P3 Quiz #1 Flashcards
1
Q
Acetaminophen with codeine phosphate Brand
A
Tylenol #3, #4
2
Q
Allopurinol brand
A
Zyloprim
3
Q
Alprazolam brand
A
Xanax
4
Q
Buprenorphine/naloxone brand
A
Suboxone
5
Q
Buspirone brand
A
Buspar
6
Q
Carisoprodol brand
A
Soma
7
Q
Clonazepam Brand
A
Klonopin
8
Q
Colchicine brand
A
Colcrys
9
Q
Diazepam
A
Valium
10
Q
Cyclobenzaprine
A
Flexeril, Amrix, Fexmid
11
Q
Fentanyl
A
Duragesic
12
Q
Hydrocodone/acetaminpophen
A
Norco, Vicodin, Lortab
13
Q
Hydroxychloroquine
A
Plaquenil
14
Q
Lorazepam
A
Ativan
15
Q
Methadone
A
Methadose, Dolophine
16
Q
Methotrexate
A
Trexall
17
Q
Methylprednisolone
A
Medrol
18
Q
Morphine sulfate (ER)
A
MS Contin
19
Q
Oxycodone
A
OxyContin, Roxicodone
20
Q
Rizatriptan
A
Maxalt
21
Q
Sumatriptan
A
Imitrex
22
Q
Tinazidine
A
Zanaflex
23
Q
Tramadol
A
Ultram
24
Q
Tylenol with Codeine dose
A
15-60 mg po q4h prn; with acetaminophen 300-1000 mg
25
Codeine with tylenol BBW
Hepatotoxicity; Children who are CYP2D6 ultrarapid metabolizers; serious risks of misuse, abuse, addiction, overdose, and death; concurrent use with benzodiazepines; immediate release only, serious risk of misuse, accidental ingestion, neonatal opioid withdrawal syndrome
26
Codeine with tylenol common AE
Nausea, vomiting, constipation, somnolence
27
Codeine with tylenol rare but serious AE
Stevens-Johnson syndrome, GI bleeding, elevated liver functions, thrombocytopenia, physical dependence, tolerance, respiratory depression, serotonin syndrome, adrenal insufficiency, decreased sex hormones
28
Allopurinol indications and dosing
Gout= 100-300mg QD
Severed Gout- 400-600 in divided doses BID-TID
Hyperuricemia- 600-800mg PO in divided doses BID-TID
Nephrolithiasis prophylaxis- 300mg/day QD-TID
29
Allopurinol MOA
Allopurinol decreases the production of uric acid by inhibiting the action of xanthine oxidase, the enzyme that converts hypoxanthine to xanthine and xanthine to uric acid.
30
DDI allopurinol
Didanosine- avoid, increases didanosine bioavailability
Azathioprine- increases effect and toxicity of azathioprine
Cylophasphamide- BMS
31
Common AE of allopurinol
None
32
Rare, serious AE of allopurinol
Stevens-Johnson syndrome, toxic epidermal necrolysis, agranulocytosis, aplastic anemia, thrombocytopenia, granulomatous hepatitis, hepatotoxicity, immune hypersensitivity reaction, renal failure
33
Alprazolam dosing and indication
Anxiety- 0.25-0.5mg PO TID, max dose 4mg divided
| Panic disorder- 0.5mg PO TID, ER 3-6 mg PO QD
34
Alprozolam MOA
Enhances the postsynaptic effect of the inhibitory neurotransmitter, 𝛾-aminobutyric acid (GABA).
35
Alprazolam BBW
Concurrent use with opioids
36
Alprazolam contraindications
Hypersensitivity to benzodiazepines, narrow-angle glaucoma, concurrent ketoconazole, or itraconazole
37
Common AE alprazolam
Ataxia, lethargy, retrograde amnesia, somnolence, weight gain, change in appetite, constipation, fatigue, cognitive dysfunction, decreased libido
38
Rare, serious AE for alprazolam
Seizures, mania, depression, liver failure, Stevens-Johnson syndrome
39
Alprazolam DDI with CYP3A4/5 inducers
increased alprazolam metabolism reduces alprazolmm efficacy
40
Alprazolam and CYP3A4/5 inhibitors DDi
Decreased alprazolam metabolism increases risk of alprazolam toxicity
41
Alprazolam and digoxin DDI
Reduced renal clearance of digoxin and increased digoxin toxicity
42
Alprazolam and ethinyl estradiol and other estrogen based BC DDI
Inhibition of alprazolam metabolism and additional toxicity
43
Baclofen use and dose
Spasticity: 5 mg po tid; may increase by 5 mg/dose every 3 d based on response
44
Baclofen MOA
Baclofen inhibits both monosynaptic and polysynaptic reflexes at the spinal level, possibly by hyperpolarization of afferent terminals, although actions at supraspinal sites may also occur and contribute to its clinical effect. Baclofen is an analogue of γ-aminobutyric acid (GABA), but there is no conclusive evidence that actions on GABA systems are involved in the production of its clinical effects.
45
Baclofen BBW
Avoid abrupt discontinuation of oral or intrathecal product
46
Baclofen DDI
None
47
Baclofen common AE
Nausea, asthenia, dizziness, somnolence, confusion
48
Baclofen rare but serious AE
Slowed or difficult breathing when used in combination with opioids, pneumonia, GI hemorrhage, seizure
49
Buprenorphine/naloxone dose
Opioid use disorder: Adults and Children >16 y of age, 12-16 mg (buprenorphine component) once daily sublingually, titrate to response; typical dose range from 4 to 24 mg/d
50
Buprenorphine/naloxone MOA
Buprenorphine is a μ-opioid receptor partial agonist and a κ-opioid receptor antagonist. Naloxone is a μ-opioid receptor antagonist that causes opioid withdrawal when injected parenterally and is included in the formulation to reduce the risk of abuse.
51
Buprenorphine/naloxone common AE
Vasodilation, sweating, headaches, insomnia, constipation, GI distress, opioid withdrawal, dizziness
52
Rare but serious AE for buprenorphine/naloxone
Stevens-Johnson syndrome, physical dependence, tolerance, elevated liver functions tests, seizures
53
Buspirone dose
Anxiety: Adults, 5 mg po bid-tid or 7.5 mg po bid, may titrate to 20-30 mg/d in 2-3 divided doses (max 60 mg/d)
54
Buspirone MOA
Buspirone is the first of a class of selective serotonin-5-HT1A receptor partial agonists. It also has some effect on dopamine-D2 auto-receptors and, like antidepressants, can downregulate β-adrenergic receptors. Unlike benzodiazepines, it lacks amnestic, anticonvulsant, muscle relaxant, and hypnotic effects. Its exact anxiolytic mechanism of action is complex and not clearly defined.
55
Buspirone with linezolid, SSRIs, St. Johns wort DDI
Risk of serotonin syndrome
56
Buspirone common AE
Dizziness
57
Buspirone rare, but serious AE
Mania, psychiatric disorder
58
Carisoprodol dosing
Disorder of musculoskeletal system: 250-350 mg po tid and hs
59
Carisoprodol MOA
Carisoprodol blocks interneuronal activity in descending reticular formation and spinal cord, resulting in muscle relaxation.
60
Carisoprodol contraindications
Hypersensitivity to carisoprodol or meprobamate, acute intermittent porphyria
61
Carisoprodol contraindications
Hypersensitivity to carisoprodol or meprobamate, acute intermittent porphyria
62
Carisoprodol CYP2C19 inducers
Increased carisoprodol metabolism reduces carisoprodol effectiveness
63
Carisoprodol CYP2C19 inhibitors
Decreased carisoprodol metabolism increases risk of carisoprodol toxicity
64
Carisoprodol common AE
Drowsiness, dizziness
65
Carisoprodol rare but serious AE
Slowed or difficult breathing when used in combination with opioids, seizure, drug dependence, withdrawal symptoms upon discontinuation after chronic use
66
Clonazepam dose
Panic disorder: 0.25 mg po bid, may titrate by 0.125-0.25 mg po bid every 3 d to a max total daily dose of 1-4 mg (divided into 2-3 daily doses)
Seizure: Infants, Children <10 y of age or <30 kg, 0.01-0.03 mg/kg/d po divided into 2-3 daily doses, may titrate by 0.25-0.5 mg po every 3 d to max of 0.1-0.2 mg/kg/d (divided into 3 daily doses); Children ≥10 y of age or ≥30 kg, 0.5 mg po tid, may titrate by 0.125-0.25 mg po bid every 3 d to a max of 1-4 mg/d (divided into 2-3 daily doses); Adults, 2-8 mg/d in 1-2 divided doses, may titrate to max 20 mg/d
67
Clonazepam contraindications
Hypersensitivity to benzodiazepines, narrow-angle glaucoma, liver disease
68
Clonazepam DDI with alfentanil, opioids, and other resp depressive agents
Additive resp depression
69
Clonazepam with theophylline DDI
Decreased clonazepam effectiveness via inhibition of adenosine receptors
70
Clonazepam common AE
Ataxia, lethargy, somnolence, weight gain
71
Clonazepam rare but serious AE
Seizures, mania, depression, withdrawal symptoms
72
Colchicine doses
Gout, acute: 1.2 mg po at the first sign of a flare followed by 0.6 mg 1 h later; max 1.8 mg over 1 h
Gout, prophylaxis: 0.6 mg po daily to bid, max of 1.2 mg/d or onset of diarrhea
Familial Mediterranean fever: Children 4-6 y of age, 0.3-1.8 mg po daily; Children 6-12 y, 0.9-1.8 mg po daily; Children ≥12 y of age and Adults, 1.2-2.4 mg po daily, increase or decrease dose in increments of 0.3 mg/d
73
Colchicine MOA
Exact mechanism unknown. In patients with gout, may interrupt the cycle of monosodium urate crystal deposition in joint tissues and the resultant inflammatory response that initiates and sustains an acute attack. Colchicine also inhibits urate crystal deposition, which is enhanced by a low pH in the tissues, probably by inhibiting oxidation of glucose and subsequent lactic acid production in leukocytes.
74
Colchicine contraindications
Hypersensitivity to colchicine; concurrent use with strong CYP3A4/5 inhibitors in patients with renal or hepatic failure
75
Colchicine DDI with fibrates and statins
Coadministration of colchicine and lipid-lowering agents may result in myopathy and rhabdomyolysis; mechanism unknown
76
Colchicine common AR
Diarrhea, nausea
77
Colchicine rare but serious AE
Agranulocytosis, Rhabdomyolysis
78
Cyclobenzaprine dose
Skeletal muscle spasm: 5 mg po tid (immediate release); may titrate to 10 mg po tid, may treat up to 2-3 wk, or 15 mg po daily (extended release), may titrate to 30 mg po daily
79
Cyclobenzaprine MOA
Cyclobenzaprine relieves skeletal muscle spasm of local origin without interfering with muscle function. It is ineffective in muscle spasm due to CNS disease. Evidence suggests that the net effect of cyclobenzaprine is a reduction in tonic motor activity, influencing both gamma (𝛾) and alpha (α) motor systems.
80
Cyclobenzaprine contraindications
Hypersensitivity to cyclobenzaprine, concomitant MAOI use, heart failure, acute coronary phase of AMI, heart block, hyperthyroidism
81
Cyclobenzaprine common AE
Xerostomia, headache, dizziness, drowsiness
82
Cyclobenzaprine rare but serious AE
Cardiac dysrhythmia, cholestasis, hepatitis, jaundice, anaphylaxis, immune hypersensitivity reaction, slowed or difficult breathing when used in combination with opioids
83
Cyclobenzaprine CYP1A2 inducers
Increased cyclobenzaprine metabolism reduces cyclobenzaprine effectiveness
84
Cyclobenzaprine CYP1A2 inhibitors
Decreased cyclobenzaprine metabolism increases risk of cyclobenzaprine toxicity
85
Cyclobenzaprine CNS depressants
Additive sedative effects
86
Cyclobenzaprine anticholinergic agents
Enhanced anticholinergic AE
87
Diazepam dose
Alcohol withdrawal syndrome: 10 mg po tid-qid in first 24 h, then 5 mg po tid-qid prn
Anxiety: Adults, 2-10 mg po bid-qid; Children, 1-2.5 mg po tid-qid
Seizure, adjunct: Adults, 2-10 mg po bid-qid; Children, 1-2.5 mg po tid-qid
88
Diazepam contraindications
Hypersensitivity to benzodiazepines, narrow-angle glaucoma, severe liver disease, myasthenia gravis, sleep apnea, respiratory insufficiency, children <6 mo
89
Diazepam digoxin
Reduced renal clearance of digoxin and increased digoxin toxicity
90
Diazepam Common AE
Drowsiness, impaired motor coordination
91
Diazepam rare but serious AE
Seizures, mania, depression, withdrawal symptoms, elevated liver function tests
92
Diazepam and ethinyl estradiol and other estrogen based bc
Inhibition of diazepam metabolism and additional toxicity
93
Diazepam and CYP2C19, 3A4/5 inducers
Increased diazepam metabolism reduces efficacy
94
Diazepam and CYP2C19, 3A4/5 inhibitors
Decreased metabolism increases toxicity
95
Diazepam and alfentanil, opioids, resp depressants
Additive respiratory depression
96
Fentanyl dose
Pain, chronic (moderate to severe): Adults and Children >2 y of age, opioid tolerant, with pain that cannot be managed by other means, transdermal fentanyl dosage based on the patient’s current 24-h oral morphine requirement; replace patch q72h; may replace patch q48h in patients not achieving adequate analgesia
97
Fentanyl MOA
Fentanyl is a phenylpiperidine opioid agonist with predominant effects on the mu opioid receptor and is about 50-100 times more potent as an analgesic than morphine.
98
Fentanyl BBW
CYP3A4/5 inhibitors; respiratory depression; transdermal not for use postoperatively; fatalities in children; formulations not interchangeable; fever; care with disposal; REMS program; concurrent use with benzodiazepines or other CNS depressants
99
Fentanyl contraindications
Acute or postoperative pain, bronchial asthma, hypersensitivity to fentanyl, mild or intermittent pain management, opioid nontolerant patients, paralytic ileus
100
Fentanyl and Barbiturates, benzodiazepines, centrally acting muscle relaxants, opioids, phenothiazines
additive CNS depression
101
Fentanyl and beta-blockers and CCBs
Additive hypotension
102
Fentanyl and Buprenorphine, opioid agonists/antagonists, opioid antagonists
Precipitation of withdrawal symptoms
103
Fentanyl and CYP3A4/5 inducers
Increased fentanyl metabolism decreases fentanyl efficacy
104
Fentanyl and CYP3A4/5 strong/moderate inhibitors
Decreased fentanyl metabolism increases risk of fentanyl toxicity
105
Fentanyl and MAOIs
Additive resp depression
106
Fentanyl and SSRIs, SNRIs, TCAs, Triptans
Increased risk of serotonin syndrome
107
Fentanyl common AE
Application site reactions, sweating, constipation, GI distress, confusion, headache, anxiety, urinary retention, fatigue
108
Fentanyl rare but serious AE
Stevens-Johnson syndrome, physical dependence, tolerance
109
Hydrocodone/Acetaminophen dose
Pain, severe: Adults, 10 mg q12h initially, may titrate to response
110
Hydrocodone/APAP BBW
Addiction, abuse, misuse, REMS, respiratory depression, accidental ingestion, neonatal opioid withdrawal, alcohol, CYP3A4/5 interactions, hepatotoxicity, concurrent use with benzodiazepines
111
Hydrocodone/APAP contraindications
Hypersensitivity, paralytic ileus, respiratory depression, severe asthma
112
Hydrocodone/APAP DDI
Same as fentanyl
113
Hydrocodone/APAP common AE
Constipation, GI distress, somnolence
114
Hydrocodone/APAP Rare but serious AE
Stevens-Johnson syndrome, physical dependence, tolerance, respiratory depression, serotonin syndrome, adrenal insufficiency, decreased sex hormones
115
Hydroxychloroquine dose
Lupus erythematosus: 200-400 mg po daily (may divide into 2 doses)
Malaria, suppression: Adults, 400 mg po q week on the same day; Children, 5 mg base/kg (200 mg hydroxychloroquine sulfate = 155 mg hydroxychloroquine base); begin 2 wk prior to entering an endemic area and continue for 4 wk after leaving the endemic area
Malaria, uncomplicated: Adults, 800 mg followed by 400 mg at 6, 24, 48 h after initial dose (total of 2 g); Children, 13 mg/kg (not to exceed 800 mg), followed by 6.5 mg/kg (not to exceed 400 mg) at 6, 24, 48 h after initial dose
Rheumatoid arthritis, maintenance: 400-600 mg po daily, after 4-12 wk reduce dose to 200-400 mg po daily
116
Hydroxychloroquine MOA
The mechanism of action of hydroxychloroquine is unknown. It is effective in treating P. vivax, P. malariae, and susceptible strains of P. falciparum.
117
Hydroxychloroquine contra
Hypersensitivity to hydroxychloroquine, retinal or visual field changes from prior hydroxychloroquine, long-term use in children
118
Hydroxychloroquine and digoxin
Increased digoxin levels
119
Hydroxychloroquin and fibrates
increased risk of cholelithiasis
120
Hydroxychloroquine and metoprolol
Decreased metabolism and increased toxicity of metoprolol
121
Hydroxychloroquine and aurothioglucose
Increased risk of blood dyscrasias. Contraindicated
122
Hydroxychloroquine common AE
none
123
Hydroxychloroquine rare but serious AE
Arrhythmias, cardiomyopathy, Stevens-Johnson syndrome, agranulocytosis, seizures, retinopathy, psychosis
124
Lorazepam dose
Anxiety: Adults, 1 mg po bid-tid
| Insomnia, due to anxiety or situational stress: Adults and Children >12 y of age, 2-4 mg po hs
125
Lorazepam BBW
concurrent use with opioids
126
Lorazepam MOA
Enhance the postsynaptic effect of the inhibitory neurotransmitter, GABA.
127
Lorazepam contraindications
Hypersensitivity to benzodiazepines, narrow-angle glaucoma
128
Lorazepam and valproic acid
Decreased metabolism of lorazepam
129
Lorazepam and amitriptyline
Additive psychomotor defects
130
Lorazepam and Ethinyl estradiol and other estrogen-based birth control products
Increased lorazepam metabolism and decreased effectiveness
131
Lorazepam and Alfentanil, opioids, and other respiratory depressants
Additive respiratory depression
132
Lorazepam common AE
Drowsiness, impaired motor coordination, retrograde amnesia
133
Lorazepam rare but serious AE
Seizures, mania, depression, withdrawal symptoms
134
Methadone dose
Pain, chronic (moderate-severe): Opioid-naive patients, 2.5 mg po q8h-q12h, may titrate to response
Drug detoxification, opioid abuse: 15-30 mg po q8h, titrate to response (usual range 80-120 mg/d); when used for treatment of opioid addiction (detoxification or maintenance), may only be dispensed by certified opioid treatment programs
135
Methadone MOA
Binds to opiate receptors in CNS, causing inhibition of ascending pain pathways, altering perception to pain, and produces generalized CNS depression. Methadone is a phenylethylamine opioid agonist qualitatively similar to morphine but with a chemical structure unrelated to the alkaloid-type structures of the opium derivatives. Analgesic activity of (R)-methadone is 8-50 times that of (S)-methadone, and (R)-methadone has a tenfold higher affinity for opioid receptors.
136
Methadone BBW
Accidental ingestion; addiction, abuse, and misuse; QTc prolongation; respiratory depression; concurrent use with benzodiazepines; REMS; neonatal opioid withdrawal; conditions for use in opioid addiction; CYP interactions
137
Methadone contraindications
Bronchial asthma, hypersensitivity to opioids, paralytic ileus, respiratory depression, hypercarbia
138
Methadone and amiodarone
QT prolongation
139
Methadone and Barbiturates, benzodiazepines, centrally acting muscle relaxants, opioids
CNS depression
140
Methadone and Buprenorphine, opioid agonists/antagonists, opioid antagonists
precipitation of withdrawal
141
Methadone and CYP3A4/5 and CYP2B6 inducers
Increased methadone metabolism and decreased methadone efficacy
142
Methadone and CYP3A4/5 and CYP2B6 inhibitors
Decreased methadone metabolism increases risk of methadone toxicity
143
Methadone and CYP2D6 substrates
Reduced metabolism of substrates and increased toxicity
144
Methadone and didanosine
Decreased didanosine absorption
145
Methadone and MAOIs
Additive respiratory depression, increased risk of serotonin syndrome
146
Methadone and SSRIs, SNRIs, TCAs, triptans
Increased risk of serotonin syndrome
147
Methadone common AE
Constipation, GI distress, hypotension, dizziness, sedation
148
Methadone rare but serious AE
Respiratory depression, arrhythmias, Stevens-Johnson syndrome, QTc prolongation, serotonin syndrome, adrenal insufficiency, hypogonadism
149
Methotrexate dosing
Non-Hodgkin lymphoma, advanced (Burkitt lymphoma, stages I and II): 10-25 mg/d po for 4-8 d for several courses with a 7-10 d rest period
Psoriasis, severe: Initial, 2.5-5 mg q12h × 3 doses/wk, may titrate dose to 10-25 mg/wk po
Rheumatoid arthritis, severe: 7.5-15 mg po once weekly, may titrate by 5 mg/wk every 2-3 wk to max 20-30 mg/wk
Juvenile rheumatoid arthritis, polyarticular course: 10 mg/m2 po once weekly, may titrate to clinical response
150
Methotrexate MOA
Reversibly inhibits dihydrofolate reductase (DHFR). Dihydrofolates are reduced to tetrahydrofolates by DHFR before they are used in DNA synthesis. Methotrexate interferes with DNA synthesis, repair, and cellular replication.
151
Methotrexate BBW
Bone marrow suppression, renal impairment, hepatotoxicity, pneumonitis, GI toxicity, secondary malignancy, tumor lysis syndrome, dermatologic toxicity, opportunistic infections, radiotherapy, hypersensitivity, pregnancy
152
Methotrexate contraindications
Hypersensitivity to methotrexate, pregnancy, nursing, preexisting blood dyscrasias in patients treated for psoriasis and rheumatoid arthritis
153
Methotrexate and Aspirin, dantrolene, loop diuretics, NSAIDs, penicillins, PPIs, salicylates, trimethoprim, sulfisoxazole
Competition for renal tubular secretion, increased methotrexate toxicity and nephrotoxicity
154
Methotrexate and BCG vaccine, other live vaccines and immunostimulants
Increased infection risk
155
Methotrexate and Eltrombopag
Inhibition of OATP1B1 by eltrombopag results in decreased methotrexate clearance and increased toxicity
156
Methotrexate and leucovorin
Leucovorin is a reduced folate that counteracts the anticancer effects of methotrexate
157
Methotrexate common AE
Myelosuppression, nausea, vomiting, alopecia, stomatitis, photosensitivity, rash
158
Methotrexate rare but serious AE
Acute renal failure, liver failure, interstitial lung disease, Stevens-Johnson syndrome, secondary malignancies (lymphomas), opportunistic infections
159
Methylprednisolone dosing
Adults, 4-48 mg po daily; Children, specific dosing parameters not specified; for all patients, adjust dose according to patient response.
```
Allergic states (eg, asthma, etc)
Dermatologic diseases (eg, exfoliative erythroderma, etc)
Endocrine disorders (eg, adrenocortical insufficiency, etc)
GI diseases (eg, regional enteritis, ulcerative colitis, etc)
Hematologic disorders (eg, acquired hemolytic anemia, etc)
Neoplastic diseases (eg, palliative management of leukemias and lymphomas, etc)
Nervous system (eg, multiple sclerosis, cerebral edema, etc)
Renal diseases (eg, idiopathic nephrotic syndrome, systemic lupus erythematosus, etc)
Respiratory diseases (eg, idiopathic eosinophilic pneumonia, etc)
Rheumatic disorders (eg, rheumatoid arthritis, etc)
```
160
Methylprednisolone MOA
Corticosteroids are naturally occurring and synthetic adrenocortical steroids that cause varied metabolic effects, modify the body’s immune responses to diverse stimuli, and are used primarily for their anti-inflammatory effects in disorders of many organ systems.
161
Methylprednisolone contraindications
Hypersensitivity to methylprednisolone or other glucocorticosteroids, administration of live vaccines, fungal infections
162
Methylprednisolone common AE
GI upset, hyperglycemia
163
Methylprednisolone rare but serious AE
Primary adrenocortical insufficiency, Cushing syndrome, decreased growth in children, increased risk of infection
164
Methylprednisolone and warfarin
Steroids can either increase or decrease INR in patients taking warfarin
165
Methylprednisolone and phenytoin
Phenytoin increases methylprednisolone metabolism; methyl-prednisolone can increase or decrease phenytoin metabolism
166
Methylprednisoone and FQs
Concurrent use of steroids and fluoroquinolones can increase risk of tendon rupture, especially in elderly
167
Methylprednisolone and CYP3A4/5 inducers
Increased methylprednisolone metabolism decreases methyl-prednisolone efficacy
168
Methylprednisolone and CYP3A4/5 inhibitors
Decreased methylprednisolone metabolism increases risk of methylprednisolone toxicity
169
Morphine dose
Chronic pain, moderate to severe: 10-20 mg po q12h, titrate to response; use immediate-release formulation to determine patient’s morphine requirement and titrate to response. Extended-release products are administered every 12-24 h
Acute pain: 10 mg po q4h prn, titrate to response (max 30 mg po q4h) in hospitalized patients at low risk of respiratory depression
170
Morphine MOA
Morphine is a pure mu agonist. Mu receptors are responsible for analgesia, respiratory depression, miosis, decreased GI motility, and euphoria. In the CNS, it promotes analgesia and respiratory depression by decreasing brain stem respiratory centers’ response to carbon dioxide tension and electrical stimulation. It also decreases gastric, biliary, and pancreatic secretion, induces peripheral vasodilation, and promotes opioid-induced hypotension due to histamine release
171
Morphine BBW
Ethanol; addiction, abuse and misuse, REMS, respiratory depression, neonatal opioid withdrawal, accidental ingestion, concurrent use with benzodiazepines, medication errors
172
Morphine contraindications
Hypersensitivity to opioids, acute or severe asthma, paralytic ileus, respiratory depression, GI obstruction; concurrent use or use within 14 days of MAOI
173
Morphine DDI
Same as fentanyl
174
Morphine common AE
Constipation, nausea, vomiting, hypotension, dizziness, sedation, diaphoresis, headaches, depression, xerostomia
175
Morphine rare but serious AE
Cardiac arrest, physical dependence, respiratory depression, serotonin syndrome, adrenal insufficiency, decreased sex hormones
176
Oxycodone dose
Pain, chronic, moderate to severe: Initial dose for opioid-naïve patient, immediate release, 5-15 mg po q4-6h prn pain; extended release, 10 mg po q12h prn pain; titrate to response
177
Oxycodone MOA
Oxycodone is pure mu agonist. Mu receptors are responsible for analgesia, respiratory depression, miosis, decreased GI motility, and euphoria. In the CNS, it promotes analgesia and respiratory depression by decreasing the brain stem respiratory centers’ response to carbon dioxide tension and electrical stimulation. It also decreases gastric, biliary, and pancreatic secretion, induces peripheral vasodilation, and promotes opioid-induced hypotension due to histamine release.
178
Oxycodone BBW
Addiction, abuse potential; REMS, respiratory depression, accidental ingestion, neonatal withdrawal, CYP3A4/5 interaction, concurrent use with benzodiazepines, medication errors with oral solution
179
Oxycodone contraindications
Hypersensitivity to oxycodone or other opioids, asthma, paralytic ileus, respiratory depression, hypercarbia
180
Oxycodone DDI
Same as morphine
181
Oxycodone common AE
Constipation, GI distress, sedation, sweating, pruritus
182
Oxycodone rare but serious AE
Cardiac arrest, respiratory depression, physical dependence, tolerance, severe hypersensitivity, serotonin syndrome, adrenal insufficiency, decreased sex hormones
183
Rizatriptan dose
Migraine: Adults, 5-10 mg po at onset of migraine, may repeat after 2 h prn; max 30 mg/d; Children ≥6 y and Adolescents, <40 kg, 5 mg po at onset of migraine, multiple doses in a 24-h period not recommended
184
Rizatriptan MOA
Rizatriptan binds with high affinity to serotonin (5HT) receptor subtypes 1B and 1D. Serotonin receptor agonists are believed to be effective in migraine either through vasoconstriction (via activation of 5-HT1 receptors located on intracranial blood vessels) or through activation of 5-HT1 receptors on sensory nerve endings in the trigeminal system resulting in the inhibition of proinflammatory neuropeptide release.
Drug Characteristics: Rizatriptan
185
Rizatriptan contraindication
Cerebrovascular syndromes, hemiplegic or basilar migraine, ischemic bowel disease, ischemic heart disease, peripheral vascular disease, severe hepatic impairment, uncontrolled HTN, MAOI, ergot alkaloids
186
Rizatriptan and SSRIs
Additive pharmacologic effects resulting in excessive serotonergic stimulation
187
Rizatriptan and other 5HT agonists
Additive pharmacologic effect leading to dangerous toxicity
188
Rizatriptan and MAOIs
Metabolism of sumatriptan inhibited by MAOI, increasing serotonin levels and risk of serotonin syndrome
189
Rizatriptan and ergot alkaloids
Enhanced vasoconstricting effects
190
Rizatriptan common AE
None
191
Rizatriptan rare but serious AE
Angina, cardiac dysrhythmia, coronary arteriosclerosis, heart block, HTN, acute myocardial infarction, aphasia, cerebral ischemia, stroke, dystonia, hemiplegia, neuropathy, transient ischemic attack, oculogyric crisis
192
Sumatriptan dose
Migraine: Oral, 25-100 mg po at onset of migraine, may repeat after 2 h prn; max 200 mg/d; Nasal, 5-20 mg in 1 nostril, may repeat after 2 h; max 40 mg/d; sq, 6 mg sq; max 12 mg/d; Transdermal, apply 1 patch, may apply a 2nd after 2 h; max 2 patches/d
Cluster headaches: 6 mg sq once; max 12 mg/d
193
Sumatriptan MOA
Sumatriptan binds with high affinity to serotonin (5-HT) subtypes 1B, 1D, and 1F receptors. It has no significant affinity or pharmacologic activity at adrenergic α1, α2, or β; dopaminergic D1 or D2; muscarinic; or opioid receptors. Serotonin receptor agonists are believed to be effective in migraine either through vasoconstriction (via activation of 5-HT1 receptors located on intracranial blood vessels) or through activation of 5-HT1 receptors on sensory nerve endings in the trigeminal system resulting in the inhibition of proinflammatory neuropeptide release.
194
Sumatriptan contraindications
Hypersensitivity to sumatriptan, cerebrovascular syndromes, hemiplegic or basilar migraine, ischemic bowel disease, ischemic heart disease, peripheral vascular disease, severe hepatic impairment, uncontrolled HTN, MAOIs, ergot alkaloids
195
Sumatriptan DDI
Same as rizatriptan
196
Sumatriptan common AE
None
197
Sumatriptan rare but serious AE
Angina, cardiac dysrhythmia, coronary arteriosclerosis, heart block, HTN, AMI, aphasia, cerebral ischemia, stroke, dystonia, hemiplegia, neuropathy, transient ischemic attack, oculogyric crisis
198
Tizanidine dose
Muscle Spasticity: 2 mg po up to tid, may titrate to 8 mg po q6-8h with max dose of 36 mg/d
199
Tizanidine MOA
Tizanidine is a centrally acting muscle relaxant. The drug is an imidazole derivative, structurally unrelated to other muscle relaxants. Tizanidine is an agonist of α2-adrenergic receptors, which decreases spasticity by increasing presynaptic inhibition; however, it does not have antihypertensive properties.
200
Tizanidine contraindications
Hypersensitivity to tizanidine; concurrent use with CYP1A2 inhibitors
201
Tizanidine and CNS depressants
Additive CNS depression
202
Tizanidine and phenytoin/fosphenytoin
Increased phenytoin concentration, phenytoin toxicity
203
Tizanidine ant CYP1A2 inhibitors
Inhibition of tizanidine metabolism and increased toxicity
204
Tizanidine common AE
Hypotension, xerostomia, asthenia, dizziness, somnolence, muscle weakness
205
Tizanidine rare but serious AE
AMI, thrombocytopenia, hepatitis, PE, hypersensitivity, death, slowed or difficult breathing when used in combination with opioids
206
Tramadol dose
Pain, chronic, moderate to moderately severe: Immediate release, 50 mg po q4-6h prn, may titrate to 400 mg/d; extended release, initial, 100 mg po daily, may titrate to 300 mg/d; to convert from immediate release, convert 1:1 and round down to nearest 100 mg dose
207
Tramadol MOA
Tramadol is a mu agonist and a weak inhibitor of serotonin and norepinephrine reuptake. Mu receptors are responsible for analgesia, respiratory depression, miosis, decreased GI motility, and euphoria. In the CNS, it promotes analgesia and respiratory depression by decreasing brain stem respiratory centers’ response to carbon dioxide tension and electrical stimulation.
208
Tramadol BBW
Addiction, abuse, misuse, REMS, respiratory depression, accidental ingestions, CYP2D6, neonatal withdrawal syndrome, drug interactions, concurrent benzodiazepines, errors
209
Tramadol contraindications
Hypersensitivity to tramadol or other opioids, paralytic ileus, respiratory depression, bronchial asthma, age <12 y, hypercapnia, MAOI use or use within last 14 d
210
Tramadol common AE
Constipation, GI distress, dizziness, sedation, edema, sweating, pruritus, headaches, flushing
211
Tramadol rare but serious AE
Cardiac arrest, physical dependence, tolerance, seizures, pancreatitis, suicidal ideation, anemia, serotonin syndrome, adrenal insufficiency, decreased sex hormones
212
Tramadol DDI
Same as morphine
