Top 200: Spring 2011

-Thiazolidinediones (TZD)

-Biguanides

-Sulfonylureas

-Meglitinides

-DPP-IV Inhibitors

-Incretin mimetics

-Alpha-glucosidase Inhibitors

-DPP-IV Inhibitors

-Thiazolidinediones (TZD)

-Biguanides

-Sulfonylureas (rate)

Brand name(s): Micronase, Glynase, DiaBeta

Drug Class: Sulfonylureas

• Adverse Effects:
• -hypoglycemia
• -weight gain

• Other Information:
• -Sulfonylureas increase endogenous insulin secretion
• -Reduces rate of hepatic glucose production
• -Generally the least expensive class of medication

Brand name(s): Amaryl

Drug Class: Sulfonylureas

• Adverse Effects:
• -hypoglycemia
• -weight gain

• Other Information:
• •Sulfonylureas increase endogenous insulin secretion
• •Reduces rate of hepatic glucose production
• •Generally the least expensive class of medication

Brand name(s): Glucotrol, Glucotrol XL

Drug Class: Sulfonylureas

• Adverse Effects:
• -hypoglycemia
• -weight gain

• Other information:
• •Sulfonylureas increase endogenous insulin secretion
• •Reduces rate of hepatic glucose production
• •Generally the least expensive class of medication

Brand name: Actos

Drug Class: Thiazolidinediones

• Adverse Effects:
• –weight gain
• –edema
• –hypoglycemia (if taken with insulin or agents that stimulate insulin release)
• –contraindicated in patients with abnormal liver function or CHF

• Other information:
• •Decrease insulin resistance by making muscle
• and adipose cells more sensitive to insulin.
• •Suppress hepatic glucose production.
• •6 weeks for maximum effect
• •Improves HDL cholesterol and plasma
• triglycerides; usually LDL neutral

Brand name: Avandia

Drug Class: Thiazolidinediones

• Adverse Effects:
• –weight gain
• –edema
• –hypoglycemia (if taken with insulin or agents that stimulate insulin release)
• –contraindicated in patients with abnormal liver function or CHF

• Other information:
• •Decrease insulin resistance by making muscleand adipose cells more sensitive to insulin
• •Suppress hepatic glucose production
• •6 weeks for maximum effect
• •Improves HDL cholesterol and plasmatriglycerides; usually LDL neutral

• Warning:
• Congestive Heart Failure and Myocardial Ischemia

Brand name(s): Glucophage, Glucophage XL

Drug Class: Biguanides

• Adverse Effects:
• -Diarrhea and Abdominal Discomfort
• -Lactic Acidosis if improperly prescribed

• Other Information:
• •Decrease hepatic glucose production
• •Increase insulin-mediated peripheral glucose
• uptake

Brand name: Prandin

Drug Class: meglitinides

• Adverse Effects:
• –Hypoglycemia (although may be less than with sulfonylureas if patient has a variable eating schedule)
• –Weight gain

• Other Information:
• •Stimulate insulin secretion (rapidly and for a short duration) in the presence of glucose.

Brand name: Precose

Drug Class: Alpha-glucosidase Inhibitors

• Adverse Effects:
• –Flatulence or abdominal discomfort

• Patient Education:
• •Take with food!!

• Other Information:
• •Block the enzymes that digests glucose in the
• small intestine (delays glucose uptake)

Brand name: Glyset

Drug Class: Alpha-glucosidase Inhibitors

• Adverse Effects:
• –Flatulence or abdominal discomfort

• Patient Education:
• •Take with food!!

• Other Information:
• •Block the enzymes that digests glucose in thesmall intestine (delays glucose uptake)

Brand name: Januvia

Drug Class: Dipeptidyl-Peptidase 4 (DPP4) Inihibitor

• Adverse Effects:
• -GI side effects

• Efficacy:
• –Decrease fasting blood glucose 10-15 mg/dl
• –Decrease A1C 0.5-0.6%
• –Decrease post-prandial glucose 50 mg/dl

• Other Information:
• •Stimulates the beta cell to release insulin
• •Decreases hepatic glucose production

Brand name: Byetta

Drug Class: Incretin Mimetics

• Other Information:
• •Incretin: hormone in the gut which act on the pancreas to increase insulin production
• •Stimulates pancreas to make more insulin
• •Increases B-cell growth/replication
• •Treats type 2 diabetes
• •Administered SQ

Brand Name(s): NovoLOG, NovoLOG FlexPen

Drug Class: Rapid Acting Insulin

• Patient Education:
• •Given SQ
• •Proper injection is KEY
• •Stored in fridge or at room temperature
• –Unopened vials kept in fridge until expiration date
• –Opened vials good at room temp for 30 days

Brand Name(s): Lantus

Drug Class: Long Acting Insulin

• Patient Education:
• •Given SQ
• •Proper injection is KEY
• •Stored in fridge or at room temp
• –Unopened vials kept in fridge until expiration date
• –Opened vials good at room temp for 30 days

Brand Name(s): HumaLOG

Drug Class: Rapid Acting Insulin

• Patient Education:
• •Given SQ
• •Proper injection is KEY
• •Stored in fridge or at room temp
• –Unopened vials kept in fridge until expiration date
• –Opened vials good at room temp for 30 days

Brand Name(s): Iletin® II Regular Purified Pork

Drug Class: Insulin

• Patient Education:
• •Given SQ
• •Proper injection is KEY
• •Stored in fridge or at room temp
• –Unopened vials kept in fridge until expiration date
• –Opened vials good at room temp for 30 days

Brand name(s): Motrin, Advil

Drug Class: NSAID

• Indications for Use:
• -Inflammatory disease
• -Rheumatoid disorders
• -mild to moderate pain
• -fever

• Adverse Effects:
• -Abdominal pain
• -Constipation
• -Indigestion

• Patient Education:
• -Take with food or milk
• -Avoid Aspirin
• -Adult Max Dose = 3.2 grams per day

• Patient Dosing:
• Pediatric dosing:
• -Approved for use in children 6 months of age and older
• -Temp <102.5: 5mg/kg/DOSE
• -Temp >102.5: 10mg/kg/DOSE
• -Dosed every 6-8 hours
• -Max dose: 40mg/kg/DAY
• Adult dosing:
• -Max adult dose 3.2 grams/day
• Ibuprofen Dosing Chart for Pediatrics:
• 

• Ibuprofen Guide to Dosing for Children:
• 

Brand name(s): Tylenol

Drug Class: Analgesic

Indication for use: Relief of mild to moderate pain and/or fever.

• Adverse Effects:
• -rash
• -anemia

• Patient Education:
• -VERY weak COX-1 and COX-2 inhibitor (no significant anti-inflammatory effects)
• -Ethanol use (increases risk of acetaminophen-induced hepatotoxicity)

• Patient Dosing:
• Children < 12 years of age:
• -10 to 15 mg/kg q4h prn
• -do not exceed 5 doses (2.6 g) in 24 hours
• Adults:
• -325 to 650 mg q4h
• -1000 mg 3 to 4 times per day
• -do not exceed 4 g in one day

APAP Dosing Guide:

Generic name(s): Aspirin, Acetylsalicylic acid

• Drug Class: Analgesic, NSAID *Aspirin was the first NSAID
• Indications for Use:
• -mild to moderate pain
• -inflammation
• -fever
• -prevention of MI & other cardiac conditions
• -inhibits prostaglandin synthesis
• -Debate about adult dosage (81 mg vs. 325 mg)

• Contraindications:
• -hypersensitivity
• -bleeding disorders (e.g. with warfarin)
• -Children <16 years old should not use Aspirin (association with Reye's syndrome)

• Pregnancy:
• -Do not use when pregnant
• -Crosses placenta & enters fetal circulation
• -3rd trimester particularly vulnerable because Aspirin may promote premature closure of the ductus areteriosus in the fetus

• Adverse Effects:
• -Bleeding (caution dose)
• -fatigue
• -rash
• -abdominal pain

• Patient Education:
• -Caution OTCs
• -Toxic dose causes salicylism (vomiting, vertigo & tinnitus)

Brand name(s): Celebrex

Drug Class: Cox II Inhibitor, NSAID

Indications for Use: Relief of osteoarthritis and rheumatoid arthritis.

• Adverse Effects:
• -GI irritation
• -Headache

• Patient Information:
• Other similar products have been taken off the market due to increased risk of heart attack & stroke.

Brand name(s): Mobic

Drug Class: Analgesic, NSAID

Indications for Use: Relief of symptoms of Osteoarthritis, Rheumatoid and Juvenile Rheumatoid arthritis

• Adverse Effects:
• -Edema
• -Headache
• -Dizziness

• Patient Education:
• -Take with food or milk
• -Avoid aspirin

Brand name(s): Lodine

Drug Class: NSAID

Indications for Use: Relief of osteoarthritis and rheumatoid arthritis.

• Adverse Effects:
• -Abdominal pain
• -Constipation
• -Nausea

• Patient Education:
• -Take with food or milk
• -Avoid Aspirin

Brand name(s): Relafen

Drug Class: NSAID

Indications for Use: Relief of osteoarthritis and rheumatoid arthritis.

• Adverse Effects:
• -Abdominal pain
• -Constipation
• -Nausea

• Patient Education:
• -Take with food or milk
• -Avoid Aspirin

Brand name(s): Cataflam

Drug Class: NSAID

Indications for Use: Treatment of osteoarthritis, rheumatoid arthritis & pain management.

• Adverse Effects:
• -Nausea
• -Indigestion
• -Constipation

• Patient Education:
• -Take with food or milk
• -Avoid Aspirin

Brand name(s): Voltaren

Drug Class: NSAID

Indications for Use: Relief of osteoarthritis and rheumatoid arthritis.

• Adverse Effects:
• -Nausea
• -Indigestion
• -Constipation

• Patient Education:
• -Take with food or milk
• -Avoid aspirin

Brand name(s): Naprosyn

Drug Class: NSAID

• Indications for use:
• -Inflammatory disease
• -rheumatoid disorders
• -mild to moderate pain
• -fever

• Adverse Effects:
• -Indigestion
• -Abdominal pain
• -Constipation

• Patient Education:
• -Take with food or milk
• -Avoid aspirin
• -Adult Max Dose = 1200-1650 mg/day

Brand name(s): Benadryl

Drug Class: Antihistamine (first generation)

Indications for use: relief of allergic symptoms; for moderate or severe allergic reaction

Adverse Effects: drowsiness, dizziness, dry mouth

• Patient Education:
• -Enters breast milk
• -May cause drowsiness, fatigue, diarrhea

Children's Dosing: 5 mg/kg/day (divided doses q 6-8 hrs)

Brand name(s): Antivert

Drug Class: Antihistamine (first generation)

Indications for use: motion sickness, vertigo

Adverse Effects: many random symptoms

• Patient Education: Avoid alcohol

Brand name(s): Antivert

Drug Class: Antihistamine (first generation)

Indications for use: pruritis (desire to itch), sedation

Adverse Effects: dry mouth, transitory drowsiness

Brand name(s): Phenergan (also available with Codeine)

Drug Class: Antihistamine (first generation), Antiemetic, Sedative

Available Formulations: Table, syrup, suppository, injection

Indications for use: allergic reactions, sedative, motion sickness, post-operative pain

Adverse Effects: drowsiness, dizziness, dry mouth

• Patient Education:
• -Enters breast milk
• -May cause drowsiness, fatigue, diarrhea

• Other information:
• -Refrigerate suppositories
• -onset of action for suppositories: 15-30 mins
• -not for children < 2 years

Brand name(s): Allegra

Drug Class: Antihistamine (second generation)

Available formulations: tablet, suspension

Indications for use: urticaria, seasonal allergic rhinitis

• Adverse Effects: headache, upper respiratory tract infection, back pain

Brand name(s): clarinex

Drug Class: Antihistamine (second generation)

Available formulations: tablet, syrup

Indications for use: urticaria, seasonal allergic rhinitis

Adverse Effects: dry mouth, somnolence (drowsiness), pharyngitis

Patient Education: may be taken without regard to meals

Brand name(s): Mucinex

Drug Class: Expectorant

Indications for use: loosens phlegm, increases lubrication of lungs, allow for a productive cough and decreased chest congestion

Adverse Effects: nausea, vomiting, dizziness, headache

• Patient Education:
• -Drink water!

• Other Information:
• -comes in many dosage forms

Brand name(s): Tussionex

Drug Class: Antitussive

Indications for use: relief of cough

Adverse Effects: drowsiness, constipation

• Patient Education:
• -SHAKE WELL!
• -Avoid alcohol
• -could be habit forming
• -not for children < 6 years old
• -not for asthmatics

Brand name(s): Tessalon or Tessalon Perles

Drug Class: Antitussive

Indications for use: relief of cough

Adverse Effects: headache, constipation, nausea

• Patient Education:
• -*LIFE THREATENING RXN with patients allergic to tetracaine or procaine
• -Do not crush, chew or dissolve
• -not for children < 10 years old

Brand name(s): various

Drug Class: Narcotic; Opiod

Indications for use: found in many cough products

Adverse Effects: dizziness, constipation, sedation

Patient Education: avoid alcohol

• Other Information:
• -Binds to opiate receptors in the CNS
• -causes cough suppression by direct central action in the medulla
• -produces generalized CNS depression

Brand name(s): Flexeril, Amrix, Fexmid

Drug Class: muscle relaxant

• Indications for use: May be used for relief of spasticity in neuromuscular diseases, such as
• - multiple sclerosis
• - spinal cord injury
• - stroke
• Also used for pain relief in minor strain injuries.

Adverse Effects: dizziness, drowsiness, dry mouth, fatigue, blurred vision, headache, nervousness, confusion

Patient Education: avoid alcohol

Brand name(s): Soma

Drug Class: muscle relaxant

• Indications for use: May be used for relief of spasticity in neuromuscular diseases, such as:
• - multiple sclerosis
• - spinal cord injury
• - stroke
• Also used for pain relief in minor strain injuries.

Adverse Effects: dizziness, drowsiness, headache

Patient Education: may be taken with meals if GI upset occurs

Brand name(s): Skelaxin

Drug Class: muscle relaxant

• Indications for use: May be used for relief of spasticity in neuromuscular diseases, such as:
• - multiple sclerosis
• - spinal cord injury
• - stroke
• Also used for pain relief in minor strain injuries.

Adverse Effects: nausea, vomiting, GI discomfort, dizziness, drowsiness, headache, nervousness

Patient Education: avoid alcohol

Brand name(s): Zanaflex

Drug Class: muscle relaxant

• Indications for use: May be used for relief of spasticity in neuromuscular diseases, such as:
• - multiple sclerosis
• - spinal cord injury
• - stroke
• Also used for pain relief in minor strain injuries.

Adverse Effects: dizziness, drowsiness, dry mouth

Patient Education: may be taken with food or milk if GI upset occurs

Brand name(s): Robaxin

Drug Class: muscle relaxant

• Indications for use: May be used for relief of spasticity in neuromuscular diseases, such as:
• - multiple sclerosis
• - spinal cord injury
• - stroke
• Also used for pain relief in minor strain injuries.

Adverse Effects: dizziness, drowsiness, nausea

• Patient Education:
• -may be taken with meals if GI upset occurs
• -avoid alcohol

Brand name(s): Aricept

Drug Class: Acetylcholinesterase Inhibitor

Indications for use: Alzheimer's Dementia

Adverse Effects: insomnia, nausea, diarrhea

• Patient Education:
• -will not cure disease
• -typically tritrated after 4-6 weeks

Brand name(s): Namenda

Drug Class: glutamate or N-Methyl-D-Aspartate (NMDA) Receptor Antagonist

Indications for use: Alzheimer's Dementia

Adverse Effects: cardiovascular and central nervous system effects, many others

• Patient Education:
• - will not cure disease
• - typically tritrated after 4-6 weeks

Brand name(s): Imitrex

• Drug Class: Antimigraine, Serotonin 5-HT1B, 1D Receptor Agonist
• Indications for use: migraines
• Available dosage forms: oral, nasal, injection

Adverse Effects: abnormal sensations (tingling, warmth/burning, pressure, etc.), dizziness, muscle weakness

• Patient Education:
• -Do not exceed dosage!
• -Do not exceed two doses in 24 hours!

• Other Information:
• -comes in tablet or nasal spray dosage forms

Brand name(s): Maxalt

Drug Class: Antimigraine, Serotonin 5-HT1B, 1D Receptor Agonist

Indications for use: migraine, with or without aura

Available dosage forms: tablet

• Adverse Effects: asthenia (lack of energy), dizziness, drowsiness

Brand name(s): Amerge

Drug Class: Antimigraine, Serotonin 5-HT1B, 1D Receptor Agonist

Indications for use: migraine, with or without aura

Available dosage forms: tablet

Adverse Effects: GI upset, nausea, neurological

Patient Education: do not take if pregnant

Brand name(s): Zomig

Drug Class: Antimigraine, Serotonin 5-HT1B, 1D Receptor Agonist

Indications for use: migraine, with or without aura

Available dosage forms: tablet, orally disintegrating tablet, nasal spray

• Adverse Effects: abnormal pain, pressure and temperature sensations, GI upset

Brand name(s): Axert

Drug Class: Antimigraine, Serotonin 5-HT1B, 1D Receptor Agonist

Indications for use: migraine, with or without aura

Available dosage forms: tablet

• Adverse Effects: nausea, paresthesia (abnormal sensations), dry mouth

Brand name(s): Prilosec

Drug Class: Proton Pump Inhibitor (PPI); gastric antisecretory

Indications for use:

Adverse Effects:

Patient Education:

Brand name(s): Nexium

Drug Class: Proton Pump Inhibitor (PPI); gastric antisecretory

Indications for use:

Adverse Effects:

Patient Education:

Brand name(s): Prevacid

Drug Class: Proton Pump Inhibitor (PPI); gastric antisecretory

Indications for use:

Adverse Effects:

Patient Education:

Brand name(s): Protonix

Drug Class: Proton Pump Inhibitor (PPI); gastric antisecretory

Indications for use:

Adverse Effects:

Patient Education:

Brand name(s): Aciphex

Drug Class: Proton Pump Inhibitor (PPI); gastric antisecretory

Indications for use:

Adverse Effects:

Patient Education:

Brand name(s): Zantac

Drug Class: H2 antagonist; gastric antisecretory

Indications for use:

Adverse Effects:

Patient Education:

Brand name(s): Pepcid

Drug Class: H2 antagonist; gastric antisecretory

Indications for use:

Adverse Effects:

Patient Education:

Brand name(s): Phenergan (also available with codeine)

Drug Class: Antiemetic, Antihistamine (first generation), Sedative, H1 antagonist, anticholinergic

Available formulations: tablet, syrup, suppository, injection (PO, IR, IM) *IV not recommended because of extravasation

Indications for use: allergic reactions, sedative, motion sickness, post-operative pain

Adverse Effects: drowsiness, dizziness, dry mouth

Patient Education: refrigerate suppositories, onset of action is 15 to 30 minutes, not for children < 2 years old

Brand name(s): Zofran

Drug Class: 5-HT3 (Serotonin) antagonist

Available formulations: PO, IV

• Indications for use: commonly used for chemotherapy-induced nausea and vomiting

Brand name(s): Reglan

Drug Class: Pro-motility agent; Antiemetic

Mechanism of Action: dopamine antagonist

• Indications for use: GERD, nausea/vomiting, gastroparesis (paralysis of the stomach
• due to damage of nerve damage in gut)

Common Adverse effects: somnolence (drowsiness), weakness

Rare Adverse effects: tardive dyskinesia (involuntary repetitive body movements), neuroleptic malignant syndrome

Brand name(s): Fosamax

Drug Class: bisphosphonates

Indications for use: prevention & treatment of osteoporosis (first line)

Adverse Effects: heartburn, indigestion, jaw bone pain

Patient Education: MUST follow proper administration technique: Take first thing in the morning, Take with a full glass of water, Nothing other than water should be taken within 30 minutes, Remain sitting up right or in a standing position for at least 30 minutes

Other Information: Inhibit osteoclast activity and reduce bone resorption and turnover; long half-life; treatment of osteoporosis in men; combination tablet with vitamin D available; avoid in renal insufficiency

Brand name(s): Actonel

Drug Class: bisphosphonates

Indications for use: prevention & treatment of osteoporosis (first line)

Adverse Effects: heartburn, indigestion, jaw bone pain

Patient Education: MUST follow proper administration technique: Take first thing in the morning, Take with a full glass of water, Nothing other than water should be taken within 30 minutes, Remain sitting up right or in a standing position for at least 30 minutes

• Other Information: Inhibit osteoclast activity and reduce bone resorption and turnover; long half-life; treatment of osteoporosis in men; avoid in renal insufficiency

Brand name(s): Boniva

Drug Class: bisphosphonates

Indications for use: prevention & treatment of osteoporosis (first line)

Adverse Effects: heartburn, indigestion, jaw bone pain

• Patient Education: MUST follow proper administration technique: Take first thing in the morning, Take with a full glass of water, Nothing other than water should be taken within 30 minutes, Must not eat and remain sitting up right or in a standing position for at least 60 minutes after dose
• Other Information: Inhibit osteoclast activity and reduce bone resorption and turnover; long half-life; PO or IV available; APAP given at time of IV treatment; avoid in renal insufficiency; for women only

Brand name(s): Evista

Drug Class: Selective Estrogen Receptor Modulator (SERM)

Indications for use: osteoporosis (second line), breast cancer, hormone replacement therapy

Adverse Effects: Hot flashes, night sweats, leg cramps, blood clots

Patient Education: estrogen-like activity on the bones

Brand name(s): Premarin

Drug Class: Estrogen derivative

Indications for use: Hormone replacement therapy; menopause

Adverse Effects: Vaginal bleeding, venous thromboembolism, stroke

Contraindications: In women with a uterus, unopposed estrogen increases risk of endometrial cancer; Estrogen derivatives are contraindicated in women with a history of breast cancer

Brand name(s): Yaz®, Yasmin® *Ocella®

Drug Class: oral contraceptive

Indications for use: Prevent pregnancy, Regulate menstrual cycles, Treat acne

Adverse Effects: many

• Other information:
• •Anti-mineralcorticoid activity
• •Avoid use in renal/adrenal insufficiency
• prevents ovulation (98-99% effective); alters endometrial lining

Brand name(s): *TriNessa®, Ortho® Tri-Cyclen® (Lo)

Drug Class: oral contraceptive

Indications for use: Prevent pregnancy, Regulate menstrual cycles, Treat acne

Adverse Effects: many

Patient Education: prevents ovulation (98-99% effective); alters endometrial lining

Brand name(s): *Loestrin 24 FE®, Necon 7/7/7®

Drug Class: oral contraceptive

Indications for use: Prevent pregnancy, Regulate menstrual cycles, Treat acne

Adverse Effects: many

Patient Education: prevents ovulation (98-99% effective); alters endometrial lining

Brand name(s): *NuvaRing®

Drug Class: contraceptive

Indications for use: birth control; prevents ovulation

Adverse Effects: many

• Patient Education:
• •Inserted every 3 wks on day 1 of cycle
• •Use back up contraception if removed > 3 hrs

Brand name(s): Detrol LA

Drug Class: antimuscarinic

Indications for use: Urinary Incontinence (UI)

Available formulations: administer once (ER) or twice (IR) daily

Adverse Effects: dry mouth, headache, constipation, blurred vision, dizziness

Other information: increased selectivity for M3 bladder receptors (vs. M2 salivary glands); dose reductions may be necessary in hepatic or renal insufficiency

Patient Education: decreases urge, decreases urination, decreases bladder contractions and detrusor pressure, decreases incomplete voiding, may take 6 weeks or more (several months) to see full effect

Brand name(s): Flomax

Drug Class: alpha-1 adrenergic blocker antagonist

Indications for use: Benign Prostatic Hyperplasia (BPH)

Administration: may be used alone or in combination with 5-alpha reductase inhibitor; combination therapy results in increased urine flow rate

Adverse Effects: Orthostatic hypotension, dizziness,weakness, libido, insomnia, rhinitis, abnormal ejaculations, ejaculatory problems,intraoperative floppy iris syndrome

Patient Education: Administer 30 minutes after the same meal each day. Generic now available!

Brand name(s): Proscar

Drug Class: 5 alpha reductase inhibitor

Indications for use: Benign Prostatic Hyperplasia (BPH)

• Administration: Treatment of symptomatic BPH alone or with an α-adrenergic blocker (usually Doxazosin) Combination therapy resulted in ↑ symptom relief and ↑ urine flow rate
• Adverse Effects: Erectile dysfunction, ↓ libido, ↑breast size/tenderness, rash

Patient Education: decreases prostate size; Pregnancy Category X

Brand name(s): Cialis

Drug Class: Phosphodiasterase (PDE) 5 Inhibitor

• Mechanism of Action: PDE5 is inhibited so that cGMP can act longer by causing increased blood flow to the penis. Nitric Oxide, which causes smooth muscle relaxation necessary for an erection is released from NANC = Nonadrenergic/Noncholinergic Neurons.
• Indications for use: Erectile Dysfunction (ED)

Adverse Effects: headache, flushing, dyspepsia, rhinitis, impaired color discrimination, dizziness, hypotension, Cardiovascular effects, sudden hearing loss

Patient Education: contraindicated with nitrates; use caution with alpha blockers and some antibiotics/antifungals; grapefruit juice may increase plasma concentrations of drug; take without food 30 to 60 minutes before intercourse; use up to once daily; avoid high fat foods because they increase total max concentration

Other information: duration of about 4 hours

Brand name(s): Cialis

Drug Class: Phosphodiasterase (PDE) 5 Inhibitor

Indications for use: Erectile Dysfunction (ED)

• Mechanism of Action: PDE5 is inhibited so that cGMP can act longer by causing increased blood flow to the penis. Nitric Oxide, which causes smooth muscle relaxation necessary for an erection is released from NANC = Nonadrenergic/Noncholinergic Neurons. .
• Adverse Effects: headache, flushing, dyspepsia, rhinitis, impaired color discrimination, dizziness, hypotension, Cardiovascular effects, sudden hearing loss

Patient Education: contraindicated with nitrates; caution with alpha blockers and some antibiotics/antifungals; grapefruit juice may increase plasma concentrations of drug; take with or without food 30 minutes before intercourse; use up to once daily; avoid high fat foods because they increase total max concentration to 2 hours

Other information: duration of 24-36 hours

Brand name(s): Ambien, Ambien CR

Drug Class: Sedative

Indications for use: Insomnia

Adverse Effects: headache, drowsiness, nausea

Patient Education: do not crush or chew; may be habit forming; avoid alcohol

Brand name(s): Lunesta

Drug Class: Sedative

Indications for use: Insomnia

Adverse Effects: drowsiness, headache, unpleasant taste sensation

Patient Education: preferably take on empty stomach; high fat meals may delay onset of action; may be habit forming

Brand name(s): Xalatan

Drug Class: Glaucoma

Indications for use: Glaucoma

Adverse Effects: blurred vision, burning/stinging, foreign body sensation

Patient Education: Store unopened bottle in refrigerator; Once opened, store in a cool place away from light for up to 6 weeks

Brand name(s): Travatan, Travatan Z

Drug Class: Glaucoma

Indications for use: Glaucoma

Adverse Effects: hyperemia, decreased visual acuity, eye discomfort, pruritis

Patient Education: Teach how to instill drops correctly; drops may tint iris brown; may increase eyelash growth

Brand name(s): Alphagan P

Drug Class: Glaucoma

Indications for use: Glaucoma

Adverse Effects: Allergic conjunctivitis, conjunctival hyperemia, eye pruritis

Patient Education: Teach how to instill drops correctly

Brand name(s): Vigamox

Drug Class: ophthalmic antibiotic

Indications for use: Conjunctivitis

Adverse Effects: eye irritation, decreased visual acuity, dry eyes

Patient Education: complete full course of therapy; cannot wear contact lenses

Brand name(s): Zymar

Drug Class: ophthalmic antibiotic

Indications for use: Conjunctivitis

Adverse Effects: conjunctival irritation, tearing, inflammation

Patient Education: contraindicated with quinolones; complete full course of therapy; cannot wear contact lenses

Brand name(s): Patanol, Pataday

Drug Class: ophthalmic anti-allergy

Indications for use: Conjunctivitis

Adverse Effects: headache, asthenia, blurred vision

Patient Education: do not wear contact lenses if eye is red

Brand name(s): Medrol

Drug Class: Anti-inflammatory, Corticosteroid

Indications for use: Autoimmune disorders

Adverse Effects: many side effects, such as blurred vision, upset stomach, nausea & vomiting, etc.

Patient Education: Do not discontinue abruptly; Take with food

Brand name(s): Decadron

Drug Class: Anti-inflammatory, Corticosteroid

Indications for use: Autoimmune disorders

Adverse Effects: many side effects, such as blurred vision, upset stomach, nausea & vomiting, etc.

Patient Education: Do not discontinue abruptly; Take with food

Brand name(s): Prednisone

Drug Class: Anti-inflammatory, Corticosteroid

Indications for use: Autoimmune disorders

Adverse Effects: many side effects, such as blurred vision, upset stomach, nausea & vomiting, etc.

Patient Education: Do not discontinue abruptly; Take with food

Brand name(s): Coumadin

Drug Class: Anticoagulant, Vitamin K Antagonist

Indications for use: prevention & treatment of thrombosis

Adverse Effects: bleeding, skin necrosis

Patient Education:

Other Information: Dosed daily, drug/food interactions, monitor INR closely, Pregnancy Category X

Brand name(s): Hep-Lock

Drug Class: Anticoagulant, Thrombin & Factor Xa Inhibitor

Indications for use: prophylaxis/treatment of thrombosis

Adverse Effects: bleeding, heparin-induced thrombocytopenia (HIT)

Patient Education:

Other Information: Does NOT enter breast milk

Antidote: Protamine

Brand name(s): Lovenox

Drug Class: Anticoagulant

Indications for use:

Adverse Effects:

Patient Education:

Brand name(s): Plavix

Drug Class: Antiplatelet

Indications for use: prophylaxis of thrombosis

Adverse Effects: bleeding, neutropenia

Mechanism of Action: Irreversibly inhibits the binding of ADP on platelet receptor; ADP induces platelet aggregation

Other Information: often used WITH aspirin

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