Quiz 4 Anti invectives and cardiovascular

Question 1

Acyclovir

Answer 1

Brand Name: Zovirax

Drug Class: Viral DNA Polymerase Inhibitor

Indications: Genital herpes simplex
Herpes zoster (shingles)
Varicella (Chickenpox)
Cold sores

Mechanisms of Action: competitively inhibits viral DNA synthesis by inactivation of viral DNA polymerase and incorporation into and termination of viral DNA replication. Acyclovir has potent activity against HSV I and II and HZV (VZV).

Pregnancy Category: Compatible

Contraindication: Hypersensitivity to acyclovir or valacyclovir

Black Box Warning: None

Counseling Points: Complete full course of therapy
ensure adequate hydration

HSV initiate treatment asap (most effective if initiated within 24 hours of leasion onset)
VZV, should begin within 24h of appearance of rash

Symptoms should improve within 2-3d. If worsen seek follow up.
If using for prophylaxis or supression of infection, this medication should reduce the number of breakouts.

Question 2

Amoxicillin

Answer 2

Brand Name: Amoxil

Drug Class: Beta-Lactam Antibiotic

Indication:Acute otitis media
Lower respiratory tract infection
Pharyngitis tonsillitis
Streptococcal pharyngitis
Ear, nose, and throat infection, infection of skin and/or subcutaneous tissue, infection of genitourinary system

MoA: Semisynthetic penicillin derivative that inhibits the biosynthesis of bacterial cell wall mucopeptide. Typically active against Streptococcus, Enterococcus, Staphylococcus, and Enterobacteriaceae.

Pregnancy Category: Human data suggests risk in 1st and 3rd trimester

Contraindication: Hypersensitivity

Black Box Warning: None

Key Counseling Points: Complete full course of therapy

For suspension shake well and store in the refrigerator. Note short expiration after reconstitution.

Can take with food if causes upset stomach

Avoid mixing suspension with food or begerage and use with measuring device that comes with prescription

Symptoms should improve within 2-3d, if they worsen, seek follow-up HCP

May decrease effectiveness of oral contaceptives and use backup contraceptive method (condom)

Question 3

Amoxicillin/Clavulanate Potassium

Answer 3

Brand name: Augmentin

Drug Class: Beta-Lactam Antibiotic

Indications: Acute otitis media
Community-acquired pneumonia
Lower respiratory tract infection
Sinus, infection of skin or subcutaneous tissue, infectious disease of genitourinary system
Urinary tract infection

MoA: Amoxicillin is a semisynthetic penicillin derivative. Typically active against Streptococcus, Enterococcus, Staphylococcus, and Enterobacteriaceae. Amoxicillin is not effective against β-lactamase–producing bacteria. Clavulanate, a β-lactamase inhibitor, has weak antibacterial activity but is a potent inhibitor of plasmid-mediated β-lactamases and protects amoxicillin from degradation by β-lactamases.

Pregnancy Category: Suggests risk in 1st and 3rd trimesters (amoxicillin); compatable for clavulante

Contraindication: Hypersensitivity to penicillins, extended release products are contraindicated in patients with a history of jaundice and hepatic dysfunction

Black Box: None

Counseling Points: Complete full course of therapy

Take with food to ensure proper absorption

For suspension, shake well and store in refrigerator.

Note: Short expiration after reconstitution of 10d. Avoid mixing suspension with food or beverages.

Symptoms should improve within 2-3 d; worsen = seek help

May decrease effectiveness of oral contraceptives

Question 4

Azithromycin

Answer 4

Brand Name: Zithromax

Drug Class: Macrolide Antibiotic

Indication: Acute infective exacerbation of COPD, skin or tissue infection
Bacterial sinusitis
Chancroid
community acquired pneumonia
Sexually transmitted infections
Streptococcal pharygtits

MoA: Azithromycin binds to the 50S ribosomal subunit, thus interfering with microbial protein synthesis.

Pregnancy Category: None

Contraindication: Hypersensitivity to azithromycin, erythromycin, or any macrolide or ketolide antibiotic

Black Box: None

Counseling Points: Complete full course of therapy

Take tablets with or without food. But the thing is that some patients report increased tolerability when given with food.

Avoid mixing suspension with food or beverages, but it can be taken after

Symptoms should improve within 2-3d, if they worsen, seek follow up with HCP

Question 5

Cefdinir

Answer 5

Brand Name: Omnicef

Drug Class: Third-generation cephalosporin

Indication: Acute otitis media
Bronchitis
Community-acquired pneumonia
COPD
Streptococcal pharyngitis

MoA: Cefdinir is a 3rd-generation cephalosporin with activity against a number of gram-positive and gram-negative bacteria including β-lactamase–producing strains.

Pregnancy Category: None

Contraindication: Hypersensitivity to cephalosporin

Black Box: None

Counseling Points: Complete full course of therapy.

For suspension shake well and can be stored at room temperature. Note 10d expiration after reconsistution. Avoid mixing suspension with food or beverages but food can be taken after

Symptoms should improve within 2-3d, if they worsen seek follow up with HCP.

Separate administration of antacids, iron, and vitamins by 2h

Question 6

Cephalexin

Answer 6

Brand Name: Keflex

Drug Class: First-generation cephalosporin

Indication: Infection of skin and/or subcutaneous tissue
Osteomyelitis
Otitis media, respiratory tract infection
Streptococcal pharyngitis
Impetigo, ecthyma
Cellulitis (nonprulent, erysipelas)

MoA: Cephalexin is a 1st-generation cephalosporin that inhibits bacterial wall synthesis of actively dividing cells by binding to ≥1 penicillin-binding proteins (PBPs).

Pregnancy Category: None

Contraindication: Hypersensitivity to cephalosporins

Black Box: None

Counseling Points: Seek medical attention if rash develops

Complete full course of therapy

For suspension, shake well and store in the refrigerator. Note short expiration after reconstitution, Avoid mixing suspension with food or beverages, but food can be taken afterward

Symptoms should improve within 2-3 d; if they worsen seek follow up with HCP

Question 7

Ciprofloxacin

Answer 7

Brand Name: Cipro

Drug Class: Fluroquinolone Antibiotic

Indication: Anthrax
Bacterial prostatitis
Bronchitis, lower respiratory tract infection
Urinary tract infectious disease

MoA: Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA gyrase. It is highly active against aerobic, gram-negative bacilli.

Pregnancy Category: Contraindicated

Contraindication: Hypersensitivity to ciprofloxacin or other quinolones, concomitant tizanidine

Black box: May exacerbate muscle weakness in patients with myasthenia gravis, tendon inflammation and rupture, peripheral neuropathy, CNS effects, cardiac, dermatologic and hypersensitivity reactions, aortic dissection and rupture, hypoglycemia, mental health adverse effects

Counseling Points: Seek medication if decreased urination, yellowing of eyes, blistering skin rash or extreme fatigue, unusual bruising or bleeding, shortness of breath or chest pain, tendon pain, muscle weakness, a “pins and needles” tingling or pricking sensation, numbness in the arms or legs, confusion or hallucinations.

Take with or without food, but not with milk or other dairy products.

Take ciprofloxacin at least 2 hours before or 6 h after antacids, sucralfate, or mineral supplements and multivitamins with calcium, iron, or zinc.

If using with suspension, shake well before use; suspension

Question 8

Clindamycin

Answer 8

Brand Name: Cleocin

Drug Class: Lincosamide Antibiotic

Indication: Bacterial infectious disease
Infection of skin and/or subcutaneous tissue
Infection of disease of abdomen
Lower respiratory tract infection
Pelvic inflammatory disease
Septicemia
Osteomyelitis
Diabetic foot infection

MoA: It inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit; it is bactericidal or bacteriostatic depending on the concentration, organism, and inoculums.

Pregnancy Category: Compatible

Contraindication: Hypersensitivity to clindamycin

Black Box: Colitis

Counseling Points: Complete full course of therapy

Symptoms should improve within 2-3d. If they worse, seek follow-up with HCP. Take with full glass of water.

Remain upright for 30 minutes after dose to minimize risk of GI ulceration

Question 9

Doxycycline

Answer 9

Brand Name: Vibramycin

Drug Class: Tetracycline Antibiotic

Indication: Acinetobacter infection
Acne vulgaris
Gonorrhea
Staphylococcal infection
Pneumonia

MoA: Doxycycline is a broad-spectrum bacteriostatic compound that inhibits protein synthesis at the 30S ribosomal subunit.

Pregnancy Category: Contraindicated 2nd and 3rd trimesters

Contraindication: Hypersensitivity to doxycycline or concurrent retinoic acid derivatives

Black Box: None

Counseling Points: May take with food that does not contain calcium.

Complete full course of therapy. Symptoms should improve within 2-3d

May cause photosensitivity; discontinue at first sign of skin erythema. Wear sunscreen and avoid prolonged exposure to sunlight and ultraviolet light. Adminsiter with 240 mL of water

Question 10

Fluconazole

Answer 10

Brand Name: Diflucan

Drug Class: Imidazole Antifulgal

Indication: Candidal vulvo
Candidal vulvovaginitis
Candidiasis
Cryptococcal meningitis
Oropharyngeal candidiasis

MoA: Fluconazole inhibits biosynthesis of ergosterol or other sterols, damaging the fungal cell wall membrane and altering its permeability.

Pregnancy: Suggests risk >400mg/d

Contraindication: Hypersensitivity to fluconazole, concurrent ergot alkaloids, CYP3A4/5 substrates that prolong QTc

Black Box: None

Counseling Points: Many medications, including OTC medications, interact with fluconazole. Do not take any new medications without consulting your doctor or pharmacist.

If taking a weekly dose, take on same day and time each week

Question 11

Ketoconazole topical

Answer 11

Brand Name: Nizoral

Drug Class: Imidazole Antifulgal

Indications: Candidiasis of skin
Dandruff
Pityriasis versicolor
Seborrheic dermatitis
Tinea corpois
Tinea cruis
Tinea pedis

MoA: Ketoconazole inhibits biosynthesis of ergosterol or other sterols, damaging the fungal cell wall membrane and altering its permeability.

Pregnancy Category: N/A

Contraindication: Hypersensitivity

Black Box: None

Counseling Points: Apply thin layer to affected area of skin. Skin should be intact. Do not get in eyes, nose, mouth, or vagina. Do not wash the areas where you applied this medicine for at least 3 hours applications

Cosmetics (makeup or sunscreens) may be put on the affected areas 20 minutes application.

Topical products are alcohol based and flammable immediately after application

Question 12

Levofloxacin

Answer 12

Brand Name: Levaquin

Drug Class: Fluoroquinolone Antibiotic

Indication: Bacterial prostatitis
Bacterial sinuitis
Bronchitis
Community acquired pneumonia
Infection of skin and/or subcutaneous tissue
Pyelonephritis

MoA: Levofloxacin is a fluoroquinolone that inhibits bacterial DNA gyrase, an enzyme responsible for the unwinding of DNA for transcription and subsequent supercoiling of DNA for packaging into chromosomal subunits. It is highly active against aerobic, gram-negative bacilli.

Pregnancy Category: CONTRAINDICATED

Contraindication: Hypersensitivity to levofloaxacin or other quinolones; concomitant tizanidine administration

Black Box: Myasthenia gravis, tendon inflammation and rupture, peripheral neuropathy, CNS effects, cardiac dermatologic and hypersensitivity reactions, aortic dissections and ruptures

Counseling Points: Seek medical attention if decreased urination, yellowing of eyes, blistering skin rash or extreme fatigue, unusual bruising or bleeding, shortness of breath or chest pain, tendon pain, muscle weekness, a “pins and needles” tingling or pricking sensation, numbness in the arms or legs, confusion or hallucinations.

Take with or without food, but not with milk, yogurt, or other dary products or calcium-fortified products (some juices and breads)

If using antacids, sucralfate, or mineral supplements and multivitamins with calcium, iron, or zinc, take levofloxacin at least 2 hours before or 6 horus after these medications

Question 13

Metronidazole

Answer 13

Brand Name: Flagyl

Drug Class: Nitroimidazole Antibiotic

Indications: Abscess
Amebic dysentery
Bacterial vaginosis
Trichomoniasis

MoA: Metronidazole is a synthetic nitroimidazole active against T. vaginalis (trichomoniasis), E. histolytica (amebiasis), and G. lamblia (giardiasis); it is bactericidal against nearly all obligate anaerobic bacteria including B. fragilis.

Pregnancy Category: Human data suggests low risk

Contraindication: Hypersensitivity to metronidazole, 1st trimester of pregnancy

Black Box: Carcinogenic

Counseling Points: Avoid alcohol while taking this medicaiton and for 3 days after, may cause severe disulfiram-like reaction.

Complete full course of therapy. Symptoms should improve within 2-3 days. If they worsen, Seek follow up with HCP. May be administered with food to minimize stomach upset

Question 14

Mupirocin

Answer 14

Brand Name: Bactroban

Drug Class: Topical Antibacterial

Indication: Impetigo
Secondary Skin infections
Eradication of nasal colonization of MRSA during institutional outbreaks

MoA: Mupirocin is an antibacterial agent active against a wide range of gram-positive bacteria including methicillin-resistant Staphylococcus aureus. It is also active against certain gram-negative bacteria. Mupirocin inhibits bacterial protein synthesis by reversibly and specifically binding to bacterial isoleucyl transfer-RNA synthetase. Because of this unique mode of action, mupirocin demonstrates no in vitro cross-resistance with other classes of antimicrobial agents.

Pregnancy: N/A

Contraindication: Hypersensitivity

Black Box: None

Counseling Points: Instruct patients on proper application technique.

Avoid drug exposure to open wounds, burns, or eyes.

Question 15

Nitrofurantoin

Answer 15

Brand Name: Macrobid, Macrodantin

Drug Class: Nitrofuran Antibiotic

Indication: UTI

MoA: Synthetic nitrofuran that inactivates bacterial ribosomes and is bactericidal in urine at therapeutic doses. It is active against most bacteria that cause UTIs except nearly all strains of Pseudomonas are resistant.

Pregnancy: Human data suggest risk in 3rd trimester

Contraindication: Hypersensitivity to nitrofurantoin, use in neonates or pregnant patients at term (38-42 weeks) due to risk of hemolytic anemia, anuria or oliguria

Black Box: None

Counseling Points: May make urine brown; this is not harmful and is a breakdown of the product of the drug

Complete full course of hterapy

For the suspension, shake well and store at room temperature, use within 30 days. Avoid mixing suspension with food or beverages, but food can be taken afterwards

Symptoms should improve within 2-3 days if they worsenl seek follow up care

Question 16

Oseltamivir Phosphate

Answer 16

Brand Name: Tamiflu

Drug Class: Neuraminidas Inhibitor, Antiviral

Indication: Influenza virus types A and B

MoA: Oseltamivir is an inhibitor of influenza virus neuraminidase, which prevents viral progeny detaching from the cellular envelope

Pregnancy: Compatable - maternal benefit > embryo-fetal risk

Contraindication: Hypersensitivity to oseltamivir

Black Box: None

Counseling Points: Complete full course of therapy. Symptoms should improve within 2-3 days; if they worsen, seek care.

Suspension is available in 6 mg mL concentration and is packed with an oral syringe calibrated in millimeters up to a total of 10 mL Instructions to the patient should be provided based on these units of measure. When providing oseltamivir suspension for children <1 y of age, use a lower calibrated oral syringe to ensure accurate dosing

If suspension is unavailable, open capsules and compound a 6 mg/mL suspension

Take with food to minimize GI irritation

Take missed dose as soon as possible, if next dose is within 2 h, skip missed dose

Question 17

Sulfamethoxazole/ Trimethoprim

Answer 17

Brand Name: Bactrim, Septra

Drug Class: Antibiotic, Antinfective Agent

Indication: UTI, Traveler’s Diarrhea, HIV infection, Acute infective COPD

MoA: Sulfamethoxazole is an intermediate-acting sulfonamide used primarily in the treatment of urinary tract infections. The chemical name of sulfamethoxazole is N-1-(5-methyl-3-isoxazolyl) sulfanilamide. The drug is structurally related to sulfisoxazole (Gantrisin(R)), but differs by virtue of its slower absorption from the GI tract and more delayed urinary excretion.

Sulfamethoxazole, and sulfonamides in general, are structural analogs and competitive antagonists of paraaminobenzoic acid (PABA). Sulfonamides prevent normal bacterial utilization of PABA for synthesis of folic acid (pteroylglutamic acid; PGA), which is required for bacterial DNA synthesis

Pregnancy Compatibility: Not enough data

Contraindication: Hypersensitivity to sulfonamides, infants less than 2 months of age (except as an adjunct with pyrimethamine in the treatment of congenital toxoplasmosis), pregnancy near term, nursing mothers

Black Box: None

Counseling Points: May make urine brown; this is not harmful and is a breakdown of the product of the drug

Complete full course of therapy

For the suspension, shake well and store at room temperature, use within 30 days. Avoid mixing suspension with food or beverages, but food can be taken afterwards

Symptoms should improve within 2-3 days if they worsenl seek follow up care

Question 18

Valacyclovir

Answer 18

Brand Name: Valtrex

Drug Class: Viral DNA Polymerase Inhibitor

Indication: Genital herpes implex
Herpes zoster
Varicella
Herpes Iabialis (cold sores)

MoA: Valacyclovir is a prodrug of acyclovir. Acyclovir is an acyclic nucleoside analogue of deoxyguanosine that is selectively phosphorylated by the virus-encoded thymidine kinase to its monophosphate form. Cellular enzymes then convert the monophosphate to the active antiviral acyclovir triphosphate, which inhibits viral DNA synthesis by incorporation into viral DNA, resulting in chain termination. Acyclovir has potent activity against herpes simplex virus (HSV) 1 and 2 and varicella-zoster virus (VZV).

Pregnancy Category: Compatible

Contraindication: Hypersensitivity

Black Box: None

Counseling Points: Seek medical attention if decreased urination, unusual bruising or bleeding, blistering skin rash, or shortness of breath.

Symptoms should improve within 2-3 d; if they worsen, seek follow-up with HCP.

If using for prophylaxis, this medication should reduce the number of breakouts.

Maintain adequate hydration during therapy to prevent renal complications.

Question 19

Amiodarone Hydrochloride (Note this is for Amiodarone)

Answer 19

Brand Name: Cordarone

Drug Class: Antiarrhythmic

Indication: Atrial fibrillation
Supraventricular arrhythmia
Maintenance of sinus rhythm

MoA: Type III antiarrhythmic that prolongs the effective refractory period of atrial and ventricular tissue by blocking potassium conductance.

Pregnancy Category: Human and animal data suggest risk

Contraindication: Hypersensitivity, severe bradycardia, severe sinus node dysfunction, 2nd- or 3rd-degree AV block, and cardiogenic shock

Black box: Arrhythmias, hepatotoxicity, proarrhythmic effects, pulmonary toxicity

Counseling Points: Use sunsceen, avoid tanning beds and prolonged sun exposure

Report signs or symptoms of cardia arrhythmias, pulmonary toxicity, or liver toxicity. Multiple drug interactios so inform providers about all medications you are taking

Take consistently with regard to meals but avoid taking with grapefruit or grapefruit juice.

Patient medication guide must be dispensed with this medication

Question 20

Apixaban

Answer 20

Brand Name: Eliquis

Drug Class: Factor Xa Inhibitor

Indication: Atrial fibrilation
Hip or knee replacement surgery
DVT or PE

MoA: Apixaban is a selective inhibitor of factor Xa. By inhibiting factor Xa, apixaban decreases thrombin generation and thrombus development.

Pregnancy Category: No human data

Contraindication: Hypersensitivity, active bleeding

Black Box: Premature discontinuation increases risk of thrombotic events, increased risk of spinal hematoma with spinal puncture or neuraxial anesthesia

Counseling Points: Seek medical attention if any unexpected bleeding or trouble bleeding

Take with or without food

Do not stop taking apixaban without talking to your HCP, stopping early may increase the risk of stroke, especially in patients with atrial fibrilation.

Apixaban shoudl be interrupted 24-48 hours in prior to dental and surgical procedures and re-started after homeostasis.

Avoid OTC NSAIDs and high-dose asprin; they increase risk of bleeding.

Question 21

Aspirin

Answer 21

Brand Name: Bayer

Drug Class: Analgesic, Antipyretic

Indication: Carotid endarterectomy
Cerebrovascular accident
Coronary bypass graft
Disorder of joint of spine
Fever
Generalized aches and pains
Headache & Migrane
Myocardial infraction
Pain
Osteoarthritis
Perclutaneous coronary intervention
Rheumatoid arthritis
Angina
Systemic lupus erythematosus

MoA: Aspirin is a more potent inhibitor of both prostaglandin synthesis and platelet aggregation than its other salicylic derivatives due to the acetyl group on the aspirin molecule, which irreversibly inactivates cyclooxygenase via acetylation. This prevents the conversion of arachidonic acid to thromboxane A. Platelet aggregation is inhibited for their lifespan of 7-10 days. The inhibition of the synthesis of thromboxane A is irreversible as the thrombocytes without nucleus are unable to synthesize new cyclooxygenase after the existing one has been acetylated by acetylsalicylic acid

Pregnancy: No data

Contraindication: Hypersensitivity to NSAIDs

Syndrome of asthma, rhitis, and nasal polyps; severe urticaria, angioedema, or bronchospasm may occur

Black Box: None

Counseling: Instruct patients to report unusual or excessive bleeding

Advise patient to report symptoms of gastrointestinal ulceration or bleeding

Side effects may include dyspepsia, agitation, confusion, dizziness, headache, lethargy, Reye syndrome, and seizures

Advise patient to take at the same time every day with a full glass of water

Durlaza: Advise patient to not take drug 2 hours before or 1 hour after alcohol use due to potential for altered absorption

Warn patients to avoid use of nonprescription aspirin or NSAID products

Question 22

Clopidogrel Bisulfate (Not bisulfate)

Answer 22

Brand Name: Plavix

Drug Class: Platelet Aggregation Inhibitor

Indications: Acute ST segment elevation MI managed medically and non-ST segment elevation MI
Thrombosis prevention in arteriosclerotic vascular disease, following stroke, in peripheral arterial occlusive disease

MoA: Clopidogrel is an antiplatelet agent that prevents platelet aggregation by direct inhibition of ADP binding to receptor sites, inhibiting subsequent activation of the glycoprotein IIb/IIIa complex. This action is irreversible; therefore, platelets exposed to clopidogrel are inhibited for their lifespans.

Pregnancy Category: Probably compatible

Contraindication: Hypersensitivity to clopidogrel and active bleeding

Black Box: Reduced CYP2C19 function

Counseling Points: Report signs/symptoms of bleeding, especially if used concomitantly with anticoagulant therapy.

Do not stop therapy abruptly without first talking with prescriber to minimize the risk of re0thrombosis, particularly after the stent placement

Question 23

Isosorbide Mononitrate

Answer 23

Brand Name: Imdur

Drug Class: Long acting nitrate, antianginal

Indication: Angina prophylaxis

MoA: Isosorbide mononitrate (ISMN) is the active 5-mononitrate metabolite of isosorbide dinitrate. Nitroglycerin and other organic nitrates are converted to NO by vascular endothelium. NO activates guanylate cyclase, increasing cyclic GMP that in turn decreases intracellular calcium, resulting in direct relaxation of vascular smooth muscle.

Pregnancy Category: Limited human data

Contraindication: Hypersensitivity to nitrate, concurrent use with PDEIs, concurrent use with nociguat

Black Box: None

Counseling Points: Best to take this medicine on an empty stomach with at least half a glass of water.

Swallow the extended release tablet as a whole. Do not break, chew, or crush it.

This medicine can cause headaches, which is a sign that the medicine is working

Acetaminophen may be used to relieve headaches.

Talk to your doctor if the headache is severe.

This medicine can cause dizziness.

Avoid driving, using machines, or doing anything else that could be dangerous if not alert.

Stand up slowly if this medicine causes light-headedness from orthostatic hypotension.

Do not stop using medicine suddenly without asking a HCP.

Dose may need to be slowly decreased before stopping completely.

Avoid contaminant use of PDEIs as this may increase risk of hypotension.

Avoid drinking alcohol while taking this drug.

Scored tablet may be split. Doses of immediate release formulation should be taken at least 7 hours apart

Question 24

Nitroglycerin

Answer 24

Brand Name: Nitrostat, Minitran

Drug Class: Nitrate, Antiangial

Indication: Angina, Anal fissure

MoA: Nitroglycerin is believed to be converted to nitric oxide (NO) by vascular endothelium. NO activates guanylate cyclase, increasing cyclic GMP that in turn decreases intracellular calcium, resulting in direct relaxation of vascular smooth muscle.

Pregnancy Category: Suggested low risk

Contraindication: Hypersensitivity to nitrate, concurrent use with PDEIs, symptomatic hypotension, marked bradychardia or tachycardia, severe anemia or increased intracranial pressure

Black Box: None

Counseling Points: Sit prior to sublingual tablets, lingual aerosol or spray. Rise slowly from a sitting position in order to prevent light-headedness

Tablets should be dissolved under tongue or buccal pouch at firs sign of angina; do not swallow or chew tablet

Do not eat or drink after placement of tablets. Spray should be sprayed onto or under tongue, do not inhale, do not spit out of rinse mouth after use.

Allow a 10-12 h/d drug free interval to avoid concurrent use of alcohol, CNS depressants, antihypertensives, or other drugs that cause hypotension. Do not use PDEIs, which may result in hypotension.

This ointment may stain clothing.

When treating acute angina, instruct patient to call 911 if symptoms are not resolved by the first dose

Question 25

Rivaroxaban

Answer 25

Brand Name: Xarelto

Drug Class: Anticoagulant , Factor Xa inhibitor

Indication: Prevention of thromboembolism in patients arfter orthopedic surgery
Prevention of thrombeombolism in patients with nonvalvular atrial fibrilation
Treatment and secondary prevention of DVT or pulmonary embolism
Coronary artery disease or peripheral artery disease

MoA: Rivaroxaban is an orally bioavailable factor Xa inhibitor that selectively blocks the active site of factor Xa and does not require a cofactor (such as antithrombin III) for activity. Activation of factor X to factor Xa via the intrinsic and extrinsic pathways plays a central role in the cascade of blood coagulation.

Pregnancy category: Limited data

Contraindication: Active bleeding

Black Box: Premature discontinuation increases risk of thrombotic risk, risk of spinal/epidural hematoma

Counseling Points: Educate patient on signs and symptoms of bleeding and interactions with other anticoagulant or antiplatelet medications, including OTC medications.

Warn of risks of epidural (spinal), anesthesia while taking rivaroxaban.

Doses greater than or equal to 15 mg should be taken with food

If taking for nonvalvular atrial fibrillation, take with evening mean.

Question 26

Verapamil Hydrochloride (not found with hydrochloride)

Answer 26

Brand Name: Calan SR

Drug Class: Calcium Channel Blocker

Indication: Angina
Atrial arrhythmia or paroxysmal supraventricular tachycardia prophylaxis
HTN

MoA: Inhibits calcium “slow channels” on vascular smooth muscle and myocardium producing relaxation of muscle and vasodilation. Increases myocardial oxygen delivery and slow conduction through the AV node.

Pregnancy Category: Compatible

Contraindication: Hypersensitivity to verapamil symptomatic hypotension, 2nd or 3rd degree AV heart block, sick sinus syndrome; severe left ventricular dysfunction, atrial fibrillation/flutter associated with accessory bypass tract

Black Box: None

Counseling Points: Signs-symptoms of heart failure, decrased HR, signs/symptoms of liver toxicity.

Exacerbations of angina pectoris or acute coronary insufficiency; while tapering chronic therapy, especially in patients with ischemic heart disease

Monitor LFTs, ECG, and vital signs

Question 27

Warfarin

Answer 27

Brand Name: Coumadin

Drug Class: Anticoagulant, Vitamin K Antagonist

Indication: Multiple FDA-labeled indications, all dosed similarly, including atrial fibrillation; myocardial infarction, prosthetic cardiac valve component embolism; pulmonary embolism; thrombosis, post-myocardial infarction; venous thromboembolisma

MoA: Warfarin prevents the conversion of vitamin K back to its active form from vitamin K epoxide. This impairs formation of the vitamin K–dependent clotting factors II, VII, IX, and X (prothrombin) and proteins C and S (physiologic anticoagulants).

Pregnancy Category: Contraindicated - 1st trimester (Category

Contraindication: Hypersensitivity, bleeding tendencies recent or potential surgery, uncontrolled HTN; pericarditis or pericardial effusion; bacterial endocarditis; noncompliant patients, eclampsia/preeclampsia, threatened abortion, pregnancy

Black Box: Bleeding

Counseling Points: Report signs/symptoms of hemorrhage, skin and tissue necrosis.

Avoid situations/activities in which cuts, bruising, or injury is likely. Many significant drug-drug interactions, consult health-care professional prior to new prescription or OTC use

Avoid alcohol, cranberry products, and drastic changes in vitamin K consumption from diet (cruiferous vegetables).