Top 200 Flashcards

Question

bactrim DS

Answer 1

sulfamethoxazole + trimethoprim DS I= UTI, Shigellosis, PCP prophylaxis and treatment, sinusitis, MOA=Inhibit production of tetrahydrofolic acid in folic acid synthesis D= PCP proph 1 DS qd or 1SS qd, PCP Tx 15-20mg/kg divided q 6-8hours (mod/sev) or TID (mild/mod), shigellosis 1 DS q12h x 5days DDI= warfarin inc INR, TCAs SE= Common: Rash, urticaria Serious: SJS, rhabodmyolysis, agranulocytosis PK=Renal elimination mostly for oral S/T C= Use sunscreen, reporst SJS (spreading red rash, drink plenty of water to prevent kidney stones

Answer 2

esomeprazole I= GERD, NSAID gastropathy, Duodenal ulcer disease MOA=proton pump inhibitor D= 20-40mg once daily 1 hour before meals DDI= ripivirine, clopidogrel, mycophenolate, iron SE= Common: diarrhea Serious: C dific diarreha, bone fracture, rhabodo PK=Renal elimination 80%, extensive cyp 3a4 metabolism C= report persistent watery diarrhea, take 1 hour before meals,

Answer 3

``` montelukast I= Asthma, allergic rhinitis MOA= leuktriene receptor antagonist, prevents inflammation, smooth muscle contraction D= 10mg orally in the evening SE= Common:Headache PK=Bile excretion C= Not for acute asthma attacks ```

Answer 4

amoxicillin + clavulanate I= Acute otitis media, CAP, sinusitis, UTI, LRTI, skin infections, strep throat, febrile neutropenia MOA=inhibit cell was synthesis, clavulanate stops beta lactamase from destroying amoxicillin D= Start 500mg bid, max 850mg TID DDI= ACE's SE= Common:diarrhea PK=A: mostly renal, Cl: renal/extensive hepatic C= decrease effectivenss of oral contraceptives , NVD, take at the start of a meal

Answer 5

cyclobenzaprine I= skeletal muscle spasm, fibromyalgia MOA=works on the CNS to reduce smoatic motor activity D= IR: 5mg TID, can inc to 10mg TID up to 2-3 weeks, ER 15mg qd, up to 30mg qd up to 2-3 weeks DDI= MAOI, duloxetine SE= Common: dizziness, HA Serious: hepatitis PK=Extensive hepatic CYP3A4 Renal elimination 50% C= not intended for long term therapy, affect mental alertness, do not use alcohol or other CNS depressants, report hepatic sx

Answer 6

gabapentin I= postherpetic neuralgia, partial seizure adjunct, diabetic neuropathy, migraine prophylaxis MOA=GABA analog but does not bind GABA receptors. MOA unknown D= 300mg qd, bid, or tie. Max 1800mg/day divided in 3 doses DDI= morphine inc gabapentin, naproxen, ketorolac, antacids SE= Common: somnolence, dizziness Serious: suicidal thoughts PK=Renal C= separate from aluminum or mg by 2 hours, avoid alcohol, report suicidal ideation

Answer 7

metoprolol xl I= hypertension, CHF, angina, AFIb MOA=beta blocker D= HTN 25-100mg orally daily, CHF up to 200mg orally daily DDI= amiodarone, diltiazem, veraamil, beta agonists SE= Common: dizziness, fatigue Serious: bronchospasm 1% PK=Hepatic 50% C= mask symptoms of hypoglyecemia except sweating, can cut tablet in half, take immediately after meals, do not stop taking suddenly

Answer 8

meloxicam I= osteoarthritis, rheumatoid arthritis MOA=NSAID cox inhibition dec prostaglandin sysnthesis D= 7.5mg once daily, max 15mg daily use lowest effective dose for shortest duration DDI= clopidogrel, warfarin, SSRIS, LMWH, thiazides, SE= Common: HA, N Serious: GI bleed PK=hepatic C= Avoid in late pregnancy, report dark stools or bleeding, report worsening BP, do not take other NSAIDs

Answer 9

potassium chloride I= hypokalemia, long QT MOA=electrolyte replenish, normalize renal fx, normal muscle contraction and nerve impulses D= doses based on serum potassium levels 20-100meq/L divided 1-5 doses after meals DDI= ACEI's, ARBs, potassium sparing diuretics, salt substitutes SE= Common:NVD, flatulence Serious: caridiac arrest, Hyperkalemia PK=Renal elimination C=Take with food and full glass of water to prevent Gastric irritation

Answer 10

warfarin I= Afib, VTE, PE, valve replacement, APS MOA=VItamin K antagonist, dec synthesis of clotting factors D= variable, titrated to INR goal DDI= amiodarone, fluoroquinolones, multivitamins, vitamin K foods, etoh SE= Common: nosebleeds, bruising Serious: excessive bleeding, inter cranial hemorrhage PK=Renal elimination C= Keep consistenet diet, report unusual bruising or bleeding, avoid binge etoh, reprot missed doses, take at bedtime

Answer 11

naproxen I= osteoarthritis, pain, acute gout, RA, tendonitis MOA=cox inhibitor D= 250-500mg bid max 1500mg/day up to 6 months DDI= ACEi, warfarin, heparin, SE= Common: abdominal pain, GI upset Serious: GI bleeding, CHF PK=Renal elimination 95% C= Report GI bleeding, increases blood pressure

Answer 12

quetiapine I= Bipolar disorder, depression, schizophrenia MOA=5ht and dopamine receptor antagonist, also antagonist alpha, histamine receptors D= Start 500mg bid, max 850mg TID DDI= barbiturates, glucocorticoids, hydromorphone SE= Common:somnolence, weight gain Serious: qt prolongation PK=Renal elimination 73% C= stand up slowly for OH, report tardive dyskinesia, monitor for sx of hyperglycemia for diabetics

Answer 13

fluticasone / salmeterol I= asthma, COPD MOA=Fluticasone antiinflammatory, Salmeterol long acting beta agonist--> smooth muscle relaxation bronchial, ihibit hypersensitivity molecules of mast cells D= 100-500/50mcg inhlation 12 hours apart twice daily DDI= ACE's SE= Common:Hyperkelemia Serious: lactic acidosis PK=Renal elimination90% C= not rescue medication, rinse mouth after use (thrush), forceful inhalation of medications, report weight gain, thin skin, facial rounding, fatigue

Answer 14

lorazepam I= anxiety, status epilepticus, CINV, seizure, etoh withdrawal MOA=benzodiazepine, binding to GABA receptor, opiods, centrally acting muscle relaxants, zolpidem D= 2-6mg/day divided in 2-3 doses (Anx) DDI= etoh, barbiturates, SE= Common:sedation Serious: lactic delirium PK=Renal elimination 88 % C= avoid alcohol, impairs alertness, memory, somnolence. Can take missed dose up to 1 hour of scheudled time, if >1h, skip dose

Answer 15

fluconazole I= candidiasis, cryptococcal meningitis, many fungal infections MOA=inhibit fungal sterol synthesis D= 100-800mg orally or IV, weekly to daily DDI= CYP3A4 inhibitors, inducers SE= Common: HA Serious: prolonged qt, agranulocytosis PK=Renal elimination 80% C= Report skin rash, NV, HA

Answer 16

topiramate I= tonic clonic seizure, partial seizure, migraine prophylaxis MOA=Unknown, maybe augemnt GABA activity D= 25-200mg twice daily, varies DDI= Metformin inc LA, citalopram long QT, naproxen SE= Common: loss of apetite, dec psychomotor performance, somnolence Serious: metbolic acidosis PK=Renal elimination 70% C= maintain adequate fluid intake, dec effectivenss of estrogen containingbirth control, avoid sudden d/c --> seizure

Answer 17

ciprofloxacin I= pyeloneprhitis, UTI, gonorrhea, sinusitis, etc, etc MOA=fluorquinolones interfere with dna gyrase, interfere with DNA synthesis bacteria D= 250-750 orally/IV q12h DDI= antidiabetic agents, warfarin, antacids SE= Common:NVD, rash Serious: hemolytic anemia, agranulcytosis BBW: increased risk of tendinitis and tendon rupture PK=liver significant C= Avoid antacids, photosensitivity, take 2 hour before or 6 hours after calcium,iron,zinc antacids

Answer 18

acetaminophen with codeine I=pain mild to moderately severe MOA=peripheral/central analgesia D= apap/codeine 300-1000/ 15-60mg (max 360) prn q 4hours DDI= barbiturates, benzos, opiates SE= Common:somnolence Serious: liver failure PK=hepatic, codein hepatic--> renal C= avoid etoh , hepatotoxcity symptosm, max 4g for APAP, somnolence

Answer 19

``` alendronate I= osteoporosis MOA=inhibit osteoclast bone resorption D= 70mg once weekly, or 5mg daily DDI: dairy foods SE= Common:fever Serious: esophageal erosions PK=Renal elimination 50% C= Take when waking up, 30 min before first food, maintain upright position x 30 minutes prevents esophageal damage ```

Answer 20

rosuvastatin I= hyperlipidemia, hypertriglyceridimia MOA=hmg coa reductase inhibitor D= 5-40mg daily DDI= APAP, fibrates CYp3a4 inducers/ ihibitors SE= Common:arthralgia Serious: rhabomyolysis PK=fecal 90%, some renal C= bilateral muscle pain, jaundice, separate antacids 2 hours

Answer 21

amitryptyline I=depression, pain, headache MOA=TCA, sedating, block uptake of serotonin, norepinephrine D= 50-100 daily divided 1-3 doses. Max output 150/day, inpt 300/day, polyneuorpathy 10-25mg HS, up to 200mg/day inc weekly DDI= MAOIs, SSRIS, CYP3A4 i/i SE= Common:wt gain, somnolence, blurry vision Serious:Qt prolongation PK=hepatic and renal C= Symptomatic imprvmt takes weeks, dont d/c abruptly, dont drink alcohol

Answer 22

``` fexofenadine I= urticaria, allergic rhinitis MOA=inhibits histamine releease and H1 receptor activity D= 60 po bid or 180mg po qd DDI= Droperidol, antacids, GFJ, SE= Common: HA PK=fecal 80% C= Take with water not fruit juices. Separate antacids by 30min before or after fexofenadine, fatigue, HA ```

Answer 23

carvedilol I= hypertension, chf MOA=alpha/beta blocker D= HTN 6.25mg bid, may be doubled 1-2 weeks, max 25mg bid, CHF start 3.125 bid, doubled q 2 weeks, max 25mg bid if 85kg max 50mg bid DDI= amiodarone, verapamil, diltiazem, alpha 1 blockers SE= Common:hyperglycemia, wtgain , dizziness, diarrhea, erectile dysfunction Serious: AV block PK=fecal /biliary C= take with food, diabetics watch sugar levles, stand up slowly

Answer 24

risperidone I= bipolar, schizophrenia MOA=Unknown. 5ht receptor blocker, weak dopamine receptor blocker D= Schz 2-8mg/day po , bipolar 2-3mg/day po , IM 25mg IM q 2weeks then 37.5-50mg IM q 4 weeks (both) DDI= TCAs, Agents that cuase qt prolongation, SE= Common: somnolence, insomnia, constipation, many, Serious: tardive dyskinesia BBW: inc mortality of elderly patients with atypical antipsychotics PK=Renal elimination 70%, hepatic extensive C= drowsiness, hyperglycemia, stand up slowly

Answer 25

``` tolteridine I= overactive bladder MOA=muscarinic receptor antagonist D= 2mg bid (IR), or 1mg BID DDI=potassium acetate, warfarin, SE= Common:dry mouth, serious; angioedema PK=Renal elimination 77% C= drymouth, dizziness, report angioedema ```

Answer 26

doxycycline I= syphyllis, gonorrhea, acne, chlamydia, shigellosis MOA=inhibits bacterial protein synthesis D= 100mg po bid, and others DDI= antacids, warfarin SE= Common: diarrhea Serious: sis PK=hepatic and renal C= sunscreen, antacids avoid, decrease oral contraceptive effectiveness, take with full glass of water

Answer 27

pantoprazole I=GERD, gastric hypersecretion, erosive esophagitis D=40mg once daily (sometimes twice daily) DDI=mycophenolate, citalopram, warfarin, itraconzole MOA=proton pump inhibitor PK=70% renal excretion, fecal 18% SE=diarrhea serious: c. dificil diarrhea, osteoporosis with multiple daily doses for longer than a year C=report diarrhea, persistent watery stools, take 30 minutes before a meal in the morning

Answer 28

amphetamine + dextroamphetamine XR I=ADHD, narcolepsy D=ADHD: ER, 20mg orally daily, narcolepsy 5-60mg/day orally in divided doses DDI=Selegiline, isocarboxazid, MOAI MOA=CNS stimulant activity, may block rueptake of NE and dopamine. for ADHD MOA unknown PK=renal elimination SE=loss of appetite, dry mouth, insomnia Serious: CVA, mania precaution/BBW: high potential for abuse may lead to drug dependence. Misuse can cause sudden seat or cardiovascular adverse events C=may lower seizure threshold, impairs mental alertness, dont stop medication suddenly, avoid citrus juices, take missed dose asap unless its 6 hrs before bedtime, then skip missed dose

Answer 29

ondansetron I=CINV, post op NV, radiation induced NV D=CINV high px :(IV) 3 doses of 0.15mg/kg IV starting 30 min before chemo, repeat 4-8 post first dose. max IV single dose 16mg, (oral) 24mg po 30 min pre chemo moderate: 8mg po 30 min pre chemo, repeate in 8 hours, then 8mg q 12h x 1-2 days post chemo DDI=fluconzole, fluoroquinolones, macrolides, tcas MOA=5 HT3 receptor antagonist PK=extensive hepatic clearance SE=Ha, constipation serious: prlonged qt precaution/BBW C=report abnormal heartbeats, bronchospasm, rash.

Answer 30

lansoprazole I=GERD, erosive esophagidtis, dudenal ulcer disease D=15-30mg orally daily DDI=citalopram, mycophenolate, GFJ, PIs MOA= proton pump inhibitor PK=hepatic, some renal SE=diarrhea, abdominal pain Serious: C. dificil diarrhea C=report persistent watery diarrhea, take 30 minutes before meals, contents of capsule can be mised with applesauce, pudding ,yogurt, apple, orange or tomato juice

Answer 31

atenolol I=HTN, angina pectoris, acute MI, cardiac dysrhythmia D=50-100mg orally daily DDI=beta agonists, diltiazem, verapamil, sulfonylureas MOA=beta blocker PK=Renal clearance SE= low heart rate, dizziness, fatigue BBW= abrupt cessation of therapy of beta blockers can lead to exacerbations of angina pectoris, sometimes MI or arrhythmias C=may mask sx of hypoglycemia, diabetics to check blood sugar regularly, take on an empty stomach, do not d/c abruptly

Answer 32

momentasone (intranasal) I=asthma, allergic rhinits, TOPICAL: inflammatory hyperkeratotic dermatosis D=nasal: 2sprays/nostril (100mcg) once daily- max 200mcg/daily, inhaler: 220-440mcg once-twice daily max 880mcg/day, Topical: apply once daily DDI=ketoconazole MOA=corticosteroid, inhibit release or arachidonic acid--> inflammation inhibited PK=hepatic met-->fecal 74% SE=thrush, headache C=rinse mouth after inhalation

Answer 33

divalproex ER I=partial epileptic seizure, absence seizure, bipolar I disorder, migraine prophylaxis D=10-15mg/kg/day, can increase by up to 10mg/kg/ week. max 60mg/kg/day, depakote ER for bipolar I: 25mg/kg/day daily DDI=carbapenems, lamotrigine, naproxen, warfarin MOA=unknown. may increase GABA levels in the brain PK=renal/hepatic clearance SE=headache, somonlence Serious: thrombocytopenia dose related BBW=hepatotoxicity within first 6 months of tx, children <2 years of age at higher risk C=may take with found to avoid GI irritation, do not drink alcohol, affects mental alertness

Answer 34

oxycodone + acetaminophen I=pain moderate to severe D= apap 325-650/oxycodone 2.5-10 orally q 6h prn, max 4g APAP DDI=benzodiazepines, PI, SSRIs, Azoles, etoH MOA=oxycodone, opioid agonist, APAP analgesic antipyretic SE=somnolence, dizziness serious hepatotoxicity, respiratory depression BBW= APAP associated with liver failure. do not exceed 4000mg/day C=report (nv jaundice), do not drink alcohol , avoid other APAP otc products

Answer 35

pregabalin I=diabetic neuropathy, fibromyalgia, neupathic pain, postherpetic neuralgia, GAD D=50mg TID or 75mg BID, max of 450mg/day DDI=ketorolac, naproxen MOA=GABA analog binds to voltage gated calcium channels in CNS tissues. Decreased calcium dependent release of neurotransmitters. MOA not fully understood. PK=renal 90% SE=somnolence, fatigue, peripheral edema Seirous: suicidal thoughts, jaundice C=avoid activiitie requiring mental alertness, adverse effects to fetus with either male or female taking medication, avoid alcohol

Answer 36

metoprolol tartrate I=hypertension, angina, cardiac dysrhytmia, CHF D=HTN: 50-100mg once or divided twice daily, 6.25mg orally twice daily titrated to target 50mg bid. Inc dose over 4-6 week to target DDI=beta agonists, verapamil, diltiazem MOA=beta blocker PK=hepatic SE=fatigue, dizziness, Serious: bronchospasm BBW: sudden cessation of some beta blockers can lead to exacerbations of angina pectoris and sometimes MI. Reduce dose gradually over 1-2 weeks C=may mask sx of hypoglycemia, diabetics monitor sugars, dont stop medications suddenly, ER for: take after with or right after meals

Answer 37

diclofenac I=osteoarthritis, RA D=Osteoarthritis :DR 100-150mg /day divided in 2-3 , ER: 100mg orally daily doses RA: DR 150-200mg/day divided 2-4 doses, ER 100mg once daily max 100mg twice daily for both DDI=warfarin, clopidogtrel, tacrolimus, ssris MOA=NSAID, cox inhibitor dec prostaglandin synthesis PK=65% renal , 35% biliary SE= Serious : GI bleed, HTN BBW:NSAIDs may cause inc risk of serious cardiovascular throbmotic events, bleeding, ulceration, perforation C=Report any blood in stools or dark coffee stools, irritates GI, take with full glass of water, milk or food, gel: dont wash area for at least an hour

Answer 38

``` dialtiazem CD or diltiazem I=angina, htn, arrhythmias (IV) D=120mg-240mg orally daily max 540mg/day DDI=beta blockers, MOA=Calcium channel blocker PK=hepatic clearance SE=Headache, Fatigue Serious: heart block C=do not drink alcohol, do not take beta blockers unless provider is aware, ```

Answer 39

venlafaxine I=major depressive disorder, GAD, panic disorder, social phobia D= 37.5 to 75mg orally divided 1-3 doses. May increaase by 75mg/day q 4 days. max dose ins 225mg/day DDI=selegiline, agents that inc bleeding risk, PIs, SSRIs, triptans MOA=serotonin, NE, dopamine reuptake inhibitor PK=87% renal, extensive first pass hepatic SE=insomnia, weight loss, nervousness serious:SS BBW: antideppressants inc risk of suicidal thinking in children, adolescents, young adults C=do not drink alcohol, vocid OTC ASA, IBU, NAPX,

Answer 40

aspirin I=HA, MI ppx, fever, pain, etc D=75-100mg anti-plalet aggregation, 325-650mg q 4h prn max 3.9g/24hours DDI=Live influenza vaccine, NSAIDS, any agents that cause bleeding MOA=irreversible COX inhibition and inhibition of platelet aggregation PK=hepatic and renal elimination SE=bleeding, GI ulcer, tinnitus Serious: Reye's C=avoid use in children and never take witf child has chicken pox or flu symptoms, avoid eton, report signs and symptoms of bleeding

Answer 41

celecoxib I=osteoarthritis, RA, acute pain D=OA; 100mg po bid, or 200mg po qd, RA 100-200 po bid prn DDI=agents that increase risk of bleeding(warf, heparin etc MOA=cox 2 inhibitor PK=p450 metabolism, some renal, 57% fecal SE=HA, Serious: MI BBW: may have inc risk of cardiovascular thrombotic events, MI stroke C=report any bleeding or allergic reaction, or MI, avoid other NSAIDS, take higher (400mg bid) doces with food, lower can be with or without food

Answer 42

lamotrigine I=bipolar I disorder, partial seizures, tonic-clonic siezures D=BPI and not taking valproic acid or enzyme inducing drugs 25 qd x 2 wks, 50 qd x 2 weeks, 100mg x 1 week, then 200mg/day (Schedule) schedule is variable see references DDI=Valproic acid, estrogens, progesterone, MOA=Unknown PK=renal and extensive hepatic SE=Blurred vision, HA, dizziness Serious: Rashes BBW: serious life threatening rashes with medication, higher if pediatric or going over max dose or coadministered with valproate C=immediately report any rashes, do not stop suddently cuz leads to seizures, any changes in estorgen containing meds reported-> changes blood levels of lamictal

Answer 43

eszopiclone I=insomnia D=2mg orally before bedtime, may be increased to 3mg DDI: oxycodone, zolpidem, ketoconazole MOA=may bind to GABA receptor, but moa unknown PK=75% renal SE=HA, disorder of taste C=DO not drink ethanol, make cause sleep driving or other activities where patient is not fully awake, take only when pt has insomnia not on a regular basis

Answer 44

tamsulosin I=benign prostatic hyperplasi D=0.4mg orally ocne daily, if no responce after 2-4 weeks, increase to 0.8mg orally once daily DDI=tadalafil, azole atnfungals, macrolide, PIs, beta blockers MOA=alpha 1a recepetor antagonist leading to rleaxation of smooth mucles of protstte, increasing urine flow rate PK=hepatic and renal SE=headache, abnormal ejaculation C=take 30min after a meal every day, rise slowly to avoid Orthostatic hypotension

Answer 45

donepezil I=alzheimers dementia D=5mg orally at bedtime, can increased to max of 10mg orally daily at 4-6 weeks DDI=succinylcholine, oxybutynin MOA= reversible acetylcholinesterase inhibitor, increasing acetylcholine PK=renal/hepatic SE=diarrhea, insomnia, cramp Serious AV block C=report GI bleeding, take at bedtime, adverse effect more frequent at dose escalation but resolve with continued use

Answer 46

diazepam I=anxiety, alcohol withdrawal, sedation pre op, seizure, muscle spasm D=2-10mg orally, IM, IV MAX dose of 30mg DDI=barbiturate, opaiates, etoh , downers MOA=benzodiazepine, binding to GABA receptor PK=hepatic and renal SE=somnolence, ataxia Serious: resp depression C=avoid activities that require mental alertness, avoid abrupt discontinuation of extended diazepam therapy cuz withdrawal, do not drink ETOH

Answer 47

metoclopramide I=diabetic gastroparesis, GERD, post op NV, CINV D=10-15mg orally 30min before meals up to 4 times daily. Can be gie 10-20mg IV/IM DDI=SSRIs ,tcas, antipsychotics, MAOIs MOA=sensitization of tissues to action of acetylcholine that increases motility stomach PK=renal elimination SE=somnolence, fatigue BBW can cause tardive dyskinesia with longer duration of treatment and cumulative dose C=do not drink alcohol, report sx of tardive dyskenesia (tongue thrusting, facial ticks, random movements

Answer 48

allopurinol I=hyperurecemia, chronic gout D=Gout MFR labeling start with 100mg/day then increase weekly to recommended dosage= mild 200-300mg/day, sever 400-600mg/day ma 800/day. *Renal dosage adjustment* DDI=thiazide & loop diuretics (inc allopurinol levels), antacids (dec allop absorption), ACEI (inc allergic hypersens to allopurinol MOA=xanthine oxidase inhibitor PK=metabolized to active metabolites and those are excreted renally SE= common: rash, diarrhea, nausea, acute attacks of gout C=benefit may be delayed 2-6 weeks, take after meals to reduce gastric irritation, maintain adequate hydration to prevent renal stones

Answer 49

fluoxetine I=major depressive disorder, OCD, PTSD & more D=Depression,OCD, PTSD 20mg/day, can increase after several weeks, max 80mg/day -lower doses for hepatic impairment DDI=Anticogulants/antiplatetel (inc risk of bleeding), CNS depressants, eton, CYP2D6 inhibitor MOA=SSRI PK=hepatic clearance, minor renal SE=Common insomnia, somnolence BBW: increased suicidal ideation in young adults (18-24), adolescents, children with MDD C=take medication in the morning , may take up to 8-12 weeks after initiation of tx, report abnormal bleeding, avoid NSAIDS or aspirin, do not drink alcohol

Answer 50

pioglitazone I=diabetes type II D=15-30mg qd start, then can increased to 45mg once daily (max) DDI=CYP3A4 inducer (weak/moderate)sulfonylureas, betal blockers & SSRIS (can enhance hypoglycemia) Thiazides, loops, corticosteroids (may diminish hypoglycemic action) MOA=decreases insulin resistnac PK=hepatic clearance, peak effect takes several weeks SE=fluid retention, (edema), weight gain precaution/BBW: increased risk of bladder cancer (Health Canada Review), AVANDIA BBW of increased MI events so not used any more C=avoid in pts with CHF, may inc risk of fractures especially in females

Answer 51

triamterene/ hydrochlorothiaze I=edema, HTN (not DOC) when hypokalemia has developed or should be prevented D=HCTZ 25-50/Triam 37.5-75 daily DDI=ACEI/ARBS (Inc K) or anything that affects potassium levels, MOA=HCTZ inhibt NaCL reabsorption in distal tubulues, Triam blocks sodium channels in the late distal convoluted tubule SE=hyper/hypokalemia, hyperglycemia, hyperurecemia, orthostatic hypotension BBW: hyperkalemia can occur with triamterene, Mx serum K C=report muscle weeakness, fatigue, slow heart rate, maintain adequate hydration, avoid salt substitutes,

Answer 52

polyethylene glycol I=constipation D=17g/day dissolved in 4-8oz of water, juice, soda, coffee or tea DDI=no significant ddis MOA=osmotic agent that causes water retentio in the stool and increases stool frequency PK=onset 24-96 hours, excrted in feces SE=bloating, cramping, diarrhea, flatulence C=may not see improvement until 2-4 days, do not take longer than 2 weeks unless instructed by healthcare professional

Answer 53

insulin glargine I=DM type 1 and type II D=DMII : 0.2 units/kg or 10 units/day Increase dose by 2 units/day every 3 days until fasting glucose levels are consistently within target range (70-130 mg/dL) DDI=sulfonylureas, beta blockers & SSRIS (can enhance hypoglycemia) Thiazides, loops, corticosteroids (may diminish hypoglycemic action) MOA=long-acting insulin PK=long duration of action (depends on UNits given), excreted in urine SE=most common is hypoglycemia, pain itching stinging at injection site C=signs and sx of hypoglycemia (tremor, dizziness, sweating, irritability, fatigue, palpitations, hunger), rotate injection sites, expires in 28 days once opened

Answer 54

levofloxacin I=UTI, CAP, HAP, Skin infections etc D=CAP 500mg q 24h x 7-14days or 750mg q 24h x 5 days, HAP 750 q 24h x 7-14 days DDI=antacids, calcium salts, iron (dec absorption), warfarin (inc INR), NSAIDs (inc seizure potentiating, sulfonylureas ( enhance hypoglecemia) MOA= inhibit DNA gyrase, promotes brekage of DNA strands PK= 99% oral bioavailability, urine excretion SE= headache, nausea, diarrhea precaution/BBW (fluroquinolones) Risk of Muscle Weakness in Patients with Myasthenia Gravis C=report muscle weakens if pt also has myasthenia gravis, avoid antacids, calcium or iron supplements

Answer 55

niacin extended release I=hyperlipidemia, hypertriglyceridemia D=regular release niacin and extedned releasse not interchangeable Initial: 500 mg at bedtime for 4 weeks, then 1 g at bedtime for 4 weeks; adjust dose to response and tolerance; may increase dose every 4 weeks by 500 mg/day to a maximum of 2 g/day DDI=bile acid binders (dec absorption), HMG coa R inhib( when niacin >1g/day inc toxicity of statins, rhabdo) MOA=inhibit synthesis of LDL and VLDL, may inc TG removal from plasma PK=urine excretion of hepatic metabolites and drug SE=flushing (can be prevented by taking ASA 325 mg 30 min before dose of Niacin) precaution/BBW C=take at bedtime with low fat snack, take ASA 325mg if flushing occurs

Answer 56

lisinopril/hydrochlorothiazide I=hypertension D=10-20 Lis/12.5 HCTZ once daily, max 80/50mg once daily DDI=antidiabetic agents (thiazides can make them less effective), salt substitutes, potassium sparing diuretics, NSAIDS MOA=ACEI/thiazide diuretic PK=lisinopril cleared renally SE=hypo/hyperkalemia, non productive cough, headache, dizziness Serious: angioedema, precaution/BBW C=contraindicated in pregnancy, avoid if sulfa allergy, photosensitivity possible can use sunscreen

Answer 57

cefdinir I=CAP, pharyngitis, skin infections etc. D=CAP/pharyngitis/skin infections 300mg Bid x 10days DDI=Aminoglycosides (Ceph Inc neprhotoxic effect of Am), iron salts dec cefdinir concentrations MOA=inhibits bacterial cell wall synthesis (cephalosporine) PK=urine excretion, minimal hepatic metab SE=common diarrhea precaution/BBW C=Twice daily doses should be given every 12 hours. May be administered with or without food. At least 2 hours before or after antacids or iron supplements. Shake suspension well before use.

Answer 58

fenofibrate I=hyperTG D=48-145 mg/day; maximum dose: 145 mg/day DDI=statins (inc rhabdomyolisis), bile acid sequestrants (dec absorption of fibric acid derivatives, take 1hr pre or 4-6post BAS), warfarin (inc INR) MOA=an agonist for the nuclear transcription factor PPAR-alpha resulting in decrease in triglyceride levels PK=hepatic and renal clearance SE=abdominal pain, headache serious: risk of rhabdomyolisis esp with statins C=separate from BAS: take 1hr pre or 4-6post BAS, report bilateral muscle pain and weakness

Answer 59

ziprasidone I=schizophrenia, bipolar disorder D=Bipolar: 40mg-80mg po bid, Schiz 20-100mg po bid DDI=alcohol or any CNS depressants MOA=antipsychotic, exact MOA unkonwn but affinity to serotonin, and dopamine receptors, moderate inhibition of 5ht and NE PK=extensive hepatic clearance--> feces SE=somnolence, headache, Serious: Qt prolongation precaution/BBW C=do not drink alcohol, stand up slowly to prevent OT hypoT

Answer 60

olmesartan I=HTN D=start with 20mg qd, can increase to 40mg qd after 2 weeks DDI=potassium sparing diuretics, salt substitutes, NSAIDs (sigf dec in renal fx) MOA=ARB, block aldoseterone activity on its receptor PK=renal clearance SE=hyperkaliemia ,HA, diarrhea, dizziness, Serious: angioedema BBW: contraindicated in pregnancy can cause injury and death to the fetus C=report plans for pregnancy (females), do not take with NSAIDS

Answer 61

thyroid, dessicated I=hypothyroidism D=start 15-30mg and increase by 15mg q 2-3 weeks maintenance usually 60-120mg. Monitor TSH DDI=calcium salts (separate by 4 hours), warfarin (inc INR) MOA=dessicated thyroid PK=urine excretion SE=if too much: hyperthyroidism: palpitations, insomnia, heat intolerance, fast HR, fatigue, trembling, weight loss precaution/BBW: do not used tyroid supplements for weight reduction in euthyroid patients: toxic C=take on an empty stomach in the morning, report sx of hyperthyroidism

Answer 62

ranitidine I=GERD, gastric or duodenal ulcer, heartburn, erosive esophagitis D=150mg po bid DDI=dec Iron absorption, sulfonylureas (dec serum [ ]), warfarin (dec INR) MOA=H2 receptor antagonist PK=hepatic and renal elimination SE= abdominal pain , constipation/diarrhea, HA precaution/BBW C=if using for heart burn take 30-60minutes before food/drinks

Answer 63

``` oxycodone (immediate release) I=pain moderate-severe D=IR: 5-15mg po q 4-6hrs prn DDI=major cyp3a4 substrate, CNS depressants, alcohol MOA=mu opioid receptor agonist PK=hepatic metabolism--> urine excretion SE=somnolence, constipation, nausea precaution/BBW C=avoid activities that require mental alertness like driving etc, avoid alcohol, if using for longterm, may need to taper dont d/c suddenly ```

Answer 64

ramipril I= HTN, CHF, diabetic nephropathy D=HTN: 2.5-5mg daily max 20mg/day, CHF: 1.25-2.5mg daily target 10mg qd DDI=nSAIDS, k sparing diurteics, salt substitutnes, incr toxicity of Lithium MOA=ACE Inhibitor, must be activated to ramiprilat (active metabolite) in liver PK=renal clearance SE=hyperkalemia, cough serious angioedema precaution/BBW contraindicated in pregnancy C=report pregnancy, report bothersome dry cough, avoid NSAIDs, report muscle weakness

Answer 65

aripiprazole I=schizophrenia, bipolar I , adjunct in MDD D=Schiz/bipolar 10-15mg po qd max 30mg/day, titration can be >q 2 weeks, DDI=Cyp3A4 substrate, CNS depressants, CYp3a4 inhibitors, SSRIs (inc Serotonin syndrome) MOA=antisychotic with agonist of D2 and 5ht1a receptors PK=hepatic clearnace SE=HA, insomnia, weight gain precaution/BBW: increased suicidality risk in pts <24 years old with MDD or other psychiatric disorders C=avoid alcohol, may impair alertness, can cause insomnia, weight gain

Answer 66

ezetimibe I=hyperlipidemia D=10mg orally daily DDI=BIle acid binding sequestrants (dec absorption) MOA=inhibits absorption of cholesterol in small intestine PK=fecal, some hepatic metabolism SE= diarrhea C=take 2 hours pre or 4 hr post BAS, report sx of angioedema (swelling in eyes, lips, tounge sometime hand or feet)

Answer 67

spironolactone I=Severe CHF, HTN, primary hyperaldosteronism D=HTN: 25-50mg divided 1-2 doses, CHF 12.5-25mg po daily (max 50mg/day) DDI=ACE I/ARBS, salt substitutes, MOA=potassium sparing diuretic, aldosterone antagonist PK=hepatic/renal clearance SE=hyperkalemia, possible gynecomastia, changes in menses precaution/BBW tumorigen in chronic toxicity in animals C=do not drink alcohol, avoid salt substitutes

Answer 68

tiotropium I=COPD D=inhale contents of one 18mcg pill once daily. Inhale and hold breath. Inhale a second time to ensure drug delivery. DDI=potassium chloride (inc ulcer risk of KCL), MOA=inhibition of M3 receptors in bronchial smooth muscle causing relaxation (anticholinergic) PK=feces, some urine SE=dry mouth, dry eyes, constipation precaution/BBW C=exhale completely then inhale medication powder and hold breath as long as is comfortable; repeat exhalation and inhalation once more before discarding the capsule. Do not swallow pill.

Answer 69

clopidogrel I= prevent atherothrombotic events post MI, stroke, PCI, UA OR NSTEMI post PCI D=75mg po daily (often receive loading doses of 300-600mg depending on indication) DDI=anticoagulants, PPIs (dec plavix concentration by inhibiting CYP2C19 which activates clopidogrel) MOA=antiplatelet agent, blocks ADP receptors and platelet aggregation SE=bruising or bleeding precaution/BBW use with cyp2c19 inhibitors leading to dec clopidogrel-> risk of cardiovascular events C=avoid NSAIDs, Avoid OTC PPIs,

Answer 70

codeine / guaifenesin I=cough D=codeine 10mg/gua 300mg po q 4h not to exceed 6 tabs/ 24 hr DDI=CNS depressants, alchohol, benzos, muscle relaxants MOA=suppression of cough reflex (codeine), thinning mucus and increasing sputum volume (guai) PK=codeine renally cleared SE=constipation, sedation, vomiting C=avoid alcohol, may cause sedation, avoid activities that require much mental alertness

Answer 71

norgestimate+ ethinyl estradiol I=prevent pregnancy, tx acne D= 21 day: take 1 daily for 21 days, 7 days off, 28 day: take 1 tab daily DDI=smoking tobacco, warfarin, MOA=inhibit ovulation and change cervical mucus and endometrium decreasing implantation and preventing fertilization PK=hepatic and renal clearanc SE=weight change, bloating, cramps precaution/BBW C=do not smoke, may increase risk of MI stroke or clots long-term, if missed dose, use back-up contraception (condoms) and contact doctor

Answer 72

ibuprofen I=HA, pain, inflammation, fever D=200-400mg po q 4-6 hours max 1.2g, or 2.4 under phycisian supervision DDI=ACEI/ARBS, anticoagulants, corticosteoids MOA=NSAID, cox inhibitor, decrease prostaglandin synthesis PK=hepatic and renal clearnace SE=abdominal pain or cramps, heartburn precaution/BBW increased GI bleeding, ulceration risk, increased risk cardiovascular thrombotic MI or stroke C=report unusal bleeding or dark stools, take with food if GI irritation or upset, avoid etoh or smoking to dec risk of GI bleed

Answer 73

``` famotidine I=GERD, heartburn, duodenal ulcer etc D=GERD 20mg po bid x 6 weeks, heartburn 10-20mg po q12h, duodenal ulcer 40mg qhs x 4-8 weeks, then 20mg/day qhs maintenance DDI=azole antifungals (dec their [ ]s), iron (dec absorption) MOA=H2 receptor antagonist PK=urine excretion SE=constipation, diarrhea, dizziness C=can take with antacids if needed ```

Answer 74

folic acid I=megaloblastic, macrocytic anemia, dietary supplement to prevent neural tube deficits, FA deficiency D=0.4-0.8mg IM, IV, po, SC once daily up to 1mg/day DDI=phenytoin (dec phe), green tea (dec FA) MOA=needed for coenzymes to make purines/pyrimidines for DNA synthesis PK=hepatic met-->urine excretion SE=bad taste in mouth, sleep pattern disturbance C=do not drink etoh, can have bad taste at larger doses

Answer 75

cephalexin I=otitis media, skin infection, pharyngitis, UTI etc D=250mg-1g orallya q6h depending on severity and type of infeciton DDI=warfarin (inc INR), metformin (inc met levels) MOA=cephalosporin, cell wall synthesis inhibition PK=renal elimination SE=diarrhea precaution/BBW C=Report sever diarrhea

Answer 76

trazodone I=Depression, insomnia D=150mg/day in divided doses, can increase by 5 q 3-4 days , max 400mg/day outpt, 600mg/d input DDI= SSRIs, protease inhibitors MOA=Unknown, thought to inhibit uptake of serotonin. Also has alpha 1 blocking activity PK=hepatic--urine excretion SE=somnolence dizziness Serious: priapism (>4hours) precaution/BBW C=can impair alerntness, take medication at bedtime

Answer 77

memantine I=alzheimer's disease mod-severe D=IR: initial start 5mg qd, increase in 5mg increments after 1 week intervals (split doses bid), target of 20mg/day. Maintenance is 10mg twice daily ER: 7mg po qd, inc to target 28mg/day q 1 week. DDI=sodium bicarb (dec excretion of namenda), TMP incr toxicity of namenda (myoclonus/delirium) MOA=NMDA receptor antagonist PK=mostly renal elimination SE=dizziness, HA, confusion C=can sprinkle ER capsule in applesauce and consume entire mixture as a single dose, can cause dizziness , follow dosing schedule

Answer 78

norgestrel+ethinyl estradiol I=contraception D=if 21, take one pill/day x 3weeks, then one week off, if 28 takes one pill daily DDI=antibiotics, smoking MOA=inhibition of implantation of the fetus and changes in endometrial lining SE=headache, bloating precaution/BBW : smoking can lead to serious cardiovascular effects C=antibiotics can decrease effectiveness, do not smoke

Answer 79

glyburide I=Diabetes II D=Regular: 1.25-20 mg orally once daily or divided in 2 doses (max 20mg/day) Micronized: 0.75-12 orally once daily or divided bid DDI=insulin MOA=sulfunylurea increase secretion of insulin PK=Renal and biliary excretion SE= heartburn, nausea, Serious : hypoglycemia precaution/BBW C=signs and symptoms of hypoglycemia, take with first main meal of the day

Answer 80

olmesartan/ hydrochlorothiazide I=hypertension D=20-40 olme/12.5-25mg once daily DDI=lithium, NSAIDs, potassium sparing diuretics, salt substitutes MOA=angiotensin receptor blocker/ thiazide diuretic PK=renal (most) for both SE=hypo/hyperkalemia, electrolytes imbalances, Serious: angioedema precaution/BBW: taking with pregnancy can lead to harm to the fetus C=maintain adequate hydration, avoid alcohol

Answer 81

``` carisoprodol I=acute muskuloskeletal pain D=250-350mg po tid at bedtime DDI=ethanol, opiiods, CNS depressants, benzos MOA= skeletal muscle relaxant PK=renal and hepatic SE=somnolence, dizziness, HA precaution/BBW C=do not drink alcohol ```

Answer 82

losartan I=hypertnsion D=25-100mg once daily or divided BID DDI=lithium, NSAIDs, potassium sparing diuretics, salt substitutes MOA=angiotensin receptor blocker PK=renal SE=hyperkalemia, electrolytes imbalances, Serious: angioedema precaution/BBW taking with pregnancy can lead to harm to the fetus C=avoid salt substitutes, may cause dizziness

Answer 83

conjugated estrogens I=menopause vasomotor sx, and other uses D=0.3mg orally daily (dose varies depending on indication) MOA=reduces the levels of LH and FSH through negative feedback PK=renal clearnace SE=edema, hustism, withdrawal bleeding, HA precaution/BBW: unopposed estrogens have an increases risk of endometrial cancer and abmormal vaginal bleeding C=do not smoke

Answer 84

valsartan I=hypertension, HF, MI D=80-320mg once daily DDI=ACE, NSAIDs, potassium sparing diuretics MOA=angiotension receptor blocker PK=hepatic SE=hyperkalemia, dizziness Serious Angioedema precaution/BBW using in pregnancy can cause damage to the fetus C=avoid potassium sparing diuretics

Answer 85

lidocaine transdermal I=local anesthesia, postherpetic neuralgia D=12 hours n and 12 hours off DDI=antiarrhythmic agents MOA=block conduction of nerve impulses PK=hepatic metabolism SE=bruising, depigmentation, itchy, irritation Seirous: seizryrs, problems breathing, cardia dysrhtymia precaution/BBW C=report difficult to breathing, applying heat or occluding skin increases rinks of of side effects,

Answer 86

enalapril I=hypertension D=5-40mg once dialy or dvided BID DDI=lithium, NSAIDS, ARB, potassium sparing diuretics, MOA=ACE inhibitor PK=renal SE=hyeperkalemia, cough Serious: angioedema precaution/BBW: pregnancy and use leads to harm to fetus C=avoid salt substithutes

Answer 87

tadalafil I=BPH, erectile dysfunction, pulmonary hypertension D= BPh 5mg once daily, erectile dysfunction prn 10mg prior to anticpated sexual activity (max 20mg/day), pulmonary hypertension 40mg once daily DDI=CYP 3a4 ihhibitors, nitrates MOA= phosphodiestrase type 5 inhibitor, leading to smooth muscle relaxation and increased blood flow PK=hepatic and renal SE=headache C=report chest pain or priapism, avoid alcohol, report loss of vision

Answer 88

glipizide I=diabetes type 2 D= xl: 5-10mg once daily max 20 daily, IR: max 40mg daily , if 15mg day divide bid DDI=fluoroquinolones MOA=sulfonylurea, increase insulin secretion PK=extensive hepatic SE=hypoglycemia C=report sx of SJS (spreading red rash with flu-like sx and mouth sores, take 30min before breakfast, do not drink etoh

Answer 89

mupirocin I=impetigo (skin infection) D=aply 2% ointment topically tid x 3-5 days MOA=inhibits bacterial protein and RNA synthesis SE=itchiness, burning sensation C=avoid eyes, open wounds, burns when applying

Answer 90

ezetemibe + simvastatin I=hyperlipidemia/ hypertriglyceridemia D= 10-80mg simva/10mg ezetemibe once daily MOA=cholesterol absorption inhibition/ hmg coa redctase inhibitor PK; ezetemibe: fecal, simva : fecal, renal SE=increase LFTs/ rhabdo C=take dose in the evening, report bilateral muscle weakness and soreness,

Answer 91

ergocalciferol I=vitamin d deficienc, hypoparathyroidism D=vit d defficiency: 50,000 once weekly 8-12 weeks, dosing can vary depending on condition MOA=increases absorption of calcium and phosphorous PK=hepatic and renal elimination SE=serious: hypercalcemia, hypervitaminosis D, constipation C=report sx of hypercalcemia

Answer 92

``` ferrous sulfate I=iron deficiency anemia D=300mg po 2-4 times daily, DDI=PPIs, antacids, levothryoxine MOA=replaces iron PK= excretion Urine, sweat, sloughing of the intestinal mucosa, and menses SE=Constipation, dark stools, epigastric pain, GI irritation C=avoid antacids ```

Answer 93

``` glimepiride I=DM II D= 1-2mg orally daily (max 8mg/day) DDI=fluoroquinolones MOA=sulfonylureas, increase hypoglycemia PK=hepatic clearnace SE=hypoglycemia C=sx of hypoglycemia, ```

Answer 94

ibandronate I=osteoporosis D=2.5mg po once daily or 150mg po once monthly, 3mg IV q 3 months MOA=osteoclast bone resorption inhibition PK=renal/fecal SE=Serious esophageal erosions precaution/BBW C=take with a full glass of water and remain upright for 30 min, 60min before first meal

Answer 95

drospirenone / ethinyl estradiol I=birth control, acne (moderate) D=depends on days on package DDI=smoking, antibiotics MOA=change endometrial lining and stop implantation of fetus SE=weight change, bloating precaution/BBW smoking can lead to serious cardiovasuclar events especially in >35yo C=antibiotics reduce effectiveness of contraception, do not smoke

Answer 96

``` minocycline I=antibiotic many indications D=50-200mg po daily, dose varies depending on indication DDI=calcium, antacids, iron MOA=tetracycline, SE=sun sensitivity precaution/BBW C=sun sensitivity so wear sunscreen, can decrease effectiveness of birht control, take with plenty of fluids, do not take with antacids ```

Answer 97

norethindrone/ ethinyl estradiol/ferrous sulfate I=contraception D=take pills as directed on package, most likely once daily DDI=antibiotics, smoking MOA=prevent implantation of the fetus SE=headache, weight change precaution/BBW: smoking increases risk of cardiovascular events C=antibiotics can decrease effectiveness, do not smoke

Answer 98

benazepril I=hypertension D= 10-40mg orally once daily max 80mg/day DDI=lithium, NSAIDs, ARBs, potassium sparking diuretics, salt substitutes, MOA=Ace inhibitor PK=converted to beazprilat SE=hyperkalemia, cough serious: angioedema precaution/BBW: Use in pregnancy can lead to fetal deformities C=report persistent dry cough, report musle sourness, or facial edema

Answer 99

fetnayl transdermal system I=moderate to severe pain D=depends on previous opioid use and equivalence DDI=any CNS depressants, alcohol, opioids, cyp3a4 inhibitors MOA=mu opioid receptor agonist PK=Cype3a4 substrate SE=constipation, somnloence, Serious: respiratory depression precaution/BBW contraindicated in patients who are not opioid tolerant, should not be used in <2years ol, use with any cyp3A4 inhibitor can cuase respiratory derpression C=apply on chest,back, flank or upper arm and hold in place , apply new patch in defferent area

Answer 100

nitrofurantoin I=UTIs D=50-100mg po 4 times a day DDI=fluconazole MOA=inhibit dna, rna, cell wally and protein synthesis PK=renal elimination SE=NV, loss of appetite Serious: hemolytic anemia C=may cause brown colored urine, take with food

Answer 101

nitrofurantoin P&G I=UTIs D=100mg po q 12h x 5-7 days DDI=fluconazole MOA=inhibit dna, rna, cell wally and protein synthesis PK=renal elimination SE=NV, loss of appetite Serious: hemolytic anemia C=may cause brown colored urine, take with food

Answer 102

digoxin I=Heart failure, AFib D=Afib : 0.125- 0.375mg po daily1.5mg max, HF 0.125-0.75 mg po daily DDI=beta blockers, CCB, MOA=block Na/K atpase, increasing contractility of heart PK=renal excretion SE=cardiac dysrrhythmia C=report symptoms of bradycardia, take after morning meal, avoid antacids

Answer 103

fluticasone inhalation I=asthma, allergic rhinits D=88-880mg inahled twice daily (varies with indication) DDI=Cyp3A4 inhibitors MOA=corticosteroid: reducing inflammation and PK=metabolic, fecal excretion SE= throat irritation, sinusitisSerious : thrush C=rinse mouth out after use to prevent thrush, not for acute attacks, symptom improvement can take weeks

Answer 104

levevtiracetam I=tonic clonic seizure, partial seizure, myoclonic seizure D=500mg bid - max daily dose of 3000mg/day DDI=ginkgo, carbamazepine MOA= unknown PK=renal SE=somnolence, fatigue Serious SJS precaution/BBW C=can affect mental alterntes, report nay symptoms of askin rash, do not d/c suddenly du to increase in seizure frequency

Answer 105

``` terazosin I=BPH, HTN D=1-10mg orally once daily max 20mg/day DDI=beta blockers MOA=alpha 1 antagonist PK=renal metabolism SE=orthostatic hypotension, peripheral edema, dizziness precaution/BBW C=may experience sudden syncope with first dose so take it at night, move slowly to standing position ```

Answer 106

acyclovir I=genital herpes, herpez zoster D=400-800mg TID ( but dosing varies based on indication) MOA=stops replication of viral DNA by blocking polyemerase activity SE=malaise Serious: renal failure, SJS C=stay adequately hydrated to prevent damage to the kidneys, reporst any new rashes, abstain from sex during acute outbreak and always use condoms

Answer 107

irbesartan I=hypertension D=150-300mg once daily DDI=NSAIDS, ACE, potassium sparing diuretics MOA=Angiotensin receptor blocker PK=fecal/renal elimination SE=hyperkalemia, Serious: angioedema precaution/BBW: use in pregnancy can lead to fetal harm C=report facial swelling, muscle soreness or pain

Answer 108

``` budesonide inhalation I=asthma and allergic rhinitis D=180-400mcg twice daily max 800mcg/day DDI=Cyp3a4 inhibitors MOA=corticosteroid with antiinflammatory properties PK=renal elimination SE=sinusitis, throat/nose irritation precaution/BBW C=not for acute asthma attacks, proper inhaler technique ```

Answer 109

``` valacyclovir I=herpes zoster, herpes genital D=1g 2-3 times daily DDI=MMF MOA=inhibition of viral dna repolication PK=renal, fecal SE=rash, headache , fatigue C=keep adequate hydration to prevent precipiation of acyclovir in renal tubules ```

Answer 110

desvenlafaxine I=major depressive disorder D=50mg orally once daily DDI=MAOis SSRIS, agents that increase risk of bleeding MOA=SNRI PK=hepatic and renal SE=insomnia, somnlence, headache SS: serotonin sydnrome precaution/BBW increased risk of suicidal thinking in children and people <24 yo C=can affect mental alertness, do not drink alcohol

Answer 111

carbamazepine I=bipolar I, epilepsy, neuralgia D= 200mg-400mg bid-tid max 1200/day (dosing varies on indication) DDI=cyp3a4 inhibitors, inducers, substrates(carbamazepine is a cyp3a4 inducer) MOA= unknown SE=dizziness, somnolence, hyper/hypotension precaution/BBW: risk of SJS C=avoid alcohol, dont d/c suddenly , report rash

Answer 112

levonorgestrel/ ethinyl estradiol I=contraception D=take pills as directed on package, most likely once daily DDI=antibiotics, smoking MOA=prevent implantation of the fetus SE=headache, weight change precaution/BBW: smoking increases risk of cardiovascular events C=antibiotics can decrease effectiveness, do not smoke,

Answer 113

lithium carbonate I=bipolar disorder D=, 900-1200mg in 2-3 divided doses. Titrate levelt to 9.6-1.2mEq/L DDI=ACE inhibitors, NSAIDS MOA=unknown but alters soidum transport in nerve and muscle cells PK=renal elimination SE=polyuria, fine tremor, nephrotoxicity precaution/BBW lithium toxicity can occur even when the level is at the therapeutic range C=maintain adequate water, sodium intake

Answer 114

etonogestrel / ehtinylstradiol I=contraception D=take pills as directed on package, most likely once daily DDI=antibiotics, smoking MOA=prevent implantation of the fetus SE=headache, weight change precaution/BBW: smoking increases risk of cardiovascular events C=antibiotics can decrease effectiveness, do not smoke,

Answer 115

``` lovastatin I=hyperlipidemia, hypertriglyceridemia D=20-60mg once daily at bedtime DDI=CYP3a4 inhibtiors MOA=HMG coa reductase inhibitor PK=hepatic metabolism SE=increased LFTs serious: rhabdomyolysis precaution/BBW C=report symptoms of liver dysfunction, report bilateral muscle pain or weakness ```

Answer 116

``` pravstatin I=hyperlipidemia, hypertriglyceridemia D= 40-80mg once daily, any time of day DDI=CYP3a4 inhibtiors MOA=HMG coa reductase inhibitor PK=hepatic metabolism, long half life SE=increased LFTs serious: rhabdomyolysis precaution/BBW C=report symptoms of liver dysfunction, report bilateral muscle pain or weakness ```

Answer 117

benzonatate I=Cough D=100-200mg po tid prn , max 600mg/day or 200mg per dose MOA=supresses cough by anesthetizing vagal afferent fibers in respiratory passages PK=renal SE=numbness of tongue, somnolence C=should swallow tablet whole or get numbenss in the mouth if chewed or dissolved

Answer 118

insulin aspart I=DM type 1 and II D=depends on insulin requirement of the patient. To be administered 5-10minutes before a meal DDI=fluroquinolones, beta blockers MOA=rapid acting insulin SE=injection site reaction, hypoglycemia C=signs and symptoms of hypoglycemia, administer 5-10minutes before a meal

Answer 119

paroxetine I=depression, GAD, panic disorder, OCD D=10-20mg once daily in the morning , depends on indication max 50-75mg/day DDI= TCAs, MAOIs, any agents that increase risk of bleeding such as clopidogrel, warfarin etc MOA=SSRIs PK=renal excretion SE=insomnia, somnolence precaution/BBW increased suicidal thinking with young adults <24yo and children C=do not drink alchohol , can affect alertness,

Answer 120

promethazine / codeine I=cough (cold or allergy) D=promethazine 6.25/cod 10 (5 ml)orally q 4-6 hours (max 30ml/24 hours) DDI=CNS depressants, alcohol MOA=antihistamine/ decrease cough reflex SE=somnolence precaution/BBW contraindicated in pts < 6 yo b/c associated with repsratory depression C=can affect alertness, can cause/worsen constipation

Answer 121

``` moxifloxacin I=sinusitis, conjunctivitis D=400mg IV/PO once daily DDI=calcium, antacids, iron, MOA=fluoroquinolones inhibt DNA gyrase and cause breaks in the DNA PK=hepatic and renal SE=diarrhea, precaution/BBW: tendonitis C=sun sensitivity so wear sunscreen, avoid antacids, calcium, iron ```

Answer 122

tizanidine I=Spasticity D=4-8mg orally every 6-8 hour max 36mg/day DDI=estrogen hormones, MOA=alpha agonist increasign presynaptic inhibition of motor neurons at alpha 2 receptor sites PK=renal fecal excretion SE=dry mouth, somnolence Serious: hepatotoxicity precaution/BBW C=may cause dry mouth, decreases alertness, do not drink alcohol. Take the medication with or without food in a consistent manner

Answer 123

clonidine I=ADHD, hypertension, and many more D=alpha 2 agonist DDI=beta blockers, CNs depressants MOA=alpha 2 agonist that reduces sympathetic outflow leading to decrease PVR, HR and BP PK=Hepatic and renal clearance SE=dry mouth, somnolence/insomnia, constipation C=do not discontinue suddenly due to rebound hypertension, do not drink alcohol

Answer 124

clonidine transdermal system I=hypertension, ADHD and others DDI=beta blockers, CNs depressants MOA=alpha 2 agonist that reduces sympathetic outflow leading to decrease PVR, HR and BP PK=Hepatic and renal clearance SE=dry mouth, somnolence/insomnia, constipation C=do not discontinue suddenly due to rebound hypertension, do not drink alcohol

Answer 125

morphine sulfate controlled release I=chronic pain, moderate to severe pain, post-operative pain D=10-120mg per day DDI=CNS depressants,alcohol, benzos etc MOA=mu opioid agonist PK=renally excreted SE=somnolence, insomnia, itchiness Serious Respiratory depression precaution/BBW extended realease form should be swaallowed whole, avoid alcohol or alcohol containing medications that may realease a potential fatal dose of morphine C=impair alertness, dont take alcohol or other CNS depressants,

Answer 126

propranolol LA I=hypertension, CHF, angina, afib D=80-240 in 2-3 divided doses DDI=beta agonists, MOA=beta blocker PK=hepatic metabolism SE=fatigue, dizziness, Serios: bradycardia precaution/BBW: sudden discontinuation can lead to exacerbations of angina or MI C=do not discontinue suddenly, can mask sx of hypoglycemia so monitor blood sugars (diabetics)

Answer 127

``` modafinil I=narcolepsy, excessive sleepiness D=200mg po daily qam DDI=estrogens MOA=Unknown but CNS activator PK=hepatic metabolism SE=insomnia, headache C=can decfrease the effectiveness of steroidal contraceptives (rec backup method), avoid alcohol, avoid use at bedtime ```

Answer 128

meclizine I=motion sickness, vertigo D=25-50mg orally 1 hour before departure (motion sickness), 25-100mg orally per day in divided doses (vertigo) MOA=antihistamine, supressing vasodepressor response to histamine. Only slight inhibition of acetylcholine SE=dry mouth, somnolence C=avoid EtOh or other CNS depressants, can cuase dry mouth and somnolence

Answer 129

hydroxyzine hydrochloride I=pruritis, N, V, anxiety, alcohol withdrawal D=50-100mg po/IM q 4-6 hours DDI=CNS depressants MOA=antispasmodic, antihistaminic, anlgesic, antiemetic, bronchodilating SE=dry mouth, somnolence C=do not drink alcohol, can affect mental alertness

Answer 130

triamcinolone intranasal I=allergic rhinitis D=nasal: 1-2 sprays in each nostril once daily (55mcg/spray) MOA= corticosteroid, antiinflammatory, antipruritic PK=renal and hepatic clearance SE=pharyngitis, headache precaution/BBW C=patient to not discontinue medications unless talks with doctor, do not blow nose until after 15min after administration

Answer 131

oxybutynin I=overactive bladder D=5-10mg orally once daily, max 30mg/day, topical: apply one satchet (100mg/g) topically daily on abdomen, upper arms/shoulders, or thighs MOA=reduces the muscarinic effect of acetylcholine in smooth muscle PK=hepatic SE=dry mouth, somnolence, constipation C=ER tablet may cause diarrhea, alcohol can enhance drowsiness,

Answer 132

diphenoxylate/atropine I=diarrhea D=2 tab or 10ml solution po 4 times daily (20mg dipheoxylate) until initial control, then reduce to amount necessary to maintain bowel control (max 20mg/day) MOA=diphen: reduces intestinal motility, atropine: anticholinergic PK=Renal and hepatic clearance SE= abdominal discomfort, somnolence Serious: pancreatitis C=avoid other CNS depressants, can affect alertness

Answer 133

fluocinonide topical I=atopic dermatitis, plaque psoriasis D=0.05-0.1% 1-4 times daily max 2 weeks and max 60g/week MOA=antiinflammatory, antiprruritic, vasocontrictor corticosteriod SE=burning sensation in skin C=max use is 2 weeks, if not working contact physician

Answer 134

``` levalbuterol I=asthma D=acute asthma: 1.25-2.5mg q 20 min x 3 doses, then 1.25-5mg q 1-4 hour as needed DDI=beta blockers MOA=short acting beta agonist SE=Rhinitis, sinusitis C=rescue inhaler, inhaler technique ```

Answer 135

``` insulin lispro I=DM 1 or 2 D=individualized for patient need DDI=FQs and beta blockers MOA=short acting insulin SE=hypoglycemia C=change injection site, sx of hypoglycemia, expires in 28 day after opening ```

Answer 136

metronidazole I=bacterial mengingitis, vaginosis, anaerobic infections etc D=250-500mg po 2-3 times daily or 0.75% gel available too. DDI= MOA=metabolized by anaerobes to a molcule that interacts with DNA and breaks strands SE=HA, nausea precaution/BBW: shown to be carcinogenic in mice. Use only when necessary C=may discolor urine to redish brown, do not drink alcohol or will get disulfiram like reaction, (flushing, vomiting, abdominal cramping)

Answer 137

``` oxcarbazepine I=partial seizure D=300-1200mg twice daily (MAX) depends on indication DDI=contraception, cns depressants MOA=anticonvulsant SE=somnolence, NV, fatigue precaution/BBW C=can dec effectiveness of hormonal contraceptives, can impair mental alertness, avoid etoh ```

Answer 138

``` levocetirizine I=allergic rhinitis, urticaria D=2.5-5mg one daily in the evening MOA=antihistamine PK=renal SE=fatigue, dry mouth C=can cut tablet in half for a child's dose, do not use any CNS depressants inc etoh ```

Answer 139

diclofenac topical I=osteoarthritis, RA D=Osteoarthritis :4grams topically 4 times daily, maax 8g/day to any UE joint, 16g LE joint, max 32 g/day total oaver all affected joints DDI=warfarin, clopidogrel, tacrolimus, ssris MOA=NSAID, cox inhibitor dec prostaglandin synthesis PK=65% renal , 35% biliary SE= Serious : GI bleed, HTN BBW:NSAIDs may cause inc risk of serious cardiovascular throbmotic events, bleeding, ulceration, perforation C=gel: dont wash area for at least an hour, avoid concomitant use with other topical products

Answer 140

estradiol I=vasomotor sx menoapuse, atrophy of vagine, postmenopausal osteoporosis etc D=0.05-2mg orally up to tid, higher doses for vaginal atrophy of 2-4g daily DDI=tipranavir MOA=bind to estrogen receptors, lower LH and FSH levels PK=enterohepatic recirculation SE=weight increase, edema, HA, Serious: VTE precaution/BBW: increased risk of endometrial cancer C=monitor for abnormal vaginal bleeding,

Answer 141

raloxifene I=breast cancer, postmenopausal osteoporosis D=60mg orally daily MOA=Selective estrogen receptor modulator, blocks estorgenic pathways by binding to estrogen receptors PK=extensive first pass SE= hot sweats, leg cramps Serious: VTE precaution/BBW: increased risk of DVT and PE reported C=avoid sitting of prolonged period of time, esp during first 4 mos of therapy, may cause leg craps and hot flash, do not take estrogen while taking this med

Answer 142

budesonide/formoterol I=asthma and COPD D=bud 80-160mcg/fom 4.5mcg800mcg 2 inhlations tice daily DDI=Cyp3a4 inhibitors MOA=corticosteroid with antiinflammatory properties/ long-acting beta agonsit PK=renal elimination SE=sinusitis, throat/nose irritation precaution/BBW C=not for acute asthma attacks, proper inhaler technique, rinse out mouth to prevent thurs

Answer 143

testosterone topical I=hypogonadism, female to male transformation D=5g applied topically cone daily in clean, dry, intact skin in the sholders, upper arms or abdomen MOA= endogenous androge involved in growth and maturation of penis, scrotum, etc PK=renal SE=acne, gynecomastia, priapism precaution/BBW virilization reported in children exposed to gel, should avoid contact C=do not apply in genitals, avoid washing, swimming etc fort at least 2 hours after application, avoid exposure to children or women,

Answer 144

``` insulin I=type 1 or type 2 diabetes D=subq administration as individualized for patients DDI=FQs and beta blockers MOA= regular insulin PK=hepatic metabolism SE=hypoglycemia C=expires 28 days after opening, rotate injections sites, sx of hypoglycemia ```

Answer 145

hyocyamine I=pancreatitis, reversal of neuromusucular blockade etc D= dose varies dramatically based on indication max 1.5mg /day MOA=inhibits the action os acetylcholine, inhibits GI propulsive motility, decreasees gastric acid secretion PK=renal SE=dry mouth, somnolence, blurred vision (anticholinergic SEs) C=antacids interfere with absorption, hyocyamine before meals, antacids after meals

Answer 146

sildenafil I=erectile dysfunction, pulmonary hypertension D=25-100mg x1 orally 1 hour before sexual activity, 20mg po TID given 4-6 hours apart for PH DDI=nitrates, alpha blockers MOA=Phosphodiesterase inhibitor PK=cyp3a4 substrate (hepatic) SE=flushing, HA Serious: priapism, ototoxicity C=report if erection lasts longer than 4 hours, report suddent changes in hearing or vision

Answer 147

bumetanide I=CHF edema D=0.5-2mg po x 1 or 0.5-1mg IV over 1-2 minutes or IM, can repeat twice more in 2-3 hours. max 10mg/day DDI=ACE inhbibitors, NSAIDS, MOA=loop diuretic PK=renal elimination SE=hypoalemia, dizziness, hyperuricemia precaution/BBW: can lead to profound diuresis and electorlyte depletion, medical supervision required C=can take with food to minimize gastric irritation

Answer 148

``` sitagliptin phosphate I=DM type 2 D=100mg orally daily MOA=DPP4 inhibitors, increasing incretin activity PK=renal clearance SE= HA, URTI Serious: pancreatitis precaution/BBW C=sx of pancreatitis (rare) N,V, anorexia, persistent severe abdominal pain ```

Answer 149

telmisartan I=hypertension D=20=-80 po once daily DDI=ACEI, Lithium, NSAIDs, potassium sparing diuretics, salt substitutes MOA=angiotensin receptor blocker PK=Renal SE=hyperkalemia, dizziness Serious: angioedema precaution/BBW: use by pregnant women leads to harm to fetus C=can cause dizziness, avoid salt substitutes

Answer 150

insulin detemir I=DM type 1 and 2 D=initial 10 U Sq at bedtime, can be divided twice daily, individualized MOA=long-acting insulin SE=injection site reaction, hypoglycemia precaution/BBW C=switch site of injection, expires 28 days after opening, sx of hypoglycemia

Answer 151

promethazine I=nausea and vomiting, D=12.5-25mg po, IV, IM or rectally , not given more than q 4 hours DDI=CNS deprressants MOA=blocks histamine 1 receptors. Antiemetic, anticholinergic, anti motion-sickness SE=dry mouth, dizziness, somnlonece precaution/BBW do not use in children < 2 yo due to risk of repsratory depression C=can affect metnal alertness, do not drink alcohol

Answer 152

mentylphenidate ER I=ADHD, narcolepsy D=:18-72mg po in the morning MOA=CNS stimulant. Unkown MOA but may block reuptake of norepinephrien and dopamine PK=renal metabolism SE=dizziness, insomnia, loss of apetite Serious: cariorespiratory arrest precaution/BBW usein in patients that are emotionally unstable, alcoholism, abuse potential C=Report changes in heart rhythm or chyest pain,

Answer 153

buspirone I=anxiety D=5mg orally 2-3 times a day or 7.5 po bid, cna increased dose by 5mg/day q 2-3 dasy prn, max 60mg/day MOA=unknown, affinityy for serotonin, and dopamine receptor but not GABA PK=renal/hepatic SE=dizziness, nausea, ha precaution/BBW C=can affect mental alertness, may not see symptomatic improvement for wew weeks, don't dc suddenly

Answer 154

lisdexamfetamine I=ADHD D=30mg po daily in the morning, can increase by 10-20mg/day at weekly intervals. max 70mg/day MOA=gets converted to dextroamphetamine whose moa is nto known but may b inc NE or Dopamine PK=renal SE=loss of appetite, insomnia, dizziness precaution/BBW schedule II medication that be subject to abuse and addtiocon. Misuse can lead to sudden death C=takie in the morning to avoid insomnia

Answer 155

cerbidopa/levodopa I=parkinsonism, D= IR form 1 tab po 3-4 times daily, SR version 1 tablet twice daily DDI=antipsychotics MAO inhibitors MOA= carbidopa inhibts the decarboxylation of levodopa. levodopa is the precursor to dopamine SE= confusion, delusions, dyskinesias, hypo/hypertension C=dont discontinue use of the medication suddenly, if taking antiHTN may lead to postural hypotension: stand up slowly

Answer 156

clindamycin I=bacterial infectiosn, skin infectiosn D=300-600mg po q 6 - 8 hours depending on indication DDI=cyp 3a4 inhibitor MOA=inhibit bacterial ribosome and protein sythensis SE=rash, diarrhea, HA precaution/BBW can lead to pseudomembranous colitis which can be lifethreatening. Use only when necessary C=report severe diarrhea, report dryness or exess skin irritation for topical

Answer 157

dipyridamole/aspirin I=thromboembolic stroke prophylaxis D=1 capsule (200mg/25mg) orally twice daily in AM and PM MOA=ASA is a cox inhibitor, dipyridamole inhibits uptake of adenosine and leadts to inhibition of platelet aggreation. SE=abdomnal pain, GI bleed, HA C=avoid aspirin or ASA containing products

Answer 158

``` darifenacin I=overactive bladder D=7.5-15mg orally once daily MOA=M3 muscarine receptor blocker PK=renal/ hepatic SE=dry mouth, constipation C=anticholinergic xs: dry mouth, blury fision, HA, constipation, ```

Answer 159

methylprednisolone I=many indications: allergies, aastma, inflammation, D=4-48mg po daily MOA=corticosteroid SE= hypertesnin, impaired wound healing, weight gain, depression/euphoria precaution/BBW C=don't discontinue medication suddenly, report signs of an infection

Answer 160

baclofen I=spasticity D= 5mg po tid, can increase by 15mg q 3 days max 80mg/day MOA=skeletal muscle relaxant SE=somnolence, HA precaution/BBW: abrupt discontinuation of intrathecal baclofen has led to high fever, AMS, muscle rigidity and sometimes rhabdomyolysis C=avoid alcohol or other CNS depressants

Answer 161

extended phenytoin I=seizure and status epilepticus D=100-200mg po TID, ER: 300mg once daily MOA=inhibits seizure activity in the motor cortex SE=slurred speech, nervousness, drug-induced gingiveal hyperplasia precaution/BBW dont exceed 50mg/min in adults or 1-3mg/kg/min pediatric becaue of risk of sever hypotension and cardiac arrhythmia C=do not drink calcohol, do not d/c suddenly due to inc in seizure activity

Answer 162

prednisolone I=many indications such as RA, inflammation, COPD, asthma etc D=5-60mg orally /day MOA=corticosteroid, anti inflammatory, immunosuppressant, SE=Short-term insomnia, HA, mood changes, GI irritation Long-term: weight gain, fluid retention, osteoporosis, acne, fat deposits in face and back C=do not D/c suddenly

Answer 163

drospierenone/ethinyl estradiol I=birth control, acne (moderate) D=depends on days on package DDI=smoking, antibiotics MOA=change endometrial lining and stop implantation of fetus SE=weight change, bloating precaution/BBW smoking can lead to serious cardiovasuclar events especially in >35yo C=antibiotics reduce effectiveness of contraception, do not smoke

Answer 164

``` mirtazapine I=depresison D=15-45mg po at bedtime DDI= MOA= SE=constiption, somnolence, dry mouth, weight gain precaution/BBW antidepressants increasing suicidality in young people <24yo C=dont drink alcohol, impairs alertness ```

Answer 165

``` gemfibrozil I=hyperlipidemai D= 600mg orally bid 30 min before meals DDI=statins MOA=Bile acid sequestrate PK=renal SE=indigestion, abdominal pain serious: rahbdo C=report muscle pain, take 30 min before meals ```

Answer 166

hydroxychloroquine I=SLE, RA, Malaria D=200-600 po daily MOA=unknown SE=disorder of the cornea, retinopathy, torsades, agranulocytosis C=take with food or milk, report changes in vision

Answer 167

olopatadine I=allergic conjunctivitis, allergic rhynitis D=0.1% i dorpe in affected eyes tice daily or 0.2% 1 drop once daily, or 2 sprays in each nostril bid MOA=antihistamine SE=altered tase sense, headache, C=remove contacts before instilling eye drops, can reinsert in 10 minutes

Answer 168

norethindrone/ethinyl estradiol I=contraception D=take pills as directed on package, most likely once daily DDI=antibiotics, smoking MOA=prevent implantation of the fetus SE=headache, weight change precaution/BBW: smoking increases risk of cardiovascular events C=antibiotics can decrease effectiveness, do not smoke

Answer 169

clozapine I=Schizophrenia D=start 12.5mg once or bid, increase, target dose 300-450mg/day in 2-3 divided doses MOA=antipsychotic, moa not well defined SE=somnolence, constipation, excessive salivation, tachycardia precaution/BBW must have WBC and ANC before tx and at least 4 weeks after d/c due to agranulocytosis. Can cause cardiac or resp arrest C=impairs alertness, anticholinergic sx, don't d/c suddenly, many DDIs report med changes

Answer 170

varenicline I=smoking cessation D=initial 0.5mg once daily days 1-3, then 0.5mg bid from days 4-7, then 1mg twice daily duration of tx 12 weeks MOA= binds to nicotinic receptors (agonist) PK=renal SE=insomnia, dream disorder, constipation, flatulence precaution/BBW depression / suicidality has been reported with medication, observe pt C=take after eating and with a full glass of water, can impair mental alertness, report changes in behavior (suicidality)

Answer 171

phenzopyridine hydrochloride I=dysuria, symptomatic relief D=200mg orally 3 times daily after meals, do not use longer thant two days if using with an antibiotic MOA=urinary tract analgesic PK=Renal SE=HA C=may discolor urine and sclera red or orange causing staining of undergarments and contacts, take with food to minimize GI irritation

Answer 172

progesterone I=contraception, endometrial hyperplasia etc D=5-10mg IM daily or 100mg vaginally 2-3 daily or 200-400mg orally daily etc MOA=transforms proliferative endometrium into secretory endometrium, suppresses pituitary gonadotropins PK=hepatic/ renal SE=abd pain, constipation, muscle cramp precaution/BBW estrogen + progestin should lnto be used to prevent CVD or dementia. Inc risk of DVT in postmenopausal women C=patient not to use tampons during therapy, avoid other vaginal drugs 6h before and after with vaginal form,

Answer 173

atomoxetine I=ADHD D= 40-80mg orally daily DDI=TCAs, MAOIs MOA=Selective norepinephrine reuptake inhibtor PK=renal SE=inc blood pressure, tachycardia, HA, insomnia precaution/BBW increased suicidal ideation in children and adolescents C=report chest pain, palpitations, parents montior growth rate and wight in children, monitor new psychiatric problems

Answer 174

chlorhexidine I=gingivitis, periodontitis, skin cleansing procedure D=gingivitis: 15mgl oral rinse 0.12% swish and spit for 30 sec twice daily after tooth brushing MOA=antimicrobial with rapid bactericidal action against a wide range of gram + and gram - bacteria SE=taste sense altered, toothache, skin irritation C=do not swallow oral soluation, avoid contact with eyes and ears, do not eat, brush or rinse immediately afterwards

Answer 175

sumatriptan I=migraine and cluster headache D=6mg SQ can repeat 6mg SQ once more, max 12mg/24h OR 25-100mg orally repeate after 2 hours (max 200mg/ 24h) DDI=SSRIs MOA=5ht1 receptor agonist SE=injection site reaction, numbness, vertigo C=report sx of serotonin syndrome: hallucination ,tachycardia, hypertehrmia, hyperreflexia

Answer 176

nystatin topical I=cadidaisis, vulvovaginitis, thrush D=oral suspension: 4-6ml orally retained in mouth as long as possb, other regimens vary depending on indication MOA=binds to sterols in cell membrane causing it to lose components of the cell by decreasing selectivity of barier SE=skin irriation serious SJS C=abstain from sex until treatment is complete, report SJS sx

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