Pcm I

Front 1

Zyloprim
1. Brand name?
2. Uses?
3. Usual dose?
4. MOA?
5. Drug interaction?
6. Counseling point

Back 1

1.Zyloprim (Allopurinol)
2. Gout,
hyperuricemia,
nephrolithiasis,
renal calculus,
uric acid nephropathy
3. 100-300 mg QD.
4. Inhibits Xanthine Oxidase --> Decrease uric acid production.
5. Azathioprine (Imuran) or 6-MP (purinethol) dose must be reduced by 1/3 or 1/4 to prevent toxicity.
6. No alcohol, ASA (unless 81mg), organ meats, lobsters, clams, shellfish & wine.

Front 2

Uloric
dose, MOA, indication

Back 2

Uloric (Febuxostat)
40-80mg tabs QD.
Inhibits Xanthine Oxidase.
for CHRONIC MANAGEMENT of hyperuricemia in pts with gout. Also has Imuran/6-MP interaction

Front 3

Benemid
dose, indication, MOA, CI'ed with which drugs?

Back 3

Benemid (Probenecid)
500mg -usually BID. start low for the first few doses.
Uses: Gout, hyperuricemia, adjuvant to antibiotic therapy.
Probenecid is an organic acid; it inhibits reabs. of uric acid (organic acid) in the proximal renal tubules. CI'ed with ASA, & other salicylates bc they're also organic acids, they compete for the sites. (unless 81mg).

Front 4

Colbenemid
dose, indication

Back 4

Colbenemid (Colchicine 0.5mg & probenecid 500mg )
For maintenance, usually BID.

Front 5

Colcrys
dose, toxic dose = ?
indication

Back 5

Colcrys (Colchicine) 0.6mg
0.6-1.2mg QD or BID. max 1.2mg/day. Toxic dose as low as 8mg.
prophylaxis and tx of gout flares. Decreases gout sx.

Front 6

Colchicine MOA

Back 6

inhibits tubulin polymerization into microtubules, prevents activation, degranulation, and migration of neutrophils.

Front 7

Colchicine dose for prevention

Back 7

0.6-1.2mg QD or BID.
Max 1.2mg/day

Front 8

Colchicine dose for tx of gout flare

Back 8

1.2 at once, 0.6mg one hour later

Front 9

Colchicine dose in renal impairment

Back 9

reduce dose to 0.3mg or increase interval (QOD)

Front 10

Colchicine counsel

Back 10

Drink adequate water to dilute systemic uric acid, decreasing gout attacks.

Front 11

Fosamax
dose, indication

Back 11

Fosamax (Alendronate)
tabs: 5, 10, 40mg.
Once weekly, 35 & 70mg
Oral solution: 75mL contains 70mg (Qweekly)
Tx and prevention of osteoporosis in postmenopausal women & men, also Paget's Dz.

Front 12

What does Fosamax Plus D
contain?

Back 12

Once weekly tablet: 70mg Fosamax plus 2,800 units or 5,600 units of Vit D

Front 13

What are the instructions for Fosamax?
what is the major problem with taking fosamax?

Back 13

Take 30min b4 breakfast on empty stomach, no juice, coffee or milk or food.
Take with lots of water, upright position for 30mins.
Major problem: esophageal irritation

Front 14

what are the Fosamax dose for prevention and treatment?

Back 14

35mg Qwk for prevention
70mg Qwk for tx
higher dose for Paget's

Front 15

What are the counseling points for pts taking Fosamax

Back 15

Recommend routine wt-bearing exercise (not swimming) & adequate calcium & Vit. D intake

Front 16

What is the generic name for Actonel?
Dose?

Back 16

Actonel (Risedronate)
5mg, 30mg
35mg Once weekly
150mg once a month

Front 17

Actonel with calcium
dosage instruction.
How many mg of elemental Ca does it contain?

Back 17

35mg tab once weekly on an empty stomach, calcium carbonate 1250mg (500mg elemental ca) daily for next 6 days with food to increase absorption

Front 18

What is the generic name for Atelvia?
dosage instruction

Back 18

Risedronate DR tabs
35mg qweek, immediately following breakfast!

Front 19

Generic name for Boniva?
dose?

Back 19

Boniva = Ibandronate
regular tabs 2.5 mg/day
150MG ONCE A MONTH

Front 20

What are the cautions for taking bisphosphonates?

Back 20

Jaw osteonecrosis, and atypical bone fracture of the femur!

Front 21

List the bisphosphonate products

Back 21

Fosamax (alendronate)
Actonel (Risedronate)
Actonel w/ calcium
Atelvia (Risedronate DR tab)
Boniva (Ibandronate)

Front 22

What is the brand name for Calcitonin-Salmon nasal spray

Back 22

Miacalcin & Fortical

Front 23

What is the use for Miacalcin & Fortical?
What is one of its advantage?

Back 23

For osteoporosis and hypercalcemia.
Calcitonin is a hormone that decreases bone resorption. Nasal Spray: an advantage for pts with GI problems who cannot tolerate bisphosphonates.

Front 24

Dose for Miacalcin & Fortical?

Back 24

200IU (one spray) daily, alternating nostrils daily. Once the pump has been activated, store at room temp

Front 25

How should Miacalcin & Fortical injection and nasal spray be stored?

Back 25

Injection: refrig. at 36-43F
Nasal spray: store unopened bottle in refrig. (2-8 C).
Potential for nasal irritation

Front 26

What is Evista?
What is the dose for Evista??

Back 26

Raloxifene, a selective Estrogen Receptor Modulator (SERM).
60mg tab QD

Front 27

What is the use of Raloxifene (Evista)?

Back 27

Treatment and prevention of osteoporosis in postmenopausal women.
Reudction in the risk of invasive breast cancer in postmenopausal women with osteoporosis or at risk of breast cancer

Front 28

What is Raloxifene (Evista)'s action?

Back 28

It selectively binds certain estrogen receptors, inhibits bone resorption & lowers LDL.

Front 29

What are the ADR of Raloxifene (Evista)? including BBW

Back 29

Peripheral edema, hot flashes. BBW: Increased risk of venous thromboembolism and death from stroke.

Front 30

Synthroid, levothroid, levoxyl, Unithroid, etc. strengths?

Back 30

0.025mg, 0.05mg, 0.75mg, 0.88mg, 0.1mg, 0.112mg, 0.125mg, 0.137mg, 0.15mg, 0.175mg, 0.2mg, 0.3mg, and injections

Front 31

The use of Synthroid, levothroid, Levoxyl, Unithroid, etc. uses?

Back 31

hypothyroidism (Elevated TSH: Thyroid stimulating hormone test)

Front 32

What is the Dosage equivalence of Synthroid, levothroid, Levoxyl, Unithroid, etc.?
What is the usual dose? Instructions

Back 32

0.05 to 0.1mg equals the potency of about 60mg (or 1 grain) of crude thyroid hormone.
Usually dosed: 1.6mcg/kg/day (KNOW)
-->Monitoring TSH and clinical features determine subsequent dosing.
--> It should be taken QD, in AM at the same time. (Preferably on an empty stomach)

Front 33

Interaction with Synthroid, levothroid, Levoxyl, Unithroid, etc.?

Back 33

Binding with AI (Maalox, etc.) and iron in vitamins and minerals, (Feosol, Theragan M and centrum)

Front 34

Cytomel (liothyronine, triodothyronine)
dose?

Back 34

5, 25, 50mcg tabs.
Rapid onset, quick-acting, produces CNS effects, is dosed more than once a day, is sometimes used in combination with levothyroxine.

Front 35

25mcg of cytomel = ? crude hormone = ? levothyroxine

Back 35

25mcg of cytomel = therapeutic effect of 1 grain(60mg) crude hormone = 50-100mcg levothyroxine

Front 36

Armour's Thyroid aka?
dose?
Special note?

Back 36

Crude thyroid hormone
15,30,60,90,120,180,240,300mg tabs. dosed QD
Crude thyroid hormone from bovine or porcine sources has T3 & T4. CONTAINS PORK MATERIAL

Front 37

What are the 2 anti-thyroid drugs? its use/MOA?

Back 37

Propulthiouracil (PTU) and Tapazole (methimazole).
They inhibit the synthesis of thyroid hormones and are effective in the treatment of hyperthyroidism (Thyrotoxicosis, or Grave's dz). PTU INHIBITS THE PERIPHERAL CONVERSION OF T4 TO T3

Front 38

What is the usual dose & instructions for PTU?

Back 38

50mg tablet.
Adults- initial 300-900mg PO QD. Maintenance - 100-500mg QD.

Take at regular intervals ATC (usually q8h) unless directed otherwise by physician.

Front 39

What is the usual dose & instructions for Tapazole (methimazole)?

Back 39

5 and 10mg tablets.
Adults- initial 15mg - 40mg QD. Maintenance 5-15mg QD.
Instruct pts to report any sx such as sore throat, skin eruptions, fever, HA, or general malaise. AGRANULOCYTOSIS is potentially the most serious SE of therapy.

Front 40

Both PTU and Tapazole can cause fetal harm (pregnancy category D), but if an antithyroid agent is needed, which one is preferred, why?

Back 40

PTU because it is less likely than methimazole to induce fetal/neonatal complications

Front 41

PTU may potentiate the effects of which drugs?
SE of PTU

Back 41

Oral anticoagulants because PTU has anti-vit K activity. Therefore, PTU may cause hypothrombinemia and bleeding.

Front 42

Name the hormone replacement Rxs

Back 42

Premarin, Prempro, & Premarin Vaginal cream

Front 43

What is Premarin?
Dose?
uses?

Back 43

Conjugated equine estrogens: derived from urine of pregnant mares.
Tabs: 0.3, 0.45, 0.625, 0.9, 1.25mg. Also injection.
Uses: menopausal sx (Atrophic vaginitis, etc), osteoporosis, and palliation only for advanced metastatic cancer in men & women.

Front 44

What is Prempro?
dose?

Back 44

Combination: Premarin/progestin
0.3/1.5, 0.45/1.5, 0.625/2.5, 0.625/5mg.

Front 45

BBW for Prempro
Negative formulary in FL!

Back 45

Endometrial carcinoma, not to be used during pregnancy.
Premarin tab cannot be substituted with generic conjugated estrogen tab. Delayed action (Each Premarin tab has a unique 24-hr dissolving pattern. It cannot be duplicated).

Front 46

Premarin Vaginal cream
2g applicator contains ? drug, or ? drug/g of cream

Back 46

2 g applicator contains 1.25mg drug, or 0.625mg drug/g of cream. (KNOW)

Front 47

What is Premarin Vaginal cream indication & dose?

Back 47

Premarin Vaginal cream indicated for dyspareunia (painful intercourse, a sx of vulvar and vaginal atrophy caused by menopause.
Dose: 0.5g PV twice weekly, or cyclic regimen of 21 days of therapy followed by 7 days off.

Front 48

What is estrogen vaginal tablets?

Back 48

1. Estrace cream( Estradiol)
2. Vagifem. It should be administered intravaginally using the supplied applicator: 10mcg tablet PV daily for 2 weeks, followed by 1 table twice weekly

Front 49

Transderm Scop (Scopolamine transdermal patch)
dose?
MOA:

Back 49

Scopolamine 1.5mg per patch (delivers 1mg over 3 days).
Scopolamine is an alkaloid, similar to atropine. It inhibits ACh in the vestibular apparatus and input to the CNS

Front 50

Transderm Scop uses
important precautions?

Back 50

systemic anticholinergic efffects + Prevention of N/V with motion sickness.
Precautions: To be used with caution in pts with pyloric obstruction, urinary bladder neck obstruction, glaucoma, and intestinal obstruction. Also elderly and pts w/ impaired kidney & liver fxn.

Front 51

Sometimes used in terminally ill pts to dry bronchial secretions. When used for this purpose, if the supply of this product is interrupted by the manufacturer, many hospice physicials will prescribe what instead? (off-label use)

Back 51

ATROPINE SULFATE 1% OPTHALMIC SOLUTION to be used SL.

Front 52

RX: Antivert (Meclizine)
OTC: Bonine or Dramamine less drowsy formula.
Doses
Uses
MOA

Back 52

tablets: 12.5, 25, 50mg. Varies from 12.5mg QD to 25mg TID
Motion sickness, N/V, vertigo.
Anticholinergic effects in brain

Front 53

DI with Antivert
caution is pt with which dz?

Back 53

Catapres, Elavil, Benadryl, Scopolamine patches, or any anticholinergics.
Watch pt with BPH, the anticholinergic effect may produce urinary obstruction since the alpha-1 receptors have more influence on the lower part of the bladder and prostate and sphincter when the muscarinic receptors are blocked by an anti-cholinergic drug. (?)

Front 54

What is Colace?
Dose?
Dosage instructions?

Back 54

Docusate sodium
50, 100mg(most common), capsules, generic also 250mg.
syrup: 60mg/15ml.
Give in milk, fruit juice or infant formula to mask tase.
Liquid (soln): 150mg/ 15ml, or 100mg/10ml)

Front 55

What is Surfak?
dose?

Back 55

Docusate calcium. (DSS, DOSS, DOS, etc.)
240mg capsules. Larger than colace, harder to swallow

Front 56

MOA, CI, Onset of action for Colace & surfak?

Back 56

MOA: facilitates admixture of fat and water to soften stool (surfactant action)
CI: Do not take with mineral oil
Onset: 12-72hrs

Front 57

What is most commly used for opioid-induced serious constipation?

Back 57

Senna + docusate (Senokot-S)

Front 58

Enulose (Lactulose) dose, indication

Back 58

solution: 10g/15ml. Contains sugars for taste!
Indicated to tx constipation and prevention & treatment of portal-systemic encephalopathy.
Poorly absorbed, metabolized by colonic bacteria in colon to mild acids(lactic, formic, acetic acid).
Adult dose: 2-3 tbsp (30-45ml, containing 20g to 30g of lactulose) TID or QID.
Hourly PO doses of 30-45ml may be used to induce the rapid laxation in the initial phase of the therapy of portal-systemic encephalopathy (can be used as rectal enema).
onset- 24-48hrs

Front 59

Miralax

Back 59

PEG 3350
Constipation or fecal impaction.
255 & 527 g (OTC: 119g) with 17g measuring cup
one dose packets: 17g
Max dose for chronic use: 34g
Binds water & causes water to be retained within the stool.
CI in pts with GI obstruction, perforation, pain.