Top 300 Drug Counseling Points

Question 1

All statins

Answer 1

• Contact prescriber immediately if pregnancy occurs while taking.
• Do not drink alcohol, eat grapefruit, or drink grapefruit juice while taking this drug.
• Does not replace lifestyle changes.
• Report signs/symptoms of rhabdomyolysis, jaundice, or renal failure.

Question 2

lovastatin (Altoprev, Mevacor, others)

Answer 2

• IR tablets should be taken with the evening meal.
• ER tablets should be taken at bedtime.
• Swallow ER tablets whole; do not chew, crush, or cut.

Question 3

ezetimibe (Zetia)

Answer 3

Dose: 10 mg tablet
Counseling: -Take with or without food and may be taken with a concurrent HMG-CoA reductase inhibitor. In patients receiving a bile acid sequestrant concurrently, ezetimibe should be taken at least 2 hrs before or 4 hrs after the bile acid sequestrant is taken.
- Tell patients to notify prescriber if they experience signs of myopathy (if on concurrent statin).

Question 4

fenofibrate (Lofibra)

Answer 4

Dosage Forms: tablets (48, 50, 54, 120, 145, 150 mg), and capsules (50, 150 mg)
- Fenoglide tablets and Lipofen R capsules should be given with food. Others can be taken without regard to food.
- Take 1 hr before or 4-6 hrs after a bile acid binding resin.
- Do not crush or chew the ER products.
- Products are not interchangeable.

Question 5

niacin (Niaspan, Slo-Niacin, others)

Answer 5

Doses: ER capsule, tablet, ER tablet
- Start with a low dose and titrate based on tolerability (flushing).
- Avoid alcohol and warm beverages with niacin to reduce flushing.
- If discontinued for several days, may need to re-start on a lower dose and re-titrate.
- Aspirin or NSIAD prior to niacin may reduce flushing.

Question 6

omega-3-acid ethyl esters (Lovaza, Omacor, others)

Answer 6

Dose: comes as 1 g liquid filled capsule
- Swallow the whole capsule, take with food.
- If you are unable to swallow the whole capsule, you may puncture the capsule and squeeze the contents into a glass or porcelain cup. Do not use a plastic cup, as this may cause foaming.
- Seek medical attention if severe rash, chest pain, heart palpitations, shortness of breath occur.

Question 7

gemfibrozil (Lopid, others)

Answer 7

Common sig: 600 mg tablet PO BID
- Instruct patients to report signs/symptoms of rhabdomyolysis, jaundice, or renal failure.

Question 8

colesevelam (Welchol)

Answer 8

Common sig: 1.875 g powder packet PO BID or 3.75 g powder packet daily
- Should be used together with diet and exercise to lower triglyceride levels.
- Empty packets of powder packet into a glass and mix with 4-8 ounces of water; stir well and drink. Oral suspension should not be taken in its dry form.
- Take with a meal. Tablet should be swallowed with liquid (water, milk, or juice).
- May be dosed concomitantly with an HMG-CoA reductase inhibitor.

Question 9

ACE inhibitors

Answer 9

• Avoid pregnancy
• Use K supplements or salt substitutes only under medical supervision
• May cause dizziness that may worsen if dehydrated

Question 10

Angiotensin Receptor Blockers ((ARBs)

Answer 10

• Seek medical attention if angioedema, excessive fluid loss, hyperkalemia, reduction in urination, jaundice, or skin rash occurs.
• Avoid pregnancy.
• Use K supplements or salt substitutes only under medical supervision.
• May cause dizziness. Avoid alcohol or driving.

Question 11

hydralazine (Apresoline)

Answer 11

• Patient should not drink alcohol while taking this drug.
• Advise patient against sudden discontinuation of drug as this may cause rebound hypertension.
• This medication may cause dizziness. Avoid driving, using machinery, or doing anything else that could be dangerous if not alert.
• Patient should report chest pain, palpitations, s/s of tachyarrhythmia, hypotension, agranulocytosis, lupus, or liver toxicity.

Question 12

isosorbide mononitrate (Imdur, ISMO)

Answer 12

• It is best to take it on empty stomach with at least half a glass of water.
• This medication may cause headaches, which means it’s working. Tylenol may be used for relief.
• May cause dizziness. Stand up slowly if you have dizziness due to orthostatic hypotension.
• To avoid tolerance, include an 8-hour nitrate free interval in every 24 hours period.
• Separate sildenafil and vardenafil from nitrates by 24 hrs, tardenafil by 48 hrs.

Question 13

nitroglycerin

Answer 13

• Sit prior to using. Tablet should be dissolved under tongue or in buccal pouch at firsts sign of angina or prophylactically; do not swallow. Spray should be sprayed onto or under tongue; do not inhale, do not spit our or rinse mouth after use. Rise slowly from a sitting/supine position in order to prevent lightheadedness. Advise patient to allow a 10-12 hr/day drug-free interval to avoid nitrate tolerance.
• Avoid alcohol, CNS depressants, antihypertensives, or other drugs which cause hypotension.