6306 Drugs ALL SOLUTION 100% CORRECT SPRING FALL-2023/24 GUARANTEED GRADE A+

Benzoyl peroxide [top.] (Clearasil) MOA: - antibacterial action against Propionibacterium acnes - keratolytic effect, which produces comedo lysis, as well as drying and desquamative actions - improves both inflammatory and noninflammatory lesions of acne - slowly releases active oxygen which is lethal to P. acne anaerobe - Indication: Acne - SEs: Skin irritation, dryness - Pt Ed: Use sunblock. Bismuth subsalicylate (Pepto-Bismol, Kaopectate) MOA: - exert its antidiarrheal action not only by stimulating absorption of fluid and electrolytes across the intestinal wall (antisecretory action) but also, when hydrolyzed to salicylic acid, by inhibiting synthesis of a prostaglandin responsible for intestinal inflammation and hypermotility. - binds toxins produced by Escherichia coli . Both bismuth subsalicylate and the intestinal reaction products, bismuth oxychloride and bismuth hydroxide, are believed to have bactericidal action. - Indication: Diarrhea - SEs: Constipation, blackened tongue/stool, bleeding **Not use in pt's with ASA allergy or in children recovering from viral infection (risk of Reye's syndrome) Calcium carbonate (Tums) - Indication: Heartburn, dyspepsia - SEs: Constipation Dextromethorphan (Delsym) - MOA: act on the cough center in the medulla oblongata by elevating the threshold for coughing - Indication: Cough - SEs: Confusion, excitement, irritability, nervousness, serotonin syndrome - Pt Ed: Do not use within 2 wks of MAOI. Epinephrine (Epipen) MOA: sympathomimetic catecholamine that acts on both alpha- and beta-adrenergic receptors. It is the most potent alpha receptor activator. - causes vasoconstriction (on alpha-adrenergic receptors) and increased vascular permeability -- loss of intravascular fluid volume and hypotension during anaphylactic reactions. - induces relaxation of the bronchial smooth muscle by acting on beta-adrenergic receptors to alleviate wheezing and dyspnea - Indication: Anaphylactic reactions - SEs: Palpitation, tremor, cardiac dysrhythmia - Monitoring: HR, BP - Pt Ed: If used, seek medical assitance immediately Guaifenesin (Robitussin, Mucinex) - MOA: act as an expectorant by increasing the volume and reducing the viscosity of secretions in the trachea and bronchi. - Indication: Cough - Pt Ed: Drink adequate water while on this medication. Loperamide (Imodium A-D) - MOA: - Indication: Diarrhea - SEs: constipation, abdominal cramping, nausea - Pt Ed: Do not use if diarrhea contains blood or is black and tarry. OTC use carries a MDD of 8mg/day. Consult prescriber if diarrhea persists 2 days. Meclizine HCl (Antivert, Bonine) MOA: - an antihistamine, suppresses the vasodepressor response to histamine while only slightly inhibiting acetylcholine - inhibition of the emetic center in the brain stem, with little or no effect on the chemoreceptor trigger zone - Indication: Motion sickness, nausea, vomiting - SEs: drowsiness, HA, anticholinergic SEs - Pt Ed: Avoid activities requiring mental alertness until drug effects are realized. To prevent motion sickness, take 1 h before travel. Avoid alcohol and other CNS depressants. Methylcellulose (Citrucel) - MOA: - Indication: Constipation - SEs: abdominal cramps, flatulence, constipation, diarrhea, GI obstruction - Pt Ed: Take with a full glass of water Oxymetazoline (Afrin) - MOA: direct-acting sympathomimetic amine. It acts on alpha-adrenergic receptors in the arterioles of the nasal mucosa to produce constriction, resulting in decreased blood flow and decreased nasal congestion, for up to 12 hours - Indication: Nasal congestion - SEs: burning, stinging in nose, sneezing, nasal discharge - Pt Ed: Do not use more than 3 days d/t risk of rebound congestion. Phenylephrine (Sudafed PE) - MOA: synthetic sympathomimetic agent, is a powerful postsynaptic alpha-receptor agonist with minimal effect on the beta-receptors of the heart. It exhibits a rapid and moderately extended vasoconstrictor and mydriatic action. Its action in the heart includes elevation of the heart rate and reduction of cardiac output - Indication: Hypotension, nasal decongestant - SEs: restlessness, dizziness, headache, N/V, cardiac arrhythmia, hypertension, hypertensive crisis, ischemia, low cardiac output, peripheral vasocontriction, reflex bradycardia, pulmonary edema - Monitoring: BP, HR - Pt Ed: No MAOI within the past 2 weeks. Avoid activities requiring mental alertness or coordination until drug effects are realized. - CI: severe hypertension, ventricular tachycardia Phosphoric acid/dextrose/fructose (Emetrol) - MOA: - Indication: Nausea - SEs: abdominal cramping, diarrhea ***Should not be used in pts with fructose intolerance or diabetes. Polycarbophil (FiberCon) - MOA: - Indication: constipation or diarrhea - SEs: abdominal cramps, flatulence, constipation, diarrhea, GI obstruction - Pt Ed: Take with a full glass of water Polyethylene Glycol (Miralax) - MOA: - Indication: constipation - SEs: diarrhea, flatulence, nausea, abdominal bloating and cramping - Pt Ed: BM may not occur for 2-4 days. Do not take for more than 2 weeks unless instructed by MD. - CI: bowel obstruction Pseudoephedrine (Sudafed) - MOA: acts as a decongestant by stimulating alpha-adrenergic receptors of vascular smooth muscle, thus constricting dilated arterioles within the nasal mucosa and reducing blood flow to the engorged area - Indication: nasal congestion - SEs: elevated BP, tachycardia, arrhythmias, restlessness, insomnia, anxiety - Pt Ed: D/C if nervousness, dizziness or sleepiness occur. No MAOI w/i 2 wks. ***Pharmacist dispensed - behind the counter. Purchase limited to 9g in 30 days (3.6g/day). Log book must be kept by pharmacy x 2yrs tracking name, address, quantity, date/time of sale. Caution in pts with HTN, DM, CHD, BPH, glaucoma, CAD Psyllium (Metamucil) - MOA: - Indication: Constipation or Diarrhea - SEs: abdominal cramps, flatulence, constipation, diarrhea, GI obstruction - Pt Ed: Take with a full glass of water Salicylic Acid [top.] (Stridex, Clearasil) - MOA: - Indication: Acne - SEs: skin irritation, dryness - Pt Ed: Use sunblock N,N-Diethyl-3-methylbenzamide [top.] (DEET) - MOA: - Indication: Insect repellant - SEs: local irritation, erythema, itching, and rash. Acetaminophen (Tylenol) MOA: - centrally acting analgesic effect = due to an inhibition of central prostaglandin synthesis (specifically cyclooxygenase (COX)-2) and an elevation of the pain threshold - reduces fever by inhibiting the formulation and release of prostaglandins in the CNS and by inhibition endogenous pyrogens at the hypothalamic thermoregulator center - Indication: Pain, fever - Renal adjusted* - SEs: nausea, vomiting, headache, SJS, TEN, hepatic injury Bacitracin/bacitracin zinc [top.] - MOA: antibiotic derived from cultures of Bacillus subtilis, exhibits antibacterial activity against a variety of gram-positive and few gram-negative organisms, however its clinical usefulness is restricted to staphylococcal infections - Indication: First aid for cuts/scrape - Pt Ed: Use 1 wk not recommended without MD Bacitracin/neomycin/polymyxin B [top.] (Neosporin) MOA: - Neomycin sulfate = an aminoglycoside antibiotic that exerts its bactericidal effect by inhibiting protein synthesis in susceptible bacterial cells. It is effective against gram-negative bacilli and some strains of gram-positive microorganisms, but ineffective against anaerobic bowel flora - Polymyxin B = basic polypeptide antibiotic that has bactericidal activity against nearly all strains of gram-negative bacilli, except those of the Proteus group. It exerts its effect by increasing bacterial cell membrane permeability leading to death of the cell. It is not effective against gram-positive bacteria, fungi, or gram-negative cocci - Indication: First aid for cuts/scrape - Pt Ed: Use 1 wk not recommended without MD Benzocaine (Anbesol) - MOA: local anesthetic that decreases sodium ion permeability through reversible stabilization of the neuronal membrane. This action inhibits depolarization of the neuronal membrane which blocks the initiation and conduction of nerve impulses - Indication: Local anesthetic - SEs: Local burning, stinging Calamine lotion [top.] (Caladryl ) - MOA: - Indication: Skin irritation, insect bites Calcium carbonate/magnesium hydroxide (Rolaids) - MOA: - Indication: Heartburn, dyspepsia Cetirizine (Zyrtec) - MOA: antihistamine that selectively inhibits the effect of peripheral H(1)-receptor - Indication: Allergic rhinitis - SEs: drowsiness, HA Diphenhydramine (Benadryl) - MOA: antihistamine by competing with histamine for receptor sites on effector cells - Indication: Allergy, sleep aid - SEs: dizziness, sedation, anaphylaxis, anticholinergic SEs - Pt Ed: Avoid activites requiring mental alertness or coordination until drug effects are realized. Do not combine with alcohol. ***Young children may experience a pradoxical excitation effect. Docosanol (Abreva) - MOA: reduces viral replication and activity by effectively inhibiting the fusion between the plasma membrane and the herpes simplex virus envelope - Indication: Cold sore/fever blister - Pt Ed: Apply at first sign of cold sore for max of 10 days. Doxylamine (Unisom) - MOA: antagonizes many of the effects of endogenous histamine by blocking H-1 receptors. - Indication: Sleep aid - SEs: drowsiness, anticholinergic SEs - Pt Ed: Avoid activites requiring mental alertness or coordination. Fexofenadine (Allegra) - MOA: - Indication: Allergic rhinitis - SEs: HA Fluticasone (nasal) (Flonase) - MOA: - Indication: allergic rhinitis Hydrocortisone [top.] - MOA: acts as an anti-inflammatory, antipruritic, vasoconstrictive agent - Indication: contact dermatitis - SEs: Burning, dryness, itchiness of skin Ibuprofen (Advil) - MOA: - Indication: Pain, fever, inflammation - Renal adjusted* - SEs: dizziness, HA, rash, edema, epigastric pain, heartburn, nausea, tinnitis, increased risk of CV event, GI bleed - Monitoring: BP in pts with HTN, [when used chronically and/or at prescription strength] CBC, chemistry profile, periodic renal & liver function tests, S/S bleeding - Pt Ed: Take with food or milk to minimize GI upset. Risk of bleed increases with concurrent alcohol. Use lowest effective dose for the shortest duration possible. Do not use prior to or following cardiac surgery. May require GI prophylaxis if used long-term and/or at a high dose. Levonorgestrel (Plan B) - MOA: - Indication: emergency contraception - SEs: Uterine bleeding, amenorrhea, vulvovaginitis, vaginal infection, acne vulgaris, HA, migraine - Pt Ed: Notify healthcare practitioner if menses is delayed 1 wk. - Caution if hx of ectopic pregnancy Loratidine (Claritin) - MOA: - Indication: Allergic rhinitis - SEs: drowsiness, HA Miconazole (Monistat 1, 3, 7) - MOA: - Indication: Vulvovaginal candidiasis - SEs: Abd cramps, irritation at application site - Pt Ed: Insert suppository vaginally at bedtime. Use Monistat 7 for 7 days, Monistat 3 for 3 days, and Monistat 1 - once only. Naproxen (Naprosyn, Aleve) - MOA: - Indication: Pain, fever, inflammation - Renal adjusted* - SEs: dizziness, HA, rash, edema, epigastric pain, heartburn, nausea, tinnitis, increased risk of CV event, GI bleed - Monitoring: BP in pts with HTN, [when used chronically and/or at prescription strength] CBC, chemistry profile, periodic renal & liver function tests, S/S bleeding - Pt Ed: Take with food or milk to minimize GI upset. Risk of bleed increases with concurrent alcohol. Use lowest effective dose for the shortest duration possible. Do not use prior to or following cardiac surgery. **Likely to be the safest of the non-selective NSAIDs for pts with high CV risk. May require GI prophylaxis if used long-term and/or at a high dose. Nonoxynol 9 [top.] - MOA: - Indication: Birth control/spermacide - SEs: Local irritation, burning, or itching - Pt Ed: Does not protect against STDs. Do not use Today's sponge within 6 weeks after giving birth; history of toxic shock syndrome; during menstrual period. Permethrin [top.] (Nix) - MOA: - Indication: Treatment of Lice - SEs: local irritation, erythema, itching, and rash. - Pt Ed: Leave on scalp for 10 minute before rinsing. Second treatment must be done in 7-10 days. Pyrethrins and Piperonyl Butoxide [top.] (Rid) - MOA: - Indication: Treatment of Lice - SEs: local irritation, erythema, itching, and rash. - Pt Ed: Leave on scalp for 10 minute before rinsing. Second treatment must be done in 7-10 days. Triamcinolone Acetonide (Nasacort AQ, Nasacort Allergy 24HR) - MOA: - Indication: Allergic rhinitis - SEs: headache, pharyngitis, sinusitis, flu-like symptoms, glaucoma - Monitoring: LT use -- Candida infection - Pt Ed: Do not blow nose for 15 min after administration. Report occurrence of nose injury to healthcare professional. - CI: concomitant administration of live or live-attenuated vaccines Fluticasone propionate (oral inhaled) (Flovent) - MOA: - Indication: Asthma, COPD - SEs: Candidiasis of mouth,cough, secondary hypocortisolism - Pt Ed: Wash mouth after use Bumetanide (Bumex) - MOA: a potent loop diuretic with a rapid onset and short duration of action, inhibits the reabsorption of sodium and chloride in the ascending limb of the loop of Henle and enhances the excretion of potassium in a dose-related manner - Indication: HTN, HF - Renal adjusted* - SEs: hyperuricemia, hypochloremia, hypokalemia, tinitis - Monitoring: SCr, electrolytes ***BBW: Bumetanide is a potent diuretic, which, if given in excessive amounts, can lead to a profound diuresis with water and electrolytes depletion. Dexlansoprazole (Dexilant) - MOA: selectively inhibits the parietal cell membrane enzyme (H+,K+)-ATPase, typically referred to as the proton pump, which blocks the final step of acid production - Indication: GERD, PUD - SEs: LT use: B12 deficiency, hypomagnesemia, C.diff, fracture - Pt Ed: Can be taken with or without food, unlike the other PPIs which should be taken on an empty stomach. Epoetin alfa (Procrit) - MOA: glycoprotein that exerts the same biological effects as endogenous erythropoietin that is produced in the kidney. It stimulates the division and differentiation of committed erythroid progenitors in the bone marrow increasing red blood cell production - Indication: Anemia - SEs: HTN, VTE - Monitoring: Iron studies; hemoglobin; BP - Pt Ed: Instruct patient to rotate injection sites when self administering drug. Ergocalciferol (Calciferol) - MOA: promotes active absorption of calcium and phosphorus, thus increasing serum calcium and phosphate levels sufficiently to allow bone mineralization. It also mobilizes calcium and phosphate from bone and increases the reabsorption of calcium and phosphate by the renal tubules - Indication: Vitamin D deficiency - SEs: hypercalcemia, hypervitaminosis D - Monitoring: Serum calcium and phosphorus; signs and symptoms of vitamin D intoxication. - Pt Ed: Instruct patient signs of hypercalcemia and hypervitaminosis D (bone pain, confusion, polyuria, polydipsia) Esomeprazole (Nexium) - MOA: a proton pump inhibitor, blocks the final step in acid production by specific inhibition of the H(+)/K(+)-ATPase in the gastric parietal cell, thus suppressing gastric acid secretion - Indication: GERD, PUD - SEs: LT use: B12 deficiency, hypomagnesemia, C.diff, fracture; possible increased risk of CV event with concurrent clopidogrel - Pt Ed: Take 30-60 min before first meal. Contents of the capsule can be mixed in applesauce if patient can't swallow capsule. * Also available as IV Famotidine (Pepcid) - MOA: a histamine H(2)-receptor antagonist, primarily inhibits both the concentration and volume of gastric secretion - Indication: GERD, PUD - Renal adjusted* - SEs: CNS effects (elderly, renal), B12 deficiency with prolonged use (2yrs) - Pt Ed: May take with antacids if needed. Consult prescriber if sx last 14 days when self-treating. *Also available as IV ferrous gluconate, iron dextran, iron sucrose (Infed, Venofer) MOA: - Iron dextran is a complex of ferric oxyhydroxide and a polyglucose that restores hemoglobin and depleted iron through the action of its iron component that forms hemosiderin or ferritin and transferrin by binding to protein moieties - Iron sucrose dissociates into iron and sucrose. Iron forms a complex with transferrin and is transported to target cells such as erythroid precursor cells, where it is incorporated into hemoglobin during the red blood cell maturation processes - Indication: Iron deficiency - SEs: (PO): constipation, dark stools, nausea, stomach cramping. (IM,IV): pain at injection site, allergic reactions. anaphylaxis reaction. - Monitoring: Iron studies, Hemoglobin, hematocrit - Pt Ed: PO: take on an empty stomach, avoid dairy products (it will decrease the absorption of iron.) Don't be alarmed by dark stools. May feel better/more energy in about 3 weeks but need to take for at least 3 months. ***Iron Dextran: (BBW):Anaphylactic-type reactions resulting in death. Need to do a test dose prior to administration. Folic acid (Folvite) - MOA: after conversion to tetrahydrofolic acid, is necessary for normal erythropoiesis [10], synthesis of purine and thymidylates [11], metabolism of amino acids such as glycine and methionine, [10] and the metabolism of histidine - Indication: Anemia - SEs: bad taste in mouth (esp large doses) - Monitoring: CBC, serum folate Furosemide (Lasix) - MOA: an anthranilic acid derivative and a potent diuretic that works by blocking the absorption of sodium and chloride in the kidney tubules (proximal and distal tubules, also in the loop of Henle), causing a profound increase in urine output - Indication: HTN, HF - Renal adjusted* - SEs: hyperuricemia, hypomagnesemia, hypokalemia, tinnitis - Monitoring: Scr, electrolytes Lansoprazole (Prevacid) - MOA: - Indication: GERD, PUD - SEs: LT use: B12 deficiency, hypomagnesemia, C.diff, fracture - Pt Ed: Take 30 min before first meal. Contents of the DR capsule can be mixed in applesauce if patient can't swallow capsule. *Also available as ODT Metoclopramide (Reglan) - MOA: promotes motility in the upper gastrointestinal tract by sensitizing tissues to the action of acetylcholine, which is independent from intact vagal innervation and does not stimulate biliary, gastric, or pancreatic secretions. It hastens gastric emptying and intestinal transit by increasing tone and amplitude of gastric contractions, relaxing the pyloric sphincter and duodenal bulb, and enhancing peristalsis of the duodenum and jejunum. Its also has antiemetic property which is attributed to the central and peripheral dopamine receptor inhibition - Indication: Antiemetic, gastrointestinal agent (GI motility) - Renal adjusted* - SEs: Extrapyramidal symptoms, tardive dyskinesia - Monitoring: Signs of tardive dyskinesias, extrapyramidal symptoms - Pt Ed: Instruct patient to report signs/symptoms of tardive dyskinesia (jerky muscle movements, tongue thrusting, facial grimacing/ticks, random movements of extremities) or EPS. - BBW: tardive dyskinesia Omeprazole (Prilosec) - MOA: - Indication: GERD, PUD - SEs: LT use: B12 deficiency, hypomagnesemia, C.diff, fracture; possible increased risk of CV event with concurrent clopidogrel - Pt Ed: Take 30 min before first meal. Contents of the DR capsule can be mixed in applesauce if patient can't swallow capsule. - Oral suspension can be given via NG tube Pantoprazole (Protonix) - MOA: - Indication: GERD, PUD - SEs: LT use: B12 deficiency, hypomagnesemia, C.diff, fracture - Pt Ed: Take 30 min before first meal. ***Also available as IV - stable in NS, LR or D5W; Oral granules can be given via NG tube; safest choice with clopidogrel Prochlorperazine (Compazine, Compro) - MOA: phenothiazine derivative that depresses the chemoreceptor trigger zone, thereby controlling severe nausea and vomiting - Indication: Severe N/V - SEs: QT Prolongation, tardive dyskinesia, neuroleptic malignant syndrome - Monitor mental status, CBC, electrolytes, LFTs, fasting plasma glucose level/HbA1c, lipid panel, abnormal involuntary movements or parkinsonian signs, tardive dyskinesia, and visual changes. - Pt Ed: Drug may cause drowsiness. Tell patient to report signs/symptoms of tardive dyskinesia (eg. jerky muscle movements, tongue thrusting, facial ticks, random movements of extremities) or EPS. Promethazine Hcl (Phenergan) - MOA: phenothiazine derivative that competitively blocks histamine H(1) receptors without blocking the secretion of histamine. The drug has sedative, antimotion-sickness, antiemetic, and anticholinergic effects but it has no dopaminergic action due to a structural difference with other phenothiazines - Indication: Motion sickness, nausea, vomiting - SEs: Extrapyramidal symptoms, lowered seizure threshold, QT prolongation - Pt Ed: Drug may cause drowsiness. Advise patient to avoid prolonged exposure to sunlight.Tell patient to report signs/symptoms of tardive dyskinesia (eg. jerky muscle movements, tongue thrusting, facial ticks, random movements of extremities) or EPS. Ranitidine (Zantac) - MOA: - Indication: GERD, PUD - Renal adjusted* - SEs: CNS effects (elderly, renal), B12 deficiency with prolonged use (2yrs) - Pt Ed: May take with antacids if needed. Consult prescriber if sx last 14 days when self-treating. *Also available as IV Amlodipine (Norvasc) - MOA: long-acting dihydropyridine calcium channel blocker that exerts its effect by blocking the transmembrane influx of calcium ions into cardiac and vascular smooth muscles. It also reduces peripheral vascular resistance and lowers blood pressure by causing a direct vasodilation in the peripheral arteries of the vascular smooth muscle. - Indication: HTN - SEs: Flushing, Palpitations, Peripheral edema, Dizziness Amlodipine/Benazepril (Lotrel) - MOA: - Indication: HTN - SEs: Edema, Hyperkalemia, Acute renal failure, Angioedema, Cough - Monitoring: SCr, K - Pt Ed: Signs of angioedema **BBW: Discountinue as soon as possible if pregnancy is detected; this drug can cause injury and death to the fetus Atenolol (Tenormin) - MOA: synthetic beta(1)-selective adrenoreceptor blocking agent without membrane stabilizing or intrinsic sympathomimetic activities. It inhibits beta(2)-adrenoreceptors primarily found in bronchial and vascular musculature at higher doses - Indication: HTN - Renal adjusted* - SEs: Bradyarrhythmia - Monitoring: BP, HR - Pt Ed: Advise patient against sudden discontinuation of drug. Atorvastatin (Lipitor) - MOA: - Indication: Hyperlipidemia - SEs: Liver failure, Rhadomyolysis - Monitoring: LFT, CPK, lipid panel - Pt Ed: Report signs/symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, weakness, fever). ***Pregnancy X Benazepril (Lotensin) - MOA: - Indication: HTN - Renal adjusted* - SEs: Cough, Hyperkalemia , Renal impairment, Angioedema - Monitoring: BP, renal function, serum potassium - Pt Ed: Signs of angioedema ***BBW: Discontinue as soon as possible when pregnancy is detected. Significant Contraindication: pregnancy Carvedilol (Coreg, Coreg CR) - MOA: - Indication: HTN, HF, MI - SEs: Bradyarrhythmia - Monitoring: BP, HR - Pt Ed: Take with food to minimized the risk of orthostatic hypotension. Advise patient against sudden discontinuation of drug. Clonidine (Catapres) - MOA: - Indication: Hypertension; ADHD - SEs: Rebound HTN, orthostasis, atrioventricular block - - Pt Ed: ER tablet should be swallowed whole. Avoid sudden discontinuation (rebound hypertension). Avoid alcohol or use CNS depressants. Diltiazem (Cardizem) - MOA: - Indication: HTN - SEs: bradyarrhythmia, peripheral edema, CHF, heart block Doxazosin (Cardura) - MOA: - Indication: HTN - SEs: Edema, orthostatic hypotension - Pt Ed: Tell patient to rise slowly from a sitting/lying position. Take initial ER dose with breakfast. Enalapril (Vasotec) - MOA: - Indication: HTN - Renal adjusted* - SEs: SCr, hyperkalemia, angioedema - Monitoring: Blood pressure; serum creatinine and potassium - Pt Ed: Signs of angioedema Enalaprilat (Vasotec IV) - MOA: - Indication: HTN - Renal adjusted* - SEs: SCr, hyperkalemia, angioedema - Monitoring: Blood pressure; serum creatinine and potassium - Pt Ed: Signs of angioedema Ezetimibe (Zetia) - MOA: - Indication: Hyperlipidemia - SEs: diarrhea, hepatitis - Monitor LFTs Fenofibrate (Tricor) - MOA: - Indication: Hyperlipidemia - SEs: Abnormal LFT, rhabdomyolysis - Pt Ed: Advise patient to report symptoms of myopathy and hepatitis. Gemfibrozil (Lopid) - MOA: - Indication: Hypertriglyceridemia - SEs: Abnormal LFT, rhabdomyolysis - Pt Ed: Advise patient to report symptoms of myopathy and hepatitis. Glimepiride (Amaryl) - MOA: - Indication: DM - Renal adjusted* - SEs: Hypoglycemia, weight gain - Monitor for signs and symptoms of hypoglycemia (fatigue, excessive hunger, profuse sweating, numbness of extremities). Monitor Fasting blood glucose, hemoglobin A1c. Glipizide (Glucotrol, glucotrol XL) - MOA: - Indication: DM - SEs: Hypoglycemia, weight gain - Monitor for signs and symptoms of hypoglycemia (fatigue, excessive hunger, profuse sweating, numbness of extremities). Monitor Fasting blood glucose, hemoglobin A1c. Glyburide (Micronase) - MOA: - Indication: DM - SEs: Hypoglycemia, weight gain - Monitor for signs and symptoms of hypoglycemia (fatigue, excessive hunger, profuse sweating, numbness of extremities). Monitor Fasting blood glucose, hemoglobin A1c. Hydralazine Hcl (Apresoline) - MOA: - Indication: HTN - Renal adjusted* - SEs: Tachycardia - Monitoring: HR, ANA titer - Pt Ed: Patient should report signs of systemic lupus erythematosus. ***Drug-induced lupus like symptoms Hydrochlorothiazide (Microzide) - MOA: - Indication: HTN - Renal adjusted* - SEs: Scr, Electrolytes - Pt Ed: Maintain adequte hydration. ***Drug ineffective for pts with CrCL30 mL/min Insulin detemir (Levemir) - MOA: - Indication: DM - SEs: Injection site reaction, hypoglycemia, weight gain - Monitor for signs and symptoms of hypoglycemia (fatigue, excessive hunger, profuse sweating, numbness of extremities). Monitor Fasting blood glucose, hemoglobin A1c. - Pt Ed: Never share insuline needles, drug may cause lipodystrophy/allergic reaction/or hypoglycemia, rotation of injection site. Insulin Glargine (Lantus Solostar,Lantus) - MOA: - Indication: DM 1 & 2 / Diabetes - SEs: Injection site reaction, hypoglycemia, weight gain - Monitor for signs and symptoms of hypoglycemia (fatigue, excessive hunger, profuse sweating, numbness of extremities). Monitor Fasting blood glucose, hemoglobin A1c. - Pt Ed: Never share insuline needles, drug may cause lipodystrophy/allergic reaction/or hypoglycemia, rotation of injection site. Isosorbide mononitrate (Imdur) - MOA: - Indication: Angina pectoris - SEs: Headaches and dizziness, orthostasis - Monitor for orthostasis - Pt Ed: Warn patients that it is normal for this drug to cause headaches its transient and it will go away. Patient should avoid concomitant use of PDE-5 inhibitors (e.g. sildenafil, tadalafil, & vardenafil) as this may increase risk of severe hypotension. Patient should not drink alcohol while taking this drug. Labetalol (Trandate) - MOA: - Indication: HTN - SEs: Orthostatic hypotension, bronchospasm, heart failure. - Pt Ed: Instruct patient to rise slowly from a sitting/supine position, as drug may cause orthostatic hypotension. Advise patient against sudden discontinuation of drug. Lisinopril (Prinivil, Zestril) - MOA: - Indication: HTN, HF, MI - Renal adjusted* - SEs: SCr, hyperkalemia, angioedema - Monitoring: BP, renal function, serum potassium - Pt Ed: Signs of angioedema ***BBW: Discontinue as soon as possible when pregnancy is detected Significant ***Contraindication: pregnancy Lisinopril/Hydrochlorothiazide (Prinzide, Zestoretic) -MOA: - Indication: HTN - Renal adjusted* - SEs: SCr, Electrolyte imbalance, angioedema - Monitoring: BP, renal function, serum electrolyte - Pt Ed: Signs of angioedema ***BBW: Discontinue as soon as possible when pregnancy is detected significant ***Contraindication: pregnancy Losartan Potassium (Cozaar) - MOA: - Indication: HTN - Renal adjusted* - SEs: SCr, Electrolyte imbalance, angioedema - Monitoring: BP, renal function, serum POTASSIUM - Pt Ed: Signs of angioedema ***BBW: Discontinue as soon as possible when pregnancy is detected Significant ***Contraindication: pregnancy Losartan/Hydrochlorothiazide (Hyzaar) - MOA: - Indication: HTN - Renal adjusted* - SEs: SCr, Electrolyte imbalance, angioedema - Monitoring: BP, renal function, serum electrolyte - Pt Ed: Signs of angioedema ***BBW: Discontinue as soon as possible when pregnancy is detected Significant ***Contraindication: pregnancy Metformin (Glucophage(IR, ER)) - MOA: - Indication: DM2 - Renal adjusted* - SEs: GI (diarhea, indigestion, N/V), lactic acidosis - Monitoring: Scr, eGFR - Pt Ed: Take tablets with meals and extended-release tablets with the evening meal. **Contraindicated for Scr1.4 (F) 1.5 (M), IV dye; **Precaution: 80YO , HF, liver dz Metoprolol succinate (Toprol-XL) - MOA: - Indication: HTN, MI, HF - SEs: bradycardia, bronchospasm - Monitoring: Blood pressure, Heart rate, ECG(IV administration) - Pt Ed: Advise diabetic patient to carefully monitor blood glucose as drug may mask symptoms of hypoglycemia. Counsel patient against sudden discontinuation of drug. ***BBW: ischemic heart disease with abrupt discontinuation. Metoprolol tartate (Lopressor) - MOA: - Indication: HTN, MI - SEs: bradycardia, bronchospasm - Monitoring: Blood pressure, Heart rate, ECG(IV administration) - Pt Ed: Advise diabetic patient to carefully monitor blood glucose as drug may mask symptoms of hypoglycemia. Counsel patient against sudden discontinuation of drug. ***BBW: ischemic heart disease with abrupt discontinuation. Nebivolol (Bystolic) - MOA: - Indication: HTN - Renal adjusted* - SEs: bradycardia, bronchospasm - Monitoring: Blood pressure, Heart rate, ECG - Pt Ed: Advise diabetic patient to carefully monitor blood glucose as drug may mask symptoms of hypoglycemia. Counsel patient against sudden discontinuation of drug. Niacin (Niaspan) - MOA: - Indication: Hyperlipidemia - SEs: flushing - Monitoring: Baseline hepatic transaminases, fasting blood glucose or hemoglobin A1c, and uric acid - Pt Ed: If medically approved, instruct patient to pretreat with aspirin or an NSAID 30 min before dose to reduce severity/frequency of flushing, pruritus, and gastrointestinal distress. ***Contraindicated in patients with significant or unexplained hepatic dysfunction, active liver disease or unexplained persistent transaminase elevations. Nifedipine ER (Procardia XL) - MOA: - Indication: HTN - SEs: flushing, peripheral edema - Monitoring: BP, HR, peripheral edema. - Pt Ed: avoid grapefruit juice Omega-3-acid ethyl esters (Lovaza) - MOA: - Indication: Hyperlipidemia - SEs: Diarrhea, nausea, abdomina pain - Pt Ed: Use caution in patients with fish or shellfish allergies. Pioglitazone (Actos) - MOA: - Indication: DM - SEs: Edema, bone fracture, Congestive heart failure, liver failure - Monitoring: LFT, s/sx of CHF/fluid retention - Pt Ed: Advise patient to report signs/symptoms of CHF (eg. rapid weight gain, edema, dyspnea) and liver problem. ***BBW: Pioglitazone is not recommended in patients with symptomatic heart failure and is contraindicated in patients with established NYHA Class III or IV heart failure. ***CI: HF (NYHA Class III or IV) Pravastatin Sodium (Pravachol) - MOA: - Indication: Hyperlipidemia - SEs: Liver failure, Rhadomyolysis - Monitoring: LFT, CPK, lipid panel - Pt Ed: Report signs/symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, weakness, fever). ***Pregnancy X Propranolol Hcl (Inderal) - MOA: - Indication: HTN - SEs: bradycardia, bronchospasm - Monitoring: Blood pressure, Heart rate, ECG(IV administration) - Pt Ed: Advise diabetic patient to carefully monitor blood glucose as drug may mask symptoms of hypoglycemia. Counsel patient against sudden discontinuation of drug. ***Warn patients against interruption or discontinuation of therapy without physician advice. Ramipril (Altace) - MOA: - Indication: HTN - Renal adjusted* - SEs: SCr, Electrolyte imbalance, angioedema - Monitoring: BP, renal function, serum potassium - Pt Ed: Signs of angioedema ***BBW: Discontinue as soon as pregnancy is detected. Rosuvastatin (Crestor) - MOA: - Indication: Hyperlipidemia - SEs: Arthralgia, Liver failure, Rhadomyolysis - Monitoring: Lipid panel, LFT, CPK - Pt Ed: Advise patient to immediately report signs/symptoms of myopathy or rhabdomyolysis including unexplained muscle pain, tenderness, or weakness especially when accompanied with fever. ***Pregnancy Category: X Simvastatin (Zocor) CONTINUED...