4 -- chapter 1 pharmacology for technicians

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Upon completion of Chapter 1, the pharmacy technician student will be able to 1. Listanddescribethevarioussystemsofthehumanbodyandtheirfunction. 2. Definethetermspharmacology, pharmacokinetics,andtherapeutic equivalence. 3. Discusstheimportanceofrecognizingdruginteractions,problems,andpregnancycategories. 4. Recognizeandrecallhowdrugnamesarecreatedandhowtheirnamescanindicateusage. 5. Recognizethefollowingforeachdrugclassificationandmedication:

• Mechanismofaction• Medicationswithineachclassification• Differencebetweeneachclassification• Brandandgenericname• Thedailydosage,dosageforms,androuteofadministration• Commonsideeffects,allergicreactions,andtherapeuticcontraindications

6. Identifycommonvitamins,electrolytes,nutritionalsupplements,minerals,andover-the-countermedications.

1Chapter

Pharmacology for Technicians

2.1 Drugclassification2.1.1 Majordrugclasses(e.g.,analgesics,anes-

thetics,antibiotics)2.1.2 Dosageforms(types,characteristics,and

uses)2.1.3 Over-the-counterproducts

2.2 Mostfrequentlyprescribedmedications2.2.1 Brandandgenericnames2.2.2 Basic mechanism of action (pharmacol-

ogy)anddrugclassification2.2.3 Primaryindications2.2.4 Common adverse drug interactions and

contraindications

ExCPT Knowledge Domains

1.1 Genericandbrandnamesofpharmaceuticals1.2 Therapeuticequivalence1.3 Druginteractions(e.g.,drug–disease,drug–drug,

drug–dietary supplement, drug–over-the-counter[OTC]drug,drug–laboratory,drug–nutrient)

1.4 Strengthsanddoses,dosageforms,physicalap-pearance, routesof administration, anddurationofdrugtherapy

1.5 Common and severe side or adverse effects,allergies,andtherapeuticcontraindicationsasso-ciatedwithmedications

1.6 Dosage and indication of legend, OTC medica-tions,herbalanddietarysupplements

PTCB Knowledge Domains

ChapterObjectives

12 Mosby’s Review for the Pharmacy Technician Certification Examination

CARDIOVASCULAR SYSTEM• Theheartisamusclethatinitiatessystemicarterial

pulsewaves,causingbloodtocirculatethroughoutthebodyandsupplyitwithnutritionandoxygen.Consists of the heart (pumps blood that supplies

nutrientsandoxygenthroughoutthebody),arter-ies(carriesoxygenatedbloodandnutrientstothetissues and organs), veins (returns deoxygenatedbloodtotheheart),andcapillaries.

ANATOMY OF THE EAR EAR COMPONENT FUNCTION

External EarAuricle ServesasentranceforsoundintotheearAuditorycanal LinkstheexternaleartothetympanicmembraneTympanicmembrane Protectsmiddleearfromforeignobjectsandtransmitssoundwavestothemiddleear

Middle EarMalleus(hammer) TransmitssoundwavesIncus(anvil) TransmitssoundwavesStapes(stirrup) TransmitssoundwavesEustachiantube Connectsmiddleeartothenasopharynx;relievesthechangeofpressurebetween

theoutsideandinsideoftheearduringswallowingoryawning

Inner EarLabyrinth TransmitsaudiblesoundsvianerveimpulsesCochlea TransmitsimpulsestothebrainVestibule ResponsibleforequilibriumandbalanceSemicircularcanal Transferofmessageviaacousticnerve

ANATOMY OF THE CARDIOVASCULAR SYSTEM FUNCTION

Aorta Thelargestarteryinthebody,originatingfromtheleftventricleoftheheartandextendingdowntotheabdomen;theaortadistributesoxygenatedbloodtoallpartsofthebodythroughthesystemiccirculation

Endocardium InnerlayeroftheheartwallthatallowstheheartwalltocollapsewhenitcontractsMyocardium MiddlelayeroftheheartwallthatcontractsEpicardium OuterlayeroftheheartwallSuperiorvenacava TransportsvenousbloodfromtheupperportionofthebodytotheheartInferiorvenacava TransportsvenousbloodfromthelowerportionofthebodytotheheartRightventricle ExpelsbloodthroughthepulmonaryarteriestothelungsLeftatrium ReceivesoxygenatedbloodfromthelungsLeftventricle ContractsandexpelsoxygenatedbloodintotheaortaRightatrium Receivesbloodfromthebody

ANATOMY AND PHYSIOLOGY

AUDITORY SYSTEM

• Responsibleforhearing,balance,equilibrium,andcommunicationskills

Chapter 1 Pharmacology for Technicians 13

ENDOCRINE SYSTEM• Responsible for the production and secretion of

hormonesfromtheglands• Hormonesstimulatespecifictargetcells,resulting

inaresponse

• Includes the pituitary gland, hypothalamus, pi-neal gland, thyroid gland, parathyroid gland,thymus, adrenal gland, pancreas, ovaries, andtestes

DIGESTIVE SYSTEM• Responsibleforthedigestion,absorption,metabo-

lism,andexcretion(elimination)offood

ANATOMY OF THE DIGESTIVE SYSTEM FUNCTION

Gallbladder SmallorganthataidsmainlyinfatdigestionandconcentratesbileproducedbytheliverMouth ChewsfoodSalivarygland SecretestheenzymeamylaseusedtobreakdowncarbohydratesPharynx ConnectsthemouthtotheesophagusEsophagus TransportsfoodfromthemouthtothestomachPancreas Bothanendocrineglandproducingseveralimportanthormones,includinginsulin,gluca-

gon,somatostatin,andpancreaticpolypeptide,andadigestiveorgan,secretingpancre-aticjuicecontainingdigestiveenzymesthatassisttheabsorptionofnutrientsandthedigestioninthesmallintestine

Stomach ReleasesacidtobreakdownfoodSmallintestine AbsorbsnutrientsfromdigestedfoodLargeintestine Reabsorbswaterbackintobody;excretesoreliminatesfoodfromthebodyRectum Excretesfecalmatterfromthebody

ANATOMY OF THE ENDOCRINE SYSTEM FUNCTION

Pituitarygland TheanteriorpituitaryglandproducesGH,TSH,ACTH,FSH,LH,andprolactin;theposteriorpituitaryglandproducesoxytocinandvasopressin(ADH)

Hypothalamus ServesasabridgebetweenthenervoussystemandthehormonalsystemPinealgland Maintainscircadianrhythmsandsleep–awakepatternsThyroidgland Producesthyroxine(T4),triiodothyronine(T3),andcalcitoninParathyroidgland SecretesPTH,whichmaintainsappropriatecalciumlevelsinthebodyThymusgland SecreteshumoralfactorsnecessaryinmaintainingtheimmunesystemAdrenalgland Themedullaregionsecretesepinephrineandnorepinephrine;thecortexregionsecretes

glucorticoidandmineralocorticoidhormonesPancreas ProducesandsecreteshormonesfromtheisletsofLangerhans;alphacellsproduce

glucagon,andbetacellsproduceinsulinOvaries(females) SecreteestrogenandprogesteroneTestes(males) Secretetestosterone

ACTH,Adrenocorticotropichormone;ADH,antidiuretichormone;FSH,follicle-stimulatinghormone;GH,growthhormone;LH,luteinizinghormone;PTH, parathyroidhormone;TSH,thyroid-stimulatinghormone.

• Organsofthedigestivesystemincludethemouth,salivary glands, pharynx, esophagus, stomach,smallintestine,largeintestine,andrectalarea

IMMUNE SYSTEM• Adefensesystemthatidentifiesanddestroysfor-

eignsubstancesthatinvadethebody

ANATOMY OF THE IMMUNE SYSTEM FUNCTION

Thymus Asmallglandularorganthatissituatedbehindthetopofthebreastbone,consistingmainlyoflymphatictissueandservingasthesiteofT-celldifferentiation

Lymphnode Filtersfluids,catchingviruses,bacteria,andotherunknownmaterialsTcells WBCsknownaslymphocytesandplayacentralroleincell-mediatedimmunityBcells Makeantibodiesagainstantigens,toperformtheroleofAPCs,andtodevelopintomemory

BcellsafteractivationbyantigeninteractionSpleen Actsasabloodfilter

APC, Antigen-presentingcell;WBC, whitebloodcell.


INTEGUMENTARY SYSTEM• Protects the body against heat, cold, light, dehy-

dration,andinfection

ANATOMY OF THE SKIN FUNCTION

Epidermis ProducesnewskincellsDermis Containscollagenandsupportsbloodvessels,glands,andnervesSC(hypodermis) StoresfatthatinsulatesthebodySebaceousglands SecretessebumthatlubricatestheskinandretainswatertokeephairandskinsoftSweatglands Actsascoolingsystemwhenthebodytemperaturerises

NERVOUS SYSTEM• Controls both voluntary and involuntary func-

tionsofthebody• Responsibleforthetransmissionofimpulsesfrom

sensory neurons to the central nervous system(CNS);interpretationofimpulsessenttotheCNSand transmission of a response to muscles or

glands; coordination of the activities of all divi-sionsof thenervoussystem;andmaintenanceofhomeostasisbyrespondingtosensorychangesinthebody.

• Consistsoftwocomponents,theCNSandperiph-eralnervoussystem(PNS)

ANATOMY FUNCTION

Cerebral CortexFrontallobe Controlsmotorfunction,partsofspeech,emotions,problemsolving,reasoning,andplanningParietallobe Responsiblefororientation,recognition,sensation,andcomprehendinglanguageOccipitallobe ControlsperceptionandinterpretationrelatedtovisionTemporallobe Responsibleforauditorystimuli,long-termmemory,andbehavior

BrainstemMidbrain Responsibleforvision,hearing,eyemovement,andvoluntarybodymovementPons AccountableformotorcontrolandsensoryanalysisMedullaoblongata Inchargeofbreathing,cardiacrate,heartcontractions,andbloodvesseldilation

DiencephalonThalamus ResponsiblefortransmittingmessagesbetweenthebrainspinalcordandforbodytemperaturecontrolHypothalamus Controlsemotions,thirst,hunger,heartrate,andautonomicnervoussystemhormoneproduction

CerebellumCerebellum Maintainsbodybalance,posture,andcoordinatingmovement

Cranial NervesI OlfactoryII OpticIII SpecificeyeandeyelidmovementIV AnotherspecifictypeofeyemovementV Providessensationtotheface,scalp,mucousmembranesinthenose,mouth,andeyesVI EyemovementVII TasteinthefrontofthetongueVIII InnerearhearingandbalanceIX ReflexcontrolofheartandswallowingX Swallowing,breathing,speaking,heartbeat,anddigestionXI Swallowingandmovementthroughthedigestivetract;musclemovementsoftheuppershoulders,head,

andneckXII Tonguemuscles

Blood–Brain BarrierBlood–brainbarrier Preventsmoleculesfromenteringanddamagingthebrainbyachemicalreaction

CENTRAL NERVOUS SYSTEM


• The spinal cord is a pathway from the brain tothePNS.

REPRODUCTIVE SYSTEM• Productionofoffspringforthesurvivalofthespecies

SYSTEM ANATOMY FUNCTION

Autonomicnervoussystem

Sympatheticsystem

Parasympatheticsystem

Responsibleforunconsciousbodyfunctionssuchastheheartbeatandbreathing

Respondsinstressfultimeandshutsdownnonessentialsystemsduringa“fight-or-flight”situation

CounterbalancesthesympatheticsystemSomaticsystem Sendsmotorimpulsestotheskeletalmuscle

PERIPHERAL NERVOUS SYSTEM

OPHTHALMIC SYSTEM• Responsibleforprovidinganindividualwithvision

ANATOMY OF THE EYE FUNCTION

Orbit SocketthatcontainstheeyeConjunctiva AthintransparentmucousmembranethatcoverstheanterioreyeSclera ProtectivewhiteportionofeyethatcontainsfibersandmusclesIris ResponsibleforthecoloroftheeyeandfilterslightCornea AllowslightintotheeyeforvisualacuityPupil AllowstheproperamountoflighttoentertheeyeLens FocusestheimageRetina ContainsreceptorcellsthatareresponsibleforvisionLacrimalgland SecretestearsthatpossessantimicrobialenzymesOpticnerve Sendsimagesfromtheeyetothebrain

MALE REPRODUCTIVE STRUCTURES FUNCTION

Testicles ProductionandimmediatestorageofspermEpididymis ResponsibleforthestorageofmaturespermcellsProstate SecretesfluidnecessaryforthetransportofspermcellsUrethra Transportspermcellsandfluidforejaculationduringsexualintercourse

MALE REPRODUCTIVE SYSTEM

ANATOMY FUNCTION

Ovary ProducesovaFallopiantube TransportstheovamonthlywhereitmaybecomefertilizedUterus HousesthefertilizedeggMammaryglands UsedduringmilkproductionEndometrium Functionsasaliningfortheuterus,preventingadhesionsbetweentheopposedwallsofthemyometriumCervix Duringmenstruation,thecervixstretchesopenslightlytoallowtheendometriumtobeshedVagina Hastwomainfunctions,sexualintercourseandchildbirth

FEMALE REPRODUCTIVE SYSTEM


RESPIRATORY SYSTEM• Responsible for respiration and maintaining

homeostasis

THERAPEUTIC EQUIVALENCE

Adrugisdefinedasbeingtherapeuticallyequivalentifthedrug:• Containsthesamechemicalentity• Containsthesamequantityofactiveingredient• Isthesamedosageform• Hasthesamerouteofadministration

RESPIRATORY SYSTEM ANATOMY FUNCTION

Upper Respiratory SystemNoseNasalcavitiesCiliaPharynxLarynx

DetectssmellandservesasadrainagesystemfortearsfromtheeyesWarmsandmoistensinhaledairCatchsmallairparticlesTubethatissharedwiththedigestivesystemContainsthevocalcordsthatproducesound

Lower Respiratory SystemAlveolusTracheaBronchialtreeLungs

Siteofgas(oxygenandcarbondioxideexchange)Trapsparticlesandexpelsthem;providesapathwaytothelungsProvidesoxygendistributionandservesasapassagewaytothealveoliPromotesbreathing,whichincludesinspirationandexpiration

URINARY SYSTEM• Responsible for the excretion of chemicals and

substancesfromthebodysystem• Responsibleforcreatingandmaintaininghomeo-

stasisthroughoutthebody

• Maintainingchemicalcompositionofelectrolytes,fluids,andtissuesthroughoutthebody

• Preservingnormalbloodpressure• Productionerythropoietin

• Consists of two systems, the upper and lowerrespiratorysystem

ORGAN ANATOMY FUNCTION

KidneyUreter Carrieswasteproductsremovedfromthebloodtothebladder;carrieswastefromthe

kidneystothebladderBladder WasteproductsarestoredatthislocationuntileliminatedUrethra CarrieswasteproductsfromthebodyNephrons Responsiblefortheregulationoffluids,solutes,andwasteRenalartery CarriesbloodintothekidneyNephron Chieffunctionistoregulatetheconcentrationofwaterandsolublesubstancessuchassodium

saltsbyfilteringtheblood,reabsorbingwhatisneeded,andexcretingtherestasurineLoopofHenle Createsaconcentrationgradientinthemedullaofthekidney

PHARMACOLOGY

Pharmacologyisdefinedasthescientificstudyoftheactionofdrugsonalivingsystem.Amedicationinter-actswithreceptorsandproducesabiologicalresponse.

PHARMACOKINETICS

Pharmacokinetics involves the absorption, distribu-tion,metabolism,andelimination (excretion)of thedruginalivingsystem.


INTERACTIONS

DRUG–DRUG INTERACTIONS

Onedrugalters theactionofanotherdrug; interac-tionsincludeaddition,antagonism,potentiation,andsynergism.• Addition:Thecombinedeffectoftwodrugs;itis

equaltothesumoftheeffectsofeachdrugtakenalone.

• Antagonism: One drug works against the actionofanotherdrug.

• Potentiation:Onedrugincreasesorprolongstheeffect of another drug; the total effect is greaterthanthesumoftheeffectsofeachdrugalone(e.g.,VistarilandDemerol).

• Synergism: The joint action of drugs in whichtheircombinedeffectismoreintenseorlongerindurationthanthesumoftheeffectsoftwodrugs

DRUG–DISEASE INTERACTIONSVariousdiseasesmayinhibittheabsorption,metabo-lism,andeliminationofdifferentdrugs.Anexampleistakingdecongestantsifthepatientishashyperten-sionordiabetes.

DRUG–DIETARY SUPPLEMENT INTERACTIONSMany herbal and dietary supplements have devel-opeddruginteractionswithprescriptiondrugs.Vita-mins, glucosamine–chondroitin, fish oil, and coen-zymeQhaveinteractedwithwarfarin.Atotalof62%of herbal supplements used have had interactionswithwarfarin.

DRUG–OVER-THE-COUNTER DRUG INTERACTIONSVarious over-the-counter (OTC) medications mayeither increase or decrease the effects of a prescrip-tion medication. For example, aspirin can increasetheeffectofwarfarin,andantacidscandecreasetheeffectsofcimetidine.

DRUG–LABORATORY INTERACTIONSMany drugs used today have demonstrated theymayhaveaneffectonserumpotassiumandcreatinelevelsinthebody.Theseinteractionscanresultinad-ditionaltestingtodetectabnormalities.

DRUG–NUTRIENT INTERACTIONSPoornutritionmayaffectthemetabolismofvariousdrugs. An example of a drug–nutrient interactionoccurswhenwarfarinandvitaminKaretakensimul-taneously.

EXAMPLES OF DRUG–FOOD INTERACTIONS• Improvedabsorptionoccursifthefollowingdrugs

aretakenwithafattymeal:ketoconazole,nitrofu-rantoin,andgriseofulvin.

• Decreased absorption occurs if the followingdrugsaretakenwithfood:tetracycline,ciprofloxa-cin, etidronate, phenytoin, norfloxacin, zidovu-dine,levothyroxine,anddidanosine.

• Grapefruit juice affects the following drugs me-tabolized by cytochrome P450: calcium channelblockers,estrogens,cyclosporine,midazolam,andtriazolam.

• Warfarin interacts with foods high in vitamin K,suchasromainelettuceandspinach.Warfarinus-ersshouldconsultacardiologistorinternistforalistofthesefoods.

DRUG-RELATED PROBLEMS

• An event or situation involving drug therapythat actually or potentially interferes with theoptimumoutcome.Thesedrug-relatedproblemsinclude an untreated indication, improper drugselection, subtherapeutic dosage, failure to re-ceiveadrug,overdosage,anddrugusewithoutanindication.

PREGNANCY CATEGORIES

When pregnancy appears as a contraindication orprecautiontotheuseofadrug,itiscategorizedasbytheFoodandDrugAdministrationinoneoffivedif-ferentcategories:• Category A: Adequate studies in pregnant

womenhavefailedtoshowarisktothefetusinthe first trimester, and there is no risk in latertrimesters.

• Category B:Animalstudieshavefailedtoshowarisktothefetus,butnoadequatestudiesinpreg-nant women or animal studies have shown anadverseeffectbuthumanstudieshavenotshownarisktothefetusinthefirsttrimesterandthereisnoevidenceofriskinlatertrimesters.

• Category C: Animal studies have shown an ad-verseeffectonthefetusandtherearenoadequatestudiesinhumans,butthebenefitsmayoutweightherisks.

• Category D: Positiveevidenceofhumanfetalrisk,butthebenefitsoutweightherisks.

• Category X: Animalorhumanstudieshaveshownfetal abnormalities or toxicity, and the risk out-weighsthebenefits.


SULFONAMIDESMechanism of action (MOA): Interfere with para-aminobenzoic acid and folic acid formation andthusdestroybacteriaCommon indications: Urinary tract infections (UTIs),otitis media, ulcerative colitis, lower respiratoryinfectionsAdverse reactions: Photosensitivity resulting in sun-burns,rashes,nauseaandvomiting,jaundice,bloodcomplications,andkidneydamageContraindications/cautions:Hepaticorrenalimpairment

Special considerations

• Avoid direct sunlight or use sunscreens whenexposed.

• Drinkplentyofwatertopreventcrystallizationintheurine.

• Sulfamethoxazole–trimethoprim infusion fluidsneedtobestoredatroomtemperature.

WORD STEM CLASSIFICATION WORD STEM CLASSIFICATION

-astine Antihistamine -prazole Antiulcer-azepam Antianxiety -pril ACEinhibitor-caine Localanesthetic -sartan AngiotensinIIreceptorantagonist-cillin Penicillin -semide Loopdiuretic-conazole Systemicantifungal -setron Serotonin(5-HT3)antagonistestr- Estrogen sulfa- Sulfonamide-glitazone Antiabetic -terol Bronchodilator-micin Aminoglycoside -tidine H2receptorantagonist-thromycin Macrolide -e-triptyline;-amine Tricyclicantidepressant-olol Beta-blocker -oxetine Fluoxetine-typeantidepressant-olone Steroid -vastatin HMGCoAreductaseinhibitor-profen Antiinflamatory

ACE,Angiotensin-convertingenzyme.

AcompletelistingofthewordstemsissuedbytheU.S.AdoptedNamesCouncilcanbefoundinAppendixB.

CONDITIONS AND TREATMENTS FOR THE IMMUNE SYSTEM

Bacterial infections: Occur when the body’s immunesystem is unable to resist bacteria. Symptoms of abacterialinfectionincludeafevergreaterthan101°Fandanincreaseinwhitebloodcells.Multidrug-resistant infections: An infection caused bybacteriathatisresistanttooneormoredrugclassifi-cations.Someexamplesofmultidrug-resistantinfec-tionsincludethefollowing:• Methicillin-resistantStaphylococcus aureus(MRSA)• Vancomycin-resistantS. aureus(VRSA)• Multidrug-resistant Streptococcus pneumoniae

(MDRSP)• Gram-negativeresistantbacilli(GNRB)• Vancomycin-resistantenterococcus(VRE)Pneumonia:An infectionthatcausesacute inflamma-tion in theairwaysof the lung,blocking themwiththickmucus

GENERIC NAME BRAND NAME DOSAGE FORMS DOSAGE*

sulfamethoxazole–trimethoprim Bactrim,Septra Oralsuspension,tablet,IV 1tabPObidsulfadiazine Silvadene Cream Apply1–2timesadaysulfasalazine Azulfidine Tablet,enteric-coatedtablet,oralsuspension 1tabPOqid

EXAMPLES OF SULFONAMIDES

*Pleasenotethatalldosagesareforadultsandexpressedinoraldosagesunlessotherwiseindicated.

DRUG NOMENCLATURE

Adrugmayhavethreedifferentnames:• Chemical name: Determined by chemical struc-

tureofthedrugentity• Proprietary (brand or trade) name:Assignedbythe

drugmanufacturerandisprotectedthroughapatent

• Nonproprietary (generic) name: Assigned to amedication and contains a word stem that hasbeenissuedbytheU.S.AdoptedNamesCouncilKnowledgeofprefixes,rootwords,andsuffixesal-

lowsapharmacytechniciantoidentifythedrugclassi-ficationandsubsequentlyitsindication.Someofthesedrugprefixesandsuffixesencountereddailyinclude:


CEPHALOSPORINSMOA:PreventbacteriafromformingacellwallIndications:Dentalwork,heartandpacemakerproce-dures,orthopedicsurgery,pneumonia,upperrespi-ratoryinfections(URIs),andsinusinfectionsAdverse reactions: Diarrhea, hives, rash, wheezing,anaphylaxis

Contraindications/cautions: Hypersensitivity to penicil-lin, history of gastrointestinal (GI) problems, renalimpairmentSpecial considerations:Approximately10%ofthepop-ulationmayhaveacross-sensitivitytopenicillin.

PENICILLINSMOA:PreventbacteriafromformingacellwallCommon indications: Abscesses, meningitis, otitis me-dia,pneumonia,respiratoryinfections,prophylaxisAdverse reactions: Diarrhea, hives, rash, wheezing,anaphylaxis

Contraindications/cautions:Hypersensitivitytob-lactams,seizuredisorders,renalimpairmentSpecial considerations:Takeonanemptystomachwithwater;avoidtakingwithcolasorjuices.


amoxicillin Amoxil,Polymox Capsule,oralsuspension,chewabletablet 1cap/tabPOtidampicillin Omnipen Capsule,oralsuspension 1capPOqidamoxicillin1clavulanate Augmentin Chewabletablet,tablet,suspension 1tabPObiddicloxacillin Dynapen Oralsuspension,oraltablet,chewabletablet 1capq6hpiperacillin None Powderforinjection 3–4gIM/IVq4–6hpiperacillin1tazobactam Zosyn Powderforinjection,solutionforinjection 3.375gIVq6hfor7–10dayspenicillin Veetids Tablet,oralsuspension 1tabPO4timesadayfor10daysticarcillin–clavulanate Timentin IV 3.1gIVq4–6h

PENICILLINS



cefaclor Ceclor Capsule,oralsuspension,extended-releasetablet 1capPOq8hcefdinir Omnicef Capsule,oralliquid 1capPOq12hfor10dayscefixime Suprax Oralsuspension,tablet 1tabPOdailycefepime Maxipime Injection(IV) 1–2gIVq12hcefpodoxime Vantin Oralsuspension 100–400mgPObidcefadroxil Duricef Capsule,oralsuspension,tablet 1–2gPOdivq12–24hceftaroline–fosamil Teflaro IV 600mgIVq12h35–7daysceftibuten Cedax Oralsuspension,capsule 1tabPOqdceftriaxone Rocephin IM,IV 1–2gIM/IVq24hcefuroxime Ceftin,Zinacef IM,IV,oralsuspension,tablet 1tabPObid310dayscephalexin Keflex Capsule,oralsuspension,tablet 1capPOqidcefprozil Cefzil Oralliquid,capsule 1capPOq12h310days

CEPHALOSPORINS


CARBAPENEMS AND MONOBACTAMSMOA:InhibitbacterialcellwallsynthesisIndications:Gram-positiveandgram-negativebacteriaContraindications/cautions:Hypersensitivitytomultipleallergens,seizurehistory,CNSdisordersAdverse reactions:Sameaspenicillinandcephalospo-rin,butthereisanincreasedpossibilityofseizures.

GENERIC NAMEBRAND NAME

DOSAGE FORM DOSAGE*

ertapenem Invanz Injection(IV) 1gIM/IVqd35–14days

imipenem–cilastatin

Primaxin Injection(IV) 250–500mgIVq6h

CARBAPENEM AGENTS



TETRACYCLINESMOA:InhibitproteinsynthesisinbacteriabybindingribosomesIndications: Acne, chronic bronchitis, Lyme disease,RockyMountain spotted fever, “walking”pneumo-nia,prophylaxisfortraveler’sdiarrheaAdverse reactions: GI, such as nausea and vomiting;photosensitivity tosunlight, resulting inrashesandsunburns

Contraindications/cautions: Pregnancy, renal or hepaticimpairment

Special Considerations

• May bind to antacids and dairy productsand therefore decrease the effectiveness of theantibiotic

• Tetracyclinesshouldbetakenseveralhoursapartfrom antacids and dairy products because of thepossibilityofchelation.

• They should not be taken by pregnant womenbecauseofthepossibilityofdentalbirthdefects.

• Childrenyoungerthan9yearsshouldnotbegiventetracyclines.

• Takingexpiredtetracyclinemayresult in toxicityandpossiblydeath.

• Doxycyclineshouldbeprotectedfromlight.


doxycyclinehyclate Vibramycin Capsule,IV,oralsuspension,tablet 100mgPOqddoxycyclinemonohydrate Monodox Tablet 100mgPOqdminocycline Minocin Capsule,IV,oralsuspension,tablet 100mgPOq12htetracycline Sumycin Capsule,oralsuspension,topical 1–2g/dayPOdivbid–qid

TETRACYCLINES


MACROLIDESMOA: Inhibit protein synthesis by interacting withribosomesIndications: Pulmonary infections, chlamydia, Hae-mophilus influenzaeAdverse reaction:MaycauseGIdistressContraindications/cautions: Hepatic or renal impair-ment,QTprolongation


• Thepatientshouldtakemacrolideswithfood.• Clarithromycinmayleaveametallictasteinone’s

mouth.• Thefirstdoseofazithromycinisaloadingdose.

GENERIC NAME

BRAND NAME

DOSAGE FORM DOSAGE*

aztreonam Azactam IV 1–2gIM/IVq8–12h

MONOBACTAM AGENT



azithromycin Zithromax Capsule,oralsuspension 500mgPO31onday1;then250mg/day34days

clarithromycin Biaxin Granulesfororalsuspension,film-coatedtablet

250–500mgPOq12h37–14days

erythromycinbase Eryc,E-Mycin,Ery-Tab

Capsule,tablet,enteric-coatedtablet,film-coatedtablet

1000mg/dayPOdivq6–12h

erythromycinethylsuccinate E.E.S. Oralsuspension,tablet,chewabletablet 1600mg/dayPOdivq6–12herythromycinstearate Erythrocin Film-coatedtablet,IM,IV 1000mg/dayPOdivq6–12herythromycin–sulfisoxazole Pediazole Oralsuspension 40–50mg/kg/dayPOdivq6–8herythromycinlactobionate Erythrocin IV 15–50mg/kg/dayIVdivq6h

MACROLIDES



KETOLIDESMOA:Blockproteinsynthesisbybindingtoribosomalsubunits;mayinhibittheformationofnewlyformingribosomesIndications: Used to treat bacterial infections in thelungsandsinusesAdverse reactions:Blurredvision;sideeffectssimilartothoseofmacrolidesContraindications/cautions: Myasthenia gravis, hyper-sensitivity to macrolides, hepatic impairment, QTprolongation

QUINOLONESMOA:AntagonizeanenzymerequiredforDNAsyn-thesis,causingDNAbreakageandfinallydeathIndications: Bone and joint infections, dental work,infectiousdiarrhea,URIs,andUTIsAdverse reactions: Nausea and vomiting, joint swell-ing,dizzinessContraindications/cautions: Myasthenia gravis, patientsyoungerthan18yearsofage,andpatientsolderthan60yearsofage


• Antacidsinterferewithabsorption.• Potentiatestheeffectoftheophyllineproductsand

maycausetoxicity• Causephototoxicity• Shouldnotbegiventopregnantwomen• Ciprofloxacin injection should be protected

fromlight.• Ofloxacin injection needs to be protected

fromlight.


DOSAGE FORM

DAILY DOSAGE*

telithromycin Ketek Tablet 800mgPOqd37–10days

KETOLIDE AGENT



ciprofloxacin Cipro Tablet,oralsuspension,ophthalmic,IM,IV 250–750mgPOq12hlevofloxacin Levaquin IV,tablet 500mgPO/IVq24h37daysmoxifloxacin Avelox,Vigamox Tablet,IV(Vigamox—ophthalmicuseonly) 400mgPO/IVq24h35–14daysnorfloxacin Noroxin Tablet 400mgPObidofloxacin Floxin,Ocuflox Tablet,ophthalmic 200–400mgPOq12h

QUINOLONE AGENTS


STREPTOGRAMINSMOA:InhibitbacterialproteinsynthesisIndications: Gram-positive infections, Enterococcus faecium, and vancomycin- and methicillin-resistantinfectionsAdverse reactions: Nausea, vomiting, joint swelling,dizziness.Thereisapossibilityofanadversereactionoccurringatthesiteofinfusion.

Contraindication/caution: Hypersensitivity to drug,class,orcomponent


• Synercidshouldnotcomeintocontactwithsalineor other medications. It must be stored in therefrigerator.

GENERIC NAME BRAND NAME DOSAGE FORM DOSAGE*

Quinupristin–dalfopristin Synercid IV 7.5mg/kgIVq8h

STREPTOGRAMIN AGENT



AMINOGLYCOSIDESMOA:InhibitbacterialproteinsynthesisIndications:Life-threatening infections,sepsis, immu-nocompromisedpatientsAdverse reactions:Nephrotoxicity,ototoxicity,tinnitus,permanentdeafnessContraindications/cautions: Neuromuscular blockade,nephrotoxicity,neurotoxicity


• Doses need to be adjusted for each patient afterthefirstdoseandcloselymonitored,especiallyinpatientswithrenalimpairment.

• Once-per-day dosage has the tendency toreduce toxicity; however, monitoring is stillrequired.


gentamicin Garamycin Cream,IM,IV,ophthalmic 1–1.7mg/kgIM/IVq8hstreptomycin Streptomycin IM 1–2g/dayIMq6–12htobramycin Nebcin IV,ophthalmic,inhaler 1–1.7mg/kgIM/IVq8h

AMINOGLYCOSIDE AGENTS


CYCLIC LIPOPEPTIDESMOA:Bindtobacterialmembranesandcausethecellmembranetodepolarize,resultinginaninhibitionofDNAandRNAsynthesisIndications:Used to treat complicated skin infectionsandaerobicgram-positivebacterialinfectionsAdverse reactions: Hypotension, headache, insomnia,allergicsitereactionsContraindication/caution:ElderlypatientsSpecial consideration: Should not be taken with3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA)reductaseinhibitors

CYCLIC LIPOPEPTIDE


DOSAGE FORM DOSAGE*

daptomycin Cubicin IV 4mg/kgIVq24h37–14days


MISCELLANEOUS ANTIBIOTICS

Clindamycin (Cleocin)MOA:InhibitsproteinsynthesisIndications: Acne, dental prophylaxis for penicillin-allergicpatients,infectionscausedbyanaerobicorgan-isms,boneinfections,femalegenitalinfectionsAdverse reaction: BloodydiarrheaContraindications/cautions: Clostridium difficile–associateddiarrhea,ulcerativecolitis,hepaticorrenalimpairmentSpecial consideration: Should be avoided duringpregnancy

Metronidazole (Flagyl)

MOA:Destroyspartsofthebacteria’sDNAnucleusIndications: Trichomonas infections of vaginal canal,cervix, andmaleurethra; amebicdysentery; intesti-nalinfectionsAdverse reactions: Metallic taste, diarrhea, rash, and“Antabuse-likereaction”whenalcoholisconsumed.AnAntabuse-like reaction results in blurred vision,confusion,difficultbreathing,hotandscarletface,anintense throbbing in the head and neck, and chestpains.Contraindications/cautions:Pregnancy,blooddyscrasiasSpecial consideration: Take with food, and avoid anyformofalcohol1daybefore,during,and2daysaftertherapywithmetronidazole.

Pentamidine (NebuPent, Pentam)

MOA:UnknownIndication:IndicatedforthetreatmentofPneumocystis cariniiinfectionAdverse reactions:Hypotension,wheezing,coughingContraindications/cautions:Hypertension,tachycardiaSpecial consideration: If themedication is inhaled, thedosemustbedilutedwithsterilewateranddeliveredatarateof6mL/minbyanebulizer.

Linezolid (Zyvox)

MOA:InhibitsbacterialproteinsynthesisIndications:Usedtotreatmethicillin-resistantS. aureusandvancomycin-resistantE. faeciumandothergram-positiveinfectionsContraindications/cautions: Thrombocytopenia, uncon-trolledhypertension



• Theintravenous(IV)formmustbeprotectedfromlightandcannotbeadministeredwithothermed-ications.

• Avoidfoodsthatarehighintyramine.

Vancomycin (Vancocin)

MOA: InterfereswithbacterialwallformationIndications: Dialysis patients, endocarditis, staphylo-coccusinfectionsAdverse reactions: Red man syndrome, ototoxicity,nephrotoxicity,neutropeniaContraindications/cautions: Renal impairment, inflam-matoryboweldiseaseSpecial considerations:Bloodureanitrogenorcreatineifrenalimpairment• Potential for overuse prompted the Centers for

Disease Control and Prevention to issue specificguidelinesforuse

• Patientneedstobekepthydrated.

ANTIFUNGALSFungal infections: Caused by single-cell organismsthatdonothavechlorophyll,possessacellwall,and

reproducebyspores.Fungusdevelopsinindividualswhoseimmunesystemshavebeencompromisedbydisease,drugtherapy,orpoornutrition.Tinea infections:AfungalinfectionoftheskinorfeetMOA:Preventsynthesisofergosterolandinhibitfun-galcytochromeP450Adverse reactions:Livertoxicitiesmaydevelop;there-fore, liver function tests are recommended. GI dis-tressmayoccur.Photosensitivity,rashes,andnauseaareothercommonsideeffects.


• Antifungalsmaybeusedaseithertopicalorsys-temicagents.

• Pulse dosing is recommended for nail fungalinfections.

• Consuming a cola before taking itraconazole isrecommended.

• Fattymealsshouldbetakenwithgriseofulvin.• Fluconazole suspension should be refrigerated

andexpiresin14days.

GENERIC NAME BRAND NAME(S) DOSAGE FORMS DAILY DOSAGE* RX or OTC

amphotericinB Amphotec,Fungizone,Amphocin

IV,topical 3–4mg/kg/dayIV

butenafine Mentax Topicalcream Apply1–2timesadayfor7–14days

RXandOTC

ciclopirox Loprox Topical Applytwiceadayfor1–4weeksclotrimazole Lotrimin Oraltroche,topical,vaginal 10mgPO53day314days RX:troche

OTC:creamclotrimazole–

betamethasoneLotrisone Cream Applybid

fluconazole Diflucan IV,tablet,oralsuspension 100mgPO/IVqdgriseofulvin Grisactin,Fulvicin,

Gris-PEGCapsule,tablet,oral

suspension500mgPOqd32–4wk

itraconazole Sporanox Capsule,oralsuspension 200mgPObid37days;off21days

ketoconazole Nizoral Tablet,topicalcream,shampoo

200–400mgPOqd

miconazole Monistat Topical,vaginal Variesbecauseofdosageandcondition

OTC

nystatin Nilstat Tablet,oralsuspension,topical,vaginal

4–6mLPOqd;1–2tabsPOtid

oxiconazole Oxistat Cream,lotion Apply1–2timesadayfor14days

sertaconazole Ertaczo Cream Applytwiceadayfor4wksulconazole Exelderm Cream Apply1–2timesadayterbinafine Lamisil Tablet,topicalcream,

solution1tabPOqd36–12wk

terconazole Terazol Vaginalcream,suppository 1applicator(supp)vaghs33–7days(dependingondosage)

voriconazole Vfend IV,oralliquid,tablet 1tabPO1hacorpc;3mg/kg/hinfusedover1–2h(IV)

ANTIFUNGAL AGENTS



ANTIVIRALSViral infections: Causedbyagentssmallerthanbac-

teria,whicharenormallyspreadbydirectcontact,ingestion of contaminated food and water, orinhalation of airborne particles. Viral infectionsmaybeacute,chronic,orslowinnature,andtheinfectionmaybelocalorgeneralized.Theirsymp-tomsaremoreseverethaninbacterial infectionsand include malaise, myalgia, headaches, chills,orfever.

Herpes: Anoutbreakoftheskinthatcausespainfulblister-likeeruptionsandiscausedbyavirus

Influenza: Arespiratorytractinfectioncausedbyaninfluenzavirus

MOA: InhibitpenetrationofthehostcellIndications: Cytomegalovirus retinitis, genital herpes,herpessimplex,herpessimplexkeratitis,herpeszoster(shingles), influenza prophylaxis, organ transplants,varicella,chickenpoxAdverse reactions: Headaches,nausea,vomiting,diar-rhea,constipation,renaldisordersContraindications/cautions: Renal or hepatic impair-ment,electrolyteimpairments


• Oralproductsshouldbetakenwithplentyofwater.• Whenacyclovirisreconstituted,theinjectionsolu-

tionshouldbeusedwithin12hours.


acyclovir Zovirax Capsule,tablet,oralsuspension,IV,ointment

200–800mgq4h5timesdailyfor7–10days

amantadine Symmetrel Capsule,syrup 200mgPOqdcidofovir Vistide IV 5mg/kgIVover1hfamciclovir Famvir Tablet 200–1000mgPOqdfoscarnet Foscavir IV 90mg/kg(over1–1½h)q12hganciclovir Cytovene Capsule,IV 5mg/kgover1hq12hfor14–21daysoseltamivir Tamiflu Capsule,oralliquid 75mgbid35dayspenciclovir Denavir Cream Applyq2hduringwakinghours34daysrimantadine Flumadine Tablet 100mgbid37daysribavirin Virazole Aerosolinhalant Continuousaerosoladministrationfor12–18hfor

3–7daysvalacyclovir Valtrex Caplet Dosagevariesbyconditionbeingtreatedvalganciclovir Valcyte Tablet,oral 900mgbid321dayszanamivir Relenza Inhalant 10mgbid35days

ANTIVIRAL AGENTS


ANTIRETROVIRALSHuman immunodeficiency virus (HIV): A blood-

borne sexually transmitted viral disease thatcauses the host to become too weak to fight anyinfection

Acquired immunodeficiency syndrome (AIDS): Anend-stage disease that occurs as a result of HIVwhen the CD4 T-cell count is less than 200 permicroliterofblood

Indication:LimitstheprogressionoftheretrovirusthatcausesHIV,whichmayprogresstoAIDS

Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

Indication: AssistinthetreatmentofHIVdiseaseMOA:Inhibitthereleaseofneuraminidase,aviralen-zyme, toprevent the spreadof thevirus tohealthycells.NRTIsbindandinhibittheactionofneuramin-idase. This results in the formation of a defectiveproviralnucleus,whichisunabletobecomepartofthehostcell’snuclei.Contraindications/cautions: Pancreatitis,lacticacidosisAdverse reactions: Nausea, vomiting, peripheralneuropathySpecial consideration: Shouldnotbeusedduringlactation


abacavir(ABC)† Ziagen Solution,tablet 300mgPObidor600mgPOqddidanosine(ddI)† Videx,VidexEC Capsule,tablet,powder 200mgPObidemtricitabine(FTC)† Emtriva Tablet 200mgPOqdlamivudine(3TC)† Epivir Tablet,solution 150mgPOqdor300mgPOqdstavudine(d4T)† Zerit Capsule,powder 30–40mgPOqd

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs)


Nonnucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Indications: AidinthetreatmentofHIVdiseaseMOA: Inhibittheactionofneuraminidasebyprevent-ingtheformationoftheproviralDNAAdverse reactions: Dizziness,headache, rashes,night-mares,hallucinations,hepatotoxicityContraindication/caution: Hepaticimpairment


• Druginteractionsarecommon.• Can induce or inhibit the cytochrome P450

systems• Resistance to one NNRTI results in resistance to

theothers.


tenofovir(TDF)† Viread Tablet 300mgPOqdzalcitabine(ddC)† Hivid Tablet 0.75mgPOq8hzidovudine(AZT)† Retrovir Capsule,syrup,IV 600mgPOqdindivdosesabacavir-lamivudine Epzicom Tablet 1tabPOqdemtricitabine–tenofovir Truvada Tablet 1tabPOqdzidovudine–lamivudine(CBV)† Combivir Tablet 1tabPObidzidovudine–lamivudine–

abacavir(TRZ)†Trizivir Tablet ItabPObid

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs)—cont’d

*Pleasenotethatalldosagesareforadultsandexpressedinoraldosagesunlessotherwiseindicated.†BothTheJointCommissionandtheInstituteforSafeMedicationPracticesareagainsttheusingofabbreviationsformedications;however,physiciansmaystillusetheseabbreviations.


delavirdine(DLV)† Rescriptor Capsule,tablet 1–2tabPOtidetravirine Intelence Tablet 200mgPObidefavirenz(EFZ)† Sustiva Capsule 600mgPOqdnevirapine(NVP)† Viramune Capsule,tablet 1tabPOqd314days,then1tabPObid

NONNUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs)

*Pleasenotethatalldosagesareforadultsandexpressedinoraldosagesunlessotherwiseindicated.†BothTheJointCommissionandtheInstituteforSafeMedicationPracticesareagainsttheusingofabbreviationsformedications;however,physiciansmaystillusetheseabbreviations.

Protease Inhibitors

Indication: AssistinthetreatmentofHIVMOA: PreventthecleavageofcertainHIVproteinpre-cursors, which are necessary for the replication ofnewviruses

Adverse reactions: Redistribution of body fat (“prote-ase paunch,” humped back), facial atrophy, breastenlargement,hyperglycemia,hyperlipidemiaContraindications/cautions: Nephrolithiasishistory,dia-betes,hepaticimpairment


amprenavir Agenerase‡ Capsule,oralliquid 1200mgPObidatazanavir Reyataz Capsule 300–400mgPOqdfosamprenavir(FPV)† Lexiva Tablet 700–1400mgPOqd–bidindinavir(IDV)† Crixivan Capsule 2capsPOq8hlopinavir–ritonavir(LPV/r)† Kaletra Solution,capsule 3–6capsPOqd–bidnelfinavir(NFV)† Viracept Powder,tablet 750mgPOtidor1250mgPObidritonavir(RTV)† Norvir Solution,capsule 600mgPObidsaquinavir(SQV-SGC)† Invirase Capsule 1000mgPObidtipranavir Aptivus Capsule 500mgPObid

PROTEASE INHIBITORS

*Pleasenotethatalldosagesareforadultsandexpressedinoraldosagesunlessotherwiseindicated.†BothTheJointCommissionandtheInstituteforSafeMedicationPracticesareagainsttheusingofabbreviationsformedications;however,physiciansmaystillusetheseabbreviations.‡BrandisnolongeravailableintheUnitedStates.


Fusion Inhibitor

Indication: AidsinthetreatmentofHIVMOA: Prevents AIDS virus from entering immunecellsAdverse reactions: Skin reactions, which may causebruising,cysts,itching,bumps,pain,andredness

Contraindication/caution: Pulmonarydisease


• TheproducthasapregnancycategoryBrating.• Itisdilutedwithsterilewater.


enfuvirtide Fuzeon SCinjection 90mgSCbidmaraviroc Selzentry Tablet 300mgPObid

FUSION INHIBITORS


ANTIPROTOZOAL AGENTSIndications: Malaria,extraintestinalamebiasisMOA: Unknown

Adverse reactions: Nauseaorvomiting,anorexia,diar-rhea,abdominalpainContraindications/cautions: Retinal field changes, long-termusage


chloroquine Aralen Tablet 500mgpoqwkiodoquinol Yodoxin Tablet 650mgpotid320daysmefloquine † Tablet 250mgpoqwkmetronidazole Flagyl Tablet 750mgpotid35–10dayspraziquantel Biltricide Tablet 54–25mg/kgpo31doseprimaquine Primaquine Tablet 30mgpoqd314dayspyrimethamine Daraprim Tablet 25mgpoqwk310wk

ANTIPROTOZOAL AGENTS

*Pleasenotethatalldosagesareforadultsandexpressedinoraldosagesunlessotherwiseindicated.†Nolongeravailableasabrandeddrug.

ANTIHISTAMINES, ANTITUSSIVES, DECONGESTANTS, AND EXPECTORANTSAllergies:Aresponseofourimmunesystemdueto

anunrecognizedsubstanceRhinitis: An irritation and inflammation of the

mucousmembranesliningthenasalpassages

Antihistamines

Indications: Treatment of allergies, insomnia, rashes,hay fever, dizziness; prophylaxis for drug reactionsandallergies

MOA: Blockthereleaseofhistamine(H1)intherespi-ratorysystemAdverse reactions: Drowsiness, anticholinergic reac-tions such as drying up of body fluids, possiblehyperactivityinchildrenContraindication/caution: Renalimpairment


• Antihistamines have a synergistic effect withalcohol.

GENERIC NAME BRAND NAME DOSAGE FORMS DOSAGE* RX OR OTC

azelastine Astelin Spray 1–2sprayspernostrilbidbudesonide RhinocortAqua Nasalspray 1–4sprays/nostrilqdcetirizine Zyrtec Tablet 5–10mgPOqd OTCchlorpheniramine Chlor-Trimeton Tablet,capsule 1tabPOq4–6hprn OTCciclesonide Omnaris Nasalspray 2sprayspernostrilqdclemastine Tavist Tablet 1tabPOq12hprn OTCcyproheptadine † Tablet,syrup 1tabPOtiddexamethasone Decadron Tablet,elixir Dosingvariesbyconditiondiphenhydramine Benadryl Capsule,tablet,topical,elixir,strips 1–2tabs/caps/stripsPOq4–6h RXandOTC

ANTIHISTAMINES


AntitussivesIndication: TreatmentofcoughMOA: DepressionofthecoughcenterorsuppressionofnervereceptorsinrespiratorysystemAdverse reactions: CNSdepression,nausea,lightheaded-nessContraindication/caution: CNSdepression


• Dextromethorphaninteractswithmonoamineoxi-daseinhibitors(MAOIs).

• Benzonatateshouldbeswallowedbutnotchewed.


fexofenadine Allegra Tablet 1tabPObid OTCfluticasone Flonase Nasalspray 2spraypernostrilperdayhydroxyzineHCl † Tablet,capsule,syrup,IM,IV 1tabPOtid–qidhydroxyzinepamoate Vistaril Capsule,syrup 1capPOtid–qidloratadine Claritin Tablet,syrup 1tabPOqd OTCmeclizine Antivert,Bonine Tablet,capsule,chewabletablet 1tabPOtid–qid OTCmometasone Nasonex Nasalspray 2sprayspernostrilqdolopatadine Patanol Ophthalmicsolution 1gttineyebidpromethazine † Tablet,syrup,suppository,IM,IV 25mgbidtriamcinolone NasacortAQ Nasalspray 1–2spraysqnostrilqd

ANTIHISTAMINES—cont’d



benzonatate TessalonPerles Capsule 1capPOtidprncoughcodeine Codeine Tablet,elixir 15–60mgPOq4hdextromethorphan Benylin,Delsym,Hold,

RobitussinDMSyrup,lozenges 10mLPOq12hprn OTC

hydrocodone–homatropine † Syrup,tablet 1tabor1tspPOq4–6hpromethazine–codeine † Oralliquid 1tspPOq4–6hpromethazine–

dextromethorphan

† Oralliquid 1tspPOq4–6h

ANTITUSSIVES


Decongestants

Indications: Temporaryreliefofnasalcongestionfromthe common cold, sinusitis, and upper respiratoryallergiesMOA: Stimulation of the a-adrenergic receptors, re-sulting in constriction of the dilated arteries withinthenasalmucosaAdverse reactions: CNS stimulation, increased bloodpressure, increased heart rate, insomnia, anxiety,tremor,rhinitismedicamentosa,andheadache

Contraindications/cautions: Urinary retention, coronaryarterydisease,uncontrolledhypertension


• Decongestants should be avoided if the patienthas diabetes, heart disease, hypertension, hyper-thyroidism, prostatic hypertrophy, or Tourettesyndrome.


oxymetazoline Afrin Nasaldrops,spray/mist 2–3spraysqnostrilq10–12hprn OTCphenylephrine Neo-Synephrine,

Neo-SynephrineIINasaldropsandspray 2–3spraysqnostrilprn OTC

pseudoephedrine Sudafed Capsule,tablet,oralsolution 1tabPOq6h OTCsoldbehindthecounter

DECONGESTANTS



Expectorants

Indications: To remove mucus from both lungs andairwaypassagesduringcoughingMOA: DecreasethicknessofmucusbydecreasingtheviscosityoftheliquidAdverse reactions: Nausea and vomiting, drowsiness,GIdistress

Contraindications/cautions: Nephrolithiasis, patientsyoungerthan6yearsofageSpecial consideration: Patientshouldconsumeplentyofwaterwhiletakingmedication.


guaifenesin Mucinex Capsule,caplet,liquid,tablet 1tspPOq4–6h OTC

EXPECTORANT


GENERIC NAME BRAND NAME DOSAGE FORM DOSAGE* RX OR OTC

chlorpheniramine/hydrocodone TussionexPennKinetic Suspension 5mLq12hguaifenesin–codeine RobitussinA-C Liquid 1tspPOq4–6hprncough Exemptnarcoticguaifenesin–pseudoephedrine MucinexD Tablet 2tabPOq12h OTCpromethazine–codeine Phenergan/codeine Syrup 5mLPOq4–6h

COMBINATION EXPECTORANTS


GENERIC NAME BRAND NAME DOSAGE FORM DOSAGE* RX OR OTC

cetirizine–pseudoephedrine Zyrtec-D Tablet 1tabPOq12h OTC(behindthecounter)fexofenadine–pseudoephedrine Allegra-D Tablet 1tabPOq12h OTC(behindthecounter)loratadine–pseudoephedrine Claritin-D Tablet 1tabPOq12h OTC(behindthecounter)

COMBINATION DECONGESTANTS



CONDITIONS AND TREATMENTS FOR THE NERVOUS SYSTEM

Anxiety: A state of uneasiness characterized byapprehension and worry about possible eventsresulting from either exogenous or endogenousstress

Panic disorders: Intense anxiety characterized by asense of fear, apprehension, or a premonition ofseriousillnessoralife-threateningattack

MOA for Antianxiety Agents

Adverse reactions: May cause either physical or psy-chological dependence, drug accumulation, birth

defectsiftakenduringearlypregnancy,musclerelax-ation,sedation,anddepressionContraindications/cautions:Pulmonaryimpairment,sleepapnea,CNSdepression,seizurehistory


• Many agents used to treat anxiety are controlledsubstances;therefore,federalandstatecontrolledsubstancelawsmustbeobeyed.

• Shouldbetaperedondiscontinuation

GENERIC NAME BRAND NAME DOSAGE FORMS DOSAGE* CONTROLLED SUBSTANCE

alprazolam Xanax Tablet 0.25–0.5mgPOtid Yesamoxapine † Tablet 100mgPObid–tid Nobuspirone BuSpar Tablet 20–30mgPOqd Nochlordiazepoxide Librium Capsule,injection 5–10mgPOtid–qid Yesclorazepate Tranxene Capsule,tablet 15–60mgPOqdindivideddoses Yesdiazepam Valium Tablet,injection 2-10mgPObid–qid Yeslorazepam Ativan Tablet,IM,IV 2–3mgPOqdindivideddoses Yesmeprobamate † Tablet 1200–1500mgPOindivideddoses Yesoxazepam Serax Capsule,tablet 10–15mgPOtid–qid Yes

ANTIANXIETY AGENTS


Depression:Psychiatricdisorderthatmaybecausedbychanges inneurotransmitters (e.g.,dopamine,norepinephrine,orserotonin)inthebrain;symp-tomsincludealossofinterestinnormalactivities,lowself-esteem,pessimism, self-pity,weight lossorgain,insomnia,lossofenergy,feelingsofworth-lessness,feelingsofguilt,orrecurrentthoughtsofdeathorsuicide

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)Indications: Major depression, obsessive-compulsivebehavior,anxiety

MOA:BlockthereuptakeofserotoninAdverse reactions:Nervousness,insomnia,nausea,di-arrhea, loss of weight, decreased libido, ejaculatorydisturbancesContraindications/cautions: Pregnancy, elderly patients,hepaticimpairment


• DelayofonsetforSSRIsis10to21days.• Alcoholshouldbeavoided.• Thesedrugsinteractwithphenytoin.


citalopram Celexa Tablet,liquid 20–40mgPOqamescitalopram Lexapro Tablet 10mgPOqamfluoxetine Prozac Capsule,liquid 20–80mgPOqamfluvoxamine Luvox Tablet 50mgPOqhsparoxetine Paxil Tablet 20–50mgPOqamsertraline Zoloft Tablet 50mgPOqam

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)



SELECTIVE SEROTONIN AND NOREPINEPHRINE REUPTAKE INHIBITORS (SSNRIs)MOA:InhibitnorepinephrineandserotoninreuptakeIndications:Majordepressivedisorder,diabeticneuro-pathicpain,generalizedanxietydisorder

Adverse effects: Suicidality, hypomania, withdrawalsyndromeContraindications/cautions:Hepaticimpairmentordisease


desvenlafaxine Pristiq Tablet 50mgPOqdduloxetine Cymbalta Capsule 40–60mgPOqamvenlafaxine Effexor Timed-releasecapsule 75–150mgPOwithfood

SELECTIVE SEROTONIN AND NOREPINEPHRINE INHIBITORS (SSNRIs)


TRICYCLIC ANTIDEPRESSANTS (TCAs)Indications:Depression,nocturia(bedwetting)inchildrenMOA:BlockreuptakeofnorepinephrineorserotoninAdverse reactions:Cardiotoxic inhighdoses,posturalhypotension in elderly adults, drowsiness, anticho-linergiceffects

Contraindications/cautions:Myocardialinfarction,elderlypatientsSpecial consideration:Noticeableresultsmaynotoccurforseveralweeks.


amitriptyline † Tablet,injection 75–150mgPOqdindivideddosesclomipramine Anafranil Capsule 25–100mgPOqhsdesipramine Norpramin Tablet 100–200mgPOqddoxepin Sinequan,Zonalon Capsule,oralliquid,cream 75–150mgPOqdimipramine Tofranil Capsule,tablet,injection 75–150mgPOqdnortriptyline Pamelor,Aventyl Capsule,oralsolution 25mgPOtid–qidprotriptyline Vivactil Tablet 15–40mgPOqdindivideddoses

TRICYCLIC ANTIDEPRESSANTS (TCAs)


MONOAMINE OXIDASE INHIBITORS (MAOIs)Indication:AtypicaldepressionMOA: Inhibit enzymes that break down catechol-aminesAdverse reaction:PossiblehypertensionContraindications/cautions: General anesthesia within10days,electivesurgerywithin10days,congestiveheartfailure


• Ifphysicianchangestherapy,MAOIsshouldbedis-continuedfor2weeksbeforenewtherapybegins.

• Patients should avoid certain foods containingtyramine(agedcheeses,certainwines,andcertainyeastproducts).

• MAOIs should not be taken if the patient istaking ephedrine, amphetamine, methylpheni-date,levodopa,ormeperidine.


phenelzine Nardil Tablet,patch 15mgPOtidselegiline Eldepryl Tablet,patch 5mgPOwithbreakfastandlunchtranylcypromine Parnate Tablet,patch 30mgPOqdindivideddoses

MONOAMINE OXIDASE INHIBITORS (MAOIs)



BIPOLAR AGENTSBipolar disease: Depressive psychosis, alternating

between excessive phases of mania and depres-sion. Mania may be characterized by exhibitingthreeof the followingsymptoms: increasedneedforsleep,distractibility,elevatedorirritablemood,excessive involvement in pleasurable activitieswithapotentialforpainfulconsequences,grandi-ose ideas, increase in activity, pressure to keeptalking,andracingthoughts.

MOA:UnknownAdverse reactions: Bloating and abdominal distress,bloody stools, acne, leucocytosis, hand tremor, in-creasedbodyweight,polyuria,polydipsia,nocturia,abnormaldevelopmentoffetusduringpregnancy

Contraindications/cautions: MAOI use within 10 days,bonemarrowdepression


• Blood levels must be established for patientstakinglithiumandshouldbeintherangeof0.6to0.8mg/mL.

• Salt content must be monitored and alcoholavoided.

• Carbamazepineinteractswithbenzodiazepines,ci-metidine, corticosteroids, cyclosporine, diltiazem,doxycycline, erythromycin, ethosuximide, isonia-zid, MAOIs, oral contraceptives, phenytoin, pro-poxyphene, theophylline, thyroid medications,TCAs,valproicacid,verapamil,andwarfarin.


carbamazepine Tegretol Tablet,chewabletablet,suspension

200mgPOtid–qid

divalproex Depakote,DepakoteER Tablet 2540–500mgPOtidlamotrigine Lamictal,LamictalER Tablet 200mgPOqdlithium Lithobid Capsule,tablet 900–1200mg/dayPOdivbid/tidolanzapine–fluoxetine Symbyax Capsule 1capPOqamvalproicacid Depakene Capsule,syrup,IV 250–500mgPOtid

EXAMPLES OF BIPOLAR AGENTS


ANTIPSYCHOTIC AGENTSNeurosis: A mental disorder arising from stress or

anxietyinthepatient’senvironmentwithoutlossofcontactwithreality

Phobias: A continuous irrational fear of a thing,place, or situation that causes significantdistress

Psychosis:A chronic psychotic disorder manifestedbyaretreatfromreality,delusions,hallucinations,ambivalence, withdrawal, and bizarre or regres-sivebehavior

Schizophrenia: Chronic psychotic disorder charac-terizedbyaretreatfromreality,delusions,halluci-nations, ambivalence, withdrawal, or regressivebehavior

MOA: BlockDopamine(D2)receptorsinthedopaminepathwaysofthebrain

Adverse reactions:Sedation,anticholinergicresponses,posturalhypotension,excessivetanning,hyperglyce-mia, lack of menses, nonreversible bone marrowdepression, dystonia, akathisia, and pseudoparkin-sonism.Thefollowingdrugsmayminimizethesideeffects: dimenhydrinate, benztropine, diphenhydr-amine,andtrihexyphenidyl.Contraindication/caution:Cardiovasculardisease


• Gainsinreducingsymptomsmaytakeanywherefrom6to12weeks.

• Discontinuingmedicationmay lead to relapseofsymptoms.

• Thioridazinehasaceilingdoseof800mg/day.• Promazinedosageshouldnotexceed1000mg/day.


aripiprazole Abilify Tablet 10–15mgPOqdclozapine Clozaril Tablet 150–300mgPObidfluphenazine † Tablet,liquid,IM,IV 2.5–10mg/dayPOdivq6–8hhaloperidol † Tablet,liquid,IM 0.5–5mgbid–tidiloperidone Fanapt Tablet 6–12mgPObidloxapine Loxitane Capsule,liquid,IM 30–50mgPObidlurasidone Latuda Tablet 40–80mgPOqd

ANTIPSYCHOTIC AGENTS

Continued


ANTIINSOMNIA AGENTSInsomnia: Characterized by the inability to sleep or

remainasleep,whichmaybecausedbysituations,medications,orpsychiatricormedicalconditions

MOA: Interact with g-aminobutyric acid (GABA)–benzodiazepinereceptorcomplexes

Adverse reactions: CNS depression, dizziness, confu-sion,impairedreflexesContraindications/cautions: Alcohol use, CNS depres-santuseSpecial consideration:Potentialforabuse


olanzapine Zyprexa Tablet 10mgPOqdprochlorperazine † Tablet,capsule,liquid,suppository,IM,IV 5mgPOq6–8hquetiapine Seroquel,SeroquelER Tablet 150–750mg/dayPOdivbid–tidpaliperidone Invega Extended-releasetablet 6mgPOqamrisperidone Risperdal Tablet,liquid 1–4mg/dayPOdivqd–bidthioridazine † Tablet,liquid 200–800mg/dayPOdivbid–qidthiothixene Navane Capsule,IM 2–5mgPObid–tidtrifluoperazine † Tablet,liquid,IM 2–5mgPObidziprasidone Geodon Capsule,injection 20mgPObid

ANTIPSYCHOTIC AGENTS—cont’d



chlordiazepoxide † Capsule 5–10mgPOqhs Yesdiazepam Valium Injection,IV,oralliquid,tablet 2.5–10mgPOqhs Yeseszopiclone Lunesta Tablet 2–3mgPOqhs Yesflurazepam Dalmane Capsule 15–30mgPOqhs Yeslorazepam Ativan Injection,IV,oralliquid,tablet 2–4mgPOqhs Yesramelteon Rozerem Tablet 8mgPOqhs Notemazepam Restoril Capsule 7.5–30mgPOqhs Yeszaleplon Sonata Capsule 5–10mgPOqhs Yeszolpidem Ambien,AmbienCR Tablet 5–12.5mgPOqhs Yes

ANTIINSOMNIA AGENTS


ATTENTION-DEFICIT DISORDER (ADD) AND ATTENTION–DEFICIT HYPERACTIVITY DISORDER (ADHD) AGENTSADD: Aphysiologicaldisorderfoundinchildrenshow-

ingsignsofattentiondeficitwithouthyperactivityADHD: A physiological disorder in which the pa-

tienthasdifficultyfocusinghisorherattentioninaquietinattentivemannerordisplayshyperactiv-ityoracombinationofbothofthese

MOA:StimulateCNSactivity;blockreuptakeandin-crease release of norepinephrine and dopamine inextraneuronalspaceAdverse reactions: Withdrawal if abrupt discontinua-tion,depression,psychosisContraindications/cautions: Breastfeeding, cardiovascu-lardisease,glaucomaSpecial consideration:Potentialforabuseanddependency

GENERIC NAME BRAND NAME DOSAGE FORM DOSAGE* CONTROLLED SUBSTANCE

amphetamine/dextroamphetamine Adderall Tablet 5–40mgPOdivqd-tid Yesatomoxetine Strattera Capsule 80mgPOqam Nodexmethylphenidate Focalin Tablet 2.5–10mgPObid Yesdextroamphetamine Dexedrine Capsule 5–40mgPOqam Yeslisdexamfetamine Vyvanse Capsule 30mgPOqam Yesmethylphenidate Ritalin Tablet 5–15mgPObid–tid Yes

ATTENTION-DEFICIT DISORDER AND ATTENTION-DEFICIT HYPERACTIVITY DISORDER AGENTS



ANTICONVULSANT AGENTSEpilepsy:Aneurologicdisorderdefinedasparoxys-

mal,recurringseizures.Itinvolvesdisturbancesofneuronalelectricalactivity.Seizurescanbepartial,generalized(grandmal,petitmal,myoclonic,andatonic),orstatusepilepticus.

MOA:Blockthefiringofneurotransmitters, resultinginaraisedlevelofdepolarizationAdverse reactions: Sedation and loss of cognitiveprocesses

Contraindications/cautions: Hypersensitivity to TCAs,bonemarrowdepression


• Monotherapyispreferredoverpolytherapyunlessthepatientisnotrespondingtomonotherapy.

• A large number of drug interactions may occurwith anticonvulsants because of induction orinhibition.

• Divalproexshouldbe takenwithwater,notwithcarbonateddrinks.


carbamazepine Tegretol Tablet,chewabletablet,suspension

Upto1200mg/dayin3–4divideddoses

No

clonazepam Klonopin Tablet 1.5–20mgPOqd Yesdiazepam Valium Injection,IV,oralliquid,tablet Dosagevaries Yesdivalproex Depakote Tablet 15–60mg/kgdayindivideddoses

2–3timesperdayNo

fosphenytoin Cerebyx IM,IV 4–6mgPe/kg/dayIM/IVqd–tid

No

gabapentin Neurontin Capsule,suspension 900–3600mgPOqd Nolacosamide Vimpat Tablet,IV 100–200mgPO/IVbid Nolamotrigine Lamictal Tablet 100–500mgPOqd Nolevetiracetam Keppra Tablet 1000–3000mgPOqd Nooxcarbazepine Trileptal Oralliquid,tablet 600–2400mgPOqd Nophenobarbital Luminal Tablet,solution,IM,IV 100mgPOqd;dosagevariesfor

injectableformsYes

phenytoin Dilantin Tablet,capsule,suspension,IV 200–400mgPOqd Nopregabalin Lyrica Capsule 150–600mgPOqd Noprimidone Mysoline Tablet,suspension 250–1000mgPOqd Notiagabine Gabitril Capsule 32–56mgPOqd Notopiramate Topamax Tablet 200mgPObid Novalproicacid Depakene Capsule,syrup,IV Upto1750mgPOqd Nozonisamide Zonegran Capsule 100–600mgPOqd No

ANTICONVULSANT AGENTS


ANTIPARKINSON AGENTSParkinson Disease: A progressive disorder of

the basal ganglia associated with a loss or defi-ciency of dopamine; symptoms include tremors,muscle rigidity, loss of balance, hypokinesia andbradykinesia

MOA:PotentiateCNSdopaminergicresponsesAdverse reactions:Nausea,vomiting, cardiacarrhyth-mias, drowsiness, postural hypotension, insomnia,constipation,diarrheaContraindications/cautions:Abruptwithdrawal,depression


• Therapyisaimedatsymptomaticrelief.• Numerous side effects may occur, resulting in a

continualchangeoftherapy.• Alcoholshouldbeavoided.


amantadine Symmetrel Capsule,syrup 100mgPObidapomorphine Apokyn Injection(SC) 0.2–0.6mLSCprnbenztropine Cogentin Tablet,IM,IV 1–2mgPO/IM/IVqhsbromocriptine Parlodel Tablet,capsule 10–30mgPOqdentacapone Comtan Tablet 200mgPOperdose

ANTIPARKINSON AGENTS

Continued


MULTIPLE SCLEROSIS AGENTSMultiple sclerosis:Anautoimmunediseaseinwhich

themyelinsheathsaroundnervesdegenerate,re-sultinginalossofmusclesandeyesight

MOA:VariabledependingonagentAdverse reaction:PhotosensitivityContraindication/caution:Hypersensitivitytoalbumin


• Productsrequirespecialstorage.• Copaxone is given daily, Betaseron is adminis-

teredeveryotherday,andAvonexisadministeredonceweekly.


levodopa–carbidopa Sinemet Tablet IndividualizeddosePOtid–qidlevodopa–carbidopa–entacapone Stalevo Tablet 1tabPOq3–8hpramipexole Mirapex Tablet 0.5mg–1.5mgPOtidrasagiline Azilect Tablet 1mgPOqdropinirole Requip Tablet 3–6mgPOtidrotigotinetransdermalsystem Neupro Transdermal 4–6mg/24hq24hselegiline Eldepryl Tablet 5mgPObidtolcapone Tasmar Tablet 100mgPOtidtrihexyphenidyl † Capsule,elixir,tablet 6–10mgPOqddivtid

ANTIPARKINSONIAN AGENTS—cont’d



dalfampridine Ampyra Tablet 10mgpoq12hglatirameracetate Copaxone Injection,SC 20mgSCqdinterferonb-1a Avonex Single-dosevial,SC 30mcgIMqwkinterferonb-1b Betaseron SCinjection 0.25mgSCqodmitoxantrone Novantrone IV 12mg/m2IV3q3mo

EXAMPLES OF MULTIPLE SCLEROSIS AGENTS

*Pleasenotethatalldosagesareforadultsandexpressedinoraldosagesunlessotherwiseindicated.†NotavailableasaBrandedDrug

ALZHEIMER DISEASE AGENTSAlzheimer disease: A chronic progressive disease

resulting in memory loss, confusion, impairedjudgment, personality changes, disorientation,andalossoflanguageskills

MOA:Reversiblybindtoandinactivateacetylcholin-esterase(cholinesteraseinhibitor)

Adverse reactions:Nausea,vomiting,diarrheaContraindications/cautions: Cardiac conduction defects,asthma, or chronic obstructive pulmonary disease(COPD)Special consideration:Nodrugscanreversethecogni-tiveabnormalitiesofAlzheimerdisease.


donepezil Aricept Tablet 5–23mgPOqhsgalantamine † Oralliquid,tablet 8–12mgPObidmemantine Namenda Tablet 10mgPObidrivastigmine Exelon Capsule,oralliquid 3–6mgPObid

ALZHEIMER DISEASE AGENTS

*Pleasenotethatalldosagesareforadultsandexpressedinoraldosagesunlessotherwiseindicated.†Notavailableasabrandeddrug.


CONDITIONS AND TREATMENTS FOR THE RESPIRATORY SYSTEM

Asthma: Characterizedby reversible smallairwayobstruction, progressive airway inflammation,and increasedairwayresponsiveness frombothendogenous and exogenous stimuli; symptomsincludewheezing,dyspnea,andcoughing

Bronchitis:Aconditioninwhichthelungs’defensemechanisms have been destroyed by cigarettesmoke,occupationaldusts,fumes,environmentalpollution,orbacterialinfection;characterizedbyacoughthatproducesapurulent,green,orblood-soakedsputum

Emphysema:Destructionofalveoli,walls,orairsacsofthelungs,resultinginanobstructionoftheair-flow on expiration; may be caused by cigarettesmoke, air pollution, occupational exposure, orgeneticfactors

Cystic fibrosis: Characterizedbyanincreasedsecre-tionofviscousmucusresultsinhypoxiaandcanbefatal

BRONCHODILATORSIndications:Airwayobstruction,COPD,reversiblebron-chospasmsassociatedwithbronchitisandemphysemaMOA: Cause the b2 receptors to relax the smoothmuscles,resultinginadecreaseofbronchospasmsAdverse reactions:CNSstimulation,whichmayresultin nervousness, tremors, anxiety, nausea, palpita-tions,tachycardia,arrhythmiasContraindications/cautions:Ischemicheartdisease,hyper-tension,seizuredisorders


• Patientsmayovermedicate themselves tocontroltheirasthma.

• Ipratropium solution needs to be protected fromlight.

• Salmeterolneedstobestoredatroomtemperatureandprotectedfromfreezingtemperaturesanddirectsunlight.

• A salmeterol canister should be stored with thenozzleenddown.


albuterol ProventilHFA,ProAirHFA,VentolinHFA

Aerosol,capsule,solution,syrup,tablet,inhaler

2puffsinhaledq4–6h

epinephrine PrimateneandBronkaidMist,Adrenalin,Epi-Pen

SC,IM,IV 0.3–0.5mgSC/IMq20min33dosesprn

formoterolfumarate Foradil Capsule 1capinhaledq12hipratropium AtroventHFA Inhaler,nasalspray 2puffsinhaledqidipratropium–albuterol Combivent Aerosol 1–2puffsinhaledqidlevalbuterol XopenexHFA Inhaler 2puffsinhaledq4–6hprnpirbuterol Maxair Inhaler 1–2puffsinhaledq4–6hprnsalmeterol SereventDiskus Inhaler,inhalantdisks 50mcginhaledq12hterbutaline † Injection,tablet 2.5mgPOtid;max15mg/qdtiotropium SpirivaHandihaler Powderedcapsuleplacedina

Handihaler1capinhaledqd

BRONCHODILATORS


XANTHINE DERIVATIVESIndications: Used to treat lung disease that is unre-sponsivetoothermedications;usedasabronchodi-lator in reversible airway obstruction caused byasthma,chronicbronchitis,oremphysemaMOA:Reversebronchospasmassociatedwithantigensandirritants;improvecontractilityofdiaphragm

Contraindications/cautions:Pepticulcerdisease,seizuredisorders,arrhythmias


• Bloodlevelsneedtobemaintainedat8to20mcg/m.• Theophylline may interact with macrolide and

fluoroquinoloneantibiotics.


aminophylline † Tablet,liquid,IM,IV 380–760mg/dayPO/IVdivq6–8htheophylline Uniphyl,Theo-24,Elixophyllin Capsule,tablet,solution 300–600mg/dayPOdivq6–8h

XANTHINE DERIVATIVES



LEUKOTRIENE INHIBITORSIndications: Prophylaxis and long-term treatment ofasthmaMOA: Block the effects of leukotrienes, resulting inblocking of tissue inflammatory responses such asedema

Adverse reactions:Headache,severeasthmaContraindication/caution:HepaticdiseaseSpecial consideration:PatientsusingSingulairmustbeolderthan6yearsofage.


montelukast Singulair Tablet 10mgPOqpmzafirlukast Accolate Tablet 20mgPObidzileuton ZyfloCR Tablet 1200mgPObid

LEUKOTRIENE INHIBITORS


CORTICOSTEROIDSMOA:Stimulateadenylatecyclaseandinhibitinflam-matorycellsAdverse reactions:Inhaled corticosteroids:Oral candidiasis, irritationandburningofthenasalmucosa,hoarseness,drymouthOral corticosteroids: Facial hair on women, breast de-velopmentinmen,“buffalohump”or“moonface,”edema,weightgain,andeasybruising

Contraindications/cautions: Unhealed nasal surgery ortraumawound,unhealednasalseptalulcer,tubercu-losisinfectionSpecial considerations:Long-termoraldosingneedstobetaperedofftoavoidnightmares.


beclomethasone BeconaseAQ Inhaler 1–2sprays/nostrilbiddexamethasone † Solution,tablet 0.75–0.9mg/dayPOdivq6–12hflunisolide † Inhaler 2sprays/nostrilbid–tidfluticasone Flovent,Flonase Inhaler 2sprays/nostrilqdfluticasone–salmeterol Advair Inhaler 1puffinhaledbidmethylprednisolone Medrol Tablet 7.5–60mgPOqd–qodmometasonefuroate Nasonex Nasalspray 2sprays/nostrilqdprednisolone Orapred,Pediapred Oralliquid,tablets 40–60mg/dayPOdivqd–bid33–10daysprednisone † Oralliquid,tablet 40–60mg/dayPOdivqd–bid33–10daystriamcinolone NasacortAQ Inhaler 1–2spraysineachnostrilqd

CORTICOSTEROIDS


MAST CELL STABILIZERSMOA:InhibitinflammatorycellsIndications:Prophylaxis;hasnouseinanacuteattackAdverse reactions:Patientsusingcromolynmayexperi-enceanunpleasanttasteafterinhalation,hoarseness,drymouth,andstuffynose.Contraindications/cautions:Patientsyoungerthan2yearsofage,arrhythmias


• Airwaypassagesmustbeopenbeforeuse;there-fore,abronchodilator isusedfirst inconjunctionwithmastcellstabilizers.

• Patientcomplianceisanobstaclebecauseofdosingfourtimesperday.


cromolyn Gastrocom Oral† 200mgPOqid

MAST CELL STABILIZER

*Pleasenotethatalldosagesareforadultsandexpressedinoraldosagesunlessotherwiseindicated.†Cromolynisavailableasanasalspray(Nasalcrom),nebulizersolution,andoralsolution.


MUCOLYTIC AGENTSMOA:Breakapartglycoprotein, resulting ina reduc-tionofviscosityandeasiermovementandremovalofsecretions

Contraindications/cautions:Inadequatecough,upperGIbleedAdverse reaction: Acetylcysteine has an unpleasantodorandtastethatmaycausenoncompliance.


fluticasone–salmeterol AdvairDiskus Inhalation 1puffinhaledbidbudesonide–formoterol Symbicort Inhalation 2puffsinhaledbid

LONG-ACTING BRONCHODILATOR/STEROID INHALER


TUBERCULOSIS AGENTSTuberculosis is a slow, progressive respiratory dis-

ease with symptoms of weight loss, fever, nightsweats,malaise,andlossofappetite.Amajorissuewithtuberculosisispatientcompliancebecauseofthelengthoftherapyandnumberofmedicationsa patient may be taking. Asymptomatic patientswillreceiveisoniaziddailyfor12months;patientswith clinical symptoms are treated with at leasttwomedications.

MOA: Bactericidal; inhibit lipid and nucleic acidsynthesisAdverse reactions: Hypersensitivity reactions, epigas-tricdiscomfortContraindications/cautions:Acutehepaticdisease,tyramine-containingfoods,histamine-containingfoodsSpecial consideration:Patientsshouldavoidalcohol.


acetylcysteine † Solution 3–5mLof20%solutioninnebulizertid–qiddornasealfa Pulmozyme Solution 2.5mginnebulizerqd

MUCOLYTIC AGENTS



cycloserine Seromycin Capsule 500–750mgPOqddivbid–qidethambutol Myambutol Tablet 15–25mg/kg/dayisoniazid(INH) Laniazid,Nydrazid Tablet 5mg/kg/dayisoniazid–pyrazinamide–rifampin Rifater Tablet 1tabletqdayisoniazid–rifampin Rifamate Tablet 2capsPOqdofloxacin Floxin IV,tablet 200–400mgPOq12hrifampin Rifadin Capsule,IV 10mg/kg/dayrifapentine Priftin Tablet 150mgPOtwiceweeklyfor2monthsfollowed

byonceamonthfor4monthsstreptomycin — Injection,IV 500mg–1gadministeredIMthreetimesa

weekforfirst3months

TUBERCULOSIS AGENTS



SMOKINGSmoking increases the risk of heart disease, COPD,and stroke.Acute risks include shortness of breath,aggravation of asthma, impotence, infertility, and

increased serum carbon monoxide concentration.Smokingcessationresultsinareducedriskoflung,laryngoesophageal, oral, pancreatic, bladder, andcervicalcancerandcoronaryarterydisease.


bupropion Zyban Tablet 150mgPObid37–12wk RXnicotine NicodermCQ,Nicotrol,

NicotrolNS,Nicorette,Transdermalpatch,gum,

spray,tabletApplyonepatchdaily;6–16cartridges

inhaleddaily;2mgPOq1–2h36wkOTC

varenicline Chantix Tablet 1mgPObid311wk RX

EXAMPLES OF SMOKING CESSATION AGENTS


CONDITIONS AND TREATMENTS FOR THE DIGESTIVE SYSTEM

Gastritis: A stomach mucosal irritation and inflam-mation that can be linked to stress, medications,infection, autoimmune disease, alcohol, bile re-flux, Helicobacter pylori infection, or NSAID useand is characterized by belching, nausea, vomit-ing,bloating,andaburningsensation

Gastroenteritis: Aninflammationoftheliningoftheintestines causedbyavirus,bacteria,orparasitethat has symptoms of diarrhea, abdominal pain,vomiting, headache, fever, chills, and loss of ap-petite

Gastroesophageal reflux disease (GERD): Charac-terizedbyradiatingburningorchestpainandthepresenceofanacidtaste

Ulcers: Disorders of the upper GI tract caused byexcessive acid secretion. Ulcers may be catego-rizedasgastriculcers,whicharelocalexcavations

ofthegastricmucosaoccurringmoreofteninmenfrom the Western hemisphere. Duodenal ulcersoccur in the duodenum of the intestine and areusually caused by hypersecretion of acid. Stressulcersdevelopfromthebreakdownofthenaturalmucosalresistancefromseverephysiologicstresscausedbyanillness.

ANTACIDSMOA: NeutralizestomachacidtopreventrefluxAdverse reactions: Constipation,diarrheaContraindications/cautions: GI obstruction, hypercalce-mia,hypophosphatemia


• Increasedfrequencyofadministrationmayresultinpoorpatientcompliance.

• Reducestheeffectivenessoftetracycline• AvailableOTC


aluminumhydroxide † Tablet,liquid 320–1280mgPOqid OTCaluminumhydroxide–

magnesiumhydroxideMaalox,Mylanta Tablet,liquid 10–20mLPOqidprn OTC

magnesiumhydroxide MilkofMagnesia Tablet,liquid 30–60mLPOqd OTC

ANTACIDS



H2 ANTAGONISTSMOA: Block gastric acid and pepsin secretion fromhistamine,gastrin,certainfoods,andcaffeine;cholin-ergic stimulation through competitive inhibition atH2receptorsofthegastricparietalcellsAdverse reactions:Constipation,drowsinessContraindications/cautions: Hepatic or renal impair-ment,elderlypatients,chronicpulmonarydisease


• Bedtimedoseisextremelyimportantintherapy.• Druginteractionsincludeaspirin,alcohol,caffeine,

andcoughandcoldpreparations.• AvailableOTCinlowerdoses• FamotidineIVshouldbestoredatroomtemperature.• Reconstituted oral suspension can be stored at

roomtemperatureandexpiresin30days.


cimetidine TagametHB(OTCformavailable) Tablet 1tabPOprnnizatidine Axid(OTCformavailable) Tablet,capsule 150mgPObidranitidine Zantac(OTCformavailable) Tablet 150mgPObidfamotidine Pepcid(PepcidAC;OTCformavailable) Tablet,suspension,IM,IV 20–40mgPOqhs

H2 ANTAGONISTS


PROTON PUMP INHIBITORSIndications: Gastroesophageal reflux disease, erosiveesophagitis; takenwithotheragents intreatmentofH. pyloriMOA:InhibittheparietalcelladenosinetriphosphatepumpAdverse reactions:Diarrhea,dehydration

Contraindications/cautions: Long-term use, high dose,hypomagnesemia

Special Consideration

• Capsules may be opened and the contentsplacedinapplesauceifthepatienthasdifficultyswallowing.

GENERIC NAME BRAND NAME DOSAGE FORMS DOSAGE* AVAILABLE OTC

dexlansoprazole Dexilant Capsule 30mgPOqd34wkesomeprazole Nexium Capsule 20mgPO/NGqd34–8wklansoprazole Prevacid Capsule,oralpowderpackets 15mgPO/NGqd38wk Yesomeprazole Prilosec Capsule 20mgPO/NGqd34–8wk Yespantoprazole Protonix Tablet,IV 20–40mgPO/NGqd34–8wkrabeprazole Aciphex Tablet 20mgPOqd34–16wk

PROTON PUMP INHIBITORS


COATING AGENTSMOA:Formaprotectivecoatoverulceragainstgastricacid,pepsin,andbilesalts

Adverse reactions:ConstipationContraindications/cautions:Renalfailure,GIobstruction

GENERIC NAME BRAND NAME DOSAGE FORMS DOSAGE* AVAILABLE OTC

alginicacid Gaviscon Tablet,chewabletablet,liquid 15–30mLPOqdprn Yessucralfate Carafate Tablet,liquidsuspension 1gPObid–qid No

COATING AGENTS


Crohn disease: Acongenitaloracquiredchronicin-flammationofthecoloncharacterizedbyabdomi-nalpain,weightlossanddiarrhea

Ulcerative colitis: A congenital or acquired chronicinflammation of the large intestine characterizedbysymptomsofrectalbleedingandpain


ANTIINFLAMMATORY AGENTSMOA: Unknown but exerts local antiinflammatoryeffectsAdverse reactions:Nausea,vomiting,headacheContraindications/cautions: Salicylates, influenza, vari-cella or febrile viral infection for patients youngerthantheageof20years


• Sulfasalazine is contraindicated in patients whoareallergictosulfadrugsandaspirin.

• Bindstoirontablets• The patient needs to be kept hydrated, and the

drugshouldbetakenaftermeals.• Stainurineorange-yellowandpermanentlystain

softcontactlensesyellow


mesalamine Rowasa,Asacol,Pentasa Suppository,enema,tablet,capsule Dosagevariesdependingondosageformsulfasalazine Azulfidine Tablet,liquid 2g/dayPOdivqid

ANTIINFLAMMATORY AGENTS


GENERIC NAME BRAND NAME INDICATION DOSAGE FORM DOSAGE*

azathioprine Imuran Crohndisease Tablet 100–250mgPOqdbalsalazide Colazal Ulcerativecolitis Capsule 2.25gPOtid38–12wkinfliximab Remicade Crohndisease IV 5mg/kgIV31duringwk0,2,6olsalazine Dipentum Ulcerativecolitis Capsule 500mgPObidpancrelipase † Exocrinepancreaticinsufficiency Capsule 500–2500lipaseunits/kgPOwith

mealsorsnacks

OTHER TREATMENTS FOR CROHN DISEASE AND ULCERATIVE COLITIS


Diarrhea: Loose, watery, and frequent stool and isconsideredchronic (long term) if it continues formorethan4weeks

Adverse reactions: Constipation, respiratory depres-sion,drowsinessContraindications/cautions: Pseudomembranous colitis,severevolumedepletion


• Diarrheamayleadtodehydrationoftheindividual.• May mask more serious conditions, including

malabsorptionofdrugsandnutrients

GENERIC NAME BRAND NAME DOSAGE FORMS DOSAGE* AVAILABLE OTCCONTROLLED SUBSTANCE

attapulgite Kaopectate Liquid,tablet 30mLPOq30–60minprn Yes Nobismuthsubsalicylate PeptoBismol Tablet,caplet,liquid 2tabsor30mLPOq30–60min Yes Nodiphenoxylatewith

atropineLomotil Tablet,liquid 1–2tabsPObid-qidprn Yes

loperamide Imodium,ImodiumAD(OTC)

Caplet,capsule,liquid

4mgPO31dose;then2mgPOaftereachloosestool

Yes No

ANTIDIARRHEALS



Constipation: Theresultoflow-fiberdiets;decreasedcolon content, increased colon pressure, anddecreasedpropulsivemotility

Emollients, Lubricants, and Saline Laxatives

MOA: Emollient laxativesdrawwater into thecolon,resultinginbowelevacuation

Adverse reactions:Nausea,vomiting,diarrheaContraindications/cautions: Fecal impaction, appendici-tis,GIobstruction


dioctylcalciumsulfosuccinate Surfak Tablet,capsule,liquid 1capPOqdprn OTCdocusatesodium Colace Tablet,capsule,microenema 50–300mg/dayPOdivqd–bidprn OTCmineraloil † Solution 15–45mLPOdivq8–24h OTCmagnesiumhydroxide MilkofMagnesia Liquid 30–60mLPOqdprn OTC

EMOLLIENTS, LUBRICANTS, AND SALINE LAXATIVES


Stimulant Laxatives

MOA: IncreasegutactivityfrommucosalstimulationAdverse reactions: Diarrhea,allergic reactions suchashives,andperipheralswelling

Contraindications/cautions: GIobstruction,elderlyuse


bisacodyl Dulcolax Tablet,suppository 1–3tabsPOqdprn;1suppprqdprn OTCsenna Senokot Tablet,syrup,granules 2–4tabsPOqhsprn OTC

STIMULANT LAXATIVES


Bulk-Forming Laxatives

MOA: Increasefiberinthediet,resultinginintestinalperistalsisAdverse reactions: Abdominalcramps,diarrhea,nausea

Contraindications/cautions: Acute abdomen, appendici-tis,fecalimpactionSpecial considerations/cautions:Consideredthesafesttouse;patientsshoulddrinkplentyofwater


methylcellulose Citrucel,FiberTrim Tablet,powder 1scoopPOqd–tidprn OTClactulose † Solution 15–30mLPOqd–bid RXpsylliumhydrophilicmucilloid Metamucil Powder 3.4gPOqd–tidprn OTC

BULK-FORMING LAXATIVES


Bowel Evacuant Laxatives

Indication: BowelcleansingbeforeGIexaminationMOA:IncreaseosmolarityofbowelfluidsAdverse reactions: Anaphylaxis,electrolyteimbalance,seizuresContraindications/cautions: Toxiccolitis,GIobstruction,intestinalperforation


• Thepatientshouldfastforatleast3hoursbeforeadministration.

• Eight ounces should be taken every 10 minutesuntil4Lisconsumed.

Example: polyethylene glycol–electrolyte solution(e.g.,GoLYTELYorNuLYTELY)


lubiprostone Amitiza Capsule 24mcgPObidpolyethyleneglycol GoLYTELY,NuLYTELY,Colyte Powder 8ozq10minuntilclear

BOWEL EVACUANT LAXATIVES



ANTIEMETICSIndication: Used to treat side effect of nausea, whichmaybeassociatedwithvariousmedicationsMOA: Inhibit the impulse going from the chemo-triggerzonetothestomachAdverse reaction:DrowsinessContraindication/caution: CongenitallongQTsyndrome


• Phenothiazines may cause hypotension and mustbeusedcautiouslyinchildrenbecauseofthepoten-tialforoverdosage,resultinginseizures.

• Promethazine suppositories need to be refriger-atedandprotectedfromlight.

GENERIC NAME BRAND NAME DOSAGE FORMS DOSAGE

chlorpromazine † Tablet,capsule 10–25mgPOq4–6hprndimenhydrinate Dramamine Tablet,chewabletablet,

oralsolution1–2tabsPOq4–6hprn

granisetron † Tablet,IV 2mgPO31dose;then1mgPOq12h32doses;10mcg/kgIV31dose

hydroxyzineHCl † Tablet,IM 25–100mgq4–6hprnmeclizine Antivert,Bonine Tablet 25–100mg/dayPOdivbid–tidmetoclopramide Reglan IM,IV 1–2mgIM/IV31doseondansetron Zofran Tablet,IV Dosagesmayvaryprochlorperazine † Tablet,capsule 5–10mgPOq6–8hpromethazine † Tablet,IM,IV 12.5–25mgPO/IM/IVq4–6htrimethobenzamide Tigan Capsule,IM 300mgPO/IMtid–qid

ANTIEMETICS


ANTIFLATULENT AGENTSIndications: Flatulence,gastricbloating,postoperativegaspainsMOA: Reducesurfacetension,resultingingasbubblesbeingreleasedmoreeasilyAdverse reaction:Diarrhea,nauseaContraindications/cautions: Intestinal perforation, GIobstructionExamples:Simethicone(Gas-X,Mylicon,Phazyme)

ANTIOBESITY AGENTSObesity:Males:25%oftotalbodyweightoverideal

bodyweightFemales:35%oftotalbodyweightoverideal

bodyweight

MOA: UnknownAdverse reactions: CNSstimulation,dizziness,fatigue,insomnia,drymouth,nausea,abdominaldiscomfort,constipation,hypertension,palpitations,arrhythmiasContraindications/cautions: Pulmonary hypertension,hyperthyroidism,glaucoma


• Allarecontrolledsubstances,exceptXenical.• Bothfederalandstatecontrolledsubstanceregula-

tionsmustbefollowedregardingprocessing,fill-ing,andrecordkeeping.

GENERIC NAME BRAND NAME DOSAGE FORM DOSAGE* CONTROLLED SUBSTANCE

diethylpropion † Tablet 25mgPOtidprnmeals Yesphentermine AdipexP Tablet 37.5mgPOqd Yesorlistat Xenical,Alli Capsule Takeduringor½hpc No

ANTI-OBESITY AGENTS



CONDITIONS AND TREATMENTS FOR THE URINARY SYSTEM

Diuretics: Maintain balance of water, electrolytes,acids,andbasesinthebody

THIAZIDE DIURETICSIndications: Adjunctivetherapyincardiovasculardis-eases,suchashypertensionMOA: Promote sodium and water excretion in theurine,resultinginlowersodiumlevelsinbloodves-selsandareductioninvasoconstriction

Adverse reactions: Hypokalemia,hypomagnesemia,hy-peruricemia, hyperglycemia, hypercalcemia, photosensitivityContraindications/cautions: Hypersensitivity to sulfon-amides,anuria,renalorhepaticimpairmentSpecial consideration: Patientsmaybeadvisedtotakepotassiumsupplementsortoaddbananasororangestotheirdiet.


hydrochlorothiazide † Tablet 12.5–200mgPOqd

THIAZIDE DIURETIC


LOOP DIURETICSIndications: Adjunctivetherapyincardiovasculardis-eases,hypertensionMOA: InhibitreabsorptionofsodiumandchlorideintheascendingloopofHenleanddistalrenaltubules,resultinginurinaryexcretionofwaterAdverse reactions: Low levels of sodium, chloride,magnesium,calcium,potassium


bumetanide † Tablet,injection 0.5–2mgqdethacrynicacid Edecrin Tablet,injection 25–100mgdivqd–tidfurosemide † Tablet,oralsolution,IM,IV 40–120mgdivqd–bidtorsemide Demadex Tablet,IV 20–200mgqd

LOOP DIURETICS


POTASSIUM-SPARING DIURETICSIndications: Adjunctive therapy in cardiovascular is-sues,hypertensionMOA: Exchangeofsodiumexcretedinurinetoreturn-ingpotassiumtothebodyAdverse reactions: Hyperkalemia, arrhythmias, gyne-comastiainmales

Contraindications/cautions: Anuria, renal impairment,hyperkalemiaSpecial consideration: Should be avoided in patientstakingangiotensin-convertingenzyme(ACE)inhibi-torsowingtopotassium-sparingeffect


amiloride † Tablet 5–10mgPOqdspironolactone Aldactone Tablet 25–200mgPOqdtriamterene Dyrenium Capsule 100mgPObid

POTASSIUM-SPARING DIURETICS


Contraindications/cautions: Anuria, hepatic coma, elec-trolyteimbalances


• Diureticsshouldbetakenearlyinthedaytoavoidnocturia(frequenturinationduringthenight).

• Discolored furosemide tablets or solution shouldbediscarded.


COMBINATION DIURETIC PRODUCTSIndications: Adjunctive therapy in cardiovascular is-sues,hypertensionAdverse reactions: Hyperkalemia;patientstakingMax-zidemayexperienceachangeintheirurinecolortoblue-green

Contraindications/cautions: Anuria,renalimpairmentSpecial consideration: Should not be given to patientstakingACEinhibitors


bisoprolol–hydrochlorothiazide Ziac Tablet 1tabPOqdspironolactone–hydrochlorothiazide Aldactazide Tablet 1–4tabPOdivqd–bidtriamterene–hydrochlorothiazide Dyazide,Maxzide Capsule,tablet 1–2cap(tab)POqd

COMBINATION DIURETIC PRODUCTS


a-BLOCKERSBenign prostatic hypertrophy: An enlargement of

theprostateofamanasheages,resultingindif-ficulturination

MOA: Relaxsmoothmuscles,especiallyintheprostatictissue,resultinginareductionofurinarysymptoms

Adverse reactions: Headache,orthostatichypotension,dizzinessContraindications/cautions: Hepatic impairment, cata-ractsurgery


alfuzosin Uroxatral Tablet 10mgPOqddoxazosin Cardura Tablet 1–8mgPOqdprazosin Minipress Capsule 0.5–1mgPObidtamsulosin Flomax Tablet 0.4mgPOqdterazosin Hytrin Capsule,tablet 1–5mgPOqhs

a-BLOCKERS



cinacalcet Sensipar Tablet IndividualizedosePObid–qiddarbepoetin Aranesp Injection IndividualizedoseSC/IVepoetinalfa Epogen,Procrit Injection,IV IndividualizedoseSC/IVirondextran InFeD Injection,IV 0.5mLIM/IVastestdosesevelamer Renagel Tablet 800–1600mgPOtid

RENAL DISEASE AGENTS



flutamide † Capsule 250mgPOq8hgoserelin Zoladex Implant 3.6mgSCq28days34dosesleuprolide Eligard Implant 7.5mgSCqmomegestrol MegaceES Oralliquid,tablet 625mgPOqdnilutamide Nilandron Tablet 150mgPOqd330d

DRUGS USED TO TREAT PROSTATIC CARCINOMAS



MISCELLANEOUS TREATMENS FOR URINARY CONDITIONSUrinary tract infections: Presence of bacteria in

the urinary tract with localized symptoms thatinclude blood in the urine, fever, and burningsensation

Urex or Hiprex (Methenamine)

Indication: UTIMOA: BactericidalAdverse reactions: Nausea,dyspepsia,dysuria,rashContraindications/cautions: Renal impairment, hepaticinsufficiency,dehydration


• Citrus products and antacids should be avoidedwhenthismedicationistaken.

• Sulfonamidesarecontraindicated.

Pyridium or Azo-Standard (Phenazopyridine)

Indication: DysuriaMOA: ProducestopicalanalgesiaAdverse reactions: Urinediscoloration,rash,pruritusContraindications/cautions: Glomerulonephritis,uremia,renalimpairmentSpecial consideration: Shouldbe takenwithanantibi-oticfor2days

Ditropan (Oxybutynin)

Indication: OveractivebladderMOA: AntagonizesacetylcholineatmuscarinicreceptorsAdverse reactions: Drymouth,dizziness,somnolence,constipationContraindications/cautions: Urinary retention, gastricretention,uncontrolledangle-closureglaucoma

Detrol (Tolterodine)

Indication: AntagonizesacetylcholinereceptorsMOA: AnticholinergicAdverse reactions: Drymouth,headache,constipation,abdominalpainContraindications/cautions: Uncontrolled angle-closureglaucoma,gastricretention,urinaryretention

CONDITIONS AND TREATMENTS FOR THE CARDIOVASCULAR SYSTEM

DYSRHYTHMIA

Dysrhythmia,formerlyreferredtoasanarrhythmia,isanirregularheartbeatresultingfromamalfunctionofthecardiacconductionsystem• Atrialflutter• Atrialfibrillation• Bradycardia:Abnormallyslowheartrate• Tachycardia:Abnormallyrapidheartrate

Membrane-Stabilizing Agents

MOA: Slow the movement of ions into the cardiaccells,resultinginareductionoftheactionpotentialAdverse reactions: Nausea,vomiting,dizzinessContraindications/cautions: Cardiogenic shock, second-orthird-degreeatrioventricular(AV)block


• Procainamideandquinidineareextremelysimilarandhavebeeninterchangedintherapy.

• Lidocaine is drug of choice for emergency IVtherapy.


disopyramide Norpace Capsule 150mgPOq6hflecainide Tambocor Tablet 5–300mgPOdivq8–12hlidocaine Xylocaine IV 1–4mg/minIVinfusionprocainamide † Tablet,capsule,IM,IV 1–6mg/minIVmexiletine † Tablet 200mgPOq8hpropafenone † Tablet 150–300mgPOq8hquinidine † Tablet,IM,IV Dosagevariesbycondition

MEMBRANE-STABILIZING AGENTS



Antiarrhythmics

MOA: PreventthereleaseofvarioustransmittersandprolongtheactionpotentialAdverse reactions: Hypotension, bradycardia, mentaldepression,decreasedsexualability

Contraindications/cautions: Cardiogenic shock, second-orthird-degreeAVblock,pregnancySpecial considerations: IV amiodarone must be mixedinaglasscontainerwithD5W.


amiodarone Cordarone Tablet,IV 200–600mgPOqddronedarone Multaq Tablet 400mgPObidsotalol Betapace Tablet 80–160mgPOq12h

ANTIARRHYTHMICS


Calcium Channel Blockers

MOA: Prevent movement of calcium ions throughslow channels, resulting in a reduction through theAV node, reduction in sinoatrial (SA) node action,andrelaxationofcoronaryarterysmoothmuscleAdverse reactions: Bradycardia,hypotension,heartblock,cardiacfailure,constipation,headache,dizziness

Contraindications: Second- or third-degree AV block,atrialfibrillationSpecial consideration: Diltiazem must be stored in alight-resistantcontainer.


diltiazem † Capsule,tablet,IM,IV 30–90mgqiddiltiazem CardizemCD Capsule 180-360mgqddiltiazem CardizemLA Caplet 180-360mgqdverapamil CalanSR,Verelan Tablet,capsule 180–480mg/dayPOdivqd–bid

CALCIUM CHANNEL BLOCKERS


CONGESTIVE HEART FAILUREThe pumping ability of the heart is unable to meetthemetabolicneedsofthebody’stissues,resultingintheheartpumpinglessbloodthanitreceives;bloodaccumulatesinthechambersoftheheart.

Cardiac Glycosides

Lanoxin (Digoxin)MOA: Increasestheforceofcontraction;increasestheeffectiverefractoryperiodoftheAVnode;andaffectstheSAnodethroughdirectstimulation

Adverse reactions: Nausea,vomiting,arrhythmiasContraindications: Ventricular fibrillation, ventriculartachycardia,sicksinussyndrome


• Concernfordigoxintoxicity• Asymptomofdigoxin toxicity isseeingagreen-

bluehalo.


Angiotensin-Converting Enzyme (ACE) Inhibitors

MOA: Inhibit the conversion of angiotensin I toangiotensin II. Lower quantities of angiotensin IIincrease plasma renin activity and reduce aldoste-ronesecretion.Adverse reactions: A dry, unproductive cough; dizzi-ness occurs during the first few days of therapy;angioedemaandpossibleposturalhypotension

Contraindications/cautions: ACE inhibitor angioedemahistory,hereditary,idiopathic,pregnancy


• ACE inhibitors have a potassium-sparing effect;therefore, one must be aware of possibility ofhyperkalemia.

• Shouldbeavoidedinpatientsreceivinglithium


benazepril Lotensin Tablet 5–20mgPOqdcaptopril Capoten Tablet 12.5–50mgPOtidenalapril Vasotec Tablet 2.5–20mgPObidfosinopril † Tablet 10–40mgPOqdlisinopril Prinivil,Zestril Tablet 5–20mgPOqdperindopril Aceon Tablet 4–16mgPOqdquinapril Accupril Tablet 5–20mgPObid

ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS


Angiotensin II Receptor Antagonists (ARBs)

MOA: BlocktheactionofangiotensinIIatitsreceptorsAdverse reactions: Angioedema,coughContraindications/cautions: Pregnancy, renal artery ste-nosis,renalorhepaticimpairment

Special consideration: Ifpatientispregnant,medicationmustbediscontinuedimmediatelyorfetalorneona-talmorbidityormortalitymayoccur.


candesartan Atacand Tablet 32mgPOqdvalsartan Diovan Capsule 40–160mgPObid

ANGIOTENSIN II ANTAGONISTS


MYOCARDIAL INFARCTIONTheheartmuscledoesnotreceiveenoughoxygenbe-causeofareducedbloodsupply,andmusclecellsdie.Myocardialinfarction(MI)canbepreventedthroughbehavior modifications, which include eliminatingsmoking,controllingdiabetes,reducinghypertension

through diet and lifestyle modification, exercisingthreetimesperweek,reducingcaloriestomeetidealweight, decreasing alcohol consumption, reducingcholesterol and triglycerides, and using aspirin ther-apyifappropriate.Beta-blockersareusedandshouldbetaperedappropriatelyaftertheoccurrenceofMI.


Beta-Blockers

MOA: Blockresponsetobetastimulation,resultinginareductionintheheartrate,myocardialcontractility,bloodpressure,andmyocardialdemandAdverse reactions: Heart depression, bronchoconstric-tion,impotence,fatigue,depression,bradycardia

Contraindications/cautions: Sinus bradycardia, second-orthird-degreeAVblock,heartfailureSpecial consideration: Discontinuationshouldbetaperedtoreducethelikelihoodofangina.


atenolol Tenormin Tablet,IV 100mg/dayPOdivqd–bidcarvedilol Coreg Tablet 25mgPObidmetoprolol Lopressor Tablet 100mgPObidpropranolol Inderal Tablet,capsule 180–240mg/dayPOdivtid–qid

BETA-BLOCKERS


ANGINA PECTORISChestpainisexperiencedbecauseofanimbalancebe-tweenoxygensupplyanddemand;maybeintheformofstableangina,variantangina,orunstableangina.

Nitrates

MOA: Relax vascular smooth muscle, resulting inlowervenousreturnandcardiacfillingandthereforedecreasedtensionincardiacwallsandcoronaryves-selsaredilated

Adverse reactions: Orthostatichypotension,flushingContraindications/cautions: Cardiomyopathy, constric-tivepericarditis,anemia


• Nitroglycerininhalantisflammable.• Nitroglycerininjectionneedstobeprotectedfrom

light.• Medication should not be stopped abruptly but

shouldbetapered.


isosorbidedinitrate Dilatrate-SR,Sorbitrate Tablet,capsule 40–80mgPOqd–bidisosorbidemononitrate Imdur Tablet 30–60mgPOqamnitroglycerin Nitrostat,Nitrobid,Nitro-Dur,

Transderm-NitroSpray,tablet,capsule,ointment,

injection,IV,transdermalpatch0.3–0.6mgSLq5min;0.5–2inch

topicalq4–6h;0.2–0.4mg/hpatchqd

NITRATES


Calcium Channel Blockers (CCBs)

MOA: Inhibitcalciumionsfromentering“slowchan-nels”ofthevascularsmoothmuscleandthemyocar-dium,resultinginrelaxationofthecoronarysmoothmuscleandcoronaryvasodilationandadecreaseinoxygendemandAdverse reactions: Constipation,drowsiness

Contraindications/cautions: Sicksinussyndrome,second-orthird-degreeAVblock,hypotension


• Shouldbetakenwithfood• Caffeineshouldbelimitedinquantity.• Nifedipine liquid-filled capsules need to be pro-

tectedfromlight.


diltiazem DilacorXR Capsule,tablet,IV 120–240mgPOqdnicardipine † Capsule,injection 20–40mgPOtidnifedipine Procardia Capsule,tablet 10–20mgPOtidverapamil CalanSR,Verelan,Covera-HS Tablet,capsule,IV 80–120mgPOtid

CALCIUM CHANNEL BLOCKERS



Beta-Blockers

MOA: Slowtheheartrate,causingdecreasedmyocar-dialcontractilityandloweredbloodpressure,result-inginadecreaseinoxygendemand.Adverse reactions: Bradycardia, hypotension, fatigue,dizziness

Contraindications/cautions: Sinus bradycardia, second-orthird-degreeAVblock,heartfailureSpecial considerations/cautions:• Maymasksymptomsofhypoglycemiaandhyper-

thyroidism• Medicationshouldbetaperedoffwhentherapyis

discontinued.


atenolol Tenormin Tablet,IV 50–200mgPOqdmetoprolol Lopressor,ToprolXL Tablet,IV 50–200mgPObidnadolol Corgard Tablet 40–80mgPOqdpropranolol Inderal Capsule,tablet,solution 80–320mgPOdivbid–qid

BETA-BLOCKERS


ranolazine Ranexa Extended-releasetablet 500–1000mgPObid

RECENTLY APPROVED AGENT FOR ANGINA


HYPERTENSIONSystolicpressure(cardiacoutput)greaterthan140mmHganddiastolicpressure(totalperipheralresistance)greater than 90 mm Hg; the disease does not havesymptoms.

Diuretics

MOA: ReducetotalperipheralresistanceAdverse reaction:Possiblehypokalemiadependingonagentused

Contraindications/cautions: Anuria, hepatic coma, elec-trolyteimbalanceSpecial consideration: Shouldbetakenearlyinthedaytoeliminatethepossibilityofnocturia


chlorothiazide † Tablet,IM,IV 250–500mgPOqd–bidfurosemide Lasix Tablet,oralsolution†,IM†,IV† 10–40mgPObidhydrochlorothiazide † Tablet 12.5-50mgPOqdspironolactone Aldactone Tablet 25–50mgPOqdtriamterene–hydrochlorothiazide Dyazide,Maxzide Capsule,tablet 1–2tabsPOqd

DIURETICS



MOA: Dilatearterioles,resultinginareductionintotalperipheralresistance,energyconsumption,andoxy-genrequirement

Adverse reactions: Drowsiness,peripheraledema,head-ache,palpitationsContraindications/cautions: Severe coronary artery dis-ease,severeaorticstenosis,congestiveheartfailure


amlodipine Norvasc Tablet 5–10mgPOqdfelodipine Plendil Tablet 2.5–10mgPOqdisradipine DynaCircCR Capsule 5mgPOqdnicardipine CardeneSR Capsule 30–60mgPObidnifedipine ProcardiaXL Capsule 30–90mgPOqdverapamil CalanSR,Verelan,Covera-HS Tablet,capsule,IV 180–480mg/dayPOdivqd–bid




Angiotensin-Converting Enzyme (ACE) Inhibitors

MOA: BlockACEtopreventtheconversionofangio-tensinItoangiotensinII,resultinginareductionintotalperipheralresistanceandimprovedelasticityofarteries

Adverse reactions: Cough,hypotension,dizziness,fatigueContraindications/cautions: ACE inhibitor angioedema(history,hereditaryoridiopathic),pregnancySpecial consideration: Ifpatientispregnant,medicationmustbediscontinuedimmediatelyorfetalorneona-talmorbidityormortalitymayoccur.


benazepril Lotensin Tablet 20–40mgPOqdcaptopril Capoten Tablet 25–50mgPObid–tidenalapril Vasotec Tablet 10–40mgPOqdfosinopril † Tablet 20–40mgPOqdlisinopril Prinivil,Zestril Tablet 10–40mgPOqdquinapril Accupril Tablet 20–80mgPOqdperindopril Aceon Tablet 4–8mgPOqdramipril Altace Capsule 2.5–20mgPOdivqd–bidtrandolapril Mavik Tablet 2–4mgPOqd

ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS


Angiotensin II Receptor Antagonists

MOA: BindtoangiotensinIIreceptorsandblockvaso-constrictiveeffectsofthearteriesAdverse reactions: URI,fatigue,dyspepsiaContraindications/cautions: Pregnancy, renal or hepaticimpairment

Special consideration: Ifpatientispregnant,medicationmustbediscontinuedimmediatelyorfetalorneona-talmorbidityormortalitymayoccur.


azilsartan Edarbi Tablet 80mgPOqdlosartan Cozaar Tablet 25–100mgPOdivqd–bidtelmisartan Micardis Tablet 20–80mgPOqdvalsartan Diovan Capsule 80–320mgPOqd

ANGIOTENSIN II RECEPTOR ANTAGONISTS


Beta-Blockers

MOA: Block beta-receptor response to adrenergic re-sponse, resulting in decreased heart rate, myocardialcontractibility,bloodpressure,andmyocardialresponse

Adverse reactions: Bradycardia,hypotension,fatigueContraindications/cautions: Sinus bradycardia, second-orthird-degreeAVblock,heartfailureSpecial consideration: Avoidabruptcessation.


acebutolol Sectral Capsule 400–800mgPOqdatenolol Tenormin Tablet 50–100mgPOqdmetoprolol Lopressor,ToprolXL Tablet 50–200mgPObid

BETA-BLOCKERS (CARDIOSELECTIVE)


Central Nervous System Agents

MOA: Stimulate a2-adrenergic responses in the brainandreducesympatheticoutflowfromthevasomotorcenterinthebrain,resultingindecreasedheartrate,cardiacoutput,andtotalperipheralresistance

Adverse reactions: Drowsiness, fatigue, depression,fluidretentionContraindications/cautions: Avoid abrupt withdrawal;cardiovasculardisease,severecoronaryarterydisease


carvedilol Coreg Tablet 6.25mgPObidlabetalol Trandate Tablet 200–400mgPObidnadolol Corgard Tablet 40–80mgPOqdpropranolol Inderal Capsule,tablet,solution,IV 80–240mgPObidtimolol † Tablet 10–20mgPObid

BETA-BLOCKERS



clonidine Catapres Tablet,patch,IV 0.1–0.3mgPObidguanfacine Tenex Tablet,liquid 1–3mgPOqhsmethyldopa † Tablet,oralsuspension,IV 250–500mgPObid

CENTRAL NERVOUS SYSTEM AGENTS


Peripherally Acting Agents

MOA: Blockastimulationtoperipheralnerves,result-inginvasodilationandhypotension

Adverse reaction:HypotensionContraindications/cautions: Hypotension,hepaticimpair-ment,cataractsurgery


doxazosin Cardura Tablet 1–4mgPOqdprazosin Minipress Capsule 3–7mgPObidterazosin Hytrin Capsule 1–5mgPOqhs

PERIPHERALLY ACTING AGENTS


Vasodilators

MOA: Reduce arteriole smooth muscle, resulting inlowerperipheralresistance

Adverse reactions: Tachycardia, palpitations, flushing,headacheContraindications/cautions: Coronaryarterydisease,mi-tralvalverheumaticheartdisease


fenoldopam Corlopam IV 0.1–1mcg/kg/minIVhydralazine † Tablet 10–50mgPOqidminoxidil † Tablet 10–40mgPOqd

VASODILATORS



Combination Products

MOA: Anadditiveeffecttolowerbloodpressureandreducethenumberofsideeffects

Special consideration: Fewersideeffectsbecausemedi-cationsareinlowerdosages


amlodipine–benazepril Lotrel Capsule 1capPOqdbenazepril–hydrochlorothiazide LotensinHCT Tablet 1tabPOqdenalapril–hydrochlorothiazide Vaseretic Tablet 1tabPOqdirbesartan–hydrochlorothiazide Avalide Tablet 1tabPOqdlosartan–hydrochlorothiazide Hyzaar Tablet 1tabPOqdtelmisartan–hydrochlorothiazide MicardisHCT Tablet 1tabPOqdtrandolapril–verapamil Tarka Tablet 1tabPOqdvalsartan–hydrochlorothiazide DiovanHCT Tablet 1tabPOqd

COMBINATION AGENTS


STROKEInterruptionoftheoxygensupplytoaspecificareaof

thebraincausedbyaruptureorobstruction(clot)ofthebloodvessel,resultinginalossofconscious-ness;complicationsmayincluderetinopathy,neu-ropathy, vascular problems, or kidney damage;maybeischemicorhemorrhagic

Transient ischemic attack (TIA): Atemporaryreduc-tioninoxygenandbloodinaportionofthebrain

Anticoagulants

MOA: Preventproperclot formationwhilemaintain-ingadequatecoagulationAdverse reactions: Bleeding; urine may turn red-orange;fecesmayturnredorblackContraindications/cautions: Hypersensitivity to porkproducts,activemajorbleeding,thrombocytopenia


• Warfarininjectionmustbeprotectedfromlight.• Patients should avoid foods rich in vitamin K if

warfarinistaken.• Manydruginteractionsoccurwithwarfarin.Me-

phytonisgiventotreatanoverdoseofwarfarin.• Blood clotting must be monitored through pro-

thrombin time or international normalized ratiotesting.

• HeparinistobegiveneitherIVorsubcutaneouslybutneverintramuscularly.

• Protamine sulfate is used to treat overdoses ofheparin.


argatroban Argatroban Injection 2mcg/kg/minIVbivalirudin Angiomax IV 0.75mg/kg/IV31dose;then1.75mg/kg/hupto

4h;thenmaycontinue0.2mg/kg/hIVupto20hdabigatran Pradaxa Tablet 150mgPObiddalteparin Fragmin SC 5000unitsSCqd35–10denoxaparin Lovenox SC 1mg/kgSCq12hfondaparinux Arixtra Injection 2.5mgSCqd35–9dheparin Heparin IV 5000unitsSCq8–12hlepirudin Refludan IV 0.15mg/kg/hIVtinzaparin Innohep SC 175units/kgSCqdwarfarin Coumadin Tablet 2–10mgPOqd

ANTICOAGULANTS



Antiplatelet Agents

MOA: Interfere with chemical reactions that causeplateletstoclotAdverse reactions: Nausea,dyspepsia,diarrhea,abdom-inalpain

Contraindications/cautions: Active bleeding, GI bleed,intracranialhemorrhageSpecial consideration: Havebeenshowntohavedimin-ishedefficacyinpoormetabolizers


abciximab ReoPro IV 0.125mcg/kg/minIV312halteplase Activase IV 0.9mg/kgIVover60minaspirin — Tablet 75–325mgPOqdclopidogrel Plavix Tablet 75mgPOqdeptifibatide Integrilin IV 2mcg/kg/minIVreteplase Retavase IV 10unitsIV32tenecteplase TNKase IV 30–50mgIVdependingonbodyweightticlopidine Ticlid Tablet 250mgPObidtirofiban Aggrastat IV 0.1mcg/kg/mininfusion

ANTIPLATELET AGENTS


HYPERLIPIDEMIAHyperlipidemiaisanelevationofoneormoreofthelipoproteinlevels.• Bloodcholesterollevelsper100mLofblood:

• 240mg:atrisk• Lessthan200mg:desirable• 135mg:moredesirable

• Bloodlow-densitylipoproteinlevelsper100mLofblood:• 160mg:highrisk• 139to159mg:borderlinerisk• Lessthan139mg:desirable

Atherosclerosis: Abuildupfattymaterialsorplaque,usuallycholesterol,inthearterialbloodvessels

HMG-COA Reductase Inhibitors

MOA: Inhibittheenzymethatcatalyzestherate-limitingstepincholesterolsynthesisAdverse reactions: GI upset, headache, muscle pain,feverContraindications/cautions: Hepaticdisease,elevatedliverfunctiontest(LFT)results,pregnancy,breastfeedingSpecial consideration: LFTsshouldbeconductedevery6months.


atorvastatin Lipitor Tablet 10–80mgPOqdfluvastatin Lescol Capsule 20–80mgPOdivqd–bidlovastatin Mevacor Tablet 10–80mgPOqpmpravastatin Pravachol Tablet 10–80mgPOqdrosuvastatin Crestor Tablet 5–40mgPOqdsimvastatin Zocor Tablet 5–40mgPOqpm

HMG-COA REDUCTASE INHIBITORS


Fibric Acid Derivatives

MOA: UnknownAdverse reactions: Headache, nausea, vomiting, diar-rhea,skinrash,alterationinliverandkidneyfunction

Contraindications/cautions: Gallbladderdisease,hepaticorrenalimpairment


fenofibrate TriCor Capsule 145mgPOqdgemfibrozil Lopid Tablet,capsule 600mgPObid

FIBRIC ACID DERIVATIVES



Bile Acid Sequestrants

MOA: Formanonabsorbablecomplexwithbileacidsintheintestine

Adverse reactions: NauseaandvomitingContraindication/caution:Biliaryobstruction


cholestyramine Questran(Light) Powder 4–8gPObidcolesevelam Welchol Tablet 3750mgPOqdcolestipol Colestid Tablet,granule 2–16g/dayPOdivqd–qid

BILE ACID SEQUESTRANTS


amlodipine–atorvastatin Caduet Tablet 1tabPOqdezetimibe Zetia Tablet 10mgPOqdezetimibe–simvastatin Vytorin Tablet 1tabPOqpmniacin–lovastatin Advicor Tablet 1–2tabsPOqhs

OTHER CHOLESTEROL-LOWERING AGENTS


NARCOTIC AND OPIOID ANALGESICSIndication: AcuteandchronicpainMOA: Narcotic and opioid analgesics interact withspecificreceptorsitesandhaveaneffectontheCNS.The body produces endorphins, enkephalins, anddynorphins. These substances are released by thebrainafterthereleaseofstimulicausedbypain.Anincreaseinthelevelofpainresultsinanincreaseinthereleaseofthesesubstances.ThereisadecreaseinthenervetransmissiontotheCNS,resultinginade-crease in thesensationofpain.Narcoticandopioidanalgesics respond to the same receptors as endor-phins,enkephalins,anddynorphins.Adverse reactions: Respiratory depression, constipa-tion,mentalconfusion,nausea,vomiting

Contraindications/cautions: Elderly patients, hepatic orrenalimpairment,drugabusehistory


• Haveapotentialfortoleranceandaddiction• All opiates are controlled substances, and one

mustadheretobothfederalandstatelawsregard-ing processing, dispensing, and maintainingproperrecordsofcontrolledsubstances.

• Increasedfluidintakeisrecommendedalongwithstoolsoftenerstocombatconstipation.

• May provide analgesia, sedation, euphoria, ordysphoriaduringpainmanagement

GENERIC NAME BRAND NAME DOSAGE FORMS DOSAGE*CONTROLLED SUBSTANCE

SCHEDULE

acetaminophenwithcodeine

TylenolwithCodeine

Capsule,tablet,IM,IV,SC,elixir

15–60mgcodeinePOq4–6hprn III

butorphanol(nasalspray)

† Nasalspray,IM,IV 0.5–2mgIVq3–4h;1mginonenostrilq3–4h

IV

codeine † Tablet 15–60mgPOq4–6hprn IIfentanyl Duragesic Transdermalpatch,IV 25–100mcg/hpatchq72h;

50–100mcgIVq1–2hprnII

hydrocodone/homatropine

† Tablet 1tabPOq4–6hprn III

hydrocodone–acetaminophen

Lortab,Vicodin Tablet 2.5–10mghydrocodonePOq4–6hprn

III

hydromorphone Dilaudid Tablet,syrup,liquid,IM,IV,SC

2-8mgPOq3–4hprn;1–4mgSC/IM/IVq3–6h

II

meperidine Demerol Tablet,syrup,IM,IV,SC 50–150mgPO/SC/IMq3–4h IImethadone Dolophine Oralconcentrate,oral

solution,tablet2.5–10mgPOq8–12hprn II

morphine MSContin Tablet 15–30mgPOq8–12h II

NARCOTICS AND OPIOIDS


NONNARCOTIC ANALGESICS

Nonsteroidal Antiinflammatory Drugs (NSAIDs)Indications: Conditionsforwhichantipyretic,analgesic,andantiinflammatoryagentsareused

MOA: Inhibitprostaglandinsynthesis,preventingthesensitizationofthepainreceptorsContraindications/cautions: Aspiring-orNSAID-inducedasthma,aspirintriad,pregnancyinthethirdtrimesterAdverse reactions: Stomachirritation,drowsiness,nau-sea,abdominalcramps,jaundice,rash

GENERIC NAME BRAND NAME DOSAGE FORMS DOSAGE*CONTROLLED SUBSTANCE

SCHEDULE

oxycodone OxyContin Capsule,liquid,tablet 10mgPOq12h IIoxycodone-

acetaminophenPercocet,Tylox Tablet,capsule 5–10mgoxycodonePOq6h II

oxycodone–aspirin Percodan Tablet 1tabPOq6hprn IIpentazocine Talwin Tablet,IM,IV,SC 30mgIM/IV/SCq3–4hprn IVpentazocine–

naloxoneTalwinNx Tablet 1–2tabsPOq3–4hprn IV

NARCOTICS AND OPIOIDS—cont’d



diclofenac Cataflam Tablet 50mgPOtiddiclofenac–misoprostol Arthrotec Tablet 1tabPObid–qiddiflunisal † Tablet 500mgPOq12hetodolac † Tablet,capsule 200–400mgPOq6–8hfenoprofen Nalfon Tablet,pulvule 200mgPOq4–6hprnflurbiprofen Ansaid,Ocufen Tablet,ophthalmicdrops 50–100mgPObid–tidibuprofen MotrinIB,Advil Tablet,liquid,drops,

chewabletablets300–800mgPOtid–qid

indomethacin † Capsule,IV,suppository 25mgPOtidketorolac † Tablet,IM,IV 10mgPOq4–6hnabumetone † Tablet 1000–2000mgPOqddivqd–bidnaproxen Anaprox,Naprosyn,

NaprelanTablet,caplet 250–500mgPOq12h

oxaprozin Daypro Caplet 1200mgPOqdpiroxicam Feldene Capsule 20mgPOqd

NONSTEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDs)


Cyclooxygenase-2 Inhibitors

Indications: Rheumatoidarthritis,osteoarthritis,men-strualcramps,acutepainMOA: Blockcyclooxygenase-2(COX-2)enzymespro-ducedduringinflammation

Contraindications/cautions: Aspirin-orNSAID-inducedasthma,pregnancyinthethirdtrimesterAdverse effects:GIdistressandfluidretention


celecoxib Celebrex Capsule 200mgPOqd

CYCLOOXYGENASE-2 INHIBITOR



Aspirin

Indications: Conditions treated with analgesic, anti-pyretic, antiinflammatory, or antirheumatic agents.Low-doseaspirinisusedforitsantiplateleteffectstopreventMI.MOA: Reduce fever by increasing blood flow to theskinandinhibitingprostaglandinandthromboxanesynthesis.Adverse reactions: Stomachulceration,antiplateletag-gregation effects leading to bleeding, anemia, pro-longed pregnancy and labor, tinnitus, dizziness,headache,mentalconfusionContraindications/cautions: Aspirin-orNSAID-inducedasthma,aspirintriad,GIbleed,GIulcer


• Should not be given to children who have beenexposedtoanyviralinfection,suchaschickenpox;mayresultinReyesyndrome

• Should not be given to patients who are takingwarfarin

Acetaminophen

Indications: Conditions treated with analgesics andantipyreticsMOA: MechanismhasnotbeenestablishedAdverse reactions: May increase bleeding in patientstaking warfarin; may damage liver and therefore

shouldnotbegiventopatientswithliverdiseaseoralcoholicsContraindications/cautions: Hepatic or renal impair-ment; limitation on daily alcohol intake. Cautionshould be noted when patient is taking multipleprescriptions or OTC medications because takingacetaminophenmayresultinoverdoseiftakenwithalcohol.Migraine headache:Causedbyadecreaseinserotoninlevels in thebody,resulting in thereleaseofneuro-peptides that travels to the meninges of the brain,resulting in dilation and an inflammation of thebloodvessels

Selective 5-HT Receptor Agonists

Indication: MigraineheadachesMOA: Stimulate serotonin receptors in the cerebraland temporal arteries, which causes vasoconstric-tion,which in turn inhibitsneural transmission, re-sulting in excessive vasoconstriction of the cranialarteriesAdverse reactions: Tinglingwarmsensation,chestdis-comfort,dizziness,vertigoContraindications/cautions: Uncontrolled hypertension,ischemicheartdisease,coronaryvasospasmSpecial consideration: Sumatriptaninjectionneedstobeprotectedfromlight.


almotriptan Axert Tablet 6.25–12.5mgPO31doseeletriptan Relpax Tablet 20–40mgPO31dosefrovatriptan Frova Tablet 2.5mgPO31doserizatriptan Maxalt,MaxaltMLT Tablet 5–10mgPO31dosesumatriptan Imitrex Tablet,SCsolution,inhaler 25–100mgPOx1dose;4–6mgSC3

1dose;5–20mginonenostril31dosesumatriptan/naproxen Treximet Tablet 1tabPO31dosezolmitriptan Zomig Tablet 1.25–2.5mgPO31dose

SELECTIVE 5-HT RECEPTOR AGONISTS

MISCELLANEOUS MIGRAINE MEDICATIONSGENERIC NAME BRAND NAME DOSAGE FORM DOSAGE*

aspirin–butalbital–caffeine Fiorinal Tablet 1–2tabsPOq4hbutorphanolnasal † Nasalspray 1mginonenostrilq3–4hergotamine–caffeine Cafergot Tablet 1–2tabsPOq30minprn



AUTOIMMUNE MEDICATIONS

Disease-Modifying Antirheumatic Drugs (DMARDs)Indication: RheumatoidarthritisMOA: Inhibitlymphocytesandcytokineactivity

Adverse reactions: URIsymptoms,headache,rashContraindications/cautions: Active infection, concurrentlivevaccination,patients65yearsofageandolder


abatacept Orencia IV Dosagevariesbybodyweightadalimumab Humira Injection 40mgSCq2wkanakinra Kineret Injection 100mgSCq24hauranofin Ridaura Capsule 3mgPObidazathioprine Imuran Tablet 1–2.5mg/kg/dayPOdivqd–bidcyclophosphamide † Injection,IV,tablet 1.5–3mg/kgPOdailyetanercept Enbrel Injection 50mgSCqwkhydroxychloroquine Plaquenil Tablet 200–400mgPOqdinfliximab Remicade IV 3mg/kgIV31onwk0,2,6leflunomide Arava Tablet 10–20mgPOqdmethotrexate † Injection,IV,tablet 7.5–25mgPO/IMqwkpenicillamine Cuprimine Capsule 250–500mgPObid–tid

DISEASE-MODIFYING ANTIRHUEMATIC DRUGS (DMARDs)


CONDITIONS AND TREATMENTS FOR THE SKELETAL SYSTEMOsteoporosis: Thinning of bone tissue and loss of

bonedensityovertime

BISPHOSPHONATESIndication: OsteoporosisMOA: InhibitsboneresorptionbyosteoclastsAdverse reactions: Abdominalpain,acidregurgitation,nausea

Contraindications/cautions: Hypocalcemia,abnormalesoph-agealperistalsis


• Itshouldbetaken30minutesbeforethefirstmeal,beverage,ormedicationoftheday.

• Themedicationshouldbetakenwith6to8ozofwatertoavoidesophagealburning.

• The patient should not lie down for at least30minutesaftertakingthemedication.


alendronate Fosamax Tablet 10mg/dayor70mgweeklyalendronate1vitaminD FosamaxwithvitaminD Tablet 10mg/dayor70mgweeklyetidronate Didronel Tablet,IV 5–10mg/kgperdayibandronate Boniva Tablet Onetabletdailyrisedronate Actonel Tablet 5mg/dayor35mg/week

or150mg/monthtiludronate Skelid Tablet 400mgPOqd33mozoledronicacid Zometa IV 4mgIVq3–4wk

BISPHOSPHONATES


SELECTIVE ESTROGEN RECEPTOR MODULATOR (SERM)

Evista (Raloxifene)Indication: OsteoporosisMOA: InhibitsestrogenreceptorsAdverse reactions: Hotflashes,infection,influenza-likesymptoms,arthralgiaContraindications/cautions: Thromboembolism,pregnancy,breastfeeding


raloxifene Evista Tablet 60mg/day

SELECTIVE ESTROGEN REPLACEMENT MODULATOR

GENERIC NAME

BRAND NAME

DOSAGE FORM DOSAGE*

denosumab Prolia Solution 650mgSCq6moteriparatide Forteo IV 20mgSCqd

OTHER BONE DISEASE AGENTS



CONDITIONS AND TREATMENTS FOR THE ENDOCRINE SYSTEM

HYPOTHYROIDISM

Congenital hypothyroidism (cretinism) is an iodinedeficiencydiseasefoundinchildren.Thesymptomsin adults include apathy, decreased heart rate, anddepression.Symptomsinchildrenincludeshortstat-ure,thicktongue,possibleenlargedthyroid,loweredvoice pitch, myxedema, puffy face, reduced mentalacuity,andweightgain.

Hypothyroidism Agents

Indications: ThyroidreplacementtherapyAdverse reactions: Cardiotoxicityandhyperthyroidism

Contraindications/cautions: Thyrotoxicosis,acuteMI,adre-nalinsufficiency

Special Considerations:

• Patientsshouldundergothyroid-stimulatinghor-monetests.

• Levothyroxine has a narrow therapeutic index,which requires caution when switching betweendifferentgenericversionsoflevothyroxine.

• Levothyroxineinjectionneedstobeusedpromptlyafterreconstitution.


levothyroxine Synthroid,Levothroid,Levoxyl Tablet,injection 100–125mcgPOqdliothyronine Cytomel Tablet 25–75mcgqdliotrix Thyrolar Tablet 1tabPOqdthyroid ArmourThyroid Tablet 60–120mgPOqd

HYPOTHYROIDISM AGENTS (MUST BE INDIVIUALIZED)


HYPERTHYROIDISM (GRAVES DISEASE)Hyperthyroidismisanexcessivesecretionofthyroidhormonesthatmaybecausedbythyroidnodules,anexcessiveiodineintake,oratumorcausingoverpro-ductionof thyroid-stimulatinghormone.Symptomsinclude decreased menses, diarrhea, exophthalmos,heatintolerance,nervousness,perspiration,tachycar-dia,andpossibleweightloss.

Hyperthyroid Agents

MOA:Therapy,surgeryAdverse reactions:Fever,sorethroat,unusualbleedingorbruising,headache,malaiseContraindications/cautions:Breastfeeding,pregnancyEXAMPLES OF HYPERTHYROID AGENTS

methimazole Tapazole Tablet 15–30mgPOqdpropylthiouracil *† Tablet 100–150mgPOqd


*Pleasenotethatalldosagesareforadultsandexpressedinoraldosagesunlessotherwiseindicated.†Nobrandnamedrugavailable;availableonlyasageneric.


HORMONE REPLACEMENT THERAPY (HRT)Indication: Estrogenreplacementtherapyrelievessymp-toms of estrogen deficiency that include vasomotorinstability, drying and atrophy of vaginal mucosa,insomnia,irritability,andmoodchanges.MOA: Suppressfollicle-stimulatinghormonesecretionAdverse reactions: Nausea, bloating, weight gain,breast tenderness, breast cancer, possible break-throughbleeding

Contraindications/cautions: Undiagnosedvaginalbleed-ing,breastcancer,pregnancy


• Allestrogenproductsshouldbedispensedwithapatientpackageinsert.

• Conjugatedestrogentherapyiscyclic.• WhereasEstradermandVivelleareappliedtwice

weekly,Climaraisappliedweekly.


conjugatedestrogen Premarin Tablet,cream 0.3–1.25mgPOqdconjugatedestrogen–

medroxyprogesteronePrempro,Premphase Tablet 1tabPOqd

estradiol Estrace Tablet,cream 1–2mgPOqdestradiol–levonorgestrel Climara,ClimaraPro Patch 1patch13/wkestradiol–norethindrone Activella,CombiPatch Tablet,transdermalpatch 1tabPOqd;1patch23/wkestropipate † Tablet,cream 0.75–6mgPOqd

ESTROGENS


PROGESTINSIndications: Treatmentofmenstrualdysfunction,suchasuterinebleeding,amenorrhea,dysmenorrhea,andendometriosisMOA: Inhibitluteinizinghormonesecretionbymeansofanegativefeedbackonthehypothalamicanteriorpituitaryaxis

Contraindications/cautions: Undiagnosedvaginalbleed-ing,breastcancer,genitalorgancancerAdverse reactions: Weight gain, depression, fatigue,acne,hirsutism

GENERIC NAME BRAND NAME DOSAGE FORM DOSAGE†

medroxyprogesterone Provera Tablet 5–10mgPOqd35–10daysnorethindrone Micronor Tablet 1tabPOqd

PROGESTINS


ADDISON DISEASEAddison disease is a deficiency of glucocorticoidsandmineralocorticoidsthatistreatedwithcorticoste-roids.SymptomsofAddisondisease includedebili-tatingweakness,weight loss,hyperpigmentationofthe skin, reduced blood pressure, low sodium andglucoselevels,andhyperkalemia.

CUSHING DISEASECushing disease results from an overproduction ofsteroids or excessive administration of corticoste-roidsoveranextendedperiod.Symptomsincludeaprotruding abdomen and fat over the shoulderblades.


Corticosteroids

MOA: CombinewithsteroidreceptorsincytoplasmIndications: Arthritis, dermatitis, allergic reactions,asthma,hepatitis,systemiclupuserythematosus,in-flammatoryboweldiseaseforglucocorticoidreplace-ment inAddison disease or other forms of adrenalinsufficiencyContraindications/cautions:Diabetes,tuberculosis,affec-tivedisorders

Adverse reactions: Stomach irritation, hypertensionfrom sodium retention, slow wound healing, thin-ning of skin, peptic ulcer disease, increased infec-tions, reduced white blood cell function, truncalobesity, moon face, buffalo hump, hyperglycemia,hypokalemia, osteoporosis, alterations in mood,manic-depressivebehavior,cataracts

CORTICOSTEROID BRAND NAME EQUIVALENCY (mg) ANTIINFLAMMATORY POTENCY

betamethasone Diprolene 0.6 25.0cortisone Cortone 25.0 0.8dexamethasone Decadron 0.75 30.0hydrocortisone Hydrocortisone 20.0 1.5methylprednisolone Medrol 4.0 5.0prednisolone Pediapred 5.0 4.0prednisone Deltasone 5.0 3.0triamcinolone Aristocort 4.0 5.0

EQUIVALENCY OF CORTICOSTEROIDS COMPARED WITH THE DAILY SECRETION OF HYDROCORTISONE (20 mg)

TYPE OF EFFECT SIDE EFFECT

Cardiovascular HypertensionDermatologic Impairedwoundhealing,thinningoftheskin,petechiae,purpuraGastrointestinal Pepticulcerdisease,pancreatitisImmunesystem InfectionsandreductionofwhitebloodcellfunctionMetabolic Redistributionoffatdeposits,acne,hirsutism,growthsuppression,hyperglycemia,hypokalemia,

sodiumandwaterretentionMusculoskeletal Osteoporosis,vertebralcompressionNeuropsychiatric Alterationsinmood;manic-depressive,psychotic,suicidal,orschizophrenictendenciesOphthalmic Cataractsandglaucoma

SIDE EFFECTS OF CORTICOSTEROIDS

DIABETES• Gestational diabetes: Occurs during the second

and third trimester of pregnancy; can be treatedwithexercise,diet,andinsulin

• Type 1 diabetes (insulin-dependent diabetes mellitus [IDDM] or juvenile-onset diabetes):In-dividual’sbodyisunabletoproduceinsulin,soheorshebecomesinsulindependent.

• Type 2 diabetes (non–insulin-dependent diabe-tes mellitus [NIDDM] or adult-onset diabetes): Conditionthatoccursinindividualswhohaveanimpaired insulin secretion and are often insulinresistant; treatment includes medication andweightreductionthroughdietandexercise

• Secondary diabetes: Onsetcausedbytakingvari-ousmedications,suchasoralcontraceptives,beta-blockers,diuretics,calciumchannelblockers,glu-cocorticoids,andphenytoin

Oral Hypoglycemic Agents

Second-Generation SulfonylureasMOA: Promotereleaseofinsulinfromthebetacellsofthepancreas;andlowerbloodglucoselevelsAdverse reactions: Diarrhea, nausea, hypoglycemia,dizzinessContraindications/cautions: Diabetic ketoacidosis, neartermpregnancy,renalorhepaticimpairmentSpecial consideration: Adjuncttoexerciseanddiet

Enzyme Inhibitors

MOA: Inhibitintestinalwallenzymesthatconvertsac-charides intoglucose,resultingin loweringofpost-prandialhyperglycemiaAdverse reactions: Abdominal pain, diarrhea, andflatulence


Contraindications/cautions: Patients with cirrhosis, in-flammatoryboweldisease, colonulceration, intesti-nalobstructionSpecial consideration: Mustbemonitoredevery3monthsfor1yearandthenperiodicallyasdirected

Biguanides

MOA: Decrease glucose production by the liver andimproveinsulinsensitivityAdverse reactions: Nausea, metallic aftertaste, weightloss

Contraindications/cautions: Renal dysfunction or dis-ease,metabolicacidosis,diabeticketoacidosisSpecial consideration: Needtobetitratedupwardoveraperiodofweeks

Glitazones

MOA: ImprovecellularresponsetoinsulinAdverse reactions: Increasedplasmavolume,elevatedhigh-densitylipoproteinlevelsContraindications/cautions: Type1diabetesmellitus,di-abeticketoacidosis

GENERIC NAME BRAND NAME AGENT TYPE DOSAGE FORM DOSAGE*

acarbose Precose Enzymeinhibitor Tablet 50–100mgPOtidglimepiride Amaryl Second-generationsulfonylureas Tablet 1–4mgPOqdglipizide Glucotrol,GlucotrolXL Second-generationsulfonylureas Tablet 5–10mgPOqdglyburide DiaBeta,Glynase,

MicronaseSecond-generationsulfonylureas Tablet 1.25–20mgPOqd

metformin Glucophage,GlucophageXR

Biguanide Tablet 850mgPObid

miglitol Glyset Enzymeinhibitor Tablet 50–100mgPOtidnateglinide Starlix Meglitinide Tablet 60–120mgPOtidbefore

mealsrepaglinide Prandin Meglitinide Tablet 0.5–4mgPOacpioglitazone Actos Glitazone Tablet 15–30mgPOqdSitagliptin Januvia DPP-4inhibitor Tablet 100mgPOqdpramlintide Symlin Amylinanalogue Injection 15mcgSCqac

Combination Productsglipizide–metformin Metaglip Tablet 1–2tabsPOqd–bidglyburide–metformin Glucovance Tablet 1–2tabsPObidrepaglinide–metformin PrandiMet Tablet Individualizedosebid–tid

HYPOGLYCEMIC AGENTS


Injectable Hypoglycemic Agents

MOA: VariabledependingontheclassofmedicationAdverse reactions: Hypoglycemia,blurryvision,hyper-sensitivity,hypertensionContraindications: Hypoglycemia

Comments

• Humulin insulincanbestoredat roomtempera-turefor1month.

• Humaloginsulinrequiresaprescription.• Regularinsulinistheonlytypeofinsulinthatcan

beusedIV.

GENERIC NAME BRAND NAME DURATION OF ACTION

exenatideinjection Byetta Longactinginsulindetemirinjection Levemir Longactinginsulininjection RegularIletinI Rapid

RegularIletinII RapidNovolinR Rapid

isophaneinsulin NPHIletinI IntermediateHumulinN Intermediate

isophaneinsulinsuspensionandinsulininjection Humulin70/30 Intermediateisophaneinsulinsuspensionandinsulininjection Humulin50/50 Intermediateinsulinglulisine Apidra Rapidinsulinzincsuspension;extendedlente HumulinUltralente Longactinginsulinanaloginjection Humalog Rapidinsulinglargine Lantus Longactingliraglutide(rDNAorigin) Victoza Longacting

INJECTABLE HYPOGLYCEMIC AGENTS


CONDITIONS AND TREATMENTS FOR THE REPRODUCTIVE SYSTEM

ORAL CONTRACEPTIVES

Indication: PreventpregnancyMOA: Suppressovulationbyinterferingwithproduc-tion of hormones that regulate the menstrual cycleandalterthecervicalmucus

Adverse reactions: Potential for heart attack, stroke,and thromboembolic disease. Other side effectsincludenausea,weightgain,breasttenderness,anddepression.Contraindications/cautions: Smokers, pregnancy, breastcancer,endometrialcancerSpecial consideration: Oralcontraceptivesmustbedis-pensedwithapatientpackageinsert.


estradiolvalerate–dienogest Natazia Tablet 1tabPOqdethinylestradiol–desogestrel Cyclessa,Desogen,Kariva,

Mircette,Ortho-CeptTablet 1tabPOqd

ethinylestradiol–drospirenone Yasmin,Yaz Tablet 1tabPOqdethinylestradiol–ethynodiol

diacetateDemulen Tablet 1tabPOqd321days(21daypack)or

1tabPOqd328days(28-daypack)ethinylestradiol–etonogestrel NuvaRing Ring Insertoneringvaginallyfor3weeks;

removeringanddispose;wait1weekandrepeat

ethinylestradiol–levonorgestrel Seasonique Tablet 1tabPOqd391daysandrepeatethinylestradiol–norelgestromin OrthoEvra Patch 1patchweeklyfor3weeks;stopfor

1weekandresumeethinylestradiol–norethindrone EstrostepFe,Femhrt,Loestrin

Fe,Ovcon,OrthoNovumTablet 1tabPOqd

ethinylestradiol–norgestimate OrthoTri-Cyclen,OrthoTri-CyclenLo

Tablet 1tabPOqd

ethinylestradiol–norgestrel Lo/Ovral,Low-Ogestrel Tablet 1tabPOqd

Emergency Contraceptiveslevonorgestrel PlanBOneChoice,NextStep Tablet 1tabPO31;1tabPOq12h32doses

Parenteralmedroxyprogesterone Depo-Provera Injection 150mgIMqmo

EXAMPLES OF ORAL CONTRACEPTIVES


CLASS DRUGS TYPE OF INTERACTION

Antibiotics Erythromycin,griseofulvin,penicillin,rifampin,tetracycline

Maydecreaseeffectivenessoforalcontraceptivefrominterferencewithenterohepaticcyclingofestrogen,resultinginafluctuationofhormonelevels

Anticonvulsants Tegretol,Dilantin,Mysoline,phenobarbital Decreasecontraceptiveactionfromincreasedmetabolismofhormones

Antifungals Diflucan,Nizoral,Sporanox MaydecreaseeffectivenessoforalcontraceptivesBenzodiazepines Dalmane,Halcion,Librium,Valium,Xanax Metabolismofbenzodiazepinemaybedecreased,

resultinginanincreaseinsideeffectsBronchodilator Theophylline Increasedsideeffectsoftheophyllineresultingfrom

decreasedtheophyllinemetabolismCorticosteroids Hydrocortisone,methylprednisolone,

prednisolone,prednisoneIncreasedeffectsfrominhibitionofmetabolismby

oralcontraceptivesLipid-loweringagents Atromid-S DecreasedoralcontraceptiveeffectTricyclicantidepressants Elavil,Tofranil Increasedsideeffectsoftricyclicantidepressants

EXAMPLES OF ORAL CONTRACEPTIVE INTERACTIONS



sildenafil Viagra Tablet 1tabPOqdtadalafil Cialis Tablet 1tabPOqdvardenafil Levitra Tablet 1tabPOqd

ERECTILE DYSFUNCTION AGENTS


Erectile dysfunction Aman’sinabilitytoachieveormaintainanerectionduetoalackofbloodflowingtothepenis

ERECTILE DYSFUNCTION AGENTSMOA: Inhibitphosphodiesterasetype5,enhancingtheeffectsofnitricoxide–activatedincreaseincGMP

Adverse reactions: Headache,flushing,dyspepsia,visualContraindications/cautions: Patients with pulmonaryveno-occlusivedisease;patientstakingnitratesshouldnottakebecauseofpossibleMI

CONDITIONS AND TREATMENTS FOR THE INTEGUMENTARY SYSTEM

Psoriasis: Consistsofpatchesofred,scalyskin,usu-allyon theelbowsandknees;maybecausedbyillness,injury,oremotionalstress

PSORIASIS AGENTSMOA: RegulateskincellproductionandproliferationAdverse reactions: Skinirritation,burning,rash,pruritusContraindications/cautions: Hypercalcemia, vitamin Dtoxicity

GENERIC NAME BRAND NAME DOSAGE FORMS DOSAGE* SPECIAL CONSIDERATIONS

acitretin Soriatane Capsule 25–50mgPOqdalefacept Amevive Injection 15mgIMqwk312wkcalcipotriene Dovonex Cream,ointment Applybid Patientshouldwashhands

aftereachapplicationcyclosporine Neoral Capsule,oralliquid 2.5-4mg/kg/dayPO

divbidmethotrexate † Tablet,IM,IV 10–25mgPO/IMqwk Mayinhibitnormalcell

growthpimecrolimus Elidel Cream Applybidtacrolimus Protopic Ointment Applybid

PSORIASIS MEDICATIONS



Acne vulgaris: Aninfectionofthesebaceousglandsthatmayproducepustules,papules, comedones,andscars

ACNE VULGARIS AGENTSMOA: Removekeratinocytes in thesebaceous follicleby loosening the horny cells at the mouth of theducts,resultingineasysloughing

Adverse reactions: Erythema,scaling,drynessContraindications/cautions: Photosensitivity, sunburn,eczemaSpecial consideration: Hands should be washed aftereachapplication.


adapalene Differin Gel Applyqhs Waterbased;causeslessirritationthanRetin-Aazelaicacid Azelex Cream Applybid Thinfilmshouldbeappliedtoaffectedarea

twiceperdayclindamycin-benzoyl

peroxideBenzaClin Gel Applybid

tretinoin Retin-A Cream,gel,lotion Applyqhs Avoidexposuretosun;handsshouldbewashedaftereachuse;maycausesevereirritation

tretinoin Renova Cream Applyqhs HasamoremoisturizingeffectthanRetina-Abenzoylperoxide Brevoxyl Lotion Applyqd–bid

ACNE VULGARIS AGENTS


Actinic keratoses: A small, rough spot occurringon skin that has been chronically exposed to thesunandgenerallymeasureinsizebetween2and6mmindiameter

ACTINIC KERATOSES AGENTSIndications: AntiproliferativeagentsforskincancerMOA:Interferewithacell’sabilitytoreproduce

Adverse reactions: Itching, burning, soreness, tender-ness,scaling,andswellingContraindications/cautions: Poor nutritional state, my-elosuppression,infectionSpecial consideration: May cause transient burning oftheskin


aminolevulinicacid LevulanKerestick Topicalsolution Applyq8wkdiclofenac Solaraze Gel Applybid360–90daysfluorouracil Efudex Cream,solution Applybid2–4wk Properhandwashingshouldbefollowed;

avoiddirectsunlight;needstobedis-posedofproperlybecauseitisananti-neoplasticagent

ACTINIC KERATOSES AGENTS



TOPICAL ANTIFUNGALSMOA: Prevent the synthesis of ergosterol, which isneededforfungalcellmembranes

Adverse reactions: Irritation, burning, stinging, pruri-tus; inhibit fungalcytochromeP450associatedwithazoledrugsContraindications/cautions: Noneidentified


butenafine Mentax Cream Applyqd–bid37–14days Usedtotreatathlete’sfoot,jockitch,andringworm;useddailyfor4weeks

ciclopirox Loprox Cream,lotion Applybid34wk AvailableOTCclotrimazole Lotrimin,Mycelex Cream,lotion,vaginal,

trocheApplybid;1appqhs3

7nights;10mgpo53/day314days

AvailableOTC

clotrimazole–betamethasone

Lotrisone Cream,lotion Applybid

econazole † Cream Applyqdgriseofulvin † Tablet,capsule,oral

suspension375mgPOqd32–6wk Fungalinfectionsofthehair,skin,

andnails;avoidexposuretosun;takewithafattymeal

miconazole Monistat Cream,vaginal,IV,spray

Dosagevariesbaseduponcondition

OTC;usedtotreatvulvovaginalcandidiasis

nystatin Mycostatin Cream,ointment,oralsuspension,capsule

Applybid–tid Commonlyusedtotreatchildrenwithcandidiasis;patientsaretoldtoswishandswallow

nystatin–triamcinolone

† Cream,ointment Applybid

oxiconazole Oxistat Cream,lotion Applyqd–bid314dayssertaconazole Ertaczo Cream Applybid34wksulconazole Exelderm Cream Applyqd–bid33–4wkterbinafine Lamisil Cream,tablet 250mgPOqd32–12wk Takenorallyonceperdayfor

6weeksforfingernailinfectionsandfor12weeksfortoenailinfections;maybepulsedosed

tolnaftate Tinactin Liquid,powder,cream,solution

Applybid OTC

TOPICAL ANTIFUNGAL AGENTS



TOPICAL CORTICOSTEROIDSMOA: Suppressthehypothalamic–pituitaryaxisIndications: Dermatitis,psoriasis,eczema,rashesContraindication/caution: NoneidentifiedAdverse reactions: Burning skin, contact dermatitis,pruritus


• Creams and ointments should not be consideredinterchangeable.

• Topicalsshouldnotbeoccludedwithacovering.• A thin layer should be applied sparingly to the

affectedarea.• Corticosteroidsshouldnotbeusedformorethan

2weeks.


amcinonide † Cream,lotion,ointment Applybid–tidbetamethasone0.05% Diprolene Cream,gel,ointment Applyqd–bidclobetasol0.05% Temovate Cream,ointment Applybiddesoximetasone0.25% Topicort Cream,ointment Applybiddiflorasone0.05% † Ointment Applybid–qidfluocinolone † Cream,ointment Applybid–qidfluocinonide0.05% † Cream,ointment,solution Applybid–tidhalobetasol0.05% Ultravate Cream,ointment Applyqd–bidhydrocortisonebutyrate Locoid Cream,ointment,solution Applybid–tidhydrocortisonevalerate Westcort Cream,ointment Applyqd–qidmometasone0.1% Elocon Ointment Applyqdtriamcinolone Kenalog Cream,lotion,ointment Apply32sectid–qid

TOPICAL CORTICOSTEROIDS



bacitracin–neomycin–polymyxinB

TripleAntibiotic Ointment Applyqd–tid

clindamycin CleocinT Cream,gel,lotion,solution Applybiderythromycin † Gel,solution Applybidmafenide Sulfamylon Cream,topicalsolution Applyqd–bidmetronidazole MetroGel,MetroCream Gel,cream Applybidmupirocin Bactroban Ointment Applytid37–14daysneomycin–polymyxinB Neosporin Ointment Applyqd-tidsilversulfadiazine Silvadene Cream Applyqd–bid

TOPICAL ANTIBIOTICS



CONDITIONS AND TREATMENTS FOR THE OPHTHALMIC SYSTEM

Glaucoma:A chronic disorder characterized by ab-normallyhighinternaleyepressurethatdestroystheopticnerveandmaycauselossofvision.Threetypes of glaucoma exist: open-angle, narrow-angle,andsecondaryglaucoma.

GLAUCOMA AGENTSMOA: ReduceintraocularpressureAdverse reactions: Blurredvision,hyperemia,pruritusContraindications/cautions: OcularinflammationSpecial consideration: Drug treatment cannot cure thediseasebutcancontrolit.

GENERIC NAME BRAND NAME OPHTHALMIC DOSAGE FORMS DOSAGE* COMMENTS

apraclonidine Iopidine Solution 1–2gttineye(s)tidbetaxolol BetopticS Solution,suspension 1–2gttineye(s)bidbimatoprost Lumigan Solution 1gttineye(s)qpmbrimonidine AlphaganP Solution 1gttineye(s)tid Reducesfluidproductionintheeyebrinzolamide Azopt Solution 1gttineye(s)tid Shouldnotbetakenwithcarbonic

anhydraseinhibitorsdorzolamide Trusopt Solution 1gttineye(s)tid Bittertastemaybepresentafter

administrationlatanoprost Xalatan Solution 1gttineye(s)qpm Maycauselight-coloredeyesto

turnbrown;shouldbestoredintherefrigerator

timolol Timoptic,TimopticXE Solution 1gttineye(s)qd–bidtravoprost TravatanZ Solution 1gttineye(s)qpm

GLAUCOMA AGENTS


Conjunctivitis (pink eye):Anacuteinflammationoftheconjunctivathatiscausedbyviruses,bacteria,fungi,orallergies

GENERIC NAME BRAND NAME DOSAGE FORMS DOSAGE* CLASSIFICATION

alcaftadine Lastacaft Solution 1gttineye(s)qd Allergybacitracin † Ointment Applyineye(s)q3–4h Antibioticciprofloxacin Ciloxan Solution 1–2gttineye(s)q2hwhileawake;then

q4h312daysAntibiotic

cromolynsodium Crolom Solution 1–2gttineye(s)4–63day Mastcellstabilizercyclosporine Restasis Solution 1gttineye(s)q12h NSAIDdexamethasone † Ointment 1gttineye(s)tid–qid Corticosteroiddiclofenac Voltaren Solution 1gttineye(s)qid32wk NSAIDflurbiprofen Ocufen Solution Dosagevariesbasedoncondition NSAIDgatifloxacin Zymar Solution 1gttineye(s)q2hupto8332d;then

1gttqid35daysAntibiotic

gentamicin Garamycin Solution,ointment 1–2gttineye(s)bid–tid Antibioticketorolac Acular Solution 1gttineye(s)qid NSAIDlevofloxacin † Solution 1–2gttineye(s)q2hwhileawake;then

q4hwhileawake3 5daysAntibiotic

naphazoline NaphconA Solution 1–2gttineye(s)prn OTCdecongestantofloxacin Ocuflox Solution 1–2gttineye(s)q2–4h32days;then

1–2gttqid35daysAntibiotic

olopatadine Patanol Solution 1gttineye(s)bid Antihistaminesulfacetamide-

prednisoloneBlephamide Ointment,solution,

suspension2gttineye(s)q4hwhileawake Corticosteroid

sulfacetamidesodium Bleph-10 Ointment,solution 1–2gttineye(s)q2–3h37–10days Antibiotictobramycin-dexa-

methasoneTobradex Ointment,solution 1–2gttineye(s)q4–6h Corticosteroid

trifluridine Viroptic Solution 1gttineye(s)q2hwhileawakeuntilreepithelization;then1gttq4hwhileawakefor7days

Antiviral

OTHER OPHTHALMIC AGENTS

*Pleasenotethatalldosagesareforadultsandexpressedinoraldosagesunlessotherwiseindicated.†Nolongeravailableasabrandeddrug.NSAID,Nonsteroidalantiinflammatorydrug;OTC,overthecounter.


Otitis media: An infection of the middle ear oftencausedbyaninflammationoftheEustachiantube

GENERIC NAME BRAND NAME DOSAGE FORMS DOSAGE* COMMENTS

antipyrine-benzocaine † Solution 2–4gttinear(s)tid32–3days Analgesiccarbamideperoxide Debrox Solution 5–10gttinear(s)bid Waxdissolverneomycin–polymyxin

B–hydrocortisone

† Suspension,solution 4gttinear(s)tid–qid Antibiotic

OTIC AGENTS


CHEMOTHERAPY AGENTS

ALKYLATING AGENTS

MOA: Formirreversiblecross-linksinDNA,resultingincellsbeingunabletoreproduceAdverse reactions: Myelosuppression,hairloss,nausea,vomiting,appetite,weightlossContraindications: Bonemarrowdepression,pregnancyduringfirsttrimester,breastfeeding

ANTIBIOTICSMOA: Inhibit DNA-dependent RNA synthesis; delayorinhibitmitosisAdverse reactions:Myelosuppression,alopecia,nausea,vomitingContraindications/cautions: Impaired cardiac function,hepaticorrenalsuppression

ANTIMETABOLITESMOA: Participates as an “imposter” in essential cellreaction,resultinginnonfunctionalfunctionstopre-ventnormalfunctionsofkeyenzymesAdverse reactions: Myelosuppression,alopecia,nausea,vomiting,diarrheaContraindications/cautions: Myelosuppression,pregnancy,anemia

PLANT ALKALOIDSMOA: Prevent formation of functional spindle fibersneededforcelldivisionAdverse reactions: Neurotoxicity, myelosuppression,alopecia,nausea,vomiting,extravasation,anemiaContraindication/caution: Breastfeeding

GENERIC NAME BRAND NAME DOSAGE FORMS CLASSIFICATION

bleomycin Blenoxane IV,IM,SC Antibioticbusulfan Myleran Tablet Alkylatingchlorambucil Leukeran Tablet Alkylatingcisplatin Platinol IV,tablet Alkylatingcyclophosphamide Cytoxan Tablet,injection Alkylatingcytarabine Cytosar-U SC,IM,IV Antimetabolitedaunorubicin Cerubidine IV Antibioticdoxorubicin Adriamycin IV Antibioticepirubicin Ellence IV Antimetaboliteetoposide * Capsule,IV Plantalkaloidfluorouracil(5-FU) Efudex Cream,IV,topicalsolution Antimetabolitehydroxyurea Hydrea Capsule Antimetabolitelomustine(CCNU)† CeeNU Capsule Alkylatingmelphalan Alkeran IV Alkylatingmercaptopurine Purinethol Tablet Antimetabolitemethotrexate Rheumatrex IM,IV,tablet AntimetabolitemitomycinC Mutamycin IV Antibiotictemozolomide Temodar Capsule Antibioticthioguanine(6TG)* Tabloid Tablet Antimetabolitethiotepa * IV Alkylatingvalrubicin Valstar Injectionintothebladder Antimetabolitevinblastine Velban IV Plantalkaloidvincristine Oncovin IV Plantalkaloid

CYTOTOXIC CHEMOTHERAPY AGENTS

*Nolongeravailableasabrandeddrug.†BothTheJointCommissionandtheInstituteforSafeMedicationPracticesareagainstusingabbreviationsformedications;however,physiciansmaystillusetheseabbreviations.


HORMONESMOA: InhibitsynthesisofadrenalsteroidsAdverse reactions: Hot flashes, transient tumor flare,headacheContraindication/caution: Pregnancy

GENERIC NAME BRAND NAME DOSAGE FORMS TARGET

aminoglutethimide * Tablet Breast,prostateanastrazole Arimidex Tablet Breastcancerexemestane Aromasin Tablet Breastcancerflutamide * Capsule Prostategoserelin Zoladex Implant,SC Prostate,endometriosis,

metastaticbreastcancerletrozole Femara Tablet Breastcancerleuprolide LupronDepot SC Prostatecarcinoma,endometriosismegestrol Megace Suspension,tablet Breast,endometriosistamoxifen * Tablet Breast

HORMONE AGENTS

*Nolongeravailableasabrandeddrug.

GENERIC NAME BRAND NAME DOSAGE FORMS ADVERSE EFFECTS

aldesleukin Proleukin IV Hypotension,diarrhea,feverorchillsinterferona-2a Roferon IM,IV,SC Weightloss,metallictaste,nausea,vomiting,abdominal

crampsinterferona-2b Intron IM,IV,SC Changesinmentalstatus,sorethroat,fever,fatigue,unusual

bleedinginterferonb-1a Avonex IM Myalgia,fever,chills,malaise,fatigueinterferonb-1b Betaseron SC Myalgia,fever,chills,malaise,fatigue

BIOLOGICAL RESPONSE MODIFIERS

GENERIC NAME BRAND NAME TREATMENT

bevacizumabinjection Avastin Treatmentofmetastaticcolorectaldiseasecetuximabinjection Erbitux Treatmentofmetastaticcolorectaldiseaseclofarabineinjection Clolar Treatmentofrelapsedorrefractorypediatricacutelymphoblastic

leukemiadasatinib Sprycel Treatmentforadultswithchronicmyeloidleukemiaerlotinib Tarceva Treatmentofadvancedandnon–smallcelllungcancerpanitumumab Vectibix Treatmentformetastaticcolorectalcarcinomapemetrexeddisodiuminjection Alimta Treatmentofmesotheliomaandnon–smallcelllungcancersorafenibtosylate Nexavar Treatmentofadvancedrenalcellcarcinomavorinostat Zolinza TreatmentofpatientswithcutaneousT-celllymphomasnelarabine Arranon TreatmentofT-celllymphoblasticleukemia

TARGETED ANTICANCER AGENTS


VITAMIN GENERIC NAME FUNCTIONS SOURCES

B1 Thiamine Coenzymeincarbohydratemetabolism;deficiencyresultsinberiberi

Pork,liver,kidney,wholecereal,grains,beans,andyeast

B2 Riboflavin Maintainsintegrityofmucousmembranesandmetabolicenergypathways

Milk,liver,kidney,cereals,andgreenvegetables

B3 Nicotinicacid Involvedinfatsynthesis,electrontransport,andproteinmetabolism;deficienciesresultindiar-rhea,dementia,anddermatitis;preventspellagra

Liver,yeast,leanmeats,peanuts,andbeans

B5 Pantothenicacid Deficienciesmayresultinfatigue,headache,sleepi-ness,nausea,GIpain,anddisturbancesofcoor-dination

Vegetables,cereals,yeast,andliver

B6 Pyridoxine Coenzymeinaminoacidandfattyacidmetabolism AllplantsandanimalsB9 Folicacid NeededfortheproductionofhealthyRBCs LiverandfreshgreenvegetablesB12 Cyanocobalamin IntrinsicfactorfortheproductionofRBCs;defi-

ciencyisseeninperniciousanemiaAnimaltissue

Biotin Deficiencyischaracterizedbydermatitisandanorexia

Yeast,eggyolk,vegetables,nuts,andcereals

C Ascorbicacid Maintainingnormalcellmembranepermeabilitypromoteswoundhealingandantiinflammatoryability;preventsscurvy

Greenplants,tomatoes,citrusfruits

EXAMPLES OF WATER-SOLUBLE VITAMINS

GI, Gastrointestinal;RBC,redbloodcell.

VITAMIN GENERIC NAME USES SOURCES

A Retinol Preventskeratomalacia Milk,butter,cheese,liver,andfishoilsD2 Ergocalciferol Preventsricketsinsmallchildrenandprevents

osteomalaciainadultsButter,milk,cheese,eggyolk,andfishoils

D3 CholecalciferolE Tocopherols Antioxidantforunsaturatedfattyacids;defi-

ciencyischaracterizedbyirritability,edema,andhemolyticanemia

Soybeanoil,wheatgerm,ricegerm,nuts,corn,butter,eggs,andleafygreenvegetables

K Phytonadione Formationofprothrombin Leafygreenvegetables,wheatbran,soybeans

EXAMPLES OF FAT-SOLUBLE VITAMINS

RefertoAppendixCforalistingofthetop200med-icationsprescribed.

VITAMINS, ELECTROLYTES, AND NUTRITIONAL SUPPLEMENTS

VITAMINS

Vitaminsareessentialorganicconstituentsfoundinmany food products and are necessary for normal

metabolicfunctions.Theymaybeeitherwatersolu-bleorfatsoluble.Fat-solublevitaminsaccumulateinlargestores,primarily in the liver.Deficienciesmayleadtodiseaseafterperiodsofrestrictedintake.Ex-cessive intake may result in toxicity. Water-solublevitamins are easily eliminated by the kidneys on adailybasis.


MINERALS• Calcium: Needed for proper muscle and nerve

function;necessaryforproperboneandtoothfor-mation;preventionofosteoporosis

• Chromium:Aidsinmetabolismofsugars• Copper:Neededforproperbloodformation• Iodine:Neededforproperthyroidfunction• Iron:Neededforredbloodcellformation• Magnesium:Neededformusclefunction

• Potassium:Neededforheartandnerve function;cellularhomeostasis

• Sodium:Neededfornerveandmuscleformation;cellularhomeostasis

• Sulfur:Neededforenergyproductionandcellularfunction

• Zinc:NeededforproperimmunefunctionRefer to Appendix D for a listing of the commonvitamins.

HERBAL MEDICATIONS

NAME USES

Aloevera WoundandburnhealingAmericanginseng Energy,stress,immunesystembuilderBasil ReducinggasBilberry EyeandvasculardisordersBlackcohosh Menopause,premenstrualsyndrome,milddepression,arthritisCascarasagrada LaxativeCat’sclaw Antiinflammatory,antimicrobial,antioxidant,immunosupportiveCatniptea DiarrheaCayenne Eliminateschillsanddiscomfortfromcolds;promotesthehealingofulcersChamomile Calmingagent,sedativeChasteberry PremenstrualsyndromeChondroitin OsteoarthritisCinnamon Gas,diarrhea,upsetstomachCrampbark MenstrualcrampingCranberry UTIDandelion WaterretentionassociatedwithpremenstrualsyndromeDill GasandindigestionDongquai Anemia,energy(females),menopause,dysmenorrhea,premenstrualsyndromeEchinacea BoostsimmunesystemEveningprimroseoil PremenstrualsyndromeFennel StomachcrampsandgasFeverfew Headaches;prophylaxisformigraineGinger Antiemetic,antiinflammatory,GIdistressGlucosamine OsteoarthritisandrheumatoidarthritisGoldenseal BoostsimmunesystemGrapeseed Antioxidant,allergies,circulationGreentea Anticancer,antioxidant,lowerscholesterolHoptea SleepingaidIsoflavones Cancerprevention,decreasedboneloss,lowercholesterol,menopausalsymptomsKava ADD,ADHD,anxiety,sedationLomatium Antiviralagentfortheflu,immunostimulantLungwort URIMarshmallowroot Scratchythroat,ulcers,colitisMelatonin InsomniaMilkthistle Antioxidant,liverdiseasePanax Energy,stress,immunesystembuilderPassionflower TranquilizerPeppermint UpsetstomachSawpalmetto BenignprostatichyperplasiaSiberianginseng Athleticperformance,stress,immunebuilderSkullcap Tensionheadaches,irritabilityandanxietyassociatedwithpremenstrualsyndrome,stressSlipperyelmbark SorethroatSt.John’swort Depression,improvesimmunesystemValerian Sedative,analgesic,nervoustensionWhitewillowbark Aspirinsubstitute(analgesic,antipyretic,andantiinflammatory)Wildyam Femalevitality

ADD,Attention-deficitdisorder;ADHD,attention-deficithyperactivitydisorder;URI,upperrespiratoryinfection;UTI,urinarytractinfection.


RefertoAppendixEforalistingofthecommonOTCproducts.

Continued

OVER-THE-COUNTER MEDICATIONSBRAND NAME GENERIC NAME DRUG PROPERTIES

Actifed pseudoephedrineandtriprolidine Decongestant,antihistamineAdvil ibuprofen Analgesic,antipyretic,antiinflammatoryAfrin oxymetazoline DecongestantAleve naproxensodium Analgesic,antipyretic,antiinflammatoryAnbesol benzocaineandphenol TopicalanestheticAspercreme trolaminesalicylate TopicalanalgesicBayerAspirin aspirin Analgesic,antipyretic,antiinflammatoryBenadryl diphenhydramine AntihistamineBenylin diphenhydramine AntitussiveBetadine povidoneiodine TopicalantisepticBonine meclizine AntiemeticBufferin aspirin Analgesic,antipyretic,antiinflammatoryCaladryl pramoxine,camphor,andcalamine ProtectantCarmex menthol,camphor,alum,andsalicylicacid ProtectantCepastat phenol AnestheticChlor-Trimeton chlorpheniramine AntihistamineChloraseptic benzocaineandmenthol TopicalanestheticCitrucel methylcellulose LaxativeClaritin loratadine AntihistamineColace docusatesodium StoolsoftenerCompoundW salicylicacid KeratolyticCortaid hydrocortisone AntiinflammatoryDelsym dextromethorphan AntitussiveDimetapp brompheniramine AntihistamineanddecongestantDonnagel attapulgite AntidiarrhealDoxidan docusatecalcium StoolsoftenerDramamine dimenhydrinate AntiemeticDulcolax bisacodyl LaxativeDuoFilm salicylicacid KeratolyticEcotrin aspirin Analgesic,antipyretic,antiinflammatoryEmetrol phosphoratedcarbohydrates AntiemeticExcedrin acetaminophen,aspirin,andcaffeine Analgesic,antipyretic,antiinflammatoryFemstat-3 butoconazole AntifungalFibercon polycarbophil LaxativeGas-X simethicone AntiflatulentGaviscon aluminumhydroxideandmagnesiumtrisilicate AntacidGly-Oxide carbamideperoxide OralantisepticGyne-Lotrimin clotrimazole AntifungalImodiumAD loperamide AntidiarrhealIvyDry tannicacid,benzocaine,menthol,and

camphorAstringent

Kaopectate attapulgite AntidiarrhealLactinex Lactobacillus LactoseintoleranceListerine thymol,eucalyptol,methylsalicylate,and

mentholOralantiseptic

LotriminAF clotrimazole AntifungalMaalox aluminumhydroxideandmagnesium

hydroxideAntacid

Metamucil psylliumhydrophilicmucilloid LaxativeMicatin miconazole AntifungalMineralIce menthol TopicalmusclerelaxantMonistat miconazole AntifungalMotrinIB ibuprofen Analgesic,antipyretic,antiinflammatoryMotrin ibuprofen Analgesic,antipyretic,antiinflammatoryMylanta aluminumhydroxideandmagnesium

hydroxideAntacid

MylantaGas simethicone AntiflatulentMyliconDrops simethicone Antiflatulent


BRAND NAME GENERIC NAME DRUG PROPERTIES

Myoflex trolaminesalicylate TopicalanalgesicNaphconA pheniramineandnaphazoline DecongestantNasalCrom cromolynsodium AntihistamineNeo-Synephrine phenylephrine DecongestantNeosporin polymyxinBsulfate,neomycin,and

bacitracinTopicalantibiotic

Nicoderm nicotinetransdermal SmokingcessationNicorette nicotinepolacrilex SmokingcessationNicotrol nicotinetransdermal SmokingcessationNix permethrin PediculusinfestationNoDoz caffeine CentralnervoussystemstimulantOcean normalsaline NasalmoisturizerOrabase-B benzocaine OralanestheticOrajel benzocaine OralanestheticOrudisKT ketoprofen Analgesic,antiinflammatoryOxy5,Oxy10 benzoylperoxide AcneagentPepcidAC famotidine AntiulcerPepto-Bismol bismuthsubsalicylate GastrointestinaldistressPercogesic phenyltoloxaminecitrateandacetaminophen AnalgesicPeri-Colace docusatesodiumandcasanthranol StoolsoftenerandlaxativePeroxyl hydrogenperoxide TopicalantisepticPhazyme simethicone AntiflatulentPhillipsMilkofMagnesia magnesiumhydroxide LaxativePrimateneMist epinephrine BronchodilatorRID pyrethrin PediculusinfestationRiopan hydroxymagnesiumandsimethicone AntacidRobitussin guaifenesin ExpectorantRogaine minoxidil HairreplacementSenokot sennaconcentrate LaxativeSominex diphenhydramine SleepSucrets hexylresorcinolanddyclonine OralanestheticSudafed pseudoephedrine DecongestantTagamet cimetidine AntiulcerTavist-D clemastinefumarateandpseudoephedrine Antihistamine,decongestantTearsNaturale hydroxypropylmethylcellulose LubricantTinactin tolnaftate AntifungalTums calciumcarbonate AntacidTylenol acetaminophen Analgesic,antipyreticZantac75 ranitidine AntiulcerZilactin tannicacid ColdsoresZostrix capsaicin Topicalmusclerelaxant

3. Whichofthefollowingmedicationsisindicatedforthetreatmentofdepression?a. Alprazolamb. Escitalopramc. Lorazepamd.Ramelteon

4. Which of the following is the generic name forSingulair?a. Albuterolb. Montelukastc. Theophyllined.Zileuton

CHAPTER 1 REVIEW QUESTIONS

1. Which of the following is not a condition fora medication to be considered therapeuticallyequivalent?a. Canbeadministeredbyanapprovedrouteb. Sameactiveingredientc. Samedosageformd.Samestrengthorconcentration

2. Whichof the following isanexampleofanACEinhibitor?a. Amlodipineb. Calanc. Corgardd.Vasotec


5. Whichofthefollowingisalong-actinginsulin?a. Insulinanaloginjectionb. Insulinglulisinec. Insulinglargined.Isophaneinsulin

6. WhichofthefollowingmedicationsisaffectedbyvitaminK?a. Clonidineb. Dabigatranc. Heparind.Warfarin

7. Which of the following medications must bemonitoredthroughabloodtest?a. Buspironeb. Hydroxyzinec. Levothyroxined.Pseudoephedrine

8. Which of the following suffixes indicates thedrugisabetablocker?a. -alolb. -ololc. -pamided.-pril

9. Which of the following medications is an ACEinhibitor used in the treatment of congestiveheartfailure?a. Capotenb. Cozaarc. Diovand.Zestoretic

10. Whichofthefollowingmedicationsmaybeusedinthetreatmentofinfluenza?a. Amantadineb. Acyclovirc. Penciclovird.Valacyclovir

11. Whichofthefollowingmedicationswilldiscolortheurine?a. Amoxicillinb. Oxybutyninc. Phenazopyridined.Tolterodine

12. Which of the following is a proton pumpinhibitor?a. Cimetidineb. Ranitidinec. Rabeprazoled.Sucralfate

13. Whichofthefollowingmedicationsisusedinthetreatmentofglaucoma?a. Ciprofloxacinb. Dexamethasonec. Latanoprostd.Naphazoline

14. Whichdrugclassificationwouldbeusedintreat-ingherpes?a. Antiviralb. Fusioninhibitorc. Nonnucleosidereversetranscriptaseinhibitord.Proteaseinhibitor

15. Which of the following medications is used toabortamigraineheadache?a. Aspirinb. Celecoxibc. Ibuprofend.Sumatriptan

16. Which of the following diuretics is often takenwithapotassiumsupplement?a. Amilorideb. Hydrochlorothiazidec. Spironolactoned.Triamterene

17. Which of the following hypoglycemic medica-tionsisclassifiedasabiguanide?a. Glipizideb. Glyburidec. Metformind.Repaglinide

18. Whichofthefollowingmedicationsifuseddur-ingpregnancymayresultinabirthdefect?a. Amoxicillinb. Clotrimazolec. Methyldopad.Tetracycline

19. Which of the following is the generic name forLexapro?a. Duloxetineb. Escitalopramc. Fluoxetined.Paroxetine

20. Which of the following OTC medications doesnotpossessesantiinflammatoryproperties?a. Acetaminophenb. Aspirinc. Ibuprofend.Naproxen


21. Which of the following drug classifications willreducetheeffectivenessoforalcontraceptives?a. Antibioticsb. Anticonvulsantsc. Antifungalsd.Alloftheabove

22. Which of the following is the generic name forPlavix?a. Clopidogrelb. Enoxaparinc. Heparind.Warfarin

23. ForwhichofthefollowingconditionsisJanuviaindicated?a. Chronicobstructivepulmonarydiseaseb. Congestiveheartfailurec. Diabetesd.Herpes

24. Whichmedicationisthedrugofchoiceforacar-diacarrhythmia?a. Digoxinb. Furosemidec. Lisinoprild.Triamterene

25. Whichof the followingantibiotics if takenwithdairyproductsorantacidswillresultinareduc-tionofitseffectiveness?a. Amoxicillinb. Cephalexinc. Erythromycind.Tetracycline

26. Which of the following is the generic name forDiovan?a. Irbesartanb. Losartanc. Olmesartand.Valsartan

27. Whichofthefollowingmedicationsisaproteaseinhibitor?a. Combivirb. Epivirc. Kaletrad.Trizivir

28. Whichofthefollowingmedicationsisindicatedinthetreatmentofangina?a. Isosorbidedinitrateb. Isosorbidemononitratec. Nitroglycerind.Alloftheabove

29. Which of the following is the brand name foripratropium–albuterol?a. Combiventb. Combivirc. Compazined.Synercid

30. Whichofthefollowingmedicationsisindicatedinthetreatmentofbipolardisease?a. Amitriptylineb. Imipraminec. Lithiumd.Pregabalin

31. Which of the following drug classificationsshouldbetakenwithfoodormilktoavoidstom-achdistress?a. Beta-blockersb. Cephalosporinsc. NSAIDsd.Protonpumpinhibitors

32. Whichofthefollowingmedicationsmustbeiniti-atedinahospital?a. Amiodaroneb. Bretylliumc. Dronedaroned.Sotalol

33. Tyramine-containingfoodsandwinesshouldbeavoidedifapatientistakingwhichofthefollow-ingdrugclassifications?a. Cephalosporinsb. COX-2inhibitorsc. Monoamineoxidaseinhibitorsd.NSAIDs

34. Whichof the followingmedications isnot indi-catedforhypothyroidism?a. Levothyroxineb. Liothyroninec. Liotrixd.Methimazole

35. Which of the following vitamins is not watersoluble?a. B2

b. Biotinc. Cd.D3


36. Whichofthefollowingmedicationsisindicatedforinsomnia?a. Etodolacb. Ibuprofenc. Valproicacidd.Zolpidem

37. Whichof the followingherbalproductsmaybeusedasalaxative?a. Cascarasagradab. Chondroitinc. Cranberryd.Glucosamine

38. Whichofthefollowingisclassifiedasahormoneagentusedaschemotherapyagent?a. Cisplatinb. Etoposidec. Interferona-2ad.Tamoxifen

39. Which of the following topical preparations isindicatedforacnevulgaris?a. Ciclopiroxb. Miconazolec. Tolnaftated.Isotretinoin

40. Whichofthefollowingglaucomaagentsmustberefrigerated?a. Brimonidineb. Latanoprostc. Timolold.Travoprost

41. Whichofthefollowingfoodsprovide(s)asourceofvitaminC?a. Cerealsb. Eggyolkc. Liverd.Tomatoes

42. WhichofthefollowingisnotanNSAID?a. Diclofenacb. Ibuprofenc. Meperidined.Piroxicam

43. Whichofthefollowingmedicationsisanexam-ple of a disease-modifying antirheumatic drug(DMARD)?a. Enbrelb. Humirac. Orenciad.Alloftheabove

44. Whichofthemedicationsisindicatedinthetreat-mentofpsoriasis?a. Adapaleneb. Azelaicacidc. Calcipotriened.Fluorouracil

45. Which of the following is the generic name forGlucovance?a. Glipizide–metforminb. Glyburide–metforminc. Pioglitazoned.Repaglinide

46. Which of the following is the generic name forSeroquel?a. Aripripazoleb. Magnesiumc. Olanzapined.Quetiapine

47. Whichofthefollowingdrugclassificationsisnotindicatedinthetreatmentofdepression?a. Benzodiazepinesb. Monoamineoxidaseinhibitorsc. Selectiveserotoninreuptakeinhibitorsd.Tricyclicantidepressants

48. WhichofthefollowingmedicationsindicatedforADHDisnotacontrolledsubstance?a. Adderallb. Cylertc. Ritalind.Strattera

49. WhatisthegenericnameforViagra?a. Sildenafilb. Selegilenec. Tadalafild.Vardenafil

50. Whichofthefollowingisasideeffectofalumi-numhydroxide?a. Constipationb. Diarrheac. Electrolyteimbalanced.Metallictaste

51. Which of the following is true when takingFosamax?a. Liedownaftertakingthemedicine.b. Takethemedicineatbedtime.c. Takewithfood.d.Takewithwater.


52. To which drug classification does furosemidebelong?a. Beta-blockerb. Calciumchannelblockerc. HMGCOAreductaseinhibitord.Loopdiuretic

53. WhatisthegenericnameforLyrica?a. Divalproexb. Gabapentinc. Pregabalind.Primidone

54. Which of the following medications should betakenwithfood?a. Latanoprostb. Ondansetronc. Prednisoned.Timolol

55. Whichofthefollowingmedicationsmayresultindrowsinessasasideeffect?a. Benadrylb. Caltratec. Sudafedd.Tylenol

56. Which of the following is the brand name forsimvastatin?a. Crestorb. Mevacorc. Zetiad.Zocor

57. Which of the following is the generic name forNasonex?a. Budesonideb. Fluticasonec. Momentasoned.Triamcinolone

58. Whatdoesthe“HCT”representinBenicarHCT?a. Hydralazineb. Hydrochlorothiazidec. Hydrocodoned.Hydrocortisone

59. Whichofthefollowingmedicationswouldnotbeusedtotreathyperthyroiddisease?a. Levothyroxineb. Medroxyprogesteronec. Mmethimazoled.Zolmitriptan

60. Which of the following medications affects theclottingofplatelets?a. Clopidogrelb. Enoxaparinc. Heparind.Warfarin

61. Whatisthebrandnameforamoxicillintrihydrate–potassiumclavulanate?a. Augmentinb. Ceftinc. Ciprod.Ketek

62. Which of the following medications is used totreatbacterialinfections?a. Acyclovirb. Cephalexinc. Clotrimazoled.Stavudine

63. Whichofthefollowingagentsisanexpectorant?a. Guaifenesinb. Cetrizinec. Loratadined.Oxymetazoline

64. Which of the following medications could beusedtotreatanxiety?a. Alprazolamb. Carbamazepinec. Cephalexind.Valproicacid

65. What electrolyte does Klor-Con provide to thebody?a. Calciumb. Magnesiumc. Potassiumd.Sodium

66. ForwhatconditionisActonelindicated?a. Acnevulgarisb. Arrhythmiac. Osteoporosisd.Parasites

67. WhatistheactiveingredientinTylenol?a. Acetaminophenb. Aspirinc. Ibuprofend.Naproxen


68. WhatisthegenericnameforFlomax?a. Doxazosinb. Dutasteridec. Tamsulosind.Terazosin

69. Whichofthefollowingvitaminsisfatsoluble?a. Ab. B1

c. B6

d.C

70. Whichofthefollowingpregnancycategoriesin-dicatesthatadequatestudiesinpregnantwomenhave failed to showa risk to fetuses in thefirsttrimesterandthereisnoevidenceofriskinlatertrimesters?a. CategoryAb. CategoryBc. CategoryCd.CategoryD

71. WhatisthegenericnameforDetrolLA?a. Flutamideb. Prazosinc. Terazosind.Tolterodine

72. Whichofthefollowingmedicationsisindicatedtotreatbipolardiseaseandepilepsy?a. Carbamazepineb. Lithiumc. Olanzapine–fluoxetined.Risperidone

73. TowhichdrugclassificationdoesSingulairbelong?a. Antihistamineb. Bronchodilatorc. Leukotrieneinhibitord.Xanthinederivative

74. Whichofthefollowingmedicationsisindicatedforarrhythmias?a. Cogentinb. Multaqc. Seroqueld.Zerit

75. WhatisthegenericnameforAricept?a. Donepezilb. Memantinec. Rivastigmined.Tacrine

4 -- chapter 1 pharmacology for technicians

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