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Pharmacy Practice 6 Final
pharm prac final drugs - mental health
84
Pharmacology
Graduate
05/01/2013

Additional Pharmacology Flashcards

 


 

Cards

Term
Halcion
Definition
Triazolam

Indication: short-term txt of insomnia

Dosing: 0.125mg-0.25mg at hs

usual/max: 0.25-0.5mg

PK: short half life, high potential for rebound and anterograde amnesia

DI: azole, antifungals, omeprazole, cimetidine and nefazodone may increase Cp

CI: Preg Cat. X. strong CYP 3A4 inhibitors

Notes: 0.125mg if elderly, short-term(7-10days). C IV.
Term
Restoril
Definition
temazepam

Indication: short-term insomnia

Dosing: 15-30mg before hs

Usual/max: 7.5-30mg

PK: conjugated with no active metablites

Notes: short-term use (10 days). C IV. Preg Cat X.
Term
Ambien
Definition
zolpidem

Indication: short-term txt of insomnia

dosing: 5 or 10 mg at hs

Max: 10mg

Notes: 5 mg if female, elderly, or hepatic impairment. Preservation of sleep cycle stages 3 and 4
Term
Ambien CR
Definition
zolpidem

Indication: short-term txt of insomnia

dosing: 6.25 or 12.5mg at hs

max: 12.5mg

notes: 6.25mg if female, elderly, or hepatic impairment. Do not crush or chew. Preservation of sleep cycle stages 3 and 4
Term
Sonata
Definition
zaleplon

Indication: short-term txt of insomnia. No decrease in nighttime awakenings. No prolongation of sleep time. Lower likelihood of residual sedation/memory impairment

Dosing: 5-10mg at hs

Max: 20 mg

DI: cimetidine, grapefruit juice, and rifampin. Food delays absorption up to 3 hrs

Notes: 5 mg if elderly or hepatic impairment or on cimetidine. Take on empty stomach
Term
Lunesta
Definition
eszopiclone

Indication: short-term txt of insomnia. Approved for up to 6 months of use.

Dosing: 2 mg at hs

max: 3 mg

PK: rapidly absorbed within 1 hr. CYP 3A4

DI: azole antifungals, clarithromycin, nefazodone

Notes: 1 mg if elderly or hepatic impairment/CYP3A4 inhibitor. Take on empty stomach for rapid absorption
Term
Rozerem
Definition
Ramelteon

Indication: insomnia due to difficulty with sleep onset

Dosing: 8 mg at hs

CI: h/o angioedema associated with ramelteon; do not administer with fluvoxamine

PK: CYP 1A2 substrate

Notes: take within 30 min of bedtime; avoid high-fat meal. Not controlled. No renal adjustment needed. Observe for complex behaviors with amnesia
Term
Hydroxyzine
Definition
Hydroxyzine

Indication: symptomatic relief of anxiety/tension. Pruritis

Dosing: 25 mg tid-qid

usual/max: 50-100mg qid

DI: CNS depressants

AE: drowsiness and dry mouth

Notes: forms include hydroxyzine base and vistaril (pamoate salt)
Term
Antivert
Definition
Meclizine

Indication: vertigo. OTC and Rx

Dosing: 12.5-25 mg tid-qid

Precautions: asthma, glaucoma, BPH

AE: drowsiness, dry mouth

Notes: can dose 1 hr prior to travel for motion sickness
Term
Amitriptyline
Definition
amitriptyline (TCA)

Indication: depression

Dosing: 40-150 mg in divided doses or qhs

AE: high drowsiness and sedation
Term
Pamelor
Definition
nortriptyline (TCA)

Indication: depression

Dosing: 75-150 mg in divided doses or qhs

AE: less sedation
Term
Tofranil, Tofranil PM caps
Definition
imipramine (TCA)

Indication: childhood enuresis (>= 6 y/o)

Dosing: enuresis start <= 25 mg 1 hr before hs. Depression 50-150 mg qd

usual/max: enuresis 50mg (age <12); 75mg (age >=12)

Notes: NO MORE THAN 2.5 mg/kg/day according to weight

AE: less sedating
Term
Anafranil
Definition
clomipramine (TCA)

Indication: OCD

Dosing: 25 mg qhs

Usual/Max: 25-100 mg qhs. Max 250mg/day
Term
Sinequan
Definition
doxepin (TCA)

Indication: depression and/or anxiety

Dosing: 75-150 mg in divided doses or qhs

Usual: 300 mg qd (severe disease)

AE: more sedating
Term
Paxil
Definition
paroxetine (SSRI)

Indication: depression, OCD, panic disorder, SAD

Dosing: 10-20 mg qd

Max: 50mg/day (60mg/day OCD)

PK: CYP 2D6 inhibitor

DI: phenytoin, phenobarbital, cimetidine, warfarin

Notes: start elderly 10mg/day. Shorter half-life which makes withdrawal effect more pronounced and quicker if missed dose

AE: weight gain high, somnolence, constipation
Term
Paxil CR
Definition
paroxetine

Indication: depression

Dosing: 12.5-25 mg qd

Max: 62.5 mg/day
Term
Prozac
Definition
fluoxetine (SSRI)

Depression 10-20 mg qd, max 80 mg. Weekly 90 mg once a week, initiate 7 days after 13 weeks of 20mg/day

OCD 10 mg qd, max 80 mg

PK: CYP 2D6 inhibitor

DI: phenytoin, carbamazepine, benzos, sumatriptan

CI: concomitant use of thioridazine, MAOI

AE: insomnia, anorexia

Notes: divide doses >20 mg; long acting agents
Term
Zoloft
Definition
sertraline (SSRI)

Indication: depression or OCD

Dosing: 25-50 mg qd

Max: 200 mg

PK: CYP 3A4, 2D6. 98% protein bound

DI: warfarin, diazepam

AE: NAUSEA, dyspepsia
Term
Celexa
Definition
citalopram (SSRI)

Indication: depression

Dosing: 10-20 mg qd

Max: 40 mg

PK: CYP 3A4, 2C19 substrate

Warnings/precaution: QT interval

DI: strong CYP 2C19 inhibitors (cimetidine, omeprazole)

AE: nausea, dry mouth

Notes: max 20 mg for age 60 and over
Term
Lexapro
Definition
escitalopram (SSRI)

Indication: depression

Dosing: 10 mg qd

Max: 20 mg

PK: CYP 3A4, 2C19 substrate

DI: strong CYP 2C19 inhibitors (cimetidine, omeprazole)

AE: nausea

Notes: 10 mg if elderly or hepatic impairment
Term
Effexor
Definition
venlafaxine (SNRI)

Indication: depression/anxiety disorders

Dosing: 25 mg tid or 37.5 mg bid

Max: 225 mg

DI: MAOI, CNS active drugs (including antihistamines)

CI: MAOI

Precautions: preexisting HTN--especially higher doses, seizures, history of mania, renal impairment/cirrhosis of the liver (require dosage adjustment)

AE: nausea, HA, dizziness, drowsiness, increase in BP

Notes: bid-tid dosing; 375 mg max for severe depression.

Pt Consult: alcohol precautions, do not crush, chew or divide capsules. Do not abruptly DC. Have BP monitored weekly
Term
Effexor XR
Definition
venlafaxine (SNRI)

Indication: depression/anxiety disorders

Dosing: 37.5-75 mg qd

Max: 225 mg

Notes: generally once daily dosing
Term
Pristiq
Definition
desvenlafaxine (SNRI)

Indication: depression

Dosing: 50 mg qd

usual/Max: 50-100 mg

DI: MAOI, CNS active drugs (including antihistamines)

CI: MAOI

Precautions: preexisting HTN--especially higher doses, seizures, history of mania, renal impairment (require dosage adjustment)

AE: nausea, HA, dizziness, drowsiness, increase in BP

Pt Consult: alcohol precaution. Do not crush or chew. Do not abruptly DC. Have BP monitored weekly

Notes: extended release tabs
Term
Cymbalta
Definition
duloxetine (SNRI)

Indication: depression/anxiety disorders

Dosing: 20-30 mg bid

Max: 60 mg

PK: CYP 2D6, 1A2 substrate

DI: 2D6- TCA, phenothiazines, fluoxetine, paroxetine. 1A2- fluvoxamine, fluoroquinolones

CI: use of MAOI, narrow angle glaucoma

Precautions: preexisting HTN--especially higher doses), seizures, history of mania

AE: nausea, dry mouth, constipation, insomnia, decreased appetite

Pt Consult: alcohol precaution. Do not abruptly DC

Notes: can dose once daily
Term
Desyrel
Definition
trazodone (SARI)

Indication: depression (+/- anxiety. Off-label for insomnia

Dosing: 150 mg in divided doses

Max: 400mg/24 hrs

PK: absorption slowed/enhanced with food

DI: CNS depressants, phenytoin, grapefruit juice (increase levels)

Precautions: priapism, recent MI, arrhythmias

AE: drowsiness, dry mouth, dizziness, OHTN (due to alpha 1 inhibitory activity)

Pt Consult: take with food for best absorption, alcohol precautions, male counseling related to priapism, do not abruptly DC

Notes: give larger doses at hs if drowsiness occuring
Term
Remeron
Definition
mirtazapine (NaSSA)

Indication: depression

Dosing: 15-45 mg qd at hs

Max: 45 mg

DI: MAOI, CNS depressants

CI: MAOI

AE: DROWSINESS, dry mouth, increased appetite/weight gain, dizziness

Pt Consult: alcohol precautions, do not abruptly DC
Term
Wellbutrin, SR, XL
Definition
bupropion (NDRI)

Indication: depression

Dosing: regular 100 mg bid up to 100 mg tid.
SR 150 mg qd up to 150 mg bid.
XL 150 mg qd up to 300 mg qd.

Max: 450 mg/day

DI: MAOI, levo-dopa (due to added augmentation of dopamine activity), alcohol

CI: use of MAOI, seizure disorder, bulimia, anorexia

Precautions: may produce mania, psychosis

AE: dizziness, nausea, anorexia/weight loss, insomnia, tremor

Pt Consult: important to keep on a regular dosage schedule, avoid alcohol, weight loss or gain may be temporary

Notes: regular - titrate no sooner than every 72 hrs
Term
BuSpar
Definition
buspirone (NDRI)

Indication: generalized anxiety

Dosing: 5 mg tid

Max: 60 mg (30 mg bid)

Precautions: renal or hepatic dysfunction, potential for movement disorders related to dopamine receptors

AE: HA, fatigue, dizziness, insomnia, nausea

Pt Consult: dizziness, report abnormal/involuntary muscle mvmt, take consistently with OR without food, does not work immediately to relieve anxiety (not prn)

Notes: May take up to 8 wks for full effect. Not controlled.
Term
Ativan
Definition
lorazepam

Indication: anxiety disorders, insomnia, status epilepticus

Dosing: 0.5 mg bid up to 3 mg bid

Max: 10 mg

PK: intermediate half-life and no active metabolites

CI: preg cat D

Precautions: hepatic dysfunction, renal impairment, depression, psychosis

Pt Consult: drowsiness, withdrawal potential



Notes: benzos best for short-term use/situational. C IV
Term
Tranxene
Definition
clorazepate

Indication: anxiety disorders, alcohol withdrawal

Dosing: 7.5-15 mg bid-tid

Max: 60 mg/24 hrs

PK: long half-life with active metabolites

DI: CNS depressants, azole antifungals, omeprazole, cimetidine, nefazodone may increase Cp

CI: preg cat X

Precautions: renal, hepatic dysfunction, elderly

Pt Consult: drowsiness, withdrawal potential

Notes: also available 11.25 and 22.5 mg extended release. C IV
Term
Valium
Definition
diazepam

Indication: anxiety disorders and skeletal muscle spasm

Dosing: 2-10 mg tid-qid

Max: anxiety disorders 40 mg

PK: long half-life with active metabolites

DI: CNS depressants, omeprazole, cimetidine, grapefruit juice

CI: preg cat D

Precautions: renal, hepatic dysfunction, elderly

Pt Consult: drowsiness, withdrawal potential

Notes: benzos best for short-term use/situational. C IV
Term
Xanax
Definition
alprazolam

Indication: anxiety/panic disorders

Dosing: 0.25-0.5 mg tid

Max: 4 mg/day

PK: intermediate half-life with active metabolites

DI: CNS depressants, azole antifungals, omeprazole, cimetidine, nefazodone may increase Cp

CI: preg cat D

Precautions: renal, hepatic dysfunction, elderly

Pt Consult: drowsiness, withdrawal potential

Notes: Xanax XR indicated for panic. Benzos best for short-term use/situational. C IV
Term
Klonopin
Definition
clonazepam

Indication: seizures

Dosing: 0.5 mg tid titrated to seizure control

Max: 20 mg/day

CI: liver disease, untreated open angle glaucoma

Precautions: abrupt DC may precipitate seizures or withdrawal symptoms

Pt Consult: drowsiness, avoid alcohol, do not stop abruptly

Notes: other uses: insomnia, restless legs. C IV
Term
Haldol
Definition
haloperidol

Indication: psychotic disorders

Dosing: 3-5 mg bid to tid (more severe)

Max: 100 mg

DI: anticholinergics, CNS depressants

CI: Parkinson's

Precautions: NMS; irreversible tardive dyskinesia, prolonged QT interval, OHTN

AE: extrapyramidal symptoms, drowsiness

Pt Consult: alcohol precaution
Term
Mellaril
Definition
thioridazone

Indication: psychotic disorders

Dosing: 200-800 mg divide in 2-4 doses

Max: 800 mg

DI: anticholinergics, CNS depressants

CI: drugs that inhibit metabolism, prolonged QT interval or use with drugs that prolong QT interval

Precautions: NMS; irreversible tardive dyskinesia, OHTN, glaucoma

AE: EPS, anticholinergic effects, OTHN, drowsiness

Pt Consult: alcohol precaution
Term
Prolixin
Definition
fluphenazine

Indication: psychotic disorders

Dosing: 2.5-10 mg divided q 6-8hrs

Max: 20 mg

DI: anticholinergics, CNS depressants

Precautions: NMS; irreversible tardive dyskinesia, OHTN

AE: EPS, drowsiness

Pt Consult: alcohol precaution

Notes: reduce dose to lowest effective (1-5 mg/day)
Term
Clozaril
Definition
clozapine

Indication: schizophrenia

Dosing: 12.5-25 mg bid

DI: anticholinergic agents, additive HTN with antihypertensives

CI: myeloproliferative disorders, h/o low WBC count

Precautions: seizure disorders, cardiovascular disease, narrow angle glaucoma

AE: drowsiness, tachycardia, dizziness, OHTN, risk of agranulocytosis

Pt Consult: mandatory WBC monitoring-counsel on s/sx of infection

Usual/max: 200-900 mg
Term
Risperdal
Definition
risperidone

Indication: schizophrenia, acute mania

Dosing: 1 mg bid to start

Usual/max: 4-12 mg per day

Precautions: NMS; irreversible tardive dyskinesia, prolonged QT interval, OHTN, seizure disorders, potential hyperglycemia

AE: EPS, insomnia, agitation, somnolence, tachycardia

Pt Consult: food or milk if needed, OHTN, alcohol precaution, avoid excessive sunlight
Term
Seroquel
Definition
quetiapine

Indication: schizophrenia, acute mania, bipolar

Dosing: 25-50 mg bid to start

Usual: 300-400 mg per day

Precautions: NMS; rare irreversible tardive dyskinesia, OHTN, seizure disorders; eye examinations for developing cataracts, potential hyperglycemia

AE: somnolence, dizziness, constipation, postural hypotension, dry mouth

Pt consult: OHTN precautions, alcohol precaution

Notes: generally divide bid-tid; max is 800 mg per day
Term
Zyprexa
Definition
olanzapine

Indication: schizophrenia, acute mania, bipolar

Dosing: 5-10 mg qhs

Usual/Max: 5-20 mg (30 mg max)

Precautions: NMS; irreversible tardive dyskinsea, OHTN, seizure disorders, potential for hyperglycemia

AE: somnolence, agitation, insomnia, dizziness, postural hypotension

Pt Consult: alcohol precaution, avoid excessive sunlight

Notes: titrate no sooner than weekly; also 5,15 mg ODT
Term
Geodon
Definition
ziprasidone

Indication: schizophrenia, acute mania, bipolar

Dosing: 20 mg bid

Usual/Max: 40-160 mg

PK: CYP 3A4

DI: carbamazepine, ketoconazole, agents that prolong QT interval

CI: acute MI, decompensated CHF, QT prolongation or receiving agents that prolong QT interval

Precautions: NMS; irreversible tardive dyskinesia, seizure disorders

AE: somnolence, nausea, constipation, dizziness, postural hypotension

Pt Consult: alcohol precaution, take with food to increase absorption

Notes: generally divide bid
Term
Abilify
Definition
aripiprazole

Indication: schizophrenia, acute mania, bipolar

Dosing: 10-15 mg qd

Usual/Max: 10-30 mg

PK: CYP 3A4, 2D6

DI: carbamazepine, fluoxetine, paroxetine

Precautions: NMS; irreversible tardive dyskinesia, seizure disorders

AE: HA, insomnia, anxiety

Pt Consult: alcohol precaution
Term
Chantix
Definition
varencycline

Indication: smoking cessation aid

Dosing: 0.5 mg q am x 3 days, bid x 4 days, 1 mg bid

Usual: 12 wk initial txt

PK: high renal elimination

DI: nicotine replacement therapies

Precautions: MED WATCH- mood changes/suicidal ideation, erratic behavior reported

AE: nausea, HA, insomnia, abnormal dreams

Pt Consult: lifestyle mods/precautions prior to quit date (remove ashtrays, avoid prior routines related to smoking)

Notes: start 7 days prior to cessation
Term
alphagan P
Definition
brimonidine

Indication: open-angle glaucoma

Dosing: 1 gtt in affected eye q 8hrs

DI: additive effects with BB

AE: allergic conjunctivitis, eye pruritis, burning, hyperemia, dry mouth, visual disturbance

Notes: ideally wait 5-10 min before using other eye drops, remove contact lenses prior to instillation
Term
betoptic
Definition
betaxolol

Indication: open-angle glaucoma

Pharmacology: beta 1 selective

dosing: 1-2 gtts in affected eye bid

CI: sinus bradycardia, heart block, overt CHF

Precations: bronchial asthma/severe COPD

AE: ocular burning, blurred vision, hyperemia, itching
Term
timoptic
Definition
timolol

Indication: open-angle glaucoma

Pharmacology: nonselective

Dosing: start with 0.25% 1 gtt in affected eye bid

CI: asthma, severe COPD, sinus bradycardia, heart block, overt CHF

AE: ocular burning, blurred vision, HA

Notes: ideally wait 5-10 min before using other eye drops
Term
Cosopt
Definition
dorzolamide/timolol

Indication: open-angle glaucoma

Pharmacology: combo with nonselective BB

Dosing: 1 gtt in affected eye bid

CI: asthma, severe COPD, sinus bradycardia, heart block, overt CHF, hypersensivity to sulfonamides

AE: taste perversion, ocular burning, blurred vision, hyperemia, itching

Pt Consult: remove contacts prior, re-insert after 15 min

Notes: ideally wait 5-10 min before using other eye drops
Term
Xalatan
Definition
latanoprost

Indication: open-angle glaucoma

Dosing: 1 gtt in affect eye q pm

Precautions: iris can permanently change color (darkening) with long-term use

AE: blurred vision, burning/stinging, itching, increased pigmentation (long-term use)

Pt Consult: store in fridge but lasts 6 wks at room temp after dispensed

Notes: ideally wait 5-10 min before using other eye drops
Term
Lumigan
Definition
bimatoprost

Indication: open-angle glaucoma. Latisse indicated for lash growth

Dosing: 1 gtt in affected eye q pm

AE: hyperemia, growth of eyelashes, ocular itching and burning, darkening of eyelashes

Pt Consult: awareness of eye/eyelash changes

Notes: may cause brown pigmentation in the iris
Term
Travatan
Definition
travoprost

Indication: open-angle glaucoma

Dosing:1 gtt in affected eye q pm

AE: hyperemia, eye discomfort/itching

Pt Consult: awareness of eye/eyelash changes

Notes: may cause brown pigmentation in the iris
Term
Sulfacetamide ophthalmic
Definition
sulfacetamide

Indication: bacterial conjunctivitis, corneal ulcer and other superficial ocular infections

Dosing: 1-2 gtts q 1-4 hrs for 7-10 days

Caution: sulfonamide allergy

Notes: ideally wait 5-10 min before using other eye drops
Term
Tobrex
Definition
tobramycin

Indication: bacterial conjunctivitis

Dosing: 1-2 gtts q 4hrs (mild-mod infection.
Max 2 gtts hourly (severe infection)

CI: fluoroquinolone allergy

Precautions: prolonged use may promote secondary fungal infection

AE: itching, swelling, hyperemia

Pt Consult: advise pt not to wear contacts during use, administer other eye drops BEFORE ointment if applicable

Notes: 1/2" ointment bid-tid or q 3-4hrs til improved
Term
Tobradex suspension
Definition
tobramycin/dexamethasone

Indication: steroid responsive with infection or risk

Dosing: start 1-2 gtts q 2hrs x 1-2 days then 1-2 gtts q 4-6hrs treat until resolved

CI/precautions: herpes simplex keratitis, varicella/other viral infections of cornea/conjunctiva, fungal infections of the eye

AE: itching, swelling, hyperemia

Pt Consult: shake suspension well, administer other eye drops BEFORE ointment if applicable

Notes: for ointment 1/2" tid-qid
Term
Restasis
Definition
cyclosporine emulsion

Indication: tear insufficiency in specific pt types

Dosing: 1 gtt each eye every 12 hrs

CI: pts with ocular infections

AE: burning, eye pain, pruritis

Pt Consult: invert the vial a few times to obtain a uniform emulsion before using

Notes: space artificial tears at least 15 min from Restasis
Term
Vigamox
Definition
moxifloxacin

Indication: bacterial conjunctivitis

Dosing: 1 gtt in affected eye tid for 7 days

CI: fluoroquinolone allergy

Precautions: do not wear contacts during txt

AE: ocular discomfort, hyperemia, itching

Notes: ideally wait 5-10 min before using other eye drops
Term
Patanol
Definition
olopatadine

Indication: allergic conjunctivitis

Dosing: 1 gtt bid (at 6-8 hr interval)

Precautions: not to be used with contacts or to treat contact-related irritation

AE: HA, blurred vision, burning/stinging, dry eye

Pt Consult: remove contact lenses prior, re-insert after at least 10 min. Advise not to wear contacts if eyes are red

Notes: wait 10 min after use before inserting contact lens
Term
Aricept
Definition
donepezil

Indication: mild to moderate Alzheimer's dementia

Dosing: 5 mg q hs. Max 10 mg q hs

DI: phenytoin, carbamazepine, phenobarbital

Precautions: sick-sinus syndrome (due to vagotonic effects), prior ulcers/GI bleeding, asthma or COPD

AE: nausea, diarrhea, anorexia common

Pt Consult: take at bedtime without regard to food
Term
Exelon
Definition
rivastigmine

Indication: mild to moderate Alzheimer's dementia

Dosing: start 1.5 mg bid. Usual 3-6 mg bid. Titrate every 2 wks according to response. Max 6 mg bid

DI: anticholinergics, cholinergic potentiation

AE: nausea, vomiting, anorexia, diarrhea, dizziness, HA
Term
Namenda
Definition
memantine

Indication: moderate to severe Alzheimer's dementia

Dosing: start 5 mg daily x 1 wk. Then 5 mg bid x 1 wk. Add 5 mg weekly x 2 wks (max 10 mg bid. Titrate no more often than weekly

DI: competitive renal tubular secretion (decreased bioavailability of HCTZ), carbonic anhydrase inhibitors alkalinize urine and decrease memantine clearance

AE: dizziness, HA, constipation
Term
Razadyne
Definition
galantamine

Indication: mild to moderate Alzheimer's dementia

Dosing: Start 4 mg bid. Max 16-24 mg/day bid. Titrate no more often than every 4 wks

DI: 2D6 and 3A4 inhibitors increase galantamine Cp (azole antifungals, paroxetine, fluoxetine, amitriptyline)

Precautions: sick-sinus syndrome (due to vagotonic effects), prior ulcers/GI bleeding, asthma or COPD

AE: nausea, diarrhea, anorexia common

Pt Consult: take with food
Term
Benztropine
Definition
benztropine

Indication: Parkinson's disease

Dosing: start 0.5-1 mg q hs. Usual 1-2 mg q hs. Max 6 mg daily

CI: children < 3 y/o

Precautions: risk of tachycardia, aggravation of BPH, narrow angle glaucoma, risk of ileus when used with other anticholinergics

AE: dry mouth, blurred vision, constipation, nausea

Pt Consult: take with food or milk if GI upset. Do not abruptly DC

Notes: titrate in gradual 0.5 mg increments
Term
Comtan
Definition
entacapone

Indication: adjunct in Parkinson's disease ("wearing off"). Only given WITH sinemet

Dosing: 200 mg per carbidopa/levodopa dose. Max 1600 mg/day

CI: MAOI

Precautions: do not abruptly withdraw Comtan; hypotension, mvmt disorders after initiation; hepatic impairment decreases clearance

AE: nausea, diarrhea, dyskinesia/hyperkinesia, orthostatic precautions

Notes: take with Sinemet doses
Term
Eldepryl
Definition
selegiline

Indication: adjunct in Parkinson's disease

Dosing: 5 mg at breakfast and lunch

CI/avoid combo: dextromethorphan, MAOI, merperidine, methadone, tramadol, agents elevating neurotransmitters (TCA, SSRI, SNRI), stimulants (methylphenidate)

Warnings: tyramine containing foods

AE: dizziness, nausea, insomnia (a metabolite is amphetamine)

Pt Consult: for bid dosing administer with breakfast and lunch, avoid alcohol and OTC/herbal products without consultation

Notes: do not exceed 10 mg/day
Term
Azilect
Definition
rasagiline

Indication: monotherapy or adjunct to sinemet in Parkinson's disease

Dosing: Start 0.5 mg qd if adjunct to sinemet. 1 mg qd if monotherapy.

CI/avoid combo: dextromethorphan, MAOI, meperidine, methadone, tramadol, agents elevating neurotransmitters (TCA, SSRI, SNRI), stimulants (methylphenidate), cyclobenzaprine

Warnings: tyramine containing foods

DI: CYP 1A2 inhibitors (ciprofloxacin)

Pt Consult: avoid alcohol and OTC/herbal products without consultation

Notes: limit to 1 mg daily or 0.5 mg daily if on 1A2 inhibitor
Term
Mirapex
Definition
pramipexole

Indication: Parkinson's disease

Dosing: Start 0.125 mg tid. Usual 1.5-4.5 mg/day divided in 3 doses. Max 4.5 mg/day

DI: cimetidine, ranitidine, diltiazem, verapamil increase Cp

Precautions: OHTN common with titrations, may potentiate dyskinesia from levodopa (a decrease in levodopa dosage may be required)

AE: early PD-dizziness, nausea, somnolence or insomnia. Advanced PD- OHTN, dyskinesia, insomnia, dizziness, hallucinations

Pt Consult: take with food to reduce nausea, counsel on OHTN, potential sleep disturbances and possibility of hallucinations

Notes: titrate at weekly intervals; take with food
Term
Requip
Definition
ropinirole

Indication: Parkinson's disease, restless leg syndrome

DI: CYP 1A2, cigarette smoking significantly decreases AUC, ciprofloxacin increases AUC, omeprazole decreases Cp

Precautions: sudden initiation of sleep can occur, OHTN common with titrations

AE: nausea, dizziness, somnolence

Pt Consult: take with food to reduce nausea, counsel on OHTN, potential sleep disturbances and possibility of hallucinations

Dosing: Start 0.25 mg tid. Usual 1 mg tid (titrated over 4 wks). Max 24 mg/day

Notes: titrate at weekly intervals; take with food
Term
Sinemet
Definition
carbidopa/levodopa

Indication: Parkinson's disease

Dosing: start 25/100 mg tid. Max 1600 mg/day

CI: narrow angle glaucoma, non-selective MAOI

Precautions: cardiovascular disease

AE: nausea, dystonia/involuntary mvmts, dementia

Pt Consult: food or milk if GI upset

Notes: can titrate every 1-2 days
Term
Sinemet CR
Definition
carbidopa/levodopa

Indication: Parkinson's disease

Dosing: Start 50/200 mg bid (about 6 hrs apart). Max 1600 mg/day

Notes: can titrate every 3 days; 4-8 hr dosing interval range. Can half CR tabs but do not chew or crush
Term
Stalevo
Definition
carbidopa, levodopa and entacapone combo

Indication: Parkinson's disease

Dosing: individualized. Max 1 tab per dose (up to 8 tabs/day)

Notes: entacapone 200 mg with carbidopa/levodopa (1:4)
Term
Symmetrel
Definition
amantadine

Indication: Parkinson's disease

Dosing: Start 100 mg bid (monotherapy). Usual 100 mg bid. Max 300-400 mg/day.

Precautions: requires dose reduction in renal impairment and may be needed with CHF, elderly

AE: nausea, dizziness/OHTN, insomnia

Pt Consult: take last dose in the early evening to reduce incidence of insomnia

Notes: 100 mg daily initial dose if on other Parkinson's agents
Term
Lyrica
Definition
pregabalin

Indication: neuropathic pain (diabetic neuropathy), postherpetic neuralgia and adjunct txt in certain seizure disorders

Dosing: Start 50 mg tid. Usual 100 mg tid. Max 300 mg/day (100 mg tid)

Precautions: taper gradually over at least 1 wk prior to DC, edema when utilized with glitazone agents, rare reports of myopathy

AE: dizziness, drowsiness, dry mouth, peripheral edema

Pt Consult: Do not DC without MD, report unexplained muscle weakness or pain

Notes: dose reduction for renal dysfunction
Term
Depakote/ER
Definition
divalproex

Indication: seizure disorders

Dosing: Start 15 mg/kg/day. Usual individualized dosing. Max 60 mg/kg/day

DI: all
CI: hepatic disease
-precautions: severe AE (decreased platelet counts and pancreatitis) report
AE: nausea, dyspepsia, somnolence, dizziness, diarrhea
Pt consult: food or milk to avoid GI; do not DC w/o MD< caps can be sprinkled on soft food and swallowed whole, do not crush or chew, contact MD for persistent GI side effects
Term
Dilantin
Definition
extended phenytoin

Indication: seizure disorders

Dosing: Start 100 mg tid (adults). Usual individualized doses. Max based on serum levels.

Notes: can dose daily once stabilized

DI: Amiodarone, Cimetidine, Fluconazole, Carbamazepine, Sucralfate, VPA, Theophylline, OC
Precautions: impaired liver fx
AE: dizziness, drowsiness, nausea, gingival hyperplasia**,
-signs of toxicity: ataxia, slurred speech, confusion, rash
Pt consult: take with food, no EtOH w/o MD direction, good oral hygiene, contact MD if rash develops, do not DC w/o MD
Term
Lamictal
Definition
lamotrigine

Indication: adjunct in seizure disorders

Dosing: Starting dependent on other seizure agents. Usual 100-500 mg qd.

Notes: dosage highly influenced by enzyme induced antiepileptic drugs and valproate

PK: t1/2 dependent on concomitant agents

DI: PHY, carbamazepine, phenobarb decrease Cp; VPA increases Cp

Precautions: serious rashes - w/in weeks of initiation & more common in children/VPA; *hypersensitivity/fever; *ophthalmic effects

Pt consult: report fever/rash; chewable tabs can be dispersed in small amt of liquid
Term
Zonegran
Definition
zonisamide

Indication: adjunct in seizure disorders

Dosing: Start 100 mg qd. Usual 100-400 mg, given daily or bid. Max 400 mg/day

Notes: dosage increases up to 100 mg every 2 wks

PK: long t1/2 (may be shortened by enzyme inducers)

DI: PHY, carbamazepine, phenobarb

CI: h/o sulfonamide allergy
-D/C in pt who develops impaired renal fx (should not be used <50ml/min)

Precautions: risk of rare derm rashes

AE: drowsiness; *rare rash & kidney stones*

Pt consult: report rash or painful urination/blood in urine
Term
Neurontin
Definition
gabapentin

Indication: adjunct in seizure disorders

Dosing: Start 300 mg q hs. Usual 900-1800 mg divided tid. Max 2400 mg/day

Notes: titrate by 300 mg/day until 300 mg tid; renal adjustment

PK: renally excreted unchanged

DI: antacids

Precautions: abrupt w/d; high renal excretion

AE: somnolence*, dizziness

Pt consult: drowsiness, avoid alcohol, avoid concomitant antacids
Term
Phenobarbital
Definition
phenobarbital

Indication: seizure disorders

Dosing: 50-100 mg bid-tid

PK: enzyme induction, long t1/2

DI: enzyme induction - warfarin, BB, quinidine, theo; CNS depressants

Precaution: elderly, impaired liver fx

AE: all (..?)

Pt consult: drowsiness and alcohol use
Term
Tegretol/Tegretol ER
Definition
carbamazepine

Indication: seizure disorders

Dosing: Start 200 mg bid (>= 12 y/o). Usual 800-1200 mg divided bid-tid. Max 1000-1200 mg (age dependent).

Notes: Tegretol ER frequency is generally bid

DI: warfarin, VPA, cimetidine, diltiazem, fluoxetine, propoxyphene, verapamil, macrolides, PHY

CI: bone marrow depression

Precaution: cardiac, renal or hepatic disorder; rare cases of aplastic anemia and agranulocytosis

AE: all

Pt consult: take w/ food or milk, avoid alcohol, follow chewable tabs w/ water, bone marrow suppression (rare) counsel precautions
Term
Trileptal
Definition
oxcarbazepine

Indication: seizure disorders

Dosing: Start 300 mg bid (> 16 y/o). Usual 600 mg bid.

Precautions: hyponatremia*, renal dysfx, Steven Johnson syndrome

DI: 3A4 inducer

AE: nausea, dizziness, somnolence, ataxia, abnormal vision

Pt consult: surveillance for derm changes and AE, maintain adequate hydration
Term
Topamax
Definition
topiramate

Indication: seizure adjunctive therapy

Dosing: Start 25-50 mg daily. Usual 200-400 mg divided bid. Max 400 mg

PK: weak carbonic anhydrase inhibitor, primarily excreted unchanged in urine, shifts to hepatic CL when used w/ other inducers

DI: CNS depressants, metformin, PHY, carbamazepine

Precautions: myopia/secondary angle closure glaucoma, kidney stones

AE: not DR - drowsiness, dizziness; DR - fatigue, nervousness, anorexia/wt. loss

Pt consult: avoid alcohol, maintain hydration

renal adjust < 70ml/min*
Term
Keppra
Definition
levetiracetam

Indication: adjunct in seizure disorders

Dosing: Start 500 mg bid. Usual 3000 mg/day divided bid. Max 3000 mg/day

Notes: dosing increments given every 2 wks (1000 mg/day)

PK: renal clearance

DI: none known

Precautions: impaired renal fx, adjustment req'd

AE: drowsiness, nausea
Term
Lithonate, Lithotabs
Definition
lithium carbonate

Indication: mania associated with bipolar disorder

Dosing: 900-2400 mg divided bid-qid. Max based on serum levels

Notes: regular release tid-qid; sustained release bid

PK: renal elim

DI: NSAIDs, ACE-i's, thiazides increase serum conc.

CI/precautions: renal or CV disease, dehydration or Na depletion

AE: tremor, nausea, thirst

PT consult: maintain consistent fluid and dietary Na intake, avoid dehydration
Term
Nardil
Definition
phenelzine

Indication: depression

Dosing: Start 15 mg tid. Titrate to response. Max 90 mg/day

Notes: avoid drug interactions and tyramine-containing foods

MAOI inhibitors, non-selective

CI: CHF, h/o hepatic disease, renal disease, concurrent use of many agents (sympathomimetics, cns depressants, flexeril, dextromethorphan, ethanol, meperidine, bupropion, buspirone, SSRI)

Pt consult: DI, avoid caffeine, alcohol and OTC meds, avoid tyramine-containing foods
Term
Parnate
Definition
tranylcypromine

Indication: depression

Dosing: Start 10 mg bid. Usual 30 mg in divided doses. Max 60 mg/day

Notes: avoid drug interactions and tyramine-containing foods

MAOI inhibitors, non-selective

CI: CHF, h/o hepatic disease, renal disease, concurrent use of many agents (sympathomimetics, cns depressants, flexeril, dextromethorphan, ethanol, meperidine, bupropion, buspirone, SSRI)

Pt consult: DI, avoid caffeine, alcohol and OTC meds, avoid tyramine-containing foods
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