NR565 Midterm Study Guide Week 1 to 5, Exams of Nursing

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NR565 Midterm Study Guide Week 1 to 5

Week 1

• Drug Schedules I- Substances or Chemicals are defined as drugs with no currently accepted Medical use and a high potiental for abuse- Heroin , LSD, Weed, II- Substances or chemicals are defined as drugs with a high potiental for abuse with use potientially leading to severe psuchological or physical dependices – Vicodine, cocaine, meth, methadone, diluadid III- Substances or chemicals are definded as drugs with moderate to low potiental for physical and psychological dependence. ( Less than 90 mg of codeine Katamine, anabolic steroids testosterone IV- Substances or chemicals are defined with low potiental for abuse and low risk of dependence. ( Xanax, Valium Ativan Talwin Darvocet V- Substances or chemicals are defined as lower potiental for abuse. Lomotil, lurica o Which ones can and can not be prescribed by nurse practitioners Schedule I
• Prescriptive Authority o Understand what prescriptive authority is and who mandates it. Prescriptive authority is the legal right to prescribe drugs. Full prescriptive authority affords the legal right to prescribe independently and without limitation. Physicians have full prescriptive authority. For nonphysician providers, the degree of prescriptive authority varies. Some have full prescriptive authority; however, for many, prescriptive authority is restricted. Limitations are generally tied to oversight by a doctor of medicine (MD) or doctor of osteopathy (DO) as part of the provider's scope of practice Mandiated by Board of Nursing, State Board of Medicine and State Board of pharmacy determinded by the state Recall that there are two components of prescriptive authority: (1) the right to prescribe independently and (2) the right to prescribe without limitation

o What problems arise when it is limited? Limited prescriptive authority creates numerous barriers to quality, affordable, and accessible patient care. restrictions on the distance of the APRN or PA from the physician providing supervision or collaboration may prevent outreach to areas of greatest need.

- Know the responsibilities of prescribing o The best way to keep your patients (and yourself) safe is to be prudent and deliberate in your decision-making process. Have a documented provider–patient relationship with the person for whom you are prescribing. Do not prescribe medications for family or friends or for yourself. Document a thorough history and physical examination in your records. Include any discussions you have with the patient regarding risk factors, side effects, or therapy options. Have a documented plan regarding drug monitoring or titration, if applicable. If you consult additional providers, note that you did so. Finally, use the references provided in the following box to assist in safely and rationally choosing one medication over another. - - Know patient reasons for medication non-adherence o Forgertfullness o Lack of Planning o Cost o Dissatisfaction o Altered Dosing - - Know how what type of evidence prescribers should use to make treatment recommendations o - - Be familiar with physiological changes of aging that impact pharmacological treatments - - Be familiar with Beer’s Criteria o potentially Inappropriate Medication (PIM) use in older adults o potentially Inappropriate Medication (PIM) use in older adults due to medication- disease or medication-syndrome interactions that may exacerbate the disease or syndrome o medications to be used cautiously in older adults o clinically significant drug interactions that should be avoided in older adults

o medications to be avoided or dosage decreased in the presence of impaired kidney function in older adults (American Geriatric Society Beers Criteria Update Expert Panel, 2019)

- - Know CYP450 inducers and inhibitors-Cytochrome P450 (CYP450) are xenobiotic- metabolizing enzymes necessary for the production of cholesterol and steroids and the detoxification of chemicals and drug metabolism o Inhibitors o Valproate o Isoniazid o Sulfdnamidies o Amidarone o Chloramephenicol o KetoConazole o Grapefruit Juice o Quinidine o VISA- credit card debt inhibits spending on designers like CK and GQ o Inducers o Carbhamazepine o Rifampin o Alcohol o Phenytoin o Griseofulvin o Phenobarbital o Sulfanyureas - - Be familiar with opioid agonists o A drug that binds to and activates a receptor. Can be full, partial or inverse. A full agonist has high efficacy, producing a full response while occupying a relatively low proportion of receptors. A partial agonist has lower efficacy than a full agonist. It produces sub-maximal activation even when occupying the total receptor population, therefore cannot produce the maximal response, irrespective of the concentration applied. An inverse agonist produces an effect opposite to that of an agonist, yet it binds to the same receptor binding-site as an agonist. - - Know the outcome of having a poor metabolism phenotype o The term bioavailability refers to the amount of an active drug that reaches the systemic circulation from its site of administration - - Know the role of the government agencies when it comes to prescription drugs

Week 2

- - Know black box warning for various pain medications. o Opioid medications can cause respiratory arrest in both opioid-naïve and opioid- tolerant patients. Monitor for respiratory depression, especially during new-onset therapy or after escalation of dose. - - Products containing fentanyl can cause fatal respiratory depression. Many of these products are only available through restricted distribution programs secondary to misuse and abuse. - - In the liver, about 10% of each dose of codeine undergoes conversion to morphine, the active form of codeine. The enzyme responsible is CYP2D6 (the 2D6 isoenzyme of cytochrome P450). Among ultrarapid metabolizers, which carry multiple copies of the CYP2D6 gene, codeine is unusually effective and has led to death in some children. Severe toxicity can also develop in breastfed infants whose mothers are taking codeine. The cause is high levels of morphine in breast milk, due to ultrarapid codeine metabolism. - - Like oxymorphone and hydromorphone, oxycodone has a high potential for abuse and can cause fatal respiratory depression. Long-acting forms of oxycodone should be prescribed only by providers with additional education regarding chronic pain. **-

• Black**^ Box^ Wa^ rn^ in^ **g
• Hydrocodone
• Black Box Wa rn in g
• Oxycodone

-** Hydromorphone and oxymorphone have high abuse potential and can cause fatal respiratory depression, especially when used in combination with other sedating agents such as alcohol. Long-acting forms of oxymorphone should be prescribed only by a provider with additional education regarding chronic pain. **- B l a c k Box Wa rn in g

• Codeine

-** Methadone prolongs the QT interval and hence may pose a risk for potentially fatal dysrhythmia. Torsades de pointes has developed in patients taking 65 to 400 mg/day. To reduce risk, methadone should be used with great caution—if at all—in patients with existing QT prolongation or a family history of long QT syndrome and in those taking other QT-prolonging drugs. In addition, methadone causes severe respiratory depression that can be potentially fatal. **- B l a c k Box Wa rn in g

• Hydromorphone and Oxymorphone
• Black Box Wa rn in g
• Methadone
• Fentanyl
• Black Box Wa rn in g**

o

- - Be familiar with patient indicators that would put them at risk for developing substance abuse disorder. o - - Be familiar with conditions that do and do not warrant opioid therapy. o Ostepoprosis - - Know what a morphine milligram equivalent is and when to use it. Use caution when prescribing opioids at any dosage and prescribe the lowest effective dose. Use extra precautions when increasing to ≥ 50 MME per day* such as:

• • Monitor and assess pain and function more frequently.
• • Discuss reducing dose or tapering and discontinuing opioids if benefits do not outweigh harms.
• • Consider offering naloxone. Avoid or carefully justify increasing dosage to ≥ 90 MME/day.* - - - Be familiar with Prescription Drug Monitoring Program (PDMP) - Other safeguards to address the opioid public health crisis include prescription drug monitoring programs (PDMPs). These electronic databases enable providers to access information regarding a patient's prescription history of controlled substances. Nearly all states have implemented PDMPs, and some states require providers to check the PDMP before prescribing controlled substances. According to the CDC (2020), PDMPs have shown promising results in changing prescribing behaviors, decreasing the use of multiple providers by patients, and decreasing substance abuse treatment admissions.
• • Know the outcomes of renal and hepatic insufficiency with opioid therapy. o Patients with liver cirrhosis often develop gastritis, portal hypertensive gastropathy, or ulcers of the gastrointestinal (GI) tract o Three mechanisms influencing renal excretion of opioids exist: glomerular filtration, tubular secretion, and tubular reabsorption - All forms of hydrocodone contain a black box warning. Products that contain acetaminophen (Vicodin) are associated with hepatotoxicity. The extended-release forms of hydrocodone can cause fatal respiratory depression and should only be prescribed by providers with additional education regarding chronic pain.

o - Know risk factors of opioid use disorder. o Typically, this disorder is marked by unsuccessful efforts to reduce or control use resulting in the inability to fulfill work, school, or home responsibilities. Opioid use disorder is different from drug tolerance and physical dependence, which may also exist. Opioid use creates high levels of positive reinforcement, increasing the likelihood of continued use. It is often a chronic lifelong disorder, leading to serious consequences such as disability and death. Opioid use disorder can lead to severe withdrawal symptoms, uncontrolled pain, as well as psychological distress, and suicidal ideation

• • Know signs of drug diversion. o Strange stories. Be wary of new patients with stories that don't seem quite right. ... o Reluctance to cooperate. ... o Unusually high (or low) understanding of medications. ... o Strange symptoms. ... o Specific drug requests. o
• • When is it appropriate to prescribe naloxone? o Consider offering naloxone when the following risk factors for opioid-related harms are found: ▪ Overdose ▪ Substance use disorder ▪ Higher opioid dosages ▪ Concurrent benzodiazepine use Naloxone is an opioid antagonist and can reverse severe respiratory depression.
• • Be familiar with drugs that are not safe to take with opioids. o Benzos
• • Be familiar with the PEG Assessment Scale. o Q1 What number from 0 - 10 best describes your pain in the past week o What number from 0 - 10 describes how during the past week has the pain interfered with your enjoyment of life o What number of pain from 0 - 10 describes during the past week has pain interfered with your general activity ▪ Pain ▪ Enjoyment of life ▪ General Activity
• • Patient and provider responsibilities in opioid drug therapy To manage opioid therapy, patients are responsible for the following:

Patient-Centered Care Across the Life

Span

Hypertension

• Taking all medications as prescribed
• Keeping appointments with provider
• Committing to all recommended therapies To manage opioid therapy, providers are responsible for the following: - Communicating expected benefits and risks throughout therapy, at least every three months - Recommending a multimodal therapy approach, combining nonopioid and nonpharmacologic therapies with opioid therapy to improve effectiveness - Reviewing the PDMP and UDT - Reviewing refill requests carefully to ensure opioid medication is used appropriately - Identifying the need for early intervention to mitigate risks
• • How to approach conversations about Opioid Use Disorder o Compassion o Relationship building skills o Explain Treatment Methods
• • What types of pain can be treated by psychotropic medications? o Nociceptive pain and Neuropathic pain 1 565 Midterm Study Guide Week 3
• Lifespan considerations including pregnancy

Drugs of choice in treating pregnant women with mild

preeclampsia include labetalol and methyldopa. Magnesium

ACEI , Angiotensin-converting enzyme inhibitor; RAAS , renin-

angiotensin-aldosterone system: SBP , systolic blood pressure

Life Stage Patient Care Concerns

Infants See later entry, “Breastfeeding women.”

Children/adolescents No data are available on the long-term effects of antihypertensive drug

on growth and development of children. Drugs recommended for

treatment of hypertension in children 1 – 18 years old include ACEI

diuretics, β blockers, and calcium channel blockers.

Pregnant women Drugs of choice in treating pregnant women with mild preeclampsia

include labetalol and methyldopa. Magnesium sulfate is used in the

prevention of seizures in severe preeclampsia or for treatment of

seizures in eclampsia.

Breastfeeding

women

Effects of RAAS-blocking drugs have not been studied in breastfeedin

blockers, such as metoprolol, appear safe for the breastfeeding infa

Diuretics appear safe but may suppress lactation.

Older adults Treatment with ACEIs, diuretics, and/or β blockers is reasonable. Cau

must be taken to avoid overdiuresis when using diuretics in the old

adult population.Central acting alpha agonists and peripheral alpha

antagonists should also be avoided.

sulfate is used in the prevention of seizures in severe

preeclampsia or for treatment of seizures in eclampsia.

Statins High-Intensity Statin Therapy

• Atorvastatin (Lipitor®) (40 mg – 80 mg)
• Rosuvastatin (Crestor®) (20 – 40 mg) Moderate-Intensity Statin Therapy
• Atorvastatin (Lipitor®) (10 mg – 20 mg)
• Rosuvastatin (Crestor®) (5 mg – 10 mg)
• Simvastatin (Zocor®) (20 mg – 40 mg)
• Pravastatin (Pravachol®) (40 mg – 80 mg)
• Lovastatin (Altoprev®) (40 mg)
• Fluvastatin XL (Lescol XL®) (80 mg)
• Fluvastatin (Lescol®) (40 mg twice daily)
• Pitavastatin (Livalo®) (2 – 4 mg) Low-Intensity Statin Therapy
• Simvastatin (Zocor®) (10 mg)
• Pravastatin (Pravachol®) (10 mg – 20 mg)
• Lovastatin (Altoprev®) (20 mg)
• Fluvastatin (Lescol®) (20 mg – 40 mg)
• Pitavastatin (Livalo®) (1 mg) o Warfarin o Blood pressure medications
• Drug interactions to be mindful of, avoid, or adjust dosing with o Warfarin

Interactions Between Warfarin and Other Drugs

Drug Category

Mechanism of Representative Interacti

Interaction Drugs

Drugs

that increase the

effects of warfarin

Displacement of

warfarin from

albumin

Aspirin and other salicylate

Sulfonamides

Inhibition of warfarin

degradation

Acetaminophen

Amiodarone

Azole antifungal agents

Cimetidine

Disulfiram

Leflunomide

Trimethoprim-sulfamethoxa

Decreased synthesis

of clotting factors

Certain parenteral

cephalosporins, including

cefoperazone and

cefamandole

Drugs that promote

bleeding

Inhibition of platelet

aggregation

Abciximab

Aspirin and other salicylate

Cilostazol

Clopidogrel

Dipyridamole

Eptifibatide

Prasugrel

Ticagrelor

Ticlopidine

Tirofiban

Interactions Between Warfarin and Other Drugs

Drug Category

Mechanism of Representative Interacti

Interaction Drugs

Inhibition of clotting

factors and/or

thrombin

Antimetabolites

Apixaban

Argatroban

Bivalirudin

Dabigatran

Desirudin

Fondaparinux

Heparins

Rivaroxaban

Promotion of ulcer

formation

Aspirin

Glucocorticoids

Indomethacin

Phenylbutazone

Drugs

that decrease the

effects of warfarin

Induction of drug-

metabolizing

enzymes

Carbamazepine

Phenobarbital

Phenytoin

Rifampin

Promotion of clotting

factor synthesis

Oral contraceptives

Vitamin K^1

Reduction of warfarin

absorption

Cholestyramine

Colestipol

o Carbamazepine o Digoxin Drugs to Avoid

Patients in stage C should avoid three classes of drugs:

antidysrhythmics, CCBs, and NSAIDs (e.g., aspirin). Reasons for

not using these drugs are as follows:

• • Antidysrhythmic agents —These drugs have

cardiosuppressant and prodysrhythmic actions

that can make HF worse. Only two agents—

amiodarone (Cordarone) and dofetilide

(Tikosyn)—have been proved not to reduce

survival.

• • Calcium channel blockers —These drugs can

make HF worse and may increase the risk for

adverse cardiovascular events. Only the long-

acting dihydropyridine CCBs, such as

amlodipine (Norvasc), have been shown not to

reduce survival.

• • NSAIDs —These drugs promote sodium

retention and peripheral vasoconstriction. Both

actions can make HF worse. In addition, NSAIDs

can reduce the efficacy and intensify the

toxicity of diuretics and ACEIs. Hence even

though aspirin has beneficial effects on

coagulation, it should still be avoided unless

clinically indicated for conditions such as

myocardial infarction.

o Prevents atrioventricular nodal conduction by vagal stimulation, directly slowing AV nodal conduction, and prolonging AV nodal refractoriness. Increases force of myocardial infarction (Chisholm-Burns et al., 2019). o bradycardia o fatigue o nausea/Vomiting o anorexia o Hypokalemia, may increase digoxin toxicity o Hypercalcemia, may increase the risk of digoxin toxicity especially with hypokalemia is present o Hypomagnesemia, may increase the risk of digoxin toxicity o diuretics may cause electrolyte abnormalities, like hypokalemia and hypomagnesemia o Hypothyroidism o Myocardial infarction (MI) o Quinidine

Quinidine is an antidysrhythmic drug that can cause plasma

levels of digoxin to rise. Quinidineincreases digoxin levels by (1)

displacing digoxin from tissue binding sites and (2) reducing

renal excretion of digoxin. By elevating levels of free

digoxin, quinidine can promote digoxin toxicity. Accordingly,

concurrent use of quinidine and digoxin should be avoided.

o Anticoagulants in general

• Treatment strategy for angina o Goalsoftreatment o Drugs to accomplish goals - Monitoring o Labs related to blood pressure medications

The following tests should be done in all patients:

electrocardiogram; complete urinalysis; hemoglobin and

hematocrit; and blood levels of sodium, potassium, calcium,

creatinine, glucose, uric acid, triglycerides, and cholesterol

(total, low-density lipoprotein, and high-density lipoprotein

cholesterol).

o Appropriate intervals for medication adjustments - Heart Failure

For routine therapy, HF is treated with three types of drugs: (1) diuretics, (2)

agents that inhibit the RAAS, and (3) β blockers. Other agents (e.g., digoxin,

dopamine, hydralazine) may be used as well.

o Role of aldosterone and how to manage those effects

Aldosterone antagonists are drugs that block receptors for

aldosterone. Two such agents are available: eplerenone and

spironolactone. Both drugs have similar structures and actions,

and both are used for the same disorders: hypertension and

heart failure. However, they differ in that spironolactone is less

selective than eplerenone. As a result, spironolactone causes

more side effects.

Black Box Warning

Spironolactone

• • Who is at risk for severe rebound hypertension?
• • Be familiar with treatment guidelines of hypertension.
• The ultimate goal in treating hypertension is to reduce

cardiovascular and renal morbidity and mortality. The hope

is that this can be accomplished without decreasing

quality of life with the drugs employed. For adult patients,

the goal is to maintain SBP below 130 mm Hg and DBP

below 80 mm Hg.

• Life Style Modifications and Drug Therapy o When one medication would be preferred over another based-on patient factors - Mechanism of action and related physiological outcomes

o Cardiac glycosides Digoxin (Lanoxin) belongs to a family of drugs

known as cardiac glycosides. These drugs are prepared by

extraction from Digitalis purpurea (purple foxglove)

and Digitalis lanata (Grecian foxglove) and hence are also

known as digitalis glycosides. In the United States digoxin is the

only cardiac glycoside available.

Digoxin exerts a positive inotropic action on the heart. That is,

the drug increases the force of ventricular contraction and can

thereby increase cardiac output

As a result of increased cardiac output, three major secondary

responses occur: (1) sympathetic tone declines, (2) urine

production increases, and (3) renin release declines. These

responses can reverse virtually all signs and symptoms of HF.

However, they do not correct the underlying problem of cardiac

remodeling.

o Verapamil These drugs act on the heart to decrease myocardial contractility and can thereby further reduce cardiac output.

Use of spironolactone is tumorigenic in chronic toxicity studies

in rats.

o Organicnitrates

The organic nitrates are the oldest and most frequently used

antianginal drugs. These agents relieve angina by causing

vasodilation. Nitroglycerin, the most familiar organic nitrate,

will serve as our prototype.

o Calciumchannelblockers Calcium channel blockers (CCBs) are also used to treat hypertension; however, these medications require special consideration for use in pregnancy and breastfeeding women. Although inadequate human data are available to assess risk, animal data demonstrate the risk of embryo-fetal death. Characteristics of these agents include:

Action: Create vasodilation by blocking voltage-gated calcium

channels in both cardiac smooth muscles as well as in blood

vessels.

o CCBs have both an inotropic and chronotropic effect, meaning the heart gets both depressed and slowed down. o Headaches o Ankle edema o Heart block or bradycardia (due to depressed muscle and AV node) o Reflect tachycardia

Contraindications: Due to the inotropic and chronotropic effects

o 2nd and 3rd degree heart block o Bradycardia o Congestive heart failure

• • Contraindications o Beta-blockers
• Uncompensated heart failure
• Pulmonary edema
• Bradycardia, heart block or sick sinus syndrome (in the absence of a pacemaker)
• Pulmonary disease, like asthma, because the beta1 selectivity may get lost with higher dosing and can cause to bronchospasms.
• Diabetes mellitus (DM), may mask symptoms of hypoglycemia
• Thyrotoxicosis may mask symptoms of tachycardia and elevated blood pressure
• Advanced age, older adults have increased sensitivity to beta blockers, therefore, start low and go slow.
• o ACEInhibitors o Results in the prevention of vasoconstriction and aldosterone-mediated volume expansion o Drug of choice for DM and/or CKD due to renal protection o Category C during first trimester o Category D during second and third trimester o Cause fetal kidney malformations and fetal hypotension

Side Effects: Dry cough (up to 10% with ACEI; less with ARBs)

o Hyperkalemia risk o Angioedema is rate bue can be life threatening

Contraindications: Moderate to severe kidney disease; monitor

GFR

o Renal artery stenosis o Acute renal failure is precipitated if given ACEI or ARB o Additive effect of hyperkalemia o o Ranolazine

Prototype Drugs

Drugs for Angina Pectoris

Organic Nitrate

• Nitroglycerin β Blockers
• Propranolol
• Metoprolol Calcium Channel Blockers
• Verapamil
• Nifedipine Drug That Increases Myocardial Efficiency
• Ranolazine

Ranolazine works by reducing accumulation of sodium and

calcium in myocardial cells, which might help the myocardium

use energy more efficiently. However, the exact mechanism of

action is unknown. Despite limited efficacy, many drug

interactions, and a risk for dysrhythmias (see later), ranolazine

is now approved as a first-line drug for angina. It may be

combined with nitrates, β blockers, amlodipine (a CCB), and

other drugs used for angina treatment.

Ranolazine can cause a dose-related increase in the QT interval

and may thereby increase the risk for torsades de pointes, a

serious ventricular dysrhythmia

• • Be familiar with clinical tools used to determine how to treat hyperlipidemia
• • Alternative treatment strategies for stain intolerant patients

Week 4

• • Be familiar with the treatment for osteoarthritis o Non Opioid treatments such as NSAIDS, and physical therapy ( ASA)
• • Treatment of gout

Glucocorticoids

• Colchicine (Colcrys, Mitigare) is an antiinflammatory agent

with effects specific for gout. In the past, colchicine was

considered a first-line drug for gout. However, owing to the

common occurrence of GI toxicity and the availability of

safe and effective alternatives, its use has been declined.

o When to use which medication o Contraindicatedmedications

Colchicine should be used with care in older adults and

debilitated patients and in patients with cardiac, renal, hepatic,

and GI disease

o Sideeffectsofmedications o Medications requiring dosage adjustments based on renal or hepatic insufficiency o Medications typically co-administered with gout treatment o Complications of untreated gout

• - Treatment of osteoporosis

• Methotrexate

• 7.5 mg/wk initially then adjusted upward until optimal

response is achieved or a maximal dose of 20 – 30 mg/wk is

reached. Optional oral dosing: 10–15 mg/wk initially, then

increased by 5 mg/wk every 2 – 4 wk up to a maintenance

level of 20 – 30 mg/wk.

•

o Patienteducationforcommonosteoporosismedications

• - Blackbox warnings

• Black Box Warning

- Methotrexate can cause numerous and potentially fatal

toxicities of the bone marrow, liver, lungs, and kidneys.

Other fatalities have occurred associated with

reactions and due to hemorrhagic enteritis

skin

and

gastrointestinal perforation.

•

- - Drug Interactions - Methotrexate increases the risk for hepatotoxicity when

other drugs that contribute to liver injury (including

alcohol) are taken. Similarly, methotrexate greatly

increases the risk for serious myelosuppression when it is

prescribed for patients taking other drugs that can

decrease bone marrow function.

- As would be expected with an immunosuppressant,

methotrexate reduces the response to vaccines, thus

decreasing their efficacy. Live vaccines are contraindicated

for patients taking methotrexate. If it is necessary to give

inactivated (killed) vaccines to patients

receiving methotrexate, patients should be revaccinated

within 3 months after therapy is discontinued. Ideally,

needed vaccines should be administered prior to starting

methotrexate. The ACR recommends that patients receive

vaccines for the following communicable diseases prior to

beginning therapy with a DMARD: pneumonia, influenza,

hepatitis B, HPV, and herpes zoster

•

- o NSAIDs - - Mechanism of action - inhibit both COX-1 and COX-2. However, in contrast to

aspirin, which causes irreversible inhibition of

cyclooxygenase, the other

traditional NSAIDs cause reversible inhibition.

•

o NSAIDs

- Methotrexate (Trexall, Otrexup, Rasuvo,

Xatmep)

• DMARDs DMARDs are drugs that reduce joint destruction and

slow disease progression. They accomplish this by interfering in

immune and inflammatory responses.

- (^) Methotrexate (Trexall, Otrexup, Rasuvo, Xatmep) - (^) Sulfasalazine (Azulfidine) - (^) Leflunomide (Arava) - (^) Hydroxychloroquine (Plaquenil)

•

o Examples o Baseline data needed for drugs in this class o Baseline diagnostics needed for drugs in this class o Patient teaching for drugs in this class o Instruction needed regarding RA treatment and oral contraceptives o Pregnancy considerations Prescription Writing

• Medications you will need to know for the prescription writing questions include: o Lortab o Lisinopril o Losartan

Lisinopr

il

Prinivil,

Zestril

Hypertensi

on

2.5-, 5 - , 10 - ,

20 - , 30-, 40-

mg tablets

10 mg

once/day

10 – 40 mg

once/d

Heart

failure

2.5– 5 mg

once/day

20 – 40 mg

once/day

Acute MI 5 mg

once/day

10 mg once

for at lea

weeks

o Amlodipine o Codeine o Alendronate

Losarta

n

Cozaa

r

Hypertension 25 - , 50 - ,

100 - mg

tablets

25 – 50 mg

once/day

25 – 100 mg/

in 1 or 2

doses

Stroke

preventionb

50 mg

once/day

50 – 100 mg

once/day

Diabetic

nephropathya

50 mg

once/day

100 mg onc

Drug Name Indications Preparation Dosage

Alendronate(Fosa

max and

Binosto)

Alendronate+

vitamin D

(Fosamax Plus

D)

Prevention and

treatment of

osteoporosis in

postmenopaus

al women,

osteoporosis in

men, Paget

disease, and

GIOP

Tablets (Fosamax):

70 mg

Tablets (generic): 5,

10, 35, 40, and

70 mg

Effervescent tablet

(Binosto): 70 mg

Oral solution

(generic):

70 mg/75 mL

Tablets (Fosamax

D):

Osteoporosis

postmeno

al women,

prevention

mg tablet

or 35 mg o

weekly

Osteoporosis

postmeno

al women,

treatment

mg tablet

o Colchicine

Drug Name Indications Preparation Dosage

70 mg alendronat

e: 2800 IU

vitamin D^3 ,

70 mg alendronat

e: 5600 IU

vitamin D^3

or 70 mg o

weekly

Osteoporosis

men: 10 - m

tablet onc

daily or 70

once week

Paget diseas

40 mg onc

daily for 6

months fo

men or wo

GIOP for me

premenop

l women,

postmeno

al women

taking

estrogen:

once daily

GIOP for

postmeno

al women

taking

estrogen:

10 mg onc

daily

Colchicine (Colcrys

and Mitigare)

Colcrys: 0.6-

mg scored

tablet

Acute attack (Colcrys only): 1.2 mg

first sign of the flare, followed by

0.6 mg 1 h later (maximum,

• Prescriber name, license number, and contact information
• Prescriber U.S. Drug Enforcement Administration (DEA) number, if applicable
• Patient name and date of birth
• Patient allergies
• Name of medication
• Indication of medication (e.g., atenolol for hypertension)
• Medication strength (e.g., 25 mg, 500 mg/mL)
• Dose of medication and frequency (e.g., 12.5 mg once daily)
• Number of tablets or capsules to dispense
• Number of refills

Mitigare: 0.6-

mg capsule

1.8 mg/24 h).

Prophylaxis (Colcrys, Mitigare): 0.6

once or twice daily (maximum,

1.2 mg/24 h).