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P2 Top 200 > 125-150 use to study > Flashcards

125-150 use to study Flashcards

1
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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2
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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3
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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4
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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5
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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6
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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7
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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8
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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9
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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10
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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11
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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12
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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13
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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14
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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15
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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16
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

17
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

18
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

19
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

20
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

21
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

22
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

23
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

24
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

25
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

26
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

P2 Top 200 (19 decks)

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