Drug Quiz 7 Counseling Points (#202-238)

Byetta (exenatide)

for diabetes

warning: pancreatitis, not recommended for use in pt with severe GI disease

side effects: weight loss, N/V/D

DI: do not use with DPP4 inhibitor due to overlapping mechanism/effect

counseling: inject subQ in abdomen, rotate injection sites, attach a new pen needle for each injection.

notes: dosed 2x daily, given within 60 min of meal

Bydureon BCise (exenatide)

for diabetes

BBW: risk of thyroid C-cell carcinomas

warning: pancreatitis, not recommended for use in pt with severe GI disease

side effects: weight loss, N/V/D

DI: do not use with DPP4 inhibitor due to overlapping mechanism/effect

counseling: inject subQ in abdomen, rotate injection sites, attach a new pen needle for each injection.

notes: dosed once weekly

Victoza (liraglutide)

for diabetes

warning: pancreatitis, not recommended for use in pt with severe GI disease

side effects: weight loss, N/V/D

DI: do not use with DPP4 inhibitor due to overlapping mechanism/effect

counseling: inject subQ in abdomen, rotate injection sites, attach a new pen needle for each injection.

note: has demonstrated ASCVD benefit, dosed once daily

Trulicity (dulaglutide)

for diabetes

warning: pancreatitis, not recommended for use in pt with severe GI disease

side effects: weight loss, N/V/D

DI: do not use with DPP4 inhibitor due to overlapping mechanism/effect

counseling: inject subQ in abdomen, rotate injection sites, attach a new pen needle for each injection.

note: dosed once weekly.

Ozempic (semaglutide)

for diabetes

warning: pancreatitis, not recommended for use in pt with severe GI disease

side effects: weight loss, N/V/D

DI: do not use with DPP4 inhibitor due to overlapping mechanism/effect

counseling: inject subQ in abdomen, rotate injection sites, attach a new pen needle for each injection.

note: dosed once weekly, increased complications with diabetes retinopathy

Actos (pioglitazone)

for diabetes

BBW: do not use in NYHA class III-IV heart failure (can exacerbate HF)

warnings: edema, risk of fractures, increased risk of bladder cancer

side effects: peripheral edema, weight gain

Novolog (insulin aspart)

Humalog (insulin lispro)

Apidra (insulin glulisine)

for diabetes

CI: do not administer during hypoglycemic episode

warning: hypoglycemia, hypokalemia

side effects: weight gain, injection site reaction

DI: avoid taking with sulfonylureas

counseling: do not shake, do not freeze or expose or extreme heat. store unopened vials or pens in the refrigerator. open vials and pens can be kept at room temp. counsel pt on injection technique (rotate injection sites, etc)

note: inject 5-15 min before meals

Humulin R, Novolin R (insulin regular)

for diabetes

CI: do not administer during hypoglycemic episode

warning: hypoglycemia, hypokalemia

side effects: weight gain, injection site reaction

DI: avoid taking with sulfonylureas

counseling: do not shake, do not freeze or expose or extreme heat. store unopened vials or pens in the refrigerator. open vials and pens can be kept at room temp. counsel pt on injection technique (rotate injection sites, etc)

note: inject 30 min prior meals

Humulin N, Novolin N (insulin isophane)

for diabetes

CI: do not administer during hypoglycemic episode

warning: hypoglycemia, hypokalemia

side effects: weight gain, injection site reaction

DI: avoid taking with sulfonylureas

counseling: do not shake, do not freeze or expose or extreme heat. store unopened vials or pens in the refrigerator. open vials and pens can be kept at room temp. counsel pt on injection technique (rotate injection sites, etc)

note: typically dosed twice daily. do not shake. roll slowly between the hands to mix the contents of the vial

Levemir (insulin detemir)

Lantus, Basaglar, Toujeo (insulin glargine)

Tresiba (insulin degludec)

for diabetes

CI: do not administer during hypoglycemic episode

warning: hypoglycemia, hypokalemia

side effects: weight gain, injection site reaction

DI: avoid taking with sulfonylureas

counseling: do not shake, do not freeze or expose or extreme heat. store unopened vials or pens in the refrigerator. open vials and pens can be kept at room temp. counsel pt on injection technique (rotate injection sites, etc)

note: usually injected once daily, do not mix with other insulins

Novolin 70/30, Humulin 70/30 (insulin NPH 70%/regular 30%)

for diabetes

CI: do not administer during hypoglycemic episode

warning: hypoglycemia, hypokalemia

side effects: weight gain, injection site reaction

DI: avoid taking with sulfonylureas

counseling: do not shake, do not freeze or expose or extreme heat. store unopened vials or pens in the refrigerator. open vials and pens can be kept at room temp. counsel pt on injection technique (rotate injection sites, etc)

note: inject 30 min prior meal. usually dosed twice daily

Novolog Mix 70/30, Humalog Mix 75/25 (insulin protamine 70%/rapid acting 30%)

for diabetes

CI: do not administer during hypoglycemic episode

warning: hypoglycemia, hypokalemia

side effects: weight gain, injection site reaction

DI: avoid taking with sulfonylureas

counseling: do not shake, do not freeze or expose or extreme heat. store unopened vials or pens in the refrigerator. open vials and pens can be kept at room temp. counsel pt on injection technique (rotate injection sites, etc)

note: inject 15 min prior meal. usually dosed 2-3 times daily

Colcrys (colchicine)

for gout

warning: myelosuppression (bone marrow does not produce enough RBC, WBC, platelets), neuromuscular toxicity (including rhabdomyolysis (skeletal muscles degrade and bad stuff is released into the bloodstream)

side effects: nausea, diarrhea, myopathy, neuropathy

DI: major substrate of CYP450 3A4 and P-gp therefore check for DIs

counseling: at first sign of attack, take 2 tabs, one hour later, take 1 more tab. do not use more than 24 tabs in 24 hours.

Zyloprim (allopurinol)

for gout

warning: hypersensitivity reactions (severe rash - SJS/TEN), hepatotoxicity, HLA-B*5801 testing prior to use in high risk pt (especially of asian descent)

side effects: rash, acute gout attacks, nausea

DIs: do not use with azathioprine or mercaptopurine

note: when initiating, use with colchicine or an NSAID for 3-6 months (due to high rate of gout attacks when starting urate lowering therapy).

counseling: take after meal to reduce GI upset. drink lots of fluids

Uloric (febuxostat)

for gout

BBW: usually limited to those who are intolerant to allopurinol due to increased CV death

CIs: do not use with azathioprine or mercaptopurine

warning: hypersensitivity reactions (SJS/TEN), hepatotoxicity

side effect: increased LFTs, rash, nausea

DIs: do not use with azathioprine or mercaptopurine

note: when initiating, use with colchicine or an NSAID for 3-6 months (due to high rate of gout attacks when starting urate lowering therapy).

Fosamax (alendronate)

for osteoporosis

CI: hypocalcemia, inability to stand or sit upright for at least 30 min

warning: osteonecrosis of the jaw, atypical femur fractures, esophagitis, esophageal ulcers, erosions, renal impairment

side effects: dyspepsia, dysphagia (difficulty swallowing), heartburn, N/V, hypocalcemia

DI: separate from calcium, antacids, iron, and magnesium by at least 2 hours

counseling: take in the morning with 6-8oz of water at least 30 min prior any food. stay sitting or standing upright for at least 30 min after taking. dental work should be completed prior this medication

Boniva (ibandronate)

for osteoporosis

CI: hypocalcemia, inability to stand or sit upright for at least 30 min

warning: osteonecrosis of the jaw, atypical femur fractures, esophagitis, esophageal ulcers, erosions, renal impairment

side effects: dyspepsia, dysphagia (difficulty swallowing), heartburn, N/V, hypocalcemia

DI: separate from calcium, antacids, iron, and magnesium by at least 2 hours

counseling: take in the morning with 6-8oz of water at least 30 min prior any food. stay sitting or standing upright for at least 60 min after taking. dental work

Actonel (risedronate)

for osteoporosis

CI: hypocalcemia, inability to stand or sit upright for at least 30 min

warning: osteonecrosis of the jaw, atypical femur fractures, esophagitis, esophageal ulcers, erosions, renal impairment

side effects: dyspepsia, dysphagia (difficulty swallowing), heartburn, N/V, hypocalcemia

DI: separate from calcium, antacids, iron, and magnesium by at least 2 hours

counseling: take in the morning with 6-8oz of water at least 30 min prior any food. stay sitting or standing upright for at least 30 min after taking. dental work

Evista (raloxifene)

for osteoporosis in post-menopausal women

BBW: increased risk of VTE (venous thromboembolism- clot formation in vein), increased risk of death due to stroke in women with CHD (coronary heart disease)

CI: history or current VTE, pregnancy

side effects: hot flashes, peripheral edema, arthralgia (joint pain), leg cramps

DI: separate from levothyroxine by several hours

counseling: D/C 72 hours before and during prolonged immobilization (risk of thrombosis)

Camila, Heather (norethindrone)

birth control

CI: breast cancer, pregnancy, active liver disease

side effects: menstrual bleeding irregularities

DI: rifampin/rifabutin decreases efficacy, check for DI

counseling: must take at the same time daily, if more than 3 hours past the scheduled time, back up contraception is needed for 48 hours

Provera (medroxyprogesterone acetate)

birth control

BBW: risk of CV disease, history or active breast cancer, hepatic impairment

CI: history of active breast cancer, hepatic impairment

side effects: menstrual bleeding irregularities

DI: rifampin/rifabutin decreases efficacy. check for DI

counseling: must take at the same time daily. if more than 3 hours past the scheduled time, back up contraceptive is needed for 48 hours

Depo-Provera (medroxyprogesterone)

birth control

BBW: loss of bone mineral density, not recommended for long term use (> 2 years)

CI: history of or active breast cancer

side effects: bone loss, menstrual bleeding irregularities, increased appetitie leading to weight gain

note: injection has lower drug interaction risk

counseling: may experience a change in menstrual cycle, take recommended daily dose of calcium and vitamin D. is injected every 3 months

Prometrium (progesterone)

hormone therapy

BBW: risk of breast cancer, CV disorders, dementia

CI: hypersensitivity to peanut/peanut oil, breast cancer, DVT, pregnancy

side effects: breast tenderness, breakthrough bleeding, fatigue, weight gain

DI: vaginal antifungal agents can diminish effects

note: comes in caps

Premarin (conjugated estrogens)

hormone therapy

BBW: increased risk of endometrial cancer, CVD (like DVT), breast cancer, and dementia

CI: DVT, breast cancer, pregnancy

side effects: HA, abdominal pain, breast soreness, back pain

DI: may diminish effects of anastrozole (hormone based breast cancer chemotherapy)

Estrace (estradiol)

hormone therapy

BBW: increased risk of endometrial cancer (cancer of your endometrium - uterus lining), CV disease, breast cancer, and dementia

CI: DVT, breast cancer, pregnancy

side effect: HA, abdominal pain, breakthrough bleeding, breast tenderness, weight gain

DI: may diminish effects of anastrozole

Vagifem (estradiol)

hormone therapy

BBW: increased risk of endometrial cancer (cancer of your endometrium - uterus lining), CV disease, breast cancer, and dementia

CI: DVT, breast cancer, pregnancy

*side effect: HA, abdominal pain, breakthrough bleeding, breast tenderness, weight gain, urticaria, vulvovaginal pruritus, genital candidiasis)

DI: may diminish effects of anastrozole

note: vaginal tab

Vivelle-Dot, Estraderm, Climara (estradiol)

hormone therapy

BBW: increased risk of endometrial cancer (cancer of your endometrium - uterus lining), CV disease, breast cancer, and dementia

CI: DVT, breast cancer, pregnancy

*side effect: HA, abdominal pain, breakthrough bleeding, breast tenderness, weight gain, edema, depression, application site reactions, arthralgia

DI: may diminish effects of anastrozole

note: transdermal patch

Combipatch (estradiol/norethindrone)

hormone therapy

BBW: increased risk of endometrial cancer (cancer of your endometrium - uterus lining), CV disease, breast cancer, and dementia

CI: DVT, breast cancer

*side effect: HA, abdominal pain, breakthrough bleeding, breast tenderness, weight gain, application site reactions, peripheral edema, weakness, arthralgia

DI: may diminish effects of anastrozole

note: transdermal patchY

Yasmin, Yaz (ethinyl estradiol/drosepirenone)

birth control

BBW: do not use in pt > 35 years who smokes

CI: migraine with aura, pregnancy, breast or liver cancer, uncontrolled HTN

side effects: nausea, breast tenderness, bloating, weight gain, thrombosis (serious but rare), HA, mood changes, fatigue

DI: may diminish effects of anastrozole, some antibiotics may decrease efficacy (rifampin/rifabutin)

counseling: if one pill is missed or late, take the missed pill as soon as possible and take the next dose as scheduled. if two or more pills are missed, take the most recent missed pill as soon as possible and take the next dose as scheduled (back up contraception will be needed for 7 days). if the missed pills are in the third week of the menstruation cycle, omit the hormone free week and start the next pack of pills without skipping days.

Kariva, Isibloom, Apri (ethinyl estradiol/desogestrel)

Loestrin, Junel (ethinyl estradiol/norethindrone)

Ortho Tri-Cyclen (Lo), Tri-Sprintec (ethinyl estradiol/norgestimate)

birth control

BBW: do not use in pt > 35 years who smokes

CI: migraine with aura, pregnancy, breast or liver cancer, uncontrolled HTN

side effects: nausea, breast tenderness, bloating, weight gain, thrombosis (serious but rare), HA, mood changes, fatigue

DI: may diminish effects of anastrozole, some antibiotics may decrease efficacy (rifampin/rifabutin)

counseling: if one pill is missed or late, take the missed pill as soon as possible and take the next dose as scheduled. if two or more pills are missed, take the most recent missed pill as soon as possible and take the next dose as scheduled (back up contraception will be needed for 7 days). if the missed pills are in the third week of the menstruation cycle, omit the hormone free week and start the next pack of pills without skipping days.

(so same as Yasmin, Yaz)

Seasonique, Twirla (ethinyl estradiol/levonorgestrel)

birth control

BBW: do not use in pt > 35 years who smokes

CI: migraine with aura, pregnancy, breast or liver cancer, uncontrolled HTN

side effects: nausea, breast tenderness, bloating, weight gain, thrombosis (serious but rare), HA, mood changes, fatigue

DI: may diminish effects of anastrozole, some antibiotics may decrease efficacy (rifampin/rifabutin)

counseling: if one pill is missed or late, take the missed pill as soon as possible and take the next dose as scheduled. if two or more pills are missed, take the most recent missed pill as soon as possible and take the next dose as scheduled (back up contracepetion will be needed for 7 days). if the missed pills are in the third week of the menstruation cycle, omit the hormone free week and start the next pack of pills without skipping days.

*notes: the second listed is a patch, apply it to clean dry skin of buttocks, stomach, upper arm, or torso once a week for 21 days followed by one week that is patch free.

NuvaRing (ethinyl estradiol/etonogestrel)

birth control

BBW: do not use in pt > 35 years who smokes

CI: migraine with aura, pregnancy, breast or liver cancer, uncontrolled HTN

side effects: nausea, breast tenderness, bloating, weight gain, thrombosis (serious but rare), HA, mood changes, fatigue

DI: may diminish effects of anastrozole, some antibiotics may decrease efficacy (rifampin/rifabutin)

counseling: if one pill is missed or late, take the missed pill as soon as possible and take the next dose as scheduled. if two or more pills are missed, take the most recent missed pill as soon as possible and take the next dose as scheduled (back up contracepetion will be needed for 7 days). if the missed pills are in the third week of the menstruation cycle, omit the hormone free week and start the next pack of pills without skipping days.

*is inserted once a month, kept in place for 3 weeks, and take out for 1 week prior replacement. refrigerate prior to dispensing. store at room temp for up to 4 months)