EXAM 1 MEDS (!!!)

Proventil / Ventolin

Generic: albuterol | Class: short-acting beta2 agonist (SABA) | Use: quick rescue for asthma or chronic obstructive pulmonary disease (COPD), not daily prevention | Understand: rapidly relaxes airway muscle | Side effects: local irritation, jitteriness, increased heart rate | Important: shake well and use correct inhaler technique.

Pulmicort

Generic: budesonide | Class: inhaled corticosteroid (ICS) | Use: daily asthma prevention, not rescue | Understand: reduces airway inflammation | Side effects: local irritation/cough, oral thrush, possible mild growth suppression | Important: rinse and spit after every dose; Flexhaler is a dry-powder inhaler and Respules require a nebulizer.

Flovent

Generic: fluticasone | Class: inhaled corticosteroid (ICS) | Use: daily asthma prevention, not rescue | Understand: reduces airway inflammation | Side effects: local irritation/cough, oral thrush, possible mild growth suppression | Important: the slides more specifically identify this as fluticasone propionate; for your medication list, memorize fluticasone. Rinse and spit; available as HFA metered-dose inhaler (MDI) and Diskus dry-powder inhaler.

Symbicort

Generics: budesonide/formoterol | Class: inhaled corticosteroid (ICS) + long-acting beta2 agonist (LABA) | Use: asthma/COPD maintenance; may also be prescribed as rescue because formoterol starts working quickly | Understand: budesonide reduces inflammation and formoterol opens airways | Side effects: thrush, local irritation/cough, jitteriness, increased heart rate | Important: rinse and spit.

Advair

Generics: fluticasone/salmeterol | Class: inhaled corticosteroid (ICS) + long-acting beta2 agonist (LABA) | Use: asthma/COPD maintenance, not rescue | Understand: reduces inflammation and keeps airways open long-term | Side effects: thrush, local irritation/cough, jitteriness, increased heart rate | Important: rinse and spit; available as HFA or Diskus.

Breo

Generics: fluticasone/vilanterol | Class: inhaled corticosteroid (ICS) + long-acting beta2 agonist (LABA) | Use: asthma/COPD maintenance, not rescue | Understand: reduces inflammation and keeps airways open long-term | Side effects: thrush, local irritation/cough, jitteriness, increased heart rate | Important: the slides more specifically identify fluticasone furoate; for your medication list, memorize fluticasone/vilanterol. Breo Ellipta is a dry-powder inhaler; rinse and spit.

Singulair

Generic: montelukast | Class: leukotriene antagonist | Use: daily asthma/allergic-rhinitis prevention, not rescue; may be given at bedtime or 2 hours before exercise | Understand: blocks inflammatory leukotrienes | Side effects: flu-like symptoms, fatigue, rash | Important: watch for mood changes; 10 mg is swallowed, while 4 mg and 5 mg are chewable.

Spiriva

Generic: tiotropium | Class: long-acting anticholinergic, also called long-acting muscarinic antagonist (LAMA) | Use: daily COPD maintenance, not rescue | Understand: blocks parasympathetic airway tightening | Side effects: local irritation, dry mouth, dry/blurred eyes, constipation, difficulty urinating | Important: the slides may write tiotropium bromide, but your medication list expects tiotropium. HandiHaler capsule is inhaled and NEVER swallowed.

Incruse

Generic: umeclidinium | Class: long-acting anticholinergic, also called long-acting muscarinic antagonist (LAMA) | Use: daily COPD maintenance, not rescue | Understand: blocks parasympathetic airway tightening | Side effects: local irritation, dry mouth, dry/blurred eyes, constipation, difficulty urinating | Important: Incruse Ellipta is a dry-powder inhaler.

Combivent / DuoNeb

Generics: albuterol/ipratropium | Class: short-acting beta2 agonist (SABA) + short-acting muscarinic antagonist (SAMA) | Use: rescue/as-needed COPD treatment | Understand: two short-acting mechanisms open airways | Side effects: local irritation/cough, jitteriness, increased heart rate, dry mouth/eyes, constipation, difficulty urinating | Important: Combivent uses Respimat; DuoNeb is nebulizer solution.

Anoro

Generics: umeclidinium/vilanterol | Class: long-acting muscarinic antagonist (LAMA) + long-acting beta2 agonist (LABA) | Use: daily COPD maintenance, not rescue | Understand: two long-acting mechanisms keep airways open | Side effects: dry mouth/eyes, constipation, difficulty urinating, jitteriness, increased heart rate | Important: Anoro Ellipta is a dry-powder inhaler.

Trelegy

Generics: umeclidinium/vilanterol/fluticasone | Class: long-acting muscarinic antagonist (LAMA) + long-acting beta2 agonist (LABA) + inhaled corticosteroid (ICS) | Use: daily COPD maintenance, not rescue | Understand: opens airways by two mechanisms and reduces inflammation | Side effects: anticholinergic dryness/constipation, jitteriness/increased heart rate, thrush/local irritation | Important: Trelegy Ellipta; rinse and spit.

Flonase

Generic: fluticasone | Class: intranasal corticosteroid | Use: allergic rhinitis | Understand: gradually reduces nasal inflammation; about 1 week for maximal effect | Side effects: local irritation/dryness, nosebleeds, bad taste; no drowsiness | Important: shake lightly, use correct spray technique, and use daily.

Celebrex

Generic: celecoxib | Class: cyclooxygenase-2 (COX-2)-selective nonsteroidal anti-inflammatory drug (NSAID) | Use: pain/inflammation | Understand: reduces prostaglandins and is easier on the stomach than other NSAIDs, but GI risk remains | Side effects: GI upset/bleeding and kidney risk | Important: take with food; avoid/use caution with severe sulfonamide allergy.

Voltaren

Generic: diclofenac sodium | Class: nonsteroidal anti-inflammatory drug (NSAID) | Use: pain/inflammation | Understand: reduces prostaglandins | Side effects: GI upset/bleeding and kidney risk | Important: take with food; avoid alcohol and duplicate OTC NSAIDs.

Motrin

Generic: ibuprofen | Class: nonsteroidal anti-inflammatory drug (NSAID) | Use: pain/inflammation | Understand: reduces prostaglandins | Side effects: GI upset/bleeding and kidney risk | Important: take with food; avoid alcohol and duplicate OTC NSAIDs.

Mobic

Generic: meloxicam | Class: nonsteroidal anti-inflammatory drug (NSAID) | Use: pain/inflammation | Understand: reduces prostaglandins | Side effects: GI upset/bleeding and kidney risk | Important: take with food; avoid alcohol and duplicate OTC NSAIDs.

Naprosyn

Generic: naproxen | Class: nonsteroidal anti-inflammatory drug (NSAID) | Use: pain/inflammation | Understand: reduces prostaglandins | Side effects: GI upset/bleeding and kidney risk | Important: take with food; avoid alcohol and duplicate OTC NSAIDs.

Toradol

Generic: ketorolac | Class: nonsteroidal anti-inflammatory drug (NSAID) | Use: potent short-term treatment of pain/inflammation | Understand: strongly reduces prostaglandins | Side effects: GI upset/bleeding and kidney risk | Important: NEVER use longer than 5 days.

Prednisone

Brand on list: none | Class: oral corticosteroid | Use: strong short-term suppression of inflammation | Side effects: GI upset, increased appetite/weight, sleep changes, increased infection risk; long-term use can cause osteoporosis and Cushingoid effects | Important: take with food, avoid bedtime, alcohol, and OTC NSAIDs; use caution with diabetes/GI-bleed history.

Medrol

Generic: methylprednisolone | Class: oral corticosteroid | Use: strong short-term suppression of inflammation | Side effects: GI upset, increased appetite/weight, sleep changes, increased infection risk; long-term use can cause osteoporosis and Cushingoid effects | Important: Medrol Dosepak follows the taper printed on the package; take with food and avoid bedtime/OTC NSAIDs.

Decadron

Generic: dexamethasone | Class: oral corticosteroid | Use: strong short-term suppression of inflammation | Side effects: GI upset, increased appetite/weight, sleep changes, increased infection risk; long-term use can cause osteoporosis and Cushingoid effects | Important: take with food, avoid bedtime, alcohol, and OTC NSAIDs.

Norco

Generics: hydrocodone/acetaminophen (APAP) | Class: immediate-release opioid combination; Schedule II (C-II) | Use: short-acting pain relief | Side effects: drowsiness, constipation, stomach upset, respiratory depression | Important: no alcohol/driving; avoid duplicate APAP; target APAP at or below 3 g/day (absolute maximum 4 g/day).

Percocet

Generics: oxycodone/acetaminophen (APAP) | Class: immediate-release opioid combination; Schedule II (C-II) | Use: short-acting pain relief | Side effects: drowsiness, constipation, stomach upset, respiratory depression | Important: no alcohol/driving; avoid duplicate APAP; target APAP at or below 3 g/day (absolute maximum 4 g/day).

Tylenol #3 / #4

Generics: acetaminophen (APAP)/codeine | Class: immediate-release opioid combination; Schedule III (C-III) | Use: short-acting pain relief | Side effects: drowsiness, constipation, stomach upset, respiratory depression | Important: no alcohol/driving; avoid duplicate APAP; target APAP at or below 3 g/day (absolute maximum 4 g/day).

Ultram

Generic: tramadol | Class: short-acting opioid-like analgesic; Schedule IV (C-IV) | Use: pain | Understand: provides opioid-like relief and inhibits serotonin/norepinephrine reuptake | Side effects: drowsiness, constipation, stomach upset, respiratory depression/dependence | Important: watch interactions with serotonergic medicines and other central nervous system (CNS) depressants.

MS Contin

Generic: morphine sulfate | Class: long-acting/extended-release opioid; Schedule II (C-II) | Use: long-lasting pain control, commonly twice daily | Side effects: drowsiness, constipation, stomach upset, potentially fatal respiratory depression | Important: the product is extended release (ER), but ER is not part of the generic name on your list; do not crush; no alcohol/driving.

OxyContin

Generic: oxycodone | Class: long-acting/extended-release opioid; Schedule II (C-II) | Use: long-lasting pain control, commonly twice daily | Side effects: drowsiness, constipation, stomach upset, potentially fatal respiratory depression | Important: the product is extended release (ER), but ER is not part of the generic name on your list; do not crush; no alcohol/driving.

Duragesic

Generic: fentanyl | Class: long-acting opioid patch; Schedule II (C-II) | Use: 72-hour pain control in opioid-tolerant patients only | Side effects: drowsiness, constipation, potentially fatal respiratory depression | Important: patch is the dosage form, not part of the generic name on your list; never cut; avoid heat; remove old patch, rotate sites, and dispose safely.

Subutex

Generic: buprenorphine | Class: partial opioid agonist; Schedule III (C-III) | Use: opioid-use disorder and pain | Understand: partially activates opioid receptors, lowering abuse potential but it can precipitate withdrawal | Side effects: drowsiness and constipation | Important: no alcohol/driving; for sublingual product, rinse and swallow after dose, wait at least 1 hour to brush, and obtain regular dental care.

Suboxone

Generics: buprenorphine/naloxone | Class: partial opioid agonist + complete opioid antagonist; Schedule III (C-III) | Use: opioid-use disorder and pain | Understand: buprenorphine treats dependence; naloxone discourages misuse | Side effects: drowsiness, constipation, precipitated withdrawal | Important: no alcohol/driving; after sublingual dose, rinse and swallow, wait at least 1 hour to brush, and obtain regular dental care.

Narcan

Generic: naloxone | Class: complete opioid antagonist | Use: reverses opioid overdose/respiratory depression; no abuse potential | Side effects/important: can precipitate withdrawal | How to use: place patient on back, spray once in one nostril, call 911 and stay, repeat every 2-3 minutes if needed.

Flexeril

Generic: cyclobenzaprine | Class: centrally acting skeletal muscle relaxant | Use: short-term acute muscle spasms | Understand: acts in the CNS, not directly on muscle | Side effects: very sedating, constipation, stomach upset, anticholinergic effects | Important: no alcohol/driving; structure is similar to tricyclic antidepressants.

Soma

Generic: carisoprodol | Class: centrally acting skeletal muscle relaxant; Schedule IV (C-IV) | Use: short-term muscle spasms | Understand: CNS depressant metabolized to sedative meprobamate | Side effects: sedation, constipation, stomach upset; abuse potential | Important: short-term use only; no alcohol/driving.

Baclofen

Brand on list: none | Class: centrally acting skeletal muscle relaxant | Use: spasticity from CNS disorders | Understand: acts in the CNS, not directly on muscle | Side effects: sedation (relatively less than some agents), constipation, stomach upset | Important: use caution with alcohol/driving.

Zanaflex

Generic: tizanidine | Class: centrally acting skeletal muscle relaxant | Use: spasticity | Understand: acts in the CNS, not directly on muscle | Side effects: sedation (relatively less), hypotension/lightheadedness, constipation, stomach upset | Important: use caution with alcohol/driving.

Short-acting beta2 agonist (SABA)

Works quickly as a rescue bronchodilator by stimulating beta2 receptors in the lungs to relax airway muscle. Common effects: jitteriness and increased heart rate. Example: albuterol.

Long-acting beta2 agonist (LABA)

Keeps airways open longer for maintenance. Common effects: jitteriness and increased heart rate. Examples in combinations: formoterol, salmeterol, vilanterol.

Inhaled corticosteroid (ICS)

Daily controller that reduces airway inflammation; not normally rescue. Common effects: local irritation/cough, thrush, mild growth suppression. Rinse and spit. Examples: budesonide and fluticasone.

Long-acting muscarinic antagonist (LAMA)

Same general category as a long-acting anticholinergic. Blocks parasympathetic airway tightening for COPD maintenance, not rescue. Effects: dry mouth/eyes, constipation, difficulty urinating. Examples: tiotropium and umeclidinium.

Short-acting muscarinic antagonist (SAMA)

Short-acting anticholinergic bronchodilator used for rescue/as-needed treatment. Example: ipratropium in Combivent/DuoNeb.

Asthma versus COPD

Asthma involves inflamed, reversibly narrowed airways. Chronic obstructive pulmonary disease (COPD) is persistent/progressive airflow obstruction, often associated with smoking. Rescue drugs act quickly; maintenance drugs are taken regularly.

Metered-dose inhaler (MDI) technique

Shake; breathe out; seal lips; begin a slow breath while pressing; continue inhaling; hold about 10 seconds; breathe out slowly. If repeating, wait 1 minute and shake again. Clean mouthpiece weekly; never wash canister.

Dry-powder inhaler technique (Diskus/Ellipta)

Hold level; load/open dose; exhale AWAY from device; seal lips; inhale QUICKLY and deeply; hold about 10 seconds; breathe out slowly. Do not block Ellipta vent. Rinse/spit if product contains corticosteroid.

Spiriva HandiHaler key technique

Keep capsule sealed until use; insert it into chamber, pierce once, exhale away, inhale slowly/deeply until capsule vibrates, hold about 10 seconds, then repeat inhalation without piercing again. Discard capsule after use; never swallow it.

Nonsteroidal anti-inflammatory drug (NSAID)

Blocks prostaglandins to reduce pain and inflammation. Common risk: GI upset/bleeding and kidney problems. Take with food; avoid alcohol and duplicate OTC NSAIDs; use caution with asthma, GI-bleed history, blood thinners, or kidney disease.

Oral corticosteroids

Stronger suppression of inflammation than NSAIDs. Take with food; avoid bedtime, alcohol, and OTC NSAIDs. Short-term use is preferred; long-term risks include infection, osteoporosis, and Cushingoid effects.

Immediate-release versus extended-release opioids

Immediate-release products are short acting, commonly every 4-6 hours as needed. Extended-release products provide long control and must not be crushed. All can cause sedation, constipation, and fatal respiratory depression.

When should naloxone be considered with an opioid?

Consider co-prescribing at 50 or more morphine milligram equivalents (MME)/day or with risk factors such as COPD/sleep apnea, benzodiazepines/other sedatives, substance-use disorder, or alcohol misuse.