Counseling point Community pharm Exam 2

12 hours on, 12 hours off; up to 3 patches; can be cut to size

Lidoderm (lidocaine) patch

Apply at night, increases sun sensitivity, acne may worsen before it improves

Retin-A (tretinoin)

1 FTU = about 0.5 g and covers about both palms

Fingertip unit dosing for topicals

Ointments are MORE potent; creams rub in better

Topical formulation rule

Middle-potency topical steroid

Kenalog (triamcinolone)

High-potency topical steroid

Temovate (clobetasol)

Glaucoma drug that BOTH decreases production and increases drainage

Alphagan P (brimonidine), alpha-2 agonist

Glaucoma drug that DECREASES aqueous humor production

Timoptic (timolol), beta blocker

Glaucoma drug that INCREASES drainage

Xalatan (latanoprost), prostaglandin agonist

Permanently turns light-colored eyes brown; lashes get longer and darker

Xalatan (latanoprost)

Refrigerate until dispensed, good at room temperature for 6 weeks

Xalatan (latanoprost)

Refrigerate until dispensed, good 4 MONTHS at room temperature

NuvaRing

Single-use preservative-free vials; delayed onset, not for immediate relief

Restasis (cyclosporine)

Eye steroid - do NOT use in infections; suspension, shake well

Pred Forte (prednisolone)

Under 3 years old pull the ear DOWN and back; over 3 pull UP and back

Ciprodex otic administration

Wait 5 minutes between doses of the SAME eye drop, 15 minutes between DIFFERENT drops

Ophthalmic counseling

Days supply calculation for eye drops in this course uses how many drops per mL?

20 gtts/mL

Empty stomach 30-60 min before breakfast; separate calcium/iron/magnesium by 4 hours

Synthroid (levothyroxine) and Armour Thyroid

Porcine-derived, contains both T3 and T4

Armour Thyroid (thyroid, desiccated)

Effects take 6-12 weeks; report fever or sore throat to the doctor

Tapazole (methimazole)

C-III; apply to upper arms not the genital area, cover with a shirt, no swimming/showering 2 hours

Androgel (testosterone)

The CLOUDY insulin - gently roll, do not shake

NPH (Humulin N / Novolin N)

Insulin storage rule

Refrigerate until opened, then room temperature, use within about 28 days

Insulin injection technique

Subcutaneous - abdomen, thigh, upper arm; 90 degree angle; rotate sites; prime the pen

Rotating sites and not reusing needles prevents this

Lipodystrophy

Most concentrated insulin on your list (U-300)

Toujeo (insulin glargine)

First-line oral medication for Type 2 diabetes

Glucophage (metformin)

Diabetes class with the MAJOR hypoglycemia risk and weight gain

Sulfonylureas (glimepiride, glipizide)

Diabetes drug causing edema - avoid in heart failure

Actos (pioglitazone)

Diabetes class causing increased genital/urinary infections and dehydration

SGLT-2 inhibitors (Invokana, Jardiance)

Weekly SQ injection, about 15% weight loss

GLP-1 agonists (Trulicity, Ozempic/Wegovy)

Dual GIP/GLP-1 agonist, about 20% weight loss

Mounjaro/Zepbound (tirzepatide)

Multi-dose pen good about 56 days at room temperature after first use

Ozempic (semaglutide)

Single-use pen; once opened good about 14 days at room temperature

Trulicity (dulaglutide)

Severe side effect to warn about with DPP-4 inhibitors and GLP-1 agonists

Pancreatitis (severe belly pain)

15-15 rule

Treatment of hypoglycemia: 15 g carbohydrate, recheck in 15 minutes

Normal fasting glucose vs. target

Normal ~70-100 mg/dL; target 80-130 mg/dL

A1c measures this and is checked how often

Average blood sugar over ~3 months; check every 3 months

Diabetes exercise recommendation

30 min/day most days = 150 min/week

COC with NEUTRAL androgen effects - good first-line default

Ortho-Cyclen / Ortho Tri-Cyclen (norgestimate/EE)

Progestin-only pill - all tablets active, more than 3 hours late means backup x 48 hours

Ortho-Micronor (norethindrone)

Antibiotic that decreases contraceptive effectiveness

Rifampin (enzyme inducer)

Missed 1 pill

Take it, keep going, no backup needed

Missed 2 pills early in the cycle

Catch up and use backup

Missed 2 or more late in cycle, or 3 or more

Restart and use backup

Typical failure rate of oral contraceptives

About 7-10%

Estrogen HRT: if the patient still has a uterus you must add this

A progestin (to protect against endometrial cancer)

Estradiol patch application site and frequency

Hips, buttocks, or lower abdomen; twice weekly

SERM with NO endometrial stimulation - osteoporosis and breast cancer prevention

Evista (raloxifene)

SERM that acts like estrogen in the endometrium and raises uterine cancer risk

Nolvadex (tamoxifen)

Aromatase inhibitor - postmenopausal use ONLY

Arimidex (anastrozole)