Indication: hypertension; congestive heart failure

Mechanism: diuretic; increases excretion of sodium and water

Special instructions/considerations: Avoid potassium supplements or high-potassium foods; rise slowly from standing or lying down; careful when driving/operating machinery; avoid alcohol; take in morning

Two adverse effects and instructions to avoid/manage:

Breast enlargement (gynecomastia)- avoid by taking only the recommended dose

Hyperkalemia (weakness, numbness, fatigue)- avoid by taking recommended dose and by avoiding potassium supplements/high potassium foods

Self-monitoring: Won't feel different; notice BP drop at check-up

Storage: CRT

Indication: Bacterial infections (antibiotic)

Mechanism: Stops bacterial growth

Special instructions/considerations: Sun sensitivity; stay well hydrated to prevent kidney stones; make sure to take until gone

Two adverse effects and instructions to avoid/manage:

Kidney stones- avoid by staying well hydrated

Sun sensitivity- avoid by wearing sunscreen and protective clothing

Stevens-Johnson syndrome- manage by immediately report widespread rash or blistering

Self-monitoring: Resolution of symptoms within a few days (but make sure to take until gone)

Storage: CRT

Indication: Bacterial infections (antibiotic)

Mechanism: Stops bacterial growth

Special instructions/considerations: CYP3A inhibitor (increase conc. of carbamazepine, quinidine, colchicine, alprazolam)- tell MD all drugs you are taking, including OTCs; take until gone

Two adverse effects and instructions to avoid/manage:

Heart arrhythmia (QT prolongation)- manage by consulting MD if pt notices abnormal heart rhythm

Taste disturbance- manage by sucking hard candies

C. diff. diarrhea- manage by immediately reporting severe, watery, or bloody diarrhea up to 2 months after antibiotic use

Self-monitoring: Symptoms should improve in a few days, but take until gone

Storage: CRT

Indication: anticoagulation

Mechanism: inhibits synthesis of vitamin-K dependent clotting factors

Special instructions/considerations: Avoid getting cuts and bruises; use a soft-bristled toothbrush; always tell doctor before starting any new medication; avoid grapefruit and cranberry; avoid vitamin K-rich foods (asparagus, broccoli, cabbage, brussels sprouts, spinach); carry ID that you are taking warfarin (Med ID bracelet); contraindicated in pregnancy; avoid alcohol

Two adverse effects and instructions to avoid/manage:

Bleeding- avoid by being careful, brushing teeth with soft-bristle brush, reporting any drug changes to doctor, etc.

Skin and tissue necrosis- manage by immediately reporting signs of lesions/necrosis, especially within first few days of treatment

Self-monitoring: Probably will not feel any different, monitor INR regularly (every day until therapeutic levels reached, then every 1-4 weeks or any time drug therapy is changed)

Storage: CRT

Indication: Glucocorticoid (steroid)

Mechanism: Decreases inflammation and immune response

Special instructions/considerations: Take with food or milk to avoid GI upset; May cause drug-induced hyperglycemia (diabetic pts); avoid alcohol and smoking (d/t increased osteoporosis risk); do not suddenly stop taking

Two adverse effects and instructions to avoid/manage:

More susceptible to infections- avoid by practicing good hygiene (hand washing), getting plenty of sleep, and eating a healthy diet; manage by reporting signs of infection right away

Delayed wound healing- avoid by taking precautions against injury

Self-monitoring: Decreased inflammation/hypersensitivity, etc.

Storage: CRT

Indication: Bacterial infections (bacterial vaginosis)

Mechanism: Kills anaerobic bacteria

Special instructions/considerations: May turn urine reddish-brown; very important to not drink alcohol while taking or until 1 day after (tablets) or 3 days after (XR and capsules) the end of therapy; take XR tablets 1 hour before or 2 hours after food

Two adverse effects and instructions to avoid/manage:

Reddish-brown urine: manage by continuing to take medication regularly; color will return to normal on its own

Headache (18%): manage with OTC pain reliever (APAP)

Vaginal irritation or candida infection: Avoid by maintaining good vaginal hygiene and eating yogurt; manage by applying topical products (Vagistat) or see MD if cottage cheese-like discharge is noted

Self-monitoring: Symptomatic improvement in a few days, but make sure to finish therapy

Storage: CRT

Indication: Osteoporosis

Mechanism: Binds to bones and prevents them from being eaten away

Special instructions/considerations: Take with a full glass of water while sitting upright, then do not lie down for 30 minutes after taking; take 30 minutes before the first food of the day

Two adverse effects and instructions to avoid/manage:

Heartburn: Avoid by taking with plenty of water, avoiding lying down for 30 minutes, and eating food before lying down; manage by telling doctor right away about new or worsening heartburn

Jaw osteonecrosis: Avoid with good oral hygiene and regular dental check-ups; manage by telling doctor right away if experiencing jaw pain

Self-monitoring: Will not feel different, but will notice improvements on doctor visits

Storage: CRT

Indication: Diabetes mellitus type 2

Mechanism: Helps body use sugar; prevents liver from releasing extra sugar

Special instructions/considerations: Take with evening meal; stay well hydrated; tell doctor you are taking metformin before any procedure using contrast dye injection

Two adverse effects and instructions to avoid/manage:

Diarrhea (53.2%): avoid by titrating dose; manage with hydration, OTC anti-diarrheals; should resolve with continued use

Kidney dysfunction: avoid by staying well hydrated and by yearly monitoring

Self-monitoring: Blood sugars and A1C within goal range

Storage: CRT

Indication: Diabetes mellitus

Mechanism: Replaces insulin; allows body to use sugar; lowers blood sugar

Special instructions/considerations: Give 15 minutes before or immediately after meals; rotate injection sites; watch for hypoglycemia (shaking, sweating, rapid heartbeat)

Two adverse effects and instructions to avoid/manage:

Hypoglycemia: Avoid by eating regular meals, titrating dose based on diet and exercise, avoiding drugs that mask the signs of hypoglycemia (beta blockers, etc.)

Lipodystrophy (injury to fat tissue): Avoid by rotating injection sites

Self-monitoring: Blood sugar and A1C

Storage: Unopened pens are stored in the refrigerator, but keep at CRT after opening the one you are using. Open pens are only good for 28 days.

Indication: Hypertension; migraine prophylaxis

Mechanism: Widens blood vessels and slows down heart

Special instructions/considerations:

Tell your doctor before having surgery with anesthesia

Do not suddenly stop taking this medication; it can make your blood pressure go up higher than it was before

Two adverse effects and instructions to avoid/manage:

May mask signs of low blood sugar: diabetic patients monitor blood pressure more frequently; also avoid alcohol

Insomnia; avoid by relaxing before bed, eliminate light/noise distractions, don't bring work into bedroom

Self-monitoring:

Will probably not feel any different, but can monitor blood pressure regularly (4 weeks to effect)

Do you know your blood pressure goals?

Storage: CRT

Indication: Diabetes mellitus

Mechanism: Help body release more insulin (prevent breakdown of "insulin signals")

Special instructions/considerations:

Can be taken with or without food

Diabetes: avoid alcohol

Two adverse effects and instructions to avoid/manage:

Hypoglycemia: avoid by checking blood sugars regularly, manage with 15 x 15 rule if blood glucose is <70

Pancreatitis: manage by reporting severe stomach pain right away

Self-monitoring:

Blood glucose monitoring

A1C at check-ups

Storage: CRT

Indication: Atrial fibrillation (irregular heart beat) or heart failure

Mechanism: Allows more calcium into the heart muscle, which allows it to contract more forcefully 

Special instructions/considerations:

Take doses regularly; if you miss a dose and the next dose is 12 hours away, skip the missed dose. Tell doctor right away if you skip more than 2 days.

Take after the morning meal

Avoid antacids

Two adverse effects and instructions to avoid/manage:

Vision disturbances (halos, blurred vision, vision tinted): Avoid by not taking more than the recommended dose, manage by avoiding driving, etc. until vision resolves

Cardiac arrhythmia: Avoid with regular electrolyte monitoring

Self-monitoring: None; doctor will monitor at appointments

Storage: CRT

Indication: Diabetes mellitus

Mechanism: Long-acting insulin; supplements body's insulin

Special instructions/considerations:

DO NOT MIX with other insulins!

Avoid alcohol

Take at the same time every day (bedtime is a good time)

Two adverse effects and instructions to avoid/manage:

Lipodystrophy and injection site pain: avoid by rotating injection sites and by administering at room temperature

Hypoglycemia: avoid by monitoring blood glucose, eating regularly, and avoiding alcohol

Self-monitoring: Blood sugars; report problems with glycemic control

A1C at checkup

Storage: Unopened pen/vial goes in the refrigerator; opened can stay at CRT for 28 days

Indication: Bacterial infection

Mechanism: Kills bacteria

Special instructions/considerations:

Separate from multivitamins, calcium, etc. by 2 hours

May interact with medications: consult doctor before starting anything new

Two adverse effects and instructions to avoid/manage:

Urine crystallization: Avoid by drinking with full glass of water

Photosensitivity: avoid with sunscreen

Tendonitis/tendon rupture: manage by immediately reporting tendon pain

Self-monitoring: Resolution of symptoms in a few days; contact MD if not resolved after course of ABX

Storage: CRT

Indication: Hypothyroidism

Mechanism: Thyroid responsible for helping your body use energy; this replaces a chemical that helps the thyroid do its job

Special instructions/considerations:

INX with calcium and iron: Take levothyroxine at least 2 hours before or 6 hours after

Take at the same time every day

Dose may need to be increased during pregnancy

Do not switch brands

Two adverse effects and instructions to avoid/manage:

Hyperthyroidism (rapid heartbeat, nervousness, sweating, irritability): avoid with TSH monitoring at 6-8 weeks after starting/changing dose and then every 6-12 months

Osteoporosis: Avoid by taking calcium and vitamin D in diet, but not at the same time as medication

Self-monitoring: Feeling better (decreased symptoms), normal TSH and free T4 levels on laboratory monitoring

Storage: CRT

Indication: Angina (chest pain), before or during an attack

Mechanism: Relaxes blood vessels quickly so heart does not have to work as hard

Special instructions/considerations:

Tablets are dissolved under the tongue, NOT swallowed

If using for prevention, take the tablet 2-5 minutes before the activity

Two adverse effects and instructions to avoid/manage:

Dizziness and low blood pressure: Manage by sitting while taking the medication

Headache (63%): Manage with OTC analgesic

Self-monitoring:Call 911 if symptoms do not resolve in 5 minutes

Storage: CRT in the original container; keep in a place that you can get to them easily, but is out of reach of children and pets

Indication: Bacterial infections

Mechanism: Kills the bacteria

Special instructions/considerations:

Make sure to finish the full course of therapy

Take 2 hours before or after multivitamins or antacids

Two adverse effects and instructions to avoid/manage:

Diarrhea: Manage by drinking plenty of fluids, report if severe

Allergic reaction: Manage by reporting hives or difficulty breathing

Self-monitoring: Symptom resolution in a few days, but still finish full course

Storage: CRT; once reconstituted, suspension can be stored at CRT for 10 days

Indication: Acne, contraception, regulating menstrual cycles

Mechanism: Stop an egg from being released (ovulation) by stopping hormones; also change cervical mucus to prevent fertilization

Special instructions/considerations:

Try to take at the same time every day

Missed dose: varies by brand; see package insert (use back-up birth control if using for contraception)

Use back-up birth control for the first week of therapy

Two adverse effects and instructions to avoid/manage:

Breast tenderness and swelling: Manage by wearing comfortable undergarments

Blood clots: Avoid by NOT SMOKING and by getting regular exercise

Self-monitoring: Make sure you're remembering to take it at the same time every day

Storage: CRT

Indication: Anticoagulant (prevent blood clots)

Mechanism: Prevents clots from forming in your blood

Special instructions/considerations:

Do not suddenly stop taking

Tell your doctor you are taking this medication if you are getting surgery

Two adverse effects and instructions to avoid/manage:

Bleeding more easily: Avoid by avoiding falls, cuts, etc.; manage by immediately reporting excessive bleeding or blood in stool

Thrombotic thrombocytopenic purpura: manage by reporting fever, weakness, pale skin, yellowing of skin, and multiple small bruises

Self-monitoring: Will not notice a difference; doctor will monitor with lab values

Storage:
CRT

Indication: High blood pressure

Mechanism: Two mechanisms: lisinopril stops narrowing of blood vessels, hydrochlorothiazide helps body remove water

Special instructions/considerations:

Do not use with alcohol

Drink plenty of fluids

Do not take potassium supplements or salt substitutes

Two adverse effects and instructions to avoid/manage:

Persistent cough: Manage with hard candy or by telling doctor if it gets troublesome

Voiding at night: Avoid by not taking close to bedtime

Self-monitoring: BP monitoring

Storage: CRT

Indication: Bacterial infections, acne

Mechanism: Stops bacteria from growing

Special instructions/considerations:

Apply plenty of sunscreen

Take with food or milk to avoid GI upset

INX with oral contraceptives

Drink plenty of fluids to avoid esophageal irritation

Two adverse effects and instructions to avoid/manage:

Photosensitivity: avoid by applying plenty of sunscreen, wearing sun-protective clothing, and avoiding excess sun exposure and tanning beds

Severe diarrhea: manage by reporting to physician, ask physician first before taking OTC diarrhea medicine

Self-monitoring: Resolution of symptoms within a few days

Storage: CRT

Indication: Hyperlipidemia

Mechanism: Ezetimibe: stops cholesterol absorption; simvastatin: Stops body from making cholesterol

Special instructions/considerations:

INX: Must take 2 hours before or 4 hours after bile acid sequestrants

Take in evening

Two adverse effects and instructions to avoid/manage:

Rhabdomyolysis: manage by reporting severe/persistent muscle pain

Upper respiratory tract infections: Avoid with good hand hygiene, adequate rest, etc.

Self-monitoring: Doctor will monitor cholesterol levels in your blood

Storage: CRT

Indication: Attention Deficit Hyperactivity Disorder (ADHD)

Mechanism: Stimulates brain, not known how this works to control ADHD

Special instructions/considerations:

If a dose is skipped, take it as soon as you remember, but not within 10 hours of bedtime

INX: MAOI, citrus fruits/juices

Do not suddenly d/c

Report new/worsened psychiatric problems right away

Two adverse effects and instructions to avoid/manage:

GI: Abdominal pain, loss of appetite, xerostomia; manage with non-upsetting foods and by sucking on hard candy

Cardio: HTN; avoid/manage with regular monitoring

Neuro: HA; manage with favorite OTC pain reliever

Self-monitoring: Ability to focus, etc.

Storage: CRT

Indication: Insomnia

Mechanism: Binds to receptors in brain to help you sleep

Special instructions/considerations:

INX: Do not take with or immediately after meals; do not take with alcohol or other CNS depressants (can lead to complex sleep behaviors)

Avoid driving/activities requiring mental alertness

Two adverse effects and instructions to avoid/manage:

Anaphylactoid reaction: immediately report difficulty breathing or swelling of the lips or tongue

Next-day somnolence: avoid by making sure you can get a full night's sleep

Behavioral changes: manage by immediately reporting

Self-monitoring:

Improvement in signs/symptoms; contact MD if not improved in 10 days

Storage: CRT

Indication: Alzheimer's disease- dementia

Mechanism: Helps brain send messages

Special instructions/considerations:

Take in evening at bedtime

Two adverse effects and instructions to avoid/manage:

Common side effects (diarrhea, n/v, muscle cramps, insomnia, fatigue) usually occur when dose increases and will resolve on their own

GI bleed: avoid by avoiding NSAIDs

Self monitoring:

Improvement in memory

Storage: CRT

Indication: Erectile dysfunction; enlarged prostate

Mechanism: Allows increased blood flow to the penis

Special instructions/considerations:

INX: Nitrates, excessive alcohol use (>5 drinks)

Two adverse effects and instructions to avoid/manage:

Headache and flushing: manage with OTC pain reliever

Prolonged erection: medical attention if >4 hours

Immediately report chest pain, heart palpitations, or rapid heartbeat

Immediately report loss of vision or hearing

Self-monitoring:

Improvement in sexual function

Storage: CRT

Indication: Anxiety, depression, chronic pain

Mechanism: Changes brain signals

Special instructions/considerations:

INX: alcohol (increased risk of hepatitis), anticoagulants (NSAIDs, warfarin, aspirin), St. John's Wort (serotonin syndrome)

Two adverse effects and instructions to avoid/manage:

Anticholinergic: dry mouth, constipation, blurred vision, etc.- manage with hard candy, eye drops, OTC stool softener

Serotonin syndrome (sweating, agitation, hallucinations, etc.): manage by immediately reporting; avoid by avoiding other serotonin reuptake inhibitors and St. John's Wort

Hepatitis and Stevens Johnson syndrome: Immediately report

Self-monitoring: Improvement in symptoms

Storage: CRT

Indication: Overactive bladder

Mechanism: Decreases pressure on the bladder

Special instructions/considerations:

INX: Potassium supplements (anticholinergic effects of the drug cause the potassium to stay in GI longer, increasing risk of gastric lesions)

Avoid activities requiring alertness until you know how the drug affects you

Do not chew or crush

Two adverse effects and instructions to avoid/manage:

Constipation, dry mouth, etc.: Manage with OTC laxatives and sucking on hard candy

Anaphylaxis reaction and angioedema: Manage by immediately reporting itching, facial swelling, rash, difficulty breathing, etc.

Self-monitoring: Improvement in symptoms

Storage: CRT

Indication: Seizures (generalized tonic-clonic and complex partial)

Mechanism: Stabilizes neurons in the brain to keep them from over-firing

Special instructions/considerations:

Strong CYP3A4 inducer!!! Decreases plasma concentration of many, many drugs! (Example: birth control)

Do not suddenly stop taking

Take with food

Separate from antacids by at least 1 hour

Do not drink alcohol--can interfere with levels

Two adverse effects and instructions to avoid/manage:

Rash: Report right away as sometimes severe skin reactions can develop

Gingival hyperplasia: avoid by not exceeding recommended dose, manage by reporting gum swelling right away

Confusion/coordination difficulties/etc.: Should improve with continued use

Self-monitoring:
Self monitor with seizure control and watch for depression/mood changes

Serum levels taken 7-10 days after starting

Storage: CRT

Indication: Benign prostatic hyperplasia

Mechanism: Relaxes muscles in prostate allowing for better urine flow

Special instructions/considerations:

Take at the same time every day, 30 minutes after a meal

Do not chew or crush

Two adverse effects and instructions to avoid/manage:

Orthostatic hypotension: Avoid by rising slowly from sitting/lying

Headache: Manage with OTC pain reliever

Rhinits: Manage with saline nasal products, humidifiers, etc.

Self-monitoring:

Improved bladder obstructive symptoms

Storage: CRT

Indication: Migraine

Mechanism: Constricts blood vessels in brain to reduce pressure

Special instructions/considerations:

INX: MAO-I use within past 2 weeks; concurrent SSRI use; St. John's Wort

Two adverse effects and instructions to avoid/manage:

Bad taste in mouth: Manage with hard candy

N/V: Manage with ginger ale, saltine crackers, etc.; can take with food

Hypertension: Avoid with regular blood pressure checks

Self-monitoring: Migraine relief

Storage: CRT

Indication: Anxiety and depression

Mechanism: SSRI: increases presence of serotonin in brain

Special instructions/considerations:

Do not drink alcohol

INX: anticoagulants, NSAIDs, etc. --> increased bleed risk; many other interactions (consult MD before starting anything new, even OTC)

Contraindicated in breastfeeding

Two adverse effects and instructions to avoid/manage:

Headache: OTC pain reliever (acetaminophen)

Insomnia: Good sleep hygiene, good sleep schedule

Serotonin syndrome: Report high fever with confusion, n/v, etc. immediately

Self-monitoring: May take several weeks to see improvement; do not suddenly stop taking

Storage: CRT

Indication: Neuropathic pain

Mechanism: Affects signaling, not really sure how that works

Special instructions/considerations:

Do not use alcohol or CNS depressants

Do not suddenly stop taking

Two adverse effects and instructions to avoid/manage:

CNS effects (dizziness, drowsiness): rise slowly from sitting/lying; be careful operating machinery

Teratogenic:Avoid conceiving while on this medication--can harm fetus (both male and female users can affect it)

Self-monitoring: Symptomatic improvement

Storage: CRT

Indication: Benign prostatic hyperplasia, male pattern alopecia

Mechanism: decreases growth of the prostate (blocks chemicals that cause prostate enlargement)

Special instructions/considerations:

Pregnant women should not handle the tablets

Two adverse effects and instructions to avoid/manage:

Sexual: impotence, ejaculation disorders, ED, and decreased libido; avoid by not exceeding dose, manage by reporting

Breast tenderness and lumpiness: manage by reporting pain, lumps, or discharge

Self-monitoring: Symptomatic improvement (alopecia may take >3 months to resolve)

Storage: CRT

Indication: Depression (major depressive disorder)

Mechanism: Affects brain signals; unknown mechanism

Special instructions/considerations:

Immediately report worsening depression or suicidal thoughts

INX: MAO-I within 14 days

No alcohol

Two adverse effects and instructions to avoid/manage:

Increased appetite and weight gain: manage with healthy eating and exercise

Dry mouth and constipation: Hard candy and OTC laxatives

Drowsiness: Don't drive/operate machinery until you know how it affects you; take at bedtime

Self-monitoring: Symptom improvement; doctor will regularly check CBC and lipid panel

Storage: CRT

Indication: Pyschiatric disorders

Mechanism: Affects brain signals

Special instructions/considerations:

Rise slowly from sitting/lying

No alcohol or medications that cause drowsiness

Two adverse effects and instructions to avoid/manage:

Impaired heat regulation: Stay well hydrated; avoid exposure to extreme heat or intense exercise

Orthostatic hypotension: Rise slowly from sitting/lying

Eldery pts only- increased risk of TIA/CVA: report symptoms immediately

Self-monitoring: Improvement of symptoms, monitoring of weight and BP; doctor will take other measurements (CBC, fasting BG, lipids, BP, waist circumference) regularly

Storage: CRT

Indication: Seizures and migraine prophylaxis

Mechanism: Affecting brain signals

Special instructions/considerations:

INX: Decreased effectiveness of estrogen OCs

Drink plenty of fluids to prevent kidney stones

Do not suddenly stop taking

Two adverse effects and instructions to avoid/manage:

Drowsiness, altered vision, slow reaction time: manage by not driving/operating machinery until effects are realized

Altered taste: should decrease with continued use; manage by eating nutritious foods that taste good to you

Ammonia increase: Immediately report unexplained extreme fatigue, vomiting, or changes in mental status

Self-monitoring: Control of seizures; body weight to make sure not losing weight

Storage: CRT

Indication: Ocular hypertension or open-angle glaucoma (Raised intraocular pressure)

Mechanism: Increase outflow of aqueous humor (allow liquid drainage to reduce pressure)

Special instructions/considerations:

Remove contacts before using and keep them out for at least 15 minutes after

Wait 5 minutes between different types of drops (always use ointments last)

Demonstrate proper technique (wash hands, look up, make pouch, apply pressure to lacrimal duct afterwards)

Two adverse effects and instructions to avoid/manage:

Blurred vision: do not drive until it resolves

Iris pigmentation brown: manage with colored contacts if desired

Self-monitoring: Resolution of symptoms within a few days (but make sure to take until gone)

Storage: Unopened bottles should be stored in the refrigerator, but open ones can be kept at room temperature up to 6 weeks