PHRA 1301 Unit 7 Counseling to DC or Generic

US Boxed Warning:

-Severe liver damage and fatal liver failure have been reported

PTU

US Boxed Warning:

-should not be used for the treatment of obesity or weight loss

Thyroid Product

US Boxed Warning:

-potent antagonist of progesterone. Antiprogesterone effects will terminate a pregnancy.

miFEPRIStone

US Boxed Warning:

-can lead to the buildup of lactic acidosis, which can result in hypotension, bradyarrhythmia, and death. Risk is increased with poor kidney function.

metFORMIN

US Boxed Warning:

-Increase the risk for the development of heart failure, and can make existing HF worse.

TZD

US Boxed Warning:

-Women with a uterus are at increased risk of developing endometrial hyperplasia, which may be a precursor to endometrial cancer

-Increase the risk for DVT, stroke, and MI

-Increase the risk of breast cancer

Estrogen

US Boxed Warning:

-Cigarette smoking increases the risk of serious cardiovascular events, particularly in women over the age of 35

Contraceptive

US Boxed Warning:

-should not be used for prolonged tocolysis (beyond 72 hours). Adverse reactions related to sympathetic activation (tachycardia, hyperglycemia, myocardial ischemia) may lead to death

Uterine Relaxant "Tocolytic"

US Boxed Warning:

-Not indicated for elective induction of labor

Oxytocin

US Boxed Warning:

-Virilization (development of male physical characteristics) has been reported in children who were secondarily exposed. Children should avoid contact with unwashed or unclothed application sites in men using topical testosterone

Androgen

Allergy Warning: Sulfonamide

Tamsulosin

Contraindication:

-Pregnancy Category X

-Pregnant women and females of childbearing potential should not touch or handle crushed or broken tablets

5α Reductase Inhibitor

Contraindication:

-Pregnancy

-Active or history of thromboembolic disorder (stroke, MI, etc)

-Active or history of breast cancer

Combination Oral Contraceptive

Contraindication:

-Active or history of breast cancer

-Liver tumors or liver disease

-Pregnancy

Progestin Only Contraceptive

Contraindication:

-Allergy Warning: Peanuts/peanut oil

-Active or history of thromboembolic disorder (stroke, MI, etc.)

Prometrium

Contraindication:

-Active or history of thromboembolic disorder (stroke, MI, etc.)

-Active or history of breast cancer, or estrogen dependent tumors

Estrogen

Contraindication:

-Renal failure (GFR <30mL/min)

Biguanide

-Do not shake.

-For SubQ injection only. Rotate injection site.

-May cause fluid retention (edema)

-May cause pain in the joints, muscles, and bones (growing pains)

Growth Hormone

-May cause abdominal distress (pain, diarrhea, flatulence, nausea)

-Schedule injections between meals to decrease GI effects.

-Administer oral capsules 1 hour before or 2 hours after a meal.

Somatostatin Analog

-Discontinue if you develop an unexplained fever

-Routine thyroid lab monitoring is recommended (TSH and T₄) to avoid accidental hypothyroidism.

Antithyroid Agent (Thioamide)

-Take on an empty stomach (30 minutes-1 hour prior to breakfast) to increase absorption.

-Switching between different products (manufacturers) may result in variation and is not recommended. (different Brands are generally not interchangeable)

-Adverse effects are generally a result of therapeutic overdosage. Follow up with all recommended lab monitoring.

Thyroid product

Nasal Spray:

-Store unopened bottle in refrigerator

-Store up to 35 days at room temp.

-Always store in upright position

-Before 1st use, prime pump until a full spray is achieved

-Alternate nostrils daily, and discard after 30 doses.

Hormone (Salmon origin)/Calcitonin

-Only available through a restricted access program (AKA REMS)

Korlym

-Administer with or without food; however, administer consistently. (Food increases bioavailability)

-May cause potassium retention (Hyperkalemia); Avoid excessive intake of potassium rich foods.

-May cause gynecomastia (breast tissue enlargement) and breast tenderness.

Aldosterone Antagonist

Injection preparations:

-Intravenous compatible

Solu-Medrol and Solu-Cortef

Injection preparations:

-(shake well) for IM or IA injection

Kenalog suspension

Oral preparations:

-Take with food to avoid GI upset

-Monitor emotions; these drugs can cause agitation, anger, rage, or other emotional instability

-use may cause psychiatric disturbances, including euphoria, insomnia, personality changes, depression, or psychotic manifestations

-Chronic use can cause Cushingoid appearance (truncal obesity, moon-face, buffalo-hump), and hyperglycemia

Glucocorticoid

Topical preparations:

-Apply only to clean, dry, intact skin

-Unless otherwise directed, only apply for 2 weeks at a time, with a 1-week break

-Do not apply bandages or other dressings to the area, unless directed to do so by your doctor

Glucocorticoid

-Store unused vials and pens in the refrigerator. Refrigeration of in-use vials/pens is not recommended.

-Protect from light

-Administer all forms via SubQ injection

-Rotate injection site with each injection

Insulin and GLP-1 Receptor Agonist

-May cause severe hypoglycemia

Insulin

-May be administered via continuous IV infusion (IV Drip)

Regular Insulin

-Pens in-use should be stored at room temperature for up to 30 days.

-May cause weight loss

-May cause diarrhea

GLP-1 Receptor Agonist

-Keep refrigerated until use, or store at room temperature up to 28 days (4 weeks)

Bydureon

-Long term use is associated with decreased vitamin B12 absorption, and subsequent anemia

-May cause abdominal distress, such as cramping, flatulence, and diarrhea

-Take each dose with a meal

Biguanide

-May cause severe disabling arthralgia (joint pain)

-May cause pancreatitis

DPP-4 Inhibitor

-May cause severe hypoglycemia

-May cause edema. Patients should monitor for water-weight gain

TZD

-May cause sever hypoglycemia

Sulfonylurea

Oral Medications

-Take with food to decrease GI upset

Estrace and Premarin

Transdermal Patch

-Apply to clean, dry, healthy skin that is free of oil, powder, or lotion. Do not apply to breasts

-Avoid waistline or other areas where tight clothing may rub the patch off

-Rotate application site

-Dispose of any used or unused patches by folding adhesive ends together, replace in pouch or sealed container and discard properly in trash away from children and pets

Climara

-May cause headache, edema, mastalgia (breast pain), and/or abnormal uterine bleeding

Estrogen

Oral Product

-Take at bedtime

-May cause headache, dizziness, mastalgia, bloating, and weight gain

Provera and Prometrium

Progesterone Vaginal Insert

-Insert tablet in vagina using the disposable applicator provided

-May cause abdominal pain

Endometrin

-Take this medication at the same time every day

-Back-up contraception should be used for 48 hours after a missed or late dose (>3 hours)

-Back-up contraception is advised if vomiting or diarrhea occur within 3 hours of taking a dose

-May cause weight gain

Progestin Only Contraceptive

-Doses should be taken at the same time every day, preferably after the evening meal or bedtime

-Administration can begin at any time of the menstrual cycle

-Back-up contraception should be used for at least 7 days after starting unless contraception was started within 5 days of menstrual bleeding

-Back-up contraception is advised if vomiting or diarrhea occur within 3-4 hours of taking an active tablet

-Avoid grapefruit and grapefruit juice

-Unscheduled vaginal bleeding or spotting may occur, especially during the first 3 months of therapy

Combination Oral Contraceptive

-Take with breakfast

glimepiride

-Take 30 minutes prior to breakfast

glipiZIDE

-Take with meals (usually twice daily)

glyburide

-Administer with or without food at any time during menstrual cycle. If vomiting occurs within 3 hours of administration, consider repeating dose

-Administer as soon as possible within 72 hours (3 days) of having unprotected sex or primary contraceptive failure

-Treatment is still moderately effective if given within 120 hours (5 days)

Progestin receptor modulator and Progestin

1.5mg Oral Tablet

-Available Over The Counter (OTC) without a prescription

-DoD Military Treatment Facilities are required to have and to dispense emergency contraception without a prescription to eligible beneficiaries

-There is no age requirement to request OTC Plan B

-Check with your pharmacist/Pharmacy standard operating procedure for OTC dispensing protocols

Levenorgestrel (Plan B One Step)

-Press sides of ring together between thumb and index finger and insert folded ring into vagina

-Specific placement is not required for ring to be effective, but ring should be inserted far enough into the vagina as to be comfortable

-To remove, hook index finger around rim and pull out. Vaginal ring cannot be disposed of in the toilet

-New rings should be inserted at approximately the same time of day the ring was removed the previous week

-If the ring accidentally falls out, it may be rinsed with cool or warm (not hot) water and replaced. However, it must be replaced within 3 hours

-Retain ring in vagina for up to 3 weeks, remove, and replace one week later

-Prior to dispensing, store NuvaRing in the refrigerator. After dispensing, patients can store unused rings at room temperature for up to 4 months

Vaginal Ring (NuvaRing)

-Patches should be worn for 1 week at a time, for 3 weeks in a row, then have a 1 week break

Transdermal Patch (Xulane)

-Must be surgically implanted in the upper arm under the skin by a trained professional. One implant lasts 3 years

-May cause weight gain, and prolonged menstrual bleeding

Subdermal Implant (Nexplanon)

-Must be placed in the uterus by a trained healthcare professional

-Uterine perforation may occur, and the device may escape into the abdominal space

-The efficacy of declines after 5 years

-May cause weight gain, and prolonged menstrual bleeding

Intrauterine Device (Mirena)

-Repeat injections every 13 weeks

-May cause weight gain, and prolonged menstrual bleeding

Intramuscular Injection (Depo-Provera)

-Administer via IV infusion pump

Uterine Relaxant "Tocolytic"

-May cause abdominal Cramping

miSOPROStol

-Apply at the same time each morning to clean, dry, intact skin to an area of the shoulder, upper arms, and/or abdomen

Transdermal Gel (AndroGel)

-Apply to clean dry intact skin once daily in the morning to skin of front and inner thighs

-Prior to first dose, prime the pump by holding canister upright and fully depressing the pump 8 times (discard this portion of the product)

Transdermal Gel (Fortesta)

-Apply at the same time each night to clean, dry area of skin on the back, abdomen, upper arms, or thigh

-Do not apply to bony areas or parts of the body that are subject to prolonged pressure while sleeping or sitting

-Change patch daily. Rotate administration sites, allowing 7 days between applying to the same site

-Follow patch disposal guidance

Transdermal Patch (Androderm)

-Administer by deep IM injection into the gluteal muscle

Intramuscular Injection (Depo-Testosterone)

-May cause decreased libido, impotence, or ejaculatory disorder.

-May cause gynecomastia

5α Reductase Inhibitor

-Take immediately following a meal at the same time each day. Swallow tablet whole; do not crush or chew

-May rarely cause priapism. Seek immediate medical attention.

Alfuzosin

-Take 30 minutes after the same mealtime each day

-Capsules should be swallowed whole; do not crush, chew, or open

-May cause ejaculatory failure

Tamsulosin

-For erectile dysfunction: Take as needed 30 minutes prior to sexual activity

-may cause severe headache

-may cause flushing

-may cause visual disturbances (bluing of vision, photophobia)

PDE₅ Inhibitor