KC's Top 200 Generic / Counseling Points - Pearls

Question 1

acyclovir

Answer 1

Common side effects: nausea, vomiting, diarrhea, headache,malaise

Initiate therapy as soon as possible, either during prodrome or at onset of rash

Take with full glass of water to decrease potential for crystallization in the kidney

Maintain adequate hydration during therapy Inhibits CYP1A2 (weak)

DIs - avoid concomitant use with: Foscarnet,Varicella vaccine, Zoster vaccine

Renal dosing: (oral) adjust with CrCl <10-25mL/min; (IV) adjust with CrCl <50mL/min

Dosage forms: (oral) capsule, suspension, tablet (parenteral) concentrate,infusion

Pregnancy cat B

Question 2

Adalimumab

Answer 2

Common side effects: injection site reaction, rash, headache, nausea, upper respiratory infection, cough, increased CPK

Avoid receiving immunizations during therapy and for at least 3 months after therapy with TNF inhibitor; decreased efficacy of inactivated vaccine, increased risk of vaccinial infection with live vaccines

If patient experiences: stomach pain or cramping, unusual bruising or bleeding, persistent fever, rash, night sweats, significant weight loss, muscle weakness, and/or signs of respiratory infection, stop medication and contact healthcare provider

High doses contraindicated in patients with moderate to severe heart failure

Biosimilar product is not interchangeable

Monitor CBC, signs/symptoms of heart failure, infection, malignancy, TB, chronic infections

Dosage form:injection

Pregnancy cat B

Question 3

Albuterol (inhalation)

Answer 3

Common side effects (more common with short-acting beta-2 ags than with long-acting agents): nervousness, tachycardia, tremor, headache, CNS stimulation, cough, nausea, throat irritation, pharyngitis respiratory infection

Counsel on proper administration technique; use spacer for increased effectiveness

Rescue use only. Contact healthcare provider if: using more than 2 times per week and not takng any anti-inflammatory inhalers

Contraindicated in patients with severe hypersensitivity to milk proteins

Dosage forms: HFA inhaler, breath-activated aerosol powder, nebulizer solution, tablet, extended-release tablet,syrup

Pregnancy cat C

Question 4

Albuterol / ipratropium

Answer 4

Common side effects: dry mouth, nervousness, throat irritation, tachycardia

Patients with glaucoma or urinary retention should report worsening symptoms

Counsel on proper administration technique; use spacer for increased effectiveness

Dosage forms: solution for oral inhalation, solution for nebulization

Pregnancy cat C

Question 5

Alendronate

Answer 5

Common side effects: abdominal pain, dyspepsia, nausea, hypocalcemia

Administration: Take at least 30 minutes before eating/drinking first thing in morning with 6-8 oz. of plain water only; do not lie down for 30 minutes after taking, and until after eating

Take supplemental calcium and vitamin D if dietary intake is inadequate

Aspirin and NSAIDs increase risk of GI events

Antacids decrease absorption of oral bisphosphonates

Renal dosing: use not recommended in CrCl <35mL/min

Dosage forms: tablet, effervescent tablet, solution

Pregnancy cat C

Question 6

Allopurinol

Answer 6

Common side effects: maculopapular rash and pruritis, acute gout attack, diarrhea, nausea, increased LFTs

Contraindicated if history of Allopurinol Hypersensitivity Syndrome

Monitor CBC, serum uric acid levels, LFTs, renal function, hydration status; increased INR frequency monitoring may be required

Report fever, sore throat, painful urination, blood in urine and/or swelling of mouth or lips to healthcare provider

Renal dosing: CrCl 10-20mL/min (200mg/day); CrCl 3-10mL/min (Do not exceed 100mg/day); CrCl <3mL/min (Extend dosing interval, do not exceed100mg/day)

Dosage forms: tablet, injection

Pregnancy cat C

Question 7

Alprazolam

Answer 7

Common side effects: Sedation, somnolence, confusion, dizziness, coordination problems, dysarthria

Contraindications: narrow-angle glaucoma, concurrent use with potent CYP3A4 inhibitors

May cause CNS depression; use caution when performing tasks such as driving or operating machinery

Avoid abrupt discontinuation- withdrawal and possible seizures may occur

Do not push ODTs through foil; peel foil back and remove with dry finger

Major substrate of CYP3A4; high DDI risk

Hepatic dosing: dose reduction in advanced hepatic disease

Dosage forms: tablet, extended-release tablet, orally disintegrating tablet (ODT), solution

Pregnancy cat D

Question 8

Amitriptyline

Answer 8

Common side effects: anticholinergic effects (dry mouth, constipation, urinary hesitation, blurred vision), orthostatic hypotension, sedation

Monitor: ECG in older patients and those with cardiac disease, blood pressure, pulse

Major substrate of CYP2D6, minor substrate of many CYPS; many DIs

Special dosing: renally eliminated and hepatically metabolized, use with caution in renal and hepatic impairment

Dosage forms: tablet, injection

Pregnancy cat C

Question 9

Amlodipine

Answer 9

Common side effects: dizziness, light-headedness, flushing, headache, hypotension, peripheral edema

Long half-life = once daily dosing, can be crushed

Preferred CCB in ESRD and dialysis - not renally eliminated

Hepatic dosing: adjustment with severe hepatic impairment

Dosage forms: tablet

Pregnancy: amlodipine crosses the placenta, agents other than amlodipine are recommended

Question 10

Amoxicillin

Answer 10

Common side effects: nausea, vomiting, diarrhea, rash

To minimize adverse GI events, take at the start of a meal

Twice daily dosing is associated with significantly less diarrhea

Use with caution in patients who are allergic to other beta-lactam antibiotics

Report any signs of an allergic reaction, such as rash or hives, to your healthcare provider immediately

Renal dosing: adjustment with CrCl <30mL/min

Dosage forms: tablet, suspension

Pregnancy cat B

Question 11

Amoxicillin / clavulanate potassium

Answer 11

Common side effects: nausea, vomiting, diarrhea, rash

To minimize adverse GI events, take at the start of a meal

Twice daily dosing is associated with significantly less diarrhea

Use with caution in patients who are allergic to other beta-lactam antibiotics

Report any signs of an allergic reaction, such as rash or hives, to your healthcare provider immediately

Renal dosing: adjustment with CrCl <30mL/min

Dosage forms: tablet, suspension

Pregnancy cat B

Question 12

Amphetamine / dextroamphetamine

Answer 12

Common side effects: insomnia, headache, weight loss, loss of appetite, nervousness, abdominal pain, tachycardia

Monitor: changes in appetite, weight, height, BP, HR, CNS activity

CYP3A4 substrate; high DI risk

Avoid abrupt discontinuation

Special dosing: use with caution in renal and hepatic impairment

Dosage forms: immediate-release and extended-release tablets

Pregnancy cat C

Question 13

Aripiprazole

Answer 13

Common side effects: agitation, insomnia, headache, EPS (dose-related)

Take at the same time each day without regard to meals

Monitor: EPS, metabolic complications

Major CYP3A4, 2D6 substrate: DIs

Dosage forms: tablet, ODT, oral solution, injection solution

Pregnancy cat C

Question 14

Aspirin/dipyridamole

Answer 14

Common side effects: headache, nausea

Contraindications: asthma, rhinitis, nasal polyps, inherited or acquired bleeding disorders

Limit alcohol intake

Monitor: s/s bleeding

Special dosing: avoid use in severe renal and severe hepatic impairment

Dosage forms: ER capsule

Pregnancy cat D

Question 15

Atenolol

Answer 15

Common side effects: bradycardia, decreased sexual ability, dizziness, hypotension, fatigue, lethargy

Monitor: heart rate and blood pressure

Renal dosing: adjustment at CrCl 15-35mL/min (max dose 50mg daily); CrCl<15mL/min (max dose 25mg daily)

Dosage forms: tablet

Pregnancy cat D

Question 16

Atomoxetine

Answer 16

Common side effects: headache, insomnia, drowsiness, hyperhidrosis, xerostomia, abdominal pain, constipation, vomiting

Evaluate CV risk, monitor HR, BP, and consider obtaining ECG prior to initiation

Major CYP2D6 substrate: DI risk

Monitoring: patient growth, hyperactivity, attention, anxiety, worsening of aggressive behavior or hostility

Dosage forms: tablet, ER tablet

Pregnancy cat C

Question 17

Atorvastatin

Answer 17

Common side effects: GI upset, myalgia (dose-related)

To minimize adverse GI events, take at the start of a meal

Reduces LDL by ~30->50%, may also increase HDL and lower triglycerides

Contraindications: active liver disease, unexplained persistent elevations in serum transaminases, pregnancy and lactation, concomitant use with strong CYP3A4 inhibitors

Monitor: fasting lipid panel and baseline LFTs; check baseline CPK in high-risk patients

Major CYP3A4 substrate: drug and food interactions

Report unexplained muscle pain, tenderness, weakness

Dosage forms: tablet

Pregnancy cat X

Question 18

Azithromycin

Answer 18

Common side effects: nausea, diarrhea, abdominal pain, rash

Should not be used as monotherapy in severly ill patients with pneumonia due to rising resistance in S. pneumo

Alternative in penicillin allergic patients

Dosage forms: tablet, capsule, suspension, injection

Pregnancy cat B

Question 19

Beclomethasone (inhalation)

Answer 19

Common side effects: hoarseness, pharyngitis, dry mouth, cough, headache, oral candidiasis (rinse mouth with water after every use), palpitations

Do not use for acute attacks, must have a rescue inhaler

It is recommended to prime the QVAR inhaler before first use and when inhaler has not been used in >10 days. Prime by releasing 2 actuations into the air away from your eyes and face

No major drug inteactions

Dosage forms: inhalation aerosol

Pregnancy cat C

Question 20

Benazapril

Answer 20

Common side effects: hypotension, hyperkalemia, cough, taste disorder (captopril)

NSAIDs reduce the hypotensive effect of ACEis

Diuretics may potentiate renal insufficiency in volume-depleted patients

K+-sparing diuretics, K+ supps, SMZ/TMP and salt subs increase risk of hyperkalemia

Concomitant use of ARBs should be avoided due to additive hypotension and increased risk of hyperkalemia

ACEi effects on: cyclosporine (increases nephrotoxicity), lithium (increases serum levels)

Monitor: serum electrolytes (potassium, serum creatinine), cough, angioedema, and blood pressure

Consider discontinuation if SCr exceeds 3mg/dL or doubles from baseline during treatment

Renal dosing: dose reduction dependent on indication and CrCl

Dosage form: tablet

Pregnancy cat D

Question 21

Bimatoprost (ophthalmic solution)

Answer 21

Common side effects: darkening of the iris, thickening of eyelashes, eyelid skin darkening, itching, blurred vision

Contraindications: hypersensitivity to benzalkonium chloride

Once daily dosing

Remove contact lenses before instilling the solution; wait for 15 minutes before reinserting contacts

Wait 5 minutes between ophthalmic drops (if you use more than one)

Dosage forms: solution

Pregnancy cat C

Question 22

Brimonidine (ophthalmic solution)

Answer 22

Common side effects: tachycardia, dry mouth, eyelid elevation, CNS effects in elderly and young adults

Contraindications: hypersensitivity to benzalkonium chloride

One drop tid

Remove contact lenses before instilling the solution; wait for 15 minutes before reinserting contacts

Wait 5 minutes between ophthalmic drops (if you use more than one)

Dosage forms: solution

Pregnancy - if ophthalmic agents are needed during pregnancy, the minimum effective dose should be used in combination with punctual occlusion to decrease potential exposure to the fetus.

Question 23

Budesonide

Answer 23

Common side effects: headache, acne vulgaris, nausea, diarrhea, dizziness, respiratory tract infection

Monitoring: CBC, LFTs, FBG, ESR, response to therapy, adverse effects

Renal/hepatic dosing: use with caution in renal impairment; adjustment with mod hepatic impairment, avoid use in severe hepatic impairment

Dosage forms: capsule, tablet

Pregnancy cat C

Question 24

Budesonide/ formoterol (inhalation)

Answer 24

Common side effects: corticosteroids: hoarseness, pharyngitis, dry mouth, cough, headache, hypokalemia, oral candidiasis (rinse mouth with water after every use), palpitations. Beta-ag: nervousness, palpitations, respiratory infection

Use every day, do not use for acute attacks, must have a rescue inhaler available for breakthrough attacks

Monitor for CYP3A4 interactions

Hepatic dosing: use with caution in hepatic impairment

Dosage forms: aerosol for oral inhalation

Pregnancy cat C

Question 25

Buprenorphine/ naloxone

Answer 25

Common side effects: headache, pain, withdrawal syndrome, GI adrs Only authorized prescribers are allowed to prescribe Monitor: LFTs, respiratory and mental status, CNS depression, blood pressure, symptoms of withdrawal, signs of addiction/abuse/misuse Special dosing: use with caution in renal impairment and moderate hepatic impairment; do not use with severe hepatic impairment Dosage forms: buccal film, sublingual film, sublingual tablet Pregnancy cat - not recommended (insufficient evidence); pregnant women should be transitioned to buprenorphine

Question 26

Bupropion

Answer 26

Common side effects: headache, insomnia, xerostomia, weight loss, agitation, tachycardia Dry mouth and insomnia are common and may improve over time Contraindications: seizure disorder (avoid alcohol- increases seizure risk), history of anorexia/bulimia Special dosing: start with reduced dose/frequency and monitor carefully in renal and hepatic impairment Dosage forms: tablet, SR tablet, ER tablet Pregnancy cat C

Question 27

Buspirone

Answer 27

Common side effects: dizziness, lightheaded, headache, nausea, nervousness, excitement Antianxiety effects may not be seen for at least a week or more Buspirone should not be stopped abruptly Avoid large quantities of grapefruit juice Major CYP3A4 substrate: high risk of DIs Monitoring: mental status, symptoms of anxiety Renal/hepatic dosing: adjustments for moderate to severe renal and hepatic impairment Dosage forms: tablet Pregnancy cat B

Question 28

Carisoprodol

Answer 28

Common side effects: dizziness, headache, somnolence Should only be used forf short periods (2-3 weeks) Do not use alcohol, prescription/OTC sedatives, CNS depressants, or psychotropic agents without consulting prescriber. Use caution when driving, climbing stairs, rising from a sitting or lying position. Do not discontinue abruptly, taper dosage slowly to reduce risk of withdrawal symptoms Contraindications: not recommended for use in geriatric patients or history of acute intermittent porphyri, hypersensitivity reaction to a carbamate, such as meprobamate Special dosing: Use with caution in renal and hepatic impairment Dosage forms: tablet Pregnancy cat C

Question 29

Carvedilol

Answer 29

Common side effects: bradycardia, decreased sexual ability, dizziness, hypotension, fatigue, lethargy Take with food to minimize the risk of orthostatic hypotension Inhibits alpha-1 receptors as well, which provides added blood pressure lowering Recommended for patients with HFrEF to reduce mortality Monitor: heart rate and blood pressure When switching from IR to ER, the conversion is not 1:1 Hepatic dosing: not recommended in severe hepatic impairment Dosage forms: tablet, extended-release capsule Pregnancy cat C

Question 30

Celecoxib

Answer 30

Common side effects: nausea, diarrhea, GI ulcers, hypertension, headached, peripheral edema Take with food if GI upset occurs Use with caution in patients with fluid retention, congestive heart failure, renal insufficiency, hypertension; report any abnormal swelling or bleeding to your healthcare provider Monitoring: s/s bleeding Renal/hepatic dosing: adjustments for moderate to severe renal and hepatic impairment Dosage forms: tablet, ER tablet Pregnancy cat C/D