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P2 Top 200 > 100-125 P2 > Flashcards

100-125 P2 Flashcards

1
Q

acetaminophen and codeine (combination)

A

MOA: Inhibit the synthesis of prostaglandins in the central nervous system and peripherally block pain impulse generation; produces antipyresis from inhibition of hypothalamic heat-regulating center.

Binds to opiate receptors in the CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; causes cough suppression by direct central action in the medulla; produces generalized CNS depression

Schedule: III

Dosing: 300mg/30mg q 4 hours PRN Max 4000mg/360mg per 24 hours

Contraindication(s):  Significant respiratory depression  postoperative pain management in children who have undergone tonsillectomy and/or adenoidectomy  GI obstruction, including paralytic ileus (known or suspected)  concurrent use with monoamine oxidase inhibitors (MAOIs) or use of MAOIs within the last 14 days.

BBW: • Risk of medication errors

  • Addiction, abuse, and misuse
  • Life-threatening respiratory depression • Accidental ingestion
  • Neonatal opioid withdrawal syndrome
  • Death related to ultra-rapid metabolism of codeine to morphine
  • Hepatoxicity
  • Interactions with drugs affecting cytochrome P450
  • Risks from concomitant use with benzodiazepines or other CNS depressants

Key Points:

 Drowsiness and sedation

 Constipation

 Pruritis

Avoid alcohol or other sedating agents and other APAP products

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2
Q

Alprazolam

A

MOA: Enhances the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions

Schedule:

IV Dosing: 0.25mg to 1mg TID Usual range 4mg/day to 6mg/day

Contraindication(s):

 Acute narrow-angle glaucoma

 Concurrent use with potent CYP 3A4 inhibitors

BBW: • Risk from concomitant use with opiods

Key Points:

 Drowsiness and sedation

 Avoid alcohol or other sedating agents

 Skin Rash

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3
Q

Amitriptyline

A

Generic : elavil

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 to 50mg daily at bedtime or in divided doses and gradually increase to 100mg to 300mg daily Ususal range 100mg to 300mg

Contraindication(s):

 MAOI use within 14 days

 Acute recovery phase following MI

BBW: •

Suicidality and antidepressant drugs

Key Points:

 Heart arrythymias

 Dry mouth, dry eyes, constipation, urinary retention (anticholinergic)

 Tremor

Sedation; take at bedtime if it causes sleepiness

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4
Q

Aripiprazole

A

Brand: Abilify

MOA: Partial agonist of D2 and 5-HT1A receptors, and an antagonist at the 5-HT2A receptor

Schedule: legend

Dosing:

Deperession adjunct: 2mg to 5mg ocne daily (Max: 15mg/day)

Schizophrenia: 10mg to 15mg once daily (Max 30mg/day)

Bipolar I: 15mg to 30mg once daily (Max 30mg/day)

Contraindication(s):

 Hypersensitivity

BBW:

  • Increased mortality in elderly patients with dementia-related psychosis
  • Suicidality and antidepressant drugs

Key Points:  Headache

 Increased glucose

 Sedation

Potential extrapyramidal reactions

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5
Q

Atomoxetine

A

Brand: Straterra

MOA: Selectively inhibits the reuptake of norepinephrine

Schedule: legend

Dosing:

40mg to 80mg daily in a single dose or 2 evenly divided doses

Max 100mg/day

Contraindication(s):

 MAOI use within 14 days

 Narrow-angle glaucoma

 History of pheochromocytoma

 Cardiac or vascular disorders that will deteriorate and cause increases in blood pressure or pulse

BBW:

• Suicidal ideation in children and adolescents

Key Points:

 Headache  Insomnia  Decreased appetite Dry mouth

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6
Q

Baclofen

A

Brand: Lioresal

MOA: Inhibits the transmission of both monosynaptic and polysynaptic reflexes at the spinal cord level, possibly by hyperpolarization of primary afferent fiber terminals

Schedule: legend

Dosing: 5mg to 20mg TID Max 80mg/day

Contraindication(s):

 Hypersensitivity  Intrathecal: IV, IM, SubQ, or epidural administration

BBW: • Abrupt withdrawal (injection)

Key Points:  Hypotonia  Drowsiness and confusion  Nausea and Vomitting Headache

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7
Q

Benztropine

A

Brand: Cogentin

MOA: Possesses both anticholinergic and antihistaminic effects

Schedule: legend

Dosing: 1mg to 2mg 2 to 3 times daily Max 6mg/day

Contraindication(s):  Hypersensitivity  Children less than 3 years old

BBW: • None

Key Points:  Tachycardia  Dry mouth, dry eyes, constipation, urinary retention (anticholinergic)

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8
Q

Buprenorphine

A

Brand: Buprenx, Butrans

MOA: Binds to mu opiate receptors in the CNS; displays partial mu agonist and weak kappa antagonist activity

Schedule: III

Dosing:

Oral SLT: 12mg to 16mg once daily

Buccal Film: 150mcg q 12 hours

Contraindication(s):  Significant respiratory depression  Acute or severe asthma  GI obstruction, including paralytic ileus (known or suspected)

BBW:

  • Addiction, abuse, and misuse (buccal film, injection, transdermal patch)
  • Life-threatening respiratory depression (buccal film, injection, transdermal patch)
  • Accidental exposure (buccal film, transdermal patch)
  • Neonatal opioid withdrawal syndrome (buccal film, injection, transdermal patch)
  • Risk associated with insertion and removal (Probuphine implant)
  • Risks from concomitant use with benzodiazepines or other CNS depressants (buccal film, injection, transdermal patch)

Key Points:  Headache  Sedation  REMS drug

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9
Q

Buprenorphine and Naloxone

A

Brand: Suboxone, Zubsolv

MOA:

Buprenorphine binds to mu opiate receptors in the CNS; displays partial mu agonist and weak kappa antagonist activity

Naloxone is a pure opioid antagonist that competes and displaces opioids at opioid receptor sites

Schedule: III

Dosing:

SL: 16mg/4mg once daily

Buccal Film: 8.4mg/1.4mg once daily

Contraindication(s):  Hypersensitivity

BBW: • None

Key Points:  Headache  Withdrawal syndrome  PainDiaphoresis

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10
Q

Bupropion

A

Brand: Wellbutrin, Zyban

MOA: Inhibits the reuptake of norepineprhine and dopamine

Schedule: legend

Dosing:

IR: 100mg BID (Max 150mg each dose)

SR: 150mg BID (Max 200mg in each dose)

XR: 150mg daily (Max 300mg/day)

Contraindication(s):

 Seizure disorder or conditions that increase seizure risk, including severe head injury or severe stroke

 History of anorexia/bulimia

 MAOI use within 14 days

BBW:

• Suicidality and antidepressant drugs

Key Points:  Seizures  Insomnia  Aggitation Weight loss

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11
Q

Butalbital, Acetaminophen and Caffeine

A

Brand: Esgic, Fioricet

MOA:

Butalbital depresses the sensory cortex, decreases motor activity, and alters cerebellar function

Acetaminophen inhibits the synthesis of prostaglandins in the central nervous system and peripherally blocks pain impulse generation Caffeine inhibits phosphodiesterase, causing vasodilation

Schedule: legend (controlled in UT)

Dosing:

1 to 2 tablets/capsules q 4 hours Max 6 tablets/capsules per day

Contraindication(s):

 Hypersensitivity  Porphyria

BBW: • Hepatotoxicity

Key Points:

 Dizziness  Sedation  Nausea and Vomitting

Avoid alcohol or other sedating agents and other acetaminophen containing products

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12
Q

Carisoprodol

A

Brand: Soma

MOA: Blocks interneuronal activity and depresses polysynaptic neuron transmission in the spinal cord and reticular formation of the brain

Schedule: IV

Dosing:

250mg to 350mg TID and at bedtime for max duration of 2-3 weeks

Contraindication(s):

 Hypersensitivity  History of acute intermittent porphyria

BBW: • None

Key Points:

 Drowsiness  Dizziness  Headache Avoid with other sedating agents

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13
Q

Celecoxib

A

Brand: Celebrex

MOA: Inhibits prostaglandin synthesis by decreasing the activity of cyclooxygenase-2 (COX-2)

Schedule: legend

Dosing:

100mg twice daily up to 200mg once or twice daily

Contraindication(s):

 Hypersensitivity to sulfonamides, aspirin, or other NSAIDs  History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDS  Use in the setting of CABG surgery

BBW:

• Serious cardiovascular risk • Serious gastrointestinal risk

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

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14
Q

Clonazepam

A

Brand: Klonopin

MOA: Enhances the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions

Schedule: IV

Dosing:

Panic Disorder: 0.5mg to 2mg BID (Max 4mg/day) Seizure Disorder: 2mg to 8mg In 1 or 2 divided doses (Max: 20mg/day)

Contraindication(s):

 Acute narrow-angle glaucoma  Significant liver disease

BBW: •

Risk from concomitant use with opioids

Key Points:

 Drowsiness/Confusion  Avoid abrupt discontinuation  Avoid alcohol or other sedating agents

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15
Q

Cyclobenzaprine

A

Brand: Amrix, Flexeril

MOA: Reduces tonic somatic motor activity influencing both alpha and gamma motor neurons

Schedule: legend

Dosing: 5mg to 10mg TID PRN

Contraindication(s):

 MAOI use within 14 days

 Hyperthyroidism  Heart failure  Arrhythmias

BBW: • None

Key Points:

 Drowsiness and sedation  Avoid alcohol or other sedating agents  Dry Mouth

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16
Q

Desvenlafaxine

A

Brand: Pristiq

MOA: Selectively inhibits the reuptake of serotonin and norepinephrine

Schedule: legend

Dosing: 50mg once daily

Contraindication(s):

 MAOI use within 14 days

 Use with linezolid

 Hypersensitivity to venlafaxine

BBW:

• Suicidal thoughts and behavior

Key Points:  Nausea  Insomnia  Hyperhidrosis Xerostomia

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17
Q

Dextroamphetamine and Amphetamine

A

Brand: Adderall

MOA: Promotes release of dopamine and norepinephrine from their storage sites in the presynaptic nerve terminals

Schedule: II

Dosing: IR: 5mg to 40mg daily in 1 to 3 divided doses ER: 20mg to 60mg once daily

Contraindication(s):

 Advanced arteriosclerosis, moderate to severe hypertension, or symptomatic cardiovascular disease  Agitated states  Glaucoma  MAOI use within 14 days

BBW: • Abuse potential • Cardiovascular events

Key Points:  Hypertension  Tachycardia  Insomnia Weight loss

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18
Q

Diazepam

A

Brand: Valium, Diastat

MOA: Enhances the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions

Schedule: IV

Dosing: 2mg to 10mg BID to QID PRN

Contraindication(s):  Acute narrow-angle glaucoma  Untreated open-angle glaucoma  Severe respiratory impariment or sleep apnea  Severe hepatic impairment

BBW: • Risks from concomitant use with opioids

Key Points:  Drowsiness and sedation  Avoid alcohol or other sedating agents

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19
Q

Diclofenac

A

Brand: Voltaren, Flector, Pensaid, Diclo gel

MOA: Reversibly inhibits cyclooxygenase-1 and 2 (COX-1 and 2) enzymes, which results in decreased formation of prostaglandin precursors

Schedule: legend

Dosing: 50mg BID to TID or 75mg BID

Contraindication(s):

 History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDS

 Use in the setting of CABG surgery

 Patients with moderate to severe renal impairment in the perioperative period and who are at risk for volume depletion (injection only)

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

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20
Q

Duloxetine

A

Brand: Cymbalta

MOA: Selectively inhibits the reuptake of serotonin and norepinephrine, weakly inhibits dopamine reuptake S

chedule: legend

Dosing: 30mg to 60mg daily as a single dose or in 2 evenly divided doses

Contraindication(s):  MAOI use within 14 days  Use with linezolid

BBW: • Suicidal thoughts and behavior

Key Points:  Headache  drowsiness and fatigue  Xerostomia Weight Loss

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21
Q

Escitalopram

A

Brand: Lexapro

MOA: Selectively inhibits serotonin reuptake in the presynaptic neurons

Schedule: legend

Dosing: 10mg to 20mg once daily

Contraindication(s):

 MAOI use within 14 days

 Use with linezolid

BBW: • Suicidality and antidepressant drugs

Key Points:

 Drowsiness and insomnia

 Dry mouth

 Decreaed Libido/Ejaculatory disorders

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22
Q

Eszopiclone

A

Brand: Lunesta

MOA: May interact with GABA-receptor complexes at binding domains located close to or allosterically coupled to benzodiazepine receptors

Schedule: IV

Dosing: 1mg to 3mg q HS 3mg max

Contraindication(s):  Hypersensitivity

BBW: • None

Key Points:

 May distort taste  Drowsiness  Avoid alcohol or other sedating agents

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23
Q

Fentanyl

A

Brand: Sublimaze, Actiq, Duragesic, Fentora

MOA: Binds with stereospecific receptors at many sites within the CNS, increases pain threshold, alters pain reception, inhibits ascending pain pathways

Schedule: II

Dosing: Individualized to patient

Contraindication(s):

 Hypersensitivity

 Significant respiratory depression

 Acute or severe bronchial asthma

 GI obstruction including paralytic ileus (known or suspected)

BBW:

  • Life-threatening respiratory depression • Addiction, abuse, and misuse
  • Accidental exposure
  • Cytochrome P450 3A4 Interaction
  • Neonatal opioid withdrawal syndrome •

Risks from concomitant use with benzodiazepines or other CNS depressants

  • Risk of medication errors (buccal, intranasal, lozenge, sublingual)
  • REMS program
  • Exposure to heat (Duragesic only)

Key Points:

 Change patch every 72 hours

 Do not cut patch and avoid exposing application site to external heat sources

 Dizziness, Drowsiness, and Constipation

Avoid alcohol or other sedating agents

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24
Q

Fluoxetine

A

Brand: Prozac, Saracen

MOA: Selectively inhibits serotonin reuptake in the presynaptic neurons

Schedule: legend Dosing: 20mg to 80mg once daily

Contraindication(s):

 MAOI use within 5 weeks of discontinuing fluoxetine or within 14 days of discontinuing the MAOI

 Use with linezolid

BBW:

• Suicidality and antidepressant drugs

Key Points:  Insomnia  Anxiety  Decreaed Libido/Ejaculatory disorders Long half life

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25
Q

Gabapentin

A

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

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26
Q

Hydrocodone and Acetaminiphen

A

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

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27
Q

Ibuprofen

A

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

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28
Q

Lamotrigine

A

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

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29
Q

Lidocaine

A

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

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30
Q

Lisdexamfetamine dimesylate

A

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

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31
Q

Lorazepam

A

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

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32
Q

Meloxicam

A

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

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33
Q

Memantine

A

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

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34
Q

Methadone

A

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.

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35
Q

Methylphenidate

A

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

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36
Q

Mirtazapine

A

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

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37
Q

Naproxen

A

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

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38
Q

Nortripyline

A

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

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39
Q

Olanzapine

A

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

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40
Q

Oxycodone

A

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

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41
Q

Oxycodone and APAP

A

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

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42
Q

Paroxetine

A

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

43
Q

Phenytoin

A

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

44
Q

Pregabalin

A

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

45
Q

Quetiapine

A

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

46
Q

Risperidone

A

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

47
Q

Sertraline

A

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

48
Q

Sumatriptan

A

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

49
Q

Temazepam

A

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

50
Q

Topiramate

A

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

51
Q

Tramadol

A

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

52
Q

Trazodone

A

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

53
Q

Valproic acid and derivatives

A

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

54
Q

Vareniciline

A

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

55
Q

Venlafaxine

A

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

56
Q

Zolpidem

A

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

57
Q

Acyclovir

A

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

58
Q

Amoxicillin

A

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

59
Q

Amoxicillin and Clavulanic acid

A

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

60
Q

Azithromycin

A

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.)

61
Q

Cefdinir

A

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

62
Q

Cefuroxime

A

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

63
Q

Cephalexin

A

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

64
Q

Ciprofloxacin

A

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)

65
Q

Clarithromycin

A

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

66
Q

Clindamycin

A

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

67
Q

Conjugated Estrogens

A

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

68
Q

Darunavir

A

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

69
Q

Doxycycline

A

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)

70
Q

Dutasteride

A

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

71
Q

Emtricitabine, Tenofovir, and Efavirenz

A

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

72
Q

Ethinyl Estradiol and Etonogestrol

A

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.)

73
Q

Finasteride

A

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

74
Q

Fluconazole

A

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

75
Q

Group: Biphasic Oral Contraceptives

A

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.)

76
Q

Group: Monophasic Oral Contraceptives

A

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.)

77
Q

Group: Triphasic oral Contraceptives

A

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.)

78
Q

Levofloxacin

A

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)

79
Q

Levothyroxine

A

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

80
Q

Levothyroxine and Liothyronine

A

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

81
Q

Liothyronine

A

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

82
Q

Medroxyprogesterone

A

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

83
Q

Metronidazole

A

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

84
Q

Minocycline

A

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)

85
Q

Moxifloxacin

A

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)

86
Q

Mupirocin

A

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

87
Q

Nitrofurantoin

A

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

88
Q

Norethindrone

A

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.)

89
Q

Oseltamivir

A

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

90
Q

Oxybutynin

A

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

91
Q

Penicillin g

A

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

92
Q

Penicillin v Potassium

A

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

93
Q

Phenazopyridine

A

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

94
Q

Sildenafil

A

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

95
Q

Sofosbuvir and Ledipasvir

A

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

96
Q

Solifenacin

A

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

97
Q

Sulfamethoxazole and Trimethoprim

A

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

98
Q

Tadalafil

A

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

99
Q

Tamsulosin

A

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

100
Q

Tenofovir alafenamide and emtricitabine

A

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

101
Q

Terazosin

A

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

102
Q

Testosterone

A

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

103
Q

Valacyclovir

A

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

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