Drug Quiz 9 Counseling Points (#275-303)

Arimidex (anastrozole)

for cancer

CI: pregnancy

warning: CVD and osteoporosis risk

effects: hot flashes, night sweats, arthralgia(joint pain) / myalgia(muscle pain), N/V

Otrexup, Rasuvo (injectable), Trexall (oral) - (methotrexate)

for cancer, RA

BBW: hepatotoxicity, myelosuppression (bone marrow doesn’t produce enough blood cells), renal damage, preganancy (teratogenic), Gi toxicity

CI: pregnancy

effects: nephrotoxicity, hepatotoxicity, N/D, mucositis, hnd-foot syndrome

notes: in autoimmune disease, folic acid supplementation can be given to reduce side effects (often in oncology leucovorin is used)

Azulfidine (sulfasalazine)

for RA

CI: sulfa or sulficylate allergy

warning: severe skin reactions (SJS, TEN), blood dyscrasias (blood abnormality)

effects: HA, rash, oligospermia (low sperm count in semen), anorexia, folate deficiency

counseling: can cause yellow-orange skin/urine discoloration

Prograf (tacrolimus)

for transplant

BBW: increased susceptibility to infections, lymphoma

effects: increased BP, nephrotoxicity, hyperglycemia, neurotoxicity, hyperlipidemia, QT prolongation, alopecia, leukopenia, leukocytosis, thrombocytopenia (low platelets in the blood)

DI: CYP 450 3A4 and P-gp substrate, many DIs

counseling: avoid alcohol

Myfortic (mycophenolic acid),

CellCept (mycophenolate mofetil)

for transplant

BBW: increased susceptibility to infections, lymphoma, skin malignancies, increased congenital malformations, spontaneous abortions

effects: diarrhea, GI upset

DI: can decrease levels of hormonal contraceptives, do not take multivitamins/antacids at the same time

notes: avoid in pregnancy, they are NOT interchangeable

Vitamin B-12 (cyanocobalamin)

for anemia, supplementation

effects: pain with injection, rash

DI: colchicine can decrease absorption of this drug

notes: IM injection and intranasal formulations available

Vitamin D3, Calcitriol (cholecalciferol)

for vitamin D supplementation

effects: generally well tolerated

notes: available OTC and Rx

Vitamin D2, Calcidol (ergocalciferol)

for vitamin D supplementation

CI: hypercalcemia

effects: generally well-tolerated

notes: available as OTC and Rx

Folic acid (folic acid)

for supplementation (prenatal, anemia, etc)

effects: rash (pruritus, rash, malaise - general feeling of discomfort/feeling ill, bronchospasm)

DI: can decrease concentrations of phenytoin and phenobarbital

notes: available as Rx and OTC, during pregnancy the folic acid requirement is at least 600 mcg/day to decrease risk of neural tube defects

Lovaza (omega-3 ethyl esters)

for dyslipidemia (mainly triglycerides)

warning: use caution in hypersensitivity to fish or shellfish

effects: burping, dyspepsia, taste perversions

DI: can prolong bleeding time (monitor INR in pt taking warfarin- INR is the time it takes for blood to clot)

notes: only Rx

Vascepa (icosapent ethyl)

for dyslipidemia (mainly triglycerides)

warning: use caution in hypersensitivity to fish or shell fish

effects: burping, dyspepsia, arthralgia (joint pain)

DI: can prolong bleeding time (monitor INR in pt taking warfarin)

notes: Rx only

counseling: take with food

Klor-Con (potassium chloride)

for supplementation

CI: severe renal impairment, hyperkalemia

effects: abdominal pain/cramping, N/D, flatulence

counseling: take with meals and a full glass of water to reduce GI irritation

FeroSul (ferrous sulfate)

for anemia, supplementation

BBW: accidental overdose is a leading cause of fatal poisoning in pt < 6 years

effects: constipation; dark, tarry stools

DI: antacids, H2RAs, and PPIs decrease absorption of this drug; this drug also decreases absorption of many drugs due to binding (fluoroquinolones, tetracyclines, bisphosphonates, levothyroxine); Vitamin C increases absorption of this drug

notes: available as Rx and OTC

counseling: take on an empty stomach, if GI upset occurs, it can be taken with food but avoid cereals, coffee, milk, eggs, and high fiber products because these decrease absorption

Alphagan P (brimonidine)

for glaucoma

warning: CNS depression

effects: dry mouth, dry nose, sedation

notes: refer to eye-drop technique handout

Timoptic (timolol)

for glaucoma

CI: heart block is greater than 1st degree, sinus bradycardia (slower heartbeat)

effect: burning, stinging, bradycardia, fatigue, bronchospasm

notes: refer to eye-drop technique handout

Combigan (brimonidine/timolol)

for glaucoma

warning: CNS depression

effects: dry mouth, dry nose, sedation, burning, stinging, bradycardia, fatigue, bronchospasm

notes: refer to eye-drop technique handout

CI: heart block is greater than 1st degree, sinus bradycardia (slower heartbeat)

notes: refer to eye-drop technique handout

Xalatan (latanoprost)

for glaucoma

warning: darkening of the iris, eyelash length and thickness can increase

effect: blurred vision, stinging, increased iris pigmentation, eyelash growth

counseling: store in the fridge before opening, once opened store at room temp

notes: refer to eye-drop technique handout

Travatan (travoprost),

Lumigan, Latisse (bimatoprost)

for glaucoma

warning: darkening of the iris, eyelash length and thickness can increase

effects: blurred vision, stinging, increased pigmentation of the iris, eyelash growth

notes: refer to the eye-drop technique handout

Cosopt (dorzolamide/timolol)

for glaucoma

warning: sulfonamide allergy

effects: burning, blurred vision, dry eyes, blepharitis (inflammation of the eyelids), stinging, bradycardia, fatigue, bronchospasm

CI: heart block is greater than 1st degree, sinus bradycardia (slower heartbeat)

notes: refer to eye-drop technique handout

Tobradex (tobramycin/dexamethasone)

for bacterial conjunctivitis

effects: eye irritation, vision changes, eyelid swelling

note: refer to eye-drop technique handout

Zymar (gatifloxacin)

for bacterial conjunctivitis

effects: eye irritation, dysguesia (condition that causes distortion or loss of taste)

notes: refer to eye-drop technique handout

Vigamox (moxifloxacin)

for bacterial conjunctivitis

effects: eye irritation, watery eyes, dry eyes

notes: refer to eye-drop technique handout

Ocuflox (ofloxacin)

for bacterial conjunctivitis

effects: eye irritation, blurred vision, burning

notes: refer to eye-drop technique handout

Polytrim (polymyxin B/trimethoprim)

for bacterial conjunctivitis

effects: burning, itching, stinging, eyelid swelling

notes: refer to eye-drop technique handout

Restasis (cyclosporine)

for keratoconjunctivitis sicca (dry eyes)

effects: burning, eye pain/redness

notes: refer to eye-drop technique handout

Pataday, Patanol (olopatadine)

for allergic conjunctivitis

effects: dry eyes, blurred vision, change in taste

notes: refer to eye-drop technique handout, is available as an OTC

Cortisporin Otic (neomycin/polymyxin/hydrocortisone)

for otitis media (inflammation or infection of the middle ear)

effects: ototoxicity (neomycin), ear irritation (stinging/burning), or pain

notes: see ear-drop instructions

Ciprodex (ciprofloxacin/dexamethasone),

Cipro HC (ciprofloxacin/hydrocortisone)

for otitis media

effects: itching, ear irritation/pain

notes: see ear-drop instructions