Top Seller Drugs - RP

  1. gabapentin
    • Neurontin
    • I: antiepiletic
    • D: 300 mg TID PO max 3,600 mg/day
    • W: DRESS, suicidal, CNS, seizures if d/c radidly
    • S: somnolence, ataxia
    • N: renally dosed, moa possibly calcium channels
  2. guanfacine ER
    • Intuniv (Tenex = HTN)
    • I: central alpha 2A adrenergic receptor agonist - ADHD
    • D: 1 mg max 4 mg/day combo, 7 mg/day mono, PO
    • W: dose-dependent cardio, sedation, skin rash, don't d/c abruptly
    • S: somnolence, dizziness, h/a, constipation
  3. progesterone
    • Prometrium 
    • I: reduce endometrial hyperplasia from estrogen with intact uterus, PO
  4. levofloxacin ☃
    • Levaquin
    • I: FQ antibiotic - inhibit DNA gyrase
    • D: 250-750 mg IV/PO daily, renal adj
    • W: B = tendon inflammation/rupture (risk -systemic steroid, organ transplant, >60 yo), peripheral neuropathy, CNS, avoid in myasthenia gravis
    • W: QT prolongation, photosens
    • S: SJS, hemolytic anemia, n/d, ARF
    • N: binds to calcium and iron
  5. diazepam
    • Valium (C-IV)
    • I: benzo, for alcohol withdrawal syndrome, anxiety/seizure
    • D: 2-10 mg BID-QID PO
    • W: B = sedation, respiratory depression, CI severe liver disease, myasthenia gravis, not <6 months of age
    • W: tolerance and dependence = taper, CNS, abuse, preggo defects
    • S: somnolence, dizziness
    • N: fast onset, long half-life, lipophilic, generally avoid in elderly
    • A: flumazenil
  6. aripiprazole
    • Abilify
    • I: SGAs - schizo, bipolar, block D2 receptors
    • D: 10-30 mg PO QAM, acute IM or monthly
    • W: -
    • S: akathisia, anxiety, insomnia, some QT
  7. estradiol (≤35 mcg)/norethindrone Fe
    • Loestrin 24 FE
    • I: contraception
    • D: 24 active/4 inactive pill pack
    • W: -
    • S: n, breast tenderness, wt gain, elevate BP, changes in mood
  8. fluticasone nasal
    • Flonase (vs Flovent)
    • I: intranasal corticosteroid, use in allergic rhinitis
    • D: 1-2 sprays per nostril daily
    • W: adrenal suppression, delayed wound healing
    • S: h/a, dry nose, epistaxis, unpleasant taste
    • N: up to 1 week for full relief, budesonide is preferred in preggo, several months need nasal exams, d/c if in contact with chicken pox, measles, or TB. Shake bottle and discard after total uses then throw away even if not empty
  9. alprazolam
    • Xanax (C-IV)
    • I: benzo - enhance GABA, acute anxiety
    • D: 0.25-0.5 mg PO TID
    • W: B = sedation, respiratory depression
    • W: tolerance and dependence - taper, CNS, preggo defects
    • S: somnolence, dizziness, ataxia
    • N: fast onset, abused, avoid in elderly
    • A: flumazenil
  10. finasteride
    • Proscar (not Propecia 1 mg - baldness)
    • I: 5 alpha reductase inhibitor - BPH with enlarged prostate
    • D: 5 mg daily PO
    • W: increase risk of high-grade cancer
    • S: impotence, decreased libido, breast enlargement
    • N: no PREGGO touchy, months to shrink prostate
  11. benazepril
    • Lotensin
    • I: ACE i - HTN, HF, CKD + DM
    • D: 5-40 mg PO daily
    • W: B = avoid in preggo, 2/3rd defects
    • W: angioedema, hyperK, hypotension, renal impairment, avoid in bilateral renal artery stenosis
    • S: cough, dizziness, h/a
    • N: daily can be used BID if needed
  12. montelukast
    • Singulair
    • I: leukotriene receptor antagonist (LTRA) - asthma
    • D: 10 mg daily QPM PO, approved for 1+ yo - 5 mg chewable tablet QHS for both allergy and asthma
    • W: neuropsych
    • S: h/a, inc LFTs (no heptic impairment)
    • N: invented in Montreal
  13. rosuvastatin
    • Crestor
    • I: statin - HLD
    • D: 5-40 mg daily PO anytime of the day, CrCl <30 ml/min - use lower starting doses
    • W: skeletal muscle effects, CI liver dx, no Preggo
    • S: myalgia, arthralgias, myopathy
    • N: 2x higher exposure in Asians - consider lower start
  14. celecoxib ☃
    • Celebrex
    • I: pain, COX-2 inhibitor
    • D: gout -800 mg, then 400 mg, then 400 mg BID, OA: 100 mg BID, RA: 100-200 mg BID
    • W: CI sulfonamide allergy, B = CV thrombotic events risk
    • N: avoid in preggo 30+ weeks gestation, kidney risk and edema risk
  15. chlorthalidone
    • Thalitone
    • I: thiazide-like diuretic - HTN
    • D: 12.5-25 mg PO daily
    • W: sulfa allergy, electrolyte changes, exacerbate other conditions
    • S: hypokalemia, hypomag, hypoNA, hyperCA, hyperUA, elevated lipids
  16. clobetasol propionate
    • Clobex, Temovate
    • I: very high potency topical steroid for psoriasis, inflammatory skin conditions
    • D: shampoo, spray, cream, lotion, ointment, foam
  17. meloxicam
    • Mobic
    • I: NSAID - pain, more COX-2, inhibits platelet activity
    • D: 7.5-15 mg once daily PO
    • W: CV thrombosis, CABG no
    • S: GI bleed risk - take with food, exacerbates CHF/edema
  18. dicyclomine
    • Bentyl
    • I: antispasmodic - for diarrhea IBS
    • D: 20 mg QID PO, max 80/day >2 weeks, 30-60 mins before meals
    • W: anticholinergic, CI GI obstruction
    • S: dizziness, dry mouth, nausea, blurred vision
  19. dextroamphetamine/amphetamine
    • Adderall XR (C-II)
    • I: stimulant for ADHD, prevents reuptake of catecholamine in CNS (dopamine, NE)
    • D: 20 mg QAM PO XR
    • W: B = misuse cause sudden death and serious CV events
    • S: wt loss, insomnia, anxiety, tachycardia, inc BP
    • N: avoid in acidic food, juice, vit C - decrease levels, swallow in applesauce
  20. nebivolol
    • Bystolic
    • I: HTN - selective blocker B1 and nitric oxide vasodilation
    • D: 5-10 mg daily PO, max 40 mg daily
    • W: CI severe liver >B
    • S: n/d
  21. colchicine
    • Colcrys
    • I: gout attack - prevent micotubule polymerization
    • D: Prophy: 0.6 QD-BID PO, Tx: 1.2 mg then 0.6 mg in 1 hour, max 2.4 mg/day, repeat in 3+ days, renal
    • W: GI
    • S: diarrhea/n, myelosuppression, myopathy, neuropathy (dose-related)
  22. citalopram ☃
    • Celexa
    • I: SSRI - depression
    • D: 20-40 mg/day; max 40 mg/day PO
    • W: B = suicidal in the young
    • W: QT, >20 mg/day in 60+, liver, CYP2C19 poor/inhibitors
    • S: sexual dysfunction, insomnia, dry mouth, SIADH, hypoNA (elderly risk)
    • N: bleeding risk with warfarin
  23. varenicline ☃
    • Chantix
    • I: smoking cessation - partial neuronal alpha-4 beta-2 nicotinic receptor agonist
    • D: 1 week before quit, 0.5 mg daily (1-3 day), 0.5 mg BID (4-7 day), 1 mg BID (8 day - quit day) PO
    • W: neuropsych - mood
    • S: nausea dose dependent, insomnia, vivid dreams, n/a
  24. metformin
    • Glucophage
    • I: diabetes type 2 first line, prevents gluconeogenesis
    • D: 500 mg BID PO, MAX 2000-2550 mg/day
    • W: B = lactic acidosis, CI eGFR <30, no initiate 30-45 eGFR
    • S: n/v/d, GI, vit B12 deficiency
  25. phenazopyridine
    • Pyridium (AZO - OTC)
    • I: urinary analgesic
    • D: 200 mg PO TID x 2 days max - food + 8 oz water for GI PO
    • W: CI - not in renal/liver impairment
    • S: h/a, dizziness, stomach cramps, body secretion discoloration (red-orange - contact lenses and clothes)
    • N: hemolytic anemia in G6PD deficiency
  26. famotidine
    • Pepcid
    • I: heartburn/GERD, H2RA
    • D: OTC 10-20 mg 1-2x PRN, Rx 20 mg BID PO
    • W: confusion, B12 deficiency +2 years, QT prolongation with renal dysfxn dec dose <50 ml/min
    • S: h/a
    • N: onset w/i 60 mins (faster than PPIs), 4-10 hr duration, ok in preggo, tachyphylaxis
  27. potassium chloride
    • Klor-Con
    • I: supplement K+
    • D: prevent hypo - 20-40 mEq/day in 1-2 divided doses, tx: 40-100 mEq/day in 2-5 divided doses PO
    • W: mild-mod renal, K+ disorders and meds
    • S: n/v/d, GI, hyperkalemia
    • N: with meals + full glass of water to minimize GI, do not crush/chew, cut (UNLESS Klor-Con M), suck, can open Micro-K
  28. sertraline ☃
    • Zoloft
    • I: antidepressant, SSRI, inhibits reuptake of serotonin which leads to higher concentrations in the synapse
    • D: 50-200 mg/day, PMDD 50-100 mg on menstrual cycle or 50-150 mg 2 weeks before PO
    • W: B = suicidal in young
    • W: CI: MAOI, linezolid
    • S: sexual dysfunction, insomnia, dry mouth, SIADH, hypoNA (elderly risk), GI, SS (up)
    • N: takes weeks to work
  29. ropinirole
    • Requip
    • I: RLS (IR form), Parkinson, dopamine agonist
    • D: IR - 0.25 mg PO TID PO, titrate weekly to max 1.5 mg TID, ER - 0.375 mg PO daily, titrate weekly to max 4.5 mg daily
    • S: somnolence, sudden sleep attacks, XERO (dry), edema, obsessive behaviors
    • N: caution with CYP1A2 inhibitors
  30. lithium
    • Lithobid
    • I: bipolar - influence reuptake of serotonin and NE, inhibit D2 receptor supersensitivity, neuroprotective inc glutamate clearance and increase brain-derived neurotropic factor (BDNF)
    • D: 150-900 mg/day TID, max 900-1800 mg/day TID-QID, ER BID (LithoBID) PO
    • W: B = monitor to avoid toxicity
    • S: GI, cognitive, cogwheel rigidity, fine hand tremor, wt gain, polyuria/polydipsia, hypothyroidism, hyperCA, cardiac, blue-gray skin pigmentation
    • N: toxicity >1.5-2.5 mEq/L, 100% renal
  31. nystatin
    • Bio-Statin (oral suspension)
    • I: antifungal
    • D: oral candidiasis suspension - 400,000-600,000 units QID, swish and swallow, other: intestinal infections - oral 500,000-1,000,000 units Q8H, topical (Nyamyc, Nyata, Nystop)
    • S: N/V/D, stomach pain
  32. sitagliptin ☃
    • Januvia
    • I: diabetes, DPP4i
    • D: 100 mg daily PO (50 mg crcl 30-49, 25 <30 ml/min)
    • W: acute pancreatitis
    • S: URTIs, UTIs, rash, GI
  33. sumatriptan
    • Imitrex, Onzetra Xsail (intranasal), Zembrace SymTouch (subq)
    • I: migraines - serotonin agonist 5HT1D receptors - vasoconstriction
    • D: PO 25, 50, 100 mg, can repeat x1 after 2 hrs
    • W: CI in cerebrovascular disease, uncontrolled HTN, IHD
    • S: pressure in chest - dissipate after administration, paresthesia, confusion, CV concerns
    • N: only 1 dose in nasal spray - don't prime, shorter half-life fast onset, subq injections
  34. amlodipine
    • Norvasc
    • I: HTN, DHP CCB
    • D: 2.5-10 mg daily PO
    • W: hypotension esp with severe aortic stenosis
    • S: peripheral edema, bradycardia, gingival hyperplasia
    • N: safest in HFrEF
  35. lovastatin
    • Mevacor
    • I: statin, HLD
    • D: 20-80 mg with evening meal PO, lower dose crcl <30 ml/min
    • W: CI: active liver disease, no preggo
    • S: myalgias, myopathy, arthralgias
  36. terbinafine
    • Lamisil
    • I: antifungal, nails
    • D: apply 1-2 inches beyond the rash, at least 2-4 weeks
  37. DDI: Kadian + Restoril
    • morphine (narcotic - C-II) + temazepam (benzo - enhances GABA for short term insomnia - C-IV)
    • morphine: ER - 15, 30, 60, 100, 200 mg Q8-12H, daily or BID, can be opened and sprinkled on soft foods, S: n/a, dizziness, pruritis
    • temazepam: 7.5-30 mg PO QHS (better for 65+, inactive metabolites) - shorter half-life than others - used for sleep, causes sedation/dizziness, generally avoid in elderly
  38. cyclobenzaprine
    • Fexmid, Amrix ER, Flexeril
    • I: pain, skeletal muscle relaxant
    • D: ER 15-30 mg daily PO, IR 5-10 mg TID PRN
    • S: dry mouth, serotonergic, caution in CV, sedating, not good in elderly
  39. trimethoprim/polymyxin B
    • Polytrim
    • I: antibacterial (cause no antivirals for eye! - thicker and yellowish) topical antibiotic eye drops/ointment
  40. prednisone
    • Deltasone, Sterapred
    • I: steroid PO - multiple ways to suppress immune system - inhibition of cytokines, chemokines, arachidonic acid, etc.
    • D: 5-60 mg daily, taper if >2 weeks
    • W: CI systemic fungal infection, live vaccines
    • S: inc BG, BP, inc appetite/wt gain, fluid retention, mood, adrenal suppression/immunosupression, osteoporosis
  41. lisinopril/HCTZ
    • Zestoretic
    • I: HTN
  42. ethinyl estradiol/norgestimate
    • TriNessa
    • I: birth control, triphasic pills
  43. morphine sulfate ER
    • MS Contin, Kadian, Arymo ER (C-II)
    • I: pain, narcotic/opioid, activate mu-opioid receptor
    • D: ER 15, 30, 60, 100, 200 mg Q8-12H
    • W: B = appropriate staff and equipment for intrathecal/epidural admin
    • S: n/a, dizziness, pruritis, diaphoresis, respiratory depression, constipation
    • N: no crush/chew, addiction/dependence risk
  44. insulin glargine
    • Lantus, Basaglar, Toujeo
    • I: diabetes, long-acting insulin, FBG
    • D: QD-BID, acidic pH may sting
    • S: wt gain, hypoglycemia
  45. lidocaine
    • Lidoderm
    • I: topical agents for localized pain, approved for shingles, inhibits sodium influxes = prevents cell action potential
    • D: apply to affected area 1-3 (max 3) patches/day for up to 12 hours/day
    • S: minor topical burning
    • N: can CUT into smaller pieces, discard fold in half, do NOT cover with heating pads/electric blankets
  46. terazosin
    • Hytrin
    • I: nonselective alpha-1 blocker BPH
    • D: 1 mg QHS, titrate slowly, 10 mg effective, max 20 mg QHS
    • W: orthostatic hypotension/syncope (given at nighttime to minimize initial first dose effect, floppy iris syndrome, priapism >4 hrs erection, angina
    • S: dizziness, fatigue, h/a
    • N: quick onset, 4-6 weeks to assess, does not affect PSA levels, alfuzosin = QT, off-label for bladder outlet obstruction in women
  47. hydrochlorothiazide
    • Microzide
    • I: HTN
    • D: 12.5-25 mg daily (max 100 mg, doses >50 mg/day limited clinical benefit, more SE)
    • W: CI: hypersensitivity to sulfonamide-derived drugs, electrolytes
    • S: hypoK, hypoMG, hypoNA, hyperCA, hyperUA, hyperBG
  48. amiodarone☃
    • Cordarone, Pacerone
    • I: antiarrhythmic class III (K+ and Na channel blocker), afib, vfib
    • D: 400-600 mg/day for 2-4 weeks, then 100-200 mg daily
    • W: B = proarrhythmic, pulmonary tox, hepatotox, CI marked brady, 2/3rd degree heart block unless ICD
    • S: hypotension, bradycardia, corneal microdepositis, dizziness, ataxia, N/V, constipation, tremor, DILE
    • N: monitor LFT, TSH, pulmonary
  49. phenytoin
    • Dilantin
    • I: epilepsy/seizures AED
    • D: LD 15-20 mg/kg, up to 300-600 mg/day, 1 mg PE = 1 mg phenytoin (fosphenytoin 1.5 mg = 1 mg PE), IV:PO = 1:1
    • W: B = IV NTE 50 mg/min, fosphenytoin IV NTE 150 mg PE/minute or 2 mg PE/kg/min = hypotension and cardiac arrhythmias
    • S: dose-related nystagmus, ataxia, diplopia/blurred vision, slurred speech, chronic: gingival hyperplasia, hair growth, hepatotoxicity
    • N: monitor LFTs, trough 10-20 mcg/mL total, 1-2.5 mcg/mL free phenytoin, highly protein bound
  50. ciprofloxacin + dexamethasone ear drops
    Ciprodex
  51. gemfibrozil
    • Lopid
    • I: PPAR alpha activators, TG
    • D: 600 mg BID, 30 mins before breakfast and dinner
    • W: myopathy, cholethiasis
    • S: inc LFTs dose-related, abdominal pain, dyspepsia
  52. fentanyl
    • Duragesic, Fentora, Subsys, Actiq, Abstral, Lazanda (C-II)
    • I: opioid of chronic pain, activates mu-opioid receptors
    • D: patch Q72H
    • W: B = med errors in converting between different dosage forms, avoid strong or mod CYP3A4 inhibitors = increased effects, potentially fatal respiratory depression
    • S: bradycardia, dry mouth, miosis
    • N: throw in toilet, not for acute very slow onset/offset
  53. diphenoxylate/atropine
    • Lomotil
    • I: antidiarrheals
    • D: 5 mg up to QID, max 20 mg/day PO
    • W: CI: diarrhea caused by enterotoxin-producing bacteria or pseudomembranous colitis, obstructive jaundice
    • S: sedation, constipation, tachycardia, depression
    • N: not for <2 yo
  54. lansoprazole☃
    • Prevacid, OTC
    • I: GERD, PPI
    • D: 15-30 mg daily PO
    • W: c diff diarrhea, osteo, hypoMG, lupus, vitB12 deficiency > 2 yrs, do not crush/chew - mix in applesauce ok!
    • S: h/a, nausea, diarrhea
    • N: onset 1-3 hours, >24 duration
  55. omeprazole ☃
    • Prilosec, OTC
    • I: GERD, PPI
    • D: 20 mg daily PO
    • W: c diff diarrhea, osteo, hypoMG, lupus, vitB12 deficiency > 2 yrs, do not crush/chew - mix in applesauce ok!
    • S: h/a, nausea, diarrhea
    • N: onset 1-3 hours, duration >24 hours
  56. clarithromycin
    • Biaxin
    • I: antibiotic macrolide - blocks 50S subunit and protein synthesis, better g+
    • D: 250-500 mg PO Q12H or 1 gm (Biaxin XL) daily
    • W: QT prolongation, CI: cholestatic jaundice/hepatic dysfunction, concomitant use with pimozide, ergotamine, dihydroergotamine, lovastatin/simvastin
    • S: GI, SJS
  57. nifedipine ER
    • Adalat CC (IR = Procardia - don't use for chronic hypertension)
    • I: CCB - HTN
    • D: 30-90 mg daily PO 
    • W: hypotension
    • S: peripheral edema, gingival hyperplasia, tachycardia, flushing
  58. levocetirizine
    • Xyzal
    • I: second gen antihistamines for allergic rhinitis
    • D: 5 mg PO QHS PO
    • W: CI: ESRD <10, hemodialysis
    • S: somnolence
    • N: discontinue 4 days prior to allergy skin testing
  59. oxcarbazepine
    • Trileptal
    • I: AED
    • D: 300 mg BID max 2400 mg/day, crcl <30: 300 mg QD PO
    • W: SJS, screen Asians HLA-B*1502, hypoNA, cross-sensitivity with carbamazepine 25-30%
    • S: somnolence, n/a, ataxia
    • N: not an autoinducer, need non-hormonal contraceptive, active metabolite MHD can increase phenytoin, fosphenytoin, phenobarbital
  60. donepazil
    • Aricept
    • I: Alzheimer's, acetylcholinesterase inhibitors
    • D: 5-10 mg QHS PO (to decrease nausea) titrate over several weeks
    • S: n/v/d, wt loss
    • N: not reverse dementia
  61. methocarbamol
    • Robaxin
    • I: antispasmodic/muscle relaxants, sedation
    • D: 1,500-2,000 mg QID PRN PO
    • S: hypotension
    • N: sparingly, no ETOH
  62. fluticasone/salmeterol
    • Advair Diskus
    • I: asthma inhaler controller - steroid/LABA
    • D: 1 inhalation BID
    • N: steroid = rinse mouth (thrush), LABA = inc HR, tremor
  63. escitalopram ☃
    • Lexapro
    • I: SSRI - depression
    • D: 10 mg/day; max 20 mg/day PO
    • W: B = suicidal in the young
    • W: QT, >20 mg/day in 60+, liver, CYP2C19 poor/inhibitors
    • S: sexual dysfunction, insomnia, dry mouth, SIADH, hypoNA (elderly risk)
    • N: bleeding risk with warfarin, SS, GI
  64. eszopiclone
    • Lunesta (C-IV)
    • I: nonbenzo, increase GABA, sleep disorders
    • D: 1-3 mg PO QHS
    • W: CNS depression, abuse potential
    • S: somnolence, dizziness, ataxia, parasomnias
    • N: do not take with fatty food, a heavy meal or alcohol, generally avoid in elderly
  65. mupirocin nasal ointment
    • Bactroban Nasal
    • I: topical decolonization of MRSA in nares
    • D: 1/2 tube in each nostril BID x 5 days
    • S: h/a, burning, localized irritation, rhinitis, pharyngitis
  66. carisoprodol
    • Soma (C-IV)
    • I: antispasmodic, muscle relaxant, sedation
    • D: 250-350 mg QID PRN PO
    • N: active metabolite meprobamate (toxic), watch for CYP2C19 rapid metabolizers
  67. allopurinol
    • Zyloprim
    • I: xanthine oxidase inhibitors for gout
    • D: 100 mg daily, slowly titrate >300 mg BID, max 200 mg/day 10-20 mL/min, <10 ml/min = 100 mg/day max PO
    • W: SJS, HLA-B*5801
    • S: rash, acute gout attacks, nausea, inc LFTs
    • N: higher dose for tumor lysis syndrome (chemo), use with colchicine or NSAID for first 3-6 months d/t high rate of gout attacks
  68. medroxyPROGESTERone
    • Provera (SC/IM Depo-Provera)
    • I: systemic hormone therapies + estrogen to prevent endrometrial hyperplasia
    • D: 2.5, 5, 10 mg PO
    • N: no need in no uterus
  69. fenofibrate
    • TriCor, Triglide, Trilipix
    • I: fibrates, TG
    • D: 45-135 mg daily PO
    • W: myopathy, CI: severe liver dx, CrCl <30 mL/min
    • S: inc LFTs (dose-related), inc CPK, dyspepsia
  70. albuterol
    • Ventolin HFA, ProAir HFA, RespiClick
    • I: SABA - asthma, COPD
    • D: 1-2 inhalations Q4-6H PRN
    • W: caution in CVD, glaucoma, hyperthyroid, seizures, diabetes
    • S: nervousness, tremor, tachycardia, palpitations, cough, hyperBG, hypoK
  71. bupropion ☃
    • Wellbutrin, Zyban
    • I: D/NE reuptake inhibitor = depression vs smoking cessation
    • D: 300-450 mg daily, IR TID, SR 200 mg BID, XL daily max 450 PO mg/day d/t seizure risk. Zyban - 1 week before quit date - 150 mg QAM for 3 days, then 150 mg BID, max 300 mg/day up to 6 months
    • W: B = suicidal in young, CI seizure disorder
    • W: neuropsych, mood
    • S: dry mouth, insomnia, tremors/seizure dose-related, no 5HT = less sexual dysfunction
  72. butalbital, acetaminophen, caffeine
    • Fioricet
    • I: barbiturate + others, PO
    • N: C-III in California
  73. duloxetine☃
    • Cymbalta
    • I: SNRI, antidepressant, neuropathy, fibromyalgia, GAD, chronic musculoskeletal pain
    • D: 40-60 mg/day or 20-30 mg BID, max 120 mg/day, doses > 60 mg/day not more effective PO
    • W: B = suicidal in the young, CI MAOI, linezolid, methylene blue
    • S: NE = inc HR, inc BP, dilated pupils (possibly leading to an episode of narrow angle glaucoma), dry mouth, excessive sweating, and constipation
    • N: no use <30 ml/min
  74. spironolactone
    • Aldactone
    • I: K+ sparing diuretic
    • D: 25-100 mg daily in 1-2 divided doses PO
    • W: B = tumorigenic in chronic toxicity studies with rats; avoid unnecessary use
    • S: gynecomastia, breast tenderness
  75. oseltamivir
    • Tamiflu
    • I: neuraminidase inhibitor, flu
    • D: tx = 75 mg BID x 5 days, prophy = 75 mg QD x 10 days PO, renal
    • W: neuropsych, SJS, anaphylaxis
    • S: h/a, n/v/d, abdominal pain
  76. lorazepam
    • Ativan (C-IV)
    • I: benzo, anxiety, sleep, ok for 65+ yo
    • D: 0.5-2 mg PO QHS sleep, 2-3 mg PO daily in divided doses for anxiety
    • W: B = sedation, respiratory depression, CI: acute narrow glaucoma, sleep apnea
    • W: dependence and tolerance with chronic use - taper!, preggo defects
    • S: somnolence, dizziness, weakness, ataxia, lightheadedness
    • N: commonly used for alcohol withdrawal syndrome, flumazenil
  77. valacyclovir
    • Valtrex 
    • I: antiviral for herpes simplex virus and varicella zoster virus, inhibits DNA polymerase
    • D: herpes labialis - 2 gm PO BID x1 day, genital herpes - 1 gm PO BID x 7-10 days, recurrent 500 mg PO BID x3 days or 1 gm PO daily x 5 days, chronic 500-1,000 mg PO daily
    • W: thrombocytopenia purpura/hemolytic uremic syndrome (TTP/HUS), caution in renal impairment, the elderly
    • S: GI, malaise, h/a, n/v/d, rash, inc LFTs, neutopenia
    • N: prodrug to acyclovir - has higher availability than acyclovir which enables a longer interval between doses, more convenient
  78. dexlansoprazole ☃
    • Dexilant
    • I: PPI for GERD, heartburn
    • D: 30-60 mg daily PO
    • W: c diff, osteo, hypoMG
    • S: h/a, nausea, diarrhea
    • N: onset 1-3 hours, duration > 24 hours - open capsule in applesauce, ok with Plavix
  79. promethazine
    • Phenergan, Promethegan, Phenadoz
    • I: n/v, allergies - dopamine receptor antagonist - block chemoreceptor trigger zone
    • D: 12.5-25 mg PO/IV/IM/PR Q4-6 PRN
    • W: B = no <2 yo = respiratory depression, IM preferred
    • W: avoid in Parkinson dx
    • S: sedation, lethargy, hypotension, acute EPS, dec seizure threshold, strong anticholinergic
  80. oxycodone controlled release
    • Oxycontin (C-II)
    • I: opioid for pain, activate mu opioid receptors
    • D: CR 10-80 mg Q12H (60, 80 mg only for opioid-tolerant) PO
    • W: B = overdose with initiation of CYP3A4 inhibitors or stopping 3A4 inducers
    • S: constipation, respiratory depression
    • N: active metabolite, avoid if renally impaired, ok with high-fat meals unlike the others
  81. atenolol/chlorthalidone
    • Tenoretic
    • I: bb, thiazide-type diuretic - HTN
  82. triamcinolone
    • Kenalog, Nasacort
    • I: topical steroid, stimulates glucocorticoid receptors to reduce inflammation, nasal spray (allergic rhinitis)
    • W: CI: live vaccines, serious systemic infections
    • W: adrenal suppression, taper slowly >14 days, immunosuppression, psych, worsen other conditions
    • S: inc appetite/wt gain, fluid retention, emotional instability, Cushing's syndrome long-term, epistaxis
  83. lisinopril
    • Zestril, Prinivil
    • I: ACEI- HTN, kidney protection + DM, HF
    • D: 5-40 mg daily PO
    • W: B = no preggo, 2/3rd trim defects, CI angioedema hx, washout with Entresto 36 hours
    • S: cough, dizziness, h/a, rash, hyperkalemia
    • N: can be used BID if needed
  84. hydrocortisone rectal
    • Cortifoam, Cortenema
    • I: IBS induction/maintenance
    • D: Cortifoam - 1 applicatorful (90 mg) 1-2 times daily for 2-3 weeks, then every other day thereafter; taper after long-term therapy
    • W: CI: obstruction, abscess, perforation, peritonitis, fresh intestinal anastomoses, extensive fistulas, sinus tracts
  85. cetirizine
    • Zyrtec
    • I: second gen antihistamine for allergic rhinitis
    • D: 5-10 mg PO daily
    • W: CNS depression, sedation
    • S: somnolence (more, but less than first gen: Benadryl)
    • N = ok in preggo, d/c at least 4 days prior to allergy skin test
  86. baclofen
    • Lioresal
    • I: antispasmodic, muscle relaxants with analgesic effects
    • D: 5-20 mg TID-QID PRN PO, injection via intrathecal pump for severe spasticity
    • W: B = abrupt withdrawal danger
    • S: sedation, dizziness, confusion
  87. methylprednisolone
    • Medrol
    • I: systemic glucocorticoid
    • D: varies by condition
    • W: CI: live vaccines, serious systemic infections
    • W: adrenal suppression, taper slowly >14 days, immunosuppression, psych, worsen other conditions
    • S: inc appetite/wt gain, fluid retention, emotional instability, Cushing's syndrome long-term
  88. nitroglycerin SL
    • Nitrostat
    • I: chest pain, relaxes vascular smoth muscle and dilates arteries and veins
    • D: 0.3, 0.4, 0.6 mg PRN dissolve in mouth
    • W: hypotension, h/a, tachyphylaxis, may aggrevate angina caused by hypertrophic cardiomyopathy
    • S: dizziness, lightheadedness, flushing, syncope
    • N: PRN, keep SL in original amber glass bottle to block light, keep out moisture, law: open fast
  89. amlodipine/benazepril
    • Lotrel
    • I: CCB/ACEi - HTN
  90. paroxetine ☃
    • Paxil, Brisdelle
    • I: SSRI, antidepressant, anxiety
    • D: IR 10-60 mg/day, CR 12.5-62.5 mg/day (max 75 mg/day for panic disorder) PO
    • each 10 mg IR = 12.5 mg CR
    • W: B = suicidal in the young, CI: MAOI, linezolid, IV methylene blue, pimozole, no preggo with Brisdelle, CI thioridazine
    • S: sexual dysfunction, somnolence, insomnia, nausea, dry mouth, tremor, hypoNA, GI
  91. sucralfate
    • Carafate
    • I: PUD ulcer healing, GERD
    • D: 1 gm QID before meals and bedtime PO
    • W: renal impairment, aluminum complex and can accumulate
    • S: constipation (chelation)
    • N: drink fluids/laxatives, separate antacids by 30 mins and other drugs 2 hours before and 4 hours after
  92. nitrofurantoin
    • Macrodantin, Macrobid
    • I: bacterial cell wall inhibitor antibiotic, for uncomplicated UTI (cystitis only)
    • D: dantin - 50-100 mg PO QID with food x3-7 days; 50-100 mg PO QHS with food for prophylaxis; BID - 100 mg PO BID x 5 days
    • W: CI CrCl <60 ml/min d/t accumulation of neurotoxins, optic neuritis, hepatotoxicity, peripheral neuropathy, pulmonary toxicity, hemolytic anemia (G6PD deficiency) 
    • S: GI (take with food to help), harmless brown urine discoloration
  93. tiotropium
    • Spiriva Handihaler, Respimat
    • I: COPD, LAMA (M3)
    • D: DPI - 1 caps 2 puffs, MDI 2 inhalations daily
    • W: caution with myasthenia gravis, narrow-angle glaucoma, urinary retention, BPH, bladder neck obstruction
    • S: dry mouth, URTI, cough, bitter taste
    • N: do not swallow DPI capsules
  94. budesonide inhaled
    • Pulmicort Flexhaler, Respules for nebulizer
    • I: inhaled corticosteroid for asthma
    • D: DOC for pregnancy, popular - DPI: 1-4 inhalations BID
    • W: high doses = adrenal suppression, inc risk of fractures and growth in children, CI acute episodes
    • S: dysphonia (difficulty speaking), thrush (oral candidiasis), cough
    • N: rinse mouth and throat with warm water and spit out
  95. methadone
    • Dolophine, Methadone Intensol, Methadose (C-II)
    • I: opioid for pain, activates mu-opioid receptor
    • D: 2.5-10 mg Q8-12H, 40 mg = detox and maintenance treatment of opioid-addicted patients PO
    • W: B = QT prolongation
    • S: addiction/dependence, respiratory depression, constipation
    • N: variable half-life, can decrease testosterone and contribute to sexual dysfunction, serotonergic, major 3A4 substrate
  96. neomycin/polmyxin B/hydrocortisone topical ointment
    • Cortisporin, + bacitracin (Neosporin, Triple Antibiotic Ointment OTC), 0.5-1% hydrocortisone OTC
    • I: popular for superficial skin infections
  97. levothyroxine
    • Synthroid, Unithroid, levoxl, Tirosint 
    • I: T4, thyroid replacement
    • D: 1.6 mcg/kg/day (IBW), if known CAD, start with 12.5-25 mcg daily, elderly often need 20-25% less per kg; may require <1 mcg/kg/day
    • W: B = not for obesity, CI: acute MI, thyrotoxicosis, uncorrected adrenal insufficiency
    • W: dec in CV, dec bone mineral density osteo
    • S: if euthryoid no SE, if too high - inc HR, palpitations, sweating, wt loss, arrhythmias, irritability, constipation
    • N: clinical symptoms every 4-6 months, TSH (rarely FT4), then 4-6 months later, then yearly, watch for calcium/iron interactions
  98. simvastatin
    • Zocor
    • I: statin - HLD
    • D: 10-40 mg QHS, crcl <30 - start at lower doses
    • W: skeletal muscle effects, may increase FBG, inc LFTs (rare), CI active liver disease, preggo, breastfeeding, strong 3A4 inhibitors (also with lovastatin)
    • S: myalgias, arthralgias, myopathy
    • N: NO grapefruit (<1 qt for atorvastatin ok)
  99. tretinoin
    • Atralin, Renova, Retin-A, Avita
    • I: topical retinoids
    • Renova - remove fine wrinkles
    • N: limit sun exposure, apply at bedtime about 20 minutes after washing face, peasize, 4-12 weeks to see response, initially worsen acne initially
  100. phentermine
    • Adipex-P (C-IV)
    • I: short term appetite suppressants - sympathomimetics (stimulants) - increase NE
    • D: 15-37.5 mg PO daily, before or after breakfast, or in divided doses
    • W: CI MAOI within 14 days, avoid use with HTN, PAH, hyperthyroid, glaucoma, abuse potential, NO PREGGO
    • S: tachycardia, agitation, inc BP, insomnia, CV complications, psych
    • N: up to 12 weeks to "jump start" a diet, taper off d/t seizure risk
  101. olmesartan/HCTZ
    • Benicar HCT
    • I: ARB/thiazide-type diuretic - HTN
    • N: no preggo, less cough
  102. prednisoLONE
    • Millipred, Orapred ODT, Pediapred
    • I: systemic glucocorticoid
    • D: varies by condition
    • W: CI: live vaccines, serious systemic infections
    • W: adrenal suppression, taper slowly >14 days, immunosuppression, psych, worsen other conditions
    • S: inc appetite/wt gain, fluid retention, emotional instability, Cushing's syndrome long-term
  103. albuterol/ipratropium
    • Combivent Respimat, Duonebs
    • I: SABA/SAMA - COPD
    • D: MDI - 20 mcg ipra/100 mcg albut 1 inhalation QID
    • W: caution in myasthenia gravis, narrow-angle glaucoma, urinary retention, BPH, dry mouth, tachycardia, tremor
  104. apixaban ☃
    • Eliquis
    • I: direct factor Xa inhibitor, DOAC, nonvalv afib, tx DVT/PE, prophy DVI (knee/hip)
    • D: afib - 5 mg BID, tx - 10 mg PO BID x 7 days, then 5 mg PO BID, prophy - 2.5 mg PO BID 12-24 hours before surgery then 12 days knee or 35 days hip replacement. adj age 80+, weight ≤60 kg, scr 1.5+
    • W: B = avoid in neuraxial anesthesia (epidural), premature discontinuation, CI active pathological bleeding, NOT in prosthetic heart valves, mod-severe hepatic impairment
    • S: bleeding
    • N: crushed and put in applesauce, mixed in water, D5W, apple juice, NG tube, d/c 48 hours prior to elective surgery or 24 hours with low bleeding risk
  105. tizanidine
    • Zanaflex
    • I: antispasmodics, muscle relaxants with analgesic effects - central alpha 2 receptor agonist inhibits motor neurons and reduces spasticity
    • S: hypotension, dry mouth, weakness, QT prolongation, dizziness, sedation
    • N: maybe better tolerated in elderly than cyclobenzaprine
  106. pramipexole
    • Mirapex
    • I: dopamine agonist, Parkinson, IR also for RLS
    • D: IR - 0.125 mg PO TID, titrate weekly to max 1.5 mg TID, ER - 0.375 mg PO daily, titrate weekly (avoid orthostasis, dizziness, sleepiness) to max 4.5 mg daily
    • S: somnolence, daytime sleep attacks, nausea, dizziness, orthostasis, hallucinations, dyskinesias, vomiting, 90% renal - dec if CrCl <50 ml/min
  107. ramipril
    • Altace
    • I: ACEi - HTN, DM and renal protection
    • D: 2.5-20 mg daily PO
    • W: B = avoid in preggo, 2/3rd defects
    • W: angioedema, hyperK, hypotension, renal impairment, avoid in bilateral renal artery stenosis
    • S: cough, dizziness, h/a
    • N: daily can be used BID if needed
  108. losartan/HCTZ
    • Hyzaar
    • I: arb (Cozaar), thiazide-type diuretic
    • S: hyperK, less cough
  109. fluoxetine ☃
    • Prozac
    • I: SSRI, antidepressant
    • D: 10-60 mg/day, max 80 mg/day, 90 mg weekly, PMDD - Sarafem 20 mg daily of menstrual cycle or 20 mg daily starting 14 days prior PO
    • W: B = suicidal in the young, CI MAOI, linezole, methylene blue, pimozide, thioridazine
    • S: sexual dysfunction, somnolence, insomnia, dry mouth, SS
    • N: activating - take QAM, or PM if sedating, SIADH/hypoNA in elderly, long half-life, takes weeks to work
  110. pantoprazole ☃
    • Protonix
    • I: PPI - inhibits H+/K+ ATPase, GERD, heartburn
    • D: 40 mg daily PO
    • W: cdiff, osteo, hypoMG, VitB12 deficiency 2+ years, acute interstitial nephritis, lupus
    • S: h/a, nausa, diarrhea, IV Protonix - thrombophlebitis, SJS
  111. risperidone
    • Risperal
    • I: SGA - psychosis, D2 receptor blockers
    • D: 4-16 mg/day PO, divided, Consta Q2 week injection 25-50 mg
    • S: somnolence, EPS at higher doses (>6 mg), inc prolactin = sexual dysfunction, galactorrhea, irregular/missed periods, orthostasis, wt gain, QT prolongation
  112. methylphenidate OROS
    • Concerta
    • I: stimulant, prevent NE/D reuptake in CNS - ADHD
    • D: 18-36 MG QAM, max 72 mg/day PO
    • S: nausea, insomnia, h/a, blurry vision, anxiety, tachycardia, wt loss
    • N: outer coat dissolves fast, rest releases slowly, hard to crush to avoid abuse potential, ghost tablet
  113. venlafaxine ☃
    • Effexor XR
    • I: SNRI - antidepressant, GAD, panic disorder, social anxiety disorder
    • D: 75-375 mg/day, max 375 mg/day for IR and 225 mg/day for ER, can start low with 37.5 mg PO
    • W: B = suicidal in the young, CI MAOI, linezole, IV methylene blue
    • S: NE = inc HR, dilated pupils, dry mouth, excessive sweating, constipation, inc BP > 150 mg/day
    • N = better at neuropathy than SSRI
  114. cycloSPORINE emulsion eye drops
    • Restasis
    • I: dry eyes eye drops, immunosuppresant
    • D: 1 drop in each eye Q12H
    • S: burning, stinging, redness, pain, blurred vision, discharge, itching eye
    • N: invert vial several times to make the emulsion uniform, 3-6 months to increase tear production, keep contacts out for 15 mins after
  115. levetiracetam
    • Keppra
    • I: AED, maybe calcium channel inhibition
    • D: 500 mg BID or 1,000 mg daily (XR), max 3,000 mg/day, CrCl <80 decrease dose, IV:PO 1:1
    • W: psych, somnolence, fatigue, SJS, loss of seizure control during preggo
    • S: irritability, dizziness, weakness, confusion, sedation
    • N: no significant drug interactions
  116. buprenorphine/naloxone
    • Suboxone (C-III)
    • I: partial mu-opioid agonist, full opioid antagonist
    • D: daily for addition, off-label for pain
    • W: CNS depression, QT prolongation
    • S: sedation, respiratory depression that is dose-dependent
    • N: DATA 2000 with DEA UIN with X
  117. warfarin ☃
    • Coumadin, Jantoven
    • I: anticoagulant - Vit K antagonist 2,7,9,10, afib, DVT/PE
    • D: 5 mg daily PO, adjust to INR 
    • W: B = major or fatal bleeding, CI preggo except with mechanical heart valves
    • W: tissue necrosis/gangrene, HIT, pharmacogenomics
    • S: bleeding, skin necrosis, purple toe syndrome
    • A: vitamin K
  118. metoprolol succinate
    • Toprol XL
    • I: B-1 selective blocker
    • D: 25-100 mg daily, max 400 mg HTN, HF - 12.5-25 mg daily, target 200 mg PO
    • W: B = do not discontinue abruptly, CI severe bradycardia, 2/3rd AV block
    • W: mask hypoglycemic sx (except sweating), mask hyperthyroidism, caution with bronchospastic dx
    • S: bradycardia, low HR, hypotension, fatigue, dizziness, depression
    • N: titrate every 1-2 weeks, with or immediately following food, same TDD as Lopressor
  119. metoprolol tartrate
    • Lopressor
    • I: B-1 selective blocker
    • D: IR 100-450 mg daily in 2-3 divided doses PO
    • W: B = do not discontinue abruptly, CI severe bradycardia, 2/3rd AV block
    • W: mask hypoglycemic sx (except sweating), mask hyperthyroidism, caution with bronchospastic dx
    • S: bradycardia, low HR, hypotension, fatigue, dizziness, depression
    • N: titrate every 1-2 weeks, with or immediately following food, IV:PO = 1:2.5
  120. prednisolone eye drops
    • Pred Forte
    • I: steroid eye drops - ocular inflammation
    • N: only short term d/t risk of inc IOP
  121. indomethacin ☃
    • Indocin
    • I: NSAIDs nonselective for pain and gout
    • D: IR 25-50 mg BID-TID, CR 75 mg daily-BID PO
    • W: CV risk, no CABG, GI
    • S: decrease renal clearance, increase BP, closure of fetal ductus arteriosis, avoid in 3rd trimester (30+ weeks), nausea esp salicylates (take with food or EC)
    • N: IR older NSAID for gout
  122. latanoprost
    • Xalatan
    • I: prostaglandin analog for glaucoma - inc aqueous humor outflow and reduces intraocular pressure
    • D: 1 drop QHS, no contact lenses because preservative BAK - wait 15 mins
    • W: darkening iris, eyelashes, eyelash length and number can increase, avoid contamination of bacterial keratitis
    • S: blurred vision, stinging, increased pigmentation
    • N: unopened bottles in refrigerator
  123. anastrozole
    • Arimidex
    • I: aromatase inhibitor - breast cancer post-menopausal to increase remission
    • D: 1 mg PO daily
    • W: CI in preggo
    • S: edema, DVT/PE, bone pain, osteo, menopausal sx, hot flashes, arthralgia/myalgia, lethargy/fatigue, HTN, dyslipidemia
  124. carbidopa/levodopa
    • Sinemet, Rytary, Duopa
    • I: parkinson disease, levodopa precursor of dopamine, carbidopa inhibits dopa decarboxylase enzyme preventing peripheral metabolism of levodopa and nausea
    • D: IR 25/100 mg PO TID, CR 50/200 mg BID (cut, no crush/chew), Rytary 23.75/95 mg TID if levodopa-naive PO
    • W: CI nonselective MAOI within 14 days, narrow angle glaucoma
    • S: nausea, dizziness, orthostasis, dry mouth, dyskinesias, brown/black/dark urine, salvia, sweat, discolor clothing, unusual sexual urges
    • N: separate from iron, protein
  125. ondansetron
    • Zofran
    • I: inhibits 5-HT3 (serotonin) receptors in chemoreceptor trigger zone to reduce nausea
    • S: rare OTc prolongation, CNS side effects, often used in emetogenic chemotherapy
  126. glimepride
    • Amaryl
    • I: T2DM, sulfonylurea - stimulates pancreatic beta cells to release insulin
    • D: 1-2 mg daily, 1-2 mg every 1-2 weeks; max 8 mg/day PO
    • W: hypoglycemia (risk: age, liver impairment, renal impairment), G6PD deficiency, hypersensitivity reactions, CI: T1DM, DKA, sulfa allergy
    • S: weight gain, nausea, hypoBG
    • N: inexpensive, must eat scheduled diet
  127. quetiapine
    • Seroquel
    • I: SGA for schizophrenia, often psychosis in Parkinson - block D2 receptors
    • D: 400-800 mg/day, divided BID or XR QHS PO
    • S: somnolence, orthostasis, wt gain, inc lipids, inc glucose
    • N: low EPS risk, lower risk of QT prolongation, XR is at night WITHOUT food or even a light meal <300 kcal
  128. triamterene/HCTZ
    • Dyazide, Maxzide
    • I: HTN, triamterene blocks epithelial sodium channels
    • D: 37.5 mg/25 mg daily or BID PO
    • W: B = triamterene - hyperkalemia - more likely in DM, renal impairment, or elderly patients, CI  K>5.5 mEq/L, anuria, renal impairment
    • S: dehydration, hypoNA, dizziness
    • N: HCTZ helps out with the K+ levels
  129. estradiol vaginal cream - 17-Beta Estradiol
    • Estrace
    • I: vulvar and vaginal atrophy secondary to menopause, systemic hormone
    • W: B = endometrial cancer (if uterus without progestin), inc risk of stroke and VTE 50-79 yo postmenopausal, breast cancer
    • S: edema, HTN, h/a, wt gain, depression
  130. acetaminophen/codeine
    • Tylenol #3 (C-III)
    • I: opioid combo for pain, codeine activates mu-opioid receptor, apap suspected to inhibit prostaglandin synthesis to reduce pain
    • D: 1 tab (apap 300 mg + codeine 30 mg) Q4-6H PRN, range 15-120 mg codeine PO
    • W: B = respiratory depression in children and ultra-rapid metabolizers of codeine d/t a 2D6 polymorphism
    • W: 12-18 yo who are obese/sleep apnea/severe lung disease are at inc risk of breathing problems, CI <12 yo, addiction/dependence risk
    • S: codeine = GI, constipation, n/v/d
  131. tramadol
    • Ultram, Conzip (C-IV)
    • I: activates mu-opioid receptors, inhibits NE and serotonin reuptake
    • D: IR - 50-100 mg Q4-6H, max 400 mg/day, ER - 100 mg daily, max 300 mg/day PO, crcl <30 ml/min - do not use ER, lower dose in IR
    • W: seizure risk, serotonin syndrome, CYP2D6, 3A4 inhibitors watch out for SS, rare respiratory depression, avoid in preggo, CI <12 yo
    • S: lower GI than other strong opioids, dizziness, loss of appetite, flushing, dry mouth
    • N: requires conversion to active metabolite by 2D6, dependence/addiction risk
  132. topiramate
    • Topamax
    • I: blocks voltage dependent sodium and calcium channels, some GABA, AED, often used in migraines too!
    • D: weeks! week 1: 25 mg BID IR, 50 mg daily XR; week 2: 50 mg BID IR, 100 mg daily XR; week 3: 75 mg BID IR, 150 mg daily XR; week 4: 100 mg BID IR or 200 mg daily XR, up by 100 mg weekly until max dose or therapeutic effect, max 400 mg/day, CRCL <70 - dec dose by 50% PO
    • W: metabolic acidosis, oligohidrosis (reduced perspiration), nephrolithiasis, hyperammonemia, fetal harm, reversible visual problems, cognitive impairment
    • S: somnolence, dizziness, weight loss, cognitive probs
  133. cefazolin
    • Ancef, Kefzol
    • I: first gen cephalosporin cover good staph and strep, surgery prophy - inhibits PBP preventing cell wall synthesis
    • D: 1-1.5 gm IV/IM Q8H
    • W: anaphylaxis, some inc INR on warfarin, cross-sensitivity (<10%) with PCN allergy (no in swelling, angioedema, anaphylaxis)
    • S: GI upset, diarrhea, rash, seizures with accumulation
    • N: IV for effective serum concentration
  134. testosterone
    • AndroGel, Androderm, Depo-Testosterone, Fortesta, Testim
    • I: androgen hormone
    • D: apply, patch = 2 mg, 4 mg
    • W: B = avoid exposure to children resulting in virilization, CI cancer, preggo, breastfeeding, DEPO = serious cardiac, hepatic or renal disease
    • W: inc risk of breast cancer, prostate cancer, CV, VTE, dyslipidemia, gynecomastia, worsen BPH
    • S: inc appetite, inc SCR, sensitive nipples, acne, edema, hepatotoxicity, reduced sperm count, sleep apnea
  135. liraglutide ☃
    • Victoza, Saxenda
    • I: dm - GLP-1 agonist, wt loss 
    • D: 0.6 mg SC daily x 1 week, then 1.2 mg SC daily x 1 week; can inc to 1.8 mg SC daily, if needed
    • W: B = risk of thyroid C-cell carcinoma - seen in rats, unknown if risk applies to humans, CI personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2)
    • W: pancreatitis, not in severe GI disease
    • S: nausea, wt loss, v/d/constipation, GI, injection site rxn
  136. hydroxyzine
    • Vistaril
    • I: first gen antihistamine, general urticaria with severe itching - H1 receptor antagonist and cause sedation too, for anxiety
    • D: 25 mg TID-QID PO
    • S: anticholinergic - primarily sedation and dry mouth
  137. verapamil
    • Calan SR, Covera HS, Verelan - PM
    • I: nonDHP CCB - HTN (IR is for rate control in afib and angina) - blocks entry of calcium into smooth muscle and heart, causing vasodilation and slowing of heart rate, chronic h/a
    • D: 240-480 mg daily PO, IR TID, Calan SR BID, others QHS
    • W: CI hypotension SBP <90 mmHg, cardiogenic shock, 2/3rd degree AV block or SSS unless with pacemaker, acute MI and pulmonary congestion
    • W: sinus bradycardia, AV block, hypotension, heart failure, inc LFTs
    • S: edema, h/a, dizziness, constipation, gingival hyperplasia
    • N: Covera HS: OROS/gel matrix formulation can leave a ghost shell
  138. furosemide
    • Lasix
    • I: heart failure - block reabsorption of sodium, chloride, and water form the ascending limb of the loop of henle to increase urine output
    • D: 20-40 mg daily or BID, max 600 mg/day PO
    • W: B = profound diuresis resulting in fluid and electrolyte depletion, CI anuria
    • W: sulfa allergy
    • S: hypo all electrolytes, hyperUA, hyperBG, orthostatic hypotension, photosensitivity, ototoxicity
    • N: take early in the day to avoid nocturia, IV store at ROOM TEMP - crystals form that dissolve when warmed, do not use if yellow, light-sensitive, do not need light protection in IV admixtures, IV:PO 1:2
  139. tamsulosin
    • Flomax
    • I: selective alpha 1 receptor blockers, BPH, off-label for bladder outlet obstruction in women
    • D: 0.4 mg daily, 30 mins after the same meal each day, max 0.8 mg daily PO
    • W: orthostatic hypotension/syncope with first dose, change in dose, fast titration, HTN agent, or PDE-5 start, floppy iris syndrome, priapism, angina
    • S: dizziness, fatigue, h/a, abnormal ejaculation
    • N: fast onset, 4-6 weeks to assess benefits, do not shrink prostate and do not change PSA levels
  140. amoxicillin
    • Amoxil, Moxatag
    • I: penicillin antibiotics, inihibits PBP to inhibit cell wall synthesis, DOC acute otitis media
    • D: 250-500 mg PO Q8H or 500-875 mg PO Q12H or 775 mg XR (Moxatag) PO daily
    • S: GI upset, diarrhea, rash/allergic reaction, seizures with accumulation
    • N: CrCl <30 ml/min = avoid amoxicillin 875 mg and 775 mg XR formulations
  141. amoxicillin/clavulanate
    • Augmentin
    • I: PBP inhibitor, abx, clavulanate = inhibits beta-lactamase which is produced by bacteria to break down beta lactam abx
    • D: 500 mg PO TID, 875 mg PO BID, or 2,000 XR PO BID with food
    • S: GI upset, diarrhea, rash/allergic reaction, seizures with accumulation
    • N: 14:1 ratio to dec diarrhea d/t to the clavulanate component
  142. mometasone/formoterol
    • Dulera
    • I: ICS/LABA - for asthma only
    • S: thrush - rinse mouth, LABA = inc HR, tremor
  143. dexamethasone taper pack
    • DexPak
    • I: acute inflammation for COPD exacerbation
  144. esomeprazole magnesium ☃
    • Nexium
    • I: GERD, PPI
    • D: 20-40 mg daily PO
    • W: c diff diarrhea, osteo, hypoMG, lupus, vitB12 deficiency > 2 yrs, do not crush/chew - mix in applesauce ok!
    • S: h/a, nausea, diarrhea
    • N: onset 1-3 hours, duration >24 hours, available IV (and pantoprazole)
  145. alendronate ☃
    • Fosamax, Binosto
    • I: bisphosphonates, inhibiting osteoclast activity and bone resorption
    • D: prevention in postmenopausal women - 5 mg PO daily, or 35 mg PO weekly; treatment in postmenopausal men and women - 10 mg PO daily, or 70 mg PO weekly; glucocorticoid-induced osteoporosis - 5 mg PO daily, postmenopausal women not on estrogen: 10 mg PO daily
    • W: CI inability to stand or sit upright for at least 30 mins, abnormalities of the esophagus, difficulty swallowing or high risk for aspiration, hypocalcemia
    • W: osteonecrosis of the jaw (ONJ) - risk inc with invasive dental procedures, poor dental hygeine, cancer diagnosis, use of chemo or corticosteroids, and duration of exposure, atypical femur fractures, esophagitis, hypocalcemia must be corrected before use, do not use if CrCl < 35 ml/min
    • S: hypocalcemia, dyspepsia, dysphagia, heartburn
    • N: check calcium and vit D levels prior, dental work done prior, aspirin/NSAIDs can worsen GI irritation, separate CA/antacids/iron/mag supplements by at least 2 hours, Binosto = effervescent alendronate tab contains 650 mg NA use with caution! extremely long half-life, assess after 5 years of use
  146. rivaroxaban ☃
    • Xarelto
    • I: direct factor Xa inhibitor, DOAC, nonvalv afib, tx DVT/PE, prophy DVI (knee/hip)
    • D: nonvalvular afib CrCl >50 = 20 mg PO with evening meal (15+ mg need food!), 15-50 ml/min = 15 mg PO daily with evening meal, avoid < 15 ml/min. Treatment of DVT/PE - 15 mg PO BID x 21 days, then 20 mg PO daily, avoid <30 ml/min. Prophy for DVT (knee/hip) - 10 mg PO daily (12 days knee, 35 days after hip replacement surgery), give first dose 6-10 hours after surgery, avoid < 30 ml/min. Reduction in teh risk of recurrence of DVT/PE = 20 mg PO daily, avoid <30 ml/min.
    • W: B = avoid in neuraxial anesthesia (epidural), premature discontinuation, CI active pathological bleeding, NOT in prosthetic heart valves, mod-severe hepatic impairment
    • S: bleeding
    • N: crushed and put in applesauce, NG tube, d/c 48 hours prior to elective surgery or 24 hours with low bleeding risk
  147. diltiazem
    • Cardizem, Cartia, Diltzac, Taztia, Tiazac
    • I: HTN, arrhythmia, nonDHP CCB, angina, chronic h/a
    • D: 120-360 mg daily, max dose varies with product, IR is QID, ER capsule is BID PO
    • W: CI hypotension SBP <90 mmHg, cardiogenic shock, 2/3rd degree AV block or SSS unless with pacemaker, acute MI and pulmonary congestion
    • W: sinus bradycardia, AV block, hypotension, heart failure, inc LFTs
    • S: edema, h/a, dizziness, constipation, gingival hyperplasia
    • N: IR indicated for angina
  148. brompheniramine/pseudophedrine/ dextromethorphan
    • Bromfed DM
    • I: antihistamine, decongestant, cough suppressant
    • D: 2 mg/30 mg/10 mg per 5 mL; 10 mL Q4H PRN, max 60 mL/day PO
    • N: avoid <6 yo AAP, avoid <4 yo labeling, avoid <2yo FDA
  149. phenobarbital
    • Luminal (C-IV)
    • I: AED
    • D: 50-100 mg BID or TID PO
    • W: CI severe hepatic impairment, dypsnea or airway obstruction, addiction, intraarterial admin
    • W: habit forming, paradoxical reactions including hyperactive or aggressive behavior, SJS, respiratory depression, fetal harm
    • S: somnolence, cognitive impairment, hangover effect, tolerance/dependence, folate deficiency
    • N: goal levels 20-40 mcg/mL adults, 15-40 mcg/mL children
  150. ibuprofen ☃
    • Motrin, Advil, Caldolor
    • I: nonselective cox for pain, reduce prostaglandins, NeoProfen injection for closure of patent ductus arteriosis (PDA) in premature infants
    • D: OTC 200-400 mg Q4-6H, max 1.2 grams/day, limit self-treatment to 10 days or less; Rx - 400-800 mg Q6-8H for antipyretic, max 3.2 grams/day; pediatric - 5-10 mg/kg/dose Q6-8H for antipyretic, max 40 mg/kg/day PO
    • W: B = GI, CV, CABG, CI preggo, avoid 3rd trimester 30+ weeks
    • S: nausea, avoid in renal failure, inc BP
    • N: inhibits platelet activity, exacerbate CHF/edema
  151. naproxen ☃
    • Aleve, Naprosyn, Anaprox, Naprelan
    • I: nonselective cox for pain, reduce prostaglandins
    • D: OTC pain/fever 200 mg (or 220 mg, if naproxen Na) 1 tab Q8-12H (may take 2 tabs for 1st dose) max 3 tabs in 24 hours, Rx - inflammation/mild-mod pain 500 mg Q12H (or occasionally 250 mg Q6-8H), max 1,250 mg on daily 1; 1,000 mg thereafter PO
    • W: B = GI, CV, CABG, CI preggo, avoid 3rd trimester 30+ weeks
    • S: nausea, avoid in renal failure, inc BP
    • N: inhibits platelet activity, exacerbate CHF/edema
  152. aspirin/acetylsalicyclic acid ☃
    • Ecotrin, Bufferin, Durlaza
    • I: cardioprotection, nonselective NSAID/salicylate Cox reduce prostaglandins
    • D: cardioprotection 81-162 mg daily, Durlaza Rx - 162.5 mg daily PO, analgesic dose - 325-650 mg Q4-6H PO
    • W: avoid with NSAID hypersensitivity, nasal polyps, asthma, avoid in children and teens with any viral infection d/t Reye's Syndrome (somnolence, N/V lethargy, confusion), SJS, risk of bleeding, avoid in 3rd trimester preggo
    • S: dyspepsia, nausea (use EC or take with food), heartburn, bleeding, renal impairment, inc BP
    • N: do not use Durlaza when immediate effect is needed (MI), overdose causes tinnitus
  153. metoclopramide ☃
    • Reglan
    • I: dopamine receptor (D2) antagonist block in the chemoreceptor trigger zone, gastroparesis
    • D: 10-40 mg PO/IV Q6H PRN
    • for highly emetic regimens: 0.5-2 mg/kg/dose PO/IV Q6H PRN, crcl <40 ml/min = 50%
    • W: B = Tardive dyskinesia (TD), avoid >12 weeks of tx
    • W: sx of Parkinson disease
    • S: sedation, lethargy, hypotension, acute EPS, dec seizure threshold, strong anticholinergic
  154. timolol/dorzolamide
    • Cosopt
    • I: carbonic anhydrase inhibitors to reduce aqueous humor production in glaucoma
    • D: 1 drop BID
    • W: sulfonamide allergy
    • S: blurred vision, blepharitis, dry eye, discharge
    • N: single-use containers
  155. valsartan/HCTZ
    • Diovan HCT
    • I: ARB/thiazide-type diuretic - HTN
    • N: no preggo, less cough
  156. valsartan
    • Diovan
    • I: ARB - HTN
    • D: 80-320 mg daily PO
    • S: no preggo, less cough, hyperkalemia
  157. divalproex
    • Depakote, Depakene (with valproic acid)
    • I: AED - seizures and migraine prophylaxis
    • D: 250-500 mg BID PO
    • S: liver toxicity, pancreatits, wt gain, sedation, teratogenicity, thrombocytopenia, alopecia (selenium and zinc supplementation), PCOS, CNS
    • N: divalproex converts to valproate
  158. erythromycin ethyl succinate 400 mg
    • EES 400 (EryTab, EryPed, Erythrocin PCE)
    • I: macrolide antibiotic - impetigo, block 50S ribsomal subunit, AUC/MIC, good atypical coverage and Haemophilus
    • D: EES 400-800 mg PO Q6-12H, no renal adj
    • W: CI history of cholestatic jaundice/hepatic dysfunction with prior use, concomitant use with pimozide, ergotamine, dihydroergotamine, lovastatin, atorvastatin
    • W: QT prolongation, esp Class I/III antiarrhythmic drugs, hepatotoxicity, exacerbation of myasthenia gravis
    • S: GI esp!, taste perversion
  159. enalapril
    • Vasotec, Epaned powder for oral solution
    • I: ACEI (less angiotensin 2 = potent vasoconstrictor)- HTN, kidney protection + DM, HF
    • D: 5-20 mg daily or BID (HF) mg daily PO
    • W: B = no preggo, 2/3rd trim defects, CI angioedema hx, washout with Entresto 36 hours
    • S: cough, dizziness, h/a, rash
    • N: can be used BID if needed
  160. benztropine
    • Cogentin
    • I: centrally-acting anticholinergic with antihistamine effects, tremors, dystonia
    • D: 0.5-2 mg TID start QHS
    • S: anticholinergic - dry mouth, constipation, urinary retention, blurred vision, somnolence, confusion
    • N: avoid use in elderly
  161. fluconazole
    • Diflucan
    • I: antifungal, inhibits fungal CYP450 14 alpha-demethylase, yeasts (Candida albicans, Candida tropicalis, Cryptococcus, Coccidioides)
    • D: 50-800 mg PO/IV daily, vaginal candidiasis 150 mg PO x1, CrCl ≤ 50 ml/min: dec by 50% (all other are cleared hepatically)
    • W: liver dysfunction, hepatotoxicity, exfoliative skin disorders
    • S: h/a, n/v, rash/pruritis, QT prolongation, hypoK, hypertension, edema, 3A4 interactions (amiodarone, phenytoin, warfarin)
    • N: penetrate the CNS adequately to treat fungal meningitis (same with voriconazole)
  162. ranitidine
    • Zantac
    • I: heartburn/GERD, H2RA
    • D: OTC 75-150 mg 1-2 times daily PRN, Rx 150 mg BID PO
    • W: confusion, B12 deficiency +2 years, QT prolongation with renal dysfxn dec dose <50 ml/min, inc ALT
    • S: h/a
    • N: onset w/i 60 mins (faster than PPIs), 4-10 hr duration, ok in preggo, tachyphylaxis
  163. zolpidem
    • Ambien (C-IV), Zolpimist oral spray, Edluar SL, Intermezzo SL
    • I: nonbenzo, increase GABA, insomnia
    • D: 5-10 mg PO QHS, max 5 mg in females and elderly; CR 6.25-12.5 mg PO QHS, max 6.25 mg in females and elderly
    • W: CNS depression, abuse potential
    • S: somnolence, dizziness, ataxia, parasomnias
    • N: do not take with fatty food, a heavy meal or alcohol, generally avoid in elderly
  164. desvenlafaxine ☃
    • Pristiq, Khedezla
    • I: SNRI - antidepressant, GAD, panic disorder, social anxiety disorder
    • D: 50 mg/day PO, can inc 100 mg/day, but no benefit > 50 mg
    • W: B = suicidal in the young, CI MAOI, linezole, IV methylene blue
    • S: NE = inc HR, dilated pupils, dry mouth, excessive sweating, constipation, inc BP > 150 mg/day
    • N = better at neuropathy than SSRI
  165. clopidogrel ☃
    • Plavix
    • I: blocks ADP to P2Y12 receptor = prevents platelet aggregation, ACS, recent MI, stroke, often with aspirin in stenting
    • D: LD 300-600 mg PO (600 mg for PCI), MD: 75 mg PO daily; no need for LD if pt. received fibrinolytic therapy for STEMI and is >75 yo
    • W: B = prodrug CYP2C19, test genotype, CI serious bleeding
    • W: inc bleeding risk, stop 5 days prior to elective surgery (CABG), avoid omeprazole/esomeprazole, premature discontinuation = risk of thrombosis, thrombotic thrombocytopenic purpura (TTP) reported
    • S: bleeding, hematoma, pruritis
  166. prasugrel ☃
    • Effient
    • I: blocks ADP to P2Y12 receptor = prevents platelet aggregation, ACS who are to be managed by PCI, often with aspirin in stenting
    • D: LD 60 mg PO no later than 1 hour after PCI, MD 10 mg PO daily  (5 mg daily if pt wt <60kg)
    • W: B = bleeding, CI history of TIA or stroke
    • W: inc bleeding risk = stop 7 days prior to elective surgery (CABG), premature discontinuation = risk of thrombosis, thrombotic thrombocytopenic purpura (TTP) reported
    • S: bleeding more than clopidogrel
    • N: keep in original container, more $$ than clopidogrel
  167. omega-3 acid ethyl esters
    • Lovaza
    • I: fish oil, in adjunct to diet with TG 500+ mg/dL
    • D: 4 caps daily or 2 caps BID. 940 mg of DHA/EPA in 1 gm cap. PO
    • W: shellfish sensitivity, inc LDL monitor!, monitor LFTS in hepatic impairment, possible recurrences of symptomatic afib/flutter in pts with afib - first months of initiating therapy
    • S: eructation (burping), dyspepsia, taste perversions, vomiting, inc risk of bleeding - stop prior to elective surgery
  168. ketorolac eye drops
    • Acular, LS (lower strength)
    • I: NSAID for inflammation and pain - popular for post-surgical procedures, post-cataract surgery
  169. doxycycline
    • Vibramycin, Doryx, Adoxa, Oracea
    • I: malaria prophy, CA-MRSA, VRE in UTI, gram+/-, tetracycline abx - inhibits bacterial protein synthesis by binding to the 30s ribosomal subunit
    • D: 100-200 mg PO/IV in 1-2 divided doses, no renal, Oracea - 40 mg on an empty stomach 1 hr before or 2 hours after meals, empty stomach for GI
    • W: <8 yo, preggo, breastfeeding = suppresses bone growth and skeletal development, permanently discolors teeth, photosensitivity, tissue hyperpigmentation, DRESS, inc BUN
    • S: n/v/d, SJS, rash
    • N: IV:PO = 1:1, binding with calcium and iron but the least likely so if needed for GI upset
  170. tadalafil
    • Cialis, Adcirca (PAH)
    • I: PDE-5 inhibitors - smooth muscle relaxation and increase blood flow to penis, ED, PAH, BPH (unlike sildenafil)
    • D: ED - 2.5-5 mg dialy daily dosing, or 5-20 mg PRN with 10 mg at least 30 min prior to sexual activity, 5 mg PRN if crcl 30-50 ml/min, <30 ml/min 5 mg PRN Q72H, half dose if 65+yo/alpha-blocker/3A4 inhibitor/severe renal or liver disease; BPH - 5 mg daily PO, CrCl 30-50 ml/min - 2.5 mg, max 5 mg daily, do not use <30 ml/min, use 2.5 mg if strong CYP3A4 inhibitors
    • W: CI nitrates or riociguat (guanylate cyclase inhibitor)
    • W: impaired color discrimination (dose-related), hearing loss, vision loss (NAION), hypotension, priapism, CVD
    • S: h/a, flushing, dizziness, dyspepsia, epistaxis
    • N: light meal, avoid fatty food
  171. sildenafil
    • Viagra, Revatio (PAH)
    • I: PDE-5 inhibitors - smooth muscle relaxation and increase blood flow to penis, ED, PAH
    • D: 25-100 mg daily PO, start at 50 mg daily, take ~1 hr before sexual activity, half dose if 65+yo/alpha-blocker/3A4 inhibitor/severe renal or liver disease
    • W: CI nitrates or riociguat (guanylate cyclase inhibitor)
    • W: impaired color discrimination (dose-related), hearing loss, vision loss (NAION), hypotension, priapism, CVD
    • S: h/a, flushing, dizziness, dyspepsia, epistaxis
    • N: light meal, avoid fatty food
  172. sulfamethoxazole/trimethoprim
    • Bactrim, Septra
    • I: sulfamethox - interferes with bacterial folate synthesis; trimethoprim blocks production of tetrahydrofolic acid in bacteria by binding dihydrofolate reductase
    • D: dose on TMP compound, severe infection - 10-20 mg/kg/day TMP divided Q6-8H (2 DS tabs BID-TID), uncomplicated UTI 1 DS tab BID x 3 day, PCP prophy 1DS os SS tab daily, PCP tx 15-20 mg/kg/day TMP IV/PO divided Q6H, CrCl 15-30 ml/min - adjust, <15 ml/min not recommended
    • W: CI sulfa allergy, preggo at term, breastfeeding, anemia d/t folate deficiency, marked renal/hepatic disease, infants, <2 months 
    • W: blood dyscrasias - agranulocytosis and aplastic anemia, SJS, TTP, G6PD deficiency, embryofetal toxicity
    • S: n/v/d, anorexia, skin reactions, crystalluria (8oz water!), photosensitivity, hypoBG, CNS
    • N: significant interaction with warfarin
  173. azithromycin
    • Zithromax, Z-Pak, Zmax, AzaSite (ophthalmic)
    • I: macrolide abx, block 50s ribosomal subunit and prevents protein synthesis, good atypical coverage and Haemophilus, better gram-negative compared to erythromycin, opportunistic infxn
    • D: PO 500 mg day 1, then 250 mg days 2-5 Z-Pak, or 500 mg x3 days or 1-2 grams x 1 Zmax or 600 mg daily, no renal, PO
    • W: CI history of cholestatic jaundice/hepatic dysfunction with prior use
    • W: QT prolongation, esp Class I/III antiarrhythmic drugs, hepatotoxicity, exacerbation of myasthenia gravis
    • S: GI, taste perversion
    • N: ER suspension (Zmax) is not equal with Zithromax, fewer side effects with 3A4, longer half-life
  174. atorvastatin
    • Lipitor
    • I: statin - HLD, HMG-CoA reductase inhibitor 
    • D: 10-80 mg daily PO
    • W: skeletal muscle effects, CI liver dx, no Preggo
    • S: myalgia, arthralgias, myopathy
    • N: anytime of the day (rosuva, pita, fluva, pravastatin), lipid panel 4-12 weeks to assess adherence
  175. pravastatin
    • Pravachol
    • I: statin - HLD, HMG-CoA reductase inhibitor 
    • D: 10-80 mg daily PO
    • W: skeletal muscle effects, CI liver dx, no Preggo (baby needs cholesterol for brain and production of hormones in preggo)
    • S: myalgia, arthralgias, myopathy
    • N: anytime of the day (rosuva, pita, fluva, pravastatin), lipid panel 4-12 weeks to assess adherence, if can't tolerate simvastatin or atorvastatin this one is often tried
  176. pregabalin
    • Lyrica (C-V)
    • I: anticonvulsant, suspected alpha2-delta binding to reduce neuronal excitability - fibromyalgia, PHN and neuropathic pain associated with diabetes and spinal cord injury
    • D: 75 mg BID or 50 mg TID, max 450 mg/day; CrCl < 60 ml/min: dec dose or extend interval, PO
    • W: angioedema, hypersensitivity, suicidal thoughts with all AEDs, inc seizure if rapid discontinuation, peripheral edema, dizziness, somnolence
    • S: dizziness, somnolence, mild euphoria, wt gain
  177. clindamycin
    • Cleocin
    • I: Bind 50s subunit of bacterial ribosome which prevents protein synthesis, most aerobic and anaerobic gram + bacteria (MRSA not Enteroccocus), vaginal cream/suppositories, topical for acne, systemic infxn, purulent and non-purulent skin infections, beta-lactam alternative to dental abscesses
    • D: 150-450 mg PO Q6H, 600-900 mg IV Q8H, no renal
    • W: B = colitis (cdiff)
    • W: SJS/TEN/DRESS
    • S: n/v/d, rash, urticaria, rare inc LFTs
    • N: D-test induction on S. aureus susceptible to clindamycin resistance to erythromycin, don't want flattened zone
  178. glipizide
    • Glucotrol
    • I: T2DM, sulfonylurea - stimulates pancreatic beta cells to release insulin
    • D: IR 5 mg daily, inc 2.5-5 mg every few days, max 40 mg/day; daily doses >15 mg should be BID; XL 5 mg dialy, titrate to max 20 mg/day, PO
    • W: hypoglycemia, G6PD deficiency, CI: T1DM, DKA, sulfa allergy
    • S: weight gain, nausea, hypoBG
    • N: IR taken 30 mins before a meal, all other with breakfast, hold if NPO, XL = OROS - see ghost tablet, inexpensive
  179. glyburide
    • glyburide ≠ Glynase
    • I: T2DM, sulfonylurea - stimulates pancreatic beta cells to release insulin
    • D: 2.5-5 mg daily, inc by 2.5 mg weekly PO, max 20 mg/day, Glynase (micronized glyburide) - 1.5-3 mg daily, inc by 1.5 mg weekly, max dose = 12 mg/day
    • W: hypoglycemia, G6PD deficiency, CI: T1DM, DKA, sulfa allergy
    • S: weight gain, nausea, hypoBG
    • N: inexpensive, weakly active metabolite that is renally cleared, not good in renal insufficiency
  180. diclofenac ☃
    • Cambia, Dyloject, Voltaren, Cataflam
    • I: nonselective COX inhibitor which reduces prostaglandins, NSAID - more COX2, inhibits platelet activity, joint pain
    • D: oral: 50-75 mg BID-TID, Flector patch - 1 patch 180 mg to most painful area BID, Voltaren gel 2-4 g to affected joint QID, Cambia - 1 packet 50 mg mixed in water for acute migraine
    • S: bleeding (take with food), exacerbates CHF/edema
    • N: oral NOT bioequivalent even with same strength, inc uterine contractions, which can terminate preggo
  181. labetolol
    • Trandate
    • I: alpha and beta blocker - HTN oral, IV - hypertensive urgency/emergency
  182. lisdexamfetamine
    • Vyvanse (C-II)
    • I: stimulant, prevents dopamine and NE reuptake in CNS synapses, pro-drug with lysine of dextroamphetamine, ADHD
    • D: 30 mg QAM, max 70 mg/day PO
    • S: weight loss, insomnia, anxiety, tachycardia, increased BP
    • N: can mix contents with water, yogurt or orange juice; take right away, low abuse potential as a prodrug
  183. atomoxetine ☃
    • Strattera
    • I: selective NE reuptake inhibitor - approved for 6+ yo, ADHD
    • D: 40 mg daily, increase after at least 3 days to 80 mg daily, max 100 mg/day, with strong CYP2D6 (paroxetine) max 80 mg/day, PO, can take in divided doses if needed
    • W: B = suicidal ideation, CI psych, mood, rare but severe hepatoxicity (within 120 days), CV, height/weight loss in children
    • S: h/a, ~10% insomnia, ~10% somnolence, hypertension, tachycardia, dry mouth, nausea, abdominal pain, dec appetite, ED, hyperhidrosis
    • N: do not open capsule = irritant
  184. clonazepam
    • Klonopin (C-IV)
    • I: Benzo - enhances GABA, sedative, hypnotic, anticonvulsant, muscle relaxant properties, acute anxiety
    • D: 0.25-0.5 mg PO BID
    • W: B = sedation, respiratory depression, CI acute narrow-angle glaucoma, sleep apnea, severe respiratory insufficiency
    • W: tolerance and dependence = taper, CNS, abuse, preggo defects
    • S: somnolence, dizziness
    • N: generally avoid in the elderly
    • A: flumazenil
  185. entacapone
    • Comtan
    • I: COMT inhibitor - inhibits the enzyme Catechol-O-methyltransferase (COMT) to prevent peripheral and central conversion of levodopa, Parkinson
    • D: 200 mg with each dose of carbidopa/levodopa, max 1,600 mg/day
    • S: similar to levodopa - nausea, dizziness, orthostasis, dry mouth, dyskinesias - can happen earlier
    • N: dec levodopa dose of 10-30% usually necessary when adding on a COMT inhibitor
  186. quinapril
    • Accupril
    • I: ACEI (reduce angiotensin 2, a potent vasoconstrictor) - HTN, kidney protection + DM, HF
    • D: 5-40 mg daily PO
    • W: B = no preggo, 2/3rd trim defects, CI angioedema hx, washout with Entresto 36 hours
    • S: cough, dizziness, h/a, rash, hyperkalemia
    • N: can be used BID if needed
  187. insulin aspart
    • Novolog
    • I: Diabetes, rapid acting analog
    • D: up to 15 mins before meals or immediately after meals, all 100 units/mL - vials 10 mL, pens 3 mL
    • W: hypoglycemia, hypoK+, may need to dec dose if renal/hepatic impairment
    • S: wt gain, lipodystrophy (thickening or thinning of adipose tissue), injection site reactions, peripheral edema, antibodies
    • N: prandial/mealtime insulin
  188. insulin lispro
    • Humalog
    • I: Diabetes, rapid acting analog
    • D: up to 15 mins before meals or immediately after meals, all 100 units/mL - vials 10 mL, pens 3 mL
    • W: hypoglycemia, hypoK+, may need to dec dose if renal/hepatic impairment
    • S: wt gain, lipodystrophy (thickening or thinning of adipose tissue), injection site reactions, peripheral edema, antibodies
    • N: prandial/mealtime insulin
  189. ketoconazole shampoo
    • Nizoral A-D
    • I: fungal scalp infections, inhibits fungal P450 14 alpha-demethylase, antiviral, off-label for advanced prostate cancer d/t anti-androgenic activity (dosing differs)
    • D: 200-400 mg PO daily, no renal
    • W: B = hepatotoxicity - led to liver transplant or death, CI for ventricular arrhythmias with cisapride, dofetilide, pimozole, quinidine, use only tablets when other effective antifungal therapy is unavailable or not tolerated
    • W: liver dysfunction, hepatotoxicity
    • S: hair loss/possible hair growth and altered hair texture 
    • N: 3A4 drug interactions with amiodarone, warfarin, phenytoin - maybe for just PO, systemic - liver concerns
  190. bimatoprost
    • Lumigan, Latisse (eyelash hypotrichosis)
    • I: prostaglandin analog for glaucoma - inc aqueous humor outflow and reduces intraocular pressure
    • D: 1 drop QHS, no contact lenses because preservative BAK - wait 15 mins
    • W: darkening iris, eyelashes, eyelash length and number can increase, avoid contamination of bacterial keratitis
    • S: blurred vision, stinging, increased pigmentation
    • N: unopened bottles in refrigerator
  191. hydroxychloroquine
    • Plaquenil
    • I: nonbiologic DMARD - RA and Lupus, originally an anti-malarial drug
    • D: 400 mg/day, then 300 mg/day for maintenance, take with food or milk, PO
    • W: irreversible retinopathy, lsos of visual acuity/macular pigment changes, caution in G6DP deficiency, bone marrow suppression, hypoBG, cardiomyopathy, neuromuscular weakness
    • S: n/v/d, abdominal pain, rash, vision changes (dose-related), rare pigmentation changes of the skin and hair, pruritis, h/a
    • N: need eye exam and muscle strength at baseline and every 3 months during prolonged therapy, CBC and LFTs at baseline and periodically
  192. carvedilol
    • Coreg
    • I: alpha + beta blocker - HTN, HF
    • D: IR 6.25-25 mg BID, CR 20-80 mg daily; HF - 3.125-25 mg BID, max 25 mg BID, and 50 mg BID if >85 kg), CR: 10-80 mg daily, PO
    • W: hyperBG in T2DM by decreasing insulin release, CI severe hepatic impairment
    • W: floppy iris syndrome
    • S: edema, weight gain, inc TGs, dec HDL, dec HR
    • N: take with food to decrease absorption and the risk of orthostatic hypotension, conversion NOT 1:1 - CR has less bioavailability than IR
  193. lamotrigine
    • Lamictal
    • I: AED, inhibits voltage sensitive sodium channels which stabilizes neuronal membranes - seizures, mood - bipolar
    • D: week 1 and 2 - 25 mg daily, week 3 and 4 - 50 mg daily, week 5 and on - inc by 50 mg daily every 1-2 weeks, maintenance - 300-400 mg BID, daily if XR
    • W: B = SJS dose-related, or co-admin with valproic acid 
    • W: risk of aseptic meningitis, blood dyscrasias, DRESS
    • S: n/a, somnolence, rash, tremor, ataxia, blurred vision, alopecia (supplement selenium and zinc)
  194. meclizine
    • Dramamine All Day Less Drowsy, Bonine, Motion-Time, Travel Sickness
    • I: antihistamine at H1 receptors, motion sickness, nausea, vertigo (previously Antivert)
    • D: 25-50 mg PO 1 hour before travel, can repeat Q24H PRN
    • W: CNS depression, worsen BPH sx, increase IOP (glaucoma)
    • S: sedation, dry mouth, dry/blurry vision, tachycardia, anticholinergic
  195. diphenhydramine
    • Benadryl, Unisom
    • I: H1 receptor antagonist, first generation antihistamine, sleep, mild-mod allergic reactions, itching
    • D: 50 mg PO QHS sleep, 25 mg Q4H PRN, max 150 mg/day
    • W: avoid in elderly (Beers), excessive sedation
    • S: somnolence, cognitive impairment, strong anticholinergic effects, seizures/arrhythmias in higher doses
    • N: avoid in lactation (use second gen), d/c 4 days prior to allergy testing, photosensitizing (protection)
  196. benzonatate
    • Tessalon Perles, Zonatuss
    • I: anesthetic type effects to numb the throat and suppress cough
    • D: 100-200 mg TID PRN, max 600 mg/day
    • W: accidental ingestion and fatal overdose have been reported in children <10 yo, avoid
    • S: somnolence, confusion, hallucinations, GI upset, make sure not to mask ACE inhibitor cough
    • N: perle = gelcap
  197. atenolol
    • Tenormin
    • I: B1 selective blocker, prevents activity of sympathetic nervous system leading to reduction in HR and BP - HTN
    • D: 25-100 mg daily PO
    • W: B = do not discontinue abruptly, CI severe bradycardia, 2/3rd AV block
    • W: mask hypoglycemic sx (except sweating), mask hyperthyroidism, caution with bronchospastic dx
    • S: bradycardia, low HR, hypotension, fatigue, dizziness, depression
    • N: safety issue in preggo
  198. bisoprolol
    • Zebeta
    • I: B1 selective blocker, prevents activity of sympathetic nervous system leading to reduction in HR and BP - HTN
    • D: 2.5-20 mg daily PO
    • W: B = do not discontinue abruptly, CI severe bradycardia, 2/3rd AV block
    • W: mask hypoglycemic sx (except sweating), mask hyperthyroidism, caution with bronchospastic dx
    • S: bradycardia, low HR, hypotension, fatigue, dizziness, depression
  199. ciprofloxacin ☃
    • Cipro
    • I: FQ - inhibits DNA gyrase in bacteria which prevents DNA separation and cell division
    • D: 250-750 mg PO or 200-400 mg IV Q8H-12H, CrCl 30-50 = Q12H, <30 = Q18-24H
    • W: B = tendon inflammation and/or rupture (esp with concurrent systemic steroid use, organ transplant patients, >60 yo), peripheral neuropathy (months to years even after no med), CNS effects, seizures, may exacerbate muscle weakness related to myasthenia gravis, alternative for bacterial sinusitis or acute exacerbation of chronic bronchitis, uncomplicated UTI if no alternative, CI with tizanidine
    • W: QT prolongation, hypo/hyperBG, hepatoxicity, photosensitivity, avoid in children unless Anthrax (benefits>risk), crystalluria (stay hydrated)
    • S: n/d, h/a, SJS, hemolytic anemia, bone marrow suppression
    • N: Cipro - crush IR, mix with water for feeding tube - hold feedings 1 hour before, 2 hours after, NOT cipro oral suspension which is oil-based and must shake vigorously for 15 seconds each time before use. Avoid cal/iron
  200. mometasone furoate
    • Elocon Ointment 0.1%
    • high potency topical steroid - poison ivy, variety of inflammatory reactions
  201. nabumetone ☃
    • Relafen
    • I: NSAID - nonselective cox inhibitor - more cox 2, reduce prostaglandins
    • D: 1,000-2,000 mg daily (can be BID), PO
    • S: bleeding (take with food), exacerbates CHF/edema, inhibits platelet activity
  202. ezetimibe
    • Zetia
    • I: inhibits intestinal absorption of cholesterol leading to lower levels
    • D: 10 mg daily PO
    • W: CI statin, active liver disease (including any unexplained inc in LFTs), preggo/breastfeeding
    • W: avoid in mod-severe hepatic impairment, skeletal muscle effects
    • S: diarrhea, URTIs, arthralgias, myalgias, sinusitis
    • N: lower on the totem pole
  203. clonidine, ER
    • Catapres, TTS Patch, Kapvay
    • I: activates alpha-2 receptors to reduce sympathetic outflow which lowers BP and pulse, stimulates in the brain, HTN, ADHD
    • D: HTN - 0.1-0.2 mg PO BID, max 2.4 mg daily, Weekly patch - Catapres TTS-1 = 0.1 mg/24hr, Catapres TTS-2 = 0.2 mg/24hr, Catapres TTS-3 = 0.3 mg/24hr,  ADHD - 0.1 mg QHS, inc by 0.1 mg weekly, max 0.4 mg/day - take BID, if uneven dosing with the higher dose QHS
    • W: do not d/c abruptly - rebound HTN, taper gradually over 2-4 days
    • S: dry mouth, somnolence, h/a, fatigue, dizziness, constipation, low HR, hypotension, depression, sexual dysfunction, patch = skin rash, pruritis, erythema, contact dermatitis
    • N: apply weekly, remove before MRI, generally avoided in elderly
  204. digoxin
    • Lanoxin
    • I: inhibits NA/K+ ATPase leading to in increase in the force of contraction of the heart, positive inotropic, also exerts parasympathetic effect for negative chronotropic effect, reduce hospitalization - HF, afib
    • D: 0.125-0.25 mg daily PO, range in HF 0.5-0.9 ng/mL, <50 ml/min = lower dose or frequency, dec dose by 20-25% when going from PO to IV. LD for afib = total digitalizing drug is 8-12 mcg/kg - range if afib 0.8-2 ng/mL
    • W: 2/3rd degree heart block without a pacemaker, Wolff-Parkinson-White Syndrome (WPW) with afib, vesicant (avoid extravasation) CI vfib
    • S: dizziness, mental disturbances, h/a, n/v/d
    • N: toxicity = n/v, loss of appetite, and bradycardia first, then blurred/double vision, altered color perception, greenish-yellow halos around lights or objects, abdominal pain, confusion, delirium, prolonged PR interval, arrhythmias, 50-70% cleared by kidneys, substrate 3A4 = 50% with amiodarone/dronedarone, can accumuulate with low potassium levels
    • A: DigiFab
  205. oxycodone/apap
    • Percocet (C-II), Endocet, Roxicet, Xartemis XR
    • I: oxycodone activates mu-opioid receptor, apap suspected to inhibit prostaglandin synthesis which reduces pain
    • W: B = 3A4 inhibitors or stopping inducers can cause fatal overdose
    • S: constipation (dose-related), respiratory depression, addiction/dependence risk, nausea
    • N: avoid high fat meals with higher doses (except OxyContin), start at lower dose if renally impaired, accumulation of parent and active metabolite
  206. hydrocodone/apap
    • Vicodin, Lortab, Norco, Lorcet, Anexsia (C-II)
    • I: hydrocodone - activates mu-opioid receptor, apap suspects to inhibit prostaglandin synthesis to reduce pain
    • D: Norco 2.5, 5, 7.5, 10 mg hydrocodone + 325 mg apap, usual starting dose 5/325 mg Q6H, PO 
    • W: B = hepatotoxicity >4 gm/day of apap
    • W: respiratory and CNS depression, constipation, hypotension, skin reactions (rare), caution in liver disease avoid/limit ETOH intake and in 2D6 poor metabolizer
    • S: n/v, dizziness, lightheadedness, rare skin rash, constipation, respiratory depression, addiction/dependence risk
  207. travoprost
    • Travatan Z
    • I: prostaglandin analog for glaucoma - inc aqueous humor outflow and reduces intraocular pressure
    • D: 1 drop QHS, no contact lenses because preservative BAK - wait 15 mins
    • W: darkening iris, eyelashes, eyelash length and number can increase, avoid contamination of bacterial keratitis
    • S: blurred vision, stinging, increased pigmentation
    • N: unopened bottles in refrigerator
  208. estradiol
    • Elestrin (topical gel), patches - Alora, Vivelle-Dot, Climera, Menostar, Minivelle, Femring (vaginal ring)
    • I: hormone therapy for menopause
    • D: Vivelle-Dot/Alora/Miniville twice weekly, Climara/Menostar once weekly, ring
    • W: B = endometrial cancer without progestin with a uterus, dementia, inc risk of VTE/stroke 50-79 yo, breast cancer, CI breast cancer hx, undiagnosed uterine bleeding, active VTE, arterial thromboembolic disease, known protein C/S/antithrombin deficiency, hepatic impairment, NO preggo
    • S: edema, hypertension, h/a, wt gain, depression, nausea, patch = redness/irritation of the skin, may need to be removed prior to MRI
  209. timolol
    • Timolol GFS, Timoptic
    • I: nonselective beta blockers to reduce aqueous humor production in glaucoma
    • D: Timolol - 1 gtt daily or BID, Timoptic-XE and Timolol GFS (gels) - daily (shake once before use, wait 10 minutes after other eye drops before inserting gel
    • W: CI sinus bradycardia, sinus node dysfunction, heart block > than first degree (except with pacemaker), cardiogenic shock, uncompensated cardiac failure, bronchospastic disease
    • S: slight burning, stinging, itching of the eye/lids, fatigue, inc sensitivity to the eyes to light, bronchospasm with non-selective agents
    • N: betaxolol is the only selective, some contain sulfites = allergic rxns, top-selling glaucoma med
  210. eplerenone
    • Inspra
    • I: k+sparing diuretic, HTN, HF
    • D: 50 mg daily/BID, HF 25-50 mg daily PO
    • W: CI K>5.5 mEq/L, anuria, renal impairment, type 2 dm with microalbuminuria, scr >2 mg/dL in males or >1.8 mg/dL in females, CrCl < 50 mL/min, co-administration of strong 3A4 inhibitors
    • S: dehydration, hyponatremia, dizziness, hyperchloremic, metabolic acidosis (rare), hyperTGemia
  211. metronidazole
    • Flagyl
    • I: disrupts bacterial DNA synthesis - anaerobes and protozoal infections - bacterial vaginosis, trichomoniasis, giardiasis, amebiasis, cdiff, combo for intra-abdominal infections
    • D: 500-750 mg IV/PO Q8-12H or 250-500 mg IV/PO Q6-8H, mild/mod CDI - 500 mg IV/PO TID for 10-14 days, no renal, take IR with food to dec GI upset, ER empty stomach
    • W: B = carcinogenic in animal data, CI preggo 1st trim, disulfiram within the past 2 weeks, use of alcohol or propylene glyco-containing products during therapy or within 3 days of therapy discontinuation
    • W: CNS effects - seizures, neuropathies, aseptic meningitis, encephalopathy
    • S: h/a, nausea, metallic taste, furry tongue, darkened urine, rash, dizziness
    • N: IV:PO  = 1:1, interaction with warfarin
  212. conjugated equine estrogens
    • Premarin
    • I: hormone therapy for menopause with sx like hot flashes, vaginal dryness, etc. 
    • D: oral: 0.3, 0.45, 0.625, 0.9, 1.25 mg, injection
    • W: B = endometrial cancer (if uterus without progestin), inc risk of stroke and VTE 50-79 yo postmenopausal, breast cancer
    • S: edema, HTN, h/a, wt gain, depression
  213. irbesartan
    • Avapro 
    • I: ARB - prevents angiotensin (vasoconstrictor) doing it's work, HTN, HF
    • D: 75-300 mg daily PO
    • S: no preggo, less cough, hyperkalemia
  214. losartan
    • Cozaar
    • I: ARB - prevents angiotensin (vasoconstrictor) doing it's work - HTN, HF
    • D: 25-100 mg in 1-2 divided doses PO
    • S: no preggo, less cough, hyperkalemia
  215. fluocinonide
    • Vanos cream 0.1% 
    • very high potency topical steroid for eczema
  216. bisoprolol/HCTZ
    • Ziac
    • I: bb/thiazide diuretic - HTN in setting of post-MI
  217. olmesartan
    • Benicar
    • I: ARB - prevents angiotensin (vasoconstrictor) doing it's work - HTN, HF
    • D: 10-40 mg daily PO
    • S: no preggo, less cough, hyperkalemia
  218. methotrexate
    • Trexall, needle - Otrexup and Rasuvo, ped oral soln - Xatmep, Rheumatrex
    • I: non biologic DMARD - inhibition of dihydrofolate reductase (anticancer) 
    • D: 7.5-20 mg once weekly PO - low dose and supplement with folic acid - dose once weekly and monitor liver function
    • W: B = hepatotoxicity, myelosuppression, mucositis/stomatitis, preggo, acute renal failure, pneumonitis, GI, derm, lymphomas, opportunistic infections, renal/lung toxicity (with higher oncology doses), CI - NO preggo, breastfeeding, alcoholism, chronic liver disease, blood dyscrasias, immunodeficiency syndrome
    • S: n/v/d, inc LFTs, stomatitis, alopecia, photosensitivity, arthralgia
    • N: folate given to dec hematological, GI, and hepatic side effects - 5 mg PO weekly on the day following MTX - some take 1 mg daily on non-MTX days
  219. doxepin
    • Silenor
    • I: tricyclic antidepressants - NE and 5HT reuptake inhibitor, block ACh and histamine receptors which cause SE - for sedation
    • D: depression doxepin 100-300 mg/day PO
    • W: B = suicide in the young, CI MAOI, linezolid, IV methylene blue, MI, glaucoma, urinary retention
    • S: QT prolongation, orthostasis, anticholinergic, sedation, wt gain
  220. epinephrine emergency pen
    • EpiPen 
    • I: allergic reactions, epinephrine constricts blood vessels to increase pressure for oxygen-rich blood flow to increase, and relaxes smooth muscle in the lungs to increase air exchange
  221. mirtazipine
    • Remeron
    • I: tetracyclic antidepressant, blocking alpha-2 receptors as well as serotonin subtypes and histamine blockade - increase appetite (to gain weight) and sedation
    • D: 15-45 mg QHS PO daily
    • W: B = suicide in the young
    • W: anticholinergic effects, QT prolongation, blood dyscrasias, CNS depression
  222. cephalexin
    • Keflex
    • I: first gen cephalosporin cover good staph and strep, inhibits PBP preventing cell wall synthesis
    • D: 250-2,000 mg PO Q6-12H
    • W: anaphylaxis, some inc INR on warfarin, cross-sensitivity (<10%) with PCN allergy (no in swelling, angioedema, anaphylaxis)
    • S: GI upset, diarrhea, rash, seizures with accumulation
  223. trazodone
    • Desyrel
    • I: possible serotonin type activity, not well understood, histamine blockade may be responsible for sedative effect - off-label for sleep primary use 
    • D: 50-100 mg QHS PO
    • W: B = suicide in the young, CI MAO inhibitors, linezolid, IV methylene blue
    • S: sedation, dry mouth, orthostasis, sexual dysfunction risk of priapism >4 hr painful erection = medical emergency
    • N: possibly safer in elderly than z drugs
  224. fexofenadine
    • Allegra, Mucinex Allergy
    • I: selective antihistamine (H1) antagonist/blocker
    • D: 60 mg PO BID or 180 mg daily; 2-11 yrs = 30 mg PO BID
    • W: CNS depression - sedation with other sedating drugs
    • S: somnolence (more with cetirizine and levocetirizine)
    • N: take with water (not juice = dec absorption), avoid admin with aluminum or magnesium-containing products, d/c at least 4 days prior to allergy skin testing, PREGGO (preferred: loratadine and cetirizine)
  225. amitriptyline
    • Elavil
    • I: tertiary amine - Tricyclic antidepressants - inhibits norepinephrine and serotonin reuptake, leading to increased concentrations in the synapse 
    • D: depression - 100-300 mg/day QHS or divided doses; neuropathic pain/migraine prophy 10-50 mg QHS PO
    • W: B = suicide in the young, CI MAO inhibitors, linezolid, IV methylene blue
    • S: cardiotox - QT prolongation with overdose, anticholinergic, fall risk, sedation, wt gain
  226. pioglitazone ☃
    • Actos
    • I: T2DM, TZDs - PPARgamma agonists = decrease insulin resistance in the periphery, greater uptake of glucose into muscle tissue and lower BG
    • D: 15-30 mg daily (15 mg/day for NYHA class I/II, max 45 mg daily PO
    • W: B = cause or exacerbate HF, CI NYHA class III/IV HF
    • W: hepatic failure, edema (including macular edema), risk of fractures, unintended preggos with ovulation in premrenopausal, increased risk of urinary bladder tumors; do not use in patients with active bladder cancer and consider risk in patients with a prior hx of bladder cancer
    • S: peripheral edema, weight gain, URTIs, myalgia, inc HDL, lower TGs and cholesterol
  227. estrogen + drospirenone, monophasic
    • Yaz
    • I: oral contraceptive - estrogen prevents ovulation and reduces risk of pregnancy
    • D: 24/4 pill pack (active/inactive) PO
    • S: DVT/PE, hypertension, h/a, GI
  228. loratadine
    • Claritin, Alavert
    • I: second gen antihistamine (H1) receptor antagonist 
    • D: 10 mg PO daily OR 5 mg PO BID (RediTabs), 2-5 yo - 5 mg PO daily
    • W: CNS depression with other sedating drugs
    • S: somnolence, dry mouth
    • N: d/c at least 4 days prior to allergy skin test, good for preggo
  229. mometasone intranasal
    • Nasonex
    • I: stimulates glucocorticoid receptors to reduce inflammation
    • D: 2 sprays per nostril, 2-11 yo - 1 spray per nostril
    • W: adrenal suppression, delayed wound healing
    • S: h/a, dry nose, epistaxis, unpleasant taste
    • N: up to 1 week for full relief, budesonide is preferred in preggo, several months need nasal exams, d/c if in contact with chicken pox, measles, or TB. Shake bottle and discard after total uses then throw away even if not empty
  230. isosorbide mononitrate
    • Imdur, Monoket
    • I: increase in nitric oxide leads to venous and arterial dilation - HF
    • D: target 120 mg daily
    • W: CI PDE-5 inhibitors and riociguat
    • S: h/a, dizziness, tachyphylaxsis need 10-12 hour nitrate-free interval
  231. cefdinir
    • Omnicef
    • I: 3rd gen cephalosporin, inhibit PBP preventing cell wall synthesis - more S. pneumo, MSSA, more HNPEK, gram+anaerobes in mouth flora
    • D: 300 mg PO Q12H or 600 mg PO daily
    • W: anaphylaxis, some inc INR on warfarin, cross-sensitivity (<10%) with PCN allergy (no in swelling, angioedema, anaphylaxis)
    • S: GI upset, diarrhea, rash, seizures with accumulation
  232. cefuroxime
    • Ceftin, Zinacef
    • I: 2nd gen cephalosporin, inhibit PBP preventing cell wall synthesis - HNPEK (only PEK in 1st gen)
    • D: 250-1,500 mg PO/IV/IM Q8-12H, take suspension with food
    • W: anaphylaxis, some inc INR on warfarin, cross-sensitivity (<10%) with PCN allergy (no in swelling, angioedema, anaphylaxis)
    • S: GI upset, diarrhea, rash, seizures with accumulation
  233. oxybutynin
    • Ditropan, Oxytrol patch
    • I: antagonist at muscarinic receptors for overactive bladder and block ACh
    • D: 5 mg PO BID-TID, 5-30 mg PO daily, patch - 3.9 mg daily = Rx patch changed every 3-4 days; OTC every 4 days
    • W: anticholinergic, angioedema, CI urinary retention, gastric retention, decreased gastric motility, and uncontrolled narrow angle glaucoma, OTC - pain or burning when urinating, blood, males, age <18 yo
    • S: dizziness, drowsiness, xerostoma, constipation
  234. hydralazine
    • Apresoline
    • I: direct vasodilator - HTN
    • D: PO 10-50 mg QID, max 300 mg daily, IV 10-20 mg Q4-6H PRN
    • W: DILE, CI mitral valvular rheumatic heart disease, CAD
    • S: h/a, hypotension, reflex tachycardia, palpitations, peripheral neuritis
  235. mirabegron
    • Myrbetriq
    • I: agonist at Beta3 receptors causes detrusor smooth muscle relaxation and can help with overactive bladder
    • D: 25-50 mg daily PO, CrCl 15-29 = 25 mg, not rec <15 ml/min
    • W: angioedema, inc BP/HR, urinary retention with BPH and combo with anticholinergic drugs
    • S: hypertension, UTI, h/a, constipation
  236. canagliflozin ☃
    • Invokana
    • I: T2DM, SGLT2 inhibitors to keep glucose in the urine 
    • D: 100 mg daily prior to first meal of the day up to 300 mg daily, eGFR 45-59 = 100 mg daily max, 30-44 = not rec, <30 = nope, PO
    • W: B = increased risk of leg and foot amputations, CI ESRD, dialysis
    • W: ketoacidosis, genital mycotic infections, urosepsis, pyelonephritis, hypotension, AKI, hyperkalemia, risk of fractures
    • S: wt loss, hypoBG, inc urination/thirst/MGPO4
  237. empagliflozin ☃
    • Jardiance
    • I: T2DM, SGLT2 inhibitors to keep glucose in the urine
    • D: 10 mg daily in the morning up to 25 mg daily, eGFR 30-44 = not rec, <30 nope, PO
    • W: ketoacidosis, genital mycotic infections, urosepsis, pyelonephritis, hypotension, AKI
    • S: wt loss, hypoBG, inc urination/thirst/MGPO4
  238. linagliptin ☃
    • Tradjenta
    • I: DDP4 inhibitor - stop DPP4 from breaking down GLP-1 which are hormones that reduce BG by promoting fullness, T2DM
    • D: 5 mg daily PO, no renal!
    • W: acute pancreatits, rash, arthralgia
    • S: nasopharyngitis, URTIs, UTIs, peripheral edema, rash, GI, low risk hypoBG monotherapy
  239. dulaglutide ☃
    • Trulicity 
    • I: T2DM, GLP-1 agonist to aid in promoting fullness, decrease appetite, and possibly stimulate insulin release
    • D: 0.75 mg SC once weekly, can inc to 1.5 mg SC once WEEKLY
    • W: B = risk of thyroid C-cell carcinomas - seen in rats, CI personal family of medullary thyroid carcinoma (MTC) or patients with multiple endocrine neoplasia syndrome (MEN 2)
    • W: pancreatitis, not rec in severe GI disease
    • S: nausea, v/d, constipation, wt loss, injection site reactions, hypoBG, CV effects (tachy, 1st degree AV block, PR interval prolongation (only one!!!)
  240. carbamazepine
    • Tegretol
    • I: sodium channel antagonist for seizure, bipolar, and trigeminal neuralgia, AED
    • D: 200 mg BID PO (QID suspension), max 1,600 mg/day +
    • W: B = SJS esp in Asians = HLA-B*1502, aplastic anemia and agranulocytosis, CI myelosuppression, hypersensitivity to TCAs, use of MAOi within 14 days, nefazodone, delavirdine or other NNRTIs
    • W: DRESS, SIADH (hypoNA), fetla harm, hypothyroidism, liver damage (monitor LFTs), HLA-A*3101 variant for hypersensitivity
    • S: n/v, dry mouth, pruritis, photosensitivity, blurred vision
    • N: autoinducer 3A4 and inducer CYP450 of many
  241. acyclovir
    • Zovirax
    • I: inhibits DNA polymerase which prevent viral replication - antiviral for herpes simplex and varicella zoster virus
    • D: 400 mg PO TID x7-10 days or 200 mg PO 5xdaily x7-10 days, recurrent 400 mg PO TID x5 days or 800 mg PO BID x 5 days, or 800 mg PO TID x 2 days, chronic 400 mg PO BID
    • W: thrombocytopenia purpura/hemolytic uremic syndrome (TTP/HUS), caution in renal impairment, the elderly
    • S: GI, malaise, h/a, n/v/d, rash, inc LFTs, neutopenia
    • N: dose is based on IBW in obese patients, 5 mg/kg IV = 1,000 mg PO, crystal nephropathy IV, drink lots of water!
  242. doxazosin
    • Cardura
    • I: alpha 1 adrenergic receptor blockers to have smooth muscle relaxation of the bladder neck adn prostate and vasodilation - BPH and HTN - since not selective
    • D: IR 1-4 mg daily, max 16 mg daily, XL 4-8 mg daily PO - usually at night
    • W: orthostatic hypotension, floppy iris syndrome, priapism, not rec in severe hepatic impairment, caution with strong 3A4 inhibitors
    • S: dizziness, fatigue, h/a, edema
  243. propranolol
    • Inderal LA, XL, InnoPran XL
    • I: nonselective BB - HTN, unique: tremors, esophageal varices, migraines
    • D: PO IR 40-160 mg BID, max 640 mg daily, LA 80-160 mg daily, max 640 mg daily, XL 80 mg daily, max 120 mg daily
    • W: B = do not discontinue abruptly, CI severe bradycardia, 2/3rd AV block
    • W: mask hypoglycemic sx (except sweating), mask hyperthyroidism, caution with bronchospastic dx
    • S: bradycardia, low HR, hypotension, fatigue, dizziness, depression
    • N: high lipid solubility to cross BBB so more CNS side effects, but unique for migraine prophy and essential tremor
  244. niacin ER
    • Niaspan
    • I: inhibit of TG synthesis by stimulating intracellar Apo-B degradation and reduces release of VLDL and LDL
    • D: PO 500 mg nigthly x 4 weeks, can inc weekly to max of 2 gm daily
    • W: in caution with unstable angina or acute phase of an MI, rhabdo 1+gm/day with statins, hepatotoxicity, CI active liver disease, active PUD, arterial bleeding
    • S: flushing, pruritis (itching), n/v/d, hyperBG, hyperUA, cough, orthostatic hypotension, hypoPHOS, dec platelets
    • N: check LFTs, IR more flushing/itching (take aspirin 325 mg, ibuprofen 200 mg - 30-60 mins before), take with food (avoid spicy/hot beverages make flushing worse) and 4-6 hours after bile acid sequestrants
  245. guaifenesin
    • Robitussin Mucus + Chest Congestion, Mucinex
    • I: cough - increases volume and reduces thickness of mucous (expectorant)
    • D: 200-400 mg Q4H PRN, or 600-1,200 mg ER Q12H, max 2.4 g/day PO, age 6-11 = 1,200 mg/day max, 4-5 years = 600 mg/day max
    • W: some contain phenylalanine
    • S: nausea dose related, v/dizziness, h/a, rash, diarrhea, stomach pain
    • N: no <2 yo, questionable effectiveness, take with lots of water
  246. buspirone
    • Buspar
    • I: serotonin partial agonist and 5HT1A receptors, moa unknown, anxiety
    • D: 7.5 mg PO BID, can inc by 5 mg/day every 2-3 days, max 30 mg PO BID, be consistent with or without food, avoid in severe kidney or liver impairment
    • W: no MAOi within 14 days, no linezolid, methylene blue
    • S: nausea, dizziness, drowsiness, h/a, excitement 
    • N: no potential for abuse, taper the benzo if putting this on cause take awhile to work!
  247. tolterodine
    • Detrol, LA
    • I: antagonist at M2, M3 muscarinic receptors for overactive bladder
    • D: IR 1-2 mg PO BID, LA 2-4 mg PO daily
    • W: anticholinergic, angioedema, CI urinary retention, gastric retention, decreased gastric motility, uncontrolled narrow angle glaucoma
    • S: dizziness, and drowsiness (less than oxybutynin), xerostoma, constipation, dry eyes/blurred vision
    • N: dec dose if CrCl <30 ml/min
  248. polyethylene glycol 3350
    • Miralax
    • I: osmotic laxative draws moisture into bowel to help relieve constipation
    • D: 17 g in 4-8 oz of water daily
    • W: CI GI obstruction
    • S: electrolyte imbalance (rare), gas, dehydration, diarrhea
    • N: onset 30 mins to 96 hours oral
  249. ibandronate ☃
    • Boniva
    • I: inhibits resorption of bone by osteoclasts for osteoporosis
    • D: treatment postmenopausal women - 3 mg IV every 3 months, over 15-30secs, prevention AND tx 150 mg PO monthly on same date every month (GI upset, and separate from ca,antacids,iron,mag by 2 hours)
    • W: ONJ, atypical femur fractures, hypocalcemia must be corrected, renal impairment do not use <30 ml/min, CI hypocalcemia, unable to sit upright for 60 mins!
    • S: hypocalcemia, hypoPHOS, acute phase reaction (flu-like)
    • N: cal+vit D checks, dental work first, separate antacid ca, etc.
  250. clotrimazole + betamethasone
    • Lotrisone
    • I: combo antifungal and topical corticosteroid - antifungal
    • N: takes a while, can thin the skin with prolonged use, skin irritation
  251. ferrous sulfate
    • Feosol
    • I: iron replacement
    • S: GI upset (can take with food), but best to be empty for absorption, constipation, dark stools
    • N: deficiency can cause anemia and RLS
  252. risedronate ☃
    • Actonel, Atelvia
    • I: inhibits resorption of bone by osteoclasts, for osteoporosis
    • D: P/T postmenopausal women - 5 mg PO daily or 35 mg PO weekly, or 75 mg PO on 2 consecutive days/month or 150 mg PO monthly, MALES tx 35 mg PO weekly, glucocorticoid-induced osteo 5 mg PO daily
    • W: ONJ, atypical femur fractures, esophagitis, fix hypocalcemia, renal no <30 ml/min, CI inability to sit upright for at least 30 mins
    • S: hypocalcemia, hypoPHOS, acute phase reaction (flu-like)
    • N: Atelvia is delayed release - requires acidic gut avoid PPIs/H2RAs, cal+vit D checks, dental work first, separate antacid ca, etc.
  253. memantine
    • Namenda
    • I: inhibits N-methyl-d-aspartate (NMDA) receptors to inhibit glutamate and dec abnormal activity and delay progression of Alzheimer's
    • D: PO, IR 5-10 mg BID (start daily and by 5 mg weekly to 10 mg BID), ER 7,14,28 mg daily (start 7 mg daily and titrate weekly, not sooner)
    • S: dizziness, constipation, H/A
    • N: CrCl <30 = NTE 5 mg BID or 14 mg XR daily, do NOT crush/chew, but sprinkle ER caps on applesauce
  254. raloxifene ☃
    • Evista
    • I: SERM - selective estrogen receptor modifier - breast cancer and osteoporosis
    • D: 60 mg PO daily
    • W: CI history DVT/PE, preggo and breastfeeding, QT prolongation, hypoK
    • S: DVT/PE, menopausal sx, hot flashes, flushing, edema, wt gain, HTN, mood, vaginal bleeding/discharge, amenorrhea, skin changes, arthralgia/myalgia
  255. olanzapine
    • Zyprexa, Relprevv inj, Zydis ODT
    • I: SGA - block D2 receptors
    • D: 10-20 mg QHS PO
    • W: B = Relprevv inj - monitored 3 hours post injection for sedation, delirium
    • S: somnolence, wt gain, inc lipids, inc glucose, EPS, QT prolongation, DRESS
    • N: smoking reduces drug levels
  256. dutasteride
    • Avodart
    • I: 5 alpha reductase inhibitor to prevent formation of DHT 
    • D: 0.5 mg daily PO
    • W: increase risk of high-grade cancer
    • S: impotence, decreased libido, breast enlargement
    • N: no PREGGO touchy, months to shrink prostate
  257. moxifloxacin ☃
    • Avelox, Vigamox eye
    • I: FQ abx, inhibits DNA gyrase in bacteria which prevents DNA separation and cell division
    • D: 400 mg IV/PO Q24H, no renal!
    • W: B = tendon inflammation and/or rupture (esp with concurrent systemic steroid use, organ transplant patients, >60 yo), peripheral neuropathy (months to years even after no med), CNS effects, seizures, may exacerbate muscle weakness related to myasthenia gravis, alternative for bacterial sinusitis or acute exacerbation of chronic bronchitis
    • W: QT prolongation (highest!), hypo/hyperBG, hepatoxicity, photosensitivity, avoid in children unless Anthrax (benefits>risk), crystalluria (stay hydrated)
    • S: n/d, h/a, SJS, hemolytic anemia, bone marrow suppression
    • N: not for UTIs, avoid iron/cal
  258. enoxaparin
    • Lovenox
    • I: anticoagulant, increases activity of antithrombin that ultimately inactivates factor 10a, some activity against clotting factor 2a (thrombin), but less than heparin
    • D: prophy of VTE 30 mg Subq Q12H or 40 mg SC daily, CrCl <30 = 30 mg SC daily, TX of VTE/UA/NSTEMI = 1 mg/kg SC Q12H (OR 1.5 mg/kg SC daily only for inpatient VTE tx), CrCl <30 = 1 mg/kg SC DAILY, use ABW for dosing; TX of STEMI - .... IT'S CRAZY
    • W: B = neuraxial anesthesia, CI hx of HIT, active major bleed
    • S: bleeding, anemia, inc LFTs, thrombocytopenia, hyperK, bruising
    • N: anti-Xa monitoring per protocol for PREGGOs, more predictable than UFH, ROOM TEMP, don't expel bubbles, NOT IM
    • A: protamine
  259. nortriptyline
    • Pamelor
    • I: secondary amines TCAs, inhibits NE and serotonin reuptake 
    • D: depression 25 mg TID-QID PO
    • W: B = suicide in the young, CI MAOi, linezolid, IV methylene blue
    • S: cardiotox - QT prolongation, anticholinergic (less than tertiary amines), fall risk
  260. minocycline
    • Minocin, Solodyn
    • I: tetracycline abx - inhibits bacterial protein synthesis by binding to the 30s ribosomal subunit
    • D: 200 mg PO/IV x1, then 50-100 mg Q12H, CrCl <80 = max 200 mg/day
    • W: <8 yo, preggo, and breastfeeding - permanently discolors teeth, suppresses bone growth, and skeletal development, photosensitivity, DRESS, inc BUN, DILE!!
    • S: n/v/d, rash/SJS/TEN
    • N: IV:PO is 1:1, bind with ca/iron
  261. ethinyl estradiol + norgestimate
    • Ortho Tri-Cyclen 
    • I: oral contraceptive, estrogen prevents ovulation and reduces risk of preggo
    • S: DVT/PE, HTN, GI, h/a
    • N: triphasic
  262. flunisolide
    AeroBID (inhaler), Aerospan (nasal spray)
Author
VASUpharm14
ID
341678
Card Set
Top Seller Drugs - RP
Description
let's do this! snowman = medguide
Updated