Naplex 9

• Oxybutynin - antimuscarinic
• Also available as a patch and gel
• 5 mg PO BID to TID
• Patch is dosed 3.9 mg daily applied 2x/week
• SE: dry mouth, constipation, dry eyes/blurred vision, urinary retention, drowsiness (especially with oxybutynin and tolterodine)

• Oxybutynin patch
• Changed twice weekly, apply on abdomen, hips or buttocks, causes less dry mouth and constipation than oral form

Oxybutynin topical

• Tolterodine IR 1-2 mg PO BID
• Tolterodine ER 2-4 mg PO daily

• Trospium
• 20 mg BID or 60 mg XR daily, take on empty stomach

• Solifenacin
• 5 to 10 mg PO daily

• Darifenacin
• 7.5 to 15 mg PO daily
• May cause most constipation

• Fesoterodine
• 4-8 mg PO daily

• Mirabegron - activates beta 3 receptors which increases bladder capacity
• SE: HTN, nasopharyngitis, UTI, HA
• 25-50 mg daily
• Reduce dose with reduced CrCl

Nonselective, reduce aqueous humor production

• Timolol opth is QD or BID
• Timolol XE is a gel used QD

Levobunolol opth

Carteolol opth

Metipranolol

Betaxolol

Increase aquoues outflow

• Travoprost - prostaglandin analog
• Travatan X doesn't contain benzalkonium chloride but has different preservative

Bimatoprost - prostaglandin analog

Bimotoprost opth indicated for eyelash hypotrichosis

• Latanoprost - prostaglandin analog
• Keep unopened bottles in fridge

• Tafluprost - comes in foil pouches of 10 single use containers
• Keep refrigerated

Increase aqueous outflow

Carbachol - miotic

Pilocarpine - miotic

Reduce aqueoue humor production

• Acetazolamide
• 250 to 500 mg oral 1-4x daily

• Brinzolamide
• TID

• Dorzolamide
• TID

Dorzolamide/Timolol

Increase aqueoue outflow and decrease production

• Apraclonidine TID
• Adrenergic

• Brimonidine TID
• Adrenergic

• Dipivefrin
• Adrenergic

Brimonidine + Timolol

Floppy iris syndrome causing difficulty in cataract surgery

Corneal deposits, optic neuropathy

Ocular inflammation

Yellow/green vision, blurriness, halos

Optic neuropathy especially with chronic use

Optic neuropathy, especially with chronic use

retinopathy

Optic neuritis

decrease in night vision which may be permanent, dry eyes/irritation

Retinal detachment

greenish tinge around objects, possible permanent vision loss in one or both eyes, also hearing loss

corneal changes, decreased color perception

blurry vision, diplopia

abnormal vision, color vision change, photophobia

Ketotifen

Naphazoline/pheniramine

Levocetirizine

Emedastine

Ketorolac

Lodoxamine - mast cell stabilizer

Nedocromil - mast cell stabilizer

Pemirolast - mast cell stabilizer

Azelastine-mast cell stabilizer and antihistamine

Epinastine - mast cell stabilizer and antihstamine

Olopatadine - antihistamine and mast cell stabilizer

Loteprednol opth

Loteprednol opth

• Cyclosporine Emulsion Eye Drops
• 1 drop to each eye BID
• Open one pack per use

Azithromycin opth - stored in refrigerator, 14 days at room temp

Moxifloxacin opth

Besifloxacin opth

Tobramycin/dexamethasone

Ciprofloxacin opth

Ofloxacin opth

Gentamicin opth

Tobramycin opth

trimethoprim/polymyxin

sulfacetamide

Sulfacetamide

Neomycin, bacitracin, polymyxin

Antipyrine and benzocaine otic

Antipyrine and benzocaine otic

Benzocaine otic

Ciprofloxacin and hydrocortisone

Ciprofloxacin and dexamethasone

Ciprofloxacin Otic

Neomycin and hydrocortisone

Carbamide peroxide

Triethanolamine

• (Carbamazepine, clonazepam, phenobarbital, phenytoin, topiramate, and valproate)
• Valproate has highest risk of fetal harm
• All other AEDs are pregnancy category C

Carbamazepine, oxcarbazepine, primidone, phenobarbital, phenytoin, and topiramate

Topiramate, Zonisamide, levetiracetam

• Clonazepam - enhanced activity of GABA
• Available: tablet, ODT
• 0.5 BID to TID
• Max 20/day
• Somnolence, dizziness/ataxia, drooling, cognitive impairment, depression, mood changes, physiological dependence, tolerance

• Clobazam
• Available: tablet
• less than 30 kg 5 daily, max 10
• more than 30 kg 10 daily max 20

• Carbamazepine - fast NA channel blocker
• Inital 200 mg BID, daily if XR
• Max 1600 mg/day
• Therapeutic range: 4-12 mcg/ml
• Available: capsule, tablet, suspension
• BBW: serious skin reactions, test for HLAB1502, fatal blood cell abnormalities
• SE: N/V, dizzy, drowsy, rare - serious skin reactions, hepatotoxicity, SIADH, vit D and Ca deficiency

Carbamazepine

Carbamazepine

Carbamazepine for bipolar

• Ethosuximide - T type calcium channel blocker
• Initial 250 mg BID
• Max 1500 mg/day
• DOC for absence
• Available: capsule, solution

• Phenobarbital - enhances GABA mediated chloride influx CIV
• Available: tablet, solution, injection
• Initial 1-3 mg/kg/day
• Max 300 mg/day
• Therapeutic range 20-40 mcg/ml in adults, 15 to 30 mcg/ml in children
• SE: Major sedation, cognitive impairment, dizziness/ataxia, dependence, tolerance

Primidone - prodrug of phenobarbital

• Phenytoin - fast sodium channel blocker
• Michalis Mentin kinetics
• If albumin is low, the true phentoin levels will be higher than it appears
• Enteral feedings may decrease phenytoin absorption, must separate
• IV to oral: 1 to 1
• SE: chronic therapy - gingival hyperplasia, lupus-like syndrome, connective tissue disorder, hirsutis,, peripheral neuropathies, vit D and cal deficiency
• Toxic sx: ataxia/slurred speech, nystagmus, blurred vision, diplopia, lethary, HA, drowsiness
• SErious adverse affects: skin reaction, purple glove syndrome
• See menumonic
• Mix injection in NS only, max infusion rate 50 mg/min
• Available: capsules, tablts, suspensions, injections
• Initial 100 mg TID
• Max 600 mg/day

• Pro-drug of phenytoin IV or IM
• I mg PE = 1 mg PHT
• Max 150 mg PE/min
• Can mix in NS or D5W

• Divaloproex - T type calcium channel blocker an fast sodium channel blocker
• Sodium valproate and valproic acid in a 1:1 ratio
• Depakote - delayed release tablet
• Depakote ER - ext release tablet
• Depakote Sprinkle
• Can increase lamotrigine levels
• See valproic acid for SE

Valproic acid - capsules, solution

• Valproic Acid
• Delayed release capsules

• Valproic acid IV
• Initial 125 to 250 mg BID
• Max 60 mg/k/day
• Range 50 to 100 mcg/ml
• If albumin is low, true valproate level may be higher
• BBW: hepatic failure, teratogen neural tube defects, pancreatitis
• SE: GI, ab painm dizziness, asthenia, alopecia (treat with selenium and zinc), somnolence, tremor, weight gain, polysystic ovary syndrome, thrombocytopenia, vit D an cal deficiency

• Lamotrigine - inhibits release of glutamate and aspartate
• Dosing: slow taper, being with 25 mg/day x 2 weeks, then 50 mg/day x 2 weeks, increase by 50 mg every 1 to 2 weeks, may have to titrate deifferently based on co-meds (carbamazepine, phenytoin, valproate, phenobarbital, primidone)
• BBW: serious skin reactions
• SE: N, sleepy, dizzy, diplobia, blurred vision, ataxia, rash, increased risk of aseptic meningitis
• Available: tablet

• Levetiracetam
• Max 3000 daily

• Oxcarbazepine
• Hyponatremia, more common with oxcarbazepine
• Max 2400 mg daily
• Carbazepine: oxcarb dose conversion: 1.2-1.5x carbamazepine dose

• Pregabalin 
• CV
• Initial 75 mg BID
• Max 450 mg/day
• Decrease dose if CrCl less than 60

• Gabapentin
• Max 3600 mg/day
• Decrease dose if interval less than 60

• Topiramate
• Decrease dose if CrCl less tha 70
• Rare side effects: oligohydrosis, hyperthemia, nephrolithiasis (kidney stones)

• Zonisamide
• Initiall 100 daily, max 400 daily
• Don't use if CrCl less than 50
• Rare SE: oligohydrosis, nephrolithiasis, serious skin reactions
• Don't use if allergic to sulfonamides

• Ezogabine
• Initial 100 mg TID
• Max 1200 daily

• Felbamate
• Initial 1200 mg daily divded TID to QID and reduce concomitant AED dose by one-third
• BBW: hepatic failure and aplastic anemia

• Lacosamide CV
• Initial 50 mg BID
• max 400 daily
• Decrease if CrCl less than 30
• Prolongs PR interval, get ECG before therapy starts

• Rufinamide
• Initial 200 to 400 mg BID
• Max 3200 mg daily
• QT shortening

• Tiagabine
• Initial 4 mg daily
• Max 56 mg daily

• Vigabatrin
• Intial 500 mg BID
• Max 3000 mg daily
• ONly available through SHARE progrma
• BBW: can cause permanent vision loss

• Perampanel
• Initial 2 mg QHS
• Max 12 mg/day

• Have antiviral and antiproliferative effects
• Avonex, Rebif, and Betaseron or Extavia
• SE: flu like reactions, injection site reactions, depression/suicide

• Interferon beta-1a
• 30 mcg weekly
• Powder for reconstitution, pre-filled syringes and pens - refrigerate

• Interferon beta-1a
• SC: 22 mcg or 44 mcg three times weekly
• Pre-filled syringes--refrigerate

• Interferon beta 1b
• SC: 0.25 mg every other day
• Power (for reconstitution) store at room temperature

• Interferon beta 1b
• SC: 0.25 mg every other day
• Power (for reconstitution) store at room temperature

• Glatiramer aceate - immune modulator
• 20 mg SC daily, single use syringe, referigerate
• INjection site reactions vasodilation, rash dyspnea, etc.

• Natalizumab - recombinant humanized monoclonal antibody
• 300 mg IV given over 1 hour every 4 weeks
• Can cause progressive mutifocal leukoencephalopathy

• Fingolimod - oral immune modulator
• 0.5 mg capsule daily with or without food
• SE: decrease in heart rate, mascular edema, increase in infections, decrease in pulmonary function tests, increase in LFTs

• Teriflunomide - prymidine synthesis inhibitor
• Active metabolite of lefluonmide
• 7 mg or 14 mg daily
• BBW: severe liver tox and teratogenicity

• Dalfampridine - K channel blocker, may increase nerve signal conduction
• 10 mg BID Ext Rel tablets