Drug Quiz 8 Counseling Points (drugs #239-274)

AndroGel (testosterone)

for hypogonadism in males (low sex-hormone production)

BBW: secondary exposure to children can lead to increased androgen production (can lead to development of male characteristics such as muscle, body hair, deep voice)

CI: prostate cancer, breast cancer, pregnancy, breastfeeding

side effects: increased appetite, acne, edema, hepatotoxicity, reduced sperm count

counseling: apply at the same time every morning, do not let other come in contact with application site. the gel is flammable when wet so do not smoke or go near flames until it is dry

Synthroid, Levoxyl (levothyroxine)

for hypothyroidism

warning: decrease the dose of this drug in pt with CV disease, this drug can also decrease bone mineral density

side effects: increases HR, sweating, palpitations, weight loss, irritability

DI: separate by at least 4 hours from antacids, polyvalent cations (iron, calcium, multivitamins, etc), sucralfate

notes: check orange book for therapeutic equivalence (not all generics are equivalent)

counseling: take with water at the same time daily for consistency. take at least 30-60 min before breakfast or at least 3 hours after the last meal of the day.

Armour Thyroid (desiccated thyroid)

for hypothyroidism

warning: decrease the dose of this drug in pt with CV disease, this drug can also decrease bone mineral density

side effects: increased HR, sweating palpitations, weight loss, irritability

counseling: take on an empty stomach at least 30-60 minutes prior breakfast, at same time every day.

Cytomel (liothyronine sodium)

for hypothyroidism

warning: decrease the dose of this drug in pt with CV disease, this drug can also decrease bone mineral density

side effects: increased HR, sweating palpitations, weight loss, irritability

Tapazole (methimazole)

for hyperthyroidism

warning: hepatotoxicity, bone marrow suspension, drug-induced lupus erythematous (DILE)

side effects: GI upset, headache, rash

notes: do not use in 1st trimester of pregnancy (2nd and 3rd trimesters are ok)

counseling: take with food to reduces SI upset,

Deltasone ( prednisone),

Decadron (dexamethasone)

for inflammation and immunosuppression

warning: adrenal suppression (reduces or stops cortisol production), if taking > 14 days, must taper slowly

side effects: increased appetite and weight gain, emotionally unstable, insomnia, indigestion. long-term effects (adrenal suppression)

counseling: take with food to reduce GI effects

Medrol (methylprednisolone)

for inflammation and immunosuppression

warning: adrenal suppression (reduces or stops cortisol production), if taking > 14 days, must taper slowly

side effects: increased appetite and weight gain, emotionally unstable, insomnia, indigestion. long-term effects (adrenal suppression)

counseling: take with food to reduce GI effects, commonly comes in a dose pack (“Medrol dose pack”)

Nexium (esomeprazole),

Prilosec (esomeprazole)

for GERD, PUD (peptic ulcer disease)

warning: C. difficile associated diarrhea (CDAD), hypomagnesemia, vitamin B12 deficiency with use > 2 years, osteoporosis-related bone fractures with use > 1 year at high doses

side effects: generally well-tolerated

DIs: interacts with drugs that require an acidic environment for absorption

notes: calcium and vitamin d supplementation may be needed, calcium citrate is preferred type of calcium when on a PPI (or an acid-suppressing agent)

counseling: take on an empty stomach in the morning at least 30 minutes prior breakfast

do not use with clopidogrel (clopidogrel effects decrease), available as Rx and OTC

Protonix (pantoprazole),

Dexilant (dexlansoprazole),

Aciphex (rabeprazole)

for GERD, PUD (peptic ulcer disease)

warning: C. difficile associated diarrhea (CDAD), hypomagnesemia, vitamin B12 deficiency with use > 2 years, osteoporosis-related bone fractures with use > 1 year at high doses

side effects: generally well-tolerated

DIs: interacts with drugs that require an acidic environment for absorption

notes: calcium and vitamin d supplementation may be needed, calcium citrate is preferred type of calcium when on a PPI (or an acid-suppressing agent)

counseling: take on an empty stomach in the morning at least 30 minutes prior breakfast

available as Rx only

Prevacid (lansoprazole)

for GERD, PUD (peptic ulcer disease)

warning: C. difficile associated diarrhea (CDAD), hypomagnesemia, vitamin B12 deficiency with use > 2 years, osteoporosis-related bone fractures with use > 1 year at high doses

side effects: generally well-tolerated

DIs: interacts with drugs that require an acidic environment for absorption

notes: calcium and vitamin d supplementation may be needed, calcium citrate is preferred type of calcium when on a PPI (or an acid-suppressing agent)

counseling: take on an empty stomach in the morning at least 30 minutes prior breakfast

available as Rx and OTC

Phenergan (promethazine)

for N/V

BBW: do not use in children under 2 years

warning: symptoms of parkinsons may be exacerbated

side effects: sedation, lethargy, acute EPS (extrapyramidal symptoms - movement disorders such as tremors, restlessness, muscle contractions, stiffness, etc), can decrease the seizure threshold

Pepcid (famotidine)

for GERD, heartburn

warning: confusion, vitamin B-12 deficiency with use > 2 years,

effects: headache

DI: interacts with drugs that require acidic environment for absorption, caution with CNS depressants due to an additive risk of cognitive impairment

notes: Rx and OTC

counseling: take PRN for symptom relief, but to prevent symptoms take PRN 30-60 minutes prior triggering foods

Linzess (linaclotide)

for IBS, constipation

BBW: do not use in pediatric patient

CI: do not use in patient < 6 years

effects: diarrhea, flatulence

notes: dispense in original container to protect from moisture

counseling: swallow capsule whole, if needed, the capsule can be opened ad the contents mixed with one teaspoon of applesauce of 30 m of room temp water and the mixture must e swallowed immediately.

Bentyl (dicycloomine)

for diarrhea

CI: GI obstruction, breastfeeding women, infants < 6 months of age

warning: anticholinergic side effects (caution in pt 65 years and older), caution in ulcerative colitis (can cause toxic megacolon or paralytic ileus)

side effects: dizziness, dry mouth, nausea, blurry vision, somnolence

Imodium (loperamide)

for diarrhea

BBW: cardiac arrest and sudden death with doses higher than recommended (do not exceed recommended dose. do not use in pt < 2 years).

CI: dysentary (infection of the intestines that causes severe diarrhea with blood or mucus), pseudomembranous colitis, bacterial enterocolitis

side effects: constipation, abdominal cramping

notes: OTC

counseling: take 4 mg after first loose stool, then take 2 mg after each subsequent loose stool. if self care, max dose if 8 mg/da (do not use > 48 hours), if under supervision max dose is 16 mg/day

Lomotil (diphenoxylate/atropine)

for diarrhea

CI: do not use in liquid form in pt < 2 years, do not use tablet form in pt < 6 years

side effects: mild euphoria (from diphenoxylate), anticholinergic effects (atropine)

notes: liquid form is recommended in pt < 13 years

Miralax, Glycolax, Go-Lytely (polyethylene glycol 3350)

for constipation, white bowel irrigation

side effects: N/V, bloating, abdominal discomfort

notes: available OTC, mix 17g with 8 oz of water.

Colace (docusate)

for constipation

side effects: abdominal cramping

DI: do not take with mineral oil

notes: available as Rx and OTC, is preferred when straining should be avoided (straining = amount of force/pressure needed when passing a stool), example when to avoid = hemmorhoid

counseling: use when stool is hard or dry. do not use OTC for more than a week

Reglan (metoclopramide)

for N/V

BBW: can cause tardive dyskinesia (involuntary, repetitive, or uncontrollable movement), decrease dose in renal impairment

warning: symptoms of parkinsons may be exacerbated

side effects: sedation, lethargy, acute EPS, can decrease seizure threshold

Carafate (sucralfate)

for PUD (peptic ulcer disease)

side effects: constipation

DI: many interactions due to binding, separate antacids by 30 min and take other drugs 2 hours before or 4 hours after

counseling: drink adequate fluids, take on empty stomach prior meals

Amitiza (lubiprostone)

for IBS, constipation

CI: mechanical bowel obstruction

side effects: nausea, diarrhea, abdominal pain

counseling: take with food and water to decrease nausea

Avodart (dutasteride),

Propecia, Proscar (finasteride)

for BPH

CI: women of child-bearing age, pregnancy, children

side effects: impotence (inability to get erection), decreased libido, ejaculation disturbances, breast enlargement and tenderness

counseling: pregnant women should not handle these medications

Flomax (tamsulosin)

for BPH

warning: orthostatic hypotension/syncope (syncope = temporary loss of consciousness) especially when used with a PDE-5 inhibitor, can cause intraoperative floppy iris syndrome (pupil vasoconstricts during cataract surgery and risks vision quality/ability), priapism (prolonged erection not associated with sexual arousal)

effects: dizziness, fatigue, HA, abnormal ejaculation

DI: caution with PDE-5 inhibitor use (risks hypotension)

Levitra (vardenafil),

Viagra (sildenafil)

for erectile dysfunction

CI: do not use with nitrates

warning: hearing loss, vision loss, impaired color discrimination, hypotension, priapism

effects: HA, flushing, dizziness, dyspepsia (discomfort in upper abdomen)

DI: caution with alpha 1 blockers

counseling: take 1 hour prior sexual activity

Cialis (tadalafil)

for erectile dysfunction

CI: do not use with nitrates

warning: hearing loss, vision loss, impaired color discrimination, hypotension, priapism

effects: HA, flushing, dizziness, dyspepsia (discomfort in upper abdomen)

DI: caution with alpha 1 blockers

counseling: take 30 min prior sexual activity

Ditropan XL (oxybutynin),

Detrol LA (tolterodine),

Enablex (darifenacin)

for urinary incontinence

CI: narrow-angle glaucoma

warning: agitation, confusion, drowsiness, dizziness, blurred vision. use caution when performing tasks that require mental alertness

effects: dizziness, drowsiness, xerostomia (dry mouth), constipation

DI: additive effects when taken with other anti-cholinergic drugs

counseling: avoid mouthwashes containing alcohol and use ice chips, sugar-free candy, or gum to help with dry mouth symptoms

XL formulation can leave ghost tablet in stool

Myrbetriq (mirabegron)

for urinary incontinence

warning: urinary retention in pt with BPH when used with anti-cholinergic drug, increase BP, angioedema

effects: constipation, diarreha, UTIs, HA

note: may take up to 8 weeks to see an effect

Pyridium (phenazopyridine)

for urinary tract infection

CI: do not use in pt with renal impairment or liver disease

effects: HA< dizziness, stomach cramps, body secretion discoloration

notes: available as OTC - AZO

counseling: causes red-orange coloring of urine and other bodily fluids, contact lenses/clothes may be stained, take with 8 oz of water after eating to minimize stomach upset, limit to 2 days of use.