Quiz 6 Drugs - Counseling Points (#173-201)

Pristiq (desvenlafaxine)

for depression

BBW: increased suicidal thoughts in children in the first few months of treatment

CI: do not use within 14 days of MAOIs, not for pt on linezolid or IV methylene blue

warnings: SIADH (inappropriate antidiuretic hormone)/hyponatremia, fall risk, bleeding risk

side effects: sexual dysfunction, somnolence, insomnia, nausea, dry mouth, diaphoresis, weakness, tremor, dizziness, HA, increased HR, dilated pupils, excess sweating, constipation, increased BP

DI: increased bleed risk, caution with other serotonergic drugs

counseling: can cause ghost tablet in stool, can take 1-2 weeks for an effect and 6-8 weeks for full effect

Cymbalta (duloxetine)

for depression

BBW: increased risk of suicidal thoughts in children, teens, and young adults in first few months of use

CI: do not use within 14 days of MAOI, do not use in pt on linezolid or methylene blue

warnings: SIADH (inappropriate anti-diuretic hormone)/hyponatremia, fall risk, bleeding risk

side effects: sexual dysfunctional, somnolence, insomnia, nausea, dry mouth, diaphoresis, weakness, tremor, dizziness, HA, increased HR, dilated pupils, excess sweating, constipation, increased BP

counseling: 1-2 weeks = effect, but 6-8 for full effect

same as desvenlafaxine (above)

also indicated for neuropathic pain

Effexor (venlafaxine)

for depression

BBW: increased risk of suicidal thoughts in children, teens, and young adults in first few months of use

CI: do not use within 14 days of MAOI, do not use in pt on linezolid or methylene blue

warnings: SIADH (inappropriate anti-diuretic hormone)/hyponatremia, fall risk, bleeding risk

side effects: sexual dysfunctional, somnolence, insomnia, nausea, dry mouth, diaphoresis, weakness, tremor, dizziness, HA, increased HR, dilated pupils, excess sweating, constipation, increased BP

counseling: 1-2 weeks = effect, but 6-8 for full effect

same as desvenlafaxine (above)

but has the highest risk of increased BP of the SNRIs (therefore caution with other QT prolonging drugs)

Celexa (citalopram)

for depression and anxiety

BBW: increased risk of suicidal thoughts in children, teens, and young adults in first few months of use

CI: do not use within 14 days of MAOI, do not use in pt on linezolid or methylene blue

warnings: SIADH (inappropriate anti-diuretic hormone)/hyponatremia, fall risk, bleeding risk, QT prolongation

same as desvenlafaxine (above), but

side effects: sexual dysfunction, somnolence, insomnia, nausea, dry mouth, diaphoresis, weakness, tremor, dizziness, HA

counseling: can take 1-2 weeks to see an effect and 4-6 weeks for full effect, in pt > 60 yrs, dose not to exceed 20mg/day due to QT prolongation (can also have serotonergic effects)

Lexapro (escitalopram)

for depression and anxiety

BBW: increased risk of suicidal thoughts in children, teens, and young adults in first few months of use

CI: do not use within 14 days of MAOI, do not use in pt on linezolid or methylene blue

warnings: SIADH (inappropriate anti-diuretic hormone)/hyponatremia, fall risk, bleeding risk, QT prolongation

side effects: sexual dysfunction, somnolence, insomnia, nausea, dry mouth, diaphoresis, weakness, tremor, dizziness, HA

counseling: can take 1-2 weeks to see an effect and 4-6 weeks for full effect

same as citalopram (other SSRI) - above

but in pt > 60 years, dose not to exceed 10 mg/day or risk QT prolongation

Prozac (fluoxetine)

for depression and anxiety

BBW: increased risk of suicidal thoughts in children, teens, and young adults in first few months of use

CI: do not use within 14 days of MAOI, do not use in pt on linezolid or methylene blue

warnings: SIADH (inappropriate anti-diuretic hormone)/hyponatremia, fall risk, bleeding risk, QT prolongation

side effects: sexual dysfunction, somnolence, insomnia, nausea, dry mouth, diaphoresis, weakness, tremor, dizziness, HA

counseling: can take 1-2 weeks to see an effect and 4-6 weeks for full effect

same as citalopram (above)

except should be taken in the morning because it is the most activating of SSRIs

also has a long half-life so there must be a five week “washout period” when switching from this drug to an MAOI (instead of 2 weeks)

Paxil (paroxetine)

for depression and anxiety

BBW: increased risk of suicidal thoughts in children, teens, and young adults in first few months of use

CI: do not use within 14 days of MAOI, do not use in pt on linezolid or methylene blue

warnings: SIADH (inappropriate anti-diuretic hormone)/hyponatremia, fall risk, bleeding risk, QT prolongation

side effects: sexual dysfunction, somnolence, insomnia, nausea, dry mouth, diaphoresis, weakness, tremor, dizziness, HA

counseling: can take 1-2 weeks to see an effect and 4-6 weeks for full effect

same as citalopram (above)

but is the most sedating of the SSRIs so it should be taken in the evening

Zoloft (sertraline)

for depression and anxiety

BBW: increased risk of suicidal thoughts in children, teens, and young adults in first few months of use

CI: do not use within 14 days of MAOI, do not use in pt on linezolid or methylene blue

warnings: SIADH (inappropriate anti-diuretic hormone)/hyponatremia, fall risk, bleeding risk, QT prolongation

side effects: sexual dysfunction, somnolence, insomnia, nausea, dry mouth, diaphoresis, weakness, tremor, dizziness, HA

counseling: can take 1-2 weeks to see an effect and 4-6 weeks for full effect

same as citalopram (above)

is preferred in pt with cardiac risk

Viibryd (vilazodone)

for depression

BBW: increased risk of suicidal thoughts in children, teens, and YAs in first few months of therapy

CI: do not use within 14 days of MAOIs, not for pt on linezolid or IV methylene blue

side effects: N/V, insomnia, decreased libido (less sexual dysfunction vs SNRIs/SSRIs)

counseling point: can take 1-2 weeks for effect and 6-8 weeks for full effect

Elavil (amitriptyline)

for depression and neuropathic pain

BBW: increased risk of suicidal thoughts in children, teens, and YAs in first few months of therapy

CIs: do not use within 14 days of MAOIs, not for pt on linezolid or IV methylene blue

side effects: QT prolongation, orthostasis, anticholinergic effects (dry mouth, blurry vision. urinary retention, constipation), weight gain, risk of falls

DIs: caution with other QT prolonging drugs

counseling points: can take 1-2 weeks for effect and 6-8 weeks for full effect

Silenor (doxepin)

for depression BUT NOT neuropathic pain

BBW: increased risk of suicidal thoughts in children, teens, and YAs in first few months of therapy

CIs: do not use within 14 days of MAOIs, not for pt on linezolid or IV methylene blue

side effects: QT prolongation, orthostasis, anticholinergic effects (dry mouth, blurry vision. urinary retention, constipation), weight gain, risk of falls

DIs: caution with other QT prolonging drugs

counseling points: can take 1-2 weeks for effect and 6-8 weeks for full effect

same as amitriptyline (but change in indication)

Pamelor (nortriptyline)

for depression BUT NOT neuropathic pain Namenda

BBW: increased risk of suicidal thoughts in children, teens, and YAs in first few months of therapy

CIs: do not use within 14 days of MAOIs, not for pt on linezolid or IV methylene blue

side effects: QT prolongation, orthostasis, anticholinergic effects (dry mouth, blurry vision. urinary retention, constipation), weight gain, risk of falls

DIs: caution with other QT prolonging drugs

counseling points: can take 1-2 weeks for effect and 6-8 weeks for full effect

same as amitriptyline (but change in indication)

Namenda (memantine)

for alzheimer’s

side effects: dizziness, HA, confusion, constipation

counseling: ER capsule ca be opened and sprinkled on applesauce, but do not crush or chew

Clobex, Temovate (clobetasol)

for inflammation/rash

side effects: skin thinning, pigment changes, irritation (burning/peeing) and possible contact dermatitis

counseling point: do not use more than directed. one fingertip is a sufficient quantity to cover an adult hand

has high(!) potency, therefore avoid on the face, eyelids, and genitals

Elocon (mometasone)

for inflammation/rash

side effects: skin thinning, pigment changes, irritation (burning/peeing) and possible contact dermatitis

counseling point: do not use more than directed. one fingertip is a sufficient quantity to cover an adult hand

same as clobetasol (above)

has medium-high(!) potency, therefore avoid on the face, eyelids, and genitals

Kenalog (triamcinolone)

for inflammation/rash

side effects: skin thinning, pigment changes, irritation (burning/peeing) and possible contact dermatitis

counseling point: do not use more than directed. one fingertip is a sufficient quantity to cover an adult hand

same as clobetasol (above)

medium potency (still avoid use on eyelids, face, and genitals

Lotrisone (clotrimazole/betamethasone dipropionate)

for dermtological fungal infection

counseling point- apply 1-2 inches beyond border to rash, minimum of 2-4 weeks even if it appears healed, limit moisture to certain areas

Retin-A (tretinoin)

for acne

CI: avoid in pregnancy

counseling: limit sun exposure, wear sunscreen, apply a pea-size amount daily at bedtime, about 20 minutes after washing your face. may take 4-12 weeks to see a response, acne may worsen before it gets better

Differin (adapalene)

for acne

CI: avoid in pregnancy

counseling: limit sun exposure, wear sunscreen, apply a pea-size amount daily at bedtime, about 20 minutes after washing your face. may take 4-12 weeks to see a response, acne may worsen before it gets better

same as tretinoin

Accutane, Claravis, Myorisan (isotretinoin)

for severe, refractory acne (refractory = worsens after treatment ends or does not respond to treatment)

BBW: may cause birth defects

side effects: dry skin, chapped lips, dry eyes, eye irritation, psychiatric issues, sun sensitivity notes: can fill 1 month prescription at a time. avoid in pregnancy. REMS program (safety eval)

counseling: must have 2 negative pregnancy tests prior to treatment. do not get pregnany one month before, while on the drug, or for 1 month after discontinuation of isotretinoin. 2 forms of birth control are required.

Glucophage/Fortamet (metformin)

for diabetes

BBW: lactic acidosis

CI: eGFR < 30 mL/min (estimated glomerular filtration rate), metabolic acidosis

warning: can cause vitamin B12 deficiency. not recommended to start if eGFR 30-45.

side effects: diarrhea, flatulence, bloating

DI: alcohol increases the risk of lactic acidosis. use of contrast media for imaging studies increases the risk of lactic acidosis (D/C prior procedure and restart 48 hours after receiving contrast)

notes: doesn’t affect weight, titrate the dose to reduce GI side effects

counseling: ER formulation can leave a ghost tablet in stool (is part of the tablet undissolved). take with food to reduce GI upset

Januvia (sitagliptan)

for diabetes

warning: pancreatitis, arthralgia, acute renal failure

side effects: typically well tolerated

DI: do not use with GLP-1 agonists

Janumet (sitagliptan/metformin)

for diabetes

BBW: lactic acidosis

CI: eGFR < 30 mL/min (estimated glomerular filtration rate), metabolic acidosis

warning: can cause vitamin B12 deficiency. not recommended to start if eGFR 30-45.

side effects: diarrhea, flatulence, bloating

DI: alcohol increases the risk of lactic acidosis. use of contrast media for imaging studies increases the risk of lactic acidosis (D/C prior procedure and restart 48 hours after receiving contrast)

notes: doesn’t affect weight, titrate the dose to reduce GI side effects

counseling: ER formulation can leave a ghost tablet in stool (is part of the tablet undissolved). take with food to reduce GI upset

same as metformin (above)

Tradjenta (linagliptan)

for diabetes

warning: pancreatitis, arthralgia, acute renal failure

side effects: typically well tolerated

DI: do not use with GLP-1 agonists

same as sitagliptan (above)

Onglyza (saxagliptan)

for diabetes

warning: pancreatitis, arthralgia, acute renal failure

side effects: typically well tolerated

DI: do not use with GLP-1 agonists

same as sitagliptan (above)

also risk of heart failure

Amaryl (glimepiride)

for diabetes

CI: sulfa allergy

warning: hypoglycemia

side effect: weight gain, nausea

DI: caution in combination with insulin and other drugs that cause hypoglycemia

take with breakfast; not recommended in geriatric pt

Glucotrol (glipizide)

for diabetes

CI: sulfa allergy

warning: hypoglycemia

side effect: weight gain, nausea

DI: caution in combination with insulin and other drugs that cause hypoglycemia

take with breakfast; not recommended in geriatric pt

same as glimepiride (above)

also XL formulation can leave ghost tablet in stool, take IR 30 minutes before breakfast

Farxiga (dapagliflozin)

for diabetes, heart failure with reduced ejection fraction (HFrEF)

CI: dialysis

warning: ketoacidosis, genital mycotic infection, urosepsis, pyelonephritis, hypotension, acute kidney injury (AKI)

side effects: weight loss, increased urination, increased thirst

Invokana (canagliflozin)

for diabetes

CI: dialysis

warning: ketoacidosis, genital mycotic infection, urosepsis, pyelonephritis, hypotension, acute kidney injury (AKI)

side effects: weight loss, increased urination, increased thirst

same as dapagliflozin but NOT indicated for HFrEF. also there is increased risk of leg and foot amputations. increased risk of hyperkalemia

Jardiance (empagliflozin)

for diabetes, heart failure with reduced ejection fraction (HFrEF)

CI: dialysis

warning: ketoacidosis, genital mycotic infection, urosepsis, pyelonephritis, hypotension, acute kidney injury (AKI)

side effects: weight loss, increased urination, increased thirst (above)