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143 Cards in this Set
- Front
- Back
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anti-epileptic drug that should be used with caution in patients who have hypersensitivity to Tricyclic Antidepressants?
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carbamazepine
it is structurally related to TCA's, and should be used with caution in pt's with hypersensitivity to TCA's |
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therapeutic serum levels of carbamazepine
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10 - 20 mcg/mL
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serious side effects of carbamazepine
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aplastic anemia
agranulocytosis |
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The active ingredient(s) of Mysoline is/are:
I. primidone II. phenobarbital III. mycolic acid a. I only b. III only c. I and II only d. II and III only e. ALL |
Mysoline = primidone
active metabolites of primidone are phenobarbital and phenylethylmalonamide (PEMA) |
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Mysoline indications & dosage
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(primidone)
antiepileptic: indicated for all types of epilepsy except Petit mal 250mg - 500mg TID - QID |
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Mysoline adverse effects
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ataxia
fatigue hyperirritability vertigo diplopia nystagmus |
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normal therapeutic serum concentration range for phenobarbital?
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10 - 20 mcg/mL
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Which of the following drugs should be avoided by a patient who is allergic to phenobarbital?
a. Mysoline b. Maalox c. Cytotec |
Mysoline (primidone)
primidone is metabolized, in part, to phenobarbital |
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Humira is NOT indicated for which of the following?
a. rheumatoid arthritis b. psoriatic arthritis c. ankylosing spondylitis d. Crohn's disease e. irritable bowel syndrome |
e: NOT indicated for IBS
(adalimumab) monoclonal antibody for TNF (tumor necrosis factor) |
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Humira indications
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rheumatoid arthritis
juvenile idiopathic rheumatoid arthritis psoriatic arthritis Crohn's disease ankylosing spondylitis plaque psoriasis |
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Humira dosing
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initial 80mg dose
then 1 week after initial dose, 40mg every other week |
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Humira warning
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increased risk of serious infection (pt's taking concommitant immunosuppressants such as MTX or steroids are at a higher risk)
reported infections include: 1. active TB 2. invasive fungal infections 3. bacterial, viral & other infections |
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Which of the following NSAIDs would be best for a patient who has a hard time remembering to take medications?
a. Ansaid b. Motrin c. Feldene d. Sulindac e. Dolobid |
c. Feldene (piroxicam)
piroxicam is usually 20mg daily in a single dose, or BID (Ansaid is flurbiprofen, NOT naproxen, and is usually QID) (sulindac usually twice daily) (Dolobid is diflunisal, usually dosed every 8-12 hours, prodrug) |
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Dolobid
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diflunisal
salicylic acid derivative/NSAID prodrug usually 500-1000 mg/day BID or TID |
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COPD treatment guideline?
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GOLD therapy
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Stage I COPD:
- diagnostic criteria - treatment |
GOLD staging: I = Mild
- FEV1/FVC <0.7 - FEV1 = 80% or greater (of predicted) Flu vaccine Add PRN short-acting bronchodilator |
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Stage II COPD:
- diagnostic criteria - treatment |
GOLD staging: II = Moderate
- FEV1/FVC <0.7 - FEV1 50% to 80% (of predicted) Add regular treatment with long-acting bronchodilator (when needed) Add pulmonary rehabilitation |
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Stage III COPD:
- diagnostic criteria - treatment |
GOLD staging: III = Severe
- FEV1/FVC <0.7 - FEV1 30% to 50% (of predicted) Add inhaled glucocorticosteroids if repeated exacerbations |
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Stage IV COPD:
- diagnostic criteria - treatment |
GOLD staging: IV = Very Severe
- FEV1/FVC <0.7 - FEV1 <30% (of predicted), OR FEV1 <50% plus chronic respiratory failure Add long-term oxygen if chronic respiratory failure Consider surgical treatments |
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What is a side effect of Effexor that is not common with other anti-depressants?
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sweating
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Which anti-depressant can cause sweating?
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Effexor
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Which anti-depressant is most likely to cause nausea?
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Cymbalta
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Which SSRI is recommended to be taken in the morning?
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escitalopram (citalopram & others generally recommended to take in the evening, although some clinicians may recommend other times of day)
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Which common antibiotics are more likely to contribute to a yeast infection?
Which common class of antibiotics is far less likely to contribute to a yeast infection? |
More yeast infections: penicillins, Augmentin, & quinolones
Unlikely to cause yeast infections: cephalosporins |
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What is the most important counseling point for dicloxacillin (that is different than most abx)?
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take on an empty stomach
dicloxacillin is rarely used because it must be taken frequently, and on an empty stomach |
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What should you tell a patient who comes in for Zostavax, and who is currently taking Zovirax?
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discontinue acyclovir (Zovirax), valacyclovir (Valtrex), etc. at least 24 hours before getting the Zostavax shot
do not re-start the above meds for at least 14 days after getting Zostavax shot (unless otherwise directed by your doctor) |
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Singulair
- MOA - indications |
(montelukast)
leukotriene-receptor antagonist (leukotrienes can cause airway edema, smooth muscle contractions, symptoms of allergic rhinitis, and activation of the inflammatory process) INDICATIONS: - chronic treatment of asthma - allergic rhinitis - excercise-induced asthma/bronchospasms |
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Singulair dosage forms
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(montelukast)
granules tablets chewable tablets |
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Singular dosing
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ALLERGIC RHINITIS and ASTHMA:
10 mg daily, in the evening EXERCISE-INDUCED ASTHMA/BRONCHOSPASMS: 10 mg at least 2 hours before exercising RENAL IMPAIRMENT: no dose adjustment take granules within 15 minutes of opening |
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How long does it take Singulair to work?
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it can take several weeks to see the effects
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Singulair precautions
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(montelukast)
in rare cases, leukotriene inhibitors can cause psychiatric events; should report: - agitation or aggression - anxiety - depression - insomnia - abnormal dreams or hallucinations - suicidal ideation |
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Singulair adverse effects?
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well tolerated in general
MOST COMMON: - cough - headache - dizziness - abdominal pain |
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Singulair major drug interactions?
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phenobarbital may increase montelukast metabolism, decreasing its effect
Look for any drugs that interact with: 2C9 2C8 3A4 |
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Singulair pregnancy category?
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Category B
breastfeeding effects unknown |
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Singulair counseling points
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- take every evening, even if you feel fine
- it may take several weeks to see an effect - do not use for asthma attacks, use rescue inhaler - some side effects are headache, fatigue, dizziness - tell your doctor if you have any mood or behavior changes - take granules within 15 minutes of opening |
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Zantac drug interactions
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(ranitidine)
avoid with delavirdine and erlotinib PGP inhibitors may increase the effects of ranitidine |
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Isoptin generic
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verapamil
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Verelan generic
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verapamil
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Calan generic
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verapamil
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Covera-HS generic
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verapamil
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Calan MOA & indications
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verapamil (a.k.a. Isoptin, Covera-HS, Verelan)
Non-DHP Calcium Channel Blocker INDICATIONS: hypertension angina SVT |
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verapamil dosage forms
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injection solution
immediate release tablets (Calan) sustained-release tablets (Isoptin SR, Calan caplets) sustained-release capsules (Verelan) extended-release tablets (Covera-HS) extended-release capsules (Verelan) |
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verapamil dosing
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ANGINA:
IR: 40-160 mg TID SR: 120-480 mg in single or divided doses ER: 120-360 mg QHS HYPERTENSION: IR: 80-320 mg dosing, usually TID SR: 120-480 mg in single or divided doses ER: 120-360 mg at bedtime |
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Isoptin contraindications
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verapamil (a.k.a. Verelan, Calan, and Covera-HS)
severe left-ventricular dysfunction hypotension (systolic < 90) AFib/AFlutter AND accessory bypass tract cardiogenic shocks sick sinus syndrome |
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Covera-HS precautions
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verapamil (a.k.a. Calan, Isoptin, Verelan)
1st-degree AV block bradycardia hypotension increased LFT's (rare) avoid use in heart failure use with caution in renal or hepatic failure specific to Covera-HS: dosage adjustment may be necessary in patients with very short GI transit time |
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Verelan adverse reactions
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headache
constipation gingival hyperplasia |
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verapamil major drug interactions
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use caution with any other drugs with SA/AV nodal blocking properties, such as beta blockers
verapamil increases digoxin levels, dose adjustment may be necessary can inhibit CYP3A4 |
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verapamil pregnancy considerations
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Category C
considered "compatible" with breastfeeding by the American Academy of Pediatrics |
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verapamil counseling points
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blood pressure drop --> dizziness
use caution with first few doses may experience headache or enlargement of the gums (gingival hyperplasia), maintain good oral hygeine and watch for gum enlargment |
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Lotensin MOA & indications
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benazepril (Lotensin)
ACE-inhibitor pro-drug metabolized to active form in the liver INDICATIONS: hypertension benazepril also decreases ventricular remodeling, cardiac hypertrophy |
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benazepril dosage forms
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tablets (Lotensin)
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Lotensin dosing
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benazepril (Lotensin)
HTN: start at 10 mg/day, work up to 80 mg/day can be given as a single dose or split BID requires renal adjustment |
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Lotensin BBW
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benazepril (Lotensin)
pregnancy: Category C in 1st Trimester Category D in 2nd & 3rd Trimesters (shown to cause injury or death) |
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Lotensin pregnancy category
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benazepril (Lotensin)
pregnancy: Category C in 1st Trimester Category D in 2nd & 3rd Trimesters (shown to cause injury or death) carries a BBW for pregnancy |
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Lotensin contraindications
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pregnancy
bilateral renal artery stenosis |
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Lotensin precautions
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benazepril (Lotensin)
can cause angioedema at any point in therapy (especially 1st dose) may cause dry cough, usually happens within the first months of therapy hyperkalemia hypotension renal dysfunction (though generally consider renal-protective, like all ACEI's, vasodilates the efferent arteriole decreasing renal pressure) |
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Lotensin adverse effects
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benazepril (Lotensin)
cough hypotension dizziness/vertigo headache increased SCr (d/c if increase is >35% baseline) |
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Lotensin major drug interactions
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NSAID's (block effects of ACEI's)
potassium sparing diuretics |
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Lotensin major counseling points
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take 1st dose at bedtime
may cause dizziness, headache, dry cough avoid salt substitutes containing potassium tell doc if you may become pregnant contact doc if signs of angioedema! |
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Altace MOA & Indication(s)
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Altace = ramipril
ACE inhibitor (inhibits Angiotensin I --> Angiotensin II conversion) ramipril is a prodrug converted to active form in liver vasodilation of renal efferent arteriole (considered renal protective), decreased aldosterone secretion, decreased sodium & water re-absorption, decreases ventricular remodeling & cardiac hypertrophy, increased serum potassium Indications: - HTN - left ventricular dysfunction after MI - MI, stroke & death risk reduction |
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ramipril:
- brand name - dosage forms - typical dosing |
Altace (ramipril)
oral tablets & capsules initiation dose: 1.25 or 2.5 mg/day typical dose: 5-10 mg (QD or split BID) max dose: 20 mg/day dose adjust for renal impairment! |
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Altace contraindications & warnings & adverse effects
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BBW: pregnancy (Cat C in 1st trim, Cat D in 2nd & 3rd, shown to cause fetal injury and death)
Contraindications: - pregnancy - hx of angioedema - bilateral renal artery stenosis Precautions: - angioedema possible, especially after 1st dose - hyperkalemia (increased risk in diabetics) - renal dysfunction (DC if SCr increases >35% above baseline) Adverse Effects: - cough - hypotension - angina - headache - dizziness/vertigo - GI upset |
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Altace major drug interactions
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Altace (ramipril)
- NSAIDs (block ACEI effects & can worsen renal impairment) - potassium-sparing diuretics (monitor for hyperkalemia) |
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Altace counseling points
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Altace (ramipril)
1st dose: take at bedtime May cause GI upset, headache, dizziness, cough Contact doc if swelling/angioedema Avoid salt substitutes containing potassium tell your doc if you may become pregnant |
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Lidoderm:
- MOA - indication(s) - dosage forms/strengths |
MOA: decreases neuronal membrane permeability to sodium, blocking neuronal impulse conduction
Indication: anesthetic (topical) Lidoderm is a 5% transdermal patch (other topical forms of lidocaine range in strength from 2% - 9.6%) |
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Lidoderm:
dosing |
3 or fewer patches can be used in a single application
Patches may be left on for 12 or fewer hours, then remove and wait at least 12 hours before applying another patch |
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Lidoderm:
- contraindications, precautions - adverse effects, pregnancy category - major drug interactions |
Lidoderm
Contraindications: hypersensitivity Precautions: do not apply to irritated skin, store away from pets & children Adverse effects: site reaction, paradoxical skeletal pain in very rare cases Pregnancy Category B, considered safe in breastfeeding Major drug interactions: conivaptan, tolvaptan, thioridazine |
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Lidoderm counseling points
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Lidoderm:
- apply patches directly to most painful area - can use up to 3 patches at the same time - leave patches on no more than 12 hours at a time - 12 hours on, 12 hours off (for efficacy) - patches can be cut to cover area if necessary! - may experience local irritation - tell your doctor if your pain gets worse |
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Evista:
- generic - MOA - indication(s) - dosage forms - dosing |
Evista (raloxifene)
MOA: SERM (selective estrogen receptor modulator); blocks and acts like estrogen at some, but not all, estrogen receptors. Prevents bone loss, may block the effect of estrogen in uterine and breast tissue where excess estrogen can lead to cancer Indications: - osteoporosis in post-menopausal women, treatment and prevention - invasive breast cancer risk reduction in post-menopausal women with high risk available as a 60 mg tablet typical dose: 60 mg/day |
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Evista:
- time to onset of action - contraindications/warnings/precautions - adverse effects |
Evista (raloxifene)
Onset of action: 8 weeks BBW: may increase risk of DVT or PE, use is contraindicated in women with a history of VTE. Also may increase risk of stroke in women already at risk. Contraindications: - hx of VTE - pregnancy & breastfeeding (again, only for post-menopausal women) Precautions: - use with caution in renal or hepatic insufficiency (effects unknown) - TG's may be increased Adverse Effects: - peripheral edema - hot flashes - joint pain - muscle cramps spasms (often in the legs) - flu-like symptoms - infections |
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Evista:
- major drug interactions - pregnancy category |
Evista (raloxifene)
Major Drug Interactions: - not many significant interactions - may decrease the effects of levothyroxine - bile acid sequestrants may affect absorption of raloxifene, separate administration by at least 4 hours Pregnancy: Category X, contraindicated in breastfeeding (raloxifene is only for post-menopausal women) |
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Evista counseling points
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Evista (raloxifene)
- only for post-menopausal women - side effects may include hot flashes, edema/swelling, muscle cramps in legs - avoid periods of prolonged restricted movement (due to DVT/PE risk) - tell your doctor immediately if you experience any of the following: A: severe abdominal pain C: chest pain or shortness of breath H: severe headache E: eye problems or visual disturbances S: severe pain in calf or thigh |
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Suboxone:
- generic - MOA - indications - dosage forms |
Suboxone (buprenorphine & naloxone)
MOA: buprenorphine: opioid analgesic, binds mu receptors in CNS naloxone: competitive opioid antagonist, used alone as an antidote in opiate overdose (note: naloxone is not effectively absorbed from Suboxone dosage forms, and is present only to deter abuse of buprenorphine by injection) Indications: treatment of opioid dependence Dosage forms: sublingual (films, tablets) - 2 mg buprenorphine + 0.5 mg naloxone - 8 mg buprenorphine + 2 mg naloxone note that the film dissolves better and has a better taste the film has slightly higher bioavailability |
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Suboxone dosing
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(buprenorphine+naloxone)
DOSING (as mg of buprenorphine): day 1: initiate at 4 mg, may repeat once after 2+ hrs day 2: if no withdrawal sx, use same dose as day 1; if withdrawal sx, double day 1 dose, may repeat after 2+ hours (max of 16 mg on day 2) subsequent days: usually 4 to 24 mg/day, max of 32 mg |
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Suboxone
- contraindications - warnings - precautions - adverse effects |
(buprenorphine/naloxone)
CI: hypersensitivity Warnings: none Precautions: CNS depression, liver impairment in pts with pre-existing liver disease, and use with caution in: - alcoholism - psychosis - bowel obstruction - thyroid dysfunction Adverse Reactions: - withdrawal sx - headache - vomiting - sweating - vasodilation |
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Suboxone
- major drug interactions - pregnancy category |
(buprenorphine/naloxone)
Major Drug Interactions: - avoid with atazanavir, conivaptan & MAO inhibitors - effects may be increased with 3A4 inhibitors, atazanavir, conivaptan, hydroxyzine & succinylcholine Pregnancy: Category C not recommended in breastfeeding, as buprenorphine does enter breast milk |
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Suboxone counseling points
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(buprenorphine/naloxone)
NOTE TO PHARMACISTS: doctors must be certified by the DEA to prescribe Suboxone for opioid dependence, but they do NOT need to be certified to prescribe for chronic pain! If a doc is certified to prescribe for dependence, then his/her DEA # should start with X - avoid with other opioids & alcohol - headache, vomiting, sweating, dizziness - report sx of liver damage (dark urine, jaundice, stabbing pain in upper right quadrant) |
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Antivert
- generic - MOA - indications |
meclizine (Antivert)
MOA: 1st generation antihistamine antiemetic (blocks CTZ via anticholinergic activity) decreases excitability/conduction in the middle ear Indications: - motion sickness - vertigo |
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Bonine
- dosage forms - adult dosing |
meclizine (Bonine)
tablets caplets chewable tablets MOTION SICKNESS: 12.5 - 25 mg ~1 hour before travelling dose may be repeated every 12 hours as needed VERTIGO: 25 - 100 mg/day in divided doses |
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Antivert
- precautions - adverse reactions - pregnancy - drug interactions |
PRECAUTIONS:
use with caution in asthma, BPH or urinary stricture, narrow-angle glaucoma, pyloric or duodenal obstruction ADVERSE REACTIONS: drowsiness thickening of bronchial secretions DRUG INTERACTIONS alcohol increases CNS depression PREGNANCY: Category B unknown breastfeeding effects |
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Oleptro
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trazodone once daily formulation
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Desyrel
- generic - class - MOA - indications |
trazodone (Desyrel)
Class: atypical antidepressant MOA: - Serotonin: serotonin reuptake inhibition - Norepinephrine: reuptake NOT affected in CNS - Dopamine: reuptake NOT affected in CNS - Histamine: H1 receptor blocker - alpha-adrenergic receptor blocking activity (hypnotic effects likely due to alpha blocking & antihistamine activity) Indications: - depression (insomnia off-label) |
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Desyrel
- dosage forms - adult dosing - onset of action |
trazodone (Desyrel)
Dosage Forms: tablets DEPRESSION: 150 - 300 mg/day divided TID (except Oleptro, QD) best to take each dose after a meal or snack because food increases absorption INSOMNIA: 25 - 200 mg QHS (typically between 25 - 50 mg QHS) best to take each dose after a meal or snack because food increases absorption Onset of Action: usually around 1 hour for sleep, may take up to 3 hours for depression, onset is ~3 weeks |
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Desyrel
- warnings - contraindications - precautions - adverse events |
trazodone (Desyrel)
BBW: watch for suicidal ideation/behavior CI: hypersensitivity Precautions: - NOT approved for bipolar, can cause a shift toward mania - orthostatic hypotension risk higher than with other antidepressants (esp. elderly) - priapism may occur in rare cases - avoid abrupt d/c - use with caution in renal/hepatic dysfunction - use with caution in hx of seizure Adverse Events: - headache - dizziness/hypotension - sedation - nausea - dry mouth - blurred vision |
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Oleptro
- major drug interactions - pregnancy |
trazodone (Oleptro)
CYP3A4 metabolism alcohol & other CNS depressants Protease Inhibitors can increase serum concentrations of trazodone other drugs affecting serotonin may increase risk of serotonin syndrome PREGNANCY: Category C use with caution in breastfeeding |
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Desyrel counseling points
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trazodone (Desyrel)
- take each dose directly after meal or snack - for insomnia, take each dose at night before you go to bed (may take ~1 hr) - may take several weeks to see effects on depression - don't d/c abruptly - main side effects are headache, dizziness, sedation, dry mouth, blurry vision - let doc or pharmacist know if you plan to become pregnant |
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Folacin
- MOA - indications - dosage forms - dosing |
folic acid (Folacin)
MOA: used to form many coenzymes, as well as in the maintenance of erythropoiesis and WBC and platelet function. Can also enhance elimination of formic acid, a toxic by-product of methanol metabolism. Deficiency in pregnancy can lead to fetal neural tube defects. Indications: Megaloblastic and Macrocytic Anemias prevention of neural tube defects in pregnancy Dosage Forms: injection solution tablets Dosing: Recommended Dietary Intake is 400 mcg/day ANEMIA: 400 - 800 mcg/day PREGNANCY: 400 - 800 mcg/day 4 g/day if pt has family history of neural tube defects |
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Folacin
- CI - Precautions - Adverse Effects - Pregnancy |
folic acid (Folacin)
CI: hypersensitivity Precautions: - should not be used as monotherapy for anemia if pt has a B12 deficiency Adverse Effects: - generally well tolerated - allergic reaction - bronchospasms - flushing/erythema - malaise - rash PREGNANCY: Category A (recommended) compatible with breastfeeding |
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Folacin
- major drug interactions |
folic acid (Folacin)
- can decrease the effects of the antineoplastic agent raltitrexed |
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Folacin counseling points
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folic acid (Folacin)
generally very well-tolerated all women of childbearing age should get adequate intake (400 mcg/day) |
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DuoNeb
- MOA - indications |
ipratropium/albuterol
ipratropium MOA: anticholinergic; blocks acetylcholine from binding bronchial smooth muscle cells causing bronchodilation, also dries bronchial secretions albuterol MOA: short-acting beta agonist, relaxes bronchial smooth muscle --> bronchodilation |
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Combivent
- dosage forms - dosing - onset of action |
ipratropium/albuterol (Combivent)
Combivent is an inhaler DuoNeb is a nebulizer solution COMBIVENT: 1 puff 4 times a day with the new Respimat inhaler (was 2 puffs QID with old formulation) DUONEB: 3 mL every 6 hours do not exceed 3 mL every 4 hours Onset of Action: usually 5-15 minutes |
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Combivent
- contraindications - precautions - adverse effects - pregnancy |
ipratropium/albuterol (Combivent, DuoNeb)
CI: hypersensitivity Precautions: - tell doc if pt gets worse with inhaler use (beta agonist can sometimes cause paradoxical bronchospasms, very rare) - CNS excitation (caution in seizures, CV conditions) - beta agonists can increase serum glucose - BPH or bladder neck obstruction (ipratropium may exacerbate) Adverse Effects: - throat irritation - cough - dizziness - nausea - headache - palpitation/tachycardia PREGNANCY category C caution in breastfeeding |
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DuoNeb major drug interactions
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ipratropium/albuterol (Combivent, DuoNeb)
beta blockers or alpha/beta blockers may decrease the effects of albuterol TCA's or sympathomimetics may increase the effects of albuterol |
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ipratropium/albuterol counseling points
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(DuoNeb, Combivent)
headache, throat irritation, cough, dizziness, nausea tell doctor if you experience increased heart rate or heart palpitations, or if your breathing seems to get worse with the medication |
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Boniva administration
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ibandronate (Boniva)
bisphosphonate on empty stomach! (food decreases absorption up to 90%) take with a full glass of water and do not lay down or recline for at least 60 minutes afterward (to avoid GI mucosa irritation) make sure pt is also taking a calcium + D supplement, but separate Boniva administration from calcium (or antacid) administration by at least 2 hours do not take any oral drugs within 1 hour of Boniva |
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Boniva counseling points
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ibandronate (Boniva)
bisphosphonate on empty stomach! (food decreases absorption up to 90%) take with a full glass of water and do not lay down or recline for at least 60 minutes afterward (to avoid GI mucosa irritation) make sure pt is also taking a calcium + D supplement, but separate Boniva administration from calcium (or antacid) administration by at least 2 hours do not take any oral drugs within 1 hour of Boniva avoid alcohol (can contribute to osteoporosis) Main side effects are GI upset, headache, insomnia, back pain Pregnancy Category C, breastfeeding effects unknown |
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Boniva renal/hepatic dosing
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ibandronate (Boniva)
bisphosphonate no hepatic dose adjustments not recommended if CrCl is < 30 mL/min |
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Boniva dosing
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ibandronate (Boniva)
bisphosphonate DAILY: 2.5 mg QD (oral tablet) MONTHLY: 150 mg Q month (oral tablet) EVERY 3 MONTHS: 3 mg IV every 3 months (IV) |
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Avapro
- indications - initiation & max dose |
irbesartan (Avapro)
ARB INDICATIONS: - hypertension - diabetic nephropathy in T2DM + HTN Initiation Dose: 75 mg QD Max Dose: 300 mg QD |
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Avapro
- warnings - contraindications - precautions - adverse effects - pregnancy |
irbesartan (Avapro)
BBW: pregnancy; fetal harm or death in 2nd & 3rd trimester CI: pregnancy, hypersensitivity, renal artery stenosis Precaution: - hyperkalemia - hypotension - AKI - use with caution in hepatic/renal impairment AE's: - dizziness - hypotensions - fatigue - diarrhea - hyperkalemia PREGNANCY: Category D in 2nd & 3rd not recommended in breastfeeding |
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Vasotec
- indications - dosage forms - dosing range |
enalapril (Vasotec)
HTN symptomatic heart failure asymptomatic left ventricular dysfunction tablets, injection solution 2.5 - 40 mg/day |
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Vasotec
- warnings - adverse effects |
enalapril (Vasotec)
BBW: pregnancy (also not recommended in breast feeding) Adverse Effects: N/V/D/constipation GI upset hypotension chest pain headache dizziness fatigue rash abnormal taste |
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Vibramycin
- dosing - contraindications |
doxycycline (Vibramycin)
usually 100 - 200 mg, once daily or divided BID CI: children under 8 (can cause permanent tooth discoloration) |
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Vibramycin
- adverse effects |
doxycycline (Vibramycin)
Adverse Effects: - GI upset - photosensitivity - joint pain - worsened menstrual cramps - esophageal irritation (take with a full glass of water and stay upright for 30 min) - tissue hyperpigmentation including skin, nails, eyes & teeth |
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Vibramycin counseling points
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doxycycline (Vibramycin)
GI upset (take with food) throat irritation (take with full glass of water & do not lie down for 30 min) joint pain, photosensitivity separate dosing from antacids, iron, magnesium, calcium pregnancy Category D! |
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Vibramycin
- pregnancy category |
doxycycline (Vibramycin)
Category D not recommended in breastfeeding |
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doxycycline hyclate
vs doxycycline monohydrate |
both equally effective
hyclate usually cheaper monohydrate dissolves slower in the stomach so may have less GI irritation, but no real evidence 2 forms are NOT generic equivalents! Non-substitutable! Must call prescriber to switch. |
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NuvaRing dosing
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NuvaRing:
0.15 mg/day ethinyl estradiol 0.12 mg/day etonogestrel |
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T or F:
Tampons do not interfere with NuvaRing absorption. |
True (tampons do not interfere with NuvaRing absorption)
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T or F:
You can repackage Norvir tablets into a new container. |
True.
However, you can NOT repackage Norvir CAPSULES (which are refrigerated, while Norvir tablets are not). |
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T or F:
Putting a baby's dose of Tri-Vi-Fluor in their formula bottle is best because it may make it more palatable. |
False.
Fluoride will bind with the calcium in the baby's bottle, and will not be absorbed systemically as a result. Tri-Vi-Fluor should be given AFTER teeth brushing (if applicable) and before bed. The child should not drink or eat anything after the drops are given. It is best to apply the drops as much on the teeth as possible (if the baby has teeth), because there is some topical benefit. However, most benefit is from systemic absorption. Note: most Tri-Vi-Fluor formulations/generics are very mild in flavor, and palatability is rarely a problem. |
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Altoprev dosing range
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lovastatin (Altoprev, Mevacor)
10 - 80 mg QHS max is 80 mg/day for IR max is 60 mg/day for ER |
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dosing:
Mevacor + cyclosporine |
lovastatin (Mevacor) 20 mg/day max
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dosing:
danazol + Altoprev |
lovastatin (Mevacor) 20 mg/day max with danazol
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dosing:
niacin + Mevacor |
lovastatin (Mevacor) 20 mg/day max with niacin
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dosing:
fibrates + Altoprev |
lovastatin (Altoprev) 20 mg/day max with fibrates
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dosing:
verapamil + Mevacor |
lovastatin (Mevacor) 40 mg/day max with verapamil
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dosing:
amiodarone + Mevacor |
lovastatin (Mevacor) 40 mg/day max with amiodarone
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Altoprev onset
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lovastatin (Altoprev, Mevacor)
Onset of LDL-lowering action: ~3 days, usually follow up in 8 weeks. |
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Zyprexa:
- MOA - Indications |
olanzapine (Zyprexa)
MOA: atypical antipsychotic potent antagonist at serotonin (5HT-2A & 5HT-2C), dopamine, histamine H1 and alpha1-adrenergic receptors weak antagonist of muscarinic receptors thought to work mainly through antagonism of dopamine and serotonin type 2 receptors INDICATIONS: - schizophrenia - bipolar (often with fluoxetine) - acute or mixed mania episodes associate with bipolar - unlabeled use in chemotherapy for delayed nausea/vomiting |
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Zyprexa dosage forms
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olanzapine (Zyprexa)
injection powder (Zyprexa Relprevv) tablets ODT's (Zyprexa & Zydis) |
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Zyprexa dosing range
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olanzapine (Zyprexa)
atypical antipsychotic 5 - 20 mg/day (once daily dosing) |
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Zyprexa counseling points
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olanzapine (Zyprexa)
with or without food (absorption unaffected) may take up to a month to see the full result fatigue, headache, dizziness, dry mouth, muscle weakness, constipation, weight gain EPS may occur Increased LFT's & cause hyperlipidemia (just tell pt may require bloodwork) note that smoking may increase clearance by ~40%! (clearance is also decreased by ~30% in females, probably don't need to tell pt this, only worry about it if they are starting on a large dose) |
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At what point would weight gain with Zyprexa be a concern?
Which drugs would be good alternatives to Zyprexa in a patient experiencing this much weight gain? |
Consider switching in increase is 5% or more of baseline weight.
Abilify (aripiprazole) Safris (asenapine) Latuda (lurasidone) Geodon (ziprasidone) |
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T or F:
Zyprexa is not approved for dementia-related psychosis. |
True.
Zyprexa (olanzapine) is not approved for dementia-related psychosis. It carries a BBW for increased incidence of death in this population. Most of these deaths are due to cardiovascular complications or infections. |
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Zyprexa precautions
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olanzapine (Zyprexa)
atypical antipsychotic May alter cardiac conduction (use with caution in cardiac abnormalities or arrhythmia; that being said, Zyprexa has a lower risk of cardiac problems compared to many other atypicals) Blood dyscrasias (neutropenia, leukopenia, agranulocytosis; MONITOR) Extrapyramidal Side-effects (EPS), including tardive dyskinesia; more risk with higher doses and in younger patients or male patients, and with use of typical antipsychotics Hyperglycemia (use with caution in diabetes, risk may be higher than with other atypicals!) Hyperlipidemia (monitor) Weight Gain (may be worse than some other atypicals like Abilify, Latuda, Saphris, Geodon) Use with caution in renal or hepatic impairment |
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Zyprexa major drug interactions
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olanzapine (Zyprexa)
atypical antipsychotic avoid use with metoclopramide avoid use with benzodiazepines CYP1A2 strong inhibitors may increase levels of Zyprexa These drugs may increase the levels/effects of Zyprexa: acetylcholinesterase inhibitors, fluvoxamine, lamotrigine, lithium |
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Zyprexa pregnancy category
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olanzapine (Zyprexa)
atypical antipsychotic Category C not recommended in breastfeeding |
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Lamictal MOA & indications
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MOA:
anticonvulsant inhibits release of glutamate (excitatory AA) also inhibits voltage-sensitive sodium channels, which normally stabilize neuronal membranes also weakly inhibits 5HT-3 receptors INDICATIONS: generalized seizures partial seizures bipolar I maintenance |
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Lamictal dosage forms
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tablets
ODT's |
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Lamictal
- initiation dose - maintenance dose |
initiation dose:
25 mg/day maintenance dose: 225 - 375 mg/day divided BID |
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Dosing:
Lamictal + Valproic Acid |
valproic acid extends the half-life of Lamictal
Cut Lamictal dose in half! |
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Which anticonvulsant significanly extends the half-life of Lamictal, requiring a dosage adjustment?
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Valproic acid
Cut Lamictal dose in half! note that the half-life is also extended in renal or hepatic impairment |
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Which anticonvulsants decrease the half-life of Lamictal, requiring a dosage adjustment?
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The following drugs decrease the half-life of Lamictal, requiring an increase in dose:
carbamazepine phenytoin phenobarbital primidone typical maintenance dose will be 300 - 500 mg/day of Lamictal divided BID (as opposed to 225 - 375 mg/day, which is the typical maintenance dose of Lamictal) Note: hormonal contraceptives may also decrease levels of Lamictal, may or may not require dose adjustments |
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Dosing:
Lamictal + carbamazepine |
The following drugs decrease the half-life of Lamictal, requiring an increase in dose:
carbamazepine phenytoin phenobarbital primidone typical maintenance dose will be 300 - 500 mg/day of Lamictal divided BID (as opposed to 225 - 375 mg/day, which is the typical maintenance dose of Lamictal) |
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Dosing:
Lamictal + phenytoin |
The following drugs decrease the half-life of Lamictal, requiring an increase in dose:
carbamazepine phenytoin phenobarbital primidone typical maintenance dose will be 300 - 500 mg/day of Lamictal divided BID (as opposed to 225 - 375 mg/day, which is the typical maintenance dose of Lamictal) |
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Dosing:
Lamictal + phenobarbital |
The following drugs decrease the half-life of Lamictal, requiring an increase in dose:
carbamazepine phenytoin phenobarbital primidone typical maintenance dose will be 300 - 500 mg/day of Lamictal divided BID (as opposed to 225 - 375 mg/day, which is the typical maintenance dose of Lamictal) |
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Dosing:
Lamictal + primidone |
The following drugs decrease the half-life of Lamictal, requiring an increase in dose:
carbamazepine phenytoin phenobarbital primidone typical maintenance dose will be 300 - 500 mg/day of Lamictal divided BID (as opposed to 225 - 375 mg/day, which is the typical maintenance dose of Lamictal) |
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Lamictal BBW
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skin rashes!
risk may be increased by starting with higher doses, rapid titration, and use with valproic acid majority of cases occur within the first 8 weeks of therapy |
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Lamictal precautions
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blood dyscrasias
CNS depression use with caution in CV disease use with caution in hepatic/renal impairment suicidal ideation do not d/c abruptly due to risk of seizure drug-induced aseptic meningitis may occur (very rare, reversible) |
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Lamictal adverse effects
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GI upset (mainly nausea)
somnolence OR insomnia impaired coordination fatigue rash dysmenorrhea weight loss or anorexia dry mouth |
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Lamictal & pregnancy
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Category C
not recommended in breastfeeding (enters breast milk) |
