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Top 200 Part 2 Final

Terms in this set (250)

amphetamine/dextroamphetamine

dexmethyphenidate

lisdexamfetamine

methylphenidate

methylphenidate ER

long-acting dosing options for CNS stimulants

Ritalin LA, Concerta, Metadate CD, Vyvanse, Adderall XR

Class: Adderall, Focalin, Vyvanse, Ritalin, Concerta

Indications: CNS stimulants

ADHD
Narcolepsy (Ritalin, Adderall)
Binge eating disorder (Vyvanse)

AE: CNS stimulants

weight loss/loss of appetite
insomnia
irritability/restlessness
headache
xerostomia
Rare: mania, cardiac issues, seizure, dependence

Interactions: CNS stimulants

TCAs
MAOIs
SSRIs (Concerta)

BBW: CNS stimulants

abuse/dependence; unmasking depression during withdrawal
serious cardiovascular events

Schedule: CNS stimulants

Counseling: CNS stimulants

-take in the morning (for once a day)
-avoid evening doses (insomnia)
-do not abruptly stop
-ERs can be sprinkled on soft food

dosage forms: divalproex

Schedule: pregabalin

Class: divalproex, gabapentin, lamotrigine, pregabalin, and topiramate

anticonvulsants

Indications: gabapentin and pregabalin

seizure (limited use), nerve pain, postherpetic neuralgia (shingles), restless leg syndrome
fibromyalgia (pregabalin only)

AE: gabapentin and pregabalin

peripheral edema, dizziness, somnolence, weight gain/increased appetite

Interactions: gabapentin and pregabalin

antacids (gabapentin only)
alcohol
CNS depressants

Pregnancy Categorgy: gabapentin and pregabalin

Counseling: gabapentin and pregabalin

-liquid pregabalin BUD is 45 days from opening
-do not stop abruptly
-gabapentin ER should be taken at bedtime
-separate antacids by 2 hours

Indications: topiramate

seizure, migraine prophylaxis, weight loss (w/phentermine)
alcohol dependence (off-label), binge eating (off-label)

Pregnancy Category: topiramate

loss of appetite, word-finding difficulty, impaired psychomotor performance, low serum bicarbonate, kidney stones

Why can topiramate cause kidney stones?

can affect carbonic anhydrase throughout the body

Interactions: topiramate

amitriptyline
oral contraceptives

Contraindications: topiramate

metabolic acidosis

Precautions: topiramate

liver and kidney disease

Counseling: topiramate

-take with full glass of water
-may decrease sweating
-should use additional contraception

Indications: lamotrigine

seizure, bipolar disorder

AE: lamotrigine

rash, diplopia, Stevens-Johnson Syndrome, N/V, sedation/insomnia

Interactions: lamotrigine

oral contraceptives (decrease lamotrigine levels)
valproate
carbamazepine

BBW: lamotrigine

Precautions: lamotrigine

aseptic meningitis, blood dyscrasias

Pregnancy Category: lamotrigine

Counseling: lamotrigine

-discuss oral contraceptive interaction
-report severe skin issues

Indications: divalproex

seizures, manic bipolar disorder, migraine prophylaxis

alopecia, tremor, vision disturbances, GI issues, thrombocytopenia

Interactions: divalproex

warfarin
olanzapine
phenytoin, carbamazepine, lamotrigine
contraceptives (decrease divalproex levels)

BBW: divalproex

hepatotoxicity, mitochondrial disease, fetal risk, pancreatitis

Pregnancy Category: divalproex

Counseling: divalproex

-importance of contraception
-watch for bleeding
-contact doctor if lethargy, N/V, anorexia, or jaundice occur

Most anticonvulsants have a BBW for...

suicidal ideation

Anticonvulsants can significantly impact ____________, so drug interactions should always be checked

liver enzymes (CYP P450)

atypical antipsychotics available as IM injection

aripiprazole
risperidone

atypical antipsychotics available as dispersable tablets or ODT

aripiprazole
olanzapine
risperidone

Class: aripiprazole, olanzapine, quetiapine, risperidone

atypical antipsychotics

Indications: atypical antipsychotics

schizophrenia, bipolar disorder, agitation/psychosis, adjunctive depression treatment

AE: atypical antipsychotics

weight gain, glucose/lipid abnormalities, tardive dyskinesia, extrapyramidal symptoms, akathisia (restlessness), somnolence/sedation

atypical antipsychotics with high incidence of sedation side effect

olanzapine
quetiapine

atypical antipsychotic with least weight gain

atypical antipsychotic with most weight gain

Interactions: atypical antipsychotics (general)

CNS depressants

Interactions: aripiprazole, quetiapine, olanzapine

azole antifungals

Interactions: risperidone

carbamazepine
paroxetine

Interactions: olanzapine

BBW: atypical antipsychotics

increased risk of death in elderly when used for dementia

Counseling: atypical antipsychotics

-important to take daily
-review weight gain side effect
-monitoring EPS symptoms

Antivert
Bonine

promethazine/codeine

antiemetic that is available OTC

common dosage form of ondansetron

dosage forms: promethazine

liquid
injection
rectal suppository*

Schedule: promethazine/codeine

Indications: antiemetics

N/V
Vertigo
motion sickness (meclizine)
chemo-N/V (ondansetron)

Class: meclizine

antiemetic
antihistamine that decreases vestibular conduction

Class: ondansetron

antiemetic
5HT3 antagonist (CTZ)

Class: promethazine

antiemetic
first generation antihistamine

Class: promethazine/codeine

antiemetic
opioid/first generation antihistamine

AE: antiemetics

sedation/somnolence, drowsiness, dry mouth, constipation
elevated liver enzymes (ondansetron)
photosensitivity (promethazine)

Interactions: antiemetics (general)

CNS depressants

Interactions: promethazine and meclizine

antihistamines
anticholinergics

Interactions: ondansetron

BBW: promethazine

should not be used in patients <2 years old due to respiratory depression

Class: metoclopramide

Indications: metoclopramide

diabetic gastroparesis*
GERD
prevention of N/V

Limitations: metoclopramide

use limited to adults
use limited to 12 weeks duration

AE: metoclopramide

extrapyramidal reactions, somnolence, bradycardia, restlessness, dystonic reaction

Interactions: metoclopramide

anticholinergics
antipsychotics
Parkinson's agents
SSRIs
promethazine

Contraindications: metoclopramide

GI obstruction/perforation, history of seizures, concomitant use of other medications with EPS risk

BBW: metoclopramide

tardive dyskinesia

Counseling: metoclopramide

-take 30 minutes before meals for gastroparesis
-use limited to 12 weeks due to risk of Parkinson's-like symptoms

Rx immunologics

allopurinol, ergocalciferol, methotrexate, potassium chloride

OTC immunologics

ferrous sulfate, cholecalciferol (vitamin D3), omega 3 fatty acids

Aloprim
Zyloprim

Trexall
Rheumatrex

Class: allopurinol

xanthine oxidase inhibitor

Indications: allopurinol

gout (prevention)
cancer-ind. hyperuricemia
calcium oxalate stones

AE: allopurinol

urticaria, skin rash, liver enzyme elevation, diarrhea, nausea

Interactions: allopurinol

azathioprine
ACE-Is
thiazide diuretics

Counseling: allopurinol

-report rashes
-drink lots of water
-take with food
-avoid vitamin C consumption

Class: methotrexate

Indications: methotrexate

chemotherapy agent
psoriasis
rheumatoid arthritis
various immunologic conditions

AE: methotrexate

alopecia, thrombocytopenia, leukopenia, liver dysfunction, GI

Interactions: methotrexate

NSAIDs
salicylates (i.e. ASA)
folic acid

Pregnancy category: methotrexate

Contraindications: methotrexate

pregnancy and lactation
alcoholism
alcoholic liver disease

BBW: methotrexate

bone marrow suppression
gastric toxicity
hepatotoxicity
opportunistic infections

-review appropriate dose schedule
-no live vaccines

Drisdol
Calcidol

cholecalciferol

ferrous sulfate

Feosol
Fer-in-Sol
Slow Fe

potassium chloride

Klor-Con Sprinkle (ER sprinkle)
Micro-K (ER cap)
K-Sol (solution)
K-Tab, Klor-Con (ER tab)

omega-3 fatty acids

Class: ergocalciferol and cholecalciferol

vitamin (supplement)

Indications: ergocalciferol and cholecalciferol

dietary supplement
prophylaxis/treatment of vitamin D deficiency

AE: ergocalciferol and cholecalciferol

Interactions: ergocalciferol and cholecalciferol

bile acid sequestrants
Orlistat
mineral oil

Counseling: ergocalciferol and cholecalciferol

-if taking calcium, take together
-do not exceed dose or duration

Class: ferrous sulfate

nutrient/mineral (supplement)

Indications: ferrous sulfate

prevention/treatment of iron-deficiency anemia

AE: ferrous sulfate

GI, black-colored stools, staining of teeth (liquid)

Interactions: ferrous sulfate

antacids
levothyroxine
H2RAs/PPIs (needs acidic environment for absorption)
tetracyclines/fluoroquinolones
bisphosphonates

Warnings: ferrous sulfate

-use should be limited to 6 months if possible
-avoid use in patients with significant GI disorders

Counseling: ferrous sulfate

-can be taken with food (minimize GI upset, but decreases absorption)
-can take with vitamin C (improve absorption)
-black stools

Class: folic acid

dietary supplement

Indications: folic acid

megaloblastic and macrocytic anemias
recommended daily allowance (pregnancy/lactation)
contained in prenatal vitamins
prevention of neural tube defects

Interactions: folic acid

methotrexate
phenytoin/fosphenytoin
primidone/pentobarbital

Counseling: folic acid

-women of child-bearing potential should have 400 mcg/day
-pregnant women should have 1000 mcg/day

Class: potassium chloride

electrolyte supplement

Indications: potassium chloride

prevention/treatment of hypokalemia

AE: potassium chloride

GI, hyperkalemia, cardiac conduction issues

Interactions: potassium chloride

ACE-I
ARB
potassium sparing diuretics
Mrs. Dash

Counseling: potassium chloride

-take each dose with a meal and full glass of water
-can be seen in stool
-capsules can be opened and sprinkled on soft food

Class: omega-3 fatty acids

dietary supplement

Indications: omega-3 fatty acids

supplement
hypertriglyceridemia

AE: omega-3 fatty acids

eructation (belching), fishy aftertaste, GI irritation

Interactions: omega-3 fatty acids

antiplatelets
warfarin

Warnings: omega-3 fatty acids

hepatic effects
lipid elevation
fish allergy
prolonged bleeding time

Counseling: omega-3 fatty acids

-fishy aftertaste can be minimized by using Rx products and freezing capsules

Discontinue an antibiotic if what AEs occur?

signs/symptoms of allergic reaction (including rash)

Class: doxycycline

Indications: doxycycline

MRSA (staph infection)
acne
gonorrhea
lyme disease (off-label)

AE: doxycycline

photosensitivity, tooth discoloration/cartilage malformation in pregnancy/children <8, NVD

Interactions: doxycycline

antacids/calcium/iron
penicillin
digoxin

Counseling: doxycycline

-apply sunscreen
-potential need for 2nd form of contraception if taking long-term for acne
-take with 240 mL of water
-separate from milk, calcium, etc. by at least 2 hours

amoxicillin/clavulanate

Class: amoxicillin, amoxicillin/clavulanate, penicillin

beta-lactams (penicillin-derivatives)

Indications: penicillin

bacterial endocarditis
otitis media
prophylaxis (i.e. wisdom teeth extraction)

Interactions: penicillin

Precautions: penicillin

should clean tray after counting

Clavulanate makes Augmentin...

extended spectrum

Indications: amoxicillin and Augmentin

otitis media
CAP

AE: amoxicillin and Augmentin

NVD, rash
mycosis/candidiasis (Augmentin)

Interactions: amoxicillin and Augmentin

It is not ok to use 1st/2nd generation cephalosporins with beta-lactams if the cross-reactivity issue is...

similar side chain

Class: cefdinir

beta-lactam
3rd generation cephalosporin

Class: cephalexin

beta-lactam
1st generation cephaolsporin

Indications: cefdinir

otitis media
bronchitis
CAP

Indications: cephalexin

skin infections
osteomyelitis
respiratory tract infections

AE: cefdinir and cephalexin

Interactions: cefdinir

iron/vitamins/calcium (cause red stool)
warfarin

Interactions: cephalexin

cholestyramine
warfarin

Class: mupirocin

topical antibiotic

Indications: mupirocin

impetigo
eradication of nasal MRSA
secondary skin infections

burning, stinging, pruritis, pain, erythema, secondary wound infections

Interactions: mupirocin

Precautions: mupirocin

avoid contact with eyes

dosage form info: mupirocin

cream does not equal ointment

E.E.S. 400
Ery-Tab

Class: azithromycin, clarithromycin, erythromycin

Indications: macrolides

pulmonary infections
gonorrhea
chlamydia
**erythromycin is used as a motility enhancer or in magic mouthwash, not so much as an antibiotic

NVD/abdominal pain, QTc prolongation, elevated liver enzymes
altered taste (clarithromycin)
flatulence (azithromycin)

Interactions: macrolides

warfarin
simvastatin, atorvastatin, lovastatin (increased risk of myopathy)
digoxin
SSRIs (clarithromycin)

Precautions: clarithromycin

some formulations contain lactose (lactose intolerance)

Counseling: macrolides

-avoid mixing suspension with food or beverages
-ER suspension should be taken on an empty stomach
-must use Zmax within 12 hours of reconstitution
-avoid aluminum or magnesium-containing antacids (not true for Zmax)

Class: clindamycin

Indications: clindamycin

SSTI - MRSA coverage
aspiration pneumonia
intra-abdominal infections

AE: clindamycin

NVD/abdominal pain, esophagitis, rash, C. diff. diarrhea

Interactions: clindamycin

cyclosporine
erythromycin
neuromuscular blocking agents

BBW: clindamycin

C. diff./pseudomembranous colitis

Counseling: clindamycin

-discontinue if significant diarrhea
-do not treat diarrhea with Immodium
-use Pedialyte not Gatorade
-take each dose with a full glass of water
-stay upright for at least 30 minutes after doses

ciprofloxacin eye drops and eye ointment

ciprofloxacin ear drops

Otiprio
Cetraxal

moxifloxacin eye drops

Class: ciprofloxacin and levofloxacin

fluoroquinolone

Class: moxifloxacin

respiratory fluoroquinolone

Indications: fluoroquinolones

-not approved for use in children < 18
-respiratory infections
-UTIs (not moxifloxacin)

AE: fluoroquinolones

NVD/abdominal pain
skin rash/photosensitivity
tendonitis/tendon rupture
cartilage deformity (children)
QTc prolongation

Interactions: fluoroquinolones

antacids/calcium/iron
corticosteroids
NSAIDs
antidiabetic agents
warfarin

BBW: fluoroquinolones

tendon rupture
myasthenia gravis

Counseling: fluoroquinolones

-apply sunscreen
-drink plenty of water
-do not take with milk, yogurt, or other calcium foods (take at least 2 hours before)
-ciprofloxacin suspension: can be stored at room temp - shake well before use

Counseling: eye drops (general)

-DO NOT refrigerate after opening
-shake well before use

Indications: TMP/SMX

many infections
UTI
respiratory tract infections
SSTIs

NVD, skin rash (mild and Stevens-Johnson), hyperkalemia, myalgia, anorexia, photosensitivity
Rare: liver/kidney failure, blood dyscrasias

Interactions: TMP/SMX

methotrexate
warfarin
oral hypoglycemic agents

Pregnancy category: TMP/SMX

Contraindications: TMP/SMX

late-stage pregnancy

Precautions: TMP/SMX

pregnancy
G6PD deficiency
folate deficiency
sulfa allergy

Counseling: TMP/SMX

-apply sunscreen
-take each dose with a full glass of water
-can be taken with food
-use should be avoided in pregnancy and breastfeeding

Class: metronidazole

Indications: metronidazole

anaerobic infections
C. diff. (drug of choice)
bacterial vaginosis
trichomoniasis (patient and partner)

AE: metronidazole

headache, nausea/diarrhea, abnormal taste (metallic)

Interactions: metronidazole

alcohol (disulfiram-like reaction)
warfarin

metronidazole gel

Counseling: metronidazole

-complete full course
-avoid consuming alcohol
-ER tabs should be taken on an empty stomach
-IR can be taken with food

Class: fluconazole

triazole antifungal

Indications: fluconazole

candidiasis (mouth and vaginal infections)

AE: fluconazole

NVD/abdominal pain
rash
elevated LFTs

Interactions: fluconazole

atorvastatin, simvastatin, lovastatin
sulfonylureas

Class: acyclovir and valacyclovir

viral DNA polymerase inhibitor

Indications: acyclovir and valacyclovir

AE: acyclovir and valacyclovir

malaise, NVD, headache, crystalluria/kidney dysfunction

Interactions: acyclovir and valacyclovir

Counseling: acyclovir and valacyclovir

-initiate as soon as possible
-HSV: start during prodromal phase
--cold sores: first tingling/burning sensation
--genital herpes: within 72 hours of first episode or within 24 hours of recurrent episode
-VZV: start when rash appears
--shingles: within 72 hours of symptom onset
-take oral products with full glass of water

Class: oseltamivir

neuraminidase inhibitor

Indications: oseltamivir

influenza A and B (treatment and prevention)

AE: oseltamivir

headache, NVD, neuropsychiatric events (mainly children), Stevens-Johnson syndrome, seizure

Interactions: oseltamivir

live, attenuated flu vaccine

Counseling: oseltamivir

-complete full course
-must be started within 48 hours of symptom onset
-not a substitute for the annual flu vaccine

Class: latanoprost

Indications: latanoprost

open-angle glaucoma
ocular hypertension

AE: latanoprost

blurred vision, sensation of foreign object in eye, dry eye, hyperpigmentation of eyelid, iris pigmentation change, eye pruritis

Interactions: latanoprost

bimatoprost
ophthalmic NSAIDs
pilocarpine

Counseling: latanoprost

-contacts should be removed and not worn for at least 15 minutes after administration
-protect medication from light
-unopened: store in refrigerator
-opened: store at room temperature up to 6 weeks

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