTAGONIST

Blocks MINeralocorticoid from binding to its receptor of the HEART, blood vessels and KIDNEY

What is the role of mineralocorticoid
* promote Na reabsorption in kidney
* cause sodium and water retention
* active secretion of potassium

Kerendia blocks all this effects
* decrease Na
* increase K

Aldosterone is an example of a mineralocorticoid

128
Q

How to take Kerendia

A

Take once daily with or without food

** AVOID grapefruit ***

129
Q

Kerendia side effects 3

A

Increase Potassium (monitor)
* nausea, numbness and tingling

Increase Na sodium

Decrease BLOOD pressure
* may get dizzy, feeling tired

130
Q

Kerendia drug interaction 2

A
  1. Grapefruit
  2. Strong CYP3A4 inhibitors
131
Q

Common strong CYP3a4 inhibitors

A
  1. Macrolides: clarithromycin, erythromycin
  2. Diltiazem and verapamil
  3. Azole antifungal: itraconazole, ketoconazole
  4. GRAPEFRUIT
132
Q

Can I breastfeed while taking Kerendia

A

No.

Must wait 24 hours after last dose

133
Q

Kerendia most important warning

A

Hyperkalemia (increase K)

** monitor

134
Q

What drug class is hyoscyamine and moa

A

Anticholinergic and antispasmodic

Inhibit acetylcholine
* especially smooth muscle of the stomach and intestines AND HEART and kidney

  • slows down the natural movement of the gut
135
Q

Hyoscyamine indications 3

A

Used for a variety of stomach issues

  1. IBS - pain and cramping
  2. Stomach ulcer
  3. Bladder and kidney pain
136
Q

How to take hyoscyamine

A

Take before meals

137
Q

Interactions between antacid and hyoscyamine

A

Decrease effectiveness of hyoscyamine

Take hyoscyamine before meal and take antacid after meal

138
Q

Common side effects of hyoscyamine 4

A

DRY MOUTH and DRY EYE

Urinary retention

Constipation

Dizzy & drowsy- caution driving

Decrease ability to focus and think

139
Q

Hyoscyamine warnings 4

A

Serious allergic reaction
** Angioedema

Hallucination - mental changes
* psychosis

Irregular heart beat or fast HR

Heat stroke
* avoid excessive heat - body’s ability to sweat decrease

140
Q

Elmiron drug class and moa

A

Urinary analgesic - for bladder pain

Works by binding to wall of bladder and acts as a barrier to protect bladder from irritating substances in urine
*** similar as Sucralfate **

141
Q

Elmiron indication

A

Relieve bladder pain (cystitis)

Cystitis is
* an inflammation of the bladder caused by bladder infection

Symptoms: pain and burning when you pee

142
Q

How to take Elmiron

A

Take on an Empty Stomach
* 1 hour before or 2 hours after meal

143
Q

Associate Elmiron with 3

A
  1. EYE damage- retina bleeding
    ** report in changes in vision or eye pain
  2. Blood thinner
    * report any blood in stool
    * report bruising
  3. Alopecia HAIR loss
    * usually in one spot - reversible upon dc
144
Q

How long does it take Elmiron to work

A

3 to 6 months

* Elmiron treats bladder pain

145
Q

Elmiron common side effects 4

A

RECTAL bleeding
* blood in stool

Hair loss

Nausea Vomiting and Headache

Change in Vision- report

146
Q

Eucrisa (crisaborole)

Indication and moa

A

Eucrisa is for ATOPIC Dermatitis

PDE-4 inhibitor (blocks PDE-4)
* PDE-4 is a protein that controls inflammation

147
Q

Eucrisa side effects

A

PAIN ON APPLICATION SITE

Burning & Stinging

148
Q

How long does it take for Eucrisa to work

A

1 wk to 4 wk

1 wk: to see improvement

4 wk: to see clear skin

149
Q

What makes Eucrisa different

A

Eucrisa is a non-steroidal ointment for atopic dermatitis

150
Q

Entresto generic

A

Sacubitril and valsartan

Sacubitril is a neprilysin inhibitor
* breaks down natriuretic peptides
* cause water and sodium retention

Valsartan
* ARB at AT1 receptor
* causes vasodilation

151
Q

Entresto indication and dosing

A

Heart Failure
* to reduce risk of hospitalization and death from heart failure

Dose TWICE daily

152
Q

Is Entresto safe in pregnancy and lactation

A

No. Black box warning of fetal harm and death

All drug affecting RASA system not recommended in pregnancy and lactation

153
Q

Contraindication to Entresto

A

Concomitant use with ACE-inhibitor or ARB

154
Q

How to convert someone from ACE inhibitors to Entresto

A

Need 36 hours washout period
* to decrease risk of Angioedema

155
Q

Entresto common side effects 3

A
  1. Decrease BP, may cause dizziness
  2. Cough
  3. Increase potassium HYPerkalemia
156
Q

Entresto + NSAID interaction

A

May worsen kidney function

  • nsaid may worsen kidney
  • Entresto can cause acute kidney failure
157
Q

Entresto warnings 5

A
  1. Angioedema
  2. Hypotension
  3. Acute kidney failure- monitor
  4. Hyperkalemia
  5. Pregnancy and lactation- fetal harm
158
Q

Entresto is Sacubitril and valsartan

Explain Sacubitril

A

Sacubitril is a NEPRILYSIN inhibitor

  • blocks the breakdown of natriuretic peptides in the body
  • natriuretic peptides cause NA and Water to pass in urine - reducing workload for the heart and reduces strain on the heart
159
Q

Why is Sacubitril used with valsartan?

And not ace inhibitor

A

Sacubitril causes elevation of angiotensin 2

Losartan blocks angiotensin 2

When Sacubitril + ace inhibitor- increase risk of Angioedema

160
Q

Entresto produced what 3 effects

A
  1. Dilate artery- helps reduce BP
  2. Decrease HEART muscle cell enlargement
    * decrease workload on heart by promoting sodium and water excretion
  3. Increase URInation of excess FLUID sand Sodium
161
Q

Aliskiren brand name

162
Q

How to take Entresto

A

Take with or without food

TWICE Daily

163
Q

Mefloquine

Drug class and dosing

A

Anti-malaria

Dose once weekly WITH FOOD

Start 2 weeks before travel and continue for 4 weeks after travel

164
Q

Mefloquine indication 2

A

Prevention of malaria

Treatment of acute malaria

165
Q

Mefloquine black box warning

A

May cause psychotic behavior

  • depression, anxiety, schizophrenia, hallucination
166
Q

Mefloquine pt information 5

A
  1. Dizziness
    * may continue for months after tx
  2. Insomnia may occur
  3. If psychiatric behavior (mood changes)
    * may need to d/c
  4. Not 100% effective
    * use protective measures (net)
  5. Any fever after returning from travel
    * inform doctor
167
Q

Mefloquine common side effects 2

A

DIZZINESS

Extrasystole = skipped heartbeat or heart hiccups

168
Q

Mefloquine warnings 4

A
  1. QT prolongation
    * ketoconazole and mefloquine separate by at least 15 weeks apart
  2. Psychiatric behaviors
    * depression, anx, hallucination
  3. Eye disorder
    * any vision change- inform MD
  4. Liver toxicity
169
Q

Mefloquine most importantly information to remember 5

A
  1. Dizziness - may continue for months after tx
  2. Take WITH FOOD (increase absorption)
  3. QT prolongation (ketoconazole)
  4. Psychiatric behaviors
  5. Liver and eye toxicity
170
Q

Bisoprolol (zebeta)

What makes it more different compared to other beta blockers?

A

More cardioselective than metoprolol and atenolol

171
Q

How to take bisoprolol?

A

Take with or without food

172
Q

Bisoprolol indication

173
Q

Bisoprolol common side effects 3

A

HEADACHE and FATIGUE

Dizziness

Diarrhea

174
Q

Bisoprolol warnings 6

Same as other beta blockers

A
  1. Worsening of CHF
  2. Do not abruptly STOP
  3. Asthmatic
  4. Diabetics
  5. Major Surgery
  6. Raynaud syndrome: decrease peripheral perfusion
175
Q

What is phexxi?

A

Use to lower pH in vagina

Not a spermicide but more effective than spermicide

Use to prevent pregnancy 86%

176
Q

How to take magnesium?

A

Take with meal and full glass of water

** take anytime, but take at night may help with sleep

177
Q

Benefits of magnesium 3

A
  1. Better sleep
  2. More energy
  3. Improve mood
178
Q

Xcorpi (cenobamate)

Indication, dose and how to take it?

A

Take once daily for seizure

Can be taken with or without food

Swallow whole do not crush or chew

179
Q

Xcorpi common side effects 4

A

SOMNOLENCE (sleepy)

DIZZY and double vision (diplopia)

Headache

180
Q

What should I avoid while taking Xcorpi?

A
  1. Driving: make sure you know how medication affects you
  2. Do not drink alcohol
181
Q

Xcorpi warnings 5

A
  1. DRESS = drug reaction with eosinophilia and systemic symptoms
    ** a SERIOUS SKIN Reaction accompany with FEVER, RASH, facial swelling and lymph node enlargement
  2. QT shortening (not prolongation)
    * report palpitation and CP
  3. Suicidal thoughts or behavior
  4. SOMNOLENCE, fatigue or vision change = caution driving
  5. DC gradually to minimize seizure
182
Q

Cefadroxil brand name

183
Q

Cefadroxil indication 4

A
  1. Bacterial infections
  2. ENT infection
  3. UTI
  4. Skin infection
184
Q

Cefadroxil common side effects 3

A

NVD

Itching

Elevated liver enzymes

185
Q

Cefadroxil warnings 2

** same as others

A
  1. Cross sensitivity reaction 10%
  2. C Dif
186
Q

How do I take Cefadroxil

A

Can be taken with or without food

Take with food - more tolerable

187
Q

Cefadroxil patient information

A
  1. Finish treatment
    * may feel better after a couple days
  2. Diarrhea is common
    * diarrhea should stop after treatment
    * if diarrhea is watery or have bloody stool wit or without fever, contact MD
188
Q

what is pyridostigmine use for?

A

myasthenia gravis

  • a weakness of muscle under voluntary control

example: droopy eyelids and mouth

189
Q

what is myasthenia gravis?

A

a weakness of muscle under voluntary control

example: droopy eyelid and mouth

190
Q

what causes myasthenia gravis?

A

myasthenia gravis is an autoimmune disorder

the body’s immune system attacks muscle protein

191
Q

moa of pyridostigmine

A

acetylcholinesterase inhibitors

  • prevents breakdown of acetylcholine,
  • acetylcholine is needed for muscle contraction
192
Q

1 side effect of pyridostigmine

A

GI: nausea, vomiting and diarrhea

193
Q

2 opzelura indications

A
  1. eczema
  2. vitiligo (a condition where the skin loses its color)
194
Q

moa of opzelura

A

JAK inhibitors (janus kinase inhibitors)

  • decrease function of immune system
195
Q

5 warnings of opzelura

A
  1. Infection (risk increase due to decreased immune system)
  2. stroke and heart attack
  3. lymphoma and skin cancer risk increase
  4. clot (PE and DVT)
  5. death (from all cause)
196
Q

1 side effect of opzelura

A

nasopharyngitis (flu-like symptoms)
* sneezing, coughing, sore throat

197
Q

after application with opzelura, should you cover the area

A

do not cover area unless directed by physician

199
Q

How to take Isosorbide mononitrate and Isosorbide dinitrate

A

With or without food

  • some literature may suggest taking on empty stomach
200
Q

Isosorbide mononitrate and dinitrate consultation tips

A
  1. For prevention of chest pain
    * not for immediate relief (not like NTG)
  2. Take with or without food
    * some reference may suggest empty stomach
  3. Headache and dizziness
201
Q

What should be avoided while taking Isosorbide mononitrate or dinitrate (2)

A
  1. Viagra related drug - due to increased risk of severe hypotension
  2. Alcohol - increase risk for dizziness
202
Q

How to take midodrine

A

Can be taken with or without food

203
Q

One warning to remember with midodrine

A

After taking it, do not lay down for 4 hours

  • can increase blood pressure
204
Q

How to take terbinafine tablets

A

WOW - can cause diarrhea or stomach upset

205
Q

Midodrine moa

A

Alpha 1 agonist

  • vasoconstrictor
  • raise blood pressure for patient with OSH
206
Q

What you should not do when taking midodrine

A

Do not LAY down for 4 hours

  • do not take late at night
207
Q

Unique midodrine side effects 2

A
  1. Goosebumps - tingling or prickling feeling
  2. Painful urination
208
Q

What is Vraylar for

A

Schizophrenia

209
Q

Think of vraylar as similar to

210
Q

How to take vraylar

A

With or without food

211
Q

Vraylar side effects 3

A

Akathisia - restlessness, inability to sit still

EPS - involuntary muscle movements

Nausea and dizzy or drowsy

212
Q

Strattera generic name

A

Atomoxetine

213
Q

What is strattera use for?

A

ADHD

Pt must be over 6 years old

214
Q

Strattera moa

A

Selective norepinephrine reuptake inhibitor (NRI)

Increases NE is thought to help with ATTENTION and lower impulsive behavior

215
Q

Strattera side effect 3

A

GI: dry mouth, nausea, decreased appetite

Somnolence- makes you feel tired, dizzy
* caution driving, alcohol makes it worse

Erectile dysfunction ***
Can cause priapism

216
Q

How to take strattera

A

With or without food

Swallow whole, do not crush or chew or do not open capsule

217
Q

Can you open strattera capsule

A

No. Eye irritant

218
Q

6 warnings strattera

A

Suicidal thoughts

Liver damage

Heart problems (stroke or Heart attack)

Worsening of bipolar
* can precipitate mania episodes

Priapism

Slow growth rate
* although with continued use, does not affect over growth height

219
Q

How long does it take strattera to work

A

May see minor improvement after 1 week

220
Q

Strattera standouts 3

A

Capsules must be swallowed whole, do not open (eye irritant)

Can make you feel sleepy or dizzy
* caution driving
* alcohol not recommended

Report any changes in mood or suicidal thoughts

221
Q

Strattera dosing

A

QAM max 100 mg

222
Q

What is xtampza ER

A

Oxycodone ER capsules

223
Q

Xtampza dosing frequency

A

Twice daily ; every 12 hours

224
Q

How to take xtampza

A

Take with Food
* capsules can be open, but do not crush, chew or dissolve

Taking on empty stomach can decrease absorption leading to less effective

225
Q

Can you take xtampza on empty stomach

A

Less absorption on empty stomach
Not as effective

226
Q

Xtampza side effects

A

Nause vomiting and constipation

Somnolence- makes you feel tired and sleepy

Dizzy and blurred vision- caution driving and avoid alcohol

227
Q

Risk with xtampza or oxycodone 5

A

Addiction dependence

Breathing problems

Overdose

Extreme tiredness

OSH can cause decreased BP from sitting to standing position

228
Q

Methimazole dosing

A

Once daily (maintenance)

229
Q

Methimazole indication

A

Hyperthyroidism

230
Q

Methimazole side effects 3

A

Rash

Drowsy

Headache

231
Q

Can methimazole may you drowsy

A

Yes

Common side effects
Rash, drowsy and headaches

232
Q

Methimazole in pregnancy
Clinical pearl

A

1st trimester- not recommended

2nd and 3rd trimester - preferred drug

Methimazole is preferred over PTU due to less liver toxicity

233
Q

Methimazole moa

A

Blocks thyroid gland from making thyroid hormones

234
Q

Methimazole serious side effects 4

Just for review not for remembering

A

Liver toxicity
- less likely compared to PTU

Bleeding and bruising

Decrease WBC - increase risk of infection
- nose and throat

Birth defects
- do not use during 1st trimester

235
Q

Methimazole

Pharmacist tips 2

A

May cause stomach upset- take with food

Increase risk of bleeding

  • monitor for sx of liver toxicity
236
Q

Iodine and thyroid

How does iodine affect your thyroid

A

Thyroid gland uses iodine to make thyroid hormone

You decrease consumption of iodine, you will decrease production of thyroid hormones
- good for hyperthyroidism

237
Q

Difference between PTU and methimazole

Clinical pearl

A

Methimazole
- drug of choice except in 1st trimester of pregnancy
- lower risk of liver toxicity
- drug of choice in 2nd and 3rd trimester

PTU
- preferred in 1st trimester
- more risk of liver toxicity

238
Q

PTU dosing

A

3 times a day

  • compared to once daily with methimazole
239
Q

Propylthiouracil PTU side effects 3

A

Nausea

Loss of taste

Joint pain

** liver damage- monitor to itchiness and upper right abdominal pain

240
Q

PTU serious side effects 4

NFR

A

Decrease WBC counts- risk of infection

Liver damage

Increase risk for bleeding and bruising

Skin reaction: rash and blisters

** rash - same with methimazole

241
Q

PTU

5 pharmacist tips

A
  1. Prefer in pregnancy P for pregnancy
  2. Can make you feel d/d caution driving
  3. Can take WOW - be consistent
  4. Report sx of infection. PTU can dec WBC
  5. Alcohol - increase risk of liver toxicity
242
Q

Sildenafil moa

A

PDE 5 inhibitor
- relax penis muscles, allow it fill with blood causing an erection

PDE 5 - an enzyme

243
Q

How to take sildenafil

A

Take 30 minutes to 4 hours before

Empty stomach preferably- works faster

244
Q

How often can you take sildenafil

A

Max once daily

Taking more can increase side effects such as changes in vision or decreased BP

245
Q

Sildenafil serious SE 3

A

Priapism

Vision loss

Decrease BP
* avoid with nitrates

246
Q

Sildenafil common SE 4

A
  1. Headache- vasodilation
  2. Flushing- vasodilation
  3. Decrease BP
    - avoid nitrates
  4. Change in Vision
247
Q

When you should not take sildenafil
* 2 situations

A
  1. Had a headache attack or stroke last 6 months
  2. Can’t combine with Nitrate
248
Q

Sildenafil pharmacist tips 3

A

Works faster on empty stomach

Priapism- call 911 if erection last longer than 4 hours

No nitrates (NTG, IMDUR)

249
Q

What is vivotif use for

A

Prevent typhoid fever

  • causes by salmonella TYPHI
250
Q

Is vivotif a live or dead vaccine

A

Live weaken vaccine

  • used weakened salmonella typhi
251
Q

How to take vivotif

A

Take on empty stomach

Take every OTHER day - finish course at least 7 days before travel

Take with cold or Luke warm water
* hot water may kill weakened salmonella typhi

Swallow whole do not crush or chew

252
Q

How long does protection from vivotif last

253
Q

Vivotif common se 2

A

Nausea

Stomach pain

254
Q

What is the injectable form of vivotif

A

Typhim Vi

See typhIM im = intramuscular

255
Q

What is doxycycline 100 mg daily for traveler most likely use for

A

Malaria prevention

  • must take at least 2 days prior to travel and continue for 4 weeks after travel
256
Q

What is Cyltezo

A

Adalimumab

  • same as humira for rheumatoid arthritis

Dose SC every 2 weeks

257
Q

Dosing of cytotec for pregnancy termination

A

800 mg buccally as a single dose

  • 400 mg right cheek and 400 mg left cheek - hold for 30 minutes then swallowed
258
Q

Cough medication for pregnant

A

Robitussin DM

259
Q

Allergy medicine for pregnant

A

Chlortrimeton preferred (most studies)

Claritin

Sudafed

260
Q

Constipation for pregnancy

A

Metamucil

Colace

Dulcolax

Milk of magnesium MOM

261
Q

Diarrhea med for pregnancy

A

Immodium

Gas-x simethicone for gas

262
Q

Headaches or fever for pregnant

A

Tylenol

Not Motrin (avoid)

263
Q

Hemorrhoids for pregnant

A

Preparation H (cream or rectal)

Tucks wipe

264
Q

Indigestion for pregnant

A

Maalox

Tums

Rolaids

265
Q

Nausea and vomiting for pregnancy

A

Emetrol

Vitamin b-6 pyridoxine

266
Q

Sore throat for pregnancy

A

Cepacol

Tylenol

267
Q

How to remember finasteride proscar indication

A

Proscar - PROstate

268
Q

How to take dutasteride avodart

A

Take WOW do not open capsule

269
Q

Dutasteride avodart dosing

A

Once daily

270
Q

Can you open dutasteride capsules

A

No

Power is a mouth irritant

271
Q

Dutasteride moa

A

5 alpha reductase inhibitor

Blocks production of dihydrotesterone 5HT

Dihydrotesterone 5HT is responsible for prostate growth

272
Q

Dutasteride se 3

A

Getting or maintaining an erection

Lower sex drive

Ejaculation problems - difficulty in getting an ejaculation

273
Q

Can you take dutasteride with tamsulsin

A

Yes. Dutasteride can be taken alone or with flomax

274
Q

Which drug has less interactions Proscar or Avodart

A

Proscar (finasteride)

275
Q

Dutasteride risks 5

A

Birth defect - women of childbearing age should not touch tablets

PSA level or testing - can lower psa level, harder to detect prostate cancer

Higher risk of developing severe form of prostate cancer

Don’t donate blood for 6 months after last dose

Decrease sperm count or volume

276
Q

How to take finasteride

A

Take WOW anything

277
Q

Finasteride moa

A

Blocks enzyme 5 alpha reductase

Block’s production of 5 hydro testosterone, responsible for growth of prostate

278
Q

Finasteride se 3

  • similar to dutasteride
A

Impotence: inability to get or maintain an erection

Lower sex drive

Decrease sperm counts or semen volume

279
Q

How long does it take for dutasteride and finasteride to work

A

Several months up to 6 month to see benefits

280
Q

Finasteride risks 4

A

Birth defects: women of childbearing age needs to avoid touching

Decrease PSA levels: harder to detect prostate cancer

Higher risk of developing severe form of prostate cancers

Decrease sperm counts and semen volume

281
Q

Uceris rectal foam generic name and indication

A

Budesonide

Ulcerative colitis

282
Q

Uceris rectal foam one side effect

283
Q

Entocort (Budesonide) indicated

A

Crohn disease
* an inflammatory bowel condition

284
Q

How to take entocort and for how long

A

Take in morning swallow whole

Usually not more than 3 months at a time

** think prednisone- same class

285
Q

Entocort moa

A

Corticosteroid - works inside your intestine to lower inflammation, swelling and irritation

286
Q

Entocort common se 3

A

Headache

GI: Nausea, indigestion and diarrhea

Increase risk of infection (nose and throat)

287
Q

Potassium + vistaril drug interaction

A

Contraindicated with SOLID a potassium
- increase risk of GI ulcers due to delayed GI transit

** consider liquid potassium **

288
Q

Entocort risk 3

A

Can weaken immune system
- increase risk of infection
- report any symptoms of infection

Avoid in pregnancy

Avoid taking with grapefruit

Drug (13 decks)

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