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Top 200 Pt. 2

Brand NameGeneric NameDosage FormsIndicationMOAKineticsADR'sMonitoringContraindications
Lomotil Diphenoxylate & Atropine Tablet, oral solution diarrhea -inhibits excessive GI motility and GI propulsion -extensive hepatic metab via ester hydrolysis -excretion: primarily feces (49% unchanged), urine -constipation-drowsiness-N/V-dry mouth-stomach pain -atropinism (dryness of skin and mucous membranes, tachycardia, flushing, thirst)-monitor # and consistency of stools-signs of toxicity-fluid and electrolytes loss -hypotension-respiratory depression -obstructive jaundice-diarrhea associated w/ pseudomembraneous enterocolitis or enterotoxin producing bacteria-children <2-use caution in those w/ hepatic and renal impairment and those w/ UC
Lopid Gemfibrozil Tablet Hyptertriglyceridemia/ Hyperlipidema -unknown-inhibit lipolysis and decrease hepatic fatty acid uptake and inhibit hepatic secretion of VLDL that decrease serum VLDL levels, increase HDL cholesterol -hepatic metabl via oxidation to 2 inactive metabolites-undergoes enterohepatic recycling-excretion: urine (70% conjugated drug), feces (6%) -dyspepsia-abdominal pain-diarrhea -serum cholesterol-LFT's periodically-CBC periodically -hepatic or severe renal fxn (needs adjustment)-primary biliary cirrhosis-pre-existing gallbladder disease-concurrent use w/ repaglinide-HMG-CoA agents -Warfarin
Lovenox Enoxaparin Injection Solution Prophylaxis/ Treatment of DVT -inhibition of factor Xa -hepatic metab to lower molecular weight fragments-excretion: urine (40% dose, 10% unchanged)) -bruising and redness around site of injection -platelets-occult blood-anti-Xa level (pregnant women, obese, renal impairment pts)-SCr -HIT-hypersensitivity to pork products-major active bleed-not for IM use-BBW: neuraxiel anesthesia-prosthetic heart valves-needs renal adjustment
Lunesta Eszopiclone Tablet Insomnia -interact w/ GABA receptor complex at the binding domain coupled to benzo's receptor -hepatic metab via oxidation and demethylation (CYP 2E1 & 3A4), to 2 active metabolites, 1 less active than parent-excretion: urine (75% conjugated drug, <10% unchanged drug) -drowsiness-HA-unpleasant taste sensation -assess history of addiction-taper slowly after long term use-CNS depression-abnormal thinking-behavior changes -needs hepatic adjustment-NO contraindicatons-depression (may worsen)-drug abuse-respiratory disease
Lyrica Pregabalin Capsule Neuropathic pain -bind to alpha-2-delta subunit of voltage gated Ca channels in CNS inhibiting excitatory NT-does not bind to GABA-exerts anti-nociceptive and anti-convulsant activity -metabolism: negligible-excretion: urine (90% unchanged drug) -dizziness-somnolence-dry mouth -degree of sedation-symptoms of myopathy or occular disturbances-weight gain/edema-CPK-skin integrity (those w/ DM)-suicidality -needs renal adj.-CVD-concurrent use w/ sedatives
Macrobid/ Macrodantin Nitrofurantoin Capsule Bacterial Infections -inhibits acetyl-CoA interfering w/ metabolism and cell wall synthesis -metab: body tissues metab 60% of drug to inactive metabolites-excretion: suspension: 40% urine and feces as metabolites and unchanged drug-macrocrystals: urine (20-25% as unchanged drug) -N/V/D-HA-flatulence-fever-cough-chills -pulmonary reaction-signs of numbness and tingling in extremities-CBC-periodic liver tests-periodic renal fxn tests w/ prolonged use-culture and sensitivity prior to use -needs renal adj-infants <1 mo-3rd trimester women-cholestatic jaundice or hepatic impaiment w/ previous nitrofurantion therapy -hemolytic anemia
Maxipime Cefepime Injection powder (reconstitution) Bacterial Infections -inhibits bacterial cell wall synthesis by binding to PBP -metab: minimally hepatic-excretion: urine (85% unchanged drug) -positive Coomb' test w/out hemolysis -get culture specificity and sensitivity before use-signs of anaphylaxis w/ first use -renal fxn -needs renal adj-allergic to other PCN's-GI disease-seizures
Medrol Methylprednisolone Tablet Inflammation or immunosuppression -regulate gene expression subsequent to binding to intracellular receptors and translocation into the nucleus-modulation of CHO, protein, & lipid metabolism-maintenance of fluid and electrolyte status -decrease inflammation by suppression of migra -excretion: reduced in obese -blurred vision-upset stomach-N/V-fluid and electrolyte imbalance -Cushing's syndrome -increased suciptibilty to infections-OP-suppression of growth in children-adrenal suppression -BP-blood glucose-electrolytes -administer dose post HD-systemic fungal infections-administration of live virus vaccines-benzyl alcohol preservatives are contra in infants-IM administration in idiopathic thrombocytopenia purpura-intrathecal administration of suspension-CVD
Merrem Meropenem Injection powder (reconstitution) Bacterial Infections -inhibits bacterial cell wall synthesis by binding to PBP -metab: hepatic to open beta-lactam form (inactive)-excretion: urine (25% unchanged drug) -anemia-N/V/D -culture and sensitivity prior to use-signs of anaphylaxis w/ 1st dose-renal fxn, liver fxn, CBC w/ prolonged use -needs renal adj.-pts w/ anaphylaxis w/ previous PCN use
Methadose Methadone Injection, solution, oral solution, tablet, dispersible tablet Moderate to severe pain management or narcotic addiction -binds to opioid receptors in CNS, causing inhibiting or ascending pain pathways, altering perception and response to pain-produces generalized CNS depression -hepatic metab via N-demethylation (CYP 3A4, 2B6, 2C19) to inactive metabolites-excretion: urine (<10% unchanged drug)-increased w/ urine pH <6 -dizziness-drowsiness-lightheadedness-N/V-sweating -baseline ECG (QTc) w/in 30 days starting therapy, then annually-pain relief-respiratory and mental status-BP -needs renal and hepatic adj.-acute bronchial asthma-paralytic ileus-concurrent use of selegiline-BBW: opioid addiction-BBW: QTc prolonguation-BBW: respiratory depression-BBW: oral use only
Methotrexate Methotrexate Injection, solution, injection powder (reconstitution), tablet Cancer/ Rheumatoid Arthritis -folate antimetabolites that inhibits DNA synthesis -irreversibly binds to dihydrofolate reductase inhibiting thymidine synthetase resulting in inhibition of purine and thymidylic acids -cell cycle specific to S phase -<10% degreaded by intestinal flora to DAMPA-hepatic aldehyde oxidates converts it to 7-OH methotrexate-polyglutamates are produced intracellularly and can be converted back to MTX-excretion: urine (44-100%), feces: minimal -ulcerative stomatitis-leukopenia-N-abdominal distress-rash-nephrotoxicity-hepatotoxicity-cough-anemia-ulcerative stomatitis-leukopenia-N-abdominal distress-rash-nephrotoxicity-hepatotoxicity-cough-anemia -lab tests should be done on day 5-6 of cycle-CBC w/ differential and platelets-liver biopsy w/ those at risk for liver damage-MTX levels in cancer-chest x-ray (baseline)-pulmonary fxn tests-SCr -needs hepatic and renal adj.-BBW: ARF-BBW: ascites/ plural effusion-BBW: bone marrow suppression-BBW: dermatologic rxns-BBW: diarrhea/ stomatitis-BBW: hepatotoxicity-BBW: lymphomas-BBW: concurrent NSAID use-BBW: opportunistic infections
MiraLax Polyethylene Glycol 3350 Power for oral solution Constipation -osmotic agent causing water retention in the stool, and increases stool frequency -excretion: feces (93%), urine (0.2%) -N/D-abdominal bloating-cramping-flatulence -assess for bowel obstruction prior to use-not to be used for longer than 1 week -use w/ caution in renal impairment-bowel obstruction
Mirapex Pramipexole Tablet Parkinson's -non-ergot DA agonist that binds to D3 and D4 to stimulate DA on the nerves of the striatum and substantia nigra -excretion: urine (90% unchanged drug) -dizziness-somnolence-asthenia-N-constipation-insomnia-hyoptension-dyskinesia-hallucinations-accidents-abnormal dreams -improvement in Parkinson's: mentation, behavior, daily living activities, motor examination's)-BP-body weight changes-HR-degree of somnolence -needs renal adj.-dyskinesias-restless leg syndrome
MS Contin Morphine Sulfate Tablet, CR tablet, ER tablet, rectal suppository, injection solution, infusion (IV) Moderate to Severe pain -binds to opioid receptors in the CNS causing inhibition on ascending pain pathways altering perception and response to pain-produces generalized CNS depression -metab: hepatic via conjugation to morphine-6-glucuronide (active metab) and morphine-3-glucuronide (inactive)-excretion: urine (primarily as morphine-3-glucuronide) -constipation-lightheadednes-dizziness-sedation-N/V-dysphoria-euphoria -pain relief-respiratory and mental status-BP-may cause physical or psychological dependence -monitor for overdose -needs renal and hepatic adj-severe respiratory depression-acute/severe asthma-paralytic ileus-SR dosage forms not for GI obstruction-oral soln contra in HF pts-pts w/ head injuries or increased intracranial pressure-circulatory shock-MAOI
Namenda Memantine Oral solution, tablet Dementia associated w/ Alzheimer's Disease -uncompetitive antagonist of the NMDA type of glutamate receptors -binds to intra-pore Mg site w/ longer dwell time to function as a receptor blocker under conditions of excessive stimulation -metab: 3 metabolites w/ minimal activity-excretion: urine (57-82%)-reduced w/ alkaline urine pH -dizziness-HA-confusion-HTN-pain-fatigue-vomiting-cough-hallucination-somnolence -hypertension-CNS changes-rash-constipation -needs renal adj-urine pH, decreased clearance in alkaline urine
Naprosyn/ Anaprox/ Aleve Naproxen Caplet, capsule, gelcap, oral suspension, tablet, DR tablet (EC), ER tablet Pain/ Inflammation -reversibly inhibits COX 1 and 2 resulting in decreased prostaglandin precursors-also has anti-pyretic, analgesic and anti-inflammatory activity -hepatic metab to metabolites-excretion: urine (95% as metabolites), feces (3%) -SOB-indigestion-tinnitus-edema-itching-constipation-dizziness-HA-N/V -occult blood loss-periodic liver fxn tests-CBC-BUNSCr-urine output -needs renal adj.-BBW: perioperative pain after CABG surgery-BBW: CV events-BBW: GI events-asthma-hepatic impairment-HTN
Nasonex/ Asmanex Mometasone Intranasal suspension Allergic rhinitis -depress formation, release, and activity of endogenous chemical mediators of inflammation -inhibits margination and cell migration into site of injury -reverses dilation and increased vascular permeability decreasing cells to get to the site of injur -hepatic metab via 3A4 to metabolite-excretion: feces, bile, and urine -local burning-itching-skin atrophy-HA-viral infections-pharyngitis-epistaxis -HPA axis suppression-asthma-FEV1-peak flow-pulmonary fxn tests-monitor growth in peds pts -treatment of acute bronchospasm-CVD-DM-GI disease-hepatic impairment-myasthenia gravis-MI-ocular disease-OP-renal impairment-seizure disorder-thyroid disorder
Neoral/ Sandimmune/ Gengraf/ Restasis Cyclosporine Capsule, gel capsule, ophthalmic emulsion, injection solution, oral solution Oral: prevention of organ rejection-Ophthalmic: increase tear production -inhibits production and release of IL-2-inhibits IL-2 induced activation of resting T lymphocytes -metab: extensive hepatic metab via 3A4 to 25 metabolites-extensive 1st pass following PO admin-excretion: primary feces, some urine -ocular burning-conjunctival hyperemia-discharge-eye pain -BP and SCr after dosage changes-plasma [ ]'s periodically-trough levels-serum electrolytes-renal fxn-hepatic fxn-lipid profile -renal and hepatic adj-abnormal renal fxn-BBW: malignancies-BBW: uncontrolled HTN-concomitant treatment w/ PUVA, UVB, MTX, immunosuppressive agents, coal tar, radiation therapy for pts w/ psoriasis -ocular: contra for active ocular infections
Neupogen/ Neulasta Filgrastim Injection solution Chemotherapy induced neutropenia -stimulates maturation, production, and activation of neutrophils-activates neutrophils to increase migration and cytotoxicity -metab: systemically degraded -fever-petechiae-rash-splenomegaly-alk phos increase-bone pain-epistaxis -CBC w/ differential prior to tx and twice weekly during use -platelets -hypersensitivity to e. coli products-sickle cell disease -do not use 24 hours prior or after chemotherapy
Neurontin Gabapentin Capsule, tablet, oral solution Seizures -may modulate the release of excitatory NT's which precipitate in epileptogenesis or noccieption -excretion: proportional to renal fxn-urine as unchanged drug -somnolence-dizziness-ataxia-fatigue-needs renal adj.-w/drawl-sedatives -serum levels of concomitant anticonvulsant therapy-suicidality-adverse effect w/ continuation of therapy-CNS depression-taper slowly when D/Cing -needs renal adj.-w/drawl-sedatives -CNS depression
Nexium Esomeprazole DR capsule, ER tablet, granules or oral suspension, injection powder (reconstitution) GERD -PPI suppresses gastric acid secretion by inhibition of the H/K/ATPase in the gastric parietal cell -hepatic metab via CYP 2C19, 3A4, to 3 metabolites (all inactive)-excretion: urine (80% inactive drug, feces 20%) -HA-N/D-constipation-flatulence-abdominal pain-dry mouth -susceptibility testing in those that fail H. pylori-rebleeding w/ pts that have had a peptic ulcer -hepatic adj. needed-gastric malignancy-GI infection-IV therapy beyond 10 days
NicoDerm/ Nicorette Nicotine Gum, transdermal patch Smoking Cessation -ganglionic and CNS stimulant -stimulation of autonomic ganglion -hepatic metab to metabolites 1/5 as active -excretion: urine-CL is pH dependent -HA-mouth/ throat irritation-dyspepsia-cough-rhinitis -HR and BP-D/C if signs of toxicity-D/C if rash develops -D/C if adverse reactions w/ patch -pts who are smoking post MI-pts w/ life-threatening arrhythmias-severe or worsening angina-active TMJ-pregnant-non-smokers-gum: dental problems may be worsened-inhaler: potential airway irritation -nasal: not recommended for chronic nasa
Niferex Polysaccharide-Iron Complex Capsule, elixir Anemia -replaces iron and allows transportation of oxygen via hemoglobin -excretion: urine, sweat, sloughing of intestinal mucosa, menses -stomach cramping-constipation-N/V-GI irritation-dark stools -serum iron-total iron binding capacity-reticulocyte count-hemoglobin -hemolytic anemia-BBW: iron toxicity-GI disease
Nitrostat Nitroglycerin Injection solution, infusion (IV), capsule, spray, patch, ointment Angina -relaxation of smooth muscle-vasodilator effect of peripheral veins and arteries-reduces cardiac O2 demand (preload)-dilates coronary arteries -improves flow to ischemic areas -extensive 1st pass metab-excretion: urine (inactive metabolites) -transient HA-N/V-dizziness-flushing of face or neck-rapid pulse -BP-HR -concurrent use of PDE-5 inhibitors-angle-closure glaucoma -head trauma or cerebral hemorrhage-severe anemia-allergy to adhesive-hypertrophic cardiomyopathy -long acting agents in pts w/ acute MI or HF
Norvasc Amlodipine Tablet HBP -inhibits Ca from entering slow-channel or select voltage-sensitive areas of smooth vascular muscle and myocardium during depolarization-producing relaxation of coronary vascular smooth muscle and coronary vasodilation-increased myocardial O2 deliver -hepatic metab: >90% to inactive metabolites-excretion: urine (60% inactive metabolite -edema-flushing-HA-fatigue-abdominal pain -HR-BP-peripheral edema -hepatic adj needed-aortic stenosis-idiopathic hypertrophic subaortic stenosis
Novolog Insulin Aspart Injection Solution DM -rapid acting insulin analog -urine excretion -injection site rxns-hypoglycemia-hypokalemia-blurred vision -plasma glucose-electrolytes-HbA1c-serum K -needs hepatic and renal adj-during episodes of hypoglycemia
NuvaRing Etonogestrel/ Ethinyl esstradiol vaginal Vaginal Ring Birth Control Device -inhibition ovulation via negative feedback on the hypothalamus altering secretion of FSH and LH-provides alterations in genital tract including changes in cervical mucous, endometrium, alter tubual transport, alter sperm fertility -hepatic metab via 3A4 to form metabolites-excretion: urine, bile, and feces -HA-N-sinusitis-upper respiratory infection -vaginal secretions-vaginitis-weight gain -physical exam before starting-rule out pregnancy-loss of vision-bulging of the eye-migraine-BP-thromboembolic disorders-depression-glycemic control in DM-lipid profiles-breast exam-pap smear -needs renal and hepatic adj.-history of clots-major surgery w/ prolonged immobilization -CVD, CAD, VHD-HTN-DM-known or suspected breast sarcoma-other cancers-jaundice of pregnancy-heavy smoking
Nystatin Nystatin Topical ointment, oral suspension, tablet, vaginal tablet Fungal Infections -binds to sterol in fungal cell membranes changing cell permeability allowing for leakage of cell wall components -excretion: feces as unchanged product -D/N/V-GI distress-rash-tachycardia-bronchospasma-facial swelling -pain on application -determine cause of fungal infection-avoid skin when applying -hypersensitivity
Omnicef Cefdinir Capsule, powder for oral suspension Bacterial infections -inhibits bacterial cell wall synthesis by binding to PBP -metab: minimal-excretion: urine -D/V-vaginal moniliasis-HA-abdominal pain -signs of anaphylaxis during 1st dose -culture and sensitivity before starting-renal fxn -needs renal impairment-allergic to other PCN's
Oxycontin Oxycodone CR tablet, ER tablet Analgesic -binds to opioid receptors in the CNS causing inhibition of ascending pathway altering perception and response to pain-CNS depression -hepatic metab to CYP 3A4 to metabolites-excretion: urine -constipation-N/V-somnolence-dizziness-puritis-HA -pain relief-respiratory and mental status-BP -needs hepatic adj. -significant respiratory depression-hypercarbia-acute of severe bronchospasm-paralytic ileus-pregnancy: prolonged or high doses-BBW: abuse potential-BBW: CR tablets
Patanol/ Patanase Olopatadine Ophthalmic solution Allergic conjunctivitis -H1 blocker inhibiting release of histamine from mast cells -inhibits histamine induced effects on conjunctival epithelial cells and the respiratory tract -metab: not extensively metabolized-excretion: urine (main) and feces -HA-asthenia-blurred vision-burning or stinging-cold symptoms-dry eye -adverse nasal effects -wait at least 10 minutes before reinserting contacts after applying dose
Paxil (CR) Paroxetine Oral suspension, tablet, ER tablet, CR tablet Depression -SSRI, inhibition of 5HT reuptake from brain synapse stimulates 5HT activity in the brain -hepatic metab via 2D6 to metabolites -excretion: urine primarily as metabolized drug and feces via bile -N/D-somnolence-HA-asthenia-sexual dysfunction-constipation-dizziness-insomnia-sweating-abnormal ejaculation -mental status for depression-suicide ideation-anxiety-social functioning-mania-panic attacks-hepatic and renal function -needs hepatic and renal adj.-use w/in 14 days of MAOI-concurrent use of pimozide-BBW: suicide ideation in young-CVS-narrow-angle glaucoma-seizure disorder
Percocet Acetaminophen & Oxycodone Tablet Pain - blocks pain perception in cerebral cortex by binding to opiate receptors, decreasing chemical transmission and inhibiting flow of pain to higher centers-APAP inhibits synthesis of prostaglandins in CNS peripherally blocking pain impulse generation -hepatic metab via 3A4 to metabolites-excretion: urine (mostly metabolites) Constipation, dizziness, dysphoria, euphoria, lightheadedness, N/V, pruritis, respiratory depression, sedation, skin rash -pain relief-respiratory & mental status-BP-constipation Contraindicated in severe respiratory depressionCaution in CNS depression, hepatotoxicity, hypotension, and phenanthrene allergy
Phenergan Promethazine Tablets, suppository, syrup, injection Nausea Competitively inhibits histamine at H1 receptor -hepatic metab via oxidation to metabolites-excretion: urine and feces (inactive metabolites) Drowsiness, rash, N/V, blurred vision, dry mouth -mental status Pts with LRI and children <2Injection not used in comatose patientsCaution in narrow angle glaucoma, BPH, CVD, impaired liver fxn, peptic ulcers
Phenobarbital Phenobarbital Tablets, elixir, injection Seizures -Produces sensory cortex depression through inhibition of conduction in the reticular formation at the thalamusGABA like action of increased chlorine conductance-Elevates seizure threshold by decreasing post synaptic excitation -hepatic metab via oxiction and glucuronidation-excretion: urine (20-50% unchanged drug) Somnolence, drowsiness, dizziness, light headedness, residual sedation, ataxia, nausea, hyperactivity, HA, unsteadiness, skin rash, blood dyscrasias -serum [ ]'s-mental status-CBC-LFT's-seizure activity Hypersensitivity to barbituates and history of manifest or latent porphyriaCaution in pts with acute or chronic pain, or impaired liver fxnCaution in depressed, suicidal tendencies, and history of drug abuse
PhosLo Calcium Acetate Gelcap Hyperphosphatemia -Combines with dietary phosphate to form insoluble calcium phosphate which is excreted in feces-Phosphate binder -excretion: feces (as unabsorbed Ca), urine Mild to severe hypercalcemia (N/V, constipation, anorexia, confusion, delirium, stupor, coma) -serum Ca and P Contraindicated in pts w/ hypercalcemia or renal calculiCaution in pts at risk for arrhythmias, hypoparathyroid disease, gastrointestinal problems (may cause bloating, constipation, and gas)
Plan B/ Plan B One Step Levonorgestrel Tablet Pregnancy prevention Affects ovulation, sperm transport, and prevents fertilization Thought to prevent a pregnancy from starting by impeding implantation -hepatic metab to inactive metabolites-excretion: urine and feces N/V, headache, dizziness, heavier or lighter menstrual bleeding, breast tenderness, abdominal pain -serum glucose in DM pts-lipids in pts w/ hyperlipidemia-prolonged bleeding-irregular menses-follicular atresia-atoptic pregnancy No contraindications
Plavix Clopidogrel Tablet Stroke prophylaxis Inhibits platelet aggregation by irreversibly modifying platelet receptors, selectively inhibiting binding of ADP to receptor (platelets)Inhibits ADP mediated activation of glycoprotein GPIIb/IIIa complexDecreases platelet-fibrinogen binding -hepatic metab via ester-hydrolysis to inactive metabs and CYP 450 via oxidation to active metab-excretion: urine and feces N/V, constipation,Increased risk of bleeding, CBC abnormalities, URIs, chest pain, HA, flu like symptoms, arthralgia, dizziness, back and abdominal pain, dyspepsia, HTN, edema(all under 10%) -signs of bleeding, Hgb, Hct Active bleeding such as peptic ulcer or intracranial hemorrhageCaution in pts at risk for bleeding (trauma or surgery)Caution in severe hepatic disease
Potassium Chloride Potassium Chloride Tablets, powder, controlled release crystals, extencaps Prevention and prophylaxis of potassium deficiency Increase potassium levels -excretion: urine, skin, feces (most is reabsorbed) N/V/D, abdominal discomfortHypokalemia may cause muscle weakness, leg cramps, irregular heartbeats -serum K-blood glucose-serum Cl-pH-cardiac monitor Hyperkalemia, patients with condition that prevents tablet from passing through GI tract undelayedCaution in patients with impaired renal function
Prednisone Prednisone Tablets, solution Inflammation Adrenocorticoids bind to certain receptors found in cytoplasm of cells and form steroid-receptor complex which enters nucleus and reacts with chromatin or DNA.This stimulates transcription of mRNA which synthesis proteins that carry out anti-allergy or -hepatic metab to active metabolite-excretion: urine (small portion) behavioral disturbances (depression, anxiety), peptic ulceration, myopathy, growth suppression, weight gain (increased appetite and fluid retention), hyperglycemia, GI upset, insomnia, increased WBC, buffalo hump, moon faciesBlurred vision, upset stomac -BP-glucose-electrolytes-prolonged use: bone mass, density, growth in children, infection, cataract formation Absolute contraindicated in active systemic fungal infections or TBRelative contraindicated in active infection, glaucomaCaution in pts with ocular herpes simplex, hypothyroidism, cirrhosis, ulcerative colitis, diverticulitis, intestinal anastomos
Prempro COnjugated Estrogens/ Medroxyprogesterone Tablets Hormone replacement therapy Enter cells of responsive tissues are transported to nucleus where they stimulate RNA and protein synthesisMedroxyprogesterone increases synthesis of RNA by interacting with chromatin causing transformation of proliferative endometrium into secretory -metab in liver-excretion: urine Rash, acne, alopecia, hirsutism, abnormal menstrual BLEEDING, edema, changes in weight, cholestatic JAUNDICE, changes in cervical secretions, mental depression, pyrexia, insomnia, nausea, somnolence. Erratic bleeding -serum cholesterol, HDL, LDL, TG-menopausal symtpoms-boen density measurments Known or suspected breast cancer or estrogen dependent neoplasia, pregnancy, abnormal genital bleeding or pts with history of thromophlebitis, thrombosis or thromboembolic diseaseDo not use in pts with liver disease
Prograf Tacrlimus Capsule, injection Prevention of organ rejection Suppresses cellular immunity (inhibits T-lymphocyte activation) by binding to intracellular protein, FKBP-12 and complexes with calcineurin dependant proteins to inhibit calcineurin phosphates activity -hepatic metab via 3A4 to 8 metabolites-excretion: feces (93%), urine HTN, nephrotoxicity, edema, HA, insomnia, pain, dizziness, N/V/D, abdominal pain, electrolyte imbalances, infections, anemia -renal & hepatic fxn-serum cholesterol-glucose-BP-anaphylaxis during 1st 30 min of infusion Black box warning for increased risk of infectionsBlack box warning for association with development of lymphoma
Proscar/ Propecia Finasteride Tablet BPH Competitvely inhibits 5-alpha reductase which is responsible for metabolizing testosterone to DHT in the prostate, liver, and skin -hepatic metab via 3A4 for 2 active metabolites-excretion: feces and urine (as metabolites) Impotence, decreased libido -signs of relief-improvement in urine flow-relief in difficulty urinating Women and childrenPregnant women should not handle crushed tablets or be exposed to semen from patient taking proscar
Proventil/ ProAir/ Ventolin Albuterol Inhaler, solution Bronchospasm Stimulates adenylate cyclase which catalyzes the formation of c-AMP from ATPThis relaxes bronchial, uterine, and vascular smooth muscle through stimulation of beta 2 adrenergic receptors -hepatic metab to inactive sulfate-excretion: urine N/V, nervousness, HA, insomnia, tremor, agitation, dizziness, HTN, tachycardia, palpitations, hypokalemia (rare) -FEV1-peak flow-BP-HR-CNS stimulation-glucose-serum K Caution in patients with CVD, HTN, hyperthyroidism, DM, pregnancy
Provigil Modafinil Tablets Narcolepsy Exact MOA unknownBinds to dopamine transporter and inhibits dopamine reuptake in parts of the brainMay have something to do with adrenergic activity; decreased GABA -hepatic metab via multiple pathways-excretion: urine (as metabolites) HA, nausea, anxiety, rhinitis, diarrhea, back pain, dizziness, insomnia, dyspepsia, serious RASH (SJ), psychiatric effects (hallucinations) -levels of sleepiness-BP-CV risk-HR-EKG prior to starting Patients with history of SJ rash, childrenCaution in patients with MI or unstable anginaReduced dose in patients with hepatic impairment
Prozac Fluoxetine Tablet, capsule, liquid Depression Blocks neuronal uptake of serotonin into platelets in CNS -hepatic metab via 2C19 and 2D6 to active metabolite-excretion: urine Nausea, insomnia (sleep disturbances), anorexia, HA, nervousness, drowsiness, tremor, diarrhea, sweating, decreased libido, abnormal ejaculation, fatigue,Agitation, dizziness, constipation, weight loss/gain, GI bleed -mental status-suicide ideation-anxiety-social fxn-mania-panic attacks-akathisia-sleep status-blood glucose-LFT's Pts taking MAOIs, and thioridazineCaution in dispensing large quantities due to suicide attemptsCaution in patients with liver disease, children, and elderly
Pulmicort/ Rhinocort/ Entocort Budesonide Suspension, inhaler Asthma Adrenocorticoids bind to certain receptors found in cytoplasm of cells and form steroid-receptor complex which enters nucleus and reacts with chromatin or DNA.This stimulates transcription of mRNA which synthesis proteins that carry out anti-allergy or -hepatic metab via 3A4 to 2 minor metabolites-excretion: urine and feces (as metabolites) HA, asthenia, pain, dyspepsia, N/V/D, oral thrush, cough, respiratory infection, rhinitis, sinusitis, otitis media -BP-serum gluocse-weight-growth in children Contraindicated in primary treatment of status asthamticusCaution in switching patients from systemic corticosteriods due to adrenal insufficiency
Pyridium Phenazopyridine Tablet Symptomatic relief of UTIs Exact MOA is unknownExcreted in the urine where it exerts topical analgesic effects on urinary tract mucosa -hepatic metab and other tissues-excretion: urine (65% unchanged drug) HA, rash, discoloration of urine, GI disturbance -none Contraindicated in patients with renal unsufficiency
Reclast/ Zometa Zoledronic Acid Injection OP Bisphosphonate which inhibits bone resorption via actions on osteoclastsInhibits osteoclastic activity, reducing bone turnoverInhibits osteoclasts from binding to bone -excretion: urine (w/in 24 hours), feces HTN, pain, fever, HA, chills, fatigue, nausea, arthralgia, myalgia, flu like syndromeAbdominal pain (most common) constipationdiarrhea, flatulenceAtrial fibrillationAcute flu like syndrome within 3 days of infusion (resolves within 3-4 days) -baseline dental exam-alk phos-SCr-Ca-P-Mg -LFT's-EKG-BMD Contraindicated in pts w/ hypocalcemia and renal insufficiencyCorrect vitamin D and mineral deficiencies before initiating therapy Caution in history of hypoparathyroidism due to risk of hypocalcemia Bisphosphonate therapy has been associated wi
Reglan Metoclopramide Injection, syrup, tablet Symptomatic relief of GERD and nausea,Diabetic gastroparesis Inhibition of dopamine receptors which decreases nerve transmission from afferent nerves to vomiting center and increases vomiting center thresholdImbalance between dopaminergic and cholinergic actions in GI tract through inhibition of dopamine induce -excretion: urine Restlessness, drowsiness, tardive dykinesia (involuntary movements of face and extremities), fatigue, insomnia, anxiety, agitation, EP effects (dystonias, akathisia, parkinsonian features), DIARRHEA -dystonic rxns-hypoglycemia-agitation-confusion-renal fxn Contraindicated in pts with pheochromocytoma, GI hemorrhage, mechanical obstruction or perforation, and epilepsyDo not use in patients taking meds that cause extrapyramidal side effectsCaution in patients with depression, HTN, or parkinsonism
Remeron Mirtazapine Tablets, ODT Depression Antagonist at central presynaptic alpha 2 adrenergic inhibitory auto and heteroreceptors, which increases central noradrenergic and serotonergic activityPotent antagonist of 5HT2 and 5HT3 receptors -hepatic metab via oxidation and demethylation to metabolites-excretion: urine and feces (as metabolites) Drowsiness, dry mouth, increased appetite, constipation, weight gain, dizziness, flu symptoms, abnormal dreamsIncreased TGs and TC, some glucose elevationsRare: agranulocytosis, neutropenia, increased LFTs -CbC-mental status-suicide ideation-anxiety-social fxn-mania-panic attacts-lipid profile-infection Increases suicidal thoughts in children and teens (use caution)Caution in geriatrics, renal and hepatic impairment
Renagel/ Renvela Sevelamer Tablet Hyperphosphatemia Binds phosphate within the intestinal lumen limiting absorption and decreasing serum phosphate concentrations w/o altering calcium, aluminum or bicarbCauses a gradient where there is a decreased amount of phosphorous in the GI tract so it pulls phosph -not absorbed-excretion: feces N/V/D, pruritis, dyspepsia, limb pain, arthralgia, nasopharyngitis, bronchitis -serum chemistries Caution in pts with gastrointestinal disordersMay bind drugs in GI tract and decrease absorption (antiarrhthymics and antiseizure meds), take these 1 hour before or 2 hours after sevelamer
Requip Ropinirol Tablet Parkinson's Non-ergoline dopamine agonist with full activity at D2 and D3 receptorsStimulation of post synaptic dopamine receptors within the caudate-putamen in the brain -hepatic metab via 1A2 to inactive emtabolites-excretion: urine (mainly meatbolite)-CL reduced in pts >65 yo Nausea, dizziness, somnolence, syncope, fatigue, dyspepsia, viral infections -BP-daytime alertness Sudden initiation of sleep without warningInhibits prolactin secretion and potentially inhibits lactation
Risperdal Risperidone Tablet, ODT, oral solution, fowder for injection Schizophrenia, bipolar Exact MOA unknownDirect antagonism of dopamine and serotonin receptors in the CNSPotent serotonin blockade with weaker dopamine blockadeBinding affinity:D2--high5HT2A--very highAlpha 1--highH1--modM1--none -hepatic metab via 2D6 and N-dealkylation to metabolites-excretion: urine and feces EXTRAPYRAMIDAL SYMPTOMS, insomnia, agitation, anxiety, somnolence, N/V, constipation, dyspepsia, rhinitis, TACHYCARDIA, dry skin, RASH, orthostatic hypotension, hyperprolactinemia -weight/ BMI-waist circumference-BP-FPG-FLP If NMS occurs, stop treatmentCaution in patients with bradycardia, electrolyte disturbances, or CVD (may increase QT interval or cause orthostatic HTN)Caution in patients with history of seizuresDo not dispense large quantities to suicidal pat
Rocephin Ceftriaxone Infusion, Injection Bacterial infections Inhibits cell wall synthesis by binding to PBPs which inhibits the final transpeptidation step of peptidoglycan in bacterial cell walls3rd generation ceph -excretion: urine (unchanged drug) and feces (inactive) IM: induration, warmth, tenderness -culture and sensitivity tests-anaphylaxis Contraindicated in hyperbilirubinemic neonates (less than 2 months), causes kernicterusCaution in pts w/ a PCN allergy, renal or hepatic disease, or gastrointestinal disease
Seroquel Quetiapine Tablet Schizophrenia, bipolar Multiple NT antagonist with activity at 5HT1a, 5HT2, D1, D2, H1, and alpha 1 and 2 receptorsMOA is due to action at D2 and 5Ht2 receptorsWeaker serotonin and D2 blockerReceptor affinity:D2--low5HT2A--lowAlpha 1--highH1--highM1--mod -hepatic metab via 3A4 to metabolites-excretion: urine (as metabolites) and feces Somnolence, dizziness, constipation, othostatic hypotension, dry mouth, dyspepsia, sedation, weight gainLess EPS and hyperprolactinemia -eye exam-weight/ BMI-waist circumference-BP-FPG-FLP Elderly pts with dementia related psychosis are at increased risk of deathMay increase suicidal thinking (black box warning)Caution in pts with hypotension, seizures, dysphagia, hypothyroidism, or history of breast cancerClosely monitor gluc
Sinemet Carbidopa/ Lovadopa Tablet, CR tab Parkinson's Levodopa crosses the BBB and is converted into dopamine in the basal gangliaCarbidopa inhibits dopa-deoxycarboxylase in extracerebral tissue, increasing levels of levodopa in the CNS--decreases side effects (nausea) from high levels of peripheral dopami -metab via gut, liver, kidney's to dopamine-excretion: urine Dystonic or involuntary movements depression, dementia, nausea -BP-symptoms of parkinson's-dyskinesia-mental status Contraindicated in narrow angle glaucoma, patients with a suspicious undiagnosed skin lesion or history of melanoma or patients taking MAOIs within 14 daysCaution in patients with psychosis, severe CVD or pulmonary disease, peptic ulcer, bronchial ast
Singulair Montelukast Tablet, chew tab, granules Asthma Binds with high affinity and selectivity to the CysLT1 receptor and inhibits physiologic actions of LTD4 (leukotriene) -hepatic metab via 3A4 and 2C9-excretion: feces (primary) and urine Similar to placeboHA (18%), influenza, cough, abdominal pain, dyspepsia, dizziness (all under 5%) -mood and behavior changes-suicide ideation Not indicated for reversal of bronchospasm in acute attackDo not replace oral or inhaled steroids with Singular w/o tapering steroid doseNot used as monotherapy for exercise induced asthma
Spiriva Tiotropium Inhalation powder COPD Long acting antagonist of ACh at M1, M2, M3 receptors in smooth muscle of bronchial tree, results in bronchodilation for over 24 hours -hepatic metab via 2D6 and 3A4-excretion: urine and feces Dry mouth -FEV1-peak flow Contraindicated in patients allergic to atropine or derivativesCaution in patients with renal impairment, narrow angle glaucoma, BPH, or bladder neck obstruction
Strattera Atomoxetine Capsules ADHD Exact MOA is unknownSelective inhibition of presynaptic NE transporterSelective NE reuptake inhibitor -hepatic metab via 2D6 and 2C19 to metabolites-excretion: urine and feces Children--dyspepsia, N/V, fatigue, appetite suppression, dizziness, mood swingsAdults--dry mouth, constipation, impotence, urinary retention, insomnia, ejaculation problems, decreased libido, dysmenorrheaPoor metabolizers of CYP2D6 are at increase -LFT's-BP-pulse-attention-hyperactivity-anxiety Contraindicated in pts with narrow angle glaucoma and pts taking MAOIs within 14 days, cardiac structural abnormalities, cardiomopathyMay increase suicidal thoughts in children (black box warning)Caution in pts with HTN, tachycardia, CVD
Synthroid/ Levoxyl Levothyroxine Tablet, Injection Hypothyroidism Exact MOA is unknownRegulation of growth and developmentIncrease in metabolic rateInhibition of secretion of thyrotropin from pituitaryVarious effects on lipid and carbohydrate metabolism -hepatic metab-kidney and periphery gluconuride and conjugation-excretion: urine and feces Adverse effects (other than overdose) is rareOverdose results in hypermetabolic state (fever, hypoglycemia, HF, fluid loss, tachycardia, anxiety, insomnia) -TSH-FT4 Relatively contraindicated in pts with uncorrected adrenal insufficiency, untreated thyrotoxicosis, and pts with acute MICaution in patients with CVD, hypopituitarism, diabetes, or pts taking anticoagulants
Tamiflu Oseltamivir Capsules, powder for oral suspension Influenza Inhibition of virus neuraminidase and alteration of virus particle aggregation and release Prevents budding of new virus -hepatic metab to inactive metabolites -excretion: urine (primary) and feces N/V/D are most common and usually subside after 2 daysRare cases of anaphylaxis, SJ syndrome, and toxic epidermal necrolysis have occurred -S/SX of unusual behavior-PCR-viral culture Not considered a substitute for influenza vaccine yearlyBeginning 40 hours after symptoms is not effective
Tegretol Carbamazepine Tablet, chew tab, suspension Seizures Reducing polysynaptic responses and blocking post tetanic potentiationAugments GABA, decreases NE and dopamine turnoverInhibition of voltage gated sodium channels -hepatic metab via 3A4 to active epoxide metabolite-excretion: urine and feces Dizziness, N/V, drowsinessRare reports of aplastic anemia, agranulocytosis, and SJAtaxia, tremors, sedation, blurred vision, slurred speech nystagmus, (like being drunk) confusion, diarrhea, elevated LFTs, hyponatremia (SIADH), rash, neutropenia -drug levels-BMP-pregnancy test-CBC w/ platelets-LFt's-EKG >40 yo-electrolytes-rash-skin abnormalities Black box warning for aplastic anemia and agranulocytosisContraindicated in pts allergic to trycyclic compounds and with bone marrow depressionCaution in pts with increased intraocular pressure, cardiac disorders, renal or hepatic impairment, or p
Tekturna Aliskiren Tablet HTN Direct renin inhibitorBlocks conversion of angiotensinogen to angiotensin 1 which decreases the production of angiotensin IIBinds to renin, inhibiting cleavage and therefore preventing the formation of Ang I, Ang II and aldosterone. Usually used -unknown metab-excretion: urine and feces Dizziness, orthostatic hypotensionDiarrhea, abdominal pain/dyspepsia, cough, angioedema, rash -BP-K-BUN-SCr Contraindicated in pregnancyCaution in pts w/ a history of angioedema, at risk for hyperkalemia, or hypotensionCaution in pts w/ severe renal impairment
Tessalon Benzonatate Capsules Cough Peripherally anesthetizes stretch receptors located in respiratory passages, lungs, and pleura by dampening their activity and reducing cough reflex -not known well (shitty i know) Drowsiness, HA, constipation, nausea, pruritis, nasal congestion, sensation of burning in the eyes -pts chest sounds-respiratory pattern Caution in pts allergic to anesthetic agents of para-aminobenzoic class (procaine, tetracaine)Overdosage may result in deathSevere life threatening rxns including CV collapse and bronchospasm have occurred from chewing or sucking capsules
Topamax Topiramate Tablets, sprinkle caps Seizures Exact MOA is unknownAction potentials elicited repetitively by sustained depolarization of neurons are blocked in a time dependent manner, state dependent sodium channel blockingIncreases frequency of GABA-A activation, enhances GABA to induce a flux -hepatic metab via 450 enzymes-excretion: urine (mainly as unchanged drug) Dose related--Fatigue, nervousness, difficulty w/ concentration, confusion, depression, anorexia, weight lossNon-dose related--somnolence, dizziness, ataxia, speech difficulties, psycohmotor slowing (cognitive dulling), abnormal vision, difficulty w -serum bicarb-ammonia levels-seizure frequency-hydration status Acute myopia associated with secondary angle glaucoma has been reported
Toprol XL/ Lopressor Metoprolol Tablets, ER tabs, injection HTN Cardio selective beta 1 blocker,Decreases HR and cardiac output,Decreases systolic and diastolic BP,Inhibits isoproterenol tachycardia,Decreases reflex orthostatic tachycardiaDecreases effect of NE -hepatic metab via 2D6-extensive 1st pass-excretion: urine Dizziness, fatigue, depression, shortness of breath, diarrhea, bradycardia -IV: EKG, BP-oral; HR, BP Contraindicated in pts with sinus bradycardia, heart block greater than first degree, overt cardiac failure, pts w/ HR <45 BPM, systolic BP <100, or moderate to severe cardiac failureCaution in pts with bronchospastic diseases (asthma, COPD), thyrotox
Toradol/ Acular Ketorolac Tablet, injection, solution, ophthalmic solution inj: mod to severe pain-oph: ocular pain and itching Reversibly inhibits COX 1 and 2 which decreases formation of prostaglandin precursors -hepatic metab-excretion: urine (mainly unchanged drug) and feces HA, gastrointestinal pain, dyspepsia, nauseaOphthalmic--transient burning/stingingMost likely to cause ulcer -CBC-platelets-liver and renal fxn-pain response -weight gain-inflammation-bleeding-bruising-confusion -Contraindicated in pts allergic to ASA or NSAIDs-Contraindicated before a major surgery or in CABG surgery-Contraindicated in pts w/ renal impairment-Contraindicated in pts on ASA or NSAID therapy-Dose adj needed in pts over 65-Contraindicated
Tricor Fenofibrate Tablet Elevated Cholesterol Lowers TC, LDL, and TGs by activation of peroxisome proliferator activated receptor A (PPARa)Increases lipolysis and elimination of TG rich particles from plasma by activating lipoprotien lipase and reducing production of apoprotein CIIIDecrease in TG -tissue and plasma esterases to active metabolites-excretion: urine and feces Higher risk of abnormal liver fxn tests, RASH, MUSCLE PAIN, Tenderness, WeaknessDyspepsia, N/V, skin rash, gallstones, myopathy -LFT's-blood counts-cholesterol, LDL, HDL, TG Contraindicated in pts w/ hepatic or severe renal dysfunction, or gall bladder diseaseIncreases cholesterol excretion into bile may cause gall stonesDo not use in pregnancy or nursing mothers
Tussionex Hydrocodone/ Chlorpheniramine ER suspension Cold and Allergy Symptoms Hydrocodone depresses the cough reflex center in the medulla oblongataChlorpheniramine is an H1 histamine antagonist which possesses anticholinergic activity -hepatic metab: O and N demethylation and reduction-excretion: urine Pruritis, drowsiness, constipation, dry mouth, N/V -LFT's Extra caution postoperatively and in pts with pulmonary disease, obstructive bowel disease, increased intracranial pressure, or head injuryCaution in pts w/ renal or hepatic impairment, narrow angle glaucoma, asthma, BPH, or Addison's disease
Tygacil Tigecycline Powder for injection Bacterial Infections Glycylcycline abx binds to 30s ribosomal subunit inhibiting protein synthesis -hepatic metab via glucuronidation, N-acetylation, and eperimization to several metabolites-excretion: feces (primarly unchanged drug) and urine N/V/D -culture and sensitivity- Caution in pts w/ allergy to TCNs due to structural similarityCaution in pts w/ hepatic impairment
Tylenol w/ Codeine APAP/ Codeine Tablets, Elixir Mild to moderate pain APAP produces analgesia by inhibiting prostaglandin synthesis in CNS and peripheral action by blocking pain impulse generationCodeine produces analgesia centrally via action on central opiate receptors -hepatic to morphine-excretion: urine Dizziness, drowsiness, constipation, N/V -relief of pain-menal and respiratory status-BP-bowel fxn Caution in pts with increased intracranial pressure, head injury, severe hepatic or renal impairment, addison's disease, hypothyroidism, BPH or urethral stricture, or acute abdominal conditions
Ultracet Tramadol/ APAP Tablet Acute Pain Tramadol is a centrally acting synthetic opioid analgesicBinding to mu receptors and inhibition of reuptake of NE and serotonin -hepatic metab via demethylation to active metabolite-excretion: urine (mainly meatabolite) Constipation somnolence, increased sweating, diarrhea, nausea, anorexia, dizziness, seizures, dry mouth, pruritis, insomnia (all under 6%) -pain relief-respiratory rate-BP-HR-signs of tolerance-abuse Contraindicated in acute intoxication with alcohol, hypnotics, centrally acting analgesics, opioids, or psychotropic drugsIncreased risk of seizures in pts w/ epileptic disorder or pts on SSRIs, TCAs, MAOIs, other opioids, or neurolepticsDo not us
Valium Diazepam Tablet, injection, oral concentrate, rectal gel Anxiety Facilitate inhibitory NT action of GABA which mediates both pre and post synaptic inhibition in all regions of CNSStimulates GABA -hepatic metab-excretion: urine Drowsiness, ataxia, fatigue -respiratory, CV, mental status Contraindicated in pts allergic to benzos, children under 6 months, narrow angle glaucoma, untreated open angle glaucomaCaution in pregnancy and patients with impaired renal or hepatic fxn or depression
Vancocin Vancomycin Tablet, Infusion, powder for injection Gram + Bacterial Infections Inhibits bacterial cell wall synthesis by blocking glycopeptide polymerization through binding tightly to D-alanyl-D-alanine portion of cell wall precursorMay inhibit RNA synthesis -excretion: urine (mainly unchanged drug) Hypotension, flushing, rash (redmans syndrome), nephrotoxicity, phlebitisOral: bitter taste, N/V -renal fxn-trough [ ]'s before 4th dose-Red Man's syndrome-phlebitis at time of infusion Contraindicated in pts w/ severe hearing lossCaution in nephrotoxicity, neurotoxicity, and renal impairment
Veetids Penicillin VK Tablet, powder for oral solution Bacterial infections, syphillis, pre-dental issues, strep Inhibits bacterial cell wall synthesis via acylation of transpeptide enzymeOccurs in 3rd and final stage of cell wall synthesis -excretion: urine and as metabolites N/V/D, HIVES, itching, RASH, allergic rxns, seizures (rare) -renal and hematologic fxn-anaphylaxis w/ 1st dose-culture and sensitivity test Contraindicated in pts allergic to PCNs or cephalosporins
Viagra Sildenafil Tablet ED Inhibits phosphodiesterase 5 which degrades cGMP in the corpus cavernosumIncreased cGMP allows inflow of blood and erection -hepatic metab via 2C9 (minor) and 3A4 (major) to active metabolite-excretion: feces (main) and urine HA, flushing, dyspepsia, nasal congestion, UTI, abnormal vision, diarrhea, dizziness, rash -CV status b4 starting Contraindicated in pts taking nitratesCaution in pts predisposed to priapism such as those with sickle cell, multiple myeloma, or leukemia, or patients with anatomical deformation of penis
Vibramycin/ Vibratabs Doxycycline tablet, capsule, syrup, powder for oral suspension, powder for injection bacterial infections, DOC for chlamydia, acne, MRSA Prevents bacterial protein synthesis by competitively binding to 30S ribosomal subunitBacteriostatic at normal doses -partially inactivated in GI tract by chelation-excretion: feces and urine Dizziness, vertigo, N/V/D, increased sensitivity to sunlight, discoloration of forming teeth, sore or darkened tongue, cramps, burning stomachFanconi's syndrome from outdated TCNs -culture and sensitivity test-renal and liver fxn Caution in children under 8 and in pts with renal dysfunctionClostridium difficile diarrhea has occurred with treatmentContraindicated in 2nd and 3rd trimester and children under 8
Vicodin/ Norco/ Lortab APAP/ Hydrocodone Tablet Moderate to Severe pain Hydrocodone produces analgesia centrally by acting on central opiate receptorsAPAP produces analgesia by inhibiting prostaglandin synthesis in the CNS and through peripheral action by blocking pain impulse generation -hepatic metab via O and N demethylation and reduction-excretion: urine Dizziness, drowsiness, constipation, N/V -pain relief-respiratory and mental status-BP Caution in pts with pulmonary disease, increased intracranial pressure, head injury, severe hepatic or renal impairment. Addison's disease, hypothyroidism, BPH, or acute abdominal conditions
Vimpat Lacosamide Tablet, injection solution Seizures Stabilizes hyperexcitable neuronal membranes and inhibits repetitive neuronal firing by enhancing slow inactivation of sodium channels -hepatic metab to metabolite-excretion: urine (mainly as inactive metab or unchanged drug) and feces Dizziness, HA, nausea -EKG Caution in pts w/ cardiac problems or suicidal thoughtsCaution in renal and hepatic impairment (not recommended in severe hepatic impairment)
Vyvanse Lisdexamfetamine Capsule ADHD Prodrug, when activated causes release of catecholamines (dopamine and NE) from storage sites in presynaptic nerve terminals -non-CYP hepatic metab or intestinal metabolism-excretion: urine and feces (minimal) HA, insomnia, decreased appetite, abdominal pain -cardiac evaluation-HR-BP Black box warning for serious cardiac eventsBlack box warning for drug dependencyCaution in pts w/ HTN, psychiatric disorders, seizure disorder, and Tourette's syndrome
Wellbutrin (SR, XL) Bupropion Tablet, SR tabs, ER tabs Depression Dose related CNS stimulant effectWeak inhibitor of neuronal uptake of NE, serotonin, and dopamineEffects are mediated by NE and dopamine mechanisms -hepatic metab via 2B6 and also non-CYP mediated metabolism-excretion: urine (as metabolites) and feces Dizziness, constipation, weight loss, dry mouth, insomnia, sweating, agitation, TREMOR -body weight-mental status-suicide ideation-anxiety-mania-panic attacks Contraindicated in pts with seizure disorder, history of anorexia or bulimia, alcohol withdrawal or current therapy with MAOICan worsen ticsMay increase suicidal thinking in childrenCaution in patients with impaired liver or kidney fxn
Xalantan Lantanoprost Ophthalmic solution Glaucoma Prostanoid selective FP receptor agonistIncreases outflow of aqueous humor -hepatic metab via beta-oxidation-excretion: urine (as metabolites) Blurred vision, burning, stinging, foreign body sensation, itching, and increase pigmentation of iris -blurred vision-burning-stinging Gradual or permanent change of iris color may occur after several months to years
Xanax Alprazolam Tablet Anxiety Facilitate the inhibitory NT action of GABA which mediates both pre and post synaptic inhibition in all regions of CNS -hepatic metab via 3A4 to 2 active metabolites-excretion: urine Drowsiness, hypotension -respiratory and CV status Contraindicated in pts allergic to benzos or w/ narrow angle glaucomaCaution in pts with primary depression, psychosis, and impaired renal or hepatic fxnWithdrawal symptoms can be serious
Xopenex Levalbuterol Solution for inhalation Asthma Sympathomimetic which stimulates adenyl cyclaseRelaxes bronchial, uterine, and vascular smooth muscle through stimulation of beta 2 receptors -metab in GI tract-excretion: urine and feces only when systemically absorbed Dizziness, pharyngitis, and rhinitisHypokalemia (rare), tremor, agitation -FEV1-peak flow-asthma symtpoms-HR-BP-CNS stimulation-serum K-glucose Caution in pts w/ CVD, HTN, DM, hyperthyroidism, and convulsive disordersCan produce paradoxical bronchospasm which can be life threatening
Yasmin/ Yaz Drospirenone/ Ethinyl Estradiol Tablet Pregnancy Prevention Suppression of LH and FSH resulting in inhibition of ovulationThickening of cervical mucous and alteration of endometrium -hepatic metab via 3A4 to active and inactive metabolites-excretion: urine and feces N/V, abdominal cramping, changes in menstrual flow, amenorrhea, edema, breast tenderness or enlargement, weight changes, migraines, depression, CV disorders, THROMBOEMBLISMRare cases of retinal thrombosis -physical exam w/ pap smear b4 starting-migraines-BP-signs of thromboembolic disorder-depression Contraindicated in renal or hepatic dysfunction, adrenal insufficiency, thromboembolic disorders, breast cancer or estrogen dependent cancer, pregnancy, abnormal genital bleeding, liver tumors developed from OC use, and cerebral vascular or CV disease
Zantac Ranitidine Tablet, effervescent tablet, syrup, injection Ulcers Competitively and reversibly inhibits histamine at H2 receptors on gastric cellsInhibits fasting and nocturnal secretions, secretions stimulated by food, caffeine, insulin, and caused by histamine, gastrin, and muscarinic agonists -hepatic metab to metaboltes-excretion: urine (unchanged drug) and feces (as metabolites) HA, dizziness, constipation, nausea, ABDOMINAL PAINMental status changes (confusion, hallucination, agitation) in elderly, rare blood dyscrasias -AST-ALT-SCr-renal fxn Caution in pts with renal or hepatic impairmentEffervescent tabs contain phenylalanine (caution in phenylketonurics)Reversible hepatitis has occurred
Zemplar Paricalcitol Capsule, Injection solution Hyperparathyroidism Decreased renal conversion of vit D to active metabolite in renal failure which leads to reduced activated vit D which removes inhibitory suppression of parathyroid hormone releaseIncreased PTH reduces calcium excretion and enhances bone resorption -hepatic and non-hepatic metab via glucuronidation and hydroxylation to metabolites-excretion: feces and urine Nausea -Serum Ca and P-PTH Contraindicated in pts w/ vitamin D toxicity and hypercalcemiaCaution in pts on digoxin since toxicity is potentiated by hypocalcemia
Zestril/ Prinivil Lisinopril Tablet HTN, HF Suppression of renin-angiotensin-aldosterone systemCompetitively inhibits ACE which decreases angiotensin II (potent vasocontrictor)Decreases release of aldosterone which decreases sodium and water reabsorptionPrevents degradation of bradykinin -NOT metabolized-excretion: urine (as unchanged drug) Dizziness, HA, fatigue, cough, diarrhea (all less than 6%)Hyperkalemia, cough, angioedema, hypotension, ARF, increased fetal mortalityRare: neutropenia, loss of taste, blood dyscrasias -BUN-SCr-renal fxn-K-CBC Contraindicated in pregnancy and RASContraindicated in patients w/ angioedema from previous ACEI treatmentCaution in renal impairmentPotentially serious hyperkalemia is increased with use of potassium sparing drugs or supplements, DM
Zetia Ezetimibe Tablet Elevated Cholesterol Selectively inhibits intestinal absorption of cholesterol and phytosterolsActs at brush border of small intestine to inhibit cholesterol absorption -glucuronide conjugation in small intestine and liver to metabolites-excretion: feces (unchanged drug) and urine (metabolite) Myalgia, increased CPK, elevations in liver transminases, hepatitis, thrombocytopenia, uticaria, arthralgia, myopathy (rhabdomyolysis), GI discomfort, pancreatitis -TC-LFT's-signs of cholelithiasis Do not use in pts w/ moderate to severe hepatic insufficiency
Zithromax/ Zmax Azithromycin Tablet, powder for suspension, powder for injection Bacterial infections Macrolide Abx binds to 50s ribosomal subunit suppressing protein synthesis -hepatic metab-excretion: biliary (major) and urine DIARRHEA, N/V, abdominal pain (all less than 5%)IV therapy may cause pain at injection site and local inflammation (all less than 7%)HA, cholestatic hepatitis -liver fxn-CBC-culture and sensititity test Contraindicated in pts allergic to macrolides or ketolidesCaution in pts with impaired hepatic fxnPseudomembranous colitis and secondary bacterial infections may occur
Zocor Simvastatin Tablet Elevated Cholesterol Inhibitor of HMG-coA reductaseInhibits rate limiting step of cholesterol synthesisReduces LDL, moderately reduces TGs and VLDL, increases HDL -hepatic metab via 3A4-extensive 1st pass-excretion: feces and urine Constipation, muscle pain, and dyspepsia (all less than 3%) -LFT's-CK Contraindicated in pregnancy, pts w/ active liver disease or elevated LFTsCaution in pts w/ liver dysfunction or who consume large amounts of alcohol
Zofran Ondansetron Tablet, ODT, oral solution, injection Nausea Selective 5HT3 receptor antagonistInhibition of serotonin receptors in small intestine -hepatic metab via glucurinidation, hydroxylation or sulfate conjugation -excretion: urine (mainly metabolites) and feces HA, fatigue, constipation -allergies prior to starting-follow administration directions exactly Not used instead of nasogastric suctionDoes not stimulate gastric or intestinal peristalsisChewable tabs contain phenylalanine (caution in phenylketonurics)
Zoloft Sertraline Tablet, oral concentate Depression Inhibition of CNS neuronal uptake of serotonin -hepatic metab via 2C19 and 2D6 to metabolites-excretion: urine and feces-extensive 1st pass Nausea, diarrhea, (serotonergic side effects)tremor, dizziness, insomnia, sweating, dry mouth, male sexual dysfunction -nutritional intake-weight-mental status-suicide ideation-anxiety-social fxn-mania-panic attacks-akathisia-growth in children Do not use with pimozide or within 14 days of an MOAIMay increase suicidal thoughts in childrenCaution in pts w/ renal or hepatic dysfunctionAbrupt discontinuation may cause adverse effects (irritability, anxiety, confusion, dysphoric mood)
Zosyn Piperacillin/ Tazobactam Infusion, Powder for injection Bacterial Infections Inhibits bacterial cell wall synthesis by binding to PBP which inhibits the final transpeptidation step of petidoglycan synthesis in cell wallTazobactam inhibits beta lactamases -to weak and inactive metabolites-excretion: urine (mainly unchanged drug) and feces Diarrhea, rash, allergic rxn -SCr-BUN-CBC-PTT-s/of bleeding-LFT's-vital signs-culture and sensitivity Caution in pts with renal impairment, seizure disorder or bleeding disorder
Zovirax Acyclovir Capsule, tablet, ointment, cream, suspension, powder for injection Herpes Virus Synthetic acyclic purine nucleotide which in vitro inhibits herpes simplex virus 1 and 2, varicella zoster, epstein-barr, and CMVTaken up and converted to active triphosphate which interferes with DNA polymerase and viral DNA replication -converted by viral and cellular enzymes to active drug-excretion: urine (mainly unchanged drug) Caps/Tabs: N/VOintment: stinging, burning, pruritisInjection: phlebitis, inflammation at injection site, transient creatinine elevations, rash, hives, reversible nephrotoxicityGI effects -urinalysis-BUN-SCr-liver enzymes-CBC Reduce dosage in renal impairmentPrecipitation in renal tubules may occur in dehydrated patients
Zyloprim Allopurinol Tablet Gout Competitively inhibits xanthine oxidase which is responsible for conversion of hypoxanthine to xanthine to uric acid -metabolized to active metabolite-excretion: urine (mainly metabolite) Drowsiness, N/V/D, abdominal pain, RASH (SJ), GI, renal failureRare: hepatomegaly, jaundice, hepatic necrosis, exfoliative dermatitis, SJ, toxic necrolysis -frequency of attacks-uric acid [ ]'s-LFT's-CBC-yearly eye exam Caution in pts with impaired renal or hepatic fxnDecrease dosing to once or twice weekly in severe renal insufficiencyGout attacks may increase during initiation of therapyColchicine and NSAIDs used prophylacticallyDo not initiate or discontin
Zyprexa Olanzapine Tablet, ODT, powder for injection Schizophrenia Selective antagonism of dopamine and serotonin 5HT2 receptors in CNSInhibitor of serotonin 5HT2a/c, muscarinic 1-5, H1, and alpha 1 receptorsReceptor affinity:D2--mod5HT2A--highAlpha1--modH1--highM1--high -CYP 450 glucuronidation and oxidation -extensive 1st pass metab-excretion: urine and feces-CL is reduced in smokers and in females Somnolence, agitation, insomnia, nervousness, hostility, dizziness, rhinitis, anxiety, constipation, dry mouth, weight gain, joint pain, fever, akathesia, tremor, tachycardia, chest/back pain, hypertonia, sedation, lipid and glucose irregularitiesRa -weight/ BMI-waist circumference-BP-FPG-FLP Caution in pts predisposed to seizures, hypothyroidism, or history of breast cancerAssociated with severe hyerglycemic rxns (monitor in DM)Caution in pts predisposed to hypotensionTardive dyskinesia has been reported
Zyrtec Cetirizine Tablets, chew tabs, syrup Allergic rhinitis Human metabolite of hydroxyzineAntagonizes H1 receptors in the peripherySuppresses histamine in the subcortical region of CNS -limited hepatic metab-excretion: urine (primary) and feces Drowsiness, somnolence, fatigue, dry mouthChildren may experience HA, pharyngitis, abdominal pain, D/V -relief of symtpoms-sedation-anticholinergic effects Contraindicated in pts allergic to cetirizine or hydroxyzineCaution in nursing mothers and pts taking CNS depressants
Zyvox Linezolid Tablet, infusion, powder for oral suspension Bacterial infections Inhibits bacterial protein synthesis by binding to 23S ribosomal RNA of 50S subunit preventing formation for a functional 70S initiation complexWeak MAOI-B inhibitor -hepatic metab via oxidation to metabolites -excretion: urine (mainly metabolites) and feces-non-renal CL is increased 65% in children 1 week to 11 years old HA, diarrhea, thrombocytopenia, leukopenia, serotonin syndrome, peripheral neuropathy -CBC-platelets-culture and sensitivity tests Contraindicated in pts on MAOIs within 2 weeks, uncontrolled HTN, or pts taking sympathomimetic or dopaminergic agentsVery closely monitor pts on SSRIs, TCAs, serotonin agonists, meperidine, or buspirone
Created by: lmiklavc



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When you need a break, try one of the other activities listed below the flashcards like Matching, Snowman, or Hungry Bug. Although it may feel like you're playing a game, your brain is still making more connections with the information to help you out.

To see how well you know the information, try the Quiz or Test activity.

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