Pharm Exam 5 Study Guide PDF

**Exam 5 Study Guide** Drugs for Pain - Drugs for Endocrine Disorders - Drugs for Bone and Joint Disorders - Nutrition and Complementary Therapies, - Drugs for Eyes, Ears, and Skin - [**[Medication Charts]**](#3rdcrjn) - **[Drugs for Pain]** **[Chapter 24 Opioid Analg...

**Exam 5 Study Guide** Drugs for Pain - Drugs for Endocrine Disorders - Drugs for Bone and Joint Disorders - Nutrition and Complementary Therapies, - Drugs for Eyes, Ears, and Skin - [**[Medication Charts]**](#3rdcrjn) - **[Drugs for Pain]** **[Chapter 24 Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics]** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **[Chapter 25 Drugs for Headache]** Abortive Therapy - - - - - - - - - - - - - **analgesics** NSAIDs, aspirin, naproxen, diclofenac, and other aspirin like analgesics can provide adequate relief of mild to moderate migraine attacks when combined with metoclopramide, aspirin may work as well as sumatriptan Tylenol should be used only in combination with other drugs. One effective combination marketed as Excedrin migraine, consist of acetaminophen, aspirin, and caffeine\\opioid analgesics are reserved for severe migraine that has not responded to first line medication-butorphanol nasal spray **Serotonin1B/1D Receptor Agonists (Triptans)** First line drugs for terminating migraine attack these agents relieve pain by constricting intracranial blood vessels and suppressing release of inflammatory neuropeptides **Sumatriptan** can be administered by mouth, nasal inhalation, or subcutaneous injection. Also available as a fixed dose combination with naproxen can abort an ongoing migraine attack. The drug relieves headache and associated symptoms **Adverse Effects:** Generally well tolerated most side effects are transient and mild. - - - avoid Sumatriptan in patients with risk factors for CAD until CAD has been ruled out Sumatriptan should not be used during pregnancy **Drug Interactions:** Ergot Alkaloids and other triptans-all cause vasoconstriction. Sumatriptan should not be used within 24 hours of an ergot derivative or another triptan **MAO**I should not be used within two weeks of using a triptan **SSRI\'s and SNRIs:** Serotonin syndrome can occur No laboratory monitoring is necessary with this drug class all triptans are contraindicated for patients with ischemic heart disease, prior MRI, or uncontrolled hypertension **Ergot alkaloids** **Ergotamine** second line drug for stopping an ongoing migraine attack in patients who have not responded to a triptan risk for dependence, should not be taken on a daily long term basis can be given oral, sublingual, or rectal **adverse effects**: well tolerated at the usual therapeutic doses nausea and vomiting-concurrent treatment with Reglan or compazine can help reduce these responses other common side effects include weakness in the legs, myalgia, numbness and tingling in the fingers and toes, angina like pain, and tachycardia or bradycardia **ergotism:** acute or chronic overdose can cause serious toxicity referred to as ergotism. Overdose can cause ischemia secondary to construction of peripheral arteries and arterioles. The extremities become cold, pale, numb, muscle pain develops, and gangrene may eventually resolve. The risk for ergotism is highest in patients with sepsis, peripheral vascular disease, and renal or hepatic impairment **drug interactions**: triptans regular daily use of this drug, even in moderate doses, can cause physical dependence. **Contraindications:** contraindicated for patients with hepatic or renal impairment, sepsis, CAD, peripheral vascular disease, uncontrolled hypertension and for those taking potent inhibitors of CYP3A4, pregnancy **Dihydroergotamine** Very similar to ergotamine second line drug for terminating A migraine attack given IM, IV, intranasally, or sub Q causes little nausea and vomiting, no physical dependence, and minimal peripheral vasoconstriction, diarrhea is prominent **[black box warning]** potent inhibitors of CYP3A4 can raise ergotamine to dangerous levels, posing a risk for intense vasospasm. Cerebral or peripheral ischemia can result. Accordingly, concurrent use with CYP 3A4 inhibitors is contraindicated **Preventative therapy** prophylactic therapy can reduce the frequency, intensity, and duration of migraine attacks and can improve responses to abortive drugs indicated for patients who have frequent attacks defined as three or more a month, especially severe, or attacks that do not respond adequately to abortive agents. **Beta blockers** beta blockers are first line drugs for migraine prevention Propranolol is used most often, although metoprolol is now deemed to be just as effective timolol, atenolol, and Nadolol can help prevent migraines as well beta blockers that possess intrinsic sympathomimetic activity are not effective antiepileptic drugs **Depakote ER** prophylaxis of migraine the most common side effect is nausea. Other side effects include fatigue, weight gain, tremor, bone loss, reversible hair loss **black box warning:** potentially fatal pancreatitis and hepatitis can occur. In addition, depakote can cause neural tube defects in the developing fetus, hence is contraindicated during pregnancy topiramate approved for migraine prophylaxis benefits take several weeks to develop and appear equal to those of beta blockers, tricyclic antidepressants, or **Depakote** much more expensive than the other drugs side effects are common especially paresthesias, fatigue, cognitive dysfunction, metabolic acidosis and moderate weight loss **tricyclic antidepressants** can prevent migraine and tension type headaches in some patients. Amitriptyline is used most often. Can cause hypotension and anticholinergic effects **estrogens and triptans for menstrually associated migraine** a migraine that routinely occurs within two days of onset of menses. An important trigger is the decline in estrogen levels that precedes menstruation. For many women, these migraines can be prevented by taking estrogen supplements, which compensate for the premenstrual estrogen drop. Topical preparations work well. Premenstrual triptans can also help. Dosing is done for six days each month, beginning two days before the expected onset of menses. In addition, naproxen a dosage of 550 milligrams twice daily, given six days before 2-7 days after minces, has demonstrated effectiveness in the prevention of migraines **other drugs for prophylaxis** **Erenumab**: **Calcitonin gene related peptide receptor antagonist** Given subcutaneously. Half life is about 28 days. Appears safe to use in patients with renal and hepatic impairment Constipation and muscle cramping, and injection site reaction are the most common side effects **Botulinum Toxin** Approved for prevention of headaches and adults with chronic migraine defined as having 15 or more headache days per month, but not for patients with less frequent headaches. Black box warning: Botox can spread from the side of injection and produce muscle weakness, difficulty with respiration, and swallowing difficulties that can be life threatening **[Cluster Headaches]** Primary therapy is directed at prophylaxis Glucocorticoids-Prednisone and dexamethasone verapamil and lithium verapamil is first line agent for preventing chronic cluster headache. This drug is effective, easy to use, safe lithium is considered a second line drug for prophylaxis. The drug is effective but can cause multiple adverse effects and dosing is difficult period to ensure therapeutic effects and to minimize toxicity, blood levels of lithium must be monitored if an attack occurs despite preventative therapy, it can be aborted with Sumatriptan or oxygen Inhaling 100% oxygen 7 to 10 liters per minute for 15 to 20 minutes is highly effective and has virtually no adverse effects **[Medication overuse headache]** in chronic headache that develops in response to frequent use of headache medicines and that resolves days to weeks after the overuse drug is withdrawn. Almost all medications used for abortive headache therapy can cause MOH the treatment for MOH is to stop taking all headache medicines. Unfortunately, when medication is withdrawn, headaches increase for a while. Implementing non drug measures such as stress reduction, avoidance of triggers, getting sufficient sleep, relaxation techniques, and biofeedback can reduce the need for headache medicines and decrease exposure to drugs that cause MOH **[Drugs for Endocrine Disorders]** **[Chapter 48 Drugs for Diabetes Mellitus]** - - - - [T1DM:] - - [T2DM:] - - [Gestational diabetes: ] - [Hemoglobin A1C-] reflect average blood glucose levels over the previous 2 to 3 months. [Insulin:] - - - - - - - **[Types of insulin: see medication charts]** **[Criteria for Dx of DM:]** - - - - [Hypoglycemia]- BG less than 70 mg/dL, occurs when insulin levels exceed insulin needs. When glucose levels fall rapidly, activation of the sympathetic nervous system occurs, resulting in *tachycardia, palpitations, sweating, and nervousness.* - - - - - **[Non-insulin medications for treatment of DM: see medication charts]** **[Chapter 49 Drugs for Thyroid Disorders] -** From audio: Don't focus on pathophysiology here. Focus on the drugs. Patient education. Pg 418. Quick review Don't need to know thyroid lab levels. **[Hypothyroid (Hasimotos) ]** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - **Levothyroxine** - - - - **[Hyperthyroid (Graves Disease)]** - - - - - - - - - - - - - - - - **Drugs:** - - - - - - - - - - - - - - - - **Radioactive Iodine** - - - - - - - - - - - - - - - - - - - **Nonradioactive Iodine: Lugol Solution** - **[Drugs for Bone and Joint Disorders ]** **[Chapter 59 Drug Therapy of Rheumatoid Arthritis]** - - - - - - - - - - - - - - - - - - - - - - - - - - **[Nutrition and Complementary Therapies ]** **[Chapter 67 Vitamins]** - - - - - - - - - - - - - - - - - - **[Chapter 69 Complementary and Alternative Therapy]** - - - - - - - - - - - - - - - - - - - - - SEE MED CHART **[Drugs for Eyes, Ears, and Skin]** **[Chapters 79 Antifungal Agents (start p. 719 drugs for superficial mycoses)]** Superficial Mycoses are caused by two agents: candida species and dematophytes. - - Dermatophytic infections (Ringworms) - - - - - - - - - - - - - - - Candidiasis - - - - - - - - - Onychomycosis - - - - - - - - - - - - - - - - - - - - - - See Table 79.5 (page 720) for drug names, route, potency, and infections treated. See Drug Cards **[Chapter 87 Drugs for the Eye] - Caroline** Background - - - - Pathophysiology of Glaucoma and TX Overview - - - - - - - - - - - - - - - - - - - - Drugs used to Manage Glaucoma - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Allergic Conjunctivitis - - - - - - - - - - - - - Additional Ophthalmic Drugs - - - - - - **[Chapter 88 Drugs for the Skin]** Anatomy of skin - - - - - - - - - - - - - - - - - - - - - - - Topical drugs - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Topical Glucocorticoids - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Keratolytic Agents (MINIMAL INFO, NO DRUG CARDS) - - - - - - - - - - - - - - - - - - - - Acne - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Topical Drugs for Acne - - - - - - - - - - - - - - - - - - - - - - - - - Oral Drugs for Acne - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- -- -- -- -- -- -- -- Sunscreens - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Atopic Dermatitis (Eczema) - - - - - - - - - - - - - - - - - - - - - - - - - - - Wart Removal Agents - - - Venereal Warts - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Common Warts (Verruca Vulgaris) - - - - - - - - - Miscellaneous Skin Conditions - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - +-------------+-------------+-------------+-------------+-------------+ | **Generic | **Trade | **Formulati | **Dosage** | | | Name** | Name** | on** | | | +=============+=============+=============+=============+=============+ | | | | **Pediatric | **Adult** | | | | | ** | | +-------------+-------------+-------------+-------------+-------------+ | **Topical** | | | | | +-------------+-------------+-------------+-------------+-------------+ | Mupirocin | Bactroban | Ointment, | Apply TID | Apply TID | | | | cream | for 3-5 | for 3-5 | | | | | days | days | +-------------+-------------+-------------+-------------+-------------+ | Retapamulin | Altabax | Ointment | Apply BID | Apply BID | | | | | for 5 days | for 5 days | +-------------+-------------+-------------+-------------+-------------+ | **Oral** | | | | | +-------------+-------------+-------------+-------------+-------------+ | Cephalexin | Keflex | Capsules, | 6.25 mg/kg | 500 mg Q | | | | suspension | QID | 6-12 hrs | +-------------+-------------+-------------+-------------+-------------+ | Dicloxacill | Generic | Capsules | 6.25 mg/kg | 250 mg QID | | in | only | | 4 times a | | | | | | day | | +-------------+-------------+-------------+-------------+-------------+ | Clindamycin | Cleocin | Capsules, | 10-20 mg/kg | 300-400 mg | | | | suspension | per day in | TID | | | | | 3 doses | | +-------------+-------------+-------------+-------------+-------------+ | Amoxicillin | Augmentin | Tablets, | *3 months & | 875 mg | | / | | suspension | older under | Amoxicillin | | Claculanate | | | 40kg:* | / 125mg | | | | | | Clavulanate | | | | | 20-40 mg/kg | BID | | | | | per day | | | | | | (amoxicilli | | | | | | n | | | | | | component) | | | | | | divided Q 8 | | | | | | hr -OR- | | | | | | | | | | | | 25-45 mg/kg | | | | | | per day | | | | | | (amoxicilli | | | | | | n | | | | | | component) | | | | | | divided Q | | | | | | 12 hr | | | | | | | | | | | | *40kg & | | | | | | greater:* | | | | | | | | | | | | 500 mg Q 12 | | | | | | hr -OR- | | | | | | | | | | | | 250 mg Q | | | | | | 8hr | | | | | | | | | | | | *Severe | | | | | | infections, | | | | | | 40kg & | | | | | | greater:* | | | | | | | | | | | | 875 mg Q 12 | | | | | | hr -OR- | | | | | | | | | | | | 500 mg Q 8 | | | | | | hr | | +-------------+-------------+-------------+-------------+-------------+ Local Anesthetics - - **[Chapter 89 Drugs for Ear] - Ashley C** Otitis Media and Its Management - - - ***Acute Otitis Media (AOM)*** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ***Otitis Media with Effusion (OME)*** - - - - - - ***Acute Otitis Externa (AOE)*** - - - - - - - - - - - - - - - - - - **Necrotizing Otitis Externa (NOE)** - - - - - - **Fungal Otitis Externa (Otomycocis)** - - **Summary of Key prescribing Considerations** - - - - - - - - - - - **[Medication Charts]** +---------+---------+---------+---------+---------+---------+---------+ | **Opioi | | | | | | | | ds | | | | | | | | (Ch. | | | | | | | | 24)** | | | | | | | +=========+=========+=========+=========+=========+=========+=========+ | **Drug* | **Indic | **Pharm | **Pop. | **AE & | **BBW / | **Teach | | * | ation** | acodyna | Differe | SE** | DDI / | & | | | | mics** | nces** | | CI** | Monitor | | | | | | | | ** | +---------+---------+---------+---------+---------+---------+---------+ | **Morph | 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{.under | | | | | ]{.unde | | | line}** | | | | | rline}* | | | start | | | | | * | | | at | | | | | not | | | small | | | | | oral | | | doses | | | | | due to | | | | | | | | rapid | | | | | | | | first-p | | | | | | | | ass | | | | | | | | inactiv | | | | | | | | ation. | | | | | | | | | | | | | | | | **[Excr | | | | | | | | etion:] | | | | | | | | {.under | | | | | | | | line}** | | | | | | | | hepatic | | | | | +---------+---------+---------+---------+---------+---------+---------+ | **Methy | Opioid- | **[MOA: | **[Chil | **[Comm | **[BBW: | **[Teac | | lnaltre | induced | ]{.unde | dren:]{ | on:]{.u | ]{.unde | h:]{.un | | xone** | constip | rline}* |.underl | nderlin | rline}* | derline | | (Relist | ation | * | ine}** | e}** | * | }** | | or) | | benefit | | abd | | only | | | | s | **[Preg | pain, | **[DDI: | for pt | | **Nalox | | derive | nancy:] | flatule | ]{.unde | who | | egol** | | from | {.under | nce, | rline}* | have | | (Movant | | blockin | line}** | nausea, | * | 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6-11 | | | | underli | | | | hours | | | | ne}** | | | | | | | | of | | | | Methyln | | | | persist | | | | altrexo | | | | ent | | | | ne: | | | | diarrhe | | | | 8 hours | | | | a: | | | | | | | | dc med | | | | **[Meta | | | | | | | | bolism: | | | | | | | | ]{.unde | | | | | | | | rline}* | | | | | | | | * | | | | | | | | naldeme | | | | | | | | dine: | | | | | | | | urine | | | | | | | | | | | | | | | | Naloxeg | | | | | | | | ol: | | | | | | | | liver | | | | | | | | | | | | | | | | **[Excr | | | | | | | | etion:] | | | | | | | | {.under | | | | | | | | line}** | | | | | | | | | | | | | | | | Naloxeg | | | | | | | | ol:fece | | | | | | | | s | | | | | | | | | | | | | | | | methyln | | | | | | | | altrexo | | | | | | | | ne: | | | | | | | | urine/f | | | | | | | | eces | | | | | | | | | | | | | | | | Naldeme | | | | | | | | dine: | | | | | | | | renally | | | | | | | | and | | | | | | | | feces | | | | | +---------+---------+---------+---------+---------+---------+---------+ | 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during | | | | | | | MAOIs | initial | | | | | | | | therapy | | | | | | | | and at | | | | | | | | times | | | | | | | | of dose | | | | | | | | increas | | | | | | | | es | +---------+---------+---------+---------+---------+---------+---------+ +---------+---------+---------+---------+---------+---------+---------+ | **Drugs | | | | | | | | for | | | | | | | | Headach | | | | | | | | es | | | | | | | | (Ch. | | | | | | | | 25)** | | | | | | | +=========+=========+=========+=========+=========+=========+=========+ | **Drug* | **Indic | **Pharm | **Pop. | **AE & | **BBW / | **Teach | | * | ation** | acodyna | Differe | SE** | DDI / | & | | | | mics** | nces** | | CI** | Monitor | | | | | | | | ** | +---------+---------+---------+---------+---------+---------+---------+ | **Tript | 1st | **[MOA: | **[Chil | **[Comm | **[BBW: | **[Teac | | ans** | line | ]{.unde | dren:]{ | on:]{.u | ]{.unde | h:]{.un | | | termina | rline}* |.underl | nderlin | rline}* | derline | | Sumatri | ting | * | ine}** | e}** | * | }** | | ptan | migrain | causes | | bad | | teach | | (Imitre | e | selecti | **[Preg | taste | **[DDI: | pt to | | x) | attack | ve | nancy:] | | ]{.unde | keep | | | | action | {.under | **[Sign | rline}* | log of | | | | of the | line}** | ificant | * | migrain | | | | 5-HT | contrai | :]{.und | ergot | e | | | | recepto | ndicati | erline} | alkaloi | to | | | | rs | on | ** | ds, | locate | | | | causing | | coronar | other | possibl | | | | vasocon | **[Brea | y | tiptans | e | | | | stricti | stfeedi | vasospa | , | trigger | | | | on | ng:]{.u | sm | MAOI's, | s | | | | & | nderlin | chest | SSRI's, | | | | | promote | e}** | symptom | SNRI's | **[Moni | | | | s | | s, | | tor:]{. | | | | release | **[Geri | teratog | **[CI:] | underli | | | | of | atric:] | enesis | {.under | ne}** | | | | inflamm | {.under | | line}** | none | | | | atory | line}** | | pregnan | | | | | neurope | | | cy | | | | | ptides | Beers | | | | | | | (decrea | Criteri | | | | | | | sed | a? | | | | | | | perivas | | | | | | | | cular | | | | | | | | inflamm | | | | | | | | ation) | | | | | | | | | | | | | | | | **[Rout | | | | | | | | e:]{.un | | | | | | | | derline | | | | | | | | }** | | | | | | | | po, | | | | | | | | intrana | | | | | | | | sal, | | | | | | | | SubQ | | | | | | | | | | | | | | | | **[½ | | | | | | | | Life:]{ | | | | | | | |.underl | | | | | | | | ine}** | | | | | | | | 2.5 | | | | | | | | hours | | | | | | | | | | | | | | | | **[Meta | | | | | | | | bolism: | | | | | | | | ]{.unde | | | | | | | | rline}* | | | | | | | | * | | | | | | | | hepatic | | | | | | | | | | | | | | | | **[Excr | | | | | | | | etion:] | | | | | | | | {.under | | | | | | | | line}** | | | | | | | | renal | | | | | +---------+---------+---------+---------+---------+---------+---------+ | **Ergot | 2nd | **[MOA: | **[Chil | **[Comm | **[BBW: | **[Teac | | Alkaloi | line | ]{.unde | dren:]{ | on:]{.u | ]{.unde | h:]{.un | | ds** | for | rline}* |.underl | nderlin | rline}* | derline | | | stoppin | * | ine}** | e}** | * | }** | | Ergotam | g | unknown | | N/V, | protein | women | | ine | ongoing | -alters | **[Preg | weaknes | inhibit | should | | | migrain | seroton | nancy:] | s | or | not | | | e | ergic, | {.under | in | CYP3A4 | take if | | | (not | dopamin | line}** | legs, | raises | wanting | | | respond | ergic, | contrai | myalgia | level, | to get | | | ed | alpha-a | ndicati | , | causing | pregnan | | | to | drenerg | on | numbnes | intense | t | | | triptan | ic | (promot | s, | vasospa | | | | ) | junctio | e | tinglin | sm, | **[Moni | | | or | n | uterine | g | central | tor:]{. | | | cluster | | contrac | in | /periph | underli | | | HA | **[Rout | tions-c | fingers | eral | ne}** | | | | e:]{.un | ausing | ,toes, | ischemi | | | | | derline | fetal | angina- | a | | | | | }** | harm/ab | like | | | | | | oral, | ortion) | pain, | **[DDI: | | | | | subling | | tachy, | ]{.unde | | | | | ual, | **[Brea | brady | rline}* | | | | | rectal | stfeedi | | * | | | | | | ng:]{.u | **[Sign | triptan | | | | | **[½ | nderlin | ificant | s, | | | | | Life:]{ | e}** | :]{.und | physica | | | | |.underl | | erline} | l | | | | | ine}** | **[Geri | ** | depende | | | | | 2 hours | atric:] | overdos | nce | | | | | (effect | {.under | e-**[er | | | | | | s | line}** | gotism] | **[CI:] | | | | | can | | {.under | {.under | | | | | still | Beers | line}** | line}** | | | | | be | Criteri | (extrem | CYP3A4, | | | | | present | a? | ities | hepatic | | | | | 24 | | become | /renal | | | | | hours | | cold, | impairm | | | | | after | | pale, | ent, | | | | | dosing) | | numb, | CAD, | | | | | | | muscle | sepsis, | | | | | **[Meta | | pain, | PVD, | | | | | bolism: | | gangren | uncontr | | | | | ]{.unde | | e) | olled | | | | | rline}* | | | HTN | | | | | * | | | | | | | | by | | | | | | | | CYP3A4 | | | | | | | | | | | | | | | | **[Excr | | | | | | | | etion:] | | | | | | | | {.under | | | | | | | | line}** | | | | | | | | bile | | | | | +---------+---------+---------+---------+---------+---------+---------+ | **Ergot | 2nd | **[MOA: | **[Chil | **[Comm | **[BBW: | **[Teac | | Alkaloi | line | ]{.unde | dren:]{ | on:]{.u | ]{.unde | h:]{.un | | ds** | for | rline}* |.underl | nderlin | rline}* | derline | | | stoppin | * | ine}** | e}** | * | }** | | Dihydro | g | unknown | | diarrhe | protein | | | ergotam | ongoing | -alters | **[Preg | a | inhibit | **[Moni | | ine | migrain | seroton | nancy:] | | or | tor:]{. | | (DHE | e | ergic, | {.under | **[Sign | CYP3A4 | underli | | 45, | | dopamin | line}** | ificant | raises | ne}** | | Migrana | | ergic, | | :]{.und | level, | | | l) | | alpha-a | **[Brea | erline} | causing | | | | | drenerg | stfeedi | ** | intense | | | | | ic | ng:]{.u | | vasospa | | | | | junctio | nderlin | | sm, | | | | | n | e}** | | central | | | | | | | | /periph | | | | | **[Rout | **[Geri | | eral | | | | | e:]{.un | atric:] | | ischemi | | | | | derline | {.under | | a | | | | | }** | line}** | | | | | | | IM, IV, | | | **[DDI: | | | | | intrana | Beers | | ]{.unde | | | | | sal, | Criteri | | rline}* | | | | | or | a? | | * | | | | | sub-Q | | | | | | | | | | | **[CI:] | | | | | **[½ | | | {.under | | | | | Life:]{ | | | line}** | | | | |.underl | | | CYP3A4 | | | | | ine}** | | | | | | | | 21 | | | | | | | | hours | | | | | | | | | | | | | | | | **[Meta | | | | | | | | bolism: | | | | | | | | ]{.unde | | | | | | | | rline}* | | | | | | | | * | | | | | | | | liver | | | | | | | | CYP3A4 | | | | | | | | | | | | | | | | **[Excr | | | | | | | | etion:] | | | | | | | | {.under | | | | | | | | line}** | | | |