PHAR 555: Exam #1 (42 DRUGS)

15 brand/generic drug names; 15 drug class; 15 indications; 15 medication safety (contraindications, boxed warnings, high alerts); 5 doses; 10 questions on week 1 and week 2 calculations lectures

GROUP #1: Cardiovascular

Generic Name	Brand Name 1
Alteplase	Activase
Hydralazine	Apresoline
Atropine	Atropen
Ticagrelor	Brilinta
Bumetanide	Bumex
Diltiazem	Cardizem
Amiodarone	Cordarone
Warfarin	Coumadin
Dobutamine	Dobutrex
Dopamine	Dopastat
Apixaban	Eliquis
Sacubitril/Valsartan	Entresto
Digoxin	Lanoxin (IV)
Furosemide	Lasix
Norepinephrine	Levophed
Metoprolol	Lopressor (tartrate)
Enoxaparin	Lovenox
Nitroglycerin	Nitrostat (SL)
Clopidogrel	Plavix
Dabigatran	Pradaxa
Labetalol	Trandate
Rivaroxaban	Xarelto
Heparin
Verapamil

Alteplase

• Activase

• parenteral

• Class: thrombolytic

• use: Acute ischemic stroke; myocardial infarction, pulmonary embolism

• dosage: Acute ischemic stroke: 0.9 mg/kg, not exceed 90 mg; 10% of total dose administered IV bolus over 1 minute, infusion of the remainder total dose over 60 minutes

• warnings: Intracranial hemorrhage, subarachnoid hemorrhage, internal bleeding. Stroke within last 3 months, serious head trauma within last 3 months, current severe uncontrolled hypertension

• high alert drug

Hydralazine

• Apresoline

• parenteral, oral

• class: vasodilator

• use: Hypertension, heart failure

• dosage: Hypertensive Emergency: 20 - 40 mg IV/IM, repeat PRN. Hypertension/CHF: 10 mg PO QID

atropine

• atropen

• parenteral

• class: Muscarinic antagonist

• use: Bradycardia (advanced cardiac life support)

• warnings: Narrow-angle glaucoma, Myasthenia gravis

Ticagrelor

• brilinta

• oral

• class: antiplatelet

• use: Acute coronary syndromes, myocardial infarction

• dosage: Load: 180 mg PO, then 90 mg PO BID x 1st year after ACS event, then 60 mg PO BID thereafter

• warnings: bleeding, Do not use ASA > 100 mg

• high alert drug

Bumetanide

• bumex

• parenteral, oral

• class: loop diuretic

• use: edema

• dosage: 0.5 - 2 mg IV/IM or PO daily; 1:40 ratio of Bumex: Lasix dose

• warnings: hypokalemia; Profound diuresis, electrolyte loss, dehyration and acute renal failure with excessive amounts

Diltiazem

• cardizem or tiazac

• parenteral, oral

• class: CCB

• use: Atrial fibrillation (rate controller), angina, hypertension

• dosage: Load: 30 mg Q6H; Maintence: 180 - 260 mg/day

• warnings: Bradycardia (heart rate <45 bpm); Second- or third-degree heart block; Severe hypotension

Amiodrarone

• Cordarone

• parenteral, oral

• class: antiarrhythmic

• use: Heart rhythm disorders (ventricular tachycardia or fibrillation).

• dosage: Load dose: 800 - 1600 mg daily x 1-3 weeks; then, 600 - 800 mg daily x 1 month; Maintenance dose: 400 mg daily

• warnings: Pulmonary toxicity (pneumonitis), hepatotoxicity, heart block. Thyrotoxicosis, optic neuropathy/neuritis

• high alert drug (with IV)

Warfarin

• Coumadin

• oral

• class: anticoagulant

• use: Thromboembolism treatment and prevention, clotting disorders

• dosage: Various: dosage adjustment based on PT/INR lab; initial dosing varies but generally 2.5 mg - 7.5 mg is reasonable

Dobutamine

• Dobutrex

• parenteral

• class: Inotrope - Beta-adrenergic agonist

• use: Cardiac decompensation

• dosage: 2.5-20 mcg/kg/min; Max: 40 mcg/kg/min

• warnings: Idiopathic hypertrophic subaortic stenosis

• high alert drug

Dopamine

• Dopastat / Intropin

• parenteral

• Class: Inotrope - Sympathomimetic amine

• use: Cardiovascular shock

• dosage: 1-5 mcg/kg/min; Max: 20 mcg/kg/min

• warnings: Pheochromocytoma, Ventricular fibrillation

• high alert drug

Apixaban

• eliquis

• oral

• class: Anticoagulant - Factor Xa inhibitor

• use: Thromboembolism treatment & prevention, stroke prevention

• dosage: VTE treatment: 10 mg PO BID x 7d, then 5mg BID; VTE prevention: 2.5 mg PO BID; Stroke prevention in nonvalvular a-fib: 5 mg PO BID

• warnings: Thrombotic events after premature discontinuation, bleeding

• high alert drug

Sacubitril/Valsartan

• Entresto

• oral

• class: Neprolysin inhibitor (Sacubitril) and angiotensin receptor blocker (ARB (Valsartan)

• use: Heart failure

• dosage: HF: 49mg/51mg PO BID, target 97mg/103mg PO BID after 2 - 4 weeks; start 24mg/26mg PO BID if eGFR <30mL/min, still same target if tolerable

Digoxin

• Lanoxin (IV) / Digitek (PO)

• parenteral, oral

• class: Cardiac glycoside

• use: Heart failure (inotrope); atrial fibrillation (rate controller)

• dosage: Heart failure: 0.125-0.25 mg PO/IV qDay

• warnings: Sinus bradycardia

• high alert drug

Furosemide

• Lasix

• parenteral, oral

• class: Loop diuretic

• use: edema

• dosage: 20-80mg/dose for edema, 40mg BID hypertension

• warnings: Hypokalemia; Profound diuresis, electrolyte loss, dehyration and acute renal failure with excessive amounts

Norepinephrine

• Levophed

• parenteral

• class: Sympathomimetic

• use: Acute hypotension

• dosage: Initial: 2 - 4 mcg/min; Maintenance: 1 - 12 mcg/min (titrate based on blood pressure)

• high drug alert

metoprolol

• Lopressor (tartrate) / Toprol (succinate)

• Parenteral (Lopressor), Oral (Toprol, Lopressor)

• class: Beta-adrenergic blocker

• use: Myocardial infarction, hypertension, angina, heart failure

• dosage: IV (Myocardial infarction): 5 mg IV inj. X 3 doses at 2-min intervals, then 50 mg PO Q6H. Maintenance: 100 mg PO BID

• warnings: Bradycardia (heart rate <45 bpm); Second- or third-degree heart block; Severe hypotension

Enoxaparin

• Lovenox

• parenteral

• class: Low molecular weight heparin

• use: Thromboembolism treatment & prevention, myocardial infarction

• dosage: Treatment: 1mg/kg SQ Q12H or 1.5mg/kg SQ daily; Prophylaxis: 30mg SQ Q12H or 40mg SQ daily. Renal dose adjustment: treatment - 1mg/kg SQ daily; prophylaxis: 30mg SQ daily

• warnings: Thrombocytopenia or active bleeding; bleeding

• high alert drug

Nitroglycerin

• Nitrostat (SL)

• parenteral, SL

• class: nitrate

• use: angina

• dosage: IV: start 5 mcg/min continuous IV infusion, increase by 5 mcg/min every 3-5 min up to 20 mcg/min

• warnings: Hypersensitivity to organic nitrates or any component of the formulation; Concurrent use with PDE-5 inhibitors

• high alert drug

Clopidogrel

• Plavix

• oral

• class: antiplatelet

• use: Acute coronary syndromes, MI and stroke prevention

• dosage: Load: 300 mg PO x 1 dose; Maintenance: 75 mg PO daily

• warnings: Diminished antiplatelet activity in patients who are CPY2C19 poor metabolizers

Dabigatran

• Pradaxa

• oral

• class: Anticoagulant - Direct thrombin inhibitor

• use: Thromboembolism treatment & prevention, stroke prevention

• dosage: 150 mg PO BID

• warnings: Thrombotic events after premature discontinuation; bleeding

• high alert drug

Labetalol

• Trandate

• parenteral, oral

• class: Beta adrenergic blocker (noncardioselective) and alpha-1 adernergic blocker

• use: Hypertension (emergency)

• dosage: IV: 20 mg slow IV over 2 min, then 40 - 80 mg at 10 min. interval, up to 300 mg; Initial: 100 mg PO BID, Maintenance: 200 - 400 mg PO BID

• high alert drug

Rivaroxaban

• Xarelto

• oral

• class: Anticoagulant - Factor Xa inhibitor

• use: Thromboembolism treatment & prevention, stroke prevention

• dosage: VTE: 15 mg PO BID x 21 days, then 20 mg PO daily; A-fib: 20 mg PO daily

• warnings: Thrombotic events after premature discontinuation; bleeding

• high alert drug

heparin

• parenteral

• class: Anticoagulant

• use: Thromboembolism treatment & prevention, myocardial infarction

• dosage: Various for thromboembolism prophylaxis and treatment

• warnings: Thrombocytopenia or active bleeding; bleeding

• high alert drug

verapamil

• parenteral, oral

• class: Calcium channel blocker

• use: Hypertension, angina, tachyarrhythmia

• dosage: Start: 5 - 10mg IV bolus over at least 2 min (0.075 - 0.15 mg/kg), repeat 10 mg (0.15mg/kg) at 30 min after first dose, if not adequate response

What are the 6 analgesics drug?

Hydromorphone	Dilaudid
Morphine	MS Contin
Naloxone	Narcan
Fentanyl	Sublimaze (IV)
Ketorolac	Toradol
Lidocaine	Xylocaine

Hydromorphone

• Dilaudid

• parenteral, oral

• class: Opioid agonist

• use: pain

• dosage: 0.2 - 1 mg Q 2-3 H

• warnings: Severe respiratory depression; risk of addiction, misuse, abuse; CNS depression

• high alert drug

Morphine

• MS Contin / MS IR

• parenteral, oral

• class: opioid agonist

• use: pain

• dosage: IV: 2.5 - 5 mg IV Q4-6H; needs to know morphine equivalent dosing or opioid conversion

• warnings: Severe respiratory depression; risk of addiction, misuse, abuse; CNS depression

• high alert drug

Naloxone

• Narcan

• parenteral

• class: Opioid antagonist

• use: Opioid overdose

• dosage: Initial: 0.4-2 mg; Maximum: 10 mg total

Fentanyl

• Sublimaze (IV) / Duragesic (Transdermal)

• Parenteral, Transdermal, Oral

• class: Opioid agonist

• use: Pain

• dosage: 50-100 mcg IV single dose; 1 mcg/kg/hr IV infusion

• warnings: Severe respiratory depression; risk of addiction, misuse, abuse; CNS depression

• high alert drug

Ketorolac

• Toradol

• parenteral

• class: Non-Steroidal Anti-inflammatory Drug (NSAID)

• use: Pain, inflammation

• dosage: IM: 60 mg as a single dose or q6h; IV: 30 mg single dose or Q6H; max for both IV, IM: 120 mg/day

• warnings: Active or history of PUD; recent or history of GI bleeding or perforation; Patients with advanced renal disease or risk of renal failure

Lidocaine

• Xylocaine

• Parenteral (as anesthetic)

• Class: Anesthetic - Local, regional

• use: Pain

• dosage: Initial: 1-1.5mg/kg repeat 0.5-0.75 mg/kg bolus every 5-10 mins

• warnings: Hypersensitivity to another local anesthetic of the amide type; Severe degrees of SA, AV, or intraventricular heart block

• high alert drug *** only as antiarrhythmic

Biologic: Trastuzumab

• Herceptin

• parenteral

• class: Human epidermal growth factor receptor (HER2) inhibitor

• use: Breast cancer

• dosage: Initial: 5 mg/kg IV over 90 min with/without paclitaxel; Maintenance: 2 mg/kg IV over 30 min once weekly

• warnings: Embryo-fetal toxicity, cardiomyopathy, pulmonary toxicity, chemo-induced neutropenia

what are the four dietary supplement drugs?

Thiamine	Vitamin B1
Cyanocobalamin	Vitamin B12
Magnesium sulfate
Potassium chloride

Thiamine

• Vitamin B1

• parenteral, oral

• class: vitamin

• use: Alcoholism, dietary supplement

• dosage: PO: 5 - 30 mg daily; IV: Wernicke-Korsakoff syndrome 100 mg IV, then 50 to 100 mg IM daily until regular diet

Cyanocobalamin

• Vitamin B12

• parenteral, oral

• class: vitamin

• use: Dietary supplement

• dosage: 100mcg IM daily x 6 - 7 days, maintain: 100 - 1000 mcg monthly

Magnesium sulfate

• Parenteral, Oral

• class: essential mineral

• use: IV: torsades de pointes; PO: magnesium deficiency

• dosage: 1 g IV Q6H for 4 doses

• warnings: Heart block; IV use for pre-eclampsia

• high alert drug *** (IV)

Potassium chloride

• parenteral, oral

• class: Essential mineral

• use: Hypokalemia

• dosage: 1-2mEq/kg/day

• warnings: Hyperkalemia; Severe renal impairment

• high alert drug *** (IV)

what are the 6 endocrine drugs and used for Diabetes mellitus?

*warnings and a high drug alert

Severe hypoglycemia

Allergy of sensitivity

ROUTE: parenteral drugs

DOSAGE: all insulin: 0.5-1 units/kg/day in divided doses (non-obese: 0.4-0.6 units/kg/day; obese: 0.8-1.2 units/kg/day)

Insulin lispro	Humalog
Insulin NPH (human)	Humulin N
Insulin regular (human)	Humulin R
Insulin glargine	Lantus
Insulin detemir	Levemir
Insulin aspart	Novolog

Insulin lispro

• Humalog

• class: Insulin - Rapid acting

Insulin NPH (human)

• Humulin N

• class: Insulin - Intermediate acting

Insulin regular (human)

• Humulin R

• class: Insulin - Short acting

Insulin glargine

• Lantus / Lantus Solostar

• class: Insulin - Long acting

Insulin detemir

• Levemir

• class: Insulin - Long acting

Insulin aspart

• Novolog

• class: Insulin - Rapid acting