-
Accutane
- Keratolytic: Isotretinoin
- Tx: Severe cystic acne
- PO - inhibits sebaceous gland activity, antikeratinizing, anti-inflammatory
- SE: teratogenic, peeling, photosensitivity, nose bleeds, links to depression, SI
- must sign pledge to use 2 forms of BC, 2 tests before then q mo
- only used in very severe cases now
-
Acyclovir
- Most commonly for HSV, not as good w Varicella,
- CMV is resistant
- Resistance rare except in immunocompromised
- HSV-1: PO for active and prophylaxis
- HSV-2: PO, topical (only initial), IV (if severe) - symptoms dec but virus not gone
- Safe during Preg: prophylactic to prevent C-section
- Varicella Zoster: PO, IV(for immunocompromised/resistant) - need higher doses bc doesn't work as well for this
- SE: N/V, HA, vertigo, stinging/burning (topical), phlebitis, reversible nephrotoxic (IV)
- use gloves applying topical to prevent spread
-
Adefovir
- Hepsera
- Tx: chronic Hep B
- SE: nephrotoxic
- rule out HIV 1st bc incs HIV resistance
- PO, dose depends on renal func
- extended tx period, high risk of relapse
-
Allopurinol
- Tx: Gout (ongoing prevention in pts w high uric acid)
- reduces blood levels of uric acid, inhibits production
- generally well tolerated
- SE: GI, HA, potentially fatal hypersensitivity reaction (rare)
- Interactions: inhibits hepatic drug metabolizing enzymes
-
Amantadine
- 1st gen Antiviral for flu type A/Dopamine releaser: Symmetrel
- Tx: Flu, Parkinson's
- SE: CNS effects (confusion, lightheadedness, anxiety), blurred vision, urine retention, dry mouth, constipation, livedo reticularis (temp skin discoloration)
- Flu develops resistance easily
- CDC doesnt rec 1st Gen, dont really use for Parkinson bc effects dont last long
- promotes release of dopamine and prevents reuptake
- 2-3 day response time, effects last 3-6mo
-
Artane
- Anticholinergic
- Tx: Parkinson's
- 2nd line, reduce tremor & rigidity, not bradykinesia
- SE: anticholinergic effects, may aggravate glaucoma
- Start w low doses and inc until desired effect
- Dont D/C abruptly, may intensify symptoms
-
Benzoyl Peroxide
- Keratolytic
- Tx: Acne
- Slowly & continuously liberates oxygen (most acne caused by anaerobes)
- improvement in 4-6 wks
- ranges from 2.5-20% strength
- Weaker typically OTC, stronger are prescription
- Bleaches fabric
-
Betoptic
- Beta Blocker: Betaxolol
- Tx: Glaucoma
- cardioselective
- lowers IOP by dec production of aqueous humor by ciliary body
- SE: stinging
-
Carbamide Peroxide
- Cerumen Emulsifier
- follow w Saline flush
-
Celebrex
- 2nd Gen NSAID: Celecoxib
- COX 2 inhibitor
- Tx: osteoarthritis, RA, dysmenorrhea, acute pain
- SE & Contraindications: similar to Ibuprofen
- inc CV risk = last choice, only remaining agent
-
Cerebrex
- Fosphenytoin
- Tx: Epilepsy
- IV Prodrug converts to phenytoin in blood
- neutral pH less irritating to veins
- faster infusion doesnt risk CV collapse
- Expensive, many places wont buy even though better
-
Ciprodex
- Tx: Otitis Externa
- Ciprofloxacin + Dexamethasone
-
Cogentin
- Anticholinergic
- Tx: Parkinson's
- 2nd line, reduce tremor & rigidity, not bradykinesia
- SE: anticholinergic effects, may aggravate glaucoma
- Start w low doses and inc until desired effect
- Dont D/C abruptly, may intensify symptoms
-
Colchicine
- Tx: acute gouty attack, not responsive to safer meds (NSAIDS and glucocorticoids)
- prevents release of inflammation glycoprotein from phagocytes - only really txs inflammation, not uric acid level
- prevention in pts who dont have high uric acid
- Caution: in cardiac, renal, GI disease
- SE: N/V/D, abd pain
- destroys rapidly dividing cells, inc GI
- 0.6 mg tabs
-
Comtan
- COMT inhibitor: entacapone
- Tx: Parkinson's
- prolongs half life of Levodopa, extends "ON" times
- SE: related to inc Levodopa
-
Cycloplegics
- Tx: eye exam, surgery, uveitis (inflammation of vascular layer of eye) only!
- Paralysis of ciliary muscle
- Dec visual acuity
- may precipitate Angle Closure Glaucoma
-
Dantrolene
- Peripherally Acting Spasmolytic: Dantrium
- Tx: Malignant hyperthermia, upper motor neuron d/o, spasticity from SCI, MS, CP, stroke
- interferes w intracellular Ca movement
- SE: muscle weakness (common), hepatotoxic
- Contraindication: when spasticity used to maintain upright posture & balance (CP)
-
Darbepoetin Alfa
- Hemat Growth Factor: Aranesp
- Same as Epoietin Alfa but longer half life
- 1/wk to bring up, 1/mo to maintain
-
Depakote
- Valproic Acid
- Tx: Epilepsy (all major types), Bipolar, Migraine
- Suppression of Na & Ca influx, potentiation of GABA
- Therapeutic level: 50-150 mg/mL
- SE: GI, Hepatotoxic &Pancreatitis (rare but serious), teratogenic
- Interactions: Dec phenobarb metab, displaces phenytoin (toxicity)
-
Diamox
- Carbonic Anhydrase Inhibitor: Acetazolamide
- Tx: Glaucoma, angle closure long term mgmt
- PO, systemic
- reduces production of aqueous humor
-
Efavirenz
- NNRTI: Sustiva
- SE: Rash (~50%, mild to SJS), CNS (altered mood, sleep, anxiety), Teratogenic
- Interactions: Induces P450 (St Johns Wart may reduce levels)
-
Enbrel
- Tumor Necrosis Factor Blocker: Enteracept
- Tx: mild to mod RA
- Binds to TNF (cytokine involved inflammation)
- delays progression of damage and suppresses S/S
- SQ
- SE: site reactions, infection (avoid live vaccines)
-
Epoetin Alfa
- Hematopoietic Growth Factor: Epogen, Procrit
- Tx: chronic renal failure, HIV pts on zidouvudine, chemo for nonmyeloid CA, anemic having surgery
- need sufficient Fe, folic acid and vits
- human erythropoietin reproduced w recombinant DNA
- SE: HTN, autoimmune red cell aplasia, CV (CVA, MI, thrombotic events if hgb >12gm/dL or inc >1 in 2 weeks)
- may take up to 3 mo to work
- SQ or IV - 3/wk to raise, 1/wk to maintain
- Dont shake!
-
Filgrastim
- Granulocyte colony stim factor: Neupogen
- Tx: chronic neutropenia, CA pts
- SE: bone pain (~50%), leukocytosis
- SQ, IV - dont shake
- Contraindication: myeloid CA
-
Flexeril
- Centrally Acting Muscle Relaxant: Cyclobenzaprine
- Tx: localized spasm from muscle injury
- SE: CNS depression, hepatotoxic, anticholinergic effects
- physical dependence, w/d over 2 weeks if on long-term
- PO
-
Fuzeon
- Fusion Inhibitor: Enfuvirtide
- Tx: HIV
- blocks HIV envelope from fusing w CD4 cell membrane
- SQ bid
- SE: site reactions
- only for resistant types
-
Ganciclovir
- Antiviral: Cytovene, Vitrasert
- Tx: Herpes, CMV
- not as safe as acyclovir, but treats CMV
- doesnt get metabolized
- give proph. in im.comp to prevent CMV retinitis
- tx indefinite, resistance can develop
- SE: Granulocytopenia (stop ANC <500), Thrombocytopenia (stop plt <25,000)
- Zidovudine can exacerbate SE, risk for im.comp
- Monitor CBC
- Teratogenic/Embryotoxic: avoid preg 90 days, pos. infertility
-
Gold Salts
- Auranofin
- relieve pain/stiffness, stop joint degeneration
- 4-6 mo onset
- SE: bone marrow suppression, GI, rashes, pruritus, stomatitis, nephrotoxic, hypotension
- last line bc bad SE
-
Ibuprofen
- 1st Gen NSAID: Motrin
- Tx: fever, mild-mod pain, dysmenorrhea, promotes closure of ductus arteriosus in preterm infants
- less GI bleeding and inhibition of plt aggregation
-
Imuran
- Cytotoxic/Im.Supp: Azathioprine
- non-specific - suppresses cell-mediated & humoral immune responses
- SE: bone marrow suppression, teratogenic, neoplasms
- only when safer agents dont work
-
Interferon Alfa
- Tx: Hep B&C
- SQ
- pegylated means its long acting (give 1/wk)
- regular - give q 3 days
- SE: flu-like syndrome, neuropsych effects (depression, SI), GI, Alppecia, pain/reaction at site, MVD, bone marrow suppression
-
Keppra
- Levetiracetam
- Tx: Epilepsy (partial & tonic-clonic)
- unknown action
- doesnt interact w other meds
-
Lamictal
- Lamotrigine
- Tx: Epilepsy (adjunct partial & tonic-clonic), bipolar
- SE: aseptic meningitis, SJS/fatal rashes
-
Lamivudine
- EpivirHBV
- Tx: Hep B&C, form for HIV
- minimal SE
- high risk of relapse
-
Lioresal
- Centrally acting Spasmolytic: Baclofen
- Tx: MS, traumatic spinal cord lesions, CP
- Not effective in Parkinson's & Huntington's
- mimics GABA, suppresses hyperactive reflexes
- Caution: pts w seizure d/o
- SE: CNS depression, anticholinergic effects
- Toxicity: coma, resp depression
- need to w/d
- PO, interthecal infusion
-
Methotrexate
- DMARD
- Tx: RA, Gout, CA, abortion
- 1st choice, rapid acting 3-6 weeks
- admin 1/wk
- SE: GI ulceration, bone marrow suppression, hepatic fibrosis, toxicities
- Monitor: kidney & liver func, CBC
- contraindicated in pregnancy
-
Mirapex
- Dopamine Agonist: Pramipexole
- Tx: Parkinson's
- nonergot
- SE: N/V, compulsive shopping and gambaling
- may be alone in early stages and later w levodopa/carbadopa
-
Mydriatics
- Tx: eye exam, surgery, uveitis (inflammation of vascular layer of eye)
- Dilates pupil
- Dec visual acuity
- May precipitate Angle Closure Glaucoma
-
Naproxen
- 1st Gen NSAID
- prolonged half-life
-
Neurontin
- Gabapentin
- Tx: Epilepsy (partial)
- adjunctive therapy, enhances GABA release
- pretty well tolerated, causes drowsiness
- May also tx bipolar, neuropathic pain, leg cramps, migrraines
-
Oprelevkin
- Thrombopoietic Growth Factor: Interleukin-11, Neumega
- Tx: chemo pts
- minimizes thrombocytopenia and need for plt transfusion
- SE: fluid retention (Na&H2O), dysrhythmias, conjunctiva redness, sudden death
- SQ
- want pts >50,000
-
Orthoclone OKT3
- Monoclonal Im.supp: Muromonab-CD3
- blocks all T-cell fun
- Tx: pre-bone marrow transplant, prevents acute rejection
- SE: fever, chills, dyspnea, chest pain, anaphylaxis
- premedicate IV glucocorticoids, acetaminophen, diphenhydramine - have intubation equip
-
Oseltamivir
- Antiviral for Flu A&B, 2nd Gen
- Tamaflu
- dec length by up to 2 days, depending on when started
- PO, can be prophylactic
- few SE, less risk of resistance
-
Oxymetazoline
- Ocular Decongestant: Visine, OcuClear
- Tx: allergic conjunctivitis
- vasoconstriction to dec redness and edema
- prolonged use may cause rebound congestion
-
Parlodel
- Dopamine Agonist: Bomocriptine
- Tx: Parkinson's
- Ergot derivate
- alone in early stages, in combo w levodopa later
- SE: dose limiting psych reactions, cumpulsive shopping and gambaling
-
Pegfilgrastin
- Long Acting Granulocyte Colony Stimulating Factor
- one dose injection
- prevention of febrile neutropenia in nonmyeloid CA chemo pts
-
Phenobarbitol
- Barbituate
- Tx: Epilepsy
- suppreses seizure at mod dosage by potentiating GABA
- PO, IM, IV
- SE: drowsiness, physical dependence (severe), teratogenic, CNS depression
- Toxicity: Nystagmus, ataxia, gen CNS depression, death
- Interactions: hepatic drug metabolizing enzymes
-
Pilocarpine
- Cholinergic Agonist
- Tx: Glaucoma
- IOP dec by contracting ciliary muscle - wider space w/in trabecular meshwork
- SE: visual changes, retinal detachment (not common)
-
Plaquenil
- Hydrooxychloroquine
- Tx: RA and Gout, Antimalarial
- 3-6 mo onset
- early use can improve long term outcomes
- used w methotrexate
- SE: Retinal damage, eye apts before start and q 6 mo
-
Probenecid
- Tx: Gout (prevention in pts w high uric acid)
- acts on renal tubules to inc excretion of uric acid
- SE: GI disturbances, renal injury, hypersensitivity
-
Prograf
- Immunosuppressant: Tacrolimus
- Tx: proph of organ rejection (kidney and liver)
- use w glucocorticoids
- toxicity problems, may have to d/c
- SE: same as cyclosporin but more likely to occur
- PO, can be IV or topical for autoimmune
- Interactions: grapefruit juice, nephrotoxic meds
-
Prostigmin
- Reversible Cholinesterase Inhibitor: Neostigmine
- Tx: MG
- prevents acetylcholine inactivation
- increases muscle strength
- can have skeletal muscle weakness from too much or too little
-
Rapamune
- Immunosuppressant: Sirolimus
- Tx: proph kidney rejection only!
- use w cyclosporin and glucocorticoid (prednisone)
- nephrotoxic
-
Retin-A
- Keratolytic: Tretinoin
- Tx: Acne and diminish changes from sun damage
- Stimulates turnover of epidermal cells, incs fibroblasts & collagen
- reduces fine wrinkles
- topical - causes photosensitivity
-
Ribavirin
- Broad Spectrum Antiviral: Bebetol, Copegus
- Tx: Hep B&C, RSV in kids (aerosol form)
- action unknown
- used in combo w peginterferon alfa
- PO 24-48 wk tx
- SE: Flu-like syndrome, Neuropsych (depression), hemolytic anemia, Birth defects (cat X)
- relapse is high when med stopped, even w long tx
-
Rimantidine
- 1st gen Antiviral for flu type A
- SE: CNS effects
- develops resistance easily
- CDC doesnt recommend 1st Gen
-
Sandimmune
- Calcineurin inhibitor im.supp: Cyclosporine
- Tx: organ rejection, autoimmune (RA, MG, psoriasis)
- SE: infection, nephrotoxic, tremor, hirsutism, htn, hyperk, hepatotoxic, lymphona
- Interactions: grapefruit juice (toxicity), nephrotoxic agents
- used in combo w glucocorticoids
- Microemulsion has better bioavail
- many form, not all are =
-
Selegiline
- MAO-B Inhibitor: Eldepryl, Carbex
- Tx: Parkinson's
- suppresses destruction of dopamine
- may delay progression of disease
- SE: insomnia
- Interaction: initially intensifies Levodopa effects
- 2nd or 3rd line drug
- not related to MAOIs (no HTN crisis)
-
Sinemet
- Tx: Parkinson's
- Levodopa + Carbidopa (no effects of its own)
- inhibits decarboxylation of levodopa in intestine and periphery, more gets to brain
- Carbidopa can reduce SE of Levodopa (CV, B6, postural hypotension, N/V)
-
Sulfasalazine
- Azulfidine
- Tx: RA, Gout, IBD
- slows progression of joint deterioration
- onset w/in 1 mo
- SE: GI upset, rash, urticaria
- Contraindicated: sulfa allergy
-
Tegretol
- Carbamazepine
- Tx: Epilepsy (not absence, myoclonic or atonic), bipolar, trigeminal &glossopharyngeal neuralgias
- inhibits Na channels
- absorption is delayed and variable
- SE: nystagmus, diplopia, blurred vision (these 3 @ begining of tx), low blood counts, teratogenic
- monitor CBC before tx and during
- give most of med HOS to minimize effects
- Interactions: hepatic drug-metabolizing enzyme, dec effect of BC, warfarin, glucocorticoids - Phenytoin and Phenobarb inc its metab
- PO, give w food
-
Timoptic
- Beta Blocker: Timolol
- Tx: Glaucoma
- nonselective
- lowers IOP by dec production of aqueous humor by ciliary body
- SE: Stinging
- Contraindications: Asthma, COPD
-
Toradol
- 1st Gen NSAID: Ketorolac
- powerful analgesic, min antiinflammatory properties
- short term use
- IM or IV
-
Tylenol
- Cyclooxygenase Inhibitor: Acetominophen
- Tx: fever, pain
- no anti-inflammatory effect, only works in CNS
- Contraindications: hepatic disease
- Caution: ETOH abuse
- OD: N/V/D, sweating, abd discomfort, then hepat injury/necrosis (jaundice, clay colored stool, orange/yellow urine)
- OD Tx: acetylcysteine (acetadote) IV or Mucomyst PO
-
Valium
- Benzodiazepine: Diazepam
- Tx: muscle relaxant acuetly, anxiety
- physical & psych dependence, need to w/d
- small risk of abuse, controlled sub
-
Xalatan
- Prostaglandin Analog: Latanoprost
- Tx: Glaucoma
- incs outflow of aqueous humor by relaxing ciliary muscle
- SE: permanent inc brown iris pigment
- as effective as beta blockers, no systemic effects
-
Zanamivir
- Antiviral for Flu A&B, 2nd gen
- inhaled
- SE: few, may cause Bronchospasm
- need to start w/in 2 days of onset
- less risk of resistance
-
Zidovudine
- NRTI: Retrovir, AZT
- unpleasant but effective, not curative
- gets build into chain
- PO, IV
- SE: anemia, neutropenia, lactic acidosis (from mitochondria damage), severe hepatomegaly, N/V/D, abd pain, dyspepsia, anorexia, CNS
- Monitor: ABG, CBC
- Interactions: myelosuppressie, nephrotoxic, toxic to blood cell meds, Bactrim, dapsone, ampho B, flucytosine, vincristine, vinblastine
- not mono therapy bc resistance
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