150-175 use to study

Question 1

Trazodone

Answer 1

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

Question 2

Valproic acid and derivatives

Answer 2

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

Question 3

Vareniciline

Answer 3

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

Question 4

Venlafaxine

Answer 4

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

Question 5

Zolpidem

Answer 5

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

Question 6

Acyclovir

Answer 6

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

Question 7

Amoxicillin

Answer 7

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

Question 8

Amoxicillin and Clavulanic acid

Answer 8

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

Question 9

Azithromycin

Answer 9

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.)

Question 10

Cefdinir

Answer 10

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

Question 11

Cefuroxime

Answer 11

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

Question 12

Cephalexin

Answer 12

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

Question 13

Ciprofloxacin

Answer 13

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)

Question 14

Clarithromycin

Answer 14

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

Question 15

Clindamycin

Answer 15

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

Question 16

Conjugated Estrogens

Answer 16

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

Question 17

Darunavir

Answer 17

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

Question 18

Doxycycline

Answer 18

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)

Question 19

Dutasteride

Answer 19

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

Question 20

Emtricitabine, Tenofovir, and Efavirenz

Answer 20

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

Question 21

Ethinyl Estradiol and Etonogestrol

Answer 21

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.)

Question 22

Finasteride

Answer 22

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

Question 23

Fluconazole

Answer 23

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

Question 24

Group: Biphasic Oral Contraceptives

Answer 24

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.)

Question 25

Group: Monophasic Oral Contraceptives

Answer 25

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.)