Brand/generic/ clinical pearls

Question 1

Metronidazole

Answer 1

Flagyl, Flagyl ER
-Anti-infective
-Anti-bacterial, Antiprotozoal
-Finish course as prescribed. Avoid alcohol during therapy and for 2 days after. May discolor urine reddish-brown

Question 2

Fluconazole

Answer 2

Diflucan
-Finish course as prescribed. May cause headache and GI upset. CYP interactions: strongly inhibits 2C9, 2C19 (clopidogrel, warfarin, and phenytoin); moderately inhibits 3A4, may prolong QT interval

Question 3

Ketoconazole

Answer 3

Nizoral
-Available topically or orally. Tablets should be taken with food. Drug is absorbed best in acidic conditions; avoid antacids, PPI’s and H2 blockers for 2 hours before and after administration. Major CYP3A4 drug interactions. Topical formulations are flammable. Potential for hepatotoxicity.

Question 4

Nystatin

Answer 4

Mycostatin, Nystop
-Available in many different dosage forms (topical, oral, suspension, powder) and some combination products. Suspensions can be dosed as “swish and spit” for oral candidiasis or “swish and swallow” for esophageal candidiasis

Question 5

Terbinafine

Answer 5

Lamisil
-Finish course as prescribed. Topical formulation available OTC and is most common use

Question 6

Acyclovir

Answer 6

Zovirax
-Available topically and orally. Avoid intercourse during herpes outbreaks. Dose and duration depends on indication. CNS side effects especially in elderly and renal impairment. Interacts with herpes zoster vaccine. Stay well hydrated.

Question 7

Valacyclovir

Answer 7

Valtrex
-Avoid intercourse during herpes outbreaks. Dose and duration depends on indication. CNS side effects especially in elderly and renal impairment/ Interacts with herpes zoster vaccine. Stay well hydrated.

Question 8

Cephalexin

Answer 8

Keflex
-Finish course as prescribed. May cause GI upset. Hypersensitivity reactions may occur if allergic to penicillin and/or other cephalosporins. May decrease absorption of oral contraceptives.

Question 9

Cefuroxime axetil

Answer 9

Ceftin
-Finish course as prescribed. May cause GI upset. Hypersensitivity reactions may occur if allergic to penicillin and or other cephalosporins. May decrease absorption of oral contraceptives

Question 10

Cefdinir

Answer 10

Omnicef
-Finish course as prescribed. May cause GI upset. Hypersensitivity reactions may occur if allergic to penicillin or other cephalosporins. May decrease absorption of oral contraceptives

Question 11

Ciprofloxacin

Answer 11

Cipro (XR)
-Finish course as prescribed. Monitor glucose. Do not take within 2 hours of consuming foods or other products containing di- or trivalent cations (milk, calcium antacids, multivitamins and supplements) May cause sun sensitivity and CNS side effects. FDA requires assessments of risk of QTc prolongation. BBW for tendonitis/ tendon rupture. Available orally and in opthalmic and otic suspensions

Question 12

Levofloxacin

Answer 12

Levaquin
-Finish course as prescribed. Monitor glucose. Do not take within 2 hours of consuming foods or other products containing di- or trivalent cations (milk, calcium antacids, multivitamins and supplements) May cause sun sensitivity and CNS side effects. FDA requires assessments of risk of QTc prolongation. BBW for tendonitis/ tendon rupture. Available orally and in ophthalmic suspensions

Question 13

Moxifloxacin

Answer 13

Avelox
-Finish course as prescribed. Monitor glucose. Do not take within 2 hours of consuming foods or other products containing di- or trivalent cations (milk, calcium antacids, multivitamins and supplements) May cause sun sensitivity and CNS side effects. FDA requires assessments of risk of QTc prolongation. BBW for tendonitis/ tendon rupture. Available orally and in ophthalmic suspensions (Vigamox, Moxeza)

Question 14

Azithroycin

Answer 14

Zithromax, zmax, Azasite
-finish course as prescribed. No 3A4 inhibition. QT prolongation possible. Ophthalmic solution (Azasite) is refrigerated

Question 15

Clarithromycin

Answer 15

Biaxin (XL)
-Finish course as prescribed. May impart metallic taste. Inhibits CYP 3A4. QT prolongation possible

Question 16

Clindamycin

Answer 16

Cleocin, Cleocin T, Evoclin, Clindagel
-Available in many dosage forms (oral, topical, vaginal suppository, powder for suspension) and combination products. Oral therapy may cause C.diff associated severe diarrhea. Suspension has a horrible taste, little flavoring options available.

Question 17

Nitrofurantoin

Answer 17

Macrobid, Macrodantin, Furadantin
-Take with food to enhance absorption. May cause peripheral neuropathy or pulmonary fibrosis. Shake suspension thoroughly.

Question 18

Amoxicillin

Answer 18

Amoxil
-Finish course as prescribed. May cause GI upset; take with food. Hypersensitivity reaction possible. May decrease efficacy of oral contraceptives. Secondary vaginal yeast infection may develop. Shake suspension well and keep refrigerated

Question 19

Amoxicillin + clavulanate

Answer 19

Augmentin, Augmentin XR
- Finish course as prescribed. May cause GI upset; take with food. More likely to have diarrhea bc of clavulanate- maintain hydration. Clavulanic acid doses vary among formulations; double-check if using alternate formulation to achieve prescribed dose. Shake susp well and keep refrigerated, note exp date

Question 20

Penicillin V potassium

Answer 20

Veetids, Pen-Vee K
-Finish course as prescribed. May cause GI Upset; take with food. C. diff associated diarrhea may develop. Hypersensitivity reactions possible

Question 21

Sulfamethoxazole + Trimethoprim

Answer 21

Bactrim, Bactrim DS, Septra, Spetra DS
-Finish course as prescribed. Take with plenty of water. Increase sensitivity to sunlight. Increased risk of hypoglycemia if taken with other sulfonylureas. Severe life-threatening skin reactions possible

Question 22

Doxycycline

Answer 22

Vibramycin, Doryx, Adoxa, Monodox, Oracea, Periostat
-May increase sensitivity to sunlight. Do not take within 2 hours of consuming food or other products containing di- or trivalent cations (ex. milk, calcium antacids, multivitamins and supplements) Hyclate and monohydrate salts not interchangeable

Question 23

Metronidazole (topical)

Answer 23

metrogel, metrogel-vaginal, metrocream, metrolotion
-use condoms during vaginal therapy. some drug is absorbed systemically; avoid alcohol consumption during therapy and for 2 days after. Also used topically on the face for rosacea.

Question 24

Mupirocin

Answer 24

Bactroban
-Used most in hospital to reduce the risk of MRSA infection from carriers

Question 25

Nystatin + triamcinolone

Answer 25

Mycolog II -use sparing amount, avoid application around eyes

Question 26

Chlorhexidine gluconate

Answer 26

Peridex, Periogard -Tx for gingivitis/ periodontitis -swish and spit 15 mls BID

Question 27

Olsetamivir

Answer 27

Tamiflu -BID dosing for Tx, QD dosing for prophylaxis, Tx within 24-48 hours of sx, rarely causes behavioral disturbances inc delirium, risk of anaphylaxis and allergic skin reactions

Question 28

Emtricitabine + Tenofovir

Answer 28

Truvada -Reverse Transcriptase inhibitor -Adherence important to prevent resistance. May be taken without regard to food. May cause decrease in bone mineral density, fat redistribution, lactic acidosis, hepatomegaly, and renal toxicity. Recently approved for pre-exposure HIV prophylaxis for those whose partner has HIV; must have regular testing every 3 months

Question 29

Zidovudine +lamivudine

Answer 29

Combivir -Reverse transcriptase inhibitor -Adherence important to prevent resistance. May be taken without regard to food. May cause fat redistribution, lactic acidosis, hepatomegaly, myopathy, and hematologic toxicity.

Question 30

Enalapril

Answer 30

Vasotec -Pregnancy category D. May cause dry cough, first-dose hypotension (especially in CHF and hypervolemia) and hyperkalemia (avoid salt substitutes) Angioedema is a serious reaction; discontinue immediately and medical intervention may be necessary. Drug has renoprotective properties, but may also cause acute renal failure; monitor serum creatinine and discontinue if >30% increase.

Question 31

Ramipril

Answer 31

Altace -Pregnancy category D. May cause dry cough, first-dose hypotension (especially in CHF and hypervolemia) and hyperkalemia (avoid salt substitutes) Angioedema is a serious reaction; discontinue immediately and medical intervention may be necessary. Drug has renoprotective properties, but may also cause acute renal failure; monitor serum creatinine and discontinue if >30% increase. May have greater benefit if dosed at bedtime

Question 32

Quinapril

Answer 32

Accupril, Accuretic -Pregnancy category D. May cause dry cough, first-dose hypotension (especially in CHF and hypervolemia) and hyperkalemia (avoid salt substitutes) Angioedema is a serious reaction; discontinue immediately and medical intervention may be necessary. Drug has renoprotective properties, but may also cause acute renal failure; monitor serum creatinine and discontinue if >30% increase.

Question 33

Benazepril, Ben/HCTZ

Answer 33

Lotensin, Lotensin HCT -Pregnancy category x. May cause dry cough, first-dose hypotension (especially in CHF and hypervolemia) and hyperkalemia (avoid salt substitutes) Angioedema is a serious reaction; discontinue immediately and medical intervention may be necessary. Drug has renoprotective properties, but may also cause acute renal failure; monitor serum creatinine and discontinue if >30% increase.

Question 34

Lisinopril, Lis/HCTZ

Answer 34

Zestril or Prinivil, Zestoretic -Pregnancy category D. May cause dry cough, first-dose hypotension (especially in CHF and hypervolemia) and hyperkalemia (avoid salt substitutes) Angioedema is a serious reaction; discontinue immediately and medical intervention may be necessary. Drug has renoprotective properties, but may also cause acute renal failure; monitor serum creatinine and discontinue if >30% increase.

Question 35

Doxazosin Mesylate

Answer 35

Cardura, Cardura XL *Alpha 1 blocker -May cause postural hypotension/orthostasis after first dose or an increase in dose. Dizziness and headache commo

Question 36

Terozosin

Answer 36

Hytrin *Alpha 1 blocker -May cause postural hypotension/ orthostasis after first dose or increase in dose. Dizziness and headache common

Question 37

Clonidine

Answer 37

Catapres, Catapres TTS, Nexiclon XR, Kapvay ER *Alpha II agonist May cause drowsiness, dry mouth, or skin reactions. Rotate patch application sites and discard patches carefully. Do not discontinue abruptly.

Question 38

Amiodarone

Answer 38

Cordarone *Antiarrhythmic Many drug interactions, complicated by extremely long half life of 40-50 days. Hepatic and pulmonary damage possible; notify MD if jaundice, dark urine or trouble breathing occur. May cause thyroid problems, hypotension, bradycardia, ocular disease and exacerbate arrhythmia. Have regular ophthalmic visits. May cause skin to turn bluish-grey in color.

Question 39

Warfarin

Answer 39

Coumadin *anticoagulant -risk of bleeding, especially GI. Very narrow therapeutic index, INR must be monitored regularly and vitamin K intake should be uniform. Many drug interactions; always check with MD or RPh when taking a new medication

Question 40

Fenofibrate

Answer 40

TRICOR, Trilipix *Antihyperlipidemic -Risk of myopathy; taking with statins increase risk. Discontinue immediately and report any signs (muscle pain, brown urine) to MD and/or RPh. Increases action of sulfonylureas; monitor for hypoglycemia. No good outcome data; FIELD and ACCORD Lipid were not positive. Safer to combine with a statin than gemfibrozil, but not evidence based. Many different "brand" formulations

Question 41

Gemfibrozil

Answer 41

Lopid -antihyperlipidemic -Increases effects of statins and therefore myopathy risk; discontinue immediately and report any signs (muscle pain, brown urine to MD or RPh. Should be taken 30 minutes before breakfast and dinner. Increased risk of gallstones.

Question 41

Niacin

Answer 41

Niaspan ER *antihyperlipidemic -Causes flushing in most individuals (>80%); take at bedtime with a low-fat snack and 325 mg aspirin to reduce effects. Doses higher than 2g/day may cause hepatotoxicity

Question 42

Atorvastatin

Answer 42

Lipitor *Antihyperlipidemic- HMG CoA reductase inhibitor -Pregnancy category X. Myopathy is a serious reaction; discontinue immediately and report any signs (muscle pain, brown urine) to MD or RPh. May be taken at anytime of day. Avoid excessive alcohol and grapefruit juice. Some CYP3A4 interactions

Question 43

Lovastatin

Answer 43

Mevacor, Altoprev ER *HMG CoA reductase inhibitor --Pregnancy category X. Myopathy is a serious reaction; discontinue immediately and report any signs (muscle pain, brown urine) to MD or RPh. Take in the evening. Avoid excessive alcohol and grapefruit juice. Some CYP3A4 interactions

Question 44

Pravastatin

Answer 44

Pravachol *HMG CoA reductase inhibitor --Pregnancy category X. Myopathy is a serious reaction; discontinue immediately and report any signs (muscle pain, brown urine) to MD or RPh. Avoid excessive alcohol and grapefruit juice. Significantly fewer drug interactions compared to other statins (cleared by kidney rather than liver)

Question 45

Rosuvastatin

Answer 45

Crestor *HMG CoA reductase inhibitor --Pregnancy category X. Myopathy is a serious reaction; discontinue immediately and report any signs (muscle pain, brown urine) to MD or RPh. May be taken at anytime of day. Avoid excessive alcohol and grapefruit juice.

Question 47

Simvastatin/ Ezetimibe

Answer 47

Vytorin *HMG CoA reductase inhibitor and cholesterol absorption inhibitor --Pregnancy category X. Myopathy is a serious reaction; discontinue immediately and report any signs (muscle pain, brown urine) to MD or RPh. Take in the evening. Avoid excessive alcohol and grapefruit juice. Several CYP 3A4 interactions. Lacks data that combination is superior to simvastatin alone.

Question 48

Simvastatin

Answer 48

Zocor *HMG reductase inhibitor --Pregnancy category X. Myopathy is a serious reaction; discontinue immediately and report any signs (muscle pain, brown urine) to MD or RPh. Take in the evening. Avoid excessive alcohol and grapefruit juice. Some CYP3A4 interactions

Question 49

Aspirin

Answer 49

Ecotrin *Antiplatelet -Used for cardiovascular or cerebrovascular accident treatment/prophylaxis. 75-325 mg po daily. Risk/benefit important for prophylaxis decisions. Increased risk of bleeding. Be aware of hypersensitivity reactions especially in patients with allergic triad as a allergy, nasal polyps, and asthma, avoid in children due to risk of Reye Syndrome

Question 50

Amlodipine + Valsartan

Answer 50

Exforge, Exforge HCT *ARB + calcium channel blocker

Question 51

Valsartan, Val/HCTZ

Answer 51

Diovan, Diovan HCT *ARB -BBW in pregnancy. May cause dizziness, hypotension, hyperkalemia (avoid salt substitutes, potassium sparing diuretics), and renal dysfunction (discontinue if serum creatinine increase >30%) NSAIDs reduce antihypertensive effect and increase risk of renal dysfunction. Taking with ACE inhibitor or renin inhibitor increases side effects with little benefit

Question 52

Irbesartan, Irbesartan/ HCTZ

Answer 52

Avapro, Avalide *ARB -BBW in pregnancy. May cause dizziness, hypotension, hyperkalemia (avoid salt substitutes, potassium sparing diuretics), and renal dysfunction (discontinue if serum creatinine increase >30%) NSAIDs reduce antihypertensive effect and increase risk of renal dysfunction. Taking with ACE inhibitor or renin inhibitor increases side effects with little benefit

Question 53

Candesartan, Can/HCTZ

Answer 53

Atacand, Atacand HCT *ARB -BBW in pregnancy. May cause dizziness, hypotension, hyperkalemia (avoid salt substitutes, potassium sparing diuretics), and renal dysfunction (discontinue if serum creatinine increase >30%) NSAIDs reduce antihypertensive effect and increase risk of renal dysfunction. Taking with ACE inhibitor or renin inhibitor increases side effects with little benefit

Question 54

Olmesartan

Answer 54

Benicar, Benicar HCT *ARB -BBW in pregnancy. May cause dizziness, hypotension, hyperkalemia (avoid salt substitutes, potassium sparing diuretics), and renal dysfunction (discontinue if serum creatinine increase >30%) NSAIDs reduce antihypertensive effect and increase risk of renal dysfunction. Taking with ACE inhibitor or renin inhibitor increases side effects with little benefit

Question 55

Losartan, Los/HCTZ

Answer 55

Cozaar, Hyzaar *ARB -BBW in pregnancy. May cause dizziness, hypotension, hyperkalemia (avoid salt substitutes, potassium sparing diuretics), and renal dysfunction (discontinue if serum creatinine increase >30%) NSAIDs reduce antihypertensive effect and increase risk of renal dysfunction. Taking with ACE inhibitor or renin inhibitor increases side effects with little benefit

Question 56

Atenolol

Answer 56

Tenormin *Beta Blocker, Beta 1 selective -May cause drowsiness. Masks symptoms of hypoglycemia. Do not discontinue abruptly. Limited evidence/data

Question 57

Metoprolol Succinate

Answer 57

Toprol XL *Beta blocker, beta 1 selective -may cause drowsiness. Masks symptoms of hypoglycemia. Do not discontinue abruptly. Succinate and tartrate salts are not interchangeable

Question 58

Metoprolol tartrate

Answer 58

Lopressor *Beta blocker, beta 1 selective -may cause drowsiness. Masks symptoms of hypoglycemia

Question 59

bisoprolol, bisoprolol + HCTZ

Answer 59

Zebeta, Ziac *Beta blocker, beta 1 selective -may cause drowsiness. Masks symptoms of hypoglycemia. Do not discontinue due to risk of tachycardia and hypertension. Bisoprolol has outcome data in heart failure; target dose of 10 mg/day

Question 60

atenolol/chlorithalidone

Answer 60

Tenoretic *beta blocker, beta 1 selective

Question 61

Propranolol

Answer 61

Inderal, Inderal LA, Innopran, Innorpan XL *Beta blocker, nonselective -May cause drowsiness. Masks symptoms of hypoglycemia. Do not discontinue abruptly. LA and immediate release formulation are not mg-mg equivalent; dose may need to be increased up to 30% when converting from immediate release to LA

Question 62

Carvedilol

Answer 62

Coreg *Beta blocker, nonselective, alpha 1 blocker -may cause drowsiness. masks symptoms of hypoglycemia. Do not discontinue abruptly. CR and immediate release are not mg-mg equivalent; CR 10 mg equivalent to 3.125 mg BID of immediate release.

Question 63

Labetalol

Answer 63

Normodyne or Tradate *Beta blocker, nonselective; alpha 1 blocker -may cause drowsiness. masks symptoms of hypoglycemia. do not discontinue abruptly

Question 64

digoxin

Answer 64

Lanoxin or Lanoxicap *Cardiac glycoside: + inotropic, - chronotropic -narrow therapeutic index, many drug interactions. Digoxin toxicity possible (anorexia, nausea, fatigue, vision disturbances, bradycardia, arrhythmias)

Question 65

Amlodipine + olmesartan

Answer 65

Azor, tribenzor

Question 66

amlodipine

Answer 66

Norvasc *dihydro calcium channel blocker -may cause drowsiness, risk of hypotension and orthostasis. Risk of peripheral edema that is not responsive to diuretics but may be relieved by ACEi or ARB

Question 67

Nifedipine

Answer 67

Procardia, Procardia XL, Adalat *Dihydro CCB -may cause drowsiness. risk of peripheral edema that is not responsive to diuretics. ACEi or ARB used to reverse. Adalat and Procardia not equivalent, double-check when dispensing generics

Question 68

Amlodipine + Benazepril

Answer 68

Lotrel *Dihydro CCB + ACEi

Question 69

Amlodipine +Atorvastatin

Answer 69

Caudet *dihydroCCB + HMG-CoA reductase inhibitor -titrate amlodipine to response over 1-2 weeks and atorvastatin in 6-8 weeks

Question 70

Dabigatran

Answer 70

Pradaxa *direct thrombin inhibitor -Monitor for bleeding. May cause some GI upset. Store capsules in original container or blister pack; discard unused medication after 4 months. Do not crush, chew or open capsules. If a dose is missed, do not take a double dose if more than 6 hours have passed. Drug interaction with p-glycoprotein substrates (dronedarone, ketoconazole, rifampin). Dose should be adjusted for kidney function. discontinuation for surgery determined by creatinine clearance

Question 71

potassium chloride

Answer 71

Klor-con -May cause GI upset, take with food. monitor salt intake

Question 72

Rivaroxaban

Answer 72

Xarelto *Factor Xa inhibitor -Monitor for bleeding. Doses of 15 mg or more must be taken with food. Compliance extremely important, but do not take a double dose if a dose is missed. discontinue at least 24 hours before surgeries. drug interactions with CYP 3A4 substrates, but benefit outweighs cost in some cases

Question 73

apixaban

Answer 73

Eliquis *Factor Xa inhibitor -Monitor for bleeding. 5 mg orally twice daily. A dose of 2.5 mg twice daily is recommended for patients at least 80 years old, who weigh no more than 60 kg, or have serum creatinine of at least 1.5 mg/dL, as well as those receiving strong dual inhibitors of cytochrome P450 3A4 and P-glycoprotein. Boxed waring- increased risk of stroke if DC'd. Not indicated in patients with prosthetic heart valves

Question 74

furosemide

Answer 74

Lasix *loop diuretic -May cause hypokalemia; monitor potassium levels and kidney function. Also watch salt intake. May be used as needed in congestive heart failure. Hypersensitivity reaction may occur in individuals with sulfa allergy. Lasix is short for "last six hours"

Question 75

Enoxaparin

Answer 75

Lovenox *Low molecular weight heparin -Increased risk of bleeding. Counsel on injection technique. Often used when beginning warfarin to achieve goal INR more quickly. In community pharmacy, double-check to make sure proper package size and quantity are being dispensed/billed

Question 76

Isosorbide Mononitrate

Answer 76

Imdur, ISMO *Nitroglycerin antianginal/ vasodilator -Frequently causes dizziness and/or headache. Dosed twice daily, but must be taken "asymmetrically" to prevent tolerance; take second dose 8 hours after first dose rather than every 12 hours

Question 77

Nitroglycerin SL

Answer 77

Nitrostat *Nitroglycerin antianginal/ vasodilator -Frequently causes dizziness and/or headache. If chest pain persist after first dose, take second dose in 5 minutes. Call 911 if symptoms persist after second dose. Store in original container

Question 78

Topical Nitroglycerin

Answer 78

Nitro-Dur *Nitroglycerin antianginal/ vasodilator -Finish course as prescribed. Apply patch for 12 hours and remove for 12 hours for nitrate-free period

Question 79

Diltiazem

Answer 79

Cardizem, Cardizem SR, Cardizem CD, Cardizem LA, Tiazac *Non-dihydro CCB -May cause drowsiness/dizziness or headache. Do not discontinue therapy without discussing with MD. Many formulations that may not be equivalent; double-check when dispensing generics

Question 80

Verapamil

Answer 80

Calan, Calan SR, Isoptin SR *Non-dihydro Calcium Channel blocker -may cause drowsiness/ dizziness, headache, or constipation. Do not discontinue therapy without discussing with MD

Question 81

Clopidogrel

Answer 81

Plavix *Platelet inhibitor -Monitor for bleeding. Compliance extremely important. CYP 2C19 inhibitors such as omeprazole and esomeprazole greatly decrease efficacy. Check with MD or RPh before starting new medications or taking OTC medications

Question 82

Triamterene +HCTZ

Answer 82

Dyazide capsule or Maxzide tablets *Potassium sparing + thiazide -Take in the early morning, monitor renal function, potassium levels, and salt intake; not to be used if renal function impaired. Risk of kidney stones; drink plenty of fluids to reduce risk. Double check patient profile when dispensing generics; patients should remain on tablets or capsules unless MD changes

Question 83

Spironolactone, Spir/HCTZ

Answer 83

Aldactone, Aldactizide *potassium sparing -take early in the morning. monitor renal function, potassium levels, and salt intake. may cause gynecomastia in males, menstrual irregularities in females (antiandrogenic properties) Evidence based data for heart failure, post MI, and resistant hypertension. Aldactazide may cause hypersensitivity reactions in individuals with sulfa allergy.

Question 84

Indapamide

Answer 84

Lozol *thiazide -take in the early morning. monitor renal function, potassium levels, and salt intake; not to be used in severe renal impairment, but may be used in minimally impaired renal function. Hypersensitivity reaction may occur in individuals with sulfa allergy.

Question 85

Chlorithalidone

Answer 85

Thalidone, Hygroton *thiazide --take in the early morning. monitor renal function, potassium levels, and salt intake; not to be used if renal function impaired. Hypersensitivity reaction may occur in individuals with sulfa allergy. Chlorithalidone is twice as potent as HCTZ

Question 86

Hydrochlorithiazide

Answer 86

Oretic, Microzide *thiazide -Take in the early morning. Monitor renal function, potassium levels and salt intake. Hypersensitivity reactions may occur in individuals with sulfa allergy

Question 87

Metolazone

Answer 87

Zaroxolyn *thiazide -take in the early morning. monitor renal function, electrolytes (potassium and magnesium) and salt intake. hypersensitivity reaction may occur in individuals with sulfa allergy. Often used in diuretic-resistant patient in combination with loop diuretics

Question 88

Ondansetron

Answer 88

Zofran, Zofran ODT *5-HT3 antagonist; antiemetic -may cause headache, fatigue, dissolve ODT under the tongue, store in original container until ready to use. QT prolongation possible

Question 89

Donepezil

Answer 89

Aricept *acetylcholinesterase inhibitor -take in the evening. significant nausea, vomiting and diarrhea possible, as well as anorexia. May also cause bradycardia and fainting. Set realistic expectations for Alzheimer's patients. Keep in mind positive statistical significance vs clinical significance

Question 90

Rivastigmine

Answer 90

Exelon, Exelon Patch *Acetylcholinesterase inhibitor -Take capsule in the evening. rotate patch application sites. Significant nausea, vomiting and diarrhea possible, as well as anorexia. May also cause bradycardia and fainting. Set realistic expectations for Alzheimer's patients

Question 91

Butalbital + aspirin + caffeine (w or wo codeine)

Answer 91

Fiorinal, Fiorinal with codeine *Analgesic combo for tension headache C-III -may cause drowsiness or dizziness; avoid alcohol use during therapy. Caution against taking other products containing aspirin

Question 92

Butalbital + acetaminophen + caffeine

Answer 92

Fioricet, Fioricet with codeine *Analgesic combo for tension headaches, C-III -May cause drowsiness or dizziness; avoid alcohol use during therapy. Do not exceed 4 g of APAP per day, 3g if frequent alcohol drinker, 2g if taking warfarin. New BBW with acetaminophen due to hepatotoxicity

Question 93

Buspirone

Answer 93

Buspar *Antianxiety- serotonin 5-HT1A receptor partial agonist -may cause drowsiness or dizziness, slow onset, mildly effective, little potential for abuse

Question 94

Scopolamine

Answer 94

Transderm-Scop *Anticholinergic -may cause drowsiness or dizziness. wash your hands after application as touching your eyes after application may result in blurred vision (dilation)

Question 95

Mirtazapine

Answer 95

Remeron *antidepressants -may cause drowsiness or dizziness, dry mouth, constipation and weight gain. do not discontinue abruptly. open from blister and dissolve on the tongue

Question 96

Trazodone

Answer 96

Desyrel *Antidepressant/ sleep aid -may cause dizziness/drowsiness/orthostasis, priapism risk

Question 97

Bupropion

Answer 97

Wellbutrin (SR) (XL) or Zyban *Antidepressant/ smoking cessation aid -Take XL tabs in the AM to avoid insomnia, do not crush or chew SR or XL tabs, do not take doses too close or exceeding maximum doses because of seizure risk. Potential side effects inc nervousness, constipation, trouble sleeping, dry mouth, tremor

Question 98

Carbamazepine

Answer 98

Tegretol (XR) *Antiepileptic -Take with food, may cause drowsiness, avoid alcohol. Serious and sometimes fatal dermatologic reactions (including Stevens-Jonson syndrome and toxic epideral necrolysis) have been reported especially in patients with the inherited allelic variant HLA-B*1502. Genetically at risk patients (IE those from Asia) should be screened prior.

Question 99

Lamotrigine

Answer 99

Lamictal *Antiepileptic -Report hypersensitivity/rash to MD, may cause drowsiness, do not operate heavy machine

Question 100

Levetiracetam

Answer 100

Keppra *Antiepileptic -May cause dizziness/drowsiness, do not operate heavy machinery, do not abruptly discontinue therapy

Question 101

Oxcarbazepine

Answer 101

Trileptal *Antiepileptic -May cause dizziness/drowsiness, do not operate heavy machinery or abruptly discontinue therapy

Question 102

Phenytoin Sodium

Answer 102

Dilantin Kapseals *Antiepileptic -May cause dizziness/drowsiness, do not operate heavy machinery. Emphasize good oral hygiene to reduce risk of gingival hyperplasia.

Question 103

Divalproex

Answer 103

Depakote (ER) *Antiepileptic, mood stabilizer -Do not abruptly discontinue therapy, avoid alcohol use, may cause drowsiness

Question 104

phenobarbital

Answer 104

phenobarbital *Antiepileptic/hypnotic; C-IV May cause drowsiness or dizziness, avoid alcohol use during therapy

Question 105

Topiramate

Answer 105

Topamax *Antiepileptic/ migraine prophylactic -May cause drowsiness or dizziness, avoid alcohol use during therapy. Confusion ("Dopamax") and it is now FDA approved in combination with phentermine in extended release- Qsymia (C-IV)

Question 106

Gabapentin

Answer 106

Neurontin *Antiepileptic/ neuropathic analgesic -May cause drowsiness or dizziness, avoid alcohol use during therapy. Edema, weight gain and confusion common, as well as generally need to titrate slowly to higher doses as this agent has dose related kinetics

Question 107

Hydroxyzine hydrochloride

Answer 107

Atarax *Antihistamine -May cause anticholinergic side effects

Question 108

Hydoxyzine pamoate

Answer 108

Vistaril *Antihistamine/ antianxiety -may cause anticholinergic side effects

Question 109

Eletriptan

Answer 109

Relpax *Antimigraine, 5-HT1 agonist -Take at onset of migraine. If headache is relieved but returns after 1st dose, repeat in 2 hours. Do not exceed 2 doses or 80 mg in a 24 hours period. If 1st dose does not relieve symptoms, reevaluate condition. Ischemic cardiovascular events possible. Drug interactions with CYP 3A4 substrates and ergot derivatives

Question 110

Rizatriptan

Answer 110

Maxalt, Maxalt MLT *Antimigraine, 5-HT1 agonist -Take at onset of migraine. If headache is relieved but returns after 1st dose, repeat in 2 hours. Do not exceed 2 doses or 80 mg in a 24 hours period. If 1st dose does not relieve symptoms, reevaluate condition. Ischemic cardiovascular events possible. Drug interactions with ergot derivatives. Dissolve tablets contain phenylalanine

Question 111

Sumatriptan

Answer 111

Imitrx *Antimigraine, 5-HT1 agonist -Take at onset of migraine. If headache is relieved but returns after 1st dose, repeat in 2 hours. Do not exceed 2 doses or 80 mg in a 24 hours period. If 1st dose does not relieve symptoms, reevaluate condition. Ischemic cardiovascular events possible. Drug interactions with ergot derivatives. Available in oral tablet, injection kit and nasal spray

Question 112

Benztropine

Answer 112

Cogentin *Antiparkinson agent -May take with food to decrease GI Symptoms. Potential anticholinergic side effectd

Question 113

Levodopa/Carbidopa

Answer 113

Sinemet (CR) *Antiparkinson Agent -Avoid products containing B6 as they reduce the effectiveness of levodopa, may be taken with food/milk if GI upset occurs

Question 114

Pramipexole

Answer 114

Mirapex *antiparkinson agent -Hallucinations may occur, report any changes in vision to MD, may cause drowsiness and even sleep attacks (falling asleep without warning)

Question 115

Ropinirole

Answer 115

Requip *antiparkinson/ restless leg agent -may cause drowsiness or dizziness, avoid alcohol use during therapy , orthostasis may occur. May also cause sleep attacks

Question 116

Olanzapine

Answer 116

Zyprexa *antipsychotic -Initially may cause dizziness, use caution when operating heavy machinery due to drowsiness, may cause wt gain, DM and dyslipidemia

Question 117

Quetiapine

Answer 117

Seroquel (XR) *Antipsychotic -Initially may cause dizziness, use caution when operating heavy machinery due to drowsiness

Question 118

Risperdone

Answer 118

Risperdal *Antipsychotic -first dose may cause fainting, may impair judgment, avoid alcohol use

Question 119

Ziprasidone

Answer 119

Geodon *Antipsychotic -May cause arrhythmias, do not discontinue use abruptly, take with food

Question 120

Aripiprazole

Answer 120

Abilify *Antipsychotic for bipolar, schizophrenia and major depressive disorder -Avoid alcohol, D/I 3A4, QT prolongation, do not discontinue abruptly

Question 121

Meclizine

Answer 121

Antivert *Antivertigo agent -potential anticholinergic side effects

Question 122

Alprazolam

Answer 122

Xanax (XR) Benzodiazepine Antianxiety, C-IV -Do not exceed prescribed dose, do not take with alcohol, may cause drowsiness/dizziness, do not operate heavy machinery, avoid abrupt discontinuation

Question 123

Clonazepam

Answer 123

Klonopin *Benzo -Do not exceed prescribed dose, do not take with alcohol, may cause drowsiness/dizziness, do not operate heavy machinery

Question 124

diazepam

Answer 124

Valium *benzo -Do not exceed prescribed dose, do not take with alcohol, may cause drowsiness/dizziness, do not operate heavy machinery

Question 125

Lorazepam

Answer 125

Ativan *Benzo -Do not exceed prescribed dose, do not take with alcohol, may cause drowsiness/dizziness, do not operate heavy machinery

Question 126

Temazepam

Answer 126

Restoril *Benzo -Do not exceed prescribed dose, do not take with alcohol, may cause drowsiness/dizziness, do not operate heavy machinery

Question 127

Phentermine

Answer 127

Adipex-P *CNS stimulant - obesity management, C-IV -Cardiovascular risk caution, take in the morning

Question 128

Methylphenidate

Answer 128

Concerta or Ritalin (ER) or Metadate CD *CNS stimulant for ADD, C-II -take as directed, don't share your pills

Question 129

Atomoxetine

Answer 129

Strattera *CNS stimulant, used for ADD may impair cognitive & motor function, use caution when operating machinery, not a drug of abuse

Question 130

(Dex)/Amphetamine mixed salts

Answer 130

Adderall (XR) *CNS stimulant, used for ADD; C-II -take as directed, don't share your pills

Question 131

Lisdexamfetamine

Answer 131

Vyvanse *CNS stimulant, used for ADHD; C-II -take as directed, don't share your pills

Question 132

Modafinil

Answer 132

Provigil *CNS stimulant, used for narcolepsy; C-IV -Take in morning or 1 hour prior to work, avoid driving until deemed safe by MD

Question 133

Dexmethylphenidate

Answer 133

Focalin (XR) *CNS stimulant; C-II -Take as directed, don't share your pills

Question 134

Zaleplon

Answer 134

Sonata *hypnotic, nonbenzo; C-IV -Take 30 mins prior to desired sleep, allocate at least 5 hours after dose to sleep (t1/2 ~1 hour)

Question 135

Cyclobenzaprine

Answer 135

Flexeril *Muscle relaxant -may cause drowsiness or dizziness and other anticholinergic side-effects, avoid alcohol use during therapy

Question 136

Metaxalone

Answer 136

Skelaxin *Muscle relaxant -Least drowsy muscle relaxant, requires frequent dosing

Question 137

Carisoprodol

Answer 137

Soma *Muscle relaxant; C-IV -drug of abuse, may be schedules in some state, caution for drowsiness

Question 138

Fentanyl

Answer 138

Duragesic *Narcotic analgesic C_II -Caution for respiratory depression, do not exceed prescribed dose. Avoid exposing patch on the skin to heat as it will increase the risk of toxicity, dispose of the used patch by folding over and flushing it, be careful when starting therapy and remember the patch is used for several days normally 72 hours but may see it unchanged every 48 hours in some patients. Caution in narcotic naive patients as it is 80-100 times more potent analgesic than morphine

Question 139

Morphine Sulfate

Answer 139

MS Contin *Narcotic -Risk of CNS and respiratory depression, avoid alcohol, may cause drowsiness/dizziness, do not operate heavy machinery, constipation

Question 140

Oxycodone

Answer 140

Oxycontin *Narcotic -CNS depression, avoid alcohol, may cause drowsiness/ dizziness, do not operate heavy machinery, constipation

Question 141

Oxycodone/APAP

Answer 141

Percocet or Roxicet *Narcotic -CNS depression, avoid alcohol, may cause drowsiness/dizziness, do not operate heavy machinery, constipation . APAP combination dose will be reduced to no more than 325 mg per tablet. Consider the total daily dose of acetaminophen from all sources

Question 142

Acetaminophen/ codeine

Answer 142

Tylenol with codeine *narcotic -CNS depression, avoid alcohol, may cause drowsiness/ dizziness, do not operate heavy machinery, constipation. Consider the total daily dose of acetaminophen from all sources

Question 143

Hydrocodone/ chlorpheniramine Polistirex

Answer 143

Tussionex *Narcotic -CNS depression, avoid alcohol, may cause drowsiness/dizziness, do not operate heavy machinery, constipation, taking with food may decrease some GI upset, Max dose 5mls BID

Question 144

Hydrocodone/ibuprofen

Answer 144

Vicoprofen *Narcotic -CNS depression, avoid alcohol, may cause drowsiness/dizziness, do not operate heavy machinery, constipation, taking with food may decrease some GI upset

Question 145

Hydrocodone/APAP

Answer 145

Lortab or Vicodin or Lorect *Narcotic -CNS depression, avoid alcohol may cause drowsiness/dizziness, do not operate heavy machinery, avoid concomitant said drugs, constipation. Vicodin reformulated to contain only 300 mg of APAP per dose to avoid generic competition and to meet new FDA requirement

Question 146

Pregabalin

Answer 146

Lyrica *Neuropathic analgesic -may cause drowsiness, do not discontinue therapy abruptly. weight gain, edema and confusion are potential side-effects

Question 147

Varenicline tartrate

Answer 147

Chantix *Nicotinic receptor agonist, smoking cessation -Usually titrated upward. most effective smoking cessation agent to date ~44% at 12 weeks, also watch for nightmares and any changes in affect and/or behavior and report them to the prescriber. side effects may be dose related

Question 148

Memantine

Answer 148

Namenda *NMDA receptor antagonist; anti-alzheimer's agent -Take in the evening, potential N&D, dizziness and agitation possible. Set realistic expectations. Keep in mind positive statistical significance vs clinical significance. Take without regard to food

Question 149

Enteric diclofenac sodium, diclofenac potassium (non-enteric coated formulation)

Answer 149

Voltaren, Cataflam *NSAID Take with food, monitor for s/sx of GI bleed, CV and renal risks. Enteric coated diclofenac sodium, slow onset not for PRN pain, greater risk of hepatotoxicity vs other NSAIDs, use the Cataflam-diclofenac potassium non-enteric coated formulation if for PRN use for pain

Question 150

Etodolac

Answer 150

Lodine (XL) *NSAID Take with food, monitor for s/sx of GI bleed, CV and renal risks

Question 151

Indomethacin

Answer 151

Indocin *NSAID -Take with food, monitor for s/sx of GI bleed. CV and renal risks. Most likely NSAID to cause headaches and CNS side effects

Question 152

Ketorolac Tromethamine

Answer 152

Toradol *NSAID -Take with food, monitor for s/sx of GI bleed. Very high risk of GI bleeding limits this drug to 5 days max of therapy. CV and renal risk s

Question 153

Meloxicam

Answer 153

Mobic *NSAID -Take with food, monitor for s/sx of GI bleed. CV and renal risks

Question 154

Nabumetone

Answer 154

Relafen *NSAID -Take with food, monitor for s/sx of GI bleed. CV and renal risks

Question 155

Naproxen and Naproxen sodium

Answer 155

Naprosyn, Anaprox/ Aleve *NSAID -Take with food, monitor for s/sx of GI bleed. CV and renal risks. Naproxen sodium Aleve/Anaprox fast onset sodium salt vs regular naproxen - Naprosyn which is slow onset and used for chronic Rx of OA and RA not acute pain relief

Question 156

Piroxicam

Answer 156

Feldene *NSAID -Take with food, monitor for s/sx of GI bleed, CV and renal risks

Question 157

Ibuprofen

Answer 157

Motrin or Advil *NSAID -take with food, monitor for s/sx of GI bleed, CV and renal risks. Motrin at low doses (IE OTC it is analgesic and antipyretic) but if you need anti-inflammatory effects then you need higher doses 2400 to 3200 mg/day

Question 158

Celecoxib

Answer 158

Celebrex *NSAID Cox-II selective -Report s/sx of GI bleed, caution for CV risks like all NSAIDs, not safer for renal function but may be slightly safer for GI bleeding risks

Question 159

Diclofenac/ Misoprostol

Answer 159

Arthrotec *NSAID / prostaglandin combo -Take with food. Misoprostol may decrease GI bleeding risks. CV and renal risks. Avoid in pregnancy. Diarrhea may be a common side effect of the prostaglandin component

Question 159

Tramadol

Answer 159

Ultram, Ultram ER *Opioid analgesic -May cause drowsiness; avoid alcohol. Drug is scheduled in some states but not by the DEA. Some risk of dependence due to weak opioid receptor agonist activity. Drug also has some serotonin reuptake inhibitor properties; increased seizure risk, and drug interactions (especially with SSRIs, SNRIs, 5-HT1 agonists/triptans)

Question 160

Tramadol + acetaminophen

Answer 160

Ultracet *Opioid analgesic combo -May cause drowsiness; avoid alcohol. Drug is scheduled in some states but not by the DEA. Some risk of dependence due to weak opioid receptors agonist activity. Drug also has some serotonin syndrome, increased seizure risk, and drug interactions (especially with SSRIs, SNRIs, 5-HT1 agonists/ triptans) Do not exceed 4g of APAP per day, 3 g if frequent alcohol drinker, 2 g if taking warfarin. BBW with acetaminophen due to hepatotoxicity

Question 161

Acetaminophen

Answer 161

Tylenol *Pain, antipyretic -Limit total daily dose <4g, 3 g in elderly or frequent ETOH, 2 g if taking warfarin, consider the total daily dose of acetaminophen from all sources. BBW with acetaminophen due to hepatotoxicity and warning related to angioedema

Question 162

Eszopiclone

Answer 162

Lunesta *sedative hypnotic -Do not take with alcohol, take 30 min prior to bed. has long half life of ~6 hours and thus an increased risk of morning residual sedation ~40% of patients complain of a bitter taste the morning after, need to have at least 8 hours to sleep after a dose and all of these agents can cause complex sleep behaviors (walking, eating, driving) Do not put yourself in a position where impairment may lead to increased risk of an accident until you know how you respond to the medication

Question 163

Zolpidem

Answer 163

Ambien (CR) *sedative hypnotic ; C-IV -Do not take with alcohol, take 30 min prior to bed. Same issues as Lunesta. Lower dosing guidelines for wome

Question 164

Desvenlafaxine

Answer 164

Pristiq *SNRI -Avoid alcohol, do not discontinue abruptly, not added benefit over venlafaxine- recommend generic venlafaxine

Question 165

Duloxetine

Answer 165

Cymbalta *SNRI -Do not abruptly discontinue therapy. report any changes in affect and or behavior as psychiatric side effects including suicidal ideation is possible

Question 166

Venlafaxine

Answer 166

Effexor (XR) *SNRI -avoid alcohol, do not discontinue abruptly, monitor BP

Question 167

Citalopram

Answer 167

Celexa *SSRI -may cause drowsiness, do not discontinue therapy abruptly. avoid in patients with CV disease as it has been shown to increase QT interval

Question 168

Escitalopram

Answer 168

Lexapro *SSRI -may cause drowsiness, do not discontinue therapy abruptly

Question 169

Fluoxetine

Answer 169

Prozac or Sarafem *SSRI -May cause drowsiness or dizziness, avoid alcohol use during therapy- prozac longest half life SSRI, most activating SSRI AM dosing not PM and a major inhibitor of CYP 2D6

Question 170

Paroxetine

Answer 170

Paxil (CR) *SSRI -May cause drowsiness, do not discontinue therapy abruptly. Paxil most likely agent to cause discontinuation syndrome. Sedation, major CYP2D6. approved for hot flashes related to menopause

Question 171

Sertraline

Answer 171

Zoloft *SSRI antidepressant -may cause drowsiness or dizziness, avoid alcohol use during therapy. Drug of choice for patients with CV disease and MDD

Question 172

Lidocaine

Answer 172

Lidoderm Patches *topical analgesic -do not apply to broken skin, do not leave patches on for more than 12 hours in a 24 hour period

Question 173

Amitriptyline

Answer 173

Elavil *TCA -may cause drowsiness or dizziness, avoid alcohol use during therapy. rarely used for depression and usually used in low doses for off label uses (headache, pain, neuropathy) as it is a side effect of this agent and it is not well tolerated secondary to anticholinergic effects, risk of overdose causing CV death and arrhythmias, caution for suicidal ideation

Question 174

Imipramine

Answer 174

Tofranil (PM) *TCA -May cause drowsiness or dizziness, avoid alcohol use during therapy. Also has significant anticholinergic effects and risk of overdose like Elavil

Question 175

Lithium Carbonate

Answer 175

Eskalith or Lithobid *Mood stabilizer -Do not exceed recommended doses, consume 2-3 quarts of water qday. monitor serum levels and watch out for drug interactions with thiazide diuretics which require a dosage reduction of lithium

Question 176

Adapalene

Answer 176

Differin *Topical acne product Acne may worsen before it improves; using more than recommended increases risk of skin reactions. Use as little product as can cover the face or affected areas with a thin film. Caution against sun exposure and recommended sunscreen

Question 177

Clindamycin/ Benzoyl Peroxide

Answer 177

Benzaclin *Topical acne product -may cause skin irritation, use a sparing amount. Topical acne products remind patients that their acne may get worse before it gets better and exceeding the recommended doses will increase the risk of severe adverse effects

Question 178

Erythromycin/ Benzoyl peroxide

Answer 178

Benzamycin *Topical acne product -May cause skin irritation, use a sparing amount. Topical acne products remind patients that their acne may get worse before it gets better and exceeding the recommended doses will increase the risk of severe adverse effects

Question 179

clobetasol

Answer 179

Clobex *topical corticosteroid -use a sparing amount, avoid application on face and around eyes

Question 180

Mometasone

Answer 180

Elocon *topical corticosteroid -use sparing amount, avoid application around eyes

Question 181

triamcinolone

Answer 181

Kenalog *topical corticosteroid -use a sparing amount, avoid application around eyes, available in ointment, cream and lotion

Question 182

pimecrolimus

Answer 182

Elidel *topical skin product BBW due to skin cancer risk

Question 183

Clotrimazole/ betamethasone diproprionate

Answer 183

Lotrisone *topical antifungal/corticosteroid -use sparing amount, avoid application

Question 184

Fluocinonide topical

Answer 184

Lidex, Lidez-E vanos *Topical corticosteroid -Use a sparing amount, avoid application on face and around eyes

Question 185

Finasteride

Answer 185

Propecia or Proscar *5 alpha reductase inhibitor -Pregnant women should not handle, will not regrow hair but will prevent additional hair loss, sexual dysfunction which may not be reversible in men, when used for BPH they are not rapidly effective and may take 6 plus months to shrink and enlarge prostate and produce a reduction in symptoms, probably best when used in combo with an alpha blocker to reduce symptoms and prevent or delay the need for surgical intervention

Question 186

isotretinoin

Answer 186

Accutane or Claravis *acne treatment -Must follow REMS system for isotrentinoin dispensing and counseling. teratogenic category X, adverse lipid effects especially increased TG and psychiatric effects and as with topical products acne may get worse before it gets better

Question 187

testosterone

Answer 187

Androgel *androgen; C-III -Use as directed to upper arm and shoulder and not to genitals. women and children should avoid contact with this medication; men with BPH may get worse

Question 187

Metformin

Answer 187

Glucophage (XR), Fortamet *antidiabetic- biguanide -GI upset, diarrhea and best titration to minimize symptoms, may lead to B12 deficiency related neuropathy

Question 188

Sitagliptin, Sit + Metformin

Answer 188

Januvia, Janumet (XR) *Antidiabetic-dipeptidyl peptidase IV inhibitor -Take without regard to food, risk of pancreatitis

Question 189

Saxaglitptin

Answer 189

Onglyza *antidiabetic- dipeptidyl peptiase IV inhibitor -take without regard to food, risk of pancreatitis, concomitant use of CYP3A4 inh- use 2.5 mg instead of 5 mg QD

Question 190

glimepiride

Answer 190

Amaryl *antidiabetic- sulfonylurea -take with breakfast, avoid alcohol use, counsel on hypoglycemic risk

Question 191

glipizide

Answer 191

Glucotrol (XL) *antidiabetic- sulfonylurea -may cause hypoglycemia due to active metabolites

Question 192

glyburide, glyburide/metformin

Answer 192

Micronase, Glucovance *antidiabetic- sulfonylurea -take with breakfast, avoid alcohol use. has an active metabolite which is renally eliminated and thus increased sick of hypoglycemia and weight gain as patients age, may also increase CV events and no longer a recommended agent by ADA

Question 193

Pioglitazone

Answer 193

Actos *antidiabetic - thiazolidinedione -take without regard to meals, increased risk of fractures, macular edema, heart failure, weight gain and edema as well as bladder CA in men

Question 194

Exenatide, Exenatide weekly

Answer 194

Byetta, Bydureon *Antidiabetic- glucagon-like peptide 1 receptor agonist -counsel on pen injection technique. nausea and vomiting tend to be dose related and transient start with 5 mcg daily dose and after a month increase to 10 mcg dose, watch for signs of pancreatitis and can be dosed 60 mins or less before meals twice a day

Question 195

liraglutide

Answer 195

victoza *antidiabetic GLP1 -Counsel on pen injection technique. nausea and vomiting tend to be dose related and transient, watch for signs of pancreatitis. Box warning- risk of thyroid C-cell tumors

Question 196

alendronate

Answer 196

Fosamax *Bisphosphonate Osteoporosis agent -Take on an empty stomach with a full glass of water, must sit or stand for 30 minutes following the dose. osteonecrosis of the jaw and atypical fractures

Question 197

Ibandronate

Answer 197

Boniva *Bisphosphonate Osteoporosis agent -take on an empty stomach with a full glass of water, must sit or stand for 60 minutes following the dose, osteonecrosis of the jaw and atypical fractures

Question 198

Risedronate, delayed release enteric coated risedonate

Answer 198

Actonel, Atelvia *Bisphosphonate Osteoporosis agent -take on an empty stomach with a full glass of water, must sit or stand for 30-60 minutes following the dose. Atelvia is enteric coated formulation which should be taken after breakfast but not available as generic, osteonecrosis of jaw and atypical fractures

Question 199

Estrogen/ methyltestosterone

Answer 199

Estratest (HS) *Combination hormone -CV, thromboembolic caution

Question 200

Estradiol/ norethindrone

Answer 200

Combipatch *Estrogen and progestin combination -stable at room temperature for 3 months

Question 201

conjugated estrogens

Answer 201

Premarin *estrogen hormone -may take with food to decrease GI symptoms

Question 202

Estradiol

Answer 202

Climara, Estrace *Estrogen hormone -CV, thromboembolic caution

Question 203

Raloxifene

Answer 203

Evista *Estrogen receptor modulator, post-menopausal osteoporosis -CV risk and thromboembolic BBWs, may increase TGs, myalgia. may cause worsen hot flashes

Question 204

Conjugated Estrogens with medroxyprogesterone

Answer 204

Prempro or Premphase *Estrogen-progestin hormone combo -increased risk of CV and DVT as well as dementia with long term therapy, report any abnormal vaginal bleeding

Question 205

Colchicine

Answer 205

Colcrys *Gout- inflammatory mediator -long term therapy requires blood work, no more than 3 tablets for an acute attack with similar efficacy to 8 tablets but with much less risk of GI toxicity

Question 206

Allopurinol

Answer 206

Zyloprim *gout- xanthine oxidase inhibitor -consume large amounts of fluids to prevent kidney stone formation. start with 100 mg QD after an acute gout attack has subsided and gradually increase the dose at no more than weekly interval to about 300 mg QD to reduce the risk of mobilization gout, may also add low dose colchicine 1-2 tabs per day for prevention of mobilization gout, D/C at first signs of a rash

Question 207

Febuxostat

Answer 207

Uloric *gout- xanthine oxidase inhibitor -same as allopurinol but may be safe in patients with a history of adverse skin reactions to allopurinol

Question 208

Medroxyprogesterone acetate

Answer 208

Provera *Hormone/progestin -may take with food to decrease GI symptoms, preg cat: X, may lead to uterine bleeding irregularities, long term use may decrease bone mineral density

Question 209

Insulin- regular

Answer 209

Humulin R *Insulin fast acting -injection technique, hypoglycemia, take 15-30 mins prior to meal

Question 210

Insulin- NPH

Answer 210

Humulin N *Insulin intermediate acting -counsel on injection technique and hypoglycemia

Question 211

Insulin detemir

Answer 211

Levemir *Insulin- intermediate-long acting -cannot be mixed with another insulin

Question 212

Insulin Glargine

Answer 212

Lantus *insulin -long acting -cannot be mixed with another insulin, may have an increase in injection site pain/rxn

Question 213

Insulin aspart

Answer 213

Novolog *insulin- rapid acting -take immediately before meals, counsel on injection technique and hypoglycemia

Question 214

Insulin lispro

Answer 214

Humalog *Insulin- Rapid Acting -Take immediately before meals, counsel on injection technique and hypoglycemia

Question 215

Insulin Glulisine

Answer 215

Apridra *Insulin- rapid acting -take immediately before meals, counsel on injection technique and hypoglycemia

Question 216

Ethinyl Estradiol/ drospirenone

Answer 216

Yasmin, Ocella, Yaz *Oral contraceptive -take everyday, counsel on missed dose protocol, caution with antibiotics, increased risk of VTEs especially in older women and those who smoke; risk of hyperkalemia

Question 217

Ethinyl estradiol/ desogestrel

Answer 217

Kariva, ortho-cept, Mircette, Desogen or Apri *Oral contraceptive -Take everyday, counsel on missed dose protocol, caution with antibiotics, increased risk VTEs especially in older women and those who smoke; risk of hyperkalemia

Question 218

Ethinyl estradiol / levonorgestrel

Answer 218

Aviane, Alesse *oral contraceptive -take everyday, counsel on missed dose protocol, caution with antibiotics. increased risk of VTEs especially in older women and those who smoke, risk of hyperkalemia

Question 219

Norethindrone/ Ethinyl Estradiol, Fe+

Answer 219

Loestrin FE *oral contraceptive -take at the same time everyday, counsel on missed dose protocol. caution with antibiotics, smoking

Question 220

norgestimate & ethinyl estradiol

Answer 220

TriNessa, Tri-Sprintec *oral contraceptive

Question 221

Norgestimate/ ethinyl estradiol

Answer 221

Ortho Tri-Cyclen (Lo) *oral contraceptive

Question 222

Insulin 70% NPH / 30% Regular

Answer 222

Novolin 70/30, Humulin 70/30 *Pre-mixed insulin -injection technique and hypoglycemia. Intermediate:fast acting

Question 223

Insulin 70% protamine/ 30% rapid acting

Answer 223

Novalog Mix 70/30, Humalog mix 70/30 *Premixed insulin -Intermediate: rapid acting

Question 224

medroxyprogesterone

Answer 224

Depa-Provera *Progestin contraceptive -may cause weight gain, pregnancy cat X, may lead to uterine bleeding irregularities, long term use may decrease bone mineral density

Question 225

Prednisone

Answer 225

Deltasone *steroid anti-inflammatory -take with food, may cause agitation, insomnia

Question 226

methylprednisolone

Answer 226

Medrol *steroid anti-inflammatory/ allergy -take with food, may cause agitation, insomnia

Question 227

Desiccated thyroid

Answer 227

Armour thyroid *Thyroid Hormone -Take on an empty stomach in the morning

Question 228

Levothyroxine

Answer 228

Synthroid or Levoxyl *Thyroid hormone (synthetic T4) -Take drug on an empty stomach in the morning with full glass of water at least 30 minutes prior to food ( not close to calcium) stay on specific brand or generic due to bioavailability issues, TSH monitoring adverse drug reactions early on often due to too high of dosing (med induced hyperthyroidism- heat intolerance and sweating, frequent bowel movements, restlessness, tachycardias, hair loss) Takes 4 weeks to reach new steady state levels and TSH may lag another 2-3 weeks

Question 229

Estradiol

Answer 229

Vivelle- Dot, Estraderm *topical estrogen patch -counsel on twice weekly patch application

Question 230

Ethinyl estradiol/ etonogestrel

Answer 230

NuvaRing *Vaginal contraceptive -Counsel on vaginal application, 3 weeks in, 1 week off

Question 231

Estradiol

Answer 231

Vagifem *Vaginal estrogen -counsel on vaginal tablet use with vagifem

Question 232

Dicyclomine

Answer 232

Bentyl *Anticholinergic for cramping/ irritable bowel -may cause dry mouth, dizziness. avoid alcohol use

Question 233

Hyoscyamine

Answer 233

Levsin/Levbid/Levsinex *anticholinergic for cramping/ irritable bowel -take before meals. may experience dizziness, blurred vision, constipation

Question 234

Loperamide

Answer 234

Imodium *antidiarrheal -may cause drowsiness, contact MD if diarrhea persists longer than 48 hours

Question 235

Diphenoxylate/ atropine

Answer 235

Lomotil *Antidiarrheal; C-V -Do not exceed prescribed dose, anticholinergic side effects possible

Question 236

Promethazine

Answer 236

Phenergan *Antihistamine- N/V -may cause anticholinergic side effects

Question 237

Lubiprostone

Answer 237

Amitiza *Chloride Channel Activator -Take with food to decrease nausea

Question 237

Famotidine

Answer 237

Pepcid *H2 antihistamine -Do not exceed 14 days of OTC therapy unless directed by MD, report severe abdominal pain/ discomfort to MD

Question 238

Orlistat

Answer 238

Xenical *Fat absorption inhibitor -caution regarding uncontrollable oily bowel movements, especially after high fat meal, patient should take supplemental fat soluble vitamins at least 2 hours prior to orlistat dose

Question 239

Ranitidine

Answer 239

Zantac *H2 antihistamine -Do not exceed 14 days of OTC therapy unless directed by MD, report severe abdominal pain/discomfort

Question 240

Polyethylene Glycol

Answer 240

Miralax, Glycolax *laxative -safe for daily use

Question 241

metoclopramide

Answer 241

Reglan *Promotility -antiemetic -take 30 minutes prior to meal, avoid use with alcohol, associated with extrapyramidal symptoms and depression, caution in elderly

Question 242

Esomeprazole

Answer 242

Nexium *PPI -Take 30-60 mins prior to a significant meal. pro-drug: need to be absorbed in that state and are activated within the parietal cell when the patient stimulates the to secrete acid by eating. They also have a short half life of 1-2 hours. Risk include C. diff, pneumonia, fractures and low serum magnesium levels in addition to b12 deficiency

Question 243

Lansoprazole

Answer 243

Prevacid *PPI -Take 30-60 mins prior to a significant meal. pro-drug: need to be absorbed in that state and are activated within the parietal cell when the patient stimulates the to secrete acid by eating. They also have a short half life of 1-2 hours. Risk include C. diff, pneumonia, fractures and low serum magnesium levels in addition to b12 deficiency

Question 244

Omeprazole

Answer 244

Prilosec *PPI - Take 30-60 mins prior to a significant meal. pro-drug: need to be absorbed in that state and are activated within the parietal cell when the patient stimulates the to secrete acid by eating. They also have a short half life of 1-2 hours. Risk include C. diff, pneumonia, fractures and low serum magnesium levels in addition to b12 deficiency

Question 245

Pantoprazole

Answer 245

Protonix *PPI -Take 30-60 mins prior to a significant meal. pro-drug: need to be absorbed in that state and are activated within the parietal cell when the patient stimulates the to secrete acid by eating. They also have a short half life of 1-2 hours. Risk include C. diff, pneumonia, fractures and low serum magnesium levels in addition to b12 deficiency

Question 246

Rabeprazole

Answer 246

Aciphex *PPI -Take 30-60 mins prior to a significant meal. pro-drug: need to be absorbed in that state and are activated within the parietal cell when the patient stimulates the to secrete acid by eating. They also have a short half life of 1-2 hours. Risk include C. diff, pneumonia, fractures and low serum magnesium levels in addition to b12 deficiency

Question 247

Omeprazole/ sodium bicarbonate

Answer 247

Zegerid *PPI/ antacid combo - Take 30-60 mins prior to a significant meal. pro-drug: need to be absorbed in that state and are activated within the parietal cell when the patient stimulates the to secrete acid by eating. They also have a short half life of 1-2 hours. Risk include C. diff, pneumonia, fractures and low serum magnesium levels in addition to b12 deficiency

Question 248

Dutasteride

Answer 248

Avodart *BPH - 5 alpha reductase inhibitor -Capsules should not be handled by women, takes time for shrinkage of prostate and symptom relief

Question 249

Tamsulosin

Answer 249

Flomax *BPH - selective alpha blocker -Take 30 minutes after the same meal every day. May cause dizziness

Question 250

Alfuzosin

Answer 250

Uroxatral *BPH- selective alpha blocker -Take prior to bedtime to avoid orthostatic hypotensive effects

Question 251

Vardenafil

Answer 251

Levitra *Erectile dysfunction- vasodilator -Report erections lasting longer than 4 hours to the ER, avoid nitroglycerin use

Question 252

sildenafil

Answer 252

Viagra *Erectile dysfunction -vasodilator -Report erections lasting longer than 4 hours to the ER, avoid nitroglycerin use

Question 253

Tadalafil

Answer 253

Cialis *Erectile dysfunction - vasodilator -Report erections lasting longer than 4 hours to the ER, avoid nitroglycerin use

Question 254

Oxybutynin

Answer 254

Ditropan (XL) *Urinary incontinence- anticholinergic *May cause dry mouth, dizziness. avoid alcohol use

Question 255

Tolterodine

Answer 255

Detrol (LA) *Urinary incontinence - anticholinergic - May cause dry mouth, dizziness. Avoid alcohol use.

Question 256

Darifenacin

Answer 256

Enablex *Urinary incontinence- anticholinergic -May cause dry mouth, dizziness. avoid alcohol use

Question 257

phenazopyridine

Answer 257

Pyridium *Urinary Tract Analgesic -urine will change to orange-red color, used for symptom relief only

Question 258

cholecalciferol

Answer 258

calcitriol *vitamin D supplement -take with food to decrease GI problems

Question 259

Brimonidine

Answer 259

Alphagan P *Agent for Glaucoma -Refer to eye-drop technique handout.

Question 260

Lantanaprost

Answer 260

Xalatan *Agent for glaucoma -Refer to eye-drop technique handout. Stable at room temperature for 6 weeks

Question 261

Timolol

Answer 261

Timoptic (XE) *Agent for glaucoma -Refer to eye-drop technique handout.

Question 262

Travoprost

Answer 262

Travatan *Agent for glaucoma -Refer to eye-drop technique handout

Question 263

Brimonidine/ Timolol

Answer 263

Combigan *Alpha II agonist/ beta blocker/ antiglaucoma -Refer to eye-drop technique handout

Question 264

Olopatadine

Answer 264

Pataday or Patanol *Antiallergy -Refer to eye-drop technique handout

Question 265

Tobramycin/ Dexamethasone

Answer 265

Tobradex *Antibiotic/anti-inflammatory -Refer to eye-drop technique handout

Question 266

Moxifloxacin

Answer 266

Vigamox *Antibiotic/ opthalmic -refer to eye drop technique handout

Question 267

Cyclosporine

Answer 267

Restasis *Calcineurin inhibitor -Invert vial several times prior to use to create uniform emulsion. Used every 12 hours

Question 268

Dorzolamide/ timolol

Answer 268

Cosopt *Carbonic anhydrase inhibitor/ beta blocker/ antiglaucoma

Question 269

gatifloxacin

Answer 269

Zymar *Fluoroquinolone -eye drop

Question 270

Bimatoprost

Answer 270

Lumigan *prostaglandin analog for glaucoma treatment -eye drop

Question 271

Neomycin/polymyxin/ hydrocortisone

Answer 271

Cortisporin Otic *Otic antibiotic -ear drop

Question 272

Ciprofloxacin/ dexamethasone, ciprofloxacin/ hydrocortisone

Answer 272

Ciprodex, Cipro HC *Otic antibiotic/ corticosteroid -ear drop

Question 273

Azelastine

Answer 273

Astelin *Allergic Rhinitis - Topical H1 antagonist -prime 4x upon assembly, 2x if left unused for 3 days or more

Question 274

Budesonide Nasal Spray

Answer 274

Rhinocort Aqua *Allergic rhinitis- nasal steroid -may cause taste distortion, effects seen after several days of therapy, may cause nasal irritation, bleeding

Question 275

Fluticasone

Answer 275

Flonase *Allergic rhinitis- nasal steroid -may cause taste distortion, effects seen after several days of therapy, may cause nasal irritation, bleeding

Question 276

Mometasone

Answer 276

Nasonex *Allergic rhinitis- nasal steroid -may cause taste distortion, effects seen after several days of therapy, may cause nasal irritation, bleeding

Question 277

Montelukast

Answer 277

Singulair *Anti-asthmatic - leukotriene inhibitor -Chewable tablet contains phenylalanine

Question 278

Albuterol

Answer 278

Proair HFA or Ventolin HFA or Proventil HFA *Anti-asthmatic - short acting beta 2 agonist -available in both MDI and nebulizer soln. Counsel on appropriate device use and prn rescue dosing. May also be use for prophylaxis for exercise-induce asthma. May cause jitteriness, nervousness, tachycardia and decrease effectiveness of beta blockers

Question 278

Budesonide inhalation suspension

Answer 278

Pulmicort Respules, Flexhaler *Anti-asthmatic- steroid - some effects seen after 2 days of therapy, max effect seen within 2 weeks, not for rescue

Question 279

Levalbuterol

Answer 279

Xopenex (HFA) *Anti-asthmatic- short acting beta 2 agonist -counsel on appropriate MDI use and prn rescue dosing

Question 279

Fluticasone/ salmeterol

Answer 279

Advair *Anti-asthmatic -steroid / LA B2 agonist/ controller - diskus; do not shake after activating, not for rescue

Question 280

Fluticasone

Answer 280

Flovent *Antiasthmatic - steroid -not for rescue

Question 281

Albuterol/ Ipratropium

Answer 281

Respimat or Duoneb *Antiasthmatic / COPD combo, Bronchodilator/ anticholinergic

Question 282

Ipratropium Bromide

Answer 282

Atrovent -Anticholinergic antibronchospasm and antisecretory

Question 282

Tiotropium

Answer 282

Spiriva HandiHaler *Anticholinergic bronchodilator for COPD

Question 283

Cetirizine

Answer 283

Zyrtec *Antihistamine 2nd generation H1 -may cause drowsiness, dizziness or dry mouth

Question 284

Desloratadine

Answer 284

Clarinex *Antihistamine, 2nd generation H1 -may cause drowsiness, dizziness or dry mouth

Question 285

Loratidine

Answer 285

Caritin *Antihistamine 2nd generation H1 -may cause drowsiness, dizziness or dry mouth

Question 286

Fexofenadine (PSE)

Answer 286

Allegra (D) *Antihistamine 2nd generation H1 (+decongestant) -may cause drowsiness, do not take with fruit juices. take D products in AM

Question 287

Guaifenesin

Answer 287

Mucinex (D, DM) *expectorant (+/- decongestant, antitussive) -take with a large glass of water, BID dosing, PSE may cause insomnia, PSE contraindicated in patients with CV risk, hypertension, DM drug interactions

Question 288

Guaifenesin & codeine

Answer 288

Cheratussin AC *Expectorant/ Antitussive combo- CV -take with water, codeine side effects possible