Drug Information 120 0129 PDF

A&D ointment Petrolatum [Diaper rash] - OTC Contains vitamin A & D Note: Refer if <6m or appears serious Absorica, Amnesteem, Clavaris, Myorisan Isotretinoin [PO retinoid] - Severe, nodular acne RxPO: 0.5-1 mg/kg/d divided BID WITH FOOD x15-20w BBW: birth defects (sign consent form + 2 negative tes...

A&D ointment Petrolatum [Diaper rash] - OTC Contains vitamin A & D Note: Refer if <6m or appears serious Absorica, Amnesteem, Clavaris, Myorisan Isotretinoin [PO retinoid] - Severe, nodular acne RxPO: 0.5-1 mg/kg/d divided BID WITH FOOD x15-20w BBW: birth defects (sign consent form + 2 negative tests prior + 2 forms of birth control, no POP). Don't get pregnant a 1m before or after using. AE: eye irritation+dryness, dry skin, chapped lips, ↑TG + BG *Can only dispense if REMS iPLEDGE pharmacy Only 1-month Rx at a time, fill within 7d w/ yellow sticker Abilify, Abilify Maintena IM, Aristada IM Aripiprazole [SGA-Atypical] MedGuide FDA: BPD, schizophrenia, tx-resistant MDD adjunctive, Tourette's syndrome, irritability assoc. w/ autistic behavior Depression: Start 2-5mg po QAM (can ↑ to 15mg/day) Schizophrenia: 10-30mg po QAM - Maintena (IM-monthly) + Aristada (IM q4-8w)- only for BP mania + schizo BBW: ↑mortality in elderly with dementia related psychosis Warnings: neuroleptic malignant syndrome, tardive dys, falls, neutropenia, pathologic gambling & other compulsive behaviors, 3A4 substrate SE: anxiety, insomnia, akathisia, constipation, agitation, dizziness, orthostasis, metabolic issues *less metabolic issues & sedation than other antipsychotics Accolate (I,D) Zafirlukast I: asthma D: 20 mg BID Abreva Docosanol - OTC cream I: herpes labialis Apply 5x daily at first sign of outbreak + cont' until healed Accupril (I,D,BBW,SE) Quinapril [ACEI] I: HTN, HF RxPO: HF target: 20 mg BID BP: 5-40mg QD, max 80 mg/d Renal dose adjust CI: hx of angioedema, within. 36h of ARNI (Entresto) BBW: pregnancy, bilateral renal artery stenosis SE: metabolic acidosis, ↑K+, ↓dry cough + angioedema *Avoid w/ NSAIDs - renal damage ↓Lithium renal CL = ↑Lithium toxicity Accutane, Absorica, Amnesteem, Claravis, Myorisan, Sotret, Zenatane (I,BBW,SE) Isotrentinoin Med Guide, iPLEDGE REMS I: severe acne BBW: pregnancy (2 forms of BC, informed consent) *No pregnancy one month before, during & x1 month after tx *Full effect in 3-5 months *SE: dryness Actonel, Atelvia Risedronate [PO Bisphosphonate] I: Osteoporosis PPX+TX: 5mg QD or 35mg qW (Atelvia) or 150mg monthly (DR) *Atelvia DR requires acidic gut - DNU w/ H2RA/PPIs CI: inability to stand/sit upright for 60min, hypoCa, pts w/ abnormalities of the esophagus Warnings: osteonecrosis of jaw, atypical femur fractures, esophagitis, esophageal ulcers, erosions, renal imp (DNU if CrCl <30) SE: hypoCa, esophagitis, musculoskeletal sxs, dyspepsia, N/V, dysphagia, heartburn *Separate admin from Ca, antacids, Fe, Mg ~2h *Take BEFORE EAT/DRINK QAM w/ 6-8oz water. ATELVIA - take AFTER BKF w/ 4oz water Aciphex Rabeprazole [PPI] MedGuide - TAPER off to avoid acid rebound I: duodenal ulcer, GERD, H. Pylori D: 20 mg QD <4-8 weeks Take WITHOUT regard to MEALS Warnings: C-diff associated diarrhea, hypoMg, ↑incidence of osteoporosis bone fractures w/ high doses or longterm therapy (≥1Y) SE: H/N/D (infrequent) C. Diff, fractures, GI infection, hypomag, VitB12 deficiency *20mg Ome/Rabe/Eso = 15mg Lanso = 40mg Panto Actos (BBW,I,D,SE) Pioglitazone [TZD] MedGuide I: T2DM, ↓A1c 0.5-1.5% RxPO: 15-30mg QD (max 45mg/d) BBW: Can cause/exacerbate HF CI: NYHA Class III/IV HF Warnings: hepatotoxicity, edema, weight gain, risk of fractures, urinary bladder tumors (DNU if active bladder cancer) SE: peripheral edema, weight gain Actiq (D, I) Fentanyl IR transmucosal lozenge Med Guide Only indicated for cancer BTP 200mcg x up to 4 BTP episodes/day. REMS: requires documentation of pt's opioid tolerance with each Rx BBW: mod-strong 3A4 inhibitors ↑ effects; potential med errors when converting between dosage forms Actos (BBW,I,D,SE) Pioglitazone [TZD -PPARgamma agonist] D: 15-30mg QD (max 45mg/d) Med Guide BBW: Can cause or exacerbate HF CI: NYHA Class III/IV HF SE: bladder cancer, edema, weight gain, fractures, hepatotoxicity Adacel, Boostrix Tdap Vaccine 1 booster of either Td or Tdap q10years Store in FRIDGE [2 - 8℃] or [36 - 46℉] Shake prefilled syringe or vial before use. Give IM Recommended in: 1. Pregnant/postpartum women with each pregnancy 2. Close contact of infants <12 months if not up-to-date 3. HCP with direct patient contact, if not up-to-date 4. Children 7-10yo not fully vaccinated with the 5-dose DTaP series; give a single dose of Tdap instead of DTaP 5. Children ≥11yo w/o previous record of TDaP AND who received Tdap between 7-10yo as part of a catch-up schedule 6. A single dose of Tdap for adults ≥65 years *Boostrix: indicated for ≥10yo *Adacel: indicated for 10-64yo Adcirca, Alyq, Cialis (I,D) Tadalafil I: PAH D: 40mg QD? *Advirca, Alyq - PAH RxPO: Daily dosing 2.5-5mg daily On demand dosing: 5-20 mg daily PRN *Start at 10mg, at least 30 min before activity *Start 5mg if >65 years, using an alpha-blocker, using a CYP3A4 inhibitor Renal adjust 30-50mL: 5mg PRN CrCl < 30 mL/min: 5mg PRN Q72H Adalat CC, Procardia XL, Afeditab CR, Nifedical XL Nifedipine ER [DHP-CCB] I: HTN, angina RxPO: 30-90 mg/d DOC for pregnancy CI: CHF, DNU w/ BB if acute MI (AV block + bradycardia) SE: reflex tachycardia, HA, flushing, edema DDI: Major 3A4 substrate - avoid grapefruit Adderall, Adderall XR (ER cap), Mydayis (ER cap) Dextroamp. + Amphetamine IR+ER C-II [Stimulant] Med Guide I: ADHD, narcolepsy RxPO: 5mg QAM or BID (max 40mg/d) BBW: abuse/dependence, misuse can cause sudden death + serious CV events CI: within 14d of MAOi Warnings: exacerbate mania, ↑seizure risk, loss of appetite AEs: N, insomnia, HA, irritability, blurry vision, dry mouth Monitor: ECG prior, BP, HR, height, weight AAP not recommend IR for ≤ 5YO (approved for ≥3Y) Acidic foods can ↓ amphetamine levels Adasuve (inhalation), Loxitane (po) (I, REMS, CI, M) Loxapine (oral inhalation, po) I: Acute tx of agitation associated with schizophrenia or BPD REMS: Serious bronchospasm (↓FEV1 persists over 24H in asthma/COPD pts) CI: asthma/COPD, current inhaler use, acute respiratory sx (wheezing) Oral inhalation must be administered in an enrolled health care setting by HCP *Monitor breathing Q15min x1 hour Adipex-P, Lomaira tab Phentermine [Appetite suppressant] - C-IV I: For BMI ≥30 kg/m2 or ≥27 kg/m2 w/ risk factors (DM, HLD, controlled HTN) Available as cap, tab, ODT RxPO: 15-37.5 mg PO QD, BEFORE/AFTER BKF Lomaira: 8 mg 3 times daily Qsymia (+ topiramate) CI: CV disease, hyperthyroidism, glaucoma, pregnancy/ breast feeding, hx of drug abuse, agitated state, within 14d of MAOi Warnings: PPHTN, Valvular heart disease, HF, CNS effects AE: tachycardia, agitation, ↑BP *Use short term, up to 12 weeks Adlyxin (I, W, SE, D) Lixisenatide [GLP1 agonist] T2DM, ↓A1c 0.5-1.5% RxInj: 10mcg SC WITHIN 60MIN OF MEALS x14days then ↑ to 20mcg daily Fridge + Protect from light *After open @RT/Fridge x14d* Warnings: pancreatitis; avoid in severe GI dz, including gastroparesis eGFR <15: not recommended Adlyxin - Pens needles not provided Advil (I,Dmax) Ibuprofen Advil, Caldolor, Motrin IB, NEoprofen I: analgesia RxOTC: 200-400mg Q4-6H (Max 1.2 g/day) Rx: 400-800 mg Q6-8 H (max 3.2 g/day) Peds: 5-10 mg/kg/dpse Q6-8H (max 40mg /kg/dau) OTC limit is <10 days SEvere skin reaction D: 200-800mg TID-QID (max: 3200mg/d) Adlyxin (I, W, SE, D) Lixisenatide GLP 1 aognist -> pancreatitis (no boxed warning for byetta and adylxin) for rosk of thyroid c-cell carcinoma T2DM, ↓A1c 0.5-1.5% W: pancreatitis; avoid in severe GI dz, including gastroparesis SE: nausea, weight loss 10mcg SC daily within 60min before BF x14days then ↑ to 20mcg daily eGFR <15: not recommended *needles needs to be purchased Afinitor, Zortress Everolimus [mTOR kinase inhibitor] I: transplant, cancer (Afinitor) SE: peripheral edema, HTN, DNU within 30d of transplant *3A4 substrate Advair (I,D) Fluticasone/salmeterol I: asthma/COPD RxDPI: 1 inhalaiton BID B/g Advair Diskus, Wixela Inhub Afluria Quadri, Fluarix Quadri, FluLaval, Fluzone Quadri, Flublok, Flucelvax, Fluzone Intradermal, FluMist Quadrivalent Inactivated Flu (Two A + two B) Store in FRIDGE [2 - 8℃] or [36 - 46℉] *Flucelvax - age ≥ 4Y, has latex *Flublok - age ≥ 18Y, no eggs *Fluzone - age ≥ 6m (MultiDV) or ≥ 3Y (prefilled syringe) *Fluzone ID - for 18-64Y, smaller needle, but ↑local rxns *FluMist - healthy people b/w 2-49Y, live, give 0.2mL divided b/w two nostrils Afluria, Fluvirin, Fluzone HD, Fluad Trivalent Inactivated Flu (Two influenza A + one B) Store in FRIDGE [2 - 8℃] or [36 - 46℉] Give IM annually *Afluria - age ≥ 9Y (needle); 18-64Y (jet injector) *Fluvirin - age ≥ 4Y, has latex *Fluzone HD - age ≥ 65Y, has 4x antigen dose *Fluad - age ≥ 65Y, has MF59 adjuvant to ↑immunity Aldomet Methyldopa [Alpha2 Agonist] - only PO RxPO: 250 - 1,000 mg divided BID (max 3,000 mg/day) Renal adjustment recommended DOC in pregnancy SE: DILE (lupus), hepatitis, hemolytic anemia Caution: bradycardia, dry mouth, fatigue, depression, psych rxns, impotence, rebound HTN, Edema, sedation Must taper off Aggrenox Dipyridamole + ASA [AntiPlatelet] - Only generic I: TIA/stroke prevention RxPO: 200mg/25mg BID SE: HA, diarrhea Warnings: Hypotension Aldomet (D,SE) Methyldopa [Alpha2 Agonist] RxPO: 250 mg BID-TID; max dose is 3g daily DOC in pregnancy SE: DILE (lupus), hepatitis, hemolytic anemia Caution: bradycardia, dry mouth, fatigue, depression, psych rxns, impotence, rebound HTN Must taper off Aldactone, CaroSpir (Suspension) Spironolactone [Aldosterone Antagonist/K+ sparing] I: HF (↑survival in EF <35%), HTN (resistant HTN), ascites HF target: 50 mg/d divided QD-BID ?HF target: 25mg QD-BID? HTN dose: 25-100 mg QD *Take WITH FOOD to ↑ absorption + ↓GI effects *Nonselective - blocks androgen - To start; Scr ≤2.5 mg/dL M and ≤2 mg/dL F or eGFR >30 and K <5 mEq/L Warnings: hyperkalemia, gout, gynecomastia SE: ↑ K+, ↓ Ca2+, gout, irregular menses, impotence, breast tenderness (d/t androgen block) CI: hyperkalemia *Suspension is not therapeutically equivalent to tablets Renal dose adjust **↑survival, manage edema, ↓hospita. in NYHA III-IV Alka-Seltzer Na bicarbonate + ASA + citric acid [Antacid] - OTC Onset: < 5m, Duration: 30-60 min Use 30 MIN AFTER MEAL Mix 2 tablets with 120 mL H2O Allegra (I,D) Fexofenadine I: upper resp. allergy D: 60mg BID (max 120mg/d) or 180mg QD Alora, Climara, Vivelle-Dot, Estraderm ClimaraPro, Combi-Patch Estrogen patch I: HRT in WOMEN WITHOUT UTERUS Vivelle / Alora: apply twice weekly Climara: once weekly ClimaraPro / Combi-Patch: has progesterone BBW: endometrial cancer, dementia, ↑risk of VTE + Stroke, breast cancer CI: breast cancer, uterine bleeding, active VTE, pregnancy Warnings: ↑risk of breast cancer, ↑TG + HDL Counseling: apply to lower abdomen, below the waistline. Do not apply to breast CombiPatch - Fridge or RT x6m Aloprim, Zyloprim (I,W,SE,D) Allopurinol - XO inhibitor, ↓ UA production I: Chronic management of gout (ppx of future attacks) W: HLA-B*5801 testing in Asians: ↑risk of SJS; BM suppression, hepatotoxicity SE: Rash, acute gout attacks, nausea, diarrhea, ↑LFTs Start: 100mg po once daily after a meal (to ↓nausea) ↑by 100mg/day q2-5wks until UA <6mg/dL *doses >300mg should be divided BID *max 800mg/day Ppx for acute gout flares (NSAIDs or colchicine) recommended for first 3-6 months Aloxi Palonosetron [5HT3 R-antagonist] I: CINV CI: DNU w/ apomorphine = Apokyn (severe hypoTN). Warnings: serotonin syndrome SE: HA, constipation *Apokyn = DA promoter; treats loss of muscle movement control in PD Alora, Climara, Delestrogen, Divigel, Dotti, Elestrin, Estrace, Evamist, Femring, Minivelle, Vivelle-dot (BW) Estradiol BBW: endometrial cancer, CV disease, breast cancer, dementia I: vasomotor sx of menopause including hot flashes & night sweats Altace (I,D,BBW,SE) Ramipril [ACEi] I: HTN, HF RxPO: 2.5-20 mg QD HF target: 10mg QD ?5 mg BID? Renal dose adjust CI: hx of angioedema, within. 36h of ARNI (Entresto) BBW: pregnancy, bilateral renal artery stenosis SE: metabolic acidosis, ↑K+, ↓dry cough + angioedema *Avoid w/ NSAIDs - renal damage ↓Lithium renal CL = ↑Lithium toxicity Altoprev ER Lovastatin [Statin] RxPO: 20-80mg WITH FOOD + IR w/ PM meal *Altoprev ER take qHS *Max 20-40mg QD w/ 3A4 inhibitors (CCBs, amiodarone, danazol (androgen)) CI: Pregnancy, breastfeeding, active LD (↑ LFTs), strong 3A4 inhibitors Warning: rhabdomyolysis, myopathy (↑risk w/ age ≥65Y + 3A4 inhibitors + niacin), hepatotoxic AEs: myalgias, arthalgias, myopathy (w/ Colchicine) Monitor: LFTs + lipid panel @baseline + 4-12 weeks after Avoid with gemfibrozil + niacin ≥ 1g Amaryl Glimepiride [SU] I: T2DM, ↓A1c 1-2% RxPO: 1-2mg WITH BF (max: 8mg/d) SE: hypogly, weight gain, N, hemolytic anemia in G6PD deficiency CI: DKA, sulfa allergy On Beers List XL Formulation - OROS system - ghost cap AmBisome Liposomal amphotericin B [Antifungal] - IV RxIV: 3-6 mg/kg/day D5W only SE: infusion-reactions (fever, chills, HA, malaise, rigors), ↓K, ↓Mg, nephrotoxicity ↓Risk of infusion reactions + nephrotoxicity Ambien, Edluar, Intermezzo Zolpidem C-IV [Non-BZDP Re. Agonist] - insomnia MedGuide DNU w/ fatty food (increases sleep onset), heavy meal or alcohol *For middle of night awakenings*. Ambien: 5-10 mg PO QHS, max 5mg in females + elderly ?IR/SL: 5mg (♀/elderly) QHS or 5-10mg ( ) CR: 6.25mg (♀/elderly) QHS or 6.25-12.5mg ( )? BBW: complex sleep behaviors (sleep-walking, driving, etc. -D/C if occurs) Warnings: CNS depression, abuse + dependence potential SE: somnolence, ataxia, dizziness, parasomnias, Preferred over BZDPs AmBisome (Use, BBW, SE) Liposomal Amphotericin B Used as initial tx for many invasive infxns including Cryptococcal meningitis, histoplasmosis, mucormycosis BBW: Death d/t errors confusing lipid based (AmBisome, Abelcet) & conventional deoxycholate→ max 1.5mg/kg/day, requires pre-med *verify product name/dose if >1.5mg/kg/day *OD can cause cardiopulmonary arrest SE: infusion-rxns; thrombophlebitis, ↓K, MG, nephrotoxicity Injection: 3-6mg/kg/day Amitiza Lubiprostone [IBS, CIConstipation, Opioid I.Const] RxPO: 24 mcg BID WITH FOOD IBS w/ constipation: 8 mcg BID (females ≥18 YO) *Dose adjust in CP Class B and C Amoxil Amoxicillin [B-Lactam] TAB + CAP + SUSP q8-12h DOC: acute OM, H.Pylori, Endocarditis Take WITH FOOD + Refrigerate *Ok @ room temp ~14days Renal metabolism Amrix, Flexeril, Fexmid Cyclobenzaprine [Muscle relaxant] TAB + CAP IR 5-10mg TID / ER 15-30mg QD AEs: sedation, dizziness, confusion, dry mouth Warnings: Serotonergic, DNU w/ other 5HT drugs Analgesic - similar to Tizanidine & Baclofen *Additive CNS depression w/ alcohol, opioids, BZDPs Amphojel, DermaMed (I) Aluminum hydroxide I: antacid, skin protectant Anafranil (BW,I,SE) Clomipramine (TCA, 3° amine) MedGuide, suicidality BBW I: OCD RxPO: No dose SE: QT prolongation (fatal arrhythmias w/ OD), orthostasis, tachycardia, anticholinergic effects, vivid dreams, weight gain, sedation, sweating, muscle twitching (toxicity sx), ↑fall risk Amphoterin. B Deoxycholate AmphoB [Antifungal] - INJ RxIV: 0.1 - 1.5 mg/kg/d BBW: Doses > 1.5 mg/kg/d → cardiopulmonary arrest SE: infusion-reactions (fever, chills, HA, malaise, rigors), ↓K, ↓Mg, nephrotoxicity Premedicate: 30-60min prior w/ APAP/NSAID, diphenhydramine and/or hydrocortisone Ancef, Kefzol Cefazolin [1st gen] - IV + IM C: Staph, Strep, PEK (Proteus, E.coli, Klebsi) DOC: surgical ppx Renal metabolism + toxicity, dose adjust CrCl Ancobon (use, BBW, SE) Flucytosine (5-FC) Rx: 50-150 mg/kg/day PO divided Q6H CrCl <= 40 mL/min Used with amphoB for invasive Cryptococcal meningitis or Candida infxns BBW: Extreme caution in pts with RI, monitor hematologic, renal & hepatic status closely SE: myelosuppresion (dose related), ↑Sc, BUN, hepatitis, ↑bilirubin, many CNS effects, hypoglycemia, ↓K Antabuse (BW,I,D) Disulfiram BW: alcohol intoxication I: alcohol use disorder D: up to 500mg QDx1-2wks; MD 250mg QD (max 500mg/d) AndroGel Gels: apply at same time each morning; flammable until dry. ⋄1% - upper arms, shoulders and/or abdomen ⋄1.62% should only be applied to upper arms or shoulders (not the abdomen) BBW: secondary exposure to testosterone in children can occur causing virilization; children should avoid contact w/ any unwashed or unclothed application sites CI: breast/prostate cancer, pregnancy, breast-feeding W: ↑ risk of breast/prostate ca, CV events, VTE, dyslipidemia, gynecomastia HI, priapism, may worsen BPH SE: ↑ appetite, ↑ Scr, sensitive nipples, acne, edema, hepatotoxicity, ↓ sperm count Antara, Tricor, TriLipix Fenofibrate [fibrate] I: high TG Multiple products = multiple doses *Fenoglide/Lipofen take WITH MEALS Renal dose adjust CI: hepatic severe LD (incl. primary biliary cirrhosis),, or severe renal dysfunction CrCl <30mL/min, gallbladder disease Warnings: myopathy (↑risk w/ statins) *DNU w/ statins or ezetimibe SE: dyspepsia (indigestion) *Can ↑LDL if TG are high AND ↑effects of SU+warfarin Androgel 1%, 1.62%, Fortesa 2%, Testim 1% Testosterone gel [C-III] Medguide I: hypogonadism (HRT for males), sexual dysFXN in M+F, hot flashes in females Counseling: Apply to upper arms, shoulders, and/or abdomen. Apply same time each morning. BBW: secondary exposure in children SE: acne, edema, hepatotoxicity, male infertility, ↑appetite, worsen BPH, prostate/breast cancer, hyperlipidemia, aggression, stroke, heart attack Withdrawal sxs: depression, fatigue, ↓appetite, ↓libido, insomnia PO testosterone not recommended d/t hepatotoxicity (Androxy, Android, Methitest, Testred, Jatenzo) - dosed QD Apidra Glulisine [Rapid acting insulin]. Give 15MIN BEFORE/IMMEDIATELY AFTER MEAL Refrigerate; stable at room temp for 28 days CI: acute hypoglycemia Warnings: hypoBG, hypokalemia SEs: weight gain, lipodystrophy Aplenzin, Forfivo XL, Wellbutrin SR/XL (BW,I,D) Bupropion BW: suicidality/antidepressant I: MDD, SAD, smoking cessation D: IR= 100mg BID (max 450mg/d); 12H ER(SR)= 150mg QAM (max 200mg bid); 24H ER= 150mg QAM (max 450mg QD) Apriso ER 24H, Delzicol DR, Pentasa ER Asacol HD DR, Lialda DR Rowasa rectal kit, SfRowasa enema Canasa supp Mesalamine ER [Aminosalicylates] I: UC induction + maintenance Induction PO 6-8wks, Rectal 3-6wks Canasa: Suppository (retain ≥1-3H) Rowasa: Enema (retain ≥30min) Asacol HD, Lialda: ER tabs Apriso, Delzicol, Pentasa: ER caps CI: HSR to salicylates or aminosalicylates *Rectal more effective for distal disease/proctitis UC Counseling: suppositories/enemas stain fabric, flooring, painted surfaces, marble, granite, vinyl & enamel *Asacol HD - Ghost tablet in feces Apokyn Apomorphine [DA - Rescue movement agent] I: PD (off episodes) Rx: SQ 0.2mL (= 2mg) (max 0.6ml) CI: DNU w/ 5HT3 antagonists (ondansetron) d/t severe hypotension + loss of consciousness SE: severe N/V, hypotension hallucinations, impulse control disorder, orthostasis, priapism, somnolence Notes: give Tigan 300mg TID for emesis prevention Aptivus Tipranavir (PI) - BID WITH FOOD w/ Norvir BID **DNU w/ any other PIs - Sulfa allergy Apresoline Hydralazine [Direct Vasodilator] - generic only I: HTN RxPO: 100-200 mg/d divided QID SE: DILE (with doses >200 mg/day) AEs: HA, hypotension, reflex tachycardia, palpitations, peripheral neuritis Combo tab: + Isosorbide dinitrate (BiDil) Aranesp Darbepoetin alfa [ESA] - Anemia Med Guide CKD: 0.45 mcg/kg IV/SC WEEKLY Cancer: 2.25 mcg/kg SC WEEKLY or 500mcg Q3W *T1/2 is 3x longer than EPO - give weekly Refrigerate + protect from light + MD vials x21d *DO NOT shake BBW: ↑death, MI, stroke, VTE, thrombosis, and tumor progression. use lowest effective dose to ↓ blood transfusions CKD: ↑death when Hgb > 11 g/dL Warning: HTN -Cancer: tumor progression or recurrence; not indicated when anticipated outcome is cure; d/c when chemo completed -CKD: ↑MACE when Hgb >11 -Peri-surgical: DVT ppx recommended d/t ↑DVT risk CI: uncontrolled HTN; IV route recommended for pts on HD Monitor: H/H, TSAT, serum ferritin, BP IV route for HD patients *I: CKD or Cancer (on chemo) when Hgb <10 *IV/SC: given every 1-4 weeks (t½ ix 3x longer than epoetin alfa). *Titrate based on Hgb levels; do not ↑ dose more frequently than once every 4wks. Arcapta Neohaler (I,D) Indacaterol I: COPD D: 1 cap inh QD Armour Thyroid Desiccated thyroid I: Hypothyroidism RxPO: 60-120 mg QD Warnings: ↓dose if CVD (pts are predisposed to CAD), ↓BMD Monitor: TSH levels + clinical sxs q4-6w until normal levels *Less predictable potency + stability Normal TSH: 0.3 - 3 mIU/L *Natural porcine-derived thyroid with both T3 & T4 *Not preferred, but some feel better using it BBW: thyroid supplements are ineffective & potentially toxic when used for obesity or weight loss, esp. if euthyroid; high doses ↑ risk of serious or life-threatening effects esp. with anorectic drugs (e.g. sympathomimetic amines) CI: uncorrected adrenal insufficiency SE: ↓BMD; If dose too high: ↑HR, palpitations, sweating, wt loss, arrhythmias, irritability Donepezil [Acetylcholinesterase inhibitor] (tablet, ODT) I: Alzheimer's RxPO: 5mg QHS can titrate to 10mg QHS **Can ↑ to 10mg after 4-6wks; up to 23mg after >3months on 10mg Give QHS to ↓N ODT has ↓GI side effects Warnings: bradycardia, fainting, QT prolongation SE: insomnia, N/V, tremors, wt loss If stable, can switch to Namzaric (Donepezil + Memantine) Asmanex (I,D) Fondaparinux (SQ/IV) I: acute DVT/PE, VTE ppx DVT Ppx: ≥50kg: 2.5mg SC daily | <50kg: CI DVT Tx: >100kg: 10mg SC daily | 50-100kg: 7.5mg | <50kg: 5mg BBW: spinal/epidural hematomas CI: CrCl <30, active major bleed, bacterial endocarditis SE: bleeding, injxn site rxns (rash, pruritus, bruising) thrombocytopenia, hypokalemia, hypotension Monitor: Anti-Xa levels (3H post-dose-peak), PLT, H/H, SCr - Anti-Xa: 1.2 to 1.26 mg/L Store at room tempe Do not expel air bubble prior to injection. Store at room tempe Arixtra Artane (I,D) Mometasone I: asthma D: 2 inh BID Aricept Trihexyphenidyl I: drug induced EPS, PD D: 1mg/d (upto 5-15mg/d 3-4 divided doses) Atacand Candesartan [ARB] - HTN, HF HF Target: 32mg QD CI: hx of angioedema BBW: pregnancy, bilateral renal artery stenosis SE: metabolic acidosis, ↑K+, ↓dry cough + angioedema ↓Lithium renal CL = ↑Lithium toxicity Hepatic dose adjust *Avoid NSAIDs - renal damage Atralin, Renova, Retin-A Micro, Retin-A Tretinoin [Topical retinoid] - Acne Effects take 4-12 weeks Warnings: Avoid in pregnancy/breastfeeding Counseling - limit sun exposure, apply qPM about 20min after washing face, use pea-sized amount *Retin-A Micro - slower release has less skin irritation d/t microsphere gel formulation *Adapalene (Differin) OCT gel 0.1% Atarax (ROA,I,D,SE) Hydroxyzine HCl (IM/PO) I: antiemetic D: Im 25-100mg/d SE: CNS depression, QT risk RxPO: 25mg TID-QID Atripla Efavirenz + TDF + Emtricitabine *Take on EMPTY STOMACH + bedtime (drowsiness) Efavirenz: CNS effects Ativan Lorazepam C-IV [BZDP] MedGuide I: anxiety (UN-CLAD), seizures, ICU agitation/sedation, alcohol withdrawal , insomnia IM/IV/PO: 0.5-2mg Q4-6H PRN (max 10mg/d) BBW: concomitant use opioids = resp. depression Warnings: anterograde amnesia, CNS depression, paradoxical rxns (hyperactive/aggression, abuse potential, pregnancy D SE: somnolence, dizziness, ataxia *Not extensively metab. by liver (LOT) - pref in elderly Antidote: Flumazenil **Injxn doses as low as 1mg/kg/d can cause propylene glycol toxicity (acute renal failure & metabolic acidosis) Atrovent (I,D) Ipratropium I: COPD D: 2 inh QID Augmentin Amoxicillin + Clavulanate [B-Lactam] TAB + SUSP (IR + ER) DOC: acute OM, H.Pylori, Endocarditis Take WITH FOOD + Refrigerate *Ok @ room temp ~14days C: MSSA, B.fragilis + all other populars (except Moraxella) Renal metabolism Avapro Irbesartan [ARB] - HTN, diabetic nephropathy HTN: 150-300mg QD (start 75mg if volume depleted) DN: 300 mg QD CI: hx of angioedema BBW: pregnancy, bilateral renal artery stenosis SE: metabolic acidosis, ↑K+, ↓dry cough + angioedema ↓Lithium renal CL = ↑Lithium toxicity Austedo (I,D) Deutetrabenazine I: Huntington dz, tardive dyskinesia D: 6mg BID (max 48mg/d) Aveed Testosterone undecanoate - IM Long acting Rx: IM q4w x2 doses, then q10w REMS - d/t anaphylaxis and serious pulmonary oil microembolism Avandia Rosiglitazone [TZD] Med Guide I: T2DM, ↓A1c 0.5-1.5% RxPO: 4-8mg QD (max 8mg/d) BBW: Can cause/exacerbate HF, ↑ risk of MI CI: NYHA Class III/IV HF SE: edema, weight gain, HF, fractures, hepatotoxicity, ovulation in premenopausal women Avelox, Vigamox Moxifloxacin [FQ] - TAB + IV (1:1 conversion) Medguide *Avoid use w/ antacids + sun exposure Moxi IV (Avelox)- DO NOT refrigerate Vigamox - bacterial conjunctivitis DDI: separate ≥4hr before/ ≥8hr after Mg, Al, Fe, Zinc, Mis, antacids, ↑AC effects (monitor INR w/ warfarin) AE: photosensitivity, dizzy + drowsy, QT prolongation, ↓BG BBW: tendon inflammation/rupture, peripheral neuropathy, CNS effects, exacerbation of myasthenia gravis DNU in UTIs - do not achieve adequate [ ] in the urine Avodart Dutasteride [5Alpha Reductase Inhibitor] I: BPH RxPO: 0.5mg QD CI: women of childbearing age, pregnancy X, children SE: impotence, ↓libido, ejaculation disturbances, breast enlargement + tenderness *TX for 6m or more for max efficacy *DO shrink prostate + ↓PSA levels *Dutasteride + Tamsulosin = Jalyn *Dutasteride + Alfuzosin = Afdura Azo, Uristat, Pyridium Phenazopyridine - PO I: Dysuria (painful urination), UTI sxs relief RxPO: 200mg TID x2d OTC-PO: 99.5mg TID x2d CI: renal insufficiency AE: Red-orange urine discoloration, acute renal failure Axid (Rx), Axid AR (OTC) Nizatidine [H2 R-antagonist] - generic only I: GERD, GI ulcer, H. pylori (off-label) Onset: 1h / Duration: 4-10h Warnings: confusion (elderly, ill, renal impairment) CrCl < 50 ↓ dose *Tab + solution ?150mg po BID x12wks? Azulfidine, Sulfazine Sulfasalazine [Aminosalicylates] I: UC, RA, spondylitis, Crohn's Disease (off-label) RxPO: 4-6 g/day WITH FOOD to ↓GI upset + H2O to ↓risk of kidney stones. CI: sulfa allergy + salicylate allergy SE: report rashes, yellow-orange skin/urine, ↓folate absorption, photosensitivity Azactam Aztreonam [Monobactam] - IV only C: StrepV + StrepPn + Neisseria + Enteroc. + Pseudomas *Rescue drug for AG nephrotoxicity Renal metabolism + toxicity, dose adjust CrCl Bactocill Oxacillin [Penicillinase-resistant PCN] IV only DOC: SSTIs, Endocarditis, Bone + Joints infections C: MSSA, Strep, Neisseria (Gram- cocci) NO renal adjustment Bactrim, Septra Sulfamethoxazole + trimethoprim - TAB + SUSP + IV - D5W only With ≥8oz WATER+FOOD to prevent kidney stones + GI upset IV - Stable at room temp ≤6h + DNRefrigerate Protect from light if undiluted AE: photosensitivity, ↑K+ CI: Pregnancy cat. D (malformations) Sulfa Allergy = rash (SJS) Renal adjust ?-SS: 400mg SMX/80mg TMP -DS: 800mg SMX/160 mg TMP CI: sulfa allergy, pregnancy/bf, folate deficiency anemia, severe RI/HI, <2months old Warnings: G6PD def; Blood dyscrasias; SJS/TEN, TTP; Teratogenic *Mod-strong CYP2C8 and 2C9 inhibitor SE: -crystalluria, photosensitivity hemolytic anemia, hyperkalemia? UTI dosing: 1 DS tab BID x 3 days Bayer, Bufferin, Ecotrin Aspirin [COX1+2 Irreversible inhibitor] I: stroke ppx (1° + 2°) RxPO: 50-325mg QD CI: NSAID/salicylate allergy, children/teenagers w/ viral infection (Reye's syndrome) Warnings: bleeding SE: dyspepsia, heartburn, N *Yosprala (+omeprazole) - pts @risk of ASA-associated gastric ulcers Bactroban Mupirocin [Burns] - RX *Good staph + strep coverage, used for MRSA nasal colonization too Benadryl (I,D) Diphenhydramine (PO/IM/IV) I: allergy, cold, motion sickness, uritcaria D: 25mg Q4-6H or 50mg Q6-8H Baxdela Delafloxacin [FQ] - IV + PO Medguide Can be used for MRSA *Avoid use w/ antacids + sun exposure DDI: separate ≥2hr from Mg, Al, Fe, Zinc, Mis, antacids,↑AC effects (watch for ↑INR w/ warfarin) Renally adjust - DNU in ERSD (eGFR < 15) AE: photosensitivity, dizzy + drowsy, ↓BG BBW: tendon inflammation/rupture, peripheral neuropathy, CNS effects, exacerbation of myasthenia gravis Benemid Probenecid [Uricosuric] I: gout ppx (↑ UA excretion) RxPO: 500 mg QD ?(max 2g/d)? *Avoid in CrCl <50 Warnings: Sulfa drug Must have adequate renal function Probenecid ↓ renal CL of other meds: - Beta lactams: PCNs/Cephs/Carbapenems - Methotrexate - Salicylates Benicar, (I,D,BBW,SE) Olmesartan [ARB] I: HTN, HF RxPO: 40mg po qd CI: hx of angioedema, within. 36h of ARNI (Entresto) BBW: pregnancy, bilateral renal artery stenosis SE: spruce-like enteropathy, metabolic acidosis, ↑K+, ↓dry cough + angioedema -SLE = severe/chronic diarrhea w/weight loss, abd pain, fatigue, bloating, N/V, anemia *Avoid w/ NSAIDs - renal damage ↓Lithium renal CL = ↑Lithium toxicity Bepreve Bepotastine eye drops 2nd gen antihistamine Benlysta Belimumab [IgG1 MaB] - Lupus Med Guide I: SLE (biologic DMARD) Rx: 200mg SC weekly or 10mg/kg IV q4w ?D, IV: 10mg/kg IV q2wks x3 doses then q4wks D, SC: 200 mg SC once weekly? Warnings: infections, DNU w/ other biologics or live vaccines ? serious/fatal infxns, PML, acute hypersensitivity rxns, malignancy, psychiatric events, do not give with other biologic DMARDs or live vaccines? Betapace (I,D,SE) Sotalol [Class III block K+ channels + BB] RxPO: 160mg PO BID; CrCl <60: ↓frequency BBW: Initiate/↑dose in hospital w/ cont ECG monitoring; dose interval adjusted per CrCl to ↓QT prolongation (risk related to concentration) CI: QTc >450 msec, bronchospastic condition, CrCl <40, K <4 SE: bradycardia, fatigue, bronchoconstriction, HF Bentyl Dicyclomine [Antispasmodic] I: D w/ IBS RxPO: 10mg AC and QH Warnings: anticholinergic (caution if ≥65Y), toxic megacolon, paralytic ileus SE: N and dizziness, anticholinergic effects (dry mouth, dry eyes, constipation, urinary retention, blurred Vision) Betoptic Betaxolol [B-Blocker] - ↓aqueous humor production I: glaucoma CI: asthma/COPD, HR<55, CHF, depression, MG SE: bronchospasm, bradycardia, ↓BP & libido, CNS depression Biaxin Clarithromycin [macrolide] - TAB + SUSP Biaxin XL - take WITH FOOD PO: 250-500mg Q12H or 1g XL daily AltPO: IR 500mg BID Warnings: -QT prolongation -Hepatotoxicity -Major CYP3A4 inhibitor -Caution in pts with CAD CI: hepatic dysfxn w/ prior use;current lovastatin or simvastatin use; colchicine in RI/HI; h/o QT prolongation or ventricular arrhythmias AE: metallic taste Hepatic metabolism - 3A4 + 1A2 strong inhibitor Renal adjustment - CrCl < 30mL/min ↓dose by 50% DNU: pregnancy, hx of QT prolongation or arrhythmia, or w/ simvastatin *DO NOT refrigerate reconstituted oral suspension- thickens + bitter Blocadren Timolol [Nonselective BB] RxPO: 10-30 mg BID BBW: Do not stop abruptly CI:↓HR, heart block - Monitor w/ diltiazam, verapamil, clonidine, digoxin, amiodarone Caution: DM (worsen BG + mask ↓BG) + COPD/asthma SE: ↓HR, hypoTN, depression, ↓libido, fatigue, dizziness Timoptic - opthalamic solution Biktarvy Nystatin [Antifungal] - SUSP+tab Oral Candidiasis: QID swish in mouth, retain several min, swallow. Bio-Statin Terbutaline BW: prolonged tocolysis (avoid in prego) I: ashtma D: 5mg TID PO; 0.25mg SQ/dose Brethine (PO/SQ) (BW,I,D) Bictegravir + TAF + Emtricitabine Bictegravir DNU if CrCl < 30 and severe hepatic impairment Boniva Ibandronate [Bisphosphonate] MedGuide I: Osteoporosis PO PPX+TX: 150mg monthly (stay upright x60min) INJ: 3mg IV q3m *pref if risk of esophageal cancer* CI: inability to stand/sit upright for 60min, hypoCa, pts w/ abnormalities of the esophagus Warnings: osteonecrosis of jaw, atypical femur fractures, esophagitis, esophageal ulcers, erosions, renal imp (DNU if CrCl <30) SE: hypoCa, esophagitis, musculoskeletal sxs, dyspepsia, N/V, dysphagia, heartburn *Separate admin from Ca, antacids, Fe, Mg ~2h *Take BEFORE EAT/DRINK QAM w/ 6-8oz water. Brevibloc Ticagrelor [P2Y12 reversible inhibitor] I: ACS RxPO: LD 180mg + MD 90mg BID x1Y, then 60mg BID BBW: ASA MD >100mg ↓Ticagrelor effectiveness, avoid in severe hepatic impairment SEs: bleeding, dyspnea Counseling: Tablets can be crushed & mixed w/ water to be swallowed or given via NG tube. *Major 3A4 substrate, avoid strong inducers/ inhibitors Brillinta Bumex Esmolol [β1-Blocker] *IV only for HTN emergency BBW: Do not stop abruptly to avoid acute tachycardia, HTN and/or ischemia CI:↓HR, heart block diabetes, asthma/COPD - Monitor w/ diltiazam, verapamil, clonidine, digoxin, amiodarone Caution: DM (worsen BG + mask ↓BG) + COPD/asthma SE: ↓HR, hypoTN, depression, ↓libido, fatigue, dizziness, dyslipidemia, weight gain, fluid retention, Bufferin Aspirin [COX Irreversible inhibitor] PO: 81, 162mg, 325 mg Caution: Reye's Syndrome pts < 16Y, overdose sxs include tinnitus S/sx: lethargy, vomiting, sleepiness Pregnancy C/D Bumetanide [Loop] - HF edema only RxPO: 0.5-1mg po BID ?RxPO: 1mg po bid? CI: sulfa allergy Warnings: ototoxicity, nephrotoxicity, hyperUA SE: metab. alkalosis, ↓K+, Na+, Mg2+, Ca2+, BMD, ↑BG, TG, Chol, UA *IV: Ototoxicity and avoid use w/ aminoglycosides Equivalency: BTFE = 1:20:40:50 Torse 20mg = bume 1mg = furo 40mg = ethacry 50mg BuSpar (Generic only) Buspirone [5HT1 Partial Agonist] I: GAD (takes 2-4 weeks) RxPO: 10-15mg/d BID-TID (max 60mg/d) Warnings: DNU w/ MAOi or within 14d SE: akathisia (restlessness), CNS depression, serotonin syndrome No potential for abuse/withdrawal *Take w/ or w/o food, but be consistent Butrans, Suboxone, Belbuca Buprenorphine [C-III] Med Guide + REMS Butrans - patch; Change weekly, apply to upper outer arm, fold & flush Suboxone - +naloxone Belbuca - buccal film Exenatide ER [GLP1 agonist] Bydureon, Bydureon BCise MedGuide T2DM, ↓A1c 0.5-1.5% RxInj: 5 mcg SC BID WITHIN 60MIN OF MEALS x1month; then can ↑ to 10 mcg SC BID Fridge + Protect from light *After open @RT/Fridge x30d* Warnings: pancreatitis; avoid in severe GI dz (inc. gastroparesis) SE: nausea, weight loss *Discard pen after 30days *ESRD or CrCl <30: not recommended Pens needles not provided Exenatide IR [GLP1 agonist] Byetta Ibuprofen I: analgesia Dose: 400-800mg Q6H prn (max: 3200mg/d) Caldolor (IV) (i,D) Med Guide T2DM, ↓A1c 0.5-1.5% D: 2mg SC once WEEKLY Fridge + Protect from light x4 weeks BBW: risk of thyroid C-cell carcinomas CI: personal or family h/o thyroid cancer or multiple endocrine neoplasia (MEN2) Warnings: pancreatitis; avoid in severe GI dz, including gastroparesis SE: nausea, weight loss, serious inj site rxns (w/without nodules) ESRD or CrCl <30: not recommended Calan, Isoptin, Verelan, Covera Verapamil [NDHP-CCB] I: HTN, angina, arrhythmia RxPO: 240-480 mg/day ?Max dose: 120mg/day (Dosed qd, bid, tid)? *Preferred if CKD and nephropathy *More negative inotropic effects = ↓HR Warnings: AV block/sinus bradycardia, skin rxns (SJS, TEN, etc. dc if it persists) SE: bradycardia, gingival hyperplasia, constipation, edema, hypoTN, dizziness DDI: 3A4 inhibitor + substrate (use ↓dose with Simva, Lova, Atorva) + Pgp substrate - avoid grapefruit May worsen s/sxs of HF Bystollic Nebivolol [β1B-NO dependent vasodilation] Max dose 40mg/day BBW: Do not stop abruptly to avoid acute tachycardia, HTN and/or ischemia CI:↓HR, heart block, Child-Pugh class C - Monitor w/ diltiazam, verapamil, clonidine, digoxin, amiodarone Caution: DM (worsen BG + mask ↓BG) + COPD/asthma SE: ↓HR, hypoTN, depression, ↓libido, fatigue, dizziness Canasa Rowasa Asacol HD, Lialda Apriso, Delzicol, Pentasa (I, formulations) Mesalamine (5-ASA) Canasa: Suppository (retain ≥1-3H) Rowasa: Enema (retain ≥30min) Asacol HD, Lialda: ER tabs Apriso, Delzicol, Pentasa: ER caps I: ulcerative colitis, induction tx for acute flares, and maintenance Counseling: suppositories/enemas stain fabric, flooring, painted surfaces, marble, granite, vinyl & enamel Cancidas Caspofungin (IV) Candidemia RxIV: 70mg IV on day 1, then 50mg IV QD Moderate hepatic impairment: 7- mg IV on day 1, then 35 mg daily Given once daily; no renal dose adjustment Warnings: histamine mediated rxns, ↑ LFTs, SJS Cardene Nicardipine [DHP-CCB] - IV + PO I: HTN, angina RxPO: 20-40 mg TID (usual 60mg/day) CI: CHF, DNU w/ BB if acute MI (AV block + bradycardia) SE: reflex tachycardia, HA, flushing, edema DDI: Major 3A4 substrate - avoid grapefruit Captopril [ACEi] - generic only I: HTN, HFrEF, diabetic nephropathy, MI w/ LV dysFXN RxPO: 50 mg TID (max) ?RxPO: 12.5-100 mg BID? CI: hx of angioedema, within 36h of ARNI (Entresto) BBW: pregnancy, bilateral renal artery stenosis SE: metab. acidosis, ↑K+, dry cough, angioedema, cholestatic jaundice *Avoid w/ NSAIDs - renal damage ↓Lithium renal CL = ↑Lithium toxicity Renal dose adjust Cardura, Cardura XL Sucralfate [PGE1 Analog] - ↑mucosal protection I: NSAID-induced gastric ulcers RxPO: 1g PO QID BEFORE MEALS + QHS SEs: constipation (d/t Aluminum component) Avoid if renal disease *Binding interactions w/ other drugs Capoten (Canada) Cardizem, Cartia XT, Tiazac Doxazosin [Non-Selective α1-blocker] I: BPH, 2nd/3rd line for HTN IR: 1mg qHS - max 4-8mg XL: 4mg WITH BKF - max 8mg HTN: 16mg QHS Warnings: orthostatic hypoTN, intraoperative floppy eye syndrome in cataract surgery, Pregnancy X SE: dizzy, fatigue, HA, abnormal ejaculation *Give at bedtime to minimize dizziness - additive effect with PDE5inhibitors *Do NOT shrink the prostate or change PSA levels. Carafate Diltiazem [NDHP-CCB] I: HTN, angina, arrhythmias RxPO: 120-360 mg/day *More negative inotropic effects = ↓HR ?Max dose: 120mg/day (Dosed qd, bid, tid)? Warnings: AV block/sinus bradycardia, skin rxns (SJS, TEN, etc. dc if it persists), hepatic effects DDI: 3A4 inhibitor + substrate (use ↓dose with Simva, Lova, Atorva) + Pgp substrate - avoid grapefruit SE: bradycardia, gingival hyperplasia, constipation, hypoTN, edema, dizziness