Saunders Nursing Drug Handbook 9780323757287

Table of contents :
Front Cover
IFC
Saunders: NURSING DRUG HANDBOOK 2021
Copyright
CONTENTS
AUTHOR BIOGRAPHIES
REVIEWERS
CONSULTANTS*
ACKNOWLEDGMENTS
DEDICATION
Newly Approved Medications
PREFACE
DRUGS BY DISORDER
DRUG CLASSIFICATION CONTENTS
Rhinitis Preparations
Beta-Adrenergic Blockers
Calcium Channel Blockers
Chemotherapeutic Agents
Contraception
Corticosteroids
Diuretics
H2 Antagonists
Hepatitis C Virus
Hormones
Hormones—cont’d
Hormones—cont’d
Immunosuppressive Agents
Laxatives
Multiple Sclerosis
Obesity Management
Osteoporosis
Parkinson’s Disease Treatment
Parkinson’s Disease Treatment
Proton Pump Inhibitors
Rheumatoid Arthritis
Sedative-Hypnotics
Skeletal Muscle Relaxants
Smoking Cessation Agents
Vitamins
A
B
C
D
E
F
G
H
I
K
L
M
N
O
P
Q
R
S
T
U
V
W
Z
A -CALCULATION OF DOSES
B -CONTROLLED DRUGS (UNITED STATES)
C -WOUND CARE
D -DRUGS OF ABUSE
E -EQUIANALGESIC DOSING
F -HERBALS: COMMON NATURAL MEDICINES
G -LIFESPAN, CULTURAL ASPECTS, AND PHARMACOGENOMICS OF DRUG THERAPY
H -NORMAL LABORATORY VALUES
I -DRUG INTERACTIONS
J -ANTIDOTE/REVERSAL AGENTS
K -PREVENTING MEDICATION ERRORS AND IMPROVING MEDICATION SAFETY
L -PARENTERAL FLUID ADMINISTRATION
M -COMMON TERMINOLOGY CRITERIA FOR ADVERSE EVENTS (CTCAE)
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z

Citation preview

Granisetron

Heparin

Hydrocortisone

Hydromorphone

Imipenem

Insulin

Labetalol

Levofloxacin

Linezolid

Lorazepam

Magnesium

Mannitol

Meropenem

Methylprednisolone

Metoclopramide

Metronidazole

Midazolam

Morphine

Nicardipine

Nitroglycerin

Nitroprusside

Norepinephrine

Octreotide

Ondansetron

Pantoprazole

Phenylephrine

Piperacillin/Tazobactam

Potassium Chloride

Propofol

Sodium Bicarbonate

Tigecycline

Tobramycin

Vancomycin

Vasopressin

C C I I N N C C N C N N C C I N C N C C I N N N N I N C C N C N C

N C N N N C N N N N N I N C C N N N N N N N C C N C N N N C N C N

C N C C N I C C N C N I C N C N C N N C C N N N N N N C N C C N C

C C C C N N C I N C I C N I N N N N N C C N N N C N N C C C N N N

N N C N C N N N N N N N C C C N N N N N C N C C N C N N N C I C N

Gentamicin

C I N N N N C N N C C I C C N N C N C C N C C C C C N C C C C I N

Furosemide

C C C C N I C C I C N C C N C N C N C C C C C C C N N C C C C C N

Fluconazole

I N I C N I C C C C N N N N N N C N C C N C I C C N N N I C C N C

Famotidine

N N C C C N N C N N N N N N N N N N C C N N N N N N N N C N I N N

Esmolol

N I I C N N I N N I C N C C I N N N N N N I I C N I N I N I C N N

Eptifibatide

I C N N N C C N N N C N C N N N C N C C N C N C N N N N N C C C N

Epinephrine

N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N

Enalapril

N C C C C N N C N C N N C N C N N N N C C N C C N C N C C N C N N

Dopamine

N N I N C N N C N N N N N N N N N N N C C N C C C C N C C N C N N

Dobutamine

N N C N C N N C N N N N N N N N N N N C C N C C C C N C C C I N N

Diphenhydramine

N C N N N N C N N C C I N N N N C N N N C N C C C C N C C N I C N

Diltiazem

C C C C C I C C C N C C C C N N C N C C C C C C C C N C C C C C C

Dexmedetomidine

N C C C C N N C I C C I C N C N C N I C C C C C N C N N C C C C N

Dexamethasone

C N N C N N I C N N C C C N C N N N N C C N N C C N N C N C N N C

Daptomycin

C N N N N N C C N I N N C N C N C N C C C C N N N N N N C C I N C

Clindamycin

C N C C N N C C N I N C C N I N C N N C I N N C C N N N C N N N C

Ciprofloxacin

I N N C N N N N N C N N N N N N N N C N N C N N C N N N N C C C N

Ceftriaxone

N C N N N N C C N N N N C N N N N N N N N N N N N N N N N N C N N

Ceftaroline Fosamil

C C I N N N C C N C C N C N I N C N N C N N C N C N N C C N N C C

Cefepime

C C C N N N I C C N N N C N C N N N C C C N C C N C N N C C C C C

Cefazolin

C C N C N N C N N C C N N C C N C N C C N C C C C N N C C N C C C

Calcium Gluconate

I C N C N I N C N N N N C N N N C C C C N N C C N C N N N N I C N

Bumetanide

N C C N N N N C N C C N I I N N C N N C C N C C C C N C C N I C N

Bivalirudin

N N C N N N C N N N C C C N N N N N N N N N C I N N N C C N N C N

Aztreonam

C N I C N I C N N N N N N N N N N N N N C C N N N N N N C I N N C

Azithromycin

C C N N N N C C N N I N C N N N C N C C C C C C N C N N C N C C C

Argatroban

C C N C C N C C N C N N C N I N C N C N C N N C C C N C C N C N C

Anidulafungin

C I I C N N C C N C C C C C I N C C C C C C C C C C N C C C C I C

Amiodarone

C — C N C N N I N N N C N C C N C N C N I C I I N N N N C C N C C C C — C C N I C C N C C C C C C C C C C C C N N C C N C N C C N C C N C — N I N N N N C I N C C C C N N C N N C C N C C C C C C C N C C C N — N N N N N N C C N C C C N C N N N C C N C N N C C C C N C N N I N — N N N N N N N N N N N N N N C C C C N N C N N N C N N C N I N N N — I C N N N N C I I I N N C N N N N N N N N I N I I N C I C N N N N — C C N C N N C C C C C C C C C C C N N N C C C C C C N C I N N C C — C C C C N C C C N C N C C C C C C C C C C C C N C N N N N N N C C — N N N C N N N N N C C N I N N N N N N N C N C C N C C N N N C C N — C N C I C N N N C N N C N C C N N C I C N C C C C I C N N C C N C — N N N N C N N C C N N N C N N C C C N I C C N C N C N N N C N N N — N N N C N N C N N I C N N N N N C C C C C C C C N N C N N C C N N — N C N N C N C C I C C N N N C C C C C C C C C C N I C C N I N N N — N I C N C C N N N N N N N C I N N C C N C C C N I C C N C N N C N — I N I C C C C C N N N N N N I C C C N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N C C C C C N I C C N N C C C I I — N N C C N N N C N N C N I N C C C N C N N N N C N N N N N N C N N — N N N N N C N N N N N C N C N C C C N C N N C C N N N N C N I N N — C N I N N N N N N C C N N C C N C C N N C C N C C C C N C C C N C — C C C C N C N C C C C C C C I C N N C N C C C N C N C C C C N N C — N C N N C N C N C I C N C C C N N C N C C N N N N C N C N N I C N — N N N N N N C C N N C C I N C C C N C C I C N C I N C N N N C C N — C C C N N C C I N C C I N C C C N C C N N N C C N C N C N C C N C — C C N C C C I N C C N C N N N N C C N C C N C N N C N N C N N C C — N N C C N N C C C N C C C N N N C N C N N N N N N N N C C N C C N — N N N N C N N C N N C N C N N C N N N N N N N N N N N N N N N N N — N N N N N N C N C C N N N N C N N C N N N N C N N C C N N C C N N — C N I C N C C N C C N I C C N C C N C C N N N C C N C C C C N N C — C C C C C C C C C N N C C N I C C C I N I C C C C C C C N N N N C — I C C C N C C C C I C C C C N C C N I N N N C I N I I N C N I C I — I C C C N C C N I C C N N I C C N C C C N C C N N N C N N C C C I — C C C C N N N N C N C C C C C C C C N C C N C C C C N N N C C C C —

Amikacin

C C C C C C C C C C C C C C C C C I C C C C C C C C C C C C C C C

Acyclovir

Sodium Chloride

C Physically compatible via Y-site administration. I Physically incompatible. N Information on compatibility not available or conflicting

Acyclovir Amikacin Amiodarone Anidulafungin Argatroban Azithromycin Aztreonam Bivalirudin Bumetanide Calcium Gluconate Cefazolin Cefepime Ceftaroline Fosamil Ceftriaxone Ciprofloxacin Clevidipine Clindamycin Daptomycin Dexamethasone Dexmedetomidine Diltiazem Diphenhydramine Dobutamine Dopamine Enalapril Epinephrine Eptifibatide Esmolol Famotidine Fluconazole Furosemide Gentamicin Granisetron

Dextrose 5%

IV Compatibilities

The IV compatibility table provides data when 2 or more medications are given in a Y-site of adminis­ tration. The data in this table largely represent physical incompatibilities (e.g., haze, precipitate, change in color). Therapeutic incompatibilities have not been included, so when using the table, professional judgement should be exercised.

Gentamicin

Granisetron

C C C C C C N C C C N N C C N C C C C C C N C N C I C C C N N C N

C N N I N N N N C N N C N C C C C N C N N N C I N C C C N C C C C

C C C N N I I C C N C C N I N C C I I C C N C C I C C C C N C N I

I N C N C C C C C C N C N N N C C C N N N N C N N N C I N C N N C

C — C C N C C I C C C N C C C C C C I C C C N C I N C C C C C I I C C C — N N N N N C C C N N N N N I C C N N C N C N N C N C C N N N N C C N — N N C N C C C N N N N C C C C C N C N C I N C N C N N C C N C N N N — C N N C I N N N N N N I N N N N N N C N N N N C I C N N C N C N N C — I C N N C N C N N N N C N C N N N N C N N N C C N C C C N C N C N I — N C C C N N N N C C C C C C C N N N N N C C N N C C N N I N C N I N — C C C N N N N N N C N I I N N N N C N C N C N N C N C C C C C N C C — C C C C C N C C C C C N N N C N N C C N C C C C C C C C C C N C C C — N N N N N C C C C C N C N I N N C C C N N N C N C C C C N C C C C N — N N N N C N C C N C N N C N N C C C N N C C N N N N N N N N N C N N — N N N N N N N N N N N N I N N C C N N N N N N C N N N C N N C N N N — N C N N C N N N C N I N N N C N N N N C C C C N N N N N N C N N N N — N C C C C N N N N I I N C I I C I N N N C C N N N N N N N N N N C N — N C C N N N N N C N N C N N N C N N N C C N C N N C N C C C N N C N — C C C N N N N N N N C N N N N N N C N C I C I N C N C C N N N C C N — C C C C C N N I N N C C I N C C N C C C C N C C C C C C N C C C C C — C C C C N C C N C C C C N C C N N I C C N N C N C C C N N C N C C C — C C C N N N N N C N N N C C N N C N C N C C I C C N N N N N N C C C — C C N N C N N N C N N N N C N C N N N N C I N N C N N N N N C C C C — C N N N N N N C N N N N N N C C C N N C N N C N N C N N N C C C C C — N N C N N C C N N N N C N N N N N N N N N N N N N N N N N N N N N N — N I N N N N N N N N N N C C C C N N N C I C N I I C N N C N N N N N — N N C C N I N N C N N I N I N C N N N N N I N I N N I C N C N C I N — N N C N N N N I C N N N N N N N C N N N N N N N N N N N N N N N N N — N N N N N N N C C C C C N N N N C C C N N C C C N C N N N C N C N N — C N C C I I C N C N N N N C C C C C C C I N N C C C N C C N C C N C — C C C N N N N C C C C C C N N C C C N I N N C C N C C C N N N C N C — C N I C N C C C N I C N C C N N N N C N N I C N N N N N I N N C C C — N N C C N C N N C N N N C N N N N I C N N N N N N N N N N N C C N N — C C N C I N C N C C N C N C N N N N N C C C N N N N N N N I N I N C — N N C I N C N C C C C C C N C N N N C C C N N N N C I N I N C C C N — N N C N N C C N N C N N N C N N C N N N C N C N N C C C N N C N N N —

Vasopressin

Furosemide

C C N N C C N C N C N N N N C N C C C C C N N I N N C C C N C C N

Vancomycin

Fluconazole

N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N

Tobramycin

Famotidine

C C C N N C C N C N N N N N N C C C C C C N N I N N N C I C N N C

Tigecycline

Esmolol

Sodium Bicarbonate

Eptifibatide

C C N N N C N C N C N C C N C N C C C C N N N N N C C C N N N C N

Propofol

Epinephrine

C C C N I C C C C N N N C N C C C C C C C N C C N C C C N C N N C

Potassium Chloride

Enalapril

Piperacillin/Tazobactam

Dopamine

C N C N C C C C C C N N N N N C C C C C C N N I N I C C N C N N C

Phenylephrine

Dobutamine

C N C C N N N C N N N C N C N C C N N N N N C I N C C C N N N N N

Pantoprazole

Diphenhydramine

C C C C N C N N C N N N I C C C C C C C C N N N N N C N I N C C C

Ondansetron

Diltiazem

C N C N N C C C C C N N C C C C C N C C C N C N C C C C C N C C N

Octreotide

Dexmedetomidine

C C C N N N C C C N N C N C N I C N N N N N C I N C C C C N N N N

Norepinephrine

Dexamethasone

C N N N N N C N N N N N N N N N N N N N N N N N N N N N N N N N N

Nitroprusside

Daptomycin

C C C N N C C C N C N N C C N C C C N N N N C N N C C C C N C N N

Nitroglycerin

Clindamycin

I I N N N N N C C I N N I C C C N N N N C N N I N N C N I C C N C

Nicardipine

Ciprofloxacin

C N N N N I N C N N N N N N N N C N N N N N N C N N N C C C N I N

Morphine

Ceftriaxone

C C C N C I C N C C C N C C C C C N N N C N C C N N C C C N C N C

Midazolam

Ceftaroline Fosamil

C N N N C N N N N N N N C N C I C I N N N N N N N N C I N I I C N

Metronidazole

Cefepime

C N I N C C N C N C N N N N C C C C N N N N C C N N N C N N N I N

Metoclopramide

Cefazolin

C C N N N C N C N C N C I I N C N C N N C N N I N C C C C N C C N

Meropenem

Calcium Gluconate

N N N N N N N N C N N N N N N I C N N N N N N N N C N C N N N N N

Mannitol

Bumetanide

C C C N N C C N C C C N C C C C C N C C C N N N C C C N C N C I N

Magnesium

Bivalirudin

C C C C C N N C I C C N C C I N C C N N N N C I N C C C C N C C N

Lorazepam

Aztreonam

N N N I N N I N N N N N N N N N I N N N N N C N N I I N N C I N N

Linezolid

Azithromycin

N C N N N N N N N N N N N N N C C N C C C N N N C N N N N N N N C

Levofloxacin

Argatroban

C C N C N N C C N N N C C N C C C N N N C N N C C C C N I N C C N

Labetalol

Anidulafungin

I N N I C C N N C I N N C N N C C N C I C N N I C I C N I N C C C

Insulin

Amiodarone

I C C N N C C C C C C N N N N C C C N N C N C I N N C I C C N C N

Imipenem

Amikacin

C C C C N N I C C C N I C C C N C N N N N N I N N I C C C N C C N

Hydromorphone

Acyclovir

C C C C C C C C C C — C C C — C C C C C C C C C C C C C C C C C C

Hydrocortisone

Sodium Chloride

C C C C N C C C N C — N C C — C C C C C C C C C C C C C C C C C —

Heparin

Dextrose 5%

C Physically compatible via Y-site administration. I Physically incompatible. N Information on compatibility not available or confl icting

Heparin Hydrocortisone Hydromorphone Imipenem Insulin Labetalol Levofloxacin Linezolid Lorazepam Magnesium Mannitol Meropenem Methylprednisolone Metoclopramide Metronidazole Midazolam Morphine Nicardipine Nitroglycerin Nitroprusside Norepinephrine Octreotide Ondansetron Pantoprazole Phenylephrine Piperacillin/Tazobactam Potassium Chloride Propofol Sodium Bicarbonate Tigecycline Tobramycin Vancomycin Vasopressin

Methylprednisolone

IV Compatibilities

The IV compatibility table provides data when 2 or more medications are given in a Y-site of adminis­ tration. The data in this table largely represent physical incompatibilities (e.g., haze, precipitate, change in color). Therapeutic incompatibilities have not been included, so when using the table, professional judgement should be exercised.

Saunders

NURSING DRUG

HANDBOOK

2021

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Saunders

NURSING DRUG HANDBOOK

2021 ROBERT J. KIZIOR, BS, RPH

Department of Pharmacology Alexian Brothers Medical Center Elk Grove Village, Illinois

KEITH J. HODGSON, RN, BSN, CCRN Staff Nurse, Intensive Care Unit Former Staff Nurse, Emergency Department St. Joseph’s Hospital Tampa, Florida

Elsevier 3251 Riverport Lane St. Louis, Missouri 63043 SAUNDERS NURSING DRUG HANDBOOK 2021 

ISBN: 978-0-323-75728-7 ISSN: 1098-8661

Copyright © 2021 by Elsevier, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors, or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence, or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Previous editions copyrighted © 2020, 2019, 2018, 2017, 2016, 2015, 2014, 2013, 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2003, 2002, 2001, 2000, 1999, 1998, 1997, 1996, 1995, 1994, and 1993. International Standard Book Number: 978-0-323-75728-7

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CONTENTS DRUGS BY DISORDER DRUG CLASSIFICATIONS A–Z DRUG ENTRIES APPENDIXES

A. Calculation of Doses B. Controlled Drugs (United States) C. Wound Care D. Drugs of Abuse E. Equianalgesic Dosing F. Herbals: Common Natural Medicines G. Lifespan, Cultural Aspects, and Pharmacogenomics of Drug Therapy H. Normal Laboratory Values I. Drug Interactions J. Antidote/Reversal Agents K. Preventing Medication Errors and Improving Medication Safety L. Parenteral Fluid Administration M. Common Terminology Criteria for Adverse Events (CTCAE)

INDEX

xiv 1C 1 1256 1256 1257 1258 1263 1270 1271 1278 1282 1284 1289 1294 1298 1301 1303

v

AUTHOR BIOGRAPHIES Robert (Bob) J. Kizior, BS, RPh Bob graduated from the University of Illinois School of Pharmacy and is licensed to practice in the state of Illinois. He has worked as a hospital pharmacist for more than 40 years at Alexian Brothers Medical Center in Elk Grove Village, Illinois—a suburb of Chicago. Bob is the Pharmacy Surgery Coordinator for the Department of Pharmacy, where he participates in educational programs for pharmacists, nurses, physicians, and patients. He plays a major role in coordinating pharmacy services in the OR satellite. Bob is a former adjunct faculty member at William Rainey Harper Community College in Palatine, Illinois. An avid sports fan, Bob also has eclectic tastes in music that range from classical, big band, rock ‘n’ roll, and jazz to country and western. Bob spends much of his free time reviewing the professional literature to stay current on new drug information. Keith J. Hodgson, RN, BSN, CCRN Keith was born into a loving family in Chicago, Illinois. His mother, Barbara B. Hodgson, was an author and publisher of several medication products, and her work has been a part of his life since he was a child. By the time he was 4 years old, Keith was already helping his mother with the drug cards by stacking the draft pages that were piled up throughout their home. Because of his mother’s influence, Keith contemplated becoming a nurse in college, but his mind was fully made up after he shadowed his sister in the Emergency Department. Keith received his Associates Degree in Nursing from Hillsborough Community College and his Bachelor of Science in Nursing from the University of South Florida in Tampa, Florida. Keith started his career in the Emergency Department and now works in the Trauma / Neurological/Surgical Intensive Care Unit at St. Joseph’s Hospital in Tampa, Florida. Keith’s favorite interests include music, reading, Kentucky basketball, and, if he gets the chance, watching every minute of the Olympic Games.

vi

REVIEWERS James Graves, PharmD

Travis E. Sonnett, PharmD

Clinical Pharmacist University of Missouri Hospital Columbia, Missouri

Inpatient Pharmacy Supervisor Mann-Grandstaff VA Medical Center; Residency Program Director Washington State University College of Pharmacy Spokane, Washington

vii

CONSULTANTS* Katherine B. Barbee, MSN, ANP, F-NP-C Kaiser Permanente Washington, District of Columbia

Marla J. DeJong, RN, MS, CCRN, CEN, Capt

Linda Laskowski-Jones, RN, MS, CS, CCRN, CEN Christiana Care Health System Newark, Delaware

Jessica K. Leet, RN, BSN

Wilford Hall Medical Center Lackland Air Force Base, Texas

Cardinal Glennon Children’s Hospital St. Louis, Missouri

Diane M. Ford, RN, MS, CCRN

Denise Macklin, BSN, RNC, CRNI

Andrews University Berrien Springs, Michigan

President, Professional Learning Systems, Inc. Marietta, Georgia

Denise D. Hopkins, PharmD

Judith L. Myers, MSN, RN

College of Pharmacy University of Arkansas Little Rock, Arkansas

Health Sciences Center St. Louis University School of Nursing St. Louis, Missouri

Barbara D. Horton, RN, MS

Kimberly R. Pugh, MSEd, RN, BS

Arnot Ogden Medical Center School of Nursing Elmira, New York

Nurse Consultant Baltimore, Maryland

Mary Beth Jenkins, RN, CCRN, CAPA

Regina T. Schiavello, BSN, RNC

Elliott One Day Surgery Center Manchester, New Hampshire

Wills Eye Hospital Philadelphia, Pennsylvania

Kelly W. Jones, PharmD, BCPS

Gregory M. Susla, PharmD, FCCM

McLeod Family Medicine Center McLeod Regional Medical Center Florence, South Carolina

National Institutes of Health Bethesda, Maryland

*The authors acknowledge the work of the consultants in previous editions.

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ACKNOWLEDGMENTS I would like to thank my co-author Bob Kizior for his knowledge, experience, ­support, and friendship. We would like to give special thanks to Sonya Seigafuse, Charlene ­Ketchum, Carrie Stetz, Tina Kaemmerer, and the entire Elsevier team for their superior ­dedication, hard work, and belief in us. Without this wonderful team, none of this would be possible. Keith J. Hodgson, RN, BSN, CCRN

DEDICATION I dedicate my work to the practicing nurse, those aspiring to become nurses, and to all health care professionals who are dedicated to the art and science of healing. Bob Kizior, BS, RPh I dedicate this work to my sister, Lauren, a foundation for our family; my sister, Kathryn, for her love and support; my father, David Hodgson, the best father a son could have; my brothers-in-law, Andy and Nick, great additions to the family; the grandchildren, Paige Olivia, Logan James, Ryan James, and Dylan Boyd; to Jen Nicely for always being there; and to my band of brothers, Peter, Jamie, Miguel, Ritch, George, Jon, Domingo, Ben, Craig, Pat, and Shay. A special thank you to David Jurocko, DMD, and his office staff for your patience, professionalism, and smiles. We also make a special dedication to Barbara B. Hodgson, RN, OCN. She truly was a piece of something wonderful. Barbara often gave her love and support without needing any in return and would do anything for a smile. Not only was she a colleague and a friend, she was also a small business owner, an artist, a dreamer, and an innovator. We hope the pride we offer in her honor comes close to what she always gave us. Her dedication and perseverance lives on. Keith J. Hodgson, RN, BSN, CCRN

BIBLIOGRAPHY Lexi-Comp’s Drug Information Handbook, ed 28, Hudson, OH, 2019–2020, ­Lexi-Comp. Medical Letter on Drugs and Therapeutics: 2018–2019, Pharmacists Letter: 2019. Takemoto CK, Hodding JH, Kraus DM: Lexi-Comp’s Pediatric Dosage Handbook, ed 25, Hudson, OH, 2018–2019, Lexi-Comp. Trissel LA: Handbook of Injectable Drugs, ed 19, Bethesda, MD, 2016, American ­Society of Health-System Pharmacists.

ILLUSTRATION CREDITS Kee JL, Hayes ER, McCuiston LE, editors: Pharmacology: A Nursing Process Approach, ed 7, Philadelphia, 2012, Saunders.

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NEWLY APPROVED MEDICATIONS

x

Binimetinib (Mektovi)

A kinase inhibitor for metastatic melanoma

Dacomitinib (Vizimpro)

A kinase inhibitor for metastatic non-small cell lung cancer (NSCLC)

Doravirine/lamivudine/tenofovir disoproxil (TDP)

A combination antiretroviral for HIV-1 infection

Duvelisib (Copiktra)

A kinase inhibitor for certain types of leukemia and lymphomas

Encorafenib (Braftovi)

A kinase inhibitor for metastatic melanoma

Erdafitinib (Balversa)

A kinase inhibitor for advanced or metastatic urothelial cancer

Gilteritinib (Xospata)

A kinase inhibitor for relapsed or refractory AML

Glasdegib (Daurismo)

A hedgehog pathway inhibitor for AML

Ivosidenib (Tibsovo)

An IDH-1 inhibitor for advanced AML

Larotrectinib (Vitrakvi)

A kinase inhibitor for solid tumors

Lorlatinib (Lorbrena)

A kinase inhibitor for metastatic non-small cell lung cancer (NSCLC)

Moxetumomab pasudotoxtdfk (Lumoxiti)

A monoclonal antibody for hairy cell leukemia

Omadacycline (Nuzyra)

An oral/injectable tetracycline class antibiotic for community acquired pneumonia and skin infections

Risankizumab-rzaa (Skyrizi)

An interleukin-23 antagonist for moderate to severe plaque psoriasis

Romosozumab-aqqg (Evenity)

A sclerostin inhibitor for treatment of postmenopausal osteoporosis in patients at high risk for fracture

Siponimod (Mayzent)

An oral formulation for relapsing forms of multiple sclerosis

Talazoparib (Talzenna)

A poly (ADP-ribose) polymerase inhibitor for advanced breast cancer

PREFACE Nurses are faced with the ever-challenging responsibility of ensuring safe and effective drug therapy for their patients. Not surprisingly, the greatest challenge for nurses is keeping up with the overwhelming amount of new drug information, including the latest FDA-approved drugs and changes to already approved drugs, such as new uses, dosage forms, warnings, and much more. Nurses must integrate this information into their patient care quickly and in an informed manner. Saunders Nursing Drug Handbook 2021 is designed as an easy-to-use source of current drug information to help the busy nurse meet these challenges. What separates this book from others is that it guides the nurse through patient care to better practice and better care. This handbook contains the following: 1. An IV compatibility chart. This handy chart is bound into the handbook to prevent accidental loss. 2. The Drug Classifications section. The action and uses for some of the most common clinical and pharmacotherapeutic classes are presented. Unique to this handbook, each class provides an at-a-glance table that compares all the generic drugs within the classification according to product availability, dosages, side effects, and other characteristics. Its half-page color tab ensures you can’t miss it! 3. An alphabetical listing of drug entries by generic name. Blue letter thumb tabs help you page through this section quickly. Information on medications that contain a Black Box Alert is an added feature of the drug entries. This alert identifies those medications for which the FDA has issued a warning that the drugs may cause serious adverse effects. Tall Man lettering, with emphasis on certain syllables to avoid confusing similar sounding/looking medications, is shown in capitalized letters (e.g., oxyCODONE). High Alert drugs with a color icon are considered dangerous by The Joint Commission and the Institute for Safe Medication Practices (ISMP) because if they are administered incorrectly, they may cause life-threatening or permanent harm to the patient. The entire High Alert generic drug entry sits on a shaded background so that it’s easy to spot! To make scanning pages easier, each new entry begins with a shaded box containing the generic name, pronunciation, trade name(s), fixed combination(s), and classification(s). 4. A comprehensive reference section. Appendixes include vital information on calculation of doses; controlled drugs; chronic wound care; drugs of abuse; equianalgesic dosing; herbals: common natural medicines; lifespan, cultural aspects, and pharmacogenomics of drug therapy; normal laboratory values; drug interactions; antidotes or reversal agents; preventing medication errors; parenteral fluid administration; and Common Terminology Criteria for Adverse Events (CTCAE). 5. Drugs by Disorder. You’ll find Drugs by Disorder in the front of the book for easy reference. It lists common disorders and the drugs most often used for treatment. 6. The index. The comprehensive index is located at the back of the book on light blue pages. Undoubtedly the best tool to help you navigate the handbook, the comprehensive index is organized by showing generic drug names in bold, trade names in regular type, classifications in italics, and the page number of the main drug entry listed first and in bold.

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xii Preface A DETAILED GUIDE TO THE SAUNDERS NURSING DRUG HANDBOOK

An intensive review by consultants and reviewers helped us to revise the Saunders Nursing Drug Handbook so that it is most useful in both educational and clinical practice. The main objective of the handbook is to provide essential drug information in a user-friendly format. The bulk of the handbook contains an alphabetical listing of drug entries by generic name. To maintain the portability of this handbook and meet the challenge of keeping content current, we have also included additional information for some medications on the Evolve® Internet site. Users can also choose from 100 monographs for the most commonly used medications and customize and print drug cards. Evolve® also includes drug alerts (e.g., medications removed from the market) and drug updates (e.g., new drugs, updates on existing entries). Information is periodically added, allowing the nurse to keep abreast of current drug information. We have incorporated the IV Incompatibilities/Compatibilities heading. The drugs listed in this section are compatible or incompatible with the generic drug when administered directly by IV push, via a Y-site, or via IV piggyback. We have highlighted the intravenous drug administration and handling information with a special heading icon and have broken it down by Reconstitution, Rate of Administration, and Storage. We present entries in an order that follows the logical thought process the nurse undergoes whenever a drug is ordered for a patient: • What is the drug? • How is the drug classified? • What does the drug do? • What is the drug used for? • Under what conditions should you not use the drug? • How do you administer the drug? • How do you store the drug? • What is the dose of the drug? • What should you monitor the patient for once he or she has received the drug? • What do you assess the patient for? • What interventions should you perform? • What should you teach the patient? The following are included within the drug entries: Generic Name, Pronunciation, Trade Names. Each entry begins with the generic name and pronunciation, followed by the U.S. and Canadian trade names. Exclusively Canadian trade names are followed by a maple leaf . Trade names that were most prescribed in the year 2017 are underlined in this section. Black Box Alert. This feature highlights drugs that carry a significant risk of serious or life-threatening adverse effects. Black Box Alerts are ordered by the FDA. Do Not Confuse With. Drug names that sound similar to the generic and/or trade names are listed under this heading to help you avoid potential medication errors. Fixed-Combination Drugs. Where appropriate, fixed-combinations, or drugs made up of two or more generic medications, are listed with the generic drug. Pharmacotherapeutic and Clinical Classification Names. Each entry includes both the pharmacotherapeutic and clinical classifications for the generic drug. Action/Therapeutic Effect. This section describes how the drug is predicted to behave, with the expected therapeutic effect(s) under a separate heading. Pharmacokinetics. This section includes the absorption, distribution, metabolism, excretion, and half-life of the medication. The half-life is bolded in blue for easy access.



Preface

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Uses/Off-Label. The listing of uses for each drug includes both the FDA uses and the off-label uses. The off-label heading is shown in bold blue for emphasis. Precautions. This heading incorporates a discussion about when the generic drug is contraindicated or should be used with caution. The cautions warn the nurse of specific situations in which a drug should be closely monitored. Lifespan Considerations . This section includes pregnancy/lactation data and agespecific information concerning children and elderly people. Interactions. This heading enumerates drug, food, and herbal interactions with the generic drug. As the number of medications a patient receives increases, awareness of drug interactions becomes more important. Also included is information about therapeutic and toxic blood levels in addition to effects the drug may have on lab results. Product Availability. Each drug monograph gives the form and availability of the drug. The icon identifies noncrushable drug forms. Administration/Handling. Instructions for administration are given for each route of administration (e.g., IV, IM, PO, rectal). Special handling, such as refrigeration, is also included where applicable. The routes in this section are always presented in the order IV, IM, SQ, and PO, with subsequent routes in alphabetical order (e.g., Ophthalmic, Otic, Topical). IV administration is broken down by reconstitution, rate of administration (how fast the IV should be given), and storage (including how long the medication is stable once reconstituted). IV Incompatibilities/IV Compatibilities . These sections give the nurse the most comprehensive compatibility information possible when administering medications by direct IV push, via a Y-site, or via IV piggyback. Indications/Routes/Dosage. Each entry provides specific dosing guidelines for adults, elderly, children, and patients with renal and/or hepatic impairment. Dose modification for toxicity has been added where applicable. Dosages are clearly indicated for each approved indication and route. Side Effects. Side effects are defined as those responses that are usually predictable with the drug, are not life-threatening, and may or may not require discontinuation of the drug. Unique to this handbook, side effects are grouped by frequency listed from highest occurrence percentage to lowest so that the nurse can focus on patient care without wading through myriad signs and symptoms of side effects. Adverse Effects/Toxic Reactions. Adverse effects and toxic reactions are very serious and often life-threatening undesirable responses that require prompt intervention from a health care provider. Nursing Considerations. Nursing considerations are organized as care is organized: • What needs to be assessed or done before the first dose is administered? (Baseline Assessment) • What interventions and evaluations are needed during drug therapy? (Intervention/Evaluation) • What teaching is needed for the patient and family? (Patient/Family Teaching) Saunders Nursing Drug Handbook is an easy-to-use source of current drug information for nurses, students, and other health care providers. It is our hope that this handbook will help you provide quality care to your patients. We welcome any comments to improve future editions of the handbook. Please contact us via the publisher at http://evolve.elsevier.com/SaundersNDH. Robert J. Kizior, BS, RPh Keith J. Hodgson, RN, BSN, CCRN

DRUGS BY DISORDER Note: Not all medications appropriate for a given condition are listed, nor are those not listed inappropriate. Generic names appear first, followed by brand names in parentheses. Alcohol dependence Acamprosate (Campral) Disulfiram (Antabuse) Naltrexone (Depade, ReVia, Vivitrol) Allergic conjunctivitis Alcaftadine (Lastacaft) Azelastine – generic Bepotastine (Bepreve) Cromolyn – generic Emedastine (Emadine) Epinastine (Elestat) Ketorolac (Acular) Ketotifen (Alaway, Zaditor) Lodoxamide (Alomide) Loteprednol (Alrex, Lotemax) Nedocromil (Alocril) Olopatadine (Pataday, Patanol, Pazeo) Prednisone (Pred Mild) Allergic rhinitis Nasal spray Azelastine (Astelin, Astepro) Azelastine/fluticasone (Dymista) Beclomethasone (Beconase AQ, Qnasl) Budesonide (Rhinocort Allergy Spray) Ciclesonide (Omnaris, Zetonna) Flunisolide Fluticasone (Flonase Sensimist Allergy Relief) Mometasone (Nasonex) Nasal spray Olopatadine (Patanase) Triamcinolone (Nasacort Allergy 24 HR) Oral form Cetirizine (Zyrtec Allergy) Cetirizine/pseudoephedrine (Zyrtec-D 12 hour) Desloratadine (Clarinex) Desloratadine/pseudoephedrine (Clarinex-D 12 hour)

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Fexofenadine (Allegra) Fexofenadine/pseudoephedrine (Allegra-D 12 hour, Allegra-D 24 hour) Levocetirizine (Xyzal Allergy 24 hour) Loratadine (Alavert, Claritin) Loratadine/pseudoephedrine (AlavertD 12 hour, Claritin-D 12 hour, Claritin-D 24 hour) Montelukast (Singulair) Alzheimer’s disease Acetylcholinesterase inhibitors Donepezil (Aricept) Galantamine (Razadyne) Rivastigmine (Exelon Patch) NMDA receptor antagonist Memantine (Namenda) NMDA receptor antagonist/ acetylcholinesterase inhibitor Namzaric Angina Amlodipine (Norvasc) Atenolol (Tenormin) Diltiazem (Cardizem, Dilacor) Isosorbide (Imdur, Isordil) Metoprolol (Lopressor) Nadolol (Corgard) Nicardipine (Cardene) Nifedipine (Adalat, Procardia) Nitroglycerin Propranolol (Inderal) Verapamil (Calan, Isoptin) Anxiety Alprazolam (Xanax) Buspirone (BuSpar) Diazepam (Valium) Hydroxyzine (Atarax, Vistaril) Lorazepam (Ativan)

Oxazepam (Serax) Paroxetine (Paxil) Trazodone (Desyrel) Venlafaxine (Effexor) Arrhythmias Adenosine (Adenocard) Amiodarone (Cordarone, Pacerone) Digoxin (Lanoxin) Diltiazem (Cardizem, Dilacor) Disopyramide (Norpace) Dofetilide (Tikosyn) Dronedarone (Multaq) Esmolol (Brevibloc) Flecainide (Tambocor) Ibutilide (Corvert) Lidocaine Metoprolol (Lopressor) Mexiletine (Mexitil) Propafenone (Rythmol) Propranolol (Inderal) Sotalol (Betapace) Verapamil (Calan, Isoptin) Arthritis, rheumatoid Conventional DMARDs Hydroxychloroquine (Plaquenil) Leflunomide (Arava) Methotrexate (Otrexup, Rasuvo, Trexall) Sulfasalazine (Azulfidine) Biologic agents TNF inhibitors Adalimumab (Humira) Certolizumab pegol (Cimzia) Etanercept (Enbrel) Golimumab (Simponi, Simponi Aria) Infliximab (Remicade, Inflectra, Renflexis) IL-6 inhibitors Sarilumab (Kevzara) Tocilizumab (Actemra) Other biologic agents Abatacept (Orencia) Anakinra (Kineret) Rituximab (Rituxan) JAK inhibitors Baricitinib (Olumiant) Tofacitinib (Xeljanz, Xeljanz XR)

Drugs by Disorder

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Asthma Short-acting beta-2 agonists (SABA) Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA, ProAir RespiClick) Levalbuterol (Xopenex HFA) Short-acting muscarinic antagonists (SAMA) Ipratropium (Atrovent HFA) Inhaled corticosteroids Beclomethasone (QVAR) Budesonide (Pulmicort) Ciclesonide (Alvesco) Flunisolide (Aerospan) Fluticasone (Arnuity Ellipta, Flovent Diskus) Mometasone (Asmanex) Long-acting beta-2 agonists (LABA) Formoterol (Perforomist) Salmeterol (Serevent) Inhaled corticosteroid/LABA combinations Budesonide/formoterol (Symbicort) Fluticasone/vilanterol (Breo Ellipta) Fluticasone/Salmeterol (Advair, AirDuo RespiClick) Mometasone, formoterol (Dulera) Inhaled long-acting muscarinic antagonist (LAMA) Tiotropium (Spiriva) Atrial fibrillation Oral anticoagulants Vitamin K antagonist Warfarin (Coumadin) Direct thrombin inhibitor Dabigatran (Pradaxa) Direct factor Xa inhibitors Apixaban (Eliquis) Edoxaban (Savaysa) Rivaroxaban (Xarelto) Rate control Beta adrenergic blockers Atenolol (Tenormin) Bisoprolol Carvedilol (Coreg, Coreg CR) Metoprolol (Lopressor, Toprol XL) Nadolol (Corgard) Propranolol (Inderal LA, InnoPran XL) Calcium channel blockers Diltiazem (Cardizem CD, Cartia XT, Taztia XT, Tiazac)

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Drugs by Disorder

Verapamil (Calan, Verelan) Other Amiodarone (Pacerone) Digoxin (Digitek, Lanoxin) Rhythm control Amiodarone (Pacerone) Dronedarone (Multaq) Dofetilide (Tikosyn) Flecainide Propafenone (Rythmol SR) Sotalol (Betapace, Sotalol AF) Attention-deficit hyperactivity disorder (ADHD) Amphetamine (Adzenys XR-ODT, Dyanavel XR) Atomoxetine (Strattera) Clonidine (Catapres, Kapvay) Desipramine (Norpramin) Dexmethylphenidate (Focalin, Focalin XR) Dextroamphetamine (Dexedrine, ProCentra, Zenzedi) Guanfacine (Intuniv) Lisdexamfetamine (Vyvanse) Methylphenidate (Aptensio XR, Concerta, Cotempla XR-ODT, Daytrana, Focalin, Focalin XR, Jornay PM, Metadate CD, Methylin, QuilliChew ER, Quillivant XR, Ritalin) Mixed amphetamine (dextroamphetamine and amphetamine salts) (Adderall, Adderall XR, Mydayis) Benign prostatic hypertrophy (BPH) Alfuzosin (Uroxatral) Doxazosin (Cardura) Dutasteride (Avodart) Fesoterodine (Toviaz) Finasteride (Proscar) Mirabegron (Myrbetriq) Silodosin (Rapaflo) Tadalafil (Cialis) Tamsulosin (Flomax) Terazosin (Hytrin) Tolterodine (Detrol) Bipolar disorder Aripiprazole (Abilify) Asenapine (Saphris) Carbamazepine (Tegretol) Lamotrigine (Lamictal)

Lithium (Lithobid) Lurasidone (Latuda) Olanzapine (Zyprexa) Olanzapine/fluoxetine (Symbyax) Oxcarbazepine (Trileptal) Paliperidone (Invega) Quetiapine (Seroquel) Risperidone (Risperdal) Valproic acid (Depakene, Depakote) Ziprasidone (Geodon) Bladder hyperactivity Darifenacin (Enablex) Oxybutynin (Ditropan, Gelnique) Solifenacin (VESIcare) Tolterodine (Detrol) Trospium (Sanctura) Bronchospasm Albuterol (Proventil, Ventolin) Bitolterol (Tornalate) Levalbuterol (Xopenex) Metaproterenol (Alupent) Salmeterol (Serevent) Terbutaline (Brethine) Cancer Abarelix (Plenaxis) Abemaciclib (Verzenio) Abiraterone (Zytiga) Acalabrutinib (Calquence) Ado-trastuzumab (Kadcyla) Afatinib (Gilotrif) Aldesleukin (Proleukin) Alemtuzumab (Campath) Alitretinoin (Panretin) Altretamine (Hexalen) Anastrozole (Arimidex) Apalutamide (Erleada) Arsenic trioxide (Trisenox) Asparaginase (Elspar) Atezolizumab (Tecentriq) Avelumab (Bavencio) Axitinib (Inlyta) Azacitidine (Vidaza) BCG (TheraCys, Tice BCG) Belinostat (Beleodaq) Bendamustine (Treanda) Bevacizumab (Avastin) Bexarotene (Targretin) Bicalutamide (Casodex)

Binimetinib (Mektovi) Bleomycin (Blenoxane) Blinatumomab (Blincyto) Bortezomib (Velcade) Bosutinib (Bosulif) Brentuximab (Adcetris) Brigatinib (Alunbrig) Busulfan (Myleran) Cabazitaxel (Jevtana) Cabozantinib (Cabometyx) Capecitabine (Xeloda) Carboplatin (Paraplatin) Carfilzomib (Kyprolis) Carmustine (BiCNU) Ceritinib (Zykadia) Cetuximab (Erbitux) Chlorambucil (Leukeran) Cisplatin (Platinol) Cladribine (Leustatin) Clofarabine (Clolar) Cobimetinib (Cotellic) Copanlisib (Aliqopa) Crizotinib (Xalkori) Cyclophosphamide (Cytoxan) Cytarabine (Ara-C, Cytosar) Dabrafenib (Tafinlar) Dacarbazine (DTIC) Dacomitinib (Vizimpro) Dactinomycin (Cosmegen) Daratumumab (Darzalex) Dasatinib (Sprycel) Daunorubicin (Cerubidine, DaunoXome) Degarelix (Firmagon) Denileukin (Ontak) Dinutuximab (Unituxin) Docetaxel (Taxotere) Doxorubicin (Adriamycin, Doxil) Durvalumab (Imfinzi) Duvelisib (Copiktra) Elotuzumab (Empliciti) Enasidenib (IDHIFA) Encorafenib (Braftovi) Enzalutamide (Xtandi) Epirubicin (Ellence) Erdafitinib (Balversa) Eribulin (Halaven) Erlotinib (Tarceva) Estramustine (Emcyt) Etoposide (VePesid) Everolimus (Afinitor) Fludarabine (Fludara)

Drugs by Disorder Fluorouracil Flutamide (Eulexin) Fulvestrant (Faslodex) Gefitinib (Iressa) Gemcitabine (Gemzar) Gilteritinib (Xospata) Glasdegib (Daurismo) Goserelin (Zoladex) Hydroxyurea (Hydrea) Ibritumomab (Zevalin) Ibrutinib (Imbruvica) Idarubicin (Idamycin) Idelalisib (Zydelig) Ifosfamide (Ifex) Imatinib (Gleevec) Inotuzumab ozogamicin (Besponsa) Interferon alfa-2b (Intron A) Ipilimumab (Yervoy) Irinotecan (Camptosar) Ivosidenib (Tibsovo) Ixabepilone (Ixempra) Ixazomib (Ninlaro) Lapatinib (Tykerb) Larotrectinib (Vitrakvi) Letrozole (Femara) Leuprolide (Lupron) Lenvatinib (Lenvima) Lomustine (CeeNU) Lorlatinib (Lorbrena) Mechlorethamine (Mustargen) Megestrol (Megace) Melphalan (Alkeran) Mercaptopurine (Purinethol) Methotrexate Midostaurin (Rydapt) Mitomycin (Mutamycin) Mitotane (Lysodren) Mitoxantrone (Novantrone) Moxetumomab (Lumoxiti) Necitumumab (Portrazza) Nelarabine (Arranon) Neratinib (Nerlynx) Nilotinib (Tasigna) Nilutamide (Nilandron) Niraparib (Zejula) Nivolumab (Opdivo) Obinutuzumab (Gazyva) Ofatumumab (Arzerra) Olaparib (Lynparza) Olaratumab (Lartruvo) Omacetaxine (Synribo)

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Drugs by Disorder

Osimertinib (Tagrisso) Oxaliplatin (Eloxatin) Paclitaxel (Taxol) Palbociclib (Ibrance) Panitumumab (Vectibix) Panobinostat (Farydak) Pazopanib (Votrient) Pegaspargase (Oncaspar) Pembrolizumab (Keytruda) Pemetrexed (Alimta) Pentostatin (Nipent) Pertuzumab (Perjeta) Plicamycin (Mithracin) Pomalidomide (Pomalyst) Ponatinib (Iclusig) Pralatrexate (Folotyn) Procarbazine (Matulane) Ramucirumab (Cyramza) Rasburicase (Elitek) Regorafenib (Stivarga) Ribociclib (Kisqali) Rituximab (Rituxan) Rituximab/hyaluronidase (Rituxan Hycela) Romidepsin (Istodax) Rucaparib (Rubraca) Sipuleucel-T (Provenge) Sonidegib (Odomzo) Sorafenib (Nexavar) Streptozocin (Zanosar) Sunitinib (Sutent) Talazoparib (Talzenna) Tamoxifen (Nolvadex) Temozolomide (Temodar) Temsirolimus (Torisel) Teniposide (Vumon) Thioguanine Thiotepa (Thioplex) Tipifarnib (Zarnestra) Tipiracil/trifluridine (Lonsurf) Tisagenlecleucel (Kymriah) Topotecan (Hycamtin) Toremifene (Fareston) Tositumomab (Bexxar) Trabectedin (Yondelis) Trametinib (Mekinist) Trastuzumab (Herceptin) Tretinoin (ATRA, Vesanoid) Valrubicin (Valstar) Vandetanib (Caprelsa) Vemurafenib (Zelboraf)

Venetoclax (Venclexta) Vinblastine (Velban) Vincristine (Oncovin) Vinorelbine (Navelbine) Vismodegib (Erivedge) Vorinostat (Zolinza) Ziv-aflibercept (Zaltrap) Cerebrovascular accident (CVA) Aspirin Clopidogrel (Plavix) Heparin Nimodipine (Nimotop) Prasugrel (Effient) Warfarin (Coumadin) Chronic obstructive pulmonary disease (COPD) Inhaled short-acting antimuscarinic Ipratropium (Atrovent HFA) Inhaled short-acting Beta-2 agonists (SABA) Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA) Levalbuterol (Xopenex HFA) Inhaled short-acting Beta-2 agonist (SABA)/short-acting antimuscarinic (SAMA) Albuterol/Ipratropium (Combivent Respimat) Inhaled long-acting Beta-2 agonists (LABA) Arformoterol (Brovana) Indacaterol (Arcapta Neohaler) Olodaterol (Striverdi Respimat) Salmeterol (Serevent Diskus) Formoterol (Perforomist) Inhaled long-acting antimuscarinic agents (LAMA) Aclidinium (Tudorza Pressair) Glycopyrrolate (Seebri Neohaler) Revefenacin (Yupelri) Tiotropium (Spiriva Respimat) Umeclidinium (Incruse Ellipta) Inhaled long-acting Beta-2 agonists (LABA)/long-acting antimuscarinic agents (LAMA) Glycopyrrolate/formoterol (Bevespi) Glycopyrrolate/indacaterol (Utibron Neohaler)

Tiotropium/olodaterol (Stiolto Respimat) Umeclidinium/vilanterol (Anoro Ellipta) Inhaled corticosteroids Beclomethasone (QVAR) Budesonide (Pulmicort) Ciclesonide (Alvesco) Flunisolide (Aerospan HFA) Fluticasone (Flovent Diskus, Flovent HFA) Mometasone (Asmanex HFA, Asmanex Twisthaler) Inhaled corticosteroids/long-acting Beta-2 agonists (LABA) Fluticasone/salmeterol (Advair Diskus) Fluticasone/vilanterol (Breo Ellipta) Budesonide/formoterol (Symbicort) Inhaled corticosteroids/longacting Beta-2 agonists (LABA)/ long-acting antimuscarinic agents (LAMA) Fluticasone/vilanterol/umeclidinium (Trelegy Ellipta) Constipation Bisacodyl (Dulcolax) Docusate (Colace) Lactulose (Kristalose) Lubiprostone (Amitiza) Methylcellulose (Citrucel) Milk of magnesia (MOM) Polyethylene glycol (MiraLAX) Psyllium (Metamucil) Senna (Senokot) Crohn’s disease Azathioprine Adalimumab (Humira) Certolizumab (Cimzia) Corticosteroids Infliximab (Inflectra, Remicade) 6-Mercaptopurine Ustekinumab (Stelara) Vedolizumab (Entyvio) Deep vein thrombosis (DVT) Dalteparin (Fragmin) Edoxaban (Savaysa) Enoxaparin (Lovenox) Heparin Tinzaparin (Innohep) Warfarin (Coumadin)

Drugs by Disorder

xix

Depression SSRIs Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac, Prozac Weekly) Paroxetine (Paxil, Paxil CR) Sertraline (Zoloft) SNRIs Desvenlafaxine (Pristiq, Khedezla) Duloxetine (Cymbalta) Venlafaxine (Effexor XR) Levomilnacipran (Fetzima) TCAs Amitriptyline (Elavil) Nortriptyline (Pamelor) MAOIs Phenelzine (Nardil) Selegiline (Emsam) Other Bupropion (Wellbutrin SR, Aplenzin, Forfivo XL) Mirtazapine (Remeron, Remeron SolTab) Trazodone (Oleptro) Vilazodone (Viibryd) Vortioxetine (Trintellix) Diabetes Biguanides Metformin (Glucophage, Glucophage XR, Glumetza, Fortamet, Riomet) Sulfonylureas Glimepiride (Amaryl, Glipizide, Glucotrol, Glucotrol XL) Glyburide (Glynase) GLP-1 receptor agonists Albiglutide (Tanzeum) Dulaglutide (Trulicity) Exenatide (Byetta, Bydureon) Liraglutide (Victoza) Lixisenatide (Adlyxin) Semaglutide (Ozempic) DDP-4 inhibitors Alogliptin (Nesina) Linagliptin (Tradjenta) Saxagliptin (Onglyza) Sitagliptin (Januvia) SGLT2 inhibitors Canagliflozin (Invokana) Dapagliflozin (Farxiga) Empagliflozin (Jardiance) Ertugliflozin (Steglatro)

xx

Drugs by Disorder

Meglitinides Nateglinide (Starlix) Repaglinide (Prandin) Thiazolidinediones Pioglitazone (Actos) Rosiglitazone (Avandia) Alpha-glucosidase inhibitors Acarbose (Precose) Miglitol (Glyset) Other Colesevelam (Welchol) Bromocriptine (Cycloset) Pramlintide (Symlin) Insulin Rapid-acting Insulin aspart (Fiasp, Novolog) Insulin glulisine (Apidra) Insulin lispro (Admelog, Humalog) Insulin inhalation powder (Afrezza) Regular insulin Humulin R Novolin R Intermediate insulin NPH (Humulin N, Novolin N) Long-acting insulin Insulin detemir (Levemir) Insulin glargine (Lantus, Toujeo, Basaglar) Insulin degludec (Tresiba) Diabetic peripheral neuropathy Amitriptyline (Elavil) Bupropion (Wellbutrin) Capsaicin (Trixaicin) Carbamazepine (Tegretol) Citalopram (Celexa) Desipramine (Norpramin) Duloxetine (Cymbalta) Gabapentin (Neurontin) Lamotrigine (Lamictal) Lidocaine patch (Lidoderm) Nortriptyline (Pamelor) Oxcarbazepine (Trileptal) Oxycodone (OxyContin) Paroxetine (Paxil) Pregabalin (Lyrica) Tramadol (Ultram) Valproic acid (Depakote) Venlafaxine, extended-release (Effexor XR)

Diarrhea Bismuth subsalicylate (Pepto-Bismol) Diphenoxylate and atropine (Lomotil) Fidaxomicin (Dificid) Kaolin-pectin (Kaopectate) Loperamide (Imodium) Octreotide (Sandostatin) Rifaximin (Xifaxan) Edema Amiloride (Midamor) Bumetanide (Bumex) Chlorthalidone (Hygroton) Ethacrynic acid (Edecrin) Furosemide (Lasix) Hydrochlorothiazide (Hydrodiuril) Indapamide (Lozol) Metolazone (Zaroxolyn) Spironolactone (Aldactone) Torsemide (Demadex) Triamterene (Dyrenium) Epilepsy Brivaracetam (Briviact) Carbamazepine (Tegretol) Clobazam (Onfi) Clonazepam (Klonopin) Clorazepate (Tranxene) Diazepam (Valium) Eslicarbazepine (Aptiom) Ethosuximide (Zarontin) Ezogabine (Potiga) Fosphenytoin (Cerebyx) Gabapentin (Neurontin) Lacosamide (Vimpat) Lamotrigine (Lamictal, Lamictal ODT, Lamictal XR) Levetiracetam (Keppra) Lorazepam (Ativan) Midazolam (Versed) Oxcarbazepine (Trileptal) Perampanel (Fycompa) Phenobarbital Phenytoin (Dilantin) Pregabalin (Lyrica) Primidone (Mysoline) Rufinamide (Banzel) Tiagabine (Gabitril)



Drugs by Disorder

Topiramate (Qudexy XR, Topamax, Trokendi XR) Valproic acid (Depakene, Depakote) Vigabatrin (Sabril) Zonisamide (Zonegran)

Gastritis Cimetidine (Tagamet) Famotidine (Pepcid) Nizatidine (Axid) Ranitidine (Zantac)

Esophageal reflux, esophagitis Cimetidine (Tagamet) Dexlansoprazole (Dexilant) Esomeprazole (Nexium) Famotidine (Pepcid) Lansoprazole (Prevacid) Nizatidine (Axid) Omeprazole (Prilosec) Pantoprazole (Protonix) Rabeprazole (AcipHex) Ranitidine (Zantac)

Gastroesophageal reflux disease (GERD) H2 receptor antagonists Cimetidine (Tagamet HB) Famotidine (Pepcid) Nizatidine Ranitidine (Zantac) Proton pump inhibitors (PPIs) Dexlansoprazole (Dexilant) Esomeprazole (Nexium) Lansoprazole (Prevacid) Omeprazole (Prilosec) Rabeprazole (AcipHex)

Fever Acetaminophen (Tylenol) Aspirin Ibuprofen (Advil, Caldolor, Motrin) Naproxen (Aleve, Anaprox, Naprosyn) Fibromyalgia Acetaminophen (Tylenol) Amitriptyline (Elavil) Carisoprodol (Soma) Citalopram (Celexa) Cyclobenzaprine (Flexeril) Duloxetine (Cymbalta) Fluoxetine (Prozac) Gabapentin (Neurontin) Milnacipran (Savella) Paroxetine (Paxil) Pregabalin (Lyrica) Tramadol (Ultram) Venlafaxine (Effexor) Gastric/duodenal ulcer Cimetidine (Tagamet) Esomeprazole (Nexium) Famotidine (Pepcid) Lansoprazole (Prevacid) Nizatidine (Axid) Omeprazole (Prilosec) Pantoprazole (Protonix) Rabeprazole (AcipHex) Ranitidine (Zantac) Sucralfate (Carafate)

Glaucoma Acetazolamide (Diamox) Apraclonidine (Iopidine) Betaxolol (Betoptic) Bimatoprost (Lumigan) Brimonidine (Alphagan) Brinzolamide (Azopt) Carbachol Dorzolamide (Trusopt) Echothiophate iodide (Phospholine) Latanoprost (Xalatan) Levobunolol (Betagan) Pilocarpine (Isopto Carpine) Tafluprost (Zioptan) Timolol (Timoptic) Travoprost (Travatan) Unoprostone (Rescula) Gout Anti-inflammatory agents Anakinra (Kineret) Canakinumab (Ilaris) Colchicine (Colcrys, Mitigare) Ibuprofen (Motrin) Naproxen (Naprosyn) Prednisone Urate-lowering agents Allopurinol (Zyloprim) Febuxostat (Uloric) Probenecid Pegloticase (Krystexxa)

xxi

xxii

Drugs by Disorder

Heart failure Angiotensin-converting enzyme (ACE) inhibitors Captopril Enalapril (Vasotec) Fosinopril Lisinopril (Prinivil, Zestril) Quinapril (Accupril) Ramipril (Altace) Angiotensin receptor blockers (ARBs) Candesartan (Atacand) Losartan (Cozaar) Valsartan (Diovan) Angiotensin receptor-neprilysin inhibitor Sacubitril/valsartan (Entresto) Beta adrenergic blockers Bisoprolol Carvedilol (Coreg) Metoprolol succinate (Toprol XL) Cardiac glycoside Digoxin (Digitek, Lanoxin) Diuretics (loop) Bumetanide (Bumex) Furosemide (Lasix) Torsemide (Demadex) HCN channel blocker Ivabradine (Corlanor) Mineralocorticoid receptor antagonists Eplerenone (Inspra) Spironolactone (Aldactone) Vasodilators Isosorbide/hydralazine (BiDil) Hepatitis B Adefovir (Hepsera) Entecavir (Baraclude) Lamivudine (Epivir) Peginterferon alpha-2a (Pegasys) Telbivudine (Tyzeka) Tenofovir (Viread) Hepatitis C Daclatasvir (Daklinza) Elbasvir/grazoprevir (Zepatier) Glecaprevir/pibrentasvir (Mavyret) Ledipasvir/sofosbuvir (Harvoni) Ombitasvir/paritaprevir/ritonavir (Technivie)

Ombitasvir/paritaprevir/ritonavir/ dasabuvir (Viekira Pak) Peginterferon alfa-2a (Pegasys) Peginterferon alfa-2b (Pegintron) Ribavirin (Copegus, Rebetol, Ribasphere) Simeprevir (Olysio) Sofosbuvir (Sovaldi) Sofosbuvir/velpatasvir (Epclusa) Sofosbuvir/velpatasvir/voxilaprevir (Vosevi) Human immunodeficiency virus (HIV) Abacavir/dolutegravir/lamivudine (Triumeq) Abacavir (Ziagen) Atazanavir (Reyataz) Bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) Cobicistat (Tybost) Darunavir (Prezista) Delavirdine (Rescriptor) Didanosine (Videx) Dolutegravir (Tivicay) Dolutegravir/lamivudine (Dovato) Doravirine (Pifeltro) Doravirine/lamivudine/tenofovir (Delstrigo) Efavirenz (Sustiva) Efavirenz/lamivudine/tenofovir disoproxil (Symfi) Elvitegravir (Vitekta) Elvitegravir/cobicistat/emtricitabine, tenofovir (Genova/Stribild) Emtricitabine (Emtriva) Emtricitabine/tenofovir (Truvada) Enfuvirtide (Fuzeon) Etravirine (Intelence) Fosamprenavir (Lexiva) Ibalizumab-uiyk (Trogarzo) Indinavir (Crixivan) Lamivudine (Epivir) Lamivudine/tenofovir (Cimduo) Lopinavir/ritonavir (Kaletra) Maraviroc (Selzentry) Nelfinavir (Viracept) Nevirapine (Viramune) Raltegravir (Isentress) Rilpivirine (Edurant) Ritonavir (Norvir) Saquinavir (Invirase)

Stavudine (Zerit) Tenofovir (Viread) Tesamorelin (Egrifta) Tipranavir (Aptivus) Zidovudine (AZT, Retrovir) Hyperphosphatemia Aluminum salts Calcium salts Ferric citrate (Auryxia) Lanthanum (Fosrenol) Sevelamer (Renagel) Hypertension Thiazide diuretics Hydrochlorothiazide Loop diuretics Bumetanide (Bumex) Furosemide (Lasix) Aldosterone antagonists Eplerenone (Inspra) Spironolactone (Aldactone) ACE inhibitors Benazepril (Lotensin) Enalapril (Vasotec) Lisinopril (Zestril, Prinivil) Quinapril (Accupril) Ramipril (Altace) ARBs Azilsartan (Edarbi) Candesartan (Atacand) Irbesartan (Avapro) Losartan (Cozaar) Valsartan (Diovan) Calcium channel blockers dihydropyridines Amlodipine (Norvasc) Nifedipine (Adalat CC, Procardia XL) Nondihydropyridines Diltiazem (Cardizem LA, Taztia XT) Verapamil (Calan) Beta blockers Atenolol (Tenormin) Carvedilol (Coreg, Coreg CR) Labetalol Metoprolol (Lopressor, Toprol XL) Nebivolol (Bystolic) Central alpha-adrenergic agonists Clonidine (Catapres) Direct vasodilators Hydralazine (Apresoline)

Drugs by Disorder

xxiii

Hypertriglyceridemia Atorvastatin (Lipitor) Colesevelam (Welchol) Fenofibrate (Tricor) Fluvastatin (Lescol) Gemfibrozil (Lopid) Icosapent (Vascepa) Lovastatin (Mevacor) Niacin (Niaspan) Omega-3 acid ethyl esters (Lovaza) Pravastatin (Pravachol) Rosuvastatin (Crestor) Simvastatin (Zocor) Hyperuricemia Allopurinol (Zyloprim) Febuxostat (Uloric) Pegloticase (Krystexxa) Probenecid (Benemid) Hypotension Dobutamine (Dobutrex) Dopamine (Intropin) Ephedrine Epinephrine Norepinephrine (Levophed) Phenylephrine (Neo-Synephrine) Hypothyroidism Levothyroxine (Levoxyl, Synthroid) Liothyronine (Cytomel) Thyroid Idiopathic thrombocytopenic purpura (ITP) Cyclophosphamide (Cytoxan) Dexamethasone (Decadron) Hydrocortisone (Solu-Cortef) Immune globulin intravenous Methylprednisolone (Solu-Medrol) Prednisone Rho(D) immune globulin (RhoGAM) Rituximab (Rituxan) Inflammatory bowel disease (Crohn’s disease, ulcerative colitis) Aminosalicylates Mesalamine: Oral: (Apriso, Asacol HD, Delzicol, Lialda, Pentasa); Rectal: (Rowasa, Canasa)

xxiv

Drugs by Disorder

5-ASA pro-drugs Balsalazide (Colazal, Giazo) Olsalazine (Dipentum) Sulfasalazine (Azulfidine) Corticosteroids Budesonide (Entocort EC, Uceris) Hydrocortisone (Colocort, Cortenema) Prednisone (Rayos) Immunosuppressants Azathioprine (Azasan, Imuran) Cyclosporine (Sandimmune) Mercaptopurine (Purixan) Methotrexate (Otrexup, Rasuvo) TNF inhibitors Adalimumab (Humira) Certolizumab pegol (Cimzia) Golimumab (Simponi, Simponi Aria) Infliximab (Remicade, Inflectra, Renflexis) Integrin receptor antagonists Natalizumab (Tysabri) Vedolizumab (Entyvio) Interleukin antagonist Ustekinumab (Stelara) JAK inhibitor Tofacitinib (Xeljanz) Insomnia Benzodiazepine receptor agonists Eszopiclone (Lunesta) Zaleplon (Sonata) Zolpidem (Ambien, Zolpimist, Edluar, Intermezzo) Benzodiazepines Estazolam Flurazepam (Dalmane) Lorazepam (Ativan) Temazepam (Restoril) Melatonin receptor agonist Ramelteon (Rozerem) Orexin receptor antagonist Suvorexant (Belsomra) Irritable bowel syndrome with constipation Chloride channel activator lubiprostone (Amitiza) Guanylate cyclase-C receptor agonist Linaclotide (Linzess)

Irritable bowel syndrome with diarrhea Antibiotic Rifaximin (Xifaxan) Mu-opioid receptor agonist/ delta-opioid receptor antagonist Eluxadoline (Viberzi) 5-HT modulators Alosetron (Lotronex) Ondansetron (Zofran) Lipid disorders Statins Atorvastatin (Lipitor) Fluvastatin (Lescol) Lovastatin (Altoprev) Pitavastatin (Livalo) Pravastatin (Pravachol) Rosuvastatin (Crestor) Simvastatin (Zocor) Cholesterol absorption inhibitor Ezetimibe (Zetia) PCSK9 inhibitors Alirocumab (Praluent) Evolocumab (Repatha) Bile acid sequestrants Colesevelam (Welchol) Colestipol (Colestid) Cholestyramine (Questran) Fibrates Gemfibrozil (Lopid) Fenofibrate (Lipofen, Lofibra, Tricor, Antara, Fibricor, Trilipix) Fish oil Icosapent ethyl (Vascepa) Omega-3 acid ethyl esters (Lovaza) Migraine prevention Erenumab-aooe (Aimovig) Fremanezumab (Ajovy) Galcanezumab-gnlm (Emgality) Migraine treatment Almotriptan (Axert) Dihydroergotamine (DHE 45, Migranal) Eletriptan (Relpax) Ergotamine/caffeine (Cafergot) Frovatriptan (Frova) Naratriptan (Amerge) Rizatriptan (Maxalt) Sumatriptan (Imitrex) Zolmitriptan (Zomig, Zomig-ZMT)

Multiple sclerosis (MS) Alemtuzumab (Lemtrada) Daclizumab (Zinbryta) Dalfampridine (Ampyra) Dimethyl fumarate (Tecfidera) Fingolimod (Gilenya) Glatiramer (Copaxone) Interferon beta-1a (Avonex, Rebif) Interferon beta-1b (Betaseron, Extavia) Mitoxantrone (Novantrone) Natalizumab (Tysabri) Ocrelizumab (Ocrevus) Peginterferon beta-la (Plegridy) Siponimod (Mayzent) Teriflunomide (Aubagio) Myelodysplastic syndrome Azacitidine (Vidaza) Clofarabine (Clolar) Decitabine (Dacogen) Lenalidomide (Revlimid) Myocardial infarction (MI) Alteplase (Activase) Aspirin Atenolol (Tenormin) Captopril (Capoten) Clopidogrel (Plavix) Dalteparin (Fragmin) Diltiazem (Cardizem, Dilacor) Enalapril (Vasotec) Enoxaparin (Lovenox) Heparin Lidocaine Lisinopril (Prinivil, Zestril) Metoprolol (Lopressor) Morphine Nitroglycerin Propranolol (Inderal) Quinapril (Accupril) Ramipril (Altace) Reteplase (Retavase) Warfarin (Coumadin) Nausea Aprepitant (Emend) Chlorpromazine (Thorazine) Dexamethasone (Decadron) Dimenhydrinate (Dramamine) Dronabinol (Marinol) Droperidol (Inapsine)

Drugs by Disorder

xxv

Fosaprepitant (Emend) Fosnetupitant/palonosetron (Akynzeo) Granisetron (Kytril) Hydroxyzine (Vistaril) Lorazepam (Ativan) Meclizine (Antivert) Metoclopramide (Reglan) Nabilone (Cesamet) Ondansetron (Zofran) Palonosetron (Aloxi) Prochlorperazine (Compazine) Promethazine (Phenergan) Rolapitant (Varubi) Obsessive-compulsive disorder (OCD) Citalopram (Celexa) Clomipramine (Anafranil) Escitalopram (Lexapro) Fluoxetine (Prozac) Fluvoxamine (Luvox) Paroxetine (Paxil) Sertraline (Zoloft) Organ transplant, rejection prophylaxis Azathioprine (Imuran) Basiliximab (Simulect) Belatacept (Nulojix) Cyclophosphamide (Cytoxan, Neosar) Cyclosporine (Sandimmune) Daclizumab (Zenapax) Everolimus (Zortress) Mycophenolate (CellCept) Sirolimus (Rapamune) Tacrolimus (Prograf) Osteoarthritis Acetaminophen (Tylenol) Celecoxib (Celebrex) Diclofenac (Cataflam, Pennsaid, Voltaren) Duloxetine (Cymbalta) Etodolac (Lodine) Flurbiprofen (Ansaid) Ibuprofen (Motrin) Ketoprofen (Orudis) Meloxicam (Mobic) Nabumetone (Relafen) Naproxen (Naprosyn) Sulindac (Clinoril) Tramadol (Ultram)

xxvi

Drugs by Disorder

Osteoporosis Bisphosphonates Alendronate (Binosto, Fosamax) Ibandronate (Boniva) Risedronate (Actonel, Atelvia) Zoledronic acid (Reclast) Anti-RANK ligand antibody Denosumab (Prolia) Parathyroid hormone receptor agonists Abaloparatide (Tymlos) Teriparatide (Forteo) Sclerostin inhibitor Romosozumab (Evenity) Selective estrogen receptor modulator (SERM) Raloxifene Conjugated estrogens/bazedoxifene (Duavee) Calcitonin Miacalcin injection Nasal spray (generic) Paget’s disease Alendronate (Fosamax) Calcitonin (Miacalcin) Etidronate (Didronel) Pamidronate (Aredia) Risedronate (Actonel) Tiludronate (Skelid) Zoledronic acid (Reclast) Pain, mild to moderate Acetaminophen (Tylenol) Aspirin Celecoxib (Celebrex) Codeine Diclofenac (Cataflam, Voltaren, Zipsor) Diflunisal (Dolobid) Etodolac (Lodine) Flurbiprofen (Ansaid) Ibuprofen (Advil, Caldolor, Motrin) Ketorolac (Toradol) Naproxen (Anaprox, Naprosyn) Salsalate (Disalcid) Tramadol (Ultram) Pain, moderate to severe Butorphanol (Stadol) Fentanyl (Onsolis, Sublimaze) Hydromorphone (Dilaudid)

Methadone (Dolophine) Morphine (MS Contin) Morphine/naltrexone (Embeda) Nalbuphine (Nubain) Oxycodone (OxyFast, Roxicodone) Oxymorphone (Opana) Ziconotide (Prialt) Panic attack disorder Alprazolam (Xanax) Clonazepam (Klonopin) Paroxetine (Paxil) Sertraline (Zoloft) Venlafaxine (Effexor) Parkinson’s disease Carbidopa/levodopa Immediate-release (Sinemet) Orally disintegrating Sustained-release (Sinemet CR) Extended-release (Rytary) Intrajejunal infusion (Duopa) Dopamine agonists Apomorphine (Apokyn) Pramipexole (Mirapex) Ropinirole (Requip) Rotigotine (Neupro) COMT inhibitors Entacapone (Comtan) Tolcapone (Tasmar) MAO-B inhibitors Rasagiline (Azilect) Safinamide (Xadago) Selegiline (Eldepryl, Zelapar) Peptic ulcer disease H2 receptor antagonists Cimetidine (Tagamet HB) Famotidine (Pepcid) Nizatidine Ranitidine (Zantac) Proton pump inhibitors (PPIs) Dexlansoprazole (Dexilant) Esomeprazole (Nexium) Lansoprazole (Prevacid) Omeprazole (Prilosec) Rabeprazole (AcipHex) Pneumonia Amoxicillin (Amoxil) Amoxicillin/clavulanate (Augmentin)

Ampicillin (Polycillin) Azithromycin (Zithromax) Cefaclor (Ceclor) Cefpodoxime (Vantin) Ceftriaxone (Rocephin) Cefuroxime (Kefurox, Zinacef) Clarithromycin (Biaxin) Co-trimoxazole (Bactrim, Septra) Erythromycin Gentamicin (Garamycin) Levofloxacin (Levaquin) Linezolid (Zyvox) Moxifloxacin (Avelox) Piperacillin/ tazobactam (Zosyn) Tobramycin (Nebcin) Vancomycin (Vancocin) Pneumonia, pneumocystis jirovecii Atovaquone (Mepron) Clindamycin (Cleocin) Co-trimoxazole (Bactrim, Septra) Pentamidine (Pentam) Trimethoprim (Proloprim) Post-traumatic stress disorder (PTSD) Amitriptyline (Elavil) Aripiprazole (Abilify) Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Imipramine (Tofranil) Lamotrigine (Lamictal) Olanzapine (Zyprexa) Paroxetine (Paxil) Phenelzine (Nardil) Prazosin (Minipress) Propranolol (Inderal) Quetiapine (Seroquel) Risperidone (Risperdal) Sertraline (Zoloft) Topiramate (Topamax) Valproic acid (Depakote) Venlafaxine (Effexor) Ziprasidone (Geodon) Pruritus Amcinonide (Cyclocort) Cetirizine (Zyrtec) Clemastine (Tavist) Clobetasol (Temovate) Cyproheptadine (Periactin)

Drugs by Disorder

xxvii

Desloratadine (Clarinex) Desonide (Tridesilon) Desoximetasone (Topicort) Diphenhydramine (Benadryl) Fluocinolone (Synalar) Fluocinonide (Lidex) Halobetasol (Ultravate) Hydrocortisone (Cort-Dome, Hytone) Hydroxyzine (Atarax, Vistaril) Prednisolone (Prelone) Prednisone (Deltasone) Promethazine (Phenergan) Psoriasis Vitamin D analogs Calcipotriene (Dovonex, Sorilux) Calcitriol (Vectical) Retinoids Acitretin (Soriatane) Tazarotene (Tazorac) Phosphodiesterase 4 (PDE4) inhibitor Apremilast (Otezla) Immunosuppressants Cyclosporine (Neoral) Methotrexate (Otrexup, Rasuvo) TNF inhibitors Adalimumab (Humira) Certolizumab pegol (Cimzia) Etanercept (Enbrel) Infliximab (Remicade, Inflectra, Renflexis) IL 12-23 antagonist Ustekinumab (Stelara) IL 17A antagonists Brodalumab (Siliq) Ixekizumab (Taltz) Secukinumab (Cosentyx) IL 23 antagonists Guselkumab (Tremfya) Risankizumab (Skyrizi) Tildrakizumab (Ilumya) Psychotic disorders Aripiprazole (Abilify) Asenapine (Saphris) Brexpiprazole (Rexulti) Cariprazine (Vraylar) Chlorpromazine (Thorazine) Clozapine (Clozaril) Fluphenazine (Prolixin)

xxviii

Drugs by Disorder

Haloperidol (Haldol) Iloperidone (Fanapt) Loxapine (Adasuve) Lurasidone (Latuda) Olanzapine (Zyprexa, Zyprexa Zydis) Paliperidone (Invega) Pimavanserin (Nuplazid) Quetiapine (Seroquel, Seroquel XR) Risperidone (Risperdal) Thioridazine (Mellaril) Thiothixene (Navane) Ziprasidone (Geodon) Pulmonary arterial hypertension Ambrisentan (Letairis) Bosentan (Tracleer) Epoprostenol (Flolan) Iloprost (Ventavis) Macitentan (Opsumit) Riociguat (Adempas) Selexipag (Uptravi) Sildenafil (Revatio) Tadalafil (Adcirca) Treprostinil (Remodulin, Tyvaso) Respiratory distress syndrome (RDS) Beractant (Survanta) Calfactant (Infasurf) Poractant alfa (Curosurf) Restless legs syndrome Cabergoline (Dostinex) Carbamazepine (Tegretol) Carbidopa/levodopa (Sinemet) Clonazepam (Klonopin) Gabapentin (Horizant, Neurontin) Levodopa Pramipexole (Mirapex) Pregabalin (Lyrica) Ropinirole (Requip) Rotigotine (Neupro) Schizophrenia Aripiprazole (Abilify) Asenapine (Saphris) Brexpiprazole (Rexulti) Cariprazine (Vraylar) Chlorpromazine (Thorazine) Clozapine (Clozaril) Fluphenazine (Prolixin)

Haloperidol (Haldol) Iloperidone (Fanapt) Lurasidone (Latuda) Olanzapine (Zyprexa, Zyprexa Zydis) Paliperidone (Invega, Invega Sustenna) Quetiapine (Seroquel, Seroquel XR) Risperidone (Risperdal) Thioridazine (Mellaril) Thiothixene (Navane) Ziprasidone (Geodon) Smoking cessation Bupropion (Zyban) Nicotine (NicoDerm, Nicotrol) Varenicline (Chantix) Thrombosis Apixaban (Eliquis) Dalteparin (Fragmin) Edoxaban (Savaysa) Enoxaparin (Lovenox) Fondaparinux (Arixtra) Heparin Tinzaparin (Innohep) Warfarin (Coumadin) Thyroid disorders Levothyroxine (Levoxyl, Synthroid) Liothyronine (Cytomel) Thyroid Transient ischemic attack (TIA) Aspirin Clopidogrel (Plavix) Prasugrel (Effient) Warfarin (Coumadin) Tremor Atenolol (Tenormin) Chlordiazepoxide (Librium) Diazepam (Valium) Lorazepam (Ativan) Metoprolol (Lopressor) Nadolol (Corgard) Propranolol (Inderal) Tuberculosis (TB) Bedaquiline (Sirturo) Cycloserine (Seromycin) Ethambutol (Myambutol) Isoniazid (INH)

Pyrazinamide Rifabutin (Mycobutin) Rifampin (Rifadin) Rifapentine (Priftin) Urticaria Cetirizine (Zyrtec) Cimetidine (Tagamet) Clemastine (Tavist) Cyproheptadine (Periactin) Diphenhydramine (Benadryl) Hydroxyzine (Atarax, Vistaril) Loratadine (Claritin) Promethazine (Phenergan) Ranitidine (Zantac) Vertigo Dimenhydrinate (Dramamine) Diphenhydramine (Benadryl) Meclizine (Antivert) Scopolamine (Trans-Derm Scop) Vomiting Aprepitant (Emend) Chlorpromazine (Thorazine) Dexamethasone (Decadron) Dimenhydrinate (Dramamine) Dronabinol (Marinol) Droperidol (Inapsine) Fosaprepitant (Emend) Granisetron (Kytril) Hydroxyzine (Vistaril) Lorazepam (Ativan) Meclizine (Antivert) Metoclopramide (Reglan)

Drugs by Disorder

xxix

Nabilone (Cesamet) Ondansetron (Zofran) Palonosetron (Aloxi) Prochlorperazine (Compazine) Promethazine (Phenergan) Rolapitant (Varubi) Scopolamine (Trans-Derm Scop) Trimethobenzamide (Tigan) Weight management Sympathomimetic amines Benzphetamine Diethylpropion Phendimetrazine Phentermine (Adipex, Lomaira) Phentermine/topiramate (Qsymia) Lipase inhibitor Orlistat (Alli, Xenical) Serotonin receptor agonist Lorcaserin (Belviq) Opioid antagonist/antidepressant Naltrexone/bupropion (Contrave) GLP-1 receptor agonist Liraglutide (Saxenda) Zollinger-Ellison syndrome Aluminum salts Cimetidine (Tagamet) Esomeprazole (Nexium) Famotidine (Pepcid) Lansoprazole (Prevacid) Omeprazole (Prilosec) Pantoprazole (Protonix) Rabeprazole (AcipHex) Ranitidine (Zantac)

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CLASSIFICATIONS

DRUG CLASSIFICATION CONTENTS allergic rhinitis nasal preparations Alzheimer’s disease agents angiotensin-converting enzyme (ACE) inhibitors angiotensin II receptor antagonists antianxiety agents antiarrhythmics antibiotics antibiotic: aminoglycosides antibiotic: carbapenems antibiotic: cephalosporins antibiotic: fluoroquinolones antibiotic: macrolides antibiotic: penicillins anticoagulants/antiplatelets/ thrombolytics anticonvulsants antidepressants antidiabetics antidiarrheals antifungals: systemic mycoses antiglaucoma agents antihistamines antihyperlipidemics antihypertensives antimigraine (triptans) antipsychotics antivirals

beta-adrenergic blockers bronchodilators calcium channel blockers chemotherapeutic agents contraception corticosteroids diuretics H2 antagonists hepatitis C virus hormones human immunodeficiency virus (HIV) infection immunosuppressive agents laxatives multiple sclerosis agents nonsteroidal anti-inflammatory drugs (NSAIDs) nutrition: enteral nutrition: parenteral obesity management osteoporosis Parkinson’s disease treatment proton pump inhibitors rheumatoid arthritis sedative-hypnotics skeletal muscle relaxants smoking cessation agents vitamins

1C

2C

Rhinitis Preparations ACTION

Allergic rhinitis or hay fever is an inflammation of the nasal airways occurring when an allergen (e.g., pollen) is inhaled. This triggers antibody production. The antibodies bind to mast cells, which contain histamine. Histamine is released, causing symptoms of allergic rhinitis.

Intranasal corticosteroids: Depress migration of polymorphonuclear leucocytes and fibroblasts, reverse capillary permeability, and stabilize nasal membranes to prevent/control inflammation. First-line therapy for moderate to severe symptoms or where nasal congestion is the dominant complaint. Intranasal antihistamines: Reduce histamine-mediated symptoms of allergic rhinitis, including pruritus, sneezing, rhinorrhea, watery eyes. Second-line therapy for intermittent nasal symptoms where congestion is not dominant. Intranasal mast cell stabilizers: Inhibit the mast cell release of histamine and other inflammatory mediators.

Intranasal anticholinergics: Block acetylcholine in the nasal mucosa. Effective in treating rhinorrhea associated with allergic rhinitis. Intranasal decongestants: Vasoconstrict the respiratory mucosa, provide short-term relief of nasal congestion. Used only as adjuvant therapy for 3–5 days. Oral antihistamines (second generation): First line therapy for mild sym­ptoms or where sneezing/itching is primary complaint (see antihistamine classification). Oral decongestants: For primary complaint of nasal congestion.

CORTICOSTEROIDS—INTRANASAL

Generic (Brand)

Adult Dose

Pediatric Dose

Class

Beclomethasone (Beconase AQ) (Qnasl)

Beconase AQ: 1–2 sprays in each nostril 2 times/day Qnasl: 80 mcg/spray: 2 sprays in each nostril once daily Rhinocort Aqua: 1–4 sprays in each nostril daily Rhinocort Allergy Spray: 1–2 sprays in each nostril once daily

Beconase AQ: 6–11 yrs: 1–2 sprays in each nostril 2 times/day Qnasl: 4–11 yrs: 40 mcg/spray: 1 spray in each nostril once daily Rhinocort Allergy Spray, Rhinocort Aqua: 6–11 yrs: 1–2 sprays in each nostril daily

Mild dryness, irritation, burning, stinging, bleeding of nasal mucosa, throat irritation, epistaxis, headache

Budesonide (Rhinocort Allergy Spray, Rhinocort Aqua)

Rhinitis Preparations

Relieve symptoms associated with allergic rhinitis. These symptoms include rhinorrhea, nasal congestion, pruritus, sneezing, postnasal drip, nasal pain.

Fluticasone (Flonase Sensimist, Flonase Allergy Relief) Fluticasone/Azelastine (Dymista) Mometasone (Nasonex) Triamcinolone (Nasacort Allergy 24 HR, Nasacort AQ)

Omnaris: 2 sprays in each nostril daily Zetonna: 1 spray in each nostril daily 2 sprays in each nostril 2 or 3 times/day (maximum: 8 sprays in each nostril daily) Flonase, Flonase Allergy Relief, Flonase Sensimist: 1–2 sprays in each nostril once daily 1 spray in each nostril 2 times/day 2 sprays in each nostril daily 1–2 sprays in each nostril daily

Omnaris: 6–11 yrs: 2 sprays in each nostril daily (seasonal allergic rhinitis only) 6–14 yrs: 2 sprays in each nostril 2 times/ day or 1 spray in each nostril 3 times/day (maximum: 4 sprays in each nostril daily) Flonase Sensimist: 2–11 yrs: 1 spray in each nostril daily Flonase Allergy Relief: 4–11 yrs: 1 spray in each nostril once daily Not indicated in children younger than 6 yrs 2–11 yrs: 1 spray in each nostril daily 2–5 yrs: 1 spray in each nostril once daily 6–11 yrs: 1–2 sprays in each nostril daily



Ciclesonide (Omnaris, Zetonna) Flunisolide (Nasalide)

ANTIHISTAMINES—INTRANASAL

Adult Dose

Pediatric Dose

Class

Azelastine Astepro 0.1%, 0.15%

Azelastine: 1–2 sprays in each nostril 2 times/day Astepro 0.1%, 0.15%: 1–2 sprays in each nostril two times/day or 2 sprays each nostril once daily (for seasonal allergic rhinitis) 1 spray in each nostril 2 times/day 2 sprays in each nostril 2 times/day

Azelastine: 5–11 yrs: 1 spray in each nostril 2 times/day Astepro 0.1%: 2–5 yrs: 1 spray 2 times/day Astepro 0.1% or 0.15%: 6–11 yrs: 1 spray 2 times/day

Nasal discomfort, epistaxis, somnolence, headache

Not approved for children younger than 6 yrs 6–11 yrs: 1 spray in each nostril 2 times/ day

3C

Continued

CLASSIFICATIONS

Azelastine/Fluticasone (Dymista) Olopatadine (Patanase)

Rhinitis Preparations

Generic (Brand)

4C

MAST CELL STABILIZERS

Adult Dose

Pediatric Dose

Side Effects

Cromolyn (NasalCrom)

1 spray in each nostril 3–4 times/day

2–11 yrs: 1 spray in each nostril 3–4 times/day

Nasal irritation, unpleasant taste

Generic (Brand)

Adult Dose

Pediatric Dose

Side Effects

Ipratropium (Atrovent) 0.03% Ipratropium (Atrovent) 0.06%

2 sprays in each nostril 2–3 times/day 2 sprays in each nostril 3–4 times/day

6–12 yrs: 2 sprays in each nostril 2–3 times/day 5–12 yrs: 2 sprays in each nostril 3–4 times/day

Nasal irritation, dizziness, ­headache

Generic (Brand)

Adult Dose

Pediatric Dose

Side Effects

Oxymetazoline (Afrin, Neo-Synephrine 12 HR)

2–3 sprays 2 times/day

6–11 yrs: 2–3 sprays 2 times/day

Phenylephrine (Neo-Synephrine Cold and Sinus, Vicks Sinus)

2–3 drops/sprays q4h as needed (0.25% or 0.5%)

6–11 yrs: 2–3 drops/sprays (0.25%) q4h as needed 1–5 yrs: 2–3 drops/sprays (0.125%) q4h as needed

Insomnia, tachycardia, nervousness, nausea, vomiting, transient burning, headache, rebound congestion if used longer than 72 hrs Restlessness, nervousness, headache, rebound nasal congestion, burning, stinging, dryness

ANTICHOLINERGICS

DECONGESTANTS

Rhinitis Preparations

Generic (Brand)



Alzheimer’s Disease Dementia is a general term used describing a decline in mental ability that is severe enough to interfere with the function of daily living. Alzheimer’s disease (AD) is the most common cause of dementia. Cognitive loss in AD is associated with depletion of acetylcholine (involved with learning and memory). AD is confirmed only at autopsy and is characterized by the presence of beta-amyloid plaques on the outer portions of neurons. Currently, two classes of medications are used as therapies for AD, acetylcholinesterase inhibitors (AChEIs) and an N-methyl-D-aspartate (NMDA) receptor antagonist. AChEIs increase the concentration of acetylcholine and may have beneficial effects on dementia. NMDA receptor antagonist mechanism of action is unclear, but may reduce glutamatergic overstimulation at the NMDA receptor, which may have symptomatic benefits on dementia. ACETYLCHOLINESTERASE INHIBITORS

Uses

Availability

Dose/Titration

Adverse Effects

Donepezil (Aricept, Aricept ODT) Galantamine (Razadyne, Razadyne ER)

Mild, moderate, severe AD

T: 5 mg, 10 mg, 23 mg ODT: 5 mg, 10 mg

Mild, moderate AD

T: 4 mg, 8 mg, 12 mg OS: 4 mg/mL ER: 8 mg, 16 mg, 24 mg

Initially, 5 mg once daily, may increase to 10 mg once daily after 4–6 wks. After 3 months, if suboptimal response, may increase to 23 mg once daily T, OS: Initially, 4 mg bid; may increase to 8 mg bid after 4 wks, then to 12 mg bid after additional 4 wks ER: Initially, 8 mg once daily, may increase to 16 mg once daily after 4 wks, then to 24 mg once daily after additional 4 wks

Nausea, vomiting, abdominal cramping, diarrhea, bradycardia, syncope Nausea, vomiting, diarrhea, weight loss, decreased appetite, syncope

Continued

Alzheimer’s Disease

Name

5C CLASSIFICATIONS

6C

ACETYLCHOLINESTERASE INHIBITORS—cont’d

Uses

Availability

Dose/Titration

Adverse Effects

Rivastigmine (Exelon, Exelon Patch)

Mild, moderate AD Patch also approved for severe AD

C: 1.5 mg, 3 mg, 4.5 mg, 6 mg OS: 2 mg/mL PATCH: 4.6 mg/24 hrs, 9.5 mg/24 hrs, 13.3 mg/24 hrs

C, OS: Initially, 1.5 mg bid, may increase in increments of 1.5 mg bid every 2 wks up to 6 mg bid

Nausea, vomiting, abdominal cramping, diarrhea, bradycardia, syncope, loss of appetite, weight loss

T: 5 mg, 10 mg OS: 2 mg/mL XR: 7 mg, 14 mg, 21 mg, 28 mg

T, OS: Initially, 5 mg once daily, may increase in increments of 5 mg/wk up to 10 mg bid

Dizziness, headache, diarrhea, constipation, confusion

14/10 mg: Once/d in evening in patients previously stabilized on memantine 5 mg bid or 14 mg once daily and donepezil 10 mg once/d 28/10 mg: Once daily in evening in patients previously stabilized on memantine 10 mg bid or 28 mg once daily and donepezil 10 mg once daily

Refer to individual agents for adverse effects

NMDA Receptor Antagonist Memantine (Namenda, Namenda XR)

Moderate, severe AD

NMDA Receptor Antagonist/ Acetylcholinesterase Inhibitor Memantine/donepezil (Namzaric)

Moderate, severe AD

ER: 14/10 mg, 28/10 mg

C: Capsule, ER: extended-release, OS: oral solution, T: tablet, XR: extended-release

Alzheimer’s Disease

Name

ACTION

Treatment of hypertension (HTN), adjunctive therapy for heart failure (HF).

Antihypertensive: Inhibits angiotensin-converting enzyme (ACE). ACE catalyzes conversion of angiotensin I to angiotensin II, a potent vasoconstrictor that also stimulates aldosterone secretion by adrenal cortex. Beneficial effects in HTN/HF appear to be suppression of the renin-angiotensin-aldosterone system. Reduces peripheral arterial resistance.

HF: Decreases peripheral vascular resistance (afterload), pulmonary capillary wedge pressure (preload); improves cardiac output, exercise tolerance.

ACE INHIBITORS

Name

Availability

Uses

Dosage Range (per day)

Frequent or Severe Side Effects

Benazepril (Lotensin) Captopril (Capoten)

T: 5 mg, 10 mg, 20 mg, 40 mg T: 12.5 mg, 25 mg, 50 mg, 100 mg

HTN

Enalapril (Vasotec)

T: 2.5 mg, 5 mg, 10 mg, 20 mg IV: 1.25 mg/mL

Class Effects Cough, hypotension, rash, acute renal failure (in pts with renal artery stenosis), angioedema, hyperkalemia, mild-moderate loss of taste, hepatotoxicity, pancreatitis, blood dyscrasias, renal damage

Fosinopril (Monopril)

T: 10 mg, 20 mg, 40 mg

HTN: Initially, 10 mg/day. Usual dose: 20–80 mg once daily or divided bid HTN: Initially, 12.5–25 mg 2–3 times/day. Usual dose: 50–100 mg 2 times/day HF: Initially, 6.25 mg 3 times/day. Target: 50 mg 3 times/day HTN: Initially, 2.5–5 mg/day; may increase at 1–2 wk intervals. Usual dose: 5–40 mg once/d or divided bid HF: Initially, 2.5 mg 2 times/day, may increase at 1–2 wk intervals. Target: 20 mg/day in 1–2 divided doses HTN: Initially, 10 mg/day Usual dose: 10–80 mg once daily HF: Initially, 5–10 mg/day Target: 10–40 mg/day

HF HTN HF HTN HF

7C

Continued

CLASSIFICATIONS

HTN

Angiotensin-Converting Enzyme (ACE) Inhibitors

USES



Angiotensin-Converting Enzyme (ACE) Inhibitors

8C

ACE INHIBITORS—cont’d

Availability

Uses

Dosage Range (per day)

Lisinopril (Prinivil, Zestril) Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril)

T: 2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg T: 7.5 mg, 15 mg

HTN HF

HTN: Initially, 5–10 mg/day. Usual dose: 10–40 mg once daily HF: Initially, 2.5–5 mg/day. Target: 20–40 mg/day

HTN

T: 2 mg, 4 mg, 6 mg T: 5 mg, 10 mg, 20 mg, 40 mg

HTN

Ramipril (Altace)

C: 1.25 mg, 2.5 mg, 5 mg, 10 mg

HTN

Trandolapril (Mavik)

T: 1 mg, 2 mg, 4 mg

HTN: Initially, 3.75–7.5 mg/day. Usual dose: 7.5–30 mg/day in 1–2 divided doses HTN: Initially, 4 mg/day. May increase at 1–2 wk intervals. Usual dose: 4–8 mg once daily or divided bid HTN: Initially, 10–20 mg once daily. Usual dose: 10–40 mg once daily or divided bid HF: Initially, 5 mg 2 times/day. Titrate to 20–40 mg/day in 2 divided doses HTN: Initially, 2.5 mg once daily. Usual dose: 2.5–20 mg once daily or divided bid HF: Initially, 1.25–2.5 mg once daily. Target: 10 mg once daily HTN: Initially, 1–2 mg once daily. Usual dose: 2–8 mg once daily or divided bid HF: Initially, 1 mg once daily. Target: 4 mg once daily

HTN HF

HF HTN HF

C, Capsules; HF, heart failure; HTN, hypertension; T, tablets.

Frequent or Severe Side Effects

Angiotensin-Converting Enzyme (ACE) Inhibitors

Name



Angiotensin II Receptor Antagonists USES

ACTION

Treatment of hypertension (HTN) alone or in combination with other antihypertensives. Treatment of heart failure (HF).

Angiotensin II receptor antagonists (AIIRA) block vasoconstrictor and aldosterone-secreting effects on angiotensin II by selectively blocking the binding of angiotensin

II to AT1 receptors in vascular smooth muscle and the adrenal gland, causing vasodilation and a decrease in aldosterone effects.

Availability

Uses

Dosage Range (per day)

Azilsartan (Edarbi) Candesartan (Atacand)

T: 40 mg, 80 mg T: 4 mg, 8 mg, 16 mg, 32 mg

HTN HTN HF

Eprosartan (Teveten) Irbesartan (Avapro)

T: 400 mg, 600 mg T: 75 mg, 150 mg, 300 mg T: 25 mg, 50 mg, 100 mg

HTN HTN Nephropathy HTN

40–80 mg once daily Initially, 16 mg once daily. Usual dose: 8–32 mg in 1–2 divided doses. Initially, 4–8 mg once daily. Double dose at 2 wk intervals. Target: 32 mg once daily Initially, 600 mg/day. Usual dose: 600 mg once daily 150–300 mg once daily 300 mg once daily Initially, 50 mg once daily. Usual dose: 25–100 mg/once daily or divided bid Initially, 50 mg/day; may increase to 100 mg/day Initially, 20 mg once daily. May increase to 40 mg once daily after 2 wks

Losartan (Cozaar) Olmesartan (Benicar)

T: 5 mg, 20 mg, 40 mg

Nephropathy HTN

Frequent or Severe Side Effects Class Effects Hypotension, rash, acute renal failure (in pts with renal artery stenosis), hyperkalemia, mildmoderate loss of taste, hepatotoxicity, pancreatitis, blood dyscrasias, renal damage

9C

Continued

CLASSIFICATIONS

Name

Angiotensin II Receptor Antagonists

ANGIOTENSIN II RECEPTOR ANTAGONISTS

ANGIOTENSIN II RECEPTOR ANTAGONISTS—cont’d

Uses

Dosage Range (per day)

Telmisartan (Micardis)

T: 40 mg, 80 mg

Valsartan (Diovan)

T: 80 mg, 160 mg

HTN CV risk reduction HTN

Initially, 40 mg once daily. Usual dose: 40–80 mg once daily. 80 mg once daily Initially, 80 or 160 mg once daily. Usual dose: 80–320 mg once daily Initially, 20–40 mg 2 times/day. Titrate to 80–160 mg 2 times/day Initially, 20 mg 2 times/day. Titrate to target of 160 mg 2 times/day

HF Post Ml

CV, Cardiovascular; HF, heart failure; HTN, hypertension; Ml, myocardial infarction; T, tablets.

Antianxiety Agents USES Anxiety disorders are the most common form of psychiatric illness and include generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), posttraumatic stress disorder (PTSD), and acute stress

disorder. Treatment options for anxiety disorders include pharmacotherapy and psychological therapy (e.g., behavioral therapy). A selective serotonin reuptake inhibitor (SSRI) or a serotonin norepinephrine reuptake inhibitor (SNRI) is generally used for initial

treatment. Benzodiazepines can provide immediate relief of anxiety symptoms and are often used as adjuncts to SSRIs and SNRIs (see classification Antidepressants for SSRI and SNRI charts).

aminobutyric acid (GABA), which inhibits nerve impulse transmission by binding to specific benzodiaz-

epine receptors in various areas of the central nervous system (CNS).

ACTION Benzodiazepines: The exact mechanism is unknown, but they may increase the inhibiting effect of gamma-

Antianxiety Agents

Availability

10C

Frequent or Severe Side Effects

Name

Name



ANTIANXIETY AGENTS

Availability

Uses

Dosage

Side Effects

Alprazolam (Xanax)

T: 0.25 mg, 0.5 mg, 1 mg, 2 mg S: 1 mg/ml ER: 0.5 mg, 1 mg, 2 mg, 3 mg ODT: 0.25 mg, 0.5 mg, 1 mg, 2 mg

Anxiety, panic disorder

Initially, 0.25–0.5 mg 3 times/day. May increase every 3–4 days. Maximum: 4 mg/day

Clonazepam ­(Klonopin) Clorazepate (Tranxene)

T: 0.5 mg, 1 mg, 2 mg ODT: 0.125, 0.25, 0.5, 1, 2 mg T: 3.75 mg, 7.5 mg, 15 mg SD: 11.25 mg, 22.5 mg

Anxiety: 1–4 mg divided bid

Diazepam (Valium)

T: 2 mg, 5 mg, 10 mg S: 5 mg/5 mL I: 5 mg/mL T: 0.5 mg, 1 mg, 2 mg S: 2 mg/mL I: 2 mg/mL, 4 mg/mL

Anxiety, panic ­disorder Anxiety, alcohol withdrawal, anticonvulsant Anxiety, alcohol withdrawal, anticonvulsant, muscle relaxant Anxiety, alcohol withdrawal

Drowsiness, weakness, fatigue, ataxia, slurred speech, confusion, lack of coordination, impaired memory, paradoxical agitation, dizziness, nausea Drowsiness, ataxia, behavioral disturbances Hypotension, drowsiness, fatigue, ataxia, memory impairment, headache, nausea Hypotension, ataxia, drowsiness, fatigue, vertigo

Benzodiazepine

Initially, 2–3 mg/day in 2–3 divided doses. Usual dose: 2–6 mg/day in divided doses

Sedation, respiratory depression, ataxia, dizziness, headache Continued

11C CLASSIFICATIONS

2–10 mg, 2–4 times/day

Antianxiety Agents

Lorazepam (Ativan)

7.5–15 mg 2–4 times/day

Name

Availability

Uses

Dosage

Side Effects

Buspirone (BuSpar)

T: 5 mg, 7.5 mg, 10 mg, 15 mg, 30 mg

Anxiety

Dizziness, light-headedness, headaches, nausea, restlessness

Hydroxyzine (Atarax, Vistaril)

T: 10 mg, 25 mg, 50 mg C: 25 mg, 50 mg, 100 mg S: 10 mg/5 mL

Anxiety

Initially, 7.5 mg 2 times/day. May increase every 2–3 days by 2.5 mg bid. Maximum: 30 mg 2 times/day 50–100 mg 4 times/day

12C

ANTIANXIETY AGENTS—cont’d

Nonbenzodiazepine

C, Capsules; CR, controlled-release; ER, extended-release; I, injection; ODT, orally disintegrating tablet; S, solution; SD, single dose; T, tablets.

Antianxiety Agents

Drowsiness; dry mouth, nose, and throat



Antiarrhythmics USES

ACTION

Prevention and treatment of cardiac arrhythmias, such as premature ventricular contractions, ventricular tachycardia, premature atrial contractions, paroxysmal atrial tachycardia, atrial fibrillation, and flutter.

The antiarrhythmics are divided into four classes based on their effects on certain ion channels and/or receptors located on the myocardial cell membrane. Class I is further divided into three subclasses (IA, IB, IC) based on electrophysiologic effects. Class I: Blocks cardiac sodium channels and slows conduction velocity, prolonging refractory period, and decreasing automaticity of sodium-dependent tissue. Class IA: Blocks sodium and potassium channels.

Class IC: Slows conduction velocity; no effect on repolarization phase. Class II: Slows sinus and atrioventricular (AV) nodal conduction. Class III: Blocks cardiac potassium channels, prolonging the repolarization phase of electrical cells. Class IV: Inhibits the influx of calcium through its channels, causing slower conduction through the sinus and AV nodes; decreases contractility.

Class IB: Shortens the repolarization phase. ANTIARRHYTHMICS

Uses

Dosage Range

Side Effects

Disopyramide (Norpace, Norpace CR) Procainamide (Procan-SR, Pronestyl)

C: 100 mg, 150 mg C (ER): 100 mg, 150 mg

AF, WPW, PSVT, PVCs, VT

C: 100–200 mg q6h ER: 200–400 mg q12h

I: 100 mg/mL, 500 mg/mL

AF, WPW, PVCs, VT

Loading dose: 15–18 mg/kg over 20–30 min. Maintenance dose: 1–4 mg/min as a continuous infusion

Dry mouth, blurred vision, urinary retention, HF, proarrhythmia, heart block, nausea, vomiting, diarrhea, hypoglycemia, nervousness Hypotension, fever, agranulocytosis, SLE, headaches, proarrhythmia, confusion, disorientation, Gl symptoms, hypotension Continued

13C

Availability

Antiarrhythmics

Name Class IA

CLASSIFICATIONS

Name

Availability

Uses

Dosage Range

Side Effects

Quinidine (Quinaglute, Quinidex)

T: 200 mg, 300 mg T (ER): 300 mg, 324 mg I: 80 mg/mL

AF, WPW, PVCs, VT

A (PO): 400 mg q6h. (ER): 300–q8–12h or 648 mg q8h

Diarrhea, hypotension, nausea, vomiting, cinchonism, fever, bitter taste, heart block, thrombocytopenia, proarrhythmia

Lidocaine (Xylocaine)

I: 300 mg for IM IV Infusion: 2 mg/mL, 4 mg/mL

PVCs, VT, VF

Drowsiness, agitation, muscle twitching, seizures, paresthesia, proarrhythmia, slurred speech, tinnitus, cardiac depression, bradycardia, asystole

Mexiletine (Mexitil)

C: 150 mg, 200 mg, 250 mg

PVCs, VT, VF

IV: Initially, 1–1.5 mg/kg. May repeat 0.5–0.75 mg/kg q5–10 min. Maximum cumulative dose: 3 mg/kg, then 1–4 mg/min infusion A: Initially, 200 mg q8h. Adjust every 2–3 days in 50–100 mg increments. ­Maximum: 1,200 mg/day

Flecainide (Tambocor)

T: 50 mg, 100 mg, 150 mg T: 150 mg, 225 mg, 300 mg ER: 225 mg, 325 mg, 425 mg

A: Initially, 100 mg q12h. May increase by 50 mg q12h at 4 day intervals. Maximum: 400 mg/day A: T: Initially, 150 mg q8h. May increase at 3–4 day intervals up to 300 mg q8h ER: Initially, 225 mg q12h. May increase at a minimum of 5 days up to 425 mg q12h

Dizziness, tremors, bradycardia, heart block, HF, Gl upset, neutropenia, flushing, blurred vision, metallic taste, proarrhythmia

Propafenone (Ryth mol)

AF, PSVT, life-threatening ventricular arrhythmias PAF, WPW, life-threatening ventricular arrhythmias

Class IB

Drowsiness, agitation, muscle twitching, seizures, paresthesia, proarrhythmia, nausea, vomiting, blood dyscrasias, hepatitis, fever

Class IC

Dizziness, blurred vision, altered taste, nausea, exacerbation of asthma, proarrhythmia, bradycardia, heart block, HF, Gl upset, bronchospasm, hepatotoxicity

14C Antiarrhythmics

ANTIARRHYTHMICS—cont’d



Class II (Beta-Blockers) Acebutolol (Sectral)

C: 100 mg, 200 mg, 400 mg

Ventricular arrhythmias

Esmolol (Brevibloc) Propranolol (Inderal)

I: 10 mg/mL

Supraventricular tachycardia Tachyarrhythmias

T: 10 mg, 20 mg, 40 mg

A: Initially, 200 mg 2 times/day. Maintenance: 600–1200 mg/day in divided doses A: 50–200 mcg/kg/min

Bradycardia, hypotension, depression, nightmares, fatigue, sexual dysfunction, SLE, ­arthritis, myalgia Hypotension, heart block, HF, bronchospasm

A: Initially, 10–30 mg 3–4 times/ day Maintenance: 10–40 mg 3–4 times/day

Bradycardia, hypotension, depression, nightmares, fatigue, sexual dysfunction, heart block, bronchospasm

Blurred vision, photophobia, constipation, ataxia, proarrhythmia, pulmonary fibrosis, bradycardia, heart block, hyperthyroidism or ­hypothyroidism, peripheral neuropathy, Gl upset, blue-gray skin, optic neuritis, hypotension Torsades de pointes, hypotension Diarrhea, nausea, abdominal pain, vomiting, asthenia Torsades de pointes

Class III AF, PAF, PSVT, life-threatening ventricular ­arrhythmias

Dofetilide (Tikosyn) Dronedarone (Multaq) Ibutilide (Corvert)

C: 125 mcg, 250 mcg, 500 mcg T: 400 mg

AF, A flutter

A (PO): 800–1,600 mg/day in ­divided doses for 1–3 wks, then 600–800 mg/day in divided doses (IV): 150 mg bolus, then 900 mg over 18 hrs A: Individualized

AF, A flutter

A (PO): 400 mg 2 times/day

I: 0.1 mg/mL

AF, A flutter

A (greater than 60 kg): 1 mg over 10 min; (less than 60 kg): 0.01 mg/kg over 10 min

Continued

15C CLASSIFICATIONS

T: 100 mg, 200 mg, 400 mg I: 50 mg/mL

Antiarrhythmics

Amiodarone (Cordarone, Pacerone)

Name

Availability

Uses

Dosage Range

Side Effects

Sotalol (Betapace)

T: 80 mg, 120 mg, 160 mg

AF, PAF, PSVT, life-threatening ventricular ­arrhythmias

A: Initially, 80 mg 2 times/day May increase at 3 day intervals up to 160 mg 2 times/day

Fatigue, dizziness, dyspnea, bradycardia, ­proarrhythmia, heart block, hypotension, ­bronchospasm

AF, A flutter, PSVT AF, A flutter, PSVT

A (IV): 20–25 mg bolus, then ­infusion of 5–15 mg/hr A (IV): 5–10 mg

Hypotension, bradycardia, dizziness, ­headaches, heart block, asystole, HF Hypotension, bradycardia, dizziness, ­headaches, constipation, heart block, HF, ­asystole, fatigue, edema, nausea

Class IV (Calcium Channel Blockers) Diltiazem (­Cardizem) Verapamil (Calan, Isoptin)

I: 25 mg/mL vials ­Infusion: 1 mg/mL I: 5 mg/2 mL

A, Adults; AF, atrial fibrillation; A flutter, atrial flutter; C, capsules; HF, heart failure; ER, extended-release; I, injection; PAF, paroxysmal atrial fibrillation; PSVT, paroxysmal supraventricular tachycardia; PVCs, premature ventricular contractions; SLE, systemic lupus erythematosus; SR, sustained-release; T, tablets; VT, ventricular tachycardia; WPW, Wolff-Parklnson-White syndrome.

16C Antiarrhythmics

ANTIARRHYTHMICS—cont’d



Antibiotics ACTION Antibiotics are natural or synthetic compounds that have the ability to kill or suppress the growth of microorganisms. One means of classifying antibiotics is by their antimicrobial spectrum. Narrow-spectrum agents are effective against few microorganisms (e.g., aminoglycosides are effective against gram-negative aerobes), whereas broad-spectrum agents are effective against a wide variety of microorganisms (e.g., fluoroquinolones are effective against gram-positive cocci and gram-negative bacilli).

Antibiotics

Antimicrobial agents may also be classified based on their mechanism of action. • Agents that inhibit cell wall synthesis or activate enzymes that disrupt the cell wall, causing a weakening in the cell, cell lysis, and death. Include penicillins, cephalosporins, vancomycin, imidazole antifungal agents. • Agents that act directly on the cell wall, affecting permeability of cell membranes, causing leakage of intracellular substances. Include antifungal agents amphotericin and nystatin, polymyxin, colistin.

• A gents that bind to ribosomal subunits, altering protein synthesis and eventually causing cell death. Include aminoglycosides. • Agents that affect bacterial ribosome function, altering protein synthesis and causing slow microbial growth. Do not cause cell death. Include chloramphenicol, clindamycin, erythromycin, tetracyclines. • Agents that inhibit nucleic acid metabolism by binding to nucleic acid or interacting with enzymes necessary for nucleic acid synthesis. Inhibit DNA or RNA synthesis. Include rifampin, metronidazole, fluoroquinolones (e.g., ciprofloxacin). • Agents that inhibit specific metabolic steps necessary for microbial growth, causing a decrease in essential cell components or synthesis of nonfunctional analogues of normal metabolites. Include trimethoprim, sulfonamides. • Agents that inhibit viral DNA synthesis by binding to viral enzymes necessary for DNA synthesis, preventing viral replication. Include acyclovir, vidarabine.

17C CLASSIFICATIONS

USES Treatment of wide range of gram-positive or gram-negative bacterial infections, suppression of intestinal flora before surgery, control of acne, prophylactically to prevent rheumatic fever, prophylactically in high-risk situations (e.g., some surgical procedures or medical conditions) to prevent bacterial infection.

The goal of therapy is to achieve antimicrobial action at the site of infection sufficient to inhibit the growth of the microorganism. The agent selected should be the most active against the most likely infecting organism, least likely to cause toxicity or allergic reaction. Factors to

consider in selection of an antimicrobial agent include the following: • Sensitivity pattern of the infecting microorganism • Location and severity of infection (may determine route of administration)

• P t’s ability to eliminate the drug (status of renal and hepatic function) • Pt’s defense mechanisms (includes both cellular and humoral immunity) • Pt’s age, pregnancy status, genetic factors, allergies, CNS disorder, preexisting medical problems

CATEGORIZATION OF ORGANISMS BY GRAM STAINING

Gram-Positive Cocci

Gram-Negative Cocci

Gram-Positive Bacilli

Gram-Negative Bacilli

Aerobic Staphylococcus aureus Staphylococcus epidermidis Streptococcus pneumoniae Streptococcus pyogenes Viridans streptococci Enterococcus faecalis Enterococcus faecium Anaerobic Peptostreptococcus spp. Peptococcus spp.

Aerobic Neisseria gonorrhoeae Neisseria meningitidis Moraxella catarrhalis

Aerobic Listeria monocytogenes Bacillus anthracis Corynebacterium diphtheriae Anaerobic Clostridium difficile Clostridium perfringens Clostridium tetani Actinomyces spp.

Aerobic Escherichia coli Klebsiella pneumoniae Proteus mirabilis Serratia marcescens Acinetobacter spp. Pseudomonas aeruginosa Enterobacter spp. Haemophilus influenzae Legionella pneumophila Anaerobic Bacteroides fragilis Fusobacterium spp.

18C Antibiotics

SELECTION OF ANTIMICROBIAL AGENTS



Antibiotic: Aminoglycosides ACTION

USES Treatment of serious infections when other less-toxic agents are not effective, are contraindicated, or require adjunctive therapy (e.g., with penicillins or cephalosporins). Used primarily in the treatment of infections caused by gram-negative microorganisms, such as those caused by Proteus, Klebsiella, Pseudomonas, Escherichia coli, Serratia, and Enterobacter. Inactive

against most gram-positive microorganisms. Not well absorbed systemically from GI tract (must be administered parenterally for systemic infections). Oral agents are given to suppress intestinal bacteria.

Bactericidal. Transported across bacterial cell membrane; irreversibly bind to specific receptor proteins of bacterial ribosomes. Interfere with protein synthesis, preventing cell reproduction and eventually causing cell death.

Name

Availability

Dosage Range

Class Side Effects

Amikacin

I: 50 mg/mL, 250 mg/mL

Nephrotoxicity, neurotoxicity, ototoxicity (both auditory and vestibular), hypersensitivity (skin itching, redness, rash, swelling)

Gentamicin

I: 10 mg/mL, 40 mg/mL

Plazomicin ­(Zemdri) Tobramycin

I: 50 mg/mL

A: 5–7.5 mg/kg q8h or 15–20 mg/kg once daily C: 5–7.5 mg/kg q8h A: 4–7 mg/kg once daily or 1–2.5 mg/kg q8–12h C: 2–2.5 mg/kg q8h A: 15 mg/kg q24h

19C

A, Adults; C (dosage), children; I, injection; T, tablets.

A: 5–7 mg/kg once daily or 1–2.5 mg/kg q8h C: 2–2.5 mg/kg q8h

CLASSIFICATIONS

I: 10 mg/mL, 40 mg/mL

Decreased renal function, diarrhea, hypertension, headache, nausea, vomiting, hypotension

Antibiotic: Aminoglycosides

ANTIBIOTIC: AMINOGLYCOSIDES

Carbapenems are a class of beta-lactam antibiotics that are used to treat severe or high-risk bacterial infections. They may be used in the treatment of intra-abdominal infections, complicated urinary tract infections, pneumonia, and sepsis. Doripenem, imipenem, and meropenem exhibit broad spectrum activity against gram-negative bacteria including most Enterobacteriaceae (e.g., Escherichia coli, Klebsiella pneumoniae, Enterobacter, Citrobacter, Proteus mirabilis, and Serratia marcescens) and good activity against Pseudomonas aeruginosa and Acinetobacter species.

Meropenem/vaborbactam exhibits activity against Enterobacter cloacae species complex, E. coli, and K. pneumoniae. Carbapenems exhibit narrower activity against grampositive bacteria including methicillin-sensitive strains of Staphylococcus and Streptococcus species. Carbapenems exhibit good activity against anaerobes (e.g., Bacteroides fragilis).

Inhibit bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins, causing cell lysis and death.

ANTIBIOTIC: CARBAPENEMS

Name

Indications

Dosage Range

Side Effects

Doripenem (Dorbax)

Intra-abdominal infection Complicated urinary tract infection (­including pyelonephritis) Acute pelvic infections Community-acquired pneumonia Complicated intra-abdominal infections, skin and skin structure, and UTI

500 mg q8h

Headache, diarrhea, nausea, skin rash, anemia

1 g once daily

Diarrhea, vomiting, nausea, abdominal pain, increased AST, ALT

Ertapenem (Invanz)

Antibiotic: Carbapenems

ACTION

SPECTRUM OF ACTIVITY

20C

Antibiotic: Carbapenems



Meropenem (Merrem)

500–1,000 mg q6h or 1,000 mg q8h

Decreased hematocrit, hemoglobin, eosinophilia, thrombocythemia, ­increased ALT, AST

1.5-6 g daily divided q8h

Headache, pain, skin rash, nausea, ­diarrhea, constipation, vomiting, ­anemia

4 g (2 g meropenem/2 g vaborbactam) q8h

Headache, diarrhea, phlebitis/infusion site reactions

Antibiotic: Carbapenems

Meropenem/vaborbactam (Vabomere)

Lower respiratory tract infections Urinary tract infections. Intra-abdominal infections. Gynecologic infections. Bacterial ­septicemia. Bone and joint infections. Skin and skin structure infections. Endocarditis Meningitis Intra-abdominal infection Pneumonia Sepsis Complicated urinary tract infection (­including pyelonephritis)

21C CLASSIFICATIONS

Imipenem (Primaxin)

22C

Antibiotic: Cephalosporins ACTION Second-generation cephalosporins have same effectiveness as first-generation and increased activity against gramnegative organisms, including Haemophilus influenzae, Neisseria gonorrhoeae, E. coli, and Klebsiella. Cefoxitin has activity against gram-negative bacilli Bacteroides fragilis and certain Enterobacteriaceae.

First-generation cephalosporins have activity against gram-positive organisms (e.g., streptococci and most staphylococci) and activity against some gram-negative organisms, including Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis.

Third-generation cephalosporins are less active against gram-positive organisms but active against gram-negative bacteria including Haemophilus influenzae, and Proteus, Citrobacter, Serratia, Enterobacteriaceae (E. coli), and Klebsiella species. Ceftazidime has activity against Pseudomonas aeruginosa. Fourth-generation cephalosporins have good activity against gram-positive organisms (e.g., Staphylococcus

aureus) and gram-negative organisms (e.g., Pseudomonas aeruginosa, E. coli, Klebsiella, and Proteus). Cefepime penetrates the CNS and can be used in treating meningitis. Fifth-generation cephalosporins have good activity against gram-positive organisms (e.g., Staphylococcus aureus, Streptococcus spp.) and gram-negative organisms (e.g., E. coli, Klebsiella spp.). Ceftaroline has activity against multidrug-resistant Staphylococcus aureus, including MRSA, VRSA, and VISA. Cephalosporins inhibit cell wall synthesis or activate enzymes that disrupt the cell wall, causing cell lysis and cell death. May be bacteriostatic or bactericidal. Most effective against rapidly dividing cells.

ANTIBIOTIC: CEPHALOSPORINS

Name

Availability

Dosage Range

Side Effects

C: 500 mg T: 1 g S: 125 mg/5 mL, 250 mg/5 mL, 500 mg/5 mL I: 500 mg, 1 g, 2 g

A: 500 mg–1 g C: 15 mg/kg ql2h

Abdominal cramps/pain, fever, nausea, vomiting, diarrhea, headaches, oral/vaginal candidiasis

A: 500 mg–2 g q6–8h C: 25–100 mg/kg/day divided q6–8h

Fever, rash, diarrhea, nausea, pain at injection site

First-Generation Cefadroxil (Duricef)

Cefazolin (Ancef)

Antibiotic: Cephalosporins

USES Broad-spectrum antibiotics, which, like penicillins, may be used in a number of diseases, including respiratory diseases, skin and soft tissue infection, bone/joint infections, and genitourinary infections and prophylactically in some surgical procedures.

A: 250 mg–1 g q6–12h C: 25–100 mg/kg/day divided q6–8h

Headache, abdominal pain, diarrhea, nausea, dyspepsia

A: 250–500 mg q8h ER: 500 mg q12h C: 20–40 mg/kg/day q8–12h

Rash, diarrhea, increased transaminases May have serum sickness-like reaction

Cefotetan

C: 250 mg, 500 mg T (ER): 500 mg S: 125 mg/5 mL, 187 mg/5 mL, 250 mg/5 mL, 375 mg/5 mL l:1g, 2 g

Cefoxitin (Mefoxin)

l:1g, 2 g

Diarrhea, increased AST, ALT, hypersensitivity reactions Diarrhea

Cefprozil (Cefzil)

T: 250 mg, 500 mg S: 125 mg/5 mL, 250 mg/5 mL T: 125 mg, 250 mg, 500 mg S: 125 mg/5 mL, 250 mg/5 mL I: 750 mg, 1.5 g

A: 500 mg–3 g q12h C: 20–40 mg/kg q12h A: 1–2 g q6–8h C: 80–160 mg/kg/day divided q6h A: 500 mg q12–24h C: 7.5–15 mg/kg q12h A (PO): 125–500 mg q12h (IM/IV): 750 mg–1.5 g q8–12h C (PO): 10–15 mg/kg q12h (IM/IV): 75–150 mg/kg/day divided q8h A: 300 mg q12h or 600 mg once daily C: 7 mg/kg q12h or 14 mg/kg once daily A: 200–400 mg q12h C: (>11 yrs): 200–400 mg q12h A: 1–2 g q4–12h C: 50–300 mg/kg/day divided q4–6h

Headache, hyperglycemia, abdominal pain, diarrhea, nausea Diarrhea, nausea



C: 250 mg, 500 mg T: 250 mg, 500 mg, 1 g

Cephalexin (Keflex, Keftab)

Second-Generation Cefaclor (Ceclor)

Third-Generation

Cefotaxime (Claforan)

I: 500 mg, 1 g, 2 g

Rash, diarrhea, nausea, pain at injection site

23C

Continued

CLASSIFICATIONS

Cefditoren (Spectracef)

C: 300 mg S: 125 mg/5 mL T: 200 mg, 400 mg

Cefdinir (Omnicef)

Antibiotic: Cephalosporins

Cefuroxime (Ceftin, Kefurox, Zinacef)

Dizziness, abdominal pain, diarrhea, nausea, increased AST, ALT Diarrhea, nausea, vomiting, thrombophlebitis, increased AST, ALT

Availability

Dosage Range

Side Effects

Cefpodoxime (Vantin)

T: 100 mg, 200 mg S: 50 mg/5 mL, 100 mg/5 mL I: 500 mg, 1 g, 2 g

A: 100–400 mg q12h C: 5 mg/kg q12h A: 500 mg–2 g q8—12h C: 30–50 mg/kg q8h A: 400 mg once daily C: 4.5 mg/kg bid or 9 mg/kg once daily A: 1–2 g q12–24h C: 50–100 mg/kg/day divided q12–24h

Rash, diarrhea, nausea

I: 1g, 2g

A: 1–2 g q8–12h C: 50 mg/kg q8–12h

Rash, diarrhea, nausea, increased AST, ALT

I: 400 mg, 600 mg

A: 600 mg q12h

Headache, insomnia, rash, pruritus, diarrhea, nausea

I: 2 g ceftazidime/0.5 g ­avibactam I: 1 g ceftolozane/0.5 g ­tazobactam

A: 2.5 g q8h

Nausea, vomiting, constipation, anxiety

A: 1.5 g q8h

Nausea, diarrhea, headache, pyrexia

Ceftazidime (Fortaz, Tazicef, Tazidime) Ceftibuten (Cedax) Ceftriaxone (Rocephin)

C: 400 mg S: 90 mg/5 mL, 180 mg/5 mL I: 250 mg, 500 mg, 1 g, 2 g

Diarrhea, pain at injection site Headache, nausea, diarrhea Rash, diarrhea, eosinophilia, increased AST, ALT

Fourth-Generation Cefepime (Maxipime)

Fifth-Generation Ceftaroline (Teflaro)

Fixed-Combinations Ceftazidime/avibactam (Avycaz) Ceftolozane/tazobactam (Zerbaxa)

A, Adults; C, capsules; C (dosage), children; ER, extended-release; I, injection; S, suspension; T, tablets.

Antibiotic: Cephalosporins

Name

24C

ANTIBIOTIC: CEPHALOSPORINS—cont’d



Antibiotic: Fluoroquinolones USES

ACTION

Fluoroquinolones act against a wide range of gram-negative and gram-positive organisms. They are used primarily in the treatment of lower respiratory infections, skin/skin

structure infections, urinary tract infections, and sexually transmitted diseases.

Bactericidal. Inhibit DNA gyrase in susceptible microorganisms, interfering with bacterial DNA replication and repair.

ANTIBIOTIC: FLUOROQUINOLONES

Dosage Range

Side Effects, Comments

T: 100 mg, 250 mg, 500 mg, 750 mg S: 250 mg/5 mL, 500 mg/5 mL I: 200 mg, 400 mg T: 450 mg I: 300 mg

A (PO): 250–750 mg q12h (IV): 200–400 mg q12h

Levofloxacin (Levaquin)

T: 250 mg, 500 mg, 750 mg I: 250 mg, 500 mg, 750 mg OS: 250 mg/10 mL

A (PO/IV): 250–750 mg/day as single dose

Moxifloxacin (Avelox)

T: 400 mg I: 400 mg

A: 400 mg/day

Dizziness, headaches, anxiety, drowsiness, insomnia, abdominal pain, nausea, diarrhea, vomiting, phlebitis (parenteral) Good aerobic gram-negative activity. Considered most ­active against Pseudomonas aeruginosa (PsAg) Nausea, diarrhea, headache, elevation of transaminases, vomiting Best aerobic gram-positive activity, good aerobic gram-­ negative activity including fluoroquinolone susceptible PsAg Headache, insomnia, dizziness, rash, nausea, diarrhea, ­constipation Good aerobic gram-positive activity, good aerobic gram-­ negative activity including fluoroquinolone susceptible PsAg Headache, dizziness, insomnia, nausea, diarrhea Good aerobic gram-positive activity, less aerobic gram-­ negative activity including fluoroquinolone susceptible PsAg Has anaerobic coverage

A (PO): 450 mg q12h (IV): 300 mg q12h

A, Adults; I, injection; OS, oral solution; PO, oral; S, suspension; T, tablets.

CLASSIFICATIONS

Delafloxacin (Baxdela)

25C

Availability

Ciprofloxacin (Cipro)

Antibiotic: Fluoroquinolones

Name

26C

Antibiotic: Macrolides ACTION Bacteriostatic or bactericidal. Reversibly binds to the P site of the 50S ribosomal subunit of susceptible organisms, inhibiting RNA-dependent protein synthesis.

ANTIBIOTIC: MACROLIDES

Name

Availability

Dosage Range

Side Effects

Azithromycin (Zithromax)

T: 250 mg, 600 mg S: 100 mg/5 mL, 200 mg/5 mL, 1-g packet I: 500 mg T: 250 mg, 500 mg T (XL): 500 mg S: 125 mg/5 mL T: 200 mg, 250 mg, 333 mg, 400 mg, 500 mg C: 250 mg S: 100 mg/2.5 mL, 125 mg/5 mL, 200 mg/ 5 mL, 250 mg/5 mL, 400 mg/5 mL

A (PO): 500 mg once, then 250 mg once daily (IV): 500 mg/day C (PO/IV): 5–10 mg/kg once daily A: 250–500 mg ql2h (or XL 1,000 mg once daily) C: 7.5 mg/kg ql2h A (PO): 250–500 mg q6h (IV): 500 mg–1 g q6h C (PO): 7.5 mg/kg q6h (IV): 15–20 mg/kg/day in divided doses q6h

PO: Nausea, diarrhea, vomiting, abdominal pain IV: Pain, redness, swelling at injection site Headaches, loss of taste, nausea, vomiting, diarrhea, abdominal pain/ discomfort PO: Nausea, vomiting, diarrhea, abdominal pain IV: Inflammation, phlebitis at injection site

Clarithromycin (Biaxin) Erythromycin (EES, Eryc, EryPed, Ery-Tab, Erythrocin, PCE)

A, Adults; C, capsules; C (dosage), children; I, injection; S, suspension; T, tablets; XL, long-acting.

Antibiotic: Macrolides

USES Macrolides act primarily against most gram-positive micro­ organisms and some gram-negative cocci. Azithromycin and clarithromycin appear to be more potent than erythromycin. Macrolides are used in the treatment of pharyngitis/tonsillitis, sinusitis, chronic bronchitis, pneumonia, uncomplicated skin/skin structure infections.



Antibiotic: Penicillins USES

ACTION

Penicillins (also referred to as beta-lactam antibiotics) may be used to treat a large number of infections, including pneumonia and other respiratory diseases, urinary tract infections, septicemia, meningitis, intraabdominal infections, gonorrhea and syphilis, and bone/joint infection.

Penicillins inhibit cell wall synthesis or activate enzymes, which disrupt the bacterial cell wall, causing cell lysis and cell death. May be bacteriostatic or bactericidal. Most effective against bacteria undergoing active growth and division.

ANTIBIOTIC: PENICILLINS

Name

Dosage Range

Side Effects

I: 600,000 units, 1.2 million units, 2.4 million units

A: 1.2–2.4 million units as single dose C: 25,000–50,000 units/kg as single dose

Mild diarrhea, nausea, vomiting, headaches, sore mouth/tongue, vaginal itching/discharge, allergic reaction (including anaphylaxis, skin rash, urticaria, pruritus) Continued

CLASSIFICATIONS

Penicillin G benzathine (Bicillin, Bicillin LA)

27C

Availability

Natural

Antibiotic: Penicillins

Penicillins are classified based on an antimicrobial spectrum: Natural penicillins are very active against gram-positive cocci but ineffective against most strains of Staphylococcus aureus (inactivated by enzyme penicillinase).

Penicillinase-resistant penicillins are effective against penicillinase-producing Staphylococcus aureus but are less effective against gram-positive cocci than the natural penicillins. Broad-spectrum penicillins are effective against grampositive cocci and some gram-negative bacteria (e.g., Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Salmonella, and Shigella). Extended-spectrum penicillins are effective against gram-negative organisms, including Pseudomonas aeruginosa, Enterobacter, Proteus spp., Klebsiella, Serratia spp., and Acinetobacter spp.

Availability

Dosage Range

Side Effects

Penicillin G potassium (Pfizerpen)

I: 1, 2, 3, 5 million-unit vials

Rash, injection site reaction, phlebitis

Penicillin V potassium (Apo-Pen-VK)

T: 250 mg, 500 mg S: 125 mg/5 mL, 250 mg/5 mL

A: 2–4 million units q4h C: 100,000–400,000 units/kg/day divided q4–6h A: 250–500 mg q6–8h C: 25–50 mg/kg/day in divided doses q6–8h A: 125–500 mg q6h C: 25–50 mg/kg/day divided q6h A (IV): 500 mg–2 g q4–6h C (IV): 50–200 mg/kg/day in divided doses q4–6h A (IV): 1–2 g q4–6h C (IV): 25–50 mg/kg q6h

Abdominal pain, diarrhea, nausea

A: 250–500 mg q8h or 500–875 g q12h C: 20–90 mg/kg/day divided q8–12h

Diarrhea, colitis, nausea

Diarrhea, nausea, vomiting

Penicillinase-Resistant Dicloxacillin (Dynapen, Pathocil) Nafcillin (Unipen)

C: 125 mg, 250 mg, 500 mg S: 62.5 mg/5 mL I: 500 mg, 1 g, 2 g

Oxacillin (Bactocill)

C: 250 mg, 500 mg S: 250 mg/5 mL I: 250 mg, 500 mg, 1 g, 2 g

Inflammation, pain, phlebitis, increased risk of interstitial nephritis Diarrhea, nausea, vomiting, increased risk of hepatotoxicity, interstitial nephritis

Broad-Spectrum Amoxicillin (Amoxil, Trimox)

T: 125 mg, 250 mg, 500 mg, 875 mg C: 250 mg, 500 mg S: 200 mg/5 mL, 400 mg/5 mL, 125 mg/5 mL, 250 mg/5 mL

Antibiotic: Penicillins

Name

28C

ANTIBIOTIC: PENICILLINS—cont’d

Ampicillin (Principen)

Ampicillin/sulbactam (Unasyn)

T: 250 mg, 500 mg, 875 mg T (chewable): 125 mg, 200 mg, 250 mg, 400 mg S: 125 mg/5 mL, 200 mg/5 mL, 250 mg/5 mL, 400 mg/5 mL C: 250 mg, 500 mg S: 125 mg/5 mL, 250 mg/5 mL I: 125 mg, 250 mg, 500 mg, 1 g, 2 g I: 1.5 g, 3 g



Amoxicillin/ clavulanate (Augmentin)

A: 875 mg q12h or 250–500 mg q8h C: 25–90 mg/kg/day divided q 12h

Diarrhea, rash, nausea, vomiting

A (PO): 250–500 mg q6h (IV): 500 mg–2 g q6h C (PO): 12.5–50 mg/kg q6h (IV): 25–50 mg/kg q6h A: 1.5–3 g q6h C: 25–50 mg/kg q6h

Nausea, vomiting, diarrhea

A: 3.375 g q6h or 4.5 g q6–8h C: 240–300 mg/kg/day divided q8h

Diarrhea, insomnia, headache, fever, rash

Local pain at injection site, rash, diarrhea

Extended-Spectrum I: 2.25 g, 3.375 g, 4.5 g

Antibiotic: Penicillins

A, Adults; C, capsules; C (dosage), children; I, injection; PO, oral; S, suspension; T, tablets.

29C CLASSIFICATIONS

Piperacillin/tazobactam (Zosyn)

ACTION

Treatment and prevention of venous thromboembolism, acute MI, acute cerebral embolism; reduce risk of acute MI; reduction of total mortality in pts with unstable angina; prevent occlusion of saphenous grafts following open heart surgery; prevent embolism in select pts with atrial fibrillation, prosthetic heart valves, valvular heart disease, cardiomyopathy. Heparin also used for acute/ chronic consumption coagulopathies (disseminated intravascular coagulation).

Anticoagulants: Inhibit blood coagulation by preventing the formation of new clots and extension of existing ones but do not dissolve formed clots. Anticoagulants are subdivided. Heparin (including low molecular weight heparin): Indirectly interferes with blood coagulation by blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin. Coumarin: Acts indirectly to prevent synthesis in the liver of vitamin K–dependent clotting factors. Direct Thrombin Inhibitors: Inhibit thrombin from converting fibrinogen to fibrin. Factor Xa Inhibitors: Inhibits platelet activation and fibrin clot formation. Antiplatelets: Interfere with platelet aggregation. Effects are irreversible for life of platelet. Medications in this

group act by different mechanisms. Aspirin irreversibly inhibits cyclo-oxygenase and formation of thromboxane Az. Clopidogrel, dipyridamole, prasugrel, and ticlopidine have similar effects as aspirin and are known as adenosine diphosphate (ADP) inhibitors. Abciximab, eptifibatide, and tirofiban block binding of fibrinogen to the glycoprotein IIb/IIIa receptor on platelet surface (known as platelet glycoprotein IIb/ IIIa receptor antagonists). Thrombolytics: Act directly or indirectly on fibrinolytic system to dissolve clots (converting plasminogen to plasmin, an enzyme that digests fibrin clot).

ANTICOAGULANTS/ANTIPLATELETS/THROMBOLYTICS

Name

Availability

Uses

Side Effects

Prevent/treat VTE in pts with HIT or at risk for HIT undergoing PCI

Bleeding, hypotension, hematuria

Anticoagulants Direct Thrombin Inhibitors Argatroban

I: 100 mg/mL

30C Anticoagulants/Antiplatelets/Thrombolytics

Anticoagulants/Antiplatelets/Thrombolytics USES

I: 250-mg vials

Pts with unstable angina undergoing PTCA

Dabigatran (Pradaxa)

C: 75 mg, 110 mg, 150 mg

Desirudin (Iprivask)

I: 15 mg

Reduce risk for stroke/embolism with nonvalvular atrial fibrillation, prevent/treat DVT/PE, postoperative prophylaxis of DVT/ PE following hip replacement Prophylaxis of DVT following hip surgery

Bleeding, hypotension, pain, headache, nausea, back pain Bleeding, gastritis, dyspepsia

Heparin, Low Molecular Weight Heparins Dalteparin (Fragmin)

I: 2,500 units, 5,000 units, 7,500 units, 10,000 units

Prevent DVT following hip surgery, abdominal surgery, unstable angina or non–Q-wave MI

Enoxaparin (Lovenox)

I: 30 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg, 150 mg

Prevent DVT following hip surgery, knee surgery, ­abdominal surgery, unstable angina or non–Q-wave MI, acute illness

Heparin

I: 1,000 units/mL, 2,500 units/mL, 5,000 units/mL, 7,500 units/mL, 10,000 units/mL, 20,000 units/mL

Prevent/treat VTE

T: 2.5 mg, 5 mg

Reduce risk of stroke/embolism in nonvalvular atrial fibrillation. Prevent VTE post hip/knee replacement surgery, prevent/treat recurrence

Bleeding, hematoma, increased ALT, AST, pain at injection site, bruising, pruritus, fever, thrombocytopenia Bleeding, thrombocytopenia, hematoma, increased ALT, AST, nausea, bruising Injection site reactions, anemia, ­diarrhea, fever Bleeding, thrombocytopenia, skin rash, itching, burning Increased hepatic transaminase

Factor Xa Inhibitor Bleeding, nausea, anemia Confusion, increased AST, ALT

31C

Continued

CLASSIFICATIONS

Apixaban (Eliquis)

Anticoagulants/Antiplatelets/Thrombolytics

Bleeding, drainage from a wound, nausea, anemia, DVT, serious allergic reactions



Bivalirudin (Angiomax)

Name

Availability

Uses

Side Effects

Betrixaban (Bevyxxa)

C: 40 mg, 80 mg

Edoxaban (Savaysa)

T: 15 mg, 30 mg, 60 mg

Fondaparinux (Arixtra)

I: 2.5 mg, 5 mg, 7.5 mg, 10 mg

Prophylaxis of VTE in adults with acute medical illness at risk for thromboembolic complications due to restricted mobility, other VTE risk factors Prevent thromboembolism in nonvalvular atrial fibrillation, treat DVT/PT Prophylaxis of DVT following hip fracture, abdominal surgery, hip surgery, knee surgery, treat DVT/PE

Rivaroxaban (Xarelto)

T: 10 mg

Prevent DVT post knee, hip replacement Prevent thromboembolism in atrial fibrillation Prevent/treat DVT/PE

Bleeding, nausea, diarrhea, UTI, ­hypokalemia, hypertension, ­headache Bleeding, anemia, rash, abnormal liver function tests Bleeding, thrombocytopenia, hematoma, fever, nausea, anemia Increased AST, ALT; insomnia, ­dizziness, hypokalemia Bleeding, abdominal pain, fatigue, muscle spasms, anxiety, depression, UTI, increased AST, ALT

PO: 1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg, 10 mg I: 5 mg

Prevent/treat VTE in pts, prevent systemic embolism in pts with heart valve replacement, valve heart disease, Ml, atrial fibrillation

Bleeding, skin necrosis, anorexia, nausea, vomiting, diarrhea, rash, abdominal cramps, purple toe syndrome, drug interactions (see individual monograph)

Abciximab (ReoPro)

I: 2 mg/mL

Adjunct to PCI to prevent acute cardiac ischemic complications (with heparin and aspirin)

Aspirin

PO: 81 mg, 165 mg, 325 mg, 500 mg, 650 mg

TIA, acute Ml, chronic stable/unstable angina, revascularization procedures, prevent reinfarction and thromboembolism post Ml

Bleeding, hypotension, nausea, vomiting, back pain, allergic reactions, thrombocytopenia Tinnitus, dizziness, hypersensitivity, dyspepsia, minor bleeding, Gl ­ulceration

Coumarin Warfarin (Coumadin)

Antiplatelets

32C Anticoagulants/Antiplatelets/Thrombolytics

ANTICOAGULANTS/ANTIPLATELETS/THROMBOLYTICS—cont’d

Reduce risk of stroke, Ml, or vascular death in pts with recent Ml, noncardioembolic stroke, peripheral artery disease, reduce CV death, Ml, stroke, reinfarction in pts with non-STEMI/STEMI Adjunct to PCI to reduce risk of Ml, repeat coronary revascularization, stent thrombosis Treat acute coronary syndrome Reduce thrombotic cardiovascular events in pts with ACS to be managed with PCI (including stenting) Reduce thrombotic cardiovascular events in pts with ACS Treat acute coronary syndrome

Cangrelor (Kengreal)

I: 50 mg

Eptifibatide (Integrilin) Prasugrel (Effient)

I: 0.75 mg/mL, 2 mg/mL PO: 5 mg, 10 mg

Ticagrelor (Brilinta)

PO: 60 mg, 90 mg

Tirofiban (Aggrastat)

I: 50 mcg/mL, 250 mcg/mL

Vorapaxar (Zontivity)

T: 2.08 mg

Reduce thrombotic cardiovascular events (e.g., Ml, stroke) in pts with history of Ml or peripheral arterial disease

I: 50 mg, 100 mg I: 50 mg

Acute Ml, acute ischemic stroke, pulmonary embolism Acute Ml

Bleeding, rash, pruritus, bruising, epistaxis Bleeding Bleeding, hypotension Bleeding, hypotension Bleeding, dyspnea Bleeding, thrombocytopenia, bradycardia, pelvic pain Bleeding

Thrombolytics Alteplase (Activase) Tenecteplase (TNKase)

Bleeding, epistaxis Bleeding, hematuria

ACS, Acute coronary syndrome; DTV, deep vein thrombosis; HIT, heparin-induced thrombocytopenia; I, injection; MI, myocardial infarction; PCI, percutaneous coronary intervention; PO, oral; PTCA, percutaneous transluminal coronary angioplasty; STEMI, ST segment elevation MI; T, tablet; TIA, transient ischemic attack; VTE, venous thromboembolism.

Anticoagulants/Antiplatelets/Thrombolytics

PO: 75 mg



Clopidogrel (Plavix)

33C CLASSIFICATIONS

USES

ACTION

Anticonvulsants are used to treat seizures. Seizures can be divided into two broad categories: partial seizures and generalized seizures. Partial seizures begin locally in the cerebral cortex, undergoing limited spread. Simple partial seizures do not involve loss of consciousness but may evolve secondarily into generalized seizures. Complex partial seizures involve impairment of consciousness.

Generalized seizures may be convulsive or nonconvulsive and usually produce immediate loss of consciousness.

Anticonvulsants can prevent or reduce excessive discharge of neurons with seizure foci or decrease the spread of excitation from seizure foci to normal neurons. The exact mechanism is unknown but may be due to (1) suppressing sodium influx, (2) suppressing calcium influx, or (3) increasing the action of gamma-aminobutyric acid (GABA), which inhibits neurotransmitters throughout the brain.

ANTICONVULSANTS

Name

Availability

Uses

Dosage Range

Side Effects

Brivaracetam (Briviact)

I: 10 mg/mL S: 10 mg/mL T: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg S: 100 mg/5 mL T (chewable): 100 mg T: 200 mg T (ER): 100 mg, 200 mg, 400 mg C (ER): 100 mg, 200 mg, 300 mg I:10 mg/mL

Partial-onset ­seizure

A: Initially, 50 mg bid. (May decrease to 25 mg bid or increase to 100 mg bid)

Nausea, vomiting, dizziness, fatigue, angioedema, ­psychiatric symptoms

Complex partial, tonic-clonic, mixed seizures; trigeminal neuralgia

Note: Refer to monograph for IV dosage A: Initially, 400 mg/day in 2 divided doses. May increase up to 200 mg/day at wkly intervals up to 800–1,600 mg/day in 2–3 doses C: Initially, 200 mg/day in 2 divided doses. May increase by 100 mg/day at wkly intervals up to 400–800 mg/day in 3–4 doses

Dizziness, diplopia, ­leukopenia, drowsiness, blurred vision, headache, ataxia, nausea, vomiting, hyponatremia, rash, pruritus

Carbamazepine (Carbatrol, Carnexiv, Epitol, Tegretol, Tegretol XR)

34C Anticonvulsants

Anticonvulsants

A: Initially, not to exceed 1.5 mg in 3 divided doses. May increase q3days up to 2–8 mg/day in 1–2 divided doses

Ezogabine (Potiga)

T: 50 mg, 200 mg, 300 mg, 400 mg

Partial onset ­seizures

A: Initially, 100 mg 3 times/day. May increase at weekly intervals up to 150 mg/day. Usual dose: 200–400 mg 3 times/day

Fosphenytoin (Cerebyx)

I: 50 mg PE/mL

A: 15–20 mg PE/kg bolus, then 4–6 mg PE/kg/ day maintenance

Gabapentin (­Neurontin)

C: 100 mg, 300 mg, 400 mg S: 250 mg/5 mL

Status epilepticus, seizures occurring during neurosurgery Partial and generalized seizures

Lacosamide (Vimpat)

T: 50 mg, 100 mg, 150 mg, 200 mg S: 10 mg/mL I: 10 mg/mL

Adjunctive therapy, partial seizures

A: Monotherapy: Initially, 100 mg 2 times/day. May increase at wkly intervals by 50 mg 2 times/day. Maintenance: 150–200 mg 2 times/day Adjunctive: Initially, 50 mg 2 times/day. May increase by 50 mg 2 times/day. Maintenance: 100–200 mg 2 times/day

A: 300 mg 3 times/day. Usual dose: 900–1,800 mg/day in 3 doses

CNS depression, sedation, ataxia, confusion, depression, behavior disorders, ­respiratory depression Dizziness, somnolence, ­fatigue, confusion, vertigo, tremor, balance disorder, urinary retention Burning, itching, paresthesia, nystagmus, ataxia CNS depression, fatigue, drowsiness, dizziness, ataxia, nystagmus, blurred vision, confusion; may cause weight gain Diplopia, headache, dizziness, nausea

Continued

35C CLASSIFICATIONS

Petit mal, akinetic, myoclonic, absence seizures

Anticonvulsants

T: 0.5 mg, 1 mg, 2 mg



Clonazepam (Klonopin)

Name

Availability

Uses

Dosage Range

Side Effects

Lamotrigine (Lamictal)

T: 25 mg, 100 mg, 150 mg, 200 mg T (ER): 25 mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg T (ODT): 25 mg, 50 mg, 100 mg, 200 mg T (Chew): 5 mg, 25 mg T: 250 mg, 500 mg, 750 mg, 1,000 mg S: 100 mg/ml T(ER): 500 mg, 750 mg

Partial seizures, primary generalized tonic-clonic seizures, generalized seizures of LennoxGastaut syndrome

A: Refer to individual monograph

Dizziness, ataxia, drowsiness, diplopia, nausea, rash, headache, vomiting, insomnia, incoordination

Adjunctive therapy, partial seizures, primary tonic-clonic seizures, myoclonic seizures Partial seizures

A: T: Initially, 500 mg 2 times/day. May increase q2wks by 500mg/dose. Usual dose: 1,500 mg 2 times/day ER: Initially, 1,000 mg once daily. May increase q2wks by 1,000 mg/day up to 3,000 mg once daily

Dizziness, drowsiness, weakness, irritability, hallucinations, psychosis

A: T: 600 mg/day in 2 divided doses. May increase by 600 mg/day at wkly intervals up to 1,200 mg/day in 2 divided doses ER: 600 mg once daily. May increase by 600 mg/ day at wkly intervals up to 1,200–2,400 mg/day A, C (12 yrs or older): Initially, 2 mg daily at hs May increase by 2 mg/d at wkly intervals Usual dose: 8–12 mg qhs

Drowsiness, dizziness, headaches, diplopia, ataxia, nausea, vomiting, hyponatremia, skin reactions Weight gain, abnormal gait, dizziness, headache, somnolence, serious psychiatric reactions CNS depression, sedation, paradoxical excitement and hyperactivity, rash, hypotension

Levetiracetam (Keppra)

Oxcarbazepine (Trileptal)

T: 150 mg, 300 mg, 600 mg T(ER): 150 mg, 300 mg, 600 mg

Perampanel (­Fycompa)

S: 0.5 mg/ml T: 2 mg, 4 mg, 6 mg, 8 mg, 10 mg, 12 mg

Partial onset seizure, primary generalized tonic-clonic seizure

Phenobarbital

T: 30 mg, 60 mg, 100 mg I: 65 mg, 130 mg

Tonic-clonic, partial seizures; status epilepticus

A(P0): 100–300 mg/day (IM/IV): 200–600 mg C (PO): 3–5 mg/kg/day (IM/IV): 100–400 mg

36C Anticonvulsants

ANTICONVULSANTS—cont’d

Pregabalin (Lyrica)

C: 25 mg, 50 mg, 75 mg, 100 mg, 150 mg, 200 mg, 225 mg, 300 mg

Adjunctive therapy, partial seizures

Primidone (Mysoline)

T: 50 mg, 250 mg

Rufinamide (Banzel)

S: 40 mg/mL T: 200 mg, 400 mg

Complex partial, akinetic, tonic-clonic seizures Lennox-Gastaut syndrome (adjunct)

Tiagabine (Gabitril)

T: 4 mg, 12 mg, 16 mg, 20 mg

Partial seizures

A: Initially, 100 mg 3 times/day. May increase at 7–10 days intervals. Usual dose: 400 mg/day C: Initially, 5 mg/kg/day in 2–3 divided doses May increase at 7–10 day intervals. Usual dose: 4–8 mg/kg/day in 1–3 doses A: Initially, 150 mg/day (75 mg 2 times/day or 50 mg 3 times/day) up to 600 mg/day in 2 or 3 doses

A: 750–1250 mg/day in 3–4 doses C: 10–25 mg/kg/day A: Initially, 400–800 mg/day in 2 divided doses May increase by 400–800 mg/day every other day C: Initially, 10 mg/kg/day in 2 divided doses May increase by 10 mg/kg/day every other day up to 45 mg/kg/day Maximum: 3,200 mg/day A: Initially, 4 mg up to 56 mg/day in 2–4 doses May increase by 4–8 mg/day at wkly intervals C: Initially, 4 mg up to 32 mg/day in 2–4 doses. May increase by 4–8 mg/day at wkly intervals

Nystagmus, ataxia, hypertrichosis, gingival hyperplasia, rash, osteomalacia, lymphadenopathy Confusion, drowsiness, dizziness, ataxia, weight gain, dry mouth, blurred vision, peripheral edema, myopathy, angioedema, ­decreased platelet count CNS depression, sedation, paradoxical excitement and hyperactivity, rash, dizziness, ataxia Fatigue, dizziness, headache, nausea, drowsiness

Dizziness, asthenia, nervousness, anxiety, tremors, abdominal pain

37C

Continued

CLASSIFICATIONS

Tonic-clonic, psychomotor seizures

Anticonvulsants

C: 30 mg, 100 mg T (chewable): 50 mg S: 125 mg/5 mL I: 50 mg/mL



Phenytoin (Dilantin)

ANTICONVULSANTS—cont’d

Availability

Uses

Dosage Range

Side Effects

Topiramate (Topamax)

T: 25 mg, 100 mg, 200 mg C (Sprinkle): 15 mg, 25 mg C (ER 24HR Sprinkle): (Qudexy XR): 25 mg, 50 mg, 100 mg, 150 mg C XR (Trokendi XR): 25 mg, 50 mg, 100 mg, 200 mg C: 250 mg S: 250 mg/5 mL Sprinkles: 125 mg T: 125 mg, 250 mg, 500 mg T (ER): 500 mg I: 100 mg/mL T: 500 mg PS: 500 mg

Partial seizures, Lennox-Gastaut syndrome

See individual monograph

Drowsiness, dizziness, headache, ataxia, confusion, weight loss, ­diplopia

Complex partial, absence seizures

A, C: Initially, 15 mg/kg/day. May increase by 5–10 mg/kg/day at wkly intervals up to 60 mg/kg/day

Nausea, vomiting, tremors, thrombocytopenia, hair loss, hepatic dysfunction, weight gain, decreased platelet function

Infantile spasms, refractory complex partial seizures

Vision changes, eye pain, abdominal pain, agitation, confusion, mood/mental changes, abnormal coordination, weight gain

C: 100 mg

Partial seizures

A: Initially, 500 mg 2 times/day. May increase by 500 mg increments at wkly intervals up to 1,500 mg 2 times/day C: Initially, 250 mg 2 times/day. May increase by 500 mg/day at wkly intervals up to 1,000 mg 2 times/day A: Initially, 100 mg/day. May increase to 200 mg/day after 2 wks, then 300 mg/day up to 400 mg/day at 2 wk intervals

Valproic acid (Depakene, Depakote)

Vigabatrin (Sabril)

Zonisamide (Zonegran)

Drowsiness, dizziness, anorexia, diarrhea, weight loss, agitation, irritability, rash, nausea, cognitive side effects, kidney stones

A, Adults; C, capsules; C (dosage), children; ER, extended-release; I, injection; ODT, orally disintegrating tablets; PE, phenytoin equivalent; PO, oral; PS, powder sachet; S, suspension; T, tablets.

38C Anticonvulsants

Name



Antidepressants USES

ACTION

Used primarily for the treatment of depression. Depression can be a chronic or recurrent mental disorder presenting with symptoms such as depressed mood, loss of interest or pleasure, guilt feelings, disturbed sleep/­ appetite, low energy, and difficulty in thinking. Depression can also lead to suicide.

Antidepressants include tricyclics, monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and other antidepressants. Depression may be due to reduced functioning of monoamine neurotransmitters (e.g., norepinephrine, serotonin [5-HT], dopamine) in the CNS (decreased amount and/or decreased effects at the receptor sites). Antidepressants

block metabolism, increase amount/effects of monoamine neurotransmitters, and act at receptor sites (change responsiveness/sensitivities of both presynaptic and postsynaptic receptor sites).

ANTIDEPRESSANTS

Uses

Dosage Range (per day)

Side Effects

Amitriptyline (Elavil)

T: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg

Depression, neuropathic pain

Initially, 25–100 mg at bedtime or in divided doses. Usual dose: 100–300 mg/day

Desipramine (Norpramin)

T: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg

Depression, neuropathic pain

Initially, 25–100 mg at bedtime or in divided doses. Usual dose: 100–300 mg/day

Drowsiness, blurred vision, constipation, confusion, postural hypotension, cardiac conduction defects, weight gain, seizures, dry mouth Dizziness, drowsiness, fatigue, headache, anorexia, diarrhea, ­nausea

Tricyclics

Continued

39C

Availability

Antidepressants

Name

CLASSIFICATIONS

Name

Availability

Uses

Dosage Range (per day)

Side Effects

Imipramine (­Tofranil)

T: 10 mg, 25 mg, 50 mg C: 75 mg, 100 mg, 125 mg, 150 mg

Initially, 25–100 mg at bedtime or in divided doses. Usual dose: 100–300 mg/day

Dizziness, fatigue, headache, vomiting, xerostomia

Nortriptyline (­Aventyl, Pamelor)

C: 10 mg, 25 mg, 50 mg, 75 mg S: 10 mg/5 mL

Depression, enuresis, neuropathic pain, panic disorder, ADHD Depression, neuropathic pain, smoking cessation

Initially, 50–100 mg once daily. Usual dose: 50–150 mg once daily

Dizziness, fatigue, headache, anorexia, xerostomia

Class Side Effects: Restlessness, sleep disturbances, nausea, diarrhea, headache, fatigue, sexual dysfunction, weight gain; increased risk of bleeding; may prolong QT interval

Selective Serotonin Reuptake Inhibitors Citalopram (Celexa)

T: 10 mg, 20 mg, 40 mg ODT: 40 mg S: 10 mg/5 mL

Depression, OCD, panic disorder

20–40 mg

Escitalopram (­Lexapro) Fluoxetine (Prozac)

T: 5 mg, 10 mg, 20 mg S: 5 mg/5 mL C: 10 mg, 20 mg, 40 mg C (DR): 90 mg T: 10 mg, 20 mg S: 20 mg/5 mL

Depression, GAD

10–20 mg Initially, 10–20 mg once daily. Usual dose: 20 mg once daily DR: 90 mg once wkly

Paroxetine (Paxil)

T: 10 mg, 20 mg, 30 mg, 40 mg S: 10 mg/5 mL ER: 12.5 mg, 25 mg, 37.5 mg

Depression, OCD, bulimia, panic ­disorder, anorexia, bipolar disorder, premenstrual ­syndrome Depression, OCD, panic attack, SAD

Initially/usual dose: 20 mg once daily ER: Initially, 12.5–25 mg once daily. Usual dose: 25 mg once daily

40C Antidepressants

ANTIDEPRESSANTS—cont’d

Sertraline (Zoloft)

Depression, OCD, panic attack Depression

50–200 mg



Vortioxetine (­Trintellix)

T: 25 mg, 50 mg, 100 mg S: 20 mg/ml T: 5 mg, 10 mg, 15 mg, 20 mg

Initially, 10 mg once daily. Usual dose: 10–20 mg once daily

Serotonin-Norepinephrine Reuptake Inhibitors Desvenlafaxine (Pristiq)

T: 25 mg, 50 mg, 100 mg

Depression

50–100 mg

Duloxetine (­Cymbalta)

C: 20 mg, 30 mg, 60 mg

Venlafaxine (­Effexor)

T: 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg, 150 mg, 225 mg T(ER): 37.5 mg, 75 mg, 150 mg

Depression, ­fibromyalgia, ­neuropathic pain Depression, ­anxiety

Initially, 30–60 mg once daily. Usual dose: 60 mg once daily or 2 divided doses Initially, 25 mg 3 times or (ER): 37.5 mg once daily. Usual dose: 75 mg 3 times/day or (ER) 75–225 mg once daily

Initially, 0.5–1 mg/day. May increase at wkly interval to 1 mg/day Maximum: 3 mg/day Initially, 100 mg 2 times/day. Usual dose: 100 mg 3 times/day SR: Initially, 150 mg once daily. Usual dose: 150 mg 2 times/day

Class Side Effects: Similar to SSRIs. Additionally, sweating, tachycardia, urinary retention, increase in blood pressure

Other Depression

Bupropion (­Wellbutrin)

T: 75 mg, 100 mg SR: 100 mg, 150 mg, 200 mg

Depression, ­smoking cessation, ADHD, bipolar ­disorder

Weight gain, akathisia Insomnia, irritability, seizures

Continued

41C CLASSIFICATIONS

T: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg

Antidepressants

Brexpiprazole (­Rexulti)

Name

Availability

Uses

Dosage Range (per day)

Side Effects

Mirtazapine (­Remeron) Trazodone (Desyrel)

T: 7.5 mg, 15 mg, 30 mg, 45 mg T: 50 mg, 100 mg, 150 mg, 300 mg ER: 150 mg, 300 mg

Depression

Sedation, dry mouth, weight gain, agranulocytosis, hepatic toxicity Sedation, orthostatic hypotension, priapism

Vilazodone (Viibryd)

T: 10 mg, 20 mg, 40 mg

Depression

Initially, 15 mg once at bedtime. Usual dose: 30–45 mg once daily Initially, 75 mg 2 times/day or (ER): 150 mg once daily. Usual dose: 150 mg bid or (ER): 150–375 mg once daily Initially, 10 mg once daily. Usual dose: 40 mg once daily

Depression

Diarrhea, nausea, dizziness, dry mouth, insomnia, vomiting, ­decreased libido

ADHD, Attention-deficit hyperactivity disorder; C, capsules; DR, delayed-release; ER, extended-release; GAD, generalized anxiety disorder; OC, oral concentrate; OCD, obsessive-compulsive disorder; ODT, orally disintegrating tablets; S, suspension; SAD, social anxiety disorder; SR, sustained-release; T, tablets.

Antidiabetics USES Insulin: Treatment of insulin-dependent diabetes (type 1) and non–insulin-dependent diabetes (type 2). Also used in acute situations such as ketoacidosis, severe infections, major surgery in otherwise non–­insulin-dependent

diabetics. Administered to pts receiving parenteral nutrition. Drug of choice during pregnancy. All insulins, including long-acting insulins, can cause hypoglycemia and weight gain.

Alpha-glucosidase inhibitors: Adjunct to diet and exercise for management of type 2 diabetes mellitus. Biguanides: Adjunct to diet and exercise for management of type 2 diabetes mellitus.

42C Antidiabetics

ANTIDEPRESSANTS—cont’d



ACTION Dipeptidyl peptidase 4 inhibitors (DPP-4): Adjunct to diet and exercise for management of type 2 diabetes mellitus.

Sulfonylureas: Adjunct to diet and exercise for management of type 2 diabetes mellitus.

Insulin: A hormone synthesized and secreted by beta cells of Langerhans’ islet in the pancreas. Controls storage and utilization of glucose, amino acids, and fatty acids by activated transport systems/enzymes. Inhibits breakdown of glycogen, fat, protein. Insulin lowers blood glucose by inhibiting glycogenolysis and gluconeogenesis in liver; stimulates glucose uptake by muscle, adipose tissue. Activity of insulin is initiated by binding to cell surface receptors.

Thiazolidinediones: Adjunct to diet and exercise for management of type 2 diabetes mellitus.

Alpha-glucosidase inhibitors: Work locally in small intestine, slowing carbohydrate breakdown and glucose absorption.

Sodium-glucose co-transporter 2 (SGLT2): Adjunct to diet and exercise for management of type 2 diabetes mellitus.

Biguanides: Inhibit hepatic gluconeogenesis, glycogenolysis; enhance insulin sensitivity in muscle and fat.

Meglitinide: Adjunct to diet and exercise for management of type 2 diabetes mellitus.

DPP-4: Inhibit degradation of endogenous incretins, which increases insulin secretion, decreases glucagon secretion. Meglitinide: Stimulates pancreatic insulin secretion. Sulfonylureas: Stimulate release of insulin from beta cells of the pancreas. Thiazolidinediones: Enhance insulin sensitivity in muscle and fat. SGLT2: Blocks glucose reabsorption in proximal tubule in the kidney, increases urinary glucose excretion.

ANTIDIABETICS

Insulin Onset

Peak

Duration

Comments

Apidra, glulisine

10–15 min

1–1.5 hrs

3–5 hrs

Admelog, lispro

15–30 min

2 hrs

6–7 hrs

Refrigerate unopened vial. Do not freeze. Stable at room temperature for 28 days after opening Can mix with NPH Refrigerate unopened vial. Do not freeze. Stable at room temperature for 28 days after opening

43C

Continued

Antidiabetics

Type Rapid-Acting

CLASSIFICATIONS

Type

Onset

Peak

Duration

Comments

Humalog, lispro

15–30 min

0.5–2.5 hrs

6–8 hrs

Novolog, aspart

10–20 min

1–3 hrs

3–5 hrs

Fiasp, aspart

15–20 min

1.5–2.5 hrs

5–7 hrs

Refrigerate unopened vial. Do not freeze. Stable at room temperature for 28 days after opening Can mix with NPH Refrigerate unopened vial. Do not freeze. Stable at room temperature for 28 days after opening Can mix with NPH Refrigerate unopened vial. Do not freeze. Stable at room temperature for 28 days after opening

30–60 min

1–5 hrs

6–10 hrs

Refrigerate unopened vial. Do not freeze. Stable at room temperature for 28 days after opening Can mix with NPH

1–2 hrs

6–14 hrs

16–24 hrs

Refrigerate unopened vial. Do not freeze. Stable at room temperature for 31 days after opening (Pen 14 days) Can mix with aspart, lispro, glulisine

Basaglar, glargine

1–4 hrs

No significant peak

24 hrs

Lantus, glargine

1–4 hrs

No significant peak

24 hrs

Do NOT mix with other insulins Refrigerate unopened vial. Do not freeze. Stable at room temperature for 28 days after opening Do NOT mix with other insulins Refrigerate unopened vial. Do not freeze. Stable at room temperature for 28 days after opening

Short-Acting Humulin R, Novolin R, regular

Intermediate-Acting Humulin N, Novolin N, NPH

Long-Acting

44C Antidiabetics

ANTIDIABETICS—cont’d

0.8–2 hrs

No significant peak

12–24 hrs (dose ­dependent)

Toujeo, glargine

1–6 hrs

No significant peak

Longer than 24 hrs

Tresiba, degludec

0.5–1.5 hrs

12 hrs

42 hrs

Do NOT mix with other insulins Refrigerate unopened vial. Do not freeze. Stable at room temperature for 42 days after opening Do NOT mix with other insulins Refrigerate unopened vial. Do not freeze. Stable at room temperature for 42 days after opening Do NOT mix with other insulins Refrigerate unopened vial. Do not freeze. Stable at room temperature for 56 days after opening



Levemir, detemir

Oral Agents Availability

Dosage Range

Side Effects

Glimepiride (Amaryl)

T: 1 mg, 2 mg, 4 mg

Glipizide (Glucotrol)

T: 5 mg, 10 mg T (XL): 5 mg T: 1.25 mg, 2.5 mg, 5 mg PT: 1.5 mg, 3 mg

Initially, 1–2 mg/day. May increase by 1–2 mg q1–2 wks. Maximum: 8 mg/day T: Initially, 5 mg/day. May increase by 2.5–5 mg q3–4 days. (XL): Initially, 5 mg/day. Maximum: 20 mg/day T: Initially, 2.5–5 mg/day. May increase by 2.5 mg/day at wkly intervals up to 20 mg/day PT: Initially, 1.5–3 mg/day. May increase by 1.5 mg at wkly intervals up to 12 mg/day

Hypoglycemia, dizziness, headache, nausea, flu-like syndrome Dizziness, nervousness, anxiety, diarrhea, tremor Dizziness, headache, nausea

Continued

45C CLASSIFICATIONS

Glyburide (DiaBeta, Micronase)

Antidiabetics

Name Sulfonylureas

Name Availability Alpha-Glucosidase Inhibitors

Dosage Range

Side Effects Flatulence, diarrhea, abdominal pain, increased risk of hypoglycemia when used with insulin or sulfonylureas Flatulence, diarrhea, abdominal pain, rash

Acarbose (Precose)

T: 25 mg, 50 mg, 100 mg

Initially, 25 mg 3 times/day. May increase at 4–8 wk intervals. Usual dose: 50–100 mg 3 times/day

Miglitol (Glyset)

T: 25 mg, 50 mg, 100 mg

Initially, 25 mg 3 times/day. May increase at 4–8 wk intervals to 50 mg 3 times/day, then 100 mg 3 times/ day

Dipeptidyl Peptidase Inhibitors 6.25–25 mg/day

Linagliptin (Tradjenta) Saxagliptin (Onglyza)

T: 6.25 mg, 12.5 mg, 25 mg T: 5 mg T: 2.5 mg, 5 mg

Sitagliptin (Januvia)

T: 25 mg, 50 mg, 100 mg

25–100 mg/day

T: 500 mg, 850 mg, 1,000 mg XR: 500 mg, 750 mg, 1,000 mg

T: Initially, 500 mg 2 times/day or 850 mg once daily. May increase by 500 mg/day at wkly intervals up to 2,550 mg/day XR: Initially, 500–1,000 mg/day. May increase by 500 mg/day at wkly intervals up to 2,500 mg/day

Alogliptin (Nesina)

5 mg/day 2.5–5 mg/day

Nasopharyngitis, cough, headache, upper respiratory tract infections Arthralgia, back pain, headache Upper respiratory tract infection, urinary tract infection, headache Nasopharyngitis, upper respiratory infection, headaches, modest weight gain, increased incidence of hypoglycemia when added to a sulfonylurea

Biguanides Metformin (Glucophage)

Nausea, vomiting, diarrhea, loss of appetite, metallic taste, lactic acidosis (rare but potentially fatal complication)

46C Antidiabetics

ANTIDIABETICS—cont’d



Glucagon-Like Peptide-1 (GLP-1) Albiglutide (Tanzeum)

I: 30 mg, 50 mg

30–50 mg once wkly

Exenatide (Byetta)

I: 5 mcg, 10 mcg

5–10 mcg 2 times/day

Exenatide extended-release (Bydureon) Liraglutide (Victoza)

I: 2 mg

2 mg once wkly

I: 0.6 mg, 1.2 mg, 1.8 mg (6 mg/mL) I: 50 mcg/mL, 100 mcg/mL

Initially, 0.6 mg/day. May increase at weekly intervals up to 1.2 mg/day, then 1.8 mg/day 20 mcg SC once daily

I: 2 mg/1.5 mL delivers 0.25 mg, 0.5 mg or 1 mg per injection

Initially, 0.25 mg once wkly for 4 wks, then 0.5 mg for at least 4 wks up to maximum of 1 mg once wkly.

Nateglinide (Starlix)

T: 60 mg, 120 mg

60–120 mg 3 times/day

Repaglinide (Prandin)

T: 0.5 mg, 1 mg, 2 mg

0.5–1 mg with each meal. Usual dose: 0.5–4 mg/day (Maximum: 16 mg/day)

Lixisenatide (Adlyxin) Semaglutide (Ozempic)

Diarrhea, nausea, upper respiratory tract infection, injection site reaction Diarrhea, dizziness, dyspnea, headaches, nausea, vomiting Diarrhea, nausea, headache Headache, nausea, diarrhea Nausea, vomiting, headache, dizziness Increased amylase, lipase, nausea, diarrhea, vomiting, abdominal pain, constipation, dyspepsia

Meglitinides

Continued

Antidiabetics

Hypoglycemia, upper respiratory infection, dizziness, back pain, flu-like syndrome Headache, hypoglycemia, upper respiratory infection

47C CLASSIFICATIONS

Name SGLT2

Availability

Dosage Range

Side Effects

Canagliflozin (Invokana)

T: 100 mg, 300 mg

100–300 mg/day before first meal of day

Dapagliflozin (Farxiga)

T: 5 mg, 10 mg

5–10 mg/day in morning

Empagliflozin (Jardiance)

T: 10 mg, 25 mg

10–25 mg/day in morning

Ertugliflozin (Steglatro)

T: 5 mg, 15 mg

Initially, 5 mg once daily in morning. Maximum: 15 mg once daily

Genital mycotic infections, recurrent urinary tract infections, increased urinary frequency, hypotension, increased serum creatinine, LDL, Hgb, Hct. Hyperkalemia, hypermagnesemia, hyperphosphatemia, fractures Genital mycotic infections, recurrent urinary tract infections, increased urinary frequency, hypotension, increased serum creatinine, LDL, Hgb, Hct. Hyperphosphatemia, fractures Genital mycotic infections, recurrent urinary tract infections, increased urinary frequency, hypotension, increased serum creatinine, LDL, Hgb, Hct Genital candidiasis, headache, back pain, urinary frequency, ­vulvovaginal pruritus, ­nasopharyngitis

48C Antidiabetics

ANTIDIABETICS—cont’d



Thiazolidinediones Pioglitazone (Actos)

T: 15 mg, 30 mg, 45 mg

15–30 mg/day

Rosiglitazone (Avandia)

T: 2 mg, 4 mg, 8 mg

Initially, 4 mg/day. May increase at 8–12 wks to 8 mg/day as a single or 2 divided doses

Bromocriptine (Cycloset)

T: 0.8 mg

1.6–4.8 mg/day

Colesevelam (Welchol)

T: 625 mg S: 1.875 g, 3.75 g packet I: 1,500 mcg/1.5 mL, 2,700 mcg/2.7 mL

3.75 g/day

Mild to moderate peripheral edema, weight gain, increased risk of HF, associated with reduced bone mineral density and increased incidence of fractures Increased cholesterol, weight gain, back pain, upper respiratory tract infection

Miscellaneous

Type 1: 15–60 mcg immediately prior to meals Type 2: 60–120 mcg immediately prior to meals

Antidiabetics

HF, Heart failure; I, injection; PT, prestab; S, suspension; T, tablets; XL, extended-release; XR, extended-release.

Abdominal pain, anorexia, headaches, nausea, vomiting, severe hypoglycemia may occur when used in combination with insulin (reduction in dosages of shortacting, including premixed, insulins recommended)

49C CLASSIFICATIONS

Pramlintide (Symlin)

Nausea, fatigue, dizziness, vomiting Constipation, dyspepsia, nausea

USES

ACTION

Acute diarrhea, chronic diarrhea of inflammatory bowel disease, reduction of fluid from ileostomies.

Systemic agents: Act as smooth muscle receptors (enteric) disrupting peristaltic movements, decreasing GI motility, increasing transit time of intestinal contents.

Local agents: Adsorb toxic substances and fluids to large surface areas of particles in the preparation. Some of these agents coat and protect irritated intestinal walls. May have local anti-inflammatory action.

ANTIDIARRHEALS

Name

Availability

Type

Dosage Range

Bismuth (Pepto-Bismol)

T: 262 mg C: 262 mg L: 130 mg/15 mL, 262 mg/15 mL, 524 mg/15 mL T: 2.5 mg L: 2.5 mg/5 mL C: 2 mg T: 2 mg L: 1 mg/5 mL, 1 mg/mL

Local

A: 2 T or 30 mL C (9–12 yrs): 1 T or 15 mL C (6–8 yrs): 2/3 T or 10 mL C (3–5 yrs): 1/3 T or 5 mL A: 5 mg 4 times/day C: 0.3–0.4 mg/kg/day in 4 divided doses (L) A: Initially, 4 mg (Maximum: 16 mg/day) C (9–12 yrs): 2 mg 3 times/day C (6–8 yrs): 2 mg 2 times/day C (2–5 yrs): 1 mg 3 times/day (L)

Diphenoxylate with atropine (Lomotil) Loperamide (Imodium)

A, Adults; C, capsules; C (dosage), children; L, liquid; S, suspension; T, tablets.

Systemic Systemic

50C Antidiarrheals

Antidiarrheals



Antifungals: Systemic Mycoses Systemic mycoses are subdivided into opportunistic infections (candidiasis, aspergillosis, cryptococcosis, and mucormycosis) that are seen primarily in debilitated or immunocompromised hosts and nonopportunistic infections (blastomycosis, histoplasmosis, and coccidioidomycosis) that occur in any host. Treatment can be difficult because these infections often resist treatment and may require prolonged therapy.

ANTIFUNGALS: SYSTEMIC MYCOSES

Indications

Side Effects

Amphotericin B

Potentially life-threatening fungal infections, including aspergillosis, blastomycosis, coccidioidomycosis, cryptococcosis, histoplasmosis, systemic candidiasis

Amphotericin B lipid complex (Abelcet) Amphotericin B liposomal (AmBisome)

Invasive fungal infections

Fever, chills, headache, nausea, vomiting, nephrotoxicity, hypokalemia, hypomagnesemia, hypotension, dyspnea, arrhythmias, abdominal pain, diarrhea, increased hepatic function tests Chills, fever, hypotension, headache, nausea, vomiting

Candidemia, esophageal candidiasis

Diarrhea, hypokalemia, increased hepatic function tests, headache

Hypotension, tachycardia, chills, fever, vomiting

Continued

51C

Peripheral edema, tachycardia, hypotension, chills, insomnia, headache

CLASSIFICATIONS

Amphotericin colloidal dispersion (Amphotec) Anidulafungin (Eraxis)

Empiric therapy for presumed fungal infections in febrile neutropenic pts, treatment of cryptococcal meningitis in HIV-infected pts, treatment of Aspergillus, Candida, Cryptococcus infections, treatment of visceral leishmaniasis Invasive Aspergillus

Antifungals: Systemic Mycoses

Name

Indications

Side Effects

Caspofungin (Cancidas)

Candidemia, invasive aspergillosis, empiric therapy for presumed fungal infections in febrile neutropenic pts Treatment of vaginal candidiasis; oropharyngeal, esophageal candidiasis; and cryptococcal meningitis. Prophylaxis to decrease incidence of candidiasis in pts undergoing bone marrow transplant receiving cytotoxic chemotherapy and/or radiation Treatment of invasive aspergillosis, invasive mucormycosis

Headache, nausea, vomiting, diarrhea, increased hepatic function tests Nausea, vomiting, abdominal pain, diarrhea, dysgeusia, increased hepatic function tests, liver necrosis, hepatitis, cholestasis, headache, rash, pruritus, eosinophilia, alopecia Nausea, vomiting, diarrhea, increased hepatic enzymes, hypokalemia, constipation, dyspnea, cough, peripheral edema, back pain Congestive heart failure, peripheral edema, nausea, vomiting, abdominal pain, diarrhea, increased hepatic function tests, liver necrosis, hepatitis, cholestasis, headache, rash, pruritus, eosinophilia Nausea, vomiting, abdominal pain, diarrhea, gynecomastia, increased LFTs, liver necrosis, hepatitis, cholestasis, headache, rash, pruritus, eosinophilia Fever, chills, hypokalemia, hypomagnesemia, hypocalcemia, myelosuppression, thrombocytopenia, nausea, vomiting, abdominal pain, diarrhea, increased LFTs, dizziness, headache, rash, pruritus, pain or inflammation at injection site, fever Fever, headaches, nausea, vomiting, diarrhea, abdominal pain, hypokalemia, cough, dyspnea

Fluconazole (Diflucan)

Isavuconazonium (Cresemba) Itraconazole (Sporanox)

Ketoconazole (Nizoral)

Blastomycosis, histoplasmosis, aspergillosis, onychomycosis, empiric therapy of febrile neutropenic pts with suspected fungal infections, treatment of oropharyngeal and esophageal candidiasis Candidiasis, chronic mucocutaneous candidiasis, oral thrush, candiduria, blastomycosis, coccidioidomycosis

Micafungin (Mycamine)

Esophageal candidiasis, Candida infections, prophylaxis in pts undergoing hematopoietin stem cell transplantation

Posaconazole (Noxafil)

Prevent invasive aspergillosis and Candida infections in pts 13 yrs and older who are immunocompromised, treatment of oropharyngeal candidiasis Invasive aspergillosis, candidemia, esophageal candidiasis, serious fungal infections

Voriconazole (Vfend)

Visual disturbances, nausea, vomiting, abdominal pain, diarrhea, increased LFTs, liver necrosis, hepatitis, cholestasis, headache, rash, pruritus, eosinophilia

Antifungals: Systemic Mycoses

Name

52C

ANTIFUNGALS: SYSTEMIC MYCOSES—cont’d



Antiglaucoma Agents USES

ACTION

Reduction of elevated intraocular pressure (IOP) in pts with open-angle glaucoma and ocular hypertension.

Medications decrease IOP by two primary mechanisms: decreasing aqueous humor (AH) production or increasing AH outflow. • Alpha2 agonists: Activate receptors in ciliary body, inhibiting aqueous secretion and increasing uveoscleral aqueous outflow. • Beta blockers: Reduce production of aqueous ­humor.

• Carbonic anhydrase inhibitors: Decrease production of AH by inhibiting enzyme carbonic anhydrase.

• Prostaglandins: Increase outflow of aqueous fluid through uveoscleral route. • R ho Kinase Inhibitors: Inhibits the norepinephrine transporter. Decreases resistance in the trabecular meshwork outflow pathway, decreases aqueous humor production and increases outflow of aqueous humor.

Name

Availability

Dosage Range

Side Effects

Apraclonidine (lopidine)

S: 0.5%, 1%

1 drop tid

Brimonidine (Alphagan HP)

S: 0.1%, 0.15%, 0.2%

1 drop tid

Fatigue, somnolence, local allergic reaction, dry eyes, stinging Same as apraclonidine

Alpha2 Agonists

Antiglaucoma Agents

ANTIGLAUCOMA AGENTS

Continued

53C CLASSIFICATIONS

Name

Availability

Dosage Range

Side Effects

Bimatoprost (Lumigan)

S: 0.01%

1 drop daily in evening

Latanoprost (Xalatan) Latanoprostene bunod (Vyzulta)

S: 0.005% S: 0.0024%

1 drop daily in evening 1 drop every evening

Tafluprost (Zioptan) Travoprost (Travatan)

S: 0.0015% S: 0.004%

1 drop daily in evening 1 drop daily in evening

Conjunctival hyperemia; darkening of iris, eyelids; increase in length, thickness, and number of eyelashes; local irritation; itching; dryness; blurred vision See bimatoprost Conjunctival hyperemia, eye irritation, eye pain, iris pigmentation See bimatoprost See bimatoprost

Betaxolol (Betoptic, Betoptic-S)

Suspension (Betoptic-S): 0.25% S (Betoptic): 0.5%

Fatigue, dizziness, bradycardia, respiratory depression, mask symptoms of hypoglycemia, block effects of beta agonists in treatment of asthma

Carteolol (Ocupress) Levobunolol (Betagan) Metipranolol (OptiPranolol) Timolol (Betimol, Istalol, Timoptic, Timoptic XE)

S: 1% S: 0.25%, 0.5% S: 0.3% S: 0.25%, 0.5% G, Timoptic XE: 0.25%, 0.5%

Betoptic-S: 1 drop 2 times/day Betoptic: 1–2 drops 2 times/day 1 drop 2 times/day 1 drop 1–2 times/day 1 drop 2 times/day S: 1 drop 2 times/day (Istalol): 1 drop daily G: 1 drop daily

Bitter taste, stinging, redness, burning, conjunctivitis, dry eyes, blurred vision Same as brinzolamide

54C

ANTIGLAUCOMA AGENTS—cont’d

Prostaglandins

Same as betaxolol Same as betaxolol Same as betaxolol Same as betaxolol

Carbonic Anhydrase Inhibitors Brinzolamide (Azopt)

Suspension: 1%

1 drop 3 times/day

Dorzolamide (Trusopt)

S: 2%

1 drop 3 times/day

Antiglaucoma Agents

Beta Blockers



Rho Kinase Inhibitors Netarsudil (Rhopressa)

S: 0.02%

1 drop every evening

Conjunctival hyperemia, corneal verticillata, instillation site pain, conjunctival hemorrhage, blurred vision, increased lacrimation, reduced visual acuity

0.2%/0.5% 1%/0.2% 0.5%/2%

1 drop bid 1 drop tid 1 drop bid

See individual agents See individual agents See individual agents

Combinations Brimonidine/timolol (Combigan) Brinzolamide/brimonidine (Simbrinza) Timolol/dorzolamide (Cosopt)

C, Capsules; G, gel; O, ointment; S, solution; T, tablets.

Antihistamines Antihistamines (H1 antagonists) inhibit vasoconstrictor effects and vasodilator effects on endothelial cells of histamine. They block increased capillary permeability, formation of edema/wheal caused by histamine. Many antihistamines can bind to receptors in CNS, causing

primarily depression (decreased alertness, slowed reaction times, drowsiness) but also stimulation (restlessness, nervousness, inability to sleep). Some may counter motion sickness.

55C CLASSIFICATIONS

ACTION

Symptomatic relief of upper respiratory allergic disorders. Allergic reactions associated with other drugs respond to antihistamines, as do blood transfusion reactions. Used as a second-choice drug in treatment of angioneurotic edema. Effective in treatment of acute urticaria and other dermatologic conditions. May also be used for preop sedation, Parkinson’s disease, and motion sickness.

Antihistamines

USES

Name

Availability

Dosage Range

Side Effects

Cetirizine (Zyrtec)

T: 5 mg, 10 mg C: 5 mg, 10 mg T (chew): 5 mg/10 mg S: 5 mg/5 mL T: 5 mg ODT: 2.5 mg, 5 mg S: 0.5 mg/mL

A: 5–10 mg/day C (6–12 yrs): 5–10 mg/day C (2–5 yrs): 2.5–5 mg/day

Headache, somnolence, fatigue, abdominal pain, dry mouth

A, C (12 yrs and older): 5 mg/day C (6–11 yrs): 2.5 mg/day C (1–5 yrs): 1.25 mg/day C (6–11 mos): 1 mg/day A: 50–100 mg q4–6h C: 12.5–50 mg q6–8h A: 25–50 mg q6–8h C (6–11 yrs): 12.5–25 mg q4–6h C (2–5 yrs): 6.25 mg q4–6h A: 60 mg q12h or 180 mg/day C (2–11 yrs): 30 mg q12h (6–23 mos): 15 mg bid A: 25 mg q6–8h C: 2 mg/kg/day in divided doses q6–8h A, C (12 yrs and older): 5 mg once daily in evening C (6–11 yrs): 2.5 mg once daily in evening (6 mos–5 yrs): 1.25 mg once daily

Dizziness, fatigue, headache, nausea

Desloratadine (Clarinex)

Dimenhydrinate (Dramamine) Diphenhydramine (Benadryl) Fexofenadine (Allegra) Hydroxyzine (Atarax) Levocetirizine (Xyzal)

T: 50 mg T (chew): 25 mg, 50 mg T: 25 mg, 50 mg C: 25 mg, 50 mg L: 12.5 mg/5 mL T: 30 mg, 60 mg, 180 mg ODT: 30 mg S: 30 mg/5 mL T: 10 mg, 25 mg, 50 mg C: 25 mg, 50 mg, 100 mg S: 10 mg/5 mL T: 5 mg S: 2.5 mg/mL

Dizziness, drowsiness, headache, nausea Chills, confusion, dizziness, fatigue, headache, sedation, nausea Headache, vomiting, fatigue, diarrhea Dizziness, drowsiness, fatigue, headache Fatigue, fever, somnolence, vomiting

56C Antihistamines

ANTIHISTAMINES

Promethazine (Phenergan)

ODT: 10 mg T(chew): 5 mg T: 10 mg S: 1 mg/mL T: 12.5 mg, 25 mg, 50 mg S: 6.25 mg/5 mL

A: 10 mg/day C (6–12 yrs): 10 mg/day (2–5 yrs): 5 mg/day

Fatigue, headache, malaise, somnolence, abdominal pain

A: 25 mg at bedtime or 12.5 mg q8h C: 0.5 mg/kg at bedtime or 0.1 mg/kg q6–8h

Confusion, dizziness, drowsiness, fatigue, constipation, nausea, vomiting



Loratadine (Claritin)

A, Adults; C, capsules; C (dosage), children; L, liquid; ODT, orally disintegrating tablet; S, syrup; SR, sustained-release; T, tablets.

Antihyperlipidemics Bile acid sequestrants: Bind bile acids in the intestine; prevent active transport and reabsorption and enhance bile acid excretion. Depletion of hepatic bile acid results in the increased conversion of cholesterol to bile acids. HMG-CoA reductase inhibitors (statins): Inhibit HMG-CoA reductase, the last regulated step in the synthesis of cholesterol. Cholesterol synthesis in the liver is reduced. Niacin (nicotinic acid): Reduces hepatic synthesis of triglycerides and secretion of very low density lipoprotein (VLDL) by inhibiting the mobilization of free fatty acids from peripheral tissues.

Cholesterol absorption inhibitor: Acts in the gut wall to prevent cholesterol absorption through the intestinal villi. Omega fatty acids: Exact mechanism unknown. Mechanisms may include inhibition of acyl-CoA, decreased lipogenesis in liver, increased lipoprotein lipase activity. PCSK9 inhibitors: Binds with high-affinity and specificity to LDL cholesterol receptors, promoting their degradation.

57C

Fibric acid: Increases the oxidation of fatty acids in the liver, resulting in reduced secretion of triglyceride-rich lipoproteins,

and increases lipoprotein lipase activity and fatty acid uptake.

CLASSIFICATIONS

ACTION

Cholesterol management.

Antihyperlipidemics

USES

Name Bile Acid Sequestrants

Primary Effect

Dosage

Comments/Side Effects

Cholestyramine (Prevalite, Questran)

Decreases LDL Increases HDL, TG

4 g 1–2 times/day. May increase over 1 mo interval. Usual dose: 8–16 g/day in 2 divided doses

Class Side Effects: Constipation, heartburn, nausea, eructation, and bloating May increase triglyceride levels. Avoid use with triglyceride levels greater than 300 mg/dL

Colesevelam (Welchol)

Decreases LDL Increases HDL, TG Decreases LDL Increases TG

3.75 g once daily or 1.875 g 2 times/day

Colestipol (Colestid)

G: Initially, 5 g once or twice daily. May increase by 5 g/day q1–2 mos. Maintenance: 5–30 g/day. T: Initially, 2 g once or twice daily. May increase by 2 g 2 times/day at 1–2 mo intervals. Maintenance: 2–16 g/day

Cholesterol Absorption Inhibitor Ezetimibe (Zetia)

Decreases LDL Increases HDL Decreases TG

10 mg once daily

Administer at least 2 hrs before or 4 hrs after bile acid sequestrants Side Effects: Dizziness, headache, fatigue, diarrhea, abdominal pain, arthralgia, sinusitis, pharyngitis

Decreases TG Decreases LDL Increases HDL

Antara: 43–130 mg/day Lofibra: 67–200 mg/day Tricor: 48–145 mg/day Triglide: 50–160 mg/day Fenoglide: 40–120 mg/day Lipofen: 50–150 mg/day

May increase levels of ezetimibe. Concomitant use of statins may increase rhabdomyolysis, elevate CPK levels, and cause myoglobinuria Side Effects: Abdominal pain, constipation, diarrhea, respiratory complaints, headache, fever, flu-like syndrome, asthenia

Fibric Acid Derivatives Fenofibrate (Antara, Lofibra, Tricor, Triglide)

58C Antihyperlipidemics

ANTIHYPERLIPIDEMICS

Decreases TG, LDL Increases HDL

Trilipix: 45–135 mg/day Fibricor: 35–105 mg/day

May give without regard to meals. Concomitant use of statins may increase rhabdomyolysis Side Effects: Headache, upper respiratory tract infection, pain, nausea, dizziness, nasopharyngitis Give 30 min before breakfast and dinner. Concomitant use of statins may increase rhabdomyolysis, elevate CPK levels, and cause myoglobinuria Side Effects: Fatigue, vertigo, headache, rash, eczema, diarrhea, abdominal pain, nausea, vomiting, constipation

Gemfibrozil (Lopid)

Decreases TG Increases HDL

600 mg 2 times/day

Decreases LDL,TG Increases HDL

Regular-release (Niacor): 1 g tid Extended-release (Niaspan): 1 g at bedtime

Diabetics may experience a dose-related elevation in glucose Side Effects: Increased LFT, hyperglycemia, dyspepsia, itching, flushing, dizziness, insomnia

Atorvastatin (Lipitor)

Decreases LDL,TG Increases HDL

Initially, 10–20 mg/day Range: 10–80 mg/day

Fluvastatin (Lescol)

Decreases LDL,TG Increases HDL

40–80 mg/day

May interact with CYP3A4 inhibitors (e.g., amiodarone, diltiazem, cyclosporine, grapefruit juice) increasing risk of myopathy Side Effects: Myalgia, myopathy, rhabdomyolysis, headache, chest pain, peripheral edema, dizziness, rash, abdominal pain, constipation, diarrhea, dyspepsia, nausea, flatulence, increased LFT, back pain, sinusitis Primarily metabolized by CYP2C9 enzyme system. May increase levels of phenytoin, rifampin. May lower fluvastatin levels. Side Effects: Headache, fatigue, dyspepsia, diarrhea, nausea, abdominal pain, myalgia, myopathy, rhabdomyolysis



Fenofibric acid (Fibricor, Trilipix)

Niacin Niacin, nicotinic acid (Niacor, Niaspan)

Statins

Antihyperlipidemics 59C

Continued

CLASSIFICATIONS

Name

Primary Effect

Dosage

Comments/Side Effects

Lovastatin (Mevacor)

Decreases LDL, TG Increases HDL

Initially, 20 mg/day. Adjust at 4 wk intervals. Maximum: 80 mg/day

May interact with CYP3A4 inhibitors (e.g., amiodarone, diltiazem, cyclosporine, grapefruit products) increasing risk of myopathy Side Effects: Increased CPK levels, headache, dizziness, rash, constipation, diarrhea, abdominal pain, dyspepsia, nausea, flatulence, myalgia, myopathy, rhabdomyolysis

Pitavastatin (Livalo)

Decreases LDL, TG Increases HDL

Initially, 2 mg/day. May increase at 4 wk intervals to 4 mg/day

Pravastatin (Pravachol)

Decreases LDL, TG Increases HDL

Initially, 40 mg/day. Titrate to response Range: 10–80 mg/day

Rosuvastatin (Crestor)

Decreases LDL, TG Increases HDL

Initially, 10–20 mg/day. Titrate to response Range: 5–40 mg/day

Erythromycin, rifampin may increase concentration Side Effects: Myalgia, back pain, diarrhea, constipation, pain in extremities May be less likely to be involved in drug interactions Cyclosporine may increase pravastatin levels Side Effects: Chest pain, headache, dizziness, rash, nausea, vomiting, diarrhea, increased LFTs, cough, flu-like symptoms, myalgia, myopathy, rhabdomyolysis May be less likely to be involved in drug interactions Cyclosporine may increase rosuvastatin levels Side Effects: Chest pain, peripheral edema, headache, rash, dizziness, vertigo, pharyngitis, diarrhea, nausea, constipation, abdominal pain, dyspepsia, sinusitis, flu-like symptoms, myalgia, myopathy, rhabdomyolysis

60C Antihyperlipidemics

ANTIHYPERLIPIDEMICS—cont’d

5–40 mg/day

May interact with CYP3A4 inhibitors (e.g., amiodarone, diltiazem, cyclosporine, grapefruit products) increasing risk of myopathy Side Effects: Constipation, flatulence, dyspepsia, increased LFTs, increased CPK, upper respiratory tract infection

Decreases TG Decreases TG Increases LDL, HDL

2 g 2 times/day 2 g 2 times/day or 4 g once daily

Side Effects: Arthralgia Use with caution with fish or shellfish allergy Side Effects: Eructation, dyspepsia, taste perversion

Alirocumab (Praluent)

Decreases LDL

SQ: 75 mg q2wks

Evolcumab (Repatha)

Decreases LDL

SQ: 140 mg q2wks or 420 mg qmo

Side Effects: Hypersensitivity reactions (e.g., rash), nasopharyngitis, injection site reactions, influenza Side Effects: Nasopharyngitis, upper respiratory tract infection, influenza, back pain, injection site reactions



Decreases LDL,TG Increases HDL

Simvastatin (Zocor)

Omega Fatty Acids Icosapent (Vascepa) Lovaza

PCSK9 Inhibitors

Antihyperlipidemics 61C CLASSIFICATIONS

CPK, Creatine phosphokinase; G, granules; HDL, high-density lipoprotein; LDL, low-density lipoprotein; SQ, subcutaneous; T, tablets; TG, triglycerides.

USES

ACTION

Treatment of mild to severe hypertension.

Many groups of medications are used in the treatment of hypertension. ACE inhibitors: Decrease conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, reducing peripheral vascular resistance and B/P. Alpha agonists (central action): Stimulate alpha2adrenergic receptors in the cardiovascular centers of the CNS, reducing sympathetic outflow and producing an antihypertensive effect.

Beta blockers: Decrease B/P by inhibiting beta1 adrenergic receptors, which lowers heart rate, heart workload, and the heart’s output of blood. Calcium channel blockers: Reduce B/P by inhibiting flow of extracellular calcium across cell membranes of vascular tissue, relaxing arterial smooth muscle. Diuretics: Inhibit sodium (Na) reabsorption, increasing excretion of Na and water. Reduce plasma, extracellular fluid volume, and peripheral vascular resistance.

Alpha antagonists (peripheral action): Block alpha1 adrenergic receptors in arterioles and veins, inhibiting vasoconstriction and decreasing peripheral vascular resistance, causing a fall in B/P.

Renin inhibitors: Directly inhibit renin, decreasing plasma renin activity (PRA), inhibiting conversion of angiotensinogen to angiotensin, producing antihypertensive effect.

Angiotensin receptor blockers: Block vasoconstrictor effects of angiotensin II by blocking the binding of angiotensin II to AT1 receptors in vascular smooth muscle, helping blood vessels to relax and reduce B/P.

Vasodilators: Directly relax arteriolar smooth muscle, decreasing vascular resistance. Exact mechanism unknown.

62C Antihypertensives

Antihypertensives

ANTIHYPERTENSIVES



Name

Availability

Dosage Range

Side Effects

Benazepril (Lotensin)

T: 5 mg, 10 mg, 20 mg, 40 mg

Postural dizziness, headache, cough

Captopril Enalapril (Vasotec)

T: 12.5 mg, 25 mg, 50 mg, 100 mg T: 2.5 mg, 5 mg, 10 mg, 20 mg

20–80 mg/day as single or 2 divided doses 50–100 mg 2 times/day 5–40 mg/day in 1–2 divided doses

Fosinopril Lisinopril (Prinivil, Zestril)

T: 10 mg, 20 mg, 40 mg T: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg T: 5 mg, 10 mg, 20 mg, 40 mg

10–80 mg once daily or divided bid 10–40 mg once daily

T or C: 1.25 mg, 2.5 mg, 5 mg, 10 mg

2.5–20 mg once daily or divided bid

(ACE) Inhibitors

Quinapril Ramipril (Altace)

10–80 mg once daily or divided bid

Rash, cough, hyperkalemia Hypotension, chest pain, syncope, headache, dizziness, fatigue Dizziness, cough, hyperkalemia Hypotension, headache, fatigue, dizziness, hyperkalemia, cough Hypotension, dizziness, fatigue, headache, myalgia, hyperkalemia Cough, hypotension, angina, headache, dizziness, hyperkalemia

Clonidine (Catapres)

T: 0.1 mg, 0.2 mg, 0.3 mg P: 0.1 mg/hr, 0.2 mg/hr, 0.3 mg/hr

Sedation, dry mouth, heart block, rebound hypertension, contact dermatitis with patch, bradycardia, drowsiness Dizziness, vertigo, headaches Dizziness, light-headedness, headaches, drowsiness, palpitations, fluid retention Dizziness, headaches, asthenia (loss of strength, energy)

Alpha Agonists: Peripheral Action T: 1 mg, 2 mg, 4 mg, 8 mg C: 1 mg, 2 mg, 5 mg

PO: 2–16 mg/day PO: 6–20 mg/day

Terazosin (Hytrin)

C: 1 mg, 2 mg, 5 mg, 10 mg

PO: 1–20 mg/day

Continued

CLASSIFICATIONS

Doxazosin (Cardura) Prazosin (Minipress)

63C

PO: 0.1–0.8 mg divided bid or tid Topical: 0.1–0.6 mg/wk

Antihypertensives

Alpha Agonists: Central Action

Name

Availability

Dosage Range

Side Effects Diarrhea, hypotension, nausea, cough Hypotension, dizziness, headache, hyperkalemia Headache, cough, dizziness Fatigue, diarrhea, cough Chest pain, fatigue, hypoglycemia, weakness, cough, hypotension Dizziness, headache, diarrhea, flu-like ­symptoms Dizziness, fatigue, increased BUN

Angiotensin Receptor Blockers Azilsartan (Edarbi) Candesartan (Atacand) Eprosartan (Teveten) Irbesartan (Avapro) Losartan (Cozaar)

T: 40 mg, 80 mg T: 4 mg, 8 mg, 16 mg, 32 mg T: 400 mg, 600 mg T: 75 mg, 150 mg, 300 mg T: 25 mg, 50 mg, 100 mg

Olmesartan (Benicar)

T: 5 mg, 20 mg, 40 mg

40–80 mg once daily 8–32 mg once daily or divided bid 600 mg once daily 150–300 mg once daily 25–100 mg once daily or divided bid 20–40 mg once daily

Valsartan (Diovan)

T: 80 mg, 160 mg, 320 mg

80–320 mg once daily

Atenolol (Tenormin)

T: 25 mg, 50 mg, 100 mg

50–100 mg once daily

Bisoprolol (Zebeta)

T: 5 mg, 10 mg

5–20 mg once daily

Carvedilol (Coreg, Coreg CR)

T: 3.125 mg, 6.25 mg, 12.5 mg, 25 mg CR: 10 mg, 20 mg, 40 mg, 80 mg T: 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg T: 25 mg, 50 mg, 100 mg, 200 mg T: 2.5 mg, 5 mg, 10 mg, 20 mg

T: 12.5–50 mg divided bid CR: 20–80 mg once daily 100–450 mg bid or tid

Beta Blockers

Metoprolol (Lopressor) Metoprolol XL (Toprol XL) Nebivolol (Bystolic)

25–400 mg once daily 5–40 mg once daily

Fatigue, bradycardia, reduced exercise tolerance, increased triglycerides, bronchospasm, sexual dysfunction, masked hypoglycemia Fatigue, insomnia, diarrhea, arthralgia, upper respiratory infections Orthostatic hypotension, fatigue, dizziness Hypotension, bradycardia, fatigue, 1st degree heart block, dizziness Same as metoprolol Upper respiratory tract infection, dizziness, fatigue

64C Antihypertensives

ANTIHYPERTENSIVES—cont’d



Calcium Channel Blockers Amlodipine (Norvasc)

T: 2.5 mg, 5 mg, 10 mg

2.5–10 mg once daily

Diltiazem CD (Cardizem CD)

C: 120 mg, 180 mg, 240 mg, 300 mg

240–360 mg once daily

Felodipine (Plendil)

T: 2.5 mg, 5 mg, 10 mg

2.5–10 mg once daily

Nifedipine XL (Adalat CC, Procardia XL) Verapamil SR (Calan SR)

T: 30 mg, 60 mg, 90 mg

30–90 mg once daily

T: 120 mg, 180 mg, 240 mg T (Sustained-Release): 120 mg, 180 mg

T (Immediate-Release): 80–160 mg tid T (Sustained-Release): 240–480 mg once daily or divided bid

T: 25 mg, 50 mg T: 25 mg, 50 mg

12.5–25 mg/day 12.5–50 mg/day

Headache, fatigue, peripheral edema, flushing, worsening heart failure, rash, gingival ­hyperplasia, tachycardia Dizziness, headache, bradycardia, heart block, worsening heart failure, edema, constipation Headache, flushing, peripheral edema, rash, gingival hyperplasia, tachycardia Flushing, peripheral edema, headache, ­dizziness, nausea Headache, gingival hyperplasia, constipation

Diuretics Same as hydrochlorothiazide Hypokalemia, hyperuricemia, hypomagnesemia, hyperglycemia Pancreatitis, rash, photosensitivity, hyponatremia, hypercalcemia, hypercholesterolemia, hypertriglyceridemia Continued

Antihypertensives 65C

CLASSIFICATIONS

Chlorthalidone (Hygroton) Hydrochlorothiazide (Hydrodiuril)

Name

Availability

Dosage Range

Side Effects

T: 150 mg, 300 mg

PO: 150–300 mg/day

Diarrhea, dyspepsia, headache, dizziness, fatigue, upper respiratory tract infection

Hydralazine (Apresoline)

T: 10 mg, 25 mg, 50 mg, 100 mg

PO: 40–300 mg/day

Minoxidil (Loniten)

T: 2.5 mg, 10 mg

PO: 10–40 mg/day

Headaches, palpitations, aggravation of angina, dizziness, fluid retention, nasal congestion Rapid/irregular heartbeat, hypertrichosis, peripheral edema, aggravation of angina, fluid retention

66C

ANTIHYPERTENSIVES—cont’d

Renin Inhibitor

Vasodilators

C, Capsules; P, patch; T, tablets.

Antimigraine (Triptans) USES

ACTION

Treatment of migraine headaches with or without aura in adults 18 yrs and older.

Triptans are selective agonists of the serotonin (5-HT) receptor in cranial arteries, which cause vasoconstriction and reduce inflammation associated with antidromic neuronal transmission correlating with relief of migraine headache.

Antimigraine (Triptans)

Aliskiren (Tekturna)



TRIPTANS

Availability

Dosage Range

Contraindications

Common Side Effects

Almotriptan (Axert)

T: 6.25 mg, 12.5 mg

6.25–12.5 mg; may repeat after 2 hrs (Maximum: 25 mg/day)

Drowsiness, dizziness, paresthesia, nausea, vomiting, headache, xerostomia

Eletriptan (Relpax)

T: 20 mg, 40 mg

A: 20–40 mg; may repeat after 2 hrs (Maximum: 80 mg/day)

Ischemic heart disease, angina pectoris, arrhythmias, previous Ml, uncontrolled hypertension, hemiplegic or basilar migraine, peripheral vascular disease Same as almotriptan

Frovatriptan (Frova)

T: 2.5 mg

2.5 mg; may repeat after 2 hrs; no more than 3 T/day (Maximum: 7.5 mg/day)

Same as almotriptan

Naratriptan (Amerge)

T: 1 mg, 2.5 mg

Rizatriptan (Maxalt, Maxalt-MLT)

T: 5 mg, 10 mg DT: 5 mg, 10 mg

1–2.5 mg; may repeat once after 4 hrs (Maximum: 5 mg/day) 5 or 10 mg; may repeat after 2 hrs (Maximum: 30 mg/day)

Same as almotriptan plus severe renal/hepatic disease Same as almotriptan

Chest pain, dizziness, drowsiness, headache, paresthesia, nausea, xerostomia, weakness Hot/cold sensations, dizziness, fatigue, headaches, skeletal pain, dyspepsia, flushing, paresthesia, drowsiness, xerostomia, nausea Neck pain, pain, nausea, fatigue Chest pain, drowsiness, xerostomia, weakness, paresthesia, nausea, dizziness, drowsiness, fatigue Continued

Antimigraine (Triptans)

Name

67C CLASSIFICATIONS

Availability

Dosage Range

Contraindications

Common Side Effects

Sumatriptan (Imitrex, Sumavel DosePro, Onzetra, Xsail, Zecuity)

T: 25 mg, 50 mg, 100 mg NS: 5 mg, 10 mg, 20 mg I: 4 mg, 6 mg NP: 8 pouches of 2 nose pieces each 11 mg/piece

PO: 25–100 mg; may repeat after 2 hrs (Maximum: 200 mg/day) NS: 5–20 mg; may repeat after 2 hrs (Maximum: 40 mg/day) SQ: 3–6 mg; may repeat after 1 hr (Maximum: 12 mg/day) NP: 22 mg; may repeat after 2 hrs (Maximum: 44 mg/day)

Same as almotriptan plus severe hepatic dysfunction

Zolmitriptan (Zomig, Zomig-ZMT)

T: 2.5 mg, 5 mg DT: 2.5 mg, 5 mg NS: 2.5 mg/0.1 mL, 5 mg/0.1 mL

PO: 2.5–5 mg; may repeat after 2 hrs (Maximum: 10 mg/day) NS: 1 spray (2.5 or 5 mg) at onset of migraine headache; may repeat after 2 hrs (Maximum: 10 mg/day)

Same as almotriptan plus symptomatic Wolff-Parkinson-White syndrome

Oral: Hot/cold flashes, paresthesia, malaise, fatigue Injection: Atypical sensations, flushing, chest pain/discomfort, injection site reaction, dizziness, vertigo, paresthesia, bleeding, bruising, swelling, ­erythema at injection site Nasal: Discomfort, nausea, vomiting, altered taste Transdermal: Localized pain, skin discoloration, allergic contact dermatitis, pruritus, local irritation Atypical sensations, pain, nausea, dizziness, asthenia, drowsiness

A, Adults; DT, disintegrating tablets; I, injection; NP, nasal powder; NS, nasal spray; SQ, subcutaneous; T, tablets.

Antimigraine (Triptans)

Name

68C

TRIPTANS—cont’d



Antipsychotics USES

ACTION

SIDE EFFECTS (Please refer to individual monographs)

Antipsychotics are primarily used in managing schizophrenia. They may also be used in treatment of bipolar disorder, schizoaffective disorder, and irritability associated with autism. The goals in treating schizophrenia include targeting symptoms, preventing relapse, and increasing adaptive functioning. Use of antipsychotic medications is the mainstay of schizophrenia management.

The precise mechanism of action of antipsychotic medications is unknown, but they have been categorized into two groups:

Typical versus atypical: Typical antipsychotics are associated with a greater risk of extrapyramidal side effects, and atypicals are associated with a greater risk of weight gain.

Typical (traditional): Associated with high dopamine antagonism and low serotonin antagonism.

Endocrine: Hyperprolactinemia, weight gain, increased risk of diabetes. Cardiovascular: Orthostatic hypotension, electrocardiographic changes. Lipids: Increased triglycerides, cholesterol. Central nervous system: Dystonic reactions, akathisia, pseudo-parkinsonism, tardive dyskinesia, sedation, risk of seizures.

Antipsychotics 69C

CLASSIFICATIONS

Atypical: Those having moderate to high dopamine antagonism and high serotonin antagonism and those having low dopamine antagonism and high serotonin antagonism.

Name

Uses

Dosage (Oral)

Fluphenazine Haloperidol (Haldol) Thioridazine Thiothixene (Navane)

Adult psychosis Adult and child psychosis Adult, adolescent, child schizophrenia and psychosis Adult and adolescent schizophrenia

1–5 mg/day 1–15 mg/day 200–800 mg/day Moderate: 15 mg/day Severe: 20–30 mg/day

70C Antipsychotics

TYPICAL ANTIPSYCHOTICS

ATYPICAL ANTIPSYCHOTICS

Name

Uses

Dosage

Aripiprazole (Abilify)

Adult and adolescent schizophrenia; adult and child bipolar 1 disorder; adult major depressive disorder; irritability with adolescent autism Adult schizophrenia; adult major depressive disorder Adult schizophrenia, bipolar I disorder (manic or mixed episodes) Schizophrenia; suicidal behavior in adult schizophrenia and schizoaffective disorder Adult schizophrenia Adult schizophrenia, bipolar I disorder (manic or mixed episodes) Adult, adolescent, and child schizophrenia; adult, adolescent mania in bipolar I disorder Adult and adolescent schizophrenia; adult schizoaffective disorder Adult and adolescent schizophrenia; adult, adolescent, and child bipolar I disorder Adult and adolescent schizophrenia; adult, adolescent, and child bipolar I disorder; irritability with adolescent and child autism Adult schizophrenia; manic or mixed episodes associated with adult bipolar I disorder

10–15 mg/day

Brexpiprazole (Rexulti) Cariprazine (Vraylar) Clozapine (Clozaril) lloperidone (Fanapt) Lurasidone (Latuda) Olanzapine (Zyprexa) Paliperidone (Invega) Quetiapine (Seroquel) Risperidone (Risperdal) Ziprasidone (Geodon)

2–4 mg/day 1.5–6 mg/day 300–450 mg/day 12–24 mg/day 40–160 mg/day 10–20 mg/day 3–12 mg/day 400–800 mg/day 4–8 mg/day 40–160 mg/day



Antivirals USES

ACTION

Treatment of HIV infection. Treatment of cytomegalovirus (CMV) retinitis in pts with AIDS, acute herpes zoster (shingles), genital herpes (recurrent), mucosal and cutaneous herpes simplex virus (HSV), chickenpox, and influenza A viral illness.

Effective antivirals must inhibit virus-specific nucleic acid/protein synthesis. Possible mechanisms of action of antivirals used for non-HIV infection may include interference with viral DNA synthesis and viral replication,

inactivation of viral DNA polymerases, incorporation and termination of the growing viral DNA chain, prevention of release of viral nucleic acid into the host cell, or interference with viral penetration into cells.

ANTIVIRALS

Availability

Uses

Side Effects

Abacavir (Ziagen)

HIV infection

Acyclovir (Zovirax)

T: 300 mg OS: 20 mg/mL T: 400 mg, 800 mg C: 200 mg I: 50 mg/mL

Nausea, vomiting, loss of appetite, diarrhea, headaches, fatigue, hypersensitivity reactions Malaise, anorexia, nausea, vomiting, light-headedness

Adefovir (Hepsera)

T: 10 mg

Amantadine (Symmetrel)

T: 100 mg C: 100 mg S: 50 mg/5 mL I: 75 mg/mL

Influenza A CMV retinitis

Asthenia, headaches, abdominal pain, nausea, diarrhea, flatulence, dyspepsia Anxiety, dizziness, headaches, nausea, loss of appetite

71C

Decreased urination, fever, chills, diarrhea, nausea, vomiting, headaches, loss of appetite Continued

CLASSIFICATIONS

Cidofovir (Vistide)

Mucosal/cutaneous HSV-1 and HSV2, varicella-zoster (shingles), genital herpes, herpes simplex, encephalitis, chickenpox Chronic hepatitis B

Antivirals

Name

Name

Availability

Uses

Side Effects

Darunavir (Prezista)

T: 75 mg, 150 mg, 400 mg, 600 mg, 800 mg T: 100 mg, 200 mg C: 125 mg, 200 mg, 250 mg, 400 mg Powder for suspension: 2 g, 4 g C: 50 mg, 200 mg T: 600 mg T: 25 mg, 100 mg, 200 mg T: 125 mg, 250 mg, 500 mg

HIV infection

Diarrhea, nausea, vomiting, headaches, skin rash, constipation Diarrhea, fatigue, rash, headaches, nausea Peripheral neuropathy, anxiety, headaches, rash, nausea, diarrhea, dry mouth

Delavirdine (Rescriptor) Didanosine (Videx)

Efavirenz (Sustiva) Etravirine (Intelence)

HIV infection HIV infection

HIV infection HIV infection

Diarrhea, dizziness, headaches, insomnia, nausea, vomiting, drowsiness Rash, nausea, abdominal pain, vomiting

Foscarnet (Foscavir)

I: 24 mg/mL

Herpes zoster, genital herpes, herpes labialis, mucosal/cutaneous herpes simplex CMV retinitis, HSV infections

Ganciclovir (Cytovene) Indinavir (Crixivan)

I: 500 mg C: 200 mg, 400 mg

CMV retinitis, CMV disease HIV infection

Lamivudine (Epivir)

T: 100 mg, 150 mg, 300 mg OS: 5 mg/mL, 10 mg/mL T: 100 mg/25 mg, 200 mg/50 mg OS: 80 mg/20 mg per mL

HIV infection, chronic hepatitis B

Decreased urination, abdominal pain, nausea, vomiting, dizziness, fatigue, headaches Sore throat, fever, unusual bleeding/bruising Blood in urine, weakness, nausea, vomiting, diarrhea, headaches, insomnia, altered taste Nausea, vomiting, abdominal pain, paresthesia

HIV infection

Diarrhea, nausea

Famciclovir (Famvir)

Lopinavir/ritonavir (Kaletra)

Headaches, nausea

72C Antivirals

ANTIVIRALS—cont’d

T: 150 mg, 300 mg

HIV infection

Nelfinavir (Viracept) Oseltamivir (Tamiflu)

T: 250 mg, 625 mg C: 30 mg, 45 mg, 75 mg S: 6 mg/mL T: 400 mg T (chew): 25 mg, 100 mg Aerosol: 6 g OS: 40 mg/mL T: 200 mg, 400 mg, 600 mg C: 100 mg T: 100 mg OS: 80 mg/mL C: 200 mg T: 500 mg C: 15 mg, 20 mg, 30 mg, 40 mg OS: 1 mg/mL

HIV infection Influenza A or B

Cough, pyrexia, upper respiratory tract infection, rash, musculoskeletal symptoms, abdominal pain, dizziness Diarrhea Diarrhea, nausea, vomiting

HIV infection

Nausea, headache, diarrhea, pyrexia

Lowers respiratory infections in infants, children due to respiratory syncytial virus (RSV), chronic hepatitis C HIV infection

Anemia

HIV infection

Weakness, diarrhea, nausea, oral ulcers, abdominal pain Paresthesia, decreased appetite, chills, fever, rash

Ribavirin (Virazole)

Ritonavir (Norvir) Saquinavir (Invirase) Stavudine (Zerit)

HIV infection

Weakness, diarrhea, nausea, decreased appetite, vomiting, altered taste

Antivirals

Continued

73C CLASSIFICATIONS

Raltegravir (Isentress)



Maraviroc (Selzentry)

Name

Availability

Uses

Side Effects

Tenofovir (Viread)

T: 150 mg, 200 mg, 250 mg, 300 mg Powder (oral): 40 mg/g T: 500 mg, 1 g

HIV infection

Diarrhea, nausea, pharyngitis, headaches

Herpes zoster, genital herpes, herpes labialis, chickenpox CMV retinitis

Headaches, nausea

Valacyclovir (Valtrex) Valganciclovir (Valcyte) Zanamivir (Relenza) Zidovudine (Retrovir)

T: 450 mg OS: 50 mg/mL Inhalation: 5 mg C: 100 mg S: 50 mg/5 mL I: 10 mg/mL

Influenza A and B HIV infection

C, Capsules; I, injection; OS, oral solution; S, syrup; T, tablets.

Anemia, abdominal pain, diarrhea, headaches, nausea, vomiting, paresthesia Cough, diarrhea, dizziness, headaches, nausea, vomiting Fatigue, fever, chills, headaches, nausea, muscle pain

74C Antivirals

ANTIVIRALS—cont’d



Beta-Adrenergic Blockers USES

ACTION

Management of hypertension, angina pectoris, arrhythmias, hypertrophic subaortic stenosis, migraine headaches, MI (prevention), glaucoma.

Beta-adrenergic blockers competitively block beta adrenergic receptors, located primarily in myocardium, and beta2-adrenergic receptors, located primarily in bronchial and vascular smooth muscle. By occupying beta-receptor sites, these agents prevent naturally occurring or administered epinephrine/norepinephrine from exerting their effects. The results are basically opposite to those of sympathetic stimulation.

BETA-ADRENERGIC BLOCKERS

Availability

Indication

Dosage Range

Frequent or Severe Side Effects

Acebutolol (Sectral)

C: 200 mg, 400 mg

HTN, ventricular arrhythmia

HTN: Initially, 400 mg once daily or 2 divided doses. Usual dose: 200–1200 mg once/d or divided bid Arrhythmia: Initially, 200 mg 2 times/day. Gradually increase to 300–600 mg 2 times/ day

CLASS: Fatigue, depression, bradycardia, decreased exercise tolerance, erectile dysfunction, heart failure, may aggravate hypoglycemia, increase incidence of diabetes, insomnia, increase triglycerides, decrease cholesterol. Sudden withdrawal may exacerbate angina and myocardial infarction. Continued

75C

Name

Beta-Adrenergic Blockers

Effects of beta1 blockade include slowing heart rate, decreasing cardiac output and contractility; effects of beta2

blockade include bronchoconstriction, increased airway resistance in pts with asthma or COPD. Beta blockers can affect cardiac rhythm/automaticity (decrease sinus rate, SA/AV conduction; increase refractory period in AV node); decrease systolic and diastolic B/P; exact mechanism unknown but may block peripheral receptors, decrease sympathetic outflow from CNS, or decrease renin release from kidney. All beta blockers mask tachycardia that occurs with hypoglycemia. When applied to the eye, reduce intraocular pressure and aqueous production.

CLASSIFICATIONS

76C

BETA-ADRENERGIC BLOCKERS—cont’d T: 25 mg, 50 mg, 100 mg

HTN, angina, Ml

Bisoprolol (Zebeta)

T: 5 mg, 10 mg

HTN

Carvedilol (Coreg)

T: 3.125 mg, 6.25 mg, 12.5 mg, 25 mg C (SR): 10 mg, 20 mg, 40 mg, 80 mg

HF, LVD after Ml, HTN

Labetalol (Trandate)

T: 100 mg, 200 mg, 300 mg

HTN

Angina: Initially, 50 mg once daily. May increase to 100 mg once daily after one wk HTN: Initially, 50 mg once daily. May increase to 100 mg once daily after 2 wks Ml: 50 mg bid or 100 mg once daily Initially, 5 mg once daily. May increase to 10 mg/day, then 20 mg/day. Usual dose: 5–10 mg/day Immediate-Release HF: Initially, 3.25 mg 2 times/day. May increase at 2-wk intervals to 6.25 mg 2 times/day, then 12.5 mg 2 times/ day, then 25 mg 2 times/day LVD after Ml: Initially, 6.25 mg 2 times/day. May increase q3–10 days to 12.5 mg 2 times/ day, then 25 mg 2 times/day HTN: Initially, 6.25 mg 2 times/day. May increase q7–14 days to 12.5 mg 2 times/day, then 25 mg 2 times/day Extended-Release HF: 10–80 mg once daily LVD after Ml: 10–80 mg once daily HTN: 20–80 mg once daily Initially, 100 mg 2 times/day. May increase q2–3 days in 100 mg 2 times/day increments. Usual dose: 200–1,200 mg 2 times/day

Beta-Adrenergic Blockers

Atenolol (Tenormin)

Dosage Range

HTN, angina, HF, Ml

Nadolol (Corgard) Nebivolol (Bystolic) Pindolol (Visken)

T: 20 mg, 40 mg, 80 mg T: 2.5 mg, 5 mg, 10 mg, 20 mg T: 5 mg, 10 mg

HTN, angina

IR: Angina: Initially, 50 mg 2 times/day. May increase up to 400 mg/day HTN: Initially, 100 mg once daily. May increase at weekly intervals up to 450 mg/ divided bid or tid Post-MI: 100 mg bid SR: Angina: 100–400 mg once daily HF: 12.5–200 mg once daily HTN: 25–400 mg once daily Angina, HTN: Initially, 40 mg once/day. Usual dose: 40–320 mg once daily Initially, 5 mg once daily. May increase at 2-wk intervals up to 40 mg once daily Initially, 5 mg 2 times/day. May increase to 10–40 mg/day. Maximum: 60 mg/day divided bid

HTN HTN

Frequent or Severe Side Effects

Continued

77C CLASSIFICATIONS

Indication

T (IR): 50 mg, 100 mg T (SR): 25 mg, 50 mg

Beta-Adrenergic Blockers

Availability

Metoprolol (Lopressor [IR], Toprol XL [SR])



Name

78C

BETA-ADRENERGIC BLOCKERS—cont’d T (IR): 10 mg, 20 mg, 40 mg, 60 mg, 80 mg C (SR): 60 mg, 80 mg, 120 mg, 160 mg S: 4 mg/mL, 8 mg/mL I: 1 mg/mL

HTN, angina, Ml, arrhythmias, migraine, essential tremor, hypertrophic subaortic stenosis

IR: Angina: 80–320 mg/day in 2–4 divided doses Arrhythmias: 10–30 mg 3–4 times/day HTN: 40 mg bid up to 240 mg/day in 2–3 divided doses Hypertrophic subaortic stenosis: 20–40 mg 3–4 times/day Post-MI: 180–240 mg/day in 2–4 divided doses Migraine: Initially, 80 mg/day. May increase gradually up to 240 mg/day in divided doses Tremor: Initially, 40 mg 2 times/day. Usual dose: 120–320 mg/day SR: Angina: Initially, 80 mg once daily. May increase q3–7days up to 320 mg/day HTN: 80–120 mg once daily at bedtime Migraine: Initially, 80 mg once daily Gradually increase up to 240 mg once daily Hypertrophic subaortic stenosis: 80–160 mg once daily

C, Capsules; HF, heart failure; HTN, hypertension; I, injection; LVD, left ventricular dysfunction; S, solution; SR, sustained-release; T, tablets.

Beta-Adrenergic Blockers

Propranolol (Inderal)



Asthma/COPD ACTION

Asthma: Chronic lung disorder marked by recurring episodes of airway obstruction (e.g., labored breathing with wheezing and coughing) and feeling of chest constriction. Asthma is triggered by hyper-reactivity to various stimuli (e.g., allergens, rapid change in air temperature). The obstruction is usually reversible with air flow good between attacks of asthma. Medication treatment includes inhaled corticosteroid (ICS), short-acting beta2 agonist (SABA) as a reliever agent, inhaled anti-muscarinic agent as a reliever agent, leukotriene-receptor antagonist (LTRA), inhaled long-acting beta2-agonist (LABA), anti–immunoglobulin E (IgE) agent, anti–interleukin-5 (IL-5) agent, oral corticosteroids, theophylline (rarely used).

Inhaled corticosteroids: Exact mechanism unknown. May act as anti-inflammatories, decrease mucus ­secretion.

Antimuscarinics: Inhibit cholinergic receptors on bronchial smooth muscle (block acetylcholine action).

IgE: Inhibits the binding of IgE to high-affinity receptors on surface of mast cells and basophils. IL-5: Binds to IL-5, reducing the production and survival of eosinophils. Methylxanthines: Directly relax smooth muscle of bronchial airway, pulmonary blood vessels (relieve bronchospasm, increase vital capacity). Increase cyclic 3,5-adenosine monophosphate.

79C

Continued

Asthma/COPD

COPD: Disorder that persistently obstructs bronchial airflow. COPD is frequently related to cigarette smoking and mainly involves two related diseases: chronic bronchitis and emphysema. The obstruction is usually permanent with progression over time. Medication treatment includes inhaled corticosteroid (ICS), inhaled anti-muscarinic agent (LAMA), and inhaled long-acting beta2-agonist (LABA).

Beta2-adrenergic agonists: Stimulate beta receptors in lung, relax bronchial smooth muscle, increase vital capacity, decrease airway resistance.

Leukotriene modifiers: Decrease effect of leukotrienes, which increase migration of eosinophils, producing mucus/edema of airway wall, causing bronchoconstriction.

CLASSIFICATIONS

USES

Name Antimuscarinics

Availability

Dosage Range

Side Effects

Aclidinium (Tudorza)

Inhalation powder: 400 mcg/actuation Inhalation Capsule: 15.6 mcg/cap

A: 400 mcg 2 times/day

Headache, nasopharyngitis, cough

A: One inhalation 2 times/day

Ipratropium (Atrovent)

NEB: 0.02% (500 mcg) MDI: 17 mcg/actuation

A (NEB): 500 mcg q6–8h A (MDI): 2 puffs 4 times/day

Revefenacin (Yupelri)

Inhalation solution for nebulization. Each vial contains 175 mcg/3 mL solution. Inhalation powder: 18 mcg/ capsule Aerosol Solution: 1.25 mcg/ inhalation Inhalation powder: 62.5 mcg/blister

One 175-mcg vial (3 mL) once daily

Fatigue, diarrhea, nausea, arthralgia, nasopharyngitis, upper respiratory tract infection, wheezing Upper respiratory tract infection, bronchitis, sinusitis, headache, dyspnea Cough, nasopharyngitis, upper ­respiratory tract infection, headache, back pain Xerostomia, upper respiratory tract infection, sinusitis, pharyngitis

A: One inhalation once daily

Nasopharyngitis, upper respiratory tract infection, cough, arthralgia

Arformoterol (Brovanna)

NEB: 15 mcg/2 mL

NEB: 15 mcg 2 times/day

Albuterol (ProAir HFA, ProAir Respiclick Proventil HFA, Ventolin HFA)

DPI: 90 mcg/actuation MDI: 90 mcg/actuation NEB: 2.5 mg/3 mL, 2.5 mg/0.5 mL, 0.63–1.25 mg/3 mL

DPI: 1–2 inhalations q4–6h as needed MDI: 2 inhalations q4–6h as needed NEB: 1.25–5 mg q4–6h as needed

Pain, diarrhea, sinusitis, leg cramps, dyspnea, rash, flu syndrome, peripheral edema Tachycardia, skeletal muscle tremors, muscle cramping, palpitations, insomnia, hypokalemia, increased serum glucose

Glycopyrrolate (Seebri Neohaler)

Tiotropium (Spiriva, Spiriva Respimat)

Umeclidinium (Incruse Ellipta)

A: Once/day (inhaled twice) Aerosol Solution: 2 inhalations once daily

Bronchodilators

80C Asthma/COPD

ASTHMA/COPD



Name

Availability

Dosage Range

Side Effects

Albuterol/ipratropium (Combivent Respimat, DuoNeb)

MDI: 90 mcg albuterol/ 18 mcg ipratropium/actuation NEB: 2.5 mg albuterol/ 0.5 mg ipratropium/3 mL NEB: 20 mcg/2 mL

MDI: 1 inhalation 4 times/day as needed NEB: 2.5 mg/0.5 mg 4 times/day as needed NEB: 20 mcg q12h

Same as individual listing for albuterol and ipratropium

DPI: 75 mcg/capsule

DPI: 75 mcg once daily

Olodaterol (Striverdi Respimat)

MDI: 45 mcg/actuation NEB: 0.31, 0.63, 1.25 mg/ 3 mL, 1.25 mg/0.5 mL MDI: 2.5 mcg/actuation

MDI: 2 inhalations q4–6h as needed NEB: 0.31–1.25 mg q6–8h MDI: 2 inhalations once daily

Salmeterol (Serevent Diskus)

DPI: 50 mcg/blister

DPI: 50 mcg q12h

Beclomethasone (Qvar)

MDI: 40, 80 mcg/inhalation

MDI: 40–320 mcg 2 times/day

Budesonide (Pulmicort Flexhaler, Pulmicort Respules)

DPI: (Flexhaler): 90,180 mcg/ inhalation DPI: (Turbuhaler): 200 mcg/ inhalation NEB: (Respules): 0.25, 0.5 mg/2 mL

DPI: (Flexhaler): 180–720 mcg 2 times/day DPI: (Turbuhaler): 400–2,400 mcg/ day in 2–4 divided doses NEB: (Respules): 250–500 mcg 1–2 times/day or 1 mg once daily

Formoterol (Foradil, Perforomist) Indacaterol (Arcapta) Levalbuterol (Xopenex)

Diarrhea, nausea, asthma exacerbation, bronchitis, infection Cough, oropharyngeal pain, nasopharyngitis, headache, nausea Tremor, rhinitis, viral infection, headache, nervousness, asthma, pharyngitis, rash Nasopharyngitis, rash, dizziness, cough, bronchitis, upper respiratory tract infections Headache, pain, throat irritation, nasal congestion, bronchitis, pharyngitis Cough, hoarseness, headache, pharyngitis Headache, nausea, respiratory infection, rhinitis

81C

Continued

Asthma/COPD

Inhaled Corticosteroids

CLASSIFICATIONS

Ciclesonide (Alvesco HFA)

HFA: 80, 160 mcg/inhalation

HFA: 80–320 mcg 2 times/day

Fluticasone (Arnuity Ellipta, Flovent Diskus, Flovent HFA)

DPI: (Flovent Diskus): 50, 100, 250 mcg/blister (Arnuity Ellipta): 100 mcg, 200 mcg/ activation MDI: (Flovent HFA): 44, 110, 220 mcg/inhalation DPI: 110–220 mcg/inhalation

DPI: (Flovent Diskus): 100–1,000 mcg 2 times/day (Arnuity Ellipta): 100–200 mcg once daily MDI: (Flovent HFA): 88–880 mcg 2 times/day DPI: 220–880 mcg once daily in evening or 220 mcg bid

Mometasone (Asmanex Twisthaler)

Headache, nasopharyngitis, upper respiratory infection, epistaxis, nasal congestion, sinusitis Headache, nasal congestion, pharyngitis, sinusitis, respiratory infections

Same as beclomethasone

Long Acting Antimuscarinic Agent/Long-Acting Beta2-Agonist (LAMA/LABA) Glycopyrrolate/formoterol (Bevespi Aerosphere) Glycopyrrolate/indacaterol (Utibron Neohaler) Tiotropium/olodaterol (Stiolto Respimat) Umeclidinium/vilanterol (Anoro Ellipta)

9 mcg/4.8 mcg/inhalation

2 inhalation bid

Urinary tract infection, cough

15.6 mcg/27.5 mcg/cap

1 inhalation bid

Nasopharyngitis, hypertension

2.5 mcg/2.5 mcg/inh

2 inhalation once daily

Nasopharyngitis, cough, back pain

62.5 mcg/25 mcg/inhalation

1 inhalation once/day

Pharyngitis, sinusitis, lower respiratory tract infections, constipation, diarrhea, muscle spasms, neck/chest pain

82C Asthma/COPD

Asthma/COPD—cont’d



Name Leukotriene Modifiers

Availability

Dosage Range

Side Effects

Montelukast (Singulair)

T: 4 mg, 5 mg, 10 mg

Dyspepsia, increased LFTs, cough, nasal congestion, headache, dizziness, fatigue

Zafirlukast (Accolate)

T: 10 mg, 20 mg

A: 10 mg/day C (6–14 yrs): 5 mg/day C (2–5 yrs): 4 mg/day A, C (12 yrs and older): 20 mg 2 times/day C (5–11 yrs): 10 mg 2 times/day A: 500 mcg once daily

Headache, dizziness, insomnia Same as individual listing for fluticasone and salmeterol Same as individual listing for fluticasone and salmeterol Same as individual listing for fluticasone and salmeterol Nasopharyngitis, upper respiratory tract infection, headache, oral candidiasis Same as individual listing for budesonide and formoterol Same as individual listing for mometasone and formoterol Continued

Headache, nausea, diarrhea, infection

PDE-4 Inhibitor Roflumilast (Daliresp)

T: 500 mcg

Inhaled Corticosteroid/Long-Acting Beta2-Agonist (ICS/LABA) 100–500 mcg bid

Budesonide/formoterol (Symbicort)

80, 160 mcg/4.5 mcg/inhalation 100, 200 mcg/5 mcg/inhalation

80–160 mcg/25 mcg bid

Mometasone/formoterol (Dulera)

2 inhalation bid 1 inhalation bid 1 inhalation once/day

2 inhalation bid

83C

CLASSIFICATIONS

100, 250, 500 mcg/50 mcg blister 45, 115, 230 mcg/21 mcg/ inhalation 55, 113, 232 mcg/14 mcg/ inhalation 100, 200 mcg/25 mcg/inhalation

Asthma/COPD

Fluticasone propionate/salmeterol (Advair Diskus) Fluticasone propionate/salmeterol (Advair HFA) Fluticasone propionate/salmeterol (AirDuo Respiclick) Fluticasone furoate/vilanterol (Breo Ellipta)

Fluticasone furoate/umeclidinium/ vilanterol (Trelegy Ellipta)

100 mcg/62.5 mcg/25 mcg/ inhalation

1 inhalation once/day

Same as individual listing for fluticasone, umeclidinium, and vilanterol

I: 150 mg

SC: 75–300 mcg q4wks

Arthralgia, pain, fatigue, dizziness, fracture, pruritus, earache Injection site reactions, urticaria, angioedema, rash Headache, injection site reaction, fatigue, back pain Antibody development, increased CPK, myalgia, oropharyngeal pain

Anti-IgE Antibody Omalizumab (Xolair)

Anti-Interleukin-5 Antibodies (Eosinophilia Asthma) Benralizumab (Fasenra)

I: 30 mg/mL

Mepolizumab (Nucala)

I: 100 mg

30 mg SC q4wks times 3 doses, then q8wks 100 mg SC q4wks

Resilizumab (Cinqair)

I: 100 mg/10-mL vial

3 mg/kg IV q4wks

A, Adults; C (dosage), children; DPI, dry powder inhaler; HFA, hydrofluoroalkane; MDI, metered dose inhaler; NEB, nebullzatlon; T, tablets.

84C Asthma/COPD

Name Availability Dosage Range Side Effects Inhaled Corticosteroid/ Long Acting Antimuscarinic Agent /Long-Acting Beta2-Agonist (ICS/LAMA/LABA)



Calcium Channel Blockers USES

ACTION

Treatment of essential hypertension, treatment of and prophylaxis of angina pectoris (including vasospastic, chronic stable, unstable), prevention/control of supraventricular tachyarrhythmias, prevention of neurologic damage due to subarachnoid hemorrhage.

Calcium channel blockers inhibit the flow of extracellular Ca2+ ions across cell membranes of cardiac cells, vascular tissue. They relax arterial smooth muscle, depress the rate of sinus node pacemaker, slow AV conduction, decrease heart rate, produce negative inotropic

effect (rarely seen clinically due to reflex response). Calcium channel blockers decrease coronary vascular resistance, increase coronary blood flow, reduce myocardial oxygen demand. Degree of action varies with individual agent.

CALCIUM CHANNEL BLOCKERS

Availability

Indications

Dosage Range

Side Effects

Amlodipine (Norvasc)

T: 2.5 mg, 5 mg, 10 mg

HTN, angina

Diltiazem (Cardizem)

T: 30 mg, 60 mg, 90 mg, 120 mg (ER): 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg C (SR-12HR): 60 mg, 90 mg, 120 mg, (ER-24HR): 120 mg, 180 mg, 240 mg, 300 mg, 360 mg, 420 mg I: 5 mg/mL T: 2.5 mg, 5 mg, 10 mg

PO: HTN, angina IV: Arrhythmias

HTN: Initially, 2.5–5 mg once daily. May titrate q7–14 days up to 10 mg/day Angina: 5–10 mg once daily See monograph HTN: 120–540 mg/day Angina: 120–480 mg/day I: 20–25 mg IV bolus, then 5–15 mg/hr infusion

Headache, peripheral edema, dizziness, flushing, rash, gingival hyperplasia, tachycardia Constipation, flushing, hypotension, dizziness, AV block, bradycardia, headache, edema, HF

Initially, 5 mg/day. May increase q2wks Usual dose: 5–10 mg/day

Headache, peripheral edema, dizziness, flushing, rash, gingival hyperplasia, tachycardia

HTN

85C

Continued

CLASSIFICATIONS

Felodipine (Plendil)

Calcium Channel Blockers

Name

Name

Indications

Dosage Range

Side Effects

C: 2.5 mg, 5 mg

HTN

Nicardipine (Cardene)

C (IR): 20 mg, 30 mg C (ER): 30 mg, 45 mg,60 mg I: 2.5 mg/mL C (IR): 10 mg, 20 mg T (ER): 30 mg, 60 mg, 90 mg

HTN, angina

Headache, peripheral edema, dizziness, flushing, rash, gingival hyperplasia, tachycardia Headache, peripheral edema, dizziness, flushing, rash, gingival hyperplasia, tachycardia Headache, peripheral edema, dizziness, flushing, rash, gingival hyperplasia, tachycardia

Nimodipine (Nimotop, Nymalize)

C: 30 mg S: 60 mg/20 mL

Verapamil (Calan, Isoptin)

T (IR): 40 mg, 80 mg, 120 mg T (SR): 120 mg, 180 mg, 240 mg

Prevent neurologic damage following subarachnoid hemorrhage HTN, angina

Initially, 2.5 mg 2 times/day. May increase at 2–4 wk intervals at 2.5–5 mg increments. Usual dose: 5–10 mg 2 times/day Angina/HTN: Initially, 20–30 mg 3 times/ day. May increase q3days. Usual dose: 20–40 mg 3 times/day HTN (ER): Initially, 30–60 mg once daily Usual dose: 90–120 mg once daily Angina (IR): 10–20 mg tid or (ER): Initially, 30–60 mg once daily. Titrate up to 90 mg daily. Maximum: 120 mg 60 mg q4h for 21 days

Angina (IR): Initially, 40–120 mg 3 times/ day. Usual dose: 80–160 mg tid or (SR): Initially, 180 mg at HS. May increase at weekly intervals up to 480 mg/day HTN (IR): Initially, 80 mg 3 times/day Usual dose: 240–480 mg/day in divided doses (SR): Initially, 120–180 mg/day. May increase at wkly intervals to 240 mg/day, then 180 mg 2 times/day Maximum: 240 mg 2 times/day

Constipation, dizziness, tachycardia, AV block, bradycardia, headache, edema, HF

Nifedipine (Adalat, Procardia)

HTN, angina

Nausea, reduced B/P, headache, rash, diarrhea

C, Capsules; CR, controlled-release; ER, extended-release; HTN, hypertension; I, injection; S, solution; SR, sustained-release; T, tablets.

Calcium Channel Blockers

Availability

Isradipine

86C

CALCIUM CHANNEL BLOCKERS—cont’d



Chemotherapeutic Agents ACTION

Treatment of a variety of cancers; may be palliative or curative. Treatment of choice in hematologic cancers. Often used as adjunctive therapy (e.g., with surgery or irradiation); most effective when tumor mass has been removed or reduced by radiation. Often used in combinations to increase therapeutic results, decrease toxic effects. Certain agents may be used in nonmalignant conditions: polycythemia vera, psoriasis, rheumatoid arthritis, or immunosuppression in organ transplantation (used only in select cases that are severe and unresponsive to other forms of therapy). Refer to individual monographs.

Most antineoplastics can be divided into alkylating agents, antimetabolites, anthracyclines, plant alkaloids, and topoisomerase inhibitors. These agents affect cell division or DNA synthesis. Newer agents (monoclonal antibodies and tyrosine kinase inhibitors) directly target a molecular abnormality in certain types of cancer. Hormones modulate tumor cell behavior without directly attacking those cells. Some agents are classified as miscellaneous.

CHEMOTHERAPEUTIC AGENTS

Name

Uses

Category

Side Effects

Abemaciclib (Verzenio)

Breast cancer, advanced or metastatic

Fatigue, diarrhea, nausea, anemia, decreased absolute lymphocyte count, neutropenia, thrombocytopenia, leukopenia, increased ALT, AST, serum creatinine

Abiraterone (Zytiga)

Prostate cancer

Cyclin-dependent kinase inhibitor Antiandrogen

Joint swelling, hypokalemia, edema, muscle discomfort, hot flashes, diarrhea, UTI, cough, hypertension, arrhythmia, dyspepsia, upper respiratory tract infection

87C

Continued

Chemotherapeutic Agents

USES

CLASSIFICATIONS

Uses

Category

Acalabrutinib (Calquence) Aldesleukin (Proleukin)

Mantle cell lymphoma (previously treated) Melanoma (metastatic), renal cell (metastatic)

Alectinib (Alecensa) Anastrozole (Arimidex)

Non–small-cell lung cancer (NSCLC), metastatic Breast cancer

Tyrosine kinase inhibitor Biologic response modifier Kinase inhibitor

Headache, fatigue, skin rash, diarrhea, nausea, neutropenia, bruising, anemia, myalgia Hypotension, sinus tachycardia, nausea, vomiting, diarrhea, renal impairment, anemia, rash, fatigue, agitation, pulmonary congestion, dyspnea, fever, chills, oliguria, weight gain, dizziness Constipation, fatigue, edema, myalgia

Aromatase inhibitor

Apalutamide (Erleada)

Antiandrogen

Arsenic trioxide (Trisenox)

Prostate cancer, nonmetastatic, castrationresistant Acute promyelocytic leukemia (APL)

Peripheral edema, chest pain, nausea, vomiting, diarrhea, constipation, abdominal pain, anorexia, pharyngitis, vaginal hemorrhage, anemia, leukopenia, rash, weight gain, diaphoresis, increased appetite, pain, headaches, dizziness, depression, paresthesia, hot flashes, increased cough, dry mouth, asthenia, dyspnea, phlebitis Hypertension, fatigue, skin rash, hypercholesterolemia, hyperglycemia, hypertriglyceridemia, hyperkalemia, diarrhea, anemia, leukopenia, lymphocytopenia

Asparaginase (Elspar)

Acute lymphoblastic leukemia (ALL)

Miscellaneous

Miscellaneous

Side Effects

AV block, GI hemorrhage, hypertension, hypoglycemia, hypokalemia, hypomagnesemia, neutropenia, oliguria, prolonged QT interval, seizures, sepsis, thrombocytopenia Anorexia, nausea, vomiting, hepatic toxicity, pancreatitis, nephrotoxicity, clotting factor abnormalities, malaise, confusion, lethargy, EEG changes, respiratory distress, fever, hyperglycemia, depression, stomatitis, allergic reactions, drowsiness

Chemotherapeutic Agents

Name

88C

CHEMOTHERAPEUTIC AGENTS—cont’d

Azacitidine (Vidaza) BCG (TheraCys, Tice BCG)

Bevacizumab (Avastin)

Bexarotene (Targretin) Bicalutamide (Casodex)

Peripheral T-cell lymphoma Chronic lymphocytic leukemia (CLL), nonHodgkin lymphoma (NHL) Cervical cancer, persistent/recurrent/metastatic, colorectal cancer, metastatic, glioblastoma, NSCLC, nonsquamous Cutaneous T-cell lymphoma Prostate cancer, metastatic

Fatigue, decreased appetite, nausea, UTI, constipation, pyrexia

PD-L1 blocking antibody Kinase inhibitor

Fatigue, musculoskeletal pain, diarrhea, nausea, infusion-related reactions, rash, decreased appetite, peripheral edema Diarrhea, hypertension, fatigue, decreased appetite, nausea, dysphoria, vomiting, asthenia, constipation Edema, hypokalemia, weight loss, myalgia, cough, dyspnea, upper respiratory tract infection, back pain, pyrexia, weakness Nausea, vomiting, anorexia, diarrhea, dysuria, hematuria, cystitis, urinary urgency, anemia, malaise, fever, chills

DNA methylation inhibitor Biologic response modulator Miscellaneous

Nausea, fatigue, pyrexia, anemia, vomiting

Alkylating agent

Neutropenia, pyrexia, thrombocytopenia, nausea, anemia, leukopenia, vomiting

Monoclonal antibody

Increased B/P, fatigue, blood clots, diarrhea, decreased WBCs, headaches, decreased appetite, stomatitis

Miscellaneous

Anemia, dermatitis, fever, hypercholesterolemia, infection, leukopenia, peripheral edema Gynecomastia, hot flashes, breast pain, nausea, diarrhea, constipation, nocturia, impotence, pain, muscle pain, asthenia, abdominal pain

Antiandrogen

89C

Continued

Chemotherapeutic Agents

Belinostat (Beleodaq) Bendamustine (Treanda)

Renal cell carcinoma, advanced Myelodysplastic (MDS) syndrome Bladder cancer

Miscellaneous

CLASSIFICATIONS

Avelumab (Bavencio) Axitinib (Inlyta)

NSCLC, metastatic, urothelial carcinoma, locally advanced or metastatic Merkel cell carcinoma



Atezolizumab (Tecentriq)

Uses

Category

Binimetinib (Mektovi) Bleomycin (Blenoxane)

Melanoma (unresectable or metastatic) Head/neck cancers, Hodgkin lymphoma, malignant pleural effusion, testicular cancer ALL

Kinase inhibitor

Mantle cell lymphoma, multiple myeloma

Proteasome inhibitor

Chronic myelogenous leukemia (CML) Anaplastic large cell lymphoma, Hodgkin lymphoma (relapsed, refractory, post-­ autologous hematopoietic stem cell transplant) NSCLC, metastatic

Kinase inhibitor

Blinatumomab (Blincyto) Bortezomib (Velcade) Bosutinib (Bosulif) Brentuximab (Adcetris)

Brigatinib (Alunbrig) Busulfan (Myleran) Cabazitaxel (Jevtana)

Antibiotic

Miscellaneous

Side Effects Fatigue, nausea, diarrhea, vomiting, anemia, hemorrhage; increased CPK, serum creatinine Nausea, vomiting, anorexia, stomatitis, hyperpigmentation, alopecia, pruritus, hyperkeratosis, urticaria, pneumonitis progression to fibrosis, weight loss, rash Pyrexia, headache, peripheral edema, febrile neutropenia, nausea, hypokalemia, tremor, rash, constipation Anxiety, dizziness, headaches, insomnia, peripheral neuropathy, pruritus, rash, abdominal pain, decreased appetite, constipation, diarrhea, dyspepsia, nausea, vomiting, arthralgia, dyspnea, asthenia, edema, pain Nausea, diarrhea, thrombocytopenia, vomiting, abdominal pain, anemia, fever, fatigue

Miscellaneous

Neutropenia, peripheral sensory neuropathy, fatigue, nausea, anemia, upper respiratory tract infection, diarrhea, pyrexia, thrombocytopenia, cough, vomiting

Kinase inhibitor

Nausea, diarrhea, fatigue, cough, headache

CML

Alkylating agent

Prostate cancer, metastatic

Microtubule inhibitor

Nausea, vomiting, hyperuricemia, myelosuppression, skin hyperpigmentation, alopecia, anorexia, weight loss, diarrhea, stomatitis Neutropenia, anemia, leukopenia, thrombocytopenia, diarrhea, fatigue, nausea, vomiting, constipation, asthenia, abdominal pain, hematuria, anorexia, peripheral neuropathy, dyspnea, alopecia

Chemotherapeutic Agents

Name

90C

CHEMOTHERAPEUTIC AGENTS—cont’d

Chlorambucil (Leukeran) Cisplatin (Platinol-AQ)

Nausea, vomiting, diarrhea, stomatitis, myelosuppression, palmar-plantar erythrodysesthesia syndrome, dermatitis, fatigue, anorexia

Alkylating agent

Nausea, vomiting, nephrotoxicity, myelosuppression, alopecia, peripheral neuropathy, hypersensitivity, ototoxicity, asthenia, diarrhea, constipation Anemia, fatigue, nausea, thrombocytopenia, dyspnea, diarrhea, pyrexia

Colorectal cancer, metastatic, head/neck cancer, squamous cell CLL

Monoclonal antibody

Bladder cancer, advanced, ovarian cancer, metastatic, testicular cancer, metastatic Hairy cell leukemia

Alkylating agent

Melanoma, unresectable or metastatic

Kinase inhibitor

Proteasome inhibitor Alkylating agent

Kinase inhibitor

Alkylating agent

Antimetabolite

Anorexia, nausea, vomiting, myelosuppression, pulmonary fibrosis, pain at injection site, diarrhea, skin discoloration

Diarrhea, nausea, increased LFTs, vomiting, abdominal pain, fatigue, decreased appetite, constipation Dyspnea, hypotension, acne-like rash, dry skin, weakness, fatigue, fever, constipation, abdominal pain Myelosuppression, dermatitis, nausea, vomiting, hepatic toxicity, anorexia, diarrhea, abdominal discomfort, rash Nausea, vomiting, nephrotoxicity, myelosuppression, neuropathies, ototoxicity, anaphylactic-like reactions, hyperuricemia, hypomagnesemia, hypophosphatemia, hypokalemia, hypocalcemia, pain at injection site Nausea, vomiting, diarrhea, myelosuppression, chills, fatigue, rash, fever, headaches, anorexia, diaphoresis Diarrhea, photosensitivity reaction, nausea, vomiting, pyrexia, increased ALT, AST, alkaline phosphatase Continued

91C

Cladribine (Leustatin) Cobimetinib (Cotellic)

Antimetabolite

Chemotherapeutic Agents

Ceritinib (Zykadia) Cetuximab (Erbitux)

Breast cancer, metastatic, colorectal cancer Ovarian cancer, advanced Multiple myeloma, relapsed/refractory Brain tumors, multiple myeloma, Hodgkin lymphoma, relapsed/refractory, NHL, relapsed/ refractory NSCLC, metastatic

CLASSIFICATIONS

Carboplatin (Paraplatin) Carfilzomib (Kyprolis) Carmustine (BiCNU)



Capecitabine (Xeloda)

Uses

Category

Copanlisib (Alqopa)

Follicular lymphoma (relapsed)

Phosphatidylinositol 3-kinase inhibitor

Crizotinib (Xalkori) Cyclophosphamide (Cytoxan)

NSCLC, metastatic

Tyrosine kinase inhibitor Alkylating agent

Cytarabine (Ara-C, Cytosar) Dabrafenib (Tafinlar) Dacarbazine (DTIC) Dacomitinib (Vizimpro) Daratumumab (Darzalex) Dasatinib (Sprycel)

ALL, AML, breast cancer, CML, Hodgkin lymphoma, multiple myeloma, NHL, ovarian carcinoma AML, ALL, CML, meningeal leukemia Melanoma, metastatic or unresectable Hodgkin lymphoma, metastatic malignant melanoma NSCLC Multiple myeloma, relapsed/refractory ALL, CML

Antimetabolite Kinase inhibitor Alkylating agent Tyrosine kinase inhibitor Monoclonal antibody Tyrosine kinase inhibitor

Side Effects Hypertension, decreased energy, hyperglycemia, hypertriglyceridemia, hypophosphatemia, hyperuricemia, diarrhea, nausea, decreased Hgb, leukopenia, decreased absolute lymphocyte count, neutropenia, thrombocytopenia, serious infection Vision disorders, nausea, vomiting, diarrhea, edema, constipation Nausea, vomiting, hemorrhagic cystitis, myelosuppression, alopecia, interstitial pulmonary fibrosis, amenorrhea, azoospermia, diarrhea, darkening skin/fingernails, headaches, diaphoresis Anorexia, nausea, vomiting, stomatitis, esophagitis, diarrhea, myelosuppression, alopecia, rash, fever, neuropathies, abdominal pain Hyperkeratosis, headache, pyrexia, arthralgia, constipation, alopecia, rash, cough, palmar-plantar erythrodysesthesia syndrome, papilloma Nausea, vomiting, anorexia, hepatic necrosis, myelosuppression, alopecia, rash, facial flushing, photosensitivity, flu-like symptoms, confusion, blurred vision Skin rash, paronychia, xeroderma, alopecia, pruritus, hypoalbuminemia, hyperglycemia, hypocalcemia, hypokalemia, hyponatremia, weight loss, diarrhea, stomatitis, anemia, lymphocytopenia Fatigue, nausea, infusion reactions, back pain, pyrexia, nausea, upper respiratory tract infections Pyrexia, pleural effusion, febrile neutropenia, Gl bleeding, pneumonia, thrombocytopenia, dyspnea, anemia, cardiac failure, diarrhea

Chemotherapeutic Agents

Name

92C

CHEMOTHERAPEUTIC AGENTS—cont’d

Durvalumab (Imfinzi) Duvelisib (Copiktra)

Anthracycline

Neuroblastoma

Monoclonal antibody Antimicrotubular

Breast cancer, NSCLC, prostate, gastric, head/ neck cancers Breast cancer, metastatic cancers AIDS-related Kaposi sarcoma, multiple myeloma, ovarian cancer, advanced Urothelial carcinoma, advanced or metastatic Chronic lymphocytic leukemia/small lymphocytic lymphoma (relapsed or refractory), follicular lymphoma (relapsed or refractory) Multiple myeloma, relapsed/refractory

Anthracycline

Anthracycline

Cardiotoxicity, including HF; arrhythmias, nausea, vomiting, stomatitis, esophagitis, GI ulceration, diarrhea, anorexia, hematuria, myelosuppression, alopecia, hyperpigmentation of nail beds and skin, local inflammation at injection site, rash, fever, chills, urticaria, lacrimation, conjunctivitis Neutropenia, palmar-plantar erythrodysesthesia syndrome, cardiomyopathy, HF

PD-L1 blocking antibody Kinase inhibitor

Fatigue, musculoskeletal pain, constipation, decreased appetite, nausea, peripheral edema, UTI Edema, fatigue, headache, skin rash, hypophosphatemia, hyponatremia, diarrhea, nausea, neutropenia; increased serum lipase/amylase

Immunostimulatory antibody

Fatigue, diarrhea, pyrexia, constipation, cough, peripheral neuropathy, nasopharyngitis, decreased appetite, upper respiratory tract infections, pneumonia Continued

93C

Elotuzumab (Empliciti)

Kaposi sarcoma

HF, nausea, vomiting, stomatitis, mucositis, diarrhea, hematuria, myelosuppression, alopecia, fever, chills, abdominal pain Nausea, diarrhea, abdominal pain, anorexia, vomiting, stomatitis, myelosuppression, rigors, back pain, headaches, neuropathy, depression, dyspnea, fatigue, fever, cough, allergic reactions, diaphoresis Pain, arthralgia, myalgia, neuralgia, pyrexia, hypotension, vomiting, diarrhea, urticaria, hypoxia Hypotension, nausea, vomiting, diarrhea, mucositis, myelosuppression, rash, paresthesia, hypersensitivity, fluid retention, alopecia, asthenia, stomatitis, fever

Chemotherapeutic Agents

Doxorubicin liposomal (Doxil)

Anthracycline

CLASSIFICATIONS

Doxorubicin (Adriamycin)

ALL, AML



Daunorubicin (Cerubidine) Daunorubicin liposomal (DaunoXome) Dinutuximab (Unituxin) Docetaxel (Taxotere)

Name

Uses

Category

Enasidenib (Idhifa)

AML, refractory

Enasidenib (IDHIFA) Encorafenib (Braftovi) Enzalutamide (Xtandi)

Acute myeloid leukemia (relapsed/refractory) Melanoma (unresectable or metastatic) Prostate cancer, metastatic

Isocitrate dehydrogenase-2 inhibitor IDH2 inhibitor

Epirubicin (Ellence) Erdafitinib ­(Balversa)

Breast cancer, adjuvant

Anthracycline

Urothelial carcinoma ­(locally advanced or metastatic) NSCLC, pancreatic cancer Small-cell lung cancer, testicular cancer Breast cancer, advanced, neuroendocrine tumors, renal cell carcinoma, advanced, subependymal giant cell astrocytoma Breast cancer

Kinase inhibitor

Fatigue, onycholysis, hyperphosphatemia, stomatitis, diarrhea, decreased Hgb, increased serum creatinine

Tyrosine kinase inhibitor Podophyllotoxin derivative mTOR kinase inhibitor

Diarrhea, rash, nausea, vomiting

Aromatase inactivator

Dyspnea, edema, hypertension, mental depression

Exemestane (Aromasin)

Antiandrogen

Nausea, vomiting, diarrhea, elevated bilirubin, decreased appetite Decreased calcium, potassium, nausea, diarrhea, decreased appetite, vomiting, leukocytosis, increased bilirubin Fatigue, hyperkeratosis, alopecia, skin rash, hyperglycemia, nausea, anemia; increased serum creatinine Fatigue, weakness, back pain, diarrhea, tissue swelling, musculoskeletal pain, headache, upper respiratory tract infections, blood in urine, spinal cord compression Anemia, leukopenia, neutropenia, infection, mucositis

Nausea, vomiting, anorexia, myelosuppression, alopecia, diarrhea, drowsiness, peripheral neuropathies Stomatitis, infections, asthenia, fatigue, cough, diarrhea

Chemotherapeutic Agents

Erlotinib (Tarceva) Etoposide (VePesid) Everolimus (Afinitor)

Kinase inhibitor

Side Effects

94C

CHEMOTHERAPEUTIC AGENTS—cont’d

Fluorouracil (Adrucil, Efudex) Flutamide (Eulexin) Fulvestrant (Faslodex)

Breast, colon, gastric, pancreatic, rectal cancers, basal cell carcinoma Prostate cancer

Antimetabolite

Breast cancer, metastatic or advanced

Estrogen receptor antagonist

Gefitinib (Iressa)

NSCLC

Gemcitabine (Gemzar) Gilteritinib ­(Xospata) Glasdegib ­(Daurismo) Goserelin (Zoladex) Hydroxyurea (Hydrea) Ibrutinib (Imbruvica)

Breast, NSCLC, ovarian, pancreatic cancers AML, relapsed or ­refractory AML

Tyrosine kinase inhibitor Antimetabolite

Breast cancer, prostate cancer CML, head/neck cancers

Kinase inhibitor Hedgehog pathway inhibitor Hormone agonist Antimetabolite Kinase inhibitor

Increased LFT, nausea, vomiting, diarrhea, stomatitis, hematuria, myelosuppression, rash, mild paresthesia, dyspnea, fever, edema, flu-like symptoms, constipation Edema, fatigue, malaise, hyperglycemia, hypertriglyceridemia, hypocalcemia, hypoalbuminemia, arthralgia, myalgia, increased serum creatinine Edema, fatigue, hyponatremia, hypomagnesemia, nausea, anemia, hemorrhage, febrile neutropenia, increased serum creatinine Hot flashes, sexual dysfunction, erectile dysfunction, gynecomastia, lethargy, pain, lower urinary tract symptoms, headaches, nausea, depression, diaphoresis Anorexia, nausea, vomiting, stomatitis, diarrhea, constipation, myelosuppression, fever, chills, malaise Neutropenia, thrombocytopenia, diarrhea, anemia, musculoskeletal pain, rash, nausea, bruising, fatigue, hemorrhage, pyrexia

Continued

95C

CLL, small lymphocytic lymphoma, mantle cell lymphoma, Waldenstrom macroglobulinemia

Antiandrogen

Nausea, diarrhea, stomatitis, bleeding, anemia, myelosuppression, skin rash, weakness, confusion, visual disturbances, peripheral neuropathy, coma, pneumonia, peripheral edema, anorexia Nausea, vomiting, stomatitis, GI ulceration, diarrhea, anorexia, myelosuppression, alopecia, skin hyperpigmentation, nail changes, headaches, drowsiness, blurred vision, fever Hot flashes, nausea, vomiting, diarrhea, hepatitis, impotence, decreased libido, rash, anorexia Asthenia, pain, headaches, injection site pain, flu-like symptoms, fever, nausea, vomiting, constipation, anorexia, diarrhea, peripheral edema, dizziness, depression, anxiety, rash, increased cough, UTI Diarrhea, rash, acne, nausea, dry skin, vomiting, pruritus, anorexia

CLASSIFICATIONS

Antimetabolite

Chemotherapeutic Agents

CLL



Fludarabine (Fludara)

Uses

Category

Idarubicin (Idamycin PFS) Idelalisib (Zydelig)

AML

Anthracycline

CLL, follicular B-cell NHL, small lymphocytic lymphoma Mantle cell lymphoma, multiple myeloma, myelodysplastic syndromes Testicular cancer

Kinase inhibitor

ALL, CML, dermatofibrosarcoma protuberans, gastrointestinal stromal tumors (GIST), chronic eosinophilic leukemias, myelodysplastic/ myeloproliferative disease Acute lymphoblastic leukemia (relapsed/refractory) AIDS-related Kaposi sarcoma, follicular lymphoma, hairy cell leukemia, malignant melanoma Melanoma, unresectable or metastatic, melanoma, adjuvant

Tyrosine kinase inhibitor

lenalidomide (Revlimid) Ifosfamide (Ifex) Imatinib (Gleevec)

Inotuzumab ozogamicin (Besponsa) Interferon alfa-2b (Intron-A)

Ipilimumab (Yervoy)

Immunomodulator Alkylating agent

Monoclonal antibody Miscellaneous

Miscellaneous

Side Effects HF, arrhythmias, nausea, vomiting, stomatitis, myelosuppression, alopecia, rash, urticaria, hyperuricemia, abdominal pain, diarrhea, esophagitis, anorexia Diarrhea, pyrexia, fatigue, nausea, cough, abdominal pain, pneumonia, increased ALT/AST Diarrhea, pruritus, rash, fatigue, DVT, pulmonary embolism, thrombocytopenia, neutropenia, upper respiratory tract infection, cellulitis, hypertension, peripheral neuropathy Nausea, vomiting, hemorrhagic cystitis, myelosuppression, alopecia, lethargy, drowsiness, confusion, hallucinations, hematuria Nausea, fluid retention, hemorrhage, musculoskeletal pain, arthralgia, weight gain, pyrexia, abdominal pain, dyspnea, pneumonia

Fatigue, headache, increased GGT, lipase, nausea, abdominal pain, thrombocytopenia, neutropenia, anemia, leukopenia, lymphocytopenia, increased ALT, AST, alkaline phosphatase, infection, fever Mild hypotension, hypertension, tachycardia with high fever, nausea, diarrhea, altered taste, weight loss, thrombocytopenia, myelosuppression, rash, pruritus, myalgia, arthralgia associated with flu-like symptoms Fatigue, diarrhea, pruritus, rash, colitis

Chemotherapeutic Agents

Name

96C

CHEMOTHERAPEUTIC AGENTS—cont’d

Proteasome inhibitor Tyrosine kinase inhibitor Tyrosine kinase inhibitor Kinase inhibitor

Breast cancer Solid tumors Renal cell carcinoma, advanced, thyroid cancer, differentiated Breast cancer in postmenopausal women Prostate cancer, advanced Brain tumors, Hodgkin lymphoma NSCLC, metastatic Breast cancer, endometrial cancer

Antimicrotubular

Aromatase inhibitor Hormone agonist Alkylating agent Tyrosine kinase inhibitor Hormone

Neurotoxicity, fatigue, dizziness, hypoalbuminemia, nausea, vomiting, anemia, cough Hypertension, fatigue, diarrhea, arthralgia, decreased weight, nausea, stomatitis, headache, vomiting, proteinuria, abdominal pain Hypertension, nausea, vomiting, constipation, diarrhea, abdominal pain, anorexia, rash, pruritus, musculoskeletal pain, arthralgia, fatigue, headaches, dyspnea, coughing, hot flashes Hot flashes, gynecomastia, nausea, vomiting, constipation, anorexia, dizziness, headaches, insomnia, paresthesia, bone pain Anorexia, nausea, vomiting, stomatitis, hepatotoxicity, nephrotoxicity, myelosuppression, alopecia, confusion, slurred speech Edema, peripheral neuropathy, hypercholesterolemia, hypertriglyceridemia, anemia, dyspnea Deep vein thrombosis, Cushing-like syndrome, alopecia, carpal tunnel syndrome, weight gain, nausea Continued

97C

Leuprolide (Lupron) Lomustine (CeeNU) Lorlatinib ­(Lorbrena) Megestrol (Megace)

Multiple myeloma

IDH1 Inhibitor

Diarrhea, nausea, vomiting, abdominal cramps, anorexia, stomatitis, increased AST, severe myelosuppression, alopecia, diaphoresis, rash, weight loss, dehydration, increased serum alkaline phosphatase, headaches, insomnia, dizziness, dyspnea, cough, asthenia, rhinitis, fever, back pain, chills Edema, fatigue, diarrhea, nausea, decreased Hgb, leukocytosis, hypomagnesemia, hypokalemia, hyponatremia Peripheral sensory neuropathy, fatigue, myalgia, alopecia, nausea, vomiting, stomatitis, diarrhea, anorexia, abdominal pain Diarrhea, constipation, thrombocytopenia, peripheral neuropathy, nausea, peripheral edema, back pain, vomiting Diarrhea, palmar-plantar erythrodysesthesia, nausea, rash, vomiting, fatigue

CLASSIFICATIONS

Letrozole (Femara)

Camptothecin

Chemotherapeutic Agents

Ivosidenib ­(Tibsovo) Ixabepilone (Ixempra) Ixazomib (Ninlaro) Lapatinib (Tykerb) Larotrectinib ­(Vitrakvi) Lenvatinib (Lenvima)

Colorectal cancer, metastatic, pancreatic adenocarcinoma, metastatic AML newly diagnosed (relapsed/refractory) Breast cancer



Irinotecan (Camptosar)

CHEMOTHERAPEUTIC AGENTS—cont’d

Category

Multiple myeloma, ovarian cancer ALL

Alkylating agent

Anorexia, nausea, vomiting, myelosuppression, diarrhea, stomatitis

Antimetabolite

ALL, trophoblastic neoplasms, breast cancer, head and neck cancer, cutaneous T-cell lymphoma, lung cancer, advanced NHL, osteosarcoma AML, aggressive systemic mastocytosis (ASM) Gastric cancer, pancreatic cancer Adrenocortical carcinoma Acute nonlymphocytic leukemias, prostate cancer, advanced hormone refractory Hairy cell leukemia (relapsed or refractory) NSCLC (squamous) metastatic

Antimetabolite

Anorexia, nausea, vomiting, stomatitis, hepatic toxicity, myelosuppression, hyperuricemia, diarrhea, rash Nausea, vomiting, stomatitis, GI ulceration, diarrhea, hepatic toxicity, renal failure, cystitis, myelosuppression, alopecia, urticaria, acne, photosensitivity, interstitial pneumonitis, fever, malaise, chills, anorexia

Midostaurin (Rhydapt) Mitomycin (Mutamycin) Mitotane (Lysodren) Mitoxantrone (Novantrone) Moxetumomab (Lumoxiti) Necitumumab (Portrazza)

Side Effects

Kinase inhibitor

Febrile neutropenia, nausea, mucositis, vomiting, headache, petechiae, musculoskeletal pain, epistaxis, hyperglycemia, upper respiratory tract infections

Antibiotic

Anorexia, nausea, vomiting, stomatitis, diarrhea, renal toxicity, myelosuppression, alopecia, pruritus, fever, hemolytic uremic syndrome, weakness Anorexia, nausea, vomiting, diarrhea, skin rashes, depression, lethargy, drowsiness, dizziness, adrenal insufficiency, blurred vision, impaired hearing HF, tachycardia, EKG changes, chest pain, nausea, vomiting, stomatitis, mucositis, myelosuppression, rash, alopecia, urine discoloration (bluish green), phlebitis, diarrhea, cough, headaches, fever

Miscellaneous Anthracenedione Anti-CD22 Epidermal growth factor receptor (EGFR) antagonist

Peripheral edema, capillary leak syndrome, fatigue, headache, hypoalbuminemia, nausea, decreased Hgb, neutropenia; increased serum ALT, AST, creatinine Rash, hypomagnesemia

Chemotherapeutic Agents

Uses

Melphalan (Alkeran) Mercaptopurine (Purinethol) Methotrexate (Rheumatrex)

98C

Name

Antimetabolite

CML

Tyrosine kinase inhibitor Antiandrogen

Niraparib (Zejula)

Epithelial carcinoma, fallopian tube or peritoneal cancer

PARP inhibitor

Nivolumab (Opdivo)

Melanoma, unresectable or metastatic, head and neck cancer, squamous cell (recurrent or metastatic), Hodgkin lymphoma, NSCLC, metastatic, renal cell cancer, advanced CLL, follicular lymphoma

Miscellaneous

Fatigue, dyspnea, musculoskeletal pain, decreased appetite, cough, nausea, constipation

Monoclonal antibody Monoclonal antibody Miscellaneous

Infusion reactions, thrombocytopenia, febrile neutropenia, lymphopenia, bone marrow failure, tumor lysis syndrome Fever, cough, diarrhea, fatigue, rash, infections, septic shock, neutropenia, thrombocytopenia, infusion reactions Anemia, fatigue, nausea, vomiting, diarrhea, dysgeusia, dyspepsia, headache, decreased appetite

CLL Ovarian cancer, advanced

99C

Continued

CLASSIFICATIONS

Obinutuzumab (Gazyva) Ofatumumab (Arzerra) Olaparib (Lynparza)

Prostate cancer, metastatic

Kinase inhibitor

Anemia, neutropenia, thrombocytopenia, nausea, vomiting, diarrhea, fatigue, fever, dyspnea, severe neurologic events (convulsions, peripheral neuropathy) Diarrhea, nausea, abdominal pain, fatigue, vomiting, stomatitis, muscle spasms increase AST/ALT, UTI Rash, pruritus, nausea, fatigue, headache, constipation, diarrhea, vomiting, thrombocytopenia, neutropenia Hypertension, angina, hot flashes, nausea, anorexia, increased hepatic enzymes, dizziness, dyspnea, visual disturbances, impaired adaptation to dark, constipation, decreased libido Thrombocytopenia, anemia, neutropenia, leukopenia, palpitations, nausea, vomiting, stomatitis, UTI, elevated AST/ALT, dyspnea, hypertension

Chemotherapeutic Agents

T-cell acute lymphoblastic leukemia/lymphoma Breast cancer



Nelarabine (Arranon) Neratinib (Nerlynx) Nilotinib (Tasigna) Nilutamide (Nilandron)

Uses

Category

Olaratumab (Lartruvo)

Soft tissue sarcoma

Nausea, fatigue, musculoskeletal pain, mucositis, alopecia, vomiting, neuropathy, headache

Omacetaxine (Synribo) Osimertinib (Tagrisso) Oxaliplatin (Eloxatin)

CML NSCLC, metastatic

PDGFR-alpha blocking antibody Protein synthesis inhibitor Kinase inhibitor

Colon cancer

Alkylating agent

Paclitaxel (Taxol)

Breast cancer, Kaposi sarcoma, NSCLC, ovarian cancer Breast cancer, advanced

Antimicrotubular

Colorectal cancer metastatic Multiple myeloma

Monoclonal antibody Miscellaneous

Renal cell carcinoma, soft tissue sarcoma

Kinase inhibitor

Fatigue, neuropathy, abdominal pain, dyspnea, diarrhea, nausea, vomiting, anorexia, fever, edema, chest pain, anemia, thrombocytopenia, thromboembolism, altered hepatic function tests Hypertension, bradycardia, ECG changes, nausea, vomiting, diarrhea, mucositis, myelosuppression, alopecia, peripheral neuropathies, hypersensitivity reaction, arthralgia, myalgia Neutropenia, leukopenia, fatigue, anemia, upper respiratory tract infection, nausea, stomatitis, alopecia, diarrhea, thrombocytopenia, decreased appetite, vomiting, asthenia, peripheral neuropathy, epistaxis Pulmonary fibrosis, severe dermatologic toxicity, infusion reactions, abdominal pain, nausea, vomiting, constipation, skin rash, fatigue Diarrhea, fatigue, nausea, peripheral edema, decreased appetite, pyrexia, vomiting Diarrhea, hypertension, nausea, fatigue, vomiting, hepatotoxicity, hemorrhagic events

Palbociclib (Ibrance) Panitumumab (Vectibix) Panobinostat (Farydak) Pazopanib (Votrient)

Kinase inhibitor

Side Effects

Diarrhea, nausea, fatigue, pyrexia, asthenia, vomiting, anorexia, headache, thrombocytopenia, neutropenia, leukopenia, lymphopenia Diarrhea, rash, dry skin, nail toxicity

Chemotherapeutic Agents

Name

100C

CHEMOTHERAPEUTIC AGENTS—cont’d

Pemetrexed (Alimta) Pentostatin (Nipent)

NSCLC, nonsquamous, mesothelioma Hairy cell leukemia

Antimetabolite

Pertuzumab (Perjeta) Pomalidomide (Pomalyst) Ponatinib (Iclusig) Procarbazine (Matulane)

Breast cancer, metastatic Multiple myeloma, relapsed/refractory ALL, CML

HER2/neu receptor antagonist Immunomodulator Kinase inhibitor

Hodgkin lymphoma, NHLs, CNS tumors

Alkylating agent

Ramucirumab (Cyramza)

Colorectal cancer, metastatic, gastric cancer, advanced or metastatic, NSCLC, metastatic Colorectal cancer, GIST

Miscellaneous

Regorafenib (Stivarga)

Antibiotic

VEGF inhibitor

Hypotension, anorexia, nausea, vomiting, hepatotoxicity, pancreatitis, depression of clotting factors, malaise, confusion, lethargy, EEG changes, respiratory distress, hypersensitivity reaction, fever, hyperglycemia, stomatitis Anorexia, constipation, diarrhea, neuropathy, anemia, chest pain, dyspnea, rash, fatigue Nausea, vomiting, hepatic disorders, elevated hepatic function tests, leukopenia, anemia, thrombocytopenia, rash, fever, upper respiratory infection, fatigue, hematuria, headaches, myalgia, arthralgia, diarrhea, anorexia Alopecia, diarrhea, nausea, neutropenia, rash, fatigue, peripheral neuropathy Dyspnea, fatigue, peripheral edema, anorexia, rash, neutropenia, leukopenia, thrombocytopenia Abdominal pain, rash, fatigue, hypertension, pyrexia, myelosuppression, arthralgia, vomiting Nausea, vomiting, stomatitis, diarrhea, constipation, myelosuppression, pruritus, hyperpigmentation, alopecia, myalgia, paresthesia, confusion, lethargy, mental depression, fever, hepatic toxicity, arthralgia, respiratory disorders Diarrhea, hypertension

Asthenia, fatigue, mucositis, weight loss, fever, GI perforation, hemorrhage, infections, palmer-planter erythrodysesthesia syndrome (PPES) Continued

101C CLASSIFICATIONS

Miscellaneous

Chemotherapeutic Agents

ALL



Pegaspargase (Oncaspar)

Uses

Category

Ribociclib (Kisqali) Rituximab (Rituxan)

Breast cancer, metastatic or advanced CLL, NHL

Kinase inhibitor

Neutropenia, nausea, fatigue, diarrhea, leukopenia, alopecia, vomiting, headache

Monoclonal antibody

Rucaparib (Rubraca) Sipuleucel-T (Provenge) Sonidegib (Odomzo)

Ovarian cancer, advanced Prostate cancer, metastatic Basal cell carcinoma, locally advanced

PARP inhibitor

Hypotension, arrhythmias, peripheral edema, nausea, vomiting, abdominal pain, leukopenia, thrombocytopenia, neutropenia, rash, pruritus, urticaria, angioedema, myalgia, headaches, dizziness, throat irritation, rhinitis, bronchospasm, hypersensitivity reaction Nausea, fatigue, vomiting, anemia, decreased appetite, diarrhea, thrombocytopenia, dyspnea, increased AST/ALT, decreased Hgb, platelets, ANC Chills, fatigue, fever, back pain, nausea, headache, joint ache

Sorafenib (Nexavar)

Hepatocellular cancer, renal cell cancer, advanced, thyroid cancer GIST, pancreatic neuroendocrine tumors, advanced, renal cell carcinoma, advanced Breast cancer

Tyrosine kinase inhibitor

Breast cancer

PARP inhibitor

Sunitinib (Sutent) Tamoxifen (Nolvadex-D) Talazoparib ­(Talzenna)

Miscellaneous Hedgehog pathway inhibitor

Side Effects

Muscle spasms, alopecia, dysgeusia, fatigue, nausea, diarrhea, decreased weight, musculoskeletal pain, myalgia, headache, abdominal pain, vomiting, pruritus Fatigue, alopecia, nausea, vomiting, anorexia, constipation, diarrhea, neuropathy, dyspnea, cough, asthenia, pain

Tyrosine kinase inhibitor

Hypotension, edema, fatigue, headache, fever, dizziness, rash, hyperpigmentation, diarrhea, nausea, dyspepsia, altered taste, vomiting, neutropenia, thrombocytopenia, increased ALT/AST

Estrogen receptor antagonist

Skin rash, nausea, vomiting, anorexia, menstrual irregularities, hot flashes, pruritus, vaginal discharge or bleeding, myelosuppression, headaches, tumor or bone pain, ophthalmic changes, weight gain, confusion Fatigue, hyperglycemia, nausea, decreased Hgb, anemia, neutropenia, increased serum AST, ALT, alkaline phosphatase

Chemotherapeutic Agents

Name

102C

CHEMOTHERAPEUTIC AGENTS—cont’d

Alkylating agent

Bladder cancer, papillary, breast cancer

Alkylating agent

Tipiracil/trifluridine (Lonsurf) Tisagenlecleucel (Kymriah)

Colorectal cancer, metastatic Acute lymphoblastic leukemia (relapsed/refractory); diffuse large B-cell lymphoma (relapsed/refractory) Cervical cancer, recurrent or resistant, ovarian cancer, metastatic, SCLC, relapsed Breast cancer

Miscellaneous

Toremifene (Fareston)

Chimeric antigen receptor T-cell immunotherapy Camptothecin

Nausea, vomiting, diarrhea, constipation, abdominal pain, stomatitis, anorexia, neutropenia, leukopenia, thrombocytopenia, anemia, alopecia, headaches, dyspnea, paresthesia

Estrogen receptor antagonist

Elevated hepatic function tests, nausea, vomiting, constipation, skin discoloration, dermatitis, dizziness, hot flashes, diaphoresis, vaginal discharge or bleeding, ocular changes, cataracts, anxiety Continued

103C CLASSIFICATIONS

Topotecan (Hycamtin)

mTOR kinase inhibitor Antimetabolite

Amnesia, fever, infection, leukopenia, neutropenia, peripheral edema, seizures, thrombocytopenia Rash, asthenia, mucositis, nausea, edema, anorexia, thrombocytopenia, leukopenia Anorexia, stomatitis, myelosuppression, hyperuricemia, nausea, vomiting, diarrhea Anorexia, nausea, vomiting, mucositis, myelosuppression, amenorrhea, reduced spermatogenesis, fever, hypersensitivity reactions, pain at injection site, headaches, dizziness, alopecia Asthenia, fatigue, nausea, diarrhea, vomiting, decreased appetite, pyrexia, abdominal pain Hypotension, tachycardia, hypertension, hypokalemia, hypophosphatemia, decreased appetite, vomiting, diarrhea, nausea, anemia, neutropenia, thrombocytopenia, lymphocytopenia, leukopenia, infection, acute renal failure, fever

Chemotherapeutic Agents

Anaplastic astrocytoma, glioblastoma multiforme Renal cell carcinoma, advanced AML



Temozolomide (Temodar) Temsirolimus (Torisel) Thioguanine (Tabloid) Thiotepa (Thioplex)

Uses

Category

Soft tissue sarcoma

Alkylating agent

Trametinib (Mekinist) Trastuzumab (Herceptin)

Melanoma, metastatic or unresectable Gastric cancer, metastatic, breast cancer, metastatic Acute promyelocytic leukemia

MEK inhibitor

Bladder cancer

Anthracycline

HF, heart murmur (S3 gallop), nausea, vomiting, diarrhea, abdominal pain, anorexia, rash, peripheral edema, back or bone pain, asthenia (loss of strength, energy), headaches, insomnia, dizziness, cough, dyspnea, rhinitis, pharyngitis Flushing, nausea, vomiting, diarrhea, constipation, dyspepsia, mucositis, leukocytosis, dry skin/mucous membranes, rash, pruritus, alopecia, dizziness, anxiety, insomnia, headaches, depression, confusion, intracranial hypertension, agitation, dyspnea, shivering, fever, visual changes, earaches, hearing loss, bone pain, myalgia, arthralgia Dysuria, hematuria, urinary frequency/incontinence/urgency

Thyroid cancer, medullary Melanoma, metastatic or unresectable CLL

Tyrosine kinase inhibitor Kinase inhibitor

Diarrhea, rash, acne, nausea, hypertension, headache, fatigue, decreased appetite, abdominal pain Arthralgia, alopecia, fatigue, malignancies, dermatological reactions

BCL-2 inhibitor

Mycosis fungoides, Hodgkin lymphoma, lymphocytic lymphoma, testicular cancer, Kaposi sarcoma

Vinca alkaloid

Diarrhea, neutropenia, anemia, nausea, upper respiratory tract infections, thrombocytopenia, fatigue Nausea, vomiting, stomatitis, constipation, myelosuppression, alopecia, peripheral neuropathy, loss of deep tendon reflexes, paresthesia, diarrhea

Tretinoin (Vesanoid)

Valrubicin (Valstar) Vandetanib (Caprelsa) Vemurafenib (Zelboraf) Venetoclax (Vencelexta) Vinblastine (Velban)

Monoclonal antibody Miscellaneous

Side Effects Nausea, vomiting, fatigue, diarrhea, decreased appetite, peripheral edema, dyspnea, headache, increased ALT, AST, alkaline phosphatase, neutropenia, thrombocytopenia, anemia Rash, peripheral edema, pyrexia, malignancies, fatigue, hemorrhagic events, HF

Chemotherapeutic Agents

Name Trabectedin (Yondelis)

104C

CHEMOTHERAPEUTIC AGENTS—cont’d

Vincristine liposomal (Marqibo) Vinorelbine (Navelbine)

Vorinostat (Zolinza) ziv-aflibercept (Zaltrap)

Vinca alkaloid

Nausea, vomiting, stomatitis, constipation, pharyngitis, polyuria, myelosuppression, alopecia, numbness, paresthesia, peripheral neuropathy, loss of deep tendon reflexes, headaches, abdominal pain

Vinca alkaloid

Constipation, nausea, pyrexia, fatigue, peripheral neuropathy, febrile neutropenia, diarrhea, anemia, reduced appetite, insomnia

NSCLC

Vinca alkaloid

Basal cell carcinoma, metastatic or locally advanced Cutaneous T-cell lymphoma Colorectal cancer, metastatic

Hedgehog pathway inhibitor

Elevated LFT, nausea, vomiting, constipation, ileus, anorexia, stomatitis, myelosuppression, alopecia, vein discoloration, venous pain, phlebitis, interstitial pulmonary changes, asthenia, fatigue, diarrhea, peripheral neuropathy, loss of deep tendon reflexes Alopecia, muscle spasms, dysgenesia, weight loss, fatigue, nausea, diarrhea, reduced appetite, vomiting, arthralgia

Histone deacetylase inhibitor Miscellaneous

Diarrhea, fatigue, nausea, thrombocytopenia, anorexia, dysgeusia Leukopenia, neutropenia, diarrhea, proteinuria, increased ALT/AST, stomatitis, thrombocytopenia, hypertension, epistaxis, headache, abdominal pain

AV, Atrioventricular; C, capsules; EEG, electroencephalogram; ECG, electrocardiogram; Gl, gastrointestinal; HF, heart failure; I, injection; LFT, liver function test; T, tablets; UTI, urinary tract infection.

Chemotherapeutic Agents

Vismodegib (Erivedge)

ALL, Hodgkin lymphoma, non-Hodgkin lymphomas, Wilm’s tumor, neuroblastoma, rhabdomyosarcoma ALL



Vincristine (Oncovin)

105C CLASSIFICATIONS

ACTION

CLASSIFICATION

Combination oral contraceptives decrease fertility primarily by inhibition of ovulation. In addition, they can promote thickening of the cervical mucus, thereby creating a physical barrier for the passage of sperm. Also, they can modify the endometrium, making it less favorable for nidation.

Oral contraceptives either contain both an estrogen and a progestin (combination oral contraceptives) or contain only a progestin (progestin-only oral contraceptives). The combination oral contraceptives have four subgroups: Monophasic: Daily estrogen and progestin dosage remains constant.

Biphasic: Estrogen remains constant, but the progestin dosage increases during the second half of the cycle. Triphasic: Progestin changes for each phase of the cycle. Four-phasic: Contains four progestin/estrogen dosing combinations during the 20-day cycle.

COMMON COMPLAINTS WITH ORAL CONTRACEPTIVES Too much estrogen Too little estrogen Too much progestin Too little progestin Too much androgen

Nausea, bloating, breast tenderness, increased B/P, melasma, headache Early or midcycle breakthrough bleeding, increased spotting, hypomenorrhea Breast tenderness, headache, fatigue, changes in mood Late breakthrough bleeding Increased appetite, weight gain, acne, oily skin, hirsutism, decreased libido, increased breast size, breast tenderness, increased LDL cholesterol, decreased HDL cholesterol

B/P, Blood pressure; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

106C Contraception

Contraception

CONTRACEPTIVES

Aubra Aviane Falmina Lessina Lutera Orsythia Sronyx Junel 1/20 Junel Fe 1/20 Loestrin Fe 1/20 Microgestin Fe 1/20 Tarina Fe 1/20 Altavera Levora Marlissa Portia-28 Cryselle-28 Lo/Ovral-28 Low-Ogestrel-28 Junel 1.5/30 Junel Fe 1.5/30 Larin 1.5/30 Loestrin Fe 1.5/30 Microgestin 1.5/30 Microgestin Fe 1.5/30

EE 20 mcg

Levonorgestrel 0.1 mg

EE 20 mcg

Norethindrone 1 mg

EE 30 mcg

Levonorgestrel 0.15 mg

EE 30 mcg

Norgestrel 0.3 mg

EE 30 mcg

Norethindrone acetate 1.5 mg

107C

Continued

CLASSIFICATIONS

Progestin Content

Contraception

Estrogen Content



Name Low-Dose Monophasic Pills

Name

Estrogen Content

Progestin Content

Apri Desogen Reclipsen Yasmin Ocella Syeda Kelnor 1/35 Zovia 1/35 Ortho-Cyclen Mononessa Previfem Sprintec Necon 1/50 Norinyl 1+50 Balziva Femcon Fe Brevicon-28 Necon 0.5/35 Nortrel 0.5/35 Nortrel 1/35 Ortho-Novum 1/35–28

EE 30 mcg

Desogestrel 0.15 mg

EE 30 mcg

Drospirenone 3 mg

EE 35 mcg

Ethynodiol diacetate 1 mg

EE 35 mcg

Norgestimate 0.25 mg

Mestranol 50 mcg

Norethindrone 1 mg

EE 35 mcg

Norethindrone 0.4 mg

EE 35 mcg

Norethindrone 0.5 mg (total of 10.5 mg/cycle)

EE 35 mcg

Norethindrone 1 mg (total of 21 mg/cycle)

108C Contraception

CONTRACEPTIVES—cont’d

High-Dose Monophasic Pills EE 50 mcg EE 50 mcg

Ethynodiol diacetate 1 mg Norgestrel 0.5 mg

EE 20 mcg × 21 days, placebo × 2 days, 10 mcg × 5 days

Desogestrel 0.15 mg × 21 days

EE 20 mcg × 5 days, 30 mcg × 7 days, 35 mcg × 9 days EE 25 mcg × 21 days EE 25 mcg × 21 days

Norethindrone 1 mg × 21 days

EE 30 mcg × 6 days, 40 mcg × 5 days, 30 mcg × 10 days EE 35 mcg × 21 days

Levonorgestrel 0.05 mg × 6 days, 0.075 mg × 5 days, 0.125 mg × 10 days Norgestimate 0.18 mg × 7 days, 0.215 mg × 7 days, 0.25 mg × 7 days

EE 35 mcg × 21 days

Norethindrone 0.5 mg × 7 days, 1 mg × 9 days, 0.5 mg × 5 days

EE 35 mcg × 21 days

Norethindrone 0.5 mg × 7 days, 0.75 mg × 7 days, 1 mg × 7 days



Zovia 1/50–28 Ogestrel 0.5/50–28

Biphasic Pills Azurette Kariva Mircette

Triphasic Pills

Norgestimate 0.18 mg × 7 days, 0.215 mg × 7 days, 0.25 mg × 7 days Desogestrel 0.1 mg × 7 days, 0.125 mg × 7 days, 0.15 mg × 7 days

Continued

Contraception 109C

CLASSIFICATIONS

Tilia Tri-Legest Fe Ortho Tri-Cyclen Lo Caziant Cyclessa Velivet Enpresse Trivora Ortho Tri-Cyclen Tri-Previfem Tri-Sprintec Aranelle Leena Ortho-Novum 7/7/7 Nortrel 7/7/7

Name Four Phasic

Estrogen Content

Progestin Content

Natazia

Estradiol 3 mg × 2 days, then 2 mg × 22 days, then 1 mg × 2 days, then 2-day pill-free interval

Dienogest none × 2 days, then 2 mg × 5 days, then 3 mg × 17 days, then none for 4 days

EE 20 mcg × 24 days EE 30 mcg × 84 days EE 20 mcg × 42 days, 25 mcg × 21 days, 30 mcg × 21 days, then 10 mcg × 7 days EE 30 mcg × 84 days, 10 mcg × 7 days EE 20 mcg × 24 days

Norethindrone 1 mg × 24 days Levonorgestrel 0.15 mg × 84 days Levonorgestrel 0.15 mg × 84 days

EE 20 mcg

Levonorgestrel 90 mcg

N/A

Norethindrone 0.35 mg

N/A N/A

Levonorgestrel 0.75-mg tablets taken 12 hrs apart Ulipristal 30 mg one time within 5 days after unprotected intercourse

Extended-Cycle Pills Loestrin FE Jolessa Quartette Seasonique Yaz Gianvi

Levonorgestrel 0.15 mg × 84 days Drospirenone 3 mg × 24 days

Continuous Cycle Pill Amethyst

Progestin-Only Pills Camilla Errin Jolivette Nora-BE

Emergency Contraception Plan B Ella

110C Contraception

CONTRACEPTIVES—cont’d



Depo-Provera CI Medroxyprogesterone Acetate Depo-SubQ Provera 104 Kyleena Liletta Mirena NuvaRing Skyla

None

Medroxyprogesterone 150 mg

None None None None Ethinyl estradiol 15 mcg/day None

Medroxyprogesterone 104 mg 19.5 mg for 5 yrs 52 mg for 3 yrs Levonorgestrel 20 mcg/day for 5 yrs Etonogestrel 0.12 mg/day 13.5 mg for 3 yrs

ACTION Suppress migration of polymorphonuclear leukocytes (PML) and reverse increased capillary permeability by their anti-inflammatory effect. Suppress immune system by decreasing activity of lymphatic system.

111C

USES Replacement therapy in adrenal insufficiency, including Addison’s disease. Symptomatic treatment of multiorgan disease/conditions. Rheumatoid arthritis (RA), osteoarthritis, severe psoriasis, ulcerative colitis, lupus erythematosus, anaphylactic shock, acute exacerbation of asthma, status asthmaticus, organ transplant.

Corticosteroids

Corticosteroids

CLASSIFICATIONS

Hormonal Alternative to Oral Contraception

Name

Availability

Beclomethasone (Beconase, Qnasl, QVAR)

Aerosol (oral inhalation), QVAR: 40 mcg/­ inhalation, 80 mcg/inhalation Aerosol (spray, intranasal), Qnasl: 80 mcg/­ inhalation Suspension (intranasal), Beconase: 42 mcg/ inhalation I: 6 mg/ml

Betamethasone (Celestone) Budesonide (Pulmicort, Rhinocort) Cortisone (Cortone) Dexamethasone (Decadron) Fludrocortisone (Florinef) Flunisolide (Nasalide) Fluticasone (Flonase, Flovent) Hydrocortisone (Solu-Cortef) Methylprednisolone (Solu-Medrol)

Nasal: 32 mcg/spray Suspension for nebulization: 250 mcg, 500 mcg T: 5 mg, 10 mg, 25 mg

Route of Administration

Side Effects

Inhalation, intranasal

I: Cough, dry mouth/throat, headaches, throat irritation, increased blood glucose Nasal: Headaches, sore throat, intranasal ulceration, increased blood glucose

IV, intralesional, intra-articular Intranasal

Nausea, vomiting, increased appetite, weight gain, insomnia, increased blood glucose Headaches, sore throat, intranasal ulceration, increased blood glucose Insomnia, nervousness, increased appetite, indigestion, increased blood glucose Insomnia, weight gain, increased appetite, increased blood glucose

PO

T: 0.5 mg, 1 mg, 4 mg, 6 mg OS: 0.5 mg/5 ml I: 4 mg/ml, 10 mg/ml T: 0.1 mg

PO, parenteral

Nasal: 25 mcg/spray

Inhalation, intranasal

Inhalation: 44 mcg, 110 mg, 220 mcg Nasal: 50 mg, 100 mcg T: 5 mg, 10 mg, 25 mg I:100 mg, 250 mg, 500 mg, 1 g T: 4 mg I: 40 mg, 125 mg, 500 mg, 1 g, 2 g

Inhalation, intranasal

PO

PO, parenteral PO, parenteral

Edema, headache, peptic ulcer, increased blood glucose Headache, nasal congestion, pharyngitis, upper respiratory infections, altered taste/ smell, increased blood glucose Headache, burning/stinging, nasal congestion, upper respiratory infections, increased blood glucose Insomnia, headache, nausea, vomiting, increased blood glucose Headache, insomnia, nervousness, increased appetite, nausea, vomiting, increased blood glucose

112C Corticosteroids

CORTICOSTEROIDS

T: 5 mg OS: 5 mg/5 ml, 15 mg/5 ml T: 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg

PO

Triamcinolone (Kenalog, Nasacort AQ)

Injection, suspension: 10 mg/ml, 40 mg/ml Intranasal, suspension: 55 mcg/ inhalation

IM, inhalation (nasal)

PO

Headache, insomnia, weight gain, nausea, vomiting, increased blood glucose Headache, insomnia, weight gain, nausea, vomiting, increased blood glucose PO: Insomnia, increased appetite, nausea, vomiting, increased blood glucose I: Cough, dry mouth/throat, headaches, throat irritation, increased blood glucose



Prednisolone (Prelone) Prednisone

I, Injection; OS, oral suspension; T, tablets.

Corticosteroids 113C CLASSIFICATIONS

114C Diuretics

Diuretics USES

ACTION

Thiazides: Management of edema resulting from a number of causes (e.g., HF, hepatic cirrhosis); hypertension either alone or in combination with other antihypertensives.

Increase the excretion of water/sodium and other electrolytes via the kidneys. Exact mechanism of antihypertensive effect unknown; may be due to reduced plasma volume or decreased peripheral vascular resistance. Subclassifications of diuretics are based on their mechanism and site of action.

Loop: Management of edema associated with HF, cirrhosis of the liver, and renal disease. Furosemide used in treatment of hypertension alone or in combination with other antihypertensives. Potassium-sparing: Adjunctive treatment with thiazides, loop diuretics in treatment of HF and hypertension.

Thiazides: Act at cortical diluting segment of nephron, block reabsorption of Na, CI, and water; promote excretion of Na, CI, K, and water.

Loop: Act primarily at the thick ascending limb of Henle’s loop to inhibit Na, CI, and water absorption. Potassium-sparing: Spironolactone blocks aldosterone action on distal nephron (causes K retention, Na excretion). Triamterene, amiloride act on distal nephron, decreasing Na reuptake, reducing K secretion.

DIURETICS

Chlorothiazide (­Diuril) Chlorthalidone

T: 250 mg, 500 mg S: 250 mg/5 mL I: 500 mg Hygroton: 25 mg, 50 mg, 100 mg

Hydrochlorothiazide

T: 12.5 mg, 25 mg, 50 mg C: 12.5 mg

Indapamide (Lozol)

T: 1.25 mg, 2.5 mg

Metolazone (Zaroxolyn)

T: 2.5 mg, 5 mg, 10 mg



Name Availability Thiazide, Thiazide-related

Dosage Range

Side Effects

Edema: 500–1,000 mg 1–2 times/day HTN: 500–2,000 mg/day in 1–2 divided doses

CLASS Hyperuricemia, hypokalemia, hypomagnesemia, hyperglycemia, hyponatremia, hypercalcemia, hypercholesterolemia, hypertriglyceridemia, pancreatitis, rash, photosensitivity

Edema: Initially, 50–100 mg once daily or 100 mg every other day Maximum: 200 mg/day Edema: 25–100 mg/day in 1–2 divided doses HTN: Initially, 12.5–25 mg once daily. May increase up to 50 mg/day in 1 or 2 divided doses Edema: Initially, 2.5 mg/day. May increase after 1 wk to 5 mg/day HTN: Initially, 2.5 mg/day. May increase q4wks to 2.5 mg, then to 5 mg/day Edema: 2.5–20 mg once daily HTN: 2.5–5 mg once daily

Loop

T: 5 mg, 10 mg, 20 mg, 100 mg I: 10 mg/mL

CLASS Dehydration, hypokalemia, hyponatremia, hypomagnesemia, hyperglycemia, metabolic alkalosis, hyperuricemia, blood dyscrasias, rash, hypercholesterolemia, hypertriglyceridemia

CLASSIFICATIONS

Torsemide (Demadex)

Edema: Initially, 0.5–2 mg/dose 1–2 times/day Maximum: 10 mg/day HTN: 20–80 mg/day in 2 divided doses Edema: PO: 20–80 mg/dose. May increase by 20–40 mg/dose up to 600 mg/day. IV: 20–40 mg/dose. May increase by 20 mg/dose. Maximum: 200 mg/dose Edema: 10–200 mg/day HTN: Initially, 5 mg/day. May increase after 4–6 wks to 10 mg/day

115C

T: 0.5 mg, 1 mg, 2 mg I: 0.25 mg/mL T: 20 mg, 40 mg, 80 mg OS: 10 mg/mL, 40 mg/5 mL I: 10 mg/mL

Diuretics

Bumetanide (Bumex) Furosemide (Lasix)

Amiloride (Midamor) Eplerenone (Inspra)

T: 5 mg

Spironolactone (Aldactone)

T: 25 mg, 50 mg, 100 mg

Triamterene (Dyrenium)

C: 50 mg, 100 mg

T: 25 mg, 50 mg

HF/Edema: Initially, 5 mg/day. May increase to 10 mg/day HF: Initially, 25 mg/day, titrate to 50 mg once daily HTN: Initially, 50 mg/day. May increase to 50 mg 2 times/day Edema: 25–200 mg/day in 1 or 2 divided doses HTN: 50–100 mg/day in 1 or 2 divided doses Hypokalemia: 25–100 mg/day HF: Initially, 12.5–25 mg once daily Maximum: 50 mg/day Edema, HTN: 100–300 mg/day in 1–2 divided doses

C, Capsules; HF, heart failure; HTN, hypertension; I, injection; OS, oral solution; S, suspension; T, tablets.

Hyperkalemia, nausea, abdominal pain, diarrhea, rash, headache Hyperkalemia, hyponatremia Hyperkalemia, nausea, vomiting, abdominal cramps, diarrhea, hyponatremia, gynecomastia, menstrual abnormalities, rash Hyperkalemia, nausea, abdominal pain, nephrolithiasis

116C Diuretics

Potassium-sparing



H2 Antagonists USES

ACTION

Short-term treatment of duodenal ulcer (DU), active benign gastric ulcer (GU), maintenance therapy of DU, pathologic hypersecretory conditions (e.g., Zollinger-Ellison syndrome), gastroesophageal reflux disease (GERD), and prevention of upper GI bleeding in critically ill pts.

Inhibits gastric acid secretion by interfering with histamine at the histamine H2 receptors in parietal cells. Decreases basal acid secretion and food-stimulated acid secretion.

H2 ANTAGONISTS

Usual Adult Dose

T: 200 mg, 300 mg, 400 mg, 800 mg L: 300 mg/5 mL T: 10 mg, 20 mg, 40 mg OS: 40 mg/5 mL I: 10 mg/mL OS: 15 mg/mL C: 75 mg, 150 mg, 300 mg T: 75 mg, 150 mg, 300 mg C: 150 mg, 300 mg Syrup: 15 mg/mL I: 25 mg/mL

200–400 mg bid

Famotidine (Pepcid) Nizatidine (Axid) Ranitidine (Zantac)

Class Side Effects

20–40 mg bid 150 mg bid

Severe effects uncommon. Hepatitis, hematologic toxicity, CNS ­effects (e.g., headache, fatigue, cognitive impairment)

150 mg bid

C, Capsules; CNS, central nervous system; DT, disintegrating tablets; DU, duodenal ulcer; GERD, gastroesophageal reflux disease; GU, gastric ulcer; I, injection; L, liquid; OS, oral suspension; T, tablets.

117C

Availability

Cimetidine (Tagamet)

H2 Antagonists

Name

CLASSIFICATIONS

118C

Hepatitis C virus (HCV) is the leading blood borne infection in the US. HCV is transmitted by exposure to infected blood products. Risk factors for acquiring HCV include injection drug use, receiving contaminated blood products, needle sticks, and vertical transmis-

sion. If untreated, HCV may progress to chronic HCV and long-term sequelae including cirrhosis and hepatocellular carcinoma. There are seven known genotypes of HCV (genotypes 1–7) which impact the selection of initial therapy and treatment response. Genotype 1 is the

most common and is further subtyped into genotypes 1a and 1b. Currently, there are two indirect-acting antivirals and seven direct-acting antivirals approved for the treatment of chronic HCV

Direct Acting Antivirals (DAA) NS3/4A Protease Inhibitors (PIs): Targets the serine protease NS3/NS4 that is responsible for processing HCV polyprotein and producing new viruses.

Nonstructural Protein 5A (NS5A) Inhibitors: Suppress the NS5A protein, which is essential for viral assembly and replication.

ACTION Indirect Acting Antivirals (IAA) Alpha Interferons (peginterferons): Induces immune response against HCV, inhibiting viral replication Ribavirin: Exact mechanism unknown but has activity against several RNA and DNA viruses

Nonstructural Protein 5B (NS5B) Inhibitors: Suppress the NS5B RNA-dependent RNA polymerase that is responsible for HCV replication.

Hepatitis C Virus

Hepatitis C Virus



ANTI-HEPATITIS C VIRUS PREPARATIONS

Name

Type

Genotype

Dosage

Side Effects

Elbasvir, ­grazoprevir (­Zepatier)

DAA NS5A/NS3/4A protease inhibitor

1, 4

Fatigue, headache, nausea

Glecaprevir, pibrentasvir (Mavyret)

DAA NS5A/NS3/4A protease inhibitor

1, 2, 3, 4, 5, 6

Simeprevir (Olysio)

DAA (NS3/4A-PI)

1, 4

Sofosbuvir (Sovaldi)

DAA (NS5B)

1, 2, 3, 4

Ledipasvir, ­Sofosbuvir (Harvoni)

DAA (NS5A/NS5B)

1, 4, 5, 6

Genotype 1a: One tablet daily for 12 wks (16 wks with baseline NS5A polymorphins) Genotype 1b: One tablet daily for 12 wks Genotype 4: One tablet daily for 12 wks (16 wks p­ eginterferon/ribavirin experienced) Genotypes 1, 2, 3, 4, 5, 6: Three tablets once daily. Treatment duration 8–16 wks based on patients that are mono-­infected, and coinfected with compensated liver disease (with or ­without cirrhosis) and with or without renal impairment 150 mg once daily plus peginterferon and ribavirin for 12 wks, then additional 12–36 wks of ­peginterferon and ribavirin 150 mg once daily plus sofosbuvir for 12 wks without ­cirrhosis or 24 wks with cirrhosis Genotypes 1, 4: 400 mg once daily plus peginterferon and ribavirin for 12 wks 400 mg once daily plus simeprevir for 12 wks ­without ­cirrhosis or 24 wks with cirrhosis Genotypes 2, 3: 400 mg once daily plus ribavirin for 12 wks for ­genotype 2 or 24 wks for genotype 3 Genotype 1: One tablet (90 mg/400 mg) for 12 wks in treatment-naïve pt with or without cirrhosis and ­treatment-experienced pt without ­cirrhosis; for 24 wks for treatment-experienced pts with cirrhosis Genotypes 4, 5, 6: One tablet daily for 12 wks

Headache, fatigue, nausea, diarrhea, increased serum bilirubin

119C

Fatigue, headache, nausea, ­diarrhea, insomnia; elevations in bilirubin, l­ipase, and creatinine ­kinase

Hepatitis C Virus

(With peginterferon, ribavirin): Rash, itching, nausea, photosensitivity (With sofosbuvir): fatigue, headache, nausea, insomnia, pruritus, rash, dizziness, diarrhea (With peginterferon, ribavirin): ­Fatigue, headache, nausea, ­insomnia, anemia (With simeprevir): fatigue, ­headache, nausea, insomnia, ­pruritus, rash, ­dizziness, diarrhea

CLASSIFICATIONS

ANTI-HEPATITIS C VIRUS PREPARATIONS—cont’d

Genotype

Dosage

Side Effects

DAA (NS5A/protease inhibitor/CYP3A inhibitor/polymerase inhibitor)

1

(With ribavirin): fatigue, nausea, itching, insomnia (Without ribavirin): nausea, ­itching, insomnia

Peginterferon alfa 2a (Pegasys) Peginterferon alfa 2b (Peglntron)

IAA (Interferon) IAA (Interferon)

1, 2, 3, 4

Two ombitasvir, paritaprevir, ritonavir tablets (12.5 mg, 75 mg, 50 mg) once daily in the morning plus one ­dasabuvir 250 mg tablet 2 times/day Patients with genotype 1a or 1b with cirrhosis will also receive ribavirin for 12 wks (genotype 1a with cirrhosis: 12–24 wks based on treatment history; liver transplant pts: 24 wks) 180 mcg SQ wkly for 12–48 wks based on antiviral regimen, pt history, response 1.5 mcg/kg SQ wkly for 12–48 wks based on antiviral ­regimen, pt history, response

Ribavirin (­Copegus, ­Ribasphere)

IAA (Nucleoside ­analogue)

1, 2, 3, 4

Daclatasvir (­Daklinza) Ombitasvir, ­paritaprevir, ­ritonavir (­Technivie) Sofosbuvir/velpatasvir (Epclusa) Sofosbuvir/velpatasvir/voxilaprevir (VOSEVI)

DAA (NS5A)

3

Genotypes 2, 3 400 mg 2 times/day (with peginterferon) Genotypes 1, 4 < 75 kg: 400 mg qam and 600 mg qpm 75 kg or greater: 600 mg 2 times/day 60 mg once daily with sofosbuvir for 12 wks

DAA (NS5A/protease inhibitor/CYP3A inhibitor) DAA (NS5B/NS5A) DAA (NS5B/ NS5A/protease inhibitor)

4

Two tablets once daily with ribavirin for 12 wks

Asthenia, fatigue, nausea, ­insomnia

1, 2, 3, 4, 5, 6 1, 2, 3, 4, 5, 6

One tablet daily for 12 wks

Insomnia, anemia, headache, ­fatigue, nausea, diarrhea Headache, fatigue, diarrhea, ­nausea

1, 2, 3, 4

One tablet daily for 12 wks

(With ribavirin): fatigue, ­weakness, fever, myalgia, ­headache (With ribavirin): injection site ­reaction, fatigue, weakness, headache, rigors, fever, nausea, myalgia, insomnia, mood ­instability, hair loss (With peginterferon): fatigue, weakness, headache, rigors, ­fever, nausea, myalgia, insomnia, mood instability, hair loss Headache, fatigue

Hepatitis C Virus

Type

Ombitasvir, Paritaprevir, Ritonavir, Dasabuvir (Viekira Pak)

120C

Name



Hormones

Hormones are concerned with control of different metabolic functions in the body (e.g., rates of chemical reactions in cells, transporting substances through cell membranes, cellular metabolism [growth/secretions]). By definition, a hormone is a chemical substance secreted into body fluids by cells and has control over other cells in the body.

Some general hormones affect all or almost all cells of the body (e.g., thyroid hormone from the thyroid gland increases the rate of most chemical reactions in almost all cells of the body); other general hormones affect only specific tissue (e.g., ovarian hormones are specific to female sex organs and secondary sexual characteristics of the female).

Endocrine hormones almost never directly act intracellularly affecting chemical reactions. They first combine with hormone receptors either on the cell surface or inside the cell (cell cytoplasm or nucleus). The combination of hormone and receptors alters the function of the receptor, and the receptor is the direct cause of the hormone effects. Altered receptor function may include the following: Altered cell permeability, which causes a change in protein structure of the receptor, usually opening or closing a channel for one or more ions. The movement of these ions causes the effect of the hormone. Activation of intracellular enzymes immediately inside the cell membrane (e.g., hormone combines with receptor that then becomes the activated enzyme adenyl cyclase, which causes formation of cAMP). cAMP has effects inside the cell. It is not the hormone but cAMP that causes these effects.

121C

Regulation of hormone secretion is controlled by an internal control system, the negative feedback system: • Endocrine gland oversecretes. • Hormone exerts more and more of its effect.

Hormones

Hormones can be local or general: • L ocal hormones have specific local effects (e.g., acetylcholine, which is secreted at parasympathetic and skeletal nerve endings).

ACTION • G  eneral hormones are mostly secreted by specific endocrine glands (e.g., epinephrine/norepinephrine are secreted by the adrenal medulla in response to sympathetic stimulation), transported in the blood to all parts of the body, causing many different reactions.

CLASSIFICATIONS

USES Functions of the body are regulated by two major control systems: the nervous system and the endocrine (hormone) system. Together they maintain homeostasis and control different metabolic functions in the body.

ACTION—cont’d • T arget organ performs its function. • Too much function in turn feeds back to endocrine gland to decrease secretory rate. The endocrine system contains many glands and hormones. A summary of the important glands and their hormones secreted are as follows: The pituitary gland (hypophysis) is a small gland found in the sella turcica at the base of the brain. The pituitary is divided into two portions physiologically: the anterior pituitary (adenohypophysis) and the posterior pituitary (neurohypophysis). Six important hormones are secreted from the anterior pituitary and two from the posterior pituitary. Anterior pituitary hormones: • Growth hormone (GH) • Adrenocorticotropin (corticotropin) • Thyroid-stimulating hormone (thyrotropin) (TSH) • Follicle-stimulating hormone (FSH) • Luteinizing hormone (LH) • Prolactin Posterior pituitary hormones: • Antidiuretic hormone (vasopressin) • Oxytocin

Almost all secretions of the pituitary hormones are controlled by hormonal or nervous signals from the hypothalamus. The hypothalamus is a center of information concerned with the well-being of the body, which in turn is used to control secretions of the important pituitary hormones just listed. Secretions from the posterior pituitary are controlled by nerve signals originating in the hypothalamus; anterior pituitary hormones are controlled by hormones secreted within the hypothalamus. These hormones are as follows: • Thyrotropin-releasing hormone (TRH) releasing thyroid-stimulating hormone • Corticotropin  releasing hormone (CRH) releasing adrenocorticotropin • Growth hormone–releasing hormone (GHRH) releasing growth hormone and growth hormone inhibitory hormone (GHIH) (same as somatostatin) • Gonadotropin-releasing hormone (GnRH) releasing the two gonadotropic hormones LH and FSH • Prolactin inhibitory factor (PIF) causing inhibition of prolactin and prolactin-releasing factor

Growth Hormone (GH)

Anterior Pituitary Hormones

Adrenocorticotropin

All anterior pituitary hormones (except growth hormone) have as their principal effect stimulating target glands.

Growth hormone affects almost all tissues of the body. GH (somatotropin) causes growth in almost all tissues of the body (increases cell size, increases mitosis with increased number of cells, and differentiates certain types of cells). Metabolic effects include increased rate of protein synthesis, mobilization of fatty acids from adipose tissue, decreased rate of glucose utilization.

Thyroid-Stimulating Hormone (TSH) Thyroid-stimulating hormone controls secretion of the thyroid hormones. The thyroid gland is located immediately below the larynx on either side of and anterior to the trachea and secretes two significant hormones, thyroxine (T4) and triiodothyronine (T3), which have a profound effect on increasing the metabolic rate of the body. The thyroid gland also secretes calcitonin, an important hormone for calcium metabolism. Calcitonin promotes deposition of calcium in the bones, which decreases calcium concentration in the extracellular fluid.

Adrenocorticotropin causes the adrenal cortex to secrete adrenocortical hormones. The adrenal glands lie at the

122C Hormones

Hormones—cont’d



Luteinizing Hormone Luteinizing hormone plays an important role in ovulation and causes secretion of female sex hormones by the ovaries and testosterone by the testes.

Ovarian sex hormones are estrogens and progestins. Estradiol is the most important estrogen; progesterone is the most important progestin.

Progesterone stimulates secretion of the uterine endometrium during the latter half of the female sexual cycle, preparing the uterus for implantation of the fertilized ovum. Decreases the frequency of uterine contractions (helps prevent expulsion of the implanted ovum). Progesterone promotes development of breasts, causing alveolar cells to proliferate, enlarge, and become secretory in nature. Testosterone is secreted by the testes and formed by the interstitial cells of Leydig. Testosterone production increases under the stimulus of the anterior pituitary gonadotropic hormones. It is responsible for distinguishing characteristics of the masculine body (stimulates the growth of male sex organs and promotes the development of male secondary sex characteristics,

e.g., distribution of body hair; effect on voice, protein formation, and muscular development). Prolactin Prolactin promotes the development of breasts and secretion of milk. POSTERIOR PITUITARY HORMONES Antidiuretic Hormone (ADH) (Vasopressin) ADH can cause antidiuresis (decreased excretion of water by the kidneys). In the presence of ADH, the permeability of the renal-collecting ducts and tubules to water increases, which allows water to be absorbed, conserving water in the body. ADH in higher concentrations is a very potent vasoconstrictor, constricting arterioles everywhere in the body, increasing B/P. Oxytocin Oxytocin contracts the uterus during the birthing process, esp. toward the end of the pregnancy, helping expel the baby. Oxytocin also contracts myoepithelial cells in the breasts, causing milk to be expressed from the alveoli into the ducts so that the baby can obtain it by suckling.

123C

Continued

Hormones

Follicle-Stimulating Hormone Follicle-stimulating hormone causes growth of follicles in the ovaries before ovulation and promotes formation of sperm in the testes.

Estrogens mainly promote proliferation and growth of specific cells in the body and are responsible for development of most of the secondary sex characteristics. Primarily cause cellular proliferation and growth of tissues of sex organs/other tissue related to reproduction. Ovaries, fallopian tubes, uterus, vagina increase in size. Estrogen initiates growth of breast and milk-producing apparatus, external appearance.

CLASSIFICATIONS

superior poles of the two kidneys. Each gland is composed of two distinct parts: the adrenal medulla and the cortex. The adrenal medulla, related to the sympathetic nervous system, secretes the hormones epinephrine and norepinephrine. When stimulated, they cause constriction of blood vessels, increased activity of the heart inhibitory effects on the GI tract, and dilation of the pupils. The adrenal cortex secretes corticosteroids, of which there are two major types: mineralocorticoids and glucocorticoids. Aldosterone, the principal mineralocorticoid, primarily affects electrolytes of the extracellular fluids. Cortisol, the principal glucocorticoid, affects glucose, protein, and fat metabolism.

124C

Hormones—cont’d ACTION—cont’d Insulin promotes glucose entry into most cells, thus controlling the rate of metabolism of most carbohydrates. Insulin also affects fat metabolism. Glucagon effects are opposite those of insulin, the most important of which is increasing blood glucose

c­ oncentration by releasing it from the liver into the circulating body fluids. Somatostatin (same chemical as secreted by the hypothalamus) has multiple inhibitory effects: depresses secretion of insulin and glucagon, decreases GI motility, decreases secretions/absorption of the GI tract.

Human Immunodeficiency Virus (HIV) Infection USES Antiretroviral (ARV) agents are used in the treatment of HIV infection. An ARV regimen for treatment-naive patients generally consists of two nucleoside reverse transcriptase inhibitors (NRTIs) in combination with a third ARV medication from one of three drug classes: an integrase inhibitor (INSTI), non-nucleoside reverse transcriptase inhibitor, or a protease inhibitor (PI) with either cobicistat or ritonavir.

ACTION Nucleoside reverse transcriptase inhibitors compete with natural substrates for formation of proviral DNA by reverse transcriptase inhibiting viral replication. Nucleotide reverse transcriptase inhibitors (NtRTIs) inhibit reverse transcriptase by competing with the natural substrate deoxyadenosine triphosphate and by DNA chain termination. Non-nucleoside reverse transcriptase inhibitors ­directly bind to reverse transcriptase and block RNA-dependent and DNA-dependent DNA polymerase activities by disrupting the enzyme’s catalytic site.

Protease inhibitors (PIs) bind to the active site of HIV-1 protease and prevent the processing of viral gag and gag-pol polyprotein precursors resulting in immature, noninfectious mal particles. Fusion inhibitors interfere with the entry of HIV-1 into cells by inhibiting fusion of viral and cellular membranes. CCR5 co-receptor antagonist selectively binds to human chemokine receptor CCR5 present on cell membrane preventing HIV-1 from entering cells. Integrase inhibitor inhibits catalytic activity of HIV-1 integrase, an HIV-1 encoded enzyme required for viral replication.

Human Immunodeficiency Virus (HIV) Infection

PANCREAS The pancreas is composed of two tissue types: acini (secrete digestive juices in the duodenum) and islets of Langerhans (secrete insulin/glucagons directly into the blood). The islets of Langerhans contain three cells: alpha, beta, and delta. Alpha cells secrete glucagon, beta cells secrete insulin, and delta cells secrete somatostatin.

Side Effects Nausea, vomiting, malaise, rash, fever, headaches, asthenia, fatigue, hypersensitivity reactions Peripheral neuropathy, pancreatitis, diarrhea, nausea, vomiting, headaches, insomnia, rash, hepatitis, seizures

T: 300 mg OS: 20 mg/mL

A: 300 mg 2 times/day or 600 mg once daily

Didanosine (Videx EC)

DR: 125 mg, 200 mg, 250 mg, 400 mg OS: 2 g/bottle, 4 g/bottle

Emtricitabine (Emtriva)

C: 200 mg OS: 10 mg/mL

DR (weighing 60 kg or more): 400 mg once daily; (weighing 25–59 kg): 250 mg once daily; (weighing 20–24 kg): 200 mg once daily OS (weighing more than 60 kg): 200 mg q12h or 400 mg once daily; (weighing less than 60 kg): 125 mg q12h or 250 mg once daily A: 200 mg/day (C) 240 mg/day (OS)

Lamivudine (Epivir)

T: 100 mg, 150 mg, 300 mg OS: 5 mg/mL, 10 mg/mL

A: 150 mg 2 times/day or 300 mg once daily C: 4 mg/kg 2 times/day

Stavudine (Zerit)

C: 15 mg, 20 mg, 30 mg, 40 mg OS: 1 mg/mL

Zidovudine (Retrovir)

C: 100 mg T: 300 mg Syrup: 50 mg/5 mL, 10 mg/mL

A (weighing more than 60 kg): 40 mg 2 times/ day (20 mg 2 times/day if peripheral neuropathy occurs); (weighing 60 kg or less): 30 mg 2 times/ day (15 mg 2 times/day if peripheral neuropathy occurs) A: 300 mg 2 times/day

Headaches, insomnia, depression, diarrhea, nausea, vomiting, rhinitis, asthenia, rash Diarrhea, malaise, fatigue, headaches, nausea, vomiting, abdominal pain, peripheral neuropathy, arthralgia, myalgia, skin rash Peripheral neuropathy, anemia, leukopenia, neutropenia

Anemia, granulocytopenia, myopathy, nausea, malaise, fatigue, insomnia Continued

125C

Abacavir (Ziagen)

Human Immunodeficiency Virus (HIV) Infection

Dosage Range

CLASSIFICATIONS

Name Availability Nucleoside Analogues



ANTIRETROVIRAL AGENTS FOR TREATMENT OF HIV INFECTION

126C

ANTIRETROVIRAL AGENTS FOR TREATMENT OF HIV INFECTION—cont’d

Nucleotide Analogues T: 25 mg

A: 25 mg once daily

Tenofovir TDF (Viread)

T: 300 mg

A: 300 mg once daily

Headache, abdominal pain, fatigue, cough, nausea, back pain Nausea, vomiting, diarrhea, headache, fatigue

Non-nucleoside Analogues Delavirdine (Rescriptor) Efavirenz (Sustiva) Etravirine (Intelence) Nevirapine (Viramune, Viramune XR) Rilpivirine (Edurant)

T: 100 mg, 200 mg

T: 200 mg T (ER): 400 mg S: 50 mg/mL T: 25 mg

A: 200 mg/day for 14 days, then (if no rash) 200 mg 2 times/day

Rash, nausea, headaches, elevated hepatic function tests Headaches, dizziness, insomnia, fatigue, rash, nightmares Skin reactions (e.g., Stevens-Johnson syndrome, erythema multiforme), nausea, abdominal pain, vomiting Rash, nausea, fatigue, fever, headaches, abnormal hepatic function tests

A: 25 mg once daily with a meal

Depression, insomnia, headache, rash

C: 100 mg, 150 mg, 200 mg, 300 mg T: 400 mg, 600 mg

A: 400 mg/day or 300 mg (with 100 mg ritonavir) once daily A: 600 mg 2 times/day (with ritonavir 100 mg) or 800 mg once daily with ritonavir 100 mg A: 1,400–2,800 mg/day with 100 mg ritonavir

Headaches, diarrhea, abdominal pain, nausea, rash Diarrhea, nausea, vomiting, headaches, skin rash, constipation Headaches, fatigue, rash, nausea, diarrhea, vomiting, abdominal pain

C: 50 mg, 200 mg T: 600 mg T: 100 mg, 200 mg

A: 200 mg 3 times/day for 14 days, then 400 mg 3 times/day A: 600 mg/day C: 200–600 mg/day based on weight A: 200 mg 2 times/day

Protease Inhibitors Atazanavir (Reyataz) Darunavir (Prezista) Fosamprenavir (Lexiva)

T: 700 mg OS: 50 mg/mL

Human Immunodeficiency Virus (HIV) Infection

Tenofovir TAF (Vemlidy)



Availability

Dosage Range

Side Effects

Indinavir (Crixivan)

C: 200 mg, 400 mg

A: 800 mg q8h or 800 mg 2 times/day with ­ritonavir 100 mg

Lopinavir/ritonavir (Kaletra)

C: 133/33 mg OS: 80/20 mg

Nelfinavir (Viracept)

T: 250 mg Oral Powder: 50 mg/g C: 100 mg OS: 80 mg/mL

A: 400 mg/100 mg 2 times/day or 800 mg/200 mg once daily C (4–12 yrs): 10–13 mg/kg 2 times/day A: 750 mg q8h or 1,250 mg 2 times/day C: 20–25 mg/kg q8h A: Titrate up to 800 mg/day based on protease inhibitor

Nephrolithiasis, hyperbilirubinemia, abdominal pain, asthenia, fatigue, flank pain, nausea, vomiting, diarrhea, headaches, insomnia, dizziness, altered taste Diarrhea, nausea, vomiting, abdominal pain, headaches, rash

Ritonavir (Norvir) Saquinavir (Invirase)

C: 200 mg T: 500 mg

A: 1,000 mg 2 times/day with ritonavir 100 mg

Tipranavir (Aptivus)

C: 250 mg OS: 100 mg/mL

A: 500 mg (with 200 mg ritonavir) 2 times/day

I: 108 mg (90 mg when reconstituted)

Subcutaneous: 90 mg 2 times/day

Diarrhea, fatigue, asthenia, headaches, hypertension, impaired concentration Nausea, vomiting, diarrhea, altered taste, fatigue, elevated LFTs and triglyceride levels Diarrhea, elevated LFTs, hypertriglycerides, cholesterol, abnormal fat accumulation, hyperglycemia Diarrhea, nausea, fatigue, headaches, vomiting

Fusion Inhibitors Insomnia, depression, peripheral neuropathy, decreased appetite, constipation, asthenia, cough Continued

127C CLASSIFICATIONS

Enfuvirtide (Fuzeon)

Human Immunodeficiency Virus (HIV) Infection

Name

128C

ANTIRETROVIRAL AGENTS FOR TREATMENT OF HIV INFECTION—cont’d

CCR5 Antagonists Maraviroc (Selzentry)

A: 300 mg 2 times/day CYP3A4 inducers: 600 mg 2 times/day CYP3A4 inhibitors: 150 mg 2 times/day

Cough, pyrexia, upper respiratory tract infections, rash, musculoskeletal symptoms, abdominal pain, dizziness

T: 400 mg T: 50 mg

A: 400 mg 2 times/day A: 50 mg once daily or 50 mg bid (with CYP3A inducers or resistance)

Nausea, headache, diarrhea, pyrexia Insomnia, headache

I: 200 mg

IV: Initially, 2000 mg as a single dose, then 800 mg q14days

Dizziness, diarrhea; decreased Hgb, leukocytes, neutrophils, platelets; increased serum bilirubin, creatinine

Integrase Inhibitor Raltegravir (Isentress) Dolutegravir (Tivicay)

Monoclonal Antibody Ibalizumab-uiyk ­(Trogarzo)

A, Adults; C, capsules; C (dosage), children; DR, delayed-release; ER, extended-release; I, injection; OS, oral solution; S, suspension; T, tablets; TAF, tenofovir alafenamide; TDF, tenofovir dlsoproxil fumarate.

Human Immunodeficiency Virus (HIV) Infection

T: 150 mg, 300 mg



FIXED-COMBINATION THERAPIES

Generic Name

Dosage

Atripla

Efavirenz 600 mg Emtricitabine 200 mg Tenofovir (TDF) 300 mg Bictegravir 50 mg Emtricitabine 200 mg Tenofovir (TAF) 25 mg Lamivudine 300 mg Tenofovir (TDF) 300 mg Lamivudine 150 mg Zidovudine 300 mg Emtricitabine 200 mg Rilpivirine 27.5 mg Tenofovir (TDF) 300 mg Doravirine 100 mg Lamivudine 300 mg Tenofovir 300 mg Emtricitabine 200 mg Tenofovir (TAF) 25 mg Dolutegravir 50 mg Lamivudine 300 mg Abacavir 600 mg Lamivudine 300 mg

1 tablet once daily

Cimduo Combivir Complera Delstrigo Descovy Dovato Epzicom

1 tablet once daily 1 tablet once daily 1 tablet twice daily 1 tablet once daily 1 tablet once daily 1 tablet once daily 1 tablet once daily 1 tablet once daily

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Continued

CLASSIFICATIONS

Biktarvy

Human Immunodeficiency Virus (HIV) Infection

Brand Name

Evotaz

Juluca Odefsey Prezcobix Stribild

Symfi Symtuza

1 tablet once daily

Emtricitabine 200 mg Rilpivirine 25 mg Tenofovir (TAF) 25 mg Cobicistat 150 mg Darunavir 800 mg Cobicistat 150 mg Elvitegravir 150 mg Emtricitabine 200 mg Tenofovir (TDF) 300 mg Efavirenz 400 mg Lamivudine 300 mg Tenofovir (TDF) 300 mg Cobicistat 150 mg Darunavir 800 mg Emtricitabine 200 mg Tenofovir 10 mg

1 tablet once daily

1 tablet once daily

1 tablet once daily

1 tablet once daily 1 tablet once daily

1 tablet once daily 1 tablet once daily

Human Immunodeficiency Virus (HIV) Infection

Genvoya

Atazanavir 300 mg Cobicistat 150 mg Cobicistat 150 mg Elvitegravir 150 mg Emtricitabine 200 mg Tenofovir (TAF) 10 mg Dolutegravir 50 mg Rilpivirine 25 mg

130C

FIXED-COMBINATION THERAPIES—cont’d

TAF, Tenofovir alafenamide; TDF, tenofovir disoproxil fumarate.

1 tablet twice daily 1 tablet once daily

Human Immunodeficiency Virus (HIV) Infection

Truvada

1 tablet once daily

131C CLASSIFICATIONS

Trizivir

Abacavir 600 mg Dolutegravir 50 mg Lamivudine 300 mg Abacavir 300 mg Lamivudine 150 mg Zidovudine 300 mg Emtricitabine 200 mg Tenofovir (TDF) 300 mg



Triumeq

132C

USES

ACTION

Improvement of both short- and long-term allograft survivals.

Basiliximab: An interleukin-2 (IL-2) receptor antagonist inhibiting IL-2 binding. This prevents activation of lymphocytes, and the response of the immune system to antigens is impaired. Cyclosporine: Inhibits production and release of IL-2. Daclizumab: An IL-2 receptor antagonist inhibiting IL-2 binding. Mycophenolate: A prodrug that reversibly binds and inhibits inosine monophosphate dehydrogenase (IMPD),

resulting in inhibition of purine nucleotide synthesis, inhibiting DNA and RNA synthesis and subsequent synthesis of T and B cells. Sirolimus: Inhibits IL-2–stimulated T-lymphocyte activation and proliferation, which may occur through formation of a complex. Tacrolimus: Inhibits IL-2–stimulated T-lymphocyte activation and proliferation, which may occur through formation of a complex.

Immunosuppressive Agents

Immunosuppressive Agents



IMMUNOSUPPRESSIVE AGENTS

Name

Availability

Dosage

Side Effects

Basiliximab (Simulect)

I: 10 mg, 20 mg

Abdominal pain, asthenia, cough, dizziness, dyspnea, dysuria, edema, hypertension, infection, tremors

Cyclosporine (Neoral, Sandimmune)

C: 25 mg, 50 mg, 100 mg S: 100 mg/mL I: 50 mg/mL

20 mg for 2 doses (on day of transplant, then 4 days after transplantation) Dose dependent on type of transplant and formulation

Mycophenolate (CellCept, Myfortic)

Cellcept: C: 250 mg I: 500 mg S: 200 mg/mL T: 500 mg Myfortic: T(DR): 180 mg, 320 mg S: 1 mg/mL T: 0.5 mg, 1 mg, 2 mg

Cellcept: 1–1.5 g 2 times/day based on type of transplant Myfortic: Renal: 720 mg 2 times/day 2–6 mg/day

C: 0.5 mg, 1 mg, 5 mg I: 5 mg/mL C(ER): 0.5 mg, 1 mg, 5 mg T(ER): 0.75 mg, 1 mg, 4 mg

Heart: 0.075 mg/kg/day in 2 divided doses q12h Kidney: 0.1–0.2 mg/kg/ day in 2 divided doses q12h Liver: 0.1–0.15 mg/kg/day in 2 divided doses q12h

133C

C, Capsules; DR, delayed release; ER, extended release; I, injection; S, oral solution or suspension; T, tablets.

CLASSIFICATIONS

Tacrolimus (Prograf)

Dyspnea, leukopenia, thrombocytopenia, hyperlipidemia, abdominal pain, acne, arthralgia, fever, diarrhea, constipation, headaches, vomiting, weight gain Nephrotoxicity, neurotoxicity, hyperglycemia, nausea, vomiting, photophobia, infections, hypertension, hyperlipidemia

Immunosuppressive Agents

Sirolimus (Rapamune)

Hypertension, hyperkalemia, nephrotoxicity, coarsening of facial features, hirsutism, gingival hyperplasia, nausea, vomiting, diarrhea, hepatotoxicity, hyperuricemia, hypertriglyceridemia, hypercholesterolemia, tremors, paresthesia, seizures, risk of infection/malignancy Diarrhea, vomiting, leukopenia, neutropenia, infections

USES

ACTION

Short-term treatment of constipation; colon evacuation before rectal/bowel examination; prevention of straining (e.g., after anorectal surgery, MI); to reduce painful elimination (e.g., episiotomy, hemorrhoids, anorectal lesions); modification of effluent from ileostomy, colostomy; prevention of fecal impaction; removal of ingested poisons.

Laxatives ease or stimulate defecation. Mechanisms by which this is accomplished include (1) attracting, retaining fluid in colonic contents due to hydrophilic or osmotic properties; (2) acting directly or indirectly on mucosa to decrease absorption of water and NaCl; or (3) increasing intestinal motility, decreasing absorption of water and NaCl by virtue of decreased transit time. Bulk-forming: Act primarily in small/large intestine. Retain water in stool, may bind water, ions in colonic lumen (soften feces, increase bulk); may increase colonic bacteria growth (increases fecal mass). Produce soft stool in 1–3 days. Osmotic agents: Act in colon. Similar to saline laxatives. Osmotic action may be enhanced in distal ileum/colon by bacterial metabolism to lactate, other organic acids. This decrease in pH increases motility, secretion. Produce soft stool in 1–3 days.

Saline: Acts in small/large intestine, colon (sodium phosphate). Poorly, slowly absorbed; causes hormone cholecystokinin release from duodenum (stimulates fluid secretion, motility); possesses osmotic properties; produces watery stool in 2–6 hrs (small doses produce semifluid stool in 6–12 hrs). Stimulant: Acts in colon. Enhances accumulation of water/electrolytes in colonic lumen, enhances intestinal motility. May act directly on intestinal mucosa. Produces semifluid stool in 6–12 hrs. Bisacodyl suppository acts in 15–60 min. Stool softener: Acts in small/large intestine. Hydrates and softens stools by its surfactant action, facilitating penetration of fat and water into stool. Produces soft stool in 1–3 days.

134C Laxatives

Laxatives



LAXATIVES

Name Bulk-forming

Onset of Action

Uses

Side Effects/Precautions

Methylcellulose ­(Citrucel)

12–24 hrs up to 3 days

Psyllium (Metamucil)

Same as methylcellulose

Treatment of constipation for postpartum women, elderly, pts with diverticulosis, irritable bowel syndrome, hemorrhoids Treatment of chronic constipation and constipation associated with rectal disorders; management of irritable bowel syndrome

Gas, bloating, esophageal obstruction, colonic obstruction, calcium and iron malabsorption Diarrhea, constipation, abdominal cramps, esophageal/colon obstruction, bronchospasm

1–3 days

Treatment of constipation due to hard stools, in painful anorectal conditions, and for those who need to avoid straining during bowel movements

Stomachache, mild nausea, cramping, diarrhea, irritated throat (with liquid and syrup dose forms)

Magnesium citrate ­(Citrate of Magnesia, Citro-Mag) Magnesium hydroxide

30 min–3 hrs

Bowel evacuation prior to certain surgical and diagnostic procedures

30 min–3 hrs

Short-term treatment of occasional constipation

Sodium phosphate (Fleet Phospho-Soda)

2–15 min

Relief of occasional constipation; bowel evacuation prior to certain surgical and diagnostic procedures

Hypotension, abdominal cramping, diarrhea, gas formation, electrolyte abnormalities Electrolyte abnormalities can occur; use caution in pts with renal or cardiac impairment; diarrhea, abdominal cramps, hypotension Electrolyte abnormalities; do not use for pts with HF, severe renal impairment, ascites, GI obstruction, active inflammatory bowel disease

Stool Softener Docusate (Colace, ­Surfak)

Saline

Laxatives 135C

Continued

CLASSIFICATIONS

Osmotic Lactulose (Kristalose)

24–48 hrs

Short-term relief of constipation

Polyethylene glycol (MiraLax)

24–48 hrs

Short-term relief of constipation

PO: 6–12 hrs Rectal: 15–60 min 6–12 hrs

Short-term relief of constipation

Nausea, vomiting, diarrhea, abdominal cramping, bloating, gas Bitter taste, diarrhea

Stimulant Bisacodyl (Dulcolax) Senna (Senokot)

GI, Gastrointestinal; HF, heart failure.

Short-term relief of constipation

Electrolyte imbalance, abdominal discomfort, gas, potential for overuse/abuse Abdominal discomfort, cramps

136C Laxatives

LAXATIVES—cont’d



Multiple Sclerosis Multiple sclerosis (MS) is the most common autoimmune disorder affecting central nervous system. MS is a demyelinating disease where insulating covers of nerve cells in the brain and spinal cord are damaged, which disrupts the ability of parts of the nervous system to communicate. Symptoms may include double vision, blindness in one eye, muscle weakness, trouble with sensation or coordination.

Presently, there is no cure for MS. Treatment attempts to improve function and prevent new attacks.

MEDICATIONS FOR MULTIPLE SCLEROSIS

Side Effects

12 mg IV once daily for 5 days followed 1 year later by 12 mg IV once daily for 3 days

Cladribine (Mavenclad) Daclizumab (Zinbryta)

Recommended cumulative dosage: 3.5 mg/kg body weight administered orally and divided into 2 yearly treatment courses (1.75 mg/kg/treatment course) 150 mg SQ once monthly

Rigors, tremors nausea, vomiting, rash, fatigue, hypotension, urticaria, pruritus, skeletal pain, headache, diarrhea, neutropenia, anemia, thrombocytopenia, respiratory toxicity (dyspnea, cough, pneumonitis, infections) Upper respiratory tract infection, headache, lymphopenia

Dimethyl fumarate (Tecfidera)

240 mg PO bid

Fingolimod (Gilenya)

0.5 mg PO once daily

Autoimmune disorders (hepatitis, lymphadenopathy, noninfectious colitis), depression, severe hypersensitivity reactions, infections Flushing, abdominal pain, diarrhea, nausea, vomiting, dyspepsia, lymphopenia, hepatotoxicity, progressive ­multifocal leukoencephalopathy (PML) Headache, back pain, cough, infections, hypersensitivity reactions, elevated LFTs, bradycardia, AV block, macular edema, decreased pulmonary function

137C

Dosage

Alemtuzumab (Lemtrada)

Multiple Sclerosis

Name

CLASSIFICATIONS

MEDICATIONS FOR MULTIPLE SCLEROSIS—cont’d

Side Effects

Copaxone: 20 mg SQ once daily or 40 mg 3 times/wk Glatopa: 20 mg SQ once daily Avonex: 30 mcg IM wkly Rebif: 44 mcg 3 times/wk

Pain, erythema, inflammation, pruritus at injection site, arthralgia, transient chest pain, post-injection reactions (chest pain, palpitations, dyspnea) Headache, flu-like symptoms, myalgia, depression with suicidal ideation, generalized pain, asthenia, chills, injection site reaction, hypersensitivity reactions, anemia, hepatotoxicity Headache, flu-like symptoms, myalgia, upper respiratory tract infection, depression with suicidal ideation, generalized pain, asthenia, chills, fever, injection site reaction, hypersensitivity reactions, anemia, hepatotoxicity, seizures Nausea, vomiting, diarrhea, cough, headache, stomatitis, abdominal discomfort, fever, alopecia, cardiotoxicity, myelosuppression, acute/chronic myeloid leukemia Headache, fatigue, depression, arthralgia, infections, hypersensitivity reactions, hepatotoxicity, PML Infusion reactions (pruritus, rash, urticaria, erythema), respiratory tract infections, skin infections, malignancies, PML Headache, flu-like symptoms, myalgia, depression with suicidal ideation, generalized pain, asthenia, chills, injection site reaction, hypersensitivity reactions, anemia, hepatotoxicity, elevated LFTs, seizures Headache, hypertension, increased serum ALT, AST

Interferon beta 1a (Avonex, Rebif)

Interferon beta 1b (Betaseron, Extavia)

250 mcg SQ every other day

Mitoxantrone

12 mg/m2 IV q3mos

Natalizumab (Tysabri)

300 mg IV q4wks

Ocrelizumab (Ocrevus)

600 mg IV q6mos

Pegylated interferon beta 1a (Plegridy)

125 mcg SQ q2wks

Siponimod (Mayzent)

Titration required for treatment initiation ­Recommended maintenance dosage: 2 mg 7 or 14 mg PO once daily

Teriflunomide (Aubagio)

Headache, diarrhea, nausea, alopecia, paresthesia, abdominal pain, elevated LFTs, neutropenia, leukopenia, hepatic failure, acute renal failure, toxic epidermal necrolysis

Multiple Sclerosis

Dosage

Glatiramer (Copaxone, Glatopa)

138C

Name



Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) ACTION

Provide symptomatic relief from pain/inflammation in the treatment of musculoskeletal disorders (e.g., rheumatoid arthritis [RA], osteoarthritis, ankylosing spondylitis), analgesic for low to moderate pain, reduction in fever (many agents not suited for routine/prolonged therapy due to toxicity). By virtue of its action on platelet function, aspirin is used in treatment or prophylaxis of diseases associated with hypercoagulability (reduces risk of stroke/heart attack).

Exact mechanism for anti-inflammatory, analgesic, antipyretic effects unknown. Inhibition of enzyme cyclooxygenase, the enzyme responsible for prostaglandin synthesis, appears to be a major mechanism of action. May inhibit other mediators of inflammation (e.g., leukotrienes). Direct action on hypothalamus heat-regulating center may contribute to antipyretic effect.

NSAIDs

Availability

Dosage Range

Side Effects

Aspirin

Caplet: 500 mg Suppository: 300 mg, 600 mg T: 325 mg T (EC): 81 mg, 325 mg T (chew): 81 mg C: 50 mg, 100 mg, 200 mg, 400 mg T: 25 mg, 50 mg, 75 mg C (Zipsor): 25 mg C (Zorvolex): 18 mg, 35 mg

Analgesic/antipyretic: 325–650 mg q4–6h prn or 975 mg q6h prn or 500–1000 mg q4–6h prn

Gl discomfort, dizziness, headaches, increased risk of bleeding

200 mg ql2h (Maximum: 600 mg day 1, then 400 mg/day) 50 mg tid (Zipsor): 25 mg 4 times/day (Zorvolex): 18–35 mg 3 times/day

Diarrhea, back pain, dizziness, heartburn, headaches, nausea, abdominal pain Indigestion, constipation, diarrhea, nausea, headaches, fluid retention, abdominal cramps Continued

CLASSIFICATIONS

Celecoxib (Celebrex) Diclofenac (Voltaren, Zipsor, Zorvolex)

139C

Name

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

USES

T: 500 mg

Etodolac (Lodine)

T: 400 mg, 500 mg T (ER): 400 mg, 500 mg, 600 mg C: 200 mg, 300 mg C: 200 mg, 400 mg T: 600 mg l: 100 mg/mL T: 100 mg, 200 mg, 400 mg, 600 mg, 800 mg T (chewable): 50 mg, 100 mg C: 200 mg S: 100 mg/5 mL (Tivorbex): 20 mg, 40 mg C: 25 mg, 50 mg C (SR): 75 mg S: 25 mg/5 mL C: 25 mg, 50 mg C (ER): 200 mg

Fenoprofen (Nalfon) Ibuprofen (Advil, Caldolor, Motrin)

Indomethacin (Indocin, Tivorbex) Ketoprofen (Orudis KT) Ketorolac (Toradol) Meloxicam (Mobic, Vivlodex)

T: 10 mg l: 15 mg/mL, 30 mg/mL C: (Vivlodex): 5 mg, 10 mg T: (Mobic): 7.5 mg, 15 mg S: 7.5 mg/5 mL

Arthritis: 0.5–1 g/day in 2 divided doses Maximum: 1.5 g/day P: 500 mg once, then 250 mg q8–12h Arthritis: 400 mg 2 times/day or 300 mg 2–3 times/day or 500 mg 2 times/day. (ER): 400 mg up to 1,000 mg once daily P: 200–400 mg q6–8h as needed Arthritis: 400–600 mg 3–4 times/day P: 200 mg q4–6h as needed Inflammatory disease: 400–800 mg/dose 3–4 times/day P: 200–400 mg/dose q4–6h as needed

Headaches, abdominal cramps, indigestion, diarrhea, nausea

Arthritis: 25–50 mg/dose 2–3 times/day Maximum: 200 mg/day P: (Tivorbex only): 20 mg 3 times/day or 40 mg 2–3 times/day Arthritis: 50 mg 4 times/day or 75 mg 3 times/ day ER: 200 mg once daily P: 25–50 mg q6–8h as needed P: (PO): 10 mg q4–6h as needed; (IM/IV): 60–120 mg/day in divided doses Arthritis: (Mobic): 7.5–15 mg once daily (Vivlodex): 5–10 mg once daily

Fluid retention, dizziness, headaches, abdominal pain, indigestion, nausea

Indigestion, dizziness, headaches, bloated feeling, diarrhea, nausea, weakness, abdominal cramps Nausea, indigestion, anxiety, constipation, shortness of breath, heartburn Dizziness, abdominal cramps, abdominal pain, heartburn, nausea

Headaches, anxiety, abdominal pain, bloated feeling, constipation, diarrhea, nausea Fluid retention, abdominal pain, diarrhea, dizziness, headaches, nausea Heartburn, indigestion, nausea, diarrhea, headaches

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Diflunisal (Dolobid)

140C

NSAIDs—cont’d



Availability

Dosage Range

Side Effects

T: 500 mg, 750 mg

Arthritis: 1–2 g/day in 1–2 divided doses

T: 250 mg, 375 mg, 500 mg T (CR): 375 mg, 500 mg S: 125 mg/5 mL

Oxaprozin (Daypro)

C: 600 mg T: 600 mg C: 10 mg, 20 mg T: 150 mg, 200 mg

Arthritis: 500–1,000 mg/day in 2 divided doses Maximum: 1,500 mg/day P: 500 mg once, then 500 mg q12h or 250 mg q6–8h as needed Arthritis: 600–1,200 mg once daily

Fluid retention, dizziness, headaches, abdominal pain, constipation, diarrhea, nausea Tinnitus, fluid retention, shortness of breath, dizziness, drowsiness, headaches, abdominal pain, constipation, heartburn, nausea

Piroxicam (Feldene) Sulindac (Clinoril)

Arthritis: 10–20 mg/day in 1–2 divided doses Arthritis: 150 mg bid

Constipation, diarrhea, nausea, indigestion Abdominal pain, stomach pain, nausea Dizziness, abdominal pain, constipation, diarrhea, nausea

A, Adults; C, capsules; CR, controlled-release; ER, extended-release; Gl, gastrointestinal; I, injection; P, pain; S, suspension; SR, sustained-release; T, tablets.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Name Nabumetone (Relafen) Naproxen (Anaprox, Naprosyn)

141C CLASSIFICATIONS

142C

Nutrition: Enteral Enteral nutrition (EN), also known as tube feedings, provides food/nutrients via the GI tract using special formulas, delivery techniques, and equipment. All routes of EN consist of a tube through which liquid formula is infused.

Tube feedings are used in pts with major trauma, burns; those undergoing radiation and/or chemotherapy; pts with hepatic failure, severe renal impairment, physical or neurologic impairment; preop and postop to promote anabolism; prevention of cachexia, malnutrition; dysphagia, pts requiring mechanical ventilation.

ROUTES OF ENTERAL NUTRITION DELIVERY Nasogastric (NG): INDICATIONS: Most common for short-term feeding in pts unable or unwilling to consume adequate nutrition by mouth. Requires at least a partially functioning GI tract. ADVANTAGES: Does not require surgical intervention and is fairly easily inserted. Allows full use of digestive tract. Decreases abdominal distention, nausea, vomiting that may be caused by hyperosmolar solutions. DISADVANTAGES: Temporary. May be easily pulled out during routine nursing care. Has potential for pulmonary aspiration of gastric contents, risk of reflux esophagitis, regurgitation. Nasoduodenal (ND), Nasojejunal (NJ): INDICATIONS: Pts unable or unwilling to consume adequate nutrition by mouth. Requires at least a partially functioning GI tract. ADVANTAGES: Does not require surgical intervention and is fairly easily inserted. Preferred for pts at risk for aspiration. Valuable for pts with gastroparesis.

Nutrition: Enteral

INDICATIONS



INITIATING ENTERAL NUTRITION

Gastrostomy: INDICATIONS: Pts with esophageal obstruction or impaired swallowing; pts in whom NG, ND, or NJ not feasible; when long-term feeding indicated.

Jejunostomy: INDICATIONS: Pts with stomach or duodenal obstruction, impaired gastric motility; pts in whom NG, ND, or NJ not feasible; when long-term feeding indicated.

With continuous feeding, initiation of isotonic (about 300 mOsm/L) or moderately hypertonic feeding (up to 495 mOsm/L) can be given full strength, usually at a slow rate (30–50 ml/hr) and gradually increased (25 ml/hr q6–24h). Formulas with osmolality greater than 500 mOsm/L are generally started at half strength and gradually increased in rate, then concentration. Tolerance is increased if the rate and concentration are not increased simultaneously.

ADVANTAGES: Allows early postop feeding (small bowel function is least affected by surgery). Risk of aspiration reduced. Rarely pulled out inadvertently. DISADVANTAGES: Requires surgery (laparotomy). Stoma care required. Risk of intraperitoneal leakage. Can be dislodged easily.

Continued

Nutrition: Enteral

ADVANTAGES: Permanent feeding access. Tubing has larger bore, allowing noncontinuous (bolus) feeding (300–400 ml over 30–60 min q3–6h). May be inserted endoscopically using local anesthetic (procedure called percutaneous endoscopic gastrostomy [PEG]).

DISADVANTAGES: Requires surgery; may be inserted in conjunction with other surgery or endoscopically (see ADVANTAGES ). Stoma care required. Tube may be inadvertently dislodged. Risk of aspiration, peritonitis, cellulitis, leakage of gastric contents.

143C CLASSIFICATIONS

DISADVANTAGES: Temporary. May be pulled out during routine nursing care. May be dislodged by coughing, vomiting. Small lumen size increases risk of clogging when medication is administered via tube, more susceptible to rupturing when using infusion device. Must be radiographed for placement, frequently extubated.

144C

Nutrition: Enteral—cont’d COMPLICATIONS

Protein: Has many important physiologic roles and is the primary source of nitrogen in the body. Provides 4 kcal/g protein. Sources of protein in enteral feedings: sodium caseinate, calcium caseinate, soy protein, dipeptides.

MECHANICAL: Usually associated with some aspect of the feeding tube.

Carbohydrate (CHO): Provides energy for the body and heat to maintain body temperature. Provides 3.4 kcal/g carbohydrate. Sources of CHO in enteral feedings: corn syrup, cornstarch, maltodextrin, lactose, sucrose, glucose. Fat: Provides concentrated source of energy. Referred to as kilocalorie dense or protein sparing. Provides 9 kcal/g fat. Sources of fat in enteral feedings: corn oil, safflower oil, medium-chain triglycerides. Electrolytes, vitamins, trace elements: Contained in formulas (not found in specialized products for renal/hepatic insufficiency). All products containing protein, fat, carbohydrate, vitamin, electrolytes, trace elements are nutritionally complete and designed to be used by pts for long periods.

Aspiration pneumonia: Caused by delayed gastric emptying, gastroparesis, gastroesophageal reflux, or decreased gag reflex. May be prevented or treated by reducing infusion rate, using lower-fat formula, feeding beyond pylorus, checking residuals, using small-bore feeding tubes, elevating head of bed 30–45 degrees during and for 30–60 min after intermittent feeding, and regularly checking tube placement. Esophageal, mucosal, pharyngeal irritation, otitis: Caused by using large-bore NG tube. Prevented by use of small bore whenever possible. Irritation, leakage at ostomy site: Caused by drainage of digestive juices from site. Prevented by close attention to skin/stoma care. Tube, lumen obstruction: Caused by thickened formula residue, formation of formula-medication complexes. Prevented by frequently irrigating tube with clear water (also before and after giving formulas/ medication), avoiding instilling medication if possible.

GASTROINTESTINAL: Usually associated with formula, rate of delivery, unsanitary handling of solutions or delivery system. Diarrhea: Caused by low-residue formulas, rapid delivery, use of hyperosmolar formula, hypoalbuminemia, malabsorption, microbial contamination, or rapid GI transit time. Prevented by using fiber supplemented formulas, decreasing rate of delivery, using dilute formula, and gradually increasing strength. Cramps, gas, abdominal distention: Caused by nutrient malabsorption, rapid delivery of refrigerated formula. Prevented by delivering formula by continuous methods, giving formulas at room temperature, decreasing rate of delivery. Nausea, vomiting: Caused by rapid delivery of formula, gastric retention. Prevented by reducing rate of delivery, using dilute formulas, selecting low-fat formulas. Constipation: Caused by inadequate fluid intake, reduced bulk, inactivity. Prevented by supplementing fluid intake, using fiber-supplemented formula, encouraging ambulation.

Nutrition: Enteral

SELECTION OF FORMULAS



MONITORING Daily: Estimate nutrient intake, fluid intake/output, weight of pt, clinical observations. Weekly: Serum electrolytes (potassium, sodium, magnesium, calcium, phosphorus), blood glucose, BUN, creatinine, hepatic function tests (e.g., AST, ALT, alkaline phosphatase), 24-hr urea and creatinine excretion, total iron-binding capacity (TIBC) or serum transferrin, triglycerides, cholesterol. Monthly: Serum albumin. Other: Urine glucose, acetone (when blood glucose is greater than 250), vital signs (temperature, respirations, pulse, B/P) q8h.

145C

Continued

Nutrition: Enteral

DRUG THERAPY: DOSAGE FOR SELECTION/ ADMINISTRATION: Drug therapy should not have to be compromised in pts receiving enteral nutrition: • Temporarily discontinue medications not immediately necessary. • Consider an alternate route for administering medications (e.g., transdermal, rectal, intravenous). • Consider alternate medications when current medication is not available in alternate dosage forms.

ENTERAL ADMINISTRATION OF MEDICATIONS: Medications may be given via feeding tube with several considerations: • Tube type • Tube location in the GI tract. • Site of drug action. • Site of drug absorption. • Effects of food on drug absorption. • Use of liquid dosage forms is preferred whenever possible; many tablets may be crushed; contents of many capsules may be emptied and given through large-bore feeding tubes. • Many oral products should not be crushed (e.g., sustained-release, enteric coated, capsule granules). • Some medications should not be given with enteral formulas because they form precipitates that may clog the feeding tube and reduce drug absorption. • Feeding tube should be flushed with water before and after administration of medications to clear any residual medication.

CLASSIFICATIONS

METABOLIC: Fluid/serum electrolyte status should be monitored. Refer to monitoring section. In addition, the very young and very old are at greater risk of developing complications such as dehydration or overhydration.

146C

Nutrition: Parenteral INDICATIONS

COMPONENTS OF PN

Conditions when pt is unable to use alimentary tract via oral, gastrostomy, or jejunostomy route. Impaired absorption of protein caused by obstruction, inflammation, or antineoplastic therapy. Bowel rest necessary because of GI surgery or ileus, fistulas, or anastomotic leaks. Conditions with increased metabolic requirements (e.g., burns, infection, trauma). Preserve tissue reserves (e.g., acute renal failure). Inadequate nutrition from tube feeding methods.

To meet IV nutritional requirements, six essential categories in PN are needed for tissue synthesis and energy balance. Protein: In the form of crystalline amino acids (CAA), primarily used for protein synthesis. Several products are designed to meet specific needs for pts with renal failure (e.g., NephrAmine), hepatic disease (e.g., Hepat Amine), stress/trauma (e.g., Aminosyn HBC), use in neonates and pediatrics (e.g., Aminosyn PF, TrophAmine). Calories: 4 kcal/g protein. Energy: In the form of dextrose, available in concentrations of 5%–70%. Dextrose less than 10% may be given peripherally; concentrations greater than 10% must be given centrally. Calories: 3.4 kcal/g dextrose. IV fat emulsion: Available in 10% and 20% concentrations. Provides a concentrated source of energy/ calories (9 kcal/g fat) and is a source of essential fatty acids. May be administered peripherally or centrally.

Nutrition: Parenteral

Parenteral nutrition (PN), also known as total parenteral nutrition (TPN) or hyperalimentation (HAL), provides required nutrients to pts by IV route of administration. The goal of PN is to maintain or restore nutritional status caused by disease, injury, or inability to consume nutrients by other means.



ROUTE OF ADMINISTRATION

Vitamins: Essential components in maintaining metabolism and cellular function; widely used in PN. Trace elements: Necessary in long-term PN administration. Trace elements include zinc, copper, chromium, manganese, selenium, molybdenum, iodine.

Peripheral: Usually involves 2–3 L /day of 5%–10% dextrose with 3%–5% amino acid solution along with IV fat emulsion. Electrolytes, vitamins, trace elements are added according to pt needs. Peripheral solutions provide about 2,000 kcal/day and 60–90 g protein/day. ADVANTAGES: Lower risks vs. central mode of administration. DISADVANTAGES: Peripheral veins may not be suitable (esp. in pts with illness of long duration); more susceptible to phlebitis (due to osmolalities greater than 600 mOsm/L); veins may be viable only 1–2 wks; large volumes of fluid are needed to meet nutritional requirements, which may be contraindicated in many pts.

solution of 3%–7% with IV fat emulsion. Electrolytes, vitamins, trace elements are added according to pt needs. Central solutions provide 2,000–4,000 kcal/ day. Must be given through large central vein with high blood flow, allowing rapid dilution, avoiding phlebitis/ thrombosis (usually through percutaneous insertion of catheter into subclavian vein, then advancement of catheter to superior vena cava). ADVANTAGES: Allows more alternatives/flexibility in establishing regimens; allows ability to provide full nutritional requirements without need of daily fat emulsion; useful in pts who are fluid restricted (increased concentration), those needing large nutritional requirements (e.g., trauma, malignancy), or those for whom PN indicated more than 7–10 days. DISADVANTAGES: Risk with insertion, use, maintenance of central line; increased risk of infection, catheter-induced trauma, and metabolic changes.

Central: Usually utilizes hypertonic dextrose (concentration range of 15%–35%) and amino acid Continued

Nutrition: Parenteral

Miscellaneous: Additives include insulin, albumin, heparin, and H2 blockers (e.g., cimetidine, ranitidine, famotidine). Other medication may be included, but compatibility for admixture should be checked on an individual basis.

PN is administered via either peripheral or central vein.

147C CLASSIFICATIONS

Electrolytes: Major electrolytes (calcium, magnesium, potassium, sodium; also acetate, chloride, phosphate). Doses of electrolytes are individualized, based on many factors (e.g., renal/hepatic function, fluid status).

148C

Nutrition: Parenteral—cont’d COMPLICATIONS Mechanical: Malfunction in system for IV delivery (e.g., pump failure; problems with lines, tubing, administration sets, catheter). Pneumothorax, catheter misdirection, arterial puncture, bleeding, hematoma formation may occur with catheter placement.

Baseline: CBC, platelet count, prothrombin time (PT), weight, body length/head circumference (in infants), serum electrolytes, glucose, BUN, creatinine, uric acid, total protein, cholesterol, triglycerides, bilirubin, alkaline phosphatase, lactate dehydrogenase (LDH), AST, albumin, prealbumin, other tests as needed. Daily: Weight, vital signs (temperature, pulse, respirations [TPR]), nutritional intake (kcal, protein, fat), serum electrolytes (potassium, sodium chloride), glucose (serum, urine), acetone, BUN, osmolarity, other tests as needed. 2–3 times/wk: CBC, coagulation studies (PT, partial thromboplastin time [PTT]), serum creatinine, calcium, magnesium, phosphorus, acid-base status, other tests as needed. Weekly: Nitrogen balance, total protein, albumin, prealbumin, transferrin, hepatic function tests (AST, ALT), serum alkaline phosphatase, LDH, bilirubin, Hgb, uric acid, cholesterol, triglycerides, other tests as needed.

Infectious: Infections (pts often more susceptible to infections), catheter sepsis (e.g., fever, shaking, chills, glucose intolerance where no other site of infection is identified). Metabolic: Includes hyperglycemia, elevated serum cholesterol and triglycerides, abnormal serum hepatic function tests. Fluid, electrolyte, acid-base disturbances: May alter serum potassium, sodium, phosphate, magnesium levels. Nutritional: Clinical effects seen may be due to lack of adequate vitamins, trace elements, essential fatty acids. DRUG THERAPY/ADMINISTRATION METHODS: Compatibility of other intravenous medications pts may be administered while receiving parenteral nutrition is an important concern.

Intravenous medications usually are given as a separate admixture via piggyback to the parenteral nutrition line, but in some instances may be added directly to the parenteral nutrition solution. Because of the possibility of incompatibility when adding medication directly to the parenteral nutrition solution, specific criteria should be considered: • Stability of the medication in the parenteral nutrition solution • Properties of the medication, including pharmacokinetics that determine if the medication is appropriate for continuous infusion • Documented chemical and physical compatibility with the parenteral nutrition solution In addition, when medication is given via piggyback using the parenteral nutrition line, important criteria should include the following: • Stability of the medication in the parenteral nutrition solution • Documented chemical and physical compatibility with the parenteral nutrition solution

Nutrition: Parenteral

MONITORING May vary slightly from institution to institution.



Obesity Management USES

ACTIONS

Adjunct to diet and physical activity in the treatment of chronic, relapsing obesity.

Two categories of medications are used for weight control. Appetite suppressants: Block neuronal uptake of norepinephrine, serotonin, dopamine, causing a feeling of fullness or satiety.

Digestion inhibitors: Reversible lipase inhibitors that block the breakdown and absorption of fats, decreasing appetite and reducing calorie intake.

ANOREXIANTS

Availability

Dosage

Side Effects

Diethylpropion (Tenuate, Tenuate ­Dospan) Liraglutide (Victoza)

T: 25 mg, T (CR): 75 mg

25 mg 3–4 times/day or 75 mg once daily in midmorning

I: 18 mg/3 mL

Lorcaserin (BelViq, ­Belviq XR)

C: 10 mg T: 20 mg

SQ: Initially, 0.6 mg/day. May ­increase by 0.6 mg/day wkly up to 3 mg/day (Belviq): 10 mg 2 times/day (Belviq XR): 20 mg once daily

Headaches, euphoria, palpitations, hypertension, pulmonary ­hypertension, valvular heart disease, seizures, bone marrow ­depression, dependence, withdrawal psychosis Diarrhea, constipation, dyspepsia, fatigue, vomiting, increased heart rate, renal impairment

Naltrexone/ bupropion (Contrave)

T: 8 mg/90 mg

149C

Continued

CLASSIFICATIONS

Titrate wkly up to 2 tablets 2 times/day (1 tablet once daily, then 1 tablet 2 times/day, then 2 tablets in am and 1 in pm, then 2 tablets 2 times/day)

Nausea, headache, dizziness, fatigue, dry mouth, diarrhea, constipation, hypoglycemia, hallucinations, decreased white/red blood cells, euphoria, cognitive impairment Suicidal ideation, mood changes, seizures, increased HR with or without B/P, allergic reactions, hepatic toxicity, nausea, vomiting, headache, dizziness, dry mouth, angle-closure glaucoma

Obesity Management

Name

Availability

Dosage

Side Effects

Orlistat (Alli, Xenical)

C: 60 mg, 120 mg

Flatulence, rectal incontinence, oily stools, cholelithiasis, abdominal/ rectal pain, hepatitis, pancreatitis, nausea

Phentermine (Apidex-P, Suprenza)

C: 15 mg, 30 mg, 37.5 mg T: 37.5 mg T (ODT): 15 mg, 30 mg, 37.5 mg

Alli: 60 mg up to tid with meals Xenical: 120 mg tid with each meal containing fat 15–37.5 mg/day in 1 or 2 divided doses ODT: 15–37.5 mg once daily in morning

Phentermine/ topiramate (Qsymia)

C: 13.75 mg/ 23 mg

3.75 mg/23 mg to 15 mg/92 mg once daily in the morning

Paresthesia, dizziness, insomnia, depression, tachycardia, cognitive impairment, angle-closure glaucoma, hypokalemia, metabolic acidosis, constipation, dry mouth, suicidal ideation, kidney stones

Headaches, euphoria, palpitations, hypertension, pulmonary hypertension, valvular heart disease, tremor, dependence, withdrawal psychosis, CNS stimulation, Gl complaints

AS, Appetite suppressant; B/P, blood pressure; C, capsules; CNS, central nervous system; CR, controlled-release; Dl, digestion inhibitor; Gl, gastrointestinal; HR, heart rate; I, injection; ODT, orally disintegrating tablets; SQ, subcutaneous; T, tablets.

Obesity Management

Name

150C

ANOREXIANTS—cont’d



Osteoporosis Bisphosphonates: Inhibit bone resorption via actions on osteoclasts or osteoclast precursors, decrease rate of bone resorption, leading to an indirect increase in BMD. Selective estrogen receptor modulator (SERM): Decreases bone resorption, increasing BMD and decreasing the incidence of fractures. Parathyroid hormone: Stimulates osteoblast function, increasing gastrointestinal calcium absorption and increasing renal tubular reabsorption of calcium. This increases BMD, bone mass, and strength, resulting in a decrease in osteoporosis-related fractures.

Calcitonin: Inhibitor of bone resorption. Efficacy not observed in early postmenopausal women and is used only in women with osteoporosis who are at least 5 yrs beyond menopause. Monoclonal antibody: Inhibits the RANK ligand (RANKL), a cytokine member of the tumor necrosis factor family. This inhibits osteoclast formation, function, and survival, which decreases bone resorption and increases bone mass and strength in cortical and trabecular bone. Sclerostin inhibitor: Sclerostin is an osteocyte-derived glycoprotein that inhibits bone formation. Inhibition of sclerostin induces osteoblast activity and bone formation, decreasing bone resorption and increasing bone mineral density.

Continued

151C CLASSIFICATIONS

ACTION

Osteoporosis is a bone disease that can lead to fractures. Bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of proteins in bone are altered. Osteoporosis primarily affects women after menopause (postmenopausal osteoporosis) but may develop in men, in anyone in the presence of particular hormonal disorders (e.g., parathyroid glands), after overconsumption of dietary proteins, or as a result of medications (e.g., glucocorticoids). Several pharmacologic options, along with lifestyle changes, that can be used to prevent and/or treat osteoporotic fractures include calcium and vitamin D supplements in patients having inadequate dietary intake of calcium, bisphosphonates, selective estrogen receptor modulator (SERM), parathyroid hormone (PTH), calcitonin, and monoclonal antibodies.

Osteoporosis

HISTORY

Name

Availability

Dosage

Alendronate (Binosto, ­Fosamax)

T: 5 mg, 10 mg, 35 mg, 40 mg, 70 mg S: 70 mg/75 mL T: 150 mg 1: 1 mg/mL T: 5 mg, 30 mg, 35 mg, 150 mg T (DR): 35 mg I: 5 mg

Prevention: 5 mg/day or 35 mg/wk Treatment: 10 mg/day or 70 mg/wk

Name

Availability

Dosage

Side Effects

Raloxifene (Evista)

T: 60 mg

Prevention and treatment: 60 mg/day

Leg cramps, hot flashes, increased risk of thromboembolic events and stroke

Ibandronate (Boniva) Risedronate (Actonel) Zoledronic acid (Reclast)

Prevention and treatment: 150 mg/mo IV Injection: Treatment: 3 mg/3 mos Prevention and treatment: 5 mg/day, 35 mg/wk, or 150 mg/mo

Class Side Effects

Hypocalcemia, may cause jaw osteonecrosis (rarely); GI (e.g., heartburn, esophageal irritation, esophagitis, abdominal pain, diarrhea); severe bone, joint, or muscle pain. IV: acute-phase reaction (e.g., low-grade fever, myalgia, arthralgia) within 1–3 days of the infusion

Prevention: IV: 5 mg every 2 yrs Treatment: IV: 5 mg every yr

SERM

152C Osteoporosis

BISPHOSPHONATES



PARATHYROID HORMONE

Name

Availability

Dosage

Class Side Effects

Abaloparatide (Tymos) Teriparatide (Forteo)

I: 2,000 mcg/mL prefilled pen delivers 80 mcg/dose I: 250 mcg/mL syringe delivers 20 mcg/dose

Treatment: 80 mcg subcutaneously once daily Treatment: 20 mcg subcutaneously once daily

Muscle cramps, injection site reactions, tachycardia, hypotension, increased serum uric acid concentration, hypercalciuria, dizziness, nausea, headache, hypercalcemia

Name

Availability

Dosage

Side Effects

Calcitonin (Fortical, Miacalcin)

I (Miacalcin): 200 units/mL Nasal (Fortical, Miacalcin): 200 units/activation

Treatment: IM/SQ (­Miacalcin): 100 units every other day Nasal: 200 units in 1 nostril daily

Rhinitis, local nasal irritation. Injection: nausea, local inflammation, flushing of face, hands

CALCITONIN

MONOCLONAL ANTIBODY RANKL INHIBITOR

Availability

Dosage

Side Effects

Denosumab (Prolia)

I: 60 mg/mL

SQ: 60 mg once every 6 mos

Dermatitis, rash, eczema, hypocalcemia. May cause jaw osteonecrosis (rarely)

SCLEROSTIN INHIBITOR

Name

Availability

Dosage

Side Effects

Romosozumab (Evenity)

I: 105 mg/1.17 mL syringe

SQ: 210 mg (2 injections) once every mo for up to 12 doses

Arthralgia, headache

153C

SQ, subcutaneous.

CLASSIFICATIONS

DR, Delayed-release; I, injection; S, solution (oral); T, tablet.

Osteoporosis

Name

154C

Parkinson’s Disease Treatment

Parkinson’s Disease Treatment USES

ACTION

To slow or stop clinical progression of Parkinson’s disease and to improve function and quality of life in pts with Parkinson’s disease, a progressive neurodegenerative disorder.

Normal motor function is dependent on the synthesis and release of dopamine by neurons projecting from the substantia nigra to the corpus striatum. In Parkinson’s disease, disruption of this pathway results in diminished levels of the neurotransmitter dopamine. Medication is aimed at providing improved function using the lowest effective dose.

TYPES OF MEDICATIONS FOR PARKINSON’S DISEASE DOPAMINE PRECURSOR Levodopa/carbidopa: Levodopa: Dopamine precursor supplementation to enhance dopaminergic neurotransmission.

A small amount of levodopa crosses the blood-brain barrier and is decarboxylated to dopamine, which is then available to stimulate dopaminergic receptors. Carbidopa: Inhibits peripheral decarboxylation of levodopa, decreasing its conversion to dopamine in peripheral tissues, which results in an increased availability of levodopa for transport across the blood-brain barrier.

COMT INHIBITORS Entacapone, tolcapone: Reversible inhibitor of catechol-O-methyltransferase (COMT). COMT

is responsible for catalyzing levodopa. In the presence of a decarboxylase inhibitor (carbidopa), COMT becomes the major metabolizing enzyme for levodopa in the brain and periphery. By inhibiting COMT, higher plasma levels of levodopa are attained, resulting in more dopaminergic stimulation in the brain and lessening the symptoms of Parkinson’s disease.

DOPAMINE RECEPTOR AGONISTS Bromocriptine: Stimulates postsynaptic dopamine type 2 receptors in the neostriatum of the CNS. Pramipexole: Stimulates dopamine receptors in the striatum of the CNS. Ropinirole: Stimulates postsynaptic dopamine D2 type receptors within the caudate putamen in

the brain.

MONOAMINE OXIDASE B INHIBITORS Rasagiline, Safinamide, Selegiline: Increase dopaminergic activity due to inhibition of mono-

amine oxidase type B (MAO B). MAO B is involved in the oxidative deamination of dopamine in the brain.



Parkinson’s Disease Treatment MEDICATIONS FOR TREATMENT OF PARKINSON’S DISEASE

Availability

Dosage

Side Effects

Dopamine agonist

100 mg 2 times/day. May increase up to 400 mg/day in divided doses ER Caps: 274 mg once at bedtime ER Tabs: 129–322 mg once daily in the morning

Cognitive impairment, confusion, insomnia, hallucinations, livido reticularis

Carbidopa/­ levodopa ­(Rytary, Sinemet, Sinemet CR)

Dopamine ­precursor

300–1,500 mg levodopa in divided doses Sinemet: 300–1,500 mg levodopa in divided doses Sinemet CR: Initially, 400 mg/day in 2 divided doses. May increase up to 1,600 mg levodopa in divided doses Rytary: Initially, 23.75 mg/95 mg 3 times/day May increase up to 612.5 mg/2,450 mg per day in divided doses

Anorexia, nausea, orthostatic hypotension initially; hallucinations, confusion, sleep disturbances with chronic use, constipation, dry mouth, headache, dyskinesia

Entacapone (Comtan) Pramipexole (Mirapex, ­Mirapex ER)

COMT inhibitor

C: 100 mg Syrup: 10 mg/mL T: 100 mg ER Caps (Gocovri): 68.5 mg, 137 mg ER Tabs (Osmolex ER): 129 mg, 193 mg, 258 mg OD: 10/100 mg, 25/100 mg, 25/250 mg Immediate-release (Sinemet): 10/100 mg, 25/100 mg, 25/250 mg ER (Sinemet CR): 25/100 mg, 50/200 mg (Rytary): 23.75 mg/95 mg, 36.25 mg/145 mg, 48.75 mg/ 195 mg, 61.25 mg/245 mg T: 200 mg

200 mg 3–4 times/day up to maximum of 8 times/day (1,600 mg) T: Initially, 0.125 mg 3 times/day May increase q5–7 days. Usual dose: 0.5–1.5 mg 3 times/day ER: Initially, 0.375 mg once daily May increase q5–7 days by 0.75 mg/dose up to 4.5 mg once daily

Dyskinesias, nausea, diarrhea, urine discoloration Side effects similar to carbidopa/ levodopa. Lower risk of dyskinesias, higher risk of hallucinations, sleepiness, edema. May cause excessive daytime sleepiness, impair impulse control (e.g., gambling)

T: 0.125 mg, 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg ER: 0.375 mg, 0.75 mg, 1.5 mg, 2.25 mg, 3 mg, 3.75 mg, 4.5 mg

CLASSIFICATIONS

Dopamine ­agonist

155C

Type

Amantadine Gocovri Osmolex ER

Parkinson’s Disease Treatment

Name

MEDICATIONS FOR TREATMENT OF PARKINSON’S DISEASE—cont’d

Availability

Dosage

Side Effects

MAO B ­inhibitor

T: 0.5 mg, 1 mg

0.5–1 mg once daily

Ropinirole (Requip, Requip XL)

Dopamine ­agonist

T: 0.25 mg, 0.5 mg, 1 mg, 2 mg, 3 mg, 4 mg, 5 mg XL: 2 mg, 4 mg, 6 mg, 8 mg, 12 mg

Rotigotine ­(Neupro)

Dopamine ­agonist

Transdermal patch: 1 mg/24 hrs, 2 mg/24 hrs, 3 mg/24 hrs, 4 mg/24 hrs, 6 mg/24 hrs, 8 mg/24 hrs

T: Initially, 0.25 mg 3 times/day. May increase at wkly intervals to 0.5 mg 3 times/day, then 0.75 mg 3 times/day, then 1 mg 3 times/day May then increase by 1.5 mg/day up to 9 mg/ day, then by 3 mg/day up to total dose of 24 mg/day in divided doses XL: Initially, 2 mg/day for 1–2 wks, then ­increase by 2 mg/day at wkly intervals Early stage: Initially, 2 mg/24 hrs up to 6 mg/24 hrs Advanced stage: Initially, 4 mg/24 hrs up to 8 mg/24 hrs

Nausea, orthostatic hypotension, hallucinations, insomnia, dry mouth, constipation, vivid dreams. Many potential drug interactions. Side effects similar to carbidopa/ levodopa. Lower risk of dyskinesias, higher risk of hallucinations, sleepiness, edema. May cause excessive daytime sleepiness, impair impulse control (e.g., gambling)

Safinamide (Xadago)

MAO B ­inhibitor

T: 50 mg, 100 mg

Initially, 50 mg once daily. May increase ­after 2 wks to 100 mg once daily

Selegiline ­(Eldepryl, Zelapar)

MAO B ­inhibitor

C (Eldepryl): 5 mg OD (Zelapar): 1.25 mg

C: 5 mg with breakfast and lunch OD: 1.25–2.5 mg daily in the morning

Tolcapone ­(Tasmar)

COMT inhibitor

T: 100 mg

Initially, 100 mg 3 times/day. May increase to 200 mg 3 times/day

Side effects similar to carbidopa/­ levodopa. Lower risk of dyskinesias, higher risk of hallucinations, sleepiness, edema. May cause ­excessive daytime sleepiness, impair impulse control (e.g., gambling) Dyskinesia, falls, hallucinations, nausea, insomnia. Many potential drug interactions Nausea, orthostatic hypotension, hallucinations, insomnia, dry mouth, constipation, vivid dreams. Many potential drug interactions Dyskinesias, nausea, diarrhea, urine discoloration

C, Capsules; COMT, catechol-O-methyltransferase; ER, extended-release; I, Injection; MAO B, monoamine oxidase B; OD, orally disintegrating; T, tablets; XL, extended-release.

Parkinson’s Disease Treatment

Type

Rasagiline (Azilect)

156C

Name



Proton Pump Inhibitors USES

ACTION

Treatment of various gastric disorders, including gastric and duodenal ulcers, gastroesophageal reflex disease (GERD), pathologic hypersecretory conditions.

Binds to the activated proton pump on the apical membrane of parietal cells. Inhibits acid secretion into the gastric lumen.

PROTON PUMP INHIBITORS

Indications

Dexlansoprazole (Dexilant) Esomeprazole (Nexium)

C: 30 mg, 60 mg

Erosive esophagitis, heartburn associated with nonerosive GERD Helicobacter pylori eradication, GERD, erosive esophagitis Duodenal ulcer, gastric ulcer, NSAID-associated gastric ulcer, hypersecretory conditions, H. ­pylori eradication, GERD, erosive esophagitis Duodenal ulcer, gastric ulcer, hypersecretory conditions, H. pylori eradication, GERD, ­erosive esophagitis Duodenal ulcer, benign gastric ulcer, GERD, erosive esophagitis Erosive esophagitis, hypersecretory conditions Duodenal ulcer, hypersecretory conditions, H. pylori eradication, GERD, erosive esophagitis

Lansoprazole (Prevacid) Omeprazole (Prilosec)

C: 20 mg, 40 mg I: 20 mg, 40 mg C: 15 mg, 30 mg T (ODT): 15 mg, 30 mg C: 10 mg, 20 mg, 40 mg

Omeprazole and Sodium P: 20 mg, 40 mg Bicarbonate (Zegerid) Pantoprazole (Protonix) T: 20 mg, 40 mg I: 40 mg Rabeprazole (Aciphex) T: 20 mg S: 5 mg, 10 mg

Usual Adult Dosage 30–60 mg/day 20–40 mg/day 15–30 mg/day

Class Side Effects Generally well tolerated. Most common: headache, nausea, constipation, diarrhea, flatulence, abdominal pain. Long-term use associated with C. difficile infection, risk of fractures, hypomagnesemia.

20–40 mg/day 20–40 mg/day 40 mg/day 20 mg/day

C, Capsules; GERD, gastroesophageal reflux disease; I, Injection; NSAID, nonsteroidal anti-inflammatory drug; ODT, orally disintegrating tablets; P, powder for suspension; S, sprinkles; T, tablets.

157C

Availability

Proton Pump Inhibitors

Name

CLASSIFICATIONS

158C

Rheumatoid Arthritis cartilage and bone destruction, and systemic features (e.g., cardiovascular, pulmonary, psychological, skeletal disorders). The clinical hallmark of RA is polyarticular synovial inflammation of peripheral joints (typically in the hands, resulting in pain, stiffness, and some degree of irreversible joint damage; deformity; and disability).

Medications used in RA include disease-modifying antirheumatic drugs (DMARDs) and biologic agents, including tumor necrosis factor (TNT) inhibitors. Combination treatment useful in pts with a long duration of disease or clinical features indicating a poor prognosis.

DMARDS

Name

Dosage

Side Effects/Comments

Hydroxychloroquine (Plaquenil)

Induction: 400–600 mg/day for 4–12 wks Maintenance: 200–400 mg/day

Leflunomide (Arava)

Induction: 100 mg/day for 3 days Maintenance: 10–20 mg/day

Methotrexate (oral) (Rheumatrex, Trexall) Methotrexate (injectable) Otrexup, Rasuvo)

Induction: 7.5–10 mg PO once wkly Maintenance: 7.5–25 mg PO once wkly Induction: 7.5 PO once wkly Maintenance: 10–25 mg IM or SQ once wkly

Sulfasalazine (Azulfidine)

Induction: 3–4 g/day in divided doses Maintenance: 2 g/day in divided doses

Side Effects: nausea, epigastric pain, hemolysis may occur in pts with G6PD deficiency, retinal toxicity with long-term use Side Effects: diarrhea, respiratory tract infection, hypertension, headache, reversible alopecia, rash, myelosuppression, and/or elevated hepatic enzymes Comments: contraindicated for use during pregnancy Side Effects: stomatitis, anorexia, nausea, vomiting, diarrhea, abdominal cramps, hepatic enzyme elevations, thrombocytopenia Comments: not recommended in pts with CrCI 104ºF) (>104º F) for for more than less than 24 hrs 24 hrs

Gastrointes- Increase of tinal ULN–1.5 times ULN

IV antibiotic, antifungal, antiviral intervention indicated. Radiologic or surgical intervention indicated > 1.5–2 >2–5 times times ULN ULN

> 5 times ULN

N/A

> ULN–5.5 mmol/L

> 5.5–6 mmol/L

> 7 mmol/L; life-threatening consequences

Death

ULN, Upper limit of normal.

> 6–7 mmol/L

Index A abacavir, 1–3 abaloparatide, 3–5 abatacept, 5–7 Abelcet, 63–66 abemaciclib, 7–10 Abenol, 15–17 Abilify, 81–83 Abilify Maintena, 81–83 abiraterone, 10–12 Abraxane, 895–898 Abstral, 481–485 acalabrutinib, 12–14 Accolate, 1239–1240 Accupril, 985–987 Accuretic, 563–565, 985–987 Acephen, 15–17 Acetadote, 17–19 acetaminophen, 15–17 acetylcysteine, 17–19 Acid Reducer Maximum Strength, 474–477 Aciphex, 988–989 Aciphex Sprinkle, 988–989 Aclasta, 1248–1250 Actemra, 1156–1159 Acticlate, 372–374 Actiq, 481–485 Activase, 49–52 Activella, 456–459 Actonel, 1020–1022 Actonel with Calcium, 1020–1022 Actoplus Met, 748–750 Acular, 650–652 Acular LS, 650–652 Acuvail, 650–652 acyclovir, 20–23 Adalat CC, 826–828 Adalat XL, 826–828 adalimumab, 23–25 Adcetris, 148–151 Adderall, 329–331 Adderall-XR, 329–331 adefovir, 25–26 Adenocard, 26–28 adenosine, 26–28 ado-trastuzumab emtansine, 28–30 Adoxa, 372–374 Adrenalin, 428–430 Adriamycin, 369–372 Adrucil, 499–501 Advair Diskus, 1054–1055 Advair HFA, 1054–1055 Advair, Advair Diskus, Advair HFA, 503–506 Advicor, 723–725 Advil, 581–584 Advil PM, 348–350 afatinib, 30–32

Afinitor, 465–468 Afinitor Disperz, 465–468 Aggrenox, 83–86 Aimovig, 440–441 Airomir, 34–36 AK-Dilate, 934–936 Akne-Mycin, 448–451 Akynzeo, 903–904 Alavert Allergy and Sinus, 715–716 Alavert, 715–716 Albuked-5, 32–34 Albuked-25, 32–34 albumin, 32–34 Albuminar-5, 32–34 Albuminar-25, 32–34 AlbuRx, 32–34 Albutein, 32–34 albuterol, 34–36 Aldactazide, 563–565, 1099–1101 Aldactone, 1099–1101 aldesleukin, 617–619 Aldoril, 563–565 Alecensa, 36–39 Alecensaro, 36–39 alectinib, 36–39 alendronate, 39–40 Alertec, 791–792 Aleve, 813–815 Alimta, 923–925 Aliqopa, 276–279 alirocumab, 41–42 aliskiren, 42–44 Alkeran, 737–739 Allegra Allergy, 488–490 Allegra Allergy Children’s, 488–490 Allegra-D 12 Hour, 488–490 Allegra-D 24 Hour, 488–490 Allerdryl, 348–350 allopurinol, 44–46 almotriptan, 46–47 Aloprim, 44–46 Alora, 456–459 Aloxi, 902–904 ALPRAZolam, 47–49 ALPRAZolam Intensol, 47–49 ALPRAZolam XR, 47–49 Altace, 993–995 alteplase, 49–52 Altoprev, 723–725 Alunbrig, 153–157 Alzheimer’s disease, 5C–6C Amaryl, 542–544 Amatine, 776–777 Ambien, 1252–1253 Ambien CR, 1252–1253 AmBisome, 63–66 Amerge, 815–817 amikacin, 52–54 Amikin, 52–54 amiodarone, 54–56

amitriptyline, 56–58 amLODIPine, 58–60 amoxicillin, 60–61 amoxicillin/clavulanate, 62–63 Amoxi-Clav, 62–63 amphotericin B, 63–66 ampicillin, 66–68 ampicillin/sulbactam, 68–70 Ampyra, 299–300 Amrix, 281–283 Amturnide, 42–44, 563–565 Anafranil, 258–260 anastrozole, 70–71 Andriol, 1135–1138 Androderm, 1135–1138 AndroGel Pump, 1135–1138 Angiomax, 139–141 Angiotensin II receptor antagonists, 9C–10C Angiotensin-converting enzyme (ACE) inhibitors, 7C–8C anidulafungin, 71–72 Anoro Ellipta, 1183–1184 Antara, 479–481 Antianxiety agents, 10C–12C Antiarrhythmics, 13C–16C Antibiotic: aminoglycosides, 19C Antibiotic: carbapenems, 20C–21C Antibiotic: cephalosporins, 22C–24C Antibiotic: fluoroquinolones, 25C Antibiotic: macrolides, 26C Antibiotic: penicillins, 27C–29C Antibiotics, 17C–18C Anticoagulants/antiplatelets/­ thrombolytics, 30C–33C Anticonvulsants, 34C–38C Antidepressants, 39C–42C Antidiabetics, 42C–49C Antidiarrheals, 50C Antidote/reversal agents, 1289–1293 Antifungals: systemic mycoses, 51C–52C Antiglaucoma agents, 53C–55C Antihistamines, 55C–57C Antihyperlipidemics, 57C–61C Antihypertensives, 62C–66C Antimigraine (triptans), 66C–68C Antipsychotics, 69C–70C Antivirals, 71C–74C Anturnide, 58–60 Anusol HC, 568–570 apalutamide, 72–74 apixaban, 74–76 Aplenzin, 168–170 Apo-Acetaminophen, 15–17 Apo-Acyclovir, 20–23 Apo-Alpraz, 47–49 Apo-Atomoxetine, 93–94 Apo-Bicalutamide, 131–132

1303

1304 Index Apo-Bisoprolol, 138–139 Apo-Cal, 175–178 Apo-Carvedilol, 199–201 Apo-Cefaclor, 203–204 Apo-Cefadroxil, 204–206 Apo-Cefprozil, 216–217 Apo-Cetirizine, 237–238 Apo-Clarithromycin, 249–250 Apo-ClomiPRAMINE, 258–260 Apo-Diazepam, 331–333 Apo-Diltiaz, 340–343 Apo-Divalproex, 1192–1194 Apo-Doxazosin, 365–367 Apo-Doxy, 372–374 Apo-Entecavir, 424–426 Apo-Erythro Base, 448–451 Apo-Famciclovir, 473–474 Apo-Famotidine, 474–477 Apo-Ferrous Gluconate, 485–487 Apo-Folic, 507–508 Apo-Furosemide, 515–518 Apo-HydrOXYzine, 573–575 Apo-Ipratropium, 622–624 Apo-ISMN, 631–633 Apo-Ketorolac, 650–652 Apo-Lactulose, 657–658 Apo-Leflunomide, 672–673 Apo-Levocarb, 188–190 Apo-Linezolid, 700–701 Apo-Loratadine, 715–716 Apo-Midodrine, 776–777 Apo-Mometasone, 792–794 Apo-OLANZapine, 854–856 Apo-Paclitaxel, 895–898 Apo-Pen-VK, 927–928 Apo-Pramipexole, 957–959 Apo-PredniSONE, 965–966 Apo-Primidone, 968–970 Apo-Propafenone, 972–973 Apo-RaNITIdine, 998–1000 Apo-Rasagiline, 1001–1003 Apo-Rosuvastatin, 1043–1044 Apo-SulfaSALAzine, 1103–1105 Apo-Telmisartan, 1126–1127 Apo-TraMADol, 1173–1175 Apo-TraZODone, 1180–1181 Apo-ValGANciclovir, 1190–1192 Apo-Valsartan, 1194–1196 Apo-Voriconazole, 1230–1232 apremilast, 76–77 aprepitant/fosaprepitant, 77–79 Apresazide, 561–562, 563–565 Apresoline, 561–562 Apriso, 745–747 Aptensio XR, 758–761 Ara-C, 288–290 Aranesp, 309–311 Arava, 672–673 Aredia, 904–906 argatroban, 79–81 Aricept, 357–359 Aricept RDT, 357–359 Arimidex, 70–71 ARIPiprazole, 81–83 Aristada Initio, 81–83 Arixtra, 509–510

bold – generic drug name

Arnuity Ellipta, 503–506 Aromasin, 468–469 Arthrotec, 334–336 Arymo ER, 796–799 Arzerra, 852–854 Asacol HD, 745–747 Asaphen E.C., 83–86 Ascriptin, 83–86 Asmanex, 792–794 Asmanex HFA, 792–794 aspirin, 83–86 Astagraf XL, 1111–1113 Asthma/COPD, 79C–84C Atacand, 180–182 Atacand HCT, 180–182, 563–565 Atarax, 573–575 Atasol, 15–17 atazanavir, 86–88 Atelvia, 1020–1022 atenolol, 88–90 atezolizumab, 90–93 Ativan, 716–718 atoMOXetine, 93–94 atorvaSTATin, 94–96 Atrovent HFA, 622–624 Aubagio, 1133–1134 Augmentin, 62–63 Augmentin ES 600, 62–63 Avalide, 563–565, 624–625 Avandamet, 748–750 Avandaryl, 542–544 Avapro, 624–625 Avastin, 129–131 Aveed, 1135–1138 Avelox, 800–802 avelumab, 96–99 Aventyl, 842–844 Avidoxy, 372–374 Avonex, 614–615 Avycaz, 220–223 Axert, 46–47 axitinib, 99–101 Azactam, 107–108 Azasan, 101–103 AzaSite, 104–106 azaTHIOprine, 101–103 Azilect, 1001–1003 azilsartan, 103–104 azithromycin, 104–106 Azor, 58–60, 861–862 aztreonam, 107–108 Azulfidine, 1103–1105 Azulfidine EN-tabs, 1103–1105

B baclofen, 109–110 Bactrim, 1101–1103 Bactrim DS, 1101–1103 Bactrim, Septra, 1101–1103 Balversa, 437–440 Banophen, 348–350 Banzel, 1046–1048 Baraclude, 424–426 baricitinib, 110–113 basiliximab, 113–114 Bavencio, 96–99

Bayer, 83–86 beclomethasone, 115–116 Beconase AQ, 115–116 belatacept, 117–119 Belbuca, 165–168 Beleodaq, 121–123 belimumab, 119–121 belinostat, 121–123 Belsomra, 1109–1110 Benadryl, 348–350 Benadryl Children’s Allergy, 348–350 benazepril, 123–124 bendamustine, 125–126 Bendeka, 125–126 Benicar HCT, 563–565, 861–862 Benicar, 861–862 Benlysta, 119–121 benralizumab, 126–128 Besponsa, 603–607 Beta-adrenergic blockers, 75C–78C Betapace, 1097–1099 Betapace AF, 1097–1099 Betaseron, 615–617 bethanechol, 128 bevacizumab, 129–131 bicalutamide, 131–132 BiCNU, 197–199 bictegravir/emtricitabine/­ tenofovir, 132–134 BiDil, 561–562, 631–633 Biktarvy, 132–134 binimetinib, 134–138 Binosto, 39–40 bisoprolol, 138–139 bivalirudin, 139–141 Bivigam, 593–595 Blephamide, 963–965 blinatumomab, 141–144 Blincyto, 141–144 Boniva, 577–579 bortezomib, 144–146 Bosulif, 146–148 bosutinib, 146–148 Braftovi, 418–421 brentuximab vedotin, 148–151 Breo Ellipta, 503–506 Brevibloc, 452–454 brexpiprazole, 151–153 brigatinib, 153–157 Brilinta, 1140–1141 Brisdelle, 913–915 brivaracetam, 157–159 Briviact, 157–159 Brivlera, 157–159 brodalumab, 159–161 Brunavail, 165–168 budesonide, 161–163 Bufferin, 83–86 bumetanide, 163–165 Bumex, 163–165 Buminate, 32–34 Buprenex, 165–168 buprenorphine, 165–168 buPROPion, 168–170 Burinex, 163–165

regular type – trade name

Index

Buscopan, 1061–1063 busPIRone, 170–171 Butrans, 165–168 Bydureon, 469–470 Bydureon BCise, 469–470 Byetta, 469–470 Byvalson, 1194–1196

C cabazitaxel, 172–174 Caduet, 58–60, 94–96 Caelyx, 369–372 Cafergot, Wigraine, 338–340 Calan, 1212–1215 Calan SR, 1212–1215 Calcijex, 1225–1228 Calcimar, 174–175 calcitonin, 174–175 Cal-Citrate, 175–178 calcitriol, 1225–1228 calcium acetate, 175–178 calcium carbonate, 175–178 Calcium channel blockers, 85C–86C calcium chloride, 175–178 calcium glubionate, 175–178 calcium gluconate, 175–178 Calculation of doses, 1256, 1260 Caldecort, 568–570 Caldolor, 581–584 Calquence, 12–14 Caltrate 600, 175–178 Cambia, 334–336 Camptosar, 625–627 canagliflozin, 178–180 Canasa, 745–747 Cancidas, 201–203 candesartan, 180–182 capecitabine, 182–183 Capozide, 183–185, 563–565 Caprelsa, 1198–1200 captopril, 183–185 Carac, 499–501 carBAMazepine, 185–187 Carbatrol, 185–187 carbidopa/levodopa, 188–190 Carbolith, 707–709 CARBOplatin, 190–191 CARBOplatin Injection, 190–191 Cardene IV, 822–824 Cardizem, 340–343 Cardizem CD, 340–343 Cardizem LA, 340–343 Cardura XL, 365–367 Cardura, 365–367 carfilzomib, 192–195 Carimune NF, 593–595 cariprazine, 195–197 carmustine, 197–199 CaroSpir, 1099–1101 Cartia XT, 340–343 carvedilol, 199–201 Casodex, 131–132 caspofungin, 201–203 Catapres, 262–264 Catapres-TTS, 262–264 Cathflo Activase, 49–52

bold page # – main drug entry

Cayston, 107–108 Ceclor, 203–204 cefaclor, 203–204 cefadroxil, 204–206 ceFAZolin, 206–208 cefdinir, 208–209 cefepime, 209–211 cefixime, 211–212 cefotaxime, 212–214 cefpodoxime, 214–215 cefprozil, 216–217 ceftaroline, 217–218 cefTAZidime, 218–220 cefTAZidime/avibactam, 220–223 Ceftin, 227–229 ceftolozane/tazobactam, 223–225 cefTRIAXone, 225–227 cefuroxime, 227–229 Cefzil, 216–217 CeleBREX, 229–231 celecoxib, 229–231 CeleXA, 247–249 CellCept, 802–804 cephalexin, 231–232 Cerebyx, 512–514 ceritinib, 232–235 certolizumab pegol, 235–237 Cerubidine, 317–319 cetirizine, 237–238 Cetraxal, 243–245 cetuximab, 238–240 Cetylev, 17–19 Champix, 1200–1202 Chantix, 1200–1202 Chemotherapeutic agents, 87C–105C Children’s Advil Cold, 581–584 chlorambucil, 240–241 Ciloxan, 243–245 Cimduo, 658–660 Cimzia, 235–237 cinacalcet, 241–242 Cinqair, 1007–1009 Cinvanti, 77–79 Cipralex, 451–452 Cipro, 243–245 Ciprodex Otic, 243–245, 325–327 ciprofloxacin, 243–245 Cipro HC Otic, 243–245 Cipro XR, 243–245 CISplatin, 245–247 citalopram, 247–249 Citracal, 175–178 Claforan, 212–214 clarithromycin, 249–250 Claritin, 715–716 Claritin-D, 715–716 Claritin Reditabs, 715–716 Clavulin, 62–63 Cleocin, 252–255 Cleocin T, 252–255 clevidipine, 251–252 Cleviprex, 251–252 Climara, 456–459 Climara PRO, 456–459

1305

Clindagel, 252–255 clindamycin, 252–255 Clindesse, 252–255 cloBAZam, 255–256 clofarabine, 257–258 Clolar, 257–258 clomiPRAMINE, 258–260 clonazePAM, 260–262 cloNIDine, 262–264 clopidogrel, 264–266 cloZAPine, 266–268 Clozaril, 266–268 cobimetinib, 268–271 colchicine, 271–273 Colcrys, 271–273 Colocort, 568–570 CoLyte, 944–945 Combi-patch, 456–459 Combivent, DuoNeb, 622–624 Combivent Respimat, 34–36 Combivir, 1241–1243 Combunox, 581–584, 890–892 Common Terminology Criteria For Adverse Events (CTCAE), 1301–1302 Compro, 970–972 Concerta, 758–761 conjugated estrogens, 273–275 Constella, 697–698 Constulose, 657–658 Contraception, 106C–111C Controlled drugs (United States), 1257 ConZip, 1173–1175 copanlisib, 276–279 Copaxone, 539–540 Copiktra, 385–389 Cordarone, 54–56 Coreg, 199–201 Coreg CR, 199–201 CoreMino, 783–784 Corlanor, 635–637 Cortaid, 568–570 Cortef, 568–570 Cortenema, 568–570 Corticosteroids, 111C–113C Cortisporin, 568–570 Cortizone-10, 568–570 Cosentyx, 1063–1065 Cosentyx Sensor Pen, 1063–1065 Cotellic, 268–271 Cotempla XR, 758–761 Coumadin, 1236–1238 Covera-HS, 1212–1215 Cozaar, 722–723 Cresemba, 627–629 Crestor, 1043–1044 crizotinib, 279–281 Crystapen, 925–926 Cubicin, 304–306 Cutivate, 503–506 cyclobenzaprine, 281–283 cyclophosphamide, 283–285 cycloSPORINE, 285–288 Cyltezo, 23–25 Cymbalta, 377–379

1306 Index Cyramza, 995–998 cytarabine, 288–290 Cytosar-U, 288–290 Cytotec, 787–789 Cytovene, 522–524

D D.H.E. 45, 338–340 dabigatran, 291–292 dabrafenib, 292–295 dacomitinib, 295–297 dalbavancin, 297–299 dalfampridine, 299–300 Daliresp, 1034–1035 dalteparin, 300–302 Dalvance, 297–299 Dantrium, 302–304 dantrolene, 302–304 DAPTOmycin, 304–306 daratumumab, 306–309 darbepoetin alfa, 309–311 darifenacin, 311–312 darunavir, 312–315 Darzalex, 306–309 dasatinib, 315–317 DAUNOrubicin, 317–319 Daurismo, 536–539 Daxas, 1034–1035 Daytrana, 758–761 D-Care DM2, 748–750 DDAVP, 323–325 DDAVP Rhinal Tube, 323–325 Decadron, 325–327 deferasirox, 319–321 Delestrogen, 456–459 Delstrigo, 361–363 Delzicol, 745–747 Demadex, 1168–1170 denosumab, 321–322 Depacon, 1192–1194 Depakene, 1192–1194 Depakote, 1192–1194 Depakote ER, 1192–1194 Depakote Sprinkle, 1192–1194 Depo-Cyt, 288–290 Depo-Estradiol, 456–459 DepoMedrol, 761–763 Depo-Provera, 733–734 Depo-SubQ Provera 104, 733–734 Depo-Testosterone, 1135–1138 desmopressin, 323–325 Detrol, 1162–1163 Detrol LA, 1162–1163 Dexacidin, Maxitrol, 325–327 dexamethasone, 325–327 Dexamethasone Intensol, 325–327 dexmedetomidine, 327–329 DexPak, 325–327 dextroamphetamine and amphetamine, 329–331 DiaBeta, 545–547 Diamode, 713–715 Diarr-Eze, 713–715 Diastat, 331–333 DiazePAM Intensol, 331–333 diazePAM, 331–333

bold – generic drug name

diclofenac, 334–336 Dificid, 490–491 Diflucan, 497–499 Digitek, 336–338 Digox, 336–338 digoxin, 336–338 dihydroergotamine, 338–340 Dilantin, 936–939 Dilatrate-SR, 631 Dilaudid, 570–573 dilTIAZem, 340–343 Dilt-XR, 340–343 dimethyl fumarate, 343–344 dinutuximab, 344–348 Diovan HCT, 563–565, 1194–1196 Diovan, 1194–1196 Diphen, 348–350 Diphenhist, 348–350 diphenhydrAMINE, 348–350 diphenoxylate with atropine, 350–351 Diprivan, 974–975 Ditropan XL, 888–890 Diuretics, 114C–116C Divigel, 456–459 Dixarit, 262–264 DOBUTamine, 351–353 Dobutrex, 351–353 DOCEtaxel, 353–356 dofetilide, 356–357 Dolophine, 751–753 dolutegravir, 1–3 donepezil, 357–359 Donnatal, 932–934, 1062–1063 DOPamine, 359–361 doravirine/lamivudine/­ tenofovir, 361–363 doripenem, 363–365 Doryx, 372–374 doxazosin, 365–367 doxepin, 367–369 doxercalciferol, 1225–1228 Doxil, 369–372 DOXOrubicin, 369–372 Doxy-100, 372–374 doxycycline, 372–374 Drisdol, 1225–1228 Drizalma Sprinkle, 377–379 dronabinol, 374–375 Drug interactions, 1284–1288 Drugs of abuse, 1263–1269, 1267–1273 Duavee, 273–275 Duetact, 542–544 Duexis, 474–477, 581–584 dulaglutide, 376–377 Dulera, 792–794 Duloxetine DR, 377–379 DULoxetine, 377–379 DuoNeb, 34–36 Duopa, 188–190 dupilumab, 379–381 Dupixent, 379–381 Duraclon, 262–264 Duramorph, 796–799 Durlaza, 83–86

durvalumab, 382–385 Dutoprol, 563–565, 767–770 duvelisib, 385–389 Duvoid, 128 Duzallo, 44–46 Dyazide/Maxide, 563–565 Dymista, 503–506

E Ebixa, 739–741 EC-Naprosyn, 813–815 Ecotrin, 83–86 Edarbi, 103–104 Edarbyclor, 103–104 Edluar, 1252–1253 edoxaban, 390–392 EES, 448–451 efavirenz/lamivudine/tenofovir, 392–395 Effexor XR, 1210–1212 Effient, 959–961 Efudex, 499–501 Elavil, 56–58 elbasvir/grazoprevir, 395–397 Elestrin, 456–459 eletriptan, 397–398 Eligard, 683–685 Eliphos, 175–178 Eliquis, 74–76 Elitek, 1003–1005 Elocon, 792–794 elotuzumab, 398–401 Eloxatin, 884–886 eltrombopag, 402–403 Eltroxin, 692–694 eluxadoline, 404–405 elvitegravir/cobicistat/emtricitabine/tenofovir, 405–408 Embeda, 812–813 Emend, 77–79 EMLA, 694–697 empagliflozin, 409–410 Empliciti, 398–401 Emsam, 1065–1067 emtricitabine/tenofovir, 411–414 Enablex, 311–312 enalapril, 414–416 enasidenib, 416–418 Enbrel, 461–463 Enbrel Mini, 461–463 Enbrel SureClick, 461–463 encorafenib, 418–421 Endocet, 15–17, 890–892 enoxaparin, 422–424 entecavir, 424–426 Entocort EC, 161–163 Entresto, 1050–1051 Entrophen, 83–86 Entyvio, 1203–1205 Enulose, 657–658 Envarsus XR, 1111–1113 enzalutamide, 426–427 Epaned, 414–416 Epclusa, 1085–1087 EPINEPHrine, 428–430 EpiPen Jr., 428–430

regular type – trade name

Index

EpiPen, 428–430 Epitol, 185–187 eplerenone, 430–431 epoetin alfa, 432–434 Epogen, 432–434 Eprex, 432–434 eprosartan, 434–435 eptifibatide, 436–437 Equetro, 185–187 Equianalgesic dosing, 1270, 1274 Eraxis, 71–72 Erbitux, 238–240 erdafitinib, 437–440 erenumab-aooe, 440–441 ergocalciferol, 1225–1228 eriBULin, 442–443 Erivedge, 1223–1225 Erleada, 72–74 erlotinib, 443–445 ertapenem, 445–446 ertugliflozin, 447–448 Erybid, 448–451 Eryc, 448–451 EryDerm, 448–451 EryPed, 448–451 Ery-Tab, 448–451 Erythrocin, 448–451 erythromycin, 448–451 Eryzole, 448–451 escitalopram, 451–452 esmolol, 452–454 esomeprazole, 454–456 estradiol, 456–459 Estrogel, 456–459 eszopiclone, 460–461 etanercept, 461–463 Etopophos, 463–465 etoposide, VP-16, 463–465 Euglucon, 545–547 Euthyrox, 692–694 Evamist, 456–459 Evenity, 1039–1041 everolimus, 465–468 Evista, 989–991 Evomela, 737–739 Evotaz: atazanavir/cobicistat, 86–88 Evzio, 812–813 Exalgo, 570–573 Exelon, 1031–1033 exemestane, 468–469 exenatide, 469–470 Exforge, 58–60, 1194–1196 Exforge HCT, 58–60, 563–565, 1194–1196 Exjade, 319–321 Extavia, 615–617 ezetimibe, 470–472 Ezetrol, 470–472

F famciclovir, 473–474 famotidine, 474–477 Fampyra, 299–300 Famvir, 473–474 Fanapt Titration Pack, 588–590 Fanapt, 588–590

bold page # – main drug entry

Farydak, 908–911 Fasenra, 126–128 Fasturtec, 1003–1005 FazaClo, 266–268 febuxostat, 477–478 felodipine, 478–479 Femara, 680–681 Femhrt, 456–459 Femring, 456–459 fenofibrate, 479–481 Fenoglide, 479–481 fentaNYL, 481–485 Fentora, 481–485 Ferate, 485–487 Fer-In-Sol, 485–487 Fer-Iron, 485–487 ferric gluconate, 485–487 Ferrlecit, 485–487 Ferrocite, 485–487 ferrous fumarate, 485–487 ferrous gluconate, 485–487 ferrous sulfate, 485–487 fesoterodine, 487–488 Feverall, 15–17 Fexmid, 281–283 fexofenadine, 488–490 Fibricor, 479–481 fidaxomicin, 490–491 filgrastim, 491–493 finasteride, 493–495 fingolimod, 495–497 Fioricet, 15–17 Fiorinal, 83–86 Flagyl, 770–772 Flebogamma DIF, 593–595 Flector, 334–336 Flexbumin, 32–34 FloLipid, 1073–1075 Flomax, 1118–1119 Flomax CR, 1118–1119 Flonase, 503–506 Flonase Allergy Relief, 503–506 Flonase Sensimist, 503–506 Flovent Diskus, 503–506 fluconazole, 497–499 Fluoroplex, 499–501 fluorouracil, 5-FU, 499–501 FLUoxetine, 499–501 fluticasone, 503–506 fluvoxaMINE, 506–507 folic acid, 507–508 Folotyn, 956–957 fondaparinux, 509–510 Forfivo XL, 168–170 Fortamet, 748–750 Fortaz, 218–220 Forteo, 1134–1135 Fortesta, 1135–1138 Fosamax, 39–40 Fosamax Plus D, 39–40 fosinopril, 511–512 fosphenytoin, 512–514 Fragmin, 300–302 Fresenius Propoven, 974–975 Frova, 514–515 frovatriptan, 514–515

1307

Fulphila, 917–918 Fungizone, 63–66 Furadantin, 832–833 furosemide, 515–518 Fycompa, 928–930

G gabapentin, 519–521 Gabitril, 1138–1140 Gablofen, 109–110 galantamine, 521–522 Gammagard Liquid, 593–595 Gammagard S/D, 593–595 Gammaplex, 593–595 Gamunex-C, 593–595 ganciclovir, 522–524 Gattex, 1122–1124 Gazyva, 845–847 gefitinib, 524–526 Gelnique, 888–890 gemcitabine, 526–528 gemfibrozil, 528–530 Gemzar, 526–528 Genahist, 348–350 Generlac, 657–658 Gengraf, 285–288 Genotropin, 1090–1093 Genotropin Miniquick, 1090–1093 gentamicin, 530–533 Genvoya, 405–408 Geodon, 1243–1245 Gilenya, 495–497 Gilotrif, 30–32 gilteritinib, 533–536 glasdegib, 536–539 Glatect, 539–540 glatiramer, 539–540 Glatopa, 539–540 glecaprevir/pibrentasvir, 540–542 Gleevec, 590–592 Gliadel Wafer, 197–199 glimepiride, 542–544 glipiZIDE, 544–545 GlipiZIDE/metFORMIN, 544–545 Glucophage, 748–750 Glucophage XR, 748–750 Glucotrol, 544–545 Glucotrol XL, 544–545 Glucovance, 545–547, 748–750 Glumetza, 748–750 glyBURIDE, 545–547 Glycon, 748–750 Glynase, 545–547 Glyxambi, 409–410, 698–699 golimumab, 547–550 GoLYTELY, 946–947 GoNitro, 833–837 Good Sense Nicotine, 824–826 goserelin, 550–551 Gralise, 519–521 granisetron, 552–553 Granix, 491–493 guselkumab, 554–555

1308 Index H H2 antagonists, 117C Habitrol, 824–826 Halaven, 442–443 Haldol, 556–558 Haldol Decanoate, 556–558 haloperidol, 556–558 Harvoni, 670–672 Hectorol, 1225–1228 Helidac, 770–772 Hemangeol, 976–979 Hepalean Leo, 558–561 heparin, 558–561 Hepatitis C Virus, 118C–120C Hepsera, 25–26 Herbals: common natural medicines, 1271–1277, 1275–1281 Herceptin, 1178–1180 Hizentra, 593–595 Holkira PAK, 870–873 Horizant, 519–521 Hormones, 121C–124C HumaLOG Mix 75/25, 607–611 Human immunodeficiency virus (HIV) infection, 124C–131C Humatrope, 1090–1093 Humira, 23–25 HumuLIN 70/30, NovoLIN 70/30, 607–611 HumuLIN Mix 50/50, 607–611 Hycamtin, 1166–1168 Hycet, 15–17, 565–568 Hycodan, 565–568 Hycotuss, Vitussin, 565–568 hydrALAZINE, 561–562 hydroCHLOROthiazide, 563–565 HYDROcodone, 565–568 hydrocortisone, 568–570 Hydromorph Contin, 570–573 HYDROmorphone, 570–573 hydrOXYzine, 573–575 Hysingla ER, 565–568 Hyzaar, 563–565, 722–723

I ibalizumab-uiyk, 576–577 ibandronate, 577–579 Ibrance, 898–900 ibrutinib, 579–581 ibuprofen, 581–584 Iclusig, 948–951 idelalisib, 584–586 Idhifa, 416–418 Ifex, 586–588 ifosfamide, 586–588 iloperidone, 588–590 Ilumya, 1143–1145 imatinib, 590–592 Imbruvica, 579–581 Imdur, 631–633 Imfinzi, 382–385 Imitrex, 1105–1107 immune globulin IV (IGIV), 593–595 Immunosuppressive agents, 132C–133C

bold – generic drug name

Imodium A-D, 713–715 Imodium Advanced, 713–715 Imuran, 101–103 Incruse Ellipta, 1183–1184 indacaterol/glycopyrrolate, 595–596 indapamide, 597–598 Inderal LA, 976–979 Inderal XL, 976–979 Inderide, 563–565, 976–979 Inderide LA, 976–979 Indocin, 598–601 indomethacin, 598–601 Inflectra, 601–603 inFLIXimab, 601–603 Infumorph, 796–799 Ingrezza, 1188–1190 Inlyta, 99–101 InnoPran XL, 976–979 inotuzumab ozogamicin, 603–607 Inspra, 430–431 insulin, 607–611 Integrilin, 436–437 interferon alfa-2b, 611–614 interferon beta-1a, 614–615 interferon beta-1b, 615–617 interleukin-2, 617–619 Intermezzo, 1252–1253 Intron-A, 611–614 INVanz, 445–446 Invega, 900–902 Invega Sustenna, 900–902 Invega Trinza, 900–902 Invokamet, 178–180, 748–750 Invokana, 178–180 Ionsys, 481–485 ipilimumab, 619–622 ipratropium, 622–624 Iquix, 689–692 irbesartan, 624–625 Iressa, 524–526 irinotecan, 625–627 isavuconazonium, 627–629 ISDN, 631 Isentress, 991–992 isoniazid, 629–631 Isoptin SR, 1212–1215 Isordil, 631 isosorbide dinitrate, 631 isosorbide mononitrate, 631–633 Isotamine, 629–631 Istodax, 1037–1039 itraconazole, 633–635 ivabradine, 635–637 ivacaftor, 637–639 ivosidenib, 639–642 ixabepilone, 642–644 ixazomib, 645–647 ixekizumab, 648–649 Ixempra, 642–644

J Jadenu, 319–321 Jakafi, 1048–1049

Jalyn, 1118–1119 Jantoven, 1236–1238 Janumet, 748–750, 1080–1081 Janumet XR, 748–750, 1080–1081 Januvia, 1080–1081 Jardiance, 409–410 Jentadueto, 698–699, 749–750 Jentadueto XR, 698–699, 749–750 Jevtana, 172–174 Juvisync, 1073–1075 Juxtapid, 711–713

K Kadcyla, 28–30 Kadian, 796–799 Kalydeco, 637–639 Kaon-Cl, 953–956 Kapvay, 262–264 Kaspargo, 767–770 Kazano, 749–750 Kedbumin, 32–34 Keflex, 231–232 Keppra, 687–689 Keppra XR, 687–689 ketorolac, 650–652 Kevzara, 1058–1061 Keytruda, 920–923 Kisqali, 1011–1014 Klean-Prep, 944–945 KlonoPIN, 260–262 Klor-Con, 953–956 Klor-Con M10, 953–956 Klor-Con M20, 953–956 Kombiglyze XR, 749–750 Kristalose, 657–658 Krystexxa, 918–920 Kymriah, 1148–1152 Kyprolis, 192–195

L labetalol, 653–655 lacosamide, 655–657 lactulose, 657–658 LaMICtal, 660–663 LaMICtal ODT, 660–662 LaMICtal XR, 660–663 lamivudine, 1–3 lamivudine/tenofovir, 658–660 lamoTRIgine, 660–663 Lanoxin, 336–338 lansoprazole, 663–665 lapatinib, 665–667 larotrectinib, 667–670 Lartruvo, 859–861 Lasix, 515–518 Latuda, 725–727 Laxatives, 134C–136C Lazanda, 481–485 ledipasvir/sofosbuvir, 670–672 leflunomide, 672–673 lenalidomide, 674–677 lenvatinib, 677–680 Lenvima, 677–680 letrozole, 680–681 leucovorin, 681–683 Leukeran, 240–241

regular type – trade name

Index

Leukine, 1056–1058 leuprolide, 683–685 levalbuterol, 685–687 Levaquin, 689–692 Levate, 56–58 levETIRAcetam, 687–689 levoFLOXacin, 691–692 Levophed, 840–842 levothyroxine, 692–694 Levoxyl, 692–694 Lexapro, 451–452 Lexxel, 414–416 Lialda, 745–747 Lidocaine with EPINEPHrine, 694–697 lidocaine, 694–697 Lidoderm, 694–697 LidoSite, 428–430, 694–697 Lifespan, cultural aspects, and pharmacogenomics of drug therapy, 1278–1281, 1282–1285 Limbitrol, 56–58 linaclotide, 697–698 linagliptin, 698–699 linezolid, 700–701 Linzess, 697–698 Lioresal, 109–110 Lipidil EZ, 479–481 Lipitor, 94–96 Lipodox-50, 369–372 Lipofen, 479–481 Lipsovir, 20–23, 568–570 Liptruzet, 470–472 liraglutide, 701–703 lisdexamfetamine, 703–705 lisinopril, 705–707 Lithane, 707–709 lithium, 707–709 Lithmax, 707–709 Lithobid, 707–709 Lixiana, 390–392 lomitapide, 711–713 Lomotil, 350–351 Lonsurf, 1146–1148 Loperacap, 713–715 loperamide, 713–715 Lopid, 528–530 Lopressor, 767–770 Lopressor HCT, 563–565, 767–770 Loradamed, 715–716 loratadine, 715–716 LORazepam, 716–718 LORazepam Intensol, 716–718 Lorbrena, 719–722 lorlatinib, 719–722 Lortab/ASA, 83–86 losartan, 722–723 Losec, 874–876 Lotensin, 123–124 Lotensin HCT, 123–124, 563–565 Lotrel, 58–60, 123–124 lovastatin, 723–725 Lovaza, 873–874 Lovenox, 422–424 Lozide, 597–598 Lunelle, 456–459

bold page # – main drug entry

Lunesta, 460–461 Lupron, 683–685 Lupron Depot, 683–685 Lupron Depot-Ped, 683–685 lurasidone, 725–727 Luvox, 506–507 Lynparza, 857–858 Lyrica, 966–968 Lyrica CR, 966–968

M Macrobid, 832–833 Macrodantin, 832–833 Magnacet, 890–892 magnesium, 728–731 magnesium chloride, 728–731 magnesium citrate, 728–731 magnesium hydroxide, 728–731 magnesium oxide, 728–731 magnesium sulfate, 728–731 mannitol, 731–733 Mapap, 15–17 Marinol, 374–375 Marqibo, 1219–1221 Matzim LA, 340–343 Mavyret, 540–542 Maxalt, 1033–1034 Maxalt-MLT, 1033–1034 Maxalt RPD, 1033–1034 Maxidex, 325–327 Maxipime, 209–211 Mayzent, 1075–1078 5 mcg Pen, 469–470 10 mcg Pen, 469–470 Medrol, 761–763 medroxyPROGESTERone, 733–734 Megace ES, 735 Megace OS, 735 megestrol, 735–736 Mekinist, 1175–1178 Mektovi, 134–138 meloxicam, 736–737 melphalan, 737–739 memantine, 739–741 Menostar, 456–459 meropenem, 741–743 meropenem/vaborbactam, 743–745 Merrem, 741–743 mesalamine, 745–747 Mesasal, 745–747 M-Eslon, 796–799 mesna, 747–748 Mesnex, 747–748 Mestinon, 981–982 Mestinon SR, 981–982 Metadate ER, 758–761 Metadol, 751–753 Metaglip, 749–750 metFORMIN, 748–750 methadone, 751–753 Methadone Intensol, 751–753 Methadose, 751–753 Methergine, 756–757 methotrexate, 753–755

1309

methylergonovine, 756–757 Methylin, 758–761 methylnaltrexone, 757–758 methylphenidate, 758–761 methylPREDNISolone, 761–763 methylPREDNISolone acetate, 761–763 methylPREDNISolone sodium succinate, 761–763 metoclopramide, 763–765 metOLazone, 765–767 Metonia, 763–765 metoprolol, 767–770 MetroCream, 770–772 MetroGel, 770–772 MetroGel-Vaginal, 770–772 metroNIDAZOLE, 770–772 Miacalcin, 174–175 micafungin, 772–773 Micardis, 1126–1127 Micardis HCT, 563–565, 1126–1127 Micro-K, 953–956 midazolam, 774–775 midodrine, 776–777 midostaurin, 777–780 Migranal, 338–340 Millipred, 963–965 milnacipran, 780–781 milrinone, 781–783 Minitran, 833–837 Mini-velle, 456–459 Minocin, 783–784 minocycline, 783–784 mirabegron, 784–786 MiraLax, 944–945 Mirapex, 957–959 Mirapex ER, 957–959 mirtazapine, 786–787 miSOPROStol, 787–789 Mitigare, 271–273 Mitigo, 796–799 mitoMYcin, 789–791 Mobic, 736–737 modafinil, 791–792 Moduretic, 563–565 mometasone, 792–794 Monolira, 783–784 montelukast, 794–796 morphine, 796–799 Motrin, 581–584 Movantik, 810–811 Moxeza, 800–802 moxifloxacin, 800–802 MS Contin, 796–799 MS-IR, 796–799 Mucomyst, 17–19 Multiple sclerosis, 137C–138C Muro 128, 1083–1085 Mutamycin, 789–791 Mycamine, 772–773 Mycobutin, 1014–1015 mycophenolate, 802–804 Mydayis, 329–331 Mydfrin, 934–936 Myfortic, 802–804 Mylanta, 728–731

1310 Index Myrbetriq, 784–786 Mysoline, 968–970

N nafcillin, 805–806 nalbuphine, 806–808 naldemedine, 808–809 naloxegol, 810–811 naloxone, 812–813 Namenda, 739–741 Namenda XR, 739–741 Namzaric, 739–741 Naprelan, 813–815 Naprosyn, 813–815 naproxen, 813–815 naratriptan, 815–817 Narcan, 812–813 Narcan Nasal Spray, 812–813 Nasal Moist, 1083–1085 Nasonex, 792–794 Natesto, 1135–1138 Navelbine, 1221–1223 Nayzilam, 774–775 necitumumab, 817–820 NeoProfen, 581–584 Neoral, 285–288 Neo-Synephrine, 934–936 neratinib, 820–822 Nerlynx, 820–822 Neulasta, 917–918 Neulasta Onpro, 917–918 Neupogen, 491–493 Neurontin, 519–521 Neut, 1081–1083 NexAVAR, 1095–1096 NexIUM 24 HR, 454–456 Nexium IV, 454–456 NexIUM, 454–456 Nexterone, 54–56 niCARdipine, 822–824 NicoDerm, 824–826 NicoDerm CQ, 824–826 Nicorette, 824–826 nicotine, 824–826 Nicotrol, 824–826 Nicotrol NS, 824–826 NidaGel, 770–772 NIFEdipine, 826–828 niMODipine, 828–829 Nimotop, 828–829 Ninlaro, 645–647 niraparib, 829–832 Nitro-Bid, 833–837 Nitro-Dur, 833–837 nitrofurantoin, 832–833 nitroglycerin, 833–837 Nitrolingual, 833–837 NitroMist, 833–837 Nitrostat, 833–837 nivolumab, 837–840 Noctiva, 323–325 Nolvadex-D, 1116–1117 Nonsteroidal anti-inflammatory drugs (NSAIDs), 139C–141C Norco, 15–17, 565–568 Norditropin FlexPro, 1090–1093

bold – generic drug name

norepinephrine, 840–842 Noritate, 770–772 Normal laboratory values, 1282–1283, 1286–1287 Normozide, 563–565, 653–655 nortriptyline, 842–844 Norvasc, 58–60 Norventyl, 842–844 Novamoxin, 60–61 Novasen, 83–86 Novo-Bisoprolol, 138–139 Novo-Carvedilol, 199–201 Novo-Cefaclor, 203–204 Novo-ClomiPRAMINE, 258–260 Novo-Dipam, 331–333 Novo-Divalproex, 1192–1194 Novo-Hydroxyzin, 573–575 NovoLOG Mix 70/30, 607–611 Novo-Pen-VK, 927–928 Novo-Peridol, 556–558 Novo-Phenytoin, 936–939 Novo-TraZO-Done, 1180–1181 Noxafil, 951–953 Nubain, 806–808 Nucynta, 1119–1121 Nucynta ER, 1119–1121 Nucynta IR, 1119–1121 Nulojix, 117–119 NuLytely, 944–945 NuPen VK, 927–928 Nutrition: enteral, 142C–145C Nutrition: parenteral, 146C–148C Nutropin, 1090–1093 Nutropin AQ NuSpin, 1090–1093 Nuzyra, 866–868 Nymalize, 828–829 Nytol, 348–350

O Obesity management, 149C–150C obinutuzumab, 845–847 Ocean, 1083–1085 ocrelizumab, 847–850 Ocrevus, 847–850 Octagam 5%, 593–595 octreotide, 850–852 Odomzo, 1093–1095 ofatumumab, 852–854 Ofirmev, 15–17 OLANZapine, 854–856 olaparib, 857–858 olaratumab, 859–861 olmesartan, 861–862 Olmetec, 861–862 olodaterol, 862–864 Olumiant, 110–113 omacetaxine, 864–866 omadacycline, 866–868 omalizumab, 868–870 ombitasvir/paritaprevir/ritonavir/ dasabuvir, 870–873 omega-3 acid-ethyl esters, 873–874 omeprazole, 874–876 Omnipred, 963–965 Omnitrope, 1090–1093

ondansetron, 876–878 Onfi, 255–256 Onglyza, 1061–1062 Onivyde, 625–627 Onzetra, 1105–1107 Opdivo, 837–840 Oracea, 372–374 Orapred ODT, 963–965 Orbactiv, 878–880 Orencia, 5–7 oritavancin, 878–880 Orkambi, 637–639 OsCal, 175–178 oseltamivir, 880–882 osimertinib, 882–884 Osmitrol, 731–733 Osteocit, 175–178 Osteoporosis, 151C–153C Otezla, 76–77 Otrexup, 753–755 oxaliplatin, 884–886 Oxaydo, 890–892 OXcarbazepine, 886–888 Oxtellar X, 886–888 Oxy CONTIN, 890–892 oxybutynin, 888–890 oxyCODONE, 890–892 OxyIR, 890–892 oxytocin, 893–894 Oxytrol for Women, 888–890 Ozempic, 1067–1069

P Pacerone, 54–56 PACLitaxel, 895–898 Palafer, 485–487 palbociclib, 898–900 paliperidone, 900–902 palonosetron, 902–904 Pamelor, 842–844 pamidronate, 904–906 panitumumab, 906–908 panobinostat, 908–911 Pantoloc, 911–913 pantoprazole, 911–913 Parenteral fluid administration, 1298–1300 paricalcitol, 1225–1228 Pariet, 988–989 Parkinson’s disease treatment, 154C–156C PARoxetine, 913–915 Parvolex, 17–19 Paxil, 913–915 Paxil CR, 913–915 PAZOPanib, 915–917 PCE Dispertab, 448–451 Pediazole, 448–451 pegfilgrastim, 917–918 pegloticase, 918–920 Peglyte, 944–945 pembrolizumab, 920–923 PEMEtrexed, 923–925 penicillin G potassium, 925–926 penicillin V potassium, 927–928 Pentasa, 745–747

regular type – trade name

Index

Pepcid, 474–477 Pepcid Complete, 474–477 perampanel, 928–930 Percocet, 15–17, 890–892 Percodan, 83–86, 890–892 Perjeta, 930–932 Perseris, 1022–1025 pertuzumab, 930–932 Pexeva, 913–915 Pfizerpen-G, 925–926 PHENobarbital, 932–934 phenylephrine, 934–936 Phenytek, 936–939 phenytoin, 936–939 PhosLo, 175–178 phosphates potassium sodium, 939–940 piperacillin/tazobactam, 941–943 Pitocin, 893–894 Plasbumin-5, 32–34 Plasbumin-25, 32–34 Plavix, 264–266 plecanatide, 943–944 Plendil, 478–479 PMS-Clarithromycin, 249–250 polyethylene glycol, 944–945 polyethylene glycol–electrolyte solution, 944–945 pomalidomide, 945–948 Pomalyst, 945–948 ponatinib, 948–951 Portrazza, 817–820 posaconazole, 951–953 Posanol, 951–953 potassium acetate, 953–956 potassium bicarbonate/citrate, 953–956 potassium chloride, 953–956 Pradaxa, 291–292 PRALAtrexate, 956–957 Praluent, 41–42 pramipexole, 957–959 PrandiMet, 749–750 prasugrel, 959–961 Pravachol, 961–963 pravastatin, 961–963 Pravigard, 83–86, 961–963 Precedex, 327–329 Pred Forte, 963–965 Pred Mild, 963–965 prednisoLONE, 963–965 predniSONE, 965–966 PredniSONE Intensol, 965–966 pregabalin, 966–968 Premarin, 273–275 Preparation H Hydrocortisone, 568–570 Pressyn, 1202–1203 Pressyn AR, 1202–1203 Prestalia, 58–60 Prevacid, 663–665 Prevacid 24HR, 663–665 Prevacid NapraPac, 663–665, 813–815 Prevacid Solu-Tab, 663–665

bold page # – main drug entry

Preventing medication errors and improving medication safety, 1294–1297 Prevpac, 663–665 Prezcobix, 312–315 Prezista, 312–315 PriLOSEC, 874–876 PriLOSEC OTC, 874–876 primidone, 968–970 Prinivil, 705–707 Prinzide/Zestoretic, 563–565, 705–707 Privigen, 593–595 ProAir HFA, 34–36 ProAir RespiClick, 34–36 Probuphine, 165–168 Procardia, 826–828 Procardia XL, 826–828 prochlorperazine, 970–972 Procrit, 432–434 Proctocort, 568–570 Procytox, 283–285 Prograf, 1111–1113 Proleukin, 617–619 Prolia, 321–322 Promacta, 402–403 propafenone, 972–973 Propecia, 493–495 propofol, 974–975 propranolol, 976–979 propylthiouracil, 979–980 Propyl-Thyracil, 979–980 Proscar, 493–495 Proton pump inhibitors, 157C Protonix, 911–913 Protopic, 1111–1113 Proventil HFA, 34–36 Provera, 733–734 Provigil, 791–792 PROzac, 499–501 Pulmicort, 161–163 Pulmicort Flexhaler, 161–163 Pylera, 770–772 pyrazinamide, 980–981 pyridostigmine, 981–982

Q Qbrelis, 705–707 Qmiiz, 736–737 QNASL, 115–116 Qternmet XR, 749–750 Qudexy XR, 1163–1165 QUEtiapine, 983–985 Quillichew ER, 758–761 Quillivant XR, 758–761 quinapril, 985–987 Quixin, 689–692 QVAR RediHaler, 115–116

R RABEprazole, 988–989 raloxifene, 989–991 raltegravir, 991–992 ramelteon, 992–993 ramipril, 993–995 ramucirumab, 995–998

1311

Ranexa, 1000–1001 raNITIdine, 998–1000 ranolazine, 1000–1001 Rapamune, 1078–1080 rasagiline, 1001–1003 rasburicase, 1003–1005 Rasilez, 42–44 Rasuvo, 753–755 Rayos, 965–966 Razadyne, 521–522 Razadyne ER, 521–522 Reactine, 237–238 Rebetol, 1009–1011 Rebetron, 611–614, 1009–1011 Rebif, 614–615 Reclast, 1248–1250 Rectiv, 833–837 Reglan, 763–765 Regonol, 981–982 regorafenib, 1005–1007 Relenza Diskhaler, 1240–1241 Relistor, 757–758 Relpax, 397–398 Remeron, 786–787 Remeron Soltab, 786–787 Remicade, 601–603 Reminyl ER, 521–522 Renagel, 1072–1073 Renflexis, 601–603 Renvela, 1072–1073 Reprexain CIII, 565–568, 581–584 Requip, 1041–1043 Requip XL, 1041–1043 Resectisol, 731–733 reslizumab, 1007–1009 Restasis, 285–288 Retrovir, 1241–1243 Revestive, 1122–1124 Revlimid, 674–677 Revolade, 402–403 Revonto, 302–304 Rexulti, 151–153 Reyataz, 86–88 Rezira, 565–568 Rheumatoid arthritis, 158C–160C Rhinitis preparations, 2C–4C Rhinocort Allergy, 161–163 Ribasphere, 1009–1011 ribavirin, 1009–1011 ribociclib, 1011–1014 rifabutin, 1014–1015 Rifadin, 1016–1017 Rifamate, 629–631, 1016–1017 rifAMPin, 1016–1017 Rifater, 629–631, 980–981, 1016–1017 rifAXIMin, 1018–1019 Riomet, 748–750 risankizumab-rzaa, 1019–1020 risedronate, 1020–1022 RisperDAL, 1022–1025 RisperDAL Consta, 1022–1025 risperiDONE, 1022–1025 RisperiDONE M-Tab, 1022–1025 Ritalin, 758–761 Ritalin LA, 758–761

1312 Index Rituxan, 1025–1029 Rituxan Hycela, 1025–1029 riTUXimab, 1025–1029 rivaroxaban, 1029–1031 rivastigmine, 1031–1033 Rivotril, 260–262 rizatriptan, 1033–1034 Robi-done, 565–568 Rocaltrol, 1225–1228 Rofact, 1016–1017 roflumilast, 1034–1035 rolapitant, 1036–1037 romiDEPsin, 1037–1039 romosozumab-aqqg, 1039–1041 rOPINIRole, 1041–1043 rosuvastatin, 1043–1044 Rowasa, 745–747 Roxicet, 890–892 Roxicodone, 890–892 Rozerem, 992–993 Rubraca, 1044–1046 rucaparib, 1044–1046 rufinamide, 1046–1048 ruxolitinib, 1048–1049 Ryanodex, 302–304 Rybelsus, 1067–1069 Rydapt, 777–780 Ryosol, 1097–1099 Rytary, 188–190 Rythmol SR, 972–973 Ryzodeg 70/30, 607–611

S sacubitril-valsartan, 1050–1051 safinamide, 1052–1054 Saizen, 1090–1093 Salazopyrin, 1103–1105 Salazopyrin EN-Tabs, 1103–1105 SalineX, 1083–1085 salmeterol, 1054–1055 Salofalk, 745–747 Sanctura XR, 1181–1182 Sancuso, 552–553 SandIMMUNE, 285–288 SandoSTATIN, 850–852 SandoSTATIN LAR Depot, 850–852 Sarafem, 499–501 sargramostim, 1056–1058 sarilumab, 1058–1061 Savaysa, 390–392 Savella, 780–781 sAXagliptin, 1061–1062 Saxenda, 701–703 scopolamine, 1062–1063 secukinumab, 1063–1065 Sedative-hypnotics, 161C–162C Segluromet, 447–448 selegiline, 1065–1067 semaglutide, 1067–1069 Sensipar, 241–242 Septra, 1100–1102 Serevent Diskhaler Disk, 1054–1055 Serevent Diskus, 1054–1055 SEROquel, 983–985 SEROquel XR, 983–985

bold – generic drug name

Serostim, 1090–1093 sertraline, 1070–1072 sevelamer, 1072–1073 sfRowasa, 745–747 Silenor, 367–369 Siliq, 159–161 Simcor, 1073–1075 Simponi, 547–550 Simponi Aria, 547–550 Simulect, 113–114 simvastatin, 1073–1075 Sinemet, 188–190 Sinemet CR, 188–190 Sinequan, 367–369 Singulair, 794–796 siponimod, 1075–1078 sirolimus, 1078–1080 SITagliptin, 1080–1081 Sivextro, 1121–1122 Skeletal muscle relaxants, 163C–165C Skyrizi, 1019–1020 Slow-Fe, 485–487 Smoking cessation agents, 166C–168C sodium bicarbonate, 1081–1083 sodium chloride, 1083–1085 sofosbuvir/velpatasvir, 1085–1087 sofosbuvir/velpatasvir/voxilaprevir, 1087–1089 solifenacin, 1089–1090 Soliqua 100/33, 607–611 Solodyn, 783–784 Soltamox, 1116–1117 SOLU-Cortef, 568–570 somatropin, 1090–1093 sonidegib, 1093–1095 SORAfenib, 1095–1096 Sorine, 1097–1099 sotalol, 1097–1099 Sotylize, 1097–1099 Spiriva HandiHaler, 1145–1146 Spiriva Respimat, 1145–1146 spironolactone, 1099–1101 Sporanox, 633–635 Spritam, 687–689 Sprix, 650–652 Sprycel, 315–317 Stalevo, 188–190 Steglatro, 447–448 Steglujan, 447–448 Stelara, 1184–1186 Stimate, 323–325 Stiolto Respimat, 862–864, 1145–1146 Stivarga, 1005–1007 Strattera, 93–94 Striant, 1135–1138 Stribild, 405–408 Striverdi Respimat, 862–864 Sublimaze, 481–485 Sublinox, 1252–1253 Suboxone, 165–168, 812–813 Subsys, 481–485 Subvenite, 660–663

Sudafed PE, 934–936 sulfamethoxazole-­ trimethoprim, 1101–1103 sulfaSALAzine, 1103–1105 Sulfatrim, 1101–1103 SUMAtriptan, 1105–1107 Sumavel DosePro, 1105–1107 SUNItinib, 1107–1109 Supeudol, 890–892 Suprax, 211–212 Sustol, 552–553 Sutent, 1107–1109 suvorexant, 1109–1110 Symbyax, 499–501, 854–856 Symdeko, 637–639 Symfi, 392–395 Symfi Lo, 392–395 Sympazan, 255–256 Symproic, 808–809 Synapryn FusePaq, 1173–1175 Syndros, 374–375 Synéra, 694–697 Synjardy, 409–410, 749–750 Synribo, 864–866 Synthroid, 692–694

T tacrolimus, 1111–1113 Tafinlar, 292–295 Tagrisso, 882–884 talazoparib, 1113–1116 Taltz, 648–649 Talzenna, 1113–1116 Tamiflu, 880–882 tamoxifen, 1116–1117 tamsulosin, 1118–1119 tapentadol, 1119–1121 Tarceva, 443–445 Targiniq ER, 890–892 Tarka, 1212–1215 Taxotere, 353–356 Tazicef, 218–220 Taztia XT, 340–343 Tebrazid, 980–981 Tecentriq, 90–93 Tecfidera, 343–344 Tecta, 911–913 Teczem, 340–343, 414–416 tedizolid, 1121–1122 teduglutide, 1122–1124 Teflaro, 217–218 TEGretol, 185–187 TEGretol XR, 185–187 Tekamlo, 42–44, 58–60 Tekturna HCT, 42–44, 563–565 Tekturna, 42–44 telavancin, 1124–1126 telmisartan, 1126–1127 telotristat ethyl, 1127–1129 Temodal, 1129–1131 Temodar, 1129–1131 temozolomide, 1129–1131 Tempra, 15–17 temsirolimus, 1131–1132 Tenormin, 88–90 teriflunomide, 1133–1134

regular type – trade name

Index

teriparatide, 1134–1135 Testim, 1135–1138 Testopel, 1135–1138 testosterone, 1135–1138 Teveten, 434–435 Teveten HCT, 434–435, 563–565 Thrive, 824–826 Thyrolar, 692–694 tiaGABine, 1138–1140 Tiazac, 340–343 Tibsovo, 639–642 ticagrelor, 1140–1141 tigecycline, 1141–1143 Tikosyn, 356–357 tildrakizumab-asmn, 1143–1145 Timolide, 563–565 tiotropium, 1145–1146 tipiracil/trifluridine, 1146–1148 Tirosint, 692–694 tisagenlecleucel, 1148–1152 Titralac, 175–178 Tivorbex, 598–601 tiZANidine, 1152–1153 TOBI, 1153–1156 TobraDex, 1154–1156 tobramycin, 1153–1156 Tobrex, 1153–1156 tocilizumab, 1156–1159 tofacitinib, 1159–1162 Tolak, 499–501 tolterodine, 1162–1163 Topamax, 1163–1165 Topamax Sprinkle, 1163–1165 topiramate, 1163–1165 Toposar, 463–465 topotecan, 1166–1168 Toprol XL, 767–770 Toradol, 650–652 Torisel, 1131–1132 torsemide, 1168–1170 Toviaz, 487–488 trabectedin, 1170–1173 Tradjenta, 698–699 traMADol, 1173–1175 trametinib, 1175–1178 Trandate, 653–655 Trans-Derm Scop, 1062–1063 trastuzumab, 1178–1180 traZODone, 1180–1181 Treanda, 125–126 Trelegy Ellipta, 503–506, 1183–1184 Tremfya, 554–555 Trexall, 753–755 Treximet, 813–815, 1105–1107 Tribenzor, 58–60, 563–565, 861–862 Tricor, 479–481 Triglide, 479–481 Trileptal, 886–888 Trilipix, 479–481 TriLyte, 944–945 Trinipatch, 833–837 Trintellix, 1233–1235 Triumeq, 1–3 Trizivir, 1241–1243

bold page # – main drug entry

Trogarzo, 576–577 Trokendi XR, 1163–1165 Trosec, 1181–1182 trospium, 1181–1182 Troxyca ER, 890–892 Trulance, 943–944 Trulicity, 376–377 Truvada, 411–414 Tums, 175–178 Tussend, 565–568 Twinject, 428–430 Twynsta, 58–60, 1126–1127 Tygacil, 1141–1143 Tykerb, 665–667 Tylenol, 15–17 Tylenol Arthritis Pain, 15–17 Tylenol Children’s Meltaways, 15–17 Tylenol Extra Strength, 15–17 Tylenol Junior Meltaways, 15–17 Tylenol with Codeine, 15–17 Tylox, 890–892 Tymlos, 3–5

U Uceris, 161–163 Udenyca, 917–918 Ulcidine, 474–477 Uloric, 477–478 Ultibro Breezhaler, 595–596 Ultracet, 15–17, 1173–1175 Ultram, 1173–1175 umeclidinium, 1183–1184 Unasyn, 68–70 Uniretic, 563–565 Unithroid, 692–694 Unituxin, 344–348 Urecholine, 128 Uromitexan, 747–748 Urozide, 563–565 ustekinumab, 1184–1186 Utibron Neohaler, 595–596

V Vabomere, 743–745 valACYclovir, 1187–1188 valbenazine, 1188–1190 Valcyte, 1190–1192 valGANciclovir, 1190–1192 Valium, 331–333 valproic acid, 1192–1194 valsartan, 1194–1196 Valtrex, 1187–1188 Valturna, 42–44, 1194–1196 Vancocin, 1196–1198 vancomycin, 1196–1198 Vandazole, 770–772 vandetanib, 1198–1200 varenicline, 1200–1202 Varubi, 1036–1037 Vascepa, 873–874 Vaseretic, 414–416, 563–565 Vasocidin, 963–965 vasopressin, 1202–1203 Vasostrict, 1202–1203 Vasotec, 414–416 Vectibix, 906–908

1313

Vectical, 1225–1228 vedolizumab, 1203–1205 Velcade, 144–146 vemurafenib, 1206–1207 Venclexta, 1207–1210 venetoclax, 1207–1210 venlafaxine, 1210–1212 Ventolin HFA, 34–36 VePesid, 463–465 verapamil, 1212–1215 Verelan, 1212–1215 Verelan PM, 1212–1215 Veripred, 963–965 Versacloz, 266–268 Verzenio, 7–10 VESIcare, 1089–1090 Vfend, 1230–1232 Vibativ, 1124–1126 Viberzi, 404–405 Vibramycin, 372–374 Vicodin, 15–17, 565–568 Vicodin ES, 15–17, 565–568 Vicodin HP, 15–17, 565–568 Vicoprofen, 565–568, 581–584 Victoza, 701–703 Viekira Pak, 870–873 Viekira XR, 870–873 Vigamox, 800–802 Viibryd, 1215–1216 vilazodone, 1215–1216 Vimovo, 454–456, 813–815 Vimpat, 655–657 vinBLAStine, 1216–1218 Vincasar PFS, 1219–1221 vinCRIStine, 1219–1221 vinorelbine, 1221–1223 Virazole, 1009–1011 vismodegib, 1223–1225 Vistaril, 573–575 vitamin D, 1225–1228 Vitamins, 169C–170C Vitrakvi, 667–670 Vivelle-Dot, 456–459 Vivlodex, 736–737 Vizimpro, 295–297 Vogelxo, 1135–1138 Voltaren Gel, 334–336 vorapaxar, 1228–1229 voriconazole, 1230–1232 vorinostat, 1232–1233 vortioxetine, 1233–1235 Vosevi, 1087–1089 VoSpire ER, 34–36 Votrient, 915–917 Vraylar, 195–197 Vytorin, 470–472, 1073–1075 Vyvanse, 703–705

W warfarin, 1236–1238 Wellbutrin SR, 168–170 Wellbutrin XL, 168–170 Westcort, 568–570 Winpred, 965–966 Wound care, 1258–1262, 1262–1266

1314 Index X Xadago, 1052–1054 Xalkori, 279–281 Xanax, 47–49 Xanax XR, 47–49 Xarelto, 1029–1031 Xartemis XR, 15–17, 890–892 Xatmep, 753–755 Xeljanz, 1159–1162 Xeljanz XR, 1159–1162 Xeloda, 182–183 Xermelo, 1127–1129 Xgeva, 321–322 Xhance, 503–506 Xifaxan, 1018–1019 Ximino, 783–784 Xodol, 15–17, 565–568 Xolair, 868–870 Xopenex, 685–687 Xopenex Concentrate, 685–687 Xopenex HFA, 685–687 Xospata, 533–536 Xsail, 1105–1107 Xtampza ER, 890–892 XTANDI, 426–427 Xultophy, 702–703 Xultophy 100/3.6, 607–611 Xylocaine, 694–697

Y Yervoy, 619–622 Yondelis, 1170–1173 Yonsa, 10–12 Yosprala, 83–86, 874–876

Z zafirlukast, 1239–1240 Zaltrap, 1245–1248

bold – generic drug name

Zanaflex, 1152–1153 zanamivir, 1240–1241 Zantac, 998–1000 Zantac-75, 998–1000 Zantac-150 Maximum Strength, 998–1000 Zaroxolyn, 765–767 Zarxio, 491–493 Zaxine, 1018–1019 Zegerid, 874–876 Zegerid Powder, 874–876 Zejula, 829–832 Zelapar, 1065–1067 Zelboraf, 1206–1207 Zeldox, 1243–1245 Zembrace SymTouch, 1105–1107 Zemplar, 1225–1228 Zepatier, 395–397 Zerbaxa, 223–225 Zestril, 705–707 Zetia, 470–472 Ziac, 138–139, 563–565 zidovudine, 1241–1243 ziprasidone, 1243–1245 Zipsor, 334–336 Zithromax SR, 104–106 Zithromax TRI-PAK, 104–106 Zithromax Z-PAK, 104–106 ziv-aflibercept, 1245–1248 Zocor, 1073–1075 Zofran, 876–878 Zohydro ER, 565–568 Zoladex, 550–551 Zoladex LA, 550–551 zoledronic acid, 1248–1250 Zolinza, 1232–1233 ZOLMitriptan, 1250–1252 Zoloft, 1070–1072

zolpidem, 1252–1253 Zolpimist, 1252–1253 Zomacton, 1090–1093 Zometa, 1248–1250 Zomig, 1250–1252 Zomig Rapimelt, 1250–1252 Zomig-ZMT, 1250–1252 Zonalon, 367–369 Zonegran, 1254–1255 zonisamide, 1254–1255 Zontivity, 1228–1229 Zorbtive, 1090–1093 Zortress, 465–468 Zorvolex, 334–336 Zosyn, 941–943 Zovirax, 20–23 Zubsolv, 165–168, 812–813 Zuplenz, 876–878 Zutripro, 565–568 Zyban, 168–170 Zydelig, 584–586 Zykadia, 232–235 Zylet, 1154–1156 Zyloprim, 44–46 ZyPREXA, 854–856 ZyPREXA Relprevv, 854–856 ZyPREXA Zydis, 854–856 ZyrTEC ALLERGY, 237–238 ZyrTEC D 12 Hour Tablets, 237–238 Zytiga, 10–12 Zyvox, 700–701 Zyvoxam, 700–701

regular type – trade name

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i

Lifespan Considerations in each monograph note factors to be considered for geriatric, pediatric, pregnant, or nursing populations. Appendix G provides additional resources.

Black Box Alerts advise about the increased risks of a particular drug.

panitumumab

2

panitumumab pan-i-toom-ue-mab (Vectibix) BLACK BOX ALERT 90% of pts experience dermatologic toxicities (dermatitis acneiform, pruritus, erythema, rash, skin exfoliation, skin fissures, abscess). Severe infusion reactions (anaphylaxis, bronchospasm, fever, chills, hypotension), fatal reactions have occurred.

Interactions identify potential herbal, drug, and food interactions with a particular drug.

CLASSIFICATION PHARMACOTHERAPEUTIC: Epidermal growth factor receptor (EGFR) inhibitor, monoclonal antibody. CLINICAL: Antineoplastic.

LIFESPAN CONSIDERATIONS Pregnancy/Lactation: May cause fetal harm. May impair fertility. May decrease fetal body weight, increase risk of skeletal fetal abnormalities. Use effective contraception during and for at least 6 mos after treatment. Breastfeeding not recommended. Children: Safety and efficacy not established. Elderly: No age-related precautions noted.

INTERACTIONS DRUG: None significant. HERBAL: None significant. FOOD: None known. LAB VALUES: May decrease serum magnesium, calcium.

AVAILABILITY (RX) Injection Solution: 20 mg/mL vial (5-mL,

20-mL vials).

USES Treatment of wild-type RAS metastatic colorectal cancer either as first-line therapy in combination with FOLFOX or as monotherapy following disease progression after prior treatment with fluoropyrimidine-, oxaliplatin-, or irinotecan-based regimens.

PRECAUTIONS P

Uses section in each monograph notes the standard and off-label uses for a particular drug.

Contraindications: Hypersensitivity to panitumumab. Cautions: Interstitial pneumonitis, pulmonary fibrosis, pulmonary infiltrates, renal impairment, baseline electrolyte imbalance. Not indicated in pts with RAS-mutant metastatic colorectal cancer or for whom RAS mutation status is unknown.

ACTION Binds specifically to epidermal growth factor receptor (EGFR) and competitively inhibits binding of epidermal growth factor. Blocks activation of intracellular tyrosine kinase. Therapeutic Effect: Inhibits tumor cell growth, survival, and proliferation.

PHARMACOKINETICS Clearance varies by body weight, gender, tumor burden. Half-life: 3–10 days.

IV Incompatibilities present important information for IV drugs.

ADMINISTRATION/HANDLING IV

ALERT Do not give by IV push or bolus. Use low protein-binding 0.2- or 0.22-micron in-line filter. Flush IV line before and after chemotherapy administration with 0.9% NaCl. Reconstitution • Dilute in 100–150 mL 0.9% NaCl to provide concentration of 10 mg/mL or less. • Do not shake solution. Invert gently to mix. • Discard any unused portion. Rate of Administration • Give as IV infusion over 60 min. • Infuse doses greater than 1,000 mg over 90 min. Storage • Refrigerate vials. • After dilution, solution may be stored for up to 6 hrs at room temperature, up to 24 hrs if refrigerated. • Discard if discolored, but solution may contain visible, translucent-to-white particulates (will be removed by in-line filter).

IV INCOMPATIBILITIES Do not mix with dextrose solutions or any other medications.

underlined – top prescribed drug

Top prescribed drugs are underlined.

panitumumab INDICATIONS/ROUTES/DOSAGE ALERT Stop infusion immediately in pts experiencing severe infusion reactions. Metastatic Colorectal Cancer IV Infusion: ADULTS, ELDERLY: 6 mg/kg once q14 days as a single agent or in combination with FOLFOX (fluorouracil, leucovorin and oxaliplatin). Continue until disease progression or unacceptable toxicity. Dose Modification Infusion Reactions Mild to moderate reactions: Reduce

infusion rate by 50% for remainder of infusion. Severe reactions: Discontinue infusion. Depending on severity, consider permanent discontinuation. Skin Toxicity

Side Effects section in each drug monograph specifies the frequency of particular side effects.

For all CTCAE grade 3 skin toxicities, withhold treatment for 1–2 doses until improved to better than grade 3. Then, reduce dose as follows: First occurrence of CTCAE grade 3: Resume at same dose. Second occurrence of CTCAE grade 3: Reduce dose to 80% of initial dose. Third occurrence of CTCAE grade 3: Reduce dose to 60% of initial dose. Fourth occurrence of CTCAE grade 3: Permanently discontinue.

NURSING CONSIDERATIONS BASELINE ASSESSMENT

Assess serum magnesium, calcium prior to therapy, periodically during therapy, and for 8 wks after completion of therapy. Assess KRAS mutational status in colorectal tumors and confirm the absence of a RAS mutation. INTERVENTION/EVALUATION

Assess for skin, ocular, mucosal, pulmonary toxicity; report effects. Median time to development of skin/ocular toxicity is 14–15 days; resolution after last dosing is 84 days. Monitor serum electrolytes for hypomagnesemia, hypocalcemia. Offer antiemetic if nausea/vomiting occurs. Monitor daily pattern of bowel activity, stool consistency. PATIENT/FAMILY TEACHING

Dosage in Renal/Hepatic Impairment

No dose adjustment.

SIDE EFFECTS Common

Adverse Reactions highlight the particularly dangerous side effects.

3

rarely. Severe infusion reactions manifested as bronchospasm, fever, chills, hypotension occur rarely. Hypomagnesemia occurs in 39% of pts. Life-threatening and/or fatal bullous fasciitis, abscess, sepsis were reported. Severe dehydration and diarrhea may increase risk of acute renal failure. Exposure to sunlight may exacerbate skin toxicities. May cause ocular toxicities including keratitis, ulcerative keratitis, corneal ulceration.

(65%–57%): Erythema, acneiform dermatitis, pruritus. Frequent (26%– 20%): Fatigue, abdominal pain, skin exfolia-

tion, paronychia (soft tissue infection around nailbed), nausea, rash, diarrhea, constipation, skin fissures. Occasional (19%–10%): Vomiting, acne, cough, peripheral edema, dry skin. Rare (7%–2%): Stomatitis, mucosal inflammation, eyelash growth, conjunctivitis, increased lacrimation.

ADVERSE EFFECTS/TOXIC REACTIONS

• Do not have immunizations without physician’s approval (drug lowers resistance). • Avoid contact with those who have recently received a live virus vaccine. • Avoid crowds, those with infection. • There is a potential risk for development of fetal abnormalities if pregnancy occurs; take measures to prevent pregnancy. • Report skin reactions, including rash, sloughing, blisters, erosions. • Report difficulty breathing, fever with cough, lung pain; may indicate life-threatening lung inflammation. • Limit sun, UV exposure. Wear protective sunscreen, hats, and clothing while outdoors.

Pulmonary fibrosis, severe dermatologic toxicity (complicated by infectious sequelae) occur Canadian trade name

Non-Crushable Drug

High Alert drug

High Alert drugs are shaded in blue for easy identification.

P

COMMONLY USED ABBREVIATIONS ABG(s)—arterial blood gas(es) ACE—angiotensin-converting enzyme ADHD—attention-deficit hyperactivity disorder AIDS—acquired immunodeficiency syndrome ALT—alanine aminotransferase, serum ANC—absolute neutrophil count aPTT—activated partial thromboplastin time AST—aspartate aminotransferase, serum AV—atrioventricular bid—twice per day BMP—basic metabolic panel B/P—blood pressure BSA—body surface area BUN—blood urea nitrogen CBC—complete blood count Ccr—creatinine clearance CNS—central nervous system CO—cardiac output COPD—chronic obstructive pulmonary disease CPK—creatine phosphokinase CSF—cerebrospinal fluid CT—computed tomography CVA—cerebrovascular accident D5W—dextrose 5% in water dl—deciliter DNA—deoxyribonucleic acid DVT—deep vein thrombosis ECG—electrocardiogram EEG—electroencephalogram esp.—especially g—gram GGT—gamma glutamyl transpeptidase GI—gastrointestinal GU—genitourinary H2—histamine Hct—hematocrit HDL—high-density lipoprotein HF—heart failure Hgb—hemoglobin HIV—human immunodeficiency virus HMG-CoA—3-hydroxy-3-methylglutarylcoenzyme A (HMG-CoA) reductase inhibitors (statins) hr/hrs—hour/hours HTN—hypertension I&O—intake and output ICP—intracranial pressure ID—intradermal IgA—immunoglobulin A

IM—intramuscular IOP—intraocular pressure IV—intravenous K—potassium kg—kilogram LDH—lactate dehydrogenase LDL—low-density lipoprotein LFT—liver function test LOC—level of consciousness MAC—Mycobacterium avium complex MAOI—monoamine oxidase inhibitor mcg—microgram mEq—milliequivalent mg—milligram MI—myocardial infarction min—minute(s) mo/mos—month/months N/A—not applicable Na—sodium NaCl—sodium chloride NG—nasogastric NSAID(s)—nonsteroidal anti-inflammatory drug(s) OD—right eye OS—left eye OTC—over the counter OU—both eyes PCP—Pneumocystis jiroveci pneumonia PO—orally, by mouth prn—as needed PSA—prostate-specific antigen pt/pts—patient/patients PT—prothrombin time PTCA—percutaneous transluminal coronary angiography q—every RBC—red blood cell count REM—rapid eye movement RNA—ribonucleic acid SA—sinoatrial node sec—second(s) SSRI—selective serotonin reuptake inhibitor tbsp—tablespoon tid—three times daily TNF—tumor necrosis factor tsp—teaspoon UTI—urinary tract infection VLDL—very-low-density lipoprotein WBC—white blood cell count wk/wks—week/weeks yr/yrs—year/years

DANGEROUS ABBREVIATIONS The 2004 National Patient Safety Goals of The Joint Commission (TJC) requires the elimination of dangerous abbreviations in an effort to promote patient safety by reducing medication errors. To achieve this goal, TJC developed a list of abbreviations, acronyms, and symbols that health care organizations must include in their “do not use” list. An abbreviation on the “do not use” list should not be used in any of its forms—uppercase or lowercase, with or without periods. For example, if Q.D. is on the organization’s list, health care organizations cannot use QD or qd because any of those variations are confusing and can be misinterpreted. Abbreviation U (for unit) IU (for international unit) Q.D., QD, q.d., qd (daily) Q.O.D., QOD, q.o.d., qod (every other day) Trailing zero (e.g., 5.0 mg); lack of leading zero (e.g., .5 mg) MS, MSO4, MgSO4

Potential Problem Mistaken as zero, four, or cc Mistaken as IV (intravenous) or 10 (ten) Mistaken for each other Period after “Q” mistaken for “I” and the “O” mistaken for “I” Decimal point is missed

Confused for one another; can mean morphine sulfate or magnesium sulfate

Preferred Term Write “unit” Write “international unit” Write “daily” Write “every other day” Always write a zero before a decimal point (0.5 mg) and never write a zero by itself after a decimal point (5 mg) Write “morphine sulfate” or “magnesium sulfate”

In addition, TJC requires an organization to identify and apply at least another three “do not use” abbreviations, acronyms, or symbols of its own choosing. The following list was developed by TJC for organizations to consider including on their list. μg (for micrograms) H.S. (for half-strength or Latin abbreviation for bedtime) T.I.W. (for three times per week) S.C. or S.Q. (for subcutaneous) D/C (for discharge) c.c. (for cubic centimeter) A.S., A.D., A.U. (Latin abbreviation for left, right, or both ears) > (greater than) < (less than) Abbreviations for drug names

Mistaken for mg (milligrams) resulting in one thousandfold-dosing overdose Mistaken for either half-strength or hour of sleep (at bedtime); q.H.S. mistaken for every hour; all can result in dosing error Mistaken for three times per day or twice weekly, resulting in an overdose Mistaken as SL for sublingual, or “5 every” Interpreted as discontinue whatever medications follow (typically discharge meds) Mistaken for U (units) when poorly written Mistaken for OS, OD, OU, etc.

Write “mcg” Write “half-strength” or “at bedtime” Write “3 times weekly” or “three times weekly” Write “Sub-Q,” “subQ,” or “subcutaneously” Write “discharge” Write “ml” for milliliters Write “left ear,” “right ear,” or “both ears”

Misinterpreted as number 7 or Write “greater than” or letter “L” “less than” Misinterpreted due to similar ab- Write drug names in full breviations for multiple drugs