Term
| Alendronate: (Fosamax) B2. |
|
Definition
Mode of Action: decrease bone resorption by inhibiting osteoclasts.
Indication: Paget’s disease, Osteoporosis (treatment and prevention),.
Dose: Treatment: 5mg daily, 10mg for postmenopausal not receiving oestrogen. Prevention: 10mg daily or 70mg weekly. Can be combo with colecalciferol 140mcg. Paget’s: 40mg daily for 6 months.
Adverse Reactions: Osteonecrosis of the jaw (OJW), NVD, headache, hypocalaemia, oesophageal ulcers, allergic reactions.
Refer: OJW, allergic reactions, bone fractures, heartburn.
Lifestyle: exercise (weight bearing), diet, reduce caffeine, alcohol and healthy diet
Interactions: Antacids, calcium, iron.
Counselling: take in morning with full glass of water and remain upright for 30 minutes. Don’t take antacids, calcium or iron within 30 minutes. |
|
|
Term
| Allopurinol: (Progout, Allosig) B2. |
|
Definition
Mode of Action: inhibits xanthine oxidase which reduces uric acid production.
Indication: Chronic gout.
Dose: 100-300mg.
Adverse Reactions: NVD, allergic reactions
Refer: increase gout symptoms, allergic reaction.
Lifestyle: decrease smoking, alcohol, shell fish.
Interactions: Azathioprine .
Counselling: reduce dose if renal impairment, take shortly after food. |
|
|
Term
| Amiodarone: (Aratac, Cardorane) C. |
|
Definition
Mode of Action: Decrease sinus node and junctional automaticity, lows AV and prolongs refractory period in myocardial tissue.
Indication: Antiarrhymthia Dose: 100-200mg, LD: 200mg tds for 7 days, then bd for 7 days, maintenance 100-200mg.
Adverse Reactions: Blue-grey skin photosensitivity, taste disturbance, constipation, worsening arrhymias, cough due to pulmonary toxicity, hypo or hyperthyroidism, liver toxicity.
Refer: Tachy or bradycardia, hyper or hypothyroidism.
Lifestyle: decrease smoking, alcohol, diet, exercise. Interactions: increase Warfarin, simvastatin, digoxin, phenytoin, metoprolol. |
|
|
Term
| Amlodipine: (Norvasc, Amlo) C. |
|
Definition
Mode of Action: Dihydropyridine: block inward current of calcium into vascular smooth muscle via L type calcium channels to reduce peripheral resistance.
Indication: Hypertension.
Dose: 5-10mg.
Adverse Reactions: peripheral oedema, rash, dizziness, hypotension, flushing, palpations.
Refer: high BP, peripheral oedema, rash, hypotension.
Lifestyle: decrease smoking, caffeine, alcohol and exercise.
Interactions: |
|
|
Term
| Betamethasone: (Dipropionate: Diprosone & Eleuphrat 0.05%. Valerate: Antroquoril 0.02%, Celestone 0.05%, Cortival 0.05%, betnovate 0.05%). |
|
Definition
Mode of Action: Suppression of inflammatory and immune responses.
Indication: Inflammation of the skin (psoriasis, eczema, dermatitis).
Dose: 0.05%, 0.02%.
Adverse Reactions: Folliculitis, dermatitis, delayed wound healing, skin thinning, depigmentation.
Refer: no improvement.
Lifestyle: ID irritant.
Interactions:
Counselling: fingertip rule, apply 1-2 times a day for 7 days. |
|
|
Term
| Celecoxib: (Celebrex), C. |
|
Definition
Mode of Action: COX 2 inhibitor.
Indication: OA, RA, period pain.
Dose: 100-200mg, Maintenance: 400mg, period pain: 400mg for 5 days, RA: 100-200 bd.
Adverse Reactions: high BP, SJS, rash, fluid retention, ulcers, headache.
Refer: swollen ankles, black stools, trouble breathing, SJS, high BP, black stools.
Lifestyle: decrease weight, decrease smoking and alcohol, exercise.
Interactions: Warfarin.
Counselling: take with food. |
|
|
Term
| Clopidogrel: (Plavix, Isocover), B1. |
|
Definition
Mode of Action: Thienopyridines and binds to the platelet P2Y12 receptor and inhibits platelet aggregation for the life of the platelet.
Indication: Prevention of ischaemic event (M I, Ischaemic stroke, adjuvant with stemi plus aspirin)
Dose: 75mg, 75/100mg.
Adverse Reactions: Bleeding, hypersensitivity, ulcer, diarrhoea.
Refer: bleeding.
Lifestyle: increase exercise, diet, weight, decrease alcohol, caffeine and smoking.
Interactions: PPI decrease it, Clarithromycin, fluoxetine. |
|
|
Term
| Digoxin: Cardiac Glycoside (Sigmaxin, Lanoxin), A. |
|
Definition
Mode of Action: Increases force of myocardial contraction and decreases AV nodal conduction.
Indication: Heart failure, AF.
Dose: LD: 250mcg-500mcg for 4-6 hours (max 1.5mg). maintenance: 250-125mcg, CrCl <60: 62.5mcg.
Adverse Reactions: Tachycardia, anorexia, NVD, blurred vision, depression.
Refer: digoxin toxicity.
Lifestyle: decrease alcohol, smoking, caffeine, diet and exercise.
Interactions: Amiodarone, carvedilol, diltrazem, verapamil, macrolides increase digoxin. SJW decrease it.
Counselling: tell your pharmacist you are on Digoxin before starting new medication. |
|
|
Term
| Diltiazem: (Benziothiazepine: vasocardol, Cardizem), C. |
|
Definition
Mode of Action: block inward current of calcium into vascular smooth muscle via L type calcium channels to reduce peripheral resistance.
Indication: AF, angina, HTN.
Dose: AF: 30mg 3-4 times a day, or CR 180-360 daily, HTN: 180-240mg.
Adverse Reactions: peripheral oedema, dizziness, gingival hyperplasia, rash, headache, hypersensitivities.
Refer: oedema, hypersensitivities, high BP, angina, palpitations.
Lifestyle: decrease alcohol, smoking, caffeine, diet and exercise.
Interactions: Digoxin, Atorvastatin, Colchicine, increases it, Cyclosporin decrease it. |
|
|
Term
| Enoxaparin: (Clexane), C. |
|
Definition
Mode of Action: LMWH, inactivate clotting factors 2a and Xa by binding to antothrombin 3.
Indication: VTE prevention, surgical risk, VTE.
Dose: 20 VTE risk (travelling), moderate surgery: 20mg, higher risk: 40mg. VTE 1mg/kg bd for 5 days.
Adverse Reactions: Bleeding, pain at site, hyperkalaemia, increased aminotransferase.
Refer: bleeding.
Lifestyle:
Interactions: |
|
|
Term
| Fluticasone: (Flixotide). |
|
Definition
Mode of Action: Suppression of inflammatory and immune responses.
Indication: Asthma, C O P D if fev 50%.
Dose: MDI: 100-200mcg bd, >800mcg severe, ideal: 100-250 daily. Nebs: 0.5/2ml or 2/2ml. MDI: 125-250mcg and child 50mcg.
Adverse Reactions: thrush, pneumonia, bruising, rash.
Refer: no improvement, C O P D with pneumonia.
Lifestyle: ID irritate, stay indoors during spring, dust free.
Interactions:
Counselling: how to use puffer. |
|
|
Term
| Frusemide: (Lasix, Urex), C. |
|
Definition
Mode of Action: inhibit reabsorption of sodium and chloride in ascending limb of the loop of henle. Accounts for retention of approx. 20% of filtered sodium, therefore a potent diuretics.
Indication: HF with oedema, liver cirrhosis, renal impairment.
Dose: 20-40mg daily, (max: 1g)
Adverse Reactions: Orthostatic hypotension, hyponatraemia, Cal, Kal, Mag, Gout (hyperuricaemia).
Refer: increase oedema, low output, low electrolytes (dehydration).
Lifestyle:
Interactions: Thiazides, sartans, ACEi, N SAIDs. |
|
|
Term
| Gliclazide: (Diamicron, Glycade), C. |
|
Definition
Mode of Action: Sulfonylureas: Increase pancreatic insulin secretion. Binds the receptors on beta cells and blocking ATP sensitive potassium channels and increasing intracellular calcium thus increasing insulin secretion.
Indication: type 2 diabetes.
Dose: max CR: 120mg, normal formulation max: 320 mg.
Adverse Reactions: weight gain, hypoglycaemia.
Refer: high BSL, increase weight.
Lifestyle: exercise, diet.
Interactions: cholestyramine and cimetidine |
|
|
Term
| Glyceryl trinitrate: (Nitrolingual, Anginine, Nitro-Duo), B2. |
|
Definition
Mode of Action: Provide exogenous source of NO causing vasodilation.
Indication: Angina, acute pulmonary oedema.
Dose: Sublingual: 300-600mcg, repeat 4 mins until pain goes, spray: 400mcg. Chronic patch: 5-15 (14 hours).
Adverse Reactions: Headache, flushing, HTN, dizziness, tolerance (12 hour free periods).
Refer: increase angina.
Lifestyle:
Interactions: Moderate exercise, decrease alcohol caffeine and diet. |
|
|
Term
| Hydrochlorothiazide: (Dithazide), C. |
|
Definition
Mode of Action: inhibit reabsorption of sodium and chloride in the proximal segment of the distal convoluted tubule and increasing potassium excretion.
Indication: HTN, moderate oedema with HF, diabetes insipidus.
Dose: 12.5-25mg, oedema: 25-100mg.
Adverse Reactions: Dizziness, hypokalaemia, Cal, mag, hyperglycaemia, polyuria, orthostatic hypotension.
Refer: high BP, high BSL, increased oedema, dehydration.
Lifestyle:
Interactions: Moderate exercise, decrease alcohol caffeine and diet. |
|
|
Term
| Irbesartan: (Avapro, Karvea), D. |
|
Definition
Mode of Action: Competitively block binding of angiotensin 2 to type 1 receptors to reduce vasoconstriction.
Indication: HTN, decrease renal disease progression in type 2 diabetes.
Dose: 150-300mg, >75mg haemodialysed.
Adverse Reactions: Dizziness, headache, hypokalaemia, hypotension, cough.
Refer: high BP.
Lifestyle: Moderate exercise, decrease alcohol caffeine and diet.
Interactions: Thiazides, Frusemide, N SAIDs. |
|
|
Term
| Isosorbide mononitrate: (Monodur, Duride), B2. |
|
Definition
Mode of Action: Provide exogenous source of NO (vasodilation).
Indication: Prevention of angina (not acute).
Dose: Initially 30-60mg d (max 120mg).
Adverse Reactions: Headache, hypotension, tachycardia, dizziness, tolerance.
Refer: Uncontrolled angina, chest pain.
Lifestyle: limit alcohol smoking and healthy diet, mild to moderate exercise.
Interactions:
Counselling: Stand up gradually, take at time attack most likely to occur. |
|
|
Term
| Latanoprost: (Xalatan), B3. |
|
Definition
Mode of Action: Selective Pg F2 alpha analogue to decrease IOP.
Indication: Glaucoma, ocular HNT, decrease IOP in open angle.
Dose: 1 drop at night.
Adverse Reactions: bitter taste, periorbital rash, stinging, blurred vision, eyelid darkening.
Refer: no improvement in symptoms.
Lifestyle: Limit smoking.
Interactions: N SAIDs can reduce latanoprost effect.
Counselling: instil in the evening. |
|
|
Term
| Mesalazine: (Salofalk, Pentasa Mesasal), C. |
|
Definition
Mode of Action: Anti-inflammatory for the bowel.
Indication: Crohns or Ulcerative colitis.
Dose: Acute UC: 2-4g, maintenance: 1.5-2g d. Acute crohns: 4g d and same for maintenance.
Adverse Reactions: Headache, Neuropathy, rash, GI upset.
Refer: increased pain.
Lifestyle: decrease smoking, caffeine and alcohol.
Interactions:
Counselling: take with food, don’t crush. |
|
|
Term
| Metformin: (Diaformin, Diabex), C. |
|
Definition
Mode of Action: Reduces hepatic glucose production and increase peripheral use of glucose
Indication: Type 2 diabetes.
Dose: 500mg-3g. renal clearance Cr/Cl 60-90: 2g, Cr/Cl 30-60g: 1g.
Adverse Reactions: NVD, lactic acidosis, anorexia, b12 deficient.
Refer: High BSL, uncontrolled diabetes.
Lifestyle: decrease alcohol, improve diet and exercise.
Interactions: Topiramate increase metformin.
Counselling: Take with food. |
|
|
Term
| Methotrexate: (Methoblastin), D. |
|
Definition
Mode of Action: Folic acid antagonist, inhibit DNA synthesis and cell replication.
Indication: Psoriasis, RA, Crohns, Ectopic pregnancy, dermatomyositis.
Dose: Crohns: 25mg weekly, RA: 5-25mg weekly.
Adverse Reactions: Myelosuppression, NVD, anaphylactic, pulmonary and hepatotoxicity.
Refer: Myelosuppression, no relief.
Lifestyle: decrease smoking and alcohol.
Interactions: Ciprofloxacin, cyclosporine, doxycycline increase methotrexate. Trimethoprim increase myelosuppression.
Counselling: take same time each week, and take folic acid sup once a week. |
|
|
Term
| Metoprolol: (Minax, Betaloc), C. |
|
Definition
Mode of Action: Selectively competitively blocks beta receptors in heart and peripheral vasculature.
Indication: HNT, Angina, M I, tachyarrhythmias, prevention of migraines.
Dose: 50-100mg, maintenance: 50-200mg.
Adverse Reactions: Nausea, dizziness, cold extremities, fatigue, rash.
Refer: high BP, Diabetic (mask hypoglycaemia).
Lifestyle: diet, exercise and diet.
Interactions: Amiodarone, paroxetine increase metoprolol.
Counselling: don’t stop abruptly, dizziness initially. |
|
|
Term
| Oxybutynin: (Ditropan), B1. |
|
Definition
Mode of Action: Anticholinergic to decrease muscle contractility and capacity.
Indication: Urinary urge incontinence.
Dose: 2.5-5mg 2-3 times a day (max 20mg), patch (oxytrol) 3.9mg for 3-4 days per patch.
Adverse Reactions: dry mouth and eyes, facial flushing.
Refer: no improvement.
Lifestyle: decrease caffeine, alcohol, exercise and healthy diet.
Interactions: |
|
|
Term
| Prazosin: (Minipress), B2. |
|
Definition
Mode of Action: Blocks alpha receptors and decrease peripheral resistance.
Indication: HTN.
Dose: 0.5mg bd or 3-20mg maintenance.
Adverse Reactions: impaired alertness, CV, CNS and neuromuscular disturbance, Anticholinergic effects.
Refer: adverse effects and high BP.
Lifestyle: Diet, decrease caffeine, alcohol and exercise.
Interactions:
Counselling: caution when standing from sitting, 1st dose at night. |
|
|
Term
| Prednisolone: (Solone, Panafcortelone). |
|
Definition
Mode of Action: regulate gene expression, glucocorticoid to decrease inflammation and immune.
Indication: Asthma, Croup, crohns, UC.
Dose: 5-60mg, Asthma: 40-50mg. child: 1mg/kg.
Adverse Reactions: Adrenal suppression, increase infection, sodium and water retention.
Refer: no improvement of symptoms.
Lifestyle:
Interactions:
Counselling: take with food, and not for prolonged use unless advised by doctor. |
|
|
Term
| Ramipril: (Tritace, Tryzan), D. |
|
Definition
Mode of Action: Block conversion of angiotensin 1 to 2, therefore decreases angiotensin 2 vasoconstriction and sodium retention, and aldosterone release, and inhibit breakdown of bradykinin.
Indication: Hypertension, Heart failure, post M I.
Dose: 2.5mg to 10mg.
Adverse Reactions: Hypotension, cough, hyperkalaemia, dizziness, headache, nausea.
Refer: Hyperkalaemia no improvement in blood pressure.
Lifestyle: Diet, decrease caffeine and alcohol and smoking, exercise.
Interactions: Loop and thiazide diuretics, N SAIDS.
Counselling: no extra potassium supplement. |
|
|
Term
| Salmeterol: (Serevent Accuhaler), B3. |
|
Definition
Mode of Action: Beta 2 agonist (LABA) and cause smooth muscle relaxation and bronchiodilation.
Indication: Maintenance for asthma and COPD.
Dose: 25-50mcg twice daily.
Adverse Reactions: tremor, palpitations.
Refer: no improvement or worsening of symptoms.
Lifestyle: ID allergen, avoid dust, cold environments, stop smoking.
Interactions: Beta blockers.
Counselling: use ICS with asthma. |
|
|
Term
| Simvastatin: (Zocor, Zimstat), D. |
|
Definition
Mode of Action: inhibit HMG CoA reductase, increase hepatic cholesterol uptake from blood and decrease total cholesterol, TC and LDL.
Indication: Hypercholesterolaemia, hyperlipidaemia.
Dose: 10-80mg.
Adverse Reactions: Myalgia, myopathy, headache, aminotransferase, peripheral neuropathy.
Refer: increased cholesterol, side effects, myopathy.
Lifestyle: exercise, diet, stop smoking, reduce alcohol.
Interactions: Amiodarone, Clarithromycin, diltiazem increase statin levels. Carbamazepine and SJW decrease statin levels.
Counselling: take in the evening, avoid grapefruit or grapefruit juice. |
|
|
Term
| Tiotropium: (Spiriva), B1. |
|
Definition
Mode of Action: Promote bronchodilation by inhibiting cholinergic bronchomotor tone.
Indication: Maintenance for COPD and severe asthma.
Dose: 18mcg daily.
Adverse Reactions: Dry mouth, throat irritation, blurred vision, dizziness, urinary retention.
Refer: no improvement of symptoms.
Lifestyle: Mild to moderate exercise.
Interactions:
Counselling: not for immediate relief, no for people with closed angle glaucoma. |
|
|
Term
| Warfarin: (Marevan, Coumadin), D. |
|
Definition
Mode of Action: inhibit synthesis of vitamin K dependent clotting factors 2, 7, 9 and 10 and antithrombotic factors protein C & S.
Indication: Prevention and treatment of VTE, AF, M I for increased risk of stroke, prevention of thromboembolism in prosthetic heart values.
Dose: 5mg daily for the 1st 2 days, adjust for INR (2-3), maintenance 1-10mg daily.
Adverse Reactions: Bleeding, skin necrosis, fever, rash.
Refer: Bleeding, increased side effects.
Lifestyle:
Interactions: Amiodarone, macrolides, metronidazole increase warfarin levels. Carbamazepine, SJW, phenytoin decrease warfarin levels.
Counselling: take same brand, same time each day. Not for people with increased disease state with risk of bleeding, uncontrolled hypertension, alcoholism, severe hepatic disease. |
|
|
