Term
|
Definition
Transdermal testosterone
Ind: replacement therapy, ED in pts with primary or secondary hypogonadism
dose: 2 mg and 4mg/24hr; apply patch nightly and change every 24 hr.
Notes: rotate application site, 7 days between same site
DI: cyclosporine
Precautions/contraindications: prostate cancer, breast cancer
AE: acne, alopecia, gynecomastia, aggressive behavior, weight gain, edema, sodium retention |
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Term
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Definition
Transdermal testosterone gel
Ind: replacement therapy, ED in pts with primary or secondary hypogonadism
dose: apply topically q 24hr
Notes: 1% and 1.62% gel pump, also unit dose packets
DI: cyclosporine
Precautions/CI: prostate cancer, breast cancer
AE: acne, alopecia, gynecomastia, aggressive behavior, weight gain, edema, sodium retention |
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Term
|
Definition
tadalafil
Ind: erectile dysfunction
dose: 10 mg prior to activity
Notes: only 1 dose per day, max dose according to renal/hepatic. Can take up to 2 hrs before, duration 36 hrs
DI: 3A4 inhibitors, nitrates (weight 48 hrs)
CI: concomitant nitrates/alpha adrenergic blockers |
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Term
|
Definition
tadalafil
Ind: erectile dysfunction (daily use)
dose: start at 2.5 mg per day
Notes: use if sexually active at least 3 times/week, max dose by renal/hepatic
AE: HA, flushing, dizziness, dyspepsia |
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Term
|
Definition
vardenafil
Ind: erectile dysfunction
dose: 10 mg one hour prior to activity
Notes: only 1 dose per day, max 5 mg for hepatic impairment, duration 4 hrs
DI: 3A4 inhibitors, nitrates
CI: concomitant nitrates
AE: HA, flushing, dizziness, dyspepsia |
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Term
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Definition
sildenafil
Ind: erectile dysfunction
dose: 50 mg 0.5 - 4 houors prior to activity
Notes: only 1 dose per day, 25 mg for renal/hepatic impairment, recommended on empty stomach 2 hrs before meals. Duration 4 hrs
CI: concomitant nitrates
AE: HA, flushing, dizziness, dyspepsia |
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Term
|
Definition
prostaglandin E1
Ind: erectile dysfunction
intracavernosal injection and intraurethral insert
DI: phosphodiesterase inhibitors
AE: pain/discomfort, priapism
Pt Consult: admin time (5-15 min prior), duration 1 hr |
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Term
|
Definition
estradiol
Ind: estrogen replacement, vasomotor symptoms/atrophic vaginitis, prevention of post-menopausal osteoporosis
dose: 1-2 mg daily
Notes: adjust as needed, 3 wk on, 1 wk off
DI: CYP inducer/inhibitor/substrate
CI: history of thromboembolic disease, breast cancer, hepatic disease
AE: nausea, edema, dysmenorrhea, breakthrough bleeding, thromboembolic disorders |
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Term
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Definition
estradiol/testosterone
Ind: severe vasomotor symptoms
dose: start at lowest dose- 0.625/1.25 mg
Notes: taper at 3 and 6 months
Pt Consult: take with food or milk if stomach upset. Can cause voice deepening and hair growth because of methyltest |
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Term
|
Definition
conjugated estrogens
Ind: estrogen replacement/osteoporosis, vasomotor symptoms, atrophic vaginitis (cream)
dose: individualized
DI: CYP inhibitors/inducers
CI: history of thromboembolic disease, breast cancer, hepatic disease
AE: nausea, edema, dysmenorrhea, breakthrough bleeding, thromboembolic disorders
Pt Consult: take with food or milk if stomach upset |
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Term
|
Definition
conjugated estrogens/medroxyprogesterone
Ind: estrogen replacement/osteoporosis, vasomotor symptoms, vaginal atrophy
AE: nausea, edema, dysmenorrhea, breakthough bleeding, thromboembolic disorders
Pt Consult: take with food or milk if stomach upset
dose: individualized |
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Term
|
Definition
medroxyprogesterone acetate
Ind: progesterone replacement, abnormal uterine bleeding, contraception, endometriosis, endometrial hyperplasia, amenorrhea
dose: 5-10 mg daily for 5-10 days
Notes: for uterine bleeding, start on 16th or 21st day
CI: history of thromboembolic ds, pregnancy, breast cancer, liver disease
AE: weight gain, dizziness, abdominal pain, amenorrhea, injection site pain. Osteoporosis with injection
Pt Consult: take with food or milk if stomach upset |
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Term
|
Definition
progesterone soft gel
Ind: prevention of endometrial hyperplasia
dose: 200 mg at bedtime
Notes: 12 consecutive days per 28 day cycle while on estrogen
CI: peanut allergy, breast cancer, liver disease
AE: dizziness, HA, breast tenderness |
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Term
|
Definition
progesterone soft gel
Ind: secondary amenorrhea
dose: 400 mg at bedtime
Notes: typically 10 consecutive days of therapy for this indication
CI: peanut allergy, history of thromboembolic ds, pregnancy, breast cancer, liver ds
AE: dizziness, HA, breast tenderness |
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Term
|
Definition
tolterodine
Ind: overactive bladder, urge incontinence
dose: 4 mg/day
Notes: 2 mg/day in hepatic dysfunction
DI: 3A4 inhibitors, anticholinergics, potassium (risk of stomach ulcers)
CI: urinary retention, gastric retention, uncontrolled narrow angle glaucoma
AE: anticholinergic
Pt Consult: avoid alcohol |
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Term
|
Definition
fesoterodine extended release
Ind: overactive bladder/urge incontinence
dose: 4-8 mg once daily
Notes: 4 mg/day if on strong 3A4 inhibitors or with very low GFR
DI: CYP3A4 inhibitors, anticholinergics
CI: urinary retention, gastric retention, uncontrolled narrow angle glaucoma
AE: anticholinergic
Pt Consult: do not crush or chew, avoid alcohol |
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Term
|
Definition
oxybutynin
Ind: bladder instability/urgency, neurogenic bladder
dose: 2.5 mg bid-qid or 5-30 mg XL qd or 1 patch per week
Notes: can titrate weekly
DI: anticholinergics, phenothiazines, haloperidol
CI: urinary retention, gastric retention, uncontrolled narrow angle glaucoma
Precautions: GERD, bisphosphonates, impaired hepatic function
AE: anticholinergic
Pt Consult avoid alcohol, do not crush XL |
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Term
|
Definition
darifenacin
Ind: bladder instability/urgency
dose: 7.5-15 mg daily, hepatic impairment dose max 7.5 mg
Notes: can titrate in two weeks up to 15 mg daily
DI: 2D6 substrates
CI: urinary retention, gastric retention, uncontrolled narrow angle glaucoma, myasthenia gravis
Precaution: bladder outflow obstruction, nursing mothers, pregnancy, hepatic impairment, ulcerative colitis, severe constipation
AE: UTI, anticholinergic |
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Term
|
Definition
solifenacin
Ind: bladder instability/urgency
dose: 5-10 mg daily
Notes: may increase to 10 mg daily if tolerated
DI: CYP3A4 inhibitors, anticholinergics
CI: urinary retention, gastric retention, uncontrolled narrow angle glaucoma
Precautions: QT prolongation, hepatic/renal impairment
AE: anticholinergics
Pt Consult: swallow tablets whole |
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Term
|
Definition
mirabegron extended release
Ind: beta 3 adrenergic agonist, overactive bladder/ urge incontinence
DI: CYP 2D6 inhibitors and 3A4 inhibitors, anticholinergics
precautions: HTN, renal/hepatic impairment
CI: HTN > 180/110
AE: HTN, dizziness, tachycardia, UTI
dose: 25-50 mg once daily
Notes: 25 mg daily for initial dose and or organ dysfunction |
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Term
|
Definition
trospium
Ind: overactive bladder/urge incontinence
dose: 20 mg twice daily. IR-tab, XR-capsule
DI: anticholinergics, potassium
CI: urinary retention, gastric retention, uncontrolled narrow angle glaucoma
AE: anticholinergic
Pt consult: take on empty stomach - at least 1 hr prior to meals |
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Term
|
Definition
trospium extended release
Ind: overactive bladder
dose: 60 mg daily in the morning |
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Term
|
Definition
raloxifene
Ind: prevention/treatment of osteoporosis, reduction of breast cancer
dose: 60 mg daily
Notes: DC 72 hours prior to immobilization
SERM - (+) at bone, (-) at breast/uterine tissue
CI: history of thromboembolic ds
AE: hot flashes, weight gain, edema, sweating
Pt Consult: VTE signs/symptoms, need calium and vit D
4th line because not effective at reducing hip fractures |
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Term
|
Definition
alendronate
Ind: prevention and treatment of osteoporosis
dose: 5 mg qd or 35 mg weekly - prevent.
Notes: empty stomach with H20 and remain upright for 30 min
DI: calcium/antacids with 30 min of dose
CI: delayed esophageal emptying, inability to remain upright for 30 min, hypocalcemia
Precaution: renal disease CrCl <35 ml/min
AE: abdominal pain, constipation, diarrhea, musculoskeletal pain, severe irritation of GI mucosa, fractures, osteonecrosis of the jaw |
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|
Term
|
Definition
alendronate
Ind: treatment of osteoporosis
dose: 10 mg qd or 70 mg weekly
Notes: empty stomach with H20 and remain upright for 30 min |
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Term
|
Definition
risedronate
Ind: prevention and treatment of osteoporosis
dose: 5 mg qd or 35 mg weekly, 150 mg monthly
Notes: empty stomach with H20 and remain upright for 30 min
CI: delayed esophageal emptying, inability to remain upright for 30 min, hypocalcemia
AE: abdominal pain, constipation, diarrhea, musculoskeletal pain, severe irritation of upper GI mucosa, fractures, osteonecrosis of the jaw |
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Term
|
Definition
ibandronate
Ind: prevention/treatment of osteoporosis
dose: 2.5 mg daily or 150 mg once a month or 3 mg IV q 3 months
Notes: empty stomach with H20 and remain upright for 60 min
CI: pts with uncorrected hypocalcemia and those unable to stand or sit upright for 60 min
Precautions: renal impairment (avoid if CrCl < 30 ml/min)
AE: esophagitis, dyspepsia, diarrhea, hyperlipidemia, pain, fractures, osteonecrosis of the jaw
Pt Consult: if missed dose take as soon as they remember but do not take within 7 days of next dose |
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Term
|
Definition
zoledronic acid
Ind: postmenopausal osteoporosis, prevention and treatment
dose: 5 mg intravenous infusion once a year
Notes: administer IV over min of 15 min duration
DI: NSAIDs, PPIs, thalidomide
CI: hypocalcemia, CrCl < 35 ml/min or acute renal dysfunction
AE: acute infusion reaction usually occurs within first 3 days after infusion. Usually will subside in 3-4 days if occurs but may take 14 days
Pt Consult: hydrate well |
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Term
|
Definition
calcitonin-salmon
Ind: treatment of osteoporosis
dose: 200 IU spray or sq injection daily
Notes: supplement with Vit D and calcium
AE nasal: rhinitis, nasal irritation
Pt Consult: after opening store at room temp for 35 days (30 days for Fortical), 30 day room temp expiration, store injection in fridge
not effective at preventing hip fractures |
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Term
|
Definition
teriparatide, rDNA
Ind: treatment of osteoporosis, promotes osteoblastic activity
dose: 20 mcg subq every day
Notes: multi-dose pen (28 doses)
DI: digoxin
Precautions: urolithiasis, skeletal malignancy, hypotension following first several doses, hypercalcemia. Use for more than 2 years is not recommended
AE: arthralgia, hypotension, syncope, rash, sweating, hyperuricemia, dizziness, cough, leg cramps
Pt Consult: rotate injection sites, rise slowly from sitting/lying to standing to prevent OHTN
3rd line agent for people that have fractures for no reason |
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Term
|
Definition
denosumab
Ind: treatment osteoporosis, bone loss in cancer tx
dose: 60 mg subq every 6 months (given with 1000 mg Ca + 400 IU vit D)
CI: hypocalcemia (correct before txt, pregnancy, hypersensitivity
Precautions: osteonecrosis of the jaw, skin rashes, sever renal impairment or dialysis
AE: hypercholesterolemia, nausea, vomiting, diarrhea, HA, asthenia, nasopharyngitis, fatigue
Pt Consult: inform dentist of use prior to procedure |
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Term
|
Definition
tamsulosin
Ind: BPH
dose: 0.4 mg-0.8 mg qd 30 min after food, after same meal daily
Notes: increase at 2-4 wks if no response
Pk: food decreases absorption
DI: alpha blockers, cimetidine
Precautions: OHTN, prostate cancer
AE: HA, dizziness, rhinitis, asthenia, abnormal ejaculation
Pt Consult: rise slowly when sitting/lying |
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Term
|
Definition
silodosin
Ind: BPH
dose: 8 mg once daily after food
Notes: CrCl 30-50 ml/min = 4 mg/day, <30 ml/min =contraindicated
CI: CYP 3A4 inhibitors, cyclosporine, phosphodiesterase inhibitors, severe renal or hepatic function
AE: OHTN, HA, dizziness, retrograde ejaculation, diarrhea, nasal congestion |
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Term
|
Definition
dutasteride/tamsulosin
Ind: BPH
dose: 0.5/0.4 mg capsule once daily
DI: tadalafil, CYP 3A4 inhibitors and substrates
Precautions: OHTN, blood donation within 6 months of last dose, skin reactions, priapism, sulfa allergy
CI: females of childbearing potential-do not handle capsules
AE: breast disorder, sexual dysfunction, dizziness
Pt Consult: swallow whole |
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Term
|
Definition
finasteride
Ind: BPH
dose: 5 mg daily
Notes: trial of 6 to 12 months necessary
DI: theophylline
CI: females of childbearing potential-do not handle capsules
Precautions: decreases PSA even if prostate cancer present
AE: impotence, decreased libido
Pt Consult: do not donate blood until 6 months after last dose |
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Term
|
Definition
dutasteride
Ind: BPH
dose: 0.5 mg daily
Notes: trial of 6 to 12 months necessary
DI: CYP 3A4 inhibitors
CI: females of childbearing potential-do not handle capsules
Precautions: new PSA level at 12 months-then double to compare to untreated men
AE: sexual dysfunction-related to decreased testosterone/will decrease in frequency after 6 months
Pt Consult: do not donate blood until 6 months after last dose |
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Term
|
Definition
levothyroxine
Ind: hypothyroidism
dose: individualized/25-300 mcg per day
Notes: titrate q 4-6wks until euthyroid by TSH
CI: acute MI
Precautions: angina pectoris, oral anticoagulants
AE: related to excessive dose |
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Term
|
Definition
propylthiouracil
Ind: hyperthyroidism
dose: 300 mg/d in divided doses
Notes: give 1/3 to 2/3 of dose when euthyroid
DI: warfarin
Boxed warning: liver damage and failure
Precautions: hematologic abnormalities (1st 3 months of therapy), fever, hepatitis, interstitial nephritis, exfoliative dermatitis
Pt Consult: watch for fever, sore throat, dermatologic changes, signs of liver ds, space out doses every 8 hrs |
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Term
|
Definition
levothyroxine
Ind: hypothyroidism
dose: individualized/25-300 mcg per day, 1.7 mcg/kg for 6-8 wk intervals then adjust based on TSH (from slides)
Notes: titrate q4-6wks until euthryoid by TSH
DI: anticoagulants. Cholestyramine, digoxin, iron, aluminum hydroxide antacids-space 4 hrs apart from these
CI: acute MI, thyrotoxicosis, nodular thyroid ds, uncorrected adrenal insufficiency
AE: hyperthyroid symptoms related to excessive dose (fever, fluid loss, tachycardia, anxiety, insomnia) |
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Term
|
Definition
methimazole
Ind: hyperthyroidism
dose: 5-20 mg q 8 h (15-60 mg q8hrs initial and 5-15 mg qd maintenance- from slides)
Notes: give 1/3 to 2/3 of dose when euthryoid
DI: warfarin
CI: pregnancy
Precautions: agranulocytosis, hepatotoxicity, hypoprothrombinemia/bleeding
Pt Consult: watch for fever, sore throat, dermatologic changes, signs of liver disease, space out doses q8hrs |
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Term
|
Definition
probenecid
Ind: prevention of gout (maintenance therapy)
dose: 250 mg bid
Notes: can titrate in 1 wk, maintenance therapy
DI: salicylates, ketorolac, zalcitabine, methotrexate
CI/Precaution: uric acid kidney stones, renal impairment, PUD
AE: SJS, hepatotoxicity
Pt Consult: increase fluids, may precipitate gout attack when starting |
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Term
|
Definition
allopurinol
Ind: Prevention and treatment of gout
dose: 100-300 mg qd, 400-600 mg qd, divided doses for severe tophaceous gout, max 800 mg/day. Titrated to achieve uric acid <6 mg/dl
Notes: adjust for renal dysfunction
DI: thiopurines, chlorprpamide
Precautions: impaired renal or hepatic function, attacks may increase during initiation of therapy (use NSAIDs or colchicine prophylaxis), adequate fluid intake (2 L/day) if concomitant uricosurics
AE: drowsiness, diarrhea, nausea, rash
PT consult: compliance is ESSENTIAL (acute attacks happen with prn use) |
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Term
|
Definition
febuxostat
Ind: maintenance therapy of gout
dose: 40 mg daily (may increase to 80 mg if uric acid levels <6 mg/dl not achieved on 40 mg)
Notes: can titrate in 2 weeks
DI: mercaptopurine, azathiopurine
Precautions: cardiovascular thromboembolic events, severe hepatic or renal impairment. Attacks may increase during initiation therapy (use NSAIDs or colchicine prophylaxis), adequate fluid intake
AE: liver enzyme abnormalities
Pt Consult: compliance ESSENTIAL (acute attacks can occur with prn use) |
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Term
|
Definition
colchicine
Ind: prophylaxis of gout attacks
dose: 0.6 mg once or twice daily
Notes: 0.6 mg tablets
DI: CYP 3A4 inhibitors
CI: renal or hepatic impairment on p-glycoprotein or strong 3A4 inhibitor
AE: DIARRHEA, nausea, vomiting
Pt Consult: do not discontinue without advising physician |
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|
Term
| Colcrys (acute attack tx) |
|
Definition
colchicine
Ind: acute treatment of gout
dose: 1.2 mg x1, repeat 0.6 mg in 1 hr
Notes: start at the first sign of gout flare |
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Term
|
Definition
phenazopyridine
Ind: urinary tract analgesic
dose: 200 mg tid x 2 days when used with antibacterial. OTC form available as 95 mg
Notes: do not use more than 2 days
CI: renal or hepatic disease
AE: HA, dizziness, stomach cramps
Pt Consult: may discolor urine, stain fabric, take with meals if GI upset |
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Term
|
Definition
dextroamphetamine/amphetamine
Ind: ADHD
dose: initially may be prescribed q AM, typically twice daily dosing
Notes: can titrate weekly, administer morning and lunch/early afternoon |
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Term
|
Definition
dextroamphetamine/amphetamine
Ind: ADHD
dose: typically q AM
Notes: can titrate weekly |
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Term
|
Definition
methylphenidate
Ind: ADHD
dose: q AM
Notes: can titrate weekly |
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Term
|
Definition
methylphenidate
Ind: ADHD
dose: initially may be prescribed qAM, typically bid to tid dosing
Notes: can titrate weekly, administer last dose before 6 pm if prescribed tid |
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Term
|
Definition
methylphenidate extended release
Ind: ADHD
dose: may require BID dosing (am and early afternoon)
Notes: can titrate weekly
SR has 3-8h duration - highly variable? |
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Term
|
Definition
dexmethylphenidate
Ind: ADHD
dose: initially may be prescribed q Am, typically BID dosing
Notes: can titrate weekly, administer morning and lunch/early afternoon
Duration: 3-5h |
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Term
|
Definition
dexmethylphenidate extended release
Ind: ADHD
dose: q AM
Notes: can titrate weekly
Duration: 8-12h
50% IR/50% ER beads can be sprinkled on food |
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Term
|
Definition
atomoxetine
Ind: ADHD
dose: qAM or divided BID (morning and late afternoon)
Notes: weight based dosing if <70 kg and 6 years or older
MOA: NE reuptake inhibitor
CI: MAOI use, severe CV disease
BBW: suicidal ideation
DI: 2D6 inhibitors (fluoxetine, paroxetine, buproprion, quinidine, ritonavir)
AE: insomnia, dizziness, upset stomach
Monitor LFT - incidence of hepatotoxicity
Pt. consult: take with food, delayed onset of action ~4 weeks --titrate 2-4 weeks |
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Term
|
Definition
modafinil
Ind: improve wakefulness (daytime sleepiness/shift work)
dose: 200 mg daily in the morning (or 1 hour prior to starting shift)
Notes: indicated for narcolepsy, obstructive sleep apnea, shift work sleep disorder
MOA: decreases GABA activity, Provigil is also a strong 2C19 inhibitor
DI: do not use with Plavix
CI: D/C at first sign of rash (SJS)
AE: HA, nervousness, dizziness, anorexia
Pt consult: take in the morning or one hour prior to shift work |
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|
Term
| Cortisporin Otic solution |
|
Definition
neomycin/polymyxin/hydrocortisone
Ind: outer ear infection
dose: 3 drops 3-4/day (peds), 4 drops 3-4 times/day( adults)
Notes: retain in ear ideally 5 min, warm before use |
|
|
Term
| Cortisporin Otic suspension |
|
Definition
neomycin/polymyxin/hydrocortisone
Ind: inner ear infection
dose: 3 drops 3-4 times/day (peds), 4 drops 3-4 times/day (adults)
Notes: retain in ear ideally 5 min, warm before use
Pt consult: shake well |
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Term
|
Definition
ciprofloxacin/dexamethasone
Ind: otitis externa/media (tympanostomy)
dose: 4 drops bid for 7 days
Notes: retain in ear for at least 1 min, warm before use
acute otitis media in pediatrics - maniuplation method for tragus to facilitate spread of med (press down gently on tragus?)
pt consult: shake well (suspension) |
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Term
|
Definition
pimecrolimus
Ind: atopic dermatitis (for non-immunocompromised > 2y/o, those w/ treatment failure or where other treatment is inadvisable, use lowest amt for shortest duration possible)
dose: thin layer to area bid, NMT 6 weeks
Notes: do not apply to active viral/bacterial infections
warnings: rare cases of lymphoma and skin malignancy
AE: transiet site burning/itching
pt consult: rub in completely, do not occlude, avoid sunlight exposure - areas will stay photosensitive even after treatment d/c
available as cream only |
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Term
|
Definition
mometasone
Ind: corticosteroid-responsive dermatoses
dose: sparingly once a day
Notes: ointment/cream/lotion |
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Term
|
Definition
triamcinolone
Ind: inflammatory conditions
dose: 2-4 times per day
Notes: ointment, cream, lotion, aerosol, injection, dental paste |
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Term
|
Definition
clotrimazole/betamethasone
Ind: tinea infections (tinea cruris/corporis - 2 wk, tinea pedis - 4 wk of treatment)
dose: apply twice daily
Notes: cream, lotion
AE: local stinging, burning, pruritis, general irritation |
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Term
|
Definition
lidocaine
Ind: post-herpetic neuralgia pain
dose: apply once daily and remove after 12 hours
Notes: can use up to 3 patches per daily dose-trim before use if necessary
Pt consult: can cut patches, do not apply to broken skin, remove after 12h, fold when throwing away, wash hands after handling and avoid eyes |
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Term
|
Definition
sumatriptan
Ind: migraine headaches
dose: 25 mg po, up to 100 mg per dose, can repeat after 2 hours
Notes: 25, 50, 100 mg tablets, max 200 mg in 24 hours
onset of about 30 mins, longer than other forms
short duration |
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Term
|
Definition
sumatriptan
Ind: migraine headaches
dose: 6 mg SQ, can repeat 6 mg after 1 hr
Notes: max 12 mg SQ in 24 hrs
may be better option if N/V with migraine
short duration |
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Term
|
Definition
sumatriptan
Ind: migraine headaches
dose: 5, 10 or 20 mg in 1 nare, can repeat after 2 hours
Notes: 5, 20 mg nasal, max 40 mg in 24 hours
shorter onset (15 minutes)
short duration |
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Term
|
Definition
rizatriptan
Ind: migraine headaches
dose: 5 mg, can repeat after 2 hours
Notes: 5/10 mg tab in regular and MLT tab, max 30 mg in 24 hrs
MLT doesn't work any faster than regular tabs
short duration |
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Term
|
Definition
zolmitriptan
Ind: migraine headaches
dose: 5 mg in 1 nare, can repeat after 2 hours
Notes: 5 mg nasal, max 10 mg per 24 hrs
short duration |
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Term
|
Definition
zolmitriptan
Ind: migraine headaches
dose: 2.5 mg, can repeat after 2 hours
Notes: 2.5/5 mg tab in regular and ZMT tab, max 10 g in 24 hrs
short duration |
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Term
|
Definition
almotriptan
Ind: migraine headaches
dose: 6.25 mg, 12.5 mg, can repeat after 2 hours
Notes: max 25 mg in 24 hours
short duration |
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Term
|
Definition
eletriptan
Ind: migraine headaches
dose: 20, 40 mg, can repeat after 2 hours
Notes: max 80 mg in 24 hrs
Should not be used within 72h of treatment with strong CYP3A4 inhibitors (azoles, clarithromycin/telithromycin, protease inhibitors, nefazodone, chloramphenicol)
short duration |
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Term
|
Definition
frovatriptan
Ind: migraine headaches
dose: 2.5 mg, can repeat after 2 hours
Notes: max 7.5 mg in 24 hours
long duration, slower onset (1-2h)
food does not affect absolute bioavailability but may delayed time to max concentration by ~1h (pt consult: take on an empty stomach)
may be better for those who have repeat HA often, but it has a slower onset compared to similar drugs? |
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Term
|
Definition
naratriptan
Ind: migraine headaches
dose: 1, 2.5 mg, can repeat after 4 hours (only one like this.._
Notes: max 5 mg in 24 hours
PKIN: ~80% renal elimination - avoid use in ESRD. mild to moderate impairment - consider 1mg dose with
long duration |
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|
Term
| Isometheptene/dicloralphenazone/APAP |
|
Definition
isometheptene/dichloralphenazone/APAP
Ind: migraine headaches
dose: 2 at onset, then 1 every hr
Notes: 5 caps/12 hours for migraine, prior brand name= Midrin
Schedule C IV
CI: HTN, glaucoma, severe renal/CV disease, MAOI use
AE: drowsiness, dizziness
isometheptene - vasoconstrictor, dichloralphenazone - antipyretic (anti-inflamm),
chlorohydrate metabolite - sedative (habit forming) |
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Term
|
Definition
norethindrone/ethinyl estradiol/ferrous fumarate
Ind: contraception
dose: one tablet daily
monophasic |
|
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Term
|
Definition
desogestrel/ethinyl estradiol
Ind: contraception
dose: one tablet daily
monophasic |
|
|
Term
|
Definition
ethinyl estradiol/levonorgestrel
Ind: contraception
dose: one tablet daily
no placebo tablets
higher rate of spotting/breakthrough bleeding
monophasic |
|
|
Term
|
Definition
ethinyl estradiol/norgestrel
Ind: contraception
dose: one tablet daily
monophasic |
|
|
Term
|
Definition
drospirenone/0.03 mg ethinyl estradiol
Ind: contraception
dose: one tablet daily
warnings/precautions: increased thromboembolic risk
drosperinone is a spironolactone analogue - minimizes water weight gain
K+ retention - ACEI, K+ sparing diuretics, NSAIDs |
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Term
|
Definition
drospirenone/0.02 mg ethinyl estradiol
Ind: contraception
dose: one tablet daily
contains 24 active tabs
warnings/precautions: increased thromboembolic risk
drosperinone is a spironolactone analogue - minimizes water weight gain
K+ retention - ACEI, K+ sparing diuretics, NSAIDs |
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Term
|
Definition
norethindrone/ethinyl estradiol
Ind: contraception
dose: one tablet daily
biphasic |
|
|
Term
|
Definition
norgestimate/ethinyl estradiol
Ind: contraception
dose: one tablet daily
triphasic |
|
|
Term
|
Definition
levonorgestrel/ethinyl estradiol
Ind: contraception
dose: one tablet daily
triphasic |
|
|
Term
|
Definition
etonogestrel/ethinyl estradiol
Ind: contraception
dose: 1 ring vaginally for 21 days, remove for 7 days
pt consult: 1. store in fridge prior to dispensing (stable 4 months at room temp)
2. re-insert new ring 7 days after removal, approximately same time of day
3. can remove for < 3hours during intercourse, rinse with cool or lukewarm water then reinsert
4. dispose of ring using reclosable foil pouch - don't flush it. |
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Term
|
Definition
estradiol transdermal
Ind: estrogen replacement
dose: apply to lower trunk (not breast area), change twice weekly - same 2 days at same time
Notes: rotate sites> weekly, 0.0375, 0.05, 0.075, 0.1 mg transdermal patches
pt consult: avoid waistline and apply immediately after removing from pouch (apply to lower abdomen, not breast), pt can swim and bathe with it on. |
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Term
|
Definition
tamoxifen
Ind: breast cancer treatment/prevention
dose: 20-40 mg/daily in divided doses
Notes: 10, 20 mg tab, 20 mg daily for 5 years in prevention. max dose 40 mg/day
DI: warfarin
CI/precautions: VTE; ocular tests (retinal changes)
AE: hot flashes; N/V
pt consult: VTE counseling - swelling/pain & SOB, contact prescriber if any visual changes |
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Term
|
Definition
anastrozole
Ind: breast cancer treatment
dose: 1 mg daily
MOA: aromatase inhibitor- blocks circulating estrogen
DI: estrogen/tamoxifen
CI/precautions: premenopausal/preg. women, loss of BMD
AE: hot flashes, N/V |
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|
Term
|
Definition
megestrol
Ind: carcinoma (CA)/weight loss
dose: up to 320 mg/day in CA, up to 800 mg day in weight loss
Notes: tablets, oral suspension, ES oral suspension
MOA: progestational agent
AE: N, weight gain
Pt consult: contact physician if you become pregnant (see MOA) |
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Term
|
Definition
promethazine
Ind: antiemetic/antivertigo
dose: 12.5 mg-25 mg q 4-6 h/25 mg BID
Notes: tablets, syrup, suppository, injection
MOA: H1 inhibition
DI: CNS depressants
AE: drowsiness, dizziness, dry mouth
Pt consult: avoid OH |
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Term
|
Definition
promethazine/codeine
Ind: cough/upper resp symptoms
dose: 1 tsp q 4-6 hrs
Notes: 6.25 mg promethazine/10 mg codeine per 5 ml, max 30 ml per 24hrs
Schedule V
AE: drowsiness, dizziness, dry mouth, nausea/constipation (from codeine)
pt consultation: avoid OH, take w/ food or milk |
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Term
|
Definition
orlistat
Ind: obesity management
dose: 120 mg tid with fat containing meal (skip if having low fat or no meal)
Notes: vitamins KADE 2 hr pre or post Xenical
DI: levothyroxine (space out doses 4 hours from this), warfarin (changes vitamin K stores)
CI: chronic malabsorption, cholestasis
Precautions: need to supplement fat soluble vitamins
AE: GI and can be related to fat content of meals; MAY decrease during continued therapy |
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Term
|
Definition
lorcaserin
Ind: adjunct weight loss treatment
dose: 10 mg twice daily
Notes: BMI of 30 or greater or 27 or greater with HTN, dyslipidemia or diabetes
D/C if < 5% BW lost within 1st 12 weeks (less effective)
MOA: 5HT2c agonist
CI: preg. cat. X
Warnings: heart valve concerns, avoid use when CrCl < 30, use caution in CrCl 30-49, can cause hyperprolactinemia (galactorrhea)
Precautions: hypoglycemia in diabetic patients losing weight
DI: lorcaserin is a moderate 2D6 inhibitor (interacts w/ TCAs, *SSRIs, opioids, BB)
AE: HA, dizziness, nausea
PT consult: surveillance for decrease in blood glucose for diabetic pt taking meds that have potential for hypoglycemia |
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|
Term
| ADHD Medication class Contraindications |
|
Definition
1. atherosclerosis, moderate HTN (CV hx - baseline EKG monitoring)
2. hyperthyroidism
3. agitated states
4. glaucoma |
|
|
Term
| ADHD medication class PRECAUTIONS |
|
Definition
mild HTN
dependence issues? |
|
|
Term
| ADHD medication class drug interactions |
|
Definition
additive stimulants
MAOI (do not use within 14 days of one another) |
|
|
Term
| Topical steroids CI/precautions |
|
Definition
| herpes simplex, varicella/other viral infections, fungal infections |
|
|
Term
| otic formulations of steroids pt. consultation |
|
Definition
not for eye
retain medication in ear for at least 5 minutes
*do not warm med above body temp (don't microwave etc.) |
|
|
Term
|
Definition
|
|
Term
| Triptan drug interactions |
|
Definition
SSRI (5HT syndrome)
No ergot alkaloids (ergotamine) within 24h of admin - increase BP/CV response |
|
|
Term
| triptan contraindications |
|
Definition
| IHD, uncontrolled HTN, MAOI |
|
|
Term
| T/F triptans are indicated for relief, not prevention of migraine HA |
|
Definition
|
|
Term
| absolute contraindications estrogen-progestin oral contraceptives |
|
Definition
1. active breast CA
2. h/o DVT/PE, IHD, h/o stroke
3. systolic > 160 or diastolic > 100
4. severely impaired liver function
5. over age of 35 and actively smoking (>15 cigs?)
6. pregnancy, known or suspected |
|
|
Term
| hormone contraceptive interactions |
|
Definition
anticonvulsants - induction of metabolism
antibiotics - rifampin and griseofulvin induce metabolism
antiretroviral therapies
st john's wort - induction of metabolism |
|
|
Term
| selected estrogen-related adverse effects |
|
Definition
HA, nausea (take at bedtime)
increase in BP
breast tenderness/swelling
fluid retention/edema, weight gain (cyclic) |
|
|
Term
| selected progestin-related adverse effects |
|
Definition
fatigue, weight gain (non-cyclic)
varicosities
insulin resistance -changes glu levels |
|
|
Term
| contraceptive selection principles: signs of hormonal deficiency - early to mid cycle spotting/ bleeding, dryness or vaginitis, decreased libido - associated with estrogen or progestin? |
|
Definition
|
|
Term
| late cycle spotting/bleeding, heavy menstrual bleeding - a sign of hormonal deficiency associated with estrogen or progestin? |
|
Definition
|
|
Term
| pt consult: if progestin only OC is used and pill is taken greater than 3 hours later than normal, what should you advise pt. to do? |
|
Definition
| use back-up contraception for 48 hours |
|
|
Term
BMI measurement classification:
normal weight:
overweight:
obesity (class 1):
obesity (class 2):
extreme obesity (class 3): |
|
Definition
normal weight: 18.5-24.9
overweight: 25-29.9
obesity (class 1): 30-34.9
obesity (class 2): 35-39.9
extreme obesity (class 3): >/= 40 |
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