ABLE 4 - Med Cards 3

Lisdexamphetamine

Brand: Vyvanse

Class: CNS stimulant

Common Dosing by Indication:

ADHD - 30mg PO daily AM up to 70mg/day

binge eating disorder - 30mg PO daily AM up to 50-70mg/day

MOA: prodrug of dextroamphetamine, causes release of dopamine and NE and prevents reuptake

ADE (>10%): insomnia, irritability, loss of appetite, upper abdominal pain, xerostomia

Monitoring Parameters:

efficacy - improvement of symptoms, decreased binge eating

safety - cardiac evaluation at baseline, BP, HR, monitor growth in children

Lithium

Brand: Eskalith, Eskalith-CR, Lithobid

Class: antimanic

Common Dosing by Indication:

bipolar disorder (maintenance) - ER: 900-1800mg/day PO in 2-3 doses OR IR: 300mg PO daily up to 900-1800mg/day in 3-4 doses

bipolar disorder (manic episode) - ER: 1800mg/day PO in 2-3 doses OR IR: 600mg PO TID

MOA: unknown, alters second messenger systems

ADE (>10%): cardiac dysrhythmias, fine tremor, hypothyroidism, leukocytosis, thrombocytosis, xerostomia

Monitoring Parameters:

efficacy - reduction in manic symptoms, prevention of manic episodes, level at 0.8-1.2 for acute mania and 0.6-1.0 for long term control

safety - kidney function, thyroid function, parathyroid function, hydration status, sodium levels, CBC, EKG, monitor for lithium toxicity

Lorazepam

Brand: Ativan

Class: benzodiazepine, short/intermediate acting

Common Dosing by Indication:

anxiety - 0.5-2mg PO Q4-6H up to 10mg/day

MOA: enhances the effect of postsynaptic GABA

ADE (>10%): drowsiness, impaired motor coordination, retrograde amnesia

Monitoring Parameters:

efficacy - reduction in symptoms

safety - drowsiness, suicidality, seizures, BP, HR, LFTs, CBC, LDH

Lurasidone

Brand: Latuda

Class: second generation atypical antipsychotic

Common Dosing by Indication:

bipolar disorder (depressive state) - 20mg PO daily daily up to 120mg/day

schizophrenia - 40mg PO daily up to 160mg/day

MOA: high affinity for dopamine D2 receptor and serotonin (5-HT7 and 5-HT2A) receptors

ADE (>10%): akathisia, extrapyramidal effects, headache, nausea, somnolence

Monitoring Parameters:

efficacy - improvement in mental status

safety - FBG, CBC, lipid panel, renal function, LFTs, TSH, electrolytes, weight, suicidality

Medroxyprogesterone

Brand: Provera, Depo-provera

Class: Progestin

Common Dosing by Indication:

abnormal uterine bleeding - 5-10mg PO daily for 5-10 days starting on day 16 or 21 of cycle

prevention of endometrial hyperplasia - 5-10mg PO daily for 12-14 days starting on day 1 or 16 of cycle

secondary amenorrhea - 5-10mg PO daily for 5-10 days

MOA: changes endometrium from proliferative to secretory

ADE (>10%): weight gain, headache, amenorrhea, breast tenderness, nervousness

Monitoring Parameters:

efficacy - resolution of bleeding

safety - baseline pelvic and breast exams, BMD, depression, baseline pregnancy test

Meloxicam

Brand: Mobic

Class: NSAID

Common Dosing by Indication:

osteoarthritis - 7.5mg PO daily up to 15mg/day (tablets) OR 5mg PO daily up to 10mg/day (capsules)

rheumatoid arthritis - 7.5mg PO daily up to 15mg/day

MOA: nonselective inhibitor of COX1 and COX2, decreases formation of prostaglandin precursors, antipyretic, analgesic, anti-inflammatory, irreversibly alters platelet function and bleeding time

ADE (>10%): GI distress

Monitoring Parameters:

efficacy - decreased pain, improved range of motion

safety - CBC, LFTs, SCr, BP, fecal blood test, rash, black tarry stools, chest pain, jaundice, urination changes

Metaxalone

Brand: Skelaxin

Class: centrally acting skeletal muscle relaxant

Common Dosing by Indication:

musculoskeletal pain/spasm - 800mg PO TID-QID

MOA: unknown, CNS depression, no effect on contractile ability of muscle

ADE (>10%): dizziness

Monitoring Parameters:

efficacy - reduction in pain/spasms

safety - LFTs, renal function, CBC

Metformin

Brand: Glucophage, Riomet

Class: hypoglycemia biguanide

Common Dosing by Indication:

T2DM - IR: 500-1000mg PO BID up to 2250mg/day OR ER: 500-2000mg PO daily up to 2000mg/day

MOA: antihyperglycemic, reduces hepatic glucose production and enhances glucose utilization

ADE (>10%): diarrhea, malabsorption, nausea, asthenia, vomiting, flatulence

Monitoring Parameters:

efficacy - FBG of 80-130mg/dL, A1C<7%

safety - eGFR prior to and annually, CBC, B12, blood glucose, urine glucose, urine ketones, rash, muscle weakness/pain, jaundice, bruising, bleeding

Methadone

Brand: Dolophine

Class: opioid analgesic

Common Dosing by Indication:

chronic pain (opioid naive) - 2.5-5mg PO Q8-12H, titrated up to response

drug detoxification (opioid abuse) - 15-30mg PO Q8H, titrated up to response

opioid withdrawal - 40mg/day in divided doses, then gradual decrease

MOA: binds to opiate receptors in CNS, inhibition of ascending pain pathways, altered perception of pain

ADE (>10%): constipation, GI distress, hypotension, dizziness, sedation

Monitoring Parameters:

efficacy - reduced pain, relief from opioid addiction

safety - BP, respiratory rate, LFTs, renal function, check for HIV and hepatitis, rash, drowsiness, decreased breathing, constipation, chest pain, dizziness, EKG

Methocarbamol

Brand: Robaxin, Tanlor

Class: centrally acting skeletal muscle relaxant

Common Dosing by Indication:

musculoskeletal pain/spasm - 1500mg PO TID-QID for 2-3 days up to 4500mg/day

MOA: unknown, CNS depression, no effect on contractile ability of muscles

ADE (>10%): somnolence

Monitoring Parameters:

efficacy - reduction in pain/spasms

safety - extreme weakness, quadriplegia, dizziness, confusion

Methylphenidate

Brand: Ritalin, Concerta, Daytrana, Metadate CD

Class: CNS stimulant

Common Dosing by Indication:

ADHD - IR: 10-60mg/day PO in 2-3 doses 30-45 minutes prior to meals OR ER: 10-20mg PO daily up to 60-72mg/day OR PATCH - 10mg patch once daily applied for 9 hours up to 30mg/day

narcolepsy - IR: 20-60mg/day PO in 2-3 doses OR ER: 20-60mg/day PO divided for Q8H

MOA: increases CNS activity by inhibiting reuptake of NE and dopamine

ADE (>10%): loss of appetite, headache, insomnia, irritability, nausea

Monitoring Parameters:

efficacy - improved symptoms, improved attention, reduced impulsivity

safety - BP, HR, height, weight, CBC, chest pain, seizures, heart palpitations, change in behavior, monitor growth in children

Mirtazapine

Brand: Remeron

Class: antidepressant with alpha-2 antagonism

Common Dosing by Indication:

depression - 15mg PO daily HS up to 45mg/day

MOA: antagonizes presynaptic alpha-2 adrenergic receptors and postsynaptic serotonin receptors, increases NE and serotonin activity

ADE (>10%): constipation, increased appetite, somnolence, xerostomia, increased cholesterol, weight gain

Monitoring Parameters:

efficacy - improvement in symptoms, reduction in headaches/panic attacks

safety - worsening depression, suicidality, changes in behavior, sodium, CBC, lipid panel, weight, renal function, LFTs

Modafinil

Brand: Provigil

Class: CNS stimulant

Common Dosing by Indication:

narcolepsy - 200mg PO daily AM up to 400mg/day

obstructive sleep apnea (add on) - 200mg PO daily AM up to 400mg/day

shift work-sleep disorder - 200mg PO daily 1 hour prior to shift up to 400mg/day

MOA: unknown

ADE (>10%): headache, insomnia, nausea

Monitoring Parameters:

efficacy - improvement of mental/behavioral symptoms, decrease in fatigue

safety - palpitations, syncope, weight, HR, BP, changes in behavior

Morphine ER

Brand: MS Contin, Avinza, Kadian

Class: opioid analgesic

Common Dosing by Indication:

chronic pain - 10-20mg PO Q12H up to response

acute pain - 10mg PO Q4H prn up to response (max 30mg Q4H)

MOA: pure mu receptor agonist, promotes analgesia and respiratory depression by decreasing brain stem action

ADE (>10%): constipation, nausea, vomiting, hypotension, dizziness, sedation, diaphoresis, headaches, depression, xerostomia

Monitoring Parameters:

efficacy - relief of pain, improved QOL

safety - drowsiness, decreased breathing, constipation, chest pain, dizziness

Nabumetone

Brand: Relafen

Class: NSAID

Common Dosing by Indication:

osteoarthritis - 1000-2000mg PO daily or divided to 2 doses

rheumatoid arthritis - 1000-2000mg PO daily or divided to 2 doses

MOA: prodrug, nonselective inhibitor of COX1 and COX2, reversibly alters platelet function and bleeding time

ADE (>10%): elevated LFTs, dyspepsia, abdominal pain, diarrhea

Monitoring Parameters:

efficacy - decreased pain, improved range of motion

safety - rash, black tarry stool, chest pain, jaundice, urination changes, BP, CBC, LFTs, SCr, fecal blood test, ophthalmic exams

Naproxen

Brand: Naprosyn, Naprelan

Class: NSAID

Common Dosing by Indication:

osteoarthritis, rheumatoid arthritis - IR: 250500mg PO BID OR ER: 750-1000mg PO once daily

acute gout - IR: 500mg PO BID OR ER: 1000mg PO daily

fever - 200-400mg PO Q8-12H prn up to 600mg/day

pain - 500mg PO Q12H prn OR 250mg PO Q6-8H prn

MOA: nonselective inhibition of COX1 and COX2

ADE (>10%): headache, dyspepsia

Monitoring Parameters:

efficacy - decreased pain, defervescence, improved range of motion

safety - rash, allergic reactions, black tarry stool, chest pain, jaundice, urination changes, CBC, LFTs, SCr, fecal blood test, BP, ophthalmic exams

Nortriptyline

Brand: Pamelor

Class: tricyclic antidepressant

Common Dosing by Indication:

depression - 25-50mg PO once daily at bedtime up to 150mg/day

MOA: blocks presynaptic reuptake of NE, results in downregulation of adrenergic receptors, less effect on serotonin

ADE (>10%): constipation

Monitoring Parameters:

efficacy - improvement in depression, reduction in pain, prevention of migraines

safety - worsening depression, suicidality, changes in behavior, EKG, LFTs, BP, HR, weight, sodium, serotonin syndrome

Olanzapine

Brand: Zyprexa

Class: atypical antipsychotic

Common Dosing by Indication:

bipolar disorder (mixed/manic episode) - 5-15mg PO daily up to 20mg/day

schizophrenia - 5-10mg PO daily up to 10-20mg/day

depression (add on) - 2.5-5mg PO daily

MOA: antagonizes serotonin and dopamine reuptake

ADE (>10%): akathisia, asthenia, dizziness, hypercholesterolemia, hyperglycemia, increased appetite, increased prolactin, increased TGs, somnolence, tremor, weight gain, xerostomia, orthostatic hypotension, increased LFTs

Monitoring Parameters:

efficacy - improvement in symptoms

safety - monitor FBG/A1C prior to and during treatment, CBC, lipid profile, weight, BMI, LFTs, electrolytes, involuntary movement

Oxcarbazepine

Brand: Trileptal, Oxtellar XR

Class: anticonvulsant

Common Dosing by Indication:

focal onset partial seizure - 300mg PO BID up to 1200-2400mg/day

MOA: analog of carbamazepine, unknown mechanism, potential inhibition of repetitive neuronal firing

ADE (>10%): somnolence, abdominal pain, headache, diplopia, dizziness

Monitoring Parameters:

efficacy - reduced seizure frequency

safety - sodium levels, worsening depression, suicidality, behavioral changes, thyroid screening, CBC

Oxycodone

Brand: OxyContin, Roxicodone

Class: opioid analgesic

Common Dosing by Indication:

chronic pain - IR: 5-15mg PO Q4-6H prn OR ER: 10mg PO Q12Hprn

MOA: pure mu receptor agonist, promotes analgesia and respiratory depression by decreasing brain stem action

ADE (>10%): constipation, GI distress, nausea, sedation, sweating, pruritus

Monitoring Parameters:

efficacy - relief of pain

safety - drowsiness, rash, decreased breathing, constipation, chest pain, dizziness, BP

Paroxetine

Brand: Paxil, Paxil CR

Class: SSRI

Common Dosing by Indication:

depression - IR: 20mg PO daily up to 50mg/day OR CR: 25mg PO daily up to 62.5mg/day

anxiety - 10-20mg PO daily up to 50mg/day

social anxiety disorder - 10-20mg PO daily up to 60mg/day

OCD, PTSD - 20mg PO daily up to 60mg/day

panic disorder - IR: 10mg PO daily up to 60mg/day OR CR: 12.5mg PO daily up to 75mg/day

premenstrual syndrome - CR: 12.5mg PO daily or started 14 days prior to menses up to 25mg/day

vasomotor symptoms of menopause - 7.5mg PO daily at bedtime

MOA: highly selective SSRI

ADE (>10%): abnormal ejaculation, asthenia, constipation, diarrhea, headache, insomnia, nausea, somnolence, diaphoresis, reduced libido

Monitoring Parameters:

efficacy - improvement in symptoms

safety - worsening depression, suicidality, behavioral changes, abnormal bleeding, kidney/liver function

Phenobarbital

Brand: Luminal, Sezaby

Class: long acting barbiturate

Common Dosing by Indication:

seizures - 50-100mg PO BID-TID

sedation - 30-120mg PO in 2-3 doses up to 400mg/day

MOA: CNS depression, depresses monosynaptic responses, delays synaptic recovery

ADE (>10%): hypotension, appetite, changes, hypoventilation

Monitoring Parameters:

efficacy - control of seizures

safety - SCr, LFTs, CBC, decreased mental acuity, respiratory distress, breakthrough seizures, rash

Phenytoin

Brand: Dilantin, Phenytek

Class: hydantoin anticonvulsant

Common Dosing by Indication:

seizure (tonic-clonic, complex partial, following neurosurgery) - 100mg PO TID up to 200mg/day

MOA: suppresses the spread of seizure activity, inhibits potentiation and propagation of electrical discharge

ADE (>10%): gingival hyperplasia

Monitoring Parameters:

efficacy - reduction in seizure activity

safety - worsening depression, suicidality, changes in behavior, CBC, LFTs, vitamin D

Pioglitazone

Brand: Actos

Class: thiazolidinedione antidiabetic

Common Dosing by Indication:

T2DM - 15-30mg PO daily up to 45mg/day

MOA: antihyperglycemic, agonist of PPAR-gamma, improves insulin sensitivity, decrease in hepatic glucose production

ADE (>10%): edema, weight gain

Monitoring Parameters:

efficacy - FBG of 80-130mg/dL, A1C<7%

safety - weight (to assess edema), Hgb, LFTs, hypoglycemia, nausea, sweating, loss of consciousness, eye exams, HF, bladder cancer

Potassium Iodide

Brand: SSKI, iOSAT, ThyroSafe

Class: antithyroid agent

Common Dosing by Indication:

prevention of thyroid dysfunction due to radiation exposure - 130mg PO daily

expectorant - 300-600mg PO TID-QID

MOA: inhibits release and synthesis of thyroid hormones via direct action on thyroid

ADE (>10%): upset stomach, diarrhea, nausea, vomiting, stomach pain

Monitoring Parameters:

efficacy - thyroid function tests

safety - potassium level, SCr, BUN, goiter, hypothyroidism, hyperthyroidism, thyroid adenoma, allergic reaction