Clobetasol

Clobex®, Cormax®, Embeline®, Olux®, Olux-E®, Temovate®

Uses: Steroid responsive dermatoses, Mild-Mod Plaque psoriasis

MOA: Exact mechanism of anti-inflammatory action unknown; inhibits multiple inflammatory cytokines, produces multiple glucocorticoid and mineralocorticoid effects

Dose: Cream/Gel/Oint: Apply BID, Max: 50 g/wk x 2 wks; Foam/Soln: Apply BID, Max 1.5 capfuls/dose, 50 g/wk x 2 wks

Caution: C, ?, Peds, skin infxn

CI: Component sensitivity

Disp: Crm, Foam, Gel, Oint, Soln 0.05%

SE: Burning, stinging, irritiation, itching, redness, dryness, abnormal hair growth, hypopigmentation

Notes: Do not apply to face, groin, axillae; Avoid occlusion

Norgestimate/Ethinyl Estradiol

Sprintec®, Ortho-Cyclen®

BBW: Cigarette smoking incr risk of serious cardiovascular side effects from combination OCPs; incr risk w/ age (particularly for women >35 yo) and w/ number of cigarettes smoked; contraindicated in smokers >35 yo

Uses: *Contraception,* Dysfunctional uterine bleeding, dysmenorrhea, endometriosis, polycystic ovary syndrome

MOA: Suppresses LH and FSH, inhibiting ovulation; alters cervical mucus and endometrium

Dose: 1 tab PO QD (0.25 mg Norgestimate/35 mcg Ethinyl estradiol)

Caution: X, +, HTN, Hyperlipidemia, DM, IBS, Fluid retention, obesity

CI: Pregnancy, Smoking esp. > 35 yo, Hx of breast cancer, endometrial cancer, Thromboembolism, Heart disease, CAD, Undiagnosed vaginal bleeding, Migraine headaches

Disp: Monophasic pack; 0.25 mg Norgestimate, 35 mcg Ethinyl estradiol

SE: Breast tenderness, HA, wgt changes, edema, depression, acne, libido changes, ↑ BP, glucose intolerance, ↑ cholesterol

Nifedipine ER

Procardia® XL, Adalat® CC

Uses: *Vaso-spastic or chronic stable angina & HTN,* tocolytic

MOA: CCB

Dose: 30-90 mg/d. Tocolysis: per local protocol

Caution: C, +, Heart block, aortic stenosis

CI: IR preparation for urgent or emergent HTN, acute MI

Disp: Caps 10, 20 mg; SR tabs 30, 60, 90 mg

SE: HA common on initial treatment, reflex tachycardia may occur w/ regular-release dosage forms, peripheral edema, ↓ BP, flushing, dizziness

Notes: Adalat CC & Procardia XL not interchangeable, SL administration not OK

Aspirin, enteric coated

Bayer®, Ecotrin®, St. Josephs®

OTC

Uses: *Angina, CABG, PTCA, carotid endarterectomy, ischemic stroke, TIA, MI, arthritis, pain, fever,* HA, inflammation, Kawasaki disease

MOA: Prostaglandin inhib by COX-2 inhib

Dose: Pain, fever: 325-650 mg q4-6h PO or PR (4g/d max). RA: 3-6 g/d PO in ÷ doses. Plt Inhib: 81-325 mg PO daily. Prevent MI: 81 (preferred)-325 mg PO daily. ACS: 160-325 mg PO ASAP, chewing preferred at onset, 4 g/day max; avoid w/ CrCl <10 mL/min, severe liver disease

Caution: C, M, Linked to Reye syndrome, avoid w/ viral illness in peds <18 y

CI: Allergy to ASA, chickenpox/flu symptoms, syndrome of nasal polyps, angioedema, & bronchospasm to NSAIDs

Disp: Tabs 325, 500 mg; Chew tabs 81 mg; EC tabs 81, 162, 325, 500, 650, 975 mg; SR tabs 650, 800 mg; Effervescent tabs 325, 500 mg; Supp 125, 200, 300, 600 mg

SE: GI upset, errosion, & bleeding

Notes: D/C 1 wk pre-op; avoid/limit EtOH; Salicylate levels: Therapeutic: 100 to 250 mcg/mL, Toxic:>300 mcg/mL 

Fenofibrate

TriCor®, Antara®, Lofibra®, Lipofen®, Triglide®

Uses: Hypertriglyceridemia, hypercholesteremia

MOA: ↓ Triglyceride synth

Dose: 43-160 mg/d; ↓ w/ renal impair; take w/ meals

Caution: C, ?

CI: Hepatic/severe renal insuff, primary biliary cirrhosis, unexplained ↑ LFTs, gallbladder disease

Disp: Caps 50, 100, 150 mg; Caps (micronized): (Lofibra) 67, 134, 200 mg; Tabs 43, 54, 130, 160 mg

SE: GI disturbances, cholecystitis, arthralgia, myalgia, dizziness, ↑ LFTs

Notes: Monitor LFTs

Levetiracetam

Keppra®

Uses: Adjunctive PO treatment in partial onset seizures (adults & peds ≥ 4 y), myoclonic seizures (adults & peds ≥ 12 y) w/ juvenile myoclonic epilepsy (JME), primary generalized tonic-clonic (PGTC) seizures (adults & peds ≥ 6 y) w/ idiopathic generalized epilepsy. Adjunctive inj treatment partial-onset seizures in adults w/ epilepsy; and myoclonic seizures in adults w/ JME. Inj alternative for adults (≥ 16 y) when PO not possible

MOA: Unknown

Dose: 500 mg PO bid; titrate q2wk, may ↑ 3000 mg/d max. ↓ in renal insuff

Caution: C, ?/-, elderly, w/ renal impair, psychological disorders, ↑ suicidality risk for antiepileptic drugs, higher for those w/ epilepsy vs. those using drug for psychological indications; Inj not for < 16 y

CI: Component allergy

Disp: Tabs 250, 500, 750, 1000 mg; soln 100 mg/mL; Inj 100 mg/mL

SE: Dizziness, somnolence, HA, N/V, hostility, aggression, hallucinations. myelosuppression, impaired coordination

Notes: Do not D/C abruptly, postmarket hepatic failure and pancytopenia reported

Nitroglycerin

Nitrostat®, Nitrolingual®, Nitro-Bid® Ointment, Nitro-Bid® IV, Nitrodisc®, Transderm-Nitro®, NitroMist®

Uses: Angina pectoris, acute & prophylactic treatment, CHF, BP control

MOA: Relaxes vascular smooth muscle, dilates coronary arteries

Dose: SL: 1 tab q5min SL PRN for 3 doses; Translingual: 1-2 metered doses sprayed onto PO mucosa q3-5 minutes, max 3 doses. PO: 2.5-9 mg TID. IV: 5-20 mcg/min, titrated to effect. Topical: Apply 1/2 inch of oint to chest wall TID, wipe off at night. Transdermal: 0.2-0.4 mg/h/patch daily; aerosol: 1 spray at 5-min intervals, max 3 doses

Caution: B, ?, restrictive cardiomyopathy

CI: w/ Sildenafil, Tadalafil, Vardenafil, head trauma, NAG, pericarial tamponade, constrictive pericarditis

Disp: SL tabs 0.3, 0.4, 0.6 mg; Translingual spray 0.4 mg/dose; SR caps 2.5, 6.5, 9 mg; Inj 0.1, 0.2, 0.4 mg/mL (premixed); Inj soln 5 mg/mL; Oint 2%, Transdermal patches 0.1, 0.2, 0.4, 0.6 mg/h; Aerosol 0.4 mg/spray

SE: HA, ↓ BP, light-headedness, GI upset

Notes: Nitrate tolerance, w/ chronic use aftr 1-2 wk; minimize by providing 10-12h nitrate-free period daily, using shorter acting nitrates TID & removing LA patches & oint before sleep to ↓ tolerance

Chlorhexidine gluconate

Peridex®

Uses: Gingivitis

MOA: Active against various bacteria

Dose: 15 mL swish/spit BID for 30 seconds

Caution: B, -

CI: Component sensitivity

Disp: Soln 0.12%

SE: Staining of teeth, dental deposits, taste changes, local irritation

Baclofen

Lioresal®

BBW: IT abrupt discontinuation can lead to organ failure, rhabdomyolysis, and death

Uses: *Spasticity d/t severe chronic disorders (e.g. MS, amyotrophic lateral sclerosis, or spinal cord lesions),* trigeminal neuralgia, intractable hiccups

MOA: Centrally acting skeletal muscle relaxant, ↓ transmission of monosynaptic & polysynaptic cord reflexes

Dose: Initial, 5 mg PO TID, ↑ q3d to effect; max 80 mg/d; IT: Via implantable pump

Caution: C, +, epilepsy, neuropsycological disturbances

Disp: Tabs 10, 20 mg; IT Inj 50 mcg/mL, 10 mg/20 mL, 10 mg/5 mL

SE: Dizziness, drowsiness, insomnia, ataxia, weakness, ↓ BP

Glipizide ER

Glucotrol® XL

Uses: Type 2 DM

MOA: Sulfonylurea; ↑ pancreatic insulin release; ↑ peripheral insulin sensitivity; ↓ hepatic glucose output/production; ↓ interstinal glucose absorption

Dose: 5 mg initial, ↑ by 2.5-5 mg/d, max 40 mg/d; XL max 20 mg; 30 minutes before meals; hold if NPO

Caution: C, ?/-, severe liver disease

CI: DKA, Type 1 DM, sulfonamide sensitivity

Disp: Tabs 5, 10 mg; XL tabs 2.5, 5, 10 mg

SE: HA, anorexia, N/V/D, constipation, fullness, rash, itching, photosensitivity

Notes: Counsel about DM management; wait several days before adjusting dose; monitor glucose