Endocrine Module p1

Alendronate

Fosamax, Binosto

Bisphosphonate

MOA: Binds to bone hydroxyapatite and inhibits osteoclast activity thereby inhibiting bone resorption and modulating bone metabolism

Doses/Dosage Forms

• Osteoporosis Prevention: 5 mg daily or 35 mg weekly

• Osteoporosis Treatment: 10 mg daily or 70 mg weekly

• Tablet

• Effervescent Tablet

• Solution

Common ADE:

• Abdominal pain

• indigestion

• Constipation or Diarrhea

• decreased serum calcium

• Myalgia

• Bone Pain

• Gastric or esophageal ulcer

• Osteonecrosis of the jaw (RARE)

Drug Interactions

• Aluminum, Calcium, magnesium or iron-containing products H2RA, PPA → Decreased bophoshonate absorption

• Parathyroid hormone analog → Counteracts activity of PTH analog

Counseling Points

• Swallow non-effervescent tablets WHOLE with large glass of water

• Take first thing in the morning on empty stomach, with full glass of water, no other ,medications, food or drink for 30 - 60 minutes

• Remain up right for at least

  • 30 minutes (alendronate, risedronate)

• Supplement with calcium and Vit D

Ibandronate

Boniva

Bisphosphonate

MOA: Binds to bone hydroxyapatite and inhibits osteoclast activity thereby inhibiting bone resorption and modulating bone metabolism

Doses/Dosage Forms

• 150 mg once monthly

• Tablet

Common ADE:

• Abdominal pain

• indigestion

• Constipation or Diarrhea

• decreased serum calcium

• Myalgia

• Bone Pain

• Gastric or esophageal ulcer

• Osteonecrosis of the jaw (RARE)

Drug Interactions

• Aluminum, Calcium, magnesium or iron-containing products H2RA, PPA → Decreased bophoshonate absorption

• Parathyroid hormone analog → Counteracts activity of PTH analog

Counseling Points

• Swallow non-effervescent tablets WHOLE with large glass of water

• Take first thing in the morning on empty stomach, with full glass of water, no other ,medications, food or drink for 30 - 60 minutes

• Remain up right for at least

  • 60 minutes (Ibandronate)

• Supplement with calcium and Vit D

Risedronate

Actonel, Atelvia

Bisphosphonate

MOA: Binds to bone hydroxyapatite and inhibits osteoclast activity thereby inhibiting bone resorption and modulating bone metabolism

Doses/Dosage Forms

• DR: 35 mg weekly

• IR: 5 mg daily or 35 mg weekly or 150 mg once monthly

• Tablet

• DR Tablet

Common ADE:

• Abdominal pain

• indigestion

• Constipation or Diarrhea

• decreased serum calcium

• Myalgia

• Bone Pain

• Gastric or esophageal ulcer

• Osteonecrosis of the jaw (RARE)

Drug Interactions

• Aluminum, Calcium, magnesium or iron-containing products H2RA, PPA → Decreased bophoshonate absorption

• Parathyroid hormone analog → Counteracts activity of PTH analog

Counseling Points

• Swallow non-effervescent tablets WHOLE with large glass of water

• Take first thing in the morning on empty stomach, with full glass of water, no other ,medications, food or drink for 30 - 60 minutes

• Remain up right for at least

  • 30 minutes (alendronate, risedronate)

• Supplement with calcium and Vit D

Canagliflozin

Invokana

Sodium - Glucose Cotransporter 2 (SGLT2) Inhibitor

MOA: Inhibits SGLT2 in the proximal renal tubules reducing reabsorption of filterd glucose from the tubular lumen

Doses/Dosage Forms

• 100-300 mg daily

• Tablet

Common ADE:

• Genitourinary Fungal Infection

• UTIs

• Electrolyte abnormalities

• Hypovolemia

• Increased urination

• Hypoglycemia (rare unless in combonation with insulin/SU)

Drug Interactions

• Insulin, Sulfinylureas → enhanced hypoglycemic effects

• Beta-Blockers → altered glucose metabolsim and increased risk of hypoglycemia masked

Counseling Points

• Take before first meal of the day to reduce post-meal hyperglycemia

Dapagliflozin

Farxiga

Sodium - Glucose Cotransporter 2 (SGLT2) Inhibitor

MOA: Inhibits SGLT2 in the proximal renal tubules reducing reabsorption of filterd glucose from the tubular lumen

Doses/Dosage Forms

• Diabetes, Type 2: 5-10 mg daily

• HF: 10 mg daily

• CKD: 10 mg daily

• Tablet

Common ADE:

• Genitourinary Fungal Infection

• UTIs

• Electrolyte abnormalities

• Hypovolemia

• Increased urination

• Hypoglycemia (rare unless in combonation with insulin/SU)

Drug Interactions

• Insulin, Sulfinylureas → enhanced hypoglycemic effects

• Beta-Blockers → altered glucose metabolsim and increased risk of hypoglycemia masked

Counseling Points

• Take before first meal of the day to reduce post-meal hyperglycemia

Empagliflozin

Jardiance

Sodium - Glucose Cotransporter 2 (SGLT2) Inhibitor

MOA: Inhibits SGLT2 in the proximal renal tubules reducing reabsorption of filterd glucose from the tubular lumen

Doses/Dosage Forms

• Diabetes, Typer 2: 10-25 mg daily

• HF: 10 mg daily

• CKD: 10 mg daily

Common ADE:

• Genitourinary Fungal Infection

• UTIs

• Electrolyte abnormalities

• Hypovolemia

• Increased urination

• Hypoglycemia (rare unless in combonation with insulin/SU)

Drug Interactions

• Insulin, Sulfinylureas → enhanced hypoglycemic effects

• Beta-Blockers → altered glucose metabolsim and increased risk of hypoglycemia masked

Counseling Points

• Take before first meal of the day to reduce post-meal hyperglycemia

Dulaglutide

Trulicity

Glucagon-Like Peptide -1 Receptor Agonist (GLP-1 RA)

MOA: Agonist of the GLP - 1 receptor and augments glucose -dependent insulin secreation and slows gastric emptying

Doses/Dosage Forms

• 0.75 - 4.5 mg SUBC once weekly

• Auto-injector

Common ADE:

• Nausea/Vomiting

• Diarrhea or constipation

• weight loss

• Hypoglycemia (rare unless in combination with insulin/SU)

• BBW: Risk of Thyroid Cancers

Drug Interactions

• Insulin, Sulfonylureas (SU) → enhanced hypoglycemic effects

• Beta-Blockers → altered glucose metabolism and increased risk of hypoglycemia masked

• Contraceptive → May decrease efficacy of oral contraceptives due to delayed gastric empting

Counseling Points

• ALWAYS COUNSEL ON ADMINSTRATION

• May decrease GI side effects by eating bland, low-fat foods, avoid lying down after eating, eating slowly and drinking plenty of water

Liraglutide

Victoza, Saxenda

Glucagon-Like Peptide -1 Receptor Agonist (GLP-1 RA)

MOA: Agonist of the GLP - 1 receptor and augments glucose -dependent insulin secreation and slows gastric emptying

Doses/Dosage Form

• DM (Victoza): 0.6 - 1.8 mg SUBC daily

• Weight Management (Saxenda): 0.6 - 3 mg SUBC daily

• Pen Injector

Common ADE:

• Nausea/Vomiting

• Diarrhea or constipation

• weight loss

• Hypoglycemia (rare unless in combination with insulin/SU)

• BBW: Risk of Thyroid Cancers

Drug Interactions

• Insulin, Sulfonylureas (SU) → enhanced hypoglycemic effects

• Beta-Blockers → altered glucose metabolism and increased risk of hypoglycemia masked

• Contraceptive → May decrease efficacy of oral contraceptives due to delayed gastric empting

Counseling Points

• ALWAYS COUNSEL ON ADMINSTRATION

• May decrease GI side effects by eating bland, low-fat foods, avoid lying down after eating, eating slowly and drinking plenty of water

Semaglutide

Ozempic, Wegovy, Rybelsus R1/R2

Glucagon-Like Peptide -1 Receptor Agonist (GLP-1 RA)

MOA: Agonist of the GLP - 1 receptor and augments glucose -dependent insulin secreation and slows gastric emptying

Doses/Dosage Forms

• DM (Ozempic): 0.25-2 mg SUBC weekly

• DM ( Rybelsus R1): 3-14 mg po daily

• DM (Rybelsus R2): 1.5 - 9 mg po daily

• Weight Management (Wegovy): 0.25 mg - 2.4 mg SUBC weekly

• Pen Injector (Ozempic)

• Auto-injector (Wegovy)

• Tablet (Rybelsus)

Common ADE:

• Nausea/Vomiting

• Diarrhea or constipation

• weight loss

• Hypoglycemia (rare unless in combination with insulin/SU)

• BBW: Risk of Thyroid Cancers

Drug Interactions

• Insulin, Sulfonylureas (SU) → enhanced hypoglycemic effects

• Beta-Blockers → altered glucose metabolism and increased risk of hypoglycemia masked

• Contraceptive → May decrease efficacy of oral contraceptives due to delayed gastric empting

Counseling Points

• ALWAYS COUNSEL ON ADMINSTRATION

• Take in the morning on an empty stomach with 4 oz of water and 30 minutes prior to food or other medication (Rybelsus)

• Swallow tablets whole (Rybelsus)

• Rybelsus R1 and R2 formulation are not substitutable on a mg per mg basis

• May decrease GI side effects by eating bland, low-fat foods, avoid lying down after eating, eating slowly and drinking plenty of water

Linagliptan

Tradjenta

Dipeptidyl Peptidase IV (DPP-4) inhibitor

MOA: Binds to and inhibits the DPP-4 enzyme resulting in prolonged incretin levels which regulates glucose metabolism and increases insulin secretion and release

Doses/Dosage Forms

• 5 mg daily

• Tablet

Common ADE:

• Hypoglycemia with SU or Insulin

• Headache

• Nasopharyngitis

• Weight gain

• diarrhea

• nausea

• arthralgia

Drug Interactions

• Corticosteroids, Thaizide diuretics → May decrease the hypoglycemic effects of DPP-4i

Counseling Points

• Do NOT take with GLP-1 RA

Sitagliptan

Januvia, Zituvio

Dipeptidyl Peptidase IV (DPP-4) inhibitor

MOA: Binds to and inhibits the DPP-4 enzyme resulting in prolonged incretin levels which regulates glucose metabolism and increases insulin secretion and release

Doses/Dosage Forms

• 100 mg daily

• Tablet

Common ADE:

• Hypoglycemia with SU or Insulin

• Headache

• Nasopharyngitis

• Weight gain

• diarrhea

• nausea

• arthralgia

Drug Interactions

• Corticosteroids, Thaizide diuretics → May decrease the hypoglycemic effects of DPP-4i

Counseling Points

• Do NOT take with GLP-1 RA

• Take with morning meal

Glimepiride

Amaryl

Sulfonylurea (SU)

MOA: Enhances insulin secretion from pancreatic B-cells and potentiates insulins action on several extrahepatic tissues

Doses/Dosage Forms

• 1-2 mg daily (MAX 8 mg daily)

• Tablet

Common ADE:

• Hypoglycemia

• Nausea

• Headache

• Dizziness

• Asthenia

Drug Interactions

• GLP -1 RA, SGLT2 Inhibitors, insulin → increased risk of hypoglycemia

• Beta Blocker → altered glucose metabolism and increased risk of hypoglycemia, symptom of hypoglycemia masked

Counseling Points

• Take with food

• USE SUNSCREEN AND AVOID SUN

• Do not drink alcohol, may cause disulfiram reaction

• Do not chew or crush ER tablets

• All are on BEERs List (glipizide preferred over others due to shorter half-life and inactive metabolites)

• Counsel patients on signs/symptoms of hypoglycemia and rule of 15

Glipizide

Glucotrol

Sulfonylurea (SU)

MOA: Enhances insulin secretion from pancreatic B-cells and potentiates insulins action on several extrahepatic tissues

Doses/Dosage Forms

• IR: 2.5 - 5 mg daily (MAX 40 mg daily)

• ER: 2.5 - 5 mg daily (MAX 20 mg daily)

• Tablet

• ER Tablet

Common ADE:

• Hypoglycemia

• Nausea

• Headache

• Dizziness

• Asthenia

Drug Interactions

• GLP -1 RA, SGLT2 Inhibitors, insulin → increased risk of hypoglycemia

• Beta Blocker → altered glucose metabolism and increased risk of hypoglycemia, symptom of hypoglycemia masked

Counseling Points

• Take with food

• USE SUNSCREEN AND AVOID SUN

• Do not drink alcohol, may cause disulfiram reaction

• Do not chew or crush ER tablets

• All are on BEERs List (glipizide preferred over others due to shorter half-life and inactive metabolites)

• Counsel patients on signs/symptoms of hypoglycemia and rule of 15

Glyburide

Glynase

Sulfonylurea (SU)

MOA: Enhances insulin secretion from pancreatic B-cells and potentiates insulins action on several extrahepatic tissues

Doses/Dosage Forms

• 1.25 - 20 mg daily (MAX 20 mg daily)

• Tablet

Common ADE:

• Hypoglycemia

• Nausea

• Headache

• Dizziness

• Asthenia

Drug Interactions

• GLP -1 RA, SGLT2 Inhibitors, insulin → increased risk of hypoglycemia

• Beta Blocker → altered glucose metabolism and increased risk of hypoglycemia, symptom of hypoglycemia masked

Counseling Points

• Take with food

• USE SUNSCREEN AND AVOID SUN

• Do not drink alcohol, may cause disulfiram reaction

• Do not chew or crush ER tablets

• All are on BEERs List (glipizide preferred over others due to shorter half-life and inactive metabolites)

• Counsel patients on signs/symptoms of hypoglycemia and rule of 15

Metformin

Glucophage, Riomet

Biguanide

MOA: Reduces hepatic glucose production and enhances glucose utilization by muscle

Doses/Dosage Forms

• IR: 500-1000mg BID (MAX 2250 mg daily)

• ER: 500-2000 mg daily (MAX 2000 mg daily)

• Renal Dosing: eGFR 30 - 45 ml/min/1.73 m² : Intiation of therapy generally not recommended, if exsisting therapy reduce to 500 mg BID

  • eGFR <30 ml/min/1.73 m² use is contraindicated

• Tablet

• ER Tablet

• Solution

Common ADE:

• Diarrhea

• Malabsorption

• Nausea

• Asthenia

• Vomiting

• Flatulence

• Cobalamin deficiency

• Weight loss

• BBW: Lactic acidosis

Drug Interactions

• Acetrizoic acid and other contrast media → increased risk of lactic acidosis and renal failure

• Beta-Blocker → altered glucose metabolism and increased risk of hypoglycemia, symptoms of hypoglycemia masked

Counseling Points

• Take with meals

• Avoid excessive alcohol (increased risk of lactic acidosis)

• ER 1000 mg tablets are rarely covered by insurance

• HOLD metformin prior to administering iodinated contrast and for 48 hrs following the procedure

Pioglitiazone

Actos

Thiazolindinedione

MOA: Potent peroxisome proliferator-activated receptor-y (PPAR-y) agonist used to improve insulin sensitivity

Doses/Dosage Forms

• 15 - 30 mg daily (MAX 45 mg daily)

• Tablet

Common ADE:

• Edema

• weight gain

• myalgia

• sinusitis

• headache

• BBW: Heart failure risk

Drug Interaction

• Sulfonamides, insulin → increased risk of hypoglycemia

• Beta-Blocker → altered glucose metabolism and increased risk of hypoglycemia, symptoms of hypoglycemia masked

Counsiling Points

• Recommended for patients at risk for liver fibrosis or MSALD

• Monitor for weight gain

Dexmethasone

Decadron

Oral Corticosteroid

MOA: Modify the body’s immune responses and used primarily for anti-inflammatory effects

Doses/Dosage Forms

• 0.75 - 40 mg daily (varies)

• Tablet

• Solution

• Elixer

• Concentrate

Common ADE

• HTN

• GI upset

• Atrophic condition of the skin and impared skin healing

• Blurred vision

• osteoporosis

• depression

• hyperglycemia

• insomnia

• anxiety

Counseling Points

• Take with food

• Mood changes may occur

• Take in the morning to helo with insomnia

Methylprednisolone

Medral

Oral Corticosteroid

MOA: Modify the body’s immune responses and used primarily for anti-inflammatory effects

Doses/Dosage Forms

• 4-64 mg daily (varies)

• Tablet

Common ADE

• HTN

• GI upset

• Atrophic condition of the skin and impared skin healing

• Blurred vision

• osteoporosis

• depression

• hyperglycemia

• insomnia

• anxiety

Counseling Points

• Take with food

• Mood changes may occur

• Take in the morning to helo with insomnia

Prednisolone

Prelone, Orapred, Pediapred

Oral Corticosteroid

MOA: Modify the body’s immune responses and used primarily for anti-inflammatory effects

Doses/Dosage Forms

• 5-60 mg daily (varies)

• Tablet

• Dispersible Tablet

• Solution

Common ADE

• HTN

• GI upset

• Atrophic condition of the skin and impared skin healing

• Blurred vision

• osteoporosis

• depression

• hyperglycemia

• insomnia

• anxiety

Counseling Points

• Take with food

• Mood changes may occur

• Take in the morning to helo with insomnia

Prednisone

Deltasone

Oral Corticosteroid

MOA: Modify the body’s immune responses and used primarily for anti-inflammatory effects

Doses/Dosage Forms

• 5 - 60 mg (varies)

• Tablet

• DR Tablet

• Solution

Common ADE

• HTN

• GI upset

• Atrophic condition of the skin and impared skin healing

• Blurred vision

• osteoporosis

• depression

• hyperglycemia

• insomnia

• anxiety

Counseling Points

• Take with food

• Mood changes may occur

• Take in the morning to helo with insomnia

Fluocinonide

Lidex

Topical Corticosteroid

MOA: Anti-inflammatory, antipuritic, and vasocontrictive thought to act by induction of phospholipase A2-inhibitory proteins

Doses/Dosage Forms

• Apply to Affected Area(s) (AAA) daily to QID

• Topical Cream/Oinment/Solution/Gel

Common ADE

• Drying Skin

• Burning sensation

• Stinging

• Pruritus at site of administration

• Headache

Counseling Points

• Avoid contact with eye and do not ingest

• Wash hands thoroughly after application

• Avoid occlusive over site

Hydrocortisone

Hydrocortisone

Topical Corticosteroid

MOA: Anti-inflammatory, antipuritic, and vasocontrictive thought to act by induction of phospholipase A2-inhibitory proteins

Doses/Dosage Forms

• Apply to the Afftected Area (AAA) daily to QID

• Rectal Cream/Enema/Foam

• Topical Cream/Lotion/Ointment/Gel

Common ADE

• Drying Skin

• Burning sensation

• Stinging

• Pruritus at site of administration

• Headache

Counseling Points

• Avoid contact with eye and do not ingest

• Wash hands thoroughly after application

• Avoid occlusive over site

Triamcinolone

Triamcinolone

Topical Corticosteroid

MOA: Anti-inflammatory, antipuritic, and vasocontrictive thought to act by induction of phospholipase A2-inhibitory proteins

Doses/Dosage Forms

• Apply to the Affected Area (s) (AAA)

• Topical Cream/Lotion/Ointment

• Aerosol Solution

Common ADE

• Drying Skin

• Burning sensation

• Stinging

• Pruritus at site of administration

• Headache

Counseling Points

• Avoid contact with eye and do not ingest

• Wash hands thoroughly after application

• Avoid occlusive over site

Clotrimazole / Betamethasone

Lortisone

Anti-Infective/Anti-inflammatory Combination

MOA

• Clotrimazole: Inhibits biosynthesis of ergosterol or other sterols damaging the fungal cell wall membranes and altering permeability

• Betamethasone: Corticosteroid that stimulates synthesis of enzymes responsible for anti-inflammatory

Doses/Dosage Forms

• Apply to Affect Area(s) (AAA) BID

• Topical Cream/Lotion

Common ADEs

• Dry skin

• Burning sensation

• Tingling

• Numbness

Counseling Points

• If using Lotion, shake well before use

Levothyroxine

Synthroid

Thyroid Supplement, Synthetic Thyroxine (T4)

MOA: Synthetic thyroid hormone; endogenous T3 and T4 diffuse into the cell nucleus and bind to the thyroid receptor protein attached to DNA

Doses/Dosage Forms

• Hypothyroidism, adults ≤ 60 w/o heart disease: 1.6 mcg/kg/day

• Hypothyroidism, adults > 60 w/o heart disease: 25 -50 mcg daily

• Hypothyroidism adults with heart failure: 12.5 - 50 mcg daily

• Tablet

• Capsules

• Oral Solution

Common ADEs

• Decrease Appetite

• Anxiety

• Diarrhea

• Insomnia

• BBW: Not for weight reduction

Drug Interaction

• Aluminum, Calcium and magnesium-containg antacids, iron, sulcrafate, orlistat, bile acid sequestrants → Decreased Absorption of levothyroxine

• Estrogen → Estrogen increases serum thyroxine-binding globulin, reducing free thyroxine resulting in hypothyroid effects

Counseling Points

• Avoid abrupt discountinuation

• Take on empty stomach with water at least 30 minutes before food

• Avoid antacids and iron with 4 hours of dose

• Avoid switching between products due to variations

• May require 6 to 8 weeks for improvement in symptoms

Methimazole

Northyx, Tapazole

Thioamide Antithyroid Agent

MOA: Inhibits the synthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid glad

Doses/Dosage Forms

• 5 - 40 mg daily

• Tablet

Common ADEs

• Nausea

• Headache

• Alopecia

• Skin rash

• Myalgia

• Hypothyroidism

Drug Interactions

• Sodium Iodide/ 131 → Diminished therapeutic effects of sodium I131

Counseling Points

• Typically antithyroid drug of first choice due to once daily dosing

• Contact provider if signs of infection or yellowing of skin

Conjugated Estrogen

Premarin

Estrogen Hormone

MOA: Binding to nuclear receptors in estrogen-responsive tissue and modulate the pituitary section of the gonadotropin, LH and FSH through a negative feedback mechanism

Doses/Dosage Forms

• Abnormal vasomotor function or genitourinary syndrome of menopause, postmenopausal osteoporosis prophylaxis, female hypogonadism syndrome: 0.3 mg daily, continuously or cyclically

• Primary Ovanrian Failure: 1.25 mg daily cyclincally ( 3 weeks on and 1 week off)

• Acute Treatment of abnormal uterine bleeding: 2.5 mg q6h decrease to 2.5 mg BID for 21 - 25 days on symptom improvement

• Tablets

Common ADE

• Abdominal Pain

• Breast pain

• disorder or menstruation

• Headache

• migraine

• weight change

• BBW: Endometrial Cancer

Drug Interactions

• Levothyroxine → Estrogen increases serum thyroxine-binding globulin, reducing free thyroxine resulting in hypothyroid effects

Counseling Points

• Take at bedtime to minimize side effects

• Discuss potential long-term adverse effects of MI, Stroke, DVT, PE and breast cancer

Estradiol Oral

Estrace

Estrogen Hormone

MOA: Produce Characteristic effects on specific tissues, cause proliferation of vaginal and uterine mucosa, increase calcium deposition in bone, accelerate epiphyseal closure after initial growth simulation

Doses/Dosage Forms

• Abnormal Vasomotor function or strophic vulva or vagina, menopause: 1-2 mg daily for 21 days followed by 7 days off

Common ADEs

• Weight chage

• nausea/vomiting

• disturbance in mood

• swelling of breast

• depression

• headache

• BBW: Increase risk of endometrial cancer

Drug Interactions

• Aromatase Inhibitors → estradiol may counteracts the effect if aromatase inhibitors

Counseling Points

• Do not smoke during therapy

• Report abnormal vaginal bleeding or signs/symptoms of thromboembolic disorders

Estradiol Transdermal Patch

Alora, Climara, Minivelle, Menostar, Vivelle-DOT

Estrogen Hormone

MOA: Produce Characteristic effects on specific tissues, cause proliferation of vaginal and uterine mucosa, increase calcium deposition in bone, accelerate epiphyseal closure after initial growth simulation

Doses/Dosage Forms

• 0.014 - 0.0375 mg/day once or twice weekly

• Transderal Patch (once or tweice weekly)

Common ADEs

• Weight Gain

• Nausea/Vomiting

• Disturbance in Mood

• Swelling of breast

• Depression

• Headache

• Application site irritation/edema

• BBW:

  • Increased risk of endometrial cancer

  • Secondary exposure risk (transdermal solution)

Drug Interactions

• Aromatase Inhibitors → estradiol may counteracts the effect if aromatase inhibitors

Counseling Points

• Do not smoke during therapy

• Report abnormal vaginal bleeding or signs/symptoms of thromboebolic disorders

• Place on clean, dry, cook skin, preferable on the lower abdominal, upper quadrant of the buttocks or outer aspects of the hip

• Do not apply to breast or waistline

• Rotate Sites

Ethinyl Estradiol/Etonogestrel Ring

Nuvaring

Constraceptive

MOA: Combination hormonal contraceptive inhibits ovulation via negative feedback mechanism on the hypothalamus, altering normal pattern of gonadotropin secretion of FSH and LH by the anterior pituitary

Doses/Dosage Forms

• 1 ring vaginally continuously for 3 weeks and remove for 1 week

• Vaginal Ring

Common ADE:

• Headache

• Intermentrual Bleeding or vaginal discharge

• Vaginitis

• Acne

• Amenorrhea

• Mood changes

• Nausea/vomiting

• Weight gain

• Abdomnial pain

• BBW: Cardiovascular risk with concurrent cigarette smoking starting at age 35 in women

Counseling Points

• If inadvertently expelled or removed it maybe rinsed in cool to lukewarm water and reinserted as soon as possible at the latest within 3 hours

• An additonal form of contraception must be used until the vaginal ring has be used continuously for 7 days

Raloxifene

Evista

Selective Estrogen Receptor Modulator (SERM)

MOA: SERM that binds to estrogen receptors resulting in activation of esrogenic pathways in some tissues and blockage of estrogenic pathways in other; appears to act as estrogen agonist in bone

Doses/Dosage Forms

• 60 mg daily

• tablet

Common ADEs

• Hot Flashes

• Arthralgia

• Flu-like symptoms

• Fluid retention

• BBW:

  • Venous Thromboembilism

  • Stroke-related deaths

Drug Interactions

• Bile acid sequestrants → Reduced absorption of raloxifene

• Estrogen Products → addictive toxic effects

Counseling Points

• Avoid sitting for long peroids and be aware of symptoms of DVT

• Consider calcium and vitamin D supplementation if taking for osteoporosis

Medroxyprogesterone

Provera, Depo-Provera

Progestin Hormone

MOA: Transforms proliferative into secretory endometrium: and androgenic and anabolic effects

Doses/Dosage Forms

• 5-10 mg for 5 - 14 days

• tablet

• Injection

Common ADE:

• Weight gain

• Headache

• Amenorrhea

• Breast tenderness

• Breakthrough bleeding

• Bloating

• depression

• BBW:

  • Increased risk of cardiovascular disorders, breast cancer, and dementia

  • Loss of BMD

  • Not for Long term use

Drug Interaction

• Corticosteroid → May cause steroid toxicity through inhibition of corticosteroid metabolism

• Warfarin → May increase or decrease warfoarin effectiveness

Counseling Points

• Take with food

• Menstrual Bleeding should occur 3-7 days after last dose

• Do not sue if you become pregnant

• Classified as Hazardous Agent

Progesterone

Prometrium

Progstin Hormone

MOA: Transform proliferative endometrium into secretory endometrium

Doses/Dosage Forms

• Prevention of estrogen-induced endometrial hyperplasia: 200 mg daily hs x12D of cycle

• Secondary Physiologic Amenorrhea: 200 - 400 mg daily HS X10D; 45 - 90 mg (4%) gel vaginally EOD for up to 6 doses

• Capsule

• Vaginal Gel

• Vaginal Insert

Common ADEs

• Weight Gain

• Headache

• Amenorrhea

• Breast Tenderness

• Nervousness

• Breakthrough bleeding

• Bloating

• depression

• BBW: Should not be used for prevention of cardiovascular disorders or dimentia

• increased risk of breast cancer

Drug Interactions

• Warfarin → May increase or decrease warfarin effectivenss

Counseling Points

• Take capsule at bedtime

• For vaginal formulation, avoid using other vaginal drugs with 6hrs before or 6hrs after

• Mentrual Bleeding should occur 3-7 days after last dose

Cyanocobalamin

Cobolin-M

Essential B Vitamin(B12)

MOA: Required for synthesis of methionine from homocysteine

Doses/Dosage Forms

• Deficiency, Normal absorption: 1000 mcg PO daily

  • 500 mcg intranasallu in 1 nostril once weekly

  • 1000 mcg IM or SUBC q7days for 4-8 weeks, then 1000 mcg IM or SUBC monthy

• Deficiency, Malabsorption: 100 mcg IM or SUBC daily for 6-7 d, then monthly

• Prevention of definciency in at-risk patients: 350-1000 mcg po daily

  • 1 spray intranasally in one nostril q7d

• Lozenge

• Troche

• Tablet

• ER/SL Tablet

• SL Liquid

• Nasal Liquid

• injection

Common ADE

• Injection site pain

• Arthralgia

• Fatigue

• Dizzines

• Headache

Counseling Points

• May require several weeks for max effects

• Take ER products with food

• Avoid Alcohol (inhibits absorption of B12)

• Seperate nasal spray by 1 hr from hot food or liquids