Top 200 Flashcards
Lortab
hydrocodone + acetaminophen
I= pain moderate -severe
d=7.5-10hydrocodone/325-500mg apap. 4-6 prn max apap 4g, max hydrocodone 60mg
MOA: opioid + unknown for apap
DDI: etoh, benzos, barbiturates,
Adverse e= inc LFTs, constipation, dizziness serious: liver toxicity, resp depression
PK= apap: hepatic, hydrocodone
C=dont take other apap containing products, dont drink ETOH, max 4g apap
Synthroid
Levothyroxine
I= hypothyroidism, myxedema coma, TSH suppression
D= ~1.7mcg/kg average, can range from 25mcg-200mcg orally once daily
MOA= (T4) synthetic thyroid hormone
DDI= antacids, estrogens, calcium carbonate, Iron
PK= T1/2 6-7 days, 80% hepatic metabolism, excreted renally/fecally
BBW= Should not be used in the treatment of obesity or for weight loss due to not being effective for this indication and increase in toxicity.
C=take in the morning on an empty stomach. 30 min before food. Separate antacids, calcium, iron by 4 hours from levothyroxine
Zocor
Simvastatin
I= hyperlipidemia, hypertriglyceridemia
D= 10-80mg orally daily in the evening
MOA= HMG COA reductase inhibitor
DDI= CYP 3A4 inhibitors/inducers, azoles, protease inhibitors, GFJ, warfarin, niacin, amlodipine, fenofibrate, cyclosporine
PK= CYP 3A4 inhibitor
SE= Rare: rhabodmyolysis, increased liver enzymes
C=take in the evening. Report any unexplained tenderness or weakness
Prilosec
Omeprazole
I= GERD, Stress ulcer prophylaxis, esophagitis, heartburn
D= 10-40mg orally dailt AM 1hour before meal
MOA= Proton pump inhibitor
DDI= CYP 3A4 inhibitors/inducers, clopidogrel, protease inhibitors, MMF, warfarin
SE= Common: Headache 7%, abdominal pain 5% rare: c. difficile colitis
C=Take 1 hour before a meal in the morning.
Prinivil OR Zestril
Lisinopril
I= Hypertension
D= 10-80mg orally daily
MOA= ACE inhibitor
DDI= potassium sparing diuretics (hyperkalemia), NSAIDs, diuretics
SE= Common:dizziness, hyperkalemia, renal function test abnormal, cough rare: Angioedema, agranulocytosis
PK=Renally excreted, no hepatic metabolism
C= Report a dry cough. Report if will/are pregnant
Ambien
Zolpidem
I= Insomnia, Middle of the night awakening
D= 6.25mg-12.5mg orally before bedtime
MOA=Sedative hypnotic that binds GABA-A receptor
DDI= opioids (CNS depression), benzos, other sedatives
SE= Common:dizziness, somnolence Serious: depression, suicidal thoughts
PK=extensive liver metabolism, ~2.5hour t1/2
C= Before bedtime, not to administer immediately after a meal, avoid alcohol
Proventil HFA, Proair HFA, Ventolin HFA
Albuterol sulfate
I= Asthma, COPD, hyperkalemia
D= 2 inhalations every 4-6 hours as needed
MOA=Beta2-agonist, Increased cAMP-> bronchial smooth muscle relaxation
DDI= Beta blockers, MAOis
SE= Common:throat irritation, pharyngitis, URTI, nervousness, tremor
PK=Renal elimination> fecal elimination
C= How to use inhaler, rescue medication
Cymbalta
Duloxetine
I= GAD, Major depressive disorder, diabetic neuropathy(pain), fibromyalgia, muskuloskeletal pain
MOA= SSRI
D= 30-60mg once daily. Max 120mg/day
DDI= CYP3A4 inhibitor, MAOIs
SE= Common: dizziness, HA, insomnia, somnolence, Serious: SJS, GI hemorrhage, Suicidal thoughts, Serotonin syndrome
PK=Renal elimination70%> fecal elimination 20%
C= Do not crush or chew, swallow whole
Glocophage
Metformin
I= DM II
MOA= Decreased hepatic glucose production, improvement of insulin sensitivity
D= Start 500mg bid, max 850mg TID
DDI= Fluoroquinolones
SE= Common:Diahrrea, flatulence, indigestion Serious: lactic acidosis
PK=Renal elimination90%
C= Take with food. Report unecxplained muscle soreness
Norvasc
amlodipine
I= hypertension
MOA=Calcium channel blocker
D= 5-10mg orally daily
DDI= Clopidogrel, beta blockers (moderate)
SE= Common: peripheral edema, palpitations, dizziness
PK=hepatic metabolism 90%–> 60% renal excretion of metabolites
C= edema, dizziness, palpitations
Welbutrin SR, XL or Zyban
bupropion SR, bupropion XL, Bupropion
I= Major depressive disorder, smoking cessation
MOA=weak inhibition of dopamine and norepinephrine uptake
D= IMD Start 100mg bid x 3 d-> 100 tid
SR Start 150mg q am x 3d-> 150mg bid
XL start 150mg qd x 3 days-> 300 mg qd
max 450mg/day
SE= Common: insomnia, dizziness, agitation, Serious: suicidal thoughts, cardiac dysrhythmia
PK=extensive hepatic metabolism-> metabolites renally excreted
C= Avoid bedtime administration, Start tx 1 week before smoking cessation
Deltasone
prednisone
I= Adrenal insufficiency, inflammation, etc
MOA=corticosteroid, salt and water retention, anti-inflammatory, immune system suppression
D= 5-60mg daily, regimen varies drastically.
SE= Common:Hypertension, impaired wound healing, body fluid retention, hypernatremia, inc risk of infection, osteoporosis, depression Serious: cushiness, hyperglycemia,
C= Do not stop suddenly. Take medication exactly as prescribed by doctor. Many possible side effects
Amoxil
Amoxicillin
I= acute otitis media, H pylori Gi infection, pharyngitis, streptococcal pharyngitis, LRTI, periodontal infection
MOA=Inhibits bacterial cell wall synthesis
D= 250 q8h or 500-875mg BID, 500mg tid in lyme disease
DDI= Venlafaxine SS, warfarin inc INR, methotrexate tox
SE= Common: diarrhea Serious: anaphylaxis
PK=Renal elimination 60%
C= diarrhea, shake well before giving dose, decreases birth control effectiveness
Lipitor
atorvastatin
I= hyperlipidemia, hypertriglyceridemia
MOA=HMG COA reductase inhibitor
D= 10-80mg orally daily , t1/2 14h
DDI= CYP 3A4 inhibitors/inducers, azoles, protease inhibitors, GFJ, warfarin, niacin, amlodipine,
SE= Common: diarrhea, arthralgia Serious: rhabdomyolisis
PK= cpy3a4 extensively metabolized, mainly biliary excretion
C= report muscle pain, tenderness, weakeness, Sx of liver problems: jaundice dark urine, upper abdomen pain, avoid excessive alcohol
xanax
alprazolam
I= anxiety, panic disorder, etoh withdrawal
MOA=benzodiazepine, GABa receptor binding
D= Anx 0.25-0.5 TID, Panic 0.5mg tid, may increase by 1mg every 3-4days max dose is 4-6mg/day
DDI= alcohol, keto/itraconazole, opiates, barbiturates, “downers”
SE= Common:somnolence, changes in appetite, sedation, memory impmt, fatigue Serious: drug withdrawal seizure
PK=Renal elimination 80%, extensive cyp 3a4 met
C= dizziness, somnloence, advise against abrupt disruption, avoid alcohol, avoid GFJ
celexa
citalopram
I= Depression, OCD, panic disorder
MOA=SSRI
D= Start 20mg orally daily, can increase to 40mg daily after a week has passed.
DDI= CYP3A4 inhi/inducers, MAOis, TCAs
SE= Common:insomnia, somnolence, N, V Serious: suicidal thoughts, prolonged QT, SS
PK=mainly hepatic elimination
C= may impair judgement, thinking, may cause sexual dysfunction in men, improvement seen for a few weeks, avoid alcohol, increases risk of bleeding, SS(high fever, hallucinations, hyperreflexia etc)
zithromax
azithromycin
I=Gonorrhea, Pelvic inflammatory disease, strept pharyngitis, otitis media, CAP etc
MOA=Macrolide antibiotic, binds to 50S ribosomal subunit, disrupting protein synthesis
D= 250mg-500mg orally daily, 1g x1 chlamydia
DDI= warfarin, fluoroquinolones,
SE= Common: diarrhea Serious: prolonged QT
PK=major excretion biliary , 35% hepatic met
C= eye solution may cause eye pain, irritation, itchiness, facial swelling. . Oral and regular suspesion, avoid magnesium contain antacids
Zmax
Azithromycin suspension
I= Gonorrhea, Pelvic inflammatory disease, strept pharyngitis, otitis media, CAP etc
MOA=Macrolide antibiotic, binds to 50S ribosomal subunit, disrupting protein synthesis
D= 250mg-500mg orally daily, 1g x1 chlamydia
DDI= warfarin, fluroquinolones
SE= Common: diarrhea Serious: prolonged QT
PK=major excretion biliary , 35% hepatic met
C= take within 12 hours and discard any unused portion
Aquazide, Zide, Microzide, Hydrocot
Hydrochlorothiazide
I= hypertension, adjunct to edema
MOA=diuretic
D=12.5-25mg orally daily, 2-3weeks to achieve optimum effect
DDI= ACE’s, NSAIDs,
SE= Common: phototoxicity Serious: hyponatremia, hypokalemia, hyperglycemia, hypercalcemia, renal impairment
PK=Renal elimination 60%
C= avoid etoh, diabetics monitor BG, electrolyte imbalances,
Klonopin
clonazepam
I= panic disorder, seizure, RLS
MOA=benzodiazepne, GABA receptor
D= panic: 0.25 orall bid x 3 days, then 0.5 bid, may increase dose up .25mg bid q 3 days, max daily 4mg div 2-3 doses, Seizure start 0.5mg tid, may inc up to 1mg every 3 days max of 20mg/day divided in 3 doses
DDI= ethanol, opiates, “downers” barbiturates, Cyp3A4 i/i
SE= Common: ataxia, somnolence Serious: respiratory depression
PK=extensive hepatically metabolized
C= avoid alcohol, somnolence, impaired cognition, avoid sudden d/c for withdrawal sx
flonase
fluticasone (nasal)
I= asthma, allergic rhinitis, atopic dermatitis
MOA=glucocorticoid receptor agonist, anti inflammatory, immunosuppressant
D=88-880mcg twice daily, starting tose depends on previous therapy
DDI= PIs, Azole antifungals
SE= Common: throat irritation, candidiasis Serious: pneumonia
PK= hepatic metabolism-> fecal excretion
C= not for acute attacks of asthma, rinse mouth out may cause thrush, proper inhalation technique`
lexapro
escitalopram
I= GAD, Depression, OCD
MOA=SSRI
D= Start 10mg orally daily then can increase to 20mg orally daily after a week has passed
DDI= CYP3A4 inhi/inducers, MAOis, TCAs
SE= Common: insomnia, somnolence, Serious: suicidal thoughts
PK=hepatic cyp 3a4, cyp 2c19
C=report suicididal ideation, abnormal bleeding, do not drink etoh, not to take with celexa
ultram
tramadol
I= moderate to severe chronic pain, dental pain
MOA=centrally acting opioid analgesic, weak SNRI
D= IR: start 25mg/day every morning, can titrate dose and inc by 50mg q 3 days max. can be 50-100mg q 4-6 hours.400mg/day ER 100mg daily, max 300mg/day
DDI= maois, SSRis
SE= Common: constipation dizziness, insomnia, somnolence
PK=Renal 60%, extensive hepatic met
C= Avoid alcohol, rport SS syms agitation, confusion, diaphoresis, hallucinations
lasix
furosemide
I= CHF edema, edema, hypertension, pulmonary edema
MOA=loop diuretic, block na/cl uptake-> urine output
D= IM/IV 20-40mg, may repeat. 600mg Max/day, Orally can give 20-80mg daily, 600mg max/day
DDI= aminoglycosides, ACEIs, NSAIDS
SE= Common:Hyperuricemia, hypomagensemia, hypokalemia Serious: SJS, Orthostatic hypotension,
PK=Renal elimination 60-90%
C= photsensistivity use sunscreen, changes in electrolytes, eat high potassium foods, do not drink alcohol
bactrim DS
sulfamethoxazole + trimethoprim DS
I= UTI, Shigellosis, PCP prophylaxis and treatment, sinusitis,
MOA=Inhibit production of tetrahydrofolic acid in folic acid synthesis
D= PCP proph 1 DS qd or 1SS qd, PCP Tx 15-20mg/kg divided q 6-8hours (mod/sev) or TID (mild/mod), shigellosis 1 DS q12h x 5days
DDI= warfarin inc INR, TCAs
SE= Common: Rash, urticaria Serious: SJS, rhabodmyolysis, agranulocytosis
PK=Renal elimination mostly for oral S/T
C= Use sunscreen, reporst SJS (spreading red rash, drink plenty of water to prevent kidney stones
nexium
esomeprazole
I= GERD, NSAID gastropathy, Duodenal ulcer disease
MOA=proton pump inhibitor
D= 20-40mg once daily 1 hour before meals
DDI= ripivirine, clopidogrel, mycophenolate, iron
SE= Common: diarrhea Serious: C dific diarreha, bone fracture, rhabodo
PK=Renal elimination 80%, extensive cyp 3a4 metabolism
C= report persistent watery diarrhea, take 1 hour before meals,
Singulair
montelukast I= Asthma, allergic rhinitis MOA= leuktriene receptor antagonist, prevents inflammation, smooth muscle contraction D= 10mg orally in the evening SE= Common:Headache PK=Bile excretion C= Not for acute asthma attacks
augmentin
amoxicillin + clavulanate
I= Acute otitis media, CAP, sinusitis, UTI, LRTI, skin infections, strep throat, febrile neutropenia
MOA=inhibit cell was synthesis, clavulanate stops beta lactamase from destroying amoxicillin
D= Start 500mg bid, max 850mg TID
DDI= ACE’s
SE= Common:diarrhea
PK=A: mostly renal, Cl: renal/extensive hepatic
C= decrease effectivenss of oral contraceptives , NVD, take at the start of a meal
flexeril
cyclobenzaprine
I= skeletal muscle spasm, fibromyalgia
MOA=works on the CNS to reduce smoatic motor activity
D= IR: 5mg TID, can inc to 10mg TID up to 2-3 weeks, ER 15mg qd, up to 30mg qd up to 2-3 weeks
DDI= MAOI, duloxetine
SE= Common: dizziness, HA Serious: hepatitis
PK=Extensive hepatic CYP3A4 Renal elimination 50%
C= not intended for long term therapy, affect mental alertness, do not use alcohol or other CNS depressants, report hepatic sx
neurontin
gabapentin
I= postherpetic neuralgia, partial seizure adjunct, diabetic neuropathy, migraine prophylaxis
MOA=GABA analog but does not bind GABA receptors. MOA unknown
D= 300mg qd, bid, or tie. Max 1800mg/day divided in 3 doses
DDI= morphine inc gabapentin, naproxen, ketorolac, antacids
SE= Common: somnolence, dizziness Serious: suicidal thoughts
PK=Renal
C= separate from aluminum or mg by 2 hours, avoid alcohol, report suicidal ideation
toprol xl
metoprolol xl
I= hypertension, CHF, angina, AFIb
MOA=beta blocker
D= HTN 25-100mg orally daily, CHF up to 200mg orally daily
DDI= amiodarone, diltiazem, veraamil, beta agonists
SE= Common: dizziness, fatigue Serious: bronchospasm 1%
PK=Hepatic 50%
C= mask symptoms of hypoglyecemia except sweating, can cut tablet in half, take immediately after meals, do not stop taking suddenly
mobic
meloxicam
I= osteoarthritis, rheumatoid arthritis
MOA=NSAID cox inhibition dec prostaglandin sysnthesis
D= 7.5mg once daily, max 15mg daily use lowest effective dose for shortest duration
DDI= clopidogrel, warfarin, SSRIS, LMWH, thiazides,
SE= Common: HA, N Serious: GI bleed
PK=hepatic
C= Avoid in late pregnancy, report dark stools or bleeding, report worsening BP, do not take other NSAIDs
klor-con
potassium chloride
I= hypokalemia, long QT
MOA=electrolyte replenish, normalize renal fx, normal muscle contraction and nerve impulses
D= doses based on serum potassium levels 20-100meq/L divided 1-5 doses after meals
DDI= ACEI’s, ARBs, potassium sparing diuretics, salt substitutes
SE= Common:NVD, flatulence Serious: caridiac arrest, Hyperkalemia
PK=Renal elimination
C=Take with food and full glass of water to prevent Gastric irritation
coumadin
warfarin
I= Afib, VTE, PE, valve replacement, APS
MOA=VItamin K antagonist, dec synthesis of clotting factors
D= variable, titrated to INR goal
DDI= amiodarone, fluoroquinolones, multivitamins, vitamin K foods, etoh
SE= Common: nosebleeds, bruising Serious: excessive bleeding, inter cranial hemorrhage
PK=Renal elimination
C= Keep consistenet diet, report unusual bruising or bleeding, avoid binge etoh, reprot missed doses, take at bedtime
naprosyn
naproxen
I= osteoarthritis, pain, acute gout, RA, tendonitis
MOA=cox inhibitor
D= 250-500mg bid max 1500mg/day up to 6 months
DDI= ACEi, warfarin, heparin,
SE= Common: abdominal pain, GI upset Serious: GI bleeding, CHF
PK=Renal elimination 95%
C= Report GI bleeding, increases blood pressure
seroquel
quetiapine
I= Bipolar disorder, depression, schizophrenia
MOA=5ht and dopamine receptor antagonist, also antagonist alpha, histamine receptors
D= Start 500mg bid, max 850mg TID
DDI= barbiturates, glucocorticoids, hydromorphone
SE= Common:somnolence, weight gain Serious: qt prolongation
PK=Renal elimination 73%
C= stand up slowly for OH, report tardive dyskinesia, monitor for sx of hyperglycemia for diabetics
advair
fluticasone / salmeterol
I= asthma, COPD
MOA=Fluticasone antiinflammatory, Salmeterol long acting beta agonist–> smooth muscle relaxation bronchial, ihibit hypersensitivity molecules of mast cells
D= 100-500/50mcg inhlation 12 hours apart twice daily
DDI= ACE’s
SE= Common:Hyperkelemia Serious: lactic acidosis
PK=Renal elimination90%
C= not rescue medication, rinse mouth after use (thrush), forceful inhalation of medications, report weight gain, thin skin, facial rounding, fatigue
ativan
lorazepam
I= anxiety, status epilepticus, CINV, seizure, etoh withdrawal
MOA=benzodiazepine, binding to GABA receptor, opiods, centrally acting muscle relaxants, zolpidem
D= 2-6mg/day divided in 2-3 doses (Anx)
DDI= etoh, barbiturates,
SE= Common:sedation Serious: lactic delirium
PK=Renal elimination 88 %
C= avoid alcohol, impairs alertness, memory, somnolence. Can take missed dose up to 1 hour of scheudled time, if >1h, skip dose
diflucan
fluconazole
I= candidiasis, cryptococcal meningitis, many fungal infections
MOA=inhibit fungal sterol synthesis
D= 100-800mg orally or IV, weekly to daily
DDI= CYP3A4 inhibitors, inducers
SE= Common: HA Serious: prolonged qt, agranulocytosis
PK=Renal elimination 80%
C= Report skin rash, NV, HA
topamax
topiramate
I= tonic clonic seizure, partial seizure, migraine prophylaxis
MOA=Unknown, maybe augemnt GABA activity
D= 25-200mg twice daily, varies
DDI= Metformin inc LA, citalopram long QT, naproxen
SE= Common: loss of apetite, dec psychomotor performance, somnolence Serious: metbolic acidosis
PK=Renal elimination 70%
C= maintain adequate fluid intake, dec effectivenss of estrogen containingbirth control, avoid sudden d/c –> seizure
cipro
ciprofloxacin
I= pyeloneprhitis, UTI, gonorrhea, sinusitis, etc, etc
MOA=fluorquinolones interfere with dna gyrase, interfere with DNA synthesis bacteria
D= 250-750 orally/IV q12h
DDI= antidiabetic agents, warfarin, antacids
SE= Common:NVD, rash Serious: hemolytic anemia, agranulcytosis
BBW: increased risk of tendinitis and tendon rupture
PK=liver significant
C= Avoid antacids, photosensitivity, take 2 hour before or 6 hours after calcium,iron,zinc antacids
tylenol with codeine
acetaminophen with codeine
I=pain mild to moderately severe
MOA=peripheral/central analgesia
D= apap/codeine 300-1000/ 15-60mg (max 360) prn q 4hours
DDI= barbiturates, benzos, opiates
SE= Common:somnolence Serious: liver failure
PK=hepatic, codein hepatic–> renal
C= avoid etoh , hepatotoxcity symptosm, max 4g for APAP, somnolence
fosamax
alendronate I= osteoporosis MOA=inhibit osteoclast bone resorption D= 70mg once weekly, or 5mg daily DDI: dairy foods SE= Common:fever Serious: esophageal erosions PK=Renal elimination 50% C= Take when waking up, 30 min before first food, maintain upright position x 30 minutes prevents esophageal damage
crestor
rosuvastatin
I= hyperlipidemia, hypertriglyceridimia
MOA=hmg coa reductase inhibitor
D= 5-40mg daily
DDI= APAP, fibrates CYp3a4 inducers/ ihibitors
SE= Common:arthralgia Serious: rhabomyolysis
PK=fecal 90%, some renal
C= bilateral muscle pain, jaundice, separate antacids 2 hours
elavil
amitryptyline
I=depression, pain, headache
MOA=TCA, sedating, block uptake of serotonin, norepinephrine
D= 50-100 daily divided 1-3 doses. Max output 150/day, inpt 300/day, polyneuorpathy 10-25mg HS, up to 200mg/day inc weekly
DDI= MAOIs, SSRIS, CYP3A4 i/i
SE= Common:wt gain, somnolence, blurry vision Serious:Qt prolongation
PK=hepatic and renal
C= Symptomatic imprvmt takes weeks, dont d/c abruptly, dont drink alcohol
allegra
fexofenadine I= urticaria, allergic rhinitis MOA=inhibits histamine releease and H1 receptor activity D= 60 po bid or 180mg po qd DDI= Droperidol, antacids, GFJ, SE= Common: HA PK=fecal 80% C= Take with water not fruit juices. Separate antacids by 30min before or after fexofenadine, fatigue, HA
coreg
carvedilol
I= hypertension, chf
MOA=alpha/beta blocker
D= HTN 6.25mg bid, may be doubled 1-2 weeks, max 25mg bid, CHF start 3.125 bid, doubled q 2 weeks, max 25mg bid if 85kg max 50mg bid
DDI= amiodarone, verapamil, diltiazem, alpha 1 blockers
SE= Common:hyperglycemia, wtgain , dizziness, diarrhea, erectile dysfunction Serious: AV block
PK=fecal /biliary
C= take with food, diabetics watch sugar levles, stand up slowly
risperidal
risperidone
I= bipolar, schizophrenia
MOA=Unknown. 5ht receptor blocker, weak dopamine receptor blocker
D= Schz 2-8mg/day po , bipolar 2-3mg/day po , IM 25mg IM q 2weeks then 37.5-50mg IM q 4 weeks (both)
DDI= TCAs, Agents that cuase qt prolongation,
SE= Common: somnolence, insomnia, constipation, many, Serious: tardive dyskinesia
BBW: inc mortality of elderly patients with atypical antipsychotics
PK=Renal elimination 70%, hepatic extensive
C= drowsiness, hyperglycemia, stand up slowly
detrol
tolteridine I= overactive bladder MOA=muscarinic receptor antagonist D= 2mg bid (IR), or 1mg BID DDI=potassium acetate, warfarin, SE= Common:dry mouth, serious; angioedema PK=Renal elimination 77% C= drymouth, dizziness, report angioedema
50 vibramycin
doxycycline
I= syphyllis, gonorrhea, acne, chlamydia, shigellosis
MOA=inhibits bacterial protein synthesis
D= 100mg po bid, and others
DDI= antacids, warfarin
SE= Common: diarrhea Serious: sis
PK=hepatic and renal
C= sunscreen, antacids avoid, decrease oral contraceptive effectiveness, take with full glass of water
protonix
pantoprazole
I=GERD, gastric hypersecretion, erosive esophagitis
D=40mg once daily (sometimes twice daily)
DDI=mycophenolate, citalopram, warfarin, itraconzole
MOA=proton pump inhibitor
PK=70% renal excretion, fecal 18%
SE=diarrhea serious: c. dificil diarrhea, osteoporosis with multiple daily doses for longer than a year
C=report diarrhea, persistent watery stools, take 30 minutes before a meal in the morning
adderal xr
amphetamine + dextroamphetamine XR
I=ADHD, narcolepsy
D=ADHD: ER, 20mg orally daily, narcolepsy 5-60mg/day orally in divided doses
DDI=Selegiline, isocarboxazid, MOAI
MOA=CNS stimulant activity, may block rueptake of NE and dopamine. for ADHD MOA unknown
PK=renal elimination
SE=loss of appetite, dry mouth, insomnia Serious: CVA, mania
precaution/BBW: high potential for abuse may lead to drug dependence. Misuse can cause sudden seat or cardiovascular adverse events
C=may lower seizure threshold, impairs mental alertness, dont stop medication suddenly, avoid citrus juices, take missed dose asap unless its 6 hrs before bedtime, then skip missed dose
zofran
ondansetron
I=CINV, post op NV, radiation induced NV
D=CINV high px :(IV) 3 doses of 0.15mg/kg IV starting 30 min before chemo, repeat 4-8 post first dose. max IV single dose 16mg, (oral) 24mg po 30 min pre chemo
moderate: 8mg po 30 min pre chemo, repeate in 8 hours, then 8mg q 12h x 1-2 days post chemo
DDI=fluconzole, fluoroquinolones, macrolides, tcas
MOA=5 HT3 receptor antagonist
PK=extensive hepatic clearance
SE=Ha, constipation serious: prlonged qt
precaution/BBW
C=report abnormal heartbeats, bronchospasm, rash.
prevacid
lansoprazole
I=GERD, erosive esophagidtis, dudenal ulcer disease
D=15-30mg orally daily
DDI=citalopram, mycophenolate, GFJ, PIs
MOA= proton pump inhibitor
PK=hepatic, some renal
SE=diarrhea, abdominal pain Serious: C. dificil diarrhea
C=report persistent watery diarrhea, take 30 minutes before meals, contents of capsule can be mised with applesauce, pudding ,yogurt, apple, orange or tomato juice
tenormin
atenolol
I=HTN, angina pectoris, acute MI, cardiac dysrhythmia
D=50-100mg orally daily
DDI=beta agonists, diltiazem, verapamil, sulfonylureas
MOA=beta blocker
PK=Renal clearance
SE= low heart rate, dizziness, fatigue
BBW= abrupt cessation of therapy of beta blockers can lead to exacerbations of angina pectoris, sometimes MI or arrhythmias
C=may mask sx of hypoglycemia, diabetics to check blood sugar regularly, take on an empty stomach, do not d/c abruptly
nasonex
momentasone (intranasal)
I=asthma, allergic rhinits, TOPICAL: inflammatory hyperkeratotic dermatosis
D=nasal: 2sprays/nostril (100mcg) once daily- max 200mcg/daily, inhaler: 220-440mcg once-twice daily max 880mcg/day, Topical: apply once daily
DDI=ketoconazole
MOA=corticosteroid, inhibit release or arachidonic acid–> inflammation inhibited
PK=hepatic met–>fecal 74%
SE=thrush, headache
C=rinse mouth after inhalation
depakote ER
divalproex ER
I=partial epileptic seizure, absence seizure, bipolar I disorder, migraine prophylaxis
D=10-15mg/kg/day, can increase by up to 10mg/kg/ week. max 60mg/kg/day, depakote ER for bipolar I: 25mg/kg/day daily
DDI=carbapenems, lamotrigine, naproxen, warfarin
MOA=unknown. may increase GABA levels in the brain
PK=renal/hepatic clearance
SE=headache, somonlence Serious: thrombocytopenia dose related
BBW=hepatotoxicity within first 6 months of tx, children <2 years of age at higher risk
C=may take with found to avoid GI irritation, do not drink alcohol, affects mental alertness
percocet
oxycodone + acetaminophen
I=pain moderate to severe
D= apap 325-650/oxycodone 2.5-10 orally q 6h prn, max 4g APAP
DDI=benzodiazepines, PI, SSRIs, Azoles, etoH
MOA=oxycodone, opioid agonist, APAP analgesic antipyretic
SE=somnolence, dizziness serious hepatotoxicity, respiratory depression
BBW= APAP associated with liver failure. do not exceed 4000mg/day
C=report (nv jaundice), do not drink alcohol , avoid other APAP otc products
lyrica
pregabalin
I=diabetic neuropathy, fibromyalgia, neupathic pain, postherpetic neuralgia, GAD
D=50mg TID or 75mg BID, max of 450mg/day
DDI=ketorolac, naproxen
MOA=GABA analog binds to voltage gated calcium channels in CNS tissues. Decreased calcium dependent release of neurotransmitters. MOA not fully understood.
PK=renal 90%
SE=somnolence, fatigue, peripheral edema Seirous: suicidal thoughts, jaundice
C=avoid activiitie requiring mental alertness, adverse effects to fetus with either male or female taking medication, avoid alcohol
lopressor
metoprolol tartrate
I=hypertension, angina, cardiac dysrhytmia, CHF
D=HTN: 50-100mg once or divided twice daily, 6.25mg orally twice daily titrated to target 50mg bid. Inc dose over 4-6 week to target
DDI=beta agonists, verapamil, diltiazem
MOA=beta blocker
PK=hepatic
SE=fatigue, dizziness, Serious: bronchospasm
BBW: sudden cessation of some beta blockers can lead to exacerbations of angina pectoris and sometimes MI. Reduce dose gradually over 1-2 weeks
C=may mask sx of hypoglycemia, diabetics monitor sugars, dont stop medications suddenly, ER for: take after with or right after meals
voltaren
diclofenac
I=osteoarthritis, RA
D=Osteoarthritis :DR 100-150mg /day divided in 2-3 , ER: 100mg orally daily doses RA: DR 150-200mg/day divided 2-4 doses, ER 100mg once daily max 100mg twice daily for both
DDI=warfarin, clopidogtrel, tacrolimus, ssris
MOA=NSAID, cox inhibitor dec prostaglandin synthesis
PK=65% renal , 35% biliary
SE= Serious : GI bleed, HTN
BBW:NSAIDs may cause inc risk of serious cardiovascular throbmotic events, bleeding, ulceration, perforation
C=Report any blood in stools or dark coffee stools, irritates GI, take with full glass of water, milk or food, gel: dont wash area for at least an hour
cardiazem DC or cartia
dialtiazem CD or diltiazem I=angina, htn, arrhythmias (IV) D=120mg-240mg orally daily max 540mg/day DDI=beta blockers, MOA=Calcium channel blocker PK=hepatic clearance SE=Headache, Fatigue Serious: heart block C=do not drink alcohol, do not take beta blockers unless provider is aware,
effexor
venlafaxine
I=major depressive disorder, GAD, panic disorder, social phobia
D= 37.5 to 75mg orally divided 1-3 doses. May increaase by 75mg/day q 4 days. max dose ins 225mg/day
DDI=selegiline, agents that inc bleeding risk, PIs, SSRIs, triptans
MOA=serotonin, NE, dopamine reuptake inhibitor
PK=87% renal, extensive first pass hepatic
SE=insomnia, weight loss, nervousness serious:SS
BBW: antideppressants inc risk of suicidal thinking in children, adolescents, young adults
C=do not drink alcohol, vocid OTC ASA, IBU, NAPX,
aspirin
aspirin
I=HA, MI ppx, fever, pain, etc
D=75-100mg anti-plalet aggregation, 325-650mg q 4h prn max 3.9g/24hours
DDI=Live influenza vaccine, NSAIDS, any agents that cause bleeding
MOA=irreversible COX inhibition and inhibition of platelet aggregation
PK=hepatic and renal elimination
SE=bleeding, GI ulcer, tinnitus Serious: Reye’s
C=avoid use in children and never take witf child has chicken pox or flu symptoms, avoid eton, report signs and symptoms of bleeding
celebrex
celecoxib
I=osteoarthritis, RA, acute pain
D=OA; 100mg po bid, or 200mg po qd, RA 100-200 po bid prn
DDI=agents that increase risk of bleeding(warf, heparin etc
MOA=cox 2 inhibitor
PK=p450 metabolism, some renal, 57% fecal
SE=HA, Serious: MI
BBW: may have inc risk of cardiovascular thrombotic events, MI stroke
C=report any bleeding or allergic reaction, or MI, avoid other NSAIDS, take higher (400mg bid) doces with food, lower can be with or without food
lamictal
lamotrigine
I=bipolar I disorder, partial seizures, tonic-clonic siezures
D=BPI and not taking valproic acid or enzyme inducing drugs 25 qd x 2 wks, 50 qd x 2 weeks, 100mg x 1 week, then 200mg/day (Schedule) schedule is variable see references
DDI=Valproic acid, estrogens, progesterone,
MOA=Unknown
PK=renal and extensive hepatic
SE=Blurred vision, HA, dizziness Serious: Rashes
BBW: serious life threatening rashes with medication, higher if pediatric or going over max dose or coadministered with valproate
C=immediately report any rashes, do not stop suddently cuz leads to seizures, any changes in estorgen containing meds reported-> changes blood levels of lamictal
lunesta
eszopiclone
I=insomnia
D=2mg orally before bedtime, may be increased to 3mg
DDI: oxycodone, zolpidem, ketoconazole
MOA=may bind to GABA receptor, but moa unknown
PK=75% renal
SE=HA, disorder of taste
C=DO not drink ethanol, make cause sleep driving or other activities where patient is not fully awake, take only when pt has insomnia not on a regular basis
flomax
tamsulosin
I=benign prostatic hyperplasi
D=0.4mg orally ocne daily, if no responce after 2-4 weeks, increase to 0.8mg orally once daily
DDI=tadalafil, azole atnfungals, macrolide, PIs, beta blockers
MOA=alpha 1a recepetor antagonist leading to rleaxation of smooth mucles of protstte, increasing urine flow rate
PK=hepatic and renal
SE=headache, abnormal ejaculation
C=take 30min after a meal every day, rise slowly to avoid Orthostatic hypotension
aricept
donepezil
I=alzheimers dementia
D=5mg orally at bedtime, can increased to max of 10mg orally daily at 4-6 weeks
DDI=succinylcholine, oxybutynin
MOA= reversible acetylcholinesterase inhibitor, increasing acetylcholine
PK=renal/hepatic
SE=diarrhea, insomnia, cramp Serious AV block
C=report GI bleeding, take at bedtime, adverse effect more frequent at dose escalation but resolve with continued use
valium
diazepam
I=anxiety, alcohol withdrawal, sedation pre op, seizure, muscle spasm
D=2-10mg orally, IM, IV MAX dose of 30mg
DDI=barbiturate, opaiates, etoh , downers
MOA=benzodiazepine, binding to GABA receptor
PK=hepatic and renal
SE=somnolence, ataxia Serious: resp depression
C=avoid activities that require mental alertness, avoid abrupt discontinuation of extended diazepam therapy cuz withdrawal, do not drink ETOH
reglan
metoclopramide
I=diabetic gastroparesis, GERD, post op NV, CINV
D=10-15mg orally 30min before meals up to 4 times daily. Can be gie 10-20mg IV/IM
DDI=SSRIs ,tcas, antipsychotics, MAOIs
MOA=sensitization of tissues to action of acetylcholine that increases motility stomach
PK=renal elimination
SE=somnolence, fatigue
BBW can cause tardive dyskinesia with longer duration of treatment and cumulative dose
C=do not drink alcohol, report sx of tardive dyskenesia (tongue thrusting, facial ticks, random movements
zyloprim
allopurinol
I=hyperurecemia, chronic gout
D=Gout MFR labeling start with 100mg/day then increase weekly to recommended dosage= mild 200-300mg/day, sever 400-600mg/day ma 800/day. Renal dosage adjustment
DDI=thiazide & loop diuretics (inc allopurinol levels), antacids (dec allop absorption), ACEI (inc allergic hypersens to allopurinol
MOA=xanthine oxidase inhibitor
PK=metabolized to active metabolites and those are excreted renally
SE= common: rash, diarrhea, nausea, acute attacks of gout
C=benefit may be delayed 2-6 weeks, take after meals to reduce gastric irritation, maintain adequate hydration to prevent renal stones
prozac
fluoxetine
I=major depressive disorder, OCD, PTSD & more
D=Depression,OCD, PTSD 20mg/day, can increase after several weeks, max 80mg/day
-lower doses for hepatic impairment
DDI=Anticogulants/antiplatetel (inc risk of bleeding), CNS depressants, eton, CYP2D6 inhibitor
MOA=SSRI
PK=hepatic clearance, minor renal
SE=Common insomnia, somnolence
BBW: increased suicidal ideation in young adults (18-24), adolescents, children with MDD
C=take medication in the morning , may take up to 8-12 weeks after initiation of tx, report abnormal bleeding, avoid NSAIDS or aspirin, do not drink alcohol
actos
pioglitazone
I=diabetes type II
D=15-30mg qd start, then can increased to 45mg once daily (max)
DDI=CYP3A4 inducer (weak/moderate)sulfonylureas, betal blockers & SSRIS (can enhance hypoglycemia) Thiazides, loops, corticosteroids (may diminish hypoglycemic action)
MOA=decreases insulin resistnac
PK=hepatic clearance, peak effect takes several weeks
SE=fluid retention, (edema), weight gain
precaution/BBW: increased risk of bladder cancer (Health Canada Review), AVANDIA BBW of increased MI events so not used any more
C=avoid in pts with CHF, may inc risk of fractures especially in females
dyazide or Maxzide
triamterene/ hydrochlorothiaze
I=edema, HTN (not DOC) when hypokalemia has developed or should be prevented
D=HCTZ 25-50/Triam 37.5-75 daily
DDI=ACEI/ARBS (Inc K) or anything that affects potassium levels,
MOA=HCTZ inhibt NaCL reabsorption in distal tubulues, Triam blocks sodium channels in the late distal convoluted tubule
SE=hyper/hypokalemia, hyperglycemia, hyperurecemia, orthostatic hypotension
BBW: hyperkalemia can occur with triamterene, Mx serum K
C=report muscle weeakness, fatigue, slow heart rate, maintain adequate hydration, avoid salt substitutes,
miralax
polyethylene glycol
I=constipation
D=17g/day dissolved in 4-8oz of water, juice, soda, coffee or tea
DDI=no significant ddis
MOA=osmotic agent that causes water retentio in the stool and increases stool frequency
PK=onset 24-96 hours, excrted in feces
SE=bloating, cramping, diarrhea, flatulence
C=may not see improvement until 2-4 days, do not take longer than 2 weeks unless instructed by healthcare professional
lantus
insulin glargine
I=DM type 1 and type II
D=DMII : 0.2 units/kg or 10 units/day Increase dose by 2 units/day every 3 days until fasting glucose levels are consistently within target range (70-130 mg/dL)
DDI=sulfonylureas, beta blockers & SSRIS (can enhance hypoglycemia) Thiazides, loops, corticosteroids (may diminish hypoglycemic action)
MOA=long-acting insulin
PK=long duration of action (depends on UNits given), excreted in urine
SE=most common is hypoglycemia, pain itching stinging at injection site
C=signs and sx of hypoglycemia (tremor, dizziness, sweating, irritability, fatigue, palpitations, hunger), rotate injection sites, expires in 28 days once opened
levaquin
levofloxacin
I=UTI, CAP, HAP, Skin infections etc
D=CAP 500mg q 24h x 7-14days or 750mg q 24h x 5 days, HAP 750 q 24h x 7-14 days
DDI=antacids, calcium salts, iron (dec absorption), warfarin (inc INR), NSAIDs (inc seizure potentiating, sulfonylureas ( enhance hypoglecemia)
MOA= inhibit DNA gyrase, promotes brekage of DNA strands
PK= 99% oral bioavailability, urine excretion
SE= headache, nausea, diarrhea
precaution/BBW (fluroquinolones) Risk of Muscle Weakness in Patients with Myasthenia Gravis
C=report muscle weakens if pt also has myasthenia gravis, avoid antacids, calcium or iron supplements
niaspan
niacin extended release
I=hyperlipidemia, hypertriglyceridemia
D=regular release niacin and extedned releasse not interchangeable
Initial: 500 mg at bedtime for 4 weeks, then 1 g at bedtime for 4 weeks; adjust dose to response and tolerance; may increase dose every 4 weeks by 500 mg/day to a maximum of 2 g/day
DDI=bile acid binders (dec absorption), HMG coa R inhib( when niacin >1g/day inc toxicity of statins, rhabdo)
MOA=inhibit synthesis of LDL and VLDL, may inc TG removal from plasma
PK=urine excretion of hepatic metabolites and drug
SE=flushing (can be prevented by taking ASA 325 mg 30 min before dose of Niacin)
precaution/BBW
C=take at bedtime with low fat snack, take ASA 325mg if flushing occurs
zestoretic or prinzide
lisinopril/hydrochlorothiazide
I=hypertension
D=10-20 Lis/12.5 HCTZ once daily, max 80/50mg once daily
DDI=antidiabetic agents (thiazides can make them less effective), salt substitutes, potassium sparing diuretics, NSAIDS
MOA=ACEI/thiazide diuretic
PK=lisinopril cleared renally
SE=hypo/hyperkalemia, non productive cough, headache, dizziness Serious: angioedema,
precaution/BBW
C=contraindicated in pregnancy, avoid if sulfa allergy, photosensitivity possible can use sunscreen
omnicef
cefdinir
I=CAP, pharyngitis, skin infections etc.
D=CAP/pharyngitis/skin infections 300mg Bid x 10days
DDI=Aminoglycosides (Ceph Inc neprhotoxic effect of Am), iron salts dec cefdinir concentrations
MOA=inhibits bacterial cell wall synthesis (cephalosporine)
PK=urine excretion, minimal hepatic metab
SE=common diarrhea
precaution/BBW
C=Twice daily doses should be given every 12 hours. May be administered with or without food. At least 2 hours before or after antacids or iron supplements. Shake suspension well before use.
tricor
fenofibrate
I=hyperTG
D=48-145 mg/day; maximum dose: 145 mg/day
DDI=statins (inc rhabdomyolisis), bile acid sequestrants (dec absorption of fibric acid derivatives, take 1hr pre or 4-6post BAS), warfarin (inc INR)
MOA=an agonist for the nuclear transcription factor PPAR-alpha resulting in decrease in triglyceride levels
PK=hepatic and renal clearance
SE=abdominal pain, headache serious: risk of rhabdomyolisis esp with statins
C=separate from BAS: take 1hr pre or 4-6post BAS, report bilateral muscle pain and weakness
geodon
ziprasidone
I=schizophrenia, bipolar disorder
D=Bipolar: 40mg-80mg po bid, Schiz 20-100mg po bid
DDI=alcohol or any CNS depressants
MOA=antipsychotic, exact MOA unkonwn but affinity to serotonin, and dopamine receptors, moderate inhibition of 5ht and NE
PK=extensive hepatic clearance–> feces
SE=somnolence, headache, Serious: Qt prolongation
precaution/BBW
C=do not drink alcohol, stand up slowly to prevent OT hypoT
benicar
olmesartan
I=HTN
D=start with 20mg qd, can increase to 40mg qd after 2 weeks
DDI=potassium sparing diuretics, salt substitutes, NSAIDs (sigf dec in renal fx)
MOA=ARB, block aldoseterone activity on its receptor
PK=renal clearance
SE=hyperkaliemia ,HA, diarrhea, dizziness, Serious: angioedema
BBW: contraindicated in pregnancy can cause injury and death to the fetus
C=report plans for pregnancy (females), do not take with NSAIDS
armour thyroid
thyroid, dessicated
I=hypothyroidism
D=start 15-30mg and increase by 15mg q 2-3 weeks maintenance usually 60-120mg. Monitor TSH
DDI=calcium salts (separate by 4 hours), warfarin (inc INR)
MOA=dessicated thyroid
PK=urine excretion
SE=if too much: hyperthyroidism: palpitations, insomnia, heat intolerance, fast HR, fatigue, trembling, weight loss
precaution/BBW: do not used tyroid supplements for weight reduction in euthyroid patients: toxic
C=take on an empty stomach in the morning, report sx of hyperthyroidism
zantac
ranitidine
I=GERD, gastric or duodenal ulcer, heartburn, erosive esophagitis
D=150mg po bid
DDI=dec Iron absorption, sulfonylureas (dec serum [ ]), warfarin (dec INR)
MOA=H2 receptor antagonist
PK=hepatic and renal elimination
SE= abdominal pain , constipation/diarrhea, HA
precaution/BBW
C=if using for heart burn take 30-60minutes before food/drinks
oxyIR or roxicodone
oxycodone (immediate release) I=pain moderate-severe D=IR: 5-15mg po q 4-6hrs prn DDI=major cyp3a4 substrate, CNS depressants, alcohol MOA=mu opioid receptor agonist PK=hepatic metabolism--> urine excretion SE=somnolence, constipation, nausea precaution/BBW C=avoid activities that require mental alertness like driving etc, avoid alcohol, if using for longterm, may need to taper dont d/c suddenly
altace
ramipril
I= HTN, CHF, diabetic nephropathy
D=HTN: 2.5-5mg daily max 20mg/day, CHF: 1.25-2.5mg daily target 10mg qd
DDI=nSAIDS, k sparing diurteics, salt substitutnes, incr toxicity of Lithium
MOA=ACE Inhibitor, must be activated to ramiprilat (active metabolite) in liver
PK=renal clearance
SE=hyperkalemia, cough serious angioedema
precaution/BBW contraindicated in pregnancy
C=report pregnancy, report bothersome dry cough, avoid NSAIDs, report muscle weakness
abilify
aripiprazole
I=schizophrenia, bipolar I , adjunct in MDD
D=Schiz/bipolar 10-15mg po qd max 30mg/day, titration can be >q 2 weeks,
DDI=Cyp3A4 substrate, CNS depressants, CYp3a4 inhibitors, SSRIs (inc Serotonin syndrome)
MOA=antisychotic with agonist of D2 and 5ht1a receptors
PK=hepatic clearnace
SE=HA, insomnia, weight gain
precaution/BBW: increased suicidality risk in pts <24 years old with MDD or other psychiatric disorders
C=avoid alcohol, may impair alertness, can cause insomnia, weight gain
zetia
ezetimibe
I=hyperlipidemia
D=10mg orally daily
DDI=BIle acid binding sequestrants (dec absorption)
MOA=inhibits absorption of cholesterol in small intestine
PK=fecal, some hepatic metabolism
SE= diarrhea
C=take 2 hours pre or 4 hr post BAS, report sx of angioedema (swelling in eyes, lips, tounge sometime hand or feet)
aldactone
spironolactone
I=Severe CHF, HTN, primary hyperaldosteronism
D=HTN: 25-50mg divided 1-2 doses, CHF 12.5-25mg po daily (max 50mg/day)
DDI=ACE I/ARBS, salt substitutes,
MOA=potassium sparing diuretic, aldosterone antagonist
PK=hepatic/renal clearance
SE=hyperkalemia, possible gynecomastia, changes in menses
precaution/BBW tumorigen in chronic toxicity in animals
C=do not drink alcohol, avoid salt substitutes
spiriva
tiotropium
I=COPD
D=inhale contents of one 18mcg pill once daily. Inhale and hold breath. Inhale a second time to ensure drug delivery.
DDI=potassium chloride (inc ulcer risk of KCL),
MOA=inhibition of M3 receptors in bronchial smooth muscle causing relaxation (anticholinergic)
PK=feces, some urine
SE=dry mouth, dry eyes, constipation
precaution/BBW
C=exhale completely then inhale medication powder and hold breath as long as is comfortable; repeat exhalation and inhalation once more before discarding the capsule. Do not swallow pill.
plavix
clopidogrel
I= prevent atherothrombotic events post MI, stroke, PCI, UA OR NSTEMI post PCI
D=75mg po daily (often receive loading doses of 300-600mg depending on indication)
DDI=anticoagulants, PPIs (dec plavix concentration by inhibiting CYP2C19 which activates clopidogrel)
MOA=antiplatelet agent, blocks ADP receptors and platelet aggregation
SE=bruising or bleeding
precaution/BBW use with cyp2c19 inhibitors leading to dec clopidogrel-> risk of cardiovascular events
C=avoid NSAIDs, Avoid OTC PPIs,
mytussin AC
codeine / guaifenesin
I=cough
D=codeine 10mg/gua 300mg po q 4h not to exceed 6 tabs/ 24 hr
DDI=CNS depressants, alchohol, benzos, muscle relaxants
MOA=suppression of cough reflex (codeine), thinning mucus and increasing sputum volume (guai)
PK=codeine renally cleared
SE=constipation, sedation, vomiting
C=avoid alcohol, may cause sedation, avoid activities that require much mental alertness
ortho tricyclen
norgestimate+ ethinyl estradiol
I=prevent pregnancy, tx acne
D= 21 day: take 1 daily for 21 days, 7 days off, 28 day: take 1 tab daily
DDI=smoking tobacco, warfarin,
MOA=inhibit ovulation and change cervical mucus and endometrium decreasing implantation and preventing fertilization
PK=hepatic and renal clearanc
SE=weight change, bloating, cramps
precaution/BBW
C=do not smoke, may increase risk of MI stroke or clots long-term, if missed dose, use back-up contraception (condoms) and contact doctor
motrin
ibuprofen
I=HA, pain, inflammation, fever
D=200-400mg po q 4-6 hours max 1.2g, or 2.4 under phycisian supervision
DDI=ACEI/ARBS, anticoagulants, corticosteoids
MOA=NSAID, cox inhibitor, decrease prostaglandin synthesis
PK=hepatic and renal clearnace
SE=abdominal pain or cramps, heartburn
precaution/BBW increased GI bleeding, ulceration risk, increased risk cardiovascular thrombotic MI or stroke
C=report unusal bleeding or dark stools, take with food if GI irritation or upset, avoid etoh or smoking to dec risk of GI bleed
pepcid
famotidine I=GERD, heartburn, duodenal ulcer etc D=GERD 20mg po bid x 6 weeks, heartburn 10-20mg po q12h, duodenal ulcer 40mg qhs x 4-8 weeks, then 20mg/day qhs maintenance DDI=azole antifungals (dec their [ ]s), iron (dec absorption) MOA=H2 receptor antagonist PK=urine excretion SE=constipation, diarrhea, dizziness C=can take with antacids if needed
folic acid
folic acid
I=megaloblastic, macrocytic anemia, dietary supplement to prevent neural tube deficits, FA deficiency
D=0.4-0.8mg IM, IV, po, SC once daily up to 1mg/day
DDI=phenytoin (dec phe), green tea (dec FA)
MOA=needed for coenzymes to make purines/pyrimidines for DNA synthesis
PK=hepatic met–>urine excretion
SE=bad taste in mouth, sleep pattern disturbance
C=do not drink etoh, can have bad taste at larger doses
keflex #100
cephalexin
I=otitis media, skin infection, pharyngitis, UTI etc
D=250mg-1g orallya q6h depending on severity and type of infeciton
DDI=warfarin (inc INR), metformin (inc met levels)
MOA=cephalosporin, cell wall synthesis inhibition
PK=renal elimination
SE=diarrhea
precaution/BBW
C=Report sever diarrhea
desyrel
trazodone
I=Depression, insomnia
D=150mg/day in divided doses, can increase by 5 q 3-4 days , max 400mg/day outpt, 600mg/d input
DDI= SSRIs, protease inhibitors
MOA=Unknown, thought to inhibit uptake of serotonin. Also has alpha 1 blocking activity
PK=hepatic–urine excretion
SE=somnolence dizziness Serious: priapism (>4hours)
precaution/BBW
C=can impair alerntness, take medication at bedtime
namenda
memantine
I=alzheimer’s disease mod-severe
D=IR: initial start 5mg qd, increase in 5mg increments after 1 week intervals (split doses bid), target of 20mg/day. Maintenance is 10mg twice daily ER: 7mg po qd, inc to target 28mg/day q 1 week.
DDI=sodium bicarb (dec excretion of namenda), TMP incr toxicity of namenda (myoclonus/delirium)
MOA=NMDA receptor antagonist
PK=mostly renal elimination
SE=dizziness, HA, confusion
C=can sprinkle ER capsule in applesauce and consume entire mixture as a single dose, can cause dizziness , follow dosing schedule
ovral
norgestrel+ethinyl estradiol
I=contraception
D=if 21, take one pill/day x 3weeks, then one week off, if 28 takes one pill daily
DDI=antibiotics, smoking
MOA=inhibition of implantation of the fetus and changes in endometrial lining
SE=headache, bloating
precaution/BBW : smoking can lead to serious cardiovascular effects
C=antibiotics can decrease effectiveness, do not smoke
micronase or diabeta
glyburide
I=Diabetes II
D=Regular: 1.25-20 mg orally once daily or divided in 2 doses (max 20mg/day) Micronized: 0.75-12 orally once daily or divided bid
DDI=insulin
MOA=sulfunylurea increase secretion of insulin
PK=Renal and biliary excretion
SE= heartburn, nausea, Serious : hypoglycemia
precaution/BBW
C=signs and symptoms of hypoglycemia, take with first main meal of the day
benicar HCT
olmesartan/ hydrochlorothiazide
I=hypertension
D=20-40 olme/12.5-25mg once daily
DDI=lithium, NSAIDs, potassium sparing diuretics, salt substitutes
MOA=angiotensin receptor blocker/ thiazide diuretic
PK=renal (most) for both
SE=hypo/hyperkalemia, electrolytes imbalances, Serious: angioedema
precaution/BBW: taking with pregnancy can lead to harm to the fetus
C=maintain adequate hydration, avoid alcohol
soma
carisoprodol I=acute muskuloskeletal pain D=250-350mg po tid at bedtime DDI=ethanol, opiiods, CNS depressants, benzos MOA= skeletal muscle relaxant PK=renal and hepatic SE=somnolence, dizziness, HA precaution/BBW C=do not drink alcohol
cozaar
losartan
I=hypertnsion
D=25-100mg once daily or divided BID
DDI=lithium, NSAIDs, potassium sparing diuretics, salt substitutes
MOA=angiotensin receptor blocker
PK=renal
SE=hyperkalemia, electrolytes imbalances, Serious: angioedema
precaution/BBW taking with pregnancy can lead to harm to the fetus
C=avoid salt substitutes, may cause dizziness
premarin
conjugated estrogens
I=menopause vasomotor sx, and other uses
D=0.3mg orally daily (dose varies depending on indication)
MOA=reduces the levels of LH and FSH through negative feedback
PK=renal clearnace
SE=edema, hustism, withdrawal bleeding, HA
precaution/BBW: unopposed estrogens have an increases risk of endometrial cancer and abmormal vaginal bleeding
C=do not smoke
conjugated estrogens
I=menopause vasomotor sx, and other uses
D=0.3mg orally daily (dose varies depending on indication)
MOA=reduces the levels of LH and FSH through negative feedback
PK=renal clearnace
SE=edema, hustism, withdrawal bleeding, HA
precaution/BBW: unopposed estrogens have an increases risk of endometrial cancer and abmormal vaginal bleeding
C=do not smoke
valsartan
I=hypertension, HF, MI
D=80-320mg once daily
DDI=ACE, NSAIDs, potassium sparing diuretics
MOA=angiotension receptor blocker
PK=hepatic
SE=hyperkalemia, dizziness Serious Angioedema
precaution/BBW using in pregnancy can cause damage to the fetus
C=avoid potassium sparing diuretics
lidoderm
lidocaine transdermal
I=local anesthesia, postherpetic neuralgia
D=12 hours n and 12 hours off
DDI=antiarrhythmic agents
MOA=block conduction of nerve impulses
PK=hepatic metabolism
SE=bruising, depigmentation, itchy, irritation Seirous: seizryrs, problems breathing, cardia dysrhtymia
precaution/BBW
C=report difficult to breathing, applying heat or occluding skin increases rinks of of side effects,
vasotec
enalapril
I=hypertension
D=5-40mg once dialy or dvided BID
DDI=lithium, NSAIDS, ARB, potassium sparing diuretics,
MOA=ACE inhibitor
PK=renal
SE=hyeperkalemia, cough Serious: angioedema
precaution/BBW: pregnancy and use leads to harm to fetus
C=avoid salt substithutes
cialis
tadalafil
I=BPH, erectile dysfunction, pulmonary hypertension
D= BPh 5mg once daily, erectile dysfunction prn 10mg prior to anticpated sexual activity (max 20mg/day), pulmonary hypertension 40mg once daily
DDI=CYP 3a4 ihhibitors, nitrates
MOA= phosphodiestrase type 5 inhibitor, leading to smooth muscle relaxation and increased blood flow
PK=hepatic and renal
SE=headache
C=report chest pain or priapism, avoid alcohol, report loss of vision
tadalafil
I=BPH, erectile dysfunction, pulmonary hypertension
D= BPh 5mg once daily, erectile dysfunction prn 10mg prior to anticpated sexual activity (max 20mg/day), pulmonary hypertension 40mg once daily
DDI=CYP 3a4 ihhibitors, nitrates
MOA= phosphodiestrase type 5 inhibitor, leading to smooth muscle relaxation and increased blood flow
PK=hepatic and renal
SE=headache
glucotrol
glipizide
I=diabetes type 2
D= xl: 5-10mg once daily max 20 daily, IR: max 40mg daily , if 15mg day divide bid
DDI=fluoroquinolones
MOA=sulfonylurea, increase insulin secretion
PK=extensive hepatic
SE=hypoglycemia
C=report sx of SJS (spreading red rash with flu-like sx and mouth sores, take 30min before breakfast, do not drink etoh
bactroban
mupirocin
I=impetigo (skin infection)
D=aply 2% ointment topically tid x 3-5 days
MOA=inhibits bacterial protein and RNA synthesis
SE=itchiness, burning sensation
C=avoid eyes, open wounds, burns when applying
vytorin
ezetemibe + simvastatin
I=hyperlipidemia/ hypertriglyceridemia
D= 10-80mg simva/10mg ezetemibe once daily
MOA=cholesterol absorption inhibition/ hmg coa redctase inhibitor
PK; ezetemibe: fecal, simva : fecal, renal
SE=increase LFTs/ rhabdo
C=take dose in the evening, report bilateral muscle weakness and soreness,
drisdol
ergocalciferol
I=vitamin d deficienc, hypoparathyroidism
D=vit d defficiency: 50,000 once weekly 8-12 weeks, dosing can vary depending on condition
MOA=increases absorption of calcium and phosphorous
PK=hepatic and renal elimination
SE=serious: hypercalcemia, hypervitaminosis D, constipation
C=report sx of hypercalcemia
ferrous sulfate
ferrous sulfate I=iron deficiency anemia D=300mg po 2-4 times daily, DDI=PPIs, antacids, levothryoxine MOA=replaces iron PK= excretion Urine, sweat, sloughing of the intestinal mucosa, and menses SE=Constipation, dark stools, epigastric pain, GI irritation C=avoid antacids
amaryl
glimepiride I=DM II D= 1-2mg orally daily (max 8mg/day) DDI=fluoroquinolones MOA=sulfonylureas, increase hypoglycemia PK=hepatic clearnace SE=hypoglycemia C=sx of hypoglycemia,
boniva
ibandronate
I=osteoporosis
D=2.5mg po once daily or 150mg po once monthly, 3mg IV q 3 months
MOA=osteoclast bone resorption inhibition
PK=renal/fecal
SE=Serious esophageal erosions
precaution/BBW
C=take with a full glass of water and remain upright for 30 min, 60min before first meal
yasmin
drospirenone / ethinyl estradiol
I=birth control, acne (moderate)
D=depends on days on package
DDI=smoking, antibiotics
MOA=change endometrial lining and stop implantation of fetus
SE=weight change, bloating
precaution/BBW smoking can lead to serious cardiovasuclar events especially in >35yo
C=antibiotics reduce effectiveness of contraception, do not smoke
minocin
minocycline I=antibiotic many indications D=50-200mg po daily, dose varies depending on indication DDI=calcium, antacids, iron MOA=tetracycline, SE=sun sensitivity precaution/BBW C=sun sensitivity so wear sunscreen, can decrease effectiveness of birht control, take with plenty of fluids, do not take with antacids
loestrine FE or leostrin 24 FE
norethindrone/ ethinyl estradiol/ferrous sulfate
I=contraception
D=take pills as directed on package, most likely once daily
DDI=antibiotics, smoking
MOA=prevent implantation of the fetus
SE=headache, weight change
precaution/BBW: smoking increases risk of cardiovascular events
C=antibiotics can decrease effectiveness, do not smoke
lotensin
benazepril
I=hypertension
D= 10-40mg orally once daily max 80mg/day
DDI=lithium, NSAIDs, ARBs, potassium sparking diuretics, salt substitutes,
MOA=Ace inhibitor
PK=converted to beazprilat
SE=hyperkalemia, cough serious: angioedema
precaution/BBW: Use in pregnancy can lead to fetal deformities
C=report persistent dry cough, report musle sourness, or facial edema
durgesic
fetnayl transdermal system
I=moderate to severe pain
D=depends on previous opioid use and equivalence
DDI=any CNS depressants, alcohol, opioids, cyp3a4 inhibitors
MOA=mu opioid receptor agonist
PK=Cype3a4 substrate
SE=constipation, somnloence, Serious: respiratory depression
precaution/BBW contraindicated in patients who are not opioid tolerant, should not be used in <2years ol, use with any cyp3A4 inhibitor can cuase respiratory derpression
C=apply on chest,back, flank or upper arm and hold in place , apply new patch in defferent area
macrodanatin
nitrofurantoin
I=UTIs
D=50-100mg po 4 times a day
DDI=fluconazole
MOA=inhibit dna, rna, cell wally and protein synthesis
PK=renal elimination
SE=NV, loss of appetite Serious: hemolytic anemia
C=may cause brown colored urine, take with food
macrobid
nitrofurantoin P&G
I=UTIs
D=100mg po q 12h x 5-7 days
DDI=fluconazole
MOA=inhibit dna, rna, cell wally and protein synthesis
PK=renal elimination
SE=NV, loss of appetite Serious: hemolytic anemia
C=may cause brown colored urine, take with food
lanoxin
digoxin
I=Heart failure, AFib
D=Afib : 0.125- 0.375mg po daily1.5mg max, HF 0.125-0.75 mg po daily
DDI=beta blockers, CCB,
MOA=block Na/K atpase, increasing contractility of heart
PK=renal excretion
SE=cardiac dysrrhythmia
C=report symptoms of bradycardia, take after morning meal, avoid antacids
flovent
fluticasone inhalation
I=asthma, allergic rhinits
D=88-880mg inahled twice daily (varies with indication)
DDI=Cyp3A4 inhibitors
MOA=corticosteroid: reducing inflammation and
PK=metabolic, fecal excretion
SE= throat irritation, sinusitisSerious : thrush
C=rinse mouth out after use to prevent thrush, not for acute attacks, symptom improvement can take weeks
keppra
levevtiracetam
I=tonic clonic seizure, partial seizure, myoclonic seizure
D=500mg bid - max daily dose of 3000mg/day
DDI=ginkgo, carbamazepine
MOA= unknown
PK=renal
SE=somnolence, fatigue Serious SJS
precaution/BBW
C=can affect mental alterntes, report nay symptoms of askin rash, do not d/c suddenly du to increase in seizure frequency
hytrin
terazosin I=BPH, HTN D=1-10mg orally once daily max 20mg/day DDI=beta blockers MOA=alpha 1 antagonist PK=renal metabolism SE=orthostatic hypotension, peripheral edema, dizziness precaution/BBW C=may experience sudden syncope with first dose so take it at night, move slowly to standing position
zovirax
acyclovir
I=genital herpes, herpez zoster
D=400-800mg TID ( but dosing varies based on indication)
MOA=stops replication of viral DNA by blocking polyemerase activity
SE=malaise Serious: renal failure, SJS
C=stay adequately hydrated to prevent damage to the kidneys, reporst any new rashes, abstain from sex during acute outbreak and always use condoms
avapro
irbesartan
I=hypertension
D=150-300mg once daily
DDI=NSAIDS, ACE, potassium sparing diuretics
MOA=Angiotensin receptor blocker
PK=fecal/renal elimination
SE=hyperkalemia, Serious: angioedema
precaution/BBW: use in pregnancy can lead to fetal harm
C=report facial swelling, muscle soreness or pain
pulmicort
budesonide inhalation I=asthma and allergic rhinitis D=180-400mcg twice daily max 800mcg/day DDI=Cyp3a4 inhibitors MOA=corticosteroid with antiinflammatory properties PK=renal elimination SE=sinusitis, throat/nose irritation precaution/BBW C=not for acute asthma attacks, proper inhaler technique
valtrex
valacyclovir I=herpes zoster, herpes genital D=1g 2-3 times daily DDI=MMF MOA=inhibition of viral dna repolication PK=renal, fecal SE=rash, headache , fatigue C=keep adequate hydration to prevent precipiation of acyclovir in renal tubules
pristiq
desvenlafaxine
I=major depressive disorder
D=50mg orally once daily
DDI=MAOis SSRIS, agents that increase risk of bleeding
MOA=SNRI
PK=hepatic and renal
SE=insomnia, somnlence, headache SS: serotonin sydnrome
precaution/BBW increased risk of suicidal thinking in children and people <24 yo
C=can affect mental alertness, do not drink alcohol
tegretol xr or carbatrol er or equetrol er
carbamazepine
I=bipolar I, epilepsy, neuralgia
D= 200mg-400mg bid-tid max 1200/day (dosing varies on indication)
DDI=cyp3a4 inhibitors, inducers, substrates(carbamazepine is a cyp3a4 inducer)
MOA= unknown
SE=dizziness, somnolence, hyper/hypotension
precaution/BBW: risk of SJS
C=avoid alcohol, dont d/c suddenly , report rash
allesse
levonorgestrel/ ethinyl estradiol
I=contraception
D=take pills as directed on package, most likely once daily
DDI=antibiotics, smoking
MOA=prevent implantation of the fetus
SE=headache, weight change
precaution/BBW: smoking increases risk of cardiovascular events
C=antibiotics can decrease effectiveness, do not smoke,
lithonate or eskalith
lithium carbonate
I=bipolar disorder
D=, 900-1200mg in 2-3 divided doses. Titrate levelt to 9.6-1.2mEq/L
DDI=ACE inhibitors, NSAIDS
MOA=unknown but alters soidum transport in nerve and muscle cells
PK=renal elimination
SE=polyuria, fine tremor, nephrotoxicity
precaution/BBW lithium toxicity can occur even when the level is at the therapeutic range
C=maintain adequate water, sodium intake
nuvaring
etonogestrel / ehtinylstradiol
I=contraception
D=take pills as directed on package, most likely once daily
DDI=antibiotics, smoking
MOA=prevent implantation of the fetus
SE=headache, weight change
precaution/BBW: smoking increases risk of cardiovascular events
C=antibiotics can decrease effectiveness, do not smoke,
mevacor
lovastatin I=hyperlipidemia, hypertriglyceridemia D=20-60mg once daily at bedtime DDI=CYP3a4 inhibtiors MOA=HMG coa reductase inhibitor PK=hepatic metabolism SE=increased LFTs serious: rhabdomyolysis precaution/BBW C=report symptoms of liver dysfunction, report bilateral muscle pain or weakness
pravachol
pravstatin I=hyperlipidemia, hypertriglyceridemia D= 40-80mg once daily, any time of day DDI=CYP3a4 inhibtiors MOA=HMG coa reductase inhibitor PK=hepatic metabolism, long half life SE=increased LFTs serious: rhabdomyolysis precaution/BBW C=report symptoms of liver dysfunction, report bilateral muscle pain or weakness
tessalon
benzonatate
I=Cough
D=100-200mg po tid prn , max 600mg/day or 200mg per dose
MOA=supresses cough by anesthetizing vagal afferent fibers in respiratory passages
PK=renal
SE=numbness of tongue, somnolence
C=should swallow tablet whole or get numbenss in the mouth if chewed or dissolved
novolog
insulin aspart
I=DM type 1 and II
D=depends on insulin requirement of the patient. To be administered 5-10minutes before a meal
DDI=fluroquinolones, beta blockers
MOA=rapid acting insulin
SE=injection site reaction, hypoglycemia
C=signs and symptoms of hypoglycemia, administer 5-10minutes before a meal
paxil
paroxetine
I=depression, GAD, panic disorder, OCD
D=10-20mg once daily in the morning , depends on indication max 50-75mg/day
DDI= TCAs, MAOIs, any agents that increase risk of bleeding such as clopidogrel, warfarin etc
MOA=SSRIs
PK=renal excretion
SE=insomnia, somnolence
precaution/BBW increased suicidal thinking with young adults <24yo and children
C=do not drink alchohol , can affect alertness,
phenergan with codeine
promethazine / codeine
I=cough (cold or allergy)
D=promethazine 6.25/cod 10 (5 ml)orally q 4-6 hours (max 30ml/24 hours)
DDI=CNS depressants, alcohol
MOA=antihistamine/ decrease cough reflex
SE=somnolence
precaution/BBW contraindicated in pts < 6 yo b/c associated with repsratory depression
C=can affect alertness, can cause/worsen constipation
aveolx
moxifloxacin I=sinusitis, conjunctivitis D=400mg IV/PO once daily DDI=calcium, antacids, iron, MOA=fluoroquinolones inhibt DNA gyrase and cause breaks in the DNA PK=hepatic and renal SE=diarrhea, precaution/BBW: tendonitis C=sun sensitivity so wear sunscreen, avoid antacids, calcium, iron
zanaflex
tizanidine
I=Spasticity
D=4-8mg orally every 6-8 hour max 36mg/day
DDI=estrogen hormones,
MOA=alpha agonist increasign presynaptic inhibition of motor neurons at alpha 2 receptor sites
PK=renal fecal excretion
SE=dry mouth, somnolence Serious: hepatotoxicity
precaution/BBW
C=may cause dry mouth, decreases alertness, do not drink alcohol. Take the medication with or without food in a consistent manner
catapres
clonidine
I=ADHD, hypertension, and many more
D=alpha 2 agonist
DDI=beta blockers, CNs depressants
MOA=alpha 2 agonist that reduces sympathetic outflow leading to decrease PVR, HR and BP
PK=Hepatic and renal clearance
SE=dry mouth, somnolence/insomnia, constipation
C=do not discontinue suddenly due to rebound hypertension, do not drink alcohol
catapres TTS
clonidine transdermal system
I=hypertension, ADHD and others
DDI=beta blockers, CNs depressants
MOA=alpha 2 agonist that reduces sympathetic outflow leading to decrease PVR, HR and BP
PK=Hepatic and renal clearance
SE=dry mouth, somnolence/insomnia, constipation
C=do not discontinue suddenly due to rebound hypertension, do not drink alcohol
ms contin
morphine sulfate controlled release
I=chronic pain, moderate to severe pain, post-operative pain
D=10-120mg per day
DDI=CNS depressants,alcohol, benzos etc
MOA=mu opioid agonist
PK=renally excreted
SE=somnolence, insomnia, itchiness Serious Respiratory depression
precaution/BBW extended realease form should be swaallowed whole, avoid alcohol or alcohol containing medications that may realease a potential fatal dose of morphine
C=impair alertness, dont take alcohol or other CNS depressants,
inderal LA #150
propranolol LA
I=hypertension, CHF, angina, afib
D=80-240 in 2-3 divided doses
DDI=beta agonists,
MOA=beta blocker
PK=hepatic metabolism
SE=fatigue, dizziness, Serios: bradycardia
precaution/BBW: sudden discontinuation can lead to exacerbations of angina or MI
C=do not discontinue suddenly, can mask sx of hypoglycemia so monitor blood sugars (diabetics)
provigil
modafinil I=narcolepsy, excessive sleepiness D=200mg po daily qam DDI=estrogens MOA=Unknown but CNS activator PK=hepatic metabolism SE=insomnia, headache C=can decfrease the effectiveness of steroidal contraceptives (rec backup method), avoid alcohol, avoid use at bedtime
antivert
meclizine
I=motion sickness, vertigo
D=25-50mg orally 1 hour before departure (motion sickness), 25-100mg orally per day in divided doses (vertigo)
MOA=antihistamine, supressing vasodepressor response to histamine. Only slight inhibition of acetylcholine
SE=dry mouth, somnolence
C=avoid EtOh or other CNS depressants, can cuase dry mouth and somnolence
atarax
hydroxyzine hydrochloride
I=pruritis, N, V, anxiety, alcohol withdrawal
D=50-100mg po/IM q 4-6 hours
DDI=CNS depressants
MOA=antispasmodic, antihistaminic, anlgesic, antiemetic, bronchodilating
SE=dry mouth, somnolence
C=do not drink alcohol, can affect mental alertness
nasacort AQ
triamcinolone intranasal
I=allergic rhinitis
D=nasal: 1-2 sprays in each nostril once daily (55mcg/spray)
MOA= corticosteroid, antiinflammatory, antipruritic
PK=renal and hepatic clearance
SE=pharyngitis, headache
precaution/BBW
C=patient to not discontinue medications unless talks with doctor, do not blow nose until after 15min after administration
ditropan
oxybutynin
I=overactive bladder
D=5-10mg orally once daily, max 30mg/day, topical: apply one satchet (100mg/g) topically daily on abdomen, upper arms/shoulders, or thighs
MOA=reduces the muscarinic effect of acetylcholine in smooth muscle
PK=hepatic
SE=dry mouth, somnolence, constipation
C=ER tablet may cause diarrhea, alcohol can enhance drowsiness,
lomotil
diphenoxylate/atropine
I=diarrhea
D=2 tab or 10ml solution po 4 times daily (20mg dipheoxylate) until initial control, then reduce to amount necessary to maintain bowel control (max 20mg/day)
MOA=diphen: reduces intestinal motility, atropine: anticholinergic
PK=Renal and hepatic clearance
SE= abdominal discomfort, somnolence Serious: pancreatitis
C=avoid other CNS depressants, can affect alertness
lidex
fluocinonide topical
I=atopic dermatitis, plaque psoriasis
D=0.05-0.1% 1-4 times daily max 2 weeks and max 60g/week
MOA=antiinflammatory, antiprruritic, vasocontrictor corticosteriod
SE=burning sensation in skin
C=max use is 2 weeks, if not working contact physician
xopenex
levalbuterol I=asthma D=acute asthma: 1.25-2.5mg q 20 min x 3 doses, then 1.25-5mg q 1-4 hour as needed DDI=beta blockers MOA=short acting beta agonist SE=Rhinitis, sinusitis C=rescue inhaler, inhaler technique
humalog
insulin lispro I=DM 1 or 2 D=individualized for patient need DDI=FQs and beta blockers MOA=short acting insulin SE=hypoglycemia C=change injection site, sx of hypoglycemia, expires in 28 day after opening
flagyl
metronidazole
I=bacterial mengingitis, vaginosis, anaerobic infections etc
D=250-500mg po 2-3 times daily or 0.75% gel available too.
DDI=
MOA=metabolized by anaerobes to a molcule that interacts with DNA and breaks strands
SE=HA, nausea
precaution/BBW: shown to be carcinogenic in mice. Use only when necessary
C=may discolor urine to redish brown, do not drink alcohol or will get disulfiram like reaction, (flushing, vomiting, abdominal cramping)
trileptal
oxcarbazepine I=partial seizure D=300-1200mg twice daily (MAX) depends on indication DDI=contraception, cns depressants MOA=anticonvulsant SE=somnolence, NV, fatigue precaution/BBW C=can dec effectiveness of hormonal contraceptives, can impair mental alertness, avoid etoh
xyzal
levocetirizine I=allergic rhinitis, urticaria D=2.5-5mg one daily in the evening MOA=antihistamine PK=renal SE=fatigue, dry mouth C=can cut tablet in half for a child's dose, do not use any CNS depressants inc etoh
voltaren gel
diclofenac topical
I=osteoarthritis, RA
D=Osteoarthritis :4grams topically 4 times daily, maax 8g/day to any UE joint, 16g LE joint, max 32 g/day total oaver all affected joints
DDI=warfarin, clopidogrel, tacrolimus, ssris
MOA=NSAID, cox inhibitor dec prostaglandin synthesis
PK=65% renal , 35% biliary
SE= Serious : GI bleed, HTN
BBW:NSAIDs may cause inc risk of serious cardiovascular throbmotic events, bleeding, ulceration, perforation
C=gel: dont wash area for at least an hour, avoid concomitant use with other topical products
estrace
estradiol
I=vasomotor sx menoapuse, atrophy of vagine, postmenopausal osteoporosis etc
D=0.05-2mg orally up to tid, higher doses for vaginal atrophy of 2-4g daily
DDI=tipranavir
MOA=bind to estrogen receptors, lower LH and FSH levels
PK=enterohepatic recirculation
SE=weight increase, edema, HA, Serious: VTE
precaution/BBW: increased risk of endometrial cancer
C=monitor for abnormal vaginal bleeding,
evista
raloxifene
I=breast cancer, postmenopausal osteoporosis
D=60mg orally daily
MOA=Selective estrogen receptor modulator, blocks estorgenic pathways by binding to estrogen receptors
PK=extensive first pass
SE= hot sweats, leg cramps Serious: VTE
precaution/BBW: increased risk of DVT and PE reported
C=avoid sitting of prolonged period of time, esp during first 4 mos of therapy, may cause leg craps and hot flash, do not take estrogen while taking this med
symbicort
budesonide/formoterol
I=asthma and COPD
D=bud 80-160mcg/fom 4.5mcg800mcg 2 inhlations tice daily
DDI=Cyp3a4 inhibitors
MOA=corticosteroid with antiinflammatory properties/ long-acting beta agonsit
PK=renal elimination
SE=sinusitis, throat/nose irritation
precaution/BBW
C=not for acute asthma attacks, proper inhaler technique, rinse out mouth to prevent thurs
androgel
testosterone topical
I=hypogonadism, female to male transformation
D=5g applied topically cone daily in clean, dry, intact skin in the sholders, upper arms or abdomen
MOA= endogenous androge involved in growth and maturation of penis, scrotum, etc
PK=renal
SE=acne, gynecomastia, priapism
precaution/BBW virilization reported in children exposed to gel, should avoid contact
C=do not apply in genitals, avoid washing, swimming etc fort at least 2 hours after application, avoid exposure to children or women,
humulin or novolin
insulin I=type 1 or type 2 diabetes D=subq administration as individualized for patients DDI=FQs and beta blockers MOA= regular insulin PK=hepatic metabolism SE=hypoglycemia C=expires 28 days after opening, rotate injections sites, sx of hypoglycemia
levsin
hyocyamine
I=pancreatitis, reversal of neuromusucular blockade etc
D= dose varies dramatically based on indication max 1.5mg /day
MOA=inhibits the action os acetylcholine, inhibits GI propulsive motility, decreasees gastric acid secretion
PK=renal
SE=dry mouth, somnolence, blurred vision (anticholinergic SEs)
C=antacids interfere with absorption, hyocyamine before meals, antacids after meals
viagra
sildenafil
I=erectile dysfunction, pulmonary hypertension
D=25-100mg x1 orally 1 hour before sexual activity, 20mg po TID given 4-6 hours apart for PH
DDI=nitrates, alpha blockers
MOA=Phosphodiesterase inhibitor
PK=cyp3a4 substrate (hepatic)
SE=flushing, HA Serious: priapism, ototoxicity
C=report if erection lasts longer than 4 hours, report suddent changes in hearing or vision
bumex
bumetanide
I=CHF edema
D=0.5-2mg po x 1 or 0.5-1mg IV over 1-2 minutes or IM, can repeat twice more in 2-3 hours. max 10mg/day
DDI=ACE inhbibitors, NSAIDS,
MOA=loop diuretic
PK=renal elimination
SE=hypoalemia, dizziness, hyperuricemia
precaution/BBW: can lead to profound diuresis and electorlyte depletion, medical supervision required
C=can take with food to minimize gastric irritation
januvia
sitagliptin phosphate I=DM type 2 D=100mg orally daily MOA=DPP4 inhibitors, increasing incretin activity PK=renal clearance SE= HA, URTI Serious: pancreatitis precaution/BBW C=sx of pancreatitis (rare) N,V, anorexia, persistent severe abdominal pain
micardis
telmisartan
I=hypertension
D=20=-80 po once daily
DDI=ACEI, Lithium, NSAIDs, potassium sparing diuretics, salt substitutes
MOA=angiotensin receptor blocker
PK=Renal
SE=hyperkalemia, dizziness Serious: angioedema
precaution/BBW: use by pregnant women leads to harm to fetus
C=can cause dizziness, avoid salt substitutes
levemir
insulin detemir
I=DM type 1 and 2
D=initial 10 U Sq at bedtime, can be divided twice daily, individualized
MOA=long-acting insulin
SE=injection site reaction, hypoglycemia
precaution/BBW
C=switch site of injection, expires 28 days after opening, sx of hypoglycemia
175 phenergan
promethazine
I=nausea and vomiting,
D=12.5-25mg po, IV, IM or rectally , not given more than q 4 hours
DDI=CNS deprressants
MOA=blocks histamine 1 receptors. Antiemetic, anticholinergic, anti motion-sickness
SE=dry mouth, dizziness, somnlonece
precaution/BBW do not use in children < 2 yo due to risk of repsratory depression
C=can affect metnal alertness, do not drink alcohol
concerta
mentylphenidate ER
I=ADHD, narcolepsy
D=:18-72mg po in the morning
MOA=CNS stimulant. Unkown MOA but may block reuptake of norepinephrien and dopamine
PK=renal metabolism
SE=dizziness, insomnia, loss of apetite Serious: cariorespiratory arrest
precaution/BBW usein in patients that are emotionally unstable, alcoholism, abuse potential
C=Report changes in heart rhythm or chyest pain,
Buspar
buspirone
I=anxiety
D=5mg orally 2-3 times a day or 7.5 po bid, cna increased dose by 5mg/day q 2-3 dasy prn, max 60mg/day
MOA=unknown, affinityy for serotonin, and dopamine receptor but not GABA
PK=renal/hepatic
SE=dizziness, nausea, ha
precaution/BBW
C=can affect mental alertness, may not see symptomatic improvement for wew weeks, don’t dc suddenly
vyvanase
lisdexamfetamine
I=ADHD
D=30mg po daily in the morning, can increase by 10-20mg/day at weekly intervals. max 70mg/day
MOA=gets converted to dextroamphetamine whose moa is nto known but may b inc NE or Dopamine
PK=renal
SE=loss of appetite, insomnia, dizziness
precaution/BBW schedule II medication that be subject to abuse and addtiocon. Misuse can lead to sudden death
C=takie in the morning to avoid insomnia
sinemet and sinemet CR
cerbidopa/levodopa
I=parkinsonism,
D= IR form 1 tab po 3-4 times daily, SR version 1 tablet twice daily
DDI=antipsychotics MAO inhibitors MOA= carbidopa inhibts the decarboxylation of levodopa. levodopa is the precursor to dopamine
SE= confusion, delusions, dyskinesias, hypo/hypertension
C=dont discontinue use of the medication suddenly, if taking antiHTN may lead to postural hypotension: stand up slowly
cleocin
clindamycin
I=bacterial infectiosn, skin infectiosn
D=300-600mg po q 6 - 8 hours depending on indication
DDI=cyp 3a4 inhibitor
MOA=inhibit bacterial ribosome and protein sythensis
SE=rash, diarrhea, HA
precaution/BBW can lead to pseudomembranous colitis which can be lifethreatening. Use only when necessary
C=report severe diarrhea, report dryness or exess skin irritation for topical
aggrenox
dipyridamole/aspirin
I=thromboembolic stroke prophylaxis
D=1 capsule (200mg/25mg) orally twice daily in AM and PM
MOA=ASA is a cox inhibitor, dipyridamole inhibits uptake of adenosine and leadts to inhibition of platelet aggreation. SE=abdomnal pain, GI bleed, HA
C=avoid aspirin or ASA containing products
enablex
darifenacin I=overactive bladder D=7.5-15mg orally once daily MOA=M3 muscarine receptor blocker PK=renal/ hepatic SE=dry mouth, constipation C=anticholinergic xs: dry mouth, blury fision, HA, constipation,
medrol
methylprednisolone
I=many indications: allergies, aastma, inflammation,
D=4-48mg po daily
MOA=corticosteroid
SE= hypertesnin, impaired wound healing, weight gain, depression/euphoria
precaution/BBW
C=don’t discontinue medication suddenly, report signs of an infection
lioresal
baclofen
I=spasticity
D= 5mg po tid, can increase by 15mg q 3 days max 80mg/day
MOA=skeletal muscle relaxant
SE=somnolence, HA
precaution/BBW: abrupt discontinuation of intrathecal baclofen has led to high fever, AMS, muscle rigidity and sometimes rhabdomyolysis
C=avoid alcohol or other CNS depressants
dilantin
extended phenytoin
I=seizure and status epilepticus
D=100-200mg po TID, ER: 300mg once daily
MOA=inhibits seizure activity in the motor cortex
SE=slurred speech, nervousness, drug-induced gingiveal hyperplasia
precaution/BBW dont exceed 50mg/min in adults or 1-3mg/kg/min pediatric becaue of risk of sever hypotension and cardiac arrhythmia
C=do not drink calcohol, do not d/c suddenly due to inc in seizure activity
orapred
prednisolone
I=many indications such as RA, inflammation, COPD, asthma etc
D=5-60mg orally /day
MOA=corticosteroid, anti inflammatory, immunosuppressant,
SE=Short-term insomnia, HA, mood changes, GI irritation Long-term: weight gain, fluid retention, osteoporosis, acne, fat deposits in face and back
C=do not D/c suddenly
yaz
drospierenone/ethinyl estradiol
I=birth control, acne (moderate)
D=depends on days on package
DDI=smoking, antibiotics
MOA=change endometrial lining and stop implantation of fetus
SE=weight change, bloating
precaution/BBW smoking can lead to serious cardiovasuclar events especially in >35yo
C=antibiotics reduce effectiveness of contraception, do not smoke
remeron
mirtazapine I=depresison D=15-45mg po at bedtime DDI= MOA= SE=constiption, somnolence, dry mouth, weight gain precaution/BBW antidepressants increasing suicidality in young people <24yo C=dont drink alcohol, impairs alertness
lopid
gemfibrozil I=hyperlipidemai D= 600mg orally bid 30 min before meals DDI=statins MOA=Bile acid sequestrate PK=renal SE=indigestion, abdominal pain serious: rahbdo C=report muscle pain, take 30 min before meals
plaquenil
hydroxychloroquine
I=SLE, RA, Malaria
D=200-600 po daily
MOA=unknown
SE=disorder of the cornea, retinopathy, torsades, agranulocytosis
C=take with food or milk, report changes in vision
pataonol or pataday
olopatadine
I=allergic conjunctivitis, allergic rhynitis
D=0.1% i dorpe in affected eyes tice daily or 0.2% 1 drop once daily, or 2 sprays in each nostril bid
MOA=antihistamine
SE=altered tase sense, headache,
C=remove contacts before instilling eye drops, can reinsert in 10 minutes
necon 1/35 or orhto novovm 1/35
norethindrone/ethinyl estradiol
I=contraception
D=take pills as directed on package, most likely once daily
DDI=antibiotics, smoking
MOA=prevent implantation of the fetus
SE=headache, weight change
precaution/BBW: smoking increases risk of cardiovascular events
C=antibiotics can decrease effectiveness, do not smoke
clozaril or Fazaclo
clozapine
I=Schizophrenia
D=start 12.5mg once or bid, increase, target dose 300-450mg/day in 2-3 divided doses
MOA=antipsychotic, moa not well defined
SE=somnolence, constipation, excessive salivation, tachycardia
precaution/BBW must have WBC and ANC before tx and at least 4 weeks after d/c due to agranulocytosis. Can cause cardiac or resp arrest
C=impairs alertness, anticholinergic sx, don’t d/c suddenly, many DDIs report med changes
chantix
varenicline
I=smoking cessation
D=initial 0.5mg once daily days 1-3, then 0.5mg bid from days 4-7, then 1mg twice daily duration of tx 12 weeks
MOA= binds to nicotinic receptors (agonist)
PK=renal
SE=insomnia, dream disorder, constipation, flatulence
precaution/BBW depression / suicidality has been reported with medication, observe pt
C=take after eating and with a full glass of water, can impair mental alertness, report changes in behavior (suicidality)
pyridium
phenzopyridine hydrochloride
I=dysuria, symptomatic relief
D=200mg orally 3 times daily after meals, do not use longer thant two days if using with an antibiotic
MOA=urinary tract analgesic
PK=Renal
SE=HA
C=may discolor urine and sclera red or orange causing staining of undergarments and contacts, take with food to minimize GI irritation
prometrium
progesterone
I=contraception, endometrial hyperplasia etc
D=5-10mg IM daily or 100mg vaginally 2-3 daily or 200-400mg orally daily etc
MOA=transforms proliferative endometrium into secretory endometrium, suppresses pituitary gonadotropins
PK=hepatic/ renal
SE=abd pain, constipation, muscle cramp
precaution/BBW estrogen + progestin should lnto be used to prevent CVD or dementia. Inc risk of DVT in postmenopausal women
C=patient not to use tampons during therapy, avoid other vaginal drugs 6h before and after with vaginal form,
strattera
atomoxetine
I=ADHD D= 40-80mg orally daily
DDI=TCAs, MAOIs
MOA=Selective norepinephrine reuptake inhibtor
PK=renal
SE=inc blood pressure, tachycardia, HA, insomnia
precaution/BBW increased suicidal ideation in children and adolescents
C=report chest pain, palpitations, parents montior growth rate and wight in children, monitor new psychiatric problems
peridex
chlorhexidine
I=gingivitis, periodontitis, skin cleansing procedure
D=gingivitis: 15mgl oral rinse 0.12% swish and spit for 30 sec twice daily after tooth brushing
MOA=antimicrobial with rapid bactericidal action against a wide range of gram + and gram - bacteria
SE=taste sense altered, toothache, skin irritation
C=do not swallow oral soluation, avoid contact with eyes and ears, do not eat, brush or rinse immediately afterwards
imitrex
sumatriptan
I=migraine and cluster headache
D=6mg SQ can repeat 6mg SQ once more, max 12mg/24h OR 25-100mg orally repeate after 2 hours (max 200mg/ 24h)
DDI=SSRIs
MOA=5ht1 receptor agonist
SE=injection site reaction, numbness, vertigo
C=report sx of serotonin syndrome: hallucination ,tachycardia, hypertehrmia, hyperreflexia
nystop
nystatin topical
I=cadidaisis, vulvovaginitis, thrush
D=oral suspension: 4-6ml orally retained in mouth as long as possb, other regimens vary depending on indication
MOA=binds to sterols in cell membrane causing it to lose components of the cell by decreasing selectivity of barier
SE=skin irriation serious SJS
C=abstain from sex until treatment is complete, report SJS sx
