The Top 200 Prescribed Drugs
By Joshua Hollingsworth
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Podcast Description
One episode a day starting with the #1 prescribed drug and working all the way to #200. We will cover the essential information for each drug (Brand/generic, MOA, Indications, Dosage forms, Doses, PK, ADRs, Major drug interactions, Contraindications/Precautions, Pregnancy Category, Major counseling points, etc). Made for Health Care Professionals and those interested in the most prescribed medications in the US Disclaimer: The Top 200 Prescribed Drugs Podcast is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians or drug manufacturers
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190 Evista® (Raloxifene) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 190 Evista® (Raloxifene) (http://thestudentpharmacist.com/wp-content/uploads/190_Evista.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Raloxifene (not available) * Brand: Evista® * Mechanism of Action * Selective Estrogen Receptor Modulator (aka SERM) * Affects some, but not all, of the receptors that are acted upon by estrogen * Actually blocks, and acts like, estrogen at these sites in order to prevent bone loss (by decreasing resorption and increasing bone mineral density) as well as potentially blocking the effect of estrogen in breast and uterine tissues (where excess estrogen can lead to cancer) * Indication(s) * Osteoporosis in postmenopausal women (treatment and/or prevention) * Invasive breast cancer risk reduction in postmenopausal women with either osteoporosis or high risk of breast cancer * Dosage form(s) * Tablet: 60 mg * Adult Dosing * 60 mg/day * Pharmacokinetics * Onset of action: ~8 weeks * Very low bioavailability: ~2% * Half life elimination: ~30 hours * Excreted primarily in the feces * Black Box Warning(s) * Evista® may increase the risk of DVT or PE * Use is contraindicated in patients with current or history of venous thromboembolism * Evista® may increase risk of death due to stroke in women with coronary heart disease or risk of such events * Contraindication(s) * Venous thromboembolic (VTE) history * Pregnancy and breastfeeding * Again, raloxifene it is only for women who are postmenopausal * Precaution(s) * Use with caution in patients with hepatic and/or renal impairment (safety not yet established) * Triglycerides (TGs) may be increased, especially if patients had increased TGs in response to oral estrogens in the past * Adverse Drug Reactions * Most common (> 10%) * Peripheral edema * Hot flashes * Arthralgia * Muscle cramps/spasms (most often occurring in the leg muscles) * Flu syndrome * Infections * MAJOR Drug Interactions * Does not appear to be many significant drug interactions * Evista® may decrease the effects of levothyroxine * Bile acid sequestrants may decrease the effects of raloxifene * Separate dosing by ≥ 4 hours * Pregnancy Category/Breast feeding * Category X (contraindicated) * Contraindicated in breast feeding * Safety & Efficacy Monitoring * Bone mineral density * Lipid panel * Monitor for s/s of deep vein thrombosis (DVT), pulmonary embolism (PE) * Major Counseling Points * Evista is taken once daily and is only meant for postmenopausal women * Common side effects include edema/welling, hot flashes, and muscle cramps/spams * Avoid prolonged periods of restricted movement (due to risk of DVT, PE) * Let your doctor or pharmacist know immediately if you experience any of the following (which are often referred to as ACHES): * A - Severe Abdominal pain * C - Chest pain or shortness of breath * H - Severe Headache * E - Eye problems or visual disturbances * S - Severe pain in the calf or thigh * As always, let your doctor or pharmacist know if you experience any severe, intolerable, or prolonged side effects References: * Raloxifene. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2011, cited 2011 Aug 25]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Evista®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx. | 11/10/11 | Free | View In iTunes |
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189 Suboxone® (Buprenorphine & Naloxone) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 189 Suboxone® (Buprenorphine & Naloxone) (http://thestudentpharmacist.com/wp-content/uploads/189_Suboxone.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Buprenorphine & Naloxone (not available) * Brand: Suboxone® * Mechanism of Action * Buprenorphine * Opioid analgesic * Binds to mu opiate receptors in the CNS * Naloxone * Opioid antagonist * Competes and displaces narcotics from opioid receptor sites * Antidote used in opioid overdose * Indication(s) * Treatment of opioid dependence * Dosage form(s) * Sublingual film and tablets * 2 mg buprenorphine, 0.5 mg naloxone * 8 mg buprenorphine, 2 mg naloxone * Few notes comparing the sublingual film vs tablet * The film has a better taste and dissolves faster * Although they come in the same strengths, the film does have a slightly higher bioavailability * Adult Dosing * Day 1: Initiate at 4 mg * If withdrawal symptoms are not relieved, the dose may be repeated after ≥ 2 hours * Max on day 1: 8 mg * Day 2: If withdrawal symptoms develop, increase the day 1 dose by 4 mg * If withdrawal symptoms do NOT develop, use the same dose as day 1 * Either way, If withdrawal symptoms are not relieved, the dose may be repeated after ≥ 2 hours * Max on day 2: 16 mg * Subsequent days: * If withdrawal symptoms have not developed, then use the established dose * If withdrawal symptoms do develop, increse the dose by 2-4 mg/day until symptoms are relieved. * Usual daily dose: 4-24 mg * Max daily dose 32 mg/day * Note: Suboxone should only be used for induction in patients who are dependent on short-acting opioids and whose last dose with ≥ 12 hours prior to induction * Buprenorphine monotherapy should be used for induction in patients dependend on long-acting opioids. The combination can then be used for maintenance therapy once an adequate daily dose is established * Pharmacokinetics * The sublingual film appears to have greater bioavailability as compared to the sublingual tablets * Half-life * Buprenorphine: 24-42 hours * Naloxone: 2-12 hours * Contraindication(s) * Hypersensitivity * Precaution(s) * May cause CNS depression, which can impair physical and mental abilities * Hepatic events have been reported with buprenorphine use including hepatitis and increased liver function tests * Use with caution in patients with pre-existing liver dysfunction * Get baseline liver function tests, and test periodically throughout therapy * Also use with caution in patients with adrenal insufficiency, biliary tract dysfunction, bowel obstruction, alcoholism, benign prostatic hyperplasia, psychosis, thyroid dysfunction, as well as any respiratory disease * Adverse Drug Reactions * Most common * Headache * Vomiting * Withdrawal symptoms * Diaphoresis * Vasodilation * MAJOR Drug Interactions * Avoid use with atazanavir, conivaptan, and MAO inhibitors * Suboxone may increase the effects of alcohol, CNS depressant, SSRIs, and MAO inhibitors * Suboxone’s effects may be increased when used with atazanavir, conivaptan, 3A4 inhibitors, hydroxyzine, and succinylcholine * Suboxone may decrease the effects of opioid analgesics (which makes sense if you think about it) as well as atazanavir * Pregnancy Category/Breast feeding * Category C * Buprenorphine enters breast milk, and is therefore not recommended in breast feeding * Safety Monitoring | 11/9/11 | Free | View In iTunes |
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188 Loestrin® 24 Fe (Ethinyl Estradiol & Norethindrone) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (www.lexi.com/top200). And, as... | 11/8/11 | Free | View In iTunes |
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185 Meclizine (Antivert®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! Note: 182 (Ciprofloxacin; Cipro®), 183 (Prednisone), and 184 (Atenolol; Tenormin®) have been covered in previous episodes. 185 Meclizine (Antivert®) (http://thestudentpharmacist.com/wp-content/uploads/185_Meclizine.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Meclizine (generic is available) * Brand: Antivert® (Rx) * OTC Brands include: Bonine®, Dramamine® Less Drowsy Formula, Trav-L-Tabs® * Mechanism of Action * 1st generation antihistamine and antiemetic * Blocks the chemoreceptor trigger zone via central anticholinergic action * Also decreases excitability and blocks conduction in the middle ear * Indication(s) * Motion sickness * Vertigo * Dosage form(s) * Caplets: 12.5 mg * Tablets: 12.5, 25, and 50 mg * Chewable tablets: 25 mg * Adult Dosing * Motion sickness * 12.5-25 mg ~1 hour before traveling * Dose may be repeated every 12 hours if needed * Vertigo * 25-100 mg/day in divided doses * Pharmacokinetics * Onset of action: ~1 hour * Duration: 8-24 hours * Metabolized in the liver * Excreted in the urine as metabolites and feces as unchanged drug * Contraindication(s) * Hypersensitivity * Precaution(s) * CNS depression may occur, which can lead to impairment of physical and mental abilities * Use with caution in patients with asthma, narrow angle glaucoma, BPH or urinary stricture, and pyloric or duodenal obstruction * All of these condition may be exacerbated by meclizine * Also use with caution in elderly patients (who may be more sensitive to the adverse effects) and children < 12 yo (because safety and efficacy has not been established for this age group) * Adverse Drug Reactions * Most common * Drowsiness * Thickening of bronchial secretions * MAJOR Drug Interactions * Meclizine may have additive effects when used with sedatives or alcohol * Pregnancy Category/Breast feeding * Category B * Excretion in breast milk in unknown * Safety & Efficacy Monitoring * Side effect profile * Relief of symptoms * Major Counseling Points * Meclizine may impair physical and mental abilities (especially if taken with sedatives or alcohol), so use with caution until you see how you will respond to the medication * Common side effects include drowsiness and thickening or bronchial secretions * Let you doctor or pharmacist know if meclizine does not relief motion sickness or vertigo symptoms * As always, let your doctor or pharmacist know if you have any severe, intolerable, or prolonged side effects References: * Meclizine. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2011, cited 2011 Aug 17]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Meclizine Hydrochloride. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Meclizine. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2011, cited 2011 Aug 17]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 11/7/11 | Free | View In iTunes |
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181 Folic Acid – Top 200 Prescribed Drugs | Note: 177 (Atenolol; Tenormin®), 178 (Metformin; Glucophage®), 179 (Lisinopril/Hydrocholorothiazide; Prinzide®, Zestoretic®), & 180 Ciprofloxacin (Cipro®) have been covered in previous episodes. 181 Folic Acid (http://thestudentpharmacist.com/wp-content/uploads/181_Folic_Acid.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Folic Acid * Brand: Folacin-800 (OTC) * Folic acid can be found in most, if not all, multivitamins (400 mcg) and prenatal vitamins (1 mg) * Mechanism of Action * Folic acid is utilized in the body to form many coenzymes as well as in the maintenance of erythropoiesis, and WBC and platelet production. * Folic acid can also enhance the elimination of formic acid, which is a toxic metabolite of methanol * Folic acid deficiency in pregnancy can lead neural tube defects of the fetus * Because of this, it is important for any woman trying to become pregnant or of child bearing age to get adequate folic acid before becoming pregnant * Indication(s) * Megaloblastic and macrocytic anemais (due to folate deficiency) * Prevention of neural tube defects in pregancy * Dosage form(s) * Injection solution: 5 mg/mL * Tablets: 0.4, 0.8, & 1 mg * Adult Dosing * Recommended dietary intake (RDA): 400 mcg/day * Anemia: * 400 mcg/day * Increase dose to 800 mcg/day if the patient is pregnant or lactating * Prevention of neural tube defects in pregnancy (all women of childbearing age) * 400-800 mcg/day * Increase the dose to 4 mg/day if the patient has a family history of neural tube defects * Pharmacokinetics * Peak effect/levels: ~1 hour * Metabolized in the liver * Excreted in the urine * Contraindication(s) * Hypersensitivity * Precaution(s) * Folic acid should not be used as monotherapy for pernicious, aplastic, or normocytic anemias if there is a vitamin B12 deficiency * Injection solution contains the preservative benzyl alcohol (1.5%), which has been associated with “gasping syndrome” in neonates * Adverse Drug Reactions * Well tolerated for the most part. May see: * Allergic reaction * Bronchospasms * Fluching or erythema * Malaise * Pruritus or rash * MAJOR Drug Interactions * Avoid coadministration of Folic Acid with Raltitrexed (Antineoplastic agent) * Folic acid can decrease the effects of Raltitrexed * Pregnancy Category/Breast feeding * Category A (recommended) * Compatible (recommended) * Safety Monitoring / Efficacy Monitoring * Anemia (if indication given for) * Side effect profile * Major Counseling Points * All women of child bearing age should get adequate folic acid intake (at least 400 mcg/day) * This is recommended to help prevent neural tube defects * Can be obtained with a multivitamin daily * Generally well tolerated with very minimal side effects * As always, report any severe, intolerable, or prolonged side effects to your doctor or pharmacist * Note: * According to an article published in the Pharmacist Letter in January or 2010, high doses of folic acid (being ≥ 800 mcg) for prolonged periods of time may be linked to increased risk of cancer * This comes from studies in which high doses of folic acid was given to patients with heart disease. This did not improve outcomes, but these patients do seem to have more cancers... “about 3 more cancers a year for every 1000 patients taking folic acid 800 mcg daily for about 3 years” according to the article * That said, it is still recommended for most patients to take up to 400 mcg/day and for women to take 400-800 mcg/day during pregnancy References: * Folic Acid. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2011, cited 2011 Aug 10]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Folic Acid. | 10/31/11 | Free | View In iTunes |
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176 Combivent® (ipratropium & albuterol) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! Note: 174 (Trazodone; Oleptro®) & 175 (Endocet®; Oxycodone/Acetaminophen) has been covered in a previous episode 176 Combivent® (ipratropium & albuterol) (http://thestudentpharmacist.com/wp-content/uploads/176_Combivent.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Ipratropium & Albuteral (Available as solution for nebulization) * Brands: * Combivent® (aerosol for oral inhalation... inhaler) * DuoNeb® (solution for nebulization) * Mechanism of Action * Ipratropium * Anticholinergic agent * Blocks acetycholine from binding in the bronchial smooth muscles which causes bronchodilation * Albuteral * Beta agonist * Stimulates beta-2 receptors which relaxes bronchial smooth muscle * Indication(s) * COPD * Should only be used in patients who are already on a bronchodilator and continue to have bronchospasms, and therefore need a 2nd bronchodilator * Dosage form(s) * Aerosol for oral inhalation (Combivent®) * 18 mcg ipratropium / 90 mcg albuteral per inhalation * Solution for nebulization (generic and DuoNeb®) * 0.5 mg ipratropium / 2.5 mg albuterol per 3 mL * Adult Dosing * Aerosol for oral inhalation (Combivent®) * 2 inhalation 4 times/day * Additional doses can be given if needed * Max daily doses should not exceed 12 inhalations * Solution for nebulization (generic and DuoNeb®) * Initiate at 3 mL every 6 hours * Max: 3 mL every 4 hours * Pharmacokinetics * Ipratropium * Onset of bronchodilation: ≤ 15 minutes * Peak effect is seen at 1-2 hours * Duration: 2-5 hours * Albuteral * Peak effect: ~ 30 minutes * Duration of action: 3-4 hours * Contraindication(s) * Hypersensitivity * Precaution(s) * Although rare, paradoxical bronchospasm can occur with inhaled beta agonist * Something to look out for if patient is seems to get worse with use of their inhaler * Immediate hypersensitivity reactions can occur and should be monitored for with initial use of albuterol * Beta agonist can cause CNS excitation * Use with caution in patients with a history of seizures or CV conditions (such as HTN or HF) * Beta agonist can increase serum glucose * Something to be aware of with diabetic patients * Use with caution in BPH (benign prostatic hyperplasia) or bladder neck obstruction * Ipratropium can potentially exacerbate the condition * Adverse Drug Reactions * Most common * Throat irritation and cough * Dizziness * Nausea * HA * Palpitations and tachycardia * MAJOR Drug Interactions * Beta blockers as well as alpha and beta blockers can decrease therapeutic effects of beta agonists * TCAs and sympathomimetics may increase adverse effects of Albuterol * Pregnancy Category/Breast feeding * Category C * Use with caution in breastfeeding * Safety Monitoring * May want to check BP, HR, and overall cardiovascular health if indicated * May want to check serum glucose and serum potassium if indicated * Efficacy Monitoring * Relief of symptoms * Major Counseling Points * Combivent specifically * If using the inhaler for the first time or if has not been used in the past 24 hours, you will need to prime the inhaler * 1st shake the inhaler for ~10 seconds * Then spray 3 actuations into the air away from your face and others * Go over proper inhalation technique * 1st breath out deeply through your mouth | 10/28/11 | Free | View In iTunes |
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172 Boniva® (ibandronate) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 172 Boniva® (ibandronate) (http://thestudentpharmacist.com/wp-content/uploads/172_Boniva.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: ibandronate (not available) * Brand: Boniva® * Mechanism of Action * Bisphosphonate * Inhibits osteoclasts, which decreases bone turnover and resorption * This indirectly increases bone mineral density * Indication(s) * Osteoporosis in postmenopausal females * Treatment and prevention * Dosage form(s) * Injection solution: 1 mg/mL (3 mg vial) * Tablets: * Once daily formulation: 2.5 mg * Once-monthly formulation: 150 mg * Adult Dosing * Oral tablets: 2.5 mg once daily or 150 mg once monthly * Treatment or prevention * IV: 3 mg every 3 months * Treatment dose * Notes: * If diet is inadequate, patients should be on supplemental calcium and vitamin D while on bisphosphonates * Vitamin D: 800-1000 Units/day * Calcium: 1200-1500 mg/day * No dosing adjustment is needed in hepatic impairment * Use is not recommended in severe renal impairment: (CrCl 10% * Dyspepsia * Back pain * 1-10% * Hypertension * Headache * Dizziness * Insomnia * GI upset * MAJOR Drug Interactions * No oral drugs should be taken within 60 minutes of Boniva® (ibandronate) * NSAIDs can increase the risk of GI irritation * Pregnancy Category/Breast feeding * Category C * Excretion in breast milk is unknown (use with caution) * Safety and Efficacy Monitoring * Central bone mineral density scan at baseline then 1-2 years after initiation * Serum Calcium and Vitamin D * Blood pressure * Major Counseling Points * Take each dose first thing in the morning with a full glass of water * Remain upright (sitting or standing) for at least 60 minutes after taking and do not take any other oral medications within 60 minutes of taking Boniva® * Patients should avoid alcohol (which can cause or contribute to osteoporosis) * Counsel on main side effects (GI upset, dyspepsia, headache, insomnia, and back pain) * As always, patients should report any persistent, severe, or intolerable side effects to their doctor or pharmacist References: * Ibandronate. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2011, cited 2011 Aug 6]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Boniva®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 | 10/27/11 | Free | View In iTunes |
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168 Avapro® (irbesartan) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 | 10/26/11 | Free | View In iTunes |
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167 Enalapril (Vasotec®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! Note: 165 (Prednisone) and 166 (Lisinopril/Hydrochlorothiazide) have been covered in previous episodes 167 Enalapril (Vasotec®) (http://thestudentpharmacist.com/wp-content/uploads/167_Enalapril.mp3) Episode Notes (References Below) * Brand/Generic: * Generic: Enalapril (available) * Brand: Vasotec® * Mechanism of Action * ACE-Inhibitor * Angiotensin converting enzyme (ACE) normally convert angiotensin I to angiotensin II, which is a potent vasoconstrictor * ACE-Is blocks this conversion * This reduction in angiotensin II also leads to reduced aldosterone secretion, which decreases sodium and water reabsorption * Decreasing angiotensin II and aldosterone also decreases ventricular remodeling, myocardial fibrosis, myocyte apoptosis, cardiac hypertrophy and norepinephrine release * The decrease in aldosterone can lead to an increase in serum potassium * Also causes vasodilation of the renal efferent arteriole which can decrease proteinuria (especially in patients with Diabetic nephropathy) and is considered renal protective * Indication(s) * Hypertension * Symptomatic heart failure * Asymptomatic left ventricular dysfunction * Dosage form(s) * Injection solution (enalaprilat): 1.25 mg/mL * Tablets: 2.5, 5, 10, and 20 mg * Adult Dosing * Dose ranges from 2.5 - 40 mg/day * Initiate at lower dose then titrate up as needed, especially in patients with hyponatremia, hypovolemia, severe heart failure, decreased renal function, or those on diuretics * Pharmacokinetics * Prodrug metabolized in the liver to enalaprilat (active) * Onset of action: ~1 hour oral (≤ 15 min IV) * Oral: Peak effect is seen in 4-6 hours and duration is 12-24 hours * Excreted mainly in the urine * Contraindication(s) * Hypersensitivity * Angioedema * Precaution(s) * ACE-Is can cause angioedema at any time during therapy * Especially after 1st dose * ACE-Is are contraindicated if patient experiences angioedema * AAs are at increased risk of developing angioedema * Due to the build up of bradykinin caused by ACE-Is, enalapril can cause chronic cough * Dry and nonproductive * Usually seen withing first months of therapy * Should resolve within a month of discontinuation * If intolerable to patient try switching therapy to an ARB (much less likely to cause cough) * ACE-Is can cause Hyperkalemia * Increased risk in: * Renal dysfunction * DM * Use of potassium sparing diuretics or potassium supplements (salts) * Monitor K levels * Hypotension * Usually seen with first doses * Risk is higher in volume depleted patients * Check volume status to make sure patient is not dehydrated * If hypotension is an issue, decrease dose (don’t discontinue) * Renal Dysfunction * Generally considered renal protective because enalapril and other ACE-Is vasodilate the efferent arteriole of the kidneys which decreases renal pressure * Can cause increase in serum creatinine * DC (ACE-Is or ARBs) if SrCr increases > 35% from baseline * Use with caution in patients with pre-existing renal impairment * Adverse Drug Reactions * Most common * GI upset (N/V/D, constipation * Hypotension, chest pain, syncope * HA, dizziness, fatigue * Rash * Abnormal taste * MAJOR Drug Interactions * NSAIDs * Block effects of ACE-Is and can enhance ADRs (renal impairment) * ASA can be used with ACE-Is if both drugs are indicated * Use ≤ 160 mg of ASA | 10/25/11 | Free | View In iTunes |
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164 Doxycyline (Vibramycin®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! Note: 163 Propoxyphene/APAP (Darvocet®) was removed from the US market in Nov 2010 164 Doxycycline (Vibramycin®) (http://thestudentpharmacist.com/wp-content/uploads/164_Doxycyline.mp3) Episode Notes (References Below) * Brand/Generic: * Generic is available * There are several name brands, including (not complete): * Adoxa® * Alodox™ * Doryx® * Monodox® * Vibramycin® * Mechanism of Action * Tetracycline derivative antibiotic * Inhibits protein synthesis by binding to the 30S (and potentially the 50S) ribosomal subunit of bacteria * Indication(s) * Susceptible bacterial infections such as: * Lyme disease * Syphillis * Chlamydia * Anthrax * Generally, tetracyclines such as doxycycline are effective against atypical bacrteria, spirochetes, Rickettsial diseases, anthrax, syphillis, and acne * Dosage form(s) * Oral capsules: 50, 100 mg * Variable release capsules: 40 mg (of which 30 mg is immediate release and 10 mg delayed release) * Injection powder (for reconstitution): 100 mg * Powder for oral suspension: 25 mg/5 mL * Oral syrup: 50 mg/5 mL * Oral tablets: 20, 50, 75, 100, & 150 mg * Delayed release tablets: 75, 100 mg * Adult Dosing * Usual dose range 100-200 mg/day as 1 or 2 doses * Pharmacokinetics * Nearly complete absorptions * t1/2 is 12-15 hours * Eliminated in the feces and urine * Contraindication(s) * Hypersensitivity * Children < 8 yo (unless he/she is being treated for anthrax exposure and tickborne rickettsial disease) * Can cause permanent tooth discoloration * Precaution(s) * Tissue hyperpigmentation can occur including, nails, skin, eyes, teeth as well as many inner organs * Can cause a dose related increase in BUN * Rarely, hepatotoxicity can occur * Adverse Drug Reactions * Most common * Photosensitivity (avoid prolonged sunlight) * GI upset including dyspepsia, diarrhea, and nausea * Joint pain and menstrual cramps * Esophogeal irritation can occur (take with full glass of water and do not lye down directly after administration) * MAJOR Drug Interactions * Avoid use with BCG or retnoic acid derivatives * The level (and effects) of doxycycline may be decreased by antacids (separate dosing), barbiturates, carbamazepine, phenytoin or fosphenytoin, as well as iron, magnesium, and calcium salts * Alcohol can also decrease the effects of doxycyline * Pregnancy Category/Breast feeding * Category D * Enters breastmilk and is not recommended * Safety Monitoring/Efficacy Monitoring * Relief of signs/symptoms of infection * Side effect profile * Major Counseling Points * Doxycycline is an antibiotic and should be taken until gone. * You may experience some GI upset (taking the medication with food should help) * Esophogeal/throat irritation can occur (take each dose with a full glass of water and do not lay down directly after) * Other side effects include joint pain, menstrual pain, and photosensitivity (avoid prolonged sunlight) * Avoid alcohol and stay well hydrated * Report any severe, persistent, or intolerable side effects to your doctor or pharmacist * Note: * There are two forms of doxycyline on the market, hyclate (Vibramycin®) and monohydrate (Monodox®): * Both are equally effective * Doxycycline hyclate should be used in most cases (cheaper) * Monohydrate dissolves slower in the stomach (which would seem to decrease GI effects), but there is no evidence this is true... | 10/23/11 | Free | View In iTunes |
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162 Budeprion XL® (bupropion) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 162 Budeprion XL® (bupropion) (http://thestudentpharmacist.com/wp-content/uploads/162_BudeprionXL.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand: Budeprion XL® * Other brand names of bupropion include: * Wellbutrin® (Budeprion XL® is considered the generic for Wellbutrin XL) * Zyban® * Generic: Bupropion HCl * Note: all the above brand names are the HCl salt * Aplenzin®, another name brand, is the hydrobromide salt and cannot be interchanged with the HCl salt forms/brands * There is no advantage to the hydrobromide salt * Mechanism of Action * Antidepressant * Dopamine re-uptake inhibitor * Also weakly inhibits the re-uptake of norepinephrine * Indication(s) * Major depressive disorder (MDD) * Seasonal affective disorder (SAD) * Smoking cessation * Unlabeled uses: * Attention deficit/hyperactivity disorder (ADHD) * Depression associated with bipolar disorder * Dosage form(s) * Budeprion XL® specifically: * Extended release oral tablets: 150 & 300 mg * Adult Dosing (specifically for Budeprion XL... which also applies to Wellbutrin XL®) * Depression: * Initiate at 150 mg daily taken in the morning * Dose can be increased to 300 mg/day after 4 days if needed * Max daily dose: 450 mg * Seasonal affective disorder * Initiate at 150 mg daily taken in the morning * Can be increased as needed to 300 mg/day if tolerated after 1 week * Pharmacokinetics * Metabolized via CYP2B6 as well as non-CYP processes to some active metabolites * Metabolites can have as much as 50% activity as the parent drug * Excreted primarily in the urine, but also in the feces mainly as metabolites * Black Box Warning(s) * Antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24 yo) with MDD and other psychiatric disorders * Bupropion is not FDA approved for children OR for bipolar depression * Observe patients for suicidal ideology especially during the 1st few months of therapy * Reason/mechanism: Antidepressants in general increase energy/appetite before they affect mood… giving the patient the energy needed for suicide * Similar to the first black box warning: Use of bupropion as been associated with serious neuropsychiatric events, including depression, suicidal thoughts, and suicide * Contraindication(s) * Hypersensitivity * Seizure disorder * History of anorexia or bulimia * Use of MAO inhibitors within 14 days * Currently undergoing abrupt discontinuation of ethanol or sedatives * Patients receiving other dosage forms of bupropion * Precaution(s) * First precaution relates to many of the contraindications for bupropion: Risk of seizures is dose-dependent and is increased in patients with a history of seizures, anorexia/bulimia, head trauma, CNS tumor, hepatic cirrhosis, abrupt discontinuation of sedatives (including alcohol), use with other medications that lower the seizure threshold, stimulants, or anti-diabetic agents * CNS stimulation can occur, which can lead to restlessness, anxiety, insomnia, or anorexia * Bupropion can impair physical and mental abilities * Warn patients to use caution, especially with initial therapy * Weight loss can occur * Use with caution in patients in which weight loss would not be favorable * Use with caution in patients with cardiovascular disease, renal impairment, or hepatic impairment | 3/28/11 | Free | View In iTunes |
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161 NuvaRing® (ethinyl estradiol & etonogestrel) – Top 200 Prescribed Drugs | Note: 160 Oxycodone (Oxycontin®) was covered as the number 126 most prescribed drug Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 161 NuvaRing® (ethinyl estradiol & etonogestrel) (http://thestudentpharmacist.com/wp-content/uploads/161_NuvaRing.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand: Nuvaring * Generic: Ethinyl estradiol & etonogestrel (not available) * Mechanism of Action * Estrogen and progestin combination contraceptive * Work thru negative feedback at the hypothalamus to inhibit ovulation * This alters normal gonadotropin secretion of follicle stimulating hormone (FSH) and luteinizing hormone (LH) by the anterior pituitary * Also alter the genital tract, making it unfavorable for sperm penetration even if ovulation occurs * Indication(s) * Prevention of pregnancy * Unlabeled uses: * Hypermenorrhea * Pain associated with endometriosis * Dysmenorrhea * Dysfunctional uterine bleeding * Dosage form(s) * Vaginal ring * 0.15 mg/day ethinyl estradiol & 0.12 mg/day etonogestrel * Adult Dosing * NuvaRing is inserted vaginally * Should be left in place for 3 weeks * The ring should then be removed and a new NuvaRing® should be inserted after 1 week (7days) * The new ring should be left inserted for 3 weeks and the process repeats * Initiation of therapy: * No hormonal contraceptive use in the previous month * The ring should be inserted on the 1st day of the menstrual cycle * Can also be inserted on day 2-5 (1st day is preferred) * Use backup contraceptive (spermicide or barrier method) for the 1st 7 days * If switching from an oral combination contraceptive * Ring should be inserted within 7 days of the last active tablet in a cycle * No backup contraceptive is needed * Pharmacokinetics * Tampons do not interfere with absorption * Both ethinyl estradiol and etonogestrel are metabolized via CYP3A4 * Black Box Warning(s) * Smoking cigarettes while taking hormonal contraceptives increases the risk of serious cardiovascular events * The risk is increased with increased age (> 35 yo) and increased number of cigarettes (> 15/day) * NuvaRing's use is contraindicated in heavy smokers (>15 cigarettes/day) who are also > 35 yoa * Contraindication(s) * Hypersensitivity * History of venous thromboembolic disorders such as deep vein thrombosis (DVT) or pulmonary embolism (PE) * Major surgery with prolonged immobilization * Cerebral vascular disease * Coronary artery disease * Valvular heart disease with complications * Severe hypertension * Diabetes mellitus with vascular involvement * Migraines with focal neurological symptoms * Presence or personal history of breast cancer * Endometrial cancer * Undiagnosed abnormal genital bleeding * Active liver disease or tumor * Cholestatic jaundice of pregnancy * Jaundice with prior combination hormonal contraceptive use * Heavy smoking (≥ 15 cigs/day) in patients > 35 yoa * Pregnancy * Precaution(s) * Hormonal contraceptives can increase the risk of thromboembolism * Use with caution patients at increased risk of VTE * Note: Risk of thrombosis with any oral contraceptive is less than the risk of thrombosis during pregnancy (just to put things in perspective) * Use of hormonal contraceptives slightly increases the risk of breast cancer * Because of this, you will want to get the patient's family history to see if breast cancer runs in her family | 3/25/11 | Free | View In iTunes |
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159 Lovastatin (Altoprev®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 159 Lovastatin (http://thestudentpharmacist.com/wp-content/uploads/159_Lovastatin.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brands: * Altoprev® * Mevacor® * Generic: Lovastatin (available) * Mechanism of Action * Statin * Inhibit HMG-CoA reductase, which is involved in the rate limiting step of the synthesis of cholesterol * This decreases the amount of cholesterol the body can produce which results in an increase LDL receptors on hepatocytes and LDL clearance and catabolism * Overal: * Reduces total cholesterol, LDL, apolipoprotein B, and triglycerides * Increase HDL * Indication(s) * Dyslipidemia * Primary prevention of coronary artery disease (in patients without symptomatic disease) * Dosage form(s) * Tablets: 10, 20, 40 mg * Extended release tablets (Altoprev® brand name only) * 20, 40, 60 mg * Adult Dosing * Initiate at 20 mg at bedtime * Dose can be adjusted at monthly intervals * Max: 80 mg/day for immediate release and 60 mg/day for extended release * NOTES about dosing * Dosing does need to be adjusted with the following medications * Cyclosporine or danazol: Initiate at 10 mg/day and recommended max is 20 mg/day * Fibrates or niacin: Max is also 20 mg/day * Amiodarone or verapamil: Max dose is 40 mg/day immediate release or 20 mg/day for extended release * Use with caution in renal impairment * If CrCl < 30 mL/min, consider using doses ≤ 20 mg/day * Pharmacokinetics * Onset of LDL lowering action is ~3 days * Metabolized by the liver extensively by the 1st pass effect * Hydrolyzed to beta-hydroxyacid (which is active) * Excreted primarily in the feces (~80%) but also in the urine * Contraindication(s) * Hypersensitivity * Active liver disease * Unexplained increased LFTs (liver function tests) * Pregnancy * Breast feeding * Precaution(s) * Myopathy (muscle pain)/rhabdomyolysis (muscle breakdown) * Dose related risk * Make sure patient is on lowest effective dose * Risk is increased with concurrent use of strong 3A4 inhibitors, fibric acid derivatives (such as gemfibrozil) or niacin at doses ≥ 1 g/day * Use with caution in the elderly (they are at increased risk of developing myopathy) * Rhabdomyolysis can result in acute renal failure if not controlled * Tell patient to report any unexplained muscle pain, tenderness or weakness, or brown urine * Hepatic impairment * Since statins can cause liver dysfunction, use with caution in patients who have a history of liver impairment or who consume large amounts of alcohol * Patients should avoid excess alcohol * Adverse Drug Reactions * Most common * Abdominal pain, nausea, and constipation * HA * Upper respiratory infections * Above are generally mild and disappear over time * Serious/Precautions * Hepatotoxicity w/ Increased LFTs * Myopathy and rhabdomyolysis with increase CPK * Also can cause pancreatitis and acute renal failure * MAJOR Drug Interactions * As mentioned before, the dose needs to be adjust when lovastatin is given with the following medications: * Cyclosporine or danazol: Initiate at 10 mg/day and recommended max is 20 mg/day * Fibrates or niacin: Max is also 20 mg/day * Amiodarone or verapamil: Max dose is 40 mg/day immediate release or 20 mg/day for extended release * Avoid use with protease inhibitors (such as ritonavir) * Look for strong 3A4 inhibitors, | 3/24/11 | Free | View In iTunes |
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158 Zyprexa® (olanzapine) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 158 Zyprexa® (olanzapine) (http://thestudentpharmacist.com/wp-content/uploads/158_Zyprexa.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand: Zyprexa® * Generic: Olanzapine (NOT available) * Mechanism of Action * Atypical antipsychotic * Potent antagonist of serotonin 5-HT2A & 5-HT2C, dopamine D1-4, histamine H1, and alpha1-adrenergic receptors * Weak antagonist of muscarinic M1-5 receptors * Mechanism is thought to work mainly thru antagonism of dopamine and serotonin type 2 receptors * Indication(s) * Schizophrenia * Bipolar disorder (often in combination with fluoxetine) * Acute or mixed mania episodes associated with bipolar disorder * Unlabeled use: * Prevent chemotherapy associated delayed nausea or vomiting (in combination with a corticosteroid and serotonin 5HT3 antagonist) * Dosage form(s) * Injection powder for reconstitution: 10 mg * Injection powder for suspension extended release kit * Zyprexa® Relprevv™: 210, 300, & 405 mg * Oral tablet: 2.5, 5, 7.5, 10, 15, & 20 mg * Orally disintegrating tablet: * Zyprexa® Zydis®: 5, 10, 15, & 20 mg * Adult Dosing (with focus on oral dosage forms) * Schizophrenia: * Initiate with 5-10 mg once daily * Increase to 10 mg within the 1st week of therapy * Dose can then be increased by 5 mg weekly as needed to a maximum of 20 mg/day * Acute mania associated with bipolar disorder * Initiate at 10-15 mg once daily * Dose can be increased at 24 hour intervals as needed to a maximum of 20 mg/day * Pharmacokinetics * Absorption is not affected by food * Tablets and orally disintegrating tablets are bioequivalent * Metabolized via glucoronidation and CYP1A2 and 2D6 * About 40% of the dose is removed by 1st pass metabolism * Clearance is increased by 40% in smokers * Decreased by ~30% in females * Black Box Warning(s) * Antipsychotics increase risk of death in elderly patients with dementia-related psychosis compared to placebo * In this case, most deaths are due to cardiovascular complications or infection * NOTE: Zyprexa® is not approved for dementia related psychosis * Specifically for Zyprexa® Relprevv™ (extended release IM injection): * Sedation (including coma) and delirium have been observed following the injection * Therefore, the injection should be adiministered at a registered healthcare facility, the patient should then be monitored for at least 3 hours and should not drive or operated heavy machinery for the rest of the day * Contraindication(s) * Hypersensitivity * Precaution(s) * Olanzapine may alter cardiac conduction * Use with caution in patients with cardiac abnormalities or arrhythmias * That said, Zyprexa® has a lower risk of cardiac problems compared to many other atypical antipsychotics * Blood dyscrasias can occur, including leukopenia, neutropenia, and agranulocytosis * Monitor blood count periodically in patients with pre-existing risk factors: * Low white blood cell (WBC) count * History of drug induced blood dyscrasia * Discontinue therapy if absolute neutrophil count drops below 1000/mm^3 * Extrapyramidal syptoms (EPS) can develop including: * Pseudoparkinsonism * Dystonic reactions (abnormal muscle tone resulting in muscle spasm) * Akathisia (state of agitation, distress, or restlessness) * Tardive Dyskinesia * Risk may be increased with higher doses, use in younger patients or male patients, | 3/23/11 | Free | View In iTunes |
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156 Lamotrigine (Lamictal®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 156 Lamotrigine (Lamictal®) (http://thestudentpharmacist.com/wp-content/uploads/156_Lamotrigine.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand: Lamictal® * Generic: Lamotrigine (available) * Mechanism of Action * Anticonvulsant * Inhibits the release of glutamate, which is an excitatory amino acid, as well as voltage-sensitive sodium channels, which normally stabilize neuronal membranes * Also weakly inhibits 5-HT3 (serotonin) receptors * Indication(s) * Generalized seizures * Partial seizures in patients ≥ 2 years old * Maintenance of bipolar I disorder in adults * Dosage form(s) * Tablets (generic) * 25, 100, 150, 200 mg * Brand name only dosage forms: * Lamictal® XR™ = Extended release tablets * 25, 50, 100, 200 mg * Lamictal® ODT™ = Orally disintegrating tablets * 25, 50, 100, 200 mg * Adult Dosing * Immediate release: * Initiate at 25 mg/day for 2 weeks * Increase to 50 mg/day for weeks 3 & 4 * After the 4th week, the daily dose can be increased by 50 mg weekly as needed * Typical maintenance dose: 225-375 mg/day as 2 divided doses * Note about dosing * Dosing does need to be adjusted if the patients is also taking any of the following: * Valproic acid (extends half life) * Basically cut dose in half * Initiate at 25 mg every other day for 2 weeks, then increase to 25 mg/day for weeks 3 & 4 * Dose can then be increasd by 25-50 mg weekly as needed * Carbamazepine, phenytoin, phenobarbital, or primidone (decrease half life) * Initiate at 50 mg/day for 2 weeks * Increase to 100 mg/day as 2 divided doses for weeks 3 & 4 * Dose can then be increased by 100 mg weekly as needed * Typical maintenance dose: 300-500 mg/day * Moderate to severe hepatic impairment: * Decrease all doses by 25%, or 50% if ascites is present * Dose may also need to be decreased in renal impairment * Pharmacokinetics * Metabolized in the liver and kidney primarily via glucoronic acid cojugation to inactive metabolites * Half life: 25-33 hours * When given with valproic acid: 48-70 hours * When given with carbamazepine, phenytoin, phenobarbital, or primidone: ~13 hours * Half life is also extended in hepatic or renal impairment * Black Box Warning(s) * Skin rashes * Severe skin rashes have been reported * Risk may be increased by higher starting doses, rapid titration, and use with valproic acid * Majority of cases occur within the 1st 8 weeks of therapy * Contraindication(s) * Hypersensitivity * Precaution(s) * Blood dyscrasias (such as neutropenia, leukopenia, thrombocytopenia, etc) have been reported * Early detection is important and patients with a history of adverse hematologic reactions with any drug may be at increased risk * CNS depression can occur, which can impair physical and mental abilities * Use with caution in patients with cardiovascular disease, hepatic impairment, and renal impairment * Increase in suicidal ideation can occur, especially with initial therapy * Do no withdrawal abruptly due to potential increase in seizure frequency * To discontinue, taper over at least 2 weeks when possible * Drug induced aseptic meningitis can occur * Very rare and is reversible upon discontinuation * Adverse Drug Reactions * Most common (quite a lot) * GI upset (mainly as nausea, but abdominal pain, vomiting, and constipation can occur) | 3/15/11 | Free | View In iTunes |
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155 Isosorbide mononitrate (Imdur®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 155 Isosorbide mononitrate (Imdur®) (http://thestudentpharmacist.com/wp-content/uploads/155_Isosorbide_mononitrate.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brands * Imdur® * Ismo® * Monoket® * Generic: Isosorbide mononitrate (available) * Mechanism of Action * Vasodilator * Forms free radical nitric oxide, which causes: * Smooth muscle relaxation * Vasodilation * Reduction in cardiac oxygen demand * Indication(s) * Prevention of angina pectoris (or chest pain) * Dosage form(s) * Regular release tablets: 10, 20 mg * Extended release tablets: 30, 60, 120 mg * Adult Dosing * Regular release tablets: * Initiate at 5-20 mg twice daily * Doses should be given about 7 hours apart to decrease tolerance development * Extended release tablets * Initiate at 30-60 mg once daily in the morning * Dose can be increased as needed every 3 days * Max dose: 240 mg/day * Note: Chronic use of nitrates can lead to tolerance * In general, increasing the dose dose not help if tolerance occurs * Tolerance can be overcome by short periods without nitrates * Pharmacokinetics * Onset of action: ~45 minutes * Duration of action * Immediate release: ≥ 6 hours * Extended release: ~12-24 hours * Metabolized in the liver * Excreted primarily in the urine * Contraindication(s) * Hypersensitivity * Concurrent use with phosphodiesterase-5 inhibitors (sildenafil [Viagra®], tadalafil [Cialis®], or vardenafil [Levitra®]) * Precaution(s) * Hypotension and bradycardia can occur * Ethanol increases risk * Use with caution in patients with low blood pressure * Tolerance can occur * Tolerance can be overcome by short periods of nitrate absense or withdrawal * This is the reason the twice daily doses should be taken ~7 hours apart (so there is a longer period without nitrates in the body) * Tolerance cannot be overcome by increasing the dose * Adverse Drug Reactions * Most common * Headache * Angina (paradoxical) * Flushing * GI upset * Cough * MAJOR Drug Interactions * Avoid use with phosphodiesterase-5 inhibitors (sildenafil [Viagra®], tadalafil [Cialis®], or vardenafil [Levitra®]) * Use with other medications that can cause hypotension, such as most all blood pressure lowering medications, increases the risk of hypotension * Pregnancy Category/Breast feeding * Category B/C (depending on the manufacturer) * Use with caution in breastfeeding * Safety Monitoring * Orthostasis * Hypotension * Efficacy Monitoring * Relief of angina * Major Counseling Points * Take the immediate release tablets twice daily about 7 hours apart (8am and 3pm) * Take the extended release tablets in the morning * Do not take phosphodiesterase-5 inhibitors while taking isosorbide mononitrate * Doing so can cause a serious drop in blood pressure * The phosphodiesterase-5 inhibitors include * sildenafil [Viagra®] * tadalafil [Cialis®] * vardenafil [Levitra®]) * Hypotension can occur * Be careful going from sitting or lying to standing and do so slowly * Most common side effects include headache, flushing, GI upset, and cough * Let your doctor know if you experience any severe, persistent, or intolerable side effects References: * Isosorbide mononitrate. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2011, cited 2010 Mar 6]. | 3/8/11 | Free | View In iTunes |
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154 Vyvanse® (lisdexamfetamine) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 154 Vyvanse® (lisdexamfetamine) (http://thestudentpharmacist.com/wp-content/uploads/154_Vyvanse.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand: Vyvanse® * Generic: lisdexamfetamine (not available) * Mechanism of Action * Central nervous system stimulant (C-II) * Lisdexamfetamine is a prodrug * Active form, dextroamphetamine * Increases the amount of catecholamines, mainly dopamine and norepinephrine, circulating in in the cerebral cortex and reticular activating system by causing their release from presynaptic nerve terminals. (Also blocks their reuptake) * Peripheral effects include increased blood pressure, bronchodilation, and increased respiration * Indication(s) * Treatment of attention deficit/hyperactivity disorder (ADHD) * Dosage form * Capsules * 20, 30, 40, 50, 60, and 70 mg * Adult Dosing * Initiate at 30 mg taken in the morning * Dose can be increased weekly by 10-20 mg/day as needed based on response * Max daily dose: 70 mg * Use lowest effective dose * Pharmacokinetics * lisdexamfetamine is converted to dextroamfetamine via 1st pass intestinal and hepatic metabolism * CYP enzymes are not involved * Vyvanse, which is similar to Adderall®, was made a prodrug to decrease abuse potential * Not likely to be effective if people snort or inject it * Black Box Warning(s) * Cardiovascular events: * CNS stimulants have been associated with cardiovascular events (such as MI, stroke, or sudden death) in patients with pre-existing structural cardiac abnormalities or other serious heart problems * Drug abuse * There is a potential for dependency AND prolonged use may lead to drug dependency * Contraindications * Hypersensitivity * Advance arteriosclerosis * Symptomatic cardiovascular disease * Moderate-severe hypertension * Hyperthyroidism * Glaucoma * History of drug abuse * Concurrent use with or use within 2 weeks of MAO inhibitors * Precautions * Vyvanse® should be used as part of a comprehensive treatment program for attention deficit disorders * Hypertension is a potential side effect * Use with caution in patients with hypertension or other cardiovascular conditions * Use with caution in patients with psychiatric disorders * Vyvanse® may exacerbate symptoms in these patients * Use with caution in patients with a seizure disorder * Vyvanse can potentially lower the seizure threshold which can increase seizure activity * Vyvanse® should be discontinued if seizures occur * Adverse Drug Reactions * Most common * Headache * Insomnia * Decreased appetite * Xerostomia (dry mouth) * MAJOR Drug Interactions * Avoid use with or within 2 weeks of MAO inhibitors * Lisdexamfetamine may increase the levels or effects of opioids as well as other sympathomimetics * Pregnancy Category/Breast feeding * Category C * Enters breast milk (not recommended) * Safety Monitoring * Cardiovascular risk * Heart rate * Blood pressure * Consider performing an ECG before initiation * Efficacy Monitoring * Improvement in ADHD symptoms (such as concentration and focus) * Major Counseling Points * Take Vyvanse® every morning * Psychological as well as physical dependence can occur (especially with prolonged use) * Avoid excess alcohol while taking Vyvanse® * Can cause CNS depression * The most common side effects include headache, | 3/7/11 | Free | View In iTunes |
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153 AcipHex® (raberprazole) – Top 200 Prescribed Drugs | Note: The 152 furosemide, has been covered in a previous episode Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 153 AcipHex (rabeprazole) (http://thestudentpharmacist.com/wp-content/uploads/153_AcipHex.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand: AcipHex® * Generic: rabeprazole (NOT available) * Mechanism of Action * Proton pump inhibitor (PPI) * Inhibits H/K-ATPase in gastric parietal cells which suppresses gastric acid secretion * Indications * Short term treatment and maintenance of GERD (4-8 weeks) * Short term treatment of duodenal ulcers (4-8 weeks) * Long term treatment of pathological hypersecretory conditions including Zollinger-Ellison syndrome * H. pylori eradcation (in combination with clarithromycin and amoxicillin) * Dosage form(s) * Delayed release, enteric coated tablets: 20 mg * Adult Dosing * GERD and duodenal ulcers: * 20 mg/day * H. pylori * 20 mg twice daily * Hypersecretory conditions * 60 mg/day * Notes about dosing * To be most effective, once daily doses should be taken ~1 hour before breakfast * Use with caution in severe hepatic impairment * Pharmacokinetics * Onset of action: ~1 hour * Durtaion: 24 hours * Metabolized in the liver via CYP3A4 and 2C19 * Mainly excreted in the urine (90%) * Black Box Warning(s) * None * Contraindication(s) * Hypersensitivity * Precautions * Use of PPIs may increase the risk of pneumonia, GI infections, as well as osteoporosis risk fractures * More of a risk in patients > 50 yo and use of AcipHex® for long periods of time (> year) * Adverse Drug Reactions * Most common * Headache * GI upset (diarrhea, flatulence, constipation, and nausea) * Pharyngitis * MAJOR Drug Interactions * Clopidogrel (Plavix®) * PPIs may reduce the production of the active metabolite of Clopidogrel * The clinical significance of this interaction currently not clear * Latest recommendations state that PPIs are appropriate in patients who are on clopidogrel and who have multiple risk factors GI bleeding * PPI thought to have the least interaction with clopidogrel = pantoprazole (Protonix®) * Also look for medications that interact with CYP3A4 and 2C19 * Pregnancy Category/Breast feeding * Category B * Not recommended in breast feeding * Safety & Efficacy Monitoring * Relief of symptoms * Healing of Gastric Mucosa * Prevention of further complications * Major Counseling Points * Take each daily dose in morning about 1 hour before breakfast * Swallow the tablets whole (do not crush or chew) * Antacids can be take with AcipHex * Side effects are rare, but may include headache and GI upset * Report any severe, persistent, or intolerable side effects References: * raberprazole. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2011, cited 2011 Mar 2]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * AcipHex®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * AcipHex®. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2011, cited 2011 Mar 2]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 3/2/11 | Free | View In iTunes |
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151 Flovent® HFA (fluticasone) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 151 Flovent® HFA (fluticasone) (http://thestudentpharmacist.com/wp-content/uploads/151_Flovent.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brands: * Flovent® HFA * Flovent® Diskus® * Generic: fluticasone propionate (not available) * Note: * Flovent® is orally inhaled fluticasone * The brand names for intranasal fluticasone are: * Flonase® * Veramyst® * Mechanism of Action * Corticosteroid (which, in the case of Flovent®, is orally inhaled) * Acts locally and inhibits anti-inflammatory cytokines * Overall effects include: * Anti-inflammatory * Immunosupression * Anti-proliferative * Indications * Flovent® (orally inhaled fluticasone) * Maintenance of asthma * Note * Low dose inhaled corticosteroids are the second step in the in maintenance of asthma. * The 1st step is as needed use of short-acting beta agonists (such as albuterol) * Dosage form(s) * Flovent® HFA (HFA stands from Hydro-Fluoro-Alkane, which is the propellant) * Aerosol for oral inhalation: 44, 110, 220 mcg/actuation * Flovent® Diskus® * Powder for oral inhalation: 50, 100, 250 mcg * Adult Dosing * Flovent® HFA: * Initiate at 88-220 mcg twice daily (12 hours apart) * Titrate the dose as needed to a maximum dose of 440 mcg twice daily * Flovent® Diskus® * Initiate at 100-250 mcg twice daily * Titrate the dose as needed to a maximum dose of 500 mcg twice daily * Note: * May take a few days to see maximum benefit * Generally, the dose should not be increased any more than every 2 weeks * Once the patient is stable (asthma is controlled), titrate down to the lowest effective dose to minimize ADRs * Pharmacokinetics * Fluticasone is a substrate for CYP3A4 * Contraindications * Hypersensitivity * Use as primary treatment of status asthmaticus or acute bronchospasms * Inhaled corticosteroids do not take effect fast enough to treat a current attack (should only be used for longterm therapy) * Precautions * Adrenal suppression can occur * Seen more commonly in younger children or patients on high doses for long periods of time * Because of this, corticosteroids should be used at the lowest effective dose and should be tapered to discontinue after long term use * Immunosuppression can occur with long term use * Use with caution in heart failure * Long term use may lead to fluid retention as well as hypertension * Use with caution in diabetes * Corticosteroids can alter glucose control and lead to hyperglycemia * Patients should rinse their mouth out after each use to prevent getting oral candida infection (aka thrush) * Adverse Drug Reactions * Most common * Headache * Upper respiratory tract infection * Throat irritation/Cough * MAJOR Drug Interactions * Use with protease inhibitors, specifically ritonavir, can increase serum levels of fluticasone * There have been reports of adrenal suppression when fluticasone and ritonavir were used together * Pregnancy Category/Breast feeding * Category C * Use with caution in breastfeeding * Safety Monitoring * Side effect * Efficacy Monitoring * Asthma symptoms * Peak flow * FEV1 * Number of exacerbations * Major Counseling Points * Flovent is to be used for long term management of asthma and should not be used to treat a current asthma attack | 2/28/11 | Free | View In iTunes |
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149 Gyburide (DiaBeta®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 | 2/24/11 | Free | View In iTunes |
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148 Cheratussin® AC (codeine & guaifenesin) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 148 Chertaussin® AC (codeine & guaifenesin) (http://thestudentpharmacist.com/wp-content/uploads/148_Cheratussin_AC.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brands (not a complete list) * Cheratussin AC * Allfen CD * Brontex® * Tusso-C™ * Generic: codeine and guaifenesin * Mechanism of Action * Codeine * Antitussive * Depresses the medullary cough center * Guaifenesin * Expectorant * Acts by irritating the gastric mucosa and stimulating secretions from the GI tract * This increases the volume and decreases the viscosity of respiratory fluid * Note: Drinking a glass of water with each dose can increase effectiveness * Indications * Cough * Dosage form * Cheratussin AC® specifically * Syrup: 100 mg guaifenesin & 10 mg codeine/5 mL * Other dosage forms (for guaifenesin & codeine): * Liquid: * 300 mg guaifenesin & 10 mg codeine/5 mL * 100 mg guaifenesin & 10 mg codeine/5 mL * Oral solution * 100 mg guaifenesin & 10 mg codeine/5 mL * 225 mg guaifenesin & 7.5 mg codeine/5 mL * Syrup * 100 mg guaifenesin & 10 mg codeine/5 mL * 200 mg guaifenesin & 10 mg codeine/5 mL * Tablets * 400 mg guaifenesin & 10 mg codeine * 400 mg guaifenesin & 20 mg codeine * Adult Dosing * See specific product labeling (due to differences in concentration) * Cheratussin AC * 10 mL every 4 hours as needed * Dosing should not exceed 60 mL/day * Note: If cough has not resolved in ≤ 5 days, then re-evaluate for an underlying cause or pathology * Pharmacokinetics * Codeine * Onset of action: ≤ 1 hour * Duration: 4-6 hours * Prodrug: Metabolized in the liver to morphine (active) * Excreted in the urine * Contraindications * Hypersensitivity * Asthma * Precautions * Codeine can cause CNS depression which can impair physical and mental abilities * Use with caution in patients with CNS depression * Use with caution if there is a history of drug or alcohol abuse * Use with caution in patients with respiratory disease * Respiratory depression can occur and is dose related * Use with caution in severe renal or hepatic impairment * Adverse Drug Reactions * Most common * Drowsiness * Dizziness or headache * GI upset (nausea / stomach pain / constipation) * MAJOR Drug Interactions * CNS depressants including alcohol can have additive effects * Guaifenesin and codeine may increase the levels/effects or SSRIs and thiazide diuretics * Pregnancy Category/Breast feeding * Category C * Use with caution in breast feeding * Safety Monitoring * Side effects * CNS and respiratory depression * Efficacy Monitoring * Relief of cough * Major Counseling Points * Cheratussin AC cause CNS depression * Use caution performing tasks requiring mental or physical alertness * Avoid alcohol while taking Cheratussin® AC (which can increase CNS depression) * Take each dose with a full glass of water (this will help the guaifenesin thin the mucous and make it easier to expel) * Common side effects include Drowsiness, headache, and GI upset * Taking each dose with food should help if GI upset is an issue * Report any severe, persistent, or intolerable side effects References: * Guaifenesin & Codeine. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2011, cited 2011 Feb 23]. [about 8 p.]. | 2/23/11 | Free | View In iTunes |
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147 Klor-Con® (potassium chloride) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 147 Klor-Con® (potassium chloride) (http://thestudentpharmacist.com/wp-content/uploads/147_Klor_Con.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brands * Klor-Con® * Epiklor® * K-Tab® * microK® * Generic: Potassium Chloride (available, except for the "powder for solution" dosage form) * Mechanism of Action * Potassium is the major cation of intracellular fluid and plays a major role in: * Nerve impulses (heart, brain, and skeletal muscle) * Muscle contractions (cardiac, skeletal, and smooth muscle) * Renal function * pH balance * Metabolism of carbohydrates * Gastric secretions * Indications * Prevention of hypokalemia * Treatment of hypokalemia * Dosage form * Extended release caplets: 10 mEq * Extended release capsules: 8 & 10 mEq * Premixed infusions: 5-40 mEq * Injection solution: 2 mEq/mL * Powder for reconstitution (Klor-Con®): 20 & 25 mEq/packet * Extended release tablets (Klor-Con®): 8, 10, 15, & 20 mEq * Adult Dosing * Normal daily requirements: 40-80 mEq/day * Prevention of hypokalemia: 20-40 mEq/day * Treatment of hypokalemia: Ranges from 40-240 mEq/day as divided doses depending on severity * Contraindications * Hypersensitivity * Hyperkalemia * Solid oral dosage forms are contraindicated in patients with delay or arrest in passage through the GI tract * Precautions * Hyperkalemia can occur. Symptoms include: * Muscle weakness or paralysis * Cardiac conduction abnormalities * Use with caution in patients with cardiovascular disease * Caution in renal impairment * Adverse Drug Reactions * Most common * GI upset (diarrhea, flatulence, abdominal pain, nausea and vomiting) * Hyperkalemia * MAJOR Drug Interactions * Use with the following medications increases the risk of hyperkalemia: * ACE-Inhibitors * ARBs * Potassium-sparing diuretics * Pregnancy Category/Breast feeding * Category C * Compatible with breastfeeding * Safety / Efficacy Monitoring * Electrolytes (especially potassium) * pH balance * Renal function (SCr) at baseline * Major Counseling Points * Swallow long acting dosage forms whole (and should not be crushed or chewed) * The powder dosage form may be dissolved in water before use * The liquid dosage form can be diluted in water or juice * Most common side effect is GI upset * Taking each dose with food should help * Let your doctor know if you experience any unexplained muscle weakness or cardiac arrhythmias * Report any severe, persistent, or intolerable side effects References: * Potassium Chloride. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2011, cited 2011 Feb 22]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Potassium Chloride. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Potassium Chloride. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2011, cited 2011 Feb22]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 2/22/11 | Free | View In iTunes |
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146 Penicillin VK – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today 146 Penicillin VK (http://thestudentpharmacist.com/wp-content/uploads/146_Penicillin_VK.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Penicillin VK (available) * Oral form of penicillin G * Mechanism of Action * Penicillin antibiotic * Binds to penicillin binding proteins (BPBs), which inhibits peptidoglycan synthesis in bacterial cell walls * This causes the bacteria to eventually lyse * Indications * Treatment of susceptible infections * That said, the natural penicillins (penicillin G and penicillin VK), in general, provide: * Good coverage (spectrum of activity) for Treponema pallidum (syphilis), most streptococci * Moderate coverage for Streptococcus pneumonia and enterococci * Poor coverage for most everything else * Dosage form * Powder for oral solution: * 125 mg/5 mL * 250 mg/5 mL * Tablets * 250 & 500 mg * Adult Dosing * Dose and duration depends on infection type and severity * Dose range (in general): 250-1000 mg given 2-4 times daily * Duration: A few days to several weeks or months * Note: Dose does need to be adjusted in renal impairment (CrCl < 50 mL/min) * Pharmacokinetics * Elimination half life: ~30 minutes * Very short half life, which is why it has to be dosed several times/day * Absorption is decreased by food * Excreted in the urine as unchanged drug and metabolites * Contraindications * Hypersensitivity * Precautions * Hypersensitivity can be severe * Use with extreme caution in a patients who have had a previous allergic reaction to a beta-lactam antibiotic (which includes the penicillins, cephalosporins, and carbapenems) * Prolonged use can lead to severe infections (such as CDAD... Clostridium difficile associated diarrhea) * This is a caution with any antibiotics and is one of the reasons antibiotics should be used at the lowest effective dose for the shortest duration * Use with caution in renal impairment * Adjust dose if CrCl < 50 mL/min * Use with caution in patients with a seizure disorder * Increased levels of penicillin may increase the risk of seizures * Adverse Drug Reactions * Most common * GI upset (N/V/D) * Oral candidiasis (thrush) * MAJOR Drug Interactions * No major drug interactions (that I see) * Pregnancy Category/Breast feeding * Category B * Compatible with breastfeeding * Safety Monitoring * Signs of anaphylaxis during the first dose * Renal function and complete blood count with prolonged therapy * Efficacy Monitoring * Relief of signs and symptoms of infection * Major Counseling Points * Take penicillin VK as directed at scheduled intervals until all of the prescription is gone * Take each dose on an empty stomach (1 hour before or 2 hours after meals) * Most common side effect is GI upset (N/V/D) * Take with small meals if this is an issue * Report any severe, persistent, or intolerable side effects to your doctor or pharmacist References: * Penicillin VK. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Sep 14]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Penicillin VK. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Penicillin VK. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, | 2/20/11 | Free | View In iTunes |
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145 TriNessa®-28 (ethinyl estradiol & norgestimate) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 | 2/16/11 | Free | View In iTunes |
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141 Detrol® LA (tolterodine) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today Note: 138 (tramadol) (http://thestudentpharmacist.com/?p=229), 139 (pantoprazole) (http://thestudentpharmacist.com/?p=373), and 140 Hyzaar® (hydrochlorothiazide (http://thestudentpharmacist.com/?p=114) & losartan (http://thestudentpharmacist.com/?p=356)) have been covered in previous episodes 141 Detrol® LA (tolterodine) (http://thestudentpharmacist.com/wp-content/uploads/141_Detrol_LA.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand: * Detrol® LA (extended release capsules) * Detrol® (tablets) * Generic: Tolterodine (not available) * Mechanism of Action * Anticholinergic agent * Competitive inhibitor of muscarinic receptor that is selective for urinary bladder receptors * Overall effects include an increase in residual urine volume and a decrease in detrusor muscle pressure * Indications * Overactive bladder (urinary frequency, urgency, or urge incontinence) * Dosage form * Extended release tablets (Detrol® LA) * 2 & 4 mg * Tablets (Detrol®) * 1 & 2 mg * Adult Dosing * Extended release (Detrol® LA) * 4 mg daily * Immediate release (Detrol®) * 2 mg twice/day * Note: * Dose (of either the immediate or extended release may need to be decreased 50% if: * The patient cannot tolerate the full dose * The patient is also taking CYP3A4 inhibitors * Renal impairment: CrCl 10-30 mL/min * Severe hepatic impairment * Pharmacokinetics * Metabolized in the liver by CYP2D6 & 3A4 * Active metabolite: 5-hydroxymethyltotlerodine * Food increases the bioavailability of the immediate release tablets by ~50% * Excreted primarily in the urine (77%) but also in the feces (17%) * Contraindications * Hypersensitivity * Urinary retention * Gastric retention * Uncontrolled narrow-angle glaucoma * Precautions * CNS effects may occur, including * Drowsiness * Blurred vision * Impairment of physical and mental abilities * Use caution (especially with initial therapy) * Use with caution in patients with bladder flow obstructions or gastrointestinal obstructive disorders * Use of tolterodine could increase the risk of urinary or gastric retention in this patient population * Use with caution in patients with myasthenia gravis * Adverse Drug Reactions * Most common * Xerostomia (dry mouth): up to 35% of patients * Headache * Dizziness * Abdominal pain * Dyspepsia * MAJOR Drug Interactions * CYP3A4 inhibitors may increase the effects of tolterodine * Suggested to decrease the tolterodine dose by 50% if a patient is on a 3A4 inhibitor, examples include: * Protease inhibitors (such as ritonavir) * Macrolide antibiotics (such as clarithromycin) * Azole antifungals (such ketoconazole & fluconazole) * Pregnancy Category/Breast feeding * Category C * Excretion in breast milk is unknown * Safety Monitoring * Renal function (BUN, creatinine) * Hepatic function (Liver function tests) * Efficacy Monitoring * Relief of symptoms * Major Counseling Points * Take each dose with food * Swallow the capsules whole (do not break, crush, or chew) * Common side effects include dry mouth, headache/dizziness, and abdominal pain * You may also experience impairment of physical and mental abilities with initial therapy (use caution performing tasks requiring mental or physical alertness) * Report any difficulty urinating or painful urination | 2/14/11 | Free | View In iTunes |
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137 Allopurinol (Zyloprim®) – Top 200 Prescribed Drugs | 137 Allopurinol (Zyloprim®) (http://thestudentpharmacist.com/wp-content/uploads/137_Allopurinol.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brands: * Aloprim® (injection powder for reconstitution) * Zyloprim® (tablets) * Generic: Allopurinol (available) * Mechanism of Action * Xanthine oxidase inhibitor * Xanthine oxidase normally converts hypoxanthine to xanthine, then to uric acid (which builds up in the case of gout) * Indications * Gout * Hyperuricemia secondary to chemotherapy * Recurrent calcium oxalate stones * Dosage form * Injection powder for reconstitution: 500 mg * Tablets: 100, 300 mg * Adult Dosing * Gout * 200-300 mg/day for mild gout * 400-600 mg/day for severe gout * Prophylaxis: initiate at 100 mg/day and increase to a daily max of 800 mg * Note: * Doses should be taken after meals with a full glass of water * Doses > 300 mg should be divided * Dose does need to be adjusted based on renal impraiment * Pharmacokinetics * Peak effect: ~1-2 weeks * Metabolized to active metabolites (mainly oxypurinol) * Excreted in the urine primarily as oxypurinol * Contraindications * Hypersensitivity * Precautions * Bone marrow suppression and reversible hepatotoxicity have been reported as side effects (rare) * Adjust dose in renal impairment * Adverse Drug Reactions * Most common * GI upset * Rash * Acute gout * MAJOR Drug Interactions * Avoid use with didanosine * Allopurinol levels and risk of hypersensitivity may be increased when taken with an ACE-I or diuretic * Risk of rash may be increased when taken with ampicillin or amoxicillin * Pregnancy Category/Breast feeding * Category C * Rated compatible in breast feeding by the American Academy of Pediatrics (AAP) * Safety / Efficacy Monitoring * Hepatic and renal function (especially at baseline) * Complete blood count (CBC) * Serum uric acid levels * Major Counseling Points * Take each dose after meals and with a full glass of water * Main side effect is GI upset * Report any severe, persistent, or intolerable side effects to your doctor or pharmacist References: * Allopurinol. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2011 Feb 13]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Allopurinol. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Allopurinol. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2011 Feb 13]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 2/13/11 | Free | View In iTunes |
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136 Niaspan® (niacin) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today 136 Niaspan® (niacin) (http://thestudentpharmacist.com/wp-content/uploads/136_Niaspan.mp3) Episode Notes (References Below: * Brand/Generic Available? * Brand: Niaspan® * Generic: Niacin * Niaspan, which is the extended release form of niacin, is not available generically * First... a few notes about the different dosage forms of niacin: * Immediate release niacin is available by prescription (as Niacor®) and OTC (as Vitamin B-3 or nicotinic acid), but is associated with truncal and facial flushing in 50-100% of patients * Sustained release niacin (slow niacin) has decreased truncal and facial flushing, BUT has an increased risk with hepatotoxicity and liver failure, and is not FDA approved for for dyslipidemia * Niaspan which, again, is the extended release form of niacin and the form we are going to focus on, has the lowest risk of both truncal and facial flushing as well as liver complications * Mechanism of Action * Most effective agent at increasing HDL while lowering triglycerides (TGs) as well as LDL * Inhibits hepatic uptake of apolipoprotein A-1, a major component of HDL * Decreases mobilization of free fatty acids (FFAs) from peripheral tissues to liver, which leads to decreased TG synthesis * Increases excretion of VLDL, leaving less VLDL available to make LDL * Indications * Dyslipidemia * Lower the risk of recurrent myocardial infarction (in patients with a previous MI and hyperlipidemia) * Treatment of hypertriglyceridemia in patients at risk of pancreatitis * Dosage forms * Niaspan® (extended release niacin) * Tablets: 500, 750, 1000 mg * Adult Dosing * Initiate at 500 mg at bedtime (QHS) for at least 4 weeks * The dose can be increased every 4 weeks to a maximum dose of 2 grams given at night * Usual daily dose is 1-2 g/day * Note: Use is contraindicated in patients with significant or unexplained hepatic dysfunction, active liver disease, or unexplained elevated liver function tests (LFTs) * Pharmacokinetics * Metabolized by the liver (undergoes extensive 1st pass effects) * Excreted primarily in the urine * Contraindications * Hypersensitivity * Active liver disease or significantly increased LFTs * Peptic ulcer disease * Arterial hemorrhage * Precautions * Truncal or facial flushing can occur * The dose is titrated gradually to help reduce flushing * Taking aspirin 325 mg or an NSAID ~1 hours before administration may also help if flushing is an issue * Use with caution in patients with unstable angina or MI * Niacan can cause arrythmias * Use with caution in patients with gout * Niacin may be associated with hyperuricemia * May increase hyperglycemia in patients with diabetes (rare) * Adverse Drug Reactions * Most common * Flushing * Pruritis or itching * GI upset (dyspepsia, nausea, abdominal pain) * MAJOR Drug Interactions * Avoid use or dosing with alcohol * Increses risk of flushing and hepatotoxicity * Pregnancy Category/Breast feeding * Category C * Enters breast milk * Safety Monitoring * Liver function tests at baseline then every ~3 months for the first year and biannually there after * Glucose in patients with diabetes * Uric acid in patients with gout * Efficacy Monitoring * Fasting lipid panel at baseline then every 6 weeks until at goal * Major Counseling Points * Do not take Niaspan with alcohol | 2/10/11 | Free | View In iTunes |
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135 Naproxen (Aleve®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today 135 Naproxen (Aleve®) (http://thestudentpharmacist.com/wp-content/uploads/135_Naproxen.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brands (not a complete list): * Aleve® [OTC] * Anaprox® * Midol® Extended Relief [OTC] * Naprosyn® * Naprelan * Generic: Naproxen (available) * Mechanism of Action * Non-selective NSAID (non-steroidal anti-inflammatory drug) * Decreases prostaglandin synthesis by inhibiting COX-1 and COX-2 * Has antipyretic, analgesic, and anti-inlammatory properties * SO it decreases heat, pain, and inflammation * Indications * Ankylosing spondylitis (form of spinal arthritis) * Osteoarthritis * Rheumatoid arthritis * Acute gout * Mild-moderate pain * Tendonitis * Bursitis * Dysmenorrhea * Fever * Dosage form (range: 125 - 825 mg) * Caplets: 220 mg * Liquid gel capsules and gelcaps: 220 mg * Oral suspension: 125 mg/5 mL * Tablets: 220, 250, 275, 375, 500, & 550 mg * Controlled release tablets: 412.5, 550, 825 mg * Delayed release tablets: 375 & 500 mg * The above are expressed as naproxen sodium... 220 mg naproxen sodium = 200 mg sodium base * Adult Dosing * Dose depends on indication * Range: 200 - 750 mg single doses * Max daily dose of 1250-1500 mg/day (depending on indication) * OTC labeling for pain or fever: * 200 mg every 8-12 hours with an initial dose of 400 mg if needed * Dose should not exceed 600 mg/day * Note: Naproxen should not be used if CrCl < 30 mL/min * Pharmacokinetics * Onset of action * Analgesic: 1 hours * Antiinflammatory: ~2 weeks * Duration * Analgesic: ≤ 7 hours * Anti-inflammatory: ≤ 12 hours * Metabolized by the liver * Excreted primarily in the urine * Black Box Warning(s) * Cardiovascular events (such as MI and Stroke) * Increased risk with prolonged use or in the presence of CV disease or CV risk factors * GI events * NSAIDs increase risk of GI irritation, ulceration, and GI bleeding * Use with caution in the following: * Concurrent ASA therapy * Corticosteroids or anti-coagulants * Patients with GI complications * Patients who smoke or drink excess alcohol * Elderly patients * If naproxen is being used in any of these situations, then consider also giving a PPI to decrease the risk of GI comlications * To decrease the risk of CV or GI events, use lowest effective dose for shortest duration * Contraindications * Hypersensitivity to naproxen or other NSAIDs * Preoperative pain in CABG (coronary artery bypass graft) * Precautions * Use with caution in hepatic impairment * Use with caution in renal impairment * NSAIDs cause constriction of the afferent arteriole, which can decrease renal function * Caution in HF, dehydration, elderly, and patients on diuretics or ACE-Inhibitors due to increase risk of renal dysfunction * Caution in HTN * Can cause HTN and decrease response to diuretics and ACE-Is (mainly due to NSAIDs effect on the kidneys) * Caution in the elderly (increased risk or ADRs) * Rated as "high severity risk" for use in elderly patients * Adverse Drug Reactions * Most common * Most common = GI * N/V/D/C, abdominal pain and heart burn * Other common side effects: * Edema or fluid retention * Rash or itching (pruritus) * Dizziness or nervousness * Tinnitus (ringing/buzzing in the ear) * MAJOR Drug Interactions | 2/9/11 | Free | View In iTunes |
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134 Amitriptyline (Elavil®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today 134 Amitriptyline (Elavil®) (http://thestudentpharmacist.com/wp-content/uploads/134_Amitriptyline.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand: Elavil® * Generic: Amitriptyline (available) * Mechanism of Action * Tricyclic Antidepressant (TCA) * Some other medications in this class include: * Clomipramine, doxepin, imipramine, trimipramine, nortriptyline * Inhibits the re-uptake of norepinephrine and serotonin, which increases their concentration in the synapses of the CNS * Indications * Major depressive disorder (MDD) * Unlabeled uses: * Chronic pain * Migraine prophylaxis * Post-traumatic stress disorder (PTSD) * Dosage form * Tablets: 10, 25, 50, 75, 100, & 150 mg * Adult Dosing * Depression * 50-150 mg/day as a single dose or divided * Max daily dose is 300 mg * Pharmacokinetics * Onset of action for antidepressant activity (as well as migraine prophylaxis): 4-6 weeks * Metabolized by the liver to nortriptyline, which is active, as well as other metabolites * Higher doses may be required in heavy smokers due to increased metabolism * Average half-life elimination: 15 hours * Black Box Warning(s) * Antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24 yo) with MDD and other psychiatric disorders * Observe patients for suicidal ideology especially during the 1st few months of therapy * Reason/mechanism: Antidepressants in general increase energy/appetite before they affect mood… giving the patient the energy needed for suicide * Contraindications * Hypersensitivity * Use of MAO inhibitors within the past 14 days * Acute recovery period after a myocardial infarction (MI) * Concurrent use with cisapride (GI, prokinetic agent) * Precautions * Amitriptyline is not FDA approved for bipolar disorder and can cause a shift towards mania in patients with bipolar disorder * The risk of arrhythmias is high with amitriptyline compared to other antidepressants * Use with caution in patients with cardiovascular disease * Use with caution in patients with diabetes due to the potential for altered glucose regulation * Use with caution in patients with seizure disorders (may lower seizure threshold) * Adverse Drug Reactions * Most common * Anticholinergic effects: * Constipation * Xerostomia * Blurred vision * Uriniary retention * Sedation * Orthostatic hypotension * MAJOR Drug Interactions * Avoid use within 14 days of MAO inhibitors * Avoid use with cisapride (GI, prokinetic agent) * Also avoid use with: * Dronedarone * Pimozide * Thrioridazine * Ziprasidone * Pregnancy Category/Breast feeding * Category C * Enters breast mile (not recommended) * Safety Monitoring * Suicidal ideation (especially with initial therapy) * Check blood pressure and pulse at baseline and during initial therapy * Side effects * Efficacy Monitoring * Depression * Mood and social functioning * Major Counseling Points * It may take 6 weeks to see effects of amitriptyline (and loner to see full effects) * Keep taking amitriptyline even if you feel better * Avoid alcohol while on amitriptyline * Main side effects include dry mouth, urinary retention (difficulty urinating), blurry vision, constipation, as well as sedation * Amitriptyline may lower your blood pressure, | 2/9/11 | Free | View In iTunes |
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133 Ciprofloxacin (Cipro®) – Top 200 Prescribed Drugs | Note: 132 (Proventil HFA) (http://thestudentpharmacist.com/?p=92) was covered in a previous episode Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today 133 Ciprofloxacin (Cipro®) (http://thestudentpharmacist.com/wp-content/uploads/133_Ciprofloxacin.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand: Cipro® * Generic: Ciprofloxacin (available) * Mechanism of Action * Fluoroquinolone (FQ) antibiotic * In susceptible bacteria, ciprofloxacin inhibits DNA gyrase, which inhibits the relaxation of supercoiled DNA and promotes breakage of double-stranded DNA * Has broad spectrum of activity and covers many Gram (+), Gram (-), & atypical bacteria * Specifically, ciprofloxacin provides good coverage of enteric Gram (-) rods and Haemophilus influenzae AND moderate coverage for Pseudomonas and atypical bacteria, such as Mycoplasma, Chlamydia, & Legionella * Indications * The following is a list of common uses of ciprofloxacin caused by susceptible bacteria: * Urinary tract infections * Lower respiratory tract infections * Acute Sinusitis * Bone & joint infections * Nosocomial pneumonia * Anthrax treatment * Gonorrhea * Dosage form * Infusion solution: 200 & 400 mg * Injection solution: 10 mg/mL * Microcapsules for oral suspension: 250 & 500 mg/5 mL (Cipro®) * Opthalmic ointment: 3.33 mg/g (Ciloxan®) * Opthalmic solution: 3.5 mg/mL (Ciloxan®) * Otic solution: 0.5 mg/0.25 mL (Cetraxal®) * Tablets: 100, 250, 500, & 750 mg * Extended release tablets: 500 & 1000 mg * Adult Dosing * Dosing and duration depends on indication and severity * Typical dosing: 400-750 mg PO (immediate release) every 12 hours * Duration ranges from a single dose to several weeks (again, depending on indication and severity) * Adjust dose with renal impairment (CrCl ≤ 50 mL/min) * CrCl 30-50: 250-500 mg PO every 12 hours * CrCl 65 years of age * FQs should be discontinued if any tendon pain or inflammation occurs * Contraindications * Hypersensitivity * Concurrent use with tizanidine * Precautions * FQs can alter cardiac conduction and prolong the QT interval * Can cause CNS stimulation (restlessness, confusion, &/or tremor) * Use with caution in patients with seizure disorders * FQs can lead to hypoglycemia (caution patients with diabetes) * As with most antibiotics, prolonged use can lead to C. difficile associated diarrhea (CDAD) (use for shortest duration needed) * Adverse effects are more common in children. Therefore FQs are not drugs of choice in children, with the exception of the treatment of anthrax * Adverse Drug Reactions * Most common * GI upset (n/v/d) * Headache * Photosensitivity * CNS effects (dizziness and/or confusion) * Increased liver function tests (ALT and AST) in ~1% of patients | 2/8/11 | Free | View In iTunes |
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131 Januvia® (sitagliptin) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today 131 Januvia® (sitagliptin) (http://thestudentpharmacist.com/wp-content/uploads/131_Januvia.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand: Januvia® * Generic: Sitagliptin (not available) * Mechanism of Action * Antidiabetic agent * DPP-IV inhibitor * Inhibits dipeptidyl peptidase-IV (DPP-IV), which normally inactivates the incretin hormones glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) * GLP-1 and GIP regulate glucose homeostasis by increasing insulin synthesis and release from beta cells of the pancreas, and decreasing glucagon secretion from alpha cells of the pancreas * Overall, helps with prandial glucose (or glucose around mealtime) * Another DDP-IV inhibitor is saxigliptin (Onglyza®) * Indications * Type 2 Diabetes Mellitus (T2DM) * Not effective in Type 1 Diabetes Mellitus, because its mechanism of action depends on the patient being able to produce insulin * Dosage form * Tablets: 25, 50, & 100 mg * Adult Dosing * 100 mg once/day * Dose may need to be reduced if the patients in also taking insulin or insulin secretagogues * Reduce the dose in renal impairment (CrCl < 50 mL/min) * CrCl 30-49 mL/min: 50 mg once/day * CrCl < 30 (including dialysis): 25 mg once/day * Pharmacokinetics * Minimally metabolized (CYP3A4 & 2C8) * Excreted mainly in the urine (87%), but also in the feces (13%) * Contraindications * Hypersensitivity * Precautions * Acute pancreatitis has been reported with use * Not to be used in patients with T1DM * Adverse Drug Reactions * Most common (1 - 10%) * Diarrhea (as well as nausea and vomiting) * Peripheral edema * Hypoglycemia * MAJOR Drug Interactions * Use with insulin or insulin secretagogues (such as sulfonylureas) increases the risk of hypoglycemia * Pregnancy Category/Breast feeding * Category B * Excretion in breast milk is unknown * Safety / Efficacy Monitoring * HbA1c at baseline then 3 months after initiation * Glucose * Renal function (at baseline and periodically thereafter) * Major Counseling Points * Januvia® is meant to work along with lifestyle modifications and is not meant to replace diet and exercise * Common side effects include GI upset, edema, and hypoglycemia * Signs/symptoms of hypoglycemia include: * Feeling ill or lethargic * HA * Hunger * Sweating * Confusion * Irritable * Rapid heart rate * If hypoglycemia occurs: * First off, always carry a rapid glucose supply with you (glucose tabs/gel or hard candy) * Check blood glucose (BG) when you notice symptoms * If < 70 mg/dL consume glucose * 3 glucose tabs * 1/2 cup fruit juice * 5-6 pieces of hard candies * 6-8 oz of soft drink (not diet) * Recheck BG in 15-20 min * If still low consume more glucose * After raising BG, eat a small meal to help stabilize serum glucose levels References: * Sitagliptin. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Sep 14]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Januvia®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Januvia®. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Sep 14]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ | 2/7/11 | Free | View In iTunes |
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130 Cialis® (tadalafil) – Top 200 Prescribed Drugs | Note: Numbers 128 (Benicar (http://thestudentpharmacist.com/?p=416) HCT (http://thestudentpharmacist.com/?p=114)) and 129 (Albuterol (http://thestudentpharmacist.com/?p=92)) have been covered in previous episodes 130 Cialis® (Tadalafil) (http://thestudentpharmacist.com/wp-content/uploads/130_Cialis.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand: Cialis® * Generic: Tadalafil (not available) * Mechanism of Action * Tadalafil is a phosphodiesterase-5 inhibitor, which (in terms of erectile dysfunction) enhances the effect of Nitric Oxide and increases the levels of cGMP in the corpus cavernosum. * The result is smooth muscle relaxation and increased blood flow to the corpus cavernosum * Tadalafil can also cause relaxation of the smooth muscles in the lungs by the same mechanism, which is beneficial for pulmonary hypertension (which is the indication for Adcirca®... another name brand for tadalafil) * Indications * Cialis® is indicated for the treatment of erectile dysfunction * Dosage form * Tablets: 2.5, 5, 10, and 20 mg * Adult Dosing * As needed: * 5-20 mg at least 30 minutes before sexual activity * Once daily dosing: * 2.5-5 mg at the same time every day * Renal impairment: Initiate lower dose if creatinine clearance is < 50 mL/min * CrCl 31-50 mL/min: Max recommended dose is 10 mg, which should not be given anymore than every 2 days * CrCl ≤ 30 mL/minL: Max recommended dose is 5 mg every 3 days * Hepatic impairment: * Child-Pugh class A or B: dose should not exceed 10 mg/day * Not recommended in Child-Pugh class C * Pharmacokinetics * Onset of action: within 1 hour * Improvement of erectile dysfunction can last up to 36 hours * Metabolized in the liver by CYP3A4 * Excreted in the urine and feces * Contraindications * Hypersensitivity * Concurrent use with nitrates of any form * Precautions * Chest pain/angina can occur * Patients should seek immediate medical attention if this is an issue * Use with caution in patients with cardiovascular disease * Hypotension can occur due to the vasodilatory effects * Because of this, use with caution in patients with cardiovascular disease * This hypotensive effect may be increased if used with other meds that can cause hypotension, as well as alcohol * Priapism can occur and patients should seek medical attention if erection lasts longer than 4 hours * Again, lower the dose of Cialis® if the patient has hepatic impairment or renal impairment with a CrCl < 50 mL/min * Just to note: Vision loss and hearing loss have been reported in rare cases * Adverse Drug Reactions * Most common * Headache * Dyspepsia * Flushing * Nausea * Myalgia * Back pain * MAJOR Drug Interactions * Dose of tadalfil may need to be lowered with the following medications * Alpha-1-blockers (such as * Protease inhibitors (such as * Other CYP3A4 inhibitors such as: * Clarithromycin * Diclofenac * Itraconazole * Ketoconazole * Nicardipine * Pregnancy Category/Breast feeding * Category B * Use with caution in breast feeding * Safety/Efficacy Monitoring * Monitor for side effects * Monitor for effectiveness * Major Counseling Points * Let your doctor or pharmacist know that you are taking Cialis® before you start any new medications * Don't combine Cialis® with other erectile dysfunction treatments without talking to your doctor or pharmacist first * Some common side effects you may experience include headache, dyspepsia, nausea, and muscle or back pain * If you have an erection lasting longer than 4 hours OR severe chest pain after taking Cialis®, seek medical help immediately * As always, report any severe, persistent, or intolerable side effects to your doctor or pharmacist References: | 2/5/11 | Free | View In iTunes |
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127 Paroxetine (Paxil®) – Top 200 Prescribed Drugs | Episode Notes (References Below) 127 Paroxetine (Paxil®) (http://thestudentpharmacist.com/wp-content/uploads/127_Paroxetine.mp3) * Brand/Generic Available? * Generic: Paroxetine (available) * Brand Names: * Paxil®, Paxil CR® * Pexeva * Mechanism of Action * Antidepressant * Selective serotonin reuptake inhibitor * Inhibits re-uptake of serotonin (5-HT) in the CNS (so it stays in the synapse longer) * Indications * Major depressive disorder (MDD) * Generalized anxiety disorder (GAD) * Obsessive compulsive disorder (OCD) * Panic disorder * Premenstrual dysphoric disorder * Post-traumatic stress disorder * Social anxiety disorder * Dosage forms * Oral suspension: 10 mg/5 mL * Tablet: 10, 20, 30, and 40 mg * Controlled release tablets: 12.5, 25, and 37.5 mg * Adult Dosing * Typical dosing for most indications: * Immediate release: * Initiate at 20 mg once daily * Increase by 10 mg weekly as needed * Max dose: 50-60 mg/day, depending on the indication * Controlled release: * Initiate at 25 mg once daily * Increase by 12.5 mg weekly as needed * Max dose: 37.5-62.5 mg/day * Pharmacokinetics * Onset of antidepressant activity is seen within 1 week * Full response may not be seen for up to 12 weeks * Metabolized in the liver by CYP2D6 * Average half-life: ~21 hours * Excreted in the urine and feces * Black Box Warning(s) * Antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24 yo) with MDD and other psychiatric disorders * Observe patients for suicidal ideology especially during the 1st few months of therapy * Reason/mechanism: Antidepressants in general increase energy/appetite before they affect mood… giving the patient the energy needed for suicide * Contraindications * Hypersensitivity * Use within 14 days of MAO inhibitors * Concurrent use with thioridazine or pimozide * Precautions * Paroxetine can inhibit platelet aggregation, which can increase the risk of bleeding * Use with aspirin, NSAIDs, or warfarin can increase the bleeding risk * Serotonin Syndrome can occur. Symptoms include: * Tachycardia * Rapid changes in blood pressure * Hallucinations * Increased body temperature * Loss of coordination * Overactive reflexes * N/V/D * Adverse Drug Reactions * Most common * Somnolence or insomnia * Headache * Dizziness * Decreased libido * GI upset (as nausea, constipation, or diarrhea) * Xerostomia * Ejaculatory disturbances * Muscle weakness or tremor * Diaphoresis * MAJOR Drug Interactions * Avoid using Paroxetine with the following medicaitons: * MAO inhibitors * Pimozide * Tamoxifen * Thioridazine * Tryptophan * Look for drugs that interact with CYP2D6 * Pregnancy Category/Breast feeding * Category C * Not recommended when breast feeding * Safety Monitoring * Suicidal ideation (especially during initial therapy) * Efficacy Monitoring * Mental status * Social functioning * Major Counseling Points * It may take 3 months to see the full effects of paroxetine * Keep taking paroxetine even if you feel better * Avoid alcohol on paroxetine * Main side effects include sleep disturbances, headache, GI upset, dry mouth, and decreased libido * Let you doctor or pharmacist know if any side effects are severe, persistent, or intolerable References: * Paroxetine. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2011, cited 2011 Jan 31]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Paroxetine. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Paroxetine. In: Epocrates Online [Internet]. | 2/4/11 | Free | View In iTunes |
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126 OxyContin® (oxycodone) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today 126 OxyContin® (oxycodone (http://thestudentpharmacist.com/wp-content/uploads/126_OxyContin.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: OxyCodone * Brands: * OxyContin® * Roxicodone® * Note: OxyContin® was recently reformulated to decrease abuse potential * The new "OP" tablets are bioequivalent to the old "OC" tablets but there are some differences: * The new "OP" tablets take a little longer to reach peak concentrations and have a slightly higher peak concentration * The main difference is that the new tablets are harder to crush, chew, snort, and inject, which is supposed to cut down on abuse potential * Mechanism of Action * Opioid analgesic * Blocks pain by binding Mu and kappa opiate receptors in the cerebral cortex * Also causes generalized CNS depression * Indications * Management of moderate-severe pain * Specifically, oxycodone should be used for around-the-clock pain management for extended periods of time * Dosage form * OxyContin®: * Controlled release tablet * 10, 15, 20, 30, 40, 60, 80 mg * Roxicodone®: * Oral concentrate: 20 mg/mL * Oral solution: 5 mg/mL * Tablets * 5, 15, 30 mg * Adult Dosing (looking at OxyContin® specifically) * Initiate at 10 mg every 12 hours * Dose should then be individualized based on pain control and tolerability * Higher doses (60 and 80 mg tablets) should be reserved for opioid tolerant patients * If patient is currently taking other opioids, then convert the current opioid dose to an equivalent dose of Oxycontin * Pharmacokinetics * Onset of action: 10-15 minutes * Metabolized my CYP3A4 and 2D6 * Some metabolites do have analgesic activity * Excreted in the urine * Black Box Warning(s) * OxyContin® should not be used on an "as-needed" basis for analgesia or for postoperative pain management * OxyContin® should not be crushed, broken, or chewed * Abuse potential should be considered and healthcare providers should be alert to problems or signs of misuse, abuse, and diversion * Use with strong 3A4 inhibitors can prolong the effect of OxyContin®, which may lead to severe of even fatal respiratory depression * Contraindications * Hypersensitivity * Significant respiratory depression * Acute of severe asthma * Paralytic ileus * Precautions * CNS depression is of concern, which may impair mental and physical abilities (especially with initial therapy) * Hypotension can occur, especially in patients who: * Are hypovolemic * Have cardiovascular disease * Or are on other drugs that can cause hypotension * Use with caution in patients with a history of seizures, thyroid dysfunction, respiratory disease, or severe renal impairment * Use with caution in elderly patients * They are more sensitive to adverse effects * Use lower initial dose * Adverse Drug Reactions * Most common * Somnolence * Dizziness * Nausea, vomiting, and constipation * NOTE: Most side-effects decrease over time except constipation, and most patients will require a stool softener and/or laxative with long term opioid therapy * MAJOR Drug Interactions * Use with other CNS depressants (including alcohol) may have additive effects * Use with strong 3A4 inhibitors can prolong or increase the overall effects of OxyContin. Examples: * Macrolide antibiotics (erythromycin, clarithromycin) * Azole-antifungals (ketoconazole, | 11/29/10 | Free | View In iTunes |
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124 Carvedilol (Coreg®) – Top 200 Prescribed Drugs | Sorry for my absence! I just finished a very time-intensive 5-week rotation. Thanks, as always, for listening/visiting! Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today 124 Carvedilol (Coreg®) (http://thestudentpharmacist.com/wp-content/uploads/124_Carvedilol.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Carvedilol (Immediate release is available) * Brand: Coreg®, Coreg CR® * Mechanism of Action * Non-selective beta-blocker (beta-1 & beta-2) with alpha-1 blocking activity * Overall effects: * Decreased * Cardiac output * Exercise induced tachycardia * Reflex orthostatic hypertension * Peripheral vascular resistance * Vasodilation * Indications * Heart failure (HF) * Left ventricular dysfunction post myocardial infarction (MI) * Hypertension (HTN) * Dosage form * Tablet: * 3.125, 6.25, and 12.5 mg * Coreg CR (extended release form and NOT available generically) * 10, 20, 40, and 80 mg * Adult Dosing * HTN * Immediate release * Initiate at 6.25 mg BID * Dose can be increased after 1-2 weeks to 12.5 mg BID if needed * Dose can then be further increased after another 1-2 weeks to a maximum of 25 mg BID if needed * Extended release * Initiate at 20 mg daily * Dose can be increased after 1-2 weeks to 40 mg daily if needed * Can be further increased after an additional 1-2 weeks to the maximum dose of 80 mg daily if needed * HF * Immediate release * Initiate at 3.125 mg BID * Double the dose every 2 weeks as tolerated to reach the maximum or target dose: * 85 kg (~187 lbs) = 50 mg BID * Extended release * Initiate at 10 mg daily * Double the dose every 2 weeks to reach the maximum/target dose of 80 mg daily as tolerated * Note: The dose should, at least, be reduced in the patient's heart rate drops below 55 bpm * Pharmacokinetics * Onset of action: ~1-2 hours * Metabolized in the liver via 2C9, 2D6, 3A4, and 2C19 * Does have 3 active metabolites * Excreted primarily in the feces * Contraindications * Hypersensitivity * Decompensated HF * Asthma or bronchospastic conditions * 2nd or 3rd degree heart block * Severe bradycardia * Cardiogenic shock * Severe hepatic impairment * Precautions * Hypotension can occur, especially upon initial treatment with carvedilol * Use with caution in patient with diabetes * Carvedilol can mask the signs/symptoms of hypoglycemia * Signs not masked by carvedilol or other beta blockers are sweating and hunger * Avoid abrupt withdrawal because it can cause reflex tachycardia, HTN, or ischemia * Adverse Drug Reactions * Most common * Hypotension * Dizziness and fatigue * Hyperglycemia * Diarrhea * Weight gain * Muscle weakness * MAJOR Drug Interactions * Many drug interaction * Use with other anti-hypertensive medications can have additive effects * Use with non-DHP CCBs (verapamil and diltiazem) should be avoided due to the potential for severe bradycardia * Because carvedilol is metabolized by the liver, look for drugs that interact with CYP enzymes (specifically 2C9, 2D6, 3A4, and 2C19) * Pregnancy Category/Breast feeding * Category C * Not recommended in breast-feeding * Safety and Efficacy Monitoring * Heart rate, blood pressure * Renal function: (SCr and BUN) * Liver function (AST and ALT) * Major Counseling Points | 11/23/10 | Free | View In iTunes |
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120 Xalatan® (lantanoprost) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today 120 Xalatan® (lantanoprost) (http://thestudentpharmacist.com/wp-content/uploads/120_Xalatan.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Latanoprost (NOT available) * Brand: Xalatan® * Mechanism of Action * Prostaglandin F2-alpha analog * Decreases intra-olcular pressure by increasing outflow of aqueous humor * Indications * Decrease intra-ocular pressure * Open angle glaucoma * Ocular hypertension * Dosage form * 2.5 mL eye drops (solution) * Concentration: 0.005% * Adult Dosing * 1 drop in the affected eyes once daily in the evening * Pharmacokinetics * Onset of action: ~3 hours * Peak effect: 8-12 hours * Contraindications * Hypersensitivity * Precautions * Lantanoprost, over long periods of time, can increase the brown pigmentation of the iris, eyelids, and eyelashes as well as increase the length or number of eyelashes * Contacts should be removed prior to administration and wait at least 15 minutes after administration before reinserting * Adverse Drug Reactions * Most common * Blurred vision * Burning/stinging * Itching * Increased pigmentation of the iris * MAJOR Drug Interactions * Opthalmic NSAIDs may decrease the effects of lantanoprost * Pregnancy Category/Breast feeding * Category C * Safety is unknown in breastfeeding * Safety and Efficacy Monitoring * Side effect profile * Relief of symptoms * Major Counseling Points * Remove contacts and wait 15 min after administration before reinserting * Common side effects include blurred vision, burning, stinging, or itching of the eyes, and increased pigmentation of the iris * Let your doctor or pharmacist know of any severe, persistent, or intolerable side effects References: * Lantaprost. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Oct 17]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Xalatan®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Xalatan. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Oct 17]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdfEpisode Notes (References Below) * Brand/Generic Available? * Generic: Latanoprost (NOT available) * Brand: Xalatan® * Mechanism of Action * Prostaglandin F2-alpha analog * Decreases intra-olcular pressure by increasing outflow of aqueous humor * Indications * Decrease intra-ocular pressure * Open angle glaucoma * Ocular hypertension * Dosage form * 2.5 mL ye drops (solution) * Concentration: 0.005% * Adult Dosing * 1 drop in the affected eyes once daily in the evening * Pharmacokinetics * Onset of action: ~3 hours * Peak effect: 8-12 hours * Contraindications * Hypersensitivity * Precautions * Lantanoprost, over long periods of time, can increase the brown pigmentation of the iris, eyelids, and eyelashes as well as increase the length or number of eyelashes * Contacts should be removed prior to administration and wait at least 15 minutes after administration before reinserting | 10/17/10 | Free | View In iTunes |
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119 Meloxicam (Mobic®) | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today Note: The number 117 (Ocella™) and 118 (Triamterene/HCTZ) have been covered in previous episodes 119 Meloxicam (Mobic®) (http://thestudentpharmacist.com/wp-content/uploads/119_Meloxicam.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Meloxicam (Available) * Brand: Mobic® * Mechanism of Action * Non-selective NSAID (non-steroidal anti-inflammatory drug) * Decreases prostaglandin synthesis by inhibiting COX-1 and COX-2 * Has antipyretic, analgesic, and anti-inlammatory properties * SO it decreases temperature, pain, and inflammation * Indications * Osteoarthritis (OA) * Rheumatoid Arthritis (RA) * Dosage form * Tablets * 7.5, 15 mg * Oral suspension * 7.5 mg/5 mL * Adult Dosing * 7.5 mg/day * Dose can be increased to a maximum of 15 mg once daily * Pharmacokinetics * Metabolized in the liver by CYP2C9 and 3A4 * Can take ~1 week to see anti-inflammatory action * Excreted in the urine and feces as inactive metabolites * Black Box Warning(s) * Cardiovascular events (such as MI and Stroke) * Increased risk with prolonged use or in the presence of CV disease or CV risk factors * Due to cardiovascular risk, use is contraindicated for the treatment of perioperative pain due to coronary artery bypass graft (CABG) * GI events * NSAIDs increase risk of GI irritation, ulceration, and GI bleeding * Use with caution in the following: * Concurrent ASA therapy * Corticosteroids or anti-coagulants * Patients with GI complications * Patients who smoke or drink excess alcohol * Elderly patients * If meloxicam is being used in any of these situations, then consider also giving a PPI to decrease the risk of GI complications * To decrease the risk of CV or GI events, use lowest effective dose for shortest duration * Contraindications * Hypersensitivity * Perioperative pain due to coronary artery bypass graft (CABG) * Precautions * CV risks * GI risks * Use with caution in hepatic impairment * Use with caution in renal impairment * NSAIDs cause constriction of the afferent arteriole, which can decrease renal function * Caution in HF, dehydration, elderly, and patients on diuretics or ACE-Inhibitors due to increase risk of renal dysfunction * Use is not recommended if CrCl < 15 mL/min * Caution in HTN * Can cause HTN and decrease response to diuretics and ACE-Is (mainly due to NSAIDs effect on the kidneys) * Caution in the elderly (increased risk or ADRs) * Adverse Drug Reactions * Most common = GI * N/V/D/C, abdominal pain and heart burn * Other common side effects: * Edema or fluid retention * Headache or dizziness * MAJOR Drug Interactions * NSAIDs can decrease the effects of ACE-I, loop diuretic, as well as thiazide diuretics * NSAIDs can increase bleeding risk with anticoagulants * Pregnancy Category/Breast feeding * Category C * Not recommended in breastfeeding * Safety Monitoring * Get a CBC and monitor renal and hepatic function with prolonged use * Also want to monitor for CV or GI events * Efficacy Monitoring * Relief of symptoms * Major Counseling Points * Take each dose with food or milk to decrease GI upset * Avoid use of aspirin and other NSAIDs (such as naproxen or ibuprofen) unless told otherwise by your doctor or pharmacist * Main side effects are GI in nature (n/v/d) * Again, take each dose with food to decrease GI effects | 10/13/10 | Free | View In iTunes |
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116 Citalopram (Celexa®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today 116 Citalopram (Celexa®) (http://thestudentpharmacist.com/wp-content/uploads/116_Citalopram.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Citalopram (available) * Brand: Celexa® * Mechanism of Action * Antidepressant * Selective Serotonin Re-uptake Inhibitor (SSRI) * Inhibits re-uptake of serotonin (5-HT) in the CNS (so it stays in the synapse longer) * Indication(s) * Major depressive disorder (MDD) * Dosage form(s) * Tablets * 10, 20, 40 mg * Oral solution * 10 mg/5 mL * Adult Dosing * Initiate at 20 mg/day * Titrate the dose slowly (no more than 20 mg per week) as needed to a maximum of 60 mg/day * That said, doses > 40 mg/day are usually not necessary * Note: Taper slowly when discontinuing (to avoid withdrawal syndrome) * Pharmacokinetics * Onset of action is usually seen within 1 week BUT * Full effect may not be seen for up to 3 months * Metabolized in the liver mainly by CYP3A4 and 2C19 * Has active, but less potent, metabolites * Excreted in the urine * Contraindication(s) * Hypersensitivity * Concurrent use or use within two week of MAO inhibitors * Concurrent use with Pimozide * Black Box Warning(s) * Antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with MDD and other psychiatric disorders * Observe patients for suicidal ideology especially during the 1st few months of therapy * Reason/mechanism: Antidepressants in general increase energy/appetite before they affect mood… giving the patient the energy needed for suicid * Precaution(s) * Can inhibit platelet aggregation = increased risk of bleeding (especially in patients taking NSAIDs or anticoagulants) * Serotonin Syndrome (symptoms below) can develop * Agitation or restlessness * Fast heart beat * Rapid changes in blood pressure * Hallucinations * Increased body temperature * Loss of coordination * Overactive reflexes * N/V/D * Use with caution in renal or hepatic impairment * With most SSRIs, withdrawal syndrome is possible upon abrupt discontinuation or dosage decrease * Some symptoms include irritability, dysphoria, confusion, headache and lethargy * Adverse Drug Reactions * Most common * GI upset * Xerostomia * Somnolence or insomnia * Diaphoresis * Sexual dysfunction can also occur (as impotence or ejaculation disorder) * Reversible upon discontinuation * MAJOR Drug Interactions * Look for drugs that interact with CYP3A4 or 2C19 * Use within 2 weeks or MAO-Inhibitors is contraindicated * Use with pimozide is contraindicated * Use with NSAIDs or other anticoagulants can increase the risk of bleeding * Alcohol can increase CNS depression * Pregnancy Category/Breast feeding * Category C * Use with caution in breastfeeding * Safety & Efficacy Monitoring * Side effect profile * Suicidal thoughts or ideation * Relief of symptoms * Anxiety * Social functioning * Panic attacks * Major Counseling Points * May take 3 months to see full effects of citalopram * Keep taking citalopram even if you feel better * Do not stop taking citalopram without talking with your doctor or pharmacist first * Avoid alcohol while on citalopram * Main side effects (GI upset, sleep disturbances, and dry mouth) * Sexual dysfunction can also occur, but is reversible upon discontinuation | 10/11/10 | Free | View In iTunes |
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115 Potassium Chloride (K-Dur®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 115 Potassium Chloride (K-Dur) (http://thestudentpharmacist.com/wp-content/uploads/115_KCl.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Potassium Chloride (Available) * Brands: * K-Dur * Klor-Con * Micro-K * Mechanism of Action * Maintain or replenish the bodies potassium levels * Potassium plays many roles in the body including: * Major cation of intracellular fluid * Essential for conduction of nerve impulses in the cardiac, skeletal, and smooth muscle as well as the brain * Maintenance of normal renal function, acid-base balance, carbohydrate metabolism, and gastric secretions * Indications * Hypokalemia (treatment and prevention) * Dosage form * Extended release caplets: 10 mEq * Extended release capsules: * 8, 10 mEq * Extended release tablets: * 8, 10 mEq * Powder for oral solutions: * 20, 25 mEq/packet * Oral solution * 20, 40 mEq/15 mL * Infusion formulations of varying concentrations * Adult Dosing * Normal daily requirements * 40-80 mEq/day * Hypokalemia (prevention) * 20-40 mEq/day * Hypokalemia (treatment) * 40-240 mEq day depending on severity * Doses > 25 mEq should be divided to decrease GI upset * Pharmacokinetics * Well absorbed from the GI tract * Excreted primarily in the urine, but also in the feces and through the skin * Contraindications * Hypersensitivity * Hyperkalemia * GI tract obstructions * Precautions * Hyperkalemia can occur * Sypmtoms include: * Muscle weakness or paralysis * Leg cramps * Cardiac conduction abnormalities (including heart block and arrhythmias) * Use with caution in patients with cardiovascular disease (due to possibility of cardiac conduction abnormalities) * Use with caution in renal impairment * Avoid use in severe impairment * Adverse Drug Reactions * Most common * Hyperkalemia * GI upset (abdominal pain, diarrhea, flatulence, n/v) * Taking each dose with plenty of fluid should decrease GI upset * MAJOR Drug Interactions * Potassium levels may be increased by: * ACE-I * ARBs * Potassium sparing diuretics * Pregnancy Category/Breast feeding * Category C * Compatible for breastfeeding * Safety & Efficacy Monitoring * Electrolytes (specifically potassium) * Blood glucose (especially in patients with diabetes) * pH * Urine output * Cardiac conduction * Major Counseling Points * Take each dose with a full glass of water * Avoid salt substitutes that contain potassium * Common side effects you may experience include GI upset * Let you doctor or pharmacist know if you have any severe or persistent side effects including: * Unexplained muscle weakness * Leg cramps * Irregular heat beat References: * Potassium chloride. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Oct 05]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Potassium chloride. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Potassium chloride. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Oct 05 ]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. | 10/5/10 | Free | View In iTunes |
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114 Namenda® (Memantine) – Top 200 Prescribed Drugs | Podcast: Play in new window (http://media.blubrry.com/top200/thestudentpharmacist.com/wp-content/uploads/113_Promethazine.mp3) | Download (http://media.blubrry.com/top200/thestudentpharmacist.com/wp-content/uploads/113_Promethazine.mp3) Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 114 Namenda® (memantine) (http://thestudentpharmacist.com/wp-content/uploads/114_Namenda.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Memantine (NOT available) * Brand: Namenda® * Mechanism of Action * N-methyl-D-aspartate (NMDA) receptor antagonist * Blocks over stimulation of NMDA receptors by glutamate in the CNS, which has been hypothesized to contribute to Alzheimer's disease * Indications * Moderate-to-severe alzheimer's disease * Dosage form * Tablets * 5, 10 mg * Oral solution * 2 mg/mL * Adult Dosing * Initiate at 5 mg/day * Titrate the dose, as tolerated, by 5 mg each week to the target dose of 20 mg/day * Doses > 5 mg/day should be divided * Pharmacokinetics * Excreted in the urine (up to 82% as unchanged drug) * Contraindications * Hypersensitivity * Precautions * Use with caution in patients with severe hepatic or renal impairment * Use with caution in patients with a history of seizures * Adverse Drug Reactions * Most common * Dizziness * Headache * Confusion * GI upset * Increases in blood pressure * MAJOR Drug Interactions * Memantine levels may be increased by drugs that increase the pH of urine: * Carbonic anhydrase inhibitors * Sodium bicarbonate * Trimethoprim * Pregnancy Category/Breast feeding * Category B * Use with caution in breast feeding * Safety & Efficacy Monitoring * Intolerable side effects (as with any all medications) * Major Counseling Points * Each dose can be taken with or without food * Common side effects you may experience include dizziness, headache and GI upset * Let your doctor or pharmacist know if you experience any severe, intolerable, or persistent side effects | 10/1/10 | Free | View In iTunes |
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113 Promethazine (Phenergan®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 113 Promethazine (http://thestudentpharmacist.com/wp-content/uploads/113_Promethazine.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Promethazine (available) * Brands * Phenergan® * Phenadoz® * Promethegan™ * Mechanism of Action * 1st generation antihistamine * Overall effects include * Sedation * Antimotion-sickness * Antiemetic * Anticholinergic * Indications * Antiemetic * Sedative * Motion sickness * Various allergic conditions * Dosage form * Injection solution * 25 and 50 mg/mL * Rectal suppository * 12.5 and 25 mg * Oral Syrup * 6.25 mg/5 mL * Tablets * 12.5, 25, and 50 mg * Adult Dosing * Dose ranges from 12.5-75 mg depending on the indication * Antiemetic * 12.5-25 mg every 4-6 hours as needed * Motion sickness * 25 mg every 12 hours as needed * First dose should be taken 30-60 minutes before departure * Sedation * 12.5-50 mg/dose * Pharmacokinetics * Onset of action (oral): ~20 minutes * Duration: ~4-6 hours * Metabolized in the liver primarily by oxidation * Excreted in the urine and feces * Black Box Warning(s) * Promethazine is contraindicated in children 2 years old * Promethazine injection can cause severe irritation and tissue damage regardless of administration route * Contraindications * Hypersensitivity * Coma * Treatment of lower respiratory tract symptoms (including asthma) * Children < 2 years old (Black Box Warning) * Intra-arterial or subcutaneous administration * Precautions * Promethazine may alter cardiac conduction * Extrapyramidal symptoms may occur (pseudoparkinsonism, dystonic reactions, akathisia, tardive dyskinesia) * Promethazine may cause anticholinergic effects (constipation, xerostomia, blurred vision, urinary retention) * Photosensitivity can also occur * Adverse Drug Reactions * Most common * Sedation * Xerostomia * Dizziness * Blurred vision * GI upset * MAJOR Drug Interactions * Anticholinergics can decrease the effect of promethazine * Other CNS depressants (including alcohol) can have additive effects * Pregnancy Category/Breast feeding * Category C * Not recommended in breastfeeding * Safety Monitoring * Mental status * Signs and symptoms of tissue injury (with IV administration) * Efficacy Monitoring * Relief of symptoms * Major Counseling Points * If taking for motion sickness, the first dose should be taken 30 minutes to an hour before departure * Some common side effects you may experience include drowsiness, dizziness, dry mouth, and GI upset * If GI upset is an issue, then taking each dose with food should help * Report any severe or persistent side effects to your doctor or pharmacist References: * Promethazine. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Sep 28]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Phenergan®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Promethazine. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Sep 28]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Statin dose comparison. | 9/29/10 | Free | View In iTunes |
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112 Carisoprodol (Soma®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 112 Carisoprodol (Soma®) (http://thestudentpharmacist.com/wp-content/uploads/112_Carisoprodol.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Carisoprodol (available) * Brand: Soma® * Mechanism of Action * Centrally acting skeletal muscle relaxant * Exact mechanism is unknown * Carisoprodol is metabolized to meprobamate, which has sedative and anxiolytic effects * Indications * Acute musculoskeletal pain * Recommended to be used for short periods (2-3 weeks) * Dosage form * Tablets: 350 mg * Adult Dosing * 350 mg, 3 times a day and at bedtime * Pharmacokinetics * Onset of action: ~30 minutes * Duration of action: ~4-6 hours * Metabolized in the liver by CYP2C19 to meprobamate (anxiolytic and sedative effects) * Excreted in the urine * Contraindications * Hypersensitivity * Acute intermittent porphyria (rare hereditary disorder in which the heme portion of hemoglobin is not made properly) * Precautions * CNS depression can occur, which can lead to impairment of mental and physical abilities * Drug abuse is of concern * Tolerance and dependence can occur with long term use * Avoid abrupt discontinuation after prolonged use * Carisoprodol should be used with caution in patients with a history of drug or alcohol abuse * Use with caution in the elderly * Elderly may have decreased tolerance to carisoprodol due to anticholinergic effects (such as sedation and weakness) * Carpisoprodol is considered "high severity risk" in the elderly on the Beers list * Use with caution in patients with either renal or hepatic impairment * Adverse Drug Reactions * Most common * Drowsiness * Dizziness * Headache * GI upset * MAJOR Drug Interactions * Carisoprodol may have additive effects with other CNS depressants (including alcohol) * Pregnancy Category/Breast feeding * Category C * Use with caution in breastfeeding * Safety Monitoring * CNS effects * Mental status (CNS depression) * Drowsiness * Signs of dependence or abuse * Efficacy Monitoring * Relief of muscle pain or muscle spams * Major Counseling Points * Carisoprodol can cause drowsiness and dizziness * Use caution performing tasks that require mental alertness, especially with initial therapy * Also want to avoid alcohol, which can add to the drowsiness caused by carisoprodol * Other side effects you may experience include headache and GI upset * Take each with food if GI upset is an issue * Report any severe or persistent side effects to your doctor or pharmacist References: * Carisoprodol. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Sep 28]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Carisoprodol. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Carisoprodol. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Sep 28]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 9/28/10 | Free | View In iTunes |
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111 Diazepam (Valium®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (http://thestudentpharmacist.com/www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 111 Diazepam (Valium®) (http://thestudentpharmacist.com/wp-content/uploads/111_Diazepam.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Diazepam (available) * Brands * Valium® * Diastat® * Mechanism of Action * Benzodiazepine (C-IV) * Binds benzodiazepine receptors in the CNS, increasing the effect of GABA * GABA is an inhibitory neurotransmitter and works by hyperpolarizing neuronal cells which makes them less excitable * Indications * Anxiety * Pre-operative sedation * Alcohol withdrawal * Muscle spasms * Seizure disorders * Status epilepticus * Dosage forms (generic) * Tablets * 2, 5, 10 mg * Oral solution * 1 mg/mL * Injection solution * 5 mg/mL * Rectal gel * 20 mg/4 mL * Adult Dosing * Anxiety, muscle spasms, or seizure disorders * 2-10 mg 2-4 times/day (depends on patient response) * Pre-operative sedation * 10 mg intramuscularly (IM) * Alcohol withdrawal * 10 mg 3-4 times/day for the first day * Then decrease the dose as necessary * Status epilepticus * 5-10 mg IV every 5-10 minutes as needed up to a maximum total of 30 mg * Lorazepam has a longer duration of action and may be preferred * Notes about dosing * Avoid abrupt discontinuation with long term therapy due to the possibility of withdrawal symptoms * Pharmacokinetics * Metabolized in the liver, including metabolism by CYP2C19 and 3A4 * Excreted in the urine * Contraindications * Hypersensitivity * Severe hepatic impairment * Myasthenia gravis * Narrow angle glaucoma * Severe respiratory insufficiency * Sleep apnea * Precautions * CNS depression is a big concern * Can impair physical and mental abilities * Due to CNS depression * Use caution in patients with major depressive disorder or respiratory disease (respiratory depression can occur) * Also, because of CNS depression that can occur, use with caution in elderly patients and patients at increased risk of falling * Use caution in patients with history or potential for drug or alcohol abuse * Use caution in renal and hepatic impairment * Adverse Drug Reactions * Most common * Drowsiness * Ataxia * Fatigue * MAJOR Drug Interactions * Use with other CNS depressants and alcohol can have additive effects * Pregnancy Category/Breast feeding * Category D * Not recommended in breastfeeding * Safety Monitoring * Signs of respiratory or CNS depression * Tolerance and dependence * Both can occur with longterm use * Renal and hepatic function with long term use * Efficacy Monitoring * Depends on the indication * Relief of symptoms * Major Counseling Points * Avoid alcohol while taking diazepam * Diazepam can be habit forming and you shouldn't exceed the recommended dose * Don't stop taking diazepam without talking with your doctor or pharmacist first, especially with long term therapy due to possible withdrawal symptoms * Some side effects you may experience include drowsiness, loss of coordination, and fatigue * Use caution performing tasks that require mental alertness while on diazepam * Especially with initial therapy * Report any persistent or severe side effects References: * Diazepam. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Sep 27]. [about 8 p.]. Available from http://online.lexi. | 9/27/10 | Free | View In iTunes |
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110 Actonel® (Risedronate) – Top 200 Prescribed Drus | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 | 9/23/10 | Free | View In iTunes |
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109 Clonidine (Catapres®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 109 Clonidine (Catapres®) (http://thestudentpharmacist.com/wp-content/uploads/109_Clonidine.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Clonidine (available) * Brands * Catapres® * Duraclon® * Injectable solution for epidural anesthesia * Will not be focused on here * Mechanism of Action * Alpha-2 agonist (postsynaptic) * Works in the brainstem to reduce sympathetic outflow * Overall effects * Decreased peripheral resistance * Decreased renal vascular resistance * Decreased heart rate * Decreased blood pressure * Indications * Hypertension * Unlabeled * Often used in opioid detox programs to reduce withdrawal symptoms * That said, there are some people who are abusing clonidine for its sedative effects, to decrease withdrawal symptoms when they can't afford street drugs, or to increase the effects of opioids, benzodiazepines, or cocaine * This can lead to very low blood pressures (with high dose) as well as very high blood pressures (when clonidine is stopped) * Watch for patients who are always wanting early refills, especially if they are prone to substance abuse * Dosage forms * Tablets * 0.1, 0.2, 0.3 mg * Transdermal (once weekly) patch * 0.1 mg/24 hours * 0.2 mg/24 hours * 0.3 mg/24 hours * Adult Dosing * Hypertension * Tablets * Initiate at 0.1 mg twice daily * Increase slowly as needed * Usual dose range: 0.1-0.8 mg/day * Max; 2.4 mg/day * Patch (in general, only used in patients who are unable to take the oral tablets) * Initiate at 0.1 mg * Increase slowly as needed * Usual dose range: 0.1-0.3 mg * Pharmacokinetics * Onset of action * Tablet: ~1 hour * Patch: 2-3 days * Duration of action (table): 6-10 hours * Metabolized in the liver * Excreted mainly in the urine * Black Box Warning(s) * No black box warnings for clonidine when it is being used as an anti-hypertensive * Contraindications * Hypersensitivity * Precautions * Abrupt withdrawal of clonidine can cause rapid increases in blood pressure * Discontinuation should be done gradually over about 1 week * If a patient is also on a beta-blocker, the beta blocker should be discontinued gradually several days before discontinuation of clonidine * Clonidine can cause CNS depression * Use with caution in patients with mental depression or any other CNS depression * Clonidine should be used with caution in patients with coronary insufficiency, recent myocardial infarct (MI), or cerebrovascular disease * Clonidine should also be used with caution in patients with chronic renal failure * Adverse Drug Reactions * Xerostomia (most common) * Dowsiness * Dizziness * Headache * Edema * Constipation * Impotence can also occur (will resolve once clonidine is discontinued) * MAJOR Drug Interactions * Clonidine's effects may be increased by: * Other antihypertensives * MAO-Inhibitors * Phosphodiesterase 5 Inhibitors * Clonidine's effects may be decreased by: * Tricyclic antidepressants * Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) * Pregnancy Category/Breast feeding * Category C * Not recommended in breastfeeding * Safety & Efficacy Monitoring * Serum creatinine at baseline * Heart rate * Mental status * Blood pressure * Major Counseling Points * Do not stop taking clonidine without talking with your doctor or pharmacist first | 9/22/10 | Free | View In iTunes |
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108 Cyclobenzaprine (Flexeril®) – Top 200 Prescribed Drugs | Today’s episode was sponsored by Lexi-Comp. To access the same great drug information that was used in today’s podcast or for a chance to win an iPod touch and free Lexi-Comp software, please visit www.lexi.com/top200 (www.lexi.com/top200). And, as a special offer to all top200 listeners, use promotion code TOP200 to save 20% on your software purchase today! 108 Cyclobenzaprine (http://thestudentpharmacist.com/wp-content/uploads/108_Cyclobenzaprine.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Cyclobenzaprine (available in tablet form) * Brand(s) * Amrix® * Flexmid® * Flexeril® * Mechanism of Action * Centrally-acting muscle relaxant * Pharmacologically related to tricyclic antidepressants (TCAs) * Most likely works at the brain stem * Reduces tonic somatic motor activity influencing both alpha and gamma motor-neurons * Indications * Muscle spasms * Musculoskeletal pain * Dosage forms * Tablets (generic available) * 5, 10 mg * Extended release capsules (brand only: Amrix®) * 15, 30 mg * Adult Dosing * Immediate release tablets * Initiate at 5 mg three times/day * Can be increased to 10 mg three times/day if needed * Extended release capsules * Initiate at 15 mg/day * Can be increased to 30 mg/day if needed * Note: Recommended to not use cyclobenzaprine > 2-3 weeks * Pharmacokinetics * Metabolized in the liver by CYP3A4, 1A2, and 2D6 * Half-life * Immediate release: ~18 hours * Extended release: ~32 hours * Excreted in the urine, as inactive metabolites, and feces, as unchanged drug * Contraindications (most have to do with the cardiovascular system) * Hypersensitivity * Use within 14 days of MAO-Inhibitors * Hyperthyroidism * Heart failure * Arrhythmias * Heart block (or conduction disturbances) * Use within the acute recovery phase of an MI (myocardial infarct) * Precautions * Cyclobenzaprine can have anticholinergic effects (such as vision disturbances, dry mouth, urinary retention, and constipation) * Use with caution in patients with angle closure glaucoma or any other issues that could be exacerbated by anticholinergic effects * CNS depression can occur with cyclobenzaprine therapy * Impair mental and physical abilities * Since cyclobenzaprine is related to tricyclic antidpressants, it has similar toxic potentials, such as * Conduction time prolongation * Arrhythmias * Tachycardia * Use with caution in patients with hepatic impairment * Avoid using the extended release capsules and decrease the initial dose of the immediate release tablets to 5 mg in MILD impairment * Avoid use all-together in moderate-severe impairment * Extended release capsules are not recommended for use in the elderly (due to poor tolerance) * Adverse Drug Reactions * Most common * Drowsiness * Dizziness * Xerostomia * MAJOR Drug Interactions * Use is contraindicated within 14 days of MAO-Inhibitors * Cyclobenzaprine can have additive effects when used with * Other CNS depressants * Including alcohol * Anticholinergics * Pregnancy Category/Breast feeding * Pregnancy category B * Use with caution in breastfeeding * Safety and Efficacy Monitoring * Relief of symptoms * Monitor for any severe or intolerable side effects * Major Counseling Points * Cyclobenzaprine can impair physical and mental abilities * Use caution performing tasks requiring mental alertness, especially during initial therapy * Avoid alcohol while taking flexeril * Can have additive effects * Some common side effects include drowsiness, dizziness, and dry mouth * Let you doctor or pharmacist know if you experience any severe or persistent side effects References: * Cyclobenzaprine. | 9/20/10 | Free | View In iTunes |
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107 Methylprednisolone (Medrol®) – Top 200 Prescribed Drugs | 107 Methylprednisolone (http://thestudentpharmacist.com/wp-content/uploads/107_Methylprednisolone.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Methylprednisolone (available) * Brand: Medrol® * Mechanism of Action * Corticosteroid * Has glucocorticoid and mineralocorticoid effects * Effects include: * Immunosuppression * Anti-allergy * Anti-inflammatory * Indications * Mainly used for immunosuppression or anti-inflammatory properties for diseases that are: * Autoimmune * Neoplastic * Hematologic * Allergic * Inflammatory * Dosage forms * Injection powder for reconstitution * 40, 125, 500, and 1000 mg * Injection suspension * 40 and 80 mg/mL * Tablets * 4, 8, 16, 32 mg * Adult Dosing * Dose varies depending on indication, severity, route, and patient response * Oral dosing for anti-inflammatory or immunosuppression * 2-60 mg/day (depending on patient response) * Use lowest possible dose * Oral dosing for allergic conditions * Initiate at 24 mg/day in 4 divided doses * Taper the dose 4 mg/day over one week * Pharmacokinetics (for oral dosage form) * Onset of action: 1-2 hours * Duration: 30-36 hours * Contraindications * Hypersensitivity * Systemic fungal infection * Live vaccines within 3 months * Precautions * Adrenal suppression or suppression of the hypothalamic-pituitary (HPA) axis * Dose and duration dependent * Corticosteroids should be tapered slowly when discontinuing if they where given for an extended period of time * Depends on what resource you use but, in general, corticosteroids do not need to be tapered if used for less than 2-3 weeks UNLESS abrupt discontinuation may cause a flare (as in poison ivy) or if the patient is very ill * Prolonged use can also cause immunosuppression, which can increase the risk of infection * Corticosteroids can cause HYPERglycemia, especially in patients with diabetes * Use with caution in patients with heart failure, due to possible fluid retention and hypertension associated with corticosteroids * Use with caution in patients with increased risk of osteoporosis, especially with prolonged use * Corticosteroids interfere with calcium absorption * Use with caution in hepatic impairment * Dose may need to be adjusted * Adverse Drug Reactions * Most common * Headache * GI upset * Sodium and fluid retention * Insomnia * MAJOR Drug Interactions * Live vaccines are contraindicated within 3 months of corticosteroid discontinuation * Barbiturates and rifampin may increase the metabolism of methylprednisolone * Estrogens may decrease its metabolism * Ketoconazole may increase its effects * Pregnancy Category/Breast feeding * Category C * Use with caution in breastfeeding * Safety Monitoring * Blood pressure * Blood glucose * Electrolytes * Efficacy Monitoring * Depends on the indication * Relief of symptoms * Major Counseling Points * Do not stop taking methylprednisolone without talking with your doctor or pharmacist first * Common side effects include headache, GI upset, and sleep disturbances * Take each dose with food if GI upset is an issue * Report any severe or persistent side effects to your doctor or pharmacist References: * Methylprednisolone. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Sep 16]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Medrol®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Methylprednisolone. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Sep 16]. [About 12 p.]. Available from: https://online. | 9/16/10 | Free | View In iTunes |
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106 Triamterene & Hydrochlorothiazide (Dyazide® / Maxzide™) – Top 200 Prescribed Drugs | 106 Triamterene and Hydrochlorothiazide (http://thestudentpharmacist.com/wp-content/uploads/106_Triamterene_HCTZ.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Combination of triamterene and hydrochlorothiazide (HCTZ) (available) * Brand * Dyazide® * Maxzide™ * Mechanism of Action * Triamterene * Potassium sparing diuretic * Inhibits sodium reabsorption in exchange for potassium at the distal renal tubule * Hydrochlorothiazide * Thiazide diuretic * Inhibits sodium and chloride reabsorption at the distal renal tubule * Indications * Hypertension * Edema * Note: Mainly used when hypokalemia is an issue (with hydrochlorothiazide alone) or when hypokalemia must be avoided * Dosage forms (generic) * Capsules (triamterene mg / hydrochlorothiazide mg) * 37.5/25, 50/25 mg * Tablets (triamterene mg / hydrochlorothiazide mg) * 37.5/25, 75/50 mg * Adult Dosing * Dose varies depending on patient response * Max dose of triamterene: 75 mg/day * Max dose of HCTZ: 50 mg/day * For hypertension, generally, doses > 25 mg/day should be avoided * Higher doses usually increase side effects and have no added therapeutic benefit * Pharmacokinetics * Half-life: 6-15 hours * Excreted as unchanged drug in the urine * Contraindications * Hypersensitivity * Including hypersensitivity to sulfonamides * Hyperkalemia * Anuria * Significant renal impairment * Black Box Warning(s) * Hyperkalemia (can be fatal if uncontrolled) * Risk is increased with renal impairment, diabetes, elderly patients, and patients who are severely ill * Serum potassium should be monitored at initiation of therapy, changes in dose, or in the case of severe illness or renal impairment * Precautions * Photosensitivity can develop * Hydrochlorothiazide can potentially precipitate or exacerbated gout in susceptible patients (history/family history, chronic renal failure) * Hydrochlorothiazide can potentially cause or worsen hypercalcemia as well as hypercholesterolemia * Use with caution in patients with hepatic impairment or kidney stones * Adverse Drug Reactions * Most common * Electrolyte disturbances * Fatigue * Muscle cramps * GI upset * Tachycardia * Hypotension * MAJOR Drug Interactions * Avoid use with the following drugs or drugs classes * Other potassium sparing or thiazide diuretics * Potassium supplements * Dofetilide * Pregnancy Category/Breast feeding * Category C * Not recommended in breastfeeding * Safety Monitoring * Serum electrolytes * Specifically potassium * Renal function * BUN * Serum creatinine * Liver function tests * Efficacy Monitoring * Blood pressure * Major Counseling Points * Take each dose in the morning (because of increased diuresis) * Avoid excess exposure to sunlight (photosensitivity can develop) * Hypotension can occur, so go from sitting or laying to standing slowly (especially with initial therapy) * Some side effects you may experience include fatigue, muscle cramps, and GI upset * Taking each dose with food should help if GI upset is an issue * Let you doctor or pharmacist know if you experience any severe or persistent side effects References: * Hydrochlorothiazide and Triamterene. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Sep 16]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Maxzide™. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Hydrochlorothiazide and Triamterene. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Sep 16]. [About 6 p.]. Available from: https://online.epocrates. | 9/16/10 | Free | View In iTunes |
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105 Pravastatin (Pravachol®) – Top 200 Prescribed Drugs | 105 Pravastatin (http://thestudentpharmacist.com/wp-content/uploads/105_Pravastatin.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Pravstatin (available) * Brand: Pravachol® * Mechanism of Action * Statin * Inhibit HMG-CoA reductase, which is involved in the rate limiting step of the synthesis of cholesterol * Decreases the amount of cholesterol the body can produce which results in an increase LDL receptors on hepatocytes and LDL clearance and catabolism * Indications * Hyperlipidemia * Cardiovascular event risk redutcion * Dosage form * Tablets * 10, 20, 40, 80 mg * Adult Dosing * Initiate at 40 mg/day in most patients * Dose can be increased at 4 week intervals to a maximum of 80 mg/day if needed * In general, pravastatin can decrease LDL 22-37%, depending on the dose * Note: * In general, statins are more effective if taken at night. However, pravastatin [along with rosuvastatin (Crestor®) and atorvastatin (Lipitor®)] can be taken at any time throughout the day * Pharmacokinetics * Peak effect: ~4 weeks * Metabolized in the liver and does have an active metabolite * 3a-hydroxy-iso-pravastatin (up to 10% activity of the parent drug) * Does NOT interact with any CYP enzymes * Contraindications * Hypersensitivity * Active liver disease * Unexplained increases in liver function tests (LFTs) * Pregnancy * Breastfeeding * Precautions * Myopathy (muscle paint)/rhabdomyolysis (muscle breakdown) * Dose related risk * Make sure patient is on lowest effective dose * Risk is increased with concurrent use of other lipid lowering medications (such as fibric acid derivatives or niacin) * Use with caution in the elderly (they are at increased risk of developing myopathy * Tell patient to report any unexplained muscle pain, tenderness or weakness, or brown urine * Hepatic impairment * Since statins can cause liver dysfunction, use with caution in patients who have a history of liver impairment or who consume large amounts of alcohol * Tell patients to avoid excess alcohol * Adverse Drug Reactions * Most common * Headache * Fatigue * Rash * GI upset * MAJOR Drug Interactions * Since pravastatin (as well as pitavastatin) does not interact with any CYP enzymes, it potentially has less drug interactions as compared to the other statins * That being said, pravastatin may increase the effects of daptomycin or vitamin K antagonists (such as warfarin) * Pregnancy Category/Breast feeding * Contraindicated in both pregnancy and breastfeeding * Category X * Safety Monitoring * At baseline (or upon change in dose): * Creatine Phosphokinase and muscle symptoms * Liver function tests (LFTs) * LFTs again at 12 weeks then semiannually * If LFTs increase > 3 x upper limit of normal (ULN), discontinue pravastatin * Can reinitiate the same pravastatin or a different statin once LFTs return to normal * Evaluate/ask about muscle symptoms at every visit * If patient complaints of abnormal muscle pain or weakness, then recheck Creatine Phosphokinase (dc if muscle pain is severe or CPK increases > 10 x ULN) * Can start a different statin once muscle pain subsides and CPK levels return to normal * Efficacy Monitoring * Fasting lipid panel at baseline * Followup in 8 weeks * Every 3 months once stable... can increase to Q6 months * Major Counseling Points * Pravastatin is meant to work along with diet and exercise (not a replacement) * Avoid excess alcohol * Recommended daily limits = 2/day for men and 1/day for women * Common side effects include headache, fatigue, and GI upset * Report any abnormal muscle pain, cramping, or weakness or brown urine (rhabdomyolysis) * Report yellowing of the skin or eyes (liver damage) * As always, | 9/14/10 | Free | View In iTunes |
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104 Benicar® (Olmesartan) – Top 200 Prescribed Drugs | Note: 103 Levoxyl, was previously covered. See 004 Levothyroxine Sodium (http://thestudentpharmacist.com/?p=55) 104 Benicar® (olmesartan) (http://thestudentpharmacist.com/wp-content/uploads/104_Benicar.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Olmesartan (not available) * Brand: Benicar * Mechanism of Action * Angiotensin II receptor blocker (ARB) * Blocks angiotensin II from binding AT1 receptors, which inhibits the vasoconstriction or aldosterone release normally caused by angtiotensin II * This results in a decrease in BP, a decrease in the reabsorption of Na and water, and vasodilation of the efferent arteriole of the kidneys, which is considered renal protective * Also prevents ventricular remodeling and cardiac hypertrophy * Indications * Hypertension * Dosage forms * Tablet (as olmesartan medoxomil * 5, 20, 40 mg * Adult Dosing * Typical starting dose: 20 mg/day * In general, the dose can be increased after 2 weeks of therapy * Max dose: 40 mg/day * Consider starting with a lower initial dose for patients who are volume depleted * Pharmacokinetics * The actual dosage form, olmesartan medoxomil, is a prodrug and is hydrolyzed in the GI tract to its active form, olmesartan * Olmesartan does not undergo any other metabolism * Excreted as unchanged drug in the feces and urine * Black Box Warning (same for all ACE-Is and ARBs) * Pregnancy * Drugs affecting the angiotensin system have been shown to cause injury or death to the fetus in the 2nd and 3rd trimesters * Contraindications * Hypersensitivity * Pregnancy * Precautions * Use with caution if any of the following are present * Renal artery stenosis or any other renal impairment * Hepatic impairment * Volume depletion * Hyponatremia * Benicar® could potentially cause the following: * Hyperkalemia * Increased risk with renal dysfunction, diabetes, or use with other drugs that can increase potassium (such as ACE-Is, potassium sparing diuretics or potassium supplements) * Renal dysfunction * Monitor serum creatinine and discontinue use if SrCr increases more than 35% over baseline * Adverse Drug Reactions * Most common * Dizziness * Headache * Hyperglycemia * Hypertriglyceridemia * Diarrhea * Hematuria * Flu-like symptoms * MAJOR Drug Interactions * NSAIDs may decrease effects and increase the risk of renal dysfunction * Cause vasoconstriction of the afferent arteriole of the kidneys, which when combined with the vasodilation of the efferent arteriole caused by ARBs, can greatly decrease renal pressure * Potassium sparing diuretics or potassium supplements * Monitor serum potassium * Pregnancy Category/Breast feeding * Again, Benicar® has a black box warning for pregnancy... * 1st trimester: Category C * 2nd/3rd trimesters: Category D * Not recommended in breastfeeding * Safety Monitoring * Serum Potassium * Renal function * BUN and SrCr * If SrCr increases > 35% over baseline, then temporarily discontinue Benicar® at least until renal function is back to normal * Monitor at baseline then 4 weeks after initiation * Efficacy Monitoring * Blood pressure * Major Counseling Points * Let your doctor or pharmacist know if you become or plan to become pregnant * Go over main side effects (most common = HA and dizziness) * Can cause hypotension * Careful at first going from sitting or lying to standing (do so slowly) * Avoid salt substitutes that contain potassium * Avoid excess alcohol * Keep taking Benicar® even if you feel better * Benicar® is not a replacement for diet and exercise as these are still very important in controlling your HTN * Side Notes * African Americans, in general, have low renin and, as a result, | 9/12/10 | Free | View In iTunes |
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102 Fexofenadine (Allegra®) – Top 200 Prescribed Drugs | 102 Fexofenadine (http://thestudentpharmacist.com/wp-content/uploads/102_Fexofenadine.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Fexofenadine (available in tablet form) * Brand: Allegra® * Mechanism of Action * Second generation antihistamine * Histamine H1 receptor antagonist in the periphery * Second generation antihistamines have less sedation than first generation antihistamines, and fexofenadine appears to have the least sedation overall * Indications * Allergic rhinitis * Chronic idiopathic urticaria * Daily (or almost daily) wheals and itching for 6 weeks or longer with no known cause * Dosage forms * Tablet (generic available): * 30, 60, 180 mg * Brand only (Allegra®) * Orally disintegrating tablet (Allegra ODT®) * 30 mg * Oral suspension * 6 mg/mL * Adult Dosing * Allergic rhinitis or Chronic idiopathic urticaria * 60 mg twice a day OR 180 mg once a day * Note: In renal impairment with a CrCl < 80 mL/min, initiate fexofenadine at 60 mg/day * Pharmacokinetics * Onset of action: ~1 hour * Duration of action: ~12 hours * Minimal metabolism * Excreted mainly in the feces but also in the urine as unchanged drug * Contraindications * Hypersensitivity * Precautions * Renal impairment * Decrease the initial dose to 60 mg/day if CrCl < 80 mL/min * Orally disintegrating tablets contain phenylalanine * Adverse Drug Reactions * Side effects are rare and similar to those seen with placebo, but the most common include: * Headache * Drowsiness * Throat irritation * Note: Nausea and vomiting is seen more commonly in children 6 months to 5 years of age * MAJOR Drug Interactions * Fexofenadine may increase the effects of: * Alcohol * Anticholinergics * CNS depressants * The effects of fexofenadine may be increased by: * Erythromycin * Itraconazole * Ketoconazole * Verapamil * Pregnancy Category/Breast feeding * Pregnancy category C * Rated "compatible" in breastfeeding by the American Academy of Pediactrics * Safety and Efficacy Monitoring * Mainly just looking at relief of symptoms * May check serum creatinine if needed/indicated * Major Counseling Points * Do not take any sooner than every 12 hours * Side effects are mild, but you may experience headache or a little drowsiness * Report any severe or persistent side effects References: * Fexofenadine. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Aug 10]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Allegra. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Fexofenadine. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Aug 10]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 9/10/10 | Free | View In iTunes |
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099 Digoxin (Lanoxin®) – Top 200 Prescribed Drugs | 099 Digoxin (http://thestudentpharmacist.com/wp-content/uploads/099_Digoxin.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Digoxin (available) * Brand: Lanoxin * Mechanism of Action * Inhibits sodium/potassium ATPase * This increases the intracellular sodium concentration, which leads to an increase in intracellular calcium * Effects: * Increase in the force and velocity of systolic contractions * Decreased heart rate * Decreased conduction velocity through the AV node * Indications * Heart failure * Atrial Fibrillation * Digoxin is considered "rate control" for atrial fibrillation * Dosage forms * Injection solution * 250 mcg/mL * Oral solution * 50 mcg/mL * Tablet * 125, 250 mcg * Adult Dosing * Doses can be individualized based on indication and severity as well as the age and weight of the patient * That being said, typical doses are as follows: * Acute atrial fibrillation * 0.25 mg every 2 hours * Max: 1.5 mg within a 24 hour period * Nonacute atrial fibrillation * 0.5 mg once a day initially for 2 days * Followed by a maintenance dose of 0.125-0.375 mg/day * Heart failure * 0.125-0.25 mg once a day * Max: 0.5 mg/day * Pharmacokinetics * Looking at heart rate control: * Onset of action * Oral dose: 1-2 hours * I.V.: Up to 1 hour * Peak effect * Oral: anywhere from 2-8 hours * I.V.: up to 6 hours * Duration of action: * 3-4 days * HYPOkalemia can lead to increased digoxin delivered to the heart and muscles * HYPERkalemia (or HYPOnatremia) can lead to decreased digoxin delivered to the heart and muscles * Digoxin is metabolized either by sugar hydrolysis in the stomach or lactone ring reduction by intestinal bacteria * Digoxin is also a minor substrate for CYP3A4 * Contraindications * Hypersensitivity * Ventricular fibrillation * Precautions * Many Precautions... Some that stand out include: * Digoxin can have proarrhythmic effects (could be due to digoxin toxicity) * Use in Wolff-Parkinson White syndrome or other accessory pathway or bypass tracts, can lead to ventricular fibrillation and should be avoided * Use can increase the risk of myocardial infarction (MI), especially within 6 months of a previous MI * Hypothyroidism can lead to increased digoxin levels while hyperthyroidism may lead to decreased digoxin levels * Adverse Drug Reactions * Most common * GI upset * Anorexia * Blurred vision * Headache * Bradycardia * MAJOR Drug Interactions * Avoid rapid IV administration of Calcium to patients on digoxin * The combination could lead to severe arrhythmias * The digoxin dose should be decreased by half upon initiation of the following drugs: * Amiodarone * Propafenone * Quinidine * Verapamil * Pregnancy Category/Breast feeding * Category C * Rated "compatible" in breastfeeding by the American Academy of Pediactrics * Safety & Efficacy Monitoring * Monitor heart rate and rhythm * Serum creatinine * Serum digoxin levels (should be checked right before the next dose... so monitoring trough levels): * Therapeutic levels * Heart failure: 0.5-0.8 ng/mL * Atrial Fibrillation: 0.8-2 ng/mL * Toxic levels : > 2 ng/mL * Major Counseling Points * Do not stop taking digoxin without talking with your doctor or pharmacist first * Check your pulse at the same time each day and let your doctor know of any changes * Maintain adequate potassium intake * Common side effects you may experience include: GI upset, headache, and decreased heart rate * Let your doctor or pharmacist know if you experience any swelling, palpitations, persistent diarrhea, visual disturbances or any other severe or persistent side effects References: | 9/7/10 | Free | View In iTunes |
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097 Concerta® (Methylphenidate) – Top 200 Prescribed Drugs | 097 Concerta® (http://thestudentpharmacist.com/wp-content/uploads/097_Concerta.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Methylphenidate * Generic IS available as Methylphenidate HCl * Immediate Release (IR) and Extended Release (ER) tablets * Brand: Concerta®Other brand names with same active ingredient include: * Daytrana * Metadate CD and ER * Methylin (regular and ER) * Ritalin (regular, LA, and SR) * Mechanism of Action * CNS stimulant * Blocks reuptake of NE and DA in the synaptic space in cerebral cortex (so they stay around longer in synapse between neurons) * Indications * ADHD * Narcoleptic symptoms * Available doses/dosage forms * Extended Release tablet with bi-modal release (IR mg/ER mg) * Concerta® 18mg (4mg/14mg), 27mg (6mg/16mg), 36mg (8mg/28mg), and 54mg (12mg/42mg) * Tablet * Methylphenidate IR * 5, 10, 20mg * Methylphenidate ER * 20mg * Methylphenidate is also available (as other brand names) in the following dosage forms: * ER capsule with bi-modal release * Patch * Oral solution * Chewable tablet * ER tablet * SR tablet * Adult Dosing (18-65yo) * ADHD (for Concerta, specifically) * Initiate at 18-36mg/day every morning * Max: 72 mg/day * Switching from methylphenidate to Concerta * Currently taking: Switch to: Methylphenidate 5mg BID-TID Concerta 18mg daily every morning Methylphenidate 10mg BID-TID Concerta 36mg daily every morning Methylphenidate 15mg BID-TID Concerta 54mg daily every morning Methylphenidate 20mg BID-TID Concerta 72mg daily every morning * Narcolepsy (for methylphenidate HCl) * Start at 10mg BID-TID; can increase up to 60mg/day * Pharmacokinetics * Onset (for IR methylphenidate tablets and Concerta): 1-2 hours * Duration: * IR methylphenidate: 3-6 hours * Concerta: ~12 hours * Time to peak (Concerta): 6-8 hours * Black Box Warnings * Drug abuse or dependency * Do not abruptly DC in pts who have been on this medication for prolonged period of time * Be cautious when considering giving to pts with a history of alcohol or drug abuse * Contraindications * Hypersensitivity * Idiosyncratic reactions to sympathomimetic amines * Significant anxiety, tension, or agitation * Glaucoma * Use w/in 14 days of MAO-Inhibitors * Family history of Tourette's or tics * Diagnosis of Tourette's or tics * Pts 65yo * Cardiac problems which include: * Structural problems * Cardiomyopathy * CVD or CAD * Arrhythmias * Severe GI stricture * Precautions * Psychosis or bipolar disorder * History or risk of seizures * History or risk of substance abuse * History of GI obstruction or stricture * Hyperthyroidism * Adverse Drug Reactions * Most common (>10% of patients) * HA * Insomnia * Decreased appetite * Nausea * * * Irritability (long-term in children) * Viral infection (long-term in children) * MAJOR Drug Interactions * Contraindicated with the following: * Anorexiants (i.e. phentermine; worry about increased CV risk and CNS stimulation) * Non-selective MAOIs (i.e. phenelzine, tranylcypromine, selegiline; worry about hypertensive crisis) * Sibutramine * Inhalational anesthetics * Pregnancy Category/Breast feeding * Pregnancy category C (use in women of child-bearing age only if benefit outweighs the risk) * Use with caution in breastfeeding (enters breastmilk) * Safety Monitoring * Vital signs (Blood pressure, heart rate, and consider EKG prior to initating) * CBC with differential * LFTs * Look for signs of increased hostility, aggression, or depression * Children-growth rate * Efficacy Monitoring | 9/6/10 | Free | View In iTunes |
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095 Abilify® (Aripiprazole) – Top 200 Prescribed Drug | 095 Abilify (http://thestudentpharmacist.com/wp-content/uploads/095_Abilify.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Aripiprazole (not available) * Brand: Abilify® * Mechanism of Action * Atypical Antipsychotic * Its exact mechanism is unknown, but it is known to be a partial agonist of dopamine D2 and serotonin 5-HT1A receptors and an antagonist of 5-HT2A receptors * Indications * Schizophrenia * Bipolar Disorder * Major Depressive Disorder (MDD) * Dosage forms * Injection solution * 7.5 mg/mL * Oral solution * 1 mg/mL * Tablet * 2, 5, 10, 15, 20, 30 mg * Orally Disintegrating Tablet * 10, 15 mg * Contains phenylalanine * Adult Dosing * Acute agitation associated with schizophrenia or bipolar disorder * 9.75 mg intramuscularly (IM) * Dose range is 5.25-15 mg (with 15 mg/dose being the max) * Additional doses can be given at 2 hour intervals as needed up to a max of 30 mg/day * Try and switch to oral as soon as possible * Schizophrenia or Bipolar Disorder * 15 mg once a day orally * Can be increased to 30 mg once a day * For schizophrenia, doses > 15 mg/day are rarely more effective * Depression * Initiate 2-5 mg/day * Daily dose may be increased 5 mg at weekly intervals * Max: 15 mg/day * Note: Abilify should be discontinued if absolute neutrophil count (ANC) drops below 1000/mm^3 or if there is an unexplained decrease in white blood cells (WBC) * Pharmacokinetics * Onset of action take ~1-3 weeks * Metabolized in the liver by CYP2D6 and 3A4 * Excreted in the urine and feces * Black Box Warnings (2) * Abilify is not approved for dementia related psychosis and its use may increase mortality in elderly patients with dementia * Most deaths are due to cardiac complications or infections * Antidepressants can increase the risk of suicidal thinking and behavior in children and adolescents with MDD and other psychiatric disorders * Contraindications * Hypersensitivity * Precautions * Blood dyscrasias such as Leukopenia, Neutropenia and Agranulocytosis have been reported * Discontinue therapy if absolute neutrophil count drops below 1000/mm^3 * Use with caution in patients with cardiovascular disease or a history of seizures * Extrapyramidal symptoms (EPS) such as psuedoparkinsonism, dystonic reactions, akithisia, and tardive diskinesia can occur * Rare cases or Neuroleptic Malignant Syndrome (NMS) have been reported * Symptoms include muscle rigidity, altered mental status, and irregular pulse or blood pressure * Adverse Drug Reactions * Most common * Headache * Agitation * Insomnia or Sedation * GI Upset * Weight gain * Consider switching to a different psychotic if weight gain is ≥ 5% of baseline weight * MAJOR Drug Interactions * Avoid use with metoclopramide * Abilify's effects may be increased when used with CYP2D6 and 3A4 inhibitors * Use with 3A4 inducers may decrease Abilify's effect * Pregnancy Category/Breast feeding * Category C * Not recommended when breast feeding * Safety Monitoring * Vital Signs * Complete Blood Count * Lipid panel and blood glucose at baseline, 3 months, and then annually * Check weight monthly for the 1st 3 months * Mental status * Efficacy Monitoring * Relief of symptoms * See how the patient feels the Abilify® is working for them * Major Counseling Points * Avoid alcohol as it can increase CNS depression * Use caution performing tasks that require mental alertness, especially with initial therapy * Oral solution should be used within 6 months of opening the bottle * Common side effects include headache, agitation, GI upset, and weight gain) * Let you doctor or pharmacist know if you have any severe or persistent side effects | 8/30/10 | Free | View In iTunes |
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094 Spiriva HandiHaler (Tiotropium) – Top 200 Prescribed Drugs | o94 Spiriva HandiHaler (http://thestudentpharmacist.com/wp-content/uploads/094_Spiriva.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Tiotropium (not available) * Brand: Spiriva® Handihaler® * Mechanism of Action * Long acting anticholinergic * Causes bronchodilation by inhibiting the action of acetylcholine at muscarinic type 3 receptors * Indication * COPD * Specifically chronic management of COPD * Dosage form * Capsule * 18 mcg powder for inhalation * Adult Dosing * COPD * One capsule once/day * Pharmacokinetics * Minimally metabolized in the liver by CYP2D6 and 3A4 * Onset of action ~30 minutes * Peak effect ~3 hours * Duration ~24 hours * Contraindication * Hypersensitivity * Precautions * Although rare, paradoxical bronchospasms can occur * Discontinue use if this is an issue * Tiotropium can potentially worsen narrow angle glaucoma, myasthenia gravis, and prostatic hyperplasia * Use with caution in these patient populations * Capsules contain lactose * Use with caution in patients with a severe milk protein allergy * Adverse Drug Reactions * Most common * Xerostomia (dry mouth) * Upper respiratory tract infection * Pharyngitis * Sinusitis * MAJOR Drug Interactions * Tiotropium can have additive effects when used with other anticholinergic drugs * Use with acetylcholinesterase inhibitors (such as physostigmine and donepezil) can decrease the effects of both medications * Pregnancy Category/Breast feeding * Category C * Use with caution in breastfeeding * Safety and Efficacy Monitoring * FEV1 * Peak Flow * Major Counseling Points * Take each dose at the same time everyday * Spiriva should not be used for current bronchospasm * Does not act fast enough * Short acting "rescue" inhaler should be used * Capsules should only be inhaled using the HandiHaler inhaler and should not be swallowed * How to use the HandiHaler: * http://www.spiriva.com/consumer/taking-spiriva/how-to-take-spiriva.jsp (http://www.spiriva.com/consumer/taking-spiriva/how-to-take-spiriva.jsp) * Remove capsule from the foil blister pack right before use * Open the dust cap and mouthpiece and place capsule in the chamber at the base of the inhaler * Close the mouthpiece (should hear a click when closed) * Hold the inhaler so the mouthpiece is facing upwards and depress the green piercing button one time (this punctures the capsule) * Exhale fully (not into the inhaler) * Place your lips around the mouth piece and inhale slowly and deeply * Should hear and/or feel the capsule vibrating * Hold you breath as long as possible (at least 5-10 seconds) * Repeat the inhalation at least one time until no powder remains in the capsule * Discard the used capsule after use * The most common side effect is dry mouth * Let you doctor or pharmacist know if you experience any severe or persistent side effects References: * Tiotropium. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Aug 25]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Spiriva. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * How to take SPIRIVA. Boehringer Ingelheim Pharmaceuticals, Inc [Internet]. 2010 [Cited 2010 Aug 25]. Available from: http://www.spiriva.com/consumer/taking-spiriva/how-to-take-spiriva.jsp (http://www.spiriva.com/consumer/taking-spiriva/how-to-take-spiriva.jsp) * Spiriva HandiHaler. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Aug 25]. [About 5 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. | 8/26/10 | Free | View In iTunes |
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093 Tamiflu® (Oseltamivir) – Top 200 Prescribed Drugs | 093 Tamiflu (http://thestudentpharmacist.com/wp-content/uploads/093_Tamiflu.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Oseltamivir (NOT available) * Brand: Tamiflu® * Mechanism of Action * Antiviral * Prodrug * Hydrolyzed in the liver to its active form, oseltamivir carboxylate * Oseltamivir carboxylate blocks the release of the influenza virus from host cells by inhibiting influenza virus' enzyme, neuraminidase * Indications * Prophylaxis and treatment of influenza A or B infection * Tamiflu, in general, should only considered for treatment if it is within 2 days of symptom onset * However, patients who are hospitalized with confirmed influenza infection may benefit even if therapy cannot be initiated within 2 days of symptom onset * Dosage forms * Capsules * 30, 45, 75 mg * Powder for oral suspension * Reconstituted as 12 mg/mL * Adult Dosing * Prophylaxis: * 75 mg/day for 5-10 days after the last known exposure * Prophylaxis treatment can be given for up to 6 weeks in the case of community break outs * Treatment * 75 mg twice/day for 5 days * Initiate therapy within 2 days of symptom onset * Hospitalized patients may need therapy for a longer duration (often 10 days or more) and a higher dose * Note: * If CrCl is 10-30 mL/min, then give half the normal dose: * Prophylaxis: 75 mg every other day * Treatment: 75 mg/day * Pharmacokinetics * Oseltamivir is metabolized by the liver to its active form, oseltamivir carboxylate * Does not interact with cytochrome P450 system * Excreted primarily in the urine but also in the feces * Contraindications * Hypersensitivity * Precautions * Although rare, anaphylaxis and neuropsychiatric events (such as confusion and hallucinations) have been reported * Use with caution in patients with hepatic or renal impairment (dose should be reduced by half if CrCl is 10-30 mL/min) * Adverse Drug Reactions * Most common * GI upset (N/V/D and abdominal pain) * Usually subsides after 2 days of treatment and taking with food may help * MAJOR Drug Interactions * Probenacid may increase the levels of Tamiflu® * Tamiflu may decrease the effect of the intranasal live/attenuated flu vaccine * The intranasal flu vaccine should not be given within 2 weeks before or 48 hours after administration of Oseltamivir. * Pregnancy Category/Breast feeding * Category C * Not recommended in breast feeding * Safety Monitoring * Monitor for hypersensitivity as well as any unusual behavior such as confusion, self injury of hallucinations * Efficacy Monitoring * Relief of symptoms and infection * Major Counseling Points * Tamiflu is not a substitute or replacement for the flu shot * Treatment with Tamiflu does not decrease the possibility of transmission to others * Take entire prescription even if you feel better * The main side effect is GI upset * Usually subside after 2 days of treatment * If this is an issue, take each dose with food * Let you doctor or pharmacist know if you have any hallucinations or abnormal confusion * Patients should report any severe or persistent side effects References: * Olsetamivir. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Aug 25]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Tamiflu®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Tamiflu. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Aug 25]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Fiore, Anthony E., Shay, David K., Broder, Karen, et al. | 8/25/10 | Free | View In iTunes |
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092 Premarin® (conjugated estrogens) – Top 200 Prescribed Drugs | 092 Premarin® (http://thestudentpharmacist.com/wp-content/uploads/092_Premarin.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Conjugated estrogens (not available) * Brand: Premarin * Mechanism of Action * Premarin contains a mixture of different estrogens, which control the development and function of the female reproductive system as well as the development of secondary sexual characteristics (i.e. breast enlargement, fat deposition, etc.) * Estrogens affect the secretion of gonadotropins, FSH, and LH thru negative feedback on the pituitary gland. * So, for postmenopausal females, levels of these hormones are reduced which improves postmenopausal symptoms * Indications * Postmenopausal vasomotor symptoms in women (i.e. hot flashes, night sweats) * Vaginal and/or vulvar atrophy * Consequential dyspareunia (painful i*********e) * Hypoestrogenism * Palliative care of prostatic or breast cancer (not for treatment) * Postmenopausal osteoporosis * Abnormal bleeding of the uterus * Dosage forms * Tablets: * 0.3, 0.45, 0.625, 0.9, and 1.25 mg * Vaginal cream: * 0.625 mg/g * Injection powder for reconstitution * 25 mg * Adult Dosing * Dosing varies depending on indication * For vasomotor symptoms and vulvar/vaginal atrophy: * Start at 0.3mg given either daily or cyclically (either 3 wks on, 1 off OR 25 days on, 5 off) * Adjust dose based on symptoms at intervals of 3-6 mos and treat with lowest effective dose * Vaginal cream for vulvar/vaginal atrophy: range 0.5-2g per day cyclically * Notes about dosing: * Reduce dose in mild to moderate hepatic impairment and do not use Premarin in severe hepatic impairment * Pharmacokinetics * Metabolized in the liver via CYP3A4 * Estradiol and estrone specifically: major CYP1A2 and 3A4 substrates * Black Box Warnings * Dementia * Increased risk in females 65 or older * Endometrial carcinoma * Be sure to rule out malignancy in situations of abnormal vaginal bleeding * CV disease * Be cautious as Premarin can increase the risks of MI, stroke, VTE, or HTN (especially in postmenopausal women) * Always weigh risks and benefits (patient-specific) before prescribing Premarin and continue to do so periodically while on therapy * Use lowest effective dose for shortest time possible * Contraindications * Hypersensitivity * Pregnancy * Abnormal vaginal bleeding (unseen/undiagnosed by a physician) * History of or current VTE * Current stroke or MI, nor within last year * Breast carcinoma (unless for metastatic disease at physicians discretion) * Estrogen-dependent tumor * Liver disease/dysfunction * Precautions * Increased risk of breast cancer * Check patient's family history to see if breast cancer runs in her family * Increased risk of venous thromboembolism * Adverse Drug Reactions * Most common * HA * Breast pain * Abdominal pain * Back pain * Vaginal hemorrhage * MAJOR Drug Interactions * Avoid taking with: * Anastrozole (decreased estrogen effects) * Alcohol (drinking regularly can increase plasma estrogen concentrations and consequential breast cancer risk) * Herbals that have estrogen-like properties (i.e. red clover, saw palmetto, soybean, etc) * Estrogen effects may be lowered by: * Strong 1A2 and 3A4 inducers * Pregnancy Category/Breast feeding * Estrogens are not recommended during or directly after pregnancy * Note to consider: vaginal cream could weaken the latex in barrier methods of contraception (condoms, diaphragms, etc.) * Enters breastmilk and has actually been seen to lower quantity/quality of human breastmilk (therefore not recommended) * Safety Monitoring * Blood pressure * Pap smear * Monthly self-breast exam and mammogram | 8/24/10 | Free | View In iTunes |
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090 Amlodipine and Benazepril (Lotrel®) – Top 200 Prescribed Drugs | 090 Amlodipine/Benazepril (Lotrel®) (http://thestudentpharmacist.com/wp-content/uploads/090_Amlodipine_Benazepril.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Amlodipine and Benazepril * Brand: Lotrel® * Mechanism of Action * Amlodipine: * DHP Calcium channel blocker * Causes relaxation of vascular smooth muscle and cardiac muscle by Inhibiting calcium influx * Works more in the vasculature (as do all DHP CCBs) than in the cardiac muscle * Non-DHP CCBs (Verapamil and Ditiazem work more in cardiac muscle) * Benazepril: * Angiotensin Converting Enzyme Inhibitor (ACE-I) * ACE normally converts angiotensin I to angiotensin II, which acts as a potent vasoconstrictor and causes the release of aldosterone (which increases sodium and water reabsorption) * ACE-Is blocks this conversion which leads to a reduction in angiotensin II and reduced aldosterone secretion * So overall, benazepril and amlodipine work together to decrease blood pressure * Indication * Hypertension * Dosage forms * Generic (Amlodipine mg/Benazepril mg) * Capsules * 2.5/10, 5/10, 5/20, and 10/20 mg * Brand (Lotrel®) is available in the same strengths as the generic as well as: * Capsules (Amlodipine mg/Benazepril mg) * 5/40 and 10/40 mg * Adult Dosing * Dose is going to be patient specific based on blood pressure response and tolerability * Usual dose range * Amlodipine: 2.5-10 mg/day * Benazepril: 10-40 mg/day * Start low and titrate slowly as needed * Max doses * Amlodipine: 10 mg/day * Benazepril: 80 mg/day * Notes about dosing * Use of this combination is not recommended if CrCl ≤ 30 mL/min * Initiate at the lowest dose (2.5/10) if the patient has hepatic impairment * Pharmacokinetics * Amlodipine: * Duration of action: ~24 hours * Metabolized by the liver and excreted in the urine * Benazepril * Prodrug * Metabolized by the liver to its active metabolite, benazeprilat * Onset of action: ~1-2 hours * Duration of action: ~24 hours * Peak blood pressure lowering effect is seen at about 2 weeks * Black Box Warnings * Pregnancy * ACEIs can cause injury or death to the fetus when used in the 2nd and 3rd trimesters and should be discontinued as soon as pregnancy is detected * Contraindications * Hypersensitivity * History of angioedema * Pregnancy * Bilateral renal artery stenosis * Precautions * We have looked at both calcium channel blockers and ACE-Is in past episodes and the same precautions still apply * For Benazepril, the main precautions we are concerned with are: * Angiodema (especially after the 1st dose) * Chronic cough (switch to an ARB if this is an issue) * Hyperkalemia (especially in patients with renal dysfunction or diabetes mellitus) * Renal dysfunction (monitor SrCr and discontinue any ACEI or ARB if it increases > 35% over baseline) * Hypotension is a concern, especially with the combination * This is one of the main reasons you want to initiate with low doses and titrate slowly as needed * Adverse Drug Reactions * Most common: * Hypotension * Headache * Cough * GI upset * MAJOR Drug Interactions * Use with other blood pressure meds can increase the risk of HYPOtension * Specifically dealing with Benazepril: * Use with NSAIDs can decrease the therapeutic effects and increase the adverse reactions * Use with potassium sparing diuretics can increase the risk of hyperkalemia * Specifically dealing with Amlodipine: * Carbamazepine, phenytoin, fosphenytoin, barbiturates, and rifampin can all decrease the effects of DHP CCBs * Pregnancy Category/Breast feeding * Use is contraindicated in 2nd and 3rd trimester in pregnancy * Not recommended in breastfeeding * Safety Monitoring | 8/23/10 | Free | View In iTunes |
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089 Pantroprazole (Protonix®) – Top 200 Prescribed Drugs | Note: 087 and 088 (metformin and toprol-XL) have been covered in previous episodes 089 Pantoprazole (Protonix®) (http://thestudentpharmacist.com/wp-content/uploads/089_Pantoprazole.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Pantoprazole (available as delayed release tablets) * Brand: Protonix® * Mechanism of Action * Proton pump inhibitor (PPI) * Inhibits H/K-ATPase in gastric parietal cells which suppresses gastric acid secretion * Indications * Erosive esophagitis associated with GERD * Hypersecretory conditions * Unlabeled indications: * Prevention of peptic ulcer rebleeding * H. pylori eradication (in combination with amoxicillin and clarithromycin for 10-14 days) * Dosage forms * Delayed release tablets (only form available generically) * 20, 40 mg * Granules for suspension (brand only) * 40 mg/packet * Injection, powder for reconstitution (brand only) * 40 mg * Adult Dosing * Erosive esophagitis associated with GERD * 40 mg/day * Hypersecretory conditions * Initiate at 40 mg twice a day * Dose can be increased as needed * Doses up to 240 mg/day have been used * Pharmacokinetics * Metabolized in the liver by CYP2C19 and 3A4 * Excreted mainly in the urine (71%) but also in the feces (18%) * Contraindications * Hypersensitivity * Precautions * Long term use can lead to increase fracture risk * Long term use can also lead to atrophic gastritis and B12 deficiency * Use caution in patients with sever hepatic impairment * May need to decrease the dose * Adverse Drug Reactions * Generally well tolerated * Most common * Headache * GI upset (abdominal pain, nausea, and diarrhea) * MAJOR Drug Interactions * Pantoprazole may decrease the effects of the following drugs: * Clopidogrel * Ketoconazole * Atazanavir * Pantoprazole may increase the levels of methotrexate, methylphenidate, or raltegravir * Pregnancy Category/Breast feeding * Category B * Not recommended in breastfeeding * Safety and Efficacy Monitoring * Relief of symptoms * Healing of Gastric Mucosa * Prevention of further complications * Major Counseling Points * Take each dose at the same time each day (preferably in the morning) * Swallow the tablets whole (don't split, chew, or crush) * Avoid alcohol (alcohol can add to GI irritation) * You can take antacids at the same time as pantoprazole if instant relief is needed * Main side effects (possible GI upset and headache) * Report any persistent or severe side effects to your doctor or pharmacist References: * Pantoprazole. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Aug 19]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Protonix. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Pantoprazole. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Aug 19]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 8/19/10 | Free | View In iTunes |
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086 Lorazepam (Ativan®) | Note: 083, 084, and 085, drugs (Alprazolam (http://thestudentpharmacist.com/?p=185), Albuterol (http://thestudentpharmacist.com/?p=92), Atenolol (http://thestudentpharmacist.com/?p=263)) have been covered in previous episodes 086 Lorazepam (Ativan®) (http://thestudentpharmacist.com/wp-content/uploads/086_Lorazepam.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Lorazepam (available) * Brand: Ativan® * Mechanism of Action * Benzodiazepine (C-IV) * Binds benzodiazepine receptors in the CNS, increasing the effect of GABA * GABA is an inhibitory neurotransmitter and works by hyperpolarizing neuronal cells which makes them less excitable * Indications * Anxiety * Status epilepticus (IV) * Sedation * Unlabeled indications: * Alcohol detoxification * Insomnia * Partial Complex Seizures * Antiemetic * Dosage forms * Tablets * 0.5, 1, 2 mg * Oral Solution * 2 mg/mL * Injection solution (can be given IV or IM) * 2 mg/mL * Adult Dosing * Dose ranges from 0.5-10 mg depending on the indication * Anxiety * 1-10 mg orally divided as 2-3 doses * Usual dose range is 2-6 mg * Max = 10 mg/day * Insomnia * 2-4 mg orally at bedtime * Status Epilepticus * 4 mg IV at a max rate of 2 mg/minute * One more 4 mg IV dose may be give in 10-15 minutes as needed * Max = 8 mg * Pharmacokinetics * Onset of action anticonvulsant properties when lorazepam is given IV: ~5 minutes * Sedation when given IV: 5-20 minutes * Duration of action: 6-8 minutes * Metabolized by the liver * Primarily excreted in the urine * Contraindications * Hypersensitivity * Acute narrow angle glaucoma * Severe respiratory impairment * Contraindications specific to the injection dosage form: * Sleep Apnea * Intra-arterial injection (can only be given IV or IM) * Precautions * CNS depression is a big concern * Can impair physical and mental abilities * Due to CNS depression * Use caution in patients with major depressive disorder or respiratory disease (respiratory depression can occur) * Also, because of CNS depression that can occur, use with caution in elderly patients and patients at increased risk of falling * Use caution in patients with history or potential for drug or alcohol abuse * Use caution in renal and hepatic impairment * Adverse Drug Reactions * CNS depression * Drowsiness or somnolence * Altered coordination or dizziness * Memory impairment * Weakness * Depression * MAJOR Drug Interactions * Use with other CNS depressants and alcohol can have additive effects * Theophylline can decrease the effects of lorazepam * Pregnancy Category/Breast feeding * Category D * Not recommended in breast feeding * Safety Monitoring * Signs of respiratory or CNS depression * Tolerance and dependence * Both can occur with longterm use * Renal and hepatic function with long term use * Efficacy Monitoring * Depends on the indication * Anxiety: Mood and social functioning * Insomnia: Quality of sleep and energy throughout the day * How does the patient feel the medication is working? * Major Counseling Points * Avoid alcohol while taking lorazepam * Lorazepam can be habit forming and you shouldn't exceed the recommended dose * Some side effects you may experience include drowsiness, dizziness, or weakness * Use caution performing tasks that require mental alertness while on lorazepam * Especially with initial therapy * Report any persistent or severe side effects References: * Lorazepam. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Aug 18]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Ativan®. | 8/19/10 | Free | View In iTunes |
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082 Valtrex® (valacyclovir) – Top 200 Prescribed Drugs | Note: 080 and 081 most prescribed drugs, warfarin (http://thestudentpharmacist.com/?p=120) and lisinopril (http://thestudentpharmacist.com/?s=lisinopril), have been covered in previous episodes 082 Valtrex® (valacyclovir) (http://thestudentpharmacist.com/wp-content/uploads/082_Valtrex.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Valacylcovir (available) * Brand: Valtrex® * Mechanism of Action * Valacyclovir is converted to acyclovir in the intestines and liver, which is eventually converted to acyclovir triphosphate * Acyclovir triphosphate Inhibits DNA polymerase and is incorporated into viral DNA itself * Results in inhibition of viral DNA synthesis and viral replication * Indications * Some indications include: * Herpes zoster (shingles) * Genital herpes * Herpes labialis (cold sores) * Chickenpox in children 2-17 years old * Dosage forms * Caplets * 500, 1000 mg * Tablets * 500, 1000 mg * Adult Dosing * Dose and duration depends on the indication * Herpes zoster (shingles): 1 g three times a day for 1 week * Herpes labialis (cold sores): 2 g twice a day for 1 day * Genital herpes * Initial episode: 1g twice a day for 10 days * Recurrent episodes: 500 mg three times a day for 3 days * Chronic suppression of recurrent genital herpes: 500-1000 mg/day * Pharmacokinetics * Valacyclovir is converted to acyclovir in the intestines and liver * Excreted in the urine primarily as acyclovir (85%) * Contraindications * Hypersensitivity * Precautions * CNS effects such as hallucinations, seizures, and confusion can occur * More likely in elderly patients * Urinary precipitation can occur * Patient needs to stay well hydrated * Use with caution in renal impairment * Dose needs to be adjusted if CrCl < 30 mL/min * Adverse Drug Reactions * Most common * Headache * GI upset * Can also cause: * Neutropenia * Increased LFTs (liver function test) * Nasopharyngitis * MAJOR Drug Interactions * The zoster vaccine should not be given while a patient is taking Valtrex® * Valtrex can decrease the effect of the vaccine * Pregnancy Category/Breast feeding * Category B * Use with caution in breastfeeding * Safety Monitoring * With long term use monitor: * Liver function (LFTs) * Renal function (BUN, SrCr) * Also get a CBC and urinalysis * Efficacy Monitoring * Relief of symptoms or infection * Major Counseling Points * Valtrex® is not a cure for genital herpes and does not prevent transmission to others * You should start taking Valtrex® at the first sign herpes onset * Stay well hydrated while taking Valtrex® * Common side effects include headache and GI upset * Report any persistent or severe side effects References: * Valacylcovir. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Aug 17]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline. * Valtrex®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Valtrex®. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Aug 17]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 8/18/10 | Free | View In iTunes |
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079 Propoxyphene & Acetaminophen (Darvocet®) – Top 200 Prescribed Drugs | 079 Propoxyphene & Acetaminophen (http://thestudentpharmacist.com/wp-content/uploads/079_Propoxyphene_Acetaminophen.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Propoxyphene and Acetaminophen (available) * Br... | 8/17/10 | Free | View In iTunes |
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078 Cozaar® (losartan) – Top 200 Prescribed Drugs | 078 Cozaar® (losartan) (http://thestudentpharmacist.com/wp-content/uploads/078_Cozaar_losartan.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Losartan (Available) * Brand: Cozaar® * Actually the first angiotensin receptor blocker (ARB) to be available generically * Mechanism of Action * Angiotensin II receptor blocker (ARB) * So angiotensin II can't bind to AT1 receptors, so it can't cause vasoconstriction or aldosterone release * This results in a decrease in BP, a decrease in the reabsorption of Na and water, and vasodilation of the efferent arteriole of the kidneys, which is considered renal protective * Also prevents ventricular remodeling and cardiac hypertrophy * Indications * Hypertension * Treatment of diabetic nephropathy in patients with type 2 diabetes and hypertension * Stroke prevention in patients with both hypertension and left ventricular hypertrophy * Dosage forms * Tablets * 25, 50, 100 mg * Adult Dosing * Initiate with 50 mg once a day * Dose can be increased to 100 mg/day as needed * Notes about dosing: * Start with 25 mg in patient who are also taking diuretics and patients who have hepatic impairment * Pharmacokinetics * Onset of action is about 6 hours * Metabolized in the liver via CYP2C9 and 3A4 * Does have an active metabolite that is actually 40 times as potent as losartan itself * Losartan moderately inhibits CYP2C8 and 2C9 * Black Box Warnings * Pregnancy * Drugs affecting the angiotensin system have been shown to cause injury or death to the fetus in the 2nd and 3rd trimesters * Contraindications * Hypersensitivity * Precautions * ARBs can cause hyperkalemia * Monitor serum potassium and use caution in patients who have diabetes or renal dysfunction * ARBs can cause hypotension * Use caution at the initiation of therapy especially in patients who are volume depleted or have HF * ARBs can lead to renal dysfunction * Especially in patients with prior renal dysfunction or decrease renal blood flow * Monitor SrCr and if it increases > 35% over baseline,then temporarily discontinue Cozaar® at least until renal function is back to normal * Use with caution in patients with hepatic impairment, renal impairment, or renal artery stenosis * Adverse Drug Reactions * Most common * Diarrhea * Chest pain * Fatigue * Hypoglycemia * Nasal congestion * Cough * Note: Most of these side effects seem to be seen more in patients with diabetic nephropathy * MAJOR Drug Interactions * Again, initiate with 25 mg (as opposed to 50 mg) in patients who are also taking diuretics * This is to decrease the risk of hypotension * Also, look for drugs that interact with or are metabolized by CYP2C8, 2C9, or 3A4 * Pregnancy Category/Breast feeding * Category C in the 1st trimester * Category D in the 2nd and 3rd trimesters * Not recommended in breast feeding * Safety Monitoring * Serum Potassium * Renal function * BUN and SrCr * If SrCr increases > 35% over baseline, then temporarily discontinue Cozaar® at least until renal function is back to normal * Monitor potassium and renal function at baseline then 4 weeks after initiation * Efficacy Monitoring * Blood pressure * Major Counseling Points * Let your doctor or pharmacist know if you become or plan to become pregnant * Go over main side effects (being diarrhea, fatigue, nasal congestion, and cough) * Losartan can cause hypotension * Careful at first going from sitting or lying to standing (do so slowly) * Avoid salt substitutes that contain potassium * Avoid excess alcohol * Keep taking Cozaar even if you feel better * Cozaar is not a replacement for diet and exercise as these are still very important in controlling your HTN | 8/16/10 | Free | View In iTunes |
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076 Fluticasone Propionate (Flonase®) – Top 200 Prescribed Drugs | 076 Fluticasone Propionate (Flonase®) (http://thestudentpharmacist.com/wp-content/uploads/076_Fluticasone.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Fluticasone propionate * Generic is available * Brand: Flonase® * There is also Veramyst® which is another nasal form of fluticasone, fluticasone furoate * Mechanism of Action * Intranasal corticosteroid that inhibits inflammatory cytokines and has glucocorticoid and mineralocorticoid effects * Overall, this gives fluticasone vasoconstrictive and anti-inflammatory properties * Indications * Allergic and nonallergic rhinitis * Note: Nasal corticosteroids are the most effective treatment for allergic rhinitis and should be used for severe or persistent symptoms * Dosage forms * Intranasal spray * 50 mcg/actuation * Adult Dosing * Initiate 2 sprays per nostril per day * You can reduce the dose to 1 spray per nostril per day for maintenance therapy after the few days of therapy * Pharmacokinetics * Fluticasone is a substrate for CYP3A4 * May take a few days to see maximum benefit * Contraindications * Hypersensitivity * Also don't want to use nasal corticosteroids if the patients has any nasal ulcers or trauma * Adverse Drug Reactions * Most common * Headache * Dizziness * Nasal irritation * MAJOR Drug Interactions * Use with protease inhibitors, specifically ritonavir, can increase serum levels of fluticasone * There have been reports of adrenal suppression when fluticasone propionate and ritonavir were used together * Pregnancy Category/Breast feeding * Category C * Use with caution in breastfeeding * Safety/Efficacy Monitoring * Relief of symptoms * Monitor for adverse effects * Major Counseling Points * Let patients know that they should expect to see relief of symptoms in a few days, but it can take as long as 3 weeks in some cases * Use fluticasone nasal spray every day as prescribed to get maximum benefit * Go over how to properly take fluticasone nasal spray * Shake the bottle well before each use * Blow your nose to try and clear your nostrils * Insert the tip into one nostril and close the other * Breathe in through your nose while pressing the pump to release the spray * Repeat for the number of instructed doses * Go over how and when to prime the pump * Prime the pump before first use and if the pump has not been used for a week or longer * Do so by depressing the 6 times until you see a fine spray * Go over the main side effects * Headache, Dizziness, and Nasal irritation * Patients should report any persistent or severe side effects References: * Fluticasone (Nasal). In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Aug 11]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * New nasal steroids: Veramyst and Omnaris. Pharmacist's Letter/Prescriber's Letter 2007;23(6):230610 * Flonase®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Flonase. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Aug 11]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 8/12/10 | Free | View In iTunes |
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075 Fluconazole – Top 200 Prescribed Drugs | 075 Fluconazole (http://thestudentpharmacist.com/wp-content/uploads/075_Fluconazole.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Fluconazole (available) * Brand: Diflucan * Mechanism of Action * Antifungal agent * Inhibits fungal cytochrome p450 and sterol C-14 alpha-demethylation * Indications * Treatment of susceptible infections such as: * Candidiasis * Cryptococcal meningitis * Also used as prophylaxis in allogenic bone marrow transplant recipients * Dosage forms * IV infusion form * 100, 200, 400 mg * Oral powder for suspension: * 10 and 40 mg/mL * Tablets * 50, 100, 150, and 200 mg * Adult Dosing * Dose and duration depends on infection and severity * Typical dose range: 150-800 mg/day * Duration can range from one dose to several weeks or months * For example: * Vaginal candidiasis: Recommended to give a single oral dose of 150 mg * Cryptococcal meningitis: 200-400 mg/day for 10-12 weeks after the cerebrospinal fluid is negative for cultures * Notes about dosing * Daily mg are the same for IV and oral * Need to adjust the dose in renal impairment with a CrCl ≤ 50 mL/min * Use half the recommended dose OR administer every 2 days (as opposed to every day) * Pharmacokinetics * Stongly inhibits CYP2C9 and 2C19 * Moderately inhibits CYP3A4 * Excreted in the urine primarily as unchanged drug * Contraindications * Hypersensitivity * Concurrent use with cisapride * Precautions * QT prolongation can occur * Use with caution in patient with arrhythmias or who are on other medications that can prolong the QT interval * Use with caution in patients with renal or hepatic impairment * Hepatotoxicity can occur and patients should report any yellowing of the skin or eyes * Adverse Drug Reactions * Common * GI upset (Nausea/Vomiting) * Headache * Rash * Although rare, angioedema and arrhythmias can occur * MAJOR Drug Interactions * A lot of drug interactions * Look for drugs that are metabolized by CYP2C9 or 2C19 (both of which are strongly inhibited by Fluconazole), such as: * Clopidogrel * Warfarin * Phenytoin * Also look for drugs that are metabolized by CYP3A4, which is moderately inhibited by fluconazole * Pregnancy Category/Breast feeding * Category C * Rated compatible with breast feeding by the American Academy of Pediatrics * Safety Monitoring * If indicated, monitor: * Liver function * Renal Function * Serum potassium * Efficacy Monitoring * Relief of symptoms and infection * Get a culture and sensitivity if indicated * Major Counseling Points * Take fluconazole as directed by your doctor or pharmacist * Take your full prescription, even if you feel better * If you are taking a suspension, shake well before each dose * Some side effects you may experience include headache and GI upset * Report are persistent or severe side effects such as: * Yellowing of the skin or eyes * Irregular heart beat * Rash References: * Fluconazole. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 May 23]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Diflucan®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * FLuconazole. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Jun 1]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 8/11/10 | Free | View In iTunes |
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073 Acetaminophen with Codeine – Top 200 Prescribed Drugs | 073 Acetaminophen and Codeine (http://thestudentpharmacist.com/wp-content/uploads/073_Acetaminophen_Codeine.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Acetaminophen and codeine (available) * Brand Names: ... | 8/10/10 | Free | View In iTunes |
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072 Viagra – Top 200 Prescribed Drugs | 072 Viagra (http://thestudentpharmacist.com/wp-content/uploads/072_Viagra.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Sildenafil (not available) * Brand: Viagra® * Revatio® * Mechanism of Action * Sildenafil is a phosphodiesterase-5 inhibitor, which (in terms of erectile dysfunction) enhances the effect of Nitric Oxide and increases the levels of cGMP in the corpus cavernosum. * The result is smooth muscle relaxation and increased blood flow to the corpus cavernosum * Sildenafil can also cause relaxation of the smooth muscles in the lungs by the same mechanism, which is beneficial for pulmonary hypertension (which is the indication for Revatio®) * Indications * Erectile dysfunction (ED) * Brand name Revatio® is indicated for pulmonary arterial hypertension * Dosage forms * Viagra® * Tablets * 25, 50, 100 mg * Revatio® * 20 mg tablets * Injection solution: 0.8 mg/mL * Adult Dosing * Erectile Dysfunction (Viagra®) * Dose ranges from 25-100 mg * Usual dose: 50 mg * Should be taken anywhere from 4 hours to a half hour before sexual activity * In hepatic impairment and renal impairment with a CrCl < 30 mL/min start with a 25 mg dose * Pulmonary Hypertension (Revatio®) * 10 mg 3 times/day IV OR * 20 mg 3 times/day orally 4-6 hours apart * Pharmacokinetics * Onset of action: about 1 hour * Duration: 2-4 hours * Metabolized in the liver via CYP3A4 (which is major) and CYP2C9 * Sildenafil does have an active metabolite * Excreted mainly in the feces * Contraindications * Hypersensitivity * Concurrent use with nitrates of any form * Precautions * Hypotension can occur due to the vasodilatory effects * Because of this, use with caution in patients with cardiovascular disease * This hypotensive effect may be increased if used with other meds that can cause hypotension as well as alcohol * Priapism can occur and patients should seek medical attention if erection lasts longer than 4 hours * Again, lower the dose of Viagra if the patient has hepatic impairment or renal impairment with a CrCl < 30 mL/min * Just to note: Vision loss and hearing loss have been reported in rare cases * Adverse Drug Reactions * Most common * Headache * Dyspepsia * Flushing * Insomnia * MAJOR Drug Interactions * Again, Viagra®'s use is contraindicated with nitrates (such as nitroglycerin and isosorbide dinitrate) * Because of the hypotension that can occur, If the patient is on an alpha blocker (such as doxazosin or tamsulosin) then initiate viagra at 25 mg * Look for 3A4 inhibitors or inducers and you may need to adjust the dose as seen with the following 3A4 inhibitors: * With erythromycin, the azole antifungals (itraconazole and ketoconazole), as well as saquinavir, initiate viagra at 25 mg * With Ritonavir, the max dose of viagra should be 25 mg every 2 days * Grapefruit juice is also a 3A4 inhibitor and its intake should be limited * Pregnancy Category/Breast feeding * Category B * Use with caution while breastfeeding * Safety/Efficacy Monitoring * Monitor for side effects * Monitor for effectiveness * Major Counseling Points * Let your doctor or pharmacist know before you start any new medications that you are taking Viagra * Also want to avoid grapefruit juice while taking Viagra * Don't combine Viagra with other erectile dysfunction treatments without talking to your doctor or pharmacist first * Some common side effects you may experience include headache, dyspepsia, flushing, and insomnia * If you have an erection lasting longer than 4 hours after taking viagra then seek medical help * Also, if you experience any hearing or vision loss, do not take Viagra and contact you doctor or pharmacist References: * Sildenafil. | 8/9/10 | Free | View In iTunes |
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071 Lyrica – Top 200 Prescribed Drugs | 071 Lyrica (http://thestudentpharmacist.com/wp-content/uploads/071_Lyrica.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Pregabalin (not available) * Brand: Lyrica® * Mechanism of Action * Anticonvulsant * Lyrica's exact mechanism is unknown, but it inhibits the release of excitatory neurotransmitters by binding to calcium channels in the CNS * Although Lyrica is structurally similar to GABA, it doesn't bind GABA or benzodiazepine receptors * It may however increase the density of GABA transporter protein * Indications * Pain associated with diabetic neuropathy * Postherpetic neuralgia * Partial onset seizures * Fibromyalgia * Dosage forms * Capsules varying from 25-300 mg * Adult Dosing * Initiate at 150 mg/day in 2-3 divided doses (depending on the indication) * For diabetic neuropathy, postherpetic neuralgia, and fibromyalgia, titrate the dose to 300 mg/day over one week * Max dose is 600 mg/day for all indications except fibromyalgia (for which the max dose if 450 mg/day) * Notes about dosing * Avoid abrupt withdrawal and taper over one week to discontinue * There are no adjustments needed in hepatic impairment but the dose does need to be decreased in renal impairment if CrCl is < 30 mL/min * Pharmacokinetics * Pregabalin is minimally metabolized * Excreted in the urine mainly as unchanged drug * Onset of pain relief can be seen within 1 week of therapy * Contraindication * Hypersensitvity * Precautions * Angioedema can occur and the risk may be increased if given with other drugs known to cause angioedema (such as ACE-Is) or if the patient has a history of angioedema * Lyrica can also cause rhabdomyolysis with increase CPK levels * Again, use with caution and adjust the dose in renal impairment with a CrCl < 30 mL/min * Lyrica can cause CNS depression and alter physical and mental abilities * Related to this, use with caution in patients with mental depression or suicidal ideation * Use with caution in patients with cardiovascular disease * Adverse Drug Reactions * Most common * Peripheral edema * CNS depression * Weight gain * Xerostomia * Blurred vision * MAJOR Drug Interactions * Lyrica can have additive effects with other CNS depressants including alcohol * Increase risk of peripheral edema when used with thiazolidinediones (rosiglitazone and pioglitazone) * Pregnancy Category/Breast feeding * Category C * Not recommended in breast feeding * Safety Monitoring * Behavioral changes and suicidal ideation * Weight gain and edema * Visual disturbances * CPK levels especially if the patient has any unexplained musclce pain or weakness * Efficacy Monitoring * Depends on indication * Going to look at either pain or seizure relief * Major Counseling Points * Do not stop taking Lyrica without talking with your doctor or pharmacist 1st * Some common side effects you may experience include weight gain, dry mouth and blurred vision * Let you doctor know if these or any other side effects are persistent or severe * Report any unexplained muscle pain or weakness * Lyrica can also cause CNS depression * Use caution performing tasks that require physical or mental alertness, especially with initial therapy * Avoid alcohol as it can add to the CNS depression References: * Pregabalin. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Aug 8]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Lyrica®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Lyrica®. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Aug 8]. [About 8 p.]. | 8/8/10 | Free | View In iTunes |
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070 Gabapentin – Top 200 Prescribed Drugs | Note: 069 Simvastatin has already been covered as the 014 most prescribed drug 070 Gabapentin (http://thestudentpharmacist.com/wp-content/uploads/070_Gabapentin.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Gabapentin (available) * Capsule and tablet form * Brand: Neurontin® * Mechanism of Action * The exact mechanism is unknown, but gabapentin is structurally similar to GABA, which is an inhibitory neurotransmitter. * Indications * Partial Seizures * Postherpetic Neuralgia * Many unlabeled indications, including: * Neuropathic pain * Diabetic peripheral neuropathy * Fibromyalgia * Bipolar Disorder * Migraine prophylaxis * Restless legs syndrome (RLS) * Dosage forms * Capsules * 100, 300, 400 mg * Tablets * 600, 800 mg * Oral solution * 250 mg/5 mL * Not available generically * Should be stored in the refrigerator * Adult Dosing * Seizures * Initiate 300 mg tid * Dose can be increased if needed * Max: 3600 mg/day * Postherpetic Neuralgia * Initiate at 300 mg once a day * Give 300 mg bid on day 2, then 300 mg tid on day 3 * Max for postherpetic neuralgia: 1800 mg/day * Notes about dosing: * Dose does need to be adjusted in renal impairment (with a CrCl < 60 mL/min) * When discontinuing Gabapentin, taper the dose over at least one week tom minimize seizure risk * Pharmacokinetics * Has saturable absorption * So doubling the dose does not double the serum concentrations of gabapentin * Neurontin is not metabolized * Excreted in the urine as unchanged drug * Contraindication * Hypersensitivity * Precautions * Can cause CNS depression which can impair physical and mental abilities * Use with caution in patients with depression or suicidal ideation * Use with caution in renal impairment * Adverse Drug Reactions * Most common * CNS depression (in the form of somnolence, dizziness, ataxia) * Peripheral edema * GI upset * MAJOR Drug Interactions * Use with other CNS depressants can have additive effects on CNS depression * Patients should avoid alcohol because of this * Antacids, if given at the same time, can decrease the bioavailability of gabapentin * Pregnancy Category/Breast feeding * Category C * Use with caution in breastfeeding * Safety Monitoring * Monitor patients mood for depression and thoughts of suicidal ideation * Efficacy Monitoring * Monitor for seizure or pain control (depending on indication) * Major Counseling Points * Gabapentin can cause CNS depression, so use caution performing tasks that require physical and mental alertness (especially during initial therapy) * Avoid alcohol because it can add to the CNS depression * Do not stop taking gabapentin without talking with your doctor or pharmacist first * Especially important if the patient is taking it for seizures) * Main side effects (drowsiness, dizziness, and GI upset) * Report any persistent or severe side effects References: * Gabapentin. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Aug 5]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Off-label uses of gabapentin: more scrutiny. Pharmacist's Letter/Prescriber's Letter 2010;26(5):260502. * Neurontin®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Gabapentin. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Aug 5]. [About 9 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes. | 8/5/10 | Free | View In iTunes |
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068 Zetia – Top 200 Prescribed Drugs | 068 Zetia (http://thestudentpharmacist.com/wp-content/uploads/068_Zetia.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: Ezetimibe (not available) * Brand Name: Zetia® * Mechanism of Action * Ezetimibe inhibits the absorption of cholesterol in the small intestines, which decreases cholesterol delivery to the liver * This causes a decrease in cholesterol stores and increases cholesterol clearance * Zetia's overall effect is a decrease in LDL cholesterol * Indications * Dyslipidemia or hypercholesterolemia * Familial sitosterolemia * Inherited lipid metabolic disorder that can lead to hypercholesterolemia * Note: In general Zetia® should only be considered if the patient is on the maximum tolerable dose of a statin and still not at LDL goal * That being said: According to the ARBITER-6 HALTS study, Niacin in combination with a statin is more effective than Zetia® in combination with a statin at reducing atherosclerosis even though it does not lower LDL as much as the Zetia/Statin combo * Dosage form * 10 mg tablet * Adult Dosing * 10 mg/day * Pharmacokinetics * Glucoronidated in the small intestines and liver (has active metabolite) * Contraindications * Hypersensitivity * Precautions * Use with caution in patients with hepatic impairment or renal impairment (being a CrCl < 30 mL/min) * Avoid use in severe hepatic impairment * Adverse Drug Reactions * Most common * Diarrhea * Fatigue * Arthralgia * Upper Respiratory tract infections * MAJOR Drug Interactions * The levels of both cyclosporine and ezetimibe may be increased when the two are used together * Use with fibric acid derivitaves (such as gemfibrozil) may increase the concentrations of Zetia® as well as the risk of gallstones (cholelithiasis) * Pregnancy Category/Breast feeding * Category C * Not recommended in breastfeeding * Safety/Efficacy Monitoring * Get a fasting lipid panel at baseline then periodically after initiation * Major Counseling Points * Take Zetia at the same time every day * If missed by 8 hours, skip that dose and return to normal dosing schedule upon next dose * Zetia not a replacement for diet and exercise and is meant to work with these lifestyle modifications to help lower your cholesterol * Go over common side effects (mainly diarrhea and fatigue) * Patients should report any severe or persistent side effects References: * Ezetimibe. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Aug 4]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Ezetimibe vs. niacin for atherosclerosis: the ARBITER 6-HALTS study. Pharmacist's Letter/Prescriber's Letter 2009;25(12):251212. * Zetia®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Zetia. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Aug 4]. [About 5 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 8/4/10 | Free | View In iTunes |
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067 Vitamin D3 – Top 200 Prescribed Drugs | Number 066, Hydrocodone and Acetaminophen, was also covered (001) This episode will focus on osteoporosis and Vitamin D3 (cholecalciferol), which is made by our bodies due to exposure to sunlight. Vitamin D2 (ergocalciferol) is made from plants. It is still effective for osteoporosis, but may not be as potent as Vitamin D3. 067 Vitamin D3 (http://thestudentpharmacist.com/wp-content/uploads/067_Vitamin_D3.mp3) Episode Notes (References Below) * Brand/Generic Available? * Vitamin D3 = Cholecalciferol * Some brand names include: * D3 * Maximum D3 * Mechanism of Action * Vitamins D2 and D3 are converted to 25-hydroxyvitamin D in the liver, which is then converted to 1,25 hydroxyvitamin D in the kidney * 1,25 hydroxyvitamin D is active vitamin D and stimulates the absorption of calcium as well as phosphorus in the intestines (so Vitamin D is needed for calcium absorption) * Vitamin D also stimulates bone mineralization * Indications (Vitamin D3) * Dietary Supplementation * Osteoporosis (prevention and treatment) * Dosage forms * Vitamin D3 (cholecalciferol) * Capsules * `1,000, 5,000, 10,000 and 50,000 IU * Softgel capsules * 2000 IU * Tablets * 400, 1,000 IU * Oral solution * 400, 2,000 IU * Adult Dosing * Dietary reference range is from 200-600 IU/day depending on age * Everyone 70 yo should get at least 600 IU/day * Osteoporosis prevention and treatment * 800-1000 IU/day * Max dose: 2000 IU/day * Pharmacokinetics * Vitamins D2 and D3 are converted to 25-hydroxyvitamin D in the liver, which is then converted to 1,25 hydroxyvitamin D in the kidney * Contraindications * Hypersensitivity * Hypercalcemia * Malabsorption syndrome * Vitamin D toxicity or Hypervitaminosis D * This can lead to hypercalcemia * Signs/symptoms include: * Constipation and GI upset (nausea/vomiting), decreased appetite, muscle weakness, and cardiac arrhythmias * Precautions * Use caution if the patient has any renal impairment or kidney stones * Adverse Drug Reactions * Vitamin D is generally well tolerated * Side effects may be signs of hypercalcemia (see above) * MAJOR Drug Interactions * There are no significant drug interactions * Use caution when using with other drugs that can cause hypercalcemia * Pregnancy Category/Breast feeding * Considered safe during pregnancy and breastfeeding * Safety Monitoring * Serum calcium and phosphorus levels * Signs of hypercalcemia (due to hypervitaminosis D) * Renal function * Efficacy Monitoring * Measure serum 25 hydroxyvitamin D levels at least 3 months after initiation * Levels > 30 ng/mL are considered healthy * Toxicity is usually not reached until levels are > 150 ng/mL * Patients should also get a central bone mineral density scan every 1-2 years References: * Cholecalciferol. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Aug 3]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Vitamin D dosing: an update. Pharmacist's Letter/Prescriber's Letter 2010;26(7):260707. * Vitamin D3. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Jun 1]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 8/3/10 | Free | View In iTunes |
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065 Yaz – Top 200 Prescribed Drugs | Sorry I haven't posted any episodes in a while. I was without internet then a little "under the weather" for a while. But to all those who have been patiently waiting, Thank you. And I'm back! 065 Yaz | 8/2/10 | Free | View In iTunes |
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064 Nasonex – Top 200 Prescribed Drugs | 064 Nasonex (http://thestudentpharmacist.com/wp-content/uploads/064_Nasonex.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic * Mometasone (NOT available) * Brand * Nasonex® * Mechanism of Action * Intranasal corticosteroid * Depresses release of inflammatory mediators (such as histamine and prostaglandins) * Also reduces intracellular edema and causes mild vasoconstriction * Indications * Allergic rhinitis * "Nasal corticosteroids are the most effective treatment for allergic rhinitis"2 * Nasal polyps * Dosage forms * Mometasone comes in different dosage forms, but Nasonex is: * Nasal suspension: 50 mcg/actuation * Adult Dosing * Allergic rhinitis * 2 sprays in each nostril once a day * If it is being used for prophylaxis/prevention of seasonal allergic rhinitis, then initiate Nasonex 2-4 weeks before pollen season * Nasal polyps * 2 sprays in each nostril once or twice a day * Pharmacokinetics * Nasonex (being a nasal suspension) has minimal systemic absorption and is not detectable in plasma (but mometasone is metabolized in the liver by CYP3A4) * Contraindications * Hypersensitivity * Precautions * In general, avoid use if any nasal ulcers or wounds are present * Wait until the issue is healed to use Nasonex * Adverse Drug Reactions * Most common * Headache * Cough * Upper respiratory tract infections * Nose bleed (epistaxis) * MAJOR Drug Interactions * Because it is a nasal supsension and not really absorbed systemically, I don't see any significant drug interactions * Pregnancy Category/Breast feeding * Category C * Use with caution in breastfeeding * Safety/Efficacy Monitoring * Relief of symptoms * Major Counseling Points * Prime the pump before first use * Shake well then pump the bottle ~10 times until you see a mist come out * You also want to pump the bottle 2 times until a mist appears if you have not used it in a week or longer * Go over how to administer * Shake the bottle well and blow your nose before each use * Tilt your head forward and insert applicator into one nostril * Close the other nostril * Spray Nasonex into the nostril and inhale through your nose, then out through your mouth * Repeat this step if using 2 sprays per nostril * Then do the same thing for the other nostril * Then clean the tip and replace the cap after use * Each Nasonex bottle should be discarded after 120 actuations (usually 30 days of use) even if there is still liquid in the bottle * Main side effects (headache, cough, nose bleed) * As always, report any persistent or severe side effects References: * Mometasone. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jul 28]. [about 13 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Drug Treatments for Allergic Rhinitis. Pharmacist's Letter/Prescriber's Letter 2006;22(4):220414 * Nasonex®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Nasonex. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Jul 28]. [About 5 p.]. Available from: https://online.epocrates.com/noFrame/ * The Right Way to Spary Nasonex [Internet]. Scheric Corp. [Cited 2010, Jul 28]. [About 2 p.]. Available from: http://www.nasonex.com/nasx/application?namespace=main&event=content_display&event_input=waytospray * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 7/28/10 | Free | View In iTunes |
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063 Cephalexin – Top 200 Prescribed Drugs | 063 Cephalexin (http://thestudentpharmacist.com/wp-content/uploads/063_Cephalexin.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic * Cephalexin (available) * Brand * Keflex * Mechanism of Action * Cephalosporin antibiotic * Acts similar to beta-lactam antibiotics * Inhibits peptidoglycan synthesis in bacterial cell walls by binding penicillin binding proteins * This prevents the formation of the cell wall and causes the bacteria to eventually lyse * Indications * Susceptible bacterial infections * Some common uses include (not a complete list): * Respiratory infections * Skin/soft tissue infections * Otitis media * Urinary tract infections * Dosage forms (for generic) * Capsules * 250, 500 mg * Powder for suspension * 125, 250 mg/5mL * Tablets * 250, 500 mg * Adult Dosing * Dose and duration depends on the infection type and severity * Typical dose range: 250-1000 mg every 6 hours * Max: 4 g/day * Notes about dosing * Adjust dose in renal impairment * CrCl < 50 mL/min: Use up to 500 mg 2-3 times a day * Pharmacokinetics * Minimally metabolized * Excreted in the urine mainly as unchanged drug * Contraindications * Hypersensitivity * Precautions * Use with caution in patients with penicillin allergy * Use with caution in renal impairment (adjust dose if CrCl < 50 mL/min) * Prolonged use can lead to super infections such as CDAD * Adverse Drug Reactions * Most common * GI upset * Headache * Rash * Dizziness * MAJOR Drug Interactions * Cephalexin can increase the concentrations of Metformin * Probenecid can increase the concentrations of Cephalosporins * Pregnancy Category/Breast feeding * Category B * Use with caution in breastfeeding * Safety Monitoring * Monitor for anaphylaxis especially just after the first dose * Monitor renal and hepatic function with prolonged use * Efficacy Monitoring * Relief of symptoms and infection * Culture and sensitivity initially * Major Counseling Points * Take entire prescription (even if you feel better) * Main side effects (GI upset, headache, dizziness) * Take with food if GI upset is an issue * Talk to your doctor if your condition worsens or dose not improve upon completing the prescription * Can decrease the effectiveness of birth control * Use back up form of contraception to be safe References: * Cephalexin. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jul 26]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Keflex. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Cephalexin. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Jul 26]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 7/26/10 | Free | View In iTunes |
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062 Vytorin – Top 200 Prescribed Drugs | 062 Vytorin (http://thestudentpharmacist.com/wp-content/uploads/062_Vytorin.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic * Ezetimibe and Simvastatin (Not available) * Brand * Vytorin® * Mechanism of Action * Simvastatin (Zocor) (already covered as the 014 most prescribed drug) * Statin * Inhibit HMG-CoA reductase, which is involved in the rate limiting step of the synthesis of cholesterol * This decreases the amount of cholesterol the body can produce which results in an increase LDL receptors on hepatocytes and LDL clearance and catabolism * Ezetimibe (Zetia) * Ezetimibe works on the brush border of the small intestines by inhibiting the absorption of cholesterol, which decreases the amount of LDL reaching the liver * Indications * High cholesterol or hyperlipidemia * Dosage forms * Tablets * All contain 10 mg of ezetimibe * 10, 20, 40, 80 mg * Adult Dosing * Depends on patient response * On average, Vytorin can lower LDL by 45-60% depending on the dose * Ezetimibe portion should be 10 mg/day * Dose range for Simvastatin: 10-80 mg/day BUT * Increasing from 40 mg to 80 mg only lowers LDL ~6% more but increases the risk of myopathy by 6 times!! * General rule: If patients need more LDL lowering and are on 40 mg, consider switching to Atorvastatin or Rosuvastatin * Pharmacokinetics * Simvastain * Onset of action = 3-5 days * Max effect is seen at about 2 weeks * Metabolized hepatically by CYP3A4 * Ezetimibe * Glucoronidated in the small intestines and liver (has active metabolite) * Contraindications * Hypersensitivity * Acute liver disease * Increased transaminases or liver function tests (LFTs) * Pregnancy * Breastfeeding * Precautions * Myopathy (muscle paint)/rhabdomyolysis (muscle breakdown) * Dose related risk * Make sure patient is on lowest effective dose * Risk is increased with concurrent use of 3A4 inhibitors, fibric acid derivatives (such as gemfibrozil), or niacin at doses ≥ 1 g/day * Use with caution in the elderly (they are at increased risk of developing myopathy) * Rhabdomyolysis can result in acute renal failure if not controlled * Tell patient to report any unexplained muscle pain, tenderness or weakness, or brown urine * Hepatic impairment * Use with caution in patients with a history of liver impairment or who consume large amounts of alcohol * Use is contraindicated in acute liver disease * Patients should avoid excess alcohol * Adverse Drug Reactions * Headache * GI upset (Diarrhea) * Increased LFTs (ALT) * Muscle pain * Upper respiratory tract infections * MAJOR Drug Interactions * Look for 3A4 inhibitors (increase concentrations of simvastatin) * Strong 3A4 inhibitors: * * Azole antifungals (Ketoconazole and itraconazole) * Erithromycin and clarithromycin * PIs (Protease Inhibitors) * To limit risk of myopathy/rhabdomyolysis, SImvastatin dose is limited if given with the following medications: * Cyclosporine OR Gemfibrozil: Max = 10 mg/day * Amiodarone OR Verapamil: Max = 20 mg/day * Diltiazem: Max = 40 mg/day * Pregnancy Category/Breast feeding * Category X (contraindication) * Contraindicated in breastfeeding * Safety Monitoring * At baseline (or upon change in dose): * Measure Creatine Phosphokinase and look at muscle symptoms * LFTs * LFTs again at 12 weeks then semiannually * If LFTs increase > 3 x ULN dc statin * Can reinitiate the same statin or a different on once LFTs return to normal * Evaluate/ask about muscle symptoms at every visit * If patient complaints of abnormal muscle pain or weakness, then recheck Creatine Phosphokinase (dc if muscle pain is severe or CPK increases > 10 x ULN) | 7/22/10 | Free | View In iTunes |
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061 Aricept – Top 200 Prescribed Drugs | 061 Aricept (http://thestudentpharmacist.com/wp-content/uploads/061_Aricept.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic * Donepezil (not available) * Brand * Aricept® * Mechanism of Action * Inhibits acetylcholinesterase (which normally hydrolyzes acetylcholine) in the CNS * Increases concentration of acetylcholine in the CNS * Important for Alzheimer's, which is characterized by a cholinergic deficiency in the CNS * Does not stop the progression of Alzheimer's * Aricept is modestly effective in slowing cognitive loss associated with Alzheimer's disease for at least 6 months * Indications * Alzheimer's Disease (1st line treatment) * Off labeled * ADHD * Dementia associated with Parkinson's disease * Dosage forms * Tablets * 5, 10 mg * Orally disintegrating tablets * 5 mg * Adult Dosing * Alzheimer's * Initiate 5 mg/day * Dose can be increased to 10 mg/day after 1 month * Notes about dosing * Each dose should be taken at bedtime * Orally disintegrating tablet should be allowed to dissolve on the tongue and then followed with water * Pharmacokinetics * Metabolized in the liver by CYP3A4 and 2D6 * Has two active metabolites * Also undergoes glucoronidation * Excreted in the urine and feces * Contraindications * Hypersensitivity * Relative contraindication * Bradycardia * Precautions * Can cause bradycardia, heart block, and cardiac conduction abnormalities * Use with caution in patients with cardiovascular issues * Use with caution in patients with COPD or asthma as well as a history of seizures * Can exacerbate urinary tract obstructions * Use with caution in patients with BPH (benign prostatic hyperplasia) * Adverse Drug Reactions * Most common * GI upset (usually resolves within 3 weeks) * Insomnia * Accidental injury * Headache * MAJOR Drug Interactions * Aricept® can increase the neuromuscular-blocking effect of Succinylcholine and other depolarizing blocking agents * Decrease the effects of NON-depolarizing neuromuscular blocking agents * Anticholinergics (with the exception of paliperidone) may decrease the therapeutic effects of Aricept® * Corticosteroids may increase the adverse side effects of Aricept® * Pregnancy Category/Breast feeding * Category C * Not recommended in breastfeeding * Safety/Efficacy Monitoring * Cognitive and social functioning * Major Counseling Points * Aricept® is not a cure Alzheimer's disease, but may slow its progression and reduce symptoms * Take each dose at night before bed * If taking the orally disintegrating tablets, allow them to dissolve and then follow with a glass of water * Main side effects (GI upset, insomnia, headache) * GI upset should subside within 3 weeks * Report any persistent or severe side effects References: * Donepezil. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jul 21]. [about 5 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Drug treatment of dementia due to Alzheimer's disease. Pharmacist's Letter/Prescriber's Letter 2006;22(10):221005. * Aricept®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Aricept. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Jun 1]. [About 7 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 7/21/10 | Free | View In iTunes |
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060 Celebrex – Top 200 Prescribed Drugs | 060 Celecoxib (http://thestudentpharmacist.com/wp-content/uploads/060_Celebrex.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic: * Celecoxib (not available) * Brand * Celebrex * Mechanism of Action * NSAID * COX-2 inhibitor * Selectively inhibits COX-2 which results in inhibition of prostaglandin synthesis * The prostaglandins produced by the COX-2 pathway have a role in pain, fever, and tissue repair among other things * Celebrex has antipyretic, analgesic, and anti-inflammatory properties * Indications * Osteoarthritis * Rheumatoid arthritis * Dysmenorrhea * Acute pain * Ankylosing spondylitis * Familial adenomatous polyposis * Dosage forms * Capsules * 50, 100, 200, 400 mg * Adult Dosing * Typical dose ranges from 200-400 mg/day usually as a 2 divided doses * Notes about dosing: * For poor CYP2C9 metabolizers, you may need to reduce the dose by 50% * Celebrex's use is not recommended in severe renal or hepatic impairment * Always want to use the lowest effective dose for the shortest duration of time * Pharmacokinetics * Metabolized in the liver by CYP2C9 * Inhibits CYP2D6 and 2C8 * Excreted in the urine and feces * Black Box Warnings * Celecoxib may increase the risk of cardiovascular thrombotic events such as MI or stroke * Risk may be increased in patients with cardiovascular issues and its recommended to avoid use in patients with heart failure * Celecoxib's use is contraindicated for treating (Coronary Artery Bypass Graft) CABG peri-operative pain * NSAIDs may increase risk of gastrointestinal irritation, ulceration, and bleeding * NOTE: Since Celebrex is selective for COX-2, it is more likely to cause the cardiovascular complications and less likely to cause the GI issues * * When only COX-2 is inhibits (as with celecoxib), it can increase the proliferation of COX-1 * COX-1 is GI protective to some extent but also increases platelet aggregation, which can lead to the development of a thrombus or MI * Contraindications * Hypersensitivity to Celecoxib, sulfonamides, aspirin, or NSAIDs * CABG Peri-operative pain * Precautions * Anaphylaxis is a concern * Again, use is contraindicated in patients with hypersensitivity to NSAIDs * Poor CYP2C9 metabolizers will most likely need the dose to be decreased by 50% * Use is not recommended in patients with severe hepatic or renal impairment * Adverse Drug Reactions * Most common * Hypertension * Headache * GI upset (mainly as diarrhea) * MAJOR Drug Interactions * Definitely want to look for drugs that induce or inhibit CYP2C9 * Also want to look for drugs metabolized by CYP2C8 and 2D6 (because both are inhibited to some extent by Celebrex) * NSAIDs can decrease the therapeutic effects of ACE-Is and ARBs * NSAIDs can increase the effects of anticoagulants and warfarin * Alcohol can increase GI irritation * Pregnancy Category/Breast feeding * Category C prior to 30 weeks gestation * Category D thereafter * Enters breast milk: Not recommended in breastfeeding * Safety Monitoring * Get a CBC as well as monitor renal and hepatic function periodically with longterm therapy * Efficacy Monitoring * Depends on the indication * Relief of symptoms (such as decreased pain, fever, inflammation) * Major Counseling Points * Take with food to reduce GI upset * Other common side effect is headache * Talk with your doctor or pharmacist before taking other NSAIDs * Report any persistent or severe side effects References: * Celecoxib. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jul 20]. [about 15 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Celebrex®. | 7/20/10 | Free | View In iTunes |
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059 Tricor – Top 200 Prescribed Drugs | Note: 056 Omeprazole, 057 Oxycodone/APAP, and 058 Alprazolam have been covered in previous episodes 059 Tricor (http://thestudentpharmacist.com/wp-content/uploads/059_Tricor.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic * Fenofibrate * Available in some dosage forms (micronized capsule and tablet) * Brands * Tricor® * Antara® * Fenoglide® * Lipofen® * Lofibra® * Triglide® * Mechanism of Action * Fibric acid derivative * Prodrug (fenofibrate is converted to its active form, fenofibric acid) * PPAR-alpha agonist = results in inhibition of triglyceride synthesis and catabolism of triglyceride rich lipoproteins * Decrease VLDL * 30-60% Decrease in triglycerides * Can cause increase in HDL in some patients * Indications * Hypertriglyceridemia * Hypercholesterolemia * Dosage forms * Different brands are available in different strengths/dosage forms * Capsules, Micronized capsules, Tablets * Tricor® Tablets * 48, 145 mg * Adult Dosing * Hypertriglyceridemia or hypercholesterolemia * 48-145 mg/day * Max 145 mg/day * Notes about dosing * Renal impairment * CrCl 30-80 mL/min: 48 mg/day * Contraindicated if CrCl 3 x ULN * CBC periodically during first year or therapy * Efficacy Monitoring * Lipid panel at baseline * Major Counseling Points * Tricor is not a replacement for diet and exercise and should be used along with these lifestyle changes * Take each dose with food to increase absorption * Go over main side effects (Headache and GI upset) * Patient should report any unexplained muscle pain or weakness to their doctor or pharmacist * Report any other persistent or severe side effects References: * Fenofibrate. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jul 19]. [about 11 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Tricor. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. | 7/19/10 | Free | View In iTunes |
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055 Amoxicillin and Clavulanate | 055 Amoxicillin & Clavulanate (http://thestudentpharmacist.com/wp-content/uploads/055_Amoxicillin_Clavulanate.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic * Amoxicillin & Clavulanate (Available excluding the extended release tablets) * Brand name * Augmentin® * Amoclan * Mechanism of Action * Beta-lactam antibiotic * Amoxicillin binds penicillin binding proteins (PBPs) which inhibits bacterial cell wall synthesis causing bacteria to eventually lyse (bactericidal) * Clavulanate is a beta-lactamase inhibitor * When present, beta-lactamases inactivate amoxicillin * So clavulanate inhibits beta lactamases, which extends the spectrum of activity of amoxicillin * Indications * Susceptible bacterial infections such as: * Otitis media * Sinusitis * Respiratory tract infections * Skin/soft tissue infections * Urinary tract infections * Dosage forms (Amoxicillin-Clavulanate mg) * Oral suspension * 250-62.5 mg/5 mL * 600-42.9 mg/5mL * Tablets * 250, 500, and 875 mg amoxicillin * All have 125 mg clavulanate * Chewable tablets * 400-57 mg * Extended-release (12 hour) Tablets (Augmentin XR™) * 1,000-62.5 mg * Not available generically * Adult Dosing (Based on Amoxicillin content/dose) * Dose and duration will vary based on indication and severity * Scheduling will also vary based on specific dosage form and strength used * A typical dose can range from 750 mg to 4 grams/day given as divided doses * Few examples: * Diabetic foot ulcer, Acute bacterial sinusitus, and community acquired pneumonia: * Extended release: 2000 mg every 12 hours for ~10 days * COPD exacerbation, animal bite wound, or skin abcess: * 875 mg every 12 hours * Notes about dosing: * Dose may need to be adjusted in renal impairment * CrCl < 30 mL/min: Avoid 875 mg tablets and extended release tablets * CrCl 10-30: up to 500 mg every 12 hours * CrCl < 10: up to 500 mg every 24 hours * Each dose should be taken with food to increase absorption and decrease GI upset * Oral suspension should be shaken well before each dose * Pharmacokinetics * Amoxicillin * Eliminated renally (mainly as unchanged drug) * Which is why you adjust the dose in renal impairment * Clavulanate * Metabolized in the liver * Excreted in the urine * Contraindications * Hypersensitivity (includes penicillin) * History of liver dysfunction or cholestatic jaundice with amox/clav * Extended release Augmentin XR™ is also contraindicated in severe renal impairment (CrCl < 30 mL/min) * Precautions * Hypersensitivity is a big concern * Use with caution in patients with hepatic impairment * Prolonged use can result in super infections such as Clostridium difficile associate diarrhea (CDAD) * Adverse Drug Reactions * Most common side effect is GI upset * Mainly as diarrhea * Can also cause abdominal pain, nausea, and vomiting * Rash is also relatively common * MAJOR Drug Interactions * Tetracycline derivatives can decrease the therapeutic effect of amoxicillin * Pregnancy Category/Breast feeding * Category B * Use caution in breast feeding * Safety Monitoring * Monitor for anaphylaxis during the first dose * Monitor renal, hepatic, and hematologic functioning periodically with prolonged use * Efficacy Monitoring * Culture and sensitivity testing at baseline * Relief of symptoms * Major Counseling Points * Each dose should be taken with food to increase absorption and decrease GI upset (which is the main side effect of Amoxicillin) * Take entire prescription (even if you feel better) * Talk to your doctor if your condition worsens or dose not improve upon completing the prescription * Can decrease the effectiveness of birth control | 7/16/10 | Free | View In iTunes |
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054 Lantus – Top 200 Prescribed Drugs | 054 Lantus (http://thestudentpharmacist.com/wp-content/uploads/054_Lantus.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic * Insulin Glargine (Not available) * Brand * Lantus® * Mechanism of Action * Long acting analog of insulin * Stimulates the uptake of glucose in the periphery * Inhibits glucose production in the liver * Inhibits proteolysis and lypolysis * Overall, regulates glucose metabolism * Indications * Type 1 and 2 Diabetes Mellitus * Dosage forms * Injection solution * 100 units/mL * Available in 3 and 10 mL vials * Also available in Lantus pen * Adult Dosing * Dose is going to be patient-specific * Type 1 Diabetes (Insulin Dependent) * Insulin is considered 1st line therapy * Usual OVERALL insulin requirements: 0.5-1 unit/kg/day * Dose is adjusted accordingly * Type 2 Diabetes (Non-Insulin Dependent) * Insulin is generally not considered 1st line unless Hb A1C is greatly elevated (≥ 8.5%), in which case medication alone would not be sufficient to lower A1c to goal (180 * If BG > 180, then you can increase by 4 units every 3 days * Notes about dosing: * Insulin glargine is given subcutaneously and should be clear * Lantus® should not be diluted or mixed with any other insulins in the same syringe * Each daily dose should be given at the same time everyday * Pharmacokinetics * Onset of action: ~1 hour * Duration: ~24 hours * Onset and duration can vary based on site of injection, exercise, temperature and other factors * Unlike other insulin products, Lantus® does not have a peak * This is because Lantus®, when injected, forms microprecipitates which allow the release of small amounts over time * Metabolized to some extent (skin, liver, and kidney) and has 2 active metabolites * Excreted in the urine * Contraindications * Hypersensitivity * Precautions * Hypoglycemia is the main concern * There are many aspects that can increase the risk of hypoglycemia such as not eating, taking too much insulin, and increased physical activity * Patients should check their blood glucose often, especially during initial therapy or during times if increased stress such as illness or emotional disturbances * Make sure patients know the signs/symptoms of hypoglycemia and what to do if hypoglycemia occurs * Hypokalemia is another concern * Insulin can cause hypokalemia which, if untreated can lead to serious cardiac and respiratory conditions * Because of this, electrolytes (especially potassium) should be monitored * Use caution if switching insulin formulations (the dose may need to be changed) * Dose may need to be altered in hepatic or renal impairment * Adverse Drug Reactions * Hypoglycemia * Hypokalemia * Injection site reactions * Weight gain can also occur * MAJOR Drug Interactions * Minimal drug interactions overall * Look for medication that can cause HYPERglycemia (such as corticosteroids or thiazide diuretics) * Look for medications that can increase the risk of HYPOglycemia (such as other anti-diabetic medications or beta blockers) * Pregnancy Category/Breast feeding * Category C * Insulin is widely used to treat diabetes in pregnancy and there are other insulin preparations that are category B * Preliminary data indicates that Lantus® is likely safe in pregnancy but more data is needed for it to be routinely recommended * Considered compatible with breastfeeding * Safety/Efficacy Monitoring * Plasma glucose * Electrolytes | 7/15/10 | Free | View In iTunes |
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053 Atenolol – Top 200 Prescribed Drugs | Note: The number 052 most prescribed drug, hydrochlorothiazide, is also the number 021 most prescribed drug and has already been covered 053 Atenolol (http://thestudentpharmacist.com/wp-content/uploads/053_Atenolol.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic * Atenolol (available) * Brand * Tenormin® * Mechanism of Action * Beta Blocker * Selectively blocks Beta-1 receptors * Cardio-selective * Decreases HR, Cardiac output, and BP * Can lose selectivity at higher doses * Indications * Hypertension * Angina pectoris * Secondary prevention post-MI * Unlabeled uses: * Acute ethanol withdrawal * Arrhythmias * Migraine prophylaxis * Dosage forms * Tablets * 25, 50, 100 mg * Adult Dosing * Hypertension * Initiate at 50 mg/day * Dose can be increased after 1 week * Max 100 mg/day * Angina * Initiate at 50 mg/day * Dose can be increased after 1 week * Max 200 mg/day * Cardiovascular Protection Post-MI * 100 mg/day * Initiate once patient is stable * Notes about dosing * Dose needs to be adjusted in Renal Impairment * CrCl 15-35 mL/min * Max: 50 mg/day * CrCl < 15 mL/min * Max: 50 mg every other day * Taper slowly when/if discontinuing!! * Pharmacokinetics * Peak effect seen in 2-4 hours * Duration of action 12-24 hours * Limited metabolism in the liver * Excreted in the urine and feces * Black Box Warning * Abrupt withdrawal can result in angina, MI, ischemia, and HTN * Taper gradually over 1-2 weeks * Restart treatment (at least temporarily) if any of the above occur * Contraindications * Hypersensitivity * Sinus bradycardia (heart rate < 45 bpm) * 2nd or 3rd degree heart block * Uncompensated heart failure * Pulmonary edema * Untreated pheochromocytoma * Cardiogenic shock * Pregnancy * Precautions * BBs can cause hypotension * Can potentially worsen bronchospastic conditions such as asthma * Since atenolol is cardio-selective it can be used with caution in patients with asthma * Caution in patients with diabetes * BBs can mask the s/s of hypoglycemia * Note: Sweating is the only sign of hypoglycemia NOT masked by BBs * Adverse Drug Reactions * Most common * Bradycardia * Hypotension * Fatigue * Drowsiness * GI upset (nausea, constipation, diarrhea) * MAJOR Drug Interactions * Use with a non-DHP calcium channel blocker (verapamil or diltiazem) can have additive effects on bradycardia and heart block * Use with clonidine or other centrally acting alpha 2 agonists may decrease anti-hypertensive response and increase the risk of rebound hypertension * Ampicillin can decrease the bioavailability of atenolol, which would decrease its effects * NSAIDs can decrease the effects of beta-blockers * Pregnancy Category/Breast feeding * Category D (contraindication) * Does enter breast milk (use with caution) * Safety/Efficacy Monitoring * Blood pressure * Heart Rate * Major Counseling Points * DO NOT stop taking atenolol w/out talking w/ your Dr. or Pharm.D * Can result in cardiovascular complications <--- Very important * Continue to take the medication even if you feel better * Tenormin® is not a replacement for diet and exercise and should be used along with these lifestyle changes * Avoid alcohol * May increase sedation and dizziness * Main side effects (GI upset, bradycardia, hypotension, drowsiness) * Because of the hypotension, go from sitting or lying to standing slowly (especially w initial therapy) * If diabetic * BBs can mask s/s of hypoglycemia except sweating References: * Atenolol. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jul 14]. [about 14 p.]. | 7/14/10 | Free | View In iTunes |
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051 Omeprazole – Top 200 Prescribed Drugs | 051 Omeprazole (http://thestudentpharmacist.com/wp-content/uploads/051_Omeprazole.mp3)Episode Notes (References Below) * Brand/Generic Available? * Generic * Omeprazole (Available) * Brand * Prilosec® (available over the counter) * Mechanism of Action * Proton pump inhibitor (PPI) * Inhibits H/K-ATPase in gastric parietal cells which suppresses gastric acid secretion * Indications * Duodenal ulcer * Gastric ulcer * GERD * Erosive Esophagitis * H. Pylori infection * Hypersecretory conditions * Dosage forms * Delayed release Capsules * 10, 20, 40 mg * Delayed release Tablets * 20, 40 mg * Granules for oral suspension * 2.5 and 10 mg/packet * Not available generically * Adult Dosing * Typical dose is 20-40 mg depending on the indication and can be up to 120 mg three times a day for hypersecretory conditions * 20 mg/day for duodenal ulcers and 40 mg/day for gastric ulcers for 1-2 months * Erosive esophagitis: 20 mg/day for up to a year (this includes maintenance therapy) * GERD: 20 mg/day for 4 weeks * Max is 80 mg/day * Maintenance therapy for GERD: 10 mg/day or 20 mg every other day * Notes about dosing * The over the counter labeling for heartburn recommends 20 mg/day for no more than 2 weeks (can be repeated every 4 months) * So, patients should not self treat for heartburn for more than 2 weeks * If more treatment is needed then patients should talk with their doctor or pharmacist * Tablets or capsules be swallowed whole (do not crush or chew) * If the capsules cannot be swallowed, the contents of the capsules can be mixed in with ~1 tablespoon of applesauce * Pharmacokinetics * Onset of action: ~1 hours * Absorption is delayed by food * Metabolized in the liver by 2C19 (mainly) and 3A4 * Excreted in the urine and feces * Contraindications * Hypersensitivity * Precautions * Long term use can lead to increase fracture risk * Use caution in patients with sever hepatic impairment * May need to decrease the dose * Adverse Drug Reactions * * Generally well tolerated * Most common * Headache * GI upset (abdominal pain, nausea, and diarrhea * MAJOR Drug Interactions * Watch for drugs that interact with 2C19 and 3A4 * Clopidogrel (Plavix) (antiplatelet agent) * PPIs may reduce the production of the active metabolite of Clopidogrel * Other acid lowering therapies do not appear to have this problem such as H2 antagonists (except cimetidine) or antacids * Pregnancy Category/Breast feeding * Category C * Not recommended in breast feeding * Safety and Efficacy Monitoring * Relief of symptoms * Healing of Gastric Mucosa * Prevention of further complication * Major Counseling Points * Once daily dosing should be taken first thing in the morning on an empty stomach (about 30 minutes to an hour before breakfast) * Avoid alcohol (alcohol can add to GI irritation) * Not recommended to self-treat for GERD or heartburn for more that 2 weeks * Patients should talk with their doctor or pharmacist if longer treatment is needed * Tablets or capsules be swallowed whole (do not crush or chew) * If the capsules cannot be swallowed, the contents of the capsules can be mixed in with ~1 tablespoon of applesauce * Main side effects (possible GI upset and headache) * Report any persistent or severe side effects to your doctor or pharmacist References: * Omeprazole. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jul 13]. [about 12 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline. * Prilosec®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Omeprazole. In: Epocrates Online [Internet]. | 7/13/10 | Free | View In iTunes |
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050 Prednisone – Top 200 Prescribed Drugs | 050 Prednisone (http://thestudentpharmacist.com/wp-content/uploads/050_Prednisone.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic * Prednisone (Available) * Brands * Prednisone Intensol™ * Sterapred® * Mechanism of Action * Corticosteroid * Prodrug * Converted to prednisolone (active) in the liver * Prednisolone binds alpha and beta glucocorticoid receptors, which are found in nearly all body tissues * Has glucocorticoid and mineralocorticoid effects * Effects include: * Anti-inflammatory * Immune suppression * Anti-tumor * Anti-emetic * Can cause adrenal suppression at high dose * Indications * Many indications including (but not limited to) disorders/conditions pertaining to: * Allergies * Autoimmune * Dermatologic conditions * GI * Endocrine * Hematologic * Respiratory * Neoplastic diseases * Dosage forms (for generic) * Oral solution * 1 mg/mL * Tablets * 2.5, 5, 10, 20, 50 mg * Adult Dosing * Dosing and duration will vary based on indication and severity * General dosing range is 5-60 mg/day * Few examples: * Asthma exacerbation: 40-60 mg/day for 3-10 days * Rheumatoid arthritis: up to 10 mg/day * Notes about dosing * Should be taken with food to decrease GI upset * Should be tapered to discontinue after prolonged use * Discussed more in "precautions" * Pharmacokinetics * Prodrug * Converted to prednisolone (active) in the liver * Minor substrate for CYP3A4 * Contraindications * Hypersensitivity * Systemic fungal infections * Live vaccines within 3 months * Precautions * Adrenal suppression or suppression of the hypothalamic-pituitary (HPA) axis * Dose and duration dependent * Corticosteroids should be tapered slowly when discontinuing if they where given for an extended period of time * Depends on what resource you use but, in general, corticosteroids do not need to be tapered if used for less than 2-3 weeks UNLESS abrupt discontinuation may cause a flare (as in poison ivy) or if the patient is very ill * Good rule of thumb: Prednisone should be tapered if ≥ 20 mg is used for ≥ 3 weeks * Taper by 5-20% every 1-2 weeks * Prolonged use can also cause immunosuppression, which can increase the risk of infection * Corticosteroids can cause HYPERglycemia, especially in patients with diabetes * Use with caution in patients with heart failure, due to possible fluid retention and hypertension associated with corticosteroids * Use with caution in patients with increased risk of osteoporosis, especially with prolonged use * Corticosteroids interfere with calcium absorption * Use with caution in hepatic impairment * Dose may need to be adjusted * Adverse Drug Reactions * Most common: * Headache * GI upset * Take with food to decrease * Avoid alcohol * Edema * Insomnia * HYPERglycemia * Increased blood pressure * MAJOR Drug Interactions * Live vaccines are contraindicated within 3 months of corticosteroid discontinuation * Avoid use with growth hormone * Combination can decrease efficacy of both drugs * Avoid use with Natalizumab * Combination can increase the risk of infection * Corticosteroids can increase bleeding risks when given with warfarin * Pregnancy Category/Breast feeding * Category C * Considered compatible with breastfeeding according to the American Academy of Pediatrics (AAP) * Safety Monitoring * Blood pressure * Blood glucose (especially in patients with diabetes) * Electrolytes * With prolonged use: * Bone density * Signs and symptoms of infection * Efficacy Monitoring * Depends on the indication * Overall, relief of symptoms * Major Counseling Points | 7/12/10 | Free | View In iTunes |
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049 Fluoxetine – Top 200 Prescribed Drugs | 049 Fluoxetine (http://thestudentpharmacist.com/wp-content/uploads/049_Fluoxetine.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic * Fluoxetine (available) * Brands * Prozac® * Prozac® Weekly™ * Sarafem® * Mechanism of Action * Antidepressant * Selective Serotonin Re-uptake Inhibitor (SSRI) * Inhibits re-uptake of serotonin (5-HT) in the CNS (so it stays in the synapse longer) * Indications * Major Depressive Disorder * Moderate-severe Bulimia Nervosa * Obsessive compulsive Disorder * Premenstrual Dysphoric Disorder * Panic Disorder * Dosage forms * Capsules * 10, 20, 40 mg * Delayed release capsules (Prozac® Weekly™) * 90 mg * Not available generically * Oral solution * 20 mg/5 mL * Tablets * 10, 20 mg * Adult Dosing (Immediate release) * Typical dose ranges from 20-80 mg/day depending on indication * Both Major Depressive Disorder & Obsessive compulsive Disorder * Initiate at 20 mg/day * Max: 80 mg/day * Moderate-severe Bulimia Nervosa * Titrate to 60 mg/day * Premenstrual Dysphoric Disorder * 20 mg/day * Panic Disorder * Initiate at 10 mg/day * Max: 60 mg/day * Notes about dosing: * Dose should always be titrated over several weeks for higher doses * Dose or frequency may need to be decreased in hepatic impairment * According to the Beers Criteria, Fluoxetine is considered "high severity risk" in elderly patients * If used in elderly patients, start low (10 mg) and titrate slow as tolerated * Pharmacokinetics * Onset of action takes about a week and full effects may not be seen for up to 3 months * Metabolized in the liver via CYP2C19 and 2D6 * Has an equally active metabolite (norfluoxetine) * Elimination half life is about 9 days (norfluoxetine) * Excreted in the urine as metabolites and unchanged drugs * Black Box Warnings * Antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with MDD and other psychiatric disorders * Observe patients for suicidal ideology especially during the 1st few months of therapy * Reason/mechanism: Antidepressants in general increase energy/appetite before they affect mood… giving the patient the energy needed for suicid * Contraindications * Hypersensitivity * Concurrent use with MAO inhibitors * Fluoxetine should not be initiated within 2 weeks of MAO inhibitors and MAO inhibitors should not be used within 5 weeks of fluoxetine discontinuation * Concurrent use with * Pimozide * Thioridazine * Precautions * Can inhibit platelet aggregation = increased risk of bleeding (especially in patients taking NSAIDs or anticoagulants) * Serotonin Syndrome (symptoms below) can develop * Agitation or restlessness * Fast heart beat * Rapid changes in blood pressure * Hallucinations * Increased body temperature * Loss of coordination * Overactive reflexes * N/V/D * Sexual dysfunction can occur * reversible upon discontinuation * Use with caution in patients with increased risk for seizures (brain damage or alcoholism) * May cause HYPOglycemia especially in patients with diabetes * Fluoxetine may cause anorexia and/or weight loss * With most SSRIs, withdrawal syndrome is possible upon discontinuation or dosage decrease * This is usually not an issue with fluoxetine due to fluoxetine's long half life * Adverse Drug Reactions * Most common * Headache * Insomnia * Anxiety * Decreased libido * GI upset * Neuromuscular weakness * MAJOR Drug Interactions * Alcohol can have an additive effect on CNS depression * Use with caution with other drugs that can lower the seizure threshold * Avoid concurrent use with pimozide or thioridazine | 7/11/10 | Free | View In iTunes |
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048 Levaquin – Top 200 Prescribed Drugs | 048 Levaquin (http://thestudentpharmacist.com/wp-content/uploads/048_Levaquin.mp3) Episode Notes (References Below) * Brand/Generic Available? * Generic * Levofloxacin (NOT available) * Brand * Levaquin® * Other brand names (... | 7/8/10 | Free | View In iTunes |
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047 Tramadol – Top 200 Prescribed Drugs | 047 Tramadol (http://thestudentpharmacist.com/wp-content/uploads/047_Tramadol.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand Names * Ryzolt™ * Ultram® * Ultram® ER * Generic * Tramadol (Available) * Mechanism of Action * Analgesic * Binds mu-opiod receptors in the CNS AND weakly inhibits norepinephrine and serotonin reuptake, all of which decreases pain * Has an active metabolite (O-desmethyl tramadol) with the same mechanism of action * Indications * Relief of moderate to severe pain * Dosage forms * Immediate Release Tablet * 50 mg * Extended Release (24 hour) Tablet * 100, 200 mg (generic) * Brand names Ryzolt™ and Ultram® ER (which are 24 hour tablets) also come in 300 mg * Adult Dosing * Immediate release * 50-100 mg every 4-6 hours * Max: 400 mg/day * Extended release * If not already on immediate release * Initiate at 100 mg/day * Dose can then be increase every 2-5 days (depending on the brand) * Already on immediate release * Find daily mg for the immediate release and round down to the nearest 100 mg * Max: 300 mg/day * Notes about dosing: * Can be taken with or without food, but be consistent (always take with or always take without) * Take with food if GI upset is an issue * Severe hepatic and/or renal impairment (CrCl < 30 mL/min): * Avoid extended release * Immediate release: max = 200 mg/day and should be dosed 2 times a day (as opposed to 3 or 4/day) * Pharmacokinetics * Metabolized in the liver via CYP 2B6, 3A4, and 2D6 * Has an active metabolite (O-desmethyl tramadol) * Excreted in the urine * Contraindications * Hypersensitivity to tramadol or opioids * Opioid dependent patients OR * Acute alcohol or drug intoxication * Extended release dosage form: * Severe renal impairment * Severe hepatic impairment * Precautions * Tramadol causes CNS depression * Impair mental and physical abilities * Use with caution with respiratory depression or major depressive disorder * And avoid use in patient at increased risk of suicide * Use with caution in patients with a history of seizures * Use with caution in patients with past or the potential for drug/alcohol abuse * Tolerance and dependence can occur and abrupt discontinuation should be avoided due to the possibility of withdrawal syndrome * Chewing or crushing extended release tablets can lead to overdose * Swallow whole * Adverse Drug Reactions * Most common * Flushing * Headache * Somnolence or insomnia * Nausea, vomiting, constipation * Neuromuscular weakness * MAJOR Drug Interactions * Other CNS depressants can have an additive effect * Avoid alcohol * Serotonergic drugs (such as tricyclic antidepressants, MAO-Inhibitors, SSRIs, etc) * Increase risk of serotonin syndrome * Look for drugs that interact with CYP2D6 and/or 3A4 * Pregnancy Category/Breast feeding * Category C * Not recommended while breastfeeding * Safety Monitoring * Respiratory rate * Blood pressure and pulse * Signs of tolerance or abuse * Efficacy Monitoring * Pain relief * How does the patient feel the medication is working for them? * Major Counseling Points * Swallow the extended release tablets whole (do not crush or chew) * Do not take more than the recommended dose (can lead to overdose) * Avoid alcohol (CNS depressant) * Main side effects (Headache, flushing, somnolence/insomnia, GI upset) * Take with food if causes GI upset * CNS depression * Perform task requiring mental alertness with caution * Report any persistent or severe side effects References: * Tramadol. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jul 7]. | 7/7/10 | Free | View In iTunes |
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046 Clonazepam – Top 200 Prescribed Drugs | 046 Clonazepam (http://thestudentpharmacist.com/wp-content/uploads/046_Clonazepam.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand * Klonopin® * Generic * Clonazepam (available) * Mechanism of Action * Benzodiazepine (C-IV) * Binds benzodiazepine receptors in the CNS, which increases the effect of GABA * GABA is an inhibitory neurotransmitter and works by hyperpolarizing neuronal cells which makes them less excitable * Indications * Seizures/Seizure disorders * Panic disorder * Unlabeled indications: * Restless legs syndrome (RLS) * Neuralgia * Bipolar disorder * Social anxiety disorder * Schizophrenia * Dosage forms * Tablets * 0.5, 1, 2 mg * Orally disintegrating Tablets * 0.125, 0.25, 0.5, 1, 2 mg * Adult Dosing * Seizures/ Seizure disorders * Initiate 0.5 mg 3 times/day (total of 1.5 mg/day) * Total daily dose can be increase by ≤ 1 mg every 3 days as needed * Max dose for seizures: 20 mg/day * Panic disorder * Initiate 0.25 mg 2 times/day (total of 0.5 mg/day) * Total daily dose can be increase by ≤ 0.5 mg every 3 days as needed * Max dose for panic disorder: 4 mg/day * Restless legs syndrome * 0.5-2 mg at bedtime * Notes about dosing: * Because withdrawal symptoms can occur, avoid abrupt discontinuation if clonazepam is used continuously for ≥ 1 month * To discontinue, the dose should be decreased by 0.25 mg/day every 3 days * Use is contraindicated in severe hepatic impairment * Pharmacokinetics * Onset of action: 30 min to 1 hour * Metabolized in the liver via glucoronidation and sulfate conjugation * Also metabolized by CYP3A4 * Excreted in the urine mainly as metabolites * Contraindications * Hypersensitivity * Severe liver disease * Narrow-angle glaucoma * Pregnancy * Precautions * CNS depression is a big concern * Can impair physical and mental abilities * Due to CNS depression * Use caution in patients with major depressive disorder or respiratory disease (respiratory depression can occur) * Also, because of CNS depression that can occur, use with caution in elderly patients and patients at increased risk of falling * Use caution in patients with history or potential for drug or alcohol abuse * Use caution in renal and hepatic impairment * Adverse Drug Reactions * CNS depression * Drowsiness or somnolence * Altered coordination * Memory impairment * Depression * Altered appetite (increased or decreased) * Anticholinergic effects (i.e. dry mouth, dry eyes, constipation, difficulty urinating) * MAJOR Drug Interactions * Watch for drugs that interact with CYP3A4 * Use with other CNS depressants may have an additive effect * Avoid alcohol (CNS depressant) * Non-DHP Calcium Channel Blockers (Diltiazem and Verapamil) can decrease the metabolism of benzodiazepines * Azole Antifungals (Ketoconazole, Metronidazole) can also decrease the metabolism of benzodiazepines * Pregnancy Category/Breast feeding * Category D * Not recommended in breast feeding * Safety Monitoring * Signs of respiratory or CNS depression * Tolerance and dependence * Both can occur with longterm use * Renal and hepatic function with long term use * Efficacy Monitoring * Depending on the indication * Relief of symptoms * Mood and social functioning * How does the patient feel the medication is working? * Major Counseling Points * Avoid alcohol (CNS depressant) * Use caution performing tasks that require mental alertness while on Clonazepam * Especially with initial therapy * Do not stop taking or change frequency of dosing without talking with your doctor or pharmacist first References: * Clonazepam. In: Lexi-Comp Online [Internet]. Hudson, | 7/6/10 | Free | View In iTunes |
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045 Prevacid – Top 200 Prescribed Drugs | 045 Prevacid (http://thestudentpharmacist.com/wp-content/uploads/045_Prevacid.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand * Prevacid® (available OTC now) * Generic * Lansoprazole (available in capsule from) * Mechanism of Action * Proton pump inhibitor (PPI) * Inhibits H/K-ATPase in gastric parietal cells which suppresses gastric acid secretion * Indications * Duodenal ulcer * Gastric ulcer * GERD * Erosive Esophagitis * H. Pylori infection * Hypersecretory conditions * Dosage forms * Delayed release capsule * 15, 30 mg * Delayed release orally disintegrating tablets * 15, 30 mg * Contain phenylalanine * Granules for delayed release oral suspension * 15, 30 mg * Adult Dosing * Dose varies from 15 - 60 mg/day depending on the indication * GERD: 15 mg/day * H. Pylori eradication: 30 mg BID * Usually In combination with clarithromycin (500 mg BID) and amoxicillin (1000 mg BID) for about 2 weeks(triple therapy) * Duodenal ulcer: 15 mg/day * Gastric ulcer: 30 mg/day * Notes about dosing: * Once daily dosing should be taken first thing in the morning on an empty stomach (about 30 minutes to an hour before breakfast) * Not recommended to self-treat for GERD (or heartburn) for more that 2 weeks * Patients should talk with their doctor or pharmacist if longer treatment is needed * If the capsules cannot be swallowed, the contents of the capsules can be mixed in with ~1 tablespoon of applesauce or ~60 mL of orange or apple juice * Take the mixture immediately and do not chew or crush the granules * Tablets should be placed on tongue and allowed to dissolve * Pharmacokinetics * * Onset of action: 1-3 hours * Metabolized in the liver mainly by CYP2C19 and 3A4 * Weakly inhibits CYP2C9 * Excreted in the urine and feces * Contraindications * Hypersensitivity * Precautions * Prolonged use can lead to increase fracture risk * Use caution in patients with sever hepatic impairment * May need to decrease the dose * Adverse Drug Reactions * Generally well tolerated * Most common * Headache * GI upset (abdominal pain, nausea, and diarrhea) * MAJOR Drug Interactions * Watch for drugs that interact with 2C19 and 3A4 * Clopidogrel (Plavix) (antiplatelet agent) * PPIs may reduce the production of the active metabolite of Clopidogrel * Other acid lowering therapies do not appear to have this problem such as H2 antagonists (except cimetidine) or antacids * Pregnancy Category/Breast feeding * Category B * Not recommended in breastfeeding * Efficacy Monitoring * Relief of symptoms * Healing of Gastric Mucosa * Prevention of further complications * Major Counseling Points * Once daily dosing should be taken first thing in the morning on an empty stomach (about 30 minutes to an hour before breakfast) * Not recommended to self-treat for GERD (or heartburn) for more that 2 weeks * Patients should talk with their doctor or pharmacist if longer treatment is needed * If the capsules cannot be swallowed, the contents of the capsules can be mixed in with ~1 tablespoon of applesauce or ~60 mL of orange or apple juice * Take the mixture immediately and do not chew or crush the granules * Tablets should be placed on tongue and allowed to dissolve * Report any persistent or severe side effects to your doctor or pharmacist References: * Lansoprazole. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jul 5]. [about 10 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Prevacid®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Lansoprazole. In: Epocrates Online [Internet]. | 7/5/10 | Free | View In iTunes |
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044 Sulfamethoxazole/Trimethoprim | 044 Sulfamethoxazole/Trimethoprim (http://thestudentpharmacist.com/wp-content/uploads/044_Trimethoprim_Sulfamethoxazole.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brands * Bactrim™ * Septra® * Sulfatrim® * Generic * Sulfamethoxazole (SMX)/Trimethoprim (TMP) * Available * Mechanism of Action * SMX * Para-aminobenzoic acid antagonist, which inhibits bacterial synthesis of dihydrofolic acid * TMP * Inhibits dihydrofolate reductase, which blocks production of tetrahydrofolic acid * So, Bactrim™ interferes with bacterial folic acid production * Indications * Bacterial infection (by susceptible bugs): * Urinary tract infection * Otitis media * Exacerbations of bronchitis * Traveler's diarrhea * PCP (Pneumocystis jiroveci pneumonitis) * Also used for skin/soft tissue infections due to MRSA (unlabeled use) * Dosage forms (SMX is always 5 x TMP portion) * Injection solution * 80 mg SMX & 16 mg TMP * Oral suspension * 200 mg SMX & 40 mg TMP (5 mL) * Tablets (SMX/TMP) * 400/80 mg * 800/160 mg (double strength tablets) * Adult Dosing * Dosing strength and duration will vary due to infection type and severity * General dose is regular or double strength tablet twice a day * Can see Bactrim™ dosed by weight (such as with PCP infection: TMP15-20 mg/kg/day divided) * Duration can be anywhere from a few days to several months (again, depending on infection type and severity) * Renal impairment * CrCl 15-30 mL/min: Use 50% of the normal dose * Use is not recommended if CrCl < 15 mL/min * Pharmacokinetics * Metabolism * Both are metabolized by CYP2C9 and 3A4 * Both TMP and SMX are excreted as metabolites and unchanged drug in the urine * Contraindications * Hypersensitivity * Including hypersensitivity to any sulfa drug * Severe renal or hepatic dysfunction * Use with caution in any form of renal or hepatic impairment * Near term pregnancy and breastfeeding * Megaloblastic anemia due to folate deficiency * Precautions * Septra® can cause blood dyscrasias, hepatic necrosis, as well as dermatologic reactions * Discontinue use if rash or severe adverse reactions develop * Sulfatrim® can also cause HYPERkalemia and HYPOglycemia * Be aware that prolonged use can result in super-infections such as C. difficile-associated diarrhea (CDAD) * Adverse Drug Reactions * Most common * Sensitivity to sunlight * GI upset (N/V/D) * Dizziness * Decreased appetite * MAJOR Drug Interactions * Look for drugs that interact with CYP2C9 and 3A4 * Can decrease the excretion of Dofetilide (avoid concurrent use) * Can increase the risk of HYPERkalemia if patient is also on an ACE-I * Monitor serum potassium * Can increase the effects of oral anticoagulants and sulfonylureas * Watch for bleeding or hypoglycemia * Pregnancy Category/Breast feeding * Category C * Contraindicated near or at term in pregnancy * Contraindicated in breastfeeding * Safety/Efficacy Monitoring * Depending on the patient and severity of infection * Culture and sensitivity at baseline * Renal function at baseline (BUN/Cr) * Complete blood count (CBC) * Urinalysis * Major Counseling Points * Best to take each dose on an empty stomach (1 hour before or 2 hours after a meal) with a full glass of water * If using the oral suspension, shake well before use * Take all of your prescription even if you feel better * Avoid prolonged exposure to sunlight * Main side effects (GI upset, dizziness, decreased appetite) * Let your doctor or pharmacist know if you have any severe or persistant side effects References: * Sulfamethoxazole and Trimethoprim. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. | 7/4/10 | Free | View In iTunes |
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043 Alendronate – Top 200 Prescribed Drugs | 043 Alendronate (http://thestudentpharmacist.com/wp-content/uploads/043_Alendronate.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand * Fosamax® * Generic * Alendronate (available in tablet form) * Mechanism of Action * Bisphosphonate * Inhibits osteoclasts, which decreases bone turnover and resorption * Indications * Osteoporosis prevention and treatment in postmenopausal women * Generally considered 1st line therapy for the treatment of osteoporosis * Osteoporosis in men * Corticosteroid induced osteoporosis * Paget's Disease * Dosage forms * Oral solution (not available in generic) * 70 mg/75 mL * Tablets * 5, 10, 35, 40, 70 mg * Adult Dosing * Osteoporosis prevention and treatment in postmenopausal women * Prevention: 5 mg/day OR 35 mg once a week * Treatment: 10 mg/day OR 70 mg once a week * Osteoporosis in men * Same as for females * Treatment: 10 mg/day OR 70 mg once a week * Corticosteroid induced osteoporosis * 5-10 mg/day * Paget's Disease * 40 mg/day for 6 months * Notes about dosing: * Should be taken in the morning at least 30 minutes before eating or drinking with a full glass of water * Should stay upright (don't lay down) for at least 30 minutes after taking alendronate * Patients should have adequate vitamin D and calcium intake * Vitamin D: 800-1000 Units/day * Calcium: 1200-1500 mg/day * Renal Impairment: Use is not recommended if CrCl is 10 years) * Low bioavailability (0.6%) which is reduced even more (~ 60%) by food * Take on an empty stomach * Contraindications * Hypersensitivity * Hypocalcemia * Inability to sit upright for 30 minutes * Esophageal emptying abnormalities * Precautions * Bisphosphonates can cause bone or muscle pain * Can cause irritation of the upper GI mucosa * This is why patients should take with a full glass of water and remain upright for at least 30 minutes following administration * Bisphosphonates can cause hypocalcemia * Again, it is a contraindication to start alendronate in patients with hypocalcemia * Always make sure patients have adequate calcium and vitamin D intake * Bisphosphonates can also cause osteonecrosis of the jaw * Adverse Drug Reactions * Hypocalcemia * Hypophosphatemia * Acid reflux * Abdominal pain * Constipation or diarrhea * Headache * MAJOR Drug Interactions * No oral drugs should be taken within 30 minutes of bisphosphonates * NSAIDs can increase the risk of GI irritation * Pregnancy Category/Breast feeding * Category C * Use with caution in breastfeeding * Safety and Efficacy Monitoring * Central bone mineral density scan at baseline then 1-2 years after initiation * Serum Calcium and Vitamin D * Major Counseling Points * Take each dose first thing in the morning with a full glass of water * Remain upright for at least 30 minutes after taking and do not take any other oral medications within 30 minutes of taking Fosamax® * Counsel on missed doses for the weekly dose: * If a dose is missed, then the missed dose can be taken the next day (> day = wait and take the next dose) * Counsel on main side effects (GI upset and headache) * Patients should report any persistent or severe side effects to their doctor or pharmacist References: * Alendronate. In: Lexi-Comp Online [Internet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jul 3]. [about 10 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Fosamax®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx. | 7/3/10 | Free | View In iTunes |
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042 Actos – Top 200 Prescribed Drugs | 042 Actos (http://thestudentpharmacist.com/wp-content/uploads/042_Actos.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand * Actos® * Generic * Pioglitazone (NOT available) * Mechanism of Action * Thiazolidinedione * PPARgamma agonist, which improves insulin sensitivity without increasing insulin secretion and also inhibits hepatic gluconeogenisis * Insulin must be present for Actos® to work * Lowers basal glucose levels (fasting plasma glucose) * Lowers A1C by 0.8% on average (0.5 - 1.4%) * Indications * Type 2 Diabetes Mellitus * Dosage forms * Tablets * 15, 30, 45 mg * Adult Dosing * In general, Actos® is considered 2nd or 3rd line therapy for Type 2 Diabetes * Metformin is generally 1st line (unless it is contraindicated for some reason) * Actos® OR a sulfonylurea should be added on after metformin if needed * Sulfonylureas are cheaper and lower A1C more than Actos® but also increase the risk of hypoglycemia more than Actos® * Actual dosing * Initiate at 15 mg once a day * Dose can be titrated to a max dose of 45 mg/day if needed * If patient is on insulin or a sulfonylurea, then the insulin or sulfonylurea dose may need to be reduced if hypoglycemia is an issue * Pharmacokinetics * It can take up to a month to see any effects and up to 3 months to see maximum effects * Metabolized by CYP2C8 and 3A4 and does have active metabolites * Excreted in the urine and feces * Black Box Warnings * Thiazolidinediones can exacerbate or cause heart failure * Monitor closely after initiation of therapy and dosage increase * Look for signs/symptoms of heart failure: * Rapid weight gain * Shortness of breath * Edema * If heart failure is suspected, then at lease reduce the dose if not completely discontinue Actos® (I would discontinue) * Note: Avandia® (Rosiglitazone... another thiazolidinedione) has an even higher risk of cardiac complications and, in general, its use should be avoided * Contraindications * Hypersensitivity * NYHA Class III/IV Heart Failure * In the Canadian labeling, severe hepatic impairment, pregnancy, and any NYHA Class of Heart Failure are also contraindications * Precautions * Pioglitazone is not recommended for Type 1 Diabetes or Diabetic Ketoacidosis * Again, actions are insulin dependent * Actos® can cause weight gain (dose related) * Actos® can increase the risk of fractures * Use with caution in those at increased risk of fractures (such as elderly women) * Use with caution in patients with hepatic impairment * Not recommended to initiate pioglitazone if ALT > 2.5 times the upper limit of normal * Recommended to discontinue use if ALT > 3 times the upper limit of normal or if jaundice occurs * Adverse Drug Reactions * Most common * Headache * Edema * Upper respiratory tract infections * MAJOR Drug Interactions * Look for drugs that interact with CYP2C8 and 3A4 * Corticosteroids can decrease the effects of Actos® as well as other antidiabetic agents * Thiazide diuretics can also decrease the effects of Actos® as well as other antidiabetic agents * Use with caution with other agents affecting glycemic control * Watch for hypoglycemia * Alcohol increases the risk of hypoglycemia * Pregnancy Category/Breast feeding * Category C * Not recommended in breast feeing * Safety Monitoring * Signs of heart failure * Rapid weight gain * Edema * Shortness of breath * Get LFTs (liver function tests) at baseline then 3 months after initiation * Efficacy Monitoring * Serum glucose levels * A1C at baseline and 3 months after initation * Major Counseling Points * Intake alcohol with caution while on Actos® (increases the risk of hypoglycemia) | 7/2/10 | Free | View In iTunes |
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041 Trazodone – Top 200 Prescribed Drugs | 041 Trazodone (http://thestudentpharmacist.com/wp-content/uploads/041_Trazodone.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand * Desyrel® * Oleptro™ * Approved in January 2010 and should be available later... | 7/1/10 | Free | View In iTunes |
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040 Diovan HCT – Top 200 Prescribed Drugs | Note: In episode "#030 Diovan (http://thestudentpharmacist.com/?p=152)", there were 2 mistakes: * Diovan comes in 40 mg, not 30 mg (so 40, 80, 160, and 320 mg) * In the "drug interactions" section I said NSAIDs cause vasoconstriction of the effer... | 6/30/10 | Free | View In iTunes |
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039 Alprazolam – Top 200 Prescribed Drugs | 039 Alprazolam (http://thestudentpharmacist.com/wp-content/uploads/039_Alprazolam.mp3) Note: The #038 most prescribed drug, Amlodipine, was already covered as the #015 most prescribed drug (http://thestudentpharmacist.com/?p=105) Episode Notes (References Below) * Brand/Generic Available? * Brands * Xanax® and Xanax XR® * Niravam * Alprazolam Intensol® * Generic, Alprazolam, is available in tablets and extended release tablets * Mechanism of Action * Benzodiazepine (C-IV) * Binds benzodiazepine receptors in the CNS, which increases the effect of GABA * GABA is an inhibitory neurotransmitter and works by hyperpolarizing neuronal cells which makes them less excitable * Indications * Generalized anxiety disorder * Anxiety associated with depression * Panic Disorder * Also used for pre-operative sedation * Unlabeled use * Anxiety in children * Alcohol withdrawal * Dosage forms * Oral Solution * 1 mg/mL * Tablets and orally disintegrating tablets * 0.25, 0.5, 1, 2 mg * Extended release tablet * 0.5, 1, 2, 3 mg * Adult Dosing * Anixety (and anxiety associated with depression) * Use immediate release * Start with lower doses (0.25-0.5 mg) and titrate up to the minimum effective dose * Effective doses usually range from 0.5-4 mg/day and should be given in divided doses (2-3 times/day) * Panic disorder * Immediate release * Initiate at 0.5 mg three times a day * Dose can be titrated up by less than 1 mg every 3-4 days to the minimum effective dose * Typical maintenance doses range from 2-10 mg (average ~6 mg) * Extended release * Initiate 0.5-1 mg once/day taken in the morning * Dose can be titrated up by less than 1 mg every 3-4 days to the minimum effective dose * Typical dose range ~3-6 mg/day * If switching from immediate release to extended release use the same daily mg * Notes about dosing * The daily extended release dose should be taken in the morning * According to the Beers criteria, alprazolam is considered high risk in elderly patients * If it is used, use lower doses and titrate slower in the elderly * Avoid using doses > 2 mg/day * Tolerance as well as physical and mental dependence can occur in as little as 10 days * Use * Avoid abrupt discontinuation * Dose should be decreased by no more than 0.5 mg every 3 days * Hepatic impairment: Reduce dose by ~50% * Pharmacokinetics * Onset of action = 1 hour * Duration * Immediate release ~ 5 hours * Extended release ~ 11 hours * Metabolized in the liver by CYP3A4 * Has two active metabolites * Excreted in the urine * Contraindications * Hypersensitivity * Narrow angle glaucoma * Use with itraconazole or ketoconazole * Pregnancy * Precautions * CNS depression is a big concern * Can impair physical and mental abilities * Due to CNS depression * Use caution in patients with major depressive disorder or respiratory disease (respiratory depression can occur) * Use caution in patients with history or potential for drug or alcohol abuse * Use caution in renal and hepatic impairment * Adverse Drug Reaction * Most common * CNS depression * Drowsiness or somnolence * Altered coordination * Memory impairment * Depression * Altered appetite (increased or decreased) * Anticholinergic effects (i.e. dry mouth, dry eyes, constipation, difficulty urinating) * MAJOR Drug Interactions * Use with other CNS depressants may have an additive effect * Avoid alcohol * Look for drugs that interact with CYP3A4 (involved in the metabolism of alprazolam) * Pregnancy Category/Breast feeding * Category D * Not recommended in breast feeding * Safety Monitoring * Signs of respiratory or CNS depression * Tolerance and dependence | 6/26/10 | Free | View In iTunes |
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037 Flomax – Top 200 Prescribed Drugs | 037 Flomax (http://thestudentpharmacist.com/wp-content/uploads/037_Flomax.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand * Flomax® * Generic * Tamsulosin (available) * Mechanism of Action * Alpha one blocker * Alpha-1a antagonist in the prostate * Causes relaxation of smooth muscle in the prostate, which improves urine flow * Indications * Benign prostatic hyperplasia (BPH) * Off label indication * Bladder outlet obstruction * Dosage forms * Capsules * 0.4 mg * Adult Dosing * BPH * Initiate at 0.4 mg/day * You can increase the dose to 0.8 mg/day after 2-4 weeks if needed * Bladder outlet obstruction * 0.4 mg/day * Notes for dosing: * Each dose should be taken at the same time each day about 30 minutes after a meal * If, for some reason, doses are missed for several days in a row (3 or more), the dose should be started back at 0.4 mg/day and can be increased back to 0.8 mg/day after 2-4 weeks if needed * PK (if important) * Metabolized by CYP2D6 and 3A4 * Contraindications * Hypersensitivity * Precautions * Before starting therapy with Flomax®, make sure the patient does not have prostate cancer * Angina, priapism, and syncope can occur * Discontinue use if any of these are an issue * Use caution in patients with sulfa allergy * May want to avoid if patient has a severe sulfa allergy * ADRs * Most common * HA * Dizziness * Abnormal ejaculation * Orthostatic Hypotension * Rhinitis * MAJOR Drug Interactions * Look for drugs that interact with CYP2D6 and 3A4 * Pregnancy Category/Breast feeding * Not approved for women * But, Flomax® is pregnancy category B * Safety Monitoring * Ask the patient about * Syncope * Angina * Efficacy Monitoring * Relief of symptoms * Major Counseling Points * Swallow capsules whole (don't crush or chew) * Take at the same time each day about 30 minutes after a meal * Main side effects (HA, dizziness, abnormal ejaculation, orthostasis, and rhinitis) * Report any persistent or severe side effects References: * Tamsulosin. In: Lexi-Comp Online [AUHSOP Intranet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jun 25]. [about 7 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Flomax®. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Flomax®. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Jun 25]. [About 6 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 6/25/10 | Free | View In iTunes |
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036 Effexor XR® – Top 200 Prescribed Drugs | 036 Effexor XR (http://thestudentpharmacist.com/wp-content/uploads/036_Effexor_XR.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand * Effexor® * Effexor XR® * Generic, venlafaxine, is available * Mechanism of Action * SNRI * Inhibits neuronal re-uptake of both serotonin and norepinephrine * Also weakly inhibits dopamine reuptake * Has an active metabolite (O-desmethylvenlafaxine) with the same mechanism of action * Indications * Major depressive disorder (MDD) * Generalized anxiety disorder (GAD) * Social anxiety disorder * Panic disorder * Off label indications * Obsessive compulsive disorder * Hot flashes * Neuropathic pain * ADHD * Post traumatic disorder * Dosage forms * Tablets * 25, 37.5, 50, 75, 100 mg * Extended release tablets * 37.5, 75, 150, 225 mg * Extended release capsules (not available in generic) * 37.5, 75, 150 mg * Dosing (for extended release, since it is the #036 most prescribed drug) * MDD and GAD * Initiate at 37.5-75 mg/day * If you start with 37.5 mg, then increase to 75 mg/day after about a week (4-7 days) * Dose can then be increased at 5 day intervals by no more than 75 mg as needed/tolerated * Max = 225 mg/day * Panic disorder * Similar to major depressive disorder and generalized anxiety disorder dosing * Start with 37.5 mg/day * Can Increase 75 mg/day after one week * Then increase at weekly intervals by no more than 75 mg as needed/tolerated * Max= 225 mg/day * Social anxiety disorder * Initiate 75 mg/day * Max = 75 mg/day * Higher doses offer no benefit * Notes on dosing * Each dose should be taken with food * Brand name Effexor XR® comes in capsules * The capsules can be sprinkled on applesauce * Do not chew the mixture and follow with a glass of water * If Effexor® is used > one week, then the dose should be tapered if discontinuing * Renal impairment (CrCl of 10-70 mL/min): Decrease dose by 25% * If patient is undergoing dialysis, then decrease the dose by 50% * Hepatic impairment: Reduce dose by 50% * PK (if important) * Metabolized in the liver via CYP2D6 * Has one active metabolite (O-desmethylvenlafaxine) * BBW * Antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with MDD and other psychiatric disorders * Observe patients for suicidal ideology especially during the 1st few months of therapy * Reason/mechanism: Antidepressants in general increase energy/appetite before they affect mood… giving the patient the energy needed for suicide * Contraindications * Hypersensitivity * Concurrent use or use within 2 weeks of MAO Inhibitors * Also, should not initiate an MAO inhibitor within 1 week of discontinuing Effexor® * Precautions * Effexor® can inhibit platelet aggregation, which can increase the risk of bleeding, especially in patients on aspirin or NSAIDs * Can cause an increase in cholesterol and blood pressure * CNS depression * Serotonin Syndrome (symptoms below) can develop * Agitation or restlessness * Tachycardia * Rapid changes in blood pressure * Loss of coordination * Overactive reflexes * Sexual dysfunction can occur * Dose related weight loss * Abrupt withdrawal can cause withdrawal syndrome * Adverse Drug Reactions * Most common * Headache and dizziness * Somnolence or insomnia * Nausea and constipation * Dry mouth * Anorexia or weight loss * Abnormal ejaculation * Sweating * MAJOR Drug Interactions * MAO Inhibitors * Use is contraindicated within 2 weeks of MAO-Is * Serotonergic drugs increase the risk of serotonin syndrome * Aspirin and NSAIDs can increase the bleeding risk * CNS depressants may have an additive effect | 6/23/10 | Free | View In iTunes |
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035 Seroquel – Top 200 Prescribed Drugs | 035 Seroquel (http://thestudentpharmacist.com/wp-content/uploads/035_Seroquel.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand name * Seroquel * Seroquel XR (extended release, 24 hour tablet) * Generic ... | 6/22/10 | Free | View In iTunes |
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034 Cymbalta – Top 200 Prescribed Drugs | 034 Cymbalta (http://thestudentpharmacist.com/wp-content/uploads/034_Cymbalta.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand * Cymbalta * Generic, Duloxetine, is not available * MOA * Antidepressant * Serotonin and Norepinephrine Re-uptake Inhibitor (SNRI) * Indications * Major depressive disorder * Generalized anxiety disorder * Diabetic neuropathy * FIbromyalgia * Dosage form * Capsules (delayed release and enteric coated) * 20, 30, 60 mg * Adult Dosing * * For all indications, 60 mg/day seems to be the target dose * Dose can be started lower and increased by 30 mg/week if tolerability is an issue * Max dose = 120 mg/day * But doses > 60 mg are not as well tolerated and don't seem to offer any additional benefit (based on clinical trials) * Not recommended in hepatic impairment or if CrCl is 30 mL/min * Note: Cymbalta is not FDA approved for children * PK (if important) * Food decreases absorption by about 10% * Metabolized in the liver by CYP1A2 and 2D6 * Excreted in the urine (mainly) and feces primarily as metabolites * BBW * Antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with MDD and other psychiatric disorders * Observe patients for suicidal ideology especially during the 1st few months of therapy * Risk of suicide is not increased in patients > 24 and is actually decreased in patients > 65 * Reason/mechanism: Antidepressants in general increase energy/appetite before they affect mood… giving the patient the energy needed for suicide * Contraindications * Hypersensitivity * Concurrent use or use within 2 weeks of MAO inhibitors * Uncontrolled narrow angle glaucoma * Again * Use is not recommended in hepatic impairment or if CrCl is < 30 mL/min * Precautions * Cymbalta can inhibit platelet aggregation, which can increase bleeding risk, especially in patients on aspirin or NSAIDs * Use caution in patients with alcoholism due to possible hepatotoxicity * Caution in patients with diabetes * Can cause an increase in serum glucose and A1C * Cymbalta can cause sexual dysfunction * Use with caution in patients with seizure disorders or increased risk of seizures * Because cymbalta decrease the reuptake of serotonin, serotonin syndrome can develop * Monitor for symptoms * Rapid changes in blood pressure * Increased body temperature * Loss of coordination * Increased reflexes * Withdrawal syndrome can develop with abrupt discontinuation * Taper gradually to discontinue * ADRs * Most common * Somnolence or insomnia * HA * Dizziness and fatigue * Nausea/constipation/diarrhea * Dry mouth * Decreased appetite * MAJOR Drug Interactions * Other serotonergic drugs increase the risk of serotonin syndrome * Other meds that decrease the seizure threshold increase the risk of seizures * Look for drugs that interact with CYP1A2 and 2D6 * Concurrent use with or use within 2 weeks of MAO-Inhibitors is contraindicated * Use with thiorizidine is contraindicated in the canadian labeling of Cymbalta * Pregnancy Category/Breast feeding * Category C * Not recommended in breast feeding * Safety Monitoring * BP * Suicidal ideation * Liver and hepatic function * Monitor glucose and A1C in patients with diabetes * Efficacy Monitoring * Mental status and social functioning in major depressive disorder and general anxiety disorder * Pain relief in fibromyalgia and diabetic neuropathy * Major Counseling Points * Swallow pill whole (do not crush or chew) * Do not discontinue Cymbalta without talking with your doctor or pharmacist first | 6/21/10 | Free | View In iTunes |
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033 Oxycodone/Acetaminophen – Top 200 Prescribed Drugs | 033 Oxycodone/Acetaminophen (http://thestudentpharmacist.com/wp-content/uploads/033_Oxycodone_APAP.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand * Endocet * Magnacet * Percocet * Roxicet * Tylox * Some dosage forms are available generic * MOA * Oxycodone = opiate analgesic * Blocks pain by binding mu and kappa opiate receptors in the cerebral cortex * APAP * Analgesic and antipyretic * Analgesic = Inhibits prostaglandin synthesis in the CNS * Antipyretic = Inhibits the hypothalamic heat-regulation center * Indications * Analgesic (management for moderate-severe pain) * Dosage forms * Caplets * Capsules * Oral Solution * Tablet * Strength ranges * Oxycodone 2.5-10 mg * APAP 300-650 mg * Adult Dosing * Initial dose is based on oxycodone * Ranges from 2.5-30 mg depending on pain severity * Doses should be given every 4-6 hours prn * Doses can be titrated up for pain relief * Maximum daily doses are limited by APAP * Should not exceed 4 g/day of APAP * PK (if important) * Onset of action is about 15 minutes * Duration of action * IR = 3-6 hours * CR = up to 12 hours * Oxycodone is metabolized by 3A4 and 2D6 to active metabolites * Both oxycodone and APAP are excreted in the urine * BBW * None * Contraindications * Hypersensitivity * Severe Respiratory depression * Prolonged use or the use of high doses just before birth in pregnancy * Opioids can cause dependence and respiratory depression in the neonate * Precautions * Use with caution in patients with a hx of drug abuse/alcoholism * Both psychological and physical dependency can develop with prolonged use * Overdose can cause hepatotoxicity (APAP) * Can cause CNS depression or hypotension * Patients should use caution when performing tasks that require mental alertness * ADRs * CNS depression * Respiratory depression * Dysphoria or euphoria * Sedation * N/V/Constipation * Most side effects decrease over time except constipation * MAJOR Drug Interactions * Alcohol * CNS depressant = additive effect * Also increases risk of hepatotoxicity with acetaminophen * Other CNS depressants * Pregnancy Category/Breast feeding * Category C * Prolonged use or the use of high doses just before birth are contraindicated * Safety Monitoring * Respiration * Mental status * Blood pressure * Constipation * Efficacy Monitoring * Pain relief * Major Counseling Points * Avoid alcohol * Consuming alcohol and taking APAP increases the risk of hepatotoxicity * Alcohol also increases CNS depression * Do not exceed recommended dosing * Percocet can cause dependence * Overdose can lead to fatal respiratory depression * Use caution performing tasks that need mental alertness (CNS effects) * Major ADRs * CNS depression, dysphoria/euphoria * GI upset * Most all side effects will diminish over time except constipation References: * Oxycodone and Acetaminophen. In: Lexi-Comp Online [AUHSOP Intranet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jun 20]. [about 11 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Percocet. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Acetaminophen/Oxycodone. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Jun 20]. [About 12 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 6/20/10 | Free | View In iTunes |
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031 Zolpidem – Top 200 Prescribed Drugs | 031 Zolpidem (http://thestudentpharmacist.com/wp-content/uploads/031_Zolpidem.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brands * Ambien * Ambien CR (Extended release) * Edluar (Sublingual tablet) * Generic (zolpidem) is available for the immediate release tablets * MOA * Imidazopyridine hypnotic * Selective benzodiazepine-1 receptor agonist * Increases the activity of GABA, which is an inhibitory neurotransmitter and results in sedation * Indications * Insomnia * Sublingual and immediate release dosage are indicated for difficulty of sleep onset * Extended release is indicated for both difficulty of sleep onset as well as sleep maintenance (so staying asleep) * Dosage forms * Tablets * 5, 10 mg * Sublingual tablets (Edluar) * 5, 10 mg * Ambien CR * 6.25, 12.5 mg * Adult Dosing * 10 mg immediate release or 12.5 mg CR * Use lower doses for elderly patients and patients with hepatic impairment (5 mg IR or 6.25 mg CR) * No adjustments for renal impairment * All doses should be taken immediately before bedtime * PK (if important) * Immediate release * Onset: 30 minutes with a 6-8 hour duration * Metabolized mainly by CYP3A4 and 2C9 * Excreted in the urine and feces * Contraindications * Hypersensitivity * Precautions * Zolpidem can cause CNS depression, behavioral changes, as well as increased risk of sleep walking or sleep driving * Because of this, Ambien should only be taken right before bed when one can get a full nights sleep * Use with caution in patients with depression, drug abuse potential, hepatic impairment, or any respiratory issues * Also, abrupt withdrawal can lead to withdrawal symptoms * ADRs * Most common * HA * Nausea * Dizziness * Somnolence * Not really an adverse effect if you ask me * More of a desired effect * Can also see * Depression * Dry mouth * GI upset * MAJOR Drug Interactions * Other CNS depressants will have additive effects * Pregnancy Category/Breast feeding * Pregnancy Category C * Compatible with breast feeding according to the American Academy of Pediatrics * Safety Monitoring * Behavioral changes * Respiratory rate * Efficacy Monitoring * Is the medication working? * Does the patient feel they are getting adequate sleep? * Are they still having trouble falling or staying asleep? * How do they feel throughout the day? * Major Counseling Points * How to take the medication * Do not chew or crush Ambien CR * Edluar should be placed under the tongue and allowed to dissolve * Take all doses right before bed * Avoid alcohol while on Zolpidem * Can be habit forming References: * Zolpidem. In: Lexi-Comp Online [AUHSOP Intranet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jun 16]. [about 10 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Ambien. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Ambien. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Jun 16]. [About 8 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 6/19/10 | Free | View In iTunes |
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030 Diovan – Top 200 Prescribed Drugs | 030 Diovan (http://thestudentpharmacist.com/wp-content/uploads/030_Diovan.mp3) **NOTE: 029, Azithromycin, was previously covered (see 016) Episode Notes (References Below) * Brand/Generic Available? * Diovan is the brand * Generic is valsartan (and is not available) * MOA * Angiotensin II receptor blocker (ARB) * So angiotensin II can't bind to AT1 receptors, so it can't cause vasoconstriction or aldosterone release * This results in a decrease in BP, a decrease in the reabsorption of Na and water, and vasodilation of the efferent arteriole of the kidneys, which is considered renal protective * Also prevents ventricular remodeling and cardiac hypertrophy * Indications * Hypertension * Heart Failure * Left ventricular dysfunction post-MI * Dosage forms * Tablets * 40, 80, 160, and 320 mg * Doses * HTN * Initiate at 80 mg/day * Max dose = 320 mg/day * Heart Failure * Initiate at 40 mg BID * Titrate to a target dose of 160 mg BID * Max dose = 320 mg * Left ventricular dysfunction post MI * Initiate 20 mg BID > 12 hours after MI in stable patients * Titrate to a target dose of 160 mg BID * Renal Impairment * Dose may need to be adjusted if CrCl 35% over baseline,then temporarily discontinue Diovan at least until renal function is back to normal * Use with caution in patients with hepatic impairment, renal impairment, or renal artery stenosis * ADRs * Generally well tolerated * Most common * Dizziness * HA * > 50% increase in BUN * Can also see * Hypotension * Hyperkalemia * MAJOR Drug Interactions * NSAIDs may decrease effects and increase the risk of renal dysfunction * Cause vasoconstriction of the afferent arteriole of the kidneys, which when combined with the vasodilation of the efferent arteriole caused by ARBs, can greatly decrease renal pressure * Potassium sparing diuretics * Monitor serum potassium * Pregnancy Category/Breast feeding * Category D in the 2nd and 3rd trimester (BBW) * Not recommended in breast feeding * Safety Monitoring * Serum Potassium * Renal function * BUN and SrCr * If SrCr increases > 35% over baseline, then temporarily discontinue Diovan at least until renal function is back to normal * Monitor at baseline then4 weeks after initiation * Efficacy Monitoring * BP * Major Counseling Points * Let your doctor or pharmacist know if you become or plan to become pregnant * Go over main side effects (most common = HA and dizziness) * Can cause hypotension * Careful at first going from sitting or lying to standing (do so slowly) * Avoid salt substitutes that contain potassium * Avoid excess alcohol * Keep taking Diovan even if you feel better * Diovan is not a replacement for diet and exercise as these are still very important in controlling your HTN * Side Notes * African Americans, | 6/18/10 | Free | View In iTunes |
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028 Sertraline – Top 200 Prescribed Drugs | 028 Sertraline (http://thestudentpharmacist.com/wp-content/uploads/028_Sertraline.mp3) Episode Notes (References Below) * Brand/Generic Available? * Zoloft * Generic (Sertraline) is available * MOA * Antidepressant * Selective Serotonin Re-uptake Inhibitor (SSRI) * Inhibits uptake of serotonin (5-HT) in the CNS * Also weakly inhibits the re-uptake of dopamine and norepinephrine * Indications * Major depressive disorder (MDD) * Obsessive compulsive disorder (OCD) * Panic Disorder * Post-traumatic disorder * Premenstrual dysphoric disorder (PMDD) * Social Anxiety Disorder * Dosage forms * Oral concentrate * 20 mg/mL * Tablets * 25, 50, 100 mg * Dosing * MDD and OCD * Initiate 50 mg Qday * Can be titrated weekly to a max dose of 200 mg * Panic disorder, post-traumatic stress disorder, and social anxiety disorder * Initiate 25 mg Qday * Can be titrated weekly to a max dose of 200 mg * PMDD, sertraline can be dose two ways: * 50 mg Qday every day * If given this way, then the dose may be increase 50 mg every menstrual cycle as needed to a maximum dose of 150 mg/day * Alternative: 50 mg Qday only during the luteal phase of the menstrual phase * Dose can be increased to a max of 100 mg/day * If the dose is increased to 100 mg/day, the 50 mg/day should be given for the first 3 days of each dosing cycle * May need to adjust the dose in severe hepatic impairment (metabolized by the liver) * Taper slowly to discontinue to avoid withdrawal syndrome * PK (if important) * Onset of action is seen within a week but the full effect may not be seen for up to 3 months * Highly protein bound * Metabolized by CYP enzymes, primarily 2C9 * Excreted in the urine and feces * BBW * Antidepressants can increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with MDD and other psychiatric disorders * Observe patients for suicidal ideology especially during the 1st few months of therapy * Reason/mechanism: Antidepressants in general increase energy/appetite before they affect mood… giving the patient the energy needed for suicide * Contraindications * Hypersensitivity * Concurrent use or use within 2 weeks of MAO-Inhibitors * Concurrent use with pimozide * Precautions * Not approved for bipolar disorder and can cause a shift towards mania in patients with bipolar disorder * Can inhibit platelet aggregation = increased risk of bleeding (especially in patients taking NSAIDs or anticoagulants) * Serotonin Syndrome (symptoms below) can develop * Agitation or restlessness * Fast heart beat * Rapid changes in blood pressure * Hallucinations * Increased body temperature * Loss of coordination * Overactive reflexes * N/V/D * Sexual dysfunction can occur * reversible upon discontinuation * Use with caution in patients with a history or increased risk for seizures (brain damage or alcoholism) * Withdrawl syndrome is possible upon discontinuation or dosage decrease * Symptoms * Anxiety * Confusion * HA * Lethargy * Insomnia * Seizures * Resume previous dose and taper more gradually if withdrawal syndrome develops * ADRs * > 10% * Dizziness * HA * Insomnia or somnolence * GI upset * Dry mouth * Tremors * Decreased libido and ejaculatory disorders * Sweating * MAJOR Drug Interactions * Alcohol can have an additive effect on CNS depression * Avoid concurrent use with pimozide * Avoid concurrent use or use within two weeks with MAO-Inhibitors * Pregnancy Category/Breast feeding * Category C * Breastfeeding is not recommended while on Sertraline * Safety Monitoring * Suicidal ideation (especially during initial therapy) * Efficacy Monitoring * Mental status * Social functioning | 6/17/10 | Free | View In iTunes |
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027 Ibuprofen – Top 200 Prescribed Drugs | 027 Ibuprofen (http://thestudentpharmacist.com/wp-content/uploads/027_Ibuprofen.mp3) Episode Notes (References Below) * Brand/Generic Available? * Ibuprofen is the generic and is available OTC in most forms * Common brand names: * Adv... | 6/16/10 | Free | View In iTunes |
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025 Advair Diskus – Top 200 Prescribed Drugs | 025 Advair Diskus (http://thestudentpharmacist.com/wp-content/uploads/025_Advair_Diskus.mp3) Episode Notes (References Below) * Brand/Generic Available? * Advair diskus is a combination of salmeterol and fluticasone * There is no generic for Advair Diskus available * MOA * Fluticasone * Corticosteroid * Anti-inflammatory, immunosupressive, and anti-proliferative properties * Salmeterol * Long acting Beta-2 agonist * Stimulate beta-2 receptors, which relaxes bronchial smooth muscle * Indications * Maintenance of both asthma and COPD * Dosage forms * Diskus * 100 mcg fluticasone, 50 mcg salmeterol * 250 mcg fluticasone, 50 mcg salmeterol * 500 mcg fluticasone, 50 mcg salmeterol * Advair is also available as a metered dose inhaler (Advair HFA) * 45 mcg fluticasone, 21 mcg salmeterol * 115 mcg fluticasone, 21 mcg salmeterol * 230 mcg fluticasone, 21 mcg salmeterol * Adult Dosing * For both COPD and Asthma * 2 inhalations a day, 12 hours apart * Strength indicated for COPD: Fluticasone 250 mcg, salmeterol 50 mcg * This is also the recommended max dose for COPD * Max dose for asthma: Fluticasone 500 mcg, salmeterol 50 mcg * For asthma, advair should only be considered if the patient is not controlled on an inhaled corticosteroid alone * It is preferred to try a low dose corticosteroid (such as fluticasone) first * If this is not sufficient, then advair should be considered * PK * Onset of action is about 30 minutes, but can take up to 4 weeks to see full effects * Duration of action is about 12 hours * Both fluticasone and salmeterol are major substrates for CYP3A4 * BBW * Long acting beta-2 agonist may increase asthma related deaths * Long acting beta 2 agonist (salmeterol and formoterol), should only be added to asthma therapy if the patient is already on an inhaled corticosteroid and more maintenance therapy is needed * Contraindications * Hypersensitivity to either fluticasone or salmeterol, or a severe hypersensitivity to milk proteins (Advair diskus contains lactose) * Acute asthma or COPD episodes * Patients should use a short acting bronchodilator such as ProAir HFA for a current attack * Status asthmaticus * Precautions * Use caution when switching a patient from a long term oral corticosteroid to an inhaled corticosteroid due to possible hypothalamic pituitary adrenal (HPA) axis suppression * This can occur if the oral corticosteroid is not tapered properly and can be fatal * Adrenal suppression is generally not an issue with severe asthma exacerbations * Patients are given oral corticosteroids for these exacerbations, but are only on them for a short period of time (7-10 days) and they don't need to be tapered * Long term use of corticosteroids can lead to increase risk of infections * Patients should wash their mouth out after every use advair to prevent oral candidiasis (or thrush) * Caution in patient with diabetes * Beta-2 agonist can increase serum glucose * Beta 2 agonists can cause CNS excitation (use caution in patients with cardiovascular disease or seizure disorders) * Corticosteroids can slow growth in children * Dose and duration related * Advair Diskus' safety and efficacy has not been established for children < 4 yo * Advair can also cause Hypokalemia * ADRs * Most common * HA or Dizziness * Upper respiratory tract infection or throat irritation * GI upset * Oral candidiasis (or thrush) * Less common but serious side effects * CNS excitation leading to arrhythmias, palpitations, hypertension or even MI * Hypothyroidism * Abnormal liver function test * MAJOR Drug Interactions * Look for 3A4 inhibitors * Live vaccines should not be given within 3 months of corticosteroids | 6/15/10 | Free | View In iTunes |
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024 Warfarin – Top 200 Prescribed Drugs | 024 Warfarin (http://thestudentpharmacist.com/wp-content/uploads/024_Warfarin.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brands * Coumadin * Generic (Warfarin) is available * MOA * Anticoagulant * Inhibits Vitamin K dependent coagulation factors II, VII, IX, and X * Also inhibits anticoagulant proteins C and S * Indications * Anticoagulation * Treatment and prevention thromboembolic disorders or complications due to A Fib or cardiac valve replacement * Dosage forms * Tablets (1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 mg) * Dosing * Typical starting dose is 2-5 mg * Adjust dose to reach target INR (International Normalized Ratio, based on Prothrombin Time) * A typical INR target range is 2-3 but varies from 1.5-4.5 based on the indication * Usual maintenance dose: 2-10 mg/day * If INR can be measured every day during the first 5 days of therapy, then this should be done and dose adjusted accordingly * After initiation, general rule: the dose should not be altered more ofter than every 3 days * Weekly dose should be adjusted 5-25% based on the current INR * Reason weekly dose is used: Easier to figure out how to dose the new calculated dose based on the dosage strengths available * Its not uncommon to take different dosage on different days of the week * PK (if important) * Peak therapeutic effect takes 5-7 days * Duration of action is 2-5 days * Metabolized primarily by CYP 2C9, but is also metabolized via 2C8, 2C18, 2C19, 1A2, and 3A4 * Excreted in the urine * BBW * Major or fatal bleeding * Some roisk factors: * INR > 4 * Age ≥ 65 * Any bleeding disorders * Drug interactions that could increase bleeding * Hypertension or CV disease * Changes in smoking habits * Changes in diet * Contraindications * Hypersensitivity * Active bleeding or increased bleeding risk * Pregnancy * Eclampsia/pre-eclampsia * Malignant hypertension * Inadequate mental state (not able to keep appointments for INR check) * Recent major surgeries * Spinal puncture * Precautions * Use with caution in the following: * Elderly patients * Increased bleeding risk * Severe renal or hepatic impairment * Caution in hypertension or CV disease * Indwelling catheters * Severe diabetes * Changes smoking habits * ADRs * Common * Bleeding or bruise easy (most common) * N/V/D * HA * Dizziness * More serious side effects: * Serious/prolonged bleeding * Skin or tissue necrosis * Gangrene * Purple toe syndrome * Due to cholesterol microembolism * MAJOR Drug Interactions * A lot of drug interactions * Check all the drugs the patient is one for possible interaction * A few commonly seen that increase INR: * Flagyl * Amiodarone * Bactrim * Fluconazole * Pregnancy Category/Breast feeding * Category X * Does not enter breast milk (use with caution) * Safety/Efficacy Monitoring * INR, Prothrombin Time, hematocrit * Consider doing genotyping of 2C9 before initiation (mainly metabolized by 2C9) * Major Counseling Points * Do not start or stop taking any medications (including OTCs and herbals) w/o talking with your Dr. or Pharmacist * Do not stop taking without talking to your Dr. or Pharmacist * Make sure patient knows that brand & generic names (warfarin and coumadin) as well as the color of the tablet they are taking * Tablets are color coated based on strength and should be checked by the patient to make sure they the proper dose is taken * Take at the same time each day (w or w/out food) * Very important not to miss visits to get INR checked! * Keep vitamin K and alcohol intake consistent (do not consume excess alcohol) * Vitamin K is mainly found in green leafy vegetables such as broccoli, spinach, etc) | 6/14/10 | Free | View In iTunes |
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023 Furosemide – Top 200 Prescribed Drugs | 023 Furosemide (http://thestudentpharmacist.com/wp-content/uploads/023_Furosemide.mp3) Episode Notes (References Below) * Brand/Generic Available? * Brand = Lasix * Generic (Furosemide) is available * MOA * Loop diuretic (causes an increase in urine excretion) * Increases the excretion of water, Na, Cl, Mg, & Ca by inhibiting the reabsorption of Na and Cl in the ascending loop of Henle and distal tubule of the kidneys * Indications * Edema * Pulmonary edema * Hypertension * Dosage forms * Injection Solution (10 mg/mL) * Oral Solution (10 mg/mL) * Tablets (20, 40, 80 mg) * Doses * Edema * Initiate 20-40 mg/dose Q6-8 hours * Dose can be raised 20-40 mg every 6-8 hours if initial dose is not adequate * Max = 600 mg/day * Pulmonary edema * 40 mg IV over 1-2 minutes * Can be increase to 80 mg Q1 hour if initial dose is not adequate * Hypertension * 20-80 mg/day divided (two doses) * Note: may need to use increased doses in acute renal failure (up to 3 g/day) * Furosemide's use is contraindicated in anuria * PK (if important) * Onset of action * Oral 30-60 minutes * IM 30 minutes * IV 5 minutes * Peak effect of oral does seen in 1-2 hours * Oral duration is about 2 hours * Excreted in urine and feces * BBW * If too high of dose is given, excessive diuresis can occur, resulting in fluid and electrolyte depletion * Doses should be individualized based on patients presentation * Contraindications * Hypersensitivity * Anuria * Precautions * Use caution concerning electrolyte imbalances * Due to the electrolyte imbalances that can occur, use with caution in patients with cirrhosis * Diabetic patients: May change glucose control (monitor) * Caution in patients with history gout (can cause exacerbation) * Can cause exacerbation or activation of Lupus (In patients with Systemic Lupus Erythematosus (SLE) * ADRs * Common: * Hypotension * Dizziness or blurred vision * N/V/D * Photosensitivity * Hypokalemia * Can also cause: * Ototoxicity * Rapid IV administration and excess doses increase risk of ototoxicity * Nephrotoxicity * MAJOR Drug Interactions * Use with aminoglycosides increases risk of ototoxicity * Furosemide can increase lithium levels * NSAIDs and phenytoin may decrease the effects of furosemide * Pregnancy Category/Breast feeding * Category C * Enters breast milk (use with caution) * Safety Monitoring * Serum electrolytes * Renal Function * Auditory test (if giving high doses or IV) * Urine output * Efficacy Monitoring * Blood pressure * Edema * Major Counseling Points * Take in the morning with food to decrease GI upset * Postural hypotension can occur * Careful going from sitting or lying to standing (do so slowly) * Keep medication in original container * Needs to be protected from light * Do not take if discolored * May cause photosensitivity * Use sunscreen and avoid prolonged sunlight * Keep track of your weight * Report any significant weight gain or loss * If patient has diabetes: Monitor glucose closely (especially during initiation of therapy References: * Furosemide. In: Lexi-Comp Online [AUHSOP Intranet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jun 6]. [about 11 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Furosemide. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Furosemide. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Jun 6]. [About 12 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. | 6/13/10 | Free | View In iTunes |
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022 Crestor – Top 200 Prescribed Drugs | 022 Crestor (http://thestudentpharmacist.com/wp-content/uploads/022_Crestor.mp3) Episode Notes (References Below) * Brand/Generic Available? * Crestor = brand * Generic (Rosuvastatin) is not available * MOA * Statin * Other... | 6/12/10 | Free | View In iTunes |
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021 Hydrochlorothiazide (HCTZ) – Top 200 Prescribed Drugs | Note: the 18, 19, and 20 most prescribed drugs (which are Levothyroxine, metoprolol, and simvastatin) have all been covered in previous episodes... 021 Hydrochlorothiazide (http://thestudentpharmacist.com/wp-content/uploads/021_Hydrochlorothiazide.mp3) Episode Notes (References Below) * Brand/Generic Available? * Microzide * Generic (hydrochlorothiazide) is available * MOA * Thiazide diuretic * Increases sodium and water excretion by inhibiting sodium and chloride reabsorption at the distal tubules of the kidney * Has a diuretic effect at first but also decreases peripheral vascular resistance over time (both of which decrease BP) * Indications * Hypertension * Edema in HF or renal dysfunction * Dosage forms * Capsules (12.5 mg) * Tablets (25, 50 mg) * Doses * HTN * 12.5-50 mg/day depending on patient response * Edema * 25-200 mg in single or divided doses * PK (if important) * Duration of action: 6-12 hours * Peak effect seen in 4-6 hours * Not metabolized and is excreted in the urine as unchanged drug * Contraindications * Hypersensitivity * Anuria * Precautions * Use caution in patients with diabetes * Can alter glucose control * Use caution in patients with a history of gout * HCTZ can precipitate gout * Use with caution in patients with hepatic or renal impairment * Not effective in severe renal impairment (CrCl < 30 mL/min) * Use with caution in patients with hypokalemia (can case hypokalemia) * ADRs * Most common * Hypotension * Photosensitvity * Hypokalemia * Anorexia * MAJOR Drug Interactions * HCTZ use is contrindicated with dofetilide * Thiazide diuretics can increase the concentration of dofetilide, which can increase its QT prolongation effect * Increase the concentrations of lithium * Pregnancy Category/Breast feeding * Category B (not preferred anti-hypertensive agent in pregnancy) * Consider labetalol or ER nefidipine * Enters breast milk but HCTZ is considered compatible according to the American Academy of pediatrics * Safety Monitoring * Monitor patients weight and BP * Renal function * Serum creatinine and BUN * Monitor electrolytes * Efficacy Monitoring * BP at baseline then periodically * Major Counseling Points * Take in the morning to avoid nocturnal diuresis * Can cause hypotension * Go from sitting or lying to standing slowly * Can cause photosensitivity (wear sunscreen and avoid prolonged direct sunlight) * Not a replacement for diet/exercise * If patient has diebetes, monitor glucose closely (especially during initiation of HCTZ) * Report any persistent side effects References: * Hydrochlorothiazide. In: Lexi-Comp Online [AUHSOP Intranet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jun 5]. [about 9 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Hydrochlorothiazide. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Hydrochlorothiazide. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Jun 5]. [About 11 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 6/11/10 | Free | View In iTunes |
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017 Metformin – Top 200 Prescribed Drugs | 017 Metformin (http://thestudentpharmacist.com/wp-content/uploads/017_Metformin.mp3) Episode Notes (References Below) * Brand/Generic Available? * Glucophage * Fortamet * Glumetza * Riomet * MOA * Decreases glucose production in the liver * Decrease the absorption of dietary glucose from the intestines * Improves insulin sensitivity * Indications * Type 2 Diabetes * Considered 1st line drug therapy (after lifestyle modifications) * Can be used along with other oral anti-diabetic medications and insulin * Unlabeled use in polycystic ovary syndrome and gestational diabetes * Dosage forms * Tablets (500, 850, 1000 mg) * Extended release 24 hour tablets (500, 750 mg) * Brand Riomet also comes in a solution 500 mg/5mL * Doses * Type 2 Diabetes * Immediate release * Initiate 500 mg BID with meals OR 850 mg Qam (with breakfast) * Titration * 500 mg: Increase by 500 mg weekly * 850 mg: Increase by 850 mg every other week * Max immediate release dose = 2550 mg/day * ER * Initiate 500 mg ER taken with dinner (or the evening meal) * Titrate 500 mg weekly to a max dose to 2000 mg/day * Dose can be divided if GI upset is an issue * Notes about dosing * Significant therapeutic effects are usually not seen at doses 80 yo) * Unstable CHF * Hepatic Dx * Symptoms may be subtle and include: * Malaise * Myalgias * Respiratory distress * Somnolence * Lab findings for Lactic acidosis include: * Decrease pH * Increased anion gap * Increased blood lactate * Contraindications * Hypersensitivity * Renal dysfunction... if serum creatinine is: * ≥ 1.5 mg/dL in men * ≥ 1.4 in women * Metabolic acidosis (including Diabetic Ketoacidosis) * NOTE: Metformin is no longer contraindicated in patients with stable HF (whether or not they are on medications for HF) * Relative contraindication in patients with hepatic dx * If patient is undergoing radiologic studies involving iodine contrast dyes, then temporarily discontinue metformin 2 days before and after * Precautions * Use with caution in patients with HF, elderly patients, patients who consume excess alcohol, and patients at risk for hypoglycemia * ADRs * Main = GI upset * Diarrhea is experienced by up to 50% of patients taking metformin * Muscle weakness is also common (9%) * Can also cause: * HA * Metallic tast * Decreased B12 absorption * Side effects generally resolve over time * MAJOR Drug Interactions * Avoid cimetidine * Avoid (or limit) alcohol * Both increase the risk of metabolic acidosis as well as hypoglycemia * Pregnancy Category/Breast feeding * Category B * We will actually start seeing metformin used more often in women who are pregnant * Latest studies show metformin has similar outcomes as insulin on newborns of women with gestational diabetes * Enters breast milk and is not recommended * Safety Monitoring * Serum creatinine at baseline then at least yearly * Monitor renal function more often if indicated (if patient is at increased risk) | 6/10/10 | Free | View In iTunes |
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016 Azithromycin – Top 200 Prescribed Drugs | 016 Azithromycin (http://thestudentpharmacist.com/wp-content/uploads/016_Azithromycin.mp3) (http://thestudentpharmacist.com/wp-content/uploads/016_Azithromycin.mp3)Episode Notes (References Below) * Brand/Generic Available? * Zithromax * Zmax * Generic (Azithromycin) IS available * MOA * Macrolide antibiotic * Bacteriostatic * Binds 50 S ribosomal subunit which suppresses protein synthesis * Indications * Bacterial infections including (but not limited to): * Conjuctivitis * Sinusitis * Community acquired pneumonia * Mild to moderate skin/soft tissue infections * Mycobacterium avium complex (MAC) treatment and prophylaxis (in patients with AIDS) * Dosage forms * Injection powder for reconstitution (500 mg) * Powder for oral suspension (100, 200 mg/5 mL) * Tablets (250, 500, 600 mg) * Zmax (brand only): Extended release microspheres for oral solution * Doses * Vary based on infection and severity * Community acquired pneumonia * 500 mg IV Qday for 2 days, then 500 mg po Qday for 7-10 days * Skin/soft tissue infections * 500 mg po on the first day then 250 mg po Qday for the following 4 days (days 2-5) * MAC * Prophylaxis: 1200 mg Qday * Treatment: 600 mg (with ethambutal 15 mg/kg) * Notes on dosing * Use with caution in patients with severe renal or hepatic impairment * Oral suspensions: Immediate release and extended release suspensions are NOT interchangeable * PK (if important) * Metabolized by the liver * Excreted primarily in the bile as unchanged drug * Contraindications * Hypersensitivity to azithromycin or any macrolide * Precautions * Although rare, macrolides can cause prolongation of the QT interval, which can result in arrhythmias * Use with caution in patients with Myasthenia Gravis (can cause exacerbations) * Can cause hepatotoxicity (rare) * DC if symptoms occur (such as N/V, malaise, and fever) * Prolong use can result in superinfections (such as CDAD) * ADRs * Most common: GI upset (Nausea, diarrhea, abdominal pain, and cramping) * HA * Rash * MAJOR Drug Interactions * Azithromycin's use is contraindicated with the following: * Cisapride * Dronedarone * Phenothiazines * Pimozide * All of these increase the risk of QT prolongation and arrhythmias * Pregnancy Category/Breast feeding * Category B * Does enter breast milk * Use caution in breast feeding * Safety Monitoring * LFTs or CBC if indicated * Efficacy Monitoring * Relief of symptoms or infection * Major Counseling Points * Talk all of the prescription even if you feel better * Taking with food may help decrease the possible GI upset * Report severe or persistent GI upset * If taking the suspension: Shake well before each dose References: * Azithromycin. In: Lexi-Comp Online [AUHSOP Intranet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jun 4]. [about 14 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Zithromax & Zmax. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Azithromycin. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Jun 4]. [About 10 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 6/9/10 | Free | View In iTunes |
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015 Amlodipine – Top 200 Prescribed Drugs | 015 Amlodipine (http://thestudentpharmacist.com/wp-content/uploads/015_Amlodipine.mp3) Episode Notes (References Below) * Brand/Generic Available? * Norvasc * Generic (Amlodipine) is available * MOA * Calcium channel blocker * Causes relaxation of vascular smooth muscle and cardiac muscle by Inhibiting calcium influx * Works more in the vasculature (as do all DHP CCBs) than in the myocardium * Non-DHP CCBs (Verapamil and Ditiazem work more in cardiac muscle) * Indications * HTN * Angina * Chronic stable angina * Vasospastic angina * Dosage forms * Tablets (2.5, 5, & 10 mg) * Doses * HTN * Initiate 2.5-5 mg/day * Increase by 2.5 mg Q1-2 weeks to most effective dose * Max dose = 10 mg * Angina * 5-10 mg/day * PK (if important) * Duration of action: 24 hours * Metabolized by the liver and excreted in the urine * Contraindications * Hypersensitivity * Precautions * Can actually cause angina or MI upon initiation or dose increase * Use caution in patients with aortic stenosis or hepatic impairment * Initiate at lower doses in elderly (2.5 mg) * ADRs * Most common side effect = peripheral edema * Dose related and patients with HF are at increase risk * Flushing * HA * Fatigue * Nausea * MAJOR Drug Interactions * Drugs to avoid * Decrease effect of DHP CCBs * Carbamazepine, Oxcarbazepine * Fosphenytoin, Phenytoin * Barbiturates (Bar-bit-your-its) * Rifampin * Pregnancy Category/Breast feeding * Category C * Not recommended when breast feeding * Safety/Efficacy Monitoring * BP and HR at baseline then periodically * Monitor for edema * Major Counseling Points * Can be taken w or w/o food * Take medication every day even if you feel fine * Not a replacement for diet and exercise * SIde effects that may be experience (HA, GI upset, fatigue) * Report any persistent side effects * Tell your Dr. or Pharm D if you experience abrupt unintentional weight gain (3-5 lbs/week) * Sign of edema * Avoid excess alcohol References: * Amlodipine. In: Lexi-Comp Online [AUHSOP Intranet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010 May 27, cited 2010 Jun 4]. [about 5 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Norvasc. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Amlodipine. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 Jun 4]. [About 5 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 6/8/10 | Free | View In iTunes |
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014 Simvastatin – Top 200 Prescribed Drug | 014 Simvastatin (http://thestudentpharmacist.com/wp-content/uploads/014_Simvastatin.mp3) Episode Notes (References Below) * Brand/Generic Available?? * Brand = Zocor * Generic (Simvastatin) IS available * MOA * Statin * Inhibit HMG-CoA reductase, which is involved in the rate limiting step of the synthesis of cholesterol * This decreases the amount of cholesterol the body can produce which results in an increase LDL receptors on hepatocytes and LDL clearance and catabolism * Indications * Treatment of dyslipidemia * Reduce TC, LDL, apolipoprotein B, and TGs * Increase HDL * Secondary prevention of CV events in patients with dyslipidemia * Dosage forms * Tablet * 5, 10, 20, 40, 80 mg * Doses * Dyslipidemia * Initial dose = 20 mg Qday in the evening * Can increase the dose Q4weeks as needed to reach goal of therapy * Dose range = 20 - 80 mg Qday in the evening * Individualized based on response and lipid levels * In general simvastatin can decrease LDL levels by 26-47% (depending on dose) * Cardiovascular risk reduction * Initiate 20-40 qday in the evening * Can increase every 4 weeks to a max of 80 mg * Notes on Dosing * I know I said you could increase the dose to 80 mg, but this greatly increase this risk of myopathy * Increasing from 40 mg to 80 mg only lowers LDL ~6% more but increases the risk of myopathy by 6 times!! * If patients need more LDL lowering and are on 40 mg, consider switching to Atorvastatin or Rosuvastatin * Severe renal impairment (CrCl 1 quart/day) * Contraindications * Hypersensitivity to simvastatin * Active Liver dx * elevations in LFTs (ALT/AT) * Pregnancy * Breast feeding * Concurrent use with strong 3A4 inhibitors (see drug interactions) * Precautions * Myopathy (muscle paint)/rhabdomyolysis (muscle breakdown) * Dose related risk * Make sure patient is on lowest effective dose * Risk is increased with concurrent use of 3A4 inhibitors, fibric acid derivatives (such as gemfibrozil), or niacin at doses ≥ 1 g/day * Use with caution in the elderly (they are at increased risk of developing myopathy) * Rhabdomyolysis can result in acute renal failure if not controlled * Tell patient to report any unexplained muscle pain, tenderness or weakness, or brown urine * Hepatic impairment * Since statins can cause liver dysfunction, use with caution in patients who have a history of liver impairment or who consume large amounts of alcohol * Patients should avoid excess alcohol * ADRs * Common * Abdominal pain, nausea, and constipation * HA * Upper respiratory infections * Above are generally mild and disappear over time * Serious/Precautions * Hepatotoxicity w/ Increased LFTs * Myopathy and rhabdomyolysis with increase CPK * Also can cause pancreatitis and acute renal failure * MAJOR Drug Interactions * Look for 3A4 inhibitors * Contraindicated with strong 3A4 inhibitors including: * Azole antifungals (Ketoconazole and itraconazole) * Erithromycin and clarithromycin * PIs (Protease Inhibitors) * To limit risk of myopathy/rhabdomyolysis, SImvastatin dose is limited if given with the following medications: * Cyclosporine OR Gemfibrozil: Max = 10 mg/day * Amiodarone OR Verapamil: Max = 20 mg/day | 6/7/10 | Free | View In iTunes |
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013 ProAir HFA – Top 200 Prescribed Drugs | 013 ProAir HFA (http://thestudentpharmacist.com/wp-content/uploads/013_ProAir_HFA.mp3) Note: The #012 Most prescribed drug is Synthroid and was covered in the Levothyroxine sodium episode (http://thestudentpharmacist.com/?p=55) (which is the #004 most prescribed drug) Episode Notes (References Below) * Brand/Generic Available? * Some other brand names: * Proventil HFA * Ventolin HFA * Generic = Albuterol and it is available * MOA * Beta agonist * Stimulates beta-2 receptors which relaxes bronchial smooth muscle * Often referred to as a rescue inhaler * Used for current "attacks" * Indications * Asthma * COPD * Prevention of exercise induced bronchospasms * Dosage forms * ProAir brand name only comes in: Aerosal solution (metered dose inhaler): 90 mcg/actuation * Generic albuterol also comes in: * Nebulizer form (0.63 - 5 mg/3 mL) * Tablets (2, 4 mg) * Oral syrup (2 mg/5 mL) * Doses (Adult) * Bronchospams * 2 puffs Q4-6 hours prn * Severe asthma exacerbation * 4-8 puffs Q20 minutes prn up to 4 hours * Then Q1-4 hours prn * Prevention of exercise induced exacerbation * 2 puffs 15-30 minutes before exercise * PK (if important) * Peak effect: ~ 30 minutes * Duration of action: 3-4 hours * Contraindications * Hypersensitivity * Precautions * Although rare, paradoxical bronchospasm can occur with inhaled beta agonist * Something to look out for if patient is seems to get worse with use of their inhaler * Immediate hypersensitivity reactions can occur and should be monitored for with initial use of albuterol * Beta agonist can cause CNS excitation * Use with caution in patients with a history of seizures or CV conditions (such as HTN or HF) * Beta agonist can increase serum glucose * Something to be aware of with diabetic patients * Beta agonist can decrease serum potassium * Caution in patients with hypokalemia * Caution in elderly patients * Tremors are seen more in elderly as a result of beta agonist use * NOTE: Most of the above are of increased concern with increased use of ProAir HFA * If patients asthma or COPD is controlled, then they will NOT have to use their ProAir inhaler as much and these side effects will be less of an issue * ADRs * Serious side effects (which we have mentioned) * Paradoxical bronchospasms * CNS excitation which can result in: * Angina * HTN * MI * Arrhythmias * Hypokalemia * Common side effects * Throat irritation and cough * Dizziness * Nausuea * HA * Palpitations and tachycardia * MAJOR Drug Interactions * Beta blockers as well as alpha and beta blockers can decrease therapeutic effects of beta agonists * TCAs and sympathomimetics may increase adverse effects of Albuterol * Pregnancy Category/Breast feeding * Category C * Caution in breastfeeding * Safety Monitoring * May want to check BP, HR, and overall cardiovascular health if indicated * May want to check serum glucose and serum potassium if indicated * Efficacy Monitoring * Relief of symptoms and FEV1 * Is it controlling the exacerbations? * Major Counseling Points * Go over proper use of inhaler * How to prime (4 test sprays into the air... away from you) * Prime before first use and if it hasn't been used for ≥ 2 weeks * How to inhale * Exhale, then inhale deeply while actuating the inhaler * Hold your breath for ~10 seconds * Wait one minute between inhalations * etc * Always keep inhaler with you * Get your prescription refilled before you run out * If using more than one inhaled medication, use albuterol first if taking them at the same time * Albuterol will "open your lungs" so the other medication is more effective | 6/6/10 | Free | View In iTunes |
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011 Metoprolol – Top 200 Prescribed Drugs | 011 Metoprolol (http://thestudentpharmacist.com/wp-content/uploads/011_Metoprolol.mp3) Episode Notes (References Below) * Brand/Generic Available? * Toprol-XL * Lopressor * Generic (Metoprolol) is available * MOA * Beta Blocker * Selectively blocks Beta-1 receptors * Cardio-selective * Decreases HR, Cardiac output, and BP * Can lose selectivity at higher doses (> 100 mg) * Indications * Angina * HTN * A Fib * Acute MI in hemodynamically stable patients * Reduce mortality and hospitalization in patients with HF * Dosage forms * Injection solution (IV) * 1 mg/mL * Tablets (25, 50, 100 mg) * Extended release tablets (25, 50, 100, 200 mg) * Doses * Dosing range: 25-450 mg depending on indication * Angina * 50 mg BID or 100 mg ER/day * Increase weakly to effective dose * A-Fib * 25-100 mg BID * HF * 25 mg ER Qday * Double the dose weekly to reach the target dose of 200 mg ER Qday * HTN * 50 mg BID or 25-100 mg ER Qday * Increase to desired effect * Usual dose range for HTN = 50-100 mg * Acute MI * 5 mg IV every 2 min for 3 doses then 50 mg po Q6 hours 15 min after last IV dose for 48 hours * Secondary prevention after MI * 25-100 mg BID * Start as soon as patient is stable * Notes about dosing * No adjustment in renal impairment * May need to decrease dose in hepatic impairment * If switching from IR to ER use same total daily dose * If switching from PO to IV: Ration = 2.5:1 (PO:IV) * PK (if important) * Peak onset of action: 1.5-4 hours for oral dose * Duration * Immediate release: 10-20 hours * Extended release: About 24 hours * Metabolized mainly by CYP-2D6 * Food increases absorption * BBW * Abrupt withdrawal can result in angina, MI, ischemia, and HTN * Taper gradually over 1-2 weeks * Restart treatment (at least temporarily) if any of the above occur * Contraindications * Hypersensitivity * Bradycardia (HR < 45 bpm) * Systolic BP < 100 mm Hg * 2nd or 3rd degree heart block * Cardiogenic shock * Pheochromocytoma (as monotherapy/without alpha blockade) * Precautions * BBs can cause hypotension * Can potentially worsen bronchospastic conditions such as asthma * Since Lopressor is cardio-selective it can be used with caution in patients with asthma * Caution in patients with diabetes * BBs can mask the s/s of hypoglycemia * Note: Sweating is the only sign of hypoglycemia NOT masked by BBs * ADRs (Common) * CV * Hypotension * Bradycardia * CNS * Dizziness * HA * Depression * Sedation * Rash (5%) * Diarrhea (5%) * MAJOR Drug Interactions * 2D6 inhibitors can increase the concentration of Toprolol-XL * Pregnancy Category/Breast feeding * Category D in 2nd & 3rd trimesters * Can be used while breastfeeding * Safety/Efficacy Monitoring * Blood pressure * Heart Rate * Major Counseling Points * DO NOT stop taking metoprolol w/out talking w/ your Dr. or Pharm.D * Can result in cardiovascular complications <--- Very important * Continue to take the medication even if you feel better * May cause hypotension * Go from sitting or lying to standing slowly (especially w initial therapy) * Toprolol is not a replacement for diet and exercise and should be used along with these lifestyle changes * Avoid alcohol * May increase sedation and dizziness * If diabetic * BBs can mask s/s of hypoglycemia except sweating References: * Metorpolol . In: Lexi-Comp Online [AUHSOP Intranet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jun 2]. [about 9 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Metoprolol Tartrate. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www. | 6/5/10 | Free | View In iTunes |
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010 Singulair – Top 200 Prescribed Drugs | 010 Singulair (http://thestudentpharmacist.com/wp-content/uploads/010_Singulair.mp3) Episode Notes (References Below) * Brand/Generic Available? * Montelukast (not available) * MOA * Leukotriene receptor antagonist * Selective for cysteinyl leukotriene receptor (so leukotrienes can't bind) * Leukotrienes cause airway edema, smooth muscle contraction, activation of the inflammatory process AND symptoms of allergic rhinitis * Montelukast blocks them from binding, which prevents these actions * Indications * Chronic treatment of asthma * Prevention of exercise induced bronchospasms * Allergic Rhinitis * Dosage forms * Granules (4mg/packet) * Tablet (10 mg) * Chewable Tablets (4 mg) * Contains phenylalanine * Use with caution if patient has phenylketonuria (PKU) * Doses * Asthma and allergic rhinitis * 10 mg Qday in the evening * Prevention of exercise induced bronchospasms * 10 mg ≥ 2 hours before exercise * Do not take additional doses within 24 hours * 10 mg = max daily dose * No adjustments in renal impairment or mid to moderate hepatic impairment * Severe hepatic impairment has not been studied * Granules may be mixed with applesauce, carrots, rice, ice cream, baby formula, or breast milk (don't mix with any other foods or liquids) * Take within 15 minutes of opening * PK (if important) * It can take several weeks to see the effect of Singulair * Metabolism * Major substrate of 2C9 and 3A4 * Weakly inhibits 2C8 and 2C9 * BBW * None * Contraindications * Hypersensitivity * Precautions * Montelukast cannot be used to treat bronchoconstriction due to ASA/NSAID hypersensitivity * Montelukast is not indicated to treat or reverse current asthmatic attacks or bronchospasms * Used as maintenance therapy * In rare cases, leukotriene inhibitors can cause neuropsychiatric events * Tell patients to report any of the following: * Agitation or Aggression * Anxiousness * Abnormal dreams or Hallucinations * Depression * Insomnia * Suicidal ideation * ADRs * Well tolerated for the most part * Most common * HA * Cough * Dizziness * Abdominal pain * Dyspepsia * MAJOR Drug Interactions * Phenobarbital may increase the metabolism of montelukast * Consider CYP interactions... look for drugs that interact with: * 2C9 * 2C8 * 3A4 * Pregnancy Category/Breast feeding * Cat B * Excretion in breast milk unknown (use caution) * Safety Monitoring * Mood/behavior changes (neuropsychiatric events) * Efficacy Monitoring * Relief of symptoms * Major Counseling Points * Take every evening (even if you feel better) * It can take several weeks to see an effect * Do not use for a current asthma attack * Will not work fast enough * Use fast acting inhaler * Granules can be taken directly or may be mixed with applesauce, carrots, rice, ice cream, baby formula, or breast milk (don't mix with any other foods or liquids) * Take within 15 minutes of opening * Some side effects you may experience include * HA (can take APAP, ASA, or Ibuprofen) * Fatigue or dizziness * Report any persistent side effects * Talk with your doctor or pharmacist if you have any mood or behavior changes, such as anxiety, depression, or suicidal thoughts * Related to the possible neuropsychiatric changes that can occur * Talk with your Dr. or pharmacist if you become pregnant or plan to become pregnant References: * Singulair. In: Lexi-Comp Online [AUHSOP Intranet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 May 28]. [about 4 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Endow-Eyer RA, Mitchell MM, Lacro JP. Schizophrenia. In: Koda-Kimble MA, Young LY, Alldredge BK, Corelli RL, | 6/4/10 | Free | View In iTunes |
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009 Lexapro – Top 200 Prescribed Drugs | 009 Lexapro (http://thestudentpharmacist.com/wp-content/uploads/009_Lexapro.mp3) Episode Notes (References Below) * Brand/Generic Available * Generic = Escitalopram (es sye tal oh pram) * Generic not available * All other SSRIs are available generically * MOA * Selective Serotonin Reuptake Inhibitor (SSRI) * Selectively inhibits the reuptake of serotonin by inhibiting serotonin transporter * S-isomer of citalopram * Indications * Labeled * Major Depressive Disorder (MDD) * Generalized Anxiety Disorder (GAD) * Unlabeled * Mild dementia associated agitation in nonpsychotic patients * Dosage forms * Oral solution (1 mg/mL) * Tablets (5, 10, 20 mg) * Doses * Initial = 10 mg Qday * Can be increased to 20 mg Qday after 1 week * Use with caution in severe renal impairment (CrCl 10% * HA * Somnolence * Insomnia * Nausea * Sexual dysfunction... ejaculation disorder (reversible with DC) * 1-10% * CNS * Fatigue, lethargy * Dizziness * Abnormal Dreams * Sexual * Decreased libido, impotence, anorgasim (reversible with DC) * GI * Xerostomia * N/V/D/C * Flu like symptoms * MAJOR Drug Interactions * A lot of DDIs... check other medications patient is on! * Avoid alcohol (increase CNS depression) * MAO inhibitors (concomitant use or within 2 weeks) (BBW) * Concomitant use with pimozide (BBW) * Pregnancy Category/Breast feeding * Cat C * Enters breast milk (consider risk:benefit) * Safety Monitoring * Suicidal ideation (especially during initial therapy) * Efficacy Monitoring * Mental status * Social functioning * Akathisia * Major Counseling Points * Do not stop taking med or change dose without talking with your Dr. or Pharmacist * Avoid caffeine and alcohol * Use caution performing tasks requiring mental alertness until response to medication is known * Inform prescriber if you become or plan to become pregnant * Side Notes * Taper when DC'ing (to avoid withdrawal syndrome) References | 6/3/10 | Free | View In iTunes |
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008 Plavix – Top 200 Prescribed Drugs | 008 Plavix (http://thestudentpharmacist.com/wp-content/uploads/008_Plavix.mp3) Episode Notes (References Below) * Brand/Generic Available? * Clopidogrel (not available) * MOA * Is a thienopyridine * Antiplatelet agent (reduces platelet aggregation) * Prevents activation of glycoprotein GPIIb/IIIa blocking P2Y12 ADP receptors on the surface of platelets * Effects platelets for their entire lifespan (7-10 days) * Prodrug (converted to active metabolite via CYP 2C19) * Indications * Reduce rate of atherothrombotic events such as MI and stroke in the following patients: * Patients who recently had a heart attack or stroke * Patients who have peripheral artery disease or unstable angina * Patients who just had a PCI (percutaneous coronary intervention) or CABG (coronary artery bypass graft) * Dosage forms * 75 and 300 mg Tablets * Doses * In general * 75 mg = daily dose * Loading dose = 300 mg if indicated * Usually given in combination with aspirin * Recent MI, stroke or if patient has established arterial dx * 75 mg po qday * Unstable angina OR NSTEMI: * 300 mg loading dose * 75 mg po qday * STEMI * ≤ 75 yo: 300 mg loading dose then 75 mg qday for up to 28 days * > 75 yo: No loading dose. 75 mg qday for up to 28 days * PCI * 300-600 mg loading dose * 75 mg qday * For ≥ 12 months * Prevention of CABG closure in patients allergic to ASA * Unlabeled use * 300 mg LD 6 hours after procedure * 75 mg po qday * PK (if important) * Metabolized via 2C19/3A4 to active metabolite * Effects of the loading dose are seen within 2 hours * Peak effect seen within 1 week * BBW * Decreased effect in patients who are poor metabolizers of plavix * Variants CYP-2C19 that make them poor metabolizers (2C19 converts clopidogrel to active metabolite) * Variant seen more in people of Chinese ancestry * There are genotype tests to detect 2C19 poor metabolizers * If detected, use alternate medication or use higher doses of Plavix * 600 mg LD and 150 mg daily dose * Contraindications * Hypersensitivity * Active bleeding * Intracranial bleeding * Both make sense... clopidogrel increases risk of bleeding * Precautions * Use with caution in patients with bleeding disorders or increased risk of bleeding * Use with caution in severe renal and hepatic impairment * ADRs * Increase risk of bleeding * Main = GI (>10%) * Dyspepsia (indigestion) * Gastritis * Constipation * N/V * Edema, HTN (4%) * CNS (~6%) * HA * Dizziness * Depression * Increased cholesterol (4%) * Increase LFTs (< 3%) * Arthralgia (6%) * URTI (9%) * Flu like symptoms * MAJOR Drug Interactions * PPIs (specifically omeprazole) * PPIs reduce the production of the active metabolite of Clopidogrel * Other acid lowering therapies do not appear to have this problem (H2 antagonists or antacids except cimetidine which inhibits 2C19) * Recommended PPI is pantoprazole * 2C19 inhibitors (prevent formation of active metabolite) * Cimetidine * Fluconazole * Ketoconazole * Etravirine * Felbamate * Fluoxetine * etc. * Pregnancy Category/Breast feeding * Category B * Excretion in breast milk unknown (not recommended) * Safety and Efficacy Monitoring * Signs of bleeding * Hemoglobin * Hematocrit * Major Counseling Points * Main ADRs (HA, dizziness, N/V/C) * May take longer than usual to stop bleeding * Seek medical help if bleeding will not stop * Report abnormal chest pain, SOB, or rash * Side Notes * Dc plavix one week before patient undergoes CABG References * Plavix. In: Lexi-Comp Online [AUHSOP Intranet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jun 1]. [about 7 p.]. | 6/2/10 | Free | View In iTunes |
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007 Nexium – Top 200 Prescribed Drugs | 007 Nexium (http://thestudentpharmacist.com/wp-content/uploads/007_Nexium.mp3) Episode Notes (References Below) * Brand/Generic Available?? * Esomeprazole * Generic NOT available * MOA * PPI * Inhibits H/K-ATPase in gastric parietal cells which suppresses gastric acid secretion * Esomeprazole = S-isomer of omeprazole * Prodrug (as are all PPIs) * Protonated in acidic environment to active form * Indications and Doses * Treatment and maintenance of erosive esophagitis * Initiate at 20-40 mg Qday for 1-2 months * Maintenance with 20 mg Qday * Nonerosive Reflux Disease (NERD) * 20 mg Qday * Trx of GERD * 20 mg Qday for 4weeks * Can continue therapy if needed * Eradication of H. Pylori induced gastric ulcers (in combination with clarithromycin and amoxicillin) * 40 mg qday (with 1000 mg amoxicillin and clarithromycin 500 mg BID) for 10 days * Prevention and treatment of NSAID induced gastric ulcers * 20-40 mg qday for up to 6 months * Treatment of hypersecretory conditions including Zollinger-Ellison syndrome * ZE syndrome (excess gastrin is produced leading to increased production of hydrochloric acid) * 40 mg BID * No adjustment needed in renal impairment * Do not exceed 20 mg/day in severe hepatic impairment (Child-Pugh class C) * Proper was to take esomeprazole * Take one hour before breakfast * Capsule contents may be mixed with applesauce or water (do not chew or warm the mixture) * Dosage forms * IV * Use short term if patient cannot take oral * Switch to oral ASAP * Safety and efficacy not established beyond 10 days * Delayed release capsules (20, 40 mg) * Delayed release granules for oral suspension (10, 20, 40 mg/packet) * PK (if important) * Substrate and inhibitor of 2C19 * Also substrate for 3A4 * Food decreases absorption by about 10% * Take 1 hour before first main meal of the day (breakfast) * Long duration of action (up to 72 hours) * BBW * None * Contraindication * Hypersensitivity * Precautions * Do not exceed 20 mg/day in severe hepatic impairment (Child-Pugh class C) * ADRs * Generally well tolerated * Most common side effects seen * HA (8%) * Nausea, diarrhea or constipation, and flatulence (probably most common) * Dry mouth * HTN, chest pain (< 3%) * Increase cholesterol (2%) * UTI (4%) * MAJOR Drug Interactions * Clopidogrel (Plavix) (antiplatelet agent) * PPIs reduce the production of the active metabolite of Clopidogrel * Other acid lowering therapies do not appear to have this problem (H2 antagonists or antacids) * Keep in mind when considering drug interactions * PPIs decrease stomach acid * Any medication dependent on stomach pH may interact * Medications that interact with CYP 3A4 or 2C19 may interact * Pregnancy Category/Breast feeding * B (Omeprazole aka Prilosec is Cat. C) * Not recommended in breast feeding * Efficacy Monitoring * Relief of symptoms * Healing of Gastric Mucosa * Prevention of further complications * Major Counseling Points * Take 1 hour before breakfast each day * Swallow capsules whole * Contents of capsules can be mixed in applesauce (1 tablespoon) * Don't chew or warm the mixture * Main ADRs * HA * GI Upset * Dry mouth * Report any persistent side effects * Antacids can be taken at the same time * Side Notes * Rebound GERD is not an issue with PPIs as it is with H2-Antagonist References * Esomeprazole. In: Lexi-Comp Online [AUHSOP Intranet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 Jun 1]. [about 6 p.]. Available from: http://online.lexi.com/crlsql/servlet/crlonline * Dipiro, J. T., R. L. Talbert, G. C. Yee, G. R. Matzke, B. G. Wells, and L. M. Posey. | 6/1/10 | Free | View In iTunes |
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006 Amoxicillin – Top 200 Prescribed Drugs | 006 Amoxicillin (http://thestudentpharmacist.com/wp-content/uploads/006_Amoxicillin.mp3) Episode Notes (References Below) * Brand/Generic Available * Amoxil * Moxatag * Generic IS available * MOA * Penicillin antibiotic * Binds to penicillin binding proteins, which inhibits bacterial cell wall synthesis causing the bacteria to eventually lyse (so it is bactericidal) * Indications (Commonly used for) * Otitis Media * Sinusitis * Respiratory tract infections * Skin Infections * Urinary tract infections * In combination with other medications (clarithromycin and a PPI) for H. pylori eradication * Dosage forms * Capsules * Powder for suspension * Tablets * Chewable tablets * ER tablets * Doses * Usual dosing: * 250-500 mg Q8 hours OR * 500-875 mg BID OR * 775 mg extended release tablet Qday * Dose and duration is going to vary based on infection type and severity * Adjust dose in Renal Impairment: * If CrCl is < 30 mL/min avoid 775 mg ER tablets and 875 mg immediate release dosage forms * CrCl 10-30 mL/min: 250-500 mg BID * < 10 mL/min: 250-500 mg Qday * PK (if important) * Eliminated renally (mainly as unchanged drug) * Which is why you adjust the dose in renal impairment * BBW * None * Contraindication * Hypersensitivity to amoxicillin, penicillin or other beta lactams * ADRs * HA, dizziness, and insomnia * Rash * GI upset (N/V/D) * Increase LFTs * Tooth discoloration * Black hairy tongue * MAJOR Drug Interactions * Increase bleeding if the patient is on warfarin * Tetracycline derivatives can decrease the therapeutic effect of amoxicillin * Antibitotics in general can decrease the effectiveness of the live Typhoid Vaccine (Ty21a) * Pregnancy Category/Breast feeding * Category B * Can be used while breast feeding * Safety Monitoring * Monitor for anaphylaxis during the first dose * Monitor renal, hepatic, and hematologic functioning periodically with prolonged use * Efficacy Monitoring * Culture and sensitivity testing at baseline * Relief of symptoms/infection * Major Counseling Points * Can take each dose with food/drink * May help with GI upset if experienced * Take entire prescription (even if you feel better) * Talk to your doctor if your condition worsens or dose not improve upon completing the prescription * Can decrease the effectiveness of birth control * Use back up form of contraceptive to be safe * One Side Note * Prolonged use can result in fungal or bacterial superinfections (including C. difficile-associated diarrhea (or CDAD) References * Amoxicillin. In: Lexi-Comp Online [AUHSOP Intranet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010, cited 2010 May 23]. [about 6 p.]. Available from: http://online.lexi.com/crlsql/servlet/crlonline * Dipiro, J. T., R. L. Talbert, G. C. Yee, G. R. Matzke, B. G. Wells, and L. M. Posey. “Chapter 111: Lower Respiratory Tract Infections.” Pharmacotherapy: A Pathophysiologic Approach. New York: McGraw Hill, 2008. 1774-1776. * Amoxicillin. In: Pharmacy Drug Cards 23rd Edition. SFI Medical Publishing; 2007. Available from: http://www.sfirx.com/view_product.php?id=17 * Amoxicillin. In: Epocrates Online [Internet]. San Mateo, CA: Epocrates, Inc. [Updated 2010, cited 2010 May 31]. [About 7 p.]. Available from: https://online.epocrates.com/noFrame/ * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 5/31/10 | Free | View In iTunes |
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005 Lisinopril – Top 200 Prescribed Drugs | 005 Lisinopril (http://thestudentpharmacist.com/wp-content/uploads/005_Lisinopril.mp3) Episode Notes (References Below) * Brand/Generic Available * Prinivil * Zestril * Generic is available * MOA (ACE-I) * Angiotensin converting enzyme (ACE) normally convert angiotensin I to angiotensin II, which is a potent vasoconstrictor * ACE-Is blocks this conversion * This reduction in angiotensin II also leads to reduced aldosterone secretion, which decreases sodium and water reabsorption * Decreasing angiotensin II and aldosterone also decreases ventricular remodeling, myocardial fibrosis, myocyte apoptosis, cardiac hypertrophy and norepinephrine release * The decrease in aldosterone can lead to an increase in serum potassium * Also causes vasodilation of the renal efferent arteriole which can decrease proteinuria (especially in patients with Diabetic nephropathy) and is considered renal protective * Indications * HTN * HF (Reduces afterload) * Post-MI * Increases morbidity and mortality * Treat LV dysfunction * Dosage forms * Tablets from 2.5 40 mg * Doses * Heart Failure * Initiate at 2.5-5 mg Qday * Use 2.5 mg initially if patient has hyponatremia or renal impairment (CrCl 3 mg/dL) * Increase 10 mg every 2 weeks to a target dose of 40 mg * HTN * Initiate at 5 mg if patient is already on a diuretic OR 10 mg if not * Usual maintenance dose = 10-40 mg/day * Depend on patient response * Renal Impairment: * CrCl 10-30 mL/min: Initiate at 5 mg/day * Hemodialysis: Initiate at 2.5 mg/day * Acute MI * Initiate 5 mg immediately (within 24 hours) of MI in hemodynamically stable patients * Then: * 5 mg at 24 hours * 10 mg at 48 hours * 10 mg Qday for 6 weeks * BBW * Pregnancy * Cat. C in 1st and D in 2nd and 3rd trimesters * Shown to cause injury or death to the fetus in the 2nd and 3rd trimester * DC if patient is pregnant or plans to become pregnant * Contraindications * Hypersensitivity * History of angioedema * Pregnancy * Bilateral renal artery stenosis * Precautions * ACE-Is can cause angioedema at any time during therapy * Especially after 1st dose * ACE-Is are contraindicated if patient experiences angioedema * AAs are at increased risk of developing angioedema * Due to the build up of bradykinin caused by ACE-Is, Lisinopril can cause chronic cough * Dry and nonproductive * Usually seen within first months of therapy * Should resolve within a month of discontinuation * If intolerable to patient try switching therapy to an ARB (much less likely to cause cough) * ACE-Is can cause Hyperkalemia * Increase risk in: * Renal dysfunction * DM * Use of potassium sparing diuretics or potassium supplements (salts) * Monitor K levels * Hypotension * Usually seen with first doses * Risk is higher in volume depleted patients * Check volume status to make sure patient is not dehydrated * If hypotension is an issue, decrease dose (don’t discontinue) * Renal Dysfunction * Generally considered renal protective because Lisinopril and other ACE-Is vasodilate the efferent arteriole of the kidneys which decreases renal pressure * Can cause increase in serum creatinine * DC (ACE-Is or ARBs) if SrCr increases > 35% from baseline * Use with caution in patients with pre-existing renal impairment * ADRs (1-10%) * Hypotension * HA, Dizziness, fatigue * Rash * Hyperkalemia * GI Upset (diarrhea) * Impotence (1% of patients) * Weakness * Increase BUN * Chronic Cough * URTI * MAJOR Drug Interactions * NSAIDs * Block effects of ACE-Is and can enhance ADRs (renal impairment) * ASA can be used with ACE-Is if both drugs are indicated * Use ≤ 160 mg of ASA * Monitor | 5/30/10 | Free | View In iTunes |
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oo4 Levothyroxine Sodium – Top 200 Prescribed Drugs | 004 Levothyroxine Sodium (http://thestudentpharmacist.com/wp-content/uploads/004_Levothyroxine_Sodium.mp3) Episode Notes (References Below) * Brand/Generic Available * Levothroid * Levothyroxine Sodium * Levoxyl * Synthroid (8th most prescribed drugs) * MOA * Synthetic T4 (Thyroxine) * Thyroid hormones increase the metabolic rate of body tissues as well as regulate cell growth and differentiation * Thyroxine is a major component of normal thyroid secretions and is needed for proper thyroid function * Indications * Hypothyroidism * Basically used as a replacement or supplement in any form of hypothyroidism except transient hypothyroidism during the recovery phase of subacute thryoiditis * Pituitary thyrotropin (thyroid-stimulating hormone or TSH) suppression * Treatment or prevention of euthyroid goiters * Treatment of myxedema coma (in patients without severe heart dx) * Dosage forms * Tablets mcg from 25-300 mg (25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, and 300 mcg) * Powder for injection (200 and 500 mcg) * Once you pick a specific brand/dosage form, you generally want to stick with it (bc there can be equivalency and absorption issues) * Doses * Hypothyroidism * Doses are patient specific and depend on age, body weight, physical condition, and severity of hypothyroid symptoms * Start with lower doses in patients with CVD, severe long standing hypothyroidism, and elderly patients * Levothyroxine can cause rapid increase in metabolic rate and cardiac output which can lead to cardiovascular issues such as: * Angina, MI, CHF, Arrhythmias, and even sudden cardiac death * Initial dosages * Usual initial oral dose for healthy individuals is 1.7 mcg/kg/day as a single dose * Patients > 50 yo OR < 50 yo with CVD = 25-50 mcg/day as single dose * Patients with severe hypothyroidism or elderly with CVD = 12.5-25 mcg/day single dose * Evaluate patient Q6-8 weeks initially and adjust dose accordingly * Increase by increments of 12.5-25 mcg * Once thyroid function and TSH are stable, then every 6 months or yearly * If cardiac symptoms develop or worsen, the hold therapy for 1 week then reinitiate at lower dose * Ideally administered orally on an empty stomach 0.5-1 hours before the the first meal of the day with a full glass of water (Levoxyl tabs can swell and disintegrate rapidly which may result in choking or difficulty swallowing) * Myxedema Coma (without severe heart disease) * Myxedema coma is a consequence of decompensated hypothyroidism * Give IV * Oral absorption is unpredictable in patients with myxedema coma * Initial IV dose = 100-500 mcg * Max effect seen within 24 hours * If a second IV dose is needed, 100-300 mcg may be administered 24 hours after the initial dose * Continue giving lower IV doses until patient is stable and able to take oral doses * Pituitary TSH Suppression * Should be individualized based on the patient and disease severity * Contraindications * Hypersensitivity * Untreated thyrotoxicosis * Untreated adrenal insufficiency * ADRs * In general, the ADRs seen are a result of the dose being too high and resemble hyperthyroidism. They include: * Difficulty concentrating * Fatigue * Frequent bowel movements * Goiter or thyroid nodules * Heat intolerance * Increased appetite * Increased sweating * Irregular menstrual periods (in women) * Nervousness * Restlessness * Unintentional weight loss (rarely, weight gain) * Palpitations, tachycardia, arrhythmias, increased HR and BP, HF * Hair loss * Increased LFTs * Major Drug Interactions * Levothyroxine may increase the effects of anticoagulants * Pregnancy Category/Breast feeding * Category A * Dose may need to be increased during pregnancy * Use with caution if breast feeding | 5/28/10 | Free | View In iTunes |
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002 Lipitor – Top 200 Prescribed Drugs | 002 Lipitor (http://thestudentpharmacist.com/wp-content/uploads/002_Lipitor.mp3) Episode Notes (References Below) * Brand/Generic Available?? * Atorvastatin * Generic NOT available * MOA * Statin * Inhibit HMG-CoA reductase, which is involved in the rate limiting step of the synthesis of cholesterol * So, decreases the amount of cholesterol the body can produce * And also increase LDL receptors on hepatocytes and LDL clearance and catabolism * Indications * Treatment of dislipidemia * Reduce TC, LDL, apolipoprotein B, and TGs * Increase HDL * Primary prevention of CVD * Primary prevention = don’t currently have CVD disease but are considered high risk for developing CVD (have multiple risk factors or T2DM_ * Secondary prevention of CVD * Secondary prevention = already have evidence of coronary heart dx and lipitor can be used to reduce the risk of MI, stroke, and angina in these patients * Dosage forms * Tablet * 10, 20, 40, and 80 mg * Doses * Dyslipidemia * Initial dose = 10-20 mg Qday * Dose range = 10-80 mg Qday * Individualized based on response and lipid levels * In general atorvastatin can decrease LDL levels by 39-60% (depending on dose) * Renal impairment = NO adjustment * Hepatic impairment = contraindicated in active liver dx * PK (if important) * CYP3A4 substrate ( 1 quart/day) * Onset of action = 3-5 days * Max effect is seen at about 2 weeks * BBW * None * Contraindications * Hypersensitivity to Atorvastatin * Active Liver dx * elevations in LFTs (ALT/AT) * Pregnancy * Breast feeding * Precautions * Myopathy (muscle pain)/rhabdomyolysis (muscle breakdown) * Monitor closely * Dose related risk * Make sure patient is on lowest effective dose * Risk is increased with concurrent use of 3A4 inhibitors, fibric acid derivatives (such as gemfibrozil), or niacin at doses ≥ 1 g/day * Use with caution in the elderly (they are at increased risk of developing myopathy * Tell patient to report any unexplained muscle pain, tenderness or weakness, or brown urine * Hepatic impairment * Since statins can cause liver dysfunction, use with caution in patients who have a history of liver impairment or who consume large amounts of alcohol * Tell patients to avoid excess alcohol * ADRs * Main = diarrhea (5-14% of patients) * Nausea * Dyspepsia (indigestion) * Arthralgia (joint pain) * Myalgia (without CPK changes) * HA * Insomnia * Dizziness * Above are generally mild and disappear over time * Increased LFTs * Myopathy and rhabdomyolysis with increase CPK * MAJOR Drug Interactions * 3A4 inhibitors * Pregnancy Category/Breast feeding * Category X (as are all statins) = do not use * Contraindicated in breast feeding * Safety Monitoring * At baseline (or upon change in dose): * Creatine Phosphokinase and muscle symptoms * LFTs * LFTs again at 12 weeks then semiannually * If LFTs increase > 3 x ULN dc statin * Can reinitiate the same statin or a different on once LFTs return to normal * Evaluate/ask about muscle symptoms at every visit * If patient complaints of abnormal muscle pain or weakness, then recheck Creatine Phosphokinase (dc if muscle pain is severe or CPK increases > 10 x ULN) * Can start a different statin once muscle pain subsides and CPK levels return to normal * Efficacy Monitoring * Fasting lipid panel at baseline * Followup in 8 weeks * Every 3 months once stable... can increase to Q6 months * Major Counseling Points | 5/27/10 | Free | View In iTunes |
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001 & 003 Hydrocodone & Acetaminophen – Top 200 Prescribed Drugs | 001 (and 003) Hydrocodone and Acetaminophen (http://thestudentpharmacist.com/wp-content/uploads/001_Hydrocodone_APAP.mp3) Episode Notes (References Below) * Brand/Generic Available * Lorcet * Lortab * Vicodin * Generic is available * MOA * Hydrocodone = opiate analgesic * Blocks pain by binding Mu and kappa opiate receptors in the cerebral cortex * APAP * Analgesic and antipyretic * Analgesic = Inhibits prostaglandin synthesis in the CNS * Antipyretic = Inhibits the hypothalamic heat-regulation center * Indications * Analgesic (management for moderate-severe pain) * Dosage forms * Many dosage forms including capsules, elixirs, oral solutions, and tablets * Dosage forms have varying amounts of hydrocodone (2.5 - 10 mg) and APAP (300-750 mg) * Doses * Going to depend on specific product * Typical starting dose = 5-10 mg hydrocodone QID (<--- 4/day) * Basically titrate to a dose that provides pain relief * Maximum hydrocodone dose = 60 mg/day * Make sure the acetaminophen dose does not exceed 4 g/day * Use with caution in patients with hepatic impairment or dring alcohol * Avoid chronic use in patients with hepatic impairment * Pharmacokinetics * Onset of action = 10-20 minutes * Duration of action = 4-8 hours * Metabolized by the liver * BBW * None * Contraindications * Hypersensitivity * CNS depression * Can cause CNS depression, which can impair both physical and mental abilities * Severe respiratory depression * Precautions * Use with caution in patients with a hx of drug abuse/alcoholism * Both psychological and physical dependency can develop with prolonged use * ADRs * CNS * CNS depression (bradycardia, hypotension) * Dizziness or lightheadedness * Drowsiness or sedation * Dysphoria * Euphoria * GI * Constipation (does not go away over time as other ADRs do) * Therefore, if on opioid long-term, pt should also be on stool softener and/or laxative. * N/V * Heartburn * Xerostomia (dry mouth) * Hematologic * Agranulocytosis * Prolonged bleeding time * Thrombocytopenia * Dermatologic: Itching and Rash * Urinary retention * Hepatic necrosis * Renal toxicity * Hearing loss * Respiratory depression (dose related!!!!) * MAJOR Drug Interactions * Alcohol * CNS depressant = additive effect * Also increases risk of hepatotoxicity with acetaminophen * Other CNS depressants * Pregnancy Category/Breast feeding * Category C * Not recommended when breast feeding * Efficacy Monitoring * Pain relief * Major Counseling Points * Avoid alcohol * Consuming alcohol and taking APAP increases the risk of developing hepatotoxicity * Alcohol also increases CNS depression * Do not exceed recommended dosing * Lortab can cause dependence * Overdose can lead to fatal respiratory depression * Use caution performing tasks that need mental alertness (CNS effects) * Major ADRs * CNS Effects (CNS depression, euphoria or dysphoria) * GI upset * Most all side effects will diminish over time except constipation References: * Hydrocodone and Acetaminophen. In: Lexi-Comp Online [AUHSOP Intranet]. Hudson, OH: Lexi-Comp, Inc. [updated 2010 May 5, cited 2010 May 23]. [about 8 p.]. Available from http://online.lexi.com/crlsql/servlet/crlonline * Klipa D, Russeau JC. Pain and Its Management. In: Endow-Eyer RA, Mitchell MM, Lacro JP. Schizophrenia. In: Koda-Kimble MA, Young LY, Alldredge BK, Corelli RL, Guglielmo BJ, Kradjan WA, Williams BR, editors. Applied Therapeutics: The Clinical Use of Drugs. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. pg. 8: 1-36 * Baumann TJ, Strickland J. Pain Management. In: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, editors. | 5/27/10 | Free | View In iTunes |
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Introduction Episode! – Top 200 Prescribed Drugs | 000 Introduction (http://thestudentpharmacist.com/wp-content/uploads/000_Introduction.mp3) Episode Notes (References Below) * Welcome to the top 200 prescribed drugs podcast * My name is Joshua Hollingsworth and this is the introduction episode * Before we get started, I want to give you a brief overview of what to expect * I plan to put out one episode/day * Each episode will cover 1 drug starting with #1 most prescribed drug and working all the way to number 200 * List we are using was compiled by IMS Health for 2009 * For each drug we will cover the following: * Brand/generic names * MOA * Indications * Dosage forms * Dosing * Pertinent PK * Any BBWs as well as precautions * Common and serious ADRs * MAJOR drug interactions * Won't go into much detail here... * Pregnancy Category/Breast feeding recommendations * Safety and Efficacy monitoring and * Major Counseling points * Who should listen to this podcast? * Anyone in the healthcare field (Pharmacist, Dr., Nurse, in school to become a HCP, or if you are just interested in learning more about the most prescribed drugs) * Each episode will be short and to the point (around 5 minutes) * References for each episode as well as show notes will be on the website * thestudentpharmacist.com * If you have any questions comments, suggestions, you can contact me: * By email: thestudentpharmacist@gmail.com * There is a link on the website you can click and contact me * Twitter: @TheStudPharm (short for TheStudentPharmacist) * So that is it * Hope to see you next episode References for this Episode: * Bartholow M. Top 200 Prescription Drugs of 2009 [Internet]. Plainsboro (NJ). Pharmacy Times. 2010 May 11 [Cited 2010 May 27]. Available from: http://www.pharmacytimes.com/media/pdf/PHTM_36.pdf | 5/27/10 | Free | View In iTunes |
| Total: 124 Episodes |
Customer Reviews
Great for on the fly
I'm a pharmacy student trying to study for my boards in the upcoming month. After studying at home all day, I go to the gym and listening to the podcasts! It makes me feel like I'm accomplishing things even when I'm not at home behind a book! Keep em coming ;)
Pharmacy Technician
I am so glad I ran into this podcast, I am currently in school to become a pharmacy technician and I will be done in about two months, I am at the top of my class on the Dean's list, but I have been having a hard time remembering certain brand name drugs vs their generic names. This podcast will help SO MUCH! Thank you!
Great review for pharmacists
Thanks for this. I am a pharmacist and I'm using this as a quick review. You wouldn't believe how much you forget when school ends.
Keep up the good work.
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