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