- auxiliary labels

Federal law requires what medications to have the following auxiliary label?

Schedule II, III and IV

Which government requires the following auxiliary label?

Federal or State?

State

What is the following auxiliary label required for?

Any single or a combination opioid

Opioid prescriptions auxiliary labels?

Federal Law Prohibits and Caution: Opioid

Which government requires the following auxiliary label?

Federal or State?

State

Which government requires the following auxiliary label?

Federal or State?

State

Which medications would require this auxiliary label sticker?

Progesterone, Clevidipine, and Propfol

Which formulation of progesterone requires the following auxiliary label?

Prometrium only

What medications would require this auxiliary label?

Neuromuscular blocking agents

Neuromuscular blocking agents can only be given to a patient who is already on BOTH…

An analgesic and under deep sedation

What medications should receive this auxiliary label?

Antibiotics, antifungals, antivirals

Other drugs that can affect vision include:

• Hydroxychloroquine

• Tamoxifen

• Amiodarone

• Ethambutol

• Isotretinoin

• Isoniazid

• Ivabradine.

Avoid prolonged exposure to direct and/or artificial sunlight while using the following medications due to increased skin sensitivity:

1. Sulfa antibiotics

2. Quinolones

3. Tetracyclines

4. Metronidazole

5. Isoniazid

6. Topical retinoids (newer ones less risk)

7. Ritonavir and a few other HIV drugs

8. NSAIDs (piroxicam, diclofenac, ibuprofen, naproxen)

9. Diuretics

10. Isotretinoin (oral)

While on the following medications, patients should be counseled to use an alternative contraceptive to prevent pregnancy since some of these medications may decrease the efficacy of birth control pills:

• Barbiturates (ex: phenobarbital)

• Ampicillin

• Tetracycline

• Rifampin, rifapentine

• Griseofulvin

• Bosentan

• Anticonvulsants (such as topiramate, lamotrigine, carbamazepine, primidone, phenytoin, oxcarbazepine)

• Some HIV drugs (some protease inhibitors, NNRTls)

Persistent diarrhea due to colitis may occur weeks after using the medication. This should be reported to your doctor immediately as it can be a dangerous side effect. What medications can cause this?

• Clindamycin

• Quinolones

• Broad-spectrum antibiotics.

May cause discoloration of the urine, skin and sweat and could stain contact lenses and clothing. List the medications that can do this.

• Entacapone

• Carbidopa/ levodopa

• Metronidazole

• Rifampin

• Nitrofurantoin

• Phenazopyridine

• Sulfasalazine

• Doxorubicin

• Mitoxantrone

Which medications should be taken on an empty stomach?

• Ampicillin

• Voriconazole (Vfend)

• Efavirenz (Sustiva/Atripla)

• Didanosine

• Bisphosphonates

• Captopril

• Iron (if tolerated)

• PPIs

• Levothyroxine

• Oxymorphone

• Mycophenolate (CellCept)

• Tacrolimus EX (Astagraf XL, Envarsus XR)

• Zafirlukast

What is the standard time frame for an individual should eat food while taking a medication that should be taken on an empty stomach?

1 hour before or 2-3 hours after a meal

Which medications should be taken with food?

• Carvedilol (Coreg)

• Metoprolol Tartrate (Lopressor)

• Lovastatin (with dinner)

• Fenofibrate and derivatives (Lipofen, Fenoglide)

• Niacin

• Gemfibrozil (Lopid)

• Metformin (IR with breakfast and dinner, XR with dinner)

• Itraconazole capsules

• Phosphate binders (when eating)

• NSAIDs

• Steroids

• Opioids (except oxymorphone)

Drugs can get "stuck" going down, especially if dysphagia is present. What drugs are preferred to be taken with a full glass of water.

• Bactrim

• Bisphosphonates

• Sulfasalazine (Azulfidine - take with water & food)

• Pancrelipase

Do not eat grapefruit or drink grapefruit juice at any time while taking the following medications to avoid drug interactions:

• Statins: lovastatin, simvastatin, atorvastatin

• Amiodarone

• Dofetilide

• Buspirone

• Carbamazepine

• Cyclosporine \

• Tacrolimus

• Diazepam, Triazolam

• HTN Meds: Verapamil, Nicardipine, Felodipine, Nisoldipine and Nifedipine

Which medications should be separated from dairy products, calcium, magnesium, iron and antacids because it can make the medication less effective?

• Tetracyclines

• Quinolones

• Levothyroxine

Which dosage forms should receive this label?

• All suspensions

• Most asthma aerosol inhalers

• Nasal steroid spray

• Lidocaine viscous topical liquid

Enteric-coated formulations (ex: bisacodyl or aspirin), any long-acting formulations, timecaps, and sprinkles should receive this sticker. Which long-acting formulations can you cut at the score line but cannot be crushed or chewed?

• Metoprolol XR

• Carbidopa/Levodopa SR

Chemotherapeutic agents require special packaging and labeling for proper handling of the medication and proper disposal of the bag and tubing. Alternative wording for an auxiliary label includes:

Chemotherapy: Dispose of Properly

Any type of irrigation should be labeled so that it is NOT administered intravenously. This includes:

1. Peritoneal dialysis irrigation solution

2. Saline

3. Sterile water irrigation solution

Epidural or ___________ solutions should be labeled to decrease risk of administration via an incorrect route.

Intrathecal

Which oral suspensions should not be refrigerated.

Azithromycin, Cefdinir, Clindamycin

Which IV medications should not be refrigerated.

• Dexmedetomidine

• Bactrim

• Phenytoin

• Furosemide

• Metronidazole

• Moxifloxacin

• Enoxaparin

Acronym to remember IV medications that should not be refrigerated:

Dear Boring Pharmacist, Freezing Makes Me Edgy (DBPFMME)

What does DBPFMME stand for?

• Dexmedetomidine

• Bactrim

• Phenytoin

• Furosemide

• Metronidazole

• Moxifloxacin

• Enoxaparin

Medications that require refrigeration should be kept between…

36-46°F

Antibiotic suspensions that require refrigerate after reconstitution:

• Augmentin

• Amoxicillin (not required, but improves taste

• Cefpodoxime

• Cefprozil

• Cefuroxime

• Ceftibuten

• Cephalexin

• Benzamycin

• Penicillin V

Eyedrops that require refrigeration until they’re opened”

• Latanoprost (Xalatan)

• Tafluprost (Zioptan)

Medications that should be protected from light:

• Phytonadione

• Epoprostenol

• Nitroprusside

• Micafungin

• Doxycycline

Acronym to remember medications that should be protected from light

PENMD

This auxiliary label is indicated for which specific dosage type? Other dosage types might need additional labels with specifics…

Topical medication

Intramuscular (IM) injections should be labeled to decrease the risk of administration via an incorrect route.

For example, the preferred route of promethazine injection is IM due to risk of…

Tissue irritation and damage

Intramuscular (IM) injections should be labeled to decrease the risk of administration via an incorrect route.

Why is promethazine contraindicated in patients < 2 years old?

Increased risk of fatal respiratory depression

It is contraindicated or not recommended to give promethazine via what other routes of administration?

Subcutaneous injection, not recommended for IV

This auxillary label is for drugs that must be administered via central (not peripheral) IV access only. Due primarily to the risk of phlebitis (vein irritation) and for vesicant medications (risk of severe tissue damage if line extravasates).

Which medications have a risk of phlebitis if given peripherally?

• Parenteral nutrition, most chemotherapeutics

• Calcium chloride

• Hypertonic saline

• Mannitol

• Digoxin

• Foscarnet

• Nafcillin

• Mitomycin

• Quinupristin/dalfopristin (Synercid)

• KCI

• Amiodarone (concentrated)

This auxillary label is for drugs that must be administered via central (not peripheral) IV access only. Due primarily to the risk of phlebitis (vein irritation) and for vesicant medications (risk of severe tissue damage if line extravasates).

Which vesicant medications should be given via a central line

• Vesicant

• Vasopressors (ex: norepinephrine, dopamine)

• Anthracyclines (ex: doxorubicin)

• Vinca alkaloids (ex: vincristine)

  • Do not administer vincristine by intrathecal administration.

Which medications should receive this auxillary label?

• Golimumab

• Amiodarone

• Phenytoin

• Parenteral nutrition

• Lipids

• Amphotericin B

• Carbazitaxel

• Paclitaxel

Dornase alfa auxiliary labels

• Keep refrigerated

• Protect from light

Pancreatic Enzyme Products (PEPs) auxiliary labels:

• Creon

• Viokace

• Zenpep

• Lip-Pro-Amyl

• Pancreaze

• Pertzye

• Swallow whole

• Do not refrigerate

• Take with food

• Drink with plenty of water