R8 Pharm(Answered)2022

For treatment of hypertension or benign prostatic hyperplasia. Normal dose range is 1 to 8 mg daily. Orthostatic hypotension may occur 2-6 hours after first dose or after increases in dosing. Monitor LFT, BP. Antagonizes alpha-1 adrenergic receptors, resulting in dilation of arterioles and veins which leads to decreased peripheral resistance and decreased blood pressure. In treatment of BPH, relaxes smooth muscle in bladder neck and prostate. Caution when used with other antihypertensives to avoid hypotension. Caution in liver impairment. To decrease chances of syncope, all patients should be started on 1mg at bedtime. AEs include dizziness, edema, fatigue, rhinitis, headache. Doxazosin Mesylate (Cardura, Cardura XL) Monotherapy or adjunctive therapy in treatment of partial seizures in adults and children ages 4-16. Adults start with 300mg given twice/day. Monitor Na. May produce anti-seizure activity by blockade of voltage-sensitive sodium channels, resulting in stabilization of hyperexcited neural membranes, inhibition of repetitive neuronal firing, and dimunition of propagation of synpatic impulses. Approx 25-30% of patients with sensitivity to carbamazepine will have similar reactions to this drug. SJS syndrome and TEN have occurred. Clinically significant hyponatremia can occur during treatment. Antiepileptics increase risk of suicidal thoughts and behaviors. Do not use in nursing mothers. AEs are dizziness, somnolence, diplopia, fatigue, nausea, vomiting, ataxia, abnormal vision, abd pain, tremor, dyspepsia, and abnormal gait. Oxcarbazepine (Trileptal, Oxtellar XR) 00:42 01:08 Available as intranasal gel, injection, oral (OTC), and sublingual forms. For treatment of pernicious anemia, folic acid deficiency, fish tapeworm infestation, total gastrectomy, pancreas or bowel malignancies, or any other GI disorder which decreases absorption. Maintenance dose is usually 1000 mcg per month. Oral supplementation of folic acid is usually necessary. Colchicine and heavy alcohol may produce malabsorption of this vitamin. Do not use in patients with early Leber's disease (hereditary optic nerve atrophy). Use with caution in patients with severe megaloblastic anemia d/t induced hypokalemia. Anaphylactic shock is a risk with initiation of parenteral therapy, so first dose IM or SC should be given in clinic. AEs are rare and transient but include headache, pain at injection site, dizziness, and infection. Cyanacobalamin (Vitamin B-12) (Nascobal) For treatment of opioid dependence. Recommended target dose is single daily sublingual dose of 16mg. Induction to an adequate maintenance dose should be reached ASAP to prevent opioid withdrawal symptoms. Prescription use of this product is limited to providers who meet certain qualifying criteria. This is a partial opioid agonist at the mu-opioid receptor and an antagonist at the kappa-opioid receptor. Caution in patients with compromised respiratory function. This drug misused intravenously has resulted in death from respiratory depression. Caution in patients with decreased hepatic fxn, increased intracranial pressure, myxedema or hypothyroidism, adrenal insufficiency, toxic psychoses, prostatic hypertrophy, acute alcoholism, DTs. AEs include headache, constipation, nausea, and sweating. Buprenorphine with Naloxone (Suboxone) For tx of serious resp tract infxs, skin and soft tissue infxns, septicemia, intra-abdominal infxns such as peritonitis and abscess, infxns of female pelvis and GU tract such as endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis. Dose is 150 to 450mg every 6 hours. Binds to 50S subunit of bacterial ribosomes and suppresses protein synthesis. Use with erythromycin decreases effectiveness of both. Pseudomembranous colitis has been reported with use and should be considered in pts with severe or persistent diarrhea. Does not cross blood/brain barrier, so do not use to treat meningitis. AEs include abd pain, nausea, vomiting, diarrhea, pruritius, and vaginitis. Muscle pain, severe diarrhea, or rash may be signs of potentially severe conditions and should be reported to provider. Clindamycin Hydrochloride (Cleocin) For acute and chronic treatment of the signs and symptoms of rheumatoid arthritis. For topical, apply 2g to affected area of upper extremity and 4g to affected area of lower extremity. For oral, use 50mg three-four times/day. For oral, monitor LFT/RFT. Mechanism may be d/t decreased prostaglandins, thromboxanes, and prostacyclin formation through inhibition of COX. Systemic exposure after topical application is much less than after oral administration. May inhibit activity of diuretics and ACE-Is. Use with warfarin increases risk of GI bleeding. Serious GI toxicity, including bleeding, ulceration, and perforation may occur at any time during chronic therapy. May cause increased risk of serious cardiovascular thrombotic events. AEs of topical include pruritis, rash, site pain, and headache. AEs of oral include nausea, indigestion, diarrhea or constipation, cramping, headache, and fluid retention. Diclofenac Sodium (topical & oral) (Voltaren Gel/Voltaren) For tx of ADHD in patients over 6 y.o. and of moderate to severe Binge Eating Disorder in adults. Recommended starting dose is 30mg per day given as single dose in the morning. This is a prodrug of dextroamphetamine, which causes CNS stimulation by direct action on adrenergic receptors, releasing norepinephrine from storage sites. Effects may be increased when used with MAOIs. Contraindicated in advanced arteriosclerosis, symptomatic CV disease, HTN, hyperthyroidism, pts with hx of drug abuse. CNS STIMULANTS HAVE HIGH POTENTIAL FOR ABUSE AND DEPENDENCE. AEs are decreased appetite, insomnia, dry mouth, diarrhea, nausea, anxiety, restlessness, increased BP, dyspnea, tachycardia. Rare cases of SJS reported. Lisdexamfetamine Dimesylate (Vyvanse) For ppx, treatment, and management of angina pectoris (sublingual), dissolve one tablet under tongue or in buccal pouch at first sign of acute anginal attack. Use no more than 3 tablets in 15 minutes. For tx of angina pectoris, perioperative HTN, CHF associated with acute MI, and for production of controlled hypotension during surgery (parenteral), dosage must be individualized. Reduces myocardial oxygen demand through relaxation of vascular smooth muscle. Results in reduction of left ventricular back pressure and more efficient blood flow within the myocardium. Hypotensive effects may be increased by SILDENAFIL CITRATE (Viagra). Contraindicated in pts with severe anemias, closed-angle glaucoma, postural hypotension, increased ICP, and during early MI. Injection contraindicated in pts w/ hypotension or uncorrected hypovolemia, and in pts with constrictive pericarditis or pericardial tamponade. Nitroglycerin (sublingual & injectable) (Nitrostat, Nitroquick) For prevention of pregnancy. Take one tablet daily for 28 days beginning on the 5th day of the cycle. Use second birth control method for during first 3 weeks of OC use. Suppresses luteinizing hormone (LH) and follicle stimulating hormone (FSH), resulting in inhibition of ovulation. Thickening of cervical mucous and alteration of the endometrium may also contribute to their effectiveness. Broad spectrum antibiotics (ampicillin, amoxicillin, metronidazole, tetracycline) may alter absorption of estrogens. Contraindicated with known thromboembolic disorders, breast carcinoma, or estrogen dependent neoplasia, pregnancy, undiagnosed abnormal genital bleeding, benign or malignant liver tumors developed during OC use, and cerebral vascular or CV disease. Use may cause depression, fluid retention, and depressed serum folate levels. AEs include abd cramping, acne, anorexia, nausea, vomiting, unusual tiredness/weakness. Norgestimate & Ethinyl Estradiol (Ortho-Cyclen, Sprintec) Available as injection, tablets, or nasal spray. For acute management of migraine w/ or w/o aura and the acute tx of cluster headaches. Oral dose is 25 to 100mg taken at the first sign of migraine attack. This drug activates 5HT-1 receptor subtypes in the brain vasculature to cause vasoconstriction, which correlates with relief of migraine. Separate use of ergot-containing drugs by 24 hours. Do not give IV because of potential for coronary vasospasm. Contraindicated in ischemic heart disease, Prinzmetal's angina, and uncontrolled HTN. Chest, jaw, or neck tightness is common after an injection, but has only rarely been a/w ischemic ECG changes. AEs include tingling, warmth, burning, feeling of heaviness, pressure, tightness, numbness, tight feeling in head, flushing, tightness in chest, bad taste, discomfort of the throat/nose/tongue/mouth, muscle weakness, neck pain/stiffness, dizziness/vertigo, diarrhea, drowsiness. Sumatriptan Succinate (Imitrex) For treatment of HTN, alone or in combo with other antihypertensives, particularly thiazide-type diuretics. Also for treatment of ADHD as monotherapy or adjunct to stimulant medications. Begin with 1mg daily. Stimulates central alpha-2 adrenergic receptors, reducing sympathetic nervous transmission from the vasomotor center in the CNS to the heart and blood vessels. This results in decreased peripheral resistance and reduction in heart rate. Caution in pts with severe coronary insufficiency, recent MI, cerebrovascular disease, or chronic renal or hepatic failure. Drowsiness is pronounced during initiation of therapy. AEs are dry mouth, drowsiness, weakness, dizziness, constipation, headache, insomnia, impotence. Guanfacine Hydrochloride (Tenex, Intuniv) For adjunct therapy to diet or in combo with HMG-CoA reductase inhibitor for reduction of elevated total-C, LDL-C, and ApoB in patients with primary (familial and nonfamilial) hypercholesterolemia. Recommended daily dose for all indications is 10mg. Monitor lipid panel. Acts at the brush border of the small intestine to inhibit cholesterol absorption, thereby decreasing delivery of cholesterol to the liver. Do not use in pts with moderate to severe hepatic insufficiency. AEs include myalgia, increased CPK, elevations in liver transaminases, hepatitis, thrombocytopenia, urticaria, arthralgia, and myopathy/rhabdomyolysis. Ezetimibe (Zetia)