08 Drugs.docx

Drug Category/ Mechanism Interaction/GI symptoms Use Megestrol Megace Appetite stimulant Nausea, dyspepsia (indigestion –bloating, burning sensation) •Take with food For wasting syndromes -Cancer, AID To treat: anorexia, cachexia, unexplained weight loss Histamine H2 antagonist Cimetidine R...

Drug Category/ Mechanism Interaction/GI symptoms Use Megestrol Megace Appetite stimulant Nausea, dyspepsia (indigestion –bloating, burning sensation) •Take with food For wasting syndromes -Cancer, AID To treat: anorexia, cachexia, unexplained weight loss Histamine H2 antagonist Cimetidine Ranitidine Antiulcer, anti GERD Mechanism:H2 blocker-prevents binding of histamine to receptor Decreases stomach acid secretion -Decrease iron and B12 absorption •Take med at least 2hr before/after iron suppl Treat gastric ulcers (H. Pylori) Bisoprolol Metoprolol (Lopressor) Antihypertensive / Beta-Blocker Mechanism :Slows heart rate, relaxes the blood vessels which makes it easier to pump blood Possible decrease Na Used for HTN and to prevent angina (chest pain), treat heart attacks Amphetamines •Dextroamphetamine (Adderall) •Methylphenidate (Ritalin) Anti-ADHD, anti narcolepsy Anorexia, weight loss, appetite suppressant, nausea, weight loss ADHD, narcolepsy (inability to regulate sleep-wake cycle) Orlistat Lipid inhibitor Decrease fat absorption by binding lipase •Supplement ADEK For weight loss (weight control) Lorcaserin Serotonin agonist (activates serotonin) Enhances satiety For weight loss (controls chronic obesity), decreases appetite Phentermine (Topiramate) Releases norepinephrine(helps break down fat and increase blood sugar levels to provide more energy to the body) Appetite suppressant Weigh loss (Control obesity) Marinol (Dronabinol) Antiemetic •Marijuana derivative Appetite stimulant Treat nausea and vomiting caused by chemotherapy and anorexia in people with AIDS HMG CoA reductase inhibitors (statins) Atorvastatin (Lipitor) Rosuvastatin lovastatin Antihyperlipidemic, cholesterol •Decrease LDL, TG,increase HDL Avoid grapefruit juice Cardiovascular, slow progression of atherosclerosis Cholestyramine Antihyperlipidemic, antidiarrheal Mechanism: Cholestyramine is a bile acid sequestrant -it works by helping the body remove bile acids, which can lower cholesterol levels in the blood -Decrease fat absorption and ADEK -May decrease absorption of calcium, folate, iron, Zn, Mg Risk for anemia, weight loss High Cholesterol Corticosteroids Hydrocortisone (cortisol) Prednisone Dexamethasone Methylprednisolone Anti-inflammatory -Steroid,Glucocorticoids Explanation: increased urinary calcium, potassium, ascorbic acid, zinc, nitrogen excretion. -Increase appetite, weight gain, -Chronic use increases risk of osteoporosis -Decrease antibodies -negative nitrogen balance due to protein catabolism -Decrease bone growth causing osteoporosis (supplement Ca and vit D) •Decrease Ca, pro absorption, decrease bone formation, increase excretion of K, Nitrogen, zinc. Increase B6 (needed for protein) and Vit D (needed for Ca absorption) requirement Trauma, COPD, rheumatoid arthritis, lupus, gout, psoriasis, other inflammatory conditions Oral contraceptive – Conjugated estrogens, ethynol estradiol, mestranol Hormone, birth control (estrogen/progestin) -Decrease folate, B6, vit C -Reduce calcium excretion Caution with grapefruit juice, avoid SJW, and saw palmetto Birth control, antiacne, regulate menstrual cycle Loop diuretics Lasix Furosemide Bumetanide Bumex Diuretic, antihypertensive Mechanism: Inhibit the sodium-potassium-chloride cotransporter. This transporter normally reabsorbs about 25% of the sodium load; therefore, inhibition of this pump can lead to a significant increase in the distal tubular concentration of sodium, reduced hypertonicity of the surrounding interstitial, and less water reabsorption in the collecting duct. This altered handling of sodium and water leads to both diuresis (increased water loss) and natriuresis (increased sodium loss). Decrease thiamin, potassium, magnesium, sodium, calcium, chloride. Potassium is our biggest concern. -Remove salt and water goes with it Used for: heart failure, kidney disease, liver disease and HTN, edema, CHF, liver disease Thiazide diuretics Hydrochlorothiazide (HCTZ) Microzide Diuretic, antihypertensive Mechanism: Inhibit the sodium - chloride transporter in the distal tubule. Because this transporter normally only reabsorbs about 5% of filtered sodium, these diuretics are less efficacious than loop diuretics in producing diuresis and natriuresis. -Deplete K (induce hypokalemia), Mg -Enhance Calcium (can lead to hypercalcemia, hypophosphatemia Used for: heart failure, HTN, edema, BP, CKD, cirrhosis, nephrotic syndrome Antibiotics Penicillin Aminoglycoside chloramphenicol Antibiotic -Antibiotics kills good bacteria –reduces intestinal Vit K (Control vit K intake) and B12 synthesis •vit K is metabolized with bacteria-Increased urinary excretion of amino acids -Possible malabsorption of fat, B12, Cl, Mg, Carotenoids Treat bacterial infection Methotrexate Antineoplastic, antiarthritic -Folic Acid Antagonist -decrease folate (gets rid of folate in the body as waste) -May impair fat, calcium, B12, lactose, folate, and carotene ab For cancer patients Clozapine, Olanzapine, and Risperidone, Quetiapine Antipsychotics -Watch for caffeine and alcohol -Weight gain may be present Bipolar disorder Lithium carbonate Antipsychotics, antidepressant. Mechanism: If sodium or caffeine are restricted, lithium excretion decreases, leading to toxicity. Maintain consistent sodium and caffeine intake to stabilize drug’s levels; if sodium or caffeine are restricted, lithium carbonate excretion decreases, leading to toxicity -Increased appetite, weight gain -Maintain consistent sodium (2g too low) and caffeine intake to stabilize drug levels. •Have enough sodium -Drink 2-3 L fluid/day (consistent fluid intake Bipolar disorder Warfarin Coumadin, heparin Anticoagulant •Antagonizes vitamin K (consistent intake of Vit K is essential) •Avoid ginkgo, garlic, ginger (may increase bleeding) •Avoid high doses of vit A and E (increases effects of the drug Help prevent blood clots Propofol (Diprivan) Hypnotic/amnestic •Administered in oil –provides 1.1 cals/cc •Consider fat calories and check TG levels Sedative, to induce coma, Phenobarbital -Phenytoin -Dilantin -Primidone -Doxycycline Floroquinolones Anticonvulsant, Sedative Hold enteral feeding 2 hours before and 2 hours after interacts with calcium abs. •Decreased folic acid, vit B12, D, Vit K, B6 Impaired Vit D metabolism leading to: •Hypomagnesemia •Hypocalcemia -interferes with calcium abs (decrease absorption of calcium) –increase risk of osteomalacia (suppl Vit D). •Hypophosphatemia For anxiety, seizures, epilepsy, insomnia Cyclosporine Immunosuppressant (weakens the immune system to help body accept the new organ) Hyperlipidemia Hyperglycemia Hyperkalemia Hypertension. Don’t take with grapefruit Avoid St. John’s Wort Treats rheumatoid arthritis, psoriasis, organ transplant Isoniazid (INH), Nydrazid TB Treatment Mechanism: Isoniazid interferes competitively with pyridoxine metabolism by inhibiting the formation of the active form of Vit B6 (results in peripheral neuropathy) -Depletes B6 (Pyroxidine) , leading to peripheral neuropathy (weakness and pain from nerve damage in hands and feet) -Don’t take medication with food as it interferes with vit D, calcium, and phos,(calcium suppl needed) •Reduce calcium abs, reduce conversion of Vit D by the liver Treats Tuberculosis (TB) Elavil Anafranil Antidepressant Weight gain, increase appetite Antidepressant (Sedative effect) Levodopa (L-dopa) Anti-Parkinson -Vit B6 and protein decrease effectiveness of medication -iron decreases absorption of the medication Take drug in the morning with low protein as protein competes with the drug for absorption sites (consume most protein with evening meal) Easy way to remember: Take 10g or less of protein before 10am with medication Parkinson’s disease Tetracycline Antibiotic, antibacterial -Calcium binds tetracycline and decreases its effectiveness -Don’t take it with Treats acne and skin infections NRTI drugs (Zidovudine, Retrovir) Mechanism: NRTI drugs are associated with bone-marrow toxicity, which may lead to reduced levels of red blood cells (anemia) and white blood cells (neutropenia), which can increase risk for infection. •macrocytic anemia •loss of appetite •can lead to low levels of Vit B12, copper, zinc Antiviral for HIV/ AIDS Digoxin Lanoxin Digitalis glycosides Mechanism: improve strength and efficiency of the heart. It leads to better circulation and decreases swelling and heart problems -Increase urinary excretion of calcium, Mg, Zn -Can cause anemia (depletes folate) -Increased K consumption decreases the effectiveness resulting in heart failure – Don’t take it with Senna or St John’s Wort –decreases action of medication Used to treat heart failure (cardiac glycosides) and abnormal heart rhythms Oral Levothyroxine Synthroid Levothroid MAOI (Monoamine Oxidase Inhibitor) -Avoid foods high in tyramine to prevent HTN, headaches, heart problems, nausea, vomiting, confusion Foods that must be avoided: -Restrict aged, fermented, dried, pickled, smoked, spoiled foods Avoid: hard, aged cheese (cheddar cheese, bleu, gorgonzola), luncheon meats/aged meat(pepperoni, salami, pastrami), tofu, soy sauce, teriyaki, miso soup, tamari, fava beans, chianti wine, Korean beer, sauerkraut, Use with caution: sour cream, yogurt, buttermilk, beer (12oz or less) Foods not limited: uncured/unfermented cheese(ricotta, cottage cheese, cream cheese), white fish, salmon, Antidepressant = MAOI Explanation: MAOIs are anti-depressants that elevate the levels of norepinephrine, serotonin, and dopamine by inhibiting an enzyme called monoamine oxidase Analgesics aspirin Antiarthritic, NSAID -Medication decreases the absorption of vit C and folate (Increase excretion in urine) -May cause GI bleeding and subsequent iron deficiency Pain medication Ciprofloxacin Cipro Ciloxan Antibiotic Take 2hrs before or 6 hrs after consuming milk/dairy (decreases effectiveness of medication) •Infections Calcium carbonate (tums)Calcium citrate Antiacids, mineral supplement Reduce iron, copper, phos, mg absorption Neutralize acid in the stomach, also used as antidiarrheal Proton Pump Inhibitor (PPI) All name send in “zole” Omeprazole, esomeprazole, pantoprazole Antiulcer, AntiGERD,antisecretory May reduce iron, B12, Calcium (seen with omeprazole) GERD, gastric ulcers, Hydralazine Antihypertensives -Pyridoxine antagonist •Increase urinary excretion of manganese and B6 (pyridoxine) CHF Sulfadoxine and Pyrimethamine Sulfadoxine: antibacterial Pyrimethamine: antiparasitic- Folate antagonists Prevent malaria (transmitted by infected mosquitos) Erythromycin Antibiotic and gut motility stimulator Caution with grapefruit juice Diabetic gastroparesis treatment, acne Metoclopramide (Reglan) Prokineticagent Explanation: increases stomach contractility and shortens gastric emptying time _________ Gastroparesis, GERD Sulfasalazine Anti-inflammatory Explanation: Acts in the colon to prevent inflammation May decrease appetite, nausea, vomiting May deplete folate Used for IBD(ulcerative colitis) Neomycin Antibiotic Destroys bacterial flora that produces ammonia Hepatic failure (ESLD),hepatic coma, minor cuts, burns Colchicine Antigout, anti-inflammatory Induces loss of nutrients –inhibits B12 absorption Avoid grapefruit juice GOUT Decrease purine in the diet when acute episode of GOUT Bisphosphonate Osteoporosis Explanation: Slow down the cells which break down bone –inhibits osteoclast Adequate amount of calcium and vitamin D. Could cause GI discomfort –nausea, abdominal pain, gastritis Osteoporosis Spironolactone Potassium –sparing diuretic Can lead to hyperkalemia Can treat HTN, edema, liver disease, heart failure Type Mechanism/Category/Function Side effects Sulfonylureas -Glipizide (Glucotrol) -Glimepiride (Amaryl) -Glyburide Promote insulin secretion. -Insulin Secretagogues -stimulate insulin secretion from the pancreatic beta cells to decrease postprandial blood glucose Watch for hypoglycemia. -Adverse effects –weight gain, nausea -Glyburide is longest acting –avoid in the elderly. -Hold dose if you plan on not eating breakfast. Meglitinides -Glinides (Prandin) -Nateglinide (Starlix) Promote insulin secretion -Insulin Secretagogues-stimulate insulin secretion from the pancreatic beta cells to decrease postprandial blood glucose Watch for hypoglycemia If skipping a particular meal, skip dose of medication as well Contraindicated with patients with heart failure Biguanides -Metformin (Glucophage) -Metformin ER (Glucophage XR, Glumetza) First-line treatment in type 2 diabetes -Decrease hepatic glucose productionand increase insulin uptake in muscle Adverse effect: N/V/D, flatulence, abdominal cramping, loss of appetite (Take it with meals) -Very LOW risk of hypoglycemia Possible weight loss Black box warning –lactic acidosis –increased risk with acute HF, sepsis, iodinated contrast, renal impairment Monitor for B12 deficiency –metformin depletes intrinsic factor -ADA recommends periodic B12 testing, especially for patients with anemia or peripheral neuropathy Thiazolidinediones (TZDs) -Pioglitazone (Actos) -Rosiglitazone (Avandia) Increases insulin sensitivity -activate peroxisome proliferator-activated receptor gamma; increase peripheral insulin sensitivity Adverse effects: peripheral edema(fluid retention), weight gain -Increased risk of urinary bladder tumors (do not use in patients with active bladder cancer) -Do not cause low blood sugar when used alone -Increased risk of congestive heart failure in those at risk DPP-4 Inhibitors -Sitagliptin (Januvia) -Saxagliptin (Onglyza) -Alogliptin (Nesina) -Linagliptin (Tradjenta) Prevent DPP-4 from breaking down incretin hormones (GLP-1); increasing insulin release and decreasing glucagon release Often used with Metformin Adverse effects –peripheral edema, rash, diarrhea, -Do not cause low blood glucose Warnings –acute pancreatitis, can increase the risk of HF (saxagliptin and alogliptin SGLT-2 Inhibitors Canagliflozin (Invokana) Dapagliflozin (Farxiga) Empaglyfloxin (Jardiance) Ertuglifoxin (Steglato) Inhibit SGLT2 in the proximal renal tubules, reducing the reabsorption of filtered glucose and lowers the renal threshold for glucose -Causes the kidneys to remove glucose from the body through the urine(glucosuria) Adverse effects –hypoglycemia, increased urination, increased K+. Mg 2+, PO4 Warnings –ketoacidosis, genital mycotic infections, urosepsis, pyelonephritis, hypotension, AKI(Acute Kidney Injury), dehydration, yeast infection, high cholesterol Hypoglycemia IF combined with other glucose lowering medications Alpha-glucosidase inhibitors -Acarbose (Precose) -Miglitol (Glyset) Delays the hydrolysis of ingested complex carbohydrates; reduces glucose peaks Adverse effects –hypoglycemia, weight gain, severe GI upset-Hypoglycemia can’t be treated with fruit juice, table sugar, or candy (all contain sucrose) GLP-1 Agonist -Exenatide (Byetta) -Liraglutide (Victoza) -Lixisenatide (Adlyxin) -Exenatide ER (Bydureon) -Dulaglutide (Trulicity) -Semaglutide (Ozempic) Enhances insulin secretion and suppresses postprandial glucagon secretion. -prevent DPP-4 from breaking down incretin hormones (GLP-1); increasing insulin release and decreasing glucagon release Diarrhea, nausea, vomiting, headaches, dizziness, increased sweating, indigestion, constipation, loss of appetite (weight loss), Warning: pancreatitis Insulin Therapy Other names, onset time, and pea Rapid-acting (prandial insulin) Onset:15min Peak: 1 hr Duration: 3 hrs -Can take up to 15 minutes before a meal or immediately after a meal Aspart (Novolog, Fiasp) Lispro (Humalog, Admelog) Glulisine (Apidra) Short-acting regular Onset: 30min Peak: 2hrs Duration: 8 hours End with an R Regular insulin (Humulin R, Novolin R) –U-100Concentrated regular insulin (Humulin R U-500) Give 30 minutes prior meal Intermediate-acting Onset: 2 hours Peak: 8 hours Duration: 16 hours-They can be given right before bed with a bed night snack NPH insulin (Humulin N, Novolin N) Long-acting (basal insulin) Onset: 2 hours Peak: none Duration: 24 hours Glargine (Lantus, Basaglar) Glargine (Toujeo) Degludec(Tresiba) Detemir (Levemir) HERB PRIMARY USEPOTENTIAL INTERACTION Comfrey Soothes nerves Liver disease Echinacea Prevents moderate cold symptoms Avoid taking >2months Ephedra Promotes weight loss Rapid heart rate, headaches Kava Kava Relieves anxiety Liver failure Thistle May help protect liver Licorice root Ulcers Avoid combination with spironolactone, thiazide and loop diuretics and hypertensives Saw palmetto Relieve symptoms of enlarged prostate diuretic Valerian root Calms nerves Avoid with liver disease Yohimbe Erectile dysfunction Elevated blood pressure