Top 300 Flashcards
Metronidazole
Flagyl, Flagyl ER
Antibacterial, Antiprotozoal
Finish course as prescribed. Avoid alcohol during therapy and for 2 days after. May discolor urine reddish-brown.
Fluconazole
Diflucan
Antifungal
Finish course as prescribed. May cause headache and GI upset. CYP interactions: strongly inhibits 2C9, 2C19 (ex. Clopidogrel, warfarin and phenytoin); moderately inhibits 3A4. May prolong QT interval.
Ketoconazole
Nizoral
Antifungal
Available topically and orally. Tablets should be taken with food. Drug is absorbed best in acidic conditions; avoid antacids, PPI’s and H2 blockers for 2 hours before and after administration. Major CYP 3A4 drug interactions. Topical formulations are flammable. Potential for hepatotoxicity.
Nystatin
Mycostatin, Nystop
Antifungal
Available in many different dosage forms (topical, oral, suspension, powder) and some combination products. Suspension can be dosed as “swish and spit” for oral candidiasis or “swish and swallow” for esophageal candidiasis.
Terbinafine
Lamisil
Antifungal
Finish course as prescribed. Topical formulation available OTC and is most common use.
Acyclovir
Zovirax
Antiviral against HSV
Available topically and orally. Avoid intercourse during herpes outbreaks. Dose and duration depends on indication. CNS side-effects especially in elderly and renal impairment. Interacts with herpes zoster vaccine. Stay well hydrated.
Valacyclovir
Valtrex
Antiviral against HSV
Avoid intercourse during herpes outbreaks. Dose and duration depends on indication. CNS side-effects especially in elderly and renal impairment. Interacts with herpes zoster vaccine. Stay well hydrated.
Cephalexin
Keflex
Cephalosporin antibiotic, 1st generation
Finish course as prescribed. May cause GI upset. Hypersensitivity reactions may occur if allergic to penicillin and/or other cephalosporins. May decrease absorption of oral contraceptives.
Cefuroxime axetil
Ceftin
Cephalosporin antibiotic, 2nd generation
Finish course as prescribed. May cause GI upset. Hypersensitivity reactions may occur if allergic to penicillin and/or other cephalosporins. May decrease absorption of oral contraceptives.
Cefdinir
Omnicef
Cephalosporin antibiotic, 3rd generation
Finish course as prescribed. May cause GI upset. Hypersensitivity reactions may occur if allergic to penicillin and/or other cephalosporins. May decrease absorption of oral contraceptives.
Ciprofloxacin
Cipro (XR)
Fluoroquinolone antibiotic
Finish course as prescribed. Monitor glucose. Do not take within 2 hours of consuming foods or other products containing di- or trivalent cations (ex. milk, calcium antacids, multivitamins and supplements). May cause sun sensitivity and CNS side-effects. FDA requires assessment of risk of QTc prolongation. Black box warning for tendonitis/tendon rupture. Available orally and in ophthalmic and otic suspensions.
Levofloxacin
Levaquin
Fluoroquinolone antibiotic
Finish course as prescribed. Monitor glucose. Do not take within 2 hours of consuming foods or other products containing di- or trivalent cations (ex. milk, calcium antacids, multivitamins and supplements). May cause sun sensitivity and CNS side-effects. FDA requires assessment of risk of QTc prolongation. Black box warning for tendonitis/tendon rupture. Available orally and in ophthalmic suspension.
Moxifloxacin
Avelox
Fluoroquinolone antibiotic
Finish course as prescribed. Monitor glucose. Do not take within 2 hours of consuming foods or other products containing di- or trivalent cations (ex. milk, calcium antacids, multivitamins and supplements). May cause sun sensitivity and CNS side-effects. FDA requires assessment of risk of QTc prolongation. Black box warning for tendonitis/tendon rupture. Available orally and in ophthalmic solution (Vigamox, Moxeza).
Azithromycin
Zithromax, Zmax, Azasite
Macrolide antibiotic
Finish course as prescribed. No CYP 3A4 inhibition. QT prolongation possible. Opthalmic solution, Azasite, is refrigerated.
Clarithromycin
Biaxin (XL)
Macrolide antibiotic
Finish course as prescribed. May impart metallic taste. Inhibits CYP 3A4. QT prolongation possible.
Clindamycin
Cleocin, Cleocin T, Evoclin, Clindagel
Available in many dosage forms (oral, topical, vaginal suppository, powder for suspension) and combination products. Oral therapy may cause C. diff-associated severe diarrhea. Suspension has horrible taste, little flavoring options available.
Nitrofurantoin
Macrobid, Macrodantin, Furadantin
Take with food to enhance absorption. May cause peripheral neuropathy or pulmonary fibrosis. Shake suspension thoroughly.
Amoxicillin
Amoxil
Penicillin antibiotic
Finish course as prescribed. May cause GI upset; take with food. Hypersensitivity reactions possible. May decrease efficacy of oral contraceptives. Secondary vaginal yeast infection may develop. Shake susp well and keep refrigerated, note exp date after reconstitution
Amoxicillin + Clavulanate
Augmentin, Augmentin XR
Penicillin antibiotic
Finish course as prescribed. May cause GI upset; take with food. More likely to have diarrhea b/c of clavulanate- maintain hydration. Clavulanic acid doses vary among formulations; double-check if using alternate formulation to achieve prescribed dose (ex. 400mg-57mg/5ml suspension cannot be substituted for 600mg-42.9mg/5ml suspension). Shake susp well and keep refrigerated, note exp date after reconstitution
Penicillin V Potassium
Veetids, Pen-Vee K
Penicillin antibiotic
Finish course as prescribed. May cause GI upset; take with food. C. diff-associated diarrhea may develop. Hypersensitivity reactions possible.
Sulfamethoxazole + Trimethoprim
Bactrim, Bactrim DS, Septra, Septra DS
Sulfonamide antibacterial
Finish course as prescribed. Take with plenty of water. Increases sensitivity to sunlight. Increased risk of hypoglycemia if taken with other sulfonylureas. Severe life-threatening skin reactions possible.
Doxycycline
Vibramycin, Doryx, Adoxa, Monodox, Oracea, Periostat
Tetracycline antibiotic
May increase sensitivity to sunlight. Do not take within 2 hours of consuming foods or other products containing di- or trivalent cations (ex. milk, calcium antacids, multivitamins and supplements). Hyclate and monohydrate salts not interchangeable.
Metronidazole
Metrogel, Metrogel-Vaginal, Metrocream, Metrolotion
Topical antibiotic
Use condoms during vaginal therapy. Some drug is absorbed systemically; avoid alcohol consumption during therapy and for 2 days after. Also used topically on the face for rosacea.
Mupirocin
Bactroban
Topical antibiotic
Used most in hospital to reduce the risk of MRSA infection from carriers
Nystatin + Triamcinolone
Mycolog II
Topical antifungal + steroid combination
Use a sparing amount, avoid application around eyes.
Chlorhexidine Gluconate
Peridex, PerioGard
Tx for gingivitis/Periodontitis
Swish/spit 15 mls BID
Olsetamivir
Tamiflu
antiviral against influenza
BID dosing for Tx, QD dosing for prophylaxis, tx within 24-48 hours of sx, rarely causes behavioral disturbances inc delirium, risk of anaphylaxis and allergic skin rxns
Emtricitabine + Tenofovir
Truvada
Reverse transcriptase inhibitor
Adherence important to prevent resistance. May be taken without regard to food. May cause decrease in bone mineral density, fat redistribution, lactic acidosis, hepatomegaly, and renal toxicity. Recently approved for pre-exposure HIV prophylaxis for those whose partner has HIV; must have regular testing every 3 months.
Zidovudine + Lamivudine
Combivir
Reverse transcriptase inhibitor
Adherence important to prevent resistance. May be taken without regard to food. May cause fat redistribution, lactic acidosis, hepatomegaly, myopathy, and hematologic toxicity.
Enalapril
Vasotec
ACE Inhibitor, antihypertensive
Pregnancy category D. May cause a dry cough, first-dose hypotension (especially in CHF and hypervolemia) and hyperkalemia (avoid salt substitutes). Angioedema is a serious reaction; discontinue immediately and medical intervention may be necessary. Drug has renoprotective properties, but may also cause acute renal failure; monitor serum creatinine and discontinue if >30% increase.
Ramipril
Altace
ACE Inhibitor, antihypertensive
Pregnancy category D. May cause a dry cough, first-dose hypotension (especially in CHF and hypovolemia) and hyperkalemia (avoid salt substitutes). Angioedema is a serious reaction; discontinue immediately and medical intervention may be necessary. Drug has renoprotective properties, but may also cause acute renal failure; monitor serum creatinine and discontinue if >30% increase. May have greater benefit if dosed at bedtime.
Quinapril
Accupril, Accuretic
ACE Inhibitor, antihypertensive; Accuretic-combo with HCTZ
Pregnancy category D. May cause a dry cough, first-dose hypotension (especially in CHF and hypovolemia) and hyperkalemia (avoid salt substitutes). Angioedema is a serious reaction; discontinue immediately and medical intervention may be necessary. Drug has renoprotective properties, but may also cause acute renal failure; monitor serum creatinine and discontinue if >30% increase.
Benazepril, Ben/HCTZ
Lotensin, Lotensin HCT
ACE Inhibitor, antihypertensive; HCT-combo with HCTZ
Pregnancy category X. May cause a dry cough, first-dose hypotension (especially in CHF and hypovolemia) and hyperkalemia (avoid salt substitutes). Angioedema is a serious reaction; discontinue immediately and medical intervention may be necessary. Drug has renoprotective properties, but may also cause acute renal failure; monitor serum creatinine and discontinue if >30% increase.
Lisinopril, Lis/HCTZ
Zestril or Prinivil, Zestoretic
ACE Inhibitor, antihypertensive; Zestoretic-combo with HCTZ
Pregnancy category D. May cause a dry cough, first-dose hypotension (especially in CHF and hypovolemia) and hyperkalemia (avoid salt substitutes). Angioedema is a serious reaction; discontinue immediately and medical intervention may be necessary. Drug has renoprotective properties, but may also cause acute renal failure; monitor serum creatinine and discontinue if >30% increase.
Doxazosin Mesylate
Cardura, Cardura XL
Alpha 1 Blocker antihypertensive, also used in BPH
May cause postural hypotension/orthostasis after first dose or an increase in dose. Dizziness and headache common.
Terazosin
Hytrin
Alpha 1 Blocker antihypertensive, also used in BPH
May cause postural hypotension/orthostasis after first dose or an increase in dose. Dizziness and headache common.
Clonidine
Catapres, Catapres TTS, Nexiclon XR, Kapvay ER
Alpha II agonist, antihypertensive
May cause drowsiness, dry mouth, or skin reactions. Rotate patch application sites and discard patches carefully. Do not discontinue abruptly.
Amiodarone
Cordarone
Antiarrhythmic
Many drug interactions, complicated by extremely long half life of 40-50 days. Hepatic and pulmonary damage possible; notify MD if jaundice, dark urine or trouble breathing occur. May cause thyroid problems, hypotension, bradycardia, ocular disease and exacerbate arrhythmia. Have regular ophthalmic visits. May cause skin to turn bluish-grey in color
Warfarin Sodium
Coumadin
Anticoagulant
Risk of bleeding, especially GI. Very narrow therapeutic index; INR must be monitored regularly and vitamin K intake should be uniform. Many drug interactions; always check with MD or RPh when taking a new medication.
Fenofibrate
TRICOR, Trilipix
Antihyperlipidemic
Risk of myopathy; taking with statins increase risk. Discontinue immediately and report any signs (muscle pain, brown urine) to MD and/or RPh. Increases action of sulfonylureas; monitor for hypoglycemia. No good outcome data; FIELD and ACCORD Lipid were not positive. Safer to combine with a statin than gemfibrozil, but not evidence based. Many different “Brand” formulations.
Gemfibrozil
Lopid
Antihyperlipidemic
Increases effects of statins and therefore myopathy risk; discontinue immediately and report any signs (muscle pain, brown urine) to MD and/or RPh. Should be taken 30 minutes before breakfast and dinner. Increased risk of gall stones.
Niacin
Niaspan ER
Antihyperlipidemic
Causes flushing in most individuals (>80%); take at bedtime with a low-fat snack and 325mg aspirin to reduce effects. Doses higher than 2g/day may cause hepatotoxicity.
Atorvastatin
Lipitor
Antihyperlipidemic - HMG CoA reductase inhibitor
Pregnancy category X. Myopathy is a serious reaction; discontinue immediately and report any signs (muscle pain, brown urine) to MD and/or RPh. May be taken at any time of day. Avoid excessive alcohol and grapefruit juice. Some CYP 3A4 interactions.
Lovastatin
Mevacor, Altoprev ER
Antihyperlipidemic - HMG CoA reductase inhibitor
Pregnancy category X. Myopathy is a serious reaction; discontinue immediately and report any signs (muscle pain, brown urine) to MD and/or RPh. Take in the evening. Avoid excessive alcohol and grapefruit juice. Several CYP 3A4 interactions.
Pravastatin
Pravachol
Antihyperlipidemic - HMG CoA reductase inhibitor
Pregnancy category X. Myopathy is a serious reaction; discontinue immediately and report any signs (muscle pain, brown urine) to MD and/or RPh. Avoid excessive alcohol. Significantly fewer drug interactions compared to other statins (cleared by kidney rather than liver).
Rosuvastatin
Crestor
Antihyperlipidemic - HMG CoA reductase inhibitor
Pregnancy category X. Myopathy is a serious reaction; discontinue immediately and report any signs (muscle pain, brown urine) to MD and/or RPh. May be taken at any time of day. Avoid excessive alcohol and grapefruit juice.
Simvastatin/ezetimibe
Vytorin
Antihyperlipidemic - HMG CoA reductase inhibitor and cholesterol absorption inhibitor
Pregnancy category X. Myopathy is a serious reaction; discontinue immediately and report any signs (muscle pain, brown urine) to MD and/or RPh. Take in the evening. Avoid excessive alcohol and grapefruit juice. Several CYP 3A4 interactions. Lacks data that combination is superior to simvastatin alone.
Simvastatin
Zocor
Antihyperlipidemic - HMG reductase inhibitor
Pregnancy category X. Myopathy is a serious reaction; discontinue immediately and report any signs (muscle pain, brown urine) to MD and/or RPh. Take in the evening. Avoid excessive alcohol and grapefruit juice. Several CYP 3A4 interactions.
Aspirin
Ecotrin
Antiplatelet
Used for cardiovascular or cerebrovascular accident treatment/prophylaxis. 75-325 mg pod daily. Risk/benefit important for prophylaxis decisions. Increased risk of bleeding. Be aware of hypersensitivity reactions especially in patients with allergic triad of as a allergy, nasal polyps, and asthma, avoid in children due to risk of Reye syndrome.
Amlodipine + Valsartan
Exforge, Exforge HCT
ARB + calcium channel blocker combo; HCT also contains diuretic
Valsartan, Val/HCTZ
Diovan, Diovan HCT
ARB Antihypertensive, HCT also contains diuretic
Black box warning in pregnancy. May cause dizziness, hypotension, hyperkalemia (avoid salt substitutes, potassium sparing diuretics), and renal dysfunction (discontinue if serum creatinine increases >30%). NSAIDs reduce antihypertensive effect and increase risk of renal dysfunction. Taking with ACE inhibitor or renin inhibitor increases side effects with little benefit.
Irbesartan, Irbesartan/HCTZ
Avapro, Avalide
ARB Antihypertensive; Avalide-combo with diuretic
Black box warning in pregnancy. May cause dizziness, hypotension, hyperkalemia (avoid salt substitutes, potassium sparing diuretics), and renal dysfunction (discontinue if serum creatinine increases >30%). NSAIDs reduce antihypertensive effect and increase risk of renal dysfunction. Taking with ACE inhibitor or renin inhibitor increases side effects with little benefit.
Candesartan, Can/HCTZ
Atacand, Atacand HCT
ARB Antihypertensive; HCT-combo with diuretic
Black box warning in pregnancy. May cause dizziness, hypotension, hyperkalemia (avoid salt substitutes, potassium sparing diuretics), and renal dysfunction (discontinue if serum creatinine increases >30%). NSAIDs reduce antihypertensive effect and increase risk of renal dysfunction. Taking with ACE inhibitor or renin inhibitor increases side effects with little benefit.
Olmesartan
Benicar, Benicar HCT
ARB Antihypertensive; HCT-combo with diuretic
Black box warning in pregnancy. May cause dizziness, hypotension, hyperkalemia (avoid salt substitutes, potassium sparing diuretics), and renal dysfunction (discontinue if serum creatinine increases >30%). NSAIDs reduce antihypertensive effect and increase risk of renal dysfunction. Taking with ACE inhibitor or renin inhibitor increases side effects with little benefit. Sprue -like enteropathy (unexplained wt loss and diarrhea)
Losartan, Los/HCTZ
Cozaar, Hyzaar
ARB Antihypertensive; Hyzaar-combo with diuretic
Black box warning in pregnancy. May cause dizziness, hypotension, hyperkalemia (avoid salt substitutes, potassium sparing diuretics), and renal dysfunction (discontinue if serum creatinine increases >30%). NSAIDs reduce antihypertensive effect and increase risk of renal dysfunction. Taking with ACE inhibitor or renin inhibitor increases side effects with little benefit.
Atenolol
Tenormin
Beta Blocker, Beta-1 Selective
May cause drowsiness. Masks symptoms of hypoglycemia. Do not discontinue abruptly. Limited evidence/data.
Metoprolol Succinate
Toprol XL
Beta Blocker, Beta-1 Selective
May cause drowsiness. Masks symptoms of hypoglycemia. Do not discontinue abruptly. Succinate and tartrate salts are not interchangeable!
Metoprolol Tartrate
Lopressor
Beta Blocker, Beta-1 selective
May cause drowsiness. Masks symptoms of hypoglycemia. Do not discontinue abruptly. Succinate and tartrate salts are not interchangeable!
Bisoprolol, Bisoprolol + HCTZ
Zebeta, Ziac
Beta Blocker, Beta-1 selective; Ziac is combo with diuretic
May cause drowsiness. Masks symptoms of hypoglycemia. Do not discontinue abruptly due to risk of tachycardia and hypertension. Bisoprolol has outcome data in heart failure; target dose of 10mg/day
Atenolol/chlorthalidone
Tenoretic
Beta Blocker, Beta-1 Selective/ thiazide diuretic
Propranolol
Inderal, Inderal LA, Innopran, Innopran XL
Beta Blocker, nonselective
May cause drowsiness. Masks symptoms of hypoglycemia. Do not discontinue abruptly. LA and immediate release formulations are not mg-mg equivalent; dose may need to be increased by up to 30% when converting from immediate release to LA.
Carvedilol
Coreg (CR)
Beta Blocker, nonselective; Alpha-1 blocker
May cause drowsiness. Masks symptoms of hypoglycemia. Do not discontinue abruptly. CR and immediate release formulations are not mg-mg equivalent; CR 10mg equivalent to 3.125mg BID of immediate release.
Labetalol
Normodyne or Trandate
Beta Blocker, nonselective; Alpha-1 blocker
May cause drowsiness. Masks symptoms of hypoglycemia. Do not discontinue abruptly.
Digoxin
Lanoxin or Lanoxicap
Cardiac glycoside: + Inotropic, - chronotropic
Narrow therapeutic index, many drug interactions. Digoxin toxicity possible (anorexia, nausea, fatigue, vision disturbances, bradycardia, arrhythmias).
Amlodipine + Olmestartan
Azor, Tribenzor
Combination of ARB + calcium channel blocker; Tribenzor also contains diuretic
Amlodipine
Norvasc
Dihydro calcium channel blocker
May cause drowsiness, risk of hypotension and orthostasis. Risk of peripheral edema that is not responsive to diuretics but may be relieved by ACEi or ARB.
Nifedipine
Procardia, Procardia XL, Adalat CC
Dihydro calcium channel blocker
May cause drowsiness. Risk of peripheral edema that is not responsive to diuretics; ACEi or ARB used to reverse. Adalat and Procardia not equivalent, double-check when dispensing generics.
Amlodipine + Benazepril
Lotrel
Dihydro calcium channel blocker + ACE inhibitor combo
Amlodipine + Atorvastatin
Caduet
Dihydro calcium channel blocker + HMG-CoA reductase inhibitor combo
trate amlodipine to response over 1-2 weeks and atorvastatin in 6-8 weeks
Dabigatran
Pradaxa
Direct thrombin inhibitor
Monitor for bleeding. May cause some GI upset. Store capsules in original container or blister pack; discard unused medication after 4 months. Do not crush, chew or open capsules. If a dose is missed, do not take a double dose if more than 6 hours have passed. Drug interactions with p-glycoprotein substrates (dronedarone, ketoconazole, rifampin). Dose should be adjusted for kidney function. Discontinuation for surgery determined by creatinine clearance
Potassium Chloride
Klor-Con
Electrolyte supplement
May cause GI upset, take with food. Monitor salt intake.
Rivaroxaban
Xarelto
Factor Xa inhibitor
Monitor for bleeding. Doses of 15 mg or more must be taken with food. Compliance extremely important, but do not take a double dose if a dose is missed. Discontinue at least 24 hours before surgeries. Drug interactions with CYP 3A4 substrates, but benefit outweighs cost in some cases.
Apixaban
Eliquis
Factor Xa inhibitor
Monitor for bleeding. 5 mg orally twice daily. A dose of 2.5 mg twice daily is recommended for patients at least 80 years old, who weigh no more than 60 kg, or who have serum creatinine of at least 1.5 mg/dL, as well as those receiving strong dual inhibitors of cytochrome P450 3A4 and P-glycoprotein. Boxed warning - inc risk of stroke if DC’d. Not indicated in patients with prosthetic heart valves.
Furosemide
Lasix
Loop diuretic
May cause hypokalemia; monitor potassium levels and kidney function. Also watch salt intake. May be used as needed in congestive heart failure. Hypersensitivity reaction may occur in individuals with sulfa allergy. Lasix short for “last six hours”.
Enoxaparin
Lovenox
Low molecular weight heparin
Increased risk of bleeding. Counsel on injection technique. Often used when beginning warfarin to achieve goal INR more quickly. In community pharmacy, double-check to make sure proper package size and quantity are being dispensed/billed.
Isosorbide Mononitrate
Imdur, ISMO
Nitroglycerin antianginal/vasodilator
Frequently causes dizziness and/or headache. Dosed twice daily, but must be taken “asymmetrically” to prevent tolerance; take second dose 8 hours after first dose rather than every 12 hours.
Nitroglycerin SL
Nitrostat
Nitroglycerin antianginal/vasodilator
Frequently causes dizziness and/or headache. If chest pain persist after first dose, take second dose in 5 minutes. Call 911 if symptoms persist after second dose. Store in original container.
Topical Nitroglycerin
Nitro-Dur
Nitroglycerin antianginal/vasodilator
Finish course as prescribed. Apply patch for 12 hours and remove for 12 hours for nitrate-free period.
Diltiazem
Cardizem, Cardizem SR, Cardizem CD, Cardizem LA, Tiazac
Non-dihydro Calcium Channel Blocker
May cause drowsiness/dizziness or headache. Do not discontinue therapy without discussing with MD. Many formulations that may not be equivalent; double-check when dispensing generics.
Verapamil
Calan, Calan SR, Isoptin SR
Non-dihydro Calcium Channel Blocker
May cause drowsiness/dizziness, headache, or constipation. Do not discontinue therapy without discussing with MD.
Clopidogrel
Plavix
Platelet Inhibitor
Monitor for bleeding. Compliance extremely important. CYP 2C19 inhibitors such as omeprazole and esomeprazole greatly decrease efficacy. Check with MD or RPh before starting new medications or taking OTC medications.
Triamterene + HCTZ
Dyazide capsules or Maxzide tablets
Potassium-sparing + thiazide diuretic combo
Take in the early morning. Monitor renal function, potassium levels, and salt intake; not to be used if renal function impaired. Risk of kidney stones; drink plenty of fluids to reduce risk. Double-check patient profile when dispensing generics; patients should remain on tablets or capsules unless MD changes.
Spironolactone, Spir/HCTZ
Aldactone, Aldactazide
Potassium-sparing diuretic; Aldactazide also contains diuretic
Take in the early morning. Monitor renal function, potassium levels, and salt intake. May cause gynecomastia in males, menstrual irregularities in females (antiandrogenic properties). Evidence-based data for heart failure, post MI, and resistant hypertension. Aldactazide may cause hypersensitivity reactions in individuals with sulfa allergy.
Indapamide
Lozol
Thiazide diuretic
Take in the early morning. Monitor renal function, potassium levels, and salt intake; not to be used in severe renal impairment, but may be used in minimally impaired renal function. Hypersensitivity reaction may occur in individuals with sulfa allergy.
Chlorthalidone
Thalidone, Hygroton
Thiazide diuretic
Take in the early morning. Monitor renal function, potassium levels, and salt intake; not to be used if renal function impaired. Hypersensitivity reaction may occur in individuals with sulfa allergy. Chlorthalidone is twice as potent as HCTZ.
Hydrochlorothiazide (aka HCTZ)
Oretic, Microzide
Thiazide diuretic
Take in the early morning. Monitor renal function, potassium levels, and salt intake. Hypersensitivity reaction may occur in individuals with sulfa allergy.
Metolazone
Zaroxolyn
Thiazide diuretic
Take in the early morning. Monitor renal function, electrolytes (esp. potassium and magnesium) and salt intake. Hypersensitivity reaction may occur in individuals with sulfa allergy. Often used in diuretic-resistant patients in combination with loop diuretics.
Ondansetron
Zofran, Zofran ODT
5-HT3 antagonist Antiemetic
May cause headache, fatigue. Dissolve ODT under the tongue, store in original container until ready to use. QT prolongation possible.
Donepezil
Aricept
Acetylcholinesterase inhibitor
Take in the evening. Significant nausea, vomiting and diarrhea possible, as well as anorexia. May also cause bradycardia and fainting. Set realistic expectations for Alzheimer’s patients. Keep in mind positive statistical significance vs. clinical significance.
Rivastigmine
Exelon, Exelon Patch
Acetylcholinesterase Inhibitor
Take capsules in the evening. Rotate patch application sites. Significant nausea, vomiting and diarrhea possible, as well as anorexia. May also cause bradycardia and fainting. Set realistic expectations for Alzheimer’s patients. Keep in mind positive statistical significance vs. clinical significance.
Butalbital + aspirin + caffeine, available with or without codeine
Fiorinal, Fiorinal with codeine
Analgesic Combo for Tension Headaches, C-III
May cause drowsiness or dizziness; avoid alcohol use during therapy. Caution against taking other products containing aspirin.
Butalbital + acetaminophen + caffeine (sometimes called B-A-C), available with or without codeine
Fioricet, Fioricet with codeine
Analgesic Combo for Tension Headaches, C-III if it has codeine
May cause drowsiness or dizziness; avoid alcohol use during therapy. Do not exceed 4g of APAP per day, 3g if frequent alcohol drinker, 2g if taking warfarin. New black box warning with acetaminophen due to hepatotoxicity.
Buspirone
Buspar
Antianxiety- serotonin 5-HT1A receptor partial agonist
May cause drowsiness or dizziness, slow onset, mildly effective, little potential for abuse.
Scopolamine
Transderm-Scop
Anticholinergic
May cause drowsiness or dizziness. wash your hands after application as touching your eyes after application may result in blurred vision (dilation)
Mirtazapine
Remeron
Antidepressant
May cause drowsiness or dizziness, dry mouth, constipation and weight gain. Do not discontinue abruptly. Open from blister and dissolve SolTab on the tongue.
Trazodone
Desyrel
Antidepressant/Sleep Aid
May cause dizziness/drowsiness/orthostasis, priapism risk.
Bupropion
Wellbutrin (SR) (XL) or Zyban
Antidepressant/smoking cessation aid
Take XL tabs in AM to avoid insomnia, do not crush or chew SR or XL tabs, do not take doses too close or exceeding maximum doses because of seizure risk. Potential side-effects inc nervousness, constipation, trouble sleeping, dry mouth, tremor.
Carbamazepine
Tegretol (XR)
Antiepileptic
Take with food, may cause drowsiness, avoid alcohol. Serious and sometimes fatal dermatologic reactions (including Stevens-Johnson syndrome and toxic epidermal necrolysis) have been reported, especially in patients with the inherited allelic variant HLA-B*1502. Genetically at-risk patients (IE those form Asia including China) should be screened prior to receiving carbamazepine.
Lamotrigine
Lamictal
Antiepileptic
Report hypersensitivity/rash to MD, may cause drowsiness, do not operate heavy machine
Levetiracetam
Keppra
Antiepileptic
May cause dizziness/drowsiness, do not operate heavy machinery, do not abruptly discontinue therapy
Oxcarbazepine
Trileptal
Antiepileptic
May cause dizziness/drowsiness, do not operate heavy machinery, do not abruptly discontinue therapy
Phenytoin Sodium
Dilantin Kapseals
Antiepileptic
May cause dizziness/drowsiness, do not operate heavy machinery. Emphasize good oral hygiene to reduce risk of gingival hyperplasia
Divalproex
Depakote (ER)
Antiepileptic, mood stabilizer
Do not abruptly discontinue therapy, avoid alcohol use, may cause drowsiness
Phenobarbital
Phenobarbital
Antiepileptic/hypnotic; C-IV
May cause drowsiness or dizziness, avoid alcohol use during therapy
Topiramate
Topamax
Antiepileptic/Migraine prophylactic
May cause drowsiness or dizziness, avoid alcohol use during therapy. Confusion (“Dopamax”) and it is now FDA approved in a combination with phentermine in extended release - Qsymia (C-IV)
Gabapentin
Neurontin
Antiepileptic/neuropathic analgesic
May cause drowsiness or dizziness, avoid alcohol use during therapy. Edema, weight gain and confusion as common side effects, as well as generally need to titrate slowly to higher doses as this agent has dose related kinetics
Hydroxyzine hydrochloride
Atarax
Antihistamine
May cause anticholinergic side-effects.
Eletriptan
Relpax
Antimigraine, 5-HT1 agonist
Take at onset of migraine. If headache is relieved but returns after 1st dose, repeat in 2 hours. Do not exceed 2 doses or 80mg in a 24 hour period. If 1st dose does not relieve symptoms, reevaluate condition. Ischemic cardiovascular events possible. Drug interactions with CYP 3A4 substrates and ergot derivatives.
Rizatriptan
Maxalt, Maxalt MLT
Antimigraine, 5-HT1 agonist
Take at onset of migraine. If headache is relieved but returns after 1st dose, repeat in 2 hours. Do not exceed 2 doses or 30mg in a 24 hour period. If 1st dose does not relieve symptoms, reevaluate condition. Ischemic cardiovascular events possible. Drug interactions with ergot derivatives. Dissolvable tablets contain phenylalanine.
Sumatriptan
Imitrex
Antimigraine, 5-HT1 agonist
Take at onset of migraine. If headache is relieved but returns after 1st dose, repeat in 2 hours. Do not exceed 2 doses or 200mg in a 24 hour period. If 1st dose does not relieve symptoms, reevaluate condition. Ischemic cardiovascular events possible. Drug interactions with ergot derivatives. Available in oral tablet, injection kit, and nasal spray.
Benztropine
Cogentin
Antiparkinson Agent
May take with food to decrease GI symptoms. Potential anticholinergic side-effects
Levodopa/Carbidopa
Sinemet (CR)
Antiparkinson Agent
Avoid products containing B6 as they reduce the effectiveness of levodopa, may be taken with food/milk if GI upset occurs
Pramipexole
Mirapex
Antiparkinson Agent
Hallucinations may occur, report any changes in vision to MD, may cause drowsiness and even sleep attacks (falling asleep without warning)
Ropinirole
Requip
Antiparkinson/Restless Leg agent
May cause drowsiness or dizziness, avoid alcohol use during therapy, orthostasis may occur. May also cause sleep attacks.
Olanzapine
Zyprexa
Antipsychotic
Initially may cause dizziness, use caution when operating heavy machinery due to drowsiness, may cause wt gain, DM and dyslipidemia
Quetiapine
Seroquel (XR)
Antipsychotic
Initially may cause dizziness, use caution when operating heavy machinery due to drowsiness
Risperidone
Risperdal
Antipsychotic
First doses may cause fainting, may impair judgment, avoid alcohol use
Ziprasidone
Geodon
Antipsychotic
May cause arrhythmias, do not discontinue use abruptly, take with food
Aripiprazole
Abilify
Antipsychotic for bipolar, schizophrenia, and major depressive disorder
Avoid alcohol, D/I 3A4, QT prolongation, do not discontinue abruptly
Meclizine
Antivert
Antivertigo Agent
Potential anticholinergic side-effects
Alprazolam
Xanax (XR)
Benzodiazepine Antianxiety, C-IV
Do not exceed prescribed dose, do not take with alcohol, may cause drowsiness/dizziness, do not operate heavy machinery, avoid abrupt discontinuation
Clonazepam
Klonopin
Benzodiazepine Antianxiety; C-IV
Do not exceed prescribed dose, do not take with alcohol, may cause drowsiness/dizziness, do not operate heavy machinery
Diazepam
Valium
Benzodiazepine Antianxiety; C-IV
Do not exceed prescribed dose, do not take with alcohol, may cause drowsiness/dizziness, do not operate heavy machinery
Lorazepam
Ativan
Benzodiazepine Antianxiety; C-IV
Do not exceed prescribed dose, do not take with alcohol, may cause drowsiness/dizziness, do not operate heavy machinery
Temazepam
Restoril
Benzodiazepine Antianxiety; C-IV
Do not exceed prescribed dose, do not take with alcohol, may cause drowsiness/dizziness, do not operate heavy machinery
Phentermine
Adipex-P
CNS stimulant - Obesity Management; C-IV
Cardiovascular risk caution, take in the morning,
Methylphenidate
Concerta or Ritalin (ER) or Metadate CD
CNS Stimulant for ADD, C-II
Take as directed, don’t share your pills
Atomoxetine
Strattera
CNS Stimulant, used for ADD
May impair cognitive & motor function, use caution when operating machinery, not a drug of abuse
(Dex)/Amphetamine Mixed salts
Adderall (XR)
CNS Stimulant, used for ADD; C-II
Take as directed, don’t share your pills
Lisdexamfetamine
Vyvanse
CNS Stimulant, used for ADHD; C-II
Take as directed, don’t share your pills
Modafinil
Provigil
CNS Stimulant, used for narcolepsy; C-IV
Take in morning or 1 hour prior to work, avoid driving until deemed safe by MD
Dexmethylphenidate
Focalin (XR)
CNS stimulant; C-II
Take as directed, don’t share your pills
Zaleplon
Sonata
hypnotic, nonbenzodiazepine; C-IV
Take 30min to 1h prior to desired sleep, Allocate at least 5 hours after a dose to sleep (T ½ ~1 hour)
Cyclobenzaprine
Flexeril
Muscle Relaxant
May cause drowsiness or dizziness and other anticholinergic side-effects, avoid alcohol use during therapy
Metaxalone
Skelaxin
Muscle Relaxant
Least drowsy muscle relaxant, requires frequent dosing
Carisoprodol
Soma
Muscle Relaxant; C-IV
Drug of abuse, may be scheduled in some states, caution for drowsiness
Fentanyl
Duragesic
Narcotic Analgesic; C-II
Caution for respiratory depression, do not exceed prescribed dose. Avoid exposing patch on the skin to heat as it will increase the delivery of the fentanyl and increase the risk of toxicity, dispose of the used patch by folding over and flushing it, be careful when starting therapy and remember the patch is used for several days normally 72 hours but may see it changed every 48 hours in some patients. Caution in narcotic naive patients as it is 80-100 times more potent analgesic than morphine.
Morphine Sulfate
MS Contin
Narcotic Analgesic; C-II
Risk of CNS and respiratory depression, avoid alcohol, may cause drowsiness/dizziness, do not operate heavy machinery, constipation
Oxycodone
Oxycontin
Narcotic Analgesic; C-II
CNS depression, avoid alcohol, may cause drowsiness/dizziness, do not operate heavy machinery, constipation
Oxycodone/APAP
Percocet or Roxicet
Narcotic Analgesic; C-II
CNS depression, avoid alcohol, may cause drowsiness/dizziness, do not operate heavy machinery, constipation. APAP combination dose will be reduced to no more than 325mg per tablet in the next year. Consider the total daily dose of acetaminophen from all sources.
Acetaminophen/ Codeine
Tylenol with Codeine
Narcotic Analgesic; C-III
CNS depression, avoid alcohol, may cause drowsiness/dizziness, do not operate heavy machinery, constipation. Consider the total daily dose of acetaminophen from all sources.
Hydrocodone / chlorpheniramine Polistirex
Tussionex
Narcotic Analgesic; C-III
CNS depression, avoid alcohol, may cause drowsiness/dizziness, do not operate heavy machinery, constipation, taking with food may decrease some GI upset, Max dose 5mls BID
Hydrocodone/Ibuprofen
Vicoprofen
Narcotic Analgesic; C-III
CNS depression, avoid alcohol, may cause drowsiness/dizziness, do not operate heavy machinery, constipation, taking with food may decrease some GI upset
Hydrocodone/APAP
1 prescribed drug! CNS depression, avoid alcohol, may cause drowsiness/dizziness, do not operate heavy machinery, avoid concomitant said drugs, constipation. Vicodin reformulated to contain only 300mg of APAP per dose to avoid generic competition and to meet new FDA requirement.
Lortab or Vicodin or Lorcet
Narcotic/APAP Analgesic - CIII
Pregabalin
Lyrica
Neuropathic Analgesic - CV
May cause drowsiness, do not discontinue therapy abruptly. Weight gain, edema and confusion are potential side-effects
Varenicline Tartrate
Chantix
Nicotinic receptor agonist, Smoking cessation
Usually titrated upward. Most effective smoking cessation agent to date ~ 44% at 12 weeks, also watch for night mares and any changes in affect and/or behavior and report them to the prescriber. Side-effects may be dose related.
Memantine
Namenda
NMDA receptor antagonist; anti-Alzheimer’s agent
Take in the evening, potential N & D, dizziness and agitation possible. Set realistic expectations. Keep in mind positive statistical significance vs. clinical significance. Take without regard to food
Enteric Diclofenac sodium, Diclofenac potassium (non-enteric coated formulation)
Voltaren, Cataflam
NSAID
Take with food, monitor for s/sx of GI bleed. CV and renal risks. Enteric coated diclofenac sodium, slow onset not for PRN pain, greater risk of hepatotoxicity vs. other NSAIDs, use the Cataflam-diclofenac potassium non-enteric coated formulation if for PRN use for pain
Etodolac
Lodine (XL)
NSAID
Take with food, monitor for s/sx of GI bleed. CV and renal risks.
Indomethacin
Indocin
NSAID
Take with food, monitor for s/sx of GI bleed.CV and renal risks. Most likely NSAID to cause headache and CNS side-effects.
Ketorolac Tromethamine
Toradol
NSAID
Take with food, monitor for s/sx of GI bleed. Very high risk of GI bleeding limits this drug to 5 days max of therapy. CV and renal risks.
Meloxicam
Mobic
NSAID
Take with food, monitor for s/sx of GI bleed. CV and renal risks.
Nabumetone
Relafen
NSAID
Take with food, monitor for s/sx of GI bleed. CV and renal risks.
Naproxen
Naprosyn, Anaprox/Aleve
NSAID
Take with food, monitor for s/sx of GI bleed. CV and renal risks. Naproxen sodium Aleve/Anaprox fast onset sodium salt vs. regular naproxen-Naprosyn which is slow onset and used for chronic Rx of OA and RA not acute pain relief
Piroxicam
Feldene
NSAID
Take with food, monitor for s/sx of GI bleed, CV and renal risks.
Ibuprofen
Motrin or Advil
NSAID
Take with food, monitor for s/sx of GI bleed. CV and renal risks. Motrin at low doses (IE OTC it is analgesic and antipyretic) but if you need anti-inflammatory effects then you need higher doses 2400 to 3200 mg/day
Celecoxib
Celebrex
NSAID Cox - II selective
Report s/sx of GI bleed, caution for CV risk like all NSAIDS, Not safer for renal function but may be slightly safer for GI bleeding risks
Diclofenac/Misoprostol
Arthrotec
NSAID/prostaglandin combo
Take with food, Misoprostol may decrease GI bleeding risks. CV and renal risks. Avoid in pregnancy. Diarrhea may be a common side effect of the prostaglandin component
Tramadol
Ultram, Ultram ER
Opioid analgesic
May cause drowsiness; avoid alcohol. Drug is scheduled in some states but not by the DEA. Some risk of dependence due to weak opioid receptor agonist activity. Drug also has some serotonin reuptake inhibitor properties; caution against GI effects, serotonin syndrome, increased seizure risk, and drug interactions (especially with SSRIs, SNRIs, 5-HT1 agonists/triptans)
Tramadol + acetaminophen
Ultracet
Opioid analgesic combo
May cause drowsiness; avoid alcohol. Drug is scheduled in some states but not by the DEA. Some risk of dependence due to weak opioid receptor agonist activity. Drug also has some serotonin reuptake inhibitor properties; caution against GI effects, serotonin syndrome, increased seizure risk, and drug interactions (especially with SSRIs, SNRIs, 5-HT1 agonists/triptans). Do not exceed 4g of APAP per day, 3g if frequent alcohol drinker, 2g/day if taking warfarin. New black box warning with acetaminophen due to hepatotoxicity.
Hydroxyzine pamoate
Vistaril
Antihistamine/antianxiety
May cause anticholinergic side-effects.
Fluoxetine
Prozac or Sarafem
SSRI Antidepressant
May cause drowsiness or dizziness, avoid alcohol use during therapy. Prozac longest half-life SSRI (metabolite norfluoxetine T1/2 is ~ 9 days) hence the Prozac weekly dosage form; also most activating of the SSRIs AM dosing not PM and a major inhibitor of CYP 2D6
Acetaminophen
Tylenol
Pain, antipyretic
Limit total daily dose
Eszopiclone
Lunesta
Sedative Hypnotic
Do not take with alcohol, take 30min prior to bed. has a long half-life of ~6 hours and thus an increased risk of morning residual sedation, ~40% of patients complain of a bitter taste the morning after, Need to have at least 8 hours to sleep after a dose and all of these agents can cause complex sleep behaviors (walking, eating, driving, etc.) Do not put yourself in a position where impairment may lead to increased risk of an accident until you know how you respond to the medication.
Zolpidem
Ambien (CR)
Sedative Hypnotic; C-IV
Do not take with alcohol, take 30min prior to bed. Same issues as Lunesta. New lower dosing guidelines for women.
Desvenlafaxine
Pristiq
SNRI antidepressant
Avoid alcohol, do not discontinue abruptly, no added benefit over venlafaxine -recommend generic venlafaxine
Duloxetine
Cymbalta
SNRI Antidepressant
Do not abruptly discontinue therapy. report any changes in affect and or behavior as psychiatric side effects including suicidal ideation is possible
Venlafaxine
Effexor (XR)
SNRI Antidepressant
Avoid alcohol, do not discontinue abruptly, monitor BP
Citalopram
Celexa
SSRI Antidepressant
May cause drowsiness, do not discontinue therapy abruptly. new dosage guidelines of no more than 40 mg/day and avoid in patients with CV disease as it has been shown to increase QT interval (previously recommended for patients with CV disease now only sertraline remains in this category)
Escitalopram
Lexapro
SSRI Antidepressant
May cause drowsiness, do not discontinue therapy abruptly, recommend generic Celexa for cost savings
Paroxetine
Paxil (CR)
SSRI Antidepressant
May cause drowsiness, do not discontinue therapy abruptly. Paxil most likely agent to cause discontinuation syndrome, short half-life and also most tricyclic like of the SSRI’s I.e. sedation, and a major inhibitor of CYP 2D6. New 7.5 mg dose and Brand name drug approved for hot flashes related to menopause.
Sertraline
Zoloft
SSRI Antidepressant
May cause drowsiness or dizziness, avoid alcohol use during therapy. Drug of choice for patients with CV disease and MDD (SAD Heart and ENRICHED Trials, as well as ACC/AHA/APA Guidelines
Lidocaine
Lidoderm Patches
Topical analgesic
Do not apply to broken skin, do not leave patches on for more than 12 hours in a 24 hour period
Amitriptyline
Elavil
Tricyclic Antidepressant
May cause drowsiness or dizziness, avoid alcohol use during therapy. Rarely used for depression and usually used in low doses for off label uses (headaches, pain, neuropathy) as it is a side effect of this agent and it is not well tolerated secondary to anticholinergic effects, risk of overdose causing CV death and arrhythmias, caution for suicidal ideation.
Imipramine
Tofranil (PM)
Tricyclic Antidepressant
May cause drowsiness or dizziness, avoid alcohol use during therapy. Also has significant anticholinergic effects and risk of overdose like Elavil
Lithium Carbonate
Eskalith or Lithobid
Mood Stabilizer
Do not exceed recommended doses, consume 2-3 quarts of water qday. monitor serum levels and watch out for drug interactions with thiazide diuretics which require a dosage reduction of lithium
Adapalene
Differin
Topical Acne Product
Acne may worsen before it improves; using more than recommended increases risk of skin reactions. Use as little product as can cover the face or affected areas with a thin film. Caution against sun exposure and recommend using sunscreen.
Clindamycin/Benzoyl Peroxide
Benzaclin
Topical Acne Product
May cause skin irritation, use a sparing amount. Topical acne products remind patients that their acne may get worse before it gets better and exceeding the recommended doses will increase the risk of severe adverse effects
Erythromycin/Benzoyl Peroxide
Benzamycin
Topical Acne Product
May cause skin irritation, use a sparing amount. Topical acne products remind patients that their acne may get worse before it gets better and exceeding the recommended doses will increase the risk of severe adverse effects
Clobetasol
Clobex
Topical Corticosteroid
Use a sparing amount, avoid application on face and around eyes
Mometasone
Elocon
Topical Corticosteroid
Use a sparing amount, avoid application on face and around eyes
Triamcinolone
Kenalog
Topical Corticosteroid
Use a sparing amount, avoid application around eyes, available in ointment, cream and lotion
Pimecrolimus
Elidel
Topical skin product
Black Box warning due to cancer risk
Clotrimazole/Betamethasone Diproprionate
Lotrisone
Topical Antifungal/Corticosteroid
Use a sparing amount, avoid application on face and around eyes
Fluocinonide topical
Lidex, Lidex-E, Vanos
Topical Corticosteroid
Use a sparing amount, avoid application on face and around eyes
Finasteride
Propecia or Proscar
5 alpha reductase inhibitor
Pregnant women should not handle, will not regrow hair but will prevent additional hair loss. new data on sexual dysfunction which may not be reversible in men, when used for BPH they are not rapidly effective and may take 6 plus months to shrink and enlarged prostate and produce a reduction in symptoms, probably best when used in combo with an alpha blocker to reduce symptoms and prevent or delay the need for surgical intervention
isotretinoin
Accutane or Claravis
Acne treatment
Must follow REMS system for isotretinoin dispensing and counseling. teratogenic category X, adverse lipid effects especially increased TG and psychiatric effects and as with the topical products acne may get worse before it gets better
Testosterone
AndroGel
Androgen; C-III
Use as directed to upper arm and shoulder and not to genitals. Women and children should avoid contact with this medication; men with BPH may get worse
Metformin
Glucophage (XR), Fortamet
Antidiabetic - Biguanide
Counsel on GI upset, diarrhea and best titration to minimize symptoms, may lead to B12 deficiency related neuropathy
Sitagliptin, Sit+Metformin
Januvia, Janumet (XR)
Take without regard to food, risk of pancreatitis
Saxagliptin
Onglyza
Antidiabetic - Dipeptidyl peptidase IV inhibitor
Take without regard to food, risk of pancreatitis, concomitant use of CYP3A4 Inh - use 2.5mg instead of 5 mg QD.
Glimepiride
Amaryl
Antidiabetic - Sulfonylurea
Take with breakfast, avoid alcohol use, counsel on hypoglycemic risk
Glipizide
Glucotrol (XL)
Antidiabetic - Sulfonylurea
May cause hypoglycemia due to active metabolites
Glyburide, Glyburide/Metformin
Micronase, Glucovance
Antidiabetic - Sulfonylurea
Take with breakfast, avoid alcohol use. Has an active metabolite which is renally eliminated and thus increased risk of hypoglycemia and weight gain as patients age, may also increase CV events and no longer a recommended agent by the ADA
Pioglitazone
Actos
Antidiabetic - Thiazolidinedione
Take without regard to meals, increased risk of fractures, macular edema, heart failure, weight gain and edema as well as bladder CA in men.
Exenatide, Exenatide weekly
Byetta, Bydureon
Antidiabetic Glucagon-Like Peptide-1 Receptor Agonist
Counsel on pen injection technique. Nausea and vomiting tend to be dose related and transient start with 5 mcg daily dose and after a month increase to 10 mcg dose, watch for signs of pancreatitis and can be dosed 60 min or less before meals twice a day
Liraglutide
Victoza
Antidiabetic Glucagon-Like Peptide-1 Receptor Agonist
Counsel on pen injection technique. Nausea and vomiting tend to be dose related and transient, watch for signs of pancreatitis. Box warning - Rodent studies - risk of thyroid C-cell tumors.
Alendronate
Fosamax
Bisphosphonate Osteoporosis Agent
Take on an empty stomach with a full glass of water, must sit or stand for 30 minutes following the dose, osteonecrosis of jaw and atypical fractures
Ibandronate
Boniva
Bisphosphonate Osteoporosis Agent
Take on an empty stomach with a full glass of water, must sit or stand for 60 minutes following the dose. osteonecrosis of jaw and atypical fractures
Risedronate, delayed release enteric coated risedronate
Actonel, Atelvia
Bisphosphonate Osteoporosis Agent
Take on an empty stomach with a full glass of water, must sit or stand for 30-60 minutes following the dose. Atelvia is enteric coated formulation which should be taken after breakfast but not available as generic. osteonecrosis of jaw and atypical fractures
Estrogen/Methyltestosterone
Estratest (HS)
Combination Hormone
CV, thromboembolic caution
Estradiol/Norethindrone
Combipatch
Estrogen and Progestin Combination
Stable at room temperature for 3 months
Conjugated Estrogens
Premarin
Estrogen hormone
May take with food to decrease GI symptoms
Estradiol
Climara, Estrace
Estrogen Hormone
CV, thromboembolic caution
Raloxifene
Evista
Estrogen receptor modulator, Post-menopausal Osteoporosis
CV risk and thromboembolic black box warnings, may inc TGs, myalgia. May cause or worsen hot flashes
Conjugated Estrogens with medroxyprogesterone
Prempro or Premphase
Estrogen-Progestin hormone combo
increased risk of CV and DVT as well as dementia with long term therapy, report any abnormal vaginal bleeding
Colchicine
Colcrys
Gout - Inflammatory Mediator
Long-term therapy requires blood work. no more than 3 tablets for an acute attack with similar efficacy to 8 tablets but with much less risk of GI toxicity
Allopurinol
Zyloprim
Gout - Xanthine Oxidase Inhibitor
Consume large amounts of fluids to prevent kidney stone formation. start with 100 mg QD after an acute gout attack has subsided and gradually increase the dose at no more than weekly interval to about 300 mg QD to reduce the risk of mobilization gout, may also add low dose colchicine 1-2 tabs per day for prevention of mobilization gout, D/C at first signs of a rash
Febuxostat
Uloric
Gout - Xanthine Oxidase Inhibitor
Same as allopurinol but may be safe in patients with a history of adverse skin reactions to allopurinol.
Medroxyprogesterone Acetate
Provera
Hormone/Progestin
May take with food to decrease GI symptoms, preg cat: X, may lead to uterine bleeding irregularities, long term use may decrease bone mineral density
Insulin - regular
Humulin R
Insulin - Fast Acting
counsel on injection technique and hypoglycemia, take 15-30 min prior to meal
Insulin - NPH
Humulin N
Insulin - Intermediate Acting
counsel on injection technique and hypoglycemia
Insulin Detemir
Levemir
Insulin - Intermediate-Long acting
cannot be mixed with another insulin
Insulin Glargine
Lantus
Insulin - Long Acting
cannot be mixed with another insulin, May have an increase in injection site pain/rxn
Insulin Aspart
Novolog
Insulin - Rapid Acting
Take immediately before meals, counsel on injection technique and hypoglycemia
Insulin Lispro
Humalog
Insulin - Rapid Acting
Take immediately before meals, counsel on injection technique and hypoglycemia
Insulin Glulisine
Apidra
Insulin - Rapid Acting
Take immediately before meals, counsel on injection technique and hypoglycemia
Ethinyl Estradiol/ Drospirenone
Yasmin, Ocella, Yaz
Oral contraceptive
Take everyday - counsel on missed dose protocol, caution with antibiotics. new warnings about increased risk of VTEs especially in older women and those who smoke ; risk of hyperkalemia
Ethinyl Estradiol / Desogestrel
Kariva, Ortho-Cept, Mircette, Desogen or Apri
Oral contraceptive
Take everyday - counsel on missed dose protocol, caution with antibiotics. new warnings about increased risk of VTEs especially in older women and those who smoke ; risk of hyperkalemia
Ethinyl Estradiol / Levonorgestrel
Aviane, Alesse
Oral contraceptive
Take everyday - counsel on missed dose protocol, caution with antibiotics. new warnings about increased risk of VTEs especially in older women and those who smoke ; risk of hyperkalemia
Norethindrone/Ethinyl Estradiol,Fe+
Loestrin FE
Oral contraceptive
Take at same time everyday, counsel on missed dose protocol. Caution with antibiotics, smoking
Norgestimate & Ethinyl Estradiol
TriNessa, Tri-Sprintec
Oral contraceptive
Take at same time everyday, counsel on missed dose protocol. Caution with antibiotics, smoking
Norgestimate/Ethinyl Estradiol
Ortho Tri-Cyclen (Lo)
Oral contraceptive
Take at same time everyday, counsel on missed dose protocol. Caution with antibiotics, smoking
Ethinyl Estradiol / Norelgestromin
Ortho Evra
Patch contraceptive
Each patch should remain in place for 7 days, CV risk, smoking risk
Insulin 70% NPH/ 30 % Regular
Novolin 70/30, Humulin 70/30
Pre-Mixed insulin
counsel on injection technique and hypoglycemia, 1st # is percent of intermediate release insulin and second is fast acting
Insulin 70% protamine/ 30 % rapid acting
Novalog Mix 70/30, Humalog Mix 75/25
Pre-Mixed insulin
counsel on injection technique and hypoglycemia, 1st # is percent of intermediate release insulin and second is rapid acting
Medroxyprogesterone
Depo-Provera
Progestin Contraceptive
May cause weight gain, preg cat: X, may lead to uterine bleeding irregularities, long term use may decrease bone mineral density
Prednisone
Deltasone
Steroid Anti-inflammatory
Take with food, may cause agitation, insomnia
Methylprednisolone
Medrol
Steroid anti-inflammatory/allergy
Take with food, may cause agitation, insomnia
Desiccated thyroid
Armour thyroid
Thyroid Hormone
Take on an empty stomach in the morning
Levothyroxine
Synthroid or Levoxyl
Thyroid Hormone (synthetic T4)
Narrow Therapeutic Index Drug: Take on an empty stomach in the morning with full glass of water at least 30 minutes prior to food (Do not take close to Calcium), Stay on specific brand or generic due to bioavailability issues, TSH monitoring (many dosages available from 25mcg to 300 mcg for fine tuning), adverse drug reactions early on often due to too high of dosing (med induced hyperthyroidism - heat intolerance and sweating, frequent bowel movements, restlessness, tachycardias, hair loss). Pregnancy Cat A:may need to increase dose in pregnancy, drug instable in light and humidity. Levothyroxine FDA Orange Book 4 sub categories of AB ratings (i.e. AB1, AB2,AB3 and AB4) so be careful when switching between brands and generic manufacturers stay within the same AB subclass; takes 4 weeks to reach new steady state levels and TSH may lag another 2-3 weeks
Estradiol
Vivelle-Dot, Estraderm
Topical estrogen patch
Counsel on twice weekly patch application. Note: Climara is once-weekly patch
Ethinyl Estradiol / Etonogestrel
NuvaRing
Vaginal contraceptive
Counsel on vaginal application, 3 weeks in, 1 week off
Estradiol
Vagifem
Vaginal estrogen
Counsel on vaginal tablet use with Vagifem
Dicyclomine
Bentyl
Anticholinergic for cramping/irritable bowel
May cause dry mouth, dizziness. Avoid alcohol use.
Hyoscyamine
Levsin/Levbid/Levsinex
Anticholinergic for cramping/irritable bowel
Take before meals. May experience dizziness, blurred vision, constipation.
Loperamide
Imodium
Antidiarrheal
May cause drowsiness, contact MD if diarrhea persists longer than 48 hours
Diphenoxylate/Atropine
Lomotil
Antidiarrheal; C-V
Do not exceed prescribed dose, anticholinergic side-effects possible
Promethazine
Phenergan
Antihistamine - Nausea/Vomiting treatment
May cause anticholinergic side-effects.
Lubiprostone
Amitiza
Chloride Channel Activator
Take with food to decrease nausea
Orlistat
Xenical
Fat absorption inhibitor
Caution regarding uncontrollable oily bowel movements especially after high fat meal, patient should take supplemental fat soluble vitamins at least 2 hrs prior to orlistat dose
Famotidine
Pepcid
H 2 Antihistamine
Do not exceed 14 days of OTC therapy unless directed by MD, report severe abdominal pain/discomfort to MD
Ranitidine
Zantac
H 2 Antihistamine
Do not exceed 14 days of OTC therapy unless directed by MD, report severe abdominal pain/discomfort to MD
Polyethylene Glycol
Miralax, Glycolax
Laxative
Safe for daily use, one heaping teaspoon dissolved in 8 oz of water once daily as needed
Metoclopramide
Reglan
Promotility-Antiemetic
Take 30 minutes prior to meal, avoid use with alcohol, associated with extrapyramidal symptoms and depression, caution in elderly
Esomeprazole
Nexium
Proton Pump Inhibitor
Take 30- 60 min prior to a significant meal. all of these meds are pro-drugs which need to be absorbed in that state and are activated within the parietal cell when the patient stimulates them to secrete acid by eating. They all also have a short half-life of 1-2 hours. Risks include C Diff diarrhea, pneumonia, fractures and low serum magnesium levels in addition to B12 deficiency
Lansoprazole
Prevacid
Proton Pump Inhibitor
Take 30- 60 min prior to a significant meal. all of these meds are pro-drugs which need to be absorbed in that state and are activated within the parietal cell when the patient stimulates them to secrete acid by eating. They all also have a short half-life of 1-2 hours. Risks include C Diff diarrhea, pneumonia, fractures and low serum magnesium levels in addition to B12 deficiency
Omeprazole
Prilosec
Proton Pump Inhibitor
Take 30- 60 min prior to a significant meal. all of these meds are pro-drugs which need to be absorbed in that state and are activated within the parietal cell when the patient stimulates them to secrete acid by eating. They all also have a short half-life of 1-2 hours. Risks include C Diff diarrhea, pneumonia, fractures and low serum magnesium levels in addition to B12 deficiency
Pantoprazole
Protonix
Proton Pump Inhibitor
Take 30- 60 min prior to a significant meal. all of these meds are pro-drugs which need to be absorbed in that state and are activated within the parietal cell when the patient stimulates them to secrete acid by eating. They all also have a short half-life of 1-2 hours. Risks include C Diff diarrhea, pneumonia, fractures and low serum magnesium levels in addition to B12 deficiency
Rabeprazole
Aciphex
Proton Pump Inhibitor
Take 30- 60 min prior to a significant meal. all of these meds are pro-drugs which need to be absorbed in that state and are activated within the parietal cell when the patient stimulates them to secrete acid by eating. They all also have a short half-life of 1-2 hours. Risks include C Diff diarrhea, pneumonia, fractures and low serum magnesium levels in addition to B12 deficiency
Omeprazole/sodium bicarbonate
Zegerid
Proton Pump Inhibitor/Antacid combo
Take 30- 60 min prior to a significant meal. all of these meds are pro-drugs which need to be absorbed in that state and are activated within the parietal cell when the patient stimulates them to secrete acid by eating. They all also have a short half-life of 1-2 hours. Risks include C Diff diarrhea, pneumonia, fractures and low serum magnesium levels in addition to B12 deficiency
Dutasteride
Avodart
BPH - 5 alpha reductase inhibitor
Capsules should not be handled by women, takes time for shrinkage of prostate and symptom relief
Tamsulosin
Flomax
BPH - selective alpha blocker
Take 30min after the same meal every day. May cause dizziness.
Alfuzosin
Uroxatral
BPH - selective alpha blocker
Take prior to bedtime to avoid orthostatic hypotensive effects
Vardenafil
Levitra
Erectile dysfunction - vasodilator
Report erections lasting longer than 4 hours to ER, avoid nitroglycerin use
Sildenafil
Viagra
Erectile dysfunction - Vasodilator
Report erections lasting longer than 4 hours to ER, avoid nitroglycerin use
Tadalafil
Cialis
Erectile dysfunction - Vasodilator
Report erections lasting longer than 4 hours to ER, avoid nitroglycerin use
Oxybutynin
Ditropan (XL)
Urinary Incontinence - Anticholinergic
May cause dry mouth, dizziness. Avoid alcohol use.
Tolterodine
Detrol (LA)
Urinary Incontinence - Anticholinergic
May cause dry mouth, dizziness. Avoid alcohol use.
Darifenacin
Enablex
Urinary Incontinence - Anticholinergic
May cause dry mouth, dizziness. Avoid alcohol use.
Phenazopyridine
Pyridium
Urinary Tract Analgesic
Urine will change to orange-red color …not a cause for alarm, used only for symptom relief and not a cure
cholecalciferol
Calcitriol
Vitamin D supplement
Take with food to decrease GI problems
Brimonidine
Alphagan P
Agent for Glaucoma
Latanaprost
Xalatan
Agent for Glaucoma
Timolol
Timoptic (XE)
Agent for Glaucoma
Travoprost
Travatan
Agent for Glaucoma
Brimonidine/Timolol
Combigan
Alpha II agonist/beta blocker/ antiglaucoma
Olopatadine
Pataday or Patanol
Antiallergy (ophthalmic)
Tobramycin/Dexamethasone
Tobradex
Antibiotic/anti-inflammatory (Ophthalmic)
Moxifloxacin
Vigamox
Antibiotic/Ophthalmic
Cyclosporine
Restasis
Calcineurin inhibitor (Ophthalmic)
nvert vial several times prior to use to create uniform emulsion. Used every 12 hours.
Dorzolamide/Timolol
Cosopt
Carbonic anhydrase inhibitor/beta blocker/antiglaucoma
Gatifloxacin
Zymar
Fluoroquinolone (Ophthalmic)
Bimatoprost
Lumigan
prostaglandin analog for glaucoma treatment
Neomycin/polymyxin/hydrocortisone
Cortisporin Otic
Otic Antibiotic
Ciprofloxacin/Dexamethasone, Ciprofloxacin/Hydrocortisone
Ciprodex, Cipro HC
Otic Antibiotic/Corticosteroid
Azelastine
Astelin
Allergic Rhinitis - Topical H1 antagonist
Prime 4x upon assembly, 2x if left unused for 3 days or more
Budesonide Nasal Spray
Rhinocort Aqua
Allergic rhinitis -Nasal Steroid
May cause taste distortion, effects seen after several days of therapy, May cause nasal irritation, bleeding
Fluticasone
Flonase
Allergic rhinitis -Nasal Steroid
May cause dysgeusia (taste distortion), effects seen after several days of therapy, May cause nasal irritation, bleeding
Mometasone
Nasonex
Allergic rhinitis -Nasal Steroid
May cause dysgeusia (taste distortion), effects seen after several days of therapy, May cause nasal irritation, bleeding
Montelukast
Singulair
Anti -asthmatic - Leukotriene inhibitor
chewable tablet contains phenylalanine
Albuterol
Proair HFA or Ventolin HFA or Proventil HFA
Anti- asthmatic - short-acting beta-2 agonist
Available in both MDI and nebulizer soln. Counsel on appropriate device use and prn rescue dosing. May also be use for prophylaxis for exercise-induce asthma. May cause jitteriness, nervousness, tachycardia and decrease effectiveness of beta blockers.
levalbuterol
Xopenex (HFA)
Anti-asthmatic - short-acting beta-2 agonist
counsel on appropriate MDI use and prn rescue dosing
Budesonide Inhalation Suspension
Pulmicort Respules, Flexhaler
Anti-asthmatic - Steroid
Some effects seen after first 2 days of therapy, maximum effect seen within first 2 weeks of therapy, not to be used for rescue
Fluticasone
Flovent
Anti-asthmatic - Steroid
Some effects seen after first 2 days of therapy, maximum effect seen within first 2 weeks of therapy, not to be used for rescue
Fluticasone/Salmeterol
Advair
Antiasthmatic - Steroid /LA B2 agonist Antiasthmatic - Controller
Diskus: Do not shake after activating, counsel on device technique, not to be used for rescue
Albuterol/Ipratropium
Respimat or Duoneb
Antiasthmatic/COPD Combo Bronchodilator/Anticholinergic
see albuterol and ipratropium counseling points, Combivent will no longer be available. Respimat is a new device with a counter - pt counseling required.
Tiotropium
Spiriva HandiHaler
Anticholinergic bronchodilator for COPD
counsel on device technique and once-daily use
Ipratropium Bromide
Atrovent
Anticholinergic antibrochospasm and antisecretory
Shake well, hold breath for 10 sec after actuation, wait 1 minute for 2nd inhalation, usually very little systemic side-effects because of poor absorption
Cetirizine
Zyrtec
Antihistamine, 2nd generation H1
May cause drowsiness, dizziness or dry mouth. Available in syrup and tablets
Desloratadine
Clarinex
Antihistamine, 2nd generation H1
May cause drowsiness, dizziness or dry mouth
Loratidine
Claritin
Antihistamine, 2nd generation H1
May cause drowsiness, dizziness or dry mouth
Fexofenadine (PSE)
Allegra (D)
Antihistamine, 2nd generation H1 (+Decongestant)
May cause drowsiness, do not take with fruit juices. PSE may cause insomnia, take D products in AM
Guaifenesin
Mucinex (D, DM)
Expectorant (+/- decongestant, antitussive)
Take with large glass of water, BID dosing, PSE may cause insomnia, PSE contraindicated in patients with CV risk, hypertension, DM drug interactions
Guaifenesin & Codeine
Cheratussin AC
Expectorant/Antitussive combo - CV
Take with water, codeine side-effect possible
herpes zoster vaccine
Zostavax
Herpes Zoster (shingles virus) Vaccine
CDC 60 yrs and above, FDA approved for 50 and above. Decreases risk of shingles and complications, such as postherpetic neuralgia. Not a substitute for varicella vaccine. Separate from Pneumovaz by 4 weeks
Human papillomavirus vaccine
Gardasil, Cervarix
Human papillomavirus vaccine (HPV)
Potentially prevents cancer. Given in 3 doses over 6 months, Gardasil approved for males also
influenza virus vaccine
Afluria or Fluvirin or Fluzone
Influenza Virus Vaccine
Once yearly dosing generally recommended before Halloween. Now, a variety of dosage forms available.
pneumococcal polysaccharide vaccine
Pneumovax
Streptococcus Pneumoniae Bacterial Vaccine
Once (or twice) life-time dosing in high risk patients. Pneumovax can now also be given along with Prevnar 13 in older patients with significant risks as of 6-21-12 ACIP Meeting
Tetanus, Diphtheria, Pertussis Vaccine
Tdap
Tetanus, Diphtheria, Pertussis
booster dose after DTaP series in childhood, can replace a Td booster, preferred administration 11-12 years of age.
