3PD Top 200 Drugs Fall

Pain/Musculoskeletal Agents

Acetaminophen; Hydrocodone Bitartrate brand name

Norco, Lortab, Vicodin, Lorcet

Acetaminophen; Hydrocodone Bitartrate Therapeutic Class

Opioid Analgesic. C-II

Acetaminophen; Hydrocodone Bitartrate FDA Labeled indications

Pain (severe)

Acetaminophen; Hydrocodone Bitartrate MOA

Hydrocodone binds to opiate receptors, resulting in altered perception of pain.

Acetaminophen; Hydrocodone Bitartrate Box Warnings

Addiction, abuse, misuse, REMS, respiratory depression, accidental ingestion, neonatal opioid withdrawal, alcohol, CYP3A4/5 interactions, hepatotoxicity, concurrent use with benzodiazepines

Acetaminophen; Hydrocodone Bitartrate Common ADRs

Constipation, GI distress, somnolence

Acetaminophen; Hydrocodone Bitartrate Patient Key Counseling Points

Use a stool softener and/or laxative for preventing constipation with chronic use.

May cause drowsiness; avoid driving or other tasks requiring motor coordination.

Avoid alcohol and other CNS depressants.

Baclofen Brand Name

Lioresal, Ozobax, Fleqsuvy

Baclofen Therapeutic class

Centrally Acting Skeletal Muscle Relaxant

Baclofen common FDA labeled indications

Spasticity

Baclofen MOA

It inhibits both monosynaptic and polysynaptic reflexes at the spinal level, possibly by hyperpolarization of afferent terminals, although actions at supraspinal sites may also occur and contribute to its clinical effect. It is an analogue of γ-aminobutyric acid (GABA), but there is no conclusive evidence that actions on GABA systems are involved in the production of its clinical effects.

Baclofen Box warnings

Avoid abrupt discontinuation of oral or intrathecal product

Baclofen Common ADRs

Nausea, asthenia (abnormal weakness), dizziness, somnolence, confusion

Baclofen Key patient counseling points

Because of the possibility of sedation, patients should be cautioned regarding the operation of motor vehicles or dangerous machinery while taking.

Patients should be cautioned that the CNS effects may be additive to those of alcohol and other CNS depressants.

Oral packet doses should be taken within 2 h when mixed with food.

Burpenorphine/Naloxone brand name

Suboxone, Zubsolv

Burpenorphine/Naloxone Therapeutic class

Opioid Partial Agonist and Antagonist Combination. C-III

Burpenorphine/Naloxone FDA labeled indications

Opioid use disorder

Burpenorphine/Naloxone MOA

a μ-opioid receptor partial agonist and alpha -opioid receptor antagonist. Naloxone is a μ-opioid receptor antagonist that causes opioid withdrawal when injected parenterally and is included in the formulation to reduce the risk of abuse.

Burpenorphine/Naloxone Box warnings

None

Burpenorphine/Naloxone common ADRs

Vasodilation, sweating, headaches, insomnia, constipation, GI distress, opioid withdrawal, dizziness

Burpenorphine/Naloxone key patient counseling points

Use a stool softener and/or laxative for preventing constipation.

May cause drowsiness; avoid driving or other tasks requiring motor coordination. Avoid alcohol and other CNS depressants.

Do not crush or swallow the sublingual tablet.

Place the tablet under the tongue until it is dissolved.

If you take ≥2 tablets at a time, place all of the tablets under the tongue together. If this is uncomfortable, place 2 tablets at a time under the tongue and repeat the process until all tablets have been taken.

If you are using the sublingual film, place the film under the tongue until it is dissolved. If you need to take an additional film, place the new film on the opposite side from the first film. Do not chew, swallow, or move the film after placing it under the tongue.

After the tablet/film has dissolved, swish and swallow water. Do not brush teeth until 1 h after tablet/film administration.

Carisoprodol brand name

Soma, Vanadom

Carisoprodol therapeutic class

Centrally Acting Skeletal Muscle Relaxant. C-IV

Carisoprodol FDA labeled indications

Disorder of musculoskeletal system

Carisoprodol MOA

blocks interneuronal activity in descending reticular formation and spinal cord, resulting in muscle relaxation.

Carisoprodol Box Warnings

none

Carisoprodol common ADRs

Drowsiness

Carisoprodol key patient counseling points

Patients should avoid consuming alcohol.

Patients should avoid activities requiring mental alertness or coordination until drug effects are known, as drug may cause dizziness or sedative effects.

Patients withdrawing from prolonged therapy should be monitored carefully for withdrawal symptoms, including seizures.

Celecoxib brand name

Celebrex, Elyxyb

Celecoxib Class

Cyclooxygenase-2 (COX-2) Inhibitor - NSAID

Celecoxib FDA labeled indications

Osteoarthritis

Rheumatoid arthritis

Ankylosing spondylitis

Acute pain, primary dysmenorrhea

Migraine, acute treatment

Celecoxib MOA

Inhibition of the COX-2 enzyme isoform is thought to be responsible for the anti-inflammatory effects of NSAIDs.

Celecoxib Box warnings

Cardiotoxicity, contraindicated for CABG, serious gastrointestinal disorders

Celecoxib Major ADRs

HTN, headaches, GI distress, diarrhea

Celecoxib Key patient counseling Points

May take with food or milk to decrease GI upset.

May open capsule and pour into a teaspoon of applesauce.

Codeine with Acetaminophen brand name

Tylenol with Codeine

Codeine with Acetaminophen Class

Opioid. C-II (when in combination with acetaminophen, C-III for tablets, C-V for liquid)

Codeine with Acetaminophen FDA labeled indications

Pain

Codeine with Acetaminophen MOA

3-methylmorphine, a phenanthrene opioid with very low affinity for opioid receptors. Its analgesic activity appears to result from conversion to morphine.

Codeine with Acetaminophen box warnings

Abuse, REMs, respiratory depression, accidental ingestion, CYP2D6 in children, neonatal withdrawal syndrome, interactions with CYP3A4/5, 2D6, avoid concomitant benzodiazepines and CNS depressants, risk of medication errors with oral solution

Codeine with Acetaminophen major ADRs

Nausea, vomiting, constipation, somnolence

Codeine with Acetaminophen key patient counseling points

Take with food to decrease stomach upset and nausea.

Avoid grapefruit or grapefruit juice due to risk of increased codeine toxicity.

If using chronically, use laxative for preventing constipation.

May cause drowsiness; avoid driving or other tasks requiring motor coordination.

If using an acetaminophen-containing product, advise patients to avoid other acetaminophen-containing products for pain.

Avoid alcohol.

Cyclobenzaprine Hydrochloride brand name

Flexeril, Amrix, Fexmid

Cyclobenzaprine Class

Centrally Acting Skeletal Muscle Relaxant

Cyclobenzaprine FDA labeled indications

Skeletal muscle spasm

Cyclobenzaprine MOA

relieves skeletal muscle spasm of local origin without interfering with muscle function. It is ineffective in muscle spasm due to CNS disease. Evidence suggests that the net effect of cyclobenzaprine is a reduction in tonic motor activity, influencing both gamma (γ) and alpha (α) motor systems.

Cyclobenzaprine Box warning

none

Cyclobenzaprine major ADRs

Xerostomia, dizziness, drowsiness

Cyclobenzaprine key patient counseling points

Patients should avoid activities requiring mental alertness or coordination until drug effects are known, as drug may cause dizziness or sedative effects.

Take extended-release capsule same time each day.

For patients with difficulty swallowing, the extended-release capsules may be opened and granules mixed with applesauce for administration.

Diclofenac sodium brand name

Voltaren, Voltaren XR

Diclofenac class

NSAID

Diclofenac FDA labeled indications

Pain

Dysmenorrhea

Migraine

Osteoarthritis

Rheumatoid arthritis

Ankylosing spondylitis

Diclofenac MOA

Nonselective inhibitor of cyclo-oxygenase-1 (COX-1) and cyclo-oxygenase-2 (COX-2).

Diclofenac box warning

Cardiovascular, GI risk, CABG

Diclofenac major ADRS

GI distress, peripheral swelling

Diclofenac patient key counseling points

Take with food or milk to decrease GI upset

Do not chew, split, or crush the delayed-release and extended-release products.

Fentanyl (Transdermal) brand name

Duragesic

Fentanyl Class

Opioid Analgesic. C-II

Fentanyl FDA labeled indications

Pain, chronic

Chronic cancer pain

Fentanyl MOA

is a phenylpiperidine opioid agonist with predominant effects on the mu-opioid receptor and is about 50-100 times more potent as an analgesic than morphine.

Fentanyl box warnings

Respiratory depression; addiction, CYP3A4/5 interactions, fatalities in children; formulations not interchangeable; care with disposal; REMS program; concurrent use with benzodiazepines or other CNS depressants, neonatal withdrawal, heat exposure with transdermal patch

Fentanyl common ADRs

Application site reactions, constipation, GI distress, confusion, headache, urinary retention, fatigue, edema, nausea, vomiting

Fentanyl patient key counseling points

A stimulant laxative should be recommended to prevent constipation.

May cause drowsiness; avoid driving or other tasks requiring motor coordination.

Avoid alcohol and other CNS depressants.

Apply to clean, dry skin.

Skin breaks may increase absorption.

Remove old patch when new patch applied.

Febrile patients may have increased absorption.

Patch should be removed prior to MRI scan as it may contain aluminum.

Do not cut patch.

Hydrocodone Bitartrate Brand Name

Norco, Lorcet, Vicodin, Hysingla ER

Hydrocodone Therapeutic Class

Opioid Analgesic. C-II

Hydrocodone FDA Labeled indications

Pain, severe

Hydrocodone MOA

binds to opiate receptors, resulting in altered perception of pain.

Hydrocodone Box warning

Addiction, abuse, misuse, REMS, respiratory depression, accidental ingestion, neonatal opioid withdrawal, alcohol, CYP3A4/5 interactions, hepatotoxicity, concurrent use with benzodiazepines

Hydrocodone Common ADRs

Constipation, GI distress, somnolence

Hydrocodone Patient Key Counseling Points

Use a stool softener and/or laxative for preventing constipation with chronic use.

May cause drowsiness; avoid driving or other tasks requiring motor coordination.

Avoid alcohol and other CNS depressants.

Hydrocortisone rectal brand name

Anusol-HC, Proctosol-HC

Hydrocortisone rectal FDA Labeled indications

Skin disorders, corticosteroid responsive

Hydrocortisone Therapeutic Classification

Topical Corticosteroid

Hydrocortisone MOA

anti-inflammatory, antipruritic, and vasoconstrictive properties. Corticosteroids are thought to act by the induction of phospholipase A2-inhibitory proteins, lipocortins. It is postulated that these proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor, arachidonic acid. Arachidonic acid is released from membrane phospholipids by phospholipase A2.

Hydrocortisone Box warning

None

Hydrocortisone common ADRs

None known

Hydrocortisone key patient counseling points

Apply thin layer to affected area of skin.

Skin should be clean and intact at site of application.

Avoid contact with eyes and do not ingest by mouth.

Avoid occlusive dressings or tight-fitting clothes over site of administration.

Wash hands after application.

Ibuprofen brand name

Motrin, Advil

Ibuprofen therapeutic class

NSAID

Ibuprofen FDA labeled indications

Fever

Pain, headache

Osteoarthritis or rheumatoid arthritis

Juvenile rheumatoid arthritis

Ibuprofen Box warning

Cardiovascular events, GI toxicity, CABG

Ibuprofen MOA

Nonselective inhibitor of cyclo-oxygenase-1 (COX-1) and cyclo-oxygenase-2 (COX-2), and reversibly alters platelet function and prolongs bleeding time.

Ibuprofen Patient Key Counseling Points

Take with food or milk to decrease GI upset. Counsel patients with heart failure to avoid NSAIDs as they may cause fluid retention which can exacerbate heart failure.

Ibuprofen common ADRs

None known

Lidocaine Transdermal brand name

Lidoderm, Lidotral

Lidocaine therapeutic class

Local Anesthetic

Lidocaine FDA Labeled indications

Postherpetic neuralgia and localized pain

Lidocaine MOA

amide-type local anesthetic agent and is suggested to stabilize neuronal membranes by inhibiting the ionic fluxes required for the initiation and conduction of impulses. The penetration of lidocaine in patch form into intact skin is sufficient to produce an analgesic effect but less than the amount necessary to produce a complete sensory block.

Lidocaine Box warning

None

Lidocaine common ADRs

Skin irritation, somnolence

Lidocaine key patient counseling points

Instruct patients on the appropriate application process.

Leave patches on skin for no longer than 12 h within a 24-h period.

Caution patients to administer only as directed, to intact skin, without covering with occlusive dressing or tight clothes.

Avoid applying external heat (eg, heating pads or heating blankets) to the lidocaine patch as this may increase drug exposure and adverse effects.

Avoid contact with eyes and wash hands immediately following patch application.

Meloxicam brand name

Mobic

Meloxicam Therapeuric Class

NSAID

Meloxicam FDA Labeled indications

Osteoarthritis

Rheumatoid arthritis

Juvenile rheumatoid arthritis

Meloxicam MOA

Nonselective inhibitor of COX-1 and COX-2 which results in decreased formation of prostaglandin precursors; has antipyretic, analgesic, and anti-inflammatory properties; reversibly alters platelet function and prolongs bleeding time.

Meloxicam Box warning

Cardiovascular thrombotic events, serious GI bleeding and perforation, CABG

Meloxicam common ADRs

GI distress

Meloxicam Key Patient Counseling Points

Take with food or milk to decrease GI upset. For suspension, shake gently before using. Avoid use around 20 wk gestation. Pregnant women should consult HCP before using.

Methocarbamol Brand name

Robaxin, Tanlor

Methocarbamol Therapeutic Class

Centrally Acting Skeletal Muscle Relaxant