non sterile Compounding lab: drug list 1 (1-37)

gn/dosage form

Flagyl, Flagyl ER

Metrogel/Metrocream

Nuvessa/vandazole

metronidazole

tablet

topical

vaginal

TC/indications/Notes

metronidazole

antibacterial, antiprotozoal

bacterial vaginosis, trichomoniasis

Take IR tablets with food to dec gi upset

BBW/Contra I.

metronidazole

possibly carcinogenic (animal data)

pregnancy (1st trimester), alcohol/propylene glycol during or 3 days after (disulfiram rxn)

Side Effects / Drug Interactions

metronidazole

metallic taste, dark urine, nausea

inc INR in patients taking warfarin (weak CYP2C9 inhibitor)

gn/tc

Diflucan

fluconazole; azole derv / anti fungal

Indications

fluconazole

yeast infection (oral, esophageal, vaginal), onychomycosis (nail bed infections), oral thrush, oral candidasis

vaginal candidiasis dose → fluconazole

150 mg po x 1 (renal dose adjustment required)

SE / drug interactions

fluconazole / ketoconazole

elevated LFTs, Qt prolongation, rash/pruritus, Headache, hair loss

CYP450 inhibitor - lots DI

gn/tc

nizoral

ketoconazole

imidazole antifungal

Indications / Notes

ketoconazole

mainly topical

shampoo can alter hair texture

warning - fluconazole

BBW - ketoconazole

hepatotoxicity, not recommended in pregnancy

severe hepatotoxicity (transplant/death), QT prologation, oral use last line for anti fungal therapy

gn/tc/dosage form

Nystop

mycostatin

nystatin → topical

nystatin → oral (suspension/tablet)

(antifungal)

indications / dosage forms

Nystatin

mild, localized candida infections (ex. thrush)

suspension counseling points: nystatin

shake well before use

swish in mouth and retain for 7 mins before swallowing

gn/tc

lamisil

terbinafine

antifungal agent (topical)

indications / dosage forms / Notes

terbinafine

dermatophytes (nail bed infection)

tablet / topical

nail bed infection - several months for results due to nail growth time

warnings / side effects

terbinafine

hepatotoxicity

headache, elevated LFTs, skin rash, pruritus

gn/tc

zovirax

acyclovir

antiviral

gn/tc

valtrex

valacyclovir

antiviral

indications / dosage forms

acyclovir/valacyclovir

herpes simplex virus, varicella zoster virus (chicken pox), herpes zoster (shingles), herpes simplex labialis (cold sores)

A - capsule, tablet, buccal tablet, suspension, injection, topical

v - tablet

valacyclovir vs. acyclovir

V = prodrug of acyclovir, more expensive, less frequent dosing, good for pt with poor adherence

Warnings / counseling

acyclovir/valacyclovir

caution in renal impairment, geriatric, taking nephrotoxic meds

No cure, condoms during sex avoid transmission, start treatment within 24 hours of symptom onset, adequate hydration

Dosing for herpes labialis (cold sores) / genital sores - acyclovir

apply topically 5/day for 4 days

dosing for herpes zoster (shingles) - acyclovir

800mg t po 5/day for 7-10 days

dosing for herpes zoster (shingles) - valacyclovir

1x 1g t po tid for 7 days

gn/tc

Keflex

cephalexin

cephalosporin antibiotic → 1st gen

gn/tc

ceftin

cefuroxime axetil

cephalosporin antibiotic → 2nd gen

gn / tc / indications

omnicef

cefdinir

cephalosporin antibiotic → 3rd gen

acute otitis media

gn/tc

cipro

ciprofloxacin

fluoroquinolone antibiotics

warnings / side effects

cephalexin, cefuroxime axetil, cefdinir

cross sensitivity with penicillin allergy

GI upset, diarrhea, serious skin rxns (SJS/TEN)

Indications / dosing

cephalexin

Skin infections (MSSA), strep throat

1× 250/500 mg t po q6-12 hours

BBW / warning

fluoroquinolones

tendon inflammation/rupture, peripheral neuropathy, CNS effects (seizures), caution in pt w/ CNS disorder or taking seizure causing meds

QT prolongation (moxifloxacin > levofloxacin > ciprofloxacin), hypo/hyperglycemia; psychiatric disturbance, photosensitivity

Counseling fluoroquinolones

oral suspension - shake vigorously for 15 seconds before dose

avoid sun exposure, separate from polyvent meds, monitor glucose, avoid in pregnancy/breastfeeding

indications / drug interactions

cefuroxime axetil

acute otitis media, community acquired pneumonia (CAP)

separate by 2 hours from short acting antacids

avoid PPIs and H2RAs

gn / tc / note

levaquin

levofloxacin

fluoroquinolone antibiotic

respiratory fluoroquinolone

gn / tc / note

Avelox

moxifloxacin

fluoroquinolone antibiotics

only fluoroquinolone NOT for UTI

Indications

Ciprofloxacin, levofloxacin, moxifloxacin

antipseudomonal (pneumonia)

gn/tc

zithromax, z-pak

azithromycin

macrolide antibiotic

indications / Dosing

azithromycin

community acquired respiratory tract infections, COPD exacerbations, Chlamydia (pregnant pts), severe traveler’s diarrhea

Z-Pak 2× 250 mg t day 1, 1× 250mg days 2-5

warnings / drug interactions

azithromycin

QT prolongation (erythromycin > azithromycin > clarithromycin), hepatotoxicity (liver disease caution)

fewer drug indications than other macrolides

gn / tc

biaxin

clarithromycin

macrolide antibiotic

indications / contraindications

clarithromycin

H. Pylori treatment regimens

simvastatin/lovastatin (inc risk of muscle toxicity)

side effects

azithromycin / clarithromycin

gi upset (diarrhea, abdominal pain, cramping), taste perversion

Warning / drug interactions

clarithromycin

QT prolongation (caution w/ other qt prolonging drugs), hepatotoxicity (liver disease), caution in artery disease

simvastatin/lovastatin

gn/tc

Clinadgel, Cleocin, Cleocin T

clindamycin

lincosamide antibiotic

indications / dosage forms

clindamycin

purulent and non-purulent skin infections, beta-lactam alternative dental abscessed, surgical prophylaxis, and infective endocarditis prohylaxis

topical, injection, capsule, suspension

BBW / side effects

clarithromycin

colitis (c. difficile)

nausea / vomiting / diarrhea

gn / tc

macrobid, macrodantin

nitrofurantoin

nitrofuran antibiotic

indications / dosing

nitrofurantoin

uncomplicated UTI (cystitis only)

macrobid → 100mg bid for 5 days

contra / warnings / side effects

nitrofurantoin

renal impairment (CrCl < 60 mL/min)

hemolytic anemia

GI upset → tk w/ food, brown urine

gn / tc

amoxil

amoxicillin

penicillin antibiotic

gn / tc

augmentin

amoxicillin/clavulanate

penicillin antibiotic

gn / tc

penn - vee k

penicillin v potassium

penicillin antibiotic

side effects

penicillin antibiotics

seizures (w/ accumulation when not renally adjusted), gi upset, diarrhea, rash, hemolytic anemia

gn/tc

septra, septra DS, Bactrim, Bactrim ds

sulfamethoxazole/trimethoprim

sulfonamide antibiotic

indications/Contra/counseling

sulfamethoxazole/trimethoprim

CA_MRSA skin infections, UTI, Pneumocystis pneumonia (PCP)

Sulfa allergy

avoid in pregnancy or sulfa allergy; take with full class of water

Dosing/ Warnings/side effects

sulfamethoxazole/trimethoprim

based on trimethoprim (TMP); SMX:TMP ratio 5:1

skin reactions (SJS/TEN), thrombotic thrombocytopenia purpura, G6PD deficiency (hemolysis risk)

photosensitivity, elevated K levels, hemolytic anemia, crystalluria

Gn/tc

Doryx, Oracea, Vibramycin

doxycycline

tetracycline antibiotic

Indications/cousenling

doxycycline

1st line treatment for lyme disease and rocky mnt spotted fever, community acquired pneumonia, COPD exacerbations, bacterial sinusitis, chlamydia, acne, CA-MRSA skin infections

Sit upright for 30 mins after to prevent esophageal irritation; tk w/ 8oz of water

Warnings

doxycycline

caution: children 8 or younger, pregnancy or breastfeeding (permanent teeth discoloration)

gn/tc

minocin

minocycline

tetracycline antibiotic

drug interactions/ side effects

doxycycline, minocycline (tetracyclines)

separate from antacids and polyvalent cations (2 hours before or 4 hours after)

N/V/D, photosensitivity

indications/warnings

minocycline

CA-MRSA skin infections, acne

caution in children <8 yr old, pregnancy, breastfeeding (permanent teeth discoloration), and lupus erythematosus (DILE)

gn/tc

bactroban

mupirocin

topical antibiotic

indications/side effects

mupirocin

elimination of MRSA colonizations of nares

HA, burning, localized irritation, rhinitis, pharyngitis

gn/tc

tamiflu

oseltamivir

antiviral → influenza

dosage form/ dosing / notes

oseltamivir

capsule, suspension

treatment > 12 yr old: 75 bid x 5 days

prophylaxis > 12 yr old: 75 qd x 10 days

pediatrics: weight based

most effective w/ 48 hrs of s/s

warnings/side effects

oseltamivir

neuropsychiatric events, serious skin rxns (SJS/TEN), anaphylaxis

HA, N/V/D, abdominal pain

gn/tc

plaquenil

hydroxychloroquine

Aminoquinoline (antimalarial agent)

DMARD - disease modifying antirheumatic

indications/notes

hydroxychloroquine

rheumatoid arthritis, lupus

causes hemolysis in patients w. G6PD deficiency

warnings/side effects

hydroxychloroquine

irreversible retinopathy, myopathy, neuropathy, cardiomyopathy, QT prolongation

N/V/D, abdominal pain, rash, pruritis, HA, vision change (dose related), bone marrow suppression, hepatotoxicity

gn/tc

peridex, perioGard

chlorhexidine gluconate

antibacterial oral rinse

indications/side effects/cousneling points

chlorhexidine gluconate

gingivitis, periodontitis

dental discoloration, dysgeusia, mouth irritation

swish and spit 15ml bid

gn/tc

descovy

emtricitabine + tenofovir alafenamide

nucleoside reverse transcriptase inhibitor (NRTI)

Drug interactions/counseling points

emtricitabine + tenofovir alafenamide

bictegravir + emtricitabine + tenofovir alafenamide

check for drug interactions

do not stop taking or skip doses of hiv medications w/out speaking to your dr. do not cure HIV → use safe sex and no share needles

indications/side effects

HIV PrEP

hyperlipidemia, weight gain, renal impairment, dec in bone mineral density (TAF), N/D, hyperpigmentation of the palms of the hands or soles of the feet (emtricitabine)

BBW/warnings

post treatment exacerbation of acute Hep B; risk of drug resistance w/ use for pre-exposure prohylaxis

immune reconstitution syndrome (IRIS); lactic acidosis; renal toxicity (TAF less severe than TDF); hepatomegaly

gn/tc

biktarvy

bictegravir + emtricitabine + tenofovir alafenamide

integrase inhibitor + nucleoside reverse transcriptase inhibitor (NRTI)

indidications/side effects

bictegravir + emtricitabine + tenofovir alafenamide

HIV treatment

weight gain, inc in serum creatinine, N/V, renal impairment (TAF), avoid w/ multivalent cations (bictegravir), hyperpigmentation of the palms of the hands or soles of the feet (emtricitabine)

BBW/warnings

bictegravir + emtricitabine + tenofovir alafenamide

post treatment exacerbation of acute hepatitis B

immune reconsiution syndrome (IRIS); lacti acidosis

gn/tc

thalidone

chlorthalidone

thiazide diuretic

indications/contra/drug interactions

chlorthalidone, hydrochlorothiazide, metolazone

hypertension

sulfa allergy

lithium (inc risk of toxicity), NSAIDs (inc NA and H2O retention)

side effects/notes

chlorthalidone, hydrochlorothiazide, metolazone

photosensitivity, impotence, electrolyte abnormalities (dec K, Na, and Mg), increase in LDL/BG/triglycerides

preferred over HCTZ bc longer duration of action (2x potent as HCTZ); take early in am (prevent nocturia); not effective when CrCl < 30 mL/min

metolazone may work in patients w/ CrCl <30mL/min or diuretic resistance

gn/tc

oretic, microzide

hydrochlorothiazide

thiazide diuretic

gn/tc

metolazone

metolazone

thiazide diuretic

gn/tc

dyazide (capsules)

maxzide (tablets)

triamterene/hydrochlorothiazide

potassium-sparing diuretic/thiazide diuretic combo

indications/contra/drug interactions

triamterene/hydrochlorothiazide

HCTZ for hypertension, combo w/ triamterene counteracts K loss

hyperkalemia, severe renal diseases

lithium (inc risk of toxicity)

BBW/side effects/notes

triamterene/hydrochlorothiazide

hyperkalemia (K > 5.5 mEq/L)

hyperkalemia, inc SCr, dizziness

monitor BP, K levels, renal function, and fluid status. s/s of heart failure

gn/tc

aldactone

caroSpir (oral suspension)

spironolactone

non-selective aldosterone receptor antagonist, potassium-sparing diuretic

indications/contra/interactions

spironolactone

heart failure w/ reduced ejection fraction (HFrEF), hypertension (refractory to other meds), edema due to cirrhosis

hyperkalemia, severe renal impairment, addison’s disease

monitor BP, K+, renal function, fluid status.

lithium (can inc toxicity)

side effects/notes

hyperkalemia, inc SCr, dizziness, breast tenderness, impotence, gynecomastia in males/menstrual irregularities in females (antiandrogenic properites)

CaroSpir is not therapeutically equivalent to Aldactone and dosing recommendations differ

gn/tc

lasix

furosemide

loop diuretic

gn/tc

demadex

torsemide

loop diuretic

gn/tc

bumex

bumetanide

loop diuretic

indications/contra/interactions

loop diuretics (bumetanide, furosemide, torsemide)

heart failure, hypertension

anuria

avoid NSAIDs (renal impairment), lithium (inc risk of toxicity)

BBW/warnings

loop diuretics (bumetanide, furosemide, torsemide)

profound diuresis (fluid and electrolyte depletion)

sulfa allergy cross reactivity (rare)

notes/counseling

loop diuretics (bumetanide, furosemide, torsemide)

furosemide 40mg, torsemide = 20mg bumetanide 1mg (more potent)

tk qam (prevent nocturia)