Questions and Answers
What is the indication for Beclomethasone (Qvar, Qnasl)?
What are the common side effects of Budesonide (Pulmicort)?
Vertigo, Upper Respiratory Infections
Fluticasone (Flovent, Flonase) has a boxed warning regarding Pneumonia Risk.
True
Ipratropium is used for COPD and Acute asthma (off-label); it works by being an anticholinergic agent that works on M3 receptors, leading to a decrease in secretions and __________.
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Match the following medications with their indications:
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What is the relative potency of Dexamethasone compared to Methylprednisolone?
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Which corticosteroid must be tapered slowly if receiving over 10-14 days of therapy due to HPA axis suppression?
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Which corticosteroid medication has the adverse effect of 'mask symptoms of infection'?
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Match the corticosteroid medication with its primary side effect:
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What is the primary function of thyroid hormones?
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Which of the following drugs is used for both asthma and COPD?
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Antithyroid agents work by enhancing the synthesis of thyroid hormones.
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_______ is responsible for competitive inhibition of histamine at H2 receptors of the gastric parietal cells.
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What is the purpose of Pylera? (List all drugs included)
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Which drug is an osmotic laxative?
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Docusate is a stool softener. (True/False)
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What is the chloride channel activator used as a treatment for constipation?
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Match the drug with its primary usage:
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What are common symptoms of GI obstruction and bowel perforation?
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What is the purpose of Diphenoxylate in the context of GI motility?
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Loperamide acts through the opioid receptor to stimulate peristalsis.
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Loperamide is commonly used for managing diarrhea; however, OTC products should be used for less than __ days.
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Match the following drug with its primary indication: Dicyclomine
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Dexamethasone is relative potent compared to Methylprednisolone, with a potency of ____ mg.
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Which side effect is NOT associated with chronic use of corticosteroids?
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Match the corticosteroid with its relative potency level:
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What is the primary usage of Xanthine Derivatives in blocking PDE?
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What is the common side effect associated with Theophylline?
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Which medication should be separated by 4 hours from antacids, iron, and calcium?
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Antihistamines like Diphenhydramine can cause central nervous system (CNS) depression.
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Histamine (H2) Receptor Antagonists competitively inhibit histamine at H2 receptors of the gastric __________ cells.
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What is the mechanism of action of Polyethylene glycol 3350?
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What is the mechanism of action of Docusate?
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What is the mechanism of action of Alosetron?
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What is the mechanism of action of Linaclotide?
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What is the mechanism of action of Lubiprostone?
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What is the mechanism of action of Lactulose?
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What is the mechanism of action of Metoclopramide?
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What is the mechanism of action of Sucralfate?
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What is the mechanism of action of Sulfate salts?
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What is the brand name of the medication Linaclotide?
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What is the brand name of the medication Sucralfate?
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What is the generic name for the drug also known as Qvar and Qnasl that is used for inhibition of inflammatory response in the airways?
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Which side effect is common for Fluticasone?
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Combination of corticosteroid and LABA improves pulmonary function more than using the products alone. (True/False)
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___ is an example of a SABA (Short Acting Beta Agonist) used for asthma rescue.
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What is the common purpose of Diphenoxylate/Atropine?
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Loperamide acts directly on the circular and longitudinal intestinal muscles to stimulate peristalsis.
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What is the common purpose of Somatostatin Analog?
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Dicyclomine (Bentyl) is commonly used for functional bowel disorders like ___ and IBS.
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What does Levothyroxine treat?
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Which common side effects are associated with Antihistamine Cetirizine?
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Proton Pump Inhibitors block the final step in gastric acid production.
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Which adverse effect is common with Suprep Bowel Kit used for colonoscopy prep?
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What are the relative side effects associated with dexamethasone?
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What is the primary function of Diphenoxylate in the commercial preparations?
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Lomotil is a medication used to treat __________.
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Hydrocortisone is also known as _____ and _____
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For which condition is Methylprednisolone commonly used?
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Loperamide demonstrates antisecretory activity.
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Prednisolone can cause growth retardation.
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Match the following common side effects with the respective medication:
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Match the corticosteroid with its relative potency:
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What is the primary use of Pylera (Bismuth/Metronidazole/Tetracycline)?
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What is the primary purpose of polyethylene glycol (Miralax)?
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Docusate (Colace) is primarily used for treating diarrhea. (True/False)
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Alosetron (Lotronex) is indicated for women with severe ____-predominant IBS.
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Match the GI agent with its primary purpose:
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What is the mechanism of action of inhaled steroids?
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What is the indication for Beclomethasone?
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What is the common side effect of inhaled steroids?
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What is the benefit of ICS/LABA combination?
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What is the mechanism of action of Short Acting Muscarinic Antagonist?
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What is the indication for Tiotropium?
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What is the common side effect of Long Acting Muscarinic Antagonist?
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What is the mechanism of action of Short Acting Beta Agonist?
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What is the common side effect of Short Acting Beta Agonist?
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What is the mechanism of action of Leukotriene Modifier?
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What is the common side effect of Phosphodiesterase 4 inhibitor?
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What is the mechanism of action of Systemic glucocorticoids?
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Study Notes
Inhaled Steroids
- Inhibit inflammatory response in the airways and increase sensitivity of beta-2 receptors
- Beclomethasone (Qvar, Qnasl): common side effects include throat irritation, cough, thrush, and headache
- Budesonide (Pulmicort): serious side effects include vertigo, upper respiratory infections, and pneumonia risk; systemic side effects are not common
- Fluticasone (Flovent, Flonase): common side effects include pneumonia risk, HPA axis suppression, and growth retardation; avoid grapefruit juice
- Mometasone (Asmanex): common side effects include pneumonia risk, HPA axis suppression, and growth retardation
ICS/LABA Combination
- Combination of corticosteroid and LABA improves pulmonary function and control
- Fluticasone/salmeterol (Advair): avoid grapefruit juice; LABA monotherapy can increase risk of asthma-related deaths and hospitalizations
- Fluticasone/vilanterol (Breo Ellipta): avoid grapefruit juice; common side effects include hoarseness, cough, thrush, and headache
- Budesonide/formoterol (Symbicort): avoid grapefruit juice; common side effects include upper respiratory infections, fib, and hypokalemia
- Mometasone/formoterol (Dulera): avoid grapefruit juice; common side effects include upper respiratory infections, fib, and hypokalemia
Short Acting Muscarinic Antagonist
- Ipratropium (Atrovent): common side effects include dry mouth, bitter taste, anticholinergic effects, and bronchitis
Long Acting Muscarinic Antagonist
- Tiotropium (Spiriva): common side effects include constipation, xerostomia, headache, and cough; serious side effects include closed angle glaucoma
Short Acting Beta Agonist
- Albuterol (ProAir, Ventolin, Proventil): common side effects include tachycardia, tremor, nausea, pharyngitis, and cough; serious side effects include A-Fib, hypertension, and hyperglycemia
SABA/SAMA Combination
- Albuterol/ipratropium (Combivent, DuoNeb): common side effects include see individual drug side effects
Leukotriene Modifier
- Montelukast (Singulair): common side effects include headache, dizziness, dyspepsia, and flu-like symptoms; serious side effects include suicidal thoughts and altered behavior
Phosphodiesterase 4 Inhibitor
- Roflumilast (Daliresp): common side effects include weight loss, diarrhea, nausea, and decrease in appetite; serious side effects include suicidal thoughts
Systemic Glucocorticoids
- Suppresses neutrophil migration and decreases inflammatory mediators
- Dexamethasone (DexPak): common side effects include increased appetite, weight gain, and Na/H2O retention
- Hydrocortisone (Cortef, Solucortef): common side effects include hypokalemia, CNS, and indigestion
- Methylprednisolone (Medrol, Solumedrol): common side effects include Cushing, dermal thinning, and diabetes
- Prednisone (Deltasone): common side effects include Cushing, osteoporosis, and glaucoma
- Prednisolone (Millipred): common side effects include Cushing, osteoporosis, and glaucoma
Xanthine Derivative
- Blocks PDE, causing increased cAMP, which promotes epinephrine release### Theophylline
- Used to treat asthma and COPD
- Causes bronchodilation
- Common side effects: nausea, vomiting, insomnia, tremor
- Serious side effects: atrial fibrillation, tachyarrhythmia, seizures
- Interacts with ciprofloxacin, carbamazepine, and phenytoin
- Dosing based on ideal body weight
- Therapeutic range: 5-15 mcg/mL
Thyroid Hormones
- Increase cellular metabolism and play a role in growth, development, CNS, and bone functions
- Levothyroxine (Synthroid) is used to treat hypothyroidism
- Common side effects: increased appetite, weight loss, insomnia, hyperhidrosis
- Serious side effects: menstrual irregularities, heat intolerance
- Liothyronine (Cytomel) is used for TSH suppression
- Desiccated thyroid (Armour thyroid) is a combination of T3 and T4
Antithyroid Agents
- Inhibit the synthesis of thyroid hormones
- Methimazole (Tapazole) is preferred in 2nd and 3rd trimesters of pregnancy
- Common side effects: hypothyroidism, GI upset
- Serious side effects: hepatotoxicity, agranulocytosis, hypothrombinemia
- Propylthiouracil is preferred in the first trimester of pregnancy and thyroid storm
Antihistamine (H1 Receptor Antagonists)
- Block H1 receptors to decrease the actions of histamine
- Cetirizine (Zyrtec) causes CNS depression
- Diphenhydramine (Benadryl) is used for upper respiratory allergies and urticaria
- Common side effects: sedation, anticholinergic ADR, HA
- Serious side effects: QT prolongation
Histamine (H2) Receptor Antagonists
- Competitive inhibition of histamine at H2 receptors of gastric parietal cells
- Famotidine (Pepcid) is used to treat GERD, heartburn, gastric/duodenal ulcer, and erosive esophagitis
- Common side effects: abdominal pain, headache
- Serious side effects: altered mental status/confusion
Proton Pump Inhibitors
- Decrease acid secretion in gastric parietal cells through inhibition of (H+, K+)-ATPase enzyme system
- Omeprazole (Prilosec) is used to treat GERD, erosive esophagitis, and H. pylori treatment
- Common side effects: abdominal pain, diarrhea
- Serious side effects: fracture risk, C. difficile infection risk
- Long-term use associated with Vitamin B12 deficiency and hypomagnesemia
Osmotic Laxative
- Polyethylene glycol 3350 causes water retention in the stool, increasing stool frequency
- Common side effects: N/D, abdominal fullness, cramping
- Serious side effects: dermatitis, rash
Stool Softener
- Docusate (Colace) draws water into the stool, softening the stool and achieving ease in bowel movement
- Common side effects: N/D, abnormal taste
- Serious side effects: intestinal obstruction
Selective 5-HT3 Receptor Antagonist
-
Alosetron (Lotronex) is used to treat irritable bowel syndrome
-
Common side effects: constipation, abdominal pain
-
Serious side effects: ischemic colitis
-
Caution in mild-moderate hepatic impairment### Linaclotide (Linzess)
-
Used to treat IBS with constipation and opioid-induced constipation
-
Acts locally on the gastrointestinal tract to increase intestinal fluid secretion and improve fecal transit
-
Contraindications: less than 6yo, GI obstruction
-
Common side effects: diarrhea, abdominal pain, flatulence
-
Serious side effects: dehydration
Lubiprostone (Amitiza)
- Used to treat IBS with constipation and opioid-induced constipation
- Acts as a chloride channel activator to increase intestinal fluid secretion and improve fecal transit
- Contraindications: GI obstruction, not approved for males with IBS-C
- Common side effects: N/V/D, flatulence, abdominal pain
- Serious side effects: dyspnea, hypotension
Lactulose (Enulose, Kristalose)
- Used to treat constipation and hepatic encephalopathy
- Acts as an osmotic laxative to increase stool water content
- Common side effects: bloating, diarrhea, flatulence, N/V
- Serious side effects: hypernatremia, hypokalemia
Metoclopramide (Reglan)
- Used to treat GERD, diabetic gastroparesis, hiccups, and nausea/vomiting
- Blocks dopamine receptors and enhances the response to acetylcholine in the upper GI tract
- Contraindications: GI obstruction, perforation, or hemorrhage, history of seizure, use with other drugs causing EPS
- Common side effects: drowsiness, insomnia, extrapyramidal symptoms, dizziness
- Serious side effects: depression, neuroleptic malignant syndrome, tardive dyskinesia
Sucralfate (Carafate)
- Used to treat duodenal ulcer
- Forms an ulcer-adherent complex that protects the ulcer site from acid, pepsin, and bile salts
- Common side effects: constipation
- Serious side effects: aluminum toxicity in patients with renal impairment
Sodium/Potassium/Magnesium (Suprep Bowel Kit)
- Used for colonoscopy prep
- Provides sulfate anions that cause water to be retained within the gastrointestinal tract
- Contraindications: GI obstruction, bowel perforation, gastric retention, ileus, toxic colitis
- Common side effects: discomfort, abdominal distention/pain, N/V
- Serious side effects: fluid/electrolyte abnormalities, cardiac arrhythmia, seizure
Diphenoxylate/Atropine (Lomotil)
- Used to treat diarrhea
- Inhibits excessive GI motility and propulsion
- Contraindications: obstructive jaundice, diarrhea associated with pseudomembranous enterocolitis or enterotoxin-producing bacteria
- Common side effects: drowsiness/sedation, euphoria, N/V, flushing
- Serious side effects: paralytic ileus, toxic megacolon, anaphylaxis, anticholinergic hyperthermia, urinary retention, respiratory depression
Loperamide (Imodium)
- Used to treat diarrhea
- Acts directly on intestinal muscles to inhibit peristalsis and prolong transit time
- Contraindications: children younger than 2 years, abdominal pain without diarrhea, acute dysentery, active ulcerative colitis, bacterial enterocolitis
- Common side effects: dizziness, abdominal pain, constipation, drowsiness
- Serious side effects: torsades de pointes
Octreotide (Ocphyl, Sandostatin)
- Used to treat acromegaly and off-label for esophageal varices bleeding and sulfonylurea toxicity
- Mimics natural somatostatin by inhibiting serotonin release and secretion of various hormones
- Common side effects: hyperhidrosis, abdominal pain, headache, sinusitis
- Serious side effects: bradyarrhythmia, hyper/hypoglycemia, cholelithiasis
Dicyclomine (Bentyl)
- Used to treat functional bowel/IBS
- Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS
- Contraindications: obstructive disease of GI tract, severe ulcerative colitis, glaucoma, myasthenia gravis, breast feeding, infants
- Common side effects: anticholinergic, lightheadedness
- Serious side effects: tachyarrhythmia, psychosis, dyspnea
Inhaled Steroids
- Inhibit inflammatory response in the airways and increase sensitivity of beta-2 receptors
- Beclomethasone (Qvar, Qnasl): common side effects include throat irritation, cough, thrush, and headache
- Budesonide (Pulmicort): serious side effects include vertigo, upper respiratory infections, and pneumonia risk; systemic side effects are not common
- Fluticasone (Flovent, Flonase): common side effects include pneumonia risk, HPA axis suppression, and growth retardation; avoid grapefruit juice
- Mometasone (Asmanex): common side effects include pneumonia risk, HPA axis suppression, and growth retardation
ICS/LABA Combination
- Combination of corticosteroid and LABA improves pulmonary function and control
- Fluticasone/salmeterol (Advair): avoid grapefruit juice; LABA monotherapy can increase risk of asthma-related deaths and hospitalizations
- Fluticasone/vilanterol (Breo Ellipta): avoid grapefruit juice; common side effects include hoarseness, cough, thrush, and headache
- Budesonide/formoterol (Symbicort): avoid grapefruit juice; common side effects include upper respiratory infections, fib, and hypokalemia
- Mometasone/formoterol (Dulera): avoid grapefruit juice; common side effects include upper respiratory infections, fib, and hypokalemia
Short Acting Muscarinic Antagonist
- Ipratropium (Atrovent): common side effects include dry mouth, bitter taste, anticholinergic effects, and bronchitis
Long Acting Muscarinic Antagonist
- Tiotropium (Spiriva): common side effects include constipation, xerostomia, headache, and cough; serious side effects include closed angle glaucoma
Short Acting Beta Agonist
- Albuterol (ProAir, Ventolin, Proventil): common side effects include tachycardia, tremor, nausea, pharyngitis, and cough; serious side effects include A-Fib, hypertension, and hyperglycemia
SABA/SAMA Combination
- Albuterol/ipratropium (Combivent, DuoNeb): common side effects include see individual drug side effects
Leukotriene Modifier
- Montelukast (Singulair): common side effects include headache, dizziness, dyspepsia, and flu-like symptoms; serious side effects include suicidal thoughts and altered behavior
Phosphodiesterase 4 Inhibitor
- Roflumilast (Daliresp): common side effects include weight loss, diarrhea, nausea, and decrease in appetite; serious side effects include suicidal thoughts
Systemic Glucocorticoids
- Suppresses neutrophil migration and decreases inflammatory mediators
- Dexamethasone (DexPak): common side effects include increased appetite, weight gain, and Na/H2O retention
- Hydrocortisone (Cortef, Solucortef): common side effects include hypokalemia, CNS, and indigestion
- Methylprednisolone (Medrol, Solumedrol): common side effects include Cushing, dermal thinning, and diabetes
- Prednisone (Deltasone): common side effects include Cushing, osteoporosis, and glaucoma
- Prednisolone (Millipred): common side effects include Cushing, osteoporosis, and glaucoma
Xanthine Derivative
- Blocks PDE, causing increased cAMP, which promotes epinephrine release### Theophylline
- Used to treat asthma and COPD
- Causes bronchodilation
- Common side effects: nausea, vomiting, insomnia, tremor
- Serious side effects: atrial fibrillation, tachyarrhythmia, seizures
- Interacts with ciprofloxacin, carbamazepine, and phenytoin
- Dosing based on ideal body weight
- Therapeutic range: 5-15 mcg/mL
Thyroid Hormones
- Increase cellular metabolism and play a role in growth, development, CNS, and bone functions
- Levothyroxine (Synthroid) is used to treat hypothyroidism
- Common side effects: increased appetite, weight loss, insomnia, hyperhidrosis
- Serious side effects: menstrual irregularities, heat intolerance
- Liothyronine (Cytomel) is used for TSH suppression
- Desiccated thyroid (Armour thyroid) is a combination of T3 and T4
Antithyroid Agents
- Inhibit the synthesis of thyroid hormones
- Methimazole (Tapazole) is preferred in 2nd and 3rd trimesters of pregnancy
- Common side effects: hypothyroidism, GI upset
- Serious side effects: hepatotoxicity, agranulocytosis, hypothrombinemia
- Propylthiouracil is preferred in the first trimester of pregnancy and thyroid storm
Antihistamine (H1 Receptor Antagonists)
- Block H1 receptors to decrease the actions of histamine
- Cetirizine (Zyrtec) causes CNS depression
- Diphenhydramine (Benadryl) is used for upper respiratory allergies and urticaria
- Common side effects: sedation, anticholinergic ADR, HA
- Serious side effects: QT prolongation
Histamine (H2) Receptor Antagonists
- Competitive inhibition of histamine at H2 receptors of gastric parietal cells
- Famotidine (Pepcid) is used to treat GERD, heartburn, gastric/duodenal ulcer, and erosive esophagitis
- Common side effects: abdominal pain, headache
- Serious side effects: altered mental status/confusion
Proton Pump Inhibitors
- Decrease acid secretion in gastric parietal cells through inhibition of (H+, K+)-ATPase enzyme system
- Omeprazole (Prilosec) is used to treat GERD, erosive esophagitis, and H. pylori treatment
- Common side effects: abdominal pain, diarrhea
- Serious side effects: fracture risk, C. difficile infection risk
- Long-term use associated with Vitamin B12 deficiency and hypomagnesemia
Osmotic Laxative
- Polyethylene glycol 3350 causes water retention in the stool, increasing stool frequency
- Common side effects: N/D, abdominal fullness, cramping
- Serious side effects: dermatitis, rash
Stool Softener
- Docusate (Colace) draws water into the stool, softening the stool and achieving ease in bowel movement
- Common side effects: N/D, abnormal taste
- Serious side effects: intestinal obstruction
Selective 5-HT3 Receptor Antagonist
-
Alosetron (Lotronex) is used to treat irritable bowel syndrome
-
Common side effects: constipation, abdominal pain
-
Serious side effects: ischemic colitis
-
Caution in mild-moderate hepatic impairment### Linaclotide (Linzess)
-
Used to treat IBS with constipation and opioid-induced constipation
-
Acts locally on the gastrointestinal tract to increase intestinal fluid secretion and improve fecal transit
-
Contraindications: less than 6yo, GI obstruction
-
Common side effects: diarrhea, abdominal pain, flatulence
-
Serious side effects: dehydration
Lubiprostone (Amitiza)
- Used to treat IBS with constipation and opioid-induced constipation
- Acts as a chloride channel activator to increase intestinal fluid secretion and improve fecal transit
- Contraindications: GI obstruction, not approved for males with IBS-C
- Common side effects: N/V/D, flatulence, abdominal pain
- Serious side effects: dyspnea, hypotension
Lactulose (Enulose, Kristalose)
- Used to treat constipation and hepatic encephalopathy
- Acts as an osmotic laxative to increase stool water content
- Common side effects: bloating, diarrhea, flatulence, N/V
- Serious side effects: hypernatremia, hypokalemia
Metoclopramide (Reglan)
- Used to treat GERD, diabetic gastroparesis, hiccups, and nausea/vomiting
- Blocks dopamine receptors and enhances the response to acetylcholine in the upper GI tract
- Contraindications: GI obstruction, perforation, or hemorrhage, history of seizure, use with other drugs causing EPS
- Common side effects: drowsiness, insomnia, extrapyramidal symptoms, dizziness
- Serious side effects: depression, neuroleptic malignant syndrome, tardive dyskinesia
Sucralfate (Carafate)
- Used to treat duodenal ulcer
- Forms an ulcer-adherent complex that protects the ulcer site from acid, pepsin, and bile salts
- Common side effects: constipation
- Serious side effects: aluminum toxicity in patients with renal impairment
Sodium/Potassium/Magnesium (Suprep Bowel Kit)
- Used for colonoscopy prep
- Provides sulfate anions that cause water to be retained within the gastrointestinal tract
- Contraindications: GI obstruction, bowel perforation, gastric retention, ileus, toxic colitis
- Common side effects: discomfort, abdominal distention/pain, N/V
- Serious side effects: fluid/electrolyte abnormalities, cardiac arrhythmia, seizure
Diphenoxylate/Atropine (Lomotil)
- Used to treat diarrhea
- Inhibits excessive GI motility and propulsion
- Contraindications: obstructive jaundice, diarrhea associated with pseudomembranous enterocolitis or enterotoxin-producing bacteria
- Common side effects: drowsiness/sedation, euphoria, N/V, flushing
- Serious side effects: paralytic ileus, toxic megacolon, anaphylaxis, anticholinergic hyperthermia, urinary retention, respiratory depression
Loperamide (Imodium)
- Used to treat diarrhea
- Acts directly on intestinal muscles to inhibit peristalsis and prolong transit time
- Contraindications: children younger than 2 years, abdominal pain without diarrhea, acute dysentery, active ulcerative colitis, bacterial enterocolitis
- Common side effects: dizziness, abdominal pain, constipation, drowsiness
- Serious side effects: torsades de pointes
Octreotide (Ocphyl, Sandostatin)
- Used to treat acromegaly and off-label for esophageal varices bleeding and sulfonylurea toxicity
- Mimics natural somatostatin by inhibiting serotonin release and secretion of various hormones
- Common side effects: hyperhidrosis, abdominal pain, headache, sinusitis
- Serious side effects: bradyarrhythmia, hyper/hypoglycemia, cholelithiasis
Dicyclomine (Bentyl)
- Used to treat functional bowel/IBS
- Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS
- Contraindications: obstructive disease of GI tract, severe ulcerative colitis, glaucoma, myasthenia gravis, breast feeding, infants
- Common side effects: anticholinergic, lightheadedness
- Serious side effects: tachyarrhythmia, psychosis, dyspnea
Inhaled Steroids
- Inhibit inflammatory response in the airways and increase sensitivity of beta-2 receptors
- Beclomethasone (Qvar, Qnasl): common side effects include throat irritation, cough, thrush, and headache
- Budesonide (Pulmicort): serious side effects include vertigo, upper respiratory infections, and pneumonia risk; systemic side effects are not common
- Fluticasone (Flovent, Flonase): common side effects include pneumonia risk, HPA axis suppression, and growth retardation; avoid grapefruit juice
- Mometasone (Asmanex): common side effects include pneumonia risk, HPA axis suppression, and growth retardation
ICS/LABA Combination
- Combination of corticosteroid and LABA improves pulmonary function and control
- Fluticasone/salmeterol (Advair): avoid grapefruit juice; LABA monotherapy can increase risk of asthma-related deaths and hospitalizations
- Fluticasone/vilanterol (Breo Ellipta): avoid grapefruit juice; common side effects include hoarseness, cough, thrush, and headache
- Budesonide/formoterol (Symbicort): avoid grapefruit juice; common side effects include upper respiratory infections, fib, and hypokalemia
- Mometasone/formoterol (Dulera): avoid grapefruit juice; common side effects include upper respiratory infections, fib, and hypokalemia
Short Acting Muscarinic Antagonist
- Ipratropium (Atrovent): common side effects include dry mouth, bitter taste, anticholinergic effects, and bronchitis
Long Acting Muscarinic Antagonist
- Tiotropium (Spiriva): common side effects include constipation, xerostomia, headache, and cough; serious side effects include closed angle glaucoma
Short Acting Beta Agonist
- Albuterol (ProAir, Ventolin, Proventil): common side effects include tachycardia, tremor, nausea, pharyngitis, and cough; serious side effects include A-Fib, hypertension, and hyperglycemia
SABA/SAMA Combination
- Albuterol/ipratropium (Combivent, DuoNeb): common side effects include see individual drug side effects
Leukotriene Modifier
- Montelukast (Singulair): common side effects include headache, dizziness, dyspepsia, and flu-like symptoms; serious side effects include suicidal thoughts and altered behavior
Phosphodiesterase 4 Inhibitor
- Roflumilast (Daliresp): common side effects include weight loss, diarrhea, nausea, and decrease in appetite; serious side effects include suicidal thoughts
Systemic Glucocorticoids
- Suppresses neutrophil migration and decreases inflammatory mediators
- Dexamethasone (DexPak): common side effects include increased appetite, weight gain, and Na/H2O retention
- Hydrocortisone (Cortef, Solucortef): common side effects include hypokalemia, CNS, and indigestion
- Methylprednisolone (Medrol, Solumedrol): common side effects include Cushing, dermal thinning, and diabetes
- Prednisone (Deltasone): common side effects include Cushing, osteoporosis, and glaucoma
- Prednisolone (Millipred): common side effects include Cushing, osteoporosis, and glaucoma
Xanthine Derivative
- Blocks PDE, causing increased cAMP, which promotes epinephrine release### Theophylline
- Used to treat asthma and COPD
- Causes bronchodilation
- Common side effects: nausea, vomiting, insomnia, tremor
- Serious side effects: atrial fibrillation, tachyarrhythmia, seizures
- Interacts with ciprofloxacin, carbamazepine, and phenytoin
- Dosing based on ideal body weight
- Therapeutic range: 5-15 mcg/mL
Thyroid Hormones
- Increase cellular metabolism and play a role in growth, development, CNS, and bone functions
- Levothyroxine (Synthroid) is used to treat hypothyroidism
- Common side effects: increased appetite, weight loss, insomnia, hyperhidrosis
- Serious side effects: menstrual irregularities, heat intolerance
- Liothyronine (Cytomel) is used for TSH suppression
- Desiccated thyroid (Armour thyroid) is a combination of T3 and T4
Antithyroid Agents
- Inhibit the synthesis of thyroid hormones
- Methimazole (Tapazole) is preferred in 2nd and 3rd trimesters of pregnancy
- Common side effects: hypothyroidism, GI upset
- Serious side effects: hepatotoxicity, agranulocytosis, hypothrombinemia
- Propylthiouracil is preferred in the first trimester of pregnancy and thyroid storm
Antihistamine (H1 Receptor Antagonists)
- Block H1 receptors to decrease the actions of histamine
- Cetirizine (Zyrtec) causes CNS depression
- Diphenhydramine (Benadryl) is used for upper respiratory allergies and urticaria
- Common side effects: sedation, anticholinergic ADR, HA
- Serious side effects: QT prolongation
Histamine (H2) Receptor Antagonists
- Competitive inhibition of histamine at H2 receptors of gastric parietal cells
- Famotidine (Pepcid) is used to treat GERD, heartburn, gastric/duodenal ulcer, and erosive esophagitis
- Common side effects: abdominal pain, headache
- Serious side effects: altered mental status/confusion
Proton Pump Inhibitors
- Decrease acid secretion in gastric parietal cells through inhibition of (H+, K+)-ATPase enzyme system
- Omeprazole (Prilosec) is used to treat GERD, erosive esophagitis, and H. pylori treatment
- Common side effects: abdominal pain, diarrhea
- Serious side effects: fracture risk, C. difficile infection risk
- Long-term use associated with Vitamin B12 deficiency and hypomagnesemia
Osmotic Laxative
- Polyethylene glycol 3350 causes water retention in the stool, increasing stool frequency
- Common side effects: N/D, abdominal fullness, cramping
- Serious side effects: dermatitis, rash
Stool Softener
- Docusate (Colace) draws water into the stool, softening the stool and achieving ease in bowel movement
- Common side effects: N/D, abnormal taste
- Serious side effects: intestinal obstruction
Selective 5-HT3 Receptor Antagonist
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Alosetron (Lotronex) is used to treat irritable bowel syndrome
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Common side effects: constipation, abdominal pain
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Serious side effects: ischemic colitis
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Caution in mild-moderate hepatic impairment### Linaclotide (Linzess)
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Used to treat IBS with constipation and opioid-induced constipation
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Acts locally on the gastrointestinal tract to increase intestinal fluid secretion and improve fecal transit
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Contraindications: less than 6yo, GI obstruction
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Common side effects: diarrhea, abdominal pain, flatulence
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Serious side effects: dehydration
Lubiprostone (Amitiza)
- Used to treat IBS with constipation and opioid-induced constipation
- Acts as a chloride channel activator to increase intestinal fluid secretion and improve fecal transit
- Contraindications: GI obstruction, not approved for males with IBS-C
- Common side effects: N/V/D, flatulence, abdominal pain
- Serious side effects: dyspnea, hypotension
Lactulose (Enulose, Kristalose)
- Used to treat constipation and hepatic encephalopathy
- Acts as an osmotic laxative to increase stool water content
- Common side effects: bloating, diarrhea, flatulence, N/V
- Serious side effects: hypernatremia, hypokalemia
Metoclopramide (Reglan)
- Used to treat GERD, diabetic gastroparesis, hiccups, and nausea/vomiting
- Blocks dopamine receptors and enhances the response to acetylcholine in the upper GI tract
- Contraindications: GI obstruction, perforation, or hemorrhage, history of seizure, use with other drugs causing EPS
- Common side effects: drowsiness, insomnia, extrapyramidal symptoms, dizziness
- Serious side effects: depression, neuroleptic malignant syndrome, tardive dyskinesia
Sucralfate (Carafate)
- Used to treat duodenal ulcer
- Forms an ulcer-adherent complex that protects the ulcer site from acid, pepsin, and bile salts
- Common side effects: constipation
- Serious side effects: aluminum toxicity in patients with renal impairment
Sodium/Potassium/Magnesium (Suprep Bowel Kit)
- Used for colonoscopy prep
- Provides sulfate anions that cause water to be retained within the gastrointestinal tract
- Contraindications: GI obstruction, bowel perforation, gastric retention, ileus, toxic colitis
- Common side effects: discomfort, abdominal distention/pain, N/V
- Serious side effects: fluid/electrolyte abnormalities, cardiac arrhythmia, seizure
Diphenoxylate/Atropine (Lomotil)
- Used to treat diarrhea
- Inhibits excessive GI motility and propulsion
- Contraindications: obstructive jaundice, diarrhea associated with pseudomembranous enterocolitis or enterotoxin-producing bacteria
- Common side effects: drowsiness/sedation, euphoria, N/V, flushing
- Serious side effects: paralytic ileus, toxic megacolon, anaphylaxis, anticholinergic hyperthermia, urinary retention, respiratory depression
Loperamide (Imodium)
- Used to treat diarrhea
- Acts directly on intestinal muscles to inhibit peristalsis and prolong transit time
- Contraindications: children younger than 2 years, abdominal pain without diarrhea, acute dysentery, active ulcerative colitis, bacterial enterocolitis
- Common side effects: dizziness, abdominal pain, constipation, drowsiness
- Serious side effects: torsades de pointes
Octreotide (Ocphyl, Sandostatin)
- Used to treat acromegaly and off-label for esophageal varices bleeding and sulfonylurea toxicity
- Mimics natural somatostatin by inhibiting serotonin release and secretion of various hormones
- Common side effects: hyperhidrosis, abdominal pain, headache, sinusitis
- Serious side effects: bradyarrhythmia, hyper/hypoglycemia, cholelithiasis
Dicyclomine (Bentyl)
- Used to treat functional bowel/IBS
- Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS
- Contraindications: obstructive disease of GI tract, severe ulcerative colitis, glaucoma, myasthenia gravis, breast feeding, infants
- Common side effects: anticholinergic, lightheadedness
- Serious side effects: tachyarrhythmia, psychosis, dyspnea
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Description
Identify key information about top drugs including generic and brand names, indications, adjustment routes, boxed warnings, contraindications, and side effects.