ABLE 5 Med Card Quiz 3

Mupirocin

Brand: Bactroban

Class: Topical Antibacterial

Dosing: 2% cream— apply bid or tid for 5-10 days

MOA: Mupirocin is an antibacterial agent active against a wide range of gram-positive bacteria including methicillin-resistant S. aureus. It is also active against certain gram-negative bacteria. Mupirocin inhibits bacterial protein synthesis by reversibly and specifically binding to bacterial isoleucyl transfer-RNA synthetase. Because of this unique mode of action, mupirocin demonstrates no in vitro cross-resistance with other classes of antimicrobial agents.

ADR: None known

Monitoring Parameters:

Efficacy: Resolution of clinical signs of infection within 3-5 d. Eradication of nasal colonization.

Toxicity: Seek medical attention if local adverse effects are severe or if patient develops hypersensitivity reaction (swelling, redness, etc.).

Nitazoxanide

Brand: Alinia

Class: Antiprotozoal

Dosing: 500 mg q12 for 3 days

MOA: Interference with the pyruvate:ferredoxin oxidoreductase (PFOR) enzyme-dependent electron transfer reaction, which is essential to anaerobic metabolism of protozoans.

ADR: None known

Monitoring Parameters:

Efficacy: Resolution of signs and symptoms of infection, improvement in diarrhea.

Toxicity: Consider LFTs and CBC prior to therapy.

Nitrofurantoin

Brand: Macrodantin, Macrobid

Class: Nitrofuran Antibiotic

Dosing: 25, 50, 100— 100 bid for 5-7 days

MOA: Synthetic nitrofuran that inactivates bacterial ribosomes and is bactericidal in urine at therapeutic doses. It is active against most bacteria that cause UTIs, except nearly all strains of Pseudomonas are resistant.

ADR: Discoloration of urine

Monitoring Parameters:

Efficacy: Resolution of clinical signs of infection within 2-3 d. Prevention of urinary tract infection.

Toxicity: Severe diarrhea, yellowing of skin or eye, unusual bruising or bleeding, blistering skin rash, or shortness of breath. Signs of pulmonary reaction, numbness or tingling of extremities. With long-term use, CBC, LFTs, SCr.

Nystatin systemic (and topical)

Brand: Bio-statin (mycostatin, nyamyc, nystop)

Class: Polyene Antifungal

Dosing: 400,000-600,000 units in suspension po qid for 7-14 days for oropharyngeal candidiasis (apply lliberally to affected areas bid-tid for skin candidiasis)

MOA: Nystatin binds to the sterols in fungal cell walls, damaging the fungal cell wall membrane and altering its permeability for leakage of cellular contents.

ADR: None known

Monitoring Parameters:

Efficacy: Resolution of clinical symptoms. Prevention of fungal infection in patients receiving peritoneal dialysis.

Toxicity: Seek medical attention if severe mucosal irritation or rash occurs.

Oseltamivir

Brand: Tamiflu

Class: Neuraminidase Inhibitor, Antiviral

Dosing: 30 mg bid for 5 days for tx, and 7 days for proph

MOA: Oseltamivir is an inhibitor of influenza virus neuraminidase, which prevents viral progeny detaching from the cellular envelope

ADR: N/V, HA

Monitoring Parameters:

Efficacy: Prevention or resolution of influenza infection symptoms.

Toxicity: Seek care if heart palpitations, shortness of breath, severe rash, swelling, confusion, or anxiety occurs.

Penicillin

Brand: —

Class: Antibiotic

Indications: otitis media, strep, erysipelas, gingivitis

Dosing: 250,500— 250-500 bid-tid-qid

MOA: Penicillins are active against most gram-positive organisms and some gram-negative organisms, notably Neisseria spp., by interfering with late stages of bacterial cell wall synthesis; resistance is caused primarily by bacterial production of β-lactamases; some organisms have altered penicillin-binding protein targets (eg, Enterococci spp. and S. pneumoniae); others have impermeable outer cell wall layers.

ADR: N/V/D, oral candidiasis

Monitoring Parameters:

Efficacy: Resolution of clinical signs of infection or prevention of infection when used for prophylaxis in asplenia.

Toxicity: Assess SCr and CBC if prolonged therapy.

Pertussis Vaccine

Brand: Daptacel, Boostrix, Infanrix

Class: Vaccine, Inactivated, Bacterial

Dosing: 5 doses at age 2,4,6, 15-18 months, then another at 4-6 yo

ADR: inj site rxns— erythema, swelling, soreness, fever, ha, fatigue

Monitoring Parameters:

Efficacy: Prevention of pertussis; antibody concentration testing for routine measurement of vaccine response is not recommended.

Toxicity: Monitor for syncope, fever, or anaphylactic hypersensitivity reaction for 15 min after administration.

Pneumococcal (Conjugate and Polysaccharide)

Brand: Pneumovax23, Vaxneuvance, Prevnar 20, Capvaxive

Class: Vaccine, inactivated, bacterial

Dosing: 1 doses after 50 y/o, and under 50 if at increased risk

ADR: Injection site reactions (erythema, swelling, and soreness), rash, decreased appetite, arthralgia, myalgia, decreased sleep, somnolence, headache, asthenia, chills, fever

Monitoring Parameters:

Efficacy: Prevention of invasive pneumococcal disease, including bacterial meningitis; antibody concentration testing for routine measurement of vaccine response is not recommended.

Toxicity: Monitor for syncope, fever, or anaphylactic hypersensitivity reaction after administration.

Poliovirus Vaccine

Brand: Ipol

Class: Vaccine, Inactivated, Viral

Dosing: dose at 2,4,6-18 moths and then at 4-6 y/o

ADR: inj site reactions, loss of appetite, fatigue, irritability

Monitoring Parameters:

Efficacy: Prevention of poliomyelitis; antibody concentration testing for routine measurement of vaccine response is not recommended.

Toxicity: Monitor for syncope, fever, or anaphylactic hypersensitivity reaction for 15 min after administration

Raltegravir

Brand: Isentress

Class: Antiretroviral Agent, Integrase Inhibitor

Dosing: 400 mg bid for HIV

MOA: Raltegravir inhibits the catalytic activity of HIV-1 integrase, thus preventing integration of the viral DNA into the host strand.

ADR: elevated LFTs

Monitoring Parameters:

Efficacy: HIV viral load, CD4 count, HIV-resistance testing. HIV testing at baseline, 1.5 mo, 3 mo, and 6 mo following exposure for post-exposure prophylaxis.

Toxicity: LFTs, bilirubin, CBC, glucose. Monitor for skin changes and unusual behavior or depression.

Rifamixin

Brand: Xifaxan

Class: Antibiotic, miscellaneous

Indications: hepatic encephalopathy, IBS-D, Traveler’s diarrhea

Dosing: 550 mg po bid

MOA: Rifaximin is a semisynthetic derivative of rifampin and inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase. It has clinical activity against E. coli.

ADR: edema, dizziness, ascites, nausea

Monitoring Parameters:

Efficacy: Resolution of diarrhea. Decreased plasma ammonium levels or improvement in mental status if used for hepatic encephalopathy.

Toxicity: Weight, LFTs. Serum ammonia when used for hepatic encephalopathy.

Rotavirus

Brand: Rotarix, RotaTeq

Class: Vaccine, Live, Viral

Dosing: 1 dose at 6 weeks then 2 more doses at 4-10 week intercals

ADR: Vomiting, irritability, fever, otitis media, diarrhea

Monitoring Parameters:

Efficacy: Prevention of viral gastroenteritis due to rotavirus infection; antibody concentration testing for routine measurement of vaccine response is not recommended.

Toxicity: Fever, number of stools, abdominal pain.

Tetanus Toxoid

Brand: Daptacel, infanrix, adacel, boostrix

Class: Vaccine, Inactivated, Bacterial

Dosing: a2,4,6, 15-18 months, then at 4-6 y/o, then at 11-12 y/o, then every 10 years

ADR: Injection site reactions, including erythema, swelling and soreness. Fever, headache, fatigue, swelling of limb

Monitoring Parameters:

Efficacy: Injection site reactions, including erythema, swelling and soreness. Fever, headache, fatigue, swelling of limb

Toxicity: Monitor for syncope, fever, or anaphylactic hypersensitivity reaction for 15 min after administration. Severe local reaction (Arthus-type) occasionally occurs in adults who have received frequent tetanus toxoid or diphtheria vaccines; booster dose vaccination in these persons should not occur more frequently than every 10 y.

Trimethoprim/Sulfamethoxazole

Brand: Bactrim, Septra

Class: Sulfonamide Antibiotic

Indications: COPD exacerbation, HIV, traveler’s diarrhea, UTI

Dosing: 800/160-1600/320 bid

MOA: SMZ competitively inhibits the synthesis of dihydropteroic acid (an inactive folic acid precursor) in microorganisms. TMP inhibits the enzymatic reduction of dihydrofolic acid to tetrahydrofolic acid. The combination is active against many bacteria and P. carinii. TMP/SMZ has in vitro activity against MRSA, but clinical success has been variable and unpredictable.

ADR: N/D

Monitoring Parameters:

Efficacy: Resolution of signs of infection within 2-3 d. Preventionof Pneumocystis pneumonia.

Toxicity: Monitor potassium in those with concurrent ACEIs. Monitor FBG with concurrent sulfonylureas. CBC monthly if using for PCP prophylaxis. Monitor renal function.

Valacyclovir

Brand: Valtrex

Class: Viral DNA Polymerase Inhibitor

Indications: HSV, shingles, varicella,

Dosing: 500-1 g qd-bid

MOA: Valacyclovir is a prodrug of acyclovir. Acyclovir is an acyclic nucleoside analogue of deoxyguanosine that is selectively phosphorylated by the virus-encoded thymidine kinase to its monophosphate form. Cellular enzymes then convert the monophosphate to the active antiviral acyclovir triphosphate, which inhibits viral DNA synthesis by incorporation into viral DNA, resulting in chain termination. Acyclovir has potent activity against herpes simplex virus (HSV) 1 and 2 and varicella-zoster virus (VZV).

ADR: Malaise, headache, nausea, neutropenia, nasopharyngitis, increased LFTs

Monitoring Parameters:

Efficacy: Resolution or prevention of clinical signs of infection (lesions).

Toxicity: Monitor CBC, LFTs, urinalysis, and SCr, monitor for unusual behavior or altered consciousness.

Varicella Vaccine

Brand: Varivax

Class: Vaccine, Live, Viral

Dosing: 2 doses at 1 yo and then 4-6 yo

ADR: Fever, injection site reactions including erythema, swelling, and soreness

Monitoring Parameters:

Efficacy: Prevention of varicella infection; antibody concentration testing for routine measurement of vaccine response is not recommended.

Toxicity: Monitor for syncope, fever, or anaphylactic hypersensitivity reaction for 15 min after administration.

Zoster Vaccine

Brand: Shingrix

Class: Vaccine, Recombinant

Dosing: 2 dose series above 50 y/o

ADR: Injection site reactions, including erythema, swelling, and soreness, myalgia, fever

Monitoring Parameters:

Efficacy: Prevention of herpes zoster (shingles); antibody concentration testing for routine measurement of vaccine response is not recommended.

Toxicity: Monitor for syncope, fever, or anaphylactic hypersensitivity reaction for 15 min after administration.

Elbasvir/Grazoprevir

Brand: Zepatier

Class: NS3/4A Protease Inhibitor (Anti-HCV)

Dosing: 50/100 mg— take 1 qd for hep C

MOA: Elbasvir inhibits HCV NS5B RNA-dependent RNA polymerase, essential for viral replication. Grazoprevir inhibits NS3/4 protease, which cleaves the HCV polyprotein into mature forms and is required for replication.

ADR: Fatigue

Monitoring Parameters:

Efficacy: Improvement in signs and symptoms of hepatitis C infection. Confirm HCV subtype/genotype. Obtain serum hepatitis C viral RNA levels prior to, during, and 3 mo following treatment completion. It is also recommended to confirm HIV status prior to treatment.

Toxicity: In female patients and female partners of male patients, pregnancy tests should be done prior to and during treatment if ribavirin is included. Ensure hepatitis A and B immunization prior to treatment. Obtain HBV viral panel prior to starting treatment and initiate HBV antiviral treatment if patient is found to be positive. May alternatively monitor HBV levels throughout treatment. Monitor glucose, CBC, SCr, LFTs, and INR, direct bilirubin.

Esomeprazole

Brand: Nexium

Class: PPI

Dosing: 20-40 mg qd for gerd, esophagitis, h.pylori inf

MOA: Esomeprazole is a proton pump inhibitor that, when protonated in the secretory canaliculi of the parietal cells, covalently binds to H⁺/K⁺-ATPase (proton pump), which is the final pathway for acid secretion. Esomeprazole produces a profound and prolonged antisecretory effect, and inhibits basal, nocturnal, pentagastrin-stimulated, and food-stimulated gastric acid secretion.

ADR: Headache

Monitoring Parameters:

Efficacy: Resolution of GI discomfort, resolution of ulcers shown on endoscopy; for treatment of H. pylori, negative urea breath test. If H. pylori treatment fails, consider performing susceptibility/sensitivity tests.

Toxicity: Severe headache or blistering skin rash. Monitor serum electrolytes (magnesium, calcium). Monitor bone density in patients on prolonged PPI therapy.

Famotidine

Brand: Pepcid

Class: Histamine H2 Antagonist

Dosing: gerd and heartburn— 10-20 mg bid

MOA: Famotidine is a competitive inhibitor of histamine H₂ receptors. The primary clinically important pharmacologic activity of famotidine is inhibition of gastric secretion. Both the acid concentration and the volume of gastric secretion are suppressed by famotidine, while changes in pepsin secretion are proportional to volume output.

ADR: Agitation (infants)

Monitoring Parameters:

Efficacy: Resolution of GI discomfort, resolution of ulcers shown on endoscopy. Prevention of stress ulcer in critically ill patients.

Toxicity: Severe blistering skin rash, baseline renal function, CBC, gastric pH, occult blood with GI bleeding.

Finasteride

Brand: Proscar, Propecia

Class: 5alpha-reductase inhibitor

Dosing: bph-5 mg qd, male pattern alopecia--1 mg qd

MOA: Finasteride inhibits the conversion of testosterone to 5α-dihydrotestosterone (DHT) by 5α-reductase, isoform 2.

ADR: Impotence, reduced libido

Monitoring Parameters:

Efficacy: American Urologic Association (AUA) Symptom Score, decrease in residual urine volume, increased urine flow if using for BPH; increased hair growth if using for male pattern alopecia. Improvement in undesirable hair growth in females.

Toxicity: PSA, BP, urinalysis, breast or prostate cancer development.

Lansoprazole

Brand: Prevacid

Class: PPI

Dosing: 15-30 qd for GERD, gastric/duodenal ulcer disease, h. pylori

MOA: Lansoprazole is a proton pump inhibitor (PPI) that, when protonated in the secretory canaliculi of the parietal cells, covalently binds to H⁺⁺/K⁺-ATPase (proton pump), which is the final pathway for acid secretion.

ADR: None known

Monitoring Parameters:

Efficacy: Resolution of GI discomfort, resolution of ulcers shown on endoscopy, for treatment of H. pylori, negative urea breath test. Gastric acid output maintained at ≤10 meq/h in patients with Zollinger-Ellison syndrome.

Toxicity: Seek medical attention if severe headache, blistering skin rash occurs, or new-onset diarrhea accompanied by signs/symptoms of infection. CBC, LFTS, SCr, serum magnesium, bone loss, and fractures.

Linaclotide

Brand: Linzess

Class: Guanylate Cyclase Agonist

Dosing: 72, 145, 290 mcg qd for IBS-C, idiopathic/functional constipation

MOA: Binds and agonizes guanylate cyclase-C in intestinal epithelium resulting in chloride and bicarbonate secretion, increased intestinal fluid, which hastens GI transit.

ADR: Diarrhea

Monitoring Parameters:

Efficacy: Bowel movement quality and frequency.

Toxicity: Sensitivity reactions, rectal bleeding, positive bowel signs. In children and adolescents, monitor for signs and symptoms of dehydration. Dose may be reduced in patients who develop diarrhea following initiation.

Lubiprostone

Brand: Amitiza

Class: Chloride Channel Activator

Dosing: 8, 24 bid for IBS-C and other constipation

MOA: Lubiprostone is a bicyclic fatty acid that acts at the apical portion of the intestine as a chloride channel activator, which increases intestinal fluid secretion and improves fecal transit. When used for opioid-induced constipation, activation of the chloride channel bypasses the antisecretory effects of opioids.

ADR: Headache, nausea, diarrhea

Monitoring Parameters:

Efficacy: Improved bowel movements and relief from constipation caused by opioids, irritable bowel syndrome, or idiopathic constipation.

Toxicity: Baseline LFTs, physical exam, and history to rule out bowel obstruction.

Metoclopramide

Brand: Reglan, Gimoti

Class: Dopamine Antagonist

Dosing: 5-10 mg qd-qid for gastroparesis and GERD

MOA: Metoclopramide stimulates motility of the upper GI tract without stimulating gastric, biliary, or pancreatic secretions. Its mode of action is unclear. It seems to sensitize tissues to the action of acetylcholine. It is also a dopamine receptor antagonist at dose >5 mg/kg.

ADR: Asthenia, somnolence

Monitoring Parameters:

Efficacy: Improvement in gastroparesis and GERD symptoms. Reduction in or prevention of nausea and vomiting.

Toxicity: Seek medical attention if elevated BP, altered mental status, heart palpitation, fluid retention, unusual bruising or bleeding, or involuntary jerking movements. Obtain a baseline ECG and monitor periodically if concomitant QTc-prolonging medications, history of CVD, previous ECG with QTc >450 ms.

Ompeprazole

Brand: Prilosec

Class: PPI

Dosing: 10, 20, 40 qd for GERD, PUD, h.pylori

MOA: Omeprazole is a PPI that, when protonated in the secretory canaliculi of the parietal cells, covalently binds to H⁺/K⁺-ATPase (proton pump), which is the final pathway for acid secretion. Produces a profound and prolonged antisecretory effect and inhibits basal, nocturnal, and pentagastrin- and food-stimulated gastric acid secretion.

ADR: None known

Monitoring Parameters:

Efficacy: Resolution of GI discomfort, resolution of ulcers shown on endoscopy; for treatment of H. pylori, susceptibility testing. If H. pylori treatment failure, consider performing susceptibility/sensitivity tests.

Toxicity: Severe headache or blistering skin rash. Seek medical attention for signs of liver failure, elevated LFTs. Monitor serum magnesium. Monitor bone density in patients on prolonged PPI therapy.

Ondansetron

Brand: Zofran

Class: Antiemetic

Dosing: 4, 8, 24 qd-qid for n/v

MOA: Ondansetron is a selective 5-HT₃ receptor antagonist. Serotonin receptors of the 5-HT₃ type are present both peripherally and centrally in the chemoreceptor trigger zone. Cytotoxic chemotherapy releases serotonin from the enterochromaffin cells of the small intestine, initiating the vomiting reflex.

ADR: Constipation, diarrhea, headache, fatigue

Monitoring Parameters:

Efficacy: Reduction or prevention of nausea and vomiting.

Toxicity: Heart palpitations, shortness of breath, severe rash. Obtain ECG when concurrent QT prolonging medications or older adult at risk for QT prolongation. Monitor serum electrolytes. Signs/symptoms of significant constipation or bowel obstruction.

Pantoprazole

Brand: Protonix

Class: PPI

Dosing: 20, 40, qd-bid

MOA: Pantoprazole is a PPI that, when protonated in the secretory canaliculi of the parietal cells, covalently binds to H⁺/K⁺-ATPase (proton pump), which is the final pathway for acid secretion. Produces a profound and prolonged antisecretory effect and inhibits basal, nocturnal, pentagastrin-stimulated, and food-stimulated gastric acid secretion.

ADR: Headache

Monitoring Parameters:

Efficacy: Resolution of GI discomfort, resolution of ulcers shown on endoscopy; for treatment of H. pylori, negative urea breath test. If H. pylori treatment failure, consider performing susceptibility/sensitivity tests.

Toxicity: Monitor serum magnesium. Monitor bone density in patients on prolonged PPI therapy.

Phenazopyridine

Brand: Pyridium

Class: Urinary Tract Analgesic

Dosing: 95, 99.5, 100, 200— tid for up to 2 days

MOA: Phenazopyridine is excreted in the urine where it exerts a topical analgesic effect on the mucosa of the urinary tract. This action helps relieve pain, burning, urgency, and frequency. The precise mechanism of action is not known.

ADR: GI upset

Monitoring Parameters:

Efficacy: Resolution of clinical symptoms of dysuria (painful urination).

Toxicity: Signs of hemolytic anemia, hepatotoxicity, or nephrotoxicity.

Polyethylene Glycol

Brand: Golytely, NuLytely, MoviPrep, Plenvu

Class: Hyperosmotic Laxative

Dosing: 100-420 g for colonoscopy prep,17 g for constipation

MOA: Polyethylene glycol (PEG) electrolyte lavage solution is a hyperosmotic solution that induces catharsis by the osmotic effects of unabsorbed sulfate salts and PEG and also includes various electrolytes (sodium sulfate, sodium bicarbonate, sodium chloride, potassium chloride).

ADR: Anal irritation, bloating symptom, epigastric fullness, nausea, stomach cramps, hypermagnesemia, increased thirst

Monitoring Parameters:

Efficacy: Bowel movements should begin within 60 min of initiating administration and dosing should continue until rectal effluent is clear if utilized as bowel preparation for imaging study.

Toxicity: Seek medical attention if urticaria, rhinorrhea, or dermatitis occurs. Monitor SCr, BUN, electrolytes, serum glucose, ECG (in patients with CVD risk).

Rabeprazole

Brand: AcipHex

Class: PPI

Dosing: 20, 40, max 60

MOA: Rabeprazole is a proton pump inhibitor (PPI) that, when protonated in the secretory canaliculi of the parietal cells, covalently binds to H⁺/K⁺-ATPase (proton pump), which is the final pathway for acid secretion. Rabeprazole produces a profound and prolonged antisecretory effect and inhibits basal, nocturnal, and pentagastrin- and food-stimulated gastric acid secretion.

ADR: Abdominal pain, diarrhea, vomiting

Monitoring Parameters:

Efficacy: Resolution of GI discomfort, resolution of ulcers shown on endoscopy; for treatment of H. pylori, susceptibility testing. If H. pylori treatment failure, consider performing susceptibility/sensitivity tests.

Toxicity: Mg, calcium, and SCr levels if long-term use. Monitor bone density in patients on prolonged PPI therapy.

Tamsulosin

Brand: Flomax

Class: Alpha1-Adrenergic Blocker

Dosing: 0.4-0.8 qd for BPH

MOA: Tamsulosin is closely related to quinazoline derivatives that selectively block postsynaptic α₁-adrenergic receptors. Total peripheral resistance is reduced through arterial and venous dilations. Reflex tachycardia that occurs with other vasodilators is infrequent because there is no presynaptic α₂-receptor blockade. The drugs also decrease total cholesterol, increase HDL cholesterol, and may improve glucose tolerance and reduce left ventricular mass during long-term therapy. They increase urine flow in BPH by relaxing smooth muscle tone in the bladder neck and prostate.

ADR: Dizziness, headache, abnormal ejaculation, rhinitis, positional hypotension

Monitoring Parameters:

Efficacy: American Urological Association (AUA) Symptom Score; decrease in residual urine volume, increased urine flow. Relief of benign prostatic hyperplasia symptoms.

Toxicity: Signs/symptoms of hypotension, BP, decreased mental alertness, falls due to orthostasis.

Tolterodine

Brand: Detrol, Detrol LA

Class: Antimuscarinic

Dosing: 1-2 mg bid or 2-4 qd of LA for bladder muscle dysfunction

MOA: Tolterodine, a competitive muscarinic receptor antagonist, has a high binding affinity for the cholinergic muscarinic receptors that mediate contraction of the urinary bladder and salivation. The drug exerts its significant effects on the lower urinary tract by increasing the residual urine and decreasing detrusor pressure.

ADR: Xerostomia

Monitoring Parameters:

Efficacy: Subjective improvement of urge incontinence (reduced desire to urinate) and urinary frequency.

Toxicity: Assess renal and hepatic function at baseline; monitor vital signs.

Glacaprevir/Pibrentasvir

Brand: Mavyret

Class: NS3/4A Protease Inhibitor (Anti-Hepatitis C Virus)

Dosing: 100/40— 3 tabs qf for 8 weeks for Hep C

MOA: Pibrentasvir inhibits hepatitis C virus NS5B RNA-dependent RNA polymerase, essential for viral replication. Glecaprevir inhibits NS3/4 protease, which cleaves the hepatitis C virus polyprotein into mature forms and is required for replication.

ADR: Fatigue, nausea, headache

Monitoring Parameters:

Efficacy: Improvement in signs and symptoms of hepatitis C infection. Serum hepatitis C viral RNA levels prior to, during, and at least 12 wk following treatment completion.

Toxicity: In female patients and female partners of male patients, pregnancy tests should be done prior to and during treatment if ribavirin is included. Monitor glucose, CBC, SCr, INR, and LFTs. Ensure patient has been vaccinated against hepatitis A and B prior to treatment initiation. Obtain pre-treatment HIV status. Confirmation of prior HBV infection should be completed prior to treatment start. If prior infection, patient should be initiated on HBV prophylaxis for the duration of therapy and 12 wk following treatment completion.

Sofosbuvir

Brand: Sovaldi

Class: Polymerase Inhibitor (Anti-HCV)

Dosing: 200, 400— qd in combo with ribavirin for Hep C

MOA: A direct-acting antiviral agent against the hepatitis C virus. It inhibits HCV NS5B RNA-dependent RNA polymerase, essential for viral replication, and acts as a chain terminator.

ADR: Fatigue, headache, insomnia, chills, pruritus, rash, nausea, anemia

Monitoring Parameters:

Efficacy: Improvement in signs and symptoms of hepatitis C infection. Monitor SCr and LFTs. Serum hepatitis C viral RNA levels prior and during treatment. Prior to starting treatment, obtain subtype and genotype of hepatitis C infection. Obtain HBV antibody (core and surface) and HBV surface antigen to determine prior infection.

Toxicity: In female patients and female partners of male patients, pregnancy tests should be done prior to and during treatment. Monitor SCr, LFTs, CBC and glucose (if diabetic). Obtain pre-treatment HIV status. Confirmation of prior HBV infection should be completed prior to treatment start. If prior infection, patient should be monitored for signs/symptoms of HBV reactivation during treatment.

Darifenacin

Brand: Enablex

Class: Urinary Antispasmodic, selective M3 muscarinic receptor antagonist

Dosing: 7.5 qd up to 15 for overactive bladder

MOA: Darifenacin is a competitive muscarinic receptor antagonist. Muscarinic receptors play an important role in several major cholinergically mediated functions, including contractions of the urinary bladder smooth muscle and stimulation of salivary secretion.

ADR: Constipation, xerostomia, blurred vision

Monitoring Parameters:

Efficacy: Resolution of clinical signs of bladder spasticity, incontinence, urinary urgency and frequency.

Toxicity: LFTs. Severe anticholinergic effects (dry mouth, ability to empty bladder on voiding, cognitive impairment, constipation, vision changes).

Dexlansoprazole

Brand: Dexilant

Class: PPI

Dosing: 30, 60 qd for 4-8 weeks adn then 30 qd

MOA: Dexlansoprazole is a proton pump inhibitor (PPI) that, when protonated in the secretory canaliculi of the parietal cells, covalently binds to H⁺/K⁺-ATPase (proton pump), which is the final pathway for acid secretion.

ADR: None known

Monitoring Parameters:

Efficacy: Resolution of GI discomfort.

Toxicity: Seek medical attention if severe headache or blistering skin rash occurs. Prolonged duration of therapy may increase risk of C. difficile infection, especially in hospitalized patients. Additionally, prolonged duration may be associated with vitamin B₁₂ deficiency, monitor and supplement as clinically indicated.

Diphenoxylate/Atropine

Brand: Lomotil

Class: Antidiarrheal— CV

Dosing: 2.5/0.025— 2 tabs qid until diarrhea resolves— max 20 mg/d

MOA: Diphenoxylate is a synthetic meperidine congener without analgesic activity that slows GI motility. Because high doses of diphenoxylate (40-60 mg) cause systemic opioid activity, atropine is added in subtherapeutic amounts to decrease abuse potential.

ADR: Abdominal discomfort, nausea, and vomiting

Monitoring Parameters:

Efficacy: Frequency and volume of bowel movements; body temperature.

Toxicity: Monitor for signs of atropine toxicity, blood in stool, and abdominal distention.