Top 200 Drugs

P2Y12 Inhibitors

(Plavix, Effient, Brilinta)

“BRAH”

Bleeding/Bruising

Rash/Pruritus

Abdominal pain, dyspepsia, diarrhea

Headache

-Take w/or w/o food, but may take with food to ⬇ stomach upset

-Notify HCP prior to surgical & dental procedures (these meds are often held prior to procedures to ⬇ risk of bleeding)

-Educate on s/sx of bleeding, such as: unusual bleeding or bruising, dark tarry stools, or blood in urine

Keppra

“FISH”

Fatigue/weakness

Irritability/behavioral problems

Somnolence/dizziness

Headache

-Do not discontinue abruptly (may ^ seizure frequency)

amiodarone (Nexterone)

“AMIODARONE”

Think: pulmonary fibrosis, bradycardia, arrhythmias, QTc prolongation, hyper/hypothyroid, hepatotoxicity, blue/grey skin (smurf syndrome), corneal deposits (iodine)

Abnormal thyroid functions (hypo/hyper)

Muscle weakness

Interstitial lung disease

Optic neuropathy

Discoloration of skin (blue skin)

Ataxia/tremors (unusual involuntary movements)

Reduction in heart rate (bradycardia)

Ocular corneal microdeposits

N/V/constipation

Enzyme fluctuations of the liver

-Take in divided doses/meals if stomach upset occurs 🍔

-Avoid grapefruit juice (^ drug levels) 🚫🍇

-Photosensitivity 🌞

-Report s/sx of chest pain, difficulty breathing, abnormal heartbeat, changes in skin color, or any unusual symptoms

-SE may remain for a while even after the drug is stopped (it stays in the body for months)

-Many DDI!! Consult HCP before starting anything new!

digoxin (Lanoxin)

“Digoxin Needs Help”

Dizziness

N/V/D

HA

Toxicity: loss of appetite, bradycardia, vision changes (blurred/double vision, greenish-yellow halos around lights or objects), confusion, delirium, arrhythmias (brady or tachy)

*Will check levels to make sure serum concentrations are in goal range at initiation & a week or so after any dose change

Thyroid replacement therapy

(Synthroid, Cytomel, Armour Thyroid)

-no pneumonic-

Hypothyroidism sx: fatigue, weight gain, dry skin, cold intolerance, constipation, muscle cramps, goiter

Hyperthyroidism sx: Sweating/heat intolerance, ^ HR, weight loss, arrhythmias, HTN, anxiety/nervousness

-Take on an empty stomach w/water at least 60 minutes before first meal or at least 3 hours after last meal

-May take 6-8 wks for full effect to be seen

-🚫 switch brands (they aren’t always equivalent)

metformin (Glucophage)

“BRAG Weight”

‘met 4 men who bragged they never gained weight’

B12 deficiency

Renal dosing required (CI if <30 mL/min)

Acidosis (lactic)

Gi disturbances (abdominal pain, flatulence, cramping)

Weight neutral

-Take w/food 🍔& titrate slowly to decrease GI upset (worse w/IR formulations)

-GI SE improve over time

-(Hold in AKI or if receiving contrast dye bc risk of lactic acidosis)

sulfonylureas

(glyburide/DiaBeta, Glucotrol/glipizide, Amaryl/glimepiride)

“Sulfonylureas Lower Glucose/SLG”

Stomach upset (N/V)

Low blood sugar (greater w/older age)

Gain weight

-Take with food 🍔 (think: otherwise they can drop your blood sugar too much!) - EXCEPT for Glucotrol (glipizide) which should be taken 30 minutes before a meal (achieves greatest reduction in postprandial hyperglycemia))

-Monitor blood glucose 2-4x/day as directed by Dr

-Sx of hypoglycemia: fatigue, hunger, increased anxiety, dizziness, palpitations

-Avoid alcohol (can ^ risk of delayed hypoglycemia)

-Start low & titrate bc of hypoglycemia risk. Glyburide has the highest hypoglycemia risk.

SGLT2-inhibitors

(Invokana, Farxiga, Jardiance, Steglatro)

“HULKY”

Hypotension

UTI

Loss of weight

Ketoacidosis

Yeast infections (genital)

Think: possible hypotension, UTIs, dehydration (drink lots of water), take in AM

-Take in AM

-Risk of hypoglycemia when used w/sulfonylureas & insulin; in this case, monitor blood glucose closely

-S/Sx of dehydration: dizziness, lightheadedness, thirst

BBW: increased risks of ketoacidosis, bladder cancer (Farxiga), fractures, UTIs, and lower limb amputations

DPP-4 inhibitors

(Tradjenta, Onglyza, Januvia, Nesina)

“REIN”

Rash

Edema

Infections (URTIs, nasopharyngitis, UTIs)

Neutral weight

Think: edema, infections, low blood sugar (maybe), pancreatitis

-Risk of hypoglycemia when used w/sulfonylureas and insulin

-Monitor for s/sx pancreatitis

BBW: pancreatitis, hepatotoxicity (Nesina), heart failure (Onglyza, Nesina)

*Also needs renal adjustments (except Tradjenta)

Thiazolidinediones

(Actos, Avandia)

“HUGE Heart”

Hypoglycemia

Upper respiratory tract infection

Gain weight

Edema

Heart failure exacerbation

-May take several weeks for effects to show

-Has CV benefits (stroke, MI) & may improve lipids

-Monitor blood glucose 2-4x/day as directed by dr

BBW: increased risks of causing or exacerbating heart failure!

CI: NYHA Class III/IV

Warning: ^ risk of MI w/rosiglitazone (Avandia)

Warning: ^ risk of fracture (women > men)

Avoid: pioglitazone (Actos) in active bladder cancer

Caution: renal, hepatic

GLP-1 agonists

(Trulicity, Byetta, Bydureon, Victoza, Ozempic, Wegovy, Rybelsus, Mounjaro, Zepbound)

“SHIP Lost”

Stomach upset (NVD) - dose related & decreases w/exposure

Hypoglycemia (rare if just used alone or w/metformin)

Injection site irritation

Pancreatitis

Loss of weight

-Give w/o regards to meals - EXCEPT Byetta (exenatide IR) should be given 1 hour before meals

-Rotate inj. sites

Caution: renal impairment

Contraindicated: family history of medullary thyroid carcinoma

Warning: increased risks of pancreatitis

Insulin

“WILD”

Weight gain

Injection site reactions

Low blood sugar

Drop in potassium

Statins

“HMGCA”

Hepatotoxicity/headache

Myalgia/myopathy

GI effects (diarrhea, flatulence)

CPK increase

Avoid in pregnancy 🚫🤰

-Take short-half-life statins at night: Simvastatin, Lovastatin, Fluvastatin (Mnemonic: Short half-Life = take before you Fall asleep)

Omega-3 fatty acids

(Lovaza, Vascepa)

“EAT”

Excess burping/gas

Abdominal pain/upset stomach

Taste perversions

-Store in freezer to help minimize fishy burps 🧊

-Take w/food to ^ absorption 🍔

-Swallow capsule whole - don’t chew or dissolve

-Stop prior to elective surgeries (may ^ bleeding time 🩸)

-Don’t take if allergic to fish or shellfish 🐟

-Seek medical attention if severe rash, chest pain, heart palpitations, or SOB occur

*Lowers TG, but may ^ LDL

fibric acids

(Lopid, Tricor)

“DUAL”

Dyspepsia

URTI

Abdominal pain

LFTs/CPK increased (dose-related)

-Take gemfibrozil 30 minutes before breakfast & dinner for best absorption 🍔

-Some formulations of fenofibrate require food, while others do not 🍔❓

-Watch out for s/sx of rhabdomyolysis or jaundice (also: ^ risk of myopathy when given w/statin in elderly, diabetics, renal failure, or hypothyroidism)

*Fibrates ^

*Avoid fenofibrate in nursing mothers (may disrupt lipid metabolism in breastfed infant)

*Fenofibrate lowers LDL & TG, while gemfibrozil (Lopid) only lowers TG

ezetimibe

“I DUMP”

Increased LFTs (esp. if used w/a statin)

Diarrhea

URTI (sinusitis)

Muscle pains (myalgia, artharlgia)

Pain in the extremities

THINK: pretty much ALWAYS an add-on to a statin!

-Take w/or w/o food

-Can take at same time as concurrent statin

-Contraindicated in pregnancy & breast-feeding

nitrates

(nitroglycerin, isosorbide mono/dinitrate)

“FLUSHED”

Flushing

Lightheadedness

Upset stomach (abdominal pain, N/V)

Syncope

Hypotension/headache

Effectiveness decreases/tolerance

Dizziness

-THINK: [orthostatic] hypotension/fainting, HA (—> acetaminophen), flushing, ER on empty stomach, dosing (10-12 hrs ‘nitrate free’, isosorbide IR at least 7 hrs apart), storage of SL nitro

-Take ER tabs on empty stomach w/at least half a glass of water 💦

-Dose so have 10-12 hour “nitrate-free” period to decrease tolerance

-Take IR isosorbide doses at least 7 hours apart

-HA = common SE & will improve over time — take acetaminophen PRN

-Rise slowly to prevent light-headedness

-Keep SL in original amber glass bottle to prevent loss of potency

CI: w/PDE-5 inhibitors

clonidine

“HTN DRUG”

Headache

Tired

Not able to poop (constipation)

Dizziness/Dry mouth

Rash or erhythema (patch)

Unable to stay awake (somnolence

GI SE (N/V)

Think: somnolence (*ER: insomnia, bad dreams, mood changes/feeling irritable), dry mouth, dizziness, constipation, N/V

-Avoid abrupt DC (rebound HTN)

-No alcohol 🚫🍻 (^sedative effects)

-Apply patch to a hairless area of skin such as arms or torso; change every 7 days

hydralazine

“HYDRANTS”

Hypotension/Headache/Hepatotoxicity

Yakking (vomiting)

Dizziness

Rash

Anorexia

Nausea

Tachycardia (reflex)

Systemic lupus erythematous (SLE)

THINK: take w/food; hypotension, edema, palpitations/reflex tachy, SLE (butterfly rash 🦋, joint/muscle pain)

-Take w/food 🍔(^ bioavailability)

-🚫 abruptly stop (rebound HTN)

Beta-blockers

“BAD FISH”

Bradycardia/Bronchospasm

AV block/Arrhythmias contraindications (CI in sinus brady, 2nd or 3rd degree 💖 block, or sick sinus syndrome)

Dizziness/Depression (CNS effects for esp. the lipophilic BBs, like metoprolol & carvedilol)

Fatigue

Impotence

S/S hypoglycemia masked (esp. for non-selective BBs)

Hypotension

-Take w/food 🍔 (decreases SE)

-🚫 DC abruptly (rebound HTN/tachycardia)

-May mask s/sx hypoglycemia & cause asthma to worsen