New Drug Encounter #3 Flashcards
1
Q
Hydralazine
Drug class
How to take it?
A
Vasodilator - relaxed peripheral smooth muscle
Take with or without food
* be consistent
2
Q
How to take hydralazine
A
Take with or without food, but be consistent
* food can increase absorption
3
Q
Hydralazine common side effects
A
- Headache- all nitrate cause this
- Fast heartbeat
- all related to vasodilation
Can cause GI symptoms: nausea
4
Q
Hydralazine consultation 3
A
For blood pressure - dilate blood vessels
Take with or without food, be consistent
Side effects: HA, fast Heart Rate, and nausea
5
Q
Isosorbide mononitrate
Drug class
Dosing IR vs ER
A
Class: nitrate, vasodilator
IR - twice daily, ** dose every 7 hours apart not every 12 hours
** need 12 hours nitrate free period to avoid tolerance
ER - once daily in the morning
6
Q
How to take isosorbide mononitrate?
A
Take in the morning with or without food
** if dose twice daily, dose every 7 hours, not every 12 hours
7
Q
Isosorbide mononitrate or nitrate side effects 2
A
Headache - an indication drug is working, can take Tylenol, will not affect drug effectiveness
Dizzy or lightheaded - upon standing
8
Q
IMDUR or nitrate one interaction to remember
A
Viagra
- can cause vasodilation, dangerous low blood pressure
9
Q
IMDUR consultation
A
For chest pain or prevention
Take in morning with or without food
May cause headache, dizziness
** if dose twice daily, take every 7 hours, not every 12 hours, needs 12 hours nitrate free period
** check viagra interaction
10
Q
Otrexup
What is this drug?
Indication
A
Otrexup- a SQ methotrexate injection
Inject once weekly for RA
11
Q
Otrexup
Drug class and simplify moa
A
Antimetabolite
Blocks DNA synthesis and prevent new cell growth
12
Q
Otrexup is usually give with ___ and ___
Why?
A
Folic acid (a vitamin) or leucovorin
Prevents side effects from methotrexate such as mouth sores
Do not administer on day you are taking methotrexate
Folic acid 1 mg per day; 5 days a week
Leucovorin 5 my once weekly
13
Q
How long does it take for methotrexate to work?
A
3 to 6 weeks to see benefits
About 1 month
14
Q
Otrexup
Injection mechanism
A
An auto injection- similar mechanism as epipen but SQ
Once you here click; hold for 3 second
15
Q
3 side effects methotrexate Otrexup
A
- Think organ system
Skin - Sun sensitivity
Liver - monitor for jaundice
Lung - monitor SHB
Kidney - monitor fluid retention; edema
Immune - increase risk of infection - GI: nausea vomiting diarrhea
* tablet - best empty stomach but can be taken with food - Hair loss
16
Q
Otrexup what to watch for 3
A
- Lots of drug interaction
- Live vaccines- consult md first
- Fertility
* not safe in pregnancy
* women 6 months to get pregnant
* men 3 months
* may cause infertility and may not be reversible
17
Q
Leucovorin is similar to ____
Real chemical name
A
A ready to use form of folate; but not use as a vitamin
Use to prevent side effects from Methotrexate
Leucovorin is “folinic acid”
18
Q
Can you take both folic acid and leucovorin
A
No
19
Q
Leucovorin side effect
A
Itchy skin rash
20
Q
Leucovorin
What to watch for
A
- Bactrim - decrease bactrim effectiveness
- Dose once weekly
21
Q
Cabergoline
Indication
Moa
What it is?
A
For hyperprolactinemia
* high level of prolactin in blood
Cabergoline is a “Long acting synthetic dopamine agonist “ - blocks the release of prolactin from pituitary gland
Long acting - dose twice weekly only
** pituitary gland is also called the “master gland” - monitor and regulate bodily’s function
22
Q
Cabergoline is for hyperprolactinemia
What is the consequences of hyperprolactinemia, high level of prolactin
A
- Unwanted increase in breast growth and milk production
- Menstrual problem (irregular, missed period)
- Fertility problems in both men and women
- Can be tumors of pituitary gland
23
Q
Cabergoline is associated with what side effect
And other side effects
A
NAUSEA and constipation
*** take with Food
Other side effects
1. Dizzy OSH b/c can lower BP
- avoid or limit alcohol intake
24
Q
Cabergoline warnings or what to remember
A
- Nausea- take with food
- Dizzy - can decrease BP cause OSH
- Not safe in pregnancy
- Impulse or behavior change
* more aggressive
* uncontrollable urge to gamble, sex, spend money, binge eating - Heart - doctor will check heart function before prescribing
25
Dupixent
What is Dupixent?
Indication
Dupixent is a monoclonal antibody- blocks IL4 and IL 13 (interleukin)
* Interleukins release chemical that causes inflammation
What is monoclonal antibody?
* clone made in labs
* works like the natural antibody your body makes to fight illness
What is antibody?
* a large Y-shape protein used by immune system to identify and neutralize pathogens such as bacteria and viruses
Dupixent is a biologic means
** drug made from living cells
Bottom line:
Dupixent is a monoclonal antibody made in lab from live cell made to recognize and block IL4 and IL13 - decreasing the inflammation process
* eczema is an inflammatory skin condition leading to itching and rash
26
How is dupixent dose for eczema
SQ once every other week
** abdomen, outer thigh or upper arm
27
Dupixent side effects 3
1. Injection site reaction
2. Pink eye (redness, itching) - if painful or bothersome report
3. Cold sores of mouth or lips
28
Dupixent is not a ____ or _____
Not a steroid or immunosuppressant
** but avoid live vaccines during dupixent treatment
29
Is dupixent a cure for eczema?
No. Not a cure for eczema. Dupixent reduces symptoms only such as flare and itch.
** there is no cure for eczema
30
Duxipent warnings 2
1. Glaucoma- eye problem
* report any eye pain or change in vision
2. Joint pain
* report worsening pain or unable to walk
31
Dupixent storage
Duxipent is store in refrigerator
* can be store at RT for upto 14 days
32
Dupixent missed dose
Have 7 days to inject missed dose and resume regular schedule; no need to change next schedule injection
33
Dupixent injection information to remember
Let it sit at RT for 30 minutes
34
Donepezil
Class: Explain how it works
An acetylcholinesterase inhibitor
* acetylcholinesterase is an enzyme that breaks down acetylcholine
What is acetylcholine?
* a NT involve in learning, memory, attention, and involuntary muscle movements
What happened if a lack of acetylcholine
* pt have difficulty in forming and recalling memories like dementia
What is the function of acetylcholine
* a NT of the autonomic nervous system that contracts smooth muscle (bladder, GI tract), dilate blood vessels (dizzy, fainting), increase bodily secretion (stomach acid), and slows heart rate.
** opposite of fight or flight response
35
How to take donepezil
Take with or without food in the evening before bed
* to minimize side effects
36
Donepezil
Think of what side effects
Nausea vomiting diarrhea
* due to increase acid secretion
Decrease HR or dizziness and fainting
* use caution when getting up from bed
37
Donepezil common side effects
1. Nausea vomiting diarrhea **
2. Fatigue
3. Insomnia, abnormal dreams
4. Muscle cramps
5. Decrease appetite- weight loss
38
Donepezil indication
Dementia
* blocks acetylcholinesterase - an enzyme that breaks down acetylcholine
* acetylcholine is involved in learning and memory
39
Donepezil warnings 6
Decrease HR and fainting
* excess acetylcholine NT
Vomiting and nausea
* acid secretion increase
Stomach ulcer or intestinal bleeding
* more acid secretion with additional acetylcholine
* monitor dark tar stool, or blood
Worsening of asthma
* tiotropium is an anticholinergic
* with donepezil - you have more acetylcholine which can worsen asthma symptoms
Urinary retention
* interaction with anticholinergic medications (bladder med)
Seizure
40
Donepezil consultation
1. Take with or without food in the evening just before bedtime
2. For dementia
3. Most CSE: NVD
4. Can decrease HR and cause fainting; use caution when getting up from bed
5. Report Vomiting, blood in stool or black tar stool - increase ulcer due to increase acid secretion
41
Namenda
Generic name
Class & indication
Memantine
Namenda = NMDA receptor antagonist
For Alzheimer’s dementia
Or Dementia
42
Explain Namenda (memantine) moa
Blocks action of glutamate at the NMDA receptor
It is postulated that glutamate overactivity results in overstimulation and neuronal (nerve) damage ** this neuronal damage linked to Alzheimer’s dementia
Glutamate- is the main excitatory NT
*** no evidence that memantine slows neurodegeneration in Alzheimer’s dementia
43
Common side effects
Usually well tolerated
Think: dizzy and headache
Other: constipation or diarrhea
** can make you drowsy but not very common
44
Consultation Namenda (memantine)
1. For dementia
2. Can be taken with or without food
* limit or avoid alcohol- can increase dizziness
3. Common side effects: dizzy and HA
* can also cause constipation or diarrhea
45
Exelon
Exelon patch
Generic name & class
Rivastigmine
Acetylcholinesterase inhibitor
* stops the enzyme that breaks down acetylcholine
Acetylcholine is needed in learning, forming and recalling memories
Acetylcholine is the NT of the autonomic nervous system (rest and digest)
* opposite fight and flight response
46
How to take Exelon (rivastigmine) and how to use Exelon patch
Dosing and what is important to remember about dosing
* take with FOOD- nausea and vomiting
* if treatment is interrupted for more than 3 days, contact doctor since dose needs to be restarted at 1.5 mg twice a day
Patch - is once daily
* patch can be applied on back or upper arms, rotation
You can shower with patch on; if it falls off, put a new one on, then replace this new patch when it’s time for your scheduled dose
* it’s okay to wear a patch for less than 24 hours
Patch: avoid heat sources
* hot tub, sauna, heating blanket
47
Is Exelon a cure for dementia
No. There’s no evidence that Exelon slows the progression of Alzheimer’s dementia
48
What is Exelon (rivastigmine) main mechanism of action
Provide the brain and body more acetylcholine
* acetylcholine is NT involved in learning, forming and recalling memories
49
Exelon (rivastigmine) side effects
Think of
Think: Nausea and Vomiting
Others: diarrhea, decrease appetite and weight loss
Dizziness and headache
* caution driving
** hallucination has been reported
50
Exelon (rivastigmine) and alcohol
No interaction, but alcohol can worsen symptoms (dizziness)
51
Exelon (rivastigmine) warnings 7
1. Nausea and vomiting
* if therapy interrupted for 3 days, needs to be restarted at 1.5 mg BID
* one case of severe nausea leading to esophageal ruptured b/c therapy was restarted at 4.5 mg BID dose
2. Wt loss and decrease appetite
3. Stomach ulcer and intestinal bleeding
* monitor blood in stool or black tar stool
* due to more acetylcholine or cholinergic activity (rest and digestion) - increased acid secretion d/t to acetylcholine
4. decrease HR may cause dizziness
* report of dizziness & fainting
* d/t acetylcholine- rest and digestion
5. Seizure has been reported - related to increased acetylcholine
6. Pulmonary- worsening of Copd or asthma
* acetylcholine or muscarinic activity causes bronchospasm ** that’s why you have drug like Spiriva (anticholinergic)
7. May cause EPS symptoms - d/t acetylcholine
* may worsen Parkinson’s symptoms
52
Exelon (rivastigmine)
3 things to remember
1. Take with food d/t N and V
2. If treatment is stopped for more than 3 days, treatment needs to be restarted at 1.5 mg BID
3. May cause stomach bleeding - monitor for blood in stool or black tar stool
4. May cause dizziness and drowsy- be careful with driving
53
Ubrelvy moa simplify
Blocks calcitonin gene-related peptide CGRP receptors
* CGRP is a potent vasodilator; cause of pain and inflammation associated with migraine
54
Ubrelvy indication
Treat an acute migraine (within 4 hours) ; not prevent migraine
55
How to take Ubrelvy
Take with or without food
Take at or after onset of migraine, can repeat 2nd dose after 2 hours
* max 200 mg per day
* no safety data on treating more than 8 migraine with Ubrelvy
56
Common side effects Ubrelvy
Think: nausea, sleepiness (somnolence)
Can also cause: dry mouth
57
Ubrelvy
What should you think of?
Drug interactions and grapefruit juice
* need to check references
58
You should not take a second dose of Ubrelvy in the next 24 hours if you take:
1. Consume grapefruit juice
2. Verapamil
3. Fluconazole
4. Cyclosporine
5. Cipro
59
If you take strong CYP3a4 inhibitor; you should not take Ubrelvy concomitant
Contraindicated
60
3 strong CYP3a4 inhibitor to know
Biaxin - usually with h. Pylori tx
Itraconazole- usually not prescribe
Ketoconazole
61
3 moderate CYP3A4 inhibitor
Cipro
Fluconazole
Grapefruit juice
62
Avoid Ubrelvy with strong CYP3a4 inducers
Name 3
Phenytoin
Barbiturates
Rifampin
63
Disadvantage of Ubrelvy
Drug interactions
64
Grapefruit juice is a ____
Moderate CYP3a4 inhibitor
65
What is a barbiturate?
A sedative hypnotic drug makes you feel sleepy
** barbiturates increase GABA, the brain inhibitory neurotransmitter
66
Name 3 drugs that are considered barbiturates
Butalbital- found in esgic; fioricet
Phenobarbital- sz med
Primidone- Sz med
67
Barbiturates are _____
Strong CYP3a4 inducer
Other strong CYP3a4 inducers:
Phenytoin
Rifampin
68
Concerta - methylphenidate ER tablets
How to take it?
Take in morning with or without food
** do not crush or chew
69
Concerta
Side effects, think of…
Nausea, decrease appetite, wt loss, increase BP
Can cause: HA, dizzy or insomnia
Increase sweating
** may cause upper abdominal pain
** decrease growth rate in children has been reported
70
Concerta
How does it work in adhd
Mechanism of action in ADHD is not known
** it has been thought that blocking the reuptake of NE and dopamine into presynaptic neurons
71
Concerta contraindication
Glaucoma
Marked anxiety, tension, agitation
MAO-I inhibitor (ex: Phenelzine)
* due to Concerta ability to inhibit reuptake of NE and dopamine
72
Concerta warnings 7
1. Sudden death d/t cardiovascular
* caution in pt with heart problems
2. Increase BP and Increase HR
3. Seizure - lower seizures threshold
* stop if occur
4. Priapism ***
5. Poor peripheral blood profusion
* Raynauld’s syndrome
6. Decrease growth in children
7. Blurry vision or change in vision
* can actually affect driving
73
Clonidine
Indication & moa
Hypertension & ADHD
Moa: central alpha2 agonist (negative feedback on presynaptic neuron)
* decrease NE into synapses ***
Less EP = decrease peripheral vascular resistant
Less EP = decrease renal vascular resistant
Less EP = decrease HR decrease BP
** however OSH is mild & infrequent
74
How to take clonidine
Take with or without food
* take last dose before bed
75
Clonidine: what should patients not do while taking clonidine 1
Do not stop abruptly- may cause rebound hypertension
76
What are the two most common side effects associated with
Clonidine
Dry mouth (40%)
Drowsy & Dizzy DD
May cause constipation
77
Rexulti (brexpiprazole)
** name is similar aripiprazole
2 indication
1. Schizophrenia
2. Adjunct treatment for depression
* take along with antidepressants
78
How to take Rexulti?
Take once daily (anytime) with or without food
79
Rexulti side effects
Most common 3
Others
Think: TREx - big (wt gain) and have to move all the time (restlessness)
Weight gain & Restlessness (akathisia)
* an inability to stay still or a feeling like you have to move all the time
Others
1. Metabolic syndrome = increase glucose, increase cholesterol, wt gain)
2. Somnolence (tired; drowsy)
* caution driving
3. Dyspepsia (nausea)
80
Rexulti black box warning
Increase risk of suicidal thoughts or behavior
* especially in dementia patient
81
Rexulti moa
Serotonin and dopamine agonist
* both are feel good hormones
5HT1a agonist; dopamine D2 agonist
5HT2a antagonist
82
What should I avoid while taking Rexulti 2
1. Do not drive- until you know how this medication affects you
* Rexulti can make you feel drowsy or tired
2. Avoid excessive exercise or heat exposure
* risk for heat stroke
83
What is metabolic syndrome 3
1. Increase glucose- diabetes risk
2. Increase cholesterol
3. Weight gain
84
Rexulti warnings
** can be applied to all antipsychotics *
1. Suicidal thoughts
2. Increase risk of stroke especially in patients with dementia
3. Tardive dyskinesia- involuntary movements of face or tongue
4. Potential for cognitive impairment
* decrease judgement; thinking or motor skill - caution driving
5. Pathologic gambling & compulsive behavior
* inability to control impulse
6. WBC counts decrease - nasopharyngitis
7. OSH & syncope
* decrease BP and HR
* risk of fall
8. Seizure- caution in patients with hx
9. Heat stroke
* avoid strenuous exercise or excessive heat exposure- stay hydrated
10. Serotonin syndrome (NMS)
* fever; change in HR and BP; stiff muscle; confusion (mental changes); sweating
* get emergency help
85
Abilify (aripiprazole) indication 3
What is different compared to Rexulti
1. Schizophrenia
2. Adjunct tx for depression
3. *** bipolar
Abilify can be use for bipolar and not Rexulti
86
Abilify side effects 4
1. Akathisia = unable to stay still
2. Nausea
3. Insomnia
4. Somnolence - driving
87
Abilify can cause OSH due to
Abilify has some alpha-1 antagonist
88
Abilify moa simplify
* same as Rexulti
Serotonin and dopamine agonist
89
How to take Abilify
Take once daily with or without food
* anytime (night - may cause insomnia)
Swallow whole - not recommended to cut or crushed
90
What should I avoid while taking Abilify?
* same for Rexulti
1. Driving
2. Excessive heat - increase risk for heat stroke
91
Abilify and Rexulti can cause serotonin syndrome NMS
What are the symptoms
1. Fever
2. Muscle stiffness
3. Changes in HR and BP
4. Confusion (mental changes)
5. Sweating
92
Abilify warnings 11
* same as Rexulti
1. Increase risk stroke
2. NMS - serotonin syndrome
3. Tardive dyskinesia
4. Metabolic syndrome
5. Pathologic gambling & compulsive behavior
6. OSH dizzy, risk of FALL
7. WBC count decreases
8. Seizure
9. Cognitive impairment
10. Suicidal
11. Heat stroke
93
Pilocarpine tablet
Indication & how to take it?
For dry mouth (xerostomia) d/t head and neck cancer treatment
Take with or without food TID
94
Pilocarpine tablet
Drug and moa
Cholinergic AGONIST (rest and digest)
* works like acetylcholine
* stimulant secretion of gland (salivary, sweat, lacrimal, gastric, intestinal)
That’s why it is used for dry mouth
95
Pilocarpine
Most common side effects
SWEATING
Other:
* HA and dizziness
* GI symptoms: N D
96
Pilocarpine tablet consultation tips
1. Take with or without food
2. For dry mouth - may take up to 3 months to work
3. Most common side effect is increase sweating. Others side effects include
* NV
* HA or Dizziness
97
Pilocarpine eye drop
Drug class MOA and indication
Cholinergic agonist
* works like acetylcholine to stimulate muscarinic receptors
1. Glaucoma
2. Eye surgery- miosis
* constriction of pupil (pin point)
* decrease light penetration into eye
Glaucoma
* increase outflow by stimulating eye smooth muscle (iris sphincter and ciliary muscle) to contract
98
Cyclopentolate (cyclogyl)
Drug class and moa
Mydriasis- to dilute pupil
* opposite pilocarpine (pin point)
Anticholinergic
* blocks acetylcholine, relaxed smooth muscle eye
99
Cyclopentolate (cyclogyl)
Most common side effects
BURNING
Vision change, light sensitivity
increase IOP - opposite pilocarpine
100
Atropine ophthalmic
Drug class and moa
Mydriasis- dilate
ANTICHOLINERGIC
* relaxes and dilate eye pupil
* blocks acetylcholine
101
Atropine ophthalmic
Most common side effects
BURNING
Vision change
Light sensitivity
102
Why is atropine drop under tongue or in mouth?
Atropine is an anticholinergic
* blocks secretion of salivary gland
* decrease saliva
103
What is a substitute for Cyclopentolate
Atropine
* both cause eye dilation
* both are ANTICHOLINERGIC
104
Pravastatin (Pravachol)
Indication 2
1. Cholesterol
2. Reduce risk of HEART attack, stroke and cardiovascular surgery
105
How to take pravastatin
Take once daily anytime with or without food
106
Pravastatin
2 warnings
1. Myopathy and rhabdo
2. Increase LFT liver toxicity
107
Pravastatin common side effects
Think
GI: Nausea Vomiting Diarrhea
Joint muscle pain - report to doctor
Increase risk Upper respiratory tract infection URTI
* bronchitis
108
Pravastatin patients info 4
1. Muscle pain
2. Liver damage
3. Increase glucose A1c - increase risk for diabetes
4. No in pregnancy and lactation
109
Pravastatin consultation tips 4
1. For cholesterol or to reduce risk of HEART attack; STROKE
2. Take once daily with or without food anytime
3. Side effects may include: NVD
4. Report unexplained or worsening muscle or joint pain
110
Rosuvastatin (crestor)
Indication 2
1. High triglycerides
** different from other statin
2. High cholesterol
** no indication for reduction of heart attack or stroke in PI**
111
How to take rosuvastatin
Take once daily anytime with or without food
112
Rosuvastatin warnings 2
1. Myopathy and rhabdo
2. Increase LFT liver toxicity
113
MOST common side effects of rosuvastatin
HEADACHE and Nausea
Muscle or joint pain
114
Can I drink alcohol while taking rosuvastatin?
Yes
Limit to no more than 2 drinks per day
115
Any interaction between rosuvastatin and antacid MAALOX
Yes. Separate doses by 2 hours
116
What kind of muscle pain do I need to report while taking rosuvastatin or STATIN
Unexplained muscle pain or weakness, especially if you have a FEVER or feels more TIRED than usual
117
Rosuvastatin in pregnancy and lactation
No. Contraindication
All statin are contraindicated in pregnancy and lactation
118
Lovastatin indication 3
* how different from other statin
1. High cholesterol
2. Primary prevention of Heart Disease or Heart attack
3. SLOW progression of coronary atherosclerosis
Atherosclerosis: deposit of plaque of fat on the inner wall of blood vessels
Difference:
* primary prevention
* slows atherosclerosis
119
Lovastatin warnings
Same as other statin
1. Myopathy and rhabdo
2. LFT LIVER TOXICITY
120
Common side effects Lovastatin
HEADACHE and Nausea
Abdominal pain
Muscle pain or aches
121
Carbidopa & levodopa
Indication and moa simplify
Parkinson’s
Parkinson’s is thought due to decrease dopamine in CNS
* levodopa- is converted into dopamine; providing CNS more dopamine
* carbidopa- blocks the breakdown of levodopa to dopamine in the peripheral, providing more levodopa to cross BBB
* carbidopa does not cross BBB
Levodopa is DOPAMINE
122
Main side effects with carbidopa and levodopa 4
Main: NAUSEA
Involuntary muscle movements
* dyskinesia
Dizziness
* levodopa & carbidopa can cause OSH
Abnormal dreams
* sinemet can cause hallucination & psychotic like behaviors
Dry mouth
123
How to take carbidopa and levodopa
Best on empty stomach but can be taken with or without food
* avoid high protein: meat, cheese and other dairy products - decrease absorption
124
Carbidopa and levodopa warnings 7
1. Suicidal thoughts
2. Sudden falling asleep during activities
* such as driving
* there has been reports of car accidents
3. Serotonin syndrome
* likely to occur during dose reduction or discontinuation
4. Dyskinesia- involuntary muscle movements
* dose may need to be decrease
5. Mental changes: hallucination or psychotic like behavior
* insomnia and abnormal dreams
6. Inability to control impulse and impulsive behaviors
* urge to gamble, have sex, spend money, binge eating
7. Melanoma- skin examination
* increase risk of melanoma
* Parkinson’s itself- increase risk of melanoma
125
Carbidopa and levodopa patient information 4
1. Dark color fluid may appear in saliva, urine or sweat
* red, brown or black bodily fluid
* no clinical significance
2. Multivitamins and Iron - may decrease absorption
3. Reported sudden onset of sleep during activity of daily living without prior warnings of being tired
4. Impulsive urge
126
Kerendia (finerenone)
Indication
Prevent more kidney damage
Prevents HEART attack and hospitalization
** specifically for patient with type 2 diabetes **
** first line treatment
127
Kerendia drug class and moa simplify
First Mineralocorticoid receptor (MR) ANTAGONIST
Blocks MINeralocorticoid from binding to its receptor of the HEART, blood vessels and KIDNEY
What is the role of mineralocorticoid
* promote Na reabsorption in kidney
* cause sodium and water retention
* active secretion of potassium
Kerendia blocks all this effects
* decrease Na
* increase K
Aldosterone is an example of a mineralocorticoid
128
How to take Kerendia
Take once daily with or without food
**** AVOID grapefruit ***
129
Kerendia side effects 3
Increase Potassium (monitor)
* nausea, numbness and tingling
Increase Na sodium
Decrease BLOOD pressure
* may get dizzy, feeling tired
130
Kerendia drug interaction 2
1. Grapefruit
2. Strong CYP3A4 inhibitors
131
Common strong CYP3a4 inhibitors
1. Macrolides: clarithromycin, erythromycin
2. Diltiazem and verapamil
3. Azole antifungal: itraconazole, ketoconazole
4. GRAPEFRUIT
132
Can I breastfeed while taking Kerendia
No.
Must wait 24 hours after last dose
133
Kerendia most important warning
Hyperkalemia (increase K)
** monitor
134
What drug class is hyoscyamine and moa
Anticholinergic and antispasmodic
Inhibit acetylcholine
* especially smooth muscle of the stomach and intestines AND HEART and kidney
* slows down the natural movement of the gut
135
Hyoscyamine indications 3
Used for a variety of stomach issues
1. IBS - pain and cramping
2. Stomach ulcer
3. Bladder and kidney pain
136
How to take hyoscyamine
Take before meals
137
Interactions between antacid and hyoscyamine
Decrease effectiveness of hyoscyamine
Take hyoscyamine before meal and take antacid after meal
138
Common side effects of hyoscyamine 4
DRY MOUTH and DRY EYE
Urinary retention
Constipation
Dizzy & drowsy- caution driving
Decrease ability to focus and think
139
Hyoscyamine warnings 4
Serious allergic reaction
** Angioedema
Hallucination - mental changes
* psychosis
Irregular heart beat or fast HR
Heat stroke
* avoid excessive heat - body’s ability to sweat decrease
140
Elmiron drug class and moa
Urinary analgesic - for bladder pain
Works by binding to wall of bladder and acts as a barrier to protect bladder from irritating substances in urine
*** similar as Sucralfate **
141
Elmiron indication
Relieve bladder pain (cystitis)
Cystitis is
* an inflammation of the bladder caused by bladder infection
Symptoms: pain and burning when you pee
142
How to take Elmiron
Take on an Empty Stomach
* 1 hour before or 2 hours after meal
143
Associate Elmiron with 3
1. EYE damage- retina bleeding
** report in changes in vision or eye pain
2. Blood thinner
* report any blood in stool
* report bruising
3. Alopecia HAIR loss
* usually in one spot - reversible upon dc
144
How long does it take Elmiron to work
3 to 6 months
*** Elmiron treats bladder pain**
145
Elmiron common side effects 4
RECTAL bleeding
* blood in stool
Hair loss
Nausea Vomiting and Headache
Change in Vision- report
146
Eucrisa (crisaborole)
Indication and moa
Eucrisa is for ATOPIC Dermatitis
PDE-4 inhibitor (blocks PDE-4)
* PDE-4 is a protein that controls inflammation
147
Eucrisa side effects
PAIN ON APPLICATION SITE
Burning & Stinging
148
How long does it take for Eucrisa to work
1 wk to 4 wk
1 wk: to see improvement
4 wk: to see clear skin
149
What makes Eucrisa different
Eucrisa is a non-steroidal ointment for atopic dermatitis
150
Entresto generic
Sacubitril and valsartan
Sacubitril is a neprilysin inhibitor
* breaks down natriuretic peptides
* cause water and sodium retention
Valsartan
* ARB at AT1 receptor
* causes vasodilation
151
Entresto indication and dosing
Heart Failure
* to reduce risk of hospitalization and death from heart failure
Dose TWICE daily
152
Is Entresto safe in pregnancy and lactation
No. Black box warning of fetal harm and death
All drug affecting RASA system not recommended in pregnancy and lactation
153
Contraindication to Entresto
Concomitant use with ACE-inhibitor or ARB
154
How to convert someone from ACE inhibitors to Entresto
Need 36 hours washout period
* to decrease risk of Angioedema
155
Entresto common side effects 3
1. Decrease BP, may cause dizziness
2. Cough
3. Increase potassium HYPerkalemia
156
Entresto + NSAID interaction
May worsen kidney function
* nsaid may worsen kidney
* Entresto can cause acute kidney failure
157
Entresto warnings 5
1. Angioedema
2. Hypotension
3. Acute kidney failure- monitor
4. Hyperkalemia
5. Pregnancy and lactation- fetal harm
158
Entresto is Sacubitril and valsartan
Explain Sacubitril
Sacubitril is a NEPRILYSIN inhibitor
* blocks the breakdown of natriuretic peptides in the body
* natriuretic peptides cause NA and Water to pass in urine - reducing workload for the heart and reduces strain on the heart
159
Why is Sacubitril used with valsartan?
And not ace inhibitor
Sacubitril causes elevation of angiotensin 2
Losartan blocks angiotensin 2
When Sacubitril + ace inhibitor- increase risk of Angioedema
160
Entresto produced what 3 effects
1. Dilate artery- helps reduce BP
2. Decrease HEART muscle cell enlargement
* decrease workload on heart by promoting sodium and water excretion
3. Increase URInation of excess FLUID sand Sodium
161
Aliskiren brand name
Tekturna
162
How to take Entresto
Take with or without food
TWICE Daily
163
Mefloquine
Drug class and dosing
Anti-malaria
Dose once weekly WITH FOOD
Start 2 weeks before travel and continue for 4 weeks after travel
164
Mefloquine indication 2
Prevention of malaria
Treatment of acute malaria
165
Mefloquine black box warning
May cause psychotic behavior
* depression, anxiety, schizophrenia, hallucination
166
Mefloquine pt information 5
1. Dizziness
* may continue for months after tx
2. Insomnia may occur
3. If psychiatric behavior (mood changes)
* may need to d/c
4. Not 100% effective
* use protective measures (net)
5. Any fever after returning from travel
* inform doctor
167
Mefloquine common side effects 2
DIZZINESS
Extrasystole = skipped heartbeat or heart hiccups
168
Mefloquine warnings 4
1. QT prolongation
* ketoconazole and mefloquine separate by at least 15 weeks apart
2. Psychiatric behaviors
* depression, anx, hallucination
3. Eye disorder
* any vision change- inform MD
4. Liver toxicity
169
Mefloquine most importantly information to remember 5
1. Dizziness - may continue for months after tx
2. Take WITH FOOD (increase absorption)
3. QT prolongation (ketoconazole)
4. Psychiatric behaviors
5. Liver and eye toxicity
170
Bisoprolol (zebeta)
What makes it more different compared to other beta blockers?
More cardioselective than metoprolol and atenolol
171
How to take bisoprolol?
Take with or without food
172
Bisoprolol indication
HTN
173
Bisoprolol common side effects 3
HEADACHE and FATIGUE
Dizziness
Diarrhea
174
Bisoprolol warnings 6
Same as other beta blockers
1. Worsening of CHF
2. Do not abruptly STOP
3. Asthmatic
4. Diabetics
5. Major Surgery
6. Raynaud syndrome: decrease peripheral perfusion
175
What is phexxi?
Use to lower pH in vagina
Not a spermicide but more effective than spermicide
Use to prevent pregnancy 86%
176
How to take magnesium?
Take with meal and full glass of water
** take anytime, but take at night may help with sleep
177
Benefits of magnesium 3
1. Better sleep
2. More energy
3. Improve mood
178
Xcorpi (cenobamate)
Indication, dose and how to take it?
Take once daily for seizure
Can be taken with or without food
Swallow whole do not crush or chew
179
Xcorpi common side effects 4
SOMNOLENCE (sleepy)
DIZZY and double vision (diplopia)
Headache
180
What should I avoid while taking Xcorpi?
1. Driving: make sure you know how medication affects you
2. Do not drink alcohol
181
Xcorpi warnings 5
1. DRESS = drug reaction with eosinophilia and systemic symptoms
** a SERIOUS SKIN Reaction accompany with FEVER, RASH, facial swelling and lymph node enlargement
2. QT shortening (not prolongation)
* report palpitation and CP
3. Suicidal thoughts or behavior
4. SOMNOLENCE, fatigue or vision change = caution driving
5. DC gradually to minimize seizure
182
Cefadroxil brand name
Duricef
183
Cefadroxil indication 4
1. Bacterial infections
2. ENT infection
3. UTI
4. Skin infection
184
Cefadroxil common side effects 3
NVD
Itching
Elevated liver enzymes
185
Cefadroxil warnings 2
** same as others
1. Cross sensitivity reaction 10%
2. C Dif
186
How do I take Cefadroxil
Can be taken with or without food
Take with food - more tolerable
187
Cefadroxil patient information
1. Finish treatment
* may feel better after a couple days
2. Diarrhea is common
* diarrhea should stop after treatment
* if diarrhea is watery or have bloody stool wit or without fever, contact MD
188
what is pyridostigmine use for?
myasthenia gravis
* a weakness of muscle under voluntary control
example: droopy eyelids and mouth
189
what is myasthenia gravis?
a weakness of muscle under voluntary control
example: droopy eyelid and mouth
190
what causes myasthenia gravis?
myasthenia gravis is an autoimmune disorder
the body's immune system attacks muscle protein
191
moa of pyridostigmine
acetylcholinesterase inhibitors
* prevents breakdown of acetylcholine,
* acetylcholine is needed for muscle contraction
192
1 side effect of pyridostigmine
GI: nausea, vomiting and diarrhea
193
2 opzelura indications
1. eczema
2. vitiligo (a condition where the skin loses its color)
194
moa of opzelura
JAK inhibitors (janus kinase inhibitors)
* decrease function of immune system
195
5 warnings of opzelura
1. Infection (risk increase due to decreased immune system)
2. stroke and heart attack
3. lymphoma and skin cancer risk increase
4. clot (PE and DVT)
5. death (from all cause)
196
1 side effect of opzelura
nasopharyngitis (flu-like symptoms)
* sneezing, coughing, sore throat
197
after application with opzelura, should you cover the area
do not cover area unless directed by physician
198
199
How to take Isosorbide mononitrate and Isosorbide dinitrate
With or without food
* some literature may suggest taking on empty stomach
200
Isosorbide mononitrate and dinitrate consultation tips
1. For prevention of chest pain
* not for immediate relief (not like NTG)
2. Take with or without food
* some reference may suggest empty stomach
3. Headache and dizziness
201
What should be avoided while taking Isosorbide mononitrate or dinitrate (2)
1. Viagra related drug - due to increased risk of severe hypotension
2. Alcohol - increase risk for dizziness
202
How to take midodrine
Can be taken with or without food
203
One warning to remember with midodrine
After taking it, do not lay down for 4 hours
* can increase blood pressure
204
How to take terbinafine tablets
WOW - can cause diarrhea or stomach upset
205
Midodrine moa
Alpha 1 agonist
* vasoconstrictor
* raise blood pressure for patient with OSH
206
What you should not do when taking midodrine
Do not LAY down for 4 hours
* do not take late at night
207
Unique midodrine side effects 2
1. Goosebumps - tingling or prickling feeling
2. Painful urination
208
What is Vraylar for
Schizophrenia
209
Think of vraylar as similar to
Abilify
210
How to take vraylar
With or without food
211
Vraylar side effects 3
Akathisia - restlessness, inability to sit still
EPS - involuntary muscle movements
Nausea and dizzy or drowsy
212
Strattera generic name
Atomoxetine
213
What is strattera use for?
ADHD
Pt must be over 6 years old
214
Strattera moa
Selective norepinephrine reuptake inhibitor (NRI)
Increases NE is thought to help with ATTENTION and lower impulsive behavior
215
Strattera side effect 3
GI: dry mouth, nausea, decreased appetite
Somnolence- makes you feel tired, dizzy
* caution driving, alcohol makes it worse
Erectile dysfunction ***
Can cause priapism
216
How to take strattera
With or without food
Swallow whole, do not crush or chew or do not open capsule
217
Can you open strattera capsule
No. Eye irritant
218
6 warnings strattera
Suicidal thoughts
Liver damage
Heart problems (stroke or Heart attack)
Worsening of bipolar
* can precipitate mania episodes
Priapism
Slow growth rate
* although with continued use, does not affect over growth height
219
How long does it take strattera to work
May see minor improvement after 1 week
220
Strattera standouts 3
Capsules must be swallowed whole, do not open (eye irritant)
Can make you feel sleepy or dizzy
* caution driving
* alcohol not recommended
Report any changes in mood or suicidal thoughts
221
Strattera dosing
QAM max 100 mg
222
What is xtampza ER
Oxycodone ER capsules
223
Xtampza dosing frequency
Twice daily ; every 12 hours
224
How to take xtampza
Take with Food
* capsules can be open, but do not crush, chew or dissolve
Taking on empty stomach can decrease absorption leading to less effective
225
Can you take xtampza on empty stomach
Less absorption on empty stomach
Not as effective
226
Xtampza side effects
Nause vomiting and constipation
Somnolence- makes you feel tired and sleepy
Dizzy and blurred vision- caution driving and avoid alcohol
227
Risk with xtampza or oxycodone 5
Addiction dependence
Breathing problems
Overdose
Extreme tiredness
OSH can cause decreased BP from sitting to standing position
228
Methimazole dosing
Once daily (maintenance)
229
Methimazole indication
Hyperthyroidism
230
Methimazole side effects 3
Rash
Drowsy
Headache
231
Can methimazole may you drowsy
Yes
Common side effects
Rash, drowsy and headaches
232
Methimazole in pregnancy
Clinical pearl
1st trimester- not recommended
2nd and 3rd trimester - preferred drug
Methimazole is preferred over PTU due to less liver toxicity
233
Methimazole moa
Blocks thyroid gland from making thyroid hormones
234
Methimazole serious side effects 4
Just for review not for remembering
Liver toxicity
- less likely compared to PTU
Bleeding and bruising
Decrease WBC - increase risk of infection
- nose and throat
Birth defects
- do not use during 1st trimester
235
Methimazole
Pharmacist tips 2
May cause stomach upset- take with food
Increase risk of bleeding
* monitor for sx of liver toxicity
236
Iodine and thyroid
How does iodine affect your thyroid
Thyroid gland uses iodine to make thyroid hormone
You decrease consumption of iodine, you will decrease production of thyroid hormones
- good for hyperthyroidism
237
Difference between PTU and methimazole
Clinical pearl
Methimazole
- drug of choice except in 1st trimester of pregnancy
- lower risk of liver toxicity
- drug of choice in 2nd and 3rd trimester
PTU
- preferred in 1st trimester
- more risk of liver toxicity
238
PTU dosing
3 times a day
- compared to once daily with methimazole
239
Propylthiouracil PTU side effects 3
Nausea
Loss of taste
Joint pain
** liver damage- monitor to itchiness and upper right abdominal pain
240
PTU serious side effects 4
NFR
Decrease WBC counts- risk of infection
Liver damage
Increase risk for bleeding and bruising
Skin reaction: rash and blisters
** rash - same with methimazole
241
PTU
5 pharmacist tips
1. Prefer in pregnancy P for pregnancy
2. Can make you feel d/d caution driving
3. Can take WOW - be consistent
4. Report sx of infection. PTU can dec WBC
5. Alcohol - increase risk of liver toxicity
242
Sildenafil moa
PDE 5 inhibitor
- relax penis muscles, allow it fill with blood causing an erection
PDE 5 - an enzyme
243
How to take sildenafil
Take 30 minutes to 4 hours before
Empty stomach preferably- works faster
244
How often can you take sildenafil
Max once daily
Taking more can increase side effects such as changes in vision or decreased BP
245
Sildenafil serious SE 3
Priapism
Vision loss
Decrease BP
* avoid with nitrates
246
Sildenafil common SE 4
1. Headache- vasodilation
2. Flushing- vasodilation
3. Decrease BP
- avoid nitrates
4. Change in Vision
247
When you should not take sildenafil
* 2 situations
1. Had a headache attack or stroke last 6 months
2. Can’t combine with Nitrate
248
Sildenafil pharmacist tips 3
Works faster on empty stomach
Priapism- call 911 if erection last longer than 4 hours
No nitrates (NTG, IMDUR)
249
What is vivotif use for
Prevent typhoid fever
* causes by salmonella TYPHI
250
Is vivotif a live or dead vaccine
Live weaken vaccine
* used weakened salmonella typhi
251
How to take vivotif
Take on empty stomach
Take every OTHER day - finish course at least 7 days before travel
Take with cold or Luke warm water
* hot water may kill weakened salmonella typhi
Swallow whole do not crush or chew
252
How long does protection from vivotif last
5 years
253
Vivotif common se 2
Nausea
Stomach pain
254
What is the injectable form of vivotif
Typhim Vi
See typhIM im = intramuscular
255
What is doxycycline 100 mg daily for traveler most likely use for
Malaria prevention
* must take at least 2 days prior to travel and continue for 4 weeks after travel
256
What is Cyltezo
Adalimumab
* same as humira for rheumatoid arthritis
Dose SC every 2 weeks
257
Dosing of cytotec for pregnancy termination
800 mg buccally as a single dose
* 400 mg right cheek and 400 mg left cheek - hold for 30 minutes then swallowed
258
Cough medication for pregnant
Robitussin DM
259
Allergy medicine for pregnant
Chlortrimeton preferred (most studies)
Claritin
Sudafed
260
Constipation for pregnancy
Metamucil
Colace
Dulcolax
Milk of magnesium MOM
261
Diarrhea med for pregnancy
Immodium
Gas-x simethicone for gas
262
Headaches or fever for pregnant
Tylenol
Not Motrin (avoid)
263
Hemorrhoids for pregnant
Preparation H (cream or rectal)
Tucks wipe
264
Indigestion for pregnant
Maalox
Tums
Rolaids
265
Nausea and vomiting for pregnancy
Emetrol
Vitamin b-6 pyridoxine
266
Sore throat for pregnancy
Cepacol
Tylenol
267
How to remember finasteride proscar indication
Proscar - PROstate
268
How to take dutasteride avodart
Take WOW do not open capsule
269
Dutasteride avodart dosing
Once daily
270
Can you open dutasteride capsules
No
Power is a mouth irritant
271
Dutasteride moa
5 alpha reductase inhibitor
Blocks production of dihydrotesterone 5HT
Dihydrotesterone 5HT is responsible for prostate growth
272
Dutasteride se 3
Getting or maintaining an erection
Lower sex drive
Ejaculation problems - difficulty in getting an ejaculation
273
Can you take dutasteride with tamsulsin
Yes. Dutasteride can be taken alone or with flomax
274
Which drug has less interactions Proscar or Avodart
Proscar (finasteride)
275
Dutasteride risks 5
Birth defect - women of childbearing age should not touch tablets
PSA level or testing - can lower psa level, harder to detect prostate cancer
Higher risk of developing severe form of prostate cancer
Don’t donate blood for 6 months after last dose
Decrease sperm count or volume
276
How to take finasteride
Take WOW anything
277
Finasteride moa
Blocks enzyme 5 alpha reductase
Block’s production of 5 hydro testosterone, responsible for growth of prostate
278
Finasteride se 3
* similar to dutasteride
Impotence: inability to get or maintain an erection
Lower sex drive
Decrease sperm counts or semen volume
279
How long does it take for dutasteride and finasteride to work
Several months up to 6 month to see benefits
280
Finasteride risks 4
Birth defects: women of childbearing age needs to avoid touching
Decrease PSA levels: harder to detect prostate cancer
Higher risk of developing severe form of prostate cancers
Decrease sperm counts and semen volume
281
Uceris rectal foam generic name and indication
Budesonide
Ulcerative colitis
282
Uceris rectal foam one side effect
Nausea
283
Entocort (Budesonide) indicated
Crohn disease
* an inflammatory bowel condition
284
How to take entocort and for how long
Take in morning swallow whole
Usually not more than 3 months at a time
** think prednisone- same class
285
Entocort moa
Corticosteroid - works inside your intestine to lower inflammation, swelling and irritation
286
Entocort common se 3
Headache
GI: Nausea, indigestion and diarrhea
Increase risk of infection (nose and throat)
287
Potassium + vistaril drug interaction
Contraindicated with SOLID a potassium
- increase risk of GI ulcers due to delayed GI transit
** consider liquid potassium **
288
Entocort risk 3
Can weaken immune system
- increase risk of infection
- report any symptoms of infection
Avoid in pregnancy
Avoid taking with grapefruit
