counseling point

Flagyl, Metrogel, Metrocream, Nuvessa,Vandazole - metronidazole

Common Indications: bacterial vaginosis, trichomoniasis, etc.

BBW: Possibly carcinogenic based on animal data

Contraindications: Pregnancy (1st trimester), use of alcohol or propylene glycol-containing products during treatment or within 3 days of treatment discontinuation (disulfiram reaction)

Side Effects: Metallic taste, darkened urine, nausea

Drug Interactions: Can increase INR in patients taking warfarin (weak CYP2C9 inhibitor)

Notes: Take IR tablets with food to decrease GI upset.

Diflucan - fluconazole

Common Indications: Yeast infections (ex. oral, esophageal, vaginal), nail bed infections (onychomycosis), oral thrush, oral candidasis

Warnings: Hepatotoxicity, not recommended in pregnancy

Side effects: Elevated LFTs, QT prolongation, rash/pruritis, headache, hair loss

Drug Interactions: CYP450 inhibitor - a lot of drug interactions

Notes: Vaginal candidiasis dose - 150 mg PO x 1 dose, renal dose adjustment required

Nizoral - ketoconazole

Common Indications: Mainly used topically

BBW: Severe hepatotoxicity (has led to transplant and/or death), QT prolongation, oral use is considered last-line for antifungal therapy

Side Effects: Same as fluconazole

Drug Interactions: CYP450 inhibitor - a lot of drug interactions

Notes: Shampoo can cause altered hair texture

Nystop, Mycostatin - nystatin

Common Indications: Mild, localized Candida infections (ex. Thrush)

Dosage forms: Suspension, tablet

Suspension Counseling Points: Shake well before using; Swish in the mouth and retain for as long as possible (seven minutes) before swallowing

Lamisil - terbinafine

Common Indications: Dermatophytes (nail bed infection)

Dosage Forms: Tablet & topical

Warnings: Hepatotoxicity

Side Effects: Headache, elevated LFTs, skin rash, pruritus

Notes: For nail bed infection treatment, may take several months after treatment continuation to see benefit due to the time it takes for nails to grow

Zovirax - acyclovir

Common Indications: Herpes simplex virus, varicella zoster virus (chicken pox), herpes zoster (shingles) herpes simplex labialis (cold sores)

Dosage Forms: Capsule, tablet, buccal tablet, suspension, injection, topical

Warnings: Caution in renal impairment, geriatrics, concomitant nephrotoxic medications

Dosing for Herpes labialis: Apply topically 5 times daily for 4 days (can be used on genital sores)

Dosing for Herpes zoster: 800 mg PO 5x daily for 7 or 10 days

Counseling: Does not cure herpes infections - use proper contraception methods during sexual intercourse to avoid transmission; start treatment within 24 hours of symptom onset, maintain adequate hydration

Valtrex - valacyclovir

Common Indications: Same as acyclovir - valacyclovir is a pro-drug of acyclovir, it is more expensive but less frequent dosing, may be a beneficial in patients with poor adherence

Dosage Forms: Tablet

Warnings: Same as acyclovir

Dosing for Herpes Zoster: 1 gram PO TID for 7 days

Counseling: Does not cure herpes infections - use proper contraception methods during sexual intercourse to avoid transmission; start treatment within 24 hours of symptom onset, maintain adequate hydration

Keflex - cephalexin

Common Indications: Skin infections (MSSA), strep throat

Warnings: Cross-sensitivity with penicillin allergy

Side Effects: GI upset, diarrhea, serious skin reactions (SJS/TEN)

Dosing: 250-500 mg PO Q6-12H

Ceftin - cefuroxime axetil

Common Indications: Acute otitis media, community-acquired pneumonia (CAP)

Warnings/Side Effects: Same as cephalexin

Drug Interactions: Separate by 2 hours from short-acting antacids; avoid PPIs & H2RAs

Omnicef - cefdinir

Common Indications: Acute otitis media

Warnings/Side Effects: Same as cephalexin

Cipro - ciprofloxacin

Common Indications: Antipseudomonal (pneumonia)

BBW: Tendon inflammation &/or rupture, peripheral neuropathy, CNS effects (seizures), use caution in patients with CNS disorders or are taking seizure-causing medications

Warnings: QT prolongation (moxifloxacin > levofloxacin > ciprofloxacin); hypo/hyperglycemia; psychiatric disturbances; photosensitivity

Counseling: Oral suspension - shake vigorously for 15 seconds before each dose; avoid sun exposure; separate from polyvalent cations; monitor blood glucose; avoid in pregnancy/breastfeeding

Levaquin - levofloxacin

Common Indications: same as ciprofloxacin

Note: "Respiratory fluoroquinolone"

Avelox - moxifloxacin

Common Indications: same as ciprofloxacin

Note: Only fluoroquinolone that cannot be used for UTI

Zithromax, Z-Pak - azithromycin

Common Indications: Community-acquired respiratory tract infections, COPD exacerbations, Chlamydia (in pregnant patients), severe traveler's diarrhea

Warnings/Precautions: QT prolongation (erythromycin > azithromycin > clarithromycin); hepatotoxicity (use caution in patients with liver disease)

Side Effects: GI upset (diarrhea, abdominal pain, cramping), taste perversion

Drug Interactions: Fewer drug interactions than other macrolides

Dosing: Z-Pak - 500 mg on day 1, 250 mg on days 2-5

Biaxin - clarithromycin

Common Indications: H. pylori treatment regimens

Contraindications: Contraindicated to take with simvastatin or lovastatin

Warnings/Precautions: QT prolongation, hepatotoxicity (use caution in patients with liver disease), Use caution in patients with coronary artery disease

Side Effects: GI upset (diarrhea, abdominal pain, cramping), taste perversion

Drug Interactions: Use caution with other QT prolonging drugs, Simvastatin and lovastatin are contraindicated (due to increased risk of muscle toxicity)

Clindagel, Cleocin - clindamycin

Common Indications: Purulent and non-purulent skin infections, beta-lactam alternative for dental abscesses, surgical prophylaxis & infective endocarditis prophylaxis

BBW: Colitis (C. difficile)

Side Effects: Nausea, vomiting, diarrhea (N/V/D)

Dosage Forms: Topical, injection, capsule, suspension

Macrobid, Macrodantin - nitrofurantoin

Common Indications: Drug of choice for uncomplicated UTI (cystitis only)

Contraindications: Renal impairment (CrCl < 60 mL/min)

Warnings: Hemolytic anemia

Side Effects: GI upset (take with food), brown urine discoloration (harmless)

Dosing: Macrobid is 100 mg BID for 5 days

Amoxil - amoxicillin

Common Indications: First-line treatment for acute otitis media; prophylaxis for infective endocarditis prior to dental procedures

Contraindications: Severe renal impairment (CrCl < 30 mL/min) - do not use extended release formulation

Side Effects: Seizures (with accumulation when not renally adjusted), GI upset, diarrhea, rash, hemolytic anemia

Dosage Forms: Tablet, capsule, chewable, suspension

Notes: Avoid in patients with beta-lactam allergy

Augmentin - amoxicillin/clavulanate

Common Indications: First-line treatment for acute otitis media & bacterial sinusitis (if antibiotics are indicated)

Contraindications: Severe renal impairment (CrCl < 30 mL/min) - do not use extended release formulation or 875 mg strength

Side Effects: Same as amoxicillin

Dosage Forms: Tablet, chewable, suspension

Notes: Use lowest dose of clavulanate to decrease diarrhea; avoid in patients with beta-lactam allergy

Pen-Vee K - penicillin V potassium

Common Indications: First-line treatment for strep throat and nonpurulent skin infections (no abscess)

Contraindications: Severe renal impairment (CrCl < 30 mL/min)

Side Effects: Same as amoxicillin

Dosage Forms: Tablet, suspension

Notes: Take on an empty stomach

Septra, Bactrim - sulfamethoxazole/trimethoprim

Common Indications: CA-MRSA skin infections, UTI, Pneumocystis pneumonia (PCP)

Dosing: Dose based on the trimethoprim (TMP) component; SMX:TMP ratio = 5:1

Contraindications: Sulfa allergy

Warnings: Skin reactions (SJS/TEN, thrombotic thrombocytopenic purpura) G6PD deficiency (hemolysis risk)

Side Effects: Photosensitivity, elevated K levels, hemolytic anemia, crystalluria

Counseling: Avoid in pregnancy and sulfa allergy; take with a full glass of water

Doryx, Oracea, Vibramycin - doxycycline

Common Indications: First-line treatment for Lyme disease and Rocky Mountain Spotted Fever, community acquired pneumonia, COPD exacerbations, bacterial sinusitis, chlamydia, acne, CA-MRSA skin infections

Contraindications:

Warnings/Precautions: Caution in children <8 years old, pregnancy, and breastfeeding (permanent teeth discoloration)

Side Effects: Nausea, vomiting, diarrhea, photosensitivity

Drug Interactions: Separate from antacids and polyvalent cations (at least 1-2 hours before or 4 hours after the chelating drug)

Counseling: Sit upright for at least 30 minutes after the dose to prevent esophageal irritation, take with at least 8 oz of water

Minocin -minocycline

Common Indications: CA-MRSA skin infections, acne

Warnings/Precautions: Caution in children <8 years old, pregnancy, and breastfeeding (permanent teeth discoloration); drug induced lupus erythematosus (DILE)

Side Effects: Nausea, vomiting, diarrhea, photosensitivity

Drug Interactions: Same as doxycycline

Bactroban - mupirocin

Common Indications: Elimination of MRSA colonization of the nares

Side Effects: Headache, burning, localized irritation, rhinitis, pharyngitis

Tamiflu - oseltamivir

Common Indications: Influenza

Dosage Forms: capsule, suspension

Warnings/Precautions: Neuropsychiatric events, serious skin reactions (SJS/TEN), anaphylaxis

Side Effects: Headache, nausea, vomiting, diarrhea, abdominal pain

Dosing: Treatment >12 years old: 75 mg BID x 5 days. Prophylaxis >12 years old: 75 mg QD x 10 days. Pediatrics: weight based.

Notes:Most effective when started within 48 hours of symptom onset

Plaquenil - hydroxychloroquine

Common Indications: Rheumatoid arthritis, Lupus

Warnings/Precautions: Can cause irreversible retinopathy, myopathy and neuropathy, cardiomyopathy, QT prolongation

Side Effects: Nausea, vomiting, diarrhea, abdominal pain, rash, pruritis, headache, vision changes (dose related), bone marrow suppression, hepatotoxicity

Notes: Causes hemolysis in patients with G6PD deficiency

Peridex, PerioGard - chlorhexidine gluconate

Common Indications: Gingivitis, periodontitis

Side Effects: Dental discoloration, dysgeusia, mouth irritation

Counseling points: Swish and spit 15 mL BID

Descovy

Common Indications: HIV PrEP

BBW: Post-treament exacerbation of acute Hepatitis B; Risk of drug resistance with use for pre-exposure prophylaxis

Warnings/Precautions: Immune reconstitution syndrome (IRIS); lactic acidosis; renal toxicity (TAF less severe than TDF); hepatomegaly

Side Effects: Hyperlipidemia, weight gain, renal impairment, decrease in bone mineral density (TAF), nausea, diarrhea, hyperpigmentation of the palms of the hands or soles of the feet (emtricitabine)

Drug Interactions: Check for drug interactions!

Counseling points: Do not stop taking or skip doses of HIV medications without speaking to your doctor. This medication does not cure HIV - use safe sex practices and do not share needles.

Thalidone. - chlorthalidone

Common Indications: Hypertension

Contraindications: Sulfa allergy

Side Effects: Photosensitivity, impotence, electrolyte abnormalities (decreased potassium, sodium, magnesium), increases in LDL/blood glucose levels/triglycerides

Drug Interactions: Lithium (can increase risk of toxicity), drugs that cause sodium and water retention (NSAIDs)

Notes: May be preferred over HCTZ due to longer duration of action (twice as potent as HCTZ); take early in the morning (to prevent nocturia); not effective when CrCl <30 mL/min

Oretic, Microzide - hydrochlorothiazide

Common Indications: Hypertension

Contraindications: Sulfa allergy

Side Effects: Photosensitivity, impotence, electrolyte abnormalities (decreased potassium, sodium, magnesium), increases in LDL/blood glucose levels/triglycerides

Drug Interactions: Lithium (can increase risk of toxicity), drugs that cause sodium and water retention (NSAIDs)

Notes: May be preferred over HCTZ due to longer duration of action (twice as potent as HCTZ); take early in the morning (to prevent nocturia); not effective when CrCl <30 mL/min

metolazone

See counseling points for chlorthalidone; Exception- metolazone may work in patients with CrCl <30 mL/min or diuretic resistance

Dyazide, Maxzide - triamterene/HCTZ

Common Indications: HCTZ is used for hypertension, combo with triamterene counteracts potassium losses

BBW: Hyperkalemia (K >5.5 mEq/L)

Contraindications: Hyperkalemia, severe renal disease

Side Effects: Hyperkalemia, increased SCr, dizziness

Drug Interactions: Lithium (can increase risk of toxicity)

Notes: Monitor blood pressure, potassium, renal function, & fluid status. Monitor for signs/symptoms of heart failure.

Aldactone, CaroSpir - spironolactone

Common Indications: Heart failure with reduced ejection fraction (HFrEF), hypertension (refractory to other medications), edema due to cirrhosis

Contraindications: Hyperkalemia, severe renal impairment, Addison's disease

Side Effects: Hyperkalemia, increased SCr, dizziness, breast tenderness, impotence, gynecomastia in males/menstrual irregularities in females (due to antiandrogenic properties)

Drug Interactions: Lithium (can increase risk of toxicity)

Notes: Monitor blood pressure, potassium, renal function, & fluid status. CaroSpir is not therapeutically equivalent to Aldactone and dosing recommendations differ.

Lasix - furosemide

Common Indications: Heart failure, hypertension

BBW: Can cause profound diuresis (fluid and electrolyte depletion)

Contraindications: Anuria

Warnings/Precautions: Sulfa allergy cross reactivity (rare)

Side Effects: Depletes electrolytes (K, Mg, Na, Cl, Ca), Increases HCO3 (metabolic alkalosis), ototoxicity, orthostatic hypotension, photosensitivity

Drug Interactions: Avoid NSAIDs (can cause renal impairment), lithium (can increase risk of toxicity)

Notes: Furosemide 40 mg = Torsemide 20 mg = Bumetanide 1 mg (most potent)

Counseling points: Take in the morning (prevent waking up at night to use the restroom)

Demadex - torsemide

Common Indications: Heart failure, hypertension

BBW: Can cause profound diuresis (fluid and electrolyte depletion)

Contraindications: Anuria

Warnings/Precautions: Sulfa allergy cross reactivity (rare)

Side Effects: Depletes electrolytes (K, Mg, Na, Cl, Ca), Increases HCO3 (metabolic alkalosis), ototoxicity, orthostatic hypotension, photosensitivity

Drug Interactions: Avoid NSAIDs (can cause renal impairment), lithium (can increase risk of toxicity)

Notes: Furosemide 40 mg = Torsemide 20 mg = Bumetanide 1 mg (most potent)

Counseling points: Take in the morning (prevent waking up at night to use the restroom)

Bumex - bumetanide

Common Indications: Heart failure, hypertension

BBW: Can cause profound diuresis (fluid and electrolyte depletion)

Contraindications: Anuria

Warnings/Precautions: Sulfa allergy cross reactivity (rare)

Side Effects: Depletes electrolytes (K, Mg, Na, Cl, Ca), Increases HCO3 (metabolic alkalosis), ototoxicity, orthostatic hypotension, photosensitivity

Drug Interactions: Avoid NSAIDs (can cause renal impairment), lithium (can increase risk of toxicity)

Notes: Furosemide 40 mg = Torsemide 20 mg = Bumetanide 1 mg (most potent)

Counseling points: Take in the morning (prevent waking up at night to use the restroom)

Biktarvy

Common Indications: HIV Treatment

BBW: Post-treament exacerbation of acute Hepatitis B

Warnings/Precautions: immune reconstitution syndrome (IRIS); lactic acidosis

Side Effects: Weight gain, increase in serum creatinine, N/V; renal impairment (TAF); Avoid with multivalent cations (bictegravir); Hyperpigmentation of the palms of the hands or soles of the feet (emtricitabine)

Drug Interactions: Check for drug interactions! Significant!

Counseling points: Do not stop taking or skip doses of HIV medications without speaking to your doctor. This medication does not cure HIV - use safe sex practices and do not share needles.

ACE inhibitor

Common Indications: Hypertension, heart failure

BBW: Fetal harm and death (avoid in pregnancy)

Contraindications: History of angioedema, Do not use within 36 hours of Entresto (valsartan/sacubitril).

Warnings/Precautions: Angioedema, hyperkalemia, hypotension, renal impairment, avoid use if bilateral renal artery stenosis

Side Effects: Dry cough, hyperkalemia, increase in SCr, hypotension, dizziness

Drug Interactions: Do not use in combination with ARBs or ARNI. Increased risk of lithium toxicity.

Counseling points: Avoid salt substitutes containing potassium

Cardura - doxazosin mesylate

Common Indications: BPH

Warnings/Precautions: Orthostatic hypotension/syncope, intraoperative floppy iris syndrome (IFIS) can occur in cataract surgery, priapism

Side Effects: Dizziness, fatigue, headache, abnormal ejaculation, fluid retention

Drug Interactions: Use caution with PDE-5 inhibitors (additive hypotensive effect). Do not use if taking tadalafil for BPH.

Notes: Not generally recommended for hypertension alone. May be used in men with HTN and BPH

Counseling points: First dose effect of orthostasis/dizziness. Cardura XL can leave a ghost tablet (empty shell) in the stool.

Hytrin - terazosin

Common Indications: BPH

Warnings/Precautions: Orthostatic hypotension/syncope, intraoperative floppy iris syndrome (IFIS) can occur in cataract surgery, priapism

Side Effects: Dizziness, fatigue, headache, abnormal ejaculation, fluid retention

Drug Interactions: Use caution with PDE-5 inhibitors (additive hypotensive effect). Do not use if taking tadalafil for BPH.

Notes: Not generally recommended for hypertension alone. May be used in men with HTN and BPH

Counseling points: First dose effect of orthostasis/dizziness. Cardura XL can leave a ghost tablet (empty shell) in the stool.

Entresto - sacubitril/valsartan

Common Indications: Heart failure

BBW: Fetal harm and death (avoid in pregnancy)

Contraindications: Do not use with or within 36 hours of ACE inhibitors. History of angioedema.

Warnings/Precautions: Angioedema, hypotension, hyperkalemia, renal impairment, bilateral renal artery stenosis (avoid use)

Side Effects: Generally well-tolerated. Can cause dry cough, hyperkalemia, increase in SCr, hypotension/dizziness

Drug Interactions: Do not use with ARB or ACE inhibitor. Increased risk of lithium toxicity.

Notes: Decreases mortality in HFrEF.

Catapres, Kapvay - clonidine