END-OF-YEAR

Olanzapine

brand: Zyprexa

Indication: Bipolar, schizophrenia, depression

MOA: atypical a antipsychotic that’s potent serotonin-5-HT2 and dopamine-D2 antagonist

Box Warning: mortality in elderly patients with dementia-related psychosis; DRESS

Preg: compatible → maternal benefit » embryo-fetal risks

Contra-in: Hypersensitivity

PTPs: Dizziness → AARMAUDEFR. May impair heat regulation. Rise from a sitting/lying down position slowly. Report symptoms of tar dive dyskinesia, neuroleptic malignant syndrome of DRESS syndrome. Diabetic patients should monitor for hyperglycemia and report difficulties with glycemic control. Avoid alcohol while taking this drug.

Lithium

Brand: eskalith, eskalith-CR, lithobid

Indication: bipolar disorder

MOA: Effect unknown

Box: lithium level monitoring required

PREG: human data suggest risk

Contrain: severe debilitation, dehydration, or sodium depletion; sig cardiovascular disease, significant renal impairment, con. diuretic therapy.

PTPs: FDA-approved med guide required. Dizziness → AARMA, report signs/symptoms of toxicity (ex. diarrhea, tremor, ataxia, drowsiness, muscle weakness, lack of coordination, giddiness, blurred vision, tinnitus, etc). Maintain adequate fluid intake and normal salt intake.

Olanzapine

brand: Zyprexa

Indication: Bipolar, schizophrenia, depression

MOA: atypical a antipsychotic that’s potent serotonin-5-HT2 and dopamine-D2 antagonist

Box Warning: mortality in elderly patients with dementia-related psychosis; DRESS

Preg: compatible → maternal benefit » embryo-fetal risks

Contra-in: Hypersensitivity

PTPs: Dizziness → AARMAUDEFR. May impair heat regulation. Rise from a sitting/lying down position slowly. Report symptoms of tar dive dyskinesia, neuroleptic malignant syndrome of DRESS syndrome. Diabetic patients should monitor for hyperglycemia and report difficulties with glycemic control. Avoid alcohol while taking this drug.

Lithium

Brand: eskalith, eskalith-CR, lithobid

Indication: bipolar disorder

MOA: Effect unknown

Box: lithium level monitoring required

PREG: human data suggest risk

Contrain: severe debilitation, dehydration, or sodium depletion; sig cardiovascular disease, significant renal impairment, con. diuretic therapy.

PTPs: FDA-approved med guide required. Dizziness → AARMA, report signs/symptoms of toxicity (ex. diarrhea, tremor, ataxia, drowsiness, muscle weakness, lack of coordination, giddiness, blurred vision, tinnitus, etc). Maintain adequate fluid intake and normal salt intake.

Carbamazepine: Tegretol

Brand: Tergetol

Indication: seizures, neuropathic pain

MOA: Acts presynaptically to block firing of action potentials

Box: Agranulocytosis, aplastic anemia; dermatological reactions; screen for HLA-B 15:02

PREG: Compatible; MB»>FR

Contrain: hypersent, history of bone marrow depression, MAOIs, Nefazodone

PTPs: May decrease effectiveness oral contraceptives, Dizziness, take with food but avoid alcohol/grapefruit. Avoid abrupt discontinuation.

Oxcarbazepine

Brand: Trileptal

MOA: effects through 10-monohydroxy metabolite (MHD)

Indication: Seizure

Box: none

PREG: animal data suggests risk

Contrain: HYpersent

PTPs: Suspension should be shaken well and dose prepared immediately using oral dosing syringe. Can be swallowed directly from syringe or mixed with water. Dizziness → avoid alcohol.graqpefruit. Take with food. Avoid abrupt stop.

Pramipexole

Brand: Mirapex, Mirapex ER

Indication: Parkinson disease, restless leg syndrome

MOA: Dopamine subtype selective agonist

Box: none

Preg: animal data suggests risk

Contrain: hypersent

PTPs: May cause dizziness. Take with food to avoid stomach upset. Report new or increased urges such as gambling, sexual, compulsive eating etc. Do not discontinue abruptly. Do not drink alcohol or use CNS depressants.

Memantine

Brand: Namenda

Indication: Alzheimer’s

MOA: Unknown

Box: none

PREG: weigh risks and benefits

Contrain: hypersent

PTPS: Take w/ or w/o food. Use dosing device with oral solution.

Dexmethylphenidate

BRand: Focalin

Indication: ADHD

MOA: Increases CNS activity by inhibiting re-uptake of norepinephrine and dopamine to stimulate cerebral cortex

Box: abuse and dependence

PREG: animal data suggests low risk

Contrain: hypersent, MAOI use, drug dependence, glaucoma, tics, or history of Tourette

PTPS: Avoid late evening use. Seek medical attention for chest pains, seizures, change in personality

Phentermine

Brand: Adipex-P. Lomiara

Indication: obesity

MOA: Pharmacologic activity similar to amphetamines for weight loss

Box: none

Preg: Contraindicated

Contrain: hypersent, use in agitated states, cardiovascular risks, history of drug abuse, glaucoma, moderate to severe hypotension, hyperthyroidism

PTPs: Dizziness, take during day to avoid insomnia

Rizatriptan Benzoate

Brand: Maxalt

Indication: Migraine

MOA: Binds with high affinity to serotonin 5-HT receptor subtypes

Box: none

PReg: animal data suggests risks

Contrain: hypersent, cerebrovascular syndromes, hemiplegic or basilar migraine, ischemic bowel disease, ischemic heart disease, peripheral vascular disease, severe hepatic dysfunction, uncontrolled HTN, MAOI, ergot alkaloids

PTPs: Avoid alcohol, CNS depressants. Dizziness. Allow disintegrating tablet to dissolve on tongue and then swallow → do not chew

Methotrexate

Brand: Trexall

Indication:rheumatoid arthritis, non-hodgkin lymphoma

MOA: Reversibly Inhibits dihydrofolate reductase

Box: Bone marrow suppression, renal impairment, hepatotoixicty, pneumonitis, GI toxicity, dermatologic toxicity, radiotherapy, pregnancy

Preg: contraindicated

Contrain: hypersent, alcohol use disorder, chronic liver disease, pregnant, nursing, blood dyscrasia in pts treating rheumatoid arthritis and psoriasis

PTPs: Take with food, avoid sun exposure. Nausea and vomiting likely. Emphasize dosing schedule (weekly vs daily)

hydroxychloroquine

Brand: Plaquenil

Indication: lupus, malaria, rheumatoid arthritis

MOA: unknown

Box: none

Preg: prob compatible

contrain: hypersent, visual or retinal changes from last use of hydroxychloroquine, long-term use in children

PTPS: take with food or milk. if weekly take same day and time every week.

Anastrozole

Brand: Arimidex

Indication: breast cancer

MOA: Aromatase inhibitor

Box: none

Preg: contraindicated

Contrain: Hypersent and pregnant

PTPs: Take with food. Decrease estrogen levels can lead to loss of BMD and increased fracture risk

Buprenophrine

Brand: Suboxone, Zubsolv

Indication: opioid use disorder

MOA: opioid receptor partial agonist and antagonist

Box: NOne

Preg: prob compatible

Contrain: Hypersent

PTPs: opioid → chronic use can cause constipation. Drosiness. Avoid alcohol and other CNS depressants. Place tablet or film under tongue until dissolved. 2 tablets under tongue at a time or all if can fit and >2

Bimatoprost

Brand: Lumigan, Latisse

Indication: ocular HTN, hypotrichosis in eyelashes

MOA: synthetic prostaglandin analogue lowers intraocular pressure by increasing aqueous humor production. Unknown MOA for eyelash growth

Box: none

Preg: prob comp

Contrain: Hypersent.

PTPs: eye drop instruction: use new applicator for second eye do not apply to lower lid or more than once a day. lie down or tilt head back for admin.

Brimonidine

Brand: Alphagan, Lumify

Indication: Glaucoma

Box: none

Preg: comp

Contrain: Hypersent, use of MAOIs, children <2 yrs

PTPs: Eye drop instruction

Cyclosporine

BRand: Restasis, Cequa, Verkazia

Indication: Keratoconjunctivitis

MOA: Anti-inflammatory

Box: none

Preg: prob compatible

Contrain: hypersent, active ocular infection

PTPs: Single-use package, use immediately after opening. Shake before use. !5 minute interval from other eye drops.

Dorzolamide/Timolol

Brand: Cosopt

Indication: Glaucoma

Mirabegron

Brand: Myrbetriq

Indication: overactive bladder

MOA: beta-3 adrenergic agonist

Box: none

Preg; animal data suggests low risk

Contrain: hypersent

PTPs: Monitor BP, HR and contact HCP for elevations, bladder irritation or difficulty urinating.

Antibiotics and anti-Infectives

Medications used to treat bacterial infections and prevent the spread of infectious diseases. They work by killing bacteria or inhibiting their growth.

Acyclovir

Generic: Acyclovir

Brand: Zovirax

Indication: An antiviral medication used to treat infections caused by certain types of viruses, such as herpes simplex and varicella-zoster.

MOA: Acyclovir is phosphorylated into its monophosate form then converted to active antiviral acyclovir triphosphate, which inhibits viral DNA synthesis.

Box Warning: None

Preg: Compatible

ContraIn: Hypersensitivity

PTPs: Complete full course of therapy and ensure adequate hydration. For HSV initiate treatment as soon as possible at first sign of lesion, for VZV treatment should begin with/n 24h of appearance of rash. Symptoms should improve with/n 2-3d. If using for prophylaxis or suppression of infection this medication should reduce number of breakouts. Not indicated for children <2y.

Amoxicillin

Generic: Amoxicillin

Brand: Amoxil, Moxatag

Indication: An antibiotic used to treat various infections caused by bacteria, including respiratory tract infections, urinary tract infections, ear/nose/throat infection, and skin/subcutaneous tissue infections.

MOA: Semisynthetic penicillin derivative that inhibits biosynthesis of bacterial cell wall mucopeptide.

Box Warning: None

Preg: risk in 1st/3rd trimester

ContraIn: Hypersensitivity to penicillin/amoxicillin

PTPs: Complete full course of therapy. For suspension shake well and store in the refrigerator. Can take with food if causes upset stomach however avoid mixing suspension with food/drinks. Use measuring device that came w/ prescription. Symptoms should improve with/n 2-3d-if worsen seek help from health practitioner. May weaken effects of other oral drugs, use backup contraceptive method (condoms)

Amoxicilllin/Clavulanate

Generic: Amoxicillin/Clavulanate

Brand: Augumentin

Indication: An antibiotic used to treat various bacterial infections (UTIs, Respiratory infection, infection of skin or subcutaneous tissue, infectious disease of genitourinary system), often those resistant to amoxicillin alone.

MOA: Amoxicillin is a semisynthetic penicillin that inhibits biosynthesis of bacterial cell wall and clavulanate protects amoxicillin from degradation

Box warning: None

Preg; Amoxicillin (1st/3rd trimester)/ Clavulanate (compatible)

ContraIn: Hypersensitivity to penicillin, ER products in patients on dialysis or severe renal dysfunction, history of cholestatic jaundice or hepatic dysfunction.

PTPs: Complete full course of therapy. Take dose with food to ensure proper absorption. For suspension-shake well and store in refrigerator. Note short expiration after reconstitution of 10d. Avoid mixing suspension with food or beverages. Symptoms should improve w/n 2-3d. Make decrease effectiveness of oral medications-encourage patients to take back-up contraceptive method.

Azithromycin

Generic: Azithromycin

Brand: Zithromax

Indication: An antibiotic used to treat various bacterial infections, including respiratory infections, skin or subcutaneous tissue infections, and sexually transmitted diseases.

MOA: Macrolide antibiotic that inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit.

Box warning: None

Preg: Compatible

ContraIn:Hypersensitivity to any macrolide or ketolide antibiotic

PTPs: Complete full course of therapy. Take tablets with or without food although increased tolerability reported with food. Avoid mixing suspension with food or beverages but food can be taken afterwards. Symptoms should improve after 2-3d.

Cefdinir

Generic: Cefdinir

Brand: Omnicef

Indication: An antibiotic used to treat various infections, including respiratory tract infections, skin or subcutaneous tissue infections, and otitis media.

MOA: Cephalosporin antibiotic that inhibits bacterial cell wall synthesis.

Box warning: None.

Preg: Compatible.

ContraIn: Hypersensitivity to cephalosporins.

PTPs: Complete full course of therapy. Can take with or without food. For suspension shake well and store in refrigerator-note 10d expiration after reconstitution. Avoid mixing suspension with food or beverages-eat afterwards. Symptoms should improve within 2-3 days. Separate administration of antacids, iron, and vitamins by 2h. Use w/ caution in penicillin-allergic patients.

Cephalexin

Generic: Cephalexin

brand: Reflex, Daxbia

Indication: An antibiotic used to treat various bacterial infections, inclui8ding respiratory tract infections, skin/subcutaneous infections, and urinary tract infections.

MOA: Inhibits bacterial wall synthesis by binding to penicillin-binding proteins.

Box warning: None

Preg: Compatible

ContraIn: Hypersensitivity

PTPs: Seek medical attention if rash develops. Compete therapy. For suspension shake well then refrigerate-not short expiration after reconstitution. Avoid mixing with food/beverages but may eat afterwards. Symptoms should improve w/n 2-3d. May resume normal activities after 24 h of antibiotics

Ciprofloxacin

Generic: Ciproflaxin

Brand: Oral-Cipro, Cipro XR Otic-Cetraxal, Otiprio

Indication: oral- An antibiotic used to treat various infections, including urinary tract infections, respiratory tract infections.

Otics- ear infection

MOA: Antibiotic that inhibits bacterial DNA gyrase

Box Warning: Serious adverse effects (tendon rupture, peripheral neuropathy, CNS) and exacerbation of myasthenia gravis

Preg: Oral- Contraindicated Otic- Weigh risks and benefits

ContraIn: Hypersensitivity to quinolones, pregnant, concomitant use with tizanidine.

PTPs: Oral-Seek medical attention if decreased urination, yellowing of eyes, blistering skin rash/extreme fatigue, unusual bruising/bleeding, SOB or chest pain, tendon pain, myasthenia, a “pins and needles” tingling or pricking sensation, numbness in the arms or legs, confusion or hallucinations. Take w or w/o food but not w/ milk or dairy products. Take at least 2 h before or 6 after antacids, sucralfate, or mineral supplements and multivitamins w/ calcium/iron/inc. If suspension-shake well and may be stored at room temperature.

Otic- Warm solution by holding container in hands for at least 1 min. Patient should lie with affected ear upward for at least 1 minute→repeat in opposite ear in neceassary. Not approved in children <1.

Clindamycin

Generic: Clindamycin

Brand: Oral- Cleocin Topical- Cleocin T, Clindagel, Clindesse, Evoclin

Indication: Oral- Antibacterial used to treat skin/sub tissue infections, abdomen infection, respiratory infection, pelvic inflammatory disease, diabetic foot infection, and bone infections

Topical- antibiotic and acne

MOA: Inhibits bacterial protein synthesis by binding to 50S ribosomal subunit

Box warning: Oral- Colitis Topical- None

Preg: Compatible

ContraIn: Hypersensitivity

PTPs: Oral- Complete full course of therapy; symptoms should improve w/n 2-3 days. Take w/ full glass of water and remain upright for 30 min after dose to minimize risk of GI ulceration. May resume normal activities after 24 h of antibiotics. Prolonged use may cause fungal or bacterial supra infection.

Topical- Wash and dry face prior to use, use on skin only (avoid eyes and mucous membrane), avoid cut and broken skin. Shake well before use. Liquid is flammable-avoid smoking while applying or exposure to heat/flame. For foam apply to tissue then to face. May have increased sensitivity to sun (use sunscreen) but wait 1-2 hours to apply.

Doxycycline

Generic: Doxycycline

Brand: Vibramycin, Doryx

Indication: antibacterial

Box warning: None

Preg: Contraindicated in pregnancy

ContraIn: hypersent, pregnancy, hepatic dysfunction

PTPs: Complete therapy. 2-3d improvement. Take with full glass of water and sit upright for ~30min to reduce GI ulcerations.

Fluconazole

Generic: Fluconazole

Brand: Diflucan

Indication: Antifungal used to treat fungal infections, including candidiasis and cryptococcal meningitis.

MOA: Damages fungal cell wall by inhibiting biosynthesis of ergosterol

Box warning: None

Preg: Data suggests risk

ContraIn: Concurrent use ergot alkaloids, CYP3A4/5 substrates

PTPs: Do not take any new medications w/o consulting your doctor or pharmacist. If taking weekly-same day and time each week.

ketoconazole - Topical

Generic: Ketoconazole

Brand: Nizoral

Indication: Antifungal used to treat skin infections and dandruff.

MOA: Inhibits fungal cell wall membrane synthesis and alter its permeability

Box warning: None

Preg: Prob compatible

ContraIn: Hypersensitivity

PTPs: Apply thin layer to affected area of skin, skin should be intact. Do not get in eye, nose, mouth, or vagina. Do not wash area where applied for at least 3h. Makeup/sunscreen and other cosmetics may be applied after 20 minutes. Alcohol based and flammable.

Metronidazole

Generic: Metrodinazole

Brand: Flagyl

Indication: Antibiotic used to treat bacterial and protozoal infections.

MOA: Disrupts DNA synthesis in anaerobic bacteria and protozoa.

Box warning: Carcinogenic

Preg: Human data suggests low risk

ContraIn: 1st trimester of pregnancy

PTPs: Avoid alcohol while taking and for 3 days after. Complete full therapy. Symptoms should improve 2-3 d. May be admin w/ food to minimized stomach upset

Nitrofurantoin

Generic: Nitrofurantoin

Brand: Macrodantin Macrobide

Indication: Antibiotic to treat UTIs

MOA: inactivates bacterial ribosomes

Box waring None

Preg: 3rd trimester

Contrain: Pregnant (38-42) or neonates

PTPs: Make urine brown (not bad just the product breaking down). Complete full therapy. Suspension-shake well and store at room temperature (exp. 30d). Avoid mixing suspension with food/beverages but can eat afterwards. Symptoms should improve w/n 2-3d.

Oseltamivir Phosphate

Generic: Oseltamivir

Brand: Tamiflu

Indication: Antiviral used to treat influenza and reduce the duration of symptoms. MOA: Neuraminidase inhibitor that prevents the release of new viral particles.

MOA: Inhibits neuraminidase enzyme, preventing viral replication.

Box warning: none

Preg: Compatible—Maternal benefit

ContraIn: Hypersensitivity

PTPs: Complete full therapy, symptoms should improve 2-3d. Suspension 6mg/mL and mix well-packaged in oral syringe calibrated up to 10mL. Use lower volume of oral syringe w/ children <1y. Can open capsules for suspension. Take with food to minimize GI irritation and take missed dose soon as possible-if next dose w/n 2h skip missed dose. In high-risk patients start treatment as soon as possible but can be initiated even after >48hr. Ppl at high risk for influenza complications (health workers,preg women) must start treatment w/n 48hr of exposure or onset of symptoms.

Trimethoprim/sulfamethoxazole

Generic: Trimethoprim/sulfamethoxazole

Brand: Bactrim, Septra

Indication: Antibiotic used to treat UTIs, HIV infection, traveler’s diarrhea

MOA: sulfamethoxazole inhibits synthesis of dihydropteroic aid and trimethoprim inhibits enzymatic reduction of dihydrofolic acid.

Box warning: None

Preg: Risk in both trimethoprim and sulfamethoxazole

ContraIn: children <2mos, pregnant patients at term, megaloblastic anemia due to folate deficiency, history of drug induced thrombocytopenia, marked hepatic damage or severe renal disease, concomitant use with dofetilide.

PTPs: Complete full therapy, for suspension shake well and store at room temperature AND protect from light. symp should improve 2-3d. May cause photosensitivity, use sunscreen. Maintain adequate hydration during therapy to prevent kidney complications. Seek med attention for severe diarrhea, dark urine, yellowing of skin/eye, unusual bruising/bleeding, blistering skin rash, or SOB. Avoid in patients with G6PD deficiency.

Valacyclovir

Generic: Valacyclovir

Brand: Valtrex

Indication: Antiviral used to treat herpes and varicella (shingles)

MOA: Phosphorylated into monophosphate to active antiviral acyclovir triphosphate which inhibits viral DNA synthesis by incorporation into viral DNA resulting in chain termination

Box warning: None

Preg: Compatible

ContraIn: Hypersensitive

PTPs: seek medical attention if decreased urination, unusual bruising/bleeding, blistering skin/rash, or SOB. Symptoms should improve 2-3 d. Maintain adequate hydration during therapy to prevent renal complications. Not indicated for children <2y. Use caution with concurrent nephrotoxins.

Amiodarone

Generic: Amiodarone

Brand: Cordarone, Pacerone

Indication: Antiarrhythmic used to treat ventricular and atrial arrhythmias (atrial fibrillation).

MOA: Prolongs effective refractory period of atrial and ventricular tissue by blocking potassium conductance.

Box warning: Arrhythmias, hepatoxicity, pro arrhythmic effects, pulmonary toxicity.

Preg: risk

ContraIn: Hypersensitivity., Severe sinus dysfunction, severe bradycardia, 2nd/3rd degree AV blockers, and cardiogenic shock.

PTPs: Use sunscreen, avoid tanning beds and prolonged sun exposure. Report signs/symptoms of cardiac arrhythmia, pulmonary toxicity, hepatoxicity. Multiple drug interactions so inform doctor before starting new drug. Take consistently with meals but avoid grapefruit. Needs pt medication guide. May turn pt bluish-gray in color→”Smurf syndrome”

Apixaban

Generic: Apixaban

Brand: Eliquis

Indication: Anticoagulant used to prevent blood clots in atrial fibrillation, hip/knee replacement surgery to reduce DVT/PE, DVT, and PE.

MOA: Direct factor Xa inhibitor that decreases thrombin generation and thrombus development.

Box warning: Premature discontinuation increases risk of thrombotic events, increased risk of spinal hematoma with spinal puncture or neuraxial anesthesia.

Preg: Potential risk

ContraIn: Active bleeding

PTPs: Seek medical attention if any unexpected bleeding to trouble breathing. Take w/ or w/o food. No abrupt stop as can increase risk of thrombotic event (stroke). Apixaban should be interrupted 24-48 hours prior to dental and surgical procedures and re-started after homeostasis. Avoid OTC NSAIDs and high-dose aspirin; increase risk of bleeding.

Aspirin

Generic: aspirin

Brand: Bayer, vazalore

Indication: Fever and generalized aches, pains, headache

MOA: Inhibits platelet aggregation by irreversibly inhibiting platelet cyclooxyrgenase preventing production of thromboxane.

Box warning: none

Preg: compatible at low doses, w/ full dose risk in 1st/3rd trimester

ContraIn: asthma, rhinitis, nasal polyps, inherited or acquired bleeding disorders, children <18y of age w/ viral infection.

PTPs: Avoid additional aspirin, NSAIDs, or aspirin-containing products during use, unless recommended particularly if history w/ GI disease. Avoid >=3 alcoholic drinks/d as risk of GI bleeds in increases. Use should be discontinued before dental procedure.

clopidogrel

Generic: clopidogrel

Brand: plavix

Indication: Thrombosis prevention and management myocardial infarction medically

MOA: Prevent platelet aggregation by direct inhibition of ADP binding to receptor sites

Box warning: Reduced CYP2C19 function

Preg: prob compatible

ContraIn: active bleeding

PTPs: Report s/s of bleeding especially if used concomitantly with anticoagulant therapy. Do not stop abruptly w/o talking to prescriber to minimize risk of re-thrombosis. Should be discontinued 5day prior to surgical procedure if anti-platelet not desired. Clopidogrel depends on CYP2C19 so in patients that lack it, med will have less effect.

Dapagliflozin

Generic: dapagliflozin

Brand: farxiga

warning; none

Preg: potential risk

ContraIn: renal impairment

PTPs: shown decrease cardiovascular death and hospitalization In pt w/ heart failure reduced ejection fraction. Watch for signs of dehydration (dizziness, low BP, decreased urination)

diltiazem

generic: diltiazem

Brand: cardizem, cartia XR, Dilacor XR, dilt-XR, taztia XT, Tiazac

Indication: calcium channel blocker - hypertension, atrial arrhythmia, supra ventricular tachycardia, and stable chronic angina.

MOA: decreases HR, prolongs AV nodal conduction decreases arteriole/coronary vascular tone

Box warning: None

Preg: low risk

ContraIn: severe hypotension, sick sinus syndrome, 2nd or 3rd degree AV block

PTPs: Report symptomatic hypo, bradyarrhythmia, peripheral edema, or syncope. Follow admin instruction particular to brand as it differs. Do not drink alcohol while taking-some products may be opened and sprinkled on applesauce (swallow w/o chewing followed by glass of water). Admin at same time of day either morning or evening Avoid concurrent use of beta-blockers or digoxin

Isosorbide Mononitrate

Generic: isosorbide mononitrate

Brand: Imdur

Indication: Angina, prophylaxis prevention.

MOA: Vasodilator that relaxes vascular smooth muscle by decreasing intracellular calcium reducing myocardial oxygen demand.

Box warning: None.

Preg: moderate risk.

ContraIn: Concurrent use with PDEIs or riociguat

PTPs: Take on empty stomach with at least half a glass of water. Swallow tablet whole-dont break or chew. Can cause HA-sign that its working, can use acetaminophen to relieve pain. Med may cause dizziness. Avoid driving/using machinery or anything else that requires alertness. Standup slowly if drug causes light-headedness. No abrupt stop with consulting doctor. Dose may need to slowly decrease to stop. Avoid drinking alcohol while taking drug. Scored tablet may be split. Doses of immediate release formulation should be taken at least 7h apart. Avoid missing with anti-hypertensive drugs as can increase of hypotension. Safety and efficacy not tested in children.

Nitroglycerin

generic: nitroglycerin

Brand: minitran, Nitro-dur, nitrostat

Indication: Treat angina, prophylaxis-acute-fissure

MOA: decreases intracellular calcium leading to relaxed vascular muscle reducing myocardial workload

Box warning: None

Preg: low risk

ContraIn: Concurrent use with PDEIs, hypotension, marked bradycardia or tachycardia, severe anemia, and increase intracranial pressure.

PTPs: sit prior to using. Do not eat or drink after. Spray should be under tongue-done rinse mouth after use. Rise slowly to prevent light-headedness. 10-12h/d drug-free interval. Avoid concurrent use of alcohol, CNS depressants, or antihypertensives. Safety and efficacy not established in children.

Rivaroxaban

Generic: Rivaroxaban

Brand: Xarelto

Indication: Anticoagulant for preventing blood clots

MOA: blocks active site of factor Xa

Box warning: Premature stop increase risk of thrombotic event, increase risk of spinal hematoma with spinal puncture/neuraxil anesthesia

Preg: risk

ContraIn: active bleeding

PTPs: report unusual bleeding or hard to breathe. Inform of drug interactions with other anticoagulants and anti-platelets. Take w/ food for doses >=15 mg. If taking for atrial fibrillation take with evening meal.

Sacubitril/valsartan

Generic: Sacubitril/valsartan

Brand: Entresto

Indication: treat heart failure with reduced ejection fraction

MOA: inhibits vasoconstriction and neprilysin leading to increased levels of natriuretic peptides, promoting vasodilation and diuresis.

Box warning: Pregnancy

Preg: contraindicated

ContraIn: Pregnancy, history of angioedema, concurrent use with aliskiren, ACEIs

PTPs: Do not abrupt stop. Use potassium supplements under med supervision only. May cause dizziness. Avoid NSAIDs.

Torsemide

Generic: torsemide

Brand: demandex, soaanz

Indication: Edema related to heart failure, renal failure, hepatic cirrhosis

MOA: loop diuretic that decreases sodium reabsorption decreasing the amount of water being absorbed

Box warning: none

Preg: prob compatible

ContraIn: hypersensitivity to sulfonylureas, anuria, hepatic coma

PTPs: Avoid alcohol and NSAIDs. Increased risk of sun-sensitivity use sunscreen and avoid tanning. Report s/s of hypo, decreased urine output, or severe skin reactions. Eat high-potassium foods and monitor weight daily. Furosemide first choice, but if inadequate response trial furosemide.

Verapamil

Generic: verapamil

Brand: Calan SR

Indication: angina, atrial arrhythmia, Hypertension

MOA: Decrease intracellular calcium levels

Box warning: none

preg: compatible

ContraIn: atrial fibrillation or ventricular dysfunction, sick sinus syndrome, concurrent use with PDEIs, hypotension, 2nd 3rd degree AV blocker,

PTPs:Report s/s of bradyarrhythmia, syncope, peripheral edema, and hypotension. Avoid alcohol and grapefruit juice. May cause dizziness, take while sitting down than slowly stand to avoid light-headedness. May open capsule and sprinkle on food-swallow whole and allow with glass of water. Not recommended in children <18

Warfarin

Generic: Warfarin

Brand: Coumadin

Indication: Anticoagulant

MOA: inhibits vitamin K epoxide reductase, reducing synthesis of vitamin K-dependent clotting factors.

box warning: bleeding

PReg: contrain în 1st trimester

ContraIn: acquired or inherited bleeding, uncontrolled HTN, noncompliant patients, bacterial endocarditis, pregnancy, threatened abortion, eclampsia/preeclampsia

PTPs: Report s/s of hemorrhage, skin and tissue necrosis. Avoid situations in which cuts, bruises, or injury are likely to occur. Many sig drug drug interactions; consult with/ healthcare provider. Avoid alcohol, cranberry products, and drastic changes in vitamin k consumption from diet.

Bronchodilators

Medications that relax and open the airways in the lungs, making it easier to breathe, commonly used in the treatment of asthma and chronic obstructive pulmonary disease (COPD).

Albuterol

Brand: albuterol

Generic: ProAir, Proventil HFA, Ventolin HFA, ProAir Respiclick

Indication: Bronchodilator → relaxes and opens the airways in the lungs to make it easier to breathe

MOA: Selective B2-adrenergic agonist that acts on B2 adrenergic receptors on the sympathetic nervous system to relax muscle in airways and make it easier to breathe

Box warning: None

Preg: Compatible

ContraIn: Hypersensitivity

PTPs: Instruct on inhaler technique including priming/shaking before using. Wash mouthpiece and air dry at least once a week. Contact prescriber if more albuterol is needed to control symptoms as it may point towards acute asthma exacerbation. Do not use more frequently than recommended. When inhaling hold breath for 10s to allow albuterol to travel deeper into lungs if allowed.

Ipratropium/albuterol

Brand: Ipratropium/albuterol

generic: Combivent Respimat

Indication: Bronchodilation → relaxes airways muscles to allow for easier breathing; chronic obstructive pulmonary disease

MOA: Albuterol is a selective B2 agonist working on sympathetic nervous system to relax smooth muscle in airways for easier breathing. Iprotropium is a competitive antagonist of acetylcholine at muscarinic receptors to prevent peripheral nervous system activity.

Box warning: None

Preg: Human data suggests low risks with ipratropium but compatible with albuterol

ContraIn:Hypersensitivity to either component, atropine, levalbuterol, or hypersensitivity to soya lecithin or related food products (soybean or peanut products)

PTPs: Instruct patient on inhaler instruction → priming and shaking well. Wash mouthpiece and let air dry at least once a week to prevent blockage. Store at room temperature. Nebulizer technique → use entire solution of opened vial to avoid contamination and seek medical attention if symptoms don’t improve or worsen.

Coticosteroids

Medications that reduce inflammation in the airways, commonly used to manage asthma and COPD symptoms. They help decrease mucus production and improve lung function.

Budesonide

Brand: Budesonide

Generic: Pulmicort Respules, pulmicort Flexhaler

Indication: Reduce inflammation and mucous production to manage asthma

MOA: Glucocorticoid and mineralocorticoid activity exhibits a broad range of active inhibition against multiple cell types and mediators involving allergic and nonallergic/irritant-mediated inflammation

Box warning: None

Preg: Compatible

ContraIn: hypersensitivity to product, hypersensitivity to milk proteins; primary treatment of status asthmatics or other acute episodes of asthma.

PTPs: Advise on inhaler technique and gently swirl nebulizer suspension before use. Use entire vial of inhalation suspension immediately to avoid contamination → deliver over 5-15 mins using mouthpiece or face mask. After admin rinse mouth with water and spit also wash face to minimize risk of developing oral candidiasis. Keep unused containers in pouch and open foil pouch only good for 2 wks.

Fluticasone (nasal,inhaled)

Brand: fluticasone

Generic: Flonase, Xhance

Indication: anti-inflammation in airways to manage asthma, decongestant for allergic and non-allergic rhinitis.

MOA: Control biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes

Box warning: none

Preg: compatible

ContraIn: Hypersensitivity

PTPs: Advise pt on proper admin technique for product. Instruct pt to monitor for signs of toxicity especially adrenal insufficiency. Inform of scent associated with product. Relief and/or adverse effects may not occur for several days after initiation.

Fluticasone (inhalation)

Brand: Fluticasone

Generic: ArmonAir Digihaler, ArmonAir RespiClick, Arnuity Ellipta, Flovent Diskus

Indication: Asthma and COPD management, anti-inflammatory treatment.

MOA: Inhibits various cell types and mediators of inflammation.

BOx: none

PReg: Comp

ContraIn: hypersensitivity to product, milk proteins; primary treatment of asthmatics or other acute asthma epodes and COPD

PTs: Instruct on how to use medication (shaking/priming before use). Monitor for toxicity especially adrenal insufficiency. Seek medical attention if symptoms don’t improve after use. Rinse mouth after use to avoid oral candidiasis. Provide package insert and other eduction materials.

Budesonide/formoterol

Brand: Budesonide/formoterol

Generic: Symbicort

Indication: anti-inflammatory ad bronchodilator combination to manage asthma and COPD

MOA: Budesonide exhibits cell types and potent mediators of inflammation and formoterol is a selective B2 agonist that relaxes smooth muscle in airway.

Box warning: Asthma deaths, pediatrics, increased risk of hospitalization

Preg: Comp

ContraIn: Hypersensivity to both products; primary treatment of asthmatics or acute asthma episodes or COPD

PTPs: Advise pt on how to admin product. Wish mouthpiece at least one a week to avoid blockage. Rinse mouth and spit after use to avoid oral candidiasis. If >1 inhalation, wait one min from initial and shake before use again.

Fluticasone/salmeterol

Brand: fluticasone/salmeterol

Generic: Advair Diskus, Advair HFA, AirDuo RespiClick, Wixela

Indication: Anti-inflammatory and long-acting B2 agonist for asthma management and COPD

MOA: Inhibits multiple cell types and potent mediators of inflammation while salmeterol acts as a long-lasting B2 agonist

Box warning: Increased asthma related deaths

Preg: Compatible

ContraIn: Hypersensitivity yo either product or milk proteins; primary treatment for asthmatics or other acute asthma episodes/COPD. Concomitant use with posaconazole.

PTPs: Advise pt on how to admin. Monitor toxicity esp, adrenal insufficiency. Rinse mouth to avoid oral candidiasis.

Fluticasone/Vilanterol

Brand: Fluticasone/Vilanterol

Generic: Breo Ellipta

Indication: Anti-inflammatory and long lasting B2 agonist to manage asthma and chronic obstructive pulmonary disease.

MOA: Anti-inflammatory and long-lasting B2 agonist

Box warning: None

Preg: Vilanterol may cause fetal harm

ContraIn: Hypersensivity to either product or milk proteins; primary treatment for asthmatics or other acute asthma episodes/COPD.

PTPs: Advise pt on how to administer. Rinse mouth to prevent oral candidiasis. Monitor for signs of toxicity, especially adrenal insufficiency. Avoid abrupt discontinuation. Seek medical attention if symptoms worsen or remain the same after admin.

Fluticasone/umeclidinium/vilanterol

Brand: Fluticasone/umeclidinium (anti-cholinergic)/vilanterol(long-lasting selective B2 agonist)

Generic: Trelegy Ellipta

Indication: Anti-inflammatory and long-acting bronchodilator for treatment of chronic obstructive pulmonary disease (COPD) and asthma.

MOA: Fluticasone → inhibits cell types and potent mediators of inflammation, umeclidinium is an anti-cholinergic so it’s an antagonist that blocks muscarinic receptors from being activated, Vilanterol. is an long lasting B2 agonist that works via sympathetic nervous system.

Box warning: None

Preg: fetal harm risks

ContraIn: Hypersensivity to products, milk proteins; primary treatment fr asthmatics or acute asthma episodes/COPD

PTPs: Instruct on how to use medication. Monitor for toxicity especially adrenal insufficiency. Don’t abrupt stop, seek medical attention if symptoms don’t improve or worsen. May cause HA, back pain, diarrhea, coughing, etc. Rinse mouth to avoid oral candidiasis.

Leukotriene Receptor Antagonist

A class of drugs that block the action of leukotrienes, which are inflammatory mediators involved in asthma and allergic responses. They are used to manage asthma symptoms and improve lung function.

Montelukast

Brand: Montelukast

Generic: Singulair

Indication: Inhibits leukotriene a mediator of inflammation for asthma or allergies.

MOA: Anti-inflammatory that inhibits leukotriene a mediator of inflammation with asthma and allergies.

Box warning: Behavior and mood-related effects

Preg: Prob compatible

ContraIn: Hypersensivity; treatment for asthmatics or other acute asthma episodes.

PTPs: Report increased use of short-acting bronchodilators and don’t discontinue or decrease current asthma medications unless instructed. Pt with allergic rhinitis or asthma should take in the evening.

Anticholinergic

Muscarinic receptor antagonist to prevent parasympathetic nervous system from acting on smooth muscle to open airways

Tiotropium

Brand: Tiotropium

Generic: Spiriva handihaler, Spiriva Respimat

Indication: Asthma

MOA: Muscarinic receptor antagonist to prevent acetylcholine from binding and causing smooth muscle constriction to essentially open your airway.

Box warning: None

Preg: Low risk

ContraIn: Hypersensitivity to product or milk proteins; treatment of acute bronchospasm

PTPs: Drug may cause increase HR, dry mouth, constipation, urinary difficulty and retention, RTI, and sinusitis. Instruct on use; inhalation and not swallowing. Handihaler → inhale contents of each capsule twice to ensure drug delivery. Max benefit may not be seen for 1-2 mos.

Antihistamines (for allergic repsitaotry conditions)

Medications that block histamine receptors to alleviate symptoms of allergies, such as sneezing, itching, and runny nose. Commonly used for allergic rhinitis and other allergic conditions.

Azelastine

Brand: Azelastine

Generic: Astelin, astepro

Indication: Allergic rhinitis

MOA: Blocks release of histamines by selectiv eH1 receptor antagonist

Box warning: None

Preg: Low risk

ContraIn: Hypersensitivity

PTPs: Avoid spraying in eyes. Somnolence has been reported with nasal administration. Avoid alcohol use and hazardous activities such as driving or operating machinery until level of sedation is known. Blow nose prior to use. Clean nose tip to avoid contamination and may cause taste disturbances typically transient and temporary.

Cetirizine

Brand: Cetirizine

Generic Zyrtec

Box: None

Preg: Low risk

ContraIn: Hypersensitivity to product or hydroxyzine

PTPs: Avoid driving/heavy machinery until sedation determined.

Levocetirizine

Brand: Levocetirizine

Generic: Xyzal

Indication: allergic rhinitis

MOA: Antagonist to H1 receptors to prevent release of histamines → mediators of inflammation in allergic rhinitis

Box: None

Preg: Low risk

ContraIn: Hypersensitivity to product, hydrazine; pt with CrCl <10 mL/min; children <12 y w/ any renal impairment, any pt on hemodialysis

PTPs: Avoid driving/ operating heavy machinery until sedation level is known.

Loratadine

Brand: Loratadine

Generic: Alavert, Claritin, Clearatadine

Indication: allergic rhinitis

MOA: Inhibit release of histamines → mediators of inflammation during allergic rhinitis

Box: none

Preg: Low risk

ContraIn: hypersensitivity

PTPs: Avoid driving/operating heavy machinery until sedation level known. May cause headaches, somnolence, or fatigue.

Gastrointestinal Agents

Medications used to treat digestive issues, such as acid reflux, nausea, and constipation.

Proton Pump inhibitors

are a class of medications that reduce stomach acid production by blocking the proton pump in the stomach lining, effectively treating conditions like gastroesophageal reflux disease (GERD) and peptic ulcers.

Esomeprazole

Brand: Esomeprazole

Generic: Nexium

Indication: Gastroesophageal reflux, erosive esophagitis (heartburn), Zollinger-Ellison syndrome, prevention of NSAID-iduced gastropathy

MOA: Binds to H+/K+-ATPase proton pump in parietal cells to inhibit its action reducing gastric acid production

Box Warning: None

Preg: Low risks

ContraIn: Hypersensitivity

PTPs: Should be taken 1 hr before meal. Do not take multiple PPI and H2 antagonist concurrently as many are available OTC. For special circumstances must complete full therapy (calcium therapy, H. pylori regimen)

Omeprazole

Brand: Omeprazole

Generic: Prilosec

Indication: GERD and peptic ulcers

MOA: Reduce gastric acid production by inhibiting H+/K+ATPase pump in parietal cells.

Box warning: None

PReg: low

ContraIn: Hypersensitivity

PTPs: take one hour before eating. Don’t take concurrently with multiple OTC H2 antagonist or PPIs. For special therapies (calcium therapy/H. pylori) should not stope therapy and/or wean off slowly.

Pantoprazole

Brand: Pantoprazole

Generic: Protonix

Indication: GERD, Zollinger-Ellison syndrome (excessive gastric acid excretion)

MOA: Reduce gastric acid production by inhibiting H+/K+ATPase pump in parietal cells.

Box warning: none

Preg: low risk

ContraIn: Hypersensitivity

PTPs: Take with or without/o food, best to take before meals. seek med care for severe HA or blistering skin rash. Don’t take concurrently with multiple other OTC meds. For special circumstances ( calcium therapy and H.polyri) don’t stop abruptly and/or may need to wean off

Histamine H2-Receptor Antagonist

A class of medications that reduce gastric acid secretion by blocking histamine H2 receptors in gastric parietal cells, commonly used to treat conditions like GERD and peptic ulcers.

Famotidine

Brand: Famotidine

Generic: Pepcid

Indication: GERD, indigestion (heartburn)

MOA: Inhibits histamine H2 receptors preventing H2 release from parietal cells

Box Warning: None

Preg: Compatible

ContraIn: Herpsensivity to product and other H2 antagonists

PTPs: Take at bedtime, May take with food or antacids, if needed. Shake suspension well before use. OTC meds available, don’t take multiple concurrently.

Antiemetics

Medications used to prevent or treat nausea and vomiting, often prescribed for conditions such as motion sickness or as a side effect of chemotherapy.

Ondansetron

Brand: Ondansetron

Generic: Zofran

Indication: chemotherapy-induced nausea/vomiting, radiation-induced nausea/vomiting, and post-operative nausea/vomiting

MOA: Selective serotonin 5-HT3 receptor antagonist that blocks the action of serotonin, a natural substance that can cause nausea and vomiting.

Box warning: none

Preg: risks

ContraIn: Hypersensitivity; concomitant apomorphine or drugs that increase QTc interval (prolongs heart’s electrical cycle)

PTPs: Dry hands before handling disintegrating tablet. Do not open the blister pack that contains the tablet until you are ready to take it. Do n to push the oral disintegrating tablet through the foil. Place tablet in mouth, allow to melt, swallow or drink water.

Promethazine

Brand: Promethazine

Generic: Phenergan

Indication: Nausea and vomiting

MOA: (antihistamine) H1 receptor antagonist that blocks histamine, reducing nausea and vomiting.

Box Warning: none

Preg: compatible

ContraIn: Hypersensitivity; asthma; children under 2yo, comatose state

PTPs: May cause drowsiness to avoid activities that require high alertness. Avoid alcohol. Use caution in elderly.

Meclizine

Brand: Meclizine

Generic: Antivert, Bonine, Dramamine

indication:Motion sickness, vertigo

MOA: Antihistamine that suppresses the vasodepressor response to histamine while only inhibiting acetylcholine

Box warning: None

Preg: Compatible

ContraIn: hypersensitivity

PTPs: May cause drowsiness → avoid activities that require alertness. Avoid alcoholic beverages and CNS depressants. Take w/ food to decrease GI symptoms. Bc anticholinergic → caution in pts with asthma, glaucoma, or enlargement of prostrate gland. Don't crush if not advertised as chewable. Multi OTC meds don’t take multiple concurrently.

Antispasmodics

Medications used to relieve muscle spasms and associated pain, often targeting the gastrointestinal tract.

Dicyclomine

Brand: Dicyclomine

Generic: Bentyl

Indication: Irritable bowel movement

MOA: Relieves smooth muscle spasms of the GI tract via anticholinergic effects

Box warning: none

Preg: comp

ContraIn: breasting <6mos, myasthenia gravis, severe ulcerative colitis, reflex esophagitis, unstable cardiovascular system, and glaucoma .

PTPs: May cause drowsiness → avoid activities that require alertness, Heat prostrations in hot environments.

Laxatives

Medications used to stimulate bowel movements and relieve constipation, often working by increasing stool bulk or softening stool.

Docusate

Brand: Docusate

Generic: Colace

Indication: Constipation

MOA: Acts as stool softener by increasing penetration of fluid into the stool

Box: None

Preg: Comp

ContraIn: hypersensitivity, intestinal obstruction

PTPs: Life-style interventions usually first-line management of constipation. May require several days of treatment before stool softening is noticeable. Can take single dose daily or divided dose. Discontinue and contact HP if rectal bleeding occurs or bowel movement fails to occur after appropriate use. Do not use with products containing mineral oil unless told to by HP.

Sucralfate

Brand: Sucralfate

Generic: Carafate

Indication: Duodenal Ulcer

MOA: Forms complex with positively-charged proteins to form protective layer over gastric lining against peptic acid

Box: None

Preg: Comp

ContraIn: Hypersensitivity

PTPs: Take on empty stomach and do not take any other medications within 2-4 hr of sucralfate. Shake suspension well before use; suspension should be stored at room temperature.

Analgesics

Pain relievers

Non-opioid analgesics

are medications used to relieve pain without the use of opioids, commonly including acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).

Acetaminophen

Generic: Acetaminophen

Brand: Tylenol

Indication: Pain, headaches, and fever

MOA: Inhibits prostaglandin synthesis in the brain, ALLEGEDLY

Box warning: Risk of medication errors (injection) and hepatotoxicity

Preg: Short term use suggests low risk; long term use suggest risk

ContraIn:Active acute hepatic dysfunction, do not use with other acetaminophen-containing products

PTPs: Do not exceed max recommended daily dose; higher dose may result in hepatic injury → severe hepatotoxicity and death. Avoid alcohol (<3 drinks/d), especially if use is chronic. Use provided measuring device and infant/children formulation is the same strength.

Opioid analgesics (narcotics)

are powerful pain-relieving medications that work by binding to opioid receptors in the brain and spinal cord.

Codeine - weak opioid so usually given with acetaminophen

Generic: Codeine

Brand: Tylenol with Codeine

Indication: Pain and cough suppression

MOA: Binds to opioid receptors, producing analgesia and sedation

Box warning: abuse, REMs, respiratory depression, accidental ingestion, CYP2D6 in children, neonatal withdrawal syndrome, interactions with CYP3A4/5, 2D6, avoid concomitant use with benzodiazepines and CNS depressants

Preg: risk Breastfeeding: ContraIndicated

ContraIn: Hypersent. Use in age <12y, use in 12-18 yrs postoperatively after tonsillectomy

PTPs: If using chronically use laxative for preventing constipation. May cause drowsinesses → avoid activities that require alertness. Avoid alcohol.

Hydrocodone

Generic: Hydrocodone

Brand: Norco, Lorcet, Vicodin, Hysingla ER

Indication: Severe pain

MOA: Binds to opioid receptors resulting in altered perception of pain

Box warning: abuse, REMS, accidental ingestion, neonatal withdrawal syndrome, CYP3A/5 interactions, hepatotoxicity, and con. use w/ benzodiazepines

Preg: risks Breastfeeding: potentially toxic

ContraIn: Hypersensitivity, paralytic ileus, respiratory depression, severe asthma

PTPs: Used chronically then use laxative, may cause dizziness so avoid activities that require alertness, avoid alcohol and other CNS depressants

Morphine

Generic: Morphine

Brand: MS Contin, Avinza, Kadian

Indication: Chronic pain (moderate to severe) and acute pain

MOA: Binds to opioid receptors (mu receptors), providing analgesia and sedation.

Box waring: Abuse, REMS, accidental ingestion, neonatal withdrawal syndrome, con, use with benzodiazepines and other CNS depressants, medication errors.

Preg: Risk Brestfeeind: potential toxicity

ContraIn: Hypersensitivity, paralytic ileus, respiratory depression, acute/severe asthma, GI obstruction, concurrent use or use w/n 14 days of MAOI

PTPs: If used chronically take with laxative to avoid constipation. May cause dizziness so avoid activities that require alertness. Avoid with alcohol and CNS depressants. ER can’t be crushed or chewed and can be opened and sprinkled on soft food but must be swallowed whole and not chewed.

oxycodone

Generic: Oxycodone

Brand: OxyContin

Indication: Chronic pain moderate to severe

MOA: Binds to opioid receptors for analgesia and sedation effects.

Box warning: Abuse, REMS, Accidental ingestion, neonatal withdrawal syndrome, CYP3A4/5 interactions, Con use with benzodiazepines and other CNS depressants

Preg: Risk Breastfeeding: risk

ContraIn: hypersensitivity, paralytic ileus,respiratory depression, severe asthma, hypercarbia

PTPs: Use laxatives if used chronically, may cause dizziness so avoid activities that require alertness,

Avoid alcohol and CNS depressants.

Tramadol

Brand name: tramadol

Generic: Ultram

Indication: Chronic pain moderate to severe

MOA: Binds to opioid receptors and inhibits reuptake of norepinephrine and serotonin, providing analgesic effects.

Box: Abuse, REMS, accidental ingestion, CYP3A4/5 interactions, neonatal withdrawal syndrome, con, use with benzodiazepines and CNS depressants

Preg: Risk BF: pot. toxicity

Contrain: Hypersensitivity, paralytic ileus, respiratory depression, severe asthma, age <12 yrs, hypercapnia, MAOI use w/ or w/n 14 days.

PTPs: if used chronically take with laxative. May cause dizziness so avoid activities that require alertness. Avoid alcohol. Extended release tablets must be swallowed whole, no crushing or chewing. Can take w/ or w/o food but must stay consistent to avoid variability in absorption.

Neuropathic Pain Agents

Medications used to treat pain caused by nerve damage or dysfunction, often including anticonvulsants and antidepressants.

Gabapentin

Generic: Gabapentin

Brand: Neurontin, Gralise

Indication: treat damage caused by nerve damage or dysfunction: partial seizure and postherpetic neuralgia

MOA: Unknown MOA but structurally similar to GABA

Box warning: None

Preg: risks

ContraIn: hypersensitivity

PTPs: 1st dose on 1st day should be taken at bedtime. ER formulation taken with evening meal. Pt should avoid activities that require mental alertness or coordination until drug effects realized. Report worsening depression, suicidal ideation, or unusual changes in behavior. Avoid sudden discontinuation as may precipitate status epilepticus. wait 2h after antacid to take Gabapentin

Pregabalin

Genric: Pregabalin

Brand: Lyrica

Indication: Neuropathic pain, fibromyalgia, or postherpetic neuralgia

MOA: binds to a2-delta a subunit og voltage-gated calcium channels in CNS tissues

Box warning: None

Preg: risk

contrain: hypersensitivity

PTPs: solution must be used w/n 45 days of opening the bottle. dizziness-AARA. Avoid sudden discontinuation as may cause precipitate epilepticus, seizures. Avoid concurrent use with CNS depressants, alcohol.

Anti-inflammatory agents

Medications that reduce inflammation and swelling, commonly used to treat conditions such as arthritis, muscle pain, and other inflammatory disorders.

NSAIDS

non-steroidal anti-inflammatory drugs

Celecoxib

Generic: Celecoxib

Brand: Celebrex

Indication: osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute pain

MOA: inhibition of the COX-2 enzyme isoform to reduce prostaglandin production, leading to decreased inflammation and pain.

Box warning: Cardiotoxicity, CABG

PReg: risks in 1st and 3rd trimester

Contrain: asthma, urticaria or allergic-type reaction following aspirin or other NSAID admin, CABG surgery, treatment of perioperative pain, hypersensitivity to sulfonamides.

PTPs: May take with food or milk to decrease GI upset. May open capsule and pour into a teaspoon of applesauce.

Diclofenac

Generic: Diclofenac

Brand: Cambia, Voltaren, Zipsor, Zorvolex

Indication: pain, dysmenorrhea, migraine, osteoarthritis, rheumatoid arthritis, ankylosing spondylitis

MOA: nonselective Inhibiton of COX-2 and COX-1 enzyme isoform

Box: cardiotoxicity, GI risk, and CABG

Preg: 1st/3rd trimester risk

Contrain: hypersensitivity, asthma, urticaria or allergic-type run to aspirin or other NSAID admin, CABG, Con. use with ketorolac

PTPs: Take with food or milk to avoid GI upset.