Drug Cards 1

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alprazolam

Brand Names: Xanax, Xanax XR, Niravam

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ALPRAZOLAM
Brand Names: Xanax, Xanax XR, Niravam
Pharm. Class: Benzodiazepines
Ther. Class Antianxiety agents
Uses: General Anxiety Disorder (GAD), Panic Disorder, Management of Anxiety associated with depression
Unlabeled Uses: PMS, Insomnia, IBS, acute mania & psyhchosis
Forms: Tabs 0.25 mg, 0.5 mg, 1 mg, 2 mg; XR Tabs 0.5 mg, 1 mg, 2 mg, 3 mg; ODT 0.25 mg, 0.5 mg, 1 mg, 2 mg
Action: Acts at many levels in the CNS to produce anxiolytic effect.
Route/Dosage: PO / Anxiety: 0.25 - 0.5 mg 2-3 x per day; Panic Attacks 0.5 3x day
Side Effects: dizziness, drowsiness, lethargy, confusion, hangover, headache, mental depression, paradoxical excitation, blurred vision, constipation, diarrhea, nausea, vomiting, weight gain, rashes, physical dependence, psychological dependence, tolerance
Patient/Family Education: Instruct patient to take medication exactly as directed; do not skip or double up on missed doses. If a dose is missed, take within 1 hr; otherwise, skip the dose and return to regular schedule. If medication is less effective after a few weeks, check with health care professional; do not increase dose. Abrupt withdrawal may cause sweating, vomiting, muscle cramps, tremors, and seizures. May cause drowsiness or dizziness. Caution patient to avoid driving and other activities requiring alertness until response to the medication is known. Geri: Instruct patient and family how to reduce falls risk at home; Advise patient to avoid drinking grapefruit juice during therapy; Advise patient to avoid the use of alcohol or other CNS depressants concurrently with alprazolam. Instruct patient to consult health care professional before taking Rx, OTC, or herbal products concurrently with this medication; Inform patient that benzodiazepines are usually prescribed for short-term use and do not cure underlying problems; Teach other methods to decrease anxiety (exercise, support group, relaxation techniques); Advise patient to not share medication with anyone

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albuterol

Trade Names: Accuneb, Proair HFA, Proventil HFA, Ventolin HFA, VoSpire ER

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ALBUTEROL
Trade Names: Accuneb, Proair HFA, Proventil HFA, Ventolin HFA, VoSpire ER
Pharm. Class: adrenergics
Ther. Class: bronchodilators
Uses:Used as a bronchodilator to control and prevent reversible airway obstruction caused by asthma or COPD; Inhaln: Used as a quick-relief agent for acute bronchospasm and for prevention of exercise-induced bronchospasm; PO: Used as a long-term control agent in patients with chronic/persistent bronchospasm
Forms: Tabs, ER Tabs, Oral Syrup, Metered-dose aerosol, inhalation solution, powder for inhalation, also in combination with: ipratropium (Combivent, DuoNeb)
Action: Binds to beta2-adrenergic receptors in airway smooth muscle, leading to activation of adenyl cyclase and increased levels of cyclic-3', 5'-adenosine monophosphate (cAMP). Increases in cAMP activate kinases, which inhibit the phosphorylation of myosin and decrease intracellular calcium. Decreased intracellular calcium relaxes smooth muscle airways; Relaxation of airway smooth muscle with subsequent bronchodilation; Relatively selective for beta2 (pulmonary) receptors
Route/Dosage:PO (Adults): 2–4 mg 3–4 times daily....(see book for additional info)
Side Effects:CNS: nervousness, restlessness, tremor, headache, insomnia (Pedi: occurs more frequently in young children than adults), hyperactivity in children, PARADOXICAL BRONCHOSPASM (excessive use of inhalers), chest pain, palpitations, angina, arrhythmias, hypertension, nausea, vomiting, hyperglycemia, hypokalemia, tremor
Patient/Family Education: Instruct patient to take albuterol as directed. If on a scheduled dosing regimen, take missed dose as soon as remembered, spacing remaining doses at regular intervals. Do not double doses or increase the dose or frequency of doses. Caution patient not to exceed recommended dose; may cause adverse effects, paradoxical bronchospasm (more likely with first dose from new canister), or loss of effectiveness of medication; Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain; Instruct patient to prime unit with 4 sprays before using and to discard cannister after 200 sprays. Actuators should not be changed among products; Inform patient that these products contain hydrofluoralkane (HFA) and the propellant and are described as non-CFC or CFC-free (contain no chlorofluorocarbons); Advise patient to consult health care professional before taking any OTC medications, natural/herbal products, or alcohol concurrently with this therapy. Caution patient also to avoid smoking and other respiratory irritants; Inform patient that albuterol may cause an unusual or bad taste; Inhaln: Instruct patient in the proper use of the metered-dose inhaler or nebulizer (see Medication Administration Techniques); Advise patients to use albuterol first if using other inhalation medications and allow 5 min to elapse before administering other inhalant medications unless otherwise directed; Advise patient to rinse mouth with water after each inhalation dose to minimize dry mouth and clean the mouthpiece with water at least once a week; Instruct patient to notify health care professional if no response to the usual dose of albuterol or if contents of one canister are used in less than 2 wk
Contraindicated in: Hypersensitivity to adrenergic

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warfarin

Brand Names: Coumadin, Jantoven

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WARFARIN
Brand Names: Coumadin, Jantoven
Pharm. Class: coumarins
Ther. Class: anticoagulants
Uses: Antiphospholipid antibody syndrome, deep vein thrombosis, prevention or treatment of venous thrombosis, pulmonary embolism, thromboembolic complications associated with a-fib or cardiac valve replacement, after MI to reduce risk of death
Forms: Tabs 1,2,2.5,3, 4,5,6,7.5,10 mg, 5.4 mg powder
Action: Interferes with blood clotting by indirect means; depresses hepatic synthesis of vit K-dependent coagulation factors (II, VII, IX, X)
Route/Dosage: PO/IV adults 2.5 - 10 mg day then titrate to INR. Geri 2-10 pedi 0.2 mg/kg/day titrated to INR
Side Effects: Fever, dizziness, fatigue headache, lethargy, angina, chest pain, edema, hypotension, syncope, diarrhea, nausea, vomiting, anorexia, stomatitis, cramps, hepatitis, cholestatic jaundice, hematuria, hemorrage, agranulocytosis, leukopenia, esinophilia, ecchymosis, anemia, petechiae, rash, dermatitis, urticaria, alopecia, pruitis, epistaxis, hemoptysis, mouth ulcers, taste disturbances, priapism, dyspnea, bone fractures, anaphylaxis, coma, cholesterol, microembolisms, exfoliative dermatitis, purple toe syndrome.
Patient/Family Education: High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error; Instruct patient to take medication as directed. Take missed doses as soon as remembered that day; do not double doses. Inform health care professional of missed doses at time of checkup or lab tests. Inform patients that anticoagulant effect may persist for 2–5 days following discontinuation. Advise patient to read Medication Guide before starting therapy and with each Rx refill; Review foods high in vitamin K (see Food Sources for Specific Nutrients). Patient should have consistent limited intake of these foods, as vitamin K is the antidote for warfarin, and alternating intake of these foods will cause PT levels to fluctuate. Advise patient to avoid cranberry juice or products during therapy; Caution patient to avoid IM injections and activities leading to injury. Instruct patient to use a soft toothbrush, not to floss, and to shave with an electric razor during warfarin therapy. Advise patient that venipunctures and injection sites require application of pressure to prevent bleeding or hematoma formation; Advise patient to report any symptoms of unusual bleeding or bruising (bleeding gums; nosebleed; black, tarry stools; hematuria; excessive menstrual flow) and pain, color, or temperature change to any area of your body to health care professional immediately. Patients with a deficiency in protein C and/or S mediated anticoagulant response may be at greater risk for tissue necrosis; Instruct patient not to drink alcohol or take other Rx, OTC, or herbal products, especially those containing aspirin or NSAIDs, or to start or stop any new medications during warfarin therapy without advice of health care professional; Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding; Instruct patient to carry identification describing medication regimen at all times and to inform all health care personnel caring for patient on anticoagulant therapy before lab tests, treatment, or surgery; Emphasize the importance of frequent lab tests to monitor coagulation factors
Contraindicated in: Uncontrolled bleeding; Open wounds; Active ulcer disease; Recent brain, eye, or spinal cord injury or surgery; Severe liver or kidney disease; Uncontrolled hypertension; OB: Crosses placenta and may cause fatal hemorrhage in the fetus. May also cause congenital malformation

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digoxin

Trade Names: Lanoxicaps, Lanoxin

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DIGOXIN
Trade Names: Lanoxicaps, Lanoxin
Pharm. Class: digitalis glycosides
Ther. Class: antiarrhythmics, inotropics
Uses: Heart failure, Atrial fibrillation and atrial flutter (slows ventricular rate), Paroxysmal atrial tachycardia
Forms: Tabs, Caps, Elixir, Injection
Action: Increases the force of myocardial contraction, Prolongs refractory period of the AV node, Decreases conduction through the SA and AV nodes; Therapeutic Effect(s): Increased cardiac output (positive inotropic effect) and slowing of the heart rate (negative chronotropic effect)
Route/Dosage: PO (Geriatric Patients): Initial daily dosage should not exceed 0.125 mg, PO Maintenance dose adults 0.125–0.5 mg/day (see book)...For rapid effect, a larger initial loading/digitalizing dose should be given in several divided doses over 12–24 hr. Maintenance doses are determined for digoxin by renal function. All dosing must be evaluated by individual response. In general, doses required for atrial arrhythmias are higher than those for inotropic effect.
Side Effects: fatigue, headache, weakness, blurred vision, yellow or green vision, ARRHYTHMIAS, bradycardia, ECG changes, AV block, SA block, anorexia, nausea, vomiting, diarrhea, thrombocytopenia, electrolyte imbalances with acute digoxin toxicity.
Patient/Family Education: High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error. Instruct patient to take medication as directed, at the same time each day. Instruct patient to take medication as directed, at the same time each day. Teach parents or caregivers of infants and children how to accurately measure medication. Take missed doses within 12 hr of scheduled dose or omit. Do not double doses. Consult health care professional if doses for 2 or more days are missed. Do not discontinue medication without consulting health care professional; Teach patient to take pulse and to contact health care professional before taking medication if pulse rate is <60 or >100; Pedi: Teach parents or caregivers that changes in heart rate, especially bradycardia, are among the first signs of digoxin toxicity in infants and children. Instruct parents or caregivers in apical heart rate assessment and ask them to notify a health care professional if heart rate is outside of range set by health care professional before administering the next scheduled dose; Review signs and symptoms of digitalis toxicity with patient and family. Advise patient to notify health care professional immediately if these or symptoms of CHF occur. Inform patient that these symptoms may be mistaken for those of colds or flu; Instruct patient to keep digoxin tablets in their original container and not to mix in pill boxes with other medications; they may look similar to and may be mistaken for other medications; Advise patient that sharing of this medication can be dangerous; Caution patient to avoid concurrent use of other Rx, OTC, and herbal products without consulting health care professional. Advise patient to avoid taking antacids or antidiarrheals within 2 hr of digoxin; Advise patient to notify health care professional of this medication regimen before treatment; Patients taking digoxin should carry identification describing disease process and medication regimen at all times; Geri: Review fall prevention strategies with older adults and their families; Emphasize the importance of routine follow-up exams to determine effectiveness and to monitor for toxicity
Contraindicated in: Hypersensitivity; Uncontrolled ventricular arrhythmias; AV block (in absence of pacemaker); Idiopathic hypertrophic subaortic stenosis; Constrictive pericarditis; Known alcohol intolerance (elixir only)

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phenytoin

Trade Names: Dilantin, Phenytek

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PHENYTOIN
Trade Names: Dilantin, Phenytek Pharm. Class: Hydantoin
Ther. Class: antiarrhythmics (group IB), anticonvulsants
Uses: Generalizi\ed tonic-clonic seizures, status epilepticus, nonepilieptic seizures associated with Reye's syndrome or after head trauma, bells palsy, complex/partial seizures
Forms: Susp 25mg/5ml; chew tabs 50 mg; inj 50 mg/ml; ER caps 100, 200, 300 mg; prompt rel caps 100 mg
Action: Inhibits spread of seizure activity in motor cortex by altering ion transport; increases AV conduction to decrease dysrhythmias.
Route/Dosage: IM administration is not recommended due to erratic absorption and pain on injection. Anticonvulsant - PO (Adults): Loading dose of 15–20 mg/kg as extended capsules in 3 divided doses given every 2–4 hr; maintenance dose 5–6 mg/kg/day given in 1–3 divided doses; usual dosing range = 200–1200 mg/day; IV (Adults): Status epilepticus loading dose—15–20 mg/kg. Rate not to exceed 25–50 mg/min. Maintenance dose—same as PO dosing above. Maintenance dose—same as PO dosing above. Antiarrhythmic: IV (Adults): 50–100 mg q 10–15 min until arrhythmia is abolished, or a total of 15 mg/kg has been given, or toxicity occurs. PO (Adults): Loading dose: 250 mg QID for 1 day, then 250 mg BID for 2 days, then maintenance at 300–400 mg/day in divided doses 1–4 times/day. IV (Children): 1.25 mg/kg q 5 min, may repeat up to total loading dose of 15 mg/kg. Maintenance dose—5–10 mg/kg/day in 2–3 divided doses IV or PO.
Side Effects: SUICIDAL THOUGHTS, ataxia, agitation, confusion, dizziness, drowsiness, dysarthria, dyskinesia, extrapyramidal syndrome, headache, insomnia, weakness, diplopia, nystagmus, hypotension (↑ with IV phenytoin), tachycardia, gingival hyperplasia, nausea, constipation, drug-induced hepatitis, vomiting, hypertrichosis, rash, exfoliative dermatitis, pruritus, purple glove syndrome, AGRANULOCYTOSIS, APLASTIC ANEMIA, leukopenia, megaloblastic anemia, thrombocytopenia, osteomalacia, osteoporosis, ALLERGIC REACTIONS INCLUDING STEVENS-JOHNSON SYNDROME, fever, lymphadenopathy
Patient/Family Education: Instruct patient to take medication as directed, at the same time each day. If a dose is missed from a once-a-day schedule, take as soon as possible and return to regular dosing schedule. If taking several doses a day, take missed dose as soon as possible within 4 hr of next scheduled dose; do not double doses. Consult health care professional if doses are missed for 2 consecutive days. Abrupt withdrawal may lead to status epilepticus; May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known. Do not resume driving until physician gives clearance based on control of seizure disorder; Caution patient to avoid taking alcohol, OTC medications, or herbal medications concurrently with phenytoin without consulting health care professional; Instruct patient on importance of maintaining good dental hygiene and seeing dentist frequently for teeth cleaning to prevent tenderness, bleeding, and gingival hyperplasia. Institution of oral hygiene program within 10 days of initiation of phenytoin therapy may minimize growth rate and severity of gingival enlargement. Patients under 23 yr of age and those taking doses >500 mg/day are at increased risk for gingival hyperplasia; Advise patient that brands of phenytoin may not be equivalent. Check with health care professional if brand or dose form is changed; Advise diabetic patients to monitor blood glucose carefully and to notify health care professional of significant changes; Instruct patient to notify health care professional of medication regimen prior to treatment or surgery; Advise patient not to take phenytoin within 2–3 hr of antacids; Advise female patients to use an additional nonhormonal method of contraception during therapy. Instruct patient to notify health care professional if pregnancy is planned or suspected; Advise patient to carry identification describing disease process and medication regimen at all times; Instruct patients that behavioral changes, skin rash, fever, sore throat, mouth ulcers, easy bruising, petechiae, unusual bleeding, abdominal pain, chills, pale stools, dark urine, jaundice, severe nausea or vomiting, drowsiness, slurred speech, unsteady gait. swollen glands,or persistent headache should be reported to health care professional immediately. Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme increase in activity and talking, other unusual changes in behavior or mood occur; Emphasize the importance of routine exams to monitor progress. Patient should have routine physical exams, especially monitoring skin and lymph nodes, and EEG testing

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NPH insulin (isophane insulin suspension)

Trade Names: Humulin N, Novolin N

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NPH INSULIN (isophane insulin suspension)
Trade Names: Humulin N, Novolin N
Pharm. Class: pancreatics
Ther. Class: antidiabetic hormones
Uses: Control of hyperglycemia in patients with diabetes mellitus
Forms: Isophane insulin suspension: 100 units/mL in 10 mL vials, 3 mL prefilled pens; NPH insulin/regular in suspension: 70 units NPH/30 units regular insulin/mL (100 units/mL total) (Humulin 70/30, Novolin 70/30) in 10 mL vials, 3 mL prefilled pens
Action: Lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat; inhibiting hepatic glucose production; Other actions of insulin - inhibition of lipolysis and proteolysis, enhanced protein synthesis
Route/Dosage: SC (Adults and Children): 0.5–1 unit total insulin/kg/day. Adolescents during rapid growth—0.8–1.2 units total insulin/kg/day.
Side Effects: HYPOGLYCEMIA, lipodystrophy, pruritus, erythema, swelling, ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS .
Patient/Family Education: High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error. Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, cartridge pens, alcohol swabs), storage, and place to discard syringes. Discuss the importance of not changing brands of insulin or syringes, selection and rotation of injection sites, and compliance with therapeutic regimen. Caution patient that insulin pens should not be shared with others, even if clean needles are used; Demonstrate technique for mixing insulins by drawing up regular insulin or insulin lispro first and rolling intermediate-acting insulin vial between palms to mix, rather than shaking (may cause inaccurate dose); Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term; Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified of significant changes; Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care professional; Advise patient to consult health care professional prior to using alcohol or other Rx, OTC, or herbal products concurrently with insulin; Advise patient to notify health care professional of medication regimen prior to treatment or surgery; Advise patient to notify health care professional if nausea, vomiting, or fever develops, if unable to eat regular diet, or if blood glucose levels are not controlled; Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur; Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding or planning to breastfeed; Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel) and identification describing their disease and treatment regimen at all times; Emphasize the importance of regular follow-up, especially during first few weeks of therapy

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insulin detemir

Trade Names: Levamir

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INSULIN DETEMIR
Trade Names: Levamir
Pharm. Class: pancreatics
Ther. Class: antidiabetic hormone
Uses: Control of hyperglycemia in patients with type 1 (IDDM) and type 2 (NIDDM) diabetes mellitus
Forms: Solution for injection: 100 units/mL in 10 vials and 3 mL cartidges
Action: Lower blood glucose by stimulating glucose uptake in skeletal muscle and fat and inhibiting hepatic glucose production; Other actions of insulin - inhibition of lipolysis and proteolysis, enhanced protein synthesis
Route/Dosage: SC (Adults and Children > 6 yr): Insulin naive patients–0.1–0.2 units/kg once daily in the evening or 10 units once or twice daily. Patients receiving basal insulin or basal bolus—may substitute on an equivalent unit-per-unit basis.
Side Effects: HYPOGLYCEMIA, lipodystrophy, pruritis, erythema, swelling, ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS .
Patient/Family Education: High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error.Patient/Family Education: High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error. Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, cartridge pens, alcohol swabs), storage, and place to discard syringes. Discuss the importance of not changing brands of insulin or syringes, selection and rotation of injection sites, and compliance with therapeutic regimen. Caution patient that insulin pens should not be shared with others, even if clean needles are used; Demonstrate technique for mixing insulins by drawing up regular insulin or insulin lispro first and rolling intermediate-acting insulin vial between palms to mix, rather than shaking (may cause inaccurate dose); Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term; Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified of significant changes; Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care professional; Advise patient to consult health care professional prior to using alcohol or other Rx, OTC, or herbal products concurrently with insulin; Advise patient to notify health care professional of medication regimen prior to treatment or surgery; Advise patient to notify health care professional if nausea, vomiting, or fever develops, if unable to eat regular diet, or if blood glucose levels are not controlled; Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur; Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding or planning to breastfeed; Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel) and identification describing their disease and treatment regimen at all times; Emphasize the importance of regular follow-up, especially during first few weeks of therapy

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lente insulin (insulin zinc suspension)

Trade Names: Humulin L, Lente Iletin II

**Off Market Drug**
This medication is no longer available in the United States.

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LENTE INSULIN (insulin zinc suspension)
Trade Names: Humulin L, Lente Iletin IIPharm.
**Off Market Drug**
Class: pancreatics
Ther. Class: antidiabetic hormone
Uses: Control of hyperglycemia in patients withdiabetes mellitus
Route/Dosage: SC (Adults and Children): 0.5–1 unit/kg/day.
Forms: Insulin zinc suspension (lente): 100 units/ml
Action: Lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat, inhibiting hepatic glucose production; Other actions of insulin - inhibition of lipolysis and proteolysis, enhanced protein synthesis
Side Effects: HYPOGLYCEMIA, lipodystrophy, pruritis, erythema, swelling, ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS
Patient/Family Education: High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error; Patient/Family Education: High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error. Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, cartridge pens, alcohol swabs), storage, and place to discard syringes. Discuss the importance of not changing brands of insulin or syringes, selection and rotation of injection sites, and compliance with therapeutic regimen. Caution patient that insulin pens should not be shared with others, even if clean needles are used; Demonstrate technique for mixing insulins by drawing up regular insulin or insulin lispro first and rolling intermediate-acting insulin vial between palms to mix, rather than shaking (may cause inaccurate dose); Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term; Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified of significant changes; Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care professional; Advise patient to consult health care professional prior to using alcohol or other Rx, OTC, or herbal products concurrently with insulin; Advise patient to notify health care professional of medication regimen prior to treatment or surgery; Advise patient to notify health care professional if nausea, vomiting, or fever develops, if unable to eat regular diet, or if blood glucose levels are not controlled; Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur; Advise patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding or planning to breastfeed; Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel) and identification describing their disease and treatment regimen at all times; Emphasize the importance of regular follow-up, especially during first few weeks of therapy

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metoprolol

Trade Names: Lopressor, Toprol-XL

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METOPROLOL
Trade Names: Lopressor, Toprol-XL
Pharm. Class: beta blockers
Ther. Class: antianginals, antihypertensives
Uses: Hypertension, Angina pectoris, Prevention of MI and decreased mortality in patients with recent MI, Management of stable, symptomatic (class II or III) heart failure due to ischemic, hypertensive or cardiomyopathc origin (may be used with ACE inhibitors, diuretics and/or digoxin; Toprol XL only)
Forms: Tablets (tartrate): 25 mg, 50 mg, 100 mg; Extended-release tablets (succinate; Toprol XL): 25 mg, 50 mg, 100 mg, 200 mg; Injection: 1 mg/mL
Action: Blocks stimulation of beta1(myocardial)-adrenergic receptors. Does not usually affect beta2(pulmonary, vascular, uterine)-adrenergic receptor sites
Route/Dosage: PO (Adults): Antihypertensive/antianginal—25–100 mg/day as a single dose initially or 2 divided doses; may be ↑ q 7 days as needed up to 450 mg/day (for angina, give in divided doses). Extended-release products are given once daily. MI—25–50 mg (starting 15 min after last IV dose) q 6 hr for 48 hr, then 100 mg twice daily for a minimum of 3 mo. Heart failure—12.5–25 mg once daily, can be doubled every 2 wk up to 200 mg/day. Migraine prevention—50–100 mg 2–4 times daily (unlabeled); IV (Adults): MI—5 mg q 2 min for 3 doses, followed by oral dosing.
Side Effects: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares, blurred vision, stuffy nose, bronchospasm, wheezing, BRADYCARDIA, CHF, PULMONARY EDEMA, hypotension, peripheral vasoconstriction, constipation, diarrhea, drug-induced hepatitis, dry mouth, flatulence, gastric pain, heartburn, ↑ liver enzymes, nausea, vomiting, erectile dysfunction, libido, urinary frequency, rashes, hyperglycemia, hypoglycemia, arthralgia, back pain, joint pain, drug-induced lupus syndrome.
Patient/Family Education: High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error. Instruct patient to take medication as directed, at the same time each day, even if feeling well; do not skip or double up on missed doses. Take missed doses as soon as possible up to 8 hr before next dose. Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia; Teach patient and family how to check pulse daily and blood pressure biweekly and to report significant changes to health care professional; May cause drowsiness. Caution patient to avoid driving or other activities that require alertness until response to the drug is known; Advise patient to change positions slowly to minimize orthostatic hypotension; Caution patient that this medication may increase sensitivity to cold; Instruct patient to consult health care professional before taking other Rx, OTC, or herbal products, especially cold preparations, concurrently with this medication. Patients on antihypertensive therapy should also avoid excessive amounts of caffeinated coffee, tea, and cola; Diabetics should closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs. Medication does not block sweating as a sign of hypoglycemia; Advise patient to notify health care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, light-headedness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs; Instruct patient to inform health care professional of medication regimen before treatment or surgery; Advise patient to carry identification describing disease process and medication regimen at all times; Hypertension: Reinforce the need to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, and smoking cessation). Medication controls but does not cure hypertension

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Metformin

Trade Names: Fortamet, Glumetza, Glucophage, Glucophage XR, Riomet

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METFORMIN
Trade Names: Fortamet, Glumetza, Glucophage, Glucophage XR, Riomet
Pharm. Class: biguanides
Ther. Class: antidiabetics
Uses: Management of type 2 diabetes mellitus; may be used with diet, insulin, or sulfonylurea oral hypoglycemics
Forms:Tablets: 500 mg, 850 mg, 1000 mg; Extended-release tablets (Fortamet, Glucophage XR, Glumetza): 500 mg, 750 mg, 1000 mg, Oral solution (cherry flavor): 100 mg/mL, In combination with: glyburide (Glucovance) glipizide (Metaglip), pioglitazone (Actoplus Met, Actoplus Met XR), repaglinide (PrandiMet), rosiglitazone (Avandamet) and sitagliptin (Janumet).
Action: Decreases hepatic glucose production, Decreases intestinal glucose absorption, Increases sensitivity to insulin
Route/Dosage: PO (Adults and children >17 yr): 500 mg twice daily; may ↑ by 500 mg at weekly intervals up to 2000 mg/day. If doses >2000 mg/day are required, give in 3 divided doses (not to exceed 2500 mg/day) or 850 mg once daily; may ↑ by 850 mg at 2-wk intervals (in divided doses) up to 2550 mg/day in divided doses (up to 850 mg 3 times daily); Extended-release tablets—500–1000 mg once daily with evening meal, may ↑ by 500 mg at weekly intervals up to 2500 mg once daily. If 2000 mg once daily is inadequate, 1000 mg twice daily may be used; PO (Children >10 yr): 500 mg twice daily, may be ↑ by 500 mg/day at 1-wk intervals, up to 2000 mg/day in 2 divided doses.
Side Effects: abdominal bloating, diarrhea, nausea, vomiting, unpleasant metallic taste, hypoglycemia, LACTIC ACIDOSIS, decreased vitamin B12 levels.
Patient/Family Education: Explain to patient the risk of lactic acidosis and the potential need for discontinuation of metformin therapy if a severe infection, dehydration, or severe or continuing diarrhea occurs or if medical tests or surgery is required. Symptoms of lactic acidosis (chills, diarrhea, dizziness, low blood pressure, muscle pain, sleepiness, slow heartbeat or pulse, dyspnea, or weakness) should be reported to health care professional immediately (see book)

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clopidogrel

Trade Name: Plavix

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CLOPIDOGREL
Trade Name: Plavix
Pharm. Class: platelet aggregation inhibitors
Ther. Class: antiplatelet agents
Uses: Reduction of atherosclerotic events (MI, stroke, vascular death) in patients at risk for such events including recent MI, acute coronary syndrome (unstable angina/non–Q-wave MI), stroke, or peripheral vascular disease
Forms: Tablets: 75 mg, 300 mg
Action:Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors. Therapeutic Effect(s): Decreased occurrence of atherosclerotic events in patients at risk
Route/Dosage:Recent MI, Stroke, or Peripheral Vascular Disease - PO (Adults): 75 mg once daily; Acute Coronary Syndrome - PO (Adults): 300 mg initially, then 75 mg once daily; aspirin 75–325 mg once daily should be given concurrently
Side Effects:Incidence of adverse reactions similar to that of aspirin. Depression, dizziness, fatigue, headache, epistaxis, cough, dyspnea, chest pain, edema, hypertension, GI BLEEDING, abdominal pain, diarrhea, dyspepsia, gastritis, pruritus, purpura, rash, BLEEDING, NEUTROPENIA, THROMBOTIC, THROMBOCYTOPENIC PURPURA, hypercholesterolemia, arthralgia, back pain, fever, hypersensitivity reactions
Patient/Family Education: Instruct patient to take medication exactly as directed. Take missed doses as soon as possible unless almost time for next dose; do not double doses; Advise patient to notify health care professional promptly if fever, chills, sore throat, or unusual bleeding or bruising occurs; Advise patient to notify health care professional of medication regimen prior to treatment or surgery; Advise patient to consult health care professional before taking any Rx, OTC, or herbal products, especially those containing aspirin or NSAIDs or proton pump inhibitors

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levothyroxine

Trade Name: SynthroidLevo-T, Levothroid, Levoxyl, Synthroid, T4, Unithroid

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LEVOTHYROXINE
Trade Name: SynthroidLevo-T, Levothroid, Levoxyl, Synthroid, T4, Unithroid
Pharm. Class: thyroid preparations
Ther. Class: hormones
Uses:Thyroid supplementation in hypothyroidism, Treatment or suppression of euthyroid goiters, Adjunctive treatment for thyrotropin-dependent thyroid cancer
Forms: Tablets: 25 mcg, 50 mcg , 75 mcg, 88 mcg, 100 mcg, 112 mcg, 125 mcg, 137 mcg, 150 mcg, 175 mcg , 200 mcg, 300 mcg; Powder for injection: 200 mcg/vial, 500 mcg/vial
Action: Replacement of or supplementation to endogenous thyroid hormones; Principal effect is increasing metabolic rate of body tissues, Promote gluconeogenesis, Increase utilization and mobilization of glycogen stores, Stimulate protein synthesis, Promote cell growth and differentiation, Aid in the development of the brain and CNS
Route/Dosage: PO (Adults): Hypothyroidism—50 mcg as a single dose initially; may be increased q 2–3 wk by 25 mcg/day; usual maintenance dose is 75–125 mcg/day (1.5 mcg/kg/day); PO (Geriatric Patients and Patients with Increased Sensitivity to Thyroid Hormones): 12.5–25 mcg as a single dose initially; may be ↑ q 6–8 wk; usual maintenance dose is 75 mcg/day.IM, IV (Adults): Hypothyroidism—50–100 mcg/day as a single dose. Myxedema coma/stupor—200–500 mcg IV; additional 100–300 mcg may be given on 2nd day, followed by daily administration of smaller doses; IM, IV (Children): Hypothyroidism—~50–80% of the oral dose.
Side Effects: Usually only seen when excessive doses cause iatrogenic hyperthyroidism; headache, insomnia, irritability, angina pectoris, arrhythmias, tachycardia, abdominal cramps, diarrhea, vomiting, sweating, hyperthyroidism, menstrual irregularities, heat intolerance, weight loss, accelerated bone maturation in children.
Patient/Family Education: Instruct patient to take medication as directed at the same time each day. Take missed doses as soon as remembered unless almost time for next dose. If more than 2–3 doses are missed, notify health care professional. Do not discontinue without consulting health care professional; Explain to patient that medication does not cure hypothyroidism; it provides a thyroid hormone supplement. Therapy is lifelong; Advise patient to notify health care professional if headache, nervousness, diarrhea, excessive sweating, heat intolerance, chest pain, increased pulse rate, palpitations, weight loss >2 lb/wk, or any unusual symptoms occur; Caution patient to avoid taking other medications concurrently with thyroid preparations unless instructed by health care professional; Instruct patient to inform health care professionals of thyroid therapy; Emphasize importance of follow-up exams to monitor effectiveness of therapy. Thyroid function tests are performed at least yearly

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cimetidine

Trade names: Tagamet, Tagamet HB

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CIMETIDINE
Trade names: Tagamet, Tagamet HB
Pharm. Class: histamine h2 antagonists
Ther. Class: antiulcer agents
Uses: Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion
Forms: Tablets: 100 mg OTC, 200 mg OTC, 300 mg, 400 mg, 600 mg[canada], 800 mg; Oral liquid (mint-peach): 300 mg/5 mL, 200 mg/5 mLOTC; Solution for injection: 300 mg/2–ml vials, 300 mg/50 mL 0.9% NaCl
Action: Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion
Route/Dosage: PO (Adults): Short-term treatment of active ulcers—300 mg 4 times daily or 800 mg at bedtime or 400–600 mg twice daily (not to exceed 2.4 g/day). Duodenal ulcer prophylaxis—300 mg twice daily or 400 mg at bedtime. IM, IV (Adults): Short-term treatment of active ulcers—300 mg q 6 hr (not to exceed 2.4 g/day). Continuous IV infusion—900 mg infused over 24 hr (37.5 mg/hr); may be preceded by a 150-mg bolus dose. Gastric hypersecretory conditions—300–600 mg q 6 hr (up to 12 g/day have been used). Prevention of aspiration pneumonitis—300 mg IM 1 hr before anesthesia, then 300 mg IV q 4 hr until patient is conscious (unlabeled). Prevention of upper GI bleeding in critically ill patients—50 mg/hr (25 mg/hr if CCr <30 mL/min). GERD—800–1600 mg/day in divided doses. Gastric hypersecretory conditions—300–600 mg q 6 hr (up to 12 g/day have been used). OTC use—up to 200 mg may be taken twice daily (for no more than 2 wk).
Side Effects: confusion, dizziness, drowsiness, hallucinations, headache, ARRHYTHMIAS, constipation, diarrhea, drug-induced hepatitis, nausea, decreased sperm count, erectile dysfunction, gynecomastia, AGRANULOCYTOSIS, APLASTIC ANEMIA, anemia, neutropenia, thrombocytopenia, pain at IM site, hypersensitivity reactions.
Patient/Family Education: Advise patient to report onset of black, tarry stools; fever; sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health care professional promptly (see book)

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SIMVASTATIN

Trade Names: Zocor

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SIMVASTATIN
Trade Names: Zocor
Pharm. Class: hmg coa reductase inhibitors, statin
Ther. Class: lipid lowering agents
Uses:Adjunctive management of primary hypercholesterolemia and mixed dyslipidemias; Secondary prevention of myocardial infarction, coronary revascularization, stroke, and cardiovascular mortality in patients with clinically evident coronary heart disease
Forms: Tablets: 5 mg, 10 mg, 20 mg, 40 mg, 80 mg;
Action: Inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, an enzyme which is responsible for catalyzing an early step in the synthesis of cholesterol
Route/Dosage: PO (Adults): 5–80 mg once daily in the evening. Geriatric patients, patients with LDL <190 mg/dL, or patients receiving cyclosporine—5 mg/day initially. Increase at 4-wk intervals (not to exceed 10 mg/day in patients receiving cyclosporine or 20 mg/day in patients receiving amiodarone or verapamil) up to 40 mg/day; PO (Children and adolescents 10–17 yr): 10 mg/day initially, may be increased at 4 wk intervals up to 40 mg/day (not to exceed 10 mg/day in patients receiving cyclosporine or 20 mg/day in patients receiving amiodarone or verapamil).
Renal Impairment; PO (Adults): Severe renal impairment—5 mg/day initially, titrate carefully.
Side Effects:dizziness, headache, insomnia, weakness, abdominal cramps, constipation, diarrhea, flatus, heartburn, altered taste, drug-induced hepatitis, dyspepsia, elevated liver enzymes, nausea, pancreatitis, erectile dysfunction, rashes, pruritus, RHABDOMYOLYSIS, arthralgia, myalgia, myositis, hypersensitivity reactions.
Patient/Family Education:Instruct patient to take medication as directed, not to skip doses or double up on missed doses. Advise patient to avoid drinking more than 1 qt of grapefruit juice/day during therapy. Medication helps control but does not cure elevated serum cholesterol levels; Advise patient that this medication should be used in conjunction with diet restrictions (fat, cholesterol, carbohydrates, alcohol), exercise, and cessation of smoking; Instruct patient to notify health care professional if unexplained muscle pain, tenderness, or weakness occurs, especially if accompanied by fever or malaise; Advise patient to wear sunscreen and protective clothing to prevent photosensitivity reactions (rare); Instruct female patients to notify health care professional promptly if pregnancy is planned or suspected; Advise patient to notify health care professional of medication regimen before treatment or surgery; Emphasize the importance of follow-up exams to determine effectiveness and to monitor for side effects