PHM 415 - Top 82 Drugs Exam

Finasteride

1. Brand Name(s):

Proscar, Propecia

2. FDA Indications/Doses:

Benign Prostatic Hyperplasia (BPH): 5 mg po daily

Male Pattern Baldness: 1 mg po daily

3. MOA:

5-Alpha Reductase Inhibitor

4. Contraindications:

Pregnancy

Use in children

5. Common ADRs:

Impotence

Reduced Libido

6. Counseling Points:

a) Hair Loss: 3 months for effect

b) Enlarged Prostate: 6 months for effect

Doxazosin

1. Brand Name(s):

Cardura, Cardura XL

2. FDA Indications/Doses:

Benign Prostatic Hyperplasia (BPH):

a) IR - 1 mg po daily

b) ER - 4 mg po daily

Hypertension (HTN):

a) IR - 1 mg po daily (max 16)

3. MOA:

Nonselective a1 Blocker

4. Contraindications

N/A

5. Common ADRs:

Dizziness

Fatigue

Malaise

6. Counseling Points:

a) Initial dose should be taken with breakfast

b) May cause orthostatic hypotension or syncope

Tamsulosin

1. Brand Name(s):

Flomax

2. FDA Indications/Doses:

Benign Prostatic Hyperplasia (BPH): 0.4 mg po daily

3. MOA:

Selective a1 Blocker

4. Contraindications:

N/A

5. Common ADRs:

Dizziness

Headache

Abnormal ejaculation

Rhinitis

6. Counseling Points:

a) Administer 30 min after same meal daily

b) May cause orthostatic hypotension or syncope

Oxybutynin

1. Brand Name(s):

Oxytrol (Patch)

2. FDA Indications/Doses:

Overactive or Neurogenic Bladder:

a) Oral (IR) - 5 mg po bid-tid (max qid)

b) Oral (ER) - 5-10 mg po daily (max 30)

c) Gel - 100 mg/g applied once daily.

d) Patch - 1 patch applied twice weekly (women 18+)

3. MOA:

Urinary Antispasmodic Agent

Muscarinic Antagonist

4. Contraindications:

Gastric + urinary retention

Glaucoma

5. Common ADRs:

Constipation

Xerostomia (reduced saliva)

Blurred vision

Application site itching (patch)

6. Counseling Points:

a) Heat prostration

b) Symptoms for 3 months before use.

c) Replace every 4 days to a new site

7. Clinical Pearls:

Cognitive decline in elderly

Tolterodine

1. Brand Name(s):

Detrol, Detrol LA

2. FDA Indications/Doses:

Overactive Bladder:

a) IR - 1-2 mg po bid

b) ER - 2-4 mg po daily

3. MOA:

Muscarinic Antagonist

4. Contraindications:

Gastric + urinary retention

Uncontrolled narrow-angle glaucoma

5. Common ADRs:

Xerostomia (reduced saliva)

6. Counseling Points:

a) Swallow ER capsule whole

b) Heat prostration

Mirabegron

1. Brand Name(s):

Myrbetriq

2. FDA Indications/Doses:

Overactive Bladder: 25-50 mg po daily

3. MOA:

Beta 3 Agonist

4. Contraindications:

N/A

5. Common ADRs:

Hypertension (HTN)

6. Counseling Points:

Monitor BP and HR

Saw Palmetto

1. Brand Name(s):

N/A

2. FDA Indications/Doses:

Benign Prostatic Hyperplasia (BPH): 320 mg/d standardized extract po in 1 or 2 divided doses

3. MOA:

N/A

4. Contraindications:

Pregnancy

Breastfeeding

5. Common ADRs:

N/A

6. Counseling Points:

Take with food for stomach upset

7. Clinical Pearls:

a) Less effective than finasteride

b) Does not impact PSA levels

Sildenafil

1. Brand Name(s):

Viagra, Revatio

2. FDA Indications/Doses:

Erectile Dysfunction: 25-100 mg po prn 1 hour prior to sex

Pulmonary Hypertension: 5-20 mg po tid

3. MOA:

Phosphodiesterase-5 Enzyme Inhibitor

4. Contraindications:

Concurrent nitrates, guanylate cyclase stimulators, and HIV protease inhibitors (for HTN)

5. Common ADRs:

Flushing

Nausea

Headache

Visual disturbances

Lack of blue/green color discrimination

6. Counseling Points:

Take 30 min to 4 hours prior to sex, do not exceed q24h.

Tadalafil

1. Brand Name(s):

Cialis, Adcirca

2. FDA Indications/Doses:

Erectile Dysfunction:

a) Daily use, Cialis only - 2.5-5 mg po daily

b) Prn use - 10-20 mg po 30 min prior to sex (do not exceed q24h)

Benign Prostatic Hyperplasia:

a) Cialis only, 5 mg po daily

b) When combined with finasteride, tadalafil administration should be discontinued at or before 26 week.

Pulmonary HTN:

a) Adcirca only, 40 mg po daily.

3. MOA:

Phosphodiesterase-5 Enzyme Inhibitor

4. Contraindications:

Concurrent nitrates + guanylate cyclase stimulators

5. Common ADRs:

Flushing

Nausea

Myalgia (muscle pain)

Headache

6. Counseling Points:

Seek medical attention if severe skin rash, chest pain, erection lasting >4 hours, tinnitus, dizziness, or shortness of breath.

Hydrochlorothiazide

1. Brand Name(s):

N/A

2. FDA Indications/Doses:

Edema: 25-100 mg po daily

Hypertension (HTN): 12.5-25 mg po daily

3. MOA:

Thiazide Diuretic

4. Contraindications:

Concomitant dofetilide therapy

Anuric patients

5. Common ADRs:

Hypotension

Dizziness

Headache

6. Counseling Points:

a) Take early in the day to avoid nocturia

b) Eat high-potassium foods

c) Avoid alcohol and NSAIDs.

Spironolactone

1. Brand Name(s):

Aldactone

2. FDA Indications/Doses:

Heart Failure (HF): 12.5-25 mg po daily (max 50)

Primary Aldoseronism: 12.5-25 mg po daily

Hypertension (HTN): 50-100 mg po daily

Ascites (cirrhosis of liver): 100 mg po daily

3. MOA:

Potassium-Sparing Diuretic

Mineralocorticoid Receptor Antagonist

4. Contraindications:

Anuria

Acute renal insufficiency

Hyperkalemia

5. Common ADRs:

N/A

6. Counseling Points:

a) May cause dizziness

b) Avoid potassium intake

c) Avoid alcohol and NSAIDs.

7. BBW:

Tumorigenic in animal models

Furosemide

1. Brand Name(s):

Lasix

2. FDA Indications/Doses:

Edema of Volume Overload Related to Heart Failure / Renal Failure: Initial 20-80 mg po daily (max 600)

3. MOA:

Loop Diuretic

4. Contraindications:

Anuria

5. Common ADRs:

Hyperuricemia

6. Counseling Points:

a) Avoid alcohol and NSAIDs

b) Increased risk of sun sensitivity

c) May cause orthostatic hypotension or dizziness

d) Eat high potassium foods

7. BBW:

Fluid and electrolyte loss

Tolvaptan

1. Brand Name(s):

Jynarque, Samsca

2. FDA Indications/Doses:

Hypervolemic or Euvolemic Hyponatremia: Samsca - 15 mg po daily (max 60)

Autosomal Dominant Polycystic Kidney Disease: Jynarque - 45 mg po upon wakening and 15 mg po 8h later

3. MOA:

Selective V2 Antagonist

4. Contraindications:

Anuria

Concurrent use of strong CYP3A4/5 inhibitors

Hypovolemic hyponatremia

5. Common ADRs:

Increased thirst

Nausea

Xerostomia

Polyuria

Fatigue

Diarrhea

6. Counseling Points:

a) Avoid grapefruit juice

b) Avoid fluid restriction for the first 24h of therapy.

7. BBW:

a) Rapid sodium correction

b) Hepatotoxicity

Calcium Carbonate

1. Brand Name(s):

Tums

2. FDA Indications/Doses:

Antacid: 2-4 tablets po q2h prn (max 8g calcium carbonate per 24h)

3. MOA:

Phosphate Binder

Antacid

4. Contraindications:

Hypercalcemia

Renal calculi

Hypophosphatemia

Digoxin toxicity

5. Common ADRs:

Diarrhea

Cramping

Abdominal pain

Constipation

6. Counseling/Clinical Pearls:

a) Food can enhance absorption (not required)

b) Bran, foods high in oxalates, or whole grain cereals may decrease calcium absorption.

7. Clinical Pearls:

a) Calcium citrate better in elderly

b) Divide doses (can lead to kidney stones)

c) Take with Vitamin D

Potassium Chloride

1. Brand Name(s):

Klor-Con

2. FDA Indications/Doses:

Hypokalemia: 20-100 mEq/d po divided 1-5 times daily after meals.

Hypokalemia (prophylaxis): 10-80 mEq/d po daily, divided into 1-4 doses.

3. MOA:

Electrolyte Supplement

4. Contraindications:

Acute renal failure

Structural, pathologic, or pharmacologic causes that delay tablet passage through the GI tract

Hyperkalemia

Addison disease

Acute dehydration

5. Common ADRs:

Nausea

Indigestion

Flatulence

6. Counseling Points:

a) Take with food.

b) Mix in 4 oz of water or juice.

c) Take capsule with apple sauce.

Ferrous Sulfate

1. Brand Name(s):

Feosol, Fer-in-Sol

2. FDA Indications/Doses:

Anemia, Iron Deficiency (Treatment): 60-100 mg elemental iron po bid-qid

Anemia, Iron Deficiency (Prevention): 60-100 mg elemental iron po daily

3. MOA:

N/A

4. Contraindications:

Hemochromatosis

Hemolytic anemia

5. Common ADRs:

GI Irritation

Constipation

6. Counseling Points:

a) May require several weeks for maximum effect.

b) Stools will turn black.

c) Take on empty stomach to maximize absorption (food if nauseas, avoid calcium)

d) Separate by 2-12 hour from tetracycline antibiotics

e) Keep out of reach of children, accidental ingestion may be fatal.

f) Do not crush or chew any formulations.

7. Clinical Pearls:

Vitamin C enhances absorption, but avoid orange juice containing calcium.

Folic Acid

1. Brand Name(s):

FA-8 (OTC)

2. FDA Indications/Doses:

Folic Acid Deficiency: 0.4-1 mg po daily

3. MOA:

Vitamin (Water Soluble)

4. Contraindications:

N/A

5. Common ADRs:

Loss of appetite

6. Counseling Points:

a) May require several weeks for maximum effect.

b) Avoid alcohol

Cyanocobalamin

1. Brand Name(s):

N/A

2. FDA Indications/Doses:

Cobalamin Deficiency (Normal Absorption):

a) Oral: 1000 mcg po daily

b) Nasal: 500 mcg in 1 nostril once weekly

Cobalamin Deficiency (Malabsorption):

a) 100 mcg IM or deep sq injection daily for 6-7 days, then 100 mcg monthly for life.

3. MOA:

Vitamin (Water Soluble)

4. Contraindications:

N/A

5. Common ADRs:

Injection site pain

Arthralgia

Fatigue

Dizziness

Headache

6. Counseling Points:

a) May require several weeks for maximum effect.

b) Take ER with food.

c) Avoid alcohol

Epoetin Alfa

1. Brand Name(s):

Epogen, Procrit, Retacrit

2. FDA Indications/Doses:

Anemia of Cancer Chemotherapy:

a) 40,000 units sq weekly

Anemia of Chronic Renal Failure:

a) Not on Dialysis - 10,000 units sq weekly

b) On Dialysis - 50-100 units/kg IV or sq 3 times per week

Anemia in HIV-infected Patients:

a) 100 units/kg IV 3 times/week

Perioperative Collection of Blood for Allogenic Infusion:

a) 300 units/kg/d sq for 10 days before surgery, on day of surgery, and for 4 days postoperatively.

3. MOA:

Colony Stimulating Factor (CSF)

Erythropoiesis-Stimulating Agent (ESA)

Hematopoietic Agent

4. Contraindications:

Uncontrolled Hypertension (HTN)

5. Common ADRs:

Edema

Hypertension

Diarrhea

Injection site thrombosis

Skin rash

Pruritus

Myalgia

Fatigue

6. Counseling Points:

a) Do not shake, dilute, or expose to light.

b) Store in box in refrigerator, do not freeze.

c) Do not combine remainders from different vials, each vial is single use.

d) May require several weeks for maximum effect.

7. BBW:

a) Stroke (increased CV)

b) DVT

c) Cancer recurrence

Cholecalciferol (Vitamin D3)

1. Brand Name(s):

N/A

2. FDA Indications/Doses:

Dietary Supplementation: see RDA requirements dependent on age.

3. MOA:

N/A

4. Contraindications:

Hypercalcemia

Hypersensitivity malabsorption syndrome

Evidence of vitamin D toxicity

5. Common ADRs:

N/A

6. Counseling Points:

a) Do not exceed RDA

b) Some formulations contain sodium or glucose, use in caution for patients with diabetes of hypertension.

7. Clinical Pearls:

a) Serum concentration of 25-hydroxyvitamin D is accepted as the best measure of vitamin D status. It also is preferred in patients with liver dysfunction.

b) Serum concentrations of 30-40 ng/mL are the optimal range for skeletal health.

c) Calcitriol (1,25-dihydroxyvitamin D) is used in patients with chronic renal failure. Has a higher absorption and a higher risk of hypercalcemia.

d) Vitamin D3 is more effective than vitamin D2 at improving vitamin D levels.

Alendronate

1. Brand Name(s):

Fosamax

2. FDA Indications/Doses:

Osteoporosis Prevention (Men & Postmenopausal Women): 5 mg po daily or 35 mg po once weekly

Osteoporosis Fracture Risk Reduction (Men & Postmenopausal Women): 10 mg po daily or 70 mg po once weekly

Glucocorticoid Induced Osteoporosis: 10 mg po daily or 70 mg po once weekly

Paget Disease: 40 mg po daily for 6 months

3. MOA:

Bisphosphonate

4. Contraindications:

Esophageal Abnormalities

Hypocalcemia

Inability to sit or stand upright for 30 minutes

5. Common ADRs:

Fever

Gastric Ulcers

Decreased calcium

6. Counseling Points:

a) Swallow whole with a glass of water (not flavored water)

b) Remain upright for 30 minutes and then eat food before laying down

Ibandronate

1. Brand Name(s):

Boniva

2. FDA Indications/Doses:

Postmenopausal Osteoporosis (Treatment + Prophylaxis): 150 mg po once monthly

3. MOA:

Bisphosphonate

4. Contraindications:

Esophageal Abnormalities

Hypocalcemia

Inability to sit or stand upright for 60 minutes

5. Common ADRs:

Respiratory Tract Infection

Indigestion

Backache

6. Counseling Points:

a) Swallow whole with a glass of water (not flavored water)

b) Remain upright for 60 minutes and then eat food before laying down

Ethinyl Estradiol / Etonogestrel Ring

1. Brand Name(s):

Nuvaring

2. FDA Indications/Doses:

Contraception: 1 ring inserted vaginally for 3 weeks and removed for 1 week.

3. MOA:

Contraceptive

4. Contraindications:

History of VTE

Endometrial cancer

Uncontrolled HTN

Pregnancy

Smoking at least 15 cigarettes a day and age >35

5. Common ADRs:

Headache

Intermenstrual bleeding

Vaginitis

6. Counseling Points:

a) If the ring falls out

Oral Contraceptives

1. Brand Name(s):

N/A

2. FDA Indications/Doses:

Contraception or Acne: take 1 tablet daily beginning either on sunday start or first day start

3. MOA:

Contraceptive

4. Contraindications:

History of VTE

Breast or endometrial cancer

Uncontrolled HTN

Pregnancy

Smoking or migraine headache if age >35

Hepatic disease

5. Common ADRs:

Weight change

Breast tenderness + swelling

6. Counseling Points:

a) Does not protect against STDs

b) Take drug same time each day

c) Continue to take even if spotting occurs

d) Report immediately if serious effects occur (ACHES acronym)

e) If more than 2 doses are missed, a 7-day backup is required.

7. BBW:

Cigarette smoking and age 35+

Estradiol Oral

1. Brand Name(s):

Estrace (Oral)

2. FDA Indications/Doses:

Vasomotor or Vulvovaginal Symptoms: 1-2 mg po daily for 3 weeks and then 1 week off

Postmenopausal Osteoporosis (Prophylaxis): 0.5 mg po daily

3. MOA:

Estrogen

4. Contraindications:

History of VTE

Breast cancer

Estrogen dependent neoplasm

Pregnancy

5. Common ADRs:

N/A

6. Counseling Points:

a) Do not smoke

b) Report abnormal vaginal bleeding or symptoms of VTE

7. BBW:

a) Endometrial and breast cancer risk

b) Dementia risk

Prenatal Vitamin

1. Brand Name(s):

N/A

2. FDA Indications/Doses:

Diet supplementation during pregnancy: 1 tablet po daily

3. MOA:

N/A

4. Contraindications:

N/A

5. Common ADRs:

Nausea

6. Counseling Points:

a) Contains iron; keep out of reach of children and stools may turn black

b) May take with food for GI upset, but avoid milk

c) If morning sickness occurs, take in the evening

7. BBW:

Iron toxicity

Medroxyprogesterone Oral

1. Brand Name(s):

Provera

2. FDA Indications/Doses:

Abnormal Uterine Bleeding: 5-10 mg po daily

Prevention of Estrogen-Induced Endometrial Hyperplasia: 5-10 mg po daily

Secondary Physiologic Amenorrhea: 5-10 mg po daily

3. MOA:

Progestin

4. Contraindications:

History of VTE (DVT or PE)

History of estrogen or progesterone neoplasia

Pregnancy

Severe liver dysfunction

Abnormal genital bleeding

5. Common ADRs:

Weight gain

Breast tenderness

Amenorrhea

Headache

Nervousness

6. Counseling Points:

Menstrual bleeding should occur 3-7 days after last dose

7. BBW:

a) Increased risk of CVD, breast cancer, and dementia

b) Loss of BMD

c) Not for long term use

Levonorgestrel

1. Brand Name(s):

Plan B

2. FDA Indications/Doses:

Emergency Contraceptive: 1.5 mg po once as soon as possible within 72 hours of unprotected sex

3. MOA:

Contraceptive

4. Contraindications:

Pregnancy

5. Common ADRs:

Nausea

Fatigue

Hypermenorrhea

Abdominal pain

6. Counseling Points:

a) If vomiting occurs within 2 hours, repeat dose

b) Breastfeeding women should pump and discard breast milk for 24 hours after use

7. Clinical Pearls:

a) May be less effective in obese women

Raloxifene

1. Brand Name(s):

Evista

2. FDA Indications/Doses:

Breast Cancer in Postmenopausal Women (Prophylaxis): 60 mg po daily

Postmenopausal Osteoporosis (Prevention and Treatment): 60 mg po daily

3. MOA:

Selective Estrogen Receptor Modulator (SERM)

4. Contraindications:

History of VTE

Pregnancy or lactation

5. Common ADRs:

Hot flashes

Arthralgia

Flu-like symptoms

6. Counseling Points:

a) Increases risk of clots, avoid sitting for too long

7. BBW:

VTE or Stroke

Clonidine

1. Brand Name(s):

Catapres-TTS (Patch)

2. FDA Indications/Doses:

ADHD in Children: N/A

Hypertension (HTN):

a) Oral: 0.1 mg po bid

b) Patch: 0.1 mg/d applied every 7 days

3. MOA:

a2 Agonist

4. Contraindications:

N/A

5. Common ADRs:

Nervousness

Headache

Somnolence

Erythema (patchy)

Xerostomia

6. Counseling Points:

a) Avoid alcohol and CNS depressants

b) Swallow ER tablet whole

c) Avoid abrupt discontinuation to avoid rebound HTN

7. BBW:

Epidural use

Losartan

1. Brand Name(s):

Cozaar

2. FDA Indications/Doses:

Hypertension (HTN): 50 mg po daily

Diabetic Nephropathy: 50 mg po daily

3. MOA:

Angiotensin II Receptor Blocker (ARB)

4. Contraindications:

Pregnancy

5. Common ADRs:

Headache

6. Counseling Points:

a) Avoid sudden discontinuation, rebound HTN can occur

b) Seek medical attention if angioedema, hyperkalemia, or jaundice occurs.

7. BBW:

Pregnancy

Valsartan

1. Brand Name(s):

Diovan

2. FDA Indications/Doses:

Hypertension (HTN): 80-160 mg po daily

Heart Failure (HF): 20-40 mg po bid

Myocardial Infarction (MI): 20 mg po bid

3. MOA:

Angiotensin II Receptor Blocker (ARB)

4. Contraindications:

Pregnancy

Concurrent use with Aliskiren in patients with Diabetes

5. Common ADRs:

Dizziness

Increased BUN

6. Counseling Points:

a) Do not discontinue abruptly, rebound HTN may occur

b) Avoid alcohol and NSAIDS

7. BBW:

Pregnancy

Enalapril

1. Brand Name(s):

Vasotec

2. FDA Indications/Doses:

Heart Failure (HF): 2.5 mg po daily

Hypertension (HTN): 5 mg po daily (max 40)

Kidney Disease (Nondiabetic): 5 mg po daily (max 40)

3. MOA:

Angiotensin-Converting Enzyme (ACE) Inhibitor

4. Contraindications:

Pregnancy

History of angioedema

Concurrent sacubitril

5. Common ADRs:

Increased SCr

6. Counseling Points:

Orthostatic hypotension or dizziness

7. BBW:

Pregnancy

Lisinopril

1. Brand Name(s):

Zestril

2. FDA Indications/Doses:

ST Elevation MI (STEMI): 2.5-5 mg po daily

Heart Failure: 2.5-5 mg po daily

Hypertension (HTN): 10 mg po daily

3. MOA:

Angiotensin-Converting Enzyme (ACE) Inhibitor

4. Contraindications:

History of angioedema

Concurrent sacubitril

Concurrent use with Aliskiren in patients with Diabetes

5. Common ADRs:

N/A

6. Counseling Points:

Orthostatic hypotension or dizziness

7. BBW:

Pregnancy

Carvedilol

1. Brand Name(s):

Coreg, Coreg CR

2. FDA Indications/Doses:

Heart Failure (HF):

a) 3.125 mg po bid

Hypertension (HTN):

a) 6.25 mg po bid (max 25 mg bid)

b) ER capsule: 20 mg po daily in the morning (max 80)

3. MOA:

Nonselective a and b blocker

4. Contraindications:

AV block

Bronchial asthma

Cardiogenic shock

Hepatic impairment

Overt HF

Sinus tachycardia

Sick sinus syndrome

5. Common ADRs:

Cold extremities

Dizziness

Erectile dysfunction

Fatigue

Hypotension

Weight gain

6. Counseling Points:

a) Take with food or milk

b) Avoid abrupt discontinuation, may cause rebound HTN

c) Diabetic patients should carefully monitor blood sugar levels as beta blockers mask symptoms of hypoglycemia

Labetalol

1. Brand Name(s):

N/A

2. FDA Indications/Doses:

HTN: initial 100 mg bid, may titrate to 200-400 mg bid (max 2400 mg daily)

3. MOA:

Nonselective a and b blocker

4. Contraindications:

Bronchial conditions (asthma)

Bradycardia

AV block

HF

Cardiogenic shock

Hypotension

5. Common ADRs:

Dizziness

Fatigue

Nausea

6. Counseling Points:

a) May cause orthostatic hypotension or syncope

b) Avoid abrupt discontinuation, may cause rebound HTN

c) Diabetic patients should carefully monitor blood sugar levels as beta blockers mask symptoms of hypoglycemia

d) Avoid alcohol

e) Report signs and symptoms of bronchospasm, slow HR, or hepatoxicity

Metoprolol

1. Brand Name(s):

Lopressor (Tartrate), Toprol XL (Succinate)

2. FDA Indications/Doses:

Angina:

a) IR - 50 mg bid (max 400 mg/d)

b) ER - 100 mg daily (max 400 mg/d)

HF:

a) NYHA II: 25 mg ER

b) NYHA III-IV: 12.5 mg ER

HTN:

a) IR - 50 mg bid

b) ER - 25-100 mg

AMI:

a) IR - 25-50 mg bid-tid (max 200 mg/d)

3. MOA:

Selective B1 blocker

4. Contraindications:

Bradycardia

AV block

Sick sinus syndrome

Decompensated HF

Cardiogenic shock

5. Common ADRs:

Dizziness

Fatigue

Hypotension

6. Counseling Points:

a) Take on empty stomach

b) Avoid alcohol

c) Avoid abrupt discontinuation (rebound HTN and angina)

d) Diabetic patients should carefully monitor blood sugar levels as beta blockers mask symptoms of hypoglycemia

7. BBW:

Ischemic heart disease with abrupt withdrawal

Propranolol

1. Brand Name(s):

Inderal, Inderal LA, Inderal XL

2. FDA Indications/Doses:

Chronic Angina:

a) IR: 80-320 mg in 2-4 doses

b) ER: 80-160 mg

Cardiac Dysrhythmia:

a) 10-30 mg po tid-qid

HTN:

a) IR - 40 mg bid

b) ER - 80 mg

Migraine (prophylaxis):

a) IR - 80 mg in divided doses

b) ER - 80 mg

3. MOA:

Nonselective B1 and B2 blocker

4. Contraindications:

Asthma

AV block

Bradycardia

Sick sinus syndrome

Cardiogenic shock

5. Common ADRs:

Hypotension

6. Counseling Points:

a) Take IR on empty stomach (ER can be taken with or without food but must keep it consistent)

b) Avoid alcohol

c) Avoid abrupt discontinuation (rebound HTN and angina)

d) Diabetic patients should carefully monitor blood sugar levels as beta blockers mask symptoms of hypoglycemia

7. BBW:

Avoid abrupt withdrawal

Amlodipine

1. Brand Name(s):

Norvasc

2. FDA Indications/Doses:

HTN: 5-10 mg

Stable or Variant Angina: 5-10 mg

3. MOA:

Calcium Channel Blocker (DHP)

4. Contraindications:

N/A

5. Common ADRs:

Edema

6. Counseling Points:

a) May cause hypotension, fatigue, dizziness, or hepatic dysfunction

b) Avoid alcohol

Nifedipine

1. Brand Name(s):

Procardia XL

2. FDA Indications/Doses:

HTN:

a) ER - 30 mg

Stable Chronic or Variant Angina:

a) IR - 10-20 mg tid (max 160 mg/d)

b) ER - 30-60 mg

3. MOA:

Calcium Channel Blocker (DHP)

4. Contraindications:

Cardiogenic shock

STEMI

Concomitant use of CYP3A4 inducers

5. Common ADRs:

Flushing

Headache

Dizziness

Weakness

Nausea

Dyspepsia

6. Counseling Points:

a) May cause hypotension, fatigue, or dizziness

b) Avoid abrupt discontinuation (rebound HTN)

c) Avoid grapefruit juice

d) May see shell of dosage form in stool

Diltiazem

1. Brand Name(s):

Cardizem, Cartia XT, Dilt-XR, Taztia XT, Tiazac

2. FDA Indications/Doses:

HTN: 60-120 mg bid

Chronic Stable Angina: 30 mg qid

Atrial Arrythmia and Paroxysmal Supraventricular Tachycardia: 180-360 mg

3. MOA:

Calcium Channel Blocker (Non-DHP)

4. Contraindications:

Hypotension

AV block

Sick sinus syndrome

5. Common ADRs:

Edema

Headache

6. Counseling Points:

a) May cause bradycardia or syncope

b) Avoid alcohol

c) May take with hot applesauce (swallow without chewing followed by water)

d) Administer same time each day

Hydralazine

1. Brand Name(s):

N/A

2. FDA Indications/Doses:

HTN: 10 mg qid (max 300 mg/d)

3. MOA:

Vasodilator

4. Contraindications:

Dissecting aortic aneurysm

CAD

Mitral valve rheumatic heart disease

5. Common ADRs:

N/A

6. Counseling Points:

a) Avoid alcohol

b) Avoid abrupt discontinuation (rebound HTN)

c) May cause dizziness

d) Report symptoms of chest pain, palpitations, systemic lupus, or hepatotoxicity

Isosorbide Mononitrate

1. Brand Name(s):

Imdur

2. FDA Indications/Doses:

Angina, prophylaxis

IR:20 mg po bid separated 7 h apart to decrease tolerance development

ER:30-60 mg po daily, may titrate to maintenance of 120-240 mg po daily

4. MOA:

Antianginal Agent; Vasodilator

5. Contraindications/Box Warnings:

N/A

6. Common ADRs:

7. Counseling/Clinical Pearls:

Take on empty stomach with atleast half a glass of water. Headache = drug is working.

Nitroglycerin

1. Brand Name(s):

Nitro-Dur, Nitrostat

2. FDA Indications/Doses:

Angina, prophylaxis

ER:2.5-6.5 mg po tid-qid

sublingual:1 tab or 1-2 sprays 5-10 min before activity, which may induce angina

transdermal: 0.2-0.4 mg/h worn topically 12-14 h/d, may titrate to 0.8 mg/h

4. MOA: Antianginal Agent; Vasodilator

5. Contraindications

Hypersensitivity to nitrates;concurrent use with PDEIs and soluble guanylate cyclase stimulators;symptomatic hypotension, marked bradycardia or tachycardia, severe anemia, or increased intracranial pressure

Box Warnings:N/A

6. Common ADRs:

7. Counseling/Clinical Pearls:

Ranolazine

1. Brand Name(s):

Ranexa

2. FDA Indications/Doses:

Chronic angina: Initial, 500 mg po bid, may titrate to max dose 1000 mg po bid

4. MOA: Antianginal Agent; Cardiovascular Agent

5. Contraindications

Hepatic cirrhosis, strong CYP3A4/5 inducers or inhibitors

Box Warnings:N/A

6. Common ADRs:

7. Counseling/Clinical Pearls:

Ezetimibe

1. Brand Name(s):

Zetia

2. FDA Indications/Doses:

-Familial hypercholesterolemia-homozygous, with atorvastatin or simvastatin: Adults and Children ≥10 y of age, 10 mg po daily

-Mixed hyperlipidemia: 10 mg po daily in combination with fenofibrate

-Primary hypercholesterolemia: 10 mg po daily, alone or in combination with an HMG-CoA reductase inhibitor (statin)

-Homozygous familial sitosterolemia: Adults and Children ≥9 y of age, 10 mg po daily

4. MOA:

Antilipemic Agent, 2-Azetidinone

5. Contraindications

Hypersensitivity to ezetimibe, gallbladder disease, severe hepatic dysfunction, concurrent use with a statin in a pregnant or nursing mother

Box Warnings:N/A

6. Common ADRs:

7. Counseling/Clinical Pearls:

Omega-3 Ethyl Esters

1. Brand Name(s):

Lovaza (Rx)

2. FDA Indications/Doses:

Hypertriglyceridemia-add to diet in adults with triglyceride levels 500 mg/dL or higher: 4 g po daily or divided into 2 doses

4. MOA:

Antilipemic Agent, Omega-3 Fatty Acids

5. Contraindications:Hypersensitivity to omega-3-acid ethyl esters, fish, or shellfish

Box Warnings:N/A

6. Common ADRs:

7. Counseling/Clinical Pearls:

Fenofibrate

1. Brand Name(s):

Fenoglide, Lipofen, Tricor, Trilipix

2. FDA Indications/Doses:

Hypertriglyceridemia, Frederickson types 4 and 5 hyperlipidemia: 35-200 mg po daily, dosing varies based on formulation

4. MOA:

Antilipemic Agent, Fibric Acid

5. Contraindications:

Hypersensitivity, gallbladder disease, severe renal dysfunction, hepatic dysfunction, nursing mothers

Box Warnings: N/A

6. Common ADRs:

7. Counseling/Clinical Pearls:

Atorvastatin

1. Brand Name(s):

Lipitor

2. FDA Indications/Doses:

-Primary and secondary prevention of atherosclerotic cardiovascular disease: 10-20 mg po daily, may increase to 40-80 mg po daily for those patients requiring high-intensity therapy (eg, LDL >190 mg/dL or high ASCVD risk)

-Secondary prevention of cardiovascular events in patients with or at high risk for CAD: 80 mg daily, may reduce dose to 40 mg po daily if high dose not tolerated.

- (homozygous or heterozygous): Children (boys and postmenarchal girls 10-17 y of age), 10 mg po daily, may titrate to 40 mg po daily; Adults, 10-80 mg po daily

4. MOA:

Antilipemic Agent, HMG-CoA Reductase Inhibitor

5. Contraindications/Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Pravastatin

1. Brand Name(s):

N/A

2. FDA Indications/Doses:

-Cerebrovascular accident (prevention), coronary arteriosclerosis (primary or secondary prevention): 40-80 mg po daily

-Familial hypercholesterolemia: Children 8-13 y of age, 20 mg po daily; Children 14-18 y of age, 40 mg po daily; Adults, 40-80 mg po daily

-Hyperlipidemia: Children (boys and postmenarchal girls) 10-17 y of age, 10 mg po daily, may titrate to 20 mg/d; Adults, 40 mg po daily, may titrate to 40-80 mg po daily

4. MOA:

Antilipemic Agent, HMG-CoA Reductase Inhibitor

5. Contraindications:

Hypersensitivity to pravastatin, use in breastfeeding, active liver disease

Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Rosuvastatin

1. Brand Name(s):

Crestor

2. FDA Indications/Doses:

-Hyperlipidemia, prevention of cardiovascular disease: Adults, 5-10 mg po daily, may increase to 20-40 mg po daily for those patients requiring high-intensity therapy (eg, LDL ≥190 mg/dL or high ASCVD risk)

-Familial hypercholesterolemia: Adults, 40 mg po daily; Children ≥7 yo, 5-20 mg po daily

4. MOA:

Antilipemic Agent, HMG-CoA Reductase Inhibitor

5. Contraindications/Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Sacubitril / Valsartan

1. Brand Name(s):

Entresto

2. FDA Indications/Doses:

Heart failure, reduced or preserved ejection fraction:Sacubitril 24 mg/valsartan 26 mg po bid or sacubitril 49 mg/valsartan 51 mg po bid, may titrate to sacubitril 97 mg/valsartan 103 mg po bid

4. MOA:

Angiotensin II Receptor Blocker; Neprilysin Inhibitor

5. Contraindications:

Hypersensitivity, history of angioedema, pregnancy, concomitant ACEIs, aliskiren

Box Warnings:

Pregnancy

6. Common ADRs:

7. Counseling/Clinical Pearls:

Dabigatran

1. Brand Name(s):

Pradaxa

2. FDA Indications/Doses:

-Treatment and prevention of initial or recurrent DVT and PE: 150 mg po bid (after 5-10 d treatment with parenteral anticoagulant)

-Prevention of stroke and systemic embolism in patient with nonvalvular atrial fibrillation: 150 mg po bid

-Prevention of deep venous thromboembolism and PE after hip replacement: 110 mg po 1-4 h postoperatively, then 220 mg po daily × 10-35 d

4. MOA:

Anticoagulant, Direct Thrombin Inhibitor; Direct Oral Anticoagulant (DOAC)

5. Contraindications:

Active bleeding, mechanical prosthetic heart valve, hypersensitivity

Box Warnings:

Risk of stroke at discontinuation; spinal epidural hematoma

6. Common ADRs:

7. Counseling/Clinical Pearls:

Apixaban

1. Brand Name(s):

Eliquis

2. FDA Indications/Doses:

-Atrial fibrillation, nonvalvular (prophylaxis, to reduce the risk of stroke): 5 mg po bid

-Hip or knee replacement surgery (prophylaxis, to reduce the risk of DVT and PE): 2.5 mg po bid × 12 d (knee replacement) or 35 d (hip replacement); start 12-24 h postoperatively

-DVT or PE (treatment and to reduce the future risk): 10 mg po bid × 7 d, then 5 mg po bid

4. MOA:

Anticoagulant, Factor Xa Inhibitor; Direct Oral Anticoagulant (DOAC)

5. Contraindications:

Hypersensitivity, active bleeding

Box Warnings:

Premature discontinuation increases risk of thrombotic events; increased risk of spinal hematoma with spinal puncture or neuraxial anesthesia

6. Common ADRs:

7. Counseling/Clinical Pearls:

Rivaroxaban

1. Brand Name(s):

Xarelto

2. FDA Indications/Doses:

-Prevention of thromboembolism in patients after orthopedic surgery: 10 mg po daily beginning at least 6 h after surgery × 10-14 d for knee replacement or 35 d for hip replacement; if CrCl 30-50 mL/min no dose adjustment, use with caution; do not use if CrCl <30 mL/min

-Prevention of thromboembolism in patients with nonvalvular atrial fibrillation: 20 mg po daily if CrCl >50 mL/min; 15 mg po daily if CrCl 15-50 mL/min; do not use if CrCl <15 mL/min

-Treatment and secondary prevention of DVT or pulmonary embolism: Adults, 15 mg po bid × 21 d, then 20 mg po daily; do not use if CrCl <30 mL/min; Children ≥ 2 yo, oral suspension should be used, and dosing is weight based

4. MOA:

Anticoagulant, Factor Xa Inhibitor; Direct Oral Anticoagulant (DOAC)

5. Contraindications:

Active bleeding

Box Warnings:

Premature discontinuation increases thrombotic risk, risk of spinal/epidural hematoma

6. Common ADRs:

7. Counseling/Clinical Pearls:

Warfarin

1. Brand Name(s):

Coumadin, Jantoven

2. FDA Indications/Doses:

-Anticoagulation, for multiple FDA-labeled indications, all dosed similarly, including atrial fibrillation; myocardial infarction; prosthetic cardiac valve component embolism; pulmonary embolism; thrombosis, post-myocardial infarction; venous thromboembolism: Initial, 2-5 mg po daily, adjust dose based on INR; usual maintenance 2-10 mg po daily

4. MOA:

Anticoagulant, Vitamin K Antagonist

5. Contraindications

Hypersensitivity, bleeding tendencies recent or potential surgery, uncontrolled HTN; pericarditis or pericardial effusion; bacterial endocarditis; noncompliant patients, eclampsia/preeclampsia, threatened abortion, pregnancy

Box Warnings:

Bleeding

6. Common ADRs:

7. Counseling/Clinical Pearls:

Enoxaparin

1. Brand Name(s):

Lovenox

2. FDA Indications/Doses:

-DVT prophylaxis, abdominal surgery: 40 mg SUBQ once 2 h prior to surgery, then daily × 10-14 d

-DVT prophylaxis, hip or knee replacement surgery: 30 mg SUBQ q12h starting 12-24 h postoperatively × 10-14 d

-DVT prophylaxis, acute medical illness: 40 mg SUBQ daily × 6-11 d

-DVT treatment: 1 mg/kg SUBQ q12h or 1.5 mg/kg q24h; initiate warfarin therapy as soon as possible and continue enoxaparin for at least 5 d and until target INR is reached

-Acute ST-segment elevation AMI: Adults <75 y of age, 30 mg IV together with 1 mg/kg SUBQ once, then 1 mg/kg SUBQ q12h (max 100 mg for the first 2 doses only); Adults ≥75 y of age, 0.75 mg/kg SUBQ q12h (no initial bolus, max 75 mg for first 2 doses only) for 2-8 d

-Unstable angina and non–Q-wave AMI: 1 mg/kg SUBQ q12h × 2-8 d with aspirin 100-325 mg po daily

4. MOA:

Anticoagulant, Low Molecular Weight Heparin

5. Contraindications:

Hypersensitivity to enoxaparin, heparin, or pork products; active major bleeding; concurrent neuraxial analgesia; heparin-induced thrombocytopenia within 100 d

Box Warnings:

Neuraxial anesthesia may cause hematomas

6. Common ADRs: CHECK THIS

7. Counseling/Clinical Pearls:

Ticagrelor

1. Brand Name(s):

Brilinta

2. FDA Indications/Doses:

-Acute coronary syndrome or history of AMI: 180 mg po loading dose, followed by 90 mg po bid (in combination with aspirin, max dose of 100 mg) for 12 mo, then reduce dose to 60 mg po bid

4. MOA:

Antiplatelet Agent, Non-thienopyridine; P2Y12 Antagonist

5. Contraindications:

Hypersensitivity, active bleeding, history of intracranial bleeding

Box Warnings:

Bleeding risk; use in CABG surgery, avoid aspirin >100 mg daily

6. Common ADRs:

7. Counseling/Clinical Pearls:

Clopidogrel

1. Brand Name(s):

Plavix

2. FDA Indications/Doses:

-Acute ST-segment elevation MI managed medically (without PCI) and non–ST segment elevation MI: 300-600 mg po loading dose, followed by 75 mg po daily (in combination with aspirin)

-Thrombosis prevention in arteriosclerotic vascular disease, following stroke, in peripheral arterial occlusive disease: 75 mg po daily

4. MOA:

Antiplatelet Agent, Thienopyridine; P2Y12 Antagonist

5. Contraindications:

Hypersensitivity to clopidogrel and active bleeding

Box Warnings:

Reduced CYP2C19 function

6. Common ADRs:

7. Counseling/Clinical Pearls:

Aspirin

1. Brand Name(s):

Bayer Aspirin

2. FDA Indications/Doses:

- headache take:1 or 2 caplets every 4 hours not to exceed 12 caplets in 24 hours unless directed by a doctor

- muscle pain:1 or 2 caplets every 4 hours not to exceed 12 caplets in 24 hours unless directed by a doctor

- toothache:1 or 2 caplets every 4 hours not to exceed 12 caplets in 24 hours unless directed by a doctor

- menstrual pain:1 or 2 caplets every 4 hours not to exceed 12 caplets in 24 hours unless directed by a doctor

- pain and fever of colds:1 or 2 caplets every 4 hours not to exceed 12 caplets in 24 hours unless directed by a doctor

- minor pain of arthritis :1 or 2 caplets every 4 hours not to exceed 12 caplets in 24 hours unless directed by a doctor

prevention of heartattack or stroke- 81 mg po once a day

4. MOA

Antiplatelet Agent; Nonsteroidal Anti-inflammatory Drug (NSAID); Analgesic,

Nonopioid; Salicylate

5. Contraindications:

Hypersensitivity to NSAIDs; patients with asthma, rhinitis, and nasal polyps; use in children or teenagers for viral infections, with or without fever.

Box Warnings:N/A

6. Common ADRs:N/A

7. Counseling/Clinical Pearls:

Heparin

1. Brand Name(s):

N/A

2. FDA Indications/Doses

-DVT/PE treatment: Adults, 80 units/kg (max 5000 units) IV bolus, then 18 units/kg/h (max 20,000-40,000 units/24 h = 833-1666 units/h) IV infusion titrate per institutional nomogram

-Thromboprophylaxis: Adults, 5000 units sq q8-12h

-Cardiothoracic surgery with cardiopulmonary bypass: Adults, 300-400 units/kg IV bolus prior to arterial or venous cannulation, titrate to activated clotting time (ACT)

-Maintenance of line patency: Adults and Children >10 kg, flush volume of IV catheter with 100 units/mL at least once daily, more frequent administration may be necessary based on observation of stagnant blood in catheter or per institutional policy

4. MOA:

Anticoagulant/Antithrombin activator

5. Contraindications:Hypersensitivity; severe thrombocytopenia; history of heparin-induced thrombocytopenia; uncontrolled active bleeding
Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Amiodarone

1. Brand Name(s):

Pacerone

2. FDA Indications/Doses:

-Secondary prophylaxis of ventricular arrhythmias: 400 mg po q8-12h × 1-2 wk, then 200-400 mg po once daily or 400 mg po q8-24h for a total load of 6-10 g, then 200-400 mg po once daily

3. Pharmacologic Class:

Antiarrhythmic Agent, Class III

5. Contraindications:

Hypersensitivity, severe bradycardia, severe sinus node dysfunction, 2nd- or 3rd-degree AV block, and cardiogenic shock

Box Warnings:

Hepatotoxicity, proarrhythmic effects, pulmonary toxicity

6. Common ADRs:

7. Counseling/Clinical Pearls:

Digoxin

1. Brand Name(s):

Lanoxin

2. FDA Indications/Doses:

-Atrial fibrillation or atrial flutter: Loading dose of 0.25-0.5 mg po, then 0.25 mg po q6h, max 1.5 mg in 24 h, then 0.0625-0.0.25 mg po daily

-Heart failure with reduced ejection fraction: Children 1-24 mo of age, 5-7.5 mcg/kg po bid; Children 2-5 y of age, 4-5 mcg/kg po bid; Children 5-10 y of age, 2.5-5 mcg/kg po bid; Children >10 y of age, 2.5-5 mcg/kg po daily; Adults, 0.125-0.25 mg po daily

4. MOA:

Antiarrhythmic Agent, Miscellaneous; Cardiac Glycoside

5. Contraindications:

Hypersensitivity to digoxin, ventricular fibrillation

Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Metformin

1. Brand Name(s):

Glucophage, Glumetza, Riomet

2. FDA Indications/Doses:

—Diabetes mellitus type 2:

-Adults, IR, 500-1000 mg po bid, may titrate to max dose 2250 mg/d;

-ER, 500-2000 mg po daily, may titrate to max dose 2000 mg/d;

4. MOA:

Antidiabetic Agent, Biguanide

5. Contraindications:

Hypersensitivity to metformin, contrast media, eGFR <30 mL/min/1.73 m2, metabolic acidosis

Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Sitagliptin

1. Brand Name(s):

Januvia

2. FDA Indications/Doses:

Diabetes mellitus, Type 2: 100 mg po daily

3. Pharmacologic Class:

4. MOA:

Antidiabetic Agent, Dipeptidyl Peptidase 4 (DPP-4) Inhibitor

5. Contraindications:

Hypersensitivity to sitagliptin

Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Dulaglutide

1. Brand Name(s):

Trulicity

2. FDA Indications/Doses:

Diabetes mellitus, type 2: Adults, 0.75 mg every wk SUBQ, may titrate every 4 wk to max 4.5 mg/wk SUBQ

4. MOA:

Antidiabetic Agent, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist

5. Contraindications:

Family history of medullary thyroid carcinoma, MEN2, hypersensitivity to dulaglutide

Box Warnings:

Risk of thyroid cancers

6. Common ADRs:

7. Counseling/Clinical Pearls:

Repaglinide

1. Brand Name(s):

N/A

2. FDA Indications/Doses:

Diabetes mellitus type 2: 0.5-4 mg po bid-qid (prior to meals), may titrate to 16 mg po daily, initial dose is dependent on HbA_lc

4. MOA

Antidiabetic Agent, Meglitinide Analog

5. Contraindications:

Hypersensitivity to repaglinide, diabetic ketoacidosis, type 1 diabetes, concurrent gemfibrozil

Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Dapagliflozin

1. Brand Name(s):

Farxiga

2. FDA Indications/Doses:

4. MOA:

Antidiabetic Agent, Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor

5. Contraindications/Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Glipizide

1. Brand Name(s):

Glucotrol XL

2. FDA Indications/Doses:

-Diabetes mellitus: Immediate release, 2.5-5 mg po daily, may titrate to max 40 mg po daily, divide bid if doses >15 mg; extended release, 2.5-5 mg po daily, may titrate to max 20 po mg daily

4. MOA: Sulfonylurea

5. Contraindications:

Hypersensitivity to sulfonylureas, diabetic ketoacidosis, type 1 diabetes

Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Pioglitazone

1. Brand Name(s):

Actos

2. FDA Indications/Doses:

-Diabetes mellitus type 2: 15-30 mg po daily; may titrate to max 45 mg po daily as monotherapy, or in combination with sulfonylurea or metformin

4. MOA:

Thiazolidinedione

5. Contraindications:

Hypersensitivity to pioglitazone, NYHA III/IV heart failure

Box Warnings:

Heart failure risk

6. Common ADRs:

7. Counseling/Clinical Pearls:

Insulins

1. Brand Name(s):

N/A

2. FDA Indications/Doses:

4. MOA:

Antidiabetic

5. Contraindications/Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Insulin Lispro

1. Brand Name(s):

HumaLOG

2. FDA Indications/Doses:

-Diabetes mellitus type 1 treatment

[[Initial TDD: SUBQ: ~0.4 to 0.5 units/kg/day; conservative initial doses of 0.2 to 0.4 units/kg/day may be considered to avoid the potential for hypoglycemia; higher initial doses may be required in patients with obesity, or who are sedentary or presenting with ketoacidosis (Ref).

Usual TDD maintenance range: SUBQ: 0.4 to 1 units/kg/day in divided doses (Ref).]]

-Diabetes mellitus type 2 treatment

[[SUBQ: 4 to 6 units or 10% of the (basal insulin dose) (standard starting recommendation for prandial insulin)]]

4. MOA:

Antidiabetic[Insulin, Rapid-Acting]

5. Contraindications:

Hypersensitivity to insulin lispro or any component of the formulation; during episodes of hypoglycemia.

Box Warnings:

6. Common ADRs:Severe hypoglycemia, Antibody development, infusion site reaction, headache, Pain , cough, flu like symptoms, nasopharyngitis Pharyngitis, rhinitis

7. Counseling/Clinical Pearls:

Insulin Aspart

1. Brand Name(s):

NovoLOG

2. FDA Indications/Doses:

—Diabetes mellitus type 1 treatment

-Initial TDD: SUBQ: ~0.4 to 0.5 units/kg/day; conservative initial doses of 0.2 to 0.4 units/kg/day may be considered to avoid the potential for hypoglycemia; higher initial doses may be required in patients with obesity, or who are sedentary or presenting with ketoacidosis.

-Usual TDD maintenance range: SUBQ: 0.4 to 1 units/kg/day in divided doses

—Diabetes mellitus type 2 treatment

-4 to 6 units or 10% of the basal insulin dose

4. MOA:

Antidiabetic[Insulin, Rapid-Acting]

5. Contraindications:

Hypersensitivity to insulin aspart or any component of the formulation; during episodes of hypoglycemia.

Box Warnings:

6. Common ADRs: Severe hypoglycemia, antibody development, headache hyporeflexia, nasopharynchitis ,viral respiratory tract infection, miscellaneous accidental injury

7. Counseling/Clinical Pearls:

Insulin Glulisine

1. Brand Name(s):

Apidra SoloStar

2. FDA Indications/Doses:

—Diabetes mellitus type 1 treatment

-Initial TDD: SUBQ: ~0.4 to 0.5 units/kg/day; conservative initial doses of 0.2 to 0.4 units/kg/day may be considered to avoid the potential for hypoglycemia; higher initial doses may be required in patients with obesity, or who are sedentary or presenting with ketoacidosis

-Usual TDD maintenance range: SUBQ: 0.4 to 1 units/kg/day in divided doses

—Diabetes mellitus type 2 treatment

-4 to 6 units or 10% of the basal insulin dose

4. MOA:

Antidiabetic[Insulin, Rapid-Acting]

5. Contraindications:

Hypersensitivity to insulin glulisine or any component of the formulation; during episodes of hypoglycemia

Box Warnings:

6. Common ADRs:

Severe hypoglycemia, Nasopharyngitis, upper respiratory tract infection

7. Counseling/Clinical Pearls:

Insulin Regular

1. Brand Name(s):

2. FDA Indications/Doses:

—Diabetes mellitus type 1 treatment

-Initial TDD: SUBQ (U-100): ~0.4 to 0.5 units/kg/day in divided doses; conservative initial doses of 0.2 to 0.4 units/kg/day may be considered to avoid the potential for hypoglycemia; higher initial doses may be required in patients with obesity, or who are sedentary or presenting with ketoacidosis.

-Usual TDD maintenance range: SUBQ (U-100[100 units of insulin per mL]): 0.4 to 1 units/kg/day in divided doses

—Diabetes mellitus type 2 treatment

-4 to 6 units or 10% of the basal insulin dose

4. MOA:

Antidiabetic[Insulin, Short-Acting]

5. Contraindications:

Hypersensitivity to regular insulin or any component of the formulation; during episodes of hypoglycemia.

Box Warnings:N/A

6. Common ADRs:N/A

7. Counseling/Clinical Pearls:

Insulin NPH / Isophane

1. Brand Name(s):

HumuLIN N KwikPen

2. FDA Indications/Doses:

—Diabetes mellitus type 1

-Initial TDD: SUBQ: ~0.4 to 0.5 units/kg/day; conservative initial doses of 0.2 to 0.4 units/kg/day may be considered to avoid the potential for hypoglycemia; higher initial doses may be required in patients with obesity, or who are sedentary or presenting with ketoacidosis.

-Usual TDD maintenance range: SUBQ: 0.4 to 1 units/kg/day in divided doses

—Diabetes mellitus type 2

-UBQ: 10 units/day or 0.1 to 0.2 units/kg/day administered as a single dose (usually at bedtime) (Ref). In patients with HbA1c >8%, fasting glucose >250 mg/dL, or insulin resistance, 0.2 to 0.3 units/kg/day is recommended (Ref). Some experts use a minimum of 10 units/day and do not exceed 20 units/day for the initial dose.

4. MOA:

Antidiabetic[Insulin, Intermediate-Acting]

5. Contraindications:

Hypersensitivity to insulin NPH or any component of the formulation; during periods of hypoglycemia.

Box Warnings:

6. Common ADRs: N/A

7. Counseling/Clinical Pearls:

Insulin Glargine

1. Brand Name(s):

2. FDA Indications/Doses:

—Diabetes mellitus type 1

Initial TDD: SUBQ: 0.4 to 0.5 units/kg/day in divided doses; conservative initial doses of 0.2 to 0.4 units/kg/day may be considered to avoid hypoglycemia

Usual TDD maintenance range: SUBQ: 0.4 to 1 units/kg/day in divided doses

—Diabetes mellitus type 2

4. MOA:

Antidiabetic

5. Contraindications:

Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Insulin Degludec

1. Brand Name(s):

2. FDA Indications/Doses:

—Diabetes mellitus type 1

—Diabetes mellitus type 2

4. MOA:

Antidiabetic

5. Contraindications:

Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Tirzepatide

1. Brand Name(s):

Mounjaro, Zepbound

2. FDA Indications/Doses:

4. MOA:

GLP-1/GIP dual agonist

5. Contraindications/Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Tiotropium

1. Brand Name(s):

Spiriva

2. FDA Indications/Doses:

3. Pharmacologic Class:

4. MOA:Anticholinergic

5. Contraindications/Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Ipratropium / Albuterol

1. Brand Name(s):

Combivent

2. FDA Indications/Doses:

4. MOA:

Anticholinergic + Selective beta 2 agonist

5. Contraindications/Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Albuterol

1. Brand Name(s):

ProAir HFA, Proventil HFA, Ventolin HFA

2. FDA Indications/Doses:

4. MOA:

Beta 2 agonist (SABA)

5. Contraindications/Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Budesonide

1. Brand Name(s):

Pulmicort

2. FDA Indications/Doses:

3. Pharmacologic Class:

4. MOA:

Corticosteroid, Inhalant (Oral)

5. Contraindications/Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Fluticasone Nasal and Oral Inhaler

1. Brand Name(s):

ArmonAir Digihaler and Arnuity Ellipta (Oral Only)

2. FDA Indications/Doses:

4. MOA:

Corticosteroid, Nasal; Inhalant (Oral)

5. Contraindications/Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Budesonide / Formoterol

1. Brand Name(s):

Symbicort

2. FDA Indications/Doses:

4. MOA:

Beta2-Adrenergic Agonist, Long-Acting; Corticosteroid, Inhalant (Oral)

5. Contraindications/Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Fluticasone / Salmeterol

1. Brand Name(s):

Advair Diskus, Advair HFA, AirDuo RespiClick, Wixela Inhub

2. FDA Indications/Doses:

4. MOA:

Beta2-Adrenergic Agonist, Long-Acting; Corticosteroid, Inhalant (Oral)

5. Contraindications/Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Montelukast

1. Brand Name(s):

Singulair

2. FDA Indications/Doses:

4. MOA:

Leukotriene Receptor Antagonist

5. Contraindications/Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Methylprednisolone Oral

1. Brand Name(s):

Medrol

2. FDA Indications/Doses:

4. MOA:

Corticosteroid, Oral

5. Contraindications/Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls:

Prednisone

1. Brand Name(s):

N/A

2. FDA Indications/Doses:

4. MOA:

Corticosteroid, Oral

5. Contraindications/Box Warnings:

6. Common ADRs:

7. Counseling/Clinical Pearls: