TOP 300 DRUGS BBW (grouped)

• Accupril

• Zestril, Prinivil

• Zestoretic, Prinzide (HCTZ/lisinopril)

• Altace

• Vasotec

• Lotrel (amplidipne/benazepril)

Fetal toxicity (d/c ACE-I in pregnancy)

• Cozaar

• Hyazaar

• Diovan

• Benicar

• Avapro

• Diovan HCT

• Benicar HCT

• Micardis

Fetal toxicity (d/c ARB in pregnancy)

Neprilysin inhibitor/ARB

• Entresto

Fetal toxicity (d/c sacubitril/valsartan in pregnancy)

Skeletal muscle relaxant

• Baclofen (Lioresal)

Abrupt withdrawal

• Ritalin/Methylin/Metadate (Methylphenidate)

• Vyvanse (Lisdexamphetamine)

• Focalin (Dexmethylphenidate)

Abuse and dependence

Adderall (Amphetamine salts)

Abuse potential; cardiovascular events

Partial opioid agonist

• Butrans

1. Addiction, abuse, and misuse; opioid REMS

2. life-threatening respiratory depression; isks from concomitant use with benzodiazepines or other central nervous system depressants

3. accidental exposure

4. neonatal opioid withdrawal syndrome

• Butrans is a patch which is why it’s accidental exposure and not ingestion.

• Hydromorphone (Dilaudid)

• Morphine (Ms Contin)

1. Addiction, abuse, and misuse; opioid REMS

2. life-threatening respiratory depression; risks from concomitant use with benzodiazepines or other central nervous system depressants

3. accidental ingestion

4. neonatal opioid withdrawal syndrome

5. risk of medication errors

Oxycontin

1. Addiction, abuse, and misuse; opioid REMS

2. life-threatening respiratory depression; risks from concomitant use with benzodiazepines or other central nervous system depressants

3. accidental ingestion

4. neonatal opioid withdrawal syndrome

5. CYP 3A4 interaction

6. Oral soln risk of medication error

Duragesic

1. Addiction, abuse, and misuse; opioid REMS

2. life-threatening respiratory depression; risks from concomitant use with benzodiazepines or other central nervous system depressants

3. accidental ingestion

4. neonatal opioid withdrawal syndrome

5. CYP 3A4 interaction

6. Exposure to heat (rmbr what happened to the pt with a patch that died due a heating blanket)

• Vicodin, Norco

• Percocet, Endocet

1. Addiction, abuse, and misuse; opioid REMS

2. life-threatening respiratory depression; risks from concomitant use with benzodiazepines or other central nervous system depressants

3. accidental ingestion

4. neonatal opioid withdrawal syndrome

5. CYP 3A4 interaction

6. Hepatotox

Tylenol with Codeine

1. Addiction, abuse, and misuse; opioid REMS

2. life-threatening respiratory depression; risks from concomitant use with benzodiazepines or other CNS depressants

3. accidental ingestion

4. neonatal opioid withdrawal syndrome

5. CYP-450 isozyme (I looked it up it’s 3A4 and 2D6 if ur curious)

6. hepatotox

7. Risk of medication errors

8. ultra-rapid metabolism of codeine and other risk factors for life-threatening respiratory depression in children;

Partial opioid agonist

• Ultram

1. Addiction, abuse, and misuse; opioid REMS

2. life-threatening respiratory depression; risks from concomitant use with benzodiazepines or other CNS depressants

3. accidental ingestion

4. neonatal opioid withdrawal syndrome

5. CYP 3A4

6. ultra-rapid metabolism of tramadol and other risk factors for life-threatening respiratory depression in children;

Tylenol

Risk of medication errors; hepatotoxicity

• Motrin, Advil

• Mobic

• Naprosyn, Aleve

• Volaren

1. Serious cardiovascular thrombotic events

2. serious gastrointestinal bleeding, ulcerations, and perforation

Coumadin, Jantoven

Bleeding risk

Brilinta

1. Bleeding risk; aspirin dose

2. ticagrelor effectiveness in patients with acute coronary syndrome (NMT 100mg of ASA)

Flagyl

Carcinogenic

Lincosamide antibiotic

• Cleocin

Colitis

• Cipro

• Levaquin

1. Serious adverse reactions

2. exacerbation of myasthenia gravis

Antiretroviral

• Truvada (Emtricitabine/TDF)

1. Posttreatment acute exacerbation of hepatitis B;

2. risk of drug resistance with use for pre-exposure prophylaxis

Ethinyl estradiol/norethindrone

1. Cigarette smoke + serious cardiovascular events

2. endometrial cancer

3. cardiovascular disease

4. breast cancer

5. dementia

6. risk vs benefit

• Premarin (Conjugated estrogens)

• Estrace, Vivele-do, Alora (Estradiol)

1. Endometrial cancer

2. cardiovascular disease

3. breast cancer

4. dementia

5. risk vs benefits

Prometrium, Progestin (Progesterone)

1. Cardiovascular disorders

2. breast cancer

3. probable dementia

4. risk versus benefits

Povera, Depo-provera (Medroxyprogesterone)

• Oral: cardiovascular disorders; breast cancer; dementia

• Injectable: long-term use; loss of bone mineral density

Androgel

• PO testosterone undecanoate and SQ testosterone enanthate: blood pressure increases

• Transdermal gel and solution: secondary exposure

• IM testosterone undecanoate: pulmonary oil microembolism

• Ambien (Zolpidem)

• Lunesta (Eszopiclone)

Complex sleep behaviors

Actos

Congestive heart failure

Plavix

Diminished antiplatelet effect in patients with two loss-of-function alleles for CYP 2C19 gene

Eliquis, Xarelto

1. Discontinuation

2. spinal and epidural hematoma

• Synthroid, Levoxyl

• Armor thyroid

• Cytomel

Do not use for the treatment of obesity or weight loss

Clonidine

Epidural clonidine not recommended for obstetrical, postpartum, or perioperative pain

• Lasix

• Bumex

Fluid and electrolyte loss (if given in excessive amounts)

Dyazide, Maxzide

Hyperkalemia

• Tenormin

• Lopressor

Gradually reduce the dose over 1-2 weeks in patients with ischemic heart disease; otherwise, may cause angina or a heart attack

Antiseizure agent

• Depakote

1. Hepatotoxicity

2. patients with mitochondrial disease

3. fetal risk

4. pancreatitis

Antiseizure agent

• Dilantin

Injection: cardiovascular risk associated with rapid infusion

Antiseizure agent

• Lactimal (Lamotrigine)

Serious skin rashes

Antiseizure agent

• Tegretol (Carbamazepine)

• Serious dermatologic reactions and HLA-B*1502 allelle

• aplastic anemia and agranulocytosis

Antimigraine agent

• Fioricet (APAP/butalbital/caffeine)

Hepatotoxicity

Second generation antipsychotic

• Risperdal (Risperidone)

• Geodon (Ziprasidone)

Increased mortality in the elderly with dementia-related psychosis

Second generation antipsychotic

• Zyprexa (Olanzapine)

1. Increased mortality in the elderly with dementia-related psychosis

2. (Relprevv injection only) post-injection delirium/sedation syndrome (Relprevv wasn’t on the list so idk why it’s here)

Second generation antipsychotic

• Seroquel (Quetiapine)

• Abilify (Ariprazole)

• Latuda (Lurasidone)

1. Increased mortality in the elderly with dementia-related psychosis

2. suicidal thoughts and behavior

• Bonus: Which ones had the same first BBW but not suicidal thoughts and behavior?

  • (ǝuopᴉsɐɹdᴉZ) uopoǝפ

  • (ǝuopᴉɹǝdsᴉɹ) lɐpɹǝdsᴉɹ

Antimanic

• Lithobid, Eskalith

Serum monitoring required

Selective serotonin reuptake inhibitor (SSRI)

• Zoloft (Sertraline)

• Lexapro (Escitalopram)

• Prozac (Fluoxetine)

• Celexa (Citalopram)

• Paxil (Paroxetine)

Suicidal thoughts and behaviors in pediatrics and young adults

Serotonin reuptake inhibitor

• Desyrel (Trazodone)

Suicidal thoughts and behaviors in pediatrics and young adults

Selective serotonin reuptake inhibitor/5HT1A receptor agonist

• Trintellix (Vortioxetine)

Suicidal thoughts and behaviors in pediatrics and young adults

Serotonin/norepinephrine reuptake inhibitor (SNRI)

• Cymbalta (Duloxetine)

• Effexor (Venlafaxine)

• Pristiq (Desvenlafaxine)

Suicidal thoughts and behaviors in pediatrics and young adults

Norepinephrine reuptake inhibitor (for ADHD)

• Strattera (Atomoxetine)

Suicidal thoughts and behaviors in pediatrics and young adults

Dopamine/norepinephrine reuptake inhibitor (DNRI)

• Wellbutrin, Zyban

Suicidal thoughts and behaviors in pediatrics and young adults

Tricyclic antidepressant

• Elavil (Amitriptyline)

• Pamelor (Nortriptyline)

• Sinequan, Silenor (Doxepin)

Suicidal thoughts and behaviors in pediatrics and young adults

Alpha blocker

• Remeron (Mirtazapine)

Suicidal thoughts and behaviors in pediatrics and young adults

Humira, Enbrel

1. Serious infections

2. malignancy

• Glucophage

• Janumet (Metformin/sitagliptan)

Lactic acidosis

Singulair

Serious neuropsychiatric events (agitation, aggression, sleep disturbances, and suicidal thoughts and behavior)

Cordarone, Pacerone

1. Life-threatening arrhythmias

2. pulmonary toxicity

3. hepatotoxicity

4. worsened arrhythmias

Betapace

Life-threatening pro-arrhythmia

Tambacor (Flecainide)

1. Mortality

2. ventricular pro-arrhythmic effects in patients with atrial fibrillation or flutter

Calcineurin inhibitor

• Prograf, Astagraf XL

1. Malignancy & serious infection

2. mortality in liver transplant (Astagraf XL only)

First generation antihistamine

• Phenergan

Pediatrics: respiratory depression;

Injection: severe tissue injury, including gangrene

Trexall

• PO: adverse reactions; hypersensitivity; pregnancy

• Inj:

  1. intrathecal and high dose therapy; hypersensitivity;

  2. appropriate use

  3. pregnancy

  4. bone marrow suppression;

  5. renal impairment; hepatotoxicity; pneumonitis; gastrointestinal toxicity

  6. dermatologic toxicity

  7. secondary malignancy

  8. tumor lysis syndrome

  9. opportunistic infections;

  10. other serious reactions;

  11. radiotherapy; (should only be used by an) experienced physician

Vitamin A derivative

• Accutane, Amnesteem, Claravis

Pregnancy; special prescribing requirements

• Restoril (Temazepam)

• Xanax (Alprazolam)

• Klonopin (Clonazepam)

• Ativan (Lorazepam)

• Valium (Diazepam)

Risk of concomitant use with opioids; abuse, misuse, and addiction; dependence and withdrawal reactions

Guanylate cyclase agonist

• Linzess (Linaclotide)

Risk of serious dehydration in pediatric patients < 2 years

• Trulicity

• Victoza, Saxenda

• Ozempic, Rybelsus

Risk of thyroid C-cell tumors

Nizoral (Ketoconazole)

Tablets

1. appropriate use (ie, not for onychomycosis, cutaneous dermatophytes, or Candida infections)

2. hepatotoxicity

3. QT prolongation and drug interactions leading to QT prolongation