Podcast
Questions and Answers
What is the indication for Beclomethasone (Qvar, Qnasl)?
What is the indication for Beclomethasone (Qvar, Qnasl)?
What are the common side effects of Budesonide (Pulmicort)?
What are the common side effects of Budesonide (Pulmicort)?
Vertigo, Upper Respiratory Infections
Fluticasone (Flovent, Flonase) has a boxed warning regarding Pneumonia Risk.
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 __________.
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:
Match the following medications with their indications:
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What is the relative potency of Dexamethasone compared to Methylprednisolone?
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?
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'?
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:
Match the corticosteroid medication with its primary side effect:
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What is the primary function of thyroid hormones?
What is the primary function of thyroid hormones?
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Which of the following drugs is used for both asthma and COPD?
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.
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.
_______ 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)
What is the purpose of Pylera? (List all drugs included)
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Which drug is an osmotic laxative?
Which drug is an osmotic laxative?
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Docusate is a stool softener. (True/False)
Docusate is a stool softener. (True/False)
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What is the chloride channel activator used as a treatment for constipation?
What is the chloride channel activator used as a treatment for constipation?
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Match the drug with its primary usage:
Match the drug with its primary usage:
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What are common symptoms of GI obstruction and bowel perforation?
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?
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.
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.
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
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.
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?
Which side effect is NOT associated with chronic use of corticosteroids?
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Match the corticosteroid with its relative potency level:
Match the corticosteroid with its relative potency level:
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What is the primary usage of Xanthine Derivatives in blocking PDE?
What is the primary usage of Xanthine Derivatives in blocking PDE?
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What is the common side effect associated with Theophylline?
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?
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.
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.
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?
What is the mechanism of action of Polyethylene glycol 3350?
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What is the mechanism of action of Docusate?
What is the mechanism of action of Docusate?
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What is the mechanism of action of Alosetron?
What is the mechanism of action of Alosetron?
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What is the mechanism of action of Linaclotide?
What is the mechanism of action of Linaclotide?
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What is the mechanism of action of Lubiprostone?
What is the mechanism of action of Lubiprostone?
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What is the mechanism of action of Lactulose?
What is the mechanism of action of Lactulose?
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What is the mechanism of action of Metoclopramide?
What is the mechanism of action of Metoclopramide?
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What is the mechanism of action of Sucralfate?
What is the mechanism of action of Sucralfate?
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What is the mechanism of action of Sulfate salts?
What is the mechanism of action of Sulfate salts?
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What is the brand name of the medication Linaclotide?
What is the brand name of the medication Linaclotide?
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What is the brand name of the medication Sucralfate?
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?
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?
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)
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.
___ 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?
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.
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?
What is the common purpose of Somatostatin Analog?
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Dicyclomine (Bentyl) is commonly used for functional bowel disorders like ___ and IBS.
Dicyclomine (Bentyl) is commonly used for functional bowel disorders like ___ and IBS.
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What does Levothyroxine treat?
What does Levothyroxine treat?
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Which common side effects are associated with Antihistamine Cetirizine?
Which common side effects are associated with Antihistamine Cetirizine?
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Proton Pump Inhibitors block the final step in gastric acid production.
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?
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?
What are the relative side effects associated with dexamethasone?
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What is the primary function of Diphenoxylate in the commercial preparations?
What is the primary function of Diphenoxylate in the commercial preparations?
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Lomotil is a medication used to treat __________.
Lomotil is a medication used to treat __________.
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Hydrocortisone is also known as _____ and _____
Hydrocortisone is also known as _____ and _____
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For which condition is Methylprednisolone commonly used?
For which condition is Methylprednisolone commonly used?
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Loperamide demonstrates antisecretory activity.
Loperamide demonstrates antisecretory activity.
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Prednisolone can cause growth retardation.
Prednisolone can cause growth retardation.
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Match the following common side effects with the respective medication:
Match the following common side effects with the respective medication:
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Match the corticosteroid with its relative potency:
Match the corticosteroid with its relative potency:
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What is the primary use of Pylera (Bismuth/Metronidazole/Tetracycline)?
What is the primary use of Pylera (Bismuth/Metronidazole/Tetracycline)?
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What is the primary purpose of polyethylene glycol (Miralax)?
What is the primary purpose of polyethylene glycol (Miralax)?
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Docusate (Colace) is primarily used for treating diarrhea. (True/False)
Docusate (Colace) is primarily used for treating diarrhea. (True/False)
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Alosetron (Lotronex) is indicated for women with severe ____-predominant IBS.
Alosetron (Lotronex) is indicated for women with severe ____-predominant IBS.
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Match the GI agent with its primary purpose:
Match the GI agent with its primary purpose:
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What is the mechanism of action of inhaled steroids?
What is the mechanism of action of inhaled steroids?
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What is the indication for Beclomethasone?
What is the indication for Beclomethasone?
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What is the common side effect of inhaled steroids?
What is the common side effect of inhaled steroids?
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What is the benefit of ICS/LABA combination?
What is the benefit of ICS/LABA combination?
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What is the mechanism of action of Short Acting Muscarinic Antagonist?
What is the mechanism of action of Short Acting Muscarinic Antagonist?
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What is the indication for Tiotropium?
What is the indication for Tiotropium?
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What is the common side effect of Long Acting Muscarinic Antagonist?
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?
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?
What is the common side effect of Short Acting Beta Agonist?
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What is the mechanism of action of Leukotriene Modifier?
What is the mechanism of action of Leukotriene Modifier?
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What is the common side effect of Phosphodiesterase 4 inhibitor?
What is the common side effect of Phosphodiesterase 4 inhibitor?
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What is the mechanism of action of Systemic glucocorticoids?
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
-
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
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Identify key information about top drugs including generic and brand names, indications, adjustment routes, boxed warnings, contraindications, and side effects.