100-125 P2 Flashcards

Question

Gabapentin

Answer 1

Brand: Neurontin MOA: May modulate the release of excitatory neurotransmitters which participate in epileptogenesis and nociception Schedule: legend Dosing: 900mg to 1800mg daily in 3 divided doses Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Drowsiness  Dizziness  Fatigue Tremor

Answer 2

Brand: Lorcet, Lortab, Vicodin, Xodol MOA: Hydrocodone: Binds to opiate receptors in the CNS, altering the perception of and response to pain Acetaminophen: Inhibits the synthesis of prostaglandins in the CNS and peripherally blocks pain impulse generation Schedule: II Dosing: 2.5mg to 10mg hydrocodone q 4 to 6 hours Max 4000mg acetaminophen/day; Max 60 mg/day hydrocodone Contraindication(s):  Significant respiratory depression  Acute or severe asthma  GI obstruction, including paralytic ileus (known or suspected) BBW: • Addiction, abuse, and misuse • Life-threatening respiratory depression • Accidental ingestion • Neonatal opioid withdrawal syndrome • Cytochrome P450 3A4 interaction • Hepatotoxicity • Risks from concomitant use with Benzodiazepines or other CNS depressants Key Points:  Drowsiness and sedation  Constipation  Avoid alcohol or other sedating agents and other acetaminophen containing products Respiratory Depression

Answer 3

Brand: Motrin, Advil MOA: Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors Schedule: legend Dosing: 200mg to 800mg TID to QID Max 3200mg/day Contraindication(s):  History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDS  Use in the setting of CABG surgery BBW: * Serious cardiovascular thrombotic events (excluding NeoProfen) * Serious gastrointestinal bleeding, ulcerations, and perforation (excluding NeoProfen) Key Points:  Take with food  May cause nephrotoxicity; look for changes in urine frequency/production  May cause GI bleed; report any blood in vomit, sputum and/or black tarry stool, or severe upper GI pain immediately to prescriber Take only as directed or as needed for pain

Answer 4

Brand: Lamictal MOA: Inhibits release of glutamate and voltage-sensitive sodium channels, which stabilizes neuronal membranes Schedule: legend Dosing: IR: 225mg to 375mg in 2 divided doses XR: 300mg to 400mg once daily Adjustments needed based on concomitant use of inducers or inhibitors Contraindication(s):  Hypersensitivity BBW: • Serious skin rashes Key Points:  Steven Johnson Syndrom / Rash  Follow titration schedule (slow titration) to reduce risk of SJS  Should contact prescriber if any rash occurs

Answer 5

Brand: Xylocaine, Lidoderm MOA: Blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions Schedule: legend Dosing: 1-3 patches applied topically for up to 12h within a 24h period Contraindication(s):  Hypersensitivity to another amide type local anesthetic  Traumatized mucousa  Bacterial infection at the site of application BBW: • Life-threatening and fatal events in infants and young children Key Points:  Erythema  Skin Edema

Answer 6

Brand: Vyvanse MOA: Promotes release of dopamine and norepinephrine from their storage sites in the presynaptic nerve terminals Schedule: II Dosing: 30mg to 70mg once daily Max: 70mg/day Contraindication(s):  MAOI use within 14 days BBW: • Abuse and dependence Key Points:  Insomnia  decreased appetite  Xerostomia Increased blood pressure

Answer 7

Brand: Ativan MOA: Enhances the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions Schedule: IV Dosing: Anxiety: 2mg to 6mg in two to three divided doses Insomnia: 0.5mg to 2mg q HS (if \>65yo: max 1mg) Contraindication(s):  Acute narrow-angle glaucoma  Severe respiratory insufficiency  Hypersensitivity to polyethylene glycol - IV only  Sleep apnea BBW: • Risks from concomitant use with opioids Key Points:  Drowsiness and sedation  Avoid alcohol or other sedating agents  IV formulatoin can cause propylene glycol toxicity

Answer 8

Brand: Mobic MOA: Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors Schedule: legend Dosing: 7.5mg to 15mg once daily Max 15mg/day Contraindication(s):  History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDS  Use in the setting of CABG surgery BBW: * Serious cardiovascular thrombotic events * Serious gastrointestinal bleeding, ulcerations, and perforation Key Points:  Take with food  May cause nephrotoxicity; look for changes in urine frequency/production  May cause GI bleed; report any blood in vomit, sputum and/or black tarry stool, or severe upper GI pain immediately to prescriber Take only as directed or as needed for pain

Answer 9

Brand: Namenda MOA: NMDA antagonist Schedule: legend Dosing: IR: 5mg to 20mg daily (Doses greater than 5mg to be given in two evenly divided doses) XR: 7mg to 28 mg once daily Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Insomnia  Hallucinations  Dizziness Agitation

Answer 10

Brand: Dolophine, Methadose MOA: Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; produces generalized CNS depression Antagonizes NMDA receptors Schedule: II Dosing: Pain: 2.5mg q 8 to 12 hours initially, then titrate up to effective dose Drug detoxification: 80mg to 120mg daily Contraindication(s):  Significant respiratory depression  Acute or severe asthma  GI obstruction, including paralytic ileus (known or suspected)  Hypercarbia BBW: • Addiction, abuse, and misuse • Life-threatening respiratory depression • Life-threatening QT prolongation • Accidental ingestion (oral formulations) • Neonatal opioid withdrawal syndrome • Conditions for distribution and use of methadone products for the treatment of opioid addiction • Cytochrome P450 interaction • Risks from concomitant use with benzodiazepines or other CNS depressants Key Points:  If for addiction must be prescribed in methadone clinic by "X-DEA" prescriber. If for pain must state "for pain" on prescription  Drowsiness, Sedation, and Constipation  Complex kinetics, Avoid frequent dose changes (i.e.

Answer 11

Brand: Concerta, Daytrana, Ritalin MOA: Blocks the reuptake of norepinephrine and dopamine into presynaptic neurons Schedule: II Dosing: IR: 10mg to 60mg daily in 2 to 3 divided doses (Max 60 mg/day) ER: 20mg once daily, Max 60 mg/day (Concerta: Max 72 mg/day) Contraindication(s):  MAOI use within 14 days  Marked anxiety, tension, or agitation  Glaucoma BBW: • Abuse and dependence Key Points:  Insomnia  Weight Loss  TachycardiaHypertension

Answer 12

Brand: Rameron MOA: Central presynaptic alpha2-adrenergic antagonist effects, which results in increased release of norepinephrine and serotonin. It is also a potent antagonist of 5-HT2 and 5-HT3 serotonin receptors and H1 histamine receptors and a moderate peripheral alpha1 Schedule: legend Dosing: 15mg to 45mg q HS Contraindication(s):  MAOI use within 14 days  Use with linezolid BBW: • Suicidality and antidepressant drugs Key Points:  Drowsiness  Weight gain  Xerostomia

Answer 13

Brand: Aleve, Anaprox, Naprosyn MOA: Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors Schedule: legend Dosing: IR: RX: 500mg to 1000mg daily in two evenly divided doses 12 hours apart ER: 750-1000 once daily Contraindication(s):  History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDS  Use in the setting of CABG surgery BBW: • Serious cardiovascular thrombotic events • Serious gastrointestinal bleeding, ulceration, and perforation Key Points:  Take with food  May cause nephrotoxicity; look for changes in urine frequency/production  May cause GI bleed; report any blood in vomit, sputum and/or black tarry stool, or severe upper GI pain immediately to prescriber Take only as directed or as needed for pain

Answer 14

Brand: Pamelor MOA: Increases the synaptic concentration of serotonin and/or norepinephrine in the central nervous system by inhibition of their reuptake by the presynaptic neuronal membrane pump Schedule: legend Dosing: 25mg TID or QID, may titrate to 150mg/day Contraindication(s):  MAOI use within 14 days  Use in acute recovery phase of MI  Use with linezolid BBW: • Suicidality in children and adolescents Key Points:  Heart arrythymias  Dry mouth, dry eyes, constipation, urinary retention (anticholinergic)  Tremor Sedation; take at bedtime if it causes sleepiness

Answer 15

Brand: Zyprexa MOA: Antagonist of dopamine and seratonin type two receptor sites Schedule: legend Dosing: 5mg to 20mg PO once daily Contraindication(s):  None BBW: * Increased mortality in elderly patients with dementia-related psychosis * Postinjection delirium/sedation syndrome (Zyprexa Relprevv) Key Points:  Weight gain  Increased glucose  drowsiness Increased prolactin levels

Answer 16

Brand: OxyContin, Roxicodone MOA: Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; produces generalized CNS depression Schedule: II Dosing: IR: 5mg to 20mg q 4 to 6 hours PRN ER tablet: 10mg to 80mg q 12 hours PRN ER capsule: 9mg q 12 hours PRN Contraindication(s):  Significant respiratory depression  Acute or severe asthma  GI obstruction, including paralytic ileus (known or suspected) BBW: • Addiction, abuse, and misuse • Life-threatening respiratory depression • Accidental ingestion • Neonatal opioid withdrawal • Cytochrome P450 3A4 interaction • Risks from concomitant use with benzodiazepines or other CNS depressants • Risk of medication errors (oral solution) Key Points:  Drowsiness and sedation  Constipation  Avoid alcohol or other sedating agentsRespiratory Depression

Answer 17

Brand: Endocet, Percocet MOA: See individual agents Schedule: II Dosing: IR: 2.5mg to 10mg q 6 hours PRN. Do not exceed acetaminophen 4 g/day ER: 2 tablets q 12 hours. Do not exceed acetaminophen 4 g/day Contraindication(s):  Significant respiratory depression  Acute or severe asthma  GI obstruction, including paralytic ileus (known or suspected) BBW: • Addiction, abuse, and misuse • Life-threatening respiratory depression • Accidental ingestion • Neonatal opioid withdrawal syndrome • Cytochrome P450 3A4 Interaction • Hepatotoxicity • Risks from concomitant use with benzodiazepines or other CNS depressants Key Points:  Drowsiness and sedation  Constipation  Avoid alcohol or other sedating agents and other acetaminophen containing productsRespiratory Depression

Answer 18

Brand: Paxil, Pexeva MOA: Selectively inhibits serotonin reuptake in the presynaptic neurons Schedule: legend Dosing: IR: 20mg to 60mg once daily CR: 25mg to 62.5mg once daily (Max 75mg once daily) Contraindication(s):  MAOI use within 14 days  Use with linezolid  Pregnancy BBW: • Suicidality and antidepressant drugs Key Points:  Drowsiness and insomnia  Dry mouth  Decreaed Libido/Ejaculatory disordersQTc prolongation

Answer 19

Brand: Dilantin, Phenytek MOA: Stabilizes neuronal membranes and decreases seizure activity by increasing efflux or decreasing influx of sodium ions across cell membranes in the motor cortex during generation of nerve impulses Schedule: legend Dosing: 300mg to 600mg daily in two to three evenly divided doses Contraindication(s):  History of acute hepatotoxicity attributable to phenytoin  concurrent use of delavirdine BBW: • Cardiovascular risk associated with rapid infusion (injection) Key Points:  Altered Mental Status  Decrease in WBCs  Gingival hyperplasia Hirsutism

Answer 20

Brand: Lyrica MOA: Binds to alpha2-delta subunit of voltage-gated calcium channels within the CNS and modulates calcium influx at the nerve terminals, thereby inhibiting excitatory neurotransmitter release Schedule: V Dosing: 150mg to 300mg BID or TID Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Weight gain  Drowsiness  DizzinessEdema

Answer 21

Brand: Seroquel MOA: Antagonist of dopamine and seratonin type two receptor sites Schedule: legend Dosing: IR and ER: 300mg to 800 mg once daily Contraindication(s):  Hypersensitivity BBW: • Increased mortality in elderly patients with dementia-related psychosis • Suicidal thoughts and behavior Key Points:  Weight gain  Increased glucose  drowsiness Increased prolactin levels

Answer 22

Brand: Risperdal MOA: Antagonist of dopamine and seratonin type two receptor sites Schedule: legend Dosing: Schizophrenia: 1mg BID, may titrate to 18mg/day Bipolar I Disorder: 2mg to 3mg once daily, may titrate 6mg/day Contraindication(s):  Hypersensitivity BBW: • Increased mortality in elderly patients with dementia-related psychosis Key Points:  Weight gain  Increased glucose  drowsiness Increased prolactin levels

Answer 23

Brand: Zoloft MOA: Selectively inhibits serotonin reuptake in the presynaptic neurons Schedule: legend Dosing: 50mg to 200mg once daily Contraindication(s):  MAOI use within 14 days BBW: • Suicidality and antidepressant drugs Key Points:  Drowsiness and insomnia  Dry mouth  Decreaed Libido/Ejaculatory disorders QTc prolongation

Answer 24

Brand: Imitrex, Sumavel MOA: Selective agonist for serotonin on intracranial blood vessels and sensory nerves of the trigeminal system Schedule: legend Dosing: 25mg to 100mg single dose at onset Contraindication(s):  Ischemic heart disease, uncotrolled hypertension, PVD, or cerebrovascular syndromes  MAOI use within 14 days  Use of ergotamine derivatives within 24 hours  Severe hepatic impairment BBW: • None Key Points:  Paresthesia  Dizziness  Flushing Risk of serotonin syndrome if used with serotonergic agents

Answer 25

Brand: Restoril MOA: Enhances the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions Schedule: IV Dosing: 15mg to 30mg q HS Contraindication(s):  Pregnancy BBW: • Risks from concomitant use with opioids Key Points:  Drowsiness and sedation  Avoid alcohol or other sedating agents

Answer 26

Brand: Topamax MOA: Blocks neuronal voltage-dependent sodium channels, enhances GABA(A) activity, antagonizes AMPA/kainate glutamate receptors, and weakly inhibits carbonic anhydrase Schedule: legend Dosing: Epilepsy: 25mg to 200mg BID Migraine Prophylaxis: 25mg to 50mg once daily or BID Contraindication(s):  XR Formulation: Recent alcohol use (within 6 hours before or after administration) BBW: • None Key Points:  Confusion, mental slowing, difficulty with speech  Weight loss  Kidney stones

Answer 27

Brand: Ultram MOA: Binds to μ-opiate receptors in the CNS causing inhibition of ascending pain pathways, altering the perception of and response to pain; also inhibits the reuptake of norepinephrine and serotonin Schedule: IV Dosing: IR tab, ODT tab: 50mg to 100mg q 4 to 6 hours ER: 100mg once daily (Max 300mg/day) Contraindication(s):  Significant respiratory depression  Acute or severe asthma  GI obstruction, including paralytic ileus (known or suspected)  MAOI use within 14 days BBW: • Addiction, abuse, and misuse • Life-threatening respiratory depression • Accidental ingestion • Neonatal opioid withdrawal syndrome • Cytochrome P450 interaction • Risks from concomitant use with benzodiazepines or other CNS depressants Key Points:  Dose adjust in renal impairment/elderly  Seizure risk

Answer 28

Brand: Desyrel MOA: Inhibits reuptake of serotonin, causes adrenoreceptor subsensitivity, and significantly blocks histamine (H1) and alpha1-adrenergic receptors Schedule: legend Dosing: IR: 50mg to 100mg po BID to TID (Max 400mg/day) Contraindication(s):  MAOI use within 14 days  Use with linezolid BBW: • Suicidality and antidepressant drugs Key Points:  Drowsiness and sedation  Avoid alcohol or other sedating agents  Risk of serotonin syndrome if used with serotonergic agents

Answer 29

Brand: Depacon, Depakote, Depakene MOA: Causes increased availability of gamma-aminobutyric acid (GABA) to brain neurons Schedule: legend Dosing: 15mg/kg/day Max: 60mg/kg/day Contraindication(s):  Hepatic disease or significant impairment  Pregnamt women for the prevention of migraine  Known mitochondrial disorders BBW: * Hepatotoxicity * Patients with mitochondrial disease * Fetal risk * Pancreatitis Key Points:  Acute pancreatitis  Liver Failure  Thrombocytopenia, Weight Gain

Answer 30

Brand: Chantix MOA: Partial neuronal α4 β2 nicotinic receptor agonist; prevents nicotine stimulation of mesolimbic dopamine system associated with nicotine addiction Schedule: legend Dosing: 0.5mg once daily for 3 days, then 0.5mg BID for 4 days, then 1mg BID for 11 weeks Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Headache, Nausea, Vomitting  Insomnia  abnormal dreams Suicidal ideation

Answer 31

Brand: Effexor MOA: Selectively inhibits the reuptake of serotonin and norepinephrine Schedule: legend Dosing: IR: 75mg to 225mg daily in 2 to 3 evenly divided doses ER: 75mg to 225mg once daily Contraindication(s):  MAOI use within 14 days  Use with linezolid BBW: • Suicidality and antidepressant drugs Key Points:  Seizures  Insomnia  HyperhidrosisXerostomia

Answer 32

Brand: Ambien MOA: Enhances activity of GABA via selective agonism at the benzodiazepine-1 (BZ1) receptor Schedule: IV Dosing: IR: 5mg (female) or 5mg to 10 mg (male) q HS ER: 6.25mg (female) or 6.25mg to 12.5mg (male) q HS Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Drowsiness/Sedation  Lethargy  Memory Impairment

Answer 33

Brand: Zovirax MOA: Inhibits DNA synthesis and viral replication by competing with deoxyguanosine triphosphate for viral DNA polymerase and being incorporated into viral DNA Schedule: legend Dosing: 200mg - 800mg 3 to 5 times daily Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Can crystalize in kidney and cause AKI  Nausea and Vomitting  Malaise

Answer 34

Brand: Moxatag MOA: Binds to penicillin-binding proteins (PBPs) which inhibits peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis Schedule: legend Dosing: 500mg q 8 hours or 875mg q 12 hours Contraindication(s):  Serious hypersensitivity to amoxicillin BBW: • None Key Points:  Diarrhea (AAD & CDAD)  Allergy  Take entire course and contact provider if symptoms do not improve within a few days of startingN/V, take with food to avoid upset stomach if needed

Answer 35

Brand: Augmentin MOA: Amoxicillin binds to penicillin-binding proteins (PBPs) which inhibits peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis Clavulanic acid binds and inhibits beta-lactamases that inactivate amoxicillin Schedule: legend Dosing: 500mg q 8 hours or 875mg q 12 hours Dosing based on amoxicillin component Contraindication(s):  Serious hypersensitivity to amoxicillin or clavulanate  History of cholestatic jaundice or hepatic dysfunction with Augmentin  Augmentin XR: Severe renal impairment (CrCl less than 30ml/min BBW: • None Key Points:  Diarrhea (AAD & CDAD)  Allergy  Take entire course and contact provider if symptoms do not improve within a few days of startingN/V, take with food to avoid upset stomach if needed

Answer 36

Brand: Z-pak, Zithromax, Zmax, Azasite MOA: Inhibits RNA-dependent protein synthesis by binding to the 50S ribosomal subunit Schedule: legend Dosing: CAP: 500mg once, then 250mg daily on days 2 to 5 STI: 1g as a single dose Contraindication(s):  Hypersensitivity  History of cholestatic jaundice or hepatic dysfunction with prior azithromycin use BBW: • None Key Points:  Diarrhea (AAD & CDAD)  Nausea and Vomitting  QTc prolongationMay bind with certain cations. Avoid taking with certain multivitamins and minerals (calcium, aluminum, magnesium, etc.)

Answer 37

Brand: Omicef MOA: Binds to penicillin-binding proteins (PBPs) which inhibits peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis Schedule: legend Dosing: 300mg q 12 hours Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Diarrhea (AAD & CDAD)  Allergy  Liquid suspension: Do not refrigerate, keep at room temperature.Take 2 hrs before or after antacids or iron supplements; If taking iron supplement, may pass red colored stools

Answer 38

Brand: Ceftin, Zinacef MOA: Binds to penicillin-binding proteins (PBPs) which inhibits peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis Schedule: legend Dosing: 250mg to 500mg q 12 hours Contraindication(s):  Hypersensitivity to cefuroxime or other beta-lactam drugs BBW: • None Key Points:  Diarrhea (AAD & CDAD)  Allergy  Take entire course and contact provider if symptoms do not improve within a few days of startingNausea and Vomitting, take with food to avoid upset stomach if needed

Answer 39

Brand: Keflex MOA: Binds to penicillin-binding proteins (PBPs) which inhibits peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis Schedule: legend Dosing: 250mg q 6 hours or 500mg q 12 hours Streptococcal Skin Infxns: 500mg q 6 hours Contraindication(s):  Hypersensitivty BBW: • None Key Points:  Diarrhea (AAD & CDAD)  Allergy  Take entire course and contact provider if symptoms do not improve within a few days of startingN/V, take with food to avoid upset stomach if needed

Answer 40

Brand: Cipro, Ciloxa, Otiptrio MOA: Inhibits DNA-gyrase and promotes breakage of double-stranded DNA Schedule: legend Dosing: 500mg to 750mg q 12 hours Contraindication(s):  Hypersensitivity to other quinolones  Concurrent use of tizanidine BBW: • Serious adverse reactions (tendinitis and tendon rupture, peripheral neuropathy, and CNS effects) • Exacerbation of myasthenia gravis Key Points:  May bind with certain cations. Avoid taking with certain multivitamins and minerals (calcium, aluminum, magnesium, etc.)  QTc prolongation  Dysglycemia, Diarrhea (AAD & CDAD)

Answer 41

Brand: Biaxin MOA: Binds to 50S ribosomal subunit resulting in inhibition of protein synthesis Schedule: legend Dosing: 250mg to 500mg q 12 hours Contraindication(s):  History of cholestatic jaundice/hepatic dysfunction associated with prior use of clarithromycin  Use with drugs extensively metabolized by CYP3A4  Use with colchicine in patients with renal or hepatic impairment BBW: • None Key Points:  Diarrhea (AAD & CDAD)  Nausea and Vomitting  qtc prolongation, Take entire course and contact provider if symptoms do not improve within a few days of starting

Answer 42

Brand: Cleocin, Evoclin, Clindesse MOA: Binds to 50S ribosomal subunit resulting in inhibition of protein synthesis Schedule: legend Dosing: 300mg to 450mg q 6 hours Contraindication(s):  Hypersensitivity BBW: • Colitis Key Points:  Diarrhea (AAD & CDAD)  Rash  Nausea and Vomitting, take with food to avoid upset stomach if neededTake entire course and contact provider if symptoms do not improve within a few days of starting

Answer 43

Brand: Premarin MOA: Modulates the pituitary secretion of gonadotropins, luteinizing hormone, and follicle-stimulating hormone through a negative feedback system, thereby reducing elevated levels of these hormones in postmenopausal women Schedule: legend Dosing: Oral: 0.3mg to 0.625mg once daily Topical: 0.5g/day, 21 days on, 7 days off Contraindication(s):  Angioedema or anaphylactic reaction to estrogens  Current history of PE or DVT or other known thrombophilic disorders  Undiagnosed abnormal genital bleeding  Pregnancy BBW: * Endometrial cancer * Cardiovascular disease * Breast cancer * Dementia • Risk vs benefit Key Points:  cream: dispense with applicators; insert amount & frequency directed by physician at bedtime  Tablet: progestin required for intact uterus  tablet: signs & symptoms of thrombosis (VTE & stroke)tablet: lowest effective dose, shortest duration

Answer 44

Brand: Prezista MOA: Binds to the site of HIV-1 protease activity and inhibits cleavage of viral Gag-Pol polyprotein precursors into individual functional proteins required for infectious HIV Schedule: legend Dosing: 800mg once daily Contraindication(s):  Coadministration with drugs highly dependent on CYP3A4 for clearence BBW: • None Key Points:  Increased LDL  Skin Rash  Diarrhea

Answer 45

Brand: Adoxa, Monodox, Oradea, Vibramycin, Doryx MOA: Inhibits protein synthesis by binding with the 30S ribosomal subunit Schedule: legend Dosing: 100mg q 12 hours Contraindication(s):  Hypersensitivity to tetracyclines BBW: • None Key Points:  Photosensitivity  Avoid \< 8 years old  Adequate fluid intake otherwise esophagitisdiarrhea (AAD & CDAD)

Answer 46

Brand: Avodart MOA: Selectively inhibits 5α-reductase, resulting in inhibition of the conversion of testosterone to dihydrotestosterone and markedly suppressed serum dihydrotestosterone levels Schedule: legend Dosing: 0.5mg once daily Contraindication(s):  Clinically significant hypersensitivity to other 5-alpa-reductase inhibitors  Use in pediatric patients, women of childbearing potential, or pregnancy BBW: • None Key Points:  Dicreased Libido  Impotence  Gynecomastia

Answer 47

Brand: Atripla MOA: Efavirenz: Non-nucleoside reverse transcriptase inhibitor of HIV-1, thereby blocking the RNA-dependent and DNA-dependent DNA polymerase resulting in inhibition of viral replication Emtricitabine: Nucleoside reverse transcriptase inhibitor, which interferes with HIV viral RNA dependent DNA polymerase resulting in inhibition of viral replication Tenofovir: Nucleotide reverse transcriptase inhibitor, interferes with the HIV viral RNA dependent DNA polymerase resulting in inhibition of viral replication Schedule: legend Dosing: 1 tablet once daily Contraindication(s):  Clinically significant hypersensitivity  Coadministration with voriconazole BBW: • Hepatitis B coinfection Key Points:  Hypercholesterolemia  Abnormal dreams  HyperglycemiaDiarrhea

Answer 48

Brand: Nuvaring MOA: Combination hormonal contraceptives inhibit ovulation via a negative feedback mechanism on the hypothalamus, which alters the normal pattern of gonadotropin secretion of a follicle-stimulating hormone (FSH) and luteinizing hormone by the anterior pituitar Schedule: legend Dosing: Insert 1 ring for 3 weeks then remove for 7 days Contraindication(s):  Breast cancer or other estrogen/progestin sensitive cancer  hepatic tumors or hepatic disease  Use in women at high risk of thrombotic disease  Undiagnosed abdominal uterine bleeding BBW: • Cigarette smoke and serious cardiovascular events Key Points:  Weight Gain  Increased risk of blood clots  Nausea and Vomting, Consider various factors that may decrease effectiveness (abx, missed dose, time to onset, etc.)

Answer 49

Brand: Proscar, Propecia MOA: Selectively inhibits 5α-reductase, resulting in inhibition of the conversion of testosterone to dihydrotestosterone and markedly suppressed serum dihydrotestosterone levels Schedule: legend Dosing: BPH: 5mg once daily Contraindication(s):  Pregnancy or women of childbearing potential BBW: • None Key Points:  Decreased libido  Pregnancy category X

Answer 50

Brand: Diflucan MOA: Interferes with fungal cytochrome P450 activity (lanosterol 14-α-demethylase), and decreases ergosterol synthesis which inhibits cell membrane formation Schedule: legend Dosing: Vaginal Candidiasis: 150mg once Candidemia: 800mg on day 1, then 400mg once daily thereafter Contraindication(s):  Coadministration with CYP3A4 substrates which may lead to QTc prolongation BBW: • None Key Points:  Headache  Nausea, vomiting, and Diarrhea  Hepatitis & jaundice, Take entire course and contact provider if symptoms do not improve within a few days of starting

Answer 51

Brand: Kariva, Mircette, Ortho Novum 10/12 MOA: Combination hormonal contraceptives inhibit ovulation via a negative feedback mechanism on the hypothalamus, which alters the normal pattern of gonadotropin secretion of a follicle-stimulating hormone (FSH) and luteinizing hormone by the anterior pituitar Schedule: legend Dosing: 1 tablet once daily Contraindication(s):  Breast cancer or other estrogen/progestin sensitive cancer  Use in women at high risk of thrombotic disease BBW: • Cigarette smoke and serious cardiovascular events Key Points:  Nausea and Vomting  Increased risk of blood clots  Weight Changes; Fluid Retention, Consider various factors that may decrease effectiveness (abx, missed dose, time to onset, etc.)

Answer 52

Brand: Avaine, Loestrin, Tasmin, Yaz, Oral MOA: Combination hormonal contraceptives inhibit ovulation via a negative feedback mechanism on the hypothalamus, which alters the normal pattern of gonadotropin secretion of a follicle-stimulating hormone (FSH) and luteinizing hormone by the anterior pituitar Schedule: legend Dosing: 1 tablet once daily Contraindication(s):  Breast cancer or other estrogen/progestin sensitive cancer  Use in women at high risk of thrombotic disease BBW: • Cigarette smoke and serious cardiovascular events Key Points:  Nausea and Vomting  Increased risk of blood clots  Weight Changes; Fluid RetentionConsider various factors that may decrease effectiveness (abx, missed dose, time to onset, etc.)

Answer 53

Brand: Ortho Tri-Cyclen, Tri-Sprintec, Trivora MOA: Combination hormonal contraceptives inhibit ovulation via a negative feedback mechanism on the hypothalamus, which alters the normal pattern of gonadotropin secretion of a follicle-stimulating hormone (FSH) and luteinizing hormone by the anterior pituitar Schedule: legend Dosing: 1 tablet once daily Contraindication(s):  Breast cancer or other estrogen/progestin sensitive cancer  Use in women at high risk of thrombotic disease BBW: • Cigarette smoke and serious cardiovascular events Key Points:  Nausea/Vomting  Increased risk of blood clots  Weight Changes; Fluid RetentionConsider various factors that may decrease effectiveness (abx, missed dose, time to onset, etc.)

Answer 54

Brand: Levaquin MOA: Inhibits DNA-gyrase and promotes breakage of double-stranded DNA Schedule: legend Dosing: 500mg to 750mg once daily Contraindication(s):  Hypersensitivity BBW: • Serious adverse reactions • Exacerbation of myasthenia gravis Key Points:  May bind with certain cations. Avoid taking with certain multivitamins and minerals (calcium, aluminum, magnesium, etc.)  QTC prolongation  DysglycemiaDiarrhea (AAD & CDAD)

Answer 55

Brand: Levoxyl, Synthroid, Tirosint, Unithroid MOA: Synthetic form of thyroxine (T4), which is converted to active thyroid hormone Schedule: legend Dosing: 25mcg to 300mcg once daily About 1.7mcg/kg/day Contraindication(s):  Acute MI  Untreated subclinical or overt thyrotoxicosis of any etiology  uncorrected adrenal insufficiency BBW: • Weight reduction Key Points:  Empty stomach; may or may not be first thing in the morning  Symptoms of hyperthyroidism if dosed too aggresively  Chelates with numerous drugs, vitamins, and mineralsRemind patient to have labs checked if new rx or changing dose

Answer 56

Brand: Thyrolar MOA: Active (T3) and synthetic (T4) thyroid hormone Schedule: legend Dosing: 50mcg/12.5mcg to 100mcg/25mcg once daily Contraindication(s):  Uncorrected adrenal insufficiency  Untreated thyrotoxicosis BBW: • Weight reduction Key Points:  Empty stomach; may or may not be first thing in the morning  Symptoms of hyperthyroidism if dosed too aggresively  Chelates with numerous drugs, vitamins, and mineralsRemind patient to have labs checked if new rx or changing dose

Answer 57

Brand: Cytomel MOA: Active (T3) thyroid hormone Schedule: legend Dosing: 25mcg to 75mcg once daily Max: 100mcg/day Contraindication(s):  Uncorrected adrenal insufficiency  Untreated thyrotoxicosis BBW: • Weight reduction Key Points:  Empty stomach; may or may not be first thing in the morning  Sxs of hyperthyroidism if dosed too aggresively  Chelates with numerous drugs, vitamins, and mineralsRemind patient to have labs checked if new rx or changing dose

Answer 58

Brand: Provera, Depo-Provera MOA: Inhibits secretion of pituitary gonadotropins, which prevents follicular maturation and ovulation and causes endometrial thinning Schedule: legend Dosing: 5mg to 10 mg PO once daily Depo-Provera: 150 mg IM every 3 months Contraindication(s):  DVT or PE  Active or history of thromboembolic disease  breast cancer  Pregnancy BBW: * Cardiovascular disorders (tablet) * Breast cancer (tablet) * Dementia (tablet) * Long-term use (injection) * Loss of bone mineral density (injection) * Patient education (subcutaneous injection) • Risk vs benefits (tablet) Key Points:  amenorrhea  Weight gain  Headache

Answer 59

Brand: Flagyl, MetroGel, MetroCream, MetroLotion MOA: Interacts with DNA to cause a loss of helical DNA structure and strand breakage resulting in inhibition of protein synthesis and cell death Schedule: legend Dosing: 500mg to 750mg BID to TID Trichomoniasis: 250mg q 8 hours x 7 days OR 1gm BID x 1 day OR 2gm once as a single dose Contraindication(s):  First trimester of pregnancy  Use of alcohol within 3 days  use of disulfiram within the past 2 weeks BBW: • Carcinogenic (systemic) Key Points:  Avoid alcohol  Metallic taste  Headache, Nausea

Answer 60

Brand: Minocin, Solodyn MOA: Inhibits protein synthesis by binding with the 30S ribosomal subunit Schedule: legend Dosing: Acne Vulgaris: 50mg to 100mg BID Infection: 200mg once daily x 1 dose, followed by 100mg BID Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Photosensitivity  Avoid \< 8 years old  Adequate fluid intake otherwise esophagitisdiarrhea (AAD & CDAD)

Answer 61

Brand: Avelox, Moxeza, Vigamox MOA: Inhibits DNA-gyrase and promotes breakage of double-stranded DNA Schedule: legend Dosing: 400mg PO or IV once daily Contraindication(s):  Hypersensitivity to other quinolones BBW: • Serious adverse reactions • Myasthenia gravis Key Points:  May bind with certain cations. Avoid taking with certain multivitamins and minerals (calcium, aluminum, magnesium, etc.)  QTC prolongation  Dysglycemia, Diarrhea (AAD & CDAD)

Answer 62

Brand: Bactroban MOA: Binds to bacterial isoleucyl transfer-RNA synthetase resulting in the inhibition of protein synthesis Schedule: legend Dosing: AAA topically TID Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Localized burning or stinging sensation  Rhinitis  Respiratory congestion

Answer 63

Brand: Macrobid, Macrodantin MOA: Inactivates or alters bacterial ribosomal proteins leading to inhibition of protein synthesis, aerobic energy metabolism, DNA, RNA, and cell wall synthesis Schedule: legend Dosing: Macrobid: 100mg BID for 7 days Macrodantin: 50mg to 100mg q 6 hours Contraindication(s):  Anuria, oliguria, or impairment of renal function (CrCl less than 60ml/min)  History of cholestatic jaundice or hepatic dysfunction associated with prior use of nitrofurantoin BBW: • None Key Points:  GI Upset  Do not use with poor renal function  Pulmonary fibrosis with long term use

Answer 64

Brand: Nor-QD, Camila, Heather, Errin MOA: Suppresses ovulation, thickens cervical mucus (which inhibits sperm penetration), alters follicle-stimulating hormone (FSH) and luteinizing hormone (LH) concentrations, slows the movement of ovum through the fallopian tubes, and alters the endometrium Schedule: legend Dosing: 1 tablet once daily at the same time each day Contraindication(s):  Hepatic impairment or disease  Breast Cancer - known, suspected, or history of  Pregnancy  Undiagnosed abdominal genital bleeding BBW: • None Key Points:  Nausea and Vomting  Increased risk of blood clots  Weight Changes; Fluid RetentionSticter dosing parmeters than other BCs. Consider various factors that may decrease effectiveness (time of dose, abx, missed dose, time to onset, etc.)

Answer 65

Brand: Tamiflu MOA: Inhibits influenza virus neuraminidase Schedule: legend Dosing: Influenza prophylaxis: 75mg once daily Influenza treatment: 75mg BID Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Headache  Nausea/Vomiting  Give within 48 hours of flu symptoms

Answer 66

Brand: Oxytrol, Ditropan MOA: Direct antispasmodic effect on smooth muscle and inhibits the action of acetylcholine Schedule: legend Dosing: ER: 5mg to 10mg po once daily (Max 30mg/day) Contraindication(s):  Patients with or at risk for uncontrolled narrow-angle glaucoma, urinary retention, gastric retention, or conditions with severely decreased GI motility BBW: • None Key Points:  Anticholinergic AE (dry mouth, sedation, constipation,e tc.)  dizziness  vision disturbance

Answer 67

Brand: Bicillin L-A MOA: Interferes with bacterial cell wall synthesis during active multiplication, causing cell wall death and resultant bactericidal activity against susceptible bacteria Schedule: legend Dosing: 1.2 million to 2.4 million units IM x1 Contraindication(s):  Hypersensitivity BBW: • Appropriate administration Key Points:  Diarrhea  Allergy  Take entire course and contact provider if symptoms do not improve within a few days of starting

Answer 68

Brand: Apo-pen VK, Novo-Pen VK, Nu-Pen VK MOA: Interferes with bacterial cell wall synthesis during active multiplication, causing cell wall death and resultant bactericidal activity against susceptible bacteria Schedule: legend Dosing: 125mg to 500mg q 6 to 8 hours Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Diarrhea  Allergy  Take entire course and contact provider if symptoms do not improve within a few days of starting

Answer 69

Brand: Pyridium MOA: Unknown - Local urinary tract anesthetic Schedule: legend Dosing: 200mg TID after meals Contraindication(s):  Hypersensitivity  renal insufficiency BBW: • None Key Points:  Do not exceed 48-72h  Urine color change

Answer 70

Brand: Viagra, Revatio MOA: Inhibits phosphodiesterase type 5 (PDE-5), causing increased levels of cGMP, resulting in smooth muscle relaxation and increased blood flow Schedule: legend Dosing: ED: 25mg to 100mg PRN 1 hour prior to actvivity (Max 100 mg once daily) Pulmonary HTN: 5mg to 20mg TID Contraindication(s):  Concurrent use of organic nitrates or riociguat BBW: • None Key Points:  Headache  Flushing  Dizziness Priapism

Answer 71

Brand: Harvoni MOA: Ledipasvir inhibits the HCV NS5A protein necessary for viral replication sofosbuvir inhibits NS5B RNA-dependent RNA polymerase Schedule: legend Dosing: 400mg/90mg once daily Contraindication(s):  None BBW: • Hepatitis B virus reactivation Key Points:  Hyperkalemia  Gynecomastia  Monitor renal function regularly

Answer 72

Brand: Vesicare MOA: Inhibits muscarinic receptors resulting in decreased urinary bladder contraction, increased residual urine volume, and decreased detrusor muscle pressure Schedule: legend Dosing: 5mg once daily, may increase to 10mg/day Contraindication(s):  Urinary retention  gastric retention  uncontrolled narrow-angle glaucoma BBW: • None Key Points:  Don't crush/chew  Dry mouth, dry eyes, constipation, urinary retention (anticholinergic)  drink plenty of water to avoid crystaluria

Answer 73

Brand: Bactrim, Sulfatrim MOA: Sulfamethoxazole interferes with bacterial folic acid synthesis trimethoprim inhibits bacterial folic acid metabolism Schedule: legend Dosing: 800mg/160mg q 12 to 24 hours Contraindication(s):  History of drug induced immun thrombocytopenia with sulfonamides  megaloblastic anemia due to folate deficiency  Marked hepatic damage or severe renal disease  Cocomitant use with dofetilide BBW: • None Key Points:  Steven Johnson Syndrome Rash  Diarrhea (AAD & CDAD)  Photosensitivitydrink plenty of water to avoid crystaluria

Answer 74

Brand: Cialis, Adcirca MOA: Inhibits phosphodiesterase type 5 (PDE-5), causing increased levels of cGMP, resulting in smooth muscle relaxation and increased blood flow Schedule: legend Dosing: ED: 2.5mg to 5mg once daily or 10mg to 20mg once daily PRN 30 min prior activity BPH: 5mg once daily Contraindication(s):  Concurrent use of organic nitrates or riociguat BBW: • None Key Points:  Headache  Flushing  DizzinessPriapism

Answer 75

Brand: Flomax MOA: Antagonist of alpha1A-adrenoreceptors leading to relaxation of smooth muscle in the bladder and prostate Schedule: legend Dosing: 0.4mg once daily Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Don't crush/chew  Take on empty stomach  Tiredness

Answer 76

Brand: Descovy MOA: Each drug interferes with HIV viral RNA dependent DNA polymerase activities resulting in inhibition of viral replication Schedule: legend Dosing: 1 tablet once daily Contraindication(s):  None BBW: • Hepatitis B coinfection Key Points:  nausea  Bone weakness  Hypercholesterolemia

Answer 77

Brand: Hytrin MOA: Competitively inhibits postsynaptic alpha1-adrenergic receptors leading to smooth muscle relaxation Schedule: legend Dosing: 1mg to 10mg q HS (Max 20mg/day) Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Dizziness  Orthostatic hypotension  at bedtime

Answer 78

Brand: Androderm, Androgel, Axiron, Testim MOA: Principle endogenous androgen responsible for growth and development of male sex organs and maintaining secondary sex characteristics Schedule: III Dosing: Gel: 50mg q AM (Max 100mg/day) Patch: 1 patch once daily INJ: 50mg to 400mg IM q 2 to 4 weeks Contraindication(s):  Breast or prostate cancer  Pregnant women or women who may become pregnant  Breastfeeding BBW: * Secondary exposure (transdermal gel, transdermal solution) * Pulmonary oil microembolism (testosterone undecanoate) Key Points:  Edema  Hypertension  CHF Erythrocytosis

Answer 79

Brand: Valtrex MOA: Inhibits DNA synthesis and viral replication by competing with deoxyguanosine triphosphate for viral DNA polymerase and being incorporated into viral DNA Schedule: legend Dosing: Genital HSV (Initial Episode):1000mg q 12 hours; (Suppression): 1000mg once daily Cold Sores (Episode): 2000mg q 12 hours x 1 day Shingles: 1000mg q 8 hours Contraindication(s):  Hypersensitivity BBW: • None Key Points:  Nausea and Vomiting  Headache

100-125 P2 Flashcards

(103 cards)