PPC2 DI 60-120 DRUGS

Meclizine brand

Antivert

Meclizine drug class

antiemetic, antihistamine, antivertigo

Meclizine indications

Motion sickness, vertigo

Meclizine adverse effects

Blurred vision, anaphylaxis

Meclizine clinical teaching

- available as OTC (Bonine/Dramamine) & Rx

- Avoid activities using mental alertness until effects are realized

- Avoid alcohol and CNS depressants

- If used for motion sickness -- take 1 hour before travel

- more potent in older adults

Metoclopramide generic

Reglan

Metoclopramide drug class

Antiemetic, DA antagonist

Metoclopramide indications

- prophylaxis of chemo-induced nausea & vomiting

- diabetic gastroparesis

- GERD

- Intestinal intubation

- Post-op N/V

- Radiography of GI tract

Metoclopramide adverse effects

COMMON:

- body fluid retention

- N/V

- Asthenia

- Headache/fatigue

- somnolence

SERIOUS

- neuroleptic malignant syndrome

- tardive dyskinesia

Metoclopramide clinical teaching

- avoid activities requiring mental alertness

- report signs of NMS like sweating, fever, and unstable bp

- report signs of tardive dyskinesia including parkinsonian symptoms and extrapyramidal effects

- oral formulations taken 30 min before meals and at bed or before provoking situation

- do not drink alcohol

- avoid MAOI, TCA, & sympathomimetic amine therapy

Ondansetron brand

Zofran

Ondansetron Drug class

Antiemetic, 5HT receptor antagonist

Ondansetron indications

- Prophylaxis for chemo-induced N/V

- Prophylaxis for post-op N/V

- Prophylaxis for radiation induced N/V

Ondansetron adverse effects

COMMON

Constipation, diarrhea, increased liver enzymes, headache, fatigue, malaise

SERIOUS

Abnormal EKG, prolonged QT interval, Torsades de pointes, anaphylaxis, bronchospasm

Ondansetron clinical teaching

May cause constipation, diarrhea, headache, fatigue, malaise

Allopurinol brand

Zyloprim

Allopurinol drug class

Anitgout, Xanthine Oxidase Inhibitor

Colchine Drug class

Antigout

Colchine brand

Colcrys

Aloopurinol indications

Gout, hyperuricemia, calcium renal calculus, cancer

Allopurinol adverse effects

COMMON

- Pruritis

- Maculopapular eruptions

SERIOUS

- rash

- Steven Johnsons syndrome

- agranulocytosis

- myelosuppression

- thrombocytopenia

- hepatotoxicity

- immune hypersensitivity rxn

- renal failure

Allopurinol clincal teaching

- report skin rash/signs of an allergic reaction to MD

- avoid activities requiring mental alertness

- benefit may be delayed 2-6 weeks

- report signs of hepatotoxicity

- take drug after meals

- maintain adequate hydration to prevent renal stones

- do not use acutely

Colchicine indications

Gout, familial Mediterranean fever

Colchicine adverse effects

COMMON

- diarrhea

- nausea

- vomiting

SERIOUS

- myelosuppression

Colchicine clinical teaching

- Discontinue drug if signs of neuromuscular toxicity

- Tell patient using prophylaxis to report gout flare

- Counsel patient against discontinuing without MD approval

- Do not eat grapefruit/grapefruit juice with drug (CYP3A4 inhibitor)

- Advise patient about drug-drug int

Latanoprost brand

Xalatan

Latanoprost drug class

Prostaglandin analog

Latanoprost indications

Glaucoma - increases outflow of intraocular fluid in eye

Latanoprost adverse effects

COMMON

- stinging, burning, itching, watering of eye

- redness of eyelid

- dry eyes

- increased brown pigmentation in iris (eye can turn brown)

- Can cause thick, long, dark eyelashes

SERIOUS

- shortness of breath/wheezingm

- chest tightness

Latanoprost clinical teaching

- Take once daily in evening

- Take 5 mins between if taking other topical eye meds

- Remove contacts before using and put back in after 15 mins

- continue use even if feeling better

- Store in fridge before using for first time, can be store for 6 weeks after opening

- keep in original container

- throw away if outdated

Valacyclovir brand

Valtrex

Valacyclovir drug class

guanosine nucleoside analog, viral DNA polymerase inhibitor

Valacyclovir indications

Genital herpes, herpes labialis, shingles, HIV, varicella

Valacyclovir adverse effects

COMMON

- rash

- abdominal pain

- nausea

- headache

- fatigue

SERIOUS

- thrombotic thrombocytopenic purpura

- aseptic meningitis

- seizure

- encephalopathy

- hemolytic uremic syndrome (RBC destruction = kidney injury)

Valacyclovir clinical teaching

- instruct to avoid sex if herpes sores present

- do not suddenly stop taking drug

- maintain adequare hydration to stop precipitation in renal tubules

Zolpidem brand

Ambien

Eszopiclone brand

Lunesta

Zolpidem drug class

Non-barbiturate hypnotic

Eszopiclone drug class

Non-barbiturate hypnotic

Nonbarbiturate hypnotics indication

- Insomnia - difficulty going back to sleep in middle of the night (Zolpidem)

- Insomnia - short-term

Nonbarbiturate hypnotics adverse effects

COMMON

- dizziness

- drugged state

- headache

- somnolence

- visual disturbance

- unpleasant taste (Lunesta)

SERIOUS

- worsened depression & suicidal thoughts

Nonbarbiturate hypnotics clinical teaching

- CIV (up to 5 refills, Rx good for 6 months)

- avoid activities involving mental alertness

- avoid sudden discontinuation

- take immediately before bed or when gone to bed and experiencing difficulty

- avoid alcohol and CNS depressants

- do not take with/after a high fat meal

Carbidopa/Levodopa brand

Sinemet

Dopaminergic: Carbidopa & Levodopa

Carbidopa - decarboxylase inhibitor

Levodopa - dopamine precursor

Carbidopa/Levodopa indications

Parkinson's disease symptoms

Carbidopa/Levodopa adverse effects

COMMON

- N/V

- Orthostatic hypotension

- dyskinesias

- headache

- insomnia - abnormal dreams

- urine color change

SERIOUS

- hallucinations

- compulsive behaviors

- sudden sleep onset

- NMS

Carbidopa/Levodopa clinical teaching

- available in IR, ODT, ER, Susp, and inhalation

- ODT - take before breakfast, place on tongue and allow dissolve, avoid food/liquids 5 mins before & after taking

- do not take with high protein meal

- ER tabs swallowed whole

- do not stop abruptly

Oxybutynin brand

Ditropan

Tolterodine ER brand

Detrol LA

Oxybutynin & Tolterodine drug class

antimuscarinic, urinary antispasmodic

Antimuscarinic indications

bladder muscle dysfunction

Oxybutynin adverse effects

COMMON

- abdominal pain

- constipation

- xerostomia

- headache

SERIOUS

- anaphylaxis

- angioedema

Tolterodine ER adverse effects

COMMON

- constipation

- diarrhea

- xerostomia

- UTI

- nasopharyngitis

- local irritation when patch/gel

SERIOUS

- anaphylaxis

- angioedema

Antimuscarinics clinical teaching

- avoid activities requiring mental alertness until drug effects are realized

- advise patient that alcohol may enhance drowsiness

- immediately report serious symptoms

Finasteride brand

Proscar, Propecia

Tamsulosin brand

Flomax

Terazosin brand

Hytrin

Finasteride drug class

5-alpha reductase inhibitor

Tamsulosin & Terazosin drug class

alpha-1 adrenergic blocker

5-alpha reductase inhibitors indications

BPH, Male pattern alopecia

5-alpha reductase inhibitors adverse effects

COMMON

- abnormal ejaculation

- breast tenderness

- reduced libido

SERIOUS

- neoplasm of male breast

- prostate cancer

5-alpha reductase inhibitors clinical teaching

- warn pregnant women about having broken/crushed tab due to male fetus risks

- report breast changes immediately

- if using drug for hair loss, symptomatic improvement may not occur for >3 months

Terazosin indications

BPH, hypertension

Tamsulosin indications

BPH

Alpha-1 adrenergic blockers adverse effects

COMMON

- orthostatic hypotension

-peripheral edema

- asthenia

- dizziness

- headache

- somnolence

- nasal congestion

SERIOUS

- retinal detachment

- priapism

- syncope

Alpha-1 adrenergic blockers clinical teaching

- avoid activities requiring mental alertness/coordination

- rise slowly from sitting/lying position

- may experience syncope/loss of conciousness with first dorse

- take drug at bedtime to minimize side effects

- avoid against sudden discontinuation

- avoid alcohol

- always use in combo for HTN (not first line)

Tadalafil brand

Cialis

Tadalafil drug class

PDE5 inhibitor

Tadalafil indications

BPH, ED, pulmonary hypertension

Tadalafil adverse effects

COMMON

- erythema

- flushing

- indigestion

- headache

- myalgia

- insomnia

- visual disturbance

- epistaxis

SERIOUS

- angina

- heart failure

- MI

- CV morbidity

- tachycardia

- SJ syndrome

- cerebrovascular accident

- seizure

- thrombosis of retinak vein

- decreased hearing

Tadalafil clinical teaching

- may cause angina, dizziness, and nausea in CV risk patients

- report erection that lasts for more than 4 hrs

- report loss of hearing or vision

- for ed, take prior to sexual activity, but not more than 1x a day

- instruct if taking for pulmonary hypertension to not take more than one PDE5 inhibitor

- avoid alcohol

- do not take if on alpha-blockers or nitrates

Donepezil brand

Aricept

Rivastigmine brand

Exelon

Memantine brand

Namenda

Donepezil and Rivastigmine drug class

Cholinesterase inhibitors

Memantine drug class

NMDA Receptor antagonist

Cholinesterase inhibitors indications

Alzheimer's disease (severe = donepezil), Parkinson's disease dementia (Rivastigmine only)

Cholinesterase inhibitors adverse effects

COMMON

- weight loss

- GI upset

- dizziness

SERIOUS

- bradyarrhythmia

- torsades de pointes

- GI hemorrhage

Cholinesterase inhibitors clinical teaching

- recommend taking with food

- dosage adjustments required if missed dose for several days

- rivastigamine is available in patch

NMDA Receptor Antagonist indication

Alzheimer's

NMDA Receptor Antagonist adverse effects

COMMON

- hypertension

- hypotension

- syncope

- confusion

- dizziness

- headache

SERIOUS

- SJ syndrome

- DVT

- liver failure

- cerebrovascular accident

- transient ischemic attack

- seizure

- renal failure

- NMS

NMDA Receptor Antagonist clinical teaching

- instruct patient on appropriate dose frequency and dose escalation

- if canot swallow ER, open capsule and sprinkle in applesauce

Cyclobenzaprine brand

Flexeril

Cyclobenzaprine indication

skeletal muscle spasm

Cyclobenzaprine adverse effects

COMMON

- palpitations

- bad taste

- nausea

- pharyngeal dryness

- xerostomia

- dizziness

- headache

- somnolence

SERIOUS

- hepatitis

- jaundice

Cyclobenzaprine clinical teaching

- instruct patient to report use of MAOI within last 14 days before taking drug

- avoid activities requiring mental alertness until drug effects realized

- report signs of decreased hepatic function

- not intended for long term

- avoid alcohol and CNS depressants and TCA with drug

Somnolence definition

Sleepy, can be woken up

Sedation definition

Very sleepy, has multiple levels

Albuterol brand

Proair, Ventolin, Proventil

Fluticasone brand

Flovent, Flovent Diskus

Mometasone brand

Asmanex, Twisthaler

Tiotropium brand

Spiriva

Umeclidinium brand

Incruse ellipta

Ipratropium/albuterol brand

Combivent

Budesonide/formoterol brand

Symbicort

Fluticasone/salmeterol brand

Advair

Fluticasone/vilanterol brand

Breo Ellipta

Montelukast brand

Singulair

Drospirenone/ethinyl estradiol brand

Yaz

Etonogestrel/ethinyl estradiol brand

Nuvaring