Pharm Final

COX-1 vs. COX-2 inhibitors
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Terms in this set (107)
COX-1 vs. COX-2 inhibitors
1 generates prostaglandins involved in GI mucosa

2 mediates pain and inflammation
Aspirin
Analgesic, anti-inflammatory, antipyretic, antiplatelet

Irreversibly inhibits COX 1 and 2

Toxicity, Reyes Syndrome, bleeding, affects renal function

Don't give to anyone under 18
NSAIDs
For OA and RA, pain, fever, inflammation

Reversibly inhibits COX 1 and 2

Can cause ulcers
Celebrex
Last choice for long-term pain management

Blocks COX 2 and spares COX 1

Can increase risk of MI and CVA
Acetaminophen
Pain and fever

Inhibits prostaglandins

SJS, hepatotoxicity, reversal agent is acetylcysteine
Opioids
Mimic action of opioid peptides and mu receptors

Respiratory depression, constipation, sedation
Nonopioid, Tramadol
Blocks uptake of norepinephrine and serotonin

Sedation, dizziness, and seizures
Colchicine
Acute gout

Unknown MOA

GI upset, suppress bone marrow, rhabdo
Allopurinol
Drug of choice for tophaceous gout

Reduce blood uric acid levels

Well-tolerated but initiation can result in acute attack
Probenecid
Maintenance therapy

Promotes renal uric acid excretion

Well tolerated, can cause renal injury
RaloxifeneOsteoporosis, breast cancer, can lower LDL Similar to estrogen Hot flashes, leg cramps, thromboembolic events No pregnancy or history of clotsFosamaxPrevention and treatment of osteoporosis, high risk fractures Suppress bone resorption by decreasing osteoclast activity Well tolerated, esophagitis, femoral fractures, renal impairment No pregnancy or any disorder that can impede swallowingCorticosteroidsSuppression of inflammation Reduces inflammation by multiple mechanisms Increased vulnerability to infection, fluid and electrolyte imbalance, osteoporosis, muscle wasting, skin thinning, PUD, Cushing's, sudden adrenal insufficiency Can't have a systemic fungal infection or receive a live virus vaccineBaclofenMuscle spasticity r/t MS or spinal injuries Suppress hyperactivity, structural analog to GABA CNS depressants, withdrawals, seizures, hallucinations Question giving to outpatient alcohol use or pts with schizophreniaDantroleneSpasticity, malignant hyperthermia, rigidity Acts directly on skeletal muscle, suppressing release of CA Hepatic toxicityCyclobenzaprine (Flexeril)Relief of muscle spasms Central acting, similar structure to TCA CNS depressant, anticholinergic effects Interacts with antidepressants and CNS depressantsBeta BlockersNonselective: blocks beta 1 and beta 2 receptors Cardioselective: Produces selective blockage of beta 1 Vasodilating: act on blood vessels to cause dilation but may produce nonselective or cardioselective beta blockageBeta Blocker ImplicationsObtain HR and BP, monitor chest pain history, ECG MAR of Orphan CCB, insulin PMH of diabetes, asthmatics, HF, sinus bradycardia, >1st AV blockTriptans (sumatriptan)Don't take with other triptans or ergot (May cause Vasospasm) or with other serotonergic meds (May Cause Serotonin Syndrome) Don't take if poor heart health or pregnant Take after symptom onset Evaluate for effectiveness/chest painErgots (Ergomar)Don't take with Triptans Don't take if hepatic/renal impaired, septic, CAD, PVD, Pregnant Take after symptom onset Many Experience Nausea/vomiting Notify Provider if extremities become cold, pale, or numb Avoid Overuse to prevent DependenceLorazepam (Ativan)-Benzodiazepine (Anxiety, Seizures, Alcohol Withdrawal) -Potentiates GABA -May Cause Daytime Sedation and Anterograde Amnesia (Can't make new memories) -Paradoxical Effect in older adults, children, psych patients -Flumazenil is reversal agent for respiratory depressionParkinson's Disease Treatment GoalsIdeal = cure/reverse neuronal degeneration Actual = Symptomatic ReliefLevodopa/Carbidopa (Sinemet)Levodopa -Crosses BBB and converts to dopamine -"Off Times" (Drug may randomly stop working) Carbidopa -Helps preserve Levodopa until it can cross the BBB -Don't Take With MAOI -Avoid High-Protein Meals -Assess Skin for Malignant Melanoma -May cause N/V, Psychosis, Dyskinesia -Urine may be DarkenedACE and Kinase IILowered ACE= vasodilation, decreased blood volume, decreased cardiac and vascular remodeling, K retention, fetal injury Increased kinase II: vasodilation, cough, angioedemaARBsBlock the action of angiotensin II Dilate blood vessels, prevent release of aldosterone, prevent or reverse pathologic changes mediated by angiotensin II and aldosteroneARBs ImplicationsObtain BP MAR of antihypertensives, diuretics PMH of pregnancy, angioedema, renal artery stenosisCCBsOrphans MOA: dilation of peripheral arterioles lower afterload, dilation of coronaries increased perfusion, decrease in HR, AV conduction, force of contraction Dipines MOA: dilation of peripheral arterioles lower afterloadCCBs Adverse EffectsWorsen cardiac dysfunction, edema, flushing, reflex tachycardia, toxicityNitratesReduction of frequency and intensity of angina attacks Acts on VSM to cause dilation of coronary veins by converting to NO, lowers preload thus reducing oxygen demand Headache, orthostatic hypotension, reflex tachycardia Obtain BP, MAR of PDE5 inhibitor, antihypertensives PMH of alcohol useStatinsMost effective drugs for lowering LDL and total cholesterol, can raise HDL Increase number of LDL receptors on hepatic cells Well tolerated, myopathy, hepatotoxicity, diabetes, memory loss Obtain LFTs MAR of any lipid lower agent or any drug that inhibits CYP3A4 or grapefruit PMH of viral or alcoholic hepatitis, pregnancyBile Acid SequestrantsReduce LDL cholesterol levels, typically used with statins Increase LDL receptors on hepatocytes, binds to bile acids in GI tract preventing their absorption and promoting excretion Constipation Interacts with thiazide, diuretics, digoxin, warfarin, some antibiotics Obtain lab values for cholesterol, LDL, HDL, TGs MAR of interactions PMH of slow GI transitFurosemideMost frequently used, rapid fluid mobilization, diuresis required in renal impaired pts Blocks Na and H2O reabsorption from the thick segment of the Loop of Henle Hyponatremia, hypocholremia, dehydration, hyperuricemia, hypokalemia, ototoxicity, hyperglycemia Assessment: weight, BP, HR MAR: digoxin, ototoxic drugs, antihypertensives, lithium, NSAIDs PMH: gout, DM, pregnancy, CV disease, renal impairmentHydrochlorothiazideHypertension and edema Blocks Na and H2O reabsorption from the early segment of the distal convoluted tubule Hyponatremia, hypochloremia, dehydration, hyperuricemia, hypokalemia, hyperglycemia Assessment: weight, BP, HR MAR: digoxin, antihypertensives, lithium, NSAIDs PMH: gout, DM, pregnancy, CV disease, renal impairmentSpironolactoneHTN, edema, HF Blocks actions of aldosterone in distal nephron Hyperkalemia, gynecomastia, menstrual irregularities, impotence, deepening of voice Assessment: weight, BP, HR, labs for Na K and Cl MAR: K supplements, salt substitutes, ACE-I, ARBs PMH: hyperkalemiaRespiratory Drug DeliveryMDI: dosed with 1/2 inhalations, one minute between inhalations, hand-breath coordination, spacers Respimates: deliver fine mist, does not use propellants, extremely small particle size, decreased drug deposited in mouth DPI: dry micronized powder, breath activated, deliver more drug to lungs vs MDI Nebulizers: can administer oxygen and drug, doesn't require coordination, potential risk of pathogens, longer dose delivery timeBeclomethasoneMaintenance treatment of asthma as prophylactic therapy and long-term control of COPD Inhibits inflammatory cells and the release of inflammatory mediators Headache, dysphonia, pharyngitis, oral candidiasis, adrenal suppression, bronchospasm, cataracts, glaucoma Assessment: peak flow, growth in children, current infection PMH: asthma severity, bone mineral density, ocular disease, immunosuppression Allow 5 min to elapse before administering steroidsPrednisoneAsthma symptoms that can't be controlled by inhaled, COPD exacerbation Suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability Nausea, vomiting, HTN, weight gain, mood change, adrenal suppression, hyperglycemia, PUD, growth suppression in children Assessment: BP, blood glucose, growth in children, current infection MAR: desmopressin PMH: GI disease, ocular disease, renal impairment, hepatic diseaseZafirlukast (Accolate)Second-line therapy Antagonizes the effects of leukotrienes which mediate airway edema, smooth muscle constriction, altered cellular activity Headache, N/V, neuropsychiatric events Black Box warningAlbuterolUsed as quick-relief agent for acute bronchospasm and for prevention of exercise-induced bronchospasm Stimulate beta2-adrenergic receptors in the smooth muscle of bronchi and bronchioles, promoting bronchodilation Nervousness, restlessness, tremor, insomnia, angina, arrhythmias, HTN, paradoxical bronchospasm Assessment: trigger factors, caffeine intake MAR: beta blockers, thyroid hormones PMH: CV disease, HTN, hyperthyroidism, diabetes, use of systemic beta agonist with DM, hyperthyroidism, HTNSalmeterolController, concomitant therapy for the treatment of asthma and the prevention of bronchospasm, for exercise induced asthma Produces accumulation of cAMP at beta2-adrenergic receptors Prolong QT interval, asthma related death when used as monotherapyIpratropiumMaintenance therapy of reversible airway obstruction due to COPD, including chronic bronchitis and emphysema, off label use for asthma Blocks the muscarinic receptors in the bronchi Dry mouth and irritation of pharynx, increases intraocular pressure PMH of hypersensitivity, atropine, patients with BPH, glaucoma, or urinary retentionLong-Acting Antimuscarinic Antagonists (LAMA)Maintenance therapy of bronchoconstriction associated with chronic bronchitis and emphysema Acts as anticholinergic by selectively and reversibly inhibiting M3 receptors in smooth muscle of airways Dry mouth, headache, open-angle glaucoma, urinary retention, bowel obstruction, immediate hypersensitivity reaction Educate pt on angioedema and glaucomaPenicillinGram-positive bacteria Diarrhea, rash, uticaria, allergic reaction, anaphylaxis, C. Diff PMH: hx of allergic reaction to other beta lactams, severe renal insufficiency, monoCefazolinGram-positive bacteria, given pre-operation prophylaxis Diarrhea, nausea, pain at injection site, phlebitis, C. diff, leukopenia, neutropenia, thrombocytopenia PMH: hx of severe allergic reaction to other beta lactamsCarbapenemsExtremely broad spectrum C. diff, CNS toxicity, seizures PMH: hypersensitivity, cross-sensitivity to PCN or cephalosporins, previous renal impairment, seizure disorders Typically used for illnesses considered criticalVancomycinGram positive bacteria, C. diff, MRSA Thrombophlebitis, renal failure, ototoxicity, red man syndrome Assessment: check serum trough level MAR: other drugs that cause ototoxicity PMH: renal impairment, previous hearing loss, older adultsTetracyclineMycoplasma, chlamydia and rickettsia, acne vulgaris, PCN allergy Bacteriostatic N/V, photosensitivity, esophagitis, hepatotoxicity, pancreatitis, blood dyscrasias, hypersensitivity, superinfection, discoloration of the teeth and enamel, hypoplasia, interferes with bone growth PMH: pregnancy, children less than 8, significant renal impairmentErythromycinPCN substitute, STI Bacteriostatic Ototoxicity, superinfection, QT interval prolongation, C. diff PMH: hypersensitivity, hx of long QT syndrome MAR: taking inhibitors of CYP3A4Aminoglycoside: GentamicinSerious aerobic gram-negative infections in combination with Vanco Bactericidal Pain at injection site, ataxia, vertigo, ototoxicity, nephrotoxicity, inhibit neuromuscular transmission Assess: serum creatinine/BUN PMH: renal impairment, hearing impairment MAR: taking ototoxic, nephrotoxic drugs (loop diuretics)SulfonamidesBronchitis, shigella enteritis, otitis media, pneumonia, UTIs, diarrhea Bacteriostatic Phlebitis, hyper-k, hypo-Na, several hematological, SJS, C. diff PMH: megaloblastic anemia, infants less than 2 months, severe hepatic or renal impairment Multiple drug interactionsFluoroquinolonesGram-negative infections and some gram positive organisms Bactericidal Phlebitis, photosensitivity, black box warnings (tendinitis, tendon rupture, peripheral neuropathy, elevated intracranial pressure, seizures, hepatoxicity, anaphylaxis, C. diff)Insulin lispro (Humalog)Onset: 15-30 min Peak: .5-2.5 hrs Duration: 3-6 hrsRegular InsulinOnset: .5-1 hr Peak: 1-5 hrs Duration: 6-10 hrsNPHOnset: 1-2 hrs Peak: 6-14 hrs Duration: 16-24 hrsInsulin glargineOnset: 1.5-2 hrs Peak: None Duration: 18-24 hrsInsulin degludecOnset: .5-1.5 hrs Peak: 9 hrs Duration: > 24hrsGlucagonAcute management of severe hypoglycemia when administration of glucose is not feasible Stimulates hepatic production of glucose from glycogen stores N/V, BP alterations, hypoglycemia Position on side to protect airway, have suction available, administer at a rate not exceeding 1 mg/min, can be administered via IV containing D5WMetforminManagement T2DM, prevention of T2DM, gestational diabetes, polycystic ovary disease Decreases hepatic glucose production, decreases intestinal glucose absorption, increases sensitivity to insulin Abdominal bloating, unpleasant metallic taste, decreased vitamin B12 levels...risk of lactic acidosis (Black box warning) PMH: severe renal dysfunction, metabolic acidosis, diabetic ketoacidosis MAR: iodinated contrast mediaGlyburide (DiaBeta)Control of blood sugar in T2DM wen diet therapy fails, requires some pancreatic function Lowers blood sugar by stimulating the release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites Weight gain, GI fullness, nausea, hypoglycemia PMH: pregnancy, breast feeding, T1DM, diabetic ketoacidosis MAR: beta blockers can mask the signs of hypoglycemiaLevothyroxine (Synthroid)Hypothyroidism Synthetic thyroxine Palpitations, nervousness, insomnia, diarrhea, weight loss, hyperthyroidism tachycardia, angina pectoris tachycardia, MI and bone loss Nursing Imp: individualized dosage, take AM empty stomach, report chest pain, heart palpitations, nervousness, or insomniaAntithyroid: MethimazoleToo much thyroid Prevents the oxidation of iodide and prevents iodinated tyrosines from coupling Rash, arthritis, agranulocytosis, vasculitis, pancreatitis, hepatoxicity Nursing Imp: takes 3-12 weeks for therapeutic effects, take once daily at the same time, inform about early signs of agranulocytosis (fever and sore throat)H2RA CimetidineTreat gastric and duodenal ulcers and GERD Blocks H2 receptors on parietal cells to decrease acid production Well tolerated, pneumonia due to low pH, CNS issues MAR: antacids PMH: renal or hepatic dysfunctionPPI OmeprazoleTreat gastric and duodenal ulcers, GERD, most effective but only for short term use Irreversible inhibition of H+ and K+ ATPase, that generated gastric acid Pneumonia, fractures due to low Ca absorption, rebound acid hypersecretion, hypomagnesemia Assess: Mg levels MAR: diuretics, clopidogrel, certain HIV drugsSerotonin Antagonists, OndansetronChemotherapy, radiation, postoperative Block serotonin receptors on vagal afferents and in the CTZ Headache, diarrhea, dizziness, prolonged QT intervalDopamine Antagonists ProchlorperazineChemotherapy, postoperative, general Block dopamine receptors in the CTZ Strong anti-cholinergic signs, hypotension and sedation, Tardive dyskinesiaBulk Forming Agents: Psyllium (Metamucil)Preferred temporary treatment of constipation, slow diarrhea by absorbing water (colostomy and ileostomy patients) Function similarly to dietary fiber, swell with water to form a gel that softens and increases fecal mass PMH: esophageal obstruction, requires plenty of fluids to avoid intestinal obstructionAntithrombolyticsDirect, reversible inhibitor of free and bound thrombin No specific antidote, GI disturbances, bleeding PMH of renal/liver impairment, pregnancyAntiplateletsInhibit platelet aggregation, mostly in arteries Abdominal pain, dyspepsia, diarrhea, bleeding, TTP MAR of PPI or drugs that promote bleeding PMH of active bleed, undernourishedFibratesEffective for lowering TG levels and raising HDL MOA is unknown Well tolerated, rash, GI disturbances, gallstones, myopathy, hepatotoxicAnticoagulantsDisrupt the coagulation cascade, thereby suppressing the production of fibrin Bleeding, HIT, Hemorrhage, fetal hemorrhage and teratogenesis (Warfarin) Assessment: BP, HR, CBC, hematocrit, aPTT MAR: antiplatelet drugs PMH: severe thrombocytopenia lumbar puncture, surgery of eye, brain, spinal cord...pregnancy, vitamin K deficiency, liver disease (Warfarin) Heparin reversal agent: protamine sulfate Warfarin reversal agent: Vitamin KAntiepileptic Drug (AED) Considerations-Balance Therapeutic Effect With Adverse Reaction -Highly Individualized drug selection/dosing -Withdraw slowly to prevent Status Epilepticus -Taper 1 drug at a time -Monitor Plasma Levels to Determine Adherence/Toxicity -Make Oral Contraceptives Less Effective -Cause Harm to FetusPhenytoin (Dilantin)Na Channel Inhibitor Slows propagation/spread of abnormal discharges Treats all forms of Epilepsy EXCEPT absence Seizures Absorption Varies Significantly Hard to Find Therapeutic Sweet Spot IV Admin: -Never Piggyback with Dextrose Solutions -Large vein/Large Bore Needle (Low Gauge) -Extravasation Risk Morbilliform Rash, Purple Glove Syndrome, Gingival Hyperplasia, Hypotension/Dysrhythmia Take Folic Acid to help manage gingival hyperplasia Don't Stop SuddenlyCarbamazepine (Tegretol) Adverse EffectsBone Marrow Suppression Hypo-osmolarity and Hyponatremia (Increased ADH)Valproic Acid (Depakote) Adverse EffectsHepatotoxicity Pancreatitis Teratogenic Don't take if < 2 years old or liver issuesGabapentin (Neurontin)GABA Analog Mostly used off label Neuropathic Pain, Migraine, Fibromyalgia, Postmenopausal Hot Flashes Label Uses Seizures Devoid of Significant Drug Interactions Somnolence, dizziness, fatigue, nystagmusSSRI/SNRIUsed for Depression Blocks Reuptake of Serotonin and Norepinephrine Check Labs for Na Don't Take with MAOI or Serotonergic Meds Admin in morning to prevent sleep disturbance Sexual Dysfunction SSRI = Fluoxetine (Prozac) SNRI = Venlafaxine (Effexor XR)TCAs (imipramine) Adverse EffectsAnticholinergic Effects: -Sweating, Seizures, Sedation, Hypomania Serious Adverse Effects: -Orthostatic Hypotension Most Dangerous Adverse Effect: -Cardiac Toxicity Adverse Drug Interactions: -Anticholinergic, Sympathomimetics, MAOIMAOI: Phenelzine (Nardil)Contraindicated by almost everything, especially SSRI Adverse Effects: -HTN Crisis, Orthostatic Hypotension Epinephrine/Norepinephrine Diseases are comorbid and lead to HTN Crisis Tyramine Rich Foods Contribute to HTN Crisis (Promote Norepinephrine Release) Avocados, Cheese, Soy SauceBenzodiazepine UsesLorazepam (Ativan): Anxiety, Seizure Disorders, Alcohol Withdrawal Zolpidem (Ambien) InsomniaAcyclovirGenital Herpes Mucocutaneous Herpes Varicella-Zoster Interferes with Viral DNA Synthesis Phlebitis Reversible Nephrotoxicity IV slow infusion over 1 hour or more Topical apply with glove Not a cure Ensure Adequate Hydration during infusion and 2 hours afterAntiviral HIV MedicationsNRTI (Nucleoside Reverse Transcriptase Inhibitors) Prevent Transcription of Viral RNA to DNA NNRTI (Nonnucleoside Reverse Transcriptase Inhibitors) Prevent Transcription of Viral RNA to DNA PI (Protease Inhibitors) Prevents maturation of virusHIV Labs to Guide TherapyCD4 T-Cell Counts Indicates how much immunity remains Plasma HIV RNA (Viral Load) Assay Guides Treatment of Infection by looking at how much virus there isLithiumBipolar Disorder Control Acute Mania Depression Prophylaxis Monitor Na/Renal Function Contraindicated for 1st Semester Pregnancy Check CBC, Renal, Thyroid Function at least once a year Healthy Lithium Level = 0.4 - 1 mEq/L Most Common Cause of Lithium Toxicity is Na Depletion Tremor, Polyuria, Renal Toxicity, Goiter, Hypothyroidism, leukocytosis, teratogenesisACE-IBlock production of Angiotensin II Dilate blood vessels (mostly arterioles), reduce blood volume (thru kidneys) No pregnancy, history of angioedema or renal artery stenosis, no K sparing drugs, supplements, or salt replacementsMemantine (Namenda)-Gates NMDA Receptor -Glutamate is released from presynaptic cell -When enough glutamate is present, memantine will move out of the way -Calcium Goes Through Channel Moderate to Severe Alzheimers Disease Dizziness, Hallucinations, Confusion, ConstipationEntacaponeCOMT Inhibitor Prevents Breakdown of Levodopa Similar to Carbidopa, but inhibits different enzymeAmantadinePromotes Release of Dopamine Only Drug Recommended for DyskinesiasDonepezil (Aricept)-Cholinesterase Inhibitor -Prevents Breakdown of Acetylcholine -Used in moderate to severe Alzheimers Disease -Withdrawal Syndrome can prolong QT interval or heart block (Agitation, Crying Easily, Intense Hallucinations) -N/V Initially, but will go awayAlzheimer's Disease Treatment GoalsIdeal = Improve and reverse cognitive decline Actual = Marginal ImprovementAmphotericin B NephrotoxicityDamage is related to amount administered Residual damage if total dose > 4 g Monitor Serum Creatinine every 2-4 days Avoid Other Nephrotoxic Drugs Avoid NSAIDS Infuse 1L of saline on treatment daysItraconazole (Sporanox)Systemic and Local Mycoses Inhibits Synthesis of Ergosterol Inhibits Fungal P450 Take WITH food Cardiosuppression, Hepatotoxicity (Check Liver Enzymes/CYP3A4) Take drugs that raise gastric pH 1 hour before or 2 hours after to prevent decreased Itraconazole Absorption BBW - Do not admin for treatment of onychomycosis patients with ventricular dysfunction such as heart failureAzoles UseBroad-Spectrum Antifungal Drugs Alternate to A icin B Lower Toxicity Inhibits P450 potentially increasing levels of other drugsAmphotericin B Infusion Reaction TreatmentMild Reactions Diphenhydramine + Acetaminophen Aspirin Rigors Meperidine or Dantrolene Hydrocortisone Phlebitis Change IV Site Use Large Central VeinSelegilineMAOB Inhibitor Prevents Breakdown of Dopamine 1st Line Therapy for "Off Time"Antifungal MedicationsPolyene, Azoles, EchinocandinsAmphotericin BFungal Infection Makes Membrane More Permeable Forms pore in ergosterol Infusion Reaction: Fever, chills, nausea, headaches Nephrotoxicity BBW - reserve use for progressive and potentially life threatening Heparin Used at infusion site to reduce phlebitisTriptans vs. Ergots (MOA/Use)Triptans: -Vasoconstrict by stimulating alpha-adrenergic and serotonergic receptors -Taken to prevent migraines -1st line of defense Ergots: -Block Inflammation by suppressing release of CGRP -Taken to stop a migraine -2nd line therapyRifampinTB Bactericidal Inhibits RNA Synthesis Red Discoloration of Tears/Urine Contraindicated for Protease Inhibitors and delavirdine Take on empty stomach (1 hour before or 2 hours after) Monitor Liver/Renal Function Interacts with CYP3A4Pramipexole (Mirapex)-Dopamine Receptor Agonist -1st Line Drug Therapy -Also used for Restless Leg Syndrome -Activates Dopamine Receptors -Nausea, Dyskinesia, Postural Hypotension, Hallucinations -Sleep Attacks (Suddenly/Randomly Fall Asleep) -Orthostatic HypotensionIsoniazid (INH)TB Inhibits Cell Wall Formation Peripheral Neuropathy, Liver Damage Optic Neuritis, Anemia, psych disturbance BBW - Hepatotoxicity Contraindicated for Acute Liver Disease or Previous INH Hepatotoxicity Take on empty stomach (1 hour before or 2 hours after) Prevents Activation of Vit B6 (Pyridoxine) leading to peripheral neuopathy, so take supplement to minimize adverse effectsTB MedicationsIsoniazid (INH) Rifampin Pyrazinamide Ethambutol (Myambutol)Surfactants Docusate SodiumCommonly used to prevent constipation Pulls water and fat in to the stool, prevents reabsorption of water by intestinesStimulants BisacodylTwo legit applications: opioid-induced constipation and for constipation from slow intestinal transit, frequently abused Stimulate intestinal motility, increase amount of water and electrolytes that stay in GI tractOsmotic Laxatives Mag Citrate, MiralaxMiralax: chronic constipation Mag Citrate: bowel prep, significant constipation, evacuation of parasites or poison Poorly absorbed salts whose osmotic action pulls water into intestines Dehydration, hypermagnesemia in renal impairedSildenafil (Viagra)ED, pulmonary HTN Prevents cGMP from converting to GMP Hypotension, especially in men taking nitrates or alpha blockers, priapism (erection longer than 6 hrs), sudden hearing loss, nonarteritic ischemic optic neuropathy MAR: nitrates PMH: hypo or hypertension, HF, unstable angina, recent MI or CVAFinasteride (Proscar)Enlarged prostate, low dose for male-pattern baldness Prevents the formation of the active form of testosterone in the prostate, promotes regression of prostate epithelial tissue Teratogenic to male fetus, reduced ejaculate volume and libido, gynecomastia in some If PSA levels do not fall as expected, the patient should be evaluated for prostate cancerTamsulosin (Flomax)Mild prostatic enlargement but symptomatic urination (does not reduce prostate size) Selective blockage of alpha receptors relaxes smooth muscle in bladder neck and prostate, must be taken for life Headache, dizziness, abnormal ejaculation Use with other drugs causing hypotension can drop BP