Top Drugs - P2 Fall DKQ PDF

Top Drugs - P2 Fall DKQ...

Top Drugs - P2 Fall DKQ 1 Generic Brand Indication(s) Adjust Route Boxed warning Contraindications Side Effects Major DDI Other Comments Inhaled Steroids: Inhibition of inflammatory response in the airways, and they also increase the sensitivity of beta-2 receptors Beclomethasone Qvar, Qnasl N inhalation Common: Throat Irritation, Cough, Thrush, Headache Rinse mouth and throat after use Budesonide Pulmicort Asthma, COPD, allergic N inhalation Serious: Vertigo, Upper Respiratory Infections, Status asthmaticus Systemic side effects are not common Fluticasone Flovent, Flonase rhinitis N inhalation Pneumonia Risk, HPA Axis Suppression, Growth Avoid grapefruit juice (fluticasone) Mometasone Asmanex N inhalation Retardation (Children/High Dose) ICS/ LABA Combination: Combination of corticosteroid and LABA will improve pulmonary function and control over using the products alone. (ICS) Corticosteroids have anti-inflammatory, immunosuppressive, and antiproliferative actions. LABAs relaxes bronchial smooth muscle by action on beta-2 receptors Fluticasone/ Avoid grapefruit juice Advair N Diskus, HFA salmeterol Salmeterol (Serevent) - LABA monotherapy LABAs used as monotherapy can Common: Hoarseness, Cough, Thrush, Headache, Fluticasone/ vilanterol Breo Ellipta N inhalation increase the risk of asthma- Avoid grapefruit juice Acute bronchospasm, status Nasal Congestion Asthma, COPD related deaths and Beta blockers Budesonide/ asthmaticus Serious: Upper Respiratory Infections (Pneumonia), A- Symbicort N inhalation hospitalizations, especially in formoterol Fib, Hypokalemia pediatric and adolescent patients formoterol (Perforomist) - LABA monotherapy Mometasone/ Dulera N inhalation formoterol Short Acting Muscarinic Antagonist: Anticholinergic agent that works on M3 receptors that leads to a decrease in secretions and bronchodilation Common: Dry Mouth, Bitter Taste, Anticholinergic COPD Nebulized, Ipratropium Atrovent N Effects, Bronchitis Anticholinergic agents Acute asthma (off-label) HFA Serious: Bronchospasm, MI, Anaphylaxis Long Acting Muscarinic Antagonist: Induction of bronchodilation via inhibition of the M3 receptor on airway smooth muscle. It is long acting with anticholinergic activity and affinity on M1 through M5. Common: Constipation, Xerostomia, Headache, Cough, COPD Respimat, Tiotropium Spiriva N Anticholinergic Effects Anticholinergic agents HandiHaler contains a capsule for inhalation Asthma (Respimat only) Handihaler Serious: Closed angle glaucoma Short Acting Beta Agonist: Activation of Beta-2 Receptors in the bronchial smooth muscle results in relaxation and inhibition of mediator release from mast cells Common: Tachycardia, Tremor, Nausea, Pharyngitis, ProAir, Ventolin, inhalation, Cough, Hypokalemia Albuterol Asthma (rescue) N Non-selective beta blockers Levalbuterol (Xopenex) - R-albuterol Proventil nebulized, PO Serious: A-Fib, Hypertension, Hyperglycemia, Bronchospasm SABA/SAMA Combination Combivent COPD Respimat, Anticholinergic agents Albuterol/ Ipratropium N See individual drug side effects DuoNeb Acute asthma (off-label) nebulized Non-selective beta blockers Leukotriene Modifier: Montelukast: Inhibits leukotriene receptors, which inhibits airway edema and facilitates bronchodilation; Zileuton – Decreases the formation of leukotrienes, which causes bronchodilation. Common: Headache, Dizziness, Dyspepsia, Flu-Like Asthma, exercise induced Increased risk for Symptoms, Cough, Abdominal Pain, and Fatigue. Montelukast Singulair bronchospasm, allergic N PO Take in evening neuropsychiatric events Serious: Suicidal thoughts, Altered Behavior, Cholestatic rhinitis Hepatitis Phosphodiesterase 4 inhibitor: PDE4 Inhibitor that increases cAMP levels, leading to a reduction in lung inflammation. Common: Weight Loss, Diarrhea, Nausea, Decrease in Moderate-severe liver impairment Roflumilast Daliresp COPD N PO Appetite, Insomnia, Headache, Influenza (Child Pugh B or C) Serious: Suicidal thoughts Systemic glucocorticoids: cause inhibition of inflammatory response. Suppresses neutrophil migration and decreases inflammatory mediators and reverses capillary permeability. Dexamethasone DexPak N PO, IV, opth Acute: increased appetite, wt gain, Na/H2O retention, PO, rectal, hypokalemia, CNS, indigestion, HTN, hyperglycemia, Relative Potency: Hydrocortisone Cortef, Solucortef N immunosuppression, impaired wound healing, mask Dexamethasone 0.75 mg enema, inj Inflammatory conditions symptoms of infection, acne, myopathy CYP3A4 inx Methylprednisolone 4 mg Medrol, Live vaccines, serious systemic Methylprednisolone (RA, asthma, COPD N PO, inj None Chronic: Cushing (moon face, buffalo hump, somatic Live vaccines Prednisone / Prednisolone 5 mg Solumedrol infections exacerbations, acute gout) muscle wasting), dermal thinning, diabetes, glaucoma, Decreased oral contraceptive Hydrocortisone 20 mg Prednisone Deltasone N PO cataracts, amenorrhea, growth retardation, acne, HPA axis suppression: must taper slowly if receiving pancreatitis, GI bleed/esophagitis/ ulcers, over 10-14 days of therapy osteoporosis/fractures, hirsutism Prednisolone Millipred N PO, opth Xanthine Derivative: Blocks PDE causing increased cAMP, which promotes epinephrine release. The result is bronchodilation CYP1A2 inx Common: Nausea, Vomiting, Insomnia, Tremor, Decreased oral contraceptives Dosing based on ideal body weight Theophylline Theo-24 Asthma, COPD N PO, IV Restlessness Ciprofloxacin Therapeutic range 5-15 mcg/mL Serious: A-fib, Tachyarrhythmia, Seizures Carbamazepine Phenytoin Top Drugs - P2 Fall DKQ 2 Thyroid Hormones: Increases cellular metabolism and plays an important role in growth, development, CNS and bone functions, food metabolism and body temperature Take 30 minutes-1 hour before breakfast Levothyroxine Synthroid N PO, IV Untreated thyrotoxicosis, Common: increased appetite, weight loss, insomnia, Separate 4 hours from antacids, iron, calcium Hypothyroidism Not for weight loss untreated adrenal insufficiency hyperhidrosis supplements Liothyronine Cytomel TSH suppression N PO, IV Serious: menstrual irregularities, heat intolerance Desiccated thyroid Armour thyroid N PO Combination of T3/T4 Antithyroid agents: Inhibit the synthesis of thyroid hormones methimazole preferred in 2nd and 3rd trimesters of Methimazole Tapazole N PO Common: hypothyroidism, GI upset pregnancy Hyperthyroidism Serious: hepatotoxicity, agranulocytosis, hypothrombinemia Preferred antithyroid in first trimester of pregnancy and Propylthiouracil N PO Hepatotoxicity thyroid storm Antihistamine (H1 Receptor Antagonists): Block H1 receptors to decrease the actions of histamine Cetirizine Zyrtec R PO, ODT, soln CNS depression Newborns or premature infants, Anticholinergic agents Diphenhydramine Benadryl Upper respiratory allergies, None PO, soln, inj Fexofenadine (Allegra) alternative antihistamine agent nursing mothers CNS depression urticaria Common: sedation, anticholinergic ADR, HA Levocetirizine Xyzal None PO, soln None ESRD CNS depression (Hydroxyzine: anxiety, Serious: (hydroxyzine: QT prolongation) Loratadine Claritin pruritis) None PO, ODT, soln QT prolonging agents Hydroxyzine HCl Vistaril R PO, soln, inj Early pregnancy, prolonged QT Hydroxyzine Pamoate (Atarax) CNS depression Histamine (H2) Receptor Antagonists: Competitive inhibition of histamine at H2 receptors of the gastric parietal cells, which inhibits gastric acid secretion GERD, heartburn, gastric/ QT prolonging agents Famotidine Pepcid R IV, PO Common: abdominal pain, headache duodenal ulcer, erosive Risedronate DR Serious: altered mental status/ confusion Ranitidine Zantac esophagitis, urticaria R IV, PO Proton Pump Inhibitors: Decreases acid secretion in gastric parietal cells through inhibition of (H+, K+)-ATPase enzyme system, blocking the final step in gastric acid production CYP2C19 inx Clopidogrel Omeprazole Prilosec N PO Atazanavir, Rilpivirine Risedronate DR CYP2C19 inx Pantoprazole Protonix N IV, PO Atazanavir, Rilpivirine Risedronate DR Long term use associated with Vitamin B12 deficiency CYP2C19 inx GERD, erosive esophagitis, Common: abdominal pain, diarrhea and hypomagnesemia Lansoprazole Prevacid N IV, PO Atazanavir, Rilpivirine H pylori treatment Serious: Fracture risk, C. Difficile infection risk Pylera- Bismuth/Metronidazole/Tetracycline used for H. Risedronate DR Pylori CYP2C19 inx Clopidogrel Esomeprazole Nexium H IV, PO Atazanavir, Rilpivirine Risedronate DR CYP2C19 inx Dexlansoprazole Dexilant N PO Atazanavir, Rilpivirine Risedronate DR Osmotic Laxative: An osmotic agent, polyethylene glycol 3350 causes water retention in the stool; increases stool frequency Known or suspected bowel Common: N/D, abdominal fullness, cramping Polyethylene glycol Miralax Constipation N PO obstruction Serious: Dermatitis, rash Stool Softener: draws water into stool, thus softening the stool and achieving ease in bowel movement Docusate Colace Constipation N PO, rectal Intestinal obstruction Common: N/D, abnormal taste Selective 5-HT3 Receptor Antagonist. 5-HT3 receptors are ligand-gated ion channels extensively distributed on enteric of GI tract Constipation, colitis, intestinal Gastrointestinal adverse obstruction, Crohns disease, Common: Constipation, abdominal pain Caution in mild-moderate hepatic impairment Alosetron Lotronex Irritable bowel syndrome N PO reactions; Only for women with severe hepatic impairment, Serious: Ischemic colitis Discontinue when constipation develops severe diarrhea-predominent IBS hypercoagulable state Guanylate Cyclase agonist: Bind and agonize guanylate cyclase-C on the luminal surface of intestinal epithelium. Intracellular and extracellular cyclic guanosine monophosphate (cGMP) Intestinal fluid increases and GI transit time is decreased Constipation Risk of serious dehydration in Common: Diarrhea, abdominal pain, flatulence Linaclotide Linzess IBS with constipation N PO Less than 6yo, GI obstruction pediatric patients Serious: Dehydration Opioid-induced constipation Top Drugs - P2 Fall DKQ 3 Chloride Channel Activator: A chloride channel activator that acts locally on the apical membrane of the gastrointestinal tract to increase intestinal fluid secretion and improve fecal transit Constipation Not approved for males with IBS-C Common: N/V/D, flatulence, abdominal pain Lubiprostone Amitiza IBS with constipation N PO GI obstruction Methylnaltrexone and Naloxegol are alternatives for Serious: Dyspnea, hypotension Opioid-induced constipation opioid induced constipation Ammonium Detoxicant: Bacteria in the colon degrade lactulose into lactic acid resulting in an increase in osmotic pressure and acidification of intestinal contents which softens the stool by promoting stool water content Constipation (Osmotic Enulose, Common: Bloating, diarrhea, flatulence, N/V Lactulose laxative) N PO Alters colonic flora to decrease ammonia production Kristalose Serious: Hypernatremia, hypokalemia Hepatic encephalopathy Dopamine Antagonists: Blocks dopamine receptors and (when given in higher doses) also blocks serotonin receptors in chemoreceptor trigger zone of the CNS; enhances the response to acetylcholine of tissue in upper GI tract causing enhanced motility and accelerated gastric emptying GERD GI obstruction, perforation or Common: Drowsiness, insomnia, Extrapyramidal SSRI/SNRI/TCAs/Antipsychotics Diabetic gastroparesis IV, PO, hemorrhage, history of seizure, symptoms, dizziness (EPS) Metoclopramide Reglan R, H Tardive dyskinesia Hiccups injection use with other drugs causing EPS Serious: Depression, neuroleptic malignant syndrome, CNS depression Nausea/vomiting symptoms tardive dyskinesia QT prolonging agents Other GI agent (sucralfate) :antiulcer activity is the result of formation of an ulcer-adherent complex that covers the ulcer site and protects it against further attack by acid, pepsin, and bile salts. Common: Constipation Sucralfate Carafate Duodenal ulcer N PO Serious: Aluminum toxicity in patients with renal impairment Bowel Prep: Sulfate salts provide sulfate anions, which are poorly absorbed. The osmotic effect of unabsorbed sulfate anions and the associated cations causes water to be retained within the gastrointestinal tract. GI obstruction, Bowel perforation, Common: Discomfort, abdominal distention/pain, N/V Sodium/ Potassium/ Suprep Bowel Kit Colonoscopy prep N PO Gastric retention, Ileus, toxic Serious: Fluid/electrolyte abnormalities, cardiac Hyperkalemia Magnesium colitis arrhythmia, seizure Antidiarrheal (Diphenoxylate/Atropine):Diphenoxylate inhibits excessive GI motility and GI propulsion obstructive jaundice; diarrhea Common: Drowsiness/ sedation, Euphoria, N/V, flushing Diphenoxylate/ associated with Serious: paralytic ileus, toxic megacolon, anaphylaxis, Anticholinergic commercial preparations contain a subtherapeutic Lomotil Diarrhea N PO atropine pseudomembranous enterocolitis hyperthermia, urinary retention, respiratory depression CNS depression amount of atropine to discourage abuse or enterotoxin-producing bacteria (overdose) Antidiarrheal (Loperamide): Acts directly on circular and longitudinal intestinal muscles, through the opioid receptor, to inhibit peristalsis and prolong transit time; reduces fecal volume, increases viscosity, and diminishes fluid and electrolyte loss; demonstrates antisecretory activity children younger than 2 years; Common: dizziness, abdominal pain, constipation, abdominal pain without diarrhea; Loperamide Imodium Diarrhea N PO Torsades and sudden death drowsiness QT prolonging agents OTC products should be used less than 2 days acute dysentery; active ulcerative Serious: Torsades de pointes colitis; bacterial enterocolitis Somatostatin Analog: Mimics natural somatostatin by inhibiting serotonin release and the secretion of gastrin, VIP, insulin, glucagon, secretin, motilin, and pancreatic polypeptide. Decreases growth hormone (GH) and IGF-1 in acromegaly Acromegaly Common: Hyperhidrosis, abdominal pain, headache, Ocphyl Off label: Esophageal sinusitis Octreotide N IV, PO Sandostatin varices bleeding, Serious: Bradyarrhythmia, hyper/hypoglycemia, Sulfonylurea toxicity cholelithiasis Antispasmodic: Block the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS Obstructive disease of GI tract, Severe ulcerative colitis, Common: anticholinergic, lightheadedness Dicyclomine Bentyl Functional bowel/ IBS N PO, IM Glaucoma, Myasthenia gravis, Anticholinergic agents Serious: tachyarrhythmia, psychosis, dyspnea breast feeding, infants