Counceling

Thionamide

Often used with beta-blockers. May cause pruritus, joint pain, fever, GI upset, and benign transient leukopenia. More rarely may cause agranulocytosis or hepatotoxicity. 

Thyroid Hormone

To increase absorption, take in the morning ~30 minutes before the first meal or ~4 hours after the last meal, with a full glass of water. Separate by ~ 4 hours from any calcium or iron containing products. Symptoms should start improving after a few weeks. Do not end abruptly. May cause symptoms of hyperthyroidism (e.g., tachycardia or decreased bone mineral density).

Thyroid Hormone

Boxed Warning: Do not use for weight loss due to lack of efficacy and risk or life-threatening toxicity.

Pherntermine (adipex-p)

Short term agent given once daily before breakfast. Because it's a stimulant, may increase BP, cause palpitations/tachycardia, agitation, restlessness, nervousness, or insomnia. Avoid in patients with heart disease or poorly controlled HTN.

Bisphosphonate

With oral, take with a full glass of water and remain upright for 30 minutes to prevent chemical esophagitis. Wait 30 minutes before taking anything else by mouth. Increased risk of osteonecrosis of the jaw after oral surgeries (e.g., tooth extraction), risk for atypical femur fractures

Bone-Modifying Agent: RANKL mab

Boxed Warning: Severe hypocalcemia in patients with advanced kidney disease

Bone-Modifying Agent: RANKL mab

Increased risk of osteonecrosis of the jaw after oral surgeries (e.g., tooth extraction), risk for atypical femur fractures

Progestin Hormone (Medroxyprogesterone, Progesterone)

Boxed Warning: ________ and _______: Questionable evidence for increased risk of CV disease, breast cancer, and dementia. ______ are not recommended long-term (>2 years) unless other options are inadequate; it can cause bone mineral density loss. 

Progestin Hormone

May cause absent/irregular menstrual periods, light bleeding/spotting, acne, increased body hair growth, weight gain, nausea, breast tenderness, headaches, fatigue, and mood changes. Progestin-only pills require perfect adherence; be taken within 3 hours of its scheduled time in order to work. If >3 hours past scheduled time take a dose as soon as possible and use backup contraception for 48 hours. Must be administered within 7 days of menstruation to reliably prevent ovulation.

•  If they have a _____ capsule that is red the red dye may appear like spotting

Testosterone

Boxed Warning: Blood pressure increases, Virilization has been reported in children who were secondarily exposed to topical ______ gel and solution.

Testosterone

hepatic toxicity, increased risk of CV risks or VTE, may increase prostate size, increase in RBC mass, increase in appetite/acne/edema/Scr, sleep apnea, application area reactions, reduced sperm count

• Classified as a hazardous drug

Estrogen

Boxed Warning: Increased risk for endometrial cancer if used as monotherapy.  Questionable evidence for increased risk of CV disease, breast cancer, and dementia.

Estrogen

May cause uterine bleeding and increase risk for breast/uterine cancer

•  May cause vaginal spotting/bleeding, headaches, nausea, and breast tenderness. May see weight gain, mood changes, and an increase in BP.

• Increased risk of developing blood clots; AVOID smoking while taking estrogen containing products. 

•  Only topical/vaginal dosage forms are recommended in postmenopausal women with coexisting atrophic vaginitis in the setting of UI

•  Avoid use in women with a history of VTE, stroke, CAD, thrombosis of heart valves, acquired hypercoagulable states, breast/ovarian/liver cancer, uncontrolled HTN (>160/100), severe headaches or migraines with aura, diabetes with vascular disease, or has unexplained uterine bleeding

SERM

Boxed Warning: Increased VTE risk

•  Increased risk of death due to stroke occurred in a trial in postmenopausal women with documented coronary heart disease or increased risk for major coronary events. Consider the risk-benefit balance in women at risk for stroke

Serm

May cause hot flashes and other menopausal symptoms, arthralgia/leg cramps, flu-like symptoms

Prostaglandin

Boxed Warning: Fetal toxicity - can cause birth defects, abortion, premature birth, or uterine rupture. 

Prostaglandin

May cause N/V/D, headache, dizziness, fever, warmth, hot flashes, chills. Patients will experience pain, bleeding. and severe cramping. Contact doctor if heavy bleeding (soaking through 2 maxi pads per hour for 2 consecutive hours)

COC

Boxed Warning: Increased risk of VTE (___transdermal patch)

COC

May consider taking at bedtime with or without food. 

• take missed pill as soon as possible and the next dose on schedule if it's been <48 hours since the last dose; no backup contraception is required. backup contraception required if >48 hours since last dose