Drug Cards Daily: Recent Episodes
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Drug Cards Daily creates simple visual & audio drug card content for Healthcare Students and Professionals. Each episode covers one drug in 20 minutes or less. A new episode is released every Monday at 7 am EST (6 am CST, 4 am PST). Please subscribe and thanks for stopping by! Support this podcast: https://anchor.fm/drugcardsdaily/support
Enalapril is an angiotensin-converting enzyme (ACE) inhibitor prescribed by healthcare professionals to manage hypertension and heart failure. By inhibiting ACE, enalapril reduces the production of angiotensin II, a substance that narrows blood vessels and increases blood pressure. Widening blood vessels alleviates hypertension and decreases the workload on the heart, making it beneficial for heart conditions. Common side effects may include cough and dizziness. Regular monitoring by healthcare providers ensures its effectiveness and manages potential side effects. Enalapril is often part of a comprehensive cardiovascular treatment plan.
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DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist.
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Prednisone, a synthetic corticosteroid, is prescribed by healthcare professionals to treat inflammatory conditions such as allergies, asthma, autoimmune diseases, and skin disorders. It works by suppressing the immune response and reducing inflammation. Available in various forms, including oral tablets and liquid solutions, prednisone's dosage and duration are tailored to the individual's condition. While effective, long-term use or high doses can lead to side effects like weight gain, mood changes, and increased susceptibility to infections. Careful monitoring by healthcare providers is essential to balance its benefits with potential risks.
- FREE Drug Card Sheet is available for this episode at DrugCardsDaily.com along with ALL past FREE drug card sheets! Please SUBSCRIBE, FOLLOW, and RATE on Spotify, Apple Podcasts, or wherever your favorite place to listen to podcasts are. I’d really appreciate hearing from you! Find me on most all socials @drugcardsdaily or send an email to contact.drugcardsdaily@gmail.com to leave feedback, request a drug, or say hello!
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Pioglitazone (Actos) is a medication used to treat type 2 diabetes mellitus. It belongs to the thiazolidinedione class of drugs and works by improving insulin sensitivity. By activating peroxisome proliferator-activated receptor gamma (PPAR-γ), pioglitazone helps the body utilize glucose more effectively and reduces the liver's production of glucose. It is typically prescribed as an adjunct to diet and exercise when other oral antidiabetic medications are insufficient in controlling blood sugar levels. Pioglitazone can be used alone or in combination with other diabetes medications, including insulin. Common side effects include weight gain, fluid retention, and edema. Rare but serious adverse events such as congestive heart failure and bladder cancer have been reported, so healthcare professionals must carefully assess the risks and benefits before prescribing pioglitazone. Regular monitoring of liver function is recommended, and patients should be educated about potential side effects and instructed to report any unusual symptoms. Overall, pioglitazone can be an effective tool in managing type 2 diabetes when used judiciously and under appropriate medical supervision.
FREE Drug Card Sheet is available for this episode at DrugCardsDaily.comalong with ALL past FREE drug card sheets! Please SUBSCRIBE, FOLLOW, and RATE on Spotify, Apple Podcasts, or wherever your favorite place to listen to podcasts are. I’d really appreciate hearing from you! Find me on most all socials @drugcardsdaily or send an email to contact.drugcardsdaily@gmail.com to leave feedback, request a drug, or say hello!
NAPLEX Math Review: The Foundation of a Logical NAPLEX Prep Strategy Amazon Affiliate link: https://amzn.to/31OkKVe
DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist.
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Suboxone is a medication commonly used for the treatment of opioid dependence. It is a combination of two active ingredients: buprenorphine and naloxone. Buprenorphine, a partial opioid agonist, helps reduce cravings and withdrawal symptoms by binding to the same receptors in the brain as opioids but with milder effects. Naloxone, an opioid antagonist, is included to deter misuse of the medication. If Suboxone is crushed or injected, naloxone counteracts the effects of other opioids, precipitating withdrawal symptoms. When taken as directed sublingually (under the tongue), naloxone has minimal bioavailability and does not interfere with the therapeutic effects of buprenorphine. Suboxone is typically prescribed as part of a comprehensive treatment program that includes counseling and psychosocial support. Healthcare professionals play a critical role in managing Suboxone treatment, including patient assessment, monitoring progress, and adjusting dosages as needed. While Suboxone is generally well-tolerated, common side effects include constipation, nausea, headache, insomnia, and sweating. Healthcare professionals should educate patients about potential side effects and provide guidance on managing them. Suboxone, when used in conjunction with a comprehensive treatment approach, can be an effective tool in helping individuals reduce cravings and work towards sustained recovery from opioid dependence.
FREE Drug Card Sheet is available for this episode at DrugCardsDaily.com along with ALL past FREE drug card sheets! Please SUBSCRIBE, FOLLOW, and RATE on Spotify, Apple Podcasts, or wherever your favorite place to listen to podcasts are. I’d really appreciate hearing from you! Find me on most all socials @drugcardsdaily or send an email to contact.drugcardsdaily@gmail.com to leave feedback, request a drug, or say hello!
NAPLEX Math Review: The Foundation of a Logical NAPLEX Prep Strategy Amazon Affiliate link: https://amzn.to/31OkKVe
DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist.
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Fentanyl is an opiate agonist, anesthetic, narcotic most commonly used in pain management. Comes in a large variety of dosage forms but is most commonly seen as a transdermal patch. It produces analgesia and sedation by binding to the mu- or k- receptor and alters the perception of pain. It is well absorbed and used in the transdermal dosage form it best when used on a fatty part of the body due to its highly lipophilic nature. Common side effects are impaired coordination, nausea/vomiting, bradycardia, euphoria, and dizziness. There is a Black Box Warning for Addiction/Abuse/Misuse, Respiratory Depression, CYP450 3A4 interactions, and Risks from Benzodiazepine/CNS Depressant use.
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FREE Drug Card Sheet is available for this episode at DrugCardsDaily.comalong with ALL past FREE drug card sheets! Please SUBSCRIBE, FOLLOW, and RATE on Spotify, Apple Podcasts, or wherever your favorite place to listen to podcasts are. I’d really appreciate hearing from you! Find me on most all socials @drugcardsdaily or send an email to contact.drugcardsdaily@gmail.com to leave feedback, request a drug, or say hello!
DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist.
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Atropine is an acetylcholine receptor antagonist that competitively inhibits autonomic effectors at muscarinic receptors. It has chronotropic effects and anticholinergic effects. Atropine comes in various injectable concentrations as low as 0.25mg/3mL up to 2mg/0.7mL. The most common side effects are xerostomia, blurred vision, tachycardia, constipation, dizziness, and headache. Some serious side effects are respiratory failure and pulmonary edema. Atropine is used in ACLS for bradycardia, anesthesia adjunct, neuromuscular blockade reversal adjunct, and for treating organophosphate poisoning.
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FREE Drug Card Sheet is available for this episode at DrugCardsDaily.com along with ALL past FREE drug card sheets! Please SUBSCRIBE, FOLLOW, and RATE on Spotify, Apple Podcasts, or wherever your favorite place to listen to podcasts are. I’d really appreciate hearing from you! Leave a voice message at anchor.fm/drugcardsdaily or find me on most all socials @drugcardsdaily or send an email to contact.drugcardsdaily@gmail.com to leave feedback, request a drug, or say hello!
DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist.
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Hyoscyamine is also known by the brand name Levsin. It is most commonly used to treat GI or bladder spasms or as adjunct treatment for IBS, PUD, and colic. It is also used in the treatment of rhinitis. It comes in a wide variety of dosage forms with the most common strengths being 0.125 mg and 0.375 mg. A common dosing regimen is between 0.125 mg - 0.25 mg every 4 hours as needed. The 0.375 mg dose is most commonly used with extended release formulations and dosed every 8-12 hours. Common side effects are xerostomia, dry eyes, dizziness, fever, blurred vision, and insomnia. There is a risk for fever or heat stroke especially when exercising or if in high heat environments.
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FREE Drug Card Sheet is available for this episode at DrugCardsDaily.com along with ALL past FREE drug card sheets! Please SUBSCRIBE, FOLLOW, and RATE on Spotify, Apple Podcasts, or wherever your favorite place to listen to podcasts are. I’d really appreciate hearing from you! Leave a voice message at anchor.fm/drugcardsdaily or find me on most all socials @drugcardsdaily or send an email to contact.drugcardsdaily@gmail.com**to leave feedback, request a drug, or say hello!
DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist.
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Haloperidol also known by the brand name Haldol is a first generation antipsychotic. Haldol is commonly used in the treatment of Psychosis and Tourette Syndrome. There is also an off label use for acute agitation. When using Haldol it is important to use the lowest effective dose. A common dosing range is between 0.5-2 mg which is taken by mouth and divided two to three times daily. In severe treatment cases the treatment range can be as high as 3-5 mg PO 2-3x daily. The mechanism of action is proposed to be from selective antagonism of dopamine D2 receptors. Haldol is widely distributed throughout the body and is 92% protein bound. There is a black box warning for dementia-related psychosis. Haldol is not approved in dementia-related psychosis due to an increased risk of cardiovascular or infectious events that can lead to mortality in elderly patients.
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FREE Drug Card Sheet is available for this episode at DrugCardsDaily.com along with ALL past FREE drug card sheets! Please SUBSCRIBE, FOLLOW, and RATE on Spotify, Apple Podcasts, or wherever your favorite place to listen to podcasts are. I’d really appreciate hearing from you! Leave a voice message at anchor.fm/drugcardsdaily or find me on most all socials @drugcardsdaily or send an email to contact.drugcardsdaily@gmail.com**to leave feedback, request a drug, or say hello!
DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist.
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Paroxetine, also known as Paxil, is a Selective Serotonin-Reuptake Inhibitor (SSRI) used in the treatment of various mood disorders. Mood disorders such as major depressive disorder, OCD, panic disorder, social anxiety disorder, generalized anxiety disorder, PTSD, premenstrual dysphoric disorder, and mild-moderate menopausal vasomotor symptoms. Dosing varies by indication but commonly between 20-50 mg PO qam for immediate release dosage forms and around 12.5-75 mg PO qam for the extended release dosage forms. The absorption of paroxetine is not affected by food and is completely bioavailable after oral administration. The half-life elimination is around 21-24 hours. There is a black box warning for suicidality with the increased risk seen in children, adolescents, and young adults. Always weigh the risks vs benefits when using the medication.
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FREE Drug Card Sheet is available for this episode at DrugCardsDaily.com along with ALL past FREE drug card sheets! Please SUBSCRIBE, FOLLOW, and RATE on Spotify, Apple Podcasts, or wherever your favorite place to listen to podcasts are. I’d really appreciate hearing from you! Leave a voice message at anchor.fm/drugcardsdaily or find me on most all socials @drugcardsdaily or send an email to contact.drugcardsdaily@gmail.com**to leave feedback, request a drug, or say hello!
DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist.
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Triamterene and hydrochlorothiazide (HCTZ) is a combination product that is known by the brand name DIazide or Maxide. It is a combination of two diuretics. Triamterene is a potassium-sparing diuretic while HCTZ is a thiazide diuretic. This combination product is used in the treatment of hypertension and peripheral edema. It comes as a capsule and as a tablet. Both work in the distal convoluted tubule but triamterene increases potassium retention while HCTZ does not. Common side effects are muscle cramps, electrolyte disorders, constipation, and orthostatic hypotension. There is a black box warning for hyperkalemia that can be potentially fatal if uncorrected and potassium should be monitored in high risk patients. It can be taken with or without food and should be taken 4 hours before or 4-6 hours after medications like cholestipol and cholestyramine.
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DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist.
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Glyburide also goes by the brand names of Diabeta, Glynase, and Micronase. It is most commonly used in the treatment of patients with type 2 diabetes. The dosing range varies and is based on the patients blood glucose and the level of control needed. The treatment range is between 1.25-20 mg PO divided 1-2 times daily. Glyburide is given with meals. The mechanism of action lowers blood glucose through the stimulation of pancreatic beta cells. It is very important to note that the conventional and micronized tablets are not interchangeable. The comparison is approximately 1.25 mg to 0.75 mg. Common side effects are weight gain, epigastric discomfort, and blurred vision. The more serious side effects are a disulfiram-like reaction, hypoglycemia, and agranulocytosis.
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DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist.
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Tamsulosin is a selective alpha-1-adrenergic blocking agent also known as the brand name Flomax. Tamsulosin comes as a 0.4 mg capsule that is typically dosed 0.4 mg PO qd for 30 minutes after the same meal. The most common side effects are dizziness, cough and various infections. Some of the more serious side effects are priapism, arrhythmia, and syncope. Tamsulosin is most commonly used in males for the treatment of enlarged prostatic hyperplasia. It is commonly used to relieve symptoms such as difficulty in the beginning of urination and for weak streams as well as the need to urinate often in the middle of the night.
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DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist.
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Alendronate is a bone resorption inhibiting bisphosphonate. The most common brand name is Fosamax. There is a dosage form specific Binosto which is a tablet that dissolves in a solution. The main indication is in the treatment of osteoporosis. Some considerations to make for patients is the supplementation of Ca and Vitamin-D if there is inadequate dietary intake. When taking the tablet it should be administered with water and taken 30 minutes before the first meal or medication of the day. It’s also very important to avoid lying down for 30 minutes after taking it. The common dosing is 70 mg PO qd. There is an alternative dosing for osteoporosis which is 5-10 mg po qd. The most common side effects are heartburn, upset stomach and nausea. When monitoring patients the bone mineral density (BMD) should be taken at baseline and periodically thereafter.
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DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist.
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Prednisone is a glucocorticoid or corticosteroid with minimal mineralocorticoid activity. It is most often used in treating conditions that are corticosteroid-responsive such as in acute exacerbation of Multiple Sclerosis, or in the treatment of Acute Asthma. Common dosing ranges between 5-60 mg PO 1-2 times daily. If the patient has been on high dose therapy or has undergone longer term therapy it is highly recommended to taper the patient gradually off the medications. The most common side effects are weight gain, loss of appetite, mood changes, muscle & joint pain, and headache. One of the more serious considerations is to not get any live vaccines while on this medication. The main concern is the vaccine will not work as well due to prednisone's ability to lower the body’s immune response.
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DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist.
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Hyzaar is the brand name for the combination of losartan and hydrochlorothiazide (HCTZ). It comes as a tablet in several strengths (losartan/HCTZ): 100 mg/25 mg, 100 mg/12.5 mg, and 50 mg/12.5 mg. The indications are for hypertension and for the prevention of stroke. Dosing is generally initiated at 50 mg/12.5 mg PO qd but if the patient has severe hypertension it is initiated at higher strengths. There is a Black Box Warning for fetal toxicity and the medication should not be used or discontinued immediately if pregnancy is detected or suspected. The most common side effects are dizziness, cough, and dyspepsia. The serious side effects are renal failure, acute angle-closure glaucoma, and non-melanoma skin cancer.
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DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist.
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Folic acid goes by many different names such as folate, Vitamin B9 or even by the brand name of FaLessa. It is a water-soluble vitamin and used in the treatment of Megaloblastic Anemia as well as in supplementation. When treating Anemia dosing is initiated at 1 mg PO qd up to a mas of 5 mg per day until hematologic correction occurs. When it comes to supplementation, dosing varies based on age. Folic acid is an important component in DNA synthesis as well as in erythropoiesis. Common side effects are rash, irritability, flatulence, and abdominal pain. Folic acid is found in a wide variety of foods such as spinach, beets, dried beans, citrus fruits, and legumes.
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DISCLAIMER: This content may contain sponsored content or the use of affiliate links. Partnerships, sponsorships, and the use of affiliate links provide monetary commissions for Drug Cards Daily at no cost to you! This is done in order to keep providing as much free content to everyone that comes to Drug Cards Daily. Thanks for your support! Drug Cards Daily provides drug information for educational and entertainment use. The information provided is not intended to be a sole source of drug information that is to be acted upon for patient care. If there are drug-related patient care concerns please contact your primary care Physician or local Pharmacist.
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Risedronate also is known by the brand names Actonel and Atelvia. It is a bisphosphonate derivative and used in the treatment of osteoporosis. A typical dosing regimen is 35 mg PO every week. Alternative dosing regimens are 5 mg PO qd and 150 mg PO every month. Risedronate works by inhibiting resorption of bone which indirectly leads to an increase of bone mineral density (BMD). Unlike other drugs, risedronate is not metabolized. This medication has an extremely long half-life at around 480-561 hours. When taking risedronate it is important to consider adequate Calcium and Vitamin-D intake. Common side effects are abdominal pain, insomnia, depression, constipation, dyspepsia, and headache. When taking risedronate it is important for it to be given with 6-8 ounces of water and for the patient to remain upright for at least 30 minutes.
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Oxycodone also is known as Roxicodone or as the extended release abuse deterrent formulations Oxycontin and Xtampza. The most common use for oxycodone is in the treatment of moderate to severe pain. When treating patients it is important to determine if the patient is opioid-naïve or opioid experienced. Opioid-naïve patients are doses at the lowest effective dose for the shortest effective duration. Initiating dosing is around 5-15 mg PO q4-6h prn. Opioid-experienced patients are dosed based on their current opioid intake and converted using the most current nomograms. There are multiple black box warnings and extreme caution and monitoring should be exercised when prescribing. The most common side effects are constipation, dizziness, fever, anxiety and confusion. Some serious side effects are abuse, dependency, seizures, and respiratory depression.
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Diazepam is also known as Valium and Diastat. It comes as a tablet, solution, nasal liquid, rectal gel, and concentrated solution. There are a wide variety of uses for diazepam such as for the treatment of anxiety, pre-op sedation, procedural sedation, alcohol withdrawal, muscle spasms, and seizures. A common dosing range when treating anxiety is 2-10 mg PO bid-qid. There are also approved uses in pediatrics such as for anxiety, muscle spasms, and status epilepticus. The benefits from diazepam are often linked to the enhancement of the GABA-A, not the GABA-B, receptors. The most common side effects are drowsiness, confusion, libido changes, and irritability. There are several Black Box Warnings to be aware of such as concomitant opioid use, the risk of abuse/misuse/addiction, and the risk of dependence/withdrawal reactions. Make sure to monitor the patients’ LFTs if prolonged usage as well as their blood pressure and mental status.
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Atenolol is a Beta-1 Selective Beta Blocker Antihypertensive Agent that is also known by the brand name Tenormin. The common indications are for Hypertension (HTN), Angina, and Post-MI Cardiovascular Event Prevention. It also has an off label use for Migraine Prophylaxis. Dosing range is between 25-200 mg PO qd depending on the indication. Should the patient ever need to discontinue the medication they should be tapered off gradually due to risks of exacerbation of treated indication. Common monitoring parameters include but are not limited to Cr and BP at baseline and periodically thereafter, ECG, and 10-year ASCVD risk assessment. Apple juice and orange juice should be avoided when taking this medication because they may prevent atenolol from being absorbed properly. The most common side effects are bradycardia, drowsiness, hypotension, fatigue, and cold extremities.
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Well it was bound to happen eventually. After recording & editing episode 58 it was brought to my attention that memantine was already covered back in episode 19! I guess here is the new version? Sorry everybody.
EPISODE #19 Summary: Memantine is a NMDA antagonist that goes by the brand name Namenda. There are also titration packs available in the name brand. Memantine treats but does not cure confusion and dementia associated with Alzheimer's disease. There are multiple dosage forms being a capsule, solution, and tablet. Special considerations are for patients with renal and hepatic impairment. Memantine does appear to have higher exposure in women than men. Memantine is proposed to work on the glutamate receptor blocking the receptor much like magnesium does under “normal” conditions. This drug has a long elimination half-life between 60-80 hours. The main side effects are weight gain, abdominal pain, constipation, diarrhea and vomiting. A serious side effect is Stevens Johnson Syndrome. Two main types of drugs that interact with Namenda are alkalinizing agents and carbonic anhydrase inhibitors. The drug can be taken with or without food and if a dose is missed it should not be doubled on the next dose. The missed dose should be skipped and resumed regularly.
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Methylprednisolone is a widely used corticosteroid used in the treatment of various corticosteroid-responsive conditions. The most commonly used dosing regimen comes in a pre-packaged punch card in order to help patients on the medication. The dosing begins at 24 mg (or six 4mg tablets) on day 1. Then decrease by 4 mg (or one tablet) each day until done. Since steroids can easily upset the stomach it is recommended to take it with food or milk. Since methylprednisolone is a steroid common concerns are either elevated blood pressure and glucose intolerance. If long term usage the concern grows to weight gain or more serious conditions such as cataracts or immunosuppression. The main concern in children with long term usage is growth suppression. Live vaccinations should not be administered to patients on methylprednisolone. The most common side effects are upset stomach, trouble sleeping, restlessness, and headache.
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Cephalexin is a widely used antibiotic. It is often used when treating various bacterial infections in both Adults and Pediatrics. Bacterial infections such as Streptococcal Pharyngitis, Uncomplicated Urinary Tract Infections (UTIs), and Bacterial Skin and Skin Structure Infections (SSSIs). There is also an off label indication for Dental Endocarditis Prophylaxis. Cephalexin works by causing bacteria cells to lyse by binding to penicillin-binding proteins (PBPs) thus inhibiting bacterial cell wall synthesis. Caution is to be used in renally impaired patients. Cephalexin appears to be safe for use during pregnancy and when breast-feeding. Common side effects are abdominal pain, nausea, vomiting, and diarrhea. If the suspension is used, after reconstitution the suspension should be refrigerated and discarded after 14 days.
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Digoxin also goes by the brand names Digox, Digitalis, and Lanoxicaps. Digoxin comes as tablets, a solution, and an injection. In both Adults and Pediatrics, when calculating doses it is important to use the patient’s lean body weight (LBW) with dose adjustments based on levels. It is important to also remember that concentrations of >2 ng/mL lead to digoxin toxicity and can also be identified with signs and symptoms such as anorexia, nausea, vomiting, and visual changes. The most common indications are for treating Heart Failure with reduced Ejection Fraction (HFrEF) and Atrial Fibrillation (AFib). Digoxin is poorly protein bound with a long duration of action between 3-4 days. THe most common side effects are dizziness, headache, bradycardia, weakness, and confusion.
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Methylphenidate comes in many dosage forms with a variety of brand names but this drug is most commonly known as Ritalin. Some of the dosage forms are as immediate release (IR) tablets, extended release (ER) capsules, patches, orally disintegrating tablets (ODT), and solutions. When treating ADHD, dosing is highly variable and based on dosage form but a common between most all of the oral dosage forms is to not take a dose after 6 pm and to take 30-45 minutes before a meal. Methylphenidate can be used in treating both children and adults with ADHD but there is one other indication for this drug being for treating narcolepsy. The mechanism of action is not fully understood but it is proposed to have CNS sympathomimetic effects which increase norepinephrine and dopamine release while blocking reuptake. This medication is poorly protein bound up to 33%. Common side effects are insomnia, weight gain, and irritability but the most serious concern is the black box warning for abuse and dependence. CNS stimulant abuse risk should be assessed and monitored in patients.
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Carvedilol comes in both an extended release capsule and an immediate release tablet. The brand name is Coreg. It is classified as an antihypertensive and beta-blocker with alpha blocking activity. Coreg works through selective alpha-1 adrenergic receptor antagonism. It has non-selective beta-1 and beta-2 adrenergic receptor antagonism. It is a racemic mixture with no intrinsic sympathomimetic activity. When discontinuing therapy taper the patient off the medication over 1-2 weeks. Some common side effects are dizziness, fatigue, and weight gain. Some serious side effects are severe bradycardia, SJS, and severe anemia. The medication should be taken with food in order to avoid and minimize orthostatic hypotension.
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Tiotropium is a long acting muscarinic antagonist (LAMA) that is also known by the brand name Spiriva. It comes as an inhaled aerosol solution as well as an inhaled capsule. The main indications are for the treatment of COPD and Asthma. Tiotropium works through reversible competitive inhibition of acetylcholine at type 3 muscarinic receptors in bronchial smooth muscle which leads to bronchodilation. The medication is poorly absorbed in the GI and hepatically metabolized via the CYP2D6 and CYP3A4 pathways. The time to peak is between 5-7 minutes with the half-life elimination between 25-44 hours. Although the data in pregnancy and lactation is limited, the benefits for use likely outweighs the risk for a patient dealing with uncontrolled asthma. Some common side effects are cough, headache, GERD, rash and UTI. Some serious side effects are paradoxical bronchospasms and angle-closure glaucoma. It is important to note that tiotropium is not intended to be a quick-relief inhaler and should not be used for flare-ups or shortness of breath. It is recommended to clean the inhaler once monthly with water air dried. After usage the patient should rinse the mouth out; not due to the risk of thrush like with an ICS but to help prevent xerostomia and throat irritation.
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Citalopram is also known by the brand name Celexa. It is an antidepressant and a selective serotonin reuptake inhibitor (SSRI). The tablet come in a 10 mg, 20 mg, and 40 mg strength and is also available as a 10 mg/5 ml solution. In adults and pediatrics it can be used to treat both major depressive and obsessive compulsive disorder. There are other off-label indications in children but the only approved use is in adults for major depressive disorder. The treatment range for treating major depressive disorder in adults is 20-40 mg PO qd with a max of 40 mg/day. There is literature with a max of 60 mg/day for OCD but 40 mg/day is the most commonly accepted max dose. The onset of action and benefits for patients are typically seen within the first 1-2 weeks with continued improvements through weeks 4-6. The medication half-life is around 24-48 hours with a duration of action being the same. There is a black box warning for suicidality with the greatest concern for children, adolescents and young adults. The risk does appear to decrease in adults >24 years of age and in the elderly >65 years of age. The medication should never be stopped without approval from the prescriber even when feeling well.
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Alprazolam, or brand name Xanax, comes as an immediate release, orally disintegrating, or extended release tablet; as well as coming as a concentrated solution. This hypnotic benzodiazepine is commonly used to treat generalized anxiety and panic disorders. There is also an off label indication for treating vertigo. Alprazolam’s proposed effects comes from an increased inhibitory effect of GABA on neurons resulting in a less excitable state of hyperpolarization creating stabilization. Alprazolam is rapidly absorbed with a time to peak b/t 1-2 hours if an immediate release formulation is used or around 9 hours if an extended release formulation is used. The half-life elimination can be approximated between 11-21 hours based on age, dosage form, and if taken with or without food. There are several Black Box warnings which are at risk from concomitant opioid use, risks of addiction/abuse/misuse, and concerns over dependence and withdrawal reactions. Alprazolam can slow or stop breathing and should not be taken by those with breathing problems such as COPD or sleep apnea.
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Benazepril, also known as Lotensin, is an antihypertensive agent. It works by competitively inhibiting the conversion of angiotensin I to angiotensin II. The onset of action is between 1-2 hours. When treating hypertension the treatment range is between 10-40 mg PO qd-bid. When first initiating, start at 10 mg PO qd with a max of 80 mg per day. There is black box warning for fetal toxicity. Common side effects are cough, fatigue, dizziness, hypotension, and hyperuricemia. Benazepril should be stopped ASAP if the patient is pregnant due to risks of fetal injury and fetal death. Sone monitoring parameters are blood pressure, BUN, Cr, electrolytes, and WBCs.After sitting down or lying down for a period of time, avoid getting up to fast to avoid orthostatic hypotension.
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Clonazepam is an anticonvulsant benzodiazepine also known as Klonopin. The main indications are for seizure disorder and panic disorder. There are many off label indications such as for anxiety, sleep terrors, sleepwalking, Tourette's syndrome, and RLS. The treatment range for seizure or panic disorders is between 0.5-5 mg PO bid-tid respectively. The mechanism of action is unknown but believed to be a result of GABA activity enhancement. The onset of action is between 20-40 minutes. The time to peak is between 1-4 hours. There are several black box warnings. The first is for the risk of concomitant opioid use; the next is for addiction, abuse, and misuse; and the last is for dependence & withdrawal reactions. Exercise extreme caution for activities that require coordination such as driving and operating machinery.
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Meloxicam is a nonsteroidal anti-inflammatory non-opioid analgesic medication used to treat osteoarthritis and rheumatoid arthritis. A treatment range is often between 5-15 mg PO qd with a max of 15 mg/day. Meloxicam works through reversible COX1/COX2 enzyme inhibition decreasing thromboxane and prostaglandins leading to antipyretic, anti-inflammatory, and analgesic effects. It is metabolized via the CYP2C9 and CYP3A4 pathways. The time to peak for tablets is around 4-5 hours with a half-life elimination of 13-22 hours. It should not be used during pregnancy and close to conception. Black Box Warning for cardiovascular thrombotic events and GI bleed/ulcerations/perforation. To avoid and minimize GI related issues take with food.
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Promethazine, also known as Phenergan and Promethegan, is a first generation H1 histamine antagonist. It comes as a solution, suppositories, syrup, and tablets. There are a wide variety of indications for adults and children 2 years of age and older such as for allergic conditions, motion sickness, and sedation. A typical dosing range is between 25-50 mg tid-qid if PO and 6.25-25 mg IM/IV tid-qid. The max dose is 100 mg/day. Promethazine works through strong alpha adrenergic inhibition from blockade of postsynaptic mesolimbic dopaminergic receptors in the brain. It is metabolized via the CYP2D6 and CYP2B6 pathways. The onset of action is around 20 minutes with the duration of action of around 4-6 hours with a max of 12 hours. Common side effects are drowsiness, dizziness, blurred vision, and confusion. Serious side effects are seizures and QT prolongation. There is a Black Box Warning for respiratory depression and gangrene/severe tissue injury. When taken orally, take with food, water, or milk to avoid GI distress.
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Quetiapine is also known by the brand name Seroquel. It comes as both an immediate release and extended release formulation. There are several indications such as for schizophrenia and various classifications of Bipolar disorder. It can also be used as adjunct treatment in major depressive disorder. The max dose for quetiapine is 800 mg/day. Doses are generally divided bid-tid. Quetiapine’s antipsychotic activity is proposed to be a result of both dopamine type 2 (D2) and serotonin type 2 (5HT2) antagonism. There are many other antagonist effects on neurotransmitter receptors in the brain such as 5HT1A, 5HT2, D1, D2, H1, and adrenergic alpha1/alpha3 receptors. There is a black box warning for dementia related psychosis and suicidality. Common side effects are somnolence, weight gain, and constipation. Quetiapine should never be stopped abruptly after prolonged usage.
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Rosuvastatin is an antilipemic agent that works through the inhibition of the rate limiting enzyme in cholesterol synthesis (HMG CoA reductase). It is used in the management of dyslipidemia as well as having benefits in cardiovascular event prevention. The typical dosing range when treating dyslipidemia is between 5-40 mg PO qd. The max dose is 40 mg/day. Dose adjustments are made every 2-4 weeks after initiating between 10-20 mg PO qd. Some concerns are to avoid red yeast rice due to the similarity to the medication lovastatin, avoid use during pregnancy and breastfeeding, and dose at the lower end of the therapeutic range in Asian American patients due to higher levels being present which could lead to an increased risk for toxicity. The most common side effects are headache, abdominal pain, nausea, joint pain, and weakness.
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Oxycodone+acetaminophen (APAP) is an analgesic combination product also known as Percocet. When dosing for Percocet one should consider also prescribing naloxone if there is a possible risk of opioid overdose or accidental ingestion. It is also very important to note that the lowest effective dose at the shortest effect duration should be used. Dosing for Percocet is based on the oxycodone component but limited by the APAP component. A general dosing range is 2.5-10 mg oxycodone PO q6h prn. Do not exceed 1 gram of APAP in 4 hours and 4 grams of APAP in 24 hours. There are a large amount of black box warnings and it is highly suggested to review them all. Some of note are for addiction/abuse/misuse, respiratory depression, and hepatotoxicity. Patients that should not use this medication are those with severe asthma or similar breathing problems, stomach or intestine blockage, drug or alcohol addiction, or problems with urination/thyroid/pancreas/gallbladder.
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Furosemide is an antihypertensive loop diuretic drug. The main indications are for edema and hypertension with an off-label use for hypercalcemia. The general dosing range is between 40-120 mg per day with a max of 600 mg per day. The mechanism of action is it interferes with the chloride-binding co-transport system causing a natriuretic effect. It inhibits sodium and chloride resorption in the ascending Loop of Henle and the proximal and distal renal tubules. The onset of action for diuresis is around 30-60 minutes with symptomatic improvement of acute pulmonary edema occurs within 15-20 minutes. Caution should be observed in patients with electrolyte imbalances, the elderly, premature neonates, patients with gout, lupus, and diabetes. There is a black box warning for fluid and electrolyte loss if excessive amounts are used. When considering the drug interactions one should consider that furosemide is an OAT1 and OAT3 substrate, it may cause hypocalcemia, hypokalemia, hyponatremia, ototoxicity, and others.
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Amlodipine is an antianginal antihypertensive agent also known as Norvasc. It is indicated for hypertension and various types of angina. In adults when treating hypertension the general dosing range is between 5-10 mg PO qd. When treating angina the general dosing range is also between 5-10 mg PO qd. Amlodipine is also indicated in pediatrics when treating hypertension. In patients between 1-5 years of age, dosing is initiated at 0.1-0.6 mg/kg/dose PO qd with a max of 5 mg/day. Between the ages of 6-17 years of age dosing is initiated at 2.5-5 mg PO qd with a max of 10 mg/day. Amlodipine should be used with caution in the elderly, patients with hepatic impairment, and patients with severe CAD. Common side effects are dizziness, fatigue, palpitations, lightheartedness, swelling ankles/feet, and flushing. If experiencing orthostatic hypotension get up slowly if getting up from a sitting or lying down position.
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Duloxetine is used in a wide variety of indications. It can be used in treating fibromyalgia, chronic musculoskeletal pain, and neuropathic pain due to diabetes mellitus. It is also used in treating mood disorders such as generalized anxiety disorder and major unipolar depressive disorder. The general dosing range for duloxetine is 30-60 mg PO qd. Although the max dose is 120 mg per day, therapeutic benefits do not appear evident past 60 mg per day. Duloxetine works through strong inhibition of neuronal serotonin and norepinephrine reuptake along with weak inhibition of dopamine reuptake. There is reduced bioavailability in patients who smoke cigarettes with a 33% reduction of bioavailability. When discontinuing therapy duloxetine should be titrated down over 2-4 weeks. There is a black box warning for suicidality and risks vs benefits should be weighted when being used in children and adolescents. When taking duloxetine capsules should be taken whole and should not be opened.
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Simvastatin is used to slow the progress of heart disease as well as lowering cholesterol in patients. It is also known by the brand name of Zocor. Simvastatin works by affecting the rate-limiting step in cholesterol synthesis. It is a competitive inhibitor of the HMG-CoA reductase enzyme. There are also other benefits such as reducing inflammation and coronary plaque sites, inhibiting platelet aggregation, as well as having an anticoagulant effect. Simvastatin is contraindicated in pregnancy and should be stopped immediately if pregnancy is suspected. Some serious side effects to be aware of are rhabdomyolysis; muscle pain, tenderness, and weakness, and dark urine. Common monitoring parameters for patients on simvastatin are lipid panels, pregnancy, hepatic transaminase levels, and CPK. In order to get the best benefit from simvastatin it is recommended to be taken in the evening.
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Esomeprazole is available over the counter and by prescription. The commonly known brand name is Nexium. Esomeprazole is a substituted benzimidazole proton pump inhibitor (PPI). It comes in a delayed release capsule and as delayed release granule packets. When treating GERD and other hypersecretory conditions a typical dosing range is between 20-40 mg po qd-bid. Esomeprazole is also used as part of a multi-drug regimen for treating H. pylori infection. The mechanism of action behind esomeprazole is through the suppression of acid secretion by inhibiting hydrogen-potassium ATPase. Esomeprazole is the S-enantiomer of omeprazole (Prilosec). Since esomeprazole affects stomach acid it may alter how well other drugs work. For example, absorption of drugs may decrease which may lead to a decrease in efficacy of those drugs. Esomeprazole is best when taken 1 hour before a meal and best if taken before the first meal of the day. If needed, the capsule can be opened.
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Gabapentin has a wide variety of uses but the main indications are for focal seizures in adults and children and for postherpatic neuralgia in adults. There are many commonly used off label indications such as for neuropathic pain, fibromyalgia, and alcohol dependence. Max dosing for gabapentin is around 3600 mg/day. Although the exact mechanism of action is unknown, it is clear that it is similar in chemical structure to GABA. This is important because GABA is responsible for modulating excitatory neurotransmitter release. Gabapentin is poorly protein bound at less than 3% and not metabolized. When discontinuing longer term therapies, doses should be tapered down over at least 7 days. Some of the most common side effects are dizziness, fatigue, and weight gain. The serious side effects are depression, suicidal thoughts and behaviors, and withdrawal related seizures.
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Azithromycin is a macrolide antibiotic used to treat many bacterial infections. Some common uses are for Community Acquired Pneumonia (CAP), Group A Strep, Acute Exacerbations of COPD, STDs, among other bacterial infections. One of the most commonly known dosing regimens is 500 mg on day one, then 250 mg on days 2-5. When using the reconstituted suspension it must be refrigerated once reconstituted it must be discarded after 10 days. Azithromycin works through the inhibition of RNA-dependent protein synthesis by binding to the 50S ribosomal subunit. By blocking transpeptidation this inhibits the chain elongation step of protein synthesis. Azithromycin distributes well into most tissues and fluids with the exception of cerebrospinal fluid (CSF). Protein binding is concentration dependent varying from 7-51%. Azithromycin can be taken with or without food but food may decrease any GI distress.
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There are two commonly used forms of potassium. Potassium chloride (to treat hypokalemia) and potassium citrate (as an alkalinizing agent). Unlike potassium chloride, potassium citrate is also measured in “mg” in addition to “mEq”. It comes in a 5 mEq (540 mg), 10 mEq (1080 mg), and 15 mEq (1620 mg) strength ER tablet. The main indication for potassium citrate in in the management of kidney stones. In mild-moderate treatment you initiate 15 mEq PO bid or 10 mEq PO tid with a max dose of 100 mEq per day. Since potassium citrate is an alkalinizing agent the way it works is it makes urine less acidic. It raises the pH of urine to 6-7 which will help rid uric acid from the body. The reduction of uric acid helps manage gout and kidney stones. Since potassium citrate is a known GI irritant it is recommended to take the tablets whole with a glass of water to remain upright after taking it with food or at least within 30 minutes of a meal or snack.
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There are two most commonly used versions of potassium. Potassium chloride (supplementation) or potassium citrate (alkalinizing agent). Potassium chloride, also known as K-Tab or Klor-Con, is an electrolyte supplementation used in treating and preventing Hypokalemia (low potassium). Potassium is an essential cation that is needed for the conduction of nerve impulses in the heart, brain, and muscle. Unlike most drugs, potassium is not measured in “mg'' and is measured in “mEq” or milliequivalents. Potassium chloride comes in multiple dosage forms such as an ER capsule and tablet, a powdered packet, oral solution, and also as an intravenous solution. When the IV solution is used a major concern is for extravasation, which is when plasma escapes from the extracellular space and forms blisters on the patient. If this occurs the drug hyaluronidase is injected as 5 separate 0.2-0.3 mL injections along with applying a cold compress and elevating the extremity. Another important note for the IV solution is that it is never administered as IV push and the solution must be diluted prior to administration.
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Valsartan, also known as Diovan, is an angiotensin II receptor blocker (ARB). It is used for treating NYHA class II to IV heart failure along with both treating and managing hypertension. Another common indication is for both STEMI and NSTEMI patients. Typical initiation dosing for heart failure, STEMI and NSTEMI is 20 mg twice daily with titrations up to 160 mg twice daily. When initiating treatment for hypertension the range begins at 80-160 mg po every day up to a max dose of 320 mg per day. Valsartan works by blocking AT2 from the AT1 receptor and is considered to be more efficient than ACEs along with having less side effects such a cough. Some common side effects are orthostatic hypotension, dizziness, and lightheadedness. Common monitoring parameters for valsartan are blood pressure, blood pressure urea, pregnancy, and electrolytes. Patients should avoid salt substitutes containing potassium. There is a black box warning for fetal toxicity because drugs that affect the renin-angiotensin system can cause injury/death to the fetus.
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Tramadol can be used to treat and manage moderate to severe acute and chronic pain. It is also known as Ultram. An off label use is for Restless Leg Syndrome (RLS). When treating acute or chronic pain initiate 25-50 mg every 4-6 hours as needed with a max dosing range of 50-100 mg every 4-6 hours. The max dose per day is 400 mg. Tramadol acts on the mu-opioid receptor by blocking the ascending pain pathway. It alters the pain response and perception along with blocking reuptake of both serotonin and norepinephrine. Tramadol is extensively metabolized hepatically via the CYP3A4 and CYP2D6 pathway creating the metabolite M1. There is concern in children that are ultra-rapid metabolizers of CYP2D6 and use should be avoided in children. There are numerous black box warnings such as for addiction/abuse/misuse, risk of medication errors, accidental ingestion, and contaminant use w/ benzodiazepines or other CNS depressants. Monitor patients for level of pain relief and EKG and HR in patients with a family history of heart conditions.
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Sertraline, also known by the brand game Zoloft, is a selective serotonin reuptake inhibitor (SSRI) that is commonly associated with being an antidepressant. There are many indications for sertraline being for depression, OCD, panic disorder, PTSD, PMDD, and anxiety. Although the manufacturer established a max daily dose of 200 mg/day higher doses from 250-400 mg/day have proven beneficial in clinical practice. Sertraline is not to be used during or within 14 days of a MAOI. Common side effects are nausea, dizziness, dry mouth, sweating, diarrhea, upset stomach, and trouble sleeping. There is a black box warning for Suicidality and antidepressant drugs but that increased risk has been seen in patients under the age of 24. Regardless it is important to monitor a patient for clinical worsening of symptoms and for the emergence of suicidal thoughts and behaviors.
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Tamoxifen is a selective estrogen receptor modulator that comes in both a tablet and solution. The tablet comes in a 10 mg and 20 mg strength and the solution comes in a 10 mg/5 mL concentration. Tamoxifen, also known as the brand name Femara, when used in reducing the risk of Breast Cancer in high risk females the dosing is 20 mg once daily for 5 years. When used in treating Breast Cancer the dosing does vary at 20-40 mg once daily. When 40 mg is needed per day the daily dose is divided into separate doses. When tamoxifen is metabolized via the CYP2D6 and CYP3A4/5 pathways the metabolites are 30-100 times more potent than tamoxifen itself. There is a black box warning for Uterine Malignancies and Thromboembolic Events. The monitoring parameters are bone mineral density, lipid panel, CBC with platelets, ophthalmic exam, and for medication adherence. The medication can be taken with or without food.
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Letrozole is an aromatase inhibitor that acts as an antineoplastic agent. The brand name for letrozole is Femara. The main indication is for hormone receptor positive breast cancer in women after menopause. If treating early breast cancer letrozole is used after a 5 year course of tamoxifen. If treating advanced breast cancer letrozole follows antiestrogen therapy. There are many off label uses of letrozole such as the many variations of breast cancer along with treating infertility due to polycystic ovary syndrome (PCOS) through ovulation stimulation. Dosing is straight forward at 2.5 mg po qd with for 5 years (in early breast cancer treatment) or 2.5-7.5 mg po qd for 5 days starting on day 3, 4, or 5 following menses or progestin induced bleed. A patient consideration of note is a decrease in bone mineral density (BMD) has been seen 2 years after usage in patients using letrozole compared to patients not on letrozole. The most common side effects seen are hot flashes, headache, hypercholesterolemia, and weight gain. Common monitoring parameters are BMD, pregnancy, cholesterol, and adherence.
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Loratadine is available over the counter and by prescription. Over the counter the most commonly known brand name is Claritin. Loratadine is a second generation antihistamine that works by antagonizing the H1 receptor. The main indications are for allergic rhinitis, conjunctivitis, and urticaria. There are many different dosage forms available from capsule, solution, syrup, tablet, chewable tablet, and disintegrating tablet. When dosing for adults the most common dosing is 10 mg po qd or 5 mg po bid with a max of 10 mg per day. For children 2-6 the chewable tablet or liquid is generally the preferred dosage form and dosed at 5 mg po qd (or 5 mL po qd if solution or syrup). When searching for an antihistamine safe during pregnancy second generation antihistamines are generally considered safe and preferred at the lowest effect dose. Limited side effects but sedation and drowsiness can occur.
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Dicyclomine is an antispasmodic anticholinergic agent that is used to treat stomach and intestinal cramping that is often associated with irritable bowel syndrome (IBS). The brand name is Bentyl. There are various dosage forms such as oral and intramuscular solutions but the most commonly used are capsules. The capsules come in a 10 and 20 mg strength. When dosing to treat the abdominal pain associated with IBS, initiate 20 mg po qid for 2 weeks or less. Longer durations of treatment have not proven any additional benefits to the patient. Dicylomine works by blocking acetylcholine at parasympathetic sites such as the smooth muscle and secretory glands in the central nervous system. This drug is not recommended for children under 6 months old and in the geriatric population due to the risk of serious side effects. The two most common side effects are dizziness and xerostomia (dry mouth). If using antacids, separate usage between the two by using dicyclomine before meals and the antacid after meals.
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Ibuprofen is a very well known medication available over the counter (OTC) and by prescription (Rx). The most common brand names are Advil and Motrin. Ibuprofen is a Non-Steroidal Anti-Inflammatory Drug (NSAID) that is often used for it’s non-opioid analgesic effect as well as it’s antipyretic effect. The OTC product comes in a wide variety of dosage forms but generally limited to a 200 mg strength. Strengths higher than that are Rx only. When treating pain in adults a common dosing regimen is 200-800 mg po 3-4 times daily (q6-8h) with the max daily dose at 3200 mg per day. When treating pain and fever in children there are weight/age/dose charts but the common rule of thumb is 4-10 mg/kg/dose po q6-7h with a max daily dose of 4 doses per day. Most common side effects are GI bleeding, stomach upset, nausea, vomiting, diarrhea, and constipation. Taking the medication with food will help avoid stomach upset and GI distress caused to the patient.
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Carisoprodol is a skeletal muscle relaxant that is most commonly known as the brand name Soma. The lesser known brand name is Vanadom. This drug has benefits in treating discomfort experienced from acute painful skeletal muscle conditions over a 2-3 week duration of therapy. The benefits beyond a short term duration (2-3 weeks) has not been proven. There are two strengths in a tablet form being 250 mg and 350 mg. The medication is dose qid with tid in addition to at bedtime. Carisoprodol forms the metabolite meprobamate which has anxiolytic and sedative effects. Since CYP2C19 function is crucial to the metabolism to meprobamate it is important to be aware of drugs that may affect CYP2C19 function along with other factors such as race and gender. Asian and African Americans are of note since there is higher prevalence of poor CYP2C19 metabolizer function. Also females generally have a higher exposure to carisoprodol but not to the metabolized form of meprobamate. When monitoring patients it is important to be aware of signs of misuse and abuse along with assessing their mental status along with their level or relief regarding pain and muscle spasms.
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Aimovig is currently the brand-only drug for erenumab. Erenumab is used in the prevention of migraines in adults. The drug comes as a 70 mg/mL or 140 mg/mL subcutaneous autoinjector that is used for one dose every month. Aimovig is considered various things being called a calcitonin gene-related (CGRP) receptor antagonist or CGRP inhibitor, a monoclonal antibody, and an antimigraine agent. Erenuman blocks the CGRP receptor which decreases the CGRP protein which is known as the cause for intense inflammation in the meninges and nerve endings in the brain. Although there are not any direct drug interactions of note, patients should be aware of injection site reactions such as pain, redness, and swelling. The main side effects of note are constipation and increased blood pressure. Increasing blood pressure is particularly of note due to disease related concerns in patients with cardiovascular disease. When monitoring patients it is appropriate to check blood pressure regularly along with the number of migraine days they experience. There are particular storage requirements for Aimovig and once opened from original container it can be stored in room temperature but should be discarded after 7 days.
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Trazodone is an antidepressant that also is commonly used for insomnia (off-label). When treating MDD in adults the immediate release tablet is initiated at 50 mg twice daily and incrementally increased every 3-7 days to a typical dose range between 200-400 mg/day. If used for treating MDD and if the sedative effect is not desired it is recommended to have a smaller daytime dose and a larger bedtime dose. When treating insomnia dosing is initiated at 50-100 mg at bedtime. Most common side effects are sedation, dizziness, and low blood pressure. Serotonin syndrome is a concern so watch for symptoms such as agitation, hallucinations, coordination problems, fast heartbeat, sweating, fever, n/v/d, and tight muscles. Trazodone has a Black Box Warning for Suicidal Thoughts and Behaviors so patients should be monitored for clinical worsening and the emergence of suicidal thoughts and behaviors.
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Esketamine is a REMS program drug that is currently brand only known as Spravato. It is a Non-Selective Non-Competitive NMDA Receptor Antagonist and typically administered in a healthcare setting that is enrolled in the REMS program. Spravato is used along with an antidepressant when treating patients with treatment-resistant depression or a major depressive disorder with acute suicidal ideation and behavior. It is not recommended for pediatric use and the efficacy in reducing and preventing suicide or suicidal behavior has not been proven. Spravato comes in a nasal spray in a 56 mg and 84 mg strength. In addition to the more common CYP pathways, Spravato is primarily metabolized via the CYP2B6 pathway. Esketamine is the S-enantiomer of racemic ketamine. Spravto should be administered by the patient under the supervision of a healthcare provider.
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Warfarin is an anticoagulant that is also known by the brand name Coumadin. It is used in the treatment of myocardial infarction and thromboembolic complications. There is a wide variety of tablet strengths from 1 mg to as high as 10 mg. When dosing warfarin it is very patient-specific. The therapeutic goal is based on various factors and treatment nomograms may vary from institution to institution. Prior to initiation it is wise to establish the patient’s genetic variant for CYP2C9 since this will play a large role in predicting their drug sensitivity. When attempting to reach a therapeutic target the healthcare professional uses INR readings to determine the level of anticoagulation. Generally a range between 2-3 is common with 2.5-3.5 when a high level of intensity is required. Other factors that may help determine patient response are age, race, and diet. The mechanism of action for warfarin lies in the antagonism of Vitamin K which leads toward the inhibition of coagulation factors 2, 7, 9, and 10. The rate-limiting factor can be seen as factor 2 due to it’s long half-life of 60-72 hours. Although INR elevation can be seen in 24-48 hours, therapeutic benefits are not achieved until around 5-7 days after initiation. There is a black box warning for bleeding risk so a patient's INR should be monitored regularly.
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Zolpidem is a hypnotic drug that selectively agonizes the benzodiazepine-1 receptor. It comes in multiple tablet forms as well as in a spray. The most common brand name zolpidem is identified with is Ambien. The most recognizable orally disintegrating tablet brand is Intermezzo. Zolpidem is used for short term treatment of sleep-onset and sleep-maintenance insomnia. It is important to transition patients off zolpidem to avoid symptoms of withdrawal. A commonly prescribed regimen for the immediate release tablet is 5 mg po immediately before bedtime allowing for 7-8 hours of uninterrupted sleep. Some factors to consider are females appear to have a higher sensitivity to the medication so lower doses should be used. This medication should not be used if a patient is pregnant due to the drug being able to cross the placenta. Data shows that the neonate is at severe risk and could be born with withdrawal symptoms. There is black box warning for Complex Sleep Behaviors which include sleep walking, sleep driving, or other activities being conducted while not fully awake which may lead to injury or death. The medication should not be taken with food since it will delay the onset of action.
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Memantine is a NMDA antagonist that goes by the brand name Namenda. There are also titration packs available in the name brand. Memantine treats but does not cure confusion and dementia associated to Alzheimer’s disease. There are multiple dosage forms being a capsule, solution, and tablet. Special considerations are for patients with renal and hepatic impairment. Memantine does appear to have higher exposure in women than men. Memantine is purposed to work on the glutamate receptor blocking the receptor much like magnesium does under “normal” conditions. This drug has a long elimination half-life between 60-80 hours. The main side effects are weight gain, abdominal pain, constipation, diarrhea and vomiting. A serious side effect is Stevens Johnson Syndrome. Two main types of drugs that interact with Namenda are alkalinizing agents and carbonic anhydrase inhibitors. The drug can be taken with or without food and if a dose is missed it should not be doubled on the next dose. The missed dose should be skipped and resumed regularly.
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Aripiprazole is an atypical second generation antipsychotic agent. It commonly goes by the brand name Abilify. It is a quinolinone derivative which looks similar to but different from quinolones (antibiotic class). There are many indications for Abilify such as in the treatment of schizophrenia and bipolar disorder but can also be used to treat the irritability often seen in autistic disorder. Dosing initiation is often titrated. For example, when initiating dosing for adults with bipolar disorder initiation begins with 10-15mg po qd with 5-10mg dose increases weekly with the max dose of 30mg/day. Common side effects are dizziness, lightheadedness, drowsiness and weight gain. There is a black box warning for increased mortality in elderly patients with dementia related psychosis and for suicidality and antidepressant drugs. Abilify should not be used to treat dementia related psychosis in elderly. Patients should be monitored for worsening or emergence of suicidal thoughts and behaviors.
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Omeprazole is a proton pump inhibiting drug that helps regulate the secretion of stomach acid. The most common brand name is Prilosec. Omeprazole is available over the counter (OTC) as well as by prescription only (RX). The OTC indication is for heartburn and should be used no longer than 14 days in a 4 month period. Typical dosing ranges from 10 -40 mg po qid to bid unless treating Zollinger-Ellison Syndrome. When treating Zollinger-Ellison Syndrome doses can get as high as 180 mg daily. The average Zollinger-Ellison Syndrome dose is 60-70 mg qd. Omeprazole should be used cautiously (if at all) in the geriatric population due to risk of bone fracture if taking longer than 1 year. This drug is primarily metabolized through the CYP2C19 pathway use with strong inducers are to be avoided. Common side effects are headache, stomach pain, diarrhea, and gas. Diarrhea may be of particular concern due to risk of C.diff.
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Albuterol is a bronchodialating beta-2 adrenergic agonist. Common brand names are ProAir, Ventolin, and Proventil. The most common use is for treating and preventing bronchospasms in patients with obstructive airway diseases. There are several dosage forms with the most common being metered dose inhalers (MDI) and dry powdered inhalers (DPI). Albuterol is generally considered a quick relief or rescue inhaler with dosing being 2 puffs by mouth every 4-6 hours as needed. Since albuterol specifically targets the beta-2 adrenergic receptor in bronchial smooth muscle there is little to no effect on heart rate. Although the drug is targeted it is still wise to monitor patients with heart issues. Common monitoring parameters are FEV1, peak flow, blood pressure, and heart rate.
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Ubrogepant is currently brand only and known as Ubrelvy. This drug is a Calcitonin Gene-Related Peptide (CGRP) Receptor Antagonist used to treat migraines. There are two tablet strengths being the 50 mg and 100 mg dose. Initiated begins between 50 - 100 mg po for one dose and may be repeated after 2 hours for one more dose. The max dose is 200 mg per day. Dose adjustments should be made in patients with renal and/or hepatic impairment. This drug is primarily metabolized hepatically through the CYP3A4 pathway. Strong inhibitors or inducers for CYP3A4 should be avoided or used with dose adjustments. Ubrelvy’s time to peak is around 1.5 hours with a half-life of 5-7 hours. Patients should be aware of drowsiness, and nausea and should not use drugs or substances that may enhance drowsiness such as alcohol. Ubrelvy can be taken with or without food and for best results not taken with a high-fat meal.
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Hydrochlorothiazide is a thiazide diuretic that goes by the brand name Microzide. The way this drug works is through the inhibition of sodium reabsorption in the distal tubules of the kidneys. The drug is most commonly used in the treatment of Edema but has other pharmacological uses. Typical edema treatment dosing is initiated at 25-100 mg po qd divided into 1-2 doses. Thiazide diuretics are not the preferred diuretic for edema but does have its place in therapy. There is a concern in patients with sulfonamide-derived drug allergies but this is often challenged. The drug is excreted in the urine with ~60% as unchanged drug. Common side effects are orthostatic hypotension, diarrhea, dizziness, and headache. Substances such as alcohol may enhance orthostatic hypotension. Blood pressure, sodium, potassium and BUN should be monitored while patients are on this drug.
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Cyclobenzaprine is a skeletal muscle relaxant that goes by brand names Flexeril and Amrix. The drug’s effects are achieved through acting centrally on the skeletal muscle and reducing the motor activity of both the alpha and gamma motor neurons. Typical dosing is initiated at 5 mg po tid with one of the doses being at bedtime. The duration of therapy is short term being 2-3 weeks max. Can be taken with or without food. Capsules can be opened and sprinkled but tablets are recommended to be taken whole. The main drug interaction concerns are with CNS depressants, serotonin increasing drugs/agents, and w/ anticholinergics. Common side effects experienced by patients are dizziness, fatigue, and constipation. This drug is metabolized hepatically and requires dose adjustments in those with impaired hepatic function.
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Escitalopram is the S-enantiomer of citalopram. This drug works by selectively inhibiting serotonin. The brand name that escitalopram is most recognized as Lexapro. Dosing is typically initiated at 10 mg po qd with adjustments made incrementally with the max dose generally being around 20 mg per day. There are many off label uses for escitalopram so those should be utilized on a case by case basis. However, the main indications for this drug is to treat depression and anxiety. Escitalopram is not approved for use in patients under the age of 12. The black box warning for escitalopram is for suicidal thoughts and behaviors. Important monitoring parameters are ECG in patients at risk of QT prolongation and pregnancy since the drug crosses the placenta.
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Metoprolol is an anti-anginal, anti-hypertensive agent that works by selectively inhibiting the beta1 adrenergic receptor. Some of the brand names are Lopressor, Toprol XL, and Kapspargo Sprinkle. Dosing may vary based on if the formulation is the IR or ER form and by indication. For Angina in adults the IR tartrate form starts at 50 mg po bid with weekly increases to a max of 400 mg/day. There is a black box warning for Ischemic Heart Disease warning that abrupt cessation of therapy may harm patients and if therapy is to be discontinued, the patient should be titrated down over 1-2 weeks. The most common side effect is orthostatic hypotension.
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Fluticasone is an inhaled corticosteroid (ICS). Some of the brand names are Flovent and Arnuity Ellipta. This drug is a potent local vasoconstrictor as well as an anti-inflammatory agent. The main indication is in the treatment of asthma with off label uses in COPD and EoE. Dosing is based on prior ICS treatment and/or level of severity. The furoate form is generally preferred over the propionate form due to a better binding affinity. The main side effect and counseling point is for oral candidiasis (Thrush).
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Montelukast is best used as an adjunctive drug. It is best when used for the treatment of allergic rhinitis, asthma, and exercise induced bronchoconstriction (EIB). The brand name is Singulair. This drug works through selectively inhibiting the cysteinyl leukotrienes which leads to pulmonary and nasal mucosal benefits along with the alteration of the inflammation process. This comes in several dosage forms being 4 mg packets/granules, a 10 mg tablet, and in 4 mg and 5 mg chewable tablets. Common side effects include dizziness, fatigue, urticaria, and infection. There is a black box warning for serious neuropsychiatric events so it is very important to access/watch for serious signs and symptoms that may be of neuropsychiatric nature, and to weigh the risk/benefits for patient usage.
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Clopidogrel is an antiplatelet drug. When I was in school it was the “classic” example of a prodrug. The brand name is Plavix. This drug works by irreversibly blocking the P2Y12 component of ADP receptors which prevents GPIIb/IIIa activation causing a reduction in platelet aggregation. Based on indications and diagnosis there may be a loading dose of 300 mg to 600 mg with the general treatment dosing of 75 mg po qd. The active form of this drug relies on the Cytochrome P450 CYP2C10 oxidation to active thiol. Common side effects include bleeding, bruising, rash. There is a black box warning for CYP2C19 metabolism and diminished efficacy in poor CYP2C19 metabolizer.
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Metformin is a medication used in the treatment of patients with Type 2 Diabetes. One of the brand names is Glucophage. This drug works by decreasing glucose production, decreasing interstitial glucose absorption, and by increasing peripheral glucose uptake and insulin sensitivity. Metformin is commonly dosed using either immediate release or extended release tablets. Initial dosing begins with 500 mg 1-2 times daily or with 850 mg once daily then titrated to a goal of 850-1000 mg twice daily. This drug is not metabolized hepatically with around 90% being excreted in the urine. Side effects include diarrhea, flatulence, and infection. There is a black box warning for lactic acidosis.
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This episode of Drug Cards Daily is on the drug atorvastatin. The name brand is Lipitor. Atorvastatin is a HMG-CoA Reductase Inhibitor that is known for treatment of Dyslipidemia and ASCVD. The tablets come in a variety of doses. Initial dosing for dyslipidemia/hypercholesterolemia begins at 10-20 mg once daily and is evaluated every 1-3 months after initiation and then every 3-12 months thereafter. This dosing distinction is categorized as either moderate-intensity (10-20 mg/day, reducing LDL-C by 30-49%) and high-intensity (40-80 mg/day, reducing LDL-C by 50% or more). ASCVD (Atherosclerotic Cardiovascular Disease) treatment follows the moderate-intensity/high-intensity dosing based on ASCVD 10-Year risk. This drug is metabolized hepatically with an onset of action between 3-5 days. Side effects include joint pain, stuffy nose, sore throat and insomnia. This drug is not to be used if the patient is or may be pregnant and should be stopped 1-2 months prior to trying to conceive.
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This episode of Drug Cards Daily is on the drug amoxicillin. The name brand is Amoxil. Amoxicillin is a penicillin antibiotic used in treating a wide variety of infections such as community acquired pneumonia (CAP), urinary tract infections (UTI), as well as others. This medication comes in a powder for reconstitutions and tablets. The general dosing in adults is around 500 mg-1000 mg po q8-12h for 5-7 days. Ranges, doses, duration is based on indication and severity of signs and symptoms. Sixty percent of this drug is excreted through the urine. Amoxicillin has a wide distribution and can be found present in the liver, lungs, ear, and even bone. When a patient is given a course, it is very important that they complete the full course.
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This episode of Drug Cards Daily is on the drug lisinopril. The name brands are Zestril, Prinivil, Qbrelis (Solution). Lisinopril is an Angiotensin-Converting Enzyme (ACE) inhibitor that is most known for treatment of hypertension. Other indications are for heart failure and ST-elevation myocardial infarction. Tablets come in a variety of doses. Initial dosing for hypertension begins at 5-10 mg once daily and is evaluated every 4-5 weeks. The dose is then doubled with the goal of 40 mg/day is achieved or until the patient’s tolerance is reached. This drug is not metabolized with any unused unchanged drug being excreted through the urine. The hallmark side effect to watch for is cough. Other side effects are syncope, chest pain, headache, and change in the sense of smell. This drug is not to be used if the patient is or may be pregnant due to fetal toxicity.
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This episode of Drug Cards Daily is on the drug Trikafta. As of 2020 it is Brand only. Trikafta consists of three drugs which are elexacaftor, ivacaftor, tezacaftor. It is twice a day dosing with 2 tablets in the morning and 1 tablet (12 hours later) in the evening. The morning tablet is orange in color and consists of elexacaftor 100 mg + tezacaftor 50mg + ivacaftor 75 mg while the evening dose (which is a light blue colored tablet) consists of ivacaftor 150 mg. Currently the drug is approved for use in ages 12 years and older. The main concerns are patients must have the F508del mutation in the CFTR gene have healthy liver function. Patients without the F508del mutation will not benefit from this drug. The other concern is that CYP3A inducers and inhibitors affect this drug greatly so that should always be considered when starting a patient on this treatment.
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This episode of Drug Cards Daily is on the drug hydrocodone/APAP. Hydrocodone/APAP has a variety of brand names but most commonly known as Norco or Vicodin. It is a combination product containing an opioid and analgesic. Hydrocodone/APAP is typically used in the management of both acute and chronic pain. It comes in a tablet, solution, and elixir form. The main concerns are the potential for abuse, the CNS depressing effects, and not exceeding >4000 mg/day of acetaminophen (APAP). Constipation is a very common concern due to the opioid component so recommending a stool softener is highly recommended.
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This episode of Drug Cards Daily is on the drug levothyroxine. Levothyroxine has many brand names such as Synthroid, and Tirosint (to name a few) and is used as first-line in hypothyroidism. It is also used in the treatment of thyrotropin-stimulating hormone (TSH) dependent thyroid cancers. The main dosage form is tablets and it comes in a wide variety of strengths commonly dosed in micrograms (mcg). Dosing is individualized with a general standard of either approximately 1-1.6 mcg/kg/day or 50 mcg/day. From there adjustments are made in 12-25 mcg increments every 3-6 weeks until serum TSH and T4 is at a normal range for greater than 5-6 weeks. It is recommended to be taken in the morning 30-60 minutes before food. If needed it can be crushed but levothyroxine should not be administered within 4 hours of calcium or iron containing products.
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