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Pharmacy Practice 6 Exam 1
Asthma/Pain
88
Cosmetology
8th Grade
02/24/2013

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Cards

Term
Flovent HFA
Definition
Fluticasone

Chronic tx of asthma

MDI individualized BID

MDI (44, 110, 220 mcg)

rinse mouth
Term
Flovent Diskus
Definition
Fluticasone

100 to 250 mcg BID

DPI; (50,100,250mcg)

rinse mouth
Term
Pulmicort Flexhaler
Definition
Budesonide

chronic treatment of asthma

BID
DPI (90, 180mcg)

rinse mouth

Pt consult: not for use with spacer, prime with one dose prior to initial use of the unit, pt may not taste or feel the powder inhalation
Term
Pulmicort respules
Definition
Budesonide

chronic asthma treatment

BID

respules given via nebulizer (0.25, 0.5, 1mg/2mL)

rinse mouth
Term
Alvesco
Definition
Ciclesonide

chronic treatment of asthma

BID or q12h whichever you prefer

MDI; (80, 160 mcg)

rinse mouth

prime with 3 sprays on initial use
Term
Asmanex
Definition
Mometasone

QD-BID

DPI; (110, 200 mcg)

rinse mouth
Term
Serevent diskus
Definition
Salmeterol

chronic treamtent and prevention of bronchospasm

1 inhalation q12h

DPI; can use 1 inhalation 30 mins pre-exercise for prophylaxis

max dose 100mcg/day (from class)
Term
Foradil aerolizer
Definition
Formoterol

chronic treatment and prevention of bronchospasm

1 inhalation q12h

DPI; capsule for inhalation; 1 inhalation at least 15 minutes pre-exercise for prophylaxis

max 24 mcg/day (from class)
Term
Perforomist
Definition
Formoterol

chronic treatment of COPD

1 nebulized vial q12h

20mcg per 2mL vial

max 40 mcg/day (from class)
Term
Brovana
Definition
Arfomoterol

chronic treatment of COPD

1 nebulized vial q12h

15mcg per 2mL vial

max 30 mcg/day (from class)
Term
Advair diskus
Definition
Fluticasone/Salmeterol

chronic treatment of asthma/COPD

1 inhalation q12h

DPI; (100/50, 250/50, 500/50)

rinse mouth
Term
Advair HFA
Definition
Fluticaonse/Salmeterol

chronic treatment of COPD

2 inhalations q12h

MDI; (45/21, 115/21, 230/21 mcg)

rinse mouth
Term
Symbicort
Definition
Budesonide/Formoterol

chronic treatment of asthma/COPD

2 inhalations q12h

MDI; (80/4.5, 160/4.5 mcg)

rinse mouth
Term
Dulera
Definition
Mometasone/Formoterol

chronic treatment of asthma

2 inhalations q12h

MDI (100/5, 200/5 mcg)

rinse mouth
Term
Aerospan
Definition
Flunisolide

chronic treatment of asthma

QD-BID

MDI (80mcg/inhalation)

prime with 2 sprays prior to use
Term
Proventil HFA/ProAir HFA
Definition
Albuterol

relief of bronchospasm

2 puffs q4-6h prn

MDI; can use 2 inhalations 15 minutes pre-exercise for prophylaxis
Term
Proventil inhalation solution
Definition
Albuterol

relief of bronchospasm

0.63-2.5 mg TID-QID

0.63, 1.25, 2.5/3mL pre-filled vials; 5mg/1mL solution for nebulization
Term
Xopenex HFA
Definition
Levalbuterol

relief of bronchospasm

2 inhalations q4-6h prn

MDI
Term
Xopenex inhalation solution
Definition
Levalbuterol

relief of bronchospasm

0.31-1.25mg q4-8h

(0.31, 0.63, 1.25 per 3 mL) pre-diluted

1.25 mg per 0.5 mL is concentrate and needs to be diluted
Term
Accolate
Definition
Zafirlukast

chronic treatment of asthma

ADULT: 20mg BID on an empty stomach

5-11y/o: 10mg BID on an empty stomach

AE: headache
Term
Singulair
Definition
Montelukast

chronic treatment of asthma/allergic rhinitis

2-5y/o - 4mg qpm

6-14y/o - 5mg qpm

>or= 15 - 10mg qpm

AE: headache, restlessness

used daily, chronic treatment
Term
Cromolyn inhalation solution
Definition
Cromolyn

chronic treatment of asthma and excercise-induced bronchospasm

1 vial by nebulization TID-QID

for nebulization (20mg/2mL); not for acute treatment; may take 4 weeks for effect

AE: cough, sore throat

oral form is used for IBD
Term
Prednisone
Definition
Prednisone

short-term treatment of respiratory inflammation, asthma exacerbations, acute exacerbations of COPD

1-2mg/kg/d for pediatricts

40-60 mg/d adults

1 or more doses

commonly used as a steroid "burst" for 3-10d; dosed as single dose or 2 divided doses
Term
Medrol
Definition
Methylprednisone

short-term treatment of respiratory inflammation (asthma, COPD)

1-2mg/kg/day for pediatrics; 40-60mg/day adults

1 or more doses

commonly used as a steroid "burst" for 3-10d; dosed as single dose or 2 divided doses
Term
Orapred/Orapred ODT
Definition
Prednisolone

short-term treatment of respiratory inflammation (asthma, COPD)

1-2mg/kg/day for pediatrics; 40-60mg/day adults

1 or more doses

3-10 day steroid "burst" single dose or 2 divided doses; 15mg/5mL or 5mg/5mL solution' 10,15,30 mg orally dispersible tab
Term
Theophylline
Definition
Theophylline

asthma/bronchospasm associated with COPD

individualized in 1 to 3 doses

serum concentration monitoring necessary range 5-15 mcg/mL adults; 5-10mcg/mL peds

DI: cimetidine, quinolone Abx, macrolides, pentoxifylline, smoking, CYP 1A2 inhibitors/inducers, absorption affected by foods(bbq increases absorption)

CI: active peptic ulcer, seizure disorder

AE: GI, CNS (tremors)
Term
Atrovent HFA
Definition
Ipratropium

maintenance tx of bronchospasm (COPD)-MDI, rhionrrhea (allergic/non-allergic)-nasal spray

2 inhalations TID-QID

up to 12 inhalations/day; use on schedule, not prn

CI/Precautions: not for acute attacks; anticholinergic precautions

AE; oral-dry mouth, couch, HA Nasal-dryness, epistaxis, irritation, HA
Term
Spiriva
Definition
Tiotropium

maintenance tx of bronchospasm (COPD)

1 inhalation daily

DPI-handihaler; 18mcg cap for inhalation; repeat inhalation of same capsule to ensure delivery

Pharmacology/PK: selective muscarinic receptor antagonist, half life 5-6 days

CI/precautions: anticholinergic (caution with glaucoma and BPH)

AE: dry mouth, constipation

PT consult: keep in original pkg till use
Term
Arcapta Neohaler
Definition
Indacaterol

chronic treatment of COPD, LABA

1 inhalation daily

DPI; 75mcg cap for inhalation; max dose 1 puff q d

half life 55 hours

AE: cough, oropharyngeal, soreness, nasopharyngitis, HA. DI: can potentiate QTc prolongations
Term
Tudorza Pressair
Definition
Aclidinium

maintenance tx of bronchospasm (COPD)

1 inhalation BID

DPI; 400mcg/inhalation

Pharmacology/PK: anticholinergic, half-life 5-8 hrs

DI: anticholinergic agents, pramlintide

CI/precautions:immediate hypersensitivity reactions, paradoxical bronchospasm

AE: HA, nasopharyngitis, cough, anticholinergic effects

PT Consult: discard 45 days after removing from pkg, if they don't hear a click need to start over
Term
Daliresp
Definition
Roflumilast

maintenance tx to reduce COPD exacerbations

500 mcg daily

500mg tab for severe COPD with bronchitis and h/o exacerbations

Pharmacology: selective phosphodiesterase-4 (PDE4) inhibitor

CI: moderate to severe liver impairment, warnings related to suicidality and weight loss

AE: insomnia, decreased appetite/weight loss, diarrhea

DI:not to be used with strong P450 inducers, systemic exposure will be increased when admin with 3A4 and 1A2 inhibitors

Pt Consult: FDA MedWatch guide must be given when dispensing (mood changes, including suicidal thoughts, sleep disturbances
Term
Duoneb inhalation solution
Definition
Ipratropium/Albuterol

maintenance tx of bronchospasm (COPD)

1 nebulized vial q6h

max dose 1 nebulized vial q4h; 0.5mg ipratropium & 2.5 mg albuterol/3mL vial

Pt Consult: protect from heat and light, keep in original foil containers
Term
Combivent respimat
Definition
Ipratropium/Albuterol

maintenance tx of bronchospasm (COPD)

2 puffs QID

max 12 puffs/day; 18mcg ipratroium and 90mg albuterol/puff
Term
Allegra allergy (OTC)
Definition
Fexofenadine

allergic rhinitis

60mg BId or 180mg Daily (adult)

also available 30mg ODT and 6mg/mL syrup (pediatrics)
Term
Allegra-D 12 or 24 (OTC)
Definition
Fexofenadine/Pseudoephedrine

allergic rhinitis

D-12 (fex 60mg/pseudo 120mg)= 1 tab q12h

D-24 (fex 180mg/pseud 240mg)= 1 tab q24h

CI/precautions: severe HTN/CAD

AE: HA, insomnia
Term
Clarinex
Definition
Desloratadine

allergic rhinitis/chronic urticaria

5mg daily (adult)

2.5mg ODT and 2.5mg/5mL syrup pediatrics

Pt Conslut: avoid OTC cough, cold, allergy products unless directed
Term
Clarinex D 12 or 24
Definition
Desloratadine/Pseudoephedrine

D-12 (deslor 2.5mg/pseudo 120mg)=1tabq12h

D-24 (deslor 5mg/pseudo 240)=1 tab q24h

CI/precautions: severe HTN/CAD

AE: HA, insomnia

PT Consult: avoid OTC cough, cold, allergy products
Term
Zyrtec Allergy (OTC)
Definition
Cetirizine

allergic rhinitis

10mg once daily

5, 10mg tabs; 1 mg/mL syrup; 5, 10mg chewable tabs

AE: drowsiness/somnolence, fatigue, dry mouth
Term
Zyrtec-D (OTC)
Definition
Cetirizine/Pseudoephedrine

allergic rhinitis

1 tab q12h cetirizine 5mg/pseudoephedrine 120mg ER tabs

Precautions: additive CNS depressants/sympathomimetics

AE: nervousness, insomnia
Term
Flonase
Definition
Fluticasone propionate

allergic rhinitis

2 sprays each nostril daily

alternative dosing 1 spray each nostril BId; utilize for chronic, not prn tx
Term
Veramyst
Definition
Fluticasone furoate

allergic rhinitis

2 sprays each nostril daily

utilize for chronic not prn tx; 1 spray each nostril daily for maintenance may be used
Term
Nasonex
Definition
Mometasone

2 sprays each nostril daily

utilize for chronci not prn tx
Term
Rhinocort AQ
Definition
Budesonide

allergic rhinitis

1-2 sprays each nostril daily

utilize for chronic, not prn tx
Term
Omnaris
Definition
Ciclesonide

allergic rhinitic

2 sprays each nostril daily

utilize for chronic, not prn tx max dose 2 sprays in each nostril BID
Term
Beconase AQ
Definition
Beclomethasone

allergic rhinitis

1-2 sprays each nostril BID

not prn tx
Term
Nasacort AQ
Definition
Triamcinolone

allergic rhinitis

2 sprays each nostril daily

not prn tx

1 spray each nostril daily for maintenance may be used
Term
Dymista
Definition
Azelastine/Fluticasone

seasonal allergic rhinitis

1 spray each nostril BID

138 mcg/azelastine 50mcg fluticasone per spray; not for prn

nasal steroid + antihistamine

DI: CNS depressants

AE: cough, epistaxis, HA, fever, abnormal taste
Term
Sudafed PE tablets
Definition
Phenylephrine

nasal congestion

10mg q4h prn

use no more than 7 days, max 60mg/24h

CI: severe CAD/HTN

AE: insomnia, restlessness, GI
Term
Sudafed
Definition
Pseudoephedrine

60 mg q4-6h prn 2 tabs per dose; max dose for all forms is 240mg/day

CI: severe CAD/HTN

AE: insomnia, restlessness, GI
Term
Tessalon
Definition
Benzonatate

symptomatic relief of nonproductive cough

100-200mg TID

generally 100mg TID; max 600mg/day; do not suck or chew caps

PK: onset in 15-20 min

CI/precautions: caution with PABA class anesthetic allergy, if chew or suck could cause bronchospasm/CV collapse

AE: drowsiness, HA

Pt consult: swallow whole, keep away from children
Term
Tussionex
Definition
Chlorpheniramine/Hydrocodone

relief of cough/upper respiratory symptoms

1 tsp (5mL) q12h (adult) Pennkinetic ER suspension; (hydrocodone 10mg & chlorpheniramine 8mg)/5 mL; 2 tsps per day max

controlled- CIII

DI: CNS depressants

CI/precautions: pulmonary disease/asthma, BPH

AE: drowsiness, dry mouth, constipation
Term
TussiCaps Full Strength
Definition
Chlorpheniramine/Hydrocodone

relief of cough/upper respiratory symptoms

1 cap q12h (adult)

8mg chlorpheniramine/10mg hydrocodone per ER cap; max dose 2 caps/24 h

same content as Tussionex
Term
Hydromet
Definition
Hydrocodone/Homatropine

relief of cough/upper respiratory symptoms

1 tsp (5mL) q4-6h prn (adult)

5mg hydrocodone/1.5mg homatropine per 5mL; max dose 30mL/24h

Controlled- CIII

DI: CNS depressants

AE: drowsiness, dry mouth, constipation
Term
Cheratussin DAC
Definition
Codeine/Guafenesin/Pseudoephedrine

relief of cough/expectorant

2 tsp (10mL) q4h prn (adult)

10mg codeine/100mg guaifenesin per 5mL; max dose 40mL/24h

DI: CNS depressants

AE: drowsiness, constipation

PT Consult: drink ample water to loosedn secretions
Term
Demerol
Definition
Meperidine

Moderate to moderately severe pain

50-150 mg po q 3-4h (prn)

Max dose individualized

tabs, liquid, injection

PK: active metabolite, normeperidine, can accumulate and cause CNS AE including seizures

CI: MAO Inhibitors

DI: phenothiazines
Term
Duragesic
Definition
Fentanyl transdermal

chronic pain

individualized (apply patch q 72hrs)

12.5, 25, 50, 75, 100 mcg/hr transdermal (start no > 25mcg/hr if naive)

PT Consult:apply to normal dry skin on upper torso; clip (not shave) hair prn, do not irritate site with soap or lotion before application, apply with pressure for 10-20 seconds, keep out of trash cans, should fold on itself and flush, rotate sites to avoid irritation, use hyrdocortisone if irritation, if dose change needed do not increase until after 2 cycles (1 week)
Term
Fentora
Definition
fentanyl citrate buccal tab

break through cancer pain (prn)

individualized (100mcg initial)

initial max up to 2 tabs each side of mouth, separate doses by 4 hrs. Titration limit to max 4 tabs simultaneously

100, 200, 400, 600, 800 mcg buccal tabs (strengths not bioequivalent)

PT Consult: no food or drink for 30 min after placement. Swallow remaining tab remnants with water after 30 min. Can repeat 2nd dose at 30 min if prescribed
Term
Actiq
Definition
fentanyl citrate buccal lollipop

break through cancer pain (prn)

individualized (200 mcg initial)

max 4 units/day (max 2/episode), separate by 4 hrs

200,400,600,800, 1200,1600 mcg buccal lollipops; for opioid tolerant

Pt Consult: try to finish lozenge in 15 min, do not crush or chew, can repeat 2nd lozenge 30 min after initial placement; GI absorption and response later than transmucosal
Term
MS Contin
Definition
morphine sulfate extended release

moderate to severe pain

individualized (q8-12hrs)

15,30,60,100,200 mg tabs
Term
Avinza
Definition
morphine sulfate extended release

moderate to severe pain

individualized (q24hrs)

30,45,60,75,90,120 mg caps

Pt Consult: can sprinkle on applesauce but need to swallow whole, not chew
Term
Kadian
Definition
morphine sulfate extended release

moderate to severe pain

individualized (q24hrs)

10,20,30,50,60,80,100,200 mg caps
Term
Morphine Sulfate
Definition
morphine sulfate immediate release

moderate to severe pain

individualized (q4hrs prn)

15,30 mg tabs
Term
Embeda
Definition
morphine sulfate/naltrexone

moderate to severe pain

individualized (q12hrs) not for prn use

20/0.8, 30/1.2, 60/2, 80/3.2, 100/4 mg tabs

Pt Consult: naloxone core not absorbed
Term
Exalgo
Definition
hydromorphone extended release

moderate to severe pain

individualized (q24hrs)

8, 12, 16 mg tabs
Term
Dilaudid
Definition
hydromorphone immediate release

moderate to severe pain

individualized (2-4 mg q 4-6 hrs initially) prn

2, 4, 8 mg tabs, also liquid and injection
Term
OxyContin
Definition
oxycodone extended release

moderate to severe pain

individualized (q12hrs)

10,15,20,30,40,60,80 mg tabs
Term
Roxicodone
Definition
oxycodone immediate release

moderate to severe pain

individualized (q4-6hrs)

5,15,30 mg tabs, 5 mg caps (generic)
Term
Nucynta
Definition
tapentadol

acute pain

50-100 mg q 4-6hrs

max 600 mg daily after day 1

50,75,100 mg tabs

CI/warnings: CI with MAOI use, warning for seizure conditions

DI: concomitant use of SSRI and SNRI, same warnings as tramadol
Term
Percocet
Definition
oxycodone with acetaminophen

moderate to moderately severe pain

1-2 tabs q 4-6hrs prn

max 1 gram APAP/dose (4 g/day)

2.5,5,7.5,10/325 mg; 7.5/500; 10/650 mg tabs
Term
Percodan
Definition
oxycodone with aspirin

moderate to moderately severe pain

1 q 4-6 hrs prn

max 12 tabs/day

5/325 mg tabs
Term
Lortab
Definition
hydrocodone with APAP

moderate to moderately severe pain

1-2 tabs q 4-6hrs prn

max 8 tabs/day (6 for 10/500)

2.5,5,7.5,10 mg/500mg tabs
Term
Lortab Elixir
Definition
hydrocodone with APAP

moderate to moderately severe pain

15 ml q 4-6hrs prn

max 90 ml/day

2.5mg/167mg per 5 ml
Term
Lorcet/Lorcet Plus
Definition
hydrocodone with APAP

moderate to moderately severe pain

1 tab q 4-6hrs prn

max 6 tabs/day

Plus=7.5/650 mg Lorcet=10/650
Term
Vicoprofen
Definition
hydrocodone with ibuprofen

acute pain, short term. Not for arthritis

1 tab q 4-6hrs prn

max 5 tabs/day

7.5/200 mg tabs

DI: NSAID interactions (lithium, diuretics, wararin) plus opioid

CI: NSAID allergy
Term
Tylenol #4
Definition
codeine with APAP

moderate to severe pain

1 tab q 4 hrs prn

max 6 tabs/day

#4 tabs (60/300)
Term
Tylenol with Codeine
Definition
codeine with APAP

mild to moderate pain

1-2 tabs q 4 hrs prn

max 4 g APAP &/or 360mg codeine/day

#2 tabs (15/300, #3 tabs (30/300)
Term
Ultram
Definition
tramadol

moderate to moderately severe pain

50-100mg q 4-6hrs prn

max 400 mg/day (8 tabs), renal adjustment

50 mg tabs

DI: CNS depressants, TCAs, SSRIs

CI: h/o addiction, acute intoxication, precaution seizure concern

AE: mu opioid activity, dizziness, drowsiness, nausea, constipation, dry mouth

Pt Consult: avoid alcohol; causes drowsiness, take with food or milk if needed but slows absorption
Term
Ultram ER
Definition
tramadol

moderate to moderately severe pain

100 mg qd

max 300 mg qd

100,200,300 mg tabs
Term
Ultracet
Definition
tramadol with APAP

moderate to moderately severe pain

2 tabs q 4-6hrs prn

max 8 tabs/day

37.5 mg tramadol/325 mg APAP per tab
Term
Fioricet
Definition
butalbital, APAP, caffeine

tension headache

1-2 tabs q 4hrs prn

max 6 tabs

50mg butalbital, 325 APAP, 40 mg caffeine

DI: enzyme induction due to barbiturate- Warfarin

CI/precaution: hypersensitivity

Pt Consult: drowsiness
Term
Fiorinal
Definition
butalbital, aspirin, caffeine

tension headache

1-2 tabs q 4hrs prn

max 6 tabs/day

50mg butalbital, 325 aspirin, 40mg caffeine

DI: enzyme induction due to barbiturate- warfarin, aspirin

CI/precaution: hypersensitivity (aspirin); PUD, coagulation disorders

Pt Consult: drowsiness
Term
Suboxone
Definition
buprenorphine/naloxone sublingual

treatment of opioid dependence

16 mg buprenorphine/day

maintenance: taper according to effects

SL-tabs, films (buprenorphine/naloxone):2/0.5mg, 8/2mg

Warnings: precipitation of physical withdrawal may occur

Pt Consult: MUST administer SL (poor oral bioavailability)
Term
Asthma Goals of Therapy
Definition
minimize day/night symptoms
minimize exacerbations/hospital visits
minimize limits on activity and missed days
maintain near normal pulmonary function
minimize need for beta-2 agonist
minimal adverse effects from medications
Term
Systemic Corticosteriods

Class Contraindications
Class Precautions
Class AE
PT Consult
Definition
CI: systemic fungal infections

Precautions: herpes co-infection, renal dysunction, HTN, osteoporosis, PUD, DM

AE: Upset stomach/N/V, fluid retention, increased glucose, decreased K, behavioral disturbances. PUD, osteoporosis/Cushing's complications (with long term use)

PT Consult: take oral with food or milk, do not stop abruptly, need to taper if >=14 days
Term
Nasal Corticosteroids

Class Precautions
Class AE
Class Pt Consult
Definition
Precautions: bacterial/viral infections of the upper airways, unhealed nasal wounds

AE: HA, pharyngitis, epistaxis, cough

Pt consult: shake before using, prime until "fine mist" is seen, tild head slightly forward, inhale through nose exhale through mouth, effects may not be seen before a few days up to 3 weeks, can use concomitant decongestants
Term
Acute Pain Characteristics

Chronic Pain Characteristics

Malignant Pain
Definition
Acute- vital sign changes, physical manisfestations

Chronic- >3 months, signs of pain diminish, vital sign changes may not be there

Malignant- could be acute or chronic
Term
Equianalgesic Dosing Principles
Definition
1. calculate total daily dose (TDD) received in mg (including prn doses). IF converting to a different opioid, decrease TDD by 25%
2. determine the equianalgesic TDD in mg based on known equivalencies
3. divide the TDD into an appropriate regimen of sustained-release product
4. provide "as needed" immediate release product equivalent to about 15% of the final TDD on a schedule of every 3-4 hrs
Term
Opioid Analgesics

Class contraindications/precautions
Class DI
Class AE
Pt Consult
Definition
CI/precautions: respiratory depression/pulmonary disorders, GI obstruction

DI: concomitant CNS depressants

AE: dizziness, drownsiness, N/V, constipation

Pt Consult: take oral dosage forms with food or milk to lessen GI effects, alcohol use will intensify CNS depression
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