Pharm part 5 Flashcards
Common indications for paroxetine
Depression
Panic d/o
OCD
GAD
MOA of paroxetine
SSRI, clinically unrelated to tricyclic, tetracyclic, or other antidepressants
Presumably, the inhibition of serotonin reuptake from brain synapse stimulated serotonin activity in the brain
Common AEs of paroxetine
Nausea Somnolence HA Sexual dysfunction Dizziness Asthenia Wt gain
Renal or hepatic dose adjustments for paroxetine
CrCl <30 mL/min: adjustment needed
Severe hepatic impairment: adjustment needed
BBW for paroxetine
Increased suicidal thinking and behavior
Clinically sig drug interactions for paroxetine
MAOIs
Chronic use with NSAIDs increases risk of GI bleed
Major counseling points for paroxetine
May cause drowsiness.
Avoid EtOH while taking this med
Therapy may take up to 2 wks to see improvement
Do not abruptly d/c
Pay close attention to any changes in mood, thought, or feelings such as suicidality
Monitoring parameters of paroxetine
Improvement of S/sx of depression/panic/GAD/OCD
Unusual changes in mood
Suicidality
Common indications of clonidine
HTN
Opioid detox
Impulse control/ADHD
MOA of clonidine
Central pre-synaptic alpha 2 receptor antagonist
Reduces the brain’s adrenergic outflow to decrease BP
Common AEs of clonidine
Drowsiness Xerostomia HA Bradycardia Rash (transdermal patch) Dizziness Somnolence
Clinically sig drug interactions of clonidine
TCAs may cause severe hypotension
Avoid CNS depressants
Major counseling points of clonidine
Do not d/c abruptly d/t rebound HTN
Patches are applied on a weekly basis
Patch site must be rotated on a weekly basis
Monitoring parameters of clonidine
Decrease in BP
Improvement of S/sx of ADHD/impulse control
Common indications for promethazine
Nausea
Motion sickness
Cough
MOA of promethazine
Competitively inhibits histamine at the H1 receptor sites, causing spasmolytic and decongestant effects
Common adverse effects of promethazine
Drowsiness Rash Nausea Vomiting Blurred vision Dry mouth Dizziness
BBW of promethazine
Do not use in patients younger than 2 years of age – potential for fatal respiratory depression; injection: tissue irritation and damage due to perivascular extravasation
Clinically significant drug interactions of promethazine
Anticholinergics may decrease effects
CNS depression with EtOH or other CNS depressants
Use with metrizamide may decrease seizure threshold
Barbiturate may decrease actions
Major counseling points of promethazine
May be taken with food or milk if GI upset occurs
May cause drowsiness
Avoid EtOH while taking this medication
Store in a cool dry place…
If dose is missed, skip it and return to nl dosing schedule- do not double doses
Drink plenty of water
Monitoring parameters of promethazine
Decrease in N/V
Decreased cough
Common indications for alendronate
Osteoporosis
Secondary osteoporosis due to glucocorticoids
Pagets disease
MOA of alendronate
Inhibits bone resorption via actions on osteoclasts or on osteoclast precursors; decreases the rate of bone resorption, leading to an indirect increase in bone mineral density
Common adverse effects of alendronate
Hypocalcemia Hypophosphatemia Abdominal pain Diarrhea Vomiting
Renal or hepatic dose adjustments of alendronate
Renal: CrCl <35: use not recommended
Clinically significant drug interactions of alendronate
Antacids must be given 30 minutes after taking alendronate or its serum concentration decreases
Major counseling point of alendronate
Administer first thing in the morning and ≥30 minutes before the first food, beverage (except plain water), or other medication(s) of the day.
Do not take with mineral water or with other beverages.
Patients should be instructed to stay upright (not to lie down) for at least 30 minutes and until after first food of the day (to reduce esophageal irritation),
Tablets and oral solution must be taken with a minimum of 6 ounces of plain water,
Do not crush or chew tablet.
Monitoring parameters of alendronate
Increase in bone density
Serum calcium/phosphorous
Common indications for allopurinol
Gout
Recurrent calcium oxalate stones
Prevention of uric acid nephropathy associated with chemo
MOA of allopurinol
Competitive inhibition of xanthine oxidase preventing the conversion of hypoxanthine to xanthine to uric acid
Common adverse effects of allopurinol
Rash
Drowsiness
Abdominal pain
N/V/D
Renal or hepatic dose adjustments for allopurinol
Renal- CrCl 10-20: 200 mg/day
CrCl 3-10: 100 mg/day
CrCl <3: 100 mg/48 hrs
Clinically significant drug interactions of allopurinol
Increases the effects and toxicity of mercaptopurine and azathioprine
Major counseling points of allopurinol
May take 1-2 wks to reach maximum effectiveness
Avoid EtOH while taking this med
Take with lots of fluids
Monitoring parameters of allopurinol
Decrease in serum acid levels
Frequency of gouty attacks
Pain relief
Common indications for enalapril
Asymptomatic left ventricular dysfunction
Heart failure
Hypertension
MOA of enalapril
ACEI
Common adverse effects of enalapril
Cough Hyperkalemia Angioedema Hypotension Dizziness Acute renal insufficiency
Renal or hepatic dosage adjustments for enalapril
Renal CrCl<30: initiate at 2.5 mg/day, max dose 40mg/day
BBW for enalapril
Fetal toxicity
Drug interactions with enalapril
Aliskiren
Major counseling points for enalapril
Avoid salt substitutes containing potassium.
Report any sign of angioedema
If planning on becoming pregnant immediately inform your physician
If a dose is missed, take it as soon as possible.
If it is closer to the time of your next dose than the dose you missed, skip the missed dose and return to your dosing schedule. Do not double doses.
Monitoring of enalapril
Decrease in BP
Decrease in S/sx of heart failure
Potassium
SCr
